| Insured Name | Policy No | Payment Status | Claim No | Transaction No | In Payment Of | Payee Name | Summary Amount |
|---|---|---|---|---|---|---|---|
| WORLD VISION INTERNATIONAL | CHC/PPI/CR2-1026 |
Full Payment | CL/CHC/PPI/21213 | CL/CHC/PPI/21213-01 |
IN-PATIENT | Vanna Dary/Mao Ravuth | 154.83 |