mcare.fhpl.net
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Submitted URL: https://secure-web.cisco.com/1kegrVJJXb52UyZ0pj6_RwkYiQYZPAk1l1kKTdvwstn9ywID70HDAeNyyy0ALLDlauQf9rhjuQWE7wuZo5441oiGd3ppyCZX...
Effective URL: https://mcare.fhpl.net/Includes/Modules/ClaimDetails.aspx?ClaimID=3376381%20-%201
Submission: On August 31 via api from SG
Effective URL: https://mcare.fhpl.net/Includes/Modules/ClaimDetails.aspx?ClaimID=3376381%20-%201
Submission: On August 31 via api from SG
Form analysis 1 forms found in the DOM
POST ./ClaimDetails.aspx?ClaimID=3376381+-+1
<form method="post" action="./ClaimDetails.aspx?ClaimID=3376381+-+1" id="form1">
<div class="aspNetHidden">
<input type="hidden" name="__EVENTTARGET" id="__EVENTTARGET" value="">
<input type="hidden" name="__EVENTARGUMENT" id="__EVENTARGUMENT" value="">
<input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE"
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<table>
<tbody>
<tr>
<td class="style6">
<table style="width: 750px" class="cssLabel">
<tbody>
<tr>
<td class="cssTableHeaderRow"> CLAIMS DETAILS </td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<td style="font-size: 5px"> </td>
</tr>
</tbody>
</table>
<div id="upnlClaimHistory">
<table class="cssLabel" style="border: thin ridge #CCCCCC; width: 750px; text-align: left" cellpadding="3px" cellspacing="0">
<tbody>
<tr>
<td> Illness Start Date </td>
<td> Received Date </td>
<td class="style40" style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Date of Admission </td>
<td> Documentation </td>
</tr>
<tr>
<td>
<input name="txtIllnessDate" type="text" readonly="readonly" id="txtIllnessDate" class="cssTextBox">
</td>
<td>
<input name="txtReceivedDate" type="text" value="06 Jul 2021" readonly="readonly" id="txtReceivedDate" class="cssTextBox" style="width:160px;">
</td>
<td class="style40" style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC">
<input name="txtDateofAdmission" type="text" value="09 May 2021" readonly="readonly" id="txtDateofAdmission" class="cssTextBox">
</td>
<td> </td>
</tr>
<tr>
<td> Date of Discharge </td>
<td> Bill No Bill Date </td>
<td style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Approved Amount </td>
<td>
<input id="chkPreauthorisation" type="checkbox" name="chkPreauthorisation"><label for="chkPreauthorisation">Is PreAuthorization</label>
</td>
</tr>
<tr>
<td>
<input name="txtDateofDischarge" type="text" value="10 May 2021" readonly="readonly" id="txtDateofDischarge" class="cssTextBox">
</td>
<td>
<input name="txtBillno" type="text" value="307" readonly="readonly" id="txtBillno" class="cssTextBox" style="height:23px;width:70px;"> <input name="txtBillDate" type="text" value="10 May 2021" readonly="readonly"
id="txtBillDate" class="cssTextBox" style="height:23px;width:85px;">
</td>
<td class="style40" style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC">
<input name="txtApprovedAmount" type="text" readonly="readonly" id="txtApprovedAmount" class="cssTextBox">
</td>
<td>
<input id="chkDischargeSummary" type="checkbox" name="chkDischargeSummary" checked="checked"><label for="chkDischargeSummary">Is Discharge Summary</label>
</td>
</tr>
<tr>
<td> Service Type </td>
<td> Room Days </td>
<td class="style40" style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> ICU Days </td>
<td>
<input id="chkHospitalizationBills" type="checkbox" name="chkHospitalizationBills"><label for="chkHospitalizationBills">Is Hospitalization Bills</label>
</td>
</tr>
<tr>
<td>
<input name="txtServiceType" type="text" value="In Patient" readonly="readonly" id="txtServiceType" class="cssTextBox">
</td>
<td>
<input name="txtRoomDays" type="text" value="1" readonly="readonly" id="txtRoomDays" class="cssTextBox" style="width:160px;">
</td>
<td class="style40" style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC">
<input name="txtICUDays" type="text" value="0" readonly="readonly" id="txtICUDays" class="cssTextBox">
</td>
<td>
<input id="chkBillBreak" type="checkbox" name="chkBillBreak"><label for="chkBillBreak">Is Bill BreakUP</label>
</td>
</tr>
<tr>
<td> Claim Amount </td>
<td> Accomodation Type </td>
<td class="style40" style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Treatment Type </td>
<td>
<input id="chkClaimForm" type="checkbox" name="chkClaimForm"><label for="chkClaimForm">Is Claim Form</label>
</td>
</tr>
<tr>
<td>
<input name="txtClaimAmount" type="text" value="63828" readonly="readonly" id="txtClaimAmount" class="cssTextBox">
</td>
<td>
<input name="txtAccomodationType" type="text" value="General" readonly="readonly" id="txtAccomodationType" class="cssTextBox" style="width:160px;">
</td>
<td class="style40" style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC">
<input name="txtTreatmentType" type="text" value="Medical" readonly="readonly" id="txtTreatmentType" class="cssTextBox">
</td>
<td>
<input id="chkBillPaid" type="checkbox" name="chkBillPaid" checked="checked"><label for="chkBillPaid">Is BillPaid</label>
</td>
</tr>
</tbody>
</table>
</div>
<table>
<tbody>
<tr>
<td style="font-size: 5px"> </td>
</tr>
</tbody>
</table>
<table class="cssLabel" style="border: thin ridge #CCCCCC; width: 750px; text-align: left" cellpadding="3px" cellspacing="0">
<tbody>
<tr>
<td> Pre/Post </td>
<td class="style2"> Re Open SL.No </td>
<td class="style4"> Claim Type </td>
<td class="style7"> Status </td>
</tr>
<tr>
<td>
<input name="txtPrepost" type="text" readonly="readonly" id="txtPrepost" class="cssTextBox" style="width:175px;">
</td>
<td class="style2">
<input name="txtReopen" type="text" readonly="readonly" id="txtReopen" class="cssTextBox" style="width:175px;">
</td>
<td class="style4">
<input name="txtClaimType" type="text" value="MR" readonly="readonly" id="txtClaimType" class="cssTextBox" style="width:175px;">
</td>
<td class="style7">
<input name="txtStatus" type="text" value="Settled" readonly="readonly" id="txtStatus" class="cssTextBox" style="width:175px;">
</td>
</tr>
<tr>
<td> Doctor Name </td>
<td class="style2"> </td>
<td class="style4"> Provider Name </td>
<td class="style7"> </td>
</tr>
<tr>
<td colspan="2">
<input name="txtDoctorName" type="text" readonly="readonly" id="txtDoctorName" class="cssTextBox" style="width:360px;">
</td>
<td class="style4" colspan="2">
<input name="txtProviderName" type="text" value="Trust Hospital" readonly="readonly" id="txtProviderName" class="cssTextBox" style="width:360px;">
</td>
</tr>
<tr>
<td colspan="2">
<textarea name="txtDoctorName1" rows="2" cols="20" readonly="readonly" id="txtDoctorName1" class="cssTextBox" style="height:61px;width:360px;"></textarea>
</td>
<td class="style4" colspan="2">
<textarea name="txtProviderName1" rows="2" cols="20" readonly="readonly" id="txtProviderName1" class="cssTextBox" style="height:61px;width:360px;">No.122,Medavakkam Tank Road,Ayanavaram,, Chennai, Tamil Nadu - 600023</textarea>
</td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<td style="font-size: 5px"> </td>
</tr>
</tbody>
</table>
<table class="cssLabel" style="border: thin ridge #CCCCCC; text-align: left;" cellpadding="3px" cellspacing="0" width="750">
<tbody>
<tr>
<td class="style38"> Diseases </td>
<td> PCS Codes </td>
<td class="style37"> Surgery Details </td>
</tr>
<tr>
<td class="style38">
<div>
<table class="cssGridViewHeader" cellspacing="0" cellpadding="4" rules="all" border="1" id="gdvClaimsICD" style="color:#333333;font-size:7pt;font-weight:normal;width:320px;border-collapse:collapse;">
<tbody>
<tr style="color:White;background-color:#5D7B9D;font-weight:bold;">
<th align="left" scope="col">DiseaseCode</th>
<th scope="col">DiseaseName</th>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td align="center" style="width:50px;">N18.9</td>
<td>Chronic kidney disease, unspecified</td>
</tr>
</tbody>
</table>
</div>
</td>
<td>
<div>
<table class="cssGridViewHeader" cellspacing="0" cellpadding="4" rules="all" border="1" id="gdvClaimsPCS" style="color:#333333;font-size:7pt;font-weight:normal;width:110px;border-collapse:collapse;">
<tbody>
<tr class="cssErrLabel">
<td>No PCS Codes Found</td>
</tr>
</tbody>
</table>
</div>
</td>
<td class="style37">
<div>
<table cellspacing="0" cellpadding="4" rules="all" border="1" id="gdvAliments" style="color:#333333;font-size:7pt;font-weight:normal;width:270px;border-collapse:collapse;">
<tbody>
<tr class="cssErrLabel">
<td colspan="2">No Surgery Details Found</td>
</tr>
</tbody>
</table>
</div>
</td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<td style="font-size: 5px"> </td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<td style="font-size: 5px"> </td>
</tr>
</tbody>
</table>
<table class="cssLabel" style="border: thin ridge #CCCCCC; width: 750px; text-align: left" cellpadding="3px" cellspacing="0">
<tbody>
<tr>
<td> Treatment UnderTaken </td>
</tr>
<tr>
<td>
<textarea name="txtTreatmentUndertaken" rows="2" cols="20" readonly="readonly" id="txtTreatmentUndertaken" class="cssTextBox" style="width:100%;">DAILYSIS</textarea>
</td>
</tr>
<tr>
<td> Diagnosis </td>
</tr>
<tr>
<td>
<textarea name="txtDiagnosis" rows="2" cols="20" readonly="readonly" id="txtDiagnosis" class="cssTextBox" style="width:100%;">Chronic Kidney Disease </textarea>
</td>
</tr>
<tr>
<td> Reason </td>
</tr>
<tr>
<td>
<div>
</div>
<div>
</div>
<textarea name="txtReason" rows="2" cols="20" readonly="readonly" id="txtReason" class="cssTextBox" style="width:100%;"></textarea>
</td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<td style="font-size: 5px"> </td>
</tr>
</tbody>
</table>
<table class="cssLabel" style="border: thin ridge #CCCCCC; width: 750px; text-align: left" cellpadding="3px" cellspacing="0">
<tbody>
<tr>
<td class="style8" style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC">
<div id="upnlServices">
<div id="pnlServiceDetails" style="height:185px;width:335px;overflow:scroll;">
<div>
<table class="cssGridViewData" cellspacing="0" cellpadding="4" rules="all" border="1" id="gdvServiceDetails" style="color:#333333;font-size:7pt;font-weight:normal;border-collapse:collapse;">
<tbody>
<tr style="color:White;background-color:#5D7B9D;font-weight:bold;">
<th scope="col">Service</th>
<th scope="col">Billed Amount</th>
<th scope="col">Deduction Amount</th>
<th scope="col">Sanctioned Amount SI</th>
<th scope="col">Buffer Amount</th>
<th scope="col">Tertiary Amount</th>
<th scope="col">Reason</th>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">SumInsured</td>
<td align="right">63828</td>
<td align="right">2275</td>
<td align="right" style="width:60px;">61553</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl02$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_0" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">--Room Rel</td>
<td align="right">1500</td>
<td align="right">0</td>
<td align="right" style="width:60px;">1500</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl03$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_1" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Room</td>
<td align="right">975</td>
<td align="right">0</td>
<td align="right" style="width:60px;">975</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl04$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_2" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----ICU</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl05$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_3" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Nursing</td>
<td align="right">525</td>
<td align="right">0</td>
<td align="right" style="width:60px;">525</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl06$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_4" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">--Prof Chrgs</td>
<td align="right">2250</td>
<td align="right">750</td>
<td align="right" style="width:60px;">1500</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl07$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_5" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Surg Chrgs</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl08$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_6" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----Anes Chrgs</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl09$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_7" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Doc. Chrgs</td>
<td align="right">2250</td>
<td align="right">750</td>
<td align="right" style="width:60px;">1500</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl10$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_8" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----Consultation</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl11$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_9" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Others</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl12$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_10" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">--Drg\Con\In</td>
<td align="right">43574</td>
<td align="right">450</td>
<td align="right" style="width:60px;">43124</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl13$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_11" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Pharmacy</td>
<td align="right">43574</td>
<td align="right">450</td>
<td align="right" style="width:60px;">43124</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl14$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_12" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----Cons</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl15$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_13" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Others</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl16$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_14" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">--Inv/Proc</td>
<td align="right">15429</td>
<td align="right">0</td>
<td align="right" style="width:60px;">15429</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl17$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_15" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Lab</td>
<td align="right">15429</td>
<td align="right">0</td>
<td align="right" style="width:60px;">15429</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl18$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_16" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----Radiology</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl19$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_17" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Procedures</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl20$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_18" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----Others</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl21$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_19" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">--Domc Hosp</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl22$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_20" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----Others</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl23$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_21" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Cns\Medprc</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl24$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_22" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----Drg\Bld\O2</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl25$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_23" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Others</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl26$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_24" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">--Day Care</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl27$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_25" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Drg\Cons</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl28$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_26" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----Inv\Proc</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl29$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_27" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Consultion</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl30$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_28" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----Others</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl31$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_29" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">--Dental</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl32$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_30" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">--MIS</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl33$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_31" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Ambulance</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl34$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_32" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----Implants</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl35$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_33" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Ser.Charges/Tax</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl36$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_34" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">--OP REl</td>
<td align="right">1075</td>
<td align="right">1075</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl37$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_35" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----OT Consum</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl38$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_36" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----OT Charges</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl39$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_37" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:200px;">----Proc</td>
<td align="right">0</td>
<td align="right">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl40$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_38" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:200px;">----Others</td>
<td align="right">1075</td>
<td align="right">1075</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td align="right" style="width:60px;">0</td>
<td>
<input type="submit" name="gdvServiceDetails$ctl41$btnReasons" value="Reasons" id="gdvServiceDetails_btnReasons_39" style="font-size:7pt;font-weight:normal;">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</td>
<td class="style5">
<table class="cssLabel" style="text-align: left" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td>
</td>
<td> Amount Details </td>
</tr>
<tr>
<td> Settled Amount </td>
<td> Buffer Amount </td>
<td> Tertiary Amount </td>
</tr>
<tr>
<td>
<input name="txtSettledAmt" type="text" value="49242" readonly="readonly" id="txtSettledAmt" class="cssTextBox" style="width:125px;">
</td>
<td>
<input name="txtBufferAmt" type="text" value="0" readonly="readonly" id="txtBufferAmt" class="cssTextBox" style="width:125px;">
</td>
<td>
<input name="txtTertiaryAmt" type="text" value="0" readonly="readonly" id="txtTertiaryAmt" class="cssTextBox" style="width:125px;">
</td>
</tr>
<tr>
<td> Cheque Number </td>
<td> Cheque Date </td>
<td> Bank </td>
</tr>
<tr>
<td>
<input name="txtChequeNumber" type="text" value="120400206GN00144" readonly="readonly" id="txtChequeNumber" class="cssTextBox" style="width:125px;">
</td>
<td>
<input name="txtChequeDate" type="text" value="7/22/2021 12:00:00 AM" readonly="readonly" id="txtChequeDate" class="cssTextBox" style="width:125px;">
</td>
<td>
<input name="txtBank" type="text" value="Indusind Bank" readonly="readonly" id="txtBank" class="cssTextBox" style="width:125px;">
</td>
</tr>
<tr>
<td> Payable At </td>
<td> Payee Name </td>
<td> Mode of Payment </td>
</tr>
<tr>
<td>
<input name="txtPayableAt" type="text" value="Hyderabad" readonly="readonly" id="txtPayableAt" class="cssTextBox" style="width:125px;">
</td>
<td>
<input name="txtPayeeName" type="text" value="Geoffrey Alan" readonly="readonly" id="txtPayeeName" class="cssTextBox" style="width:125px;">
</td>
<td>
<input name="txtModeOfPayment" type="text" value="NEFT" readonly="readonly" id="txtModeOfPayment" class="cssTextBox" style="width:125px;">
</td>
</tr>
<tr>
<td> Notes </td>
<td>
</td>
<td>
</td>
</tr>
<tr>
<td colspan="3">
<textarea name="txtNotes" rows="2" cols="20" readonly="readonly" id="txtNotes" class="cssTextBox" style="width:100%;"></textarea>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<td style="font-size: 5px"> </td>
</tr>
</tbody>
</table>
<table class="cssLabel" style="border: ridge thin #CCCCCC; width: 100%; font-size: 10px;" cellpadding="3px" cellspacing="0px">
<tbody>
<tr>
<td>
<input type="submit" name="btnBufferBalance" value="Buffer Calc" id="btnBufferBalance" style="color:Red;width:82px;font-weight: 700;">
</td>
</tr>
<tr>
<td style="border-bottom-style: ridge; border-bottom-width: thin; border-bottom-color: #CCCCCC;" colspan="6"> Buffer Balances </td>
</tr>
<tr>
<td style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Member Balance </td>
<td style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Family Balance </td>
<td style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Eligible Balance </td>
<td style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Claim Limit </td>
<td style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Illness Limit </td>
<td> Group Balance </td>
</tr>
<tr>
<td style="text-align: right; border-right-style: ridge; border-right-width: thin;
border-right-color: #CCCCCC;">
<span id="lblBufMemberBalance" style="display:inline-block;font-weight:normal;width:100px;"></span>
</td>
<td style="text-align: right; border-right-style: ridge; border-right-width: thin;
border-right-color: #CCCCCC;">
<span id="lblBufFamilyBalance" style="display:inline-block;font-weight:normal;width:100px;"></span>
</td>
<td style="text-align: right; border-right-style: ridge; border-right-width: thin;
border-right-color: #CCCCCC;">
<span id="lblBufEligibleBalance" style="display:inline-block;font-weight:normal;width:100px;"></span>
</td>
<td style="text-align: right; border-right-style: ridge; border-right-width: thin;
border-right-color: #CCCCCC;">
<span id="lblBufClaimLimit" style="display:inline-block;font-weight:normal;width:100px;"></span>
</td>
<td style="text-align: right; border-right-style: ridge; border-right-width: thin;
border-right-color: #CCCCCC;">
<span id="lblBufIllnessLimit" style="display:inline-block;font-weight:normal;width:100px;"></span>
</td>
<td style="text-align: right">
<span id="lblBufGroupBalance" style="display:inline-block;font-weight:normal;width:100px;"></span>
</td>
</tr>
<tr>
<td style="border-bottom-style: ridge; border-bottom-width: thin; border-bottom-color: #CCCCCC;
border-top-style: ridge; border-top-width: thin; border-top-color: #CCCCCC;" colspan="6"> Tertiary Balances </td>
</tr>
<tr>
<td style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Member Balance </td>
<td style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Family Balance </td>
<td style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Eligible Balance </td>
<td style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Claim Limit </td>
<td style="border-right-style: ridge; border-right-width: thin; border-right-color: #CCCCCC"> Illness Limit </td>
<td> Group Balance </td>
</tr>
<tr>
<td style="text-align: right; border-right-style: ridge; border-right-width: thin;
border-right-color: #CCCCCC;">
<span id="lblTerMemberBalance" style="display:inline-block;font-weight:normal;width:100px;"></span>
</td>
<td style="text-align: right; border-right-style: ridge; border-right-width: thin;
border-right-color: #CCCCCC;">
<span id="lblTerFamilyBalance" style="display:inline-block;font-weight:normal;width:100px;"></span>
</td>
<td style="text-align: right; border-right-style: ridge; border-right-width: thin;
border-right-color: #CCCCCC;">
<span id="lblTerEligibleBalance" style="display:inline-block;font-weight:normal;width:100px;"></span>
</td>
<td style="text-align: right; border-right-style: ridge; border-right-width: thin;
border-right-color: #CCCCCC;">
<span id="lblTerClaimLimit" style="display:inline-block;font-weight:normal;width:100px;"></span>
</td>
<td style="text-align: right; border-right-style: ridge; border-right-width: thin;
border-right-color: #CCCCCC;">
<span id="lblTerIllnessLimit" style="display:inline-block;font-weight:normal;width:100px;"></span>
</td>
<td style="text-align: right">
<span id="lblTerGroupBalance" style="display:inline-block;font-weight:normal;width:100px;"></span>
</td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<td style="text-align: center">
</td>
<td>
</td>
<td>
</td>
<td>
</td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<td style="font-size: 5px"> </td>
</tr>
</tbody>
</table>
<table style="text-align: left; width: 750px; border: thin ridge #CCCCCC;" class="cssLabel">
<tbody>
<tr>
<td style="border-bottom-style: ridge; border-bottom-width: thin; border-bottom-color: #CCCCCC"> Detailed Status </td>
<td class="style39" style="border-bottom-style: ridge; border-bottom-width: thin;
border-bottom-color: #CCCCCC"> Consignment Details </td>
</tr>
<tr>
<td>
<div id="Panel1" style="height:185px;width:360px;overflow:scroll;">
<div>
<table class="cssGridViewData" cellspacing="0" cellpadding="4" rules="all" border="1" id="gdvDetailedStatus" style="color:#333333;font-size:7pt;font-weight:normal;width:98%;border-collapse:collapse;">
<tbody>
<tr style="color:White;background-color:#5D7B9D;font-weight:bold;">
<th scope="col">Claim ID</th>
<th scope="col">SLNO</th>
<th scope="col">Status</th>
<th scope="col">Created Date Time</th>
<th scope="col">Operator Name</th>
<th scope="col">Location</th>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>InProcess</td>
<td style="width:175px;">06 Jul 2021 12:39:39</td>
<td>Damodar Sawant</td>
<td style="width:150px;">Mumbai, Maharashtra</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>Medical Scrutiny Done [For Processing]</td>
<td style="width:175px;">08 Jul 2021 12:09:59</td>
<td>Vijay Shelkar</td>
<td style="width:150px;">Mumbai, Maharashtra</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>Sent for Audit</td>
<td style="width:175px;">12 Jul 2021 19:14:29</td>
<td>Abhijit Rane </td>
<td style="width:150px;">Mumbai, Maharashtra</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>Medical Scrutiny Done [IR Pending]</td>
<td style="width:175px;">13 Jul 2021 11:33:21</td>
<td>Vijay Shelkar</td>
<td style="width:150px;">Mumbai, Maharashtra</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>Medical Scrutiny Done [IR Pending]</td>
<td style="width:175px;">13 Jul 2021 11:34:09</td>
<td>Vijay Shelkar</td>
<td style="width:150px;">Mumbai, Maharashtra</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>IR Pending [IR Letter]</td>
<td style="width:175px;">13 Jul 2021 11:35:23</td>
<td>Vijay Shelkar</td>
<td style="width:150px;">Mumbai, Maharashtra</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>Medical Scrutiny Done [For Processing]</td>
<td style="width:175px;">14 Jul 2021 18:28:53</td>
<td>Vaibhav K Keni</td>
<td style="width:150px;">Mumbai, Maharashtra</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>Sent for Audit</td>
<td style="width:175px;">17 Jul 2021 11:49:17</td>
<td>Kiran Poojari</td>
<td style="width:150px;">Mumbai, Maharashtra</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>Sent for Audit</td>
<td style="width:175px;">21 Jul 2021 16:49:17</td>
<td>Karuna Vasant Vaity</td>
<td style="width:150px;">mumbai, Maharashtra</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>Audit Complete</td>
<td style="width:175px;">21 Jul 2021 16:51:36</td>
<td>Karuna Vasant Vaity</td>
<td style="width:150px;">mumbai, Maharashtra</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>Voucher Prepared</td>
<td style="width:175px;">22 Jul 2021 10:23:19</td>
<td>Thirupathi Pamula</td>
<td style="width:150px;">Hyderabad, Telangana</td>
</tr>
<tr style="color:#333333;background-color:White;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>Claim Passed</td>
<td style="width:175px;">22 Jul 2021 10:28:50</td>
<td>Thirupathi Pamula</td>
<td style="width:150px;">Hyderabad, Telangana</td>
</tr>
<tr style="color:#333333;background-color:#F7F6F3;">
<td style="width:90px;">3376381</td>
<td>1</td>
<td>Settled</td>
<td style="width:175px;">27 Jul 2021 12:36:34</td>
<td>Divakar P</td>
<td style="width:150px;">Hyderabad, Andhra Pradesh</td>
</tr>
</tbody>
</table>
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<table class="cssGridViewData" cellspacing="0" cellpadding="4" rules="all" border="1" id="gdvConsignmentDetails" style="color:#333333;font-size:7pt;font-weight:normal;width:98%;border-collapse:collapse;">
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<tr class="cssErrLabel">
<td colspan="5">No Consignment Details</td>
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</div>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
</form>Text Content
CLAIMS DETAILS Illness Start Date Received Date Date of Admission Documentation Date of Discharge Bill No Bill Date Approved Amount Is PreAuthorization Is Discharge Summary Service Type Room Days ICU Days Is Hospitalization Bills Is Bill BreakUP Claim Amount Accomodation Type Treatment Type Is Claim Form Is BillPaid Pre/Post Re Open SL.No Claim Type Status Doctor Name Provider Name No.122,Medavakkam Tank Road,Ayanavaram,, Chennai, Tamil Nadu - 600023 Diseases PCS Codes Surgery Details DiseaseCodeDiseaseName N18.9Chronic kidney disease, unspecified No PCS Codes Found No Surgery Details Found Treatment UnderTaken DAILYSIS Diagnosis Chronic Kidney Disease Reason ServiceBilled AmountDeduction AmountSanctioned Amount SIBuffer AmountTertiary AmountReason SumInsured6382822756155300 --Room Rel15000150000 ----Room975097500 ----ICU00000 ----Nursing525052500 --Prof Chrgs2250750150000 ----Surg Chrgs00000 ----Anes Chrgs00000 ----Doc. Chrgs2250750150000 ----Consultation00000 ----Others00000 --Drg\Con\In435744504312400 ----Pharmacy435744504312400 ----Cons00000 ----Others00000 --Inv/Proc1542901542900 ----Lab1542901542900 ----Radiology00000 ----Procedures00000 ----Others00000 --Domc Hosp00000 ----Others00000 ----Cns\Medprc00000 ----Drg\Bld\O200000 ----Others00000 --Day Care00000 ----Drg\Cons00000 ----Inv\Proc00000 ----Consultion00000 ----Others00000 --Dental00000 --MIS00000 ----Ambulance00000 ----Implants00000 ----Ser.Charges/Tax00000 --OP REl10751075000 ----OT Consum00000 ----OT Charges00000 ----Proc00000 ----Others10751075000 Amount Details Settled Amount Buffer Amount Tertiary Amount Cheque Number Cheque Date Bank Payable At Payee Name Mode of Payment Notes Buffer Balances Member Balance Family Balance Eligible Balance Claim Limit Illness Limit Group Balance Tertiary Balances Member Balance Family Balance Eligible Balance Claim Limit Illness Limit Group Balance Detailed Status Consignment Details Claim IDSLNOStatusCreated Date TimeOperator NameLocation 33763811InProcess06 Jul 2021 12:39:39Damodar SawantMumbai, Maharashtra 33763811Medical Scrutiny Done [For Processing]08 Jul 2021 12:09:59Vijay ShelkarMumbai, Maharashtra 33763811Sent for Audit12 Jul 2021 19:14:29Abhijit Rane Mumbai, Maharashtra 33763811Medical Scrutiny Done [IR Pending]13 Jul 2021 11:33:21Vijay ShelkarMumbai, Maharashtra 33763811Medical Scrutiny Done [IR Pending]13 Jul 2021 11:34:09Vijay ShelkarMumbai, Maharashtra 33763811IR Pending [IR Letter]13 Jul 2021 11:35:23Vijay ShelkarMumbai, Maharashtra 33763811Medical Scrutiny Done [For Processing]14 Jul 2021 18:28:53Vaibhav K KeniMumbai, Maharashtra 33763811Sent for Audit17 Jul 2021 11:49:17Kiran PoojariMumbai, Maharashtra 33763811Sent for Audit21 Jul 2021 16:49:17Karuna Vasant Vaitymumbai, Maharashtra 33763811Audit Complete21 Jul 2021 16:51:36Karuna Vasant Vaitymumbai, Maharashtra 33763811Voucher Prepared22 Jul 2021 10:23:19Thirupathi PamulaHyderabad, Telangana 33763811Claim Passed22 Jul 2021 10:28:50Thirupathi PamulaHyderabad, Telangana 33763811Settled27 Jul 2021 12:36:34Divakar PHyderabad, Andhra Pradesh No Consignment Details