‫ﻣﻮﺍﻓﻘﺔ ﺭﻗﻢ‪154894651/1 :‬‬ ‫*‪*154894651/1‬‬

‫‪ NEXtCARE‬ﺑﺎﻟﻨﻴﺎﺑﺔ ﻋﻦ ﺷﺮﻛﺔ ‪Allianz‬‬

‫‪Mohamed Salah elnagar‬‬ ‫ﻗﺴﻢ ﺍﻟﻤﻮﺍﻓﻘﺎﺕ‬ ‫‪Dr . Abdel Fattah Taha Pharmacy . Alex - HO‬‬ ‫ﻣﻘﺪﻡ ﺍﻟﺨﺪﻣﺔ‬
‫ﻫﺬﺓ ﺍﻟﻤﻮﺍﻓﻘﺔ ﺻﺎﻟﺤﺔ‬
‫‪26-Jun-2023‬‬ ‫‪19-Jun-2023‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬
‫ﻟﻼﺳﺘﺨﺪﺍﻡ ﺣﺘﻲ ﺗﺎﺭﻳﺦ‬
‫ﺍﻟﻤﺴﺘﻔﻴﺪ ‪ /‬ﻣﺘﻠﻘﻲ ﺍﻟﺨﺪﻣﺔ‬
‫‪07-Aug-1983‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‬ ‫‪Zinab nasr elsayed nasr‬‬ ‫ﺇﺳﻢ ﺍﻟﻤﺆﻣﻦ‬
‫‪10-Jun-2024‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﻮﺛﻴﻘﺔ‬ ‫‪90500009332‬‬ ‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬
‫‪DC7A-1BBA-9D0F-72BD‬‬ ‫ﺭﻗﻢ ﺍﻟﺒﻄﺎﻗﺔ‬ ‫‪GSM‬‬ ‫ﺍﺳﻢ ﺍﻟﻌﻘﺪ‬
‫ﺍﻟﺪﺭﺟﺔ‬ ‫‪Plan-1 2023‬‬ ‫ﺇﺳﻢ ﺍﻟﻤﻨﺘﺞ‬
‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ‬ ‫ﺗﺄﻣﻴﻦ ﺃﻭّﻟﻲ‬
‫ﺭﻣﺰ ﺍﻟﻤﺴﺘﻔﻴﺪ‬ ‫ﺭﻗﻢ ﺍﻟﻤﻠﻒ‬
‫ﻣﻌﻠﻮﻣﺎﺕ ﻃﺒﻴﺔ‬
‫‪Out-Patient‬‬ ‫ﻧﻮﻉ ﺍﻟﺨﺪﻣﺔ‬ ‫ﺍﻟﻄﺒﻴﺐ ﺍﻟﻤﻌﺎﻟﺞ‬
‫‪Physical Illness‬‬ ‫ﺳﺒﺐ ﺍﻟﺪﺧﻮﻝ‬ ‫ﺍﻹﺧﺘﺼﺎﺹ‬
‫‪19-Jun-2023‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﺪﺧﻮﻝ‬ ‫‪19-Jun-2023‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻌﺎﻳﻨﺔ‬
‫‪ 0‬ﺃﻳﺎﻡ‬ ‫ﻣﺪﺓ ﺍﻻﻗﺎﻣﺔ ﺍﻟﻤﻮﺍﻓﻖ ﻋﻠﻴﻬﺎ‪:‬‬ ‫‪0‬‬ ‫ﻓﺮﺯ ﺍﻟﻄﻮﺍﺭﺉ‬
‫‪I10 Essential (primary) hypertension‬‬ ‫ﺍﻟﺘﺸﺨﻴﺺ ﺍﻟﻄﺒﻲ‬ ‫‪No‬‬ ‫ﻃﻮﺍﺭﺉ‬
‫ﺍﻟﺸﻜﻮﻯ ﺍﻟﺮﺋﻴﺴﻴﺔ ﻭﺍﻻﻋﺮﺍﺽ ﺍﻟﻤﺮﺿﻴﺔ‬

‫ﺷﺮﻭﻁ ﺧﺎﺻﺔ ﺑﺎﻟﻤﻮﺍﻓﻘﺔ‬

‫‪nevilob 2.5 1*1*30‬‬
‫‪enrich cap 1*1*30‬‬
‫‪zurcal 20mg 1*1*30‬‬

‫‪without attachments‬‬

‫ﻣﻊ ﺗﺤﻤﻞ ﺍﻟﻌﻤﻴﻞ ‪ 20 %‬ﻋﻠﻰ ﻗﻴﻤﻪ ﺍﻟﺨﺪﻣﺎﺕ ﻣﻊ ﺍﻟﺮﺟﻮﻉ ﻟﻨﻴﻜﺴﺖ ﻛﻴﺮ ﺍﺫﺍ ﺗﻌﺪﺕ ﺗﻜﻠﻔﻪ ﺍﻟﺨﺪﻣﺎﺕ ‪ 240‬ﺟﻨﻴﺔ ﺑﻌﺪ ﺗﺤﻤﻞ ﺍﻟﻌﻤﻴﻞ ‪-‬‬
‫ﻳﺮﺟﻲ ﺍﻟﺼﺮﻑ ﺣﺴﺐ ﺍﻟﺠﺮﻋﺔ ﻭ ﺍﻟﻤﺪﺓ ﻭ ﺍﻟﻤﺤﺪﺩﺓ ﻓﻰ ﺣﺎﻟﻴﺔ ﺳﺮﻳﺎﻥ ﺍﻟﻜﺎﺭﺕ ﺍﻟﺘﺄﻣﻴﻨﻲ ﺍﻭ ﺻﺮﻑ ﺟﺮﻋﺔ ﻛﺎﻓﻴﺔ ﺣﺘﻲ ﺍﻧﺘﻬﺎﺀ ﺍﻟﻜﺎﺭﺕ ﺍﻟﺘﺄﻣﻴﻨﻲ ﻓﻰ ﺣﺎﻟﺔ ﻗﺮﺏ‬
‫ﺍﻧﺘﻬﺎﺋﻪ‬

‫ﺻﻴﺪﻟﻴﺔ ﺩ ﻋﺒﺪ ﺍﻟﻔﺘﺎﺡ ﻃﻪ ﺑﺒﺮﺝ ﺍﻟﻌﺮﺏ‬

‫ﺍﻟﻤﻮﺍﻓﻘﺔ ﻋﻠﻰ ﺣﺴﺎﺏ ﺍﻷﺳﻌﺎﺭ ﺍﻟﻤﺘﻌﺎﻗﺪ ﻋﻠﻴﻬﺎ ﺑﻴﻦ ﻣﻘﺪﻡ ﺍﻟﺨﺪﻣﺔ ﻭﻧﻜﺴﺘﻜﺮ‬

‫ﻣﻼﺣﻈﺎﺕ ﻫﺎﻣﺔ‬
‫‪ .١‬ﻓﻲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﺃﻱ ﺗﻌﺪﻳﻼﺕ ﻋﻠﻰ ﺍﻟﻤﻮﺍﻓﻘﺔ‪ ،‬ﻳﺠﺐ ﺇﺑﻼﻍ ﻗﺴﻢ ﺍﻟﻤﻮﺍﻓﻘﺎﺕ ﻓﻲ ﺃﺳﺮﻉ ﻭﻗﺖ ﻟﺘﻌﺪﻳﻞ ﺍﻟﻤﻮﺍﻓﻘﺔ ﺍﻟﻤﺮﻓﻘﺔ‪ .‬ﻓﻲ ﺣﺎﻟﺔ ﻋﺪﻡ ﺍﺑﻼﻍ ﻗﺴﻢ ﺍﻟﻤﻮﺍﻓﻘﺎﺕ ‪،‬ﻗﺪ ﻳﺘﻢ ﺧﺼﻢ ﺟﺰﺀ ﺃﻭ ﻛﻞ ﺍﻟﻤﻄﺎﻟﺒﺔ ﺍﻟﻤﺮﻓﻘﺔ‪.‬‬

‫‪ .٢‬ﻳﺘﻢ ﺇﺻﺪﺍﺭ ﺍﻟﻤﻮﺍﻓﻘﺔ ﻃﺒﻘﺎ ﻟﻠﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺮﺳﻠﺔ ﻣﻦ ﻣﻘﺪﻡ ﺍﻟﺨﺪﻣﺔ‪ .‬ﻓﻲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﺍﻱ ﻧﻘﺺ ﺃﻭ ﺧﻄﺄ ﻓﻲ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺮﺳﻠﺔ‪ ،‬ﻳﺤﻖ ﻟﻠﺸﺮﻛﺔ ﺳﺤﺐ ﺃﻭ ﺍﻟﻐﺎﺀ ﺍﻟﻤﻮﺍﻓﻘﺔ ﺍﻟﻤﺮﺳﻠﺔ‪.‬‬

‫‪ .٣‬ﻳﺠﺐ ﺗﻘﺪﻳﻢ ﺁﺧﺮ ﻧﺴﺨﺔ ﻣﺤﺪﺛﺔ ﻣﻦ ﺍﻟﻤﻮﺍﻓﻘﺔ ﺍﻟﻤﺮﺳﻠﺔ ﻣﻊ ﺍﻟﻤﻄﺎﻟﺒﺔ‪.‬‬

‫‪ .٤‬ﺗﻘﻮﻡ ﺍﻟﺸﺮﻛﺔ ﺑﺪﻓﻊ ﺍﻟﻤﻄﺎﻟﺒﺎﺕ ﺇﻟﺘﺰﺍﻣﺎ ﺑﺎﻟﻤﻮﺍﻓﻘﺔ ﺍﻟﺼﺎﺩﺭﺓ ﻭﺗﻘﻮﻡ ﺑﺈﺻﺪﺍﺭ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺍﻟﻨﻬﺎﺋﻴﺔ ﺑﻌﺪ ﺍﻟﻤﺮﺍﺟﻌﺔ ﺍﻟﻤﺎﻟﻴﺔ ﻭﺍﻟﻄﺒﻴﺔ ﻭﺑﻤﺎ ﻳﺘﻔﻖ ﻣﻊ ﺟﻤﻴﻊ ﺍﻟﻠﻮﺍﺋﺢ ﺍﻟﺪﺍﺧﻠﻴﺔ ﻭﺍﻟﻤﺘﻌﺎﺭﻑ ﻋﻠﻴﻬﺎ ﻓﻲ ﺍﻟﻤﺮﺍﺟﻌﺔ‪.‬‬

‫‪ .٥‬ﻓﻲ ﺣﺎﻟﺔ ﻭﺟﻮﺩ ﺃﻱ ﺍﺳﺘﻔﺴﺎﺭﺍﺕ ﺍﻟﺮﺟﺎﺀ ﺍﻹﺗﺼﺎﻝ ﺑﺨﺪﻣﺔ ﺍﻟﻌﻤﻼﺀ ‪ +20 2 24632300‬ﺍﻟﻤﺘﻮﻓﺮﺓ ﻋﻠﻰ ﻣﺪﺍﺭ ﺍﻟﺴﺎﻋﺔ ﺍﻭ ﺍﻟﺨﻂ ﺍﻟﺴﺎﺧﻦ ‪ ،19154‬ﺍﻭ ﺍﻟﺒﺮﻳﺪ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ‪cs.eg@nextcarehealth.com‬‬

‫ﺇﺳﻢ ﻭﺗﻮﻗﻴﻊ ﺍﻟﻤﺮﻳﺾ‬ ‫ﺇﺳﻢ ﻭﺗﻮﻗﻴﻊ ﻣﻘﺪﻡ ﺍﻟﺨﺪﻣﺎﺕ‬

‫‪Zinab nasr elsayed nasr‬‬ ‫‪Dr . Abdel Fattah Taha Pharmacy . Alex - HO‬‬

‫ﻧﻜﺴﺘﻜﻴﺮ‬
‫ﻣﺒﻨﻰ ﺃﻟﻴﺎﻧﺰ‪ ،‬ﻛﺎﻳﺮﻭ ﻓﻴﺴﺘﻴﻔﺎﻝ ﺳﻴﺘﻰ ‪ ،‬ﺍﻟﺘﺠﻤﻊ ﺍﻟﺨﺎﻣﺲ ‪ ،‬ﺍﻟﻘﺎﻫﺮﺓ ﺍﻟﺠﺪﻳﺪﺓ ‪ ،‬ﺟﻤﻬﻮﺭﻳﺔ ﻣﺼﺮ ﺍﻟﻌﺮﺑﻴﺔ‪.‬‬
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