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  • Contoh Sep Manual1 PDF

    Diunggah oleh

    Ibrahim Chandra
    24 tayangan1 halaman

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    CONTOH SEP MANUAL1.pdf

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    24 tayangan1 halaman

    Contoh Sep Manual1 PDF

    Diunggah oleh

    Ibrahim Chandra

    Hak Cipta:

    © All Rights Reserved
    Unduh sebagai PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 1

    RUMAH SAKIT UMUM XXXXX XXXXXX XXXXXX

    BUKTI PELAYANAN PESERTA BPJS KESEHATAN


    No. RM
    Nama Pasien
    Alamat

    RAWAT JALAN
    No. SEP : .............

    : ...................................................
    : ...................................................
    : ...................................................

    Dokter
    Klinik Tujuan

    : 1. ................................................................................

    ...................................

    2. .................................................................................
    Diagnosa Utama

    Prosedur /Tindakan

    Penunjang

    Biaya INA-CBGs

    : 1 ........................................................................................

    ...................................
    Kode ICD X
    Dokter
    ......................
    ..................

    2 ........................................................................................

    ......................

    ..................

    3 ........................................................................................
    : 1 ........................................................................................

    ......................
    Kode ICD 9 CM
    ......................

    ..................
    Dokter
    ..................

    2 ........................................................................................

    ......................

    ..................

    3 ........................................................................................

    ......................

    ..................

    : LAB PK
    LAB PA
    Radiologi
    : ..............

    Elektro Medik
    Endoscopy
    Pontianak,
    Petugas RSUD XXXXXXXXX

    Pasien,

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

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

    RUMAH SAKIT UMUM XXXXX XXXXXX XXXXXX


    BUKTI PELAYANAN PESERTA BPJS KESEHATAN
    RAWAT JALAN
    No. SEP : .............

    No. RM
    Nama Pasien
    Alamat

    : ...................................................
    : ...................................................
    : ...................................................

    Klinik Tujuan

    : 1. ................................................................................

    Dokter
    ...................................

    2. .................................................................................
    Diagnosa Utama

    Prosedur /Tindakan

    : 1 ........................................................................................

    ...................................
    Kode ICD X
    Dokter
    ......................
    ..................

    2 ........................................................................................

    ......................

    ..................

    3 ........................................................................................
    : 1 ........................................................................................

    ......................
    Kode ICD 9 CM
    ......................

    ..................
    Dokter
    ..................

    2 ........................................................................................

    ......................

    ..................

    3 ........................................................................................

    ......................

    ..................

    Penunjang

    : LAB PK
    LAB PA
    Radiologi

    Biaya INA-CBGs

    : ..............

    Elektro Medik
    Endoscopy

    Pasien,

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

    Pontianak,
    Petugas RSUD XXXXXXXXX

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

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