MINISTERE DE LA SANTE , DE LA POPULATION ET DE LE REFORME HOSPITALIERE PAGE : 1

CANEVAS DES INFORMATIONS A TRANSMETTRE MENSUELLEMENT PAR LES ETABLISSEMENTS PUBLICS DE SANTE A
L'AGENCE DE SECURITE SOCIALE DE LA WILAYA
Etablissement de santé :Hôpital FRERES BOUKHCHEM Wilaya :MILA PERIODE : M06 Année : 2020
Ú_____________________________________________________________________________________________________________________________________________________________________________________________________________¿
| Nø | PATIENT | DATE | A D R E S S E | |DUREE | TOTAL ACTES SELON | MONTANT |
|IMMATRICULATION|_________________________________________| DE | | LIBELLE SERVICE | DE | NGAP | MEDICAMENTS |
| DE L'ASSURE | | |NAISSANCE | C O M M U N E / W I L A Y A | (SPECIALITE) |SEJOUR|___________________________________________| |
| SOCIALE | N O M | P R E N O M | | | | | K | B | R | AMI | |
| | | | | | (2) | | (3) | (4) | (5) | (6) | (7) |
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|28004600755400 |BAGHDADI |ACHOUR |31/12/1928|OUED ATHMANIA/MILA |MEDECINE INTERNE | 3 | 0| 0| 0| 108| 36 912,44|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|38000102536900 |BOUDIAF |LARBI |03/01/1938|MILA/MILA |MEDECINE INTERNE | 5 | 0| 0| 0| 45| 13 066,41|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|38016700674600 |BETACHE |YAMNA |29/01/1938|EL EULMA/SETIF |CHIRURGIE GENERALE | 7 | 0| 10| 10| 50| 28 233,47|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|41000700207980 |BOUHARATI |FATIMA |05/05/1947|OUED ATHMANIA/MILA |MEDECINE INTERNE | 13 | 0| 283| 0| 80| 33 891,06|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|41008700684700 |AMRI |AISSA |10/02/1941|OUED ATHMANIA/MILA |URGENCES MEDICO-CHIR. | 0 | 10| 248| 0| 62| 20 411,86|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|41008700684700 |AMRI |AISSA |10/02/1941|OUED ATHMANIA/MILA |CHIRURGIE GENERALE | 11 | 10| 248| 0| 62| 20 411,86|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|42046200465780 |HAMIME |REBIHA |01/01/1950|OUED ATHMANIA/MILA |MEDECINE INTERNE | 6 | 0| 0| 0| 54| 15 993,88|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|45031500117380 |CHERTIOUA |ZARHOUNA |08/02/1945|OUED ATHMANIA/MILA |MEDECINE INTERNE | 10 | 0| 281| 0| 68| 12 985,13|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|45182000176300 |BENSIALI |MEBROUK |23/03/1945|OUED ATHMANIA/MILA |URGENCES MEDICO-CHIR. | 1 | 0| 0| 0| 0| 0,00|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|45225700036000 |ZIKEM |AICHA |31/12/1945|OUED ATHMANIA/MILA |URGENCES MEDICO-CHIR. | 0 | 0| 205| 10| 193| 38 319,87|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|45225700036000 |ZIKEM |AICHA |31/12/1945|OUED ATHMANIA/MILA |MEDECINE INTERNE | 9 | 0| 205| 10| 193| 38 319,87|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|49008200814700 |KHENICHE |SLIMANE |31/12/1949|TELERGHMA/MILA |MEDECINE INTERNE | 20 | 0| 315| 20| 116| 38 798,81|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|49043200086280 |MEKADEM |ZINEB |31/12/1966|TELERGHMA/MILA |MEDECINE INTERNE | 2 | 0| 0| 0| 17| 6 831,95|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|53084000026800 |KECHAR |GOUISSEM |25/12/1953|TELERGHMA/MILA |MEDECINE INTERNE | 17 | 0| 50| 0| 172| 46 367,71|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|56000504286200 |KERFACI |MOSBAH |31/12/1956|TELERGHMA/MILA |MEDECINE INTERNE | 5 | 0| 0| 0| 60| 17 575,95|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|56013400994500 |SELMANI |LEULMI |01/03/1956|EL EULMA/SETIF |CHIRURGIE GENERALE | 14 | 15| 586| 10| 86| 31 899,60|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|59005900035800 |MAKHLOUFI |ABDESSELEM |15/03/1959|OUED ATHMANIA/MILA |MEDECINE INTERNE | 1 | 0| 303| 0| 45| 11 275,99|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|59515000015800 |MOKRANE |KOUIDER |02/03/1959|MILA/MILA |CHIRURGIE GENERALE | 5 | 0| 305| 10| 44| 7 220,21|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|60085600135800 |BOUMALA |ABDELHAMID |28/10/1960|CHELGHOUM EL LAID/MILA |MEDECINE INTERNE | 4 | 0| 0| 0| 36| 12 462,43|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|61039600464500 |BELGHIT |MOHAMMED |15/12/1961|OUED ATHMANIA/MILA |MEDECINE INTERNE | 5 | 0| 0| 0| 45| 19 279,09|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|63 0509 0030 6 |BOUABID |HABIBA |05/04/1969|OUED ATHMANIA/MILA |URGENCES MEDICO-CHIR. | 0 | 15| 23| 0| 5| 3 145,19|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|63 0509 0030 6 |BOUABID |HABIBA |05/04/1969|OUED ATHMANIA/MILA |CHIRURGIE GENERALE | 1 | 15| 23| 0| 5| 3 145,19|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|63009300355280 |TABAL |ELYAMNA |26/09/1960|OUED SEGUEN/MILA |MEDECINE INTERNE | 0 | 0| 0| 0| 80| 25 379,94|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
Responsable Bureau des Entrées D.S.S Le Directeur
 MINISTERE DE LA SANTE , DE LA POPULATION ET DE LE REFORME HOSPITALIERE PAGE : 2

CANEVAS DES INFORMATIONS A TRANSMETTRE MENSUELLEMENT PAR LES ETABLISSEMENTS PUBLICS DE SANTE A
L'AGENCE DE SECURITE SOCIALE DE LA WILAYA

Etablissement de santé :Hôpital FRERES BOUKHCHEM Wilaya :MILA PERIODE : M06 Année : 2020
Ú_____________________________________________________________________________________________________________________________________________________________________________________________________________¿
| Nø | PATIENT | DATE | A D R E S S E | |DUREE | TOTAL ACTES SELON | MONTANT |
|IMMATRICULATION|_________________________________________| DE | | LIBELLE SERVICE | DE | NGAP | MEDICAMENTS |
| DE L'ASSURE | | |NAISSANCE | C O M M U N E / W I L A Y A | (SPECIALITE) |SEJOUR|___________________________________________| |
| SOCIALE | N O M | P R E N O M | | | | | K | B | R | AMI | |
| | | | | | (2) | | (3) | (4) | (5) | (6) | (7) |
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|65019402235000 |AOUFI |MAHEIDDINE |10/02/1965|OUED ATHMANIA/MILA |CHIRURGIE GENERALE | 2 | 0| 0| 0| 7| 0,00|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|66001501735600 |OULMI |ABDELMADJID |31/12/1966|OUED ATHMANIA/MILA |MEDECINE INTERNE | 4 | 0| 220| 0| 23| 4 824,35|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|66062200545580 |RAMACH |RAHIMA |16/01/1965|OUED ATHMANIA/MILA |URGENCES MEDICO-CHIR. | 0 | 0| 0| 0| 17| 5 804,92|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|66062200545580 |RAMACH |RAHIMA |16/01/1965|OUED ATHMANIA/MILA |MEDECINE INTERNE | 2 | 0| 0| 0| 17| 5 804,92|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|66100000167180 |ARREM |AKILA |08/01/1975|SIDI KHELIFA/MILA |MATERNITE | 1 | 1| 0| 0| 5| 1 415,88|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|670332005257 |TOUHAMI |AMAR |03/05/1967|OUED ATHMANIA/MILA |MEDECINE INTERNE | 4 | 0| 0| 0| 36| 13 844,45|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|69073700184800 |HAMMIM |SAMIR |18/12/1969|OUED ATHMANIA/MILA |MEDECINE INTERNE | 6 | 0| 0| 0| 54| 11 354,15|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|70042402236480 |BOULAININE |NADA |21/08/1987|OUED ATHMANIA/MILA |MATERNITE | 2 | 29| 0| 0| 0| 362,85|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|72088000045500 |REGHIOUA |DJAMEL |13/07/1972|TELERGHMA/MILA |MEDECINE INTERNE | 3 | 0| 0| 0| 55| 31 578,25|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|73075600914000 |TORCHI |DALILA |30/11/1973|OUED ATHMANIA/MILA |MEDECINE INTERNE | 13 | 0| 386| 0| 98| 19 357,85|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|73349500124501 |DERAOUI |MANAR |29/05/2003|OUED ATHMANIA/MILA |MEDECINE INTERNE | 3 | 0| 0| 0| 0| 7 998,58|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|74034901065401 |BENDADA |IBRAHIM |04/06/2007|TADJENANET/MILA |URGENCES MEDICO-CHIR. | 0 | 15| 0| 4| 37| 5 253,00|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|74034901065401 |BENDADA |IBRAHIM |04/06/2007|TADJENANET/MILA |CHIRURGIE GENERALE | 3 | 15| 0| 4| 37| 5 253,00|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|74090600425680 |BENMERARA |MOUFIDA |07/01/1983|SIDI KHELIFA/MILA |MATERNITE | 1 | 21| 0| 0| 0| 238,50|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|75021600864802 |BELAOUIRA |EL AMINE |29/01/2009|SIDI MEROUANE/MILA |CHIRURGIE GENERALE | 2 | 0| 0| 0| 0| 1 095,75|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|75023401904900 |ALIOUAT |ADEL |21/03/1975|OUED ATHMANIA/MILA |MEDECINE INTERNE | 3 | 0| 0| 0| 36| 11 324,05|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|76062800085380 |BENGHALIA |SALIHA |03/11/1982|OUED ATHMANIA/MILA |MEDECINE INTERNE | 2 | 0| 293| 0| 60| 11 763,77|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|78001702445400 |OULTACHE |REDHA |02/01/1978|OUED ATHMANIA/MILA |MEDECINE INTERNE | 3 | 0| 0| 0| 36| 9 843,59|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|78162600274880 |BENKHELLAF |MENOUBA |30/01/1983|SIDI KHELIFA/MILA |MATERNITE | 1 | 21| 0| 0| 0| 222,22|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|79001902794080 |GHODBANE |FATIHA |25/05/1985|AIN TINE/MILA |MATERNITE | 1 | 21| 60| 0| 2| 1 327,96|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|79008702324305 |ABBAS |NAOUFEL |21/08/2019|OUED ATHMANIA/MILA |MEDECINE INFANTILE | 5 | 0| 50| 0| 43| 3 387,45|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|79050000086303 |BOUHALA |RAFIF |11/10/2018|ZEGHAIA/MILA |CHIRURGIE GENERALE | 0 | 0| 0| 0| 12| 2 077,46|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|80167400374400 |MEDJANI |BARKAHEM |03/09/1980|OUED ATHMANIA/MILA |MATERNITE | 1 | 0| 0| 0| 5| 1 689,68|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
Responsable Bureau des Entrées D.S.S Le Directeur
 MINISTERE DE LA SANTE , DE LA POPULATION ET DE LE REFORME HOSPITALIERE PAGE : 3

CANEVAS DES INFORMATIONS A TRANSMETTRE MENSUELLEMENT PAR LES ETABLISSEMENTS PUBLICS DE SANTE A
L'AGENCE DE SECURITE SOCIALE DE LA WILAYA

Etablissement de santé :Hôpital FRERES BOUKHCHEM Wilaya :MILA PERIODE : M06 Année : 2020
Ú_____________________________________________________________________________________________________________________________________________________________________________________________________________¿
| Nø | PATIENT | DATE | A D R E S S E | |DUREE | TOTAL ACTES SELON | MONTANT |
|IMMATRICULATION|_________________________________________| DE | | LIBELLE SERVICE | DE | NGAP | MEDICAMENTS |
| DE L'ASSURE | | |NAISSANCE | C O M M U N E / W I L A Y A | (SPECIALITE) |SEJOUR|___________________________________________| |
| SOCIALE | N O M | P R E N O M | | | | | K | B | R | AMI | |
| | | | | | (2) | | (3) | (4) | (5) | (6) | (7) |
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|80182200295400 |SAIFI |NAOUAL |18/08/1980|MILA/MILA |MATERNITE | 2 | 1| 15| 0| 8| 7 544,13|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|80195400205480 |MECHENOUAI |IMANE |24/04/1988|OUED ATHMANIA/MILA |MATERNITE | 1 | 21| 0| 0| 5| 1 520,00|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|80446100025600 |CHOUKIRED |FATEH |30/03/1980|OUED ATHMANIA/MILA |MEDECINE INTERNE | 7 | 0| 0| 0| 63| 26 218,82|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|81032200216880 |BELEMOUFAK |YASMINA |01/10/1987|OUED ATHMANIA/MILA |MATERNITE | 1 | 29| 0| 0| 5| 1 494,74|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|81092200794480 |GUERBA |NADJAT |04/04/1988|OUED ATHMANIA/MILA |MATERNITE | 1 | 21| 0| 0| 5| 1 396,32|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|81215900205403 |KHELLAF |ROUDEINA |25/08/2016|CHELGHOUM EL LAID/MILA |URGENCES MEDICO-CHIR. | 0 | 15| 95| 20| 32| 2 137,82|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|81215900205403 |KHELLAF |ROUDEINA |25/08/2016|CHELGHOUM EL LAID/MILA |CHIRURGIE GENERALE | 2 | 15| 95| 20| 32| 2 137,82|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|82016600445000 |ALKEMA |DOUNYAZAD |03/02/1982|OUED ATHMANIA/MILA |MATERNITE | 7 | 0| 0| 0| 12| 4 956,00|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|82034100206580 |GUESSOUM |MEBARKA |09/09/1988|OUED ATHMANIA/MILA |MATERNITE | 1 | 29| 0| 0| 7| 1 238,05|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|82048001125680 |KEDDIDA |AMINA |28/03/1984|OUED ATHMANIA/MILA |MATERNITE | 1 | 21| 0| 0| 10| 748,50|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|82073700215600 |BENHARKOU |ROKIA |11/07/1982|OUED ATHMANIA/MILA |URGENCES MEDICO-CHIR. | 0 | 0| 0| 0| 60| 14 562,70|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|82073700215600 |BENHARKOU |ROKIA |11/07/1982|OUED ATHMANIA/MILA |CHIRURGIE GENERALE | 7 | 0| 0| 0| 60| 14 562,70|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|83130000037280 |BELDJOUDI |IMENE |24/06/1988|OUED SEGUEN/MILA |MATERNITE | 1 | 21| 0| 0| 5| 4 110,50|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|85012701694400 |MEGARI |AFAFE |16/09/1985|OUED ATHMANIA/MILA |MATERNITE | 1 | 89| 0| 0| 0| 533,27|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|85017002185180 |KEBBABI |FAIZA |16/06/1991|OUED ATHMANIA/MILA |MATERNITE | 1 | 29| 0| 0| 5| 728,11|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|86100900894180 |AYAD |BOCHRA |11/11/1994|OUED ATHMANIA/MILA |MATERNITE | 2 | 0| 120| 0| 15| 5 928,69|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|86100900894180 |AYAD |BOCHRA |11/11/1994|OUED ATHMANIA/MILA |MATERNITE | 1 | 0| 30| 0| 2| 5 385,96|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|86247400424100 |BENMERIDJA |FATIMA |17/02/1986|OUED ATHMANIA/MILA |URGENCES MEDICO-CHIR. | 0 | 0| 0| 0| 37| 19 249,55|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|86247400424100 |BENMERIDJA |FATIMA |17/02/1986|OUED ATHMANIA/MILA |CHIRURGIE GENERALE | 2 | 0| 0| 0| 37| 19 249,55|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|87229600333700 |BENAMIRA |AMMAR |18/08/1987|TELERGHMA/MILA |MEDECINE INTERNE | 8 | 0| 0| 0| 90| 23 117,00|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|88104400075400 |KASRI |AMIRA |01/01/1993|TADJENANET/MILA |MATERNITE | 3 | 0| 15| 0| 7| 19 061,64|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|89049000364000 |SEKHRI |AICHA |13/04/1989|OUED ATHMANIA/MILA |MATERNITE | 1 | 30| 35| 0| 0| 3 141,65|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|89160000615300 |KENZAI |SARA |01/09/1989|OUED ATHMANIA/MILA |MATERNITE | 1 | 29| 0| 0| 5| 5 288,25|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
Responsable Bureau des Entrées D.S.S Le Directeur
 MINISTERE DE LA SANTE , DE LA POPULATION ET DE LE REFORME HOSPITALIERE PAGE : 4

CANEVAS DES INFORMATIONS A TRANSMETTRE MENSUELLEMENT PAR LES ETABLISSEMENTS PUBLICS DE SANTE A
L'AGENCE DE SECURITE SOCIALE DE LA WILAYA

Etablissement de santé :Hôpital FRERES BOUKHCHEM Wilaya :MILA PERIODE : M06 Année : 2020
Ú_____________________________________________________________________________________________________________________________________________________________________________________________________________¿
| Nø | PATIENT | DATE | A D R E S S E | |DUREE | TOTAL ACTES SELON | MONTANT |
|IMMATRICULATION|_________________________________________| DE | | LIBELLE SERVICE | DE | NGAP | MEDICAMENTS |
| DE L'ASSURE | | |NAISSANCE | C O M M U N E / W I L A Y A | (SPECIALITE) |SEJOUR|___________________________________________| |
| SOCIALE | N O M | P R E N O M | | | | | K | B | R | AMI | |
| | | | | | (2) | | (3) | (4) | (5) | (6) | (7) |
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|90088500214780 |GUERRIOUNE |FATMA |16/12/1998|OUED ATHMANIA/MILA |MATERNITE | 1 | 29| 0| 0| 5| 1 545,85|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|91015201475100 |AMRI |FATIMA |01/09/1991|AIN MELLOUK/MILA |MATERNITE | 1 | 29| 0| 0| 7| 4 591,25|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|91101600465600 |MAY |IMANE |24/09/1991|OUED ATHMANIA/MILA |URGENCES MEDICO-CHIR. | 1 | 0| 0| 0| 0| 4 501,56|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|91101600465600 |MAY |IMANE |24/09/1991|OUED ATHMANIA/MILA |MEDECINE INTERNE | 3 | 0| 0| 0| 0| 4 501,56|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|92012802494780 |MEHENNI |ABIR |02/08/1995|OUED ATHMANIA/MILA |MATERNITE | 0 | 241| 0| 0| 0| 2 268,40|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|94327300174300 |BEKRAR |IKRAM |12/03/1994|CHELGHOUM EL LAID/MILA |MATERNITE | 1 | 0| 0| 0| 5| 970,56|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|97136300633900 |BOUSSIADI |AYMEN |18/07/1997|CHELGHOUM EL LAID/MILA |MEDECINE INTERNE | 13 | 0| 293| 23| 62| 5 387,10|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
|98042300654500 |DJAOUT |AMIRA |24/07/1998|OUED ATHMANIA/MILA |MEDECINE INTERNE | 1 | 0| 0| 0| 8| 1 206,33|
|_______________|____________________|____________________|__________|________________________________________|_________________________|______|__________|__________|__________|__________|__________________|
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