RAWAT INAP

KODE ICD DX INA

NO NO RM NAMA UMUR TANGGAL TANGGAL LOS LAYANAN SEP PROSEDUR NAMA TNDK TARIF RS TARIF BPJS KELAS
MASUK KELUAR
PRIMER SEKUNDER PRIMER SEKUNDER

1 035350 ACH FAREL DANENDRA F. 6 30/09/18 03/10/18 WATUM 0187R0160918V001094 J06.9 ISPA MRS Rp 1,273,100 Rp 2,082,000 2
2 029090 DANADYAKSA HERNANDO 2 01/10/18 03/10/18 WATUM 0187R0161018V000043 A01.0 Typhoid Fever MRS Rp 1,257,400 Rp 2,511,000 2
3 035366 IMAM SUGENG DIONO 37 01/10/18 03/10/18 WATUM 0187R0161018V000063 A01.0 Typhoid Fever MRS Rp 1,177,150 Rp 2,092,500 3
4 034836 UMI KULSUM 63 01/10/18 03/10/18 WATUM 0187R0161018V000062 J06.9 ISPA MRS Rp 1,250,700 Rp 2,082,000 2
5 035371 SUNAMI 57 02/10/18 03/10/18 WATUM 0187R0161018V000080 D17.7 Soft Tissue Tumor 86.3 Excisi Rp 5,647,100 Rp 3,870,300 2
6 035367 KARIATI 61 01/10/18 03/10/18 WATUM 0187R0161018V000061 I25.1 ASHD MRS Rp 1,072,400 Rp 1,362,800 3
7 028771 PERMADI AGUNG NUROHMAN 25 03/10/18 06/10/18 WATUM 0187R0161018V000200 I84.2 Hemoroid Interna 49.46 Hemoroidectomy Rp 6,270,900 Rp 4,628,800 2
8 034428 NITA TRISANTI 28 01/10/18 04/10/18 OBSGYN 0187R0161018V000060 N83.0 Cysta Ovarii 65.49 SOS Rp 5,193,400 Rp 5,353,800 3
9 035330 THALHA NABILA 17 02/10/18 03/10/18 WATUM 0187R0161018V000109 D17.7 Soft Tissue Tumor 86.3 Excisi Rp 2,282,600 Rp 3,225,200 3
10 035393 MISDIARI 31 03/10/18 04/10/18 WATUM 0187R0161018V000199 D17.7 Soft Tissue Tumor 86.3 Excisi Rp 2,358,600 Rp 3,870,300 2
11 035335 SULIHA 46 28/09/18 01/10/18 OBSGYN 0187R0160918V001043 O14.1 O82.0 PEB Lahir SC 74.0 SC Rp 6,082,300 Rp 4,542,200 3
12 035360 AGUSTINA SUSANTI 25 01/10/18 04/10/18 OBSGYN 0187R0161018V000059 O21.0 Hyperemesis Gravidarum MRS Rp 1,106,000 Rp 2,279,800 2
13 007424 EVANGELINA BONITA DOS S. 20 01/10/18 04/10/18 OBSGYN 0187R0161018V000455 O42.9 O82.0 KPD Lahir SC 74.0 SC Rp 6,305,500 Rp 5,152,300 2
14 022592 ANISYA RHAMAWATI 27 03/10/18 04/10/18 OBSGYN 0187R0161018V000201 O06.9 Abortus Incomplete 69.01 Curretage Rp 2,783,900 Rp 1,659,800 2
15 035378 DHIMAS TRI ANGGARA 20 02/10/18 03/10/18 WATUM 0187R0161018V000105 D17.7 Soft Tissue Tumor 86.3 Excisi Rp 2,282,600 Rp 3,225,200 3
16 020235 KUNTI WAHYUNI 38 08/10/18 09/10/18 OBSGYN 0187R0161018V000377 O06.9 Abortus Incomplete 69.01 Curretage Rp 2,609,400 Rp 5,353,800 3
17 021494 DIMAZ FAHRIZAL AL FARDAN 9 02/10/18 04/10/18 WATUM 0187R0161018V000103 A01.0 Typhoid Fever MRS Rp 1,270,550 Rp 2,092,500 3
18 035349 HAMDHA KUSUMA WARDANA 5 29/09/18 02/10/18 WATUM 0187R0160918V001092 A01.0 Typhoid Fever MRS Rp 1,386,300 Rp 2,092,500 3
19 035518 ANAIYA ANGELINA S. 8 10/10/18 12/10/18 WATUM 0187R0161018V000508 A01.0 Typhoid Fever MRS Rp 1,058,600 Rp 2,511,000 2
20 025512 SRI HASTUTI MOKOGINTA 35 06/10/18 08/10/18 WATUM 0187R0161018V000267 A01.0 N39.0 Typhoid Fever ISK MRS Rp 1,685,500 Rp 3,048,000 2
21 007788 WIYONO 58 09/10/18 12/10/18 WATUM 0187R0161018V000437 I11.9 HHD MRS Rp 1,592,700 Rp 2,004,800 2
22 009189 NENENG HASANAH 41 12/10/18 13/10/18 OBSGYN 0187R0161018V000606 O42.9 O80.0 KPD Lahir Spontan 73.59 Partus Rp 2,042,080 Rp 2,084,400 2
23 035480 YULIANA 30 10/10/18 13/10/18 OBSGYN 0187R0161018V000483 O32.2 O82.0 Letak Lintang Lahir SC 74.0 SC Rp 5,939,400 Rp 5,152,300 2
24 035557 LUTFIYAH 32 12/10/18 13/10/18 OBSGYN 0187R0161018V000605 O02.0 Blighted Ovum 69.09 Curretage Rp 2,753,400 Rp 1,659,800 2
25 027452 MARIA ULFA 34 09/10/18 11/10/18 WATUM 0187R0161018V000433 K30 Dyspepsia MRS Rp 969,600 Rp 1,300,900 2
26 031228 RUSMIATI NINGSIH 35 05/10/18 08/10/18 OBSGYN 0187R0161018V000253 N83.0 Cysta Ovarii 65.49 SOS Rp 5,147,400 Rp 5,353,800 3
27 030038 MUNIFATUL LUTFIAH 24 08/10/18 11/10/18 OBSGYN 0187R0161018V000374 O33.9 O82.0 CPD Lahir SC 74.0 SC Rp 6,304,300 Rp 5,152,300 2
28 035465 AGNESA FITRI AMELLIZA 10 07/10/18 09/10/18 WATUM 0187R0161018V000310 A01.0 Typhoid Fever MRS Rp 1,198,200 Rp 2,511,000 2
29 030749 WILDAN ALI WAFA 16 13/10/18 14/10/18 WATUM 0187R0161018V000608 D17.7 Soft Tissue Tumor 86.3 Excisi Rp 4,926,400 Rp 3,870,300 2
30 035478 ANDI SANJAYA 20 08/10/18 11/10/18 WATUM 0187R0161018V000801 I84.2 Hemoroid Interna 49.46 Hemoroidectomy Rp 6,030,200 Rp 4,628,800 2
31 035486 SUGENG RIADI 38 09/10/18 10/10/18 WATUM 0187R0161018V000421 D17.7 Soft Tissue Tumor 86.3 Excisi Rp 4,843,500 Rp 3,870,300 2
32 027702 YODA VIONIGARRA 4 13/10/18 17/10/18 WATUM 0187R0161018V000646 A01.0 Typhoid Fever MRS Rp 2,029,500 Rp 2,511,000 2
33 035585 NASYA THADILLA ATHIYAN 9 15/10/18 17/10/18 WATUM 0187R0161018V000702 A01.0 Typhoid Fever MRS Rp 1,115,600 Rp 2,511,000 2
34 035591 ASTY OLIVIA PUTRI PRATIWI 5 15/10/18 17/10/18 WATUM 0187R0161018V000728 A01.0 Typhoid Fever MRS Rp 1,042,200 Rp 2,092,500 3
35 020689 ATIM NURJANAH 35 19/10/18 22/10/18 OBSGYN 0187R0161018V000935 O48 O82.0 Post Date Lahir SC 74.0 SC Rp 6,082,900 Rp 5,152,300 2
36 035630 AMADEUS DIRGHAM HAIDAR 5 17/10/18 18/10/18 WATUM 0187R0161018V000828 A01.0 Typhoid Fever MRS Rp 918,900 Rp 2,511,000 2
37 035477 TITIN VERLAEN 40 08/10/18 11/10/18 OBSGYN 0187R0161018V000376 N83.0 Cysta Ovarii 65.49 SOS Rp 5,790,850 Rp 6,424,600 2
38 034086 AKHALENDRA ROLAND AKBAR 1 17/10/18 18/10/18 WATUM 0187R0161018V000798 K30 Dyspepsia MRS Rp 853,300 Rp 1,300,900 2
39 024920 PRASETYO HIDAYAT IQBAL 5 17/10/18 18/10/18 WATUM 0187R0161018V000836 A01.0 Typhoid Fever MRS Rp 743,600 Rp 2,929,500 1
40 035593 LESTARI SITA AGUSTIN 22 15/10/18 18/10/18 OBSGYN 0187R0161018V000730 O42.9 O82.0 KPD Lahir SC 74.0 SC Rp 6,181,300 Rp 5,152,300 2
41 035535 ARIS RATNAWATI 34 11/10/18 14/10/18 OBSGYN 0187R0161018V000555 O63.0 O82.0 Prolonged Laten Fase Lahir SC 74.0 SC Rp 5,839,200 Rp 4,293,500 3
42 035590 ANGGELA INDRI LESTARI 21 15/10/18 16/10/18 OBSGYN 0187R0161018V000716 O06.9 Abortus Incomplete 69.01 Curretage Rp 2,575,900 Rp 1,383,100 3
43 024300 RIKMA NOVITASARI 21 15/10/18 16/10/18 OBSGYN 0187R0161018V001035 O06.9 Abortus Incomplete 69.01 Curretage Rp 2,757,400 Rp 1,659,800 2
44 033257 MAHATTA SULTAN MACHSUM 6 03/10/18 07/10/18 WATUM 0187R0161018V000156 A01.0 Typhoid Fever MRS Rp 1,687,900 Rp 2,511,000 2
45 035582 MOH. RADITYA BAGUS 5 15/10/18 19/10/18 WATUM 0187R0161018V000687 A01.0 Typhoid Fever MRS Rp 1,221,000 Rp 2,511,000 2
46 035624 AULIA ULINNUHA FITRIA 7 17/10/18 19/10/18 WATUM 0187R0161018V000819 A01.0 Typhoid Fever MRS Rp 1,288,200 Rp 2,511,000 2
47 035610 ILHAM BINTANG PUTRA FAUZI 10 16/10/18 19/10/18 WATUM 0187R0161018V000769 A01.0 Typhoid Fever MRS Rp 1,482,400 Rp 2,929,500 1
48 020535 ANIK SRIWIDAYATI 48 16/10/18 19/10/18 WATUM 0187R0161018V000789 K80.8 Cholelithiasis MRS Rp 1,758,300 Rp 3,809,100 1

Page 1 of 53
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49 035660 IIS PURWANINGTYAS 24 19/10/18 20/10/18 WATUM 0187R0161018V000926 D17.7 Soft Tissue Tumor 86.3 Excisi Rp 4,904,700 Rp 3,870,300 2
50 035621 PIPIT HERMANTO 35 17/10/18 20/10/18 WATUM 0187R0161018V000851 L04.1 N48.2 Lympadenitis Fibrosis Penis MRS Rp 1,214,700 Rp 2,490,500 2
51 032628 DODIK WIJAYA 39 17/10/18 19/10/18 WATUM 0187R0161018V000853 A01.0 Typhoid Fever MRS Rp 1,651,300 Rp 2,511,000 2
52 009497 NUR FADILAH 44 18/10/18 20/10/18 WATUM 0187R0161018V000903 J06.9 ISPA MRS Rp 1,034,100 Rp 2,082,000 2
53 009617 DHEA AYU GITA 17 10/10/18 12/10/18 WATUM 0187R0161018V000502 K30 Dyspepsia MRS Rp 1,107,250 Rp 1,300,900 2
54 035502 LINA ALIFIA CAHYANINGRUM 29 22/10/18 23/10/18 WATUM 0187R0161018V001043 D17.7 Soft Tissue Tumor 86.3 Excisi Rp 4,226,700 Rp 4,515,300 1
55 028545 ABDUS SALAM AFANDI 34 22/10/18 23/10/18 WATUM 0187R0161018V000986 K30 Dyspepsia MRS Rp 1,062,900 Rp 1,300,900 2
56 021180 H. ALI HAMDAN MUJIANA 78 21/10/18 23/10/18 WATUM 0187R0161018V000981 K80.8 N39.0 Cholelithiasis ISK MRS Rp 1,086,600 Rp 3,174,100 3
57 033871 AZKA AZFAR RABBANI 0 20/10/18 22/10/18 WATUM 0187R0161018V000967 J02.9 Pharingitis Acute MRS Rp 987,400 Rp 2,082,000 2
58 035581 JEFFRY ANTON PRAKOSO 24 17/10/18 22/10/18 WATUM 0187R0161018V000852 I84.2 Hemoroid Interna 49.46 Hemoroidectomy Rp 5,722,800 Rp 4,628,800 2
59 035649 MAISA S. TOSSE 43 18/10/18 20/10/18 WATUM 0187R0161018V000892 A01.0 N39.0 Typhoid Fever ISK MRS Rp 1,228,000 Rp 3,048,000 2
60 035700 DICKY ARLANGGA 6 22/10/18 24/10/18 WATUM 0187R0161018V001034 A01.0 Typhoid Fever MRS Rp 1,319,500 Rp 2,511,000 2
61 025024 DEVINA SAVANA 5 22/10/18 24/10/18 WATUM 0187R0161018V001041 A01.0 Typhoid Fever MRS Rp 1,285,000 Rp 2,511,000 2
62 035632 RUTH SENNIA DINASTRY 24 17/10/18 19/10/18 WATUM 0187R0161018V000834 A01.0 Typhoid Fever MRS Rp 1,212,800 Rp 2,511,000 2
63 024298 FITRIA NUR AGUSTINA 42 18/10/18 20/10/18 WATUM 0187R0161018V000895 E11.9 N39.0 DM ISK MRS Rp 1,480,200 Rp 5,305,500 2
64 035704 IDA TRI WULANDARI 46 24/10/18 27/10/18 OBSGYN 0187R0161018V001166 N83.0 Cysta Ovarii 65.49 SOS Rp 5,949,950 Rp 6,424,600 2
65 035724 LUSI ARUM PRATIWI 19 23/10/18 25/10/18 WATUM 0187R0161018V001120 T78.3 Angio Edema MRS Rp 1,114,400 Rp 1,779,600 2
66 020738 REFLY BOGI 31 26/10/18 28/10/18 WATUM 0187R0161018V001232 K81.8 Cholecystitis MRS Rp 1,406,800 Rp 3,264,900 2
67 035437 VIVIT RAHAYU 26 22/10/18 26/10/18 OBSGYN 0187R0161018V001053 O42.9 O82.0 KPD Lahir SC 74.0 SC Rp 6,799,500 Rp 5,152,300 2
68 035666 KURNIA DUSA AGUSTINA 32 19/10/18 20/10/18 2 OBSGYN 0187R0161018V000931 O06.9 Abortus Incomplete 69.01 Curretage Rp 2,813,900 Rp 1,659,800 2
69 029910 MANISAH 41 25/10/18 27/10/18 3 WATUM 0187R0161018V001229 A01.0 Typhoid Fever MRS Rp 1,457,600 Rp 2,929,500 1
70 035503 BUDIONO LADI 69 10/10/18 12/10/18 3 WATUM 0187R0161018V000453 D64.8 J44.8 Anemia COPD MRS Rp 1,134,900 Rp 2,738,800 3
71 029885 KARLINA TATYANASARI 28 03/10/18 05/10/18 3 WATUM 0187R0161018V000185 E11.9 DM Tipe II MRS Rp 2,211,500 Rp 3,796,900 2
72 035690 NOVITA KONTESA 20 22/10/18 25/10/18 4 OBSGYN 0187R0161018V000991 O47.0 Obs. HIS MRS Rp 1,150,500 Rp 1,427,900 3
73 020448 M. BINTANG IQBAL M. 16 09/10/18 11/10/18 3 WATUM 0187R0161018V000412 N39.0 ISK MRS Rp 1,249,300 Rp 2,327,800 2
74 033809 WIWIK SRI WIDAYATI 54 13/10/18 14/10/18 2 WATUM 0187R0161018V000711 A01.0 Typhoid Fever MRS Rp 1,202,650 Rp 2,511,000 2
75 032850 HARI MULYADI 49 09/10/18 10/10/18 2 WATUM 0187R0161018V000378 A09 GEA MRS Rp 1,500,000 Rp 1,511,400 1
76 024609 SHOLIK ACHMAD 49 11/10/18 14/10/18 4 WATUM 0187R0161018V000557 E11.9 DM Tipe II MRS Rp 1,620,350 Rp 4,429,700 1
77 035736 ZAHRA AULIA P 12 29/10/18 30/10/18 2 WATUM 0187R0161018V001337 D17.7 Soft Tissue Tumor 86.3 Excisi Rp 4,881,200 Rp 3,870,300 2
78 035755 SULISTIONO 44 28/10/18 30/10/18 3 WATUM 0187R0161018V001324 D11.0 Tumor Parotid 26.29 Excisi Rp 4,965,200 Rp 4,846,900 2
79 032845 ARIE ULLI PUTRIYANI 39 15/10/18 18/10/18 4 OBSGYN 0187R0161018V000726 O47.0 Obs. HIS MRS Rp 1,328,100 Rp 1,999,100 1
80 035514 ADELIA DEWI PUSPITASARI 21 12/10/18 15/10/18 4 OBSGYN 0187R0161018V000590 N83.0 Cysta Ovarii 65.49 SOS Rp 5,470,350 Rp 5,353,800 3
81 030375 CICIK NOVIKAWATI 34 20/10/18 25/10/18 6 WATUM 0187R0161018V000939 B17.8 N39.0 Hepatitis ISK MRS Rp 2,619,400 Rp 3,807,600 2
82 034924 AYU TITIN LESTARI 24 11/10/18 12/10/18 2 WATUM 0187R0161018V000527 K30 Dyspepsia MRS Rp 793,600 Rp 1,084,000 3
83 035617 KUKUH DWI LAKSONO 20 16/10/18 18/10/18 3 WATUM 0187R0161018V000790 A01.0 N39.0 Typhoid Fever ISK MRS Rp 1,108,500 Rp 3,048,000 2

Page 2 of 53
NO RM NAMA POLI UMUR NO SEP TANGGAL ICD 10 DX UTAMA ICD 10 DX SEKUNDER TOTAL TARIF
025634 SITI KHORIROH IGD 39 0187R0161018V000140 03/10/2018 J45.9 Asma Rp 292,900
035118 SUCI FITRIANA IGD 28 0187R0161018V000127 02/10/2018 Z48.8 Post Op D24 FAM Rp 176,200
035381 RAHMAT HIDAYAT IGD 22 0187R0161018V000104 02/10/2018 T14.1 V. App Rp 194,400
035306 LILIK KARIANI IGD 45 0187R0161018V000108 02/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
033968 SUCIATI SASTAVIANA OBSTETRI 30 0187R0161018V000058 01/10/2018 Z48.8 Post Op O06.9 Abortus Incomplete Rp 176,200
033073 RUBA'IYAH OBSTETRI 51 0187R0161018V000049 01/10/2018 Z48.8 Post Op N83.0 Cyst Ovarii Rp 176,200
021480 YUSTINA DEWI OBSTETRI 25 0187R0161018V000047 01/10/2018 Z48.8 Post Op O82.0 Lahir SC Rp 176,200
025971 SUCI UDRIANA OBSTETRI 27 0187R0161018V000054 01/10/2018 Z35.3 USG Rp 281,500
035254 SULISTIYOWATI DINA AFIANA OBSTETRI 23 0187R0161018V000053 01/10/2018 Z48.8 Post Op O82.0 Lahir SC Rp 176,200
035370 MARYAM IFFAH OKTAVIKA RYLEESAS IGD 20 0187R0161018V000072 02/10/2018 K35.8 Appendicitis Acute Rp 508,200
023995 RATNA SARI ENDAH PALUPI OBSTETRI 32 0187R0161018V000052 01/10/2018 Z48.8 Post Op N83.0 Cyst Ovarii Rp 176,200
032845 ARIE ULLI PUTRIYANI OBSTETRI 39 0187R0161018V000051 01/10/2018 Z35.3 USG Rp 117,600
035073 SLAMET SUGIARTO IGD 51 0187R0161018V000048 01/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
026170 SULIPAH DALAM 56 0187R0161018V000042 01/10/2018 Z03.8 Suspect A01.0 Typhoid Fever Rp 176,200
011524 CHAYRA FAYYOLA N. SAKHI IGD 1 0187R0161018V000046 01/10/2018 A09 GEA Rp 173,400
028660 ENDANG SUSIATI IGD 40 0187R0161018V000089 02/10/2018 Z03.8 Suspect A01.0 Typhoid Fever Rp 176,200
035316 PUDJI WINARTI MATA 63 0187R0161018V000004 01/10/2018 H26.9 Cataract Rp 6,300,000
035316 PUDJI WINARTI MATA 63 0187R0161018V000180 03/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034949 ASPAN MUNADI MATA 72 0187R0161018V000002 01/10/2018 H26.9 Cataract Rp 6,300,000
034949 ASPAN MUNADI MATA 72 0187R0161018V000194 03/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034514 SRIYANTI MATA 51 0187R0161018V000008 01/10/2018 H26.9 Cataract Rp 6,300,000
034514 SRIYANTI MATA 51 0187R0161018V000197 03/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035400 FERRY OCTAVIAN PRATAMA IGD 25 0187R0161018V000186 03/10/2018 T14.1 V. App Rp 173,400
029211 KUSTONO NURHADI DALAM 63 0187R0161018V000173 03/10/2018 Z03.8 Suspect I50.9 Heart Failure Rp 176,200
035280 SITI ALIYAH OBSTETRI 43 0187R0161018V000181 03/10/2018 Z09.8 Kontrol N89.8 Flour Albus Rp 281,500
035399 ERVINA FRESETIANA OBSTETRI 29 0187R0161018V000183 03/10/2018 Z35.3 USG Rp 117,600
034978 HENY PUSPITANINGTYASTUTIK OBSTETRI 37 0187R0161018V000198 03/10/2018 Z35.3 USG Rp 281,500
020204 RATIH PUSPITASARI OBSTETRI 26 0187R0161018V000195 03/10/2018 Z35.3 USG Rp 281,500
035397 RINA PUJI LESTARI OBSTETRI 25 0187R0161018V000174 03/10/2018 Z35.3 USG Rp 281,500
034131 SADEWI SETYOWATI OBSTETRI 50 0187R0161018V000175 03/10/2018 Z48.8 Post Op N83.0 Cyst Ovarii Rp 176,200
035396 YENI KUSTIANINGSIH OBSTETRI 29 0187R0161018V000176 03/10/2018 Z35.3 USG Rp 281,500
033711 FETI IRAWATI OBSTETRI 33 0187R0161018V000172 03/10/2018 Z35.3 USG Rp 281,500
031228 RUSMIATI NINGSIH OBSTETRI 35 0187R0161018V000188 03/10/2018 N76.8 Inflamation Vagina Rp 281,500
035402 ESSY RINAWATI OBSTETRI 48 0187R0161018V000193 03/10/2018 N92.0 Excessive Menstruation Rp 281,500
035307 RUDI SALAM DALAM 35 0187R0161018V000196 03/10/2018 Z09.8 Kontrol J90 Efusi Pleura Rp 176,200
021779 NINIK MARWATI DALAM 67 0187R0161018V000192 03/10/2018 Z09.8 Kontrol E11.9 DM Tipe II Rp 176,200
033662 ASTIKA MATA 67 0187R0161018V000110 02/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035382 SITI NUR ALVIYAH MATA 29 0187R0161018V000106 02/10/2018 H52.2 Astigmatism Rp 176,200
031334 SRIYATI MATA 61 0187R0161018V000068 02/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 176,200
034650 SATUNI MATA 70 0187R0161018V000075 02/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
007466 FEBRIANA KARTIKA OBSTETRI 28 0187R0161018V000261 05/10/2018 Z35.3 USG Rp 117,600
033644 YAYUK SUDARWANTININGSIH OBSTETRI 38 0187R0161018V000263 05/10/2018 Z35.3 USG Rp 117,600
035159 HENNY SRI NARSWATI OBSTETRI 46 0187R0161018V000255 05/10/2018 Z48.8 Post Op O06.9 Abortus Incomplete Rp 176,200
021130 NAYLA DIVA SYAMARA IGD 12 0187R0161018V000309 07/10/2018 J45.9 Asma Rp 292,900
025634 SITI KHORIROH IGD 39 0187R0161018V000311 07/10/2018 J45.9 Asma Rp 292,900
035371 SUNAMI IGD 57 0187R0161018V000290 06/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
032913 NOVITA ANGGRAENI IGD 32 0187R0161018V000283 06/10/2018 A09 GEA Rp 173,400
035038 ANI ROHANI IGD 26 0187R0161018V000264 05/10/2018 J45.9 Asma Rp 292,900
035330 THALHA NABILA IGD 17 0187R0161018V000243 05/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
035436 NAUFAL ZAIDAN IGD 10 0187R0161018V000251 05/10/2018 J45.9 Asma Rp 292,900
035440 NUR CAHYA BAGAS TRIVANDA IGD 16 0187R0161018V000259 05/10/2018 T14.1 V. App Rp 194,400
035479 ALFIN DWI WICAKSONO IGD 20 0187R0161018V000371 08/10/2018 Z03.8 Suspect T09.2 Dislocation of Strain Rp 176,200
033778 HUSNUL CHOTIMAH IGD 25 0187R0161018V000307 07/10/2018 J45.9 Asma Rp 292,900
035335 SULIHA OBSTETRI 46 0187R0161018V000254 05/10/2018 Z48.8 Post Op O82.0 Lahir SC Rp 176,200
035378 DHIMAS TRI ANGGARA IGD 20 0187R0161018V000265 05/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
035371 SUNAMI IGD 57 0187R0161018V000398 09/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
035440 NUR CAHYA BAGAS TRIVANDA IGD 16 0187R0161018V000438 09/10/2018 Z09.8 Kontrol T14.1 V. App Rp 176,200
035381 RAHMAT HIDAYAT IGD 22 0187R0161018V000299 06/10/2018 Z09.8 Kontrol T14.1 V. App Rp 176,200
035330 THALHA NABILA IGD 17 0187R0161018V000372 08/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
022317 ARIF RAMADHANI MATA 27 0187R0161018V000367 08/10/2018 Z09.8 Kontrol H10.2 Conjunctivitis Rp 176,200
033693 SYAIFUL ARIFIN MATA 52 0187R0161018V000249 05/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035432 SUHARTIWI MATA 53 0187R0161018V000244 05/10/2018 H26.9 Cataract Rp 226,000
032505 SOETANI MATA 67 0187R0161018V000245 05/10/2018 H26.9 Cataract Rp 425,800
035434 MAX CAVALERA MATA 15 0187R0161018V000248 05/10/2018 H52.2 Astigmatism Rp 176,200
034133 SUNARSIH MATA 65 0187R0161018V000235 05/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035243 SUKISWATI MATA 63 0187R0161018V000236 05/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
033602 EMMY ROSTIANI MATA 46 0187R0161018V000234 05/10/2018 H52.2 Astigmatism Rp 176,200
030959 KUSIYAMIN MATA 91 0187R0161018V000233 05/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034531 NARTI MATA 44 0187R0161018V000240 05/10/2018 H40.8 Glaucoma Rp 176,200
029363 DORKAS MATA 72 0187R0161018V000241 05/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035429 SUTINI MATA 53 0187R0161018V000237 05/10/2018 H11.0 Pterygium Rp 176,200
035056 LASMIYATI MATA 60 0187R0161018V000242 05/10/2018 Z09.8 Kontrol H43.3 Vitreous Opacities Rp 226,000
031469 MOCH ASTAR MATA 73 0187R0161018V000337 08/10/2018 H26.9 Cataract Rp 6,300,000
031469 MOCH ASTAR MATA 73 0187R0161018V000529 11/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035472 MUSTAKIM MATA 59 0187R0161018V000399 09/10/2018 H26.9 Cataract Rp 6,300,000
035472 MUSTAKIM MATA 59 0187R0161018V000533 11/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
025490 MUJIATI MATA 63 0187R0161018V000238 05/10/2018 H26.9 Cataract Rp 226,000
025490 MUJIATI MATA 63 0187R0161018V000358 08/10/2018 H26.9 Cataract Rp 6,300,000
025490 MUJIATI MATA 63 0187R0161018V000536 10/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035414 ABDUL SYUKUR MATA 68 0187R0161018V000395 09/10/2018 H26.9 Cataract Rp 425,800
032536 WENY RIDYASTUTIK MATA 41 0187R0161018V000461 10/10/2018 H52.1 Myopia Rp 176,200
035394 LAILA MATA 71 0187R0161018V000382 09/10/2018 H26.9 Cataract Rp 6,300,000
035394 LAILA MATA 71 0187R0161018V000538 11/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035456 DJUREMI AFANDI MATA 62 0187R0161018V000449 10/10/2018 Z09.8 Kontrol H10.8 Conjunctivitis Rp 176,200
035446 HERI DWI ATMAJI MATA 59 0187R0161018V000383 09/10/2018 H26.9 Cataract Rp 6,300,000
035446 HERI DWI ATMAJI MATA 59 0187R0161018V000539 11/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035505 NURUL AL FAJRIN ARKAN GANI MATA 5 0187R0161018V000459 10/10/2018 H27.0 Aphakia Rp 176,200
033694 SUNARKO MATA 70 0187R0161018V000478 10/10/2018 H33.5 Retinal Detachment Rp 226,000
034382 ENDANG SISWATININGSIH MATA 66 0187R0161018V000380 09/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035494 JOHNY TAMPILANG MATA 59 0187R0161018V000410 09/10/2018 H26.9 Cataract Rp 226,000
033473 MARATUL MUSLIMAH MATA 73 0187R0161018V000324 08/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
034368 ACHMAD MATA 76 0187R0161018V000396 09/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035488 NUR IMAM MAWARDI MATA 40 0187R0161018V000397 09/10/2018 H50.9 Strabismus Rp 176,200
030826 BERTHA GULTOM MATA 70 0187R0161018V000406 09/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035491 CHRIS EVAN SAHAT YEHESKIEL MATA 9 0187R0161018V000401 09/10/2018 Z03.8 Suspect H10.8 Conjunctivitis Rp 176,200
030827 BERMAN SIMANJUNTAK MATA 71 0187R0161018V000405 09/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
035381 RAHMAT HIDAYAT IGD 22 0187R0161018V000351 08/10/2018 Z09.8 Kontrol T14.1 V. App Rp 176,200
035492 DWI ARI SUTANTI MATA 25 0187R0161018V000404 09/10/2018 H52.2 Astigmatism Rp 176,200
035493 ABDI MUNIF MATA 52 0187R0161018V000407 09/10/2018 H26.9 Cataract Rp 226,000
032161 BURHANUDIN MATA 76 0187R0161018V000408 09/10/2018 H26.9 Cataract Rp 226,000
031783 JUDI WAHJONO MATA 77 0187R0161018V000379 09/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
034788 BUDI EFFENDI MATA 58 0187R0161018V000355 08/10/2018 H26.9 Cataract Rp 6,300,000
034788 BUDI EFFENDI MATA 58 0187R0161018V000544 10/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034696 MUKHTIYAH MATA 83 0187R0161018V000385 09/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
033503 WAHYUDI MATA 68 0187R0161018V000387 09/10/2018 H40.1 POAG Rp 176,200
034757 SOEMIJATI MATA 65 0187R0161018V000390 09/10/2018 Z09.8 Kontrol H40.1 Glaucoma Rp 176,200
035450 BAMBANG SOEDIONO MATA 69 0187R0161018V000394 09/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 425,800
035469 M. NOOR YASIN MATA 69 0187R0161018V000339 08/10/2018 H26.9 Cataract Rp 6,300,000
035469 M. NOOR YASIN MATA 69 0187R0161018V000545 10/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
013115 DJIMAT MATA 81 0187R0161018V000322 08/10/2018 H26.9 Cataract Rp 6,300,000
013115 DJIMAT MATA 81 0187R0161018V000546 10/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034664 HALIMAH MATA 68 0187R0161018V000366 08/10/2018 H26.9 Cataract Rp 6,300,000
034664 HALIMAH MATA 68 0187R0161018V000548 10/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
028771 PERMADI AGUNG NUROHMAN IGD 25 0187R0161018V000454 10/10/2018 Z48.8 Post Op I84.2 Hemorrhoid Rp 176,200
022393 HERMAWAN IGD 46 0187R0161018V000505 10/10/2018 Z03.8 Suspect N39.0 ISK Rp 176,200
035381 RAHMAT HIDAYAT IGD 22 0187R0161018V000526 11/10/2018 Z09.8 Kontrol T14.1 V. App Rp 176,200
016999 SOEGI ROHANI IGD 59 0187R0161018V000537 11/10/2018 J45.9 Asma Rp 292,900
035308 M. ROBI YAHYA PRATAMA ANAK 9 0187R0161018V000402 09/10/2018 Z09.8 Kontrol J20.9 Bronchitis Rp 176,200
035349 HAMDHA KUSUMA WARDANA ANAK 5 0187R0161018V000392 09/10/2018 Z09.8 Kontrol A01.0 Typhoid Fever Rp 176,200
032098 AHMAD YAHYA A. K ANAK 6 0187R0161018V000388 09/10/2018 Z09.8 Kontrol J20.9 Bronchitis Rp 176,200
029090 DANADYAKSA HERNANDO YUSUF ANAK 2 0187R0161018V000400 09/10/2018 Z09.8 Kontrol A01.0 Typhoid Fever Rp 176,200
035350 ACH FAREL DANENDRA ANAK 6 0187R0161018V000393 09/10/2018 Z09.8 Kontrol J06.9 ISPA Rp 176,200
035447 SUMIATI MATA 63 0187R0161018V000386 09/10/2018 H26.9 Cataract Rp 6,300,000
035447 SUMIATI MATA 63 0187R0161018V000552 11/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
031714 SADONO MATA 64 0187R0161018V000381 09/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035473 SALAM MATA 82 0187R0161018V000623 13/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 425,800
035286 SLAMET PURNOMO MATA 47 0187R0161018V000609 13/10/2018 Z09.8 Kontrol H20.9 Uveitis Rp 176,200
035056 LASMIYATI MATA 60 0187R0161018V000566 12/10/2018 Z09.8 Kontrol H43.3 Vitreous Opacities Rp 176,200
034531 NARTI MATA 44 0187R0161018V000564 12/10/2018 H40.8 Glaucoma Rp 425,800
034133 SUNARSIH MATA 65 0187R0161018V000561 12/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034915 SUMINAH MATA 61 0187R0161018V000560 12/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034718 SUPARMI MATA 66 0187R0161018V000625 13/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034673 TANIA APRILIA MATA 18 0187R0161018V000628 13/10/2018 Z09.8 Kontrol H00.0 Hordeoulum Rp 176,200
035565 FAKIH SETIAWAN MATA 45 0187R0161018V000640 13/10/2018 H52.2 Astigmatism Rp 176,200
031602 SALIMAH MATA 55 0187R0161018V000622 13/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
027338 RIZKY SULISTYOWATI MATA 28 0187R0161018V000624 13/10/2018 H52.2 Astigmatism Rp 176,200
035432 SUHARTIWI MATA 53 0187R0161018V000585 12/10/2018 H26.9 Cataract Rp 6,300,000
035432 SUHARTIWI MATA 53 0187R0161018V000708 15/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035474 ILHAM ALDIANSYAH MATA 18 0187R0161018V000626 13/10/2018 Z09.8 Kontrol H16.9 Keratitis Rp 176,200
035546 MARLENE SUSANNA MATA 69 0187R0161018V000579 12/10/2018 H40.8 Glaucoma Rp 226,000
035546 MARLENE SUSANNA MATA 69 0187R0161018V000709 15/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 425,800
033736 SUTARDI MATA 72 0187R0161018V000587 12/10/2018 H26.9 Cataract Rp 176,200
033736 SUTARDI MATA 72 0187R0161018V000710 15/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034734 FURQAN MATA 46 0187R0161018V000616 13/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035542 BAYU SUDI GUNAWAN MATA 44 0187R0161018V000570 12/10/2018 H52.2 Astigmatism Rp 176,200
035243 SUKISWATI MATA 63 0187R0161018V000559 12/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034398 DJUWARIYAH MATA 67 0187R0161018V000617 13/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
034127 SITI CHOTIDJAH MATA 66 0187R0161018V000584 12/10/2018 Z09.8 Kontrol H04.1 Dry Eye Syndrome Rp 176,200
035541 TAMIRA MATA 61 0187R0161018V000567 12/10/2018 H11.0 Pterygium Rp 837,100
035429 SUTINI MATA 53 0187R0161018V000558 12/10/2018 H11.0 Pterygium Rp 837,100
035548 RUKMININGSIH MATA 42 0187R0161018V000586 12/10/2018 H52.4 Presbyopia Rp 176,200
035149 ERDY, BA MATA 77 0187R0161018V000580 12/10/2018 Z09.8 Kontrol H04.1 Dry Eye Syndrome Rp 176,200
035545 SUPA'AT MATA 48 0187R0161018V000578 12/10/2018 H52.2 Astigmatism Rp 176,200
034048 EMI WIDARTI MATA 63 0187R0161018V000576 12/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
032647 DARLIYAH MATA 63 0187R0161018V000575 12/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034941 FRANKY HARIYANTO LIANOTO MATA 63 0187R0161018V000577 12/10/2018 Z09.8 Kontrol H04.1 Dry Eye Syndrome Rp 176,200
030218 YOHANES SOENARNO MATA 76 0187R0161018V000572 12/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
033878 DANIATI MATA 60 0187R0161018V000573 12/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
017017 JUMIATI MATA 58 0187R0161018V000614 13/10/2018 H02.8 Entropion Rp 478,300
035562 DINIATUL KUSNAH MATA 25 0187R0161018V000630 13/10/2018 H52.1 Myopia Rp 176,200
035564 UMMI SOLIHAWATI MATA 34 0187R0161018V000636 13/10/2018 H52.1 Myopia Rp 176,200
034534 NURHAYATI MATA 58 0187R0161018V000568 12/10/2018 H26.9 Cataract Rp 6,300,000
034534 NURHAYATI MATA 58 0187R0161018V000712 15/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035414 ABDUL SYUKUR MATA 68 0187R0161018V000582 12/10/2018 H26.9 Cataract Rp 6,300,000
035414 ABDUL SYUKUR MATA 68 0187R0161018V000713 15/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035440 NUR CAHYA BAGAS TRIVANDA IGD 16 0187R0161018V000556 11/10/2018 Z09.8 Kontrol T14.1 V. App Rp 176,200
035330 THALHA NABILA IGD 17 0187R0161018V000591 12/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
035371 SUNAMI IGD 57 0187R0161018V000571 12/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
025512 SRI HASTUTI MOKOGINTA DALAM 35 0187R0161018V000432 09/10/2018 Z09.8 Kontrol A01.0 Typhoid Fever Rp 176,200
020235 KUNTI WAHYUNI OBSTETRI 38 0187R0161018V000721 15/10/2018 Z48.8 Post Op O06.9 Abortus Incomplete Rp 176,200
035360 AGUSTINA SUSANTI OBSTETRI 25 0187R0161018V000724 15/10/2018 Z09.8 Kontrol O21.0 Hyperemesis Rp 176,200
007424 EVANGELINA BONITA DOS SANTOS OBSTETRI 20 0187R0161018V000725 15/10/2018 Z48.8 Post Op O82.0 Lahir SC Rp 176,200
030749 WILDAN ALI WAFA IGD 16 0187R0161018V000535 11/10/2018 Z09.8 Kontrol D17.7 Soft Tissue Tumor Rp 176,200
035478 ANDI SANJAYA IGD 20 0187R0161018V000692 15/10/2018 Z48.8 Post Op I84.2 Hemorrhoid Rp 176,200
035486 SUGENG RIADI IGD 38 0187R0161018V000688 15/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
028771 PERMADI AGUNG NUROHMAN IGD 25 0187R0161018V000707 15/10/2018 Z48.8 Post Op I84.2 Hemorrhoid Rp 176,200
035581 JEFRY ANTON PRAKOSO IGD 24 0187R0161018V000690 15/10/2018 I84.2 Hemoroid Rp 176,200
035602 SELECHUN DALAM 35 0187R0161018V000751 16/10/2018 Z03.8 Suspect E05.9 Struma Rp 176,200
035603 HERMIATI DALAM 62 0187R0161018V000752 16/10/2018 Z03.8 Suspect E11.9 DM Tipe II Rp 176,200
035616 WAHYUNI PUJIASTUTI DALAM 44 0187R0161018V000788 16/10/2018 E03.9 Hypotyroid Rp 176,200
016268 YOESOEF AKOEAN DALAM 78 0187R0161018V000787 16/10/2018 Z09.8 Kontrol E11.9 DM Tipe II Rp 176,200
035611 MARETA SULISTIYAWATI MATA 47 0187R0161018V000772 16/10/2018 H52.2 Astigmatism Rp 176,200
022744 NISRINA AZKA DZALULIA MATA 10 0187R0161018V000779 16/10/2018 Z09.8 Kontrol H10.8 Conjunctivitis Rp 176,200
035608 BUASAN MATA 47 0187R0161018V000766 16/10/2018 T15.9 Corpus Alienum Mata Rp 240,700
035614 ENA ZAENAB RACHMAN MATA 49 0187R0161018V000778 16/10/2018 H52.4 Presbyopia Rp 176,200
012820 M. KHOLILUDIN AKBAR MATA 11 0187R0161018V000833 17/10/2018 H52.1 Myopia Rp 176,200
035619 SUPARDI MATA 50 0187R0161018V000796 17/10/2018 H26.9 Cataract Rp 226,000
035622 SUNARSIH MATA 45 0187R0161018V000807 17/10/2018 H52.4 Presbyopia Rp 176,200
035626 WULAN DWI LUSIA RANI MATA 16 0187R0161018V000816 17/10/2018 H40.8 Glaucoma Rp 176,200
031722 SOEKARNO MATA 76 0187R0161018V000835 17/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
029614 UCIK SULISTYOWATI MATA 44 0187R0161018V000793 17/10/2018 Z09.8 Kontrol H11.0 Pterygium Rp 176,200
035629 NAFA DWI PUTRI MATA 14 0187R0161018V000821 17/10/2018 H53.8 Astenopia Rp 176,200
035608 BUASAN MATA 47 0187R0161018V000893 18/10/2018 Z09.8 Kontrol T15.9 Erosi Kornea Rp 226,000
035627 TRISNO PRANOTO MATA 44 0187R0161018V000817 17/10/2018 Z09.8 Kontrol H10.8 Conjunctivitis Rp 176,200
035628 SUTRISNO MATA 49 0187R0161018V000818 17/10/2018 H52.4 Presbyopia Rp 176,200
034382 ENDANG SISWATININGSIH MATA 66 0187R0161018V000731 16/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035394 LAILA MATA 71 0187R0161018V000734 16/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035446 HERI DWI ATMAJI MATA 59 0187R0161018V000733 16/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035597 SUMARNI MATA 70 0187R0161018V000736 16/10/2018 H40.8 Glaucoma Rp 176,200
034676 HERMAN YOSEP SUKAMAD MATA 69 0187R0161018V000740 16/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
031835 MUJIATI MATA 58 0187R0161018V000737 16/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035598 SATI MATA 46 0187R0161018V000739 16/10/2018 H52.0 Hypermetropia Rp 176,200
035600 FIRMAN ROIS AL HAFID MATA 19 0187R0161018V000745 16/10/2018 H52.1 Myopia Rp 176,200
035447 SUMIATI MATA 63 0187R0161018V000746 16/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035457 LASMI MATA 75 0187R0161018V000747 16/10/2018 Z09.8 Kontrol H16.0 Cornea Ulcer Rp 176,200
028883 CIONG LUN BIE MATA 63 0187R0161018V000749 16/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035379 BRAMASTA PARTHA PERMANA MATA 3 0187R0161018V000689 15/10/2018 Z09.8 Kontrol H00.1 Chalazion Rp 176,200
029090 DANADYAKSA HERNANDO YUSUF ANAK 2 0187R0161018V000875 18/10/2018 Z09.8 Kontrol A01.0 Typhoid Fever Rp 176,200
032098 AHMAD YAHYA A. K ANAK 6 0187R0161018V000874 18/10/2018 Z09.8 Kontrol J20.9 Bronchitis Rp 176,200
035640 KHANSA ARSYA RAMADEVA ANAK 6 0187R0161018V000869 18/10/2018 Z03.8 Suspect B01.0 Varicella Rp 176,200
033945 GIORGINO KENZO NUHASINA ANAK 2 0187R0161018V000902 18/10/2018 Z09.8 Kontrol L30.9 Dermatitis Rp 176,200
025490 MUJIATI MATA 63 0187R0161018V000774 16/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035381 RAHMAT HIDAYAT IGD 22 0187R0161018V000980 21/10/2018 Z09.8 Kontrol T14.1 V. App Rp 176,200
030749 WILDAN ALI WAFA IGD 16 0187R0161018V000982 21/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
034023 WAIS IQBALLUDIN IGD 7 0187R0161018V000983 21/10/2018 J45.9 Asma Rp 292,900
032249 AHDIYAN TASYA YURIL IMANI IGD 6 0187R0161018V000921 19/10/2018 Z03.8 Suspect J18.0 Bronchopneumonia Rp 176,200
035502 LINA ALIFIA CAHYANINGRUM IGD 29 0187R0161018V000971 20/10/2018 D17.7 Soft Tissue Tumor Rp 176,200
025393 AGUNG NURRAHMAN IGD 14 0187R0161018V000924 19/10/2018 D17.7 Soft Tissue Tumor Rp 176,200
032081 MOHAMMAD RIFKY DWI ARDIANSYAH IGD 11 0187R0161018V000930 19/10/2018 D17.7 Soft Tissue Tumor Rp 176,200
035681 REIGN ARGA MAHESWARA YOSEP IGD 2 0187R0161018V000973 20/10/2018 D17.7 Soft Tissue Tumor Rp 176,200
035607 SUHARTO IGD 50 0187R0161018V000887 18/10/2018 Z09.8 Kontrol D17.7 Soft Tissue Tumor Rp 176,200
035543 MUDJI SAJOGA IGD 55 0187R0161018V000922 19/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
035634 SUROSO LABORAT 30 0187R0161018V000979 20/10/2018 Z09.8 Kontrol K30 Dyspepsia Rp 176,200
035663 CHALISTA NAYA AZZAHRA MATA 6 0187R0161018V000918 19/10/2018 Z09.8 Kontrol H00.1 Chalazion Rp 176,200
035541 TAMIRA MATA 61 0187R0161018V000916 19/10/2018 Z48.8 Post Op H11.0 Pterygium Rp 176,200
035661 MISBAKHUL MUNDIR MATA 53 0187R0161018V000915 19/10/2018 H52.4 Presbyopia Rp 176,200
035243 SUKISWATI MATA 63 0187R0161018V000908 19/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
011315 DJIMAT MATA 81 0187R0161018V000907 19/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
033380 ADENAN MATA 77 0187R0161018V000904 19/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
033736 SUTARDI MATA 72 0187R0161018V000906 19/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035429 SUTINI MATA 53 0187R0161018V000905 19/10/2018 Z48.8 Post Op H11.0 Pterygium Rp 176,200
033878 DANIATI MATA 60 0187R0161018V000911 19/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
035414 ABDUL SYUKUR MATA 68 0187R0161018V000909 19/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035658 SAURI MATA 49 0187R0161018V000913 19/10/2018 H20.8 Uveitis Rp 176,200
035486 SUGENG RIADI IGD 38 0187R0161018V000877 18/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
035664 AISYAH AYUDIA INARA IGD 0 0187R0161018V000920 19/10/2018 P59.9 Neonatal Jaundice Rp 279,200
013042 REVA AJUSTANIA BARATA P. IGD 11 0187R0161018V000886 18/10/2018 Z09.8 Kontrol D17.7 Soft Tissue Tumor Rp 176,200
035651 ANISA JUWITA IGD 28 0187R0161018V001025 22/10/2018 K30 Dyspepsia Rp 229,900
035543 MUDJI SAJOGA IGD 55 0187R0161018V000732 16/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
032247 WAHYUNINGSIH OBSTETRI 46 0187R0161018V000929 19/10/2018 Z48.8 Post Op N83.0 Cyst Ovarii Rp 176,200
035557 LUTFIYAH OBSTETRI 32 0187R0161018V000932 19/10/2018 Z48.8 Post Op O02.0 Blighted OVum Rp 176,200
035398 YENI KUSTIANINGSIH OBSTETRI 29 0187R0161018V000927 19/10/2018 Z35.3 USG Rp 281,500
030038 MUNIFATUL LUTFIAH OBSTETRI 46 0187R0161018V000933 19/10/2018 Z48.8 Post Op O06.9 Abortus Incomplete Rp 176,200
035674 NURKHAMIM MATA 39 0187R0161018V000959 20/10/2018 H52.1 Myopia Rp 176,200
033935 DZIKRI MAULANA RAMADHAN SYAPUTRA MATA 7 0187R0161018V000977 20/10/2018 Z09.8 Kontrol H18.0 VKC Rp 176,200
035660 IIS PURWANINGTYAS IGD 24 0187R0161018V001078 23/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
035643 MUJIYATI MATA 68 0187R0161018V001027 22/10/2018 H26.9 Cataract Rp 6,300,000
035643 MUJIYATI MATA 68 0187R0161018V001144 24/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035364 FIFIN ARUM ANGGRAENY OBSTETRI 32 0187R0161018V001052 22/10/2018 Z35.3 USG Rp 281,500
033681 AINI AZIZAH OBSTETRI 31 0187R0161018V001051 22/10/2018 Z09.8 Kontrol O21.0 Hyperemesis Rp 176,200
035704 IDA TRI WULANDARI OBSTETRI 46 0187R0161018V001047 22/10/2018 Z09.8 Kontrol N91.2 Amenorrhea Rp 176,200
035514 ADELIA DEWI PUSPITASARI OBSTETRI 21 0187R0161018V001046 22/10/2018 Z48.8 Post Op N83.0 Cyst Ovarii Rp 176,200
035535 ARIS RATNAWATI OBSTETRI 34 0187R0161018V001049 22/10/2018 Z48.8 Post Op O82.0 Lahir SC Rp 176,200
024300 RIKMA NOVITASARI OBSTETRI 21 0187R0161018V001048 22/10/2018 Z48.8 Post Op O06.9 Abortus Incomplete Rp 176,200
035610 ILHAM BINTANG PUTRA FAUZI ANAK 10 0187R0161018V001060 23/10/2018 Z09.8 Kontrol A01.0 Typhoid Fever Rp 176,200
035585 NASYA THADILLA ATHIYAH SYIFA ANAK 9 0187R0161018V001071 23/10/2018 Z09.8 Kontrol A01.0 Typhoid Fever Rp 176,200
035582 MOH RADITYA BAGUS ANAK 5 0187R0161018V001056 23/10/2018 Z09.8 Kontrol A01.0 Typhoid Fever Rp 176,200
034816 SLAMET MATA 69 0187R0161018V001153 24/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
009590 MAM HENDRIK LABORAT 33 0187R0161018V001161 24/10/2018 Z03.8 Suspect I63.9 CVA Rp 176,200
029271 WIDAYATI DALAM 45 0187R0161018V001205 25/10/2018 J45.9 Asma Rp 292,900
032585 ARDIAN ANANDA MATA 36 0187R0161018V001151 24/10/2018 Z09.8 Kontrol H10.8 Conjunctivitis Rp 176,200
031098 MUHAMMAD NIZAM ALFARISY MATA 6 0187R0161018V001138 24/10/2018 Z09.8 Kontrol H16.2 VKC Rp 176,200
029604 MARIA ULFA MATA 55 0187R0161018V001136 24/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
033075 DRA SUHARTATI MATA 75 0187R0161018V001140 24/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035731 KOKO DWI SUSANTO MATA 39 0187R0161018V001137 24/10/2018 H26.9 Cataract Rp 226,000
035580 HARTINI MATA 66 0187R0161018V001165 24/10/2018 Z09.8 Kontrol H40.1 POAG Rp 226,000
034921 SAHURI MATA 55 0187R0161018V001159 24/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
032200 HILMI WAHYU SETYAWAN IGD 14 0187R0161018V001185 25/10/2018 Z03.8 Suspect A01.0 Typhoid Fever Rp 176,200
020559 M. FADIL RAYNALDI OCTAVIAN IGD 8 0187R0161018V001143 24/10/2018 Z03.8 Suspect A01.0 Typhoid Fever Rp 176,200
027598 YETI SRI HARTATI LABORAT 53 0187R0161018V001146 24/10/2018 M13.9 Arthritis Rp 176,200
030385 DJOKO PRIAMBODO IGD 52 0187R0161018V001145 24/10/2018 Z03.8 Suspect K35 Appendi Rp 176,200
035736 ZAHRA AULIA P. P IGD 12 0187R0161018V001181 24/10/2018 D17.7 Soft Tissue Tumor Rp 176,200
032435 VENNY EDDA MASRIASTUTI DALAM 43 0187R0161018V001164 24/10/2018 H81.1 BPPV Rp 176,200
035477 TITIN VERLAEN OBSTETRI 40 0187R0161018V001155 24/10/2018 Z48.8 Post Op N83.0 Cyst Ovarii Rp 176,200
035593 LESTARI SITA AGUSTIN OBSTETRI 22 0187R0161018V001172 24/10/2018 Z48.8 Post Op O82.0 Lahir SC Rp 176,200
032845 ARIE ULLI PUTRIYANI OBSTETRI 39 0187R0161018V001173 24/10/2018 Z48.8 Post Op O82.0 Lahir SC Rp 176,200
030038 MUNIFATUL LUTFIAH OBSTETRI 24 0187R0161018V001178 24/10/2018 Z48.8 Post Op O82.0 Lahir SC Rp 176,200
035632 RUTH SENNIA DINASTRY DALAM 24 0187R0161018V001132 24/10/2018 Z09.8 Kontrol A01.0 Typhoid Fever Rp 176,200
035758 NURUL AINI PUTRI S IGD 27 0187R0161018V001260 26/10/2018 K30 Dyspepsia Rp 229,900
035756 DIANDRA APTA AZKAYRA ANAK 9 0187R0161018V001257 26/10/2018 D17.7 Soft Tissue Tumor Rp 178,000
035660 IIS PURWANINGTYAS IGD 24 0187R0161018V001266 26/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
032081 M. RIFKY DWI ARDIANSYAH IGD 11 0187R0161018V001270 26/10/2018 Z09.8 Kontrol D17.7 Soft Tissue Tumor Rp 176,200
035170 JUMARI IGD 53 0187R0161018V001345 29/10/2018 Z09.8 Kontrol D17.7 Soft Tissue Tumor Rp 176,200
029739 AISHA RAMADHAN YASMINE IGD 6 0187R0161018V001347 29/10/2018 A01.0 Typhoid Fever Rp 173,400
034707 ENIKE OCTAVIASARI OBSTETRI 35 0187R0161018V001264 26/10/2018 Z35.3 USG Rp 281,500
012244 MIFTA DWI HARTATI OBSTETRI 25 0187R0161018V001268 26/10/2018 Z35.3 USG Rp 281,500
035762 PUTU MANIK KENCANA DEWI OBSTETRI 38 0187R0161018V001269 26/10/2018 Z35.3 USG Rp 281,500
035553 EKA YULIANTASARI OBSTETRI 22 0187R0161018V001273 26/10/2018 Z35.3 USG Rp 281,500
035666 KURNIA DUSA AGUSTINA OBSTETRI 32 0187R0161018V001272 26/10/2018 Z48.8 Post Op O06.9 Abortus Incomplete Rp 176,200
035764 SUSAN SWARDHINI OBSTETRI 37 0187R0161018V001274 26/10/2018 Z35.3 USG Rp 117,600
035778 KINANDITA SHIFA AULIA IGD 6 0187R0161018V001326 28/10/2018 A09 GEA Rp 173,400
035713 DARMADJI IGD 64 0187R0161018V001084 23/10/2018 T14.1 V. App Rp 194,400
035713 DARMADJI IGD 64 0187R0161018V001222 25/10/2018 Z09.8 Kontrol T14.1 V. App Rp 176,200
035713 DARMADJI IGD 64 0187R0161018V001327 28/10/2018 Z09.8 Kontrol T14.1 V. App Rp 176,200
035621 PIPIT HERMANTO IGD 35 0187R0161018V001255 26/10/2018 Z09.8 Kontrol L04.1 Lymphadenitis Rp 176,200
033979 PUDJI HARTINI LABORAT 62 0187R0161018V001310 27/10/2018 Z03.8 Suspect A01.0 Typhoid Fever Rp 176,200
012980 DEASY YUANITA PRASMANASARI OBSTETRI 32 0187R0161018V001184 24/10/2018 Z48.8 Post Op O82.0 Lahir SC Rp 176,200
033809 WIWIK SRI WIDAYATI DALAM 54 0187R0161018V001158 24/10/2018 Z09.8 Kontrol A01.0 Typhoid Fever Rp 176,200
033878 DANIATI MATA 60 0187R0161018V001278 27/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
024609 SHOLIK ACHMAD MATA 49 0187R0161018V001283 27/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
031334 SRIYATI MATA 61 0187R0161018V001279 27/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
027502 MARIA NGATMINAH MATA 75 0187R0161018V001277 27/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035432 SUHARTIWI MATA 53 0187R0161018V001302 27/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034718 SUPARMI MATA 67 0187R0161018V001303 27/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
034398 DJUWARIYAH MATA 67 0187R0161018V001301 27/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035768 CITRA WIDYASARI MATA 34 0187R0161018V001304 27/10/2018 H52.1 Myopia Rp 176,200
031126 SUTIYEM MATA 71 0187R0161018V001308 27/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035767 MAIMUNAH MATA 51 0187R0161018V001288 27/10/2018 H52.4 Presbyopia Rp 176,200
035801 LA'ONE AZBIM BAIS LABORAT 1 0187R0161018V001404 30/10/2018 H92.2 Ottorhagia Rp 176,200
035802 SENIMAN IGD 40 0187R0161018V001416 30/10/2018 T14.1 V. App Rp 194,400
035713 DARMADJI IGD 64 0187R0161018V001402 30/10/2018 Z09.8 Kontrol T14.1 V. App Rp 176,200
033571 GUNAWAN DALAM 39 0187R0161018V001397 30/10/2018 Z09.8 Kontrol E11.9 DM Tipe II Rp 176,200
023720 DWI ISHIKAWATI LABORAT 34 0187R0161018V001365 29/10/2018 Z03.8 Suspect A01.0 Typhoid Fever Rp 176,200
032376 WAWAN HERMAWAN IGD 51 0187R0161018V001374 29/10/2018 Z03.8 Suspect M10.9 Gout Rp 176,200
035502 LINA ALIFIA CAHYANINGRUM IGD 29 0187R0161018V001366 29/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
028771 PERMADI AGUNG NUROHMAN IGD 25 0187R0161018V001360 29/10/2018 Z48.8 Post Op I84.2 Hemorrhoid Rp 176,200
033087 LINAWATI DALAM 53 0187R0161018V001436 30/10/2018 M13.08 Polyarthritis Rp 176,200
007835 MISENI DALAM 44 0187R0161018V001437 30/10/2018 R07.4 Chest Pain Rp 274,800
035798 SOEPARTI DALAM 76 0187R0161018V001384 30/10/2018 Z03.8 Suspect I11.8 HHD Rp 176,200
035722 SUPI'A DALAM 50 0187R0161018V001432 30/10/2018 Z03.8 Suspect H81.4 Vertigo Rp 176,200
009497 NUR FADILAH DALAM 44 0187R0161018V001435 30/10/2018 Z09.8 Kontrol J06.9 ISPA Rp 176,200
035810 NINA ZAINAH DALAM 39 0187R0161018V001434 30/10/2018 M13.08 Polyarthritis Rp 176,200
014778 RUKMINI DALAM 67 0187R0161018V001428 30/10/2018 Z09.8 Kontrol E11.9 DM Tipe II Rp 176,200
008527 SUJID DALAM 52 0187R0161018V001438 30/10/2018 Z03.8 Suspect I20.9 CAD Rp 176,200
035721 BUADI DALAM 57 0187R0161018V001431 30/10/2018 Z09.8 Kontrol E11.9 DM Tipe II Rp 176,200
023175 SUDARMADJI DALAM 62 0187R0161018V001431 30/10/2018 Z03.8 Suspect I11.9 HHD Rp 176,200
033014 SLAMET DALAM 78 0187R0161018V001429 30/10/2018 Z03.8 Suspect C34.9 CA. Paru Rp 176,200
021023 YULI SETYAWATI DALAM 53 0187R0161018V001424 30/10/2018 Z09.8 Kontrol G54.2 CRS Rp 176,200
021022 DJOEL HARSOWO DALAM 60 0187R0161018V001423 30/10/2018 Z09.8 Kontrol M19.9 OA Rp 176,200
032411 SLAMET SUDIBYO DALAM 66 0187R0161018V001410 30/10/2018 Z09.8 Kontrol G63.8 Polyneuropathy Rp 176,200
035723 YULIASTINI DALAM 56 0187R0161018V001411 30/10/2018 Z09.8 Kontrol E11.9 DM Tipe II Rp 176,200
035218 DARWATI DALAM 55 0187R0161018V001427 30/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
022514 PONARI DALAM 68 0187R0161018V001421 30/10/2018 Z09.8 Kontrol K30 Dyspepsia Rp 176,200
033592 DJUMAIYAH DALAM 65 0187R0161018V001419 30/10/2018 Z09.8 Kontrol E11.9 DM Tipe II Rp 176,200
029910 MANISAH DALAM 41 0187R0161018V001426 30/10/2018 Z09.8 Kontrol A01.0 Typhoid Fever Rp 176,200
021180 H. ALI HAMDAN MUJIANA DALAM 78 0187R0161018V001395 30/10/2018 Z09.8 Kontrol K80.8 Cholelithiasis Rp 176,200
032033 SAMPUR SARI DALAM 60 0187R0161018V001414 30/10/2018 Z09.8 Kontrol I11.9 HHD Rp 176,200
014756 GATOT SETIA BOEDI DALAM 58 0187R0161018V001413 30/10/2018 Z09.8 Kontrol E11.9 DM Tipe II Rp 176,200
029710 OEMAN TARDJO DALAM 75 0187R0161018V001412 30/10/2018 Z09.8 Kontrol E11.9 DM Tipe II Rp 176,200
035615 SUHAIMI DALAM 40 0187R0161018V001387 30/10/2018 Z09.8 Kontrol E11.9 DM Tipe II Rp 176,200
029360 CHUMAIDAH DALAM 62 0187R0161018V001388 30/10/2018 Z09.8 Kontrol E11.9 DM Tipe II Rp 176,200
030799 UDRALIA DALAM 50 0187R0161018V001385 30/10/2018 Z09.8 Kontrol I11.9 HHD Rp 176,200
035503 BUDIONO LADI DALAM 69 0187R0161018V001401 30/10/2018 Z09.8 Kontrol K30 Dyspepsia Rp 176,200
035761 ENDRI KUSUMA WARDANI IGD 37 0187R0161018V001267 26/10/2018 Z48.8 Post Op D17.7 Soft Tissue Tumor Rp 176,200
030375 CICIK NOVIKAWATI DALAM 34 0187R0161018V001467 31/10/2018 Z09.8 Kontrol B17.8 Hepatitis Rp 176,200
035787 REGINA SHAFA CAHYANINGRUM MATA 9 0187R0161018V001362 29/10/2018 H52.1 Myopia Rp 176,200
035787 REGINA SHAFA CAHYANINGRUM MATA 9 0187R0161018V001458 31/10/2018 Z09.8 Kontrol H52.1 Myopia Rp 176,200
035626 WULAN DWI LUSIA RANI MATA 16 0187R0161018V001482 31/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 425,800
035805 HASNA NJUR SALSA ANAK 15 0187R0161018V001415 30/10/2018 J20.9 Bronchitis Rp 178,000
035580 HARTINI MATA 66 0187R0161018V001480 31/10/2018 Z09.8 Kontrol H40.1 POAG Rp 176,200
021957 IMROTIN MATA 59 0187R0161018V001461 31/10/2018 H10.8 Conjunctivitis Rp 176,200
030674 RAHMAT MATA 62 0187R0161018V001456 31/10/2018 Z09.8 Kontrol H10.4 DES Rp 176,200
035815 KASBULLAH MATA 75 0187R0161018V001457 31/10/2018 Z48.8 Post Op H26.9 Cataract Rp 176,200
035816 SOENARJO MATA 63 0187R0161018V001463 31/10/2018 H52.0 Hypermetropia Rp 176,200
035821 PANCA HADI WIBAWA MATA 41 0187R0161018V001477 31/10/2018 S05.8 Traum Oculi Rp 274,800
035818 DAIVA RAJENDRA FIRJATULLAH MATA 9 0187R0161018V001474 31/10/2018 Z09.8 Kontrol H10.8 Conjunctivitis Rp 176,200
013228 VELLYCIA PUJA ARTA MEIVIA MATA 16 0187R0161018V001472 31/10/2018 Z09.8 Kontrol H10.8 Conjunctivitis Rp 176,200
033473 MARATUL MUSLIMAH MATA 73 0187R0161018V000007 01/10/2018 Z09.8 Kontrol E10.3 DM Rp 176,200
034594 SUDARMINI MATA 68 0187R0161018V000001 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
031126 SUTIYEM MATA 71 0187R0161018V000031 01/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
034788 BUDI EFFENDI MATA 58 0187R0161018V000005 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034426 MOH AFFANDI YUSUF MATA 77 0187R0161018V000006 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
032826 ACHMAD TARNUDJI MATA 77 0187R0161018V000010 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034666 GUSTI SALMIAH MATA 64 0187R0161018V000015 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034539 RESTU MOSES ANUGRAH LAILA MATA 19 0187R0161018V000014 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034719 SULCHAH MATA 70 0187R0161018V000017 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
020253 DANUN MATA 80 0187R0161018V000018 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034696 MUKHTIYAH MATA 83 0187R0161018V000019 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033367 BAMBANG MUJIONO MATA 65 0187R0161018V000020 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035022 LUSIANA MATA 72 0187R0161018V000022 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
032771 SRI PUJI RAHAYU MATA 61 0187R0161018V000021 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
016999 SOEGI ROHANI MATA 59 0187R0161018V000013 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
031281 IPIN SURYANA MATA 54 0187R0161018V000023 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034998 HERI HADIJONO MATA 51 0187R0161018V000016 01/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
029535 DRA CLARA M MUDJIHERTI MATA 73 0187R0161018V000024 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
031835 MUJIATI MATA 58 0187R0161018V000026 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035078 MAHMUD MATA 73 0187R0161018V000027 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034794 SUSIANI MATA 63 0187R0161018V000029 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
031548 AQILA ALMAHYRA MISHALL IRAWAN MATA 0 0187R0161018V000030 01/10/2018 Z09.8 Kontrol H27.0 Aphakia Rp 176,200
033205 DWI ASTUTI MATA 58 0187R0161018V000011 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033294 SADI'YAH MATA 58 0187R0161018V000028 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033582 SUPARNI MATA 66 0187R0161018V000033 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035023 DRS MOCH JASIN MATA 75 0187R0161018V000032 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035068 MAHRA'JAH MATA 69 0187R0161018V000034 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035354 WIWIT SUGIATI MATA 50 0187R0161018V000035 01/10/2018 H52.3 AMK H52.4 Presbyopi Rp 176,200
032033 SAMPUR,SARI MATA 60 0187R0161018V000039 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
031738 LILIK SUMARNI MATA 58 0187R0161018V000040 01/10/2018 Z09.8 Kontrol H04.1 DES Rp 176,200
035357 SITI MARYAM MATA 56 0187R0161018V000044 01/10/2018 H52.2 AMS H52.4 Presbyopi Rp 176,200
031100 KADIYEM MATA 75 0187R0161018V000037 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
027901 ARMAJI MATA 55 0187R0161018V000111 02/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 176,200
008561 RAYHAN FARIS HERFYANDO ANAK 14 0187R0161018V000067 02/10/2018 Z09.8 Kontrol A01.0 Thypoid Fever Rp 176,200
025974 DWI PANJI SETYO UTOMO ANAK 7 0187R0161018V000079 02/10/2018 Z09.8 Kontrol J20 Bronchithis Rp 176,200
030694 NAFIZ RESWARA CAHYADI ANAK 5 0187R0161018V000087 02/10/2018 Z09.8 Kontrol J20 Bronchithis Rp 176,200
035267 OCTA INDAH GIAN LESTARI ANAK 16 0187R0161018V000091 02/10/2018 Z09.8 Kontrol A01.0 Thypoid Fever Rp 176,200
035290 BAMBANG MINARKO ANAK 31 0187R0161018V000092 02/10/2018 Z09.8 Kontrol A01.0 Thypoid Fever Rp 176,200
032098 AHMAD YAHYA ATHOK'ILLAH K ANAK 6 0187R0161018V000094 02/10/2018 Z09.8 Kontrol J18.0 Pneumonia Rp 176,200
035264 MIFTAKHUN NIIAM MA'SUM MAKHALI ANAK 4 0187R0161018V000097 02/10/2018 Z09.8 Kontrol B01.2 Varicella Rp 176,200
035297 SOELASTRI DALAM 80 0187R0161018V000145 02/10/2018 M79.7 Fibromyalgia Rp 176,200
034755 MOCHMAD MANSYUR DALAM 66 0187R0161018V000124 02/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
035127 SUTINAH DALAM 61 0187R0161018V000082 02/10/2018 Z09.8 Kontrol K30 Dyspepsia Rp 176,200
026700 LILIK PURNIASIH DALAM 50 0187R0161018V000137 02/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
034705 ABDUL RASYID DALAM 53 0187R0161018V000136 02/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
035386 RUMANI DALAM 69 0187R0161018V000130 02/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
032033 SAMPUR,SARI DALAM 60 0187R0161018V000135 02/10/2018 Z09.8 Kontrol K30 Dyspepsia Rp 176,200
032648 SUWARNINGSIH DALAM 60 0187R0161018V000132 02/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
033187 SULIKAH DALAM 67 0187R0161018V000131 02/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
032251 SEVIA ITO PERMADANI DALAM 17 0187R0161018V000139 02/10/2018 K30 Dyspepsia Rp 229,900
019869 CAHYUNINGSIH SIGIARTI DALAM 50 0187R0161018V000133 02/10/2018 Z09.8 Kontrol N39.0 UTI Rp 176,200
024609 SHOLIK ACHMAD DALAM 49 0187R0161018V000134 02/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035385 TITIK WARIANTI DALAM 47 0187R0161018V000123 02/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
032858 SUPARMAN DALAM 60 0187R0161018V000074 02/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
030799 UDRALIA DALAM 50 0187R0161018V000076 02/10/2018 I50.9 Heart Failure Rp 176,200
031403 WUJUD KARTIMIN DALAM 62 0187R0161018V000086 02/10/2018 Z09.8 Kontrol K30 Dyspepsia Rp 176,200
027507 SITI AMINAH DALAM 50 0187R0161018V000129 02/10/2018 I50.9 Heart Failure K30 Dyspepsia Rp 176,200
031823 SULASTRI DALAM 61 0187R0161018V000085 02/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
033878 DANIATI DALAM 60 0187R0161018V000113 02/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
022514 PONARI DALAM 65 0187R0161018V000115 02/10/2018 I50.9 Heart Failure K30 Dyspepsia Rp 176,200
035208 RUBA'I DALAM 67 0187R0161018V000116 02/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
027153 IMAM MUKSIN DALAM 64 0187R0161018V000118 02/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
034793 SUBAKRI DALAM 63 0187R0161018V000117 02/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035299 TUKIRAH DALAM 62 0187R0161018V000114 02/10/2018 Z09.8 Kontrol M54.5 LBP Rp 176,200
032093 JUWARNO DALAM 52 0187R0161018V000120 02/10/2018 M19.9 OA Rp 176,200
032534 BUAMAT MATA 64 0187R0161018V000009 01/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
032534 BUAMAT DALAM 64 0187R0161018V000077 02/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
027523 POETRI MAYASARI SRI MELIK DALAM 41 0187R0161018V000122 02/10/2018 I10 HT I11.0 HHD Rp 176,200
026607 DEWI RAHAYU YULIANA DALAM 60 0187R0161018V000121 02/10/2018 Z09.8 Kontrol E78.5 Dislipedemia Rp 176,200
032175 SUDARMADJI DALAM 61 0187R0161018V000119 02/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
029360 CHUMAIDAH DALAM 62 0187R0161018V000126 02/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
021958 KOEI FA DALAM 75 0187R0161018V000125 02/10/2018 I50.9 Heart Failure M19.9 Heart Failure Rp 176,200
035300 MAMAK HASAN DALAM 54 0187R0161018V000128 02/10/2018 Z09.8 Kontrol I10 Hypertensi Rp 176,200
033592 DJUMAIYAH MATA 65 0187R0161018V000088 02/10/2018 Z48.8 Post OP H26.9 Cataract Rp 6,300,000
034718 SUPARMI MATA 66 0187R0161018V000038 01/10/2018 H26.0 Cataract Rp 6,300,000
034718 SUPARMI MATA 66 0187R0161018V000149 03/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
029614 UCIK SULISTYOWATI MATA 44 0187R0161018V000064 02/10/2018 Z48.8 Post OP H11.0 Pterygium Rp 176,200
035380 KESUMA RENI MURWATI MATA 64 0187R0161018V000102 02/10/2018 H52.1 Myopi H52.3 AMK Rp 226,000
035379 BRAMASTA PARTHA PERMANA MATA 3 0187R0161018V000100 02/10/2018 Z09.8 Kontrol H00.1 Chalazion Rp 176,200
035383 KHAIRIL ANWAR MATA 29 0187R0161018V000107 02/10/2018 Z09.8 Kontrol H10.9 Conjungivitis Rp 176,200
035375 SULASTRI MATA 56 0187R0161018V000093 02/10/2018 H26.0 Cataract Rp 176,200
035369 CLARA AGUSTINA MATA 28 0187R0161018V000069 02/10/2018 H52.2 AMK H52.1 Myopi Rp 176,200
011315 DJIMAT MATA 81 0187R0161018V000070 02/10/2018 H26.0 Cataract Rp 226,000
029771 TITIK SETIOWATI MATA 59 0187R0161018V000066 02/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035355 JALAL MATA 69 0187R0161018V000036 01/10/2018 H26.0 Cataract Rp 6,300,000
035355 JALAL MATA 69 0187R0161018V000152 03/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035243 SUKISWATI MATA 63 0187R0161018V000003 01/10/2018 H26.0 Cataract Rp 6,300,000
035243 SUKISWATI MATA 63 0187R0161018V000153 03/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035315 AMINAH MATA 63 0187R0161018V000045 01/10/2018 H26.0 Cataract Rp 6,300,000
035315 AMINAH MATA 63 0187R0161018V000154 03/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035373 RIKO WICAKSONO MAGHFIROH MATA 15 0187R0161018V000090 02/10/2018 H52.1 Myopi H52.3 AMK Rp 176,200
027502 MARIA NGATMINAH MATA 75 0187R0161018V000012 01/10/2018 H26.0 Cataract Rp 6,300,000
027502 MARIA NGATMINAH MATA 75 0187R0161018V000155 03/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
030892 ENDANG TRUSILOWATI MATA 44 0187R0161018V000084 02/10/2018 H52.3 AMK Rp 176,200
033568 SUPRIONO LABORAT 53 0187R0161018V000025 01/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035025 ISTIRAHAYU DALAM 48 0187R0161018V000142 03/10/2018 J06.9 ISPA G62.9 Polyneuropathy Rp 292,900
033568 SUPRIONO DALAM 53 0187R0161018V000143 03/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
033568 SUPRIONO MATA 53 0187R0161018V000071 02/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034417 PUJIATI DALAM 56 0187R0161018V000144 03/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
031503 RAHMAWATI DALAM 58 0187R0161018V000147 03/10/2018 I50.9 Heart Failure Rp 176,200
031366 SAMADI DALAM 65 0187R0161018V000146 03/10/2018 K30 Dyspepsia E11.9 DM Rp 229,900
033592 DJUMAIYAH DALAM 65 0187R0161018V000150 03/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
014756 GATOT SETIA BUDI DALAM 58 0187R0161018V000164 03/10/2018 Z09.8 Kontrol M54.5 LBP Rp 176,200
030621 SUJAK DALAM 53 0187R0161018V000171 03/10/2018 Z09.8 Kontrol E119 DM Rp 176,200
025490 MUJIATI DALAM 63 0187R0161018V000165 03/10/2018 I50.9 Heart Failure Rp 176,200
035069 SITI MUSOFAH DALAM 47 0187R0161018V000178 03/10/2018 K30 Dyspepsia Rp 229,900
035222 SUKARDAM DALAM 52 0187R0161018V000179 03/10/2018 Z09.8 Kontrol M79.9 Fybromalgia Rp 176,200
035305 HILDA MEGA CAHYANI DALAM 21 0187R0161018V000187 03/10/2018 Z09.8 Kontrol R10.4 Abdominal Pain Rp 176,200
033440 MUHAMMAD VENNANDY K F DALAM 15 0187R0161018V000189 03/10/2018 J20 Bronchitis Rp 178,000
030958 HARIYANTO DALAM 46 0187R0161018V000182 03/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
031602 SALIMAH DALAM 55 0187R0161018V000190 03/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035410 NURUL ISMAWATI DALAM 35 0187R0161018V000191 03/10/2018 Z09.8 Kontrol K30 Dyspepsia Rp 176,200
035396 LILIK SUSIYATI MATA 46 0187R0161018V000169 03/10/2018 H52.4 Presbyopi Rp 176,200
024909 CHANDRA BEMPAH MATA 58 0187R0161018V000158 03/10/2018 Z48.8 Post OP H26.9 Cataract Rp 425,800
035394 LAILA MATA 71 0187R0161018V000167 03/10/2018 H26.0 Cataract Rp 226,000
021911 WAYAN CHANDRA MATA 80 0187R0161018V000170 03/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034664 HALIMAH MATA 68 0187R0161018V000166 03/10/2018 H26.0 Cataract Rp 176,200
035395 AGUSTIN NURHIDAYAH MATA 44 0187R0161018V000168 03/10/2018 H52.4 Presbyopi Rp 176,200
035332 UCI WANIATI MATA 45 0187R0161018V000159 03/10/2018 Z48.8 Post OP H11.0 Pterygium Rp 176,200
035233 NOVAN ARIS HERIATNA MATA 37 0187R0161018V000161 03/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
010230 JASULI NURDIANTO MATA 39 0187R0161018V000160 03/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 176,200
020112 CHALLULA DELINDA SALVIA MATA 11 0187R0161018V000162 03/10/2018 Z09.8 Kontrol H10.9 Conjungivitis Rp 176,200
034332 SUGENG HERI HARJONO MATA 54 0187R0161018V000218 04/10/2018 I11.0 HHD Rp 248,800
033816 BUDIWATI,SH LABORAT 72 0187R0161018V000163 03/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
025883 AGUNG SETYAWAN LABORAT 31 0187R0161018V000213 04/10/2018 Z03.8 Suspec A01.0 Thypoid Fever Rp 176,200
032076 V NARYATI DALAM 58 0187R0161018V000203 04/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
030606 SAYUNAH DALAM 68 0187R0161018V000205 04/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
024081 PATIMAH DALAM 60 0187R0161018V000202 04/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
029347 PUTRI FARAH AZZAHRA ANAK 9 0187R0161018V000212 04/10/2018 Z09.8 Kontrol A01.0 Thypoid Fever Rp 176,200
035308 M ROBI YAHYA PRATAMA ANAK 9 0187R0161018V000221 04/10/2018 Z09.8 Kontrol J20 Bronchithis Rp 176,200
035419 SULISWATI MATA 19 0187R0161018V000227 04/10/2018 H11.0 Pterygium Rp 176,200
031032 SUWARNO MATA 61 0187R0161018V000226 04/10/2018 Z09.8 Kontrol H27.0 Aphakia Rp 176,200
030841 LILIK KUSUMAWATI MATA 59 0187R0161018V000223 04/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035127 SUTINAH IGD 61 0187R0161018V000224 04/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035425 NGADIMIN IGD 48 0187R0161018V000246 05/10/2018 J45.9 Asthma Rp 292,900
035417 MISNAN IGD 51 0187R0161018V000225 04/10/2018 D17.2 Benign Neoplasm Rp 176,200
030838 CATUR BUDIONO MATA 56 0187R0161018V000232 04/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035423 BERNADIUS BOGOHANTO MATA 34 0187R0161018V000231 04/10/2018 H52.2 Astimaghsim Rp 176,200
035421 NINDI YUNARISTA RO'IS MATA 27 0187R0161018V000229 04/10/2018 H52.3 AMK Rp 176,200
035422 CITRA KARTIKA DEWI MATA 31 0187R0161018V000230 04/10/2018 Z09.8 Kontrol H27.0 Aphakia Rp 176,200
031891 SUGIONO MATA 53 0187R0161018V000215 04/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
035413 NOVA ERIK NATAN ULIN MATA 19 0187R0161018V000214 04/10/2018 H40.5 Glaukoma Rp 176,200
035408 NINUK STIYATI MATA 50 0187R0161018V000208 04/10/2018 H52.4 Presbyopi Rp 226,000
033944 ROBIAH MATA 70 0187R0161018V000211 04/10/2018 H40.8 Glaucoma Rp 176,200
029506 MASHUDI MATA 78 0187R0161018V000209 04/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035406 SUDARMAN MATA 76 0187R0161018V000204 04/10/2018 H26.0 Cataract Rp 226,000
034915 SUMINAH MATA 61 0187R0161018V000207 04/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035410 NURUL ISMAWATI MATA 39 0187R0161018V000210 04/10/2018 H52.1 Myopi H52.2 AMS Rp 176,200
029538 SUTIONO MATA 63 0187R0161018V000206 04/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035415 REHNING NIRAMI MATA 53 0187R0161018V000216 04/10/2018 H18.0 Ulcus Cornea Rp 176,200
033896 NURUL FATIMAH MATA 56 0187R0161018V000219 04/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035416 ALIF RANGGA ADIPUTRA MATA 11 0187R0161018V000217 04/10/2018 H52.1 Myopi H52.3 AMK Rp 176,200
034633 KUSMIATI MATA 72 0187R0161018V000222 04/10/2018 H04.1 DES H26.9 Cataract Rp 176,200
035420 CHERYL FLORENZA LOVINA MATA 8 0187R0161018V000228 04/10/2018 H52.3 AMK Rp 176,200
030467 SANIJEM MATA 68 0187R0161018V000220 04/10/2018 H26.0 Cataract Rp 226,000
035394 LAILA MATA 71 0187R0161018V000287 06/10/2018 H26.0 Cataract Rp 226,000
010230 JASULI NURDIANTO MATA 49 0187R0161018V000247 05/10/2018 H40.8 Glaucoma Rp 425,800
035286 SLAMET PURNOMO MATA 47 0187R0161018V000270 06/10/2018 Z09.8 Kontrol H20.9 Iridocycilitis Rp 176,200
035373 RIKO WICAKSONO MAGHFIROH MATA 15 0187R0161018V000269 06/10/2018 Z09.8 Kontrol H52.1 Myopi Rp 176,200
024081 PATIMAH LABORAT 54 0187R0161018V000328 08/10/2018 Z09.8 Kontrol E119 DM Rp 176,200
034427 RISNOWATI MATA 68 0187R0161018V000276 06/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
031144 SANDJAYA MATA 61 0187R0161018V000273 06/10/2018 Z09.8 Kontrol E119 DM Rp 226,000
033068 SUPARMAN MATA 65 0187R0161018V000271 06/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035447 SUMIATI MATA 63 0187R0161018V000282 06/10/2018 H26.0 Cataract Rp 226,000
035446 HERI DWI ATMAJI MATA 59 0187R0161018V000279 06/10/2018 H26.0 Cataract Rp 226,000
035456 DJUREMI AFANDI MATA 62 0187R0161018V000295 06/10/2018 Z09.8 Kontrol H10.9 Conjungivitis Rp 176,200
030120 RR MARDIKANINGSIH MATA 70 0187R0161018V000288 06/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035454 ANITA INDAH SULISTYOWATI MATA 39 0187R0161018V000291 06/10/2018 Z09.8 Kontrol H10.9 Conjungivitis Rp 176,200
035455 VANIA FITRI ANINDITA MATA 12 0187R0161018V000294 06/10/2018 H52.3 AMK Rp 176,200
035448 ETIK YULIATI MATA 45 0187R0161018V000285 06/10/2018 H52.1 Myopi H52.4 Presbyopi Rp 176,200
035347 FADILAH CAHYO MATA 6 0187R0161018V000296 06/10/2018 Z09.8 Kontrol H10.9 Conjungivitis Rp 176,200
035461 MOH SHOLEH MATA 44 0187R0161018V000302 06/10/2018 H52.4 Presbyopi Rp 176,200
035457 LASMI MATA 75 0187R0161018V000297 06/10/2018 H18.0 Ulcus Cornea Rp 176,200
035450 BAMBANG SOEDIONO MATA 62 0187R0161018V000286 06/10/2018 H26.0 Cataract Rp 176,200
035458 MAUHIBAH HAFIZATUL AFIFAH MATA 14 0187R0161018V000298 06/10/2018 H52.1 Myopi H47.1 PapilOedema Rp 176,200
032043 SOEWARTONO MATA 61 0187R0161018V000305 06/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035346 ENDAH SRI WAHYUNI MATA 34 0187R0161018V000301 06/10/2018 Z09.8 Kontrol H44.1 Endophthalmitis Rp 176,200
033935 DZIKRI MAULANA RAMADHAN SYAHPUTRA MATA 7 0187R0161018V000303 06/10/2018 Z09.8 Kontrol H18.0 Ulcus Cornea Rp 176,200
035462 LUTFI MUSTOFA MATA 29 0187R0161018V000304 06/10/2018 H52.3 AMK H52.1 Myopi Rp 176,200
035321 SALEH ALWI MATA 52 0187R0161018V000300 06/10/2018 Z09.8 Kontrol E119 DM Rp 176,200
035069 SITI MUSOFAH LABORAT 47 0187R0161018V000306 06/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
027507 SITI AMINAH LABORAT 50 0187R0161018V000293 06/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035386 RUMANI LABORAT 69 0187R0161018V000292 06/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
032093 JUWARNO LABORAT 52 0187R0161018V000284 06/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
033592 DJUMAIYAH LABORAT 65 0187R0161018V000281 06/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
027153 IMAM MUKSIN LABORAT 64 0187R0161018V000280 06/10/2018 Z09.8 Kontrol E119 DM Rp 176,200
034755 MOCHMAD MANSYUR LABORAT 66 0187R0161018V000268 06/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
034417 PUJIATI LABORAT 56 0187R0161018V000278 06/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
032076 V NARYATI LABORAT 58 0187R0161018V000277 06/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
033487 SR EMERENSIANA AK LABORAT 58 0187R0161018V000275 06/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
031602 SALIMAH LABORAT 55 0187R0161018V000274 06/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
030606 SAYUNAH LABORAT 68 0187R0161018V000272 06/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
034418 AWALIATUN NIKMAH OBSTETRI 27 0187R0161018V000256 05/10/2018 Z09.8 Kontrol O20.0 Threatened Abortion Rp 176,200
023995 RATNA SARI ENDAH PALUPY OBSTETRI 32 0187R0161018V000257 05/10/2018 Z48.8 Post OP N83.0 Cysta Ovari Rp 176,200
030038 MUNIFATUL LUTFIAH OBSTETRI 24 0187R0161018V000260 05/10/2018 Z35.3 Antenatal Screening Rp 281,500
035437 VIVIT RAHAYU OBSTETRI 26 0187R0161018V000252 05/10/2018 Z09.8 Kontrol Z36 Antenatal Screening Rp 176,200
035439 LAILATUL FITRIANI OBSTETRI 26 0187R0161018V000258 05/10/2018 Z35.3 Antenatal Screening Rp 281,500
034426 MOH AFFANDI YUSUF MATA 77 0187R0161018V000323 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034424 SUGIHARTINI MATA 54 0187R0161018V000334 08/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
030467 SANIJEM MATA 68 0187R0161018V000336 08/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
027502 MARIA NGATMINAH MATA 75 0187R0161018V000314 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035475 GIFTA AIDILIA RAYA MATA 8 0187R0161018V000364 08/10/2018 H53.0 Amblyopia Rp 176,200
035468 INDAH HERMIATI MATA 39 0187R0161018V000312 08/10/2018 H52.4 Presbyopi H53.0 Amblyopia Rp 176,200
031738 LILIK SUMARNI MATA 58 0187R0161018V000363 08/10/2018 Z48.8 Post OP H04.1 DES Rp 176,200
035471 MASHUDI MATA 44 0187R0161018V000353 08/10/2018 Z09.8 Kontrol T16 Foreign Body In Rp 176,200
034921 SAHURI MATA 55 0187R0161018V000349 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035078 MAHMUD MATA 73 0187R0161018V000340 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
029535 DRA CLARA M MUDJIHERTI MATA 73 0187R0161018V000341 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034650 SATUNI MATA 70 0187R0161018V000326 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034719 SULCHAH MATA 70 0187R0161018V000325 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035068 MAHRA'JAH MATA 69 0187R0161018V000327 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033582 SUPARNI MATA 66 0187R0161018V000342 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034998 HERI HADIJONO MATA 54 0187R0161018V000321 08/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
034794 SUSIANI MATA 64 0187R0161018V000333 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035316 PUDJI WINARTI MATA 63 0187R0161018V000331 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
031126 SUTIYEM MATA 71 0187R0161018V000335 08/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
031835 MUJIATI MATA 58 0187R0161018V000329 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035023 DRS MOCH JASIN MATA 75 0187R0161018V000332 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035473 SALAM MATA 82 0187R0161018V000360 08/10/2018 H40.8 Glaucoma Rp 200,600
031281 IPIN SURYANA MATA 54 0187R0161018V000316 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034594 SUDARMINI MATA 68 0187R0161018V000313 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034539 RESTU MOSES ANUGRAH LAILA MATA 19 0187R0161018V000318 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033460 RUMINI MATA 63 0187R0161018V000315 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034935 INDAH PURNAMA SARI MATA 35 0187R0161018V000356 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034949 ASPAN MUNADI MATA 72 0187R0161018V000317 08/10/2018 Z09.8 Kontrol Z91.1 Presence of Lens Rp 176,200
035022 LUSIANA MATA 77 0187R0161018V000319 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034666 GUSTI SALMIAH MATA 64 0187R0161018V000320 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035383 KHAIRIL ANWAR MATA 29 0187R0161018V000361 08/10/2018 Z09.8 Kontrol H10.9 Conjungivitis Rp 176,200
035449 ANA SETYOWATI MATA 42 0187R0161018V000452 06/10/2018 Z09.8 Kontrol H52.3 AMK Rp 176,200
035474 ILHAM ALDIANSYAH MATA 18 0187R0161018V000362 08/10/2018 Z09.8 Kontrol H10.9 Conjungivitis Rp 176,200
034266 MOESTADJAB MATA 72 0187R0161018V000354 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034534 NURHAYATI MATA 58 0187R0161018V000239 05/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034534 NURHAYATI MATA 58 0187R0161018V000352 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
029322 SURACHMAN MATA 72 0187R0161018V000350 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034718 SUPARMI MATA 66 0187R0161018V000348 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
030477 FATIMAH WAELANI MATA 78 0187R0161018V000343 08/10/2018 H26.0 Cataract H40.8 Glaucoma Rp 200,600
035316 AMINAH MATA 63 0187R0161018V000347 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035355 JALAL MATA 69 0187R0161018V000346 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033646 BOINEM MATA 65 0187R0161018V000338 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 425,800
033592 DJUMAIYAH MATA 65 0187R0161018V000345 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035131 RIZKI NOVA SETIAWAN DALAM 21 0187R0161018V000427 09/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
023267 MOCHAMAD MUNIR DALAM 68 0187R0161018V000436 09/10/2018 Z09.8 Kontrol I25.9 CAD Rp 176,200
023267 MOCHAMAD MUNIR MATA 68 0187R0161018V000359 08/10/2018 H26.0 Cataract Rp 6,300,000
023267 MOCHAMAD MUNIR MATA 68 0187R0161018V000456 10/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
030745 GUNAWAN TARIGAN DALAM 49 0187R0161018V000458 10/10/2018 Z09.8 Kontrol E78.5 Dislipedemia Rp 176,200
034836 UMI KULSUM DALAM 63 0187R0161018V000435 09/10/2018 Z09.8 Kontrol K29.7 Gastritis Rp 176,200
032534 BUAMAT MATA 63 0187R0161018V000344 08/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
032534 BUAMAT DALAM 63 0187R0161018V000434 09/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035366 IMAM SUGENG DIONO DALAM 37 0187R0161018V000429 09/10/2018 Z09.8 Kontrol A01.0 Thypoid Fever Rp 176,200
034793 SUBAKRI DALAM 63 0187R0161018V000420 09/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
034945 SINI DALAM 58 0187R0161018V000430 09/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
032648 SUWARNINGSIH DALAM 60 0187R0161018V000418 09/10/2018 I11.0 HHD E11.9 DM Rp 248,800
030799 UDRALIA DALAM 50 0187R0161018V000384 09/10/2018 I11.0 HHD Rp 248,800
035127 SUTINAH DALAM 61 0187R0161018V000403 09/10/2018 N61 Ulcus Mamae E11.9 DM Rp 176,200
029710 OEMAN TARDJO DALAM 75 0187R0161018V000409 09/10/2018 E11.9 DM Rp 176,200
033878 DANIATI DALAM 60 0187R0161018V000423 09/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
022514 PONARI DALAM 68 0187R0161018V000413 09/10/2018 L75.0 Bromhidrosis Rp 176,200
032093 JUWARNO DALAM 52 0187R0161018V000414 09/10/2018 E78.5 Dislipedemia M19.9 Arthorisis Rp 176,200
023853 JUMIRAH DALAM 40 0187R0161018V000416 09/10/2018 I20.9 Angina Pectoris Rp 248,800
027507 SITI AMINAH DALAM 50 0187R0161018V000428 09/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035208 RUBA'I DALAM 67 0187R0161018V000417 09/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
029360 CHUMAIDAH DALAM 62 0187R0161018V000419 09/10/2018 I25.9 CAD E11.9 DM Rp 248,800
027153 IMAM MUKSIN DALAM 54 0187R0161018V000422 09/10/2018 E11.9 DM G62.9 Polyneuropathy Rp 176,200
035367 KARIATI DALAM 61 0187R0161018V000424 09/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
030472 ELVI KARYANINGTYAS DALAM 46 0187R0161018V000425 09/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
034332 SUGENG HERI HARJONO DALAM 54 0187R0161018V000426 09/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
035498 MARATUL KHUMAIDA MATA 37 0187R0161018V000415 09/10/2018 Z09.8 Kontrol H00.1 Hordeulum Rp 176,200
035509 M NAUFAL ABROR WAHYUDI MATA 13 0187R0161018V000467 10/10/2018 Z09.8 Kontrol H10.9 Conjungivitis Rp 176,200
035458 MAUHIBAH HAFIZATUL AFIFAH MATA 14 0187R0161018V000469 10/10/2018 H47.1 Papil Oedema Rp 425,800
030898 DAYATIN DALAM 67 0187R0161018V000519 11/10/2018 I11.0 HHD E11.9 DM Rp 248,800
014778 RUKMINI DALAM 47 0187R0161018V000518 11/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
017017 JUMIATI DALAM 58 0187R0161018V000515 11/10/2018 I50.9 Heart Failure E11.9 DM Rp 176,200
033187 SULIKAH DALAM 67 0187R0161018V000517 11/10/2018 I50.9 Heart Failure Rp 176,200
021310 NANIK HERAWAHYU DALAM 63 0187R0161018V000516 11/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
033487 SR EMERENSIANA AK DALAM 58 0187R0161018V000514 11/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035523 HERI KUSDARIYANTO DALAM 59 0187R0161018V000511 11/10/2018 I25.9 CAD E11.9 DM Rp 248,800
032076 V NARYATI DALAM 58 0187R0161018V000509 11/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
027762 BONG HIANG NYONG MATA 73 0187R0161018V000476 10/10/2018 H26.0 Cataract Rp 176,200
032319 SUYATMI MATA 61 0187R0161018V000475 10/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035510 MUHAMMAD YUSRIL AL FATHIR MATA 7 0187R0161018V000475 10/10/2018 H52.2 AMS H52.0 Hypermetropia Rp 176,200
028610 SRI PRAPTININGSIH MATA 36 0187R0161018V000474 10/10/2018 H52.1 Myopi Rp 176,200
035511 SUYONO EFENDI MATA 57 0187R0161018V000470 10/10/2018 H26.0 Cataract H40.8 Glaucoma Rp 200,600
035480 YULIANA OBSTETRI 30 0187R0161018V000373 08/10/2018 Z09.8 Kontrol N92.4 Menstruation Rp 176,200
034816 SLAMET MATA 63 0187R0161018V000463 10/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035508 SAFITRI HAPSARI MATA 22 0187R0161018V000465 10/10/2018 H52.3 AMK Rp 176,200
035504 MISYOKO MATA 57 0187R0161018V000457 10/10/2018 H52.0 Hipermetropia Rp 176,200
035233 NOVAN ARIS HERIATNA MATA 37 0187R0161018V000471 10/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
020852 SUGITO DALAM 43 0187R0161018V000489 10/10/2018 E11.9 DM Rp 176,200
033440 MUHAMMAD VENNANDY K F DALAM 15 0187R0161018V000500 10/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
021480 YUSTINA DEWI OBSTETRI 25 0187R0161018V000368 08/10/2018 Z48.8 Post OP O82.0 SC Rp 176,200
035158 NUR ITAMI POERNOMO OBSTETRI 29 0187R0161018V000375 08/10/2018 Z35.3 Antenatal Screening Rp 281,500
035457 LASMI MATA 75 0187R0161018V000473 10/10/2018 Z09.8 Kontrol H18.0 Ulcus Cornea Rp 176,200
024081 PATIMAH DALAM 60 0187R0161018V000510 11/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
034796 DESI NURMARLINA OBSTETRI 23 0187R0161018V000496 10/10/2018 Z35.3 Antenatal Screening Rp 281,500
033266 SUTINI OBSTETRI 39 0187R0161018V000486 10/10/2018 Z35.3 Antenatal Screening Rp 281,500
035514 ADELIA DEWI PUSPITASARI OBSTETRI 21 0187R0161018V000497 10/10/2018 Z09.8 Kontrol N92.4 Menstruation Rp 176,200
021617 MIA SRIWAHYUNI OBSTETRI 20 0187R0161018V000499 10/10/2018 Z35.3 Antenatal Screening Rp 281,500
035361 SITI KHOTIMATUL KHUSNAH OBSTETRI 25 0187R0161018V000488 10/10/2018 Z35.3 Antenatal Screening Rp 281,500
022592 ANISYA RHAMAWATI OBSTETRI 27 0187R0161018V000498 10/10/2018 Z48.8 Post OP O06.9 Curretage Rp 281,500
035046 ENDANG SRI UTAMI OBSTETRI 37 0187R0161018V000504 10/10/2018 Z35.3 Antenatal Screening Rp 281,500
012980 DEASY YUANITA PRASMANASARI OBSTETRI 32 0187R0161018V000507 10/10/2018 Z35.3 Antenatal Screening Rp 281,500
031602 SALIMAH DALAM 55 0187R0161018V000492 10/10/2018 E11.9 DM Rp 176,200
021022 DJOEL HARSOWO DALAM 60 0187R0161018V000480 10/10/2018 Z09.8 Kontrol I10 Hipertensi Rp 176,200
030606 SAYUNAH DALAM 68 0187R0161018V000481 10/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
030833 SUHARTONO DALAM 66 0187R0161018V000477 10/10/2018 Z09.8 Kontrol E119 DM Rp 176,200
021023 YULI SETYAWATI DALAM 53 0187R0161018V000479 10/10/2018 G54.2 Cervical Rp 229,900
026700 LILIK PURNIASIH DALAM 49 0187R0161018V000482 10/10/2018 E11.9 DM Rp 176,200
032033 SAMPUR,SARI DALAM 60 0187R0161018V000485 10/10/2018 K30 Dyspepsia Rp 229,900
035069 SITI MUSOFAH DALAM 47 0187R0161018V000485 10/10/2018 K30 Dyspepsia Rp 229,900
006144 MEI SUPRIONO DALAM 60 0187R0161018V000490 10/10/2018 E11.9 DM K30 Dyspepsia Rp 176,200
035516 PONALIM DALAM 73 0187R0161018V000506 10/10/2018 I11.0 HHD Rp 248,800
035025 ISTIRAHAYU DALAM 48 0187R0161018V000440 10/10/2018 J18.9 Pneumonia Rp 233,400
033568 SUPRIONO DALAM 53 0187R0161018V000439 10/10/2018 I50.9 Heart Failure Rp 176,200
032858 SUPARMAN DALAM 60 0187R0161018V000441 10/10/2018 Z09.8 Kontrol I10 Hipertensi Rp 176,200
034417 PUJIATI DALAM 56 0187R0161018V000442 10/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
024796 HOSIM DALAM 69 0187R0161018V000491 10/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035130 SUNDARI DALAM 63 0187R0161018V000460 10/10/2018 E11.9 DM G62.9 Polyneuropathy Rp 176,200
031503 RAHMAWATI DALAM 50 0187R0161018V000444 10/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
031366 SAMADI DALAM 65 0187R0161018V000443 10/10/2018 K30 Dyspepsia E11.9 DM Rp 176,200
024609 SHOLIK ACHMAD DALAM 49 0187R0161018V000450 10/10/2018 Z09.8 Kontrol R50.9 Fever Rp 176,200
033592 DJUMAIYAH DALAM 65 0187R0161018V000462 10/10/2018 Z09.8 Kontrol K30 Dyspepsia Rp 176,200
031627 KARTINI DALAM 62 0187R0161018V000466 10/10/2018 K30 Dyspepsia Rp 229,900
005611 MARWIN DALAM 48 0187R0161018V000472 10/10/2018 E11.9 DM M54.5 LBP Rp 176,200
018765 EKA SRI WINARTI DALAM 53 0187R0161018V000503 10/10/2018 E11.9 DM 1 Rp 176,200
035052 SABARIMAN DALAM 49 0187R0161018V000494 10/10/2018 I10 HT Rp 176,200
034516 SULIATI DALAM 71 0187R0161018V000495 10/10/2018 I11.0 HHD J06.9 ISPA Rp 248,800
020812 SUNARTININGWATI DALAM 64 0187R0161018V000493 10/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035386 RUMANI DALAM 69 0187R0161018V000451 10/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
031823 SULASTRI DALAM 61 0187R0161018V000445 10/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
031403 WUJUD KARTIMIN DALAM 62 0187R0161018V000446 10/10/2018 I110 HHD E11.9 DM Rp 248,800
035513 DYAH TRI RATNA NINGSIH DALAM 48 0187R0161018V000484 10/10/2018 M13.0 Polyarthritis Rp 176,200
027502 MARIA NGATMINAH DALAM 75 0187R0161018V000547 10/10/2018 E11.9 DM Rp 176,200
034614 RIZKI ABDAN AFFANDI ANAK 4 0187R0161018V000534 11/10/2018 J18.9 Bronchopneumonia Rp 233,400
033945 GIORGINO KENZO NUHASIN ANAK 2 0187R0161018V000525 11/10/2018 J20 Bronchitis Rp 178,000
033257 MAHATTA SULTAN MACHSUM ANAK 6 0187R0161018V000523 11/10/2018 Z09.8 Kontrol A01.0 Thypoid Fever Rp 176,200
035534 WARTINI MATA 35 0187R0161018V000550 11/10/2018 Z09.8 Kontrol H33.3 RRD Rp 176,200
030123 SUDJAWOTO MATA 74 0187R0161018V000553 11/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
022213 SARTI MATA 52 0187R0161018V000554 11/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
030742 FIRYAL NABILLA MAULIDYA MATA 13 0187R0161018V000551 11/10/2018 H52.1 Myopi H52.3 AMK Rp 176,200
035533 MUHAMMAD FAISAL ARIEF MATA 44 0187R0161018V000541 11/10/2018 H26.0 Cataract Rp 226,000
023964 KUSWANTI MATA 65 0187R0161018V000543 11/10/2018 H52.3 AMK Rp 176,200
034514 SRIYATI MATA 51 0187R0161018V000542 11/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033724 CHAMIDAH MATA 65 0187R0161018V000532 11/10/2018 Z48.8 Post OP H26.9 Cataract Rp 226,000
035529 NORMA MATA 83 0187R0161018V000528 11/10/2018 H26.0 Cataract Rp 226,000
035530 MUHAMMAD ALIYAFI MATA 23 0187R0161018V000531 11/10/2018 H52.1 Myopi H52.3 AMK Rp 176,200
031098 MUHAMMAD NIZAM ALFARISY MATA 6 0187R0161018V000512 11/10/2018 Z09.8 Kontrol H52.7 AMK Rp 176,200
035526 TOSARI MATA 35 0187R0161018V000524 11/10/2018 Z09.8 Kontrol H10.9 Conjungivitis Rp 176,200
031620 ENDAH RATNA WINARTI MATA 35 0187R0161018V000513 11/10/2018 H52.1 Myopi Rp 176,200
035415 REHNING NIRAMI MATA 53 0187R0161018V000522 11/10/2018 H52.1 Myopi Rp 176,200
035413 NOVA ERIK NATAN ULIN MATA 19 0187R0161018V000520 11/10/2018 H40.8 Glaucoma Rp 425,800
035502 LINA ALIFIA CAHYANINGRUM MATA 29 0187R0161018V000447 10/10/2018 H52.3 AMK H52.1 Myopi Rp 176,200
033247 KASDI MATA 73 0187R0161018V000540 11/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 176,200
027507 SITI AMINAH LABORAT 50 0187R0161018V000569 12/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
030472 ELVI KARYANINGTYAS LABORAT 46 0187R0161018V000565 12/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035024 LILIK SUMARTININGSIH MATA 54 0187R0161018V000530 11/10/2018 H04.1 DES H52.4 Presbyopi Rp 176,200
031627 KARTINI LABORAT 62 0187R0161018V000678 15/10/2018 Z09.8 Kontrol K21.9 GERD Rp 176,200
023853 JUMIRAH LABORAT 62 0187R0161018V000644 13/10/2018 Z09.8 Kontrol K30 Dyspepsia Rp 176,200
035130 SUNDARI LABORAT 63 0187R0161018V000675 15/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
034793 SUBAKRI LABORAT 63 0187R0161018V000627 13/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
031403 WUJUD KARTIMIN LABORAT 62 0187R0161018V000619 13/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
031823 SULASTRI LABORAT 61 0187R0161018V000620 13/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
033187 SULIKAH LABORAT 67 0187R0161018V000621 13/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
030898 DAYATIN LABORAT 67 0187R0161018V000618 13/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035127 SUTINAH IGD 61 0187R0161018V000598 12/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
033210 ANISAH MATA 62 0187R0161018V000632 13/10/2018 H26.0 Cataract Rp 176,200
033068 SUPARMAN MATA 65 0187R0161018V000610 13/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035457 LASMI MATA 75 0187R0161018V000634 13/10/2018 Z09.8 Kontrol H44.1 Uveivitis Rp 176,200
027750 LIANANTA AZZARAH MATA 21 0187R0161018V000635 13/10/2018 H53.0 Astenopia Rp 176,200
031009 MATIUS SLAMET MATA 74 0187R0161018V000637 13/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 176,200
035563 LILIK DJUWARIYAH MATA 60 0187R0161018V000633 13/10/2018 H26.0 Cataract Rp 226,000
035386 RUMANI MATA 69 0187R0161018V000638 13/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 226,000
035566 MOSES ABIYASA SUBARJO MATA 8 0187R0161018V000641 13/10/2018 Z09.8 Kontrol H10.9 Conjungivitis Rp 176,200
035567 AHMAD MATA 49 0187R0161018V000643 13/10/2018 H52.4 Presbyopi Rp 176,200
011315 DJIMAT MATA 81 0187R0161018V000612 13/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
031469 MOCH ASTAR MATA 73 0187R0161018V000613 13/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035472 MUSTAKIM MATA 59 0187R0161018V000615 13/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035588 DEASSY AYU SARI MATA 23 0187R0161018V000706 15/10/2018 H52.7 Refraction Rp 176,200
029535 DRA CLARA M MUDJIHERTI MATA 73 0187R0161018V000677 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034594 SUDARMINI MATA 68 0187R0161018V000649 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034426 MOH AFFANDI YUSUF MATA 77 0187R0161018V000656 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035022 LUSIANA MATA 72 0187R0161018V000658 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033473 MARATUL MUSLIMAH MATA 73 0187R0161018V000659 15/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
034666 GUSTI SALMIAH MATA 66 0187R0161018V000664 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034650 SATUNI MATA 70 0187R0161018V000679 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033582 SUPARNI MATA 66 0187R0161018V000666 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
025582 YETI INDRASARI MATA 30 0187R0161018V000700 15/10/2018 H40.8 Glaucoma Rp 176,200
034998 HERI HADIJONO MATA 51 0187R0161018V000661 15/10/2018 H26.0 Cataract Rp 176,200
035068 MAHRA'JAH MATA 60 0187R0161018V000654 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034424 SUGIHARTINI MATA 54 0187R0161018V000663 15/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035586 YENI AGUSTINAH MATA 40 0187R0161018V000701 15/10/2018 H52.3 AMK Rp 176,200
027502 MARIA NGATMINAH MATA 75 0187R0161018V000650 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
031281 IPIN SURYANA MATA 54 0187R0161018V000651 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
032675 WIWIK RAHAYU MATA 58 0187R0161018V000652 15/10/2018 H40.8 Glaucoma Rp 176,200
034949 ASPAN MUNADI MATA 72 0187R0161018V000653 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034699 MARYAM MATA 50 0187R0161018V000655 15/10/2018 H40.8 Glaucoma Rp 176,200
034788 BUDI EFFENDI MATA 58 0187R0161018V000657 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
031548 AQILA ALMAHYRA MISHALL IRAWAN MATA 1 0187R0161018V000662 15/10/2018 H27.0 Aphakia Rp 176,200
035355 JALAL MATA 69 0187R0161018V000682 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
032534 BUAMAT MATA 64 0187R0161018V000684 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034664 HALIMAH MATA 68 0187R0161018V000685 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035509 M NAUFAL ABROR WAHYUDI MATA 13 0187R0161018V000697 15/10/2018 Z09.8 Kontrol H10.9 Conjungivitis Rp 176,200
035315 AMINAH MATA 63 0187R0161018V000704 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035511 SUYONO EFENDI MATA 57 0187R0161018V000694 15/10/2018 H26.0 Cataract Rp 226,000
032043 SOEWARTONO MATA 61 0187R0161018V000676 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 425,800
020253 DANUN MATA 88 0187R0161018V000672 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035469 M NOOR YASIN MATA 69 0187R0161018V000671 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035316 PUDJI WINARTI MATA 63 0187R0161018V000667 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035023 DRS MOCH JASIN MATA 75 0187R0161018V000683 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
029222 DJOKO SETYANTO MATA 46 0187R0161018V000686 15/10/2018 H52.4 Presbyopi Rp 176,200
035584 LULUK SIH SUBEKTI MATA 60 0187R0161018V000695 15/10/2018 H52.4 Presbyopi Rp 176,200
031738 LILIK SUMARNI MATA 58 0187R0161018V000699 15/10/2018 Z09.8 Kontrol H04.1 DES Rp 176,200
034696 MUKHTIYAH MATA 83 0187R0161018V000665 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034539 RESTU MOSES ANUGRAH LAILA MATA 19 0187R0161018V000670 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035078 MAHMUD MATA 73 0187R0161018V000668 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034719 SULCHAH MATA 70 0187R0161018V000673 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033592 DJUMAIYAH MATA 65 0187R0161018V000669 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034794 SUSIANI MATA 63 0187R0161018V000680 15/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034707 ENIKE OCTAVIASARI OBSTETRI 35 0187R0161018V000588 12/10/2018 Z35.3 Antenatal Screening Rp 281,500
035550 ZUDHA QOYIMIL OBSTETRI 21 0187R0161018V000592 12/10/2018 Z35.3 Antenatal Screening Rp 281,500
035552 ELY SULISTININGSIH OBSTETRI 35 0187R0161018V000600 12/10/2018 Z35.3 Antenatal Screening Rp 281,500
031228 RUSMIATI NINGSIH OBSTETRI 35 0187R0161018V000601 12/10/2018 Z48.8 Post OP N83.0 Cysta Ovari Rp 176,200
023519 PURIANI OBSTETRI 41 0187R0161018V000597 12/10/2018 Z09.8 Kontrol N92.4 Menstruation Rp 176,200
009452 DINA TRI WAHYUNI OBSTETRI 36 0187R0161018V000599 12/10/2018 Z09.8 Kontrol N92.4 Menstruation Rp 176,200
035553 EKAYULIANTASARI OBSTETRI 22 0187R0161018V000602 12/10/2018 Z09.8 Kontrol N92.4 Menstruation Rp 176,200
032720 IDA PUSPITA SARI OBSTETRI 28 0187R0161018V000595 12/10/2018 Z35.3 Antenatal Screening Rp 281,500
034898 PIPIT NOVIAH OBSTETRI 20 0187R0161018V000723 15/10/2018 Z35.3 Antenatal Screening Rp 176,200
034928 MADE AUNUROHMA OBSTETRI 36 0187R0161018V000714 15/10/2018 Z09.8 Kontrol D25.9 Leiyoma Rp 176,200
025971 SUCI UDRIANA OBSTETRI 27 0187R0161018V000719 15/10/2018 Z09.8 Kontrol Z36 Antenatal Screening Rp 176,200
034620 SULIS ERNAWATI OBSTETRI 38 0187R0161018V000720 15/10/2018 Z35.3 Antenatal Screening Rp 281,500
035254 SULISTIYOWATI DINA OBSTETRI 23 0187R0161018V000722 15/10/2018 Z48.8 Post OP O82.0 SC Rp 176,200
032411 SLAMET SUDIBYO DALAM 66 0187R0161018V000786 16/10/2018 Z09.8 Kontrol M75.0 Frozen Shoulder Rp 176,200
029885 KARLINA TATYANASARI DALAM 27 0187R0161018V000753 16/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
030799 UDRALIA DALAM 50 0187R0161018V000744 16/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
030472 ELVI KARYANINGTYAS DALAM 46 0187R0161018V000743 16/10/2018 Z09.8 Kontrol E78.5 Dislipedemia Rp 176,200
034332 SUGENG HERI HARJONO DALAM 54 0187R0161018V000741 16/10/2018 I25.9 CAD Rp 248,800
032199 SIYADI DALAM 59 0187R0161018V000757 16/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
032542 DJUMA'ATI DALAM 52 0187R0161018V000758 16/10/2018 Z09.8 Kontrol R60.9 Oedema Rp 176,200
034120 YANTI HANDAYANI DALAM 55 0187R0161018V000748 16/10/2018 I50.9 Heart Failure E11.9 DM Rp 176,200
008527 SUJID DALAM 52 0187R0161018V000770 16/10/2018 I50.9 Heart Failure E11.9 DM Rp 176,200
032534 BUAMAT DALAM 64 0187R0161018V000768 16/10/2018 E11.9 DM Rp 176,200
014756 GATOT SETIA BUDI DALAM 58 0187R0161018V000763 16/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
033878 DANIATI DALAM 60 0187R0161018V000771 16/10/2018 I50.9 Heart Failure Rp 176,200
030351 MARIJANI DALAM 59 0187R0161018V000773 16/10/2018 J20.9 Bronchitis Rp 178,000
027153 IMAM MUKSIN DALAM 64 0187R0161018V000775 16/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
029710 OEMAN TARDJO DALAM 75 0187R0161018V000762 16/10/2018 E11.9 DM G62.9 Polyneuropathy Rp 176,200
006144 MEI SUPRIONO DALAM 53 0187R0161018V000738 16/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
029360 CHUMAIDAH DALAM 62 0187R0161018V000776 16/10/2018 E11.9 DM Rp 176,200
033014 SLAMET DALAM 78 0187R0161018V000780 16/10/2018 Z09.8 Kontrol C34.9 Ca Paru Rp 176,200
035503 BUDIONO LADI DALAM 69 0187R0161018V000781 16/10/2018 Z09.8 Kontrol J44.9 COPD Rp 176,200
034793 SUBAKRI DALAM 63 0187R0161018V000784 16/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035615 SUHAIMI DALAM 60 0187R0161018V000785 16/10/2018 K30 Dyspepsia Rp 229,900
027507 SITI AMINAH DALAM 50 0187R0161018V000783 16/10/2018 Z09.8 Kontrol K30 Dyspepsia Rp 176,200
035605 MUSTOFA IGD 43 0187R0161018V000759 16/10/2018 L97 ULCUS PEDIS Rp 248,800
034794 SUSIANI IGD 63 0187R0161018V000760 16/10/2018 J45.9 Asthma Rp 292,900
035607 SUHARTO IGD 50 0187R0161018V000765 16/10/2018 L97 ULCUS PEDIS Rp 248,800
035378 DHIMAS TRI ANGGARA IGD 20 0187R0161018V000755 16/10/2018 Z48.8 Post OP D17.7 Benigh Neoplasm Rp 176,200
035440 NUR CAHYA BAGAS TRIVANDA IGD 16 0187R0161018V000777 16/10/2018 Z09.8 Kontrol T14.1 Open Wound Rp 176,200
007369 CHOIRIAH INDAH PERMATA S IGD 6 0187R0161018V000791 16/10/2018 J45.9 Asthma Rp 292,900
035637 ANIK SULIYATI DALAM 45 0187R0161018V000864 18/10/2018 B16 Hepatitis B Rp 274,800
032199 SIYADI LABORAT 59 0187R0161018V000882 18/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
032542 DJUMA'ATI LABORAT 52 0187R0161018V000881 18/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035516 PONALIM DALAM 73 0187R0161018V000850 17/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
034945 SINI DALAM 58 0187R0161018V000840 17/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
032033 SAMPUR,SARI DALAM 60 0187R0161018V000839 17/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
025512 SRI HASTUTI MOKOGINTA DALAM 35 0187R0161018V000845 17/10/2018 Z09.8 Kontrol A91 DHF Rp 176,200
027502 MARIA NGATMINAH DALAM 76 0187R0161018V000814 17/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035623 SISWANINGSIH SRI RAHAYU DALAM 50 0187R0161018V000813 17/10/2018 K30 Dyspepsia Rp 229,900
030833 SUHARTONO DALAM 66 0187R0161018V000825 17/10/2018 E11.9 DM Rp 176,200
030216 ANLIK NUR ALIMAH DALAM 26 0187R0161018V000826 17/10/2018 K30 Dyspepsia Rp 229,900
035634 SUROSO DALAM 30 0187R0161018V000842 17/10/2018 K30 Dyspepsia Rp 229,900
031823 SULASTRI DALAM 61 0187R0161018V000810 17/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
031403 WUJUD KARTIMIN DALAM 62 0187R0161018V000809 17/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
023853 JUMIRAH DALAM 40 0187R0161018V000799 17/10/2018 K30 Dyspepsia Rp 229,900
032093 JUWARNO DALAM 52 0187R0161018V000804 17/10/2018 G56.0 CTS Rp 229,900
035130 SUNDARI DALAM 63 0187R0161018V000805 17/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
031366 SAMADI DALAM 65 0187R0161018V000803 17/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200

035208 RUBA'I DALAM 67 0187R0161018V000827 17/10/2018 I10 HT K29.1 Melena Rp 176,200

033187 SULIKAH DALAM 67 0187R0161018V000830 17/10/2018 I11.0 HHD E11.9 DM Rp 248,800
025490 MUJIATI DALAM 63 0187R0161018V000831 17/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
031627 KARTINI DALAM 63 0187R0161018V000824 17/10/2018 Z09.8 Kontrol K30 Dyspepsia Rp 176,200
032858 SUPARMAN DALAM 60 0187R0161018V000792 17/10/2018 Z09.8 Kontrol I63.9 CVA Rp 176,200
034417 PUJIATI DALAM 56 0187R0161018V000794 17/10/2018 I11.0 HHD E11.9 DM Rp 248,800
024796 HOSIM DALAM 56 0187R0161018V000808 17/10/2018 Z09.8 Kontrol B01.2 Heart Failure Rp 176,200
024081 PATIMAH DALAM 60 0187R0161018V000855 18/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035523 HERI KUSDARIYANTO DALAM 60 0187R0161018V000856 18/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
030606 SAYUNAH DALAM 68 0187R0161018V000857 18/10/2018 D45 Polycythaema Rp 248,800
035305 HILDA MEGA CAHYANI DALAM 21 0187R0161018V000865 18/10/2018 K30 Dyspepsia Rp 229,900
007177 BENG INDRAWIYATI DALAM 56 0187R0161018V000859 18/10/2018 I87.1 VCS Rp 176,200
031602 SALIMAH DALAM 55 0187R0161018V000848 17/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
023267 MOCHAMAD MUNIR DALAM 68 0187R0161018V000849 17/10/2018 Z09.8 Kontrol I50.9 Heart Failure Rp 176,200
005611 MARWIN DALAM 58 0187R0161018V000838 17/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
031503 RAHMAWATI DALAM 58 0187R0161018V000802 17/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
009617 DHEA AYU GITA DALAM 17 0187R0161018V000844 17/10/2018 Z09.8 Kontrol A01.0 GEA Rp 176,200
035635 MARIYANTO DALAM 48 0187R0161018V000843 17/10/2018 I11.0 HHD Rp 248,800
007788 WIYONO DALAM 58 0187R0161018V000846 17/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
034516 SULIATI DALAM 71 0187R0161018V000847 17/10/2018 J45.9 Asthma Rp 292,900
024609 SHOLIK ACHMAD DALAM 49 0187R0161018V000837 17/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035069 SITI MUSOFAH DALAM 49 0187R0161018V000823 17/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035513 DYAH TRI RATNA NINGSIH DALAM 48 0187R0161018V000822 17/10/2018 M13.0 Polyarthritis Rp 176,200
035394 HAMDHA KUSUMA WARDANA ANAK 6 0187R0161018V000894 18/10/2018 Z09.8 Kontrol A01.0 Thypoid Fever Rp 176,200
035544 MIMIN SITI AMINAH MATA 68 0187R0161018V000574 12/10/2018 H26.0 Cataract Rp 226,000
035544 MIMIN SITI AMINAH MATA 68 0187R0161018V000674 15/10/2018 H26.0 Cataract Rp 6,300,000
035544 MIMIN SITI AMINAH MATA 68 0187R0161018V000896 17/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035452 HJ MAHMUDAH MATA 57 0187R0161018V000639 13/10/2018 H26.0 Cataract Rp 226,000
035452 HJ MAHMUDAH MATA 57 0187R0161018V000693 15/10/2018 H26.0 Cataract Rp 6,300,000
035452 HJ MAHMUDAH MATA 57 0187R0161018V000897 17/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035493 ABDI MUNIF MATA 52 0187R0161018V000691 15/10/2018 H26.0 Cataract Rp 6,300,000
035493 ABDI MUNIF MATA 52 0187R0161018V000899 17/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033568 SUPRIONO MATA 53 0187R0161018V000611 13/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033568 SUPRIONO MATA 53 0187R0161018V000660 15/10/2018 H26.0 Cataract Rp 6,300,000
035596 MARIANA MATA 64 0187R0161018V000735 16/10/2018 H11.0 Pterygium Rp 837,100
035606 LUTFIYAH MATA 42 0187R0161018V000761 16/10/2018 H52.1 Myopi Rp 176,200
034816 SLAMET MATA 69 0187R0161018V000767 16/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
031334 SRIYATI MATA 61 0187R0161018V000742 16/10/2018 H40.8 Glaucoma Rp 425,800
035127 SUTINAH IGD 61 0187R0161018V000811 17/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035381 RAHMAT HIDAYAT IGD 22 0187R0161018V000800 17/10/2018 Z09.8 Kontrol T14.1 Open Wound Rp 176,200
035633 MULIYANI DALAM 56 0187R0161018V000841 17/10/2018 M54.5 LBP Rp 176,200
033568 SUPRIONO MATA 53 0187R0161018V000900 17/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
023267 MOCHAMAD MUNIR MATA 68 0187R0161018V000750 16/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035665 SUNARTIN LABORAT 61 0187R0161018V000750 18/10/2018 Z09.8 Kontrol N18.2 CKD Rp 176,200
035615 SUHAIMI LABORAT 40 0187R0161018V000912 19/10/2018 Z09.8 Kontrol E11.9 DM Tipe II Rp 176,200
033682 MUSTARI MATA 76 0187R0161018V000871 18/10/2018 Z09.8 Kontrol H40.1 POAG Rp 176,200
035639 LILIS SETYAWATI MATA 35 0187R0161018V000868 18/10/2018 H52.2 Astimaghsim Rp 176,200
033724 CHAMIDAH MATA 65 0187R0161018V000872 18/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 176,200
031417 SAMSUKAMI MATA 63 0187R0161018V000873 18/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 176,200
031728 E. WAHYU SRI INDARWATI MATA 70 0187R0161018V000880 18/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 176,200
031729 G. F. MOERGITO MATA 78 0187R0161018V000879 18/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
030841 LILIK KUSUMAWATI MATA 59 0187R0161018V000878 18/10/2018 Z09.8 Kontrol H43.3 Floaters Rp 176,200
029444 SAMSURI MATA 72 0187R0161018V000870 18/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035644 FATIMAH ALAYDRUS MATA 50 0187R0161018V000885 18/10/2018 H52.4 Presbyopi Rp 176,200
035641 MINARTI MATA 73 0187R0161018V000876 18/10/2018 H26.0 Cataract Rp 226,000
035643 MUJIYATI MATA 68 0187R0161018V000884 18/10/2018 H26.0 Cataract Rp 226,000
035647 NURUL HINDARWATI MATA 45 0187R0161018V000888 18/10/2018 Z09.8 Kontrol H10.8 Conjungivitis Rp 176,200
030838 CATUR BUDIONO MATA 56 0187R0161018V000890 18/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 176,200
035642 ENY YULIASTUTIK MATA 58 0187R0161018V000883 18/10/2018 H26.0 Cataract Rp 226,000
033503 WAHYUDI MATA 68 0187R0161018V000795 17/10/2018 Z09.8 Kontrol H40.1 Glaucoma Rp 176,200
035406 SUDARMAN MATA 75 0187R0161018V000858 18/10/2018 H52.2 Astimaghsim Rp 176,200
031891 SUGIONO MATA 53 0187R0161018V000863 18/10/2018 Z09.8 Kontrol E10.3 DM Opthalmic Rp 176,200
030401 SAMUIN MATA 69 0187R0161018V000862 18/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 425,800
029778 NINIK ARIYANTI MATA 52 0187R0161018V000861 18/10/2018 H52.4 Presbyopi Rp 176,200
029506 MASHUDI MATA 78 0187R0161018V000866 18/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
035665 MUFIT SEMIARTO LABORAT 51 0187R0161018V000923 19/10/2018 Z03.8 Suspec M19.9 Arthrosis Rp 176,200
035516 PONALIM LABORAT 73 0187R0161018V000965 20/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
034945 SINI LABORAT 58 0187R0161018V000963 20/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
034120 YANTI HANDAYANI LABORAT 55 0187R0161018V000962 20/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
031823 SULASTRI LABORAT 61 0187R0161018V000958 20/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
029360 CHUMAIDAH LABORAT 62 0187R0161018V000941 20/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
030833 SUHARTONO LABORAT 66 0187R0161018V000945 20/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
027502 MARIA NGATMINAH LABORAT 75 0187R0161018V000976 20/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035635 MARIYANTO LABORAT 48 0187R0161018V001000 22/10/2018 Z09.8 Kontrol I11.0 HHD Rp 176,200
035633 MULIYANI LABORAT 56 0187R0161018V000937 20/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035623 SISWANINGSIH SRI RAHAYU LABORAT 50 0187R0161018V001011 22/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
034718 SUPARMI MATA 66 0187R0161018V000956 20/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034755 MOCHMAD MANSYUR MATA 66 0187R0161018V000972 20/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
034031 AGUS SUWANDI MATA 48 0187R0161018V000975 20/10/2018 H11.0 Pterygium Rp 176,200
034514 SRIYATI MATA 51 0187R0161018V000969 20/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035286 SLAMET PURNOMO MATA 47 0187R0161018V000940 20/10/2018 Z09.8 Kontrol H20.9 Iridocycilitis Rp 176,200
032199 SIYADI MATA 59 0187R0161018V000974 20/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035566 MOSES ABIYASA SUBARJO MATA 8 0187R0161018V000966 20/10/2018 Z09.8 Kontrol H10.8 Conjungivitis Rp 176,200
032033 SAMPUR,SARI MATA 60 0187R0161018V000968 20/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
014778 RUKMINI MATA 67 0187R0161018V000946 20/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035679 SUWANDI MATA 48 0187R0161018V000964 20/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035313 SJAIN MATA 77 0187R0161018V000953 20/10/2018 Z09.8 Kontrol H01.9 Blepharitis Rp 176,200
035432 SUHARTIWI MATA 53 0187R0161018V000952 20/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034793 SUBAKRI MATA 63 0187R0161018V000938 20/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
034194 SUTRISNO ASIH MATA 64 0187R0161018V000955 20/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
017017 JUMIATI MATA 58 0187R0161018V000950 20/10/2018 Z09.8 Kontrol H02.9 Entropion Rp 176,200
034534 NURHAYATI MATA 58 0187R0161018V000961 20/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035675 DAFA BAGASDITYA PRATAM MATA 3 0187R0161018V000960 20/10/2018 Z09.8 Kontrol H00.1 Hordeulum Rp 176,200
035472 MUSTAKIM MATA 54 0187R0161018V000951 20/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033068 SUPARMAN MATA 68 0187R0161018V000943 20/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
025582 YETI INDRASARI MATA 30 0187R0161018V000954 20/10/2018 H40.8 Glaucoma Rp 425,800
031144 SANDJAYA MATA 61 0187R0161018V000948 20/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035457 LASMI MATA 75 0187R0161018V000949 20/10/2018 Z09.8 Kontrol H18.0 Ulcus Cornea Rp 176,200
031469 MOCH ASTAR MATA 73 0187R0161018V000947 20/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
029536 NGATININGSIH MATA 62 0187R0161018V000957 20/10/2018 Z09.8 Kontrol H40.8 Glaucoma Rp 176,200
033568 SUPRIONO MATA 53 0187R0161018V000942 20/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033066 SADJID MATA 74 0187R0161018V000944 20/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035518 ANAIYA ANGELINA SEPTYANTORO ANAK 8 0187R0161018V000867 18/10/2018 Z09.8 Kontrol A01.0 Thypoid Fever Rp 176,200
035699 DEDI SUTIKNO IGD 37 0187R0161018V001028 22/10/2018 A91 DHF Rp 274,800
035702 DINAR PERTA KHANZA MATA 23 0187R0161018V001044 22/10/2018 H52.7 Disorders Of Refarction Rp 176,200
035629 NAFA DWI PUTRI MATA 14 0187R0161018V001045 22/10/2018 H53.0 Astenopia Rp 176,200
029507 LILIS SULISTYA NINGSIH MATA 58 0187R0161018V001032 22/10/2018 H04.1 DES Rp 176,200
010230 JASULI NURDIANTO MATA 49 0187R0161018V001031 22/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
035315 AMINAH MATA 63 0187R0161018V001030 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034794 SUSIANI MATA 66 0187R0161018V001037 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
031602 SALIMAH MATA 55 0187R0161018V001036 22/10/2018 Z09.8 Kontrol H26.9 Cataract Rp 176,200
033587 SITI ROCHAYATIN MATA 66 0187R0161018V001038 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034788 BUDI EFFENDI MATA 58 0187R0161018V000994 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034949 ASPAN MUNADI MATA 72 0187R0161018V000989 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034664 HALIMAH MATA 68 0187R0161018V000990 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
029995 SOEKEMI MATA 85 0187R0161018V000997 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035316 PUDJI WINARTI MATA 65 0187R0161018V000999 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033582 SUPARNI MATA 66 0187R0161018V001003 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035544 MIMIN SITI AMINAH MATA 69 0187R0161018V001005 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
033707 SUNDRIK MATA 41 0187R0161018V001006 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
032534 BUAMAT MATA 64 0187R0161018V001007 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035068 MAHRA'JAH MATA 69 0187R0161018V000998 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035469 M NOOR YASIN MATA 69 0187R0161018V000996 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
030342 SEI ASRIPAH MATA 68 0187R0161018V001008 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
028536 NOVITA SHYLA NUR FITRI MATA 11 0187R0161018V001004 22/10/2018 H52.2 AMS H52.1 Myopi Rp 176,200
035692 RAHMAD MUHAMAD MATA 43 0187R0161018V001012 22/10/2018 H52.4 Presbyopi Rp 176,200
035697 ENI RUSDIANA PUSPITASARI MATA 34 0187R0161018V001019 22/10/2018 H408 Glaucoma Rp 200,600
035452 HJ MAHMUDAH MATA 57 0187R0161018V001021 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035355 JALAL MATA 69 0187R0161018V001020 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
034426 MOH AFFANDI YUSUF MATA 77 0187R0161018V000992 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035473 SALAM MATA 82 0187R0161018V001009 22/10/2018 H26.0 Cataract Rp 226,000
034026 RAMIYEM MATA 54 0187R0161018V001023 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035694 HEYKEL ERVANDA MATA 46 0187R0161018V001015 22/10/2018 H16.8 Keratitis Rp 176,200
033866 RAMUIN MATA 72 0187R0161018V001017 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 200,600
033605 SITI CHOTIJAH MATA 65 0187R0161018V001018 22/10/2018 H26.0 Cataract Rp 176,200
035691 RUSMINI MATA 78 0187R0161018V001010 22/10/2018 H26.0 Cataract Rp 226,000
030408 ERNIES WULANDARI MATA 45 0187R0161018V001022 22/10/2018 Z48.8 Post OP H26.9 Cataract Rp 176,200
035695 ROFI'I S.PD MATA 70 0187R0161018V001016 22/10/2018 H26.0 Cataract Rp 176,200
031738 LILIK SUMARNI MATA 58 0187R0161018V001093 23/10/2018 Z09.8 Kontrol H04.1 DES Rp 176,200
022514 PONARI DALAM 68 0187R0161018V001095 23/10/2018 J20 Bronchitis K30 Dyspepsia Rp 178,000
030799 UDRALIA DALAM 50 0187R0161018V001086 23/10/2018 I11.0 HHD Rp 248,800
035503 BUDIONO LADI DALAM 69 0187R0161018V001094 23/10/2018 Z09.8 Kontrol D64.9 Anemia Rp 176,200
032033 SAMPUR,SARI DALAM 60 0187R0161018V001083 23/10/2018 Z09.8 Kontrol I10 HT Rp 176,200
021856 JUWARIYAH DALAM 51 0187R0161018V001103 23/10/2018 Z09.8 Kontrol J44.9 COPD Rp 176,200
033187 SULIKAH DALAM 67 0187R0161018V001098 23/10/2018 I11.0 HHD E11.9 DM Rp 248,800
033571 GUNAWAN DALAM 39 0187R0161018V001105 23/10/2018 Z09.8 Kontrol E11.9 DM Rp 176,200
025393 AGUNG NURRAHMAN DALAM 15 0187R0161018V001118 23/10/2018 L60.0 Ingrowing Nail Rp 176,200
032628 DODIK WIJAYA DALAM 39 0187R0161018V001115 23/10/2018 Z09.8 Kontrol A01.0 Thypoid Fever Rp 176,200
032199 SIYADI DALAM 59 0187R0161018V001100 23/10/2018 I11.0 HHD Rp 248,800
DATASEMEN KESEHATAN WILAYAH MALANG
RUMAH SAKIT BANTUAN 05.08.04 LAWANG
DATA KUNJUNGAN & PENNGUNJUNG PASIEN
RUMAH SAKIT BANTUAN 05.08.04 LAWANG
BULAN : AGUSTUS 2018
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 JUMLAH
PASIEN BPJS SWASTA
KUNJUNGAN BPJS SWASTA 4 3 5 0 1 1 1 3 4 4 3 4 3 0 7 4 8 3 3 2 2 6 0 1 1 0 1 1 4 0 0 79
PENGUNJUNG BPJS SWASTA 3 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 8
PASIEN BPJS TNI
MILITER 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 1 0 0 0 0 0 1
KUNJUNGAN TNI AD KELUARGA 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 3
SIPIL 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 0
MILITER 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 0
PENGUNJUNG TNI AD KELUARGA 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 0
SIPIL 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 0
MILITER 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 0
KUNJUNGAN TNI AU KELUARGA 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 0
SIPIL 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 0
MILITER 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 0
PENGUNJUNG TNI AU KELUARGA 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 0
SIPIL 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 0
MILITER 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 0
KUNJUNGAN TNI AL KELUARGA 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 0
SIPIL 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 0
MILITER 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 0
PENGUNJUNG TNI AL KELUARGA 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 0
SIPIL 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 0
JUMLAH 8 4 5 0 1 1 1 4 5 4 3 4 3 0 7 4 8 3 4 2 2 6 1 1 3 1 1 1 4 0 0 91
WATUM 4 4 4 0 0 1 1 1 5 3 2 1 3 0 3 4 8 3 1 2 1 4 1 0 3 1 0 1 4 0 0 65
PX IRNA
OBSGYN 4 0 1 0 1 0 0 3 0 1 1 4 0 0 4 0 0 0 3 0 1 2 0 1 0 0 1 0 0 0 0 27
92

Ka Ru Rekam Medis

Dessy Irasari, Amd. Keb

JUMLAH PASIEN KLAIM PER JENIS PERAWATAN
NO KELAS JUMLAH TOTAL NO JENIS PERAWATAN TOTAL KLAIM JUMLAH PX
1 1 9 Rp 29,482,800 1 WATUM Rp 194,116,900 68
2 2 66 Rp 202,782,400 2 OBSGYN Rp 100,159,600 28
3 3 21 Rp 62,011,300 KLAIM RAWAT INAP Rp 294,276,500 96
KLAIM RAWAT JALAN Rp 459,540,000 1282
TOTAL KLAIM RI + RJ Rp 753,816,500 1378

RAWAT INAP
KODE DOKTER NAMA DOKTER JML PX TOTAL KLAIM NO JENIS TINDAKAN JML
1 dr. Zainal Alim, Sp.OG 26 Rp 100,159,600 1 Perawatan Umum 54
2 dr. Fitri, Sp. OG 0 Rp - 2 Perawatan Obgyn 5
3 dr. Devi, Sp. A 0 Rp - 3 SC 8
4 dr. Subiyati, Sp. A 20 Rp 47,733,400 4 Curretage 8
5 dr. Soleh, Sp. S 0 Rp - 5 SOS 5
6 dr. Ade, Sp.PD 32 Rp 83,646,700 6 Herniorrhapy 0
7 dr. Hanafi, Sp. B 0 Rp - 7 Partus 2
8 dr. Artha Sandy, Sp. M 0 Rp - 8 Excisi 11
9 dr. Arif, Sp.B 16 Rp 62,736,800 9 Marsupialisasi 0
JUMLAH 94 Rp 294,276,500 10 SVH 0
11 Laparotomy 0
RAWAT JALAN 12 Hemoroidectomy 3
KODE DOKTER NAMA DOKTER JML PX TOTAL KLAIM JUMLAH 96
1 dr. Zainal Alim, Sp.OG 83 Rp 17,806,500
2 dr. Fitri. Sp. OG 0 Rp -
3 dr. Devi, Sp. A 0 Rp -
4 dr. Subiyati, Sp. A 32 Rp 5,702,800
5 dr. Soleh, Sp. S 0 Rp -
6 dr. Ade Nurshanty, Sp.PD 324 Rp 60,727,800
7 dr. Hanafi, Sp. B 0 Rp -
8 dr. Artha Sandy, Sp. M 675 Rp 343,222,500
9 dr. Nur Herdiyanti 23 Rp 4,681,500
10 dr. Fanny 30 Rp 6,019,000
11 dr. Farid 25 Rp 4,990,200
12 dr. Meisyarah 22 Rp 4,408,100
13 Laborat 68 Rp 11,981,600
14 dr. Arif, Sp.B 0 Rp -
JUMLAH 1282 Rp 459,540,000
TANGGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 JML
JML PX 52 63 50 31 30 39 3 59 52 67 38 36 33 1 66 54 50 38 23 40 3 54 61 59 43 41 44 2 42 54 54 1282
 RAWAT JALAN RAWAT INAP
BERKAS BPJS
TGL JUMLAH
TGL BERKAS BPJS 1 2 3 1
1 52 1 0 1 1 2
2 63 2 0 0 1 1
3 50 3 0 5 4 9
4 31 4 0 4 2 6
5 30 5 0 1 0 1
6 39 6 0 1 0 1
7 3 7 0 1 0 1
8 59 8 0 1 1 2
9 52 9 0 1 1 2
10 67 10 1 1 0 2
11 38 11 0 5 0 5
12 36 12 0 3 2 5
13 33 13 0 4 0 4
14 1 14 1 3 1 5
15 66 15 0 0 1 1
16 54 16 0 1 1 2
17 50 17 0 2 1 3
18 38 18 2 5 0 7
19 23 19 2 4 0 6
20 40 20 0 6 0 6
21 3 21 0 0 0 0
22 54 22 0 4 1 5
23 61 23 1 1 1 3
24 59 24 0 2 0 2
25 43 25 0 2 1 3
26 41 26 0 1 0 1
27 44 27 1 2 0 3
28 2 28 0 1 1 2
29 42 29 0 1 0 1
30 54 30 0 2 0 2
31 54 31 1 1 1 3
JML 1282 JML 9 66 21 96
AP
BPJS
JUMLAH KETERANGAN
2 3
NO NO. RM NAMA TGL MRS TGL KRS LOS
RM 01 RM 02 RM 03 RM 04

1 035350 ACH FAREL DANENDRA F. 30/09/2018 03/10/2018 0 1 1 1 0

2 029090 DANADYAKSA HERNANDO Err:509 03/10/2018 0
3 035366 IMAM SUGENG DIONO 01/10/2018 03/10/2018 0
4 034836 UMI KULSUM 01/10/2018 03/10/2018 0
5 035371 SUNAMI 01/10/2018 03/10/2018 0
6 035367 KARIATI 02/10/2018 03/10/2018 0
7 028771 PERMADI AGUNG NUROHMAN 01/10/2018 06/10/2018 0
8 034428 NITA TRISANTI 03/10/2018 04/10/2018 0
9 035330 THALHA NABILA 01/10/2018 03/10/2018 0
10 035393 MISDIARI 02/10/2018 04/10/2018 0
11 035335 SULIHA 03/10/2018 01/10/2018 0
12 035360 AGUSTINA SUSANTI 28/09/2018 04/10/2018 0
13 007424 EVANGELINA BONITA DOS S. 01/10/2018 04/10/2018 0
14 022592 ANISYA RHAMAWATI 01/10/2018 04/10/2018 0
15 Err:509 Err:509 03/10/2018 Err:509 Err:509
16 035378 DHIMAS TRI ANGGARA Err:509 03/10/2018 0
17 020235 KUNTI WAHYUNI 02/10/2018 09/10/2018 0
18 021494 DIMAZ FAHRIZAL AL FARDAN 08/10/2018 04/10/2018 0
19 035349 HAMDHA KUSUMA WARDANA 02/10/2018 02/10/2018 0
20 035518 ANAIYA ANGELINA S. 29/09/2018 12/10/2018 0
21 025512 SRI HASTUTI MOKOGINTA 10/10/2018 08/10/2018 0
22 007788 WIYONO 06/10/2018 12/10/2018 0
23 009189 NENENG HASANAH 09/10/2018 13/10/2018 0
24 035480 YULIANA 12/10/2018 13/10/2018 0
25 035557 LUTFIYAH 10/10/2018 13/10/2018 0
26 027452 MARIA ULFA 12/10/2018 11/10/2018 0
27 031228 RUSMIATI NINGSIH 09/10/2018 08/10/2018 0
28 030038 MUNIFATUL LUTFIAH 05/10/2018 11/10/2018 0
29 035465 AGNESA FITRI AMELLIZA 08/10/2018 09/10/2018 0
30 030749 WILDAN ALI WAFA 07/10/2018 14/10/2018 0
31 035478 ANDI SANJAYA 13/10/2018 11/10/2018 0
32 035486 SUGENG RIADI 08/10/2018 10/10/2018 0
33 027702 YODA VIONIGARRA 09/10/2018 17/10/2018 0
34 035585 NASYA THADILLA ATHIYAN 13/10/2018 17/10/2018 0
35 035591 ASTY OLIVIA PUTRI PRATIWI 15/10/2018 17/10/2018 0
36 020689 ATIM NURJANAH 15/10/2018 22/10/2018 0
37 035630 AMADEUS DIRGHAM HAIDAR 19/10/2018 18/10/2018 0
38 035477 TITIN VERLAEN 17/10/2018 11/10/2018 0
39 034086 AKHALENDRA ROLAND AKBAR 08/10/2018 18/10/2018 0
40 024920 PRASETYO HIDAYAT IQBAL 17/10/2018 18/10/2018 0
41 035593 LESTARI SITA AGUSTIN 17/10/2018 18/10/2018 0
42 035535 ARIS RATNAWATI 15/10/2018 14/10/2018 0
43 035590 ANGGELA INDRI LESTARI 11/10/2018 16/10/2018 0
44 024300 RIKMA NOVITASARI 15/10/2018 16/10/2018 0
45 033257 MAHATTA SULTAN MACHSUM 15/10/2018 07/10/2018 0
46 035582 MOH. RADITYA BAGUS 03/10/2018 19/10/2018 0
47 035624 AULIA ULINNUHA FITRIA 15/10/2018 19/10/2018 0
48 035610 ILHAM BINTANG PUTRA FAUZI 17/10/2018 19/10/2018 0
49 020535 ANIK SRIWIDAYATI 16/10/2018 19/10/2018 0
50 035660 IIS PURWANINGTYAS 16/10/2018 20/10/2018 0
51 035621 PIPIT HERMANTO 19/10/2018 20/10/2018 0
52 032628 DODIK WIJAYA 17/10/2018 19/10/2018 0
53 009497 NUR FADILAH 17/10/2018 20/10/2018 0
54 009617 DHEA AYU GITA 18/10/2018 12/10/2018 0
55 035502 LINA ALIFIA CAHYANINGRUM 10/10/2018 23/10/2018 0
56 028545 ABDUS SALAM AFANDI 22/10/2018 23/10/2018 0
57 021180 H. ALI HAMDAN MUJIANA 22/10/2018 23/10/2018 0
58 033871 AZKA AZFAR RABBANI 21/10/2018 22/10/2018 0
59 035581 JEFFRY ANTON PRAKOSO 20/10/2018 22/10/2018 0
60 Err:509 Err:509 17/10/2018 Err:509 Err:509
61 035649 MAISA S. TOSSE Err:509 20/10/2018 0
62 035700 DICKY ARLANGGA 18/10/2018 24/10/2018 0
63 025024 DEVINA SAVANA 22/10/2018 24/10/2018 0
64 035632 RUTH SENNIA DINASTRY 22/10/2018 19/10/2018 0
65 024298 FITRIA NUR AGUSTINA 17/10/2018 20/10/2018 0
66 035704 IDA TRI WULANDARI 18/10/2018 27/10/2018 0
67 035724 LUSI ARUM PRATIWI 24/10/2018 25/10/2018 0
68 020738 REFLY BOGI 23/10/2018 28/10/2018 0
69 035437 VIVIT RAHAYU 26/10/2018 26/10/2018 0
70 035666 KURNIA DUSA AGUSTINA 22/10/2018 20/10/2018 2
71 029910 MANISAH 19/10/2018 27/10/2018 3
72 035503 BUDIONO LADI 25/10/2018 12/10/2018 3
73 029885 KARLINA TATYANASARI 10/10/2018 05/10/2018 3
74 035690 NOVITA KONTESA 03/10/2018 25/10/2018 4
75 020448 M. BINTANG IQBAL M. 22/10/2018 11/10/2018 3
76 033809 WIWIK SRI WIDAYATI 09/10/2018 14/10/2018 2
77 032850 HARI MULYADI 13/10/2018 10/10/2018 2
78 024609 SHOLIK ACHMAD 09/10/2018 14/10/2018 4
79 035736 ZAHRA AULIA P 11/10/2018 30/10/2018 2
80 035755 SULISTIONO 29/10/2018 30/10/2018 3
81 032845 ARIE ULLI PUTRIYANI 28/10/2018 18/10/2018 4
82 035514 ADELIA DEWI PUSPITASARI 15/10/2018 15/10/2018 4
83 030375 CICIK NOVIKAWATI 12/10/2018 25/10/2018 6
84 034924 AYU TITIN LESTARI 20/10/2018 12/10/2018 2
 85 035617 KUKUH DWI LAKSONO 11/10/2018 18/10/2018 3
86 035604 NABILA DIWANTI 16/10/2018 18/10/2018 3
87 035364 FIFIN ARUM ANGGRAENI 16/10/2018 14/10/2018 3
88 012980 DEASY YUANITA P. 12/10/2018 22/10/2018 4
89 035281 ZAKIA OMA RAHAYU 19/10/2018 01/10/2018 8
90 Err:509 Err:509 24/09/2018 Err:509 Err:509
91 035361 SITI KHOTIMATUL KHUSNAH Err:509 03/10/2018 3
92 035745 RUDI RIYANTO 01/10/2018 27/10/2018 9
93 035758 NURUL AINI PUTRI 25/10/2018 31/10/2018 3
94 035779 RUKAN HADI WINOTO 29/10/2018 31/10/2018 3
95 035793 I MADE AGHASTYA DEVA 29/10/2018 31/10/2018 3
96 032338 DIAN ANGGRAINI 29/10/2018 29/10/2018 3
97 035543 MUDJI SAJOGA 27/10/2018 13/10/2018 2
98 035687 LAMASIASIH 12/10/2018 22/10/2018 2
99 033568 SUPRIONO 21/10/2018 28/10/2018 4
100 0 0 25/10/2018 30/12/1899 0
101 0 0 30/12/1899 30/12/1899 0
102 0 0 30/12/1899 30/12/1899 0
103 0 0 30/12/1899 30/12/1899 0
104 0 0 30/12/1899 30/12/1899 0
105 0 0 30/12/1899 30/12/1899 0
106 0 0 30/12/1899 30/12/1899 0
107 0 0 30/12/1899 30/12/1899 0
108 0 0 30/12/1899 30/12/1899 0
109 0 0 30/12/1899 30/12/1899 0
110 0 0 30/12/1899 30/12/1899 0
111 0 0 30/12/1899 30/12/1899 0
112 0 0 30/12/1899 30/12/1899 0
113 0 0 30/12/1899 30/12/1899 0
114 0 0 30/12/1899 30/12/1899 0
115 0 0 30/12/1899 30/12/1899 0
116 0 0 30/12/1899 30/12/1899 0
117 0 0 30/12/1899 30/12/1899 0
118 0 0 30/12/1899 30/12/1899 0
119 0 0 30/12/1899 30/12/1899 0
120 0 0 30/12/1899 30/12/1899 0
121 0 0 30/12/1899 30/12/1899 0
122 0 0 30/12/1899 30/12/1899 0
123 0 0 30/12/1899 30/12/1899 0
124 0 0 30/12/1899 30/12/1899 0
125 0 0 30/12/1899 30/12/1899 0
126 0 0 30/12/1899 30/12/1899 0
127 0 0 30/12/1899 30/12/1899 0
128 0 0 30/12/1899 30/12/1899 0
129 0 0 30/12/1899 30/12/1899 0
130 0 0 30/12/1899 30/12/1899 0
131 0 0 30/12/1899 30/12/1899 0
132 0 0 30/12/1899 30/12/1899 0
133 0 0 30/12/1899 30/12/1899 0
134 0 0 30/12/1899 30/12/1899 0
135 0 0 30/12/1899 30/12/1899 0
136 0 0 30/12/1899 30/12/1899 0
137 0 0 30/12/1899 30/12/1899 0
138 0 0 30/12/1899 30/12/1899 0
139 0 0 30/12/1899 30/12/1899 0
140 0 0 30/12/1899 30/12/1899 0
141 0 0 30/12/1899 30/12/1899 0
142 0 0 30/12/1899 30/12/1899 0
143 0 0 30/12/1899 30/12/1899 0
144 0 0 30/12/1899 30/12/1899 0
145 0 0 30/12/1899 30/12/1899 0
146 0 0 30/12/1899 30/12/1899 0
147 0 0 30/12/1899 30/12/1899 0
148 0 0 30/12/1899 30/12/1899 0
149 0 0 30/12/1899 30/12/1899 0
150 0 0 30/12/1899 30/12/1899 0
151 0 0 30/12/1899 30/12/1899 0
152 0 0 30/12/1899 30/12/1899 0
153 0 0 30/12/1899 30/12/1899 0
154 0 0 30/12/1899 30/12/1899 0
155 0 0 30/12/1899 30/12/1899 0
156 0 0 30/12/1899 30/12/1899 0
157 0 0 30/12/1899 30/12/1899 0
158 0 0 30/12/1899 30/12/1899 0
159 0 0 30/12/1899 30/12/1899 0
160 0 0 30/12/1899 30/12/1899 0
161 0 0 30/12/1899 30/12/1899 0
162 0 0 30/12/1899 30/12/1899 0
163 0 0 30/12/1899 30/12/1899 0
164 0 0 30/12/1899 30/12/1899 0
165 0 0 30/12/1899 30/12/1899 0
166 0 0 30/12/1899 30/12/1899 0
167 0 0 30/12/1899 30/12/1899 0
168 0 0 30/12/1899 30/12/1899 0
169 0 0 30/12/1899 30/12/1899 0
170 0 0 30/12/1899 30/12/1899 0
171 0 0 30/12/1899 30/12/1899 0
172 0 0 30/12/1899 30/12/1899 0
173 0 0 30/12/1899 30/12/1899 0
174 0 0 30/12/1899 30/12/1899 0
175 0 0 30/12/1899 30/12/1899 0
176 0 0 30/12/1899 30/12/1899 0
177 0 0 30/12/1899 30/12/1899 0
178 0 0 30/12/1899 30/12/1899 0
179 0 0 30/12/1899 30/12/1899 0
180 0 0 30/12/1899 30/12/1899 0
181 0 0 30/12/1899 30/12/1899 0
182 0 0 30/12/1899 30/12/1899 0
183 0 0 30/12/1899 30/12/1899 0
184 0 0 30/12/1899 30/12/1899 0
185 0 0 30/12/1899 30/12/1899 0
 FORM REKAM MEDIS
RM 05 RM 06 RM 07 RM 08 RM 09 RM 10 RM 11 RM 12 RM 13 RM 14 RM 15 RM 16 RM 17 RM 18 RM 19 RM 20 RM 21 RM 22 RM 23 RM 24 RM 25

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LKP / TDK
LKP
0
 RWT INAP SWT

KODE ICD DX INA

NO NO RM NAMA TANGGAL TANGGAL LOS LAYANAN PROSEDUR NAMA TNDK KELAS DPJP
MASUK KELUAR
PRIMER SEKUNDER PRIMER SEKUNDER

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34

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 RWT INAP SWT

35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
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