Unimed de São Luís extrato de utilização por contrato

ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 1
Unimed de So Lus Cooperativa de Trabalho Mdico

Extrato de Utilizao por Contrato (Referncia: 201112) (Referncia: 201112)
Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Cod. Contrato / Prestador Prest.Trnsito Data
Atendimento/Lote/Nota
Justica Federal De Primeiro Grau No
468
0468000002003
Adriana De Jesus Pinho Costa
0468000002003
Adriana De Jesus Pinho Costa
3485
/ Deyse Maria Rodrigues Soares
13/12/2011
7677133 / 99999 / 10250572
Procedimento/Cd.Intercmbio/Participao
10101012 Em consultrio (no horrio normal ou
/10101012
Obs.
Qtd/Partic
1/0
83,07
83,07
Total:
0468000003000
0468000003000
Vl.Cob
Adriana Sousa Lima

Adriana Sousa Lima
310000145
/ Laboratorio Gaspar Ltda
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40306674 Citomegalovrus IgM
/40306674
1/0
29,50
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40307026 Hepatite C - anti-HCV
/40307026
1/0
33,72
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40311210 Rotina de urina (caracteres fsicos,
/40311210
1/0
11,20
210000879
/ Ultrimagem - Serv. De Diag. Por
30/11/2011
40901297 Obsttrica 1 trimestre (endovaginal)
/40901297
1/0
147,34
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40316114 Antigeno Australia (HBSAG)
/40316114
1/0
35,29
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40304361 Hemograma com contagem de plaquetas /40304361
1/0
11,78
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40307760 Sfilis - VDRL
/40307760
1/0
9,99
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40307832 Toxoplasmose IgM
/40307832
1/0
29,50
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40316408 Progesterona
/40316408
1/0
31,43
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40302040 Glicose
/40302040
1/0
5,28
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40307182 HIV1+ HIV2, (determinao conjunta),
/40307182
1/0
45,07
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40306666 Citomegalovrus IgG
/40306666
1/0
24,29
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40307824 Toxoplasmose IgG
/40307824
1/0
24,29
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
40301150 cido rico
/40301150
1/0
5,28
210000879
30/11/2011
1 FILME
0,34 / 0
7,72
310000145
29/11/2011 08:34:00 7613503 / 99999 / 30484419
2 UCO
/90000021
21,856 / 0
0,00
210000879
30/11/2011
2 UCO
/90000021
3,82 / 0
0,00
7605057 / 99999 / 30485952
7605057 / 99999 / 30485952
7605057 / 99999 / 30485952
Total:
0468000008001
0468000008001
Aluizio De Paula Carvalho

Aluizio De Paula Carvalho
451,68
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 2

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
11001700
/ Mauro Jose Melo Fonseca
21/12/2011
110000443
/ Centro Diag E Trat Cardiologico
21/12/2011 14:52:00 7637816 / 99999 / 30516755
110000443
21/12/2011 14:52:00 7637816 / 99999 / 30516755
0468000008010
7672188 / 99999 / 10256793
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
40101010 ECG convencional de at 12 derivaes /40101010
1/0
15,35
/90000021
0,75 / 0
2 UCO
0,00
Clelia Valporto Carvalho
2603
/ Ibraim Almeida Filho
13/12/2011
7654853 / 99999 / 10251322
/10101012
1/0
83,07
3197
/ Raquel Moraes Da Rocha
05/12/2011
7665192 / 99999 / 10246002
/10101012
1/0
83,07
264,56
Total:
0468000010006
0468000010510
Ametista Alves Brandao

Ametista Alves Brandao
310000242
/ Inlab - Investigacao Laboratorial
19/12/2011 10:00:00 7615177 / 99999 / 30512193
40302040 Glicose
/40302040
2/0
10,55
310000242
19/12/2011 10:00:00 7615177 / 99999 / 30512193
40302512 Transaminase pirvica (amino
/40302512
1/0
9,76
310000242
19/12/2011 10:00:00 7615177 / 99999 / 30512193
40302733 Hemoglobina glicada (Frao A1c)
/40302733
1/0
44,71
310000242
19/12/2011 10:00:00 7615177 / 99999 / 30512193
40302750 Perfil lipdico / lipidograma (lpidios
/40302750
1/0
22,46
310000242
19/12/2011 10:00:00 7615177 / 99999 / 30512193
/90000021
4,761 / 0
2 UCO
87,48
Total:
0468000011002
0468000011002
5064
Ana Cristina Mariz Montenegro

Ana Cristina Mariz Montenegro
/ Eduardo Henrique Jorge Lago
01/12/2011
7665521 / 99999 / 10243777
/10101012
1/0
Total:
0468000013005
0468000013099
0,00
83,07
83,07
Ana Maria Turolia Da Silva Estrela

Marco Aurelio Lobato Estrela
310000110
/ Lab.De Investigacao
25/11/2011
7624541 / 99999 / 30477339
/40302512
1/0
9,76
310000110
25/11/2011
7624541 / 99999 / 30477339
40301281 Amilase
/40301281
1/0
9,76
310000110
25/11/2011
7624541 / 99999 / 30477339
40302199 Lipase
/40302199
1/0
9,76
310000110
25/11/2011
7624541 / 99999 / 30477339
1/0
11,78
310000110
25/11/2011
7624542 / 99999 / 30477348
40308383 Proteina C reativa, qualitativa
/40308383
1/0
15,82
310000110
25/11/2011
7624541 / 99999 / 30477339
40302504 Transaminase oxalactica (amino
/40302504
1/0
9,76
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 3

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
310000110
25/11/2011
7624542 / 99999 / 30477348
310000110
25/11/2011
7624542 / 99999 / 30477348
310000110
25/11/2011
7624541 / 99999 / 30477339
0468000013102
40304370 Hemossedimentao, (VHS)
Obs.
Qtd/Partic
1/0
5,28
2 UCO
/90000021
1,557 / 0
0,00
2 UCO
/90000021
3,75 / 0
0,00
06/12/2011
7675167 / 99999 / 10246789
/10101012
1/0
Ana Paula Costa Salgado

Ana Paula Costa Salgado
1341576
/ Jose De Ribamar Pinho Franca
29/11/2011
310000145
29/11/2011 11:31:00 7613505 / 99999 / 30484742
310000145
29/11/2011 11:31:00 7613505 / 99999 / 30484742
0468000015105
1360554
7666708 / 99999 / 10241928
/10101012
1/0
83,07
40310060 Bacterioscopia (Gram, Ziehl, Albert etc), /40310060
1/0
9,63
/90000021
0,693 / 0
0,00
/10101012
1/0
2 UCO
Marco Tulio Costa Salgado
/ Christiane Gomes De Azevedo
07/12/2011
7666873 / 99999 / 10247962
83,07
175,77
Total:
0468000016004
0468000016004
83,07
154,99
Total:
0468000014001
0468000014001
Vl.Cob
/40304370
Victor Turolia Silva Estrela
/ Tiago Barbosa De Carvalho
4994
Ana Raquel De Sousa Ribeiro

Ana Raquel De Sousa Ribeiro
310000242
14/12/2011 10:00:00 7615168 / 99999 / 30506312
40316530 Tireoglobulina
/40316530
1/0
52,78
310000242
14/12/2011 10:00:00 7615168 / 99999 / 30506312
40301150 cido rico
/40301150
1/0
5,28
310000242
14/12/2011 10:00:00 7615168 / 99999 / 30506312
40316521 Tireoestimulante, hormonio (TSH)
/40316521
1/0
27,52
310000242
14/12/2011 10:00:00 7615168 / 99999 / 30506312
40302040 Glicose
/40302040
1/0
5,28
310000242
14/12/2011 10:00:00 7615168 / 99999 / 30506312
40316491 T4 livre
/40316491
1/0
34,39
310000242
14/12/2011 10:00:00 7615168 / 99999 / 30506312
1/0
11,78
310000242
14/12/2011 10:00:00 7615168 / 99999 / 30506312
40301630 Creatinina
/40301630
1/0
5,28
310000242
14/12/2011 10:00:00 7615168 / 99999 / 30506312
40316106 Anticorpos antitireoide (tireoglobulina)
/40316106
1/0
52,78
310000242
14/12/2011 10:00:00 7615168 / 99999 / 30506312
/40302750
1/0
22,46
310000242
14/12/2011 10:00:00 7615168 / 99999 / 30506312
/90000021
14,421 / 0
2 UCO
Total:
0,00
217,55
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 4

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468000019003
Angela Karina De Carvalho Via
0468000019097
Leonardo Henrique Ferreira
1400963
/ Doris Maria Da Costa Rocha
05/12/2011
1400963
/ Doris Maria Da Costa Rocha
05/12/2011 10:13:00 7670033 / 99999 / 30493085
0468000019119
7677378 / 99999 / 10245660
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
40201023 Anuscopia (interna e externa)
/40201023
1/0
23,03
Daniel Viana Ferreira
210020543
/ Unid.De Pediatria E Cirurgia Ltd
13/12/2011 13:21:00 7627935 / 99999 / 576244
90001591 Pct de Urgncia (UPC)
/10101039
1/0
40,95
310000030
/ Laboratorio Cedro Ltda
15/12/2011
7616093 / 99999 / 30507232
1/0
11,78
310000030
15/12/2011
7616093 / 99999 / 30507232
40308391 Proteina C reativa, quantitativa
/40308391
1/0
36,82
210020560
/ S.O.S Infantil Ltda
13/12/2011 13:59:00 7635497 / 99999 / 30505096
10101039 Em pronto socorro
/10101039
1/0
52,65
310000030
15/12/2011
/90000021
0,87 / 0
7616093 / 99999 / 30507232
2 UCO
248,30
Total:
0468000021008
0468000021008
0,00
Antomar Barbosa
Antomar Barbosa
3369
/ Aeriberto Carlos Lindoso De
26/11/2011 08:30:00 7661638 / 99999 / 30452476
20102011 Holter de 24 horas - 2 ou mais canais -
/20102011
1/0
30,70
3369
26/11/2011 08:30:00 7661638 / 99999 / 30452476
40101029 ECG de alta resoluo
/40101029
1/0
15,35
25204
/ Bruno Neves Ramos
17/11/2011 14:20:00 7632942 / 99999 / 657071
40701131 Cintilografia do miocrdio perfuso -
/40701131
/Clinico
1/1
0,00
25204
/ Bruno Neves Ramos
16/11/2011 14:20:00 7632942 / 99999 / 657071
40701069 Cintilografia do miocrdio perfuso -
/40701069
/Clinico
1/1
0,00
210002332
/ Nuclear Medical Image Ltda
16/11/2011 14:20:00 7632942 / 99999 / 657071
2 UCO
/90000021
38,852 / 0
0,00
3369
26/11/2011 08:30:00 7661638 / 99999 / 30452476
2 UCO
/90000021
9,94 / 0
0,00
210002332
16/11/2011 14:20:00 7632942 / 99999 / 657071
1 FILME
1,14 / 0
25,88
210002332
16/11/2011 14:20:00 7632942 / 99999 / 657071
0 Materiais em Geral
/90000021
1/0
11,38
210002332
16/11/2011 14:20:00 7632942 / 99999 / 657071
0 Medicamentos em Geral
/90000013
1/0
560,34
643,65
Total:
0468000022004
0468000022004
Antonia Percilio Costa

Antonia Percilio Costa
11002006
/ Fabio Lucio Campos Dos Santos
14/12/2011
7671954 / 99999 / 10251972
/10101012
1/0
83,07
11001883
/ Tarcisio Mota Coelho
30/11/2011
7656253 / 99999 / 10243087
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 5

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
17449
/ Elcio Francisco Cossetti
25/11/2011
11001883
30/11/2011 18:27:00 7656197 / 99999 / 30486759
11001883
30/11/2011 18:27:00 7656197 / 99999 / 30486759
0468000022519
7656120 / 99999 / 10239928
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
41301102 Colposcopia (crvice uterina e vagina)
/41301102
/Clinico
1/1
0,00
/90000021
2,78 / 0
0,00
2 UCO
Catarina Matilde P Costa
17449
25/11/2011
7656167 / 99999 / 117292
/10101012
1/0
83,07
11002146
/ Geraulina Mendonca Castro
15/12/2011
7660436 / 99999 / 10252519
/10101012
1/0
83,07
11002030
/ Simone De Souza Santos
01/12/2011
7671482 / 99999 / 192790
/10101012
1/0
83,07
2013
/ Jos Nicodemo Barbosa
07/12/2011
7640010 / 99999 / 10247850
/10101012
1/0
83,07
11002006
/ Fabio Lucio Campos Dos Santos
14/12/2011
7671951 / 99999 / 10251431
/10101012
1/0
83,07
310000145
10/12/2011 06:54:00 7622513 / 99999 / 30500988
40301630 Creatinina
/40301630
1/0
5,28
310000145
10/12/2011 06:54:00 7622513 / 99999 / 30500988
40302580 Uria
/40302580
1/0
5,28
310000145
10/12/2011 06:54:00 7622513 / 99999 / 30500988
40302318 Potssio
/40302318
1/0
5,28
310000145
10/12/2011 06:54:00 7622513 / 99999 / 30500988
/40308391
1/0
36,82
310000145
10/12/2011 06:54:00 7622513 / 99999 / 30500988
40302423 Sdio
/40302423
1/0
5,28
310000145
10/12/2011 06:54:00 7622513 / 99999 / 30500988
40302040 Glicose
/40302040
1/0
5,28
310000145
10/12/2011 06:54:00 7622513 / 99999 / 30500988
40301150 cido rico
/40301150
1/0
5,28
11002030
06/12/2011 08:52:00 7671133 / 99999 / 665739
20104065 Cerumen - remoo (bilateral)
/20104065
1/0
17,06
110000079
/ Udi- Cardio /Unid Diag. Trat.
07/12/2011 10:35:00 7636533 / 99999 / 30497384
1/0
25,45
310000145
10/12/2011 06:54:00 7622513 / 99999 / 30500988
1/0
11,78
310000145
10/12/2011 06:54:00 7622513 / 99999 / 30500988
/40302750
1/0
22,46
310000145
10/12/2011 06:54:00 7622513 / 99999 / 30500988
2 UCO
/90000021
3,192 / 0
0,00
110000079
07/12/2011 10:35:00 7636533 / 99999 / 30497384
2 UCO
/90000021
0,75 / 0
0,00
Total:
0468000023000
0468000023108
Antonio De Padua Araujo De Menezes

Ana Mary Gomes Lima De Menezes
809,81
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 6

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
89000099
/ Unimed Teresina
99
0468000023302
89000099
7250
13/10/2011
7650883 / 223086 / 2234941
Obs.
Qtd/Partic
/10101012
Lote: 223086 Nota: 324
1/0
58,97
20102070 Tilt teste
/20102070
Lote: 223086 Nota: 324
1/0
167,17
Ana Caroline Gomes Lima De Menezes
/ Unimed Teresina
99
21000037 29/09/2011 08:00:00 7650884 / 223086 / 3385299
226,14
Total:
0468000025003
0468000025003
Antonio Eduardo P Silva

Antonio Eduardo P Silva
37504
/ Joangela Pereira Costa
07/12/2011
37504
/ Joangela Pereira Costa
210000828
210000828
/10101012
1/0
83,07
07/12/2011 15:21:00 7626865 / 99999 / 30497912
41301323 Tonometria - binocular
/41301323
/Clinico
1/1
22,08
/ Pro-Visao S/C
07/12/2011 15:21:00 7626865 / 99999 / 30497912
41301250 Mapeamento de retina (oftalmoscopia
/41301250
2/0
69,22
/ Pro-Visao S/C
07/12/2011 15:21:00 7626865 / 99999 / 30497912
/90000021
1,08 / 0
/10101012
1/0
0468000025100
7672524 / 99999 / 10248095
2 UCO
01/12/2011
7665937 / 99999 / 10244016
83,07
257,44
Total:
0468000026000
0468000026000
0,00
Izabel Bezerra dos Santos
/ Helio Stenio Neves Noleto
4712
Vl.Cob
Antonio J S da Silva
Antonio J S da Silva
11001107
/ Maria Do Rosario Lima Lobao
25/11/2011
7640120 / 99999 / 10240113
/10101012
1/0
83,07
1160970
/ Doroty Antonia Lopes Trinta
20/12/2011
7656585 / 99999 / 148342
/10101012
1/0
83,07
110000079
25/11/2011 10:48:00 7632806 / 99999 / 30479415
1/0
25,45
110000079
25/11/2011 10:48:00 7632806 / 99999 / 30479415
/90000021
0,75 / 0
0468000026107
2 UCO
0,00
Mariana de F A da Silva
11001620
/ Maria Da Conceicao M De
12/12/2011
7642907 / 99999 / 145325
/10101012
1/0
83,07
17848
/ Silvana Silva Sombra
30/11/2011
7672823 / 99999 / 10242681
/10101012
1/0
83,07
5064
30/11/2011
7665508 / 99999 / 10243437
/10101012
1/0
83,07
310000030
15/12/2011
7616120 / 99999 / 30505651
40601110 "Procedimento diagnstico em bipsia
/40601110
1/0
58,42
5064
13/12/2011 16:38:00 7660789 / 99999 / 30505545
30210127 Exrese de tumor benigno, cisto ou
/30210127
1/0
106,59
5064
07/12/2011 16:40:00 7660768 / 99999 / 30496319
30101298 Eletrocoagulao de leses de pele e
/30101298
1/0
53,29
5064
07/12/2011 16:40:00 7660768 / 99999 / 30496319
/80051510
1/0
45,45
TU37 BISTURI ELTRICO
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 7

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
5064
13/12/2011 16:38:00 7660789 / 99999 / 30505545
5064
13/12/2011 16:38:00 7660789 / 99999 / 30505545
310000030
15/12/2011
5064
5064
5064
Obs.
Qtd/Partic
Vl.Cob
/80051510
1/0
45,45
/90000021
1/0
32,74
2 UCO
/90000021
2,06 / 0
0,00
07/12/2011 16:40:00 7660768 / 99999 / 30496319
/90000021
1/0
5,70
13/12/2011 16:38:00 7660789 / 99999 / 30505545
/90000013
1/0
6,75
07/12/2011 16:40:00 7660768 / 99999 / 30496319
/90000013
1/0
6,75
7616120 / 99999 / 30505651
Total:
0468000028002
0468000028320
801,94
Antonio Jose de Souza

Marina Maffessoni Araujo De Souza
310000242
02/12/2011 10:00:00 7601882 / 99999 / 30489619
40302628 Xilose, teste de absoro
/40302628
1/0
28,97
310000242
02/12/2011 10:00:00 7601882 / 99999 / 30489619
40301400 Clcio
/40301400
1/0
5,28
310000242
02/12/2011 10:00:00 7601882 / 99999 / 30489619
40303110 Parasitolgico
/40303110
1/0
12,78
310000242
02/12/2011 10:00:00 7601882 / 99999 / 30489619
40305015 1,25-dihidroxi vitamina D
/40305015
1/0
72,47
310000242
02/12/2011 10:00:00 7601882 / 99999 / 30489619
40303039 Coprolgico funcional (caracteres, pH,
/40303039
1/0
21,61
310000242
02/12/2011 10:00:00 7601882 / 99999 / 30489619
1/0
11,78
310000242
02/12/2011 10:00:00 7601882 / 99999 / 30489619
40303055 Gordura fecal, dosagem
/40303055
1/0
37,00
310000242
02/12/2011 10:00:00 7601882 / 99999 / 30489619
40306259 Anticorpos antiendomisio - IgG, IgM, IgA /40306259
1/0
45,07
310000242
02/12/2011 10:00:00 7601882 / 99999 / 30489619
40301931 Fsforo
/40301931
1/0
5,28
310000242
02/12/2011 10:00:00 7601882 / 99999 / 30489619
40316270 Ferritina
/40316270
1/0
27,61
310000242
07/11/2011 12:00:00 7677788 / 223200 / 691203
/90000021
1/0
56,04
310000242
02/12/2011 10:00:00 7601882 / 99999 / 30489619
2 UCO
/90000021
19,65 / 0
/80000037
Lote: 223500 Nota: 325
36 / 0
0468000028517
0,00
Aurelia M de Souza
89000080
/ Unimed Vitoria Coop De
80
600093
16/09/2011
7653526 / 223500 / 985243
80000037 Taxa Genrica (*)
89000080
80
600093
16/09/2011
7653526 / 223500 / 985243
52299 SONDA URETRAL NR 12
/77826906
Lote: 223500 Nota: 325
200 / 0
89000080
80
600093
16/09/2011
7653526 / 223500 / 985243
47735 SERINGA DESC 20ML C/BICO SLIP SS /70801401
Lote: 223500 Nota: 325
8/0
1.097,65
140,40
7,39
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 8

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000080
80
600093
16/09/2011
7653526 / 223500 / 985243
21829 FRASCO P/NUTRICAO ENTERAL 300ML/70338310
Lote: 223500 Nota: 325
20 / 0
20,59
89000080
80
600093
16/09/2011
7653526 / 223500 / 985243
53243 EQUIPO P/NUTRICAO ENTERAL
/79923593
Lote: 223500 Nota: 325
21 / 0
140,29
89000080
80
600093
16/09/2011
7653526 / 223500 / 985243
/90000021
Lote: 223500 Nota: 325
10 / 0
96,17
1.826,38
Total:
0468000031003
0468000031003
Aristoteles Santos Filho

Aristoteles Santos Filho
110000052
/ Hospital So Domingos Ltda
29/11/2011 21:45:00 7604779 / 99999 / 30485465
40804011 Bacia
/40804011
1/0
15,35
110000052
29/11/2011 21:45:00 7604779 / 99999 / 30485465
40804054 Joelho
/40804054
1/0
15,35
110000052
29/11/2011 21:45:00 7604779 / 99999 / 30485465
40803090 Cotovelo
/40803090
2/0
30,70
110000052
29/11/2011 21:45:00 7604779 / 99999 / 30485465
40805018 Trax - 1 incidncia
/40805018
1/0
15,35
110000052
29/11/2011 21:45:00 7604779 / 99999 / 30485465
40802019 Coluna cervical - 3 incidncias
/40802019
1/0
15,35
110000052
07/12/2011 23:47:21 7622705 / 99999 / 30498564
90000790 Pct - URGNCIA E EMERGNCIA -
/10101039
1/0
94,77
110000052
29/11/2011 21:32:41 7603456 / 99999 / 30485446
/10101039
1/0
94,77
110000052
29/11/2011 21:45:00 7604779 / 99999 / 30485465
40803104 Antebrao
/40803104
2/0
30,70
110000052
29/11/2011 23:16:00 7636763 / 99999 / 30485510
/10101039
1/0
94,77
110000052
29/11/2011 21:45:00 7604779 / 99999 / 30485465
2 UCO
/90000021
9,46 / 0
110000052
29/11/2011 21:45:00 7604779 / 99999 / 30485465
1 FILME
1,0424 / 0
23,66
430,77
Total:
0468000032000
0468000032000
0,00
Arthur Ramos Braganca

Arthur Ramos Braganca
11001360
/ Heloiza Helena De Souza Aragao
06/12/2011
310000242
310000242
7667405 / 99999 / 10246811
/10101012
1/0
83,07
02/12/2011 10:00:00 7608122 / 99999 / 30490242
1/0
11,78
02/12/2011 10:00:00 7608122 / 99999 / 30490242
40304590 Tempo de protrombina
/40304590
1/0
7,70
310000242
02/12/2011 10:00:00 7608122 / 99999 / 30490242
/40302504
1/0
9,76
310000242
02/12/2011 10:00:00 7608122 / 99999 / 30490242
/40302512
1/0
9,76
310000242
02/12/2011 10:00:00 7608122 / 99999 / 30490242
40301990 Gama-glutamil transferase
/40301990
1/0
9,76
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 9

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000242
02/12/2011 10:00:00 7608122 / 99999 / 30490242
/40307760
1/0
9,99
310000242
02/12/2011 10:00:00 7608122 / 99999 / 30490242
40302040 Glicose
/40302040
1/0
5,28
310000242
02/12/2011 10:00:00 7608122 / 99999 / 30490242
/40304370
1/0
5,28
310000242
02/12/2011 10:00:00 7608122 / 99999 / 30490242
/40302750
1/0
22,46
310000242
02/12/2011 10:00:00 7608122 / 99999 / 30490242
/90000021
5,091 / 0
2 UCO
174,84
Total:
0468000034002
0468000034010
Bento Ives B O Gomes

Rosanna M Costa Bezerra
110000079
30/11/2011 09:28:00 7636198 / 99999 / 30486022
110000079
30/11/2011 09:28:00 7636198 / 99999 / 30486022
110000079
30/11/2011 09:28:00 7636198 / 99999 / 30486022
40901360 Doppler colorido de vasos cervicais
/40901360
1/0
2 UCO
/90000021
8,26 / 0
0,00
1 FILME
0,68 / 0
15,43
Bernardo Wanghon M Junior

Laiza Maria F B Maia
1360490
/ Jose Osvalneide Pereira Costa
25/11/2011
1100153
/ Fernando Jose Silva Freire
15/12/2011 12:00:00 7677907 / 223240 / 15759
7659921 / 99999 / 10240066
/10101012
1/0
83,07
/10101012
1/0
83,07
166,14
Total:
0468000036005
0468000036315
14465
Blandina Lago Goncalves

Ludmila de Jesus G Costa
/ Nisete Trajano Borges E Jorge
02/12/2011
7658473 / 99999 / 10244731
/10101012
1/0
3921
Braitner Izaias Cunha Do Nascimento

Braitner Izaias Cunha Do Nascimento
/ Carlos Adriano Pacheco De
19/12/2011
7676610 / 99999 / 10254826
/10101012
1/0
11000518
83,07
83,07
Total:
0468000040002
0468000040002
83,07
83,07
Total:
0468000037001
0468000037001
226,27
241,70
Total:
0468000035009
0468000035017
0,00
Carlos Alberto De Araujo Costa

Carlos Alberto De Araujo Costa
/ Erivaldo Sousa Dos Santos
28/11/2011
7672341 / 99999 / 10241509
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 10

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Total:
0468000041009
0468000041106
Vl.Cob
83,07
Carlos Frederico De Castro Santos

Carlos Gabriel Trindade Santos
310000030
25/11/2011
7609855 / 99999 / 30477424
/40308391
1/0
36,82
310000030
25/11/2011
7609855 / 99999 / 30477424
1/0
11,78
310000030
25/11/2011
7609855 / 99999 / 30477424
0,87 / 0
2 UCO
/90000021
48,60
Total:
0468000042005
0468000042315
0,00
Carlos Magno Martins Santos

Ana Carina Camara Martins Santos
1937
/ Jose Wanderley Vasconcelos
06/12/2011
210020314
/ S.O.S Trauma Ltda
210020314
7668135 / 99999 / 10246744
/10101012
1/0
83,07
06/12/2011 10:04:00 7643213 / 99999 / 30495472
40803104 Antebrao
/40803104
1/0
15,35
/ S.O.S Trauma Ltda
13/12/2011 08:45:00 7643249 / 99999 / 30504423
40803104 Antebrao
/40803104
1/0
15,35
310000030
07/12/2011
40302040 Glicose
/40302040
1/0
5,28
210020314
/ S.O.S Trauma Ltda
13/12/2011 08:45:00 7643249 / 99999 / 30504423
40803082 Brao
/40803082
1/0
15,35
210020314
/ S.O.S Trauma Ltda
06/12/2011 10:04:00 7643213 / 99999 / 30495472
40803112 Punho
/40803112
1/0
15,35
210020314
/ S.O.S Trauma Ltda
06/12/2011 10:04:00 7643213 / 99999 / 30495472
40803090 Cotovelo
/40803090
1/0
15,35
210020314
/ S.O.S Trauma Ltda
06/12/2011 10:04:00 7643213 / 99999 / 30495472
40803082 Brao
/40803082
1/0
15,35
310000030
07/12/2011
1/0
11,78
210020314
/ S.O.S Trauma Ltda
13/12/2011 08:45:00 7643249 / 99999 / 30504423
40803090 Cotovelo
/40803090
1/0
15,35
210020314
/ S.O.S Trauma Ltda
19/12/2011 15:18:00 7643297 / 99999 / 30513506
40803090 Cotovelo
/40803090
1/0
15,35
1937
13/12/2011 08:45:00 7640712 / 99999 / 30504434
30712017 xilo-palmar ou pendente
/30712017
/Cirurgiao
1/1
14,98
1937
06/12/2011 10:04:00 7640697 / 99999 / 30495754
30712017 xilo-palmar ou pendente
/30712017
/Cirurgiao
1/1
14,98
310000030
07/12/2011
40304922 Coagulograma (TS, TC, prova do lao,
/40304922
1/0
33,50
210020314
/ S.O.S Trauma Ltda
13/12/2011 08:45:00 7640712 / 99999 / 30504434
TO31 TAXA AMBULATORIAL
/80031005
1/0
10,64
210020314
/ S.O.S Trauma Ltda
06/12/2011 10:04:00 7640697 / 99999 / 30495754
/80031005
1/0
10,64
210020314
/ S.O.S Trauma Ltda
06/12/2011 10:04:00 7643213 / 99999 / 30495472
/90000021
4,97 / 0
7617326 / 99999 / 30497074
7617326 / 99999 / 30497074
7617326 / 99999 / 30497074
2 UCO
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 11

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
210020314
/ S.O.S Trauma Ltda
19/12/2011 15:18:00 7643297 / 99999 / 30513506
2 UCO
/90000021
1,22 / 0
0,00
210020314
/ S.O.S Trauma Ltda
13/12/2011 08:45:00 7643249 / 99999 / 30504423
2 UCO
/90000021
3,75 / 0
0,00
210020314
/ S.O.S Trauma Ltda
06/12/2011 10:04:00 7640697 / 99999 / 30495754
/90000021
1/0
32,53
210020314
/ S.O.S Trauma Ltda
06/12/2011 10:04:00 7643213 / 99999 / 30495472
1 FILME
0,5472 / 0
12,42
210020314
/ S.O.S Trauma Ltda
19/12/2011 15:18:00 7643297 / 99999 / 30513506
1 FILME
0,0864 / 0
1,96
210020314
/ S.O.S Trauma Ltda
13/12/2011 08:45:00 7643249 / 99999 / 30504423
1 FILME
0,3744 / 0
8,50
210020314
/ S.O.S Trauma Ltda
13/12/2011 08:45:00 7640712 / 99999 / 30504434
/90000021
1/0
310000030
07/12/2011
2 UCO
/90000021
3,741 / 0
7617326 / 99999 / 30497074
0,00
395,61
Total:
0468000043001
0468000043001
32,53
Catia A A Rocha
Catia A A Rocha
110000079
09/11/2011 07:48:00 7636119 / 99999 / 30452701
40901114 Mamas
/40901114
1/0
86,31
110000079
08/11/2011 10:24:00 7635094 / 99999 / 30452697
40808033 MAMOGRAFIA
/40808033
1/0
85,11
110000079
09/11/2011 07:48:00 7636119 / 99999 / 30452701
1 FILME
0,34 / 0
7,72
110000079
09/11/2011 07:48:00 7636119 / 99999 / 30452701
2 UCO
/90000021
3,42 / 0
0,00
110000079
08/11/2011 10:24:00 7635094 / 99999 / 30452697
2 UCO
/90000021
2,76 / 0
0,00
110000079
08/11/2011 10:24:00 7635094 / 99999 / 30452697
1 FILME
1,2 / 0
27,24
0468000043109
Gustavo A Rocha
310000242
06/12/2011 10:00:00 7610595 / 99999 / 648575
1/0
11,78
310000242
06/12/2011 10:00:00 7610595 / 99999 / 648575
40302040 Glicose
/40302040
1/0
5,28
310000242
06/12/2011 10:00:00 7610595 / 99999 / 648575
/40316521
1/0
27,52
310000242
06/12/2011 10:00:00 7610595 / 99999 / 648575
40316203 Crescimento, hormonio do (HGH)
/40316203
1/0
31,43
310000242
06/12/2011 10:00:00 7610595 / 99999 / 648575
/40302750
1/0
22,46
310000242
06/12/2011 10:00:00 7610595 / 99999 / 648575
/90000021
5,627 / 0
2 UCO
Total:
0468000046000
Cesario Lopes Moreira
0,00
304,85
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 12

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468000046019
Joseneide Lopes M Moreira
Obs.
Qtd/Partic
Vl.Cob
310000145
29/11/2011 06:39:00 7622146 / 99999 / 30484332
1/0
11,78
310000145
13/12/2011 06:51:00 7618890 / 99999 / 30505051
1/0
11,78
110000052
18/11/2011 19:00:00 7619695 / 99999 / 3458645
20104308 Terapia oncolgica - por dia
/20104308
1/0
23,03
110000052
16/11/2011 19:08:00 7619694 / 99999 / 30458645
20104294 Terapia oncolgica - planejamento e 1
/20104294
1/0
115,13
21002622
/ Anestlife-Servicos Medicos S/C
09/11/2011 14:07:00 7646594 / 99999 / 417462
40813231 Colocao de cateter venoso central ou /40813231
/Anestesis
1/1
151,22
4832
/ Rodolfo Marques Mansano
09/11/2011 14:07:00 7646594 / 99999 / 417462
40813231 Colocao de cateter venoso central ou /40813231
/Cirurgiao
1/1
115,13
110000052
16/11/2011 19:08:00 7619694 / 99999 / 30458645
TE33 QUIMIOTERAPIA
/80031706
1/0
45,03
110000052
09/11/2011 14:07:00 7646594 / 99999 / 417462
T129 RX COM INTENSIF IMAGEM
/80053122
1/0
303,24
110000052
09/11/2011 14:07:00 7646594 / 99999 / 417462
G751 OXIGNIO EM CATETER (HORA
/80061400
1/0
12,26
110000052
02/12/2011 13:24:00 7677961 / 223267 / 304829051
TO35 TAXA DE OBSERVAO 1
/80031501
1/0
39,42
110000052
09/11/2011 14:07:00 7646594 / 99999 / 417462
TC12 PORTE II
/80021026
1/0
205,49
110000052
30/11/2011 13:38:00 7677960 / 223267 / 30482905
TE33 QUIMIOTERAPIA
/80031706
1/0
45,03
110000052
09/11/2011 14:07:00 7646594 / 99999 / 417462
T164 TAXA - OPMS
/80990029
1/0
0,00
110000052
30/11/2011 13:38:00 7677960 / 223267 / 30482905
TU41 BOMBA INFUSO (FORA DA UTI)
/80051537
1/0
36,39
110000052
16/11/2011 19:08:00 7619694 / 99999 / 30458645
TU41 BOMBA INFUSO (FORA DA UTI)
/80051537
1/0
36,39
110000052
18/11/2011 19:00:00 7619695 / 99999 / 3458645
TO35 TAXA DE OBSERVAO 1
/80031501
1/0
39,42
110090957
/ Unimed Sao Luis
09/11/2011 12:00:00 7681165 / 224052 / 497901
/90000021
1/0
1.404,00
110000052
30/11/2011 13:38:00 7677960 / 223267 / 30482905
/90000021
1/0
2.395,80
110000052
18/11/2011 19:00:00 7619695 / 99999 / 3458645
/90000021
1/0
48,45
110000052
16/11/2011 19:08:00 7619694 / 99999 / 30458645
/90000021
1/0
2.055,28
110000052
02/12/2011 13:24:00 7677961 / 223267 / 304829051
/90000021
1/0
26,40
310000145
29/11/2011 06:39:00 7622146 / 99999 / 30484332
2 UCO
/90000021
0,87 / 0
110000052
09/11/2011 14:07:00 7646594 / 99999 / 417462
/90000021
1/0
310000145
13/12/2011 06:51:00 7618890 / 99999 / 30505051
2 UCO
/90000021
0,87 / 0
0,00
206,95
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 13

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
110000052
18/11/2011 19:00:00 7619695 / 99999 / 3458645
/90000013
1/0
37,67
110000052
16/11/2011 19:08:00 7619694 / 99999 / 30458645
/90000013
1/0
9.385,37
110000052
02/12/2011 13:24:00 7677961 / 223267 / 304829051
/90000013
1/0
34,00
110000052
09/11/2011 14:07:00 7646594 / 99999 / 417462
/90000013
1/0
113,88
110000052
30/11/2011 13:38:00 7677960 / 223267 / 30482905
/90000013
1/0
8.562,42
25.460,96
Total:
0468000049000
0468000049018
Claudio Da Costa Coutinho

Eliane M Silva Coutinho
210000763
/ Cent De Ortopedia E Clinicas
07/11/2011 07:31:00 7639054 / 99999 / 30450117
210000763
/ Cent De Ortopedia E Clinicas
07/11/2011 07:31:00 7639054 / 99999 / 30450117
20103484 Patologia osteomioarticular em um membro

/20103484
2 UCO
/90000021
8/0
3,76 / 0
0,00
234,84
Total:
0468000052000
0468000052000
234,84
Daniel Soares De Quadros Nepomuceno

Daniel Soares De Quadros Nepomuceno
210020314
/ S.O.S Trauma Ltda
04/11/2011 11:05:00 7605332 / 99999 / 30446514
20103492 Patologia osteomioarticular em dois ou
/20103492
9/0
276,31
210020314
/ S.O.S Trauma Ltda
04/11/2011 11:05:00 7605332 / 99999 / 30446514
/20103492
1/0
30,70
5064
05/12/2011 18:39:00 7660746 / 99999 / 30485320
/30101298
6/0
319,76
5064
05/12/2011 18:39:00 7660746 / 99999 / 30485320
/30210127
1/0
106,59
5064
05/12/2011 18:39:00 7660746 / 99999 / 30485320
/80051510
1/0
45,45
5064
05/12/2011 18:39:00 7660746 / 99999 / 30485320
/90000021
1/0
66,43
210020314
/ S.O.S Trauma Ltda
04/11/2011 11:05:00 7605332 / 99999 / 30446514
2 UCO
/90000021
6/0
0,00
5064
05/12/2011 18:39:00 7660746 / 99999 / 30485320
/90000013
1/0
47,26
/10101012
1/0
83,07
/10101012
1/0
83,07
0468000052108
5064
Gabriel Jose Nepomuceno
0468000052302
1937
29/11/2011
7665494 / 99999 / 10242458
Gabriela Rodrigues Nepomuceno
12/12/2011
7668157 / 99999 / 10250407
Total:
0468000055000
Delimar Azevedo Martins
1.058,64
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 14

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468000055000
Delimar Azevedo Martins
2461
/ Marcelo De Almeida Borges
13/12/2011
210020314
/ S.O.S Trauma Ltda
210020314
7655650 / 99999 / 10251287
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
13/12/2011 15:33:00 7643258 / 99999 / 30505670
40802035 Coluna dorsal - 2 incidncias
/40802035
1/0
15,35
/ S.O.S Trauma Ltda
13/12/2011 15:33:00 7643258 / 99999 / 30505670
40804011 Bacia
/40804011
1/0
15,35
210020314
/ S.O.S Trauma Ltda
13/12/2011 15:33:00 7643258 / 99999 / 30505670
/40802019
1/0
15,35
210020314
/ S.O.S Trauma Ltda
13/12/2011 15:33:00 7643258 / 99999 / 30505670
40802051 Coluna lombo-sacra -3 incidncias
/40802051
1/0
15,35
210020314
/ S.O.S Trauma Ltda
13/12/2011 15:33:00 7643258 / 99999 / 30505670
1 FILME
0,8356 / 0
18,97
210020314
/ S.O.S Trauma Ltda
13/12/2011 15:33:00 7643258 / 99999 / 30505670
2 UCO
/90000021
5,33 / 0
163,44
Total:
0468000056006
0468000056502
0,00
Denis De Jesus Ferreira Sa

Manoel Ferreira Sa
310000145
28/11/2011 07:02:00 7613262 / 99999 / 518386
40302040 Glicose
/40302040
1/0
5,28
310000145
28/11/2011 07:02:00 7613262 / 99999 / 518386
40302040 Glicose
/40302040
1/0
5,28
310000145
28/11/2011 07:02:00 7613262 / 99999 / 518386
/40302750
1/0
22,46
310000145
28/11/2011 07:02:00 7613262 / 99999 / 518386
/40302733
1/0
44,71
310000145
28/11/2011 07:02:00 7613262 / 99999 / 518386
/90000021
4,041 / 0
/10101012
1/0
83,07
0468000056510
2 UCO
0,00
Maria Da Graca Marques Sousa
1341665
/ Julio Cezar Uchoa Serra
12/12/2011
7615049 / 99999 / 10250163
110010198
/ Fundacao Antonio Jorge Dino
05/12/2011 09:08:00 7643356 / 99999 / 30492859
40901300 Transvaginal (inclui abdome inferior
/40901300
1/0
91,69
110010198
25/11/2011 09:05:00 7643348 / 99999 / 30479019
40601137 Procedimento diagnstico em
/40601137
1/0
29,21
110010198
05/12/2011 09:09:00 7643357 / 99999 / 30492848
40901114 Mamas
/40901114
1/0
86,31
210001638
/ Incordis-Inst De Cardilogia Sao
12/12/2011
1/0
25,45
110010198
25/11/2011 09:04:00 7643347 / 99999 / 30479014
/41301102
1/0
62,98
210001638
/ Incordis-Inst De Cardilogia Sao
12/12/2011
2 UCO
/90000021
0,75 / 0
0,00
110010198
05/12/2011 09:08:00 7643356 / 99999 / 30492859
1 FILME
0,17 / 0
3,86
110010198
05/12/2011 09:08:00 7643356 / 99999 / 30492859
2 UCO
/90000021
3,82 / 0
0,00
7632911 / 99999 / 30503348
7632911 / 99999 / 30503348
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 15

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
110010198
05/12/2011 09:09:00 7643357 / 99999 / 30492848
1 FILME
0,34 / 0
7,72
110010198
05/12/2011 09:09:00 7643357 / 99999 / 30492848
2 UCO
/90000021
3,42 / 0
0,00
110010198
25/11/2011 09:04:00 7643347 / 99999 / 30479014
2 UCO
/90000021
2,78 / 0
0,00
110010198
25/11/2011 09:05:00 7643348 / 99999 / 30479019
2 UCO
/90000021
1,03 / 0
0,00
Total:
0468000058009
0468000058114
21002629
468,02
Dnalva Cutrim Silva

Igor Thiago S de Sousa
/ M D De Macedo Caldas
08/11/2011 12:00:00 7678180 / 223351 / 271943
10101144 Sessoes de Fonoaudiologia
/10101144
10 / 0
280,80
Total:
0468000063002
0468000063096
280,80
Edith Irene F Cabral

Inacio De Loiola Martins Cabral
310000030
28/11/2011
7601412 / 99999 / 30481007
1/0
11,78
310000030
28/11/2011
7601412 / 99999 / 30481007
/40308391
1/0
36,82
310000030
28/11/2011
7601412 / 99999 / 30481007
/90000021
0,87 / 0
0468000063517
2 UCO
0,00
Marinete da P R Fontenel
11866
/ Lila Isabel Camara De Paula
09/12/2011
7666836 / 99999 / 0317922
/10101012
1/0
83,07
11000690
/ Antonio Carlos P De Oliveira
15/12/2011
7676652 / 99999 / 10253232
/10101012
1/0
83,07
210000291
/ Clinica Maranhense Ltda
13/12/2011 10:29:00 7624830 / 99999 / 30504663
40804054 Joelho
/40804054
1/0
31,77
210000291
13/12/2011 10:29:00 7624830 / 99999 / 30504663
40804054 Joelho
/40804054
1/0
31,77
210000143
/ Fisioclin - Clin.De Fisioterapia
31/10/2011 12:00:00 7679241 / 223973 / 706784
/20103492
10 / 0
387,74
210000143
/ Fisioclin - Clin.De Fisioterapia
31/10/2011 12:00:00 7679241 / 223973 / 706784
2 UCO
/90000021
6/0
0,00
210000291
13/12/2011 10:29:00 7624830 / 99999 / 30504663
2 UCO
/90000021
2,44 / 0
0,00
210000291
13/12/2011 10:29:00 7624830 / 99999 / 30504663
1 FILME
0,288 / 0
6,54
672,56
Total:
0468000064009
0468000064017
11000488
Edivaldo Nascimento Castro

Dulcimar Miranda Castro
/ Sonia Maria Tavares Lima
12/12/2011
7647541 / 99999 / 149057
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 16

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
2908
/ Fernando Cesar Muniz De
14/12/2011
310000242
310000242
7672645 / 99999 / 10251710
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
16/12/2011 10:00:00 7615106 / 99999 / 30509566
40302580 Uria
/40302580
1/0
5,28
16/12/2011 10:00:00 7615106 / 99999 / 30509566
/40311210
1/0
11,20
310000242
16/12/2011 10:00:00 7615106 / 99999 / 30509566
40301150 cido rico
/40301150
1/0
5,28
310000242
16/12/2011 10:00:00 7615106 / 99999 / 30509566
40301125 cido oxlico
/40301125
1/0
28,97
310000242
16/12/2011 10:00:00 7615106 / 99999 / 30509566
40301630 Creatinina
/40301630
1/0
5,28
310000242
16/12/2011 10:00:00 7615106 / 99999 / 30509566
40311180 Pesquisa ou dosagem de um
/40311180
3/0
19,06
310000242
16/12/2011 10:00:00 7615106 / 99999 / 30509566
40311015 cido ctrico
/40311015
1/0
28,97
310000242
16/12/2011 10:00:00 7615106 / 99999 / 30509566
40301508 Clearance de creatinina
/40301508
1/0
14,47
310000242
16/12/2011 10:00:00 7615106 / 99999 / 30509566
/90000021
8,568 / 0
2 UCO
284,65
Total:
0468000066001
0468000066109
0,00
Edson Verde Pontes

Edson Romario C Pontes
1400386
/ Jose Ribamar Baldez
07/12/2011
7647680 / 99999 / 10248255
/10101012
1/0
83,07
310000030
13/12/2011
7616883 / 99999 / 30504603
1/0
11,78
310000030
13/12/2011
7616883 / 99999 / 30504603
40307441 Linfcitos T supressores contagem de
/40307441
1/0
49,19
310000030
13/12/2011
7616883 / 99999 / 30504603
40314120 HIV - carga viral PCR
/40314120
1/0
405,12
310000030
13/12/2011
7616883 / 99999 / 30504603
40307433 "Linfcitos T ""helper"" contagem de (IF /40307433
1/0
49,19
1400386
/ Jose Ribamar Baldez
07/12/2011 14:51:00 7662266 / 99999 / 30498106
/40201023
1/0
23,03
110000419
/ Clin. De Proctologia Do
19/12/2011 08:15:00 7642079 / 99999 / 30512274
40201082 Colonoscopia (inclui a
/40201082
/Clinico
1/1
191,88
1221163
/ Joao De Oliveira Prazeres
19/12/2011 08:15:00 7642079 / 99999 / 30512274
/40201082
/Anestesis
1/1
151,22
110000419
19/12/2011 08:15:00 7642079 / 99999 / 30512274
2 UCO
/90000021
14,798 / 0
110000419
19/12/2011 08:15:00 7642079 / 99999 / 30512274
/90000021
1/0
310000030
13/12/2011
2 UCO
/90000021
38,04 / 0
110000419
19/12/2011 08:15:00 7642079 / 99999 / 30512274
/90000013
1/0
7616883 / 99999 / 30504603
0,00
28,71
0,00
58,04
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 17

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Total:
0468000070009
0468000070009
Vl.Cob
1.051,23
Eliana Veloso de A Rocha

Eliana Veloso de A Rocha
3197
06/12/2011
7665204 / 99999 / 10247408
/10101012
1/0
83,07
2178
/ Jos Xavier De Melo Filho
25/11/2011
7640057 / 99999 / 10240169
/10101012
1/0
83,07
7662222 / 99999 / 10241971
/10101012
1/0
83,07
0468000070092
6008
Pedro V Rocha Neto
/ Luis Felipe Lepkoski Chaves
0468000070513
29/11/2011
Raimunda Veloso de Amorim
950000970
/ Licia Maria Rodrigues Fonseca
10/12/2011
7658827 / 99999 / 10249273
/10101012
1/0
83,07
3612
/ Viviane Chaves De Carvalho
19/12/2011
7662665 / 99999 / 10255117
/10101012
1/0
83,07
3197
20/12/2011
7665229 / 99999 / 10256118
/10101012
1/0
83,07
310000030
28/11/2011
7601440 / 99999 / 30481006
40302318 Potssio
/40302318
1/0
5,28
310000030
28/11/2011
7601441 / 99999 / 30481010
40301885 Fosfatase alcalina
/40301885
1/0
9,76
310000030
28/11/2011
7601440 / 99999 / 30481006
40302040 Glicose
/40302040
1/0
5,28
310000030
28/11/2011
7601440 / 99999 / 30481006
/40303110
1/0
12,78
310000030
28/11/2011
7601440 / 99999 / 30481006
40302580 Uria
/40302580
1/0
5,28
310000030
28/11/2011
7601440 / 99999 / 30481006
40301630 Creatinina
/40301630
1/0
5,28
210000372
/ Cent.De Densitom.Ossea Do
01/12/2011 06:00:00 7628014 / 99999 / 019911
40808130 Densitometria ssea - 2 segmentos
/40808130
1/0
185,89
310000030
28/11/2011
7601440 / 99999 / 30481006
40316491 T4 livre
/40316491
1/0
34,39
310000030
28/11/2011
7601440 / 99999 / 30481006
/40316521
1/0
27,52
310000030
28/11/2011
7601440 / 99999 / 30481006
40302423 Sdio
/40302423
1/0
5,28
310000030
28/11/2011
7601441 / 99999 / 30481010
/40302512
1/0
9,76
310000030
14/12/2011
7624384 / 99999 / 30501365
40303136 Sangue oculto, pesquisa
/40303136
1/0
12,78
310000030
28/11/2011
7601441 / 99999 / 30481010
/40308391
1/0
36,82
310000030
28/11/2011
7601440 / 99999 / 30481006
40301222 Albumina
/40301222
1/0
5,28
310000030
28/11/2011
7601440 / 99999 / 30481006
40301931 Fsforo
/40301931
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 18

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
28/11/2011
7601441 / 99999 / 30481010
/40304370
1/0
5,28
310000030
28/11/2011
7601441 / 99999 / 30481010
40305465 Paratormnio - PTH ou frao (cada)
/40305465
1/0
91,48
310000030
28/11/2011
7601441 / 99999 / 30481010
/40302504
1/0
9,76
310000030
28/11/2011
7601440 / 99999 / 30481006
40301400 Clcio
/40301400
1/0
5,28
310000030
28/11/2011
7601440 / 99999 / 30481006
40311171 Microalbuminria
/40311171
1/0
24,49
310000030
28/11/2011
7601441 / 99999 / 30481010
1/0
11,78
310000030
28/11/2011
7601440 / 99999 / 30481006
/40302750
1/0
22,46
310000030
28/11/2011
7601440 / 99999 / 30481006
/40302733
1/0
44,71
310000030
14/12/2011
7624384 / 99999 / 30501365
2 UCO
/90000021
0,927 / 0
0,00
310000030
28/11/2011
7601441 / 99999 / 30481010
2 UCO
/90000021
10,077 / 0
0,00
210000372
/ Cent.De Densitom.Ossea Do
01/12/2011 06:00:00 7628014 / 99999 / 019911
2 UCO
/90000021
10,25 / 0
0,00
310000030
28/11/2011
2 UCO
/90000021
13,644 / 0
0,00
7601440 / 99999 / 30481006
1.080,32
Total:
0468000073008
0468000073016
Emilia Costa Sousa Fonseca

Paulo Victor Ferreira Fonseca
11002235
/ George Hermes Rego De Oliveira
29/11/2011
7659483 / 99999 / 10241948
/10101012
1/0
83,07
3612
12/12/2011
7662720 / 99999 / 10250079
/10101012
1/0
83,07
310000145
13/12/2011 07:29:00 7620808 / 99999 / 30504767
40316491 T4 livre
/40316491
1/0
34,39
310000145
13/12/2011 07:29:00 7620808 / 99999 / 30504767
/40316521
1/0
27,52
310000145
13/12/2011 07:29:00 7620808 / 99999 / 30504767
40302040 Glicose
/40302040
1/0
5,28
310000145
13/12/2011 07:29:00 7620808 / 99999 / 30504767
40316360 Insulina
/40316360
1/0
29,27
310000145
13/12/2011 07:29:00 7620808 / 99999 / 30504767
40301648 Creatino fosfoquinase total (CK)
/40301648
1/0
14,47
310000145
13/12/2011 07:29:00 7620808 / 99999 / 30504767
/40302750
1/0
22,46
310000145
13/12/2011 07:29:00 7620808 / 99999 / 30504767
/90000021
8,2 / 0
2 UCO
Total:
0468000075000
Ezio Emmanoel Farah
0,00
299,53
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 19

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468000075000
Ezio Emmanoel Farah
Obs.
Qtd/Partic
Vl.Cob
4590
/ Mauricio Lima Palacio
25/11/2011
7604434 / 99999 / 10240478
/10101012
1/0
83,07
21002595
/ Hro Hospital De Referencia
25/11/2011
7601005 / 99999 / 30480163
/41301323
1/0
22,08
21002595
29/11/2011
7601024 / 99999 / 30483778
41301269 Microscopia especular de crnea -
/41301269
2/0
177,49
21002595
29/11/2011
7601024 / 99999 / 30483778
41301080 Ceratoscopia computadorizada -
/41301080
2/0
151,66
21002595
29/11/2011
7601024 / 99999 / 30483778
41501128 Paquimetria ultra-snica - monocular
/41501128
2/0
75,39
21002595
29/11/2011
7601024 / 99999 / 30483778
/41301250
2/0
69,22
21002595
25/11/2011
7601005 / 99999 / 30480163
2 UCO
/90000021
0,5 / 0
0,00
21002595
29/11/2011
7601024 / 99999 / 30483778
2 UCO
/90000021
11,82 / 0
0,00
/10101012
1/0
83,07
0468000075302
Maria Clara Silva Farah
4825
/ Milena Fernanda Vieira Pinheiro
13/12/2011
7663847 / 99999 / 10250929
4825
13/12/2011 09:00:00 7663869 / 99999 / 30504817
/41301250
2/0
61,40
4825
13/12/2011 09:00:00 7663869 / 99999 / 30504817
/41301323
1/0
15,35
4825
13/12/2011 09:00:00 7663869 / 99999 / 30504817
/41501128
2/0
61,40
4825
13/12/2011 09:00:00 7663869 / 99999 / 30504817
/90000021
2,12 / 0
2 UCO
800,13
Total:
0468000076007
0468000076007
0,00
Fabio Mendonca Santiago

Fabio Mendonca Santiago
310000030
26/11/2011
7609961 / 99999 / 30477572
/40302512
1/0
9,76
310000030
26/11/2011
7609961 / 99999 / 30477572
/40308391
1/0
36,82
310000030
26/11/2011
7609966 / 99999 / 30479423
40302040 Glicose
/40302040
1/0
5,28
310000030
26/11/2011
7609966 / 99999 / 30479423
40301630 Creatinina
/40301630
1/0
5,28
310000030
26/11/2011
7609961 / 99999 / 30477572
/40301885
1/0
9,76
310000030
26/11/2011
7609961 / 99999 / 30477572
40301281 Amilase
/40301281
1/0
9,76
310000030
29/11/2011
7609983 / 99999 / 30482267
40301281 Amilase
/40301281
1/0
9,76
310000030
29/11/2011
7609983 / 99999 / 30482267
1/0
11,78
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 20

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
26/11/2011
7609961 / 99999 / 30477572
/40302504
1/0
9,76
310000030
26/11/2011
7609966 / 99999 / 30479423
40302199 Lipase
/40302199
1/0
9,76
310000030
26/11/2011
7609966 / 99999 / 30479423
/40311210
1/0
11,20
310000030
26/11/2011
7609966 / 99999 / 30479423
40302580 Uria
/40302580
1/0
5,28
310000030
26/11/2011
7609966 / 99999 / 30479423
40302318 Potssio
/40302318
1/0
5,28
310000030
26/11/2011
7609961 / 99999 / 30477572
1/0
11,78
310000030
26/11/2011
7609966 / 99999 / 30479423
40302423 Sdio
/40302423
1/0
5,28
310000030
26/11/2011
7609966 / 99999 / 30479423
1/0
11,78
310000030
29/11/2011
7609983 / 99999 / 30482267
/40302512
1/0
9,76
310000030
26/11/2011
7609966 / 99999 / 30479423
/40302504
1/0
9,76
310000030
26/11/2011
7609966 / 99999 / 30479423
/40301990
1/0
9,76
310000030
29/11/2011
7609983 / 99999 / 30482267
/40301990
1/0
9,76
310000030
29/11/2011
7609983 / 99999 / 30482267
40302040 Glicose
/40302040
1/0
5,28
310000030
29/11/2011
7609982 / 99999 / 30482181
/40601110
1/0
58,42
310000030
26/11/2011
7609966 / 99999 / 30479423
40301281 Amilase
/40301281
1/0
9,76
310000030
29/11/2011
7609983 / 99999 / 30482267
/40302504
1/0
9,76
310000030
26/11/2011
7609966 / 99999 / 30479423
/40302512
1/0
9,76
310000030
26/11/2011
7609961 / 99999 / 30477572
/40301990
1/0
9,76
310000030
26/11/2011
7609966 / 99999 / 30479423
/40308391
1/0
36,82
310000030
26/11/2011
7609961 / 99999 / 30477572
40302199 Lipase
/40302199
1/0
9,76
310000030
29/11/2011
7609983 / 99999 / 30482267
40301630 Creatinina
/40301630
1/0
5,28
310000030
29/11/2011
7609983 / 99999 / 30482267
/40301885
1/0
9,76
310000030
29/11/2011
7609983 / 99999 / 30482267
/40308391
1/0
36,82
310000030
29/11/2011
7609983 / 99999 / 30482267
2 UCO
/90000021
5,244 / 0
0,00
310000030
26/11/2011
7609961 / 99999 / 30477572
2 UCO
/90000021
5,19 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 21

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
29/11/2011
7609982 / 99999 / 30482181
2 UCO
/90000021
2,06 / 0
0,00
310000030
26/11/2011
7609966 / 99999 / 30479423
2 UCO
/90000021
7,215 / 0
0,00
/41301323
0468000076325
89000025
Luisa Pinheiro Da Silveira
/ Unimed Grande Florianopolis
25
56435
01/11/2011 17:10:00 7652342 / 223120 / 00000000000034676997

Lote: 223120 Nota: 325
1/0
418,67
Total:
0468000078000
0468000078506
89000063
Fernanda Maria Cabral Da Nobrega

Jeronimo Cabral De Oliveira
/ Unimed Fortaleza Coop De
0468000078514
63
6506
28/10/2011 08:10:12 7652595 / 223142 / 87634484
/10101012
Lote: 223142 Nota: 325
1/0
58,97
/10101012
Lote: 223142 Nota: 325
1/0
58,97
/40601137
Lote: 223142 Nota: 325
1/0
20,64
Maria Stela De Oliveira
89000063
63
3943
89000063
63
11005118 28/10/2011 11:09:21 7652834 / 223142 / 87644025
28/10/2011 08:39:11 7652596 / 223142 / 87636221
138,58
Total:
0468000083003
0468000083003
10,13
Francisco Das C De C Caldas

Francisco Das C De C Caldas
310000030
31/10/2011 12:00:00 7679248 / 223976 / 451765
40302040 Glicose
/40302040
1/0
5,28
310000030
31/10/2011 12:00:00 7679248 / 223976 / 451765
40301630 Creatinina
/40301630
1/0
5,28
310000030
31/10/2011 12:00:00 7679248 / 223976 / 451765
40316149 Antigeno especifico prostatico total
/40316149
1/0
32,99
310000030
31/10/2011 12:00:00 7679248 / 223976 / 451765
40302580 Uria
/40302580
1/0
5,28
310000030
31/10/2011 12:00:00 7679248 / 223976 / 451765
/40311210
1/0
11,20
310000030
31/10/2011 12:00:00 7679248 / 223976 / 451765
/40301885
1/0
9,76
310000030
31/10/2011 12:00:00 7679248 / 223976 / 451765
40301150 cido rico
/40301150
1/0
5,28
310000030
31/10/2011 12:00:00 7679248 / 223976 / 451765
/40302512
1/0
9,76
310000030
31/10/2011 12:00:00 7679248 / 223976 / 451765
1/0
11,78
310000030
31/10/2011 12:00:00 7679248 / 223976 / 451765
/40301990
1/0
9,76
310000030
31/10/2011 12:00:00 7679248 / 223976 / 451765
/40302504
1/0
9,76
310000030
31/10/2011 12:00:00 7679248 / 223976 / 451765
/40302750
1/0
22,46
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 22

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
310000030
0468000083305
2 UCO
Qtd/Partic
Vl.Cob
/90000021
Obs.
8,538 / 0
0,00
/10101012
1/0
Beatriz de Araujo Caldas
/ Luciano Moreira Pinto
5559
31/10/2011 12:00:00 7679248 / 223976 / 451765
23/11/2011
7659879 / 99999 / 10237770
221,66
Total:
0468000084000
0468000084000
83,07
Francisco das C Santos

Francisco das C Santos
310000242
05/12/2011 10:00:00 7604996 / 99999 / 30492664
/40601110
1/0
58,42
310000242
05/12/2011 10:00:00 7604996 / 99999 / 30492664
40306917 Helicobacter pylori - IgG
/40306917
1/0
39,02
950000970
05/12/2011 07:09:00 7678755 / 223677 / 7889
40202615 Endoscopia digestiva alta com bipsia e /40202615
1/0
157,75
310000242
05/12/2011 10:00:00 7604996 / 99999 / 30492664
2 UCO
/90000021
4,904 / 0
0,00
950000970
05/12/2011 07:09:00 7678755 / 223677 / 7889
2 UCO
/90000021
13,67 / 0
0,00
950000970
05/12/2011 07:09:00 7678755 / 223677 / 7889
/90000021
1/0
13,86
/10101012
1/0
83,07
0468000084018
Maria Ilma F Santos
11002952
/ Licia Christina Monteiro Santana
21/12/2011
11000399
/ Calide Soares Gomes
21/12/2011 12:00:00 7678710 / 223655 / 10256599
/10101012
1/0
83,07
110000443
30/11/2011 08:11:00 7637521 / 99999 / 30485673
40101045 Teste ergomtrico convencional - 3 ou
/40101045
1/0
30,70
11002952
21/12/2011 17:22:00 7644828 / 99999 / 690531
/41301102
1/0
25,58
21002625
/ Centro De Cardiologia Invasiva
25/11/2011 15:33:00 7641688 / 99999 / 30470619
41001095 Abdome total (abdome superior, pelve e /41001095
1/0
599,84
21002625
25/11/2011 15:33:00 7641688 / 99999 / 30470619
2 UCO
/90000021
37,45 / 0
0,00
11002952
21/12/2011 17:22:00 7644828 / 99999 / 690531
2 UCO
/90000021
2,78 / 0
0,00
21002625
25/11/2011 15:33:00 7641688 / 99999 / 30470619
1 FILME
2,5 / 0
56,75
110000443
30/11/2011 08:11:00 7637521 / 99999 / 30485673
2 UCO
/90000021
7,16 / 0
0,00
0468000084301
7644730 / 99999 / 10256754
Ariane Ferreira Santos
11000739
/ Luciane Maria Oliveira Brito
21/12/2011
7646737 / 99999 / 10256503
/10101012
1/0
83,07
11001298
/ Maria Da Gloria Melo
21/12/2011
7660667 / 99999 / 10256621
/10101012
1/0
83,07
1342092
/ Joao Batista Lima Filho
25/11/2011
7655490 / 99999 / 10240265
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 23

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000242
06/12/2011 10:00:00 7610580 / 99999 / 30495373
40304108 Coombs direto
/40304108
1/0
8,55
310000250
/ Lab Galgani E Luna S/C Ltda
23/11/2011 10:00:00 7619848 / 99999 / 30474768
/40307832
1/0
29,50
310000242
06/12/2011 10:00:00 7610580 / 99999 / 30495373
40301397 Bilirrubinas (direta, indireta e total)
/40301397
1/0
5,28
310000250
23/11/2011 10:00:00 7619848 / 99999 / 30474768
/40307824
1/0
24,29
310000242
07/12/2011 10:00:00 7601939 / 99999 / 30500169
/40301397
1/0
5,28
310000242
06/12/2011 10:00:00 7610580 / 99999 / 30495373
40304299 Grupo sanguneo ABO, e fator Rho
/40304299
1/0
8,55
210020438
/ Clinica Integrada Medica
20/12/2011 15:01:00 7639358 / 99999 / 5984280
40103463 Otoemisses evocadas transientes
/40103463
1/0
59,96
310000250
23/11/2011 10:00:00 7619848 / 99999 / 30474768
2 UCO
/90000021
3,987 / 0
0,00
210020438
20/12/2011 15:01:00 7639358 / 99999 / 5984280
2 UCO
/90000021
1,462 / 0
0,00
310000242
06/12/2011 10:00:00 7610580 / 99999 / 30495373
2 UCO
/90000021
1,647 / 0
0,00
310000242
07/12/2011 10:00:00 7601939 / 99999 / 30500169
2 UCO
/90000021
0,387 / 0
0,00
1.538,68
Total:
0468000088005
0468000088005
Francy Elena Porto Ribeiro Da Silva

Francy Elena Porto Ribeiro Da Silva
11000917
/ Oscar Reynaldo Molina Benitez
12/12/2011
7669868 / 99999 / 10250179
/10101012
1/0
83,07
1340340
/ Galvani Ascar Sauaia
13/12/2011
7660517 / 99999 / 218255
/10101012
1/0
83,07
210000291
20/12/2011 10:03:00 7624902 / 99999 / 30514455
40808033 MAMOGRAFIA
/40808033
1/0
85,11
1340340
15/12/2011 15:23:00 7660554 / 99999 / 717520
/41301102
1/0
25,58
110000443
12/12/2011 15:36:00 7619823 / 99999 / 30503367
1/0
15,35
210000291
20/12/2011 10:03:00 7624902 / 99999 / 30514455
/40901300
1/0
91,69
210000291
20/12/2011 10:03:00 7624902 / 99999 / 30514455
2 UCO
/90000021
6,58 / 0
0,00
210000291
20/12/2011 10:03:00 7624902 / 99999 / 30514455
1 FILME
1,37 / 0
31,10
110000443
12/12/2011 15:36:00 7619823 / 99999 / 30503367
2 UCO
/90000021
0,75 / 0
0,00
1340340
15/12/2011 15:23:00 7660554 / 99999 / 717520
2 UCO
/90000021
2,78 / 0
0,00
0468000088102
Luciano Porto Nascimento
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 24

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
1111120
/ Maria De Fatima L F Ribeiro
0468000088110
15/12/2011
Obs.
Qtd/Partic
Vl.Cob
7671724 / 99999 / 095178
/10101012
1/0
83,07
Gabriel Porto Nascimento
1111120
15/12/2011 12:00:00 7679063 / 223864 / 95179
/10101012
1/0
83,07
1111120
15/12/2011
/10101012
1/0
83,07
7671725 / 99999 / 095179
664,18
Total:
0468000091006
0468000091014
Gilberto Silva Oliveira

Luz Maria Oliveira Guimaraes
21002602
/ Centerfisio - Clnica De
07/12/2011 11:15:00 7615466 / 99999 / 30494753
20103646 Reabilitao perineal com biofeedback
/20103646
5/0
1.038,08
21002602
25/11/2011 08:45:00 7615465 / 99999 / 30480057
20103646 Reabilitao perineal com biofeedback
/20103646
5/0
1.038,08
21002602
07/12/2011 11:15:00 7615466 / 99999 / 30494753
2 UCO
/90000021
41,5 / 0
0,00
21002602
25/11/2011 08:45:00 7615465 / 99999 / 30480057
2 UCO
/90000021
41,5 / 0
0,00
2.076,16
Total:
0468000092002
0468000092002
Giovana Simoes Castro

Giovana Simoes Castro
11000909
/ Solange De Fatima C Noronha
30/11/2011
310000145
310000145
7664888 / 99999 / 10243372
/10101012
1/0
83,07
14/12/2011 09:03:00 7620861 / 99999 / 599393
40302040 Glicose
/40302040
1/0
5,28
14/12/2011 09:03:00 7620861 / 99999 / 599393
40316491 T4 livre
/40316491
1/0
34,39
310000145
14/12/2011 09:03:00 7620861 / 99999 / 599393
/40316521
1/0
27,52
310000226
/ Lab.Anal.Clinicas Correa Ltda.
22/12/2011 10:23:00 7627721 / 99999 / 599389
/40601137
1/0
29,21
310000145
14/12/2011 09:03:00 7620861 / 99999 / 599393
40316157 Anti-TIPO
/40316157
1/0
42,41
11000909
30/11/2011 17:40:00 7668908 / 99999 / 30487077
/41301102
1/0
25,58
310000145
14/12/2011 09:03:00 7620861 / 99999 / 599393
/40311210
1/0
11,20
310000145
14/12/2011 09:03:00 7620861 / 99999 / 599393
1/0
11,78
310000145
14/12/2011 09:03:00 7620861 / 99999 / 599393
40316246 Estradiol
/40316246
1/0
40,84
310000145
14/12/2011 09:03:00 7620861 / 99999 / 599393
/40304922
1/0
33,50
310000145
14/12/2011 09:03:00 7620861 / 99999 / 599393
/40302750
1/0
22,46
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 25

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
11000909
30/11/2011 17:40:00 7668908 / 99999 / 30487077
2 UCO
/90000021
2,78 / 0
0,00
310000145
14/12/2011 09:03:00 7620861 / 99999 / 599393
2 UCO
/90000021
15,301 / 0
0,00
310000226
22/12/2011 10:23:00 7627721 / 99999 / 599389
2 UCO
/90000021
1,03 / 0
0,00
/10101012
1/0
83,07
0468000092304
Laura Simoes C K Saldanha
11000909
30/11/2011
7664889 / 99999 / 10243363
11000909
30/11/2011 17:33:00 7668909 / 99999 / 30487062
/41301102
1/0
25,58
310000145
14/12/2011 12:00:00 7678006 / 223279 / 599388
40302040 Glicose
/40302040
1/0
5,28
310000145
14/12/2011 12:00:00 7678006 / 223279 / 599388
1/0
11,78
310000145
14/12/2011 12:00:00 7678006 / 223279 / 599388
/40316521
1/0
27,52
310000145
14/12/2011 12:00:00 7678006 / 223279 / 599388
/40311210
1/0
11,20
310000145
14/12/2011 12:00:00 7678006 / 223279 / 599388
/40302750
1/0
22,46
310000145
14/12/2011 12:00:00 7678006 / 223279 / 599388
2 UCO
/90000021
4,107 / 0
0,00
11000909
30/11/2011 17:33:00 7668909 / 99999 / 30487062
2 UCO
/90000021
2,78 / 0
0,00
Total:
0468000095001
0468000095001
554,13
Heloiza de F J L Rocha
Heloiza de F J L Rocha
310000030
20/12/2011
7623346 / 99999 / 30512026
/40308391
1/0
36,82
310000030
20/12/2011
7623346 / 99999 / 30512026
1/0
11,78
310000030
20/12/2011
7623346 / 99999 / 30512026
/40311210
1/0
11,20
310000030
20/12/2011
7623346 / 99999 / 30512026
40310213 Cultura, urina com contagem de colnias /40310213
1/0
24,52
310000030
20/12/2011
7623346 / 99999 / 30512026
/90000021
3,48 / 0
/10101012
1/0
0468000095095
1130583
/ Natan Rosa Da Costa
2 UCO
Marco Antonio de M Rocha

24/11/2011
7640628 / 99999 / 10239055
Total:
0468000096008
0468000096008
0,00
Herbert de Sousa Rubim

Herbert de Sousa Rubim
83,07
167,39
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 26

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
110000079
09/11/2011 08:56:00 7636128 / 99999 / 30454452
110000079
09/11/2011 08:56:00 7636128 / 99999 / 30454452
110000079
09/11/2011 08:56:00 7636128 / 99999 / 30454452
0468000096016
40901203 rgos superficiais (tireide ou escroto
Obs.
Qtd/Partic
Vl.Cob
/40901203
1/0
76,72
2 UCO
/90000021
3,42 / 0
0,00
1 FILME
0,17 / 0
3,86
Silvana F Lima Rubim
1342173
/ Ana Maria Rocha Bringel
20/12/2011 12:24:41 7659546 / 99999 / 30493277
/10101012
1/0
83,07
1342173
20/12/2011 12:24:41 7659546 / 99999 / 30493277
41301099 Coleta de material crvico-vaginal
/41301099
1/0
7,68
1342173
20/12/2011 12:24:41 7659546 / 99999 / 30493277
/41301102
1/0
25,58
310000145
05/12/2011 14:27:00 7622472 / 99999 / 30493881
/40601137
1/0
29,21
110000052
19/11/2011 23:28:56 7603170 / 99999 / 30469901
/10101039
1/0
94,77
1221163
07/12/2011 12:57:00 7642049 / 99999 / 30498123
/40201082
/Anestesis
1/1
151,22
110000419
07/12/2011 12:57:00 7642049 / 99999 / 30498123
/40201082
/Clinico
1/1
191,88
110000419
07/12/2011 12:57:00 7642049 / 99999 / 30498123
2 UCO
/90000021
14,798 / 0
0,00
310000145
05/12/2011 14:27:00 7622472 / 99999 / 30493881
2 UCO
/90000021
1,03 / 0
0,00
110000419
07/12/2011 12:57:00 7642049 / 99999 / 30498123
/90000021
1/0
1342173
20/12/2011 12:24:41 7659546 / 99999 / 30493277
2 UCO
/90000021
2,78 / 0
110000419
07/12/2011 12:57:00 7642049 / 99999 / 30498123
/90000013
1/0
58,04
0468000096300
28,71
0,00
Amanda Lima Rubim
1342173
20/12/2011 12:24:11 7659545 / 99999 / 30493262
/10101012
1/0
83,07
3612
16/12/2011
/10101012
1/0
83,07
1342173
20/12/2011 12:24:11 7659545 / 99999 / 30493262
/41301099
1/0
7,68
310000145
05/12/2011 14:24:00 7622471 / 99999 / 30493887
1/0
9,63
1342173
20/12/2011 12:24:11 7659545 / 99999 / 30493262
/41301102
1/0
25,58
5263
/ Marianna Leticia Barbosa Leite
20/12/2011 09:56:00 7662825 / 99999 / 30513653
10101179 Consulta/sessao de nutricao - 6 por ano /10101179
1/0
28,08
1342173
20/12/2011 12:24:11 7659545 / 99999 / 30493262
2 UCO
/90000021
2,78 / 0
0,00
310000145
05/12/2011 14:24:00 7622471 / 99999 / 30493887
2 UCO
/90000021
0,693 / 0
0,00
7662674 / 99999 / 10253664
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 27

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468000096318
Milena Lima Rubim
Obs.
Qtd/Partic
Vl.Cob
1342173
20/12/2011 12:23:46 7659544 / 99999 / 30493295
/10101012
1/0
83,07
1342173
20/12/2011 12:23:46 7659544 / 99999 / 30493295
/41301099
1/0
7,68
310000145
05/12/2011 14:22:00 7622470 / 99999 / 30493874
1/0
9,63
1342173
20/12/2011 12:23:46 7659544 / 99999 / 30493295
/41301102
1/0
25,58
310000145
05/12/2011 14:22:00 7622470 / 99999 / 30493874
2 UCO
/90000021
0,693 / 0
0,00
1342173
20/12/2011 12:23:46 7659544 / 99999 / 30493295
2 UCO
/90000021
2,78 / 0
0,00
1.113,81
Total:
0468000099007
0468000099007
Ivan Porto De Sa
Ivan Porto De Sa
310000145
24/11/2011 07:03:00 7613133 / 99999 / 30477054
310000145
24/11/2011 07:03:00 7613133 / 99999 / 30477054
0468000099015
/40310400
1/0
/90000021
4,977 / 0
/10101012
1/0
83,07
/40601137
1/0
29,21
/90000021
1,03 / 0
2 UCO
67,72
0,00
Rosangela Lopes Da Silva Porto
1341339
/ Abigail De O Souza Cunha
06/12/2011
310000242
06/12/2011 10:00:00 7602003 / 99999 / 729361
310000242
06/12/2011 10:00:00 7602003 / 99999 / 729361
0468000099503
40310400 Cultura automatizada
7673433 / 99999 / 10246384
2 UCO
0,00
Pedro Alves Porto
47224
/ Ronald Wagner Pereira Coelho
01/12/2011
7670201 / 99999 / 10244049
/10101012
1/0
83,07
310000030
21/11/2011
7601242 / 99999 / 30470510
1/0
11,78
11003061
/ Luiz Gonzaga Martins
31/10/2011 09:10:00 7679280 / 223985 / 30423222
20102011 Holter de 24 horas - 2 ou mais canais -
/20102011
1/0
30,70
310000030
21/11/2011
7601242 / 99999 / 30470510
40301630 Creatinina
/40301630
1/0
5,28
310000030
21/11/2011
7601242 / 99999 / 30470510
40302580 Uria
/40302580
1/0
5,28
310000030
21/11/2011
7601242 / 99999 / 30470510
/40316149
1/0
32,99
11003061
31/10/2011 09:10:00 7679280 / 223985 / 30423222
40901106 Ecodopplercardiograma transtorcico
/40901106
1/0
239,62
21002609
/ Cancerologia Servios Medicos
01/12/2011 14:30:43 7624106 / 99999 / 30474245
90000145 Pct-Tx. Ambulatorial de Quimioterapia
/20104286
1/0
12,17
21002609
01/12/2011 14:30:00 7624106 / 99999 / 30474245
/20104294
1/0
115,13
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 28

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
21002609
01/12/2011 14:30:00 7624106 / 99999 / 30474245
/90000021
1/0
9,27
310000030
21/11/2011
2 UCO
/90000021
4,074 / 0
0,00
11003061
31/10/2011 09:10:00 7679280 / 223985 / 30423222
2 UCO
/90000021
8,1 / 0
0,00
21002609
01/12/2011 14:30:00 7624106 / 99999 / 30474245
/90000013
1/0
2.265,48
/10101012
1/0
83,07
0468000099511
7601242 / 99999 / 30470510
Maria Porto De Sa
3583
/ Joao Evaristo De Oliveira
24/11/2011
7656576 / 99999 / 179511
210000291
13/10/2011 15:28:00 7679205 / 223964 / 30415199
40801063 Seios da face
/40801063
1/0
35,14
3583
01/12/2011 10:10:00 7657719 / 99999 / 30486803
20102038 Monitorizao ambulatorial da presso
/20102038
1/0
30,70
3583
24/11/2011 09:45:00 7657742 / 99999 / 319498
1/0
15,35
210000291
13/10/2011 15:28:00 7679205 / 223964 / 30415199
40805026 Trax - 2 incidncias
/40805026
1/0
31,23
3583
01/12/2011 10:10:00 7657719 / 99999 / 30486803
/40901360
1/0
115,13
3583
24/11/2011 09:45:00 7657742 / 99999 / 319498
2 UCO
/90000021
0,75 / 0
0,00
3583
01/12/2011 10:10:00 7657719 / 99999 / 30486803
1 FILME
0,68 / 0
15,43
210000291
13/10/2011 15:28:00 7679205 / 223964 / 30415199
1 FILME
0,4376 / 0
9,93
3583
01/12/2011 10:10:00 7657719 / 99999 / 30486803
2 UCO
/90000021
20,26 / 0
0,00
210000291
13/10/2011 15:28:00 7679205 / 223964 / 30415199
2 UCO
/90000021
2,65 / 0
0,00
3.326,75
Total:
0468000100005
0468000100307
Jair Santos De Oliveira

Abilly Eduarda Sousa Gouveia Oliveira
89000098
/ Unimed Imperatriz
98
50000001 01/10/2011 19:02:00 7649125 / 223079 / 271852
/10101039
Lote: 223079 Nota: 324
1/0
43,00
89000098
/ Unimed Imperatriz
98
17354
/10101039
Lote: 223079 Nota: 324
1/0
43,00
89000098
/ Unimed Imperatriz
98
50000001 01/10/2011 20:49:00 7649553 / 223079 / 271990
80041868 CURATIVO EM GERAL
/80041868
Lote: 223079 Nota: 324
1/0
12,29
89000098
/ Unimed Imperatriz
98
50000001 30/09/2011 19:56:00 7648853 / 223079 / 2719200
80031501 Sala de Observao em Pronto Socorro /80031501
Lote: 223079 Nota: 324
1/0
37,43
89000098
/ Unimed Imperatriz
98
50000001 29/09/2011 19:54:00 7650044 / 223079 / 355745
80041868 CURATIVO EM GERAL
/80041868
Lote: 223079 Nota: 324
1/0
12,29
89000098
/ Unimed Imperatriz
98
50000001 30/09/2011 19:56:00 7648853 / 223079 / 2719200
/90000021
Lote: 223079 Nota: 324
1/0
10,52
30/09/2011 19:56:00 7649959 / 223079 / 2719200
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 29

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
89000098
/ Unimed Imperatriz
98
50000001 30/09/2011 19:56:00 7648853 / 223079 / 2719200
/90000013
Obs.
/
Qtd/Partic
Lote: 223079 Nota: 324
1/0
11,01
169,54
Total:
0468000106003
0468000106003
Vl.Cob
Joao Batista Tavares De Oliveira

Joao Batista Tavares De Oliveira
4990
/ Douglas Pereira Costa
01/12/2011
4990
/ Douglas Pereira Costa
24240
/10101012
1/0
83,07
01/12/2011 09:55:00 7622419 / 99999 / 30487837
/41301323
/Clinico
1/1
22,08
/ Cesar Augusto Mendonca
29/11/2011 08:48:00 7660363 / 99999 / 30483976
1/0
157,75
210000828
/ Pro-Visao S/C
01/12/2011 09:55:00 7622419 / 99999 / 30487837
/41301250
2/0
69,22
210000828
/ Pro-Visao S/C
01/12/2011 09:55:00 7622419 / 99999 / 30487837
2 UCO
/90000021
1,08 / 0
0,00
24240
29/11/2011 08:48:00 7660363 / 99999 / 30483976
2 UCO
/90000021
13,67 / 0
0,00
24240
29/11/2011 08:48:00 7660363 / 99999 / 30483976
/90000021
1/0
6,86
24240
29/11/2011 08:48:00 7660363 / 99999 / 30483976
/90000013
1/0
7,01
0468000106011
7679449 / 99999 / 10243675
Ana Elisa Fernandes De Oliveira
6422
/ Naldirene De Araujo Maya
20/12/2011
7643377 / 99999 / 696054
/10101012
1/0
83,07
34696
/ Jose Sergio Macedo Coelho
07/12/2011
7671884 / 99999 / 10247941
/10101012
1/0
83,07
0468000106305
Luciana Aparecida Fernandes De Oliveira
110000052
22/11/2011 11:38:00 7603209 / 99999 / 30472855
/10101039
1/0
94,77
310000145
22/11/2011 10:00:00 7613100 / 99999 / 30473027
40310337 Rotavrus, pesquisa, Elisa
/40310337
1/0
24,52
310000145
22/11/2011 10:00:00 7613100 / 99999 / 30473027
1/0
11,78
310000145
22/11/2011 10:00:00 7613100 / 99999 / 30473027
/40308391
1/0
36,82
310000145
22/11/2011 10:00:00 7613100 / 99999 / 30473027
/40303110
1/0
12,78
310000145
22/11/2011 10:00:00 7613100 / 99999 / 30473027
2 UCO
/90000021
3,597 / 0
0468000106755
0,00
Anna Clara Almeida De Oliveira
310000145
21/11/2011 06:23:00 7617742 / 99999 / 30479050
/40310337
1/0
24,52
310000145
21/11/2011 06:23:00 7617742 / 99999 / 30479050
40302423 Sdio
/40302423
1/0
5,28
310000145
21/11/2011 06:23:00 7617742 / 99999 / 30479050
/40303136
1/0
12,78
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 30

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000145
21/11/2011 06:23:00 7617742 / 99999 / 30479050
1/0
11,78
310000145
21/11/2011 06:23:00 7617742 / 99999 / 30479050
/40308391
1/0
36,82
310000145
21/11/2011 06:23:00 7617742 / 99999 / 30479050
/40303110
1/0
12,78
310000145
21/11/2011 06:23:00 7617742 / 99999 / 30479050
40303098 Leuccitos e hemcias, pesquisa nas
/40303098
1/0
5,99
310000145
21/11/2011 06:23:00 7617742 / 99999 / 30479050
40302318 Potssio
/40302318
1/0
5,28
310000145
21/11/2011 06:23:00 7617742 / 99999 / 30479050
/40311210
1/0
11,20
310000145
21/11/2011 06:23:00 7617742 / 99999 / 30479050
/90000021
6,531 / 0
2 UCO
819,23
Total:
0468000109002
0468000109002
0,00
Joaquim Da Silva Oliveira

Joaquim Da Silva Oliveira
110000346
/ Casa Da Saude E Matern De
22/10/2011 12:00:00 7679251 / 223981 / 920000
40301605 Colesterol total
/40301605
1/0
0,07
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
1/0
0,07
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
/40805026
1/0
15,35
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
40302580 Uria
/40302580
1/0
0,07
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
40302547 Triglicerdeos
/40302547
1/0
0,07
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
/40307760
1/0
0,30
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
/40303110
1/0
0,30
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
40306615 Chagas IgG
/40306615
1/0
0,30
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
40301630 Creatinina
/40301630
1/0
0,07
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
40302040 Glicose
/40302040
1/0
0,07
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
/40304299
1/0
0,07
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
40306623 Chagas IgM
/40306623
1/0
0,30
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
/40311210
1/0
0,30
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
1 FILME
0,308 / 0
6,99
110000346
22/10/2011 12:00:00 7679251 / 223981 / 920000
2 UCO
/90000021
11,212 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 31

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468000109312
Eloiza Beatriz Barros Oliveira
110000346
0468000109517
28/11/2011
Obs.
Qtd/Partic
Vl.Cob
7646785 / 99999 / 10240849
/10101012
1/0
83,07
7639912 / 99999 / 30446253
/10101012
1/0
83,07
Iracema Da Silva Oliveira
210001611
/ Oftalmodonto Center Ltda
03/11/2011
210000674
/ Cl De Fisiot Reab Funcion-
26/09/2011 08:00:00 7642776 / 99999 / 921172482
/20103492
10 / 0
387,74
210001611
03/11/2011
7639912 / 99999 / 30446253
/41301323
1/0
22,08
210001611
03/11/2011
7639912 / 99999 / 30446253
2 UCO
/90000021
0,5 / 0
0,00
210000674
26/09/2011 08:00:00 7642776 / 99999 / 921172482
2 UCO
/90000021
6/0
0,00
600,29
Total:
0468000111007
0468000111007
89000098
/ Unimed Imperatriz
0468000111503
Joel Marco Franco Moreira

Joel Marco Franco Moreira
98
42189
26/10/2011 12:00:00 7650208 / 223079 / 424924
/10101012
Lote: 223079 Nota: 324
1/0
58,97
Pedro Jorge D Moreira
89000098
/ Unimed Imperatriz
98
52689
15/09/2011
7650046 / 223079 / 2181758
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
52689
20/10/2011
7650047 / 223079 / 2192019
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
21000019 18/10/2011 08:00:00 7648493 / 223079 / 648094
/40805026
Lote: 223079 Nota: 324
1/0
15,03
89000098
/ Unimed Imperatriz
98
31000018 21/10/2011 10:10:00 7649384 / 223079 / 4151199
40301400 Clcio
/40301400
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000018 21/10/2011 10:10:00 7649384 / 223079 / 4151199
40301630 Creatinina
/40301630
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000021 14/10/2011 08:00:00 7649385 / 223079 / 648096
/40301885
Lote: 223079 Nota: 324
1/0
5,31
89000098
/ Unimed Imperatriz
98
31000018 21/10/2011 10:10:00 7649384 / 223079 / 4151199
40302318 Potssio
/40302318
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000021 14/10/2011 08:00:00 7649385 / 223079 / 648096
40302580 Uria
/40302580
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
21000019 18/10/2011 08:00:00 7650045 / 223079 / 648095
40901122 Abdome total (inclui pelve)
/40901122
Lote: 223079 Nota: 324
1/0
98,77
89000098
/ Unimed Imperatriz
98
31000018 21/10/2011 10:10:00 7649384 / 223079 / 4151199
/40301990
Lote: 223079 Nota: 324
1/0
5,90
89000098
/ Unimed Imperatriz
98
31000021 14/10/2011 08:00:00 7649385 / 223079 / 648096
40301400 Clcio
/40301400
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000021 14/10/2011 08:00:00 7649385 / 223079 / 648096
40301630 Creatinina
/40301630
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000018 21/10/2011 10:10:00 7649384 / 223079 / 4151199
40302580 Uria
/40302580
Lote: 223079 Nota: 324
1/0
4,13
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 32

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
31000018 21/10/2011 10:10:00 7649384 / 223079 / 4151199
/40301885
Lote: 223079 Nota: 324
1/0
5,31
89000098
/ Unimed Imperatriz
98
31000018 21/10/2011 10:10:00 7649384 / 223079 / 4151199
40302423 Sdio
/40302423
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000018 21/10/2011 10:10:00 7649384 / 223079 / 4151199
Lote: 223079 Nota: 324
1/0
8,85
89000098
/ Unimed Imperatriz
98
21000100 24/10/2011 12:00:00 7649726 / 223079 / 272436
20203047 Assistncia fisitrica respiratria em
/20203047
Lote: 223079 Nota: 324
10 / 0
88,45
89000098
/ Unimed Imperatriz
98
31000021 14/10/2011 08:00:00 7649385 / 223079 / 648096
Lote: 223079 Nota: 324
1/0
8,85
89000098
/ Unimed Imperatriz
98
50000001 20/10/2011 10:33:00 7649554 / 223079 / 256549
20104235 Terapia inalatria - por nebulizao
/20104235
Lote: 223079 Nota: 324
12 / 0
35,38
89000098
/ Unimed Imperatriz
98
52689
/10101039
Lote: 223079 Nota: 324
1/0
43,00
89000098
/ Unimed Imperatriz
98
50000001 20/10/2011 10:33:00 7649554 / 223079 / 256549
10102019 Visita hospitalar (paciente internado)
/10102019
Lote: 223079 Nota: 324
2/0
171,99
89000098
/ Unimed Imperatriz
98
21000106 23/09/2011 10:00:00 7648854 / 223079 / 608193
/90000021
Lote: 223079 Nota: 324
1/0
42,39
89000098
/ Unimed Imperatriz
98
21000019 18/10/2011 08:00:00 7648493 / 223079 / 648094
1 FILME
Lote: 223079 Nota: 324
0,3078 / 0
7,34
89000098
/ Unimed Imperatriz
98
21000019 18/10/2011 08:00:00 7650045 / 223079 / 648095
1 FILME
Lote: 223079 Nota: 324
0,7599 / 0
18,11
89000098
/ Unimed Imperatriz
98
50000001 20/10/2011 10:33:00 7649554 / 223079 / 256549
/90000021
Lote: 223079 Nota: 324
1/0
76,07
89000098
/ Unimed Imperatriz
98
50000001 20/10/2011 10:33:00 7649554 / 223079 / 256549
/90000013
Lote: 223079 Nota: 324
1/0
670,47
89000098
/ Unimed Imperatriz
98
21000106 23/09/2011 10:00:00 7648854 / 223079 / 608193
/90000013
Lote: 223079 Nota: 324
1/0
13,15
/10101012
Lote: 223079 Nota: 324
1/0
58,97
40103315 Eletroneuromiografia de MMII
/40103315
Lote: 223079 Nota: 324
1/0
243,24
0468000111511
23/09/2011 10:00:00 7649555 / 223079 / 608193
Esmeralda Franco Moreira
89000098
/ Unimed Imperatriz
98
7294
24/10/2011
7649556 / 223079 / 2193118
89000098
/ Unimed Imperatriz
98
21000102 06/10/2011 17:30:00 7649802 / 223079 / 629498
Total:
0468000112003
0468000112518
1932
1.826,53
Jorge Luis C Batalha

Dulce Esperanza Calado Batalha
/ Periguari Luis Holanda De
17/12/2011
7669122 / 99999 / 10254181
/10101012
1/0
83,07
Total:
0468000118001
0468000118001
83,07
Jose de R De A Bezerra
Jose de R De A Bezerra
310000065
/ Furtado E Guillen Ltda
21/11/2011 08:30:00 7679189 / 223955 / 7851
310000065
/ Furtado E Guillen Ltda
21/11/2011 08:30:00 7679189 / 223955 / 7851

2 UCO
/40601110
1/0
/90000021
2,06 / 0
58,42
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 33

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468000118010
Giselia Gomes Bezerra
3343
/ Maria Paula Meneses De
05/12/2011
210000020
/ Centro Diagnostico Medico Do
210000020
7670665 / 99999 / 10245892
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
15/12/2011 08:00:00 7637967 / 99999 / 248895
/40901203
1/0
76,72
15/12/2011 08:00:00 7637967 / 99999 / 248895
40809099 Puno aspirativa orientada por RX
/40809099
1/0
66,20
210000020
15/12/2011 08:00:00 7637967 / 99999 / 248895
2 UCO
/90000021
3,42 / 0
0,00
210000020
15/12/2011 08:00:00 7637967 / 99999 / 248895
1 FILME
0,17 / 0
3,86
288,27
Total:
0468000121002
0468000121010
Jose Guilherme Braga Dieguez

Elyana Oliveira Dieguez Fernandes
14806
/ Jose Carlos Amaral Sousa
13/12/2011
7670956 / 99999 / 10251462
/10101012
1/0
83,07
310000030
26/11/2011
7609963 / 99999 / 30477608
/40302504
1/0
9,76
310000030
26/11/2011
7609963 / 99999 / 30477608
/40311210
1/0
11,20
310000030
26/11/2011
7609963 / 99999 / 30477608
40301281 Amilase
/40301281
1/0
9,76
310000030
26/11/2011
7609963 / 99999 / 30477608
/40308391
1/0
36,82
310000030
26/11/2011
7609963 / 99999 / 30477608
40302040 Glicose
/40302040
1/0
5,28
310000030
26/11/2011
7609963 / 99999 / 30477608
40302199 Lipase
/40302199
1/0
9,76
310000030
26/11/2011
7609963 / 99999 / 30477608
/40301990
1/0
9,76
310000030
26/11/2011
7609963 / 99999 / 30477608
40302423 Sdio
/40302423
1/0
5,28
310000030
26/11/2011
7609963 / 99999 / 30477608
40302580 Uria
/40302580
1/0
5,28
310000030
26/11/2011
7609963 / 99999 / 30477608
40301630 Creatinina
/40301630
1/0
5,28
310000030
26/11/2011
7609964 / 99999 / 30477611
40302571 Troponina
/40302571
1/0
44,71
310000030
26/11/2011
7609963 / 99999 / 30477608
1/0
11,78
310000030
26/11/2011
7609964 / 99999 / 30477611
/40301648
1/0
14,47
310000030
26/11/2011
7609963 / 99999 / 30477608
/40301885
1/0
9,76
310000030
26/11/2011
7609963 / 99999 / 30477608
/40301397
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 34

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
26/11/2011
7609963 / 99999 / 30477608
/40302512
1/0
9,76
310000030
26/11/2011
7609963 / 99999 / 30477608
40302318 Potssio
/40302318
1/0
5,28
310000030
26/11/2011
7609964 / 99999 / 30477611
40301656 Creatino fosfoquinase - frao MB -
/40301656
1/0
44,71
310000030
26/11/2011
7609963 / 99999 / 30477608
2 UCO
/90000021
8,322 / 0
0,00
310000030
26/11/2011
7609964 / 99999 / 30477611
2 UCO
/90000021
7,587 / 0
0,00
0468000121304
Flora M Oliveira Dieguez Fernandes
310000030
02/12/2011
7610382 / 99999 / 30489379
1/0
11,78
310000030
02/12/2011
7610382 / 99999 / 30489379
/40308391
1/0
36,82
310000030
02/12/2011
7610382 / 99999 / 30489379
/90000021
0,87 / 0
2 UCO
385,60
Total:
0468000122009
0468000122009
0,00
Jose Henrique Coelho

Jose Henrique Coelho
25956
/ Luiz Eufrasio Ribeiro Filho
28/11/2011
7661948 / 99999 / 10240705
/10101012
1/0
83,07
11002103
/ Maria De Fatima Resende
05/12/2011
7661120 / 99999 / 10246075
/10101012
1/0
83,07
310000145
29/11/2011 06:47:00 7613510 / 99999 / 6641202
/40311210
1/0
11,20
25956
28/11/2011 08:23:00 7662053 / 99999 / 30481924
/41301323
1/0
15,35
25956
28/11/2011 08:23:00 7662053 / 99999 / 30481924
2 UCO
/90000021
0,5 / 0
0,00
310000145
29/11/2011 06:47:00 7613510 / 99999 / 6641202
2 UCO
/90000021
0,81 / 0
0,00
0468000122017
Maria Da Luz Botelho Coelho
11001646
/ Ligia Maria Mendes Goncalves
14/12/2011
7658980 / 99999 / 10252042
/10101012
1/0
83,07
310000030
12/12/2011
7627448 / 99999 / 30502126
1/0
11,78
310000030
12/12/2011
7627448 / 99999 / 30502126
/40301990
1/0
9,76
310000030
12/12/2011
7627448 / 99999 / 30502126
40302040 Glicose
/40302040
1/0
5,28
310000030
12/12/2011
7627448 / 99999 / 30502126
40301630 Creatinina
/40301630
1/0
5,28
310000030
12/12/2011
7627448 / 99999 / 30502126
/40302512
1/0
9,76
310000030
12/12/2011
7627448 / 99999 / 30502126
40301150 cido rico
/40301150
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 35

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
12/12/2011
7627448 / 99999 / 30502126
40302580 Uria
/40302580
1/0
5,28
310000030
12/12/2011
7627448 / 99999 / 30502126
/40301885
1/0
9,76
310000030
12/12/2011
7627448 / 99999 / 30502126
/40302504
1/0
9,76
310000030
12/12/2011
7627448 / 99999 / 30502126
40301729 Desidrogenase lctica
/40301729
1/0
9,76
310000030
12/12/2011
7627448 / 99999 / 30502126
40301400 Clcio
/40301400
1/0
5,28
210001590
/ Centro De Oncologia Medica
14/12/2011 14:07:00 7655396 / 99999 / 438993
/80031706
1/0
28,03
310000030
12/12/2011
2 UCO
/90000021
6,405 / 0
210001590
14/12/2011 14:07:00 7655396 / 99999 / 438993
/90000021
1/0
71,73
210001590
14/12/2011 14:07:00 7655396 / 99999 / 438993
/90000013
1/0
1.381,48
7627448 / 99999 / 30502126
TE33 QUIMIOTERAPIA
1.843,98
Total:
0468000124001
0468000124001
0,00
Jose J Ferreira Filho

Jose J Ferreira Filho
5064
28/11/2011
7665445 / 99999 / 10241361
/10101012
1/0
83,07
5064
13/12/2011 17:43:00 7660770 / 99999 / 30496468
/30101298
3/0
159,88
5064
13/12/2011 17:43:00 7660770 / 99999 / 30496468
/80051510
1/0
45,45
5064
13/12/2011 17:43:00 7660770 / 99999 / 30496468
/90000021
1/0
17,09
5064
13/12/2011 17:43:00 7660770 / 99999 / 30496468
/90000013
1/0
20,25
/10101012
1/0
83,07
0468000124010
Valeria Cristina Abreu Ferreira
5064
28/11/2011
7665442 / 99999 / 10241351
310000145
25/11/2011 07:51:00 7600682 / 99999 / 30478780
40302040 Glicose
/40302040
1/0
5,28
310000242
24/11/2011 10:00:00 7605983 / 99999 / 652230
/40601137
1/0
29,21
310000145
25/11/2011 07:51:00 7600682 / 99999 / 30478780
/40302504
1/0
9,76
310000145
25/11/2011 07:51:00 7600682 / 99999 / 30478780
/40301990
1/0
9,76
310000145
25/11/2011 07:51:00 7600682 / 99999 / 30478780
/40316521
1/0
27,52
310000145
25/11/2011 07:51:00 7600682 / 99999 / 30478780
40301630 Creatinina
/40301630
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 36

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000145
25/11/2011 07:51:00 7600682 / 99999 / 30478780
/40302512
1/0
9,76
310000145
25/11/2011 07:51:00 7600682 / 99999 / 30478780
40302580 Uria
/40302580
1/0
5,28
310000145
25/11/2011 07:51:00 7600682 / 99999 / 30478780
1/0
11,78
310000145
25/11/2011 07:51:00 7600682 / 99999 / 30478780
40316491 T4 livre
/40316491
1/0
34,39
310000145
25/11/2011 07:51:00 7600682 / 99999 / 30478780
/40302750
1/0
22,46
5064
13/12/2011 17:39:00 7660771 / 99999 / 30496469
/30101298
1/0
53,29
5064
13/12/2011 17:39:00 7660771 / 99999 / 30496469
/80051510
1/0
45,45
5064
13/12/2011 17:39:00 7660771 / 99999 / 30496469
/90000021
1/0
5,70
310000242
24/11/2011 10:00:00 7605983 / 99999 / 652230
2 UCO
/90000021
1,03 / 0
0,00
310000145
25/11/2011 07:51:00 7600682 / 99999 / 30478780
2 UCO
/90000021
8,781 / 0
0,00
5064
13/12/2011 17:39:00 7660771 / 99999 / 30496469
/90000013
1/0
6,75
0468000124311
Luisa Abreu Ferreira
5064
28/11/2011
7665444 / 99999 / 10241355
/10101012
1/0
83,07
5064
13/12/2011 17:45:00 7660769 / 99999 / 30496466
30101255 Curetagem simples de leses de pele
/30101255
2/0
68,21
5064
13/12/2011 17:45:00 7660769 / 99999 / 30496466
/90000021
1/0
11,40
5064
13/12/2011 17:45:00 7660769 / 99999 / 30496466
/90000013
1/0
13,50
866,66
Total:
0468000126004
0468000126004
Jose Maria Azevedo Silva

Jose Maria Azevedo Silva
310000030
13/12/2011
7616898 / 99999 / 30502860
/40301885
1/0
9,76
310000030
13/12/2011
7616898 / 99999 / 30502860
40302199 Lipase
/40302199
1/0
9,76
310000030
13/12/2011
7616898 / 99999 / 30502860
1/0
11,78
310000030
13/12/2011
7616898 / 99999 / 30502860
/40302512
1/0
9,76
310000030
13/12/2011
7616898 / 99999 / 30502860
/40302504
1/0
9,76
310000030
13/12/2011
7616898 / 99999 / 30502860
/40301990
1/0
9,76
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 37

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
13/12/2011
7616898 / 99999 / 30502860
40301281 Amilase
/40301281
1/0
9,76
310000030
13/12/2011
7616898 / 99999 / 30502860
/40301397
1/0
5,28
310000030
13/12/2011
7616898 / 99999 / 30502860
/40308391
1/0
36,82
310000030
13/12/2011
7616898 / 99999 / 30502860
/90000021
5,577 / 0
/10101012
1/0
83,07
0468000126020
2 UCO
0,00
Raimunda Gomes Penha
14465
01/12/2011
210000062
/ Clinica De Imagenologia Medica
09/12/2011 15:03:00 7639611 / 99999 / 731191
40901114 Mamas
/40901114
1/0
86,31
310030141
/ Centrolab-Centro Lab De Anal
01/12/2011
1/0
9,63
14465
01/12/2011 11:41:00 7658529 / 99999 / 30488352
/41301102
1/0
25,58
310030141
01/12/2011
40310019 A fresco, exame
/40310019
1/0
9,63
310000145
13/12/2011 06:56:00 7624178 / 99999 / 30504463
/40310400
1/0
67,72
310000145
13/12/2011 06:56:00 7624178 / 99999 / 30504463
2 UCO
/90000021
4,977 / 0
0,00
210000062
09/12/2011 15:03:00 7639611 / 99999 / 731191
1 FILME
0,34 / 0
7,72
14465
01/12/2011 11:41:00 7658529 / 99999 / 30488352
2 UCO
/90000021
2,78 / 0
0,00
310030141
01/12/2011
7613836 / 99999 / 731189
2 UCO
/90000021
1,386 / 0
0,00
210000062
09/12/2011 15:03:00 7639611 / 99999 / 731191
2 UCO
/90000021
3,42 / 0
0,00
/10101012
1/0
83,07
0468000126144
7658469 / 99999 / 10243872
7613836 / 99999 / 731189
7613836 / 99999 / 731189
Paloma Penha Silva
1130583
13/12/2011
7640579 / 99999 / 10250592
310000145
15/12/2011 07:27:00 7620863 / 99999 / 30507762
/40310400
1/0
67,72
310000145
15/12/2011 07:27:00 7620863 / 99999 / 30507762
/40310400
1/0
67,72
310000145
15/12/2011 07:27:00 7620863 / 99999 / 30507762
/90000021
9,954 / 0
2 UCO
620,61
Total:
0468000127000
0468000127000
0,00
Jose Orleans Coelho Dos Santos

Jose Orleans Coelho Dos Santos
310000242
02/12/2011 10:00:00 7608126 / 99999 / 30490126
1/0
24,52
11001654
/ Marcus Aurelio B Vasconcelos
11/11/2011 00:00:14 7646570 / 99999 / 70009224
31103090 Cistolitotomia
/Cirurgiao
1/1
191,88
/31103090
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 38

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
11001654
/ Marcus Aurelio B Vasconcelos
11/11/2011 09:30:00 7646570 / 99999 / 70009224
31103219 Colo vesical - resseco endoscpica
/31103219
/Cirurgiao
1/1
383,76
21002622
11/11/2011 09:30:00 7646570 / 99999 / 70009224
31103219 Colo vesical - resseco endoscpica
/31103219
/Anestesis
1/1
447,62
21002622
11/11/2011 00:00:14 7646570 / 99999 / 70009224
31103090 Cistolitotomia
/31103090
/Anestesis
1/1
151,22
110000052
11/11/2011
DA02 APARTAMENTO
/80011020
1/0
245,48
110000052
11/11/2011 08:27:00 7646570 / 99999 / 70009224
/80061400
2/0
24,52
110000052
11/11/2011 08:27:00 7646570 / 99999 / 70009224
TC13 PORTE III
/80021034
1/0
278,68
310000242
02/12/2011 10:00:00 7608126 / 99999 / 30490126
2 UCO
/90000021
1,8 / 0
110000052
11/11/2011 08:27:00 7646570 / 99999 / 70009224
/90000021
1/0
891,56
110000052
11/11/2011 08:27:00 7646570 / 99999 / 70009224
/90000013
1/0
397,41
/10101012
1/0
83,07
0468000127019
15/12/2011
7647293 / 99999 / 160963
Total:
0468000129003
0468000129011
0,00
Elisangela Silva L Dos Santos
/ Rosy Ane De Jesus Pereira
3484
7646570 / 99999 / 70009224
3.119,72
Jose Rolim dos Santos

Jaldenira Matias Rolim
310000242
12/12/2011 10:00:00 7602015 / 99999 / 30502333
1/0
11,78
310000242
12/12/2011 10:00:00 7602015 / 99999 / 30502333
/40302504
1/0
9,76
310000242
12/12/2011 10:00:00 7602015 / 99999 / 30502333
/40302512
1/0
9,76
310000242
12/12/2011 10:00:00 7602015 / 99999 / 30502333
/40302750
1/0
22,46
310000242
12/12/2011 10:00:00 7602015 / 99999 / 30502333
/90000021
2,31 / 0
2 UCO
53,76
Total:
0468000130001
0468000130095
1130460
Jose Valdir Goncalves Dos Santos

Cleidiane Francisca De Moura Santos
/ Yone Bastos Azevedo
0468000130109
14/12/2011
0468000130516
89000099
/ Unimed Teresina
7647250 / 99999 / 173223
/10101012
1/0
83,07
/10101012
1/0
83,07
/41301323
1/0
10,13
Jose Valdir Goncalves Dos Santos Filho
4825
0,00
01/12/2011
7655372 / 99999 / 10244369
Emilia Goncalves Silva Santos

99
21000071 30/09/2011 14:25:00 7650886 / 223086 / 3416661
Lote: 223086 Nota: 324
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 39

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000265
/ Unimed Regional De Picos
265 11000169 09/09/2011 12:00:00 7647926 / 223015 / 55208
/10101039
Lote: 223015 Nota: 324
1/0
40,15
89000099
/ Unimed Teresina
99
30306027 Facectomia com lente intra-ocular com
/30306027
Lote: 223086 Nota: 324
1/0
884,52
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
/10102019
Lote: 223015 Nota: 324
1/0
70,08
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
80011039 Apartamento Standart
/80011039
Lote: 223015 Nota: 324
1/0
0,00
89000099
/ Unimed Teresina
99
21000071 04/10/2011 12:49:00 7650885 / 223086 / 3418245
G753 CILINDRO DE OXIGENIO - (VIDAS
/80061400
Lote: 223086 Nota: 324
1/0
15,97
89000099
/ Unimed Teresina
99
21000071 04/10/2011 12:49:00 7650885 / 223086 / 3418245
TU55 MICROSCPIO CIRRGICO
/80053327
Lote: 223086 Nota: 324
1/0
43,00
89000099
/ Unimed Teresina
99
21000071 04/10/2011 12:49:00 7650885 / 223086 / 3418245
T144 BISTURI DE ALTA FREQUNCIA
/80051510
Lote: 223086 Nota: 324
1/0
24,57
89000099
/ Unimed Teresina
99
21000071 04/10/2011 12:49:00 7650885 / 223086 / 3418245
TC15 PORTE V
/80021050
Lote: 223086 Nota: 324
1/0
348,89
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
/80031005
Lote: 223015 Nota: 324
1/0
16,43
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
52303 TORNEIRINHA 3VIAS DESC LL P/SOL /77827643
Lote: 223015 Nota: 324
1/0
7,99
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
18283 SERINGA DESC 20ML S/AG BICO SLIP /70285349
Lote: 223015 Nota: 324
2/0
3,53
89000099
/ Unimed Teresina
99
/90000021
Lote: 223086 Nota: 324
1/0
1.140,05
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
/79923070
Lote: 223015 Nota: 324
1/0
3,79
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
2002 EQUIPO MACROGOTAS PINCA ROL
/70037124
Lote: 223015 Nota: 324
1/0
2,43
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
4562 PVPI GEYER 1% 30 ML FR
/90228260
Lote: 223015 Nota: 324
2/0
10,95
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
/90143540
Lote: 223015 Nota: 324
2/0
3,35
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
4568 COMPLEXO B 2 ML CX 100 AMPS
/90228324
Lote: 223015 Nota: 324
2/0
1,50
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
2889 BUSCOPAN COMP AMP 5 ML 3
/90196538
Lote: 223015 Nota: 324
3/0
12,64
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
6758 PLASIL INJ CX 100 AMPS EMB
/90380037
Lote: 223015 Nota: 324
2/0
3,09
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
2801 AGUA P/ INJECAO AMP 5 ML
/90193423
Lote: 223015 Nota: 324
1/0
0,70
89000265
265 11000169 09/09/2011 15:35:00 7647927 / 223015 / 471
/92395511
Lote: 223015 Nota: 324
2/0
50,85
21000071 04/10/2011 12:49:00 7650885 / 223086 / 3418245
21000071 04/10/2011 12:49:00 7650885 / 223086 / 3418245
53218 CATETER INTRAVASCULAR
805 CLORIDRATO DE RANITIDINA
10424 CEFTRIAX IM 1 G 1 AMP
Total:
0468000131008
0468000131105
89000098
/ Unimed Imperatriz
2.860,75
Joseane Vale dos Santos

Danilo Augusto Dos Santos Silva
98
16811
20/10/2011 12:00:00 7649557 / 223079 / 420310
/10101012
Lote: 223079 Nota: 324
1/0
58,97
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 40

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
11000008 19/10/2011 12:00:00 7649803 / 223079 / 653680
/10101039
Lote: 223079 Nota: 324
1/0
43,00
89000098
/ Unimed Imperatriz
98
11000008 19/10/2011 12:00:00 7649803 / 223079 / 653680
Lote: 223079 Nota: 324
1/0
14,24
89000098
/ Unimed Imperatriz
98
11000008 19/10/2011 12:00:00 7649803 / 223079 / 653680
/90000021
Lote: 223079 Nota: 324
1/0
7,50
89000098
/ Unimed Imperatriz
98
11000008 19/10/2011 12:00:00 7649803 / 223079 / 653680
/90000013
Lote: 223079 Nota: 324
1/0
27,09
Total:
0468000135003
0468000135305
150,80
Julio Gustavo L Santos

Blenda C M L Santos
11003061
01/12/2011 08:10:00 7660974 / 99999 / 30462075
/40901106
1/0
239,62
11003061
01/12/2011 08:10:00 7660974 / 99999 / 30462075
/20102038
1/0
30,70
11003061
01/12/2011 08:10:00 7660974 / 99999 / 30462075
/40101045
1/0
30,70
11003061
01/12/2011 08:10:00 7660974 / 99999 / 30462075
/90000021
19,16 / 0
2 UCO
301,02
Total:
0468000137006
0468000137103
0,00
Justino C de Almeida
Fabio C de Almeida
1100153
20/12/2011
7617590 / 99999 / 10256159
/10101012
1/0
83,07
1360554
/ Christiane Gomes De Azevedo
06/12/2011
7666869 / 99999 / 10246839
/10101012
1/0
83,07
0468000137120
Cristiano Dos Santos De Almeida
210020543
07/12/2011 10:45:00 7630239 / 99999 / 6876925
/10101039
1/0
40,95
310000030
07/12/2011
7617271 / 99999 / 30497445
40302040 Glicose
/40302040
1/0
5,28
310000030
07/12/2011
7617271 / 99999 / 30497445
/40302504
1/0
9,76
310000030
07/12/2011
7617271 / 99999 / 30497445
1/0
11,78
310000030
07/12/2011
7617271 / 99999 / 30497445
/40302512
1/0
9,76
310000030
07/12/2011
7617271 / 99999 / 30497445
40302423 Sdio
/40302423
1/0
5,28
210002590
/ Clinimagem Clinica Mdica E
07/12/2011 15:12:00 7646138 / 99999 / 663036
/40801063
1/0
35,14
310000030
07/12/2011
7617271 / 99999 / 30497445
40302318 Potssio
/40302318
1/0
5,28
310000030
07/12/2011
7617271 / 99999 / 30497445
/40308391
1/0
36,82
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 41

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
210020560
07/12/2011 10:59:00 7629407 / 99999 / 30497284
210002590
07/12/2011 15:12:00 7646138 / 99999 / 663036
210002590
310000030
Obs.
Qtd/Partic
1/0
2 UCO
/90000021
1,47 / 0
0,00
07/12/2011 15:12:00 7646138 / 99999 / 663036
1 FILME
0,1296 / 0
2,94
07/12/2011
2 UCO
/90000021
3,471 / 0
0,00
Total:
0468000139009
0468000139092
52,65
381,78
Karla Costa E Silva

Danilo De Deus Moreno
310000145
09/11/2011 07:54:00 7616017 / 99999 / 407507
310000145
09/11/2011 07:54:00 7616017 / 99999 / 407507

2 UCO
/40601110
1/0
/90000021
2,06 / 0
58,42
0,00
58,42
Total:
0468000141003
0468000141003
Vl.Cob
/10101039
7617271 / 99999 / 30497445
Katia da Silva Burgos

Katia da Silva Burgos
210000518
/ Otorrinos Reunidos Ltda
01/12/2011 10:12:00 7643140 / 99999 / 519727
40103749 Vectoeletronistagmografia -
/40103749
1/0
131,79
210000518
01/12/2011 10:12:00 7643140 / 99999 / 519727
41401476 Testes vestibulares, com prova calrica, /41401476
1/0
105,56
210000518
01/12/2011 10:12:00 7643140 / 99999 / 519727
40103650 Registro do nistagmo pendular
/40103650
1/0
90,58
210000518
01/12/2011 10:12:00 7643140 / 99999 / 519727
/90000021
11,537 / 0
0468000141100
2 UCO
0,00
Luis Fernando B Garcia
11003053
/ Roberto Cesar Teixeira Bringel
25/11/2011
7657833 / 99999 / 10239768
/10101012
1/0
83,07
11002103
25/11/2011
7665689 / 99999 / 10240266
/10101012
1/0
83,07
110000052
29/11/2011 15:23:00 7604752 / 99999 / 30484948
40804011 Bacia
/40804011
1/0
15,35
110000052
29/11/2011 15:23:00 7604752 / 99999 / 30484948
40804097 P ou pododctilo
/40804097
2/0
30,70
110000052
29/11/2011 15:23:00 7604752 / 99999 / 30484948
40804054 Joelho
/40804054
2/0
30,70
110000052
29/11/2011 15:23:00 7604752 / 99999 / 30484948
1 FILME
0,73 / 0
16,57
110000052
29/11/2011 15:23:00 7604752 / 99999 / 30484948
2 UCO
/90000021
6,1 / 0
0,00
Total:
0468000142000
0468000142000
Katiana Galeno De Sousa

Katiana Galeno De Sousa
587,39
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 42

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
4549
/ Joana Darc Matos Franca De
15/12/2011
7675695 / 99999 / 10252715
/10101012
Obs.
Qtd/Partic
1/0
1340120
Klycia Pinheiro Silva

Klycia Pinheiro Silva
/ Lucia Maria Moreira Lopes
0468000143510
16/12/2011
7675754 / 99999 / 1895920
/10101012
1/0
83,07
/40601137
1/0
29,21
/90000021
1,03 / 0
Marinalva Pinheiro Silva
310000250
18/11/2011 10:00:00 7619849 / 99999 / 675691
310000250
18/11/2011 10:00:00 7619849 / 99999 / 675691
2 UCO
Total:
0468000145009
0468000145513
83,07
83,07
Total:
0468000143006
0468000143006
Vl.Cob
0,00
112,28
Lhusandro C Campos Pinto

Maria Luisa C Pinto
11000909
07/12/2011
11000909
310000226
7664856 / 99999 / 107505
/10101012
1/0
83,07
07/12/2011 20:43:00 7668888 / 99999 / 719602
/41301102
1/0
25,58
22/12/2011 15:49:00 7627700 / 99999 / 30518378
/40601137
1/0
29,21
11000909
07/12/2011 20:43:00 7668888 / 99999 / 719602
2 UCO
/90000021
2,78 / 0
0,00
310000226
22/12/2011 15:49:00 7627700 / 99999 / 30518378
2 UCO
/90000021
1,03 / 0
0,00
Total:
0468000147001
0468000147001
3921
137,86
Liana Cecilia Raposo Silva

Liana Cecilia Raposo Silva
/ Carlos Adriano Pacheco De
01/12/2011
7676599 / 99999 / 10244089
/10101012
1/0
83,07
Total:
0468000148008
0468000148512
83,07
Lidia F de A Santos
Jesuina B de A Santos
11000739
/ Luciane Maria Oliveira Brito
09/12/2011
210000291
310030141
310030141
7646741 / 99999 / 10248747
/10101012
1/0
83,07
14/12/2011 14:57:00 7624852 / 99999 / 30507056
41001010 Crnio ou sela trsica ou rbitas
/41001010
1/0
341,42
09/12/2011
7613909 / 99999 / 656645
/40311210
1/0
11,20
09/12/2011
7613909 / 99999 / 656645
40316556 Triiodotironina (T3)
/40316556
1/0
54,57
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 43

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
210000291
14/12/2011 08:19:00 7624841 / 99999 / 30506014
40808130 Densitometria ssea - 2 segmentos
/40808130
1/0
185,89
310030141
09/12/2011
7613909 / 99999 / 656645
40302040 Glicose
/40302040
1/0
5,28
310030141
09/12/2011
7613909 / 99999 / 656645
40316491 T4 livre
/40316491
1/0
34,39
210000291
14/12/2011 08:19:00 7624841 / 99999 / 30506014
40808033 MAMOGRAFIA
/40808033
1/0
85,11
310030141
09/12/2011
/40303110
1/0
12,78
210000291
14/12/2011 08:19:00 7624841 / 99999 / 30506014
/40901203
1/0
76,72
310030141
09/12/2011
7613909 / 99999 / 656645
/40601137
1/0
29,21
310030141
09/12/2011
7613909 / 99999 / 656645
/40316521
1/0
27,52
310030141
09/12/2011
7613909 / 99999 / 656645
40316548 Tiroxina (T4)
/40316548
1/0
27,52
310030141
09/12/2011
7613909 / 99999 / 656645
1/0
11,78
310030141
09/12/2011
7613909 / 99999 / 656645
/40302750
1/0
22,46
210000291
14/12/2011 08:19:00 7624841 / 99999 / 30506014
2 UCO
/90000021
16,43 / 0
0,00
210000291
14/12/2011 14:57:00 7624852 / 99999 / 30507056
2 UCO
/90000021
19,1 / 0
0,00
210000291
14/12/2011 14:57:00 7624852 / 99999 / 30507056
1 FILME
1/0
22,70
210000291
14/12/2011 08:19:00 7624841 / 99999 / 30506014
1 FILME
1,37 / 0
31,10
310030141
09/12/2011
2 UCO
/90000021
14,654 / 0
7613909 / 99999 / 656645
7613909 / 99999 / 656645
1.062,72
Total:
0468000149004
0468000149004
Lino Osvaldo Serra Sousa Segundo

Lino Osvaldo Serra Sousa Segundo
/ Antonio Afonso Reis Farias
5440
0468000149012
11002030
12/12/2011
7655102 / 99999 / 10249721
/10101012
1/0
83,07
7671465 / 99999 / 139209
/10101012
1/0
83,07
Therena Correia Lima Sousa
15/12/2011
166,14
Total:
0468000150002
0468000150002
4186
/ Aloisio Rosado Filho
0,00
Lourdilene De Fatima Moraes Serejo

Lourdilene De Fatima Moraes Serejo
06/12/2011
7656016 / 99999 / 10246746
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 44

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
4134
/ Manoela Fonseca Rodrigues
0468000150096
28/11/2011
7675239 / 99999 / 1491780
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
Marcus Aurelio Serejo Dias
210020438
01/12/2011 13:15:00 7638484 / 99999 / 30478909
20103506 Patologia osteomioarticular em um
/20103506
1/0
26,66
210020438
01/12/2011 13:15:00 7638484 / 99999 / 30478909
20103506 Patologia osteomioarticular em um
/20103506
3/0
79,99
110000079
28/11/2011 19:04:00 7636372 / 99999 / 30471946
41101227 Coluna cervical ou dorsal ou lombar
/41101227
1/0
731,55
110000079
28/11/2011 20:16:00 7636372 / 99999 / 30471946
41101227 Coluna cervical ou dorsal ou lombar
/41101227
1/0
731,55
3737
/ Daniela Arajo Silva
09/12/2011 12:00:00 7679158 / 223940 / 4137377
40103315 Eletroneuromiografia de MMII
/40103315
1/0
140,69
110000079
28/11/2011 19:04:00 7636372 / 99999 / 30471946
2 UCO
/90000021
94,48 / 0
110000079
28/11/2011 19:04:00 7636372 / 99999 / 30471946
1 FILME
8/0
210020438
01/12/2011 13:15:00 7638484 / 99999 / 30478909
2 UCO
/90000021
1,08 / 0
0,00
3737
/ Daniela Arajo Silva
09/12/2011 12:00:00 7679158 / 223940 / 4137377
2 UCO
/90000021
9,6 / 0
0,00
/10101012
1/0
0468000150100
11002049
09/12/2011
7671260 / 99999 / 1946000
Luis Fernando Lopes Silva

Luenir Fabia L Silva
17449
19/12/2011
17449
19/12/2011 08:51:00 7669669 / 99999 / 30512870
17449
19/12/2011 08:51:00 7669669 / 99999 / 30512870
7656155 / 99999 / 10254398
/10101012
1/0
83,07
/41301250
2/0
61,40
/90000021
0,58 / 0
2 UCO
Total:
30/11/2011 10:00:00 7606899 / 99999 / 141550
310000242
30/11/2011 10:00:00 7606899 / 99999 / 141550
0468000156019
144,47
40302032 Glicemia aps sobrecarga com dextrosol /40302032

2 UCO
1/0
7,57
/90000021
0,54 / 0
0,00
/10101012
1/0
Ana Julia C Araujo
0468000156302
0,00
Luiz Antonio Martins Araujo

Luiz Antonio Martins Araujo
310000242
11000909
83,07
2.141,23
Total:
0468000156000
0468000156000
181,58
Pedro Henrique M Serejo Dias
/ Rubens Sousa Santos
0468000152102
0468000152315
0,00
14/12/2011
Luana Campos Araujo
7664828 / 99999 / 10252307
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 45

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
11000909
14/12/2011
310000145
310000145
310000145
Obs.
Qtd/Partic
Vl.Cob
/10101012
1/0
83,07
12/11/2011 10:22:00 7607624 / 99999 / 624217
40316416 Prolactina
/40316416
2/0
74,95
12/11/2011 10:22:00 7607624 / 99999 / 624217
40316416 Prolactina
/40316416
1/0
37,48
12/11/2011 10:22:00 7607624 / 99999 / 624217
/90000021
8,34 / 0
0468000156507
7664827 / 99999 / 10252313
2 UCO
0,00
Luiz Antonio Souza Araujo
11001808
/ Francisco Das Chagas Monteiro
14/12/2011
7657145 / 99999 / 10251893
/10101012
1/0
83,07
4473
/ Alessandra Porto De Macedo
06/12/2011
7663769 / 99999 / 10246616
/10101012
1/0
83,07
310000145
02/12/2011 07:55:00 7636593 / 99999 / 170401
40302040 Glicose
/40302040
1/0
5,28
310000145
02/12/2011 07:55:00 7636593 / 99999 / 170401
/40302512
1/0
9,76
310000145
02/12/2011 07:55:00 7636593 / 99999 / 170401
40306992 Hepatite B - HBSAC (anti-antgeno de
/40306992
1/0
24,52
310000145
02/12/2011 07:55:00 7636593 / 99999 / 170401
/40301885
1/0
9,76
310000145
02/12/2011 07:55:00 7636593 / 99999 / 170401
/40302504
1/0
9,76
310000145
02/12/2011 07:55:00 7636593 / 99999 / 170401
/40301990
1/0
9,76
310000145
02/12/2011 07:55:00 7636593 / 99999 / 170401
/40304590
1/0
7,70
110000443
14/12/2011 10:53:00 7623522 / 99999 / 30506618
1/0
15,35
310000145
02/12/2011 07:55:00 7636593 / 99999 / 170401
/40302750
1/0
22,46
110000443
14/12/2011 10:53:00 7623522 / 99999 / 30506618
2 UCO
/90000021
0,75 / 0
0,00
310000145
02/12/2011 07:55:00 7636593 / 99999 / 170401
2 UCO
/90000021
5,634 / 0
0,00
566,63
Total:
0468000157007
0468000157015
Luiz Fernando Martins Araujo

Ma de Lourdes E Ribeiro
310000145
08/11/2011 12:00:00 7677618 / 223147 / 652316
/40311210
1/0
11,20
310000145
08/11/2011 12:00:00 7677619 / 223147 / 6523161
/40302512
1/0
9,76
310000145
08/11/2011 12:00:00 7677619 / 223147 / 6523161
/40302504
1/0
9,76
310000145
08/11/2011 12:00:00 7677619 / 223147 / 6523161
40302040 Glicose
/40302040
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 46

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000145
08/11/2011 12:00:00 7677618 / 223147 / 652316
1/0
11,78
310000145
08/11/2011 12:00:00 7677618 / 223147 / 652316
/40316521
1/0
27,52
310000145
08/11/2011 12:00:00 7677619 / 223147 / 6523161
40301150 cido rico
/40301150
1/0
5,28
310000145
08/11/2011 12:00:00 7677618 / 223147 / 652316
/40307760
1/0
9,99
310000145
08/11/2011 12:00:00 7677619 / 223147 / 6523161
/40302750
1/0
22,46
310000145
08/11/2011 12:00:00 7677618 / 223147 / 652316
2 UCO
/90000021
4,44 / 0
0,00
310000145
08/11/2011 12:00:00 7677619 / 223147 / 6523161
2 UCO
/90000021
2,214 / 0
0,00
0468000157511
Doralice G M Araujo
17449
02/12/2011
7656132 / 99999 / 10244596
/10101012
1/0
83,07
11003010
/ Jucelia Sousa Santos Ganz
30/11/2011
7679646 / 99999 / 10242608
/10101012
1/0
83,07
4473
/ Alessandra Porto De Macedo
06/12/2011
7663768 / 99999 / 10246593
/10101012
1/0
83,07
17449
14/12/2011 14:00:00 7669663 / 99999 / 30506996
/41301269
2/0
95,94
310000030
14/12/2011
7624388 / 99999 / 30501992
40306950 Hepatite B - HBCAC - IgG (anti-core IgG /40306950
1/0
24,52
310000030
14/12/2011
7624388 / 99999 / 30501992
/40304590
1/0
7,70
310000030
14/12/2011
7624388 / 99999 / 30501992
/40301885
1/0
9,76
310000030
14/12/2011
7624388 / 99999 / 30501992
40302040 Glicose
/40302040
1/0
5,28
310000030
14/12/2011
7624388 / 99999 / 30501992
40306992 Hepatite B - HBSAC (anti-antgeno de
/40306992
1/0
24,52
310000030
14/12/2011
7624388 / 99999 / 30501992
40316270 Ferritina
/40316270
1/0
27,61
310000030
14/12/2011
7624388 / 99999 / 30501992
40316114 Antigeno Australia (HBSAG)
/40316114
1/0
35,29
310000030
14/12/2011
7624388 / 99999 / 30501992
/40307026
1/0
33,72
310000030
14/12/2011
7624388 / 99999 / 30501992
40301761 Eletroferese de protenas
/40301761
1/0
24,49
310000030
14/12/2011
7624388 / 99999 / 30501992
/40301397
1/0
5,28
310000030
14/12/2011
7624388 / 99999 / 30501992
/40301990
1/0
9,76
310000030
14/12/2011
7624388 / 99999 / 30501992
/40302512
1/0
9,76
17449
02/12/2011 08:36:00 7669646 / 99999 / 30489995
/41301323
1/0
15,35
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 47

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
110000079
12/12/2011 06:54:00 7636274 / 99999 / 30499400
40901130 Abdome superior (fgado, vias biliares,
/40901130
1/0
99,91
310000030
14/12/2011
7624388 / 99999 / 30501992
/40302504
1/0
9,76
310000030
14/12/2011
7624388 / 99999 / 30501992
/40302750
1/0
22,46
310000030
14/12/2011
7624388 / 99999 / 30501992
2 UCO
/90000021
16,716 / 0
0,00
17449
02/12/2011 08:36:00 7669646 / 99999 / 30489995
2 UCO
/90000021
0,5 / 0
0,00
17449
14/12/2011 14:00:00 7669663 / 99999 / 30506996
2 UCO
/90000021
6,06 / 0
0,00
110000079
12/12/2011 06:54:00 7636274 / 99999 / 30499400
2 UCO
/90000021
3,86 / 0
0,00
110000079
12/12/2011 06:54:00 7636274 / 99999 / 30499400
1 FILME
0,51 / 0
11,58
834,93
Total:
0468000159000
0468000159093
Luzia A R de Oliveira
Francisco De Assis De Oliveira
14148
/ Raimundo Joao Costa Furtado
07/11/2011 16:07:00 7679282 / 223988 / 30451188
14148
07/11/2011 16:07:00 7679282 / 223988 / 30451188

2 UCO
/90000021
1/0
0,75 / 0
0,00
15,35
Total:
0468000163007
0468000163007
15,35
Marcelo Henrique R Freire

Marcelo Henrique R Freire
1937
02/12/2011
210020314
/ S.O.S Trauma Ltda
210020314
7601612 / 99999 / 10244679
/10101012
1/0
83,07
12/12/2011 10:28:00 7640355 / 99999 / 30502627
20103514 Patologia osteomioarticular em diferentes /20103514
5/0
153,50
/ S.O.S Trauma Ltda
02/12/2011 09:45:00 7601864 / 99999 / 30490358
40803066 Articulao acromioclavicular
/40803066
1/0
15,35
210020314
/ S.O.S Trauma Ltda
02/12/2011 09:45:00 7601864 / 99999 / 30490358
40803074 Articulao escapuloumeral (ombro)
/40803074
1/0
15,35
210020314
/ S.O.S Trauma Ltda
02/12/2011 09:45:00 7601864 / 99999 / 30490358
/40805018
1/0
15,35
210020314
/ S.O.S Trauma Ltda
02/12/2011 09:45:00 7601864 / 99999 / 30490358
40803082 Brao
/40803082
1/0
15,35
210020314
/ S.O.S Trauma Ltda
12/12/2011 10:28:00 7640355 / 99999 / 30502627
/20103492
5/0
153,50
210020314
/ S.O.S Trauma Ltda
02/12/2011 09:45:00 7601864 / 99999 / 30490358
2 UCO
/90000021
4,76 / 0
210020314
/ S.O.S Trauma Ltda
02/12/2011 09:45:00 7601864 / 99999 / 30490358
1 FILME
0,4708 / 0
210020314
/ S.O.S Trauma Ltda
12/12/2011 10:28:00 7640355 / 99999 / 30502627
2 UCO
/90000021
10,8 / 0
0,00
10,69
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 48

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468000163317
Kadyja Santos Freire
Obs.
Qtd/Partic
Vl.Cob
11001298
/ Maria Da Gloria Melo
25/11/2011
7660675 / 99999 / 1466171
/10101012
1/0
83,07
1110710
/ Maria De Fatima A Calderoni
28/11/2011
7680579 / 99999 / 189531
/10101012
1/0
83,07
210020438
25/11/2011 11:58:00 7639405 / 99999 / 714991
40103463 Otoemisses evocadas transientes
/40103463
1/0
59,96
210020438
25/11/2011 11:58:00 7639405 / 99999 / 714991
/90000021
1,462 / 0
2 UCO
688,26
Total:
0468000165000
0468000165000
0,00
Marcos Antonio S Freire

Marcos Antonio S Freire
310000145
02/12/2011 08:18:00 7636910 / 99999 / 6662749
/40301885
1/0
9,76
310000145
02/12/2011 08:18:00 7636910 / 99999 / 6662749
40302318 Potssio
/40302318
1/0
5,28
310000145
02/12/2011 08:18:00 7636910 / 99999 / 6662749
40302423 Sdio
/40302423
1/0
5,28
310000145
02/12/2011 08:18:00 7636910 / 99999 / 6662749
/40301990
1/0
9,76
310000145
02/12/2011 08:18:00 7636910 / 99999 / 6662749
40301630 Creatinina
/40301630
1/0
5,28
310000145
02/12/2011 08:18:00 7636910 / 99999 / 6662749
/90000021
2,601 / 0
0,00
/10101012
1/0
0468000165026
3813
2 UCO
Rose Nea dos Santos
/ Joao Furtado De Araujo
02/12/2011
7667012 / 99999 / 10244953
118,43
Total:
0468000167002
0468000167118
210020543
Maria Aldenir Dos Santos Nunes

Elias Ribeiro Nunes Da Silva
22/11/2011 10:23:00 7604192 / 99999 / 729811
/10101039
1/0
52,65
52,65
Total:
0468000170003
0468000170003
83,07
Maria Cristina N Ferreira

Maria Cristina N Ferreira
950000970
12/12/2011 08:19:00 7678757 / 223677 / 451786
1/0
157,75
950000970
12/12/2011 09:39:00 7678758 / 223677 / 713323
40202550 Polipectomia do esfago, estmago ou
/40202550
1/0
362,40
950000970
12/12/2011 08:19:00 7678757 / 223677 / 451786
/90000021
1/0
13,86
950000970
12/12/2011 08:19:00 7678757 / 223677 / 451786
2 UCO
/90000021
13,67 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 49

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
950000970
12/12/2011 09:39:00 7678758 / 223677 / 713323
2 UCO
/90000021
Obs.
Qtd/Partic
14,806 / 0
11002103
Maria Cristina Sousa

Ashbel S Sousa Muniz
30/11/2011
7665666 / 99999 / 10242566
/10101012
1/0
Maria Das Dores Almeida

Maria Das Dores Almeida
5440
/ Antonio Afonso Reis Farias
22/12/2011
310000145
30/11/2011 12:00:00 7677620 / 223147 / 451785
310000145
30/11/2011 12:00:00 7677620 / 223147 / 451785
7655061 / 99999 / 10257401
/10101012
1/0
83,07
/40311210
1/0
11,20
/90000021
0,81 / 0
2 UCO
Total:
0468000173002
0468000173509
83,07
83,07
Total:
0468000172006
0468000172006
0,00
534,01
Total:
0468000171000
0468000171107
Vl.Cob
0,00
94,27
Maria Das Graas De F Moraes

Jaldo da Cruz Moraes
310000145
18/11/2011 07:13:00 7608668 / 99999 / 435344
40302040 Glicose
/40302040
1/0
5,28
310000145
18/11/2011 07:13:00 7608668 / 99999 / 435344
40302040 Glicose
/40302040
1/0
5,28
310000145
18/11/2011 07:13:00 7608668 / 99999 / 435344
1/0
11,78
310000145
18/11/2011 07:13:00 7608668 / 99999 / 435344
/40302733
1/0
44,71
310000145
18/11/2011 07:13:00 7608668 / 99999 / 435344
/40302750
1/0
22,46
310000145
18/11/2011 07:13:00 7608668 / 99999 / 435344
/90000021
4,911 / 0
2 UCO
89,51
Total:
0468000174009
0468000174009
Maria De Fatima Do Nascimento

Maria De Fatima Do Nascimento
18305
/ Honorina Anne Pessoa Costa
07/12/2011
18305
07/12/2011 13:59:00 7659210 / 99999 / 30497888
18305
07/12/2011 13:59:00 7659210 / 99999 / 30497888
7659165 / 99999 / 10248072
/10101012
1/0
83,07
/41301102
1/0
25,58
/90000021
2,78 / 0
2 UCO
Total:
0468000177008
0,00
Maria De Nazareth A Aranha
0,00
108,65
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 50

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468000177512
Maria Da Conceio E Alvares
Obs.
Qtd/Partic
Vl.Cob
89000088
/ Unimed Belem Coop De
88
10000096 30/09/2011
7648221 / 223066 / 16170114
40301583 Colesterol (HDL)
/40301583
Lote: 223066 Nota: 324
1/0
8,85
89000088
88
10000096 30/09/2011
7648221 / 223066 / 16170114
40301591 Colesterol (LDL)
/40301591
Lote: 223066 Nota: 324
1/0
11,79
89000088
88
10000096 30/09/2011
7648221 / 223066 / 16170114
/40316521
Lote: 223066 Nota: 324
1/0
25,06
89000088
88
10000096 30/09/2011
7648221 / 223066 / 16170114
/40302512
Lote: 223066 Nota: 324
1/0
4,13
89000088
88
10000096 30/09/2011
7648221 / 223066 / 16170114
40302318 Potssio
/40302318
Lote: 223066 Nota: 324
1/0
4,13
89000088
88
10000096 30/09/2011
7648221 / 223066 / 16170114
Lote: 223066 Nota: 324
1/0
8,85
89000088
88
10000096 30/09/2011
7648221 / 223066 / 16170114
40302040 Glicose
/40302040
Lote: 223066 Nota: 324
1/0
4,13
89000088
88
10000096 30/09/2011
7648221 / 223066 / 16170114
/40301605
Lote: 223066 Nota: 324
1/0
4,13
89000088
88
10000096 30/09/2011
7648221 / 223066 / 16170114
/40311210
Lote: 223066 Nota: 324
1/0
5,90
89000088
88
10000096 30/09/2011
7648221 / 223066 / 16170114
/40302504
Lote: 223066 Nota: 324
1/0
4,13
89000088
88
10000096 30/09/2011
7648221 / 223066 / 16170114
40316491 T4 livre
/40316491
Lote: 223066 Nota: 324
1/0
25,06
89000088
88
10000096 30/09/2011
7648221 / 223066 / 16170114
/40302547
Lote: 223066 Nota: 324
1/0
5,90
Total:
0468000178004
0468000178004
112,06
Maria Do Rosario E Alvares

Maria Do Rosario E Alvares
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
/40316521
1/0
27,52
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
40301150 cido rico
/40301150
1/0
5,28
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
/40302512
1/0
9,76
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
40316491 T4 livre
/40316491
1/0
34,39
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
/40308391
1/0
36,82
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
40302580 Uria
/40302580
1/0
5,28
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
/40302504
1/0
9,76
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
1/0
11,78
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
40302040 Glicose
1/0
5,28
/40302040
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 51

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
40302423 Sdio
/40302423
1/0
5,28
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
/40301990
1/0
9,76
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
40301630 Creatinina
/40301630
1/0
5,28
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
/40316556
1/0
54,57
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
/40302733
1/0
44,71
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
/40302750
1/0
22,46
310000030
25/11/2011 12:00:00 7677715 / 223183 / 400077137
/90000021
16,822 / 0
2 UCO
287,93
Total:
0468000180009
0468000180009
0,00
Maria Elizabeth De Nazare Bulcao

Maria Elizabeth De Nazare Bulcao
1201804
/ Mahiba Mattar R De Sousa
19/12/2011
7661302 / 99999 / 10254714
/10101012
1/0
83,07
21002604
/ F C Leite - Me
29/11/2011
7639265 / 99999 / 596399

/20103484
10 / 0
293,55
21002604
/ F C Leite - Me
29/11/2011
7639265 / 99999 / 596399
4,7 / 0
0,00
2 UCO
/90000021
376,62
Total:
0468000182001
0468000182001
Maria Hedna B A Ferreira

Maria Hedna B A Ferreira
310000145
17/11/2011 07:18:00 7607233 / 99999 / 665133
/40302504
1/0
9,76
310000145
17/11/2011 07:18:00 7607233 / 99999 / 665133
40316491 T4 livre
/40316491
1/0
34,39
310000145
17/11/2011 07:18:00 7607233 / 99999 / 665133
40302580 Uria
/40302580
1/0
5,28
310000145
17/11/2011 07:18:00 7607233 / 99999 / 665133
40302040 Glicose
/40302040
1/0
5,28
310000145
17/11/2011 07:18:00 7607233 / 99999 / 665133
/40302512
1/0
9,76
310000145
17/11/2011 07:18:00 7607233 / 99999 / 665133
1/0
11,78
310000145
17/11/2011 07:18:00 7607233 / 99999 / 665133
/40316521
1/0
27,52
310000145
17/11/2011 07:18:00 7607233 / 99999 / 665133
40301630 Creatinina
/40301630
1/0
5,28
110000052
28/11/2011 15:13:00 7616208 / 99999 / 30482936
40901211 Estruturas superficiais (cervical ou
/40901211
1/0
30,70
310000145
17/11/2011 07:18:00 7607233 / 99999 / 665133
/40311210
1/0
11,20
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 52

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
310000145
17/11/2011 07:18:00 7607233 / 99999 / 665133
110000052
28/11/2011 15:13:00 7616208 / 99999 / 30482936
110000052
310000145
Obs.
Qtd/Partic
1/0
2 UCO
/90000021
3,42 / 0
0,00
28/11/2011 15:13:00 7616208 / 99999 / 30482936
1 FILME
0,17 / 0
3,86
17/11/2011 07:18:00 7607233 / 99999 / 665133
2 UCO
/90000021
8,871 / 0
0,00
Total:
0468000183008
0468000183008
18/10/2011 08:06:00 7679250 / 223979 / 400075886
110000079
18/10/2011 08:06:00 7679250 / 223979 / 400075886
177,27
40901076 Ecodopplercardiograma com estresse

2 UCO
/40901076
1/0
/90000021
28 / 0
0,00
Maria Izabel P Lemos

Jose Sidney V Lemos
/ Unimed Recife
34
18009179 19/11/2011 07:29:50 7647839 / 223008 / 8258072
/40316149
Lote: 223008 Nota: 324
1/0
Total:
0468000185000
0468000185701
466,53
466,53
Total:
89000034
22,46
Maria Helena Braga De Carvalho Kupsch

Maria Helena Braga De Carvalho Kupsch
110000079
0468000184004
0468000184098
Vl.Cob
/40302750
44,23
44,23
Maria Jose Pinto Rosa

Paulo Roberto Diniz Pinto
11001751
/ Iara Silva Sousa Pinheiro
06/12/2011 08:27:00 7659721 / 99999 / 451757
40201120 Endoscopia digestiva alta
/40201120
1/0
127,90
310030249
/ Udt-Med (Unid De Diagnstico
09/12/2011 13:53:00 7633548 / 99999 / 30500145
/40601110
3/0
175,25
21002622
06/12/2011 07:19:00 7646019 / 99999 / 451757
/40201120
/Anestesis
1/1
223,81
11001751
06/12/2011 07:19:00 7646019 / 99999 / 451757
/40201120
/Clinico
1/1
115,13
310030249
09/12/2011 13:53:00 7633548 / 99999 / 30500145
40601269 Colorao especial por colorao
/40601269
3/0
87,64
110000052
06/12/2011 07:19:00 7646019 / 99999 / 451757
TC13 PORTE III
/80021034
1/0
278,68
110000052
06/12/2011 07:19:00 7646019 / 99999 / 451757
/80061400
1/0
12,26
11001751
06/12/2011 08:27:00 7659721 / 99999 / 451757
2 UCO
/90000021
12,585 / 0
0,00
310030249
09/12/2011 13:53:00 7633548 / 99999 / 30500145
2 UCO
/90000021
9,27 / 0
0,00
110000052
06/12/2011 07:19:00 7646019 / 99999 / 451757
/90000021
1/0
110000052
06/12/2011 07:19:00 7646019 / 99999 / 451757
2 UCO
/90000021
12,585 / 0
119,74
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 53

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
11001751
06/12/2011 08:27:00 7659721 / 99999 / 451757
/90000013
1/0
13,86
110000052
06/12/2011 07:19:00 7646019 / 99999 / 451757
/90000013
1/0
58,61
Total:
0468000187003
0468000187003
12919
1.212,88
Mario G de J B Pereira
Mario G de J B Pereira
/ Antonio De Padua Silva Souza
30/11/2011
7677507 / 99999 / 10243019
/10101012
1/0
83,07
Total:
0468000193003
0468000193003
83,07
Moacir Santos
Moacir Santos
110010198
18/11/2011 09:00:00 7643337 / 99999 / 475594
40601200 Procedimento diagnstico em pea
/40601200
2/0
178,14
110010198
18/11/2011 09:00:00 7643337 / 99999 / 475594
40601226 Procedimento diagnstico em grupos de /40601226
2/0
116,84
110010198
18/11/2011 08:39:00 7646650 / 99999 / 475593
30101522 Extensos ferimentos, cicatrizes ou
/30101522
2/0
736,82
110010198
18/11/2011 08:39:00 7646650 / 99999 / 475593
/80051510
1/0
45,45
110010198
18/11/2011 08:39:00 7646650 / 99999 / 475593
T134 POS ANESTSICO
/80000037
1/0
22,82
110010198
18/11/2011 08:39:00 7646650 / 99999 / 475593
TC14 PORTE IV
/80021042
1/0
183,95
110010198
18/11/2011 09:00:00 7643337 / 99999 / 475594
2 UCO
/90000021
7,52 / 0
110010198
18/11/2011 08:39:00 7646650 / 99999 / 475593
/90000021
1/0
129,51
110010198
18/11/2011 08:39:00 7646650 / 99999 / 475593
/90000013
1/0
63,11
1.476,64
Total:
0468000195006
0468000195090
0,00
Nelma Cristina Reis Ribeiro

Ronaldo Santos de Brito
3393
/ Giovanna Valeria Belo Cordeiro
24/11/2011
310000242
3393
7672546 / 99999 / 10239045
/10101012
1/0
83,07
28/11/2011 10:00:00 7606944 / 99999 / 486984
/40316149
1/0
32,99
13/12/2011 10:21:00 7670296 / 99999 / 30504700
40201066 Cistoscopia e/ou uretroscopia
/40201066
1/0
93,80
310000242
28/11/2011 10:00:00 7606944 / 99999 / 486984
40302040 Glicose
/40302040
1/0
5,28
3393
13/12/2011 10:21:00 7670296 / 99999 / 30504700
41301340 Urodinmica completa
/41301340
1/0
140,69
310000242
28/11/2011 10:00:00 7606944 / 99999 / 486984
40302580 Uria
/40302580
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 54

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
210000879
06/12/2011
3393
310000242
Obs.
Qtd/Partic
Vl.Cob
40901173 Abdome inferior masculino (bexiga,
/40901173
1/0
86,18
13/12/2011 10:21:00 7670296 / 99999 / 30504700
90000897 Pct de urodinmica
/41301340
1/0
117,23
28/11/2011 10:00:00 7606944 / 99999 / 486984
40301630 Creatinina
/40301630
1/0
5,28
3393
13/12/2011 10:21:00 7670296 / 99999 / 30504700
90000889 Pct cistoscopia e/ou uretroscopia
/40201066
1/0
162,45
210000879
06/12/2011
1 FILME
0,51 / 0
11,58
310000242
28/11/2011 10:00:00 7606944 / 99999 / 486984
2 UCO
/90000021
3,591 / 0
0,00
210000879
06/12/2011
7605123 / 99999 / 30495318
2 UCO
/90000021
3,41 / 0
0,00
3393
13/12/2011 10:21:00 7670296 / 99999 / 30504700
2 UCO
/90000021
13,39 / 0
0,00
/10101012
1/0
0468000195316
1111120
7605123 / 99999 / 30495318
7605123 / 99999 / 30495318
Gisele Ribeiro De Brito
01/12/2011 12:00:00 7679067 / 223864 / 95164
826,90
Total:
0468000196002
0468000196002
83,07
Nelma C Viana de Souza

Nelma C Viana de Souza
11001115
/ Armando Bogea De Oliveira
13/12/2011
210001530
/ Cegine-Centro
11001115
7603956 / 99999 / 10251438
/10101012
1/0
83,07
03/12/2011 12:00:00 7678168 / 223341 / 483393
40808041 Mamografia digital bilateral
/40808041
1/0
135,16
13/12/2011 18:22:00 7603917 / 99999 / 30505623
1/0
15,35
11001115
13/12/2011 18:22:00 7603917 / 99999 / 30505623
2 UCO
/90000021
0,75 / 0
0,00
210001530
/ Cegine-Centro
03/12/2011 12:00:00 7678168 / 223341 / 483393
2 UCO
/90000021
6,48 / 0
0,00
210001530
/ Cegine-Centro
03/12/2011 12:00:00 7678168 / 223341 / 483393
1 FILME
1,2 / 0
27,24
260,82
Total:
0468000197009
0468000197009
11000364
Nelson de Castro Weba

Nelson de Castro Weba
/ Eduardo De Castro Ferreira
12/12/2011
7659636 / 99999 / 10250202
/10101012
1/0
83,07
Total:
0468000198005
0468000198005
310000030
83,07
Neusa Ribeiro dos Santos

Neusa Ribeiro dos Santos
10/12/2011
7621498 / 99999 / 30498868
40301931 Fsforo
/40301931
1/0
5,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 55

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
09/12/2011
7616840 / 99999 / 30497763
40316165 Calcitonia
/40316165
1/0
94,00
310000030
29/11/2011
7609984 / 99999 / 30482332
/40304590
1/0
7,70
310000030
29/11/2011
7609984 / 99999 / 30482332
40304639 Tempo de tromboplastina parcial ativada /40304639
1/0
7,70
310000030
29/11/2011
7609984 / 99999 / 30482332
40301222 Albumina
/40301222
1/0
5,28
310000030
06/12/2011
7616756 / 99999 / 30489950
40302016 Gasometria (pH, pCO2, SA, O2,
/40302016
1/0
24,49
310000030
29/11/2011
7609984 / 99999 / 30482332
40302423 Sdio
/40302423
1/0
5,28
310000030
29/11/2011
7609984 / 99999 / 30482332
40302237 Magnsio
/40302237
1/0
5,28
310000030
29/11/2011
7609984 / 99999 / 30482332
40301931 Fsforo
/40301931
1/0
5,28
310000030
09/12/2011
7616841 / 99999 / 30497777
/40302016
1/0
24,49
310000030
29/11/2011
7609984 / 99999 / 30482332
40301419 Clcio inico
/40301419
1/0
14,47
310000030
29/11/2011
7609984 / 99999 / 30482332
40302580 Uria
/40302580
1/0
5,28
310000030
09/12/2011
7616840 / 99999 / 30497763
1/0
11,78
310000030
10/12/2011
7621498 / 99999 / 30498868
40301400 Clcio
/40301400
1/0
5,28
310000030
10/12/2011
7621498 / 99999 / 30498868
/40302016
1/0
24,49
310000030
06/12/2011
7616758 / 99999 / 30489964
/40302016
1/0
24,49
310000030
10/12/2011
7621498 / 99999 / 30498868
40302423 Sdio
/40302423
1/0
5,28
310000030
10/12/2011
7621498 / 99999 / 30498868
40302237 Magnsio
/40302237
1/0
5,28
310000030
10/12/2011
7621498 / 99999 / 30498868
40302318 Potssio
/40302318
1/0
5,28
310000030
01/12/2011
7610279 / 99999 / 30470208
/40310400
1/0
67,72
310000030
29/11/2011
7609984 / 99999 / 30482332
40302318 Potssio
/40302318
1/0
5,28
310000030
29/11/2011
7609984 / 99999 / 30482332
/40301397
1/0
5,28
310000030
29/11/2011
7609984 / 99999 / 30482332
/40308391
1/0
36,82
310000030
29/11/2011
7609984 / 99999 / 30482332
40301630 Creatinina
/40301630
1/0
5,28
310000030
06/12/2011
7616757 / 99999 / 30489973
/40302016
1/0
24,49
310000030
29/11/2011
7609984 / 99999 / 30482332
1/0
11,78
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 56

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
29/11/2011
7609984 / 99999 / 30482332
/40302512
1/0
9,76
310000030
01/12/2011
7610279 / 99999 / 30470208
1/0
11,78
310000030
29/11/2011
7609984 / 99999 / 30482332
/40302504
1/0
9,76
310000030
01/12/2011
7610279 / 99999 / 30470208
40302687 Procalcitonina
/40302687
1/0
202,09
310000030
10/12/2011
7621498 / 99999 / 30498868
2 UCO
/90000021
3,699 / 0
0,00
310000030
09/12/2011
7616841 / 99999 / 30497777
2 UCO
/90000021
1,764 / 0
0,00
310000030
06/12/2011
7616757 / 99999 / 30489973
2 UCO
/90000021
1,764 / 0
0,00
310000030
29/11/2011
7609984 / 99999 / 30482332
2 UCO
/90000021
7,593 / 0
0,00
310000030
06/12/2011
7616756 / 99999 / 30489950
2 UCO
/90000021
1,764 / 0
0,00
310000030
06/12/2011
7616758 / 99999 / 30489964
2 UCO
/90000021
1,764 / 0
0,00
310000030
09/12/2011
7616840 / 99999 / 30497763
2 UCO
/90000021
7,8 / 0
0,00
310000030
01/12/2011
7610279 / 99999 / 30470208
2 UCO
/90000021
20,589 / 0
0,00
676,45
Total:
0468000199001
0468000199010
Ney de Barros Bello Filho

Gabriela De C Gaspar De B Bello
310000145
10/12/2011 08:31:00 7615916 / 99999 / 30501239
/40311210
1/0
11,20
310000145
10/12/2011 08:31:00 7615916 / 99999 / 30501239
40301630 Creatinina
/40301630
1/0
5,28
310000145
10/12/2011 08:31:00 7615916 / 99999 / 30501239
1/0
11,78
310000145
10/12/2011 08:31:00 7615916 / 99999 / 30501239
/40302504
1/0
9,76
110000079
14/12/2011 14:01:00 7637106 / 99999 / 30506960
/40901203
1/0
76,72
310000145
10/12/2011 08:31:00 7615916 / 99999 / 30501239
/40302512
1/0
9,76
310000145
10/12/2011 08:31:00 7615916 / 99999 / 30501239
40302040 Glicose
/40302040
1/0
5,28
110000079
14/12/2011 14:01:00 7637106 / 99999 / 30506960
/40901211
1/0
76,72
310000145
10/12/2011 08:31:00 7615916 / 99999 / 30501239
/40302750
1/0
22,46
110000079
14/12/2011 14:01:00 7637106 / 99999 / 30506960
/90000021
6,84 / 0
2 UCO
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 57

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Qtd/Partic
Vl.Cob
310000145
10/12/2011 08:31:00 7615916 / 99999 / 30501239
2 UCO
/90000021
Obs.
3,894 / 0
0,00
110000079
14/12/2011 14:01:00 7637106 / 99999 / 30506960
1 FILME
0,34 / 0
7,72
Total:
0468000200000
0468000200000
236,68
Oriana de Araujo E Silva

Oriana de Araujo E Silva
21002618
/ Unimagem Sao Marcos Ltda
28/11/2011 16:35:00 7643783 / 99999 / 672892
/40901300
1/0
91,69
21002618
28/11/2011 16:35:00 7643783 / 99999 / 672892
40901114 Mamas
/40901114
1/0
86,31
21002618
28/11/2011 16:35:00 7643783 / 99999 / 672892
1 FILME
0,51 / 0
11,58
21002618
28/11/2011 16:35:00 7643783 / 99999 / 672892
2 UCO
/90000021
7,24 / 0
0,00
0468000200026
Sebastiao Castelo Branco Lima Junior
310000242
15/12/2011 10:00:00 7602135 / 99999 / 535905
40302040 Glicose
/40302040
1/0
5,28
310000242
15/12/2011 10:00:00 7602135 / 99999 / 535905
/40302512
1/0
9,76
310000242
15/12/2011 10:00:00 7602135 / 99999 / 535905
/40301990
1/0
9,76
310000242
15/12/2011 10:00:00 7602135 / 99999 / 535905
40301150 cido rico
/40301150
1/0
5,28
310000242
15/12/2011 10:00:00 7602135 / 99999 / 535905
/40302504
1/0
9,76
310000242
15/12/2011 10:00:00 7602135 / 99999 / 535905
/40301885
1/0
9,76
310000242
15/12/2011 10:00:00 7602135 / 99999 / 535905
40301630 Creatinina
/40301630
1/0
5,28
310000242
15/12/2011 10:00:00 7602135 / 99999 / 535905
1/0
11,78
310000242
15/12/2011 10:00:00 7602135 / 99999 / 535905
40302580 Uria
/40302580
1/0
5,28
310000242
15/12/2011 10:00:00 7602135 / 99999 / 535905
/40316149
1/0
32,99
310000242
15/12/2011 10:00:00 7602135 / 99999 / 535905
/40302750
1/0
22,46
310000242
15/12/2011 10:00:00 7602135 / 99999 / 535905
2 UCO
/90000021
7,728 / 0
0,00
0468000200107
Gabriel De Araujo Silva Goncalves
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
40302580 Uria
/40302580
1/0
5,28
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
/40302504
1/0
9,76
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
1/0
11,78
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 58

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
/40302512
1/0
9,76
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
40302040 Glicose
/40302040
1/0
5,28
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
/40311210
1/0
11,20
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
40316491 T4 livre
/40316491
1/0
34,39
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
40316246 Estradiol
/40316246
1/0
40,84
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
40316289 Foliculo estimulante, hormonio (FSH)
/40316289
1/0
29,27
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
40301630 Creatinina
/40301630
1/0
5,28
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
40316335 Hormonio luteinizante (LH)
/40316335
1/0
29,27
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
/40316521
1/0
27,52
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
/40307760
1/0
9,99
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
40316513 Testosterona total
/40316513
1/0
40,84
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
/40302750
1/0
22,46
310000242
30/11/2011 10:00:00 7606308 / 99999 / 30486480
/90000021
19,991 / 0
2 UCO
609,89
Total:
0468000201006
0468000201758
0,00
Orlando Santos Barroso

Ana Clara Carvalho Barroso
310000030
19/11/2011
7609395 / 99999 / 30469233
/40316335
1/0
29,27
310000030
19/11/2011
7609395 / 99999 / 30469233
40316017 17 - alfa-hidroxiprogesterona
/40316017
1/0
40,44
310000030
19/11/2011
7609395 / 99999 / 30469233
40316076 Androstenediona
/40316076
1/0
64,75
310000030
19/11/2011
7609395 / 99999 / 30469233
40316246 Estradiol
/40316246
1/0
40,84
310000030
19/11/2011
7609395 / 99999 / 30469233
/40316289
1/0
29,27
310000030
19/11/2011
7609395 / 99999 / 30469233
/90000021
15,16 / 0
2 UCO
Total:
0468000206008
0468000206016
2178
0,00
204,57
Paulo Guilherme Marques Moreira

Ivanice Borges De Aquines Moreira
/ Jos Xavier De Melo Filho
06/12/2011
7640091 / 99999 / 10246947
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 59

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310030250
/ Guar & Gomes Ltda
15/12/2011 08:05:00 7614829 / 99999 / 30507879
/40311210
1/0
11,20
110000079
06/12/2011 13:41:00 7637076 / 99999 / 30495812
1/0
25,45
310030250
/ Guar & Gomes Ltda
15/12/2011 08:05:00 7614829 / 99999 / 30507879
40301621 Creatina
/40301621
1/0
9,76
310030250
/ Guar & Gomes Ltda
15/12/2011 08:05:00 7614829 / 99999 / 30507879
1/0
11,78
310030250
/ Guar & Gomes Ltda
15/12/2011 08:05:00 7614829 / 99999 / 30507879
/40303110
1/0
12,78
310030250
/ Guar & Gomes Ltda
15/12/2011 08:05:00 7614829 / 99999 / 30507879
40302040 Glicose
/40302040
1/0
5,28
310030250
/ Guar & Gomes Ltda
15/12/2011 08:05:00 7614829 / 99999 / 30507879
40302580 Uria
/40302580
1/0
5,28
310030250
/ Guar & Gomes Ltda
15/12/2011 08:05:00 7614829 / 99999 / 30507879
/40302750
1/0
22,46
310030250
/ Guar & Gomes Ltda
15/12/2011 08:05:00 7614829 / 99999 / 30507879
/40304922
1/0
33,50
110000079
06/12/2011 13:41:00 7637076 / 99999 / 30495812
2 UCO
/90000021
0,75 / 0
0,00
310030250
/ Guar & Gomes Ltda
15/12/2011 08:05:00 7614829 / 99999 / 30507879
2 UCO
/90000021
6,585 / 0
0,00
220,56
Total:
0468000207004
0468000207004
2461
Paulo Roberto Caldeira

Paulo Roberto Caldeira
/ Marcelo De Almeida Borges
0468000207012
29/11/2011
7601694 / 99999 / 10241679
/10101012
1/0
83,07
Ligia Ribeiro Ramos Caldeira
368
/ Jos Bonifcio Barbosa
09/12/2011
7645973 / 99999 / 10248685
/10101012
1/0
83,07
310000030
15/12/2011
7616128 / 99999 / 30505997
/40311210
1/0
11,20
310000030
15/12/2011
7616128 / 99999 / 30505997
40301630 Creatinina
/40301630
1/0
5,28
110000079
09/12/2011 08:31:00 7634297 / 99999 / 30499529
1/0
25,45
310000030
15/12/2011
7616128 / 99999 / 30505997
40302040 Glicose
/40302040
1/0
5,28
310000030
15/12/2011
7616128 / 99999 / 30505997
/40316521
1/0
27,52
310000030
15/12/2011
7616128 / 99999 / 30505997
40301150 cido rico
/40301150
1/0
5,28
310000030
15/12/2011
7616128 / 99999 / 30505997
/40302750
1/0
22,46
310000030
15/12/2011
7616128 / 99999 / 30505997
/90000021
4,011 / 0
2 UCO
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 60

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
110000079
0468000207101
09/12/2011 08:31:00 7634297 / 99999 / 30499529
2 UCO
Obs.
Qtd/Partic
Vl.Cob
/90000021
0,75 / 0
0,00
/10101012
1/0
83,07
1/0
25,45
/90000021
0,75 / 0
/10101012
1/0
83,07
Felipe Ramos Caldeira
368
09/12/2011
110000079
09/12/2011 08:35:00 7634299 / 99999 / 30499422
110000079
09/12/2011 08:35:00 7634299 / 99999 / 30499422
0468000207110
7645974 / 99999 / 10248622
2 UCO
0,00
Kalil Ramos Caldeira
368
09/12/2011
7645975 / 99999 / 10248631
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
40301842 Ferro srico
/40301842
1/0
7,34
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
1/0
11,78
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
/40316521
1/0
27,52
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
40306313 Antigliadina (glten) - IgG
/40306313
1/0
24,52
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
40316491 T4 livre
/40316491
1/0
34,39
210000020
26/11/2011 08:00:00 7638157 / 99999 / 451683
40803139 Mos e punhos para idade ssea
/40803139
1/0
31,77
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
40301400 Clcio
/40301400
1/0
5,28
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
40301931 Fsforo
/40301931
1/0
5,28
110000052
27/11/2011 22:32:00 7603358 / 99999 / 30481591
/10101039
1/0
94,77
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
40316203 Crescimento, hormonio do (HGH)
/40316203
5/0
157,13
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
40316440 Somatomedina C (IGF1)
/40316440
1/0
72,47
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
/40311210
1/0
11,20
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
40305406 "IGF BP3 (protena ligadora dos fatores /40305406
1/0
72,47
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
40306305 Antigliadina (glten) - IgA
/40306305
1/0
33,72
310000242
26/11/2011 10:00:00 7606914 / 99999 / 451684
2 UCO
/90000021
34,178 / 0
0,00
210000020
26/11/2011 08:00:00 7638157 / 99999 / 451683
1 FILME
0,072 / 0
1,63
210000020
26/11/2011 08:00:00 7638157 / 99999 / 451683
2 UCO
/90000021
1,22 / 0
0,00
310000242
26/11/2011 12:00:00 7677780 / 223200 / 435023
/90000021
1/0
204,73
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 61

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468000207519
Abadia Albertina De Sousa
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
43800
21/10/2011 12:00:00 7648494 / 223079 / 2192473
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000099
/ Unimed Teresina
99
30434
13/10/2011
/10101012
Lote: 223086 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
31000018 24/10/2011 06:36:00 7649804 / 223079 / 615143
/40304299
Lote: 223079 Nota: 324
1/0
8,85
89000098
/ Unimed Imperatriz
98
31000018 24/10/2011 06:36:00 7649804 / 223079 / 615143
/40301583
Lote: 223079 Nota: 324
1/0
8,85
89000098
/ Unimed Imperatriz
98
31000018 24/10/2011 06:36:00 7649804 / 223079 / 615143
/40301605
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000018 24/10/2011 06:36:00 7649804 / 223079 / 615143
/40302547
Lote: 223079 Nota: 324
1/0
5,90
89000098
/ Unimed Imperatriz
98
31000018 24/10/2011 06:36:00 7649804 / 223079 / 615143
Lote: 223079 Nota: 324
1/0
8,85
89000098
/ Unimed Imperatriz
98
31000018 24/10/2011 06:36:00 7649804 / 223079 / 615143
40302040 Glicose
/40302040
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000018 24/10/2011 06:36:00 7649804 / 223079 / 615143
/40304922
Lote: 223079 Nota: 324
1/0
17,69
7650887 / 223086 / 2234084
1.432,54
Total:
0468000209007
0468000209007
Paulo Sergio Nascimento De Araujo

Paulo Sergio Nascimento De Araujo
89000098
/ Unimed Imperatriz
98
42189
19/10/2011 12:00:00 7649386 / 223079 / 416598
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
44572
17/10/2011
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
21000075 24/10/2011 13:00:00 7650209 / 223079 / 4151432
41401492 Testes vestibulares, com vecto-
/41401492
Lote: 223079 Nota: 324
1/0
121,62
89000098
/ Unimed Imperatriz
98
21000075 22/10/2011 08:15:00 7648856 / 223079 / 4151433
40103439 Impedanciometria
/40103439
Lote: 223079 Nota: 324
1/0
36,49
89000098
/ Unimed Imperatriz
98
21000075 22/10/2011 08:15:00 7648856 / 223079 / 4151433
40103099 Audiometria vocal - pesquisa de limiar de /40103099
Lote: 223079 Nota: 324
1/0
16,22
89000098
/ Unimed Imperatriz
98
21000019 30/09/2011 07:00:00 7648855 / 223079 / 632949
41001125 Coluna cervical ou dorsal ou lombar (at /41001125
Lote: 223079 Nota: 324
2/0
445,21
89000098
/ Unimed Imperatriz
98
21000075 22/10/2011 08:15:00 7648856 / 223079 / 4151433
40103072 Audiometria tonal limiar com testes de
/40103072
Lote: 223079 Nota: 324
1/0
36,49
89000098
/ Unimed Imperatriz
98
21000075 24/10/2011 13:00:00 7650209 / 223079 / 4151432
Lote: 223079 Nota: 324
1/0
81,08
89000098
/ Unimed Imperatriz
98
21000075 24/10/2011 13:00:00 7650209 / 223079 / 4151432
40103480 Pesquisa de pares cranianos
/40103480
Lote: 223079 Nota: 324
1/0
40,54
89000098
/ Unimed Imperatriz
98
21000019 30/09/2011 07:00:00 7648855 / 223079 / 632949
Lote: 223079 Nota: 324
2,0898 / 0
49,81
/10101012
Lote: 223079 Nota: 324
1/0
58,97
41401492 Testes vestibulares, com vecto-
/41401492
Lote: 223079 Nota: 324
1/0
121,62
0468000209015
7649805 / 223079 / 2191119
1 FILME
Carleanne De Andrade Araujo
89000098
/ Unimed Imperatriz
98
44572
17/10/2011
7648857 / 223079 / 2191093
89000098
/ Unimed Imperatriz
98
21000075 01/10/2011 12:00:00 7649806 / 223079 / 587510
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 62

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
21000075 01/10/2011 12:00:00 7649806 / 223079 / 587510
40103480 Pesquisa de pares cranianos
/40103480
Lote: 223079 Nota: 324
1/0
40,54
89000098
/ Unimed Imperatriz
98
21000075 01/10/2011 12:00:00 7649806 / 223079 / 587510
Lote: 223079 Nota: 324
1/0
81,08
/10101012
Lote: 223079 Nota: 324
1/0
58,97
0468000209104
Paulo Victor Nascimento De Araujo
89000098
/ Unimed Imperatriz
98
44572
89000098
/ Unimed Imperatriz
98
21000075 01/10/2011 12:00:00 7650048 / 223079 / 587506
Lote: 223079 Nota: 324
1/0
16,22
89000098
/ Unimed Imperatriz
98
21000075 01/10/2011 12:00:00 7650048 / 223079 / 587506
/40103439
Lote: 223079 Nota: 324
1/0
36,49
89000098
/ Unimed Imperatriz
98
21000075 01/10/2011 12:00:00 7650048 / 223079 / 587506
/40103072
Lote: 223079 Nota: 324
1/0
36,49
89000098
/ Unimed Imperatriz
98
21000075 01/10/2011 12:00:00 7650048 / 223079 / 587506
40103455 Otoemisses acsticas produto de
/40103455
Lote: 223079 Nota: 324
1/0
57,79
/10101012
Lote: 223079 Nota: 324
1/0
58,97
0468000209325
17/10/2011
7648495 / 223079 / 2191110
Anna Sarah Nascimento De Araujo
89000098
/ Unimed Imperatriz
98
44572
89000098
/ Unimed Imperatriz
98
21000075 01/10/2011 12:00:00 7648497 / 223079 / 587503
/40103072
Lote: 223079 Nota: 324
1/0
36,49
89000098
/ Unimed Imperatriz
98
21000062 10/10/2011 12:00:00 7650210 / 223079 / 4148461
41401077 Provas imuno-alrgicas para fungos (por /41401077
Lote: 223079 Nota: 324
1/0
17,69
89000098
/ Unimed Imperatriz
98
21000075 01/10/2011 12:00:00 7648497 / 223079 / 587503
/40103439
Lote: 223079 Nota: 324
1/0
36,49
89000098
/ Unimed Imperatriz
98
21000062 10/10/2011 12:00:00 7650210 / 223079 / 4148461
41401379 Testes cutneo-alrgicos para alimentos /41401379
Lote: 223079 Nota: 324
1/0
18,58
89000098
/ Unimed Imperatriz
98
21000062 10/10/2011 12:00:00 7650210 / 223079 / 4148461
41401069 Provas imuno-alrgicas para bactrias
/41401069
Lote: 223079 Nota: 324
1/0
17,69
89000098
/ Unimed Imperatriz
98
21000062 10/10/2011 12:00:00 7650210 / 223079 / 4148461
41401387 Testes cutneo-alrgicos para fungos
/41401387
Lote: 223079 Nota: 324
1/0
18,58
89000098
/ Unimed Imperatriz
98
21000075 01/10/2011 12:00:00 7648497 / 223079 / 587503
40103455 Otoemisses acsticas produto de
/40103455
Lote: 223079 Nota: 324
1/0
57,79
89000098
/ Unimed Imperatriz
98
21000062 10/10/2011 12:00:00 7650210 / 223079 / 4148461
41401395 Testes cutneo-alrgicos para insetos
/41401395
Lote: 223079 Nota: 324
1/0
18,58
89000098
/ Unimed Imperatriz
98
21000062 10/10/2011 12:00:00 7650210 / 223079 / 4148461
41401409 Testes cutneo-alrgicos para plens
/41401409
Lote: 223079 Nota: 324
1/0
18,58
89000098
/ Unimed Imperatriz
98
21000062 10/10/2011 12:00:00 7650210 / 223079 / 4148461
41401360 Testes cutneo-alrgicos para alrgenos /41401360
Lote: 223079 Nota: 324
1/0
18,58
89000098
/ Unimed Imperatriz
98
21000062 10/10/2011 12:00:00 7650210 / 223079 / 4148461
/90000021
Lote: 223079 Nota: 324
1/0
1,42
0468000209503
17/10/2011
7648496 / 223079 / 2191087
Raimundo Santos De Araujo
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
40302040 Glicose
/40302040
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 14/11/2011 00:08:00 7647883 / 223012 / 12006930
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
/40301885
Lote: 223012 Nota: 324
1/0
5,31
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 63

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
/40901122
Lote: 223496 Nota: 325
1/0
98,77
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
40301281 Amilase
/40301281
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 11/11/2011 01:44:00 7647880 / 223012 / 11767062
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 17/11/2011 01:05:00 7647892 / 223012 / 12006970
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 10/11/2011 00:17:00 7647905 / 223012 / 11767128
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 10/11/2011 00:17:00 7647905 / 223012 / 11767128
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 19/11/2011 02:04:00 7647908 / 223012 / 12008038
40302407 Reserva alcalina (bicarbonato)
/40302407
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 15/11/2011 11:40:00 7647906 / 223012 / 11762125
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 14/11/2011 00:08:00 7647883 / 223012 / 12006930
40301559 Cloro
/40301559
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 19/11/2011 02:04:00 7647908 / 223012 / 12008038
40301559 Cloro
/40301559
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 20/11/2011 00:44:00 7647909 / 223012 / 11754493
40301559 Cloro
/40301559
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 16/11/2011 13:05:00 7647910 / 223012 / 12006978
/40301729
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
/40302016
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 22/11/2011 01:11:00 7647885 / 223012 / 11759619
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 23/11/2011 00:40:00 7647897 / 223012 / 11749245
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 15/11/2011 11:40:00 7647906 / 223012 / 11762125
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 19/11/2011 02:04:00 7647908 / 223012 / 12008038
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 20/11/2011 00:44:00 7647909 / 223012 / 11754493
40302040 Glicose
/40302040
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 11/11/2011 01:44:00 7647880 / 223012 / 11767062
/40304590
Lote: 223012 Nota: 324
1/0
4,42
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
40302571 Troponina
/40302571
Lote: 223012 Nota: 324
1/0
25,35
89000034
/ Unimed Recife
34
18009098 11/11/2011 01:44:00 7647880 / 223012 / 11767062
40302040 Glicose
/40302040
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
/40301885
Lote: 223012 Nota: 324
1/0
5,31
89000034
/ Unimed Recife
34
18009098 21/11/2011 00:52:00 7647891 / 223012 / 11754363
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 17/11/2011 01:05:00 7647892 / 223012 / 12006970
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 64

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
18009098 19/11/2011 02:04:00 7647908 / 223012 / 12008038
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 16/11/2011 13:05:00 7647910 / 223012 / 12006978
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 19/11/2011 02:04:00 7647908 / 223012 / 12008038
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 12/11/2011 06:10:00 7647886 / 223012 / 11057346
/40310400
Lote: 223012 Nota: 324
1/0
17,69
89000034
/ Unimed Recife
34
102673
40901165 Aparelho urinrio masculino (rins,
/40901165
Lote: 223009 Nota: 324
1/0
64,86
89000034
/ Unimed Recife
34
18009098 09/11/2011 13:11:00 7647882 / 223012 / 11755296
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 09/11/2011 13:11:00 7647882 / 223012 / 11755296
/40302407
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 09/11/2011 16:47:00 7647911 / 223012 / 11755299
/40302016
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 20/11/2011 09:06:00 7647914 / 223012 / 11754356
/40302016
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 10/11/2011 00:17:00 7647905 / 223012 / 11767128
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 23/11/2011 00:40:00 7647897 / 223012 / 11749245
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 11/11/2011 01:44:00 7647880 / 223012 / 11767062
40301400 Clcio
/40301400
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 22/11/2011 01:11:00 7647885 / 223012 / 11759619
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 18/11/2011 12:19:00 7647901 / 223012 / 12008025
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 18/11/2011 00:23:00 7647884 / 223012 / 12006990
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 19/11/2011 02:04:00 7647908 / 223012 / 12008038
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 20/11/2011 00:44:00 7647909 / 223012 / 11754493
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 11/11/2011 01:44:00 7647880 / 223012 / 11767062
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
/40302407
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 11/11/2011 01:44:00 7647880 / 223012 / 11767062
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
40301559 Cloro
/40301559
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 23/11/2011 00:40:00 7647897 / 223012 / 11749245
40301559 Cloro
/40301559
Lote: 223012 Nota: 324
1/0
4,13
18/10/2011 16:00:00 7647844 / 223009 / 10893026
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 65

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
18009098 15/11/2011 11:40:00 7647906 / 223012 / 11762125
40301559 Cloro
/40301559
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
40301559 Cloro
/40301559
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 23/11/2011 00:40:00 7647897 / 223012 / 11749245
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 18/11/2011 12:19:00 7647901 / 223012 / 12008025
40301559 Cloro
/40301559
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 16/11/2011 13:05:00 7647910 / 223012 / 12006978
40316491 T4 livre
/40316491
Lote: 223012 Nota: 324
1/0
25,06
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
/40302512
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 10/11/2011 00:17:00 7647905 / 223012 / 11767128
40302040 Glicose
/40302040
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 23/11/2011 00:40:00 7647897 / 223012 / 11749245
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 11/11/2011 01:44:00 7647880 / 223012 / 11767062
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
40808017 Abdome simples
/40808017
Lote: 223496 Nota: 325
1/0
20,04
89000034
/ Unimed Recife
34
18009098 09/11/2011 13:11:00 7647882 / 223012 / 11755296
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 21/11/2011 00:52:00 7647891 / 223012 / 11754363
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 18/11/2011 12:19:00 7647901 / 223012 / 12008025
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 20/11/2011 00:44:00 7647909 / 223012 / 11754493
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 16/11/2011 00:28:00 7647898 / 223012 / 12006956
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 09/11/2011 13:11:00 7647882 / 223012 / 11755296
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 14/11/2011 00:08:00 7647883 / 223012 / 12006930
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 19/11/2011 02:04:00 7647908 / 223012 / 12008038
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 09/11/2011 13:11:00 7647882 / 223012 / 11755296
40301559 Cloro
/40301559
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 21/11/2011 00:52:00 7647891 / 223012 / 11754363
40301559 Cloro
/40301559
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
/40302504
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 18/11/2011 00:23:00 7647884 / 223012 / 12006990
/40302016
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 10/11/2011 00:17:00 7647905 / 223012 / 11767128
/40302016
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 11/11/2011 16:01:00 7647913 / 223012 / 11767098
/40302016
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
/40302016
Lote: 223012 Nota: 324
1/0
19,75
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 66

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
/40301990
Lote: 223012 Nota: 324
1/0
5,90
89000034
/ Unimed Recife
34
18009098 12/11/2011 13:00:00 7647896 / 223012 / 12006127
/40301648
Lote: 223012 Nota: 324
1/0
14,74
89000034
/ Unimed Recife
34
18009098 09/11/2011 13:11:00 7647882 / 223012 / 11755296
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 17/11/2011 01:05:00 7647892 / 223012 / 12006970
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 16/11/2011 00:28:00 7647898 / 223012 / 12006956
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 20/11/2011 00:44:00 7647909 / 223012 / 11754493
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 18/11/2011 12:19:00 7647901 / 223012 / 12008025
/40308391
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 14/11/2011 00:08:00 7647883 / 223012 / 12006930
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 15/11/2011 11:40:00 7647906 / 223012 / 11762125
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 10/11/2011 00:17:00 7647905 / 223012 / 11767128
/40302407
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
/40304370
Lote: 223012 Nota: 324
1/0
2,95
89000034
/ Unimed Recife
34
18009098 18/11/2011 12:19:00 7647901 / 223012 / 12008025
/40301729
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 16/11/2011 00:28:00 7647898 / 223012 / 12006956
/40302016
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 21/11/2011 00:52:00 7647891 / 223012 / 11754363
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 10/11/2011 00:17:00 7647905 / 223012 / 11767128
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
40302377 Protenas totais
/40302377
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
/40302377
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 21/11/2011 00:52:00 7647891 / 223012 / 11754363
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 23/11/2011 00:40:00 7647897 / 223012 / 11749245
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 12/11/2011 13:00:00 7647896 / 223012 / 12006127
/40301729
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 19/11/2011 02:04:00 7647908 / 223012 / 12008038
/40302016
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
/40301990
Lote: 223012 Nota: 324
1/0
5,90
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 67

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
40302237 Magnsio
/40302237
Lote: 223012 Nota: 324
1/0
4,72
89000034
/ Unimed Recife
34
18009098 12/11/2011 13:00:00 7647896 / 223012 / 12006127
40302571 Troponina
/40302571
Lote: 223012 Nota: 324
1/0
25,35
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
/40304590
Lote: 223012 Nota: 324
1/0
4,42
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
/40805018
Lote: 223496 Nota: 325
5/0
67,80
89000034
/ Unimed Recife
34
18009098 14/11/2011 00:08:00 7647883 / 223012 / 12006930
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 18/11/2011 12:19:00 7647901 / 223012 / 12008025
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 15/11/2011 11:40:00 7647906 / 223012 / 11762125
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 09/11/2011 13:11:00 7647882 / 223012 / 11755296
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
40301400 Clcio
/40301400
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 14/11/2011 00:08:00 7647883 / 223012 / 12006930
/40302407
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
/40302407
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 18/11/2011 12:19:00 7647901 / 223012 / 12008025
/40302407
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 12/11/2011 13:00:00 7647896 / 223012 / 12006127
/40301397
Lote: 223012 Nota: 324
1/0
4,42
89000034
/ Unimed Recife
34
18009098 17/11/2011 01:05:00 7647892 / 223012 / 12006970
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 18/11/2011 12:19:00 7647901 / 223012 / 12008025
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 20/11/2011 00:44:00 7647909 / 223012 / 11754493
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 16/11/2011 13:05:00 7647910 / 223012 / 12006978
/40316521
Lote: 223012 Nota: 324
1/0
25,06
89000034
/ Unimed Recife
34
18009098 12/11/2011 13:00:00 7647896 / 223012 / 12006127
40301664 Creatino fosfoquinase - frao MB -
/40301664
Lote: 223012 Nota: 324
1/0
29,48
89000034
/ Unimed Recife
34
18009098 14/11/2011 00:08:00 7647883 / 223012 / 12006930
/40302016
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 17/11/2011 01:05:00 7647892 / 223012 / 12006970
/40302016
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 17/11/2011 23:10:00 7647893 / 223012 / 12008016
/40302016
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
/40308391
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 12/11/2011 13:00:00 7647896 / 223012 / 12006127
/40308391
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 16/11/2011 13:05:00 7647910 / 223012 / 12006978
/40308391
Lote: 223012 Nota: 324
1/0
19,75
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 68

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 20/11/2011 00:44:00 7647909 / 223012 / 11754493
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 15/11/2011 11:40:00 7647906 / 223012 / 11762125
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 16/11/2011 13:05:00 7647910 / 223012 / 12006978
40301630 Creatinina
/40301630
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 17/11/2011 01:05:00 7647892 / 223012 / 12006970
40302318 Potssio
/40302318
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 21/11/2011 00:52:00 7647891 / 223012 / 11754363
/40302407
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 23/11/2011 00:40:00 7647897 / 223012 / 11749245
/40302407
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 15/11/2011 11:40:00 7647906 / 223012 / 11762125
/40302407
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 20/11/2011 00:44:00 7647909 / 223012 / 11754493
/40302407
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 18/11/2011 00:23:00 7647884 / 223012 / 12006990
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 22/11/2011 01:11:00 7647885 / 223012 / 11759619
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 21/11/2011 00:52:00 7647891 / 223012 / 11754363
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 16/11/2011 00:28:00 7647898 / 223012 / 12006956
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 10/11/2011 00:17:00 7647905 / 223012 / 11767128
Lote: 223012 Nota: 324
1/0
8,85
89000034
/ Unimed Recife
34
18009098 10/11/2011 00:17:00 7647905 / 223012 / 11767128
40301559 Cloro
/40301559
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 13/11/2011 00:41:00 7647881 / 223012 / 11767081
40301931 Fsforo
/40301931
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 10/11/2011 17:48:00 7647907 / 223012 / 12006125
/40302016
Lote: 223012 Nota: 324
1/0
19,75
89000034
/ Unimed Recife
34
18009098 14/11/2011 00:08:00 7647883 / 223012 / 12006930
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 18/11/2011 00:23:00 7647884 / 223012 / 12006990
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 18/11/2011 12:19:00 7647901 / 223012 / 12008025
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 11/11/2011 01:44:00 7647880 / 223012 / 11767062
40302423 Sdio
/40302423
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 09/11/2011 13:11:00 7647882 / 223012 / 11755296
40302040 Glicose
/40302040
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
40302199 Lipase
/40302199
Lote: 223012 Nota: 324
1/0
4,42
89000034
/ Unimed Recife
34
18009098 12/11/2011 00:18:00 7647895 / 223012 / 12006913
40302580 Uria
/40302580
Lote: 223012 Nota: 324
1/0
4,13
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
40202534 Passagem de sonda naso-enteral
/40202534
Lote: 223496 Nota: 325
1/0
98,28
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 69

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
/40901360
Lote: 223496 Nota: 325
1/0
212,28
89000034
/ Unimed Recife
34
18009000 09/11/2011 11:59:00 7653463 / 223495 / 325169
/10101039
Lote: 223495 Nota: 325
1/0
31,45
89000034
/ Unimed Recife
34
18009000 10/11/2011 10:00:00 7653473 / 223496 / 115841483
/10102019
Lote: 223496 Nota: 325
4/0
171,99
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
10104020 Atendimento mdico do intensivista em
/10104020
Lote: 223496 Nota: 325
20 / 0
1.965,60
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
/80017010
Lote: 223496 Nota: 325
10 / 0
11.486,48
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
/80061435
Lote: 223496 Nota: 325
11530 / 0
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
/80061400
Lote: 223496 Nota: 325
1530 / 0
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
80052762 Ecodopler
/80052762
Lote: 223496 Nota: 325
1/0
47,91
89000034
/ Unimed Recife
34
18009000 09/11/2011 11:59:00 7653463 / 223495 / 325169
Lote: 223495 Nota: 325
1/0
62,65
89000034
/ Unimed Recife
34
18009000 09/11/2011 11:59:00 7653463 / 223495 / 325169
/90000021
Lote: 223495 Nota: 325
1/0
150,33
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
1 FILME
Lote: 223496 Nota: 325
2,4438 / 0
58,24
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
/90000021
Lote: 223496 Nota: 325
1/0
50,12
89000034
/ Unimed Recife
34
102673
1 FILME
Lote: 223009 Nota: 324
0,38 / 0
89000034
/ Unimed Recife
34
18009000 09/11/2011 11:59:00 7653463 / 223495 / 325169
/90000013
Lote: 223495 Nota: 325
1/0
922,51
89000034
/ Unimed Recife
34
18009000 09/11/2011 16:59:00 7653473 / 223496 / 115841483
/90000013
Lote: 223496 Nota: 325
1/0
368,99
18/10/2011 16:00:00 7647844 / 223009 / 10893026
DU05 UTI GERAL CONF N COMPLEMENT.

80061435 Oxignio 10 l/m
G753 CILINDRO DE OXIGENIO - (VIDAS
662,34
9,06
26.174,51
Total:
0468000210005
0468000210005
6.745,05
Pedro Filho De Carvalho Silva

Pedro Filho De Carvalho Silva
210000712
/ Inst De Reumatologia E Med
14/12/2011 07:30:00 7626899 / 99999 / 70814700
/20103492
9/0
348,96
210000712
13/12/2011 15:00:00 7626899 / 99999 / 70814700
1/0
51,69
210000712
13/12/2011 15:00:00 7626899 / 99999 / 70814700
/20103492
1/0
38,77
210000712
14/12/2011 07:30:00 7626899 / 99999 / 70814700
9/0
465,22
210000712
13/12/2011 15:00:00 7626899 / 99999 / 70814700
21,6 / 0
2 UCO
/90000021
Total:
0468000213004
0468000213012
Raimundo Jose Pereira De Sousa

Maria Das Gracas Santos Pereira
0,00
904,64
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 70

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
1342173
20/12/2011 12:06:45 7659536 / 99999 / 30484480
/10101012
1/0
83,07
1381748
/ Patricia Regina Dutra Prazeres
06/12/2011
/10101012
1/0
83,07
310000242
03/12/2011 10:00:00 7610572 / 99999 / 30491525
40316491 T4 livre
/40316491
1/0
34,39
310000242
03/12/2011 10:00:00 7610572 / 99999 / 30491525
/40316521
1/0
27,52
1342173
20/12/2011 12:06:45 7659536 / 99999 / 30484480
/41301099
1/0
7,68
310030249
30/11/2011 09:00:00 7633476 / 99999 / 30486737
/40601137
1/0
29,21
310000242
03/12/2011 10:00:00 7610572 / 99999 / 30491525
1/0
11,78
310000242
03/12/2011 10:00:00 7610572 / 99999 / 30491525
40302040 Glicose
/40302040
1/0
5,28
1342173
20/12/2011 12:06:45 7659536 / 99999 / 30484480
/41301102
1/0
25,58
310000242
03/12/2011 10:00:00 7610572 / 99999 / 30491525
/40302750
1/0
22,46
310000242
03/12/2011 10:00:00 7610572 / 99999 / 30491525
2 UCO
/90000021
5,847 / 0
0,00
310030249
30/11/2011 09:00:00 7633476 / 99999 / 30486737
2 UCO
/90000021
1,03 / 0
0,00
1342173
20/12/2011 12:06:45 7659536 / 99999 / 30484480
2 UCO
/90000021
2,78 / 0
0,00
7665550 / 99999 / 10246562
330,04
Total:
0468000216003
0468000216003
Raimundo Roseno Sousa

Raimundo Roseno Sousa
310000145
11/11/2011 12:00:00 7677617 / 223147 / 451771
40311180 Pesquisa ou dosagem de um
/40311180
1/0
6,35
310000145
11/11/2011 12:00:00 7677617 / 223147 / 451771
40311171 Microalbuminria
/40311171
1/0
24,49
310000145
11/11/2011 12:00:00 7677617 / 223147 / 451771
/90000021
2,214 / 0
2 UCO
30,84
Total:
0468000217000
0468000217301
0,00
Raimundo Sampaio Goncalves

Erika Vanessa Guedes Costa Goncalves
1341576
01/12/2011
7666699 / 99999 / 10244344
/10101012
1/0
83,07
11002944
/ Arnaldo Sousa Barros
15/12/2011
7644708 / 99999 / 10252615
/10101012
1/0
83,07
310000030
24/11/2011
7609817 / 99999 / 30477131
40304051 Anticorpos irregulares, pesquisa (meio
/40304051
1/0
11,56
310000030
02/12/2011
7610419 / 99999 / 30489673
/40311210
1/0
11,20
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 71

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
310000030
02/12/2011
7610419 / 99999 / 30489673
310000030
02/12/2011
7610419 / 99999 / 30489673
2 UCO
310000030
24/11/2011
7609817 / 99999 / 30477131
0468000217506
Obs.
Qtd/Partic
Vl.Cob
1/0
24,52
/90000021
2,61 / 0
0,00
2 UCO
/90000021
0,837 / 0
0,00
Raimundo S Goncalves
310000030
21/11/2011
7609471 / 99999 / 30470255
40302580 Uria
/40302580
1/0
5,28
310000030
21/11/2011
7609471 / 99999 / 30470255
/40304590
1/0
7,70
310000030
21/11/2011
7609471 / 99999 / 30470255
40301931 Fsforo
/40301931
1/0
5,28
310000030
21/11/2011
7609471 / 99999 / 30470255
1/0
11,78
310000030
21/11/2011
7609471 / 99999 / 30470255
40302318 Potssio
/40302318
1/0
5,28
310000030
21/11/2011
7609471 / 99999 / 30470255
40301109 cido lctico (lactato)
/40301109
1/0
9,76
310000030
21/11/2011
7609471 / 99999 / 30470255
/40302016
1/0
24,49
310000030
21/11/2011
7609471 / 99999 / 30470255
40301630 Creatinina
/40301630
1/0
5,28
310000030
21/11/2011
7609471 / 99999 / 30470255
/40308391
1/0
36,82
310000030
21/11/2011
7609471 / 99999 / 30470255
/40301419
1/0
14,47
310000030
21/11/2011
7609471 / 99999 / 30470255
40302423 Sdio
/40302423
1/0
5,28
310000030
21/11/2011
7609470 / 99999 / 30470266
/40302016
1/0
24,49
310000030
21/11/2011
7609471 / 99999 / 30470255
1/0
7,70
310000030
24/11/2011
7609714 / 99999 / 30473616
/40302016
1/0
24,49
310000030
21/11/2011
7609471 / 99999 / 30470255
40302237 Magnsio
/40302237
1/0
5,28
310000030
21/11/2011
7609471 / 99999 / 30470255
2 UCO
/90000021
7,863 / 0
0,00
310000030
21/11/2011
7609470 / 99999 / 30470266
2 UCO
/90000021
1,764 / 0
0,00
310000030
24/11/2011
7609714 / 99999 / 30473616
2 UCO
/90000021
1,764 / 0
0,00
Total:
0468000218006
0468000218006
Raymundo De Jesus Oliveira

Raymundo De Jesus Oliveira
406,80
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 72

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
1180858
/ Antonio Augusto Soares Da
12/12/2011
7658009 / 99999 / 171521
/10101012
Obs.
Qtd/Partic
1/0
83,07
83,07
Total:
0468000219002
0468000219002
Vl.Cob
Regina Maria Teixeira Lima

Regina Maria Teixeira Lima
11001662
/ Jorge Vitorino O Bastos
28/11/2011
210000755
/ Multimagem Diag Medicos Sc
210000755
/10101012
1/0
83,07
13/12/2011 10:11:00 7634051 / 99999 / 451676
40901114 Mamas
/40901114
1/0
86,31
13/12/2011 10:11:00 7634071 / 99999 / 643188
/40901300
1/0
91,69
210000755
13/12/2011 10:11:00 7634071 / 99999 / 643188
2 UCO
/90000021
3,82 / 0
0,00
210000755
13/12/2011 10:11:00 7634051 / 99999 / 451676
1 FILME
0,34 / 0
7,72
210000755
13/12/2011 10:11:00 7634051 / 99999 / 451676
2 UCO
/90000021
3,42 / 0
0,00
210000755
13/12/2011 10:11:00 7634071 / 99999 / 643188
1 FILME
0,17 / 0
3,86
/10101012
1/0
83,07
40901181 Abdome inferior feminino (bexiga, tero, /40901181
1/0
92,23
0468000219304
7657532 / 99999 / 10240850
Nathalia Teixeira Lima
3485
/ Deyse Maria Rodrigues Soares
13/12/2011
210000755
29/11/2011 08:34:00 7634072 / 99999 / 643195
210000755
29/11/2011 08:34:00 7634072 / 99999 / 643195
1 FILME
0,51 / 0
11,58
210000755
29/11/2011 08:34:00 7634072 / 99999 / 643195
2 UCO
/90000021
3,86 / 0
0,00
0468000219517
7677132 / 99999 / 10250656
Raimunda Rodrigues Alves
89000063
63
5527
16/11/2011 10:22:25 7652660 / 223142 / 88017566
/10101012
Lote: 223142 Nota: 325
1/0
61,43
89000063
63
5527
16/11/2011 10:21:45 7652558 / 223142 / 88017531
/41301323
Lote: 223142 Nota: 325
1/0
10,13
Total:
0468000222003
0468000222011
11001336
531,09
Renato Leite Serra

Adriana Silva Serra
/ Domingos Matos Pereira Filho
0468000222305
09/12/2011
7673209 / 99999 / 10248913
/10101012
1/0
83,07
/40901300
1/0
91,69
Paula Rayane Silva Serra
21002606
/ Centro De Diagnostico Da
06/12/2011 14:28:00 7632684 / 99999 / 513502
21002606
06/12/2011 14:28:00 7632684 / 99999 / 513502
1 FILME
0,17 / 0
3,86
21002606
06/12/2011 14:28:00 7632684 / 99999 / 513502
2 UCO
/90000021
3,82 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 73

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Total:
0468000223000
0468000223000
Vl.Cob
178,62
Ricardo Felipe Rodrigues Macieira

Ricardo Felipe Rodrigues Macieira
11001280
/ Justino Lopes Macieira Neto
02/12/2011
7667745 / 99999 / 10245186
/10101012
1/0
83,07
11000585
/ Jose Albuquerque De F Neto
30/11/2011
7645441 / 99999 / 10243436
/10101012
1/0
83,07
950000970
01/12/2011 07:33:00 7678754 / 223677 / 451787
1/0
157,75
21002607
/ Instituto De Hipertenso Do
30/11/2011 18:36:00 7623322 / 99999 / 30487187
1/0
25,45
950000970
01/12/2011 07:33:00 7678754 / 223677 / 451787
/90000021
1/0
13,86
21002607
/ Instituto De Hipertenso Do
30/11/2011 18:36:00 7623322 / 99999 / 30487187
2 UCO
/90000021
0,75 / 0
0,00
950000970
01/12/2011 07:33:00 7678754 / 223677 / 451787
2 UCO
/90000021
13,67 / 0
0,00
363,20
Total:
0468000225002
0468000225002
Rita Maria Lobo De Queiroz

Rita Maria Lobo De Queiroz
89000062
/ Unimed Natal Soc Coop De
62
31000083 07/11/2011 06:43:35 7652373 / 223122 / 42157958
/40301842
Lote: 223122 Nota: 325
1/0
5,31
89000062
62
31000083 07/11/2011 06:46:02 7652372 / 223122 / 42157944
Lote: 223122 Nota: 325
1/0
8,85
89000062
62
31000083 07/11/2011 06:45:02 7652372 / 223122 / 42157944
/40302377
Lote: 223122 Nota: 325
1/0
4,13
89000062
62
31000083 07/11/2011 06:47:02 7652372 / 223122 / 42157944
40313328 Zinco
/40313328
Lote: 223122 Nota: 325
1/0
35,38
89000062
62
31000083 07/11/2011 06:45:35 7652373 / 223122 / 42157958
40316270 Ferritina
/40316270
Lote: 223122 Nota: 325
1/0
36,86
89000062
62
31000083 07/11/2011 06:43:02 7652372 / 223122 / 42157944
40302237 Magnsio
/40302237
Lote: 223122 Nota: 325
1/0
4,72
89000062
62
31000083 24/11/2011 06:47:25 7652386 / 223122 / 42264321
/40301990
Lote: 223122 Nota: 325
1/0
5,90
89000062
62
31000083 24/11/2011 06:48:25 7652386 / 223122 / 42264321
/40302504
Lote: 223122 Nota: 325
1/0
4,13
89000062
62
31000083 07/11/2011 06:44:35 7652373 / 223122 / 42157958
40302423 Sdio
/40302423
Lote: 223122 Nota: 325
1/0
4,13
89000062
62
31000083 24/11/2011 06:46:25 7652386 / 223122 / 42264321
/40301885
Lote: 223122 Nota: 325
1/0
5,31
89000062
62
31000083 24/11/2011 06:49:25 7652386 / 223122 / 42264321
/40302512
Lote: 223122 Nota: 325
1/0
4,13
89000062
62
31000083 07/11/2011 06:44:02 7652372 / 223122 / 42157944
40302318 Potssio
/40302318
Lote: 223122 Nota: 325
1/0
4,13
0468000225096
Jose Maria De Queiroz
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 74

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000062
62
21000053 07/10/2011
7652366 / 223122 / 12462287
/90000021
Lote: 223122 Nota: 325
1/0
29,85
89000062
62
21000053 07/10/2011
7652366 / 223122 / 12462287
/90000013
Lote: 223122 Nota: 325
1/0
301,85
/40103323
Lote: 223086 Nota: 324
1/0
243,24
0468000225509
89000099
Helio Marques Lobo
/ Unimed Teresina
99
11000020 05/09/2011
7650888 / 223086 / 3377925
40103323 Eletroneuromiografia de MMSS
697,92
Total:
0468000227005
0468000227013
Rogerio C de M Viana
Sandra Marboure De Melo Viana
5064
30/11/2011 12:00:00 7679105 / 223896 / 30485370
5064
30/11/2011 12:00:00 7679105 / 223896 / 30485370
5064
30/11/2011 12:00:00 7679105 / 223896 / 30485370
5064
30/11/2011 12:00:00 7679105 / 223896 / 30485370
/30101298
1/0
53,29
/80051510
1/0
45,45
/90000021
1/0
5,70
/90000013
1/0
6,75
111,19
Total:
0468000229008
0468000229512
Ronaldo Silva Fernandes

Eugenia Silva
17490
/ Luis Fernando Bezerra Figueredo
28/11/2011
210020314
/ S.O.S Trauma Ltda
210020314
7601658 / 99999 / 10241196
/10101012
1/0
83,07
28/11/2011 14:27:00 7601807 / 99999 / 30482989
40804054 Joelho
/40804054
1/0
15,35
/ S.O.S Trauma Ltda
08/11/2011 14:17:00 7605338 / 99999 / 30452223
/20103492
9/0
276,31
210020314
/ S.O.S Trauma Ltda
29/11/2011 15:08:00 7640339 / 99999 / 30484873

/20103484
10 / 0
230,26
210020314
/ S.O.S Trauma Ltda
08/11/2011 14:17:00 7605338 / 99999 / 30452223
/20103492
1/0
30,70
210020314
/ S.O.S Trauma Ltda
28/11/2011 14:27:00 7601807 / 99999 / 30482989
40804062 Patela
/40804062
1/0
15,35
210020314
/ S.O.S Trauma Ltda
28/11/2011 14:27:00 7601807 / 99999 / 30482989
1 FILME
0,3312 / 0
7,52
210020314
/ S.O.S Trauma Ltda
29/11/2011 15:08:00 7640339 / 99999 / 30484873
2 UCO
/90000021
4,7 / 0
0,00
210020314
/ S.O.S Trauma Ltda
08/11/2011 14:17:00 7605338 / 99999 / 30452223
2 UCO
/90000021
6/0
0,00
210020314
/ S.O.S Trauma Ltda
28/11/2011 14:27:00 7601807 / 99999 / 30482989
2 UCO
/90000021
2,53 / 0
0,00
Total:
0468000231002
0468000231002
Rosenira Pires
Rosenira Pires
658,56
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 75

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
11001107
/ Maria Do Rosario Lima Lobao
22/11/2011
110000079
22/11/2011 08:57:00 7634981 / 99999 / 30473097
110000079
22/11/2011 08:57:00 7634981 / 99999 / 30473097
0468000231517
89000088
7640112 / 99999 / 10236765
Obs.
Qtd/Partic
1/0
83,07
1/0
25,45
/90000021
0,75 / 0
/10101012
2 UCO
0,00
Maria Do Rosario P Rodrigues
88
15303
01/12/2011 14:43:40 7653765 / 223523 / 17270154
Lote: 223523 Nota: 325
1/0
58,97
167,49
Total:
0468000232009
0468000232009
Vl.Cob
/10101012
Rosilene Sampaio Ericeira

Rosilene Sampaio Ericeira
1360562
/ Raissa Brauna Moreira Lima
06/12/2011
1360562
06/12/2011 17:20:00 7668400 / 99999 / 6812390
1360562
06/12/2011 17:20:00 7668400 / 99999 / 6812390
0468000232092
7663698 / 99999 / 10247325
/10101012
1/0
83,07
/41301323
1/0
15,35
/90000021
0,5 / 0
/10101012
1/0
83,07
2 UCO
0,00
Cleber Santos Ericeira
11000518
20/12/2011
4665
/ Jandrey Paulo Juliao De Souza
26/12/2011 12:00:00 7678897 / 223758 / 10258600
/10101012
1/0
83,07
110000079
01/11/2011 15:24:00 7634791 / 99999 / 30443741
/40901211
1/0
76,72
110000079
01/11/2011 15:24:00 7634791 / 99999 / 30443741
1 FILME
0,17 / 0
3,86
110000079
01/11/2011 15:24:00 7634791 / 99999 / 30443741
2 UCO
/90000021
3,42 / 0
0,00
0468000232106
1360562
Diogo Sampaio Ericeira
0468000232300
1360562
7672357 / 99999 / 10256083
06/12/2011
7663700 / 99999 / 10247330
/10101012
1/0
83,07
7663699 / 99999 / 10247328
/10101012
1/0
83,07
Diana Sampaio Ericeira
06/12/2011
511,28
Total:
0468000233005
0468000233005
Samoel Silva Diniz

Samoel Silva Diniz
5490
/ Roberto Coelho Netto Da Cunha
04/10/2011 15:50:00 7679017 / 223838 / 10207475
/10101012
1/0
83,07
5490
/ Roberto Coelho Netto Da Cunha
04/10/2011 16:14:00 7679030 / 223844 / 30402114
/40201023
1/0
23,03
0468000233307
Samila Santos Diniz
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 76

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
29/11/2011
7609985 / 99999 / 30483455
1/0
11,78
310000030
29/11/2011
7609985 / 99999 / 30483455
/40311210
1/0
11,20
310000030
29/11/2011
7609985 / 99999 / 30483455
/90000021
1,68 / 0
2 UCO
129,08
Total:
0468000234001
0468000234109
0,00
Sandra Cristina Maranho Serra

Guilherme R Serra Franca
520
/ Jos De Ribamar Abreu
20/12/2011 12:00:00 7679025 / 223842 / 10255805
/10101012
1/0
83,07
210020160
/ Cotrauma-Clin.Orto.Traum.Ma
20/12/2011 16:05:00 7626388 / 99999 / 30515283
/40805026
1/0
15,35
210020160
20/12/2011 16:05:00 7626388 / 99999 / 30515283
2 UCO
/90000021
1,18 / 0
0,00
210020160
20/12/2011 16:05:00 7626388 / 99999 / 30515283
1 FILME
0,308 / 0
6,99
/10101012
1/0
0468000234117
Ricardo Victor S Franca
/ Orlando Matos De Matos
4268
06/12/2011
7670533 / 99999 / 10247309
Total:
0468000235008
0468000235008
188,48
Sandra Regina Costa Silva

Sandra Regina Costa Silva
4825
83,07
0468000235512
28/11/2011
7670620 / 99999 / 10240864
/10101012
1/0
83,07
Georgina Costa Silva
310000145
05/11/2011 07:50:00 7607520 / 99999 / 596343
40301931 Fsforo
/40301931
1/0
5,28
310000145
05/11/2011 07:50:00 7607520 / 99999 / 596343
40301400 Clcio
/40301400
1/0
5,28
310000145
05/11/2011 07:50:00 7607520 / 99999 / 596343
/40301885
1/0
9,76
310000145
05/11/2011 07:50:00 7607520 / 99999 / 596343
/90000021
1,494 / 0
0,00
2 UCO
103,39
Total:
0468000238007
0468000238511
Silvio Cesar B Soares

Maria Isabel Brito
310000030
20/12/2011
7623345 / 99999 / 30511264
40302423 Sdio
/40302423
1/0
5,28
310000030
20/12/2011
7623345 / 99999 / 30511264
/40302512
1/0
9,76
310000030
20/12/2011
7623345 / 99999 / 30511264
1/0
7,70
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 77

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
16/12/2011
7619428 / 99999 / 30506369
40302237 Magnsio
/40302237
1/0
5,28
310000030
16/12/2011
7619428 / 99999 / 30506369
/40311210
1/0
11,20
310000030
20/12/2011
7623345 / 99999 / 30511264
40302237 Magnsio
/40302237
1/0
5,28
310000030
20/12/2011
7623345 / 99999 / 30511264
40301109 cido lctico (lactato)
/40301109
1/0
9,76
310000030
16/12/2011
7619428 / 99999 / 30506369
/40302504
1/0
9,76
310000030
20/12/2011
7623345 / 99999 / 30511264
40301931 Fsforo
/40301931
1/0
5,28
310000030
16/12/2011
7619428 / 99999 / 30506369
/40301990
1/0
9,76
310000030
20/12/2011
7623345 / 99999 / 30511264
40301630 Creatinina
/40301630
1/0
5,28
310000030
16/12/2011
7619429 / 99999 / 30508558
40302580 Uria
/40302580
1/0
5,28
310000030
20/12/2011
7623345 / 99999 / 30511264
1/0
11,78
310000030
16/12/2011
7619428 / 99999 / 30506369
1/0
11,78
310000030
16/12/2011
7619428 / 99999 / 30506369
/40302512
1/0
9,76
310000030
16/12/2011
7619428 / 99999 / 30506369
40302423 Sdio
/40302423
1/0
5,28
310000030
16/12/2011
7619428 / 99999 / 30506369
40301400 Clcio
/40301400
1/0
5,28
310000030
16/12/2011
7619428 / 99999 / 30506369
/40301885
1/0
9,76
310000030
16/12/2011
7619428 / 99999 / 30506369
40301630 Creatinina
/40301630
1/0
5,28
310000030
20/12/2011
7623345 / 99999 / 30511264
40302318 Potssio
/40302318
1/0
5,28
310000030
16/12/2011
7619428 / 99999 / 30506369
40302318 Potssio
/40302318
1/0
5,28
310000030
20/12/2011
7623345 / 99999 / 30511264
/40302504
1/0
9,76
310000030
20/12/2011
7623345 / 99999 / 30511264
/40304590
1/0
7,70
310000030
20/12/2011
7623345 / 99999 / 30511264
/40301419
1/0
14,47
310000030
20/12/2011
7623344 / 99999 / 30511271
/40601110
1/0
58,42
310000030
20/12/2011
7623345 / 99999 / 30511264
/40308391
1/0
36,82
310000030
16/12/2011
7619428 / 99999 / 30506369
/40308391
1/0
36,82
310000030
20/12/2011
7623345 / 99999 / 30511264
/40302016
2/0
48,98
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 78

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Qtd/Partic
Vl.Cob
310000030
16/12/2011
7619429 / 99999 / 30508558
2 UCO
/90000021
Obs.
0,387 / 0
0,00
310000030
20/12/2011
7623344 / 99999 / 30511271
2 UCO
/90000021
2,06 / 0
0,00
310000030
16/12/2011
7619428 / 99999 / 30506369
2 UCO
/90000021
6,495 / 0
0,00
310000030
20/12/2011
7623345 / 99999 / 30511264
2 UCO
/90000021
10,68 / 0
0,00
Total:
0468000239003
0468000239011
372,07
Silvio Henrique Dos Santos Rayol

Rosangela Reis Batalha Rayol
110000079
14/11/2011 14:14:00 7637048 / 99999 / 30462153
40901114 Mamas
/40901114
1/0
86,31
110000079
14/11/2011 13:02:00 7637048 / 99999 / 30462153
40808033 MAMOGRAFIA
/40808033
1/0
85,11
110000079
14/11/2011 13:02:00 7637048 / 99999 / 30462153
1 FILME
1,54 / 0
34,95
110000079
14/11/2011 13:02:00 7637048 / 99999 / 30462153
2 UCO
/90000021
6,18 / 0
0,00
206,37
Total:
0468000240001
0468000240109
Simei Oliveira Ribeiro

Pedro Oliveira Camara
310000145
05/12/2011 09:51:00 7626634 / 99999 / 485972
/40310400
1/0
67,72
310000145
05/12/2011 09:51:00 7626634 / 99999 / 485972
/40307760
1/0
9,99
310000145
05/12/2011 09:51:00 7626634 / 99999 / 485972
/40311210
1/0
11,20
310000145
05/12/2011 09:51:00 7626634 / 99999 / 485972
/40310400
2/0
135,44
310000145
05/12/2011 09:51:00 7626634 / 99999 / 485972
/40307182
1/0
45,07
310000145
05/12/2011 09:51:00 7626634 / 99999 / 485972
/90000021
19,755 / 0
2 UCO
269,42
Total:
0468000241008
0468000241008
1201804
Sofia Brasil Lopes

Sofia Brasil Lopes
/ Mahiba Mattar R De Sousa
28/11/2011
7661434 / 99999 / 10241189
/10101012
1/0
Total:
0468000243000
0468000243302
0,00
Sonia Aparecida Jansen

Mariana Jansen Carneiro
83,07
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 79

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000333
/ Unimed Paulistana Soc De
333 4246
30/11/2011 08:01:35 7653833 / 223524 / 00000000000160517892

/10101012
Lote: 223524 Nota: 325
1/0
61,43
89000333
333 3888
25/11/2011 08:01:33 7653831 / 223524 / 00000000000160372635

/10101012
Lote: 223524 Nota: 325
1/0
61,43
89000333
333 11000421 12/11/2011 16:01:14 7648289 / 223068 / 00000000000000326893

/10101039
Lote: 223068 Nota: 324
1/0
63,88
186,74
Total:
0468000245003
0468000245011
Sylvio Cesar Costa De Brito

Marjorie Cesar Dantas Cunha Da Silva De Brito
1341762
/ Raimundo Francisco Rabelo
25/11/2011
7674017 / 99999 / 10240118
/10101012
1/0
83,07
110000052
27/11/2011 13:03:00 7603306 / 99999 / 30481337
/10101039
1/0
94,77
110000079
16/11/2011 14:16:00 7635291 / 99999 / 30464499
40901297 Obsttrica 1 trimestre (endovaginal)
/40901297
1/0
147,34
110000052
27/11/2011 13:03:00 7603306 / 99999 / 30481337
30101484 Exrese de unha
/30101484
1/0
40,29
110000079
16/11/2011 14:16:00 7635291 / 99999 / 30464499
1 FILME
0,34 / 0
7,72
110000079
16/11/2011 14:16:00 7635291 / 99999 / 30464499
2 UCO
/90000021
3,82 / 0
0,00
/10101012
1/0
83,07
0468000245100
Joao Pedro Passos De Brito
1110981
/ Getulio Ferreira De Albuquerque
16/12/2011
7604009 / 99999 / 096790
210020543
25/11/2011 00:04:00 7643704 / 99999 / 30478506
/10101039
1/0
40,95
210020560
24/11/2011 20:59:00 7635553 / 99999 / 30478506
/10101039
1/0
68,45
565,66
Total:
0468000246000
0468000246000
1340340
Taniana Carlinda Viana Pitombeira

Taniana Carlinda Viana Pitombeira
0468000246310
07/12/2011
7660523 / 99999 / 218246
/10101012
1/0
83,07
Lara Luiza Pitombeira Rocha
310000030
17/12/2011
7616450 / 99999 / 30509677
/40311210
1/0
11,20
310000030
17/12/2011
7616450 / 99999 / 30509677
/40308391
1/0
36,82
310000030
17/12/2011
7616450 / 99999 / 30509677
1/0
11,78
310000030
17/12/2011
7616450 / 99999 / 30509677
/90000021
1,68 / 0
/10101012
1/0
0468000246514
11000690
2 UCO
0,00
Ana de J V Pitombeira
/ Antonio Carlos P De Oliveira
12/12/2011
7676644 / 99999 / 10249461
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 80

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
110000079
12/12/2011 09:50:00 7636292 / 99999 / 30502441
40802035 Coluna dorsal - 2 incidncias
/40802035
1/0
34,19
110000079
12/12/2011 09:50:00 7636292 / 99999 / 30502441
40803074 Articulao escapuloumeral (ombro)
/40803074
1/0
32,98
110000079
12/12/2011 13:05:00 7636306 / 99999 / 30502443
40901220 Articular (por articulao)
/40901220
1/0
86,31
110000079
12/12/2011 09:50:00 7636292 / 99999 / 30502441
/40802019
1/0
32,98
110000079
12/12/2011 13:05:00 7636306 / 99999 / 30502443
1 FILME
0,34 / 0
7,72
110000079
12/12/2011 09:50:00 7636292 / 99999 / 30502441
1 FILME
0,456 / 0
10,35
110000079
12/12/2011 09:50:00 7636292 / 99999 / 30502441
2 UCO
/90000021
4,02 / 0
0,00
110000079
12/12/2011 13:05:00 7636306 / 99999 / 30502443
2 UCO
/90000021
3,42 / 0
0,00
/10101012
1/0
0468000246603
1340340
Daniela Pitombeira Campos
07/12/2011
7660526 / 99999 / 218243
513,54
Total:
0468000250007
0468000250007
83,07
Terezinha De Jesus Araujo

Terezinha De Jesus Araujo
110000052
22/11/2011 14:31:31 7603247 / 99999 / 30479988
/10101039
1/0
94,77
110000052
21/11/2011 14:44:02 7612648 / 99999 / 30471877
/10101039
1/0
94,77
189,54
Total:
0468000252000
0468000252000
Tomaz Aquino Rodrigues De Sousa

Tomaz Aquino Rodrigues De Sousa
4350
/ Stenio Roberto De Castro Lima
16/12/2011
7674210 / 99999 / 10253628
/10101012
1/0
83,07
1430013
/ Jose Ulcijara Aquino
04/10/2011
7656911 / 99999 / 190644
/10101012
1/0
83,07
0468000252018
Maria Madalena Silva De Sousa
25204
/ Bruno Neves Ramos
01/12/2011
7673094 / 99999 / 10244046
/10101012
1/0
83,07
1430013
/ Jose Ulcijara Aquino
03/10/2011
7656910 / 99999 / 190645
/10101012
1/0
83,07
7673093 / 99999 / 10244033
/10101012
1/0
83,07
0468000252107
25204
/ Bruno Neves Ramos
Simone Silva De Sousa

01/12/2011
Total:
0468000255009
Vera Lucia B Nunes
415,35
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 81

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468000255092
Antonio Rodrigues Nunes
146000109
/ Simone Santos Lameiras Teixeira
14/12/2011
7676150 / 99999 / 10251604
/10101012
Obs.
Qtd/Partic
1/0
83,07
83,07
Total:
0468000260002
0468000260002
Vl.Cob
Wilson Azevedo Pereira

Wilson Azevedo Pereira
11000518
24/10/2011 18:00:00 7679152 / 223936 / 10219355
/10101012
1/0
83,07
26340
/ Acacia Patricia Jordao Da Silva
22/11/2011 09:00:00 7666112 / 99999 / 30473310
/41301250
1/0
30,70
26340
22/11/2011 09:00:00 7666112 / 99999 / 30473310
/41501128
1/0
30,70
3583
28/10/2011 16:11:00 7679185 / 223950 / 30432428
/40901106
1/0
239,62
3583
28/10/2011 16:11:00 7679185 / 223950 / 30432428
/40101045
1/0
30,70
26340
19/11/2011 08:59:00 7666110 / 99999 / 30469430
40103137 Campimetria computadorizada - monocular

/40103137
1/0
30,70
26340
22/11/2011 09:00:00 7666112 / 99999 / 30473310
41301129 Curva tensional diria - binocular
/41301129
1/0
40,29
3583
28/10/2011 16:11:00 7679184 / 223950 / 30432436
/40901360
1/0
115,13
26340
19/11/2011 08:59:00 7666110 / 99999 / 30469430
40103137 Campimetria computadorizada - monocular

/40103137
1/0
30,70
26340
22/11/2011 09:00:00 7666112 / 99999 / 30473310
2 UCO
/90000021
1,68 / 0
0,00
3583
28/10/2011 16:11:00 7679185 / 223950 / 30432428
2 UCO
/90000021
7,16 / 0
0,00
3583
28/10/2011 16:11:00 7679184 / 223950 / 30432436
2 UCO
/90000021
8,26 / 0
0,00
3583
28/10/2011 16:11:00 7679184 / 223950 / 30432436
1 FILME
0,68 / 0
15,43
26340
19/11/2011 08:59:00 7666110 / 99999 / 30469430
2 UCO
/90000021
5,54 / 0
0,00
/40311210
1/0
11,20
0468000260304
Maria Eduarda Pereira Azevedo
310000030
12/12/2011
7627032 / 99999 / 687658
210020543
11/12/2011 17:10:00 7627853 / 99999 / 573028
/10101039
1/0
40,95
310000030
12/12/2011
1/0
11,78
210020543
12/12/2011 08:00:00 7627865 / 99999 / 686072
/10101039
1/0
40,95
310000030
12/12/2011
/40308391
1/0
36,82
210020560
11/12/2011 17:59:00 7635457 / 99999 / 30501765
/10101039
1/0
68,45
7627032 / 99999 / 687658
7627032 / 99999 / 687658
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 82

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
310000030
12/12/2011
7627032 / 99999 / 687658
2 UCO
/90000021
Obs.
Qtd/Partic
1,68 / 0
Wilson De Jesus Barros Junior

Vitor Cunha Barros
89000006
/ Unimed Belo Horizonte Coop De 6
22000401 12/11/2011 12:46:00 7647954 / 223022 / 275384249
89000006
/ Unimed Belo Horizonte Coop De 6
22000401 12/11/2011 12:46:00 7647954 / 223022 / 275384249

/10101039
Lote: 223022 Nota: 324
1/0
63,88
/80031005
Lote: 223022 Nota: 324
1/0
4,20
68,08
Total:
0468000263001
0468000263001
0,00
857,19
Total:
0468000261009
0468000261106
Vl.Cob
Zenaide Do Socorro Santos Bayma

Zenaide Do Socorro Santos Bayma
28547
/ Jose Roberto Pereira Guimaraes
14/12/2011
7655955 / 99999 / 10252254
/10101012
1/0
83,07
4712
/ Helio Stenio Neves Noleto
15/12/2011
7665975 / 99999 / 10252712
/10101012
1/0
83,07
0468000263095
Antonio E Gomes Bayma
310000145
08/12/2011 22:25:00 7618409 / 99999 / 30499093
40301630 Creatinina
/40301630
1/0
5,28
110000052
08/12/2011 22:16:50 7615561 / 99999 / 30499082
/10101039
1/0
94,77
310000145
08/12/2011 22:25:00 7618409 / 99999 / 30499093
1/0
11,78
110000052
08/12/2011 22:45:00 7616350 / 99999 / 30499098
/40805026
1/0
15,35
310000145
08/12/2011 22:25:00 7618409 / 99999 / 30499093
/40302512
1/0
9,76
310000145
08/12/2011 22:25:00 7618409 / 99999 / 30499093
/40308391
1/0
36,82
310000145
08/12/2011 22:25:00 7618409 / 99999 / 30499093
40302318 Potssio
/40302318
1/0
5,28
310000145
08/12/2011 22:25:00 7618409 / 99999 / 30499093
40302580 Uria
/40302580
1/0
5,28
310000145
08/12/2011 22:25:00 7618409 / 99999 / 30499093
/40301990
1/0
9,76
310000145
08/12/2011 22:25:00 7618409 / 99999 / 30499093
/40302504
1/0
9,76
310000145
08/12/2011 22:25:00 7618409 / 99999 / 30499093
40302423 Sdio
/40302423
1/0
5,28
310000145
08/12/2011 22:25:00 7618409 / 99999 / 30499093
40302040 Glicose
/40302040
1/0
5,28
310000145
08/12/2011 22:25:00 7618409 / 99999 / 30499093
2 UCO
/90000021
4,965 / 0
0,00
110000052
08/12/2011 22:45:00 7616350 / 99999 / 30499098
1 FILME
0,308 / 0
6,99
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 83

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
110000052
08/12/2011 22:45:00 7616350 / 99999 / 30499098
2 UCO
/90000021
Obs.
Qtd/Partic
1,18 / 0
1101893
0,00
387,53
Total:
0468000265004
0468000265012
Vl.Cob
Jivago Ribeiro De Carvalho

Fernanda Da Cunha Amaral Oliveira De Carvalho
/ Jose Manoel Alves Da Silva
0468000265101
16/12/2011
7647277 / 99999 / 35152
/10101012
1/0
83,07
Jivago Alexandrino Feitosa Carvalho
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
40301630 Creatinina
/40301630
Lote: 223086 Nota: 324
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
/40311210
Lote: 223086 Nota: 324
1/0
5,90
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
40302636 Lipdios totais
/40302636
Lote: 223086 Nota: 324
1/0
2,95
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
40301150 cido rico
/40301150
Lote: 223086 Nota: 324
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
40302040 Glicose
/40302040
Lote: 223086 Nota: 324
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
/40302512
Lote: 223086 Nota: 324
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
/40302504
Lote: 223086 Nota: 324
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
/40301605
Lote: 223086 Nota: 324
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
Lote: 223086 Nota: 324
1/0
8,85
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
40302580 Uria
/40302580
Lote: 223086 Nota: 324
1/0
4,13
89000099
/ Unimed Teresina
99
31000022 24/09/2011 08:24:00 7650890 / 223086 / 3407295
40310124 Cultura bacteriana (em diversos
/40310124
Lote: 223086 Nota: 324
1/0
14,74
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
/40308391
Lote: 223086 Nota: 324
1/0
24,77
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
/40302547
Lote: 223086 Nota: 324
1/0
5,90
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
/40307760
Lote: 223086 Nota: 324
1/0
5,90
89000099
/ Unimed Teresina
99
31000022 16/09/2011
7650889 / 223086 / 6609861
/40307182
Lote: 223086 Nota: 324
1/0
58,97
0468000265110
Luiz Amaral Oliveira De Carvalho
1101893
/ Jose Manoel Alves Da Silva
16/12/2011
7647276 / 99999 / 35151
/10101012
1/0
83,07
310000030
28/11/2011
7601403 / 99999 / 30481518
/40310400
1/0
67,72
310000030
26/11/2011
7609965 / 99999 / 30479976
1/0
11,78
310000030
22/11/2011
7609526 / 99999 / 30471427
1/0
11,20
/40311210
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 84

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
22/11/2011
7609526 / 99999 / 30471427
40302040 Glicose
/40302040
1/0
5,28
310000030
28/11/2011
7601407 / 99999 / 30481470
/40303098
1/0
5,99
310000030
22/11/2011
7609526 / 99999 / 30471427
/40302512
1/0
9,76
310000030
22/11/2011
7609526 / 99999 / 30471427
1/0
11,78
310000030
26/11/2011
7609965 / 99999 / 30479976
/40304370
1/0
5,28
310000030
22/11/2011
7609526 / 99999 / 30471427
/40304370
1/0
5,28
310000030
22/11/2011
7609526 / 99999 / 30471427
/40310337
1/0
24,52
310000030
22/11/2011
7609526 / 99999 / 30471427
40303152 Substncias redutoras nas fezes
/40303152
1/0
5,99
310000030
28/11/2011
7601407 / 99999 / 30481470
/40310337
1/0
24,52
310000030
22/11/2011
7609526 / 99999 / 30471427
/40303098
1/0
5,99
310000030
28/11/2011
7601407 / 99999 / 30481470
40304329 Hemcias fetais, pesquisa
/40304329
1/0
5,51
310000030
22/11/2011
7609526 / 99999 / 30471427
/40302504
1/0
9,76
310000030
26/11/2011
7609965 / 99999 / 30479976
/40308391
1/0
36,82
310000030
22/11/2011
7609526 / 99999 / 30471427
40310230 Fungos, pesquisa de (a fresco
/40310230
1/0
9,63
310000030
28/11/2011
7601407 / 99999 / 30481470
/40303110
1/0
12,78
310000030
22/11/2011
7609526 / 99999 / 30471427
/40308391
1/0
36,82
310000030
28/11/2011
7601407 / 99999 / 30481470
2 UCO
/90000021
3,537 / 0
0,00
310000030
28/11/2011
7601403 / 99999 / 30481518
2 UCO
/90000021
4,977 / 0
0,00
310000030
26/11/2011
7609965 / 99999 / 30479976
2 UCO
/90000021
1,257 / 0
0,00
310000030
22/11/2011
7609526 / 99999 / 30471427
2 UCO
/90000021
7,233 / 0
0,00
/10101012
1/0
0468000265128
1110981
Joao Amaral Oliveira De Carvalho
/ Getulio Ferreira De Albuquerque
30/11/2011
7604036 / 99999 / 144702
Total:
0468000266000
0468000266019
Odival Quaresma Filho

Maria Gorete Pinto Quaresma
83,07
712,51
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 85

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
20/12/2011
7623347 / 99999 / 30513254
/40311210
1/0
11,20
310000030
20/12/2011
7623347 / 99999 / 30513254
/40308391
1/0
36,82
310000030
20/12/2011
7623347 / 99999 / 30513254
1/0
24,52
310000030
20/12/2011
7623347 / 99999 / 30513254
1/0
11,78
310000030
20/12/2011
7623347 / 99999 / 30513254
/90000021
3,48 / 0
0,00
0468000266515
2 UCO
Maria Lucia De Almeida Quaresma
89000088
88
10000479 19/10/2011
7648190 / 223066 / 16563448
Lote: 223066 Nota: 324
1/0
8,85
89000088
88
10000479 21/10/2011
7648244 / 223066 / 16602618
/40301605
Lote: 223066 Nota: 324
1/0
4,13
89000088
88
10018368 03/11/2011
7648213 / 223066 / 16602796
/40901106
Lote: 223066 Nota: 324
1/0
147,42
89000088
88
10000479 21/10/2011
7648244 / 223066 / 16602618
/40301583
Lote: 223066 Nota: 324
1/0
8,85
89000088
88
10018368 20/10/2011
7648212 / 223066 / 16589942
Lote: 223066 Nota: 324
1/0
17,69
89000088
88
10000479 21/10/2011
7648244 / 223066 / 16602618
40301630 Creatinina
/40301630
Lote: 223066 Nota: 324
1/0
4,13
89000088
88
10000479 19/10/2011
7648190 / 223066 / 16563448
40302040 Glicose
/40302040
Lote: 223066 Nota: 324
1/0
4,13
89000088
88
10000479 21/10/2011
7648244 / 223066 / 16602618
/40302547
Lote: 223066 Nota: 324
1/0
5,90
89000088
88
10000479 19/10/2011
7648190 / 223066 / 16563448
/40304922
Lote: 223066 Nota: 324
1/0
17,69
Total:
0468000268003
0468000268100
89000098
303,11
Itamar Machado Cardoso

Jorge Vieira Cardoso
/ Unimed Imperatriz
98
12980
03/10/2011 12:00:00 7648858 / 223079 / 41885
/10101012
Lote: 223079 Nota: 324
1/0
58,97
Total:
0468000273007
0468000273104
58,97
Raimundo Nonato Porto De Lima

Rafael Levi Holanda Porto
310000145
20/11/2011 17:52:00 7613029 / 99999 / 30470261
/40303098
1/0
5,99
310000145
20/11/2011 17:52:00 7613029 / 99999 / 30470261
40303152 Substncias redutoras nas fezes
/40303152
1/0
5,99
310000145
20/11/2011 17:52:00 7613029 / 99999 / 30470261
/40308391
1/0
36,82
310000145
20/11/2011 17:52:00 7613029 / 99999 / 30470261
/40311210
1/0
11,20
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 86

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000145
20/11/2011 17:52:00 7613029 / 99999 / 30470261
/40303039
1/0
21,61
310000145
20/11/2011 17:52:00 7613029 / 99999 / 30470261
1/0
11,78
310000145
20/11/2011 17:52:00 7613029 / 99999 / 30470261
/40310337
1/0
24,52
310000145
20/11/2011 17:52:00 7613029 / 99999 / 30470261
/40303110
1/0
12,78
110000052
20/11/2011 17:40:29 7605614 / 99999 / 30470248
/10101039
1/0
94,77
310000145
20/11/2011 17:52:00 7613029 / 99999 / 30470261
/40303136
1/0
12,78
310000145
20/11/2011 17:52:00 7613029 / 99999 / 30470261
/90000021
7,764 / 0
2 UCO
238,24
Total:
0468000275000
0468000275107
0,00
Geovane Leocadio De Almeida

Thalison Souza De Almeida
310000030
18/11/2011 12:00:00 7679247 / 223976 / 567911
/40311210
1/0
11,20
310000030
18/11/2011 12:00:00 7679247 / 223976 / 567911
1/0
11,78
310000030
18/11/2011 12:00:00 7679247 / 223976 / 567911
/40303110
1/0
12,78
310000030
18/11/2011 12:00:00 7679247 / 223976 / 567911
2 UCO
/90000021
2,607 / 0
/10101012
1/0
83,07
0468000275514
0,00
Magnolia Leocadio De Almeida
11000011
/ Joaquim Clementino Lobato Filho
28/11/2011
7659499 / 99999 / 10240729
310000242
28/11/2011 10:00:00 7606605 / 99999 / 446127
/40601110
1/0
58,42
11000011
28/11/2011 10:03:00 7660008 / 99999 / 507482
1/0
157,75
310000242
28/11/2011 10:00:00 7606605 / 99999 / 446127
2 UCO
/90000021
2,06 / 0
0,00
11000011
28/11/2011 10:03:00 7660008 / 99999 / 507482
/90000021
1/0
6,86
11000011
28/11/2011 10:03:00 7660008 / 99999 / 507482
2 UCO
/90000021
13,67 / 0
0,00
11000011
28/11/2011 10:03:00 7660008 / 99999 / 507482
/90000013
1/0
7,01
348,87
Total:
0468000285005
0468000285005
110000079
Ricardo Luis Da Silva

Ricardo Luis Da Silva
13/10/2011 10:23:00 7634101 / 99999 / 30412961
/40901106
1/0
299,80
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 87

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
110000079
13/10/2011 09:11:00 7634101 / 99999 / 30412961
110000079
13/10/2011 09:11:00 7634101 / 99999 / 30412961
2 UCO
Obs.
Qtd/Partic
/20102038
1/0
/90000021
12 / 0
Total:
0468000286001
0468000286095
110000052
192,16
0,00
491,96
Ileana Pereira Mota Magalhaes

Fabio Magalhaes Pinto
23/11/2011 21:49:44 7612411 / 99999 / 30476601
/10101039
1/0
94,77
94,77
Total:
0468000287008
0468000287008
Vl.Cob
Fernanda Guimaraes Alves

Fernanda Guimaraes Alves
1360473
/ Romero H Carvalho Bertrand
25/11/2011
1360473
1360473
7655031 / 99999 / 2299577
/10101012
1/0
83,07
02/12/2011 10:32:00 7657231 / 99999 / 30490322
/41301080
2/0
95,94
25/11/2011 09:00:00 7657274 / 99999 / 563762
/41301323
1/0
15,35
1360473
02/12/2011 10:32:00 7657231 / 99999 / 30490322
/41301269
2/0
95,94
1360473
02/12/2011 10:32:00 7657231 / 99999 / 30490322
/41501128
2/0
61,40
36605
/ Fernando Cleydson Lima Paiva
02/12/2011 13:39:00 7659426 / 99999 / 30490689
/41301250
2/0
61,40
1360473
25/11/2011 09:00:00 7657274 / 99999 / 563762
2 UCO
/90000021
0,5 / 0
0,00
1360473
02/12/2011 10:32:00 7657231 / 99999 / 30490322
2 UCO
/90000021
11,24 / 0
0,00
36605
/ Fernando Cleydson Lima Paiva
02/12/2011 13:39:00 7659426 / 99999 / 30490689
2 UCO
/90000021
0,58 / 0
0,00
413,10
Total:
0468000288004
0468000288101
11000569
Ronilson Machado Barbosa

Edmar Marques Barbosa
/ Maria Da Gloria M Barbosa
15/12/2011
7674156 / 99999 / 10253369
/10101012
1/0
83,07
Total:
0468000291005
0468000291005
11000720
Andrea Ferreira Torreao Moura De Lima

Andrea Ferreira Torreao Moura De Lima
/ Maria Bethania Da Costa Chein
09/12/2011
7646718 / 99999 / 10249006
/10101012
1/0
Total:
0468000292001
83,07
Maria Antonia Pinheiro Brito
83,07
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 88

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468000292001
Maria Antonia Pinheiro Brito
Obs.
Qtd/Partic
Vl.Cob
310000242
05/12/2011 10:00:00 7604927 / 99999 / 30492718
/40601110
1/0
58,42
950000970
05/12/2011 07:14:00 7678756 / 223677 / 451789
1/0
157,75
310000242
05/12/2011 10:00:00 7604927 / 99999 / 30492718
40306917 Helicobacter pylori - IgG
/40306917
1/0
39,02
310000242
05/12/2011 10:00:00 7604927 / 99999 / 30492718
2 UCO
/90000021
4,904 / 0
950000970
05/12/2011 07:14:00 7678756 / 223677 / 451789
/90000021
1/0
950000970
05/12/2011 07:14:00 7678756 / 223677 / 451789
2 UCO
/90000021
13,67 / 0
/10101012
1/0
83,07
1/0
15,35
/90000021
0,75 / 0
/10101012
1/0
0468000292095
/ Francisco Das Chagas Monteiro
16/12/2011
110000443
16/12/2011 09:26:00 7623542 / 99999 / 30509628
110000443
16/12/2011 09:26:00 7623542 / 99999 / 30509628
0468000292516
7657153 / 99999 / 10253534
2 UCO
12/12/2011
7675081 / 99999 / 10250217
83,07
Valdinar Rodrigues De Moraes

Cristina Vieira De Moraes
/ Nutricon Clinica E Consultoria
19/12/2011 15:16:00 7626454 / 99999 / 30497432
1/0
28,08
28,08
Total:
0468000294004
0468000294306
0,00
450,54
Total:
21002620
0,00
Ila Pinheiro Brito
/ Merly Costa Ferreira
0468000293008
0468000293016
13,86
Lineu De Oliveira Nobrega
11001808
1852
0,00
Luis Gonzaga De Araujo Neto

Maysa Farias De Almeida Araujo
89000178
/ Unimed Anapolis - Coop De
178 3839
89000178
89000178
05/12/2011
7654272 / 223555 / 2568708
/10101012
Lote: 223555 Nota: 325
1/0
61,43
178 31000001 23/11/2011 21:48:00 7654271 / 223555 / 4771981
Lote: 223555 Nota: 325
1/0
8,85
178 17800476 23/11/2011 20:27:00 7654257 / 223554 / 4771951
/10101039
Lote: 223554 Nota: 325
1/0
63,88
89000178
178 11000002 23/11/2011
7654270 / 223555 / 484146
/80031005
Lote: 223555 Nota: 325
3/0
12,71
89000178
178 11000002 23/11/2011
7654270 / 223555 / 484146
26298 SERINGA 10ML C/AG 25X8 DESC
/70438471
Lote: 223555 Nota: 325
1/0
0,43
89000178
178 11000002 23/11/2011
7654270 / 223555 / 484146
51798 CATETER PERIFERICO AGULHADO
/75600021
Lote: 223555 Nota: 325
1/0
0,39
89000178
178 11000002 23/11/2011
7654270 / 223555 / 484146
52830 ALGODAO HIDROFILO EM BOLAS
/79908039
Lote: 223555 Nota: 325
1/0
0,01
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 89

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000178
178 11000002 23/11/2011
7654270 / 223555 / 484146
51553 ESPARADRAPO 10CMX4 5MT 198 973 /71700013
Lote: 223555 Nota: 325
10 / 0
0,23
89000178
178 11000002 23/11/2011
7654270 / 223555 / 484146
51544 EQUIPO MACROGOTAS C/INJ
/71600213
Lote: 223555 Nota: 325
1/0
1,52
89000178
178 11000002 23/11/2011
7654270 / 223555 / 484146
/90000013
Lote: 223555 Nota: 325
1/0
0,01
89000178
178 11000002 23/11/2011
7654270 / 223555 / 484146
2807 GLICOSE 50% AMP 10 ML
/90193571
Lote: 223555 Nota: 325
3/0
2,98
89000178
178 11000002 23/11/2011
7654270 / 223555 / 484146
11202 RINGER SIST FECH BOLSA 500 ML /92409911
Lote: 223555 Nota: 325
3/0
22,85
89000178
178 11000002 23/11/2011
7654270 / 223555 / 484146
/90196015
Lote: 223555 Nota: 325
2/0
6,20
0468000294314
2860 FLORATIL 100 MG 12 CAPS
Luisa Helena Di Melo Araujo
89000098
/ Unimed Imperatriz
98
17796
18/10/2011 12:00:00 7648859 / 223079 / 422266
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
35999
07/10/2011 12:00:00 7649807 / 223079 / 2188964
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000178
178 21000022 01/11/2011 09:39:00 7654273 / 223555 / 4750596
40901220 Articular (por articulao)
/40901220
Lote: 223555 Nota: 325
1/0
62,12
89000098
/ Unimed Imperatriz
98
10724
/10101039
Lote: 223079 Nota: 324
1/0
43,00
89000098
/ Unimed Imperatriz
98
50000001 08/10/2011 06:44:00 7648460 / 223079 / 4147945
20104235 Terapia inalatria - por nebulizao
/20104235
Lote: 223079 Nota: 324
2/0
5,90
89000098
/ Unimed Imperatriz
98
50000001 08/10/2011 06:44:00 7648460 / 223079 / 4147945
Lote: 223079 Nota: 324
1/0
37,43
89000178
178 21000022 01/11/2011 09:39:00 7654273 / 223555 / 4750596
1 FILME
Lote: 223555 Nota: 325
0,0005 / 0
89000098
/ Unimed Imperatriz
98
50000001 08/10/2011 06:44:00 7648460 / 223079 / 4147945
/90000021
Lote: 223079 Nota: 324
1/0
11,22
89000098
/ Unimed Imperatriz
98
50000001 08/10/2011 06:44:00 7648460 / 223079 / 4147945
/90000013
Lote: 223079 Nota: 324
1/0
31,61
08/10/2011 06:44:00 7650049 / 223079 / 4147945
490,72
Total:
0468000296007
0468000168092
3657
Maria Augusta Brandao Pereira

Tiago Pereira
/ Adelson Henrique Marinho Da
19/12/2011
7674765 / 99999 / 115170
/10101012
1/0
83,07
83,07
Total:
0468000299006
0468000299006
0,01
Luciano Augusto Linhares Santos

Luciano Augusto Linhares Santos
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
/40307760
Lote: 223079 Nota: 324
1/0
5,90
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
/40307182
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
40316416 Prolactina
/40316416
Lote: 223079 Nota: 324
1/0
25,06
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 90

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
40316491 T4 livre
/40316491
Lote: 223079 Nota: 324
1/0
25,06
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
/40316521
Lote: 223079 Nota: 324
1/0
25,06
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
/40311210
Lote: 223079 Nota: 324
1/0
5,90
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
/40316289
Lote: 223079 Nota: 324
1/0
19,16
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
Lote: 223079 Nota: 324
1/0
8,85
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
/40307026
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
40302040 Glicose
/40302040
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
40307018 Hepatite B - HBSAG (AU, antgeno
/40307018
Lote: 223079 Nota: 324
1/0
20,64
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
/40316335
Lote: 223079 Nota: 324
1/0
18,58
89000098
/ Unimed Imperatriz
98
31000002 06/10/2011 16:45:00 7649126 / 223079 / 649696
/40302750
Lote: 223079 Nota: 324
1/0
20,64
0468000299022
Karem Denise Silva Costa
89000098
/ Unimed Imperatriz
98
12972
06/10/2011 12:00:00 7649127 / 223079 / 411423
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
39348
06/10/2011 12:00:00 7648861 / 223079 / 2188640
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
52395
03/10/2011
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
40316416 Prolactina
/40316416
Lote: 223079 Nota: 324
1/0
25,06
89000098
/ Unimed Imperatriz
98
31000026 26/10/2011 10:43:00 7648862 / 223079 / 4152610
/40601137
Lote: 223079 Nota: 324
1/0
20,64
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
/40307760
Lote: 223079 Nota: 324
1/0
5,90
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
/40307026
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
40316246 Estradiol
/40316246
Lote: 223079 Nota: 324
1/0
29,48
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
/40311210
Lote: 223079 Nota: 324
1/0
5,90
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
40302040 Glicose
/40302040
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
Lote: 223079 Nota: 324
1/0
8,85
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
/40307018
Lote: 223079 Nota: 324
1/0
20,64
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
/40316289
Lote: 223079 Nota: 324
1/0
19,16
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
/40316335
Lote: 223079 Nota: 324
1/0
18,58
7648498 / 223079 / 2187450
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 91

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
/40316521
Lote: 223079 Nota: 324
1/0
25,06
89000098
/ Unimed Imperatriz
98
21000104 17/10/2011 09:24:00 7649558 / 223079 / 649690
/40901300
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
/40307182
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
/40316548
Lote: 223079 Nota: 324
1/0
19,16
89000098
/ Unimed Imperatriz
98
39348
30101492 Exrese e sutura simples de pequenas
/30101492
Lote: 223079 Nota: 324
1/0
97,30
89000098
/ Unimed Imperatriz
98
31000002 07/10/2011 16:06:00 7648461 / 223079 / 649691
/40302750
Lote: 223079 Nota: 324
1/0
20,64
89000098
/ Unimed Imperatriz
98
39348
80031609 Sala de pequenas cirurgias
/80031609
Lote: 223079 Nota: 324
1/0
12,29
89000098
/ Unimed Imperatriz
98
21000104 17/10/2011 09:24:00 7649558 / 223079 / 649690
1 FILME
Lote: 223079 Nota: 324
0,19 / 0
89000098
/ Unimed Imperatriz
98
39348
07/10/2011 12:00:00 7648860 / 223079 / 624345
/90000021
Lote: 223079 Nota: 324
1/0
73,10
89000098
/ Unimed Imperatriz
98
39348
07/10/2011 12:00:00 7648860 / 223079 / 624345
/90000013
Lote: 223079 Nota: 324
1/0
13,02
07/10/2011 12:00:00 7648860 / 223079 / 624345
07/10/2011 12:00:00 7648860 / 223079 / 624345
1.074,18
Total:
0468000300004
0468000300004
4,53
Helena Cristina Do Nascimento Goltzman Garces

Helena Cristina Do Nascimento Goltzman Garces
11002103
28/11/2011
7665678 / 99999 / 10241408
/10101012
1/0
83,07
310000030
23/11/2011
7609690 / 99999 / 30465413
/40316289
1/0
29,27
210000062
18/11/2011 08:30:00 7639558 / 99999 / 653916
/40901300
1/0
91,69
310000030
23/11/2011
7609690 / 99999 / 30465413
40316246 Estradiol
/40316246
1/0
40,84
310000030
23/11/2011
7609690 / 99999 / 30465413
/40316335
1/0
29,27
310000030
23/11/2011
7609690 / 99999 / 30465413
2 UCO
/90000021
7,37 / 0
0,00
210000062
18/11/2011 08:30:00 7639558 / 99999 / 653916
1 FILME
0,17 / 0
3,86
210000062
18/11/2011 08:30:00 7639558 / 99999 / 653916
2 UCO
/90000021
3,82 / 0
0,00
/10101012
1/0
0468000300098
11002103
Fabio Henrique Soares Garces
28/11/2011
7665679 / 99999 / 10241368
Total:
0468000302007
0468000302007
Talita Larissa Lima

Talita Larissa Lima
83,07
361,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 92

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
110000079
14/11/2011 14:01:00 7635254 / 99999 / 30462247
40901181 Abdome inferior feminino (bexiga, tero, /40901181
110000079
14/11/2011 14:01:00 7635254 / 99999 / 30462247
2 UCO
110000079
14/11/2011 14:01:00 7635254 / 99999 / 30462247
1 FILME
Obs.
Qtd/Partic
1/0
/90000021
3,86 / 0
0,00
0,51 / 0
11,58
Mauricio Rios Junior

Gustavo Ortegal Rios
1111120
28/11/2011
310000242
310000242
310000242
/10101012
1/0
83,07
01/12/2011 10:00:00 7608142 / 99999 / 488842
40307255 IgE, grupo especfico, cada
/40307255
4/0
118,92
01/12/2011 10:00:00 7608142 / 99999 / 488842
40307271 IgE, total
/40307271
1/0
27,54
01/12/2011 10:00:00 7608142 / 99999 / 488842
/90000021
10,789 / 0
/10101012
1/0
0468000305308
1111120
92,23
103,81
Total:
0468000305006
0468000305111
Vl.Cob
7671738 / 99999 / 095135
2 UCO
Mylenna Ortegal Rios
28/11/2011
7671739 / 99999 / 095134
Total:
0468000306002
0468000306002
0,00
83,07
312,60
Senilson Charles Araujo Lima

Senilson Charles Araujo Lima
89000098
/ Unimed Imperatriz
98
36286
27/10/2011 12:00:00 7648863 / 223079 / 380125
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
36286
06/10/2011 12:00:00 7649808 / 223079 / 333867
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
14789
31/10/2011
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
31000003 07/10/2011 07:43:00 7648499 / 223079 / 649346
/40316149
Lote: 223079 Nota: 324
1/0
44,23
89000098
/ Unimed Imperatriz
98
31000003 07/10/2011 07:43:00 7648499 / 223079 / 649346
40316130 Antigeno especifico prostatico livre
/40316130
Lote: 223079 Nota: 324
1/0
61,03
89000098
/ Unimed Imperatriz
98
31000003 07/10/2011 07:43:00 7648499 / 223079 / 649346
40302040 Glicose
/40302040
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000003 07/10/2011 07:43:00 7648499 / 223079 / 649346
/40311210
Lote: 223079 Nota: 324
1/0
5,90
89000098
/ Unimed Imperatriz
98
31000003 07/10/2011 07:43:00 7648499 / 223079 / 649346
/40316513
Lote: 223079 Nota: 324
1/0
30,96
89000098
/ Unimed Imperatriz
98
31000003 07/10/2011 07:43:00 7648499 / 223079 / 649346
40301150 cido rico
/40301150
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000003 07/10/2011 07:43:00 7648499 / 223079 / 649346
Lote: 223079 Nota: 324
1/0
8,85
89000098
/ Unimed Imperatriz
98
31000003 07/10/2011 07:43:00 7648499 / 223079 / 649346
Lote: 223079 Nota: 324
1/0
5,90
7648462 / 223079 / 2195075
/40303110
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 93

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
21000068 31/10/2011 11:29:00 7649809 / 223079 / 4153939
/41301323
Lote: 223079 Nota: 324
1/0
10,13
89000098
/ Unimed Imperatriz
98
31000003 07/10/2011 07:43:00 7648499 / 223079 / 649346
40307166 HIV - antgeno P24
/40307166
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
21000053 06/10/2011 12:00:00 7648864 / 223079 / 4147426
Lote: 223079 Nota: 324
1/0
17,69
89000098
/ Unimed Imperatriz
98
31000003 07/10/2011 07:43:00 7648499 / 223079 / 649346
/40302750
Lote: 223079 Nota: 324
1/0
20,64
0468000306010
Keila Cristhane Franco Mesquita Lima
89000098
/ Unimed Imperatriz
98
21000109 17/10/2011 12:00:00 7649810 / 223079 / 427820
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
21000036 06/10/2011 12:00:00 7650050 / 223079 / 638467
/41301102
Lote: 223079 Nota: 324
1/0
24,32
89000098
/ Unimed Imperatriz
98
21000036 06/10/2011 12:00:00 7650050 / 223079 / 638467
/40901300
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
21000036 06/10/2011 12:00:00 7650050 / 223079 / 638467
41301374 Vulvoscopia (vulva e perneo)
/41301374
Lote: 223079 Nota: 324
1/0
24,32
89000098
/ Unimed Imperatriz
98
11000007 20/10/2011 12:00:00 7650051 / 223079 / 655927
/40601110
Lote: 223079 Nota: 324
3/0
123,83
89000098
/ Unimed Imperatriz
98
11000007 19/10/2011 09:18:00 7648463 / 223079 / 251800
31302050 Colpoplastia posterior com perineorrafia /31302050
Lote: 223079 Nota: 324
2/0
1.238,33
89000098
/ Unimed Imperatriz
98
11000007 19/10/2011 09:18:00 7648463 / 223079 / 251800
31307027 Cirurgia (via alta ou baixa) do
/31307027
Lote: 223079 Nota: 324
2/0
2.317,44
89000098
/ Unimed Imperatriz
98
11000007 19/10/2011 09:18:00 7648463 / 223079 / 251800
31303102 Histerectomia total (qualquer via)
/31303102
Lote: 223079 Nota: 324
2/0
2.476,66
89000098
/ Unimed Imperatriz
98
11000007 19/10/2011 09:18:00 7648463 / 223079 / 251800
80011039 Apartamento Standart
/80011039
Lote: 223079 Nota: 324
1/0
0,00
89000098
/ Unimed Imperatriz
98
11000007 19/10/2011 09:18:00 7648463 / 223079 / 251800
/80021050
Lote: 223079 Nota: 324
1/0
311,81
89000098
/ Unimed Imperatriz
98
11000007 19/10/2011 09:18:00 7648463 / 223079 / 251800
/90000021
Lote: 223079 Nota: 324
1/0
401,95
89000098
/ Unimed Imperatriz
98
21000036 06/10/2011 12:00:00 7650050 / 223079 / 638467
1 FILME
Lote: 223079 Nota: 324
0,19 / 0
89000098
/ Unimed Imperatriz
98
11000007 19/10/2011 09:18:00 7648463 / 223079 / 251800
/90000013
Lote: 223079 Nota: 324
1/0
433,68
/10101012
Lote: 223079 Nota: 324
1/0
58,97
0468000306100
89000098
/ Unimed Imperatriz
TC15 PORTE V
Pedro Mesquita Lima

98
44572
20/10/2011
7648464 / 223079 / 2192158
7.983,25
Total:
0468000307009
0468000307009
4,53
Gilcimar Lopes De Sousa Menez

Gilcimar Lopes De Sousa Menez
89000098
/ Unimed Imperatriz
98
50000001 15/10/2011 12:25:00 7648465 / 223079 / 4149840
/10101039
Lote: 223079 Nota: 324
1/0
43,00
89000098
/ Unimed Imperatriz
98
50000001 15/10/2011 12:25:00 7648465 / 223079 / 4149840
80031609 Sala de pequenas cirurgias
/80031609
Lote: 223079 Nota: 324
1/0
19,70
89000098
/ Unimed Imperatriz
98
50000001 15/10/2011 12:25:00 7648465 / 223079 / 4149840
/90000021
Lote: 223079 Nota: 324
1/0
4,24
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 94

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
89000098
/ Unimed Imperatriz
98
0468000307017
50000001 15/10/2011 12:25:00 7648465 / 223079 / 4149840
Obs.
Qtd/Partic
Lote: 223079 Nota: 324
1/0
6,70
/40901122
Lote: 223079 Nota: 324
1/0
98,77
Lote: 223079 Nota: 324
0,7599 / 0
18,11
/10101039
Lote: 223079 Nota: 324
1/0
43,00
Lote: 223079 Nota: 324
1/0
37,43
Lote: 223079 Nota: 324
1/0
14,41
Leidiane Melo De Menez Sousa
89000098
/ Unimed Imperatriz
98
21000001 24/10/2011 16:47:00 7650052 / 223079 / 608049
89000098
/ Unimed Imperatriz
98
21000001 24/10/2011 16:47:00 7650052 / 223079 / 608049
0468000307106

1 FILME
Carlos Eduardo Menez De Sousa
89000098
/ Unimed Imperatriz
98
15491
89000098
/ Unimed Imperatriz
98
50000001 28/09/2011 13:30:00 7648500 / 223079 / 271923
89000098
/ Unimed Imperatriz
98
50000001 28/09/2011 13:30:00 7648500 / 223079 / 271923
28/09/2011 13:30:00 7649811 / 223079 / 271923
/90000013
285,36
Total:
0468000310000
0468000310000
Vl.Cob
/90000013
Luzia Marilia Ferro Baima Santos

Luzia Marilia Ferro Baima Santos
14806
/ Jose Carlos Amaral Sousa
19/12/2011
7670968 / 99999 / 10255225
/10101012
1/0
83,07
1381446
/ Maria Denise Batista Barros
16/12/2011
7659325 / 99999 / 10254027
/10101012
1/0
83,07
21002618
17/11/2011 14:34:00 7643752 / 99999 / 645175
40901114 Mamas
/40901114
1/0
86,31
21002618
17/11/2011 14:34:00 7643752 / 99999 / 645175
1 FILME
0,34 / 0
7,72
21002618
17/11/2011 14:34:00 7643752 / 99999 / 645175
2 UCO
/90000021
3,42 / 0
0,00
0468000310093
Jose Carlos Teixeira Santos
89000063
63
6506
03/11/2011 13:10:55 7652616 / 223142 / 87752203
/10101012
Lote: 223142 Nota: 325
1/0
61,43
89000063
63
6506
03/11/2011 17:27:06 7652720 / 223142 / 87762433
/20104294
Lote: 223142 Nota: 325
1/0
132,68
454,28
Total:
0468000311006
0468000311103
110000052
Rosimary Lacerda Nascimento Almeida

Luis Miguel Lacerda Nascimento Almeida
26/09/2011 16:01:00 7679150 / 223933 / 30390431
/10101039
1/0
Total:
0468000314005
0468000314013
110000052
94,77
94,77
Luis Danilo Costa Oliveira

Nericia Regina De Carvalho Oliveira
29/11/2011 07:59:12 7612601 / 99999 / 30483708
/10101039
1/0
94,77
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 95

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000145
29/11/2011 08:50:00 7631116 / 99999 / 30483915
/40308391
1/0
36,82
310000145
29/11/2011 08:50:00 7631116 / 99999 / 30483915
/40311210
1/0
11,20
310000030
13/12/2011
1/0
24,52
310000145
29/11/2011 08:50:00 7631116 / 99999 / 30483915
/40310400
1/0
67,72
310000030
13/12/2011
/40311210
1/0
11,20
310000145
29/11/2011 08:50:00 7631116 / 99999 / 30483915
1/0
11,78
310000030
13/12/2011
7624317 / 99999 / 30503956
2 UCO
/90000021
2,61 / 0
0,00
310000145
29/11/2011 08:50:00 7631116 / 99999 / 30483915
2 UCO
/90000021
6,657 / 0
0,00
0468000314102
7624317 / 99999 / 30503956
7624317 / 99999 / 30503956
Ivo Luis De Carvalho Oliveira
310000145
02/11/2011 03:16:00 7607449 / 99999 / 30448197
1/0
11,78
110000052
27/11/2011 04:01:00 7603650 / 99999 / 30481270
/10101039
1/0
94,77
310000145
02/11/2011 03:16:00 7607449 / 99999 / 30448197
/40311210
1/0
11,20
310000145
02/11/2011 03:16:00 7607449 / 99999 / 30448197
/90000021
1,68 / 0
2 UCO
Total:
0468000553000
0468000553000
375,76
Ingrid Aragao Freitas Porto

Ingrid Aragao Freitas Porto
110000346
26/10/2011 13:45:00 7646906 / 99999 / 30430724
110000346
26/10/2011 13:45:00 7646906 / 99999 / 30430724
110000346
26/10/2011 13:45:00 7646906 / 99999 / 30430724
/40901300
1/0
1 FILME
0,17 / 0
3,86
2 UCO
/90000021
3,82 / 0
0,00
40,29
44,15
Total:
0468003501000
0468003501000
0,00
Jesumar Furtado Martins E Rocha

Jesumar Furtado Martins E Rocha
89000099
/ Unimed Teresina
99
11000028 16/10/2011 15:17:00 7650891 / 223086 / 3436973
89000099
/ Unimed Teresina
99
11000028 16/10/2011 15:17:00 7650891 / 223086 / 3436973
89000099
/ Unimed Teresina
99
89000099
/ Unimed Teresina
99
/10101039
Lote: 223086 Nota: 324
1/0
55,90
30680 SERINGA 20ML S/AG C/BICO LUER
/70525048
Lote: 223086 Nota: 324
1/0
2,20
11000028 16/10/2011 15:17:00 7650891 / 223086 / 3436973
26311 AGULHA 25X7 DESC
/70438609
Lote: 223086 Nota: 324
1/0
0,25
11000028 16/10/2011 15:17:00 7650891 / 223086 / 3436973
51544 EQUIPO MACROGOTAS C/INJ
/71600213
Lote: 223086 Nota: 324
1/0
3,63
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 96

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000099
/ Unimed Teresina
99
11000028 16/10/2011 15:17:00 7650891 / 223086 / 3436973
47764 ESCALPE P/INFUSAO 19GX3/4"
/70801690
Lote: 223086 Nota: 324
1/0
1,66
89000099
/ Unimed Teresina
99
11000028 16/10/2011 15:17:00 7650891 / 223086 / 3436973
37 CLORETO DE SODIO 0 9%
/90120450
Lote: 223086 Nota: 324
1/0
3,11
89000099
/ Unimed Teresina
99
11000028 16/10/2011 15:17:00 7650891 / 223086 / 3436973
10717 CLORETO DE POTASSIO 10% CX 100 /92400922
Lote: 223086 Nota: 324
1/0
0,64
89000099
/ Unimed Teresina
99
11000028 16/10/2011 15:17:00 7650891 / 223086 / 3436973
19214 CLORIDRATO DE RANITIDINA 25
/90285859
Lote: 223086 Nota: 324
2/0
2,93
89000099
/ Unimed Teresina
99
11000028 16/10/2011 15:17:00 7650891 / 223086 / 3436973
/90000013
Lote: 223086 Nota: 324
1/0
2,93
89000099
/ Unimed Teresina
99
11000028 16/10/2011 15:17:00 7650891 / 223086 / 3436973
3051 SOLUCAO DE GLICOSE A 5% SOL INJ /90199367
Lote: 223086 Nota: 324
2/0
2,43
1/0
83,07
0468003501019
25204
SIST
Andrea Sodre Martins E Rocha
/ Bruno Neves Ramos
05/12/2011
7673095 / 99999 / 10246026
/10101012
158,75
Total:
0468052026000
0468052026000
Giordana Bruna De Queiroz Cavalcante Silva

Giordana Bruna De Queiroz Cavalcante Silva
89000098
/ Unimed Imperatriz
98
21238
31/10/2011
7648941 / 223079 / 386177
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
21238
05/10/2011
7649128 / 223079 / 385154
/10101012
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
31000002 19/10/2011 15:14:00 7648466 / 223079 / 651741
/40307018
Lote: 223079 Nota: 324
1/0
20,64
89000098
/ Unimed Imperatriz
98
31000002 19/10/2011 15:14:00 7648466 / 223079 / 651741
/40307760
Lote: 223079 Nota: 324
1/0
5,90
89000098
/ Unimed Imperatriz
98
31000002 19/10/2011 15:14:00 7648466 / 223079 / 651741
/40316548
Lote: 223079 Nota: 324
1/0
19,16
89000098
/ Unimed Imperatriz
98
31000002 19/10/2011 15:14:00 7648466 / 223079 / 651741
/40316521
Lote: 223079 Nota: 324
1/0
25,06
89000098
/ Unimed Imperatriz
98
21000104 11/10/2011 08:23:00 7649671 / 223079 / 649726
/40901300
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
31000002 19/10/2011 15:14:00 7648466 / 223079 / 651741
/40307824
Lote: 223079 Nota: 324
1/0
17,69
89000098
/ Unimed Imperatriz
98
31000002 19/10/2011 15:14:00 7648466 / 223079 / 651741
Lote: 223079 Nota: 324
1/0
8,85
89000098
/ Unimed Imperatriz
98
21000104 20/10/2011 09:23:00 7649387 / 223079 / 651739
40901262 Obsttrica morfolgica
/40901262
Lote: 223079 Nota: 324
1/0
71,35
89000098
/ Unimed Imperatriz
98
31000002 19/10/2011 15:14:00 7648466 / 223079 / 651741
40302040 Glicose
/40302040
Lote: 223079 Nota: 324
1/0
4,13
89000098
/ Unimed Imperatriz
98
31000002 19/10/2011 15:14:00 7648466 / 223079 / 651741
/40307182
Lote: 223079 Nota: 324
1/0
58,97
89000098
/ Unimed Imperatriz
98
31000002 19/10/2011 15:14:00 7648466 / 223079 / 651741
/40307832
Lote: 223079 Nota: 324
1/0
10,32
89000098
/ Unimed Imperatriz
98
50000001 01/10/2011 10:19:00 7648501 / 223079 / 4145803
/10101039
Lote: 223079 Nota: 324
1/0
43,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 97

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
89000098
/ Unimed Imperatriz
98
31000002 19/10/2011 15:14:00 7648466 / 223079 / 651741
/40302750
Lote: 223079 Nota: 324
1/0
20,64
89000098
/ Unimed Imperatriz
98
50000001 01/10/2011 10:19:00 7648501 / 223079 / 4145803
Lote: 223079 Nota: 324
1/0
37,43
89000098
/ Unimed Imperatriz
98
50000001 01/10/2011 10:19:00 7648501 / 223079 / 4145803
/90000021
Lote: 223079 Nota: 324
1/0
14,39
89000098
/ Unimed Imperatriz
98
21000104 11/10/2011 08:23:00 7649671 / 223079 / 649726
1 FILME
Lote: 223079 Nota: 324
0,19 / 0
4,53
89000098
/ Unimed Imperatriz
98
21000104 20/10/2011 09:23:00 7649387 / 223079 / 651739
1 FILME
Lote: 223079 Nota: 324
0,3402 / 0
8,11
89000098
/ Unimed Imperatriz
98
50000001 01/10/2011 10:19:00 7648501 / 223079 / 4145803
/90000013
Lote: 223079 Nota: 324
1/0
16,89
/10101012
Lote: 223079 Nota: 324
1/0
58,97
/10101012
Lote: 223079 Nota: 324
1/0
58,97
0468052026302
89000098
Larissa De Queiroz Cavalcante Silva
/ Unimed Imperatriz
98
0468052026515
89000098
17354
17/10/2011
7649812 / 223079 / 2190694
Maria De Fatima De Queiroz Cavalcante
/ Unimed Imperatriz
98
21238
26/10/2011
7649813 / 223079 / 385193
681,91
Total:
0468052031004
0468052031012
Veridiano Alves Oliveira

Elisangela Relsani Reis Marques
89000099
/ Unimed Teresina
99
16127
20/10/2011
7650893 / 223086 / 2240588
/10101012
Lote: 223086 Nota: 324
1/0
58,97
89000099
/ Unimed Teresina
99
17476
24/10/2011
7650892 / 223086 / 2242553
/10101012
Lote: 223086 Nota: 324
1/0
58,97
10 / 0
516,91
15,6 / 0
0468052031500
Germano Francisco De Oliveira
210000674
05/12/2011 08:00:22 7642771 / 99999 / 1035606
210000674
05/12/2011 08:00:00 7642771 / 99999 / 1035606
2 UCO
/90000021
634,85
Total:
0468052054004
0468052054012
11003096
0,00
Renato Madeira Reis

Djanne Lopes Rego Reis
/ Jose Francisco Das Chagas
0468052054101
14/12/2011 12:00:00 7680870 / 224012 / 138374
/10101012
1/0
83,07
Delane Rego Reis
11003096
/ Jose Francisco Das Chagas
23/12/2011 12:00:00 7680966 / 224012 / 138375
/10101012
1/0
83,07
310000145
12/12/2011 13:09:00 7631781 / 99999 / 30503062
/40303039
1/0
21,61
310000145
12/12/2011 13:09:00 7631781 / 99999 / 30503062
/40303110
1/0
12,78
310000145
12/12/2011 13:09:00 7631781 / 99999 / 30503062
2 UCO
/90000021
2,511 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 98

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468052054519
Katia Ferreira Madeira
5064
29/11/2011 18:41:00 7660735 / 99999 / 30479762
5064
29/11/2011 18:41:00 7660735 / 99999 / 30479762
5064
29/11/2011 18:41:00 7660735 / 99999 / 30479762
5064
29/11/2011 18:41:00 7660735 / 99999 / 30479762
Obs.
Qtd/Partic
/30210127
1/0
106,59
/80051510
1/0
45,45
/90000021
1/0
32,74
/90000013
1/0
6,75
392,06
Total:
0468052077004
0468052077004
Vl.Cob
Josielza Ramalho Froz

Josielza Ramalho Froz
310000242
28/11/2011 10:00:00 7610835 / 99999 / 602944
40310019 A fresco, exame
/40310019
1/0
9,63
310000242
28/11/2011 10:00:00 7610835 / 99999 / 602944
1/0
9,63
310000242
28/11/2011 10:00:00 7610835 / 99999 / 602944
/90000021
1,386 / 0
0,00
1/0
0,75 / 0
0468052077500
2 UCO
Josemias Leocadio Froz
14148
05/11/2011 12:19:00 7679281 / 223988 / 30449036
14148
05/11/2011 12:19:00 7679281 / 223988 / 30449036
2 UCO
/90000021
0,00
34,61
Total:
0468052085007
0468052085015
15,35
Abdoral Saldanha Maia Junior

Thalita Fernanda De Carvalho Luz
89000099
/ Unimed Teresina
99
13160
17/10/2011
7650896 / 223086 / 2238041
/10101012
Lote: 223086 Nota: 324
1/0
58,97
89000099
/ Unimed Teresina
99
25819
17/10/2011
7650895 / 223086 / 2237393
/10101012
Lote: 223086 Nota: 324
1/0
58,97
89000099
/ Unimed Teresina
99
21000072 17/10/2011 17:45:00 7650894 / 223086 / 3439133
/40601137
Lote: 223086 Nota: 324
1/0
20,64
89000099
/ Unimed Teresina
99
21000072 17/10/2011 17:45:00 7650894 / 223086 / 3439133
/41301102
Lote: 223086 Nota: 324
1/0
24,32
162,90
Total:
0468052096009
0468052096009
89000099
/ Unimed Teresina
Debora Neide Aranha Soares

Debora Neide Aranha Soares
99
31000040 29/09/2011 09:25:00 7650897 / 223086 / 3413686
/40601137
Lote: 223086 Nota: 324
Total:
0468052104001
0468052104117
George De Sousa Garrido

Nicolas Gabriel De Lacerda Garrido
1/0
20,64
20,64
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 99

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
110000346
28/11/2011 16:16:00 7646891 / 99999 / 30482962
/40302512
1/0
0,07
110000346
28/11/2011 16:16:00 7646891 / 99999 / 30482962
40302040 Glicose
/40302040
1/0
0,07
110000346
28/11/2011 16:16:00 7646891 / 99999 / 30482962
/40302504
1/0
0,07
110000346
28/11/2011 16:16:00 7646891 / 99999 / 30482962
/40302750
1/0
22,46
110000346
28/11/2011 16:16:00 7646891 / 99999 / 30482962
/90000021
1,827 / 0
2 UCO
22,67
Total:
0468052112004
0468052112004
0,00
Arthur Pontes Da Fonseca

Arthur Pontes Da Fonseca
210000518
13/12/2011 11:26:00 7643141 / 99999 / 519773
/40103439
1/0
50,79
210000518
13/12/2011 11:26:00 7643141 / 99999 / 519773
1/0
27,60
210000518
13/12/2011 11:26:00 7643141 / 99999 / 519773
/40103072
1/0
41,20
21002620
/ Nutricon Clinica E Consultoria
02/12/2011 08:53:00 7626467 / 99999 / 30489912
1/0
28,08
210000518
13/12/2011 11:26:00 7643141 / 99999 / 519773
/90000021
2,47 / 0
0468052112012
2 UCO
0,00
Jordania De Oliveira Conceicao
110000052
29/11/2011 21:53:00 7604780 / 99999 / 30485468
/40805034
1/0
15,35
110000052
29/11/2011 22:17:00 7636758 / 99999 / 30485427
/10101039
1/0
94,77
110000052
29/11/2011 21:53:00 7604780 / 99999 / 30485468
2 UCO
/90000021
1,22 / 0
0,00
110000052
29/11/2011 21:53:00 7604780 / 99999 / 30485468
1 FILME
0,462 / 0
10,49
/10101012
1/0
83,07
0468052112101
11003150
Filipe De Oliveira Pontes Da Fonseca
/ Luciane Dualibe Da Costa
19/12/2011
7666472 / 99999 / 0805905
351,35
Total:
0468052114007
0468052114007
89000099
/ Unimed Teresina
89000099
/ Unimed Teresina
0468052114015
89000099
/ Unimed Teresina
Joao Batista Dantas Da Silva

Joao Batista Dantas Da Silva
99
29339
17/10/2011
7650898 / 223086 / 2238304
08/09/2011 17:30:00 7650899 / 223086 / 3378831
/10101012
Lote: 223086 Nota: 324
1/0
58,97
31601014 Acupuntura por sesso
/31601014
Lote: 223086 Nota: 324
1/0
515,97
/10101012
Lote: 223086 Nota: 324
1/0
58,97
Marcela Cristina Melo Dantas

99
12636
31/10/2011
7650900 / 223086 / 2251141
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 100

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Total:
0468052125009
0468052125009
1100420
Antonio Pontes De Aguiar Filho

Antonio Pontes De Aguiar Filho
/ Cristiane Fiquene Conti
0468052125017
20/12/2011
7655282 / 99999 / 10255561
/10101012
1/0
83,07
/10101012
1/0
83,07
/41301102
1/0
25,58
/90000021
2,78 / 0
Thalita Mercia Bogea Rolim Pontes
11000909
07/12/2011
11000909
07/12/2011 20:53:00 7668886 / 99999 / 719604
11000909
07/12/2011 20:53:00 7668886 / 99999 / 719604
7664854 / 99999 / 107501
2 UCO
Total:
0468052127001
0468052127001
1342181
0,00
191,72
Lucimar Alves Sombra

Lucimar Alves Sombra
/ Solange Goulart Souza
20/12/2011
7664343 / 99999 / 10255304
/10101012
1/0
83,07
83,07
Total:
0468052136000
0468052136019
Vl.Cob
633,91
Joao Maria Da Silva Bezerra

Yalkiria Guadalupe Vaca Diaz Bezerra
89000062
62
21000166 14/11/2011 08:36:25 7652375 / 223122 / 42207801
/40901203
Lote: 223122 Nota: 325
1/0
53,07
89000062
62
4560
40809099 Puno aspirativa orientada por RX
/40809099
Lote: 223122 Nota: 325
2/0
421,04
89000062
62
31000094 23/11/2011 15:09:54 7652385 / 223122 / 42261392
40601250 Procedimento diagnstico em lminas de /40601250
Lote: 223122 Nota: 325
1/0
54,84
89000062
62
21000166 14/11/2011 08:35:25 7652375 / 223122 / 42207801
Lote: 223122 Nota: 325
0,19 / 0
14/11/2011 08:37:45 7652376 / 223122 / 42207823
1 FILME
533,48
Total:
0468314602003
0468314602305
4,53
Wellington Claudio Pinho De Castro

Juliana Pacheco De Castro
1342173
14/12/2011
1342173
1342173
7658703 / 99999 / 10251825
/10101012
1/0
83,07
20/12/2011 12:02:15 7659555 / 99999 / 30506473
/41301099
1/0
7,68
20/12/2011 12:02:15 7659555 / 99999 / 30506473
/41301102
1/0
25,58
310000145
14/12/2011 11:35:00 7618927 / 99999 / 30506724
/40601137
1/0
29,21
1342173
20/12/2011 12:02:15 7659555 / 99999 / 30506473
/90000021
2,78 / 0
2 UCO
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 101

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
310000145
14/12/2011 11:35:00 7618927 / 99999 / 30506724
2 UCO
/90000021
Obs.
Qtd/Partic
1,03 / 0
0,00
145,54
Total:
0468314603000
0468314603018
Vl.Cob
Germano Paiva De Castro

Beatriz Araujo Lima De Castro
89000063
63
1239
01/11/2011 16:41:24 7652614 / 223142 / 87726466
/10101012
Lote: 223142 Nota: 325
1/0
61,43
89000063
63
5910
08/11/2011 11:41:10 7652633 / 223142 / 87855960
/10101012
Lote: 223142 Nota: 325
1/0
61,43
89000063
63
21019025 14/11/2011 12:16:54 7652547 / 223142 / 87990185
/40901122
Lote: 223142 Nota: 325
1/0
98,77
89000063
63
31006044 07/11/2011 06:54:05 7652890 / 223142 / 87809185
40302040 Glicose
/40302040
Lote: 223142 Nota: 325
1/0
4,13
89000063
63
31006044 07/11/2011 06:55:05 7652890 / 223142 / 87809185
40302580 Uria
/40302580
Lote: 223142 Nota: 325
1/0
4,13
89000063
63
31006044 07/11/2011 06:52:05 7652890 / 223142 / 87809185
40301150 cido rico
/40301150
Lote: 223142 Nota: 325
1/0
4,13
89000063
63
31006044 07/11/2011 06:53:06 7652891 / 223142 / 87809212
/40311210
Lote: 223142 Nota: 325
1/0
5,90
89000063
63
21019025 01/11/2011 15:44:40 7652857 / 223142 / 87723809
40901246 Obsttrica convencional com Doppler
/40901246
Lote: 223142 Nota: 325
1/0
88,45
89000063
63
21019025 14/11/2011 12:15:54 7652547 / 223142 / 87990185
40808017 Abdome simples
/40808017
Lote: 223142 Nota: 325
1/0
20,04
89000063
63
31006044 07/11/2011 06:56:05 7652890 / 223142 / 87809185
Lote: 223142 Nota: 325
1/0
8,85
89000063
63
31006044 07/11/2011 06:53:05 7652890 / 223142 / 87809185
40301630 Creatinina
/40301630
Lote: 223142 Nota: 325
1/0
4,13
89000063
63
21019025 14/11/2011 12:14:54 7652547 / 223142 / 87990185
/40805026
Lote: 223142 Nota: 325
1/0
15,03
89000063
63
31006044 07/11/2011 06:57:05 7652890 / 223142 / 87809185
/40304922
Lote: 223142 Nota: 325
1/0
17,69
89000063
63
21009040 17/10/2011 15:54:38 7652748 / 223142 / 87363821
40901505 Obsttrica: perfil biofsico fetal
/40901505
Lote: 223142 Nota: 325
1/0
68,98
89000063
63
21019025 14/11/2011 12:13:54 7652547 / 223142 / 87990185
1 FILME
Lote: 223142 Nota: 325
1,2223 / 0
29,13
89000063
63
21019025 01/11/2011 15:43:40 7652857 / 223142 / 87723809
1 FILME
Lote: 223142 Nota: 325
0,5096 / 0
12,15
89000063
63
21009040 17/10/2011 15:53:38 7652748 / 223142 / 87363821
1 FILME
Lote: 223142 Nota: 325
0,3402 / 0
8,11
512,48
Total:
0468321407008
0468321407008
Renato Romero Froes Araujo

Renato Romero Froes Araujo
110000290
/ Policlinica Ibirapuera Ltda
07/11/2011
7621825 / 99999 / 30449754
110000290
07/11/2011
7621825 / 99999 / 30449754

/10101039
1/0
68,45
/80031005
1/0
10,64
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 102

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
110000290
07/11/2011
7621825 / 99999 / 30449754
/90000021
1/0
7,59
110000290
07/11/2011
7621825 / 99999 / 30449754
/90000013
1/0
26,62
/10101039
1/0
52,65
0468321407105
110000290
Renato Romero Froes Araujo Junior
0468321407300
11/11/2011 11:38:00 7617508 / 99999 / 30458207
Raquel Costa Froes Araujo
310000145
25/11/2011 14:13:00 7613247 / 99999 / 639263
40316270 Ferritina
/40316270
1/0
27,61
310000145
25/11/2011 14:13:00 7613247 / 99999 / 639263
/40301842
1/0
7,34
310000145
25/11/2011 14:13:00 7613247 / 99999 / 639263
1/0
11,78
110000290
25/11/2011 14:45:00 7617435 / 99999 / 30479120
/10101039
1/0
52,65
110000290
25/11/2011 14:45:00 7617435 / 99999 / 30479120
/80031005
1/0
10,64
110000290
25/11/2011 14:45:00 7617435 / 99999 / 30479120
/90000021
1/0
5,22
310000145
25/11/2011 14:13:00 7613247 / 99999 / 639263
2 UCO
/90000021
3,457 / 0
0,00
110000290
25/11/2011 14:45:00 7617435 / 99999 / 30479120
/90000013
1/0
7,06
288,25
Total:
0468321408004
0468321408004
Francisco Araujo Braga

Francisco Araujo Braga
310000145
28/11/2011 15:48:00 7626726 / 99999 / 30482966
40302199 Lipase
/40302199
1/0
9,76
310000145
28/11/2011 15:48:00 7626726 / 99999 / 30482966
/40302504
1/0
9,76
310000145
28/11/2011 15:48:00 7626726 / 99999 / 30482966
/40302512
1/0
9,76
310000145
28/11/2011 15:48:00 7626726 / 99999 / 30482966
/40303098
1/0
5,99
310000030
07/12/2011
7619360 / 99999 / 30496751
/40302504
1/0
9,76
310000030
07/12/2011
7619360 / 99999 / 30496751
/40302512
1/0
9,76
310000030
07/12/2011
7619360 / 99999 / 30496751
1/0
11,78
310000145
28/11/2011 15:48:00 7626726 / 99999 / 30482966
40302318 Potssio
/40302318
1/0
5,28
310000145
28/11/2011 15:48:00 7626726 / 99999 / 30482966
40302423 Sdio
/40302423
1/0
5,28
310000145
28/11/2011 15:48:00 7626726 / 99999 / 30482966
/40303136
1/0
12,78
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 103

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
07/12/2011
7619360 / 99999 / 30496751
40314090 Hepatite C (qualitativo) por PCR
/40314090
1/0
145,85
310000030
07/12/2011
7619360 / 99999 / 30496751
40301150 cido rico
/40301150
1/0
5,28
110000052
28/11/2011 23:37:00 7636737 / 99999 / 30482769
/10101039
1/0
94,77
310000145
28/11/2011 15:48:00 7626726 / 99999 / 30482966
/40310337
1/0
24,52
310000145
28/11/2011 15:48:00 7626726 / 99999 / 30482966
40307891 Widal, reao de
/40307891
1/0
9,99
310000145
28/11/2011 15:48:00 7626726 / 99999 / 30482966
1/0
11,78
110000052
29/11/2011 10:00:08 7646641 / 99999 / 70009740
/10102019
3/0
184,20
110000052
28/11/2011
/80011020
3/0
736,43
310000145
28/11/2011 15:48:00 7626726 / 99999 / 30482966
2 UCO
/90000021
7,674 / 0
0,00
310000030
07/12/2011
2 UCO
/90000021
13,398 / 0
0,00
110000052
28/11/2011 23:37:00 7646641 / 99999 / 70009740
/90000021
1/0
171,08
110000052
28/11/2011 23:37:00 7646641 / 99999 / 70009740
/90000013
1/0
797,57
0468321408012
7646641 / 99999 / 70009740
7619360 / 99999 / 30496751
DA02 APARTAMENTO
Elizabeth Bonfim De Melo Braga
210000240
/ Centro De Olhos De Sao Luis
12/12/2011 12:00:00 7678264 / 223372 / 30502728
/41301250
2/0
69,22
210000240
12/12/2011 12:00:00 7678264 / 223372 / 30502728
/41301323
1/0
22,08
210020314
/ S.O.S Trauma Ltda
22/11/2011 14:52:00 7605369 / 99999 / 30472768
3/0
92,10
210020314
/ S.O.S Trauma Ltda
22/11/2011 14:52:00 7605369 / 99999 / 30472768
1/0
30,70
210000240
12/12/2011 12:00:00 7678264 / 223372 / 30502728
2 UCO
/90000021
1,08 / 0
0,00
210020314
/ S.O.S Trauma Ltda
22/11/2011 14:52:00 7605369 / 99999 / 30472768
2 UCO
/90000021
6,24 / 0
0,00
0468321408101
Rafaela Melo Braga
3657
19/12/2011
7674759 / 99999 / 115178
/10101012
1/0
83,07
310000030
14/12/2011
7625133 / 99999 / 30506040
/40302504
1/0
9,76
310000030
14/12/2011
7625133 / 99999 / 30506040
1/0
11,78
310000030
14/12/2011
7625133 / 99999 / 30506040
40302040 Glicose
/40302040
1/0
5,28
310000030
14/12/2011
7625133 / 99999 / 30506040
40316327 Gonadotrofico corionico, hormonio (HCG)/40305759
1/0
40,73
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 104

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
14/12/2011
7625133 / 99999 / 30506040
/40302512
1/0
9,76
310000030
14/12/2011
7625133 / 99999 / 30506040
/40301885
1/0
9,76
310000030
14/12/2011
7625133 / 99999 / 30506040
40302580 Uria
/40302580
1/0
5,28
310000030
14/12/2011
7625133 / 99999 / 30506040
40301630 Creatinina
/40301630
1/0
5,28
310000030
14/12/2011
7625133 / 99999 / 30506040
/40302750
1/0
22,46
310000030
14/12/2011
7625133 / 99999 / 30506040
/40304922
1/0
33,50
310000030
14/12/2011
7625133 / 99999 / 30506040
/90000021
8,345 / 0
/10101012
1/0
0468321408110
3657
2 UCO
Janselmo Melo Braga
19/12/2011
7674760 / 99999 / 115177
83,07
2.805,21
Total:
0468352026006
0468352026006
0,00
Lister De Melo Saraiva Leao

Lister De Melo Saraiva Leao
89000063
63
11005026 29/09/2011
7652740 / 223142 / 988366
52917 EQUIPO P/SORO GTS 1 20M INTRAFIX /79911617
Lote: 223142 Nota: 325
1/0
3,24
89000063
63
11005026 29/09/2011
7652740 / 223142 / 988366
50826 AGULHA HIPODERMICA 13X4 AH 2713 /70945420
Lote: 223142 Nota: 325
1/0
0,23
89000063
63
11005026 29/09/2011
7652740 / 223142 / 988366
52975 SCALP NR 27G MEDSCALP EMB PLAST/79913970
Lote: 223142 Nota: 325
1/0
1,54
89000063
63
11005026 29/09/2011
7652740 / 223142 / 988366
30726 SERINGA 10ML S/AG C/BICO LUER
/70525528
Lote: 223142 Nota: 325
1/0
1,05
89000063
63
11005026 29/09/2011
7652740 / 223142 / 988366
4576 HIOSCINA COMPOSTA GENERICO 20 /90228413
Lote: 223142 Nota: 325
1/0
2,91
89000063
63
11005026 29/09/2011
7652740 / 223142 / 988366
13105 CLORIDRATO DE METOCLOPRAMIDA/92447570
Lote: 223142 Nota: 325
1/0
0,56
89000063
63
11005026 29/09/2011
7652740 / 223142 / 988366
18643 FISIOLOGICO 0,9% - MED FLEX -
Lote: 223142 Nota: 325
1/0
4,33
/90281292
13,86
Total:
0468352051000
0468352051000
4127
Claudio Ribamar Da Silveira Pereira

Claudio Ribamar Da Silveira Pereira
/ Luprcio Luz Brito
19/12/2011
7671425 / 99999 / 1957000
/10101012
1/0
83,07
Total:
0468352060000
0468352030100
1240648
83,07
Eliza Ary Medeiros Peixoto

Miguel Afonso Peixoto Bogea Vaz
/ Francisco Sergio De O Martins
15/12/2011
7660107 / 99999 / 111207
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 105

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
110000079
13/12/2011 17:33:00 7636472 / 99999 / 30505639
40803139 Mos e punhos para idade ssea
/40803139
1/0
31,77
1240648
15/12/2011 17:05:00 7660207 / 99999 / 683901
41401379 Testes cutneo-alrgicos para alimentos /41401379
1/0
23,03
1240648
15/12/2011 17:05:00 7660207 / 99999 / 683901
41401387 Testes cutneo-alrgicos para fungos
/41401387
1/0
23,03
1240648
15/12/2011 17:05:00 7660207 / 99999 / 683901
41401360 Testes cutneo-alrgicos para alrgenos /41401360
1/0
23,03
1240648
15/12/2011 17:05:00 7660207 / 99999 / 683901
41401409 Testes cutneo-alrgicos para plens
/41401409
1/0
23,03
1240648
15/12/2011 17:05:00 7660207 / 99999 / 683901
41401395 Testes cutneo-alrgicos para insetos
/41401395
1/0
23,03
110000079
13/12/2011 17:33:00 7636472 / 99999 / 30505639
2 UCO
/90000021
1,22 / 0
0,00
110000079
13/12/2011 17:33:00 7636472 / 99999 / 30505639
1 FILME
0,072 / 0
1,63
231,62
Total:
0468352067004
0468352067004
11002316
Aderson De Jesus Pereira

Aderson De Jesus Pereira
/ Jose Luiz Pires De Menezes
0468352067012
19/12/2011
7679842 / 99999 / 1455111
/10101012
1/0
83,07
7666300 / 99999 / 10245449
/10101012
1/0
83,07
Ana Luiza Silva Pereira
1341614
/ Walquiria Machado Xavier
05/12/2011
1221163
16/11/2011 07:40:00 7645739 / 99999 / 70009219
31303170 Histeroscopia cirrgica p/ bipsia
/31303170
/Anestesis
1/1
332,69
1341576
16/11/2011 07:40:00 7645739 / 99999 / 70009219
/31303170
/1o.
1/1
105,92
1340898
/ Antonio Carlos N Pereira
16/11/2011 07:40:00 7645739 / 99999 / 70009219
/31303170
/Cirurgiao
1/1
353,06
110000133
/ Clinica Sao Marcos Ltda
16/11/2011 06:41:00 7645739 / 99999 / 70009219
T162 VIDEO HISTEROSCPIO CIRRGICO /80053050
1/0
524,52
110000133
16/11/2011 06:41:00 7645739 / 99999 / 70009219
TC14 PORTE IV
/80021042
1/0
332,16
110000133
16/11/2011 06:41:00 7645739 / 99999 / 70009219
GA75 OXIGENIO EM RESPIRADOR
/80061400
1/0
23,41
110000133
16/11/2011 06:41:00 7645739 / 99999 / 70009219
/90000021
1/0
91,13
110000133
16/11/2011 06:41:00 7645739 / 99999 / 70009219
/90000013
1/0
65,38
/10101012
1/0
83,07
0468352067500
Martinho Pereira
11000313
/ Luis Carlos Muniz Cantanhede
29/11/2011
7658874 / 99999 / 10242261
11000313
05/12/2011 12:01:00 7659662 / 99999 / 668668
20104111 Dilatao uretral (sesso)
/20104111
1/0
53,29
11000313
05/12/2011 00:00:31 7659662 / 99999 / 668668
90000862 Pct dilatao uretral (sesso)
/20104111
1/0
127,53
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 106

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
11000313
05/12/2011 12:01:00 7659662 / 99999 / 668668
31104223 Uretrotomia interna
1341665
/ Julio Cezar Uchoa Serra
17/11/2011 12:10:15 7645630 / 99999 / 0139393
1101125
/ Leudo Campos Silva
17/11/2011 12:10:15 7645630 / 99999 / 0139393
110000028
/ Centro Medico Maranhense
17/11/2011
110000028
110000028
7645630 / 99999 / 0139393
/31104223
Obs.
Qtd/Partic
Vl.Cob
1/0
176,53
30912105 Implante de stent coronrio com ou sem /30912105
/1o.
1/1
379,64
30912105 Implante de stent coronrio com ou sem /30912105
/Cirurgiao
1/1
1.265,47
DA02 APARTAMENTO
/80011020
1/0
245,48
17/11/2011 14:20:00 7645630 / 99999 / 0139393
T130 RX C/INTENSIF IMAGEM GDE
/80053122
1/0
315,55
17/11/2011 14:20:00 7645630 / 99999 / 0139393
TE34 HEMODINAMICA
/80031412
1/0
630,63
11000313
05/12/2011 12:01:00 7659662 / 99999 / 668668
/90000021
1/0
691,66
110090957
/ Unimed Sao Luis
17/11/2011 12:10:00 7678698 / 223652 / 649668
/90000021
1/0
12.090,78
110000028
17/11/2011 14:20:00 7645630 / 99999 / 0139393
/90000021
1/0
1.017,00
11000313
05/12/2011 12:01:00 7659662 / 99999 / 668668
/90000013
1/0
65,70
110000028
17/11/2011 14:20:00 7645630 / 99999 / 0139393
/90000013
1/0
45,31
19.182,05
Total:
0468752040006
0468752040006
89000098
/ Unimed Imperatriz
Keila Maria De Araujo Santos

Keila Maria De Araujo Santos
98
44082
10/10/2011
7649814 / 223079 / 2189184
/10101012
Lote: 223079 Nota: 324
1/0
58,97
Total:
0468752041002
0468752041100
58,97
Paulo Renner Rocha Ferro

Gabriel Alencar Batista
89000098
/ Unimed Imperatriz
98
45704
89000098
/ Unimed Imperatriz
98
89000098
/ Unimed Imperatriz
89000098
05/10/2011
7649388 / 223079 / 2188302
/10101012
Lote: 223079 Nota: 324
1/0
58,97
21000067 10/10/2011 12:00:00 7650053 / 223079 / 650646
20103220 Doenas pulmonares atendidas em
/20103220
Lote: 223079 Nota: 324
10 / 0
94,30
98
33472
/10101039
Lote: 223079 Nota: 324
1/0
43,00
/ Unimed Imperatriz
98
21000071 20/10/2011 12:00:00 7649672 / 223079 / 635777
40702103 Cintilografia para pesquisa de refluxo
/40702103
Lote: 223079 Nota: 324
1/0
168,06
89000098
/ Unimed Imperatriz
98
21000071 20/10/2011 12:00:00 7649672 / 223079 / 635777
40709019 Cintilografia para deteco de aspirao /40709019
Lote: 223079 Nota: 324
1/0
159,21
89000098
/ Unimed Imperatriz
98
21000071 20/10/2011 12:00:00 7649672 / 223079 / 635777
1 FILME
Lote: 223079 Nota: 324
1,3299 / 0
89000098
/ Unimed Imperatriz
98
21000071 20/10/2011 12:00:00 7649672 / 223079 / 635777
/90000013
Lote: 223079 Nota: 324
1/0
29/09/2011 15:22:00 7649673 / 223079 / 271892
Total:
31,70
309,61
864,85
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 107

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468752042009
Bruno Mendes De Moura
0468752042017
Nayara Marinho Braga De Moura
Obs.
Qtd/Partic
Vl.Cob
89000099
/ Unimed Teresina
99
21000024 28/10/2011 16:59:00 7650901 / 223086 / 3448614
40201252 Vdeo-faringo-laringoscopia com
/40201252
Lote: 223086 Nota: 324
1/0
118,38
89000099
/ Unimed Teresina
99
21000024 20/10/2011 09:43:00 7650902 / 223086 / 3442370
/10101039
Lote: 223086 Nota: 324
1/0
43,00
161,38
Total:
0468752045008
0468752045504
Clodomir Sebastiao Reis

Saturnino Sebastiao Dos Reis
310000145
23/11/2011 09:27:00 7608692 / 99999 / 721145
/40316513
1/0
40,84
110000079
24/11/2011 09:28:00 7632755 / 99999 / 721147
/40901106
1/0
299,80
310000145
23/11/2011 09:27:00 7608692 / 99999 / 721145
40302040 Glicose
/40302040
1/0
5,28
310000145
23/11/2011 09:27:00 7608692 / 99999 / 721145
40301150 cido rico
/40301150
1/0
5,28
310000145
23/11/2011 09:27:00 7608692 / 99999 / 721145
/40316149
1/0
32,99
110000079
24/11/2011 10:40:00 7632755 / 99999 / 721147
1/0
25,45
310000145
23/11/2011 09:27:00 7608692 / 99999 / 721145
1/0
11,78
310000145
23/11/2011 09:27:00 7608692 / 99999 / 721145
40302040 Glicose
/40302040
1/0
5,28
310000145
23/11/2011 09:27:00 7608692 / 99999 / 721145
40302580 Uria
/40302580
1/0
5,28
110000079
24/11/2011 00:00:59 7632755 / 99999 / 721147
/40101045
1/0
127,04
310000145
23/11/2011 09:27:00 7608692 / 99999 / 721145
40301630 Creatinina
/40301630
1/0
5,28
310000145
23/11/2011 09:27:00 7608692 / 99999 / 721145
/40302750
1/0
22,46
310000145
23/11/2011 09:27:00 7608692 / 99999 / 721145
/40302733
1/0
44,71
110000079
24/11/2011 09:28:00 7632755 / 99999 / 721147
2 UCO
/90000021
0,75 / 0
0,00
310000145
23/11/2011 09:27:00 7608692 / 99999 / 721145
2 UCO
/90000021
11,532 / 0
0,00
631,47
Total:
0468752046004
0468752046004
1360473
Valdimary Melo Correa

Valdimary Melo Correa
01/12/2011 08:19:00 7657224 / 99999 / 30487707
/41501128
2/0
61,40
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 108

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000030
07/12/2011
7617299 / 99999 / 30497814
40304523 Protoporfirina eritrocitria livre - zinco
/40304523
1/0
19,68
310000030
07/12/2011
7617298 / 99999 / 30485577
/40316548
1/0
27,52
1360473
01/12/2011 08:19:00 7657224 / 99999 / 30487707
/41301080
2/0
95,94
310000030
07/12/2011
7617298 / 99999 / 30485577
/40316521
1/0
27,52
310000030
07/12/2011
7617298 / 99999 / 30485577
40316270 Ferritina
/40316270
1/0
27,61
310000030
07/12/2011
7617299 / 99999 / 30497814
40301150 cido rico
/40301150
1/0
5,28
1360473
01/12/2011 08:19:00 7657224 / 99999 / 30487707
/41301269
2/0
95,94
310000030
07/12/2011
7617298 / 99999 / 30485577
/40301842
1/0
7,34
310000030
07/12/2011
7617298 / 99999 / 30485577
40301630 Creatinina
/40301630
1/0
5,28
310000030
14/12/2011
7624385 / 99999 / 30501570
1/0
11,78
310000030
07/12/2011
7617299 / 99999 / 30497814
/40302504
1/0
9,76
310000030
07/12/2011
7617298 / 99999 / 30485577
40316572 Vitamina B12
/40316572
1/0
23,81
310000030
07/12/2011
7617298 / 99999 / 30485577
40301761 Eletroferese de protenas
/40301761
1/0
24,49
310000030
07/12/2011
7617298 / 99999 / 30485577
/40316556
1/0
54,57
310000030
07/12/2011
7617298 / 99999 / 30485577
/40302512
1/0
9,76
310000030
14/12/2011
7624385 / 99999 / 30501570
40302040 Glicose
/40302040
1/0
5,28
310000030
07/12/2011
7617298 / 99999 / 30485577
40302580 Uria
/40302580
1/0
5,28
310000030
07/12/2011
7617298 / 99999 / 30485577
1/0
11,78
310000030
07/12/2011
7617298 / 99999 / 30485577
40302040 Glicose
/40302040
1/0
5,28
310000030
07/12/2011
7617299 / 99999 / 30497814
40301087 cido flico, dosagem nos eritrcitos
/40301087
1/0
24,49
310000030
07/12/2011
7617299 / 99999 / 30497814
40301400 Clcio
/40301400
1/0
5,28
310000030
14/12/2011
7624385 / 99999 / 30501570
/40311210
1/0
11,20
310000030
07/12/2011
7617299 / 99999 / 30497814
40301567 Cobre
/40301567
1/0
44,71
310000030
07/12/2011
7617298 / 99999 / 30485577
/40302750
1/0
22,46
310000030
07/12/2011
7617298 / 99999 / 30485577
/40302733
1/0
44,71
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 109

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
310000030
14/12/2011
7624385 / 99999 / 30501570
310000030
14/12/2011
7624385 / 99999 / 30501570
310000030
07/12/2011
1360473
310000030
Obs.
Qtd/Partic
Vl.Cob
/40304922
1/0
2 UCO
/90000021
4,551 / 0
0,00
7617298 / 99999 / 30485577
2 UCO
/90000021
20,213 / 0
0,00
01/12/2011 08:19:00 7657224 / 99999 / 30487707
2 UCO
/90000021
11,24 / 0
0,00
07/12/2011
2 UCO
/90000021
7,965 / 0
0,00
0468752046020
7617299 / 99999 / 30497814
33,50
Adelson De Pontes Cunha
89000222
/ Unimed Palmas- Coop De
222 25457
31/10/2011
7653412 / 223484 / 00001626010
/10101012
Lote: 223484 Nota: 325
1/0
58,97
89000222
/ Unimed Palmas- Coop De
222 644
07/11/2011
7653403 / 223484 / 00003167866
10101187 Sessao de Psicoterapia - 12 por ano
/10101187
Lote: 223484 Nota: 325
1/0
29,48
810,10
Total:
0468752048007
0468752048007
Antonio Ergori Borges De Sousa

Antonio Ergori Borges De Sousa
89000099
/ Unimed Teresina
99
11000026 26/09/2011 08:56:00 7650903 / 223086 / 3408384
40804097 P ou pododctilo
/40804097
Lote: 223086 Nota: 324
1/0
17,40
89000099
/ Unimed Teresina
99
11000026 26/09/2011 08:48:00 7650903 / 223086 / 3408384
/10101039
Lote: 223086 Nota: 324
1/0
43,00
89000099
/ Unimed Teresina
99
11000026 26/09/2011 08:48:00 7650903 / 223086 / 3408384
Lote: 223086 Nota: 324
0,1438 / 0
3,43
89000099
/ Unimed Teresina
99
11000026 26/09/2011 08:48:00 7650903 / 223086 / 3408384
/70438625
Lote: 223086 Nota: 324
1/0
0,42
89000099
/ Unimed Teresina
99
11000026 26/09/2011 08:48:00 7650903 / 223086 / 3408384
/90000013
Lote: 223086 Nota: 324
2/0
3,46
89000099
/ Unimed Teresina
99
11000026 26/09/2011 08:48:00 7650903 / 223086 / 3408384
6166 AGUA P/ INJECAO 10 ML 50 AMPS
/90248767
Lote: 223086 Nota: 324
1/0
0,56
89000099
/ Unimed Teresina
99
11000026 26/09/2011 08:48:00 7650903 / 223086 / 3408384
1982 DIPIRONA SODICA GENERICO 500
/90171152
Lote: 223086 Nota: 324
1/0
1,21
0468752048023
1 FILME
26313 AGULHA 40X12 DESC
Ana Carolina Laurenti Dos Santos
89000099
/ Unimed Teresina
99
21000099 14/09/2011 18:00:00 7650904 / 223086 / 3375244
/20103492
Lote: 223086 Nota: 324
10 / 0
147,42
89000099
/ Unimed Teresina
99
31000040 14/10/2011 14:15:00 7650905 / 223086 / 3435753
/40601137
Lote: 223086 Nota: 324
1/0
20,64
Total:
0468752049003
0468752049518
237,54
Eudes Silva Cruz

Creuza Rodrigues Da Silva
1100145
/ Joao Jose Dos Reis Neto
13/12/2011
7644639 / 99999 / 10251154
/10101012
1/0
83,07
18305
09/12/2011
7659166 / 99999 / 10248928
/10101012
1/0
83,07
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 110

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
Obs.
Qtd/Partic
Vl.Cob
310000110
13/12/2011
7619214 / 99999 / 30505198
40302040 Glicose
/40302040
2/0
10,55
310000110
13/12/2011
7619214 / 99999 / 30505198
40302075 Hemoglobina glicada (A1 total)
/40302733
1/0
24,49
310000110
13/12/2011
7619214 / 99999 / 30505198
1/0
11,78
18305
09/12/2011 12:28:00 7659211 / 99999 / 30500134
/41301102
1/0
25,58
310000110
13/12/2011
7619214 / 99999 / 30505198
/40302750
1/0
22,46
310000110
13/12/2011
7619214 / 99999 / 30505198
2 UCO
/90000021
3,408 / 0
0,00
18305
09/12/2011 12:28:00 7659211 / 99999 / 30500134
2 UCO
/90000021
2,78 / 0
0,00
261,00
Total:
0468752051008
0468752051300
Thiago Pereira Aguiar

Rebeca Frazao Aguiar
210000291
03/10/2011 14:13:00 7679204 / 223964 / 30399776
/40801063
1/0
210000291
03/10/2011 14:13:00 7679204 / 223964 / 30399776
2 UCO
/90000021
1,47 / 0
0,00
210000291
03/10/2011 14:13:00 7679204 / 223964 / 30399776
1 FILME
0,1296 / 0
2,94
/10101039
1/0
0468752051512
110000052
Silvana Sousa Pereira
30/11/2011 09:05:38 7603478 / 99999 / 30485816
94,77
132,85
Total:
0468752055003
0468752055003
35,14
Maria Lucia Saraiva De Morais

Maria Lucia Saraiva De Morais
1100153
20/12/2011
7617597 / 99999 / 10256137
/10101012
1/0
83,07
1121690
/ Vania Costa Leite
16/12/2011
7661567 / 99999 / 10254108
/10101012
1/0
83,07
210000879
15/12/2011
7605203 / 99999 / 648854
40901114 Mamas
/40901114
1/0
86,31
210000879
15/12/2011
7605202 / 99999 / 648851
/40901122
1/0
144,92
210000879
15/12/2011
7605202 / 99999 / 648851
1 FILME
0,68 / 0
15,43
210000879
15/12/2011
7605203 / 99999 / 648854
1 FILME
0,34 / 0
7,72
210000879
15/12/2011
7605203 / 99999 / 648854
2 UCO
/90000021
3,42 / 0
0,00
210000879
15/12/2011
7605202 / 99999 / 648851
2 UCO
/90000021
5,85 / 0
0,00
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 111

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468752055020
Adriely Sacramento Diniz
Obs.
Qtd/Partic
Vl.Cob
1360562
17/12/2011
7663719 / 99999 / 10254218
/10101012
1/0
83,07
310000030
30/11/2011
7610152 / 99999 / 30484580
/40301990
1/0
9,76
310000030
30/11/2011
7610152 / 99999 / 30484580
/40301885
1/0
9,76
310000030
30/11/2011
7610152 / 99999 / 30484580
40302199 Lipase
/40302199
1/0
9,76
310000030
30/11/2011
7610152 / 99999 / 30484580
40301281 Amilase
/40301281
1/0
9,76
310000030
30/11/2011
7610152 / 99999 / 30484580
/40308391
1/0
36,82
310000030
30/11/2011
7610152 / 99999 / 30484580
40301630 Creatinina
/40301630
1/0
5,28
310000030
30/11/2011
7610152 / 99999 / 30484580
/40302512
1/0
9,76
310000030
30/11/2011
7610152 / 99999 / 30484580
/40302504
1/0
9,76
210000879
15/12/2011
7605201 / 99999 / 648855
/40901300
1/0
91,69
310000030
30/11/2011
7610152 / 99999 / 30484580
1/0
11,78
1100331
/ Raimundo Joao Valois Neto
13/12/2011 18:00:00 7668463 / 99999 / 30488091
30303010 Autotransplante conjuntival
/30303010
/Cirurgiao
1/1
140,69
1100331
/ Raimundo Joao Valois Neto
13/12/2011 18:00:00 7668463 / 99999 / 30488091
30303060 Ptergio - exrese
/30303060
/Cirurgiao
1/1
106,59
1360562
13/12/2011 18:00:00 7668463 / 99999 / 30488091
1/0
0,00
310000030
30/11/2011
7610152 / 99999 / 30484580
2 UCO
/90000021
5,577 / 0
0,00
210000879
15/12/2011
7605201 / 99999 / 648855
1 FILME
0,17 / 0
3,86
210000879
15/12/2011
7605201 / 99999 / 648855
2 UCO
/90000021
3,82 / 0
0,00
TXTISS TAXA IMPORTACAO TISS
958,86
Total:
0468752057006
0468752057006
89000099
/ Unimed Teresina
0468752057103
Ana Maria De Carvalho Pinto

Ana Maria De Carvalho Pinto
99
21325
31/10/2011
7650906 / 223086 / 2251610
/10101012
Lote: 223086 Nota: 324
1/0
58,97
Gustavo Henrique De Carvalho Pinto
89000099
/ Unimed Teresina
99
21001006 20/09/2011 10:00:00 7650908 / 223086 / 3398529
/20103492
Lote: 223086 Nota: 324
10 / 0
147,42
89000099
/ Unimed Teresina
99
21001006 06/10/2011 14:36:00 7650907 / 223086 / 3423160
/20103492
Lote: 223086 Nota: 324
10 / 0
147,42
Total:
353,81
ANS n
338559
338559
Unimed So Luis
17/01/2012
09:36:05
Pgina 112

Contrato
Contratante
Cdigo do Titular
Nome do Titular
Cdigo Beneficirio
Nome Beneficirio
0468752059009
Luis Mendes De Castro Filho
0468752059009
Luis Mendes De Castro Filho
Obs.
Qtd/Partic
Vl.Cob
310000030
30/11/2011
7610159 / 99999 / 30484458
1/0
11,78
310000030
30/11/2011
7610159 / 99999 / 30484458
40302040 Glicose
/40302040
1/0
5,28
310000030
30/11/2011
7610159 / 99999 / 30484458
/40302750
1/0
22,46
310000030
30/11/2011
7610159 / 99999 / 30484458
/90000021
1,257 / 0
0468752059017
2 UCO
0,00
Raiane De Jesus Santos Mendes De Castro
1130583
16/12/2011
7640563 / 99999 / 10253951
/10101012
1/0
83,07
310000030
17/12/2011
7616435 / 99999 / 30510693
40316327 Gonadotrofico corionico, hormonio (HCG)/40305759
1/0
40,73
310000030
17/12/2011
7616435 / 99999 / 30510693
1,67 / 0
2 UCO
/90000021
163,32
Total:
0468752061003
0468752061003
3570
Silvia Teresa Serra Valente

Silvia Teresa Serra Valente
/ Arnaldo De Jesus Dominici
13/12/2011
7661490 / 99999 / 10251331
/10101012
1/0
1360473
Kildare Cley Marinho De Souza

Kildare Cley Marinho De Souza
20/12/2011
7655019 / 99999 / 10256047
/10101012
1/0
83,07
83,07
Total:
0486000313007
0486000313104
83,07
83,07
Total:
0468752062000
0468752062000
0,00
Carlos Magno Coelho Santos

Filipe Valente Santos
11000933
/ Cely Aguiar Ramos De F Lima
06/12/2011
7676166 / 99999 / 10246587
/10101012
1/0
83,07
1381748
/ Patricia Regina Dutra Prazeres
09/12/2011
7665560 / 99999 / 10249055
/10101012
1/0
83,07
Total:
Total do Contrato:
166,14
164.208,98

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ANS n

Unimed de So Lus Cooperativa de Trabalho Mdico

/ Deyse Maria Rodrigues Soares

7677133 / 99999 / 10250572

10101012 Em consultrio (no horrio normal ou

Adriana Sousa Lima

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

40306674 Citomegalovrus IgM

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

40307026 Hepatite C - anti-HCV

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

40311210 Rotina de urina (caracteres fsicos,

/ Ultrimagem - Serv. De Diag. Por

40901297 Obsttrica 1 trimestre (endovaginal)

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

40316114 Antigeno Australia (HBSAG)

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

40304361 Hemograma com contagem de plaquetas /40304361

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

40307760 Sfilis - VDRL

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

40307832 Toxoplasmose IgM

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

40307182 HIV1+ HIV2, (determinao conjunta),

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

40306666 Citomegalovrus IgG

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

40307824 Toxoplasmose IgG

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

40301150 cido rico

/ Ultrimagem - Serv. De Diag. Por

/ Laboratorio Gaspar Ltda

29/11/2011 08:34:00 7613503 / 99999 / 30484419

/ Ultrimagem - Serv. De Diag. Por

7605057 / 99999 / 30485952

7605057 / 99999 / 30485952

7605057 / 99999 / 30485952

Aluizio De Paula Carvalho

Unimed de So Lus Cooperativa de Trabalho Mdico

/ Mauro Jose Melo Fonseca

/ Centro Diag E Trat Cardiologico

21/12/2011 14:52:00 7637816 / 99999 / 30516755

/ Centro Diag E Trat Cardiologico

21/12/2011 14:52:00 7637816 / 99999 / 30516755

7672188 / 99999 / 10256793

40101010 ECG convencional de at 12 derivaes /40101010

Clelia Valporto Carvalho

/ Ibraim Almeida Filho