Before forwarding to MOH PBF business unit, approved by: District PBF Steering Committee: name, position: Annex 19. MONTHLY PBF INVOICE FOR DISTRICT/LOCAL HOSPITALS Provisory Monthly Invoice for Hospital Services (secondary care only) District: Month: Hospital: Year: Quantity Quantity Quantity Quantity for Unit Fee PBF benefits Service reported verified reported/ PBF earned in LSL verified payment (95 in % 105%) – correct reporting (= Q verified) 1 Number of referred indigent patients from Health
Before forwarding to MOH PBF business unit, approved by: District PBF Steering Committee: name, position: Annex 19. MONTHLY PBF INVOICE FOR DISTRICT/LOCAL HOSPITALS Provisory Monthly Invoice for Hospital Services (secondary care only) District: Month: Hospital: Year: Service Quantity reported Quantity verified Quantity reported/ verified in % Quantity for PBF payment (95 – 105%) correct reporting (= Q verified) Unit Fee PBF benefits earned in LSL 1 Number of referred indigent patients from Health