Claim Date: 2023-04-11

LUMWANA DISTRICT HOSPITAL Claim Number: 08B1-09101-34655-A43

Practice Number: ZM996246 Claim Status: Partially Accepted
Web User: ZM996246 -02
NHIMA
Member Number: 17548204110125
Dependant Code: 03
Member Name: MR FEMAS KASUSUTE
Date of Birth: 2020-10-20

Date Code Description Diag. Qty Total Cost Scheme Pay Patient Pay
2023-04-11 10001 CONSULTATION OPD VISIT (LEVEL ONE PROVIDER) J06.9 1.00 79.71 79.71 0.00
2023-04-11 10018 CEPHALEXIN 100ML (125MG/5ML - SUSPENSION) J06.9 1.00 0.00 0.00 0.00
2023-04-11 90007 PARACETAMOL (100MG - TABLET) J06.9 18.00 0.00 0.00 0.00

79.71 79.71 0.00

Claim Messages:
I - 150: Claim has been allowed without biometrics because the beneficiary is a child under 6 years

Submitted via NHIMA Online Claim Capture