RS BINTANG LAUT

Tel No: 0471-21302/21059

TID: 12392112 [RS BINTANG LAUT]
JL. K HM KASYIM NO. 5 PALOPO, PALOPO
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Patient Name: Bambang Hariyanto Se
Card No.: 8000151012927210
Date of Birth: Sep-23-1978
Policy No: 00001282
Payor Member ID: 31386-00
===============DISCHARGE================
Reference ID : 51763362

PENGESAHAN & TAGIHAN

ASTRA LIFE
BANK TABUNGAN PENSIUNAN
31386-00
DIAG:R51 IZIN SAKIT:0
B.DR.UMUM 80000
B.DR.SPEC 75000
B.TEST DIAG 182500
B.OBAT 319002
P.KESEHATAN 0
JUM.BIAYA :656502
JUM.DIBYR ASS:656502
DIBYR PASIEN: 0
SISA LIMIT :2490498
REFRAKSI MATA DIJAMIN
JMN VIT/F.SUPL RSP DKTR
EKSES BAYAR DI TEMPAT
By: RS BINTANG LAUT (PK2107)
June 11, 2016, 11:26 am