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  • Inhealth Des 3

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    virginia adinda
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    This document is a receipt for medication pickup from RS Islam Karawang hospital by patient Nurhadi Mulyadi. It lists 6 medications including their codes, names, quantities dispensed, and total cost of 129,876. The receipt includes patient identification details like membership number, date of birth, and employer. It was issued on December 14, 2023 for claim number 1012R0041223X000004.

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    INHEALTH

    Original Title

    INHEALTH DES 3

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    This document is a receipt for medication pickup from RS Islam Karawang hospital by patient Nurhadi Mulyadi. It lists 6 medications including their codes, names, quantities dispensed, and total cost of 129,876. The receipt includes patient identification details like membership number, date of birth, and employer. It was issued on December 14, 2023 for claim number 1012R0041223X000004.

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    © All Rights Reserved
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    16 views1 page

    Inhealth Des 3

    Uploaded by

    virginia adinda
    This document is a receipt for medication pickup from RS Islam Karawang hospital by patient Nurhadi Mulyadi. It lists 6 medications including their codes, names, quantities dispensed, and total cost of 129,876. The receipt includes patient identification details like membership number, date of birth, and employer. It was issued on December 14, 2023 for claim number 1012R0041223X000004.

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    of 1

    PT ASURANSI JIWA INHEALTH INDONESIA

    BUKTI PENGAMBILAN OBAT


    IF RS ISLAM KARAWANG

    Nomor SJP : 1012A0130124X000004 Tanggal Pelayanan : 14-12-2023


    Nomor Claim : 1012R0041223X000004 Tanggal Resep : 14-12-2023
    Nomor Resep : 0004 Jenis Obat : OBAT RJTL
    Asal Resep : RS ISLAM KARAWANG

    Nama Peserta : NURHADI MULYADI Tanggal Lahir : 01-05-1952


    Nomor Kepesertaan : 1001463688934 Produk : SILVER
    Badan Usaha : PENSIUNAN LPND BULOG

    Jumlah
    No R / NR Kode Obat Nama Obat Biaya Obat
    Obat

    1 N STFDH.01 Aspilets Chewable DAVA tab kunyah 80 mg 30 17.032


    2 N STFDH.02 Bisoprolol Fumarate HEXP tab salut selaput 5 mg 30 26.824
    3 N STFDH.03 Candesartan Cilexetil BERN tab 16 mg 30 42.376
    4 N STFDH.04 Furosemide INFA tab 40 mg 60 16.168
    5 N STFDH.05 Simvastatin 20 HEXP tab salut selaput 20mg 30 11.596
    6 N STFDH.06 Spironolactone 25 OTTO tab 25 mg 30 15.880
    TOTAL 129.876

    Mengetahui:

    Pasien / Penerima Obat,

    (.............................................)

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