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KODE_RS KELAS_RS KELAS_RAWAT KODE_TARIF PTD ADMISSION_DATE

DISCHARGE_DATE BIRTH_DATE BIRTH_WEIGHT SEX DISCHARGE_STATUS


DIAGLIST PROCLIST ADL1 ADL2 IN_SP IN_SR IN_SI IN_SD INACBG
SUBACUTE CHRONIC SP SR SI SD DESKRIPSI_INACBG TARIF_INACBG
TARIF_SUBACUTE TARIF_CHRONIC DESKRIPSI_SP TARIF_SP DESKRIPSI_SR
TARIF_SR DESKRIPSI_SI TARIF_SI DESKRIPSI_SD TARIF_SD
TOTAL_TARIF TARIF_RS TARIF_POLI_EKS LOS ICU_INDIKATOR ICU_LOS
VENT_HOUR NAMA_PASIEN MRN UMUR_TAHUN UMUR_HARI DPJP SEP NOKARTU
PAYOR_ID CODER_ID VERSI_INACBG VERSI_GROUPER C1 C2 C3
C4 PROSEDUR_NON_BEDAH PROSEDUR_BEDAH KONSULTASI TENAGA_AHLI
KEPERAWATAN PENUNJANG RADIOLOGI LABORATORIUM PELAYANAN_DARAH
REHABILITASI KAMAR_AKOMODASI RAWAT_INTENSIF OBAT ALKES BMHP
SEWA_ALAT
6472130 C 3 CS 2 01/09/2018 01/09/2018 13/04/1957 0 2
1 Z09.8;E11.9 - - - None None None None Q-5-44-0 None
None None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600
0 0 - 0 - 0 - 0 - 0 195600 139238
0 1 0 0 0 ALUH AMAMI C2001625 61 22421 DR. INDRIATY
SASONGKO SP.PD 0302R1160918V000006 0001925318463 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 950 1#0##0#0#0.0#2018-
09-04 08:36:09#0#07:33:56#07:33:56#00:00:00 1
8836dcc5b1877aebe995f7b5aaa281cd 0 0 78240 0 0 0 0
58800 0 0 0 0 2198 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 17/08/1965 0 2
1 Z09.8;I10 - - - None None None None Q-5-44-0 None
None None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600
0 0 - 0 - 0 - 0 - 0 195600 161988
0 1 0 0 0 MINARSIH C2001634 53 19373 DR. INDRIATY
SASONGKO SP.PD 0302R1160918V0000002 0001732393113 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 948 1#0##0#0#0.0#2018-
09-04 08:38:07#0#07:32:03#07:32:03#00:00:00 1
b46cab62a43a7a394d1406a43d5e38c3 0 0 78240 0 0 0 0
58800 0 0 0 0 24948 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 11/07/2007 0 2
1 S42.21 - - - None None None None Q-5-31-0 None
None None None None None FRAKTUR 139700 0 0 - 0
- 0 - 0 - 0 139700 337240 0 1 0
0 0 NUR HABIBAH C2001757 11 4070 DR. JASIN WIJANARKO SP.B
0302R1160918V000013 0002026307406 3;JKN INACBG;123123123123
5.2.2.201806040537 4 953 1#0##0#0#0.0#2018-09-04
08:46:40#0#07:40:05#07:40:05#00:00:00 1 28b7300d4976efc05958912a483199fd
0 0 78240 0 0 0 259000 0 0 0 0 0
0 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 04/01/1963 0 2
1 Z09.8;E11.9;I10;I63.9 - - - None None None None Q-5-
44-0 None None None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600
0 0 - 0 - 0 - 0 - 0 195600 312085
0 1 0 0 0 NOOR ASANAH C2001433 55 20329 FISIOTERAPI
0302R1160918V000014 0000123035681 3;JKN INACBG;123123123123
5.2.2.201806040537 4 958 1#0##0#0#0.0#2018-09-04
08:52:33#0#07:50:15#07:50:15#00:00:00 1 b1e1e8d2da309ef9bd75a7a370198dd3
0 0 78240 0 0 0 0 223800 0 0 0 0
10045 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 17/07/1968 0 2
1 Z09.8;I10;M17.9 - - - None None None None Q-5-44-0
None None None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600
0 0 - 0 - 0 - 0 - 0 195600 302040
0 1 0 0 0 MISMIWATI C2001652 50 18308 DR. INDRIATY
SASONGKO SP.PD 0302R1160918V000004 0001610281056 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 962 1#0##0#0#0.0#2018-
09-04 09:01:31#0#08:00:31#08:00:31#00:00:00 1
b0e7f16ed2fb55dd0add5ecb9e78ebcb 0 0 78240 0 0 0 0
223800 0 0 0 0 0 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 30/12/1988 0 2
1 Z50.9;G56.0 93.34 - - None None None None M-3-16-0 None
None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
MUSKULOSKLETAL 115800 0 0 - 0 - 0 - 0 -
0 115800 84000 0 1 0 0 0 DIANA HASNAH
C2001201 29 10837 FISIOTERAPI 0302R1160918V000010 0001267319261
3;JKN INACBG;123123123123 5.2.2.201806040537 4 966
1#0##0#0#0.0#2018-09-04 09:45:18#0#08:43:23#08:43:23#00:00:00 1
bddadbfc2f797c13e56dc531ff5bc167 0 0 84000 0 0 0 0
0 0 0 0 0 0 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 22/02/1946 0 2
1 Z50.9;M17.9 93.39 - - None None None None M-3-16-0 None
None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
MUSKULOSKLETAL 115800 0 0 - 0 - 0 - 0 -
0 115800 104000 0 1 0 0 0 TIAMIN HARAHAP
C2001424 72 26489 FISIOTERAPI 0302R1160918V000007 0002076528587
3;JKN INACBG;123123123123 5.2.2.201806040537 4 967
1#0##0#0#0.0#2018-09-04 09:48:57#0#08:46:31#08:46:31#00:00:00 1
95f283e83076afc17b1e31bba340ad46 0 0 104000 0 0 0
0 0 0 0 0 0 0 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 28/06/2008 0 1
1 Z09.8;M01.49 - - - None None None None Q-5-44-0
None None None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600
0 0 - 0 - 0 - 0 - 0 195600 350493
0 1 0 0 0 HAIKAL AZKA FIRMANSYAH C2001588 10 3717
DR ROMADHAN S.PA 0302R1160918V000015 0000200758893 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 969 1#0##0#0#0.0#2018-
09-04 10:04:45#0#08:56:30#08:56:30#00:00:00 1
2313863b4bf0629fd6d42fdbc0d86e2d 0 0 78240 0 0 0 249000
0 0 0 0 0 23253 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 01/04/1950 0 1
1 J06.9;J40;I10 - - - None None None None Q-5-42-0
None None None None None None PENYAKIT AKUT KECIL LAIN-LAIN 196900
0 0 - 0 - 0 - 0 - 0 196900 133331
0 1 0 0 0 NOERACHMAN C2001763 68 24990 DR DEDY
ZULFA 0302R1160918V000025 0000120725021 3;JKN INACBG;123123123123
5.2.2.201806040537 4 972 1#0##0#0#0.0#2018-09-04
10:36:14#0#09:33:54#09:33:54#00:00:00 1 1929f92c224a44034a3bd8533019db71
0 0 58680 0 0 64000 0 0 0 0 0 0 10651
0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 19/05/1989 0 2
1 N91.1 88.79 - - None None None None Z-3-23-0 None None
None None None None PROSEDUR ULTRASOUND LAIN-LAIN 592500 0 0
- 0 - 0 - 0 - 0 592500 255240 0
1 0 0 0 DWI ASTUTI C2001770 29 10697 DR. GUSTI HESTY
NURAINI, SP.OG 0302R1160918V000029 0002231613764 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 975 1#0##0#0#0.0#2018-
09-04 10:55:18#0#09:48:07#09:48:07#00:00:00 1
aacfa489008cb994591e150fa6891972 0 0 78240 0 0 0 142000
0 0 0 0 0 35000 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 06/03/1979 0 1
1 Z50.9;F80.9 93.39 - - None None None None M-3-16-0 None
None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
MUSKULOSKLETAL 115800 0 0 - 0 - 0 - 0 -
0 115800 84000 0 1 0 0 0 ARDIANSYAH C2001481
39 14424 FISIOTERAPI 0302R1160918V000028 0002046526053 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 976 1#0##0#0#0.0#2018-
09-04 10:57:22#0#09:56:22#09:56:22#00:00:00 1
fbc03a9d68dce5e364ad664729c575e7 0 0 84000 0 0 0 0
0 0 0 0 0 0 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 19/06/1982 0 2
1 Z50.9;M54.3 93.34;93.39 - - None None None None M-3-16-0
None None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
MUSKULOSKLETAL 115800 0 0 - 0 - 0 - 0 -
0 115800 168000 0 1 0 0 0 NURLAILA M DJA
AFARA C2001609 36 13223 FISIOTERAPI 0302R1160918V000031 0000201266392
3;JKN INACBG;123123123123 5.2.2.201806040537 4 977
1#0##0#0#0.0#2018-09-04 10:59:29#0#09:58:18#09:58:18#00:00:00 1
fabfa601740319d52e72e7fe5c375246 0 0 168000 0 0 0
0 0 0 0 0 0 0 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 31/12/1960 0 2
1 K02.9 24.4 - - None None None None U-2-32-0 None None
None None None None PROSEDUR KECIL PADA MULUT DAN LIDAH 274400 0
0 - 0 - 0 - 0 - 0 274400 323341
0 1 0 0 0 WA ERO C2001614 57 21063 DR. SUMARDI
YAHYA SP.BM 0302R1160918V000027 0001925263528 3;JKN INACBG;123123123123
5.2.2.201806040537 4 978 1#0##0#0#0.0#2018-09-04
11:05:40#0#10:02:04#10:02:04#00:00:00 1 050b9e298dd879bb6271929d581f8ff9
0 0 306100 0 0 0 0 0 0 0 0 0
17241 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 09/08/1991 0 2
1 K30;A01.0 - - - None None None None K-5-18-0 None
None None None None None PENYAKIT SISTEM PENCERNAAN LAIN-LAIN 261100
0 0 - 0 - 0 - 0 - 0 261100 91240
0 1 0 0 0 YETTI PIETER BARANA G207159 27 9885
DR. INDRIATY SASONGKO SP.PD 0302R1160918V000156 0001175087193 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 963 1#0##0#0#0.0#2018-
09-07 10:37:10#0#08:02:46#08:02:46#00:00:00 2
742f5b2084a98aeaff2207d71c17fcd2 0 0 78240 0 0 0 0
0 0 0 0 0 13000 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 17/08/1965 0 2
1 Z09.8;I10 - - - None None None None Q-5-44-0 None
None None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600
0 0 - 0 - 0 - 0 - 0 195600 161988
0 1 0 0 0 MINARSIH C2001634 53 19373 DR. INDRIATY
SASONGKO SP.PD 0302R1160918V000002 0001732393113 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 948 1#0##0#0#0.0#2018-
09-08 11:11:06#0#07:32:03#07:32:03#00:00:00 2
5e932d909499b126047a3543af42e436 0 0 78240 0 0 0 0
58800 0 0 0 0 24948 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 05/10/1962 0 2
1 Z50.9;M79.7 93.34 - - None None None None M-3-16-0 None
None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
MUSKULOSKLETAL 115800 0 0 - 0 - 0 - 0 -
0 115800 91000 0 1 0 0 0 MUTMAINNAH C2001152
55 20420 FISIOTERAPI 0302R1160918V000003 0001278751904 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 965 1#0##0#0#0.0#2018-
09-08 11:19:01#0#08:39:27#08:39:27#00:00:00 3
450dd7aa61b52063b01887bd3769438a 0 0 91000 0 0 0 0
0 0 0 0 0 0 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 11/03/1969 0 2
1 Z09.8;N61 93.57 - - None None None None Z-3-27-0 None
None None None None None PERAWATAN LUKA 198400 0 0 -
0 - 0 - 0 - 0 198400 194934 0 1
0 0 0 LASINEM C2001426 49 18071 DR. JASIN WIJANARKO SP.B
0302R1160918V000011 0001551407927 3;JKN INACBG;123123123123
5.2.2.201806040537 4 964 1#0##0#0#0.0#2018-09-25
12:00:14#0#08:03:25#08:03:25#00:00:00 4 d2da9f877d8f7f644a74e66ba904eaec
0 0 78240 0 90000 0 0 0 0 0 0 0 26694
0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 15/06/1957 0 1
1 E11.9 - - - None None None None Q-5-44-0 None None
None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600 0
0 - 0 - 0 - 0 - 0 195600 154010
0 1 0 0 0 MASKANI C2001769 61 22358 DR KHAIRANI
HAJJAH 0302R1160918V000030 0002450838251 3;JKN INACBG;123123123123
5.2.2.201806040537 4 980 1#0##0#0#0.0#2018-09-25
12:01:07#0#10:15:39#10:15:39#00:00:00 2 49a1d16ac99e12a3176b08ab4855d8d7
0 0 58680 0 0 0 0 94800 0 0 0 0 530
0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 11/10/1968 0 2
1 Z09.8;M17.9;I10 - - - None None None None Q-5-44-0
None None None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600
0 0 - 0 - 0 - 0 - 0 195600 310237
0 1 0 0 0 SUPRIYAH MERAWATI C2001638 49 18222 DR.
INDRIATY SASONGKO SP.PD 0302R1160918V000005 0002217442285 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 961 1#0##0#0#0.0#2018-
09-25 12:18:08#0#07:57:59#07:57:59#00:00:00 2
24718001b59bb9899b63e0782b1bfccc 0 0 78240 0 0 0 0
223800 0 0 0 0 8197 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 15/06/1977 0 2
1 Z87.5 88.78 - - None None None None Z-3-25-0 None None
None None None None PROSEDUR ULTRASOUND GINEKOLOGIK 319700 0
0 - 0 - 0 - 0 - 0 319700 220240
0 1 0 0 0 HASNAWATI C2001760 41 15053 DR. IRFAN
SP.OG KFER 0302R1160918V000018 0001132059418 3;JKN INACBG;123123123123
5.2.2.201806040537 4 959 1#0##0#0#0.0#2018-10-16
13:05:36#0#07:54:45#07:54:45#00:00:00 4 ccfc8e435ebbb684959a200c2e5c720e
0 0 78240 0 0 0 142000 0 0 0 0 0
0 0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 09/05/1976 0 1
1 I63.9;I10 - - - None None None None Q-5-27-0 None
None None None None None SISTEM SARAF PUSAT AKUT 147800 0 0
- 0 - 0 - 0 - 0 147800 95600 0 1
0 0 0 IRWAN HB C2001764 42 15455 DR. SUSILO SISWONOTO SPS
0302R1160918V000020 0000123080894 3;JKN INACBG;123123123123
5.2.2.201806040537 4 974 1#0##0#0#0.0#2018-10-24
19:55:38#0#09:44:06#09:44:06#00:00:00 2 b140cfeed7fa770d5fcb4132173f0c7e
0 0 78240 0 0 0 0 0 0 0 0 0 17360
0 0 0
6472130 C 3 CS 2 01/09/2018 01/09/2018 03/08/2013 0 1
1 Z09.8;E64.0 - - - None None None None Q-5-44-0 None
None None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600
0 0 - 0 - 0 - 0 - 0 195600 508081
0 1 0 0 0 ABDUL JABBAR C2001693 5 1855 DR
ROMADHAN S.PA 0302R1160918V000017 0002090537087 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 973 1#0##0#0#0.0#2018-
10-27 09:25:04#0#09:38:53#09:38:53#00:00:00 3
68e873e5c96af2271a4bee2ca053976f 0 0 78240 0 0 0 259000
90600 0 0 0 0 80241 0 0 0
6472130 C 3 CS 2 02/09/2018 02/09/2018 22/07/2018 0 2
1 H60.0 - - - None None None None Q-5-42-0 None None
None None None None PENYAKIT AKUT KECIL LAIN-LAIN 196900 0 0
- 0 - 0 - 0 - 0 196900 75080 0 1
0 0 0 KHAIRINA AKLEEMA C2001800 0 42 DR. ZUBAIDAH
0302R1160918V000039 0002455340905 3;JKN INACBG;123123123123
5.2.2.201806040537 4 985 1#0##0#0#0.0#2018-09-04
16:03:48#0#15:00:16#15:00:16#00:00:00 1 f4832eabb0bed6567242499ce1998d19
0 0 58680 0 0 0 0 0 0 0 0 0 16400
0 0 0
6472130 C 3 CS 2 02/09/2018 02/09/2018 07/08/1948 0 1
1 I11.9 89.52 - - None None None None Q-5-44-0 None None
None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600 0
0 - 0 - 0 - 0 - 0 195600 133000
0 1 0 0 0 JAINI C2001796 70 25593 DR. ZUBAIDAH
0302R1160918V000038 0001969505932 3;JKN INACBG;123123123123
5.2.2.201806040537 4 986 1#0##0#0#0.0#2018-09-04
16:09:12#0#15:05:31#15:05:31#00:00:00 2 ba0845ca0bddcb9d72144a9afdef0b42
0 0 58680 0 0 64000 0 0 0 0 0 0 10320
0 0 0
6472130 C 3 CS 2 02/09/2018 02/09/2018 23/09/2001 0 2
1 S80.9 - - - None None None None Q-5-42-0 None None
None None None None PENYAKIT AKUT KECIL LAIN-LAIN 196900 0 0
- 0 - 0 - 0 - 0 196900 66980 0 1
0 0 0 SITI NURHAIMATUL SHIFA C2001795 16 6188 DR KHAIRANI
HAJJAH 0302R1160918V000037 0000123690824 3;JKN INACBG;123123123123
5.2.2.201806040537 4 987 1#0##0#0#0.0#2018-09-04
16:13:59#0#15:11:36#15:11:36#00:00:00 1 3fa6f5d8c196d30e307f936d7c8f569b
0 0 58680 0 0 0 0 0 0 0 0 0 8300
0 0 0
6472130 C 3 CS 2 02/09/2018 02/09/2018 05/04/1989 0 1
1 N39.0 - - - None None None None Q-5-40-0 None None
None None None None INFEKSI SALURAN KEMIH AKUT 136500 0 0
- 0 - 0 - 0 - 0 136500 152287 0
1 0 0 0 FAJRI DJOHAR C2001766 29 10742 DR. INDRIATY
SASONGKO SP.PD 0302R1160918V000033 0002311204476 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 991 1#0##0#0#0.0#2018-
09-04 16:54:27#0#15:53:14#15:53:14#00:00:00 1
62223d37ed85d972b4bec50b87c513ea 0 0 58680 0 0 0 0
0 0 0 0 0 93607 0 0 0
6472130 C 3 CS 2 02/09/2018 02/09/2018 02/04/2018 0 1
1 J06.9 - - - None None None None Q-5-42-0 None None
None None None None PENYAKIT AKUT KECIL LAIN-LAIN 196900 0 0
- 0 - 0 - 0 - 0 196900 96760 0 1
0 0 0 ADIBA ANINDITA SUSANTO C2001788 0 153 DR CALVARICA
LUN LOLONGAN 0302R1160918V000745 0002433354761 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 2169 1#0##0#0#0.0#2018-
09-24 14:31:36#0#13:29:19#13:29:19#00:00:00 1
fb3a75bd5f7542f1fa8d5885ddc2239d 0 0 93000 0 0 0 0
0 0 0 0 0 3760 0 0 0
6472130 C 3 CS 2 02/09/2018 02/09/2018 05/07/1942 0 2
1 K30 - - - None None None None K-5-18-0 None None
None None None None PENYAKIT SISTEM PENCERNAAN LAIN-LAIN 261100
0 0 - 0 - 0 - 0 - 0 261100 98303
0 1 0 0 0 SIYAH C2001784 76 27818 DR CALVARICA LUN
LOLONGAN 0302R1160918V000034 0000120453164 3;JKN INACBG;123123123123
5.2.2.201806040537 4 989 1#0##0#0#0.0#2018-09-25
14:08:56#0#15:49:17#15:49:17#00:00:00 2 974d7c093e8d2a1fcdc052be822fe738
0 0 58680 0 0 0 0 29400 0 0 0 0 10223
0 0 0
6472130 C 3 CS 2 03/09/2018 03/09/2018 16/05/1989 0 1
1 K04.4 - - - None None None None Q-5-12-0 None None
None None None None GIGI DAN PERMASALAHANNYA 222900 0 0
- 0 - 0 - 0 - 0 222900 228655 0
1 0 0 0 DEDDY SUPRIADI C2001852 29 10702 DR DEDIK
NURWIDIANTORO SPBM 0302R1160918V000106 0002236910433 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 992 1#0##0#0#0.0#2018-
09-04 17:30:33#0#16:00:24#16:00:24#00:00:00 2
f29534204f96beaa268681c81a94432f 0 0 222900 0 0 0
0 0 0 0 0 0 5755 0 0 0
6472130 C 3 CS 2 03/09/2018 03/09/2018 03/08/1985 0 1
1 A09.9 - - - None None None None Q-5-42-0 None None
None None None None PENYAKIT AKUT KECIL LAIN-LAIN 196900 0 0
- 0 - 0 - 0 - 0 196900 114025 0
1 0 0 0 YUSAK GANTI PASUANG C2001803 33 12084 DR.
ZUBAIDAH 0302R1160918V000041 0002218401898 3;JKN INACBG;123123123123
5.2.2.201806040537 4 995 1#0##0#0#0.0#2018-09-04
17:34:52#0#16:23:14#16:23:14#00:00:00 2 b2d12729b2b270ffaaba5beb0e67004c
0 0 58680 0 0 0 0 0 0 0 0 0 41345
0 14000 0
6472130 C 3 CS 2 03/09/2018 03/09/2018 12/06/1967 0 1
1 Z86.3;E11.9 - - - None None None None Q-5-44-0 None
None None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600
0 0 - 0 - 0 - 0 - 0 195600 179640
0 1 0 0 0 SUFIANSYAH C2001687 51 18711 DR. INDRIATY
SASONGKO SP.PD 0302R1160918V000054 0002220537914 3;JKN
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6472130 C 3 CS 2 19/09/2018 19/09/2018 29/05/1991 0 2
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1 Z50.9;H91.9 93.83 - - None None None None Z-3-12-0 None
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13:17:56#0#12:15:03#12:15:03#00:00:00 1 010d33aee3f627cac0dd4fbaa13920d0
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6472130 C 3 CS 2 19/09/2018 19/09/2018 17/07/2013 0 2
1 J06.9;H66.9 - - - None None None None Q-5-42-0 None
None None None None None PENYAKIT AKUT KECIL LAIN-LAIN 196900 0
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INACBG;123123123123 5.2.2.201806040537 4 1954 1#0##0#0#0.0#2018-
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6472130 C 3 CS 2 19/09/2018 19/09/2018 13/06/1945 0 1
1 Z50.9;G81.9 93.12 - - None None None None M-3-16-0 None
None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
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6472130 C 3 CS 2 19/09/2018 19/09/2018 27/02/2009 0 2
1 Z50.9;M43.6 93.34 - - None None None None M-3-16-0 None
None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
MUSKULOSKLETAL 115800 0 0 - 0 - 0 - 0 -
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C2002121 9 3491 FISIOTERAPI 0302R1160918V001125 0002479063004
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1#0##0#0#0.0#2018-09-20 13:35:02#0#12:33:18#12:33:18#00:00:00 1
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6472130 C 3 CS 2 19/09/2018 19/09/2018 06/09/1996 0 2
1 Z87.5 88.78 - - None None None None Z-3-25-0 None None
None None None None PROSEDUR ULTRASOUND GINEKOLOGIK 319700 0
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WAHYU WITJAKSONO, SP.OG 0302R1160918V001115 0001817458716 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 1958 1#0##0#0#0.0#2018-
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6472130 C 3 CS 2 19/09/2018 19/09/2018 11/09/1984 0 2
1 Z09.8;J40 - - - None None None None Q-5-44-0 None
None None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600
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0 1 0 0 0 AMINAH C2002199 34 12426 DR.
PARLUHUTAN DOLI SIREGAR SPP 0302R1160918V001128 0002302379853 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 1961 1#0##0#0#0.0#2018-
09-20 13:50:01#0#12:48:08#12:48:08#00:00:00 1
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6472130 C 3 CS 2 19/09/2018 19/09/2018 15/02/1955 0 1
1 Z09.8;K04.0 23.2 - - None None None None U-3-16-0 None
None None None None None PROSEDUR PADA GIGI 306100 0 0
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INACBG;123123123123 5.2.2.201806040537 4 1962 1#0##0#0#0.0#2018-
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6472130 C 3 CS 2 19/09/2018 19/09/2018 09/08/2003 0 2
1 Z09.8;K04.0 23.71 - - None None None None U-3-16-0 None
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INACBG;123123123123 5.2.2.201806040537 4 1963 1#0##0#0#0.0#2018-
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6472130 C 3 CS 2 19/09/2018 19/09/2018 25/06/1974 0 1
1 K04.7 26.32 - - None None None None U-2-13-0 None None
None None None None PROSEDUR KELENJAR LUDAH 332300 0 0 -
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INACBG;123123123123 5.2.2.201806040537 4 1964 1#0##0#0#0.0#2018-
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6472130 C 3 CS 2 19/09/2018 19/09/2018 30/07/2007 0 2
1 Z09.8;K04.0 23.2 - - None None None None U-3-16-0 None
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INACBG;123123123123 5.2.2.201806040537 4 1965 1#0##0#0#0.0#2018-
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6472130 C 3 CS 2 19/09/2018 19/09/2018 16/05/1989 0 1
1 Z09.8;K04.4 24.4 - - None None None None U-2-32-0 None
None None None None None PROSEDUR KECIL PADA MULUT DAN LIDAH 274400
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INACBG;123123123123 5.2.2.201806040537 4 1966 1#0##0#0#0.0#2018-
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6472130 C 3 CS 2 19/09/2018 19/09/2018 11/10/1979 0 2
1 K01.1 23.09 - - None None None None U-3-16-0 None None
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14:16:29#0#13:11:28#13:11:28#00:00:00 1 b4b10b091579ce0c440052b9b1511232
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6472130 C 3 CS 2 19/09/2018 19/09/2018 09/08/2013 0 1
1 Z50.9;F80.9 93.83 - - None None None None Z-3-12-0 None
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1 Z50.9;F90.0 93.89 - - None None None None Z-3-12-0 None
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1 Z50.9;F80.9 93.89 - - None None None None Z-3-12-0 None
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FISIOTERAPI 0302R1160918V001070 0002073282704 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 1972 1#0##0#0#0.0#2018-
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6472130 C 3 CS 2 19/09/2018 19/09/2018 29/01/2013 0 1
1 Z50.9;R13 93.83 - - None None None None Z-3-12-0 None
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0302R1160918V001098 0001843899816 3;JKN INACBG;123123123123
5.2.2.201806040537 4 1973 1#0##0#0#0.0#2018-09-20
15:10:41#0#14:08:59#14:08:59#00:00:00 1 ae975ad363106bb7b1ada272a4e7d73f
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6472130 C 3 CS 2 19/09/2018 19/09/2018 03/11/2012 0 1
1 Z50.9;R13 93.83 - - None None None None Z-3-12-0 None
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1 0 0 0 YAHYA WIJATSANA C2001728 5 2146 FISIOTERAPI
0302R1160918V001105 0001835161795 3;JKN INACBG;123123123123
5.2.2.201806040537 4 1974 1#0##0#0#0.0#2018-09-20
15:14:49#0#14:13:35#14:13:35#00:00:00 1 d55690e3937113d007263d581525bbb1
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6472130 C 3 CS 2 19/09/2018 19/09/2018 15/01/2015 0 1
1 Z50.9;F80.9 93.83;93.34 - - None None None None Z-3-12-0
None None None None None None PROSEDUR REHABILITASI 149200 0
0 - 0 - 0 - 0 - 0 149200 110000
0 1 0 0 0 ZIDAN FADLUR RAHDIAN C2001543 3 1343
FISIOTERAPI 0302R1160918V001088 0001843316763 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 1975 1#0##0#0#0.0#2018-
09-20 15:17:24#0#14:15:30#14:15:30#00:00:00 1
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6472130 C 3 CS 2 19/09/2018 19/09/2018 07/01/2009 0 1
1 Z50.9;F71.9 93.12 - - None None None None M-3-16-0 None
None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
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SETIAWAN C2001159 9 3542 FISIOTERAPI 0302R1160918V001037
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1976 1#0##0#0#0.0#2018-09-20 15:19:49#0#14:17:58#14:17:58#00:00:00 1
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6472130 C 3 CS 2 19/09/2018 19/09/2018 02/04/1949 0 2
1 Z50.9;M17.9 93.34 - - None None None None M-3-16-0 None
None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
MUSKULOSKLETAL 115800 0 0 - 0 - 0 - 0 -
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69 25372 FISIOTERAPI 0302R1160918V001077 0000120700001 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 1977 1#0##0#0#0.0#2018-
09-20 15:22:44#0#14:21:32#14:21:32#00:00:00 1
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6472130 C 3 CS 2 19/09/2018 19/09/2018 09/01/1991 0 2
1 Z50.9;M79.7 93.34 - - None None None None M-3-16-0 None
None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
MUSKULOSKLETAL 115800 0 0 - 0 - 0 - 0 -
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27 10115 DR NUR INDAH ISTY SP.KFR 0302R1160918V001122
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1978 1#0##0#0#0.0#2018-09-20 15:25:02#0#14:23:17#14:23:17#00:00:00 1
53d0528e514e359f1a82ffc90c2b1f3e 0 0 91000 0 0 0 0
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6472130 C 3 CS 2 19/09/2018 19/09/2018 13/03/1978 0 2
1 Z50.9;M54.3 93.34 - - None None None None M-3-16-0 None
None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
MUSKULOSKLETAL 115800 0 0 - 0 - 0 - 0 -
0 115800 91000 0 1 0 0 0 ERLY SETIA MARWATI
C2002210 40 14800 FISIOTERAPI 0302R1160918V001053 0001881066093
3;JKN INACBG;123123123123 5.2.2.201806040537 4 1979
1#0##0#0#0.0#2018-09-20 15:26:54#0#14:25:47#14:25:47#00:00:00 1
fb0126cc2639efd5fe4bb5c233da5c7a 0 0 91000 0 0 0 0
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6472130 C 3 CS 2 19/09/2018 19/09/2018 15/09/1973 0 2
1 Z50.9;M65.3 93.34 - - None None None None M-3-16-0 None
None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
MUSKULOSKLETAL 115800 0 0 - 0 - 0 - 0 -
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C2002254 45 16440 FISIOTERAPI 0302R1160918V001130 0000166610889
3;JKN INACBG;123123123123 5.2.2.201806040537 4 1981
1#0##0#0#0.0#2018-09-20 15:32:05#0#14:30:08#14:30:08#00:00:00 1
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6472130 C 3 CS 2 19/09/2018 19/09/2018 20/11/2017 0 2
1 Z50.9;G80.9 93.12 - - None None None None M-3-16-0 None
None None None None None PROSEDUR THERAPI FISIK DAN PROSEDUR KECIL
MUSKULOSKLETAL 115800 0 0 - 0 - 0 - 0 -
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C2002099 0 303 FISIOTERAPI 0302R1160918V001121 0002480974648
3;JKN INACBG;123123123123 5.2.2.201806040537 4 1982
1#0##0#0#0.0#2018-09-20 15:33:52#0#14:32:47#14:32:47#00:00:00 1
2d4cac5512a3eb1b66210541d8d46d73 0 0 137000 0 0 0
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6472130 C 3 CS 2 19/09/2018 19/09/2018 14/10/1966 0 2
1 Z09.8;I50.9 - - - None None None None Q-5-44-0 None
None None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600
0 0 - 0 - 0 - 0 - 0 195600 853665
0 1 0 0 0 IDA PURWANTI C2002292 51 18968 DR.
INDRIATY SASONGKO SP.PD 0302R1160918V001056 0000120864925 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 1894 1#0##0#0#0.0#2018-
09-20 15:36:23#0#09:42:37#09:42:37#00:00:00 2
28fcc97973597e443a90c458adec0cdb 0 0 78240 0 0 0 690000
72000 0 0 0 0 13425 0 0 0
6472130 C 3 CS 2 19/09/2018 19/09/2018 04/05/1963 0 2
1 Z09.8;E11.6;E11.9 - - - None None None None Q-5-44-0
None None None None None None PENYAKIT KRONIS KECIL LAIN-LAIN 195600
0 0 - 0 - 0 - 0 - 0 195600 201090
0 1 0 0 0 KUSNIAH C2002313 55 20227 DR. INDRIATY
SASONGKO SP.PD 0302R1160918V001044 0002066208467 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 1899 1#0##0#0#0.0#2018-
09-20 15:43:54#0#09:52:33#09:52:33#00:00:00 2
2d9e92787b8d7ea43443aea20310d01f 0 0 78240 0 0 0 0
101400 0 0 0 0 21450 0 0 0
6472130 C 3 CS 2 19/09/2018 19/09/2018 12/03/2000 0 2
1 K30 - - - None None None None K-5-18-0 None None
None None None None PENYAKIT SISTEM PENCERNAAN LAIN-LAIN 261100
0 0 - 0 - 0 - 0 - 0 261100 185740
0 1 0 0 0 SUSI RAHMA YANTI C2002452 18 6765 DR.
INDRIATY SASONGKO SP.PD 0302R1160918V001065 0000902701282 3;JKN
INACBG;123123123123 5.2.2.201806040537 4 1888 1#0##0#0#0.0#2018-
09-20 15:47:07#0#09:16:26#09:16:26#00:00:00 2
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6472130 C 3 CS 2 19/09/2018 19/09/2018 10/11/1966 0 2
1 Z09.8;E11.9 93.57 - - None None None None Z-3-27-0 None
None None None None None PERAWATAN LUKA 198400 0 0 -
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0 0 0 NASRIATI C2001218 51 18941 DR. JASIN WIJANARKO SP.B
0302R1160918V001100 0002478692147 3;JKN INACBG;123123123123
5.2.2.201806040537 4 1984 1#0##0#0#0.0#2018-09-21
09:15:41#0#08:12:00#08:12:00#00:00:00 1 abf27b7b662fe9d00c1e16a8f76dee1e
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6472130 C 3 CS 2 19/09/2018 19/09/2018 26/08/1988 0 2
1 K04.0 25.92 - - None None None None U-3-11-0 None None
None None None None PROSEDUR KECIL LAIN-LAIN PADA TELINGA, HIDUNG, MULUT
DAN TENGGOROKAN 327900 0 0 - 0 - 0 - 0 -
0 327900 225300 0 1 0 0 0 USELA DIAN
DWIYASARI C2002469 30 10981 DR NOVELIN YOHANES OMPUSUNGGU SPKG
0302R1160918V001102 0001737342178 3;JKN INACBG;123123123123
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