PENDAPATAN POLY Dr. Cakrabumi W, Sp.

OG
NO

Tanggal

27 Desember 2013

Nama Pasien

ALAMAT

Ny. Nani

Wonogiri

Ny. Sri Ika

Wonogiri

Ny. Riyatmi

Wonogiri

Ny. Tobat

Wonogiri

Ny. Sri H

Eromoko

Ny. Wahyuni

Ny. Tri M

Ny. Yusi

Pule Selogiri

Ny. Etik

Brumbung

10

Ny. Shella

Wonokarto

11

Ny. Suci

Sukoharjo

12

Ny. Indiah

Wonogiri

13

Ny. Yuli

Selogiri

Ny. Sumarni

Selogiri

Ny. Elis

Pacitan

16

Ny. Eka

Manyaran

17

Ny. Wuri

Giriwoyo

18

Ny. Marta

Kaloran

19

Ny. Astrid

Kaloran

20

Ny. Lina

21

Ny. Renita

Selogiri

22

Ny. Nanik

Batuwarno

23

Ny. Warsi

Sidoharjo

24

Ny. Astri

Wonokarto

25

Ny. Mujiyanti

Baturetno

26

Ny. Shella

Wonokarto

27

Ny. Sariyana

Selogiri

28

Ny. Sutarmi

Selogiri

29

Ny. Karsi

Jatipuro

30

Ny. Sumarni

Wonogiri

31

Ny. Sumiati

Wonokarto

32

Ny. Siti N

Tirtomoyo

2
3

28 Desember 2013

14

30 Desember 2013

15

04 Januari 2014

Karang Tengah
Donorojo

Jatisrono

33

Ny. Hartini

Perum Citra Alam

34

Ny. Yuli Ika

Pule Selogiri

35

Ny. Kamtinah

Karanganyar

36

05 Januari 2014

Ny. Tutik

Wonogiri

37

06 Januari 2014

Ny. Asih

Nguter

38

08 Januari 2014

Ny. Sri S

Sukoharjo

39

Ny. Suyani

Wonogiri

40

Ny. Sri W

Wonogiri

41

Ny. Lina A

Wonogiri

42

Ny. Sumarsih

Jatisrono

43

Ny. Sariatin

Wonogiri

44

Ny. Etik

Jatisrono

45

Ny. Dwi S

Wonogiri

46

Ny. Sri J

Wonogiri

47

Ny. Nuri M

Wonogiri

48

Ny. Lusi

Giri Asri

49

Ny. Nurul

Tirtomoyo

50

Ny. Atik

Giritontro

51

Ny. Evi

Wonokarto

52

Ny. Rose

53

Ny. Novita

Paranggupito

54

Ny. Nur A

Wonokarto

55

Ny. Niatun

Pacitan

56

Ny. Sri H

Purworejo

57

Ny. Siti K

Wonokarto

Ny. Eka Puji

Wuryantoro

59

Ny. Eksa

Pracimantoro

60

Ny. Yulia

Manyaran

61

Ny. Ririh

Sukorejo

62

Ny. Reza

Eromoko

63

Ny. Sumarni

Pojok

64

Ny. Sariyana

Garon

65

Ny. Dian

Giriwoyo

66

Ny. Vina

Gunung Kidul

58

11 Januari 2014

Giri Asri

67

Ny. Mariyem

Wonogiri

68

Ny. Fitri

Sidoharjo

69

Ny.Dian I

Nambangan

70

Ny. Kamtinah

71

Ny. Tri M

Donoharjo

72

Ny. Shelly

Girimarto

73

Ny. Panti

Jatipurno

74

Ny. Paini

Jatipurno

75

Ny. Giyarsi

Slogohimo

76

Ny. Eni

Jatiroto

77

Ny. Novi

Wonogiri

78

Ny. Retno

Wonokarto

79

Ny. Yusi

Selogiri
Wonokarto

Jatiyoso

80

13 Januari 2014

Ny. Evi

81

15 Januari 2014

Ny. Sumarsih

Jatisrono

82

Ny. Mudiatun

Wuryantoro

83

Ny. Sutarni

Tirtomoyo

84

Ny. Sunarmi

Jatiyoso

85

Ny. Aristina

Wuryantoro

86

Ny. Wuri

Pengkol

87

Ny. Parini

Wuryantoro

88

Ny. Ersi

89

Ny. Nurlia

90

17 Januari 2014

Ny. Maryati

91

18 Januari 2014

Ny. Wulan

Eromoko
Baturetno
Wuryantoro
Jatipurno

92

Ny. Lilis

93

Ny. Tarmi

94

Ny. Ernawati

95

Ny. Lestari

96

Ny. Eksa

Pracimantoro

97

Ny. Retno

Wuryantoro

98

Ny. Retno D

Wonogiri

99

Ny. Supadmi

Selogiri

100

Ny. Sariatin

Baturetno

Selogiri
Manyaran
Pracimantoro
Manyaran

101

Ny. Sri H

Sukorejo

102

Ny. Lasi

Ngadirojo

Ny. Nurul

Tirtomoyo

103

22 Januari 2014

104

Ny. Jarsini

Pracimantoro

105

Ny. Narni

Paranggupito

106

Ny. Dian

Giri Asri

107

25 Januari 2014

Ny. Dwi Retno

Bulu

108

Ny. Hartati

109

Ny. Elis

110

Ny. Dewi a

Selogiri

111

Ny. Arnita

Ngadirojo

112

Ny. Febri

Sukorejo

113

Ny. Sri W

Pokoh

114

Ny. Warsi

Sidoharjo

115

Ny. Sri L

Nambangan

116

Ny. Mukiyati

Sukoharjo

117

Ny. Nanik

Pacitan

118

Ny. Sukini

Jatisrono

Paranggupito
Baturetno

Nama Tindakan

Jasa dokter

RS

Obat

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00 Rp

161,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00 Rp

66,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00

Rp

108,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00 Rp

46,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00 Rp

38,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00 Rp

46,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00 Rp

55,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00 Rp

55,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00 Rp

55,000.00

Pemeriksaan

Rp

50,000.00 Rp

25,000.00 Rp

75,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00 Rp

20,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

25,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

202,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

42,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

125,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

55,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

102,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

215,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

54,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

53,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

75,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

40,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

65,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

155,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

USG+Pemeriksaan

Rp

USG+Pemeriksaan

Rp

175,000.00

50,000.00

Rp

150,000.00

50,000.00 Rp

50,000.00

Rp

188,000.00

Rp

50,000.00 Rp

50,000.00 Rp

40,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

68,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

153,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

53,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

20,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

140,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

95,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

101,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

120,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

95,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

100,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

42,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

102,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

102,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

65,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

55,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

60,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

120,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

102,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

60,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

39,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

100,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

47,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

102,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

40,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

60,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

105,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

135,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

165,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

41,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

55,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

41,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

89,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

60,000.00

60,000.00

85,000.00

89,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

95,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

130,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

100,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

89,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

51,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

48,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

43,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

120,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

30,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

87,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

89,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

158,000.00

Lain-Lain

Rp

30,000.00

Keterangan

Total Bayar
Rp

241,000.00

Rp

146,000.00

Rp

188,000.00

Rp

126,000.00

Rp

118,000.00

Rp

126,000.00

Rp

125,000.00

Rp

135,000.00

Rp

135,000.00

Rp

135,000.00

Rp

155,000.00

Rp

100,000.00

Rp

115,000.00

Rp

80,000.00

Rp

307,000.00

Rp

147,000.00

Rp

230,000.00

Rp

160,000.00

Rp

207,000.00

Rp

320,000.00

Rp

105,000.00

Rp

159,000.00

Rp

158,000.00

Rp

175,000.00

Rp

180,000.00

Rp

145,000.00

Rp

150,000.00

Rp

170,000.00

Rp

260,000.00

Rp

205,000.00

Rp

105,000.00

Rp

155,000.00

Rp

Rp

75,000.00

300,000.00

Rp

150,000.00

Rp

195,000.00

Rp

80,000.00

Rp

355,000.00

Rp

105,000.00

Rp

255,000.00

Rp

243,000.00

Rp

145,000.00

Rp

173,000.00

Rp

140,000.00

Rp

258,000.00

Rp

158,000.00

Rp

150,000.00

Rp

195,000.00

Rp

150,000.00

Rp

125,000.00

Rp

140,000.00

Rp

245,000.00

Rp

230,000.00

Rp

206,000.00

Rp

225,000.00

Rp

200,000.00

Rp

140,000.00

Rp

155,000.00

Rp

205,000.00

Rp

155,000.00

Rp

147,000.00

Rp

207,000.00

Rp

207,000.00

Rp

170,000.00

Rp

160,000.00

Rp

165,000.00

Rp

225,000.00

Rp

195,000.00

Rp

150,000.00

Rp

140,000.00

Rp

207,000.00

Rp

165,000.00

Rp

144,000.00

Rp

140,000.00

Rp

105,000.00

Rp

165,000.00

Rp

205,000.00

Rp

152,000.00

Rp

207,000.00

Rp

145,000.00

Rp

165,000.00

Rp

105,000.00

Rp

195,000.00

Rp

195,000.00

Rp

105,000.00

Rp

105,000.00

Rp

165,000.00

Rp

210,000.00

Rp

195,000.00

Rp

240,000.00

Rp

195,000.00

Rp

105,000.00

Rp

190,000.00

Rp

30,000.00

Rp

300,000.00

Rp

120,000.00

Rp

275,000.00

Rp

146,000.00

Rp

150,000.00

Rp

160,000.00

Rp

146,000.00

Rp

194,000.00

Rp

230,000.00

Rp

194,000.00

Rp

175,000.00

Rp

105,000.00

Rp

200,000.00

Rp

150,000.00

Rp

150,000.00

Rp

235,000.00

Rp

155,000.00

Rp

194,000.00

Rp

156,000.00

Rp

105,000.00

Rp

153,000.00

Rp

148,000.00

Rp

225,000.00

Rp

85,000.00

Rp

140,000.00

Rp

192,000.00

Rp

194,000.00

Rp

263,000.00

Rp

105,000.00

Rp

20,362,000.00

PENDAPATAN POLY Dr. Cakrabumi W, Sp.OG

NO

Tanggal

29 Januari 2014

Nama Pasien

ALAMAT

Ny. Nurul

Tirtomoyo

Ny. Retno

Giriwono

Ny. Jarsini

Wonogiri

Ny. Ika

Jatipurno

Ny. Eka

Giriwoyo

Ny. Heni

Paranggupito

30 Januari 2014

Ny. Sariatin

Baturetno

01 Februari 2014

Ny. Sunarsih

Wuryantoro

Ny. Novi

Jatirejo

10

Ny. Astri

Wonokarto

11

Ny. Endang

12

Ny. Sri S

13

Ny. Kartika

Selogiri

14

Ny. Daryuni

Pancuran
Tenongan

Bauresan
Pule

15

02 Februari 2014

Ny. Weni

16

05 Februari 2014

Ny. Winarsih

Selogiri

17

Ny. Hartini

Eromoko

18

Ny. Mutidatun

19

Ny. Sumiyati

Jatipuro

20

Ny. Retno W

Giriwono

21

Ny. Aristina

Wuryantoro

22

Ny. Wahyu

Giriwoyo

23

Ny. Tri R

Kaloran

24

Ny. Eka

Giriwoyo

25

Ny. Eni

Paranggupito

Ny. Evi

Sidoharjo

26

08 Februari 2014

Wuryantoro

27

Ny. Astrid

Kaloran

28

Ny. Marlia

Selogiri

29

Ny. Kartika

Selogiri

30

Ny. Niken

Wonogiri

31

Ny. Anis

Selogiri

32

Ny. Tiwi

Jatipuro

33

Ny. Ririh

Sukorejo

34

Ny. Lina

Jatisrono

35

Ny. Riyanti

Kaliancar

36

Ny. Winarsih

Selogiri

37

Ny. Lina

Wonogiri

38

Ny. Dias

Girimarto

39

Ny. Hartini

Giriwoyo

40

Ny. Parwitri

Ngadirojo

41

Ny. Erna

42

Ny. Weni K

Wonogiri

43

Ny. Nur Widia

Ngadirojo

44

Ny. Sri D

Girimarto

45

Ny. Vina

Girimarto

46

Ny. Astrid

47

15 Februari 2014

Wonokarto

Ny. Sukatmi

Pracimantoro

48

Ny. Dwi M

Paranggupito

49

Ny. Dewi S

Wonogiri

50

Ny. Ika

Wonogiri

51

Ny. Tarsi

Ngadirojo

52

Ny. Tri W

Girimarto

53

Ny. Romalia

Jatipuro

Ny. Hartini

Giriwoyo

54

19 Februari 2014

Gunturharjo

22 Februari 2014

55

Ny. Eko Warni

56

Ny. Ana W

57

Ny. Suyatmi

Nguntoronadi

58

Ny. Kristanti

Tirtomoyo

59

Ny. Murni

Pacitan

Ledok Jatipurno
Jatipurno

60

23 Februari 2014

Ny. Suryani

Pacitan

61

25 Februari 2014

Ny. Sariatin

Baturetno

Nama Tindakan

Jasa dokter

RS

Obat

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

60,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

60,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

USG+Pemeriksaan

Rp

155,000.00

50,000.00 Rp

50,000.00

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

100,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

USG+Pemeriksaan

35,000.00

Rp

195,000.00

50,000.00

Rp

45,000.00

Rp

50,000.00

Rp

159,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

Rp

50,000.00 Rp

55,000.00

50,000.00 Rp

45,000.00

Rp

90,000.00

USG+Pemeriksaan

gratis

USG+Pemeriksaan

Rp

50,000.00 Rp

USG+Pemeriksaan

Rp

50,000.00

USG+Pemeriksaan

gratis

Rp

50,000.00

Rp

100,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

170,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

100,000.00

50,000.00 Rp

55,000.00

Rp

105,000.00
70,000.00

USG+Pemeriksaan

gratis

Rp

USG+Pemeriksaan

Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

gratis

Rp

Rp

135,000.00

50,000.00 Rp

20,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

USG+Pemeriksaan

55,000.00

Rp

130,000.00

50,000.00 Rp

50,000.00

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

165,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

120,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

15,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

105,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

100,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

120,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

85,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

Rp

125,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

10,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

20,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

55,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

15,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00

50,000.00

Rp

173,000.00

Lain-Lain

Rp

Rp

Rp

30,000.00

50,000.00

50,000.00

Keterangan

Total Bayar
Rp

165,000.00

Rp

150,000.00

Rp

165,000.00

Rp

105,000.00

Rp

150,000.00

Rp

175,000.00

Rp

260,000.00

Rp

105,000.00

Rp

195,000.00

Rp

105,000.00

Rp

140,000.00

Rp

55,000.00

Rp

205,000.00

Rp

175,000.00

Rp

105,000.00

Rp

300,000.00

Rp

100,000.00

Rp

214,000.00

Rp

175,000.00

Rp

145,000.00

Rp

195,000.00

Rp

140,000.00

Rp

150,000.00

Rp

145,000.00

Rp

155,000.00

Rp

275,000.00

Rp

205,000.00

Rp

110,000.00

Rp

160,000.00

Rp

175,000.00

Rp

290,000.00

Rp

75,000.00

Rp

160,000.00

Rp

235,000.00

Rp

105,000.00

Rp

175,000.00

Rp

175,000.00

Rp

220,000.00

Rp

175,000.00

Rp

150,000.00

Rp

145,000.00

Rp

70,000.00

Rp

155,000.00

Rp

210,000.00

Rp

205,000.00

Rp

140,000.00

Rp

30,000.00

Rp

205,000.00

Rp

30,000.00

Rp

120,000.00

Rp

30,000.00

Rp

170,000.00

Rp

230,000.00

Rp

185,000.00

Rp

105,000.00

Rp

175,000.00

Rp

120,000.00

Rp

50,000.00

Rp

125,000.00

Rp

30,000.00

Rp

175,000.00

Rp

160,000.00

Rp

170,000.00

Rp

195,000.00

Rp

140,000.00

Rp

105,000.00

Rp

230,000.00

Rp

50,000.00

Rp

10,074,000.00

PENDAPATAN POLY Dr. Cakrabumi W, Sp.OG

NO

Tanggal

26 Februari 2014

Nama Pasien

ALAMAT

Ny. Dwi M

Paranggupito

Ny. Dewi S

Semin

Ny. Astri

Wonokarto

Ny. Uswatun

Tirtomoyo

Ny. Sukatmi

Pracimantoro

Ny. Wahyu

Wonogiri

Ny. Dian

Giri Asri

Ny. Weni

Tenongan

Ny. Lina

Gunung Gadung

10

Ny. Isna

Perum Pal Pesona

11

Ny. Febri

Wonogiri

12

Ny. Hartanti

Paranggupito

13

Ny. Linawati

Girimarto

14

Ny. Anik W

Karanganyar

15

01 Maret 2014

05 Maret 2014

16

Ny. Ririh

Wonogiri

Ny. Titik

Wonokarto

17

02 Maret 2014

Ny. Yuli

Selorejo

18

08 Maret 2014

Ny. Isna

Perum Pal Pesona

19

Ny. Dian

Giriwoyo

20

Ny. Anisa

Nguter

21

10 Maret 2014

Ny. Sutarmi

Wonogiri

22

12 Maret 2014

Ny. Marsini

Manyaran

23

Ny. Hartini

Giriwoyo

24

Ny. Kirni

25

Ny. Supartini

Selogiri

26

Ny. Aristina

Wonogiri

27

Ny. Rohmania

Pacitan

Ny. Winarsih

Girimarto

Ny. Sarmiati

Bulusulur

Ny. Yayuk

Girimarto

Nuy. Indrawati

Sidoharjo

Ny. Lina A

Wonogiri

28

15 Maret 2014

29
30

16 Maret 2014

31
32

19 Maret 2014

Wuryantoro

33

Ny. Yuli

34

Ny. Suharmi

35

Ny. Riyana

Jatiroto

36

Ny. Sriyanti

Girimarto

37

Ny. Tatik

Wonogiri

38

Ny. Fitriana

Sonoharjo
Ngoro-ngoro

Wonokarto

39

21 Maret 2014

Ny. Ririh

Sukorejo

40

22 Maret 2014

Ny. Eka P

Wuryantoro

41

Ny. Sumarni

42

Ny. Diyah

Sidoharjo

43

Ny. Irnawati

Sidoharjo

44

Ny. Umi S

Girimarto

45

Ny. Riyem

Girimarto

46

Ny. Sayem

Nguter

47

Ny. Ayu S

Ngadirojo

48

Ny. Beta

Manyaran

Nguter

Nama Tindakan

Jasa dokter

RS

Obat

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

135,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

65,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

USG+Pemeriksaan

Rp

50,000.00

Pemeriksaan

Rp

USG+Pemeriksaan

Rp

100,000.00

Rp

90,000.00

50,000.00 Rp

53,000.00

Rp

45,000.00

50,000.00 Rp

50,000.00

Rp

50,000.00 Rp

50,000.00 Rp

80,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

USG+Pemeriksaan

Rp

USG+Pemeriksaan
USG+Pemeriksaan

Rp

60,000.00

50,000.00

Rp

100,000.00

50,000.00 Rp

50,000.00

Rp

105,000.00

Rp

50,000.00 Rp

50,000.00

Rp

50,000.00

Rp

45,000.00

Rp

120,000.00

Rp

30,000.00

USG+Pemeriksaan
USG+Pemeriksaan

Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

120,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

65,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

130,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

USG+Pemeriksaan

50,000.00

Rp

100,000.00

50,000.00 Rp

50,000.00

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

USG+Pemeriksaan

GRATIS

Rp

50,000.00

20,000.00

Rp

135,000.00
60,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

195,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

125,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

Rp

145,000.00

Lain-Lain

Rp

Rp

50,000.00

50,000.00

Keterangan

Total Bayar
Rp

195,000.00

Rp

155,000.00

Rp

140,000.00

Rp

140,000.00

Rp

240,000.00

Rp

170,000.00

Rp

205,000.00

Rp

145,000.00

Rp

158,000.00

Rp

100,000.00

Rp

155,000.00

Rp

185,000.00

Rp

175,000.00

Rp

195,000.00

Rp

140,000.00

Rp

175,000.00

Rp

105,000.00

Rp

115,000.00

Rp

205,000.00

Rp

210,000.00

Rp

105,000.00

Rp

100,000.00

Rp

175,000.00

Rp

135,000.00

Rp

225,000.00

Rp

170,000.00

Rp

235,000.00

Rp

175,000.00

Rp

150,000.00

Rp

105,000.00

Rp

105,000.00

Rp

140,000.00

Rp

155,000.00

Rp

205,000.00

Rp

105,000.00

Rp

150,000.00

Rp

105,000.00

Rp

55,000.00

Rp

105,000.00

Rp

125,000.00

Rp

190,000.00

Rp

165,000.00

Rp

300,000.00

Rp

175,000.00

Rp

140,000.00

Rp

195,000.00

Rp

230,000.00

Rp

250,000.00

Rp

7,778,000.00

PENDAPATAN POLY Dr. Cakrabumi W, Sp.OG

NO

Tanggal

26 Maret 2014

Nama Pasien

ALAMAT

Ny. Kartini

Giriwoyo

Ny. Winarsih

Nangger

Ny. Ririh

Sukorejo

Ny. Lina

Gunung Gadung

Ny. Eka

Krisak

Ny. Aristina

Wuryantoro

Ny. Giyanti

Jatisrono

Ny. Parti

Wonogiri

Ny. Dian

Giri Asri

Ny. Vera

Wonogiri

11

Ny. Hartini

Giriwoyo

12

Ny. Partini

Selogiri

13

Ny. Sumarmi

Munggur

14

Ny. Yulia A

Wonogiri

15

Ny. Erna

Kenteng

16

Ny. Anisa

Wonogiri

17

Ny. Vina

Wonogiri

Ny. Adi

Ponorogo

19

Ny. Partini

Selogiri

20

Ny. Winarsih

Selogiri

21

Ny. Wulan

Selogiri

22

Ny. Susi W

Paranggupito

23

Ny. Neta

Wonogiri

24

Ny. Sinta

Selogiri

25

Ny. Nur H

Selogiri

26

Ny. Vera

Eromoko

Ny. Eli S

Sonoharjo

2
3

10

18

27

02 April 2014

05 April 2014

12 April 2014

19 April 2014

28

Ny. Daniati

Jatiyoso

29

Ny. Sri W

Gentan

30

Ny. Shoimah

31

Ny. Leoni Dita

32

Ny. Yuli

Wonogiri
Nguter
Sonoharjo

33

Ny. Ernawati

34

Ny. Kesi

Eromoko

35

Ny. Purwanti

Giriwono

36

Ny. Dian

Giri Asri

Wuryantoro

Nama Tindakan

Jasa dokter

RS

Obat
Rp

105,000.00

Rp

175,000.00

50,000.00 Rp

50,000.00 Rp

45,000.00

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

65,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

USG+Pemeriksaan

USG+Pemeriksaan

Rp

170,000.00

Rp

50,000.00 Rp

75,000.00

50,000.00 Rp

95,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

Pemeriksaan

Rp

50,000.00

Rp

60,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

35,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

20,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

205,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

65,000.00

USG+Pemeriksaan

GRATIS

USG+Pemeriksaan

Rp

50,000.00

USG+Pemeriksaan

Rp

USG+Pemeriksaan

Rp

50,000.00
Rp

60,000.00

50,000.00 Rp

50,000.00 Rp

30,000.00

Rp

50,000.00 Rp

50,000.00 Rp

75,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

90,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

70,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

80,000.00

USG+Pemeriksaan

Rp

50,000.00

Rp

45,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

Rp

105,000.00

50,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

55,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

55,000.00

USG+Pemeriksaan

Rp

50,000.00 Rp

50,000.00 Rp

75,000.00

USG+Pemeriksaan

GRATIS

Rp

50,000.00

Lain-Lain
Rp

Rp

50,000.00

50,000.00

Keterangan

Total Bayar
Rp

210,000.00

Rp

280,000.00

Rp

150,000.00

Rp

175,000.00

Rp

175,000.00

Rp

170,000.00

Rp

275,000.00

Rp

105,000.00

Rp

130,000.00

Rp

200,000.00

Rp

165,000.00

Rp

90,000.00

Rp

105,000.00

Rp

175,000.00

Rp

75,000.00

Rp

310,000.00

Rp

170,000.00

Rp

55,000.00

Rp

115,000.00

Rp

135,000.00

Rp

180,000.00

Rp

175,000.00

Rp

175,000.00

Rp

195,000.00

Rp

195,000.00

Rp

175,000.00

Rp

100,000.00

Rp

100,000.00

Rp

150,000.00

Rp

135,000.00

Rp

100,000.00

Rp

210,000.00

Rp

160,000.00

Rp

160,000.00

Rp

18,000.00

Rp

55,000.00

Rp

5,548,000.00