Dendadiagnosaawalkeu1187653.pdf
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Formulir Keterangan DIagnosa Awal
KETERANGAN BIAYA PELAYANAN DIAGNOSA AWAL
Nama
: FATAH AZHARI,S.Ag
Nomor kartu JKN-KIS
: 0001543307016
Diagnosa Awal
: E14.9
Kode CBGs
: E-4-10-i
Nilai Biaya
: 3.910.800
Nilai Denda
: 195.540
Tanggal Entri Denda
: 25-10-2018
KETERANGAN BIAYA PELAYANAN DIAGNOSA AWAL
Nama
: FATAH AZHARI,S.Ag
Nomor kartu JKN-KIS
: 0001543307016
Diagnosa Awal
: E14.9
Kode CBGs
: E-4-10-i
Nilai Biaya
: 3.910.800
Nilai Denda
: 195.540
Tanggal Entri Denda
: 25-10-2018
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