DAFTAR PASIEN DOKTER UMUM DAN GIGI PT.

RAMAMUZA B
BULAN SEPTEMBER 2014

NO TGL NOMOR NAMA U P/I/S/A L/P

1 1-Sep 504086 RISTA WULANDARI 16 A P
2 501488 ARI SUKOCO 33 P L
3 504001 HENI 38 P P
4 503630 MASANI 30 P P
5 DD1211100 RAYES SURATMAN 35 P L
6 503325 LINDAH 31 I P
7 DD0112063 DARMAN 25 P L
8 504074 SITI AISYAH 5 A P
9 2-Sep 507104 ITA ROSITA 26 I P
10 502709 ROSDAH 34 P P
11 RBHPK5462 SALSABILA MAHARANI 9 A P
12 RBHPP6570 MUKHLISIN 25 P L
13 3-Sep 501860 KHOIRUL ANWAR 7 A L
14 RBHPP6190 RIYANTI 20 P P
15 507104 NAILA SAPUTRA 4.3 A P
16 507104 SAIPUL ANWAR 27 P L
17 DD1211100 RAYES SURATMAN 35 P L
18 DD203016 NUR ALI 32 P L
19 212007 HENDRA IRAWAN 28 P L
20 DD1204005 NANANG 21 P L
21 500167 ASLAMIAH 40 I P
22 500167 QOLBIYATUN NISA 17 A P
23 4-Sep 501488 ARI SUKOCO 33 P L
24 DD1205088 CICIH HANDAYANI 23 P P
25 506734 DRI WULAN NINGSIH 30 I P

NO TGL NOMOR NAMA U P/I/S/A L/P

26 RBHPP6047 BAKTI KADARYANTO 24 P L
27 5-Sep DD1204029 IMAM MAHDI 21 P L
28 500167 ASLAMIAH 40 I P
29 RBHPP6190 RIYANTI 21 P P
30 507104 SAIPUL ANWAR 27 P L
31 DD113018 RINA RIADI 26 P P
32 6-Sep GIU B120 ADDIN DANDI P 9BLN A L
 33 501140 ROHMAT 46 P L
34 504569 SINDI RAHAYU 14 A P
35 8-Sep DD1302139 AZMAR 21 P L
36 DD1303184 ITA SETIANA 21 P P
37 DD1111029 YUYUN REZAKIAH 25 P P
38 DD1203116 DASKONAH AMILASARI 22 P P
39 DD1301055 RAMADIAH M 22 P P
40 DD1204144 YETI NURHIDAYANTI 22 P P
41 DD1204144 EKA WIJAYA 24 P L
42 DD1205005 FERIANSYAH 30 P L
43 DD1111157 CARYATI 23 P P
44 DD1205003 MUKHLIS S.H 26 P L
45 504074 UTARIAH 45 P P
46 DD1211100 RAYES SURATMAN 36 P L
47 DD1304232 REFNIWATI 35 P P
48 9-Sep RBHPP5915 DWI WAHYU KURNIATI 21 P P
49 DD1303184 ITA SETIANA 21 P P
50 DD130529 MUSTIKA SARI 22 P P

NO TGL NOMOR NAMA U P/I/S/A L/P

51 507104 SAIPUL ANWAR 27 P L
52 DD1111113 ALIN 24 P P
53 DD1111075 NURHANA 23 P P
54 DD1211018 WARSIDI 26 P L
55 DD1301059 LENY LESTARI 22 P P
56 DD1302134 HERU RISWANTO 24 P L
57 DD1203089 EVI NURAENI 25 P P
58 DD1305262 AKHMAD IKHSAN 24 P L
59 10-Sep DD1211045 SETIYAWATI 22 P P
60 DD1401448 MARDIAH POHAN 22 P P
61 DD1204109 HARLIAWATI 22 P P
62 DD1111008 PUJI ASTUTI 29 P P
63 DD1206097 SITI HINDUN 22 P P
64 DD1205076 HERI ISWANTO 24 P L
65 DD1211034 NANANG JAENUDIN 24 P L
66 501284 NUR AMANDA 10 A P
67 DD0112046 HERLINA 37 I P
68 DD0112046 SARLITA SALMA 5A P
 69 504569 HENI 34 P P
70 504569 NURUL AMIN 8A L
71 DD0112006 AGUS SANTOSO 31 P L
72 11-Sep DD1401512 NURUL HIKMAH 22 P P
73 507104 NAILA PUTRI 4A P
74 504074 SAUWIH 60 S L
75 DD1401448 MARDIAH POHAN 22 P P

NO TGL NOMOR NAMA U P/I/S/A L/P

76 DD1408139 SAZALI 24 P L
77 DD1305340 MOCH SIRI 23 P L
78 DD112064 HENDRI ANANG 24 P L
79 12-Sep DD0112027 LEPI NUSWANDARI 25 P P
80 501667 RISQI FADILLAH 8A L
81 DD1211025 FIRMANSYAH 24 P L
82 DD1302121 ABDUL KALIM 25 P L
83 DD1204070 MAHLIHATUN NUFUS 21 P P
84 DD1211072 RUKHMANA 19 P P
85 502709 ROSDAH 34 P P
86 DD1204029 IMAM MAHDI 21 P L
87 13-Sep 508734 AFRIYENI 25 P P
88 DD1304232 REFNIWATI 36 P P
89 503788 NAPIAH 47 P P
90 15-Sep 1204031 ATI RUSMIATI 27 P P
91 GIU 0092 DANNING INDAH S 24 P P
92 DD1211096 KUKUH AJI PAMUNGKAS 21 P L
93 DD1205071 SUHARTI 22 P P
94 DD0112028 RIZKI AMALIA 23 P P
95 DD0112020 NURI RAHMAWATI 24 P P
96 DD0112133 DARYANTO 32 P P
97 DD1304232 REFNIWATI 36 P P
98 DD1205069 KURSILAH K 23 P P
99 DD0911046 AHMAD THAMRIN 32 P L
100 DD1203115 SUSMIYATI 24 P P
NO TGL NOMOR NAMA U P/I/S/A L/P
101 DD0112063 DARMAN 25 P L
102 DD1205060 EKA KURNIAWATI 26 P P
103 16-Sep DD1206173 DIANA 30 P P
104 DD1205073 JEMIRAH 23 P P
105 DD1204184 NIKEN AYU 22 P P
106 DD1204038 SARWONO 24 P L
107 DD1203022 RANDI 24 P L
108 DD1210046 YENI 20 P P
109 504207 KAMTINI 38 P P
110 DD0112150 JONI RAHMAD 22 P L
111 DD1204070 MALIHATUN NUFUS 21 p p
112 DD0112042 MUHAMMAD NUR SENO 21 P L
113 DD0112063 ADINDA 4A L
114 17-Sep DD1111015 YON PATRA WIJAYA 25 P L
115 503484 JIHAN NAURA 6A P
116 DD0112157 ABDUL ROHMAN 22 P L
117 507104 ITA ROSITA 26 I P
118 DD1203044 KIKI LUTFIA HILMI 22 P P
119 500209 MUHYANIH 39 I P
120 DD1211025 FIRMANSYAH 24 P L
121 DD1111040 HERMAN 24 P L
122 18-Sep DD0112156 RISKY RASHA 22 P L
123 DD1204115 YULIANA 25 P P
124 504274 UTARIAH 45 P P
125 DD1203051 ABDUL KARIM 27 P L

NO TGL NOMOR NAMA U P/I/S/A L/P

126 19-Sep DD1401501 ARDIANSYAH 26 P L
127 DD0112076 ACHMAD SOBARI 30 P L
128 DD1203094 MASLIKHA 24 P P
129 DD1204050 ISWATUN HASANAH 25 P P
130 DD1205088 CICIH HANDAYANI 22 P P
131 502709 ROSDAH 34 P P
132 DD0112097 DEKA SURYA P 27 P L
133 20-Sep DD1310365 M NUR HENDRO 27 P L
134 DD1204088 TITIN NURHAYATI 30 I P
135 500167 QOLBIYATUN NISA 17 A P
136 22-Sep 502203 YULIANA 36 I P
137 DD1205071 SUHARTI 22 P P
138 DD1401512 NURUL HIKMAH 22 P P
139 501860 KHOIRUL ANWAR 7A L
140 DD1011027 TRI HARYANTO 20 P L
141 DD1202015 IKWAN FIRDAUS 24 P L
142 DD1204082 SRI JAYANI 22 P P
143 DD1204165 DESTI ERNAWATI 22 P P
144 503630 MASANI 30 P P
145 505043 KOMARUDIN 33 S L
146 DD1205005 FERIANSYAH 30 P L
147 DD1111075 NURHANA 23 P P
148 DD1202044 RICAN WIJAYA 25 P P
149 DD1401419 ASRIANI 21 P P
150 DD1111156 AGUSTIN RIYANTI 24 P P

NO TGL NOMOR NAMA U P/I/S/A L/P

151 DD11111039 EDI SUKAMTO 25 P L
152 DD0212007 SEPTIA RHAMADANI 8A P
153 23-Sep DD1204150 AMRI 24 P L
154 DD1302121 ABDUL KALIM 25 P L
155 504569 NURUL AMIN 8A P
156 DD1401448 MARDIAH POHAN 22 P P
157 DD0112046 MARLINA 36 I P
158 DD1203071 WAHYUDIN 29 P L
159 DD1202021 JAJANG HERMAWAN 21 P L
160 DD1305294 MUTTAQIN 27 P L
161 24-Sep 503325 NASYWA AZIZAH 6BLN A P
162 DD1211002 SUMI 21 P P
163 DD1211100 RAYES SURATMAN 35 P L
164 DD1204002 MUSTAQIM 23 P L
165 GIU 0293 SAEKHAWATI 34 P P
166 GIU 0293 LUTFI DIMAS A 8A L
167 DD0911016 AHMAD THAMRIN 32 P L
168 DD1210045 YUSRIJAL 26 P L
169 DD1111147 ZAHRUDIN 29 P L
170 DD01312412 DARNO 23 P L
171 25-Sep DD1204025 CARNITA 23 P L
172 DD1111029 YUYUN REZAKIAH 24 P P
173 DD1111164 MARIYAM 24 P P
174 DD1111087 BUSTOMI A 2A L
175 DD1204152 SISWANTO 27 P L

NO TGL NOMOR NAMA U P/I/S/A L/P

176 DD0112063 DARMAN 26 P L
177 DD1401501 ARDIANSYAH 26 P L
178 DD1203051 ABDUL KARIM 26 P L
179 26-Sep DD0112053 DARWITA 24 P L
180 DD1111161 IDA FITRI 20 P P
181 DD1205087 ANDRIYAWAN 20 P L
182 DD1111159 AMELIA 25 P P
183 DD1204031 ATI RUSMIATI 21 P P
184 DD1302137 IKA UTAMI 24 P P
185 27-Sep DD1401479 TUTIK YUNIANTI 24 P P
186 504569 SINDI RAHAYU 14 A P
187 DD1404970 DIANA MERZAN 26 P P
188 29-Sep 501785 MOH NASIKIN 46 P L
189 504201 SAFINA RIYANAN 7.5 A P
190 501284 PRIYANI 30 I P
191 DD1401512 NURUL HIKMAH 22 P P
192 GIU B149 MAMAN SURATMAN 25 S L
193 DD1111113 ALIN 24 P P
194 DD1205003 MUKHLIS S.H 26 P L
195 30-Sep DD1301063 SUSI SOPIYATI 27 P P
196 509336 SILVIA MARIFAH 11 A P
197 DD1111007 DWI RATIH 26 P P
198 DD1205060 EKA KURNIAWATI 26 P P
199 DD1202009 M YUSUP 27 P L
200 504086 TAHMILATUL JAHINAH 42 I P
NO TGL NOMOR NAMA U P/I/S/A L/P
201 504086 RIZTA WULIANSARI 16 A P
202 503741 NINUK SITI R 44 P P
203 508734 AFRIYENI 25 P P
204 DD1111157 CARYATI 24 P P
205 DD1111157 AISY SABILA 10BL A P
206 DD1111019 MUH SOFIYAN 23 P L
207 DD1206096 RINA PRIYANDARI 22 P P
208 DD1302134 HERU RISWANTO 24 P L
209 DD1203095 RIYANTI 21 P P
210 DD1203089 EVI NURAENI 25 P P
UMUM DAN GIGI PT.RAMAMUZA BHATI HUSADA
BULAN SEPTEMBER 2014

BIAYA
DIAGNOSA TINDAKAN BIAYA TINDAKAN
POST RAWAT TYPHOID 10,000
ISPA+LBP 40,000
EPTOPIC PREGNANCY 10,000
GEA 40,000
CARIES DENTIS 40,000
CEPHALGIA 40,000
CEPHALGIA 40,000
DKA 40,000
GEA 40,000
OTITIS MEDIA 10,000
TONSILITIS 40,000
ISPA+CARIES DENTIS 40,000
ISPA 40,000
CARIES DENTIS 40,000
GEA 40,000
PULPITIS KRONIS DEVITALISASI+TAMBAL 40,000 150,000
PULPITIS IREVERSIBLE DEVITALISASI+TAMBAL 40,000
MYALGIA 40,000
KONSTIPASI+RA 40,000
ISPA 40,000
CEPHALGIA 40,000
SUSP TB PARU 40,000
GASTRITIS+RA 40,000
VERTIGO+GASTRITIS 40,000
GINGIVITIS SCALLING 44,45,46 - 75,000

Jakarta,......................2014

..........................................

BIAYA
DIAGNOSA TINDAKAN TINDAKAN
GEA 40,000
CEPHALGIA 40,000
PULPITIS 40,000
PULPITIS OPEN ACCESS+TAMBAL 40,000
PULPITIS KRONIS OPEN CAVUM+TAMBAL 40,000 150,000
GINGIVITIS SCALLING RA+RB 40,000
GEA 40,000
VULNUS LOCERATUM 40,000
ISPA+DKA 40,000
OTITIS EXTERNA 40,000
MYALGIA 40,000
ISPA 40,000
LUPUS 10,000
DYSPEPSIA 40,000
DYSPEPSIA 40,000
CARIES DENTIS 40,000
DYSPEPSIA 40,000
LBP 40,000
STOMATITIS+HORDEOLUM 40,000
SUSP CORPUS ALIENUM 40,000
MIGRAIN+DYSPEPSIA 40,000
LBP+ISPA 40,000
DYSPEPSIA 40,000
GINGIVITIS SCALLING RA+RB - 200,000
CARIES +GANGREN RADIX TAMBAL+CABUT GIGI 40,000 300,000

Jakarta,......................2014

..........................................

BIAYA
DIAGNOSA TINDAKAN TINDAKAN
PULPITIS KRONIS 40,000
DYSPEPSIA 40,000
DYSPEPSIA 40,000
HORDEOLUM 40,000
DYSPEPSIA+GEA 40,000
ISPA 40,000
STOMATITIS+GINGIVITIS 40,000
GEA 40,000
DISENTRI 40,000
FLUOR ALBUS 40,000
ISPA 40,000
GINGIVITIS SCALLING RA+RB - 300,000
GINGIVITIS SCALLING RA+RB - 250,000
CEPHALGIA 40,000
ISPA+GEA 40,000
ISPA 40,000
HEMOROID 40,000
KONSULTASI GIGI 40,000
ISPA 40,000
PERIODONTITIS CABUT GIGI SUSU 40,000 70,000
DKA 40,000
IMPETIGO 10,000
ISPA 40,000
DIABETES 40,000
FLUOR ALBUS 40,000

Jakarta,......................2014

..........................................

BIAYA
DIAGNOSA TINDAKAN TINDAKAN
DYSPEPSIA+MYALGIA 40,000
ISPA+STOMATITIS 40,000
ISPA 40,000
HORDEOLUM INTERNA 10,000
CARIES DENTIS TAMBAL GLASS IONOMER 40,000 80,000
GEA 40,000
ISPA 40,000
DYSPEPSIA+GEA 40,000
ANC 40,000
PERIODONTITIS 40,000
ISPA 40,000
ISPA 40,000
SUSP TYPHOID 40,000
RA+HT 40,000
DYSPEPSIA 40,000
FARINGITIS 40,000
COMMON COLD 40,000
DYSPEPSIA+GEA 40,000
DYSPEPSIA 40,000
CARIES DENTIS 40,000
VULNUS LOCERATUM 40,000
ISPA 40,000
GEA 40,000
ICHIALGIA 10,000
KONSTIPASI 40,000

Jakarta,......................2014
 ..........................................

BIAYA
DIAGNOSA TINDAKAN TINDAKAN
CEPHALGIA 40,000
LBP 40,000
OBS FEBRIS 40,000
CEPHALGIA+OA 40,000
OBS FEBRIS+DYSPEPSIA 40,000
DYSPEPSIA+ISPA 40,000
GEA+DYSPEPSIA 40,000
DYSPEPSIA 40,000
ISPA+MYALGIA 40,000
DKA 40,000
DISMENORHOE 40,000
GEA 40,000
ISPA 40,000
ISPA 40,000
ISPA 40,000
HEMOROID 40,000
DYSPEPSIA 40,000
ISPA 40,000
ANC 40,000
LBP 40,000
GEA 40,000
ISPA 40,000
ISK 40,000
CARIES DENTIS+OF 40,000
ISPA 40,000

Jakarta,......................2014

..........................................

BIAYA
DIAGNOSA TINDAKAN TINDAKAN
ISPA+DYSPEPSIA 40,000
NEURALGIA 40,000
ASMA+DYSPEPSIA 40,000
ASMA 40,000
DYSPEPSIA 40,000
PERIODONTITIS 40,000
GEA 40,000
GINGIVITIS SCALLING RA+RB - 250,000
DKA 40,000
VULNUS LOCERATUM 40,000
ANC 40,000
GEA 40,000
DKA+TONSILITIS 40,000
ISPA 40,000
ISPA+RA 40,000
OBS FEBRIS 40,000
OBS FEBRIS+ANC 40,000
KOSTIPASI+VERTIGO 40,000
DYSPEPSIA 40,000
GEA+ISPA 40,000
DYSPEPSIA 40,000
DYSPEPSIA 40,000
GEA+HEADACHE 40,000
CARIES DENTIS 40,000
VERTIGO 40,000

Jakarta,......................2014

..........................................

BIAYA
DIAGNOSA TINDAKAN TINDAKAN
KONJUNCTIVITIS 40,000
ISPA 40,000
SUSP.BRONCHITIS 40,000
GEA 40,000
ISPA 40,000
GEA 40,000
DYSPEPSIA+COLIC ABDOMEN 40,000
GEA 40,000
GEA 40,000
TFA 40,000
ISPA 40,000
GEA 40,000
PULPITIS IRREVESIBLE BUKA CAVUM+TAMBAL 40,000 200,000
DYSPEPSIA 40,000
HT+ISPA 40,000
SUSP TB PARU 40,000
ICHIALGIA 10,000
ISPA 40,000
GEA+ISPA 40,000
ISPA 40,000
GEA 40,000
ISPA 40,000
ISPA+GASTRITIS 40,000
ISPA+SUSP TYPHOID 40,000
ISPA+CONJUNCTIVITIS 40,000

Jakarta,......................2014

..........................................

BIAYA
DIAGNOSA TINDAKAN TINDAKAN
ISPA 40,000
ISPA 40,000
ISK+ISPA 40,000
HEMOROID+ISPA 40,000
ISPA 40,000
SUSP DISENTRI 10,000
ISPA 40,000
ISPA 40,000
CEPHALGIA+DISMENORHOE 40,000
ISPA 40,000
ISPA 40,000
OMA 40,000
HT+CARIES DENTIS 40,000
OEDEMA 40,000
KB 35,000
DYSPEPSIA+GEA 40,000
ISPA 40,000
GEA 40,000
GEA 40,000
CEPHALGIA+ANEMIA 40,000
ISPA+GEA 40,000
ISK 40,000
DISMENORHOE 40,000
GEA 40,000
VERTIGO 40,000

Jakarta,......................2014
 ..........................................

BIAYA
DIAGNOSA TINDAKAN TINDAKAN
KONSTIPASI 40,000
ISPA 40,000
ISPA 40,000
MYALGIA 40,000
GEA 40,000
CC+ISPA 40,000
VERTIGO+DISMENORHOE 40,000
ISPA 40,000
ISPA 40,000
GEA 40,000

Jakarta,......................2014

..........................................
 RUJUKAN TTD
Sp.PD RS ISLAM SUKAPURA

Sp.OG RS ISLAM SUKAPURA

Sp THT RS ISLAM SUKAPURA

RUJUKAN TTD
Sp.PD RS ISLAM SUKAPURA

RUJUKAN TTD
SpKK RS ISLAM SUKAPURA

RUJUKAN TTD

SpM RS ISLAM SUKAPURA

RM RS ISLAM SUKAPURA
RUJUKAN TTD

RUJUKAN TTD
 RUJUKAN TTD

SpPD RS ISLAM SUKAPURA

SpAN RS ISLAM SUKAPURA
SpSARAF RS ISLAM SUKAPURA
 RUJUKAN TTD

LAB RS ISLAM SUKAPURA

RUJUKAN TTD