‫‪Inpatient Claim Details‬‬

‫‪Approval ID‬‬ ‫‪236092‬‬ ‫ﺭﻗﻢ ﺍﻟﻤﻮﺍﻓﻘﻪ‬

‫‪Beneficiary Name‬‬ ‫ﻣﺤﻤﺪ ﻋﻼﺀ ﺍﻟﺪﻳﻦ ﺭﻣﻀﺎﻥ ﺷﺤﺎﺗﻪ‬ ‫ﺇﺳﻢ ﺍﻟﻤﺆﻣﻦ‬
‫‪Card Number‬‬ ‫‪535916‬‬ ‫ﺍﻟﻜﺎﺭﺕ‬
‫‪Client Name‬‬ ‫‪MASHROEY‬‬ ‫ﺇﺳﻢ ﺍﻟﻌﻤﻴﻞ‬
‫‪Employee Code‬‬ ‫‪MASH-010151-E‬‬ ‫ﺍﻟﺮﻗﻢ ﺍﻟﻮﻇﻴﻔﻲ‬
‫‪Co-Payment %‬‬ ‫‪0%‬‬ ‫ﻧﺴﺒﺔ ﺗﺤﻤﻞ ﺍﻟﻤﺆﻣﻦ ﻋﻠﻴﻪ‬
‫‪Service‬‬ ‫‪Hos-IP-Srv‬‬ ‫ﻧﻮﻉ ﺍﻟﺨﺪﻣﺔ‬
‫‪ICD Code‬‬ ‫‪R06.0‬‬ ‫ﻛﻮﺩ‬

‫‪Hospital‬‬ ‫‪Mokattam Specialized Hospital-Cairo‬‬ ‫ﺇﺳﻢ ﺍﻟﻤﺴﺘﺸﻔﻲ‬

‫‪Medical Operation‬‬ ‫‪Hospital Admission‬‬ ‫ﺍﻟﻌﻤﻠﻴﺔ ﺍﻟﻄﺒﻴﻪ‬
‫‪Stay length‬‬ ‫‪2‬‬ ‫ﻣﺪﻩ ﺍﻻﻗﺎﻣﻪ‬
‫‪Till Date‬‬ ‫‪02-JUL-24‬‬ ‫ﺍﻗﺎﻣﻪ ﺣﺘﻲ ﺗﺎﺭﻳﺦ‬
‫)‪limit (if specified‬‬ ‫‪10000‬‬ ‫ﺍﻟﺤﺪ ﺍﻷﻗﺼﻰ )ﺇﻥ ﻭﺟﺪ(‬
‫‪Issuance Date‬‬ ‫‪02-JUL-24‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻻﺻﺪﺍﺭ‬
‫‪Modified Date‬‬ ‫ﺗﺎﺭﻳﺦ ﻣﺪ ﺍﻟﻤﻮﺍﻓﻘﺔ‬
‫‪Accommodiation‬‬ ‫ﻏﺮﻓﺔ ﻣﺰﺩﻭﺟﺔ‬ ‫ﺩﺭﺟﺔ ﺍﻹﻗﺎﻣﺔ‬
‫‪Notes‬‬ ‫ﺍﻟﺤﺎﻗﺎ ﺑﺎﻟﻤﻮﺍﻓﻘﺔ ﺍﻟﺴﺎﺑﻘﺔ‬ ‫ﻣﻠﺤﻮﻇﺎﺕ‬
‫ﻣﺪ ﺇﻓﺎﻣﺔ ﻋﺪﺩ ‪ ٢‬ﻳﻮﻡ‬
‫ﺷﺎﻣﻞ ﺍﻻﺷﺮﺍﻑ ﺍﻟﻄﺒﻲ ﻭﺍﻟﻔﺤﻮﺻﺎﺕ ﻭﺍﻟﻌﻼﺝ‬
‫ﺍﻟﻤﻮﺍﻓﻘﺔ ﻻ ﺗﺸﻤﻞ ﺍﻱ ﺍﺟﺮﺍﺀﺍﺕ ﺗﺪﺍﺧﻠﻴﺔ‬
‫ﻣﻊ ﺿﺮﻭﺭﺓ ﺍﺭﺳﺎﻝ ﺻﻮﺭﺓ ﻣﻦ ﺗﻘﺎﺭﻳﺮ ﺍﻟﻔﺤﻮﺻﺎﺕ ﻋﻨﺪ ﻃﻠﺐ ﻣﺪ ﺍﻻﻗﺎﻣﺔ‬
‫ﻣﻊ ﻣﺮﺍﻋﺎﺓ ﺍﻟﺤﺪ ﺍﻻﻗﺼﻲ ﺍﻟﻤﺬﻛﻮﺭ ﻋﺎﻟﻴﻪ ‪ -‬ﻣﺎ ﻳﺰﻳﺪ ﻳﺤﺘﺎﺝ ﻣﻮﺍﻓﻘﺔ ﺍﺧﺮﻱ‬
‫‪DOA 30-6-2024‬‬

‫‪Mokattam Specialized Hospital-C‬‬

‫‪%0‬‬
‫‪02/07/2024‬‬
‫‪236092‬‬
‫‪alaa elmelegy‬‬
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