The Future Of Healthcare At Your Fingertips
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SURAT JAMINAN
(SURAT JAMINAN INI HARUS DITANDATANGANI OLEH PASIEN)
| No. Klaim |
: |
{{ wordwrap($request_logs->code,15,"
\n")}} |
Tanggal |
: |
{{ \Carbon\Carbon::parse($request_logs->created_final_at)->format('d M Y') }} |
| Kepada |
: |
{{ !empty($rumahSakit->nama_rumahsakit) ? $rumahSakit->nama_rumahsakit : '' }} |
Plan Polis |
: |
{{ $dataMember->code_plan }} |
LinkSehat bertindak mewakili perusahaan asuransi/penanggung untuk mengeluarkan Surat Jaminan Akhir untuk peserta dibawah ini :
| Jenis Surat Jaminan |
: |
SURAT JAMINAN AKHIR |
| Nama Peserta |
: |
{{ $dataMember->name }} |
| Nama Karyawan |
: |
{{ $namaKaryawan }} |
| Tanggal Lahir |
: |
{{ \Carbon\Carbon::parse($dataMember->birth_date)->format('d M Y') }} |
| Jenis Kelamin |
: |
{{ $dataMember->gender == 'male' ? 'Laki-Laki' : 'Perempuan' }} |
| Member ID (BN) |
: |
{{ $dataMember->member_id }} |
| Identitas Peserta |
: |
{{ $dataMember->nric }} |
| Hak Kamar Pasien |
: |
{{ !empty($dataRequestLog->hak_kamar_pasien) ? $dataRequestLog->hak_kamar_pasien : ''}} |
| Penempatan Kamar |
: |
{{ !empty($dataRequestLog->penempatan_kamar) ? $dataRequestLog->penempatan_kamar : ''}} |
| No. Rekam Medis |
: |
|
| Jenis Perawatan |
: |
{{ $dataMember->jenis_perwatan }} |
| Penjamin |
: |
{{ $penjamin }} |
| Nama Perusahaan |
: |
{{ $dataMember->branch_code }} |
| Phone Perusahaan |
: |
0896-8177-3366 |
| No. Polis |
: |
{{ $dataMember->no_polis }} |
| Tipe |
: |
Tarif IM-009 {{ $dataMember->limit_rules == '999999999' ? 'As Charge' : 'Max Amount, Rp '.number_format($dataMember->limit_rules, 2, ',', '.') }} |
| Status Polis |
: |
{{ $dataMember->status_polis == 'active' ? 'Aktif' : 'Tidak Aktif' }} |
| Periode Jaminan |
: |
{{ \Carbon\Carbon::parse($request_logs->submission_date)->format('d M Y') . ($request_logs->discharge_date ? ' - ' . \Carbon\Carbon::parse($request_logs->discharge_date)->format('d M Y') : '') }} |
| Mata Uang |
: |
{{ $dataMember->mata_uang }} |
| Alamat Provider |
: |
{{ !empty($rumahSakit->alamat_rumahsakit) ? $rumahSakit->alamat_rumahsakit : '' }} |
|
|
|
|
|
|
| No. |
Item Layanan |
Total Klaim |
Total Disetujui |
Total Yang Dibayarkan Peserta |
Total Selisih |
Keterangan |
@php
$No = 1;
$total_claim = 0;
$total_disetujui = 0;
$total_selisih = 0;
$total_bayar = 0;
@endphp
@foreach($dataClaimLog as $claimLog)
@php
$total_claim += $claimLog->amount_incurred;
$total_disetujui += $claimLog->amount_approved;
$total_selisih += $claimLog->excess_paid;
$total_bayar += $claimLog->amount_incurred - $claimLog->amount_approved;
@endphp
| {{ $No++ }} |
{{ $claimLog->code . '-' . $claimLog->benfit }} |
{{ number_format($claimLog->amount_incurred, 2, ',', '.') }} |
{{ number_format($claimLog->amount_approved, 2, ',', '.') }} |
{{ number_format($claimLog->amount_incurred - $claimLog->amount_approved, 2, ',', '.') }} |
{{ number_format($claimLog->excess_paid, 2, ',', '.') }} |
{{ $claimLog->keterangan}} |
@endforeach
| Total |
{{ number_format($total_claim, 2, ',', '.') }} |
{{ number_format($total_disetujui, 2, ',', '.') }} |
{{ number_format($total_bayar, 2, ',', '.') }} |
{{ number_format($total_selisih, 2, ',', '.') }} |
|
| Diagnosis |
@php
if(count($dataDiagnosis))
{
foreach ($dataDiagnosis as $valDiagnosis)
{
@endphp
| {{ !empty($valDiagnosis->name) ? ' - '.$valDiagnosis->code.'-'.$valDiagnosis->name : '-'}} |
@php
}
}
else
{
@endphp
| - |
@php
}
@endphp
| CATATAN |
| {{ !empty($dataRequestLog->catatan) ? $dataRequestLog->catatan : '-'}} |
PT Link Medis Sehat
Primaya Hospital Corporate
Graha Cempaka Mas Blok D5-6
Jl. Let. Jend. Suprapto, Jakarta Pusat 10640, Indonesia
Telp 0896-8177-3366