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    This 3 sentence summary provides the key details from the medical document: The document is a medical record from Provider EDC (Web Version) of Rsia. Graha Kumia [12405164] detailing a prenatal checkup for patient Biarti Yulensi with insurance coverage through Admedika -Brilife and Bank Rakyat Indonesia. The checkup included screening for pregnancy including HIV, TORCH, and 4D ultrasound with 900/o of expenses covered by insurance aside from any balance to be paid on site.

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    This 3 sentence summary provides the key details from the medical document: The document is a medical record from Provider EDC (Web Version) of Rsia. Graha Kumia [12405164] detailing a prenatal checkup for patient Biarti Yulensi with insurance coverage through Admedika -Brilife and Bank Rakyat Indonesia. The checkup included screening for pregnancy including HIV, TORCH, and 4D ultrasound with 900/o of expenses covered by insurance aside from any balance to be paid on site.

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    15 views1 page

    Img 002

    Uploaded by

    RSIA Graha Kurnia
    This 3 sentence summary provides the key details from the medical document: The document is a medical record from Provider EDC (Web Version) of Rsia. Graha Kumia [12405164] detailing a prenatal checkup for patient Biarti Yulensi with insurance coverage through Admedika -Brilife and Bank Rakyat Indonesia. The checkup included screening for pregnancy including HIV, TORCH, and 4D ultrasound with 900/o of expenses covered by insurance aside from any balance to be paid on site.

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    2/3/23, 5:37 PM Provider EDC (Web Version) of Rsia.

    Graha Kumia [12405164]

    RSIAGRAHAKURNIA
    Tel No: 0735-3740538|
    TID: 12405164 [RSIA GRAHA KURNIA]
    JL. SYEKH A.KALIYUDDIN (KEMILING) RT.11/RW.04 DESA TANJUNG BARU, BATURAJA TIMUR AdMA,ka
    •*co._._se
    OGAN KOMERING ULU

    PaLtient: BIARTI YULENSI


    PrincipaLL Name: DANNY TRIWIDODO
    Card No.: 8001001000460034
    Date of Birth: Jul-08-1987
    Policy No: 30000005
    Member lD: 001199190
    Policy Date: Apr-01-2022 To Mar-31-2023
    plan: 30000005GHOP006
    *ELIGIBILITY (PENDAFTARAN PASIEN)

    Reference lD : 120357636

    PENDAFTARAN PASIEN
    PAYOR: ADMEDIKA -BRILIFE (BANK BRl)
    PT. BANK RAKYAT INDONESIA (Persero), Tbk
    BENEFIT:CEK HAMIL
    ****************************************
    CEK HAMIL SESuAI TAGIHAN
    ****************************************
    900/a DIJAMIN ASURANSI
    SCRENING KEHAMILAN TERMASUK
    PEMERIKSAAN HIV,TORCH & USG 4 DIMENSI
    MENJAMIN KONTROL HAMIL SAMPAI DENGAN -
    KELAHIRAN ANAK KE 3 HIDUP
    SELISIH BIAYA BAYAR DI TEMPAT

    Scan your Reference ID

    By: RSIA GRAHA KURNIA (PK9425)

    https://mobile.admedika.com/edc/# ini'

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