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Get and Sign Formulir Klaim Rawat Inap

Get and Sign Formulir Klaim Rawat Inap

Use a klaim rawat form 0 template to make your document workflow more streamlined.

Perusahaan Name of Company Tanggal Pelayanan Date of Service Nama Pasien Name of Patient Tempat Pelayanan No. Peserta Pasien No. of Patient Member Jenis Klaim Type of Claim Rawat Inap Inpatient Hubungan Pasien dengan Karyawan Patient s Status Operasi Bedah 1 Hari One Day Care Surgery Melahirkan Maternity Sendiri Self Suami Husband Isteri Wife Anak Child Kematian Death Catatan alasan pelayanan medis dengan reimbursement bila Peserta berhak menggunakan fasilitas Cashless Note reason for...
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