UIIC6-Apr-15CASHLESS INTIMATIONSr. No.Claim No.Policy NOINSUREDNAMEMEMBERNAMESEXAGERELATIONSUM INSUREDPeriod of insurance - fromPeriod of insurance - toInsured addressInsured contact noHospital NameHospital Address & PhoneICD codeDiseaseCashless request received - DateCashless request received - TimeDate Of AdmissionApprove DateExpected discharge dateClaim AmountApproved AmountSTATUS120150405B006C2A062190101/47/14/09/00000005VIHAN NETWORKS LIMITEDSHANTA RAINAFEMALE78Mother011/3/1510/3/16MAX HOSPITALBLOCK-B,SUSHANT LOK ,PHASE- I, NEXT TO PARK PLAZA HOTEL,, , GURGAON, Ph: 0124-6623000C25Malignant neoplasm of pancreas5/4/1511:04:023/4/155/4/1512055050000Approved220150404B006C2A0561901012814P102313573MR. RAKESH TADIYAMRS. MANJU TADIYAFemale46Wife012/7/1411/7/15BHAGAT SINGH MARG POST & DISTT. ASHOK NAGAR ,BHOPAL0SNG HOSPITAL16/1, SOUTH TUKOGANJ, NEAR SAMAVSHARAN MANDIR, KANCHAN BAGH MAIN ROAD, , INDORE, Ph: 0731-2525555, 58,4219191K80Cholelithiasis4/4/1513:30:503/4/154/4/155240039425Approved320150404B006C2A0611901012814P104540427M/s VARDHMAN FABRICS BUDYHNIDEEPAK ARORAMale29Employee500001/9/1431/08/2015BUDHANI ,SEHORE0NARMADA APNA HOSPITALDOUBLE PATHAK, HARDA BYPASS ROAD, HOSHANGABAD, , HOSHANGABAD, Ph: 07574 - 405060N45Orchitis and epididymitis LT SIDE4/4/1517:36:113/4/154/4/15150008000Approved420150404B006C2A0521901012814P109636840Mr. ARVIND BARJATYAVEENA BARJATYAFemale62Wife22500011/2/1510/2/16139/98, SAKET NAGAR ,BHOPAL9993176939 09713600000NARMADA TRAUMA CENTER PVT.LTDE-3/23, ARERA COLONY,BHOPAL, , BHOPAL, Ph: 0755-4040000, 4040001, 4040002, 4040003N20.1Calculus of ureter4/4/1511:24:232/4/154/4/15595000Query520150404B006C2A0541901032814P102909665SHRI AVINASH VYASMASTER YASH VYASMale9SON-212500024/07/201423/07/2015E-8/24, BHARAT NAGAR, SHAHPURA, BHOPAL ,BHOPAL0000000000 0000000000HAJELA HOSPITALGEETANJALI COMPLEX, ,MAIN ROAD NO. 2,NEAR MATA MANDIR, T.T.NAGAR, , BHOPAL, Ph: 0755-230578/237578/2671188/ 2671959/2773392 - 93E10Insulin-dependent diabetes mellitus4/4/1511:29:483/4/154/4/152500010000Approved620150406B006C2A0711901032814P109027193HARENDER SINGH SODHIHARENDER SINGH SODHIMale44Self30000014/03/201513/03/201685 DANISH KUNJ-1, KOLAR ROAD ,BHOPAL08962435899 9826016861 0000000000R.K. HOSPITAL & RESEARCH CENTRE226 -C -SECTOR,INDRAPURI,RAISEN ROAD, NEAR ESIC HOSPITAL, , BHOPAL, Ph: 0755 - 2750754, 42606056/4/1510:53:048/4/15550000Pending720150404B006C2A0571901032814P110600191MR. BHAGWANDAS VALECHAMR. BHAGWANDAS VALECHAMale57Self30000031/03/201530/03/2016127,A NEW SINDHI COLONY BEHIND RED ROSE SCHOOL BERSIA ROAD ,BHOPAL0000000000 0000000000CHIRAYU HEALTH & MEDICARE(P) LTD6 MALIPURA, PEERGATE, , BHOPAL, Ph: 2531122, 2531133, 2531777C00CA BUCCAL MUCOSA4/4/1514:36:253/4/154/4/153500015000Approved820150404B006C2A058190403/48/14/06/00000205MR. JEET SINGH RAJPALMR. JEET SINGH RAJPALMale55Self20000024/06/201423/06/2015KASTURBA MARG PUNJABI MOHALLA SHUJALPUR MANDI DIST. SHAJAPUR ,SHAHJAPUR9826373265RAJSHREE HOSPITAL & RESEARCH CENTRE PVT. LTD.SCH. NO. 74-C, SECTOR-D, VIJAY NAGAR, INDORE, , INDORE, Ph: 9859907673I20.0Unstable angina4/4/1516:01:214/4/154/4/15200000Query920150404B006C2A059190804/48/14/41/00000066M/s S R F LIMITEDPALAKFemale10Daughter027/04/201426/04/2015MALANPUR ,BHIND0MAHESHWARI NURSING HOMELAXMI BAI COLONY, PADAV, GWALIOR, Ph: 0751-4012551/52N20.1Calculus of ureter RT.4/4/1516:14:594/4/154/4/1582000Rejected1020150405B006C2A065190804/48/14/41/00000066M/s S R F LIMITEDKEDAR LAL SHARMAMale47Employee10000027/04/201426/04/2015MALANPUR ,BHIND0BIMR HOSPITALS (RUN BY BIRLA NAGAR JANA SEVA TRUST)SURYA MANDIR ROAD, RESIDENCY, MORAR, , GWALIOR, Ph: 0751-2405702F55Abuse of non-dependence-producing substances OPIOID5/4/1514:53:445/4/155/4/15510000Rejected1120150406B006C2A070191100/48/14/06/00000160MR. KULDEEP B. SONIMR. KULDEEP B. SONIMale46Self2500007/5/146/5/15F-4, SIRT COLLEGE CAMPUS AYODHYA BY PASS ROAD ,BHOPAL0NARMADA TRAUMA CENTER PVT.LTDE-3/23, ARERA COLONY,BHOPAL, , BHOPAL, Ph: 0755-4040000, 4040001, 4040002, 4040003J09Influenza due to certain identified influenza virus6/4/1510:43:104/4/156/4/155400010000Approved1220150404B006C2A051191100/48/14/06/00000160MR. KULDEEP B. SONISMT. SUSHMA SONIFemale40Wife07/5/146/5/15F-4, SIRT COLLEGE CAMPUS AYODHYA BY PASS ROAD ,BHOPAL0NARMADA TRAUMA CENTER PVT.LTDE-3/23, ARERA COLONY,BHOPAL, , BHOPAL, Ph: 0755-4040000, 4040001, 4040002, 4040003J22LOWER RESPIRATORY TRACT INFECTION4/4/1511:18:423/4/154/4/157600010000Approved1320150405B006C2A0631911032814P108372059BASANT KUMAR PATELMRS. KAVITA PATELFemale36WIFE07/1/156/1/16S/O MR. KANHAIYA LAL PATEL H.NO-26/4, W.NO-02, PATEL MOHALLA DHANASARI , POST-PUNOUR PIPARIYA , NA ,HOSHANGABAD0NEW PANDEY HOSPITALEKTA CHOWK, SANICKASA, , HOSHANGABAD, Ph: 07574-252536A01.0Typhoid fever5/4/1511:35:274/4/155/4/15180008000ApprovedGENRAL INTIMATIONSr. No.Claim No.Policy NOINSUREDNAMEMEMBERNAMESEXAGERELATIONSUM INSUREDPeriod of insurance - fromPeriod of insurance - toInsured addressInsured contact noHospital NameHospital addressRemarksDiseaseDate Of AdmissionExpected discharge dateClaim Amount120150404B006R2A0501901012814P102313573MR. RAKESH TADIYAMRS. MANJU TADIYAFemale46Wife10000012/7/1411/7/15BHAGAT SINGH MARG POST & DISTT. ASHOK NAGAR ,BHOPAL0SNG HOSPITAL ~ INDORE16/1, SOUTH TUKOGANJ, NEAR SAMAVSHARAN MANDIR, KANCHAN BAGH MAIN ROAD ,INDORE3/4/151000220150406B006R2A0671901012814P104353497SMT. ANNIE MARY JOHNMASTER JOEL. K. JOHNMale20Son10000015/09/201414/09/2015MIG-28 SHIV KALP AYODHYA BY PASS PEOPLE HOSPITAL BHANPUR ,BHOPALPEOPLES GENERAL HOSPITAL BHOPAL ~ BHOPAL6 MALVIYA NAGAR ,BHOPAL1/4/151000320150404B006R2A053190300/48/14/41/00000672SMT. SUNITA JAINMR. VIPIN JAINMale47Husband15000020/05/201419/05/201580, IMLI BAZAR MANJU SHREE TENT HOUSE INDORE ,INDORE9926101490 07312432043 9926101490PRINCE ALY KHAN HOSPITAL,3/4/151000420150405B006R2A0661904002814P110411244SHRI UMESH KUMAR JAINSHRI UMESH KUMAR JAINMale56Self10000026/02/201525/02/201659/2,NAGNATH KI GALI BHAGSIPURA ,UJJAIN9425379373MEDICARE HOSPITAL & RESEARCH CENTRE (UNIT OF LAHOTI MEDICARE PVT LTD) ~ INDORE4/5, OLD PALASIA, RAVINDRA NAGAR ,INDOREDisease;- brain embrage estimate amount not conform5/4/151000520150404B006R2A0551904002814P110411244SHRI UMESH KUMAR JAINSHRI UMESH KUMAR JAINMale56Self10000026/02/201525/02/201659/2,NAGNATH KI GALI BHAGSIPURA ,UJJAIN9425379373CHL- MEDICAL CENTER (UNIT OF APOLLO HOSPITAL, INFORE ~ UJJAINNANAKHEDA, HARI PHATAK BYPASS (MAHAKAL ROAD) ,UJJAIN3/4/151000620150405B006R2A0641904022814P109549050SHRI PRAKASH CHANDRA SETHIASHRI PRAKASH CHANDRA SETHIAMale56Self15000024/02/201523/02/201643-B, DINDAYAL NAGAR, BEHIND MANOHAR GENERAL STORES, RATLAM DIST. : RATLAM, MADHYA PRADESH , NA ,RATLAM9827769429 9827769429CHL APOLO JAIN DIWAKAR HOSPITAL,ADDRESS - SAGOD ROAD RATLAM MADHYA PRADESH 230231 DISEASE - PAIN IN HOLE BODY4/4/151000720150404B006R2A048190403/48/14/06/00000205MR. JEET SINGH RAJPALMR. JEET SINGH RAJPALMale55Self20000024/06/201423/06/2015KASTURBA MARG PUNJABI MOHALLA SHUJALPUR MANDI DIST. SHAJAPUR ,SHAHJAPUR9826373265VISHESH HOSPITAL INDORE ~ INDOREA B ROAD NEAR GEETA BHAWAN CHOURAHA ,INDOREcontact no -07314238111, Disease - heart problem .4/4/151000820150404B006R2A049190403/48/14/06/00000205MR. JEET SINGH RAJPALMR. JEET SINGH RAJPALMale55Self20000024/06/201423/06/2015KASTURBA MARG PUNJABI MOHALLA SHUJALPUR MANDI DIST. SHAJAPUR ,SHAHJAPUR9826373265RAJSHRI APOLLO HOSPITAL,address - scheme no. 74 c sector D vijay nagar indore contact no - 07312445566, 2445544 Disease - heart problem .4/4/151000920150406B006R2A069190900/48/14/97/00000018MR. GYAN SWAROOP NIGAMMR. GYAN SWAROOP NIGAMMale61SELF1000008/4/147/4/15ATUL VIHAR FLAT NO C-2,FIRST FLOOR,WRIGHT TOWN ,JABALPURASHISH HOAPITAL ~ JABALPURHOME SCIENCE COLLEGE ROAD NRPIER TOWN ,JABALPUR5/4/1510001020150406B006R2A068190900/48/14/97/00000133SHRI MUKESH SINGH PATELSHRI MUKESH SINGH PATELMale53SELF15000030/04/201429/04/2015723 PATEL MARG HATHITAL COLONY JABALPUR ,JABALPURSARVODAY HOSPITAL & RESEARCH CENTRE ~ JABALPUR864 NAPIER TOWN ,JABALPUR2/4/151000