Izwan Billing Testing New Radiology Billing Charge FormΔType of SubmissionType of ChargesBilling DetailsType of Submission New Billing Charge Resubmit Billing ChargePlease insert the wrong submission IDPreviousNextType of Charges DVD only Normal Case Charge (NON US) IR Case Charge (NON US) Mammogram Case Charge LPPKN Case Charge Normal Case (US) IR Case Charge (US)PreviousNextSASMEC RNPatient's NameRIS Procedure CodeRIS Procedure NameProcedure Done for Mammogram Case Mammogram only Mammogram & Ultrasound BreastProcedure Done for LPPKN Case Mammogram only Mammogram & Ultrasound BreastLPPKN Subsidy Status Full Covered - RM150 Partial Covered - RM50MMA Charges CodeAmount Charge (RM)Total Procedure Amount Charge (RM)Amount of Consultation Fee (min: 1, max: 235)Procedure Doctor Charge CodeProcedure Doctor Charge AmountDVD Burn? Yes NoNumber of DVD Burn 1 pcs 2 pcs 3 pcs 4 pcs 5 pcsIIUMSC Status. New Registration? Yes NoRadiologist In-Charge of the procedure- Select -AzianRazaliRadhianaSiti KamariahRadhwanAidiIrfanIntanRajeevRaihanahSuzeanaZakwan----------------Al-BaqlishRidzuanRadiographer performing the caseUS ProcedureTARMIZIIMA JULIAIZWANYUSOFNORLINIROSLINAARINAAIDIJANNAHFARAHKHAIRUNISAMUZAMILNURULSHARKILAFATEHAHZAMRITAUFIQINTANRASYDANAFILAHATHIRAHSUHADAAQILNABILAHNURAINICHE NAJIHAHEMYIZZULAINNURUL NAJIHAHHASLIZASYAMIMISUHAILAAZIMSHAFIQFAIZALAABIDASHRAFMOHAMADAZWANASNAZULFIKARRAZLINIZZATULLAHNIK FATINHUDAANISAFAEZAHSYAHIFANURSYAHIDAHAZIQAHAZIEMAHMedical Officer performing the caseNo US ProcedureDr. DarDr. RidhuanDr. NasriqDr. LowDr. AizuddinDr. SuzeanaDr. VivienDr. AisyahDr. FarhanahDr. AdilahDr. AiniDr. NurnawwarDr. Geetha RakwanDr. IsminhazimDr. KhairiahDr. ShahidaDr. AzillaDr. Siti SaharahDr. FirdausDr. Se ToDr. ChristinaDr. NabilaDr. Geetha BalasubramaniyamDr. FakhriahDr. SivaneswaryDr. Wan FirdausDr. AllifDr. JovanDr. AsrafDr. Firdaus IbrahimDr. Nur SaufiahDr. Nurul AifaDr. PushpaDr. Raja AzmiDr. SalmanDr. ShobaDr. FarahiyahDr. Nur HananiDr. AzwanDr. AizatDr. ShakirDr. Tengku IzzudinDr. HuzaifahDr. NurashiqinDr. Nik AimiDr. Nur AliyaDoes the staff nurse involve in the procedure? Yes NoStaff Nurse assisting the case (interventional case / coming from home)ROHANIAZRINASMIHAFIZAHMAIZATULALMIRRASYAAHIDAHEZAYUSURAYAZULHAIMIMASTURAHAMIRAHRemarks (if any): Previous Submit Form