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  • Amanda

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    amandaamanda

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    amandaamanda

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    © All Rights Reserved
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    10 views1 page

    Amanda

    Uploaded by

    rs.bhayangkara.palem
    amandaamanda

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    BPJS Kesehatan Cab.

    PALEMBANG
    SURAT LEGALISASI PELAYANAN
    Nomor Legalisasi : 16120156330
    Jenis Legalisasi : Kacamata

    Nama Pasien : AMANDA TSABITA PUTRI X Kacamata


    No.Kartu BPJS : 0001174064185 X Lensa Lensa Kiri Kanan

    Tgl. Lahir : 23 March 2004 Spheris -0.50 -0.50


    Jenis Kelamin : Perempuan
    Cylindris 0.00 0.00

    No SJP : 0601R00612160004321 Keterangan : acc kacamata kelas 2


    rp 200.000
    PPK Asal SJP : RS BHAYANGKARA PALEMBANG
    Tanggal SJP : 22 December 2016 Tanggal, 22 December 2016
    Legalisator BPJS Kesehatan

    22/12/2016 13.31.57 ( FAIZNUR RIDHO )

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