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DossUniq05
Hieronder vindt u een overzicht met de verrichtingen.
Ryckaert Michel 45022803980 1 28/02/1945 0000002123653
1 (1)
Datum
behandeling
Betreft Bedrag Rekeningnummer Mededeling
09/06/2020 Betaling e-attest 22,78 BE28 3900 6902 1720 /C/ 300-1-200608-0003230-75 Raadpleging
huisarts
Prestatie datum Naam zorgverstrekker Aard van de verstrekking Aantal Bedrag Totaal Betaald Ereloon Persoonlijk
aandeel
Supplement
VERZORGING
08/06/2020 BOONE BRUNO 101076 Raadpleg./bezoeken 1 22,78 22,78 26,78 26,78 4,00
BETAL. 12/06/20 OP REK. BE28
3900 6902 1720
22,78
Handtekening
Sarah Willockx
Provinciaal secretaris
De bedragen in de kolommen Betaald en Supplement worden vermeld op basis van de informatie
die uw zorgverlener op het getuigschrift vermeldde. Indien u méér betaalde, raden wij u aan om uw
bewijsstuk van uw zorgverlener goed bij te houden.
Indien u een verzekering heeft afgesloten, kan u dit bewijsstuk vervolgens overmaken aan uw
verzekeringsmaatschappij voor een eventuele bijkomende terugbetaling.


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