Tarmizi Testing Billing Testing Radiology Billing Charge FormΔSASMEC RNPatient's NameType of Submission New Charge Resubmission ChargePlease insert the wrong submission IDType of Charges DVD only Full ProcedureRIS Procedure CodeProcedure NameMMA Charges CodeAmount Charge (RM)Total Procedure Amount Charge (RM)Is this an INTERVENTIONAL PROCEDURE (IR CASE)? Yes NoProcedure Doctor Charge CodeProcedure Doctor Charge AmountDVD burn? Yes NoFor mammogram only: Patient is first timer or not? Yes NoRadiologist In-Charge of the procedure- Select -AzianRazaliRadhianaSiti KamariahRadhwanAidiIrfanIntanRajeevRaihanahRadiographer / Medical Officer performing the case (normal case/intervention case)RadiographerIzwanTarmiziYusofNorliniMedical OfficerDr. DarDr. RidhwanDoes the staff nurse involve in the procedure? Yes NoStaff Nurse assisting the case (interventional case / coming from home)Remarks (if any):Submit Form