Scribd Logo
Upload

Welcome to Scribd!

  • 9 views

    Letter of Authorization: Rsia Sentosa

    Uploaded by

    Moko Kunaichi
    This document is a letter of authorization from RSIA Sentosa Makassar hospital with patient information and insurance eligibility details for Isabelle Aurora Sianturi. It lists the patient's name, insurance card and policy numbers, date of birth, payor ID, and policy dates. It also summarizes the insurance benefits including coverage for outpatient care up to 500,000, hearing aids up to 750,000, tests and diagnostics, physiotherapy according to treatment guidelines, hospitalization and medicines up to 250,000, immunizations up to 500,000 for children until age 15, admission and medicines for general/specialist treatment, specialist treatment without referral, guaranteed refraction, vitamins and supplements not guaranteed, patient

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Letter of Authorization: Rsia Sentosa

    Uploaded by

    Moko Kunaichi
    9 views1 page
    This document is a letter of authorization from RSIA Sentosa Makassar hospital with patient information and insurance eligibility details for Isabelle Aurora Sianturi. It lists the patient's name, insurance card and policy numbers, date of birth, payor ID, and policy dates. It also summarizes the insurance benefits including coverage for outpatient care up to 500,000, hearing aids up to 750,000, tests and diagnostics, physiotherapy according to treatment guidelines, hospitalization and medicines up to 250,000, immunizations up to 500,000 for children until age 15, admission and medicines for general/specialist treatment, specialist treatment without referral, guaranteed refraction, vitamins and supplements not guaranteed, patient

    Original Description:

    gsdfyhy h

    Original Title

    Isabelle Aurora

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document is a letter of authorization from RSIA Sentosa Makassar hospital with patient information and insurance eligibility details for Isabelle Aurora Sianturi. It lists the patient's name, insurance card and policy numbers, date of birth, payor ID, and policy dates. It also summarizes the insurance benefits including coverage for outpatient care up to 500,000, hearing aids up to 750,000, tests and diagnostics, physiotherapy according to treatment guidelines, hospitalization and medicines up to 250,000, immunizations up to 500,000 for children until age 15, admission and medicines for general/specialist treatment, specialist treatment without referral, guaranteed refraction, vitamins and supplements not guaranteed, patient

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    9 views1 page

    Letter of Authorization: Rsia Sentosa

    Uploaded by

    Moko Kunaichi
    This document is a letter of authorization from RSIA Sentosa Makassar hospital with patient information and insurance eligibility details for Isabelle Aurora Sianturi. It lists the patient's name, insurance card and policy numbers, date of birth, payor ID, and policy dates. It also summarizes the insurance benefits including coverage for outpatient care up to 500,000, hearing aids up to 750,000, tests and diagnostics, physiotherapy according to treatment guidelines, hospitalization and medicines up to 250,000, immunizations up to 500,000 for children until age 15, admission and medicines for general/specialist treatment, specialist treatment without referral, guaranteed refraction, vitamins and supplements not guaranteed, patient

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Provider EDC (Web Version) of Rsia. Sentosa Makassar [12387364] https://mobile.admedika.co.

    id/edc/

    Letter of Authorization will be issue here

    RSIA SENTOSA
    Tel No: 0411-3612720
    TID: 12387364 [RSIA SENTOSA MAKASSAR]
    JL. JEND.SUDIRMAN 52,, MAKASSAR
    ======================================
    Patient Name: ISABELLE AURORA SIANTURI
    Principal Name: YULIANA
    Card No.: 8000287101296065
    Date of Birth: Apr-27-2018
    Policy No: 680111001000
    Payor Member ID: 0100010927304
    Policy Date: Apr-19-2019 To Apr-18-2020
    Plan: OP5000J

    *ELIGIBILITY (PENDAFTARAN PASIEN)

    Reference ID : 84270622

    PENDAFTARAN PASIEN
    CHUBB
    PT BANK CENTRAL ASIA. TBK
    BENEFIT:RAWAT JALAN
    SPES+OBAT 500000
    ALAT DENGAR 750000
    B.TEST DIAG SESUAI TGH
    FISIOTHERAPI SESUAI TGH
    UMUM+OBAT 250000
    IMUNISASI 500000
    IMUN ANAK S.D 15 THN
    ADM & OBAT JMN DR.UMUM/SPES
    SPES TNPA RUJUKAN,REFRAKSI DIJAMIN
    VIT/F.SUPL DIJAMIN TIDAK
    BERDIRI SENDIRI
    EKSES BAYAR DI TEMPAT

    Scan your Reference ID

    By: RSIA SENTOSA MAKASSAR (RSBSENT)


    July 20, 2019, 6:35 pm

    _________________________________
    Sign here

    1 of 1 7/20/2019, 7:38 PM

    You might also like