Daftar Klaim

DAFTAR KLAIM RAWAT INAP PASIEN JAMKESDA RSUD TANAH BUMBU
PROPINSI : KALIMANTAN SELATAN

KABUPATEN : TANAH BUMBU
Umur (Thn)
NO
NAMA PASIEN
NO.REKOMENDASI JAMKESDA
TANGGAL
Alamat
L
Jl.Ins Gub GG Pelita III 010/003
Kampung Baru Simpang Empat
Jl. Raya Batulicin Rt 002 Segumbang
Batulicin
Jl.Brigjen H.Hasan Basri 008 Batuah
Kusan Hilir
Saring Sungai binjai Rt 004 desa
saring sungai binjai Kusan hilir
LOS
DIAGNOSA
Masuk
Keluar
28
25 September 2013
07 Oktober 2013
12 (hari)
old unrednled hip sort
40
30 September 2013
05 Oktober 2013
5 (Hari)
Hepatitis
68
29 September 2013
08 Oktober 2013
9 (Hari)
Obs.Dispneu Sups CHI
69
26 September 2013
07 Oktober 2013
11 (Hari)
Asma
Tn. Zainal Arifin
6310090302850001
Tn. Mansur
6310010107690053
Tn.Goga
6310020107650035
Tn.Jadu
6310020107440067
Ny.Hj.Norhasanah
631009650540004
Jl.Pelabuhan Samudra rt 001/001

desa Sejahtera Kec.Simpang Empat
49
24 September 2013
05 Oktober 2013
11 (Hari)
Dispepsia
Ny.Panda
6310094109670004
Jl Bina Bakti GG H.Bayo Rt.009/003

Desa Sejahtera Kec.Simpang Empat
56
30 September 2013
08 Oktober 2013
8 (Hari)
gastroebuler
Tn.Saharudin
6310021007900004
25
02 Oktober 2013
08 Oktober 2013
6 (Hari)
Tb.Paru
Tn.Hutomo
6310031606650002
58
20 Oktober 2013
22 Oktober 2013
2 (hari)
Hil riporsible
Ny.Rosma S
6310095107690005
Jl.Bina Bersama Rt 001 Desa Gunung

Besar Kec.Simpang Empat
04 Oktober 2013
08 Oktober 2013
4 (Hari)
Hemi Pans dextra sups SNH
10
Tn.Rahmadi
6310033112760015
Jl.Sebamban 3 Blok A rt 005/002

Desa Sumber Sari Kec.Sungai Loban
06 Oktober 2013
10 Oktober 2013
4 (Hari)
Obs.Cefalgia
11
Ny.Supiyem
6310084107520028
61
10 Oktober 2013
13 Oktober 2013
3 (Hari)
obs Febris
12
Ny.Cicih
6310074107410002
72
09 Oktober 2013
12 Oktober 2013
3 (hari)
Diare Akut
13
Tn.Lasono
6310060602650001
11 Oktober 2013
14 Oktober 2013
3 (Hari)
cokc abdoea ec sups isk
14
Ny.Mastia
6310094107670235
07 Oktober 2013
17 Oktober 2013
10 (Hari)
HT Emergency
15
Tn.Endra Irawan
6310081612920003
Manunggal Dusun III RT 018 Desa

Manunggal Kec.Karang Bintang
07 Oktober 2013
09 Oktober 2013
2 (hari)
obs Febris
16
Ny.Ani
6310094903820007
Jl.Raya Batulicin Rt 003 Desa

Kampung Baru Kec.Simpang Empat
04 Oktober 2013
09 Oktober 2013
5 (Hari)
Dispepsia
17
Tn. Dardiansyah
6310031506600004
Jl. Propinsi Rt.003 Rw.002 Ds.

Sebamban Lama Kec. Sungai Loban
53
26 September 2013
03 Oktober 2013
7 (Hari)
CHF + ASHD
18
Tn. Yadiman
6310100603080978
Jl. Raya Transmigrasi Dusun IV

Rt.017 Rw.009 Ds. Sukadamai Kec.
Mantewe
18
29 September 2013
04 Oktober 2013
5 (Hari)
Susp. Frakture os zygomantens D
Jl.Muara Pagatan Rt 002 Muara

Pagatan Kec.Kusan Hilir
Jl.Sebamban 1 Blok H rt 003/002
Desa Biduri Bersujud Kec.Sungai
Loban
Jl.Kamboja Rt 011/006 Desa Pandan

Sari Kec.Karang bintang
Jl Desa Giri Mulya Rt 020/006 Desa
Giri Mulya Kec.Kuranji
Jl.Jeruk rt 001 Des Purwodadi
Kec.Angsana
Jl.Kodeko Km 10 Rt 004 Desa
Sarigadung Kec.Simpang Empat
44
37
50
46
21
23
19
Tn. Prato
6310100602120007
Jl. Raya Transmigrasi Km.37 Dusun

III Rt.009 Ds.Bulu Rejo Kec.
Mantewe
58
29 September 2013
12 Oktober 2013
13 (Hari)
Obs. Abdomen Pain
20
Tn. Dodde
631010022812610001
Jl. Ladeleng Rt.001 Ds.Muara

Pagatan Tengah Kec.Kusan Hilir
52
29 September 2013
17 Oktober 2013
18 (Hari)
Asites + Hepatosplenomegali
21
Tn. Susilo Sudarman
6310080811860001
30
05 Agustus 2013
06 Agustus 2013
1 (Hari)
22
Tn. Sumantra
6310090811580002
40
17 Oktober 2013
21 Oktober 2013
4 (Hari)
Hil
23
Tn. Roel Darwis
6310090402920008
21
27 Oktober 2013
29 Oktober 2013
2 (hari)
vulnus laceratum
24
Ny. Wahidah
6310094505690010
22 Oktober 2013
24 Oktober 2013
2 (hari)
Lipoma regio
25
Tn. Awaludin
6310020307930002
20
19 Oktober 2013
23 Oktober 2013
4 (Hari)
Sekunder post hectigo
26
Tn. Ambo tang
6310022601790001
43
15 Oktober 2013
18 Oktober 2013
3 (Hari)
CF
27
An. Aldi Indofani
6310082405030003
10
16 Oktober 2013
21 Oktober 2013
5 (Hari)
vulnus laceratum
28
Tn. Rian
6310091104890006
23
18 Oktober 2013
21 Oktober 2013
3 (Hari)
HIL
29
Ny. Poniah
6310084107720099
41
10 Oktober 2013
16 Oktober 2013
6 (Hari)
Neglicted dislocation
30
An. Selsy
6310016601080001
18 Oktober 2013
21 Oktober 2013
3 (Hari)
soft tissue
31
Ny. Hukmatang
6310024107470131
66
post Db
32
Tn. Rahman
6310091408850001
33
Tn. Darko Cahyo
631009110390005
34
Tn. Fahrul
6310020405940002
35
Tn. M. Riyan
6310102802970001
36
Ny. Masnuatul
6310034204830003
37
An. Rendi
6310020702120003
38
An. M. Seman Almadani
6310091910110002
39
Ny. Mahrita
6310014611870002
40
Ny. Asmah
6310096901790003
41
An. Azka Dwi. H
6310101710100001
42
Tn. Ngadi
6310081302480001
43
Tn. Maksum
6310091306510001
44
Tn. Goga
6310020107650035
45
Tn. Ruswan
6310080107530075
Ds. Karang Bintang rt 012

Jl. Kupang Rt 007 desa sari gadung,
simpang empat
Jl. Hidayah Gg. Kelapa dua Rt 007
desa bersujud, simpang empat
Jl. Lapangan 5 oktober Rt 005 desa
bersujud, simpang empat
Jl. H.M. Amin Rt 004 desa pakatellu,
kusan hilir
Jl. Mustika No. 34 Rt 007 Desa
Batuah, Kusan Hilir
Blok C.I Rt 008 desa Madu retno,
Karang Bintang
jl. Pelabuhan samudra rt 001 desa
sejahtera, simpang empat
Jl. Tidar Rt 010 desa pematang ulin,
karang bintang
jl. Cempaka batulicin rt 016,
batulicin
Baru gelang rt 001, kusan hilir
Gg. Musyawarah rt 002, desa
sejahtera, simpang empat
Jl. Pasar sabtu rt 001, desa
tungkaran pangeran, simpang
empat
desa puau satu rt 001, kusan hilir
Jl. Raya Transmigrasi dusu I rt 004
desa suka damai, mantewe
sebamban I blok C rt 006, desa
damar indah, sungai loban
jl. Teoian sungai kusan rt 007, desa
salimuran, kusan hilir
jl. Raya serongga Km 4,5 rt 002 desa
gunung besar, simpang empat
44
16 Oktober 2013
21 Oktober 2013
5 (Hari)
28
10 Oktober 2013
14 Oktober 2013
4 (Hari)
16
15 Oktober 2013
21 Oktober 2013
6 (Hari)
open fraktur 1/3 proximal
19
16 Oktober 2013
21 Oktober 2013
5 (Hari)
KIL
16
07 Oktober 2013
12 Oktober 2013
5 (Hari)
Susp close fraktur 1/3 proximal os fektur
07 Oktober 2013
10 Oktober 2013
3 (Hari)
FAM
20 Oktober 2013
24 Oktober 2013
4 (Hari)
DADR
23 Oktober 2013
25 Oktober 2013
2 (hari)
diare akut dehidrasi
26
24 Oktober 2013
31 Oktober 2013
7 (Hari)
34
25 Oktober 2013
27 Oktober 2013
2 (hari)
Bakterial infection
30
segumbang rt 001, batulicin

jl. Teratai rt 005 desa gunung besar,
simpang empat
jl. Raya transmigrasi dusun IV rt 015
Desa karang bintang rt 010
jl. Raya batulicin, gg. Mantooangin
rt 003 desa kampung baru, simpang
empat
jl. Brigjen H.hasan basri rt 008 desa
batuah, kusan hilir
25 Oktober 2013
26 Oktober 2013
1 (Hari)
Diare cair akut
65
23 Oktober 2013
27 Oktober 2013
4 (Hari)
pnemonia berat
62
23 Oktober 2013
25 Oktober 2013
2 (hari)
Retensi urine
68
23 Oktober 2013
31 Oktober 2013
8 (Hari)
Obs. Dispneu ec susup PPOK
ds. Karang rejo rt 006 desa

mentawakan mulia,, karang bintang
60
28 Oktober 2013
30 Oktober 2013
2 (hari)

Batulicin
jl. Kurma rt 009 desa puurwodadi,
angsana
jl. Tepi sungai antasan rt 004, saring
sungai binjai,, kusan hilir
Manunggal dusun II rt 012 desa
manunggal, karang bintang
46
Nn. Wardah
6310015505960003
47
Tn. Widianto
6310060107450005
48
Ny. Benda
6310024504480002
49
Tn. Ahmad Rosyadi
6310080310790001
50
An. Nur aminah
6310055204980009
51
Ny. Masniah
6310026407790001
52
Tn. Abdul safa
'6310021205480001
53
Tn. Asrofi
6310080307920002
54
Ny. Bestiyah
6310094107480039
55
An. Abit
6310020902130001
56
Tn. Agus Hariadi
6310091208800004
57
Tn. Bagas Prianggodo
6310022506960001
58
Tn. Amit
6310030210830002
59
An. Azhar zain
6310020904120001
60
Ny. Jahroliana
6310025704910006
61
Ny. Atim
6310095204650003
62
Ny. Hernawati
6310026605670001
63
Tn. Harjo suwito
6310030107470049
64
Nn. Novita wulandari
6310036309970001
65
By. Ny. Erlangga
6310061004130003
66
Tn. Bahrain
6310021206860007
67
An. Rina Ananta
6310104912110003
68
Tn. Aminin
6310091204650009
69
Nn. Nur eva yanti
6310036308940001
Ny. Hj. Lame
6310021011550001
Gg. Kurnia makmur rt 010 desa

jl. H.m ali rt 001 desa tanete, kusan
hilir
dusun tirta mulia rt 008 desa batu
meranti, sungai loban
Sebamban III Blok D Rt 006 Desa Tri
martani, sungai loban
Jl. Bayangkara rt 011, tungkaran
pangeran, simpang empat
Jl. Ladongnga rt 002, muara
pagatan, kusan hilir
Jl. Raya transmigrasi dusun IV rt 016
Jl. Transmigrasi rt 009, barokah,
simpang empat
Sebamban I blok B1 rt 012, sari
utama, sungai loban
Gg. Tenggiri rt 003, wirittasi, kusan
hilir
71
Tn. Bejan
6310050107450003
Desa Wonorejo rt 013, kusan hulu
72
Tn. Senen
6310042101450001
73
Tn. Jeddi
6310020107590141
74
Ny. Zaitun
6310085811870001
Jl. Desa rt 005, satui timur

Jl. Asoka rt 002, sepunggur, kusan
hilir
Desa manunggal dusun 1 rt 02,
karang bintang
70
16
16 Oktober 2013
17 Oktober 2013
1 (Hari)
Cefalgia+dispepsia
09 Oktober 2013
16 Oktober 2013
7 (Hari)
Bronkhitis kronis
17 Oktober 2013
22 Oktober 2013
5 (Hari)
DM
21 Oktober 2013
27 Oktober 2013
6 (Hari)
Melena susp gastritis erosit
16
20 Oktober 2013
22 Oktober 2013
2 (hari)
34
22 Oktober 2013
25 Oktober 2013
3 (Hari)
Disentri
65
23 Oktober 2013
26 Oktober 2013
3 (Hari)
malaise
21
22 Oktober 2013
25 Oktober 2013
3 (Hari)
CKS
21 Oktober 2013
28 Oktober 2013
7 (Hari)
Susp hepatoma
8 (Bulan)
23 Oktober 2013
25 Oktober 2013
2 (hari)
diare akut tanpa dehidrasi
32
17 Oktober 2013
18 Oktober 2013
1 (Hari)
vulnus laceratum
17
13 Oktober 2013
19 Oktober 2013
6 (Hari)
multiple vulnus
30
16 Oktober 2013
20 Oktober 2013
4 (Hari)
obs malaise
19 Oktober 2013
21 Oktober 2013
2 (hari)
Diare acute
22
09 Oktober 2013
12 Oktober 2013
3 (Hari)
Febris
48
09 Oktober 2013
19 Oktober 2013
10 (Hari)
Anemia kronis
45
12 Oktober 2013
18 Oktober 2013
6 (Hari)
dispneu
24 Oktober 2013
25 Oktober 2013
1 (Hari)
penurunan kesadaran
26 Oktober 2013
27 Oktober 2013
1 (Hari)
Chefalgia
6 (Bulan)
26 Oktober 2013
29 Oktober 2013
3 (Hari)
Diare akut dehidrasi ringan
28
20 Oktober 2013
25 Oktober 2013
5 (Hari)
Obs febris ec. Susp malaria
11 Oktober 2013
19 Oktober 2013
8 (Hari)
Diare Akut
12 Oktober 2013
15 Oktober 2013
3 (Hari)
Obs Febris
20 Oktober 2013
21 Oktober 2013
1 (Hari)
CKR
21 Oktober 2013
26 Oktober 2013
5 (Hari)
CHF
68
11 Oktober 2013
16 Oktober 2013
5 (Hari)
Susp Stroke
68
21 Oktober 2013
26 Oktober 2013
5 (Hari)
Melena susp gastritis+HT grade II
11 Oktober 2013
14 Oktober 2013
3 (Hari)
Selulitis
19 Oktober 2013
21 Oktober 2013
2 (hari)
Asma Bronchiale
68
65
38
Ds. Karang sari rt 005, kusan hulu

jl. Karya 2 rt 003 desa batuah, kusan
hilir
jl. Poros batulicin pagatan rt 003
desa api-api, kusan hilir
Jl. Kemuning rt 012 desa pandan
sari, karang bintang
jl. Kuranji rt 008 desa sari gadung,
simpang empat
Jl. Pangeran antasari rt 006 desa
batuah, kusan hilir
Jl. Senada rt 006 desa gunung
antasari, simpang empat
batuah, kusan hilir
Jl. Propinsi rt 003, sungai loban
batuah, kusan hilir
65
Desa Pulau Satu Rt 004, kusan hilir
66
17
1
48
19
58
54
26
75
An. Ahmad Suhada
6310063005110001
Jl. Karang Bintang rt 003, sari

gadung, simpang empat
76
Ny. Irus
6310024107620365
Desa Pulau Satu Rt 004, kusan hilir
77
Tn. Abdul Hasad/Abdul rasyad
6310021207590001
78
Tn. Makruong
6310022312550001
79
Tn. Syaifullah
6310011011840001
80
Ny. Sumini
6310054107620023
81
An. M. Rahmatullah
6310020610120004
82
83
An. Gina Atha. A

Ny. Haliyah
6310015910100001
6310014304690001
84
Tn. Ahmad faisal
6310011005940002
85
Ny. Kusmawati
6310094102710007
86
Tn. Masdol
6310022102790001
87
Tn. Firman S
6310020701680001
88
An. Azwa Aulia
6310075603130001
89
An. M. Tyo Ramadhani
6310011508120001
90
Ny. Siti Maysaroh
6310056807690002
91
An. Jarkani
6310023010000007
92
Tn. Kunyani
6310090205700007
93
Ny. Halinah
6310034305580013
94
Ny. Sudarmiati
6310095302500001
95
Ny. Norma
6310014107670063
96
Tn. Kaspul anwar
6310020403880001
97
Ny. Sale
6310024205620006
98
Tn. Abdul Rais
6310092001780003
99
By. M. Hisbi Assegaf
6310032903130001
100 Tn. Hammang
6310021805580003
101 Tn. Suyadi
6310100306420001
102 Tn. Al-masyhar
6310021710640001
103 Ny. Hj. Badiah
6310065311650001
104 Tn. Syahrullah
6310023101640002
Jl. Andi Idham rt 004, kampung

baru, kusan hilir
Rantau panjang hulu rt 001, kusan
hilir
Batulicin
2
51
52
45
29
50
Desa Wonorejo rt 012, kusan hulu

Jl. H. Supu rt 003, rantau panjang
hilir, kusan hilir
Jl. Mutiara rt 012, batulicin
Jl. Pasar lama rt 001, batulicin
Dusun Padang membangun rt 005,
kersik putih, batulicin
Gg. Terbina rt 003 desa sejahtera,
simpang empat
Jl. Pejala Baru Gg. Tarawani No 31 rt
003, pejala, kusan hilir
batuah, kusan hilir
Desa Ringkit rt 003, kuranji
Jl. Pasar lama Gg sepakat rt 003,
batulicin
1
3
44
19
42
34
45
5 (Bulan)
1
44
Desa Bakarangan rt 002, kusan hulu

Jl. Arif Rahman hakim rt 007 desa
pasar baru, kusan hilir
simpang empat
12
43
09 Oktober 2013
2 (hari)
Diare akut dehidrasi berat
12 Oktober 2013
21 Oktober 2013
9 (Hari)
Obs Melena
08 Oktober 2013
09 Oktober 2013
1 (Hari)
CHF
16 Oktober 2013
22 Oktober 2013
6 (Hari)
CKR
16 Oktober 2013
19 Oktober 2013
3 (Hari)
obs febris
12 Oktober 2013
22 Oktober 2013
10 (Hari)
Akut Miokarel
21 Oktober 2013
24 Oktober 2013
3 (Hari)
Diare Akut
18 Oktober 2013
16 Oktober 2013
23 Oktober 2013
21 Oktober 2013
5 (Hari)
5 (Hari)
16 Oktober 2013
18 Oktober 2013
2 (hari)
Obs Febris
13 Oktober 2013
13 Oktober 2013
16 Oktober 2013
21 Oktober 2013
5 (Hari)
Obs dispneu, susp CHF
17 Oktober 2013
21 Oktober 2013
4 (Hari)
Susp LBP
13 Oktober 2013
16 Oktober 2013
3 (Hari)
KDK
13 Oktober 2013
16 Oktober 2013
3 (Hari)
Diare Akut
15 Oktober 2013
21 Oktober 2013
6 (Hari)
Obs abdominal pain
16 Oktober 2013
21 Oktober 2013
5 (Hari)
Ovchitis
17 Oktober 2013
25 Oktober 2013
8 (Hari)
Susp Tb paru
55
01 Oktober 2013
04 Oktober 2013
3 (Hari)
Obs Febris
63
01 Oktober 2013
08 Oktober 2013
7 (Hari)
Hipertensi Emergency
45
03 Oktober 2013
08 Oktober 2013
5 (Hari)
DM type II
05 Oktober 2013
21 Oktober 2013
16 (Hari)
03 Oktober 2013
10 Oktober 2013
7 (Hari)
35
04 Oktober 2013
04 Oktober 2013
6 (Bulan)
02 Oktober 2013
07 Oktober 2013
5 (Hari)
Dehidrasi tak berat, dermatitis pustulosa
64
06 Oktober 2013
20 Oktober 2013
14 (Hari)
TB Paru
71
05 Oktober 2013
10 Oktober 2013
5 (Hari)
PPOK
49
05 Oktober 2013
10 Oktober 2013
5 (Hari)
Susp TBC
03 Oktober 2013
11 Oktober 2013
8 (Hari)
Obs Febris
09 Oktober 2013
21 Oktober 2013
12 (hari)
Gastritis
Jl. Bhayangkara rt 011, tungkaran

Jl. Raya batulicin rt 002, segumbang,
btl
Jl. Raya batulicin rt 001 , Sepunggur,
kusan hilir
hilir
Gg. Sabar subur rt 002, barokah,
simpang empat
Sebamban I blok B rt 003, marga
mulya, sungai loban
Jl. Al-Wusqo rt 001, batuah, kusan
hilir
Jl. Supriadi dusun III rt 016, sepakat,
mantewe
Jl. Mustika No 14 rt 005 batuah,
kusan hilr
Jl. Bina Bakti rt 026 desa sejahtera,
simpang empat
Jl. Pangeran antasari rt 007 desa
batuah, kusan hilir
07 Oktober 2013
25
50
48
49
HT grade II
Dispepsia
6310011510450001
Jl. PLN Lama rt 007, sungai danau,

satui
Ds. Rejowinangun rt 007, karang
bintang
Jl. Malewa rt 008,, Ds Gunung
antasari, simpang empat
Jl. P. Antasari No 92 rt 001,
gusungge, kusan hilir
Jl. Ps. Lama batulicin rt 002, BTL
68
6310061805450001
Dusun 1 rt 003, makmur, angsana
111 Tn. Slamet
63100413048500055
Jl. Kuripan rt 002, ds. Sinar bulan,

satui
112 Ny. Intorika
6310094605560001
Jl. Pasar Sabtu rt 003, ds. Tungkaran

113 Ny. Agus Riyanti
63100256089000004
Jl. Muara Pagatan rt 003, kusan hilir
114 Tn. Gatot Santoso
6310051412690001
115 Tn. Abdullah
6310021302690001
116 Tn. Hairan
6310040901500001
117 Tn. Soinem
6310037007420001
118 an. irfan
6310020607040006
119 Tn soniman
6310100107670041
120 Tn Deni Rosadi
6310022002900002
121 Tn Muhlan
6310090304670003
122 Tn Aminudin
6310090707710004
123 Tn Adi Amir
6310022102980002
124 Tn Suyati
6310104107730075
125 Tn Suparmin
6310080507450001
126 An Ayu Zainab
63100095904120001
127 Ny Siti hadijah
6310094706650001
128 By Ahmad Taufik
6310061506130002
129 Ny raniah
6310094810540001
Ds. Wonorejo rt 010, kusan hulu

jl. Padat karya rt 002, pulau salak,
kusan hilir
jl. Perintis rt 004, makmur mulia,
satui
Dusun tirta mulia rt 008, batu
Gg. Bahagia.2
Jl. Transmigrasi KM.23, Dusun I,
002/001, sari mulya, Mentewa
jl. Cepaka 2, 005/.batuah. Kusan
hilir
Ds. Tungkaran
Pengeran.005/.tungkaran pangeran.
Simpang empat
Jl.singosari.022/-,tungkaran
pangaran. Simpang empang
Batuah. Husan hilir
jl. Bukit raya dusun 1,004/002,karya
bakti, mentewe
blok C 1. 007/004, madu retno,
karang bintang
jl. Raya batulicin. 003/001. Kampung
baru
jl. Melati.007. sejahtera. Simpang
empat
jl. Pelabuahan speed. 005/002 .
Sejahtera
jl. Batu benawa. 015/. Tungkaran
pangeran
130 Nn. Salma Aprilia
6310044504980002
GG. Imus No. 137 RT. 005 Kec. Satui
131 Tn. Anton
6310020511870003
Jl. Pejala Baru RT. 003 Desa Pejala

Kec. Kusan Hilir
132 An. M. Rizki
6310030707120001
133 An. Adrian AP
6310083110100002
105 Ny. Astika
6310044704820004
106 An. Alfa Rizkia. A
6310081602090001
107 Ny. Misdinawati
6310096505920003
108 Ny. Suenah
63100257047300055
109 Tn. Akhmad

110 Tn. Selamet Hariyadi
31
28 Oktober 2013
04 Nopember 2013
7 (Hari)
Obs Febris
30 Oktober 2013
01 Nopember 2013
2 (Hari)
DHF
21
30 Oktober 2013
05 Nopember 2013
6 (Hari)
Malaria
39
27 Oktober 2013
04 Nopember 2013
8 (Hari)
Ulkus peptikum
27 Oktober 2013
02 Nopember 2013
6 (Hari)
Obs Dispneu
62
31 Oktober 2013
02 Nopember 2013
2 (Hari)
Obs Dispneu
28
31 Oktober 2013
05 Nopember 2013
5 (Hari)
Obs Febris
57
27 Oktober 2013
02 Nopember 2013
6 (Hari)
Obs Febris
23
24 Oktober 2013
01 Nopember 2013
8 (Hari)
Obs Dispneu, anemia
44
22 Oktober 2013
01 Nopember 2013
10 (Hari)
Gastritis erosif
44
23 Oktober 2013
02 Nopember 2013
10 (Hari)
TB Paru
53
25 Oktober 2013
05 Nopember 2013
11 (Hari)
Syndrom dispepsia
14 Oktober 2013
02 Nopember 2013
19 (Hari)
Gastritis akut
11
71
22 Oktober 2013
24 Oktober 2013
2 (hari)
infeked woond, occipitalis
46
17 Oktober 2013
20 Oktober 2013
3 (hari)
hil (s)
21
18 Oktober 2013
28 Oktober 2013
20 (hari)
fishula ani
48
20 Oktober 2013
31 Oktober 2013
3 (hari)
post eksisi lifoma
42
24 Januari 2013
28 Oktober 2013
4 (hari)
susp eolic ureter
16
24 Januari 2013
27 Oktober 2013
3 (hari)
gastroenteristis Akut
31 Oktober 2013
02 Nopember 2013
2 (hari)
DX. OBS. Edema tungkai simp oktif
31 Oktober 2013
08 Nopember 2013
8 (hari)
DX.
30 Oktober 2013
02 Nopember 2013
3 (hari)
DX. Dea tanpa dehidras
58
31 Oktober 2013
02 Nopember 2013
2 (hari)
Dx. OA bilater ast. Gew dextert.
31 Oktober 2013
02 Nopember 2013
2 (hari)
diare akut dgn deledrasi ode berat
59
26 Oktober 2013
30 Oktober 2013
4 (hari)
qu. Gastur
15
13 Oktober 2013
16 Oktober 2013
3 (hari)
Colic Abdomen
26
27 Oktober 2013
31 Oktober 2013
4 (hari)
CKR + Susp Fruktur
Sebamban I Blok A RT. 002 RW. 001

Desa Sari Mulya Kec. Sungai Loban
29 Oktober 2013
31 Oktober 2013
2 (hari)
Desa Karang Rejo RT 002 RW 001

Kec. Karang Bintang
30 Oktober 2013
31 Oktober 2013
1 (hari)
40
68
4 bulan
Diare Akut
Kenari Blik A Ds. Manunggal Dsn 1

RT 005 Kec. Karang Bintang
Jl. H. Nurung RT. 003 Desa Kota
Pagatan Kec. Kusan Hilir
Jl. Banyuwangi Gg. Pinang RT. 007
Desa Gunung Antasari Kec. Simpang
Empat
Desa Karang Indah RT. 012 RW. 003
Kec. Angsana
Jl. Transmigrasi Dusun II RT 010
Desa Dukuh Rejo Kec. Mantewe
Jl. Raya Transmigrasi Dusun III RT.
008 RW. 003 Desa Rejosari Kec.
Mantewe
Jl. Kupang RT. 007 Desa Sarigadung
Kec. Simpang Empat
Jl. Tajur RT. 010 Desa Sungai Dua
Kec. Simpang Empat
Gg. Mudding RT.009 RW.002 Desa
Kersik Putih Kec. Batulicin
Jl. Ansoka RT. 005 Desa Sepunggur
Kec. Kusan Hilir
Jl. Provinsi RT. 004 Desa Beringin
Kec. Kusan Hilir
Jl. Sampurna RT.008 Desa Barokah
Kec. Simpang Empat
Jl. Tramsigrasi KM. 30 Dusun II RT.
005 RW. 003 Desa Sidomulyo Kec.
Mantewe
134 Ny. Sunarmi
6310084302530001
135 An. Raftasya
6310021101120001
136 Tn. Sukamto
6310091208670005
137 Ny. Wisri
6310066412570001
138 Tn. Ponijan
6310101908470001
139 An. Dariel Afriadi
6310081904130001
140 An. Asyha NZ
6310095708110001
141 An. Hajar Aswad D
6310090205000008
142 Ny. Nadiah
6310014107500024
143 Ny. Mastiara
6310024505770003
144 Tn. Baharuddin
6310020107820306
145 Ny. Normi
6310094505700014
146 An. Radis Pangestu
6310102101010001
147 Ny. Sumini
6310085608470001
Jln. Anggrek RT. 003 RW. 002 Desa

Pandan Sari Kec. Karang Bintang
148 Tn. Agus Tri Safaat
6310103108920002
Jl. Raya Transmigrasi Dusun II RT.

010 Desa Dukuh Rejo Kec. Mantewe
60
29 Oktober 2013
31 Oktober 2013
2 (hari)
28 Oktober 2013
30 Oktober 2013
2 (hari)
27 Oktober 2013
30 Oktober 2013
3 (hari)
Dispepsia
28 Oktober 2013
31 Oktober 2013
3 (hari)
Discompordus var
66
01 Oktober 1956
29 Oktober 2013
3 (hari)
Colic Abdomrn Obs. Anemia Gravis
6 (Bulan)
29 Oktober 2013
31 Oktober 2013
2 (hari)
Obs. KDS + Diare Akut
30 Oktober 2013
31 Oktober 2013
1 (hari)
Diare Akut
25 Oktober 2013
30 Oktober 2013
5 (hari)
Leupademitis
63
27 Oktober 2013
30 Oktober 2013
3 (hari)
Hopertensi Emergency
36
28 Oktober 2013
31 Oktober 2013
3 (hari)
Susp. CHK Nhya III-IV
28 Oktober 2013
29 Oktober 2013
1 (hari)
Elektrik Injury
30 Oktober 2013
31 Oktober 2013
1 (hari)
Asma + Gastritis
30 Oktober 2013
04 Nopember 2013
4 (hari)
Kejang Demam
31 Oktober 2013
03 Nopember 2013
3 (hari)
Susp Stroke Iskemik
29 Oktober 2013
03 Nopember 2013
3 (hari)
Susp Malaria
16 Oktober 2013
22 Oktober 2013
6 (Hari)
08 Oktober 2013
11 Oktober 2013
3 (Hari)
20 Oktober 2013
23 Oktober 2013
3 (Hari)
06 Oktober 2013
09 Oktober 2013
3 (Hari)
27 Oktober 2013
04 Nopember 2013
8 (Hari)
29 Oktober 2013
02 Nopember 2013
4 (Hari)
02 Oktober 2013
10 Nopember 2013
39 (Hari)
25 Oktober 2013
01 Nopember 2013
7 (Hari)
21 Oktober 2013
01 Nopember 2013
11 (Hari)
30 Oktober 2013
13 Nopember 2013
14 (Hari)
29 Oktober 2013
13 Nopember 2013
15 (Hari)
46
56
2
13
31
43
2
66
21
Asma Attack
149
150
Tn. Hendra
151
Tn. Hatta
152 An. Tasya
153
6310021205950002
6310031312720002
6310076504100001
Tn. Misrani
6310093112720004
Tn. Somo
155 Ny. Marliah
6310082401580001
6310097009700002
154
156
157
158
159
160
Nn. Santi
6310024505910002
Ny. Hajar
6310025005500003
Ny. Rubini
6310034107460003
An. Aulia Rahmah
6310094305040005
Tn. Junaidi
6310060509770001
Jl. Ladelleng rt 002, muara tengah

Jl. Busman rt 003, sungai dua laut,
sungai loban
Ds. Giri mulya rt 008, kuranji
Jl. Kodeco KM. 5,5 rt 001, sari
Jl. Semeru rt 010, pematang ulin,
karang bintang
Promnas rt 007, gunung besar
Ds. Muara pagatan tengah rt 004,
kusan hilir
Jl. Raya batulicin rt 003, sepunggur,
kusan hilir
Dusun abdi kencana rt 019, batu
Jl. Poros 5 oktober rt 005, ds.
Bersujud, simpang empat
Gg. Anda ujung rt 009 desa
18
37
3
41
43
22
50
60
9
36
Cf
HILL
Diare akut
Susp koma hipoglikemia

Obs. Sakit pinggang
Reglected CF. Femur
Obs. Vomitue+GEA
Susp pnemonia
CF
Diabetik
161
162
163
164
165
Tn. Mardian
Tn. Nyoman Duria
6310015411730001
An. Nur Naili. R
6310094802130001
An. Jumaisah
An. Jefri Al-buchori

167 Ny. Masriyati
168 Tn saiful anwar
169 Tn. Gempa Alwi
171
172
173
174
6310082503540001
Ny. Monanang
166
170
6310091204830003
6310024512120001
6310090509090002
6310055012580001
6310012807570001
6310030101650006
Tn. Jumri
6310020107580271
Ny. Samiyah
6310095011700011
Tn. Ahman
6310100307510001
An. Iyan
6310102506100001
An. Nur Iman
6310092301120001
Nn. Linda
6310064902990001
Nn. Bungati
6310026002950002
175
176
177
Ny. Markani
178 Tn. H. Matar
179
Ny. Rasidah
180 An. M. Husni
181
182
183
184
185
186
187
188
189
190
An. Dewi lestari
6310024503560001
6310010107460020
6310044208610001
6310021401030001
6310026010120002
An. Azkiyah
631002410110003
Ny. Dainah
6310025003440001
Ny. Tini
6310025007620001
Tn. Akhmad
6310090809480003
Tn. Maser
6310020309630002
Tn. Paiman
6310080107420016
Tn. Ngadiman
6310101511780001
Tn. Kamarudin
6310021611810002
Tn. Asran
6310020107400079
Jl. Veteran rt 007 desa barokah,

simpang empat
Blok C.1 rt 004, desa madu retno,
karang bintang
Jl. Dharma praja rt 001, gunnung
tinggi, BTL
Jl. Transmigrasi KM. 2 rt 011,
barokah, simpang empat
Jl. Tambak rt 006, sepunggur kusan
hilir
Jl. Batu benawa rt 009 desa
bersujud, simpnag empat
desa tapus rt 005, kusan hulu
Jl. Anggrek rt 014, BTL
Gg. Sarioga no 59, pejala, kusan hilir
Gg. Baru rt 004 desa sejahtera,
simpang empat
Jl. Raya transmigrasi dusun V rt 017,
Jl. Transmigrasi KM 37 dusun I rt
002, bulu rejo, mantewe
Jl. Ins Gub Gg. Pelita 3 rt 010,
kampung baru, simpang empat
Jl. Raya batulicin gg. Mattoanging rt
003, kampung baru, kusan hilir
Jl. Akasia Gg. Tarakulu rt 001, pejala,
kusan hilir
Jl. P. Antasari No 11 rt 001,
Jl. Raya batulicin rt 016 BTL
Jl. Warga baru 1 rt 008, makmur
mulia satui
Ds. Pulau satu rt 002, kusan hilir
Jl. Kapitan laut pulo rt 001, wirittasi,
kusan hilir
Jl. Brigjen H. Hasan basri rt 008,
kusan hilir
Jl. Pangeran antasari no 05 rt 001,
Jl. Raya batulicin rt 003, sepunggur,
kusan hilir
Jl. Agathis rt 013, tungkaran
pangeran , simpang empat
Jl. Provinsi rt 004, sungai lembu,
kusan hilir
Manunggal dusun II rt 014, karang
bintang
Jl. Transmigrasi KM 37 dusun I rt
002, bulu rejo, mantewe
Jl. Mustika ds. Batuah, kusan hilir
Jl. Tepi sungai kusan rt 004, satiung,
kusan hilir
30
59
38
9 (Bulan)
11 (Bulan)
4
55
56
51
55
58
63
3
2
30 Oktober 2013
02 Nopember 2013
3 (Hari)
30 Oktober 2013
05 Nopember 2013
6 (Hari)
29 Oktober 2013
14 Nopember 2013
16 (Hari)
11 Nopember 2013
14 Nopember 2013
3 (Hari)
16 Nopember 2013
21 Nopember 2013
5 (Hari)
07 Nopember 2013
10 Nopember 2013
3 (Hari)
02 Nopember 2013
15 Nopember 2013
19 Nopember 2013
06 Nopember 2013
25 Nopember 2013
22 Nopember 2013
4 (Hari)
10 (Hari)
3 (Hari)
15 Nopember 2013
20 Nopember 2013
5 (Hari)
11 Nopember 2013
18 Nopember 2013
7 (Hari)
05 Nopember 2013
13 Nopember 2013
8 (Hari)
05 Nopember 2013
23 Nopember 2013
18 (Hari)
04 Nopember 2013
07 Nopember 2013
3 (Hari)
04 Nopember 2013
07 Nopember 2013
3 (Hari)
15
18
57
70
60
10
1
3
69
51
65
50
71
35
31
73
Susp tisue
Hematemesis
Tumor colli, Ca Thyroid
GEA dehidrasi berat
Pnemonia, diare, persistan, anemia
Diare akut tanpa dehidrasi
Hipertensi grade II
HT II, Susp SNA
Vertigo
CKR+trauma tumpul thorax

Dehidrasi Berat
diare cair akut dg dehidrasi berat
V. Laceratum cc palpebra
02 Nopember 2013
22 Nopember 2013
20 (Hari)
07 Nopember 2013
11 Nopember 2013
4 (Hari)
01 Nopember 2013
04 Nopember 2013
3 (Hari)
07 Nopember 2013
14 Nopember 2013
7 (Hari)
09 Oktober 2013
10 Nopember 2013
1 (Hari)
17 Nopember 2013
18 Nopember 2013
1 (Hari)
12 Nopember 2013
14 Nopember 2013
2 (Hari)
11 Nopember 2013
14 Nopember 2013
3 (Hari)
17 Nopember 2013
20 Nopember 2013
3 (Hari)
04 Nopember 2013
11 Nopember 2013
7 (Hari)
06 Nopember 2013
13 Nopember 2013
7 (Hari)
16 Nopember 2013
20 Nopember 2013
4 (Hari)
18 Nopember 2013
19 Nopember 2013
1 (Hari)
02 Nopember 2013
07 Nopember 2013
5 (Hari)
03 Nopember 2013
06 Nopember 2013
3 (Hari)
Obs dispneu
CF
Ca mamae
Snake bite
Diare cairr akut dg dehidrasi tak berat
GEA
Gastritis Akut
Anemia
Arthritis akut
Susp BPH
CKS
CF
Tuboroolosis
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
Tn. Untung Sutaryo

Ny. Paridah
6310054107970101
Nn. Misdiyanti
6310024107880321
An. Sifa Anggraini
210
211
212
213
214
215
6210074107570001
Tn. Misrudin
6310092510540001
Tn . Junaidi
6310081204510001
Ny. Huswatun hasanah
6310085106960005
Tn. Martono
6310021004520001
Ny. Poni
6310084107590044
Ny. Sawidah
6310094303600002
Ny. Becce
6310025008690001
Ny. Sapinah
6310024107470152
Tn. Maksum
6310100107560002
6310011712670001
6310101712370001
Ny. Kasmini
6310084107550060
Tn. Supadi
6310090809620003
Tn. Deni
6310090107530071
An. Muhajir
6310021511120001
Tn. Abdul syukur
6310020107560083
An. M. Reza aditya. P
6310033009120001
Ny. Suwanti
Ny. Banong
217 Ny. Sudiah
219
6310085202730001
Ny. Noor hayati
216
218
6310066203130002
Ny. Waginem
Tn. Jaimin
207 Tn. Bahrudin
209
6310095212740013
Nn. Parniwati
206
208
64310071412780001
6310105010890003
6310095411750001
6310044403670001
Ny. Jasmi
6310095807620001
Ny. Tugiyem
6310085508420001
sebamban 3F rt 006, indra loka jaya,

kuranji
35
39
ds. Karang sari rt 004, kusan hulu

Jl. Padat karya No 10 rt 001,
beringin, kusan hilir
simpang empat
Ds. Indra loka jaya rt 005, kuranji
Gg. Purnama indah rt 006, baroka,
simpang empat
Ds. Karang rejo rt 005, karang
bintang
Manunggal dusun II rt 013, karang
bintang
hilir
Jl. Semeru rt 010, pematang ulin,
karang bintang
bintan
Jl. Veteran rt 007 desa barokah,
simpang empat
Jl. tepi sungai kusan rt 007,
salimuran, kusan hilir
Jl. Tepi sungai kusan rt 004, satiung,
kusan hilir
Jl. Raya transmigrasi dusun III rt 010,
desa rejosari, mantewe
Jl. Polewali rt 001, BTL
Jl. Transmigrasi KM 30 dusun I,
mantewe
bintan
komplek BHP blok M rt 003, gunung
besar, simpang empat
Jl. Raya serongga rt 002, gunung
besar, simpang empat
Jl. Saring sei bubu rt 004, pakatellu,
kusan hilir
Jl. Al wusqo rt 001, batuah, kusan
hilir
sebamban 1 blok c rt 003, sungai
loban
jl. Kodeco KM 37 dusun II rt 004,
mentawakan mulya, mantewe
UPT bukit baru rt 009, satui
Jl. Gunung besar rt 002, simpang
empat
Ds. Karang rejo rt 005, karang
bintang
16
25
7,5 (Bulan)
56
58
62
18
61
54
40
53
44
65
57
46
76
58
51
60
1
51
1.1
24
38
47
51
71
17 Nopember 2013
20 Nopember 2013
3 (Hari)
12 Nopember 2013
14 Nopember 2013
2 (Hari)
11 Nopember 2013
13 Nopember 2013
2 (Hari)
08 Nopember 2013
13 Nopember 2013
5 (Hari)
10 Nopember 2013
12 Nopember 2013
2 (Hari)
07 Nopember 2013
18 Nopember 2013
11 (Hari)
08 Nopember 2013
18 Nopember 2013
10 (Hari)
10 Nopember 2013
13 Nopember 2013
3 (Hari)
16 Nopember 2013
18 Nopember 2013
2 (Hari)
13 Nopember 2013
14 Nopember 2013
1 (Hari)
11 Nopember 2013
12 Nopember 2013
1 (Hari)
08 Nopember 2013
11 Nopember 2013
3 (Hari)
09 Nopember 2013
17 Nopember 2013
8 (Hari)
10 Nopember 2013
12 Nopember 2013
2 (Hari)
03 Nopember 2013
05 Nopember 2013
2 (Hari)
02 Nopember 2013
06 Nopember 2013
4 (Hari)
06 Nopember 2013
07 Nopember 2013
1 (Hari)
07 Nopember 2013
15 Nopember 2013
8 (Hari)
14 Nopember 2013
15 Nopember 2013
1 (Hari)
10 Nopember 2013
12 Nopember 2013
2 (Hari)
04 Nopember 2013
14 Nopember 2013
10 (Hari)
13 Nopember 2013
16 Nopember 2013
3 (Hari)
10 Nopember 2013
18 Nopember 2013
8 (Hari)
02 Nopember 2013
05 Nopember 2013
3 (Hari)
02 Nopember 2013
05 Nopember 2013
3 (Hari)
04 Nopember 2013
14 Nopember 2013
10 (Hari)
14 Nopember 2013
16 Nopember 2013
2 (Hari)
14 Nopember 2013
16 Nopember 2013
2 (Hari)
14 Nopember 2013
16 Nopember 2013
2 (Hari)
Colic abdomen
Vertigo
Obs. Abdominal pain
Infected
DCA
Susp closed Fr. Femur dx
Anemia
Syndrom dispepsia
Obs febris
HT emergency
GEA
Obs. Anemia
Obs. Vomitue+GEA
Efusi pliarat
Colic abdomen
asma attack
Diare
DM tipe II
Open fraktur 1/3 distal
diare cair akut
Asma
Kejang demam
Obs febris
Obs abdominal pain
Obs dispneu
DCA
220
Ny.Marfuah
6310044107530031
Ds. Indra loka jaya rt 005, kuranji

jl. Karya STHIL rt 001, kampung
baru, simpang empat
Ds. Karang indah rt 012, angsana
Jl. Anggrek rt 003, pandan sari,
karang bintan
Jl.Raya Transmigrasi Dusun II
Rt011/005 Desa Rejosari
Jl.Karya I Rt 005 Desa Batuah Kusan
Hilir
Jl.Raya Serongga Km 7 Rt 5 Gunung
Besar Simpang Empat
Jl Poros Batulicin Rt 03 Desa Api-api
Kusan Hilir
Jl.Batu Benawa Rt 009 DesaBersujud
Simpang Empat
Jl .Ladongga Rt 03 Desa Muara
Tengah Kusan Hilir
Desa Sungai Cuka Pantai Rt 03 Desa
Sungai Cuka Satui
An.Muhammad Muhrani
6310022006030003
Jl.Brigjen H.Hasan Basri GG Daha RT

02 Desa Pagaruyung Kusan Hilir
An.Ayla
6310066510120001
Tn. Parnoto
221
Ny. Sanah
222 an. Deni
223
224
225
226
227
228
229
230
6310071902490001
6310094107500043
6310060402020001
An. Hafid Az-zuhri
6310070507120001
Tn.Teguh
6310101112630002
Tn.Herdiansyah
6310021202900006
An.Mila Arum
6310094808090004
Ny.Kamalia
6310024107730375
Ny.Rusminah
631009480870009
Tn.Newang
6310021512680002
231
232
233
234
235
236
237
Ny.Usmul Fatimah
6310084710930003
GG.Al.Huda Rt 015 Desa Tungkaran

Pangeran Simpang Empat
Darsan Binjai Rt 02/001 Desa
Derasan Binjai Kusan Hulu
Jl Hidayah Gang Kelapa 11 Rt 07
Desa Bersujud Simpang Empat
Jl.Kodeco Pal 35 Rt 011 Gunung
Antasari Simpang Empat
Jl.Angkasa Rt 03Desa Sungai Danau
Satui
Jl.Raya Batulicin Tanah Merah Rt 09
Kersik Putih Batulicin
jl.Desa Pacakan Rt 06 Desa Pacakan
Kusan hulu
Bekarangan Rt 02 Kusan Hulu
Jl.H.M.Amin rt 02 Mudalang Kusan
Hilir
Jl.Anggrek rt 03 Pandan sari Karang
Bintang
Jl.Provinsi Sekapuk II Rt 07 Sekapuk
Satui
Jl.H.Hamsyah Rt 04 Sungai Dua Laut
Sungai Loban
Jl.H.Djanawie Rt 06 Sinar Bulan
Satui
Desa Batu Ampar Rt 03 Simpang
Empat
Jl melati Rt 13 Pandan Sari Karang
Bintang
Ny.Aluh
6310054606640002
Desa Mangkalapi rt 01 Kusan Hulu
Ny.Rohayah
6310054101600004
Tn.Jumadil
6310092006970004
Tn.Sabari
6310090802930004
An.Abdul Karim
6310042201090001
An.M.Galib
6310010405120001
An.Akhmad Zaki
239 Nn.Wahdatun
6310051711120001
6310056407950001
238
240
241
242
243
244
245
246
247
Tn.Matto
6310020107600239
Ny.Amah
6310085010550001
Ny.Fatqiah
6310044405820001
Ny.hatiah
6310037112640002
Ny.Fatimah
6310046512620003
Tn.Mukmin
6310091304460001
64
63
12
1
50
23
4
40
40
45
60
07 Nopember 2013
11 Nopember 2013
4 (Hari)
01 Nopember 2013
09 Nopember 2013
8 (Hari)
07 Nopember 2013
12 Nopember 2013
5 (Hari)
06 Nopember 2013
08 Nopember 2013
2 (Hari)
08 Nopember 2013
11 Nopember 2013
3 (Hari)
08 Nopember 2013
11 Nopember 2013
3 (Hari)
17 Nopember 2013
19 Nopember 2013
2 (Hari)
12 Nopember 2013
16 Nopember 2013
4 (Hari)
06 Nopember 2013
09 Nopember 2013
3 (Hari)
07 Nopember 2013
16 Nopember 2013
9 (Hari)
05 Nopember 2013
09 Nopember 2013
4 (Hari)
04 Nopember 2013
05 Nopember 2013
1 (Hari)
10
low back pain

Obs dispneu
Obs febris
Hernia scrotalis inkarserata dextra
DCA
Bronchitis TB Paru
Tumor Mammae Dersha
Asma Bronchitis
SNH
CKR
03 Nopember 2013
06 Nopember 2013
3 (Hari)
12 Nopember 2013
14 Nopember 2013
2 (Hari)
14 Nopember 2013
18 Nopember 2013
4 (Hari)
12 Nopember 2013
15 Nopember 2013
3 (Hari)
12 Nopember 2013
16 Nopember 2013
4 (Hari)
06 Nopember 2013
09 Nopember 2013
3 (Hari)
04 Nopember 2013
06 Nopember 2013
2 (Hari)
02 Nopember 2013
04 Nopember 2013
2 (Hari)
02 Nopember 2013
05 Nopember 2013
3 (Hari)
10 Nopember 2013
12 Nopember 2013
2 (Hari)
06 Nopember 2013
08 Nopember 2013
2 (Hari)
05 Nopember 2013
08 Nopember 2013
3 (Hari)
05 Nopember 2013
13 Nopember 2013
8 (Hari)
06 Nopember 2013
14 Nopember 2013
8 (Hari)
09 Nopember 2013
13 Nopember 2013
4 (Hari)
13 Nopember 2013
19 Nopember 2013
6 (Hari)
1
55
16
22
3
1
1
18
50
58
31
38
51
70
20
59
DCA tanpa Dehidrasi
open fr dista radius ulna sinistra

GEA
Penumonia
Diare cair akut dengan dehidrasi tak berat
Diare cair akut
Trauma Abdomen
sindrom Dispepsia
Hepatitis Stadium II
sindrom Dispepsia
SNH
SNH
Batu ginjal
TB Paru
Motion siknes
248
249
250
251
Tn.Makholik
Ny.Mariam
6310031010650003
6310095707770004
Ny.Sumarni Hutapea
6310095202750001
Ny.harmi
6310095407910006
Dusun widya mandala rt 02 batu

meranti sungai loban
Jl.transmigrasi rt 06 kampung baru
simpang empat
Jl Transmigrasi Rt 03 Desa Barokah
Simpang Empat
Jl Kodeko Km 1 rt 03 Gunung
Antasari Simpang Empat
48
36
38
22
06 Nopember 2013
09 Nopember 2013
3 (Hari)
06 Nopember 2013
09 Nopember 2013
3 (Hari)
02 Nopember 2013
07 Nopember 2013
5 (Hari)
09 Nopember 2013
09 Nopember 2013
Hill
GEA+ ISK
CF Distal
DCA Dehidrasi Tak Berat
BULAN : Nopember
TAHUN : 2013
Pelayanan Kesehatan Dan Besaran Tarif sesuai PERDA (Rp)
Akomodasi
Jasa Medis
Spesialis
Rp
600,000 Rp
630,000
Rp
250,000 Rp
180,000
Rp
450,000 Rp
240,000
Rp
550,000 Rp
Rp
Jasa Medis
Umum
Rp
Jasa Keperawatan
Tindakan Kecil
40,000 Rp
260,000
Rp
120,000
Rp
60,000 Rp
520,000
270,000
Rp
40,000 Rp
600,000
550,000 Rp
270,000
Rp
60,000 Rp
Rp
400,000 Rp
210,000
Rp
Rp
300,000 Rp
120,000
Rp
Rp
100,000 Rp
60,000
Rp
200,000 Rp
90,000
Rp
20,000 Rp
200,000
Rp
200,000 Rp
210,000
Rp
40,000 Rp
320,000
Rp
150,000 Rp
60,000
Rp
40,000 Rp
200,000
Rp
150,000 Rp
90,000
Rp
100,000 Rp
240,000
Rp
150,000 Rp
60,000
Rp
20,000 Rp
80,000
Rp
500,000 Rp
270,000
Rp
20,000 Rp
560,000
Rp
100,000 Rp
60,000
Rp
40,000 Rp
160,000
Rp
250,000 Rp
120,000
Rp
60,000 Rp
360,000
Rp
350,000 Rp
180,000
Rp
40,000 Rp
320,000
Rp
250,000 Rp
180,000
Rp
40,000 Rp
120,000
Tindakan
Sedang
Tindakan di UGD
Konsultasi
Tindakan
Intensif
Jasa Apoteker
Berkas RM
Medis Gigi
Sederhana
Sederhana Poli
Umum
Kecil
Rp
5,000
Rp
10,000
Rp
90,000 Rp
5,000
Rp
10,000
Rp
225,000 Rp
5,000
Rp
10,000
Rp
5,000
Rp
10,000
Rp
100,000
600,000
Rp
5,000
Rp
10,000
Rp
100,000
80,000 Rp
400,000
Rp
5,000
Rp
10,000
40,000 Rp
360,000
Rp
5,000
Rp
10,000
Rp
10,000
Rp
600,000
Rp
Rp
Rp
Rp
Rp
120,000
30,000
Rp
Sedang
Besar
100,000
Rp
Rp
100,000
Rp
5,000
Rp
10,000
135,000 Rp
5,000
Rp
10,000
Rp
100,000
Rp
5,000
Rp
10,000
Rp
100,000
180,000 Rp
5,000
Rp
10,000
Rp
100,000
Rp
5,000
Rp
10,000
Rp
100,000
225,000 Rp
5,000
Rp
10,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
5,000
Rp
10,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
200,000
Rp
200,000
125,000
Tindakan Penyakit Dalam
Rp
650,000 Rp
210,000
Rp
40,000 Rp
280,000
Rp
900,000 Rp
690,000
Rp
40,000 Rp
800,000
Rp
40,000 Rp
120,000
Rp
80,000
Rp
20,000 Rp
60,000
Rp
Rp
50,000
Rp
5,000
Rp
10,000
Rp
400,000
45,000 Rp
5,000
Rp
10,000
Rp
200,000
Rp
10,000
5,000
Rp
10,000
Rp
5,000
Rp
10,000
Rp
200,000
60,000
Rp
5,000
Rp
10,000
20,000 Rp
100,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
5,000
Rp
10,000
Rp
10,000
Rp
200,000
Rp
200,000
Rp
400,000
Rp
200,000
Rp
30,000 Rp
Rp
100,000
Rp
200,000 Rp
210,000
Rp
100,000 Rp
150,000
Rp
100,000 Rp
90,000
Rp
200,000 Rp
150,000
Rp
150,000 Rp
120,000
Rp
60,000
Rp
250,000 Rp
210,000
Rp
120,000
Rp
150,000 Rp
150,000
Rp
80,000
Rp
5,000
Rp
10,000
Rp
300,000 Rp
210,000
Rp
100,000
Rp
5,000
Rp
10,000
Rp
150,000 Rp
90,000
Rp
80,000
Rp
5,000
Rp
10,000
Rp
250,000 Rp
240,000
Rp
100,000
Rp
5,000
Rp
10,000
Rp
200,000 Rp
120,000
Rp
100,000
Rp
5,000
Rp
10,000
Rp
300,000 Rp
240,000
20,000 Rp
140,000
Rp
10,000
Rp
250,000 Rp
150,000
Rp
120,000
Rp
10,000
Rp
250,000 Rp
210,000
20,000 Rp
120,000
Rp
5,000
Rp
10,000
Rp
150,000 Rp
90,000
Rp
80,000
Rp
5,000
Rp
10,000
Rp
200,000 Rp
120,000
Rp
20,000
Rp
150,000 Rp
225,000 Rp
5,000
Rp
10,000
Rp
100,000 Rp
60,000
Rp
40,000
Rp
90,000 Rp
90,000 Rp
5,000
Rp
10,000
Rp
350,000 Rp
120,000
Rp
80,000 Rp
400,000
Rp
180,000 Rp
5,000
Rp
10,000
Rp
100,000 Rp
30,000
Rp
40,000 Rp
80,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
Rp
Rp
Rp
Rp
45,000
Rp
50,000
50,000
Rp
Rp
125,000
100,000
Rp
50,000 Rp
30,000
Rp
40,000
Rp
10,000
Rp
200,000
Rp
200,000 Rp
180,000
Rp
60,000 Rp
160,000
Rp
45,000 Rp
5,000
Rp
10,000
Rp
200,000
Rp
100,000 Rp
150,000
Rp
40,000 Rp
120,000
Rp
90,000 Rp
5,000
Rp
10,000
Rp
200,000
Rp
400,000 Rp
150,000
Rp
120,000 Rp
480,000
540,000 Rp
225,000 Rp
5,000
Rp
10,000
Rp
200,000
Rp
100,000 Rp
60,000
Rp
60,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
30,000 Rp
Rp
Rp
50,000 Rp
30,000
Rp
20,000 Rp
80,000
Rp
5,000
Rp
10,000
Rp
350,000 Rp
180,000
Rp
20,000 Rp
460,000
120,000 Rp
90,000 Rp
5,000
Rp
10,000
Rp
250,000 Rp
150,000
Rp
60,000 Rp
360,000
Rp
45,000 Rp
5,000
Rp
10,000
Rp
300,000 Rp
120,000
Rp
60,000 Rp
240,000
Rp
135,000 Rp
5,000
Rp
10,000
Rp
100,000 Rp
60,000
Rp
60,000
Rp
5,000
Rp
10,000
Rp
150,000 Rp
120,000
Rp
40,000 Rp
240,000
90,000 Rp
5,000
Rp
Rp
150,000 Rp
90,000
Rp
20,000 Rp
120,000
Rp
5,000
Rp
150,000 Rp
180,000
Rp
80,000
Rp
Rp
350,000 Rp
210,000
Rp
140,000 Rp
400,000
315,000 Rp
Rp
100,000 Rp
60,000
Rp
Rp
50,000 Rp
60,000
Rp
300,000 Rp
150,000
Rp
200,000 Rp
Rp
50,000 Rp
Rp
20,000
Rp
40,000
Rp
20,000 Rp
120,000
30,000
Rp
80,000 Rp
80,000
30,000
Rp
40,000 Rp
20,000
150,000 Rp
90,000
Rp
60,000 Rp
240,000
Rp
500,000 Rp
210,000
Rp
80,000 Rp
440,000
Rp
300,000 Rp
120,000
Rp
60,000 Rp
Rp
50,000 Rp
30,000
Rp
Rp
50,000
Rp
Rp
Rp
Rp
90,000 Rp
Rp
30,000
10,000
Rp
200,000
Rp
10,000
Rp
200,000
5,000
Rp
10,000
Rp
200,000
5,000
Rp
10,000
Rp
200,000
Rp
10,000
Rp
200,000
Rp
200,000
90,000
Rp
5,000
Rp
10,000
Rp
5,000
Rp
10,000
90,000 Rp
5,000
Rp
10,000
90,000 Rp
5,000
Rp
10,000
Rp
180,000 Rp
5,000
Rp
10,000
180,000 Rp
270,000 Rp
5,000
Rp
440,000
Rp
225,000 Rp
5,000
20,000 Rp
120,000
Rp
Rp
Rp
40,000 Rp
40,000
Rp
150,000 Rp
60,000
Rp
40,000
Rp
Rp
250,000 Rp
120,000
Rp
80,000
Rp
Rp
400,000 Rp
150,000
Rp
80,000
Rp
Rp
150,000 Rp
30,000
Rp
40,000
Rp
Rp
50,000 Rp
30,000
Rp
250,000 Rp
Rp
250,000
Rp
Rp
Rp
120,000
90,000
100,000
200,000
Rp
Rp
Rp
Rp
Rp
100,000
100,000
Rp
100,000
10,000
Rp
100,000
Rp
10,000
Rp
100,000
5,000
Rp
10,000
Rp
200,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
180,000
Rp
5,000
Rp
10,000
Rp
225,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
360,000
Rp
5,000
Rp
10,000
Rp
100,000
200,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
40,000
Rp
5,000
Rp
10,000
120,000 Rp
40,000 Rp
360,000
Rp
270,000 Rp
5,000
Rp
10,000
Rp
100,000
Rp
120,000
Rp
20,000
Rp
480,000
Rp
45,000
Rp
5,000
Rp
10,000
Rp
100,000
250,000
Rp
120,000
Rp
60,000
Rp
400,000
Rp
315,000
Rp
5,000
Rp
10,000
Rp
100,000
150,000
Rp
60,000
Rp
20,000
Rp
240,000
Rp
45,000
Rp
5,000
Rp
10,000
Rp
100,000
100,000
Rp
30,000
Rp
40,000
Rp
200,000
Rp
90,000
Rp
5,000
Rp
10,000
40,000 Rp
Rp
Rp
180,000
90,000
90,000
125,000
Rp
Rp
360,000
125,000
Rp
60,000 Rp
Rp
Rp
Rp
50,000
Rp
60,000
Rp
450,000
Rp
90,000
Rp
Rp
50,000
Rp
60,000
Rp
Rp
300,000
Rp
300,000
Rp
150,000
Rp
60,000
Rp
Rp
500,000
Rp
180,000
Rp
150,000
Rp
Rp
Rp
250,000
250,000
Rp
Rp
Rp
100,000
Rp
Rp
50,000
Rp
250,000
Rp
90,000
Rp
Rp
200,000
Rp
180,000
Rp
150,000
Rp
Rp
150,000
Rp
Rp
60,000
Rp
90,000
Rp
5,000
Rp
10,000
Rp
100,000
80,000
Rp
640,000
Rp
150,000
Rp
5,000
Rp
10,000
Rp
100,000
20,000
Rp
120,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
160,000
Rp
5,000
Rp
10,000
Rp
200,000
40,000
Rp
240,000
Rp
90,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
80,000
Rp
520,000
Rp
405,000
Rp
5,000
Rp
10,000
120,000
Rp
20,000
120,000
300,000
Rp
Rp
40,000
40,000
Rp
Rp
100,000
320,000
30,000
Rp
20,000
Rp
80,000
Rp
40,000
180,000
Rp
360,000
Rp
270,000
Rp
Rp
60,000
Rp
280,000
Rp
135,000
30,000
Rp
60,000
Rp
20,000
Rp
90,000
Rp
Rp
30,000
Rp
40,000
Rp
20,000
Rp
90,000
Rp
300,000
Rp
210,000
Rp
Rp
250,000
Rp
180,000
Rp
400,000
Rp
120,000
Rp
150,000
Rp
90,000
Rp
350,000
Rp
180,000
Rp
Rp
250,000
Rp
120,000
Rp
800,000
Rp
Rp
350,000
Rp
Rp
225,000
Rp
100,000
Rp
120,000
Rp
180,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
30,000
Rp
Rp
225,000
135,000
Rp
Rp
5,000
5,000
Rp
Rp
10,000
10,000
Rp
Rp
200,000
200,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
10,000
Rp
100,000
5,000
Rp
10,000
Rp
100,000
Rp
5,000
Rp
10,000
Rp
100,000
135,000
Rp
5,000
Rp
10,000
Rp
100,000
135,000
Rp
5,000
Rp
10,000
Rp
100,000
140,000
Rp
5,000
Rp
10,000
Rp
120,000
Rp
5,000
Rp
10,000
Rp
480,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
120,000
Rp
5,000
Rp
10,000
Rp
100,000
40,000
Rp
280,000
Rp
90,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
40,000
Rp
280,000
Rp
45,000
Rp
5,000
Rp
10,000
Rp
100,000
300,000
Rp
60,000
Rp
320,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
180,000
Rp
60,000
Rp
320,000
Rp
5,000
Rp
10,000
Rp
100,000
50,000
Rp
30,000
Rp
40,000
Rp
5,000
Rp
10,000
Rp
250,000
Rp
120,000
Rp
20,000
Rp
20,000
Rp
225,000
Rp
10,000
Rp
700,000
Rp
270,000
Rp
100,000
Rp
560,000
Rp
315,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
250,000
Rp
180,000
Rp
360,000
Rp
135,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
250,000
Rp
150,000
Rp
20,000
Rp
360,000
Rp
135,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
400,000
Rp
270,000
Rp
60,000
Rp
280,000
Rp
135,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
600,000
Rp
240,000
Rp
140,000
Rp
600,000
Rp
225,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
100,000
Rp
Rp
240,000
30,000
Rp
360,000
Rp
125,000
Rp
350,000
Rp
180,000
Rp
400,000
Rp
100,000
Rp
60,000
Rp
40,000
Rp
300,000
Rp
120,000
Rp
80,000
Rp
440,000
Rp
400,000
Rp
210,000
Rp
120,000
Rp
440,000
Rp
300,000
Rp
150,000
Rp
60,000
Rp
400,000
Rp
100,000
Rp
90,000
Rp
60,000
Rp
Rp
250,000
Rp
30,000
Rp
100,000
Rp
300,000
Rp
180,000
Rp
Rp
400,000
Rp
240,000
Rp
500,000
Rp
Rp
500,000
Rp
Rp
550,000
Rp
Rp
950,000
Rp
Rp
Rp
90,000
Rp
135,000
Rp
5,000
Rp
10,000
Rp
400,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
225,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
315,000
Rp
5,000
Rp
10,000
Rp
200,000
120,000
Rp
135,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
400,000
Rp
225,000
Rp
5,000
Rp
10,000
Rp
200,000
40,000
Rp
400,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
40,000
Rp
300,000
Rp
90,000
Rp
5,000
Rp
10,000
Rp
200,000
60,000
Rp
120,000
Rp
440,000
Rp
270,000
Rp
5,000
Rp
10,000
180,000
Rp
120,000
Rp
520,000
Rp
270,000
Rp
5,000
Rp
10,000
Rp
200,000
180,000
Rp
120,000
Rp
600,000
Rp
450,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
330,000
Rp
180,000
Rp
920,000
Rp
450,000
Rp
5,000
Rp
10,000
100,000 Rp
150,000
Rp
60,000
Rp
5,000
Rp
10,000
150,000 Rp
180,000
Rp
80,000
Rp
5,000
Rp
10,000
Rp
500,000 Rp
390,000
20,000 Rp
220,000
Rp
5,000
Rp
10,000
Rp
150,000 Rp
90,000
Rp
80,000
Rp
5,000
Rp
10,000
Rp
200,000 Rp
90,000
Rp
20,000 Rp
80,000
Rp
10,000
Rp
200,000
Rp
150,000 Rp
30,000
Rp
40,000 Rp
160,000
Rp
5,000
Rp
10,000
Rp
200,000
Rp
100,000 Rp
60,000
Rp
20,000 Rp
200,000
Rp
90,000 Rp
5,000
Rp
10,000
Rp
200,000
Rp
400,000 Rp
180,000
Rp
40,000 Rp
440,000
Rp
45,000 Rp
5,000
Rp
10,000
Rp
150,000 Rp
90,000
Rp
20,000
90,000 Rp
135,000 Rp
5,000
Rp
10,000
Rp
100,000
Rp
100,000 Rp
90,000
Rp
20,000 Rp
60,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
100,000 Rp
60,000
Rp
20,000 Rp
20,000
Rp
10,000
Rp
200,000
Rp
200,000 Rp
120,000
Rp
40,000 Rp
320,000
Rp
150,000 Rp
120,000
Rp
Rp
200,000 Rp
120,000
Rp
200,000
Rp
100,000 Rp
90,000
Rp
50,000 Rp
60,000
Rp
200,000
Rp
Rp
Rp
Rp
Rp
Rp
420,000
210,000
60,000 Rp
Rp
90,000
270,000 Rp
5,000
Rp
10,000
80,000
Rp
5,000
Rp
10,000
20,000 Rp
100,000
Rp
5,000
Rp
10,000
Rp
20,000
Rp
60,000 Rp
135,000 Rp
5,000
Rp
10,000
Rp
60,000 Rp
45,000 Rp
5,000
Rp
10,000
Rp
Rp
Rp
100,000
Rp
100,000
Rp
100,000
50,000
100,000
Rp
100,000 Rp
90,000
Rp
100,000 Rp
60,000
Rp
150,000 Rp
60,000
Rp
150,000 Rp
120,000
Rp
150,000 Rp
30,000
Rp
100,000 Rp
60,000
Rp
50,000 Rp
60,000
Rp
250,000 Rp
180,000
Rp
20,000 Rp
80,000
Rp
150,000 Rp
90,000
Rp
40,000 Rp
240,000
Rp
150,000 Rp
90,000
Rp
20,000 Rp
240,000
Rp
50,000 Rp
30,000
Rp
40,000
Rp
50,000 Rp
30,000
20,000 Rp
120,000
Rp
Rp
200,000 Rp
120,000
Rp
100,000
Rp
Rp
150,000 Rp
300,000
Rp
40,000 Rp
Rp
150,000 Rp
90,000
Rp
20,000 Rp
Rp
Rp
Rp
300,000
150,000
150,000
Rp
Rp
Rp
210,000
150,000
90,000
Rp
Rp
Rp
Rp
Rp
Rp
20,000 Rp
240,000
Rp
60,000 Rp
180,000 Rp
5,000
90,000
Rp
10,000
Rp
200,000
Rp
10,000
Rp
200,000
160,000
Rp
45,000 Rp
5,000
Rp
10,000
Rp
200,000
Rp
240,000
Rp
180,000 Rp
5,000
Rp
10,000
Rp
200,000
60,000 Rp
240,000
Rp
135,000 Rp
5,000
Rp
10,000
Rp
200,000
Rp
90,000 Rp
135,000 Rp
5,000
Rp
10,000
Rp
200,000
Rp
60,000 Rp
Rp
10,000
Rp
200,000
40,000
20,000
Rp
Rp
Rp
45,000
Rp
5,000
Rp
10,000
Rp
90,000 Rp
5,000
Rp
10,000
Rp
200,000
120,000 Rp
180,000 Rp
5,000
Rp
10,000
Rp
200,000
Rp
5,000
Rp
10,000
Rp
200,000
120,000 Rp
45,000 Rp
5,000
Rp
10,000
Rp
200,000
150,000 Rp
225,000 Rp
5,000
Rp
10,000
440,000
Rp
225,000 Rp
5,000
Rp
10,000
Rp
200,000
240,000
Rp
90,000 Rp
5,000
Rp
10,000
Rp
200,000
Rp
10,000
Rp
10,000
Rp
200,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
200,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
200,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
200,000
Rp
140,000
80,000
20,000
150,000
Rp
30,000
Rp
40,000
Rp
200,000
Rp
Rp
400,000
200,000
Rp
Rp
390,000
120,000
Rp
Rp
100,000
20,000
Rp
Rp
480,000
280,000
Rp 1,950,000
Rp 1,170,000
Rp
40,000
Rp
800,000
Rp
Rp
Rp
160,000
Rp
400,000
120,000
240,000 Rp
20,000 Rp
Rp
350,000
Rp
Rp
550,000
Rp
180,000
Rp
100,000
Rp
520,000
Rp
700,000
Rp
540,000
Rp
40,000
Rp
Rp
750,000
Rp
540,000
Rp
40,000
Rp
Rp
Rp
90,000
Rp
Rp
Rp
Rp
225,000
45,000
60,000
Rp
Rp
135,000
600,000
Rp
225,000
360,000
Rp
Rp
5,000
5,000
5,000
Rp
5,000
Rp
Rp
5,000
5,000
Rp
5,000
Rp
5,000
Rp
5,000
280,000
Rp
5,000
360,000
Rp
5,000
Rp
100,000
Rp
100,000
Rp
100,000
Rp
150,000
Rp
120,000
Rp
300,000
Rp
120,000
Rp
800,000
Rp
420,000
Rp
150,000
Rp
90,000
Rp
Rp
Rp
20,000
40,000
20,000
Rp
60,000
Rp
440,000
Rp
340,000
Rp
80,000
Rp
Rp
Rp
120,000
Rp
45,000
180,000
5,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
250,000
Rp
120,000
Rp
20,000
Rp
120,000
Rp
180,000
Rp
270,000
Rp
Rp
Rp
Rp
150,000
200,000
500,000
150,000
Rp
Rp
Rp
Rp
60,000
60,000
150,000
330,000
Rp
Rp
Rp
Rp
40,000
120,000
120,000
100,000
Rp
Rp
Rp
Rp
80,000
320,000
780,000
500,000
Rp
120,000
Rp
Rp
Rp
180,000
90,000
450,000
Rp
Rp
Rp
Rp
5,000
5,000
5,000
5,000
Rp
250,000
Rp
210,000
Rp
40,000
Rp
320,000
Rp
45,000
Rp
5,000
Rp
350,000
Rp
120,000
Rp
80,000
Rp
400,000
Rp
270,000
Rp
5,000
Rp
400,000
Rp
240,000
Rp
200,000
Rp
300,000
Rp
5,000
Rp
900,000
Rp
510,000
Rp
140,000
Rp
380,000
Rp
570,000
Rp
855,000
Rp
5,000
Rp
150,000
Rp
60,000
Rp
20,000
Rp
80,000
Rp
120,000
Rp
180,000
Rp
5,000
Rp
150,000
Rp
60,000
Rp
20,000
Rp
80,000
Rp
5,000
Rp 1,000,000
Rp
420,000
Rp
120,000
Rp
800,000
Rp
5,000
Rp
Rp
200,000
150,000
Rp
Rp
Rp
Rp
350,000
50,000
Rp
Rp
50,000
Rp
210,000
60,000
Rp
Rp
180,000
30,000
20,000
Rp
Rp
180,000
40,000
Rp
20,000
Rp
40,000
Rp
100,000
Rp
90,000
Rp
60,000
Rp
150,000
Rp
120,000
Rp
Rp
150,000
Rp
90,000
Rp
40,000
Rp
350,000
Rp
150,000
Rp
160,000
Rp
350,000
Rp
120,000
Rp
120,000
Rp
200,000
Rp
90,000
Rp
50,000
Rp
60,000
Rp
20,000
180,000
100,000
80,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
60,000
90,000
Rp
Rp
90,000
135,000
5,000
5,000
Rp
Rp
5,000
5,000
Rp
5,000
Rp
5,000
80,000
Rp
5,000
240,000
Rp
5,000
Rp
5,000
Rp
400,000
Rp
5,000
Rp
100,000
Rp
5,000
Rp
40,000
Rp
250,000
Rp
150,000
Rp
20,000
Rp
120,000
Rp
150,000
Rp
60,000
Rp
100,000
Rp
240,000
Rp
Rp
45,000
90,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
Rp
10,000
10,000
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
100,000
Rp
200,000
Rp
Rp
Rp
Rp
200,000
200,000
200,000
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
Rp
200,000
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
100,000
Rp
Rp
150,000
100,000
Rp
Rp
90,000
30,000
Rp
100,000
Rp
60,000
Rp
250,000
Rp
120,000
Rp
100,000
Rp
60,000
Rp
550,000
Rp
330,000
Rp
500,000
Rp
480,000
Rp
150,000
Rp
30,000
Rp
100,000
Rp
Rp
Rp
Rp
Rp
40,000
80,000
60,000
200,000
Rp
5,000
5,000
Rp
40,000
Rp
5,000
Rp
100,000
Rp
5,000
Rp
60,000
Rp
260,000
Rp
220,000
Rp
200,000
Rp
Rp
90,000
60,000
Rp
135,000
Rp
90,000
Rp
5,000
Rp
315,000
Rp
5,000
Rp
5,000
Rp
5,000
50,000
Rp
40,000
Rp
120,000
Rp
5,000
50,000
Rp
40,000
Rp
120,000
Rp
5,000
Rp
100,000
Rp
100,000
200,000
50,000
400,000
Rp
Rp
Rp
Rp
Rp
30,000
150,000
30,000
30,000
30,000
60,000
Rp
40,000
Rp
Rp
80,000
Rp
400,000
Rp
60,000
Rp
240,000
Rp
60,000
Rp
200,000
Rp
Rp
Rp
100,000
20,000
140,000
Rp
Rp
Rp
480,000
Rp
30,000
Rp
40,000
Rp
120,000
Rp
100,000
Rp
30,000
Rp
80,000
Rp
120,000
Rp
420,000
Rp
20,000
Rp
45,000
Rp
Rp
120,000
340,000
Rp
Rp
320,000
40,000
50,000
500,000
Rp
200,000
Rp
Rp
Rp
160,000
400,000
Rp
Rp
20,000
Rp
200,000
Rp
Rp
Rp
Rp
Rp
40,000
Rp
20,000
Rp
30,000
Rp
20,000
Rp
150,000
Rp
Rp
Rp
Rp
420,000
Rp
Rp
Rp
210,000
Rp
180,000
90,000
45,000
270,000
135,000
180,000
5,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
Rp
Rp
5,000
5,000
5,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
150,000
Rp
90,000
Rp
20,000
Rp
80,000
Rp
120,000
Rp
180,000
Rp
400,000
Rp
90,000
Rp
100,000
Rp
440,000
Rp
420,000
Rp
225,000
Rp
5,000
Rp
150,000
Rp
30,000
Rp
40,000
Rp
80,000
Rp
90,000
Rp
135,000
Rp
5,000
Rp
150,000
Rp
30,000
Rp
80,000
Rp
240,000
Rp
Rp
500,000
100,000
Rp
Rp
150,000
60,000
Rp
Rp
140,000
20,000
Rp
Rp
520,000
80,000
Rp
100,000
Rp
60,000
Rp
20,000
Rp
Rp
100,000
Rp
60,000
Rp
20,000
Rp
Rp
Rp
270,000
5,000
Rp
Rp
5,000
5,000
80,000
Rp
5,000
200,000
Rp
5,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
Rp
200,000
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
150,000
Rp
20,000
Rp
100,000
Rp
5,000
Rp
Rp
400,000
250,000
Rp
Rp
180,000
120,000
Rp
Rp
80,000
100,000
Rp
Rp
440,000
120,000
Rp
Rp
480,000
180,000
Rp
Rp
360,000
270,000
Rp
Rp
5,000
5,000
Rp
100,000
Rp
60,000
Rp
20,000
Rp
60,000
Rp
90,000
Rp
135,000
Rp
5,000
Rp
150,000
Rp
90,000
Rp
20,000
Rp
80,000
Rp
5,000
Rp
150,000
Rp
120,000
Rp
20,000
Rp
80,000
Rp
5,000
Rp
100,000
Rp
60,000
Rp
20,000
Rp
60,000
Rp
5,000
Rp
200,000
Rp
90,000
Rp
150,000
Rp
90,000
Rp
450,000
Rp
180,000
Rp
Rp
40,000
140,000
Rp
200,000
Rp
210,000
Rp
40,000
Rp
50,000
Rp
20,000
Rp
40,000
Rp
150,000
Rp
60,000
Rp
40,000
Rp
100,000
Rp
90,000
Rp
200,000
Rp
90,000
Rp
Rp
150,000
Rp
60,000
Rp
Rp
200,000
Rp
120,000
Rp
Rp
120,000
Rp
80,000
Rp
440,000
Rp
Rp
Rp
90,000
Rp
Rp
840,000
240,000
60,000
Rp
Rp
Rp
Rp
90,000
Rp
135,000
135,000
225,000
135,000
100,000
Rp
5,000
40,000
Rp
240,000
Rp
5,000
20,000
Rp
100,000
Rp
150,000
Rp
225,000
60,000
Rp
90,000
Rp
135,000
Rp
Rp
100,000
100,000
Rp
Rp
30,000
60,000
Rp
Rp
40,000
20,000
Rp
Rp
40,000
60,000
Rp
60,000
Rp
90,000
Rp
150,000
Rp
60,000
Rp
80,000
Rp
240,000
Rp
Rp
100,000
Rp
60,000
Rp
160,000
Rp
Rp
100,000
Rp
90,000
Rp
20,000
Rp
200,000
Rp
150,000
Rp
150,000
Rp
40,000
Rp
240,000
Rp
Rp
400,000
Rp
240,000
Rp
40,000
Rp
480,000
Rp
Rp
300,000
Rp
240,000
5,000
Rp
Rp
200,000
Rp
20,000
20,000
Rp
5,000
5,000
Rp
Rp
Rp
Rp
120,000
90,000
5,000
40,000
Rp
Rp
Rp
Rp
150,000
400,000
5,000
180,000
Rp
480,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
135,000
Rp
Rp
Rp
Rp
Rp
5,000
Rp
5,000
Rp
5,000
90,000
Rp
5,000
90,000
Rp
5,000
Rp
5,000
90,000
Rp
5,000
270,000
Rp
5,000
225,000
Rp
5,000
Rp
60,000
Rp
280,000
Rp
5,000
Rp
20,000
Rp
140,000
Rp
5,000
Rp
Rp
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
Rp
200,000
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
Rp
400,000
Rp
200,000
Rp
200,000
Rp
200,000
100,000
50,000
Rp
Rp
150,000
150,000
Rp
250,000
Rp
50,000
Rp
Rp
Rp
90,000
90,000
150,000
Rp
Rp
20,000
80,000
Rp
Rp
80,000
240,000
Rp
20,000
Rp
120,000
Rp
20,000
Rp
80,000
Rp
120,000
Rp
Rp
90,000
Rp
Rp
5,000
5,000
5,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
Rp
50,000
Rp
200,000
Rp
200,000
sesuai PERDA (Rp)

Tindakan Operasi Bedah
Sederhana
Kecil
Sedang
Besar
Pemakaian
Oksigen
Anastesi
Besar
Khusus
Rp
5,250,000
Sederhana
Kecil
Sedang
Besar
Besar
Rontgen
USG
EKG
Khusus
Rp 1,800,000
Rp
120,000
Rp
100,000
Rp 1,000,000
Rp
60,000
Rp
60,000
Rp
Rp
60,000
Rp
120,000
Rp
60,000
Rp
120,000
Rp
60,000
Rp
120,000
Rp
320,000
200,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
Rp
60,000
Rp
190,000
200,000
Rp
4,000,000
Rp 1,400,000
Rp
4,000,000
2,187,500
Rp
750,000
Rp
1,750,000
Rp
600,000
Rp
3,500,000
Rp 1,200,000
Rp
1,750,000
340,000
Rp
200,000
Rp
280,000
Rp
70,000
Rp
150,000
5,250,000
Rp 1,800,000
Rp
60,000
Rp
5,250,000
Rp 1,800,000
Rp
60,000
Rp 1,800,000
Rp
60,000
4,000,000
Rp
500,000
Rp
60,000
Rp
60,000
Rp 1,400,000
5,250,000
Rp
4,000,000
Rp 1,400,000
Rp
4,000,000
Rp 1,400,000
Rp
4,000,000
Rp 1,400,000
4,000,000
Rp
Rp
Rp
Rp
100,000
Rp 1,400,000
Rp
Rp
Rp
Rp
5,250,000
Rp 1,800,000
Rp
5,250,000
Rp 1,800,000
Rp
5,250,000
Rp 1,400,000
Rp
Rp
70,000
Rp
50,000
Rp
60,000
Rp
430,000
Rp
60,000
Rp
120,000
Rp
200,000
Rp
60,000
Rp
60,000
Rp
800,000
Rp
60,000
Rp
220,000
Rp 1,800,000
600,000
Rp
Rp
300,000
Rp
160,000
Rp
70,000
Rp
160,000
Rp
280,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
200,000
Rp
300,000
Rp 1,450,000
Rp
200,000
Rp
200,000
Rp
520,000
Rp
110,000
Rp
350,000 Rp
60,000
Rp
120,000
Rp
100,000
Rp
60,000
Rp
60,000
Rp
50,000
Rp
Rp
Rp
Rp
Rp
300,000
300,000
Rp
60,000
Rp
120,000
Rp
60,000
Rp
240,000
Rp
180,000
Rp
60,000
Rp
60,000
Rp
100,000
Rp
160,000
Rp
180,000
Rp
120,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
100,000
300,000
100,000
300,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
240,000
Rp
60,000
Rp 2,000,000
Rp
100,000
Rp
Rp
1,750,000
1,750,000
Rp
100,000
Rp
700,000
Rp
60,000
Rp
180,000
Rp
420,000
Rp
60,000
Rp
120,000
Rp
30,000
Rp
60,000
Rp
60,000
Rp
300,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
120,000
Rp
230,000
Rp
100,000
Rp
300,000
Rp
60,000
Rp
600,000
Rp
60,000
Rp
400,000
Rp
300,000
600,000
Rp
4,000,000
Rp 1,400,000
Rp
4,000,000
Rp 1,400,000
Rp
Rp
600,000
Rp
200,000
Rp
200,000
Rp
Rp
200,000
100,000
Rp
160,000
Rp
120,000
Rp
60,000
Rp
100,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
100,000
Rp
100,000
Rp
Rp
5,250,000
4,000,000
Rp 1,800,000
Rp
60,000
Rp
400,000
Rp
60,000
Rp
200,000
Rp
220,000
Rp
60,000
Rp
60,000
Rp
Rp
200,000
400,000
Rp
30,000
Rp
300,000
Rp
300,000
Rp
20,000
Rp
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
70,000
Rp 1,400,000
Rp
Rp 15,750,000
500,000
Rp 5,400,000
Rp
5,250,000
Rp 1,800,000
Rp
100,000
Rp
600,000
Rp
300,000
Rp
60,000
Rp
240,000
Rp
700,000
Rp
60,000
Rp
60,000
Rp
140,000
Rp
Rp
Rp
1,750,000
Rp
1,750,000
Rp
1,750,000
Rp
600,000
600,000
1,750,000
Rp
20,000
Rp
Rp
450,000
300,000
Rp
Rp
Rp
60,000
160,000
240,000
Rp
Rp
60,000
180,000
Rp
300,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
100,000
Rp
60,000
Rp
70,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
240,000
Rp
60,000
Rp
60,000
600,000
Rp
1,750,000
Rp
600,000
Rp
1,750,000
Rp
600,000
Rp
5,250,000
500,000
Rp 3,600,000
Rp
Rp
50,000
600,000
Rp 10,500,000
60,000
60,000
Rp
Rp
Rp
Rp
Rp
20,000
Rp 1,800,000
Rp
200,000
Rp
90,000
Rp
160,000
Rp
210,000
Rp
60,000
Rp
60,000
Rp
Rp
1,750,000
Rp
600,000
Rp
Rp
Rp
Rp 15,750,000
160,000
Rp 5,400,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
Rp
60,000
60,000
150,000
200,000
200,000
Rp
60,000
Rp
Rp
100,000
290,000
Rp
400,000
Rp
50,000
Rp
400,000
Rp
400,000
Rp
60,000
Rp
Rp
620,000
50,000
Rp
Rp
160,000
60,000
Rp
30,000
Rp
300,000
Rp
Rp
5,000,000
Rp 1,750,000
Rp
8,000,000
Rp 1,400,000
Rp
Rp
1,750,000
Rp
Rp
410,000
250,000
Rp
250,000
Rp
60,000
Rp
Rp
60,000
60,000
Rp
120,000
Rp
120,000
Rp
60,000
Rp
60,000
600,000
4,000,000
Rp
400,000
Rp
60,000
Rp
400,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
130,000
Rp
60,000
Rp
60,000
Rp 1,400,000
Rp 10,500,000
Rp 3,000,000
Rp
200,000
Rp
200,000
Rp
Rp
4,000,000
Rp 1,400,000
120,000
Rp
200,000
Rp
60,000
Rp
400,000
Rp
120,000
Rp
400,000
Rp
60,000
Rp
160,000
Rp
60,000
Rp
4,000,000
Rp 1,400,000
Rp
5,250,000
Rp
Rp 1,800,000
Rp
60,000
60,000
TOTAL KLAIM
Pemeriksaan
Darah Untuk
Tranfusi dan
Kantong
Rp
Rp
260,000
260,000
Laboratorium
Obat, alat suntik,

alat infus dan
cairan infus
selama dirawat
dan atau operasi
Tindakan Medis
Lepas Infus
Injeksi IV
Injeksi IM
Pasang Infus
Pasang Infus
Ngt
Observasi
Rp
350,500
Rp
1,795,500
Rp
20,000
Rp
25,000
Rp
279,500
Rp
293,000
Rp
15,000
Rp
75,000
Rp
241,500
Rp
2,027,500
Rp
20,000
Rp
100,000
Rp
1,464,500
Rp
90,000
Rp
250,000
Rp
250,000
Rp
50,000
Rp
150,000
Rp
225,000
Rp
50,000
Rp
250,000
Rp
409,000
Rp
474,000
Rp
50,000
Rp
320,000
Rp
1,310,500
Rp
20,000
Rp
100,000
Rp
78,000
Rp
1,317,500
Rp
20,000
Rp
100,000
Rp
135,000
Rp
184,500
Rp
722,000
Rp
10,000
Rp
50,000
Rp
165,000
Rp
1,018,000
Rp
20,000
Rp
100,000
Rp
115,000
Rp
462,000
Rp
10,000
Rp
75,000
Rp
207,000
Rp
473,000
Rp
40,000
Rp
100,000
Rp
62,000
Rp
815,500
Rp
135,000
Rp
1,256,000
Rp
50,000
Rp
250,000
Rp
300,000
Rp
240,500
Rp
5,000
Rp
25,000
Rp
152,500
Rp
976,500
Rp
25,000
Rp
125,000
Rp
165,000
Rp
353,000
Rp
20,000
Rp
75,000
Rp
416,000
Rp
10,000
Rp
25,000
Rp
Observasi IGD
Pasang OGT
Pemberian
Transfusi
Darah
Nebulisasi
650,000
Rp
160,000
Rp
20,000
Nebulizer
Inkubator
Jahit luka
Rp
397,500
Rp
2,760,000
Rp
20,000
Rp
25,000
Rp
700,000
Rp
225,000
Rp
6,654,000
Rp
25,000
Rp
150,000
Rp
95,000
Rp
195,000
Rp
5,000
Rp
161,500
Rp
739,500
Rp
5,000
Rp
25,000
Rp
200,000
Rp
63,000
Rp
279,000
Rp
5,000
Rp
25,000
Rp
200,000
Rp
147,500
Rp
565,000
Rp
5,000
Rp
25,000
Rp
150,000
Rp
218,500
Rp
1,353,000
Rp
5,000
Rp
250,000
Rp
184,000
Rp
2,165,000
Rp
5,000
Rp
150,000
Rp
193,000
Rp
5,000
Rp
300,000
Rp
220,000
Rp
1,158,500
Rp
5,000
Rp
25,000
Rp
200,000
Rp
170,000
Rp
2,040,000
Rp
10,000
Rp
25,000
Rp
250,000
Rp
165,500
Rp
817,500
Rp
5,000
Rp
25,000
Rp
200,000
Rp
115,000
Rp
358,000
Rp
Rp
170,500
Rp
475,000
5,000
Rp
50,000
Rp
300,000
Rp
50,000
Rp
250,000
Rp
222,000
Rp
25,000
Rp
350,000
Rp
300,000
Rp
5,000
Rp
5,000
Rp
25,000
Rp
122,500
Rp
1,859,000
Rp
10,000
Rp
25,000
Rp
250,000
Rp
40,500
Rp
767,000
Rp
5,000
Rp
25,000
Rp
200,000
Rp
45,000
Rp
269,000
Rp
200,000
Rp
135,000
Rp
5,000
Rp
100,000
Rp
50,000
Rp
105,000
Rp
1,736,000
Rp
40,000
Rp
200,000
Rp
95,000
Rp
153,000
Rp
5,000
Rp
25,000
Rp
50,000
Rp
17,000
Rp
21,000
Rp
135,000
Rp
472,000
Rp
10,000
Rp
192,000
Rp
678,000
Rp
5,000
Rp
50,000
Rp
122,500
Rp
2,983,500
Rp
45,000
Rp
225,000
Rp
130,000
Rp
361,500
Rp
5,000
Rp
25,000
Rp
Rp
100,000
Rp
150,000
50,000
Rp
Rp
520,000
192,000
Rp
151,000
Rp
589,000
Rp
50,000
Rp
125,000
Rp
250,000
Rp
150,000
Rp
200,000
Rp
150,000
Rp
150,000
Rp
310,000
Rp
826,000
Rp
30,000
Rp
150,000
Rp
329,500
Rp
529,000
Rp
5,000
Rp
75,000
Rp
67,000
Rp
304,000
Rp
5,000
Rp
45,000
Rp
377,000
Rp
20,000
Rp
100,000
Rp
277,000
Rp
407,000
Rp
5,000
Rp
25,000
Rp
95,000
Rp
805,500
Rp
5,000
Rp
372,500
Rp
1,224,500
Rp
60,000
Rp
17,000
Rp
165,000
Rp
5,000
Rp
60,000
Rp
193,000
Rp
5,000
Rp
50,000
Rp
63,000
Rp
818,000
Rp
5,000
Rp
250,000
Rp
198,000
Rp
252,000
Rp
10,000
Rp
79,500
Rp
5,000
Rp
100,000
Rp
50,000
Rp
250,000
Rp
100,000
Rp
100,000
Rp
Rp
125,000
10,000
Rp
50,000
Rp
255,000
Rp
365,000
Rp
20,000
Rp
100,000
Rp
192,000
Rp
1,281,500
Rp
45,000
Rp
225,000
Rp
114,500
Rp
372,500
Rp
70,000
Rp
225,000
Rp
187,000 Rp
229,000 Rp
10,000
Rp
50,000
Rp
81,500 Rp
10,000
Rp
25,000
45,000 Rp
77,000 Rp
Rp
Rp
Rp
Rp
240,000
Rp
17,000 Rp
757,000
Rp
5,000 Rp
20,000
30,000
Rp
222,000 Rp
5,000 Rp
70,000
Rp
296,500 Rp
10,000
130,000
Rp
5,000
Rp
Rp
150,000
100,000
Rp
135,000 Rp
1,092,000 Rp
75,000
Rp
150,000
Rp
261,500
Rp
1,179,500
Rp
20,000
Rp
75,000
Rp
243,000
Rp
1,580,500
Rp
35,000
Rp
175,000
Rp
169,500
Rp
378,000
Rp
5,000
Rp
75,000
Rp
45,000
Rp
204,000
Rp
30,000
Rp
75,000
Rp
40,000
40,000
Rp
520,000
Rp
105,000
Rp
155,500
Rp
118,000
Rp
717,500
Rp
50,000
Rp
250,000
Rp
184,000
Rp
399,500
Rp
5,000
Rp
25,000
Rp
60,000
Rp
356,000
Rp
10,000
Rp
25,000
Rp
235,000
Rp
703,500
Rp
20,000
Rp
100,000
Rp
224,500
Rp
666,500
Rp
95,000
Rp
225,000
Rp
17,000
Rp
202,000
Rp
5,000
Rp
10,000
Rp
25,000
Rp
Rp
17,000
177,500
Rp
Rp
271,000
1,181,000
Rp
Rp
5,000
30,000
Rp
10,000
Rp
170,000
Rp
572,500
Rp
Rp
81,000
260,000
20,000
Rp
5,000
Rp
150,000
5,000
Rp
25,000
Rp
5,000
Rp
25,000
Rp
246,000
Rp
2,067,500
Rp
30,000
Rp
150,000
Rp
152,000
Rp
728,500
Rp
20,000
Rp
100,000
Rp
217,000
Rp
5,000
Rp
59,000
Rp
5,000
Rp
237,000
Rp
5,000
Rp
370,000
Rp
5,000
Rp
Rp
Rp
152,000
Rp
10,000
Rp
25,000
Rp
564,500
Rp
65,000
Rp
200,000
Rp
170,000
Rp
327,500
Rp
5,000
Rp
25,000
Rp
112,000
Rp
801,500
Rp
15,000
Rp
75,000
Rp
371,500
Rp
628,000
Rp
15,000
Rp
75,000
Rp
129,000
Rp
1,660,500
Rp
25,000
Rp
100,000
Rp
635,000
Rp
15,000
Rp
75,000
Rp
55,000
Rp
276,000
Rp
5,000
Rp
25,000
Rp
47,000
Rp
52,000
Rp
5,000
Rp
25,000
Rp
164,000
Rp
1,767,500
Rp
40,000
Rp
225,000
Rp
135,000
Rp
603,000
Rp
40,000
Rp
100,000
Rp
100,000
Rp
1,716,000
Rp
40,000
Rp
100,000
Rp
160,000
Rp
1,112,000
Rp
35,000
Rp
175,000
Rp
148,000
Rp
553,500
Rp
50,000
Rp
250,000
Rp
40,000
Rp
450,000
Rp
250,000
Rp
200,000
Rp
100,000
Rp
100,000
Rp
350,000
Rp
300,000
Rp
800,000
Rp
250,000
Rp
165,000
Rp
416,000
Rp
40,000
Rp
100,000
Rp
153,000
Rp
5,000
Rp
193,000
Rp
618,000
Rp
40,000
Rp
200,000
Rp
120,000
Rp
1,353,000
Rp
80,000
Rp
200,000
Rp
45,000
Rp
371,500
Rp
70,000
Rp
175,000
Rp
180,000
Rp
371,000
Rp
5,000
Rp
25,000
Rp
353,000
Rp
767,500
Rp
35,000
Rp
175,000
Rp
210,000
Rp
1,431,000
Rp
35,000
Rp
175,000
780,000
Rp
259,000
Rp
716,000
Rp
20,000
Rp
50,000
Rp 1,040,000
Rp
245,500
Rp
971,000
Rp
25,000
Rp
75,000
Rp
158,000
Rp
816,000
Rp
45,000
Rp
225,000
Rp
409,000
Rp
1,919,000
Rp
115,000
Rp
250,000
Rp
454,500
Rp
976,000
Rp
150,000
Rp
375,000
Rp
112,500
Rp
198,000
Rp
5,000
Rp
Rp
358,500
Rp
1,378,000
Rp
5,000
Rp
Rp
65,000
Rp
1,730,500
Rp
170,000
Rp
585,000
Rp
85,000
Rp
152,000
Rp
187,500
Rp
Rp
162,500
Rp
215,000
Rp
Rp
142,000
Rp
592,000
Rp
Rp
Rp
260,000
Rp
170,000
Rp
Rp
5,000
200,000
Rp
150,000
Rp
450,000
25,000
Rp
150,000
25,000
Rp
200,000
Rp
550,000
Rp
25,000
Rp
150,000
Rp
25,000
Rp
200,000
10,000
Rp
75,000
30,000
Rp
75,000
Rp
45,000
Rp
225,000
127,000
Rp
5,000
Rp
150,000
Rp
311,000
Rp
5,000
Rp
150,000
Rp
86,000
Rp
5,000
Rp
100,000
Rp
200,000
Rp
242,000
Rp
411,000
Rp
60,000
Rp
74,500
Rp
565,000
Rp
5,000
Rp
218,000
Rp
68,000
Rp
5,000
Rp
75,000
Rp
5,000
Rp
Rp
20,000
20,000
Rp
Rp
10,000
150,000
Rp
25,000
Rp
200,000
Rp
25,000
Rp
150,000
Rp
100,000
Rp
200,000
Rp
Rp
520,000
520,000
Rp
60,000
Rp
135,000
Rp
40,000
Rp
100,000
Rp
82,000
Rp
196,500
Rp
10,000
Rp
25,000
Rp
209,500
Rp
10,000
Rp
50,000
Rp
20,000
Rp
50,000
Rp
102,000
Rp
125,000
Rp
40,000
Rp
100,000
Rp
138,000
Rp
564,000
Rp
40,000
Rp
100,000
Rp
60,000
Rp
105,000
Rp
5,000
Rp
150,000
Rp
62,000
Rp
109,500
Rp
5,000
Rp
100,000
Rp
152,500
Rp
592,000
Rp
5,000
Rp
200,000
Rp
117,000
Rp
639,000
Rp
20,000
Rp
100,000
Rp
50,000
Rp
330,000
Rp
196,000
Rp
40,000
Rp
100,000
Rp
135,000
Rp
128,000
Rp
5,000
Rp
100,000
Rp
100,000
Rp
182,500
Rp
10,000
Rp
72,000
Rp
210,500
Rp
5,000
Rp
382,000
Rp
475,000
Rp
Rp
150,000
Rp
217,500
Rp
112,500
Rp
Rp
62,000
Rp
Rp
50,000
Rp
25,000
Rp
250,000
90,000
Rp
225,000
Rp
50,000
Rp
20,000
Rp
100,000
3,512,500
Rp
5,000
Rp
400,000
Rp
Rp
849,000
99,500
Rp
Rp
5,000
5,000
Rp
25,000
Rp
Rp
200,000
200,000
115,000
Rp
935,000
Rp
5,000
Rp
25,000
Rp
Rp
636,000
128,000
Rp
Rp
1,316,000
391,000
Rp
Rp
90,000
25,000
Rp
Rp
225,000
125,000
Rp
50,000
Rp
477,500
Rp
3,611,000
Rp
20,000
Rp
100,000
Rp 2,050,000
Rp
78,000
Rp
532,000
Rp
70,000
Rp
175,000
Rp
177,000
Rp
961,000
Rp
110,000
Rp
275,000
Rp
237,500
Rp
3,165,000
Rp
5,000
Rp
25,000
Rp
750,000
Rp
494,500
Rp
965,000
Rp
20,000
Rp
50,000
Rp
700,000
Rp
50,000
Rp
5,000
Rp
260,000
Rp
73,000
Rp
361,000
Rp
10,000
Rp
95,000
Rp
653,000
Rp
40,000
Rp
210,000
Rp
1,871,000
Rp
17,000
Rp
162,000
Rp
5,000
Rp
20,000
Rp
140,000
Rp
171,000
Rp
5,000
Rp
40,000
Rp
Rp
Rp
162,000
299,000
249,000
Rp
Rp
Rp
Rp
176,000
751,000
614,000
1,562,000
Rp
Rp
Rp
Rp
Rp
465,000
Rp
614,000
Rp
1,365,000
Rp
614,000
Rp
25,000
Rp
120,000
Rp
126,000
Rp
5,000
Rp
10,000
Rp
Rp
160,000
182,000
Rp
200,000
Rp
25,000
Rp
25,000
5,000
30,000
55,000
15,000
Rp
Rp
Rp
150,000
275,000
75,000
Rp
30,000
Rp
150,000
Rp
80,000
Rp
200,000
Rp
10,000
Rp
100,000
Rp
20,000
Rp
150,000
Rp
850,000
Rp
500,000
Rp
150,000
Rp
400,000
Rp
150,000
Rp
600,000
Rp
800,000
Rp
150,000
Rp
200,000
Rp
Rp
250,000
200,000
Rp
188,000
Rp
211,500
Rp
5,000
Rp
45,000
Rp
3,511,000
Rp
100,000
Rp
120,500
Rp
Rp
1,513,000
311,000
Rp
Rp
5,000
5,000
Rp
Rp
1,507,000
103,500
Rp
5,000
Rp
Rp
450,000
100,000
Rp
94,000
Rp
5,000
Rp
50,000
Rp
176,500
Rp
5,000
Rp
100,000
Rp
965,000
Rp
5,000
Rp
200,000
Rp
311,000
Rp
20,000
Rp
100,000
Rp
250,000
Rp
17,000
Rp
Rp
200,000
Rp
250,000
Rp
25,000
30,000
Rp
163,000
Rp
863,000
Rp
40,000
Rp
200,000
Rp
251,500
Rp
561,000
Rp
40,000
Rp
200,000
Rp
100,000
Rp
366,500
Rp
5,000
Rp
336,000
Rp
10,000
Rp
2,113,000
Rp
361,000
Rp
148,000
Rp
40,000
Rp
25,000
Rp
100,000
Rp
25,000
Rp
300,000
Rp
100,000
Rp
50,000
Rp
350,000
Rp
150,000
Rp
Rp
102,000
Rp
251,000
Rp
20,000
Rp
127,000
Rp
15,000
Rp
Rp
100,000
Rp
250,000
Rp
62,000
Rp
216,000
Rp
5,000
Rp
170,500
Rp
961,000
Rp
5,000
Rp
121,000
Rp
5,000
Rp
150,000
Rp
550,000
Rp
500,000
Rp
150,000
Rp
50,000
Rp
25,000
Rp
495,000
Rp
2,561,000
Rp
5,000
Rp 1,040,000
Rp
939,000
Rp
1,710,000
Rp
15,000
Rp
25,000
Rp
369,500
Rp
295,500
Rp
20,000
Rp
100,000
Rp
115,000
Rp
181,000
Rp
15,000
Rp
75,000
Rp
125,000
Rp
131,500
Rp
10,000
Rp
50,000
Rp
97,000
Rp
10,000
Rp
75,000
Rp
198,000
Rp
15,000
Rp
75,000
Rp 1,040,000
100,000
75,000
260,000
Rp 1,040,000
Rp
Rp
309,500
Rp
716,000
Rp
25,000
Rp
250,000
Rp
100,000
Rp
281,000
Rp
20,000
Rp
100,000
Rp
180,000
Rp
371,000
Rp
30,000
Rp
75,000
Rp
Rp
62,000
60,000
Rp
Rp
521,000
106,000
Rp
Rp
30,000
5,000
Rp
Rp
150,000
100,000
Rp
85,000
Rp
1,916,000
Rp
45,000
Rp
225,000
Rp
95,000
Rp
126,000
Rp
10,000
Rp
50,000
Rp
180,000
Rp
516,000
Rp
15,000
Rp
25,000
Rp
150,000
Rp
300,000
Rp
961,000
Rp
10,000
Rp
50,000
Rp
850,000
Rp
137,000
Rp
5,000
Rp
500,000
Rp
1,215,000
Rp
45,000
Rp
117,000
Rp
5,000
Rp
150,000
Rp
100,000
Rp
40,000
Rp
Rp
225,000
10,000
Rp
80,000
Rp
316,000
Rp
20,000
Rp
100,000
Rp
277,500
Rp
Rp
2,125,000
136,000
Rp
Rp
110,000
5,000
Rp
Rp
275,000
25,000
Rp
177,000
Rp
5,000
Rp
25,000
Rp
211,000
Rp
15,000
Rp
75,000
Rp
179,500
Rp
460,000
Rp
5,000
Rp
Rp
272,500
699,000
Rp
Rp
1,956,000
179,000
Rp
Rp
90,000
5,000
Rp
226,000
Rp
5,000
Rp
Rp
Rp
250,000
Rp
300,000
Rp
50,000
225,000
10,000
Rp
198,000
Rp
681,500
Rp
10,000
Rp
200,000
Rp
350,500
Rp
791,500
Rp
10,000
Rp
450,000
Rp
99,000
Rp
5,000
Rp
250,000
Rp
110,000
Rp
285,000
Rp
30,000
Rp
100,000
Rp
55,000
Rp
471,500
Rp
5,000
Rp
25,000
Rp
200,000
Rp
152,500
Rp
1,940,000
Rp
40,000
Rp
200,000
Rp
100,000
Rp
304,500
Rp
417,000
Rp
40,000
Rp
100,000
Rp
97,000
Rp
5,000
Rp
100,000
Rp
116,000
Rp
5,000
Rp
150,000
Rp
20,000
Rp
25,000
Rp
818,000
Rp
5,000
Rp
100,000
Rp
170,500
Rp
817,000
Rp
5,000
Rp
200,000
Rp
80,000
Rp
271,000
Rp
20,000
Rp
114,000
Rp
216,000
Rp
5,000
Rp
50,000
Rp
200,000
Rp
17,000
Rp
181,000
Rp
5,000
Rp
10,000
Rp
Rp
45,000
80,000
Rp
Rp
169,500
191,000
Rp
Rp
Rp
374,000
Rp
311,000
Rp
Rp
100,000
Rp
50,000
Rp
150,000
10,000
5,000
Rp
25,000
Rp
Rp
100,000
150,000
Rp
30,000
Rp
100,000
161,000
Rp
30,000
Rp
75,000
Rp
50,000
Rp
350,000
Rp
145,000
Rp
251,000
Rp
15,000
Rp
75,000
Rp
269,500
Rp
423,500
Rp
40,000
Rp
100,000
Rp
264,500
Rp
817,000
Rp
90,000
Rp
225,000
Rp
170,000
Rp
1,151,000
Rp
45,000
Rp
225,000
Rp
105,000
Rp
176,500
Rp
25,000
Rp
125,000
Rp
356,500
Rp
716,000
Rp
975,000
Rp
10,000
Rp
25,000
Rp
200,000
Rp
100,000
Rp
200,000
Rp
300,000
Rp
237,000
Rp
292,000
Rp
20,000
Rp
170,500
Rp
1,710,500
Rp
5,000
Rp
86,000
Rp
5,000
Rp
50,000
3497500
15000
3512500
edis
JUMLAH
Angkat jahitan Rawat Luka OP Rehab Medik
Rp
75,000
Rp
120,000
Suction
Psikologi
Rp
30,000
Heacting
Konseling
Penyimpanan
Jenazah
Biaya
Pemeriksaan
poliklinik
TAGIHAN
UPF
Orthopedi
Rp
12,041,000 08.19.04
Interna
Rp
1,517,500 08.22.49
Interna
Rp
5,379,000 08.12.76
Interna
Rp
4,499,500 08.19.85
Interna
Rp
2,958,000 08.19.36
Interna
Rp
3,090,500 08.21.54
Interna
Rp
2,350,500 08.23.70
Bedah
Rp
555,000 08.24.88
Neurologi
Rp
1,491,500 08.24.87
Interna
Rp
2,323,000 08.25.90
Interna
Rp
1,347,000 08.28.59
Interna
Rp
2,015,000 08.27.80
Bedah
Rp
1,527,500 08.29.24
Interna
Rp
3,651,000 08.26.40
Interna
Rp
1,045,500 08.27.06
Interna
Rp
2,764,000 08.24.74
Interna
Rp
1,578,000 07.63.49
Bedah
Rp
1,726,000 08.21.24
Rp
Rp
75,000
225,000
Bedah
Rp
6,437,500 08.21.37
Interna & Bedah
Rp
15,714,000 08.21.52
Interna
Rp
615,000 07.90.61
Bedah
Rp
7,036,000 08.31.97
Bedah
Rp
4,124,500 08.37.67
Bedah
Rp
3,557,500 08.34.82
Bedah
Rp
7,361,500 08.33.91
Bedah
Rp
10,034,000 08.29.30
Orthopedi
Rp
8,398,000 08.31.41
Bedah
Rp
7,403,500 08.33.10
Orthopedi
Rp
10,305,000 08.28.73
Bedah
Rp
6,948,000 07.91.90
Bedah
Rp
6,893,000 08.31.36
Bedah
Rp
7,005,500 08.08.52.
Orthopedi
Rp
8,632,000 08.30.66
Orthopedi
Rp
8,120,000 08.30.88
Rp
225,000
Bedah
Rp
15,956,500 08.26.09
Rp
75,000
Bedah
Rp
3,797,500 08.23.98
Kes. Anak
Rp
1,344,000 08.34.41
Kes. Anak
Rp
835,000 08.38.03
Interna
Rp
3,226,000 08.36.76
Interna
Rp
743,000 08.37.41
Anak
Rp
503,000 08.37.44
Interna
Rp
2,177,000 08.35.97
Bedah
Rp
2,060,000 07.73.82
Interna
Rp
6,366,000 08.12.76
Bedah
Rp
1,326,500 08.37.98
Rp
Rp
Rp
225,000
225,000
225,000
Interna
Rp
663,000 08.31.42
Interna
Rp
2,749,000 08.06.90
Interna
Rp
2,421,000 08.32.01
Interna
Rp
2,228,500 08.30.58
Bedah
Rp
931,000 08.34.44
Interna
Rp
1,597,000 08.35.91
Interna
Rp
1,769,000 08.36.01
Bedah
Rp
1,955,500 08.35.96
Interna
Rp
5,012,000 08.34.57
Anak
Rp
917,000 08.36.43
Bedah
Rp
603,000 08.31.60
Bedah
Rp
2,446,000 08.30.29
Interna
Rp
1,190,000 08.31.47
Anak
Rp
589,500 08.33.85
Interna
Rp
1,475,000 08.26.07
Interna
Rp
4,058,500 08.27.83
Interna
Rp
2,412,000 08.29.50
Saraf
Rp
1,261,000 08.36.92
Interna
Rp
981,500 08.37.71
Anak
Rp
1,162,000 07.91.31
Interna
Rp
2,327,000 08.34.33
Kes. Anak
Rp
1,889,000 06.14.78
Interna
Rp
1,071,500 07.88.16
Bedah
Rp
440,000 08.34.25
Rp
3,137,000 08.34.59
Saraf
Rp
2,566,000 08.29.45
Interna
Rp
3,543,500 08.34.47
Interna
Rp
1,337,500 08.29.22
Interna
Rp
1,169,000 07.82.66
Interna
Rp
20,000
Anak
Rp
660,500 08.26.44
Interna
Rp
3,405,500 08.30.01
Interna
Rp
1,158,500 06.86.57
Bedah
Rp
1,876,000 08.30.87
Interna
Rp
1,853,500 08.31.40
Interna
Rp
3,611,000 07.71.21
Anak
Rp
1,314,000 08.34.49
Kes. Anak
Interna
Rp
Rp
1,483,000 08.33.25
2,978,500 08.30.92
Interna
Rp
1,217,500 08.30.91
Interna
Rp
311,000 08.30.15
Interna
Rp
4,178,500 08.30.85
Interna
Rp
2,070,500 08.11.16
Kes. Anak
Rp
932,000 08.09.53
Kes. Anak
Rp
744,000 08.30.19
Bedah
Rp
1,819,000 08.05.26
Bedah
Rp
1,240,000 08.31.28
Interna
Rp
3,044,500 08.31.17
Interna
Rp
1,002,500 08.22.63
Interna
Rp
2,358,500 08.23.29
Interna
Rp
2,059,500 07.33.37
Bedah
Rp
4,209,500 08.25.16
Interna
Rp
2,010,000 07.52.30
Interna
Rp
556,000 08.24.69
Anak
Rp
1,064,000 08.15.37
Interna
Rp
4,376,500 08.25.93
Interna
Rp
2,338,000 08.25.69
Interna
Rp
5,046,000 08.25..58
Interna
Rp
2,982,000 08.24.59
Interna
Rp
3,371,500 08.27.94
Rp
Rp
75,000
225,000
Rp
Interna
Rp
2,266,000 08.33.76
Kes. Anak
Rp
1,048,000 08.39.43
Interna
Rp
2,466,000 08.30.49
Interna
Rp
4,303,000 08.37.83
Interna
Rp
3,121,500 08.37.74
Interna
Rp
1,451,000 0839.97
Interna
Rp
2,850,500 08.39.96
Interna
Rp
3,256,000 08.37.91
Bedah
Rp
4,050,000 08.36.42
Interna
Rp
4,321,500 07.38.16
Interna
Rp
3,409,000 08.33.53
Interna
Rp
5,468,000 08.30.32
Interna
Rp
5,420,500 08.30.39
Bedah
Rp
3,215,500 08.33.07
Bedah
Rp
7,791,500 08.30.99
Bedah
Rp
8,990,500 08.31.07
130,000 Bedah
Rp
3,825,000 08.38.27
Bedah
Rp
1,070,000 08.36.45
Rehab medik
Rp
1,219,500 08.36.52
Interna
Rp
1,547,500 08.40.53
Interna
Rp
2,284,000 08.40.29
Kesehatan Anak
Rp
902,000 08.39.85
Bedah
Rp
1,141,000 08.38.37
Kesehatan Anak
Rp
771,000 08.40.00
Interna
Rp
2,128,000 08.37.49
Bedah
Rp
1,409,500 08.30.23
Bedah
Rp
1,423,000 08.37.82
Anak
Rp
678,000 08.38.95
Anak
Rp
610,000 08.39.20
Interna
Rp
1,740,000 08.39.18
Anak
Rp
903,500 08.38.50
Interna
Rp
979,500 07.90.91
Interna
Rp
1,792,000 08.38.51
Interna
Rp
2,092,000 08.37.70
Anak
Rp
920,000 08.38.66
Anak
Rp
701,500 08.39.28
Bedah
Rp
1,494,500 08.35.57
Interna
Rp
1,811,000 08.58.55
Interna
Rp
2,201,000 08.38.07
Interna
Rp
763,000 08.38.53
Interna
Rp
972,500 08.39.35
Anak
Rp
1,527,500 07.96.03
Interna
Rp
2,952,000 08.39.25
Interna
Rp
1,592,500 08.27.66
Rp
Rp
75,000
Rp 1,575,000
Rp
375,000
Rp 2,100,000
Rp
79,000
10,000
Bedah
Rp
12,075,000 08.31.49
Bedah
Rp
6,949,000 08.25.82
Kes. Anak
Rp
986,500 08.34.39
Interna
Rp
1,675,000 08.25.83
Interna
Rp
4,627,000 08.37.75
Interna
Rp
1,449,000 08.20.48
Bedah Orthopedi
Rp
34,217,500 07.62.19
Interna
Rp
2,925,000 08.36.94
Interna
Rp
4,668,000 06.93.77
Bedah Orthopedi
Rp
13,842,500 08.30.93
Orthopedi
Rp
6,234,500 08.39.26
Rp
Rp
Rp
Rp
75,000
75,000
75,000
75,000
Rp
180,000
Bedah
Rp
3,484,000 08.38.93
Interna
Rp
2,008,000 08.39.54
Bedah
Rp
6,941,000 05.99.50
Kes. Anak
Rp
1,579,000 08.46.94
Kes. Anak
Rp
1,761,000 08.50.11
Kes. Anak
Rp
1,426,000 0844.39
Interna
Interna
Interna & Bedah
Rp
Rp
Rp
2,218,000 08.41.02
4,248,000 08.49.05
3,886,000 08.45.62
Interna
Rp
1,525,000 08.49.04
Interna
Rp
2,909,000 08.46.93
Bedah
Rp
5,730,000 08.42.80
Kes. Anak
Rp
5,841,000 08.42.44
Kes. Anak
Rp
1,116,000 08.42.37
Bedah
Rp
3,479,500 08.41.39
Interna
Rp
7,401,000 08.41.08
Bedah Orthopedi
Rp
16,923,500 08.44.21
Bedah
Rp
1,021,000 08.40.81
Bedah
Rp
5,297,000 08.43.61
Bedah
Rp
528,500 08.45.57
Kes. Anak
Rp
804,000 08.50.44
Kes. Anak
Rp
1,018,500 08.47.07
Bedah
Rp
4,020,000 08.46.19
Interna
Rp
1,406,000 08.50.48
Interna
Rp
2,001,000 08.41.90
Neurologi
Rp
2,347,500 08.23.07
Bedah
Rp
1,486,500 08.49.69
Bedah
Rp
1,131,000 08.50.50
Bedah Orthopedi
Rp
10,326,000 08.35.72
Interna
Rp
1,726,000 08.41.22
Rp
225,000
Interna
Rp
1,308,000 08.28.07
Interna
Rp
802,000 08.47.17
Bedah
Rp
818,000 08.46.08
Bedah
Rp
4,246,500 08.43.52
Kes. Anak
Rp
971,000 08.45.77
Bedah
Rp
5,456,000 08.44.38
Orthopedi
Rp
6,169,000 07.93.21
Interna
Rp
1,640,000 08.45.75
Interna
Rp
911,000 08.49.70
Interna
Rp
801,500 08.47.84
Interna
Rp
802,000 08.46.85
Interna
Rp
923,000 08.44.59
Interna
Rp
3,885,500 08.45.06
Interna
Rp
1,116,000 08.45.76
Interna
Rp
1,671,000 08.41.24
Interna
Rp
1,933,000 08.41.19
Bedah
Rp
916,000 08.42.74
Interna
Rp
4,766,000 08.43.70
Interna
Rp
736,000 08.48.56
Interna
Rp
1,566,000 08.45.91
Orthopedi
Rp
26,981,000 08.41.33
Kes. Anak
Rp
1,532,000 08.47.93
Interna
Rp
3,835,000 08.45.78
Anak
Rp
1,022,000 08.41.15
Interna
Rp
1,231,000
Interna
Rp
5,422,500 08.41.40
Interna
Rp
811,000 08.48.65
Interna
Rp
812,000 08.48.68
Interna
Rp
896,000 08.48.75
Rp
75,000
Rp
Rp
Rp
75,000
150,000
75,000
Bedah
Rp
1,889,500 08.44.37
Interna
Rp
5,288,500 08.40.88
Kes. Anak
Rp
2,398,000 08.44.43
Kes. Anak
Rp
971,000 08.42.70
Bedah
Rp
8,469,500 08.44.95
Bedah
Rp
11,782,000 08.44.46
Kesehatan Anak
Rp
1,034,000 08.50.28
Interna
Rp
1,635,000 08.47.77
Bedah
Rp
3,551,500 08.39.14
Interna
Rp
5,382,500 08.43.59
Interna
Rp
2,361,500 08.42.59
Bedah
Rp
582,000 08.41.44
Kesehatan Anak
Rp
1,036,000 08.41.30
Bedah
Rp
6,593,000 08.41.56
Bedah Orthopedi
Rp
15,522,500 08.47.11
Interna
Rp
1,176,000 08.47.09
Kesehatan Anak
Rp
1,675,000 08.47.16
Kesehatan Anak
Rp
1,003,000 08.43.15
Kesehatan Anak
Rp
894,500 08.42.32
Bedah
Rp
966,000 08.41.11
Interna
Rp
1,910,000 08.40.97
Interna
Rp
1,141,000 08.45.93
Interna
Rp
1,231,000 08.42.68
Interna
Rp
1,978,000 08.42.50
Interna
Rp
3,761,500 08.42.61
Interna
Rp
3,741,000 08.42.85
Interna
Rp
1,186,500 08.45.55
Bedah
Rp
8,007,500 08.47.95
Rp
(600,000)
Bedah
Rp
7,195,000 08.41.74
Interna
Rp
1,714,000 08.42.90
Bedah Orthopedi
Rp
9,851,000 08.39.16
Interna
Rp
501,000 08.45.07
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
Rp
828,968,500
Sepunggur , Desember 2013

Mengetahui
Direktur RSUD Tanah Bumbu
Bendahara Jamkesmas
dr.H.Daru Dewa, M.Kes

NIP.19680710 199803 1 011
M. Adhi Sulaiman, SKM

NIP.19840415 200908 1 001
DAFTAR KLAIM RAWAT INAP PASIEN KEBIDANAN JAMKESDA RSUD TANAH BUMBU
Umur (Thn)
NO
NAMA PASIEN
NO.REKOMENDASI JAMKESDA
TANGGAL
LOS
Alamat
DIAGNOSA
Akomodasi
L
Jl. Promnas rt 007 Desa Gunung
Besar Kec.Simpang Empat
By.Ny Marliah
6310097009700002
Ny. Koriyani
6310095002860007
By.Ny.Koriyani
6310095002860007
By.Ny. Megawati
6310036208970001
Ny.Muhanifah
6310085002940001
By. Ny. Muhanifah
6310085002940001
Ny.Ni Ketut Nurhayati
6310034607860006
Jl sebamban III block c rt 008/003

kerta buana sungai loban
By. Ny. Ni ketut Nurhayati
63100346078600006
Jl sebamban III block c rt 008/003

kerta buana sungai loban
Ny.rovita Prada sari
6310104711940001
Jl Raya Transmigrai dusun 1 Rt

001/001 Suka Damai Mantewe
10
Ny. Ani Mulyani
6310020110130003
11
Ny. Alpisah
6310065003840001
12
By. Ny. Alpisah I
6310065003840001
13
By. Ny. Alpisah II
6310065003840001
14
Ny. Erni Dwi Pamuji
6310106610870001
15
Ny. Marlina
6310095504880003
16
By. Ny. Marlina
6310095504880003
17
Ny. Hj. Kamila Farid
6310016111790002
Masuk
Keluar
1 (hari)
27 September 2013
11 Oktober 2013
14 (Hari)
27
23 September 2013
26 September 2013
3 (Hari)
3 (Hari)
25 September 2013
07 Oktober 2013
3 (Hari)
29 September 2013
19
Rp
700,000
G1p0a0
Rp
150,000
12 (Hari)
BBLR Kurang Bulan,SMK, Spontan
Rp
300,000
09 Oktober 2013
10 (Hari)
BBLR Kurang Bulan,SMK, Spontan
Rp
550,000
08 Oktober 2013
10 Oktober 2013
2 (Hari)
G1 P0A0 hamil dengan KPA
Rp
100,000
0 (Hari)
08 Oktober 2013
14 Oktober 2013
6 (hari)
Bayi Baru Lahir
Rp
150,000
27
19 oktober 2013
21 oktober 2013
2 (Hari)
G1P1A0 aterm dengan kala I fase aktif
Rp
100,000
19 Oktober 2013
19 Oktober 2013
Bayi Baru Lahir
Rp
25,000
19
13 Oktober 2013
15 Oktober 2013
2 (Hari)
G1 P1 A0 hamil 12 minggu dengan AB INKOMPLIT
Rp
100,000
30
01 Oktober 2013
07 Oktober 2013
6 (Hari)
G3 P2 A0 uk 28-29 minggu dengan IUFD
Rp
300,000
29
11 Oktober 2013
13 Oktober 2013
2 (Hari)
G2 P1 A0 hamil aterm inpartu kala I fase aktif +

gemeli
Rp
100,000
0 (Hari)
11 Oktober 2013
14 Oktober 2013
3 (Hari)
Bayi baru lahir
Rp
75,000
0 (Hari)
12 Oktober 2013
14 Oktober 2013
2 (Hari)
Bayi baru lahir
Rp
50,000
26
11 Oktober 2013
12 Oktober 2013
1 (Hari)
G2 P1 A0 hamil post term dengan inpartu kala I fase

aktif
Rp
50,000
25
12 Oktober 2013
14 Oktober 2013
2 (Hari)

aktif
Rp
100,000
0 (Hari)
12 Oktober 2013
14 Oktober 2013
2 (Hari)
Bayi baru lahir
Rp
50,000
34
13 Oktober 2013
14 Oktober 2013
1 (Hari)
G3 P2 A0 hamil aterm inpartu kala I fase aktif
Rp
50,000
Pasar Ampera rt 004 Ds.

Tungkaran pangeran, simpang
empat
Jl Pasar ampera Rt 004 Desa
tungkaran pangeran simpang
empat
jL Sebamban III D rt 003/002 Desa
tri martani sungailoban
Jl Kodeko KM42 Rt 002 Desa
Mantewe Kec.Mantewe
Jl. Kodeco KM. 42 rt 002,
mantewe
Jl. Kaca Piring Rt.002 Ds. Kota

Pagatan Kec. Kusan Hilir
Rt.001 Ds. Sungai Rukam Kec.
Kusan Hulu
Kusan Hulu
Kusan Hulu
Jl. Raya Transmigrasi Dusun I
Rt.019 Rw.001 Ds. Rejosari Kec.
Mantewe
Jl. Ins-Gub gg.Pelita II Rt.010
Rw.003 Kampung Baru Kec.
Simpang Empat
Jl. Ins-Gub gg.Pelita II Rt.010
Rw.003 Kampung Baru Kec.
Simpang Empat
Rt.003 Rw.001 Ds. Kersik Putih
Kec. Batulicin
0 (Hari)
18
By. Ny. Hj. Kamila Farid
6310016111790002
19
Ny. Annisa Meidina
6310024305950008
20
By. Ny. Annisa Meidina
6310024305950008
21
Ny. Rahmiati
6310095704850001
22
By. Ny. Rahmiati
23
Rt.003 Rw.001 Ds. Kersik Putih

Kec. Batulicin
Jl. Karya II Rt. 005 Ds. Batuah Kec.
Kusan Hilir
Jl. Karya II Rt. 005 Ds. Batuah Kec.
Kusan Hilir
0 (Hari)
13 Oktober 2013
14 Oktober 2013
1 (Hari)
Bayi baru lahir
Rp
25,000
18
17 Oktober 2013
18 Oktober 2013
1 (Hari)
G1 P0 A0 hamil aterm dengan kala II + Pres-bok
Rp
50,000
0 (Hari)
17 Oktober 2013
18 Oktober 2013
1 (Hari)
Bayi baru lahir
Rp
25,000
Rawa-rawa Rt.011 Rw.003 Ds.

Sejahtera Kec. Simpang Empat
28
17 Oktober 2013
18 Oktober 2013
1 (Hari)
G2 P1 A0 dengan hamil + 40 minggu kala I fase laten
Rp
50,000
6310095704850001
Rawa-rawa Rt.011 Rw.003 Ds.

Sejahtera Kec. Simpang Empat
0 (Hari)
17 Oktober 2013
18 Oktober 2013
1 (Hari)
Bayi baru lahir
Rp
25,000
Ny. Hamdah
6310014302820002
Jl. Raya Batulicin rt.009 rw.001

Ds. Kersik Putih Kec. Batulicin
31
18 Oktober 2013
21 Oktober 2013
3 (Hari)
G4 P3 A0 hamil + 8 minggu dengan Abortus Incomplit Rp
150,000
24
Ny. Yayuk Marini
6310016205790002
34
25 Oktober 2013
28 Oktober 2013
3 (Hari)
G5 P2 A2 inpartu kala II + PEB
Rp
150,000
25
By. Ny. Yayuk Marini
6310016205790002
0 (Hari)
25 Oktober 2013
28 Oktober 2013
3 (Hari)
Bayi baru lahir
Rp
75,000
26
Ny. Isna Mulyani
6310026608780002
Jl. Muara Pagatan rt.004 Ds.

Muara Pagatan Kec. Kusan Hilir
35
25 Oktober 2013
28 Oktober 2013
3 (Hari)
G2 P1 A0 dengan Oligohidramnion
Rp
150,000
27
By. Isna Mulyani
6310026608780002
Jl. Muara Pagatan rt.004 Ds.

Muara Pagatan Kec. Kusan Hilir
0 (Hari)
25 Oktober 2013
28 Oktober 2013
3 (Hari)
Bayi baru lahir
Rp
75,000
28
Ny. Safira Rahmadani
6310080507130014
Jl. Transmigrasi Km.30 Dusun I

Rt.002 Ds. Sidomulyo
18
25 Oktober 2013
26 Oktober 2013
1 (Hari)
G1 P0 A0 Hamil 40 minggu
Rp
50,000
29
By. Ny. Safira Rahmadani
6310080507130014
Jl. Transmigrasi Km.30 Dusun I

Rt.002 Ds. Sidomulyo
25 Oktober 2013
26 Oktober 2013
1 (Hari)
Bayi baru lahir
Rp
25,000
30
Ny. Eka Darmawati
6310074101930001
20
25 Oktober 2013
28 Oktober 2013
3 (Hari)
G1 P0 A0 Hamil aterm inpartu kala I fase laten
Rp
150,000
31
By. Ny. Eka Darmawati
6310074101930001
0 (Hari)
26 Oktober 2013
28 Oktober 2013
2 (Hari)
Bayi baru lahir
Rp
50,000
32
Ny. Fitriani
6310084107850073
Dusun III Rt.022 Ds. Manunggal

Kec. Karang Bintang
28
26 Oktober 2013
28 Oktober 2013
2 (Hari)
G3 P2 A0 Uk 42 minggu
Rp
100,000
33
By. Ny. Fitriani
6310084107850073
Dusun III Rt.022 Ds. Manunggal

Kec. Karang Bintang
0 (Hari)
27 Oktober 2013
28 Oktober 2013
1 (Hari)
Bayi baru lahir
Rp
25,000
34
Ny. Hasnawati
6310096001910003
Jl. Singo Sari Rt.015 Ds.Tungkaran

Pangeran Kec.Simpang Empat
22
09 Oktober 2013
13 Oktober 2013
4 (Hari)
G1 P0 A0 Hamil aterm + Susp. CPD
Rp
200,000
35
By. Ny. Hasnawati
6310096001910003
Jl. Singo Sari Rt.015 Ds.Tungkaran

Pangeran Kec.Simpang Empat
10 Oktober 2013
14 Oktober 2013
4 (Hari)
Bayi baru lahir
Rp
100,000
36
Ny. Maemunah
6310090110120022
09 Oktober 2013
14 Oktober 2013
5 (Hari)
G3 P2 A0 dengan kala I fase laten
Rp
250,000
37
By. Ny. Maemunah
6310090110120022
10 Oktober 2013
13 Oktober 2013
3 (Hari)
Bayi baru lahir
Rp
75,000
38
Ny. Siti Aminah
6310044708820009
11 Oktober 2013
14 Oktober 2013
3 (Hari)
G3 P2 A0 uk. 40-41 minggu dengan Susp.

Oligohidamnion
Rp
150,000
Jl. AMD Rt.002 Rw.001 Ds. Suka

Maju Kec.Batulicin
Jl. AMD Rt.002 Rw.001 Ds. Suka
Maju Kec.Batulicin
0 (Hari)
Rt.007 Rw.003 Ds. Karang Intan

Kec. Kuranji
Rt.007 Rw.003 Ds. Karang Intan
Kec. Kuranji
Rt.010 Ds.Sungai Dua

Kec.Simpang Empat
Kec.Simpang Empat
Komplek Bumi Danau Indah Rt.
009 Rw.003 Ds.Sungai Cuka
Kec.Satui
0 (Hari)
35
0 (Hari)
31
39
By. Ny. Siti Aminah
6310044708820009
40
Ny. Sawiyah
6310095402880005
41
By. Ny. Sawiyah
6310095402880005
42
Ny. Riyan Trisna Berliani
6310036304960001
43
By. Ny. Riyan Trisna Berliani
6310036304960001
44
Ny. Marwati
6310026801840003
45
Ny. Watirah
6310070207130064
46
Ny. Any Karni
6310096206750001
47
Ny. Siti Bariah
48
Komplek Bumi Danau Indah Rt.

009 Rw.003 Ds.Sungai Cuka
Kec.Satui
Jl. Banyuwangi gg.Pinang Rt.007
Ds.Gunung Antasari Kec.Simpang
Empat
Jl. Banyuwangi gg.Pinang Rt.007
Ds.Gunung Antasari Kec.Simpang
Empat
Sebamban I Blok B1 Rt.001
Rw.001 Ds.Sari Utama Kec.Sungai
Loban
Sebamban I Blok B1 Rt.001
Rw.001 Ds.Sari Utama Kec.Sungai
Loban
Jl.Arif Rahman Hakim Rt.003
Ds.Juku Eja Kec.Kusan Hilir
Rt.004 Rw.002 Ds.Batulicin Irigasi
Kec.Karang Bintang
12 Oktober 2013
14 Oktober 2013
2 (Hari)
Bayi baru lahir
Rp
50,000
25
12 Oktober 2013
17 Oktober 2013
5 (Hari)
G2 P1 A0 hamil aterm 41-42 minggu
Rp
250,000
0 (Hari)
13 Oktober 2013
17 Oktober 2013
4 (Hari)
Bayi baru lahir
Rp
100,000
17
15 Oktober 2013
17 Oktober 2013
2 (Hari)
Rp
100,000
0 (Hari)
16 Oktober 2013
17 Oktober 2013
1 (Hari)
Bayi baru lahir
Rp
25,000
29
16 Oktober 2013
19 Oktober 2013
3 (Hari)
KET
Rp
150,000
36
17 Oktober 2013
23 Oktober 2013
6 (Hari)
Perdarahan pervaginam + anemis
Rp
300,000
Gg.Al-Hijrah Rt.006 Ds.Kampung

Baru Kec.Simpang Empat
38
19 Oktober 2013
21 Oktober 2013
2 (Hari)
G4 P3 A0 hamil 8 minggu Susp. Ab
Rp
100,000
6310095012810003
Jl. Liana Ujung Rt.008 Rw.002 Ds.

Sejahtera Kec.Simpang Empat
32
20 Oktober 2013
21 Oktober 2013
1 (Hari)
G3 P2 A0 hamil aterm inpartu kala I fase laten
Rp
50,000
By. Ny. Siti Bariah
6310095012810003
Jl. Liana Ujung Rt.008 Rw.002 Ds.

Sejahtera Kec.Simpang Empat
20 Oktober 2013
21 Oktober 2013
1 (Hari)
Bayi baru lahir
Rp
25,000
49
Ny. Kamsinah
6310022712110034
Jl. Padat Karya Rt. 003

Ds.Barugelang Kec.Kusan Hilir
30
20 Oktober 2013
24 Oktober 2013
4 (Hari)
G4 P3 A0 uk. 43 minggu dengan kala I fase aktif +

Susp.Makrosomia
Rp
200,000
50
By. Ny. Kamsinah
6310022712110034
Jl. Padat Karya Rt. 003

Ds.Barugelang Kec.Kusan Hilir
30
20 Oktober 2013
25 Oktober 2013
5 (Hari)
Bayi baru lahir
Rp
125,000
51
Ny. Ramlah
6310095508900009
Jl.Hidayah No.87 Rt.001

Ds.Bersujud Kec.Simpang Empat
23
20 Oktober 2013
25 Oktober 2013
5 (Hari)
Rp
250,000
52
By. Ny. Ramlah
6310095508900009
Jl.Hidayah No.87 Rt.001

Ds.Bersujud Kec.Simpang Empat
23
22 Oktober 2013
25 Oktober 2013
3 (Hari)
Bayi baru lahir
Rp
75,000
53
Ny. Yety
6310095507870008
26
21 Oktober 2013
25 Oktober 2013
4 (Hari)
G2 P1 A0 dengan Eklamsi
Rp
200,000
54
By. Ny. Yety
6310095507870008
26
21 Oktober 2013
26 Oktober 2013
5 (Hari)
Bayi baru lahir
Rp
125,000

Kec.Simpang Empat
Kec.Simpang Empat
0 (Hari)
0 (Hari)
55
Ny. Mardiana
6310021712860002
Jl.Padat Karya Rt.003 Ds.Pulau

Salak Kec.Kusan Hilir
56
By. Ny. Mardiana
6310021712860002
Jl.Padat Karya Rt.003 Ds.Pulau

Salak Kec.Kusan Hilir
57
Ny. Noorliany
6310015804860001
Jl. Dharma Praja Rt.001 Ds.Kersik

Putih Kec.Batulicin
58
By. Ny. Noorliany
6310015804860001
Jl. Dharma Praja Rt.001 Ds.Kersik

Putih Kec.Batulicin
59
Ny. Andi Rahmatiah
6310015807770001
Jl. Cappa Padang Rt.007 Rw.002

Ds.Batulicin Kec.Batulicin
60
By. Ny. Andi Rahmatiah
6310015807770001
Jl. Cappa Padang Rt.007 Rw.002

Ds.Batulicin Kec.Batulicin
61
Ny. Sumai
6310045205810008
62
By. Ny. Sumai
6310045205810008
63
Ny. Rohani
6310065211730001
64
Ny. Yulianti
6310056407960004
65
By. Ny. Yulianti
6310056407960004
66
Ny. Hartati
6310022910120036
67
By. Ny. Hartati
6310022910120036
68
Ny. Ruslina
6310094408830008
69
By. Ny. Ruslina
6310094408830008
70
Ny. Sutini
6310095004830011
71
By. Ny. Sutini
6310095004830011
72
Ny. Emilinda Nurlaili KZ
6310094707880006
73
By. Ny. Emilinda Nurlaili KZ
6310094707880006
74
Ny. Ismiati
6310084506860004
75
By. Ny. Ismiati
6310084506860004
Gg.Imus Rt.005 Ds.Sinar Bulan

Kec.Satui
Gg.Imus Rt.005 Ds.Sinar Bulan
Kec.Satui
Dusun II Rt.010 Ds.Bayan Sari
Kec.Angsana
Rt.001 Rw.001 Ds.Darasan Binjai
Kec.Kusan Hulu
Rt.001 Rw.001 Ds.Darasan Binjai
Kec.Kusan Hulu
Jl.Bakarangan Rt.002 Ds.Betung
Kec.Kusan Hilir
Jl.Bakarangan Rt.002 Ds.Betung
Kec.Kusan Hilir
32
21 Oktober 2013
25 Oktober 2013
4 (Hari)
G1 P0 A0 inpartu letak lintang + PER
Rp
200,000
21 Oktober 2013
24 Oktober 2013
3 (Hari)
Bayi baru lahir
Rp
75,000
22 Oktober 2013
25 Oktober 2013
3 (Hari)
Rp
150,000
22 Oktober 2013
25 Oktober 2013
3 (Hari)
Bayi baru lahir
Rp
75,000
38
23 Oktober 2013
26 Oktober 2013
3 (Hari)
G3 P2 A0 hamil aterm dengan inpartu kala I fase aktif Rp
150,000
0 (Hari)
23 Oktober 2013
26 Oktober 2013
3 (Hari)
Bayi baru lahir
Rp
75,000
32
26 Oktober 2013
31 Oktober 2013
5 (Hari)
G4 P3 A0 hamil aterm dengan KPD
Rp
250,000
27 Oktober 2013
31 Oktober 2013
4 (Hari)
Bayi baru lahir
Rp
100,000
29 Oktober 2013
31 Oktober 2013
2 (Hari)
P5 A0 dengan perdarahan post partum 6 jam
Rp
100,000
Rp
200,000
0 (Hari)
27
0 (Hari)
0 (Hari)
40
28 Oktober 2013
01 Nopember 2013
4 (Hari)

aktif
28 Oktober 2013
31 Oktober 2013
3 (Hari)
Bayi baru lahir
Rp
75,000
24
27 Oktober 2013
31 Oktober 2013
4 (Hari)
Rp
200,000
0 (Hari)
27 Oktober 2013
31 Oktober 2013
4 (Hari)
Bayi baru lahir
Rp
100,000
Jl.Kodeco Km.2 Rt.006 Ds.Gunung

Antasari Kec.Simpang Empat
30
24 Oktober 2013
29 Oktober 2013
5 (Hari)
G3 P0 A2 hamil 38-39 minggu dengan pres-bok
Rp
250,000
Jl.Kodeco Km.2 Rt.006 Ds.Gunung

0 (Hari)
25 Oktober 2013
29 Oktober 2013
4 (Hari)
Bayi baru lahir
Rp
100,000
30
29 Oktober 2013
30 Oktober 2013
1 (Hari)
G2 P1 A0 hamil 40 minggu inpartu kala I fase laten
Rp
50,000
0 (Hari)
30 Oktober 2013
30 Oktober 2013
1 (Hari)
Bayi baru lahir
Rp
25,000
Jl.Senada Rt.007 Ds.Gunung

25
29 Oktober 2013
30 Oktober 2013
1 (Hari)
G3 P2 A0 Hamil 38-39 minggu kala I inpartu
Rp
50,000
Jl.Senada Rt.007 Ds.Gunung

0 (Hari)
29 Oktober 2013
30 Oktober 2013
1 (Hari)
Bayi baru lahir
Rp
25,000
27
27 Oktober 2013
29 Oktober 2013
2 (Hari)
G2 P1 A0 hamil 35 minggu dengan kala I fase laten
Rp
100,000
28 Oktober 2013
29 Oktober 2013
1 (Hari)
Bayi baru lahir
Rp
25,000
17
0 (Hari)
Jl.Bhayangkara Km.4,5 Rt.002

Ds.Gunung Besar Kec.Simpang
Empat
Jl.Bhayangkara Km.4,5 Rt.002
Ds.Gunung Besar Kec.Simpang
Empat
Rt.005 Rw.003 Ds.Karang Rejo

Kec.Karang Bintang
Rt.005 Rw.003 Ds.Karang Rejo
Kec.Karang Bintang
0 (Hari)
76
Ny. Muflihatul Hasanah
6310095212820011
77
Ny. Wiji Sukarsih
6310031007080076
78
Ny. Syariatul Amalia Jati
6310036006910001
79
Ny. Umi Karomah
6310035604810001
80
By. Ny. Umi Karomah
6310035604810001
81
Ny. Nasrawati. N
6310026911900002
82
Ny. Yuni Dwi A
6310054501830002
83
By. Ny. Yuni Dwi A
6310054501830002
84
Ny. Murlina. M
6310094801730002
85
Ny. Jawita
6310095003840006
86
By. Ny. Jawita
6310095003840006
87
Ny. Siti Aisyah
6310094106840009
88
By. Ny. Siti Aisyah
6310094106840009
89
Ny. Rini Purnama
6310095407880001
90
Ny. Kustiani
6310105004900005
91
By. Ny. Kustiani
6310105004900005
92
Ny. Mila
6310094509660002
93
Ny. Normalia
6310095010920010
94
Ny. Imarotun
6310075105950003
95
By. Ny. Imarotun
6310075105950003
96
Ny. Mahani
6310064608680001
Jl.Plajau Indah Rt.007 Ds.Barokah

Kec.Simpang Empat
31
28 Oktober 2013
02 Nopember 2013
5 (Hari)
Kista Coklat Kanan
Rp
250,000
30
30 Oktober 2013
31 Oktober 2013
1 (Hari)
G3 P2 A0 hamil 17 minggu dengan eklamsi
Rp
50,000
22
30 Oktober 2013
31 Oktober 2013
1 (Hari)
G1 P0 A0 dengan Susp. KET
Rp
50,000
32
24 Oktober 2013
29 Oktober 2013
5 (Hari)
G4P3A0, hamil 40-41 Minggu
Rp
250,000
0 (Hari)
25 Oktober 2013
29 Oktober 2013
4 (Hari)
Bayi Baru Lahir
Rp
100,000
23
24 Oktober 2013
26 Oktober 2013
2 (Hari)
Kista Bartolini
Rp
100,000
30
24 Oktober 2013
28 Oktober 2013
4 (Hari)
G2P1A0
Rp
200,000
24 Oktober 2013
28 Oktober 2013
4 (Hari)
Bayi Baru Lahir
Rp
100,000
40
21 Oktober 2013
25 Oktober 2013
4 (Hari)
Mioma Uteri
Rp
200,000
29
25 Oktober 2013
29 Oktober 2013
4 (Hari)
G2P1A0
Rp
200,000
0 (Hari)
26 Oktober 2013
29 Oktober 2013
3 (Hari)
Bayi baru lahir
Rp
75,000
Jl. Perumahan Pama RT.002 Desa

Gunung Besar Kec. Simpang 4
29
26 Oktober 2013
30 Oktober 2013
4 (Hari)
G2P2A0, Aterm, Inpartu Kala I
Rp
200,000
Jl. Perumahan Pama RT.002 Desa

Gunung Besar Kec. Simpang 4
0 (Hari)
26 Oktober 2013
30 Oktober 2013
4 (Hari)
Bayi baru lahir
Rp
100,000
25
22 Oktober 2013
24 Oktober 2013
2 (Hari)
P1A0 dg Letensio Plasenta
Rp
100,000
23
16 Oktober 2013
20 Oktober 2013
4 (Hari)
G2P1A0
Rp
200,000
0 (Hari)
16 Oktober 2013
20 Oktober 2013
4 (Hari)
Bayi baru lahir
Rp
100,000
Jl. PNPM RT 018 Desa Tungkaran

Pangeran kec. Simpang 4
47
09 Oktober 2013
14 Oktober 2013
5 (Hari)
Myome Uteri
Rp
250,000
Jl. Kedondong Desa Tungkaran

Pangeran Kec. Simpang 4
21
13 Oktober 2013
20 Oktober 2013
7 (Hari)
G1P0A0 dg Pendarhan Pervaginan
Rp
350,000
18
13 Oktober 2013
18 Oktober 2013
5 (Hari)
G1P0A0 dg Kala I Fase Laten
Rp
250,000
0 (Hari)
14 Oktober 2013
18 Oktober 2013
4 (Hari)
Bayi baru lahir
Rp
100,000
45
01 Oktober 2013
12 Oktober 2013
11 (Hari)
Mioma Uteri
Rp
550,000
Jl.Propinsi Rt.004 Rw.002

Ds.Sebamban Lama Kec.Sungai
Loban
Jl.Sebamban I blok B Rt.002
Rw.001 Ds.Marga Mulia
Kec.Sungai Loban
Jl. Dusun Lingga Wiyata RT 016
RW 003 Desa Batu Meranti
Sungai Loban
Jl. Dusun Lingga Wiyata RT 016
RW 003 Desa Batu Meranti
Sungai Loban
Gg. Bahagia I RT 006 Desa Pasar
Baru Kec. Kusan Hilir
Desa Wonorejo RT 013 Kec.
Kusan Hulu
Desa Wonorejo RT 013 Kec.
Kusan Hulu
Jl. Hidayah Gg. Hikmah RT 002
Desa Bersujud Kec. Simpang 4
Gg. Sabar Subur RT 002 Desa
Barokah Kec. Simpang 4
Gg. Sabar Subur RT 002 Desa
Jl. Nusa Indah RT 001 Desa

Jl. RA. Kartini Dusun III RT 017
Desa Sepakat Kec. Mantewe
Jl. RA. Kartini Dusun III RT 017
Desa Sepakat Kec. Mantewe
Jl. Transmigrasi KM. 04 RT 012

RW 001 Desa Sari Gadung Kec.
Simpang 4
Jl. Transmigrasi KM. 04 RT 012
RW 001 Desa Sari Gadung Kec.
Simpang 4
Gg. Rahmad RT. 002 RW. 001
Desa Kmapung Baru Kec.
Simpang 4
0 (Hari)
97
Ny. Khadijah
6310044507900006
Jl. Angkasa Rt 001 Desa Sungai

Danau Kec. Satui
23
04 Oktober 2013
09 Oktober 2013
5 (Hari)
G1P0A0, Hamil Aterm Kala I Fase Laten
Rp
250,000
98
Ny. Mursidah
6310047007910005
jl. Karya Bersama No. 96 RT 019

Desa Sungai Danau Kec. Satui
22
08 Oktober 2013
13 Oktober 2013
5 (Hari)
G1P0A0 Inpartu Kala II dg Pres. Bok
Rp
250,000
99
By. Ny. Mursidah
6310047007910005
jl. Karya Bersama No. 96 RT 019

Desa Sungai Danau Kec. Satui
0 (Hari)
08 Oktober 2013
14 Oktober 2013
6 (Hari)
Bayi baru lahir
Rp
150,000
53
24 Oktober 2013
28 Oktober 2013
4 (Hari)
P2A0 dg Mioma
Rp
200,000
34
10 Oktober 2013
16 Oktober 2013
6 (Hari)
G3P2A0 H. 40-41 Minggu
Rp
300,000
0 (Hari)
12 Oktober 2013
16 Oktober 2013
4 (Hari)
Bayi baru lahir
Rp
100,000
38
23 Oktober 2013
25 Oktober 2013
2 (Hari)
G3P0A2 dg. Abortus Incomplete
Rp
100,000
22
24 Oktober 2013
25 Oktober 2013
1 (Hari)
Abortus Inkomplit (Susp BO)
Rp
50,000
34
17 Oktober 2013
22 Oktober 2013
5 (Hari)
Retencio Placento
Rp
250,000
44
12 Oktober 2013
14 Oktober 2013
2 (Hari)
Pendarahan Pervaginan
Rp
100,000
30
19 Oktober 2013
24 Oktober 2013
5 (Hari)
Pendarahan Post Partum Late
Rp
250,000
29
21 Oktober 2013
22 Oktober 2013
1 (Hari)
Post Partum dg Retensio Placenta
Rp
50,000
21
16 Oktober 2013
19 Oktober 2013
3 (Hari)
G3P2A0 dg ab. Inkomplit
Rp
150,000
13 Oktober 2013
23 Oktober 2013
10 (hari)
BKB, KMK, BBLR + Asfiksia
Rp
250,000
01 Oktober 2013
09 Oktober 2013
8 (hari)
Sepsis
Rp
200,000
04 Oktober 2013
10 Oktober 2013
6 (hari)
BBL SC a/I Bayi Besar Asfiksia Sedang
Rp
150,000
33
27 Oktober 2013
28 Oktober 2013
1 (Hari)
P6 Aminore
Rp
50,000
36
16 Oktober 2013
19 Oktober 2013
3 (Hari)
G4p2a1 Uk 34-35 minggu dgn KPD
Rp
150,000
18
19 Oktober 2013
21 Oktober 2013
2 (Hari)
G1p0a0 H. 28 minggu dg KPD
Rp
100,000
40
26 Oktober 2013
28 Oktober 2013
2 (Hari)
Retensio uri post Op
Rp
100,000
Rp
150,000
Rp
75,000
Rp
100,000
Rp
25,000
100 Ny. Tuminah
6310104107600059
101 Ny. Siti Mardziyah
63101056117920002
102 By. Ny. Siti Mardziyah
63101056117920002
103 Ny. Sofiah
6310094204750006
104 Ny. Nurbainah
6310095505910003
105 Ny. Ernawati
6310064205790003
106 Ny. Ni Wayan Purniasih
6310034107690025
107 Ny. Putri Hasanah
6310084806830001
108 Ny. Suai Batul A
6310047107840001
109 Ny. Misdinawati
6319996505920003
110 By. Ny. Salmah/By. Roisul Islam
6310061210130001
111 By. Arlita Rahmawati
6310066309130001
112 By. Ny. Hadijah/By. M. Nur Firdaus
6310040410430001
113 Ny. Salasiah
6310024605800002
114 Ny. Evi puji. A
6310016511770001
115 Ny. Ira Hastin
6310026305950002
116 Ny. Mur lina Manurung
6310094801730002
Jl. Raya Transmigrasi Dusun II RT

004 RW 002 Desa Rejosari Kec.
Mentewe
Jl. Transmigrasi KM.30 Dusun II
RT 007 RW 004 Desa Sido Mulyo
Kec. Mantewe
Jl. Transmigrasi KM.30 Dusun II
RT 007 RW 004 Desa Sido Mulyo
Kec. Mantewe
Jl. Veteran RT 007 Desa Barokah
Kec. Simpang 4
Jl. Pegangsaan RT 10 Desa
Sarigadung kec. Simpang 4
Desa Angsana RT 2 RW 1 Kec.
Angsana
Sebamban 1 Blok D RT 005 RW
001 Desa Wanasari Kec. Sungai
Loban
Jl. Wilis RT 001 RW 001 Desa
Pematang Ulin Kec. Karang
Bintang
Jl. Perintis RT.5 RW.2 Desa
Makmur Mulia Kec. Satui
Jl. Malewa RT. 8 Desa Gunung
Antasari Kec. Simpang 4
Gg. Selamat RT. 005 Desa
Kampung Baru Kec. Simpang
Empat
Gg. Karang Indah RT. 012 Desa
Barokah Kec. Simpang Empat
Jl. Angkasa RT. 001 Desa Sungai
Danau Kec. Satui
Jl. Kapitan Laut pulo rt 003,
wirittasi, kusan hilir
Ds. Kersik putih rt 004, BTL
Ds. UPT karya bakti rt 004, kusan
hilir
Jl. Hidayah Gg. Hikmah rt 002 ds.
Bersujud, simpang empat
117 Ny. Hamidah
6310055211780001
Sungai rukam rt 004, kusan hulu
118 By. Ny. Hamidah
6310055211780001
Sungai rukam rt 004, kusan hulu
119 Ny. Arbayah
6310094505810014
120 By. Ny. Arbayah
6310094505810014
Jl. Raya serongga KM 6,5 rt 005,

simpang empat
simpang empat
2 (Hari)
8 (hari)
6 (hari)
35
0 (Hari)
32
0 (Hari)
18 Oktober 2013
21 Oktober 2013
3 (Hari)
G2p1a0 H. 38-39 minggu inpartu kala 1 fase

aktif+anemia
18 Oktober 2013
21 Oktober 2013
3 (Hari)
Bayi Baru Lahir
31 Oktober 2013
02 Nopember 2013
2 (Hari)
01 Nopember 2013
02 Nopember 2013
1 (Hari)
Bayi Baru Lahir
121 Ny. Murniati
6310035410870002
122 By. Ny. Murniati
6310035410870002
123
124
125
126
6310035708950004
6310035708950004
6310016511770001
6310016511770001
Ny. Wardaniah
By. Ny. Wardaniah
Ny. Evi puji. A
By. Ny. Evi Puji. A
127 Ny. Tulbiah
6310054504840002
128 By. Ny. Tulbiah
6310054504840002
129 Ny. Erni sari
6310025208920002
130 By. Ny. Erni Sari
6310025208920002
131 Ny. Mariyun

132 By. Ny. Mariyun
63100741001920001
63100741001920001
133 Ny. Duana Haibaho
6310046806830004
134 By. Ny. Duana
6310046806830004
135 Ny. Yuni Jumiarti
6310024106900002
136 By. Ny. Yuni. J
6310024106900002
137 Ny. St. Faridah
6310024711810003
138 By. Ny. St. Faridah
6310024711810003
Ds. Sari mulya rt 007, sungai

loban
Ds. Sari mulya rt 007, sungai
loban
Ds. Sungai Loban rt 001
Ds. Sungai Loban rt 001
Ds. Darasan Binjai rt 001, kusan
Hulu
Ds. Darasan Binjai rt 001, kusan
Hulu
Jl. Anang panangah Gg.
Kedondong rt 007, pasar baru,
kusan hilir
Jl. Anang panangah Gg.
Kedondong rt 007, pasar baru,
kusan hilir
Ds. Mustika rt 010, kuranji
Ds. Mustika rt 010, kuranji
Gg. Bombai rt 019, sungai danau,
satui
Gg. Bombai rt 019, sungai danau,
satui
Jl. Melati rt 007, batuah kusan
hilir
Jl. Melati rt 007, batuah kusan
hilir
Jl. Brigjen H.Hasan Basri rt 002,
batuah kusan hilir
Jl. Brigjen H.Hasan Basri rt 002,
batuah kusan hilir
26
29 Oktober 2013
31 Oktober 2013
2 (Hari)
G2p1a0 H. Aterm dgn kala 1 fase laten
Rp
100,000
0 (Hari)
30 Oktober 2013
31 Oktober 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
18
0 (Hari)
35
27 Oktober 2013
27 Oktober 2013
31 Oktober 2013
31 Oktober 2013
30 Oktober 2013
30 Oktober 2013
04 Nopember 2013
04 Nopember 2013
3 (Hari)
3 (Hari)
4 (Hari)
4 (Hari)
G1p0a0 H.aterm dg inpartu kala 1 fase aktif

Bayi Baru Lahir
G4p2a1 H.aterm dgn KPD+R/ SC
Bayi Baru Lahir
Rp
Rp
Rp
Rp
150,000
75,000
200,000
100,000
29
04 Oktober 2013
09 Oktober 2013
5 (Hari)
G3p1a1 H. Aterm inpartu kala 1 fase aktif dg PEB
Rp
250,000
04 Oktober 2013
09 Oktober 2013
5 (Hari)
Bayi Baru Lahir
Rp
125,000
27 Oktober 2013
01 Nopember 2013
5 (Hari)
G2p1a0 Uk. 43-44 minggu
Rp
250,000
29 Oktober 2013
01 Nopember 2013
3 (Hari)
Bayi Baru Lahir
Rp
75,000
21
0 (Hari)
29 Oktober 2013
30 Oktober 2013
02 Nopember 2013
03 Nopember 2013
4 (Hari)
4 (Hari)
G1p0a0 H.43 minggu dg IUGR

Bayi Baru Lahir
Rp
Rp
200,000
100,000
30
29 Oktober 2013
02 Nopember 2013
4 (Hari)
Post SC a/i riwayat Sc 2 kali
Rp
200,000
0 (Hari)
30 Oktober 2013
02 Nopember 2013
3 (Hari)
Bayi Baru Lahir
Rp
75,000
23
31 Oktober 2013
03 Nopember 2013
3 (Hari)
G1p0a0 dgn presbok
Rp
150,000
31 Oktober 2013
04 Nopember 2013
4 (Hari)
Bayi Baru Lahir
Rp
100,000
30 Oktober 2013
03 Nopember 2013
4 (Hari)
G6p5a0 H. 25 Minggu
Rp
200,000
31 Oktober 2013
03 Nopember 2013
3 (Hari)
Bayi Baru Lahir
Rp
75,000
0 (Hari)
0 (Hari)
21
0 (Hari)
0 (Hari)
28
0 (Hari)
139 Ny. Siti Nurhaliza

140
141
6310025910940003
By. Ny. Siti Nurhalisa
6310025910940003
Ny. Rahmawati
6310024107800146
Jl. Raya Batulicin rt 001,

sepunggur
Jl. Raya Batulicin rt 001,
sepunggur
Ds. Saring Sungai Binjai rt 007,
kusan hilir
Ds. Saring Sungai Binjai rt 007,
kusan hilir
18
21 Oktober 2013
22 Oktober 2013
1 (Hari)
Rp
50,000
21 Oktober 2013
22 Oktober 2013
1 (Hari)
Rp
25,000
21 Oktober 2013
24 Oktober 2013
3 (Hari)
Rp
150,000
0 (Hari)
21 Oktober 2013
24 Oktober 2013
3 (Hari)
Bayi Baru Lahir
Rp
75,000
22
23 Oktober 2013
25 Oktober 2013
2 (Hari)
G1p0a0 hamil 40-41 minggu ipartu kala 1 fase laten
Rp
100,000
24 Oktober 2013
25 Oktober 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
15 Oktober 2013
19 Oktober 2013
4 (Hari)
KJDR
Rp
200,000
18 Oktober 2013
18 Oktober 2013
Bayi Baru Lahir
Rp
25,000
17 Oktober 2013
18 Oktober 2013
1 (Hari)
G1p0a0 H. Aterm 40 minggu dgn inpartu kala 1 fase

laten
Rp
50,000
17 Oktober 2013
18 Oktober 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
20
21 Oktober 2013
30 Oktober 2013
9 (Hari)
G1p0a0 aterm dgn gemelli
Rp
450,000
0 (Hari)
22 Oktober 2013
30 Oktober 2013
8 (hari)
Bayi Baru Lahir
Rp
200,000
0 (Hari)
22 Oktober 2013
30 Oktober 2013
8 (hari)
Bayi Baru Lahir
Rp
200,000
19
09 Oktober 2013
15 Oktober 2013
6 (hari)
Rp
300,000
12 Oktober 2013
14 Oktober 2013
2 (Hari)
Bayi Baru Lahir
Rp
50,000
18
07 Oktober 2013
09 Oktober 2013
2 (Hari)
G1p0a0 H. 36-37 minggu dg susp gemeli
Rp
100,000
0 (Hari)
08 Oktober 2013
09 Oktober 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
37
06 Oktober 2013
08 Oktober 2013
2 (Hari)
G3p2a0 H. Aterm dgn inpartu kala 1 fase laten
Rp
100,000
07 Oktober 2013
08 Oktober 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
29 Oktober 2013
03 Nopember 2013
5 (Hari)
g2p1a0 H. 39 minggu dg letak lintang
Rp
250,000
0 (Hari)
33
G1p0a0 Uk 37-38 minggu dgn KPD

Bayi Baru Lahir
G2p1a0 hamil aterm dg letsu
142 By. Ny. Rahmawati
6310024107800146
143 Ny. Enik Oktavia
6310094510910007

144 By.. Ny. Enik Oktavia
6310094510910007

145 Ny. Siti Maisaroh
6310076705840002
146 By. Ny. St. Maysaroh
6310076705840002
147 Ny. Khatimah
6310024302860004
148 By. Ny. Khatimah
6310024302860004
149 Ny. Mastia
6310067112930003
150 By. Ny. Mastia 1
6310067112930003
151 By. Ny. Mastia 2
6310067112930003
152 Ny. Faridah
6310095012940004
153 By. Ny. Faridah
6310095012940004
154 Ny. Rini wulandari
6310024510950006
155 By. Rini wulandari
6310024510950006
156 Ny. Heri sakmawati
6310024404760002
157 By. Ny. Heri. S
6310024404760002
158 Ny. Rusmilawati
6310056504870002
Ds. Binawara rt 004, kusan hulu
159 By. Ny. Rusmilawati
6310056504870002
Ds. Binawara rt 004, kusan hulu
30 Oktober 2013
02 Nopember 2013
3 (Hari)
Bayi Baru Lahir
Rp
75,000
160 Ny. Yatimah

161 By. Ny. Yatimah
6310066609820002
6310066609820001
Ds. Mekar jaya rt 009, angsana

Ds. Mekar jaya rt 009, angsana
31
0 (Hari)
30 Oktober 2013
30 Oktober 2013
04 Nopember 2013
04 Nopember 2013
5 (Hari)
5 (Hari)
G3p2a0 H. 37 minggu dgn PE

Bayi Baru Lahir
Rp
Rp
250,000
125,000
162 Ny. Myla
6310095406930003
Jl. Raya serogga rt 002, ds.

Gunung besar, simpang empat
20
07 Nopember 2013
08 Nopember 2013
1 (Hari)
G2p0a1 dg inpartu kala&fase aktif
Rp
50,000
163 By. Ny. Myla J
6310095406930003

simpang empat
0 (Hari)
07 Nopember 2013
08 Nopember 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
Ds. Waringin tunggal rt 004,

kuranji
Ds. Waringin tunggal rt 004,
kuranji
Jl. Tepian sungai rt 001 desa
penyolongan, kusan hilir
Jl. Tepian sungai rt 001 desa
penyolongan, kusan hilir
Jl. Raya kampung baru Gg.
Borneo rt 014 desa sejahtera,
simpang empat
simpang empat
simpang empat
Jl. Mawar rt 006 desan sejahtera,
simpang empat
Jl. Mawar rt 006 desan sejahtera,
simpang empat
Jl. Padat karya rt 002 desa baru
gelang, kusan hilir
Jl. Padat karya rt 002 desa baru
gelang, kusan hilir
Jl. H.M amin no 08 rt 001,
pakatellu, kusan hilir
Jl. H.M amin no 08 rt 001,
pakatellu, kusan hilir
0 (Hari)
29
0 (Hari)
27
0 (Hari)
0 (Hari)
0 (Hari)
26
0 (Hari)
Jl. Karya 1 rt 003, batuah, kusan

hilir
Jl. Karya 1 rt 003, batuah, kusan
hilir
164 Ny. Melvina
6310024601890003
165 By. Ny. Melvina
6310024601890003
166 Ny. Winarti
6310096012840006
Jl. Kodeco KM 1,5 rt 003 desa

gunung antasari, simpang empat
167 By. Ny. Winarti
6310096012840006
Jl. Kodeco KM 1,5 rt 003 desa

168 Ny. Nita Nor A
6310095804950001
169 By. Ny. Nita Nor Adinda
6310095804950001
170 Ny. Rusmawati
6310024107710244
171 By. Ny. Rusmawati
6310024107710244
172 Ny. Heldayani
6310094205860008
173 By. Ny. Heldayani
6310094205860008
174 Ny. Mirnawati
6310025011920002
175 By. Ny. Mirnawati
6310025011920002
176 Ny. St. Khadijah
6310016802920001
177 By. Ny. St. Khadijah
631001802920001
178 Ny. Niatul fitriah
6310034505790003
Sebamban 1 blok C rt 003 desa

179 By. Niatul Fitriah
6310034505790003
Sebamban 1 blok C rt 003 desa

180 Ny. Fitri handayani
6310094910870003
181 By. Ny. Fitri handayani
6310094910870003
182 Ny. Sarinah
6310015604750004
183 By. Ny. Sarinah
6310015604750004
184 Ny. Jumiati
6310024702860002
185 By. Ny. Jumiati
6310024702860002

Jl. Timp mattone No 42 rt 001,
kampung baru, kusan hilir
Jl. Timp mattone No 42 rt 001,
kampung baru, kusan hilir
186 Ny. Mustika Atasiah
6310096202770003
Jl. Kodeco KM 1 rt 003 desa

187 By. Ny. Mustika. A
6310096202770003

Ds. Sungai dua rt 004, simpang

empat
Ds. Sungai dua rt 004, simpang
empat
Jl. Propinsi Gg. H. Aliansyah, sei
lembu
Jl. Propinsi Gg. H. Aliansyah, sei
lembu
Gg. Amandit 4 rt 001, barokah,
simpang empat
Gg. Amandit 4 rt 001, barokah,
simpang empat
Jl. Hasta karya II No 09 rt 005
desa pagaruyung, kusan hilir
Jl. Hasta karya II No 09 rt 005
desa pagaruyung, kusan hilir
Jl. Darma Praja rt 002 desa gunun
tinggi, batulicin
Jl. Darma Praja rt 002 desa gunun
tinggi, batulicin
Jl. Karang jawa rt 004 desa

Jl. Karang jawa rt 004 desa
24
17 Nopember 2013
18 Nopember 2013
1 (Hari)
G3p1a0 dgn kala 1 fase aktif
Rp
50,000
17 Nopember 2013
18 Nopember 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
07 Nopember 2013
11 Nopember 2013
4 (Hari)
g4p3a0 dgn inpartu kala+fase laten susp KPD
Rp
200,000
09 Oktober 2013
11 Nopember 2013
2 (Hari)
Bayi Baru Lahir
Rp
50,000
10 Nopember 2013
12 Nopember 2013
2 (Hari)
G1p0a0 43 minggu inpartu kala 1 fase aktif
Rp
100,000
11 Nopember 2013
12 Nopember 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
41
09 Nopember 2013
11 Nopember 2013
2 (Hari)
G9p8a0 inpartu kala 1 fase aktif
Rp
100,000
0 (Hari)
09 Nopember 2013
11 Nopember 2013
2 (Hari)
Bayi Baru Lahir
Rp
50,000
27
10 Nopember 2013
16 Nopember 2013
6 (hari)
g2p1a0 H. Posterm dg KPD
Rp
300,000
0 (Hari)
11 Nopember 2013
16 Nopember 2013
5 (Hari)
Bayi Baru Lahir
Rp
125,000
20
12 Nopember 2013
16 Nopember 2013
4 (Hari)
G1p0a0 H.posterm dg malposisi janin
Rp
200,000
13 Nopember 2013
16 Nopember 2013
3 (Hari)
Bayi Baru Lahir
Rp
75,000
16 Nopember 2013
18 Nopember 2013
2 (Hari)
G1p0a0 hamil 39-40 minggu, inpartu kala 1 fase laten Rp
100,000
16 Oktober 2013
18 Oktober 2013
2 (Hari)
Rp
50,000
10 Nopember 2013
11 Nopember 2013
1 (Hari)
Rp
50,000
10 Nopember 2013
11 Nopember 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
12 Nopember 2013
18 Nopember 2013
6 (hari)
G1p0a0 hamil 39 minggu inpartu kala 1 fase laten
Rp
300,000
13 Nopember 2013
18 Nopember 2013
5 (Hari)
Bayi Baru Lahir
Rp
125,000
38
07 Nopember 2013
11 Nopember 2013
4 (Hari)
Rp
200,000
0 (Hari)
07 Nopember 2013
11 Nopember 2013
4 (Hari)
G1p0a0 H. Aterm kala 1 fase aktif dg

hipertensi+primitua sekunder
Bayi Baru Lahir
Rp
100,000
27
14 Nopember 2013
15 Nopember 2013
1 (Hari)
G2p1a0 hamil 35 minggu, inpartu kala 1 fase laten
Rp
50,000
15 Nopember 2013
16 Nopember 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
36
11 Nopember 2013
12 Nopember 2013
1 (Hari)
G3p1a0 H. Aterm inpartu kala 1 fase laten
Rp
50,000
0 (Hari)
11 Nopember 2013
12 Nopember 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
0 (Hari)
28
0 (Hari)
18
0 (Hari)
0 (Hari)
21
0 (Hari)
34
0 (Hari)
26
0 (Hari)
0 (Hari)
Bayi Baru Lahir

Mentewe
Mentewe
188 Ny. Nur janah
6310105006760001
189 By. Ny. Nur janah
6310105006760001
190 Ny. Emi rukayah
6310104408840001
191 Ny. Endang purwanti
6310026812790002
192 Ny. Kasmawati
6310026310830002
193 Ny. Ida farida
6310094703790003
194 Ny. Berlian
6310095311820001
195 Ny. Harisah
6310065303740003
196 By. Ny. Harisah
6310065303740003
37
Jl. Arif rahman hakim rt 007 desa

pasar baru, kusan hilir
Jl. UDKP rt 001 kota pgatan,
kusan hilir
simpang empat
Jl. Transmigrasi gg. Kasturi rt 006
desa kampung baru, simpang
empat
197 Ny. Norma riana
6310096012870012
198 By. Norma riana
6310096012870012
199 Ny. Rinna
6310095710910003

200 By. Ny. Rinna
6310095710910003

201 Ny. Siti Nur. H
6310064209920001
202 By. Ny Siti Nurhanifah 1
6310064209920001
203 By. Ny. Siti Nurhanifah 2
6310064209920001
204 Ny. Endang Wahyuni
6310037007880004
205 By. Endang Wahyuni
6310037007880004
206 Ny. Hariati
6310094211860006
Ps. Ampera rt 004 desa tungkaran

207 By. Ny. Hariati
6310094211860006
Ps. Ampera rt 004 desa tungkaran

208 Ny. Rapidah
6310024506840002
209 By. Ny. Rapidah
6310024506840002
Jl. Kupang gg. Senang rt 011, sari

Dusun banjar sari rt 006, sungai
loban
Dusun banjar sari rt 006, sungai
loban
Jl. Tepian sungai kusan rt 002,

salimuran
Jl. Tepian sungai kusan rt 002,
salimuran
16 Nopember 2013
G4p4a0 H. Pre term dg inpartu kala II
Rp
50,000
15 Nopember 2013
15 Nopember 2013
Bayi Baru Lahir
Rp
25,000
29
02 Nopember 2013
04 Nopember 2013
2 (Hari)
G2p1a0 H.6 mg dg Hg
Rp
100,000
34
03 Nopember 2013
06 Nopember 2013
3 (Hari)
G5p2a2 hamil 12-13 minggu dgn blighted ovum
Rp
150,000
30
02 Nopember 2013
07 Nopember 2013
5 (Hari)
p2a1 dgn retensio placenta
Rp
250,000
34
15 Nopember 2013
20 Nopember 2013
5 (Hari)
G5p3a1 H. 6 mg dg abortus immens
Rp
250,000
31
13 Nopember 2013
14 Nopember 2013
1 (Hari)
G5p3a1 H. 12 mg dg abortus
Rp
50,000
39
11 Nopember 2013
14 Nopember 2013
3 (Hari)
G3p2a0 a/i KPD+letak bokong
Rp
150,000
11 Nopember 2013
14 Nopember 2013
3 (Hari)
Bayi Baru Lahir
Rp
75,000
04 Nopember 2013
06 Nopember 2013
2 (Hari)
G2p2a0 post term kala 1 fase laten
Rp
100,000
05 Nopember 2013
06 Nopember 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
04 Nopember 2013
06 Nopember 2013
2 (Hari)
G2p1a0 H. Aterm inpartu kala 1 fase laten
Rp
100,000
05 Nopember 2013
06 Nopember 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
21
01 Nopember 2013
02 Nopember 2013
1 (Hari)
G1p0a0 dgn inpartu kala 1 fase aktif
Rp
50,000
0 (Hari)
01 Nopember 2013
02 Nopember 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
0 (Hari)
01 Nopember 2013
02 Nopember 2013
1 (Hari)
Bayi Baru Lahir
Rp
25,000
25
01 Nopember 2013
06 Nopember 2013
5 (Hari)
G2p1a0 inpartu kala 1 fase laten
Rp
250,000
02 Nopember 2013
06 Nopember 2013
4 (Hari)
Bayi Baru Lahir
Rp
100,000
03 Nopember 2013
07 Nopember 2013
4 (Hari)
G2p0a1 H.aterm dgn kala 1 fase laten
Rp
200,000
03 Nopember 2013
07 Nopember 2013
4 (Hari)
Bayi Baru Lahir
Rp
100,000
06 Nopember 2013
09 Nopember 2013
3 (Hari)
G1p0a0 inpartu kala 1 fase aktif letsu
Rp
150,000
06 Nopember 2013
09 Nopember 2013
3 (Hari)
Bayi Baru Lahir
Rp
75,000
0 (Hari)
Jl. Transmigrasi Km. 30 dusun II

rt 005 desa sido mulyo, mantewe
Jl. Agathis G 014 rt 013 desa

empat
Jl. Agathis G 014 rt 013 desa
empat
15 Nopember 2013
0 (Hari)
25
0 (Hari)
22
0 (Hari)
0 (Hari)
27
0 (Hari)
25
0 (Hari)
1 (Hari)
210 Ny. Dewa Ayu, K
6310035107840001
211 By.Ny Dewa Ayu, K
6310035107840001
212 Ny. Handayani
6310015212800002
213 Ny. Rusita Dahlia
6310015508760005
214 Ny. Tarikem
6310086304730001
215 Ny. Zulianah
6310095007850020
216 Ny. Murdia
6310036410810001
Sebamban I blok G rt 015

desasari utama, sungai loban
Sebamban I blok G rt 015
desasari utama, sungai loban
Ds. kersik putih rt 009, BTL
Jl. Kuranji rt 001 ds. Maju
bersama, BTL
ds. Karang rejo rt 008, karang
bintang
jl. Kupang rt 007 ds. Sari
gadung,simpang empat
Jl. Manggis kelapa gading 1 rt
011, BTL
Jl. H. M. Nurung rt 002, kota
Jl. Pangeran antasari rt 001,
gusungee, kusan hilir
29
07 Nopember 2013
11 Nopember 2013
4 (Hari)
G2p1a0 H. aterm inpartu kala 1 fase latendgKPD
Rp
200,000
07 Nopember 2013
11 Nopember 2013
4 (Hari)
Bayi Baru Lahir
Rp
100,000
33
08 Nopember 2013
11 Nopember 2013
3 (Hari)
Myoma geburt
Rp
150,000
43
05 Nopember 2013
13 Nopember 2013
8 (hari)
P1a2 susp Ca. cerviks
Rp
400,000
40
08 Nopember 2013
09 Nopember 2013
1 (Hari)
G1p0a0 dgAb. Incomple
Rp
50,000
23
04 Nopember 2013
04 Nopember 2013
P2a0 dg perdarahan post partus
Rp
50,000
35
06 Nopember 2013
07 Nopember 2013
1 (Hari)
G1p0a0 dg Ab incomplete
Rp
50,000
30
04 Nopember 2013
08 Nopember 2013
4 (Hari)
G2p1a0 H. 24-26 mg + diare cair akut
Rp
200,000
33
03 Nopember 2013
07 Nopember 2013
4 (Hari)
Perdarahan pervagina
Rp
200,000
25
15 Nopember 2013
16 Nopember 2013
1 (Hari)
Rp
50,000
34
06 Nopember 2013
12 Nopember 2013
6 (hari)
Rp
300,000
26
07 Nopember 2013
09 Nopember 2013
2 (Hari)
Rp
100,000
0 (Hari)
217 Ny. Sulistiawati
6310015111830007
218 Ny. Salasiah
6310024605800002
219 Ny. Ratna Candra. K
6310025910880001
220 Ny. Endreana
6310026503790001
221 Ny. Riana
6310024712870001
222 Ny. Maslina
6431002551093002
Ds. Pulau satu rt 002, kusan hilir
20
05 Nopember 2013
07 Nopember 2013
2 (Hari)
G1p0a0 dgn Ab. Incomplete
Rp
100,000
223 Ny. Masnur
6310044101910009
Ds. Pendamaran jaya rt 004, satui
22
06 Nopember 2013
09 Nopember 2013
3 (Hari)
Abortus inkomplit
Rp
150,000
T O T A L
G4p3a0 hamil 13 minggu+Susp hipokalemia
BULAN : Nopember
TAHUN : 2013
Jasa Medis
Spesialis
Jasa Keperawatan
Jasa Medis
Umum
Tindakan Kecil
Rp
Tindakan Kecil
Nifas
Tindakan Kecil
Perinatalogi
Tindakan
Sedang
390,000
Rp
90,000
Rp
330,000
Rp
40,000
Rp
Rp
270,000
Rp
20,000
Rp
90,000
Rp
120,000
Rp
60,000
Rp
30,000
Rp
120,000
Rp
300,000
Rp
90,000
Rp
30,000
Rp
20,000
Rp
180,000
Rp
120,000
Rp
30,000
Rp
20,000
Rp
180,000
Rp
120,000
Rp
60,000
Rp
90,000
800,000
Rp
20,000
Rp
Tindakan
Sedang Nifas
Tindakan
Intensif
Tindakan
Intensif VK
Tindakan
Intensif VK
Bersalin
Tindakan
Intensif Nifas
Rp
30,000
700,000
Rp
300,000
Rp
620,000
Rp
330,000
Rp
140,000
Rp
30,000
Rp
Rp
30,000
180,000
380,000
Rp
Rp
40,000
Rp
60,000
Rp
Rp
Tindakan
Sedang VK
Bersalin
420,000
Rp
40,000
Tindakan
Sedang VK
Rp
Rp
Rp
90,000
Rp
Tindakan Kecil
VK Bersalin
Rp
Rp
80,000
Tindakan Kecil
VK
Jasa
80,000
20,000
Rp
180,000
120,000
Rp
Rp
20,000
Rp
60,000
60,000
Rp
45,000
Rp
90,000
Rp
5,000
Rp
5,000
45,000
Rp
5,000
Rp
45,000
Rp
5,000
Rp
45,000
Rp
5,000
210,000
120,000
Rp
Rp
Apoteker
Rp
30,000
Rp
30,000
Rp
60,000
Rp
45,000
Rp
5,000
Rp
45,000
Rp
5,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
90,000
Rp
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
90,000
Rp
120,000
Rp
60,000
Rp
210,000
Rp
60,000
Rp
60,000
Rp
30,000
Rp
90,000
Rp
60,000
Rp
120,000
Rp
30,000
Rp
180,000
Rp
90,000
Rp
120,000
Rp
60,000
Rp
120,000
40,000
Rp
80,000
Rp
Rp
Rp
20,000
Rp
Rp
Rp
Rp
20,000
Rp
20,000
Rp
20,000
Rp
20,000
Rp
Rp
20,000
Rp
20,000
Rp
45,000
Rp
5,000
60,000
Rp
5,000
Rp
140,000
Rp
30,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
60,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
90,000 Rp
5,000
Rp
120,000
60,000
120,000
20,000
80,000
Rp
60,000
80,000
120,000
Rp
90,000
40,000
80,000
Rp
Rp
Rp
Rp
180,000
120,000
Rp
150,000
200,000
160,000
Rp
60,000
160,000
200,000
20,000
Rp
45,000
Rp
Rp
30,000
Rp
Rp
Rp
Rp
60,000
Rp
Rp
5,000
Rp
160,000
Rp
Rp
30,000
Rp
Rp
45,000
Rp
Rp
Rp
Rp
60,000
Rp
40,000
30,000
Rp
160,000
Rp
Rp
20,000
Rp
60,000
120,000
80,000
Rp
Rp
120,000
60,000
Rp
60,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
120,000
Rp
Rp
150,000
Rp
60,000
Rp
90,000
Rp
60,000
Rp
150,000
Rp
40,000
Rp
120,000
Rp
Rp
Rp
60,000
Rp
Rp
260,000
180,000
Rp
Rp
Rp
40,000
20,000
Rp
Rp
120,000
Rp
90,000
Rp
45,000
Rp
30,000
Rp
30,000
Rp
30,000
Rp
60,000
180,000
240,000
Rp
400,000
Rp
150,000
Rp
90,000
Rp
20,000
Rp
30,000
Rp
60,000
Rp
30,000
Rp
180,000
Rp
180,000
Rp
240,000
Rp
150,000
Rp
300,000
Rp
210,000
20,000
Rp
60,000
Rp
Rp
Rp
20,000
Rp
Rp
60,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
Rp
5,000
Rp
5,000
Rp
Rp
5,000
90,000 Rp
5,000
90,000
45,000
Rp
30,000
Rp
150,000
Rp
45,000
Rp
Rp
30,000
Rp
180,000
Rp
45,000
Rp
180,000
Rp
5,000
Rp
30,000
Rp
300,000
Rp
45,000
Rp
180,000
Rp
5,000
120,000
500,000
Rp
90,000 Rp
180,000
320,000
160,000
240,000
30,000
Rp
Rp
Rp
Rp
340,000
240,000
Rp
Rp
20,000
Rp
60,000
Rp
Rp
40,000
Rp
150,000
80,000
60,000
Rp
90,000
180,000
Rp
180,000
Rp
Rp
30,000
Rp
120,000
Rp
90,000
Rp
180,000
Rp
150,000
Rp
240,000
Rp
150,000
Rp
20,000
Rp
120,000
Rp
20,000
Rp
210,000
Rp
180,000
Rp
180,000
Rp
180,000
Rp
240,000
Rp
150,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
30,000
Rp
40,000
Rp
100,000
Rp
Rp
Rp
20,000
Rp
20,000
Rp
Rp
20,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
20,000
Rp
20,000
Rp
20,000
Rp
30,000
Rp
90,000
Rp
45,000
Rp
5,000
Rp
90,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
5,000
120,000
150,000
Rp
300,000
Rp
30,000
Rp
90,000
Rp
30,000
Rp
90,000
Rp
150,000
Rp
Rp
40,000
Rp
Rp
Rp
20,000
80,000
Rp
Rp
225,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
135,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
60,000
20,000
Rp
45,000
30,000
20,000
Rp
Rp
150,000
20,000
60,000
45,000
150,000
100,000
200,000
Rp
150,000
80,000
200,000
80,000
Rp
20,000
Rp
Rp
5,000
Rp
Rp
Rp
Rp
30,000
Rp
Rp
45,000
Rp
Rp
Rp
Rp
40,000
20,000
5,000
90,000
Rp
Rp
Rp
Rp
20,000
Rp
90,000
30,000
Rp
200,000
Rp
Rp
100,000
200,000
180,000
120,000
120,000
140,000
Rp
90,000
200,000
160,000
Rp
Rp
300,000
60,000
Rp
210,000
Rp
300,000
Rp
90,000
Rp
40,000
Rp
90,000
Rp
40,000
Rp
240,000
Rp
100,000
Rp
180,000
Rp
120,000
Rp
210,000
Rp
150,000
Rp
150,000
Rp
20,000
Rp
320,000
Rp
210,000
Rp
20,000
Rp
80,000
Rp
90,000
Rp
210,000
Rp
150,000
Rp
210,000
Rp
20,000
Rp
Rp
150,000
Rp
40,000
Rp
Rp
120,000
Rp
270,000
Rp
20,000
Rp
Rp
270,000
Rp
20,000
Rp
210,000
Rp
40,000
Rp
90,000
Rp
40,000
Rp
420,000
Rp
180,000
Rp
Rp
20,000
Rp
200,000
Rp
20,000
20,000
Rp
Rp
20,000
Rp
20,000
20,000
Rp
Rp
Rp
Rp
60,000
30,000
30,000
Rp
Rp
150,000
Rp
45,000
45,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
5,000
150,000
Rp
120,000
Rp
60,000
Rp
5,000
Rp
240,000
Rp
60,000
Rp
5,000
Rp
150,000
Rp
5,000
Rp
120,000
Rp
5,000
Rp
120,000
Rp
5,000
120,000
Rp
90,000
Rp
90,000
Rp
5,000
220,000
Rp
90,000
Rp
45,000
Rp
5,000
200,000
Rp
90,000
Rp
5,000
Rp
160,000
Rp
90,000
Rp
5,000
Rp
240,000
Rp
30,000
Rp
5,000
Rp
330,000
Rp
5,000
220,000
Rp
160,000
30,000
Rp
200,000
Rp
180,000
220,000
Rp
45,000
90,000
150,000
150,000
Rp
Rp
Rp
120,000
80,000
200,000
Rp
150,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
20,000
Rp
60,000
Rp
45,000
150,000
Rp
240,000
Rp
100,000
Rp
30,000
Rp
150,000
Rp
45,000
Rp
5,000
Rp
240,000
Rp
200,000
Rp
30,000
Rp
90,000
Rp
45,000
Rp
5,000
Rp
120,000
Rp
120,000
Rp
60,000
Rp
5,000
Rp
240,000
Rp
60,000
Rp
120,000
Rp
20,000
Rp
120,000
Rp
20,000
Rp
180,000
Rp
40,000
Rp
240,000
Rp
120,000
Rp
20,000
Rp
60,000
Rp
210,000
Rp
40,000
Rp
Rp
60,000
Rp
40,000
Rp
180,000
Rp
20,000
Rp
240,000
Rp
140,000 Rp
580,000
Rp
210,000
Rp
20,000 Rp
520,000
Rp
150,000
Rp
40,000 Rp
400,000
Rp
40,000
Rp
120,000
Rp
160,000
Rp
90,000
Rp
40,000
Rp
90,000
Rp
120,000
Rp
90,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
60,000
Rp
40,000
Rp
380,000
Rp
Rp
Rp
40,000
Rp
Rp
20,000
Rp
20,000
Rp
Rp
200,000
Rp
Rp
Rp
30,000
Rp
90,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
60,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
5,000
Rp
5,000
150,000
160,000
Rp
120,000
Rp
45,000
Rp
30,000
Rp
45,000
440,000
Rp
90,000
Rp
90,000
Rp
135,000
Rp
5,000
Rp
60,000
Rp
30,000
Rp
90,000
Rp
45,000
Rp
5,000
Rp
160,000
Rp
45,000
Rp
90,000
Rp
5,000
Rp
5,000
Rp
45,000
Rp
90,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
Rp
Rp
300,000
Rp
360,000
30,000
30,000
Rp
135,000
40,000
20,000
140,000
Rp
Rp
Rp
240,000
180,000
Rp
Rp
60,000
Rp
210,000
100,000
20,000
Rp
30,000
Rp
30,000
60,000
Rp
60,000
Rp
45,000
Rp
45,000
120,000
40,000
Rp
Rp
Rp
60,000
Rp
45,000
Rp
90,000
Rp
30,000
Rp
Rp
Rp
Rp
180,000
150,000
180,000
120,000
Rp
270,000
Rp
120,000
Rp
240,000
Rp
150,000
Rp
Rp
210,000
150,000
Rp
180,000
Rp
120,000
Rp
180,000
Rp
120,000
Rp
240,000
Rp
120,000
Rp
20,000
Rp
80,000
Rp
180,000
Rp
180,000
Rp
20,000
Rp
60,000
Rp
40,000
Rp
60,000
Rp
Rp
20,000
Rp
Rp
20,000
Rp
Rp
200,000
Rp
Rp
40,000
20,000
Rp
Rp
Rp
40,000
Rp
40,000
Rp
20,000
Rp
Rp
20,000
Rp
Rp
120,000
5,000
Rp
90,000
Rp
5,000
Rp
60,000
Rp
5,000
Rp
150,000
Rp
5,000
Rp
150,000
Rp
5,000
Rp
150,000
Rp
5,000
180,000
Rp
45,000
Rp
Rp
200,000
135,000
45,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
135,000
Rp
5,000
Rp
135,000
Rp
5,000
90,000
260,000
Rp
30,000
Rp
150,000
Rp
30,000
Rp
150,000
150,000
280,000
Rp
Rp
180,000
Rp
Rp
20,000
30,000
280,000
200,000
140,000
150,000
Rp
Rp
Rp
Rp
100,000
200,000
Rp
Rp
120,000
Rp
Rp
160,000
Rp
30,000
180,000
240,000
Rp
Rp
120,000
Rp
45,000
Rp
60,000
Rp
Rp
30,000
Rp
180,000
Rp
120,000
Rp
90,000
Rp
60,000
Rp
120,000
Rp
20,000
Rp
Rp
90,000
Rp
20,000
Rp
Rp
60,000
Rp
360,000
Rp
300,000
Rp
360,000
Rp
270,000
Rp
300,000
Rp
380,000
Rp
270,000
Rp
270,000
Rp
30,000
Rp
60,000
Rp
60,000
Rp
120,000
Rp
30,000
Rp
210,000
Rp
150,000
Rp
20,000
Rp
Rp
240,000
180,000
Rp
Rp
20,000
20,000
Rp
60,000
Rp
30,000
Rp
60,000
20,000
Rp
Rp
Rp
Rp
20,000
Rp
Rp
20,000
Rp
20,000
Rp
Rp
Rp
20,000
Rp
Rp
20,000
Rp
Rp
260,000
Rp
240,000
160,000
240,000
60,000
40,000
Rp
Rp
90,000
Rp
5,000
Rp
5,000
30,000
Rp
45,000
Rp
5,000
30,000
Rp
45,000
Rp
5,000
Rp
270,000
Rp
60,000
Rp
45,000
Rp
90,000
Rp
5,000
Rp
90,000
Rp
5,000
120,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
5,000
60,000
60,000
Rp
120,000
Rp
180,000
Rp
20,000
Rp
30,000
5,000
60,000
40,000
Rp
Rp
Rp
60,000
40,000
60,000
150,000
45,000
45,000
320,000
Rp
Rp
Rp
Rp
180,000
80,000
Rp
Rp
60,000
Rp
Rp
Rp
Rp
140,000
Rp
Rp
60,000
Rp
Rp
Rp
30,000
60,000
30,000
120,000
Rp
Rp
Rp
60,000
100,000
100,000
20,000
30,000
240,000
140,000
Rp
Rp
Rp
Rp
Rp
Rp
40,000
60,000
30,000
Rp
150,000
Rp
150,000
Rp
135,000
Rp
45,000
Rp
5,000
Rp
90,000
Rp
5,000
Rp
60,000
Rp
Rp
30,000
Rp
150,000
Rp
60,000
Rp
90,000
Rp
60,000
Rp
90,000
Rp
60,000
Rp
210,000
Rp
180,000
Rp
210,000
Rp
150,000
Rp
90,000
Rp
30,000
Rp
60,000
Rp
30,000
Rp
240,000
Rp
180,000
Rp
240,000
Rp
210,000
Rp
220,000
Rp
90,000
Rp
120,000
Rp
180,000
Rp
150,000
Rp
90,000
Rp
60,000
Rp
60,000
Rp
30,000
Rp
80,000
Rp
Rp
Rp
20,000
Rp
20,000
Rp
20,000
Rp
40,000
Rp
Rp
Rp
Rp
Rp
20,000
Rp
Rp
Rp
Rp
20,000
Rp
Rp
Rp
20,000
Rp
20,000
Rp
60,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
90,000
Rp
5,000
Rp
45,000
Rp
5,000
Rp
5,000
30,000
60,000
Rp
150,000
Rp
180,000
Rp
270,000
Rp
135,000
Rp
60,000
Rp
135,000
Rp
5,000
Rp
60,000
Rp
45,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
5,000
90,000
60,000
Rp
30,000
180,000
120,000
Rp
20,000
Rp
120,000
260,000
100,000
Rp
Rp
Rp
Rp
Rp
20,000
20,000
30,000
180,000
20,000
60,000
Rp
Rp
Rp
Rp
90,000
80,000
120,000
40,000
5,000
340,000
180,000
Rp
Rp
Rp
Rp
Rp
45,000
60,000
380,000
240,000
Rp
Rp
40,000
100,000
20,000
30,000
90,000
60,000
Rp
Rp
60,000
60,000
60,000
Rp
Rp
Rp
Rp
Rp
Rp
20,000
100,000
Rp
Rp
60,000
Rp
30,000
Rp
30,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
45,000
Rp
5,000
60,000
Rp
90,000
Rp
Rp
20,000
Rp
160,000
20,000
Rp
Rp
Rp
90,000
Rp
120,000
Rp
Rp
180,000
Rp
30,000
120,000
20,000
Rp
140,000
Rp
30,000
Rp
40,000
Rp
220,000
Rp
60,000
180,000
Rp
20,000
Rp
300,000
Rp
30,000
Rp
90,000
Rp
20,000
Rp
80,000
Rp
30,000
Rp
120,000
Rp
260,000
Rp
150,000
Rp
90,000
Rp
30,000
Rp
90,000
Rp
30,000
Rp
60,000
Rp
30,000
Rp
20,000
Rp
60,000
Rp
60,000
Rp
30,000
Rp
20,000
Rp
60,000
Rp
60,000
Rp
180,000
Rp
90,000
Rp
150,000
Rp
90,000
Rp
150,000
Rp
120,000
140,000
Rp
Rp
Rp
40,000
Rp
40,000
Rp
Rp
Rp
20,000
Rp
Rp
Rp
Rp
Rp
20,000
Rp
20,000
40,000
Rp
Rp
140,000
5,000
Rp
5,000
Rp
5,000
Rp
30,000
Rp
150,000
45,000
Rp
45,000
Rp
45,000
Rp
5,000
Rp
45,000
Rp
5,000
Rp
5,000
Rp
Rp
45,000
135,000
45,000
Rp
5,000
Rp
30,000
Rp
45,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
5,000
30,000
Rp
Rp
60,000
Rp
90,000
Rp
60,000
Rp
45,000
Rp
150,000
45,000
Rp
90,000
150,000
30,000
150,000
300,000
Rp
30,000
Rp
Rp
Rp
Rp
Rp
Rp
60,000
260,000
180,000
5,000
30,000
220,000
Rp
Rp
Rp
Rp
Rp
180,000
Rp
Rp
20,000
Rp
45,000
60,000
80,000
60,000
Rp
120,000
80,000
60,000
Rp
Rp
20,000
30,000
100,000
Rp
Rp
Rp
120,000
Rp
135,000
Rp
240,000
Rp
Rp
120,000
Rp
150,000
Rp
20,000
Rp
60,000
Rp
300,000
Rp
60,000
Rp
320,000
Rp
90,000
Rp
20,000
Rp
90,000
Rp
20,000
Rp
90,000
Rp
20,000
Rp
150,000
Rp
120,000
Rp
60,000
Rp
180,000
Rp
90,000
Rp
120,000
Rp
150,000
Rp
Rp
Rp
220,000
180,000
20,000
Rp
Rp
20,000
40,000
Rp
Rp
150,000
Rp
30,000
Rp
Rp
80,000
Rp
180,000
Rp
20,000
Rp
30,000
Rp
90,000
Rp
45,000
Rp
90,000
Rp
45,000
Rp
90,000
Rp
60,000
30,000
Rp
Rp
5,000
Rp
5,000
Rp
5,000
45,000
Rp
5,000
Rp
45,000
Rp
5,000
Rp
45,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
90,000
60,000
Rp
45,000
80,000
Rp
Rp
Rp
260,000
120,000
Rp
60,000
20,000
Rp
60,000
Rp
60,000
Rp
45,000
Rp
5,000
Rp
135,000
Rp
5,000
Rp
90,000
Rp
5,000
Rp
135,000
Pelayanan Kesehatan Dan Besaran Tarif sesuai PERDA (Rp)

Tindakan di UGD
Tindakan di VK
Berkas RM
Kecil
Sederhana
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
Sedang
Tindakan
Penyakit Dalam
Sederhana
Kecil
Sedang
Besar Laminarta
Persalinan
Normal
Persalinan Sulit
Persalinan Sulit
VK
Persalinan Sulit
VK Bersalin
Persalinan Sulit
VK III
Resusitasi Bayi
Baru Lahir
100,000
Rp
Rp
Besar
Tindakan Persalinan & Kebidanan
125,000
Rp
1,200,000
Rp
125,000
Rp
125,000
100,000
Rp
125,000
Rp
1,200,000
Rp
125,000
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
1,200,000
Rp
10,000
Rp
125,000
Rp
1,200,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
Rp
125,000
200,000
Rp
1,200,000
Rp
1,200,000
Rp
1,200,000
Rp
1,200,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
Rp
10,000
Rp
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
Rp
1,200,000
125,000
Rp
1,200,000
125,000
Rp
1,200,000
100,000
Rp
Rp
Rp
125,000
125,000
Rp
125,000
Rp
125,000
Rp
125,000
Rp
Rp
Rp
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
1,200,000
Rp
Rp
Rp
1,200,000
1,200,000
1,200,000
1,200,000
1,200,000
1,200,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
Rp
Rp
Rp
125,000
Rp
125,000
Rp
125,000
1,200,000
200,000
Rp
Rp
200,000
Rp
200,000
125,000
1,200,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
125,000
Rp
Rp
Rp
125,000
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
125,000
125,000
1,200,000
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
200,000
Rp
Rp
Rp
1,200,000
1,200,000
1,200,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
200,000
Rp
200,000
10,000
Rp
200,000
Rp
10,000
Rp
200,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
100,000
Rp
200,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
125,000
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
200,000
Rp
200,000
Rp
200,000
125,000
Rp
Rp
Rp
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
200,000
Rp
125,000
Rp
125,000
Rp
Rp
125,000
125,000
Rp
Rp
1,200,000
Rp
125,000
Rp
125,000
1,200,000
Rp
10,000
Rp
10,000
Rp
Rp
Rp
Rp
10,000
10,000
10,000
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
10,000
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
200,000
Rp
1,200,000
Rp
Rp
125,000
Rp
125,000
Rp
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
200,000
125,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
Rp
125,000
Rp
Rp
Rp
100,000
1,200,000
125,000
Rp
1,200,000
Rp
125,000
Rp
1,200,000
Rp
125,000
Rp
125,000
10,000
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
1,200,000
Rp
125,000
125,000
200,000
Rp
Rp
Rp
Rp
Rp
Rp
1,200,000
1,200,000
1,200,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
Rp
Rp
Rp
125,000
125,000
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
Rp
Rp
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
1,200,000
1,200,000
1,200,000
Rp
1,200,000
Rp
1,200,000
125,000
Rp
Rp
1,200,000
125,000
200,000
Rp
Rp
1,200,000
1,200,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
Rp
200,000
Rp
200,000
Rp
1,200,000
Rp
1,200,000
Rp
1,200,000
Rp 1,200,000
Rp
200,000
Rp
125,000
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
125,000
Rp
125,000
Rp
200,000
Rp
200,000
1,200,000
Rp
1,200,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
125,000
Rp
10,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
Rp
Rp
Rp
200,000
Rp
200,000
Rp
200,000
Rp
200,000
125,000
125,000

Kuretasi +
Anastesi
RJPO

Kuretasi +
Anastesi VK
Kuretasi Sulit +
Anastesi
Kuretasi sulit +
Anastesi VK
Manual Plasenta Manual Plasenta

+ Anastesi VK
+ Anastesi
Sederhana
Kecil
Sedang
Rp
Rp
1,750,000
1,750,000
Anastesi
Besar
Khusus
Sederhana
Kecil
Sedang
Rp
600,000
Rp
1,750,000
Rp
1,625,000
Rp
Rp
200,000
Rp
1,625,000
4,000,000
Rp
Rp
5,000,000
Rp
5,000,000
200,000
Rp
Rp
Rp
2,187,500
Rp
5,250,000
Rp
6,562,500
Rp
6,562,500
200,000
200,000
Rp
Rp
Rp
200,000
5,000,000
750,000
Rp
Rp
Rp
Rp
Rp
5,000,000
Rp
5,000,000
Rp
5,000,000
200,000
200,000
200,000
Rp
Rp
Rp
1,750,000
Rp
Rp
5,000,000
Rp
5,000,000
Rp
4,000,000
200,000
200,000
200,000
Rp
1,625,000
600,000
Rp
Rp
Rp
1,750,000
Rp
Rp
Rp
5,000,000
200,000
Rp
Rp
5,250,000
Rp
600,000
Rp
750,000
5,000,000
200,000
Rp
5,250,000
Rp
5,250,000
Rp
6,562,500
200,000
Rp
5,000,000
Rp
5,000,000
200,000
Rp 10,500,000
Rp
2,187,500
Rp
Rp
5,000,000
200,000
Rp
5,250,000
Rp
Rp
Rp
5,000,000
Rp
5,000,000
Rp
4,000,000
Rp
5,000,000
200,000
200,000
Rp
1,750,000
Rp
1,750,000
Rp
1,750,000
Rp
Rp
2,050,000
1,750,000
Rp
Rp
1,750,000
Rp
200,000
1,625,000
Rp
200,000
Rp
200,000
Rp
5,000,000
Rp
5,000,000
Rp
5,000,000
Rp
4,000,000
Rp
4,000,000
200,000
Rp
200,000
Rp
200,000
Rp
Rp
Rp
5,250,000
Rp
6,562,500
200,000
Rp
Rp
Rp
5,000,000
200,000
200,000
Rp
5,000,000
Rp
4,000,000
Rp
5,000,000
200,000
Rp
200,000
Rp
200,000
Rp
Rp
200,000
Rp
Rp
200,000
Rp
200,000
Rp
5,000,000
5,250,000
Rp
Rp
Rp
5,000,000
Rp
4,000,000
Rp
5,000,000
Rp
5,000,000
200,000
200,000
Rp
200,000
Rp
200,000
Rp
Rp
2,050,000
Rp
Rp
Rp
1,625,000
1,625,000
2,050,000
1,750,000
Rp
Rp
Rp
1,750,000
Rp
5,000,000
Rp
5,000,000
Rp
200,000
200,000
Rp
Rp
200,000
Rp
Rp
200,000
5,000,000
6,562,500
600,000
Rp
Rp
5,000,000
200,000
Rp
Rp
1,750,000
Rp
1,750,000
Rp
1,750,000
Rp
2,050,000
5,250,000
Rp
1,750,000
Rp
600,000
Rp
1,750,000
Rp
600,000
Anastesi
Pemakaian
Oksigen
Besar
Rontgen
USG
Khusus
Rp
1,810,000
Rp
1,600,000
Rp
800,000
EKG
Pemeriksaan
Darah Untuk
Tranfusi dan
Kantong
Golongan Darah
Laboratorium
Rp
456,000
Rp
392,000
Rp
215,000
Rp
152,500
Rp
78,000
Rp
340,000
Rp
183,000
Rp
275,000
Rp
Rp
198,000
1,000,000
Rp
Rp
100,000
300,000
Obat, alat suntik,

alat infus dan
cairan infus
selama dirawat
dan atau operasi
Lepas Infus
Rp
Lepas Infus
Nifas
5,000
Rp
Rp
Rp
Lepas Infus VK
Injeksi IV
Rp
270,000
Rp
400,000
Injeksi IV Nifas Injeksi IV (VK)
5,000
15,000
Rp
5,000
Rp
20,000
Rp
5,000
Rp
20,000
Rp
30,000
Rp
10,000
10,000
Rp
210,000
Rp
392,500
Rp
381,000
Rp
129,000
Rp
193,000
Rp
678,500
Rp
5,000
Rp
186,000 Rp
233,000
Rp
5,000
Rp
210,000 Rp
151,000
Rp
5,000
Rp
193,000 Rp
254,500 Rp
Rp
193,000 Rp
174,000
Rp
5,000
5,000
Rp
20,000
Rp
Rp
1,400,000
Rp
520,000
Rp
193,000
Rp
169,000
Rp
5,000
Rp
210,000
Rp
160,000
Rp
225,000
Rp
265,500
Rp
5,000
Rp
10,000
Rp
205,000
Rp
348,500
Rp
5,000
Rp
10,000
Rp
52,000
Rp
5,000
Rp
20,000
Rp
10,000
Rp
10,000
Rp
20,000
Rp
5,000
Rp
105,000
Rp
205,500
Rp
220,000
Rp
210,500
Rp
5,000
Rp
215,000
Rp
106,000
Rp
5,000
Rp
214,500
Rp
442,500
Rp
230,000
Rp
375,000
Rp
313,000
Rp
236,000
Rp
5,000
Rp
220,000
Rp
239,500
Rp
5,000
Rp
Rp
5,000
10,000
Rp
100,000
Rp
20,000
200,000
Rp
100,000
Rp
Rp
Rp
1,750,000
1,750,000
Rp
Rp
400,000
1,750,000
1,800,000
Rp
60,000
Rp
191,000
Rp
185,000
Rp
1,188,000
Rp
5,000
Rp
80,000
Rp
227,000
Rp
184,000
Rp
5,000
Rp
10,000
Rp
255,000
Rp
3,172,000
Rp
5,000
Rp
120,000
Rp
493,000
Rp
880,000
Rp
5,000
Rp
130,000
Rp
210,000 Rp
177,500
Rp
5,000
Rp
40,000
Rp
215,000
Rp
156,000
Rp
357,000
Rp
5,000
Rp
210,000
Rp
150,000
Rp
10,000
Rp
360,000
Rp
20,000
Rp
2,250,000
Rp
377,000
Rp
2,250,000
Rp
125,000 Rp
Rp
293,500 Rp
Rp
260,000
Rp
1,221,500 Rp
980,500
5,000
5,000
Rp
5,000
Rp
1,750,000
Rp
237,500
Rp
947,500
Rp
294,500
Rp
266,500
Rp
5,000
Rp
160,000
Rp
50,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
1,750,000
Rp
220,000
Rp
141,000
Rp
5,000
Rp
100,000
Rp
1,750,000
Rp
230,000
Rp
1,085,500
Rp
5,000
Rp
130,000
Rp
235,000
Rp
534,500
Rp
5,000
Rp
Rp
1,750,000
Rp
Rp
1,750,000
Rp
1,400,000
100,000
Rp
520,000
Rp
230,000
Rp
416,000
Rp
5,000
Rp
120,000
Rp
260,000
Rp
80,000
Rp
1,201,000
Rp
10,000
Rp
110,000
Rp
225,000
Rp
699,000
Rp
5,000
Rp
150,000
Rp
175,000
Rp
105,000
Rp
215,000
Rp
155,000
Rp
5,000
Rp
215,000
Rp
151,000
Rp
5,000
150,000
Rp
5,000
Rp
Rp
Rp
1,800,000
1,750,000
Rp
200,000
Rp
1,750,000
Rp
1,750,000
1,800,000
Rp
1,800,000
Rp
10,000
Rp
232,500
Rp
144,000
Rp
5,000
Rp
424,000
Rp
5,000
Rp
100,000
Rp
213,000
Rp
1,600,500
Rp
5,000
Rp
52,500
Rp
275,000
Rp
5,000
Rp
60,000
520,000
2,250,000
3,600,000
1,800,000
Rp
145,000
520,000
1,750,000
Rp
211,000
Rp
Rp
Rp
Rp
100,000
Rp
Rp
230,500
Rp
1,750,000
Rp
Rp
Rp
60,000
Rp
1,560,000
Rp
110,000
Rp
130,000
Rp
20,000
30,000
Rp
237,000
Rp
965,500
Rp
5,000
Rp
150,000
Rp
223,000 Rp
1,124,000
Rp
5,000
Rp
120,000
Rp
143,000 Rp
557,500
Rp
5,000
Rp
130,000
Rp
52,000
Rp
203,000 Rp
1,362,000
Rp
5,000
Rp
110,000
Rp
253,000 Rp
637,500
Rp
5,000
Rp
140,000 Rp
Rp
258,000 Rp
2,786,500
Rp
5,000
Rp
130,000
Rp
213,000
Rp
203,000
Rp
1,286,000
Rp
5,000
Rp
130,000
Rp
167,000
Rp
477,000
Rp
5,000
Rp
100,000
Rp
211,000 Rp
1,593,000
Rp
5,000
Rp
140,000
Rp
471,500
1,319,000
Rp
25,000
Rp
150,000
Rp
Rp
30,000
Rp
1,750,000
Rp
264,000 Rp
1,661,500
Rp
5,000
Rp
200,000 Rp
Rp
1,750,000
Rp
255,000 Rp
1,055,000
Rp
5,000
Rp
190,000
Rp
Rp
1,400,000
Rp
1,750,000
400,000
Rp
Rp
Rp
600,000
Rp
Rp
5,000
Rp
150,000
Rp
160,000
Rp
168,000
Rp
2,193,000
Rp
5,000
Rp
100,000
Rp
210,000 Rp
119,000
Rp
5,000
Rp
100,000
Rp
185,000 Rp
34,000
Rp
195,000 Rp
633,500
Rp
5,000
Rp
315,000 Rp
549,000
Rp
5,000
Rp
Rp
100,000
1,300,000
Rp
Rp
30,000
Rp
20,000
Rp
10,000
60,000 Rp
30,000
Rp
20,000
Rp
520,000
Rp
143,000
Rp
629,000
Rp
10,000
Rp
60,000
Rp
30,000
Rp
260,000
Rp
210,000
Rp
529,000
Rp
5,000
Rp
50,000
Rp
20,000
Rp
520,000
Rp
203,000
Rp
142,000
Rp
5,000
Rp
10,000
Rp
30,000
Rp
140,000
100,000
100,000
190,000
891,000
100,000
Rp
100,000
15,000
Rp
Rp
Rp
10,000 Rp
177,000 Rp
10,000
Rp
520,000
Rp
780,000
Rp
36,000
Rp
205,000
Rp
10,000
Rp
15,000
Rp
115,000
Rp
295,000
Rp
118,000
Rp
219,500
Rp
5,000
Rp
210,000
Rp
238,000
Rp
297,000
Rp
210,000
Rp
178,000
Rp
5,000
Rp
158,000
Rp
218,000
Rp
5,000
Rp
100,000
Rp
271,000
Rp
5,000
Rp
60,000
Rp
225,000
Rp
265,500
Rp
5,000
Rp
10,000
Rp
253,000
Rp
162,000
Rp
5,000
Rp
40,000
Rp
175,000
Rp
187,000
Rp
5,000
Rp
5,000
Rp
170,000
Rp
5,000
Rp
80,000
Rp
1,750,000
Rp
250,000
Rp
1,197,000
Rp
1,750,000
Rp
178,000
Rp
1,716,000
Rp
1,750,000
Rp
305,500
Rp
1,779,000
Rp
5,000
Rp
170,000
Rp
1,400,000
Rp
203,000
Rp
346,000
Rp
5,000
Rp
100,000
Rp
1,400,000
Rp
168,000
Rp
471,000
Rp
5,000
Rp
120,000
Rp
160,000
Rp
510,000
Rp
5,000
Rp
100,000
Rp
60,000
Rp
252,500
Rp
211,500
Rp
5,000
Rp
140,000
Rp
237,500
Rp
311,000
Rp
5,000
Rp
210,000
Rp
Rp
1,800,000
1,750,000
Rp
2,250,000
Rp
5,000
Rp
20,000
Rp
10,000
Rp
1,750,000
Rp
1,400,000
Rp
1,750,000
Rp
Rp
Rp
1,750,000
200,000
100,000
198,000
Rp
152,000
Rp
5,000
Rp
20,000
Rp
203,000
Rp
1,242,000
Rp
5,000
Rp
210,000
Rp
383,000
Rp
5,000
Rp
10,000
Rp
220,000
Rp
306,000
Rp
5,000
Rp
20,000
Rp
210,000
Rp
178,000
Rp
5,000
Rp
10,000
Rp
20,000
Rp
520,000
Rp
302,000
Rp
1,263,000
Rp
5,000
Rp
260,000
Rp
198,000
Rp
1,896,000
Rp
5,000
Rp
193,000
Rp
319,000
Rp
5,000
Rp
210,000
Rp
122,000
Rp
5,000
Rp
185,000
Rp
371,000
Rp
Rp
65,000
Rp
340,000
Rp
Rp
1,493,500
62,500
Rp
198,000
Rp
122,000
1,800,000
Rp
Rp
Rp
1,040,000
Rp
Rp
Rp
50,000
150,000
5,000
Rp
20,000
Rp
20,000
5,000
Rp
160,000
Rp
10,000
Rp
280,000
Rp
5,000
Rp
Rp
1,750,000
Rp
1,400,000
Rp
1,750,000
Rp
1,750,000
200,000
Rp
Rp
100,000
1,040,000
Rp
131,000
Rp
5,000
Rp
10,000
Rp
175,000
Rp
183,000
Rp
5,000
Rp
10,000
Rp
158,000
Rp
81,500
Rp
5,000
Rp
20,000
Rp
210,500
Rp
153,000
Rp
5,000
Rp
10,000
Rp
198,000
Rp
236,000
Rp
5,000
Rp
300,000
Rp
10,000
Rp
123,000
Rp
961,000
Rp
10,000
Rp
220,000
Rp
210,000
Rp
261,000
Rp
5,000
Rp
30,000
Rp
227,500
Rp
135,000
Rp
5,000
Rp
237,500
Rp
566,000
Rp
5,000
Rp
90,000
Rp
20,000
Rp
247,000
Rp
265,000
Rp
5,000
Rp
180,000
Rp
215,000
Rp
201,000
Rp
5,000
Rp
10,000
Rp
175,000
Rp
110,000
Rp
5,000
Rp
10,000
Rp
100,000
Rp
Rp
Rp
1,750,000
2,250,000
126,500
Rp
5,000
Rp
50,000
Rp
210,500
Rp
155,000
Rp
5,000
Rp
20,000
Rp
235,000
Rp
357,000
Rp
5,000
Rp
20,000
Rp
228,000
Rp
241,000
Rp
5,000
Rp
10,000
Rp
5,000
Rp
30,000
Rp
10,000
Rp
140,000
Rp
218,500
Rp
100,000
Rp
192,500
Rp
136,000
Rp
10,000
Rp
1,651,000
Rp
5,000
Rp
210,000
Rp
117,000
Rp
5,000
Rp
210,000
Rp
196,000
Rp
5,000
Rp
230,000
Rp
261,500
Rp
205,000
Rp
875,000
Rp
Rp
220,000
Rp
1,825,000
Rp
195,000
Rp
280,000
200,000
Rp
Rp
Rp
150,000
1,750,000
1,750,000
210,000
Rp
Rp
Rp
1,040,000
Rp
520,000
Rp
Rp
20,000
5,000
Rp
130,000
5,000
Rp
140,000
Rp
5,000
Rp
160,000
Rp
5,000
Rp
120,000
Rp
1,750,000
Rp
1,800,000
Rp
100,000
Rp
200,000
Rp
Rp
50,000
260,000
Rp
258,000
Rp
617,500
Rp
5,000
Rp
150,000
Rp
10,000
Rp
198,000
Rp
316,000
Rp
5,000
Rp
120,000
Rp
10,000
Rp
252,500
Rp
569,000
Rp
5,000
Rp
30,000
Rp
50,000
Rp
70,000
Rp
162,500
Rp
203,000
Rp
176,500
Rp
10,000
Rp
10,000
Rp
20,000
Rp
30,000
Rp
100,000
Rp
100,000
Rp
100,000
Rp
245,000
Rp
113,500
Rp
5,000
Rp
100,000
Rp
198,000
Rp
241,000
Rp
5,000
Rp
100,000
Rp
187,500
Rp
229,000
Rp
5,000
Rp
180,000
Rp
100,000
Rp
158,000
Rp
56,000
Rp
100,000
Rp
262,500
Rp
561,000
Rp
90,000
Rp
131,500
Rp
5,000
Rp
100,000
Rp
193,000
Rp
176,500
Rp
175,000
Rp
478,000
Rp
Rp
60,000
260,000
Rp
Rp
10,000
5,000
Tindakan Medis
Injeksi IV VK
Bersalin
Injeksi IV VK III
Injeksi IM
Rp
Injeksi IM (VK)
Injeksi IM VK
Bersalin
Injeksi IM
Nifas
Pasang Infus
5,000
5,000
Rp
Pasang Infus
Nifas
Observasi
5,000
5,000
Rp
Rp
25,000
25,000
Rp
650,000
Rp
550,000
Rp
Observasi VK
Rp
150,000
Rp
100,000
Rp
50,000
Rp
100,000
Rp
50,000
Rp
50,000
Rp
50,000
Rp
100,000
350,000
5,000
Rp
5,000
Rp
50,000
Rp
200,000
Rp
5,000
Rp
50,000 Rp
200,000
Rp
5,000
Rp
50,000
Rp
5,000
Rp
50,000
Rp
Observasi Nifas
700,000
5,000
Rp
Rp
Pasang Infus
VK
Rp
Rp
Rp
Injeksi IM VK
III
Rp
5,000
Rp
50,000 Rp
200,000
Rp
5,000
Rp
50,000 Rp
100,000
Rp
50,000 Rp
100,000
5,000
Rp
Rp
5,000
50,000
Observasi VK III
Observasi VK
Bersalin
Observasi IGD
Rp
5,000
Rp
Rp
Rp
5,000
Rp
5,000
Rp
5,000
Rp
5,000
Rp
10,000
Rp
15,000
Rp
10,000
Rp
Rp
10,000
Rp
5,000
Rp
10,000
Rp
Rp
Rp
Rp
Rp
Rp
5,000
Rp
Rp
50,000
Rp
100,000
Rp
50,000
Rp
100,000
Rp
50,000
Rp
150,000
Rp
100,000
Rp
200,000
Rp
50,000
Rp
100,000
Rp
50,000
Rp
100,000
Rp
200,000
50,000
50,000
50,000
50,000
Rp
5,000
Rp
100,000
Rp
50,000
Rp
100,000
Rp
50,000
Rp
150,000
50,000
5,000
5,000
Rp
100,000
5,000
10,000
Rp
Rp
50,000
5,000
Rp
50,000
50,000
25,000
Rp
Rp
50,000
5,000
Rp
Rp
Rp
5,000
Rp
Rp
50,000
100,000
Rp
5,000
Rp
Rp
Rp
Rp
25,000
5,000
Rp
Rp
50,000
Rp
Rp
25,000
5,000
Rp
100,000
Rp
5,000
Rp
50,000
Rp
Rp
10,000
5,000
10,000
Rp
Rp
Rp
Rp
100,000
Rp
50,000
Rp
100,000
Rp
100,000
Rp
100,000
Rp
150,000
Rp
100,000
Rp
150,000
Rp
100,000
Rp
250,000 Rp
150,000
Rp
400,000 Rp
100,000
50,000
Rp
Rp
100,000
50,000
5,000
5,000
Rp
100,000
50,000
50,000
Rp
5,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
Rp
Rp
10,000
10,000
Rp
Rp
Rp
Rp
Rp
Rp
10,000
Rp
50,000
Rp
100,000
Rp
100,000
Rp
100,000
Rp
50,000
Rp
200,000
Rp
150,000
Rp
200,000
Rp
100,000
Rp
150,000
Rp
100,000
Rp
100,000
Rp
100,000
50,000
50,000
50,000
50,000
50,000
50,000
5,000
10,000
Rp
Rp
100,000
5,000
10,000
Rp
Rp
50,000
25,000
Rp
150,000
150,000
5,000
10,000
Rp
50,000
Rp
250,000
Rp
50,000
Rp
100,000
50,000
5,000
Rp
Rp
50,000
Rp
Rp
10,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
10,000
Rp
10,000
Rp
Rp
50,000
Rp
50,000
Rp
50,000
Rp
Rp
200,000
100,000
Rp
200,000
Rp
50,000
Rp
100,000
Rp
100,000
Rp
150,000
Rp
100,000 Rp
50,000
Rp
100,000
Rp
100,000 Rp
200,000
Rp
100,000 Rp
100,000
Rp
100,000
Rp
100,000
50,000
25,000
10,000
Rp
50,000
25,000
10,000
Rp
Rp
50,000
50,000
50,000
100,000
25,000
Rp
Rp
10,000
Rp
Rp
125,000
Rp
100,000
50,000 Rp
100,000
50,000
Rp
100,000
Rp
50,000
Rp
Rp
5,000
Rp
45,000
Rp
25,000
5,000
Rp
Rp
Rp
Rp
10,000
Rp
100,000
Rp
50,000
25,000
Rp
50,000
Rp
550,000
Rp
45,000
Rp
450,000
Rp
25,000
Rp
350,000
Rp
25,000
Rp
25,000
5,000
5,000
Rp
Rp
Rp
5,000
100,000
Rp
100,000 Rp
100,000
Rp
100,000
Rp
200,000
Rp
100,000 Rp
100,000
Rp
100,000
Rp
150,000 Rp
100,000
Rp
50,000 Rp
100,000
Rp
150,000
Rp
200,000
Rp
50,000
Rp
200,000
Rp
100,000
Rp
100,000
Rp
50,000
Rp
50,000
Rp
50,000
Rp
50,000
Rp
50,000
Rp
100,000
Rp
50,000
Rp
300,000
50,000
10,000
Rp
100,000 Rp
350,000
10,000
5,000
Rp
Rp
Rp
Rp
50,000
Rp
5,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
5,000
Rp
Rp
Rp
50,000
50,000
50,000
Rp
Rp
25,000
5,000
Rp
10,000
Rp
50,000
Rp
20,000
Rp
50,000
Rp
Rp
10,000
10,000
Rp
Rp
Rp
10,000
25,000
Rp
Rp
100,000
Rp
100,000
Rp
50,000
Rp
100,000
Rp
100,000
Rp
100,000
Rp
50,000
Rp
100,000
Rp
50,000
Rp
100,000
Rp
100,000
Rp
200,000
Rp
100,000
Rp
200,000
100,000
50,000
5,000
Rp
50,000
50,000
Rp
Rp
Rp
50,000
Rp
Rp
Rp
5,000
Rp
5,000
Rp
Rp
Rp
Rp
5,000
Rp
Rp
5,000
Rp
50,000
Rp
100,000
Rp
100,000
Rp
100,000
Rp
50,000
Rp
100,000
Rp
50,000
Rp
200,000
Rp
100,000
Rp
150,000
Rp
100,000
Rp
50,000
Rp
200,000
Rp
50,000
50,000
5,000
Rp
Rp
Rp
10,000
Rp
5,000
10,000
50,000
5,000
Rp
Rp
Rp
100,000
200,000
Rp
Rp
Rp
Rp
10,000
5,000
50,000
50,000
Rp
Rp
Rp
Rp
50,000
5,000
150,000
5,000
Rp
Rp
Rp
50,000
10,000
5,000
100,000
Rp
5,000
Rp
Rp
50,000
Rp
Rp
50,000
50,000
5,000
5,000
Rp
50,000
50,000
Rp
50,000
Rp
50,000
5,000
Rp
50,000
Rp
Rp
10,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
50,000
Rp
10,000
Rp
50,000
Rp
Rp
10,000
10,000
Rp
50,000
Rp
150,000
Rp
50,000
Rp
100,000
Rp
200,000
Rp
100,000
Rp
150,000
Rp
50,000
Rp
200,000
Rp
50,000
Rp
100,000
Rp
100,000
Rp
150,000
Rp
100,000
Rp
100,000
Rp
100,000
Rp
100,000
Rp
50,000
Rp
100,000
50,000
5,000
Rp
300,000
50,000
Rp
Rp
Rp
50,000
5,000
10,000
50,000
50,000
10,000
Rp
Rp
50,000
Rp
Rp
100,000
50,000
5,000
5,000
Rp
100,000
5,000
10,000
50,000
50,000
5,000
10,000
Rp
50,000
5,000
10,000
Rp
Rp
5,000
50,000
Rp
Rp
Rp
10,000
Rp
5,000
Rp
10,000
Rp
5,000
Rp
Rp
Rp
Rp
10,000
Rp
10,000
Rp
5,000
Rp
Rp
10,000
Rp
50,000
Rp
10,000
20,000
50,000
Rp
100,000
Rp
50,000
Rp
200,000
Rp
100,000
Rp
200,000
Rp
50,000
Rp
100,000
Rp
50,000
Rp
100,000
Rp
100,000
Rp
50,000
Rp
100,000
Rp
50,000
Rp
100,000
Rp
50,000
Rp
Rp
5,000
Rp
Rp
Rp
100,000
50,000
10,000
10,000
Rp
50,000
Rp
Rp
50,000
50,000
5,000
10,000
Rp
Rp
100,000
Rp
300,000
Rp
100,000
Rp
200,000
Rp
100,000
50,000
5,000
Rp
Rp
50,000
100,000
100,000
Rp
100,000
Rp
10,000
Rp
Rp
5,000
Rp
Rp
100,000
Rp
200,000
Rp
100,000
Rp
50,000
Rp
100,000
Rp
100,000
Rp
100,000
50,000
25,000
Rp
5,000
Rp
200,000
Rp
5,000
Rp
100,000
Rp
100,000
Rp
25,000
Rp
25,000
Rp
100,000
Rp
100,000
Rp
50,000
Rp
50,000
Rp
50,000
Rp
50,000
Rp
100,000
Rp
200,000
Rp
100,000
Rp
50,000
Pasang OGT
Nebulizer
Inkubator
Rp
Jahit luka
Jahit Luka VK
Jahit Luka VK
Angkat jahitan Rawat Luka OP
Bersalin
Rawat Luka OP
Nifas
Suction
CPAP
Heacting
Perawatan
Jenazah
Perawatan Jenazah
Perinatalogi
700,000
Rp
Rp
650,000
Rp
20,000
Rp
550,000
Rp
20,000
Rp
250,000
300,000
Rp
10,000
Rp
10,000
Rp
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
350,000
100,000
Konseling
Biaya Tindakan
Poli Umum
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
10,000
Rp
Rp
150,000
50,000
Rp
100,000
Rp
250,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
10,000
Rp
Rp
200,000
50,000
Rp
200,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
75,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
150,000
Rp
50,000
Rp
Rp
Rp
50,000
Rp
75,000
Rp
75,000
50,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
75,000
50,000
Rp
Rp
10,000
75,000
50,000
Rp
Rp
Rp
250,000
Rp
Rp
10,000
75,000
50,000
Rp
Rp
75,000
Rp
75,000
Rp
150,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
50,000
Rp
Rp
75,000
50,000
Rp
Rp
75,000
50,000
Rp
Rp
75,000
75,000
50,000
Rp
75,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
10,000
Rp
Rp
50,000
150,000
Rp
Rp
75,000
Rp
75,000
50,000
Rp
Rp
Rp
Rp
Rp
75,000
Rp
75,000
50,000
Rp
Rp
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
75,000
50,000
Rp
10,000
75,000
50,000
Rp
Rp
75,000
50,000
Rp
10,000
75,000
50,000
Rp
Rp
75,000
Rp
Rp
Rp
75,000
Rp
75,000
250,000
50,000
Rp
Rp
40,000
Rp
500,000
Rp
20,000
Rp
50,000
Rp
75,000
Rp
75,000
Rp
10,000
Rp
10,000
Rp
10,000
200,000
Rp
100,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
50,000
Rp
Rp
Rp
75,000
Rp
75,000
Rp
75,000
50,000
50,000
Rp
Rp
50,000
Rp
50,000
Rp
Rp
Rp
Rp
Rp
50,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
75,000
75,000
75,000
50,000
Rp
10,000
75,000
50,000
Rp
Rp
75,000
Rp
Rp
200,000
50,000
Rp
Rp
Rp
10,000
Rp
10,000
Rp
10,000
75,000
50,000
Rp
Rp
200,000
50,000
Rp
Rp
Rp
150,000
50,000
Rp
Rp
10,000
75,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
75,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
Rp
Rp
50,000
Rp
75,000
Rp
75,000
50,000
100,000
Rp
Rp
250,000
50,000
250,000
100,000
Rp
200,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
300,000
Rp
100,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
Rp
50,000
Rp
Rp
75,000
150,000
50,000
Rp
300,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
10,000
Rp
75,000
Rp
50,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
10,000
Rp
Rp
Rp
50,000
75,000
350,000
Rp
350,000
Rp
75,000
Rp
50,000
Rp
10,000
Rp
50,000
Rp
10,000
Rp
10,000
Rp
Rp
300,000
50,000
Rp
300,000
Rp
50,000
Rp
10,000
Rp
100,000
Rp
10,000
Rp
10,000
Rp
10,000
Rp
20,000
Rp
Rp
50,000
Rp
Rp
150,000
50,000
Rp
Rp
75,000
100,000
75,000
Rp
Rp
75,000
50,000
Rp
Rp
10,000
75,000
Mengetahui
dr.H.Daru Dewa, M.Kes
NIP.19680710 199803 1 011
JUMLAH
TAGIHAN
UPF
Perinatologi
Rp
6,838,000
08.19.88
Obstetri
Rp
2,917,500
08.17..76
Perinatologi
Rp
4,798,000
08.18.83
Perinatologi
Rp
4,605,000
08.21.49
Obstetri
Rp
2,301,000
08.27.19
Perinatologi
Rp
2,960,000
08.27.72
Obstetri
Rp
2,447,500
08.33.80
Perinatologi
Rp
165,000
08.33.86
Obstetri
Rp
3,475,000
08.30.13
Ginekologi
Rp
5,366,500
08.22.68
Obstetri
Rp
2,429,000
07.95.16
Perinatologi
Rp
675,000
08.29.48
Perinatologi
Rp
650,000
08.29.49
Obstetri
Rp
2,216,000
08.29.13
Obstetri
Rp
2,392,500
08.30.05
Perinatologi
Rp
550,000
08.30.08
Obstetri
Rp
2,512,000
08.10.11
Perinatologi
Rp
455,000
08.30.09
Obstetri
Rp
2,187,000
08.79.10
Perinatologi
Rp
455,000
08.13.64
Obstetri
Rp
2,325,000
08.31.59
Perinatologi
Rp
475,000
08.31.62
Obstetri
Rp
3,075,500
08.33.39
Obstetri
Rp
2,878,500
08.37.42
Perinatologi
Rp
742,000
08.37.43
Obstetri
Rp
5,830,500
08.33.54
Perinatologi
Rp
690,000
08.37.48
Obstetri
Rp
2,320,500
08.36.98
Perinatologi
Rp
470,000
08.36.99
Obstetri
Rp
2,426,000
08.37.45
Perinatologi
Rp
595,000
08.37.57
Obstetri
Rp
2,547,000
08.37.54
Perinatologi
Rp
470,000
08.37.87
Obstetri
Rp
7,175,000
08.27.93
Perinatologi
Rp
865,000
08.28.51
Obstetri
Rp
2,714,000
08.27.95
Perinatologi
Rp
935,000
08.28.53
Obstetri
Rp
4,449,500
08.29.44
Perinatologi
Rp
1,141,000
08.29.96
Obstetri
Rp
9,523,000
08.29.65
Perinatologi
Rp
875,000
08.30.28
Obstetri
Rp
2,566,000
08.30.69
Perinatologi
Rp
455,000
08.30.90
Ginekologi
Rp
14,364,500
07.46.49
Ginekologi
Rp
10,038,000
08.21.34
Ginekologi
Rp
912,500
07.27.04
Obstetri
Rp
2,006,000
08.34.31
Perinatologi
Rp
395,000
08.34.38
Obstetri
Rp
11,356,500
08.33.96
Perinatologi
Rp
1,105,000
08.34.29
Obstetri
Rp
12,204,000
08.34.30
Perinatologi
Rp
830,000
08.35.31
Obstetri
Rp
11,014,000
08.34.50
Perinatologi
Rp
1,085,000
08.34.53
Obstetri
Rp
9,290,000
08.35.41
Perinatologi
Rp
860,000
08.34.68
Obstetri
Rp
2,771,000
08.35.89
Perinatologi
Rp
720,000
08.35.94
Obstetri
Rp
8,351,000
08.36.02
Perinatologi
Rp
815,000
08.36.05
Obstetri
Rp
9,195,500
08.37.68
Perinatologi
Rp
950,000
08.37.92
Ginekologi
Rp
3,999,500
08.38.68
Obstetri
Rp
9,736,000
08.38.36
Perinatologi
Rp
1,085,000
08.38.58
Obstetri
Rp
9,501,000
08.37.86
Perinatologi
Rp
960,000
08.37.94
Obstetri
Rp
7,729,000
08.05.74
Perinatologi
Rp
950,000
08.36.97
Obstetri
Rp
3,570,000
08.39.14
Perinatologi
Rp
430,000
08.39.33
Obstetri
Rp
2,335,000
07.17.30
Perinatologi
Rp
500,000
08.30.60
Obstetri
Rp
2,271,000
08.37.76
Perinatologi
Rp
470,000
08.37.97
Ginekologi
Rp
8,946,500
08.11.64
Obstetri
Rp
1,121,500
08.39.51
Ginekologi
Rp
1,044,000
08.39.68
Obstetri
Rp
10,148,500
08.00.30
Perinatologi
Rp
1,032,500
08.30.96
Ginekologi
Rp
3,340,000
08.23.12
Obstetri
Rp
9,207,500
08.10.72
Perinatologi
Rp
970,000
08.36.48
Ginekologi
Rp
9,782,000
08.27.34
Obstetri
Rp
8,825,500
08.29.32
Perinatologi
Rp
847,000
08.37,51
Obstetri
Rp
9,230,000
08.37.69
Perinatologi
Rp
950,000
08.37.73
Ginekologi
Rp
9,480,500
08.35.32
Obstetri
Rp
13,227,000
07.99.44
Perinatologi
Rp
1,183,000
08.31.73
Ginekologi
Rp
16,744,000
08.24.31
Ginekologi
Rp
5,536,500
08.30.18
Obstetri
Rp
9,819,000
08.30.24
Perinatologi
Rp
890,000
08.30.61
Ginekologi
Rp
12,825,500
08.19.78
Obstetri
Rp
10,195,500
08.25.72
Obstetri
Rp
9,525,000
08.27.67
Perinatologi
Rp
2,552,000
08.27.72
Ginekologi
Rp
7,491,000
08.36.26
Obstetri
Rp
10,886,000
07.93.90
Perinatologi
Rp
855,000
08.29.95
Obstetri
Rp
3,079,000
08.34.95
Obstetri
Rp
2,584,000
08.36.72
Ginekologi
Rp
5,373,500
08.31.71
Ginekologi
Rp
3,634,000
08.29.89
Ginekologi
Rp
4,887,000
08.34.01
Obstetri
Rp
3,674,000
08.34.56
Ginekologi
Rp
3,750,000
08.30.94
Perinatologi
Rp
3,240,000 08.30.22
Perinatologi
Rp
2,815,000 08.23.25
Perinatologi
Rp
2,107,500 08.25.62
Ginekologi
Rp
835,000
08.37.80
Obstetri
Rp
1,103,000
08.12.73
Obstetri
Rp
1,001,000
08.24.26
Obstetri
Rp
971,000
08.27.34
Obstetri
Rp
3,075,500
08.33.39
Perinatologi
Rp
665,000
08.33.75
Obstetri
Rp
3,416,000
07.39.79
Perinatologi
Rp
520,000
08.40.55
Obstetri
Rp
2,217,000
08.39.23
Perinatologi
Rp
470,000
08.39.80
Obstetri
Perinatologi
Obstetri
Perinatologi
Rp
Rp
Rp
Rp
9,167,000
855,000
9,694,000
895,000
08.37.77
08.37.88
08.12.73
08.40.05
Obstetri
Rp
10,364,500
08.24.77
Perinatologi
Rp
1,010,000
08.25.59
Obstetri
Rp
7,424,000
08.37.57
Perinatologi
Rp
835,000
08.38.65
Obstetri
Perinatologi
Rp
Rp
7,194,000
980,000
08.39.02
08.39.74
Obstetri
Rp
8,745,000
08.39.11
Perinatologi
Rp
965,000
08.39.32
Obstetri
Rp
8,799,000
07.67.17
Perinatologi
Rp
940,000
08.40.02
Obstetri
Rp
11,196,000
08.39.70
Perinatologi
Rp
805,000
08.39.94
Obstetri
Rp
2,325,000
Perinatologi
Rp
425,000
08.34.67
Obstetri
Rp
9,500,000
08.34.70
Perinatologi
Rp
780,000
08.35.29
Obstetri
Rp
2,673,000
08.35.99
Perinatologi
Rp
515,000
08.36.51
Obstetri
Rp
2,621,000
08.31.23
Perinatologi
Rp
135,000
08.33.73
Obstetri
Rp
2,333,000
08.00.68
Perinatologi
Rp
455,000
08.31.65
Obstetri
Rp
9,400,000
08.02.34
Perinatologi
Rp
1,460,000
08.35.84
Perinatologi
Rp
1,480,000
08.35.85
Obstetri
Rp
10,384,000
08.28.24
Perinatologi
Rp
685,000
08.29.52
Obstetri
Rp
2,302,000
08.26.50
Perinatologi
Rp
495,000
08.27.09
Obstetri
Rp
2,577,000
08.25.98
Perinatologi
Rp
445,000
08.26.49
Obstetri
Rp
9,091,000
08.01.98
Perinatologi
Rp
920,000
08.39.44
Obstetri
Perinatologi
Rp
Rp
11,458,500
1,182,500
08.38.47
08.39.87
Obstetri
Rp
2,445,000
08.43.69
Perinatologi
Rp
450,000
08.44.33
Obstetri
Rp
2,086,000
08.50.37
Perinatologi
Rp
450,000
08.50.38
Obstetri
Rp
2,773,000
08.43.73
Perinatologi
Rp
555,000
08.45.56
Obstetri
Rp
2,454,500
08.45.89
Perinatologi
Rp
580,000
08.46.00
Obstetri
Rp
Perinatologi
Rp
575,000
08.45.05
Obstetri
Rp
10,459,000
08.45.92
Perinatologi
Rp
1,055,000
08.47.00
Obstetri
Rp
8,219,000
07.73.23
Perinatologi
Rp
855,000
08.47.92
Obstetri
Rp
2,866,000
08.49.71
Perinatologi
Rp
565,000
08.50.20
Obstetri
Rp
2,137,500
08.45.68
Perinatologi
Rp
445,000
08.41.75
Obstetri
Rp
9,163,500
07.99.48
Perinatologi
Rp
1,055,000
08.48.58
2,228,500 08.39.400
Obstetri
Rp
8,657,000
08.43.62
Perinatologi
Rp
880,000
08.43.63
Obstetri
Rp
2,366,000
08.05.75
Perinatologi
Rp
520,000
08.49.02
Obstetri
Rp
2,410,000
08.17.92
Perinatologi
Rp
390,000
08.47.04
Obstetri
Rp
4,016,500
08.49.50
Perinatologi
Rp
155,000
08.49.55
Obstetri
Rp
1,065,500
08.24.29
Ginekologi
Rp
3,667,000
07.11.67
Obstetri
Rp
4,809,000
08.40.94
Ginekologi
Rp
4,898,500
08.49.58
Ginekologi
Rp
2,848,500
08.47.88
Obstetri
Rp
12,101,000
08.46.37
Perinatologi
Rp
815,000
08.46.90
Obstetri
Rp
2,192,000
08.41.45
Perinatologi
Rp
470,000
08.42.41
Obstetri
Rp
Perinatologi
Rp
470,000
08.42.42
Obstetri
Rp
3,956,500
08.34.97
Perinatologi
Rp
450,000
08.40.86
Perinatologi
Rp
500,000
08.40.87
Obstetri
Rp
10,030,000
08.09.36
Perinatologi
Rp
870,000
08.41.09
Obstetri
Rp
12,437,500
08.41.14
Perinatologi
Rp
890,000
08.41.19
Obstetri
Rp
8,625,000
08.42.71
Perinatologi
Rp
905,000
07.42.76
2,571,000 08.411.35
Obstetri
Rp
9,325,500
08.01.76
Perinatologi
Rp
880,000
08.44.36
Ginekologi
Rp
8,784,000
05.93.65
Ginekologi
Rp
5,146,500
08.41.31
Ginekologi
Rp
3,027,500
08.44.50
Ginekologi
Rp
3,109,500
08.41.41
Ginekologi
Rp
2,798,500
08.42.77
Ginekologi
Rp
1,314,000
08.42.17
Ginekologi
Rp
1,676,500
08.37.80
Obstetri
Rp
794,000
08.49.47
Ginekologi
Rp
1,758,500
08.42.72
Ginekologi
Rp
981,500
08.36.13
Ginekologi
Rp
2,759,500
08.41.57
Ginekologi
Rp
3,988,000
08.39.76
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
819,197,500
Sepunggur,
Desember 2013
Bendahara Jamkesmas
M.Adhi Sulaiman
NIP.19840415 200908 1 001
DAFTAR TAGIHAN OBAT KLAIM RAWAT INAP PASIEN JAMKESDA RSUD TANAH BUMBU
NO
NAMA PASIEN
BULAN :
TAHUN :
NO.REKOMENDASI
JAMKESDA
Umur (Thn)
TANGGAL
DIAGNOSA
P
30
40
Masuk
29 Nopember 2012
25 Nopember 2012
28 Nopember 2012
Keluar
05 Desember 2012
11 Desember 2012
17 Desember 2012
1
2
3
Anita
Warsiki
By Marti
33811
33780
33807
Tamsiyah
33803
39
29 Nopember 2012
03 Desember 2012
5
6
Safarina Anggraini
Siti Fiteriani
33808
33798
22
25
03 Desember 2012
27 Nopember 2012
05 Desember 2012
04 Desember 2012
Jum'riah
31484
45
04 Desember 2012
08 Desember 2012
8
9
10
11
12
13
14
15
16
17
18
19
20
M. Ilyas
Iva Isnaini
Nur'aidah
Abdul Aziz
Muna
Rusmatika
Juhanah
Tn Johardin
33828
33826
33840
33839
13290
33875
33894
33919
0 (Hr)
16
25
48
25
40
24
37
25
05 Desember 2012
08 Desember 2012
04 Desember 2012
08 Desember 2012
08 Desember 2012
12 Desember 2012
09 Desember 2012
16 Desember 2012
14 Desember 2012
21 Desember 2012
17 Desember 2012
21 Desember 2012
20 Desember 2012
26 Desember 2012
###################### #####################
Obat
Rp
Rp
Rp
73,625
208,500
892,500
Obs Febris Susp Malaria dd thypoid Rp
22,800
FAM
Susp DHF + Malaria
Rp
Rp
559,750
15,000
Retensi Urine Susp Mioma Uteri
Rp
1,517,456
Hepatitis A
Hepatitis Virus
Susp SNH
Efusi Pleura
Obs Stoke Hemoragik
Anemia
G7P4A2
Obs Dyspepsia + Gastritis
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
55,000
32,800
317,300
115,000
935,500
144,760
326,000
63,100
G4P3A0
Colic Abdomonal
Sepsis Cleonatarum + BBLSR
JUMLAH TOTAL
Sepunggur, 15 Januari 2013

Mengetahui
Bendahara Jamkesmas
dr. H. Daru Dewa, M.Kes

NIP. 19680710 199803 1 011
M. Adhi Sulaiman
NIP. 19840415 200908 1 001
Desember
2012
JUMLAH
TAGIHAN
Rp
Rp
Rp
73,625
208,500
892,500
Rp
22,800
Rp
Rp
559,750
15,000
Rp
1,517,456
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
55,000
32,800
317,300
115,000
935,500
144,760
326,000
63,100
5,279,091
Sepunggur, 15 Januari 2013

Bendahara Jamkesmas
M. Adhi Sulaiman
NIP. 19840415 200908 1 001

NO
NAMA PASIEN
NO.REKOMENDASI
JAMKESDA
Umur (Thn)
L
33
TANGGAL
Masuk
03 Agustus 2012
21 Agustus 2012
28 Agustus 2012
28 Agustus 2012
29 Agustus 2012
31 Agustus 2012
1
2
3
4
5
6
Rusian Wahyudi
Nor Ainah
M. Sipe
Gunawan
Hayat Syamsudin
Lippu
33407
33102
9913
33310
33472
33474
Suryaningsih
33496
24
31 Agustus 2012
Sumarmi
33471
50
01 September 2012
Andre Hernuan / M Ramadhan
33479
10
11
12
13
14
15
16
Arpiah
Adi Setiawan / Wahyu Saputra
Jawahir
Rohmiati
By Syafi'atul Uzma
Jenah
Juarti
33483
33487
33500
33558
33489
15321
33493
17
Bahrun
33490
18
19
20
Suparmi
Marisa Dewi
Ulfah Nurul
20152
33515
33501
21
Yahmarudin
33512
22
23
24
25
Mahrita
By Mina
Supiani
Mustaming
33504
33508
29536
33521
26
Siti Nafisah
27
28
29
30
31
Masumi
By Vera Yulita
Suginem
Cunde
M. Rayhan
21
67
56
52
42
10
01 September 2012
60
4
70
25
2 (Bln)
32
46
40
02 September 2012
03 September 2012
03 September 2012
04 September 2012
13 September 2012
04 September 2012
05 September 2012
05 September 2012
47
24
32
35
06 September 2012
06 September 2012
06 September 2012
07 September 2012
34
3 (Hr)
07 September 2012
07 September 2012
07 September 2012
07 September 2012
33496
39
07 September 2012
32506
33520
33509
33507
33527
43
1 ( Hr)
60
08 September 2012
08 September 2012
08 September 2012
08 September 2012
09 September 2012
50
50
65
1
32
33
34
35
Nanda Saputra/an M. Rauf

Dian Ariyama
Hardiana
Vera Yulita
33509
33491
33513
33519
36
Tunia Wati
33543
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
68
69
70
71
72
73
74
75
Yanto
Daimah
Muhyati
Sutrisno
Linda Sriyanti
Mahirap
Sri Juwariah
By Saiful Uzma
Mila Amalia
Ali Azhar
Lippu
Tukijem
Indo Upe
Kahar
Nonong
Murni
Mahjur
Riduan
M. Zainur Ramadani
Menceng
Hanisa
Maryam
Rukmiati
Ainun
Dika
M. Nor Efendi
Hamzah
Iriani
Basse Hikmawati
By Syafi'atul Uzma
Suwardiyono
Abd. Hafid
Madiana
Renawati
Marhana
Rusmin
Nurlaina
M. Amirullah
Sudirman
33525
32356
33516
33518
33528
33551
33531
33495
33532
33540
33474
33545
33526
33549
33544
33542
33533
33560
33541
33556
33547
33552
33546
33557
33555
33566
33559
33535
33564
33489
33567
33561
33562
33569
33463
33524
33578
33065
33495
76
By Ulfah Nurul
33505
9
47
44
24
09 September 2012
06 September 2012
10 September 2012
08 September 2012
29
10 September 2012
50
36
30
70
23
41
40
2 (Bln)
20
3 (Bln)
42
44
44
40
30
50
60
55
1 (Bln)
52
36
30
32
20
18
23
12
30
25
3 (Bln)
13
60
23
35
50
55
40
53
40
0 (Hr)
10 September 2012
11 September 2012
11 September 2012
12 September 2012
12 September 2012
12 September 2012
12 September 2012
13 September 2012
14 September 2012
15 September 2012
16 September 2012
16 September 2012
17 September 2012
17 September 2012
17 September 2012
17 September 2012
17 September 2012
18 September 2012
18 September 2012
18 September 2012
18 September 2012
19 September 2012
19 September 2012
19 September 2012
19 September 2012
20 September 2012
21 September 2012
21 September 2012
23 September 2012
23 September 2012
23 September 2012
23 September 2012
23 September 2012
24 September 2012
26 September 2012
26 September 2012
27 September 2012
27 Agustus 2012
05 September 2012
06 September 2012
77
78
BULAN : Septembner
Pelayanan Kes.Dan Besaran Tarif sesuai PERDA (Rp)
TANGGAL
DIAGNOSA
Akomodasi
Keluar
03 September 2012
08 September 2012
01 September 2012
12 September 2012
05 September 2012
10 September 2012
Penetrating Thoraxo Abdomial

Suspect Tumor Abdomen
Decomp Cordis cc Asmd
Decomp Cordis cc Asmd
Syndrom Dispepsia
Smoke Islienik
Jasa Medis
Spesialis
Jasa Medis
Umum
Rp 1,550,000 Rp
Rp 850,000 Rp
Rp 200,000 Rp
Rp 750,000 Rp
Rp 350,000 Rp
Rp 550,000 Rp
780,000
330,000
60,000
360,000
180,000
300,000
04 September 2012 G1PoA, kala II Loma gawat Janin
Rp
200,000 Rp
120,000
01 September 2012 Ca. Mamae

Suspect Hepatitis + Ensepalopati
02 September 2012
Fibrosa
10 September 2012 Musa Abdomen, Mioma Uteri
05 September 2012 Abshes Colli
06 September 2012 Anemia
09 September 2012 Ketuban Mudighae
16 September 2012 Diare Cair Akut
07 September 2012 Abortus
08 September 2012 Gastritis
Obs Hipoestesia Perianal Post
08 September 2012
Trauma + Retensio Urine
07 September 2012 Mioma Uteri
12 September 2012 Ispa
15 September 2012 Partus Abnorm dgn SC
Multiple Laceratum Wound +
08 September 2012
Fractur Phalange P Roximal
10 September 2012 Retensio Plasenta
11 September 2012 Hiperbilirubinemia
08 September 2012 Koma Hipoglikemia
15 September 2012 Asma Attack
Rp
Rp
Rp
Rp
Rp
200,000
200,000
50,000
450,000
10 September 2012 G1 Hamil Aterm dgn gawat janin
Rp
200,000 Rp
120,000
10 September 2012
24 September 2012
15 September 2012
20 September 2012
12 September 2012
Rp
Rp
Rp
Rp
Rp
150,000
850,000
400,000
600,000
150,000
Rp
480,000 Rp
210,000 Rp
270,000 Rp
90,000
Obs Cholic Abdomen

Asfiksia Berat +BBLC
Hipertensi Emergency
Malaria
Diare Cair Akut
Rp
Rp
Rp
Rp
Rp
Rp
100,000
140,000
40,000
60,000
20,000
20,000
50,000 Rp
30,000 Rp
20,000
Rp
100,000 Rp
30,000 Rp
20,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
400,000
150,000
200,000
300,000
150,000
200,000
200,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
240,000
60,000
90,000
180,000
60,000
120,000
60,000
Rp
Rp
20,000
20,000
Rp
20,000
Rp
40,000
200,000 Rp
90,000 Rp
20,000
Rp
Rp
Rp
100,000 Rp
300,000 Rp
500,000 Rp
60,000
120,000 Rp
150,000 Rp
40,000
100,000
Rp
50,000 Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
30,000
120,000
120,000
30,000 Rp
210,000 Rp
20,000
40,000
60,000
20,000
20,000
60,000
13 September 2012
13 September 2012
12 September 2012
24 September 2012
17 September 2012
Malaria dgn Komplikasi

Gangren Diabets
Syndrom Dispepsia
Kala II Inpartus dgn SC
G3P2A0 Hamil 34 minggu dgn
Inpartus
Asma Attack
Ulcus Pepticum
Retensio Plasenta
Calic Abdomen
Tuba Ovarium Abses
Hil
Mioma Uteri
Diare Cair Akut
Dyspepsia
Mertigoensetalitis
Stroke Iskemik
Stroke Iskemik
P0A0 dgn cista Ovarium
Kiral Inspection
G3P2A0 PEW
Syndrom Dispepsia
Syndrom Dispepsia
PPOK
Imetigo Krustosub
HIL
Asma Bronkeal
Placenta Previa
G4P3A0
G1P0A0 Kala II lama
Malaria
Open Fractur Talus
CKE
Soft Tissue Tumor
Retensio Plasenta
Diare Cair Akut
Heald Injury GCS 15
ISPA
Malaria Tropik
G3P2A0 dgn PEB
Stroke Intrakranial
HIL
13 September 2012
14 September 2012
13 September 2012
14 September 2012
14 September 2012
15 September 2012
17 September 2012
16 September 2012
21 September 2012
20 September 2012
22 September 2012
26 September 2012
21 September 2012
21 September 2012
21 September 2012
24 September 2012
19 September 2012
29 September 2012
21 September 2012
21 September 2012
24 September 2012
21 September 2012
23 September 2012
21 September 2012
21 September 2012
28 September 2012
22 September 2012
25 September 2012
24 September 2012
25 September 2012
25 September 2012
27 September 2012
26 September 2012
25 September 2012
28 September 2012
29 September 2012
28 September 2012
03 September 2012 DM Type II
13 September 2012 Cirosis Hapatis
Abfirasi Meconium Hipoxic
15 September 2012
Ischemic
Rp
Rp
Rp
Rp
200,000
400,000
150,000
850,000
Rp
Rp
Rp
Rp
120,000
240,000
60,000 Rp
480,000 Rp
20,000
20,000
Rp
150,000 Rp
60,000 Rp
20,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
150,000
200,000
150,000
150,000
150,000
150,000
150,000
150,000
400,000
300,000
350,000
550,000
250,000
250,000
200,000
400,000
150,000
600,000
200,000
200,000
350,000
150,000
450,000
150,000
150,000
400,000
100,000
250,000
50,000
150,000
150,000
250,000
200,000
200,000
150,000
200,000
100,000
400,000
400,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
60,000
90,000
90,000
60,000
60,000
90,000
90,000
60,000
120,000
120,000
150,000
240,000
150,000
60,000
120,000
60,000
60,000
180,000
120,000
120,000
30,000
90,000
240,000
90,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
180,000
30,000
120,000
30,000
60,000
60,000
90,000
60,000
90,000
90,000
90,000
60,000
150,000
180,000
250,000 Rp
300,000
Rp
Rp
20,000
20,000
Rp
Rp
20,000
20,000
Rp
Rp
Rp
Rp
Rp
20,000
80,000
40,000
40,000
60,000
Rp
60,000
Rp
Rp
Rp
120,000
20,000
120,000
Rp
Rp
20,000
120,000
Rp
20,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
60,000
40,000
20,000
20,000
20,000
20,000
20,000
40,000
40,000
20,000
Rp
20,000
Rp
Rp
60,000
40,000
DAFTAR TAGIHAN KALIM RAWAT JALA
AN : Septembner
ai PERDA (Rp)
Jasa Keperawatan
Tindakan Kecil
Rp
Rp
Rp
Rp
Rp
Rp
620,000
360,000
80,000
320,000
140,000
200,000
Rp
80,000
Rp
20,000
Rp
60,000
Rp
Rp
Rp
Rp
Rp
Tindakan di UGD
Tindakan
Tindakan
Sedang
Intensif
Rp 210,000 Rp 1,350,000
Rp 120,000 Rp 180,000
Rp
30,000
Rp 160,000
Rp
30,000
Rp
30,000
180,000 Rp
20,000 Rp
80,000 Rp
40,000
80,000
Rp
60,000 Rp
Rp
80,000
10,000
90,000 Rp
Rp
Rp
180,000 Rp
Rp
135,000 Rp
Rp
30,000
10,000 Rp
10,000
10,000 Rp
10,000
10,000
10,000
10,000
10,000
10,000
Rp
Rp
135,000 Rp
10,000
10,000
10,000
Rp
10,000
Rp
80,000 Rp
160,000
60,000
45,000 Rp
90,000 Rp
Rp
Rp
10,000
10,000
10,000
10,000
Rp
90,000 Rp
10,000 Rp
Rp
150,000 Rp
90,000
30,000
Rp
450,000 Rp
315,000 Rp
Rp
Rp
10,000
10,000
10,000
10,000
10,000 Rp
20,000 Rp
60,000
Rp
Rp
Rp
Rp
60,000
60,000 Rp
40,000 Rp
180,000 Rp
Rp
Kecil
Rp
100,000
Rp
100,000
Rp
Rp
Rp
100,000
100,000
100,000
Rp
100,000
Rp
100,000
Rp
100,000
50,000
10,000
Rp
Rp
60,000
20,000
140,000 Rp
240,000 Rp
80,000 Rp
90,000 Rp
60,000 Rp
90,000
30,000
Rp
90,000
Rp
Rp
Rp
Rp
Rp
10,000
10,000
10,000
10,000
10,000
10,000
90,000 Rp
20,000
140,000 Rp
40,000
80,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Sederhana
Rp
Rp
Rp
Berkas RM
50,000
50,000
50,000
Rp
Rp
Rp
Rp
100,000
160,000 Rp
60,000
20,000
Rp
40,000
Rp
Rp
Rp
Rp
Rp
Rp
60,000
80,000
60,000
60,000
60,000
80,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
80,000
160,000
120,000
140,000
220,000
40,000
100,000
20,000
140,000
60,000
220,000
20,000
80,000
120,000
20,000
80,000
60,000
60,000
60,000
20,000
100,000
40,000
60,000
60,000
80,000
60,000
60,000
60,000
20,000
Rp
Rp
160,000 Rp
160,000 Rp
Rp
20,000
Rp
10,000
10,000
10,000
10,000
Rp
Rp
Rp
100,000
100,000
100,000
Rp
90,000 Rp
Rp
Rp
405,000 Rp
Rp
90,000 Rp
10,000
Rp
100,000
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
20,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
10,000
20,000
10,000
10,000
10,000
10,000
10,000
Rp
100,000
Rp
100,000
Rp
Rp
100,000
100,000
Rp
Rp
100,000
100,000
Rp
Rp
100,000
100,000
Rp
Rp
100,000
100,000
Rp
Rp
100,000
100,000
Rp
Rp
Rp
Rp
100,000
100,000
100,000
100,000
Rp
100,000
Rp
100,000
360,000 Rp
10,000
360,000
Rp
Rp
Rp
60,000
30,000
90,000
Rp
Rp
90,000 Rp
30,000 Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
30,000
90,000 Rp
60,000
90,000 Rp
Rp
30,000
60,000 Rp
30,000
60,000
60,000
60,000 Rp
90,000
30,000
Rp
120,000 Rp
Rp
45,000
45,000
270,000
360,000
135,000
180,000
90,000
135,000
90,000
90,000
240,000 Rp
30,000
120,000 Rp
Rp
60,000
60,000
90,000
30,000
Rp
270,000
90,000 Rp
Rp
120,000
30,000
135,000
45,000
Rp
45,000
90,000
135,000
JUMLAH TOTAL
Mengetahui
dr. H. Daru Dewa, M.Kes

NIP. 19680710 199803 1 011
DAFTAR TAGIHAN KALIM RAWAT JALAN PASIEN JAMKESDA RSUD TANAH BUMBU
Tindakan di UGD
Sedang
Rp
Besar
Persalinan
Normal
Persalinan Sulit
Resusitasi Bayi
Baru Lahir
125,000
Rp
Rp
125,000
Rp
125,000
Rp
125,000
Rp
125,000
200,000
125,000
Rp
Rp
125,000
Rp 3,500,000
Rp
Rp
Kuretasi +
Anastesi
125,000
125,000
Rp
Rp
Rp
Rp
Rp
800,000
Rp
800,000
Rp
125,000
Rp
125,000
Rp
Rp
Rp
125,000
125,000
125,000
125,000
125,000
125,000
125,000
Rp 1,200,000
Rp
125,000
Rp 1,200,000
Rp
200,000
SUD Tanah Bumbu
ru Dewa, M.Kes
710 199803 1 011
JUMLAH TOTAL
n & Kebidanan
Kuretasi Sulit + Manual Plasenta +

Anastesi
Anastesi
Sederhana
Kecil
Sedang
Besar
Rp 1,000,000 Rp 1,750,000 Rp 5,000,000
Rp 4,000,000
Rp 4,000,000
Rp 1,750,000
Rp 4,000,000
Rp
1,625,000
Rp 5,000,000
Rp 1,750,000
Rp 1,750,000 Rp 5,000,000
Rp
1,625,000
Rp 1,750,000
Rp 4,000,000
Rp 4,000,000
Rp 4,000,000
Rp 5,000,000
Rp 4,000,000
Rp 5,000,000
Rp 1,750,000
Rp 1,750,000
Rp
1,625,000
Rp 4,000,000
Sepunggur,
November 2012
Bendahara Jamkesmas
M. Adhi Sulaiman
NIP. 19840415 200908 1 001
Anastesi
Khusus
Sederhana
Kecil
Rp
Sedang
360,000 Rp
Besar
600,000 Rp 1,750,000
Rp 1,400,000
Rp 1,400,000
Rp
600,000
Rp 1,400,000
Rp 1,750,000
Khusus
Rp
600,000
Rp
600,000 Rp 1,750,000
Rp
600,000
Rp 1,400,000
Rp 1,400,000
Rp 1,400,000
Rp 1,750,000
Rp 1,400,000 Rp 1,800,000
Rp 1,750,000
Rp 5,250,000
Rp
600,000
Rp
600,000
Rp 1,400,000
TAHUN :
2012
JUMLAH
Pemeriksaan
Penunjang
Tindakan
Medis
Rp 6,091,000
Rp 1,586,000 Rp
Rp 1,194,000
Rp 774,000
Rp 372,000
Rp 774,000
Obat
TAGIHAN
Rp 1,779,417 Rp
20,000 Rp 553,075 Rp
Rp
Rp 197,768 Rp
Rp
43,406 Rp
Rp 183,639 Rp
22,950,417
4,149,075
1,614,000
2,731,768
1,145,406
2,192,639
Rp
6,437,000
55,000 Rp
396,000
Rp
412,000
Rp
161,000
Rp
801,500
Rp
1,236,500
Rp
Rp
Rp
Rp
Rp
Rp
Rp
937,500
170,000
338,000
85,000
120,500
167,000
983,500
Rp 9,029,378 Rp
Rp
Rp
56,211 Rp
Rp 217,309 Rp
Rp 314,145 Rp
Rp
55,810 Rp
Rp 119,991 Rp
16,446,878
2,920,000
824,211
4,637,309
854,645
787,810
1,603,491
Rp
434,500
Rp
80,022 Rp
1,039,522
Rp 215,500
Rp 1,475,000
Rp 1,222,000 Rp
Rp
50,000 Rp
Rp
268,373 Rp
32,000 Rp
405,500
2,443,373
7,764,000
Rp
75,000
Rp
472,500
2,823,625
768,000
1,079,175
1,564,040
27,500 Rp
Rp
Rp
Rp
Rp
Rp
638,000
208,000
185,500
443,000
Rp
Rp
Rp
125,625 Rp
Rp
458,675 Rp
71,040 Rp
Rp
582,500
Rp
355,645 Rp
8,363,145
50,000 Rp
50,000 Rp
Rp
Rp
299,802 Rp
15,902 Rp
85,955 Rp
Rp
558,000
3,057,802
2,445,402
3,985,455
551,000
Rp 178,000
Rp 878,000 Rp
Rp 1,009,500 Rp
Rp 2,529,500
Rp 141,000
Rp 948,000
Rp 2,139,000
Rp 316,500
Rp 1,491,500 Rp
Rp
Rp 1,143,182 Rp
Rp
40,938 Rp
150,000 Rp 617,198 Rp
Rp
212,500
Rp
Rp
Rp
Rp
Rp
510,500
372,000
333,000
109,500
Rp
Rp
Rp
Rp 648,500
Rp 525,000
Rp 120,500
Rp 492,500
Rp 460,000
Rp 412,000
Rp 1,039,500
Rp 550,000 Rp
Rp 197,000
Rp 336,000
Rp 519,000
Rp 356,500
Rp 429,000
Rp 226,000 Rp
Rp 582,500
Rp 221,000
Rp 398,000 Rp
Rp 939,000 Rp
Rp 666,000
Rp 244,000
Rp 927,000
Rp 665,000
Rp 499,000
Rp 1,214,000
Rp
43,500
Rp 412,000
Rp 431,000 Rp
Rp 507,500
Rp 368,000 Rp
Rp 325,500
Rp 818,000
Rp 273,000 Rp
Rp 565,500
Rp 707,000
Rp
808,500 Rp
1,568,000
6,902,182
757,438
13,268,698
47,494 Rp
1,529,994
Rp
Rp
50,082 Rp
210,815 Rp
42,374 Rp
Rp
84,609 Rp
318,149 Rp
Rp
117,070 Rp
Rp
Rp
145,401 Rp
640,917 Rp
127,104 Rp
Rp
Rp
62,868 Rp
Rp
Rp
53,507 Rp
6,634 Rp
75,523 Rp
Rp
101,768 Rp
9,500 Rp
649,653 Rp
Rp
62,544 Rp
30,000 Rp
Rp
84,800 Rp
65,175 Rp
6,634 Rp
Rp
2,634 Rp
19,739 Rp
106,018 Rp
Rp
78,420 Rp
870,500
952,082
2,568,815
451,874
425,000
3,648,109
7,368,149
540,500
1,509,570
1,535,000
1,287,000
2,839,901
7,500,917
934,104
2,126,000
1,379,000
879,368
1,619,000
776,000
6,556,007
987,634
7,903,523
14,584,000
8,042,768
533,500
5,251,653
975,000
3,676,544
3,109,000
503,500
956,800
1,196,175
1,014,134
2,193,000
638,134
6,902,739
644,018
1,465,500
1,705,420
100,000 Rp
280,126 Rp
2,328,626
Rp
Rp
Rp
Rp
100,000 Rp
Rp
Rp
50,000
Rp
Rp
50,000 Rp
50,000
Rp
Rp
Rp
Rp
Rp
Rp
40,000 Rp
Rp
100,000
Rp
Rp
50,000 Rp
Rp
242,652,564

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DAFTAR KLAIM RAWAT INAP PASIEN JAMKESDA RSUD TANAH BUMBU

PROPINSI : KALIMANTAN SELATAN

old unrednled hip sort

Obs.Dispneu Sups CHI

Tn. Zainal Arifin

Jl.Pelabuhan Samudra rt 001/001

Jl Bina Bakti GG H.Bayo Rt.009/003

Jl.Bina Bersama Rt 001 Desa Gunung

Hemi Pans dextra sups SNH

Jl.Sebamban 3 Blok A rt 005/002

cokc abdoea ec sups isk

Manunggal Dusun III RT 018 Desa

Jl.Raya Batulicin Rt 003 Desa

Jl. Propinsi Rt.003 Rw.002 Ds.

Jl. Raya Transmigrasi Dusun IV

Susp. Frakture os zygomantens D

Jl.Muara Pagatan Rt 002 Muara

Jl.Kamboja Rt 011/006 Desa Pandan

Jl. Raya Transmigrasi Km.37 Dusun

Obs. Abdomen Pain

Jl. Ladeleng Rt.001 Ds.Muara

Tn. Susilo Sudarman

Tn. Roel Darwis

Sekunder post hectigo

Tn. Ambo tang

An. Aldi Indofani

Tn. Darko Cahyo

An. M. Seman Almadani

An. Azka Dwi. H

Ds. Karang Bintang rt 012

open fraktur 1/3 proximal

Susp close fraktur 1/3 proximal os fektur

diare akut dehidrasi

segumbang rt 001, batulicin

Diare cair akut

Obs. Dispneu ec susup PPOK

ds. Karang rejo rt 006 desa

Jl. Raya Batulicin Rt 002 Segumbang

Tn. Ahmad Rosyadi

An. Nur aminah

Tn. Abdul safa

Tn. Agus Hariadi

Tn. Bagas Prianggodo

An. Azhar zain

Tn. Harjo suwito

Nn. Novita wulandari

By. Ny. Erlangga

An. Rina Ananta

Nn. Nur eva yanti

Ny. Hj. Lame

Gg. Kurnia makmur rt 010 desa

Desa Wonorejo rt 013, kusan hulu

Jl. Desa rt 005, satui timur

Melena susp gastritis erosit

diare akut tanpa dehidrasi

Diare akut dehidrasi ringan

Obs febris ec. Susp malaria

Melena susp gastritis+HT grade II

Ds. Karang sari rt 005, kusan hulu

Desa Pulau Satu Rt 004, kusan hilir

An. Ahmad Suhada

Jl. Karang Bintang rt 003, sari

Desa Pulau Satu Rt 004, kusan hilir

Tn. Abdul Hasad/Abdul rasyad