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POLIKLINIK SYARAF

NO
1
2
3
4

5
6
7
8

6
7
8
9
10
11
12
13
14
15
16
17

TGL

NAMA PASIEN

NO KARTU

NO. MR

DX

DOKTER

P1

DR.FERDHI ADHA

DR. RUHAYA

dr. Letmi Yestrijal, Sp.PD

0
DOKTER
DR. FERDI ADHA

P1
0

dr. Letmi Yestrijal, Sp.PD


Total

0
0
0

MR

LABOR

RONTGEN

OBAT

USG

MR
0

LABOR
0

RONTGEN
0

OBAT
0

USG
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

EKG

JUMLAH
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

EKG
0

0
0
0

POLIKLINIK INTERNE
NO

TGL

NAMA PASIEN

NO KARTU

NO. MR

DX

1
2
3
4

5
6
7
8

6
7
8
9
10
11
12

DOKTER

P1

MR

LABOR

RONTGEN

OBAT

12,000
12,000
12,000

6,000
6,000
6,000

36,000

18,000

12,000
12,000
12,000
12,000
14,000
12,000

6,000
6,000
6,000
6,000
11,000

74,000

35,000

24,000

353,319

110,000

53,000

24,000

627,925

P1
36,000
74,000
0
110,000

MR
18,000
35,000
0
53,000

LABOR
0
24,000
0
24,000

RONTGEN
0
0
0
0

OBAT
274,606
353,319
0
627,925

dr. YUGO ALISON O

03/07/15
26/06/15
25/07/15

29/06/15
07/07/15
14/07/15
20/07/15
23/07/15
22/07/15

TAHDJUL AS
YENNI HARTATI
SUMARNI

AMELIA AGUSTINA
MUHAMMAD RASID ASRI

0000018397664
0001819391128
0001424534859

397205
150311
958105

CAD
DYSPEPSIA
HHD

0001475080108
0000017287907

371302
146011

GEA
HERNIA SCROTALIS

NUZUAR JAMIN

0000274303719

975811

IKTERIK

MARTINI

0000272249381

769507

ABSES DM

0001332710954
0000018346476

089808
966411

DM TYPE II
VULNUS PAPTIKUM

ARNI
AHMAD RUSDI

dr. Drajad Priyono, Sp.PD

dr. Letmi Yestrijal, Sp.PD

DOKTER
dr. Drajad Priyono, Sp.PD
dr. Letmi Yestrijal, Sp.PD
dr. YUGO ALISON O
Total

92,987
55,106
126,513

274,606
33,530
154,912
82,796

24,000

82,081

USG

EKG

JUMLAH
0
0
0
0
0

35,000

35,000

145,987
73,106
144,513
0
0
0
363,606

51,530
18,000
172,912
124,796
14,000
105,081
0
486,319

35,000

USG
0
0
0
0

EKG
35,000
0
0
35,000

849,925

363,606
486,319
0
849,925

POLIKLINIK BEDAH
NO

TGL

NAMA PASIEN

NO KARTU

No MR

DX

DOKTER

P1

MR

TINDAKAN

LABOR

06/07/15

MUTIA HARMADELI

0001245455368

336311

POLY RECTI

12,000

11,000

23/07/15

ILZA RAHMA PUTRA

0000284526191

851903

UNDECMIDR TESTIS

12,000

6,000

42,000

23/07/15

DASMI

0000274296429

767009

SOFT TISSUE TUMOR

12,000

6,000

74,000

5
6
7

23/07/15
23/07/15
02/07/15

SITI MAISARAH
DJAHAR S

0000275384564
0000018387101

356511
561705

SOFT TISSUE TUMOR


BENIGN NEOPLASMA

02/07/15

0000017191517
0000274963781

11,000
6,000
6,000

BASTARI
FAJRI PRATAMA

12,000
12,000
12,000
12,000

11,000

50,000

02/07/15

AFNI WULANDARI

0001318194808

293007

TUMOR ET BIBIR

12,000

6,000

74,000

10

23/07/15

ARNI

0001332710954

089808

DM TYPE II

12,000

6,000

108,000

69,000

115,000

12,000
12,000
12,000
12,000
12,000

6,000
6,000
6,000
6,000
6,000

36,000

60,000

30,000

36,000

200,000

168,000

99,000

151,000

654,000

P1
60,000
108,000
168,000

MR
TINDAKAN
30,000
36,000
69,000
115,000
99,000
151,000

LABOR
200,000
454,000
654,000

5
6
10
14
15

30/06/15
30/06/15
10/07/15
07/07/15
07/07/15

JAFRIZAL
ERA OKTARIANA
RANTIKA FEBRIANTY
FIFI MAIYUSRIANTI
RESTI

0000149042621
0001271705319
0001331250783
0001440404234
0000284310224

903904 SOFT TISSUE TUMOR


7756011 HERNIA SCROTALIS

371810
822401
775811
057704
796011

ABSES
ABSES MAMAE
MAMAE DEXTRA
TUMOR MAMAE
APENDIK AKUT

DOKTER
dr. Zaitul Ikhlas, Sp.B
dr.Syahrial,Sp.B
Total

115,000

66,000
74,000
74,000

454,000

50,000
50,000
50,000
50,000

EKG

OBAT

RONTGEN

JUMLAH

90,302

113,302

91,244

151,244

17,732

109,732

14,756
14,756
17,409

103,756
221,756
109,409

90,302

163,302

90,302

182,302
18,000

426,803

1,172,803

1,172,803

528,586

28,704
46,014
81,009

202,586

82,704
114,014
149,009
68,000
114,859
528,586

629,389

1,701,389

1,701,389

OBAT
202,586
426,803
629,389

528,586
1,172,803
1,701,389

1,701,389

46,859

RONTGEN

POLIKLINIK ORTOPEDI
NO

TGL

NAMA PASIEN

NO KARTU

MR

DX

DOKTER

P1

MR

RONGTEN

PI
0
0
0

MR
0
0
0

RONGTEN
0
0
0

dr. Endayani, MPH

DOKTER
dr. Noverial, Sp.OT
dr. Endayani, MPH
Total

TINDAKAN

LABOR

Obat2an

JUMLAH
0
0
0

0
0
0

TINDAKAN
0
0
0

LABOR
0
0
0

Obat2an

0
0
0

0
0
0

POLIKLINIK JANTUNG
NO

TGL

NAMA PASIEN

NO KARTU

NO. MR

DX

DOKTER

P1

MR

RONTGEN

EKG

LABOR

ECHO
CHARDIOGRAF

Obat2an

JUMLAH

0
0
0

dr. M.FADIL, SP.JP

2
3
4

1
2

29/06/15

ASNIMAR

0001433367099

624710

CAD

0
12,000

0
6,000

0
35,000

0
595,977

12,000

6,000

35,000

595,977

P1
12,000
0
0
12,000

MR
6,000
0
0
6,000

INJEKSI
0
0
0
0

LABOR
0
0
0
0

RONTGEN
595,977
0
0
595,977

JUMLAH
648,977
0
0
648,977

dr. Susi Yanti

DR. NORA FITRI

DOKTER
DR. SUSI
DR NORA F
Total

FISIOTERAPY MANTOX TEST


0
35,000
0
0
0
0
0
35,000

0
648,977
0
0
648,977
0
0
0
0
0
0
0
0
0
0

648,977

POLIKLINIK ANAK
NO

TGL

NAMA PASIEN

NO KARTU

NO MR

DX

DOKTER

MR

INJEKSI

MANTOX
TEST

ROTGEN

LABOR

Obat2an

14,000

14,000

P1
14,000
0
14,000

MR
0
0
0

INJEKSI
0
0
0

MANTOX TEST
0
0
0

ROTGEN
0
0
0

LABOR
0
0
0

Obat2an
0
0
0

P1
14,000

2
3

dr. Yunira Yunirman, Sp.A

3
4
dr. Asrinal, Sp.A

DOKTER
dr. Yunira Yunirman, Sp.A
dr. Asrinal, Sp.A
Total

JUMLAH
14,000
0
0
0
0
0
0
0
0
0
0
14,000
0
0
0
0
0
0

14,000

14,000
0
14,000

HAEMODALISA
NO

RUANGAN

1
2
3
4

INTERNE
INTERNE
INTERNE
INTERNE
INTERNE
INTERNE

TGL
02/
03/07
06/08/
12/07/15
27/07/15
28/07/15

NAMA PASIEN
LUKFIAH HAKIM
MURNI HAYANI
SYAFNIDAR
MAIYAR
NURDIAS

HENDRA DIANOF

NO KARTU

NO MR

DX

0001337391718
0001383589899
000020013502
0001820539056

225111
232210
970910
966211

CKD
DM TYPE II + HT
FEBRIS
CHRONIC KIDNEY DISEASES

0001306847013

717608

CKD STG V

0001321330105

776411

CKD ST V

DOKTER

P1

MR

HD
1,000,000
1,000,000
2,000,000
1,000,000
1,000,000
1,000,000

dr. DRAJAD PRIYONO, SP.PD

7,000,000

PEMASANGAN
CDL
2,500,000
2,500,000
2,500,000

7,500,000

TINDAKAN

LABOR

TRANFUSI/
DARAH

OBAT

117,000

1,117,000
3,500,000
2,108,000
3,575,000
3,512,000
1,012,000
0
0
0
0
0

108,000
75,000
12,000
12,000

249,000

75,000

JUMLAH

14,824,000

14,824,000

POLIKLINIK THT
NO

TGL

NAMA PASIEN

NO KARTU

NO MR

DX

DOKTER

P1

MR

EXT
CERUMEN

LABOR

LARINGOS
KOPI

P1

MR

EXT
CERUMEN

1
2
dr. Yuhisdiarman, Sp.THT

DOKTER
dr. Yuhisdiarman, Sp.THT

LARINGOS
KOPI

SINUSCOPY

OBAT

JUMLAH
0
0
0
0
0

POLIKLINIK MATA
NO

TGL

NAMA PASIEN

NO KARTU

NO MR

DX

DOKTER

P1

MR

SLIT LAMP

KERATOMETRI

P1

MR

SLIT LAMP

KERATOMETRI

1
2
3
dr. Joni Sastra, Sp.M

DOKTER
dr. Joni Sastra, Sp.M

TONOMETRI

AUTHOREF

BIOMETRI

OBAT

LABOR

JUMLAH
0
0
0
0
0
0
0

0
LABOR

POLIKLINIK KEBIDANAN
NO

TGL

NAMA PASIEN

NO KARTU

NO. MR

DX

1
2
3
4
5

DOKTER

P1

MR

USG

TINDAKAN

12,000

11,000

100,000

12,000

11,000

100,000

12,000

11,000

100,000

P1
0
12,000
12,000

MR
0
11,000
11,000

USG
0
100,000
100,000

TINDAKAN
0
0
0

dr. Adriswan, Sp.OG

01/07/15

MELLY A REMITASARI

0000987489189

626011

GR 41-42 MGG

7
8
9

dr. Syahrial Syukur, Sp.OG

DOKTER
dr. Adriswan, Sp.OG
dr. Syahrial Syukur, Sp.OG
Total

OBAT

LABOR

JUMLAH
0
0
0
0
0
0
0
0
0

123,000
0
0
0
0
0
0
0

123,000

123,000

OBAT
0
0
0

LABOR
0
0
0

0
123,000
123,000

123,000

123,000

POLIKLINIK PARU
NO

TGL

NAMA PASIEN

NO.KARTU

NO. MR

DX

DOKTER

P1

MR

NEBU

LABOR

OBAT

P1
0
0
0
0

MR
0
0
0
0

NEBU
0
0
0
0

LABOR
0
0
0
0

OBAT
0
0
0
0

1
2
3
dr. Yenny Muchtar, Sp.P

2
3
4
5
6
7
8

dr. Dessi Susyanti, Sp.P

5
DR. WAYUDAPEMIL

DOKTER
dr. Yenny Muchtar, Sp.P
dr. Dessi susyanti, Sp.P
dr. Wahyu Depamil
TOTAL

RONTGEN

JUMLAH
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0

RONTGEN
0
0
0
0

JUMLAH
0
0
0
0

IGD

NO

NAMA PASIEN

NO.KARTU

29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68

28/06/15
29/06/15
25/06/15
27/06/15
27/06/15
28/06/15
26/06/15
29/06/15
01/07/15
29/06/15
29/06/15
03/07/15
29/06/15
29/06/15
02/07/15
30/06/15
01/07/15
30/06/15
30/06/15
23/06/15
30/06/15
26/06/15
28/06/15
26/06/15
04/07/15
04/07/15
05/07/15
01/07/15
30/06/15
01/07/15
04/07/15
01/07/15
04/07/15
02/07/15
04/07/15
05/06/15
30/06/15
02/07/15
01/07/15
29/06/15
05/07/15
30/06/15
03/07/15
05/07/15
06/07/15
06/07/15
29/06/15
07/07/15
03/07/15
07/07/15
03/07/15
07/07/15
02/07/15
05/07/15
01/07/15
07/07/15
04/07/15
07/07/15
09/07/15
06/07/15
09/07/15

MUTIA HARMADELI
RATINA
RABIK
ZULFAHMI
NURANI
TAROPEN
NAIMAH
VIVI SELVINA
ZULHADI
BARINIH
FAIZI AL BARI
ZAKWAN ZAFER ATHARI
BY.NY.SISKAN SARI/ASYILA
RABIATUL ADAWIYAH
ATHALLAH SHAKIL HAZIQ SILITONGA
SOFIAL AWAL
ZALMASRI
SITI RASANI
RITNA MELATI SUCI
SUMIATI
YUSNI
SURYANTI
LUKFIAH HAKIM
MURNI HAYANI
DELFI JUMAYENTI
MUSLIM
SHALLI RAHMINA
DENI ELITA
RINNI
LIDIYA MARTIN
EPA LIASMAWATI
GUSNIAR
VIEN SILVIA NINGSIH
LIDIIYA
ERA DILLA SPT
ZULMIYETTI
ZAIDAR ZA
ASTITUT NELIANTI
ALIYUS
AMRAN
MUHAMMAD JIHAD
HANIFAH
NURHAIMI
SYAFNIDAR
NELI KARTIKA SARI
FEBY ELFRIMA
ANIF MUHAMMAD RIDWAN
AGIL SAPUTRA

0001245455368
1304144107470017
0001245418953
0000273725258
0001333282083
0000275539015
0000016559987
0000273576857
0000274273334
0001838772112
00000172025493
0001085897182
0001845301781
0000273979697
0001855987481
0000272844268
0001618536148
0001825168713
0000284919581
0001303247711
0001862533912
0001331740292
0001337391718
0001383589899
0001864202174
0000018376907
0000283913381
0001841575781
0000017178759
0001179109269
0001425353354
0001846451531
0000196923802
0000273705963
0001089054819
0000986635102
0000042969262
0000017469268
0000274716639
0001435508234
0001442906853
0001381620609
0001331189469
000020013502
0000273996066
0000986503465
0001334632465
0001841694434

69

08/07/15

ERLINDA WATI

70
71
72
73
74
75
76
77
78
79
80
81
83
84

04/07/15
08/07/15
05/07/15
07/07/15
02/07/15
08/07/15
11/07/15
12/07/15
06/07/15
08/07/15
07/07/15
15/07/15
19/07/15
09/07/15

SUYARMA
ASNIMAR S.KAR
NURMAN AMRI , SE
RIKA JUITA, A.MD.KEP
FATIH NAIL ABROR
GADIH
LUTHFIAH AZRA
NAYARA SAUFA NAQISYA
KEVIN ILHAM
NABILA PUTRI
RAYHAN
FHMI ABDILAH
NAZARUDDIN
ZULMIYETTI

0001451608975
0000018413638
0000017212961
0000149093032
0000201622904
0001430184677
0001330852061
0001795171689
0001331811404
0000274004976
0000283392397
0000272821612
0000017289011
0000986636102

576211
519008
9171910
446211
596211
239900
416511
307011
275911

85

12/07/15

RIKA

0001843965753

86
87
88
89
90
91
92
93
94
95
96
97
99
100
101

13/07/15
05/07/15
13/07/15
10/07/15
04/07/15
09/07/15
11/07/15
10/07/15
01/07/15
11/07/15
12/07/15
11/07/15
15/07/15
06/07/15
08/07/15

MONA FEBRILIA
AMIRUDDIN
WIDYA NELVI

0000274007654
0000018328498
0001144967106

1
2
3
4
5
6
7
8
9
15
16
17
18
19
20
21
22
23
24
25
27

TGL

NO. MR

DX

DOKTER

PEMERIKSAAN

MR

14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000

HEACTING

OBSERVASI

INJEKSI

6,000
11,000
6,000
6,000
6,000
6,000
6,000
11,000
6,000
6,000
11,000
11,000
11,000
6,000
11,000
6,000
6,000
6,000
6,000
6,000
11,000
6,000
6,000
6,000
11,000
6,000
11,000
6,000
6,000
6,000
11,000
6,000
6,000
11,000
11,000
6,000
6,000
6,000
6,000
6,000
6,000
11,000
11,000
6,000
11,000
6,000
6,000
11,000
11,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
11,000
6,000
6,000

30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
42,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000

36,000
12,000
24,000
36,000
36,000
36,000
24,000
12,000
22,000
60,000
24,000

476211

GEA DG DEHIDRASI
GASTRITIS AKUT
STROKE ISKEMIK
DEMAM TYPOID
FEBRIS
DEMAM TYPOID
LOW BACK PAIN
TB PARU
ASMA BRNCIAL DLM SRGN
APENDIC AKUT
HYPERPEREXIA
DIARE AKUT
IKTERIK NEONATUM
BRONKOPNEUMONI
BRONKOLITIS
ANEMIA BERAT
GASTRITIS AKUT
OBS FEBRIS
OBS FEBRIS
HYPERPEREXIA
TINEA CORPONS
SIROSIS HEPATIS
CKD
DM TYPE II + HT
SYNDROM DYSPEPSIA
DEMAM DENGUE
FEBRIS
G1P0A0H0
G2P1A0H1 GR ATERM
G3P1A1H1+ KPD
G3P2A1H1+ INPARTU
G4P3A0H3+ KPD
G2P1A0H1+ OBS INPARTU
G1P0A0H0+ PR INDUKSI
LATE HPP
VOMITUS DEHIDRASI
GASTRITIS AKUT
EPISTALIS ANTENUR
GASTRITIS AKUT
HT URGENCY
GEA DG DEHIDRASI
HT URGENCY
DEMAM TYPOID
FEBRIS
GASTRITIS AKUT
DYSPEPSIA
OBS FEBRIS
ASMA DLM SERANGAN

BY.NY.YULI SUSANTI

0001868010219

262611

HYPERPEREXIA

ALI IMRAN
BUYUNG GADANG
NUR INDAH ERNA SARI
ERI WIDYA CANDRA
GUSTINAR
NOFRITO BAHAR
ASNI EMRI
LIZWIRDA
ERMA YENTI
MIRA WAHYUNINGSIH
ERNITA
NAZARUDDIN

0000284177068
0000015629308
0001808992822
0000284691903
0001300069574
00002841492690
0000284504152
0001267031215
0000273405071
0001851908714
0001330547523
0001329921066

644601
443408

536211
686211
233711
004708

PPOK EKSASERBASI AKUT


CAP + PPOK
G4P1AOH1
G3P2A0H2
CA PARU + EFUSI PLUERA
STEMI INTERIOR
UAP
CHF + HHD
G1P0A0H1 + PERDRHN PERVGNN
G2P1A0H1+ GR ATERM INPARTU
EFUSI PLUERA
PPOK EKSASERBASI AKUT

DR. RANI
DR. DIAH
DR. DESSY R
DR. DESSY R
DR. HEPI
DR. RANI
DR. DIAH
DR. WENNY
DR. DESY
DR. DIAH
DR. WENNY
DR. DESSY R
DR. DESSY R
DR. DESSY R
DR. DESSY R
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DESSY R
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DESSY R
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DESSY R
DR. DIAH
DR. DIAH
DR. DIAH
DE. NEVI
DR. DIAH
DR. DIAH
DR. DESSY R
DR. DESSY R
DR. DIAH
DR. DIAH
DR. DESSY R
DR. DIAH
DR. DIAH
DR. DIAH
DR. DESSY R
DR. DIAH
DR. DESSY R
DR. DIAH
DR. DESSY R
DR. DIAH
DR.DIAH
DR. RANI
DR. NEVI
DR. DIAH
DR. DESSY R
DR. DIAH
DR. DIAH
DR. NEVI
DR. DESSY R

0001081140208

433408

G2P1A0H1

DR. DIAH

14,000

6,000

30,000

FEBRIS + LOW INTAKE


DEMAM TYPOID
COLIC RENAL
G3P2AOH2
OBS FEBRIS
HYPOGLIKEMIA
GEA DEHIDRASI RINGAN
BRONKOPNEUMANIA
HYPERPEREXIA
OBS . VOMITUS
DHF
KOLIK ABDOMEN
HEMATUSIA
G1P0A0H0

DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.

14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000

6,000
6,000
6,000
6,000
6,000
11,000
6,000
6,000
11,000
11,000
6,000
11,000
6,000
6,000

30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000

056511

G1P0A0H1+OBS INPARTU

DR. DIAH

14,000

11,000

156511
256211
176511

DHF GR I
SYNDROM DYSPEPSIA
DHF GR II

0000274591585

806211

DYSPEPSIA

0001437135445
0000284691701
0001820539056

655310
796211
966211

DEMAM TYPOID
HEMATEMESIS
CHRONIC KIDNEY DISEASES

0000986496434

967208

GASTRITIS AKUT

DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.

14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000

11,000
6,000
11,000
11,000
11,000
11,000
11,000
6,000
6,000
11,000
6,000
6,000
6,000
6,000
6,000

SAMSIDAR

MARINIH
GUSTIARDI
MAIYAR
SRI WARTI

NASRIL
HASAN BASRI BA
DELMI MASNITA
JUSNI MALITA
KHAIDIR
CHASIAH
SALMI

00002741879768
0000025088837
0000274207105
0000227802418
0000273501808
0000018386289
0000282379915

877409
004711
285911
552311
774602
525911
091408
215911
545911
036211
455911
815911
645911

166300
585911
225111
232210
196211
515507
296211
725911
806302
136211

795911
176211
275911
665911
641507
735911
444610
595911
016211
970910

343911
575110
161508

245409
864405

946211
026511
546208
001790
294811

SYNDROM NEFROTIK
GASTRITITIS AKUT
VERTIGO
SYNDROM DYSPEPSIA
GASTRITIS AKUT
GASTRITIS AKUT
GASTRITIS AKUT

DESSY R
DIAH
RANI
DIAH
DESSY R
DIAH
DIAH
DIAH
NEVI
DIAH
DIAH
DIAH
DIAH
DIAH
DESI
RANI
DESSY R
DIAH
DIAH
NEVI
DIAH
DIAH
DIAH
DESSY R
RANI
DIAH
DESSY R
NEVI
DIAH

24,000
36,000
36,000
36,000
24,000
36,000
24,000
24,000
24,000
36,000
36,000
60,000
24,000
48,000
12,000

SKINTEST

LABOR

66,000
66,000
90,000
80,000
66,000
26,000

26,000

42,000
42,000
52,000

26,000

80,000
42,000
42,000
66,000

26,000

66,000
74,000
66,000
76,000

PASANG INFUS

PASANG
KATETER

12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
20,000
12,000

12,000

KONSUL
SPESIALIS

CORPUS
ALIENUM

NGT

35,000
35,000
35,000
35,000
35,000
35,000

12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000

EKG

35,000
35,000
35,000
35,000

12,000

35,000
35,000

12,000
12,000

12,000

36,000
24,000
36,000
36,000
36,000
36,000
24,000
12,000
46,000
36,000
24,000
12,000

58,000
24,000

24,000
24,000
12,000
24,000

26,000

52,000
80,000
66,000
42,000
66,000
66,000
66,000
66,000
66,000
90,000
80,000
42,000
66,000

12,000

66,000

12,000

26,000

66,000

66,000

66,000

30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000

26,000
24,000
36,000
24,000
48,000
96,000
26,000
48,000
48,000
12,000
36,000
24,000
24,000
36,000
26,000

26,000

26,000

90,000
104,000
80,000
42,000
128,000
42,000

26,000
42,000
66,000
42,000
26,000
26,000

35,000
35,000
35,000
12,000

12,000
12,000
12,000
12,000
12,000
12,000

24,000

24,000
36,000
26,000
12,000
12,000
12,000
48,000
12,000
46,000
24,000
12,000
36,000
48,000
72,000
12,000

12,000
12,000
12,000
12,000
12,000
12,000

12,000
12,000
12,000
12,000

35,000
35,000

12,000

35,000
30,000

12,000

35,000
70,000
35,000
35,000

12,000
12,000

12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000

30,000

35,000
35,000
35,000
35,000
30,000
12,000

35,000

12,000

76,000

12,000

12,000
35,000

12,000
42,000
66,000
66,000

26,000
26,000

90,000
42,000
162,000

26,000

66,000
66,000
66,000
434,000
66,000

12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000

35,000

12,000
12,000

35,000
35,000
35,000
35,000
35,000

12,000
35,000
35,000
35,000
35,000
35,000

12,000

PSG TAMPON

102
103
104
105
106
107
108

BAHARUDIN

110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129

29/06/15
09/07/15
07/07/15
14/07/15
14/07/15
07/07/15
06/07/15
15/07/15
19/07/15
04/07/15
19/07/15
19/07/15
19/07/15
22/07/15
23/07/15
22/07/15
22/07/15
17/07/15
22/07/15
15/07/15
21/07/15
19/07/15
19/07/15
22/07/15
22/07/15
18/07/15
23/07/15
23/07/15

131

27/07/15

NUR AISAH

132
133
134
135
136
137
138
139

26/07/15
27/07/15
17/07/15
23/07/15
21/07/15
25/07/15
15/07/15
19/07/15

ULAN SARI ASIH


ISNI MARDOLI
FARIDA
NASRIL
KHUSNUL KHOTIMAH AZNUR
KARTIKA SARI
IKRA RIZA,A.MD.KEP
FITRIANISA

140

20/07/15

141

21/07/15

142

20/07/15

WIWID HANDANI
RINA LESTARI
MULYETI

143
144
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
175
191
192
193
194
195
196
197
198
199
200
201
204

21/07/15
01/07/15
20/07/15
21/07/15
25/07/15
15/07/15
20/07/15
20/07/15
21/07/15
28/07/15
20/07/15
13/07/15
20/07/15
11/07/15/15
11/07/15
26/07/15
24/07/15
26/07/15
24/07/15
20/07/15
29/07/15
27/07/15
28/07/15
30/07/15
25/07/15
26/07/15
26/07/15
21/07/15
20/07/15
22/07/15
29/07/15
29/06/15
22/07/15
30/06/15
12/07/15
02/07/15
29/06/15
03/07/15
13/07/15
13/07/15
13/07/15
10/07/15
19/07/15
28/06/15
17/07/15
19/07/15
19/07/15
20/07/15
22/07/15
13/07/15
23/07/15
25/07/15
22/07/15
22/06/15
22/07/15
28/07/15

MASNI

SAMUAL
YULIA EFENDI
ERNIATI
RUSLI RAUSTIM

MARLIS

BY.NY.PUTRI TELLY PRIMA SARI


YOLLA SEPTIANI S
NURKASIAH
FAUZI
GUSTIARDI

ROSNA ONJONG
ERMAYULIS
ARMEL

TAUFIK HIDAYAT
DINI HARI YANTI

ERMALIS
ZULMIYETTI
LUKMAN
RAKIAH
AMSAR
BAINAR
M GANI
MAWARDI

ILHAAM GHAANII MAULANA


RISKI MAULANA
NAUFAL ATHARIS CANDRA

SAMUAL

0001861509835

969308

NEURALGIA

0000274376215

676211

GASTRITIS AKUT

987011
792611
367011
037111
527905

GASTRITIS AKUT
DM TYPE II + HT
HT URGENCY
PNURAN KESDRAN
CAP + PPOK
TB PARU
TB PARU BERAT
PPOK + SUSP CPC

0001276481294

007011

KEJANG DMM SIMPLEK

0000274758783
0001302576647

217111

GASTROENTERITIS AKUT
FEBRIS + KDK

DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.

0000274705863

767111

G4P3A0H3 + OBS INPARTU

DR. DIAH

14,000

11,000

0000284432995
0000283557326
0000275004955
0000018357783
0001796585275
0000284269263
0000165052517
0001855911172

537111
899409
776511
664305
977011
307111
247303

G1P0A0H0
G3P1A1H1+ HYPREMERIS
G1P0A0H0 + LETSU
BRADHIKARDI DG HT GR II
OBS FEBRIS
G1P0A0H0
G1P0A0H0
ABORTUS IMINEMS

DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.

14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000

11,000
6,000
11,000
6,000
11,000
6,000
6,000
11,000

30,000
20,000
30,000
30,000
30,000
30,000
30,000
30,000

36,000
36,000

42,000
32,000

12,000
12,000

36,000
14,000

42,000

12,000
12,000

G1P0A0H0

DR. NORA

14,000

6,000

30,000

12,000

G1P0A0H0 + HEG

DR. RINA

14,000

6,000

30,000

24,000

98,000

12,000

G5P2A2H2+ INPARTU

DR. HAIKAL

14,000

11,000

30,000

TYPOID

DR. RIKA
DR. DESSY R
DR. NORA
DR. RIZKI
DR. DESSY R
DR. DESSY R
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. LINA
DR. DESSY R
DR. DIAH
DR. DESSY R
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DESSY R
DR. DIAH
DR. DIAH
DR. DIAH
DR. NORA
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. NORA
DR. NORA
DR. DESSY R
DR. NORA
DR. WENNY
DR. WENNY
DR. DESSY R
DR.WENY
DR. DIAH
DR. DESSY R
DR. DESSY R
DR. HERU
DR. DIAH
DR.DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. DIAH
DR. HERU
DR. DESSY R
DR. DIAH
DR. KHAI
DR. DIAH

14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000

6,000
6,000
6,000
6,000
6,000
6,000
11,000
11,000
6,000
6,000
6,000
11,000
6,000
6,000
11,000
6,000
6,000
6,000
6,000
11,000
6,000
6,000
11,000
6,000
6,000
6,000
11,000
6,000
11,000
6,000
11,000
11,000
6,000
6,000
6,000
11,000
11,000
6,000
11,000
11,000
11,000
6,000
6,000
6,000
6,000
11,000
6,000
6,000
25,000
6,000
6,000
6,000
11,000
6,000
6,000
6,000

30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000

24,000
36,000
36,000
12,000
48,000
24,000
12,000
36,000
36,000

198,000
24,000
66,000
78,000
162,000
66,000
42,000

12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000

0000274145725

DEMAM TYPOID

0001330486514
0000284294823
0001833060644

256511
276511
862411

DEMAM DENGUE
KOLIK ABDOMEN
GASTRITIS AKUT

0001868190232

416211

GEA + DEHIDRASI SEDANG

0001868339733
0000284778279

406511
207011

ASPIXIA
OBS FEBRIS

0000016165776
0001334991352

721811

OTITIS MEDIA SURATIF


HT ST II

0000284691701

796211

ANEMIA BERAT

0000275436246
0000019195874

715000
630407

KOMPRESI LUMBAL
GASTROENTERITIS AKUT

0000167603387

HT URGENCY

0001270497014

SUSP INFEKSI

0001265785569

0000986641929
0000986635102
0000272762447
0001333353644
000183346739
0000274299423
0000284010041
0001331346069

FEBRIS

275911

0001388132662
0000284188465
0000274964725

264709

0000274145725
0000017801379

321206

0000284575386
0000171767957
0000977274415
0001190600717
00012454541650
1304014107580206

068401
974911
427111
981100
447011
757011

0000273764204
0000284271017
0000017620828
0000017167757
0001793171801
0001288921961
0001336891757
0000018412391
0001315884069
0000017374173
0000284459027
0001386747369

744908

2909004
996211

0000283201119

027211

GASTRITIS AKUT

0000274013392
0000283341879
0001869449949
0000018386021

937111
972904
078909

DEMAM TYPOID
GASTRITIS AKUT
GASTRITIS AKUT
FEBRIS H3

0000017286491

266702

DYSPEPSIA

BUNGA DENILA

0000284256461

627111

ZULMAIDI EDWIN
FAIZUL
KARTALENA
HALIMAH

0001274312417
0000017426474
0001273604646
0000273557136

220004
777011
632711
067211

GEA
ASMA BRONCHIAL
CHF EC CAD
DM TYPE II + HT
SUSP STEMI

0000018388809

375911

GASTRITIS AKUT

0001270265152
0000016732901
0001274861441
0001855987481
0000018329083
0000018328116
0000018350728
0001279975792
0000016072187
0001424449383
0000018334732
0001277419408
0000017212961
0000018708636
0000017411141
0000018402592
0001134376569
0000018373577
0001807904024
0000205696855
0000194762248
0000018392578
0001437284496
0001261576067

158203
033003

DEMAM DENGUE
HT URGENCY
PPV MYUOMS UTERI
BRONKHITIS
OBS FEBRIS
DEMAM TYPOID
GASTRITIS AKUT
VERTIGO FEVER
SYNDROM DYSPEPSIA
DM TYPE II + HT
OBS FEBRIS
GASTRITIS AKUT
KONSTIPASI + LOW INTAKE
GASTRITIS AKUT
DEMAM DENGUE
ANEMIA BERAT
APENDIC AKUT
CA BRONKOGENIK
CAP + PPOK
DEMAM DENGUE
DHF GR II
FEBRIS DEMAM DENGUE
HT EMERGENCY
UAP / NSTEMI

ZULRIANI
BUSIAR
PEMIL PERSADA
AGUSNOLI
SELVIRA
BOTI SALDORIA
NURMI

M RIDWAN
IRMA SURYANI
SYAFRUDIN
NOFRIALDI
SURYATI
NURAINI
ASNITA
YUSMAR
SYAMSURI
AZHARI BUCHARI
RATNA
JHONI SAMALO
AKHIRUDDIN

MARISA A
INDRA
AJIRIN DT.MAJO BASA
MARDJANI
MARTINI

FATIMAH HASBULLAH BA
VERAWATY SARI SIMAMORA
KASTERWIDA
NURAINI
ATHALLAH SHAKIL HAZIQ SILITONGA
ERMITA
NURUL AULIA RAHMI
ROMI WENDRAYATI B.GUMAM,SPD
NADIYA WULANDA
GUSMAIZAL SYANDRI
SYAFIAH
SYAMSIAR
AYU MARISKA
NURMAN AMRI , SE
ROBI ABIDIN
YULITA NOVIARTI
WASTIAH
ROBBI S FIDELITY
H. JUNAEDI
KAMAL ZANID
SURYANI AFDANELLA
CANTIKA TAMARA LISTIN
MUHAMMAD JAMIL
NURLELI
DASRUL

466411

967100
379003

815911
495911
238106
196511
186511
226511
099806
237011
355911
267011
227011
928409
997011
623405
167111
497111
47111
642910
107111
449202

HT URGENCY
DYSPEPSIA + SKA
FEBRIS KE II
STROKE ISKEMIK
GEA
CEPHALGIA + PSIKOMATIS
ANEMIA BERAT

VARICOCELE
G4P3A0H3 + INPARTU 41-42 MG
NSTEMI
CHF + HHD
NSTEMI
HT EMERGENCY+ STEMI INTERIOR
HT EMERGENCY
CHF
CHF EC HHD
UAP / NSTEMI
ADFH UAP / NSTEMI
CHF EC HHD

WENNY
DIAH
RAHMI
DIAH
DIAH
DIAH
NEVI
DIAH
DIAH
DESSY R
DIAH
DIAH
DIAH
DIAH
DIAH
DIAH
NORA
DESSY R
DIAH
DIAH
DIAH
DIAH
DIAH
DIAH
DIAH
DIAH
DIAH
DIAH
DIAH
DIAH
DIAH
DIAH
DIAH
NORA
DESSY R
DIAH

14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000

6,000
11,000
6,000
6,000
6,000
11,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
11,000
6,000
6,000

30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000

12,000
26,000
24,000
36,000
24,000
36,000
24,000

30,000
30,000

12,000
24,000
24,000
60,000
24,000
24,000
36,000
24,000
24,000
36,000
12,000
48,000
24,000
24,000
36,000
36,000
58,000
24,000
12,000
36,000

24,000
90,000
42,000

26,000
26,000

26,000

26,000

26,000
26,000
26,000

42,000
66,000
66,000
42,000
66,000
66,000
66,000
74,000
66,000
314,000
162,000

66,000
66,000
42,000

12,000
12,000
12,000
12,000
12,000
12,000
12,000

40,000

12,000

35,000
35,000

35,000
35,000
35,000

12,000
35,000
35,000
35,000
35,000

12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000

35,000

35,000

12,000

12,000
12,000
12,000
12,000
12,000
12,000

35,000
35,000
35,000
35,000
35,000

12,000

35,000

12,000
12,000

12,000

26,000
26,000

26,000

36,000
36,000
12,000
12,000
12,000
24,000
36,000
24,000
24,000
24,000
36,000
12,000
60,000
24,000
36,000
12,000

26,000

36,000
36,000
24,000
36,000
24,000
12,000
48,000
36,000
24,000
36,000
36,000

26,000
26,000

66,000

424,000
162,000
26,000

26,000

42,000
90,000
66,000
42,000
66,000

66,000

24,000
24,000
36,000
36,000
12,000
60,000
24,000
36,000
24,000
24,000
58,000
36,000
12,000
12,000
36,000
24,000

26,000

26,000
26,000
26,000

410,000
138,000
24,000
66,000
66,000
42,000
42,000
66,000
42,000
42,000
66,000
66,000
66,000
66,000
66,000
42,000
66,000
162,000
66,000
162,000

26,000
66,000
90,000
66,000
26,000

24,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000

35,000
35,000
35,000
35,000
35,000

12,000

12,000

12,000
12,000

35,000
35,000
105,000
35,000
35,000
35,000
35,000
35,000
35,000

35,000
35,000
35,000

12,000
12,000

35,000
35,000
35,000
35,000
35,000
35,000
35,000

35,000
35,000
35,000

12,000

35,000
35,000

12,000

35,000

12,000

35,000
35,000
35,000

12,000

205
206
207
208
209
210
211
212
213
214
215
216
217

27/07/15
27/07/15
31/07/15
26/07/15
29/06/15
10/07/15
28/07/15
27/07/15
28/07/15
26/07/15
28/07/15

NUSYIRWAN
ASMIWARNI
ERMITA

FAUZAN IHSAN EKA PUTRA


GILANG RAMADHAN
ROSNITA
SYAFARUDIN
HENDRA DIANOF
BOBY SASTRA SP
ERMAN
MARDIANA A

0000018373419
0001864689895

415700
6677111

0000986489583

860210

ANGINA PS HT
INPARTUS/G1P0A0H0

0000018373601

954301

ASMA DLM SERANGAN

0001330964212
0001481583363
0000018356736
0001321330105
0000018406945
0000018358525
0000018412029

365911
816211
533205
776411
36910
561604
518304

TONSILOFSRINGITIS
GASTRITIS AKUT
GASTRITIS AKUT
CKD ST V
GASTRITIS AKUT
COLIC RENAL
HYPERPEREXIA

KOMA DIABETIKUM

DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.
DR.

DIAH
DIAH
DIAH
DIAH
DIAH
DESSY R
DIAH
DIAH
DIAH
DIAH
DIAH

DOKTER
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.

Ahmadal
Anna
Dikha Dwi Putra
Dinny F
Feby
Feri
Fitri F
M. Ihsan
Mardlatillah
Monika
Mutiara Maharani
Nora
Ony Fitria Sari
Oswaldo
Poby
Pratiwi
Siska
Yugo Alison O
Total

14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000
14,000

6,000
6,000
6,000
6,000
6,000
11,000
6,000
6,000
6,000
6,000
20,000

2,786,000

1,512,000

30,000
30,000

24,000

66,000

12,000

12,000

35,000

30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000

12,000
24,000
24,000
12,000
24,000
60,000
36,000

26,000
26,000

42,000

12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000
12,000

5,822,000

5,004,000

986,000

9,588,000

1,952,000

364,000

3,490,000

30,000

K+S+D

HEACTING

OBSERVASI

INJEKSI

SKINTEST

LABOR

PASANG INFUS

PASANG
KATETER

EKG

KONSUL
SPESIALIS

42,000
102,000
66,000
42,000

12,000

35,000

12,000

35,000
35,000

35,000
35,000

60,000

USG

SAMPEL
DARAH

PERAWATAN
LUKA

ECOCARDIOGRAF

PASANG SPALK

PARTUS

PERAWATAN TALI
PUSAT

PERAWATAN BBL

NEBU

75,000

RONTGEN

VULVA
HIGIENE

WSD

MONITOR

DUMIN
SUSP

Obat

JUMLAH

62,746

160,746
114,000
275,453
241,911
277,413
186,242
212,457
248,898
361,645
231,419
154,580
55,000
125,924
246,456
240,053
222,589
86,000
279,618
181,476
155,087
278,976
204,576
98,000
390,392
228,860
247,605
189,426
50,000
89,500
77,500
70,500
62,000
162,533
55,000
211,361
215,162
199,000
190,541
239,259
267,859
196,314
368,583
208,695
355,628
276,457
195,906
189,022
185,415
55,000
630,137
397,152
65,500
50,000
825,217
156,000
640,150
328,984
50,000
55,000
309,022
449,699

88,453
42,911
54,413
53,242
11,457
111,898
78,645
75,419
63,580

58,000
58,000

34,924
80,456
95,053
37,589
40,618
53,476
4,087
52,976
40,576

100,000

58,000

15,500

81,892
37,860
36,605
34,426

15,500
15,500
15,500

112,533
15,500
15,500

50,541
40,259
10,859
68,314
123,583
63,695
96,628
58,457
55,906
49,022
43,415

58,000
58,000

75,000
75,000
75,000

40,861
33,662

58,000
58,000

276,137
124,152
15,500

58,000

554,217

58,000
15,500

12,000
75,000

58,000
58,000

473,150
114,484

111,022
195,699

50,000
75,000

79,738
33,883
30,184

15,500

116,000

63,433
128,774
78,393
114,207
40,322
47,111
33,251
178,161
145,941
44,233

391,738
248,883
219,184
104,000
179,433
472,274
194,393
248,207
173,322
192,111
173,251
429,161
404,941
118,233
25,000

48,224
37,626
48,224

15,500

58,870
234,985
100,683
196,658
8,970
52,088
48,575
44,855
76,736

183,224
224,626
217,224
126,000
298,870
524,985
444,183
145,000
410,658
122,970
251,088
200,575
599,855
133,000
265,736

38,632
43,138
41,690

71,818
32,942
56,880
51,378
70,560
152,983
49,974

12,000
116,000

61,639
38,267

12,000

58,000

15,500

35,057
64,565
141,924

75,000
58,000
58,000

47,627
149,940
183,402
65,179

75,000

211,632
128,000
219,138
181,690
121,000
150,000
192,818
50,000
148,942
257,880
276,378
269,560
455,983
201,974
133,000
239,639
198,267
133,000
175,057
537,565
534,424
184,000
264,627
397,940
505,402
198,179
74,000
98,000
25,000

42,359
37,671

72,450

15,500

187,359
157,671
55,000
145,000
195,450
50,000
62,000
82,500

1,929

63,929

54,647

250,647

58,000
58,000

81,703
510,829
85,031
50,477
91,910
40,989
13,365

58,000
58,000
58,000

408,392
39,392
718,466
33,736
164,656
141,270
104,575

458,703
725,829
310,031
249,477
424,910
192,989
146,365
103,000
271,562
50,000
578,392
247,392
912,966
636,736
498,656
347,770
321,575
121,000
747,423
296,799
271,089
232,391
266,868
210,757
239,857
109,000
67,000
568,333
219,677
1,238,857
1,337,286
222,829
199,454
221,746
145,000
240,053
203,901
212,228
185,357
137,741
234,190
262,466
225,000
211,807
201,242
183,000
273,726
541,329
271,650
730,377
221,000
235,734
218,424
280,007
684,156
720,181

12,000

82,500

15,500

12,000

12,000

81,562

15,500

58,000
58,000
58,000

15,500

58,000
58,000

15,500
15,000

58,000
58,000

15,500
15,500

12,000

75,000

540,923
97,799
105,089
56,391
73,868
47,757
40,857

365,333
55,677
584,357
987,786
60,829
47,454
46,746
95,053
35,901
48,228
40,357
28,741
42,190
59,466

16,000

47,807
61,242

15,500

12,000

86,726
192,829
62,650
435,377

75,000
12,000
58,000
15,500

58,000

71,734
37,424
77,007
497,656
541,181

102,154
15,000
15,500

75,000
60,619
121,362

108,000

16,000

825,000

1,956,000

355,500

PERAWATAN
LUKA

NEBU

RONTGEN

VULVA
HIGIENE

PASANG
TAMPON

24,000

103,524
14,273
182,671
73,398

24,000

16,347,463

289,154
65,000
118,500
137,000
176,619
349,362
121,000
243,524
142,273
365,671
312,398
0
0

51,225,963

RAWATAN INTERNE / TDK PENDING


NO
1
2
3
4
5
7
8
9
10
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
48
49
51
52
53
54
56
58
59
60
61

JALUR
MASUK

IGD
IGD
POLIKLINIK
IGD
IGD
IGD
IGD
IGD
IGD
IGD
PDHN ICU
IGD
IGD
POLIKLINIK
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
POLIKLINIK
IGD
IGD
IGD
IGD
PDHN ICU
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
POLIKLINIK

TGL
MASUK

TGL
KELUAR

29/06/15
25/06/15
29/06/15
30/06/15
01/07/15
30/06/15
30/06/15
25/06/15
01/07/15
30/06/15
29/06/15
03/07/15
06/07/15
06/07/15
07/07/15
15/07/15
05/07/15
15/08/15
06/07/15
08/07/15
29/06/15
09/07/15
07/07/15
09/07/15
14/07/15
14/07/15
15/07/15
14/07/15
07/07/15
06/07/15
14/07/15
20/07/15
20/07/15
04/07/15
21/07/15
22/07/15
23/07/15
20/07/15
21/07/15
22/07/15
22/07/15
22/07/15
15/07/15
21/07/15
16/07/15
29/07/15
27/07/15
28/07/15
22/07/15
30/06/15
29/06/15
23/07/15
28/07/15
22/07/15

01/07/15
01/07/15
01/07/15
06/07/15
03/07/15
03/07/15
03/07/15
04/07/15
06/07/15
04/07/15
06/07/15
05/07/15
09/07/15
09/07/15
07/07/15
16/07/15
13/07/15
18/07/15
11/07/15
13/07/15
11/07/15
11/07/15
11/07/15
14/07/15
16/07/15
16/07/15
16/07/15
15/07/15
07/07/15
10/07/15
18/07/15
27/07/15
27/07/15
15/07/15
24/07/15
23/07/15
23/07/15
23/07/15
25/07/15
25/07/15
24/07/15
24/07/15
24/07/15
22/07/15
19/07/15
31/07/15
30/07/15
29/07/15
23/07/15
01/07/15
30/06/15
30/07/15
30/07/15
26/07/15

RATINA
00012454189
70017
9
RABIK
53
AMELIA AGUSTINA
0001475080108371302
SOFIAL AWAL
0000272844268645911
ZALMASRI
0001618536148
SITI RASANI
0001825168713
RITNA MELATI SUCI
0000284919581
SUMIATI
0001303247711166300
0000017801379 321206
ZULRIANI
00018625339 58591
YUSNI
00014355082
12
1
AMRAN
00013816206
34
59591
HANIFAH
00002739960
09
1
NELI KARTIKA SARI
66
00009865034
FEBY ELFRIMA
65
MUHAMMAD RASID ASRI0000017287907146011
0000016041677 426511
ADHYAKSA JP
00000183284 25621
AMIRUDDIN
00002735018
98
54620
1
KHAIDIR
00000183862
08
00179
8
CHASIAH
00002823799
89
29481
0
SALMI
00018615098
15
96930
1
BAHARUDIN
35
8
0000274376215 676211
MASNI
00002741457
SAMUAL
25
0000284512746 776211
DARMIUS
0001330486514 256511
YULIA EFENDI
0000274303719 975811
NUZUAR JAMIN
0001190600717 981100
SELVIRA
0000284294823 276511
ERNIATI
0001833060644 862411
RUSLI RAUSTIM
00018681902 41621
MARLIS
00014301846
32
57621
1
GADIH
77
1
0000284575386 068401
BUSIAR
1304014107580
757011
NURMI
206
00000161657
NURKASIAH
76
0000171767957 974911
PEMIL PERSADA
00000191958 63040
ERMAYULIS
74
7
0000167603387
ARMEL
0001245454165
447011
BOTI SALDORIA
0
0000274280016
JARUDIN
00012704970
TAUFIK HIDAYAT
14
0001265785569
DINI HARI YANTI
00009866351 27591
ZULMIYETTI
00002727624
02
1
LUKMAN
00013333536
47
98701
RAKIAH
44
1
0000284174998 466511
YULIA SASWITA
0000283201119 027211
AKHIRUDDIN
00002740133
MARISA A
00002833418
92
93711
INDRA
00012702651
79
15820
1
VERAWATY SARI SIMAM
52
3
00000167329
03300
KASTERWIDA
00000183290
01
49591
3
ERMITA
83
1
ARNI
0001332710954089808
0001245403675 725801
FAIZATUL KHAIRA
AHMAD RUSDI
0000018346476966411

GASTRITIS AKUT
STROKE ISKEMIK
GEA
ANEMIA BERAT
GASTRITIS AKUT
OBS FEBRIS
OBS FEBRIS
HT

IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
POLIKLINIK
IGD
IGD
IGD
IGD
POLIKLINIK
IGD
IGD
IGD
IGD
IGD
IGD
POLIKLINIK
-

28/06/15
28/06/15
30/06/15
27/06/15
27/06/15
28/06/15
26/06/15
26/06/15
29/06/15
26/06/15
05/07/15
04/07/15
04/07/15
05/07/15
03/07/15
05/07/15
03/07/15
12/07/15
13/07/15
13/07/15
10/07/15
04/07/15
09/07/15
11/07/15
10/07/15
01/07/15
11/07/15
12/07/15
11/07/15
20/07/15
19/07/15
19/07/15
19/07/15
25/07/15
26/07/15
17/07/15
30/07/15
25/07/15
26/07/15
24/07/15
26/07/15
01/07/15
28/06/15
10/07/15
31/07/15
10/07/15
25/07/15
03/07/15

02/07/15
02/07/15
02/07/15
01/07/15
01/07/15
01/07/15
01/07/15
03/07/15
02/07/15
04/07/15
06/07/15
06/07/15
07/07/15
07/07/15
08/07/15
08/07/15
08/07/15
16/07/15
16/07/15
16/07/15
12/07/15
11/07/15
13/07/150
13/07/05
13/07/15
11/07/15
14/07/15
13/07/15
14/07/15
27/07/15
24/07/15
22/07/15
26/07/15
26/07/15
27/06/15
26/07/15
31/07/15
25/07/15
28/07/15
30/07/15
28/07/15
03/07/15
30/06/15
13/07/15
31/07/15
14/07/15
25/07/15
09/07/15

0000195145536 345911
SUNDARI
00012454553
MUTIA HARMADELI
68
995511
CHARMEINTO JUDA PER 0001294458952
00002737252 00471
ZULFAHMI
00013332820
28591
58
1
NURANI
00002755390
55231
83
1
TAROPEN
00000165599
77460
15
1
NAIMAH
00013317402
87
2
SURYANTI
00013373917
22511
92
LUKFIAH HAKIM
00013835898
23221
18
1
MURNI HAYANI
99
0
0000986635102
275911
ZULMIYETTI
00018642021 19621
DELFI JUMAYENTI
00000183769
51550
74
1
MUSLIM
00002839133
29621
07
7
SHALLI RAHMINA
00013311894
01621
81
1
NURHAIMI
97091
69
1
000020013502
SYAFNIDAR
0
TAHDJUL AS
0000018397664397205
0001275886978 452200
ANISAH
00002740076 15651
MONA FEBRILIA
00011449671
17651
54
1
WIDYA NELVI
06
1
0000274591585
806211
SAMSIDAR
00014371354 65531
MARINIH
00002846917
79621
45
0
GUSTIARDI
00018205390
96621
01
1
MAIYAR
56
1
0000986496434 967208
SRI WARTI
00002741879
NASRIL
00000250888
94621
768
HASAN BASRI BA
00002742071
37
1
DELMI MASNITA
00002278024
02651
05
JUSNI MALITA
18
1
0000272249381
769507
MARTINI
00013349913 72181
FAUZI
52
1
0000284691701
796211
GUSTIARDI
00002754362 71500
ROSNA ONJONG
46
0
0000977274415 427111
AGUSNOLI
YENNI HARTATI
0001819391128150311
00009866419
ERMALIS
00018694499
97290
29
AJIRIN DT.MAJO BASA
00000183860
07890
49
4
MARDJANI
21
9
0000017286491
266702
MARTINI
0001424091148 702011
ERMAWATI
0001306847013 717608
NURDIAS
0000018367143 208903
ALDORINO
00012774194 35591
AYU MARISKA
08
1
SOFI YERNI
0001828415216
0000986489583 860210
ERMITA
00014815833 81621
ROSNITA
63
1
SUMARNI
0001424534859958105
0001828415215 775611
SOFI YERNI

DEMAM TYPOID

NAMA PASIEN

NO KARTU
13041441074

NO.
MR
87740

DX

DOKTER

HT URGENCY

TINEA CORPONS
HT URGENCY
HT URGENCY
GASTRITIS AKUT
DYSPEPSIA
HERNIA SCROTALIS
MULTIPLE VULNUS

SYNDROM DYSPEPS
GASTRITIS AKUT
GASTRITIS AKUT
GASTRITIS AKUT
NEURALGIA
GASTRITIS AKUT

DEMAM TYPOID
GASTROENTERITIS
DEMAM DENGUE
IKTERIK
GEA
KOLIK ABDOMEN
GASTRITIS AKUT

GEA + DEHIDRASI dr. Letmi Yestrijal, Sp.PD


HYPOGLIKEMIA
DYSPEPSIA + SKA
ANEMIA BERAT

OTITIS MEDIA SURA


FEBRIS KE II

GASTROENTERITIS
HT URGENCY
CEPHALGIA + PSIKOM
GASTRITIS AKUT

SUSP INFEKSI
FEBRIS

DM TYPE II + HT
HT URGENCY
PNURAN KESDRAN
DEMAM DENGUE
GASTRITIS AKUT

DEMAM TYPOID
GASTRITIS AKUT
DEMAM DENGUE
HT URGENCY
OBS FEBRIS
DM TYPE II
THALASEMIA

VULNUS PAPTIKUM

RAWATAN /
HCU
80,000
240,000
180,000
240,000
120,000
120,000
120,000
540,000
600,000
200,000
480,000
360,000
160,000
160,000
120,000
240,000
1,080,000
160,000
720,000
200,000
520,000
120,000
200,000
240,000
120,000
120,000
80,000
40,000
60,000
200,000
300,000
320,000
320,000
1,440,000
480,000
240,000
125,000
120,000
200,000
160,000
120,000
120,000
400,000
80,000
160,000
120,000
120,000
40,000
240,000
240,000
240,000
320,000
120,000
600,000

VISITE DR.
SPESIALIS

VISITE DR.
UMUM

LABOR
129,000
114,000
292,500

12,000

6,000
72,000

48,000
48,000

24,000
36,000

48,000
24,000

18,000
24,000

234,500
174,000
27,000

117,000
12,000
168,000
48,000

101,500
394,000
36,000
201,000
251,500

38,000
126,000
214,000

INJEKSI
90,000
120,000
48,000
150,000
84,000
70,000
60,000
336,000
20,000
220,000
72,000
135,000
40,000
80,000
15,000
15,000
510,000
30,000
285,000
110,000
320,000
60,000
40,000
120,000
50,000
70,000
30,000
10,000

SKINTEST

RONTGEN

PERWTN
LUKA

PASANG
INFUS

DARAH

TRANSFUSIAMBIL DARAH EKG

ROM

OKSIGEN

12,000
1,250,000

24,000

250,000

210,000

50,000

58,000

24,000

15,000
58,000
58,000
18,000
18,000

63,000

158,000

60,000

500,000

18,000

857,000
1,000,000

105,000
140,000

240,000

40,000

PENDISTRIBUSI
AN MAKANAN

REDRESING

4,000
12,000
6,000
14,000
4,000
6,000
6,000
18,000
10,000
10,000
14,000
6,000
8,000
8,000
2,000
4,000
18,000
6,000
12,000
10,000
26,000
6,000
10,000
12,000
6,000
6,000
4,000
2,000

FISIOTERAP
ENDOSCOPY
Y

BIOPSI

NGT/DC

KONSUL GIZI

ROHIS

KONSUL
SPESIALIS

KLISMA

30,000
30,000

78,000
800,000

TOTAL CARE

RJP

NEBU

PASANG
KATETER

66,000
14,000
30,000

30,000

30,000

22,500

30,000

30,000
60,000

50,000

30,000

24,000
12,000

18,000
133,500
123,000

168,000
48,000

24,000
24,000
12,000
12,000

59,500

50,500
76,000
167,000
307,500
114,000
38,000

12,000
24,000
24,000
38,000
24,000

24,000

14,445,000

708,000

270,000

480,000
200,000
360,000
160,000
200,000
160,000
720,000
320,000
240,000
540,000
80,000
120,000
480,000
120,000
240,000
480,000
720,000
300,000
160,000
240,000
120,000
320,000
160,000
180,000
120,000
440,000
480,000
80,000
160,000
280,000
240,000
160,000
320,000
240,000
240,000
400,000
40,000
120,000
240,000
280,000
80,000
360,000
360,000
720,000
125,000
300,000
60,000
420,000

14,000

12,000

80,000
60,000
330,000
170,000
675,000
45,000
90,000
12,000
10,000
90,000
120,000
50,000
100,000
260,000
40,000
70,000
100,000
40,000
20,000
30,000
75,000
30,000
290,000
90,000
75,000

18,000

6,142,000

140,000

90,000

10,000
20,000
30,000

25,000

31,500

960,000

15,000

30,000
10,000

500,000

70,000

10,000
18,000
10,000
18,000

18,000

158,000

64,000

50,000
10,000
15,000

1,000,000
750,000

140,000
105,000

490,000

64,000

361,000

6,107,000

838,000

25,000

PERAWATAN
JENAZAH

21,000

10,000
10,000
16,000

20,000

24,000
8,000
4,000
2,000
6,000
10,000
8,000
6,000
6,000
20,000
4,000
8,000
6,000
6,000
2,000
4,000
4,000
4,000
16,000
6,000
10,000

30,000

3,000

15,000
7,000
30,000

102,000

200,000

90,000

8,500
21,000

10,000

7,000
7,000

90,000

90,000

62

1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
18
19
20
21
22
25
26
27
28
29
30
31
32
34
35
36
37
38
39
40
41
42
43
44
47
48
49
50
51
52
53
24

GEA DG DEHIDRASI
CKD ST V ON HD

DEMAM TYPOID
FEBRIS
DEMAM TYPOID
LOW BACK PAIN
SIROSIS HEPATIS
CKD
DM TYPE II + HT

G1P0A0H0 + DEHIDR

SYNDROM DYSPEPS
DEMAM DENGUE
FEBRIS
DEMAM TYPOID
FEBRIS
CAD
GASTROPATI

DHF GR I
DHF GR II

DYSPEPSIA

DEMAM TYPOID
HEMATEMESIS
CHRONIC KIDNEY D
GASTRITIS AKUT

SYNDROM NEFROTIdr. Drajad Priyono, Sp.PD


GASTRITITIS AKUT
VERTIGO
SYNDROM
DYSPEPSIA
ABSES DM
HT ST II

ANEMIA BERAT

KOMPRESI LUMBAL
STROKE ISKEMIK

DYSPEPSIA
GASTRITIS AKUT
GASTRITIS AKUT
FEBRIS H3

DYSPEPSIA
HT
CKD STG V
FEBRIS H2 DEMAM D

GASTRITIS AKUT

CHRONIC KIDNEY DI
KOMA DIABETIKUM

GASTRITIS AKUT
HHD
HEPATIS KRONIS

24,000

3,593,000

22,000
81,000
81,000

72,000

24,000
208,000

36,000

18,000
18,000

842,200
74,000
72,000

96,000
96,000
120,000
12,000

12,000

12,000

18,000

24,000

59,500
136,500
38,000
266,500
152,000
211,500
232,500
119,000
180,000
421,000
328,000

24,000

12,000
317,000
165,500
98,000

24,000

349,000

12,000
36,000

205,500
59,500
97,500
114,000

120,000
150,000
150,000
20,000
70,000
30,000
75,000
300,000
144,000
216,000
10,000
75,000
10,000
80,000
240,000
25,000
120,000
100,000
96,000
170,000
190,000
270,000
72,000
70,000
330,000
75,000
80,000
40,000
420,000
100,000
340,000
190,000
150,000
60,000
180,000
30,000
45,000
210,000
10,000
90,000
90,000
165,000

24,000
24,000
96,000

12,000

36,000

6,000

173,000

72,000

6,000

67,000

72,000
36,000
156,000

13,365,000

830,000

162,000

5,237,700

5,672,000

67,000

160,500

1,200,000

10,000
58,000
10,000
58,000
116,000

15,000
20,000
24,000

18,000

250,000

58,000

24,000

18,000

864,000

40,000
24,000

189,000
1,857,000

150,000

500,000
250,000

70,000

250,000

35,000

1,250,000

175,000

38,000

18,000

64,000

18,000

30,000
10,000

116,000
18,000

20,000
58,000

24,000
24,000

58,000
10,000
24,000

450,000
8,000
10,000
6,000
8,000
10,000
8,000
12,000
16,000
8,000
18,000
2,000
6,000
8,000
6,000
12,000
8,000
12,000
10,000
8,000
8,000
6,000
16,000
8,000
6,000
6,000
22,000
8,000
4,000
8,000
14,000
12,000
8,000
16,000
4,000
4,000
10,000
2,000
2,000
4,000
14,000
4,000
6,000
6,000
10,000

78,000

800,000

66,000

80,000

3,000

360,000

10,000

30,000

225,000

250,000

30,000

270,000

14,000
7,000
28,000
32,000
67,500

75,000

90,000

30,000
17,000

30,000
15,000

30,000
7,000

39,000
7,000
452,500

15,000

4,000

34,000

4,500

70,000
10,000
2,000
14,000

24,000

7,000

90,000

30,000
30,000

155,000

54

128,000

522,000

64,000

237,000

4,357,000

430,000

285,000

1,268,000

445,500

27,810,000

1,538,000

432,000

8,830,700

11,814,000

268,000

1,012,000

128,000

598,000

###

DOKTER

RAWATAN /
HCU

VISITE DR.
SPESIALIS

VISITE DR.
UMUM

LABOR

INJEKSI

SKINTEST

RONTGEN

PERWTN
LUKA

PASANG
INFUS

DARAH

dr. Letmi Yestrijal, Sp.P

14,445,000

708,000

270,000

3,593,000

6,142,000

140,000

490,000

64,000

361,000

6,107,000

TRANSFUSIAMBIL DARAH EKG


838,000

160,500

868,500

410,000

32,000

2,068,500

860,000

32,000

ROM

OKSIGEN

PENDISTRIBUSI
AN MAKANAN

REDRESING

1,200,000

450,000

39,000

15,000

117,000

800,000

66,000

BIOPSI
66,000

FISIOTERAP
ENDOSCOPY
Y
78,000

800,000

452,500

4,000

180,000

7,000

336,500

145,000

15,000

180,000

95,000

452,500

7,000

540,000

NGT/DC

KONSUL GIZI

ROHIS

KONSUL
SPESIALIS

17,000

561,500

145,000

250,000

45,000

450,000

KLISMA

TOTAL CARE

RJP

NEBU

PASANG
KATETER

80,000

3,000

360,000

PERAWATAN
JENAZAH

10,000

225,000

250,000

30,000

270,000

DR. Drajad Priyono,SP

13,365,000

830,000

162,000

5,237,700

5,672,000

128,000

522,000

64,000

237,000

4,357,000

430,000

285,000

868,500

410,000

32,000

39,000

15,000

452,500

4,000

180,000

7,000

336,500

145,000

15,000

180,000

Total

27,810,000

1,538,000

432,000

8,830,700

11,814,000

268,000

1,012,000

128,000

598,000

10,464,000

1,268,000

445,500

2,068,500

860,000

32,000

117,000

800,000

66,000

95,000

452,500

7,000

540,000

17,000

561,500

145,000

250,000

45,000

450,000

PS MONITOR

ABDOMIN TAMPON
AL TAP
HIDUNG

USG DR
ROSMA
YULITA

OBAT
285,429
240,401
12,235
174,867
120,631
126,018
98,959
1,139,566
87,410
281,360
231,334
113,146
98,332
191,803
97,081
830,041
225,758
479,147
158,373
1,005,198
113,399
221,894
115,689
45,758
437,799
107,897
59,650
503,374
145,060
679,872
762,824
1,996,366
214,942
78,910
96,523
64,584
224,973
88,337
26,711
258,651
379,029
57,832
101,088
467,645
126,840
59,643
76,974
133,117
16,852
784,802
284,710
189,892

65,000

JUMLAH
489,429
870,401
1,238,235
2,345,367
376,631
394,018
284,959
2,664,066
975,410
738,360
1,027,834
549,000
321,146
346,332
460,803
368,081
2,825,541
815,758
2,051,147
697,373
2,906,698
299,399
511,894
487,689
259,758
759,799
221,897
325,650
174,000
841,374
563,060
2,468,372
2,545,824
5,795,866
819,942
499,410
321,023
200,584
1,145,973
436,837
278,711
651,651
1,393,529
296,832
463,088
749,645
292,840
121,643
362,974
476,117
314,852
2,930,802
1,403,710
962,892

1,145,854
1,289,765
2,567,956
462,631
673,636
466,435
2,819,153
1,701,239
1,017,336
3,672,130
597,603
542,238

3,050,167
1,415,613
2,184,147
963,109
3,118,330
427,399
731,032
441,448
932,711
414,886
446,650
324,000
1,034,192
2,778,403
2,648,824
6,053,746
1,069,419
701,384
454,023
346,949
4
676,476
476,978
826,708
1,931,094
831,256
1,020,734
525,231
388,511
1,581,842
2,814,110
1,611,939
2,962,802
2,606,555

0
0

65,000

14,918,726
103,702
196,534
70,549
109,285
110,648
59,875
90,170
2,014,982
1,061,437
233,568
9,677
3,235
125,166
47,161
434,617
1,574,749
1,367,354
214,652
104,819
132,154
262,152
373,140
325,415
687,509
138,201
2,019,948
131,631
110,166
31,476
801,493
217,072
406,318
985,285
80,485
119,516
247,257
50,712
55,814
183,126
268,219
1,920,577
126,627
219,859
223,824

325,000

304,891
223,824

325,000

390,000

PS MONITOR

65,000

ABDOMIN TAMPON
AL TAP
HIDUNG

52,124,226
737,702
603,534
632,549
369,285
488,648
396,875
1,124,170
2,924,982
1,777,437
3,082,268
175,677
201,235
784,166
183,161
914,117
2,535,249
2,837,354
2,942,152
524,819
717,654
790,652
1,056,140
1,513,415
1,640,509
334,201
3,169,948
745,631
274,166
239,476
2,229,493
599,072
2,511,818
1,637,285
474,485
796,516
876,257
99,712
541,314
567,626
1,360,219
2,072,577
732,627
699,859
1,334,824
313,500
1,013,891
108,000
1,191,824
0
0
0
0

18,578,871

52,878,071

33,497,597

105,002,297

USG DR
ROSMA
YULITA

OBAT

JUMLAH

14,918,726

52,124,226

764,280
611,196
766,061
583,117
1,336,627
3,129,558
2,992,437
6,972,660
390,839
430,095
1,031,771
372,587
1,122,812
4,998,877
2,983,341
708,043
934,878
916,652
1,355,010
2,038,400
5,659,692
479,201
3,580,606
868,601
525,254
440,051
2,354,289
875,450
2,781,378
2,093,268
2,316,744
2,928,904
1,009,257
310,469
3,343,256
676,626
5,584,577
2,251,204
2,394,221
432,000
1,363,253
2,051,660

52,878,071

105,002,297

52,124,226

325,000

18,578,871

52,878,071

390,000

33,497,597

105,002,297

105,002,297

RAWATAN BEDAH/ TDK PENDNG


NO JALUR MASUK TGL MASUK

4
7
9
13
16
17
18
19
20
24
25
10
15

POLIKLINIK
POLIKLINIK
IGD
POLIKLINIK
POLIKLINIK
POLIKLINIK
POLIKLINIK
IGD
IGD
POLIKLINIK
POLIKLINIK

30/06/15
30/06/15
29/06/15
10/07/15
07/07/15
07/07/15
06/07/15
15/07/15
19/07/15
28/07/15
28/07/15
03/07/15
07/07/15

TGL
KELUAR

01/07/15
03/07/15
05/07/15
13/07/15
10/07/15
10/07/15
13/07/15
19/07/15
22/07/15
31/07/15
30/07/15
06/07/15
10/07/15

NAMA PASIEN

JAFRIZAL
ERA OKTARIANA
BARINIH
RANTIKA FEBRIANTY
FIFI MAIYUSRIANTI
RESTI
MUTIA HARMADELI
FHMI ABDILAH
NAZARUDDIN
NADIA
NADIA URBA
RISSE PUTRIA AFRIENI
NANDIPINTO HARIS PUT

NO KARTU

0000149042621
0001271705319
0001838772112
0001331250783
0001440404234
0000284310224
0001245455368
0000272821612
0000017289011
0000284127546
0000283437189
00017957081680
000016029551

NO. MR

371810
822401
215911
775811
057704
796011
336311
416511
307011
376711
96711
116311
696009

DX

ABSES
ABSES MAMAE
APENDIC AKUT
MAMAE DEXTRA
TUMOR MAMAE
APENDIK AKUT
POLY RECTI
KOLIK ABDOMEN
HEMATUSIA
APENDIK AKUT
SOFT TISSUE TUMOR
TUMOR
HERNIA

DOKTER

ANESTESI

DR. LILLAH SPN


DR. LILLAH SPN
DR. LILLAH SPN
DR. LILLAH SPN
DR. LILLAH SPN
DR. LILLAH SPN
DR. LILLAH SPN

DR. ZAITUL
DR. LILLAH SPN
DR. LILLAH SPN
DR. LILLAH SPN
DR. LILLAH SPN

VISITE
PERAWATAN
DR.
VISITE DR.
PRE/POST
SPESIA
UMUM
OP
LIS

RAWATAN

OPERASI

240,000
160,000
280,000
160,000
160,000
160,000
320,000
200,000
480,000
160,000
120,000
160,000
480,000

2,100,000
1,200,000
1,200,000
1,200,000
1,200,000
1,200,000
1,200,000

30,000
20,000
20,000
20,000
20,000
20,000

1,200,000
1,200,000
1,200,000
2,100,000

20,000
10,000
20,000
30,000

3,080,000

15,000,000

210,000

240,000
200,000
240,000
60,000
120,000
80,000
80,000
240,000
120,000
80,000
160,000
960,000
40,000
600,000

1,200,000
1,200,000
1,650,000

20,000
20,000
25,000
12,500

1,200,000
1,200,000
2,100,000
1,650,000
1,200,000
1,200,000
2,100,000
2,100,000

20,000
20,000
30,000
25,000
20,000
20,000
30,000
30,000
30,000

3,220,000

16,800,000

302,500

6,300,000

31,800,000

512,500

KONSUL
SPS

KO
NS
UL
GIZI
/
VISI
TE
0

PLY
N
DIE
T
KH
US
US
GIZ
0I

TE
ST
MI
NU
M

SKINTEST

INJEKSI

GV

PASANG
INFUS

PERAWATAN
LUKA

FIBRIDING

AFF/HEACTIN
G

TAMPON

RONTGEN

TRANFUSI

LABOR

26,000
26,000
26,000
26,000
26,000
26,000

26,000
26,000
26,000
33,000

120,000
280,000
120,000
120,000
120,000
480,000
100,000
240,000
120,000
90,000
150,000
180,000

267,000

2,120,000

26,000

150,000
108,000
24,000
12,000

36,000

48,000

24,000

84,000

24,000

15,000
15,000
30,000
15,000
15,000
15,000

10,000

36,000
36,000
72,000
36,000
35,000
36,000
128,000

15,000
15,000

10,000
10,000
10,000
10,000
22,000
15,000
10,000
10,000
10,000
15,000

150,000

132,000

502,000

15,000
15,000
15,000

10,000

36,000
36,000
36,000

15,000

40,000
5,500

10,000

55,000

210,000
150,000

36,000
15,000
36,000
36,000

26

40
43
44
50
51
52
53
55
57
58

59

PDHN INT
IGD
IGD
-

02/7/2015
02/07/15
06/07/15
22/07/15
21/07/15
23/07/15
23/07/15
23/07/15
27/07/15
27/07/15
27/07/15
23/07/15
02/07/15
23/07/15

03/07/15
06/07/15
09/07/15
22/07/15
23/07/15
24/07/15
24/07/15
24/07/15
28/07/15
28/07/15
30/07/15
30/07/15
02/07/15
27/07/15

BASTARI
FAJRI PRATAMA
AMRAN
ROBBI S FIDELITY
M RIDWAN
SITI MAISARAH
DASMI
DJAHAR S
DARMAYET AGUS
ASDIR
INDRA YENTI
AMRINA
AFNI WULANDARI
IHSAN AULIA FAUZI

0000017191517
0000274963781
0001435508234
0001134378569
0000273764204
0000275384564
0000274296429
0000018387101
0001265021324
0000283330034
0001868511969
0000017228643
0001318194808
0000201721623

903904
7756011
997011
744908
356511
767009
561705
965709
036711
346511
785600
293007
050705

SOFT TISSUE TUMOR


HERNIA SCROTALIS

ADI

HT URGENCY
APENDIC AKUT
VARICOCELE
SOFT TISSUE TUMOR
SOFT TISSUE TUMOR
BENIGN NEOPLASMA
SOFT TISSUE TUMOR
SOFT TISSUE TUMOR
TUMOR
ET REGIO
TUMOR ET BIBIR
SOFT TISSUE TUMOR

ADI

ADI

ADI
ADI
ADI

dr.Syahrial, Sp.B

ADI
ADI
ADI
ADI

DOKTER

ANESTESI

RAWATAN

12,000
48,000

12,000
26,000

OPERASI

96,000

10,000

5,500

95,000

360,000

38,000

26,000
33,000
33,000
33,000

120,000
360,000

15,000
15,000

10,000
15,000

26,000
36,000

135,000

15,000

15,000

36,000

58,000

48,000

24,000

204,000

36,000

177,000

909,000

90,000

50,000

206,000

58,000

38,000

288,000

60,000

444,000

3,029,000

240,000

182,000

708,000

10,000

5,500

95,000

58,000

360,000

38,000

KONSUL
SPS

KO
NS
UL
GIZI
/
VISI
TE

PLY
N
DIE
T
KH
US
US
GIZ
I

TE
ST
MI
NU
M

SKINTEST

INJEKSI

GV

PASANG
INFUS

PERAWATAN
LUKA

FIBRIDING

AFF/HEACTIN
G

TAMPON

RONTGEN

TRANFUSI

LABOR

VISITE
PERAWATAN
DR.
VISITE DR.
PRE/POST
SPESIA
UMUM
OP
LIS

dr. Noverial, Sp.OT

dr. zaitul iklas spb

3,080,000

15,000,000

210,000

84,000

24,000

267,000

2,120,000

150,000

132,000

502,000

10,000

5,500

95,000

360,000

dr. syahrial spb

3,220,000

16,800,000

302,500

204,000

36,000

177,000

909,000

90,000

50,000

206,000

58,000

38,000

6,300,000

31,800,000

512,500

288,000

60,000

444,000

3,029,000

240,000

182,000

708,000

10,000

5,500

95,000

58,000

360,000

38,000

Total

DARAH

ROM

PENDISTRIBU
SIAN
MAKANAN

OBAT

JUMLAH

2,000,000

20,000
20,000
20,000
20,000
20,000

20,000
25,000

4,000
8,000
14,000
8,000
8,000
8,000
16,000
10,000
8,000
8,000
6,000
8,000
8,000

13,245
157,396
663,525
305,620
246,035
175,983
922,588
222,246
139,277
152,512
116,022
160,484
243,241

165,000

114,000

3,518,174

500,000
20,000

2,500,000

2,478,245
1,752,396
2,611,025
1,920,620
1,860,035
1,790,983
5,397,588
554,246
1,568,277
1,767,512
1,593,022
1,805,484
3,237,241
0
0
0

20,000
24,000
24,000

10,000

292,401

130,500

84,000

3,958,139

26,263,139

2,500,000

295,500

198,000

7,476,313

54,599,813

DARAH

ROM

PENDISTRIBU
SIAN
MAKANAN

OBAT

JUMLAH

20,000

310,668
211,937
65,063
184,192
1,838
1,747,521

263,211
881,308

1,920,098
3,237,241

28,336,674

4,000
10,000
8,000
2,000
6,000
4,000
4,000
4,000
4,000
4,000
8,000
16,000

20,000
22,500

2,560,949
1,866,410
2,842,444
2,069,629
1,928,035
1,905,842
5,510,890
983,407
1,973,218

1,527,000
1,997,668
2,376,437
201,563
348,192
1,325,838
1,304,000
4,121,521
1,799,000
1,304,000
1,868,211
4,624,308
103,000
3,362,401
0
0
0
0
0

1,636,409
2,160,970
4,776,724
619,754
1,429,594
1,413,732
4,343,277

3,399,646

54,599,813

2,500,000

165,000

114,000

3,518,174

28,336,674

130,500

84,000

3,958,139

26,263,139

2,500,000

295,500

198,000

7,476,313

54,599,813

54,599,813

6,503.00
6,503.00

RAWATAN ICU / TDK PENDING


NO

JALUR
MASUK

1
2
3
4
5
6
7

PDHN
MATA/THT
IGD
IGD
PDHN JTG
IGD
IGD
IGD

TGL
MASUK
01/07/15

TGL
KELUAR
03/07/15

08/07/15 14/07/15
23/07/15
24/07/15
22/07/15

26/07/15

22/07/15
24/07/15
28/07/15
29/07/15
27/07/15 29/07/15

NO KARTU

NO. MR

HANIFAH

NAMA PASIEN

0001381620609

595911

HT URGENCY

DX

GADIH
NASRIL
FAIZUL
NURLELI
DASRUL
NUSYIRWAN

0001430184677
0000018357783
0000017426474
0001437284496
0001261576067
0000018373419

576211
664305
777011
107111
449202
415700

HYPOGLIKEMIA
BRADHIKARDI DG HT GR II
CHF EC CAD
HT EMERGENCY
UAP / NSTEMI
ANGINA PS HT

DOKTER

DR.YENDI, SP.AN

RAWATAN /
HCU

450,000
1,050,000
300,000
750,000
450,000
300,000
450,000

RAWATAN
DECABITUS
DG KSR

150,000
375,000
225,000
150,000

RESUSITASI
CAIRAN

BRONKIAL
TOILET

INJEKSI

MASSAGE

25,000
75,000
12,500
50,000
37,500
25,000
25,000

20,000
60,000

500,000
500,000
500,000
500,000
500,000

60,000
345,000
30,000
240,000
90,000
60,000
45,000

PASANG
INFUS

TOTAL CARE

ROM

36,000
63,000
273,000
682,500
409,500
273,200
409,800

50,000
175,000
25,000
100,000
75,000
12,500
12,500

70,000
795,000

CEDOR SRYN
PUMP

SYRNE PUMP

INFUS PUMP

PASANG
KATETER

PERAWATAN
LUKA

VISITE
SPESIALIS

70,000
324,000

35,000

70,000
385,000
35,000
70,000
105,000

70,000
175,000
105,000
70,000
105,000

15,000
15,000

40,000

737,000
135,000
134,000
134,000

VISITE DR.
UMUM

36,000
72,000
33,500
67,000
33,500

EKG

VH

PENDISTRIBUSIAN
MAKANAN

31,000
93,000

6,000
14,000

50,000

570,000

42,000
96,000
84,000
126,000
126,000
126,000
84,000

LABOR

1,267,000

SUCTION

DARAH

TRANFUSI

500,000

75,000

3,750,000

900,000

2,500,000

870,000

250,000

80,000

2,147,000

450,000

865,000

35,000

665,000

595,000

30,000

40,000

1,464,000

242,000

1,837,000

684,000

124,000

20,000

50,000

500,000

75,000

3,750,000

900,000

2,500,000

870,000

250,000

80,000

2,147,000

450,000

865,000

35,000

665,000

595,000

30,000

40,000

1,464,000

242,000

1,837,000

684,000

124,000

20,000

50,000

500,000

75,000

RAWATAN /
HCU

RAWATAN
DECABITUS
DG KSR

RESUSITASI
CAIRAN

INJEKSI

MASSAGE

BRONKIAL
TOILET

TOTAL CARE

ROM

PASANG
INFUS

CEDOR SRYN
PUMP

SYRNE PUMP

INFUS PUMP

PASANG
KATETER

PERAWATAN
LUKA

VISITE
SPESIALIS

VISITE DR.
UMUM

LABOR

EKG

VH

PENDISTRIBUSIAN
MAKANAN

SUCTION

DARAH

TRANFUSI

DR.YENDI, SP.AN

3,750,000

900,000

2,500,000

870,000

250,000

80,000

2,147,000

450,000

865,000

35,000

665,000

595,000

30,000

40,000

1,464,000

242,000

1,837,000

684,000

124,000

20,000

50,000

500,000

75,000

TOTAL

3,750,000

900,000

2,500,000

870,000

250,000

80,000

2,147,000

450,000

865,000

35,000

665,000

595,000

30,000

40,000

1,464,000

242,000

1,837,000

684,000

124,000

20,000

50,000

500,000

75,000

DOKTER

OKSIGEN

174,000
720,000
120,000
350,000
175,000
165,000
175,000

PHLEBOTOMI

KONSUL
DOKTER

PASANG
MONITOR

OBAT

324,000

195,000
455,000
130,000
325,000
195,000
130,000
195,000

470,034
835,624
101,748
729,231
668,644
1,204,527
490,931

201,000

JUMLAH

2,634,034
6,489,624
2,100,748
5,631,731
3,260,144
3,479,227
3,316,231
0
0

75,000

134,000

1,879,000

75,000

659,000

1,625,000

4,500,739

26,911,739

1,879,000

75,000

659,000

1,625,000

4,500,739

26,911,739

OKSIGEN

PHLEBOTOMI

KONSUL
DOKTER

PASANG
MONITOR

OBAT

JUMLAH

1,879,000

75,000

659,000

1,625,000

4,500,739

26,911,739

1,879,000

75,000

659,000

1,625,000

4,500,739

26,911,739

7,524,958
2,642,129
4,408,103
4,199,408
3,605,385

26,911,739

26,911,739

RAWATAN VIP/ TDK PENDING


NO. MR

RAWATAN / HCU

VISITE DR.
SPESIALIS

VISITE DR.
UMUM

855611

ADOMINAL

500,000

36,000

18,000

VERAWATY SARI SIMAMORA

0001270265152

158203

DEMAM DENGUE

750,000

36,000

36,000

45,000

27,000

97,500

04/07/15

KASTERWIDA

0000016732901

033003

HT URGENCY

1,250,000

108,000

72,000

150,000

45,000

253,000

02/07/15

ERMITA

0000018329083

495911

OBS FEBRIS

750,000

72,000

36,000

45,000

27,000

152,000

07/07/15

NURUL AULIA RAHMI

0000018328116

238106

DEMAM TYPOID

1,250,000

36,000

54,000

120,000

45,000

173,500

13/07/15

15/07/15

ROMI WENDRAYATI B.GUMAM,SPD

0000018350728

196511

GASTRITIS AKUT

750,000

36,000

36,000

90,000

27,000

IGD

13/07/15

15/07/15

GUSMAIZAL SYANDRI

0000016072187

226511

SYNDROM DYSPEPSIA

750,000

36,000

36,000

90,000

27,000

JALUR MASUK

09/07/15

10/07/15

MASRUL

PDHN INT

23/07/15

25/07/15

PDHN INT

01/07/15

PDHN INT

30/06/15

IGD

03/07/15

IGD

KONSUL
RO PERAWATAN
KONSUL GIZI
DR.
HIS
LUKA
SPESIALIS

NO KARTU
0001859525548

TGL MASUK

TGL
KELUAR

NO

NAMA PASIEN

DX

DOKTER

ANESTESI

IGD

10/07/15

16/07/15

SYAFIAH

0001424449383

099806

DM TYPE II + HT

1,750,000

144,000

108,000

PDHN INT

03/07/15

06/07/15

ALDORINO

0000018367143

208903

FEBRIS H2 DEMAM DENGUE

1,000,000

36,000

54,000

IGD

19/07/15

21/07/15

ROBI ABIDIN

0000018708636

267011

GASTRITIS AKUT

IGD

19/07/15

25/07/15

YULITA NOVIARTI

0000017411141

227011

DEMAM DENGUE

1,750,000

144,000

108,000

IGD

20/07/15

26/07/15

WASTIAH

0000018402592

928409

ANEMIA BERAT

1,750,000

144,000

108,000

IGD

25/07/15

27/07/15

SURYANI AFDANELLA

0000205696855

497111

DEMAM DENGUE

750,000

36,000

18,000

IGD

22/07/15

23/07/15

CANTIKA TAMARA LISTIN

0000194762248

47111

DHF GR II

500,000

72,000

IGD

28/07/15

31/07/15

SYAFARUDIN

0000018356736

533205

GASTRITIS AKUT

1,000,000

72,000

IGD

750,000
dr. letmi

28/07/15

30/07/15

BOBY SASTRA SP

0000018406945

36910

GASTRITIS AKUT

IGD

26/07/15

29/07/15

ERMAN

0000018358525

561604

COLIC RENAL

PDHN INT

26/07/15

28/07/15

AGUSNOLI

0000977274415

427111

STROKE ISKEMIK

PDHN INT

26/07/15

29/07/15

AHMAD RUSDI

0000018346476

966411

VULNUS PAPTIKUM

1
2
3
4

IGD
IGD
IGD
IGD

04/07/15
08/07/15
05/07/15
06/07/15

09/07/15
11/07/15
08/07/15
08/07/15

SUYARMA
ASNIMAR S.KAR
NURMAN AMRI , SE
RIKA JUITA, A.MD.KEP

0001451608975
0000018413638
0000017212961
0000149093032

245409
864405

FEBRIS + LOW INTAKE


DEMAM TYPOID
COLIC RENAL
G3P2AOH2

PDHN INT

27/06/15

01/07/15

YENNI HARTATI

0001819391128

150311

IGD

29/06/15

03/07/15

FATIMAH HASBULLAH BA

0000018388809

375911

IGD

13/07/15

15/07/15

NADIYA WULANDA

0001279975792

186511

VERTIGO FEVER

IGD

19/07/15

23/07/15

SYAMSIAR

0000018334732

237011

PDHN INT

30/06/15

03/07/15

AYU MARISKA

0001277419408

355911

10

IGD

21/07/15

23/07/15

NURMAN AMRI , SE

0000017212961

11

23/07/15

25/07/15

DRS ANAS HAMIR

0000018387753

777703

CHF + BRONCHITIS AKUT

12

07/07/15

10/07/15

HENKI HELLEN

0000018369922

486211

13

IGD

22/06/15

04/07/15

MUHAMMAD JAMIL

0000018392578

642910

14

IGD

27/07/15

29/07/15

HENDRA DIANOF

0001321330105

776411

CKD ST V

15

PDHN INT

25/07/15

29/07/15

SUMARNI

0001424534859

958105

HHD

16

PDHN INT

25/07/15

31/07/15

MARDJANI

0000018386021

078909

FEBRIS H3

1,750,000

17

IGD

28/07/15

31/07/15

MARDIANA A

0000018412029

518304

HYPERPEREXIA

SKINTEST

PASANG
INFUS

PSG NGT

PASANG
KATETER

INJEKSI

15,000

TOTAL CARE

35,000

270,000

TRANSFUSI

DARAH

OPERASI

PRE/POST
OP

RONTGEN

USG

OKSIGEN

LABOR

36,000
15,000

115,000

90,000

27,000

90,000

63,000

225,000

63,000

66,000

38,000
249,500
300,000

1,107,000

184,000
38,000

30,000

18,000

119,000

54,000

45,000

36,000

157,000

750,000

72,000

36,000

90,000

27,000

1,000,000

108,000

54,000

180,000

36,000

750,000

72,000

72,000

165,000

27,000

146,000

1,000,000

108,000

54,000

120,000

36,000

60,000

18,750,000

1,368,000

1,008,000

1,935,000

774,000

1,500,000
1,000,000
1,000,000
750,000

144,000
108,000
72,000
144,000

72,000
72,000
54,000
18,000

180,000
165,000
60,000

54,000
36,000
36,000
27,000

DYSPEPSIA

1,250,000

72,000

108,000

60,000

45,000

GASTRITIS AKUT

1,250,000

36,000

72,000

105,000

45,000

750,000

72,000

36,000

60,000

27,000

54,000

OBS FEBRIS

1,250,000

36,000

54,000

450,000

45,000

320,500

GASTRITIS AKUT

1,000,000

36,000

72,000

165,000

36,000

750,000

72,000

54,000

750,000

72,000

36,000

ANEMIA BERAT

1,000,000

144,000

72,000

FEBRIS DEMAM DENGUE

3,250,000

396,000

180,000

750,000

36,000

1,250,000

36,000

72,000

72,000

126,000

1,000,000

72,000

36,000

20,250,000

1,620,000

1,188,000

KONSTIPASI + LOW INTAKE

DR. DRAJAD PRIYONO, SP.PD

25,000

35,000

30,000

30,000

36,000

NEBU

114,000

18,000

FISI
MINI OTE
USD RAP
Y

167,000

27,000

115,000

PLU
RAL ABDMINAL
FUN
TAP
GSI

38,000
58,000
36,000

90,000

GV

60,000

63,000
135,000

25,000

EKG

18,000

38,000
58,000

36,000

300,000

1,107,000

116,000

72,000

2,162,500

60,000

240,000

75,000
220,500
72,000
179,000

58,000

435,600
42,000

157,000

38,100

27,000
45,000
35,000
30,000

54,000
30,000
15,000

27,000

58,000
375,000

59,500

300,000

36,000

270,000

117,000

1,500,000

105,000

27,000

167,000

225,000

45,000

127,500

150,000

63,000

281,500

60,000

36,000

2,400,000

729,000

210,000

90,000

18,000

75,000

97,500

168,000

473,500

269,500

18

PDHN BDH

02/07/15

03/07/15

AFNI WULANDARI

0001318194808

293007

TUMOR ET BIBIR

PDHN BEDAH

22/07/15

25/07/15

ROBBI S FIDELITY

0001134378569

997011

APENDIC AKUT

13/07/15

14/07/15

RADIG ARDITYATAMA

0000167655453

428800

SOFT TISSUE TUMOR

500,000

DR. SYAHRIAL, SP.B

ADI

1,000,000

ADI

500,000

2,000,000

1
2

1
2
3
4
5

IGD

IGD
PDHN ANAK
IGD

12/07/15

02/07/15
03/07/15
10/07/15
26/07/15

14/07/15

09/07/15
06/07/15
11/07/15
30/07/15

NURAINI

FATIH NAIL ABROR


ATHALLAH SHAKIL HAZIQ SILITONGA

M. BERLIAN CONSTANTA M
FAUZAN IHSAN EKA PUTRA

0001274861441

PPV MYUOMS UTERI

0000201622904

OBS FEBRIS

0001855987481

815911

BRONKOLITIS

0001261217081
0000018373601

860607
954301

ANEMIA THALASEMIA
ASMA DLM SERANGAN

DR. YUNIRA YUNIRMAN, SP.A

35,000

75,000

30,000

18,000
72,000

54,000

12,500

35,000

18,000

72,000

750,000

DR. SYAHRIAL
SPOG( OBG )

36,000

90,000

255,000
15,000

12,500

35,000

15,000

36,000

750,000

36,000

2,000,000
1,000,000
500,000
1,250,000

216,000
72,000
144,000

108,000
54,000
18,000
36,000

4,750,000

432,000

216,000

1,250,000

108,000

72,000

1,250,000

108,000

72,000

750,000

108,000

72,000

750,000

15,000
15,000

2,400,000

15,000

59,500

8,000

2,400,000

15,000

38,000

18,000

2,400,000

30,000

65,500

255,000

116,000

180,000

27,000

180,000

27,000

1,500,000

116,000

240,000

18,000

7,200,000

60,000

2,952,700

163,000

150,000

20,000

20,000

38,000

60,000

72,000
36,000
18,000
45,000

240,000

171,000

105,000

45,000

105,000

45,000

180,000

27,000

42,000

180,000

27,000

42,000

90,000
135,000

18,000
27,000

180,000

375,000

58,000

38,000

50,500
120,000

150,000

500,000

150,000

500,000

59,500

225,000

1
2

IGD

23/07/15

27/07/15

KAMAL ZANID

0001807904024

167111

CAP + PPOK

1
2
3

IGD

14/07/15

16/07/15

H. JUNAEDI

0000018373577

623405

CA BRONKOGENIK

PDHN INT

DR. DESSY ( SP PARU)

276,000

276,000

30,000

15,000

15,000

15,000

15,000

15,000

58,000

120,000

58,000

58,000

110,000

59,500

59,500

120,000

146,000

120,000

146,000

225,000

150,000

150,000

70,000

DR. YENNY P ( PARU )

24/07/15
30/06/15
07/07/15

25/07/15
02/07/15
13/07/15

ZASKIA PUTRI CELSI


MUHAMMAD AQIL
MUHAMMAD RASID ASRI

0001611128823
0000018403391

356611
757710

GANGLION CYSTA
MULTIPLE SOFT TISSUE

0000017287907

146011

HERNIA SCROTALIS

108,000

72,000

500,000
750,000

36,000

18,000
36,000

1,750,000

339,000

90,000

3,000,000

375,000

144,000

51,500,000

4,083,000

2,826,000

36,000

391,000

RAWATAN / HCU

VISITE DR.
SPESIALIS

VISITE DR.
UMUM

1 DR. LETMI YESTRIJAL,SP.PD

18,750,000

1,368,000

1,008,000

115,000

2 DR. DRAJAD PRIYONO, SP.PD

20,250,000

1,620,000

1,188,000

36,000

3 DR. SYAHRIAL, SP.B

2,000,000

72,000

90,000

DR. ZAITUL I

DR. LILLAH SPN

DOKTER

4 DR. SYAHRIAL SPOG

ANESTESI

15,000

35,000

15,000

12,500

35,000

15,000

315,000

63,000

12,500

70,000

30,000

540,000

108,000

7,200,000

60,000

88,000

50,000

175,000

210,000

15,000

30,000

5,835,000

1,997,000

306,000

825,000

3,107,000

14,400,000

120,000

348,000

480,000

SKINTEST

PASANG
INFUS

PSG NGT

PASANG
KATETER

INJEKSI

TOTAL CARE

EKG

TRANSFUSI

DARAH

OPERASI

PRE/POST
OP

RONTGEN

USG

25,000

35,000

30,000

1,935,000

774,000

36,000

300,000

1,107,000

116,000

35,000

75,000

30,000

2,400,000

729,000

210,000

375,000

1,500,000

116,000

12,500

35,000

15,000

255,000

116,000

18,000

7,200,000

60,000

KONSUL
RO PERAWATAN
DR.
KONSUL GIZI
HIS
LUKA
SPESIALIS

2,400,000
2,400,000

30,000
30,000

70,000

20,000

5,719,700

40,000

60,000

595,000

OKSIGEN

LABOR

GV

2,162,500

60,000

240,000

2,952,700

150,000

163,000

20,000

2,400,000

44,000
44,000
20,000

PLU
RAL ABDMINAL
FUN
TAP
GSI

FISI
MINI OTE
USD RAP
Y

NEBU

750,000

36,000

180,000

27,000

38,000

5 DR. YUNIRA YUNIRMAN, SP.A

4,750,000

432,000

216,000

30,000

240,000

171,000

150,000

500,000

58,000

120,000

110,000

225,000

6 DR. DESI SUSYANTI , SP.P

1,250,000

108,000

72,000

276,000

15,000

105,000

45,000

58,000

59,500

150,000

750,000

108,000

72,000

15,000

15,000

180,000

27,000

42,000

120,000

146,000

70,000

3,000,000

375,000

144,000

12,500

70,000

30,000

540,000

108,000

7,200,000

60,000

88,000

20,000

7 DR. YENI M ( PARU )


8 DR. ZAITUL I

TOTAL

51,500,000

4,083,000

2,826,000

36,000

391,000

50,000

175,000

210,000

15,000

30,000

5,835,000

1,997,000

306,000

825,000

3,107,000

14,400,000

120,000

348,000

480,000

5,719,700

40,000

60,000

595,000

PENDISTRIBUSI
AN MAKANAN

MONTOUX
TEX

USG
ABD/ROSMA
YULITA

PERWTN
JENAZAH

PEN
GOL
AH
DAR
AH
PMI

OBAT

JUMLAH

33,429

684,429

6,000

21,914

1,019,414

10,000

228,247

2,116,247

4,000

5,186

1,093,186

10,000

6,000

51,357

1,739,857

1,952,085

6,000

114,702

1,097,702

1,283,059

6,000

35,943

1,046,943

1,281,133

14,000

784,591

3,393,591

3,656,057

8,000

135,577

1,518,577

6,000

67,000

1,014,000

1,197,000

14,000

78,066

2,496,566

2,770,292

14,000

661,249

4,596,249

5,137,578

6,000

6,947

1,086,947

1,322,681

4,000

9,510

770,510

988,934

8,000

529,182

1,901,182

2,022,182

130,715

1,149,715

1,291,988

397,290

2,013,290

2,378,961

179,349

1,417,349

52,582

1,538,582

6,000
8,000

100,000

6,000
8,000

100,000

0
0
150,000

12,000
8,000
8,000
6,000

200,000

3,522,836

31,694,336

2,762,179
1,995,255
1,691,173
1,342,973

93,441
106,872
71,989
54,973

2,370,441
1,746,372
1,471,989
1,238,973

10,000

42,682

2,059,282

10,000

49,945

1,766,945

1,989,774

6,000

13,201

1,018,201

1,155,942

10,000

298,963

2,464,463

2,689,463

8,000

127,455

1,482,555

6,000

26,545

935,545

6,000

132,612

1,261,112

8,000

306,692

3,874,192

26,000

471,023

5,381,523

5,661,530

6,000

869,070

2,014,070

3,269,594

10,000

33,647

1,799,147

14,000

75,585

2,562,085

8,000

67,509

100,000

1,564,009

1,136,787
#VALUE!

1,876,407

0
162,000

100,000

2,842,204

35,010,904

4,000

9,844

3,114,344

36,000

358,011

4,303,511

4,000

5,350

3,055,850
-

44,000

373,205

6,000

118,899

16,000
8,000
4,000
10,000

36,000

38,000

36,000

6,000

118,899

47,583
80,868
32,959
97,649

10,473,705
0

1,155,899
0

1,300,899

1,155,899

2,604,083
1,565,868
1,237,959
1,927,149
0

2,783,516

2,064,149

0
0

10,000

10,000

1,204,726

6,000

6,000

259,059

90,000

90,000

1,204,726

171,544

171,544

4,000
6,000

17,098
36,127

14,000

253,481

7,335,059

3,353,226
0
0

3,574,226

3,353,226

1,812,544
0
0
0

2,542,921

1,812,544

3,171,098
3,500,127
5,306,981
0

24,000

306,706

440,000

36,000

300,000

90,000

8,799,179

PENDISTRIBUSI
AN MAKANAN

MONTOUX
TEX

USG
ABD/ROSMA
YULITA

PERWTN
JENAZAH

PEN
GOL
AH
DAR
AH
PMI

OBAT

150,000

200,000

3,522,836

31,694,336

162,000

100,000

2,842,204

35,010,904

44,000

373,205

10,473,705

6,000

118,899

1,155,899

38,000

36,000

259,059

7,335,059

10,000

1,204,726

6,000

90,000

171,544

1,812,544

24,000

306,706

11,978,206

5,306,981

11,978,206

102,813,879

JUMLAH

3,353,226

102,813,879

440,000

36,000

300,000

90,000

8,799,179

102,813,879

102,813,879

RAWATAN ANAK/ TIDAK PEDNG


TGL
MASUK

TGL
KELUAR

NO

JALUR MASUK

1
2
3
4
5
6
7
8
9

IGD
IGD
IGD
IGD
IGD
RWT GBG IBU
RWT GBG IBU

03/07/15
29/06/15
02/07/15
03/07/15
29/06/15
29/06/15
02/07/15

06/07/15
05/07/15
05/07/15
05/07/15
04/07/15
03/07/15
03/07/15

30/06/15
01/07/15

10
14
15
16
17
18
19
20
21
22
23
24
25
59

RWT
RWT
RWT
RWT
RWT

58
28

NAMA PASIEN
BY.NY.YULI SUSANTI

NO KARTU

NO. MR

DX

0001868010219

262611

HYPERPEREXIA

FAIZI AL BARI

00000172025493

545911

HYPERPEREXIA

BY. NY. ERI WIDYA CANDRA

0001868185146

855911

ASPPHYXIATION

0001085897182
0001845301781
0000273979697
0001855987481
0000017178759
0001841575781

036211
455911

02/07/15
03/07/15

ZAKWAN ZAFER ATHARI


BY.NY.YASISKAN SARI/ASYILA
RABIATUL ADAWIYAH
ATHALLAH SHAKIL HAZIQ SILITONGA
BY. RINNI
BY. DENI ELITA

DIARE AKUT
IKTERIK NEONATUM
BRONKOPNEUMONI
BRONKOLITIS
NBBLC
NBBLC

01/07/15

03/07/15

BY. LIDIYA MARTIN

0001179109269

04/07/15
04/07/15
02/07/15
01/07/15

05/07/15
05/07/15
04/07/15
07/07/15

BY. EPA LIASMAWATI


BY. VIEN SILVIA NINGSIH
BY. LIDIIYA

0001425353354
0000196923802
0000273705963

136211

BY. MELLY A REMITASARI

0000987489189

626011

29/06/15
04/07/15

09/07/15
06/07/1

02/07/15
09/07/15

03/07/15
11/07/15

06/07/15
08/07/15
23/07/15
23/07/15
23/07/15

14/0715
13/07/15
25/07/15
25/07/15
25/07/15

ANIF MUHAMMAD RIDWAN


BY. NUR INDAH ERNA SARI
BY. ERI WIDYA CANDRA
BY. MIRA WAHYUNINGSIH
KEVIN ILHAM
NABILA PUTRI
RISKI MAULANA
NAUFAL ATHARIS CANDRA

0001334632465
0001808992822
0000284691903
0001851908714
0001331811404
0000274004976
0000274758783
0001302576647

RWT GBG IBU

20/07/15

21/07/15

RWT GBG IBU

15/07/15

19/07/15

29
30
31
32

RWT GBG IBU


IGD
-

25/07/15

28/07/15

33
34
35

50
51
52
53
54
55
56
57
58
59
60
61
62
63
65

GBG
GBG
GBG
GBG
GBG
IGD
RWT GBG
RWT GBG
RWT GBG
IGD
IGD
IGD
IGD
-

IBU
IBU
IBU
IBU
IBU
IBU
IBU
IBU

FACHRI AZZAM

BY. MULYETI
BY. IKRA RIZA A.MD.KEP
BY. KARTIKA SARI

815911
806302
725911

795911

207,500
375,500

24,000
12,000

440,000

OBS FEBRIS
NBBLC

INJEKSI

PERTOLONG
AN BBL

162,000
81,000

78,000

22,000

121,500

120,000
80,000
30,000
20,000
10,000

27,500

35,000
25,000

10,000
10,000
20,000
10,000
10,000

32,000
25,000
45,000
25,000
25,000

10,000
10,000
10,000
90,000

25,000
25,000
25,000

30,000

30,000

36,000

0001787855141

187111

OBS FEBRIS+ TANPA DEHIDRASI

0000274964725

264709

NBBLC

10,000

25,000

0000165052517

247303

NBBLC

20,000

27,500

0000284269263

NBBLC
GEA
SYNDROME NETRONIK
INJEKSI NEONATUS

10,000

25,000

0000284256461
0000018406552
0001864690402

307111
627111
423111
667111

001840490313

227111

G3P2A0H2+ HT

0001330964212

365911

TONSILOFSRINGITIS

IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD

30/06/15
30/06/15
05/07/15
30/06/15
07/07/15
02/07/15
11/07/15
12/07/15
07/07/15
15/07/15
06/07/15
19/07/15
21/07/15
18/07/15

02/07/15

GHIBRAN ALGIVARI

0001867491707

635911

ISPA

01/07/15
06/07/15
03/07/15
09/07/15
09/07/15
13/07/15
15/07/15
14/07/15
21/07/15
10/07/15
23/07/15
23/07/15
24/07/15

GITA ANJELITA
MUHAMMAD JIHAD
BY.NY. RINNI

0000275551176
0001442906853
0001867693127

776706
444616
685911

THALASEMIA
GEA
ASFIKSIA NEONATORIUM
ASMA DLM SERANGAN

0001841694434

476211

0001868339733

9059011

HYPERBILIRUBIN

0001330852061
0001795171689
0000283392397

519008
9171910
239900

GEA DEHIDRASI RINGAN


BRONKOPNEUMANIA
DHF

0001868339733
0001868869833
0000284778279
0001796585275
0001276481294

406511
086211
207011
977011
007011

ASPIXIA
INFEKSI NEONATUM
OBS FEBRIS
GEA
KEJANG DMM SIMPLEK

120,000
240,000
220,000

dr. H. Asrinal, Sp.A

533,000
59,500
12,000
12,000
12,000

12,000
24,000

200,000

10,000

4,630,000

170,000

80,000
80,000
80,000
220,000
180,000
420,000
120,000
375,000
680,000
360,000
240,000
540,000
180,000
360,000

DARAH

TRANSFU
SI

OKSIGEN

24,000

1,410,000

364,500

10,000
10,000

25,000

48,000
96,000

650,000

389,500

10,000
104,500

36,000

114,000

50,000

4,000
4,000
4,000

59,500
86,000
38,000
267,500
38,000
38,000
325,500
223,000

15,000

144,000

33,000

38,000
10,000
10,000
30,000

50,000

6,000
72,000

24,000

24,000

18,000
12,000
6,000
6,000
6,000

59,500
7,000

VISITE DR.
SPESIALIS
180,000
144,000
48,000
24,000
60,000

14,000

22,000

66,000

40,500

78,000
12,000

308,000
77,000
211,500

500,000

70,000

175,000

6,000

768,000

40,000
108,000

48,000
24,000
60,000

38,500
6,000
6,000
14,000

90,000
120,000
405,000
202,500

39,000

405,000

72,000
120,000

72,000
144,000

44,000
10,000
6,000
12,000

500,000

225,000

48,000
72,000
36,000
24,000

3,915,000

65,000

1,710,000

1,053,000

492,000

121,500

175,000

72,000

1,000,000

295,000

148,000

528,000

8,545,000

235,000

24,000

3,120,000

1,417,500

1,142,000

389,500

226,000

36,000

175,000

186,000

50,000

1,000,000

295,000

148,000

1,296,000

DARAH

TRANSFU
SI

OKSIGEN

VISITE DR.
SPESIALIS

768,000

RAWATAN /
HCU

PASANG
INFUS

PERWTN
LUKA

dr. Yunira Yunirman, Sp.A

4,630,000

170,000

24,000

1,410,000

dr. Asrinal, Sp.A

3,915,000

65,000

1,710,000

Total

8,545,000

235,000

24,000

3,120,000

1,417,500

DOKTER

VT
PENDISTRIBUS
P/
RONTGEN
IAN MAKANAN
RJ
P

8,000
2,000

72,000

dr. Yunira Yunirman, Sp.A


870,000
240,000
120,000
120,000
120,000

PE
MB
ERI
AN
MA NEBULIZER
KA
N
NG
T

4,000
12,000
10,000

NBBLC
NBBLC
HYPERPEREXIA
OBS . VOMITUS
GASTROENTERITIS AKUT
FEBRIS + KDK

PERAWATAN
TALI PUSAT
22,000

343911
686211
446211
596211
217111

GILANG RAMADHAN

BY.NY.PUTRI TELLY PRIMA SARI


BY.NY.MELLY A
YOLLA SEPTIANI S
KHUSNUL KHOTIMAH AZNUR
ILHAAM GHAANII MAULANA

LABORSKINTESTFOTOTHERAPY

NBBLC
NBBLC

RWT GBG IBU


IGD

LUTHFIAH AZRA
NAYARA SAUFA NAQISYA
RAYHAN

PERWTN
LUKA

NBBLC

BUNGA DENILA
HABIL SYAUQI
CLON.BY.NY.ASMIWARNI

BY.NY.PUTRI TELLY PRIMA SARI

240,000
840,000
220,000
120,000
300,000
160,000
60,000

PASANG
INFUS

NBBLC

28/07/15
31/07/15
29/07/15
25/07/15
03/07/15

AGIL SAPUTRA

RAWATAN /
HCU

NBBLC

26/07/15
27/07/15
27/07/15
24/07/15
29/06/15

FITRIA AULIA SARI

DOKTER

PA
SA
N
MANTOX TEST
G
N
GT

PA
SA
N
MANTOX TEST
G
N
GT

PE
MB
ERI
AN
MA NEBULIZER
KA
N
NG
T

VT
PENDISTRIBUS
P/
RONTGEN
IAN MAKANAN
RJ
P

INJEKSI

PERTOLONG
AN BBL

PERAWATAN
TALI PUSAT

364,500

650,000

389,500

104,500

36,000

114,000

50,000

1,053,000

492,000

121,500

175,000

72,000

1,000,000

295,000

148,000

528,000

1,142,000

389,500

226,000

36,000

175,000

186,000

50,000

1,000,000

295,000

148,000

1,296,000

LABORSKINTESTFOTOTHERAPY

PASA
VISITE DR.
NG
UMUM
MONI
TOR

GIZI

OBAT
4,929
161,629
94,725

12,000

25,398
40,532
43,387

193,516

220,858
111,924
37,521
40,957
24,030

JUMLAH
816,429
1,571,129
555,725
148,000
666,398
328,532
159,387
55,000
35,000
42,000
35,000
65,000
35,000
35,000
843,516
35,000
35,000
35,000
1,875,858
423,424
175,521
178,957
228,030

792,322
574,988
1,965,308

1,032,538

2,049,180
615,535
249,521
276,957

35,000
47,500
20,660
9,360
25,654
16,380
12,000

9,793,960

73,477
70,797
58,898
33,514
57,471

195,477
734,797
212,398
615,014
600,471
1,191,000
212,446
637,377
1,469,648
1,024,000
655,837
2,023,347
323,721
778,270
0

36,000
49,337
224,347
24,721
146,770

24,000

35,000
246,380
0

1,071,460

48,446
41,377
186,148

24,000

35,000
206,160
340,360
470,654

84,000

1,015,303

10,673,803

96,000

2,086,763

20,467,763

GIZI

OBAT

JUMLAH

PASA
VISITE DR.
NG
UMUM
MONI
TOR

12,000

1,071,460

9,793,960

84,000

1,015,303

10,673,803

96,000

2,086,763

20,467,763

273,160

422,999

408,712
785,886
406,839
885,584
1,642,899
1,074,000
2,172,289
519,171
976,449

20,467,763

20,467,763

RAWATAN JANTUNG/ TDK PENDING

1
2
3
4
5
6
7

JALUR
MASUK
POLIKLINIK
PDHN PARU
IGD
IGD
IGD

8
9

IGD

NO

10
11
12
13

IGD
IGD

14
15
16
17
18
19
20
21
22
23
24
25
26

IGD
IGD
IGD
IGD
IGD
IGD
IGD
IGD
PDHN ICU
PDHN icu
IGD
IGD
PDHN ICU

27
28
29
30

TGL
MASUK

TGL
KELUAR

NAMA PASIEN

NO KARTU
0001433367099
0000200913625
0000284062667
0000043452538
00002841492690
0000284504152
0001267031215

NO. MR
624710
306011
382400
555911
575110
161508

DX

29/06/15
01/07/15
30/06/15
03/07/15
01/07/15
07/07/15
04/07/15

02/07/15
04/07/15
03/07/15
04/07/15
07/07/15
10/07/15
07/07/15

ASNIMAR
ENDRA EFENDI
DESNIWATI
ERVIN RIZALDI
NOFRITO BAHAR
ASNI EMRI
LIZWIRDA

09/07/15

16/07/15

YENI ERNITA

0001267723405

20/07/15

26/07/15

SYAFRUDIN

0000017620828

1516451
CHF + HHD
1
NSTEMI

22/07/15

25/07/15

DARINA

0000273914818

6575511 HT EMERGENCY

16/07/15
13/07/15
20/07/15

17/07/15
15/07/15
23/07/15

MuRSYIDA
NOFRIALDI
SURYATI

0000018380619
0000017167757
0001793171801

11/07/15

14/07/15

NURAINI

0001288921961

11/07/15
28/07/15
26/07/15
27/07/15
24/07/15
26/07/15
24/07/15
20/07/15
20/07/15
24/07/15
26/07/15
22/07/15
29/07/15
24/07/15

14/07/15
31/07/15
28/07/150
30/07/15
27/07/15
28/07/15
28/07/15
29/07/15
22/07/15
25/07/15
31/07/15
25/07/15
31/07/15
25/07/15

ASNITA
ZULFAHMI
YUSMAR
RITA NURYANTI
SYAMSURI

0001336891757
0001275355359
0000018412391
0001261597724
0001315884069

996211 HT EMERGENCY
317609 BRADIKARDIA
CHF
341209 ADHF EC CAD
967100 CHF EC HHD

AZHARI BUCHARI
RATNA
JHONI SAMALO
FAIZUL
NASRIL
FAIZUL
KARTALENA
HALIMAH
NURLELI

0000017374173
0000284459027
0001386747369
0000017426474
0000018357783
0000017426474
0001273604646
0000273557136
0001437284496

379003 UAP / NSTEMI


ADFH UAP / NSTEMI
CHF EC HHD
777011 CHF EC CAD
664305 BRADHIKARDI DG HT GR II
777011 CHF EC CAD
632711 DM TYPE II + HT
067211 SUSP STEMI
107111 HT EMERGENCY

DOKTER

490,000
495,000
330,000
250,000
790,000
330,000
495,000

CAD
UNSTABLE ANGINA PECTORIS
UNSTABLE ANGINA PECTORIS
PPOK EX + TB PARU
STEMI INTERIOR
UAP
CHF + HHD

538100 ANGINA PECTORIS


466411 CHF + HHD
NSTEMI
2909004 HT EMERGENCY+ STEMI INTERIOR

RAWATAN /HCU

DR. SUSIYANTI,SP.JP

VISITE DR
SPESIALIS
72,000
24,000
24,000
24,000
24,000
24,000

660,000
855,000

24,000
72,000

330,000
250,000
375,000
500,000

24,000

415,000
415,000
415,000
370,000
415,000
330,000
370,000
370,000
1,215,000
375,000
240,000
620,000
370,000
290,000
240,000

24,000
24,000
48,000
48,000
48,000
24,000
48,000
24,000
144,000
24,000

12,600,000

VISITE DR
UMUM

INJEKSI

12,000

30,000
90,000
60,000
15,000
100,000
50,000
60,000

12,000
12,000

150,000
315,000

12,000
24,000
36,000

70,000
24,000

48,000

90,000
180,000

SYRING
PUMP
70,000
70,000
70,000
105,000
70,000

EKG

168,000
168,000
130,000
84,000
227,500
130,000
168,000

KONSUL
SPESIALI
S

260,000
294,000

60,000
30,000

70,000
70,000
140,000
280,000

130,000
70,000
126,000
140,000

60,000
30,000
30,000

70,000
70,000
70,000

130,000
130,000
130,000
126,000
130,000
130,000
126,000
162,500
420,000
105,000
84,000
210,000
140,000
97,500
84,000

30,000
30,000

12,000

972,000

198,000

2,782,000

2,100,000

4,300,500

630,000

96,000
36,000
24,000

12,000
12,000
12,000

6,000

280,000
70,000
35,000

ECOCARDIOGRAFY

PASANG
INFUS

PASANG
KATETER

12,000
12,000
12,000

12,000
12,000

30,000
30,000
30,000

35,000

140,000
35,000
35,000
105,000
105,000
105,000

SKINTEST

285,000

70,000
30,000
110,000
90,000
110,000
80,000
90,000
240,000
270,000
84,000
15,000
96,000
192,000
50,000
45,000

12,000

KONSUL
ROHANI

3,000

ROM

75,000
40,000
50,000
20,000
20,000
100,000

100,000
100,000
80,000
50,000
140,000
80,000
100,000

P.JE
NAZ RJP FISIOTERAPY
AH

12,000

40,000
50,000

260,000
195,000

160,000
175,000

26,000

12,000
12,000

12,000

20,000
45,000
100,000
112,500

130,000
130,000
195,000
260,000

80,000
45,000
75,000
90,000

19,500

40,000
20,000
40,000
75,000
80,000
80,000
40,000
60,000
100,000
67,500

195,000
195,000
195,000
130,000
195,000
130,000
130,000
130,000
195,000
195,000

19,500

22,500
67,500
60,000

130,000
130,000

80,000
80,000
80,000
75,000
80,000
80,000
75,000
100,000
250,000
67,500
50,000
150,000
90,000
60,000
50,000

12,000
12,000

12,000

12,000

12,000

285,000
30,000
285,000

60,000
30,000

12,000

INHALASY
TERAPY

RO
TRA
NT
NSF
GE
USI
N

50,000

22,000
15,000

26,000
33,000

3,000

MONITOR

130,000
195,000
130,000
130,000
390,000
130,000
195,000

26,000

30,000
30,000
30,000
30,000
30,000
30,000

OKSIGEN

225,000

150,000
75,000
75,000
175,000

111,000

855,000

175,000

72,000

1,425,000

4,420,000

2,642,500

39,000

111,000

855,000

175,000

72,000

1,425,000

4,420,000

2,642,500

39,000

PASANG
KATETER

750,000

DR. M FADIL, SP.JP

12,600,000

972,000

198,000

2,782,000

2,100,000

4,300,500

630,000

VISITE DR
UMUM

KONSUL
ROHANI

SKINTEST

ECOCARDIOGRAFY

PASANG
INFUS

OKSIGEN

MONITOR

ROM

3,000

111,000

855,000

175,000

72,000

1,425,000

4,420,000

2,642,500

39,000

111,000

855,000

175,000

72,000

1,425,000

4,420,000

2,642,500

39,000

RAWATAN /HCU

VISITE DR
SPESIALIS

INJEKSI

SYRING
PUMP

EKG

KONSUL
SPESIALI
S

dr. susiyanti sp.jp

12,600,000

972,000

198,000

2,782,000

2,100,000

4,300,500

630,000

DR. M FADIL, SP.JP

12,600,000

972,000

198,000

2,782,000

2,100,000

4,300,500

630,000

DOKTER

TOTAL

3,000

P.JE
NAZ RJP FISIOTERAPY
AH

INHALASY
TERAPY

750,000

750,000

RO
TRA
NT
NSF
GE
USI
N

LABOR

PENDISTRIBUSIA
N MAKANAN

OBAT

235,500
705,000
702,500

274,500

8,000
8,000
8,000
4,000
14,000
8,000
8,000

347,467
1,093,590
889,704
151,446
1,532,249
921,808
98,723

1,674,967
3,059,590
2,476,204
1,093,446
3,892,749
1,793,808
1,565,223

357,500
416,000

16,000
14,000

507,338
1,523,663

2,794,838
4,001,663

4,580,055

397,500

8,000
4,000
6,000
8,000

410,103
226,864
396,370
2,109,826

1,739,103
912,864
1,557,370
4,454,826

1,804,762
5,367,792

8,000
8,000
8,000
6,000
8,000
8,000
6,000
10,000
20,000
6,000
4,000
12,000
8,000
6,000
4,000

1,245,119
588,217
312,799
206,061
482,389
628,709
857,950
2,127,135
1,612,686
1,282,172
3,381

2,326,619
1,602,217
2,002,799
1,443,061
2,192,889
1,810,709
2,092,950
4,238,135
4,918,186
3,054,672
396,381
1,486,500
3,102,782
1,540,068
463,803
0
0

236,000

20,885,422

484,000

696,500

570,000
137,000
480,500
168,000
766,500
306,500
416,500

722,000
656,000

8,492,000

1,199,282
101,568
28,803

JUMLAH

63,688,422

2,323,944

4,048,749
2,433,958
1,894,207

2,963,355
2,100,873
1,790,831
2,132,284
2,213,950
4,985,558
5,214,985
8,906,080

4,812,892
2,877,354

63,688,422
0
0
0
0
0

8,492,000

236,000

20,885,422

63,688,422

LABOR

PENDISTRIBUSIA
N MAKANAN

OBAT

8,492,000

236,000

20,885,422

8,492,000

236,000

20,885,422

JUMLAH
63,688,422
0
63,688,422

63,688,422

RAWATAN MATA / TDK PENDING


NO

JALUR MASUK

TGL
MASUK

TGL
KELUAR

NAMA PASIEN

NO KARTU

NO. MR

DX

DOKTER

ANESTESI

2
3

1
2
3
4
5
6
7
8
9

PER
AWA
TAN
RAWATANOPERASI
PRE/
POS
T OP

PER
AWA TON
TAN OME VISITE DR.SP
LUK TRI
A

VISITE
DR.UMUM

KONSUL DR.
SP

INJEKSI

SKINTEST

LABOR

PASANG
INFUS

PENDISTRIBUSIAN
MAKANAN

OKSIGEN

24,000

36,000

26,000

PEN
USG
YUL
ABDO
UHA
MEN
N

59,500

15,000

333,000

15,000

6,000
6,000
6,000

50,000

dr.Drajad Priyono, Sp.PD

1
2
DR. YUNIRA YUNIRMAN,SP.A

1
2

IGD
IGD
IGD

30/06/1

02/07/15

01/07/15

03/07/15

30/06/15

02/07/15

ZAIDAR ZA
ALIYUS
HANIFAH

0000042969262
0000274716639
0001381620609

665911
735911
595911

GASTRITIS AKUT
GASTRITIS AKUT
HT URGENCY

360,000
120,000
360,000

DR. LETMI

DOKTER

dr. Joni Sastra, Sp.M


dr.Drajad Priyono, Sp.PD
DR. YUNIRA YUNIRMAN,SP.A
DR. LETMI Y

ANESTESI

24,000

12,000

24,000

135,000
80,000
15,000

840,000

48,000

48,000

24,000

230,000

26,000

392,500

30,000

18,000

50,000

840,000

48,000

48,000

24,000

230,000

26,000

392,500

30,000

18,000

50,000

VISITE
DR.UMUM

KONSUL DR.
SP

INJEKSI

SKINTEST

LABOR

PASANG
INFUS

PENDISTRIBUSIAN
MAKANAN

OKSIGEN

0
0
0
48,000
48,000

0
0
0
24,000
24,000

0
0
0
230,000
230,000

0
0
0
26,000
26,000

0
0
0
392,500
392,500

0
0
0
30,000
30,000

0
0
0
18,000
18,000

0
0
0
50,000
50,000

PER
AWA
TAN
RAWATANOPERASI
PRE/
POS
T OP
0
0
0
840,000
840,000

0
0
0
0
0

0
0
0
0
0

PER
AWA TON
TAN OME VISITE DR.SP
LUK TRI
A

0
0
0
0
0

0
0
0
0
0

0
0
0
48,000
48,000

PEN
USG
YUL
ABDO
UHA
MEN
N

0
0
0
0
0

0
0
0
0
0

RONTGEN

OBAT

JUMLAH
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0

58,000

269,875
89,447
48,275

58,000

407,597

2,172,097

58,000

407,597

2,172,097

RONTGEN

OBAT

JUMLAH

0
0
0
58,000
58,000

0
0
0
407,597
407,597

963,375
321,447
887,275
0
0

0
0
0
2,172,097
2,172,097

1,162,375
560,706
3,889,892

2,172,097

2,172,097

RAWATAN KEBIDANAN
JALUR
MASUK

IGD

04/07/15

05/07/15

IGD

01/07/15

06/07/15

IGD

04/07/15

05/07/15

29/06/15

04/07/15

IGD

02/07/15

04/07/15

POLIKLINIK 01/07/15

07/07/15

IGD

04/07/15

07/07/15

IGD

08/07/15

08/07/15

IGD

04/07/15

06/07/15

10

IGD

02/07/15

03/07/15

11

IGD

09/07/15

11/07/15

12

10/07/15

12/07/15

13

6
7

TGL
MASUK

/ TDK PENDING

NO

TGL KELUAR

IGD

09/07/15

14/07/15

14

16/07/15

18/07/15

15

IGD

19/07/15

21/07/15

16

15/07/15

19/07/15

17

IGD

25/07/15

28/07/15

19

IGD

17/07/15

19/07/15

20

23/07/15

25/07/15

21

23/07/15

25/07/15

22

23/07/15

24/07/15

23

24/07/15

25/07/15

NAMA PASIEN

NO KARTU

0001425353354
EPA LIASMAWATI
0001846451531
GUSNIAR
VIEN SILVIA NINGSIH 0000196923802
RISKALIATI
0001867199872
0000273705963
LIDIIYA
MELLY A REMITASARI 0000987489189
0001089054819
ERA DILLA SPT
0001081140208
ERLINDA WATI
NUR INDAH ERNA SA 0001808992822
ERI WIDYA CANDRA 0000284691903
MIRA WAHYUNINGSI 0001851908714
0000987489753
ELMITA
0000986636102
ZULMIYETTI
INTAN PERMATA SARI 0001858113281
0001855911172
FITRIANISA
IKRA RIZA A.MD.KEP 0000165052517
KARTIKA SARI
0000284269263
0000275004955
FARIDA
RIKA JUITA, A.MD.KE 0000149093032
YUNIMAR
0000273006314
IRA SAFIRA
0000283948672
001840490313
FITRIA AULIA SARI

NO. MR
136211

DX

DOKTER

ANESTESI

G3P2A1H1+ INPARTU
G4P3A0H3+ KPD

DR. LILLAH

RAWATAN / HCU

INJEKSI

PERAWATAN
TALI PUSAT

PERSALINAN

80,000

81,000

9,000

250,000

13,000

375,000

285,000

60,000

G2P1A0H1+ OBS INPARTU

240,000

60,000

505911

MOLA HIDAHSOSA

240,000

795911

G1P0A0H0+ PR INDUKSI

120,000

20,000

365,000

40,000
15,000

626011 GR 41-42 MGG

DR. LILLAH

176211

LATE HPP

480,000

433408

G2P1A0H1

120,000

G4P1AOH1

120,000

343911

G3P2A0H2

686211

G2P1A0H1+ GR ATERM INPART

366411

MISSED ABORTION

275911

G1P0A0H0

566511

G3P1A1H1 GR 12-13 MGG

ABORTUS IMINEMS

dr. Adriswan,
ADI
Sp.OG
DR. LILLAH

1,200,000

LAPARATOMY

CURRATACE

MANUAL
KONTAP
TUBEKTOMY
PLACENTA

540,000

PERAWATAN
PRE/POST OP

PASANG IUD

20,000
320,000

HEACTING

62,000

44,000

VAK
UM
DIGIT EKT
RAK
SI

EKPLORASI

PASANG
TAMPON

68,000

60,000

PASANG
KATETER

PASANG
INFUS

20,000

10,000

10,000

10,000

40,000

50,000
1,200,000

20,000

78,000

PASANG
INDUKSI

AKTE
KELAHIRAN

RAWATAN BAYI

15,000

40,000

50,000

15,000

20,000

275,000
22,500

VH

65,000
50,000

840,000

44,000

LABOR

USG

SKL

63,000

100,000

15,000

120,000
100,000

130,000

10,000

10,000

FIBRIDING/K
LISMA

DARAH

TRANSFUSI

TUKAR
VERBAN

PERAWATAN
LUKA

15,000

100,000

15,000

OKSI
GEN

10,000
15,000

100,000

GV/DC

30,000

38,000

150,000

60,000

15,000

16,000
20,000

100,000

20,000

8,000
500,000

150,000

45,000

13,000
30,000

250,000

80,000

20,000

250,000

120,000

166,000

250,000

120,000

10,000

410,000

140,000

120,000

20,000

120,000

40,000

300,000

36,000

247303

G1P0A0H0+ 39-40 MGG

307111

G1P0A0H0+ CPD

285,000

20,000

776511

G1P0A0H0 + LETSU

120,000

20,000

084502

G3P2A0H2 + SYIMPIOLISIS

180,000

60,000

036611

G2P2A0H2

120,000

20,000

125911

G1P0A0H0+ HAP

80,000

60,000

227111

G3P2A0H2+ HT

80,000

20,000

4,185,000

938,000

61,000

DR. LILLAH

OPERASI / SC

78,000

26,000

30,000

10,000

50,000

10,000

50,000

10,000

100,000

60,000

15,000

39,000

26,000

1,500,000

30,000

78,000

300,000

16,000

15,000
60,000

840,000

20,000

26,000

10,000

10,000

15,000
100,000
273,500

30,000

10,000
28,500

325,000
18,000

60,000
1,200,000

20,000

60,000

12,000

52,000

10,000

275,000

26,000

60,000

250,000

98,000

44,000

55,000

10,000

15,000
15,000

24,000

8,000
15,000

20,000

100,000

13,000
250,000

30,000

91,000

25,000

100,000

50,000

26,000

10,000

150,000

1,018,000

338,000

275,000

39,000

44,000

375,000

40,000

60,000

300,000

26,000

44,000

12,500

10,000

25

IGD

01/07/15

03/07/15

IGD

30/06/15

02/07/15

IGD

01/07/15

03/07/15

IGD

07/07/15

10/07/15

13/07/15

15/07/15

IGD

12/07/15

16/07/15

20/07/15

21/07/15

IGD

21/07/15

23/07/15

20/07/15

22/07/15

10

IGD

27/07/15

28/07/15

11

IGD

26/07/15

27/07/15

12

IGD

27/07/15

29/07/15

13

IGD

28/07/15

30/07/15

14

28/07/15

29/07/15

15

27/07/15

28/07/15

DENI ELITA
RINNI
LIDIYA MARTIN
ERMA YENTI
RUSTINA
RIKA
MULYETI
RINA LESTARI
WIWID HANDANI
NUR AISAH
ULAN SARI ASIH
ISNI MARDOLI
IRMA SURYANI
RINA LESTARI
ASMIWARNI

0001841575781

725911

G1P0A0H0

120,000

0000017178759

806302

G2P1A0H1 GR ATERM

360,000

0001179109269

71,000

G3P1A1H1+ KPD

180,000

36,000

0000273405071

536211

G1P0A0H1 + PERDRHN PERVG

500,000

140,000

0000284581686

764407

ABORTUS INCOMPLIT

ADI

205,000

0001843965753

056511

G1P0A0H1+OBS INPARTU

ADI

285,000

40,000

0000274964725

264709

G5P2A2H2+ INPARTU

80,000

20,000

120,000

20,000

0000284188465

G1P0A0H0 + HEG

0001388132662

G1P0A0H0

dr. Syahrial
Syukur, Sp.OG

62,500

11,000

2,750,000

5,940,000

540,000

840,000

620,000

90,000

65,000

90,000

132,000

755,000

30,000

50,000

30,000

280,000

840,000
1,500,000

20,000

250,000

500,000

15,000
300,000

12,000

60,000
50,500

26,000

10,000

50,000

78,000

10,000

50,000

39,000

506,500

135,000

40,000

500,000

150,000

78,000

199,000

15,000

25,000

30,000

15,000

20,000

12,000

15,000

10,000

100,000

10,000

100,000
38,000

10,000
15,000

44,000

10,000

20,000

15,000
88,000

180,000

0000274705863

767111

G4P3A0H3 + OBS INPARTU

0000284432995

537111

G1P0A0H0

120,000

60,000

0000283557326

899409

G3P1A1H1+ HYPREMERIS

120,000

60,000

0000284271017

G4P3A0H3 + INPARTU 41-42 M

120,000

20,000

0000284188465

G1P0A0H1 GR 6-7 MGG + HEG

80,000

100,000

80,000

20,000

2,630,000

648,000

11,000

1,725,000

1,500,000

840,000

20,000

6,815,000

1,586,000

73,500

4,475,000

7,440,000

540,000

1,680,000

620,000

RAWATAN / HCU

INJEKSI

PERAWATAN
TALI PUSAT

PERSALINAN

OPERASI / SC

LAPARATOMY

CURRATACE

4,185,000

938,000

62,500

2,750,000

5,940,000

540,000

840,000

0001864689895

80,000

6677111 INPARTUS/G1P0A0H0

10,000

38,000
28,500

250,000

26,000

10,000

15,000

275,000

26,000

44,000

300,000

236,000

300,000

10,000

97,000

150,000

15,000

60,000

315,000

200,000

90,000

10,000

45,000

82,000

110,000

150,000

1,318,000

574,000

300,000

65,000

100,000

229,000

905,000

45,000

340,000

821,500

700,000

225,000

40,000

500,000

150,000

10,000

123,000

281,000

PERAWATAN
PRE/POST OP

PASANG IUD

VH

HEACTING

EKPLORASI

PASANG
TAMPON

PASANG
KATETER

PASANG
INFUS

PASANG
INDUKSI

AKTE
KELAHIRAN

RAWATAN BAYI

LABOR

USG

SKL

FIBRIDING/K
LISMA

DARAH

TRANSFUSI

TUKAR
VERBAN

PERAWATAN
LUKA

GV/DC

OKSI
GEN

90,000

150,000

1,018,000

338,000

65,000

90,000

132,000

755,000

30,000

280,000

506,500

500,000

135,000

40,000

500,000

150,000

78,000

199,000

72,000
15,000

16

DOKTER

ANESTESI

dr. Adriswan, Sp.OG


dr. Syahrial
Syukur,
Sp.OG
Total

MANUAL
KONTAP
TUBEKTOMY
PLACENTA
0

620,000

VAK
UM
DIGIT EKT
RAK
SI
0
0

2,630,000

648,000

11,000

1,725,000

1,500,000

840,000

20,000

300,000

236,000

300,000

10,000

97,000

150,000

15,000

60,000

315,000

200,000

90,000

10,000

45,000

82,000

6,815,000

1,586,000

73,500

4,475,000

7,440,000

540,000

1,680,000

620,000

110,000

150,000

1,318,000

574,000

300,000

65,000

100,000

229,000

905,000

45,000

340,000

821,500

700,000

225,000

40,000

500,000

150,000

10,000

123,000

281,000

SKINSTEST

CO.
SPESIALIS

VISITE DR.
UMUM

VISITE DR.
SPS

18,000

18,000

18,000

27,000

PEL
YN
MK
PENDISTRIBU N VISIT KO
SIAN
DIE
E
NSL
MAKANAN
T
GIZI GIZI
KH
USU
4,000
S
10,000

OBAT

124,483

739,483

844,983

245,145

2,691,145

2,753,145

4,000

12,240

1,422,240

1,649,773

10,000

103,644

1,361,644

4,000

201,175

993,175

1,083,175

14,000

172,091

2,244,591

2,402,591

8,000

42,573

1,415,573

1,626,934

2,000

30,338

165,338

215,338

6,000

125,493

836,493

936,993

4,000

113,526

531,526

616,526

6,000

47,588

664,588

6,000

125,821

1,287,821

12,000

337,712

2,966,212

6,000

6,656

6,000
72,000
18,000

72,000

JUMLAH

719,588

3,084,445

498,656
194,500

277,000

10,000

145,655

1,144,655

1,206,655

8,000

155,603

1,910,603

1,995,603

6,000

743,029

121,029

688,029

6,000

62,405

380,405

6,000

124,390

762,390

4,000

40,269

297,269

4,000

124,623

587,123
0

72,000

27,000

144,000

146,000

6,000

12,000

2,462,459

776,320

861,320

48,000

4,000

1,043,000

1,187,500

24,000

4,000

135,182

1,191,182

1,310,682

8,000

1,065,474

18,000

136,320

23,783,459

196,974

1,015,474

6,000

60,231

1,307,231

10,000

263,463

2,357,463

2,382,463

4,000

110,215

562,215

679,715

6,000

61,231

295,231

545,878

6,000

5,560

191,560

255,489

1,230

81,230

106,230

6,000

65,434

299,434

486,793

6,000

15,724

230,224

387,895

6,000

73,893

520,893

570,893

46,782

308,782

33,565

497,565

10,000
4,000

562,565

0
28,000

12,000

72,000

76,000

1,205,804

10,677,804

100,000

27,000

12,000

216,000

222,000

3,668,263

34,461,263

SKINSTEST

CO.
SPESIALIS

VISITE DR.
UMUM

VISITE DR.
SPS

72,000

27,000

144,000

28,000

12,000

72,000

100,000

27,000

12,000

216,000

PEL
YN
MK
PENDISTRIBU N VISIT KO
SIAN
DIE
E
NSL
MAKANAN
T
GIZI GIZI
KH
146,000
0
0
0
USU
S
76,000
0
0
0
222,000

OBAT

JUMLAH

2,462,459

23,783,459

1,205,804

10,677,804

3,668,263

34,461,263

34,461,263

34,461,263

RAWATAN THT / TDK PENDING


NO
1
2
3
4

JALUR
MASUK
IGD
-

TGL
MASUK
02/07/15
30/06/15

TGL
KELUAR
04/07/15
02/07/15

NAMA PASIEN
ASTITUT NELIANTI
ANISA RAHAYU

NO KARTU
0000017469268
0001807874335

NO. MR
641507
815211

DX

VISITE
SPESIALIS

VISITE
UMUM

360,000
120,000

48,000

12,000

480,000

48,000

DOKTER ANESTESI RAWATAN

EPISTALIS ANTENUR
TONDILITIS KRONIS

PE
RA
WA
TA
N
LU
KA

WAT
ER
RO
KONS
DRI
NG
UL
NKI
TE
GIZI
NG
N
TEST

CM

LABOR

KONSUL SPES

120,000

24,000

OPERASI

PERAWATAN
OKSIGEN
PRE/POST OP

3,500,000

PASANG
INFUS

SKINTEST

INJEKSI

30,000

10,000

26,000

135,000
30,000

30,000

10,000

26,000

165,000

dr.
Yuhisdiarman,
Sp.THT. KL

12,000

120,000

24,000

3,500,000

PENDISTRIBU

TAMPON
PENYULUHANSIAN

MAKANAN

40,000

40,000

OBAT

6,000
6,000

103,646
62,816

12,000

166,462

JUMLAH
848,646
3,784,816
0
0
0
0
0
0
0
0
0
0

4,633,462

1,039,187

4,633,462

RAWATAN PARU/ TDK PENDING


NO

JALUR MASUK

TGL
MASUK

TGL
KELUAR

IGD
IGD
IGD
IGD
IGD
IGD
IGD
-

29/06/15
01/07/15
05/07/15
06/07/15
22/07/15
22/07/15
21/07/15
22/07/15
21/07/15
26/07/15

03/07/15
03/07/15
09/07/15
13/07/15
25/07/15
25/07/15
24/07/15
24/07/15
28/07/15
29/07/15

2
3

4
6
7
8
9
10
11
12
13

IGD
IGD
IGD
IGD
IGD
IGD
PDHN JTG

02/07/15
29/06/15
04/07/15
03/07/15
09/07/15
19/07/15
19/07/15
23/07/15
22/07/15
25/07/15

04/07/15
03/07/15
07/07/15
10/07/15
13/07/15
22/07/15
24/07/15
24/07/15
27/07/15
27/07/15

NAMA PASIEN

NO KARTU

NO. MR

VIVI SELVINA
ZULHADI
GUSTINAR
ERNITA
NURMAILIS
LINUR
SAMUAL
M GANI
ZULMAIDI EDWIN
SYAFRIAL ST. RKY SATI

0000273576857
0000274273334
0001300069574
0001330547523
0001433461432
0000274704175
0000274145725
0000284010041
0001274312417
0001245427288

525911
091408

037111
220004
567111

TB PARU
ASMA BRNCIAL DLM SRGN
CA PARU + EFUSI PLUERA
HT STG II
PPOK + PNEUMONIA
ASMA BRNCIAL DLM SRGN
ANEMIA KEJANG
TB PARU BERAT
ASMA BRONCHIAL
PNEUMONIA + PPOK

LINUR
ERVIN RIZALDI
ALI IMRAN
BUYUNG GADANG
NAZARUDDIN
AMSAR
BAINAR
WIRDA
MAWARDI
KARTALENA

0000274704175
0000043452538
0000284177068
0000015629308
0001329921066
000183346739
0000274299423
0001431493571
0001331346069
0001273604646

178303
555911
644601
443408
004708
792611
367011
909410
527905
632711

PPOK
PPOK EX + TB PARU
PPOK EKSASERBASI AKUT
CAP + PPOK
PPOK EKSASERBASI AKUT
CAP + PPOK
TB PARU
EFUSI PLUERA DEXTRA
PPOK + SUSP CPC
DM TYPE II + HT

233711
454610
178303

DX

DOKTER

DR. YENNY MUCHTAR

dr. Desi Susyanti, Sp.P

RAWATAN

VISITE DR VISITE DR KONSUL


SPESIALIS
UMUM
SPESIALIS

300,000
120,000
300,000
480,000
240,000
160,000
240,000
120,000
320,000
160,000

36,000

6,000

48,000
72,000
12,000

12,000
12,000

2,440,000

222,000

180,000
480,000

36,000
120,000

240,000
960,000
300,000
240,000
360,000
120,000
300,000
120,000

24,000
120,000
24,000

3,300,000

420,000

66,000

330,000

5,740,000

642,000

108,000

630,000

24,000

6,000
6,000

30,000
30,000
60,000
60,000

SKINTEST

60,000
30,000

30,000
30,000
30,000

30,000
30,000

24,000
12,000
48,000
12,000

42,000

300,000

24,000

60,000
90,000

6,000
18,000
18,000

30,000
30,000
30,000
30,000
30,000

90,000

INJEKSI

OKSIGEN

12,000
20,000
108,000
228,000
84,000
40,000
108,000
60,000
10,000
20,000

24,000

690,000

152,000

70,000

15,000

6,000
8,000

216,000
368,000
216,000
600,000
432,000
216,000
324,000
13,500
324,000

84,000
75,000
30,000

PASANG
INFUS

ASP
REP IRA
NEC AIR SI PENY
ULUH
PNE
PENDISTRIBUSI ROT E
AN
AN MAKANAN OM JAH UM
PULA
Y ITA OTH NG
10,000
N ORA
6,000
K
10,000
16,000
8,000
8,000
8,000
4,000

36,000
36,000
12,000
10,000
24,000
10,000

108,000
180,000
48,000
48,000
120,000

22,500
192,000
324,000
162,000
216,000
288,000
324,000
162,000
288,000
96,000

2,074,500

EKG

RAWATAN

PMKAIN
MONITOR

PERA
WATA
N
LUKA

INHALASI
TERAPY

ROHI
FISIOTHERPY
S

PRWTN
JENAZAH

S.
KEMATIAN

90,000
90,000

10,000
10,000

180,000

20,000

216,000
118,000
180,000
252,000
35,000
35,000

65,000
65,000
216,000
36,000

70,000

118,000

130,000

900,000

337,500
475,000

126,000

96,000
72,000

12,000

30,000

831,000

39,000

86,000

2,709,500

126,000

118,000

2,568,000

39,000

120,000

1,521,000

191,000

156,000

4,784,000

196,000

236,000

130,000

3,468,000

39,000

180,000

20,000

INJEKSI

PASANG
INFUS

OKSIGEN

EKG

RON
TGE
N

PLEURA
PUNCTIE
PROF/WSD

PMKAIN
MONITOR

PERA
WATA
N
LUKA

INHALASI
TERAPY

PRWTN
JENAZAH

S.
KEMATIAN

20,000

12,000

225,000
775,000
360,000
125,500

SKINTEST

PNE
PENDISTRIBUSI ROT E
AN MAKANAN OM JAH UM
Y

ITA OTH
N ORA
K

ULUH
AN
PULA
NG

39,000

118,000
270,000

ASP
REP IRA
NEC AIR SI PENY
DOKTER

PLEURA
PUNCTIE
PROF/WSD

8,000
16,000
10,000
8,000
12,000
4,000
10,000
4,000

30,000

VISITE DR VISITE DR KONSUL


SPESIALIS
UMUM
SPESIALIS

RON
TGE
N

ROHI
FISIOTHERPY
S

dr. Yenny Muchtar, Sp.P

2,440,000

222,000

42,000

300,000

90,000

690,000

152,000

70,000

2,074,500

70,000

118,000

130,000

900,000

180,000

dr. Desi Susyanti, Sp.P

3,300,000

420,000

66,000

330,000

30,000

831,000

39,000

86,000

2,709,500

126,000

118,000

2,568,000

39,000

5,740,000

642,000

108,000

630,000

120,000

1,521,000

191,000

156,000

4,784,000

196,000

236,000

130,000

3,468,000

39,000

180,000

20,000

TOTAL

RJP

ECOCARDIOG
RAF

KONSUL
GIZI

285,000

285,000

OBAT

JUMLAH

240,240
185,764
963,439
2,175,308
1,267,292
424,879
3,018,790
1,283,032

814,740
769,764
1,946,439
3,728,808
2,099,292
1,535,879
4,451,790
2,138,532
912,000
481,000
0
0

97,000
309,500
38,000
38,000
394,000
198,500
38,000
139,000

75,000
75,000

150,000

LABOR
134,000

1,386,000

9,558,744

18,878,244

4,000

59,500
344,500

306,391
409,004

1,285,391
2,538,504

59,500
167,500

254,793
484,456
284,823
108,439
79,138
37,530
203,802
83,753

1,135,793
3,285,956
1,554,623
793,939
1,086,638
317,030
1,341,302
471,253
0

81,500
59,800
119,500

4,000

891,800

2,252,129

13,810,429

150,000

285,000

4,000

2,277,800

11,810,873

32,688,673

RJP

ECOCARDIOG
RAF

KONSUL
GIZI

LABOR

OBAT

JUMLAH

150,000

285,000

1,386,000

9,558,744

18,878,244

4,000

891,800

2,252,129

13,810,429

150,000

285,000

4,000

2,277,800

11,810,873

32,688,673

1,063,638
1,131,409
2,771,656
4,037,830

4,910,493
2,536,472
1,480,333

3,631,950
1,765,930
3,683,108
2,004,322
977,939
1,351,265
1,846,704

32,688,673

32,688,673

BULAN JULI 2015


NO

RUANGAN

JUMLAH

IGD

51,225,963

Poliklinik Interne

Poliklinik Bedah

Poliklinik Ortopedi

Poliklinik Jantung

Poliklinik Anak

Poliklinik Syaraf

Poliklinik Mata

Poliklinik Kebidanan

849,925
1,701,389
648,977
14,000

123,000

10

Poliklinik Paru

11

Hemodialisa

12

Rawatan Interne

13

Rawatan Bedah

54,599,813

14

Rawatan ICU

26,911,739

15

Rawatan VIP

102,813,879

16

Rawatan Anak

20,467,763

17

Rawatan Jantung

63,688,422

18

Rawatan Mata

2,172,097

19

Rawatan THT

4,633,462

20

Rawatan Kebidanan

34,461,263

21

Rawatan Paru

32,688,673

14,824,000

69,387,254

105,002,297

TOTAL

516,826,662

342,437,111

TINDAKAN
IGD

9,694,500

P. INTERNE

dr. Drajad Priyono, Sp.PD


dr. Letmi Yestrijal, Sp.PD
dr. YUGO ALISON O
TOTAL

P. BEDAH

dr. Zaitul Ikhlas, Sp.B


dr.Syahrial,Sp.B
TOTAL

36,000
115,000
151,000

P. ORTOPEDI

dr. Noverial, Sp.OT


dr. Endayani, MPH
TOTAL

P. ANAK

dr. Yunira Yunirman, Sp.A


dr. Asrinal, Sp.A
TOTAL

P. SARAF
P. MATA

HEMODIALISA (DR.DRAJAD)

249,000
249,000

P. KEBIDANAN

dr. Adriswan, Sp.OG


dr. Syahrial Syukur, Sp.OG
TOTAL

P. JANTUNG (DR. M. FADIL, SP.JP)


dr. Susiyanti Spjp
dr. Nora F

TOTAL

P. PARU

dr. Yenny Muchtar, Sp.P


dr. Dessi susyanti, Sp.P
dr. Wahyu Depamil
TOTAL

10,094,500

TINDAKAN

R. INTERNE

dr. Drajad Priyono, Sp.PD


dr. Letmi Yestrijal, Sp.PD

8,455,000
9,741,000
18,196,000

R. BEDAH

dr. Zaitul Ikhlas, Sp.B


dr. Syahrial, Sp.B
dr. Noverial, Sp.OT

4,016,500
1,865,000
5,881,500

R. ICU

DR.YENDI, SP.AN

13,255,000
13,255,000

R. VIP

DR. LETMI YESTRIJAL,SP.PD


DR. DRAJAD PRIYONO, SP.PD
DR. SYAHRIAL, SP.B
dr. Syahrial Syukur, Sp.OG
DR. YUNIRA YUNIRMAN,SP.A
DR. DESI SUSIYANTI
DR. YENNY MUCHTAR, SP.P
dr. Zaitul Ikhlas, Sp.B

3,159,000
4,034,000
513,500
207,000
936,000
315,000
517,000
840,500
10,522,000

R. ANAK

dr. Yunira Yunirman, Sp.A


dr. Asrinal, Sp.A

1,702,500
2,349,500
4,052,000

R. KEBIDANAN
dr. Adriswan, Sp.OG

4,622,500

dr. Syahrial Syukur, Sp.OG

1,802,000
6,424,500

R. MATA
dr.Drajad Priyono, Sp.PD

dr. Yunira Yunirman

DR. LETMI YETRIZAL

336,000
-

R. JANTUNG
DR. SUSIYANTI SPJP
DR. M FADIL, SP.JP

14,477,500
14,477,500

R. THT
DR. YUHISDIARMAN

271,000

R. PARU

dr. Yenny Muchtar, Sp.P


dr. Desi Susyanti, Sp.P

4,354,500
6,295,500
10,650,000
83,729,500

OBSERVASI

KONSUL/P1

5,822,000

MR

EKG

2,786,000

1,512,000

3,490,000

36,000

18,000

35,000

74,000

35,000

110,000

53,000

35,000

60,000

30,000

108,000

69,000

168,000

99,000

14,000

14,000

12,000

11,000

12,000

11,000

12,000

6,000

35,000

12,000

6,000

35,000

5,822,000

RJP

3,102,000

VISITE DR. SPES

1,681,000

3,560,000

VISITE DR.
UMUM

FISIOTERAPY

830,000

39,000

162,000

708,000

78,000

270,000

1,538,000

117,000

432,000

84,000

204,000

#REF!

1,464,000

#REF!

1,464,000
1,368,000
1,620,000
72,000
432,000
108,000
108,000
375,000

4,083,000

768,000
528,000

1,296,000

288,000
242,000

242,000
1,008,000
1,188,000
90,000
36,000
216,000
72,000
72,000
144,000
2,826,000
12,000
84,000

96,000

144,000

72,000

12,000

216,000

12,000

48,000

48,000

972,000

39,000

198,000

972,000

39,000

198,000

48,000

12,000

150,000

222,000

42,000

420,000

39,000

66,000

150,000

642,000

39,000

108,000

10,259,000

195,000

4,214,000

#REF!

REKAP KLAIM MAI 2015


PSIKOT

MANTUK

KONSUL SPES

HEMODIALISA

30,000

7,000,000

7,000,000

KONSUL SPES

KONSUL GIZI

30,000

ROHIS

7,000,000

RAWATAN

180,000

452,500

4,000

13,365,000

360,000

3,000

14,445,000

540,000

452,500

7,000

27,810,000

24,000

3,080,000

36,000

3,220,000
-

60,000

659,000

6,300,000
3,750,000

659,000

3,750,000

36,000

115,000
-

18,750,000
20,250,000
2,000,000
750,000
4,750,000
1,250,000
750,000
3,000,000

51,500,000

276,000

36,000

391,000

4,630,000
3,915,000
-

27,000

8,545,000
4,185,000
2,630,000

27,000

6,815,000
-

24,000
-

840,000
-

630,000

3,000

12,600,000

630,000

3,000

12,600,000

24,000

480,000

300,000

2,440,000

330,000

4,000

3,300,000

630,000

4,000

5,740,000

2,606,000

847,500

10,000

123,540,000

PEMASANGAN CDL

ECOCARDIOGRAF

CTG

USG

7,500,000
7,500,000

100,000
-

100,000

7,500,000

EKG

MANTUK

Resusitasi

100,000

CTG

285,000
160,500
445,500

684,000
684,000
36,000
210,000
18,000
36,000
42,000
306,000

36,000
36,000
-

36,000

196,000

5,932,000

72,000

4,300,500
4,300,500

70,000
126,000

OBAT

LABOR

16,347,463

RONTGEN

9,588,000

DARAH

1,956,000

274,606
353,319

24,000

627,925

24,000

202,586

200,000

426,803

454,000

629,389

654,000

75,000
-

75,000

595,977

595,977

18,200,754

USG

10,266,000

1,956,000

PENDISTRIBUSIAN
MAKANAN

OBAT

75,000

LABOR

18,578,871

410,000

5,237,700

14,918,726

450,000

3,593,000

33,497,597

860,000

8,830,700

3,518,174

114,000

3,958,139

84,000

38,000

7,476,313

198,000

38,000

4,500,739

20,000

1,837,000

4,500,739

20,000

1,837,000

200,000
100,000

3,522,836
2,842,204
373,205
118,899
259,059
1,204,726
171,544
306,706

150,000
162,000
44,000
6,000
38,000
10,000
6,000
24,000

2,162,500
2,952,700
163,000
38,000
110,000
59,500
146,000
88,000

300,000

8,799,179

440,000

5,719,700

1,071,460
1,015,303

114,000
72,000

1,410,000
1,710,000

2,086,763

186,000

3,120,000

500,000

2,462,459

146,000

506,500

200,000

1,205,804

76,000

315,000

700,000

3,668,263

222,000

821,500

407,597

18,000

392,500

20,885,422

236,000

8,492,000

20,885,422

236,000

8,492,000

166,462

12,000

120,000

9,558,744

70,000

1,386,000

2,252,129

86,000

891,800

11,810,873

156,000

2,277,800

1,000,000

92,891,611

2,330,000

31,256,700

TOTAL
51,225,963
363,606
486,319
849,925
528,586
1,172,803
1,701,389
14,000
14,000
14,824,000
14,824,000
123,000
123,000
648,977
648,977
-

69,387,254

69,387,254

BIOPSI

ENDOSCOPY

RONTGEN

KOLONOSCOPY DKK

522,000

800,000

490,000

800,000

1,012,000

58,000
-

58,000

116,000
116,000

58,000
58,000
-

348,000

50,000
-

50,000

58,000
-

800,000

1,468,000

69,387,254

ECOCARDIOGRAFI

PERSALINAN/MANUA
L
PLACENTA/EKSPLRSI

DARAH

OPERASI/ SC

4,357,000
6,107,000
-

10,464,000

2,500,000

15,000,000

16,800,000
-

2,500,000

31,800,000

500,000
-

500,000
1,107,000
1,500,000

7,200,000
500,000
7,200,000
-

3,107,000

14,400,000

1,000,000

500,000

3,370,000

5,940,000

2,025,000

1,500,000

500,000

5,395,000

7,440,000

1,000,000
-

855,000
855,000

3,500,000

285,000
285,000

1,140,000

18,071,000

5,395,000

57,140,000

CURRETAGE

LAPARATOMY/KONTA
PTUBEKTOMI

TOTAL

52,878,071
52,124,226
-

105,002,297
28,336,674
26,263,139
-

54,599,813
#REF!

#REF!
31,694,336
35,010,904
10,473,705
1,155,899
7,335,059
3,353,226
1,812,544
11,978,206

102,813,879
9,793,960
10,673,803

20,467,763
-

840,000

540,000

23,783,459

840,000

10,677,804

1,680,000

540,000

34,461,263
-

2,172,097
-

2,172,097
63,688,422
-

63,688,422
4,633,462
18,878,244
13,810,429

1,680,000

540,000

32,688,673
#REF!
#REF!

#REF!

105,002,297

54,599,813

#REF!

102,813,879

20,467,763

34,461,263

63,688,422

32,688,673
#REF!

APRIL 2012
OPERASI

KELOMPOK I
MATA
BEDAH (ZAITUL)
(RISBENY)
KEBIDANAN
THT

200,000
240,000
240,000
200,000

KELOMPOK II
KEBIDANAN (ADRISWAN)
KEBIDANAN (SYAHRIAL)
BEDAH ( ZAITUL )
ORTOPEDI
THT
ANAK
PARU

700,000
840,000
840,000
700,000
700,000
700,000
700,000

KELOMPOK III
BEDAH ( NOVLI )
THT
ORTOPEDI
KEBIDANAN (ADRISWAN)
(SYAHRIAL)
KEBIDANAN (ADRISWAN)
KEBIDANAN (SYAHRIAL)
MATA

1,200,000
1,000,000
1,000,000
1,200,000
1,000,000
1,500,000
1,250,000
1,200,000

KELOMPOK KHUSUS
BEDAH ( NOVLI )
ORTOPEDI
MATA

2,150,000
1,800,000
2,150,000

PERSALINAN DG EPISIATOMI
TINDAKAN (ADRISWAN)
TINDAKAN (SYAHRIAL)

275,000
275,000

PERSALINAN TANPA PENYULIT


IBU
TINDAKAN (ADRISWAN)
(SYAHRIAL

65,000
250,000
250,000

PERSALINAN DENGAN PENYULIT


IBU
TINDAKAN (ADRISWAN)
(SYAHRIAL

65,000
350,000
300,000

TOTAL OPERASI

REKAP KLAIM MARET 2015


PEMERIKSAAN/P1
IGD

2,786,000

P1

P. INTERNE

MR

HEACTING

1,512,000

MR

OBSERVASI
-

LABOR

INJEKSI

5,822,000

RONTGEN

SKINTEST

5,004,000

OBAT

LABOR

986,000

USG

PASANG INFUS

9,588,000

PASANG
KATETER

1,952,000

KONSUL
SPESIALIS

EKG

364,000

3,490,000

CORPUS
ALIENUM

30,000

NGT
-

PSG TAMPON

60,000

PERAWATAN
LUKA

USG
-

ECOCARDIOGRA
F

16,000

PASANG SPALK

EKG

PARTUS

PERAWATAN
TALI PUSAT

PERAWATAN
BBL

NEBU

VULVA
HIGIENE

RONTGEN

825,000

1,956,000

WSD

355,500

MONITOR
-

DUMIN SUSP

24,000

Obat

JUMLAH

16,347,463

51,117,963
-

dr. Drajad Priyono, Sp.PD

36,000

18,000

274,606

35,000

363,606

dr. Letmi Yestrijal, Sp.PD


dr. YUGO ALISON O

74,000

35,000

24,000

353,319

486,319

110,000
P. BEDAH

P1

dr. Zaitul Ikhlas, Sp.B


dr.Syahrial,Sp.B

53,000

MR

200,000

108,000

69,000

115,000

454,000

#REF!

P1

dr. Noverial, Sp.OT

#REF!

#REF!

MR

#REF!

RONGTEN

627,925

EKG

36,000

#REF!
P. ORTOPEDI

LABOR

30,000

#REF!

#REF!

24,000

TINDAKAN

60,000

#REF!

426,803

#REF!

LABOR

35,000

528,586

1,172,803

#REF!

#REF!

#REF!

#REF!

#REF!
-

#REF!
-

Obat2an

dr. Endayani, MPH


P. ANAK

849,925
-

RONTGEN

202,586

#REF!

#REF!

TINDAKAN

OBAT
-

P1

dr. Yunira Yunirman, Sp.A


dr. Asrinal, Sp.A

MR

INJEKSI

MANTOX TEST

ROTGEN

LABOR

Obat2an

14,000

14,000

14,000
-

14,000

P. THT
P. MATA

HEMODIALISA (DR.DRAJAD)

P. KEBIDANAN

P1

MR

SLIT LAMP

KERATOMETRI

TONOMETRI

LABOR

OBAT

P1

MR

HD

0
0

0
0

7,000,000
7,000,000

7,500,000
7,500,000

P1

MR
-

dr. Syahrial Syukur, Sp.OG

BIOMETRI

PEMASANGAN
CDL

dr. Adriswan, Sp.OG

AUTHOREF

USG

TINDAKAN

TINDAKAN
249,000
249,000
OBAT

LABOR

TRANFUSI/
DARAH

OBAT

0
0

75,000
75,000

0
0

14,824,000

0
-

LABOR
-

12,000

11,000

100,000

12,000

11,000

100,000

123,000

P. JANTUNG (DR. M. FADIL, SP.JP)

0
P. PARU

123,000

P1

MR

NEBU

LABOR

OBAT

RONTGEN

dr. Yenny Muchtar, Sp.P


dr. Dessi susyanti, Sp.P

dr. WAHYU depamil

#REF!

#REF!

#REF!

#REF!

#REF!

#REF!

#REF!

1,952,000

364,000

3,490,000

30,000

60,000

16,000

825,000

1,956,000

355,500

24,000

16,347,463

#REF!
#REF!

VISITE DR.
SPESIALIS

RAWATAN / HCU

VISITE DR.
UMUM

LABOR

INJEKSI

SKINTEST

RONTGEN

PASANG INFUS

DARAH

TRANSFUSI

AMBIL DARAH

EKG

ROM

PENDISTRIBUSIAN
MAKANAN

OKSIGEN

REDRESING

FISIOTERAPY

ENDOSCOPY

NGT/DC

KONSUL GIZI

KONSUL
SPESIALIS

ROHIS

TOTAL CARE

PASANG
KATETER

NEBU

PERAWATAN
JENAZAH

ABDOMINAL
TAP

TAMPON
HIDUNG

OBAT

R. INTERNE

dr. Letmi Yestrijal, Sp.PD

14,445,000

708,000

270,000

3,593,000

6,142,000

140,000

490,000

361,000

6,107,000

838,000

160,500

1,200,000

450,000

78,000

800,000

80,000

3,000

360,000

225,000

250,000

30,000

270,000

DR. Drajad Priyono,SPPD

13,365,000

830,000

162,000

5,237,700

5,672,000

128,000

522,000

237,000

4,357,000

430,000

285,000

868,500

410,000

32,000

39,000

15,000

452,500

4,000

180,000

336,500

15,000

180,000

18,578,871

540,000

561,500

250,000

45,000

450,000

33,497,597

27,810,000
R. BEDAH

RAWATAN

1,538,000

432,000
PERAWATAN
PRE/POST OP

OPERASI

8,830,700
VISITE DR.
SPESIALIS

11,814,000
VISITE DR.
UMUM

268,000
KONSUL SPS

1,012,000
KONSUL GIZI

598,000
TEST MINUM

10,464,000
SKINTEST

1,268,000
INJEKSI

GV

445,500
PASANG INFUS

PERAWATAN LUKA

2,068,500
FIBRIDING

860,000
AFF/HEACTING

32,000
TAMPON

117,000
RONTGEN

800,000
LABOR

95,000
DARAH

7,000
PENDISTRIBUS
IAN MAKANAN

OBAT

dr. zaitul iklas spb

3,080,000

15,000,000

210,000

84,000

24,000

267,000

2,120,000

150,000

132,000

502,000

10,000

5,500

95,000

2,500,000

165,000

114,000

3,518,174

28,336,674

dr. syahrial spb

3,220,000

16,800,000

302,500

204,000

36,000

177,000

909,000

90,000

50,000

206,000

58,000

38,000

130,500

84,000

3,958,139

26,263,139

6,300,000

31,800,000

512,500

288,000

60,000

444,000

3,029,000

240,000

182,000

708,000

10,000

5,500

95,000

58,000

38,000

2,500,000

295,500

198,000

7,476,313

54,599,813

dr. Noverial, Sp.OT

R. ICU

DR.YENDI, SP.AN

RAWATAN / HCU
3,750,000
3,750,000

RAWATAN / HCU
R. VIP

DR. LETMI YESTRIJAL,SP.PD


DR. DRAJAD PRIYONO, SP.PD
DR. SYAHRIAL, SP.B
DR. YUNIRA YUNIRMAN
DR. DESSY SP.P
DR. ZAITUL I
dr. Yenny Muchtar, Sp.P

18,750,000
20,250,000
2,000,000
4,750,000
1,250,000
3,000,000
#REF!
#REF!

R. ANAK

dr. Yunira Yunirman, Sp.A


dr. Asrinal, Sp.A

R. KEBIDANAN
dr. Adriswan, Sp.OG
dr. Syahrial Syukur, Sp.OG

R. MATA

RAWATAN / HCU

INJEKSI
870,000
870,000

VISITE DR.
SPESIALIS
1,368,000
1,620,000
72,000
432,000
108,000
375,000
#REF!
#REF!

PASANG
INFUS
170,000
65,000
235,000

#REF!

INJEKSI
938,000

2,630,000

648,000
1,586,000

OPERASI

TOTAL CARE

ROM

PSG NGT

80,000

2,147,000

450,000

80,000

2,147,000

450,000

KONSUL DR.
SPESIALIS

KONSUL GIZI

36,000
#REF!
#REF!

SKINTEST

#REF!

#REF!

FOTOTHERAPY

#REF!

865,000

#REF!

865,000

PERAWATAN
LUKA

ROHIS

115,000
276,000
#REF!

PASANG INFUS ORAL HIEGINE

#REF!

SKINTEST

25,000
12,500
12,500
#REF!

35,000
35,000
35,000
70,000
#REF!

#REF!

#REF!

PERTOLONGA PERAWATAN
N BBL
TALI PUSAT

INJEKSI

#REF!
#REF!

PASANG
INFUS
30,000
75,000
15,000
30,000
15,000
30,000
#REF!

364,500
1,053,000

650,000
492,000

389,500
-

104,500
121,500

36,000
-

1,417,500

1,142,000

389,500

226,000

36,000

62,500

2,750,000

OPERASI / SC

KONTAP

40,000

1,464,000

242,000

1,837,000

684,000

124,000

#REF!

20,000

#REF!

#REF!

1,464,000

242,000

1,837,000

684,000

124,000

#REF!

20,000

#REF!

#REF!

INJEKSI

30,000
#REF!
#REF!

TOTAL CARE

1,935,000
2,400,000
255,000
240,000
105,000
540,000
#REF!

DARAH

300,000
375,000
150,000
#REF!

#REF!

OPERASI

1,107,000
1,500,000
500,000
#REF!

#REF!

PENDISTRIBUS
IAN MAKANAN

NEBULIZER

7,200,000
7,200,000
#REF!

#REF!

RONTGEN

PRE/POST OP

#REF!

VTP/RJP

50,000
-

1,000,000

295,000

148,000

50,000

1,000,000

295,000

148,000

PASANG IUD

VH

HEACTING

1,625,000

659,000

1,625,000

MONTOUX
TEX

#REF!
#REF!

PENGOLAH
DARAH PMI

USG ABD

#REF!

#REF!

#REF!

150,000
225,000
150,000
#REF!

150,000
162,000
44,000
38,000
10,000
24,000
#REF!

36,000
#REF!

200,000
100,000
#REF!

#REF!

#REF!

#REF!

#REF!

#REF!

#REF!

#REF!

#REF!

#REF!

OBAT
-

PASANG
INDUKSI

1,071,460
1,015,303
-

RAWATAN
BAYI

150,000
-

300,000

236,000

300,000

10,000

97,000

150,000

15,000

60,000

315,000

200,000

90,000

1,318,000

574,000

300,000

65,000

100,000

229,000

905,000

45,000

340,000

821,500

700,000

225,000

40,000

500,000

150,000

#REF!

#REF!

OBAT

198,000
198,000

2,782,000
2,782,000

2,100,000
2,100,000

4,300,500
4,300,500

630,000
630,000

111,000
111,000

PASANG INFUS

PENDISTRIBUSIAN
MAKANAN

855,000
855,000

175,000
175,000

R. THT

VISITE DR
UMUM

KONSUL
SPESIALIS

SKINTEST

INJEKSI

dr. Yenny Muchtar, Sp.P

2,440,000

222,000

42,000

300,000

90,000

690,000

152,000

70,000

dr. Desi Susyanti, Sp.P

3,300,000
5,740,000
#REF!

420,000
642,000
#REF!

66,000
108,000
#REF!

330,000
630,000
#REF!

30,000
120,000
#REF!

831,000
1,521,000
#REF!

39,000
191,000
#REF!

86,000
156,000
#REF!

TOTAL KLAIM MARET 2015

ASPIRASI
PNEUMOTHOR
AK

REPAIRE
JAHITAN

NECROTOMY

72,000
72,000

1,425,000
1,425,000

ROM

4,420,000
4,420,000
PENYULUHAN
PULANG

NEBU

#REF!

#REF!

#REF!

#REF!

#REF!
#REF!
#REF!

#REF!

2,074,500
2,709,500
4,784,000
#REF!

150,000

P.JENAZAH

RJP

2,642,500
2,642,500

OKSIGEN

500,000

MONITOR

40,000

TRANSFUSI

150,000
PENDISTRIBUSIA
PASANG INFUS
N MAKANAN
-

OKSIGEN

135,000

DARAH

20,000

PASANG KATETER

500,000

FIBRIDING/K
LISMA

90,000

PASANG INFUS

506,500

SKL

110,000

ECOCARDIOGRAFY

280,000

USG

SKINTEST

30,000

LABOR

620,000

KONSUL
SPESIALIS

755,000

2,086,763

AKTE
KELAHIRAN

EKG

132,000

NEBU

1,879,000

SYRING PUMP

90,000

MINI USD

659,000

1,879,000

PENDISTRI
BUSIAN
MAKANAN

VISITE DR
SPESIALIS

12,000
84,000
96,000

PASANG
INFUS

#REF!

INJEKSI

65,000

#REF!

PASANG
MONITOR

#REF!

TAMPON HDG

840,000

VISITE DR
UMUM

20,000
20,000
#REF!

75,000
75,000

FISIOTERA
PY

PASANG
MONITOR

1,680,000

USG ABDOMEN

#REF!

VISITE DR.
UMUM

500,000
500,000

KONSUL
DOKTER

OKSIGEN

PENYULUHAN

PASANG TAMPON

768,000
528,000
1,296,000

PASANG
KATETER

GV

2,162,500
2,952,700
163,000
110,000
59,500
88,000
#REF!

50,000
50,000

PLURAL
FUNGSI

PERAWATAN
JENAZAH

TRANFUSI

540,000

LABOR

338,000

EKPLORASI

#REF!

LABOR

DARAH

1,500,000

SKINTEST

1,018,000

DIGITAL(MANUAL) VAKUM EKTRAKS

240,000
120,000
#REF!

VISITE DR.
SPESIALIS

114,000
72,000

RAWATAN

#REF!

OKSIGEN

186,000

R. PARU

#REF!

TRANSFUSI

#REF!

175,000

DR. M FADIL, SP.JP

116,000
116,000
58,000
58,000
#REF!

OKSIGEN

175,000

972,000
972,000

USG

12,600,000
12,600,000

#REF!

DARAH

dr. susiyanti sp.jp

60,000
60,000
#REF!

RONTGEN

PERAWATAN
PRE/POST OP

620,000

774,000
729,000
116,000
171,000
45,000
108,000
#REF!

#REF!

PEMBERIAN
MAKAN NGT

TRANSFUSI

DR. YUNIRA YUNIRMAN,SP.A

VISITE DR
SPESIALIS

SUCTION

40,000

dr.Drajad Priyono, Sp.PD

RAWATAN /HCU

RJP

30,000

dr. Joni Sastra, Sp.M

R. JANTUNG

RONTGEN

7,440,000

INJEKSI

SKINTEST

1,725,000

VISITE DR.UMUM

VH

4,475,000

VISITE DR.SP

840,000

EKG

30,000

MANUAL
PLACENTA

TUBEKTOMY

LABOR

11,000

TONOMETRI

540,000

CURRATACE

VISITE DR.
UMUM

73,500

PERAWATAN
PERAWATAN LUKA
PRE/POST OP

5,940,000

LAPARATOMY

VISITE
SPESIALIS

595,000

PASANG NGT

PERAWATAN
LUKA

PENDISTRIBU
SIAN
MAKANAN

595,000

#REF!

MANTOX
TEST

1,410,000
1,710,000

PERSALINAN

PASANG
KATETER

INFUS PUMP

PASANG
KATETER

3,120,000

PERAWATAN
TALI PUSAT

6,815,000

RAWATAN

1,008,000
1,188,000
90,000
216,000
72,000
144,000
#REF!

LABOR

4,630,000
3,915,000

4,185,000

250,000
250,000

VISITE DR.
UMUM

8,545,000

RAWATAN / HCU

BRONKIAL
TOILET

MASSAGE

452,500
ROM

14,918,726

PLEURA
PUNCTIE
PROF/WSD

RONTGEN
#REF!

FISIOTERAPY

118,000
118,000
236,000
#REF!

TRANSFUSI

PRAWTN LUKA

FISIOTERAPY/INH
ALASI TERAPY

#REF!

900,000
2,568,000
3,468,000
#REF!

LABOR

RONTGEN

39,000
39,000

8,492,000
8,492,000

PENDISTRIBUSIAN
MAKANAN

236,000
236,000

ECOCARDIOG
KONSUL GIZI
RAF

ROHIS
#REF!

285,000
285,000
#REF!

4,000
4,000
#REF!

OBAT

LABOR

20,885,422
20,885,422

OBAT

1,386,000

9,558,744

891,800
2,277,800
#REF!

2,252,129
11,810,873
#REF!

#REF!

#REF!

#REF!

#REF!

PERAWATAN
LUKA

GV/DC

OKSIGEN

SKINSTEST

VISITE DR. VISITE DR.


UMUM
SPS

PENDISTRI
BUSIAN
MAKANAN

JUMLAH

OBAT

51,919,226
52,337,071
104,256,297
JUMLAH
56,313,348
52,526,278
-

108,839,626
JUMLAH

OBAT
4,500,739

#REF!

4,500,739

OBAT

#REF!
JUMLAH

3,522,836
2,842,204
373,205
259,059
1,204,726
306,706
#REF!

31,598,336
34,800,904
10,455,705
7,335,059
3,353,226
11,978,206
#REF!

#REF!

#REF!
JUMLAH
9,769,960
10,673,803

PERAWATAN
LUKA

GV/DC

OKSIGEN

VISITE DR. VISITE DR.


SKINSTEST
UMUM
SPS

PENDISTRI
BUSIAN
MAKANAN

20,443,763
JUMLAH

OBAT

78,000

199,000

72,000

144,000

146,000

2,462,459

45,000

82,000

28,000

12,000

72,000

76,000

1,205,804

10,667,804

123,000

281,000

100,000

12,000

216,000

222,000

3,668,263

34,424,263

23,756,459

JUMLAH
-

JUMLAH

62,935,422
62,935,422

JUMLAH
#REF!
#REF!

281,000

100,000

12,000

216,000

222,000

3,668,263

#REF!
#REF!
#REF!
#REF!

160,000
20,000
26,000
10,000
120,000
15,000
36,000
8,000
1,200,000
20,000
1,615,000