Izwan Billing Testing ΔType of SubmissionType of ChargesBilling DetailsType of Submission New Billing Charge Resubmit Billing ChargePlease insert the wrong submission ID PreviousNextType 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 RN Patient's Name RIS Procedure Code RIS Procedure Name Procedure 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 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 NoIIUMSC Status. New Registration? Yes NoRadiologist In-Charge of the procedure - Select -AzianRazaliRadhianaSiti KamariahRadhwanAidiIrfanIntanRajeevRaihanahSuzeanaZakwan----------------Al-BaqlishRidzuanRadiographer performing the case US ProcedureIMA JULIAIZWANYUSOFNORLINIROSLINAARINAAIDIJANNAHFARAHKHAIRUNISANORFADILAHMUZAMILNURULSHARKILAFATEHAHTARMIZIZAMRITAUFIQINTANRASYDANAFILAHHAMIEZAHATHIRAHSUHADAAQILNABILAHNURAINICHE NAJIHAHEMYIZZULAINNURUL NAJIHAHHASLIZASYAMIMISUHAILAIZZATIAZIMSHAFIQFAIZALAABIDASHRAFMOHAMADAZWANASNAZULFIKARRAZLINNORZATULFAZERAIZZATULLAHNIK FATINHUDAANISAFAEZAHSYAHIFAMedical Officer performing the case No 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) ASMIHAFIZAHMAIZATULALMIRRASYAAHIDAHEZAYUSURAYAZULHAIMIROHANIMASTURAHAMIRAHAZRINRemarks (if any): Previous Submit Form