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  • FPK Bpjs Bulan Juni 2023

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    internasionallahat lahat
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    The document is a claim form from Optik Internasional Lahat provider submitted to BPJS Kesehatan Cab. Lubuklinggau for the month of June 2023 totaling 9,075,000. It includes 36 transactions ranging from May 5 to June 27, 2023 for various patients purchasing eyeglasses priced between 165,000-330,000. The total number of claims is 36 and the total bill amount is 9,075,000.

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    Fpk Bpjs Bulan Juni 2023

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    The document is a claim form from Optik Internasional Lahat provider submitted to BPJS Kesehatan Cab. Lubuklinggau for the month of June 2023 totaling 9,075,000. It includes 36 transactions ranging from May 5 to June 27, 2023 for various patients purchasing eyeglasses priced between 165,000-330,000. The total number of claims is 36 and the total bill amount is 9,075,000.

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    © All Rights Reserved
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    10 views2 pages

    FPK Bpjs Bulan Juni 2023

    Uploaded by

    internasionallahat lahat
    The document is a claim form from Optik Internasional Lahat provider submitted to BPJS Kesehatan Cab. Lubuklinggau for the month of June 2023 totaling 9,075,000. It includes 36 transactions ranging from May 5 to June 27, 2023 for various patients purchasing eyeglasses priced between 165,000-330,000. The total number of claims is 36 and the total bill amount is 9,075,000.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 2

    BPJS Kesehatan Cab.

    LUBUKLINGGAU
    FORMULIR PENGAJUAN KLAIM

    Nomor FPK : L2306000000691


    Provider : OPTIK INTERNASIONAL LAHAT
    Bulan Pelayanan : June, 2023
    Pelayanan : Rawat Jalan Tingkat Lanjut

    Total Data : 36

    Total Tagihan : 9,075,000

    NO TRANSAKSI TANGGAL NAMA PESERTA JENIS KLAIM Biaya


    0086O004L2306005625 05/06/2023 RENNY SELVIA Kacamata 165,000
    0086O004L2306005643 05/06/2023 EVI HARIANI Kacamata 165,000
    0086O004L2306008118 06/06/2023 KASWATI Kacamata 165,000
    0086O004L2306010899 07/06/2023 AMELIA FENANDA Kacamata 165,000
    0086O004L2306011012 07/06/2023 DASTAM Kacamata 165,000
    0086O004L2306017816 09/06/2023 AWAL MILLAN SYAHID Kacamata 220,000
    0086O004L2306021088 10/06/2023 ALDEGONDA elisabet mentasir Kacamata 220,000
    0086O004L2306027536 12/06/2023 RISMA HANDAYANI Kacamata 220,000
    0086O004L2306031607 13/06/2023 TUTI SRIYANI Kacamata 165,000
    0086O004L2306039682 15/06/2023 CIK SALEH Kacamata 330,000
    0086O004L2306040951 15/06/2023 YULIDAR Kacamata 165,000
    0086O004L2306045174 16/06/2023 HOMISAH Kacamata 330,000
    0086O004L2306045302 16/06/2023 YUSHARTONO Kacamata 330,000
    0086O004L2306045327 16/06/2023 ANNA YUSUF Kacamata 330,000
    0086O004L2306047428 16/06/2023 MEI INDRIATI Kacamata 330,000
    0086O004L2306055714 19/06/2023 SOHINAP Kacamata 165,000
    0086O004L2306055912 19/06/2023 CAHAYA REFA AMANDA Kacamata 165,000
    0086O004L2306059068 20/06/2023 KANISIUS L SOFYAN Kacamata 165,000
    0086O004L2306061652 20/06/2023 RASWAN Kacamata 330,000
    0086O004L2306061787 20/06/2023 SULASTRI TAJRI Kacamata 330,000
    0086O004L2306062060 20/06/2023 ZULKIFLI Kacamata 330,000
    0086O004L2306063522 20/06/2023 ANWAR SADAT Kacamata 220,000
    0086O004L2306063546 20/06/2023 NURHAYATI Kacamata 330,000
    0086O004L2306063590 20/06/2023 EVA KOESTILLA Kacamata 220,000
    0086O004L2306066993 21/06/2023 ASMAWATI Kacamata 330,000
    0086O004L2306072477 22/06/2023 RAYZA YULIANDA JAHARA Kacamata 220,000
    0086O004L2306072522 22/06/2023 SRI WAHYUNI. Kacamata 220,000
    0086O004L2306072579 22/06/2023 RELA HAYATI,SP Kacamata 330,000
    0086O004L2306074412 22/06/2023 MIPI NIHARTI Kacamata 220,000
    0086O004L2306077432 23/06/2023 YUHAsnah Kacamata 330,000
    0086O004L2306090024 26/06/2023 SAIF GHOZI AL KAUTSAR Kacamata 330,000
    0086O004L2306090400 26/06/2023 NANDA OKTA PUTRI RYANTI Kacamata 220,000
    0086O004L2306091073 26/06/2023 UMI MUTHOLI'AH Kacamata 330,000
    0086O004L2306091953 26/06/2023 SYAFROYUNAH.S.PSI Kacamata 330,000
    0086O004L2306092361 26/06/2023 MUHAMMAD KEVIN AL GHIFARI Kacamata 330,000
    0086O004L2306098529 27/06/2023 MEKO SALTAPIA Kacamata 165,000
    Tanggal,
    Pengaju Klaim,

    30/06/2023 21.02.11

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