Daftar Sep

1 MEI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
010516420057
010516420061
010516430254
010516390257
010516390228
010516390019
010516420066
010516420063
010516420046
010516420064
010516420062
010516420067
010516390010
010516420065
010516420050
010516420052
010516390009
010516390008
010516390041
010516390011
010516390020
010516390209
010516420129
010516390201
010516390147
010516420188
010516420185
010516390211
010516430352
010516430357
010516430227
010516390229
010516430238
010516430239
010516430240
010516430241
010516390242
010516430235
010516390296
010516390260
010516430274
TANGGAL
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
SEP
0090R03105160001094
0090R03105160001095
0090R03105160001097
0090R03105160001098
0090R03105160001098
00
00
00
00
00
00
00
00
00
0090R03105160000001
0090R03105160000003
0090R03105160000005
0090R03105160000005
0090R03105160000006
0090R03105160000006
0090R03105160000007
0090R03105160000009
0090R03105160000009
0090R03105160000010
0090R03105160000010
0090R03105160000011
0090R03105160000011
0090R03105160000012
0090R03105160000013
0090R03105160000014
0090R03105160000015
0090R03105160000016
0090R03105160000017
0090R03105160000018
0090R03105160000019
0090R03105160000020
0090R03105160000021
0090R03105160000022
0090R03105160000023
0090R03105160000024
0090R03105160000025
Page 1
1 MEI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
010516390286
010516430280
010516430290
010516390314
010516430325
010516390341
010516430345
010516430349
010516390353
010516430367
010516390218
010516390031
010516390045
010516390219
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
05/01/2016
0090R03105160000026
0090R03105160000026
0090R03105160000027
0090R03105160000029
0090R03105160000032
0090R03105160000033
0090R03105160000034
0090R03105160000036
0090R03105160000037
0090R03105160000038
Page 2
1 MEI 2016
010516420057
010516420061
010516430254
010516390257
010516390228
010516390019
010516420066
010516420063
010516420046
010516420064
010516420062
010516420067
010516390010
010516420065
010516420050
010516420052
010516390009
010516390008
010516390041
010516390011
010516390020
010516390209
010516420129
010516390201
010516390147
010516420188
010516420185
010516390211
010516430352
010516430357
010516430227
010516390229
010516430238
010516430239
010516430240
010516430241
010516390242
010516430235
010516390296
010516390260
010516430274
NAMA PASIEN
TRANSAKSI
NURLELA HADI NY.
57,448
NAPSAN SEPRIAL TN
159,710
SORAYA AKIKO NN.
47,130
GAVAPUTRI ALIFA NAUFALYN AN
65,900
GAVAPUTRI ALIFA NAUFALYN AN
102,400
MONTES SRIWATI NY
14,000
YULIANA BINTI JUNAIDI NY
60,000
SUWANDI BIN SUDHARMANTO TN.
78,000
DJONI TN.
129,000
SUMINEM SUDIRMAN NY.
138,800
JUHANDI BIN HASAN TN.
262,500
ARYANTO TN.
410,700
ILAL YATI NY.
579,170
ISRIL HENDRA TN
872,765
ZIDAN AKBAR PUTRA F AN
113,266
SUMIATI BINTI SULAIMAN NN.
58,638
ARZIKI ADITYA PRATAMA AN.
8,700
131,840
FARISAH AZZAHRA AN.
44,315
FARISAH AZZAHRA AN.
73,080
AHMAD SATRIO AN.
144,000
RINI OVIRA NY.
53,500
RINI OVIRA NY.
226,400
JUNALIS SURAHMAN TN
52,410
JUNALIS SURAHMAN TN
216,800
RAFFA FARAZ ALFATHI AN
14,700
112,451
MARIA BINTI UJANG NY
218,336
M. FADHIL RAVAJUNA AN
161,200
EVA JULIANA NAINGGOLAN NY
129,800
RITA SARI A.MD NY.
61,370
THENG BAN LAY TN,
126,000
VENTI NURAINI NN
154,230
DUWI PARAWATI NN
146,270
ANNISA MAGHDARINA NY.
151,500
M. RAHSYA IFASSY ALTHAFIO A
125,400
SUGIARTO TN
128,560
AMIR CHANIAGO TN
49,305
HERU NUGROHO TN.
161,600
ASMAWATI BINTI BACHTIAR NY
189,026
MURYATI BINTI ADAM HJ NY
146,300
Page 3
1 MEI 2016
010516390286
010516430280
010516430290
010516390314
010516430325
010516390341
010516430345
010516430349
010516390353
010516430367
010516390218
010516390031
010516390045
010516390219
M YUSUF JAYA TN
M YUSUF JAYA TN
IMRON MARIE TN
ETTY LEILIAH NY.
SUKANTO TN.
HOLIANAH NY
MUNAWAROH BINTI YAUMUN NY.
RANDY SAGITA TN.
MAIZAL PURWANTO TN.
SITI ROHAYAH NY
KHAIRAN FATTAN RADITYA AN.
MARLIANSYAH TN
ADY APRIYANTO TN
KHAIRAN FATTAN RADITYA AN.
Page 4
52,000
135,335
214,400
135,375
61,323
145,136
63,210
63,100
60,286
255,200
60,000
81,300
156,686
205,850
2 MEI 2016
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
NO RJ
020516380587
020516390089
020516390127
020516390207
020516390445
020516390489
020516400022
020516400023
020516381057
020516390085
020516390036
020516420597
020516420605
020516390058
020516390007
020516390299
020516400119
020516390017
020516390018
020516390301
020516390009
020516390006
020516390027
020516390028
020516390378
020516390021
020516390025
020516390081
020516390294
020516390011
020516400040
020516400035
020516400037
020516390240
020516400054
020516390117
020516390048
020516390049
020516390317
020516400369
020516390506
TANGGAL
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
SEP
00
00
00
00
00
00
00
00
0090R03104160007976
0090R03105160000041
0090R03105160000042
0090R03105160000044
0090R03105160000044
0090R03105160000046
0090R03105160000047
0090R03105160000048
0090R03105160000049
0090R03105160000050
0090R03105160000050
0090R03105160000051
0090R03105160000052
0090R03105160000053
0090R03105160000054
0090R03105160000054
0090R03105160000055
0090R03105160000056
0090R03105160000056
0090R03105160000057
0090R03105160000057
0090R03105160000058
0090R03105160000059
0090R03105160000060
0090R03105160000060
0090R03105160000061
0090R03105160000062
0090R03105160000063
0090R03105160000064
0090R03105160000064
0090R03105160000065
0090R03105160000066
0090R03105160000067
Page 5
2 MEI 2016
19
20
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25
26
27
28
29
30
31
32
33
34
35
36
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38
39
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42
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020516390125
020516390111
020516390112
020516390124
020516400102
020516390091
020516390147
020516390031
020516400039
020516400108
020516400109
020516390105
020516390086
020516390087
020516390262
020516400033
020516390465
020516400038
020516390140
020516390143
020516390047
020516390013
020516390082
020516390084
020516390114
020516390205
020516400157
020516390305
020516390474
020516450564
020516400195
020516400197
020516390046
020516390094
020516390012
020516390171
020516390172
020516400068
020516390214
020516400246
020516400161
020516400174
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
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05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
0090R03105160000068
0090R03105160000069
0090R03105160000069
0090R03105160000070
0090R03105160000071
0090R03105160000072
0090R03105160000072
0090R03105160000073
0090R03105160000074
0090R03105160000075
0090R03105160000075
0090R03105160000076
0090R03105160000077
0090R03105160000077
0090R03105160000078
0090R03105160000078
0090R03105160000079
0090R03105160000080
0090R03105160000081
0090R03105160000081
0090R03105160000082
0090R03105160000083
0090R03105160000084
0090R03105160000084
0090R03105160000085
0090R03105160000086
0090R03105160000086
0090R03105160000087
0090R03105160000088
0090R03105160000089
0090R03105160000090
0090R03105160000090
0090R03105160000091
0090R03105160000092
0090R03105160000093
0090R03105160000094
0090R03105160000094
0090R03105160000095
0090R03105160000096
0090R03105160000097
0090R03105160000098
0090R03105160000099
Page 6
2 MEI 2016
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
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102
020516400175
020516390019
020516400257
020516400260
020516400192
020516390216
020516390218
020516390065
020516390507
020516390060
020516390265
020516390160
020516390488
020516390209
020516390092
020516400224
020516400228
020516400061
020516390096
020516390359
020516380667
020516380668
020516390468
020516390442
020516400059
020516400396
020516390302
020516390304
020516390115
020516390093
020516390309
020516390310
020516390121
020516390123
020516390132
020516390376
020516390377
020516380624
020516380628
020516390129
020516390134
020516390080
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
05/02/2016
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05/02/2016
05/02/2016
05/02/2016
05/02/2016
0090R03105160000099
0090R03105160000100
0090R03105160000101
0090R03105160000101
0090R03105160000102
0090R03105160000103
0090R03105160000103
0090R03105160000104
0090R03105160000105
0090R03105160000106
0090R03105160000107
0090R03105160000108
0090R03105160000109
0090R03105160000110
0090R03105160000111
0090R03105160000112
0090R03105160000112
0090R03105160000114
0090R03105160000115
0090R03105160000116
0090R03105160000117
0090R03105160000117
0090R03105160000118
0090R03105160000119
0090R03105160000120
0090R03105160000122
0090R03105160000123
0090R03105160000123
0090R03105160000124
0090R03105160000125
0090R03105160000126
0090R03105160000126
0090R03105160000127
0090R03105160000128
0090R03105160000129
0090R03105160000130
0090R03105160000130
0090R03105160000131
0090R03105160000131
0090R03105160000132
0090R03105160000133
0090R03105160000134
Page 7
2 MEI 2016
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
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020516400152
020516390097
020516390328
020516390330
020516390321
020516390329
020516390470
020516390472
020516280915
020516390196
020516390181
020516390137
020516380621
020516400103
020516400364
020516400365
020516400261
020516390458
020516390460
020516400141
020516390421
020516390424
020516400156
020516390417
020516390418
020516390208
020516390159
020516390414
020516390415
020516390450
020516390452
020516400169
020516400229
020516400176
020516390116
020516380643
020516380646
020516390225
020516400254
020516420566
020516390206
020516390467
05/02/2016
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05/02/2016
0090R03105160000135
0090R03105160000136
0090R03105160000137
0090R03105160000137
0090R03105160000138
0090R03105160000138
0090R03105160000139
0090R03105160000139
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0090R03105160000140
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0090R03105160000155
0090R03105160000156
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0090R03105160000158
0090R03105160000159
0090R03105160000160
0090R03105160000160
0090R03105160000161
0090R03105160000162
0090R03105160000163
0090R03105160000166
0090R03105160000167
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2 MEI 2016
145
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020516390243
020516400067
020516400198
020516390270
020516390203
020516390353
020516400165
020516400244
020516390282
020516390219
020516390241
020516390258
020516390269
020516390289
020516390457
020516390252
020516390453
020516390249
020516390239
020516390279
020516400268
020516390256
020516450719
020516450720
020516390334
020516390349
020516390420
020516400266
020516390230
020516390499
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020516390311
020516390227
020516450565
020516390238
020516420524
05/02/2016
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05/02/2016
0090R03105160000168
0090R03105160000169
0090R03105160000170
0090R03105160000171
0090R03105160000172
0090R03105160000172
0090R03105160000173
0090R03105160000174
0090R03105160000174
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0090R03105160000198
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Page 9
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020516420525
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2 MEI 2016
020516380587
020516390089
020516390127
020516390207
020516390445
020516390489
020516400022
020516400023
020516381057
020516390085
020516390036
020516420597
020516420605
020516390058
020516390007
020516390299
020516400119
020516390017
020516390018
020516390301
020516390009
020516390006
020516390027
020516390028
020516390378
020516390021
020516390025
020516390081
020516390294
020516390011
020516400040
020516400035
020516400037
020516390240
020516400054
020516390117
020516390048
020516390049
020516390317
020516400369
020516390506
NAMA PASIEN
TRANSAKSI
SUSILAWATI BINTI CIK MAN NY
33,068
SUWANDI BIN SUDHARMANTO TN
155,970
ARFAN ZAINURI SH TN.
126,000
HO LI IN NY
485,250
RIZKI PRATAMA PUTRA TN.
61,100
ASKINAH BINTI M. SUHERMAN N
23,452
A. SUBKI MAHMUD TN.
330,000
ELANI HASANAH HS NY.
70,200
KARTINI DAUD NY
40,000
NOVI AMALIA NY.
215,856
ABDUL SANI,SE TN.
183,850
KMS EFFENDY TN.
10,000
KMS EFFENDY TN.
177,000
DESSY BINTI SATIM NY.
146,000
RATNAWATI BINTI ABDULLAH NY
119,750
TISNALIA NY.
257,616
TJEPUK S TN.
219,000
ELIS NILAYATI NY.
10,000
ELIS NILAYATI NY.
160,000
M.NAUFAL AQILA AL BAAQI AN.
120,000
SUKATI BINTI HARJO NY
169,800
MARWAH BUNGLAI TN.
176,480
NISWATI BINTI ROZALI NY.
10,000
160,000
LIM KOEIJ ING NY
949,000
SITI FATIMAH NY
10,000
SITI FATIMAH NY
160,000
DANDHI PRIMA MARTIANO AN
194,400
DANDHI PRIMA MARTIANO AN
122,950
EVLIN NARITA NY
106,400
JUNAIDI HASAN TN.
251,650
EMYWATI BINTI CAKAP NY.
10,000
160,000
CANDRA DOAN TN.
254,785
SAFITRI RATNA KARMILA NY
1,041,900
YULIA HANAN NY.
143,300
MARHAMA M.FAUZAN NY.
10,000
91,000
DAVID ISKANDAR TN
918,200
PUTRO SETYONO TN
1,192,000
M. BAGAS AL-GHIFARI AN.
120,000
Page 15
2 MEI 2016
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020516390112
020516390124
020516400102
020516390091
020516390147
020516390031
020516400039
020516400108
020516400109
020516390105
020516390086
020516390087
020516390262
020516400033
020516390465
020516400038
020516390140
020516390143
020516390047
020516390013
020516390082
020516390084
020516390114
020516390205
020516400157
020516390305
020516390474
020516450564
020516400195
020516400197
020516390046
020516390094
020516390012
020516390171
020516390172
020516400068
020516390214
020516400246
020516400161
020516400174
HENDRA NUGRAHA TN.

204,640
HASIAM INDRIANI NY
10,000
HASIAM INDRIANI NY
160,000
ZUBER HUSIN TN
79,550
SAKDIAH BINTI M.UMAR NY.
200,800
TUTI PURNAMAWATI NY
10,000
TUTI PURNAMAWATI NY
160,000
MUSTHOFA BIN M. SOLEH TN.
94,880
SAENAH NY
181,280
HENDRA HARTANTO TN.
10,000
HENDRA HARTANTO TN.
177,000
SYAHRIAL TANJUNG TN.
180,850
ARI SUSANTI NN.
10,000
ARI SUSANTI NN.
177,000
NASRUN BASRI TN
171,250
NASRUN BASRI TN
106,400
ROSDIANA BINTI IBRAHIM NY.
2,155,300
R. A. MARYAM SARTIKA NY.
106,400
SANJOTO BIN MARTO SUNTONO T
10,000
160,000
PURWATI BINTI ABU THOYIB NY
65,600
DAMSI BIN BUSTAMI TN.
188,000
TUTI BINTI DANI MANSYUR H.
10,000
TUTI BINTI DANI MANSYUR H.
160,000
KADEK HANING M AN.
60,000
BARIYAH BR NY.
12,603
BARIYAH BR NY.
250,050
ASMANIA BINTI RADEN NY.
918,200
HARTATI BINTI ALFIAN NY
258,019
ROSA GITARIA NY.
512,000
RATNA BUDIARTI T HJ NY.
10,000
160,000
HIMAWAN SALIM TN.
260,400
SUHARTINI BINTI IBRAHIM NY
224,800
YASIR SATRIA TN
109,600
MIRA ASDIANA NY.
10,000
MIRA ASDIANA NY.
160,000
ASIAH BINTI TAMAT NY.
890,000
EMISNAH BINTI ABDULLAH NY
209,000
RAFFA ATHILLA MOHAMMAD AN.
110,000
ZAHRI ZAINURI TN
137,600
AMINAH H BINTI HAMZAH NY.
10,000
Page 16
2 MEI 2016
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020516400192
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020516390218
020516390065
020516390507
020516390060
020516390265
020516390160
020516390488
020516390209
020516390092
020516400224
020516400228
020516400061
020516390096
020516390359
020516380667
020516380668
020516390468
020516390442
020516400059
020516400396
020516390302
020516390304
020516390115
020516390093
020516390309
020516390310
020516390121
020516390123
020516390132
020516390376
020516390377
020516380624
020516380628
020516390129
020516390134
020516390080

DENI KURNIADI TN
ELLANWATI PUTRA KENTJANA NY
MARDIANA BINTI RUSBAD NY.
LELY WATI NY
LELY WATI NY
RUSNIARTI BINTI RUSTAM NY.
REZA APRIANTI NY.
ALIZAR BIN ANDA TN.
NABILA SYAHARANI AN
AGUSTINA BINTI SARNO NY.
ERNITA TAHER NY.
LASMIATI BINTI DAHLAN NY
NURAINI BINTI A. WAHAB NY
M. ALI SEKAMIN TN
M. ALI SEKAMIN TN
MISRAN BIN ABDULLAH TN
MARTOYO SF TN.
SUYADI H. TN
ALFI SYAHRIN TN.
ALFI SYAHRIN TN.
RURIN AGUSTIYANTI NY
ARIANA TUSEN NY.
SOLHA NAZORI GUNADI HJ. NY
HENDRY RIANTO TN
MEGAWATI BINTI A.HAMID HJ N
MEGAWATI BINTI A.HAMID HJ N
USMAN ZAINI TN
HENDRI NASUTION TN
WAHYU ESA PURWANTO TN.
ISFAI IYAT TN.
RONIMAH NY
NURMALAWATY BINTI MU IN NY.
ARIFIN SITOHANG TN.
ARIFIN SITOHANG TN.
SHOFWAN TN.
SHOFWAN TN.
HASAN BASRI TN
HENNY CHARITAS SARI NY
NASRY BIN YUSUF TN
160,000
101,810
10,000
160,000
402,400
10,000
160,000
188,000
193,585
128,400
297,020
461,600
281,085
267,162
319,200
10,000
95,000
142,400
194,400
1,192,000
10,000
160,000
299,835
60,000
188,000
890,000
10,000
160,000
461,000
194,400
10,000
160,000
120,680
230,500
264,800
10,000
160,000
10,000
125,000
230,380
101,650
182,400
Page 17
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020516390097
020516390328
020516390330
020516390321
020516390329
020516390470
020516390472
020516280915
020516390196
020516390181
020516390137
020516380621
020516400103
020516400364
020516400365
020516400261
020516390458
020516390460
020516400141
020516390421
020516390424
020516400156
020516390417
020516390418
020516390208
020516390159
020516390414
020516390415
020516390450
020516390452
020516400169
020516400229
020516400176
020516390116
020516380643
020516380646
020516390225
020516400254
020516420566
020516390206
020516390467
DJUNAIDY DJAMID TN.

SURTINA BINTI AHMAD NY.
SUGINAH ABBAS NY.
SUGINAH ABBAS NY.
M. ABBAS HASAN TN
M. ABBAS HASAN TN
AZILAH BINTI MASPIN NY
MURISAH BINTI TOHA NY
M FAIZ ABQORY ISMANTORO AN
ACHMAD SYAHRUL ALFARISI TN.
ASMAWATI BINTI ALIM NY
OKI FIRMANDO, ST TN
INDAWATI NY.
INDAWATI NY.
ARSYADI BIN M.YUSUF TN.
SURYATI BINTI YANG UN THIAM
SURYATI BINTI YANG UN THIAM
NYIMAS ZALEHA NY.
SARIPAH BINTI JEMANI NY.
HERMAN CORDY TN.
JACUB RAHMAN TN.
JACUB RAHMAN TN.
JURMANI BINTI JUMIN NY
M. HABIBIE AL FAEYZA AN
NADROH BINTI ISMAIL NY.
DARWATI BI RASIDIN NY
WARSITO BIN RIDWAN H TN.
FAJRIAH PURNAMA NY.
RAPMINDO LINA HASIBUAN NY
M. RAFIE KHAIRY AN
MELIANA BINTI ABDULLAH T. N
MELIANA BINTI ABDULLAH T. N
HALIM BIN MUKSIN TN.
ZAIBERI BIN BASIR TN.
ACHMAD ZAINI AR. TN.
CIK LUNAH NY.
NURJANAH BINTI IDRUS NY.
Page 18
160,830
135,680
10,000
160,000
10,000
160,000
10,000
160,000
82,800
115,800
880,000
234,400
60,000
188,000
10,000
160,000
271,000
10,000
160,000
180,042
10,000
160,000
458,270
10,000
160,000
101,650
544,800
10,000
160,000
10,000
177,000
106,400
60,000
200,800
120,000
10,000
160,000
302,600
270,950
60,000
321,070
271,068
2 MEI 2016
020516400177
020516390168
020516390148
020516390281
020516390462
020516390464
020516390243
020516400067
020516400198
020516390270
020516390203
020516390353
020516400165
020516400244
020516390282
020516390219
020516390241
020516390258
020516390269
020516390289
020516390457
020516390252
020516390453
020516390249
020516390239
020516390279
020516400268
020516390256
020516450719
020516450720
020516390334
020516390349
020516390420
020516400266
020516390230
020516390499
020516390501
020516390311
020516390227
020516450565
020516390238
020516420524
SRI RAHAYU NY
CHODIJAH AHMAD NN.
SAYUTI BINTI ZENAWI NY
MARIA BINTI M TOHIR KOSIM N
GETRUIDA M. JOOSTENSZ NY.
ABD MADJID TN.
ASEP SUTANTO TN.
ASEP SUTANTO TN.
OKTA WIAJAYA TN
MARSOEP BIN MAYAKIN H TN
MUHAMMAD AULADI AN
LIAUW KUN FUNG NY.
M. HATTA TN
WINDA YULIANTI NY.
PR. SIMANUNGKALIT TN.
FEBBY FENISYA NY
YUSVA OKTARINA NY
DJALILI SOLIHIN TN
AZKA AZFAR AN
AYU PUTRI ANDARIETA NN.
DEWI MAYA NY
ENDANG PROBOWATI DRA. NY
SRI PURNAMAWATI NY.
ARSO BIN ARSUJANG TN
MERY MEILINA NY
MERY MEILINA NY
RINI HARYANI NY
SUHENI BINTI M. RONI NY
SRI UTAMI NY.
LASTARI BINTI HERMANSYAH NY
CIKNAH BINTI M. YASIT NY
SUCONURWATI BINTI SONAN NY
ELLYA BINTI JAMAL NY
MATTOBI I BIN ANWAR TN.
ALFONS SISWADI TN
FITRIA YULIANTI NY
ROSITA BINTI HASBULAH NY.
ACHMAD ZARNUBI TN.
Page 19
359,135
134,880
71,450
174,710
10,000
160,000
210,380
78,869
60,000
84,915
176,000
60,000
117,710
185,000
249,845
89,500
216,339
284,000
543,300
159,683
180,414
207,650
329,856
276,835
285,600
478,200
201,590
198,530
10,000
160,000
524,800
233,145
48,300
319,800
273,800
10,000
160,000
488,200
127,940
60,000
319,200
10,000
2 MEI 2016
020516420525
020516390498
020516390456
020516400358
020516400360
020516390341
020516450551
020516450552
020516390259
020516390318
020516420608
020516450577
020516390368
020516450865
020516390411
020516400352
020516390297
020516400264
020516400403
020516400306
020516390314
020516280712
020516450510
020516450511
020516390325
020516390423
020516380706
020516280835
020516380827
020516390469
020516380661
020516390348
020516390484
020516390485
020516390486
020516450689
020516390408
020516280861
020516450536
020516450550
020516420699
020516380759
ACHMAD ZARNUBI TN.

SRI SUHARNI NY.
DEWI RATIH NY
SYAHBUDDIN H BIN MUCHTAR TN
SRI WAHYU WIDAYATI NY
NING SULISTYOWATI NY.
MARIA ILYAS NY
MARYAM RAMLI NY.
RIZKA RACHMA UTAMI AN.
RIZKA RACHMA UTAMI AN.
PIPIT DWITYA SE NY.
DARWIEN ZAINAL TN
RUSNAWATI BINTI CILIAMAT NY
KHODIJAH BINTI SANTOWI NY.
MANTHO HARUN TN
WAGINEM BINTI KASAN WIRYO N
WIJIATI BINTI WONGSOYUDO NY
TATI HARTATI NY
JAURAH BINTI HANBALI H NY
SUSILAH BINTI H.AZIS NY.
SUSI HARTOYO TN.
RAKHMAN M. NUR TN
ANTI AGNI NY.
AROSON BIN ABDUL LEMAN TN
HENDRA IRAWAN TN
OKTO TRIANTO SIHOMBING TN.
AFIFAH NAYRAH RANGKUTI AN.
DEVINA ANGELINA AN.
AMIR HAMZAH TN
AMIR HAMZAH TN
ZULKIPLI BIN SUBKI ARIF TN.
NURMALA DEWI NY.
H.M NASIR SYAFEI IR TN.
SURYANI BINTI ZAINUL BAKTI
SURYANI BINTI ZAINUL BAKTI
ABDURROHMAN BAHRI, H TN
RIA WULANDARI NY
160,000
218,830
437,880
10,000
167,000
813,400
10,000
160,000
234,400
1,950,462
51,337
80,487
266,775
352,200
36,600
823,650
285,175
1,117,130
165,300
215,024
381,370
188,800
10,000
160,000
227,362
524,800
275,100
95,691
732,000
110,132
890,000
174,400
60,000
10,000
167,000
1,192,000
224,800
1,749,850
10,000
160,000
890,000
60,000
Page 20
2 MEI 2016
020516450678
020516450874
020516420592
020516420595
020516420545
020516420688
020516380591
020516380594
020516390386
020516420580
020516420583
020516450698
020516450701
020516280694
020516280696
020516420655
020516420656
020516280976
020516380724
020516380727
020516280730
020516280736
020516280979
020516450762
020516450767
020516420526
020516420529
020516450796
020516450797
020516420755
020516380598
020516380994
020516420527
020516380734
020516281012
020516280716
020516421042
020516280832
020516380654
020516280750
020516420685
020516450681
RITA BINTI HERI GUNAWAN NY.

ZALEHA BINTI ZAINUDIN NY
ADINDA NURIANA TRIHAPSARI A
M. FAIDZAN ALTHAF AN
AHMAD MAULANA TN
BETIN TEGUH NY.
BETIN TEGUH NY.
M. HAIKAL KAMIL AN
FEBRUANITA BINTI HASAN A. N
FEBRUANITA BINTI HASAN A. N
PARIS PRATAMA TN.
PARIS PRATAMA TN.
TJIKNUT SYUKUR NY
TJIKNUT SYUKUR NY
TIMURIAH BINTI RASUKI NY.
YAHUMI ZAHRI TN
TJUNG SEN WAN NY.
TJUNG SEN WAN NY.
TJOE HOEN NIO NY.
TJOE HOEN NIO NY.
REGINA ARTA LESTARI S AN
WINDA SAFITRI NY.
WINDA SAFITRI NY.
ASNAWATI NY
SUSIANA NY
SITI NURAINI NY.
SITI NURAINI NY.
MARTIKA BINTI MARTIN NY.
M. RIO OKAMAHENDRA AN
NYS AZZAHRA RIZKYILAH AN
DESSY SURYANI NN.
MARIATUL KIBTIA NY.
ANYAH BINTI AMANG NY.
JUVENDY S TN.
HARMADI LATIEF TN.
WARTIK BINTI DARSA NY.
MACHMUDI MUIB TN.
RATNA JUWITA NN.
BAMBANG HERMANSYAH TN.
890,000
182,290
102,000
10,000
120,000
1,192,000
10,000
160,000
60,000
10,000
160,000
10,000
160,000
160,000
10,000
10,000
160,000
841,500
10,000
160,000
160,000
10,000
243,204
10,000
160,000
462,600
236,555
10,000
160,000
210,106
60,000
137,220
204,645
172,220
236,000
165,540
769,700
268,560
104,040
183,000
58,440
60,000
Page 21
2 MEI 2016
020516280824
020516380823
020516380826
020516380548
020516380728
020516281029
020516380549
020516420889
020516280862
020516420558
020516450623
020516450721
020516280705
020516280840
020516280841
020516380590
020516420691
020516421034
020516421075
020516420586
020516380641
020516450732
020516280635
020516420838
020516450846
020516450850
020516280637
020516280867
020516280868
020516280746
020516420993
020516380991
020516380987
020516280666
020516380886
020516280753
020516421039
020516280785
020516280788
020516380821
020516450582
020516450914
AGUS PIANTO, SH TN.

LANIYATI NY.
LANIYATI NY.
SUHAITO BIN GUNAWAN TN
SAFRIANI BINTI ABDUL HAMID
DASTIAN BIN JAMAAN TN
KARTIKA DYAN K NY
SUKANTO KESUMAH TN
ILRAUF HUSIN,DRS TN
AISYAH NN.
APRILIANA SRIKANDINAVIA. NN
KEMAS ZULKIFLI TOYIB TN.
FETTY DWI UTAMI NY.
FATIMAH BINTI KMS MANSYUR N
FATIMAH BINTI KMS MANSYUR N
MANUMPAK P BATUBARA TN.
HUSIN KASMADI TN.
FARIDA NY.
MARISA HAK NY.
SUNARYO BIN JAYAR TN
IYNAS ATMUTHILILLAH AN.
R.A DESTI AMALIA NY
ABU BAKAR AHMAD TN.
ABU BAKAR AHMAD TN.
SANARIMA BINTI SAMSUDIN NY.
YOAN ADITIA NY.
DEWITA BR SEMBIRING SE NN
M. TAUFIK TN.
ALESHA ZAHRA AN.
MARYANTI ASSIK NY.
SURYADI SOLIHIN TN.
ISMALINDA BINTI ISMAIL NY.
CITRA ANGGRAENI NY.
SUSILAWATY NY
HILMA YORITA NY
ASKURNI APSA TN.
RA FARIDA NY.
RAFANDRA ATHAR ZABIAN AN
ASNANI BINTI PARMELI NY
OKTA SAPUTRA TN
Page 22
60,000
10,000
160,000
215,000
278,550
478,470
357,080
277,500
522,680
325,250
244,520
60,000
180,000
160,000
10,000
260,540
311,500
209,854
266,405
147,200
60,000
60,000
253,800
470,200
160,000
10,000
306,235
160,000
10,000
333,830
60,000
781,230
952,830
269,500
193,585
137,445
195,700
251,040
213,830
125,183
60,000
10,000
2 MEI 2016
020516450917
020516380833
020516450845
020516450644
020516280859
020516280860
020516450926
020516450928
020516450675
020516420847
020516450808
020516450896
020516280822
020516280697
020516281009
020516380647
020516420708
020516280941
020516280944
020516450745
020516450752
020516420758
020516380810
020516380904
020516380831
020516420895
020516381006
020516420881
020516420885
020516280919
020516451046
020516380973
020516421068
020516381016
020516380651
020516390133
020516390481
020516390422
020516390291
020516390405
020516390400
020516450645
OKTA SAPUTRA TN
RATNA ESA NY.
DJUMLI ARIFIN TN
ANDI MUSTOPA TN
NINING SUROCHMININGSIH NY
NORMANDIA C MORONG NY.
WAYAN NANIK TARMIATI NY
OLIVER CHRIS W AN
JESICCA FABEL AN.
FATIMAH BINTI HJ. MUHAMMAD
DARMAWAN TH. DRS TN.
ADZKA FAIZAN ARZIKI AN
KASTIBI BIN ABU SERI TN.
M. YUSRAN YUSUF TN.
M. RIFKY HASLAN K. AN
DAHLAN BIN ANAFIA TN.
TUNIA BINTI PONIMAN NY.
TUNIA BINTI PONIMAN NY.
M. FADHLAN AR RASYA. S AN.
KORBI KOWI TN.
KORBI KOWI TN.
WAHYUNI APRIYANI NN.
AUDREY MYESHA SHAVIRA AB AN
PIPIT YULIANTI NN
PIPIT YULIANTI NN
CHACHA MUHAMMAD FASYAH TN
DINY OCTANIA NY
ROHANI TOHA NY
YUKI VANESSA QUEEN AN
YUKI VANESSA QUEEN AN
ROSNIDAWATI NY.
LEMIDIYATI GUSTARINI NN
KGS. MOCH THAMRINE TN
ASKINAH BINTI M. SUHERMAN N
KURNIA AGUSTINA NY.
AZHARA ARIFAH AN.
PEBRINA EVA NANDA NY.
HERMAYATI NY
MARYAM BT ALIAS NY.
Page 23
177,000
164,400
258,400
228,000
160,000
10,000
10,000
160,000
204,000
110,000
302,145
136,743
586,000
120,000
519,670
488,200
60,000
177,000
10,000
40,000
847,615
199,800
105,233
70,764
222,000
111,900
16,684
102,400
130,600
174,400
228,585
174,400
80,513
137,600
195,585
240,800
240,585
219,085
140,550
229,032
125,280
10,000
2 MEI 2016
020516450649
020516390319
020516420606
020516420657
020516390493
020516450650
020516450601
020516450855
020516450894
020516451002
020516451089
020516420747
020516390363
020516420519
020516390477
020516390425
020516450761
020516390402
020516280870
020516280700
020516390379
020516280780
020516420738
020516420778
020516380662
020516420995
020516400300
020516390431
020516390032
MARYAM BT ALIAS NY.

RISMIMANILA BINTI SALIHIN N
JOVAN OWEN ZEFANYA AN.
TITIN SHIRLIANI NN
MELATI BINTI SUKARMO NY
SUBUR PRAYOGI TN
TAPNA WARDINA NY
SUARNI BINTI BUSTOMI NY.
ANDRI JAYA TN.
AHMAD SUPARDI .H. TN.
KIRANA KHARISMAJATI NY.
CITRA PURNAMA WENI DUNAN NY
ANNISA OKTA K. AN
YENI NURITA SARI NN.
RUSMALA DEWI NY.
YUSUF USMAN TN
WIWIEK DAMAYANTI NY
FARIDA BINTI KIMANTO NY
M. HAFIZ ALAMSYAH AN
CHATARINA FEBRIANTI NY
DESI NATALIA LESTARI NY.
DAVIJANI E.A. RUMENGAN SE.
NOPI ELI PUSPITA NY
YUHANAH BINTI YASIN, DRA NY
M. FAUZI H. HASYIM TN
MUHAMMAD TN.
RIZKI PRATAMA PUTRA TN.
NAVISYAH BADARIA NY
SURYANINGSIH NY.
Page 24
137,000
384,845
80,487
143,200
60,000
60,000
78,410
419,900
90,954
542,700
527,755
275,255
138,995
93,110
240,800 MASIH RWI TUNGGU BALEK BRU BISA CETAK SEP
232,200
281,145
210,717
110,091
164,100
206,485
184,250
204,645
212,935
890,000
611,100
203,660
524,800
155,970
2 MEI 2016
Page 25
2 MEI 2016
Page 26
2 MEI 2016
Page 27
2 MEI 2016
Page 28
2 MEI 2016
Page 29
2 MEI 2016
Page 30
2 MEI 2016
Page 31
2 MEI 2016
Page 32
2 MEI 2016
Page 33
2 MEI 2016
NGGU BALEK BRU BISA CETAK SEP
Page 34
3 MEI 2016
NO
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
NO RJ
030516430412
030516390402
030516380547
030516390049
030516390119
030516280565
030516390098
030516390142
030516390087
030516390091
030516390071
030516390147
030516390100
030516390096
030516390082
030516390079
030516390062
030516390058
030516390037
030516390137
030516390081
030516430077
030516390055
030516390056
030516390060
030516430127
030516430050
030516430051
030516390189
030516380691
030516430023
030516390301
030516430146
030516390045
030516390046
030516390378
030516390188
030516430034
030516390080
030516390203
030516430398
TANGGAL
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
SEP
00
00
00
00
0090R03105160000043
0090R03105160000165
0090R03105160000265
0090R03105160000293
0090R03105160000302
0090R03105160000313
0090R03105160000315
0090R03105160000329
0090R03105160000331
0090R03105160000333
0090R03105160000372
0090R03105160000376
0090R03105160000377
0090R03105160000379
0090R03105160000380
0090R03105160000381
0090R03105160000382
0090R03105160000382
0090R03105160000383
0090R03105160000384
0090R03105160000384
0090R03105160000385
0090R03105160000386
0090R03105160000386
0090R03105160000387
0090R03105160000388
0090R03105160000389
0090R03105160000390
0090R03105160000391
0090R03105160000392
0090R03105160000392
0090R03105160000393
0090R03105160000394
0090R03105160000395
0090R03105160000396
0090R03105160000397
0090r03105160000398
Page 35
3 MEI 2016
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
030516390083
030516390084
030516430124
030516390419
030516390278
030516390376
030516390350
030516430267
030516390230
030516390094
030516390092
030516430043
030516430101
030516430097
030516390295
030516390089
030516430109
030516430104
030516430161
030516390118
030516390095
030516390054
030516430160
030516390099
030516390107
030516390106
030516430103
030516430073
030516430132
030516430066
030516390285
030516390086
030516390227
030516430120
030516430157
030516430158
030516390357
030516430370
030516430149
030516390126
030516390366
030516390393
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
05/03/2016
0090R03105160000399
0090R03105160000399
0090R03105160000400
0090R03105160000401
0090R03105160000402
0090R03105160000403
0090R03105160000403
0090R03105160000404
0090R03105160000405
0090R03105160000406
0090R03105160000406
0090R03105160000407
0090R03105160000408
0090r03105160000409
0090r03105160000409
0090R03105160000410
0090R03105160000411
0090R03105160000411
0090R03105160000411
0090R03105160000412
0090R03105160000413
0090R03105160000414
0090R03105160000415
0090R03105160000416
0090R03105160000417
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030516390476
030516390193
030516430210
030516430417
030516390238
030516390240
030516390470
030516380530
030516390187
030516430432
030516390307
030516390263
030516430256
030516390224
030516280705
030516430434
030516450626
030516380501
030516400525
030516390282
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030516380773
030516390204
030516390233
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030516380505
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030516390332
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030516390328
030516390329
030516390395
030516430365
030516390427
030516390426
030516390320
030516390335
030516390349
030516280574
030516400613
030516390345
030516400633
030516430347
030516390396
030516390391
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030516400637
030516280733
030516390371
030516390322
030516430404
030516280659
030516450680
030516450678
030516390364
030516400524
030516400522
030516400699
030516450726
030516280757
030516390448
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030516430481
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0090R03105160000510
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030516390388
030516390466
030516450658
030516380821
030516280746
030516390439
030516280872
030516280566
030516280873
030516380598
030516380602
030516280622
030516380609
030516280708
030516280638
030516280647
030516280690
030516450713
030516380716
030516400730
030516380740
030516280754
030516400592
030516280764
030516450806
030516280780
030516450788
030516380814
030516430450
030516450801
030516400818
030516280644
030516380828
030516380704
030516390461
030516390463
030516380535
030516390459
030516280660
030516380774
030516280865
030516400617
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030516400744
030516430480
030516390487
030516280662
030516400512
030516400511
030516280681
030516280669
030516280751
030516400521
030516400520
030516280587
030516280586
030516400863
030516380533
030516380534
030516450811
030516390475
030516450559
030516450541
030516400848
030516380861
030516400847
030516450575
030516280693
030516380722
030516450898
030516400601
030516450723
030516380892
030516280831
030516400741
030516280763
030516380595
030516380596
030516400783
030516400739
030516450573
030516450670
030516280676
030516400880
030516280641
05/03/2016
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030516400610
030516400612
030516280649
030516400634
030516280768
030516280591
030516380654
030516280784
030516280653
030516280709
030516380606
030516280727
030516280748
030516400789
030516280629
030516280878
030516380779
030516450711
030516280830
030516450692
030516400749
030516380684
030516400823
030516380667
030516450793
030516450628
030516450685
030516450663
030516400819
030516380687
030516450781
030516450785
030516450905
030516450908
030516390075
030516280743
030516390294
030516430148
030516390220
030516390221
030516450812
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05/03/2016
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0090R03105160000649
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0090R03105160001066
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Page 42
3 MEI 2016
NAMA PASIEN
ENIROSA BINTI HASAN NY.
ISRIL HENDRA TN
KMS EFFENDY TN.
NURJANAH BINTI ISMIRI NY.
YULIANTI BINTI HASANUDDIN NY.
SATIA BINTI ZABIDI NN.
SRI WULAN NY
MARIA HARTANINGSIH NY.
JUMAIDA BINTI H RASUL NY.
MARLIZA JULIANTI NY.
DESI ANITAWATI NY
AMALIA OKTARINA NY.
NURUL CAHYANI NY
SHINTA ADYA RAHAYU NY.
DEANDRA GHANIYAH KIRANA AN
NURLELA BINTI AHMAD ROZALI NY.
ADY APRIYANTO TN
M. ATHAYA AZHIM APRILIO AN
M. JAUHARI EFENDI TN
EPTA SARTIKA NY
AMRUL BIN ROBI TN
AMRUL BIN ROBI TN
E. SIMATUPANG TN
E. SIMATUPANG TN
MUTMAINNAH BINTI IBNU NY.
SITI MAIMUNAH NY
SITI MAIMUNAH NY
PARINA BINTI PAGI NY.
HERIYANTO TN
KURNIAWATI PURNOMO NY.
BAMBANG SUTARAM TN
MELIANA BINTI ABDULLAH T. NY
MELIANA BINTI ABDULLAH T. NY
DIANA NOVITA NY
SUKIRMAN TN.
NURHAYATI BINTI H.HASAN NY.
RIO REZA ZULKARNAIN TN.
TRANSAKSI
1,812,900.00
133,500.00
30,000.00
1,248,900.00
107,980.00
60,000.00
308,035.00
221,235.00
662,835.00
289,935.00
85,750.00
221,235.00
493,590.00
221,235.00
143,615.00
44,278.00
215,406.00
113,400.00
177,850.00
40,000.00
36,000.00
675,200.00
56,036.00
10,000.00
125,000.00
109,600.00
10,000.00
160,000.00
490,700.00
120,000.00
890,000.00
890,000.00
394,000.00
10,000.00
160,000.00
890,000.00
513,000.00
182,400.00
472,000.00
197,900.00
890,000.00
Page 43
3 MEI 2016
ROFE AH BINTI AGUS CIK NY
ABDURRAHMAN BAHRI, H TN
WATIKA BINTI AMRIN NY
AMRAN BIN ROHIB TN
ZULFARNA BIN A. GAFFAR TN
SUGINAH ABBAS NY.
SYAHRIR YASIN TN
SOMAD BIN SAKIMAN TN
RAISHA NUR KHAYLA AN
SRI YULIDAR NY.
FRANS KELLY EDWARD TN.
NURBAITI BINTI H.M. YUSUF NY.
NYAYU HALIMAH NN.
NYAYU HALIMAH NN.
NYAYU HALIMAH NN.
MANAMPIN SILABAN TN
K.M. RIDWAN SAID, SH TN.
ZAINUDDIN BIN JAMALUDDIN TN
KOMRI BIN HASAN TN
JUNAIDA PRIANI NY
MUHAMMAD TONI TN.
MUHAMMAD TONI TN.
DEVINA ANGELINA AN.
FEBI DAYANA NY
VICKY NURHARIYANTO TN.
ARTHA ZENDA TN
YURNIATI SUSANTO NY.
MUSLIMIN KADIR TN
SITI AISYAH NY.
ZUBAIRI BAKAR TN.
RUSDIANA BINTI TEGUH NY.
ANIMINASUKA NY
SHOFWAN TN.
AZHAR RUMAWIE TN.
LIDAWATI BINTI M. IDRIS NY.
10,000.00
160,000.00
60,000.00
186,000.00
107,000.00
177,000.00
10,000.00
152,068.00
378,200.00
160,000.00
10,000.00
115,000.00
80,065.00
195,500.00
21,500.00
165,750.00
160,000.00
10,000.00
219,000.00
192,800.00
87,950.00
187,200.00
917,900.00
160,000.00
160,000.00
10,000.00
512,000.00
175,680.00
259,835.00
234,400.00
74,140.00
472,000.00
316,000.00
83,160.00
10,000.00
160,000.00
597,750.00
1,192,000.00
216,115.00
202,315.00
818,150.00
160,000.00
Page 44
3 MEI 2016
PONIATI BINTI SUBARTO NY.
AGUSTIANI BINTI IRWANDI NY
JEANNE KUSSOY NY
JEANNE KUSSOY NY
MOHD DAIM DRS TN.
MAMAT SADI TN.
KAROLINA NY.
ANITA BINTI SOLEH NY
DEWI MONALISA NY.
SUKANTO KESUMAH TN
ROHANI LUMBAN GAOL NY.
LIES PERMATA SARI R.A.W NY.
NILA ANDRAINI NY.
SAUT SITUMORANG TN.
CHADIDJAH SALEH NY
WIF AZRIEL SYLVESTER AN
HUSNI THAMRIN TN
TARMIZI BIN ABDUL WAHAB TN.
NELAWATI BINTI BAYRUNAS NY
MUHAMMAD ARIEF RIADY TN.
TRISITA ETA NY.
M FARHAN AT THAHIRY AN
RANEM BINTI RAKINEM NY
TRIANA GESURIWATI, HJ NY
NITA RISPA RO M,SI. NY.
HAMZAH BIN TAYIB TN
KARTINI NY
KARTINI NY
IBRON TN.
KHAIRY ASROL APRIANSAH AN
UMAR H TN.
ABU KOSIM TN.
ABU KOSIM TN.
HANIFAH AFAF AN.
10,000.00
208,920.00
329,245.00
95,000.00
10,000.00
231,070.00
216,480.00
149,450.00
148,900.00
185,930.00
1,034,000.00
512,000.00
194,340.00
174,800.00
254,140.00
160,000.00
10,000.00
103,415.00
196,500.00
110,000.00
2,500.00
111,660.00
60,000.00
202,000.00
141,500.00
160,000.00
10,000.00
335,450.00
488,200.00
18,515.00
306,400.00
488,200.00
277,526.00
157,150.00
160,000.00
10,000.00
146,400.00
120,000.00
410,500.00
160,000.00
10,000.00
102,400.00
Page 45
3 MEI 2016
HANIFAH AFAF AN.
AHMAD RAFI MAULANA AN
DEVI MARINA NY.
M. FIRMAN ADJI CANDRA K TN
ZAMROH SATAR DRA HJ NY.
AS AD SAYUTI DRS TN
AS AD SAYUTI DRS TN
GATOT SUGEMTO TN
PUTRI AULIYA TSAQIB AN.
YESISCA SUSANTI NY.
HIDAYAH BINTI SBAIN NY
MOHSAN TURIP TN.
MARDIANA NY.
SRIVITA, SH, MM NY.
HIDAYAT BIN SUDIRMAN TN.
LINAWATI BINTI YUSUF NY.
RATIH NURHAYATI AN
RATIH NURHAYATI AN
OEY LAY OA NY
NURMARIAH BINTI H. ASIF NY.
RACHMAD SANTOSO TN
ANGGA PRIMA SIMAMORA TN
ANGGA PRIMA SIMAMORA TN
HERMIYATI BINTI BUSTAM NY
ROSIANNA SIMATUPANG NY
NUNUNG NURISA NY
NAIM HASAN TN
NAIM HASAN TN
TAUFIK HIDAYAT TN.
NURLIANAH BINTI LAMSARI NY.
ELVINASARI BINTI ARIF NY
SUTIMIN BIN GIMAN TN.
MOHAMAD DARMAWAN AN
ZAIDAR BINTI M.NURLEMAN,HJ NY.
RIZAL AZKA HIDAYAT AN
WILBER YOSEANDRO RISIN AN.
CINDY MARDENA NY
SUMIRAH BINTI MAS''UD NY
81,800.00
120,000.00
326,480.00
318,130.00
173,450.00
10,000.00
167,000.00
1,192,000.00
120,000.00
397,080.00
134,640.00
159,764.00
70,450.00
501,600.00
187,200.00
49,870.00
278,000.00
21,372.00
101,992.00
11,500.00
254,370.00
140,865.00
488,200.00
58,415.00
39,500.00
185,000.00
211,000.00
180,000.00
158,700.00
282,581.00
209,800.00
93,865.00
10,000.00
160,000.00
562,250.00
159,764.00
86,450.00
214,400.00
60,000.00
193,585.00
193,585.00
102,400.00
Page 46
3 MEI 2016
ANNE YULIETTA NY
NURHAYATI NY.
RETNO WULANDARI NY
FEMILIA MARLINA NY.
FEMILIA MARLINA NY.
MELIANA BINTI EDI NURASIT NY
PURNOMO TN.
PURNOMO TN.
SRI MULYATI NY.
MITA RAMADHANI NN
MARIA BINTI M TOHIR KOSIM NY.
YUNITA BINTI THAMRIN NY
IMAM FIRDAUS TN
SARNAWATI BINTI TARCA UJANG NY
HARNING SYAHDA NY.
M. IMRON TN.
ISMAIL ALI TN
SEPTIANA NURAINI NN
SUHAIMY BIN SUSANTO TN
NAZMA BINTI ZOEKRI NY.
DHARMA HERLINA NY
YUWINTI NEARTI NN
HERU SUPENO TN.
VERA SISKA NY
SHOLHA AFRIYANTI NN.
CALLISTA LAURA ANGELINA S.AN
RUSTAM HALIM TN
ROSNI BINTI YATIM NY.
DAHLIA BINTI NUNG CIK NY
MUHAMMAD RIFQI TN
MUHAMMAD RIFQI TN
LIESMAWATY BINTI LI ENGWAN NN
DESMIYARTI BINTI SUMADAR NY
MARIA HARTANINGSIH NY.
HARNISAH BINTI M. YUNUS NY.
NOVA TARIDA SINAGA NY.
ELCY ZIVILIA AN.
DIAN PUTRI NY
126,000.00
118,040.00
64,000.00
245,763.00
10,000.00
160,000.00
199,000.00
10,000.00
167,000.00
60,000.00
269,520.00
160,000.00
10,000.00
199,000.00
249,000.00
314,000.00
303,000.00
103,050.00
144,500.00
148,231.00
216,000.00
167,000.00
10,000.00
110,600.00
138,300.00
111,824.00
501,600.00
187,624.00
124,400.00
1,254,400.00
160,000.00
10,000.00
180,000.00
177,000.00
10,000.00
200,000.00
180,000.00
108,500.00
269,700.00
199,350.00
173,050.00
180,000.00
Page 47
3 MEI 2016
A. RACHMAN TN
MUHAMMAD FATIH AN
ANI HASAN NY
SALDI BIN SYAHRUDDIN TN
MULKAS ADE PUTRA TN
BILAL BIN ARIE HERDIAN AN.
PUJI ASIH NY
RAHULLA HUANG AN.
JAP DJIT SING TN
ACHMAD ZARNUBI TN.
TRIMURTI ERNA DARLIS NY
NELLY JUWITA SARI NY
HASIAM INDRIANI NY
SURYATINI BINTI WASRAN NY.
NURLIANA SALIM NY
DIKSON MATHEOS TN.
ZUBAIDAH BINTI A. MAJID NY.
A. JAMALUDDIN TN.
YULIANTI BINTI AMSIRI NY
SUMIATY JUMAHAT NY
M RIZKY KURNIAWAN AN.
TAJUDIN, DRS,SH,MM, H TN
ALEN AFRIANI NY.
FEBRUANITA BINTI HASAN A. NY
YUTI BINTI HUSIN GUNAWAN NY
SHINTA HASANA NY.
KHAIRA ANNAILA JASTRA AN.
ZIGAN AHMAD DJALJADDI AN
SUKARDI BIN JAIDI TN.
DIAN ANGGRAINI NY.
SULIYEM BINTI TONDO SUROYO NY
DORTA SINAGA NY.
M. RAIHAN RAFANDRA ZAFLI AN.
SUNARMAN BIN ATMO SUWITO TN
YOHANES TN.
ROHANI TOHA NY
SUSIANI BINTI SUMARJO NY
SITTI FILDZAH RAHMA AN
94,880.00
375,020.00
890,000.00
488,200.00
142,050.00
151,350.00
77,160.00
60,000.00
83,160.00
107,450.00
107,450.00
91,450.00
71,450.00
1,192,000.00
129,450.00
60,000.00
94,250.00
71,450.00
219,450.00
152,000.00
60,000.00
71,450.00
135,900.00
99,450.00
158,031.00
71,450.00
109,900.00
60,000.00
60,000.00
68,000.00
169,450.00
264,000.00
84,800.00
219,781.00
110,000.00
10,000.00
60,000.00
880,000.00
159,115.00
122,513.00
83,160.00
294,520.00
Page 48
3 MEI 2016
BASTIANSYAH BIN RZ ABIDIN TN
ADELIYAN BINTI A HALIM NY
SRI NURUL HIDAYATI NY
RUSMALA DEWI NY.
RUKIYAH BINTI ADB. RAUP NY
SHINTA RESTY PRATIWI NN.
TRI ARYANI NY.
SUTAN MAKMUR MANAN TN
ABAS H BIN BAHARUDDIN TN
JUNIARTI PEBRIANA AN
FARIZ AFRAND PRATAMA AN
LINA PURWANTI NY.
MARTINI THAMRIN NY
ALEXANDER BIN BUJANG W TN.
HARINI OKTAFENI NY.
GITA ATIKA HERVINA NY.
CHAERUL FADJAR MD DRS TN
HERMI BINTI M ALI NY
ELLOHI ARVIN DARELL PH AN
SITI NURAINI NY.
NYAYU ASIAH NY
MUHAMMAD GHOZALI AN.
ALDEN HAZEN WIRANEGARA AN
HERMAWATI BINTI PADANG NY
ROSYADI BIN ABD ROHIM TN
KRISTINA IMRON NY.
KEVIN NAUFAL D AN.
APRIANTI BINTI SOBRI AHMAD NY.
DWI LESTARI NY.
USNAWATI BINTI AHMAD B NY.
NAHDIAH NY.
459,600.00
517,080.00
1,041,900.00
102,865.00
160,000.00
10,000.00
97,865.00
123,720.00
327,450.00
160,000.00
10,000.00
10,000.00
160,000.00
453,000.00
125,000.00
10,000.00
110,000.00
222,400.00
160,000.00
10,000.00
108,750.00
12,650.00
149,850.00
200,000.00
180,000.00
508,950.00
97,640.00
148,200.00
81,700.00
104,324.00
126,496.00
110,000.00
60,000.00
10,000.00
160,000.00
172,040.00
517,800.00
61,000.00
60,000.00
180,000.00
60,000.00
180,000.00
Page 49
3 MEI 2016
WINDA SAFITRI NY.
WINDA SAFITRI NY.
FARIAH BINTI LA HAKIM NY.
ZENNITA ANGGUN PRADITA PUTRI N
ANWAR TN.
ALYSKA FITRI AZZAHRAH AN.
DEWI KASUMA NY.
ZAINAB SYAM NY.
CAESA AYUNI NADILLAH AN.
ZUBAIDAH HJ NY
MUHAMMAD HUSNI TN.
RASMIYATIE BINTI RASIMIN,HJ NY
SRI HARTI ATMODJO NY
SRI HARTI ATMODJO NY
M. RASYA PUTRA HERMANDO AN
EFENDI BIN JASAN TN
WATIMA BINTI LAIMAN NY.
MUHAMAD FARHAN YUSUF ILHAM A
DEWI JUWITA. NY
M ZIEBRAN IBRAHIM AN
RUSMALA DEWI NN.
EDDI AZ TN.
FAKHIRA AZRADILLA AN
DARMA SURYATI NY
ROHELA BINTI JUMRO NY
M. FAKHRI ABYANSYAH AN.
M. FAKHRI ABYANSYAH AN.
SRI PUJIWATI NY
HENI RADNA NY.
FITRI INDAH WULANDHARI NY
NESIA PUTRI SELSIWIJAYA NN
SLAMET INDRA WIJAYA TN
DEDI KUSUMA TN
MUHAMMAD IQBAL N TN.
MIRANTI OCTARINA NN.
ANDJAR NUR WAHJUNI NY
NADYA PUTRI AURORA INDARTO AN
DAVID ISKANDAR TN
ZURAIDAH BINTI KGS M. SALIM NY
IDAH DESIANA NY.
IDAH DESIANA NY.
10,000.00
160,000.00
126,430.00
216,250.00
422,311.00
110,000.00
174,400.00
186,231.00
180,000.00
328,780.00
224,800.00
97,574.00
476,100.00
27,600.00
120,000.00
94,606.00
361,150.00
120,000.00
117,249.00
110,000.00
190,790.00
116,910.00
60,000.00
186,000.00
275,200.00
102,400.00
65,900.00
131,710.00
201,272.00
120,030.00
95,500.00
594,504.00
77,160.00
60,000.00
94,664.00
253,100.00
115,000.00
60,000.00
10,000.00
137,000.00
302,280.00
115,000.00
Page 50
4 MEI 2016
NO
1
2
3
4
5
6
7
8
9
10
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22
23
24
25
26
27
28
29
30
31
32
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34
35
36
37
38
39
40
41
NO RJ
040516430727
040516390186
040516390080
040516390089
040516280144
040516380041
040516390137
040516430517
040516420509
040516390098
040516390093
040516430512
040516280164
040516390031
040516380374
040516420576
040516390564
040516390092
040516430514
040516390736
040516390015
040516380165
040516390085
040516390069
040516390360
040516390016
040516390024
040516390028
040516280132
040516390032
040516390037
040516280104
040516390073
040516390047
040516390019
040516390020
040516380042
040516430757
040516430751
040516390034
040516390033
TANGGAL
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03104160000695
0090R03104160007427
0090R03105160000507
0090R03105160000608
0090R03105160000612
0090R03105160000618
0090R03105160000623
0090R03105160000624
0090R03105160000694
0090R03105160000696
0090R03105160000697
0090R03105160000698
0090R03105160000699
0090R03105160000700
0090R03105160000701
0090R03105160000701
0090R03105160000702
0090R03105160000702
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4 MEI 2016
42
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61
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63
64
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70
71
72
73
74
75
76
77
78
79
80
81
82
83
040516380282
040516280243
040516380061
040516380059
040516380108
040516420965
040516390018
040516390087
040516390083
040516390022
040516390058
040516390062
040516390119
040516390026
040516390056
040516390057
040516380081
040516380079
040516280139
040516280143
040516390030
040516380051
040516420909
040516280187
040516380071
040516390341
040516390338
040516380063
040516390333
040516390336
040516380295
040516280181
040516280184
040516390029
040516380269
040516390200
040516390199
040516380105
040516390086
040516390276
040516380136
040516380141
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
0090R03105160000703
0090R03105160000704
0090R03105160000705
0090R03105160000705
0090R03105160000706
0090R03105160000707
0090R03105160000707
0090R03105160000708
0090R03105160000708
0090R03105160000709
0090R03105160000710
0090R03105160000710
0090R03105160000711
0090R03105160000712
0090R03105160000713
0090R03105160000713
0090R03105160000714
0090R03105160000714
0090R03105160000715
0090R03105160000715
0090r03105160000716
0090R03105160000717
0090R03105160000719
0090R03105160000720
0090R03105160000721
0090R03105160000722
0090R03105160000722
0090R03105160000723
0090R03105160000724
0090R03105160000724
0090R03105160000725
0090R03105160000726
0090R03105160000726
0090R03105160000727
0090R03105160000728
0090R03105160000729
0090R03105160000729
0090R03105160000730
0090R03105160000731
0090R03105160000731
0090R03105160000732
0090R03105160000732
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4 MEI 2016
84
85
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94
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100
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103
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108
109
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112
113
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115
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117
118
119
120
121
122
123
124
125
040516380188
040516380168
040516380167
040516380246
040516280466
040516280204
040516390198
040516390196
040516280239
040516390088
040516280207
040516280206
040516390035
040516390602
040516390598
040516390189
040516390036
040516390215
040516390066
040516280229
040516280228
040516280208
040516280288
040516280410
040516280418
040516380322
040516380256
040516380253
040516280285
040516280286
040516390201
040516380292
040516380074
040516280227
040516450587
040516450591
040516390060
040516380050
040516390078
040516390170
040516390154
040516390115
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
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05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
0090R03105160000733
0090R03105160000734
0090R03105160000734
0090R03105160000735
0090R03105160000736
0090R03105160000737
0090R03105160000738
0090R03105160000738
0090R03105160000739
0090R03105160000740
0090R03105160000741
0090R03105160000741
0090R03105160000742
0090R03105160000743
0090R03105160000743
0090R03105160000744
0090R03105160000745
0090R03105160000746
0090R03105160000747
0090R03105160000748
0090R03105160000748
0090R03105160000749
0090R03105160000750
0090R03105160000751
0090R03105160000751
0090R03105160000752
0090R03105160000753
0090R03105160000753
0090R03105160000754
0090R03105160000754
0090R03105160000755
0090R03105160000756
0090R03105160000757
0090R03105160000758
0090R03105160000759
0090R03105160000759
0090R03105160000760
0090R03105160000761
0090R03105160000761
0090R03105160000762
0090R03105160000763
0090R03105160000764
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040516380354
040516380352
040516280308
040516280306
040516390366
040516390370
040516380155
040516390311
040516390307
040516390065
040516280262
040516280255
040516280116
040516280313
040516280310
040516380161
040516390323
040516390156
040516380153
040516390075
040516390159
040516380067
040516390382
040516390379
040516380457
040516390109
040516280211
040516280216
040516380172
040516390166
040516380482
040516380483
040516431008
040516390454
040516390453
040516390317
040516390224
040516390107
040516390452
040516380157
040516450537
040516390183
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
05/04/2016
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4 MEI 2016
NAMA PASIEN
HAIDA BINTI SYAFAR NY.
HASNAN HAROM TN.
ILAL YATI NY.
JUNAIDI HASAN TN.
MELINA RAHAYU NY.
MUKROMIN TN.
NURHAYATI BA HJ NY
NYIMAS ZALEHA NY.
RATIH NURHAYATI AN
RITA LIZIANA NY
ROSIANNA SIMATUPANG NY
SAFRI,H TN.
SANGKUT BIN ATUT TN
SOFRIN ROMSAU TN.
SUYATNO BIN REBIN TN.
YARSAN PANANG TN.
YULITA HANDINI IRA W NY.
ZUBER HUSIN TN
IBRAHIM KHOLIL TN.
LIUSNANI BINTI LAATIEF NY.
SHERLY SAKA NY
DESI YANTI NY.
RIZA FAHLEPI TN.
JASMIARNI BINTI JASRIAL NY
DIANA EKA SETIARINI NY.
NATIYEM NY
NIKEN LARASATI NY
MARIYAM AMAK NY.
AGUSTINA MAILANY NN.
BENI HERIANSYAH TN
VERA SISKA NY
KAROLINA NY.
KAROLINA NY.
ELIS NILAYATI NY.
ELIS NILAYATI NY.
TRANSAKSI
262,500.00
249,000.00
126,000.00
249,000.00
32,750.00
832,600.00
249,000.00
37,100.00
77,220.00
60,600.00
1,040,750.00
81,000.00
249,000.00
54,000.00
82,500.00
249,000.00
249,000.00
12,600.00
81,000.00
45,000.00
308,700.00
144,000.00
237,000.00
126,000.00
60,000.00
60,000.00
180,000.00
180,000.00
860,000.00
210,000.00
180,000.00
192,548.00
61,369.00
99,124.00
127,200.00
57,450.00
60,000.00
10,000.00
177,000.00
160,000.00
10,000.00
Page 62
4 MEI 2016
SOFIA AZZAHRA AN.
115,000.00
120,000.00
160,000.00
10,000.00
HASIAM INDRIANI NY
262,520.00
159,000.00
60,000.00
NURLIANA SALIM NY
160,000.00
NURLIANA SALIM NY
10,000.00
216,480.00
HENDRA HARTANTO TN.
10,000.00
HENDRA HARTANTO TN.
177,000.00
HERLANI BIN HARUN TN.
185,500.00
WAGINEM BINTI KASAN WIRYO NY
106,400.00
SITI FATIMAH NY
10,000.00
SITI FATIMAH NY
160,000.00
160,000.00
10,000.00
SURYANI BINTI ZAINUL BAKTI NY
10,000.00
160,000.00
YULIANA BINTI AJIU NY
577,600.00
A. NASIR RASYAD TN.
179,000.00
JANSSEN KEITARO YUUJI AN
110,000.00
MARMI BINTI MIMIK NY.
212,920.00
HENDRA NUGRAHA TN.
176,480.00
M. ABBAS HASAN TN
160,000.00
M. ABBAS HASAN TN
10,000.00
99,450.00
SUGINAH ABBAS NY.
10,000.00
SUGINAH ABBAS NY.
160,000.00
RUSDIANTO BIN RUSTAM TN.
1,192,000.00
10,000.00
160,000.00
DARMO BIN JINOMO TN
147,200.00
SUTARWO BIN KARDI P.A TN.
991,315.00
SANJOTO BIN MARTO SUNTONO TN 160,000.00
SANJOTO BIN MARTO SUNTONO TN
10,000.00
R. A. MARYAM SARTIKA NY.
99,000.00
78,000.00
183,200.00
10,000.00
160,000.00
Page 63
4 MEI 2016
AS AD SAYUTI DRS TN
LELY WATI NY
LELY WATI NY
HARBEI PASAH TN
SARI NILA KUSUMA NY
DARMANSYAH BIN M. NUR TN
TUTI PURNAMAWATI NY
TUTI PURNAMAWATI NY
KARIMAH, HJ BINTI KHOLIQ NY.
NYIMAS NURMANI NY.
TUTUN SUKARTINAH NY.
IWAN WATAK TN.
JULIANA KOWIRA NY.
MARTOYO SF TN.
HASAN BASRI TN
M. ALI SEKAMIN TN
M. ALI SEKAMIN TN
NINA PRATIWI NY
TEGUH BIN HOKSAN TN
DIKSON MATHEOS TN.
DIKSON MATHEOS TN.
SULAIMAN NADEAK TN.
MIRA ASDIANA NY.
MIRA ASDIANA NY.
HASANUDDIN H TN.
BUDI BIN DARMO WASITO TN.
MASAYU UMI KALSUM HJ NY.
ALFI SYAHRIN TN.
ALFI SYAHRIN TN.
NAZHA BINTI HAMBALI NY
HILMA YORITA NY
HILMA YORITA NY
ZAWIYAH ERMAWATI HJ. NY
311,430.00
160,000.00
10,000.00
890,000.00
1,341,600.00
1,197,000.00
160,000.00
10,000.00
890,000.00
310,200.00
160,000.00
10,000.00
140,480.00
160,000.00
10,000.00
80,000.00
82,400.00
69,000.00
512,000.00
95,000.00
10,000.00
139,800.00
890,000.00
10,000.00
125,000.00
890,000.00
160,000.00
10,000.00
10,000.00
160,000.00
157,252.00
999,800.00
110,000.00
433,950.00
10,000.00
160,000.00
512,000.00
147,200.00
168,000.00
67,065.00
134,750.00
214,600.00
Page 64
4 MEI 2016
SITI ROHMA NY
SITI ROHMA NY
ALI NURDIN TN.
ALI NURDIN TN.
SAIFUL NURAINI TN.
SAIFUL NURAINI TN.
NASRY BIN YUSUF TN
MEGAWATI BINTI A.HAMID HJ NY.
HERSAWANA BINTI MUHAMMAD NY
IBRON TN.
JACUB RAHMAN TN.
JACUB RAHMAN TN.
RAMLAN M.I TN.
JANNI BURHAN NY
FEMILIA MARLINA NY.
ASRUL JALIL TN.
ALEXANDER BIN UJANG TN
APRILIA AGUSTINA AN
A. JAMALUDDIN TN.
A. JAMALUDDIN TN.
SYAHABUDIN T TN.
RODIAH RAHMAT, SKM NY
RAMALIAH BINTI NURKI R NY.
RIZKI HARTANTRI NY
KMS A RONI H TN.
INDAWATI NY.
INDAWATI NY.
MSY. NORMA YUNITA SARI NY.
SURYATI BINTI YANG UN THIAM NY
ATMAYATI ABDULLAH NY
PATMAN ROZI TN
PETER AFALIO FERNANDEZ AN
HERDAWATY BINTI AHMAD N. NY
AJENG RATRI WULANDARI AN.
MICHIKO TIARA SUKMA NY.
SRI UTAMI NY.
160,000.00
10,000.00
160,000.00
10,000.00
10,000.00
160,000.00
118,280.00
160,000.00
10,000.00
221,280.00
160,000.00
10,000.00
68,000.00
160,000.00
10,000.00
418,840.00
156,865.00
78,000.00
138,000.00
120,000.00
172,100.00
63,240.00
160,000.00
10,000.00
384,200.00
60,000.00
394,800.00
172,800.00
211,200.00
112,300.00
10,000.00
160,000.00
216,465.00
160,000.00
10,000.00
233,800.00
78,200.00
118,900.00
92,000.00
222,000.00
338,650.00
146,000.00
Page 65
4 MEI 2016
YURINDA WITHA SARI NY.
NURBAYA BINTI SANI NY
ASRIL UDIN TN.
M. ABID AL KHAIRAN AN
NURHAYATI BINTI HANIFAN NY
YESISCA SUSANTI NY.
DIAN ANGGRAINI NY.
AZZAHRA NURUL FADHILA AN.
NYIMAS NURIA HASNAH NY.
HASIDAH BINTI HADIS NY.
TETI ENDARAWATI NY.
ABD. HALIK SY. TN.
FITRI JUWITA NY
FITRI JUWITA NY
FITRI JUWITA NY
KOMALASARI BINTI ANSORI NY
MERY MEILINA NY
NILA ANDRAINI NY.
CHAIRUNNISA BINTI ANWAR NY.
RITA ERYANI NY.
NITA RISPA RO M,SI. NY.
AINUN BINTI ABDUL MAJID NY.
RAHMAWATI BINTI A. HASIM NY.
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
ZULKARNAIN BIN AZHARI TN.
AZIZAH BINTI M.NAWAWI NY.
RENY YULISTRI NY.
LANIYATI NY.
LANIYATI NY.
BETIN TEGUH NY.
BETIN TEGUH NY.
DARMO TAPSIAH, HJ NY.
114,130.00
238,650.00
1,066,570.00
81,600.00
132,250.00
167,000.00
10,000.00
119,250.00
160,000.00
10,000.00
194,900.00
228,687.00
78,200.00
135,545.00
216,480.00
175,680.00
205,290.00
503,800.00
16,100.00
80,800.00
8,020.00
224,330.00
146,000.00
165,000.00
227,650.00
228,527.00
108,008.00
160,000.00
10,000.00
101,865.00
160,000.00
10,000.00
168,402.00
60,000.00
224,650.00
160,000.00
10,000.00
10,000.00
160,000.00
60,000.00
223,200.00
146,000.00
Page 66
4 MEI 2016
SEPTIANA NURAINI NN
BAMBANG IRAWAN TN.
NIKEN LARASATI NY
ZUBAIDAH AZ NY.
EDY ABDULLAH TN
ARBAIN GANTI TN
ARBAIN GANTI TN
DIANA EKA SETIARINI NY.
BOEN MEI YUN NY.
HENDRA SUCIADI TN.
LUCIANA HUTAGALUNG NY
TATI HARTATI NY
DEVINA ANGELINA AN.
FRANSISKA APRIANTY N NN.
ROBIAH BINTI MAT TONI NY.
ARIFIN SITOHANG TN.
ARIFIN SITOHANG TN.
MARISYA OKTARINA NY
RUKIAH HB, HJ NY
FETTY DWI UTAMI NY.
M.ARI MULYONO TN.
EDY BURHAN DRS. TN.
SAZILI SULAIMAN TN
SUGIAWATI BINTISUMO DIHARJO N
ADHA BUDI RAHAYU NY.
YUSUF USMAN TN
ENDANG LITNA MARPAUNG NY
HIKMAH BINTI MISBACH NY
MANTHO HARUN TN
MANTHO HARUN TN
VINCENT LIE SARIPUTRA AN
SA''ADAH BINTI MAJID NY.
SULASIAH BINTI M. SOLEH NY.
TRI PUSPITASARI NY.
MUHAMMAD YUNUS FRUZA TN.
SRIVITA, SH, MM NY.
EKA RATIH RADELLAH AN.
264,800.00
139,443.00
180,000.00
245,000.00
890,000.00
10,000.00
160,000.00
483,080.00
193,000.00
101,500.00
66,000.00
160,000.00
10,000.00
264,800.00
82,050.00
121,300.00
207,060.00
160,000.00
10,000.00
289,700.00
110,000.00
547,600.00
141,400.00
470,020.00
379,200.00
237,150.00
10,000.00
160,000.00
205,000.00
183,700.00
691,480.00
54,000.00
114,900.00
110,000.00
146,000.00
257,000.00
284,830.00
40,000.00
130,427.00
32,000.00
146,000.00
120,000.00
Page 67
4 MEI 2016
ANITA OKTARINA NY.
192,900.00
DJUARA BINTI SUHARI NY
196,230.00
YUHANA BINTI LEBEK H NY
171,781.00
SYIHABUDIN BIN MAKMUN TN.
10,000.00
160,000.00
RIZKA ANDINI DWI SETYA NN
212,520.00
MEGAFREYA OKYLA AN.
80,000.00
MEGAFREYA OKYLA AN.
110,000.00
YULIANA PUSPA DEWI, SE, AK NY.
140,600.00
DJAKFAR LEKAP TN.
128,400.00
CHERLYNDA SARI ST. NY.
306,290.00
ERWIN AZHARI TN.
1,192,000.00
60,000.00
RUSNAH BINTI ALI HASAN NY
890,000.00
160,000.00
10,000.00
NINGGU HJ. NY.
66,450.00
LENI APRIYANTI NY
174,400.00
LENI APRIYANTI NY
517,080.00
NURMAH BINTI MUNIR NY
890,000.00
ARIYANTI NY
192,200.00
SHINTA HASANA NY.
125,000.00
SHINTA HASANA NY.
10,000.00
MUHAMMAD NURDIN TN.
598,850.00
SOEPRAPTO TN.
210,200.00
YULIANA OH NY
362,700.00
MEYSA RANNY AN.
286,100.00
MUHAMMAD ABU DAUD TN
60,000.00
RONIMAH NY
60,000.00
ASYIFA SHAKILA PUTRI AN.
88,600.00
M.FAIZ RAMADHAN AN.
103,200.00
99,450.00
WINDA SAFITRI NY.
71,450.00
60,000.00
NICKY VERDIANTO TN.
890,000.00
60,000.00
NYAYU HALIMAH NN.
71,450.00
WASNITA BINTI ROSTAM NY
194,500.00
SETIA WATI NY
60,000.00
ISKARYANI BINTI IKRAK A. NY
141,400.00
NASRUN BASRI TN
71,450.00
ZENNITA ANGGUN PRADITA PUTRI
160,000.00
Page 68
4 MEI 2016
10,000.00
NATHAN OLIVER GUNARDI AN
60,000.00
HELNAWATY NY.
297,000.00
SUSI HARTOYO TN.
10,000.00
SUSI HARTOYO TN.
136,000.00
A. RACHMAN KARIM TN
328,700.00
SITI NURAINI NY.
71,450.00
71,450.00
RUSNAN CHANDRA TN
890,000.00
NAVISYAH BADARIA NY
60,000.00
KUSMANETTI NY
213,600.00
SHOFWAN TN.
71,450.00
SATRIA NAZHIRUL A.W AN
60,000.00
THERESIA NILAWATI NY
71,450.00
DORTA SINAGA NY.
60,000.00
RACHMAD SANTOSO TN
146,000.00
60,000.00
MINA BINTI BOMAN NY.
60,000.00
60,000.00
BENEDIKTUS ADYARAKA LISBERT A
67,200.00
71,450.00
37,030.00
SUSILAWATY NY
60,000.00
60,000.00
MARIYAH BINTI H. UTI NY.
515,800.00
RASYHA FAJAR RIANTO AN
60,000.00
ESY MARLIAH NY.
202,530.00
DIAN EKA SAPUTRA TN.
488,200.00
MARIAMIN BINTI JOHAN NY
180,000.00
ELLY HERYATI NY.
71,200.00
AAN EFIANA NY.
292,730.00
NOFIANTI BINTI MUNIR NY
178,110.00
MEIRINDA RUGUN NY
180,000.00
ELLYA KUSUMA NY.
142,381.00
EFRIYON BIN RUSLAM TN.
77,985.00
352,500.00
NURMALA BINTI MAT NALI NY.
160,075.00
EVAN VLADIMIR THENG AN
139,800.00
HELNA JUWITA NY
479,000.00
79,450.00
ABDULLAH MASUD TN
92,500.00
BAHARIAH BINTI ABDUL NY
1,495,500.00
Page 69
4 MEI 2016
EVLIN NARITA NY
SUGIARTI BINTI ARAHMAN NY.
FERANI WANTO NY.
ASPRIANE DORA FLORENCHIA NN.
ZAIDAN ACHMAD TN.
ZAINAB BINTI ALI NY
LENA NURHASANA MAHDALENA NY
NURAINI BINTI SYARKOWI, H NY.
MENTARI ANGGRAINI NN.
M. KAISAN PRATAMA AN.
SHERLYN CENYAWAN NY.
MARDIANA BINTI NURDIN NY
HAMIDIAH NY.
TJIKNUT SYUKUR NY
TJIKNUT SYUKUR NY
SRI YULIDAR NY.
SRI YULIDAR NY.
SANGKUT BIN ATUT TN
SYAMSUL RIZAL, H TN
HERI SUKANDAR TN
MELLY ERSYA PUTERI NY.
TOHARTO BIN HAMDANITN
M. ILHAM AL HABIBI AN
AHMAD MAULANA TN
IRMA WENI NY
DINDIANTO BIN KADARUDIN TN
M. FADHLAN AR RASYA. S AN.
KGS M RUSDI TN
YULIANA BINTISAMBAKRI NY
SYAMSUL ARIF TN
YAHDIANI RANGKUTI NY.
YUSFARDIYAH NY.
YUSFARDIYAH NY.
KUSMAWATI BINTI KUSMEDI NY
ADINDA NURIANA TRIHAPSARI AN
60,000.00
60,000.00
224,700.00
180,000.00
120,425.00
124,000.00
246,100.00
242,668.00
82,500.00
261,144.00
60,000.00
78,000.00
176,222.00
521,100.00
160,000.00
10,000.00
315,150.00
529,200.00
60,000.00
76,800.00
125,000.00
10,000.00
534,000.00
90,000.00
10,000.00
167,000.00
224,286.00
143,245.00
60,000.00
164,000.00
293,790.00
179,830.00
157,565.00
137,400.00
726,900.00
60,000.00
234,400.00
97,800.00
142,830.00
204,800.00
190,000.00
10,000.00
Page 70
4 MEI 2016
AHMAD SALIM, SE TN.
MARYAM BT ALIAS NY.
M.JUNAIDI DRS TN.
MERYYANTI BINTI WANO NY
MARDIANA BINTI H.MUSTOPA NY.
RIMON A PANGGABEAN TN
MAIMIK BINTI SAPRIK NY
ROSITA BINTI HASBULAH NY.
NUR EKA SANFITRI DR. NY.
SUMIYATI BINTI ABU MAHDI NY
USMAN GUMANTI TN
AL KOBRI IDRUS TN
JESICCA FABEL AN.
WAYAN NANIK TARMIATI NY
JOHNSON SE TN.
HENDRI NASUTION TN
OKTA SAPUTRA TN
OKTA SAPUTRA TN
M. ARFAN MADJID H TN.
YULI NINGSIH NY
ROHANAH BINTI HARUN NY
NAUFAL MUHAMMAD SALMAN AN
RUSTEM PUAD TN.
ZAINUDDIN BIN BASTOMI TN
ELI MEGAWATI NY.
JEANNE KUSSOY NY
MISROAINI BINTI AMRAH NY.
NURMALA DEWI NY.
ISTIKORI BIN MUHYIDIN TN
LAURA OKTAVIA NY.
MUZAKKIR A.H.A TN
AZKA RIZKY PRATAMA AN.
SUTAMI INDRI W NY.
JESICA SITORUS AN.
KHOIRURRIJAL BIN M. BUDI AN.
KHOIRURRIJAL BIN M. BUDI AN.
102,000.00 00
493,831.00
175,430.00
175,800.00
292,165.00
161,997.00
127,438.00
779,300.00
177,500.00
488,200.00
288,295.00
190,000.00
61,000.00
460,100.00
125,000.00
10,000.00
160,000.00
10,000.00
224,800.00
200,000.00
240,800.00
86,000.00
10,000.00
177,000.00
488,200.00
125,000.00
112,100.00
110,000.00
176,970.00
255,500.00
291,720.00
701,206.00
328,800.00
193,130.00
215,970.00
248,000.00
691,770.00
98,000.00
180,000.00
115,800.00
131,851.00
17,921.00
Page 71
4 MEI 2016
TJIUW TJIN HE TN.
OLIVER CHRIS W AN
SAMUDIN TN.
SAMUDIN TN.
FATIMAH BINTI KMS MANSYUR NY
MUHAMMAD GHAZI AL ADLI AN.
DEVI AMELIA NY.
CICIH NY.
PASHA FAZILAH A. AN.
TRI NUNGKI AZIZAH AN.
SHOLHA AFRIYANTI NN.
AFRIZAL UTOMI TN
M. RAFA PRANAJAYA AN
NELDA SUSANA SUNDANA NY.
MIKHAEL RUKINEM NY.
RAKHA RIZKY NATALEON AN
YULIA HANAN NY.
NETY SULFIANTY NY.
MELINA RAHAYU NY.
AZZAWIYAH BINTI HAROM NY
M.FAIZ AR RAZI SYAHIANSYAH AN
NINGYU, HJ BINTI HASYIM, H NY.
NASHIRA ANDREA PUTRI AN.
SINDI NANDASARI NN
120,000.00
271,500.00
110,000.00
78,000.00
688,000.00
160,000.00
10,000.00
142,906.00
264,560.00
129,520.00
188,665.00
102,400.00
180,000.00
40,000.00
86,900.00
116,900.00
227,800.00
137,960.00
268,000.00
257,600.00
102,400.00
399,200.00
103,300.00
178,000.00
234,602.00
40,000.00
Page 72
5 MEI 2016
NO
1
2
3
4
5
6
7
8
9
10
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19
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21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
NO RJ
050516450113
050516380168
050516420193
050516390335
050516450112
050516450147
050516450039
050516420342
050516390244
050516380120
050516390272
050516390273
050516450148
050516450099
050516450103
050516450114
050516380152
050516380018
050516380133
050516450043
050516450045
050516450062
050516380063
050516380065
050516380066
050516380067
050516450095
050516450096
050516380069
050516450087
050516450094
050516420221
050516390234
050516420238
050516420237
050516390240
050516420183
050516390185
050516390249
050516390248
050516390285
TANGGAL
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
SEP
00
00
00
00
00
00
00
00
00
00
0090R03105160001002
0090R03105160001004
0090R03105160001120
0090r03105160001121
0090R03105160001123
0090R03105160001124
0090R03105160001125
0090R03105160001127
0090R03105160001128
0090R03105160001129
0090R03105160001130
0090R03105160001131
0090R03105160001132
0090R03105160001133
0090R03105160001134
0090R03105160001135
0090R03105160001136
0090R03105160001137
0090R03105160001139
0090R03105160001141
0090R03105160001142
0090R03105160001144
0090R03105160001146
0090R03105160001147
0090R03105160001148
0090R03105160001149
0090R03105160001152
0090R03105160001153
0090R03105160001170
0090R03105160001170
0090R03105160001172
Page 73
5 MEI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
050516420291
050516390295
050516390311
050516390317
050516390312
050516390323
050516390334
050516420328
050516390326
050516390333
050516390340
050516420338
050516390197
050516390201
050516390195
050516380123
050516380145
050516380143
050516380126
050516420196
050516420198
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
05/05/2016
0090R03105160001174
0090R03105160001175
0090R03105160001176
0090R03105160001178
0090R03105160001178
0090R03105160001179
0090R03105160001180
0090R03105160001181
0090R03105160001182
0090R03105160001183
0090R03105160001184
0090R03105160001185
0090R03105160001921
0090R03105160001922
0090R03105160001923
0090R03105160001928
0090R03105160001929
0090R03105160001929
0090R03105160001932
Page 74
5 MEI 2016
NAMA PASIEN
TRANSAKSI
AROSON BIN ABDUL LEMAN TN
54,000.00
ASMAWATY BINTI ABDULLAH NY
297,000.00
BUN SUI HIONG NY.
5,000.00
IYUT SARWIYAH AN
59,013.00
JUWITA PRATIWI NN.
65,678.00
MARDIANA NY.
210,000.00
MARIAM BINTI ALIBIDIN NY
4,500.00
MASUWITA TN.
62,238.00
MIKHAEL RUKINEM NY.
1,192,000.00
17,600.00
KARTINI BINTI ALI HANAFIA NY
398,030.00
ERLINA BINTI NAYAN NY.
476,981.00
LIM KOEIJ ING NY
890,000.00
890,000.00
1,192,000.00
SUYADI H. TN
890,000.00
DAVID ISKANDAR TN
890,000.00
FAIZ AMMAR IMANSYAH AN
119,800.00
890,000.00
ERWIN SH SITOMPUL TN
108,800.00
JUWITA PRATIWI NN.
174,400.00
TIARA INTAN JIWANTI NN.
295,526.00
LINA ANGGRAINI NN
156,750.00
ROSILA BINTI DUMYATI NN
154,650.00
RIKA ANGGRAINI NN.
130,943.00
HARYATI BINTI SARWANI NN
141,693.00
WULAN SURYANI NN.
87,250.00
A. YULLIUS MARTA TN.
99,000.00
GUNTUR KURNIAWAN TN
142,250.00
AMIR HAMZAH TN
181,760.00
RYAN AGUNG KISTIANTO,DR TN
156,364.00
890,000.00
890,000.00
890,000.00
890,000.00
AHMAD MAULANA TN
999,800.00
BUN SUI HIONG NY.
332,404.00
GWENETTA ADALLEY ELOM AN
127,300.00
INDAH MEGAWATI NY
5,600.00
INDAH MEGAWATI NY
158,500.00
MEISYA SALSABILA AZ ZAHRA AN
101,702.00
Page 75
5 MEI 2016
FEBRA A. NN
FARHAN PRIMA THORIQ AN.
IYUT SARWIYAH AN
EDDY SUSANTO TN.
EDDY SUSANTO TN.
NURLAILA BINTI M.SYAFYUDIN NY.
SUMARNO KUSDARI TN
MASUWITA TN.
NURHAYATI BINTI SAMSUDIN NY.
M. SHEIKH RZEEQILLAH AN
MAHYUDI BIN MADANI M TN.
AQILAH ZHAFIRAH SAIDAH AN.
SUKANTO KESUMAH TN
ADEHAN BIN CAMIK TN.
HENDRY RIANTO TN
IRMA NOVIYANTI,AM.KEB NY.
IRMA NOVIYANTI,AM.KEB NY.
MIKHAEL RUKINEM NY.
K H M ARSYAD PROF DR TN
K H M ARSYAD PROF DR TN
343,800.00
168,590.00
174,400.00
40,800.00
126,000.00
177,700.00
178,300.00
154,800.00
96,010.00
174,400.00
99,013.00
102,400.00
40,000.00
40,000.00
126,000.00
890,000.00
238,630.00
40,000.00
328,900.00
10,000.00
235,000.00
Page 76
6 MEI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
060516390047
060516390048
060516390052
060516390057
060516390063
060516390062
060516390051
060516390046
060516390055
060516390059
060516400271
060516390064
060516390053
060516280152
060516390026
060516390050
060516390049
060516390056
060516390054
060516390058
060516390012
060516390013
060516390019
060516390017
060516390040
060516390016
060516390034
060516390027
060516390039
060516390022
060516390008
060516280095
060516390131
060516390007
060516280149
060516280101
060516280208
060516280078
060516280086
060516280089
060516280099
TANGGAL
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160001186
0090R03105160001187
0090R03105160001188
0090R03105160001190
0090R03105160001192
0090R03105160001193
0090R03105160001194
0090R03105160001195
0090R03105160001196
0090R03105160001198
0090R03105160001199
0090R03105160001200
0090R03105160001201
0090R03105160001202
0090R03105160001203
0090R03105160001204
0090R03105160001208
0090R03105160001209
0090R03105160001210
0090R03105160001211
0090R03105160001212
Page 77
6 MEI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
060516280096
060516420233
060516420234
060516420245
060516390162
060516390141
060516390161
060516280155
060516390166
060516390174
060516420191
060516420219
060516400222
060516420256
060516420357
060516400390
060516420394
060516420398
060516400401
060516400411
060516280102
060516390011
060516400249
060516390042
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
05/06/2016
0090R03105160001213
0090R03105160001214
0090R03105160001215
0090R03105160001216
0090R03105160001217
0090R03105160001219
0090R03105160001219
0090R03105160001220
0090R03105160001221
0090R03105160001222
0090R03105160001223
0090R03105160001225
0090R03105160001226
0090R03105160001228
0090R03105160001233
0090R03105160001234
0090R03105160001234
0090R03105160001235
0090R03105160001236
0090R03105160001238
0090R03105160001377
0090R03105160001379
0090R03105160001934
MASUK RWI
Page 78
6 MEI 2016
NAMA PASIEN
TRANSAKSI
A. NASIR RASYAD TN.
30,600.00
ABDULLAH MASUD TN
337,200.00
398,970.00
AMRAN BIN ROHIB TN
289,500.00
AQILAH ZHAFIRAH SAIDAH AN.
83,800.00
FITRIYANTI BINTI M. YASIN NY
149,800.00
###
IBRON TN.
439,500.00
ISFAI IYAT TN.
228,000.00
78,000.00
LAURA FAMELIA NY.
29,900.00
M. SHEIKH RZEEQILLAH AN
110,484.00
MARTINI THAMRIN NY
323,070.00
NANIK HANDAYANI NY
231,000.00
NAZHIFA ATIQAH FIRDIANSYAH A
39,100.00
129,000.00
SYAMSUL RIZAL, H TN
663,000.00
TJEPUK S TN.
415,920.00
YAHUMI ZAHRI TN
129,000.00
ZAMROH SATAR DRA HJ NY.
60,000.00
KARLINA BINTI CIK MAMAT NY
332,830.00
WELLEN NOPRIANI NN
142,300.00
ZUALFI AZYADI TN
87,500.00
RAMADHAN SAPUTRA TN.
97,443.00
YUNI KARTIKA SARI NN.
125,430.00
ADY APRIYANTO TN
106,680.00
RANGGA MANDARA,DR TN.
193,200.00
M. RAHSYA IFASSY ALTHAFIO AN 181,700.00
RIZKI AMALIA NN
179,600.00
SRI WAHYUNI UTAMI NY
287,100.00
HERIYANTO TN
890,000.00
###
PUTRO SETYONO TN
890,000.00
RAFFI RAIHAN AKBAR AN
161,800.00
DIANA NOVITA NY
###
###
890,000.00
RICHA SUSANTY BY NY
48,600.00
HERLINA WATI NY.
107,110.00
SAID BUSRA TN.
65,661.00
KGS M KEMAL AL AZIZ AN
63,100.00
Page 79
6 MEI 2016
NYAYU NADYA ASY SYIFA AN
GATOT SUGEMTO TN
ANI HASAN NY
RUSTAM HALIM TN
BENI HERIANSYAH TN
BENI HERIANSYAH TN
MUHAMMAD DAVIN AN.
NIKEN RISKAWATY NN.
LUTHFI RAFIF AN.
HOLILAWATI BINTI WANSIR NY.
TRINUR HANDAYANI NY
SUPARDIANTO BIN MADANI TN.
NABILA ASTARI AN
ROSMALA DEWI NY
FARID ROFI RIZQULLAH SYAH AN
FARID ROFI RIZQULLAH SYAH AN
M.AIDIL SAPUTRA AN
ARKENZIE AKHMAD ZHAFIFI AN
ANDINI CHAIRANI RAMADHANI N
NAZHIFA ATIQAH FIRDIANSYAH A
LAURA FAMELIA NY.
DEA MEY AMANDA AN.
92,000.00
890,000.00
890,000.00
890,000.00
105,094.00
103,350.00
10,000.00
61,867.00
156,316.00
102,400.00
50,600.00
93,000.00
118,900.00
81,700.00
81,500.00
490,629.00
65,587.00
94,920.00
121,595.00
183,216.00
54,000.00
102,400.00
102,400.00
174,400.00
Page 80
7 MEI 2016
NO
NO RJ
070516450038
070516450018
070516450012
070516400595
070516450363
070516450017
070516450011
070516380197
070516450164
070516430600
070516450014
070516450010
070516380396
070516380063
070516450020
070516450021
070516450022
070516450039
070516450050
070516390098
070516390102
070516390108
070516390027
070516390025
070516450029
070516450026
070516450030
070516450031
070516390118
070516390115
070516390028
070516390043
070516450128
070516450126
070516450323
070516450325
070516390079
070516390078
070516390077
070516390048
070516390244
TANGGAL
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
SEP
00
00
00
00
00
00
00
00
00
00
00
00
0090R03104160007977
0090R03105160001218
0090R03105160001240
0090R03105160001241
0090R03105160001242
0090R03105160001244
0090R03105160001245
0090R03105160001246
0090R03105160001246
0090R03105160001247
0090r03105160001248
0090r03105160001248
0090R03105160001249
0090R03105160001249
0090R03105160001250
0090R03105160001250
0090r03105160001251
0090r03105160001251
0090r03105160001252
0090r03105160001252
0090R03105160001253
0090R03105160001253
0090R03105160001254
0090R03105160001254
0090R03105160001255
0090R03105160001255
0090R03105160001256
0090R03105160001256
0090r03105160001257
Page 81
7 MEI 2016
070516450116
070516450112
070516390229
070516450203
070516450204
070516420418
070516420417
070516450067
070516380147
070516450163
070516450162
070516390261
070516450191
070516450189
070516390276
070516390106
070516390222
070516380366
070516380354
070516380152
070516380153
070516450238
070516450232
070516420536
070516420537
070516450272
070516390181
070516390182
070516450249
070516450250
070516450209
070516450282
070516390045
070516450336
070516450337
070516450071
070516390293
070516390296
070516450300
070516450299
070516380304
070516380306
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
0090R03105160001258
0090R03105160001258
0090R03105160001259
0090R03105160001260
0090R03105160001260
0090R03105160001261
0090R03105160001261
0090R03105160001262
0090R03105160001263
0090R03105160001264
0090R03105160001264
0090R03105160001265
0090R03105160001266
0090R03105160001266
0090R03105160001267
0090R03105160001268
0090R03105160001269
0090R03105160001270
0090R03105160001270
0090R03105160001271
0090R03105160001271
0090R03105160001272
0090R03105160001272
0090R03105160001273
0090R03105160001273
0090R03105160001274
0090R03105160001275
0090R03105160001275
0090R03105160001276
0090R03105160001276
0090R03105160001277
0090R03105160001277
0090R03105160001278
0090R03105160001279
0090R03105160001279
0090R03105160001280
0090R03105160001281
0090R03105160001281
0090R03105160001282
0090R03105160001282
0090R03105160001283
0090R03105160001283
Page 82
7 MEI 2016
070516380312
070516380311
070516390080
070516450410
070516450412
070516450387
070516450386
070516390122
070516280669
070516420492
070516380175
070516420457
070516420455
070516380333
070516380334
070516400497
070516400478
070516450227
070516280463
070516280462
070516280466
070516280464
070516430642
070516400543
070516400498
070516400506
070516430602
070516430606
070516400564
070516420510
070516420504
070516430558
070516380338
070516420511
070516420519
070516430612
070516430613
070516400604
070516400603
070516420436
070516400447
070516420489
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
0090R03105160001284
0090R03105160001284
0090R03105160001285
0090R03105160001286
0090R03105160001286
0090R03105160001287
0090R03105160001287
0090R03105160001288
0090R03105160001291
0090R03105160001292
0090R03105160001293
0090R03105160001294
0090R03105160001294
0090R03105160001295
0090R03105160001295
0090R03105160001296
0090R03105160001296
0090R03105160001297
0090R03105160001298
0090R03105160001298
0090R03105160001299
0090R03105160001299
0090R03105160001300
0090R03105160001301
0090R03105160001302
0090R03105160001302
0090R03105160001303
0090R03105160001303
0090R03105160001304
0090R03105160001305
0090R03105160001305
0090R03105160001306
0090R03105160001307
0090R03105160001308
0090R03105160001308
0090R03105160001309
0090R03105160001309
0090R03105160001310
0090R03105160001310
0090R03105160001311
0090R03105160001312
0090R03105160001313
Page 83
7 MEI 2016
070516420652
070516400672
070516400677
070516280719
070516420737
070516430724
070516380393
070516380064
070516430444
070516450266
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
05/07/2016
0090R03105160001315
0090R03105160001317
0090R03105160001318
0090R03105160001321
0090R03105160001322
0090R03105160001323
0090R03105160001380
0090R03105160001587
0090R03105160001609
0090R03105160001926
Page 84
7 MEI 2016
NAMA PASIEN
DEMSI BIN AMIR HAMZAH TN
ISRIL HENDRA TN
NINDI AYUDIA INARA AN
NURPADLAH BINTI M. SAID H NY.
RAMLAN M.I TN.
SYAPRINI PRATIWI AN.
USMAN BIN USMAN DANI TN
WENDY TAURIANSYAH TN
YUSUF USMAN TN
ENRICO SYAKHI PRANONDO AN.
BILLY ANGGARA TN
FEBBY FENISYA BY NY
R.A ANDRIYANA NY.
IBNU FADHIL ROBBY AN
HERU NUGROHO TN
KMS EFFENDY TN.
KMS EFFENDY TN.
IYUT SARWIYAH AN
E. SIMATUPANG TN
E. SIMATUPANG TN
M. ABBAS HASAN TN
M. ABBAS HASAN TN
SUGINAH ABBAS NY.
SUGINAH ABBAS NY.
SHOFWAN TN.
SHOFWAN TN.
HENDRA HARTANTO TN.
HENDRA HARTANTO TN.
NASRUN BASRI TN
NASRUN BASRI TN
NURLIANA SALIM NY
NURLIANA SALIM NY
TRANSAKSI
99,200.00
25,200.00
22,500.00
48,300.00
30,000.00
160,800.00
362,700.00
51,200.00
55,150.00
29,313.00
460,950.00
155,970.00
341,825.00
40,000.00
75,400.00
48,700.00
192,860.00
81,700.00
180,948.00
10,000.00
137,000.00
40,000.00
125,000.00
10,000.00
160,000.00
10,000.00
10,000.00
160,000.00
125,000.00
10,000.00
10,000.00
177,000.00
160,000.00
10,000.00
10,000.00
177,000.00
160,000.00
10,000.00
160,000.00
10,000.00
890,000.00
Page 85
7 MEI 2016
JACUB RAHMAN TN.
JACUB RAHMAN TN.
SITI ROHMA NY
SITI ROHMA NY
SOFIA AZZAHRA AN.
SAIFUL NURAINI TN.
SAIFUL NURAINI TN.
HARBEI PASAH TN
INDAWATI NY.
INDAWATI NY.
SULAIMAN NADEAK TN.
SURYATI BINTI ANWAR NY
DIKSON MATHEOS TN.
DIKSON MATHEOS TN.
ALFI SYAHRIN TN.
ALFI SYAHRIN TN.
GHALY ASROL APRIANSAH AN
BETIN TEGUH NY.
BETIN TEGUH NY.
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
ARBAIN GANTI TN
ARBAIN GANTI TN
160,000.00
10,000.00
890,000.00
10,000.00
160,000.00
160,000.00
10,000.00
120,000.00
115,000.00
160,000.00
10,000.00
890,000.00
160,000.00
10,000.00
890,000.00
115,000.00
890,000.00
160,000.00
10,000.00
10,000.00
160,000.00
160,000.00
10,000.00
10,000.00
167,000.00
890,000.00
10,000.00
160,000.00
10,000.00
125,000.00
10,000.00
160,000.00
110,000.00
10,000.00
160,000.00
110,000.00
10,000.00
160,000.00
160,000.00
10,000.00
10,000.00
160,000.00
Page 86
7 MEI 2016
SHINTA HASANA NY.
SHINTA HASANA NY.
KARTINI NY
KARTINI NY
DERI KURNIAWAN PRATAMA AN
EDY ABDULLAH TN
BUDI SETIAWAN TN
MUHAMMAD RIFQI TN
MUHAMMAD RIFQI TN
AZWAWI KERIT TN
AZWAWI KERIT TN
TJOE HOEN NIO NY.
TJOE HOEN NIO NY.
TJUNG SEN WAN NY.
TJUNG SEN WAN NY.
NICKY VERDIANTO TN.
ANTONIUS EDUARD B. TN
AS AD SAYUTI DRS TN
AS AD SAYUTI DRS TN
M. ZARKONI TN.
M. ZARKONI TN.
RUSNAN CHANDRA TN
HIFZI IMRAN ALGHIFARI AN
MARYAM BT ALIAS NY.
MARYAM BT ALIAS NY.
USMAN BIN USMAN DANI TN
WINDY YOVITA SARI NN
NINDI AYUDIA INARA AN
125,000.00
10,000.00
174,400.00
10,000.00
160,000.00
125,000.00
10,000.00
49,600.00
110,000.00
890,000.00
47,650.00
177,000.00
10,000.00
10,000.00
160,000.00
10,000.00
160,000.00
120,000.00
10,000.00
160,000.00
10,000.00
160,000.00
890,000.00
###
10,000.00
125,000.00
10,000.00
167,000.00
890,000.00
160,000.00
10,000.00
###
110,000.00
10,000.00
160,000.00
10,000.00
177,000.00
137,000.00
10,000.00
126,000.00
121,536.00
174,400.00
Page 87
7 MEI 2016
INDRA PRATAMA TN
M. MUJAHIDUL AKBAR, A.K AN
KAMAL DIAH TN.
STEVANUS PUTRA MAHENDRA AN.
RIKA SULISTIANA NN
AYUNAH, HJ NY.
RAVEL GALANG TRI F NN.
M ABID PRANAJA AN.
ARIE PRAMESTI HENDRANINGSIH N
TEGUH BIN HOKSAN TN
115,096.00
92,325.00
124,080.00
153,690.00
178,413.00
174,400.00
174,800.00
40,000.00
134,200.00
890,000.00
Page 88
8 MEI 2016
NO
NO RJ
080516390027
080516390028
080516400159
080516280224
080516450179
080516390034
080516450268
080516280176
080516450206
080516390035
080516390038
080516390030
080516280199
080516390017
080516390009
080516390019
080516390020
080516390018
080516450289
080516390012
080516390010
080516390007
080516390006
080516390005
080516390004
080516450193
080516400023
080516390031
080516390048
080516390124
080516390126
080516400141
080516400160
080516280184
080516450188
080516450204
080516280208
080516450237
080516450272
080516450282
080516450287
TANGGAL
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
Page 89
SEP
00
00
00
00
00
00
00
00
00
00
00
00
0090R03104160007095
0090R03105160001324
0090R03105160001325
0090R03105160001326
0090R03105160001327
0090R03105160001328
0090R03105160001329
0090R03105160001329
0090R03105160001330
0090R03105160001331
0090R03105160001332
0090R03105160001333
0090R03105160001334
0090R03105160001335
0090R03105160001337
0090R03105160001338
0090R03105160001339
0090R03105160001340
0090R03105160001341
0090R03105160001342
0090R03105160001345
0090R03105160001349
0090R03105160001350
0090R03105160001351
0090R03105160001352
0090R03105160001360
0090R03105160001361
0090R03105160001362
0090R03105160001363
8 MEI 2016
080516280288
080516400094
080516390055
080516390058
080516450203
05/08/2016
05/08/2016
05/08/2016
05/08/2016
05/08/2016
Page 90
0090R03105160001364
0090R03105160001375
0090R03105160001381
0090R03105160001383
0090R03105160002049
8 MEI 2016
NAMA PASIEN
AYUNAH, HJ NY.
HERIYANTO TN
INTAN PUSPA SARI NY
M. IKHSAN FADIL AN.
M. ROFIQ ABDULLAH AN.
MARTOYO SF TN.
MIA PARAMITHA NN.
NAILAH SEPTIANI AN.
NURSIDAH BINTI RASID NY
RIKA SULISTIANA NN
YESISCA SUSANTI NY.
NOPI APRIANTI NY
V. VANIA NARESWARI AN
BIANCA LATHIFAH AURORA AN.
DEWI SRIWULANDARI NY.
RYAN ARANA DZAKI DANISWARA AN.
RYAN NOVITA SARI NY
RYAN NOVITA SARI NY
BONG MIE NON NY
M. HUSAINI TN
SITI MARYAM NY
FAHREZA DINATA TN
ATHIRA RAMADHANI FIKRI AN.
HERU NUGROHO TN.
SRI HASNANI NY.
ISKANDAR BIN AMIN TN.
SULASTRI BINTI ABDULAH NY.
INTAN PUSPA SARI NY
NAILAH SEPTIANI AN.
MELY SEPRIZA NY.
M. ROFIQ ABDULLAH AN.
FATIMAH AZZAHRA AN.
YOSSI FANSISKA NY.
M. IKHSAN FADIL AN.
SAYIDIN ARKAN MUHAMMAD AN.
MIA PARAMITHA NN.
DANANG ARYANTO TN
FERIADI SH BIN CHOLIK TN
SULASTRI MARSAN NY
TRANSAKSI
37,100.00
###
18,100.00
86,483.00
28,000.00
###
17,000.00
64,400.00
38,500.00
47,190.00
###
66,000.00
###
###
###
###
###
###
###
###
54,100.00
###
###
###
###
###
48,600.00
###
###
###
###
###
###
###
70,500.00
###
###
###
###
###
###
Page 91
8 MEI 2016
YUSMIATI BINTI H.M NING NY.
EGGY REGIKA NN
A YUSA TN.
###
78,219.00
###
###
89,232.00
Page 92
9 MEI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
090516380908
090516450593
090516420041
090516280232
090516430229
090516450617
090516451054
090516451142
090516451131
090516380694
090516451048
090516451071
090516450596
090516420384
090516420039
090516420083
090516420087
090516430048
090516420073
090516420047
090516420042
090516420066
090516430046
090516280347
090516420074
090516420072
090516280231
090516430011
090516430061
090516430060
090516430359
090516430043
090516280111
090516280105
090516420151
090516420076
090516420015
090516280100
090516280098
090516430049
090516450546
TANGGAL
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
Page 93
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160001344
0090R03105160001369
0090R03105160001370
0090R03105160001371
0090R03105160001372
0090R03105160001384
0090R03105160001387
0090R03105160001388
0090R03105160001388
0090R03105160001389
0090R03105160001390
0090R03105160001391
0090R03105160001391
0090R03105160001392
0090R03105160001393
0090R03105160001394
0090R03105160001394
0090R03105160001395
0090R03105160001396
0090R03105160001397
0090R03105160001398
0090R03105160001398
0090R03105160001399
0090R03105160001400
9 MEI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
090516420017
090516420511
090516430058
090516280168
090516280165
090516420507
090516430177
090516430170
090516420397
090516420106
090516280171
090516280169
090516280173
090516280172
090516450754
090516450756
090516280244
090516420207
090516420206
090516280238
090516280345
090516280344
090516430062
090516420184
090516420180
090516420423
090516420075
090516280236
090516280235
090516420114
090516280442
090516280446
090516280123
090516420377
090516280101
090516420159
090516420278
090516420285
090516430128
090516280342
090516280340
090516420263
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
Page 94
0090R03105160001401
0090R03105160001402
0090R03105160001403
0090R03105160001404
0090R03105160001404
0090R03105160001405
0090R03105160001406
0090R03105160001406
0090R03105160001407
0090R03105160001408
0090R03105160001409
0090R03105160001409
0090R03105160001410
0090R03105160001410
0090R03105160001411
0090R03105160001411
0090R03105160001412
0090R03105160001413
0090R03105160001413
0090R03105160001414
0090R03105160001415
0090R03105160001415
0090R03105160001416
0090R03105160001417
0090R03105160001417
0090R03105160001418
0090R03105160001419
0090R03105160001420
0090R03105160001420
0090R03105160001421
0090R03105160001422
0090R03105160001422
0090R03105160001423
0090R03105160001424
0090R03105160001425
0090R03105160001426
0090R03105160001427
0090R03105160001427
0090R03105160001428
0090R03105160001429
0090R03105160001429
0090R03105160001430
9 MEI 2016
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
090516420282
090516420273
090516420065
090516390787
090516420369
090516420365
090516280160
090516420380
090516280332
090516280331
090516420375
090516420371
090516420376
090516280256
090516420199
090516420220
090516430430
090516430431
090516420224
090516420386
090516420382
090516430435
090516430432
090516280241
090516420142
090516430054
090516430414
090516430413
090516420252
090516280127
090516420234
090516420145
090516280163
090516420295
090516420467
090516420466
090516420468
090516430178
090516380576
090516380578
090516430187
090516430119
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
Page 95
0090R03105160001431
0090R03105160001431
0090R03105160001432
0090R03105160001433
0090R03105160001434
0090R03105160001434
0090R03105160001435
0090R03105160001436
0090R03105160001437
0090R03105160001437
0090R03105160001438
0090R03105160001439
0090R03105160001439
0090R03105160001440
0090R03105160001441
0090R03105160001443
0090R03105160001444
0090R03105160001444
0090R03105160001445
0090R03105160001446
0090R03105160001446
0090R03105160001447
0090R03105160001447
0090R03105160001448
0090R03105160001449
0090R03105160001450
0090R03105160001451
0090R03105160001451
0090R03105160001452
0090R03105160001453
0090R03105160001454
0090R03105160001455
0090R03105160001456
0090R03105160001457
0090R03105160001458
0090R03105160001458
0090R03105160001459
0090R03105160001460
0090R03105160001461
0090R03105160001461
0090R03105160001462
0090R03105160001463
9 MEI 2016
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
090516280078
090516430470
090516430464
090516430113
090516280447
090516430214
090516280275
090516420478
090516420487
090516430315
090516280124
090516420362
090516280089
090516280308
090516430436
090516430216
090516280226
090516430328
090516280125
090516420434
090516420402
090516280250
090516420389
090516430204
090516420126
090516420449
090516390648
090516390643
090516430141
090516280422
090516450811
090516450808
090516280346
090516430240
090516280412
090516450683
090516450604
090516280181
090516430280
090516430191
090516430357
090516420228
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
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05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
Page 96
0090R03105160001464
0090R03105160001465
0090R03105160001465
0090R03105160001466
0090R03105160001467
0090R03105160001468
0090R03105160001469
0090R03105160001470
0090R03105160001470
0090R03105160001471
0090R03105160001473
0090R03105160001474
0090R03105160001475
0090R03105160001476
0090R03105160001478
0090R03105160001479
0090R03105160001480
0090R03105160001482
0090R03105160001483
0090R03105160001484
0090R03105160001485
0090R03105160001486
0090R03105160001487
0090R03105160001488
0090R03105160001489
0090R03105160001490
0090R03105160001491
0090R03105160001491
0090R03105160001492
0090R03105160001494
0090R03105160001495
0090R03105160001495
0090R03105160001496
0090R03105160001497
0090R03105160001498
0090R03105160001499
0090R03105160001501
0090R03105160001502
0090R03105160001503
0090R03105160001504
0090R03105160001505
0090R03105160001506
9 MEI 2016
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
090516420153
090516280356
090516430203
090516420268
090516430188
090516420208
090516280338
090516280398
090516280200
090516280279
090516430281
090516420350
090516430237
090516280519
090516280517
090516420440
090516280450
090516280509
090516280213
090516430246
090516280393
090516420211
090516420242
090516280417
090516280269
090516280441
090516430298
090516280333
090516420349
090516450559
090516450558
090516420352
090516430260
090516430243
090516280451
090516280457
090516280363
090516280300
090516420322
090516280358
090516430307
090516280303
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
05/09/2016
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0090R03105160001514
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0090R03105160001516
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0090R03105160001518
0090R03105160001519
0090R03105160001520
0090R03105160001520
0090R03105160001521
0090R03105160001522
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0090R03105160001524
0090R03105160001525
0090R03105160001527
0090R03105160001530
0090R03105160001530
0090R03105160001531
0090R03105160001533
0090R03105160001534
0090R03105160001535
0090R03105160001536
0090R03105160001537
0090R03105160001538
0090R03105160001538
0090R03105160001539
0090R03105160001540
0090R03105160001541
0090R03105160001544
0090R03105160001545
0090R03105160001546
0090R03105160001547
0090R03105160001548
0090R03105160001549
0090R03105160001550
0090R03105160001551
9 MEI 2016
210
211
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090516390843
090516390841
090516390591
090516430323
090516380598
090516380595
090516390768
090516390912
090516280415
090516280489
090516280543
090516430317
090516380749
090516430392
090516280419
090516280406
090516390687
090516380633
090516380632
090516280486
090516450854
090516390577
090516280378
090516280458
090516380958
090516420400
090516450960
090516420488
090516450831
090516380923
090516450949
090516380789
090516450866
090516450697
090516390750
090516390818
090516390568
090516280459
090516390860
090516390728
090516390872
090516380848
05/09/2016
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0090R03105160001561
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0090R03105160001563
0090R03105160001564
0090R03105160001565
0090R03105160001567
0090R03105160001567
0090R03105160001568
0090R03105160001569
0090R03105160001571
0090R03105160001572
0090R03105160001575
0090R03105160001576
0090R03105160001577
0090R03105160001578
0090R03105160001579
0090R03105160001580
0090R03105160001581
0090R03105160001582
0090R03105160001583
0090R03105160001584
0090R03105160001585
0090R03105160001586
0090R03105160001588
0090R03105160001589
0090R03105160001591
0090R03105160001592
0090R03105160001593
0090R03105160001594
0090R03105160001595
9 MEI 2016
252
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258
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261
262
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264
265
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090516390716
090516390708
090516451124
090516390863
090516391002
090516390853
090516380875
090516390785
090516430460
090516430518
090516450784
090516420515
090516380886
090516280513
090516380599
090516380602
090516390861
090516390859
090516450878
090516390773
090516450566
090516450885
090516390846
090516390855
090516280465
090516380895
090516420443
090516390758
090516430475
090516430471
090516451096
090516380715
090516390779
090516420531
090516390719
090516391003
090516380711
090516450542
090516380634
090516381007
090516390869
090516380892
05/09/2016
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0090R03105160001615
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0090R03105160001617
0090R03105160001618
0090R03105160001619
0090R03105160001620
0090R03105160001621
0090R03105160001622
0090R03105160001623
0090R03105160001624
0090R03105160001625
0090R03105160001627
0090R03105160001627
0090R03105160001628
0090R03105160001629
0090R03105160001631
0090R03105160001633
0090R03105160001634
0090R03105160001635
0090R03105160001636
0090R03105160001637
0090R03105160001638
0090R03105160001640
0090R03105160001641
0090R03105160001642
9 MEI 2016
294
295
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300
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303
304
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306
307
308
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313
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090516450816
090516380894
090516450730
090516390778
090516450726
090516390899
090516450589
090516450608
090516451020
090516380733
090516420530
090516451030
090516391081
090516390688
090516390689
090516390880
090516450570
090516390554
090516450587
090516450540
090516390755
090516390790
090516450585
090516450799
090516390700
090516450630
090516450881
090516390723
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090516390806
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090516380603
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090516380607
090516451132
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090516381113
090516380824
090516380879
090516380888
090516380645
05/09/2016
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0090R03105160001658
0090R03105160001659
0090R03105160001661
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0090R03105160001664
0090R03105160001665
0090R03105160001666
0090R03105160001667
0090R03105160001668
0090R03105160001670
0090R03105160001671
0090R03105160001672
0090R03105160001673
0090R03105160001674
0090R03105160001675
0090R03105160001676
0090R03105160001677
0090R03105160001678
0090R03105160001679
0090R03105160001680
0090R03105160001681
0090R03105160001682
0090R03105160001683
0090R03105160001684
0090R03105160001685
0090R03105160001686
0090R03105160001686
0090R03105160001688
9 MEI 2016
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
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090516380710
090516451129
090516380928
090516450813
090516380766
090516390613
090516380627
090516390605
090516450600
090516380781
090516380966
090516390798
090516450722
090516451028
090516390883
090516390982
090516391019
090516381037
090516390940
090516380663
090516380968
090516390771
090516380786
090516390704
090516390693
090516390695
090516381039
090516390671
090516450674
090516450672
090516390692
090516390698
090516451056
090516390868
090516451025
090516380769
090516450836
090516391083
090516451026
090516450838
090516390788
090516450830
05/09/2016
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0090R03105160001691
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0090R03105160001700
0090R03105160001701
0090R03105160001702
0090R03105160001703
0090R03105160001704
0090R03105160001705
0090R03105160001707
0090R03105160001708
0090R03105160001710
0090R03105160001711
0090R03105160001713
0090R03105160001714
0090R03105160001715
0090R03105160001716
0090R03105160001718
0090R03105160001719
0090R03105160001720
0090R03105160001721
0090R03105160001721
0090R03105160001722
0090R03105160001723
0090R03105160001724
0090R03105160001725
0090R03105160001726
0090R03105160001726
0090R03105160001727
0090R03105160001728
0090R03105160001729
0090R03105160001731
0090R03105160001733
0090R03105160001734
0090R03105160001735
0090R03105160001736
0090R03105160001737
0090R03105160001738
9 MEI 2016
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
090516450867
090516390761
090516390763
090516390945
090516380814
090516380810
090516390857
090516380969
090516450805
090516380736
090516450804
090516450801
090516450870
090516390920
090516390918
090516451031
090516390937
090516391085
090516380849
090516390746
090516380743
090516390774
090516390802
090516391086
090516380964
090516390959
090516420396
090516390967
090516451016
090516381065
090516451077
090516451116
090516430495
090516430497
090516420088
090516430230
090516280179
090516450917
090516280409
090516280410
090516280394
090516390946
05/09/2016
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0090R03105160001739
0090R03105160001740
0090R03105160001740
0090R03105160001742
0090R03105160001743
0090R03105160001743
0090R03105160001744
0090R03105160001745
0090R03105160001746
0090R03105160001747
0090R03105160001748
0090R03105160001748
0090R03105160001749
0090R03105160001750
0090R03105160001750
0090R03105160001751
0090R03105160001752
0090R03105160001753
0090R03105160001754
0090R03105160001755
0090R03105160001757
0090R03105160001759
0090R03105160001763
0090R03105160001769
0090R03105160001770
0090R03105160001774
0090R03105160001777
0090R03105160001777
0090R03105160001779
0090R03105160001782
0090R03105160001783
0090R03105160001785
0090R03105160001832
0090R03105160001832
0090R03105160002029
0090R03105160002030
0090R03105160002033
0090R03105160002035
0090R03105160002038
0090R03105160002038
0090R03105160002039
0090R03105160002040
9 MEI 2016
420
421
422
423
090516450887
090516450762
090516451066
090516380962
05/09/2016
05/09/2016
05/09/2016
05/09/2016
Page 103
0090R03105160002043
0090R03105160002046
0090R03105160002048
0090R03105160002050
9 MEI 2016
NAMA PASIEN
BONG MIE NON NY
DIANA FATMAWATI NY.
JIHAN SYAFIRA AN.
JUANDA BIN H. CIK DIN TN.
LISCA AGUSUSANTY NY.
MSY IDHA NURSANDA AN.
NADRAWARSINI BINTI RUSLI NY.
RAKAINI BINTI BUSAR NY.
RHAPTYALYANI NY
RIA MEI SAFITRI NY
SANTI RUSLIANTI NY.
SARI NILA KUSUMA NY
SYUKRI MUBARAK TN.
BACHTIAR BIN SAYRLAN TN.
RIRIN MARISTA NN.
CANTIKA MUTIARA BAITUL M J AN
MARLIANSYAH TN
EKA MARDIANA NY
SRIVITA, SH, MM NY.
CHALIMATUS SA''DIYAH NY
HASIAM INDRIANI NY
HASIAM INDRIANI NY
ALWANI BIN HULIK TN.
SOEHARTO BIN KARYOWIRJO TN.
SITI FATIMAH NY
SITI FATIMAH NY
NASRUN BASRI TN
TJEPUK S TN.
YUHERMAWATI BINTI SAYID NY
ARI SUSANTI NN.
ARI SUSANTI NN.
ROHANI BINTI NGADIMAN NY
TRANSAKSI
79,200.00
20,000.00
491,600.00
149,800.00
1,494,700.00
129,700.00
33,000.00
397,080.00
58,500.00
32,350.00
16,700.00
107,400.00
29,000.00
120,600.00
491,600.00
245,800.00
129,000.00
126,000.00
224,842.00
131,500.00
167,700.00
153,420.00
40,000.00
194,520.00
160,000.00
10,000.00
112,430.00
135,680.00
160,000.00
10,000.00
120,000.00
151,600.00
91,000.00
10,000.00
167,800.00
512,000.00
94,880.00
10,000.00
177,000.00
143,756.00
306,400.00
Page 104
9 MEI 2016
MARIA BINTI ABDUL MUROD NY
RONIMAH NY
RONIMAH NY
LIM KOEIJ ING NY
MAGDALENA MD SITORUS, SH NN.
PUTRO SETYONO TN
BELINA FELICIA KIARIA AN.
SUGINAH ABBAS NY.
SUGINAH ABBAS NY.
M. ABBAS HASAN TN
M. ABBAS HASAN TN
SHOFWAN TN.
SHOFWAN TN.
AMALIA MAHARANI AN.
NYAYU HALIMAH NN.
NYAYU HALIMAH NN.
LELY WATI NY
LELY WATI NY
NURHAYATI BINTI BASIR NY.
ALIZAR BIN ANDA TN.
WAGINEM BINTI KASAN WIRYO NY
SANTI RUSLIANTI NY.
JUSRIZAL RUSLAN TN
SURYA MEGAWATI NY
SURYA MEGAWATI NY
SAENAH NY
94,880.00
120,000.00
228,999.00
160,000.00
10,000.00
958,000.00
160,000.00
10,000.00
1,192,000.00
60,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
125,000.00
213,300.00
160,000.00
10,000.00
239,400.00
160,000.00
10,000.00
147,000.00
160,000.00
10,000.00
110,000.00
867,570.00
10,000.00
160,000.00
226,700.00
160,000.00
10,000.00
94,200.00
180,000.00
146,400.00
205,550.00
10,000.00
160,000.00
71,600.00
137,000.00
10,000.00
264,000.00
Page 105
9 MEI 2016
TUTI PURNAMAWATI NY
TUTI PURNAMAWATI NY
DARMO BIN JINOMO TN
PURNAMA ISWARI NY.
TISNALIA NY.
INDAWATI NY.
INDAWATI NY.
HASAN BASRI TN
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
DIKSON MATHEOS TN.
DIKSON MATHEOS TN.
A. RACHMAN TN
TJIKMAD. B TN.
ARIFIN SITOHANG TN.
ARIFIN SITOHANG TN.
MAMAT SADI TN.
M. RAFIE KHAIRY AN
MUCHTAR TS TN
SUYADI H. TN
SHINTA HASANA NY.
SHINTA HASANA NY.
JADIDAH HJ. BINTI A. ANAS NY.
A. JAMALUDDIN TN.
A. JAMALUDDIN TN.
SITI AMINAH NY.
MARIA THERESIA NY.
160,000.00
10,000.00
94,880.00
249,764.00
160,000.00
10,000.00
525,550.00
205,068.00
160,000.00
10,000.00
890,000.00
10,000.00
160,000.00
301,762.00
106,280.00
727,470.00
10,000.00
160,000.00
167,380.00
160,000.00
10,000.00
125,000.00
10,000.00
69,900.00
94,880.00
215,600.00
160,000.00
10,000.00
1,715,560.00
120,000.00
235,750.00
215,127.00
1,635,370.00
82,830.00
125,000.00
10,000.00
191,200.00
278,600.00
10,000.00
160,000.00
137,221.00
238,235.00
Page 106
9 MEI 2016
KGS M RUSDI TN
NASRULIYA BINTI M. EFRI NY
MERYANTI BINTI ROZALI NY.
YASSER ARIWIBOWO TN.
SUHARTUTI BINTI A. KOHAR NY
ALMAYRA TUNGGA DEWI AN.
SRI MULYATI NY.
ATIKAH RAHMAH NN.
SITI ASIAH NY.
AHMAD BUSTAMAL H TN.
ALEXIUS HARTANTO TN.
AFNUR IMSYA NY
HENDRY RIANTO TN
KODRI BIN ABDULLAH TN
RUKIAH HB, HJ NY
IRFA KODRI TN.
SRI SUHARNI NY.
AHMAT REYHAN AN.
ELLY HERYATI NY.
SUTIMIN BIN GIMAN TN.
MUHAMMAD RIFQI TN
MUHAMMAD RIFQI TN
NURSAH BINTI ISHAK NY
SUSIANI BINTI SUMOREJO NY
FEMILIA MARLINA NY.
DERI AGUSTIA NY.
DHUHA ASY SYUARA AN.
JUNIAR DWI ASTUTI NY.
SURTINA BINTI AHMAD NY.
SITI HASMAYANI NY
MARIA ESTETI NY.
216,480.00
160,000.00
10,000.00
204,800.00
155,100.00
488,200.00
460,715.00
10,000.00
160,000.00
93,600.00
101,687.00
269,500.00
472,000.00
163,320.00
184,300.00
488,200.00
387,300.00
315,250.00
193,585.00
890,000.00
890,000.00
540,490.00
70,893.00
131,000.00
142,400.00
274,000.00
160,000.00
10,000.00
222,080.00
250,000.00
102,000.00
10,000.00
197,600.00
1,081,900.00
352,500.00
339,600.00
60,000.00
204,080.00
104,880.00
162,200.00
88,790.00
542,200.00
Page 107
9 MEI 2016
EVIYANTI BR SINULINGGA NY.
WILLY WIJAYA TN.
DJALILI SOLIHIN TN
ZUBAIDAH HJ NY
NUR ARLINDENI NY.
HARNING SYAHDA NY.
ABD MADJID TN.
SINAR SIBERO TARIGAN TN.
KHODIJAH BINTI SANTOWI NY.
NABIILA NURIA ATIFAH AN
TASNANIA BINTI H.A.RIVAI NY.
RACHMAD SANTOSO TN
SUWARSO BIN MARSIMIN TN.
ANGELINA ASRODITA AN
RINI HARYANI NY
ANTONI KOHARRUDIN KOH TN
SRI ASTUTI NY
PIPIT DWITYA SE NY.
PIPIT DWITYA SE NY.
SANGKA RIANTO TN
RAPIKA MAHARANI NN
NURHAYATI BINTI SAMSUDDIN NY.
HUSNA INTAN NY.
VERA DIANTI ZALEHA NY.
DORTA SINAGA NY.
DORTA SINAGA NY.
DIANA FATMAWATI NY.
KASMIATUN BINTI KARTO NY
LIS DIANA NY.
HATI INDAWATI NY.
ISKANDAR ISHAK TN.
SUSI HARTOYO TN.
ARDILA AYU RESTA NN
NAVISYAH BADARIA NY
NIRA SITI DANINGSIH NY
MARIA ILYAS NY
472,000.00
80,665.00
94,881.00
340,800.00
144,100.00
840,000.00
251,645.00
85,900.00
79,123.00
239,216.00
258,735.00
60,000.00
280,458.00
10,000.00
160,000.00
384,200.00
461,295.00
188,910.00
268,000.00
174,430.00
268,200.00
106,000.00
441,600.00
159,000.00
180,000.00
192,900.00
1,073,750.00
204,645.00
180,000.00
137,000.00
10,000.00
283,200.00
488,200.00
60,000.00
926,300.00
60,000.00
90,610.00
488,200.00
177,656.00
290,645.00
273,762.00
60,000.00
Page 108
9 MEI 2016
OKTA SAPUTRA TN
OKTA SAPUTRA TN
NOVIEANA NISFURITA NY
NURHAYATI KHD NY.
ROSITA BINTI LEHAN NY.
CARISSA ADELIA AN.
RIKHA FITRIYANTI ALI, AMD NY
M. GILANG AL-HASYIM AN.
M. GILANG AL-HASYIM AN.
DEVINA ANGELINA AN.
WIDIHARTI BINTI NASIHIN NY
MARTINA ADITYA SARI NY.
MUHAMMAD FATIH AN
RAHMAWATI FARAMESWARI NY.
NETTY NETTY NY.
NETTY NETTY NY.
TRIANA GESURIWATI, HJ NY
WIRMA OCTAVIA NY.
EDDI AZ TN.
NYIMAS NURMANI NY.
LETTI PRIYANTI NY
SAULINA M. PANJAITAN NY.
TASMANIAH BINTI RUSMAN NY.
SARI NILA KUSUMA NY
BELLA NOVIANTY NY
WAHYU MUZHAFAR TN.
DARMANSYAH BIN YAKUP TN.
AMALIAH BINTI M. UKUP NY
RINAH BINTI ANSORI NY.
MELLYFIANY NY.
ASMILAH BINTI A. DAHLAN NY.
M ARYA PRADANA AL FIRDAUS AN
LIE KIM LAN NY.
ERLINAWATI BINTI A. GOFUR NY
YUSMARTANI BIN SOLEH TN.
DESSY SURYANI NN.
177,000.00
10,000.00
341,100.00
277,762.00
160,000.00
10,000.00
259,600.00
110,000.00
200,000.00
196,806.00
84,210.00
221,400.00
60,000.00
209,900.00
190,000.00
218,900.00
890,000.00
160,000.00
10,000.00
146,000.00
60,000.00
120,000.00
234,400.00
298,950.00
465,670.00
200,800.00
875,660.00
234,400.00
60,000.00
181,200.00
136,100.00
60,000.00
178,200.00
63,500.00
327,600.00
155,000.00
91,100.00
60,000.00
240,600.00
890,000.00
164,300.00
60,000.00
Page 109
9 MEI 2016
AHMAD MAULANA TN
SUPIANI BINTI SAMIAN NY
ANTI AGNI NY.
GUSMANITA BINTI AGUS SALIM NY
TUTWURI ANDAYANI NY
TAPNA WARDINA NY
ISMAH HJ BINTI BERLIAN H NY
ABU LAHAB TN.
MERRY DWI ANGGRELYA NY
MAYA TRI WIDIASTUTI NY.
AZMUL MAMMON TN.
GIO ELVERO PUTRA ANGGARA AN.
AMILIA BINTI M DAUD NY.
ARIFIN HANAFIAH TN
KEMALIA LUKMAN NY
USAR QURROTUAINI NN.
TJOE KIE TJAK TN
RUSMI BINTI ABDURAHMAN NY.
VIVIAN SYAFARINA NN
NURHAYATI BINTI JAMAIN NY
NATHAN WIJAYA AN.
MIKHAEL RUKINEM NY.
NOVI SAIDA ALAM NY
NOVI SAIDA ALAM NY
YURNI THALIB, HJ NY.
MURANAH BINTI MISNAR NY.
ROHANA NY.
DITA PUSVITA SARY, SE NY.
ELIYA MARGARITA NY.
NURAINI BINTI H. SOAR NY
USAR HILYATI NY.
TRI OKTARINI NY.
ROHANA BINTI SAHAR NY.
IJAH BINTI SASTRA NY
890,000.00
890,000.00
554,515.00
89,200.00
331,200.00
60,000.00
337,000.00
222,000.00
485,970.00
433,795.00
198,805.00
165,695.00
408,330.00
147,730.00
10,000.00
160,000.00
60,000.00
172,790.00
60,000.00
297,495.00
78,200.00
890,000.00
273,875.00
280,620.00
233,000.00
60,000.00
102,400.00
890,000.00
40,000.00
186,240.00
221,235.00
152,281.00
890,000.00
123,700.00
253,340.00
188,981.00
60,000.00
121,812.00
202,606.00
443,125.00
60,000.00
60,000.00
Page 110
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RIO ABDILLAH AN
SYAIFULLAH BIN SATA TN
EVAN VLADIMIR THENG AN
SUPRIATY DRA BINTI KROMO S. NY
TATI HARTATI NY
DIAH TRI WINARSIH NN.
RIA MEI SAFITRI NY
NURLIANA SALIM NY
HARMADI LATIEF TN.
ASRUL JALIL TN.
ZULKARNAIN BIN A HALIM TN.
RUSLAINI NY.
ARWATI BINTI RUSLAN NY.
SUHAMA BINTI KHOLIM NY.
RIANTI NY.
RENY OKTARINA NY
JIHAN SYAFIRA AN.
ELLYA KUSUMA NY.
NURLELA BINTI H. ABDUL G NY.
YULIA HANAN NY.
THERESIA BIN THENG PENG S NY.
ARIS MUHARAM
EMIYUTI BINTI UMAR NY
AULIEFIA HANNY SALSABILA AN.
ANDRI JAYA TN.
SAHIMA BINTI SAHARUDIN NY
JUNIAR BINTI MERAHMAD DRA NY.
NARISAH BINTI TARMAWIH NY.
M. HAFIZ ALAMSYAH AN
TRI YULIANITA NY.
TETTY NURHATI NY.
NADRAWARSINI BINTI RUSLI NY.
PRAMANIKA ARIEYANTINI NY
SHINTA YULANDA BY NY
ADAM IDRIS TN.
RIANDY KAREL TUMANGGOR AN.
110,000.00
60,000.00
60,000.00
60,000.00
157,200.00
60,000.00
60,000.00
71,700.00
78,000.00
68,000.00
326,000.00
428,075.00
352,000.00
10,000.00
102,000.00
217,585.00
301,315.00
316,608.00
229,600.00
264,800.00
114,500.00
130,581.00
430,015.00
177,300.00
206,069.00
1,538,350.00
100,390.00
90,450.00
75,015.00
138,964.00
729,000.00
110,091.00
229,610.00
199,046.00
113,200.00
193,585.00
117,100.00
204,385.00
60,000.00
10,000.00
125,000.00
117,750.00
Page 111
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SALMAWATI BINTI SUBLI NY
AHMAD HAYAT ISMAIL TN.
DORTY SIMANJUNTAK NY.
AMIR S. TN.
MARYANI BINTI NURDIN NY
MULYANI BINTI SUKARDI NY
ANISA OKTAVIA PUTRI AN.
ABID ZHAFRAN MAULANA AN.
INTAN PUSPA SARI NY
AMINAH BINTI IDING MANSUR NY.
NURYANTO TN.
ZAINAB A,MD. BINTI IBRAHIM NY
MONICA FEBRIANTI NY
SHINTA YULANDA NY
HANAFIAH BIN ARSYID MUROD TN
ARMA ZUAZLA NY.
LI LIE NY.
MIKE ANDIANI NY.
IRWANTO TN
YULITA MARNI NY.
NAWARA BINTI MADRAS NY.
KAYLA NADA FATIHAH AN
SUKRI BIN ABDUL GOFAR TN
HALIMAH TUSSAKDIAH NY
MISBAH BINTI A RIVAI NY.
TITIEN SUHARTI NY.
REKNO EVIYANTI NY.
MUHAMMAD TSAQIB AN.
IDA MASHUDA, HJ NY.
NUR LIES ROCHYATI NY.
GANEF ISKANDAR TN.
TJIUW TJIN HE TN.
ZAILANI ANAS H S.E TN.
141,650.00
193,585.00
95,740.00
910,700.00
111,360.00
433,545.00
217,037.00
60,000.00
49,000.00
122,400.00
808,500.00
64,000.00
357,300.00
305,145.00
448,200.00
460,400.00
81,000.00
392,600.00
193,585.00
202,046.00
496,700.00
60,000.00
197,145.00
222,000.00
10,000.00
160,000.00
106,200.00
268,000.00
199,046.00
85,900.00
10,000.00
160,000.00
99,920.00
343,575.00
1,002,850.00
219,700.00
177,481.00
248,560.00
85,200.00
110,000.00
234,400.00
399,915.00
Page 112
9 MEI 2016
SITI NURAINI NY.
SITI NURAINI NY.
HARIS FADILA TN
VIVI FERIKA NN.
ALESHA ZAHRA AN.
YOHANES TN.
DIANA NATALIA NY
RANITA SARI SIP, NY.
MUHAMMAD NAIM TN.
OLIVER CHRIS W AN
NOVENDA ALIANDO TN
YUHANAH BINTI YASIN, DRA NY.
FAHIRA CHALISA PUTRI AN.
BONG MIE NON NY
HENI PUTRI AGUSTINI NN.
RIKA SULISTIAWATI NN
ANDY ANDRY TN
AHMAD MAULANA TN
AHMAD ZHAFRAN SAIRULLAH AN.
KHOSYURRIJAL BIN M.BUDI AN.
RUSMINI BINTI ABDUL HAMID NY.
YONA RACHMAN NY.
MSY IDHA NURSANDA AN.
LIDYA MARULITA AN
LENI APRIYANTI NY
HENDRA NUGRAHA TN.
RAKAINI BINTI BUSAR NY.
DAVID ISKANDAR TN
SIDI AMBO TN
60,000.00
10,000.00
160,000.00
661,000.00
160,000.00
10,000.00
60,000.00
60,000.00
78,900.00
206,485.00
91,000.00
10,000.00
256,000.00
177,000.00
10,000.00
421,900.00
110,000.00
244,810.00
193,281.00
193,585.00
96,935.00
167,474.00
174,400.00
104,536.00
451,720.00
227,256.00
420,370.00
174,400.00
432,600.00
52,000.00
160,210.00
258,800.00
10,000.00
102,000.00
105,483.00
60,000.00
115,600.00
174,400.00
10,000.00
125,000.00
900,500.00
135,950.00
Page 113
9 MEI 2016
KUSNUL KHOTIMAH NY.
RHAPTYALYANI NY
YUSDIANTO BIN ONI TN.
165,700.00
255,895.00
383,040.00
310,800.00
Page 114
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NO
1
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NO RJ
100516390924
100516390930
100516430023
100516430021
100516450027
100516380782
100516430729
100516450214
100516430615
100516430272
100516390843
100516430052
100516450039
100516450029
100516430061
100516450049
100516450050
100516430304
100516450098
100516430059
100516430062
100516380574
100516280056
100516280198
100516280079
100516450048
100516450047
100516430011
100516430044
100516450087
100516450088
100516450299
100516430019
100516450336
100516430128
100516280068
100516450042
100516450041
100516430015
100516380643
100516450046
TANGGAL
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
SEP
00
00
00
00
00
00
00
00
00
00
0090R03105160001730
0090R03105160001732
0090R03105160001775
0090R03105160001776
0090R03105160001786
0090R03105160001787
0090R03105160001787
0090R03105160001788
0090R03105160001789
0090R03105160001790
0090R03105160001790
0090R03105160001792
0090R03105160001793
0090R03105160001794
0090R03105160001795
0090R03105160001796
0090R03105160001796
0090R03105160001797
0090R03105160001798
0090R03105160001799
0090R03105160001799
0090R03105160001800
0090R03105160001802
0090R03105160001803
0090R03105160001805
0090R03105160001808
0090R03105160001809
0090R03105160001809
0090R03105160001810
0090R03105160001811
0090R03105160001812
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100516450043
100516450348
100516450144
100516450146
100516430120
100516430122
100516430085
100516430136
100516430137
100516430104
100516430292
100516430297
100516430177
100516430153
100516430152
100516430118
100516430109
100516430271
100516430135
100516430113
100516450158
100516450155
100516450168
100516450171
100516280247
100516280250
100516430022
100516450141
100516450143
100516430203
100516380534
100516380532
100516430211
100516430248
100516280054
100516450241
100516430140
100516430254
100516430191
100516430190
100516430040
100516430129
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
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05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
05/10/2016
0090R03105160001812
0090R03105160001813
0090R03105160001814
0090R03105160001814
0090R03105160001815
0090R03105160001815
0090R03105160001816
0090R03105160001817
0090R03105160001817
0090R03105160001818
0090R03105160001819
0090R03105160001819
0090R03105160001820
0090R03105160001821
0090R03105160001821
0090R03105160001822
0090R03105160001823
0090R03105160001824
0090R03105160001825
0090R03105160001826
0090R03105160001827
0090R03105160001827
0090R03105160001828
0090R03105160001829
0090R03105160001830
0090R03105160001830
0090R03105160001831
0090R03105160001832
0090R03105160001832
0090R03105160001834
0090R03105160001835
0090R03105160001835
0090R03105160001836
0090R03105160001836
0090R03105160001837
0090R03105160001838
0090R03105160001839
0090R03105160001840
0090R03105160001841
0090R03105160001841
0090R03105160001842
0090R03105160001843
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100516430350
100516430644
100516450315
100516450133
100516430157
100516430073
100516450182
100516450181
100516450066
100516450246
100516450245
100516280294
100516450369
100516280251
100516280060
100516380560
100516450148
100516450055
100516450266
100516450263
100516430111
100516430196
100516430316
100516430194
100516450305
100516430117
100516280257
100516280260
100516430465
100516430314
100516280373
100516450320
100516280324
100516280282
100516450346
100516450116
100516430175
100516430178
100516420715
100516420714
100516450368
100516280185
05/10/2016
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05/10/2016
05/10/2016
05/10/2016
0090R03105160001844
0090R03105160001845
0090R03105160001846
0090R03105160001847
0090R03105160001848
0090R03105160001849
0090R03105160001850
0090R03105160001850
0090R03105160001851
0090R03105160001852
0090R03105160001853
0090R03105160001854
0090R03105160001855
0090R03105160001856
0090R03105160001857
0090R03105160001858
0090R03105160001859
0090R03105160001860
0090R03105160001861
0090R03105160001861
0090R03105160001862
0090R03105160001863
0090R03105160001864
0090R03105160001865
0090R03105160001866
0090R03105160001867
0090R03105160001868
0090R03105160001868
0090R03105160001870
0090R03105160001871
0090R03105160001872
0090R03105160001874
0090R03105160001875
0090R03105160001875
0090R03105160001876
0090R03105160001877
0090R03105160001878
0090R03105160001879
0090R03105160001880
0090R03105160001880
0090R03105160001881
0090R03105160001882
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100516430318
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100516430255
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0090R03105160001883
0090R03105160001884
0090R03105160001885
0090R03105160001886
0090R03105160001887
0090R03105160001888
0090R03105160001889
0090R03105160001890
0090R03105160001891
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0090R03105160001893
0090R03105160001894
0090R03105160001895
0090R03105160001896
0090R03105160001897
0090R03105160001898
0090R03105160001898
0090R03105160001899
0090R03105160001900
0090R03105160001901
0090R03105160001903
0090R03105160001904
0090R03105160001905
0090R03105160001905
0090R03105160001906
0090R03105160001907
0090R03105160001909
0090R03105160001910
0090R03105160001911
0090R03105160001912
0090R03105160001914
0090R03105160001915
0090R03105160001916
0090R03105160001918
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0090R03105160001920
0090R03105160001927
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100516450243
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100516450384
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100516430374
100516390628
100516390626
100516450329
100516450335
100516280461
100516420500
100516380485
100516380492
100516450343
100516280325
100516280377
100516450390
100516390809
100516280388
100516390590
100516430535
100516430360
100516420541
100516380675
100516430481
100516430546
100516380544
100516420542
100516380563
100516430689
100516380561
100516380579
100516380683
100516380685
100516420627
100516380639
100516380631
100516390629
05/10/2016
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0090R03105160001941
0090R03105160001943
0090R03105160001944
0090R03105160001945
0090R03105160001947
0090R03105160001948
0090R03105160001949
0090R03105160001950
0090R03105160001951
0090R03105160001952
0090R03105160001952
0090R03105160001953
0090R03105160001953
0090R03105160001954
0090R03105160001957
0090R03105160001958
0090R03105160001959
0090R03105160001961
0090R03105160001962
0090R03105160001963
0090R03105160001964
0090R03105160001966
0090R03105160001967
0090R03105160001968
0090R03105160001969
0090R03105160001970
0090R03105160001971
0090R03105160001972
0090R03105160001974
0090R03105160001975
0090R03105160001976
0090R03105160001977
0090R03105160001978
0090R03105160001979
0090R03105160001980
0090R03105160001981
0090R03105160001982
0090R03105160001982
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0090R03105160001984
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251
100516380484
100516380650
100516380657
100516380673
100516420679
100516430692
100516420684
100516430705
100516420707
100516380718
100516390746
100516380721
100516390745
100516380750
100516390578
100516380716
100516430438
100516430435
100516380633
100516380519
100516430443
100516280440
100516280441
100516280427
100516390767
100516380711
100516430651
100516390640
100516380742
100516450455
100516450454
100516390504
100516380748
100516430413
100516430795
100516390505
100516430720
100516420664
100516390511
100516390508
100516450448
100516390601
05/10/2016
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05/10/2016
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05/10/2016
0090R03105160001987
0090R03105160001988
0090R03105160001991
0090R03105160001992
0090R03105160001993
0090R03105160001994
0090R03105160001995
0090R03105160001996
0090R03105160001997
0090R03105160001998
0090R03105160001999
0090R03105160002000
0090R03105160002001
0090R03105160002002
0090R03105160002003
0090R03105160002004
0090R03105160002005
0090R03105160002005
0090R03105160002006
0090R03105160002007
0090R03105160002008
0090R03105160002009
0090R03105160002009
0090R03105160002010
0090R03105160002011
0090R03105160002012
0090R03105160002013
0090R03105160002015
0090R03105160002016
0090R03105160002017
0090R03105160002017
0090R03105160002019
0090R03105160002020
0090R03105160002021
0090R03105160002022
0090R03105160002023
0090R03105160002024
0090R03105160002028
0090R03105160002031
0090R03105160002032
0090R03105160002034
0090R03105160002036
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100516430477
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100516420676
100516390512
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100516430706
100516420551
100516420550
100516430756
100516420824
100516390515
100516380538
100516380536
100516390565
100516390616
100516430603
100516390494
100516420503
100516380654
100516430694
100516380649
100516380647
100516420733
100516380731
100516390652
100516430690
100516430554
100516390499
100516430801
100516420666
100516380545
100516430670
100516430648
100516380784
100516420668
100516430642
100516430830
100516420709
100516390567
100516420686
100516420571
100516380768
05/10/2016
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0090R03105160002037
0090R03105160002041
0090R03105160002044
0090R03105160002045
0090R03105160002047
0090R03105160002051
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0090R03105160002071
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0090R03105160002073
0090R03105160002076
0090R03105160002077
0090R03105160002078
0090R03105160002079
0090R03105160002080
0090R03105160002081
0090R03105160002082
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100516430695
100516380635
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100516380580
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100516380658
100516390636
100516380869
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100516380892
100516420901
100516390939
100516420908
100516430134
100516430928
100516390621
100516390632
100516430399
100516450414
100516430057
100516430045
05/10/2016
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0090R03105160002090
0090R03105160002092
0090R03105160002093
0090R03105160002094
0090R03105160002095
0090R03105160002098
0090R03105160002099
0090R03105160002109
0090R03105160002110
0090R03105160002111
0090R03105160002112
0090R03105160002113
0090R03105160002114
0090R03105160002375
0090R03105160002376
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0090R03105160002382
0090R03105160002738
0090R03105160002739
0090R03105160002742
Page 122
10 MEI 2016
NAMA PASIEN
DJAKFAR LEKAP TN.
HASAN BASRI TN
ISWANDI BIN ALITIAR TN.
RAFIKA SURIANDARI NN.
ROHANI TOHA NY
SUKANTO KESUMAH TN
YANTI SAFITRI NY.
YUNANI BINTI SUNTAK NY.
ARIEF RAHMAN TN
DIAN EKA PRATIWI NY.
AMSONI GULTOM TN.
CIK TAMAH NY.
AHMAD REZA FAHLEVI TN.
AMRUL BIN ROBI TN
TANG WEI HENG NY
TANG WEI HENG NY
HASIAM INDRIANI NY
USNITA USMAN NY.
HERIYANTO TN
LAM SURYA NY.
TAFRONI BIN HURMAIN TN
PURWADI BIN PARIDIN TN
JUNIAL KOMAR TN.
M. IMRON TN.
DJAKFAR LEKAP TN.
TRANSAKSI
78,000.00
21,670.00
330,000.00
166,000.00
135,135.00
98,190.00
337,080.00
565,870.00
12,900.00
174,400.00
240,960.00
193,585.00
40,000.00
40,000.00
66,870.00
10,000.00
177,000.00
890,000.00
201,350.00
10,000.00
167,000.00
120,000.00
105,600.00
488,200.00
1,362,900.00
160,000.00
10,000.00
1,192,000.00
1,844,950.00
10,000.00
160,000.00
617,700.00
115,000.00
173,000.00
155,000.00
198,000.00
91,000.00
10,000.00
472,000.00
205,255.00
95,000.00
Page 123
10 MEI 2016
SRI MULATSIH NY.
JUNAIDA PRIANI NY
JUNAIDA PRIANI NY
NURLIANA SALIM NY
NURLIANA SALIM NY
NASRUN BASRI TN
NASRUN BASRI TN
ALMIANAH HJ. BINTI MADELI NY
SITI ROHMA NY
SITI ROHMA NY
MUSLIMIN KADIR TN
MUSTOPA BIN ANANG TN.
NURYANI NY.
YULIATI BINTI NANGUNING NY.
SHOFWAN TN.
Z. HAYATI NY
ROCHADI BIN SUARNO TN
MUHAMMAD TONI TN.
MUHAMMAD TONI TN.
MASRIPAH BINTI YAKUP NY.
BUYUNG LEMAN TN.
BUYUNG LEMAN TN.
HERU SUPENO TN.
BUN TJAUN MIE NY
DANIEL TANDINGAN TN.
JEANNE KUSSOY NY
JEANNE KUSSOY NY
CHADIDJAH SALEH NY
EVI WAHYUNI NY.
10,000.00
158,150.00
10,000.00
160,000.00
10,000.00
200,000.00
215,000.00
10,000.00
160,000.00
226,770.00
10,000.00
160,000.00
199,370.00
167,000.00
10,000.00
74,790.00
131,650.00
890,000.00
107,200.00
179,400.00
160,000.00
10,000.00
318,865.00
325,320.00
160,000.00
10,000.00
187,200.00
10,000.00
160,000.00
516,000.00
125,000.00
10,000.00
313,800.00
174,400.00
75,600.00
165,370.00
95,500.00
60,000.00
95,000.00
10,000.00
147,200.00
180,000.00
Page 124
10 MEI 2016
IDAYATI BINTI JASIRUN NY
VICKY NURHARIYANTO TN.
TJIKMAD. B TN.
SUPRIANTI BINTI SOFRIN NY.
SUSILAWATY NY
SUSILAWATY NY
ALIDUN SIHOMBING TN
TERMEI PAKPAHAN NY
KOMARIA BINTI ALIUN NY.
SRI NUR AINI NY
ERNAWATI BINTI HARUN NY.
MISTUTI BINTI R. SUKARDI NY
HARITS ABDULHAMID AN.
JAKA SUBAGJA TN.
ANDI SUPRIYADI TN.
DANILAH ADHAN,HJ NY.
RIA MEI SAFITRI NY
OEY LAY OA NY
SYAIFUL BASRI TN.
TJIE GOEI SIOE NY
SUNADIA HJ NY.
MOHSAN TURIP TN.
KHALISA ANGGRAINI PUTRI AN
MUHAMMAD RIFQI TN
MUHAMMAD RIFQI TN
NINA MARLINA NY.
117,600.00
367,545.00
78,000.00
480,231.00
146,000.00
334,960.00
160,000.00
10,000.00
240,800.00
80,100.00
246,920.00
312,400.00
125,850.00
194,000.00
185,400.00
367,700.00
306,235.00
513,200.00
243,877.00
84,210.00
77,600.00
240,000.00
191,400.00
120,000.00
311,452.00
488,800.00
160,000.00
10,000.00
120,000.00
281,700.00
225,150.00
313,190.00
160,000.00
10,000.00
401,000.00
240,800.00
129,500.00
244,520.00
177,000.00
10,000.00
120,000.00
205,800.00
Page 125
10 MEI 2016
SUYADI H. TN
NASRUL MUIS TN
EVLIN FERONIKA MAGDALENA NY
TRISNAWATY BINTI THAMRIN NN
ZAINAL BIN H ARSYAD TN.
ALYA DANIA NY.
JERRY SETIAWAN AN
ESY MARLIAH NY.
JUNAIDI TN.
DANA LISTIYANTI NN.
NILA ANDRAINI NY.
M RAFAIZAN AL HAFIDZ AN.
ISWALINA RAHMAN NY
ALMIRA SYIFA AZZAHRA AN.
ISMAYANI BINTI ANSYORI NY.
TRISITA ETA NY.
NADYA PUTRI AURORA INDARTO AN.
EKA YULINA KUSUMAWATY NY.
HELMI APRIANDOKO TN.
AZWAWI KERIT TN
EVA NURBANI KUSUMAWATY NY.
SRI UTAMI NY.
DAMSI BIN BUSTAMI TN.
ANITA BINTI MUSTAJAB NY
M. FIRMAN ADJI CANDRA K TN
ALISPER SILALAHI TN.
BUDI AZHARI IR TN
YUOLIN DITA HUMAIRAH NN.
WARSITO BIN RIDWAN H TN.
SITI KHODIJAH ADZANIA AN.
CANDRA DOAN TN.
FITRIYANTI NY
217,000.00
390,300.00
195,000.00
139,200.00
226,538.00
214,106.00
221,235.00
289,800.00
221,235.00
75,700.00
875,050.00
75,280.00
99,130.00
65,000.00
140,700.00
167,000.00
10,000.00
358,545.00
60,000.00
180,000.00
306,900.00
228,000.00
95,000.00
10,000.00
155,850.00
115,000.00
60,000.00
123,830.00
233,000.00
368,410.00
313,800.00
60,000.00
267,000.00
221,235.00
119,380.00
128,000.00
133,900.00
160,620.00
249,800.00
245,900.00
241,775.00
180,000.00
Page 126
10 MEI 2016
ISRIL HENDRA TN
OKTAVIANI BINTI ANANG ZAHRI NY
DIAN ANGGRAINI NN.
RAHAYU BINTI SALIM NY
ARIANTO WAGISO TN.
DEWI SRI JAYAWATI NY.
AUGUST FANIJAYA TN.
ANI HASAN NY
ADINDA AYU NINGTYAS L AN.
SETIA WATI NY
SETIA WATI NY
LINDA BINTI AWIE NY
SRI MULYATI NY.
KEBAN MAILANI TN.
AMRINA ROSYADAH NN
FAHRUDDIN BIN BURHANUDDIN TN.
MUHAMMAD SANUSI, DRS TN
DJUMLI ARIFIN TN
AGUSTINA BINTI M.ALI NY.
YANTI SAFITRI NY.
FASYA AULIA ROHALI AN
ANSAHRI NIZAR TN
BUDI NOPRIANI NY.
TENNY MAYA SARI NY
E. SIMATUPANG TN
JACUB RAHMAN TN.
LELY WATI NY
ELIS NILAYATI NY.
ONI BINTI RIMIN NY.
ELLYANA ROSITA NY.
RIYAN OKTA PRIYANSYAH AN.
ZAIDAN ACHMAD TN.
MULKAS ADE PUTRA TN
119,380.00
193,585.00
269,520.00
213,000.00
266,424.00
267,313.00
231,400.00
1,192,000.00
60,000.00
160,000.00
10,000.00
10,000.00
160,000.00
214,500.00
233,000.00
212,800.00
158,000.00
91,940.00
115,430.00
244,500.00
1,084,330.00
60,000.00
327,086.00
193,585.00
190,000.00
330,950.00
264,700.00
294,585.00
60,000.00
205,450.00
223,450.00
149,450.00
85,450.00
220,000.00
60,000.00
192,650.00
10,000.00
91,000.00
150,450.00
60,000.00
118,850.00
60,000.00
Page 127
10 MEI 2016
INDRA SANDI TN
ROSNAH BINTI A. KARIM NY.
NOVENDA ALIANDO TN
SUGINAH ABBAS NY.
MIRA ASDIANA NY.
M. ABBAS HASAN TN
SRI MULYATI NY
SITI AISYAH ZURYATI NY.
ABU KOSIM TN.
TJIKNUT SYUKUR NY
MACHMUDI MUIB TN.
AUSTATILY SYARTIAN TN.
CHERLYNDA SARI ST. NY.
PARIS PRATAMA TN.
PARIS PRATAMA TN.
EUIS ARTATI SH NY.
YULIA DASWATI NY.
MEKAWANSARI NY.
BETY DWI ASTUTI NY.
TEGUH BIN HOKSAN TN
NURYATI BINTI SITOEN NY.
SUSROYANI BINTI SUDIRMAN NY.
DESMIYANTI BINTI M. YUN NY
HANDINI BINTI MASDAR HANAFI NY
ARSYAH HAKIM, A.MA.PD NY
ROHANI TOHA NY
SEPTIANA NY.
MIKE ANDIANI NY.
SEPTRYSEA RACHMATYKA NY.
RIZKI AMALIA NN
MUCHTAR TS TN
163,160.00
99,450.00
60,000.00
215,900.00
139,000.00
145,300.00
60,000.00
60,000.00
277,900.00
150,450.00
146,800.00
176,900.00
146,850.00
118,850.00
60,000.00
276,370.00
160,000.00
10,000.00
142,675.00
60,000.00
274,585.00
160,000.00
10,000.00
261,000.00
544,990.00
186,950.00
192,900.00
197,857.00
564,970.00
160,000.00
10,000.00
182,400.00
180,000.00
126,220.00
209,340.00
79,450.00
215,000.00
248,785.00
316,860.00
488,200.00
82,620.00
274,530.00
Page 128
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RINI RISMAYANI NY
DEVI HERLINA NY.
MILYA ZAKIAH NN.
ERIKA PUTRI NN.
RIKA ARDIANSI, SE NY
SHINTA HASANA NY.
SHINTA HASANA NY.
HIMAWAN SALIM TN.
MARYAM BT ALIAS NY.
MARYAM BT ALIAS NY.
NANA SUPRIYATNA TN
RUMIATI BINTI SUYOTO NY.
ARIE PRAMESTI HENDRANINGSIH NY
ERSYE HARTANU NY.
ISMAIL BIN SASTOR TN.
TITIN AGUSTINA NY.
DEWI SARTIKA NY
SITY YULIZA SHAUALA NN.
DIARNA OKTABELINA NY
DANANG PRAMADI M TN.
AKHMAD FERDIAN TN
AULIA RAHMAN TN.
MIKHAEL RUKINEM NY.
ELIZABETH AGOES NY.
NERISSA ARVIANA AN.
MARISA OKTARINA NY
LAMRIA BINTI SIMINTAHAR NY
M.JUNAIDI DRS TN.
NOVA TARIDA SINAGA NY.
MINGSI BINTI HASAN NY.
EFENDI BIN JASAN TN
KAHFIAH BINTI ABDULLAH NY
JOHNSON SE TN.
HENI SUMARNI NY
TJIUW TJIN HE TN.
YUNI FARIYASI NY.
155,000.00
193,585.00
230,385.00
313,800.00
205,500.00
110,000.00
125,000.00
10,000.00
358,500.00
60,000.00
110,000.00
177,000.00
10,000.00
195,580.00
301,585.00
341,400.00
155,000.00
488,200.00
202,606.00
199,350.00
125,000.00
10,000.00
72,000.00
193,585.00
229,330.00
110,000.00
152,069.00
141,766.00
118,500.00
219,470.00
161,427.00
283,000.00
272,442.00
60,000.00
193,585.00
219,854.00
197,900.00
174,831.00
234,400.00
60,000.00
150,050.00
217,435.00
Page 129
10 MEI 2016
MUHAMAD FARHAN YUSUF ILHAM AN
ROZALI BIN UDIN H TN
AGUS LANI TN
RAPIKA MAHARANI NN
RINI KURNIATI NN.
HANA AZALIA AN.
RAFIKA SURIANDARI NN.
R. DENCIK TN
DIO MARSHALL TRI PUTRA TN.
SANDY ADITYA PUTRA TN
HOLLY CHRISTIAN FADLY TN
IMRON SAININ TN.
ZAFRAN MUHAMMAD NABIL AN.
H. IDRUM SOBRIE HI TN.
WAHBI FAIZ AN
SUPRIYATI BINTI MATSARI NY
JAMIA BINTI HASANUDDIN NY.
SUKANTO KESUMAH TN
NUR AZIZAH SALSABILA AN
A KALZANI JAFRI TN
110,000.00
791,150.00
121,600.00
461,600.00
183,700.00
111,087.00
245,000.00
88,590.00
64,600.00
75,200.00
147,180.00
131,573.00
127,000.00
303,750.00
104,000.00
212,935.00
211,645.00
1,192,000.00
135,150.00
115,050.00
129,632.00
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11 MEI 2016
NO
1
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21
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23
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26
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29
30
31
32
33
34
35
36
37
38
39
40
41
NO RJ
110516280099
110516450083
110516450363
110516450221
110516430741
110516430751
110516450024
110516380735
110516380734
110516380731
110516280135
110516450149
110516380725
110516380729
110516280043
110516280042
110516280044
110516280015
110516280017
110516450334
110516280084
110516450034
110516450038
110516450173
110516450019
110516450054
110516450056
110516280218
110516450184
110516280125
110516280122
110516280031
110516450040
110516450039
110516280096
110516280033
110516280036
110516280179
110516280290
110516280289
110516280095
TANGGAL
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
SEP
00
00
00
00
00
00
0090R03104160007280
0090R03105160001806
0090R03105160001807
0090R03105160001833
0090R03105160001908
0090R03105160001935
0090R03105160001956
0090R03105160001960
0090R03105160002115
0090R03105160002118
0090R03105160002122
0090R03105160002124
0090R03105160002124
0090R03105160002126
0090R03105160002127
0090R03105160002128
0090R03105160002128
0090R03105160002129
0090R03105160002130
0090R03105160002131
0090R03105160002131
0090R03105160002132
0090R03105160002133
0090R03105160002134
0090R03105160002135
0090R03105160002136
0090R03105160002137
0090R03105160002137
0090R03105160002138
0090R03105160002139
0090R03105160002139
0090R03105160002140
0090R03105160002141
0090R03105160002141
0090R03105160002142
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110516280087
110516280081
110516280013
110516280225
110516430861
110516450209
110516280199
110516280190
110516280012
110516280200
110516280203
110516280307
110516280106
110516280104
110516280072
110516450088
110516450086
110516280297
110516450198
110516450154
110516450150
110516380721
110516390678
110516450233
110516450232
110516450022
110516280220
110516280217
110516280421
110516280425
110516280284
110516280282
110516280115
110516450245
110516450240
110516420554
110516420556
110516280029
110516450369
110516280066
110516380718
110516280194
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
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05/11/2016
05/11/2016
05/11/2016
05/11/2016
05/11/2016
0090R03105160002143
0090R03105160002143
0090R03105160002144
0090R03105160002145
0090R03105160002146
0090R03105160002147
0090R03105160002148
0090R03105160002148
0090R03105160002149
0090R03105160002150
0090R03105160002150
0090R03105160002151
0090R03105160002152
0090R03105160002152
0090R03105160002153
0090R03105160002154
0090R03105160002154
0090R03105160002156
0090R03105160002157
0090R03105160002158
0090R03105160002158
0090R03105160002159
0090R03105160002160
0090R03105160002161
0090R03105160002161
0090R03105160002162
0090R03105160002163
0090R03105160002163
0090R03105160002165
0090R03105160002165
0090R03105160002166
0090R03105160002167
0090R03105160002168
0090R03105160002169
0090R03105160002169
0090R03105160002171
0090R03105160002171
0090R03105160002172
0090R03105160002173
0090R03105160002174
0090R03105160002175
0090R03105160002176
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110516280280
110516380720
110516280062
110516280060
110516280343
110516380716
110516280048
110516280350
110516280347
110516450215
110516280032
110516280151
110516450216
110516380715
110516450058
110516280305
110516280317
110516280248
110516450052
110516280391
110516280390
110516450161
110516280047
110516280185
110516280377
110516280376
110516280061
110516280405
110516280404
110516450346
110516280423
110516280422
110516280067
110516450093
110516450090
110516280263
110516280068
110516450063
110516450070
110516280460
110516280459
110516280410
05/11/2016
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05/11/2016
0090R03105160002177
0090R03105160002177
0090R03105160002178
0090R03105160002179
0090R03105160002180
0090R03105160002181
0090R03105160002182
0090R03105160002183
0090R03105160002183
0090R03105160002184
0090R03105160002185
0090R03105160002186
0090R03105160002187
0090R03105160002188
0090R03105160002189
0090R03105160002190
0090R03105160002190
0090R03105160002191
0090R03105160002192
0090R03105160002193
0090R03105160002193
0090R03105160002194
0090R03105160002196
0090R03105160002198
0090R03105160002199
0090R03105160002199
0090R03105160002200
0090R03105160002201
0090R03105160002201
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0090R03105160002204
0090R03105160002204
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0090R03105160002207
0090R03105160002207
0090R03105160002208
0090R03105160002209
0090R03105160002210
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0090R03105160002212
0090R03105160002212
0090R03105160002213
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0090R03105160002214
0090R03105160002215
0090R03105160002215
0090R03105160002216
0090R03105160002217
0090R03105160002218
0090R03105160002218
0090R03105160002219
0090R03105160002219
0090R03105160002220
0090R03105160002221
0090R03105160002222
0090R03105160002223
0090R03105160002223
0090R03105160002225
0090R03105160002226
0090R03105160002227
0090R03105160002228
0090R03105160002229
0090R03105160002230
0090R03105160002231
0090R03105160002232
0090R03105160002233
0090R03105160002234
0090R03105160002235
0090R03105160002236
0090R03105160002237
0090R03105160002238
0090R03105160002239
0090R03105160002241
0090R03105160002242
0090R03105160002243
0090R03105160002244
0090R03105160002245
0090R03105160002246
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0090R03105160002248
0090R03105160002249
0090R03105160002250
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0090R03105160002253
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110516430508
110516430510
110516280236
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110516390858
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110516280177
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110516280370
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0090R03105160002254
0090R03105160002254
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0090R03105160002275
0090R03105160002275
0090R03105160002276
0090R03105160002276
0090R03105160002277
0090R03105160002278
0090R03105160002279
0090R03105160002280
0090R03105160002281
0090R03105160002282
0090R03105160002283
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0090R03105160002285
0090R03105160002286
0090R03105160002286
0090R03105160002287
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110516390571
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110516380600
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110516430705
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0090R03105160002288
0090R03105160002290
0090R03105160002291
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0090R03105160002318
0090R03105160002319
0090R03105160002320
0090R03105160002321
0090R03105160002324
0090R03105160002325
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0090R03105160002332
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NAMA PASIEN
METTIE YOYCE PAGHUNIE NY.
NUR AINI NY.
SARPIAH BINTI KASIT NY
SHOFWAN TN.
SUSITA HARTATI NY
DIANA NOVITA NY
ARDILA AYU RESTA NN
ELDA HANDAYANI NY
GATOT SUGEMTO TN
EMDINA JUNIKA SIBURIAN NY
ANITA BINTI A. GANI NY
MUHAMMAD ROSYIDI TN
ELIS NILAYATI NY.
ELIS NILAYATI NY.
N. ACHMAD ABUMAN TN
SITI FATIMAH NY
SITI FATIMAH NY
SYARKOWI TN.
BURHANUDDIN HATTA TN.
SOFIA AZZAHRA AN.
M. ADIAN AFRIANSYAH TN
RA FARIDA NY.
ASKURNI APSA TN.
HENY SOFNIAR NY.
RONIMAH NY
RONIMAH NY
RUSDI BIN YASIR TN.
JACUB RAHMAN TN.
JACUB RAHMAN TN.
SRI WAHYUNI NY.
TRANSAKSI
624,450.00
148,920.00
174,400.00
22,415.00
126,000.00
43,500.00
193,585.00
1,192,000.00
1,192,000.00
1,192,000.00
60,000.00
40,000.00
1,192,000.00
1,192,000.00
93,328.00
40,000.00
185,233.00
125,000.00
10,000.00
120,000.00
115,850.00
10,000.00
160,000.00
249,000.00
134,880.00
10,000.00
91,000.00
115,000.00
141,000.00
121,700.00
353,250.00
221,280.00
160,000.00
10,000.00
64,000.00
160,000.00
10,000.00
87,000.00
125,000.00
10,000.00
485,600.00
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11 MEI 2016
160,000.00
10,000.00
AGUS LANI TN
164,000.00
MARIA BINTI ABDUL MUROD NY 251,400.00
110,000.00
100,800.00
FERIAL BINTI MUHAMMAD NN.
160,000.00
10,000.00
TITIEN SUHARTI NY.
106,400.00
MAYA E LEBIS NY.
10,000.00
MAYA E LEBIS NY.
160,000.00
NETI HARTINI NY.
97,500.00
SANJOTO BIN MARTO SUNTONO 160,000.00
SANJOTO BIN MARTO SUNTONO
10,000.00
SOEHARTO BIN KARYOWIRJO TN
81,000.00
160,000.00
10,000.00
1,192,000.00
232,200.00
NOVENDA ALIANDO TN
112,000.00
NOVENDA ALIANDO TN
10,000.00
BUDI BIN DARMO WASITO TN. 1,192,000.00
MUHAMMAD YUNUS TN.
150,000.00
160,000.00
10,000.00
HARIS FADILA TN
512,000.00
160,000.00
10,000.00
10,000.00
160,000.00
ENDAR JAYA TN
227,751.00
SURYATI BINTI M. ROIBI NY
105,000.00
115,000.00
ELLYANA ROSITA NY.
160,000.00
ELLYANA ROSITA NY.
10,000.00
10,000.00
125,000.00
TUTI PURNAMAWATI NY
95,600.00
TIAMSAH AMBARITA NY.
220,550.00
362,250.00
KARIMAH, HJ BINTI KHOLIQ NY. 1,192,000.00
HAMZAH BIN TAYIB TN
174,275.00
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184,800.00
DARMANSYAH BIN M. NUR TN 1,192,000.00
RAFFA ATHILLA MOHAMMAD AN 110,000.00
PANDU ADIYAKSA WIJAKSONO
60,000.00
HASNA BINTI HASAN BASRI NY.
193,585.00
TEGUH BIN HOKSAN TN
1,192,000.00
SRI SUHARNI NY.
154,500.00
DIKSON MATHEOS TN.
125,000.00
DIKSON MATHEOS TN.
10,000.00
WAGINEM BINTI KASAN WIRYO
252,030.00
OESMAN AIDIT TN.
216,480.00
LIONG KIM LIAN NY.
221,400.00
SAUDAH BINTI HASAN NY
226,995.00
SULAIMAN NADEAK TN.
1,192,000.00
WINDIKA BINTI AMANCIK NY.
219,750.00
ARIFIN SITOHANG TN.
10,000.00
ARIFIN SITOHANG TN.
160,000.00
FRANSISKA APRIANTY N NN.
158,740.00
NARISAH BINTI A ROHMAN NY
967,750.00
ISMIWATI LAMSYARIAH NY.
10,000.00
ISMIWATI LAMSYARIAH NY.
160,000.00
GHANI ALFARIZI AN.
123,287.00
NOVIYANTI NY.
94,880.00
106,015.00
ARBAIN GANTI TN
10,000.00
ARBAIN GANTI TN
160,000.00
LATIFAH BINTI NANING NY
94,880.00
ACHMAD ZARNUBI TN.
160,000.00
ACHMAD ZARNUBI TN.
10,000.00
271,075.00
10,000.00
160,000.00
MURYANI BINTI M YUSUF NY.
142,900.00
SITI MARIAM NY
167,000.00
SITI MARIAM NY
10,000.00
INDRA GUNAWAN TN.
225,878.00
SOEHERMAN H TN.
135,680.00
120,000.00
CHODIJAH BINTI MUHAMMAD H
134,880.00
BETIN TEGUH NY.
160,000.00
BETIN TEGUH NY.
10,000.00
HERLINA WATI NY.
488,200.00
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ANNA KUSNAINI NY.
ZAIDAR BINTI M.NURLEMAN,HJ
ALI BASTOMI TN
SHOFWAN TN.
SHOFWAN TN.
RIO HUTABARAT TN.
SUFIAH NY.
RUSLAN BIN ASMAWAI TN.
SRI DAMAYATI NY.
M. HATTA YUSUF TN
SYAMSUL BAHRUN TN.
MAYA KARTIKA NN.
SURATMI NY
ROSDIANA DAHLAN NY.
IRA PUSPITA SARI NY
RIA INDAH NASTITI NY
M. RAFIE KHAIRY AN
MAGDALENAWATY NY.
TJHANG HON LION-HANDRI S T
SUMARNI BINTI JUKRI E NY.
YULIANA AMINUDDIN NY
NUR AINI NY.
MAMAT SADI TN.
EFENDI LUMBAN GAOL TN.
KARINI YOHANA TARIGAN DRG
ZALEHA BINTI USMAN NY.
SRI NUR IRIANTI NY.
PAHIMA, HJ NY
THENG LIM HWIE MEI NY
253,700.00
10,000.00
160,000.00
176,000.00
152,068.00
125,000.00
10,000.00
160,000.00
10,000.00
183,560.00
114,800.00
272,100.00
10,000.00
125,000.00
110,000.00
245,000.00
313,900.00
161,050.00
240,800.00
373,415.00
366,000.00
142,400.00
210,785.00
193,585.00
87,600.00
120,000.00
320,520.00
283,615.00
159,764.00
178,000.00
75,800.00
200,800.00
234,400.00
336,000.00
603,260.00
152,560.00
200,285.00
67,065.00
116,380.00
193,585.00
146,000.00
200,800.00
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MULKAS ADE PUTRA TN
160,000.00
MULKAS ADE PUTRA TN
10,000.00
ROSANIA DEWI NY.
143,460.00
SUSY YANTINY.
192,900.00
SUMIATY JUMAHAT NY
167,000.00
REFKI FATHI CORIE TN
182,760.00
147,000.00
10,000.00
SISWANTY K. R NY.
97,600.00
SYARIFAH BINTI SOLEH H NY.
131,540.00
HESTI MARLINA NY.
198,796.00
KARTINI NY
10,000.00
KARTINI NY
160,000.00
LASTARI BINTI HERMANSYAH N
261,735.00
RM SYABIAN FARHAN N AN
162,300.00
MUHAMMAD RIFQI TN
177,000.00
MUHAMMAD RIFQI TN
10,000.00
PURNOMO TN.
10,000.00
PURNOMO TN.
167,000.00
EMMY YAHIMI NY
363,000.00
108,050.00
50,000.00
FEBBY FENISYA NY
221,235.00
FITRI YANI NY.
180,000.00
MSY EMILIA BINTI SOFIAN NY.
133,585.00
MSY EMILIA BINTI SOFIAN NY.
60,000.00
10,000.00
91,000.00
10,000.00
125,000.00
MISIS SUHARTI NY.
221,235.00
IRMAWATY SURYANI HJ NY.
249,000.00
ADAM MALIK TN.
95,300.00
SUWIRMAN BIN KAMARUDDIN
207,060.00
EDY ABDULLAH TN
1,192,000.00
SUHARNI BIN HASYIM NY.
218,215.00
FAUSTINA BUDIYATI NN.
296,535.00
NURHAYATI BINTI JOHAN NY.
219,600.00
ABU LAHAB TN.
264,800.00
BIDUAN SITUMORANG TN
160,000.00
10,000.00
SUSITA HARTATI NY
310,000.00
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HATI INDAWATI NY.
175,680.00
NURHADI SE BIN ZAIRUL ALI TN 181,065.00
RITA MELLA NY.
237,008.00
160,000.00
10,000.00
FITRI ANGGRAINI NY
132,000.00
YUS ROHANA NY.
160,000.00
YUS ROHANA NY.
10,000.00
AMIR HAMZAH TN
167,000.00
AMIR HAMZAH TN
10,000.00
ELLY ASMAWATI NY.
180,000.00
ERWIN AZHARI TN.
1,192,000.00
ALVARO MUDA SIMANJUNTAK A
60,000.00
NETTY NETTY NY.
10,000.00
NETTY NETTY NY.
160,000.00
DAHLIA BINTI KGS NOERONI AD 255,400.00
110,000.00
M. SHEVA KHATAMI AN.
155,000.00
MUHAMMAD KHADAFI AN.
234,400.00
NOVI YANTI NY.
85,500.00
ELLY HERYATI NY.
142,800.00
SITI ASIAH NY.
276,000.00
GUNTUR BIN MANSYUR TN.
146,100.00
MEIRINDA RUGUN NY
658,200.00
NINGSIH BINTI KUSNADI NY.
707,600.00
DEWI AMBAR NY
87,281.00
CIK NANUNG TN.
352,800.00
ASMAWI H BIN M ALI TN.
254,900.00
414,760.00
109,450.00
RUSNAN CHANDRA TN
1,192,000.00
M. KAISAN PRATAMA AN.
60,000.00
NURMALA DEWI NY.
71,450.00
ELLANWATI PUTRA KENTJANA N
71,450.00
137,000.00
M. ALI SEKAMIN TN
176,000.00
223,450.00
INDRA SANDI TN
60,000.00
HENDRA HARTANTO TN.
60,000.00
ANWAR ARIFAI, IR, H TN
60,000.00
60,000.00
MUHAMMAD ABDILLAH TN.
60,000.00
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60,000.00
99,950.00
CHATARINA FEBRIANTI NY
228,200.00
60,000.00
60,000.00
INDAWATI NY.
187,450.00
SAIFUL NURAINI TN.
71,450.00
JUMAINAH BINTI DULROKIM NY.
76,964.00
71,450.00
TASMANIAH BINTI USMAN NY.
68,000.00
NASRUN BASRI TN
127,900.00
ARSAVIN JANUAR DWI PUTRA A
60,000.00
60,000.00
137,300.00
ROMLAH BINTI UMAR NY.
1,022,870.00
ELIYA MARGARITA NY.
91,450.00
KARTINI BINTI ROZALI NY
741,570.00
60,000.00
99,034.00
60,000.00
DIAN SAFIRA AN
285,365.00
JEANI SUCI NY.
318,145.00
YULITA MARNI NY.
325,255.00
DEVINA ANGELINA AN.
121,980.00
SURYANI BINTI ZAINUL BAKTI N
160,000.00
SURYANI BINTI ZAINUL BAKTI N
10,000.00
DESI WINDASARI NY.
217,435.00
LINDA DAHLIA NY.
297,000.00
TITA RATNA WULAN DARI NY.
200,000.00
YUSUF USMAN TN
384,200.00
92,200.00
NURHIDAYATI BINTI AHMAD MA
338,220.00
DINDIANTO BIN KADARUDIN TN 171,240.00
HENGKI FIRNANDES AN.
384,900.00
SEPTI YANTI NY
215,876.00
SRI WULAN NY
180,000.00
HENDRIK HENDRIK TN.
488,200.00
SITI NURAINI NY.
10,000.00
SITI NURAINI NY.
160,000.00
ADINDA NURIANA TRIHAPSARI
102,000.00
ADINDA NURIANA TRIHAPSARI
10,000.00
A. RACHMAN TN
93,676.00
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RUBIJO BIN A MARDI TN.
VIVI FERIKA NN.
LANIYATI NY.
AZWAR FANANI TN.
FATIMAH BINTI KMS MANSYUR
APRIANTI BINTI SOBRI AHMAD N
LINAOKTRIYANA PB NY.
PUTRI YOLANDA SARI NN.
CORNILIA ANITA NY.
YUNARNI BINTI A.ROHIM NY.
HARTINI BINTI AMIR HAMZAH NY
CHAERUL FADJAR MD DRS TN
NASRY BIN YUSUF TN
DAFFA RAHMATULLAH AN.
BETY NN.
RUSTEM PUAD TN.
ROMI BIN MUSTAKIM, ST TN
ZAMIRA KHADRA TN
HENDRA SUCIADI TN.
FREADY BIN DANIEL T TN
ERNA KURNIATY NY.
AAN EFIANA NY.
SUMARSIH BINTI SURAT NY.
NURYANTO TN.
ELLOHI ARVIN DARELL PH AN
MUHAMMAD IRFAN TN
SOFIATUN BINTI GUSPURWANTO
AISYAH NUR RAMADHANI AN
MEISHA DWI UTAMI NN
ALIFAH NUR SABILLA AN
RINI RILYANASARI NY.
NURHAYANI NY
SYAMSUDIN SAZANUS RASSAT
SYAMSUDIN SAZANUS RASSAT
KHOIRUNNISA SR NN
350,662.00
488,800.00
159,625.00
662,700.00
72,584.00
60,000.00
138,000.00
213,605.00
137,460.00
172,500.00
180,000.00
247,450.00
172,050.00
130,835.00
73,287.00
180,000.00
203,800.00
250,200.00
227,164.00
217,435.00
290,800.00
10,000.00
160,000.00
158,406.00
241,390.00
180,000.00
173,870.00
80,300.00
10,000.00
125,000.00
60,000.00
92,961.00
193,585.00
142,685.00
248,870.00
102,900.00
622,632.00
85,300.00
120,000.00
160,000.00
10,000.00
102,700.00
Page 163
11 MEI 2016
PUTI BYDURI BULAN AN.
TJASINI BINTI DARMO NY.
REZA MELINA NY
NURHASANAH DEWI NY
ALESHA ZAHRA AN.
EMILZA EPRIYANI NY.
DIANA ABIKUSNO NY
RACHEL A AN
LINA WATI NY.
INDAH MEGAWATI NY
FARIDA ABIDIN NY
MARTINA BINTI BUSTOMI NY
M. SULTAN FAWWAZ AN.
YOHANES PRATAMA AN
M. ZAWAWI , DR TN
NOVARIZA HANIA SYAFIRA AN.
TIKA DWI AZURA AN.
LASMINI BINTI LATIF NY.
KAROLINA NY.
KAROLINA NY.
RUSTAM HALIM TN
YUSRON KOSIM TN.
INDRIANY NY.
DARMAN BIN CIK ANAN TN
NOVIKA BINTI DONO NY.
MUHAMMAD EFFENDI TN
TUMIN BIN RESO SUNJOYO TN
211,550.00
135,950.00
10,000.00
160,000.00
231,424.00
371,760.00
193,585.00
253,800.00
199,046.00
220,000.00
1,405,710.00
274,400.00
221,840.00
10,000.00
177,000.00
97,900.00
218,415.00
488,200.00
75,330.00
131,390.00
127,077.00
202,875.00
243,206.00
10,000.00
177,000.00
1,192,000.00
228,320.00
114,760.00
115,130.00
141,600.00
211,000.00
397,700.00
Page 164
12 MEI 2016
NO
1
2
3
4
5
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10
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41
NO RJ
120516430749
120516420066
120516420099
120516420319
120516430724
120516390162
120516430590
120516380268
120516420063
120516420065
120516430423
120516420120
120516380358
120516420061
120516450560
120516390403
120516420069
120516380377
120516450673
120516380165
120516450478
120516420067
120516420345
120516390163
120516450429
120516420040
120516420054
120516420089
120516420052
120516420056
120516380323
120516420046
120516420070
120516420124
120516420101
120516420050
120516420038
120516420134
120516420143
120516280468
120516280464
TANGGAL
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
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SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160002170
0090R03105160002297
0090R03105160002309
0090R03105160002322
0090R03105160002329
0090R03105160002368
0090R03105160002470
0090R03105160002471
0090R03105160002473
0090R03105160002474
0090R03105160002477
0090R03105160002478
0090R03105160002479
0090R03105160002480
0090R03105160002481
0090R03105160002481
12 MEI 2016
42
43
44
45
46
47
48
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50
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52
53
54
55
56
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83
120516430576
120516430577
120516420022
120516420033
120516420032
120516390217
120516420029
120516420031
120516420021
120516390203
120516420231
120516420145
120516420025
120516420023
120516420027
120516420026
120516420149
120516420092
120516420094
120516380028
120516420085
120516420083
120516420042
120516390130
120516390123
120516380044
120516390131
120516390132
120516420107
120516420109
120516420080
120516420082
120516420057
120516390114
120516380045
120516420058
120516420136
120516420138
120516450448
120516420064
120516390175
120516390176
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
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0090R03105160002482
0090R03105160002482
0090R03105160002483
0090R03105160002484
0090R03105160002484
0090R03105160002485
0090R03105160002486
0090R03105160002486
0090R03105160002487
0090R03105160002488
0090R03105160002489
0090R03105160002490
0090R03105160002491
0090R03105160002491
0090R03105160002492
0090R03105160002492
0090R03105160002493
0090R03105160002494
0090R03105160002494
0090R03105160002495
0090R03105160002496
0090R03105160002496
0090R03105160002497
0090R03105160002498
0090R03105160002498
0090R03105160002499
0090R03105160002500
0090R03105160002500
0090R03105160002501
0090R03105160002501
0090R03105160002502
0090R03105160002502
0090R03105160002503
0090R03105160002504
0090R03105160002505
0090R03105160002506
0090R03105160002507
0090R03105160002507
0090R03105160002508
0090R03105160002509
0090R03105160002510
0090R03105160002510
12 MEI 2016
84
85
86
87
88
89
90
91
92
93
94
95
96
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98
99
100
101
102
103
104
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120516420076
120516420173
120516420172
120516420248
120516390267
120516420115
120516420113
120516420088
120516420239
120516420073
120516420086
120516390253
120516390246
120516390244
120516420221
120516420218
120516420216
120516420147
120516390264
120516390266
120516390305
120516390308
120516390312
120516390311
120516390326
120516420055
120516420183
120516420129
120516420135
120516420051
120516420232
120516420098
120516390233
120516420336
120516420333
120516430581
120516420048
120516390201
120516390200
120516390332
120516420078
120516420209
05/12/2016
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0090R03105160002512
0090R03105160002512
0090R03105160002513
0090R03105160002514
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0090R03105160002515
0090R03105160002516
0090R03105160002517
0090R03105160002518
0090R03105160002519
0090R03105160002520
0090R03105160002521
0090R03105160002521
0090R03105160002522
0090R03105160002522
0090R03105160002523
0090R03105160002524
0090R03105160002525
0090R03105160002525
0090R03105160002526
0090R03105160002526
0090R03105160002527
0090R03105160002527
0090R03105160002528
0090R03105160002529
0090R03105160002530
0090R03105160002531
0090R03105160002531
0090R03105160002532
0090R03105160002533
0090R03105160002534
0090R03105160002536
0090R03105160002537
0090R03105160002537
0090R03105160002538
0090R03105160002539
0090R03105160002540
0090R03105160002540
0090R03105160002541
0090R03105160002542
0090R03105160002543
12 MEI 2016
126
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136
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120516390386
120516380160
120516420141
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120516390121
120516420125
120516420128
120516380387
120516380388
120516390242
120516390247
120516420126
120516430522
120516390229
120516390260
120516420234
120516420347
120516420364
120516380154
120516380370
120516380376
05/12/2016
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0090R03105160002545
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0090R03105160002550
0090R03105160002550
0090R03105160002553
0090R03105160002554
0090R03105160002555
0090R03105160002556
0090R03105160002557
0090R03105160002558
0090R03105160002559
0090R03105160002559
0090R03105160002560
0090R03105160002561
0090R03105160002562
0090R03105160002564
0090R03105160002565
0090R03105160002566
0090R03105160002567
0090R03105160002568
0090R03105160002569
0090R03105160002570
0090R03105160002571
0090R03105160002572
0090R03105160002573
0090R03105160002573
0090R03105160002574
0090R03105160002575
0090R03105160002576
0090R03105160002577
0090R03105160002578
0090R03105160002579
0090R03105160002580
0090R03105160002581
0090R03105160002581
0090R03105160002582
0090R03105160002584
0090R03105160002584
12 MEI 2016
168
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120516450687
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120516390157
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120516420227
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120516420292
120516380269
120516390313
120516380318
120516390272
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120516280450
05/12/2016
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0090R03105160002592
0090R03105160002593
0090R03105160002594
0090R03105160002594
0090R03105160002595
0090R03105160002596
0090R03105160002597
0090R03105160002598
0090R03105160002599
0090R03105160002599
0090R03105160002601
0090R03105160002602
0090R03105160002603
0090R03105160002604
0090R03105160002605
0090R03105160002606
0090R03105160002607
0090R03105160002608
0090R03105160002608
0090R03105160002609
0090R03105160002610
0090R03105160002611
0090R03105160002612
0090R03105160002613
0090R03105160002614
0090R03105160002615
0090R03105160002615
0090R03105160002616
0090R03105160002617
0090R03105160002619
0090R03105160002621
0090R03105160002624
0090R03105160002625
0090R03105160002626
0090R03105160002626
12 MEI 2016
210
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120516390258
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120516430656
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120516280499
120516430528
120516430524
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120516430604
120516450472
120516280567
120516430584
120516430613
120516280659
120516430573
120516430480
05/12/2016
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0090R03105160002633
0090R03105160002634
0090R03105160002636
0090R03105160002637
0090R03105160002639
0090R03105160002641
0090R03105160002642
0090R03105160002643
0090R03105160002644
0090R03105160002645
0090R03105160002645
0090R03105160002646
0090R03105160002647
0090R03105160002648
0090R03105160002649
0090R03105160002650
0090R03105160002651
0090R03105160002652
0090R03105160002653
0090R03105160002654
0090R03105160002655
0090R03105160002656
0090R03105160002659
0090R03105160002660
0090R03105160002661
0090R03105160002662
0090R03105160002663
0090R03105160002664
0090R03105160002665
0090R03105160002666
0090R03105160002669
0090R03105160002670
0090R03105160002671
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0090R03105160002673
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120516280733
120516280520
120516280521
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120516430641
120516280540
120516450396
120516430721
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120516390389
120516450411
120516450407
120516280685
120516430597
120516430431
120516450500
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120516430616
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120516450430
120516450697
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120516430695
120516430698
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05/12/2016
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05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
Page 171
0090R03105160002675
0090R03105160002676
0090R03105160002677
0090R03105160002678
0090R03105160002679
0090R03105160002681
0090R03105160002682
0090R03105160002683
0090R03105160002685
0090R03105160002686
0090R03105160002686
0090R03105160002688
0090R03105160002689
0090R03105160002689
0090R03105160002690
0090R03105160002691
0090R03105160002692
0090R03105160002693
0090R03105160002694
0090R03105160002695
0090R03105160002696
0090R03105160002697
0090R03105160002698
0090R03105160002699
0090R03105160002700
0090R03105160002701
0090R03105160002702
0090R03105160002704
0090R03105160002705
0090R03105160002705
0090R03105160002706
0090R03105160002707
0090R03105160002708
0090R03105160002710
0090R03105160002711
0090R03105160002712
0090R03105160002713
0090R03105160002715
0090R03105160002716
0090R03105160002716
0090R03105160002717
0090R03105160002717
12 MEI 2016
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
120516430527
120516280598
120516280596
120516430611
120516280684
120516430693
120516280627
120516280633
120516280506
120516450714
120516430557
120516430556
120516450578
120516390274
120516390168
120516450675
120516430680
120516430787
120516450812
120516430495
120516430568
120516280533
120516420093
120516420142
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
05/12/2016
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Page 172
0090R03105160002720
0090R03105160002722
0090R03105160002722
0090R03105160002723
0090R03105160002724
0090R03105160002725
0090R03105160002727
0090R03105160002728
0090R03105160002729
0090R03105160002730
0090R03105160002731
0090R03105160002732
0090R03105160002733
0090R03105160002740
0090R03105160002741
0090R03105160002745
0090R03105160002746
0090R03105160002753
0090r03105160002755
0090R03105160002964
0090R03105160002967
0090R03105160003042
0090R03105160004304
0090R03105160008133
12 MEI 2016
NAMA PASIEN
ABDULLAH MASUD TN
BILQIS JIHAN SHADIQAH AN.
ELLYCE TABITA NN
FATHIAN FAUZANNY A. AN
FITRI KOMALASARI NY.
HAMIDIAH NY.
IWAN WATAK TN.
MEIRINDA RUGUN NY
MUHAMMAD DYLAN ARTHABRATA AN.
QUEENSHA ZULAIKHA AN.
RUSTEM PUAD TN.
SISWANTY K. R NY.
TAPNA WARDINA NY
TEGUH BIN HOKSAN TN
WAHYU MARDIANSYAH AN.
WIRMA OCTAVIA NY.
NICKY VERDIANTO TN.
WASILAH BINTI M. RASYID NY.
NOVA YANTI NY
INDRIANAH DRA NY.
M. FARIZ PRASETYA SILABAN AN.
FERANITA BINTI NASRUL NY.
MARIYAM AMAK NY.
INDRA WIJAYA TN
CHUSNUL DJAMIL DRS TN.
BENI HERIANSYAH TN
RIKA NUR SEPRIYANTI NY.
TRANSAKSI
9,000.00
249,000.00
63,000.00
76,000.00
29,084.00
108,000.00
53,900.00
108,000.00
534,000.00
63,000.00
446,000.00
6,030.00
29,615.00
249,000.00
104,600.00
121,030.00
4,900.00
11,450.00
148,920.00
6,000.00
165,000.00
78,000.00
42,000.00
108,000.00
133,500.00
420,370.00
1,192,000.00
348,908.00
1,612,370.00
1,612,370.00
105,000.00
177,790.00
228,641.00
214,400.00
40,000.00
404,018.00
180,278.00
239,000.00
98,880.00
10,000.00
177,000.00
Page 173
12 MEI 2016
KAROLINA NY.
KAROLINA NY.
NURHAYATI KHD NY.
AGUSTINA BINTI SARNO NY.
M. IQBAL TN.
LIM KOEIJ ING NY
SJAFRAN SOHIB TN
M. ABBAS HASAN TN
M. ABBAS HASAN TN
SUGINAH ABBAS NY.
SUGINAH ABBAS NY.
LATIPAH BINTI MARJANI NY
ZAIDAN ACHMAD TN.
ZAIDAN ACHMAD TN.
HASIAM INDRIANI NY
HASIAM INDRIANI NY
JACUB RAHMAN TN.
NYAYU HALIMAH NN.
NYAYU HALIMAH NN.
YANTI SAFITRI NY.
TITIEN SUHARTI NY.
KOMARIAH BINTI BOHIR NY
IQBAL SAULI DJAKFAR TN..
10,000.00
177,000.00
94,880.00
160,000.00
10,000.00
315,860.00
10,000.00
160,000.00
94,880.00
120,930.00
1,612,370.00
695,100.00
160,000.00
10,000.00
160,000.00
10,000.00
266,900.00
10,000.00
125,000.00
208,381.00
160,000.00
10,000.00
60,000.00
160,000.00
10,000.00
189,000.00
10,000.00
137,000.00
10,000.00
91,000.00
10,000.00
160,000.00
472,000.00
505,600.00
102,000.00
243,465.00
10,000.00
160,000.00
62,100.00
288,000.00
10,000.00
95,000.00
Page 174
12 MEI 2016
BUSTAN BIN SENEN TN.
AMALIA MAHARANI AN.
AUGUST FANIJAYA TN.
NASRUN BASRI TN
NASRUN BASRI TN
ARYANI SARASWATI NY
JENIFFER AGATHA AN
M. ALI SEKAMIN TN
M. ALI SEKAMIN TN
A. JAMALUDDIN TN.
A. JAMALUDDIN TN.
DAVID ISKANDAR TN
SUSILAWATY NY
TRI RAMADANI NY.
MEIRINDA RUGUN NY
ELIDA BINTI BACHTIAR NY.
ELIYA MARGARITA NY.
ELIYA MARGARITA NY.
ROHIMAH NY.
NAWAL FIKRI ROZAK TN
KMS EFFENDY TN.
KMS EFFENDY TN.
HENDRY RIANTO TN
RINDA UTARI SINAGA AN
231,500.00
160,000.00
10,000.00
268,300.00
223,400.00
160,000.00
10,000.00
230,410.00
1,612,370.00
110,000.00
175,130.00
1,192,000.00
95,000.00
10,000.00
10,000.00
160,000.00
68,415.00
1,612,370.00
10,000.00
160,000.00
10,000.00
125,000.00
160,000.00
10,000.00
160,000.00
472,000.00
228,116.00
10,000.00
167,000.00
60,800.00
60,000.00
60,000.00
220,362.00
160,000.00
10,000.00
241,800.00
176,480.00
177,000.00
10,000.00
1,192,000.00
60,000.00
10,000.00
Page 175
12 MEI 2016
SITI MARIAM NY
SITI MARIAM NY
ARSENIO CETTA AN.
SITI AISYAH AN.
CHAIRUL SEMIDANG TN.
T EVITA SYAHRIZAD NY
JAMILAH BINTI GUNAWAN NY.
ZURIATI BINTI LUTHAIN NY
MEI KURNIATI NY
MUHAMMAD AMIN TN.
RAFA ALVARO AN
EFVA OCTAVINA DONATA GOZALI NY
SUYADI H. TN
NYIMAS FATIMAH NY.
TAN SIUH WAN NY
JERRY SETIAWAN AN
SANURIA BINTI SANAWI NY
ZALEHA AZIZ DRA NY.
MARTO JOYO BIN AKIN TN
WARDIAH IDRIS NY
ANNISA BINTI ARSYADI Y AN.
LISIANA OSWARI NN.
DWI YANA FIRMAWATIE NY
102,000.00
10,000.00
167,000.00
137,900.00
110,000.00
418,200.00
10,000.00
160,000.00
501,425.00
147,200.00
389,800.00
94,880.00
92,156.00
239,257.00
160,000.00
10,000.00
446,850.00
110,000.00
587,600.00
1,192,000.00
418,924.00
440,112.00
110,000.00
254,140.00
635,185.00
60,000.00
72,000.00
60,000.00
10,000.00
177,000.00
455,650.00
238,954.00
60,000.00
120,000.00
559,200.00
488,200.00
305,000.00
10,000.00
160,000.00
222,000.00
10,000.00
137,000.00
Page 176
12 MEI 2016
ARKAAN AKHMAD RIANSYAH AN.
ELLA ARIANI NY
NURI KARTIKA SARI NY
ROPEAH BINTI A. GOPA NY.
LASTRI ANITA NY
SHINTA PARAMITA NY
TRI NUNGKI AZIZAH AN.
RONGGO WARSITO TN
CINDY MARDENA NY
PUJI ASTUTI NY
M.JUNAIDI DRS TN.
LENI APRIYANTI NY
NURAIJAH BINTI NAZARUDDIN NY
SRI UTAMI BINTI M. AMAN NY.
M. SULTAN FAWWAZ AN.
INDAH TRI UTAMI NY.
FEMILIA MARLINA NY.
FEMILIA MARLINA NY.
YATIN. S TN.
MUHAMMAD MIFTHAURRAHMAN AN.
HOIRIAH BINTI AHMAD NY.
MARDIANA KUSUMA NY.
SRI MULYATI NY
SRI MULYATI NY
SITI ELVINA YENI NY.
JIHAN MAURA ZHAFIRA AN
NURISAH BINTI ABDULLAH NY
JUSRIZAL RUSLAN TN
SITI AISYAH NY
NUR KHORIYA SABILA NY.
NURMALA DEWI NY.
NURMALA DEWI NY.
110,000.00
318,085.00
10,000.00
160,000.00
202,945.00
354,000.00
416,250.00
222,900.00
135,625.00
10,000.00
160,000.00
98,378.00
333,697.00
169,748.00
880,000.00
10,000.00
160,000.00
204,800.00
214,603.00
115,000.00
180,000.00
179,700.00
60,000.00
302,145.00
160,000.00
10,000.00
265,362.00
120,000.00
120,000.00
253,800.00
110,000.00
364,085.00
160,000.00
10,000.00
286,400.00
68,455.00
134,193.00
117,623.00
87,915.00
207,585.00
160,000.00
10,000.00
Page 177
12 MEI 2016
ANDY ANDRY TN
WAHYU MARDIANSYAH AN.
NIKMAH SAID TOYIB NY
HAMDI BIN M. NIZAR TN
M.GAOQI FADHAILILAH AN.
BILQIS JIHAN SHADIQAH AN.
VIKA EFRINA NY
ARYA RAMADHAN AN
SRI PURNAMAWATI NY.
LIM JOHO HALIM TN
WULANDARI BINTI BASIRUN N NY.
MUHAMMAD DYLAN ARTHABRATA AN.
TJUNG SEN WAN NY.
TJUNG SEN WAN NY.
TJOE HOEN NIO NY.
EMA ANDALYA NY.
RICKY RIANSYAH AN.
MARJOHAN BIN M YASIN TN
YEMILIA BINTI YURHAN NY
AURELIA PUTRI FADILAH AN
NINGSIH BINTI KUSNADI NY.
DWI CRISTIANI NY
TUTI BINTI DANI MANSYUR H. NY
YATINO BIN YADIMAN TN
SRI PURNAMAWATI NY.
TANG WEI HENG NY
MUHAMMAD YUNUS TN.
216,500.00
160,000.00
10,000.00
242,800.00
160,000.00
60,000.00
120,000.00
174,400.00
60,000.00
110,000.00
71,700.00
420,370.00
66,580.00
233,620.00
148,400.00
160,000.00
10,000.00
120,385.00
272,953.00
222,000.00
107,600.00
319,600.00
102,400.00
273,985.00
193,585.00
71,450.00
202,800.00
60,000.00
99,450.00
71,450.00
79,450.00
420,370.00
71,450.00
60,000.00
60,000.00
187,450.00
71,450.00
60,000.00
60,000.00
395,600.00
1,192,000.00
71,450.00
Page 178
12 MEI 2016
SOFIA AZZAHRA AN.
KERRIN NATHANIA AN.
UMAR H TN.
EDDY MAKSURI TN.
MIRZA RASYID AL AHMAD AN.
RASKAN ANIDA HASTUTI NY.
M. BAYU SAPUTRA AN.
NETTY NETTY NY.
AS AD SAYUTI DRS TN
AS AD SAYUTI DRS TN
SUSILAWATI BINTI ABU NY
MUHAMMAD TONI TN.
MUHAMMAD TONI TN.
ME. LEONAWATI NN.
MULYADI CUAN BIE TN
ISMI JELITA NY
ROMVINA SIALLAGAN NY
FAJRIAH PURNAMA NY.
WITA KUSUMA AYU NN
SARTIKA BINTI SANUSI NN
RIZAL FAUZI TN.
LOUIS ALVARO AN.
MSY LUTFIAH NN
FATHIAN FAUZANNY A. AN
MARLENA BINTI ZAKARIA NY
PETRUS THEORANDA TAUFIK TN
INDRA SANDI TN
ZAINAB HJ BINTI A.WAHID NY.
SOEHERMAN H TN.
MANTHO HARUN TN
MUHAMMAD DAVIN AN.
WARDIAH NY
60,000.00
60,000.00
130,800.00
71,450.00
99,450.00
148,638.00
205,400.00
110,000.00
151,280.00
167,000.00
10,000.00
128,787.00
160,000.00
10,000.00
244,954.00
224,831.00
137,050.00
71,450.00
341,780.00
261,360.00
98,600.00
194,400.00
222,000.00
222,000.00
74,250.00
120,000.00
275,650.00
122,400.00
10,000.00
160,000.00
163,450.00
159,441.00
104,600.00
454,450.00
349,550.00
182,400.00
99,787.00
88,200.00
160,000.00
10,000.00
10,000.00
125,000.00
Page 179
12 MEI 2016
ABRISAM NUH AL FATIH AN
SHINTA HASANA NY.
SHINTA HASANA NY.
NOVENDA ALIANDO TN
DEBIANSYAH BIN M. RIZAL TN
PITRUS BISMAR SAMOSIR TN.
DEWI TRI UTAMI NY
SUKANTO KESUMAH TN
M. ROBBY SETIAWAN TN.
ZUBAIDAH HJ NY
FEBY SETIAWAN TN
M MIFTAH FAUZUN AN
WALANG POTOK NY
IKA YUNIZAR NY.
ROSMANIAH BINTI DAMIRI NY
FERNANDO AKBAR HARDIANSYAH AN
ELLYCE TABITA NN
ONG LAM KIONG TN.
CITRA MAYA SARI NN.
SUGIARTO TN
ELVIRA BINTI AWALUDIN NY
MIKHAEL RUKINEM NY.
REYQAL OKTAMA AN.
M.FAUZHAN HABIBIE AN
110,000.00
10,000.00
125,000.00
102,500.00
83,800.00
267,281.00
164,085.00
197,200.00
190,770.00
189,000.00
60,000.00
163,300.00
320,556.00
342,022.00
451,900.00
102,400.00
102,400.00
147,500.00
254,196.00
59,800.00
60,000.00
137,400.00
324,900.00
60,000.00
Page 180
13 MEI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
130516430020
130516430312
130516450208
130516380823
130516430094
130516430023
130516420570
130516280525
130516430015
130516280543
130516430220
130516430109
130516420734
130516450191
130516280494
130516430017
130516430019
130516280845
130516430018
130516430022
130516390227
130516450197
130516430035
130516380906
130516380903
130516450396
130516280502
130516450186
130516450150
130516450157
130516450155
130516450161
130516450154
130516450156
130516450139
130516450013
130516450021
130516420854
130516450016
130516430096
130516450057
TANGGAL
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
Page 181
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160000986
0090R03105160002170
0090R03105160002195
0090R03105160002641
0090R03105160002662
0090R03105160002668
0090R0310516000268
0090R03105160002718
0090R03105160002754
0090R03105160002760
0090R03105160002760
0090R03105160002761
0090R03105160002766
0090R03105160002767
13 MEI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
130516450063
130516430014
130516450012
130516450298
130516450308
130516450011
130516430040
130516430038
130516450142
130516430030
130516450328
130516430042
130516430043
130516450055
130516450039
130516430034
130516450351
130516430050
130516430049
130516450060
130516450059
130516430029
130516430048
130516450293
130516450352
130516430099
130516430100
130516430103
130516430102
130516430131
130516450134
130516450113
130516390207
130516450108
130516450112
130516450061
130516450091
130516450058
130516430053
130516450056
130516430170
130516430175
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
05/13/2016
Page 182
0090R03105160002768
0090R03105160002769
0090R03105160002770
0090R03105160002771
0090R03105160002771
0090R03105160002772
0090R03105160002773
0090R03105160002773
0090R03105160002774
0090R03105160002775
0090R03105160002776
0090R03105160002777
0090R03105160002777
0090R03105160002778
0090R03105160002778
0090R03105160002779
0090R03105160002780
0090R03105160002781
0090R03105160002781
0090R03105160002782
0090R03105160002782
0090R03105160002783
0090R03105160002784
0090R03105160002785
0090R03105160002786
0090R03105160002787
0090R03105160002787
0090R03105160002788
0090R03105160002788
0090R03105160002789
0090R03105160002790
0090R03105160002790
0090R03105160002791
0090R03105160002792
0090R03105160002792
0090R03105160002793
0090R03105160002794
0090R03105160002795
0090R03105160002796
0090R03105160002797
0090R03105160002798
0090R03105160002798
13 MEI 2016
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
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0090R03105160002810
0090R03105160002811
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0090R03105160002813
0090R03105160002814
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0090R03105160002824
0090R03105160002825
0090R03105160002827
0090R03105160002828
0090R03105160002829
0090R03105160002830
13 MEI 2016
126
127
128
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130
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132
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134
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136
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130516450257
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130516430163
130516390249
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130516390332
130516430217
130516450181
130516430147
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130516450381
130516430069
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130516430408
130516430406
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130516390357
130516390275
130516390214
130516390264
130516450213
130516390229
130516450143
130516390211
05/13/2016
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0090R03105160002860
0090R03105160002860
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0090R03105160002862
0090R03105160002863
0090R03105160002864
0090R03105160002866
0090R03105160002867
0090R03105160002869
13 MEI 2016
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
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130516390300
130516450189
130516450243
130516430212
130516430310
130516450309
130516390242
130516390337
130516430230
130516390342
130516450280
130516430294
130516390375
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130516430281
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130516380731
130516380732
130516390370
130516280726
130516280722
130516390279
130516420489
130516430296
05/13/2016
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0090R03105160002890
0090R03105160002890
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0090R03105160002892
0090R03105160002893
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0090R03105160002895
0090R03105160002898
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0090R03105160002900
0090R03105160002901
0090R03105160002902
0090R03105160002903
0090R03105160002904
0090R03105160002904
0090R03105160002905
0090R03105160002905
0090R03105160002906
0090R03105160002907
0090R03105160002907
0090R03105160002908
0090R03105160002909
0090R03105160002910
13 MEI 2016
210
211
212
213
214
215
216
217
218
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220
221
222
223
224
225
226
227
228
229
230
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130516430395
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130516380760
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130516450326
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130516280786
130516430333
130516280738
130516280740
130516430445
130516280785
130516450387
130516380669
05/13/2016
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0090R03105160002925
0090R03105160002926
0090R03105160002927
0090R03105160002928
0090R03105160002929
0090R03105160002930
0090R03105160002931
0090R03105160002933
0090R03105160002934
0090R03105160002936
0090R03105160002937
0090R03105160002938
0090R03105160002939
0090R03105160002940
0090R03105160002941
0090R03105160002942
0090R03105160002943
0090R03105160002944
0090R03105160002944
0090R03105160002945
0090R03105160002946
0090R03105160002947
0090R03105160002949
0090R03105160002950
0090R03105160002951
0090R03105160002952
0090R03105160002953
0090R03105160002954
0090R03105160002956
13 MEI 2016
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
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130516380892
130516380624
130516380625
130516430384
130516280887
130516280881
130516280551
130516280550
130516420870
130516420868
130516380580
130516380578
130516280604
130516280597
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130516420590
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130516380469
130516280614
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130516280702
130516280661
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130516420485
130516380820
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130516420725
05/13/2016
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0090R03105160002988
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0090R03105160002992
0090R03105160002993
0090R03105160002994
0090R03105160002995
0090R03105160002996
0090R03105160002997
0090R03105160002998
0090R03105160002999
0090R03105160003000
0090R03105160003001
0090R03105160003002
13 MEI 2016
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
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310
311
312
313
314
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130516280898
130516280902
130516420511
130516420708
130516280904
130516380467
130516380466
130516280594
130516420486
130516380671
130516380673
130516420602
130516380507
130516380508
130516380455
130516430447
130516380520
130516380519
130516280491
130516280643
130516280642
130516420774
130516380748
130516380475
130516380463
130516380581
130516280497
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130516280531
130516380741
130516280718
130516280737
130516280698
130516420484
130516380454
130516420706
130516450162
130516280712
130516280493
130516420871
130516380464
130516380662
05/13/2016
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0090R03105160003016
0090R03105160003017
0090R03105160003017
0090R03105160003019
0090R03105160003020
0090R03105160003021
0090R03105160003022
0090R03105160003024
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0090R03105160003026
0090R03105160003027
0090R03105160003028
0090R03105160003029
0090R03105160003030
0090R03105160003031
0090R03105160003032
0090R03105160003033
0090R03105160003038
0090R03105160003039
0090R03105160003040
0090R03105160003041
0090R03105160003042
0090R03105160003043
0090R03105160003044
0090R03105160003045
0090R03105160003046
0090R03105160003047
13 MEI 2016
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
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130516280839
130516280529
130516280900
130516380894
130516280615
130516420569
130516420576
130516420628
130516380844
130516280606
130516380558
130516420749
130516420865
130516380717
130516420703
130516380577
130516380575
130516280556
130516280528
130516420613
130516420623
130516280565
130516280563
130516380562
130516280564
130516420863
130516280889
130516420534
130516280864
130516280547
130516380817
130516280866
130516280607
130516280862
130516380635
130516280910
130516280688
130516380736
130516280901
130516280609
130516280812
130516420695
05/13/2016
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0090R03105160003060
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0090R03105160003062
0090R03105160003063
0090R03105160003064
0090R03105160003066
0090R03105160003066
0090R03105160003067
0090R03105160003068
0090R03105160003069
0090R03105160003070
0090R03105160003071
0090R03105160003072
0090R03105160003073
0090R03105160003074
0090R03105160003076
0090R03105160003077
0090R03105160003079
0090R03105160003081
0090R03105160003082
0090R03105160003083
0090R03105160003084
0090R03105160003085
0090R03105160003086
0090R03105160003087
0090R03105160003089
0090R03105160003090
0090R03105160003091
0090R03105160003092
0090R03105160003093
0090R03105160003094
0090R03105160003095
13 MEI 2016
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
130516420696
130516280915
130516280601
130516380914
130516280699
130516420626
130516380647
130516280700
130516420724
130516380799
130516420851
130516380936
130516280943
130516450295
130516280876
130516420771
130516380681
130516450304
130516280891
130516390329
130516420859
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0090R03105160003095
0090R03105160003097
0090R03105160003098
0090R03105160003099
0090R03105160003100
0090R03105160003102
0090R03105160003103
0090R03105160003107
0090R03105160003108
0090R03105160003109
0090R03105160003113
0090R03105160003118
0090R03105160003214
0090R03105160004323
0090R03105160004850
0090R03105160004862
0090R03105160004868
0090R03105160008132
0090R03105160008134
MASUK RAWAT INAP
MASUK RAWAT INAP
13 MEI 2016
NAMA PASIEN
AZ ZUHRI AN.
DEDY SUMARDI TN
DIAN UTAMA JENAHAR TN
ENDAR JAYA TN
FARIDA ABIDIN NY
M. SALMAN AL FARIZI AN
M.ZAKKY AZAMI SAUQI AN.
MAYURI HASANI TN
MUSA ISMAIL DRS TN
NASRY BIN YUSUF TN
NURAINI BINTI SYARKOWI, H NY.
NURYANTO TN.
NYIMAS NURMANI NY.
RAISYA GAYATRI AN
RIANDY KAREL TUMANGGOR AN.
RUBIJO BIN A MARDI TN.
SHAFA AULIA NUR AFDILLAH AN
SURATMI NY
SUSANTI TASLIM NY
SUYANTO SULISTIO TN.
WIDI METRI HARDINI NN
YUNIAR MUSA NY.
FIRMANSYAH MUNAF . K TN.
NICKY VERDIANTO TN.
HARBEI PASAH TN
AHMAD MAULANA TN
IRAWATI BINTI MAZENI NY
HOTNA INDRIANI AN
KALSUM IBRAHIM NY.
RISMINA BINTI H ABDUROHMAN NY.
SARDJONO, H TN
DEWI JUWITA. NY
TRANSAKSI
198,000.00
129,000.00
174,400.00
128,800.00
86,400.00
69,000.00
87,000.00
11,450.00
174,000.00
28,000.00
27,487.00
19,870.00
31,180.00
58,000.00
337,200.00
125,040.00
155,970.00
65,865.00
278,850.00
78,000.00
512,000.00
74,500.00
78,000.00
11,200.00
315,000.00
7,000.00
71,000.00
234,400.00
1,192,000.00
1,192,000.00
1,192,000.00
1,192,000.00
1,192,000.00
1,192,000.00
217,000.00
71,040.00
56,000.00
1,367,200.00
98,200.00
224,800.00
40,000.00
Page 191
13 MEI 2016
M. RIZKY ADITYA ARYANSAH AN.
N. ACHMAD ABUMAN TN
NOVI MARTADINATA TN
SHAFA AULIA NUR AFDILLAH AN
ELIS NILAYATI NY.
ELIS NILAYATI NY.
ZAIDAN ACHMAD TN.
HERIYANTO TN
DIANA NOVITA NY
HENDRA HARTANTO TN.
HENDRA HARTANTO TN.
SYAMSUL ARIF TN
RONIMAH NY
RONIMAH NY
JACUB RAHMAN TN.
MAYA E LEBIS NY.
MAYA E LEBIS NY.
MUTIAR DJANAN TN
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
A. SANUSI TN
DEAN BUTAR BUTAR AN..
HASLINDA ARSAN NY.
JENIFFER AGATHA AN
LELY WATI NY
NOVENDA ALIANDO TN
NOVENDA ALIANDO TN
147,300.00
141,600.00
78,150.00
150,600.00
1,192,000.00
223,000.00
125,000.00
10,000.00
248,060.00
1,192,000.00
1,192,000.00
10,000.00
160,000.00
177,000.00
10,000.00
273,800.00
384,200.00
160,000.00
10,000.00
91,000.00
10,000.00
214,800.00
60,000.00
60,000.00
1,192,000.00
10,000.00
160,000.00
160,000.00
10,000.00
329,085.00
183,000.00
10,000.00
291,795.00
10,000.00
160,000.00
218,400.00
115,000.00
548,200.00
110,000.00
60,000.00
10,000.00
102,000.00
Page 192
13 MEI 2016
BARLIAN YASIN H SH TN.
YUSNI BINTI M. SABKI NY.
SURYA MEGAWATI NY
SURYA MEGAWATI NY
ELLYANA ROSITA NY.
ELLYANA ROSITA NY.
M. ALI SEKAMIN TN
H ABDUL GHOPAR, SH TN.
ELIYA MARGARITA NY.
ELIYA MARGARITA NY.
SUTASMI NY
RUSNAINI BINTI IBRAHIM A. NY
AMINAH BINTI HAMIRIN NY
ROZANA MEILINDA NY.
ALIDUN SIHOMBING TN
HENGKI PERMANA. TN
DEDY SUMARDI TN
HENDRIK BIN TAN ALIEN TN
PASWANI BINTI HASBULLAH NY
KASMI HELINA HJ NY.
DIKSON MATHEOS TN.
DIKSON MATHEOS TN.
ARTATI BINTI IMAM NY.
HERRY ATAK TN.
NIO KWEE LAN NY.
M.ALWI TN.
60,000.00
160,000.00
10,000.00
661,430.00
160,000.00
10,000.00
160,000.00
10,000.00
60,000.00
279,764.00
10,000.00
160,000.00
128,000.00
374,325.00
10,000.00
160,000.00
78,450.00
225,200.00
216,480.00
125,000.00
10,000.00
10,000.00
160,000.00
222,000.00
313,800.00
10,000.00
125,000.00
10,000.00
160,000.00
268,400.00
177,000.00
10,000.00
218,000.00
235,700.00
125,000.00
10,000.00
254,790.00
72,000.00
93,500.00
215,584.00
357,630.00
60,000.00
Page 193
13 MEI 2016
SRI DARMAYANTI NY.
ARIFIN SITOHANG TN.
ARIFIN SITOHANG TN.
FEBRIANA BINTI HUZAINI NY
WIYANDA VERANUR FAJRIANI NN.
FADILAH BINTI ABDUL NY
ANSYORI RIDUAN TN
SUKANTO KESUMAH TN
LISTI ARMAWATI NY.
TJIKMAD. B TN.
AFFANDY USMAN,SH , MSI TN
ESY MARLIAH NY.
KARTIKA DYAN K NY
MAYURI HASANI TN
SUDARYONO BIN SALAMUN TN.
PUTRO SETYONO TN
NYIMAS NURIA HASNAH NY.
MOHSAN TURIP TN.
IRMA SURYANI NY.
META AFRILIA AMRI NY.
MARDIANA BINTI DAHALIM NY
SITI ROHMA NY
SITI ROHMA NY
AISYAH BIN YATMURI NN.
REMI ASNANI NY
RITA LIZIANA NY
SYAMSIAH BINTI M LEKAT NY
NURYANTO TN.
YULIA DASWATI NY.
177,000.00
10,000.00
336,495.00
10,000.00
160,000.00
294,050.00
264,800.00
117,630.00
225,345.00
232,330.00
1,192,000.00
60,000.00
265,000.00
240,800.00
125,000.00
10,000.00
198,000.00
587,600.00
200,800.00
278,145.00
229,290.00
162,960.00
1,192,000.00
1,192,000.00
10,000.00
160,000.00
216,480.00
193,045.00
228,000.00
343,995.00
234,400.00
270,762.00
60,000.00
125,000.00
10,000.00
193,585.00
264,800.00
327,145.00
196,995.00
373,800.00
249,600.00
264,800.00
Page 194
13 MEI 2016
EDDY MAKSURI TN.
TJIUW TJIN HE TN.
ISMET TUSSAL TN.
ADAM MALIK TN.
AZ ZUHRI AN.
HERSAN BIN AMRIN TN
DINNI PUSPASARI NY.
AYU PUTRI ANDARIETA NN.
SYEHABUDIN BIN M DAUNI TN
SAHINGIN BIN ALI AMA TN
KHAIRA DEWI CANTIKA AN.
DEWI ALINA BERLIAN, HJ NY
ROMZI HASYIM TN
FITRIANA BINTI HAZALI NY
NURHAYATI BINTI MAJID NY
NYIMAS JUNAINA DRA NY
LASTRI ANITA NY
UUT TRIANI NY.
SUKAINAYATI BINTI MUHAYAN NY.
ASNAH MADANI A. HJ. NY
DWI NOVITA KUSUMAWATI NY
JANSEN FIRMAN M TN
CARISSA ADELIA AN.
YEMIAR HJ. NY.
SETIA WATI NY
SETIA WATI NY
RIZKY MAULANA ANUGRAH AN.
SITI SALMIJATI NY
AULIA KAMILA RAMADHANI AN.
523,185.00
182,400.00
180,000.00
240,800.00
78,900.00
60,000.00
241,590.00
80,610.00
60,000.00
138,000.00
937,000.00
280,000.00
60,000.00
125,756.00
208,200.00
180,000.00
125,000.00
10,000.00
226,100.00
160,000.00
10,000.00
205,500.00
384,200.00
237,915.00
88,530.00
110,000.00
109,914.00
463,500.00
193,585.00
276,400.00
120,000.00
115,000.00
160,000.00
10,000.00
10,000.00
95,000.00
71,250.00
10,000.00
160,000.00
163,320.00
895,585.00
307,500.00
Page 195
LENAWATI
13 MEI 2016
REYSHA ALMIRA NAGITA PUTRI AN.
NURHAYATI BINTI NUNGCIK NY.
FITRI YULIANTY NY
SUSI BINTI THENG CING KOK NN
BADRIYAH BINTI M. ZAINUDDIN NY
NURHAINI BINTI M. ZEN NY
ALFATH BIN OKTA PERIANSYAH AN.
VERONICA WINARTI NY.
JAPRIANSYAH BINTI ABDUL R TN.
NUR AINI NY.
ROHANI TOHA NY
M. IMRON TN.
MARYANI BINTI K ARAHMAN NY.
SOPINAH BINTI SAPEIH NY
RENDI JOAN NUGRAHA TN
KIKI MARIA NY.
RIFFAT JAZMI RAZIQ AN
MURNI KURNIASARI NY
RIO HUTABARAT TN.
ANI HASAN NY
NURMALA NY.
YANTI SAFITRI NY.
INGGRITA SAPUTRI RAHAYU NN
AMANDA KUSUMA NY.
AMANDA KUSUMA NY.
GATOT SUGEMTO TN
SITI AZKIYA PUTRI AN.
SITI FARIDA NY.
CHAIRUL SALEH TN.
ALFONS SISWADI TN
RUSTAM HALIM TN
ENDANG HENY HENDRIYATI NY
RUSNIARTI BINTI RUSTAM NY.
166,135.00
612,950.00
10,000.00
160,000.00
60,000.00
259,036.00
163,020.00
152,520.00
60,000.00
635,185.00
110,000.00
316,675.00
313,800.00
233,584.00
110,000.00
107,350.00
257,000.00
212,000.00
488,200.00
635,185.00
110,000.00
209,315.00
110,000.00
1,021,900.00
110,000.00
1,192,000.00
525,600.00
60,000.00
1,192,000.00
528,800.00
323,785.00
30,000.00
313,800.00
77,000.00
1,192,000.00
70,800.00
390,330.00
586,000.00
166,875.00
1,192,000.00
194,650.00
1,196,600.00
Page 196
13 MEI 2016
SITI ASIAH NY.
AMIR HAMZAH TN
AMIR HAMZAH TN
NURMINAH M HUTASUHUT HJ NY.
HARMADI LATIEF TN.
ENDANG SUDARMI NN.
MUHAMMAD TONI TN.
JUNAIDA PRIANI NY
HILMA YORITA NY
HARIS FADILA TN
UMIYATI BINTI ANWAR NY.
ISKANDAR ZULKARNAIN SE TN.
MUHAMMAD NUR TN.
M. DZAKY SALFIANSYAH AN.
HENDRY GOZALI TN
SUSANTI TASLIM NY
OKTA SAPUTRA TN
DIYAH RACHMAWATY NY.
ARBAIN GANTI TN
TJOE HOEN NIO NY.
LANIYATI NY.
HERWIN CIPUTRA TN
LINDA HALIM NY
HENY SOFNIAR NY.
NURYANI BINTI ABDULLAH NY.
SITI FATIMAH NY
OLIVER CHRIS W AN
M. FAHRY MAIZA AN.
SUSILA S NATAWIRIA TN.
TJIK ISA NY.
236,600.00
10,000.00
167,000.00
193,000.00
117,200.00
384,200.00
187,450.00
99,450.00
135,000.00
60,000.00
137,450.00
125,600.00
294,920.00
451,350.00
425,470.00
60,000.00
81,000.00
60,000.00
98,790.00
176,000.00
195,000.00
60,000.00
107,450.00
1,192,000.00
60,000.00
1,192,000.00
255,450.00
68,000.00
60,000.00
136,130.00
421,415.00
133,600.00
239,000.00
60,000.00
507,300.00
60,000.00
60,000.00
60,000.00
163,700.00
870,800.00
1,033,900.00
316,830.00
Page 197
13 MEI 2016
EL FATH HARRIS ABQORI AN
AFANDY BIN SAMSUDIN TN.
NOVIYANTI NY.
ASMA WATI NY.
NURLAILA BINTI M.SYAFYUDIN NY.
APRIANI NY.
EDUARDUS EDDY SUPRAPTO TN.
AQUILINA SRI RUSNIATI NY.
MURTIANA BINTI SOPIAN NY
ISMI JELITA NY
ISMI JELITA NY
SRI NUR IRIANTI NY.
RADEN AYU ERMA HJ SE NY
NURLAILA PERMATASARI NY.
ZAHIDAH BINTI CEK NUNGCIK NY.
ROMLAH AZHARI ,HJ NY.
M. ARIF BONDAN TN.
KASMIATUN BINTI KARTO NY
AYU ASTUTI NY.
M SYAFEI WAHID TN
SYAHRIR YASIN TN
YUNIAR MUSA NY.
H. IDRUM SOBRIE HI TN.
EDDI AZ TN.
TINA MARLINA NY
DAVID ISKANDAR TN
ERNA KURNIATY NY.
SISWANTY K. R NY.
RORA DONA NN.
LIU HENDRY TN.
MIKHAEL RUKINEM NY.
JO SIOE LING NY.
LASMINA BR. SILALAHI NY.
M. WIM PENGEMANAS SUGIA AN.
60,000.00
573,170.00
92,400.00
284,175.00
251,030.00
160,000.00
10,000.00
239,600.00
120,000.00
241,000.00
108,400.00
63,500.00
10,000.00
200,000.00
135,640.00
240,800.00
160,000.00
10,000.00
264,560.00
81,695.00
117,330.00
625,800.00
470,200.00
60,000.00
1,041,900.00
244,500.00
183,000.00
60,000.00
195,000.00
365,250.00
214,531.00
313,800.00
190,000.00
200,800.00
161,400.00
104,000.00
1,192,000.00
79,000.00
419,450.00
1,081,900.00
261,770.00
60,000.00
Page 198
13 MEI 2016
ABDUL RONI TN.
M ABID RAGENDRA AN
MIRUSDIN BIN YAMAN TN.
MUHAMMAD AZKA AKBAR AN
NUR ASIA YANTI NY
NINA SEPTIANA NY.
SUKESIH BINTI SAMSURI NY.
SRI SUPATMI NY.
YULIANA HASAN NY
ALI HASAN TN
ROCHMAH BINTI ADBUL MALIK NY
MUHAMMAD FADLI TN
SHINTA HASANA NY.
AFRILLINA NY
TUTI ATIKA NY.
ANGGAHANI PUTRA PERMADANI AN
NURSYAWALI KANIA AYUDIA AN
SYAKHISYAH RAFIFAH LUTFIAH AN.
LENI SUSANTI. DR. NY.
ABU BAKAR AHMAD TN.
A. MURSALIN. SE. TN.
SRI YULIDAR NY.
ALESHA ZAHRA AN.
M. SALMAN AL FARIZI AN
ROHINAH,HJ BINTI H.A.RAHMAN NY
M HABIBULLAH AN.
SANTI BINTI SYAFEI CHAN NY.
M. ADRIAN A TN.
HASMAH ALI HASAN NY
ANWAR MALIK,H TN.
RIDUAN YUSUF TN.
NUZUL QURNIATI NY
HASINI THOYIB NY.
KGS M RUSDI TN
FARIDA ABIDIN NY
ROBBY PANCA MAULANA TN
110,210.00
60,000.00
749,670.00
60,000.00
326,495.00
488,200.00
174,400.00
180,000.00
520,500.00
93,050.00
488,200.00
316,350.00
60,000.00
470,200.00
120,500.00
160,000.00
10,000.00
193,585.00
234,400.00
105,300.00
78,900.00
166,890.00
402,420.00
150,536.00
357,920.00
70,000.00
60,000.00
102,400.00
1,582,750.00
155,000.00
60,000.00
1,478,300.00
102,395.00
1,571,900.00
110,000.00
384,200.00
111,691.00
646,300.00
235,000.00
264,800.00
1,163,200.00
10,000.00
Page 199
13 MEI 2016
RAFFASYA ZIDAN HISYAM AL A AN
HERI PURWANTO TN
ATIKA ROSANTI NY.
ROSA DESITA NY.
MUSA ISMAIL DRS TN
BAHRIA ROMLIYUNUS NY.
LENAWATI NY
RAISYA GAYATRI AN
SOPIYAH UTARI BY NY
AMALIA OKTARINA BY NY
MELVA BINTI RAIS NY
KHUMAIRAH CHISCHARIA YAZID AN.
MUHAMMAD EFFENDI TN
AINI BINTI AHMAD SAFAWI NY.
ANSHOR HALIMUDIN TN
UDNI USMAN, S.PD TN
ALVER AZHAR SAFARAZ AN.
M. IRZAN TN.
177,000.00
409,600.00
106,995.00
413,075.00
119,691.00
102,400.00
152,600.00
143,200.00
102,400.00
212,000.00
143,200.00
60,480.00
220,800.00
228,000.00
285,400.00
402,755.00
395,700.00
174,400.00
453,450.00
139,800.00
89,860.00
Page 200
14 MEI 2016
NO
1
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23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
NO RJ
140516280753
140516450053
140516380061
140516390451
140516450059
140516380062
140516280126
140516450052
140516450044
140516450045
140516450048
140516450050
140516450217
140516450047
140516450054
140516450321
140516450051
140516390768
140516380267
140516450021
140516450018
140516450016
140516450015
140516450014
140516450012
140516450017
140516450020
140516450025
140516450023
140516450035
140516450022
140516280233
140516280232
140516380240
140516450037
140516450038
140516450030
140516450033
140516450028
140516450029
140516450026
TANGGAL
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
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SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160002955
0090R03105160003105
0090R03105160003119
0090R03105160003120
0090R03105160003121
0090R03105160003123
0090R03105160003124
0090R03105160003127
0090R03105160003131
0090R03105160003133
0090R03105160003134
0090R03105160003136
0090R03105160003137
0090R03105160003138
0090R03105160003138
0090R03105160003139
0090R03105160003140
0090R03105160003140
0090R03105160003141
0090R03105160003141
0090R03105160003142
0090R03105160003142
0090R03105160003143
14 MEI 2016
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79
80
81
82
83
140516450027
140516450011
140516450056
140516450058
140516390687
140516380064
140516380065
140516450072
140516450073
140516450074
140516450075
140516280125
140516280123
140516280243
140516390689
140516450098
140516450099
140516280129
140516280132
140516380101
140516380094
140516380095
140516280237
140516380141
140516380142
140516380138
140516380139
140516280263
140516280261
140516380147
140516280265
140516280264
140516450215
140516450216
140516280178
140516280175
140516280190
140516280189
140516430600
140516430601
140516390688
140516280399
05/14/2016
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05/14/2016
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05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
Page 202
0090R03105160003143
0090R03105160003144
0090R03105160003145
0090R03105160003145
0090R03105160003146
0090R03105160003147
0090R03105160003147
0090R03105160003148
0090R03105160003148
0090R03105160003149
0090R03105160003149
0090R03105160003150
0090R03105160003150
0090R03105160003151
0090R03105160003151
0090R03105160003152
0090R03105160003152
0090R03105160003153
0090R03105160003153
0090R03105160003154
0090R03105160003155
0090R03105160003155
0090R03105160003156
0090R03105160003157
0090R03105160003157
0090R03105160003158
0090R03105160003158
0090R03105160003159
0090R03105160003159
0090R03105160003160
0090R03105160003162
0090R03105160003162
0090R03105160003163
0090R03105160003163
0090R03105160003164
0090R03105160003164
0090R03105160003165
0090R03105160003165
0090R03105160003166
0090R03105160003166
0090R03105160003167
0090R03105160003168
14 MEI 2016
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
140516280397
140516450281
140516380246
140516380251
140516280239
140516280337
140516280331
140516380252
140516380259
140516380342
140516380344
140516430470
140516280300
140516280298
140516380067
140516280401
140516280402
140516390452
140516390456
140516390513
140516380312
140516380313
140516380407
140516380408
140516280355
140516280363
140516450350
140516450366
140516450110
140516380167
140516380135
140516380131
140516450404
140516450405
140516380288
140516390420
140516430519
140516450262
140516280669
140516280671
140516390685
140516280677
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
Page 203
0090R03105160003168
0090R03105160003169
0090R03105160003170
0090R03105160003170
0090R03105160003171
0090R03105160003172
0090R03105160003172
0090R03105160003173
0090R03105160003173
0090R03105160003174
0090R03105160003174
0090R03105160003175
0090R03105160003176
0090R03105160003176
0090R03105160003177
0090R03105160003178
0090R03105160003178
0090R03105160003179
0090R03105160003179
0090R03105160003180
0090R03105160003181
0090R03105160003181
0090R03105160003182
0090R03105160003182
0090R03105160003183
0090R03105160003183
0090R03105160003185
0090R03105160003185
0090R03105160003187
0090R03105160003188
0090R03105160003188
0090R03105160003188
0090R03105160003189
0090R03105160003189
0090R03105160003190
0090R03105160003192
0090R03105160003193
0090R03105160003195
0090R03105160003196
0090R03105160003196
0090R03105160003197
0090R03105160003198
14 MEI 2016
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
140516450318
140516450275
140516280254
140516390684
140516280640
140516390683
140516390662
140516280347
140516390686
140516380368
140516390682
140516390442
140516390454
140516390467
140516390468
140516280663
140516390651
140516390692
140516430720
140516280723
140516390738
140516390758
140516450039
140516450040
140516280495
140516450036
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
05/14/2016
Page 204
0090R03105160003199
0090R03105160003200
0090R03105160003201
0090R03105160003202
0090R03105160003203
0090R03105160003203
0090R03105160003204
0090R03105160003205
0090R03105160003206
0090R03105160003207
0090R03105160003208
0090R03105160003210
0090R03105160003211
0090R03105160003213
0090R03105160003213
0090R03105160003220
0090R03105160003226
0090R03105160003227
0090r03105160003228
0090R03105160003230
0090R03105160003231
0090R03105160003233
0090R03105160003532
0090R03105160003622
0090R03105160003627
0090R03105160004318
14 MEI 2016
NAMA PASIEN
ARDIYANSYAH AN
DEWI AMBAR NY
DEWI AMBAR NY
ELIYA MARGARITA NY.
GANEF ISKANDAR TN.
HERWIN CIPUTRA TN
LINDA HALIM NY
NETI HARTINI NY.
RORA DONA NN.
SRI NUR IRIANTI NY.
WIRDANILA BINTI SIROJUDIN NY
DWI RAHMI PRAFITA NN
ERNAWATI HJ BINTI M. AZAM NY
NYIMAS ZUBAIDAH, S.PD NY.
WALANG POTOK NY
PUJI ASTUTI BY NY
SRI PURNAMA DEWI NY.
MUHAMMAD IRFAN TN
ALLICE TEMAWATY NY.
TRI WULANDARI NY
NOVI DITYA.NY
DESTRI KUMALA SARI NN
KAROLINA NY.
KAROLINA NY.
SUGINAH ABBAS NY.
SUGINAH ABBAS NY.
M. ABBAS HASAN TN
TRANSAKSI
155,700.00
66,900.00
58,000.00
87,130.00
198,000.00
198,000.00
58,000.00
249,000.00
3,150.00
78,300.00
48,750.00
200,970.00
10,700.00
198,000.00
350,970.00
58,000.00
108,000.00
7,630.00
60,000.00
224,900.00
70,460.00
74,068.00
48,600.00
155,780.00
120,103.00
151,658.00
138,600.00
306,000.00
233,490.00
89,313.00
282,500.00
10,000.00
177,000.00
1,192,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
Page 205
14 MEI 2016
M. ABBAS HASAN TN
RORA DONA NN.
ZAIDAN ACHMAD TN.
ZAIDAN ACHMAD TN.
HARBEI PASAH TN
A. JAMALUDDIN TN.
A. JAMALUDDIN TN.
E. SIMATUPANG TN
E. SIMATUPANG TN
NASRUN BASRI TN
NASRUN BASRI TN
SHOFWAN TN.
SHOFWAN TN.
ELLY ZAMAR NY.
ELLY ZAMAR NY.
NURLIANA SALIM NY
NURLIANA SALIM NY
SOFIA AZZAHRA AN.
ELIYA MARGARITA NY.
ELIYA MARGARITA NY.
SAIFUL NURAINI TN.
SAIFUL NURAINI TN.
SULAIMAN NADEAK TN.
M. ALI SEKAMIN TN
160,000.00
143,200.00
10,000.00
125,000.00
1,192,000.00
10,000.00
160,000.00
10,000.00
125,000.00
10,000.00
160,000.00
10,000.00
125,000.00
150,600.00
1,192,000.00
10,000.00
160,000.00
10,000.00
95,000.00
105,000.00
10,000.00
160,000.00
1,192,000.00
10,000.00
200,000.00
10,000.00
160,000.00
10,000.00
160,000.00
115,000.00
10,000.00
160,000.00
10,000.00
95,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
167,000.00
1,192,000.00
10,000.00
Page 206
14 MEI 2016
M. ALI SEKAMIN TN
TEGUH BIN HOKSAN TN
JACUB RAHMAN TN.
JACUB RAHMAN TN.
NURMALA DEWI NY.
NURMALA DEWI NY.
SUSILAWATY NY
MULKAS ADE PUTRA TN
MULKAS ADE PUTRA TN
ARBAIN GANTI TN
ARBAIN GANTI TN
KARTINI NY
KARTINI NY
FEMILIA MARLINA NY.
FEMILIA MARLINA NY.
AZWAWI KERIT TN
AZWAWI KERIT TN
MUHAMMAD ZIDANE AN
THERESSIA ASIA NY
THERESSIA ASIA NY
THERESSIA ASIA NY
OKTA SAPUTRA TN
OKTA SAPUTRA TN
DIAN SARA AGUSTINA NN.
RAFA ALVARO AN
AS AD SAYUTI DRS TN
AS AD SAYUTI DRS TN
EDY ABDULLAH TN
95,000.00
1,192,000.00
10,000.00
160,000.00
1,192,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
177,000.00
160,000.00
10,000.00
160,000.00
110,000.00
10,000.00
160,000.00
10,000.00
160,000.00
110,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
40,000.00
51,700.00
88,200.00
157,590.00
10,000.00
177,000.00
98,300.00
110,000.00
110,000.00
120,000.00
10,000.00
167,000.00
1,192,000.00
110,000.00
Page 207
14 MEI 2016
RIO ABDILLAH AN
ERWIN AZHARI TN.
ERWIN AZHARI TN.
NICKY VERDIANTO TN.
M. BAYU SAPUTRA AN.
RUSNAN CHANDRA TN
M. FAHRY MAIZA AN.
TITINSUMARNI NY
ARZA VITO GHAZALI AN
ATRI MULYATI NY
ARDIYANSYAH AN
YULINTIA WINDARLINA NN.
WIRDANILA BINTI SIROJUDIN NY
M HILALI RAMADHAN TN
GARIN WAHYU NUGRAHA TN.
M. FARIZ PRASETYA SILABAN AN.
NUR APRIYANI NY
110,000.00
110,000.00
63,582.00
1,192,000.00
28,200.00
1,192,000.00
1,192,000.00
110,000.00
1,192,000.00
110,000.00
1,192,000.00
110,000.00
110,000.00
10,000.00
167,000.00
180,000.00
54,700.00
211,068.00
174,400.00
166,700.00
202,000.00
102,400.00
148,800.00
443,080.00
83,598.00
110,110.00
Page 208
15 MEI 2016
NO
NO RJ
150516430027
150516430025
150516430028
150516430010
150516430014
150516430016
150516430015
150516430019
150516430026
150516430017
150516430013
150516430011
150516430024
150516430018
150516430043
150516430038
150516430035
150516430036
150516430052
150516430044
150516430032
150516430030
150516430055
150516430093
150516430141
150516430143
150516390146
150516390154
150516390155
150516380180
150516390224
150516390219
150516380230
150516390234
150516380275
150516430039
150516430053
150516430037
TANGGAL
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
05/15/2016
Page 209
15 MEI 2016
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160003235
0090R03105160003236
0090R03105160003237
0090R03105160003239
0090R03105160003240
0090R03105160003241
0090R03105160003242
0090R03105160003243
0090R03105160003245
0090R03105160003246
0090R03105160003248
0090R03105160003249
0090R03105160003251
0090R03105160003252
0090R03105160003253
0090R03105160003256
0090R03105160003260
0090R03105160003261
0090R03105160003266
0090R03105160003267
0090R03105160003270
0090R03105160003517
0090R03105160003618
0090R03105160003624
NAMA PASIEN
A. SANUSI TN
HENY SOFNIAR NY.
ISKANDAR ZULKARNAIN SE TN.
LISTI ARMAWATI NY.
YUNIAR MUSA NY.
ZAIDAN ACHMAD TN.
ZAIDAN ACHMAD TN.
ILHAM WIBISANA AN.
SRI RAHAYU NY
M.FAJRI MEDIANSYAH
DESRI AMRIN TN.
M. ARFA RAFIQI AN.
DZAKY ALFARIZI AN
M. QAISHAR RAHID AN.
SITI AZKIYA PUTRI AN.
M. ARFA ANAQISOFA AN.
EVA SUSANTI NY.
DAVID LUMBAN TOBING AN.
DESY MAULIA NN.
HENDRI HASYIM TN
M. ADITYA RAYYAN AN
FARRENO GUSTIANSYAH AN.
AKHSAN AMRIN H. DRS TN
ADINDA PUTRI AZZAHRA AN
NOVI MARTADINATA TN
EVI SILVIANI NY
FATIMAH AZ ZAHRAH AN
JASON CHANDRA AN
MUHAMMAD RAJENDRA AHZA Q AN
RUSDIANA BINTI HANANG NY.
ZAFRAN MUHAMMAD NABIL AN.
Page 210
15 MEI 2016
TRANSAKSI
1,665,200.00
220,500.00
135,600.00
804,000.00
198,000.00
55,800.00
155,970.00
281,250.00
9,450.00
339,600.00
154,200.00
135,000.00
763,200.00
155,970.00
221,949.00
90,200.00
146,830.00
178,692.00
136,600.00
100,932.00
209,265.00
102,400.00
70,533.00
111,533.00
238,860.00
77,500.00
254,000.00
161,800.00
102,800.00
100,200.00
123,320.00
125,200.00
142,000.00
174,400.00
102,400.00
132,880.00
221,690.00
109,432.00
Page 211
16 MEI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
160516420809
160516390542
160516280313
160516390125
160516390124
160516390158
160516431111
160516390108
160516280173
160516430698
160516430675
160516390123
160516390115
160516390107
160516451129
160516390169
160516390524
160516280146
160516390111
160516390119
160516280147
160516390117
160516390129
160516390525
160516390128
160516390007
160516390121
160516390112
160516280215
160516430624
160516430681
160516390011
160516390010
160516390016
160516390063
160516390102
160516390056
160516390039
160516390029
160516390035
160516280290
TANGGAL
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
Page 212
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0060R03105160003366
0090R03105160002667
0090R03105160003212
0090R03105160003216
0090R03105160003217
0090R03105160003271
0090R03105160003273
0090R03105160003274
0090R03105160003275
0090R03105160003276
0090R03105160003278
0090R03105160003279
0090R03105160003281
16 MEI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
160516280289
160516390025
160516390051
160516390081
160516430562
160516390013
160516390032
160516390033
160516280274
160516390012
160516390372
160516390054
160516390024
160516390028
160516390043
160516390041
160516390061
160516390060
160516390015
160516390078
160516390079
160516390073
160516390026
160516280097
160516390027
160516390099
160516390095
160516280105
160516390014
160516280163
160516280160
160516280362
160516390021
160516390417
160516390416
160516280143
160516280293
160516280295
160516390070
160516280170
160516280171
160516390047
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
05/16/2016
Page 213
0090R03105160003281
0090R03105160003282
0090R03105160003283
0090R03105160003283
0090R03105160003284
0090R03105160003285
0090R03105160003286
0090R03105160003286
0090R03105160003287
0090R03105160003288
0090R03105160003289
0090R03105160003290
0090R03105160003291
0090R03105160003292
0090R03105160003293
0090R03105160003293
0090R03105160003294
0090R03105160003294
0090R03105160003295
0090R03105160003296
0090R03105160003297
0090R03105160003297
0090R03105160003298
0090R03105160003299
0090R03105160003300
0090R03105160003301
0090R03105160003301
0090R03105160003302
0090R03105160003304
0090R03105160003305
0090R03105160003305
0090R03105160003306
0090R03105160003307
0090R03105160003308
0090R03105160003308
0090R03105160003309
0090R03105160003310
0090R03105160003310
0090R03105160003311
0090R03105160003312
0090R03105160003312
0090R03105160003313
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126
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0090R03105160003609
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16 MEI 2016
NAMA PASIEN
ANITA OKTARINA NY.
ANWAR PUTRA BAYU TN
ERWIN AZHARI TN.
GHANI ALFARIZI AN.
RUBYADEEVA CHIKA LA DENTA A
HENDRY GOZALI TN
ISMET TUSSAL TN.
JASON CHANDRA AN
M. ADITYA RAYYAN AN
M. ALI SEKAMIN TN
M. YUSRI LUBIS TN.
NURUL HUDA FADILLAH NN.
RIZAL FATONI TN
SURIYATI BINTI RIVAI NY.
SUSANTI TASLIM NY
SUTASMI NY
T EVITA SYAHRIZAD NY
YEMIAR HJ. NY.
MARIA MAGDALENA MERIANI NN.
SUYADI H. TN
RIZKI AMALIA NN
MARLIANSYAH TN
SRI WAHYUNI UTAMI NY
RIZAL FATONI TN
AHMAD DZAKI ZAIDAN AN
BUSRONI ASNAWI TN
IKA YUNIZAR NY.
RUBYADEEVA CHIKA LA DENTA A
KMS EFFENDY TN.
TRANSAKSI
28,200.00
63,000.00
100,600.00
60,000.00
113,400.00
58,000.00
420,370.00
58,000.00
174,400.00
48,000.00
186,600.00
45,000.00
495,000.00
28,000.00
14,922.00
135,000.00
27,000.00
86,310.00
129,000.00
78,000.00
134,400.00
243,450.00
220,500.00
32,175.00
262,500.00
81,450.00
225,600.00
243,450.00
60,000.00
60,000.00
40,000.00
70,800.00
126,090.00
93,600.00
73,813.00
119,500.00
71,999.00
158,850.00
239,776.00
107,600.00
137,000.00
Page 223
16 MEI 2016
KMS EFFENDY TN.
YOEDY AS TN
MUHAMMAD YUNUS TN.
MUHAMMAD YUNUS TN.
DAHLAN YAUMID TN
A. SANUSI TN
YULIA NGADIO NY.
NASRUN BASRI TN
RONIMAH NY
RONIMAH NY
NIO KWEE LAN NY.
DEDY SUMARDI TN
KUSMANETTI NY
NURUL HUDA FADILLAH NN.
ROSIDA TOMZAH NY.
YANG CIK NY.
MARIATI BINTI MANSUR NY
HASIAM INDRIANI NY
HASIAM INDRIANI NY
MURNIWATI BINTI BAHARUDDIN
NYAYU HALIMAH NN.
NYAYU HALIMAH NN.
YAJASMAN AMD TN.
MAGDALENA MD SITORUS, SH NN
JACUB RAHMAN TN.
NOVENDA ALIANDO TN
NOVENDA ALIANDO TN
10,000.00
132,213.00
10,000.00
160,000.00
120,000.00
142,400.00
10,000.00
125,000.00
520,200.00
123,200.00
120,000.00
486,050.00
528,800.00
295,600.00
160,000.00
10,000.00
160,000.00
10,000.00
183,200.00
146,000.00
160,000.00
10,000.00
174,800.00
60,000.00
183,200.00
183,000.00
10,000.00
365,770.00
94,880.00
160,000.00
10,000.00
396,370.00
221,280.00
160,000.00
10,000.00
450,570.00
160,000.00
10,000.00
104,084.00
102,000.00
10,000.00
188,000.00
Page 224
16 MEI 2016
SHOFWAN TN.
SHOFWAN TN.
NURAINI BINTI HUSIN NY.
ARI SUSANTI NN.
ARI SUSANTI NN.
SAUDAH BINTI TIMBUL NY.
MAYA E LEBIS NY.
MAYA E LEBIS NY.
NETTY BINTI SAYUTI NY.
FITRI YULIANTY NY
H. SRI RAHARDJO TN.
AMALIA MAHARANI AN.
NURLIANA SALIM NY
NURLIANA SALIM NY
KAILANI HUSIN TN
LELY WATI NY
LELY WATI NY
MIRA ASDIANA NY.
MIRA ASDIANA NY.
ANSYORI RIDUAN TN
KARIMA KESUMA NN.
DARMAWIYAH BINTI NAZANI NY
ELLYANA ROSITA NY.
ELLYANA ROSITA NY.
GHANI ALFARIZI AN.
MARIMAH C AHMAD NY.
MARIMAH C AHMAD NY.
10,000.00
125,000.00
842,850.00
488,200.00
177,000.00
10,000.00
890,000.00
244,840.00
160,000.00
10,000.00
188,000.00
10,000.00
160,000.00
528,800.00
60,000.00
10,000.00
160,000.00
178,287.00
10,000.00
200,000.00
134,280.00
10,000.00
160,000.00
10,000.00
160,000.00
281,300.00
100,800.00
10,000.00
160,000.00
204,800.00
276,816.00
1,192,000.00
160,000.00
10,000.00
244,520.00
255,068.00
10,000.00
160,000.00
65,000.00
10,000.00
160,000.00
100,000.00
Page 225
16 MEI 2016
SITI AMINAH NY.
AMINUDDIN WALUDIN TN.
TISNALIA NY.
M. YUSRI LUBIS TN.
RAFFASYA ZIDAN HISYAM AL A A
SITI NUR ASIYAH, HJ NY.
M. RAFIE KHAIRY AN
HILMA YORITA NY
FAHRUL ROZI TN
YULINA RUSDI NY.
ZAINONA BINTI USMAN NY.
MULKAS ADE PUTRA TN
MULKAS ADE PUTRA TN
VERONICA WINARTI NY.
M. NAJIB ASY''ARI AN.
MUSLIMIN KADIR TN
TENTREM SETIAWATI NY.
M. ZUHRI, IR TN
MULYADI CUAN BIE TN
TJIKMAD. B TN.
ARIANTO WAGISO TN.
WIYANDA VERANUR FAJRIANI NN.
LASMIATY BINTI DAUT NY.
EUIS ARTATI SH NY.
ANWAR PUTRA BAYU TN
HAMDANA BINTI HASAN NY
HENRYKEN FEDROZA AN.
LINDA VELANI NY
MUSTOPA BIN K.H MASTJEK A TN.
473,080.00
254,175.00
10,000.00
177,000.00
267,110.00
620,885.00
160,000.00
10,000.00
440,000.00
165,540.00
120,000.00
175,680.00
160,000.00
10,000.00
94,880.00
333,920.00
1,557,900.00
1,677,900.00
160,000.00
10,000.00
10,000.00
160,000.00
146,000.00
488,200.00
223,200.00
104,130.00
826,750.00
175,680.00
141,980.00
10,000.00
177,000.00
173,150.00
185,716.00
110,000.00
77,450.00
68,000.00
199,850.00
381,770.00
183,010.00
60,000.00
168,000.00
304,100.00
Page 226
16 MEI 2016
SRI SUHARNI NY.
L. YOHANES SOEKADI TN
PUTRO SETYONO TN
SUYADI H. TN
DAVID ISKANDAR TN
ROHANI NY.
ELIYA MARGARITA NY.
ELIYA MARGARITA NY.
DERI AGUSTIA NY.
TATI BINTI SARYONO NY.
MERYANTI BINTI ROZALI NY.
NOVERIDA ARIANI NY.
DESI ERYANI BY NY
AHMAD BUSTAMAL H TN.
AMANDA KUSUMA NY.
M. ALI SEKAMIN TN
ADAM MALIK TN.
LILI SUHAIMI NY.
SAPTO BIN ALI TN.
AHMAD DEDY TN.
SARTINI BINTI SALIMAN NY.
BOGA PABELLA TN.
160,000.00
10,000.00
200,800.00
346,790.00
1,612,370.00
1,192,000.00
1,207,500.00
1,563,050.00
160,000.00
10,000.00
274,130.00
361,653.00
264,800.00
165,400.00
140,900.00
251,130.00
100,800.00
81,800.00
10,000.00
125,000.00
10,000.00
160,000.00
890,000.00
312,500.00
91,500.00
204,000.00
228,000.00
178,520.00
10,000.00
160,000.00
226,860.00
352,500.00
224,500.00
60,000.00
61,600.00
160,000.00
10,000.00
435,500.00
174,600.00
125,000.00
10,000.00
326,245.00
Page 227
16 MEI 2016
ERLIN PURWANTI NY
ABD MADJID TN.
ABU LAHAB TN.
HASINI BINTI MATSIDI NY.
FENI HAPITA NY.
ANTONI KOHARRUDIN KOH TN
MUHAMMAD EFFENDI TN
FAISAL JUNED DRS TN.
SETIA WATI NY
SETIA WATI NY
M. FATHUL IMAM AN.
LAILI HANDAYANI NY.
AHMAD ROCKY EL MALIKI AN
M.RIFKY SYAHRAZI AN.
FEMILIA MARLINA NY.
FEMILIA MARLINA NY.
SUMARKO ACHMAD CHOZI TN
DJALILI SOLIHIN TN
ISNA AZ ZAHRO AN.
DIAN PRIHATINI NY
ANISA VITRI NY.
HARLENA BINTI MUSTOPA NY
NUR HUSNAWATI NY
NIKEN LARASATI NY
AGUS TRIANTO TN
HENDRY RIANTO TN
JUAIRIAH BINTI HASAN ZAHRI NY
NURHAYATI KHD NY.
ZUBAIDAH BINTI H. IBRAHIM NY
KHAIRA KEMILAU FAIRUZI AN.
LAY NAI LIN NY.
AALIYAH GHASANI AN.
ARDILA AYU RESTA NN
SANTI RUSLIANTI NY.
ERNA RAYA NY.
RISMIMANILA BINTI SALIHIN NY
M. MAKMOEN SYECH TN.
192,900.00
178,000.00
217,280.00
461,600.00
141,600.00
192,900.00
151,130.00
840,000.00
729,800.00
10,000.00
160,000.00
10,000.00
177,000.00
147,087.00
60,000.00
194,500.00
201,568.00
160,000.00
10,000.00
259,600.00
448,800.00
488,200.00
252,245.00
209,500.00
60,000.00
452,000.00
138,000.00
206,800.00
1,677,900.00
890,000.00
258,800.00
309,230.00
275,295.00
95,030.00
107,350.00
136,187.00
218,000.00
239,990.00
199,046.00
60,000.00
251,365.00
152,300.00
Page 228
16 MEI 2016
SANTI BINTI SELAMET NY
MUHAMMAD GHAZI AL ADLI AN.
ANDY ANDRY TN
HAMIDA BINTI BURHANI NY.
M. CHILO ALFARIZI AN
ANGGAHANI PUTRA PERMADANI
WINDA BINTI AWALUDDIN NY
TONY NOER TN
DIAN MAYASARI NY.
TJIKNUT SYUKUR NY
TJIKNUT SYUKUR NY
MUHAMMAD FATIH AN
IKRAN RASWANI TN.
HUSNA INTAN NY.
INDAWATI NY.
CARISSA ADELIA AN.
SUDIRMAN TAUHID H TN.
RAFIKA YULIANTI NY.
SAMSU RIZAL TN.
CANDRA DOAN TN.
SAADAH BINTI LATIF NY.
ROSDIANA BINTI ABDUL LATIF NY
MASRIAH BINTI ABDUL NY
AIDI SYAMSUDIN TN.
A. NASIR RASYAD TN.
NORIAH BINTI NOPANDI NY
ABU BAKAR TN
TJOE HOEN NIO NY.
TJOE HOEN NIO NY.
UKOILI BIN AMILUDIN TN.
FATIHA BINTI MAT KOSIM NY
SARMADI BIN H.MUCHTAR TN.
ITA HERTAWANI NY.
199,100.00
208,919.00
280,400.00
163,200.00
175,960.00
357,000.00
1,041,900.00
269,215.00
242,600.00
264,115.00
10,000.00
160,000.00
149,797.00
621,600.00
222,000.00
217,037.00
259,756.00
110,000.00
488,200.00
225,000.00
78,481.00
254,600.00
60,000.00
303,000.00
79,113.00
165,700.00
240,313.00
160,000.00
10,000.00
890,000.00
890,000.00
60,000.00
669,200.00
235,830.00
160,000.00
10,000.00
148,540.00
67,200.00
890,000.00
113,592.00
287,556.00
60,000.00
Page 229
16 MEI 2016
ACHMAD MAULANA,H TN
JUNIAL KOMAR TN.
AMIR HAMZAH TN
AMIR HAMZAH TN
HARNATI NY
SANGKUT BIN ATUT TN
ISMI JELITA NY
ISMI JELITA NY
TJHANG TJONG TJHAK TN
RATNA DJUITA NY
MELLYFIANY NY.
ELYU CHOMISAH, SIP,M.KES,HJ N
SUMIATI BINTI SAYUTI NY.
EDDY MAKSURI TN.
EDDY MAKSURI TN.
YULIANA HASAN NY
IMAN BUDIONO AN.
NYAYU NING NY.
MIKHAEL RUKINEM NY.
OKTA SAPUTRA TN
OKTA SAPUTRA TN
TASYA NAIRA PUTRI CHANDRA AN
AFIFAH RAHMA DIAN NN.
EDDYN FAUZI R TN
WILLY WIJAYA TN.
SUNARTI NY
MARDIANA BINTI ABAS ,SH NY.
MARDIANA BINTI ABAS ,SH NY.
ANITA OKTARINA NY.
YULIUS AIDA NY.
245,900.00
890,000.00
144,500.00
167,000.00
10,000.00
384,200.00
890,000.00
488,200.00
218,400.00
200,000.00
10,000.00
659,500.00
120,000.00
395,000.00
60,000.00
374,800.00
72,700.00
10,000.00
85,000.00
234,400.00
204,600.00
87,342.00
488,200.00
140,400.00
72,948.00
890,000.00
10,000.00
102,000.00
111,142.00
60,000.00
316,400.00
209,000.00
65,600.00
160,000.00
10,000.00
229,200.00
102,000.00
10,000.00
10,000.00
102,000.00
60,000.00
179,660.00
Page 230
16 MEI 2016
DESY MAULIA NN.
NAYLA SYIFA SAUQIAH AN.
JOVIAN ALVIANO AN.
ANDRI JAYA TN.
EVIANA NY
SRI RATNA BAYUNDARI NY.
SLAMET CAHYONO DRS. M PD TN
SITI NURAINI NY.
SITI NURAINI NY.
MARIATUL KIBTIA NY.
ENDAH SELVIA NINGSIH NY.
SJAFRAN SOHIB TN
RUSLAN EFFENDI TN.
DIANA NOVITA NY
ISRIL HENDRA TN
INDRIANAH DRA NY.
ELLYA KUSUMA NY.
PANDU PRASETYA TN.
PUTRI SALSABILA ANTISA AN
ASKURNI APSA TN.
ASKURNI APSA TN.
MARIZA NOVISAFITRI NN.
RIKA AIRIN ASTRIANI NY
AFRIAN BIN WONG TN
ROSHAN MUMTAZA NAHLA AN
DIKSON MATHEOS TN.
CHOLILAH BINTI MATKOWI NY
MULYANI BINTI SUKARDI NY
SUNARTI BINTI ROBIS NY.
DWI SHINTA OSAKA NY
RA FARIDA NY.
270,805.00
174,160.00
132,100.00
110,000.00
117,354.00
295,000.00
184,720.00
640,500.00
160,000.00
10,000.00
132,000.00
160,000.00
10,000.00
229,650.00
384,200.00
153,500.00
534,170.00
112,200.00
142,400.00
157,550.00
107,600.00
145,750.00
10,000.00
137,000.00
60,000.00
160,000.00
10,000.00
528,800.00
504,160.00
60,000.00
60,000.00
138,300.00
60,000.00
278,585.00
1,844,350.00
60,000.00
160,000.00
10,000.00
230,700.00
10,000.00
160,000.00
401,306.00
Page 231
16 MEI 2016
TITIEN SUHARTI NY.
NING AYU NY.
SALSABILA EKA PUTRI AN
SUMARYATI BINTI SUKILAN NN
OLIVER CHRIS W AN
ERMA PAULINA NY.
SITI AISYAH NY.
MAYA KARTIKA NN.
BETIN TEGUH NY.
NURHAYATI BINTI M. YASIN NY
SIDI AMBO TN
ELA MARTINA NY
ASNAH MADANI A. HJ. NY
ZAINUDDIN BIN AHMAD TN
PRIMA ANGGARA PUTRA TN
SRI WAHDIAH NY
MAZNAH BINTI MOCHERAN NY.
DAMAN HURI TN
VIVI FERIKA NN.
ALI HASAN TN
SHANTI MEGASARI NY.
NURYANTO TN.
JUMAIDA BINTI H RASUL NY.
MISROAINI BINTI AMRAH NY.
LISIANA OSWARI NN.
HASRI TANJUNG H TN.
ERNA KURNIATY NY.
YESI MANDA SARI NY.
DEVI AWALIA NY
ERWIN AZHARI TN.
AZIZAH MUNAUWARAH NY.
438,000.00
298,000.00
244,520.00
80,320.00
107,614.00
172,476.00
110,000.00
634,148.00
141,600.00
89,400.00
188,400.00
194,000.00
128,600.00
566,024.00
110,000.00
178,130.00
790,200.00
561,000.00
397,520.00
100,800.00
165,700.00
379,330.00
191,600.00
60,000.00
160,000.00
10,000.00
384,200.00
160,000.00
10,000.00 SUYADI GANTI TGL JADI ADLY
350,500.00
110,016.00
261,000.00
172,000.00
172,331.00
240,800.00
330,031.00
179,600.00
399,600.00
242,500.00
171,431.00
126,000.00
210,585.00
Page 232
16 MEI 2016
SULKANI BIN HAMID TN
TARWIENANG IBRAHIM TN
TJIUW TJIN HE TN.
BAMBANG KUSBIANTORO TN.
BRENDA FELLICIA S. NN
SARDJONO, H TN
EMIWATI BINTI NAZARUDIN NY
DESSY BINTI SATIM NY.
RAIHANAH ANNAQU ADDEVA AN
ROKNA LATIFA NY
ROKNA LATIFA NY
M. ADITYA RAYYAN AN
NAILAH IZZATI S AN.
KHOLIFAH ASIAH NY.
ELYA SUSANTI NY
SITI MARIAM NY
SITI MARIAM NY
OKTAVIANUS BIN M SAID TN.
MAIZAL PURWANTO TN.
SALSA AMEYLIA ZAHRA AN
ANDRY OKRIANTO TN.
ANDRY OKRIANTO TN.
ZAIDAN ACHMAD TN.
M. FAUZHAN HABIBIE AN
ZURAIDAH BINTI KGS M. SALIM N
ZURAIDAH BINTI KGS M. SALIM N
NOPARIYADI BIN YAHYA T. TN.
HOIRUNNISYAH NN.
H. SRI RAHARDJO TN.
811,500.00
524,781.00
131,000.00
106,830.00
61,430.00
110,000.00
120,000.00
200,450.00
216,886.00
177,000.00
10,000.00
181,450.00
96,392.00
310,220.00
184,680.00
40,000.00
193,585.00
174,400.00
80,800.00
86,222.00
165,303.00
345,974.00
125,000.00
10,000.00
167,000.00
10,000.00
66,195.00
207,624.00
168,200.00
195,900.00
40,000.00
348,050.00
119,014.00
60,000.00
137,000.00
10,000.00
60,000.00
109,500.00
168,700.00
43,881.00
Page 233
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NO
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NO RJ
170516390771
170516390730
170516430047
170516430021
170516390866
170516390126
170516430011
170516380878
170516430016
170516390527
170516380650
170516430268
170516450828
170516430539
170516390438
170516390129
170516430020
170516390113
170516390267
170516280439
170516390445
170516430005
170516430007
170516390052
170516390870
170516390868
170516380785
170516430041
170516380560
170516380587
170516430103
170516430028
170516430027
170516430045
170516430292
170516430057
170516430036
170516390069
170516390049
170516390046
170516390050
TANGGAL
05/17/2016
05/17/2016
05/17/2016
05/17/2016
05/17/2016
05/17/2016
05/17/2016
05/17/2016
05/17/2016
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05/17/2016
05/17/2016
05/17/2016
05/17/2016
05/17/2016
05/17/2016
05/17/2016
05/17/2016
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160003587
0090R03105160003601
0090R03105160003601
0090R03105160003616
0090R03105160003682
0090R03105160003684
0090R03105160003687
0090R03105160003690
0090R03105160003691
0090R03105160003691
0090R03105160003692
0090R03105160003694
0090R03105160003694
0090R03105160003695
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170516390051
170516430034
170516430090
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170516390063
170516430078
170516430077
170516280212
170516430304
170516280213
170516390356
170516390092
170516390023
170516430106
170516390357
170516430123
170516430226
170516430225
170516430131
170516430130
170516280275
170516430055
170516430081
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170516390308
170516430037
170516390312
170516390088
170516390091
170516430173
170516390058
170516430219
170516390309
170516280328
170516390062
170516430110
170516430180
170516430185
170516430108
170516430148
170516280321
170516280319
05/17/2016
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0090R03105160003695
0090R03105160003696
0090R03105160003697
0090R03105160003698
0090R03105160003698
0090R03105160003699
0090R03105160003699
0090R03105160003700
0090R03105160003701
0090R03105160003702
0090R03105160003703
0090R03105160003704
0090R03105160003705
0090R03105160003706
0090R03105160003707
0090R03105160003708
0090R03105160003709
0090R03105160003709
0090R03105160003710
0090R03105160003710
0090R03105160003711
0090R03105160003712
0090R03105160003713
0090R03105160003713
0090R03105160003714
0090R03105160003715
0090R03105160003716
0090R03105160003717
0090R03105160003717
0090R03105160003718
0090R03105160003719
0090R03105160003720
0090R03105160003721
0090R03105160003722
0090R03105160003723
0090R03105160003724
0090R03105160003725
0090R03105160003725
0090R03105160003726
0090R03105160003727
0090R03105160003728
0090R03105160003728
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84
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170516390054
170516390107
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170516390115
170516430252
170516280176
170516280175
170516390285
170516390576
170516390578
170516430392
170516390086
170516380544
170516380543
170516390093
170516430234
170516430085
170516390183
170516390179
170516430305
170516430087
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170516390376
170516430245
170516430147
170516430137
170516430318
170516430080
170516390060
170516280340
170516390257
170516430163
170516430084
170516430329
170516430333
170516430265
170516390236
170516390231
170516390239
170516390237
170516390208
170516430264
05/17/2016
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0090R03105160003729
0090R03105160003730
0090R03105160003731
0090R03105160003731
0090R03105160003732
0090R03105160003733
0090R03105160003733
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0090R03105160003735
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170516390272
170516390270
170516430238
170516390339
170516390336
170516390423
170516430526
170516430475
170516430244
170516430580
170516390218
170516390243
170516390449
170516430260
170516390266
170516380659
170516380657
05/17/2016
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0090R03105160003762
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0090R03105160003826
0090R03105160003827
0090R03105160003828
0090R03105160003829
0090R03105160003830
0090R03105160003831
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0090R03105160003833
0090R03105160003833
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0090R03105160003834
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170516430577
170516450872
05/17/2016
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0090R03105160003888
0090R03105160003889
0090R03105160003890
0090R03105160003891
0090R03105160003892
0090R03105160003893
0090R03105160003894
0090R03105160003895
0090R03105160003896
0090R03105160003898
0090R03105160003900
0090R03105160003901
0090R03105160003902
0090R03105160003903
0090R03105160003904
0090R03105160003905
0090R03105160003906
0090R03105160003907
0090R03105160003909
0090R03105160003910
0090R03105160003912
0090R03105160003913
0090R03105160003914
0090R03105160003915
0090R03105160003916
0090R03105160003920
0090R03105160003922
0090R03105160003923
0090R03105160003924
0090R03105160003925
0090R03105160003925
0090R03105160003926
0090R03105160003927
0090R03105160003929
0090R03105160003931
0090R03105160003932
0090R03105160003934
0090R03105160003935
0090R03105160003936
0090R03105160003937
0090R03105160003937
0090R03105160003939
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170516430042
170516390812
170516390662
170516380554
170516390653
170516390652
170516380711
170516380755
170516380757
170516390724
170516430620
170516430612
170516390723
170516380572
170516380573
170516380801
170516430585
170516380716
170516390842
170516450834
170516380745
170516430562
170516390805
170516390942
170516380651
170516450865
170516450867
170516390873
170516390776
170516390859
170516390896
170516380751
170516380747
170516380764
170516430629
170516380977
170516390705
170516390707
170516380807
170516450754
170516380921
170516380902
05/17/2016
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0090R03105160003941
0090R03105160003942
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0090R03105160003946
0090R03105160003946
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0090R03105160003948
0090R03105160003949
0090R03105160003950
0090R03105160003951
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0090R03105160003952
0090R03105160003953
0090R03105160003953
0090R03105160003956
0090R03105160003957
0090R03105160003959
0090R03105160003961
0090R03105160003962
0090R03105160003963
0090R03105160003964
0090R03105160003965
0090R03105160003966
0090R03105160003967
0090R03105160003968
0090R03105160003968
0090R03105160003969
0090R03105160003970
0090R03105160003971
0090R03105160003972
0090R03105160003973
0090R03105160003975
0090R03105160003976
0090R03105160003977
0090R03105160003978
0090R03105160003979
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0090R03105160003993
0090R03105160003995
0090R03105160003996
0090R03105160003998
0090R03105160003999
0090R03105160004000
0090R03105160004001
0090R03105160004002
0090R03105160004003
0090R03105160004004
0090R03105160004005
0090R03105160004010
0090R03105160004011
0090R03105160004012
0090R03105160004014
0090R03105160004017
0090R03105160004019
0090R03105160004021
0090R03105160004248
Page 242
17 MEI 2016
NAMA PASIEN
DEWI MONALISA NY.
EKA SUPRIYANTINI NY.
EMIWATI BINTI NAZARUDIN NY
FAHRUL ROZI TN
IKA YUNIZAR NY.
ISMET TUSSAL TN.
JADIDAH HJ. BINTI A. ANAS NY.
M. ARIF BONDAN TN.
MADIUM BINTI MESIR NY.
MIS YANTI NY
MUHAMMAD RAFI AL ZUHRI AN.
NOVERA PRATIWI NN.
NURHAYATI BINTI M. YASIN NY
NURUL APRILIA FITRA NN.
POPPY MARETHA NY.
RUSDI BIN YASIR TN.
SIDI AMBO TN
SUSILA S NATAWIRIA TN.
YULINA RUSDI NY.
ZAINONA BINTI USMAN NY.
BENYAMIN JACUB TN.
DIANI HAYARA NY
M.JUNAIDI DRS TN.
ZAFRAN AZKA PRATAMA AN
RAFARDHAN RAFIF ABQARI AN
DEVI HERYANI NN
PURNOMO YUWONO TN
HENDRA HARTANTO TN.
HENDRA HARTANTO TN.
SYARKOWI TN.
SUGINAH ABBAS NY.
SUGINAH ABBAS NY.
M. ABBAS HASAN TN
TRANSAKSI
36,600.00
28,500.00
24,400.00
11,700.00
315,000.00
41,400.00
20,400.00
30,000.00
22,500.00
135,000.00
96,000.00
253,800.00
174,400.00
184,813.00
30,500.00
90,000.00
36,600.00
135,000.00
22,520.00
80,300.00
213,600.00
18,000.00
27,000.00
20,250.00
315,000.00
315,000.00
12,960.00
60,000.00
10,000.00
177,000.00
60,000.00
96,140.00
69,061.00
181,036.00
356,700.00
177,000.00
10,000.00
98,900.00
160,000.00
10,000.00
10,000.00
Page 243
17 MEI 2016
M. ABBAS HASAN TN
LEGINAH BINTI SUPARTO NY
ALI NURDIN TN.
NASRUN BASRI TN
NASRUN BASRI TN
HERAWATI HJ. NY
DANI SENEN H. TN
DIANA NOVITA NY
LENI MARLINA NY
HERIYANTO TN
M YUSUF JAYA TN
JACUB RAHMAN TN.
ELIYA MARGARITA NY.
ELIYA MARGARITA NY.
SAUT SITUMORANG TN.
NING AYU NY.
NING AYU NY.
NAFISAH BINTHASIM H NY
RUSLI TABEK TN.
SULIYEM BINTI TONDO SUROYO N
SULIYEM BINTI TONDO SUROYO N
SISMAWATI BINTI SUDIN NY.
HASIAM INDRIANI NY
M HATTA SALEH TN.
SAWIDA BINTI JENAL S NY.
EMMY YAHIMI NY
M. ALI SEKAMIN TN
M. ALI SEKAMIN TN
SHOFWAN TN.
160,000.00
142,400.00
365,850.00
125,000.00
10,000.00
160,000.00
10,000.00
71,450.00
890,000.00
382,770.00
890,000.00
488,200.00
890,000.00
115,900.00
890,000.00
209,450.00
160,000.00
10,000.00
160,000.00
10,000.00
141,600.00
142,400.00
10,000.00
137,000.00
260,020.00
100,800.00
444,000.00
10,000.00
95,000.00
805,433.00
512,000.00
186,000.00
216,920.00
131,810.00
218,000.00
120,850.00
10,000.00
95,000.00
116,450.00
188,315.00
10,000.00
160,000.00
Page 244
17 MEI 2016
JO SIOE LING NY.
NILHAYATI BINTI HASAN NY.
MUSLIMIN KADIR TN
ALFIAN BIN NAZARUDDIN TN.
LIU HENDRY TN.
SITI NURJANA NY
SUKANTO KESUMAH TN
ALIDUN SIHOMBING TN
SYAMSUL BAHRUN TN.
YUNITA TRIANA NY
SRI MULYATI NY.
AURELIA PUTRI FADILAH AN
ERLILI JUNAIDI NY
JEANNE KUSSOY NY
JUNAIDA PRIANI NY
JUNAIDA PRIANI NY
MUHAMMAD TONI TN.
MUHAMMAD TONI TN.
SUSI IRITO NY.
BUYUNG LEMAN TN.
182,400.00
198,000.00
160,000.00
10,000.00
406,300.00
10,000.00
125,000.00
327,584.00
10,000.00
200,000.00
1,192,000.00
683,750.00
125,000.00
10,000.00
84,660.00
324,000.00
106,400.00
177,000.00
10,000.00
890,000.00
264,800.00
461,600.00
890,000.00
166,750.00
160,000.00
10,000.00
102,900.00
240,800.00
91,992.00
60,000.00
883,001.00
60,000.00
319,200.00
10,000.00
160,000.00
147,200.00
160,000.00
10,000.00
160,000.00
10,000.00
60,000.00
122,540.00
Page 245
17 MEI 2016
M. ADELIO CETTA AN
DIAN TRI WAHYUNI NY.
SUSILAWATY NY
SUSILAWATY NY
M. AZIL AZZUHRI AN
DAVID ISKANDAR TN
MUHAMMAD ALFATIR AN.
MADIUM BINTI MESIR NY.
ROHMAH ROSTIYANI NY.
M. AZIZ PANGESTU AN.
RADINAL MUHTAR TN.
ENDANG SUDARMI NN.
NURHAYATI BINTI HARIDI NY.
YASSER ARIWIBOWO TN.
FERNANDO AKBAR HARDIANSYAH
KAILANI HUSIN TN
NOVERA PRATIWI NN.
ZAIDAR BINTI M.NURLEMAN,HJ NY
ISNA AZ ZAHRO AN.
NINA MARLINA NY.
INDRA SANDI TN
LANIYATI NY.
LANIYATI NY.
LINI HARTINA NY.
M. IQBAL SALIM TN
KIKI SUTRAVIANTI NY.
PATMAN ROZI TN
PUJI ASTUTI NY
CHAIRUL MUCHLIS TN
TRISITA ETA NY.
NURUL APRILIA FITRA NN.
M. ZAKY ALFAREZI AN
92,380.00
193,585.00
10,000.00
160,000.00
138,600.00
60,000.00
60,000.00
419,400.00
247,485.00
113,440.00
160,000.00
10,000.00
101,470.00
208,920.00
552,100.00
60,000.00
108,750.00
249,000.00
60,000.00
212,920.00
60,000.00
153,160.00
132,550.00
120,000.00
880,000.00
160,000.00
10,000.00
88,900.00
160,000.00
10,000.00
60,000.00
120,000.00
213,000.00
270,685.00
194,450.00
264,800.00
488,200.00
179,900.00
222,000.00
78,605.00
160,000.00
10,000.00
Page 246
17 MEI 2016
OESMAN AIDIT TN.
MELLY SURYANTI A. BY NY G1
OKTARINI BINTI EDI GUNAWAN N
NURYA BINTI KASIM NY.
NADYA PUTRI AURORA INDARTO A
ELY ERNI NY.
KURNIA AGUSTINA NY.
RIZAL FAUZI TN.
YENNI BINTI AHMAD RIFAI, SH NY
MIRUSDIN BIN YAMAN TN.
TAHIR MANURUNG TN
TJUNG SEN WAN NY.
TJUNG SEN WAN NY.
NAILAH RAMADHANI F. AN
SITI ASIAH NY.
FEMILIA MARLINA NY.
SURIANI BINTI SUBAGIO NY.
HALIMAH BINTI DAREM NY
HERLENA BINTI A. ZAINI, HJ NY
PUADI BIN NURDIN TN
EKA SUPRIYANTINI NY.
AGUNG PRAKOSO A AN.
SRI MULYATI NY
SRI MULYATI NY
ZAIDAN ACHMAD TN.
ZAIDAN ACHMAD TN.
LUTHFI ZIRWANSYAH AN.
FLORENTINA BR PINEM NY.
HADIJAH NY.
KUSMAH BINTI KUSIR NY.
ANI HASAN NY
HERMAN ZAKARIA TN.
442,265.00
60,000.00
114,012.00
210,485.00
257,034.00
115,000.00
160,000.00
10,000.00
183,150.00
200,000.00
234,400.00
183,918.00
60,000.00
233,000.00
160,000.00
10,000.00
190,300.00
114,600.00
110,400.00
89,790.00
138,300.00
10,000.00
160,000.00
139,280.00
291,045.00
178,000.00
208,000.00
204,000.00
145,300.00
199,046.00
214,287.00
10,000.00
160,000.00
125,000.00
10,000.00
173,068.00
252,030.00
897,703.00
890,000.00
271,580.00
890,000.00
488,200.00
Page 247
17 MEI 2016
MARYAM BT ALIAS NY.
MULIANA WIJAYANTI NY
APRINA SUSANTI NY
GATOT SUGEMTO TN
BUDI NOPRIANI NY.
M.SAYYID ABDULLAH TN.
DITA MUTIARA IRAWAN NN
DEWI MONALISA NY.
MARDIANA NY.
NURMALA DEWI NY.
NURMALA DEWI NY.
ASEP SUTANTO TN.
POPPY MARETHA NY.
PRATIWI SURYANI NY
TUTI PURNAMAWATI NY
MAIDAH BINTI H. MUSTOPA NY.
NURLIANA SALIM NY
YUSLAINI BINTI MONERAJO NY.
ACHMAD ZARNUBI TN.
MUHAMMAD RIFQI TN
AUREL GRACIA.R HUTABARAT AN.
ROKIAH BINTI HAMDAN NY.
MAYA E LEBIS NY.
TATI HARTATI NY
RUSTAM HALIM TN
MUHAMMAD RAFI AL ZUHRI AN.
HUSNI THAMRIN TN
60,000.00
257,034.00
92,000.00
890,000.00
134,030.00
140,000.00
76,000.00
153,685.00
177,600.00
193,585.00
10,000.00
160,000.00
120,000.00
253,681.00
199,108.00
10,000.00
160,000.00
193,585.00
194,950.00
107,450.00
84,450.00
187,450.00
172,500.00
129,450.00
221,280.00
107,450.00
890,000.00
86,000.00
165,700.00
60,000.00
125,450.00
102,300.00
10,000.00
85,750.00
134,450.00
190,320.00
890,000.00
120,000.00
10,000.00
60,000.00
192,400.00
60,000.00
Page 248
17 MEI 2016
LIA PUTRI APRIANI AN.
FIRDAUS ZEN TN
AS AD SAYUTI DRS TN
NYAYU ROMADIANA A NY
KASMAWATI BINTI MADIYAH NY.
HENRYKEN FEDROZA AN.
MACHYUDIN BIN IBRAHIM TN
YANTI SAFITRI NY.
HARIS FADILA TN
NURLELI BINTI KMS NUNGCIK NY.
ALFI SYAHRIN TN.
ACHRIA BINTI ISKANDAR NY.
ILHAM HERIYANTO TN.
A. FAHRIE ZUHRIE AN
DAHLAN YAUMID TN
ANTHONY AGUS TN
MANARIAH BINTI USMAN NY
SRI SUDIYARINI NN
EDDY MAKSURI TN.
EDDY MAKSURI TN.
ALZIRO FITRIANSYAH TN.
BETIN TEGUH NY.
DESY MAULIA NN.
SRI ENDRI YANA NY.
AMRI BIN ALWI TN.
SARAH MEITY PITA SARI NY
BENYAMIN JACUB TN.
92,000.00
86,640.00
60,000.00
377,663.00
60,000.00
60,000.00
60,000.00
77,160.00
60,000.00
60,000.00
60,000.00
136,900.00
288,206.00
193,585.00
613,370.00
174,400.00
60,000.00
222,000.00
99,450.00
240,800.00
102,000.00
217,280.00
488,200.00
92,000.00
199,585.00
71,450.00
174,050.00
437,000.00
210,585.00
85,000.00
10,000.00
76,691.00
60,000.00
161,900.00
180,000.00
189,650.00
176,900.00
258,085.00
363,000.00
10,000.00
160,000.00
87,000.00
Page 249
17 MEI 2016
ADINDA NURZAHIRAH AN.
MIS YANTI NY
SYAMSUDDIN TOHIR, H TN
SLAMET SOETANTO TN.
ROKNA LATIFA NY
ROKNA LATIFA NY
HASANAH BINTIRIFIN NY
BERLIN INDAH PERMATA S. NY
NIRWANAA CANDRA NY.
AKHMAD KASIRO TN.
SUNARMAN BIN ATMO SUWITO T
SUNARMAN BIN ATMO SUWITO T
YULIA DASWATI NY.
IKA YUNIZAR NY.
SRI SUMARNI NY.
FADILAH BINTI KOSIM NY
DWIN PERMANA TN
SEPTI YANTI NY
ELVIRA BINTI AWALUDIN NY
RITA OKTARINA NY
TITIN AGUSTINA NY.
MURNI YANTI NY.
NINA AKSARI NY
FEMY ROSITA HJ NY
NUR TJAHYO TN
NURHAYATI BINTI YAHYA NY.
HERMAN BIN BUSTOMI TN.
RICAWATI BINTI H. BURLIAN NY
RUSNAN CHANDRA TN
354,422.00
517,080.00
110,400.00
181,280.00
40,000.00
60,000.00
1,423,500.00
326,205.00
60,000.00
180,806.00
160,000.00
10,000.00
169,200.00
10,000.00
167,000.00
148,200.00
60,000.00
170,400.00
251,185.00
292,085.00
208,050.00
122,120.00
196,303.00
488,200.00
296,000.00
10,000.00
160,000.00
155,000.00
197,145.00
212,103.00
517,080.00
203,145.00
216,046.00
334,880.00
110,000.00
488,200.00
10,000.00
160,000.00
228,615.00
98,300.00
60,000.00
75,000.00
Page 250
17 MEI 2016
NUR AINI NY.
SUMARNI BINTI NANGCIK NY
AMIR HAMSAH TN.
JESICCA FABEL AN.
DEWI HARTATI NY.
YOHANI BINTI KEMIS NY
DINDA ZALFAA SYAIRA AN.
M. RAHSYA IFASSY ALTHAFIO AN
AISYAH NN.
DESY MAULIA NN.
RULLY REFTIKA SARI NY
ANDRY OKRIANTO TN.
68,000.00
110,000.00
120,000.00
202,803.00
110,000.00
264,427.00
221,185.00
199,863.00
193,585.00
193,663.00
86,700.00
163,000.00
160,550.00
183,300.00
77,400.00
112,140.00
351,690.00
73,191.00
176,650.00
Page 251
18 MEI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
180516390421
180516430370
180516380925
180516390817
180516380790
180516380788
180516420273
180516430011
180516390112
180516430452
180516430144
180516430014
180516430012
180516430013
180516381023
180516430015
180516450878
180516380966
180516430010
180516430393
180516390463
180516420230
180516430009
180516430051
180516430131
180516430132
180516390027
180516390028
180516390059
180516390060
180516420040
180516420042
180516380556
180516430031
180516430032
180516390021
180516390005
180516430067
180516390022
180516390024
180516390127
TANGGAL
05/18/2016
05/18/2016
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SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160003917
0090R03105160003940
0090R03105160004028
0090R03105160004032
0090R03105160004033
0090R03105160004034
0090R03105160004034
0090R03105160004035
0090R03105160004035
0090R03105160004036
0090R03105160004036
0090R03105160004037
0090R03105160004038
0090R03105160004039
0090R03105160004040
0090R03105160004040
0090R03105160004041
0090R03105160004042
0090R03105160004043
0090R03105160004044
0090R03105160004044
0090R03105160004045
18 MEI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
180516430235
180516390048
180516390053
180516430236
180516390091
180516390092
180516390061
180516430237
180516390089
180516420050
180516420052
180516430229
180516390055
180516390057
180516430157
180516430161
180516390096
180516390098
180516390134
180516420049
180516420292
180516430097
180516430100
180516390182
180516390085
180516390086
180516430331
180516430162
180516430165
180516390078
180516390025
180516430107
180516430108
180516390226
180516390232
180516430023
180516390150
180516390149
180516390026
180516420259
180516420266
180516390209
05/18/2016
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0090R03105160004051
0090R03105160004052
0090R03105160004053
0090R03105160004053
0090R03105160004054
0090R03105160004055
0090R03105160004055
0090R03105160004056
0090R03105160004056
0090R03105160004057
0090R03105160004057
0090R03105160004058
0090R03105160004059
0090R03105160004060
0090R03105160004061
0090R03105160004061
0090R03105160004062
0090R03105160004063
0090R03105160004063
0090R03105160004064
0090R03105160004065
0090R03105160004065
0090R03105160004066
0090R03105160004067
0090R03105160004068
0090R03105160004068
0090R03105160004069
0090R03105160004069
0090R03105160004070
0090R03105160004071
0090R03105160004072
0090R03105160004074
0090R03105160004075
0090R03105160004075
0090R03105160004078
18 MEI 2016
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
180516390211
180516390058
180516430070
180516430399
180516430404
180516420043
180516420202
180516430218
180516430219
180516420286
180516420288
180516390046
180516420281
180516420284
180516430101
180516390342
180516390343
180516430192
180516430297
180516430300
180516390087
180516390093
180516430072
180516430293
180516430295
180516390130
180516390324
180516390326
180516390164
180516430133
180516430354
180516390077
180516430171
180516430173
180516430231
180516390063
180516390125
180516430225
180516430371
180516430374
180516390084
180516430234
05/18/2016
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0090R03105160004084
0090R03105160004084
0090R03105160004085
0090R03105160004085
0090R03105160004086
0090R03105160004087
0090R03105160004087
0090R03105160004088
0090R03105160004089
0090R03105160004089
0090R03105160004090
0090R03105160004091
0090R03105160004091
0090R03105160004092
0090R03105160004093
0090R03105160004094
0090R03105160004095
0090R03105160004095
0090R03105160004096
0090R03105160004097
0090R03105160004097
0090R03105160004098
0090R03105160004099
0090R03105160004100
0090R03105160004101
0090R03105160004102
0090R03105160004103
0090R03105160004104
0090R03105160004105
0090R03105160004106
0090R03105160004107
0090R03105160004108
0090R03105160004108
0090R03105160004109
0090R03105160004110
18 MEI 2016
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
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152
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164
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167
180516430124
180516390082
180516450725
180516450727
180516430123
180516390080
180516430357
180516430359
180516390062
180516390436
180516430141
180516390081
180516390178
180516420294
180516430118
180516390737
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180516420104
180516420160
180516390491
180516390492
180516430074
180516390302
180516430454
180516430459
180516430239
180516390088
180516390522
180516390530
180516390258
180516420183
180516430116
180516430277
180516420406
180516420407
180516390115
180516420247
180516430394
180516430412
180516430414
180516390079
180516390238
05/18/2016
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0090R03105160004111
0090R03105160004112
0090R03105160004113
0090R03105160004113
0090R03105160004114
0090R03105160004115
0090R03105160004116
0090R03105160004116
0090R03105160004117
0090R03105160004118
0090R03105160004119
0090R03105160004120
0090R03105160004121
0090R03105160004122
0090R03105160004123
0090R03105160004124
0090R03105160004124
0090R03105160004125
0090R03105160004126
0090R03105160004127
0090R03105160004127
0090R03105160004128
0090R03105160004129
0090R03105160004130
0090R03105160004130
0090R03105160004131
0090R03105160004132
0090R03105160004133
0090R03105160004133
0090R03105160004134
0090R03105160004135
0090R03105160004136
0090R03105160004137
0090R03105160004138
0090R03105160004138
0090R03105160004139
0090R03105160004140
0090R03105160004141
0090R03105160004142
0090R03105160004142
0090R03105160004143
0090R03105160004144
18 MEI 2016
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
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192
193
194
195
196
197
198
199
200
201
202
203
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180516420195
180516430176
180516430174
180516390417
180516390418
180516380572
180516430445
180516430446
180516390175
180516390154
180516430312
180516430205
180516390506
180516390508
180516420227
180516380663
180516380793
180516380794
180516430262
180516390233
180516430220
180516430271
180516420159
180516450871
180516420251
180516420361
180516380904
180516390476
180516390477
180516430263
180516430341
180516430428
180516430429
180516430246
180516430208
180516430187
180516430189
180516430449
180516430451
180516380480
180516380936
180516390311
05/18/2016
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0090R03105160004150
0090R03105160004150
0090R03105160004151
0090R03105160004152
0090R03105160004153
0090R03105160004154
0090R03105160004155
0090R03105160004155
0090R03105160004156
0090R03105160004157
0090R03105160004158
0090R03105160004158
0090R03105160004159
0090R03105160004160
0090R03105160004161
0090R03105160004163
0090R03105160004164
0090R03105160004165
0090R03105160004166
0090R03105160004168
0090R03105160004169
0090R03105160004170
0090R03105160004170
0090R03105160004171
0090R03105160004172
0090R03105160004173
0090R03105160004173
0090R03105160004174
0090R03105160004176
0090R03105160004177
0090R03105160004178
0090R03105160004180
0090R03105160004180
0090R03105160004181
0090R03105160004182
0090R03105160004183
18 MEI 2016
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
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234
235
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239
240
241
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180516420307
180516390261
180516380765
180516420340
180516420350
180516420362
180516430270
180516420279
180516380560
180516380561
180516430422
180516430464
180516390296
180516430252
180516390304
180516390347
180516420303
180516381067
180516430269
180516390344
180516430385
180516390420
180516420256
180516390319
180516430330
180516380660
180516390315
180516430243
180516420363
180516420402
180516380577
180516420338
180516380667
180516390520
180516380807
180516380810
180516450764
180516390859
180516380686
180516390322
180516380500
180516380724
05/18/2016
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0090R03105160004186
0090R03105160004187
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0090R03105160004192
0090R03105160004193
0090R03105160004193
0090R03105160004194
0090R03105160004195
0090R03105160004196
0090R03105160004197
0090R03105160004198
0090R03105160004199
0090R03105160004200
0090R03105160004202
0090R03105160004203
0090R03105160004204
0090R03105160004205
0090R03105160004206
0090R03105160004207
0090R03105160004208
0090R03105160004209
0090R03105160004210
0090R03105160004211
0090R03105160004212
0090R03105160004213
0090R03105160004214
0090R03105160004215
0090R03105160004216
0090R03105160004217
0090R03105160004218
0090R03105160004219
0090R03105160004219
0090R03105160004220
0090R03105160004221
0090R03105160004222
0090R03105160004223
0090R03105160004224
0090R03105160004225
18 MEI 2016
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
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180516420408
180516430472
180516380510
180516390656
180516450786
180516451097
180516450842
180516430391
180516430425
180516390803
180516380917
180516420298
180516430375
180516430405
180516390309
180516450770
180516450835
180516380559
180516390413
180516380574
180516390411
180516430453
180516430416
180516380674
180516380866
180516380892
180516390455
180516390456
180516380613
180516390806
180516380717
180516380637
180516380681
180516450805
180516450730
180516390639
180516380536
180516390629
180516390538
180516380644
180516380680
180516450912
05/18/2016
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0090R03105160004233
0090R03105160004236
0090R03105160004237
0090R03105160004238
0090R03105160004239
0090R03105160004240
0090R03105160004242
0090R03105160004243
0090R03105160004244
0090R03105160004245
0090R03105160004246
0090R03105160004247
0090R03105160004249
0090R03105160004250
0090R03105160004251
0090R03105160004252
0090R03105160004253
0090R03105160004254
0090r03105160004255
0090R03105160004256
0090R03105160004256
0090R03105160004257
0090R03105160004258
0090R03105160004259
0090R03105160004260
0090R03105160004261
0090R03105160004262
0090R03105160004263
0090R03105160004264
0090R03105160004265
0090R03105160004267
0090R03105160004270
0090R03105160004271
0090R03105160004272
0090R03105160004273
18 MEI 2016
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
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318
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180516451096
180516380924
180516390774
180516380729
180516380694
180516380494
180516390739
180516380495
180516380789
180516380693
180516390633
180516450719
180516380961
180516450813
180516450858
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180516380928
180516390851
180516380943
180516450822
180516380927
180516380844
180516390848
180516380957
180516380671
180516450760
180516390823
180516390825
180516381017
180516381029
180516380958
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180516380575
180516450974
180516380766
180516380949
180516380515
180516380518
180516380861
180516430438
180516380683
180516450728
05/18/2016
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0090R03105160004281
0090R03105160004282
0090R03105160004283
0090r03105160004284
0090R03105160004285
0090R03105160004286
0090R03105160004287
0090R03105160004288
0090R03105160004289
0090R03105160004290
0090R03105160004291
0090R03105160004292
0090R03105160004293
0090R03105160004294
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0090R03105160004296
0090R03105160004297
0090R03105160004298
0090R03105160004299
0090R03105160004300
0090R03105160004301
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0090R03105160004302
0090R03105160004303
0090R03105160004305
0090R03105160004306
0090R03105160004306
0090R03105160004307
0090R03105160004308
0090R03105160004309
0090R03105160004310
0090R03105160004311
0090R03105160004312
0090R03105160004313
0090R03105160004314
0090R03105160004315
18 MEI 2016
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180516380978
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180516380630
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180516390745
180516450696
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180516380685
180516380570
180516380907
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180516380723
180516390636
180516390638
180516390920
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0090R03105160004325
0090R03105160004326
0090R03105160004327
0090R03105160004328
0090R03105160004329
0090R03105160004330
0090R03105160004331
0090R03105160004332
0090R03105160004333
0090R03105160004334
0090R03105160004335
0090R03105160004336
0090R03105160004337
0090R03105160004338
0090R03105160004339
0090R03105160004340
0090R03105160004341
0090R03105160004342
0090R03105160004343
0090R03105160004344
0090R03105160004346
0090R03105160004347
0090R03105160004348
0090R03105160004349
0090R03105160004350
0090R03105160004351
0090R03105160004352
0090R03105160004353
0090R03105160004354
0090R03105160004355
0090R03105160004356
0090R03105160004357
0090R03105160004357
0090R03105160004358
0090R03105160004359
0090R03105160004359
0090R03105160004360
18 MEI 2016
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
180516450735
180516380679
180516390792
180516380567
180516390757
180516380981
180516380944
180516380640
180516450819
180516380886
180516380650
180516390742
180516450776
180516450780
180516390759
180516390678
180516380797
180516380802
180516381005
180516380902
180516390612
180516380627
180516380987
180516450785
180516390695
180516380967
180516450808
180516380709
180516450767
180516380710
180516380622
180516380731
180516380733
180516390743
180516380874
180516450750
180516380864
180516450876
180516390801
180516450972
180516380715
180516380908
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0090R03105160004376
0090R03105160004376
0090R03105160004378
0090R03105160004379
0090R03105160004380
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0090R03105160004384
0090R03105160004385
0090R03105160004386
0090R03105160004387
0090R03105160004388
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0090R03105160004390
0090R03105160004391
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0090R03105160004392
0090R03105160004393
0090R03105160004395
0090R03105160004396
0090R03105160004397
0090R03105160004398
0090R03105160004399
0090R03105160004400
0090R03105160004401
0090R03105160004402
18 MEI 2016
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
180516380909
180516450782
180516450781
180516380932
180516390846
180516380937
180516450732
180516380970
180516380921
180516451001
180516451006
180516390768
180516390698
180516380945
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180516420245
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180516420244
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180516380673
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180516450762
180516430427
180516430285
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0090R03105160004409
0090R03105160004410
0090R03105160004412
0090R03105160004412
0090R03105160004414
0090R03105160004415
0090R03105160004416
0090R03105160004417
0090R03105160004417
0090R03105160004418
0090R03105160004418
0090R03105160004419
0090R03105160004422
0090R03105160004424
0090R03105160004425
0090R03105160004426
0090R03105160004429
0090R03105160004431
0090R03105160004572
0090R03105160004575
0090R03105160004581
0090R03105160004583
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0090R03105160004625
0090R03105160004629
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0090R03105160004639
0090R03105160004639
18 MEI 2016
NAMA PASIEN
ARFAH BIN A. RONI TN.
CHERRY LEMBEK TN.
ELLY SUMARYATI NY.
ERMA PAULINA NY.
EVIANA NY
ISMI FITRIA AN
MAMAT SADI TN.
MEYLINDA NY
NIO KWEE LAN NY.
ROHANI NY.
SAHINGIN BIN ALI AMA TN
SARTINI BINTI SALIMAN NY.
SITI MAEMUNAH NY.
SOEHERMAN H TN.
YULINA RUSDI NY.
ZULKARNAIN BIN A. KARIM TN
FARIDA BINTI M. ALI NY
MISDIANA KESUMA NY.
EVI SILVIANI NY
ANGGRAINI BINTI USMAN NY.
ANGGRAINI BINTI USMAN NY.
RA FARIDA NY.
ASKURNI APSA TN.
ANAN ROWI TN.
F EFFENDY TN.
ELIS NILAYATI NY.
ELIS NILAYATI NY.
HASIAM INDRIANI NY
TRANSAKSI
28,000.00
55,600.00
204,800.00
33,990.00
216,300.00
83,000.00
50,751.00
108,200.00
324,600.00
10,050.00
209,950.00
216,400.00
216,400.00
108,200.00
216,300.00
108,200.00
174,400.00
108,200.00
1,465,300.00
60,000.00
240,800.00
986,460.00
55,032.00
642,560.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
136,400.00
74,000.00
85,200.00
10,000.00
160,000.00
221,280.00
134,880.00
148,900.00
10,000.00
125,000.00
125,068.00
Page 263
18 MEI 2016
RONIMAH NY
RONIMAH NY
SUGINAH ABBAS NY.
N. ACHMAD ABUMAN TN
NOVENDA ALIANDO TN
NOVENDA ALIANDO TN
NASLIA INDRAWATI NY.
SOFIA AZZAHRA AN.
SAIFUL NURAINI TN.
SAIFUL NURAINI TN.
HENDI YANTO TN.
FEBI ANJARSARI PUTERI D.NY.
SUDIRMAN M DRS H TN.
NURLIANA SALIM NY
NURLIANA SALIM NY
EUIS ARTATI SH NY.
YUNIAR MUSA NY.
SYAHRIR YASIN TN
M. ALI SEKAMIN TN
LELY WATI NY
890,000.00
10,000.00
160,000.00
1,192,000.00
10,000.00
160,000.00
114,000.00
890,000.00
115,850.00
10,000.00
160,000.00
890,000.00
10,000.00
102,000.00
10,000.00
160,000.00
10,000.00
160,000.00
338,820.00
115,000.00
115,000.00
10,000.00
160,000.00
414,000.00
10,000.00
160,000.00
193,585.00
10,000.00
160,000.00
509,250.00
175,680.00
10,000.00
160,000.00
10,000.00
177,000.00
214,800.00
219,500.00
198,700.00
71,450.00
10,000.00
160,000.00
10,000.00
Page 264
18 MEI 2016
LELY WATI NY
ROHANI TOHA NY
ARYUANIS BINTI MARULIS NY
JACUB RAHMAN TN.
JACUB RAHMAN TN.
NOVIA KOMALASARI AN
ROSIDA TOMZAH NY.
ELLYANA ROSITA NY.
ELLYANA ROSITA NY.
ASYARI BURHAN H DRS TN
MARIMAH C AHMAD NY.
MARIMAH C AHMAD NY.
NIO KWEE LAN NY.
TITIN AGUSTINA NY.
MARDJUKIE TN.
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
JULIANA KOWIRA NY.
LIAREMILI ADLI NY.
IRMA SURYANI NY.
AMIR S. TN.
JAYANIS AMIR NY.
HARBEI PASAH TN
YUNITA TRIANA NY
TEGUH BIN HOKSAN TN
SARJIANTI BINTI SAIMUN NY.
SULAIMAN NADEAK TN.
160,000.00
60,000.00
139,884.00
10,000.00
125,000.00
110,000.00
93,120.00
10,000.00
160,000.00
10,000.00
160,000.00
147,664.00
10,000.00
137,000.00
107,240.00
10,000.00
160,000.00
245,000.00
10,000.00
160,000.00
146,000.00
117,630.00
60,000.00
10,000.00
160,000.00
120,065.00
10,000.00
160,000.00
219,500.00
64,000.00
218,444.00
142,400.00
718,180.00
137,540.00
1,192,000.00
512,000.00
92,300.00
890,000.00
10,000.00
160,000.00
122,000.00
890,000.00
Page 265
18 MEI 2016
SAFRI,H TN.
ISMI FITRIA AN
MONTES SRIWATI NY
LINDA VELANI NY
MUHAMMAD YUNUS TN.
MUHAMMAD YUNUS TN.
SUMIATY JUMAHAT NY
NUMARITIN BINTI H RUSWI NY.
ZAWIYAH ERMAWATI HJ. NY
YULINAR NURUT NY.
EDDI AZ TN.
LIONG KIM LIAN NY.
HUSNI THAMRIN TN
HUSNI THAMRIN TN
MOHSAN TURIP TN.
CHADIDJAH SALEH NY
KHAIRUL ANWAR TN
A. JAMALUDDIN TN.
A. JAMALUDDIN TN.
INDAH PURNAMA SARI NY
MULKAS ADE PUTRA TN
MULKAS ADE PUTRA TN
KAILANI HUSIN TN
TRI MURTI NY.
SOLIHIN BIN SABTU TN.
RIO HUTABARAT TN.
NURHAYATI BINTI M. OTEH NY
RIZKI HARTANTRI NY
NYAYU FATIMAH TUZAHRO NY.
SHANTY HAMDAYANI NY.
67,500.00
238,200.00
10,000.00
125,000.00
171,650.00
183,800.00
10,000.00
125,000.00
472,000.00
60,000.00
230,900.00
472,000.00
239,520.00
169,300.00
110,000.00
10,000.00
160,000.00
226,000.00
146,000.00
10,000.00
125,000.00
840,000.00
113,308.00
10,000.00
160,000.00
194,400.00
1,081,900.00
10,000.00
160,000.00
240,800.00
60,000.00
240,800.00
99,400.00
10,000.00
160,000.00
118,930.00
142,790.00
227,658.00
10,000.00
160,000.00
237,296.00
245,105.00
Page 266
18 MEI 2016
YUDHISTIRA ARYA N TN
RUSLAN BIN ASMAWAI TN.
SRI DAMAYATI NY.
SOLDA BINTI KORI NY.
ARBAIN GANTI TN
ARBAIN GANTI TN
EMIR AHMAD SYAPUTRA AN.
SAID SALIM TN
MELVI JENISCA NN.
DEWO ANGGORO AN.
NUR HAYATI NY
AMRULLAH BIN NUNGCIK TN
YULITA ANGGRAINI NY.
AISYAH BIN YATMURI NN.
IMASIAH BINTI MAT DOA NY.
INDAWATI NY.
INDAWATI NY.
TJIUW TJIN HE TN.
NURAINI BINTI MANAP NY
HANAFI BIN ABDUL HALIM TN.
NAFISAH AINU RODIAH AN
KARINI YOHANA TARIGAN DRG
NYAYU NING NY.
TJIKNUT SYUKUR NY
TJIKNUT SYUKUR NY
HENIWATI NY
NUR ZAHRA NABILA AN.
1,208,000.00
280,000.00
317,500.00
10,000.00
160,000.00
105,125.00
10,000.00
160,000.00
144,164.00
234,400.00
202,000.00
100,800.00
10,000.00
160,000.00
194,400.00
198,500.00
10,000.00
95,000.00
146,950.00
193,585.00
91,100.00
104,650.00
68,000.00
414,897.00
155,003.00
193,585.00
317,130.00
10,000.00
160,000.00
260,400.00
72,150.00
10,000.00
160,000.00
263,878.00
110,304.00
528,800.00
228,000.00
10,000.00
160,000.00
151,000.00
232,416.00
347,150.00
Page 267
18 MEI 2016
MANTHO HARUN TN
ABDULLAH JAMALULLAIL AN
INDRAYANTA TN
RENA KUMALA DEWI NY.
RATNA SARI NY
NGADIMAN TN.
DAFINA ADIBAH MUFIDAH AN.
ERNI AMELIA NY
MIS YANTI NY
KHADIJAH BINTI ALWI NY
SISWANTY K. R NY.
NESLI HARTI HJ NY.
AZWAN ANWAR TN.
M. RAIHAN ARIF AN.
METHA MAGDALENA H NN
ENDAH KUSUMAWATI NY
IMANIAH BINTI HAMDAN NY
MAHBUBA BINTI ABDUL HASIM NY.
SITI MARIAM NY
ERWIN AZHARI TN.
AKHTAR KANZ R AN
NOVITA BINTI ANDI NY
TRI DIAN FERDIANTI SARI NY.
MISDAR NIZAWATI NY
FITRI YULIANTY NY
RIKI ROHIMAT TN
EDY ABDULLAH TN
RITA ELVIRA NY.
YUS ROHANA NY.
YUS ROHANA NY.
NUR TJAHYO TN
HERMANTO BIN A WAHID TN
SUSI BINTI THENG CING KOK NN
HASBIAH BINTI ABDU NY.
FATMAWATI BINTI SUANDA NY
133,500.00
274,851.00
165,000.00
223,545.00
98,900.00
72,150.00
88,951.00
125,040.00
10,000.00
177,000.00
149,900.00
120,000.00
341,750.00
110,000.00
77,500.00
476,000.00
289,068.00
60,000.00
136,305.00
373,446.00
221,500.00
219,085.00
164,000.00
200,700.00
110,000.00
890,000.00
122,400.00
313,090.00
206,485.00
128,000.00
60,000.00
164,520.00
890,000.00
270,076.00
10,000.00
160,000.00
146,000.00
60,000.00
170,360.00
124,552.00
130,400.00
210,030.00
Page 268
18 MEI 2016
CANDRA DOAN TN.
ADERLIN SALAM NY.
NICKY VERDIANTO TN.
M GUNTUR PAMUNGKAS AN
YANSEN BIN DAHLAN AN
DESI AMANDA AN
MASWAH BINTI MASAN NY.
DIAH EVA SYOFARIAH NY
ZAID KHAIRUL ISNAN AN.
ZAINAL IMRON TN.
ZAINAB BINTI MUHAMMAD NY.
MUHADI TN.
MAULANA RAMADHAN A. HANUN A
SHOFWAN TN.
MIDO H BIRAN TN
KHO SUI HONG NY
FITRIA BINTI ZAKARIAH NY.
KWEE WIE BENG TN
SELAMET BIN SAFEI TN
SRI YULIDAR NY.
DEA AMANDA F. AN
TAN NIE NIO TATTY NURJATI NY
CHERRY LEMBEK TN.
CHAIRUL MUCHLIS TN
RUSNAN CHANDRA TN
WARTINI BINTI MAHAR NY
MARZUKI ABDULLAH TN
270,964.00
384,200.00
106,200.00
351,040.00
999,800.00
60,000.00
60,000.00
60,000.00
222,100.00
237,945.00
156,920.00
60,000.00
257,485.00
280,960.00
60,000.00
107,450.00
435,700.00
118,160.00
84,096.00
590,200.00
60,000.00
205,150.00
193,585.00
165,120.00
60,000.00
174,320.00
10,000.00
167,000.00
60,000.00
470,200.00
60,000.00
60,000.00
890,000.00
79,450.00
890,000.00
165,450.00
105,000.00
204,250.00
246,160.00
60,000.00
60,000.00
60,000.00
Page 269
18 MEI 2016
KARTINI NY
BETIN TEGUH NY.
FARINA BINTI SARBUNI NY.
SITI ROHMA NY
AMIR HAMZAH TN
FEBRIANSYAH ANUGRAH WIJAYA AN
CALLYSTA BELVA H. AN
ALI NURDIN TN.
SUHARNI NORI KOYANA NY
RAFA ALVARO AN
DAVID ISKANDAR TN
ZURYATI BINTI ZAHARI NY
KHODIJAH BINTI M.LEKAT NY
ELIYA MARGARITA NY.
SRI RAHAJU NY.
MUHAMMAD MIFTHAURRAHMAN AN
NURHAYATI BINTI AHMAD NY
ARIFIN SITOHANG TN.
MURNI BINTI NANGCIEK NY
MUHAMMAD AL FATIIH AN.
KAROLINA NY.
SETIA WATI NY
SETIA WATI NY
PAUZI THAMRIN TN
HARTATI OH NY
ELIS TJEN NY
ISMI JELITA NY
ISMI JELITA NY
MUCHTAR TS TN
MARIA HALIMA NY
SUNARYATI BINTI MASDI NY
RATIH AMELIA NN
RAHMA AYU PUTRI AN.
MEYLINDA NY
ERLINA AYOEB NY.
81,950.00
99,450.00
1,450,800.00
141,450.00
60,000.00
111,287.00
10,000.00
111,287.00
164,580.00
890,000.00
152,960.00
60,000.00
136,500.00
79,450.00
635,100.00
163,580.00
186,700.00
158,580.00
791,400.00
60,000.00
112,643.00
99,450.00
60,000.00
194,030.00
60,000.00
177,000.00
10,000.00
160,000.00
60,000.00
60,000.00
129,600.00
10,000.00
200,000.00
93,600.00
60,000.00
60,000.00
222,000.00
222,000.00
60,000.00
140,400.00
470,200.00
134,830.00
Page 270
18 MEI 2016
TRI PUTRA H SURBAKTI TN.
ROHANA NY.
HILMA YORITA NY
NAILAH RAMADHANI F. AN
INDRIYANI BINTI M. SOLEH NY.
HERMAN ZAKARIA TN.
RUSIA BINTI YAMIN NY.
SOFYAN DEDI TN
PAULUS JUMIRAN TN.
NURDJANAH AKIL NY
HERI SUKANDAR TN
HENGKI FIRNANDES AN.
NURBAITI BINTI SUIB NY
SUNARTI NY
SUMIANAH BINTI SUHEF NY.
ATIKA ROSANTI NY.
HANIFAH ANDINI C AN
SANTI MUTIARA SARI NY.
SURATNI BINTI SALI NY.
MACHFUS TARMIZI, H TN.
AHMAD BIN DUHAK TN
SITI MAEMUNAH NY.
JANSEN SIRAIT TN.
MAYSAROH BINTI MUHAMMAD NY.
INDRA SANDI TN
ELSA SUMARSIH NY.
YULIA HANAN NY.
TIN HAYANI AGUSTIA NY.
ENI MARADONI NY
SITI NURAINI NY.
SITI NURAINI NY.
CORNILIA ANITA NY.
ELLY SUMARYATI NY.
488,200.00
154,148.00
60,000.00
60,000.00
319,245.00
158,580.00
476,520.00
292,500.00
147,040.00
165,000.00
414,897.00
889,400.00
423,800.00
234,400.00
103,740.00
247,951.00
60,000.00
193,585.00
571,200.00
60,000.00
169,541.00
193,585.00
115,000.00
197,145.00
680,200.00
1,088,400.00
60,000.00
313,800.00
71,000.00
240,800.00
234,400.00
178,500.00
298,005.00
129,400.00
217,037.00
353,295.00
10,000.00
160,000.00
180,950.00
10,000.00
160,000.00
264,000.00
Page 271
18 MEI 2016
SAFRIANI BINTI ABDUL HAMID NY
NUR EKA SANFITRI DR. NY.
IRNOV YAMUAR. TN.
ASWIN BIN JUKI TN.
SITI MASIAH M ZACHRI HJ NY
PANDU PRASETYA TN.
ROHANA BINTI ARSYAD RONI NY
YOLIN ERWIN TN.
ARIANA TUSEN NY.
LIONG FOET PO NY.
HERNANI DRA NY.
ZEFRI SURYA ARI YAWAN TN
CIK IMA NY
SETIA HENILIANTI NY.
AHMAD ATHALLAH GIGIH.E AN.
NUR AINI NY.
FAUZI DAHLAN IR TN
TOBING BIN MAWAN TN.
MARISA OKTARINA NY
ROSALINA NY
ERMAWATI BINTI SAHRI H NY.
SAMUDIN TN.
AS AD SAYUTI DRS TN
AS AD SAYUTI DRS TN
RUSTEM PUAD TN.
RICHA SUSANTY NY
AYU LUTHFIYAH AN.
MISNAR, HJ BINTI MUSLIM NY.
FARIDA ABIDIN NY
OLIVER CHRIS W AN
DARLINA BINTI SUDAR NY.
H. GOENTOMO IBRAHIM TN.
272,650.00
60,000.00
385,500.00
183,200.00
240,800.00
120,600.00
221,945.00
1,430,500.00
240,800.00
387,105.00
581,700.00
134,830.00
10,000.00
125,000.00
94,620.00
125,300.00
10,000.00
135,000.00
193,585.00
75,000.00
110,000.00
122,400.00
368,780.00
470,200.00
373,500.00
84,580.00
260,400.00
93,775.00
140,821.00
325,062.00
244,660.00
10,000.00
167,000.00
516,720.00
405,509.00
65,000.00
263,095.00
120,000.00
179,230.00
110,000.00
60,000.00
10,000.00
Page 272
18 MEI 2016
K A LATIF TN
DEWI IKRAR BHAKTI NY
YENNI NOVIANI NY
SETYORINI NY.
LILY SULASTRI NY.
ZANARIAH BINTI HAMSIH NY.
SOLLY YANCIK BERLIAN TN
MIE TJAN YENI NY
RANITA BINTI BAHRI NN.
MANIAH BINTI AGUNG ALI NY.
DIANA OKTAVIA NY
KRISTOPEL SIMATUPANG TN.
M.AMIN LISON TN
AMIRUDDIN B MAHMUD TN.
YOEDY AS TN
MINGSI BINTI HASAN NY.
SUMARNO KUSDARI TN
DIKI RAFIKIH TN
ASMIZAR BINTI ASMAN NY.
AUFAR PUTRA FABIAN AN
MIKHAEL RUKINEM NY.
KAROLINA NY.
MASWAH BINTI MASAN NY.
95,000.00
430,900.00
115,000.00
210,278.00
115,600.00
193,585.00
143,650.00
482,265.00
135,000.00
10,000.00
160,000.00
60,000.00
110,000.00
60,000.00
10,000.00
160,000.00
10,000.00
160,000.00
193,585.00
83,000.00
40,000.00
102,710.00
150,432.00
264,900.00
145,376.00
174,400.00
40,000.00
673,254.00
452,000.00
854,200.00
221,280.00
106,052.00
159,500.00
10,000.00
160,000.00
10,000.00
75,000.00
172,000.00
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NO
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NO RJ
190516390084
190516390081
190516390031
190516280223
190516280465
190516390089
190516390160
190516390083
190516390085
190516390088
190516450674
190516280033
190516390080
190516280315
190516390121
190516390082
190516430833
190516390173
190516430890
190516430778
190516390093
190516390291
190516390086
190516390387
190516390187
190516390312
190516430734
190516450756
190516390073
190516390046
190516390045
190516390043
190516280234
190516280235
190516280021
190516390022
190516390023
190516390034
190516390024
190516390025
190516390013
TANGGAL
05/19/2016
05/19/2016
05/19/2016
05/19/2016
05/19/2016
05/19/2016
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05/19/2016
05/19/2016
05/19/2016
05/19/2016
05/19/2016
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160004026
0090R03105160004435
0090R03105160004436
0090R03105160004441
0090R03105160004443
0090R03105160004444
0090R03105160004444
0090R03105160004446
0090R03105160004447
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190516390111
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190516280103
190516280074
190516280184
190516280186
190516390389
190516280217
190516280219
190516390177
190516390044
190516390041
190516390042
190516390480
190516390288
190516280205
190516280213
190516390110
190516390191
190516390026
190516390029
190516390353
190516390017
190516280101
190516280102
190516390343
190516390027
190516390040
190516390116
190516390118
190516280019
190516390068
190516390119
190516430617
190516430619
190516390097
190516280180
190516280183
190516280107
190516390243
190516390244
05/19/2016
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05/19/2016
05/19/2016
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05/19/2016
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0090R03105160004451
0090R03105160004452
0090R03105160004452
0090R03105160004453
0090R03105160004454
0090R03105160004455
0090R03105160004455
0090R03105160004456
0090R03105160004457
0090R03105160004457
0090R03105160004458
0090R03105160004459
0090R03105160004460
0090R03105160004460
0090R03105160004461
0090R03105160004462
0090R03105160004463
0090R03105160004463
0090R03105160004464
0090R03105160004465
0090R03105160004466
0090R03105160004466
0090R03105160004467
0090R03105160004468
0090R03105160004469
0090R03105160004469
0090R03105160004470
0090R03105160004471
0090R03105160004472
0090R03105160004473
0090R03105160004473
0090R03105160004474
0090R03105160004475
0090R03105160004476
0090R03105160004477
0090R03105160004477
0090R03105160004478
0090R03105160004479
0090R03105160004479
0090R03105160004480
0090R03105160004481
0090R03105160004481
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190516390065
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190516390094
190516280129
190516280408
190516280413
190516280091
190516280095
190516280133
190516390265
190516390268
190516280096
190516390131
190516390125
190516280372
190516280373
190516390146
190516390299
190516390301
190516390380
190516280361
190516280362
190516390166
190516280066
190516280069
190516280214
190516280056
190516390059
190516430667
190516430669
190516280226
190516280365
190516280366
190516390053
190516280304
190516390162
190516280172
190516390113
05/19/2016
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0090R03105160004482
0090R03105160004482
0090R03105160004483
0090R03105160004484
0090R03105160004485
0090R03105160004485
0090R03105160004486
0090R03105160004487
0090R03105160004488
0090R03105160004488
0090R03105160004489
0090R03105160004489
0090R03105160004490
0090R03105160004491
0090R03105160004491
0090R03105160004492
0090R03105160004493
0090R03105160004494
0090R03105160004495
0090R03105160004495
0090R03105160004496
0090R03105160004497
0090R03105160004497
0090R03105160004498
0090R03105160004499
0090R03105160004499
0090R03105160004500
0090R03105160004501
0090R03105160004501
0090R03105160004502
0090R03105160004503
0090R03105160004504
0090R03105160004505
0090R03105160004505
0090R03105160004506
0090R03105160004507
0090R03105160004507
0090R03105160004508
0090R03105160004509
0090R03105160004510
0090R03105160004511
0090R03105160004512
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190516390392
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190516390379
190516390262
190516390263
190516450509
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190516280098
190516280070
190516390348
190516390072
190516390100
190516280169
190516390090
190516390425
190516390426
190516280167
190516280071
190516390294
190516280242
190516390079
190516390104
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190516390230
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190516430513
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05/19/2016
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0090R03105160004517
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0090R03105160004519
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0090R03105160004522
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0090R03105160004525
0090R03105160004526
0090R03105160004527
0090R03105160004528
0090R03105160004529
0090R03105160004530
0090R03105160004531
0090R03105160004531
0090R03105160004532
0090R03105160004533
0090R03105160004534
0090R03105160004535
0090R03105160004536
0090R03105160004537
0090R03105160004537
0090R03105160004538
0090R03105160004539
0090R03105160004540
0090R03105160004541
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0090R03105160004560
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0090R03105160004566
0090R03105160004567
0090R03105160004568
0090R03105160004568
0090R03105160004569
0090R03105160004570
0090R03105160004571
0090R03105160004573
0090R03105160004576
0090R03105160004577
0090R03105160004577
0090R03105160004579
0090R03105160004580
0090R03105160004582
0090R03105160004584
0090R03105160004586
0090R03105160004586
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0090R03105160004664
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0090R03105160004668
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0090R03105160004729
0090R03105160004730
0090R03105160004731
0090R03105160004732
0090R03105160004732
0090R03105160004733
0090R03105160004743
0090R03105160004748
0090R03105160004750
0090R03105160004751
0090R03105160004751
0090R03105160004753
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0090R03105160005025
0090R03105160005025
0090R03105160005227
DI KASIR
MASUK RAWAT INAP
Page 282
19 MEI 2016
NAMA PASIEN
AGUS TRIANTO TN
AIDI SYAMSUDIN TN.
JULIANA KOWIRA NY.
KWEE WIE BENG TN
LAM SURYA NY.
LELY WATI NY
LELY WATI NY
MISDAR NIZAWATI NY
RATNA SARI NY
ROHANA NY.
SAADAH BINTI LATIF NY.
SITI AISYAH NY.
SITI AISYAH NY.
SJAFRAN SOHIB TN
SUDARMI BINTI KADAR NY.
SULAIMAN NADEAK TN.
SUMARNO KUSDARI TN
SYAMSAIMUN KOMAR TN.
TONY NOER TN
WARTINI BINTI MAHAR NY
WARTISYAH BINTI M SOLEH NY
ZUBAIDAH BINTI H. IBRAHIM NY
FITRI BAROKAH NN.
M. ADIWITYA ALKHAFID. AN
RATNA DJUAMI NY.
KMS EFFENDY TN.
KMS EFFENDY TN.
SJAFRAN SOHIB TN
M. ABBAS HASAN TN
M. ABBAS HASAN TN
M. AZKA AZFAR AN.
SUGINAH ABBAS NY.
SUGINAH ABBAS NY.
ARIANA TUSEN NY.
TRANSAKSI
1,714,300.00
513,000.00
108,200.00
249,000.00
7,150.00
129,000.00
216,400.00
135,000.00
135,000.00
30,600.00
18,075.00
148,920.00
45,000.00
35,500.00
309,600.00
45,000.00
21,750.00
114,400.00
55,650.00
129,000.00
22,500.00
60,713.00
133,500.00
249,000.00
48,300.00
289,500.00
11,250.00
107,450.00
251,416.00
213,099.00
293,930.00
65,966.00
137,000.00
10,000.00
232,370.00
10,000.00
160,000.00
61,341.00
10,000.00
160,000.00
217,280.00
Page 283
19 MEI 2016
SUGIRAN BIN KARYO PRAWIRO TN.
FARIDA BINTI M.SALEH NY
TUTI PURNAMAWATI NY
TUTI PURNAMAWATI NY
LIM KOEIJ ING NY
ZAINAB BINTI ALI NY
TANG WEI HENG NY
TANG WEI HENG NY
HENDRA HARTANTO TN.
HENDRA HARTANTO TN.
WARDIAH IDRIS NY
SONIA PARAMITA AN
ZAIDAN ACHMAD TN.
ZAIDAN ACHMAD TN.
SUYADI H. TN
UMNI AZIS NY.
HASIAM INDRIANI NY
HASIAM INDRIANI NY
DAVID ISKANDAR TN
HASBULLAH TN
PATMAN ROZI TN
RUSLAINI HJ BINTI H ALI NY.
MAIMUNAH BINTI M. AMIN NY.
162,656.00
10,000.00
160,000.00
737,631.00
173,000.00
10,000.00
160,000.00
890,000.00
10,000.00
160,000.00
152,700.00
275,400.00
10,000.00
167,000.00
890,000.00
890,000.00
10,000.00
177,000.00
119,025.00
148,370.00
10,000.00
125,000.00
1,192,000.00
60,800.00
10,000.00
160,000.00
890,000.00
181,280.00
199,370.00
10,000.00
160,000.00
216,000.00
300,560.00
393,000.00
10,000.00
125,000.00
233,900.00
10,000.00
160,000.00
523,400.00
10,000.00
95,000.00
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19 MEI 2016
PAINO TN
OKTA SAPUTRA TN
OKTA SAPUTRA TN
JENIFFER AGATHA AN
SOEWOTO EDDY M TN
ELIYA MARGARITA NY.
ELIYA MARGARITA NY.
ARISTA SIMANJUNTAK NY.
SP. TOEGINO SUDARTA TN
SUPINI BINTI HAMDATI NY
M. ALI SEKAMIN TN
M. ALI SEKAMIN TN
M. SYAMSUDIN SOLEH, H TN
HENDRY RIANTO TN
NYAYU HALIMAH NN.
NYAYU HALIMAH NN.
SITI NURBAYA NY
M.ZAYYAN ZAIDAN HANAN AN
ERLILI JUNAIDI NY
ALFI SYAHRIN TN.
ALFI SYAHRIN TN.
AYU WANDIRA NY.
DEVI AWALIA NY
WINDA EFRIANI NY
ST. JAMILAH NY.
10,000.00
160,000.00
167,000.00
488,200.00
10,000.00
177,000.00
110,000.00
459,850.00
10,000.00
160,000.00
10,000.00
160,000.00
441,500.00
10,000.00
160,000.00
115,000.00
152,415.00
188,900.00
10,000.00
95,000.00
166,785.00
10,000.00
160,000.00
890,000.00
10,000.00
160,000.00
116,500.00
10,000.00
190,000.00
132,687.00
60,000.00
117,920.00
10,000.00
160,000.00
60,000.00
10,000.00
137,000.00
268,000.00
890,000.00
349,900.00
176,330.00
123,700.00
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19 MEI 2016
YUSLAINI BINTI MONERAJO NY.
JUNAIDA PRIANI NY
JUNAIDA PRIANI NY
MUHAMMAD TONI TN.
MUHAMMAD TONI TN.
SYAFRIL MAHYUDIN TN.
EMMY YAHIMI NY
EMMY YAHIMI NY
NURMA HASAN, HJ NY.
SYAFEI BIN MUROD TN
ROBBY PANCA MAULANA TN
RACHMAD SANTOSO TN
NADYA PRISKA HAMIDYA NN.
TRIANA APRIANI NY
RITA ZAHARA NY
FERIYANTO BIN EFFENDI TN
ARIFIN SITOHANG TN.
ARIFIN SITOHANG TN.
SRI MULYONO TN
PIPIT DWITYA SE NY.
FADILLAH FAJRIANSYAH AN.
ISMAIL BIN SASTOR TN.
KMS A RONI H TN.
MIRIN IRVAN H TN.
MUHAMMAD MUKHSIN H TN
YURIKA ROSALINA NY
ADLY AL HABSYI.H AN.
ISMAIL ALI TN
349,200.00
10,000.00
160,000.00
10,000.00
160,000.00
238,500.00
10,000.00
160,000.00
60,000.00
10,000.00
160,000.00
10,000.00
177,000.00
384,200.00
163,100.00
10,000.00
160,000.00
226,500.00
188,000.00
254,370.00
60,000.00
60,000.00
357,400.00
327,500.00
10,000.00
160,000.00
155,600.00
279,200.00
339,725.00
240,800.00
82,400.00
76,800.00
50,000.00
182,930.00
240,200.00
208,580.00
10,000.00
125,000.00
122,400.00
273,467.00
120,000.00
283,580.00
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19 MEI 2016
ATMINA PENI GINTING NY.
FATIMAH BINTI M. DAHLAN NY
MAMAT SADI TN.
NURSYAWALI KANIA AYUDIA AN
ADWINA BATARI NY
LISIANA OSWARI NN.
ERNA RAYA NY.
SALMADEA BINTI IDRUS NY.
ERNA KURNIATY NY.
FEMILIA MARLINA NY.
JUMIARTI BINTI MURDIN BAKTI NY
SRI RAHAYU BY NY.
JUSRIZAL RUSLAN TN
SRI MULYATI NY
SRI MULYATI NY
AISYAH NN.
ENI WARDANI NY.
10,000.00
160,000.00
468,265.00
264,800.00
234,400.00
160,000.00
10,000.00
840,000.00
221,400.00
198,700.00
65,650.00
193,585.00
193,585.00
10,000.00
160,000.00
110,000.00
10,000.00
160,000.00
106,010.00
67,120.00
120,000.00
501,600.00
10,000.00
160,000.00
187,200.00
488,200.00
282,800.00
91,050.00
184,700.00
10,000.00
167,000.00
116,000.00
115,000.00
227,262.00
110,000.00
10,000.00
160,000.00
120,000.00
93,790.00
145,700.00
120,000.00
255,985.00
Page 287
19 MEI 2016
CHENIE LEANITA HARMENT NY.
SRI PURNAMAWATI NY.
SRI PURNAMAWATI NY.
HIDAYATI UMAR, HJ, SPD NY
AMIR HAMZAH TN
AMIR HAMZAH TN
SHINTA ERLINA NY.
SYAMSAIMUN KOMAR TN.
DEFRI SYAHPUTRA TN
NURBAITI BINTI YAHYA NY.
NURMA BINTI SAMSARI NY.
FEBRY SAFITRI NY
RINNY HENDRIATY NY.
ROSPITA BINTI SAMIRI NY
ATIKA, IR, MM NY
RONIMAH NY
NANDRI AL FARABI AN.
M. BAYU SAPUTRA AN.
ACHMAD MAULANA,H TN
MULYADI CUAN BIE TN
MUHAMMAD ARDIANSYAH TN
NICKY VERDIANTO TN.
TRI LIANA NN.
SARDJONO, H TN
70,480.00
217,037.00
10,000.00
160,000.00
257,800.00
167,000.00
10,000.00
301,685.00
180,000.00
840,000.00
978,800.00
840,000.00
221,235.00
260,857.00
407,252.00
120,000.00
60,000.00
222,965.00
90,000.00
249,600.00
60,000.00
890,000.00
110,350.00
60,000.00
60,000.00
890,000.00
186,250.00
890,000.00
213,560.00
111,250.00
138,500.00
890,000.00
528,500.00
120,000.00
146,850.00
164,981.00
528,800.00
60,000.00
60,000.00
96,000.00
118,850.00
60,000.00
Page 288
19 MEI 2016
FITRYADI SINGARIMBUN TN.
KAROLINA NY.
SRI AGUS TINA NY.
DJALILI SOLIHIN TN
DANILA BINTI KGS A KARIM H NY
TJAN TJHUINGAN NY
MIKHAEL RUKINEM NY.
NURPELAM BINTI JAILANI NY
JANSEN SIRAIT TN.
SITTI CHAMSIDAR HJ NY.
S. MAIMUNAH NY.
TJIK YAH SAHAB NY.
NUR AINI NN.
UJANG TONI TN
DAMUIR BIN JABAN TN.
FINIA TONI NN.
YULIA DASWATI NY.
HERMELIA FITRI A. NY
EMIYUTI BINTI UMAR NY
LINAWATY NY
RAUDYA TUZZAHRA NN.
SITI LASIAH NY
M. DIO KASYAFANI AN.
HASRI TANJUNG H TN.
MIS YANTI NY
NASRUN BASRI TN
HOMSIANA BINTI ABDUL HAQ NY.
SULAIMAN NADEAK TN.
STEFFI BINTI LIE TJIN PO NY.
60,000.00
223,450.00
107,450.00
97,485.00
60,000.00
89,094.00
149,350.00
60,000.00
319,520.00
107,450.00
76,800.00
890,000.00
240,800.00
60,000.00
204,645.00
10,000.00
160,000.00
10,000.00
160,000.00
244,885.00
293,100.00
219,325.00
244,520.00
115,919.00
256,960.00
144,500.00
71,450.00
236,030.00
60,000.00
193,585.00
60,000.00
230,000.00
205,030.00
60,000.00
240,800.00
10,000.00
160,000.00
180,000.00
132,950.00
621,600.00
1,357,400.00
221,235.00
Page 289
19 MEI 2016
SYAIFUL BACHRI TN.
ZARWINI BINTI A. HAMID NY
ENDAR WIRANAWATI NY.
RICKI FENDY KURNIAWAN TN.
RATNA SARTIKA NY
MARIATUL KIBTIA NY.
INTAN PUSPA SARI NY
MEY SUSIANAWATI SKM. NY
DARMAWANSYAH MADDIN TN.
FAJRIAH PURNAMA NY.
RAFA ALVARO AN
NAAILAH FAIRUS HAWA AN
SHINTA PARAMITA NY
BETIN TEGUH NY.
BETIN TEGUH NY.
LENI MARLINA NY
YASIR SATRIA TN
LEMIDIYATI GUSTARINI NN
TUTI ROBIAH NY.
WENTI KUMALA SARI NN.
ROHITA WIDIYAH NY.
SLAMET SOETANTO TN.
ROKIAH BINTI HAMDAN NY.
ELYU CHOMISAH, SIP,M.KES,HJ NY
HABSAH BINTI MAHMUD NY.
TITIN INDAH YANTI NY
LELA ANGGRAINI NY
MARIANA BINTI S. IBRAHIM NY
TJIUW TJIN HE TN.
MUHAMMAD EFFENDI TN
M. HANAN HAWARI AN
MUHAMMAD NASIR TN.
AMALIA OKTARINA NY.
KWEE WIE BENG TN
LASMA MEGAWATI SITORUS NY
141,200.00
221,235.00
221,235.00
144,319.00
221,235.00
120,170.00
90,450.00
193,585.00
60,300.00
278,145.00
110,000.00
109,805.00
193,585.00
10,000.00
160,000.00
60,000.00
10,000.00
160,000.00
415,800.00
169,836.00
169,000.00
180,000.00
246,975.00
110,094.00
101,235.00
177,500.00
110,000.00
60,000.00
167,500.00
238,640.00
110,000.00
193,610.00
104,140.00
246,360.00
78,000.00
152,055.00
60,000.00
120,600.00
143,750.00
360,274.00
364,000.00
193,585.00
Page 290
19 MEI 2016
ASNAWIYAH BINTI M FUDIN NY
FETTY DWI UTAMI NY.
HENRYAWAN HERLIYANTI TN.
ALIFAH NAILAH AB QORIAH AN
M.RISKY PRATAMA AN.
IKE APRIANI NY
IKE APRIANI NY
NENI TRIANA NY
LENY NOVARITA, S.KOM NY
DEVI HERLINA NY.
IKA YUNIZAR NY.
LENY NOVITA S.KOM BY NY.
245,085.00
324,005.00
76,800.00
10,000.00
177,000.00
251,150.00
174,400.00
174,400.00
145,495.00
288,965.00
40,000.00
159,100.00
323,195.00
204,645.00
10,000.00
102,000.00
60,800.00
134,450.00
192,815.00
Page 291
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NO
1
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41
NO RJ
200516430163
200516430075
200516450415
200516450724
200516430033
200516450381
200516450416
200516450235
200516430325
200516450403
200516430206
200516430058
200516430062
200516430371
200516450113
200516450414
200516390596
200516450915
200516430057
200516450413
200516430081
200516420745
200516450395
200516430080
200516380445
200516430082
200516450053
200516390518
200516430071
200516430061
200516430367
200516450459
200516430076
200516430074
200516430077
200516430056
200516380183
200516430078
200516390749
200516430059
200516450419
TANGGAL
05/20/2016
05/20/2016
05/20/2016
05/20/2016
05/20/2016
05/20/2016
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05/20/2016
05/20/2016
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05/20/2016
05/20/2016
05/20/2016
05/20/2016
05/20/2016
05/20/2016
05/20/2016
05/20/2016
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
Page 292
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200516380268
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200516430024
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200516430036
200516430008
200516450090
200516450094
200516450041
200516450042
200516430282
200516380095
200516380092
200516450423
200516380118
200516380123
200516450175
200516430160
200516380170
200516380176
200516380169
200516380165
200516380089
200516380088
200516380087
200516380052
200516380086
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200516450066
200516450161
200516450159
200516380047
200516450079
200516430015
05/20/2016
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05/20/2016
05/20/2016
05/20/2016
00
0090R03105160004076
0090R03105160004587
0090R03105160004587
0090R03105160004720
0090R03105160004754
0090R03105160004755
0090R03105160004758
0090R03105160004760
0090R03105160004763
0090R03105160004765
0090R03105160004765
0090R03105160004768
0090R03105160004769
0090R03105160004770
0090R03105160004771
0090R03105160004772
0090R03105160004772
0090R03105160004774
0090R03105160004775
0090R03105160004775
0090R03105160004776
0090R03105160004777
0090R03105160004777
0090R03105160004778
0090R03105160004779
0090R03105160004780
0090R03105160004780
0090R03105160004781
0090R03105160004781
0090R03105160004782
0090R03105160004783
0090R03105160004783
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0090R03105160004785
0090R03105160004785
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0090R03105160004791
0090R03105160004793
0090R03105160004794
0090R03105160004795
0090R03105160004795
0090R03105160004795
0090R03105160004796
0090R03105160004797
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0090R03105160004799
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0090R03105160004800
0090R03105160004801
0090R03105160004802
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0090R03105160004804
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0090R03105160004806
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0090R03105160004807
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0090R03105160004811
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0090R03105160004812
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0090R03105160004814
0090R03105160004815
0090R03105160004815
0090R03105160004816
0090R03105160004816
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0090R03105160004992
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200516450914
200516390772
200516390529
200516390523
200516450738
200516450694
200516450692
200516390507
200516450543
200516390606
200516450540
200516390544
200516390570
200516390818
200516390752
200516450723
200516450721
200516420714
200516420716
200516450532
200516390563
200516390560
200516390654
200516450521
200516450548
200516450520
200516390825
200516420623
200516390733
200516390728
200516450556
200516390536
200516420625
200516390883
200516450687
200516450564
200516450858
200516450698
200516390675
200516390652
200516450637
200516390592
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MASUK RWI
Page 301
20 MEI 2016
NAMA PASIEN
TRANSAKSI
AGUS TRIANTO TN
210,000.00
ALIFAH NAILAH AB QORIAH AN
28,176.00
78,000.00
BAIHAKI BIN R. KEPALO TN.
2,000.00
DAVID ISKANDAR TN
276,000.00
DESI ANITAWATI NY
54,000.00
FAHRUL ROZI TN
149,800.00
FATIMAH BINTI M.ZEN NY.
65,700.00
FAUZI DAHLAN IR TN
9,000.00
FERIYANTO BIN EFFENDI TN
78,000.00
H. SRI RAHARDJO TN.
243,000.00
HASMAH ALI HASAN NY
45,000.00
HENDI YANTO TN.
148,600.00
HENNY PURWANTI NY.
80,430.00
IDRIS BIN YASWANDI TN.
25,200.00
IRNOV YAMUAR. TN.
154,200.00
ISRIL HENDRA TN
149,800.00
JAYANIS AMIR NY.
155,970.00
JULIANA KOWIRA NY.
111,600.00
198,000.00
LELY WATI NY
249,000.00
M. AZKA AZFAR AN.
68,100.00
MANTHO HARUN TN
249,000.00
249,000.00
NOCE TEATER TN.
22,480.00
540,000.00
108,200.00
155,970.00
ROSIDA TOMZAH NY.
4,500.00
RUSIA BINTI YAMIN NY.
156,000.00
51,400.00
1,250.00
SISMAWATI BINTI SUDIN NY.
108,200.00
SP. TOEGINO SUDARTA TN
58,000.00
SUNARTI NY
78,000.00
SUPINI BINTI HAMDATI NY
324,000.00
33,068.00
SYARKOWI TN.
387,000.00
TJOE KIE TJAK TN
160,470.00
YANG CIK NY.
1,463,950.00
YULIUS AIDA NY.
149,800.00
Page 302
20 MEI 2016
ZURIA BINTI A. RAHMAN NY
SOLLY HARAHAP TN.
JENIANA BINTI MULYADI AN
JENIANA BINTI MULYADI AN
NURUL HAYATI NY.
SUHARTO TN
HERI SUDARMAN TN
MONICA SEPTI ARIANI NY.
AQILA ADZKIAJOYU AN
KHODIJAH BINTI SAMSUL NY
KHODIJAH BINTI SAMSUL NY
HAIRUN ANISYAH NY
IDRIS BIN YASWANDI TN.
SOGIRAH BINTI TUPARI NY.
DIANA NOVITA NY
R.M ZAINAL ABIDIN TN.
INDRAWATY BINTI M. DAUD NY.
JACUB RAHMAN TN.
JACUB RAHMAN TN.
J S NAMI NY
SITI MAIMUNAH NY
SITI MAIMUNAH NY
ZAINAL ARIFIN H TN.
LINDA VELANI NY
JASON CHANDRA AN
327,000.00
315,800.00
58,600.00
60,000.00
234,400.00
41,300.00
137,422.00
61,900.00
229,550.00
63,076.00
25,000.00
156,260.00
281,060.00
131,000.00
114,450.00
145,600.00
10,000.00
160,000.00
890,000.00
160,000.00
10,000.00
890,000.00
10,000.00
160,000.00
205,200.00
110,000.00
10,000.00
160,000.00
137,000.00
10,000.00
231,700.00
160,000.00
10,000.00
110,700.00
125,000.00
10,000.00
252,150.00
160,000.00
10,000.00
142,400.00
185,495.00
174,400.00
Page 303
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A. SANUSI TN
MUHAMMAD YUNUS TN.
MUHAMMAD YUNUS TN.
MUHAMMAD YUNUS TN.
ARIANA TUSEN NY.
MIRA ASDIANA NY.
MIRA ASDIANA NY.
TRI MURTI NY.
NOVENDA ALIANDO TN
NOVENDA ALIANDO TN
MUSLIM BIN M. ARBI TN.
PAUZI THAMRIN TN
HARTATI OH NY
LIONG KIM LIAN NY.
PAINO TN
NURSINAH BINTI NURTAK NY.
HUSNI THAMRIN TN
HUSNI THAMRIN TN
EDDY INDRAJAYA TN.
YUSMAN HANI TN
YUSMAN HANI TN
ELLYANA ROSITA NY.
ELLYANA ROSITA NY.
ANSYORI RIDUAN TN
SYUKRI MUBARAK TN.
LELY WATI NY
115,000.00
273,800.00
148,295.00
10,000.00
125,000.00
96,000.00
116,000.00
160,000.00
10,000.00
194,400.00
455,200.00
10,000.00
160,000.00
310,400.00
10,000.00
102,000.00
133,691.00
214,800.00
174,800.00
10,000.00
160,000.00
122,400.00
563,200.00
174,720.00
233,130.00
160,000.00
10,000.00
160,000.00
10,000.00
2,757,030.00
120,000.00
301,200.00
10,000.00
137,000.00
232,830.00
160,000.00
10,000.00
295,262.00
10,000.00
125,000.00
899,200.00
160,000.00
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LELY WATI NY
AZHAR MUHAMMAD DRS TN
NURMALA DEWI NY.
ROHIBA BINTI ABUN NY
ASMANIAH BINTI IDRUS H NY
SARMINI BINTI KASIR NY.
TONI YULIZAR TN.
MARDJUKIE TN.
SUSILAWATY NY
SUSILAWATY NY
YANTI SAFITRI NY.
SITI MARIAM NY
SITI MARIAM NY
MARITA RAMIANTI NY.
EUIS ARTATI SH NY.
KAILANI HUSIN TN
SUKANTO KESUMAH TN
ETIKA SUSANTI NY.
HARTATI ISMAWATI SENEN NY.
ALIDUN SIHOMBING TN
ENDANG SUDARMI NN.
NESLI HARTI HJ NY.
10,000.00
583,700.00
286,650.00
149,200.00
10,000.00
125,000.00
110,000.00
160,000.00
10,000.00
157,200.00
10,000.00
160,000.00
64,330.00
10,000.00
160,000.00
175,230.00
528,800.00
228,000.00
135,680.00
160,000.00
10,000.00
483,080.00
10,000.00
160,000.00
10,000.00
167,000.00
336,000.00
90,000.00
135,680.00
136,431.00
10,000.00
160,000.00
890,000.00
10,000.00
167,000.00
513,000.00
122,000.00
261,235.00
188,000.00
512,000.00
199,115.00
230,000.00
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DIAN ANGGRAINI NY.
HENNY PURWANTI NY.
SITI MAEMUNAH NY.
REZA APRIANTI BY NY.
ENDAH KUSUMAWATI NY
NURAINI BETTY NY.
ALIFA KHANZA AZZAHRA AN
AZWAWI KERIT TN
AZWAWI KERIT TN
MUSRIL BIN SOPRI TN
INDAWATI NY.
INDAWATI NY.
ERNA RAYA NY.
AISYAH NY.
WINARTI BINTI SUARDI NY
ILHAM HERIYANTO TN.
IRMA SURYANI NY.
MUHAMMAD ARDHYA PRAWIRA AN
LANIYATI NY.
LANIYATI NY.
LIONG FOET PO NY.
YANTI MARLINA NY.
A. SUBKI MAHMUD TN.
TJIKNUT SYUKUR NY
TJIKNUT SYUKUR NY
ARTATI BINTI A. MUIS NY
SRI RAHAYU, SH, MSI NY
305,070.00
264,615.00
221,235.00
60,000.00
512,000.00
202,080.00
216,480.00
137,400.00
587,600.00
204,000.00
160,000.00
10,000.00
230,000.00
87,412.00
160,000.00
10,000.00
208,800.00
160,000.00
10,000.00
10,000.00
160,000.00
488,200.00
181,280.00
264,800.00
10,000.00
160,000.00
227,788.00
799,460.00
102,580.00
193,585.00
117,876.00
10,000.00
160,000.00
146,400.00
213,585.00
168,580.00
115,000.00
303,580.00
160,000.00
10,000.00
327,780.00
180,000.00
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RANTI OKTALIA NY.
SULIANTI CANDRA NY.
CARISSA ADELIA AN.
MAYMUNAH BINTI DAUD NY
M. RIZKY ARAFAH AN.
ZURIA BINTI A. RAHMAN NY
DESMANIAR BINTI KAPROWI NY
NOVITA INDRIANI NY
ISMED ARAHMAN TN
FITRIANA BINTI PAIJO NY.
PUJI ASTUTI NY
M.ALI HANAFIAH TN.
SAKDIA IRA FINADIA NY
TRI SATRIYA YUDIANSYAH TN
LESTARI BIN LASIRUN TN
YUSMIRA BINTI HASADAN NY.
SRIWISMI MARLIA M. NY
ATIKA, IR, MM NY
DIANA HASTINI NY.
RAHMA AYU PUTRI AN.
RAHMA AYU PUTRI AN.
YULIA DASWATI NY.
YULIA DASWATI NY.
ASNAH BINTI BASRIA NY.
TAOR GURNING TN
TAOR GURNING TN
BUSTANI BIN AHMAD TN
BUDHI DJUHARSONO TN.
RAFIKA FITRIANTI NY.
78,000.00
193,585.00
110,000.00
320,440.00
120,000.00
110,000.00
102,540.00
439,200.00
411,330.00
274,835.00
180,000.00
79,660.00
213,585.00
161,240.00
10,000.00
177,000.00
138,440.00
207,685.00
177,000.00
10,000.00
208,800.00
176,950.00
273,695.00
221,280.00
109,495.00
240,800.00
60,000.00
205,577.00
110,000.00
102,000.00
10,000.00
10,000.00
160,000.00
60,000.00
73,300.00
105,000.00
362,800.00
303,070.00
890,000.00
110,000.00
222,300.00
102,400.00
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222,496.00
M. NASIR SE MSI TN.
1,807,240.00
AMALIA MAHARANI AN.
114,300.00
ANDRIANSITO BIN A. RAHMAN TN.
240,800.00
TJOE HOEN NIO NY.
160,000.00
TJOE HOEN NIO NY.
10,000.00
SRI SUHARNI NY.
60,000.00
OKTAVIANI BINTI ANANG ZAHRI N
662,835.00
DEDI KUSUMA TN
83,610.00
DEWI ANGGRAINI NY.
223,200.00
LINI HARTINA NY.
74,300.00
NYAYU NING NY.
113,050.00
HANNY OCTAVIA NY.
354,000.00
AGUNG MACHMUDI TN
137,930.00
153,981.00
ZIO ATHALLAH AN
176,378.00
ARYA RAMADHAN AN
110,000.00
INDRA KURNIAWAN TN
185,700.00
SIAMILIANI MAKMUR NY
180,200.00
MUNA''AMAH H SY.SH NY.
340,320.00
890,000.00
118,000.00
TRIANA APRIANI NY
129,450.00
ANI HASAN NY
999,800.00
YUNITA TRIANA NY
420,600.00
ELLYA KUSUMA NY.
71,450.00
ROSA GITARIA NY.
85,740.00
73,950.00
DJUNAIDI JUMJUNG MULIANTO TN.
131,000.00
71,450.00
68,000.00
RA FARIDA NY.
162,200.00
ASKURNI APSA TN.
384,200.00
NOPA ROSETA NN.
144,600.00
CORNILIA ANITA NY.
71,450.00
890,000.00
RUSTAM HALIM TN
890,000.00
97,100.00
JEANNE KUSSOY NY
71,450.00
NOCE TEATER TN.
102,400.00
110,000.00
IMAS KAMILAH NY.
60,000.00
Page 308
20 MEI 2016
HASIAM INDRIANI NY
ROHAINA HJ, NY.
JUNAIDI BIN ZAINI TN.
MAIMUNAH BINTI H.UMAR NY
MARIANA NY
SARDJONO, H TN
SARDJONO, H TN
RUSNAN CHANDRA TN
DJAMILAH BINTI SOMAD NY.
SEPTIANITA NY
YULIANA HASAN NY
EDDY MAKSURI TN.
EDDY MAKSURI TN.
M. AZKA AL KHALIFI AN
TUTI ATIKA NY.
HERLINA WATI NY.
SAURAH BINTI MINAN NY.
SYAMSURI BIN AMAN TN.
HERLINA SIREGAR NY
LATIFAH BINTI M. ZEN ASRI NN.
PETRUS KANDAR SINAGA TN
MASTIAH BINTI ARDANI NY
MUHAMMAD ROSYIDI TN
AMIR ISMAIL TN.
DAHLAN YAUMID TN
TRI LIANA NN.
ESTY APRILIANTY NY.
MUHAMMAD AL FATIIH AN.
ANDY ANDRY TN
M. FAHRY MAIZA AN.
AS AD SAYUTI DRS TN
LETTI PRIYANTI NY
ANNISA BINTI ARSYADI Y AN.
MUHAMMAD GHOZALI AN.
153,800.00
127,415.00
315,500.00
226,600.00
168,340.00
160,000.00
10,000.00
349,500.00
85,450.00
199,530.00
223,285.00
121,910.00
85,000.00
10,000.00
160,000.00
10,000.00
77,500.00
62,065.00
60,000.00
307,400.00
415,700.00
472,000.00
10,000.00
160,000.00
230,385.00
234,771.00
60,000.00
204,175.00
812,300.00
185,856.00
198,600.00
105,000.00
234,400.00
96,500.00
78,462.00
60,000.00
144,800.00
110,000.00
117,000.00
298,136.00
172,075.00
152,686.00
Page 309
20 MEI 2016
DRAVINSKY KYAN TIARADY AN.
SHOFWAN TN.
PANDU PRASETYA TN.
ERIKA PUTRI NN.
SUDIRMAN M DRS H TN.
CHAIRANI BINTI IBRAHIM NY.
GINA YULIANA NY
RUSLAN MUROD TN
A. JAMALUDDIN TN.
EGGY REGIKA NN
SYAKHISYAH RAFIFAH LUTFIAH AN
ENIZA WULANDARI NN
HASANAH BINTI JOHAR NY
JUSTIN NABIL RATAMA AN
LIU HENDRY TN.
ARMEN AZ TN
NURHAYATI BINTI SUKRI HJ. NY.
MARISKA HELENA NY
SITI ULLIYAH HJ NY
HERI PURWANTO TN
M. REZA ADRIAN TN.
SISWANTO RUSLAN TN.
SULE ALEX JAUHARI TN.
488,200.00
483,000.00
228,000.00
210,600.00
135,800.00
95,000.00
10,000.00
512,000.00
172,700.00
158,850.00
229,320.00
60,000.00
485,200.00
183,585.00
521,875.00
160,000.00
10,000.00
10,000.00
160,000.00
648,800.00
104,500.00
60,000.00
133,106.00
103,399.00
60,000.00
138,140.00
626,700.00
440,000.00
125,000.00
10,000.00
132,500.00
528,800.00
283,300.00
99,200.00
257,665.00
74,890.00
510,770.00
214,500.00
440,000.00
217,700.00
173,350.00
214,800.00
Page 310
20 MEI 2016
ERNA KURNIATY NY.
183,040.00
SYAMSIAH BINTI SALEH NY
77,750.00
160,000.00
10,000.00
ANGGAHANI PUTRA PERMADANI A
166,700.00
101,100.00
SHERLIANA SETIAWAN NY.
278,700.00
AGUSMAN SETIAWAN TN.
152,700.00
110,000.00
KRISTIN MAYA SUSANTI NY.
238,830.00
IRWAN WIDJAYA TN.
1,746,500.00
JO SIOE LING NY.
126,000.00
LIM NYUK JIN NY.
217,010.00
60,000.00
BAIHAKI BIN R. KEPALO TN.
226,800.00
PEBRI PUTRA TN
87,800.00
SYAPRIADI BIN JUNAIDI TN
148,710.00
IKE TRISNAWATI, DR NY
80,900.00
M. AZKA AZFAR AN.
163,400.00
GARIN WAHYU NUGRAHA TN.
132,000.00
AAN ANDRIANI NY.
329,526.00
MUSDALIFAH ADAWIYAH AN
85,148.00
NURMA YANTI NY
249,036.00
M HASBI RIDHO AN.
94,592.00
AISYAH RIZKI RAHMADANI AN.
159,997.00
NURAINI BINTI PARMO NY
42,478.00
NINDIA AULIA SVIT AN
219,960.00
NAAILAH FAIRUS HAWA AN
201,430.00
LAILA ROSALINA NY.
763,900.00
ZAIDAN ACHMAD TN.
288,384.00
DJAMALUDDIN ANTHONI SH. TN
60,000.00
RAFAEL WILLIAM PANGGABEAN AN 180,120.00
PUTRO SETYONO TN
890,000.00
CHEARA QINAIA ADRIANI AN
40,000.00
Page 311
21 MEI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
210516420436
210516450015
210516450012
210516380310
210516450020
210516380305
210516450016
210516280697
210516450056
210516280690
210516420733
210516390626
210516390731
210516450353
210516450044
210516390688
210516420734
210516380060
210516450019
210516450057
210516280695
210516280696
210516390526
210516450043
210516450017
210516390576
210516280426
210516450059
210516450023
210516450031
210516450024
210516450034
210516450082
210516450037
210516450036
210516450055
210516390048
210516390045
210516450052
210516450050
210516450053
TANGGAL
SEP
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/2016
00
05/21/20160090R03105160004792
05/21/20160090R03105160005124
05/21/20160090R03105160005125
05/21/20160090R03105160005127
05/21/20160090R03105160005128
05/21/20160090R03105160005128
05/21/20160090R03105160005129
05/21/20160090R03105160005130
05/21/20160090R03105160005131
05/21/20160090R03105160005132
05/21/20160090R03105160005132
05/21/20160090R03105160005133
05/21/20160090R03105160005133
05/21/20160090R03105160005134
Page 312
21 MEI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
210516450054
210516380084
210516380085
210516380079
210516380080
210516380083
210516380081
210516380096
210516380094
210516450106
210516450105
210516450110
210516450111
210516450142
210516450140
210516450202
210516450199
210516450184
210516450183
210516380231
210516450186
210516450195
210516450198
210516450197
210516450215
210516450214
210516450253
210516450250
210516450213
210516450212
210516380238
210516380236
210516390261
210516390242
210516380161
210516390262
210516390271
210516450287
210516450282
210516390230
210516390412
210516390410
05/21/20160090R03105160005134
05/21/20160090R03105160005135
05/21/20160090R03105160005135
05/21/20160090R03105160005137
05/21/20160090R03105160005137
05/21/20160090R03105160005138
05/21/20160090R03105160005138
05/21/20160090R03105160005139
05/21/20160090R03105160005139
05/21/20160090R03105160005141
05/21/20160090R03105160005141
05/21/20160090R03105160005142
05/21/20160090R03105160005142
05/21/20160090R03105160005143
05/21/20160090R03105160005143
05/21/20160090R03105160005144
05/21/20160090R03105160005144
05/21/20160090R03105160005145
05/21/20160090R03105160005145
05/21/20160090R03105160005147
05/21/20160090R03105160005148
05/21/20160090R03105160005148
05/21/20160090R03105160005149
05/21/20160090R03105160005149
05/21/20160090R03105160005150
05/21/20160090R03105160005150
05/21/20160090R03105160005151
05/21/20160090R03105160005151
05/21/20160090R03105160005152
05/21/20160090R03105160005152
05/21/20160090R03105160005153
05/21/20160090R03105160005153
05/21/20160090R03105160005154
05/21/20160090R03105160005154
05/21/20160090R03105160005155
05/21/20160090R03105160005156
05/21/20160090R03105160005156
05/21/20160090R03105160005157
05/21/20160090R03105160005157
05/21/20160090R03105160005158
05/21/20160090R03105160005159
05/21/20160090R03105160005159
Page 313
21 MEI 2016
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
210516380160
210516450063
210516450062
210516450222
210516450278
210516450279
210516450265
210516450103
210516450102
210516450146
210516450317
210516450316
210516380299
210516380300
210516380335
210516380334
210516390449
210516390448
210516390058
210516450351
210516450346
210516450373
210516450399
210516450415
210516450414
210516390519
210516390520
210516380088
210516390360
210516390357
210516390568
210516390567
210516380365
210516380363
210516420541
210516420540
210516390646
210516390642
210516390633
210516390634
210516280457
210516280452
05/21/20160090R03105160005160
05/21/20160090R03105160005161
05/21/20160090R03105160005161
05/21/20160090R03105160005162
05/21/20160090R03105160005163
05/21/20160090R03105160005163
05/21/20160090R03105160005164
05/21/20160090R03105160005165
05/21/20160090R03105160005165
05/21/20160090R03105160005166
05/21/20160090R03105160005167
05/21/20160090R03105160005167
05/21/20160090R03105160005168
05/21/20160090R03105160005168
05/21/20160090R03105160005169
05/21/20160090R03105160005169
05/21/20160090R03105160005170
05/21/20160090R03105160005170
05/21/20160090R03105160005171
05/21/20160090R03105160005172
05/21/20160090R03105160005172
05/21/20160090R03105160005174
05/21/20160090R03105160005174
05/21/20160090R03105160005175
05/21/20160090R03105160005175
05/21/20160090R03105160005176
05/21/20160090R03105160005176
05/21/20160090R03105160005178
05/21/20160090R03105160005179
05/21/20160090R03105160005179
05/21/20160090R03105160005181
05/21/20160090R03105160005181
05/21/20160090R03105160005183
05/21/20160090R03105160005183
05/21/20160090R03105160005185
05/21/20160090R03105160005185
05/21/20160090R03105160005188
05/21/20160090R03105160005188
05/21/20160090R03105160005189
05/21/20160090R03105160005189
05/21/20160090R03105160005192
05/21/20160090R03105160005192
Page 314
21 MEI 2016
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
210516380403
210516380408
210516450147
210516450143
210516420621
210516420622
210516390534
210516390529
210516390586
210516380240
210516380245
210516380243
210516380244
210516380204
210516420513
210516420511
210516450196
210516390587
210516390405
210516420444
210516420445
210516420572
210516420574
210516380268
210516280578
210516450249
210516280555
210516280602
210516280607
210516390591
210516380285
210516280676
210516450382
210516390693
210516420429
210516420669
210516420668
210516420434
210516390588
210516390723
210516420746
210516420749
05/21/20160090R03105160005193
05/21/20160090R03105160005193
05/21/20160090R03105160005194
05/21/20160090R03105160005196
05/21/20160090R03105160005197
05/21/20160090R03105160005197
05/21/2016 0090r03105160005198
05/21/2016 0090r03105160005198
05/21/20160090R03105160005199
05/21/20160090R03105160005200
05/21/20160090R03105160005201
05/21/20160090R03105160005203
05/21/20160090R03105160005203
05/21/20160090R03105160005204
05/21/20160090R03105160005205
05/21/20160090R03105160005205
05/21/20160090R03105160005206
05/21/20160090R03105160005207
05/21/20160090R03105160005209
05/21/20160090R03105160005211
05/21/20160090R03105160005211
05/21/20160090R03105160005213
05/21/20160090R03105160005213
05/21/20160090R03105160005214
05/21/20160090R03105160005215
05/21/20160090R03105160005216
05/21/20160090R03105160005217
05/21/20160090R03105160005218
05/21/20160090R03105160005218
05/21/2016 0090r03105160005219
05/21/20160090R03105160005220
05/21/20160090R03105160005221
05/21/20160090R03105160005222
05/21/20160090R03105160005223
05/21/20160090R03105160005225
05/21/20160090R03105160005226
05/21/20160090R03105160005226
05/21/20160090R03105160005228
05/21/20160090R03105160005230
05/21/20160090R03105160005231
05/21/20160090R03105160005233
05/21/20160090R03105160005234
Page 315
21 MEI 2016
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
210516390753
210516420763
210516420764
210516450021
210516450229
210516450029
210516450032
210516450014
210516420505
210516450047
210516450025
210516450027
210516450011
210516450022
210516450026
210516450018
05/21/20160090R03105160005235
05/21/20160090R03105160005236
05/21/20160090R03105160005237
05/21/20160090R03105160005535
05/21/20160090R03105160005537
05/21/2016
05/21/2016
05/21/2016
05/21/2016
05/21/2016
05/21/2016
05/21/2016
05/21/2016
05/21/2016
05/21/2016
05/21/2016
Page 316
21 MEI 2016
NAMA PASIEN
TRANSAKSI
###
ARIANA TUSEN NY.
###
ASMANIAH BINTI IDRUS H NY
###
ASMIZAR BINTI ASMAN NY.
###
DEWO ANGGORO AN.
92,950.00
ELY ERNI NY.
###
5,000.00
###
HASNAN HAROM TN.
81,500.00
HASRI TANJUNG H TN.
77,985.00
HERLENA BINTI A. ZAINI, HJ NY
###
###
IMANIAH BINTI HAMDAN NY
###
###
MISDAR NIZAWATI NY
###
NICKY VERDIANTO TN.
###
PUADI BIN NURDIN TN
###
ROHIBA BINTI ABUN NY
###
ROSIDA TOMZAH NY.
###
RUSLAN EFFENDI TN.
###
RUSNAN CHANDRA TN
###
###
###
SYAHRIR YASIN TN
###
TRI SATRIYA YUDIANSYAH TN
70,200.00
WARDIAH IDRIS NY
###
ZARWINI BINTI A. HAMID NY
94,050.00
HERIYANTO TN
###
RISMI ARYATI NN
###
MAGDALENA HARTANTO BUSTAN NY
###
YUSNI DARWIN TN
###
M. ZAHRAIN R. AN.
###
M. ZAHRAIN R. AN.
###
CANDRA DOAN TN.
###
WULAN SURYANI NN.
###
MUHAMMAD ALI TN.
###
E. SIMATUPANG TN
###
E. SIMATUPANG TN
10,000.00
SUGINAH ABBAS NY.
###
SUGINAH ABBAS NY.
10,000.00
M. ABBAS HASAN TN
10,000.00
Page 317
21 MEI 2016
M. ABBAS HASAN TN
MARIMAH C AHMAD NY.
MARIMAH C AHMAD NY.
ALI NURDIN TN.
ALI NURDIN TN.
SAIFUL NURAINI TN.
SAIFUL NURAINI TN.
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
M. ALI SEKAMIN TN
M. ALI SEKAMIN TN
YULIA DASWATI NY.
YULIA DASWATI NY.
SOFIA AZZAHRA AN.
SULAIMAN NADEAK TN.
SHOFWAN TN.
SHOFWAN TN.
###
10,000.00
###
10,000.00
###
###
10,000.00
###
10,000.00
###
10,000.00
10,000.00
###
###
10,000.00
###
10,000.00
###
10,000.00
###
10,000.00
###
###
10,000.00
###
10,000.00
95,000.00
10,000.00
###
10,000.00
###
10,000.00
###
10,000.00
###
10,000.00
###
###
10,000.00
###
###
10,000.00
Page 318
21 MEI 2016
ERIANA BINTI BAKORONI NY.
TEGUH BIN HOKSAN TN
HARBEI PASAH TN
KARTINI NY
KARTINI NY
ELIYA MARGARITA NY.
ELIYA MARGARITA NY.
HOIRUNNISYAH NN.
ARIFIN SITOHANG TN.
ARIFIN SITOHANG TN.
ZAIDAN ACHMAD TN.
ZAIDAN ACHMAD TN.
ARBAIN GANTI TN
ARBAIN GANTI TN
NURLIANA SALIM NY
NURLIANA SALIM NY
NORMA SIREGAR NY.
NORMA SIREGAR NY.
OKTA SAPUTRA TN
OKTA SAPUTRA TN
###
10,000.00
###
###
10,000.00
###
###
10,000.00
###
###
###
10,000.00
10,000.00
###
###
10,000.00
###
10,000.00
###
###
10,000.00
###
10,000.00
###
10,000.00
10,000.00
###
###
###
10,000.00
###
10,000.00
###
10,000.00
###
10,000.00
###
10,000.00
10,000.00
###
###
10,000.00
Page 319
21 MEI 2016
AS AD SAYUTI DRS TN
AS AD SAYUTI DRS TN
HARDIMAN, SH TN
SITI ROHMA NY
SITI ROHMA NY
EDY ABDULLAH TN
INDAH MEGAWATI NY
WAGINEM BINTI WAGIMAN NY
ERWIN AZHARI TN.
M. FAHRY MAIZA AN.
NURMALA DEWI NY.
NURMALA DEWI NY.
M. ZARKONI TN.
M. ZARKONI TN.
MEI TRI WAHYUNI NN.
AULIA ARISVIANI NN.
RUSNAN CHANDRA TN
NICKY VERDIANTO TN.
M. BAYU SAPUTRA AN.
ANGGI ARINI NN.
RUSNAINI BIN YUSUF TN.
DIAN SARA AGUSTINA NN.
NAYLA AZKA KHAIRIYAH AN.
10,000.00
###
###
50,300.00
10,000.00
###
###
10,000.00
###
###
###
10,000.00
###
###
95,000.00
10,000.00
70,500.00
###
###
10,000.00
###
10,000.00
###
###
###
###
###
10,000.00
###
###
###
###
###
###
###
###
10,000.00
###
91,590.00
68,310.00
###
###
Page 320
21 MEI 2016
M. ZAHRAIN R. AN.
WULAN SURYANI NN.
BRENDA FELLICIA S. NN
M. KOSASI TN
ANDRY SYAMSUDIN DIPURA TN
BALQIS RAFIFAH ARTANTI AN.
DARMA ERLINA NY.
ENVER AYDIN S. AN
HILYA RAHMA FERIAL AN.
M. DZAKY BIANTARA ARDHANA AN
M. FIRZA ATHARIZZ CALIEF AN
MELIYA MAILANA NN
NAURA GHISTI AULYA AN
ROHANA BINTI SAHAR NY.
WARDIAH NY
###
###
###
###
###
86,500.00
###
###
###
56,722.00
###
40,000.00
###
###
40,000.00
30,300.00
Page 321
22 MEI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
220516450259
220516390042
220516390045
220516390043
220516390041
220516450212
220516390182
220516390064
220516450230
220516390032
220516390029
220516390024
220516390025
220516390016
220516390020
220516390017
220516390013
220516390011
220516390012
220516390040
220516390049
220516390052
220516380180
220516390026
220516380115
220516380155
220516380151
220516380157
220516380164
220516390161
220516390207
220516390206
220516380203
220516390205
220516450219
220516450218
220516450234
220516450239
220516450240
220516450251
220516450254
TANGGAL
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
05/22/2016
SEP
00
00
00
00
00
00
00
0090R03105160002467
0090R03105160002579
0090R03105160005241
0090R03105160005242
0090R03105160005243
0090R03105160005244
0090R03105160005245
0090R03105160005246
0090R03105160005247
0090R03105160005250
0090R03105160005252
0090R03105160005254
0090R03105160005256
0090R03105160005257
0090R03105160005258
0090R03105160005260
0090R03105160005261
0090R03105160005264
0090R03105160005265
0090R03105160005266
0090R03105160005268
0090R03105160005269
0090R03105160005270
0090R03105160005271
0090R03105160005272
0090R03105160005273
0090R03105160005274
0090R03105160005277
0090R03105160005278
0090R03105160005280
0090R03105160005281
0090R03105160005282
0090R03105160005283
0090R03105160005284
Page 322
22 MEI 2016
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43
220516450287
220516390028
05/22/2016
05/22/2016
0090R03105160005289
0090R03105160005531
Page 323
22 MEI 2016
NAMA PASIEN
TRANSAKSI
DAVA AWANINDRA A AN
78,041.00
K A LATIF TN
27,600.00
M. AL FARUQ HAIDAR AN
96,855.00
MIDO H BIRAN TN
###
SAFRI,H TN.
34,500.00
###
VIRA CHALISYA PUTRI S. AN
24,600.00
RIRIN BINTI AMIGUS NN
96,870.00
AFRIZAL PRASYIDI TN
###
###
LELY YULIA NN
###
FAHREZA DINATA TN
###
CLAUDYA MERISCHA AN
###
RYSKA PURNAMA SARI NN.
###
NANDA GUSVITA NN
###
YERISTA INDAH WARDANI NN
###
RENITA BINTI WINARTO NN
###
RIRIN BINTI AMIGUS NN
###
RIZKY WIJAYA PUTRA TN
94,921.00
M. AL FARUQ HAIDAR AN
###
MUHAMMAD KOBRI TN.
63,370.00
NUR AZALEA ZAHIRAN ATHALLAH A
###
INDAH MEGAWATI NY
###
YMV GUISTI PAMBAYUN SARI NY
65,791.00
MUHAMMAD NURI AL MALIKI AN.
###
ATHIRA RAMADHANI FIKRI AN.
###
M. IRSAN FIKRI TN
###
NURUL HASANAH NY
###
VIRA CHALISYA PUTRI S. AN
###
NOPI APRIANTI NY
###
SYLVIA ADRIYANITA NN.
###
LISNA MAYANG SARI NN.
###
M. DAFHA HERMAWAN AN
96,141.00
DWI INDAH LESTARI NN
###
JALALLUDIN. TN
###
CHOIRIL EFRIYANI TN.
###
MARIJONO BIN SANUT TN
52,386.00
MUHAMMAD FATHIR AN
###
MISLENA BINTI A. LATIF NY.
###
DAVA AWANINDRA A AN
###
SALMAH KISTOLANI NY.
###
Page 324
22 MEI 2016
INDRI CITRA SARI NY
MARISA EKA PURNAMA SARI NY
65,366.00
###
Page 325
23 MEI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
230516280413
230516280213
230516280154
230516280326
230516280457
230516380839
230516380571
230516450196
230516280024
230516280202
230516280047
230516381148
230516280020
230516280212
230516450473
230516420906
230516280409
230516381050
230516381145
230516280423
230516280017
230516280048
230516430665
230516280101
230516431079
230516280055
230516450058
230516431008
230516280403
230516280139
230516280346
230516280043
230516380924
230516450060
230516450007
230516280468
230516430878
230516280462
230516280040
230516280437
230516280435
TANGGAL
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
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05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160004956
0090R03105160004956
Page 326
23 MEI 2016
42
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44
45
46
47
48
49
50
51
52
53
54
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61
62
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64
65
66
67
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70
71
72
73
74
75
76
77
78
79
80
81
82
83
230516280094
230516280096
230516280031
230516280039
230516450042
230516380877
230516450286
230516280056
230516390029
230516390021
230516450083
230516450012
230516450347
230516390030
230516280189
230516280045
230516280044
230516280151
230516390010
230516450015
230516280014
230516450121
230516450136
230516280320
230516280321
230516450016
230516280148
230516280147
230516280150
230516280283
230516280144
230516280146
230516280049
230516280085
230516390093
230516390081
230516280141
230516280140
230516280069
230516280490
230516430990
230516450333
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
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05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
0090R03105160005190
0090R03105160005190
0090R03105160005291
0090R03105160005294
0090R03105160005295
0090R03105160005296
0090R03105160005297
0090R03105160005298
0090R03105160005299
0090R03105160005299
0090R03105160005300
0090R03105160005301
0090R03105160005302
0090R03105160005303
0090R03105160005304
0090R03105160005305
0090R03105160005305
0090R03105160005306
0090R03105160005307
0090R03105160005308
0090R03105160005309
0090R03105160005310
0090R03105160005310
0090R03105160005311
0090R03105160005311
0090R03105160005312
0090R03105160005313
0090R03105160005313
0090R03105160005314
0090R03105160005315
0090R03105160005316
0090R03105160005316
0090R03105160005317
0090R03105160005318
0090R03105160005319
0090R03105160005319
0090R03105160005320
0090R03105160005320
0090R03105160005321
0090R03105160005322
0090R03105160005324
0090R03105160005325
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84
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96
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103
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105
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109
110
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115
116
117
118
119
120
121
122
123
124
125
230516280116
230516280114
230516450078
230516450380
230516430988
230516280124
230516280123
230516390184
230516450027
230516390300
230516280174
230516280172
230516450190
230516280019
230516390281
230516450173
230516450166
230516450268
230516450188
230516450186
230516280050
230516280149
230516280037
230516450217
230516450219
230516450194
230516280224
230516280216
230516280135
230516280033
230516450236
230516450234
230516450142
230516280294
230516280301
230516430639
230516450419
230516450417
230516450115
230516450119
230516450285
230516450284
05/23/2016
05/23/2016
05/23/2016
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05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
0090R03105160005326
0090R03105160005326
0090R03105160005327
0090R03105160005328
0090R03105160005329
0090R03105160005330
0090R03105160005330
0090R03105160005331
0090R03105160005332
0090R03105160005333
0090R03105160005334
0090R03105160005334
0090R03105160005335
0090R03105160005336
0090R03105160005337
0090R03105160005339
0090R03105160005339
0090R03105160005340
0090R03105160005341
0090R03105160005341
0090R03105160005342
0090R03105160005343
0090R03105160005344
0090R03105160005345
0090R03105160005345
0090R03105160005346
0090R03105160005347
0090R03105160005347
0090R03105160005348
0090R03105160005349
0090R03105160005350
0090R03105160005350
0090R03105160005351
0090R03105160005352
0090R03105160005352
0090R03105160005353
0090R03105160005354
0090R03105160005356
0090R03105160005357
0090R03105160005358
0090R03105160005359
0090R03105160005359
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126
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148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
230516280134
230516390125
230516450079
230516280319
230516280322
230516280057
230516430567
230516430566
230516280061
230516380700
230516380698
230516380754
230516380753
230516450405
230516450341
230516450108
230516390355
230516390356
230516280373
230516390352
230516390351
230516280206
230516280211
230516450076
230516450160
230516450072
230516280084
230516450181
230516380696
230516280100
230516280306
230516390109
230516280082
230516420801
230516420804
230516420807
230516420806
230516430535
230516280342
230516430656
230516280222
230516390353
05/23/2016
05/23/2016
05/23/2016
05/23/2016
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05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
0090R03105160005360
0090R03105160005361
0090R03105160005362
0090R03105160005363
0090R03105160005363
0090R03105160005364
0090R03105160005365
0090R03105160005365
0090R03105160005366
0090R03105160005367
0090R03105160005367
0090R03105160005369
0090R03105160005369
0090R03105160005370
0090R03105160005371
0090R03105160005372
0090R03105160005373
0090R03105160005373
0090R03105160005374
0090R03105160005376
0090R03105160005376
0090R03105160005377
0090R03105160005377
0090R03105160005378
0090R03105160005379
0090R03105160005380
0090R03105160005381
0090R03105160005382
0090R03105160005383
0090R03105160005384
0090R03105160005385
0090R03105160005386
0090R03105160005387
0090R03105160005388
0090R03105160005388
0090R03105160005389
0090R03105160005389
0090R03105160005390
0090R03105160005391
0090R03105160005392
0090R03105160005393
0090R03105160005394
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168
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190
191
192
193
194
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196
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198
199
200
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203
204
205
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207
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209
230516280170
230516280218
230516280120
230516280235
230516280407
230516390259
230516280516
230516280519
230516450137
230516280264
230516450410
230516450408
230516280152
230516420640
230516420636
230516430599
230516430598
230516280246
230516280361
230516450232
230516420673
230516420671
230516280304
230516280257
230516280228
230516280258
230516450175
230516280398
230516280393
230516280330
230516280200
230516450185
230516280514
230516280391
230516450183
230516280177
230516280312
230516450203
230516280453
230516280448
230516390187
230516390210
05/23/2016
05/23/2016
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05/23/2016
05/23/2016
05/23/2016
05/23/2016
05/23/2016
0090R03105160005395
0090R03105160005396
0090R03105160005397
0090R03105160005398
0090R03105160005399
0090R03105160005400
0090R03105160005401
0090R03105160005401
0090R03105160005403
0090R03105160005404
0090R03105160005405
0090R03105160005405
0090R03105160005406
0090R03105160005407
0090R03105160005407
0090R03105160005408
0090R03105160005408
0090R03105160005409
0090R03105160005410
0090R03105160005411
0090R03105160005412
0090R03105160005412
0090R03105160005413
0090R03105160005414
0090R03105160005414
0090R03105160005416
0090R03105160005417
0090R03105160005418
0090R03105160005418
0090R03105160005419
0090R03105160005420
0090R03105160005422
0090R03105160005423
0090R03105160005424
0090R03105160005425
0090R03105160005426
0090R03105160005427
0090R03105160005428
0090R03105160005429
0090R03105160005429
0090R03105160005430
0090R03105160005431
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218
219
220
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222
223
224
225
226
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228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
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250
251
230516450339
230516280207
230516390204
230516280386
230516280384
230516450198
230516380545
230516380544
230516450336
230516390376
230516450214
230516280288
230516280243
230516450475
230516450476
230516450237
230516280442
230516280443
230516280280
230516280278
230516280415
230516280420
230516280254
230516430679
230516430683
230516280303
230516450277
230516280267
230516280382
230516280229
230516280363
230516450318
230516280247
230516450365
230516280238
230516390349
230516380858
230516430797
230516390260
230516390276
230516280366
230516280295
05/23/2016
05/23/2016
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05/23/2016
05/23/2016
05/23/2016
05/23/2016
0090R03105160005432
0090R03105160005433
0090R03105160005434
0090R03105160005435
0090R03105160005436
0090R03105160005437
0090R03105160005438
0090R03105160005438
0090R03105160005439
0090R03105160005440
0090R03105160005441
0090R03105160005442
0090R03105160005443
0090R03105160005444
0090R03105160005444
0090R03105160005445
0090R03105160005446
0090R03105160005446
0090R03105160005447
0090R03105160005449
0090R03105160005450
0090R03105160005450
0090R03105160005451
0090R03105160005452
0090R03105160005452
0090R03105160005453
0090R03105160005454
0090R03105160005455
0090R03105160005456
0090R03105160005457
0090R03105160005458
0090R03105160005459
0090R03105160005460
0090R03105160005461
0090R03105160005462
0090R03105160005463
0090R03105160005464
0090R03105160005465
0090R03105160005466
0090R03105160005467
0090R03105160005468
0090R03105160005469
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252
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265
266
267
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270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
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291
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230516450328
230516420517
230516280377
230516280491
230516280492
230516280323
230516450378
230516450416
230516280482
230516280483
230516280307
230516430817
230516280338
230516420953
230516280308
230516280367
230516390293
230516430833
230516390494
230516280329
230516280370
230516450331
230516280344
230516450362
230516431129
230516430685
230516450412
230516380837
230516280480
230516280474
230516450375
230516280428
230516280383
230516420579
230516380717
230516380882
230516430607
230516390360
230516430633
230516450406
230516420626
230516280429
05/23/2016
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0090R03105160005470
0090R03105160005472
0090R03105160005473
0090R03105160005474
0090R03105160005474
0090R03105160005475
0090R03105160005476
0090R03105160005477
0090R03105160005478
0090R03105160005478
0090R03105160005479
0090R03105160005480
0090R03105160005481
0090R03105160005482
0090R03105160005483
0090R03105160005483
0090R03105160005484
0090R03105160005485
0090R03105160005486
0090R03105160005487
0090R03105160005488
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23 MEI 2016
NAMA PASIEN
AGUS TRIANTO TN
DAVID ISKANDAR TN
ERNA RAYA NY.
HERAWATI HJ. NY
HERU SUPENO TN.
ISMAIL ALI TN
J S NAMI NY
JACK PANTOW TN
JUNIAL KOMAR TN.
LILI SUHAIMI NY.
M HASBI RIDHO AN.
M. RAZQA AZZAM AN.
M.FAREL ABDI PRATAMA AN.
MICHAEL GODWIN PANJAITAN AN
MIKHAEL RUKINEM NY.
MUSLIMIN KADIR TN
NURAINI BETTY NY.
NYAYU NING NY.
OKTORIANSYAH BIN SULASMAN TN
RA FARIDA NY.
RANDI SENATRA TN.
ROSIDA TOMZAH NY.
SRI RAHAYU, SH, MSI NY
SUGINAH ABBAS NY.
TJHANG TJONG TJHAK TN
ZAINAL ARIFIN H TN.
TRANSAKSI
149,800.00
21,000.00
420,370.00
7,500.00
82,000.00
420,370.00
368,520.00
92,378.00
155,970.00
38,400.00
1,780,300.00
30,150.00
207,000.00
11,250.00
16,341.00
29,615.00
21,000.00
81,600.00
90,537.00
420,370.00
155,970.00
408,000.00
87,000.00
155,970.00
174,800.00
1,780,300.00
148,920.00
41,500.00
24,325.00
216,300.00
420,370.00
135,000.00
590,690.00
220,500.00
148,920.00
18,400.00
174,400.00
155,970.00
220,500.00
102,000.00
10,000.00
Page 338
23 MEI 2016
RAFSYA AL ZAINUL MUTTAQIN AN
ABDULLAH MAMING DJASIM TN
FIKRI HASAN BASRI TN.
EKA PERMATASARI NY
TISNALIA NY.
LEGINAH BINTI SUPARTO NY
ELIS NILAYATI NY.
ELIS NILAYATI NY.
MUNA AMAH H SY.SH NY.
M YUSUF JAYA TN
TJEPUK S TN.
RONIMAH NY
RONIMAH NY
ZAINAL ARIFIN H TN.
HASIAM INDRIANI NY
HASIAM INDRIANI NY
KHO SUI HONG NY
TUTI PURNAMAWATI NY
TUTI PURNAMAWATI NY
UKON RIYADI TN.
LIM KOEIJ ING NY
SAID SALIM TN
NURIJAH BINTI USUP NY.
LELY WATI NY
LELY WATI NY
ASMANA RUMIYATI NY
SUYADI H. TN
DAVID ISKANDAR TN
10,000.00
95,000.00
109,365.00
85,850.00
140,930.00
196,585.00
256,762.00
420,269.00
125,000.00
10,000.00
139,800.00
216,480.00
120,000.00
210,300.00
60,000.00
160,000.00
10,000.00
72,600.00
182,400.00
472,000.00
472,000.00
10,000.00
160,000.00
10,000.00
160,000.00
134,880.00
160,000.00
10,000.00
386,650.00
1,192,000.00
10,000.00
160,000.00
200,800.00
207,885.00
160,000.00
10,000.00
10,000.00
160,000.00
115,550.00
120,000.00
1,192,000.00
890,000.00
Page 339
23 MEI 2016
BAHARUDDIN BIN HASAN TN.
PUTRO SETYONO TN
YUNAIDA BINTI MASNA NY
FAIZAH ADNAN NY.
MIRA ASDIANA NY.
MIRA ASDIANA NY.
HERU SUPENO TN.
SALMAN BIN NAMUNING TN.
EMMY YAHIMI NY
EMMY YAHIMI NY
NURMA HASAN, HJ NY.
M. MUSTAR TN
N SEMBIRING NY
JACUB RAHMAN TN.
JACUB RAHMAN TN.
ALFONS SISWADI TN
GHANI ALFARIZI AN.
ROOSPINA ROWI NY.
ARI SUSANTI NN.
ARI SUSANTI NN.
KANG SIOE TJIN NY.
INDAH PURNAMA SARI NY
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
160,000.00
10,000.00
98,130.00
890,000.00
1,192,000.00
125,000.00
10,000.00
183,170.00
182,400.00
890,000.00
160,000.00
10,000.00
148,890.00
182,400.00
890,000.00
10,000.00
160,000.00
489,400.00
160,000.00
10,000.00
147,200.00
603,500.00
141,600.00
10,000.00
160,000.00
233,420.00
160,000.00
10,000.00
60,000.00
134,880.00
137,000.00
10,000.00
109,750.00
177,000.00
10,000.00
110,000.00
312,000.00
114,131.00
75,800.00
60,000.00
160,000.00
10,000.00
Page 340
23 MEI 2016
MARIA ESTETI NY.
M. RAFIE KHAIRY AN
ROHAINA HJ, NY.
NURLIANA SALIM NY
NURLIANA SALIM NY
ISMED ARAHMAN TN
METHA MAGDALENA H NN
SITI SALMIJATI NY
ALI NURDIN TN.
ALI NURDIN TN.
LIAREMILI ADLI NY.
SARDJONO, H TN
SARDJONO, H TN
NIRWANAA CANDRA NY.
EMI YANI S.E NY.
AKHMAD KASIRO TN.
ERNA KURNIATY NY.
DEWI ANGGRAINI NY.
M. RIZKY ARAFAH AN.
RATNA SARI NY
KARTIKA NY
GLORY GRACIELLA AN.
INDRA KURNIAWAN TN
HUSNI THAMRIN TN
HUSNI THAMRIN TN
ASMAH ABDULLAH NY.
TJIUW TJIN HE TN.
NABILA SYAHARANI AN
FADILLAH FAJRIANSYAH AN.
188,400.00
120,000.00
240,800.00
10,000.00
160,000.00
224,800.00
125,000.00
10,000.00
512,000.00
177,000.00
10,000.00
125,000.00
10,000.00
60,000.00
246,116.00
189,600.00
10,000.00
160,000.00
295,833.00
160,000.00
10,000.00
10,000.00
160,000.00
262,080.00
72,584.00
262,080.00
224,800.00
105,000.00
455,200.00
187,200.00
193,800.00
107,190.00
146,400.00
10,000.00
160,000.00
160,000.00
10,000.00
111,034.00
273,800.00
240,000.00
222,000.00
60,000.00
Page 341
23 MEI 2016
ABD MADJID TN.
KHOIRUNNISA SR NN
JIHAN MISHALL AURISKA AN.
RITA MELLA NY.
SALMIATI BINTI HARUN NY
JANSEN SIRAIT TN.
JANSEN SIRAIT TN.
SITI NURBAYA NY
SAUDAH BINTI TIMBUL NY.
LENI APRIYANTI NY
IRYANTO ASYIK TN.
ELOYSIUS SIHOTANG AN.
SUTIYONO BIN SAID TN.
ICE FITRI YANTI NY.
M. MAS''SUM SETIADI TN.
NUR ARLINDENI NY.
ARIANTO WAGISO TN.
R. KOHARUDDIN AHMAD TN.
AGUS LANI TN
ERNA RAYA NY.
SULIANTI CANDRA NY.
ROKIYAH BINTI M. ZEN NY
607,700.00
116,280.00
194,785.00
134,880.00
89,615.00
650,364.00
160,000.00
10,000.00
60,000.00
257,616.00
125,000.00
10,000.00
234,400.00
160,000.00
10,000.00
102,000.00
10,000.00
270,000.00
387,553.00
130,280.00
160,000.00
10,000.00
75,950.00
40,800.00
95,300.00
146,000.00
141,600.00
160,000.00
10,000.00
452,933.00
74,014.00
60,000.00
180,000.00
113,480.00
140,500.00
60,000.00
146,000.00
60,000.00
160,000.00
10,000.00
183,200.00
116,781.00
Page 342
23 MEI 2016
MERY BINTI ANANG NY.
DIANA HASTINI NY.
M.ZAINI RACHMAN TN.
HERLINDA BINTI JUNAIDI NY.
ILAL YATI NY.
SAZILI SULAIMAN TN
M HASBI RIDHO AN.
DJALILI SOLIHIN TN
DJALILI SOLIHIN TN
NAZURMANBIN IBRAHIM TN.
ANAN ROWI TN.
ELLYA KUSUMA NY.
ELLYA KUSUMA NY.
Z. ARIFIN WAZIR H. TN.
INDAWATI NY.
INDAWATI NY.
ASEP DEDI SETIAWAN TN.
MUHAMMAD FIRDAUS TN.
NAYLA AZKA KHAIRIYAH AN.
FENI HAPITA NY.
SITI HASMAYANI NY
MELIYA MAILANA NN
SITI NURMA NY.
ANIZAR BINTI ABDUL H NY.
REZA APRIANTI NY.
SILVIA EKA FIORA NN
ELLY SUMARYATI NY.
SITI MASIAH M ZACHRI HJ NY
UMAR SAJAD SY TN.
ARIS OKTARIAN TN.
TAN LAIJ NIO NY.
M. HISHAM RAHMANY AN.
228,116.00
82,050.00
130,980.00
189,201.00
141,312.00
60,000.00
160,000.00
10,000.00
351,400.00
198,785.00
165,800.00
83,000.00
194,400.00
10,000.00
160,000.00
460,725.00
160,000.00
10,000.00
425,100.00
208,900.00
10,000.00
160,000.00
319,070.00
10,000.00
160,000.00
84,652.00
244,520.00
60,000.00
240,173.00
224,800.00
277,280.00
186,195.00
135,623.00
228,116.00
57,245.00
123,766.00
154,850.00
225,200.00
60,000.00
85,400.00
332,973.00
104,415.00
Page 343
23 MEI 2016
SABRINA CAHYA KIRANA NY.
TJIKNUT SYUKUR NY
TJIKNUT SYUKUR NY
NOVITA BINTI ASRUL NY.
OKTA SAPUTRA TN.
YUSUF USMAN TN
UMI HAMI NY.
YUSNAWATI BINTI M.YUSUF NY.
HERAWATI BINTI SUPARMAN NY.
HERAWATI BINTI SUPARMAN NY.
MARYANI BINTI NUNGCIK NY.
SYAFRIL MAHYUDIN TN.
ESY MARLIAH BY NY.
YUNI RIA HERAWATI NY.
MARDIANA KUSUMA NY.
SITI SUSILAWATI NY.
INDRA SANDI TN
FARIDA NY.
CORNILIA ANITA NY.
CORNILIA ANITA NY.
ANA MARLINA NY.
MUHAMMAD RUDY TN
KMS EFFENDY TN.
SITI ROSA HARTINA NY
SUSILAWATY NY
RUBYADEEVA CHIKA LA DENTA AN
NAZAM GOZALI ALWIE TN.
60,000.00
120,000.00
300,259.00
10,000.00
160,000.00
293,430.00
87,350.00
91,170.00
160,000.00
10,000.00
358,900.00
313,800.00
287,800.00
171,929.00
234,085.00
78,560.00
212,968.00
168,689.00
384,200.00
163,200.00
60,000.00
880,000.00
256,762.00
284,645.00
405,010.00
127,500.00
73,760.00
429,500.00
160,000.00
10,000.00
509,143.00
114,211.00
230,416.00
194,000.00
60,000.00
206,900.00
129,450.00
83,200.00
99,450.00
165,350.00
135,250.00
677,870.00
Page 344
23 MEI 2016
BASIR DAMILI H. TN.
M. ABBAS HASAN TN
UTHAMI PUTRI NN
SUGINAH ABBAS NY.
HERDIATI BINTI HARJO NY
INDRAYANTA TN
CHERRY LEMBEK TN.
ACHMAD MAULANA,H TN
ROHIMAH NY.
HARTATI OH NY
PAUZI THAMRIN TN
MUHAMMAD EFFENDI TN
M. ALI SEKAMIN TN
HOLIL AZHAR TN
SARWIYA BINTI ABDUL M NY.
AHMAD FANFANI TN.
MARIYAH BINTI H. UTI NY.
NASRUN BASRI TN
NAJWA KHAIRA WILDA AN
MARIANA NY
NOPA ROSETA NN.
TAUFIK BARLIAN TN
AFRIMANSYAH BIN NURPALA TN.
TUSIRAH BINTI SUTORJO NY.
AHDI BIN ANTAJAYA TN
MARZUKI ABDULLAH TN
AMIR HAMZAH TN
AMIR HAMZAH TN
253,530.00
60,000.00
362,540.00
60,000.00
100,900.00
158,000.00
1,192,000.00
160,810.00
99,450.00
1,192,000.00
60,000.00
60,000.00
60,000.00
890,000.00
60,000.00
890,000.00
137,450.00
85,090.00
284,763.00
890,000.00
99,450.00
60,000.00
60,000.00
107,450.00
71,450.00
143,315.00
158,810.00
60,000.00
88,400.00
71,450.00
75,570.00
141,231.00
488,200.00
10,000.00
167,000.00
664,300.00
10,000.00
160,000.00
558,324.00
144,200.00
167,000.00
10,000.00
Page 345
23 MEI 2016
HIKMAH BINTI JAFAR HJ NY.
FAITH AQIL SENDRA AN
AISYAH NY.
MSY PURBAYA NY.
SARI NILA KUSUMA NY
HARTINI BINTI MUHAMMAD NY
NINA SEPTIANA NY.
RUSNANI BINTI DULLA IHSAN NY
NOVENDA ALIANDO TN
M ILHAM TN
NANIK HANDAYANI NY
M. REZA ADRIAN TN.
TJOE HOEN NIO NY.
TJOE HOEN NIO NY.
ARKOM BIN ARSYAD TN
YULIANTO BIN WAHAB SAYUTI TN
IRWAN SALIM TN.
INDRIANAH DRA NY.
ARIANA TUSEN NY.
MAYA KARTIKA NN.
MUSLIM BIN M. ARBI TN.
DESKA YANA NY.
KMS ABDULLAH TN.
SIRZIAH ETTY. NY
MAYA SAVITRI NY
NURSIAH HJ. NY
ENY RUSMIATI NY
M. RIDHO DWINATA AN.
ANASRUDDIN TN.
MUHAMMAD TN.
POPPY DECE LOVINA W NY
406,400.00
98,150.00
356,770.00
72,600.00
60,000.00
105,446.00
180,000.00
149,150.00
275,300.00
60,000.00
548,502.00
678,500.00
493,550.00
488,200.00
260,970.00
199,581.00
60,000.00
10,000.00
160,000.00
746,700.00
540,200.00
60,000.00
100,800.00
60,000.00
197,500.00
60,000.00
186,000.00
60,000.00
123,000.00
210,585.00
472,200.00
60,000.00
60,000.00
319,200.00
347,850.00
99,200.00
890,000.00
136,881.00
265,920.00
233,000.00
389,500.00
180,000.00
Page 346
23 MEI 2016
SUPARSIH NY
DWI INDAH LESTARI NN
UMAR HAMID TN
TENG SO HIE NY
ANDRI JAYA TN.
MELLYFIANY NY.
MELISA SUCI PUTRI NY
MUHAMMAD KAMIL TN
MARIMAH C AHMAD NY.
MARIMAH C AHMAD NY.
FADILA SARI NN.
DEVI AWALIA NY
CARISSA ADELIA AN.
DIAN ANGGRAINI NN.
SILVIA NOVIANI NN.
M. HAFIZH AN
TJIT SEN TN.
SALMAWATI BINTI SUBLI NY
PUJI ASTUTI NY
HERLATINI BINTI M.TOHIR NY
ROSUNAH, HJ NY
CENDY WIDYANINGRUM NY
MERY APRIANTI NY.
ZIVANA FEVIA A AN.
BAYU ANANTA EKA P AN.
RENILDA BINTI ASDINEL NY
170,200.00
240,285.00
146,000.00
193,585.00
292,730.00
319,200.00
83,954.00
295,585.00
126,200.00
60,000.00
102,350.00
1,081,900.00
528,800.00
115,910.00
10,000.00
160,000.00
60,000.00
141,600.00
110,000.00
72,300.00
101,100.00
230,700.00
144,620.00
110,000.00
60,000.00
623,810.00
122,200.00
233,005.00
224,415.00
186,600.00
488,200.00
215,085.00
604,230.00
418,975.00
168,480.00
130,602.00
60,000.00
69,790.00
252,485.00
60,000.00
239,800.00
92,000.00
Page 347
23 MEI 2016
JACK PANTOW TN
DARMAH BINTI H. AMIN NY
SYAMSIAH BINTI SALEH NY
M. RAZQA AZZAM AN.
M. RAZQA AZZAM AN.
RATNA JUWITA NY.
M. HABIBI PRATAMA AN.
MUHAMMAD JAUHARI TN
BETIN TEGUH NY.
BETIN TEGUH NY.
ACHMAD ZAIKAL AZIZ TN.
HASRI TANJUNG H TN.
ELYANI WIRZA NY
ANDY ANDRY TN
M. REFORMA MIERIANDY AN.
SYAIFUL BACHRI TN.
JUNAEDY TN.
YULIUS CHANDRA TN
IMAN YUSMAN TN
DERI AGUSTIA NY.
PAULUS JUMIRAN TN.
OKTA SAPUTRA TN
OKTA SAPUTRA TN
YUSFARDIYAH NY.
SANTI NOVITA SARI NY.
OLIVER CHRIS W AN
RANDI SENATRA TN.
60,000.00
264,000.00
60,000.00
62,400.00
123,200.00
660,000.00
92,595.00
217,935.00
264,800.00
160,000.00
10,000.00
97,500.00
192,250.00
94,431.00
144,140.00
166,700.00
122,250.00
167,920.00
252,700.00
177,320.00
860,500.00
144,164.00
125,000.00
108,830.00
192,780.00
10,000.00
160,000.00
183,130.00
60,000.00
116,030.00
10,000.00
160,000.00
10,000.00
177,000.00
164,181.00
120,000.00
177,000.00
10,000.00
721,185.00
110,000.00
110,000.00
86,980.00
Page 348
23 MEI 2016
OKY MARSELINA NY.
NENI TRIANA NY
DESSI ANGRAINI NN.
MICHAEL GODWIN PANJAITAN AN
DHIETA RIZKY P P AN.
OKTORIANSYAH BIN SULASMAN TN
SUPIARTI BINTI SOIB NY
ZAENAH NURHASANAH NY
MIKHAEL RUKINEM NY.
SANI AGUSTINA NY
SITI FATHIMAH NY
IKA YUNIZAR NY.
FORA AGUSTINA NY
MUHAMMAD HAQQI MAHDY AN.
146,689.00
163,202.00
70,720.00
92,770.00
174,400.00
102,400.00
54,100.00
102,400.00
126,690.00
324,600.00
890,000.00
172,300.00
46,240.00
151,900.00
193,585.00
233,100.00
60,000.00
167,800.00
Page 349
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NO
1
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21
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23
24
25
26
27
28
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30
31
32
33
34
35
36
37
38
39
40
41
NO RJ
240516380705
240516280848
240516390353
240516380864
240516430928
240516390354
240516390168
240516431014
240516390166
240516390087
240516390293
240516420346
240516390098
240516390096
240516390471
240516390136
240516390165
240516390419
240516390268
240516390219
240516390020
240516390018
240516390182
240516390239
240516390249
240516420084
240516420082
240516390390
240516390216
240516390364
240516390028
240516390027
240516390289
240516390008
240516390026
240516390025
240516420234
240516390149
240516390031
240516390030
240516390119
TANGGAL
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
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05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
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05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
SEP
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160004824
0090R03105160004824
0090R03105160005512
0090R03105160005611
0090R03105160005651
0090R03105160005691
0090R03105160005737
0090R03105160005739
0090R03105160005740
0090R03105160005740
0090R03105160005741
0090R03105160005742
0090R03105160005743
0090R03105160005744
0090R03105160005744
0090R03105160005745
0090R03105160005746
0090R03105160005747
0090R03105160005748
0090R03105160005748
0090R03105160005749
0090R03105160005750
0090R03105160005751
0090R03105160005751
0090R03105160005752
0090R03105160005753
0090R03105160005754
0090R03105160005754
0090R03105160005755
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83
240516390007
240516390083
240516390201
240516390200
240516390009
240516390228
240516390099
240516390101
240516420267
240516390143
240516390147
240516390145
240516390108
240516390102
240516390074
240516390109
240516390110
240516390073
240516390017
240516420144
240516420141
240516390076
240516390247
240516280831
240516390295
240516390225
240516390223
240516390308
240516390162
240516390163
240516390148
240516280909
240516280904
240516390318
240516390056
240516390321
240516280676
240516280673
240516390037
240516420198
240516420206
240516390137
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
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05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
0090R03105160005756
0090R03105160005757
0090R03105160005758
0090R03105160005758
0090R03105160005759
0090R03105160005760
0090R03105160005761
0090R03105160005761
0090R03105160005762
0090R03105160005763
0090R03105160005763
0090R03105160005764
0090R03105160005765
0090R03105160005765
0090R03105160005766
0090R03105160005767
0090R03105160005767
0090R03105160005768
0090R03105160005769
0090R03105160005770
0090R03105160005770
0090R03105160005771
0090R03105160005772
0090R03105160005773
0090R03105160005774
0090R03105160005776
0090R03105160005776
0090R03105160005777
0090R03105160005778
0090R03105160005778
0090R03105160005779
0090R03105160005780
0090R03105160005780
0090R03105160005781
0090R03105160005782
0090R03105160005783
0090R03105160005784
0090R03105160005784
0090R03105160005785
0090R03105160005786
0090R03105160005786
0090R03105160005787
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240516390218
240516390221
240516390246
240516390242
240516390307
240516390412
240516390410
240516380754
240516380750
240516390187
240516390464
240516390465
240516390227
240516390381
240516390215
240516420417
240516420414
240516390042
240516390036
240516390078
240516390070
240516390051
240516420337
240516390435
240516390433
240516390047
240516430873
240516430876
240516390115
240516390305
240516380675
240516280757
240516280755
240516420359
240516430617
240516430615
240516390081
240516380545
240516380542
240516390379
240516390432
240516390061
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
05/24/2016
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05/24/2016
05/24/2016
0090R03105160005788
0090R03105160005788
0090R03105160005789
0090R03105160005789
0090R03105160005790
0090R03105160005791
0090R03105160005791
0090R03105160005792
0090R03105160005792
0090R03105160005794
0090R03105160005795
0090R03105160005795
0090R03105160005796
0090R03105160005798
0090R03105160005799
0090R03105160005800
0090R03105160005800
0090R03105160005801
0090R03105160005802
0090R03105160005803
0090R03105160005804
0090R03105160005805
0090R03105160005806
0090R03105160005807
0090R03105160005807
0090R03105160005808
0090R03105160005809
0090R03105160005809
0090R03105160005810
0090R03105160005811
0090R03105160005812
0090R03105160005813
0090R03105160005813
0090R03105160005814
0090R03105160005815
0090R03105160005815
0090R03105160005816
0090R03105160005817
0090R03105160005817
0090R03105160005818
0090R03105160005819
0090R03105160005821
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240516390153
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240516390161
240516420484
240516420486
240516390424
240516390180
240516390131
240516390175
240516390426
240516390396
240516380588
240516420139
240516390428
240516420317
240516390204
240516390142
240516390436
240516390439
240516430843
240516430844
240516390156
240516390309
240516390160
240516390310
240516390157
240516390205
240516390320
240516430521
240516420244
240516390188
240516390135
240516390231
240516420235
240516430624
240516390222
240516390233
240516390369
240516390250
240516420210
240516390382
05/24/2016
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0090R03105160005822
0090R03105160005823
0090R03105160005824
0090R03105160005825
0090R03105160005827
0090R03105160005827
0090R03105160005828
0090R03105160005830
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NAMA PASIEN
AHMAD QAESER AL FARISI AN.
CHYNTIA DWI YULIANTI NN
DORTA SINAGA NY.
LISIANA OSWARI NN.
M. BAYU RAMATEPA TN.
MARDJUKIE TN.
NURAINI BETTY NY.
OEY SIAU HONG NY.
SARWIYA BINTI ABDUL M NY.
SUMIATY JUMAHAT NY
WALANG POTOK NY
MARHAM EFFENDI TN
TITIEH TRI KUSUMA W NY
KRISTIANTI RIFAI NY.
NURDILAH NY
HERIYANTO TN
HENDRA HARTANTO TN.
HENDRA HARTANTO TN.
AL HUSAINI TN
NURIAH BINTI SYAKRI NY.
NOVENDA ALIANDO TN
NOVENDA ALIANDO TN
DIANA NOVITA NY
UMNI AZIS NY.
RUWITA BINTI MARJAK NY
NING AYU NY.
NING AYU NY.
SUKIRMAN BIN PAIJO TN.
ALI NURDIN TN.
ROBIAH BINTI SYAKRONI NY.
TRANSAKSI
35,828.00
3,750.00
129,000.00
200,970.00
9,000.00
84,700.00
30,000.00
6,000.00
135,000.00
40,800.00
9,000.00
60,000.00
160,000.00
10,000.00
60,000.00
179,420.00
193,585.00
261,085.00
109,196.00
###
177,000.00
10,000.00
374,800.00
890,000.00
303,450.00
102,000.00
10,000.00
897,200.00
279,450.00
890,000.00
160,000.00
10,000.00
723,200.00
101,600.00
137,000.00
10,000.00
72,150.00
204,370.00
160,000.00
10,000.00
###
Page 359
24 MEI 2016
MARYAM BINTI UMAR BAHRAK NY.
NYAYU HALIMAH NN.
NYAYU HALIMAH NN.
SITTI NURHAWAN NY.
RUSNI BINTI NGADIONO NY.
JUNAIDA PRIANI NY
JUNAIDA PRIANI NY
M. ABBAS HASAN TN
M. ABBAS HASAN TN
SUGINAH ABBAS NY.
SUGINAH ABBAS NY.
VALENSI DWI ANGGRIANI AN.
NASRUN BASRI TN
ALFI SYAHRIN TN.
ALFI SYAHRIN TN.
AGUSTINI BINTI SUKARMAN NY.
M. HATTA YUSUF TN
INDRAYANTA TN
INDRAYANTA TN
ZAHRI ZAINURI TN
MUHAMMAD TONI TN.
MUHAMMAD TONI TN.
ELLAN AMRIZAL TN
106,400.00
303,000.00
160,000.00
10,000.00
106,400.00
237,870.00
10,000.00
160,000.00
554,300.00
10,000.00
160,000.00
67,500.00
160,000.00
10,000.00
90,600.00
10,000.00
160,000.00
148,900.00
117,200.00
160,000.00
10,000.00
202,000.00
124,900.00
120,000.00
60,000.00
160,000.00
10,000.00
111,050.00
10,000.00
177,000.00
158,840.00
10,000.00
160,000.00
98,000.00
115,000.00
392,700.00
10,000.00
160,000.00
360,420.00
10,000.00
160,000.00
332,070.00
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24 MEI 2016
SUMIATY JUMAHAT NY
MUSLIMIN KADIR TN
SUKANTO KESUMAH TN
SHOFWAN TN.
M. HAFIZ AL FARIZIH AN.
JEANNE KUSSOY NY
LIDAWATI NY.
LIDAWATI NY.
MARLIANA BINTI ANSORI NY
SURYA MEGAWATI NY
SURYA MEGAWATI NY
ALIDUN SIHOMBING TN
HASAN SAARI TN,
SUBAGIO BIN SUJOKO TN
KARTINI NY
KARTINI NY
SYAMSUL BAHRUN TN.
NOPA ROSETA NN.
NOPA ROSETA NN.
MARDJUKIE TN.
ARIFIN SITOHANG TN.
ARIFIN SITOHANG TN.
SYARIPAH BINTI SYARIP NY
MUHAMMAD SYAHIR TN
DAVID ISKANDAR TN
10,000.00
160,000.00
160,000.00
10,000.00
139,200.00
160,000.00
10,000.00
160,000.00
10,000.00
154,400.00
10,000.00
160,000.00
254,100.00
890,000.00
204,530.00
125,000.00
10,000.00
60,000.00
60,000.00
159,764.00
85,020.00
531,740.00
118,650.00
160,000.00
10,000.00
261,000.00
10,000.00
160,000.00
132,800.00
399,100.00
890,000.00
160,000.00
10,000.00
102,950.00
160,000.00
10,000.00
69,215.00
160,000.00
10,000.00
165,900.00
236,300.00
155,000.00
Page 361
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SRI MARYATY NY.
SUWONDO SONDI TN.
ASRONI BIN SARBANI TN
ELIYA MARGARITA NY.
ELIYA MARGARITA NY.
HERTY S. PANJAITAN NY
ISNA AZ ZAHRO AN.
AMALIA OKTARINA BY NY
NURPELAM BINTI JAILANI NY
SITI ASIAH NY.
DIAN EKAWATI NY
ESY MARLIAH NY.
ANDIKA PRATAMA AN.
MAKHMUD NAKTRA TN.
AKHMAD YANI, DRS, MM TN
KIAGUS MUHAMMAD IRIANSYAH TN.
SUHARI JUWUTO DRS TN.
ELLYANA ROSITA NY.
SITI AZMAWATI NY.
RUSMIDIUS NY.
ABDUL RONI TN.
SYAHTA BINTI CIK NANG NY
SUMINTEN BINTI RA. WIJAYA NY
DEWI FITRI NY
HERIYADI BIN SUHARDI TN
PAULUS LINGGO M TN.
GATOT SUGEMTO TN
IMAS KAMILAH NY.
YOSEPHA NPS NN
M. RAFI ADIPUTRA AN.
HILILAH HALIK BA NY
ABU BAKAR AHMAD TN.
BUDI NOPRIANI NY.
ZALEHA AZIZ DRA NY.
JANIAH BINTI SENALIP NY.
NIKEN RISKAWATY NN.
SARTONO BIN ABD. MUID TN
254,175.00
160,000.00
408,000.00
235,878.00
10,000.00
160,000.00
242,900.00
190,300.00
60,000.00
111,950.00
60,000.00
232,220.00
289,795.00
60,000.00
274,200.00
514,100.00
84,596.00
175,680.00
758,900.00
118,513.00
10,000.00
137,000.00
84,940.00
272,750.00
170,830.00
272,245.00
162,830.00
240,800.00
272,635.00
890,000.00
165,000.00
252,030.00
595,400.00
254,175.00
158,100.00
640,646.00
129,500.00
253,700.00
603,100.00
280,300.00
143,800.00
436,000.00
Page 362
24 MEI 2016
MELA ANGGRAINI NY
JIHAN PALESTIN. AN
DEDI KUSUMA TN
SYARIFAH BINTI SOLEH H NY.
SITI SANTURA NY
M.ATHAR KURNIAWAN AN.
WALANG POTOK NY
ZAHRATUSYIFA SURYA ANJANI AN.
INDAH LUKIRIA S NY
LIONG TSOOI KEM NY.
HERMAN ZAKARIA TN.
SITI ELVINA YENI NY.
MINARSIH BINTI CIKDENI NY
FENY ERNANINGSIH, AMG NY.
RIKA ARIANTI NY
LENY NOVARITA S.KOM BY NY.
ERMIATI KOTO NY
SRI MULYATI NY
SRI MULYATI NY
YUNITA MAYA NY.
SUSILAWATY NY
SUSILAWATY NY
YULIMAH BINTI M KAWI NY
DARKIAH BINTI BURSANA NY
SYAINA BINTI SEKIMAN NY
ANI HASAN NY
MAITA USFILEKA NY
TRIANA APRIANI NY
318,885.00
117,300.00
###
148,853.00
526,050.00
167,296.00
60,000.00
303,000.00
160,000.00
10,000.00
187,903.00
269,885.00
254,140.00
395,600.00
164,250.00
89,106.00
303,306.00
408,962.00
170,030.00
501,600.00
###
279,060.00
60,000.00
160,000.00
10,000.00
281,600.00
10,000.00
160,000.00
257,693.00
10,000.00
160,000.00
529,800.00
120,000.00
60,000.00
66,195.00
512,000.00
890,000.00
890,000.00
310,005.00
160,000.00
10,000.00
10,000.00
Page 363
24 MEI 2016
TRIANA APRIANI NY
JAP DJIT SING TN
PUJI ASIH NY
BAYU WIRA HADI KUSUMA TN
SEPTI HANDAYANI NY.
RITA ERYANI NY.
M. IRZAN TN.
HASIAM INDRIANI NY
YUNITA SARI NY
DORTA SINAGA NY.
DORTA SINAGA NY.
RUSTAM HALIM TN
OKTA SAPUTRA TN
ZAIDAN ACHMAD TN.
JACUB RAHMAN TN.
RENI ARCAN DAVINSI NY
AL GHIFAR DZAKY AN.
M. ZAINUL QURDI TN.
YURNI THALIB, HJ NY.
RAMEYZA KALIKA AN
JUANISAH BINTI M. FAISOL HS NY
DIKSON MATHEOS TN.
GHANI ALFARIZI AN.
SYAMSIAR RUSNAINI NY
TIUM SINARIA ANGGRAENI NY.
NURMALA DEWI NY.
NURMALA DEWI NY.
KMS ADIM BINTI AHMAD TN.
160,000.00
84,024.00
85,740.00
333,200.00
174,400.00
193,585.00
550,690.00
202,585.00
179,000.00
107,450.00
291,540.00
10,000.00
137,000.00
890,000.00
248,000.00
50,000.00
249,485.00
107,450.00
129,450.00
153,000.00
207,000.00
164,450.00
10,000.00
107,450.00
80,592.00
247,700.00
252,485.00
125,990.00
186,650.00
179,200.00
180,000.00
143,900.00
10,000.00
60,000.00
284,500.00
211,585.00
160,000.00
10,000.00
60,000.00
102,000.00
10,000.00
60,000.00
Page 364
24 MEI 2016
SRI YULIDAR NY.
MUSA ISMAIL DRS TN
LENI APRIYANTI NY
LISIANA OSWARI NN.
TARA PRADITA AN
EDDY MAKSURI TN.
EDDY MAKSURI TN.
YUSUF USMAN TN
SITI NURAINI NY.
SITI NURAINI NY.
ACHMAD ZARNUBI TN.
DAHNIAR, HJ BINTI M AMIN NY
RIKA AIRIN ASTRIANI NY
HERAWATI BINTI A HAMID NY.
DAHLAN YAUMID TN
TJIKMAD. B TN.
SETIA WATI NY
SETIA WATI NY
DEFRI SYAHPUTRA TN
DESSY HERLIANI NN
SRI NANANG TN
LIDYA SISCA NY.
AISYAH NN.
160,000.00
10,000.00
120,000.00
375,400.00
202,072.00
128,700.00
136,610.00
125,000.00
10,000.00
281,500.00
60,000.00
102,000.00
10,000.00
60,000.00
60,000.00
10,000.00
85,000.00
189,500.00
160,000.00
10,000.00
274,000.00
115,881.00
170,500.00
60,000.00
120,050.00
217,140.00
60,000.00
79,450.00
160,000.00
10,000.00
60,000.00
60,000.00
108,000.00
60,000.00
87,500.00
10,000.00
190,000.00
121,200.00
193,585.00
229,970.00
241,135.00
94,320.00
Page 365
24 MEI 2016
RANDI SENATRA TN.
DEWI MURNI NY.
TUTY HERAWATI NN
TETI ELIYANA NY.
INDRI TRIANA SAFITRI NN
PARDIAH BINTI HAYAT ISMAIL NY
SRI RIZKI HANDAYANI NY.
DRAVINSKY KYAN TIARADY AN.
RAHULLA HUANG AN.
CHAIRULLAH BIN ABI TN.
SUTARMAN BIN PONI TN.
AGUS LANI TN
ADITYA PERMANA AN
ERNES PUTRA GUNAWAN TN
NANI WIDIA NY
GUSTINIAR BINTI JAMIL NY.
WINDY YOVITA SARI NN
DESTIANA PUTRI AYU NN.
MARYANI BINTI ZAWAWI NY
AHMAD QAESER AL FARISI AN.
LIM KOEIJ ING NY
HARBEI PASAH TN
OEY SIAU HONG NY.
HANNY TRIDIYANTI NY.
SHINTA PARAMITA NY
SRI INDRAWATI NY.
ARIS MUHARAM
ERIKA PUTRI NN.
ORDI TN.
PURWANINGRUM NY
10,000.00
167,000.00
102,400.00
160,000.00
10,000.00
40,000.00
207,885.00
193,585.00
174,610.00
312,445.00
388,585.00
60,000.00
110,000.00
74,500.00
501,370.00
107,060.00
140,900.00
233,410.00
169,710.00
110,000.00
150,560.00
193,585.00
151,900.00
193,585.00
197,585.00
416,575.00
10,000.00
160,000.00
111,400.00
555,370.00
110,000.00
954,370.00
193,585.00
193,585.00
180,000.00
280,700.00
94,820.00
154,433.00
192,100.00
224,721.00
93,600.00
210,585.00
Page 366
24 MEI 2016
MISDARITA BINTI M.IDRIS NY.
SITTI FITRASARI NY.
KALSUM IBRAHIM NY.
NURHAYATI KHD NY.
ROSA DESITA NY.
SANTOSO BIN SULAIMAN TN
HINDUN BINTI AZHARI NY.
ANDRY PURWA SAPUTRA. TN
M. ILHAM ANDRIANSYAH AN
MUHAMMAD AROFFI AN
ITA TRIGAWATI NY
HERLINA EFFENDY. NY
SRI RAHAYU BY NY.
MUHAMMAD SAAN TN
IRIANSYAH PRABATA TN
RENY FEBRIKA SARY NY
172,000.00
120,000.00
110,000.00
110,000.00
140,050.00
474,321.00
249,000.00
157,324.00
528,000.00
367,400.00
72,590.00
102,400.00
157,980.00
65,705.00
48,260.00
451,800.00
137,000.00
10,000.00
60,000.00
60,000.00
218,000.00
45,060.00
125,000.00
10,000.00
60,000.00
240,645.00
10,000.00
102,000.00
115,000.00
Page 367
25 MEI 2016
NO
1
2
3
4
5
6
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8
9
10
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16
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19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
NO RJ
250516420205
250516430634
250516390199
250516430904
250516390198
250516420387
250516280613
250516390170
250516390195
250516420071
250516390396
250516280792
250516390349
250516390154
250516420273
250516430520
250516391136
250516420030
250516430894
250516280843
250516390346
250516390409
250516430560
250516420037
250516420046
250516420074
250516420068
250516390256
250516420366
250516390127
250516390124
250516420136
250516420131
250516420009
250516420010
250516390294
250516390292
250516390286
250516420035
250516420033
250516420314
TANGGAL
05/25/2016
05/25/2016
05/25/2016
05/25/2016
05/25/2016
05/25/2016
05/25/2016
05/25/2016
05/25/2016
05/25/2016
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SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160005775
0090R03105160005982
0090R03105160006029
0090R03105160006031
0090R03105160006080
0090R03105160006083
0090R03105160006084
0090R03105160006085
0090R03105160006085
0090R03105160006086
0090R03105160006086
0090R03105160006087
0090R03105160006087
0090R03105160006088
0090R03105160006089
0090R03105160006090
0090R03105160006091
0090R03105160006091
0090R03105160006092
25 MEI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
250516390060
250516390064
250516390069
250516390048
250516390043
250516420002
250516420056
250516420058
250516420078
250516420062
250516420019
250516390156
250516390150
250516420015
250516430951
250516420309
250516390087
250516390088
250516420017
250516420241
250516420242
250516420106
250516420332
250516420094
250516420272
250516420274
250516390296
250516390181
250516390183
250516390149
250516420240
250516420236
250516420104
250516420102
250516390301
250516420032
250516390304
250516420026
250516420083
250516420082
250516420197
250516390375
05/25/2016
05/25/2016
05/25/2016
05/25/2016
05/25/2016
05/25/2016
05/25/2016
05/25/2016
05/25/2016
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Page 369
0090R03105160006093
0090R03105160006093
0090R03105160006094
0090R03105160006095
0090R03105160006095
0090R03105160006096
0090R03105160006098
0090R03105160006098
0090R03105160006099
0090R03105160006100
0090R03105160006101
0090R03105160006102
0090R03105160006102
0090R03105160006103
0090R03105160006104
0090R03105160006105
0090R03105160006106
0090R03105160006106
0090R03105160006107
0090R03105160006108
0090R03105160006108
0090R03105160006109
0090R03105160006110
0090R03105160006111
0090R03105160006112
0090R03105160006112
0090R03105160006113
0090R03105160006115
0090R03105160006115
0090R03105160006116
0090R03105160006117
0090R03105160006117
0090R03105160006118
0090R03105160006118
0090R03105160006119
0090R03105160006120
0090R03105160006121
0090R03105160006122
0090R03105160006123
0090R03105160006123
0090R03105160006124
0090R03105160006125
25 MEI 2016
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
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109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
250516390157
250516390103
250516390101
250516431089
250516431086
250516420107
250516430835
250516420067
250516420081
250516420075
250516390055
250516390333
250516390330
250516390334
250516390089
250516420061
250516390585
250516390583
250516420185
250516420057
250516420429
250516420430
250516390320
250516420041
250516390167
250516390086
250516420163
250516430660
250516430662
250516420420
250516280734
250516280735
250516390105
250516420204
250516420201
250516390378
250516280689
250516280686
250516390193
250516280669
250516280673
250516390165
05/25/2016
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0090R03105160006126
0090R03105160006127
0090R03105160006127
0090R03105160006128
0090R03105160006128
0090R03105160006129
0090R03105160006130
0090R03105160006131
0090R03105160006132
0090R03105160006133
0090R03105160006134
0090R03105160006135
0090R03105160006135
0090R03105160006136
0090R03105160006137
0090R03105160006138
0090R03105160006139
0090R03105160006139
0090R03105160006140
0090R03105160006141
0090R03105160006143
0090R03105160006143
0090R03105160006144
0090R03105160006145
0090R03105160006146
0090R03105160006147
0090R03105160006148
0090R03105160006149
0090R03105160006149
0090R03105160006150
0090R03105160006151
0090R03105160006151
0090R03105160006152
0090R03105160006153
0090R03105160006153
0090R03105160006154
0090R03105160006155
0090R03105160006155
0090R03105160006156
0090R03105160006157
0090R03105160006157
0090R03105160006158
25 MEI 2016
126
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132
133
134
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136
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142
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250516390085
250516420232
250516420221
250516420239
250516390203
250516390206
250516420072
250516420063
250516420438
250516390268
250516390263
250516390099
250516430570
250516430571
250516390295
250516390169
250516420095
250516390298
250516390146
250516420446
250516420091
250516390178
250516390360
250516390277
250516420376
250516390279
250516420278
250516390187
250516420172
250516390134
250516390188
250516390299
250516390297
250516390337
250516390336
250516390224
250516420287
250516420308
250516420372
250516420380
250516390385
250516390142
05/25/2016
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0090R03105160006159
0090R03105160006160
0090R03105160006160
0090R03105160006161
0090R03105160006162
0090R03105160006162
0090R03105160006163
0090R03105160006164
0090R03105160006165
0090R03105160006166
0090R03105160006166
0090R03105160006167
0090R03105160006168
0090R03105160006168
0090R03105160006169
0090R03105160006170
0090R03105160006171
0090R03105160006172
0090R03105160006173
0090R03105160006174
0090R03105160006175
0090R03105160006176
0090R03105160006178
0090R03105160006179
0090R03105160006180
0090R03105160006181
0090R03105160006182
0090R03105160006183
0090R03105160006184
0090R03105160006185
0090R03105160006186
0090R03105160006189
0090R03105160006189
0090R03105160006190
0090R03105160006190
0090R03105160006191
0090R03105160006192
0090R03105160006192
0090R03105160006193
0090R03105160006193
0090R03105160006194
0090R03105160006195
25 MEI 2016
168
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250516390249
250516420285
250516420276
250516390164
250516390251
250516420489
250516420493
250516420130
250516420123
250516420190
250516390259
250516430593
250516390474
250516420367
250516420370
250516420419
250516420431
250516390386
250516390390
250516280656
250516280655
250516280730
250516280731
250516420189
250516390535
250516390229
250516420428
250516390226
250516390223
250516420421
250516420422
250516390220
250516420321
250516420322
250516420358
250516420335
250516420212
250516390450
250516420267
250516390401
250516390391
250516390245
05/25/2016
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0090R03105160006196
0090R03105160006197
0090R03105160006198
0090R03105160006199
0090R03105160006200
0090R03105160006201
0090R03105160006201
0090R03105160006202
0090R03105160006203
0090R03105160006204
0090R03105160006205
0090R03105160006206
0090R03105160006208
0090R03105160006209
0090R03105160006209
0090R03105160006211
0090R03105160006212
0090R03105160006213
0090R03105160006213
0090R03105160006214
0090R03105160006214
0090R03105160006215
0090R03105160006215
0090R03105160006216
0090R03105160006217
0090R03105160006218
0090R03105160006219
0090R03105160006220
0090R03105160006221
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0090R03105160006229
0090R03105160006230
0090R03105160006231
0090R03105160006232
0090R03105160006233
25 MEI 2016
210
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0090R03105160006265
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0090R03105160006268
0090R03105160006269
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0090R03105160006272
0090R03105160006272
25 MEI 2016
252
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250516390871
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250516391096
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250516280847
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0090R03105160006305
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0090R03105160006308
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0090R03105160006309
0090R03105160006310
0090R03105160006311
0090R03105160006311
0090R03105160006312
0090R03105160006313
0090R03105160006316
0090R03105160006317
25 MEI 2016
294
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250516430672
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250516280980
250516430768
250516430913
250516430646
250516431034
250516280649
250516280783
250516430770
250516430643
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250516281024
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0090R03105160006360
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0090R03105160006364
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25 MEI 2016
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0090R03105160006399
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0090R03105160006402
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0090R03105160006404
0090R03105160006405
0090R03105160006405
0090R03105160006406
0090R03105160006407
0090R03105160006408
0090R03105160006409
25 MEI 2016
378
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381
382
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384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
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250516280780
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250516281054
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250516390746
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250516280964
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250516430762
250516280790
250516431002
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250516430978
250516390942
250516430778
250516390911
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250516280801
250516431036
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250516430820
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250516430740
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0090R03105160006449
0090R03105160006450
0090R03105160006452
0090R03105160006453
0090R03105160006455
0090R03105160006456
0090R03105160006457
25 MEI 2016
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
250516280802
250516280870
250516430852
250516280831
250516280799
250516430800
250516430842
250516280959
250516430767
250516280922
250516430807
250516430804
250516390955
250516280990
250516391004
250516390200
250516420014
250516420024
250516420023
250516420050
250516390121
250516431106
250516391112
250516281132
250516280895
250516430537
250516420013
250516390192
250516390718
250516390918
250516281140
05/25/2016
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0090R03105160006459
0090R03105160006460
0090R03105160006461
0090R03105160006463
0090R03105160006464
0090R03105160006465
0090R03105160006467
0090R03105160006469
0090R03105160006470
0090R03105160006471
0090R03105160006472
0090R03105160006472
0090R03105160006476
0090R03105160006478
0090R03105160006479
0090R03105160006484
0090R03105160006485
0090R03105160006486
0090R03105160006487
0090R03105160006488
0090R03105160006489
0090R03105160006492
0090R03105160006493
0090R03105160006494
0090R03105160006801
0090R03105160007259
0090R03105160007260
0090R03105160007261
0090R03105160007262
0090R03105160007264
MASUK RWT INAP
25 MEI 2016
NAMA PASIEN
AMRI BIN ALWI TN.
BUSTAN BIN SENEN TN.
HOLIL AZHAR TN
MIRIN IRVAN H TN.
MUHAMMAD ALI AKBAR AN
S. PAINUN TN
SIDI AMBO TN
SJAFRAN SOHIB TN
SRI REJEKI AGUSTINI NY.
SULAIMAN NADEAK TN.
SUZANA BINTI A TAHDIL NY
THALIA HERLINDA NY
YULIANTI BINTI M. HATTA NY.
SEFTA OTARINA NY
DESI YANTI NY.
MEILITA SARI NY.
SUPIANI BINTI SAMIAN NY
NENI TRIANI NY
SULASTRI BINTI ABDULAH NY.
KAROLINA NY.
KAROLINA NY.
SHOFWAN TN.
SHOFWAN TN.
ELIS NILAYATI NY.
ELIS NILAYATI NY.
ASKURNI APSA TN.
RA FARIDA NY.
RONIMAH NY
RONIMAH NY
N. ACHMAD ABUMAN TN
TRANSAKSI
48,300.00
576,340.00
135,000.00
441,600.00
13,513.00
11,800.00
216,300.00
194,700.00
38,400.00
8,300.00
20,000.00
38,500.00
43,592.00
129,000.00
27,000.00
16,500.00
90,000.00
420,370.00
174,400.00
15,000.00
10,065.00
208,920.00
270,605.00
193,585.00
206,485.00
220,660.00
148,775.00
163,750.00
140,015.00
10,000.00
177,000.00
125,000.00
10,000.00
10,000.00
125,000.00
66,500.00
86,600.00
120,000.00
160,000.00
10,000.00
380,350.00
Page 379
25 MEI 2016
EMMY YAHIMI NY
EMMY YAHIMI NY
MUHAMMAD ALI AKBAR AN
IBNU HASIM TN
FARIDA BINTI WAZIR M. NY
HARTINI, IR, MT NY
MAULANA YUSUF, IR, H TN
MAYA E LEBIS NY.
MAYA E LEBIS NY.
NGADIMAN TN.
NURLIANA SALIM NY
NURLIANA SALIM NY
LELY WATI NY
LELY WATI NY
SRI MULYONO TN
TEGUH BIN HOKSAN TN
SYUKRI MUBARAK TN.
MARITA RAMIANTI NY.
NURHAYATI BA HJ NY
10,000.00
177,000.00
232,100.00
160,000.00
10,000.00
183,400.00
10,000.00
160,000.00
60,000.00
60,000.00
175,680.00
160,000.00
10,000.00
175,680.00
110,000.00
80,000.00
10,000.00
160,000.00
134,880.00
10,000.00
160,000.00
87,545.00
890,000.00
67,675.00
10,000.00
160,000.00
999,800.00
10,000.00
160,000.00
247,445.00
95,000.00
10,000.00
160,000.00
10,000.00
1,192,000.00
175,680.00
890,000.00
94,880.00
137,000.00
10,000.00
98,000.00
70,730.00
Page 380
25 MEI 2016
ISTIMATUL HUKAMA NY
SAIFUL NURAINI TN.
SAIFUL NURAINI TN.
NAURA ZAHIRA AN.
SUDIRMAN BIN HAMBALI TN
FARIDA BINTI LATIEF NY.
ISMI JELITA NY
ISMI JELITA NY
UMAIROH BINTI HAMDAN NY.
MARTINI ASRIL NY.
MAYA KARTIKA NN.
SUGINAH ABBAS NY.
YULIUS CHANDRA TN
ELLYA KUSUMA NY.
ELLYA KUSUMA NY.
SULAIMAN NADEAK TN.
SRI RAHAYU BY NY.
DEDY SUMARDI TN
MIGIAWATI BINTI M. DAUD NY
ARIANA TUSEN NY.
INDAWATI NY.
INDAWATI NY.
HARBEI PASAH TN
M. RUIS H. TN.
NOPA ROSETA NN.
NOPA ROSETA NN.
373,585.00
160,000.00
10,000.00
10,000.00
160,000.00
60,000.00
60,000.00
115,000.00
384,600.00
487,450.00
228,000.00
200,000.00
10,000.00
535,400.00
98,865.00
1,041,900.00
125,000.00
10,000.00
152,068.00
60,800.00
10,000.00
160,000.00
1,040,600.00
472,000.00
355,220.00
114,215.00
60,000.00
10,000.00
167,000.00
384,200.00
160,000.00
10,000.00
122,400.00
160,000.00
10,000.00
890,000.00
10,000.00
125,000.00
259,068.00
160,000.00
10,000.00
488,200.00
Page 381
25 MEI 2016
TIMURATINI S SOS NY
RATNA YUNIDAR NY.
GHANI ALFARIZI AN.
GHANI ALFARIZI AN.
ASMAH ABDULLAH NY.
SAID SALIM TN
DJALILI SOLIHIN TN
DJALILI SOLIHIN TN
TRI MURNI, HJ NY
PUJI WATI NINGSIH NN.
TRI MURTI NY.
SOEGIANTO WIDJAJA TN.
LIONG KIM LIAN NY.
SYECH MUHAMMAD TN.
ARIS MUHARAM
NURSINAH BINTI NURTAK NY.
AIDIL FIKRI TN
ROSIA KARTIKA SARI NY
JEANNE KUSSOY NY
YUSRON KOSIM TN.
MELISA ANDRIANI NN
ANDRY OKRIANTO TN.
MARIYAM BINTI A. KADIR NY
TJIKMAD. B TN.
TJIKMAD. B TN.
SYAIFUL ANWAR TN
LANIYATI NY.
LANIYATI NY.
ARBAIN GANTI TN
ARBAIN GANTI TN
79,730.00
160,000.00
10,000.00
249,000.00
10,000.00
62,000.00
110,000.00
83,000.00
77,500.00
160,000.00
10,000.00
516,600.00
10,000.00
160,000.00
60,000.00
89,500.00
134,880.00
125,730.00
60,000.00
452,285.00
224,800.00
171,220.00
423,600.00
809,585.00
134,900.00
112,508.00
809,585.00
1,560,000.00
134,150.00
214,785.00
224,800.00
160,000.00
10,000.00
160,000.00
10,000.00
60,000.00
10,000.00
160,000.00
10,000.00
160,000.00
104,600.00
262,080.00
Page 382
25 MEI 2016
DIANA HASTINI NY.
WIDYA TAMARA NN
JOHANES LAY TN.
TRI YUSMATHILDA NY
RAPIKA MAHARANI NN
JANSEN SIRAIT TN.
JANSEN SIRAIT TN.
M. FARAZ ALKALIFI AN.
NURLELA BINTI ROHIM S NY.
M KEVIN DHANI ALVARO AN
KANG SIOE TJIN NY.
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
DIANA ABIKUSNO NY
MUCHTAR TS TN
MUCHTAR TS TN
HUSNI THAMRIN TN
HUSNI THAMRIN TN
LAY NAI LIN NY.
SIDI AMBO TN
KOSIM JOHAN TN
SUPINAH NY
ENI YANI NY
ZULKIFLI TN
SUJITNO CHANDRA TN
SITI NURBAYA NY
UMAR HAMID TN
DESSY HERLIANI NN
GUSTI DIANSYAH TN
AGUS EFFENDI, SE TN
RAFIKA FITRIANTI NY.
157,150.00
291,490.00
117,016.00
232,285.00
599,345.00
10,000.00
125,000.00
128,000.00
123,231.00
213,945.00
244,520.00
79,200.00
384,200.00
10,000.00
160,000.00
60,000.00
170,600.00
10,000.00
160,000.00
10,000.00
102,000.00
10,000.00
160,000.00
147,200.00
260,970.00
297,000.00
488,200.00
255,068.00
249,000.00
10,000.00
125,000.00
249,000.00
131,750.00
176,900.00
96,865.00
70,730.00
176,480.00
193,585.00
166,427.00
100,730.00
512,000.00
166,720.00
Page 383
25 MEI 2016
RUSNAH BINTI ABDUL GHANI NY.
LISIANA OSWARI NN.
LISIANA OSWARI NN.
ZURIAH,HJ NY.
HILMI BIN ZAKRI TN.
THOIBAH BINTI ADNAN NY
MUHAMMAD MURNI MZ,H TN.
EDY ABDULLAH TN
AISYAH NY.
HARMADI LATIEF TN.
YUNALNI NY.
SOFIAH HASAN, HJ NY.
BRYAN TOBIAS AN.
SURYANAH BINTI SOIN NY.
FATIMAH BAHIYA AN.
SAMSU RIZAL TN.
RAHMA WATI NY
MUSWATI BINTI KARTONO NY.
WESLY SIAHAAN TN
FEBBY FENISYA NY
ERWIN AZHARI TN.
KHO SUI HONG NY
LENI APRIYANTI NY
LENI APRIYANTI NY
AFFAN FADLULLAH RASHAD AN
FARIDAH BINTI AQSO NY.
FITRI YULIANTY NY
YULIANTI BINTI M. HATTA NY.
125,130.00
167,720.00
160,000.00
10,000.00
127,600.00
10,000.00
160,000.00
135,950.00
10,000.00
160,000.00
173,400.00
1,537,745.00
237,920.00
890,000.00
384,200.00
100,800.00
60,000.00
170,015.00
120,000.00
69,300.00
488,200.00
138,000.00
60,000.00
84,950.00
119,725.00
809,585.00
157,150.00
555,700.00
261,948.00
890,000.00
60,000.00
88,400.00
125,000.00
10,000.00
10,000.00
125,000.00
103,055.00
60,000.00
60,000.00
237,800.00
10,000.00
160,000.00
Page 384
25 MEI 2016
RAKHMAT ICHSAN TN.
MARZUKI ABDULLAH TN
HARTI TRISANTI NY
CORNILIA ANITA NY.
CORNILIA ANITA NY.
S. PAINUN TN
PRABAWATI NY.
HERA SYARTIKA NY.
HAIRONNINGSIH BINTI BARLIAN NY
M. YUSMAN DJANI TN.
IRYANTO ASYIK TN.
SYAFRIN SYAARANI TN.
ALFATIH IZQIAN SYADAAD AN
ESA ERLISA NURDIN NY.
MARZUKI BIN HASAN TN
PUSPA WULAN SARI NN.
M. RISKY SAHPUTRA TN.
NURDEWA BINTI ZEN H NY
TJIKNUT SYUKUR NY
TJIKNUT SYUKUR NY
ENDANG SUDARMI NN.
BUN A KIN NY.
KERRIN NATHANIA AN.
ITA HERTAWANI NY.
DEFI DWI OKTIYANI, DRG NY.
DEWI MONALISA NY.
SITI FATIMAH NY
HASBIAH BINTI ABDU NY.
167,000.00
384,200.00
60,000.00
198,085.00
160,000.00
10,000.00
166,800.00
110,000.00
890,000.00
347,175.00
189,030.00
97,180.00
957,700.00
890,000.00
77,500.00
234,400.00
160,000.00
10,000.00
140,855.00
312,600.00
334,530.00
156,810.00
488,200.00
129,450.00
293,150.00
234,400.00
170,420.00
234,400.00
10,000.00
160,000.00
621,600.00
640,022.00
110,000.00
95,000.00
10,000.00
146,400.00
86,000.00
180,000.00
158,700.00
160,100.00
80,750.00
98,400.00
Page 385
25 MEI 2016
ARIANIS OKTAVERINA NY.
AMALIA MAHARANI AN.
NYAYU HALIMAH NN.
BINSAR MP SITORUS TN
LIDAWATI NY.
SJAFRAN SOHIB TN
NURSIAH HJ. NY
ZUBIR A JALIL TN.
MARYAM BT ALIAS NY.
SRI REJEKI AGUSTINI NY.
ZAKARIA BIN YAKUB TN
NASRY BIN YUSUF TN
NOVENDA ALIANDO TN
SALAMUN BIN KARTO TN.
SHINTA DWI MARLINA,DR NY
M. RAFIE KHAIRY AN
DEWI SHINTAWATI NY.
169,450.00
217,200.00
211,260.00
60,000.00
86,791.00
71,450.00
68,000.00
123,000.00
99,450.00
418,500.00
107,450.00
217,500.00
255,830.00
121,621.00
60,000.00
152,830.00
160,000.00
10,000.00
60,000.00
159,800.00
72,500.00
60,000.00
219,450.00
159,850.00
157,450.00
60,000.00
10,000.00
102,000.00
60,000.00
182,893.00
60,000.00
597,200.00
60,000.00
91,640.00
488,200.00
384,200.00
110,000.00
170,600.00
60,000.00
138,270.00
180,000.00
107,900.00
Page 386
25 MEI 2016
NYAYU ROMADIANA A NY
ARYA RAMADHAN AN
KALSUM IBRAHIM NY.
AS AD SAYUTI DRS TN
AS AD SAYUTI DRS TN
TUGIMIN BIN SUMOTIGROMO TN
MARSITO TN
TENG SO HIE NY
DESSY SURYATI NY
SITU BINTI BUDI DARMA NY
MARIANA NY
HOPIAH BINTI ABDURAHMAN NY.
RESTY SARI WAHYUNI NY
NURBAYA BINTI SANI NY
R. A. INDRI NESTIANI NY.
HENDRY RIANTO TN
ERNA KURNIATY NY.
MAIQONAH NINGSIH NY
MEIRITA RUSLIE NY.
DARIASTI BINTI JAMAL NY
AZWAWI KERIT TN
YUSTIANUS JAFAR TN.
KIKI MARIA NY.
RIKA AGUSTINA NY.
MUHAMMAD JAUHARI TN
JAMILAH BINTI GUNAWAN NY.
RUSTEM PUAD TN.
DEVINA ANGELINA AN.
MIGDAD MEUTUAH F. AN
NURHANI BINTI H NASIR NY
300,330.00
110,000.00
10,000.00
60,000.00
171,981.00
60,000.00
10,000.00
167,000.00
170,250.00
860,000.00
571,310.00
60,000.00
810,000.00
60,000.00
120,500.00
260,400.00
136,180.00
180,000.00
160,800.00
193,585.00
718,570.00
211,820.00
160,400.00
160,806.00
160,000.00
10,000.00
186,400.00
472,500.00
107,450.00
293,000.00
173,580.00
402,405.00
10,000.00
160,000.00
104,830.00
286,830.00
10,000.00
160,000.00
210,570.00
152,780.00
47,345.00
193,420.00
Page 387
25 MEI 2016
LINAOKTRIYANA PB NY.
SURYANI BINTI IMRON NY.
EMI YANI S.E NY.
ESRA MOLINA NABABAN AN
CHOLIDAH UTAMA NY
MUHAMMAD NURDINSYAH TN.
RIZAL FAUZI TN.
RIZKI RAMADHAN RASSAT. AN
SYLVIA WIJAYA NY.
RAKHA RIZQURRAMADHAN R. AN
NOVIANA BINTI ASNAWI NY.
YULINAR NURUT NY.
SYAMSUL ARIF TN
MACHYUDIN BIN IBRAHIM TN
DARMAYANTI BINTI ZAMRI NY
RIDUAN YUSUF TN.
NUZUL QURNIATI NY
FERRY PATRIA TN
WISTANIO BINTI SAFE''I,H NY
SUTARJO BIN SAHUDI TN.
YUSNI DARWIN TN
JUNAEDY TN.
RASMIYATIE BINTI RASIMIN,HJ NY
ELIZABETH AGOES NY.
MEILISA DJUNAIDI NN.
OLIVER CHRIS W AN
ABDUL RONI TN.
DWI YANA FIDAYANTI NY.
RADEN AYU FATIMAH M. NY.
ROHANA BINTI SOLIMIN NY.
AMRI BIN ALWI TN.
197,000.00
146,625.00
234,400.00
174,260.00
180,000.00
375,000.00
240,800.00
93,030.00
519,630.00
371,310.00
60,000.00
180,000.00
60,000.00
203,850.00
10,000.00
160,000.00
219,900.00
170,320.00
60,000.00
175,701.00
295,515.00
189,881.00
94,300.00
164,088.00
60,000.00
196,000.00
125,000.00
10,000.00
273,400.00
586,000.00
60,000.00
164,221.00
193,300.00
62,000.00
110,000.00
541,450.00
60,000.00
214,531.00
240,330.00
310,000.00
60,000.00
331,500.00
Page 388
25 MEI 2016
DELISKA NY.
YULISNAWATI BINTI ABU HASAN NN
DARMAH BINTI H. AMIN NY
AFRIYANTI HANURA NY.
M.AMIN LISON TN
TITIN AGUSTINA NY.
TITIN AGUSTINA NY.
M. ROZAQ AL KHALIFI MUDA AN
M.MUSLIMIN FATHULLAH N. AN.
ISMAIL BIN ROMLI TN.
AGUS INDRI ATMAJA TN
SUNARTI.NY
PUJO HANDOKO TN
TRI PUSPITASARI NY.
DIANA ABIKUSNO NY
FATTARAZZA GAYENDRA PUTRA AN.
ROYANI BIN CIK BIK TN.
JIHAN VEASNA ALIFIA AN.
RA. ROSALINA NY.
SRI RAMADONA, DRA NY
THALIA HERLINDA NY
YOGA SAPUTRA AN
180,000.00
1,387,400.00
313,800.00
153,000.00
68,000.00
274,981.00
170,481.00
189,854.00
110,000.00
60,000.00
129,539.00
261,000.00
244,530.00
129,600.00
50,580.00
441,349.00
40,000.00
235,600.00
235,600.00
165,400.00
530,665.00
102,400.00
196,600.00
93,660.00
331,400.00
60,000.00
134,880.00
110,128.00
266,000.00
126,000.00
102,400.00
Page 389
26 MEI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
260516430004
260516430242
260516390053
260516390089
260516430310
260516390038
260516390009
260516430006
260516430324
260516390044
260516390043
260516420727
260516390045
260516390050
260516390051
260516430098
260516390052
260516390029
260516430062
260516430011
260516430316
260516390034
260516390015
260516390063
260516430217
260516430097
260516430095
260516430083
260516430060
260516430061
260516430065
260516430008
260516430320
260516390035
260516430356
260516390049
260516430079
260516430080
260516430054
260516430048
260516430007
TANGGAL
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160006078
0090R03105160006081
0090R03105160006278
0090R03105160006369
0090R03105160006503
0090R03105160006505
0090R03105160006507
0090R03105160006508
0090R03105160006509
0090R03105160006509
0090R03105160006510
0090R03105160006511
0090R03105160006511
0090R03105160006512
0090R03105160006513
0090R03105160006513
0090R03105160006514
0090R03105160006515
0090R03105160006516
0090R03105160006517
0090R03105160006517
0090R03105160006518
0090R03105160006518
0090R03105160006519
Page 390
26 MEI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
260516430315
260516390190
260516430042
260516430047
260516390150
260516430108
260516430109
260516390155
260516390231
260516390232
260516430078
260516430077
260516430086
260516430085
260516390230
260516390229
260516390130
260516390129
260516430114
260516430205
260516430204
260516430024
260516430210
260516390146
260516390149
260516430127
260516430025
260516430140
260516430141
260516430067
260516390174
260516390172
260516430041
260516430173
260516390118
260516430264
260516430323
260516390117
260516390120
260516380740
260516380742
260516430341
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
0090R03105160006520
0090R03105160006521
0090R03105160006522
0090R03105160006522
0090R03105160006523
0090R03105160006524
0090R03105160006524
0090R03105160006525
0090R03105160006526
0090R03105160006526
0090R03105160006527
0090R03105160006527
0090R03105160006529
0090R03105160006530
0090R03105160006531
0090R03105160006531
0090R03105160006532
0090R03105160006532
0090R03105160006533
0090R03105160006534
0090R03105160006534
0090R03105160006535
0090R03105160006536
0090R03105160006537
0090R03105160006537
0090R03105160006538
0090R03105160006539
0090R03105160006540
0090R03105160006540
0090R03105160006541
0090R03105160006542
0090R03105160006542
0090R03105160006543
0090R03105160006544
0090R03105160006544
0090R03105160006545
0090R03105160006546
0090R03105160006547
0090R03105160006548
0090R03105160006549
0090R03105160006549
0090R03105160006550
Page 391
26 MEI 2016
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
260516430037
260516430199
260516430184
260516430179
260516430026
260516430132
260516380527
260516380525
260516430144
260516430069
260516390197
260516390336
260516390333
260516390196
260516390200
260516430348
260516430347
260516380620
260516380616
260516390261
260516390168
260516390252
260516390253
260516430116
260516390251
260516390249
260516430194
260516390257
260516390254
260516390220
260516390304
260516390307
260516420628
260516420627
260516430082
260516430198
260516430152
260516390094
260516430340
260516430335
260516380508
260516430071
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
05/26/2016
0090R03105160006551
0090R03105160006552
0090R03105160006552
0090R03105160006553
0090R03105160006554
0090R03105160006555
0090R03105160006556
0090R03105160006556
0090R03105160006557
0090R03105160006558
0090R03105160006558
0090R03105160006559
0090R03105160006559
0090R03105160006560
0090R03105160006560
0090R03105160006561
0090R03105160006561
0090R03105160006562
0090R03105160006562
0090R03105160006563
0090R03105160006564
0090R03105160006565
0090R03105160006565
0090R03105160006565
0090R03105160006566
0090R03105160006566
0090R03105160006567
0090R03105160006569
0090R03105160006569
0090R03105160006570
0090R03105160006571
0090R03105160006571
0090R03105160006572
0090R03105160006572
0090R03105160006573
0090R03105160006574
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NAMA PASIEN
ACHMAD ZARNUBI TN.
AS AD SAYUTI DRS TN
M.AMIN LISON TN
M.AMIN LISON TN
MARTINI ASRIL NY.
MSY PURBAYA NY.
SAFRI,H TN.
SANGKUT BIN ATUT TN
SITI NURMA NY.
ZAHRI ZAINURI TN
MASTIAH BINTI ARDANI NY
HEFRIANSYAH TN
ASWATY BINTI ADEMAN NY.
RAZIQ ATALLAH AN.
MIKHAEL RUKINEM NY.
ABDUL LATIF TN
SITI FATIMAH NY
SITI FATIMAH NY
RIKAWATI BINTI NUYSIRWAN NY.
LIM KOEIJ ING NY
DENCIK NAYA TN
TANG WEI HENG NY
TANG WEI HENG NY
TRANSAKSI
420,370.00
672,000.00
11,250.00
25,200.00
5,000.00
378,000.00
17,000.00
768,420.00
672,000.00
66,000.00
367,500.00
75,600.00
25,200.00
135,000.00
350,970.00
148,920.00
155,970.00
93,400.00
176,100.00
60,000.00
287,320.00
110,460.00
302,630.00
126,300.00
512,053.00
125,000.00
10,000.00
257,400.00
10,000.00
137,000.00
80,660.00
116,900.00
197,105.00
133,550.00
890,000.00
184,200.00
10,000.00
167,000.00
160,000.00
10,000.00
396,000.00
Page 400
26 MEI 2016
890,000.00
440,900.00
10,000.00
160,000.00
MASNAH HAKIM NY.
187,200.00
HASIAM INDRIANI NY
10,000.00
HASIAM INDRIANI NY
160,000.00
ROSDIANA BINTI H.ZAINAL NY.
519,400.00
10,000.00
160,000.00
TUTI PURNAMAWATI NY
160,000.00
TUTI PURNAMAWATI NY
10,000.00
IBRAHIM SANI TN.
100,184.00
RAHMAWATI BINTI M YUSUF HJ, NY
563,870.00
125,000.00
10,000.00
NING AYU NY.
137,000.00
NING AYU NY.
10,000.00
YULIANA GAINAU NY
555,000.00
NOVENDA ALIANDO TN
102,000.00
NOVENDA ALIANDO TN
10,000.00
WINDA LESTARI NN
76,976.00
181,375.00
10,000.00
160,000.00
BETIN TEGUH NY.
205,400.00
AMRI BIN CIK AMAN TN
142,400.00
10,000.00
160,000.00
RAHMA WATI NY
171,500.00
125,000.00
10,000.00
216,480.00
SITI MAIMUNAH NY
10,000.00
SITI MAIMUNAH NY
160,000.00
890,000.00
898,620.00
LIE WIE SENG TN
60,000.00
HO LI IN NY
128,682.00
ALFI SYAHRIN TN.
10,000.00
ALFI SYAHRIN TN.
160,000.00
DAVID ISKANDAR TN
1,192,000.00
Page 401
26 MEI 2016
SRI YUSNITA NY.
187,200.00
160,000.00
10,000.00
BARIYAH BR NY.
203,500.00
244,800.00
232,900.00
160,000.00
10,000.00
YOSEPHINE MARIA NELLYWATI NY
94,700.00
M. YUSMAN DJANI TN.
512,000.00
SUYADI H. TN
1,040,600.00
M. ABBAS HASAN TN
160,000.00
M. ABBAS HASAN TN
10,000.00
10,000.00
160,000.00
ZAIDAN ACHMAD TN.
125,000.00
ZAIDAN ACHMAD TN.
10,000.00
160,000.00
10,000.00
HENDRY RIANTO TN
890,000.00
N SEMBIRING NY
298,060.00
MUHAMMAD TONI TN.
10,000.00
MUHAMMAD TONI TN.
160,000.00
WIWIK ANI NY
60,000.00
JUNAIDA PRIANI NY
160,000.00
JUNAIDA PRIANI NY
10,000.00
197,200.00
GHANI ALFARIZI AN.
62,000.00
GHANI ALFARIZI AN.
10,000.00
MARIA ESTETI NY.
180,000.00
SARDJONO, H TN
10,000.00
SARDJONO, H TN
160,000.00
125,000.00
10,000.00
AZHARI BSC TN.
80,660.00
FIKRI HASAN BASRI TN.
130,720.00
RITA ZAHARA NY
194,500.00
LENI MARLINA NY
169,500.00
177,000.00
10,000.00
AISYAH NY.
86,320.00
ZAKARIA BIN YAKUB TN
512,000.00
Page 402
26 MEI 2016
FITRI SYAWALIAH NY
SITI ROHMA NY
SITI ROHMA NY
ARNESIA INDIRA SARI NN
DENI KURNIADI TN
MUSA ISMAIL DRS TN
SUGINAH ABBAS NY.
SUGINAH ABBAS NY.
JACUB RAHMAN TN.
LIDAWATI NY.
LIDAWATI NY.
SUSTERIWATI BINTI MAD NY.
INDRAYANTA TN
INDRAYANTA TN
NURMA HASAN, HJ NY.
WATINI BINTI TUKIMAN NN
ASKURNI APSA TN.
PAULUS LINGGO M TN.
YUSMAWATI BINTI SANULIP NY
NOPA ROSETA NN.
NOPA ROSETA NN.
KALSUM IBRAHIM NY.
SITI AISYAH AN.
SUSILAWATY NY
SUSILAWATY NY
ARSENIO CETTA AN.
ENDANG SUDARMI NN.
216,036.00
117,910.00
125,000.00
10,000.00
248,700.00
62,880.00
177,000.00
10,000.00
234,400.00
106,000.00
127,200.00
10,000.00
160,000.00
170,050.00
160,000.00
10,000.00
359,000.00
10,000.00
160,000.00
160,000.00
10,000.00
146,100.00
258,079.00
167,000.00
10,000.00
306,295.00
186,000.00
194,400.00
155,580.00
160,000.00
10,000.00
268,000.00
1,073,278.00
110,000.00
10,000.00
160,000.00
189,350.00
320,400.00
10,000.00
160,000.00
320,400.00
82,600.00
Page 403
26 MEI 2016
AGUS EFFENDI, SE TN
MARWAN DJEMALIP TN
AMIR HAMZAH TN
AMIR HAMZAH TN
HERDAWATY BINTI AHMAD N. NY
MARIANA NY
MARIANA NY
MELISA ANDRIANI NN
HENNY BINTI AMIR EFFENDI NY
NYIMAS ULFA HIDAYATI NY.
AMALIA MAHARANI AN.
TIHAR BUTAR BUTAR TN.
MARDIAH BINTI M. NUR NY.
KERRIN NATHANIA AN.
KOSIM JOHAN TN
KOSIM JOHAN TN
EVA TRIANA NY.
ABDUL SANI,SE TN.
KMS EFFENDY TN.
NURHIDAYATI BINTI ALAM SUDI NY
OKTA SAPUTRA TN
OKTA SAPUTRA TN
OKTARINI BINTI EDI GUNAWAN NN
MUHAMMAD MIFTHAURRAHMAN AN
NUR HUSNAWATI NY
81,830.00
370,970.00
167,000.00
10,000.00
411,090.00
60,800.00
160,000.00
10,000.00
60,000.00
160,000.00
10,000.00
222,000.00
235,600.00
10,000.00
160,000.00
259,600.00
110,000.00
112,500.00
391,800.00
110,000.00
419,400.00
120,000.00
110,000.00
115,000.00
69,300.00
240,800.00
86,000.00
180,000.00
284,258.00
249,000.00
125,000.00
174,730.00
177,000.00
10,000.00
180,000.00
174,400.00
10,000.00
167,000.00
234,400.00
120,000.00
398,800.00
181,201.00
Page 404
26 MEI 2016
BUDI NOPRIANI NY.
SULIANTI CANDRA NY.
CANDRA DOAN TN.
CANDRA DOAN TN.
A. FAHRIE ZUHRIE AN
ANDY ANDRY TN
NYAYU SARIFAH NY
HAJI EFENDI TN.
DORTA SINAGA NY.
DORTA SINAGA NY.
TJOE HOEN NIO NY.
TJOE HOEN NIO NY.
RINA AQUARINA NY.
ANA YUSTIA SHINTA NY.
JUARIA BINTI YUSLI NY
TRI LIANA NN.
EMI MARLINA NY.
EMI MARLINA NY.
SRI PURNAMAWATI NY.
SRI PURNAMAWATI NY.
MURNIATI NY.
ELLY ASMAWATI NY.
MUHAMAD FARHAN YUSUF ILHAM
TRIANA APRIANI NY
TRIANA APRIANI NY
LENI APRIYANTI NY
60,000.00
160,000.00
10,000.00
83,950.00
120,000.00
89,750.00
155,000.00
234,056.00
110,000.00
185,720.00
186,000.00
137,000.00
10,000.00
160,000.00
10,000.00
262,557.00
10,000.00
95,000.00
621,600.00
60,000.00
60,000.00
130,000.00
292,900.00
60,000.00
160,000.00
10,000.00
890,000.00
267,200.00
137,000.00
10,000.00
160,000.00
10,000.00
221,500.00
120,000.00
216,940.00
167,000.00
10,000.00
345,100.00
110,000.00
10,000.00
160,000.00
10,000.00
Page 405
26 MEI 2016
LENI APRIYANTI NY
HALIMAH BINTI NANGUNING NY.
SILVIA EKA FIORA NN
LASMIATY BINTI DAUT NY.
SAID SALIM TN
RITA KAINAR, HJ NY.
MARIMAH C AHMAD NY.
SITI NURAINI NY.
RAFA ALVARO AN
ROMLAH ARMA RACHMAN NY.
RIFFAT IDLAN A. AN
MULYADI CUAN BIE TN
FARRENO GUSTIANSYAH AN.
SINTHA VALENTINA NY.
SALSABILA EKA PUTRI AN
NURMALA DEWI NY.
HERIYANA BINTI IBRAHIM NY.
ACHMAD MAULANA,H TN
TIA ANDRIANI NY
CHRISTIYAN ADHINATA TN.
YUSUF USMAN TN
ZULHAYATI ALWIN NY.
SANIYATI BINTI KHORIB NY.
125,000.00
10,000.00
160,000.00
163,920.00
79,690.00
269,400.00
145,080.00
160,000.00
10,000.00
10,000.00
60,000.00
187,450.00
890,000.00
60,000.00
108,350.00
71,450.00
71,450.00
110,000.00
90,300.00
397,080.00
890,000.00
97,200.00
106,800.00
71,450.00
207,876.00
890,000.00
117,200.00
180,000.00
218,525.00
71,450.00
71,450.00
183,560.00
890,000.00
195,900.00
132,350.00
85,691.00
100,800.00
535,370.00
60,000.00
164,081.00
222,080.00
60,000.00
Page 406
26 MEI 2016
INDRA WATI NY
HARTINI BINTI AMIR HAMZAH NY.
YOS INDRIANTINA NY.
LENI MARLINA NY.
ASMA WATI NY.
WILLY WIJAYA TN.
M. AFRIZAL TN
NASRUN BASRI TN
SYARIFIN BIN PAIMIN TN
EDDY MAKSURI TN.
EDDY MAKSURI TN.
NIRWANAA CANDRA NY.
AKHMAD KASIRO TN.
RICKI FENDY KURNIAWAN TN.
AGUS LANI TN
ADITYA PERMANA AN
SENJA NOVITRI NY
PUTRI FAHRIZA NY
SUHERMI BINTI SUKARJO NY.
RITA MARLINA NY
JULIANA BINTI HASAN S NN
ANI HAIRANI NY.
SUKMANIAR BINTI MAWARDI NY.
MARLINA ZAHARA NY.
VERA DIANTI ZALEHA NY.
ISMAH HJ BINTI BERLIAN H NY
RUSLAINI WILDAN TN
DWI YULITA NN.
197,440.00
309,700.00
323,820.00
313,800.00
152,300.00
285,800.00
71,450.00
170,440.00
94,130.00
91,120.00
306,853.00
93,500.00
264,050.00
85,000.00
10,000.00
207,720.00
162,900.00
175,669.00
117,900.00
10,000.00
160,000.00
104,130.00
60,000.00
125,000.00
10,000.00
200,510.00
285,360.00
110,170.00
279,708.00
274,050.00
123,140.00
180,000.00
200,000.00
188,580.00
180,000.00
312,000.00
254,640.00
110,000.00
10,000.00
125,000.00
136,140.00
110,000.00
Page 407
26 MEI 2016
OLIVIA TERISIA NY
HERU NUGROHO TN.
NATALENA BINTI MUHARI NY.
NYAYU NUR''AINI NY
DJAKFAR LEKAP TN.
LATIFAH BINTI AHMAD HASAN NY
ENDAR WIRANAWATI NY.
HERLINA MEGAWATI NY
RAHNAH NY.
EPIN NURYANI NY
NUR AINUN ISLAMIYAH NY.
SITI MARYANI NN.
ATRI MULYATI NY
HEKSI TRIDIARSI NY.
ZHIFARA YUDA MULIA AN
NELLY ABDULLAH NY.
AYUN WIJAYANTI NY
NURIL HASANAH NY
NURIL HASANAH NY
EGGY REGIKA NN
KEYZA NAJMA ORLIN AN.
MEYLINDA BINTI YUSNI NY
SUDARMI BINTI SAYAN NY.
YUNITA MAYA NY.
184,000.00
120,720.00
162,300.00
211,380.00
235,390.00
198,060.00
362,850.00
117,970.00
298,060.00
185,280.00
128,320.00
177,000.00
10,000.00
185,110.00
136,830.00
197,160.00
214,581.00
108,120.00
225,680.00
68,160.00
145,303.00
97,402.00
102,400.00
101,234.00
130,600.00
40,000.00
127,806.00
102,000.00
10,000.00
154,000.00
137,900.00
109,940.00
175,680.00
87,000.00
114,638.00
Page 408
26 MEI 2016
Page 409
27 MEI 2016
NO
1
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23
24
25
26
27
28
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30
31
32
33
34
35
36
37
38
39
40
41
NO RJ
270516280403
270516390755
270516280087
270516280181
270516280218
270516280108
270516380180
270516380137
270516430870
270516430873
270516390954
270516280060
270516280084
270516390616
270516280281
270516390578
270516390761
270516280088
270516280059
270516280339
270516380334
270516390569
270516280058
270516280062
270516280054
270516280056
270516280025
270516280026
270516280143
270516280030
270516280023
270516280124
270516280021
270516280035
270516390678
270516280125
270516280122
270516380300
270516280291
270516280022
270516280371
TANGGAL
SEP
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/2016
00
05/27/20160090R03105160006257
05/27/20160090R03105160006693
05/27/20160090R03105160006693
05/27/20160090R03105160006697
05/27/20160090R03105160006769
05/27/20160090R03105160006773
05/27/20160090R03105160006777
05/27/20160090R03105160006823
05/27/20160090r03105160006827
05/27/20160090R03105160006828
05/27/20160090R03105160006832
05/27/20160090R03105160006833
05/27/20160090R03105160006835
05/27/20160090R03105160006836
05/27/20160090R03105160006837
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27 MEI 2016
42
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270516280362
270516380210
270516280130
270516280068
270516280042
270516280041
270516280034
270516280140
270516280053
270516280055
270516280076
270516280006
270516280008
270516280039
270516280010
270516380074
270516380077
270516280037
270516380091
270516380095
270516280092
270516280024
270516280081
270516280083
270516380252
270516380134
270516380136
270516280078
270516280215
270516280220
270516380349
270516280135
270516280163
270516280166
270516280036
270516280045
270516280239
270516280242
270516280048
270516280202
270516280017
270516280070
05/27/20160090R03105160006838
05/27/20160090R03105160006839
05/27/20160090R03105160006840
05/27/20160090R03105160006841
05/27/20160090R03105160006843
05/27/20160090R03105160006843
05/27/20160090R03105160006844
05/27/20160090R03105160006845
05/27/20160090R03105160006846
05/27/20160090R03105160006846
05/27/20160090R03105160006847
05/27/20160090R03105160006848
05/27/20160090R03105160006849
05/27/20160090R03105160006850
05/27/20160090R03105160006851
05/27/20160090R03105160006852
05/27/20160090R03105160006852
05/27/20160090R03105160006853
05/27/20160090R03105160006854
05/27/20160090R03105160006854
05/27/20160090R03105160006855
05/27/20160090R03105160006856
05/27/20160090R03105160006857
05/27/20160090R03105160006857
05/27/20160090R03105160006858
05/27/20160090R03105160006859
05/27/20160090R03105160006859
05/27/20160090R03105160006860
05/27/20160090R03105160006861
05/27/20160090R03105160006861
05/27/20160090R03105160006862
05/27/20160090R03105160006863
05/27/20160090r03105160006864
05/27/20160090r03105160006864
05/27/20160090R03105160006865
05/27/20160090R03105160006866
05/27/20160090R03105160006867
05/27/20160090R03105160006867
05/27/20160090R03105160006868
05/27/20160090R03105160006869
05/27/20160090R03105160006870
05/27/20160090R03105160006871
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27 MEI 2016
84
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270516280057
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270516280246
270516380073
270516280128
270516280179
270516280187
270516380170
270516280075
270516280061
270516380120
270516280086
270516390509
270516390511
270516280271
270516280258
270516280194
270516280245
270516280064
270516280063
270516280306
270516280308
270516380096
270516380317
270516380321
270516280230
270516390548
270516390552
270516280104
270516280350
270516380139
270516280286
270516280288
270516280402
270516280316
270516280341
270516280082
270516380131
270516380367
05/27/20160090R03105160006872
05/27/20160090R03105160006873
05/27/20160090R03105160006874
05/27/20160090R03105160006875
05/27/20160090R03105160006876
05/27/20160090R03105160006877
05/27/20160090R03105160006878
05/27/20160090R03105160006879
05/27/20160090R03105160006880
05/27/20160090R03105160006880
05/27/20160090R03105160006881
05/27/20160090R03105160006882
05/27/20160090R03105160006883
05/27/20160090R03105160006884
05/27/20160090R03105160006885
05/27/20160090R03105160006886
05/27/20160090R03105160006886
05/27/20160090R03105160006887
05/27/20160090R03105160006888
05/27/20160090R03105160006889
05/27/20160090R03105160006889
05/27/20160090R03105160006890
05/27/20160090R03105160006891
05/27/20160090R03105160006893
05/27/20160090R03105160006893
05/27/20160090R03105160006894
05/27/20160090R03105160006895
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05/27/20160090R03105160006896
05/27/20160090R03105160006897
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05/27/20160090R03105160006900
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05/27/20160090R03105160006901
05/27/20160090r03105160006902
05/27/20160090R03105160006903
05/27/20160090R03105160006903
05/27/20160090R03105160006904
05/27/20160090R03105160006905
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27 MEI 2016
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05/27/20160090R03105160006906
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05/27/20160090R03105160006980
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252
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270516390636
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270516390714
270516390711
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270516390504
270516390880
270516420697
270516430443
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270516280412
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270516420532
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270516280401
270516390881
270516390746
270516390752
270516390544
270516390769
270516390503
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270516280422
270516280430
05/27/20160090R03105160007027
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27 MEI 2016
294
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302
303
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308
309
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312
313
314
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270516420607
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270516280406
270516390630
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270516420726
270516430876
270516390673
270516390676
270516390624
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270516430715
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270516430618
270516430619
270516420473
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270516390553
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270516390538
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270516390585
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270516390574
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270516390879
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270516390562
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05/27/20160090R03105160007066
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336
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344
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350
351
352
353
354
355
356
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270516420909
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270516390583
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05/27/20160090R03105160007111
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27 MEI 2016
378
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381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
270516430867
270516390699
270516390856
270516390731
270516420613
270516390669
270516420907
270516430922
270516390951
270516390955
270516280032
270516280049
270516280044
270516280043
270516280005
270516280221
270516280224
270516430712
270516390923
270516390916
270516390924
270516280414
270516280250
05/27/20160090R03105160007154
05/27/20160090r03105160007155
05/27/20160090R03105160007156
05/27/20160090R03105160007157
05/27/20160090R03105160007158
05/27/20160090R03105160007160
05/27/20160090R03105160007174
05/27/20160090R03105160007176
05/27/20160090R03105160007178
05/27/20160090R03105160007179
05/27/20160090R03105160007257
05/27/20160090R03105160008129
05/27/20160090R03105160008130
05/27/20160090R03105160008130
05/27/20160090R03105160008131
05/27/20160090R03105160008136
05/27/20160090R03105160008136
05/27/20160090R03105160008137
05/27/20160090R03105160008138
05/27/20160090R03105160008139
05/27/20160090R03105160008140
05/27/2016 MASUK RAWAT INAP
05/27/2016
Page 419
27 MEI 2016
NAMA PASIEN
ABDUL RONI TN.
AHMAD FANFANI TN.
ANA MARLINA NY.
ASWATY BINTI ADEMAN NY.
DEWI IKRAR BHAKTI NY
GUSTI DAHLIANA NY
INDRAWATY BINTI M. DAUD NY.
J S NAMI NY
NURMA HARYANI NY.
SAFRI,H TN.
SIAMILIANI MAKMUR NY
ZHIFARA YUDA MULIA AN
ZULHAYATI ALWIN NY.
NOVA YANTI NY
RUSMIDIUS NY.
HOLIANAH NY
TITIN KUSMETA NY.
BOBBY ANGGARA TN.
TARIZA PUTRI RAMAYANTI,SE NY.
AYU PRATIWI NY
JAP GUAN SENG TN.
ARUMIYANA NY
PUTRO SETYONO TN
TRANSAKSI
129,000.00
167,000.00
1,714,300.00
40,800.00
82,800.00
82,800.00
1,672,100.00
18,000.00
1,780,300.00
249,000.00
20,400.00
78,000.00
30,000.00
672,000.00
174,400.00
629,781.00
73,880.00
249,000.00
60,000.00
62,400.00
40,160.00
148,920.00
61,000.00
45,000.00
16,989.00
61,000.00
154,400.00
192,900.00
228,000.00
250,530.00
222,060.00
40,000.00
192,900.00
157,800.00
207,063.00
109,000.00
40,000.00
180,000.00
1,192,000.00
119,262.00
1,647,150.00
Page 420
27 MEI 2016
DIANA NOVITA NY
M. NURHADI H. TN.
HERIYANTO TN
MUTIAR DJANAN TN
MAYA E LEBIS NY.
MAYA E LEBIS NY.
RA LAYSHA RIANDA AN.
RONIMAH NY
RONIMAH NY
NASRUN BASRI TN
THIO PING TJIANG TN.
M YUSUF JAYA TN
LIE PO NIE NY
HAMIDAH BINTI SENIN NY.
TITIN SURYANI. NY
ZAINAL ARIFIN H TN.
THERESIA PARJIAH NY
NYAYU HALIMAH NN.
NYAYU HALIMAH NN.
GHANI ALFARIZI AN.
GHANI ALFARIZI AN.
ROZANA MEILINDA NY.
AGUSTRIANI BINTY SUKIMAN NY
MULKAS ADE PUTRA TN
SUJITNO CHANDRA TN
918,200.00
231,370.00
1,192,000.00
214,568.00
160,000.00
10,000.00
60,000.00
143,080.00
10,000.00
160,000.00
134,600.00
587,600.00
134,880.00
152,530.00
94,880.00
160,000.00
10,000.00
174,800.00
10,000.00
160,000.00
78,000.00
140,000.00
10,000.00
160,000.00
157,252.00
10,000.00
160,000.00
500,100.00
10,000.00
160,000.00
1,192,000.00
227,600.00
10,000.00
62,000.00
160,400.00
227,162.00
160,000.00
10,000.00
266,195.00
194,520.00
472,000.00
129,843.00
Page 421
27 MEI 2016
MARYANTI BINTI KGS BUSTOMI NY
WIWIK ANI NY
UMARIDDIN LATIEF H TN
INTENAWATY HS NY
ELANI HASANAH HS NY.
NONI BINTI SANYU NY
EMMY YAHIMI NY
EMMY YAHIMI NY
FAIZAH ADNAN NY.
AMRI BIN CIK AMAN TN
HAJI EFENDI TN.
MUHAMMAD SYAHIR TN
TJIKMAD. B TN.
TJIKMAD. B TN.
GUSTI DAHLIANA NY
RIZKI HARTANTRI NY
INDRAYANTA TN
INDRAYANTA TN
SITI NURJANA NY
SUKANTO KESUMAH TN
SYAHRUDDIN BIN SYAMSUDDIN TN
BRYAN TOBIAS AN.
YULIA DASWATI NY.
YULIA DASWATI NY.
MEIRITA RUSLIE NY.
ELLY FALLAH HJ NN
159,900.00
228,000.00
223,200.00
554,650.00
126,495.00
247,030.00
142,030.00
194,000.00
10,000.00
160,000.00
146,000.00
309,800.00
451,800.00
297,900.00
166,968.00
10,000.00
125,000.00
253,700.00
232,150.00
10,000.00
137,000.00
188,000.00
240,800.00
160,000.00
10,000.00
273,200.00
10,000.00
160,000.00
266,800.00
10,000.00
160,000.00
264,560.00
1,216,800.00
334,400.00
10,000.00
160,000.00
124,600.00
10,000.00
160,000.00
264,800.00
212,945.00
10,000.00
Page 422
27 MEI 2016
HAUNAH SAID HJ. NY
KMS A RONI H TN.
SRI MULYONO TN
NOPA ROSETA NN.
NOPA ROSETA NN.
FATIMAH BINTI PONIRAN NY
JEANNE KUSSOY NY
JANSEN SIRAIT TN.
JANSEN SIRAIT TN.
M HASBI RIDHO AN.
RITA MELLA NY.
RISCA LARASATI NN.
MARIANA NY
MARIANA NY
SUGIAWATI BINTISUMO DIHARJO NY
RENA KUMALA DEWI NY.
TRISTAN SAPTA PARDEDE AN.
MASAYU JAMALIA NY.
HUSNI THAMRIN TN
HUSNI THAMRIN TN
ARIFIN SITOHANG TN.
ARIFIN SITOHANG TN.
125,000.00
457,262.00
264,800.00
263,500.00
60,000.00
10,000.00
160,000.00
10,000.00
160,000.00
890,000.00
10,000.00
160,000.00
10,000.00
167,000.00
501,600.00
10,000.00
160,000.00
60,000.00
170,000.00
106,200.00
10,000.00
125,000.00
116,841.00
104,680.00
146,000.00
110,981.00
181,575.00
10,000.00
160,000.00
230,700.00
180,000.00
10,000.00
160,000.00
60,000.00
213,200.00
10,000.00
160,000.00
212,000.00
1,041,900.00
10,000.00
160,000.00
210,600.00
Page 423
27 MEI 2016
ANI HASAN NY
DEWI FATIMAH PUTIH MELODY NN.
ISKANDAR HASBULLAH Z TN.
IMAS KAMILAH NY.
DJALILI SOLIHIN TN
DJALILI SOLIHIN TN
LYDIA VALENSIA NY.
MARTILAWATI BINTI AHMAD NY
LAY NAI LIN NY.
ELLYA KUSUMA NY.
ELLYA KUSUMA NY.
LISDA BINTI EDI NY
LINDA SURYANI NY
SITI MARIAM NY
SITI MARIAM NY
KARTINI NY
KARTINI NY
ONI AISYAH NY.
WINARTI BINTI SATIYO NY.
ARMANSYAH BIN SOEWANDI TN
M. RIZKY ARAFAH AN.
CARISSA ADELIA AN.
LISIANA OSWARI NN.
LISIANA OSWARI NN.
NUR AINI NY.
SYUKRI MUBARAK TN.
GUSTINA HUTAPEA NY
HERMI ZULITA NY.
SITI SALMIJATI NY
ERMIATI KOTO NY
YUS ROHANA NY.
YUS ROHANA NY.
890,000.00
60,000.00
109,850.00
60,000.00
10,000.00
160,000.00
334,526.00
379,894.00
188,000.00
10,000.00
160,000.00
194,100.00
193,000.00
167,000.00
10,000.00
10,000.00
160,000.00
205,450.00
183,560.00
137,000.00
289,080.00
280,360.00
161,774.00
60,000.00
10,000.00
160,000.00
110,000.00
192,775.00
110,000.00
120,000.00
10,000.00
160,000.00
317,540.00
60,000.00
488,200.00
125,910.00
60,000.00
890,000.00
146,000.00
200,800.00
10,000.00
160,000.00
Page 424
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DZAKIRA GHANIYYAH QUEEN AN
ZHAFIRAH AINAYYA MAHIRA AN
HERMAN ZAKARIA TN.
RA ZULEICHA ETTY NY.
EGI NAUFAL ZUHDI TN
ALMAPIS SUDUR TN
ELVINA BINTI AZWAR NY
ELFERENO ZACKY AN.
GATOT SUGEMTO TN
M. AZKA ALMA ATHALLAH AN
M. RIO OKAMAHENDRA AN
HARMAIDI LATIEF TN.
DJONI BIN SUTINI TN.
RIANA EKASARI NY.
RUSTAM HALIM TN
HERMANSYAH HAMID, S.H TN.
FYERDA OCTARIANI NY
SYAKHISYAH RAFIFAH LUTFIAH AN.
SUHARI JUWUTO DRS TN.
SYAMSUL ARIF TN
RINA PUJI ASTUTI. HJ.NY.
ANASTASIA LENI NY
SULASTRI BINTI SARIMUN NY
134,415.00
110,000.00
233,387.00
60,000.00
110,000.00
110,000.00
249,000.00
82,350.00
110,000.00
137,000.00
558,160.00
160,000.00
10,000.00
110,000.00
313,800.00
110,000.00
205,740.00
71,800.00
182,400.00
1,192,000.00
111,600.00
192,787.00
155,000.00
67,000.00
502,200.00
183,762.00
890,000.00
108,300.00
180,000.00
145,792.00
88,951.00
10,000.00
185,040.00
81,950.00
158,000.00
442,500.00
60,000.00
60,000.00
68,400.00
60,000.00
123,050.00
82,680.00
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27 MEI 2016
SYARIFUDDIN BIN CIK MAN TN.
WIDYA SUZANIE NY
HASRI TANJUNG H TN.
AKHMAD TAJIR HSY TN.
FEMILIA MARLINA NY.
FEBRIANI BINTI MUCHTAR NY.
EMA ANDALYA NY.
MARTEWI BINTI JERAIS NY.
EDDY HENDRA SUTION TN.
ANTONI SUDARSONO SO TN.
SUWANDI BIN SUDHARMANTO TN.
SUSILAWATI BINTI M. YUSUF NY
MEYTIKA WIDIYA PUTRI NY.
BETIN TEGUH NY.
CAHYANI INDAH PUSPITA NY.
AZIZ YASIN H. A TN.
LENI APRIYANTI NY
LENI APRIYANTI NY
ENITA DIANA NY.
MEGAWATI. DR. NY
SYARIFUDDIN RM H TN
AGUSTRIA Z SALEH, DR, SPOG TN.
SATIAH BINTI ALIASA NY
SYAMSUL BAHRI TN
NUR HAYATI NY
SETIA WATI NY
SOVIA BINTI ANOM NY.
EDDI AZ TN.
ERNA KURNIATY NY.
60,000.00
297,400.00
60,000.00
65,000.00
961,100.00
60,000.00
402,750.00
134,450.00
139,291.00
260,184.00
196,590.00
545,500.00
118,000.00
10,000.00
160,000.00
69,300.00
10,000.00
160,000.00
330,000.00
423,780.00
693,000.00
621,600.00
203,131.00
180,000.00
61,330.00
10,000.00
125,000.00
435,950.00
406,500.00
225,260.00
123,000.00
81,000.00
194,400.00
438,000.00
10,000.00
160,000.00
60,000.00
99,450.00
145,415.00
133,000.00
273,800.00
141,600.00
Page 426
27 MEI 2016
ZAINAB BINTI NAAMIN NY
HENDRI HASAN TN
MUHAMMAD HANIFA TN.
SUKARMAN BIN ALIASIN TN
SUDARMI BINTI SAYAN NY.
SAHLAN BIN SAIDI TN.
MULYADI CUAN BIE TN
MULYADI CUAN BIE TN
NINA PRATIWI NY
LINDA IRIANA NY
SITI MAIMUNAH NY
AISYAH BINTI RUSLAN NY.
HARTINI, IR, MT NY
MAHANI BINTI HAMBALI NY
MEI TRI WAHYUNI
ROHAINA HJ, NY.
HERMANSYAH BIN HUSIN ZEN TN.
M.ATHAR KURNIAWAN AN.
TANG WEI HENG NY
MUHAMMAD AULADI AN
SUPRAPTO BINSURATIN TN
SON ESWANDY, DRS, H TN
NAZIMUDDIN AGUS TN
EL FATH HARRIS ABQORI AN
ME. LEONAWATI NN.
SALLY PRAMONTHY S KOM NY
ASKURNI APSA TN.
ASKURNI APSA TN.
WIDIA TRISUSANTY DR. NY
311,920.00
73,610.00
120,000.00
99,670.00
165,263.00
168,600.00
60,000.00
516,000.00
10,000.00
160,000.00
60,000.00
468,000.00
71,450.00
113,890.00
160,000.00
10,000.00
400,200.00
171,600.00
313,800.00
290,415.00
194,073.00
202,000.00
10,000.00
160,000.00
125,900.00
107,865.00
87,000.00
60,000.00
198,313.00
264,800.00
60,000.00
186,950.00
608,900.00
595,050.00
195,725.00
313,800.00
129,450.00
230,700.00
259,500.00
10,000.00
137,000.00
181,092.00
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27 MEI 2016
WARTONO TN
RANI DWI AMELIA NY
IMELDA TELISA NY
HANIFAH ANDINI C AN
TJUNG SEN WAN NY.
YULIA HANAN NY.
ARYA RAMADHAN AN
YULIARTY MOERLYNA NY.
SHINTA HASANA NY.
SHINTA HASANA NY.
INDRIANY NY.
HERLINA WATI NY.
NURI KARTIKA SARI NY
JANTI YULIANTI NY.
JAMIA BINTI HASANUDDIN NY.
SHALIHUL MAKMUN TN
SIDI AMBO TN
KMS IBRAHIM, H TN
HERI PURWANTO TN
ENGGA SASONGKO TN
AISYAH NN.
SITI ZAHNIAR NY
488,200.00
396,530.00
144,200.00
10,000.00
125,000.00
10,000.00
160,000.00
236,760.00
220,200.00
141,335.00
179,440.00
110,000.00
88,450.00
182,184.00
458,700.00
155,290.00
10,000.00
125,000.00
94,300.00
77,160.00
180,000.00
166,800.00
85,900.00
223,260.00
16,800.00
10,000.00
125,000.00
279,603.00
234,090.00
201,000.00
542,700.00
60,000.00
130,100.00
227,660.00
339,304.00
105,600.00
110,268.00
243,323.00
155,302.00
10,000.00
160,000.00
424,900.00
Page 428
27 MEI 2016
SRI INDRAWATI NY.
RETNO SARI NN
OCHE SOFFIAH NY.
JOVIAN ALVIANO AN.
BEIBY SINAGA AN.
NURMA HARYANI NY.
AJENG WIDYA NINGRUM NN
M. AQSHA AL FATIH AN
IHSANI BIN A. GHOFAR TN
RAZA MUHAMMAD ATTAYA AN.
R.M. RUSLI AZIZ TN.
MARFIAN IKHSAN TN.
ANDRY OKRIANTO TN.
M. KURDI TN
931,770.00
128,300.00
310,000.00
120,000.00
65,341.00
143,200.00
59,710.00
102,400.00
61,600.00
172,050.00
185,224.00
255,320.00
95,000.00
10,000.00
221,280.00
10,000.00
137,000.00
890,000.00
60,000.00
60,000.00
313,800.00
60,000.00
45,000.00
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28 MEI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
280516430788
280516390321
280516430498
280516390054
280516390066
280516390050
280516390602
280516390027
280516430651
280516430815
280516390057
280516390055
280516390053
280516390063
280516390064
280516390058
280516390041
280516390059
280516390060
280516390056
280516390061
280516390024
280516390039
280516390081
280516390080
280516390078
280516390033
280516390023
280516390044
280516390042
280516390076
280516390077
280516390022
280516380051
280516380048
280516390185
280516390186
280516380084
280516380085
280516390014
280516390070
TANGGAL
SEP
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/2016
00
05/28/20160090R03105160007095
05/28/20160090R03105160007096
05/28/20160090R03105160007140
05/28/20160090R03105160007169
05/28/20160090R03105160007177
05/28/20160090R03105160007183
05/28/20160090R03105160007187
05/28/20160090R03105160007189
05/28/20160090R03105160007190
05/28/20160090R03105160007191
05/28/20160090R03105160007192
05/28/20160090R03105160007193
05/28/20160090R03105160007194
05/28/20160090R03105160007194
05/28/20160090R03105160007195
05/28/20160090R03105160007195
05/28/20160090R03105160007196
05/28/20160090R03105160007196
05/28/20160090R03105160007197
05/28/20160090R03105160007198
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42
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61
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82
83
280516390068
280516390105
280516390101
280516380090
280516380089
280516390279
280516380088
280516380087
280516390095
280516390100
280516390110
280516390108
280516390106
280516390107
280516390137
280516390136
280516390113
280516390130
280516380313
280516390280
280516390146
280516390145
280516380258
280516380254
280516390127
280516430796
280516390177
280516390174
280516390034
280516390160
280516390255
280516390253
280516380301
280516390225
280516390227
280516380140
280516380142
280516380291
280516390188
280516390187
280516390344
280516390203
05/28/20160090R03105160007198
05/28/20160090R03105160007201
05/28/20160090R03105160007201
05/28/20160090R03105160007202
05/28/20160090R03105160007202
05/28/20160090R03105160007203
05/28/20160090R03105160007205
05/28/20160090R03105160007205
05/28/20160090R03105160007206
05/28/20160090R03105160007206
05/28/20160090R03105160007207
05/28/20160090R03105160007207
05/28/20160090R03105160007208
05/28/20160090R03105160007208
05/28/20160090R03105160007210
05/28/20160090R03105160007210
05/28/20160090R03105160007211
05/28/20160090R03105160007211
05/28/20160090R03105160007212
05/28/20160090R03105160007213
05/28/20160090R03105160007214
05/28/20160090R03105160007214
05/28/20160090R03105160007215
05/28/20160090R03105160007215
05/28/20160090R03105160007216
05/28/20160090R03105160007216
05/28/20160090R03105160007219
05/28/20160090R03105160007219
05/28/20160090R03105160007220
05/28/20160090R03105160007220
05/28/20160090R03105160007221
05/28/20160090R03105160007221
05/28/20160090R03105160007222
05/28/20160090R03105160007223
05/28/20160090R03105160007223
05/28/20160090R03105160007225
05/28/20160090R03105160007225
05/28/20160090R03105160007226
05/28/20160090R03105160007227
05/28/20160090R03105160007227
05/28/20160090R03105160007229
05/28/20160090R03105160007230
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84
85
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125
280516390205
280516390273
280516390274
280516390289
280516390296
280516450699
280516450701
280516450716
280516450713
280516380351
280516380349
280516390367
280516390366
280516390335
280516390334
280516390405
280516390406
280516390375
280516390374
280516390382
280516390381
280516390379
280516390378
280516390143
280516390132
280516390413
280516390412
280516380348
280516430420
280516430418
280516430433
280516430434
280516430544
280516430546
280516390111
280516390470
280516390467
280516390450
280516390451
280516390422
280516430534
280516390396
05/28/20160090R03105160007230
05/28/20160090R03105160007231
05/28/20160090R03105160007231
05/28/20160090R03105160007233
05/28/20160090R03105160007233
05/28/20160090R03105160007234
05/28/20160090R03105160007234
05/28/20160090R03105160007235
05/28/20160090R03105160007235
05/28/20160090R03105160007236
05/28/20160090R03105160007236
05/28/20160090R03105160007237
05/28/20160090R03105160007237
05/28/20160090R03105160007238
05/28/20160090R03105160007238
05/28/20160090R03105160007239
05/28/20160090R03105160007239
05/28/20160090R03105160007240
05/28/20160090R03105160007240
05/28/20160090R03105160007241
05/28/20160090R03105160007241
05/28/20160090R03105160007242
05/28/20160090R03105160007242
05/28/20160090R03105160007243
05/28/20160090R03105160007243
05/28/20160090R03105160007244
05/28/20160090R03105160007244
05/28/20160090R03105160007245
05/28/20160090R03105160007246
05/28/20160090R03105160007246
05/28/20160090R03105160007247
05/28/20160090R03105160007247
05/28/20160090R03105160007248
05/28/20160090R03105160007248
05/28/20160090R03105160007249
05/28/20160090R03105160007250
05/28/20160090R03105160007250
05/28/20160090R03105160007251
05/28/20160090R03105160007251
05/28/20160090R03105160007252
05/28/20160090R03105160007253
05/28/20160090R03105160007255
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280516390395
280516430481
280516430480
280516430479
280516430478
280516430509
280516430506
280516430516
280516430513
280516430512
280516430510
280516390234
280516430529
280516430518
280516430548
280516430547
280516390179
280516430693
280516430679
280516390567
280516390561
280516390340
280516390343
280516380298
280516430605
280516430604
280516430601
280516430603
280516430676
280516430711
280516430714
280516430600
280516430599
280516430658
280516430620
280516430624
280516380300
280516390353
280516380311
280516380302
280516430653
280516430654
05/28/20160090R03105160007255
05/28/20160090R03105160007263
05/28/20160090R03105160007263
05/28/20160090R03105160007265
05/28/20160090R03105160007265
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05/28/20160090R03105160007266
05/28/20160090R03105160007267
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05/28/20160090R03105160007268
05/28/20160090R03105160007269
05/28/20160090R03105160007270
05/28/20160090R03105160007270
05/28/20160090R03105160007271
05/28/20160090R03105160007271
05/28/20160090R03105160007272
05/28/20160090R03105160007273
05/28/20160090R03105160007273
05/28/20160090R03105160007274
05/28/20160090R03105160007274
05/28/20160090R03105160007275
05/28/20160090R03105160007275
05/28/20160090R03105160007276
05/28/20160090R03105160007278
05/28/20160090R03105160007278
05/28/20160090R03105160007279
05/28/20160090R03105160007279
05/28/20160090R03105160007280
05/28/20160090R03105160007281
05/28/20160090R03105160007281
05/28/20160090R03105160007282
05/28/20160090R03105160007282
05/28/20160090R03105160007283
05/28/20160090R03105160007284
05/28/20160090R03105160007284
05/28/20160090R03105160007285
05/28/20160090R03105160007286
05/28/20160090R03105160007287
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280516450663
280516450664
280516430754
280516430612
280516430577
280516390319
280516430615
280516430677
280516390361
280516390275
280516390380
280516430484
280516430524
280516430528
280516450622
280516450731
280516450727
280516430738
280516430776
280516430774
280516430794
280516430799
280516450807
280516450809
280516450824
05/28/20160090R03105160007289
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28 MEI 2016
NAMA PASIEN
ALMAPIS SUDUR TN
ANJAR WAHYUNI NY.
AZIZ YASIN H. A TN.
BASIR DAMILI H. TN.
ELIS TJEN NY
FARZANA NUR AZIMAH AN.
FIRSA ASKANA SAKHI AN
IBRAHIM SANI TN.
KMS IBRAHIM, H TN
M. AQSHA AL FATIH AN
MSY PURBAYA NY.
MUHAMMAD KAMIL TN
RIDUAN YUSUF TN.
RUSTEM PUAD TN.
TIMURATINI S SOS NY
TRI OKTARINI NY.
FRISKA THERESIA TOBING NY.
AYU MANDASARI NY
SYAMSURI BINTI MANUJUD TN
ARUM WULANDARI KESUMA NN
DEA FITRIANI NN.
RENY ADELINA NN.
AZAM SYAAMIL AHMAD FADHLAN AN
ASMAWATI BINTI M.YUSUF NY.
ANISA BINTI MASNUN NY.
FITRI AYUNITA NY
BERYL AMMARTAQI LUBIS AN.
E. SIMATUPANG TN
E. SIMATUPANG TN
FARZANA NUR AZIMAH AN.
HENDRA HARTANTO TN.
TRANSAKSI
13,300.00
13,300.00
31,701.00
63,000.00
262,500.00
58,000.00
216,300.00
64,700.00
72,000.00
122,112.00
243,450.00
169,500.00
34,100.00
168,000.00
262,500.00
51,000.00
90,600.00
78,000.00
78,000.00
319,500.00
135,600.00
348,360.00
301,100.00
205,200.00
224,734.00
77,610.00
210,186.00
173,980.00
40,000.00
126,000.00
40,000.00
40,000.00
224,600.00
125,000.00
10,000.00
10,000.00
137,000.00
10,000.00
125,000.00
188,800.00
177,000.00
Page 475
28 MEI 2016
HENDRA HARTANTO TN.
ZAIDAN ACHMAD TN.
ZAIDAN ACHMAD TN.
M. ABBAS HASAN TN
M. ABBAS HASAN TN
SUGINAH ABBAS NY.
SUGINAH ABBAS NY.
NOVENDA ALIANDO TN
NOVENDA ALIANDO TN
HARBEI PASAH TN
SARDJONO, H TN
SARDJONO, H TN
YULIA DASWATI NY.
YULIA DASWATI NY.
SHOFWAN TN.
SHOFWAN TN.
GHANI ALFARIZI AN.
GHANI ALFARIZI AN.
SULAIMAN NADEAK TN.
JACUB RAHMAN TN.
JACUB RAHMAN TN.
EDY ABDULLAH TN
10,000.00
125,000.00
10,000.00
160,000.00
10,000.00
890,000.00
160,000.00
10,000.00
10,000.00
160,000.00
160,000.00
10,000.00
10,000.00
102,000.00
160,000.00
10,000.00
10,000.00
160,000.00
1,040,600.00
890,000.00
160,000.00
10,000.00
160,000.00
10,000.00
10,000.00
160,000.00
160,000.00
10,000.00
10,000.00
160,000.00
125,000.00
10,000.00
890,000.00
10,000.00
177,000.00
10,000.00
62,000.00
890,000.00
160,000.00
10,000.00
890,000.00
10,000.00
Page 476
28 MEI 2016
NASRUN BASRI TN
NASRUN BASRI TN
NURLIANA SALIM NY
NURLIANA SALIM NY
ALFI SYAHRIN TN.
ALFI SYAHRIN TN.
SAIFUL NURAINI TN.
SAIFUL NURAINI TN.
OKTA SAPUTRA TN
OKTA SAPUTRA TN
LIDAWATI NY.
LIDAWATI NY.
TEGUH BIN HOKSAN TN
ARBAIN GANTI TN
ARBAIN GANTI TN
RAFA ALVARO AN
AS AD SAYUTI DRS TN
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
10,000.00
95,000.00
177,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
10,000.00
167,000.00
160,000.00
10,000.00
918,200.00
160,000.00
10,000.00
10,000.00
160,000.00
10,000.00
160,000.00
110,000.00
10,000.00
125,000.00
10,000.00
160,000.00
110,000.00
110,000.00
167,000.00
Page 477
28 MEI 2016
AS AD SAYUTI DRS TN
SUSILAWATY NY
SUSILAWATY NY
SITI FATIMAH NY
SITI FATIMAH NY
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
TRIANA APRIANI NY
TRIANA APRIANI NY
MARIANA NY
MARIANA NY
SRI MULYATI NY
SRI MULYATI NY
NURMALA DEWI NY.
NURMALA DEWI NY.
ERWIN AZHARI TN.
BENYAMIN JACUB TN.
BENYAMIN JACUB TN.
FEMILIA MARLINA NY.
FEMILIA MARLINA NY.
MUHAMAD FARHAN YUSUF ILHAM AN
BENYAMIN JACUB TN.
10,000.00
160,000.00
10,000.00
137,000.00
10,000.00
160,000.00
10,000.00
125,000.00
10,000.00
160,000.00
10,000.00
110,000.00
160,000.00
10,000.00
160,000.00
10,000.00
110,000.00
160,000.00
10,000.00
160,000.00
10,000.00
10,000.00
160,000.00
110,000.00
102,000.00
10,000.00
10,000.00
160,000.00
890,000.00
10,000.00
160,000.00
125,000.00
10,000.00
110,000.00
10,000.00
160,000.00
120,000.00
120,000.00
167,000.00
10,000.00
10,000.00
137,000.00
Page 478
28 MEI 2016
SAID SALIM TN
SAID SALIM TN
INDAWATI NY.
INDAWATI NY.
SYAIFUL ANWAR TN
RUSNAN CHANDRA TN
NICKY VERDIANTO TN.
M. BAYU SAPUTRA AN.
ANJAR WAHYUNI NY.
ANITA MARIYANTINI NY.
NOVI MARTADINATA TN
FIRSA ASKANA SAKHI AN
MARLIANSYAH TN
DANESHA AQUINA ATHAYA TOSCA AN
EKA MARDIANA NY
BIANCA LATHIFAH AURORA AN.
TIKA DWI AZURA AN.
SUHARYONO BIN KUSNANDI TN
TUTI HIDAYANI NN
M. AZZAM UWAIS AL Q AN
10,000.00
160,000.00
160,000.00
10,000.00
10,000.00
160,000.00
110,000.00
890,000.00
890,000.00
334,022.00
890,000.00
890,000.00
110,000.00
110,000.00
102,400.00
110,000.00
56,320.00
118,940.00
102,400.00
110,790.00
142,960.00
62,000.00
187,733.00
233,600.00
256,992.00
310,000.00
258,200.00
86,450.00
59,468.00
Page 479
29 MEI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
290516280143
290516280062
290516430043
290516430146
290516420347
290516280193
290516430035
290516450305
290516430024
290516430033
290516430036
290516280192
290516450244
290516430032
290516280207
290516430037
290516430034
290516420309
290516450300
290516430019
290516430038
290516430039
290516430017
290516430044
290516430048
290516430042
290516430049
290516280054
290516280097
290516280116
290516430138
290516430144
290516430154
290516280163
290516280171
290516430230
290516430047
290516430046
290516430041
290516430031
290516450255
TANGGAL
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
SEP
0
0
0
0
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160007277
0090R03105160007277
0090R03105160007311
0090R03105160007312
0090R03105160007313
0090R03105160007322
0090R03105160007328
0090R03105160007329
0090R03105160007334
0090R03105160007336
0090R03105160007337
0090R03105160007338
0090R03105160007339
0090R03105160007340
0090R03105160007341
0090R03105160007343
0090R03105160007344
0090R03105160007346
0090R03105160007348
0090R03105160007349
0090R03105160007350
0090R03105160007351
0090R03105160007353
Page 480
29 MEI 2016
42
43
44
45
46
47
48
49
50
51
52
53
290516420265
290516420282
290516420283
290516420284
290516450318
290516450299
290516420314
290516450307
290516420315
290516450308
290516450329
290516450334
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
05/29/2016
0090R03105160007354
0090R03105160007355
0090R03105160007356
0090R03105160007357
0090R03105160007358
0090R03105160007359
0090R03105160007362
0090R03105160007363
0090R03105160007364
0090R03105160007365
0090R03105160007368
0090R03105160007369
Page 481
29 MEI 2016
NAMA PASIEN
M. IRSAN FIKRI TN
M. JAUNUHARDI HASAN TN.
WULAN SURYANI NN.
A. JAMALUDDIN TN.
ANASTASIA LENI NY
FAUZAN RIZKY UMMARI AN
INDRA SANDI TN
LIE WIE SENG TN
MARYANTI BINTI KGS BUSTOMI NY
NABIELA AZZAH ATIQOH AN.
SRI INDRAWATI NY.
SYUKRI MUBARAK TN.
WATINI BINTI TUKIMAN NN
YULIANA PURNAMA DEWI NN
YULIANA PURNAMA DEWI NN
ZANARIA BINTI ZAKARIA NY
RYAN ARANA DZAKI DANISWARA AN
AHMAD DZAKY ABIYYU EDIKA AN
DESMIRIYANTI BINTI YANSARI NY.
AKIN Z.M TN
R. A. RURI LAVENUARY NN
ISMAN HADI TN.
YANTI SAFITRI NY.
FEBRIANA DWI LESTARI NN.
AGUSTINA MAILANY NN.
MUHSON BIN MUGRI TN.
SIWI UTAMI NY.
SUNDARI BINTI FARUK NY.
ADE EMILYA SEPA NN.
DEWI INDAH PERMATA SARI NN
ENIZA WULANDARI NN
JESSICA AMANDA AULIA AN.
FAUZAN RIZKY UMMARI AN
TRANSAKSI
126,000.00
145,910.00
233,838.00
162,830.00
94,000.00
249,000.00
45,000.00
23,950.00
210,000.00
474,000.00
103,200.00
12,841.00
1,695.00
1,008,000.00
216,300.00
78,000.00
135,000.00
65,100.00
240,400.00
40,000.00
174,800.00
160,200.00
49,000.00
93,900.00
332,280.00
152,100.00
130,200.00
338,072.00
70,310.00
570,140.00
293,765.00
98,040.00
224,704.00
102,400.00
144,965.00
151,914.00
359,594.00
149,113.00
62,900.00
84,448.00
142,000.00
Page 482
29 MEI 2016
SUTAN HIMSAR S TN
ROBBY ARYA WIBOWO TN
AHMAD ELFAEYZA ARASY AN
RINI KURNIATI NN.
KHOIRUNNISA SR NN
ROSALINDA NY
PUTRI NOOR IMAN NN
KENZIE VEASNA LEFRAN AN
419,100.00
163,000.00
147,400.00
161,600.00
145,500.00
74,700.00
153,284.00
163,300.00
156,784.00
177,400.00
304,115.00
118,945.00
Page 483
30 MEI 2016
NO
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
35
36
37
38
39
40
41
42
43
44
45
46
47
48
NO RJ
300516390095
300516280297
300516450551
300516431052
300516280401
300516390491
300516280051
300516390103
300516280045
300516380611
300516390105
300516390106
300516430982
300516390113
300516280509
300516450582
300516390216
300516430834
300516380610
300516280403
300516390222
300516390107
300516390111
300516390100
300516450538
300516390109
300516280512
300516390117
300516390108
300516451026
300516421056
300516390110
300516390104
300516420650
300516390026
300516390020
300516390030
300516390019
300516390025
300516390041
300516390040
300516390039
300516390016
300516390037
300516390043
300516390303
300516390069
300516390068
TANGGAL
SEP
5/30/16
0
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16
00
5/30/16 0090R03105160005638
5/30/16 0090R03105160007331
5/30/16 0090R03105160007372
5/30/16 0090R03105160007375
5/30/16 0090R03105160007376
5/30/16 0090R03105160007377
5/30/16 0090R03105160007381
5/30/16 0090R03105160007382
5/30/16 0090r03105160007383
5/30/16 0090R03105160007384
5/30/16 0090R03105160007384
5/30/16 0090R03105160007385
5/30/16 0090R03105160007386
5/30/16 0090R03105160007386
Page 484
30 MEI 2016
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
300516390044
300516390046
300516390013
300516280084
300516430514
300516390055
300516390052
300516390011
300516280097
300516390038
300516280090
300516280089
300516390188
300516280083
300516280080
300516390028
300516390093
300516390094
300516390029
300516280086
300516280087
300516390014
300516280132
300516280133
300516280050
300516280049
300516390015
300516280152
300516280154
300516390366
300516390023
300516390162
300516390141
300516390140
300516280203
300516280342
300516390121
300516390160
300516390173
300516390231
300516390226
300516390251
300516390153
300516390155
300516390027
300516390395
300516390036
300516390166
300516390193
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
0090R03105160007387
0090R03105160007387
0090R03105160007389
0090R03105160007390
0090R03105160007391
0090R03105160007392
0090R03105160007392
0090R03105160007393
0090R03105160007394
0090R03105160007395
0090R03105160007396
0090R03105160007396
0090R03105160007397
0090R03105160007398
0090R03105160007398
0090R03105160007399
0090R03105160007400
0090R03105160007400
0090R03105160007401
0090R03105160007402
0090R03105160007402
0090R03105160007403
0090R03105160007404
0090R03105160007404
0090R03105160007405
0090R03105160007405
0090R03105160007406
0090R03105160007407
0090R03105160007407
0090R03105160007408
0090R03105160007410
0090R03105160007411
0090R03105160007412
0090R03105160007412
0090R03105160007413
0090R03105160007414
0090R03105160007415
0090R03105160007415
0090R03105160007416
0090r03105160007417
0090r03105160007417
0090R03105160007418
0090R03105160007419
0090R03105160007419
0090R03105160007421
0090R03105160007422
0090R03105160007423
0090R03105160007424
0090R03105160007425
Page 485
30 MEI 2016
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
300516390194
300516390373
300516280204
300516280205
300516390343
300516390238
300516390225
300516390345
300516390224
300516390228
300516390333
300516390314
300516280244
300516280319
300516380796
300516380793
300516280320
300516390272
300516390277
300516390034
300516430696
300516430695
300516390061
300516390346
300516390306
300516390308
300516390433
300516280206
300516380799
300516380797
300516280329
300516280292
300516280291
300516280183
300516280327
300516280325
300516390047
300516280191
300516280196
300516390195
300516450581
300516450562
300516280355
300516280353
300516390214
300516390439
300516390437
300516390054
300516280335
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
0090R03105160007425
0090R03105160007426
0090R03105160007427
0090R03105160007427
0090R03105160007428
0090R03105160007429
0090R03105160007429
0090R03105160007430
0090R03105160007431
0090R03105160007431
0090R03105160007432
0090R03105160007433
0090R03105160007434
0090R03105160007434
0090R03105160007435
0090R03105160007435
0090R03105160007436
0090R03105160007437
0090R03105160007437
0090R03105160007438
0090R03105160007439
0090R03105160007439
0090R03105160007440
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0090R03105160007746
0090R03105160007747
0090R03105160007749
0090R03105160007750
0090R03105160007751
0090R03105160007751
0090R03105160007752
0090R03105160007753
Page 492
30 MEI 2016
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467
468
300516380959
300516380778
300516380950
300516380726
300516450651
300516430972
300516380965
300516431046
300516430739
300516430786
300516420937
300516430735
300516380999
300516430768
300516430764
300516380692
300516430783
300516380704
300516420993
300516450765
300516450845
300516431065
300516450941
300516450541
300516390057
300516390092
300516390263
300516390468
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
5/30/16
0090R03105160007754
0090R03105160007755
0090R03105160007758
0090R03105160007759
0090R03105160007762
0090R03105160007763
0090R03105160007764
0090R03105160007765
0090R03105160007767
0090R03105160007768
0090R03105160007771
0090R03105160007772
0090R03105160007773
0090R03105160007775
0090R03105160007775
0090R03105160007776
0090R03105160007777
0090R03105160007778
0090R03105160007780
0090R03105160007781
0090R03105160007789
0090R03105160007794
0090R03105160007904
0090R03105160007906
0090R03105160008104
0090R03105160008106
0090R03105160007488
Page 493
30 MEI 2016
NAMA PASIEN
ANDRY OKRIANTO TN.
AYU LUTHFIYAH AN.
DAFINA ADIBAH MUFIDAH AN.
DIAN ANGGRAINI NN.
FATIMAH BINTI PONIRAN NY
FIRDAUS ZEN TN
HERMANSYAH BIN HUSIN ZEN TN.
HERMANSYAH HAMID, S.H TN.
ILHAM HERIYANTO TN.
JANTI YULIANTI NY.
M HASBI RIDHO AN.
MEILISA DJUNAIDI NN.
NOVI YANTI NY.
PUTRI SALSABILA ANTISA AN
RIDUAN YUSUF TN.
SITI SALMIJATI NY
SOFIAH HASAN, HJ NY.
SOVIA BINTI ANOM NY.
SUJITNO CHANDRA TN
THERESIA PARJIAH NY
YEHEZKIEL BIN YANTO AN.
TONI YULIZAR TN.
NOVI DITYA.NY
MARINA SUCI HARDIANTI NY
ACHMAD BARLY S TN
IJCHE WAHYUNI NY.
NURMETA SYASILIA AN.
AURORA HUMAIRAH AN
VICTOR ALARAKHA TN
DEWI INDAH PERMATA SARI NN
M. ABBAS HASAN TN
M. ABBAS HASAN TN
EMMY YAHIMI NY
EMMY YAHIMI NY
TRANSAKSI
364,000
210,000
92,950
270,800
148,920
210,000
21,000
2,406,350
210,000
174,400
414,600
289,500
135,000
45,000
32,439
20,487
210,000
210,000
17,000
149,800
210,000
129,000
267,450
21,000
174,400
349,050
267,000
522,000
45,000
87,600
534,000
4,000
672,450
116,528
60,000
190,200
316,532
83,930
102,580
87,423
133,200
209,560
88,578
10,000
160,000
225,860
160,000
10,000
Page 494
30 MEI 2016
SUGINAH ABBAS NY.
SUGINAH ABBAS NY.
N. ACHMAD ABUMAN TN
RATNAWATI BINTI ABDULLAH NY.
ABDUL LATIF TN
M YUSUF JAYA TN
NING AYU NY.
NING AYU NY.
DAFA IBNU HAFIS AN
NOVENDA ALIANDO TN
NOVENDA ALIANDO TN
DENCIK NAYA TN
SARDJONO, H TN
SARDJONO, H TN
ELLAN AMRIZAL TN
SITI FATIMAH NY
SITI FATIMAH NY
LINAWATI FAUZI NY.
MASNAH HAKIM NY.
JUNAIDI HASAN TN.
YOS INDRIANTINA NY.
GHANI ALFARIZI AN.
GHANI ALFARIZI AN.
ZUBER HUSIN TN
HILMI BIN ZAKRI TN.
AHMAN SAMSUL TN
RONIMAH NY
10,000
160,000
512,000
168,550
120,000
160,000
10,000
216,480
68,000
472,000
137,000
10,000
60,000
102,000
10,000
188,000
10,000
160,000
101,600
10,000
160,000
181,280
160,000
10,000
10,000
167,000
175,680
137,000
10,000
253,400
142,400
402,180
125,000
10,000
194,400
890,000
10,000
62,000
290,000
160,000
10,000
1,040,600
10,000
160,000
180,480
120,000
472,000
203,000
10,000
Page 495
30 MEI 2016
RONIMAH NY
LIM KOEIJ ING NY
MIRA ASDIANA NY.
SUTINAH BINTI CEK IT NY.
HASIAM INDRIANI NY
HASIAM INDRIANI NY
DJALILI SOLIHIN TN
INDRAYANTA TN
INDRAYANTA TN
LIE PO NIE NY
DAVID ISKANDAR TN
PUTRO SETYONO TN
HENDRY RIANTO TN
SAENAH NY
ASMANA RUMIYATI NY
KMS EFFENDY TN.
KMS EFFENDY TN.
EMI YANI S.E NY.
CORNILIA ANITA NY.
CORNILIA ANITA NY.
HABIBA BINTI MEDUNG NY.
JUNAIDA PRIANI NY
JUNAIDA PRIANI NY
LIAREMILI ADLI NY.
160,000
890,000
10,000
160,000
190,000
10,000
160,000
180,000
10,000
160,000
890,000
2,101,100
10,000
160,000
160,000
10,000
372,000
10,000
160,000
204,600
160,000
10,000
574,980
890,000
10,000
177,000
1,192,000
890,000
160,000
10,000
1,668,612
160,000
10,000
300,850
137,000
10,000
100,800
10,000
125,000
126,480
160,000
10,000
160,000
10,000
381,950
10,000
160,000
512,000
260,145
Page 496
30 MEI 2016
HO LI IN NY
ELLY FALLAH HJ NN
DIAN ANGGRAINI NY.
HAUNAH SAID HJ. NY
YULIA DASWATI NY.
YULIA DASWATI NY.
MIGIAWATI BINTI M. DAUD NY
MASNUN MANALU NY
MUHAMMAD TONI TN.
MUHAMMAD TONI TN.
M FIRLY ZAMAN TN.
MUHAMMAD SYAHIR TN
NASRUN BASRI TN
NASRUN BASRI TN
SUMIATY JUMAHAT NY
SITI SALMIJATI NY
DAFFA AL ZAIDAN.AN
RAHNAH NY.
SYAMSUL ARIF TN
SYAMSUL ARIF TN
TJIKMAD. B TN.
TJIKMAD. B TN.
SRI YUSNITA NY.
MARHAM EFFENDI TN
SARTINI NY.
AHMAD HASIM NASUTION TN.
HERLINA MEGAWATI NY
CIK LUNAH NY.
376,000
110,000
251,100
160,000
10,000
182,400
155,580
182,400
160,000
10,000
112,980
118,547
110,000
162,040
335,590
840,000
160,000
10,000
308,400
10,000
125,000
2,033,900
110,000
676,000
113,450
160,000
10,000
183,200
543,565
123,153
10,000
175,680
125,000
10,000
160,000
10,000
194,000
532,040
222,000
202,668
582,400
141,600
880,000
587,600
10,000
160,000
216,480
371,930
160,000
Page 497
30 MEI 2016
JANSEN SIRAIT TN.
JANSEN SIRAIT TN.
PUJI ASTUTI NY
THIO PING TJIANG TN.
CHAIRUL MUCHLIS TN
ARIFIN SITOHANG TN.
ARIFIN SITOHANG TN.
ZURIAH,HJ NY.
ABD MADJID TN.
AZHARI BSC TN.
IDA MASHUDA, HJ NY.
TISNALIA NY.
SUTIAH BINTI SAHIL NY.
BUSTANI BIN AHMAD TN
NURUL AYU ANNISYAH NN.
IDRIS IE TN
SITI SANTURA NY
NUR HALIMAH NY.
ISWATI DEIING NY.
YENI APRIANI NN.
SAMSILAWATI BINTI USMAN NY
SEPFIANI L NY.
SANTI BINTI ONG KIAN CAI NY
ELIDA BINTI BACHTIAR NY.
YUNALNI NY.
R. BACHARDEAN H TN
LISIANA OSWARI NN.
LISIANA OSWARI NN.
10,000
86,000
512,000
10,000
125,000
304,900
10,000
95,000
126,631
101,400
146,564
10,000
160,000
215,970
240,800
125,000
10,000
136,510
200,800
135,140
229,562
125,000
10,000
456,845
374,600
247,863
393,000
202,400
165,480
234,400
260,085
266,600
125,000
10,000
216,585
160,000
10,000
86,410
60,000
264,560
290,395
524,800
382,532
240,800
200,400
160,000
10,000
10,000
160,000
Page 498
30 MEI 2016
M. FATTAH TN
M. ADAFFA AQILLA SITOMPUL AN
M. THOYIB HADI TN.
MURYANA BINTI SUDAR NY.
ISRIL HENDRA TN
FATMAWATI BINTI
RETNO WULANDARI NY
UUT TRIANI NY.
MITA AGUSTRI AN.
M HASBI RIDHO AN.
IRYANTO ASYIK TN.
JAMILAH BINTI AMEL NY
M. NAJIB ASY''ARI AN.
SULIANTI CANDRA NY.
ERMIATI KOTO NY
SAINAH BINTI AGUS NY
YEHEZKIEL BIN YANTO AN.
MARISYA OKTARINA NY
RUSMINI NY
ANNA SURYANI NY.
ANTIKA BINTI JOKO WIYONO NY
NG SIN TET TN
AZMANIAR ZULYANA NY
LENI APRIYANTI NY
DARWIEN ZAINAL TN
RIKA WULANDARI AN
60,000
273,061
160,000
10,000
607,570
204,000
180,000
72,675
119,594
94,284
96,150
146,400
299,026
1,310,370
180,000
180,000
122,400
146,000
60,800
80,584
10,000
160,000
160,000
10,000
227,962
10,000
160,000
294,040
180,000
240,800
63,560
268,825
203,050
160,000
10,000
82,400
338,830
206,485
234,400
160,000
209,635
1,537,350
296,480
80,136
60,000
310,954
356,085
285,000
145,531
Page 499
30 MEI 2016
RA ZULEICHA ETTY NY.
AMIR HAMZAH TN
AMIR HAMZAH TN
TONY NOER TN
M. FACHRI ADRIANSYAH TN
AISYAH BINTI RUSLAN NY.
ILZAMRI NAZAR TN.
HERSAWANA BINTI MUHAMMAD NY.
ELIS RAHMAWATI NY.
DORTA SINAGA NY.
DORTA SINAGA NY.
ACHMAD ZARNUBI TN.
MUHAMMAD FAUZI.S TN.
TJIKNUT SYUKUR NY
ACHMAD MAULANA,H TN
MUNIAH MUCHTAR NN
DENNY HERDIAN TN
C. SILVIANTI BISMARK NY
ZULHAYATI ALWIN NY.
NANDA GUSVITA NN
INDAWATI NY.
YUYUN SYARILIZA NY.
M. ZULAINI TN
KHODIJAH BINTI M.LEKAT NY
EDDY MAKSURI TN.
TITIN AGUSTINA NY.
HERMAN ZAKARIA TN.
SITI MARIAM NY
357,530
62,600
1,041,900
10,000
137,000
167,000
10,000
391,700
502,440
60,000
243,000
890,000
102,000
10,000
96,530
448,000
192,900
1,310,370
60,000
10,000
137,000
276,900
217,450
105,450
636,150
129,450
126,000
1,310,370
351,260
60,000
119,800
168,450
137,450
60,000
97,450
162,450
193,210
107,450
481,250
242,090
60,000
152,900
129,450
376,070
238,800
72,800
60,000
237,500
97,450
Page 500
30 MEI 2016
DEVI AWALIA NY
INDAH ELVALISA NY.
JUNAIDI SYAWALUDIN TN.
SRI DAMYATI NY.
SARIDA BINTI AAZIZ NY
KASILAWATI HJ, S.PD NY.
DEVINA ANGELINA AN.
YUNIZAR BINTI HAROMAN NY
MONNA OKTA NINDA NY.
NOPI APRIANTI NY
SULASTRI HJ BINTI MULYADI NY
MARIANA NY
MARIANA NY
THERESIA PARJIAH NY
JUNI ASTUTI NY
LEADI DIANA NY.
ROHAINA HJ, NY.
SETIA WATI NY
SETIA WATI NY
NOVI YANTI NY.
YULISTINA BINTI MULYO NY.
RUSMAWATI BINTI HAJAMUDIN NY.
ANRY YUNAZILLATN.
DALHURI BIN MAT ALI TN
164,000
102,000
10,000
60,000
137,450
71,450
890,000
193,585
930,200
791,100
129,450
207,060
60,000
60,000
224,050
64,541
223,830
90,343
193,585
188,650
95,410
168,124
160,000
10,000
160,000
10,000
10,000
160,000
60,000
60,000
384,200
236,085
184,200
177,058
60,000
10,000
160,000
204,385
158,020
122,400
60,000
221,475
204,277
115,650
447,500
313,800
199,295
542,900
82,300
Page 501
30 MEI 2016
DYA PRATIWI NY
HASRI TANJUNG H TN.
HASRI TANJUNG H TN.
SUYADI H. TN
SUYADI H. TN
MELY SEPRIZA NY.
JOVIAN ALVIANO AN.
DIANA NOVITA NY
ANDRI JAYA TN.
RAKA RADITYA PRATAMA AN.
ENDANG LIDAWATI NY
ASKURNI APSA TN.
MUSA ISMAIL DRS TN
SOFRIN ROMSAU TN.
ERNA KURNIATY NY.
CARISSA ADELIA AN.
ELLYA KUSUMA NY.
ELLYA KUSUMA NY.
NURULFAJRIYAH WIDYA UTAMI NY
NOPA ROSETA NN.
NOPA ROSETA NN.
AFRIZAL PRASYIDI TN
RINI FITRIANI, SKM.NY.
NURYANTO TN.
DEBY CANDRA NY.
LIDYA SISCA NY.
SAMUDIN TN.
MEIRITA RUSLIE NY.
WIDADIYAH NY
TJUNG SEN WAN NY.
SYAMSIDA SUKMA SARI NY.
MARLINA BINTI NURSALIM NY.
SITI NURAINI NY.
SITI NURAINI NY.
AISYAH HJ BINTI SAINI H NY.
AGUS RIYADI TN
102,000
10,000
260,430
171,181
133,860
193,585
102,000
10,000
420,370
1,192,000
116,170
110,000
142,220
10,000
160,000
83,954
60,000
135,800
512,000
140,600
128,400
1,800,300
160,000
10,000
131,081
110,000
10,000
160,000
333,971
160,000
10,000
219,114
155,400
232,470
294,366
304,950
180,000
141,220
281,870
110,820
181,050
420,875
152,170
258,300
216,078
160,000
10,000
347,900
788,350
Page 502
30 MEI 2016
ABDUL NAIM TN
RATNA JUWITA NN.
YULIUS CHANDRA TN
DAHLIA AGELINA NY
MUSLIMAH BINTI AHMAD BUSTAM NY
KISTIKA AYUNAWATI NY.
BETTY NURHASANAH NY
VENY MAYASARI NY.
WIDIYA GUNAWAN NY.
WIWIK ANI NY
NURMALAH BINTI M. ZEN NY
SUJITNO CHANDRA TN
HADIJAH NY.
HADIJAH NY.
NOVRIYANTI WAHYUNI NN.
ZELVIE MEIZARINA NY.
HENNY RASIDATHY NY
DERI AGUSTIA NY.
ELVI INDAHWATI NY
MUHAMMAD AL ISRA K.AN.
DEWI SARTIKA NY
ANITA TRISIA SE, NY
YULIA KARTIKASARI NY
ASYTAR REYZACKI AN
466,700
193,585
129,705
68,000
283,000
310,000
193,585
202,260
193,585
296,958
60,000
100,630
193,600
54,350
336,600
89,505
182,200
120,000
193,585
60,000
167,500
62,415
193,585
210,585
207,868
118,235
411,024
160,000
Page 503
31 MEI 2016
NO
1
2
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4
5
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7
8
9
10
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18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
NO RJ
310516450045
310516450149
310516390467
310516380365
310516420481
310516380065
310516450276
310516450051
310516390343
310516420587
310516450039
310516450044
310516450033
310516450316
310516280759
310516380298
310516380268
310516390406
310516380464
310516450287
310516450340
310516450017
310516450025
310516450010
310516450009
310516420518
310516420528
310516450012
310516450011
310516380050
310516380072
310516380071
310516380061
310516380062
310516390038
310516390043
310516380063
310516380064
310516390019
310516390007
310516450110
TANGGAL
SEP
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/2016
00
05/31/20160090R03105160007757
05/31/20160090R03105160007757
05/31/20160090R03105160007769
05/31/20160090R03105160007779
05/31/20160090R03105160007800
05/31/20160090R03105160007801
05/31/20160090R03105160007802
05/31/20160090R03105160007803
05/31/20160090R03105160007804
05/31/20160090R03105160007805
05/31/20160090R03105160007805
05/31/20160090R03105160007806
05/31/20160090R03105160007807
05/31/20160090R03105160007807
05/31/20160090R03105160007808
05/31/20160090R03105160007808
05/31/20160090R03105160007809
05/31/20160090R03105160007810
05/31/20160090R03105160007811
05/31/20160090R03105160007811
05/31/20160090R03105160007812
05/31/20160090R03105160007812
05/31/20160090R03105160007813
Page 504
31 MEI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
310516450141
310516450197
310516450275
310516380034
310516380031
310516390037
310516450008
310516390027
310516390338
310516450168
310516390101
310516450080
310516450082
310516380053
310516280860
310516380117
310516450085
310516450084
310516380181
310516380067
310516390242
310516390245
310516450088
310516450122
310516390020
310516390046
310516450093
310516450086
310516450331
310516450161
310516390087
310516390409
310516390408
310516450030
310516390100
310516390098
310516450159
310516420491
310516420492
310516450318
310516450166
310516450174
05/31/20160090R03105160007814
05/31/20160090R03105160007815
05/31/20160090R03105160007816
05/31/20160090R03105160007817
05/31/20160090R03105160007817
05/31/20160090R03105160007818
05/31/20160090R03105160007819
05/31/20160090R03105160007820
05/31/20160090R03105160007821
05/31/20160090R03105160007822
05/31/20160090R03105160007823
05/31/20160090R03105160007825
05/31/20160090R03105160007825
05/31/20160090R03105160007826
05/31/20160090R03105160007827
05/31/20160090R03105160007828
05/31/20160090R03105160007829
05/31/20160090R03105160007829
05/31/20160090R03105160007830
05/31/20160090R03105160007831
05/31/20160090R03105160007832
05/31/20160090R03105160007832
05/31/20160090R03105160007833
05/31/20160090R03105160007835
05/31/20160090R03105160007836
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Page 512
31 MEI 2016
NAMA PASIEN
AGUSTRIA Z SALEH, DR, SPOG TN.
ALICIA RAMADHANTI ZULKARNAIN A
ANITA ROSALINA NY.
CANDRA DOAN TN.
DAHLIA AGELINA NY
EGIDIA AVIASKA PUTRI NN.
ENDAH SELVIA NINGSIH NY.
IVANNOV KENNEDY AN.
LINAWATI FAUZI NY.
MEGAWATI. DR. NY
NURHAYATI BA HJ NY
SYAFRIN SYAARANI TN.
OLIVER CHRIS W AN
SUTIANI BINTI HASAN WIJAYA NY.
ROSALINDA NY
NETTI BINTI SUKIRMAN NY.
KODRI BIN ABDULLAH TN
M. KEYSAR AIDIL AN.
NURMETA SYASILIA AN.
DEWI SARTIKA NANABAN NY.
YUANITA DINDIATI NY.
ZAIDAN ACHMAD TN.
ZAIDAN ACHMAD TN.
HASIAM INDRIANI NY
JACUB RAHMAN TN.
JACUB RAHMAN TN.
TANG WEI HENG NY
TANG WEI HENG NY
SITI MAIMUNAH NY
SITI MAIMUNAH NY
SHOFWAN TN.
TRANSAKSI
325,920.00
141,035.00
88,200.00
1,575.00
446,000.00
210,000.00
40,800.00
210,000.00
49,941.00
72,570.00
202,500.00
331,500.00
298,720.00
1,600.00
128,800.00
98,415.00
534,000.00
148,920.00
110,000.00
446,400.00
181,200.00
217,435.00
94,700.00
82,089.00
106,686.00
40,000.00
40,000.00
125,000.00
10,000.00
173,966.00
160,000.00
10,000.00
10,000.00
137,000.00
118,550.00
196,465.00
10,000.00
167,000.00
160,000.00
10,000.00
130,195.00
Page 513
31 MEI 2016
ALMIANAH HJ. BINTI MADELI NY
DIANA NOVITA NY
HERIYANTO TN
SRI YULIDAR NY.
MUHAMMAD RAFIQ AN.
SRI HARTATI YUNITA NY
ACHMAD MAULANA,H TN
MARIMAH C AHMAD NY.
MARIMAH C AHMAD NY.
DEDI DARMA TN.
ROSLINA NY.
ZULHAYATI ALWIN NY.
ZULHAYATI ALWIN NY.
MARWAH BUNGLAI TN.
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
DEVI ARIANTI BY NY
AHMAD HASIM NASUTION TN.
DEVI ARIANTI NY.
DJALILI SOLIHIN TN
DJALILI SOLIHIN TN
MUSLIMIN KADIR TN
100,250.00
1,192,000.00
1,192,000.00
160,000.00
10,000.00
203,600.00
890,000.00
441,750.00
890,000.00
255,040.00
607,100.00
10,000.00
160,000.00
90,600.00
501,600.00
146,000.00
160,000.00
10,000.00
124,600.00
344,015.00
10,000.00
160,000.00
182,000.00
602,100.00
101,600.00
609,900.00
160,000.00
10,000.00
92,003.00
60,000.00
533,600.00
160,000.00
10,000.00
216,480.00
160,000.00
10,000.00
255,000.00
10,000.00
125,000.00
890,000.00
255,040.00
146,600.00
Page 514
31 MEI 2016
JEANNE KUSSOY NY
JEANNE KUSSOY NY
MULYANA BINTI ABDUL MUIS NY.
MUHAMMAD YAHYA AN
SITI SALMIJATI NY
SUKANTO KESUMAH TN
MELIYA MAILANA NN
ADHWA KATRINA SHAKILA AN
MUHAMMAD SAAN TN
LIDAWATI NY.
LIDAWATI NY.
ROMELI RASENI TN
AMANDA PARAMITA W AN.
MUNASIH BINTI MUNADI NY
RUSMIDIUS NY.
TRIANA APRIANI NY
SYAHIRA NADIFA AN.
NURHAMLAH BINTI SAID NY.
JULIANA KOWIRA NY.
LINDA IRIANA NY
SUGENG BIN YOTO WIHARJO TN.
10,000.00
160,000.00
91,680.00
890,000.00
10,000.00
160,000.00
181,800.00
60,000.00
141,500.00
155,000.00
1,192,000.00
269,520.00
678,136.00
152,950.00
177,000.00
10,000.00
194,400.00
10,000.00
555,600.00
148,200.00
160,000.00
10,000.00
225,796.00
102,000.00
10,000.00
115,000.00
88,536.00
135,587.00
152,100.00
66,000.00
97,265.00
160,000.00
10,000.00
110,787.00
234,400.00
262,550.00
182,400.00
60,000.00
1,040,600.00
76,500.00
188,000.00
124,198.00
Page 515
31 MEI 2016
TRIANA APRIANI NY
TRIANA APRIANI NY
KARTINI NY
KARTINI NY
SUNARTI.NY
OKTA SAPUTRA TN.
ZALEHA AZIZ DRA NY.
ABDUL RAFFA AN
M ARYA RIZQULLAH AN.
MAIZATUZZAHRO NY.
CAHYA NINGRUM YANIARTI NY
KMS YANGCIK TN
TITIN SURYANI. NY
YAMINUDDIN BIN HASANUDDIN TN
NORARIA BINTI YANI NY
DEVI AWALIA NY
DEVI AWALIA NY
R. BACHARDEAN H TN
SHINTA HASANA NY.
SHINTA HASANA NY.
SITI ANNISA ADETIA NN
RIKA ARIANTI NY
ONDIANA BINTI MARKAN NY.
PAINO BIN MADARJO TN
RICHANA MAYANG SARI NY.
SUSILAWATY NY
SUSILAWATY NY
NURMALA DEWI NY.
NURMALA DEWI NY.
264,800.00
160,000.00
10,000.00
160,000.00
10,000.00
55,950.00
123,000.00
276,700.00
133,910.00
124,300.00
160,000.00
10,000.00
140,028.00
10,000.00
167,000.00
295,960.00
206,000.00
120,000.00
313,800.00
390,970.00
110,000.00
531,740.00
120,000.00
319,520.00
169,600.00
10,000.00
160,000.00
194,400.00
10,000.00
125,000.00
292,885.00
291,910.00
110,000.00
261,248.00
180,000.00
160,000.00
10,000.00
160,000.00
10,000.00
224,632.00
10,000.00
160,000.00
Page 516
31 MEI 2016
BILQIS ALIFYA AZZAHRA AN
MERRY ARISANTY NY
SUSILAWATI BINTI SUHAIMI NY
EIRIN CAROLINA NY.
MELANI ANGGRAENI AN
LAY NAI LIN NY.
DANILAH ADHAN,HJ NY.
HERI YANTO TN.
HINDUN BINTI AZHARI NY.
MULYADI CUAN BIE TN
MULYADI CUAN BIE TN
M. DAFFA ARDELI AN.
ABU BAKAR AHMAD TN.
OKTA SAPUTRA TN
OKTA SAPUTRA TN
GUSTI DIANSYAH TN
IMELDA TELISA NY
AMALIA MAHARANI AN.
AMALIA MAHARANI AN.
ELIS SETIAWATY NY.
HOMSIANA BINTI ABDUL HAQ NY.
ALMAPIS SUDUR TN
HENDRI HASAN TN
FEMILIA MARLINA NY.
FEMILIA MARLINA NY.
ANJAS GALIH PRASETIO TN
ANI HASAN NY
GATOT SUGEMTO TN
SAPUTRA MUHAMMAD ROZZAQ AN.
SAID SALIM TN
SAID SALIM TN
A. RIVAI TN.
139,800.00
174,400.00
461,600.00
484,800.00
240,800.00
262,585.00
110,000.00
136,964.00
247,062.00
227,362.00
213,688.00
408,060.00
249,000.00
10,000.00
160,000.00
180,000.00
123,287.00
420,200.00
177,000.00
10,000.00
214,140.00
240,800.00
10,000.00
50,000.00
195,585.00
263,684.00
297,500.00
158,500.00
99,330.00
160,000.00
10,000.00
10,000.00
160,000.00
289,483.00
890,000.00
890,000.00
60,000.00
10,000.00
160,000.00
10,000.00
160,000.00
146,000.00
Page 517
31 MEI 2016
EGIDIA AVIASKA PUTRI NN.
CANDRA DOAN TN.
LENI APRIYANTI NY
LENI APRIYANTI NY
GHANI ALFARIZI AN.
MUHAMMAD TONI TN.
JUNAIDA PRIANI NY
DAFA IBNU HAFIS AN
RACHMAD SANTOSO TN
NURLIANA SALIM NY
NAFISAH ADELIA TAUFIK AN
RUSTAM HALIM TN
NYAYU NURHAYATI NY
DEDI KUSUMA TN
MANARIAH BINTI USMAN NY
ARIFIN SITOHANG TN.
AZIZ YASIN H. A TN.
HARDIYAH BINTI INOL NY.
SITI AISYAH AHMAD NY.
SYARIFUDDIN BIN CIK MAN TN.
M. REZA ADRIAN TN.
NYAYU YULI NY.
105,600.00
263,575.00
890,000.00
10,000.00
125,000.00
60,000.00
259,450.00
99,450.00
125,450.00
60,000.00
60,000.00
155,000.00
73,950.00
890,000.00
129,450.00
113,450.00
259,000.00
60,000.00
1,192,000.00
116,630.00
103,963.00
60,000.00
240,531.00
228,000.00
99,450.00
253,920.00
423,400.00
129,450.00
452,400.00
108,500.00
231,000.00
64,000.00
282,700.00
60,000.00
83,160.00
10,000.00
167,000.00
120,000.00
193,585.00
60,000.00
10,000.00
125,000.00
Page 518
31 MEI 2016
ANITA ROSALINA NY.
TRI MAULINA NY
RAKA RADITYA PRATAMA AN.
M. BAGAS PRATAMA AN.
YULIA DASWATI NY.
TABRONI ROZAK H TN
BUDIMAN BIN ISMAIL TN
EDDY MAKSURI TN.
EDDY MAKSURI TN.
PAKONI BIN HUSIN TN
RAHULLA HUANG AN.
AHMAD RIFAI TN.
IVANNOV KENNEDY AN.
MARIANA NY
MARIANA NY
SANGKUT BIN ATUT TN
CHAIRULLAH BIN HABI TN.
DANIASARY BINTI ABDUL M NY.
DJIAUW LIE TJEN NY
AISYAH NN.
ERNA RAYA NY.
DJAKFAR LEKAP TN.
APENDI BIN KORI TN.
APENDI BIN KORI TN.
ACHMAD SYAFRI HAN TN.
EDI FIRDAUS TN
TITIN KUSMETA NY.
R. AZAMUDIN TN
RIA MEI SAFITRI NY
SRI WULAN NY
60,000.00
174,400.00
191,470.00
60,000.00
90,471.00
71,450.00
146,640.00
65,800.00
10,000.00
160,000.00
414,830.00
110,000.00
189,280.00
190,000.00
10,000.00
160,000.00
470,800.00
675,300.00
102,000.00
10,000.00
110,000.00
488,200.00
180,000.00
10,000.00
160,000.00
152,960.00
165,000.00
457,800.00
120,000.00
125,000.00
10,000.00
153,620.00
86,000.00
150,050.00
243,000.00
488,200.00
190,000.00
130,700.00
249,000.00
488,200.00
373,925.00
96,860.00
Page 519
31 MEI 2016
KALSUM IBRAHIM NY.
OCTAVIANA KARUNIA ILAHI NY
SITI MUNDRAH NY
OLIVER CHRIS W AN
NAJAT KAILANI NY
NOPA ROSETA NN.
LILI SUSANTI NY.
IRMA WENI NY
MUSA ISMAIL DRS TN
INDAH MEGAWATI NY
EVI DAMAYANTI NY.
YUSNAWATI BINTI M.YUSUF NY.
POLMAN SIRINGORINGO TN.
TIARLIN GULTOM NY.
PITRUS BISMAR SAMOSIR TN.
BUDI NOPRIANI NY.
ROUSTEFLIKA GRISANTY NY
BAMBANG IRAWANSYAH TN
BAMBANG IRAWANSYAH TN
SANTI BINTI SYAFEI CHAN NY.
YAHYA AZKIN TN.
FEMY ROSITA HJ NY
RUSMALA DEWI NN.
SRI YANTI NY.
FATIMAH BINTI ABDULAH HJ NY.
ROHAINA HJ, NY.
ROHAINA HJ, NY.
ALDITHA KURNIA FEBRIANI AN
129,781.00
218,385.00
217,000.00
60,000.00
194,000.00
71,450.00
60,000.00
242,250.00
60,000.00
110,000.00
193,585.00
95,000.00
137,120.00
210,585.00
10,000.00
160,000.00
164,086.00
423,000.00
209,960.00
120,000.00
175,600.00
60,000.00
110,000.00
227,610.00
52,037.00
110,000.00
40,000.00
144,040.00
85,740.00
144,520.00
110,000.00
316,066.00
209,685.00
10,000.00
177,000.00
169,600.00
60,000.00
284,250.00
10,000.00
160,000.00
94,310.00
116,141.00
Page 520
31 MEI 2016
PUTRI PERMATA SARI NN.
ERMA JAYA NY
YUSNAWATI NN.
FENI MARSEPTIANI NN
RIZKI AMALIA NN
VALENTINO SIMATUPANG TN.
ENILISAH BINTI RUSYADI NY.
ABDULLAH BIN M. TEGUH TN.
M. ALFARIDZI FAIZ AN.
MARHARILI SURBA NY.
174,703.00
285,956.00
166,270.00
160,270.00
156,505.00
630,840.00
10,000.00
102,000.00
381,673.00
512,000.00
512,000.00
279,835.00
160,000.00
Page 521
1 JUNI 2016
NO
NO RJ
010616450877
010616450879
010616450830
010616450725
010616450774
010616450882
010616450876
010616390375
010616430038
010616430040
010616420912
010616430270
010616390588
010616420569
010616430045
010616430468
010616460332
010616390051
010616390336
010616460408
010616430411
010616430015
010616990156
010616990066
010616990077
010616430072
010616430074
010616990152
010616430115
010616430118
010616430053
010616430057
010616430090
010616430063
010616430067
010616430052
010616390095
010616430036
010616430037
010616430203
010616430356
TANGGAL
SEP
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/2016
00
06/01/20160090R03105160008023
06/01/20160090R03105160008028
06/01/20160090R03105160008121
06/01/20160090R03105160008123
06/01/20160090R03105160008124
06/01/20160090R03105160008125
06/01/20160090R03105160008125
06/01/20160090R03105160008142
06/01/20160090R03106160000001
06/01/20160090R03106160000001
06/01/20160090R03106160000002
06/01/20160090R03106160000002
06/01/20160090R03106160000003
06/01/20160090R03106160000004
06/01/20160090R03106160000004
06/01/20160090R03106160000005
06/01/20160090R03106160000006
06/01/20160090R03106160000007
06/01/20160090R03106160000007
06/01/20160090R03106160000008
06/01/20160090R03106160000009
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1 JUNI 2016
010616990161
010616990199
010616460189
010616430061
010616430062
010616460325
010616430146
010616450550
010616430111
010616430112
010616430020
010616390225
010616430107
010616430110
010616430109
010616430114
010616390339
010616390176
010616390177
010616390010
010616390011
010616430216
010616430217
010616460341
010616430295
010616420828
010616430321
010616390227
010616390229
010616430320
010616430218
010616430219
010616390157
010616430097
010616430165
010616430093
010616430239
010616430240
010616430144
010616460369
010616390271
010616390275
06/01/20160090R03106160000010
06/01/20160090R03106160000010
06/01/20160090R03106160000011
06/01/20160090R03106160000012
06/01/20160090R03106160000012
06/01/20160090R03106160000013
06/01/20160090R03106160000014
06/01/20160090R03106160000015
06/01/20160090R03106160000016
06/01/20160090R03106160000016
06/01/20160090R03106160000017
06/01/20160090R03106160000018
06/01/20160090R03106160000019
06/01/20160090R03106160000019
06/01/20160090R03106160000020
06/01/20160090R03106160000020
06/01/20160090R03106160000021
06/01/20160090R03106160000022
06/01/20160090R03106160000022
06/01/20160090R03106160000023
06/01/20160090R03106160000024
06/01/20160090R03106160000025
06/01/20160090R03106160000025
06/01/20160090R03106160000026
06/01/20160090R03106160000027
06/01/20160090R03106160000028
06/01/20160090R03106160000029
06/01/20160090R03106160000030
06/01/20160090R03106160000030
06/01/20160090R03106160000031
06/01/20160090R03106160000032
06/01/20160090R03106160000032
06/01/20160090R03106160000033
06/01/20160090R03106160000034
06/01/20160090R03106160000035
06/01/20160090R03106160000036
06/01/20160090R03106160000037
06/01/20160090R03106160000037
06/01/20160090R03106160000038
06/01/20160090R03106160000039
06/01/20160090R03106160000040
06/01/20160090R03106160000040
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1 JUNI 2016
010616430121
010616460272
010616460274
010616430130
010616430220
010616430221
010616430306
010616430307
010616450750
010616450753
010616430103
010616390296
010616390299
010616430413
010616430022
010616390048
010616390185
010616390187
010616390317
010616430350
010616430353
010616390204
010616390365
010616390367
010616460175
010616430318
010616430078
010616430079
010616430085
010616460347
010616390503
010616430102
010616460362
010616430315
010616430380
010616430381
010616430083
010616430084
010616430139
010616430142
010616430143
010616390376
06/01/20160090R03106160000041
06/01/20160090R03106160000042
06/01/20160090R03106160000042
06/01/20160090R03106160000043
06/01/20160090R03106160000044
06/01/20160090R03106160000044
06/01/20160090R03106160000045
06/01/20160090R03106160000045
06/01/20160090R03106160000046
06/01/20160090R03106160000046
06/01/20160090R03106160000047
06/01/20160090R03106160000048
06/01/20160090R03106160000048
06/01/20160090R03106160000049
06/01/20160090R03106160000049
06/01/20160090R03106160000050
06/01/20160090R03106160000051
06/01/20160090R03106160000051
06/01/20160090R03106160000052
06/01/20160090R03106160000053
06/01/20160090R03106160000053
06/01/20160090R03106160000054
06/01/20160090R03106160000055
06/01/20160090R03106160000055
06/01/20160090R03106160000056
06/01/20160090R03106160000057
06/01/20160090R03106160000058
06/01/20160090R03106160000058
06/01/20160090R03106160000059
06/01/20160090R03106160000060
06/01/20160090R03106160000061
06/01/20160090R03106160000062
06/01/20160090R03106160000063
06/01/20160090R03106160000064
06/01/20160090R03106160000065
06/01/20160090R03106160000065
06/01/20160090R03106160000066
06/01/20160090R03106160000067
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06/01/20160090R03106160000069
06/01/20160090R03106160000070
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1 JUNI 2016
010616390378
010616430228
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010616430324
010616460242
010616390210
010616430088
010616430337
010616390209
010616390250
010616390364
010616390276
010616390404
010616390405
010616390474
010616390475
010616390238
010616390268
010616430075
010616430133
010616430235
010616430233
010616430263
010616430294
010616390266
010616430247
010616390422
010616390423
010616430395
010616390425
010616390427
010616430166
010616430167
010616390198
010616430297
010616430148
010616430181
010616430119
010616430168
010616430424
06/01/20160090R03106160000070
06/01/20160090R03106160000071
06/01/20160090R03106160000072
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010616390576
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010616450701
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010616390646
010616430402
010616430393
010616450681
010616450870
010616390893
010616430440
010616390785
010616430443
010616450846
010616430461
010616430459
010616450686
010616450598
010616450599
010616450568
010616450583
010616450585
010616390786
010616390820
010616450908
010616420793
010616450574
010616390758
010616450628
010616450630
010616450907
010616450579
010616450829
010616430434
010616420495
010616450658
010616450668
06/01/20160090R03106160000188
06/01/20160090R03106160000191
06/01/20160090R03106160000192
06/01/20160090R03106160000193
06/01/20160090R03106160000195
06/01/20160090R03106160000196
06/01/20160090R03106160000197
06/01/20160090R03106160000198
06/01/20160090R03106160000199
06/01/20160090R03106160000200
06/01/20160090R03106160000201
06/01/20160090R03106160000202
06/01/20160090R03106160000203
06/01/20160090R03106160000204
06/01/20160090R03106160000205
06/01/20160090R03106160000206
06/01/20160090R03106160000207
06/01/20160090R03106160000208
06/01/20160090R03106160000209
06/01/20160090R03106160000213
06/01/20160090R03106160000214
06/01/20160090R03106160000215
06/01/20160090R03106160000216
06/01/20160090R03106160000216
06/01/20160090R03106160000217
06/01/20160090R03106160000218
06/01/20160090R03106160000218
06/01/20160090R03106160000220
06/01/20160090R03106160000221
06/01/20160090R03106160000222
06/01/20160090R03106160000223
06/01/20160090R03106160000224
06/01/20160090R03106160000225
06/01/20160090R03106160000226
06/01/20160090R03106160000226
06/01/20160090R03106160000228
06/01/20160090R03106160000229
06/01/20160090R03106160000230
06/01/20160090R03106160000231
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010616450671
010616420788
010616450592
010616390815
010616450736
010616450839
010616390590
010616450553
010616450638
010616420667
010616420816
010616420796
010616450848
010616450695
010616390652
010616450700
010616450623
010616420500
010616450672
010616450567
010616390606
010616450674
010616450843
010616390852
010616420654
010616420656
010616420910
010616390640
010616450717
010616450618
010616390913
010616450857
010616450915
010616390650
010616390651
010616450872
010616390779
010616390781
010616450800
010616390759
010616450777
010616420632
06/01/20160090R03106160000234
06/01/20160090R03106160000235
06/01/20160090R03106160000236
06/01/20160090R03106160000238
06/01/20160090R03106160000239
06/01/20160090R03106160000240
06/01/20160090R03106160000242
06/01/20160090R03106160000243
06/01/20160090R03106160000244
06/01/20160090R03106160000245
06/01/20160090R03106160000248
06/01/20160090R03106160000250
06/01/20160090R03106160000251
06/01/20160090R03106160000252
06/01/20160090R03106160000253
06/01/20160090R03106160000254
06/01/20160090R03106160000257
06/01/20160090R03106160000258
06/01/20160090R03106160000259
06/01/20160090R03106160000260
06/01/20160090R03106160000261
06/01/20160090R03106160000262
06/01/20160090R03106160000263
06/01/20160090R03106160000264
06/01/20160090R03106160000265
06/01/20160090R03106160000265
06/01/20160090R03106160000266
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06/01/20160090R03106160000273
06/01/20160090R03106160000275
06/01/20160090R03106160000276
06/01/20160090R03106160000276
06/01/20160090R03106160000277
06/01/20160090R03106160000278
06/01/20160090R03106160000278
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010616450660
010616450663
010616420886
010616390737
010616450708
010616450697
010616450743
010616390734
010616420810
010616420980
010616390988
010616390981
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010616420987
010616390990
010616450982
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010616420974
010616420989
010616420976
010616421015
010616430013
010616390811
010616430024
06/01/20160090R03106160000285
06/01/20160090R03106160000285
06/01/20160090R03106160000286
06/01/20160090R03106160000287
06/01/20160090R03106160000290
06/01/20160090R03106160000291
06/01/20160090R03106160000292
06/01/20160090R03106160000293
06/01/20160090R03106160000294
06/01/20160090R03106160000295
06/01/20160090R03106160000296
06/01/20160090R03106160000297
06/01/20160090R03106160000298
06/01/20160090R03106160000299
06/01/20160090R03106160000300
06/01/20160090R03106160000301
06/01/20160090R03106160000302
06/01/20160090R03106160000305
06/01/20160090R03106160000306
06/01/20160090R03106160000307
06/01/20160090R03106160000308
06/01/20160090R03106160000309
06/01/20160090R03106160000310
06/01/20160090R03106160000312
06/01/20160090R03106160000313
06/01/20160090R03106160000317
06/01/20160090R03106160000318
06/01/20160090R03106160000320
06/01/20160090R03106160000321
06/01/20160090R03106160000322
06/01/20160090R03106160000323
06/01/20160090R03106160000324
06/01/20160090R03106160000325
06/01/20160090R03106160000326
06/01/20160090R03106160000327
06/01/20160090R03106160000328
06/01/20160090R03106160000329
06/01/20160090R03106160000330
06/01/20160090R03106160000335
06/01/20160090R03106160000683
06/01/20160090R03106160000685
06/01/20160090R03106160000785
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010616990087
010616450616
06/01/2016
06/01/2016
Page 531
1 JUNI 2016
NAMA PASIEN
ANNISA WIRANTI UTAMI NY
EDY SURYANTO TN.
EDY SURYANTO TN.
HADIN AZHARI TN
HILMI BIN ZAKRI TN.
INDRA SANDI TN
M.FAJRI MEDIANSYAH
M.FAJRI MEDIANSYAH
M.USNAN SEPROANTO TN
NURHAYATI BA HJ NY
NURYANTO TN.
SANTOSO BIN SULAIMAN TN
SJAFRAN SOHIB TN
SOLDA BINTI KORI NY.
SUNARTI.NY
KAROLINA NY.
AZHIKA SAMHA SAUFA AN.
NOVRIYANTI WAHYUNI NN.
RUSTAM BIN SYAMSUDIN TN.
AIRUM BELLVANIA PUTRI W. AN.
AIRUM BELLVANIA PUTRI W. AN.
NURBAITI BINTI DALI NY.
SHOFWAN TN.
SHOFWAN TN.
ACHMAD ABUMAN, H TN
ALFI SYAHRIN TN.
ALFI SYAHRIN TN.
MERRY ARISANTY NY
M YUSUF JAYA TN
HASIAM INDRIANI NY
HARBEI PASAH TN
TRANSAKSI
168,000.00
31,200.00
53,600.00
79,800.00
15,700.00
23,800.00
25,500.00
49,000.00
32,230.00
4,541.00
47,500.00
108,200.00
79,200.00
25,200.00
21,000.00
103,200.00
155,970.00
45,000.00
125,400.00
41,140.00
177,000.00
252,585.00
64,441.00
94,170.00
40,000.00
40,000.00
60,000.00
565,600.00
10,000.00
125,000.00
10,000.00
160,000.00
141,750.00
10,000.00
160,000.00
146,000.00
182,400.00
10,000.00
160,000.00
360,200.00
890,000.00
Page 532
1 JUNI 2016
NURLIANA SALIM NY
NOVENDA ALIANDO TN
NOVENDA ALIANDO TN
SITI FATIMAH NY
SITI FATIMAH NY
IDA MASHUDA, HJ NY.
DELLA ANGGRAIN NN
ABDUL LATIF TN
RONIMAH NY
RONIMAH NY
SOFIA AZZAHRA AN.
BAMBANG SUTARAM TN
AMRAN BIN ROHIB TN
SITI FATIMAH NY
EDY ABDULLAH TN
10,000.00
125,000.00
97,200.00
10,000.00
102,000.00
890,000.00
60,000.00
71,450.00
10,000.00
137,000.00
512,000.00
194,000.00
10,000.00
160,000.00
10,000.00
160,000.00
109,182.00
10,000.00
160,000.00
472,000.00
228,000.00
10,000.00
160,000.00
120,000.00
115,000.00
110,000.00
110,008.00
10,000.00
160,000.00
68,000.00
10,000.00
125,000.00
68,415.00
115,000.00
351,320.00
110,000.00
10,000.00
160,000.00
327,250.00
###
10,000.00
160,000.00
Page 533
1 JUNI 2016
JANSEN JOSHUA AN.
SANDRA VERONICA GUNAWI NY
INDRAYANTA TN
INDRAYANTA TN
RIKAWATI BINTI NUSYIRWAN NN
NYAYU HALIMAH NN.
KAROLINA NY.
KAROLLINA NY
WANG RIZMANTIO TN
GHANI ALFARIZI AN.
GHANI ALFARIZI AN.
ENDANG PUJI ASTUTI HJ NY.
INDRAYATI NY.
RASKAN ANIDA HASTUTI NY.
TEGUH BIN HOKSAN TN
YARSAN PANANG TN.
SULAIMAN NADEAK TN.
TUTI PURNAMAWATI NY
TUTI PURNAMAWATI NY
ZUBIR A JALIL TN.
84,130.00
10,000.00
160,000.00
89,600.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
97,750.00
10,000.00
160,000.00
10,000.00
583,200.00
152,200.00
10,000.00
114,650.00
649,050.00
10,000.00
160,000.00
840,000.00
10,000.00
160,000.00
273,800.00
890,000.00
10,000.00
167,000.00
###
890,000.00
567,150.00
376,000.00
890,000.00
303,650.00
10,000.00
160,000.00
60,000.00
71,450.00
401,414.00
134,030.00
86,000.00
10,000.00
Page 534
1 JUNI 2016
ZUBIR A JALIL TN.
JANNI BURHAN NY
TRI MURNI, HJ NY
RASTITI WIGATI NY.
SUNADIA HJ NY.
BETIN TEGUH NY.
BETIN TEGUH NY.
MITA AGUSTRI AN.
RAHMAD ELYADDI, SE TN.
MERRY SUSILAWATI NY.
PIRMAN BIN KOPLIH TN
HILMI BIN ZAKRI TN.
UUT TRIANI NY.
KENY SURYATMI NY.
YULIAR BINTI AMIRUDDIN NY.
ELLYA KUSUMA NY.
ELLYA KUSUMA NY.
M. RAFIE KHAIRY AN
YURNAINI BINTI ABUSUI NY.
SOFI SALAMAH NY
YOLITA NY
SAMUDIN TN.
LIDYA SISCA NY.
ZAIDAN ACHMAD TN.
125,000.00
288,700.00
132,750.00
10,000.00
160,000.00
890,000.00
332,000.00
205,000.00
246,130.00
110,000.00
146,000.00
100,600.00
379,800.00
###
125,000.00
10,000.00
10,000.00
160,000.00
114,250.00
809,585.00
175,680.00
247,740.00
74,265.00
532,815.00
488,200.00
162,000.00
193,585.00
247,100.00
10,000.00
95,000.00
164,938.00
10,000.00
160,000.00
10,000.00
167,000.00
120,000.00
60,002.00
217,665.00
123,300.00
216,600.00
122,130.00
168,300.00
Page 535
1 JUNI 2016
RITA MELLA NY.
PUTRI KIRANA NN.
JANSEN SIRAIT TN.
JANSEN SIRAIT TN.
LANIYATI NY.
LANIYATI NY.
SITI MARIYAH NY.
SUMIATY JUMAHAT NY
DZAKIRA GHANIYYAH QUEEN AN
FITRI YANTY NY.
LISIANA OSWARI NN.
LISIANA OSWARI NN.
MASPERI YANTI NY.
CORNILIA ANITA NY.
CORNILIA ANITA NY.
YUDITH ANGGRIANI NY
SITI NURBAYA NY
INDAH KOMALA SARI NN.
AMORA GHALIYA SABINA AN.
SUTAMI INDRI W NY.
FERDI CANDRA PERMANA AN.
M. FACHRUR ROZI TN.
RUSMINI NY
DORTA SINAGA NY.
DORTA SINAGA NY.
WIDYA TAMARA NN
109,730.00
180,000.00
10,000.00
125,000.00
10,000.00
160,000.00
134,880.00
206,000.00
141,313.00
100,800.00
162,300.00
224,500.00
10,000.00
160,000.00
10,000.00
160,000.00
512,000.00
10,000.00
137,000.00
10,000.00
160,000.00
200,160.00
85,130.00
194,400.00
193,585.00
60,000.00
220,183.00
10,000.00
160,000.00
10,000.00
160,000.00
160,000.00
10,000.00
115,500.00
10,000.00
160,000.00
214,800.00
240,800.00
10,000.00
137,000.00
206,584.00
169,200.00
Page 536
1 JUNI 2016
TJIKNUT SYUKUR NY
TJIKNUT SYUKUR NY
IRYANTO ASYIK TN.
FAUZIAH BINTI MUSTOFA NY.
DJIAUW LIE TJEN NY
TJOE HOEN NIO NY.
TJOE HOEN NIO NY.
A. FATKULLAH TN.
LUKMAN NILHAKIM, IR TN
HAUDA NY.
RITA ZAHARA NY.
WILLY WIJAYA TN.
SAIFUL NURAINI TN.
EGI NAUFAL ZUHDI TN
PUJI ASTUTI NY
ARBAIN GANTI TN
TJUNG SEN WAN NY.
AINI BINTI AHMAD SAFAWI NY.
IRAWATY BINTI RAMALI NY.
JUHANDI BIN HASAN TN.
NICKY VERDIANTO TN.
ARI KUSUMA FAHMAN NY
NAFHAH ARDIANA PUTRI AN
ABDUL MUNAF TN
RESTY SARI WAHYUNI NY
GUSNIMAR BINTI AGUS NY.
ZUBAIR YUSUF TN.
60,000.00
10,000.00
160,000.00
99,800.00
264,050.00
384,335.00
110,000.00
10,000.00
160,000.00
143,252.00
164,586.00
314,100.00
197,700.00
214,000.00
170,000.00
91,600.00
79,450.00
10,000.00
95,000.00
107,450.00
60,000.00
139,500.00
291,800.00
118,000.00
107,450.00
71,450.00
236,500.00
97,695.00
577,700.00
###
890,000.00
150,776.00
60,000.00
99,450.00
171,341.00
82,548.00
193,585.00
10,000.00
160,000.00
460,700.00
823,200.00
60,000.00
Page 537
1 JUNI 2016
RATNA DJUITA NY
HATI INDAWATI NY.
RANDI SENATRA TN.
ZANARIA BINTI ZAINAL ABIDIN NY
MAIDAH BINTI H. MUSTOPA NY.
JASMAN BIN JAHARUDIN TN
EDY SURYANTO TN.
RUSNAN CHANDRA TN
ISRIL HENDRA TN
SAMSU AMAR TN.
SHELMA SITI AZ ZAHRA AN.
LINDA HARTATI NY.
LENY WINARTA SAPUTRO NY
SJAFRAN SOHIB TN
DESY NATALIANI, A.MD NY.
FAUZI AWANG DARMAWAN TN
M MULARIS AN.
M MULARIS AN.
YUNANI BINTI M. HASYIM NY.
YAHUMI ZAHRI TN
LINDA BINTI AWIE NY
SUKMAWATI BINTI M.YUSUF NY
NASRUN BASRI TN
NASRUN BASRI TN
MELLY RIANA NY
CHRYSAN ANASTASIA AN
AFRIMANSYAH BIN NURPALA TN.
JUVENDY S TN.
TJIKMAD. B TN.
105,500.00
116,080.00
150,450.00
71,450.00
175,650.00
69,866.00
182,400.00
193,585.00
199,175.00
948,100.00
69,898.00
588,056.00
###
517,470.00
428,500.00
60,000.00
512,981.00
180,000.00
60,000.00
233,900.00
229,400.00
201,585.00
10,000.00
160,000.00
71,800.00
60,000.00
104,500.00
721,185.00
441,820.00
99,600.00
193,585.00
103,698.00
110,000.00
10,000.00
160,000.00
374,700.00
64,000.00
109,940.00
129,650.00
233,770.00
65,000.00
10,000.00
Page 538
1 JUNI 2016
TJIKMAD. B TN.
ALI ASAN, DRS, M.PDI TN.
MEIRITA RUSLIE NY.
HASTUTI NY.
EKA PERMATASARI NY
M.TEGUH H.TN.
ZELVIE MEIZARINA NY.
SUNARYO BIN JAYAR TN
HADIN AZHARI TN
DJAKFAR LEKAP TN.
RITA SAHARA NY
HO LI IN NY
KALSUM IBRAHIM NY.
DEWI MONALISA NY.
GITA YUNITA NY.
RAMLAH SALEH, DRA NY
SUGIARTI BINTI SUTARSO NY.
PUJI ASTUTI NY.
SUSY YANTINY.
ARMA ZUAZLA NY.
MINARNI BINTI MURSI NY
SYAIFUL BACHRI TN.
ELIS SETIAWATY NY.
JONATHAN SITORUS AN.
ARKANA ALKHALIFI AN
160,000.00
713,400.00
60,000.00
193,585.00
200,585.00
965,830.00
101,300.00
###
153,170.00
206,500.00
133,900.00
632,418.00
125,000.00
525,800.00
158,700.00
201,585.00
119,400.00
60,000.00
170,600.00
110,000.00
71,450.00
170,600.00
193,585.00
294,763.00
10,000.00
160,000.00
718,550.00
158,781.00
201,585.00
60,000.00
128,000.00
60,000.00
573,375.00
10,000.00
160,000.00
480,370.00
10,000.00
160,000.00
140,600.00
205,585.00
74,291.00
102,900.00
Page 539
1 JUNI 2016
LENI APRIYANTI NY
LENI APRIYANTI NY
ARYANTO TN.
RUSTEM PUAD TN.
GUSTIN DWI CAHYANTI NY.
ASNAWATI S. BSC NY.
MIE TJAN YENI NY
YURNANI BINTIMAD KASIM NY.
ASFARIYATI BINTI MUHADI NY.
PRETTY MAYANG SEPTIKA NY.
RIFFAT IDLAN A. AN
KASTIBI BIN ABU SERI TN.
NURUL CITRA PERTIWI NN
ANA PRATIWI NN
ENDANG KURNIATI NY
ROHANA MURSYID NY.
SUGIARTO TN
ERICK JUMADI TN
ANNISA WIRANTI UTAMI NY
M.USNAN SEPROANTO TN
SYAFIYAH ALMAHYRA AN.
SYAKIRA AYESHA NUR AQILLA AN
ENDANG SUTISNA TN
MOH.MAQQON TN.
KIKI ANDAYANI SP NY.
SUMARTINI NY
TRI SALMA NOVINA. NN
DIAN KUSUMA WIJAYA TN.
R. A. RURI LAVENUARY NN
SYAPRIADI BIN JUNAIDI TN
NICHOLAS HALIM AN.
M.FAJRI MEDIANSYAH
MUHAMMAD NAIM TN.
10,000.00
125,000.00
199,000.00
220,420.00
110,350.00
388,494.00
292,315.00
193,585.00
282,282.00
308,650.00
495,400.00
265,725.00
60,000.00
166,857.00
551,470.00
250,470.00
119,381.00
205,285.00
131,000.00
225,646.00
234,400.00
154,650.00
153,433.00
247,321.00
154,800.00
359,715.00
156,070.00
134,700.00
120,300.00
175,040.00
178,900.00
163,000.00
160,750.00
174,900.00
121,400.00
101,878.00
117,210.00
222,700.00
102,400.00
174,400.00
629,200.00
146,400.00
Page 540
1 JUNI 2016
RIKA SUSANTI NY.
SETIAWAN SANTOSA AN.
199,115.00
172,612.00
Page 541
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NO
NO RJ
020616390341
020616460310
020616420541
020616460020
020616460010
020616450928
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020616460398
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TANGGAL
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06/02/2016
06/02/2016
06/02/2016
06/02/2016
06/02/2016
06/02/2016
06/02/2016
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
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00
00
00
00
00
00
0090R03105160002462
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020616460083
020616460257
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020616460085
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020616460109
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020616390156
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020616460143
020616450066
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0090R03106160000580
0090R03106160000580
0090R03106160000581
0090R03106160000581
0090R03106160000582
0090R03106160000582
0090R03106160000583
0090R03106160000584
0090R03106160000585
0090R03106160000585
0090R03106160000586
0090R03106160000587
0090R03106160000588
0090R03106160000589
0090R03106160000590
0090R03106160000591
0090R03106160000592
0090R03106160000593
0090R03106160000594
0090R03106160000594
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0090R03106160000598
0090R03106160000598
0090R03106160000599
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0090R03106160000602
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020616280783
020616450575
020616450544
020616450545
020616450644
020616390550
020616450775
020616450488
020616280664
020616450888
020616450743
020616390556
020616280878
020616420737
020616420739
020616451006
020616280700
020616450508
020616280829
020616450868
020616420974
020616280762
020616450565
020616390738
020616390742
020616280825
020616390668
020616420887
020616280757
020616280726
020616450602
020616390749
020616450672
020616390547
020616390842
020616390548
020616450714
020616280685
020616450705
020616450708
020616390759
020616420831
06/02/2016
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06/02/2016
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06/02/2016
06/02/2016
06/02/2016
06/02/2016
06/02/2016
06/02/2016
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06/02/2016
06/02/2016
06/02/2016
06/02/2016
06/02/2016
06/02/2016
06/02/2016
06/02/2016
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0090R03106160000603
0090R03106160000604
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0090R03106160000605
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0090R03106160000609
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0090R03106160000611
0090R03106160000612
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0090R03106160000615
0090R03106160000615
0090R03106160000616
0090R03106160000617
0090R03106160000618
0090R03106160000619
0090R03106160000620
0090R03106160000622
0090R03106160000623
0090R03106160000624
0090R03106160000625
0090R03106160000626
0090R03106160000627
0090R03106160000628
0090R03106160000629
0090R03106160000631
0090R03106160000632
0090R03106160000633
0090R03106160000635
0090R03106160000636
0090R03106160000637
0090R03106160000638
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0090R03106160000640
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0090R03106160000642
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020616420681
020616280770
020616390616
020616390634
020616390722
020616390732
020616420600
020616280725
020616280891
020616390710
020616390712
020616280652
020616420625
020616390704
020616280781
020616280609
020616280711
020616280760
020616390703
020616280656
020616280890
020616280830
020616280832
020616390849
020616451005
020616390956
020616280947
020616460025
020616450023
020616460022
020616450074
020616281004
020616450862
020616450709
020616450824
020616450026
020616280640
020616450834
06/02/2016
06/02/2016
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0090R03106160000649
0090R03106160000650
0090R03106160000651
0090R03106160000652
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0090R03106160000654
0090R03106160000654
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0090R03106160000656
0090R03106160000657
0090R03106160000658
0090R03106160000659
0090R03106160000660
0090R03106160000661
0090R03106160000662
0090R03106160000663
0090R03106160000665
0090R03106160000666
0090R03106160000667
0090R03106160000668
0090R03106160000670
0090R03106160000678
0090R03106160000679
0090R03106160000681
0090R03106160000684
0090R03106160000686
0090R03106160000687
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0090R03106160000840
0090R03106160000844
0090r03106160000845
0090R03106160000870
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Page 551
2 JUNI 2016
NAMA PASIEN
M.ARKAAN RAEES SADAN AN.
ADNAN ZAILANI TN
AFRIZAL PRASYIDI TN
ARYANTO TN.
CIK LUNAH NY.
DJONI BIN SUTINI TN.
ERNITA TAHER NY.
HARIS FADILA TN
HARMAIDI LATIEF TN.
ILRAUF HUSIN,DRS TN
ISRIL HENDRA TN
M. RAIHAN R AN
MEI PUJI RAHAYU AN.
NANDA GUSVITA NN
NICHOLAS HALIM AN.
SARMANAH NY
SUROTO TN
TAMIM SUPRIATNA TN
USMAN ZAINI TN
SOVIA APRIYANTIE NY
FERANI WANTO NY.
VALENTINE NN
LILY KARTIKA SARI NY
RUSWATI BINTI CIK AMIT NY.
SUGIARTO TN
TRANSAKSI
10,000.00
5,000.00
84,210.00
446,700.00
78,000.00
460,500.00
129,000.00
52,000.00
174,400.00
14,400.00
216,300.00
298,500.00
335,800.00
1,259,550.00
284,970.00
87,300.00
34,005.00
55,000.00
112,900.00
16,653.00
15,800.00
437,460.00
62,400.00
423,950.00
149,800.00
79,200.00
484,070.00
42,200.00
68,000.00
155,970.00
60,000.00
40,000.00
10,000.00
160,000.00
10,000.00
138,000.00
193,585.00
239,935.00
193,585.00
103,700.00
149,118.00
Page 552
2 JUNI 2016
DAVID RIZKY TRI WAHYUDI TN.
SUYITNO BIN BEJO UTOMO TN.
M. ABBAS HASAN TN
M. ABBAS HASAN TN
SUGINAH ABBAS NY.
SUGINAH ABBAS NY.
DENCIK NAYA TN
LIM KOEIJ ING NY
NING AYU NY.
NING AYU NY.
SJAFRAN SOHIB TN
ZAIDAN ACHMAD TN.
ZAIDAN ACHMAD TN.
HARYATI BINTI AHMAD NY.
JACUB RAHMAN TN.
JACUB RAHMAN TN.
DAVID ISKANDAR TN
HERRI HANDOKO TN.
NASRUN BASRI TN
SUYADI H. TN
USMAN ZAINI TN
SRI YULIDAR NY.
121,140.00
122,376.00
499,731.00
10,000.00
160,000.00
10,000.00
160,000.00
176,000.00
890,000.00
160,000.00
10,000.00
10,000.00
137,000.00
232,830.00
137,700.00
10,000.00
125,000.00
191,000.00
587,600.00
10,000.00
160,000.00
269,000.00
10,000.00
137,000.00
890,000.00
1,193,050.00
1,192,000.00
10,000.00
177,000.00
87,000.00
890,000.00
160,000.00
10,000.00
363,900.00
240,000.00
160,000.00
10,000.00
145,252.00
321,800.00
160,800.00
167,770.00
160,800.00
Page 553
2 JUNI 2016
SARMANAH NY
DEWI FITRI NY
MUHAMMAD RAFIQ AN.
ISFAI IYAT TN.
R.M. ARIF H BIN ZAINUDIN. TN.
MASNAH HAKIM NY.
SOEPRAPTO TN.
GHANI ALFARIZI AN.
GHANI ALFARIZI AN.
NYAYU FARIDA NY.
ERMAILINA BINTI A. WAHAB NY
HENDRY RIANTO TN
JUYATMI BINTI MUHAMAD NY.
JULIANA KOWIRA NY.
NYIMAS NURMANI NY.
ZULHAYATI ALWIN NY.
ZULHAYATI ALWIN NY.
ADNAN ZAILANI TN
SYARIFUDIN BIN KARDINI TN
MUCHTAR TS TN
MUCHTAR TS TN
SUJITNO CHANDRA TN
TITIN SURYANI. NY
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
10,000.00
160,000.00
10,000.00
160,000.00
60,000.00
166,980.00
60,000.00
267,739.00
10,000.00
125,000.00
188,000.00
265,692.00
313,800.00
144,404.00
160,000.00
10,000.00
84,050.00
10,000.00
124,650.00
185,252.00
160,000.00
10,000.00
108,000.00
890,000.00
415,152.00
240,800.00
60,000.00
180,480.00
890,000.00
160,000.00
10,000.00
325,549.00
135,680.00
92,900.00
131,400.00
102,000.00
10,000.00
141,600.00
132,400.00
10,000.00
160,000.00
94,880.00
Page 554
2 JUNI 2016
SITI ROHMA NY
SITI ROHMA NY
M. HATTA YUSUF TN
FARIDA BINTI TOYIB NY
HODIDJAH BINTI M.ALI, HJ NY
M.ALI HANAFIAH TN.
ERMIATI KOTO NY
RIKA DWI PRATIWI,S.SOS,MM NY
KORBI KOWI TN.
AZHARI BSC TN.
EDDYN FAUZI R TN
DEWI AMILYA NY.
RITA ARSYAD NY.
MEIDI YUSRI, MS TN
RAFA ALVARO AN
SITI AISYAH AN.
MAMAT SADI TN.
ARI IRFAN LESMANA AN.
YULIA DASWATI NY.
MUNASIH BINTI MUNADI NY
INDRAWATI BOEN NN.
ILAL YATI NY.
SITI BINTI SIDIK NY
ARIFAH ZAHRA MUTIAH AN
125,000.00
10,000.00
191,200.00
160,000.00
10,000.00
177,000.00
10,000.00
296,591.00
840,000.00
80,160.00
160,000.00
10,000.00
156,300.00
120,298.00
102,000.00
193,585.00
264,764.00
239,250.00
90,600.00
313,800.00
274,000.00
60,000.00
222,080.00
570,085.00
326,700.00
107,430.00
10,000.00
125,000.00
110,000.00
110,000.00
216,480.00
60,000.00
227,362.00
488,200.00
205,400.00
120,000.00
110,000.00
10,000.00
160,000.00
960,400.00
266,595.00
107,087.00
Page 555
2 JUNI 2016
ARIFAH ZAHRA MUTIAH AN
M. TOIS TANDA JAYA TN.
LAMRIA MANURUNG NY.
IRYANTO ASYIK TN.
OLIVIA AZ-ZAHRA AN.
MEIRITA RUSLIE NY.
MEIRITA RUSLIE NY.
SHINTA ERLINA NY.
RANU ARDANA AN.
ERLYAWITA NY.
ISKANDAR ZULKARNAIN TN
NURMALA DEWI NY.
NURMALA DEWI NY.
MARIANA NY
NETTI BINTI A.BADARUDDIN NY.
SOEBROTO DRS TN.
SUWARNO BIN ROHIYAT TN
SUROTO TN
NURJANAH BINTI M.NOOR NY.
TARMIZI, ST BIN M.ANANG TN
SRI PURNAMAWATI NY.
SRI PURNAMAWATI NY.
DEVI AWALIA NY
DEVI AWALIA NY
YAN ADITYA KURNIAWAN TN
SRI MARHENINGSIH NY
RAHULLA HUANG AN.
RUASNA RISI NY.
KARTINI NY.
93,600.00
493,200.00
149,610.00
84,584.00
278,051.00
160,000.00
10,000.00
126,430.00
213,585.00
60,000.00
635,185.00
223,750.00
10,000.00
160,000.00
125,621.00
60,000.00
480,690.00
224,800.00
136,900.00
346,100.00
100,800.00
235,000.00
194,230.00
160,000.00
10,000.00
160,000.00
10,000.00
214,600.00
1,081,900.00
160,000.00
10,000.00
110,000.00
269,800.00
110,000.00
10,000.00
160,000.00
201,585.00
211,500.00
483,080.00
138,000.00
96,000.00
120,000.00
Page 556
2 JUNI 2016
OKTA SAPUTRA TN
OKTA SAPUTRA TN
KERRIN NATHANIA AN.
M. IMRON TN.
ARBAIN GANTI TN
ARBAIN GANTI TN
RINI HERDIANI NY
TJUNG SEN WAN NY.
TJUNG SEN WAN NY.
AZLIN NATASHA NN.
DEWITA BINTI H.A.AZIZ,HJ NY.
NYIMAS AMNAH NY
TRI LIANA NN.
WINDA WIDIANTI NY.
ERNITA TAHER NY.
JUSRIZAL RUSLAN TN
AUGUST SANIE TN
RINA AQUARINA NY.
ETY SUSANTI NY
SYAIFUL ANWAR TN
NUR KHORIYA SABILA NY.
PUSPA ETIKA NY.
WINDA BINTI AWALUDDIN NY
BAHRIA ROMLIYUNUS NY.
10,000.00
177,000.00
60,000.00
71,800.00
110,000.00
158,500.00
160,000.00
10,000.00
209,485.00
115,000.00
160,000.00
10,000.00
233,973.00
809,585.00
102,000.00
10,000.00
138,000.00
313,800.00
264,400.00
258,162.00
528,800.00
216,773.00
176,900.00
196,000.00
222,373.00
512,000.00
120,000.00
256,585.00
120,000.00
264,185.00
149,790.00
890,000.00
110,000.00
278,585.00
60,000.00
381,915.00
60,000.00
321,645.00
105,315.00
337,033.00
160,000.00
10,000.00
Page 557
2 JUNI 2016
LIS DIANA NY.
SAID SALIM TN
SAID SALIM TN
MEI PUJI RAHAYU AN.
ROHAINA HJ, NY.
ROHAINA HJ, NY.
JALILAH BINTI H. ABUBAKAR NY
NUR ASIA NY.
ERVINA RAHMA DIANA NN
CITRA PURNAMA WENI DUNAN NY.
WIDYA AYU PARASHATI NY.
NOVA TRIBUYANA NY
HASRI TANJUNG H TN.
HASRI TANJUNG H TN.
JANSEN SIRAIT TN.
RONIMAH NY
EMMY YAHIMI NY
NUR HAYANI NY.
NUR HAYANI NY.
FITRI JUWITA NY
HO LI IN NY
DINI PRATIWI NY.
69,000.00
10,000.00
160,000.00
102,400.00
10,000.00
160,000.00
193,585.00
320,905.00
277,585.00
268,400.00
217,435.00
261,685.00
111,200.00
344,256.00
10,000.00
160,000.00
96,000.00
102,000.00
10,000.00
96,000.00
107,450.00
890,000.00
157,450.00
121,850.00
60,000.00
99,450.00
139,550.00
76,000.00
120,000.00
60,000.00
205,525.00
173,106.00
367,985.00
1,192,000.00
150,600.00
236,750.00
60,000.00
160,000.00
10,000.00
68,000.00
71,450.00
193,585.00
Page 558
2 JUNI 2016
TRI CAHYAWATI NN.
AS AD SAYUTI DRS TN
AS AD SAYUTI DRS TN
M. BAYU SAPUTRA AN.
TAMARA MEILINDA GUNAWAN NN
EVA PAHRIAH NY.
DEVI ARIANTI NY.
HENIWATI NY
ZULKIFLI HAMID TN
SRI RAHAYU AGUSTINA NY
SEPTIANA NY.
TATI HARTATI NY
JUNAIDA PRIANI NY
JUNAIDA PRIANI NY
SETIA WATI NY
SETIA WATI NY
MUHAMMAD TONI TN.
MUHAMMAD TONI TN.
DORTA SINAGA NY.
SARDJONO, H TN
RUSMIDIUS NY.
HASTRI ARTINI NY
MACHMUDI MUIB TN.
YETI KUSUMARITA NY
FEMILIA MARLINA NY.
RAHMA FADHILLA AN.
ROMLAWATI BINTI S. A. KADIR NY
SARIKA DARWATI. SE, M.SI NY.
MARTINI THAMRIN NY
111,510.00
167,000.00
10,000.00
205,740.00
110,000.00
128,515.00
160,000.00
10,000.00
68,000.00
890,000.00
297,905.00
193,585.00
488,200.00
322,325.00
193,585.00
172,920.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
107,450.00
160,000.00
10,000.00
60,000.00
279,585.00
60,000.00
60,000.00
263,000.00
60,000.00
359,773.00
233,444.00
10,000.00
167,000.00
153,280.00
484,200.00
33,500.00
298,985.00
60,000.00
95,080.00
Page 559
2 JUNI 2016
PONIMAN BIN WARLIM TN
ELYANI WIRZA NY
TITIN KUSMETA NY.
M. RAIHAN R AN
MERIANA SIDABUTAR NY.
DAHLAN YAUMID TN
EFFIANA RITA ADNAN,DRA NY.
CHOLIDAH UTAMA NY
NUR ASSYIAH NY.
RUSMAWATI BINTI HAJAMUDIN NY.
BEBY LITISYAH LIREINA AN
SUKANTO KESUMAH TN
PARDIAH BINTI HAYAT ISMAIL NY
VERONIKA LIANI NY
LENNY SILVANI NY.
HADIJAH NY.
NUR HUSNAWATI NY
ZAINAB BINTI ADAM NY
HUSNI THAMRIN TN
ERNA KURNIATY NY.
TETI ELIYANA NY.
R NAPITUPULU NY
WINDA LESTARI NN
EKA INDAH RIA NN
YUSUF USMAN TN
SITI NURAINI NY.
SITI NURAINI NY.
MERI SUSANTI NY
SETIAWAN SANTOSA AN.
110,000.00
110,250.00
10,000.00
160,000.00
164,200.00
101,300.00
60,000.00
102,400.00
125,625.00
241,427.00
201,585.00
252,000.00
114,130.00
10,000.00
137,000.00
316,975.00
95,160.00
151,820.00
85,300.00
562,900.00
199,046.00
193,585.00
60,000.00
226,350.00
301,660.00
139,550.00
139,000.00
222,825.00
110,000.00
371,970.00
120,331.00
193,585.00
76,800.00
74,464.00
71,450.00
84,580.00
84,600.00
93,020.00
160,000.00
10,000.00
193,585.00
60,000.00
Page 560
2 JUNI 2016
HANNY TRIDIYANTI NY.
MARITA RAMIANTI NY.
MUSLIMAH BINTI AHMAD BUSTAM NY
ASWIN BIN JUKI TN.
SOVIA APRIYANTIE NY
HENDRI HASAN TN
INDRA SANDI TN
MARIATUL KIBTIA NY.
RINA ANDRIANA NY.
ISMALINDA BINTI ISMAIL NY.
RUSIK AYU NY
ROSPITA BINTI SAMIRI NY
TITIN SHIRLIANI NN
NOVENDA ALIANDO TN
MARSHELLA TALITA AN
MERDI APRIADI TN
YASIR SATRIA TN
YENNI ANGGRIANI NY.
MARLIANSYAH TN
TAMIM SUPRIATNA TN
SYAQILA KHANZA INARA AN.
MALIKAH ANINDIYA W AN.
VITO ADITYA AN
FATIMAH FIBRRINA NY.
ALBY DAFFA ANANDA AN.
AMANDA FIRLY AN.
FEBY SETIAWAN TN
RANITA SARI SIP, NY.
WARDIAH IDRIS NY
MIKHAEL RUKINEM NY.
ILRAUF HUSIN,DRS TN
180,170.00
193,585.00
449,905.00
175,100.00
209,828.00
405,150.00
101,630.00
103,565.00
462,220.00
177,000.00
10,000.00
76,560.00
75,330.00
207,781.00
233,700.00
60,000.00
89,162.00
155,800.00
100,000.00
105,000.00
100,030.00
165,315.00
200,742.00
161,650.00
161,100.00
84,050.00
192,900.00
55,713.00
227,109.00
81,402.00
40,780.00
516,590.00
154,454.00
60,000.00
329,200.00
216,480.00
1,192,000.00
154,700.00
Page 561
3 JUNI 2016
NO
NO RJ
030616450950
030616280593
030616450006
030616430547
030616450007
030616450012
030616450008
030616450017
030616450015
030616450189
030616450005
030616430627
030616450010
030616450004
030616450952
030616420274
030616450292
030616430546
030616390251
030616450011
030616280754
030616450003
030616450014
030616450718
030616420239
030616420417
030616420065
030616450124
030616420312
030616450060
030616420039
030616450023
030616450049
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0090R03106160001005
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0090R03106160001007
0090R03106160001008
0090R03106160001009
0090R03106160001010
0090R03106160001011
0090R03106160001011
0090R03106160001012
0090R03106160001013
0090R03106160001014
0090R03106160001015
0090R03106160001017
0090R03106160001018
0090R03106160001019
0090R03106160001020
0090R03106160001021
0090R03106160001021
0090R03106160001022
0090R03106160001023
0090R03106160001024
0090R03106160001025
0090R03106160001026
0090R03106160001027
0090R03106160001028
0090R03106160001029
Page 570
3 JUNI 2016
030616430709
030616460743
030616430745
030616280821
030616450643
030616450827
030616430757
030616430758
030616430639
030616280644
030616280748
030616460780
030616430629
030616460732
030616430740
030616450933
030616450941
030616450943
030616280947
030616280962
030616460492
030616280915
030616430448
030616450433
030616450029
030616420044
030616450050
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
06/03/2016
0090R03106160001030
0090R03106160001031
0090R03106160001032
0090R03106160001033
0090R03106160001034
0090R03106160001035
0090R03106160001036
0090R03106160001036
0090R03106160001037
0090R03106160001038
0090R03106160001039
0090R03106160001040
0090R03106160001042
0090R03106160001043
0090R03106160001044
0090R03106160001054
0090R03106160001055
0090R03106160001056
0090R03106160001057
0090R03106160001059
0090r03106160001107
0090r03106160001111
0090R03106160001126
0090R03106160001128
0090R03106160001129
0090R03106160001144
MASUK RWI
Page 571
3 JUNI 2016
NAMA PASIEN
TRANSAKSI
ABDUL SANI,SE TN.
149,800.00
ALYA ZAHWA NATASYA AN.
107,850.00
430,500.00
DAFFA AMIRULLAH AN
85,205.00
DARWIEN ZAINAL TN
158,700.00
418,470.00
DJALILI SOLIHIN TN
21,000.00
HO LI IN NY
485,250.00
JUVENDY S TN.
95,040.00
107,250.00
LIM KOEIJ ING NY
45,000.00
M. RAJA SHADIQ BASKORO AN.
35,781.00
30,000.00
138,600.00
MURNIATI NY.
149,800.00
MUSRIL BIN SOPRI TN
149,800.00
NURHAYATI BA HJ NY
208,150.00
RIPQI ALVARO AKBAR AN
114,156.00
SRI RIZKY HANDINI PRATIWI NN
87,270.00
871,400.00
19,450.00
YAHUMI ZAHRI TN
160,500.00
51,000.00
51,000.00
160,000.00
AHMAD RIFAI TN.
60,000.00
ISTIANA BINTI ABDULLAH S NY.
635,185.00
146,000.00
ENDAH KUSUMAWATI NY
352,185.00
M. HUSEIN SAID,H TN.
195,490.00
85,914.00
RIZKA AMELIA NN
192,080.00
SYAQILA KHANZA INARA AN.
74,560.00
M.ALIEF AKBAR TN.
211,980.00
SUPARDIANTO BIN MADANI TN.
233,618.00
SETIYO CAHYONO TN
183,280.00
KHOTIJAH BINTI KASIM SAKTI NY
197,102.00
FITRI KURNIA SUSANTY NY
40,000.00
10,000.00
125,000.00
NURHAYATI BA HJ NY
911,510.00
Page 572
3 JUNI 2016
GILANG NOPRIANSYAH AN.
M YUSUF JAYA TN
SITI FATIMAH NY
SITI FATIMAH NY
ZUBIR A JALIL TN.
ZUBIR A JALIL TN.
PUTRO SETYONO TN
MARDJUKI TN.
DIANA NOVITA NY
ROSDIANA BINTI IBRAHIM NY.
HERIYANTO TN
RAHMA WATI NY
ABDUL LATIF TN
LAM SURYA NY.
MARIMAH C AHMAD NY.
MARIMAH C AHMAD NY.
A. SANUSI TN
LINDA HARTATI NY.
SITI MAIMUNAH NY
SITI MAIMUNAH NY
SUKANTO KESUMAH TN
SUNADIA HJ NY.
CORNILIA ANITA NY.
CORNILIA ANITA NY.
ISKARYANI BINTI IKRAK A. NY
HO LI IN NY
HO LI IN NY
MISTAMAH HASYIM HJ NY.
ZUBAIR YUSUF TN.
10,000.00
125,000.00
172,000.00
121,000.00
10,000.00
137,000.00
10,000.00
125,000.00
1,097,000.00
1,399,000.00
2,670,600.00
1,125,200.00
2,332,250.00
1,097,000.00
235,585.00
221,280.00
125,000.00
10,000.00
89,000.00
164,210.00
202,140.00
10,000.00
160,000.00
90,030.00
221,280.00
10,000.00
160,000.00
174,480.00
1,097,000.00
531,740.00
10,000.00
160,000.00
197,231.00
10,000.00
160,000.00
93,340.00
10,000.00
160,000.00
329,860.00
1,097,000.00
277,020.00
10,000.00
Page 573
3 JUNI 2016
GUSNIMAR BINTI AGUS NY.
JANIAH BINTI SANGUN NY.
DJALILI SOLIHIN TN
DJALILI SOLIHIN TN
MOH. KASAN KS TN.
APENDI BIN KORI TN.
NOVI CAHYADI TN
A.RIVAI TN.
NELLY SUHARTINI NY.
SITI BINTI SIDIK NY
JEANNE KUSSOY NY
JEANNE KUSSOY NY
EDDY MAKSURI TN.
ZAINAB BINTI ANANG HAMID NY
ARMAYANA BINTI AMRIN NY.
MARYATIN BINTI MAKSUS NY
ARYANTO TN.
RUSMIDIUS NY.
RUSMIDIUS NY.
SYAIFUL ANWAR TN
RANU ARDANA AN.
HAZAIRIN ZEN TN.
TRIANA APRIANI NY
TRIANA APRIANI NY
160,000.00
247,740.00
155,650.00
10,000.00
160,000.00
91,130.00
10,000.00
160,000.00
230,800.00
216,480.00
488,200.00
524,684.00
60,000.00
2,205,300.00
10,000.00
160,000.00
132,230.00
10,000.00
160,000.00
223,830.00
10,000.00
160,000.00
81,000.00
189,000.00
500,195.00
219,325.00
190,503.00
240,173.00
10,000.00
160,000.00
214,800.00
1,264,900.00
10,000.00
95,000.00
668,800.00
512,000.00
110,000.00
87,742.00
134,895.00
110,000.00
10,000.00
160,000.00
Page 574
3 JUNI 2016
YULIANA BINTI ABDURAHMAN NY
ABU KASMAN SE TN.
YAHYA AZKIN TN.
ANDI BIN MUHAMMAD TN.
IBRON TN.
KALSUM IBRAHIM NY.
KALSUM IBRAHIM NY.
ELLY FALLAH HJ NN
HAUNAH SAID HJ. NY
DZAKIRA TALITA HUMAIRA AN.
CIK IMAH NY
SURYANINGSIH NY.
KMS A RONI H TN.
DULIFEA KRISTIN R. DR NY.
WILLY WIJAYA TN.
YUNALNI NY.
RUKIATI NY.
SOPINAH BINTI SAPEIH NY
GUNA DHARMA TN
GUNA DHARMA TN
NYAYU NURHAYATI NY
ACHMAD MAULANA,H TN
KENY SURYATMI NY.
ISMED ARAHMAN TN
MEWA ROSITA NY
A.TRUMAN S.O BAKRI,SH,M.HUM TN
ABDUL MUNAF TN
146,400.00
240,878.00
193,585.00
637,200.00
221,280.00
60,000.00
459,500.00
160,000.00
10,000.00
145,900.00
145,900.00
60,000.00
72,000.00
193,585.00
186,118.00
364,650.00
10,000.00
160,000.00
244,170.00
160,300.00
616,665.00
134,880.00
10,000.00
160,000.00
110,981.00
153,695.00
187,200.00
313,800.00
174,400.00
244,520.00
314,200.00
1,264,900.00
276,000.00
345,300.00
193,585.00
91,123.00
95,000.00
10,000.00
194,850.00
240,800.00
1,081,900.00
242,240.00
Page 575
3 JUNI 2016
RINA AQUARINA NY.
GUSTI AYU NATIH ARNITI NY.
ASIA ATIKA NY
SHINTA HASANA NY.
SHINTA HASANA NY.
YUS ROHANA NY.
YUS ROHANA NY.
A. SUBKI MAHMUD TN.
ONI AISYAH NY.
SUTIANI BINTI HASAN WIJAYA NY.
TJIKNUT SYUKUR NY
TJIKNUT SYUKUR NY
ERLIN PURWANTI NY
SISKA DWI WANSYAH NN.
SUSILAWATY NY
SUSILAWATY NY
M. ZIDAN ALFATHA AN
INDRA KURNIAWAN TN
CARISSA ADELIA AN.
NURUL CITRA PERTIWI NN
SAMSU AMAR TN.
OKI JAYA HERNANTO TN
SITI FARIDAH NY.
LISIANA OSWARI NN.
LISIANA OSWARI NN.
REFIDA SILITONGA NY.
RITA ZAHARA NY.
TARUNA BINTI BOAN NY
M. RAJA SHADIQ BASKORO AN.
MARHATI NY.
258,585.00
313,485.00
317,025.00
212,400.00
10,000.00
125,000.00
10,000.00
160,000.00
354,500.00
238,080.00
216,175.00
10,000.00
160,000.00
10,000.00
160,000.00
201,585.00
190,040.00
202,455.00
10,000.00
160,000.00
115,000.00
239,741.00
110,000.00
78,550.00
120,000.00
235,520.00
284,450.00
252,030.00
235,824.00
155,050.00
110,981.00
10,000.00
160,000.00
110,000.00
89,560.00
234,400.00
78,130.00
194,400.00
145,200.00
106,640.00
10,000.00
160,000.00
Page 576
3 JUNI 2016
SRI LUKITA NINGSIH NY.
PUJI ASTUTI NY
PUJI ASTUTI NY
DWI HANDAYANI NY.
DONA NAULITA NY.
EVY MARSITA NN
LEMBAYUNG HUMAIRAH AN
M. EGHA AHWAS PERDANA AN
IVANALI A. MA NY.
SULHIAWATI BINTI ZAINI NY
DESAK EKA WIDYA ASTUTI NY
LOUIS ALVARO AN.
HASTUTI NY.
RUSDIAH BINTI HOIRUDIN NY
ANI HASAN NY
MERI HARTATI NY.
HENICA FITRIANTI NY.
TIWAN BIN SUNARYO TN.
AHMAD ATHAR IZZULHAQ N. AN
SUTANTO BIN BUDIMAN TN
TUMIAR SILABAN NY.
ISMI JELITA NY
ISMI JELITA NY
SULIANTI CANDRA NY.
GATOT SUGEMTO TN
FAJRIAH SALSA M AN.
MUHAMMAD FADHLI AN
ABDULLAH S. NATO TN.
KEISHA LASITA JUDAZA AN.
AS AD SAYUTI DRS TN
204,370.00
110,000.00
10,000.00
160,000.00
110,000.00
252,030.00
280,800.00
83,800.00
205,670.00
134,777.00
60,000.00
105,500.00
205,195.00
193,585.00
120,000.00
1,081,900.00
243,845.00
60,000.00
1,192,000.00
247,285.00
207,585.00
635,185.00
1,566,900.00
199,000.00
89,400.00
164,000.00
187,450.00
295,720.00
10,000.00
200,000.00
104,012.00
1,264,900.00
60,000.00
60,000.00
1,479,265.00
890,000.00
384,200.00
240,800.00
110,000.00
219,800.00
10,000.00
95,000.00
Page 577
3 JUNI 2016
ELLYA KUSUMA NY.
SITI ZAHARA NY.
RUSTAM HALIM TN
NING AYU NY.
RIPQI ALVARO AKBAR AN
DAFFA AMIRULLAH AN
MAITA USFILEKA NY
AMIR HAMZAH TN
AMIR HAMZAH TN
SUSI IRITO NY.
KOSIM JOHAN TN
AMALIA MAHARANI AN.
ISNAINI BINTI HAMIDAR NY.
M. FAHRY MAIZA AN.
YURNAINI BINTI ABUSUI NY.
KASMAWATI BINTI MADIYAH NY.
HAMIDAH BINTI BIDIN NY
SRI MULYATI NY
SRIYANTI BINTI M ANANG NY
AHMAD RIFAI TN.
SAHID TRI KURNIAWAN TN.
BRYAN TOBIAS AN.
TATI HARTATI NY
RUSMALA DEWI HJ NY.
NASRUN BASRI TN
BOY D.J MAKADADA TN
571,650.00
167,450.00
169,450.00
119,691.00
129,450.00
189,170.00
1,264,900.00
107,450.00
71,450.00
157,450.00
60,000.00
122,400.00
122,400.00
346,700.00
120,900.00
132,250.00
100,800.00
167,000.00
10,000.00
128,125.00
164,000.00
191,300.00
60,000.00
585,300.00
110,000.00
384,200.00
112,900.00
60,000.00
243,305.00
102,190.00
187,450.00
218,000.00
240,600.00
110,000.00
890,000.00
219,000.00
155,000.00
99,450.00
222,000.00
217,590.00
162,830.00
68,415.00
Page 578
3 JUNI 2016
EDDI AZ TN.
ZUBAIRI BAKAR TN.
AZHARI BSC TN.
RISKI OKTARIA NY
PUSPA WULAN SARI NN.
DEWI AMILYA NY.
DIAN TRI WAHYUNI NY.
ZURIAH,HJ NY.
TJIKMAD. B TN.
TJIKMAD. B TN.
RA FARIDA NY.
DEWI YANTI NY
ERZA HOTIMAH NN.
PUJI ASIH NY
FATIMAH BINTI ABDUL KARIM NY.
DEWITA BINTI H.A.AZIZ,HJ NY.
RATNA DEWI MARPAUNG NY.
IMELDA TELISA NY
ASIA HERNAWATI NY.
INDRAWATI BOEN NN.
MSY. NORMA YUNITA SARI NY.
219,800.00
626,800.00
87,000.00
129,450.00
240,800.00
186,000.00
348,000.00
193,585.00
108,995.00
1,676,650.00
169,235.00
146,600.00
86,000.00
60,000.00
328,729.00
143,865.00
65,000.00
10,000.00
160,000.00
100,730.00
71,450.00
190,500.00
341,200.00
199,651.00
160,000.00
10,000.00
71,450.00
60,000.00
108,600.00
672,200.00
120,000.00
249,175.00
64,500.00
314,250.00
167,000.00
10,000.00
60,000.00
518,530.00
247,000.00
180,000.00
171,200.00
10,000.00
Page 579
3 JUNI 2016
RETNO SARI NN
HERRU DWI PRAYITNO AN
AHMAD SALIM, SE TN.
SHOFWAN TN.
ELYANI WIRZA NY
HERLINA MEGAWATI NY
ZAINAL ABIDIN SYARKOWI TN
ISMAIL IRAGI TN.
GROMIKO SAWALUDIN B SH TN
MUHAMMAD TN.
FIRDO IRAWAN TN.
YUSNIZAR A NY
AYU KUSUMANINGSIH NN
KHAIRUL RUSDI TN
KGS M RUSDI TN
MUHAMMAD NURDIN TN.
BARIYAH BR NY.
ROHANA BINTI ARSYAD RONI NY
RUSMINI NY
ALI HASAN TN
HERI PURWANTO TN
SITI MARIAM NY
SITI MARIAM NY
MERRY SUSILAWATI NY.
ENGGA SASONGKO TN
NYIMAS NURHAYATI HJ NY
HARIS FADILA TN
M. RAKA PRATAMA AN
OKTA SAPUTRA TN.
LENI APRIYANTI NY
102,000.00
149,480.00
69,740.00
155,064.00
60,000.00
246,600.00
233,200.00
769,200.00
383,920.00
668,760.00
60,000.00
147,600.00
124,000.00
322,530.00
60,000.00
10,000.00
160,000.00
930,650.00
314,200.00
60,000.00
688,950.00
60,000.00
10,000.00
125,000.00
681,200.00
204,085.00
118,000.00
79,450.00
170,404.00
138,695.00
215,120.00
228,695.00
167,000.00
10,000.00
228,000.00
233,895.00
492,265.00
271,034.00
151,341.00
60,000.00
1,041,900.00
60,000.00
Page 580
3 JUNI 2016
SYAMSUL ARIF TN
ZULKIFLI HAMID TN
NURMA ZAITA NY
INNA MARTINI NY.
ZUMROWI BIN ABDUR RAHMAN TN.
ZAINUBAH BINTI M. YUSUF NY
RATIH NURHAYATI AN
SITI ULLIYAH HJ NY
FINAJMI BIN SHOFWAN TN
NASIROH BINTI HUSNI T. NY
RICKY RIANSYAH AN.
ABDUL SANI,SE TN.
RAKA HERIYADI AN
OKY MARSELINA NY.
EKA RETNAWIYATI NY.
MUHAMMAD IRFAN TN
MINAL ALKARHI TN
ALYA ZAHWA NATASYA AN.
RUSDIAH BINTI HOIRUDIN NY
SITI AISYAH NY.
FITRI YULIANTY NY
207,300.00
470,200.00
260,118.00
502,000.00
276,665.00
162,750.00
10,000.00
160,000.00
221,000.00
177,054.00
60,000.00
155,600.00
200,262.00
183,800.00
278,640.00
174,400.00
216,312.00
174,400.00
138,490.00
101,832.00
554,400.00
139,000.00
119,800.00
40,000.00
251,975.00
512,000.00
40,000.00
Page 581
4 JUNI 2016
NO
1
2
3
4
5
6
7
8
9
10
11
12
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14
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17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
NO RJ
040616460040
040616460063
040616460058
040616390303
040616430827
040616460032
040616430780
040616460067
040616420590
040616390350
040616430592
040616460066
040616460068
040616460080
040616460023
040616460015
040616460014
040616460018
040616460020
040616460045
040616450164
040616460021
040616430446
040616450057
040616430445
040616450055
040616460031
040616460074
040616450062
040616450038
040616450044
040616450019
040616450125
040616450123
040616450096
040616450097
040616460048
040616460049
040616450033
040616450035
040616390070
TANGGAL
SEP
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/2016
00
06/04/20160090R03106160000696
06/04/20160090R03106160000906
06/04/20160090R03106160000941
06/04/20160090R03106160000970
06/04/20160090R03106160000995
06/04/20160090R03106160000995
06/04/20160090R03106160001045
06/04/20160090R03106160001063
06/04/20160090R03106160001064
06/04/20160090R03106160001065
06/04/20160090R03106160001067
06/04/20160090R03106160001067
06/04/20160090R03106160001068
06/04/20160090R03106160001068
06/04/20160090R03106160001069
06/04/20160090R03106160001069
06/04/20160090R03106160001070
06/04/20160090R03106160001070
06/04/20160090R03106160001071
Page 582
4 JUNI 2016
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45
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48
49
50
51
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64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
040616390072
040616390073
040616390075
040616390077
040616390076
040616460238
040616460086
040616460087
040616450084
040616450083
040616450098
040616450099
040616450228
040616460093
040616460091
040616390234
040616450111
040616450112
040616390262
040616460116
040616450310
040616390266
040616450169
040616450168
040616450082
040616390148
040616390146
040616460186
040616460185
040616390222
040616390225
040616390214
040616390216
040616390221
040616390220
040616390267
040616390268
040616450427
040616450423
040616390296
040616390321
040616450106
06/04/20160090R03106160001071
06/04/20160090R03106160001072
06/04/20160090R03106160001072
06/04/20160090R03106160001074
06/04/20160090R03106160001074
06/04/20160090R03106160001075
06/04/20160090R03106160001076
06/04/20160090R03106160001076
06/04/20160090R03106160001077
06/04/20160090R03106160001077
06/04/20160090R03106160001078
06/04/20160090R03106160001078
06/04/20160090R03106160001079
06/04/20160090R03106160001080
06/04/20160090R03106160001080
06/04/20160090R03106160001081
06/04/20160090R03106160001082
06/04/20160090R03106160001082
06/04/20160090R03106160001083
06/04/20160090R03106160001084
06/04/20160090R03106160001086
06/04/20160090R03106160001087
06/04/20160090R03106160001088
06/04/20160090R03106160001088
06/04/20160090R03106160001090
06/04/20160090R03106160001091
06/04/20160090R03106160001091
06/04/20160090R03106160001093
06/04/20160090R03106160001093
06/04/20160090R03106160001094
06/04/20160090R03106160001094
06/04/20160090R03106160001095
06/04/20160090R03106160001095
06/04/20160090R03106160001096
06/04/20160090R03106160001096
06/04/20160090R03106160001097
06/04/20160090R03106160001097
06/04/20160090R03106160001099
06/04/20160090R03106160001099
06/04/20160090R03106160001102
06/04/20160090R03106160001102
06/04/20160090R03106160001103
Page 583
4 JUNI 2016
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
040616450101
040616450110
040616390305
040616390304
040616450255
040616450256
040616460008
040616390281
040616390280
040616420509
040616420507
040616450383
040616450374
040616390269
040616390274
040616390079
040616450289
040616450288
040616430609
040616430607
040616450317
040616450316
040616450398
040616450397
040616390544
040616390541
040616450355
040616450356
040616390174
040616390278
040616390364
040616390362
040616430569
040616460353
040616460352
040616390549
040616390550
040616390552
040616390551
040616420556
040616430675
040616450257
06/04/20160090R03106160001103
06/04/20160090R03106160001104
06/04/20160090R03106160001105
06/04/20160090R03106160001105
06/04/20160090R03106160001106
06/04/20160090R03106160001106
06/04/20160090r03106160001108
06/04/20160090R03106160001109
06/04/20160090R03106160001109
06/04/20160090R03106160001110
06/04/20160090R03106160001110
06/04/20160090R03106160001112
06/04/20160090R03106160001112
06/04/20160090R03106160001113
06/04/20160090R03106160001113
06/04/20160090R03106160001115
06/04/20160090R03106160001116
06/04/20160090R03106160001116
06/04/20160090R03106160001118
06/04/20160090R03106160001118
06/04/20160090R03106160001119
06/04/20160090R03106160001119
06/04/20160090R03106160001120
06/04/20160090R03106160001120
06/04/20160090R03106160001121
06/04/20160090R03106160001121
06/04/20160090R03106160001122
06/04/20160090R03106160001122
06/04/20160090R03106160001123
06/04/20160090R03106160001125
06/04/20160090R03106160001130
06/04/20160090R03106160001130
06/04/20160090R03106160001131
06/04/20160090R03106160001132
06/04/20160090R03106160001132
06/04/20160090R03106160001133
06/04/20160090R03106160001133
06/04/20160090R03106160001133
06/04/20160090R03106160001133
06/04/20160090R03106160001135
06/04/20160090R03106160001136
06/04/20160090R03106160001138
Page 584
4 JUNI 2016
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
040616420626
040616420628
040616450329
040616390347
040616430588
040616450540
040616390621
040616390323
040616460319
040616390365
040616450412
040616450414
040616450373
040616450395
040616430689
040616420779
040616460410
040616390468
040616450475
040616450476
040616420542
040616430605
040616430604
040616420758
040616450816
040616450838
040616450839
040616430849
040616430847
040616450864
040616450874
040616390889
040616390899
040616390535
040616450189
040616390313
040616450138
040616450147
06/04/20160090R03106160001139
06/04/20160090R03106160001139
06/04/20160090R03106160001140
06/04/20160090R03106160001141
06/04/20160090R03106160001142
06/04/20160090R03106160001143
06/04/20160090R03106160001145
06/04/20160090R03106160001147
06/04/20160090R03106160001148
06/04/20160090R03106160001149
06/04/20160090R03106160001150
06/04/20160090R03106160001150
06/04/20160090R03106160001151
06/04/20160090R03106160001152
06/04/20160090R03106160001153
06/04/20160090R03106160001153
06/04/20160090R03106160001155
06/04/20160090R03106160001157
06/04/20160090R03106160001157
06/04/20160090R03106160001157
06/04/20160090R03106160001158
06/04/20160090R03106160001159
06/04/20160090R03106160001159
06/04/20160090R03106160001160
06/04/20160090R03106160001164
06/04/20160090R03106160001167
06/04/20160090R03106160001168
06/04/20160090R03106160001169
06/04/20160090R03106160001170
06/04/20160090R03106160001172
06/04/20160090R03106160001174
06/04/20160090R03106160001175
06/04/20160090R03106160001176
06/04/20160090R03106160001337
06/04/20160090R03106160001341
06/04/20160090R03106160001342
06/04/20160090R03106160007092
06/04/20160090R03106160007092
Page 585
4 JUNI 2016
NAMA PASIEN
TRANSAKSI
375,000.00
BAMBANG SUTARAM TN
198,000.00
138,600.00
DALHURI BIN MAT ALI TN
35,027.00
DZAKWAN HARIST AN.
15,650.00
1,812,900.00
ENIZA WULANDARI NN
27,100.00
JANNI BURHAN NY
60,000.00
108,200.00
MISKIYAH BINTI SAIJO NY.
59,660.00
NURAINI BINTI IBRAHIM L NY
218,000.00
250,200.00
NYAYU HALIMAH NN.
219,000.00
78,000.00
330,000.00
RAKA HERIYADI AN
107,384.00
RICKY RIANSYAH AN.
14,114.00
132,900.00
SAMSILAWATI BINTI USMAN NY
35,388.00
243,000.00
YULIANA BINTI ABDURAHMAN NY
18,000.00
YUSUF USMAN TN
135,000.00
M. HUSEIN SAID,H TN.
54,600.00
SULIYASWATI BINTI SUGYANTO N
60,000.00
INDAH MEGAWATI NY
89,000.00
MARSUAN TN.
60,000.00
60,000.00
115,000.00
40,000.00
159,988.00
102,400.00
M. AFRIZAL TN
97,794.00
SHOFWAN TN.
125,000.00
SHOFWAN TN.
10,000.00
KAROLINA NY.
10,000.00
KAROLINA NY.
177,000.00
E. SIMATUPANG TN
10,000.00
E. SIMATUPANG TN
125,000.00
10,000.00
ZAIDAN ACHMAD TN.
125,000.00
JACUB RAHMAN TN.
10,000.00
Page 586
4 JUNI 2016
JACUB RAHMAN TN.
EMMY YAHIMI NY
EMMY YAHIMI NY
NASRUN BASRI TN
NASRUN BASRI TN
SOFIA AZZAHRA AN.
HARBEI PASAH TN
SULAIMAN NADEAK TN.
SULIYEM BINTI TONDO SUROYO
SAIFUL NURAINI TN.
SAIFUL NURAINI TN.
OKTA SAPUTRA TN
OKTA SAPUTRA TN
NOPA ROSETA NN.
NOPA ROSETA NN.
GHANI ALFARIZI AN.
160,000.00
10,000.00
137,000.00
160,000.00
10,000.00
890,000.00
10,000.00
160,000.00
160,000.00
10,000.00
10,000.00
160,000.00
1,192,000.00
160,000.00
10,000.00
890,000.00
10,000.00
160,000.00
890,000.00
115,000.00
890,000.00
890,000.00
160,000.00
10,000.00
115,000.00
160,000.00
10,000.00
160,000.00
10,000.00
10,000.00
95,000.00
10,000.00
177,000.00
125,000.00
10,000.00
10,000.00
177,000.00
160,000.00
10,000.00
160,000.00
10,000.00
124,650.00
Page 587
4 JUNI 2016
GHANI ALFARIZI AN.
AZWAWI KERIT TN
AZWAWI KERIT TN
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
IMAM VIRANDA TN
DEVI AWALIA NY
DEVI AWALIA NY
MUCHTAR TS TN
MUCHTAR TS TN
BETIN TEGUH NY.
BETIN TEGUH NY.
BASRI INTIP, DRS TN
KARTINI NY
KARTINI NY
EDY ABDULLAH TN
ROHAINA HJ, NY.
ROHAINA HJ, NY.
SAID SALIM TN
SAID SALIM TN
ERWIN AZHARI TN.
NICKY VERDIANTO TN.
MUHAMMAD ALI TN.
10,000.00
110,000.00
160,000.00
10,000.00
10,000.00
160,000.00
60,000.00
137,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
10,000.00
160,000.00
110,000.00
160,000.00
10,000.00
102,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
102,000.00
10,000.00
10,000.00
160,000.00
226,400.00
120,000.00
160,000.00
10,000.00
890,000.00
160,000.00
10,000.00
10,000.00
160,000.00
160,000.00
10,000.00
890,000.00
890,000.00
58,800.00
Page 588
4 JUNI 2016
AS AD SAYUTI DRS TN
AS AD SAYUTI DRS TN
RIO ABDILLAH AN
RUSNAN CHANDRA TN
MISKIYAH BINTI SAIJO NY.
M. BAYU SAPUTRA AN.
AULIA RAHMAN TN.
M. FAHRY MAIZA AN.
M. KEYSAR AIDIL AN.
NAILAH DINNIA ADAWIYYAH AN.
NURAINI BINTI IBRAHIM L NY
DWI ANGGRAINI NY
DWI ANGGRAINI NY
MURTI UMIATSIH NY.
DZAKWAN HARIST AN.
MESYIL NN
SUMARTINI NY
ENDANG SUTISNA TN
ISMAN HADI TN.
ZAHRA AMIRA RAHMANI AN.
M KHAIZURAN ZAMKA AN
RANDI SENATRA TN.
M. AZZAM FATHURRAHMAN AN.
SRI EVA SIMANGUNSONG NY.
TEGUH BIN HOKSAN TN
ZULHAYATI ALWIN NY.
ZULHAYATI ALWIN NY.
10,000.00
167,000.00
120,000.00
110,000.00
890,000.00
895,000.00
890,000.00
110,000.00
174,400.00
110,000.00
10,000.00
160,000.00
202,534.00
110,000.00
110,000.00
154,400.00
96,680.00
167,655.00
10,000.00
190,000.00
86,940.00
180,000.00
40,000.00
80,800.00
154,400.00
148,500.00
144,000.00
138,900.00
138,900.00
171,300.00
163,400.00
129,941.00
149,084.00
96,628.00
147,900.00
1,192,000.00
10,000.00
160,000.00
Page 589
5 JUNI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
050616420119
050616420121
050616390250
050616420177
050616390184
050616390263
050616420122
050616420123
050616420089
050616430202
050616420125
050616420126
050616420117
050616390013
050616390052
050616390049
050616420100
050616420091
050616420081
050616420090
050616420093
050616420095
050616420176
050616420170
050616390051
050616390012
050616390015
050616390032
050616390027
050616390035
050616390040
050616390082
050616420109
050616390165
050616390185
050616430190
050616390192
050616390198
050616390217
050616430209
050616430216
TANGGAL
SEP
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/2016
00
06/05/20160090R03106160001161
06/05/20160090R03106160001177
06/05/20160090R03106160001178
06/05/20160090R03106160001179
06/05/20160090R03106160001180
06/05/20160090R03106160001181
06/05/20160090R03106160001182
06/05/20160090R03106160001184
06/05/20160090R03106160001185
06/05/20160090R03106160001187
06/05/20160090R03106160001188
06/05/20160090R03106160001189
06/05/20160090R03106160001190
06/05/20160090R03106160001191
06/05/20160090R03106160001193
06/05/20160090R03106160001194
06/05/20160090R03106160001199
06/05/20160090R03106160001200
06/05/20160090R03106160001202
06/05/20160090R03106160001204
06/05/20160090R03106160001205
06/05/20160090R03106160001206
06/05/20160090R03106160001207
06/05/20160090R03106160001207
06/05/20160090R03106160001208
06/05/20160090R03106160001209
Page 590
5 JUNI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
050616390269
050616390268
050616390288
050616430307
050616430314
050616430330
050616430344
050616390351
050616390363
050616390391
050616390390
050616390389
050616430339
050616420098
050616420084
050616390249
06/05/20160090R03106160001210
06/05/20160090R03106160001211
06/05/20160090R03106160001212
06/05/20160090R03106160001213
06/05/20160090R03106160001216
06/05/20160090R03106160001222
06/05/20160090R03106160001223
06/05/20160090R03106160001224
06/05/20160090R03106160001228
06/05/20160090R03106160001230
06/05/20160090R03106160001231
06/05/20160090R03106160001232
06/05/20160090R03106160001317
06/05/20160090R03106160001318
06/05/20160090R03106160001322
06/05/2016
Page 591
5 JUNI 2016
NAMA PASIEN
AS AD SAYUTI DRS TN
ILAL YATI NY.
M. THOYIB HADI TN.
M. THOYIB HADI TN.
MUHAMMAD NURDIN TN.
NINA PRATIWI NY
SAMUDIN TN.
SOEPRAPTO TN.
ZAHRA AMIRA RAHMANI AN.
ZUBER HUSIN TN
ZURIAH,HJ NY.
SITI NURBAYA NY
DUWI PARAWATI NN
MOH.MAQQON TN.
DWI INDAH JUNIARTI NY
HARYATI BINTI SARWANI NN
NOPI APRIANTI NY
ZANAWATY NY.
GUNADI WAHAB TN.
ERLINA BINTI M. YAKUB NN
ROSILA BINTI DUMYATI NN
TIARA MARETA PRAHARSINI NN
HERU ISKANDAR TN
SHAKIRA EVELYNE P AN.
M. A RAFI KURNIAWAN AN
R. ISKANDAR LANDUT, SH TN
SUSILO TN
RESINTA BUTAR BUTAR NY
M. ALI NAWAWI TN.
KAISA AFIQAH KHAIRANAA AN.
KAISA AFIQAH KHAIRANAA AN.
EVA SORAYA HASTRI NY.
DESTI HUMAIRAH NY
TRANSAKSI
129,000.00
1,282,500.00
459,000.00
1,248,900.00
108,200.00
6,600.00
626,400.00
50,400.00
78,300.00
472,200.00
103,200.00
700,500.00
43,941.00
129,000.00
28,000.00
173,216.00
155,105.00
187,800.00
380,000.00
333,962.00
258,370.00
278,686.00
159,484.00
157,133.00
104,580.00
42,340.00
166,949.00
92,400.00
109,430.00
110,770.00
56,201.00
81,700.00
174,400.00
228,323.00
85,866.00
154,020.00
88,000.00
484,889.00
21,500.00
75,178.00
112,600.00
Page 592
5 JUNI 2016
M. ALIF AL FAREZI AN.
M KHAIZURAN ZAMKA AN
MARIAM LUSIDA, HJ NY.
DARMADI BIN MATNUR TN
FATIMAH BINTI ABDUL MAJID NY.
M. YUSUF MAULANA AN
SRI ANDRIANI NY.
KHANSA NAZIFA RAMADHANI AN.
MAULANA BIN M. IDRUS TN
ZAINURI,SPD BIN HATTA TN
MASNAH NY.
JAYANTHI MANDASARI N. NY
SUSILO TN
124,240.00
102,400.00
176,830.00
47,000.00
125,700.00
229,550.00
40,000.00
56,341.00
102,800.00
149,400.00
93,010.00
49,392.00
214,400.00
161,178.00
188,500.00
298,500.00
Page 593
6 JUNI 2016
NO
NO RJ
060616390139
060616450004
060616450852
060616280857
060616430469
060616460526
060616280924
060616390022
060616450556
060616390116
060616430036
060616390140
060616390501
060616430362
060616430209
060616420753
060616450481
060616430348
060616450008
060616450090
060616450074
060616390021
060616450042
060616450039
060616450028
060616450024
060616450014
060616450030
060616450049
060616450047
060616450453
060616450068
060616450050
060616450051
060616430349
060616430368
060616450060
060616450413
060616450058
060616450056
060616450096
TANGGAL
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
SEP
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
0090R03105160007914
0090R03105160007914
0090R03106160000773
0090R03106160001233
0090R03106160001234
0090R03106160001235
0090R03106160001236
0090R03106160001237
0090R03106160001240
0090R03106160001241
0090R03106160001241
0090R03106160001242
0090R03106160001243
0090R03106160001244
0090R03106160001244
0090R03106160001246
0090R03106160001247
0090R03106160001248
0090R03106160001249
0090R03106160001250
0090R03106160001250
0090R03106160001251
Page 594
6 JUNI 2016
060616450092
060616390207
060616420606
060616430354
060616420705
060616450054
060616450055
060616450045
060616430120
060616430119
060616390490
060616390489
060616430089
060616430098
060616390208
060616450101
060616450097
060616430182
060616430180
060616450225
060616450228
060616430037
060616390176
060616390173
060616450073
060616430175
060616430179
060616450052
060616430198
060616430197
060616450248
060616390205
060616390206
060616430256
060616430255
060616450736
060616450737
060616390088
060616390187
060616390188
060616460613
060616460598
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
06/06/2016
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Page 602
6 JUNI 2016
NAMA PASIEN
DIANA ABIKUSNO NY
DIANA ABIKUSNO NY
DINDAN RIZKIKA JULIANI AN.
ERI SYAFRANTO TN.
JUNAIDI HASAN TN.
M. FARHAN ADHIRAJASA AN
MAIZATUZZAHRO NY.
MARTINI THAMRIN NY
NOVI YANTI NY
R NAPITUPULU NY
SAZILI SULAIMAN TN
TISNALIA NY.
YAHUMI ZAHRI TN
INDRAYANTA TN
PARIS PRATAMA TN.
M. ILHAM ANDRIANSYAH AN
IRYANTO ASYIK TN.
RIAHTA VALENTINA NY.
MARINA BINTI H A RIVAI NY
LIM KOEIJ ING NY
DAVID ISKANDAR TN
PUTRO SETYONO TN
RONIMAH NY
RONIMAH NY
TRANSAKSI
320,970.00
267,000.00
20,020.00
35,030.00
5,190.00
28,000.00
18,000.00
249,000.00
8,475.00
10,000.00
28,000.00
300,570.00
29,900.00
5,600.00
155,970.00
52,700.00
28,000.00
61,000.00
129,000.00
160,000.00
10,000.00
187,450.00
47,560.00
73,453.00
254,464.00
84,300.00
257,218.00
258,345.00
160,000.00
10,000.00
1,115,160.00
165,000.00
10,000.00
160,000.00
1,192,000.00
120,000.00
396,195.00
1,192,000.00
160,000.00
10,000.00
177,000.00
Page 603
6 JUNI 2016
KALSUM IBRAHIM NY.
KALSUM IBRAHIM NY.
INDRAYANTA TN
INDRAYANTA TN
ZUBIR A JALIL TN.
ZUBIR A JALIL TN.
SARDJONO, H TN
SARDJONO, H TN
NETI SUSANTI NY.
ISTIANA BINTI ABDULLAH S NY.
A. SANUSI TN
SUYADI H. TN
FATMAWATI BINTI ISMAIL NY
RUSMIDIUS NY.
RUSMIDIUS NY.
10,000.00
195,200.00
120,000.00
1,192,000.00
223,800.00
10,000.00
160,000.00
94,700.00
160,000.00
10,000.00
160,000.00
10,000.00
10,000.00
125,000.00
102,200.00
160,000.00
10,000.00
160,000.00
10,000.00
10,000.00
160,000.00
61,680.00
160,000.00
10,000.00
60,000.00
10,000.00
160,000.00
121,600.00
160,000.00
10,000.00
1,243,000.00
10,000.00
160,000.00
160,000.00
10,000.00
10,000.00
160,000.00
100,050.00
10,000.00
95,000.00
125,000.00
10,000.00
Page 604
6 JUNI 2016
NURLIANA SALIM NY
NURLIANA SALIM NY
JAP DJIT SING TN
INNA MARTINI NY.
HO LI IN NY
HO LI IN NY
DIAN EKAWATI NY
ARSENIO CETTA AN.
SYARIFUDIN BIN KARDINI TN
AZHARI BSC TN.
AZHARI BSC TN.
FERDI CANDRA PERMANA AN.
SITI FARIDAH NY.
MAIZATUZZAHRO NY.
MEIRITA RUSLIE NY.
MEIRITA RUSLIE NY.
M. RAFIE KHAIRY AN
ARIFIN SITOHANG TN.
ARIFIN SITOHANG TN.
SITI AMINAH NY.
AYU KUSUMANINGSIH NN
MARHAM EFFENDI TN
SAZILI SULAIMAN TN
MEIDI YUSRI, MS TN
TUMIAR SILABAN NY.
SUDARMAN TN
YULI HELYANI NY.
10,000.00
160,000.00
236,800.00
200,000.00
10,000.00
315,268.00
890,000.00
10,000.00
160,000.00
188,000.00
188,000.00
10,000.00
160,000.00
225,920.00
168,733.00
247,200.00
181,280.00
160,000.00
10,000.00
214,800.00
704,520.00
160,000.00
10,000.00
161,800.00
228,000.00
263,340.00
10,000.00
160,000.00
120,000.00
160,000.00
10,000.00
156,700.00
225,585.00
606,630.00
60,000.00
488,800.00
166,050.00
454,400.00
264,800.00
376,000.00
587,450.00
262,735.00
Page 605
6 JUNI 2016
RAPIKA MAHARANI NN
MARIANA NY
MARIANA NY
SAPTO BIN ALI TN.
NOVI YANTI NY
YULIA DASWATI NY.
YULIA DASWATI NY.
ISNAINI HAFIDZON NN
ONGKY PRASTIANTO B TN
M.NIZAM FAHREZI AN
RUSLENA BINTI M.ROZAK NY
RYANI SIMORANGKIR NY
ANGGA ARDIANSYAH TN
BOY D.J MAKADADA TN
RISMALA KESUMA NY
WILLY WIJAYA TN.
MARIA ILYAS NY
RUDIANTO BIN NAWAWI YUNUS TN
AHMAD RIFAI TN.
RUKIATI BINTI SULAI NY.
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
YAHYA AZKIN TN.
AXEL MANIK AN.
ASRIL UDIN TN.
OEY LAY OA NY
ARBAIN BIN HASAN TN
SITI NURMA NY.
FAUSTINA BUDIYATI NN.
287,485.00
10,000.00
160,000.00
188,000.00
102,000.00
10,000.00
180,000.00
142,400.00
194,400.00
279,272.00
160,000.00
10,000.00
166,832.00
315,572.00
10,000.00
160,000.00
104,181.00
10,000.00
160,000.00
407,852.00
60,000.00
228,000.00
472,000.00
325,285.00
194,400.00
275,840.00
10,000.00
160,000.00
264,000.00
165,500.00
512,000.00
223,200.00
160,000.00
10,000.00
285,255.00
104,266.00
1,276,520.00
60,000.00
255,068.00
138,970.00
191,000.00
182,717.00
Page 606
6 JUNI 2016
DIANA HASTINI NY.
JANSEN SIRAIT TN.
JANSEN SIRAIT TN.
CHERRY LEMBEK TN.
ARLIN DORISTA NY.
AMINAH BINTI SUKARMAN NY
SRI YANTI NY.
ST. SUHARSYAH BAHAR TN
PUJI ASTUTI NY
PUJI ASTUTI NY
NETTI BINTI A.BADARUDDIN NY.
ASMAH ABDULLAH NY.
ENI WARDANI NY.
TISNALIA NY.
HARNING SYAHDA NY.
SETIA WATI NY
SETIA WATI NY
ASKURNI APSA TN.
INDRA SETIAWAN TN
SYAMSUL ARIF TN
SYAMSUL ARIF TN
RA FARIDA NY.
RA FARIDA NY.
R NAPITUPULU NY
INDRA SANDI TN
JUARIAH BINTI SUPARTI NY.
DESI BINTI SANGKUT NY
ALMAPIS SUDUR TN
SEPTI MARINDA NY
NYIMAS ATHIYYAH FAIHA A AN
MARITA RAMIANTI NY.
DESY MAULIA NN.
201,200.00
80,370.00
125,000.00
10,000.00
165,110.00
67,100.00
488,200.00
264,800.00
257,500.00
160,000.00
10,000.00
121,090.00
224,800.00
219,600.00
213,585.00
101,350.00
234,830.00
234,600.00
234,400.00
423,000.00
160,000.00
10,000.00
160,000.00
10,000.00
60,000.00
170,710.00
125,000.00
10,000.00
160,000.00
10,000.00
137,852.00
488,200.00
232,090.00
283,985.00
119,451.00
85,200.00
304,600.00
233,585.00
234,400.00
365,200.00
880,000.00
130,252.00
Page 607
6 JUNI 2016
R. BACHARDEAN H TN
RISKY AMELIA PRASTIWI NY.
ENI PUSRI NY.
FATIMAH BINTI MAHMUD NY.
SUKEMI H BIN JUMADI TN
AMIR HAMZAH TN
ABDUL MUNAF TN
M. FERI HERIYANTO TN
CANDRA DOAN TN.
ZAIDAN ACHMAD TN.
SRY SUSANTI DIANA NY
M. FARHAN ADHIRAJASA AN
PARIS PRATAMA TN.
ELIA YUNIARTI NY.
MUSDALIFAH ADAWIYAH AN
WIDIHARTI BINTI NASIHIN NY
YOSSI SHOPIANA NY
HARIS FADILA TN
SAMSU AMAR TN.
FADILA SARI NN.
NOVITA ASRIANI NN
RAKHMAN M. NUR TN
HAMIDA BINTI BURHANI NY.
DIAH TRI WINARSIH NN.
BS. BAIDHOWIE TN
MELLYFIANY NY.
194,380.00
207,585.00
338,500.00
180,500.00
595,700.00
123,450.00
74,000.00
241,650.00
212,350.00
129,450.00
110,000.00
91,620.00
890,000.00
156,166.00
194,400.00
220,914.00
240,800.00
102,000.00
10,000.00
146,176.00
119,634.00
60,000.00
58,230.00
107,450.00
234,400.00
99,450.00
76,000.00
60,000.00
199,770.00
60,000.00
60,000.00
98,500.00
126,500.00
890,000.00
836,181.00
60,000.00
890,000.00
60,000.00
1,192,000.00
423,500.00
60,000.00
83,000.00
Page 608
6 JUNI 2016
HENDRY RIANTO TN
HASRI TANJUNG H TN.
HASRI TANJUNG H TN.
GUNA DHARMA TN
IRYANTO ASYIK TN.
ABDULLAH MASUD TN
AMIR HAMZAH TN
OKY MARSELINA NY.
TITIEH TRI KUSUMA W NY
NURHAYATI BINTI JAMAIN NY
BUSTARI TN.
DERMAWAN ASITO TN
LISIANA OSWARI NN.
ACHMAD MAULANA,H TN
TRI ARYANI NY.
MULYADI HARTONO TN
MISDALAILA BINTI ARIPAI NY
FARIDA BINTI ROMUZUN NY
HAMIDIAH NY.
DJALILI SOLIHIN TN
ROHILAH BINTI IBRAHIM NY
ASWARI TN
HUSNA INTAN NY.
TONI YULIZAR TN.
SILVIA NOVIANI NN.
MUHAMMAD JAUHARI TN
AFIQA DWINSA PUTERI AN
CARISSA ADELIA AN.
HUSNI THAMRIN TN
890,000.00
167,000.00
50,000.00
122,906.00
60,000.00
127,950.00
155,000.00
410,500.00
60,000.00
98,200.00
180,000.00
146,400.00
60,000.00
890,000.00
134,100.00
253,700.00
60,000.00
890,000.00
327,000.00
209,800.00
213,585.00
161,950.00
415,600.00
480,012.00
60,000.00
225,000.00
60,000.00
100,125.00
280,378.00
274,200.00
488,200.00
138,000.00
120,000.00
112,695.00
160,000.00
10,000.00
10,000.00
160,000.00
210,741.00
236,560.00
110,000.00
228,000.00
Page 609
6 JUNI 2016
SYUKRI MUBARAK TN.
HELMIDA DAMANIK NY
MAYA KARTIKA NN.
MURNIATI BINTI KASMAN NY.
NASRUN BASRI TN
NASRUN BASRI TN
HARNATI BINTI HAJRI NY
GONDO PONIMIN TN
LENI APRIYANTI NY
M. TAUFIK TN.
ELIS SUNDARI NY
YUNIZAR BINTI HAROMAN NY
SYAIFULLAH BIN SATA TN
FARIDA BINTI A. ZAHRI NY
JOVIAN ALVIANO AN.
MAUREEN ANGELICA BASRI AN
MICHELLE BASRI AN
HERMANSYAH TN
LINA WATY NY
M. TOIS TANDA JAYA TN.
AS AD SAYUTI DRS TN
ARYANTO TN.
ERNA KURNIATY NY.
10,000.00
160,000.00
66,600.00
213,585.00
60,000.00
189,400.00
92,100.00
10,000.00
160,000.00
233,000.00
429,075.00
242,700.00
311,781.00
242,750.00
16,000.00
163,200.00
489,200.00
440,600.00
561,900.00
488,200.00
69,700.00
60,000.00
10,000.00
125,000.00
110,000.00
60,000.00
222,000.00
222,000.00
222,000.00
222,000.00
470,200.00
738,898.00
122,400.00
60,000.00
78,550.00
60,000.00
188,130.00
136,300.00
181,920.00
10,000.00
102,000.00
193,200.00
Page 610
6 JUNI 2016
WIDIYA GUNAWAN NY.
ANDRI JAYA TN.
SUWARDY BIN TJAN TJU KIANG TN
SRI INDRAWATI NY.
SITI AISYAH NY.
JUSRIZAL RUSLAN TN
APENDI BIN KORI TN.
MUHAMMAD ARIF TN
DESSY SURYANI NN.
NOVI CAHYADI TN
ARIVAN AMIR TN.
DIANA ABIKUSNO NY
NYIMAS AMNAH NY
NAHDIAH NY.
ERI SYAFRANTO TN.
A. RAHMAN H,BBA. TN
JUWITA KUSUMAWATI NY.
RYAN ARANA DZAKI DANISWARA AN
AMRINA ROSYADAH NN
M. HUSAINI TN
LADY SHAINA RIFKALINDA AN.
EKA TRI SUSANTI, SH NY.
FARIDA NY.
KALFIN LEKALFI AL KAUSAR AN.
AQILAH KHAIRUNNISA AN
RUBIYAH BINTI H.M YUSUF NY
YUNALNI NY.
MIKHAEL RUKINEM NY.
180,000.00
83,954.00
244,100.00
425,400.00
253,700.00
271,700.00
83,200.00
87,300.00
176,800.00
146,400.00
384,200.00
356,000.00
86,550.00
60,000.00
470,200.00
609,200.00
283,685.00
72,000.00
304,245.00
79,450.00
579,200.00
104,400.00
318,351.00
225,000.00
140,000.00
91,764.00
121,750.00
170,880.00
154,464.00
54,652.00
232,525.00
192,482.00
122,781.00
166,370.00
60,000.00
890,000.00
Page 611
7 JUNI 2016
NO
NO RJ
070616430453
070616450028
070616390250
070616430288
070616450813
070616450025
070616450029
070616450834
070616430433
070616280781
070616430438
070616450727
070616390443
070616450186
070616460774
070616390291
070616450850
070616450748
070616430401
070616280877
070616460772
070616450663
070616450184
070616450019
070616450140
070616450157
070616450319
070616430286
070616390009
070616450017
070616450022
070616450031
070616390076
070616390075
070616390198
070616450047
070616450046
070616390391
070616390150
070616390062
070616390148
TANGGAL
SEP
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/2016
00
06/07/20160090R03106160000171
06/07/20160090R03106160001596
06/07/20160090R03106160001602
06/07/20160090R03106160001604
06/07/20160090R03106160001605
06/07/20160090R03106160001606
06/07/20160090R03106160001607
06/07/20160090R03106160001608
06/07/20160090R03106160001609
06/07/20160090R03106160001610
06/07/20160090R03106160001611
06/07/20160090R03106160001611
06/07/20160090R03106160001612
06/07/20160090R03106160001613
06/07/20160090R03106160001613
06/07/20160090R03106160001614
06/07/20160090R03106160001615
06/07/20160090R03106160001616
06/07/20160090R03106160001617
Page 612
7 JUNI 2016
070616390135
070616390134
070616390176
070616430363
070616450034
070616450033
070616390109
070616450055
070616450054
070616390104
070616450057
070616450056
070616390112
070616450756
070616450265
070616450065
070616450063
070616390116
070616450051
070616390129
070616390131
070616390125
070616450089
070616450083
070616390226
070616390248
070616390101
070616390099
070616390095
070616450039
070616450136
070616450133
070616390137
070616450142
070616390146
070616390143
070616450021
070616390253
070616450230
070616450233
070616450040
070616390114
06/07/20160090R03106160001618
06/07/20160090R03106160001618
06/07/20160090R03106160001619
06/07/20160090R03106160001620
06/07/20160090R03106160001621
06/07/20160090R03106160001621
06/07/20160090R03106160001622
06/07/20160090R03106160001623
06/07/20160090R03106160001623
06/07/20160090R03106160001624
06/07/20160090R03106160001625
06/07/20160090R03106160001625
06/07/20160090R03106160001626
06/07/20160090R03106160001627
06/07/20160090R03106160001628
06/07/20160090R03106160001629
06/07/20160090R03106160001629
06/07/20160090R03106160001630
06/07/20160090R03106160001631
06/07/20160090R03106160001632
06/07/20160090R03106160001632
06/07/20160090R03106160001633
06/07/20160090R03106160001634
06/07/20160090R03106160001634
06/07/20160090R03106160001635
06/07/20160090R03106160001636
06/07/20160090R03106160001637
06/07/20160090R03106160001637
06/07/20160090R03106160001638
06/07/20160090R03106160001639
06/07/20160090R03106160001640
06/07/20160090R03106160001640
06/07/20160090R03106160001641
06/07/20160090R03106160001642
06/07/20160090R03106160001643
06/07/20160090R03106160001643
06/07/20160090R03106160001644
06/07/20160090R03106160001645
06/07/20160090R03106160001646
06/07/20160090R03106160001646
06/07/20160090R03106160001647
06/07/20160090R03106160001648
Page 613
7 JUNI 2016
070616450059
070616450159
070616450163
070616390287
070616390194
070616390195
070616390295
070616450045
070616450260
070616280656
070616280661
070616450043
070616390299
070616450097
070616390274
070616390087
070616450115
070616450221
070616450222
070616430331
070616430329
070616390259
070616390256
070616390308
070616390244
070616390243
070616450210
070616450277
070616450275
070616430509
070616430508
070616430335
070616450188
070616430399
070616450048
070616430468
070616450052
070616390160
070616390497
070616390496
070616450098
070616450526
06/07/20160090R03106160001649
06/07/20160090R03106160001650
06/07/20160090R03106160001651
06/07/20160090R03106160001652
06/07/20160090R03106160001653
06/07/20160090R03106160001653
06/07/20160090R03106160001654
06/07/20160090R03106160001655
06/07/20160090R03106160001656
06/07/20160090R03106160001657
06/07/20160090R03106160001657
06/07/20160090R03106160001658
06/07/20160090R03106160001659
06/07/20160090R03106160001660
06/07/20160090R03106160001662
06/07/20160090R03106160001663
06/07/20160090R03106160001664
06/07/20160090R03106160001665
06/07/20160090R03106160001665
06/07/20160090R03106160001666
06/07/20160090R03106160001667
06/07/20160090R03106160001668
06/07/20160090R03106160001668
06/07/20160090R03106160001669
06/07/20160090R03106160001671
06/07/20160090R03106160001671
06/07/20160090R03106160001672
06/07/20160090R03106160001673
06/07/20160090R03106160001673
06/07/20160090R03106160001674
06/07/20160090R03106160001674
06/07/20160090R03106160001675
06/07/20160090R03106160001676
06/07/20160090R03106160001677
06/07/20160090R03106160001678
06/07/20160090R03106160001679
06/07/20160090R03106160001680
06/07/20160090R03106160001681
06/07/20160090R03106160001682
06/07/20160090R03106160001682
06/07/20160090R03106160001683
06/07/20160090R03106160001684
Page 614
7 JUNI 2016
070616450527
070616450178
070616450218
070616390223
070616450173
070616390444
070616280535
070616280545
070616390297
070616390296
070616450175
070616390141
070616390270
070616430362
070616430354
070616390227
070616450138
070616450228
070616430369
070616430368
070616390126
070616390219
070616390276
070616450575
070616450121
070616450349
070616390177
070616450733
070616430311
070616430309
070616450145
070616430231
070616390120
070616450187
070616450203
070616450729
070616450209
070616450179
070616450168
070616390232
070616390139
070616450257
06/07/20160090R03106160001684
06/07/20160090R03106160001685
06/07/20160090R03106160001685
06/07/20160090R03106160001686
06/07/20160090R03106160001687
06/07/20160090R03106160001688
06/07/20160090R03106160001689
06/07/20160090R03106160001689
06/07/20160090R03106160001690
06/07/20160090R03106160001690
06/07/20160090R03106160001691
06/07/20160090R03106160001692
06/07/20160090R03106160001693
06/07/20160090R03106160001694
06/07/20160090R03106160001694
06/07/20160090R03106160001695
06/07/20160090R03106160001696
06/07/20160090R03106160001697
06/07/20160090R03106160001698
06/07/20160090R03106160001699
06/07/20160090R03106160001701
06/07/20160090R03106160001702
06/07/20160090R03106160001703
06/07/20160090R03106160001704
06/07/20160090R03106160001705
06/07/20160090R03106160001706
06/07/20160090R03106160001707
06/07/20160090R03106160001708
06/07/20160090R03106160001709
06/07/20160090R03106160001709
06/07/20160090R03106160001710
06/07/20160090R03106160001711
06/07/20160090R03106160001712
06/07/20160090R03106160001713
06/07/20160090R03106160001714
06/07/20160090R03106160001715
06/07/20160090R03106160001716
06/07/20160090R03106160001717
06/07/20160090R03106160001718
06/07/20160090R03106160001719
06/07/20160090R03106160001720
06/07/20160090R03106160001721
Page 615
7 JUNI 2016
070616450418
070616390359
070616430279
070616390220
070616390166
070616390339
070616390343
070616450242
070616390236
070616390334
070616450409
070616450181
070616450224
070616390255
070616460731
070616430300
070616390241
070616450340
070616450338
070616390315
070616450249
070616450267
070616450398
070616450397
070616430238
070616430239
070616450341
070616450342
070616390263
070616450345
070616390283
070616450278
070616460552
070616390306
070616390290
070616450373
070616450370
070616450281
070616430464
070616390273
070616450425
070616450421
06/07/20160090R03106160001722
06/07/20160090R03106160001725
06/07/20160090R03106160001728
06/07/20160090R03106160001730
06/07/20160090R03106160001731
06/07/20160090R03106160001732
06/07/20160090R03106160001732
06/07/20160090R03106160001734
06/07/20160090R03106160001735
06/07/20160090R03106160001736
06/07/20160090R03106160001738
06/07/20160090R03106160001738
06/07/20160090R03106160001739
06/07/20160090R03106160001740
06/07/20160090R03106160001741
06/07/20160090R03106160001742
06/07/20160090R03106160001743
06/07/20160090R03106160001744
06/07/20160090R03106160001744
06/07/20160090R03106160001745
06/07/20160090R03106160001746
06/07/20160090R03106160001747
06/07/20160090R03106160001748
06/07/20160090R03106160001748
06/07/20160090R03106160001749
06/07/20160090R03106160001749
06/07/20160090R03106160001750
06/07/20160090R03106160001750
06/07/20160090R03106160001751
06/07/20160090R03106160001753
06/07/20160090R03106160001754
06/07/20160090R03106160001755
06/07/20160090R03106160001756
06/07/20160090R03106160001757
06/07/20160090R03106160001758
06/07/20160090R03106160001760
06/07/20160090R03106160001760
06/07/20160090R03106160001761
06/07/20160090R03106160001763
06/07/20160090R03106160001764
06/07/20160090R03106160001765
06/07/20160090R03106160001765
Page 616
7 JUNI 2016
070616450632
070616390285
070616450492
070616450491
070616450621
070616450619
070616460798
070616390337
070616390298
070616390322
070616450429
070616450426
070616390307
070616450377
070616430348
070616460659
070616430293
070616390318
070616430683
070616430667
070616390183
070616450386
070616280579
070616430321
070616390396
070616430351
070616450393
070616450473
070616430445
070616430449
070616280597
070616460530
070616460784
070616450832
070616280568
070616460655
070616430646
070616450609
070616460536
070616460550
070616460525
070616430674
06/07/20160090R03106160001767
06/07/20160090R03106160001769
06/07/20160090R03106160001770
06/07/20160090R03106160001770
06/07/20160090R03106160001772
06/07/20160090R03106160001772
06/07/20160090R03106160001773
06/07/20160090R03106160001774
06/07/20160090R03106160001775
06/07/20160090R03106160001776
06/07/20160090R03106160001778
06/07/20160090R03106160001778
06/07/20160090R03106160001779
06/07/20160090R03106160001780
06/07/20160090R03106160001781
06/07/20160090R03106160001782
06/07/20160090R03106160001783
06/07/20160090R03106160001784
06/07/20160090R03106160001785
06/07/20160090R03106160001786
06/07/20160090R03106160001787
06/07/20160090R03106160001788
06/07/20160090R03106160001790
06/07/20160090R03106160001791
06/07/20160090R03106160001792
06/07/20160090R03106160001793
06/07/20160090R03106160001794
06/07/20160090R03106160001796
06/07/20160090R03106160001797
06/07/20160090R03106160001797
06/07/20160090R03106160001798
06/07/20160090R03106160001799
06/07/20160090R03106160001800
06/07/20160090R03106160001800
06/07/20160090R03106160001801
06/07/20160090R03106160001802
06/07/20160090R03106160001803
06/07/20160090R03106160001804
06/07/20160090R03106160001805
06/07/20160090R03106160001806
06/07/20160090R03106160001807
06/07/20160090R03106160001809
Page 617
7 JUNI 2016
070616280542
070616430726
070616280554
070616450704
070616430580
070616450643
070616450483
070616450487
070616430598
070616280618
070616450765
070616460586
070616450700
070616280702
070616430460
070616430458
070616280534
070616430470
070616430469
070616450050
070616450020
070616430471
070616390410
070616280540
070616450035
070616450036
070616450037
070616430452
070616450049
070616450066
070616430709
070616280549
070616450068
070616450524
070616450522
070616390102
070616450032
070616280574
070616280759
070616280800
070616450766
070616450520
06/07/20160090R03106160001810
06/07/20160090R03106160001811
06/07/20160090R03106160001812
06/07/20160090R03106160001813
06/07/20160090R03106160001814
06/07/20160090R03106160001816
06/07/20160090R03106160001818
06/07/20160090R03106160001818
06/07/20160090R03106160001819
06/07/20160090R03106160001820
06/07/20160090R03106160001822
06/07/20160090R03106160001823
06/07/20160090R03106160001824
06/07/20160090R03106160001825
06/07/20160090R03106160001826
06/07/20160090R03106160001826
06/07/20160090R03106160001827
06/07/20160090R03106160001828
06/07/20160090R03106160001828
06/07/20160090R03106160001829
06/07/20160090R03106160001830
06/07/20160090R03106160001831
06/07/20160090R03106160001832
06/07/20160090R03106160001833
06/07/20160090R03106160001834
06/07/20160090R03106160001835
06/07/20160090R03106160001836
06/07/20160090R03106160001837
06/07/20160090R03106160001838
06/07/20160090R03106160001839
06/07/20160090R03106160001840
06/07/20160090R03106160001841
06/07/20160090R03106160001842
06/07/20160090R03106160001843
06/07/20160090R03106160001843
06/07/20160090R03106160001844
06/07/20160090R03106160001845
06/07/20160090R03106160001846
06/07/20160090R03106160001847
06/07/20160090R03106160001848
06/07/20160090R03106160001849
06/07/20160090R03106160001852
Page 618
7 JUNI 2016
070616450543
070616430589
070616430584
070616450555
070616430711
070616430716
070616450563
070616430682
070616430679
070616460591
070616460660
070616460665
070616280672
070616460820
070616460815
070616450519
070616430728
070616460523
070616430503
070616460533
070616280547
070616280546
070616450777
070616460771
070616460770
070616430676
070616430638
070616280593
070616280675
070616430719
070616430717
070616460585
070616460583
070616460807
070616460811
070616460637
070616450553
070616280582
070616450755
070616450754
070616280615
070616450617
06/07/20160090R03106160001853
06/07/20160090R03106160001854
06/07/20160090R03106160001854
06/07/20160090R03106160001857
06/07/20160090R03106160001859
06/07/20160090R03106160001859
06/07/20160090R03106160001860
06/07/20160090R03106160001861
06/07/20160090R03106160001861
06/07/20160090R03106160001862
06/07/20160090R03106160001863
06/07/20160090R03106160001864
06/07/20160090R03106160001865
06/07/20160090R03106160001867
06/07/20160090R03106160001868
06/07/20160090R03106160001869
06/07/20160090R03106160001870
06/07/20160090R03106160001871
06/07/20160090R03106160001872
06/07/20160090R03106160001873
06/07/20160090R03106160001874
06/07/20160090R03106160001874
06/07/20160090R03106160001875
06/07/20160090R03106160001876
06/07/20160090R03106160001876
06/07/20160090R03106160001877
06/07/20160090R03106160001878
06/07/20160090R03106160001879
06/07/20160090R03106160001880
06/07/20160090R03106160001881
06/07/20160090R03106160001881
06/07/20160090R03106160001882
06/07/20160090R03106160001882
06/07/20160090R03106160001883
06/07/20160090R03106160001884
06/07/20160090R03106160001885
06/07/20160090R03106160001886
06/07/20160090R03106160001888
06/07/20160090R03106160001889
06/07/20160090R03106160001889
06/07/20160090R03106160001890
06/07/20160090R03106160001891
Page 619
7 JUNI 2016
070616280673
070616280799
070616430595
070616460862
070616280776
070616280742
070616450747
070616430695
070616430669
070616280603
070616280699
070616280662
070616450718
070616450819
070616450648
070616280712
070616450814
070616450751
070616460852
070616460863
070616280806
070616460847
070616450920
070616280913
070616450929
070616450932
070616280905
070616450838
070616450484
070616450018
070616280680
070616280684
070616390251
070616390446
070616450077
070616390081
06/07/20160090R03106160001892
06/07/20160090R03106160001893
06/07/20160090R03106160001894
06/07/20160090R03106160001897
06/07/20160090R03106160001898
06/07/20160090R03106160001899
06/07/20160090R03106160001900
06/07/20160090R03106160001901
06/07/20160090R03106160001902
06/07/20160090R03106160001903
06/07/20160090R03106160001904
06/07/20160090R03106160001906
06/07/20160090R03106160001907
06/07/20160090R03106160001908
06/07/20160090R03106160001909
06/07/20160090R03106160001910
06/07/20160090R03106160001911
06/07/20160090R03106160001912
06/07/20160090R03106160001914
06/07/20160090R03106160001915
06/07/20160090R03106160001916
06/07/20160090R03106160001922
06/07/20160090R03106160001926
06/07/20160090R03106160001927
06/07/20160090R03106160001928
06/07/20160090R03106160001988
06/07/20160090R03106160001993
06/07/20160090R03106160001995
06/07/20160090R03106160001999
06/07/20160090R03106160002115
06/07/20160090R03106160002120
06/07/20160090R03106160002120
06/07/20160090R03106160002123
06/07/2016
06/07/2016
06/07/2016
Page 620
7 JUNI 2016
NAMA PASIEN
AMRAN BIN ROHIB TN
EDY ZULKARNAIN TN.
EMELEYA SISKA NY.
FARIDA NY.
ISFAI IYAT TN.
M IHSAN AN.
MURNIATI BINTI KASMAN NY.
NUZRAL BOESTHAM. TN
RAMA SATRIYA TN
SUKIRMAN TN.
TJIKMAD. B TN.
YETTY MORINAGA NY
ZAWIYAH BINTI H. KODAR NY.
AINI LUTHFIYYAH NN
EKA DIANA PRATIWI NY
JIHAN MISHALL AURISKA AN.
DEDE A.RAHMAN S AN.
DIANA NOVITA NY
HERIYANTO TN
NYAYU HALIMAH NN.
ALI NURDIN TN.
LAM SURYA NY.
M. REZA DESFERINDO AN.
SUKIRMAN TN.
TRANSAKSI
273,750.00
81,000.00
30,500.00
61,000.00
32,000.00
1,095,420.00
330,000.00
223,000.00
8,300.00
669,000.00
41,800.00
172,000.00
101,360.00
96,000.00
135,000.00
45,000.00
155,970.00
8,000.00
39,100.00
3,250.00
23,550.00
40,800.00
157,256.00
150,390.00
172,420.00
55,348.00
1,192,000.00
890,000.00
221,394.00
890,000.00
240,800.00
240,800.00
125,000.00
10,000.00
356,370.00
160,000.00
10,000.00
516,500.00
232,657.00
128,287.00
378,000.00
Page 621
7 JUNI 2016
DEVI AWALIA NY
DEVI AWALIA NY
ZAIDAN ACHMAD TN.
ZAIDAN ACHMAD TN.
JACUB RAHMAN TN.
JACUB RAHMAN TN.
ZAHRI ZAINURI TN
ACHMAD MAULANA,H TN
APENDI BIN KORI TN.
EMMY YAHIMI NY
EMMY YAHIMI NY
MARHAMAH BINTI MUNIR NY.
ZULHAYATI ALWIN NY.
ZULHAYATI ALWIN NY.
TRISTIANA NY.
TITIN KUSMETA NY.
TITIN KUSMETA NY.
YULITA HANDINI IRA W NY.
RAMANG BIN PADUKABAH TN
AMALIA MAHARANI AN.
AMALIA MAHARANI AN.
RAMA SATRIYA TN
WALANG POTOK NY
SHINTA HASANA NY.
SHINTA HASANA NY.
SITI BINTI SIDIK NY
JULIANA KOWIRA NY.
160,000.00
10,000.00
319,516.00
890,000.00
125,000.00
10,000.00
147,315.00
160,000.00
10,000.00
109,950.00
137,000.00
10,000.00
218,000.00
110,000.00
213,050.00
160,000.00
10,000.00
60,000.00
138,000.00
10,000.00
160,000.00
87,660.00
160,000.00
10,000.00
154,000.00
60,000.00
160,000.00
10,000.00
262,000.00
260,400.00
160,000.00
10,000.00
1,591,750.00
158,000.00
50,000.00
10,000.00
174,800.00
283,020.00
10,000.00
125,000.00
214,800.00
84,660.00
Page 622
7 JUNI 2016
FITRIYANTI BINTI M. YASIN NY
NOVIYANTI NY.
ALIDUN SIHOMBING TN
SRI MULYATI NY
KARIMIN TN
LIU HENDRY TN.
PARIS PRATAMA TN.
FITRI JUWITA NY
NILA ANDRAINI NY.
KEVIN DESPERADOPPH AN.
ASMAH ABDULLAH NY.
DJALILI SOLIHIN TN
DJALILI SOLIHIN TN
SUNADIA HJ NY.
MUHAMMAD SAAN TN
SAIFUL NURAINI TN.
SAIFUL NURAINI TN.
SUMARNI BINTI YUSRI NY
EDISON SIANTURI TN.
OKTA SAPUTRA TN.
SUKANTO KESUMAH TN
SINTIA CAROLIN AN
SIDIK BIN DAKUM TN
SYIFA ALMIRA AN
MAMAT SADI TN.
311,950.00
80,415.00
120,610.00
379,275.00
10,000.00
160,000.00
563,100.00
134,880.00
166,614.00
160,000.00
10,000.00
512,000.00
204,750.00
587,600.00
69,000.00
114,130.00
121,024.00
10,000.00
160,000.00
144,500.00
78,550.00
95,000.00
10,000.00
188,350.00
125,000.00
10,000.00
60,000.00
160,000.00
10,000.00
125,000.00
10,000.00
1,192,000.00
158,500.00
890,000.00
202,580.00
60,000.00
115,000.00
60,000.00
160,000.00
10,000.00
204,180.00
10,000.00
Page 623
7 JUNI 2016
M. FAIZ IRFAN UTAMA AN.
FARHAN ALMADILA MUHAMMAD AN.
INDRA SANDI TN
KMS EFFENDY TN.
KMS EFFENDY TN.
TITIN SURYANI. NY
MOHD DAIM DRS TN.
DIAN SAFIRA AN
SITI AISYAH NY.
YULITA MARNI NY.
PONIATI BINTI SUBARTO NY.
AZHAR RUMAWIE TN.
RITA ARSYAD NY.
MAMAN SUPARMAN TN.
TJIE GOEI SIOE NY
RAHULLA HUANG AN.
RIKA DWI AFRIANI NN.
PONIYEM BINTI SUTOYO NY.
MARIA ESTETI NY.
NOVI ARIANI NY
GABRIELA YELLANDA NY.
GHANI ALFARIZI AN.
LIDYA SISCA NY.
RITA ZAHARA NY.
YUDITH ANGGRIANI NY
ANDRY OKRIANTO TN.
SYAIFUL ANWAR TN
ABU BAKAR AHMAD TN.
M. DIO KASYAFANI AN.
160,000.00
234,400.00
253,800.00
174,171.00
890,000.00
296,960.00
125,000.00
10,000.00
137,000.00
10,000.00
97,050.00
199,764.00
306,370.00
160,000.00
10,000.00
271,520.00
114,130.00
344,615.00
357,920.00
809,150.00
60,000.00
141,791.00
94,762.00
120,000.00
125,390.00
310,800.00
128,350.00
352,745.00
160,000.00
10,000.00
635,185.00
234,400.00
1,162,000.00
265,410.00
161,050.00
233,000.00
120,000.00
240,800.00
472,000.00
157,600.00
135,070.00
258,484.00
Page 624
7 JUNI 2016
AMINAH BINTI SUKARMAN NY
EDDI AZ TN.
UDIN BIN AMIT TN.
EDY ZULKARNAIN TN.
ROHAINA HJ, NY.
ROHAINA HJ, NY.
ALJABAR SEMBIRING TN.
M.RIFKY SYAHRAZI AN.
HERMILAH BINTI CHOIRUL NY
YETTY MORINAGA NY
YETTY MORINAGA NY
NURDEWA BINTI ZEN H NY
MANTHO HARUN TN
FITRI YULIANTY NY
MUCHTAR TS TN
MUCHTAR TS TN
TIMURATINI S SOS NY
M. HABIBI PRATAMA AN.
HANIFAH ANDINI C AN
HANIFAH ANDINI C AN
ENDANG KUSNANINGSIH NY.
RISDIA WATI NY.
EMELEYA SISKA NY.
INDAH MEGAWATI NY
WINDA WIDIANTI NY.
TRISITA ETA NY.
RINCE CAROLINA NY.
TAHIR MANURUNG TN
APRI SUSANTI NY.
M ILMAN NAFIA AN.
TJIKNUT SYUKUR NY
TJIKNUT SYUKUR NY
146,000.00
70,000.00
180,000.00
156,720.00
48,895.00
10,000.00
160,000.00
118,198.00
249,000.00
635,185.00
133,996.00
174,400.00
158,500.00
105,000.00
110,000.00
245,360.00
115,000.00
102,000.00
10,000.00
193,585.00
194,400.00
152,168.00
102,000.00
10,000.00
73,200.00
50,000.00
10,000.00
125,000.00
193,585.00
193,585.00
227,362.00
501,600.00
488,200.00
504,500.00
488,200.00
160,000.00
10,000.00
76,460.00
60,000.00
131,510.00
160,000.00
10,000.00
Page 625
7 JUNI 2016
ANI HASAN NY
RIKA ARIANTI NY
SAID SALIM TN
SAID SALIM TN
EKI EVI NOVITASARI NY
M IHSAN AN.
HOTMA SIMANUNGKALIT TN.
SRI ANDRIANI NY.
ELLYA KUSUMA NY.
ELLYA KUSUMA NY.
SIDI AMBO TN
NURHAYATI NY.
JUANISAH BINTI M. FAISOL HS NY
GATOT SUGEMTO TN
M. HAIKAL KAMIL AN
NURMALINAH BINTI NANGASING NY.
NOVENDA ALIANDO TN
NAILA RIANTI PUTRI AN
HARTINI BINTI M. ZAINI NY.
WANG RIZMANTIO TN
RAMA SATRIYA TN
DIAN YULIANTI NY.
YUHENDRI WIJAYA TN
RIANTI NY.
HASNAN HAROM TN.
FARIDA NY.
FARIDA NY.
HERMAN TN.
NASRUN BASRI TN
TIARLIN GULTOM NY.
890,000.00
193,585.00
160,000.00
10,000.00
160,000.00
10,000.00
635,185.00
165,000.00
243,282.00
250,085.00
160,000.00
10,000.00
60,000.00
249,000.00
193,585.00
890,000.00
60,000.00
237,698.00
890,000.00
890,000.00
234,400.00
244,520.00
212,000.00
146,400.00
157,930.00
60,000.00
270,900.00
213,585.00
10,000.00
125,000.00
104,000.00
60,000.00
354,910.00
158,700.00
71,450.00
1,192,000.00
79,450.00
711,200.00
107,450.00
84,963.00
71,450.00
60,000.00
Page 626
7 JUNI 2016
CHERRY LEMBEK TN.
RUSTAM HALIM TN
SITI FATIMAH NY
SEVVY YOSSA NY.
EMI MULYATI NN
EMI MULYATI NN
ELLIS SUSANA NY
YEVI MAIBELLA NN
M FAHRI ALDINO AN.
EDDY MAKSURI TN.
EDDY MAKSURI TN.
CIKHANI,SPD, HJ. NY
YULIANI BINTI TUKINO NY
ABU MANSYUR TN
HERIANA MUSYAFIRA NY.
NUZRAL BOESTHAM. TN
RENATALIE ALRUBY AN
DINDA ASTRIANI NN
AL WALID WILLIAN HAEDY AN
RAISA ZHAAFIRAH AN
M.AIDIL PRASETYA AN
M AQUILAKHENZA AZKA A AN
RIZKI PEBRIANI NN
OKTA SAPUTRA TN
FLORENSIA CAROLINA AN
MULYADI CUAN BIE TN
MULYADI CUAN BIE TN
SUKMAWATI BINTI H.ZAINAL NY.
LUTHFIE SAKHI IRZANI AN
BOY D.J MAKADADA TN
AHMAD RIFAI TN.
MARISA OKTARINA NY
DEVY YULIANA AFRIANTY NY.
60,000.00
890,000.00
107,450.00
173,000.00
107,366.00
99,450.00
207,465.00
61,500.00
71,450.00
328,630.00
193,585.00
488,200.00
169,450.00
212,635.00
160,000.00
50,000.00
347,445.00
160,000.00
10,000.00
167,900.00
40,000.00
223,585.00
63,590.00
189,192.00
196,244.00
120,100.00
101,140.00
60,000.00
174,400.00
237,302.00
248,000.00
60,000.00
82,492.00
160,000.00
10,000.00
137,500.00
96,140.00
60,000.00
488,200.00
193,700.00
193,585.00
190,000.00
Page 627
7 JUNI 2016
TRI OKTARI ADELINA AAS NY.
ZURIAH,HJ NY.
YUS ROHANA NY.
ULFATIA NANDA PATY NY
TJIKMAD. B TN.
TEGUH BIN HOKSAN TN
MIS YANTI NY
JAP DJIT SING TN
ALVIN GOZALI TN.
AINI BIN DUMALI TN.
TAMARA MEILINDA GUNAWAN NN
SAMMY NUGRAHA ADYASA T AN
KOSIM JOHAN TN
MARIA THERESIA NY.
HASTUTI NY.
FITRI WULANDARI NY.
ASNAWIYAH BINTI M FUDIN NY
MELIA WULANDARI NY.
RUSTEM PUAD TN.
190,000.00
160,000.00
10,000.00
60,000.00
10,000.00
160,000.00
60,000.00
160,000.00
10,000.00
60,000.00
137,450.00
193,585.00
99,450.00
496,400.00
77,160.00
274,000.00
141,560.00
157,600.00
120,000.00
60,000.00
167,000.00
10,000.00
537,000.00
125,000.00
10,000.00
60,000.00
60,000.00
233,000.00
222,200.00
160,000.00
10,000.00
10,000.00
167,000.00
279,478.00
279,585.00
213,585.00
274,000.00
190,000.00
160,000.00
10,000.00
110,000.00
134,450.00
Page 628
7 JUNI 2016
LINDA BINTI ALI NY.
SYAFRIZAL BIN HASANUDIN TN.
AISYAH NN.
NELDA OKTA YUSNITA NY.
GUNADI WAHAB TN.
ZAWIYAH BINTI H. KODAR NY.
ADY APRIYANTO TN
HENDRI HASAN TN
OCTAVIANA KARUNIA ILAHI NY
MUHAMMAD NURDIN TN.
PUTRI RAHMI YANTI NY.
IMAM SUBAKRI TN.
MONIKA YOFITA SARI NN.
LUKMAN BIN HAZUYARIS TN
VENI WIDYA ASTUTI NN
EKA INDAH RIA NN
NUR APRIYANI NY
HAURA ISLAMI FASYAH AN.
PAHIRA SHAKILA FIKRI AN
RABIAH AL ADAWIYAH NN
ABU LAHAB TN.
INDRA SANDI TN
VELLY FAJRIYAH AN
92,300.00
635,185.00
101,830.00
184,350.00
60,000.00
512,000.00
276,165.00
298,500.00
219,100.00
101,378.00
164,230.00
60,000.00
355,046.00
83,000.00
255,600.00
368,400.00
277,875.00
110,000.00
225,000.00
140,000.00
154,660.00
420,360.00
134,430.00
85,000.00
205,171.00
132,600.00
292,340.00
118,041.00
238,652.00
40,000.00
137,000.00
10,000.00
85,430.00
86,000.00
58,000.00
67,824.00
Page 629
8 JUNI 2016
NO
NO RJ
080616450182
080616390580
080616450179
080616390683
080616460725
080616390482
080616390478
080616280704
080616280699
080616420389
080616420388
080616450051
080616460560
080616450174
080616450070
080616450064
080616450191
080616460440
080616280692
080616280789
080616280696
080616390629
080616450353
080616450251
080616450290
080616450243
080616450110
080616450186
080616450190
080616420369
080616280844
080616280846
080616450348
080616420362
080616280466
080616460817
080616450220
080616450343
080616450344
080616390483
080616450188
TANGGAL
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
Page 630
SEP
8 JUNI 2016
080616450392
080616450400
080616450399
080616450103
080616450216
080616420137
080616390564
080616430659
080616460437
080616460429
080616420313
080616450195
080616450197
080616430587
080616430455
080616450253
080616450231
080616460734
080616420266
080616420385
080616450288
080616390588
080616390585
080616390614
080616420390
080616430684
080616450058
080616450067
080616430751
080616460731
080616430624
080616450292
080616280800
080616280799
080616450208
080616460645
080616450031
080616450209
080616450393
080616450283
080616280861
080616450211
06/08/2016
06/08/2016
06/08/2016
06/08/20160090R03106160002382
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
Page 631
8 JUNI 2016
080616420214
080616420213
080616450245
080616420274
080616460652
080616420295
080616450154
080616460551
080616450168
080616450048
080616420107
080616420105
080616430582
080616450023
080616450375
080616450242
080616280606
080616280649
080616450161
080616450296
080616450352
080616430462
080616450136
080616430457
080616450159
080616280798
080616280797
080616280603
080616280792
080616280801
080616450412
080616450185
080616450187
080616420268
080616450178
080616450435
080616450432
080616450417
080616430718
080616450311
080616430878
080616460819
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
Page 632
8 JUNI 2016
080616280520
080616430454
080616450359
080616450360
080616460754
080616460756
080616430595
080616450028
080616280782
080616280780
080616450239
080616450240
080616450246
080616450241
080616450219
080616280636
080616460689
080616450428
080616450194
080616450193
080616460427
080616450235
080616280839
080616450148
080616420366
080616420363
080616280791
080616450413
080616450236
080616390716
080616390721
080616450250
080616420328
080616450321
080616430741
080616430739
080616430647
080616450015
080616430628
080616390761
080616420372
080616450063
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
Page 633
8 JUNI 2016
080616420087
080616450374
080616450336
080616280885
080616450247
080616420225
080616450042
080616450043
080616450020
080616450202
080616450238
080616430605
080616450071
080616450081
080616450073
080616450112
080616450049
080616420156
080616450309
080616430691
080616450278
080616450265
080616450184
080616450171
080616460763
080616450401
080616450076
080616450072
080616450022
080616450050
080616450365
080616450364
080616450124
080616450260
080616460443
080616280865
080616450206
080616450421
080616450340
080616430701
080616450029
080616450404
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
Page 634
8 JUNI 2016
080616450324
080616450331
080616450212
080616460535
080616390722
080616390549
080616390522
080616450012
080616450310
080616460746
080616390497
080616390490
080616390563
080616390561
080616460508
080616450396
080616460446
080616280662
080616390555
080616390559
080616450044
080616280658
080616420354
080616420350
080616420167
080616390788
080616390768
080616450119
080616450252
080616450173
080616450145
080616450147
080616430491
080616430493
080616390537
080616390534
080616430832
080616430771
080616450054
080616280562
080616280616
080616450394
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
Page 635
8 JUNI 2016
080616420255
080616430786
080616460441
080616460810
080616390860
080616280678
080616450262
080616390675
080616390676
080616420257
080616420284
080616450325
080616450329
080616450397
080616430584
080616450079
080616450200
080616450371
080616450055
080616450056
080616450196
080616460757
080616450237
080616280816
080616450317
080616450040
080616450039
080616390511
080616460617
080616390639
080616390641
080616450052
080616390547
080616450405
080616420101
080616450153
080616450151
080616420420
080616450019
080616280586
080616420215
080616450285
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
Page 636
8 JUNI 2016
080616450069
080616450068
080616450109
080616450106
080616460622
080616460618
080616430626
080616390648
080616450025
080616390714
080616450181
080616450060
080616430538
080616450199
080616430528
080616430525
080616450347
080616280850
080616450308
080616430531
080616280745
080616280747
080616430451
080616450205
080616450221
080616280849
080616450080
080616280505
080616280504
080616450011
080616450249
080616430467
080616430694
080616430495
080616430494
080616450248
080616280518
080616430644
080616280793
080616390765
080616460824
080616280842
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/20160090R03106160002001
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
Page 637
8 JUNI 2016
080616390532
080616420294
080616450395
080616450264
080616450030
080616450261
080616420286
080616390882
080616450335
080616430707
080616450144
080616450141
080616420410
080616420414
080616280480
080616460826
080616450318
080616450065
080616450077
080616450275
080616450272
080616450175
080616450177
080616420097
080616420100
080616430749
080616430460
080616430458
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
06/08/2016
Page 638
8 JUNI 2016
NAMA PASIEN
A. RACHMAN HASAN H TN.
A.TRUMAN S.O BAKRI,SH,M.HUM TN
ABD. HALIK SY. TN.
ABU LAHAB TN.
ACHMAD MAULANA,H TN
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
ADY APRIYANTO TN
AHMAD RIFAI TN.
AHMAD ROCKY EL MALIKI AN
ALDINA PUTRI HARAHAP NY
ALMER ZAIDAN PASHA AN
ALMER ZAIDAN PASHA AN
AMIR HAMZAH TN
ANA YUSTIA SHINTA NY.
ANDRY OKRIANTO TN.
APRI YANTI NY.
APRILA HARTINI ANA NY.
AR SIRA AWFIYAH ABRORI AN
ARBAIN GANTI TN
ARBAIN GANTI TN
ARMANSYAH BIN SOEWANDI TN
AS AD SAYUTI DRS TN
AS AD SAYUTI DRS TN
ASRIL UDIN TN.
ASWIN BIN JUKI TN.
ATIKA BENDRA NN.
ATMAYATI ABDULLAH NY
AZHARI BSC TN.
AZHARI BSC TN.
AZWAR FANANI TN.
TRANSAKSI
123,300.00
89,300.00
516,400.00
60,000.00
506,839.00
160,000.00
10,000.00
10,000.00
160,000.00
102,000.00
10,000.00
472,000.00
384,200.00
185,252.00
160,000.00
10,000.00
234,800.00
78,000.00
102,400.00
50,792.00
110,000.00
167,000.00
296,545.00
198,000.00
209,800.00
94,135.00
66,300.00
10,000.00
160,000.00
174,720.00
167,000.00
10,000.00
162,036.00
142,400.00
247,200.00
165,550.00
223,865.00
10,000.00
160,000.00
60,000.00
257,418.00
Page 639
8 JUNI 2016
BETIN TEGUH NY.
BETIN TEGUH NY.
BS. BAIDHOWIE TN
CHADIDJAH SALEH NY
CHOIRUN NURLISA NY
CORNILIA ANITA NY.
DAMSIAH BINTI BUSTOMI NY.
DENI SAMBORA TN
DETY SEFTRIANITA NY
DETY SEFTRIANITA NY
DEWI JUWITA. NY
DIAH CITRA NY.
DIANA HASTINI NY.
DIANI HAYARA NY
DJOKO WARDIYANTO TN.
DJUMADI BIN MUKIAD TN
DWI ANGGUN SARI NY
EDDY MAKSURI TN.
EDDY MAKSURI TN.
EDI CATUR WAHYUDI TN.
EDY ABDULLAH TN
EIRIN CAROLINA NY.
ENDANG SUTISNA TN
ERMA WATI NY.
278,800.00
160,000.00
10,000.00
234,400.00
###
198,950.00
209,485.00
129,450.00
125,000.00
10,000.00
83,720.00
10,000.00
160,000.00
60,000.00
231,400.00
66,000.00
890,000.00
488,200.00
290,034.00
88,980.00
60,000.00
160,000.00
10,000.00
279,833.00
193,585.00
274,050.00
13,000.00
759,300.00
88,140.00
60,000.00
642,035.00
78,000.00
160,000.00
10,000.00
925,200.00
890,000.00
25,200.00
291,397.00
120,000.00
252,030.00
157,000.00
193,585.00
Page 640
8 JUNI 2016
ERMAWATI BINTI HASANUDIN NY.
ERNITA TAHER NY.
ERWIN AZHARI TN.
EVLIN NARITA NY
F EFFENDY TN.
FARZAN AZKA MAHARDIKA AN
FIQRY NOVIANDI, SIP. MSI. TN
FIRRIZKI BACHSIR TN
FITRI YULIANTY NY
FITRIA YULIANTI NY
HALILAH BINTI MAHMUD NY.
HALIMATUSAKDIAH BNTI MALAWI NY
HANIFAH ANDINI C AN
HARBEI PASAH TN
HARINI OKTAFENI NY.
HARTATI ISMAWATI SENEN NY.
HASANAH BINTI KMS HABUBAKAR NY
HASIAM INDRIANI NY
HASNIHI HAMZAH, SH TN.
HENI AGUS FITRIANI NY
HENI AGUS FITRIANI NY
HO LI IN NY
HO LI IN NY
IMAM SUBAKRI TN.
INDRAWATI BOEN NN.
INDRAYANTA TN
INDRAYANTA TN
IRYANTO ASYIK TN.
ISKANDAR BIN ABDUL H. TN
ISMAWATI BINTI BAMBANG NY
IVAN JUANTHREE ROMULUS AN
IVAN JUANTHREE ROMULUS AN
160,000.00
10,000.00
146,715.00
223,228.00
999,800.00
212,600.00
100,900.00
60,000.00
175,587.00
512,000.00
160,000.00
10,000.00
778,370.00
182,400.00
60,000.00
60,000.00
448,500.00
180,000.00
254,175.00
49,764.00
###
317,318.00
266,064.00
377,850.00
330,686.00
10,000.00
160,000.00
730,700.00
517,080.00
62,630.00
171,500.00
10,000.00
160,000.00
113,300.00
245,000.00
160,000.00
10,000.00
106,400.00
305,300.00
177,220.00
31,500.00
174,400.00
Page 641
8 JUNI 2016
JACUB RAHMAN TN.
JEANNE KUSSOY NY
JEANNE KUSSOY NY
JELLY BENRO NY
JELLY BENRO NY
JENTINA RAJA GUKGUK NY.
JUNAIDI HASAN TN.
KALSUM IBRAHIM NY.
KALSUM IBRAHIM NY.
KARTINI BINTI SAPUAN NY.
KERRIN NATHANIA AN.
KETUT DEGENG TN
KHALISA NAURA ATHIEFA AN.
KHALISA NAURA ATHIEFA AN.
KIRANA AZ ZAHRA HARAHAP AN.
LENA ELVITA NY
LIS SUMARTINI NY.
LISIANA OSWARI NN.
LISIANA OSWARI NN.
LUKMAN NILHAKIM, IR TN
M IHSAN AN.
M. ABDUL AZIZ AN
M. ARFA RAFIQI AN.
M. ASHRAF SAFARAZ AN.
M. FACHRI ADRIANSYAH TN
215,450.00
110,000.00
10,000.00
160,000.00
190,700.00
40,000.00
334,360.00
135,000.00
10,000.00
125,000.00
10,000.00
160,000.00
160,000.00
10,000.00
890,000.00
749,500.00
110,000.00
60,000.00
160,000.00
10,000.00
62,876.00
102,400.00
158,100.00
102,900.00
160,000.00
10,000.00
180,000.00
540,170.00
174,790.00
10,000.00
160,000.00
61,900.00
472,000.00
88,951.00
125,000.00
10,000.00
172,664.00
156,095.00
178,000.00
102,000.00
157,848.00
60,000.00
Page 642
8 JUNI 2016
M. RAFIE KHAIRY AN
M. YUSMAN DJANI TN.
M.HAFIZ RAFFI RABBANI AN.
M.TEGUH H.TN.
MAGDALENAWATY NY.
MARIA ILYAS NY
MARIA KRISANTO NY
MARIA NY
MARIANI HJ BINTI ABDUROHIM NY.
MARIZA ELIA NY
MARMI BINTI MIMIK NY.
MARSUDI TN
MARTINI THAMRIN NY
MASPERI YANTI NY.
MEI TRI WAHYUNI NY
MEIDI YUSRI, MS TN
MEIRITA RUSLIE NY.
MEIRITA RUSLIE NY.
MENIEK NILAM PUSPITA SARI NY
MERRY ROSITA NY.
MOH.MAQQON TN.
MSY. CHOIRIYAH NY.
MUHAMMAD ALDI AN
MUHAMMAD ARIF TN
MULYATI CAHAYA NY.
120,000.00
60,000.00
263,700.00
111,400.00
120,000.00
30,041.00
10,000.00
160,000.00
181,280.00
60,000.00
356,878.00
157,450.00
10,000.00
67,200.00
160,000.00
240,800.00
176,480.00
193,585.00
389,320.00
192,000.00
160,000.00
10,000.00
218,720.00
768,600.00
255,960.00
60,000.00
160,000.00
10,000.00
184,814.00
141,600.00
160,000.00
10,000.00
318,659.00
297,000.00
100,800.00
155,150.00
636,600.00
488,200.00
234,400.00
60,000.00
125,750.00
258,000.00
Page 643
8 JUNI 2016
MUSTOPA BIN K.H MASTJEK A TN.
NABIILA NURIA ATIFAH AN
NASREL HAYATI NY.
NASRUN BASRI TN
NAURA GHISTI AULYA AN
NETI HARTINI NY.
NICKY VERDIANTO TN.
NOPA ROSETA NN.
NOPA ROSETA NN.
NOVITA ASRIANI NN
NUR ARLINDENI NY.
NUR ARLINDENI NY.
NURHASANAH BINTI HAIRUDDIN NY
NURIDA ANGGRAINI NY.
NURLIANA SALIM NY
NURLIANA SALIM NY
NYIMAS ATHIYYAH FAIHA A AN
OKTA SAPUTRA TN
OKTA SAPUTRA TN
OLIVIA AZ-ZAHRA AN.
PARLIN SYAHPUTRA SIREGAR TN.
PUJI ASTUTI NY
PUJI ASTUTI NY
QUTHBIE AHNAF AL FATIH AN.
RAHMA FADHILLA AN.
RAHMA FADHILLA AN.
RAHMA SERLIANI PUTRI NY
10,000.00
160,000.00
98,900.00
60,000.00
916,200.00
160,000.00
110,000.00
135,215.00
124,100.00
###
160,000.00
10,000.00
102,000.00
10,000.00
###
193,585.00
29,700.00
246,800.00
10,000.00
137,000.00
199,600.00
191,200.00
200,000.00
10,000.00
135,612.00
10,000.00
177,000.00
215,587.00
284,690.00
111,000.00
10,000.00
160,000.00
10,000.00
95,000.00
160,000.00
10,000.00
60,000.00
60,000.00
110,000.00
514,200.00
174,400.00
209,485.00
Page 644
8 JUNI 2016
RAMALIAH BINTI NURKI R NY.
RANDI SENATRA TN.
RASKA KENZI SYAHPUTRA AN.
REYQAL OKTAMA AN.
RISNAWATI NY.
RITA ARSYAD NY.
RITA MELLA NY.
ROHAMA NY.
ROMZAH BINTI MADANI NY
RONIMAH NY
RONIMAH NY
ROSMALA DEWI NY
RUSLAN BIN SUHAILI TN
RUSLI BIN HARUN TN
RUSMIDIUS NY.
RUSMIDIUS NY.
RUSNAN CHANDRA TN
RUSTEM PUAD TN.
RUSTEM PUAD TN.
RYANI SIMORANGKIR NY
SAID SALIM TN
SALIM ATMAJAYA TN
SARDJONO, H TN
SARDJONO, H TN
SARKANI BIN M. NUR TN.
SAWALIYAH, S.PD TN
SEKAR SARI WIRADARMA NN.
SITI ASIAH NY.
172,800.00
70,800.00
114,600.00
122,215.00
219,088.00
99,450.00
116,900.00
10,000.00
125,000.00
191,700.00
75,000.00
10,000.00
160,000.00
201,020.00
60,000.00
204,800.00
238,200.00
195,985.00
10,000.00
160,000.00
246,699.00
131,939.00
890,000.00
184,180.00
60,000.00
95,000.00
10,000.00
890,000.00
890,000.00
10,000.00
160,000.00
138,300.00
71,450.00
211,500.00
135,800.00
160,000.00
10,000.00
215,985.00
80,660.00
589,470.00
81,400.00
309,040.00
Page 645
8 JUNI 2016
SITI FATIMAH NY
SITI FATIMAH NY
SITI MAIMUNAH NY
SITI MAIMUNAH NY
SITI NURAINI NY.
SITI NURAINI NY.
SITI ZAHARA NY.
SOEHERMAN H TN.
SRI NUR AINI NY
SUDARMAN TN
SUJITNO CHANDRA TN
SULAIMAN NADEAK TN.
SUMARTINI NY
SUWIRMAN BIN KAMARUDDIN TN
SYAIFUL ANWAR TN.
SYAIFUL ANWAR TN.
TASYA HUMAIRAH AZ ZAHRA AN
TEGUH BIN HOKSAN TN
TETI NEVISKA NY
TEUNKU DENARSYAH TN
TIARLIN GULTOM NY.
TIARLIN GULTOM NY.
TIMURATINI S SOS NY
TJOE HOEN NIO NY.
TJUNG SEN WAN NY.
TJUNG SEN WAN NY.
TRI INDAH NN.
137,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
42,000.00
192,512.00
232,960.00
164,175.00
81,300.00
182,400.00
71,450.00
60,000.00
160,000.00
10,000.00
890,000.00
162,500.00
202,265.00
190,000.00
160,000.00
10,000.00
60,000.00
270,600.00
276,000.00
145,700.00
99,450.00
160,000.00
10,000.00
168,666.00
890,000.00
796,000.00
763,400.00
160,000.00
10,000.00
356,700.00
92,350.00
68,000.00
160,000.00
10,000.00
169,200.00
271,006.00
Page 646
8 JUNI 2016
TUMIAR SILABAN NY.
USAR QURROTUAINI NN.
UYUNG HJ. NY
WIDYA TAMARA NN
WILLY WIJAYA TN.
WINDA BINTI M JIDOL. NY.
WINDA WIDIANTI NY.
YULIA DASWATI NY.
YULIA DASWATI NY.
YUNALNI NY.
YUNALNI NY.
YUNI LILIYANA NY.
YUSNAWATI NN.
YUSRI MB TN.
YUSUF USMAN TN
ZUBIR A JALIL TN.
ZUBIR A JALIL TN.
ZUL SUSIANA TN
ZURIAH,HJ NY.
ZURIAH,HJ NY.
60,000.00
60,000.00
420,753.00
110,000.00
460,500.00
306,920.00
74,000.00
141,600.00
146,000.00
111,800.00
160,000.00
10,000.00
10,000.00
160,000.00
164,520.00
161,530.00
126,305.00
155,970.00
101,600.00
160,000.00
10,000.00
162,427.00
8,000.00
10,000.00
125,000.00
108,000.00
160,000.00
10,000.00
Page 647
9 JUNI 2016
NO
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
35
36
37
38
39
40
41
42
43
44
45
46
47
48
NO RJ
TANGGAL
SEP
NAMA PASIEN
09061628025206/09/2016
0
EDY SURYANTO TN.
09061628012506/09/2016
0
MAYURI HASANI TN
09061642041806/09/2016
0
NYIMAS NURMANI NY.
09061639063906/09/2016
0
ROMZAH BINTI MADANI NY
09061646021706/09/2016
0
09061642010806/09/2016
00
AGUS SALIM YAHYA DRS TN.
09061628036706/09/2016
00
09061642001506/09/2016
00
ESA ERLISA NURDIN NY.
09061642043406/09/2016
00
FITRI YASRINA NY
09061642001306/09/2016
00
HAMIDIAH NY.
09061639056906/09/2016
00
09061645055206/09/2016
00
09061628036806/09/2016
00
09061645065106/09/2016
00
09061645050406/09/2016
00
NYIMAS NURMANI NY.
09061646019406/09/2016
00
RITA ZAHARA NY
09061643017006/09/2016
00
SAENAH NY
09061639070306/09/2016
00
SUHEDI TN.
09061642000706/09/2016
00
SUKMAWATI BINTI H.ZAINAL NY.
09061645073806/09/2016
00
09061642000906/09/2016
00
WINDA BINTI M JIDOL. NY.
09061642001206/09/2016
0090R03106160002222
DEWI KASUMA NY.
09061642001106/09/2016
0090R03106160002245
KARYN TJONG AN.
09061642001606/09/2016
0090R03106160002248
JUMIASIH BINTI ASMO NY.
09061646009606/09/2016
0090R03106160002251
AGUS SALIM YAHYA DRS TN.
09061646008706/09/2016
0090R03106160002252
USMAN ZAINI TN
09061628003806/09/2016
0090R03106160002253
09061628003706/09/2016
0090R03106160002253
09061643013106/09/2016
0090R03106160002254
TJEPUK S TN.
09061646043106/09/2016
0090R03106160002255
DAVID ISKANDAR TN
09061646002706/09/2016
0090R03106160002256
09061646000306/09/2016
0090R03106160002256
09061643002106/09/2016
0090R03106160002258
LIU HENDRY TN.
09061628016306/09/2016
0090R03106160002259
09061628003006/09/2016
0090R03106160002260
09061628002906/09/2016
0090R03106160002260
09061646003306/09/2016
0090R03106160002261
09061646002806/09/2016
0090R03106160002261
09061643006606/09/2016
0090R03106160002262
SRI YULIDAR NY.
09061628017806/09/2016
0090R03106160002263
09061628005906/09/2016
0090R03106160002264
EMMY YAHIMI NY
09061628005806/09/2016
0090R03106160002264
EMMY YAHIMI NY
09061643007906/09/2016
0090R03106160002265
09061643006106/09/2016
0090R03106160002266
TANG WEI HENG NY
09061643006306/09/2016
0090R03106160002266
TANG WEI HENG NY
09061643002306/09/2016
0090R03106160002268
BUSTARI TN.
09061646009406/09/2016
0090R03106160002269
09061628005306/09/2016
0090R03106160002270
Page 648
9 JUNI 2016
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
09061628005406/09/2016
0090R03106160002270
09061645050906/09/2016
0090R03106160002271
09061645051006/09/2016
0090R03106160002271
09061646027506/09/2016
0090R03106160002272
09061646010606/09/2016
0090R03106160002274
BURHANUDDIN TN
09061646023606/09/2016
0090R03106160002275
NOVI DITYA.NY
09061628034606/09/2016
0090R03106160002276
HENDRY RIANTO TN
09061643006806/09/2016
0090R03106160002277
MARIMAH C AHMAD NY.
09061643006706/09/2016
0090R03106160002277
MARIMAH C AHMAD NY.
09061646023506/09/2016
0090R03106160002278
09061642001706/09/2016
0090R03106160002279
SUYADI H. TN
09061643007106/09/2016
0090R03106160002280
ZAINAB BINTI ALI NY
09061643007306/09/2016
0090R03106160002281
09061643007206/09/2016
0090R03106160002281
09061628039806/09/2016
0090R03106160002282
LIM KOEIJ ING NY
09061646009206/09/2016
0090R03106160002283
MARIA KRISANTO NY
09061643001906/09/2016
0090R03106160002284
09061642010206/09/2016
0090R03106160002285
09061642010106/09/2016
0090R03106160002285
09061642010906/09/2016
0090R03106160002286
JACUB RAHMAN TN.
09061642011006/09/2016
0090R03106160002286
JACUB RAHMAN TN.
09061642010706/09/2016
0090R03106160002287
09061642010406/09/2016
0090R03106160002287
09061646011606/09/2016
0090R03106160002288
DEVI AWALIA NY
09061646011306/09/2016
0090R03106160002288
DEVI AWALIA NY
09061643014506/09/2016
0090R03106160002289
09061646013806/09/2016
0090R03106160002290
M. ADIL PUTRA PRATAMA AN.
09061628004806/09/2016
0090R03106160002291
09061642020906/09/2016
0090R03106160002292
SHINTA HASANA NY.
09061642021106/09/2016
0090R03106160002292
SHINTA HASANA NY.
09061643033506/09/2016
0090R03106160002293
09061643014406/09/2016
0090R03106160002294
TITIN KUSMETA NY.
09061643014306/09/2016
0090R03106160002294
TITIN KUSMETA NY.
09061643005606/09/2016
0090R03106160002295
09061646026406/09/2016
0090R03106160002296
ZULHAYATI ALWIN NY.
09061642014906/09/2016
0090R03106160002297
09061642014706/09/2016
0090R03106160002297
09061646026906/09/2016
0090R03106160002298
09061646026606/09/2016
0090R03106160002298
09061642018806/09/2016
0090R03106160002299
09061642018406/09/2016
0090R03106160002299
09061643007506/09/2016
0090R03106160002300
ASRIL UDIN TN.
09061646027106/09/2016
0090R03106160002301
09061628045206/09/2016
0090R03106160002302
NOPA ROSETA NN.
09061628045406/09/2016
0090R03106160002302
NOPA ROSETA NN.
09061628032406/09/2016
0090R03106160002303
09061643003906/09/2016
0090R03106160002304
09061642013006/09/2016
0090R03106160002305
09061645064206/09/2016
0090R03106160002306
Page 649
9 JUNI 2016
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
09061645064306/09/2016
0090R03106160002306
09061642011706/09/2016
0090R03106160002307
DIAN ANGGRAINI NY.
09061643004306/09/2016
0090R03106160002308
ELLIS SUSANA NY
09061643007806/09/2016
0090R03106160002309
QUTHBIE AHNAF AL FATIH AN.
09061643014806/09/2016
0090R03106160002310
M. SHAFA ADHITIYA AN
09061628016106/09/2016
0090R03106160002311
ROHAINA HJ, NY.
09061628015806/09/2016
0090R03106160002311
ROHAINA HJ, NY.
09061628018606/09/2016
0090R03106160002312
09061646011806/09/2016
0090R03106160002313
DARMO BIN JINOMO TN
09061628014206/09/2016
0090R03106160002314
09061628016606/09/2016
0090R03106160002315
NELLY M. RAMAS NY
09061628020406/09/2016
0090R03106160002315
NELLY M. RAMAS NY
09061643024306/09/2016
0090R03106160002316
TJIKMAD. B TN.
09061643024206/09/2016
0090R03106160002316
TJIKMAD. B TN.
09061643024106/09/2016
0090R03106160002317
09061643024006/09/2016
0090R03106160002317
09061642041706/09/2016
0090R03106160002318
09061642041506/09/2016
0090R03106160002318
09061628013606/09/2016
0090R03106160002319
ELVI SURYATI NY
09061628027206/09/2016
0090R03106160002320
09061628014006/09/2016
0090R03106160002321
09061643018906/09/2016
0090R03106160002322
09061646019306/09/2016
0090R03106160002323
DJALILI SOLIHIN TN
09061646015206/09/2016
0090R03106160002323
DJALILI SOLIHIN TN
09061642039306/09/2016
0090R03106160002324
09061643022106/09/2016
0090R03106160002325
EMILIA BINTI YAKUB, HJ NY.
09061645059406/09/2016
0090R03106160002326
09061643029606/09/2016
0090R03106160002327
09061643029406/09/2016
0090R03106160002327
09061628019006/09/2016
0090R03106160002328
ASIANA BINTI DARSIMIN NN
09061646008906/09/2016
0090R03106160002329
EMELEYA SISKA NY.
09061639047006/09/2016
0090R03106160002330
09061639046706/09/2016
0090R03106160002330
09061628031806/09/2016
0090R03106160002331
LIDYA BINTI DARSONO NY
09061645064106/09/2016
0090R03106160002332
09061642025506/09/2016
0090R03106160002333
HARMAIDI LATIEF TN.
09061628039606/09/2016
0090R03106160002334
09061642011106/09/2016
0090R03106160002335
09061642035906/09/2016
0090R03106160002336
RAHULLA HUANG AN.
09061642041206/09/2016
0090R03106160002338
ARIFIN SITOHANG TN.
09061642040806/09/2016
0090R03106160002338
ARIFIN SITOHANG TN.
09061646028906/09/2016
0090R03106160002339
09061646029306/09/2016
0090R03106160002339
09061645046906/09/2016
0090R03106160002340
ENILISAH BINTI RUSYADI NY.
09061628035706/09/2016
0090R03106160002342
TUMIAR SILABAN NY.
09061628035406/09/2016
0090R03106160002342
TUMIAR SILABAN NY.
09061643008506/09/2016
0090R03106160002343
ATHALLAH GHAZAN KURNIAWAN AN
09061628037606/09/2016
0090R03106160002344
RITA ARSYAD NY.
09061628037506/09/2016
0090R03106160002344
RITA ARSYAD NY.
Page 650
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153
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156
157
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161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
09061642023406/09/2016
0090R03106160002346
EKI EVI NOVITASARI NY
09061628018206/09/2016
0090R03106160002347
SITI FARIDAH NY.
09061646026106/09/2016
0090R03106160002348
RATNA BINTI ABU BAKAR NY
09061643013206/09/2016
0090R03106160002350
RENY YULISTRI NY.
09061646031206/09/2016
0090R03106160002352
SAMSU RIZAL TN.
09061643024806/09/2016
0090R03106160002354
M.ARKAAN RAEES SADAN AN.
09061628021006/09/2016
0090R03106160002355
DWI KUNCOROJATI TN.
09061643019106/09/2016
0090R03106160002357
RITA ZAHARA NY
09061642035106/09/2016
0090R03106160002358
09061628019506/09/2016
0090R03106160002359
SRI YULIANA NY
09061642018106/09/2016
0090R03106160002360
NAZARUDDIN RONA TN
09061642016006/09/2016
0090R03106160002361
09061643024706/09/2016
0090R03106160002365
RIO SAPUTRA AN.
09061642020506/09/2016
0090R03106160002367
SRY SUSANTI DIANA NY
09061643030406/09/2016
0090R03106160002368
09061628013706/09/2016
0090R03106160002369
KALSUM IBRAHIM NY.
09061628020306/09/2016
0090R03106160002369
KALSUM IBRAHIM NY.
09061642022206/09/2016
0090R03106160002370
YENI YANUARTI BY NY.
09061642022706/09/2016
0090R03106160002372
TRI LIANA NN.
09061639047206/09/2016
0090R03106160002373
MASITOH BINTI M. AMIN NY
09061639047406/09/2016
0090R03106160002373
MASITOH BINTI M. AMIN NY
09061628021206/09/2016
0090R03106160002374
M. FIKRI AXEL ZACHRY AN.
09061642023706/09/2016
0090R03106160002376
09061628026006/09/2016
0090R03106160002377
IDHAM CHOLID PRATAMA AN
09061642023906/09/2016
0090R03106160002378
UMI HOIDIAH NY.
09061643020806/09/2016
0090R03106160002379
09061628025306/09/2016
0090R03106160002380
SHOBA RIZKIYAH HASANAH NN
09061642022406/09/2016
0090R03106160002381
JASMAN BIN JAHARUDIN TN
09061643029706/09/2016
0090R03106160002384
09061639061606/09/2016
0090R03106160002385
09061642029106/09/2016
0090R03106160002389
09061628040606/09/2016
0090R03106160002390
09061628025906/09/2016
0090R03106160002391
WYDIA WATI NY.
09061639058106/09/2016
0090R03106160002392
09061639057406/09/2016
0090R03106160002392
09061642025106/09/2016
0090R03106160002393
09061628032906/09/2016
0090R03106160002394
09061628033406/09/2016
0090R03106160002394
09061639066706/09/2016
0090R03106160002395
SULASTRI HJ BINTI MULYADI NY
09061639066506/09/2016
0090R03106160002396
SETIA WATI NY
09061639066406/09/2016
0090R03106160002396
SETIA WATI NY
09061642040506/09/2016
0090R03106160002397
09061628025406/09/2016
0090R03106160002398
ELIS RAHMAWATI NY.
09061628028406/09/2016
0090R03106160002399
AYU RETNO WULANDARI NY
09061642034206/09/2016
0090R03106160002400
M. RINALDI AN.
09061643031306/09/2016
0090R03106160002401
DWI LISTANTI NY
09061642031006/09/2016
0090R03106160002402
CANDRA DOAN TN.
09061642029806/09/2016
0090R03106160002403
ADAM PROPERTA MC KENZIE AN
09061642035506/09/2016
0090R03106160002404
Page 651
9 JUNI 2016
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
09061642000806/09/2016
0090R03106160002404
M.HAFIZ RAFFI RABBANI AN.
09061643030606/09/2016
0090R03106160002405
FITRI DIANI NY
09061645060506/09/2016
0090R03106160002407
09061643038106/09/2016
0090R03106160002408
SRI PURNAMAWATI NY.
09061643038006/09/2016
0090R03106160002408
SRI PURNAMAWATI NY.
09061628032706/09/2016
0090R03106160002411
ABU BAKAR TN.
09061646029506/09/2016
0090R03106160002412
HESTI WAHYUNI ANGGRAINI NN
09061643032206/09/2016
0090R03106160002413
09061643034306/09/2016
0090R03106160002414
ANISA OKTAVIA S NY.
09061639053406/09/2016
0090R03106160002415
ACHMAD ZARNUBI TN.
09061645057206/09/2016
0090R03106160002416
ACHMAD ZAINI AR. TN.
09061642033906/09/2016
0090R03106160002417
09061642033306/09/2016
0090R03106160002417
09061642036306/09/2016
0090R03106160002419
TJIKNUT SYUKUR NY
09061642036006/09/2016
0090R03106160002419
TJIKNUT SYUKUR NY
09061645052906/09/2016
0090R03106160002422
09061639061006/09/2016
0090R03106160002423
09061645051306/09/2016
0090R03106160002424
NURMALA DEWI NY.
09061645051106/09/2016
0090R03106160002424
NURMALA DEWI NY.
09061645068306/09/2016
0090R03106160002425
09061628041006/09/2016
0090R03106160002428
HASRI TANJUNG H TN.
09061628040906/09/2016
0090R03106160002428
HASRI TANJUNG H TN.
09061645062806/09/2016
0090R03106160002430
09061645058706/09/2016
0090R03106160002431
09061639060406/09/2016
0090R03106160002432
MIKHAEL RUKINEM NY.
09061639067306/09/2016
0090R03106160002433
ACHMAD MAULANA,H TN
09061645068606/09/2016
0090R03106160002434
MUHAMMAD ISA TN.
09061645063306/09/2016
0090R03106160002435
09061642041306/09/2016
0090R03106160002436
M. BAYU SAPUTRA AN.
09061628040006/09/2016
0090R03106160002437
RITA MARLINA NY
09061645060306/09/2016
0090R03106160002438
RAFA ALVARO AN
09061639051506/09/2016
0090R03106160002439
ANGGI TANTI SILVIANI NY
09061643040206/09/2016
0090R03106160002440
SELVIA GANGGA NY
09061639048306/09/2016
0090R03106160002441
09061639062506/09/2016
0090R03106160002442
09061628037306/09/2016
0090R03106160002443
KERRIN NATHANIA AN.
09061645058606/09/2016
0090R03106160002444
M. FAHRY MAIZA AN.
09061645068806/09/2016
0090R03106160002445
09061628045906/09/2016
0090R03106160002446
TIARLIN GULTOM NY.
09061628046606/09/2016
0090R03106160002446
TIARLIN GULTOM NY.
09061628045506/09/2016
0090R03106160002447
09061628045806/09/2016
0090R03106160002447
09061639055006/09/2016
0090R03106160002448
M.FABIO ZAVIER AN.
09061628043206/09/2016
0090R03106160002449
AMRINA ROSYADAH NN
09061645064506/09/2016
0090R03106160002450
AHD SUFRI HAMID TN.
09061645052706/09/2016
0090R03106160002451
YULIA BINTI ABDULLAH NY
09061645064806/09/2016
0090R03106160002452
MEY SUSIANAWATI SKM. NY
09061642042406/09/2016
0090R03106160002453
GUNADI WAHAB TN.
09061628042906/09/2016
0090R03106160002454
FITRI YASRINA NY
Page 652
9 JUNI 2016
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
09061646043306/09/2016
0090R03106160002455
M. RUZZA KENJI PRADETA AN.
09061645064906/09/2016
0090R03106160002456
M. AIDIL RULIANSYAH TN.
09061645064006/09/2016
0090R03106160002457
09061639058206/09/2016
0090R03106160002458
YUNI FARIYASI NY.
09061639051206/09/2016
0090R03106160002459
09061639051906/09/2016
0090R03106160002459
09061645045006/09/2016
0090R03106160002460
09061628042806/09/2016
0090R03106160002461
AFIQAH KHANZA KHUMAIRA AN
09061639045306/09/2016
0090R03106160002462
09061639048206/09/2016
0090R03106160002464
RAHMA FADHILLA AN.
09061639053106/09/2016
0090R03106160002465
MERIANA SIDABUTAR NY.
09061639066306/09/2016
0090R03106160002466
09061645065606/09/2016
0090R03106160002467
MARITA RAMIANTI NY.
09061645055106/09/2016
0090R03106160002468
RUSTEM PUAD TN.
09061645059106/09/2016
0090R03106160002469
JULIAN RAMADHONI TN
09061645049006/09/2016
0090R03106160002470
WIDIYANTI BINTI M ZAINI NY
09061639061406/09/2016
0090R03106160002471
LENNY SILVANI NY.
09061645047706/09/2016
0090R03106160002472
CIKHANI,SPD, HJ. NY
09061639066006/09/2016
0090R03106160002475
09061645061106/09/2016
0090R03106160002476
KARTINI ERWAN NY
09061645065406/09/2016
0090R03106160002477
ACHRUL BAKRI DR.TN.
09061645063606/09/2016
0090R03106160002478
09061645065506/09/2016
0090R03106160002479
YUNIAR MADIAN DR.NY.
09061645054206/09/2016
0090R03106160002480
09061645065006/09/2016
0090R03106160002481
MIS YANTI NY
09061639052206/09/2016
0090R03106160002482
09061639050306/09/2016
0090R03106160002484
ELIYA ZEN NY
09061639076206/09/2016
0090R03106160002485
ANDRIAMELLA ELFARISSYAH NY
09061639068106/09/2016
0090R03106160002486
UNTUNG SOBIRIN TN
09061645059506/09/2016
0090R03106160002487
SITI AISYAH NY.
09061645056006/09/2016
0090R03106160002488
SRI YANTI NY.
09061645056106/09/2016
0090R03106160002489
YULINAR NURUT NY.
09061645058406/09/2016
0090R03106160002490
ZULKIFLI ADAM TN
09061645062406/09/2016
0090R03106160002491
09061645062606/09/2016
0090R03106160002491
09061645060006/09/2016
0090R03106160002492
MARDIANA NY.
09061639076406/09/2016
0090R03106160002493
TINA MARLINA NY
09061639061906/09/2016
0090R03106160002494
HUSNI THAMRIN TN
09061645061206/09/2016
0090R03106160002496
TUTI NAWIYAH NY
09061639053506/09/2016
0090R03106160002498
CARISSA ADELIA AN.
09061645052806/09/2016
0090R03106160002499
AMALIA HASANAH NY.
09061645057806/09/2016
0090R03106160002500
ADITYA PERMANA AN
09061645055406/09/2016
0090R03106160002501
MUHAMMAD AZKA PRATAMA AN.
09061645059206/09/2016
0090R03106160002503
09061645059006/09/2016
0090R03106160002504
CHOLIDAH UTAMA NY
09061645057906/09/2016
0090R03106160002505
SITI KARTINAH NY
09061645065906/09/2016
0090R03106160002506
ABU BAKAR TN
09061645059306/09/2016
0090R03106160002507
HENDRI HASAN TN
09061645060206/09/2016
0090R03106160002508
Page 653
9 JUNI 2016
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
09061645060906/09/2016
0090R03106160002509
SITI ZAIN UNAH NY
09061639056606/09/2016
0090R03106160002510
09061645059806/09/2016
0090R03106160002513
09061645069106/09/2016
0090R03106160002514
YAKOBUS EFFENDI LAY TN
09061639063106/09/2016
0090R03106160002515
INNA MARTINI NY.
09061639066606/09/2016
0090R03106160002516
FITRI WULANDARI NY.
09061639061806/09/2016
0090R03106160002518
09061639062006/09/2016
0090R03106160002519
MOH.MAQQON TN.
09061639069206/09/2016
0090R03106160002521
SUHEDI TN.
09061645071806/09/2016
0090R03106160002525
DEKA FERDIANTO TN.
09061645073106/09/2016
0090R03106160002526
NETTI HERAWATI NY
09061639074006/09/2016
0090R03106160002527
KARYN TJONG AN.
09061639075606/09/2016
0090R03106160002528
FARRAS PASHA AL AIMAR AN.
09061645076506/09/2016
0090R03106160002529
KHOLIFAH ASIAH NY.
09061645079706/09/2016
0090R03106160002535
M. AFDILLAH AL KATIRI AN
06/09/2016
0090R03106160007007
DJASWATI, HJ NY.
09061642001006/09/2016
0090R03106160002345
ERICK JUMADI TN
09061628023006/09/2016
09061646003506/09/2016
0090R03106160002341
PANI IBROHIM TN.
09061646004406/09/2016
0090R03106160002366
RIZKI EKA PUTERI NY
09061645048706/09/2016
TITIN SHIRLIANI NN
09061642001406/09/2016
Page 654
9 JUNI 2016
TRANSAKSI
228,360
638,000
72,130
234,400
140,000
32,350
77,985
534,000
17,000
606,000
77,985
11,450
77,985
30,000
140,400
38,500
168,000
65,300
155,970
102,060
16,000
101,505
82,405
96,132
151,900
380,000
10,000
125,000
519,620
890,000
125,000
10,000
122,400
657,870
10,000
160,000
160,000
10,000
304,470
226,000
10,000
160,000
60,000
10,000
167,000
240,800
205,400
137,000
Page 655
9 JUNI 2016
10,000
10,000
160,000
890,000
260,400
349,030
1,192,000
160,000
10,000
225,000
890,000
130,252
160,000
10,000
890,000
618,420
110,760
177,000
10,000
10,000
160,000
137,000
10,000
160,000
10,000
60,000
240,800
739,000
10,000
125,000
890,000
160,000
10,000
115,000
160,000
167,000
10,000
160,000
10,000
125,000
10,000
60,000
1,192,000
10,000
160,000
488,200
174,800
188,400
10,000
Page 656
9 JUNI 2016
160,000
166,980
147,200
60,000
60,000
160,000
10,000
134,030
162,050
111,600
84,660
204,000
160,000
10,000
160,000
10,000
160,000
10,000
268,800
309,000
106,400
158,800
160,000
10,000
110,000
351,300
120,000
160,000
10,000
60,000
234,400
160,000
10,000
338,500
130,580
228,010
453,800
120,000
110,000
160,000
10,000
10,000
160,000
180,000
160,000
10,000
245,377
160,000
10,000
Page 657
9 JUNI 2016
168,100
126,030
131,910
286,640
69,000
152,950
131,040
297,000
279,575
202,434
60,000
115,000
88,951
252,000
288,600
449,010
40,800
181,800
276,810
50,000
130,000
111,828
129,195
105,500
181,800
120,000
60,000
114,530
285,100
140,000
120,000
160,000
209,300
160,000
10,000
224,545
10,000
125,000
107,614
160,000
10,000
406,300
621,600
214,320
488,200
60,000
212,350
60,000
120,000
Page 658
9 JUNI 2016
40,007
209,600
1,192,000
160,000
10,000
238,560
60,000
338,310
266,300
117,450
176,600
120,000
159,262
160,000
10,000
10,000
890,000
160,000
10,000
60,000
10,000
167,000
890,000
144,250
890,000
890,000
95,386
890,000
110,000
180,000
110,000
188,000
192,600
208,878
195,534
110,000
60,000
110,000
160,000
10,000
95,000
10,000
60,000
135,800
329,600
142,600
185,461
174,800
180,000
Page 659
9 JUNI 2016
60,000
67,900
235,050
343,100
10,000
160,000
60,000
151,652
60,000
60,000
60,000
463,800
161,450
160,060
274,500
180,000
125,000
146,400
130,800
258,000
431,300
146,900
258,000
164,600
126,200
218,200
337,449
210,000
104,986
214,427
157,300
150,100
949,000
10,000
160,000
275,600
254,530
313,500
90,954
10,000
92,000
93,030
133,800
242,461
156,270
198,500
188,504
82,400
160,000
Page 660
9 JUNI 2016
102,850
306,860
60,000
263,228
178,956
180,000
157,000
157,000
126,000
135,200
47,100
102,400
111,400
167,576
159,470
384,500
127,774
23,023
92,400
40,000
138,500
66,000
Page 661
10 JUNI 2016
NO
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
35
36
37
38
39
40
41
NO RJ
100616390196
100616390019
100616390128
100616420654
100616280207
100616420806
100616390131
100616450628
100616460065
100616460232
100616431028
100616390331
100616430748
100616450791
100616430715
100616450616
100616430563
100616430579
100616451036
100616390414
100616280457
100616390210
100616390213
100616390215
100616450898
100616460182
100616450731
100616390327
100616390325
100616280256
100616430869
100616420702
100616390137
100616430756
100616390026
100616390127
100616390246
100616450726
100616390350
100616450623
100616420594
TANGGAL
SEP
06/10/2016
06/10/2016
00
06/10/2016
00
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/20160090R03106160002593
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/20160090R03106160002681
06/10/20160090R03106160002789
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/20160090R03106160002788
06/10/2016
06/10/2016
06/10/2016
00
06/10/2016
06/10/2016
0
06/10/2016
06/10/2016
06/10/2016
06/10/2016
Page 662
10 JUNI 2016
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
100616420591
100616450775
100616390369
100616450542
100616390439
100616390443
100616450874
100616450873
100616430697
100616390153
100616390358
100616390354
100616390285
100616460097
100616430640
100616420578
100616450770
100616430865
100616430882
100616450848
100616390032
100616420712
100616450636
100616430698
100616420638
100616450899
100616450844
100616450681
100616280204
100616431025
100616390179
100616390177
100616280173
100616420934
100616430714
100616390023
100616390035
100616280320
100616390025
100616460357
100616390130
100616450870
06/10/2016
06/10/2016
06/10/2016
06/10/20160090R03106160002636
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
06/10/2016
00
06/10/2016
06/10/2016
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00
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00
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100616430858
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100616450903
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100616390237
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100616390221
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00
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00
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100616450747
100616460321
100616390012
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100616390476
100616390473
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100616420792
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00
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00
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100616430562
100616450790
100616450785
100616420652
100616390373
100616460399
100616431029
100616451051
100616280229
100616390224
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100616390202
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100616390471
100616420625
100616420682
100616450598
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100616280184
100616450582
100616420938
100616390467
100616390216
100616420759
100616420757
100616390144
100616390138
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100616420760
06/10/2016
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00
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00
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00
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252
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100616280162
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100616450650
100616420684
100616390324
100616390319
100616390387
100616460292
100616390218
100616450854
100616420805
100616390340
100616390265
100616420908
100616430771
100616450655
100616280231
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100616390243
100616390124
100616430875
100616390120
100616390122
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100616430709
100616430708
100616390533
100616450550
100616460168
100616450737
100616280276
100616390133
100616460203
100616430893
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00
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100616450653
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100616430911
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100616460078
100616430565
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100616390264
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00
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100616450571
100616390468
100616450744
100616420808
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100616450645
100616390295
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100616280440
100616390248
100616390311
100616390344
100616390342
100616450673
100616420632
100616450789
100616280159
100616450929
100616430639
100616390486
100616390488
100616430773
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100616430602
100616460410
100616460249
100616450849
100616280254
06/10/2016
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06/10/2016
06/10/2016
06/10/2016
06/10/2016
00
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06/10/2016
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00
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Page 670
10 JUNI 2016
NAMA PASIEN
TRANSAKSI
A. SANUSI TN
311,662.00
ABU LAHAB TN.
227,000.00
ACHRUL BAKRI DR.TN.
9,400.00
ADIGUNA PUTRA TN
60,000.00
110,000.00
ADY APRIYANTO TN
181,200.00
78,000.00
AGUSTINA BINTI M.ALI NY.
347,060.00
60,800.00
110,000.00
ALESHA ZAHRA AN.
68,600.00
AMALIA HASANAH NY.
133,800.00
890,000.00
ANI HASAN NY
890,000.00
145,200.00
ANSAHRI NIZAR TN
407,365.00
ASKURNI APSA TN.
148,800.00
ASLAMIA BINTI ZUKMINAH NY.
255,068.00
163,200.00
AULIA ZANNATY ARIANI AN
139,561.00
AULIA ZANNATY ARIANI AN
84,210.00
132,495.00
AZHARI BSC TN.
10,000.00
AZHARI BSC TN.
160,000.00
BASIR DAMILI H. TN.
325,200.00
115,000.00
BETIN TEGUH NY.
176,456.00
160,000.00
10,000.00
CARISSA ADELIA AN.
120,000.00
CHAIRUL SALEH TN.
112,000.00
CORNILIA ANITA NY.
180,400.00
160,000.00
169,372.00
DARMO BIN JINOMO TN
276,450.00
115,000.00
DEDY HENDIKON TN
212,445.00
110,000.00
DERMAULI SITINJAK NN
224,500.00
DEVI AWALIA NY
79,450.00
160,000.00
Page 671
10 JUNI 2016
DEWI MONALISA NY.
DIANA NOVITA NY
DJUMADI BIN MUKIAD TN
DJUNAIDY DJAMID TN.
DJUNAIDY DJAMID TN.
EDDY MAKSURI TN.
EDDY MAKSURI TN.
ELIA YUNIARTI NY.
ELLYA KUSUMA NY.
ELLYA KUSUMA NY.
ELVI SURYATI NY
EMILIA MONICA NY
EMILIA MONICA NY
ENDANG SUDARMI NN.
ENGGA SASONGKO TN
ENGGA SASONGKO TN
ENI YULIANI NY
ERMAWATI BINTI SAPEI NY
F. ARYANI NY.
FATHYA MUSDALIFA AN.
FATMAWATY BINTI HASAN HS NY
FIRRIZKI BACHSIR TN
FREDY KESUMA TN.
GATOT SUGEMTO TN
HARIS FADILA TN
HARTATI BINTI ALFIAN NY
HASANAH BINTI KMS HABUBAKAR NY
10,000.00
145,200.00
890,000.00
229,600.00
260,975.00
86,000.00
160,000.00
10,000.00
136,881.00
136,000.00
160,000.00
10,000.00
60,000.00
126,550.00
17,900.00
145,030.00
180,000.00
123,500.00
84,495.00
114,810.00
216,400.00
60,000.00
137,450.00
2,386,815.00
105,470.00
60,000.00
117,400.00
119,687.00
70,440.00
69,064.00
160,000.00
10,000.00
78,160.00
403,500.00
890,000.00
133,500.00
1,465,300.00
216,600.00
129,000.00
196,000.00
200,800.00
10,000.00
Page 672
10 JUNI 2016
HENDRI HASAN TN
HENNY RASIDATHY NY
HERI PURWANTO TN
HERI PURWANTO TN
HERIYANTO TN
HERRI HANDOKO TN.
HO LI IN NY
HO LI IN NY
IMAM SUBAKRI TN.
INARA AZALEA DZAHIN AN
INDO LAMING NY.
INDRA SETIAWAN TN
INDRAYANI BINTI SAHUNI NY
IRYANTO ASYIK TN.
JAUHARI BIN KEMAS H MANSUR TN
JEANNE KUSSOY NY
JEANNE KUSSOY NY
JIHAN KHAIRUNNISA AN
JOVIAN ALVIANO AN.
KARIMIN TN
KAROLLINA NY
KASMI HELINA HJ NY.
KENCANAWATI LATIF HUSIN NY
KERRIN NATHANIA AN.
KHOTIMAH BIMTI AGUSCIK NY.
KRISTIANI NDRURU NY.
KWEE WIE BENG TN
LEDIS HERU SARYONO TN
LIDYA SISCA NY.
LIS SUMARTINI NY.
LISIANA OSWARI NN.
LISIANA OSWARI NN.
160,000.00
214,800.00
403,266.00
146,695.00
50,000.00
1,566,900.00
221,280.00
10,000.00
160,000.00
512,000.00
130,100.00
180,000.00
134,427.00
221,080.00
95,000.00
146,450.00
160,000.00
10,000.00
127,396.00
120,000.00
60,000.00
10,000.00
160,000.00
569,820.00
210,243.00
85,200.00
429,200.00
60,000.00
319,200.00
114,130.00
214,000.00
956,000.00
455,600.00
160,000.00
10,000.00
222,000.00
143,130.00
512,000.00
10,000.00
160,000.00
160,000.00
10,000.00
Page 673
10 JUNI 2016
LOUIS ALVARO AN.
M H NABIL ABIYAKTA AN.
M. ARKAN ZABIAN AN.
M. FAHRY MAIZA AN.
M. HUSAINI TN
M. RAIHAN AS SHIDDIQ AN.
M. RUZZA KENJI PRADETA AN.
M.AMIN LISON TN
M.RASYID ALFATHIR AN.
M.WAHID AN.
MACHMUDI MUIB TN.
MAGDALENAWATY NY.
MAHDALIA YUKLANDARI NY.
MAHDALIA YUKLANDARI NY.
MAMAT SADI TN.
MARIAMIN BINTI JOHAN NY
MARIANA NY
MARIANA NY
MARIANI HJ BINTI ABDUROHIM NY.
MARITA RAMIANTI NY.
MARTIN TRI KARTIKA NY
MARYANI BINTI NUNGCIK NY.
MEI PUJI RAHAYU AN.
MEIDI YUSRI, MS TN
MEIRITA RUSLIE NY.
MEIRITA RUSLIE NY.
MERIE YULITA NY
MERRY SIANA NY
60,000.00
313,800.00
153,187.00
60,000.00
154,280.00
112,300.00
110,000.00
110,000.00
172,900.00
93,446.00
161,570.00
60,000.00
360,392.00
111,684.00
117,800.00
60,000.00
128,800.00
151,800.00
102,400.00
74,646.00
235,200.00
1,030,600.00
10,000.00
160,000.00
180,000.00
10,000.00
160,000.00
183,620.00
97,800.00
180,000.00
142,684.00
489,450.00
86,460.00
199,666.00
77,160.00
94,280.00
10,000.00
160,000.00
157,848.00
222,000.00
244,520.00
162,585.00
Page 674
10 JUNI 2016
MIE TJAN YENI NY
MIKHAEL RUKINEM NY.
MIS YANTI NY
MUCHTAR BIN KATIMAN TN.
MUCHTAR TS TN
MUCHTAR TS TN
MUHAMAD ADELARD ARRASYID AN
MUHAMMAD ABDILLAH TN.
MUHAMMAD AHSAN BAIHAQI AN.
MUHAMMAD ALDI AN
MUHAMMAD NAIM TN.
MUHAMMAD NURDIN TN.
MUHAMMAD QODRI TN
MUIZAH BINTI M. NUH NY
MULYATI CAHAYA NY.
MUTIAR DJANAN TN
NASREL HAYATI NY.
NASRUN BASRI TN
NASRUN BASRI TN
NING AYU NY.
NING AYU NY.
NOPA ROSETA NN.
NOPA ROSETA NN.
NOVIEANA NISFURITA NY
NUR AINI NY.
NURHAYATI BINTI HILAL NN
NURIDA ANGGRAINI NY.
NURLIANA SALIM NY
191,200.00
517,080.00
87,300.00
229,915.00
149,600.00
256,160.00
366,450.00
102,000.00
10,000.00
134,105.00
22,000.00
156,690.00
60,000.00
240,800.00
314,700.00
111,000.00
151,556.00
425,100.00
234,400.00
234,700.00
470,200.00
10,000.00
160,000.00
167,000.00
10,000.00
71,450.00
10,000.00
137,000.00
98,950.00
10,000.00
160,000.00
126,000.00
257,280.00
242,280.00
416,300.00
405,890.00
60,000.00
137,000.00
10,000.00
488,200.00
166,400.00
93,950.00
Page 675
10 JUNI 2016
NYIMAS ZALEHA NY.
OKTA SAPUTRA TN
PAIMAN BIN MARJANI TN
PARIS PRATAMA TN.
PUJI ASTUTI NY
PUJI ASTUTI NY
PUTRO SETYONO TN
RA FARIDA NY.
RAFA ALVARO AN
RAHULLA HUANG AN.
RAMLAN M.I TN.
RAMLAN M.I TN.
RANU ARDANA AN.
RASYAH ADITYA AN
RATNA DEWI SARTIKA NY.
RATNA MAIDA NY
RETNO SARI NN
RETNO SARI NN
RIKA DWI AFRIANI NN.
RINCE CAROLINA NY.
RINDA DESIANA NY.
RITA LIZIANA NY
RONIMAH NY
RONIMAH NY
ROYKE SURACHMAN TN
100,590.00
390,280.00
248,000.00
595,200.00
279,021.00
160,000.00
10,000.00
1,192,000.00
262,424.00
163,190.00
60,000.00
60,000.00
60,000.00
122,400.00
37,620.00
233,606.00
40,800.00
60,000.00
116,841.00
160,000.00
10,000.00
592,810.00
180,000.00
102,865.00
345,900.00
87,500.00
118,611.00
51,600.00
110,000.00
40,000.00
60,000.00
470,200.00
244,080.00
201,525.00
125,000.00
10,000.00
160,000.00
10,000.00
299,376.00
10,000.00
160,000.00
60,000.00
Page 676
10 JUNI 2016
ROZANA MEILINDA NY.
RUKIATI BINTI SULAI NY.
RUSMIDIUS NY.
RUSMIDIUS NY.
RUSNI BINTI MARIDUN NY.
RUSTAM HALIM TN
RUSTEM PUAD TN.
RUSTEM PUAD TN.
SARDJONO, H TN
SARDJONO, H TN
SEKAR SARI WIRADARMA NN.
SELPI DIPEGA NY.
SEPTI SARMINI NY.
SEPTIANA BINTI EFFENDI HALIM N
SEPTIANA BINTI EFFENDI HALIM N
SEPTIANA NY.
SHOFWAN TN.
SISKA FITRIYANTI NY.
SITI AISYAH NY.
SITI AMINAH NY.
SITI ASIAH NY.
SITI BINTI SIDIK NY
SITI FARIDA NY.
SITI FATIMAH NY
SITI FATIMAH NY
SITI HASMAYANI NY
SITI NURAINI NY.
SITI NURAINI NY.
SITI RAHMAH NY.
SITI ROHANA THALIB NY.
SLAMET SOETANTO TN.
SOFIA AZZAHRA AN.
SUDARMAN TN
122,445.00
256,495.00
1,375,600.00
95,000.00
10,000.00
245,240.00
152,724.00
890,000.00
160,000.00
10,000.00
216,000.00
60,000.00
160,000.00
10,000.00
60,000.00
115,000.00
488,200.00
226,470.00
180,000.00
63,507.00
278,000.00
272,890.00
350,150.00
149,800.00
1,081,900.00
45,000.00
246,580.00
245,830.00
144,330.00
10,000.00
137,000.00
357,762.00
160,000.00
10,000.00
80,800.00
146,700.00
166,695.00
60,000.00
174,720.00
66,400.00
156,000.00
188,000.00
Page 677
10 JUNI 2016
SUKANTO KESUMAH TN
SUKANTO KESUMAH TN
SUKANTO KESUMAH TN
SUMARIAH BINTI SUGIYO NY.
SUMARIAH BINTI SUGIYO NY.
SUPIYANI NY.
SURYA MEGAWATI NY
SURYA MEGAWATI NY
SYAIFUL ANWAR TN
SYAIFUL BACHRI TN.
SYAMSUL ARIF TN
SYARIP TOHARLI TN.
SYLVIA ADRIYANITA NN.
SYUKRI MUBARAK TN.
TALITA DZAKIRA AZALEA AN.
TAN NIE NIO TATTY NURJATI NY
TETI NEVISKA NY
TEUNKU DENARSYAH TN
TIARA NITA NY.
TITIN SURYANI. NY
TJHANG HON LION-HANDRI S TN
TRI PUTRA H SURBAKTI TN.
TRI SANDI APRI S TN.
TRISNAWATY BINTI THAMRIN NN
TUGINO BIN PARMONO TN.
71,450.00
10,000.00
160,000.00
119,262.00
890,000.00
164,860.00
97,142.00
60,000.00
121,950.00
452,000.00
303,606.00
160,000.00
10,000.00
10,000.00
160,000.00
890,000.00
230,000.00
141,600.00
78,000.00
189,280.00
214,060.00
268,830.00
60,000.00
813,030.00
194,520.00
108,200.00
617,700.00
120,000.00
488,200.00
472,000.00
10,000.00
160,000.00
384,200.00
228,000.00
236,000.00
187,200.00
68,000.00
60,000.00
244,520.00
139,200.00
60,000.00
231,970.00
Page 678
10 JUNI 2016
UUT PUSPITASARI NY.
YANTIMALA BINTI NYAK ACEH NY.
YOSSI SHOPIANA NY
YULIA DASWATI NY.
YULIA DASWATI NY.
YULINAR NURUT NY.
YULISMA BINTI SUHARNO NY
YUNALNI NY.
YUNALNI NY.
YUNITA NATALIA WULANDARI NY
YUSNI DARWIN TN
YUSUF USMAN TN
Z. HAYATI NY
ZAKARIA BIN CIK ITAM TN
ZANARIA BINTI ZAINAL ABIDIN NY
ZURIAH,HJ NY.
ZURIAH,HJ NY.
158,930.00
110,000.00
890,000.00
110,000.00
132,150.00
351,000.00
326,420.00
60,000.00
113,980.00
160,000.00
10,000.00
258,700.00
231,000.00
160,000.00
10,000.00
60,000.00
168,000.00
194,950.00
109,562.00
422,400.00
243,300.00
10,000.00
160,000.00
325,320.00
305,895.00
488,200.00
890,000.00
180,000.00
241,288.00
160,000.00
10,000.00
Page 679
11 JUNI 2016
NO
NO RJ
110616280213
110616280215
110616450627
110616450631
110616280090
110616450716
110616450728
110616450014
110616450013
110616450808
110616280298
110616390129
110616390131
110616390035
110616450089
110616390039
110616390053
110616390052
110616450277
110616450023
110616450033
110616450022
110616450015
110616450018
110616390045
110616390027
110616450030
110616450032
110616450028
110616450029
110616450280
110616450281
110616390233
110616450235
110616390024
110616390025
110616390070
110616390073
110616280109
110616280110
110616390055
TANGGAL
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
SEP
0
0
0
0
00
00
00
00
00
00
00
0090R03106160002708
0090R03106160002708
0090R03106160002741
0090R03106160002767
0090R03106160002851
0090R03106160002867
0090R03106160002868
0090R03106160002876
0090R03106160002877
0090R03106160002877
0090R03106160002878
0090R03106160002879
0090R03106160002880
0090R03106160002881
0090R03106160002883
0090R03106160002884
0090R03106160002884
0090R03106160002885
0090R03106160002885
0090R03106160002886
0090R03106160002886
0090R03106160002887
0090R03106160002888
0090R03106160002889
0090R03106160002889
0090R03106160002890
0090R03106160002890
0090R03106160002891
0090R03106160002891
0090R03106160002892
Page 680
11 JUNI 2016
110616390057
110616390080
110616390081
110616450278
110616450279
110616450079
110616450083
110616390176
110616390179
110616390285
110616390142
110616390160
110616280122
110616280124
110616390318
110616450231
110616390413
110616280112
110616280113
110616390139
110616390140
110616450169
110616450172
110616390187
110616390189
110616390193
110616390194
110616390054
110616280234
110616280238
110616280244
110616280247
110616280268
110616280271
110616390250
110616450059
110616450060
110616280148
110616390299
110616390300
110616390382
110616390383
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
0090R03106160002892
0090R03106160002893
0090R03106160002893
0090R03106160002894
0090R03106160002894
0090R03106160002896
0090R03106160002896
0090R03106160002897
0090R03106160002897
0090R03106160002898
0090R03106160002899
0090R03106160002899
0090R03106160002900
0090R03106160002900
0090R03106160002901
0090R03106160002902
0090R03106160002903
0090R03106160002904
0090R03106160002904
0090R03106160002905
0090R03106160002905
0090R03106160002906
0090R03106160002906
0090R03106160002907
0090R03106160002907
0090R03106160002908
0090R03106160002908
0090R03106160002909
0090R03106160002910
0090R03106160002910
0090R03106160002911
0090R03106160002911
0090R03106160002913
0090R03106160002913
0090R03106160002914
0090R03106160002915
0090R03106160002915
0090R03106160002916
0090R03106160002917
0090R03106160002917
0090R03106160002918
0090R03106160002918
Page 681
11 JUNI 2016
110616390290
110616390291
110616450301
110616450303
110616390443
110616390444
110616450093
110616280354
110616280358
110616280351
110616280352
110616280416
110616280419
110616390067
110616280100
110616280101
110616390361
110616390376
110616430460
110616430461
110616450370
110616450373
110616390415
110616390417
110616430474
110616430477
110616390393
110616390403
110616450466
110616450467
110616390494
110616390497
110616280251
110616450516
110616450519
110616450659
110616450662
110616430543
110616430547
110616280283
110616390309
110616390310
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
0090R03106160002919
0090R03106160002919
0090R03106160002920
0090R03106160002920
0090R03106160002921
0090R03106160002921
0090R03106160002922
0090R03106160002923
0090R03106160002923
0090R03106160002924
0090R03106160002924
0090R03106160002925
0090R03106160002925
0090R03106160002926
0090R03106160002927
0090R03106160002927
0090R03106160002928
0090R03106160002928
0090R03106160002929
0090R03106160002929
0090R03106160002930
0090R03106160002930
0090R03106160002932
0090R03106160002932
0090R03106160002933
0090R03106160002933
0090R03106160002934
0090R03106160002934
0090R03106160002935
0090R03106160002935
0090R03106160002936
0090R03106160002936
0090R03106160002938
0090R03106160002939
0090R03106160002939
0090R03106160002940
0090R03106160002940
0090R03106160002941
0090R03106160002941
0090R03106160002942
0090R03106160002943
0090R03106160002943
Page 682
11 JUNI 2016
110616430605
110616430613
110616450520
110616450527
110616390593
110616390647
110616390603
110616390604
110616390606
110616390607
110616430617
110616450304
110616430584
110616430585
110616390656
110616430628
110616390313
110616430615
110616280398
110616280399
110616390696
110616450353
110616390682
110616390684
110616390699
110616450463
110616390645
110616390646
110616450486
110616460778
110616430765
110616430557
110616430755
110616460771
110616460767
110616460770
110616460774
110616450561
110616460769
110616390721
110616430734
110616450737
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
11/06/2016
0090R03106160002944
0090R03106160002945
0090R03106160002946
0090R03106160002946
0090R03106160002947
0090R03106160002947
0090R03106160002948
0090R03106160002948
0090R03106160002949
0090R03106160002949
0090R03106160002950
0090R03106160002951
0090R03106160002952
0090R03106160002952
0090R03106160002953
0090R03106160002954
0090R03106160002956
0090R03106160002957
0090R03106160002958
0090R03106160002958
0090R03106160002960
0090R03106160002961
0090R03106160002963
0090R03106160002963
0090R03106160002965
0090R03106160002966
0090R03106160002968
0090R03106160002968
0090R03106160002970
0090R03106160002971
0090R03106160002972
0090R03106160002973
0090R03106160002974
0090R03106160002975
0090R03106160002976
0090R03106160002977
0090R03106160002978
0090R03106160002979
0090R03106160002982
0090R03106160002984
0090R03106160002985
0090R03106160002987
Page 683
11 JUNI 2016
110616460725
110616390764
110616430799
11/06/2016
11/06/2016
11/06/2016
0090R03106160002990
0090R03106160002992
0090R03106160002993
Page 684
11 JUNI 2016
NAMA PASIEN
TRANSAKSI
CHERRY LEMBEK TN.
10,000.00
CHERRY LEMBEK TN.
160,000.00
10,000.00
137,000.00
AZMUL MAMMON TN.
16,100.00
DESWITA ANANDA ARISYAFA AN
50,800.00
FIDELA CALYSTA LEFRAN AN
34,005.00
LAM SURYA NY.
###
409,950.00
RAAIDA NAJAH HAKIMAH AN
116,625.00
557,700.00
ARYA RAMADHAN AN
100,000.00
ARYA RAMADHAN AN
35,000.00
SRIYANTI BINTI M ANANG NY
60,000.00
AZMUL MAMMON TN.
370,000.00
40,000.00
KURNIATI LILI NY
40,000.00
KURNIADY DELIMA TN
40,000.00
DEWI FATIMAH PUTIH MELODY N 218,000.00
TOMMY MAULANA TN.
343,170.00
TOMMY MAULANA TN.
40,800.00
KHOIRUNNISA SR NN
170,996.00
137,400.00
233,532.00
SUKRI SIARAP TN.
62,020.00
DESWITA ANANDA ARISYAFA AN 113,500.00
MAGDALENA MD SITORUS, SH NN 10,000.00
MAGDALENA MD SITORUS, SH NN 160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
890,000.00
###
E. SIMATUPANG TN
10,000.00
E. SIMATUPANG TN
125,000.00
10,000.00
125,000.00
10,000.00
125,000.00
10,000.00
Page 685
11 JUNI 2016
EMMY YAHIMI NY
EMMY YAHIMI NY
ZUBIR A JALIL TN.
ZUBIR A JALIL TN.
SULAIMAN NADEAK TN.
SAIFUL NURAINI TN.
SAIFUL NURAINI TN.
HARBEI PASAH TN
TEGUH BIN HOKSAN TN
TITIN KUSMETA NY.
TITIN KUSMETA NY.
DEVI AWALIA NY
DEVI AWALIA NY
JACUB RAHMAN TN.
JACUB RAHMAN TN.
ARBAIN GANTI TN
ARBAIN GANTI TN
DJALILI SOLIHIN TN
DJALILI SOLIHIN TN
SOFIA AZZAHRA AN.
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
125,000.00
###
10,000.00
137,000.00
10,000.00
95,000.00
###
890,000.00
890,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
137,000.00
10,000.00
160,000.00
115,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
890,000.00
167,000.00
10,000.00
115,000.00
10,000.00
160,000.00
10,000.00
160,000.00
Page 686
11 JUNI 2016
NOPA ROSETA NN.
NOPA ROSETA NN.
TJIKMAD. B TN.
TJIKMAD. B TN.
ARIFIN SITOHANG TN.
ARIFIN SITOHANG TN.
M. ARSYAD YAHYA ALKHALIFI AN
AMIR HAMZAH TN
AMIR HAMZAH TN
ACHMAD ZARNUBI TN.
ACHMAD ZARNUBI TN.
TUMIAR SILABAN NY.
TUMIAR SILABAN NY.
TJIKNUT SYUKUR NY
TJIKNUT SYUKUR NY
RITA ARSYAD NY.
RITA ARSYAD NY.
MULYADI CUAN BIE TN
MULYADI CUAN BIE TN
HASRI TANJUNG H TN.
HASRI TANJUNG H TN.
10,000.00
125,000.00
10,000.00
125,000.00
10,000.00
160,000.00
110,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
49,000.00
10,000.00
167,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
102,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
160,000.00
120,000.00
10,000.00
160,000.00
10,000.00
160,000.00
10,000.00
102,000.00
110,000.00
10,000.00
167,000.00
Page 687
11 JUNI 2016
ERWIN AZHARI TN.
EDY ABDULLAH TN
M. ZARKONI TN.
M. ZARKONI TN.
SAID SALIM TN
SAID SALIM TN
RUSNAN CHANDRA TN
RIO ABDILLAH AN
AS AD SAYUTI DRS TN
AS AD SAYUTI DRS TN
NICKY VERDIANTO TN.
NADHIRA AZKA ANINDYA AN
MOH.MAQQON TN.
ENDANG SUTISNA TN
MIKHAYLA ADZKIA PUTRI AN
SUMARTINI NY
YULINTIA WINDARLINA NN.
NOPI APRIANTI NY
FIDELA CALYSTA LEFRAN AN
WINDA LESTARI NN
FEBRIANI NN
890,000.00
890,000.00
10,000.00
125,000.00
160,000.00
10,000.00
10,000.00
160,000.00
10,000.00
160,000.00
932,500.00
110,000.00
10,000.00
125,000.00
110,000.00
###
120,000.00
890,000.00
167,000.00
10,000.00
890,000.00
110,000.00
10,000.00
160,000.00
110,000.00
110,000.00
10,000.00
160,000.00
87,100.00
117,400.00
133,200.00
260,915.00
130,300.00
209,270.00
139,500.00
139,500.00
136,700.00
179,100.00
144,500.00
111,400.00
159,978.00
90,300.00
Page 688
11 JUNI 2016
RAAIDA NAJAH HAKIMAH AN
183,400.00
BADRULLAH DAUD KOHAR DRS H 170,560.00
SIWI UTAMI NY.
151,200.00
Page 689
12 JUNI 2016
NO
NO RJ
120616420111
120616420106
120616280181
120616420118
120616390142
120616420114
120616420109
120616390149
120616420135
120616420110
120616420113
120616420107
120616420133
120616420112
120616390032
120616390033
120616390035
120616420042
120616420037
120616420039
120616390038
120616420023
120616420027
120616420014
120616390040
120616390085
120616390102
120616420136
120616420139
120616420140
120616420161
120616460176
120616460186
120616280234
120616280268
120616460279
120616280293
120616420138
120616420020
120616420018
TANGGAL
SEP
12/06/2016
00
12/06/2016
00
12/06/2016
00
12/06/2016
00
12/06/2016
00
12/06/2016
00
12/06/2016
00
12/06/2016
00
12/06/2016
00
12/06/2016
00
12/06/2016
00
12/06/2016
00
12/06/2016
00
12/06/2016
00
12/06/20160090R03106160002937
12/06/20160090R03106160002955
12/06/20160090R03106160002967
12/06/20160090R03106160002988
12/06/20160090R03106160002989
12/06/20160090R03106160002991
12/06/20160090R03106160002995
12/06/20160090R03106160002997
12/06/20160090R03106160002998
12/06/20160090R03106160003000
12/06/20160090R03106160003003
12/06/20160090R03106160003004
12/06/20160090R03106160003008
12/06/20160090R03106160003009
12/06/20160090R03106160003012
12/06/20160090R03106160003013
12/06/20160090R03106160003015
12/06/20160090R03106160003016
12/06/20160090R03106160003018
12/06/20160090R03106160003021
12/06/20160090R03106160003024
12/06/20160090R03106160003026
12/06/20160090R03106160003027
12/06/2016
12/06/2016
12/06/2016
Page 690
12 JUNI 2016
NAMA PASIEN
TRANSAKSI
78,000.00
AZWAR FANANI TN.
###
CHADIDJAH SALEH NY
5,478.00
###
HERIYANTAMA TN
16,006.00
MAGDALENAWATY NY.
###
###
NADHIFA AYU MAHARANI AN
23,000.00
NETI HARTINI NY.
71,250.00
78,300.00
SHOFWAN TN.
###
SUWIRMAN BIN KAMARUDDIN TN
###
TJHANG HON LION-HANDRI S TN
78,000.00
81,450.00
ABDUL HAMID TN.
###
MUHAMMAD YUSUF TN
40,000.00
DIAN YULIANA NY.
40,000.00
###
NOVI DITYA.NY
###
###
MIKHAEL RUKINEM NY.
###
M. RAYYAN AL GHIFFARI AN
###
NAILAH ATIKAH ZAHRA AN
###
MARODI TN
###
HERLINAWATI BY NY
###
AYU LUTHFIYAH AN.
###
TOMMY MAULANA TN.
80,800.00
YULITA AMAK NY
74,481.00
NADHIFA AYU MAHARANI AN
###
HERIYANTAMA TN
40,000.00
RAHMATUNISYAH BIN HAMID NY
95,180.00
CHADIDJAH SALEH NY
76,403.00
###
NUR HIDAYAH NY.
###
EVA J POLUAN NY.
###
BADARUDDIN BIN MARKOWI TN.
###
RAHMI YANTI OKTORA NY
80,100.00
M ALI HANAFIAH TN
72,300.00
MONIKA YOFITA SARI NN.
###
TAN LAIJ NIO NY.
###
Page 691

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