Izwan Billing Testing

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Type of Submission

New Billing Charge

Resubmit Billing Charge

Please insert the wrong submission ID

Type 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)

SASMEC RN

Patient's Name

RIS Procedure Code

RIS Procedure Name

Procedure Done for Mammogram Case

Mammogram only

Mammogram & Ultrasound Breast

Procedure Done for LPPKN Case

Mammogram only

Mammogram & Ultrasound Breast

LPPKN Subsidy Status

Full Covered - RM150

Partial Covered - RM50

MMA Charges Code

Amount Charge (RM)

Total Procedure Amount Charge (RM)

Amount of Consultation Fee (min: 1, max: 235)

Procedure Doctor Charge Code

Procedure Doctor Charge Amount

DVD burn?

Yes

No

IIUMSC Status. New Registration?

Yes

No

Radiologist In-Charge of the procedure

Radiographer performing the case

Medical Officer performing the case

Does the staff nurse involve in the procedure?

Yes

No

Staff Nurse assisting the case (interventional case / coming from home)

Remarks (if any):

IIUM Specialist Centre Database