LAPORAN PERHARI KLIN

RAWAT JALA

NO TANGGAL SHIFT NAMA PASIEN ADM DOKTER

1 19-08-2013 Pagi Liaw 5,000 70,000

2 19-08-2013 Pagi Cecep Kuswan 5,000 70,000
1 19-08-2013 Sore Suryati 5,000 70,000
2 19-08-2013 Sore Endan Sukanda 5,000 70,000
3 19-08-2013 Sore Syamsudin 5,000 70,000
4 19-08-2013 Sore Yudi mulyadi 5,000 70,000
5 19-08-2013 Sore Endang 5,000 70,000
6 19-08-2013 Sore Wen Suhaebah 5,000 70,000
7 19-08-2013 Sore Elah 5,000 70,000
8 19-08-2013 Sore Rizky Kurniawan 5,000 70,000
9 19-08-2013 Sore Pujiawati 5,000 70,000
10 19-08-2013 Sore Ai Aisyah 5,000 70,000
11 19-08-2013 Sore Lia Sri Haryati 5,000 70,000
12 19-08-2013 Sore Odeh 5,000 70,000
13 19-08-2013 Sore Milah 5,000 70,000
14 19-08-2013 Sore M Farid Sandiawan 5,000 70,000
15 19-08-2013 Sore Sutisna 5,000 70,000

19-08-2013 Total 85,000 1,190,000

1 20-08-2013 Pagi Sutisna - -

2 20-08-2013 Pagi Melaminanggi 5,000 70,000
1 20-08-2013 Sore Yani Suryani HJ 5,000 70,000
2 20-08-2013 Sore Lilis 5,000 70,000
3 20-08-2013 Sore Sri Maryantini 5,000 70,000
4 20-08-2013 Sore Mintarsih 5,000 70,000
5 20-08-2013 Sore Acep Thamrin 5,000 70,000
6 20-08-2013 Sore Joko Sumhari 5,000 70,000
7 20-08-2013 Sore Nesa Apriani 5,000 70,000
8 20-08-2013 Sore Sutisna 5,000 70,000
9 20-08-2013 Sore Elsa 5,000 70,000
10 20-08-2013 Sore Mariam 5,000 70,000

20-08-2013 Total 55,000 770,000

1 21-08-2013 Pagi Edi Baehaki H 5,000 70,000

2 21-08-2013 Sore Cicih 5,000 70,000
 3 21-08-2013 Sore Neneng - -
4 21-08-2013 Sore Tien Rustiana 5,000 70,000
5 21-08-2013 Sore Mugi Restu 5,000 70,000
6 21-08-2013 Sore Deden 5,000 70,000
7 21-08-2013 Sore Patimah 5,000 70,000
8 21-08-2013 Sore Jubaedah 5,000 70,000
9 21-08-2013 Sore Dinda - -
10 21-08-2013 Sore Dinda - -
11 21-08-2013 Sore Anisa 5,000 70,000
12 21-08-2013 Sore Dewi Nuryanti 5,000 70,000
13 21-08-2013 Sore Evie Sopia 5,000 70,000
14 21-08-2013 Sore Empud 5,000 70,000
15 21-08-2013 Sore Faridah 5,000 70,000

21-08-2013 Total 60,000 840,000

1 22-08-2013 Pagi Mugi - -

1 22-08-2013 Sore Aldi Renaldi 5,000 70,000
2 22-08-2013 Sore Ai Syamsiah 5,000 70,000
3 22-08-2013 Sore Mugi Restu 5,000 30,000
4 22-08-2013 Sore Yudi - -
5 22-08-2013 Sore Suhendi 5,000 70,000
6 22-08-2013 Sore Neni Nuraeni 5,000 70,000
7 22-08-2013 Sore Asep Bayu 5,000 70,000
8 22-08-2013 Sore Rossy 5,000 70,000
9 22-08-2013 Sore Lilis 5,000 70,000
10 22-08-2013 Sore Asep Popo 5,000 70,000
11 22-08-2013 Sore Zahwa - -
12 22-08-2013 Sore Sandy 5,000 75,000

22-08-2013 TOTAL 50,000 665,000

1 23-08-2013 Pagi Enen hj 5,000 70,000

2 23-08-2013 Pagi Wen Suhaebah 5,000 70,000
3 23-08-2013 Pagi Aldi Renaldi 5,000 70,000
4 23-08-2013 Pagi Fitri - -
5 23-08-2013 Pagi Ulfa - -
1 23-08-2013 Sore Jejeh 5,000 70,000
2 23-08-2013 Sore Fila Melani 5,000 70,000
3 23-08-2013 Sore Lilis 5,000 70,000
4 23-08-2013 Sore Rosidah 5,000 70,000
 5 23-08-2013 Sore Mamah Mukrimah 5,000 70,000
6 23-08-2013 Sore Noneng 5,000 70,000
7 23-08-2013 Sore Riesty 5,000 70,000
8 23-08-2013 Sore D Najmudin 5,000 70,000
9 23-08-2013 Sore Sri Rahayu 5,000 70,000
10 23-08-2013 Sore Dahlia 5,000 70,000
11 23-08-2013 Sore Bandan 5,000 70,000
12 23-08-2013 Sore Rodiah 5,000 70,000
13 23-08-2013 Sore Indarti 5,000 70,000
14 23-08-2013 Sore Deni Awal 5,000 70,000
15 23-08-2013 Sore Ina Rustiana 5,000 70,000
16 23-028-2013 Sore Sakila 5,000 70,000
17 23-08-2013 Sore Tubagus 5,000 70,000

Total 100,000 1,400,000

1 24-08-2013 Pagi Ayi Abdulah 5,000 70,000

2 24-08-2013 Pagi Sakila - -
1 24-08-2013 Sore Fatonah 5,000 70,000
2 24-08-2013 Sore Kosasih 5,000 70,000
3 24-08-2013 Sore Arsil Adifa 5,000 50,000
4 24-08-2013 Sore Sukarjo 5,000 70,000

Total 25,000 330,000

1 26-08-2013 Pagi Dadang 5,000 70,000

2 26-08-2013 Pagi Karnaen 5,000 70,000
3 26-08-2013 Pagi Hasan 5,000 70,000
4 26-08-2013 Pagi Apt Sahabat - -
5 26-08-2013 Pagi Eneng - -
1 26-08-2013 Sore Holil 5,000 70,000
2 26-08-2013 Sore Pepen Supendi 5,000 70,000
3 26-08-2013 Sore Sri Rohayati 5,000 70,000
4 26-08-2013 Sore Nanan Suminar 5,000 70,000
5 26-08-2013 Sore Ai Aisyah 5,000 70,000
6 26-08-2013 Sore Indah Permata 5,000 70,000
7 26-08-2013 Sore Aisyah 5,000 70,000
8 26-08-2013 Sore Puadijah 5,000 70,000
9 26-08-2013 Sore Ujang 5,000 70,000
10 26-08-2013 Sore Deden 5,000 70,000
11 26-08-2013 Sore Sukarjo 5,000 70,000
12 26-08-2013 Sore Anwar 5,000 70,000
13 26-08-2013 Sore Ridan 5,000 70,000
14 26-08-2013 Sore Juanedi 5,000 70,000
15 26-08-2013 Sore Marsini 5,000 70,000
16 26-08-2013 Sore Resti 5,000 70,000
17 26-08-2013 Sore nn - -
18 26-08-2013 Sore nn - -

Total 95,000 1,330,000

1 27-08-2013 Sore Ema Wati 5,000 70,000

2 27-08-2013 Sore Alwi Salam 5,000 70,000
3 27-08-2013 Sore Kuraesin - -
4 27-08-2013 Sore Nn - -
5 27-08-2013 Sore Mulyono 5,000 70,000
6 27-08-2013 Sore Neti Sudarti 5,000 70,000
7 27-08-2013 Sore Khoiriah 5,000 70,000
8 27-08-2013 Sore Lusi Damayanti 5,000 70,000
9 27-08-2013 Sore Okti Sri 5,000 70,000
10 27-08-2013 Sore Viddy 5,000 70,000

27-08-2013 Total 40,000 560,000

1 28-08-2013 Pagi Nn - -
2 28-08-2013 Pagi Apt Sahabat - -
3 28-08-2013 Pagi Nuraidah hj 5,000 80,000
4 28-08-2013 Pagi Yayan - -
5 28-08-2013 Pagi Damanhuri - -
1 28-08-2013 Sore Nn - -
2 28-08-2013 Sore Nurlaela 5,000 70,000
3 28-08-2013 Sore Nancy Arianti 5,000 250,000
4 28-08-2013 Sore Ica Julia 5,000 70,000
5 28-08-2013 Sore Esih 5,000 70,000
6 28-08-2013 Sore Edward 5,000 70,000
7 28-08-2013 Sore Abdurachman 5,000 70,000
8 28-08-2013 Sore Dodo Jimirianto 5,000 70,000
9 28-08-2013 Sore Nn - -
10 28-08-2013 Sore Devi 5,000 70,000
11 28-08-2013 Sore Dede hj 5,000 70,000
12 28-08-2013 Sore Iis tim 5,000 70,000
13 28-08-2013 Sore Nurmala 5,000 70,000
14 28-08-2013 Sore Iis Sumiati 5,000 70,000
15 28-08-2013 Sore Barni 5,000 70,000
16 28-08-2013 Sore Wati 5,000 70,000
17 28-08-2013 Sore Uun Sunarsih 5,000 70,000
18 28-08-2013 Sore Khoeriyah hj - -
19 28-08-2013 Sore Neng Rosti 5,000 70,000
20 28-08-2013 Sore Budi Supriadi 5,000 70,000
21 28-08-2013 Sore Asep popo 5,000 70,000
22 28-08-2013 Sore Nn - -

28-08-2013 Total 95,000 1,520,000

1 29-08-2013 Pagi Nn - -
2 29-08-2013 Pagi Nn - -
3 29-08-2013 Pagi Nurwulan - -
4 29-08-2013 Pagi Dedeh - -
5 29-08-2013 Pagi Ibah - -
1 29-08-2013 Sore Nn - -
2 29-08-2013 Sore Mimin Mariam hj 5,000 70,000
3 29-08-2013 Sore Kiki Hermawan 5,000 70,000
4 29-08-2013 Sore Atik Sartika - -
5 29-08-2013 Sore Dedeh Hj 5,000 70,000
6 29-08-2013 Sore Putri amanda 5,000 70,000
7 29-08-2013 Sore Hisyam 5,000 70,000
8 29-08-2013 Sore Arya 5,000 70,000
9 29-08-2013 Sore Utami 5,000 70,000
10 29-08-2013 Sore Dadang 5,000 70,000

29-08-2013 Total 40,000 560,000

1 30-08-2013 Pagi Abdulah - -

2 30-08-2013 Pagi Yadi Madsoleh 5,000 70,000
3 30-08-2013 Pagi Yati Rohayati 5,000 70,000
4 30-08-2013 Pagi Irni - -
5 30-08-2013 Pagi Yadi - -
1 30-08-2013 Sore Marliana 5,000 70,000
2 30-08-2013 Sore Tubagus 5,000 70,000
3 30-08-2013 Sore Risna 5,000 70,000
4 30-08-2013 Sore Tin Kartini 5,000 70,000
5 30-08-2013 Sore Nuramani 5,000 70,000
 6 30-08-2013 Sore Yati Hayati 5,000 70,000
7 30-08-2013 Sore Novi Supenti 5,000 70,000
8 30-08-2013 Sore Devi Firdaus - -
9 30-08-2013 Sore Jaeludin 5,000 70,000
10 30-08-2013 Sore Siti Masitoh 5,000 70,000
11 30-08-2013 Sore Evan Widyatama 5,000 70,000
12 30-08-2013 Sore Nn - -
13 30-08-2013 Sore Lilis Muhlisoh 5,000 70,000
14 30-08-2013 Sore Suyati 5,000 70,000
15 30-08-2013 Sore Ati Nurhayati 5,000 70,000
16 30-08-2013 Sore Wari 5,000 70,000

80,000 1,120,000

1 31-08-2013 Pagi Insi - -

2 31-08-2013 Pagi Siti Nurasri 5,000 70,000
1 31-08-2013 Sore Nn - -
2 31-08-2013 Sore Tan - -
3 31-08-2013 Sore Yano Susilo 5,000 70,000

10,000 140,000

1 1/9/2013 Pagi Nn -
2 1/9/2013 Pagi Nn - -

0 0

1 2/9/2013 Pagi Wen Suhaebah 5,000 70,000

2 2/9/2013 Pagi Faridah 5,000 70,000
3 2/9/2013 Pagi Lina Marlina 5,000 70,000
4 2/9/2013 Pagi Nunung 5,000 70,000
5 2/9/2013 Pagi Devi - -
1 2/9/2013 Sore Imas Maesaroh 5,000 70,000
2 2/9/2013 Sore Edi Kaharudin 5,000 70,000
3 2/9/2013 Sore Sutisna 5,000 70,000
4 2/9/2013 Sore Jaya Suherman 5,000 70,000
5 2/9/2013 Sore Salman 5,000 70,000
6 2/9/2013 Sore Diding 5,000 70,000
7 2/9/2013 Sore Lina Marlina - -
 8 2/9/2013 Sore Abdul Aziz 5,000 70,000
9 2/9/2013 Sore Yogaswara 5,000 70,000
10 2/9/2013 Sore Eneng Jaitun 5,000 70,000
11 2/9/2013 Sore Fakhrijal Akbar 5,000 70,000
12 2/9/2013 Sore Viddy - -
13 2/9/2013 Sore Nn - -
14 2/9/2013 Sore Elia - -
15 2/9/2013 Sore Maryati 5,000 70,000
16 2/9/2013 Sore Nur Indri 5,000 70,000
17 2/9/2013 Sore Isman 5,000 70,000
18 2/9/2013 Sore Damar Harin 5,000 70,000
19 2/9/2013 Sore Lusi Damayanti 5,000 70,000
1 2/9/2013 Malam Maryani 5,000 75,000
2 2/9/2013 Malam Ujang 5,000 75,000

105,000 1,480,000

1 3/9/2013 Pagi Yogaswara - -

2 3/9/2013 Pagi Umamah 5,000 70,000
3 3/9/2013 Pagi Lisda 5,000 70,000
4 3/9/2013 Pagi Nunung Suyeti 5,000 70,000
1 3/9/2013 Sore Yoyoh 5,000 70,000
2 3/9/2013 Sore Hasan 5,000 70,000
3 3/9/2013 Sore Irni 5,000 70,000
4 3/9/2013 Sore Rosdiana 5,000 70,000
5 3/9/2013 Sore Fitria 5,000 70,000
6 3/9/2013 Sore Neneng Solihat 5,000 70,000
7 3/9/2013 Sore Karmilah 5,000 70,000
8 3/9/2013 Sore Kubes 5,000 70,000
9 3/9/2013 Sore Ina Rustiana 5,000 70,000
10 3/9/2013 Sore Husen 5,000 70,000
11 3/9/2013 Sore Wati - -
12 3/9/2013 Sore Dwi Pertiwi 5,000 70,000
13 3/9/2013 Sore Elia Herlina 5,000 70,000

75,000 1,050,000

1 4/9/2013 Pagi Yana 5,000 70,000

2 4/9/2013 Pagi Purnama 5,000 70,000
3 4/9/2013 Pagi Nani 5,000 70,000
4 4/9/2013 Pagi M Reski 5,000 70,000
 5 4/9/2013 Pagi Otang 5,000 70,000
6 4/9/2013 Pagi Aan - -
7 4/9/2013 Pagi Kubes - -
1 4/9/2013 Sore Diah Rahmawati - -
2 4/9/2013 Sore Dadang Ruswandi 5,000 70,000
3 4/9/2013 Sore Indarti 5,000 70,000
4 4/9/2013 Sore Enong Suherman 5,000 70,000
5 4/9/2013 Sore Nani Maryani 5,000 70,000
6 4/9/2013 Sore Anwar 5,000 70,000
7 4/9/2013 Sore Diah Rahmawati - -
8 4/9/2013 Sore Ilat Sumarni 5,000 70,000
9 4/9/2013 Sore Eni Nurlena 5,000 70,000
10 4/9/2013 Sore Rugun 5,000 70,000
11 4/9/2013 Sore Nn - -

65,000 910,000

1 5/9/2013 Pagi Nur Indri - -

1 5/9/2013 Sore Nn - -
2 5/9/2013 Sore Siti Zubaiqoh 5,000 70,000
3 5/9/2013 Sore Narsiah 5,000 70,000
4 5/9/2013 Sore Rahmiati Thutami 5,000 70,000
5 5/9/2013 Sore E Rohanah 5,000 70,000
6 5/9/2013 Sore Berliana 5,000 70,000
7 5/9/2013 Sore Rohman 5,000 70,000

30,000 420,000

1 6/9/2013 Pagi Hartini 5,000 70,000

2 6/9/2013 Pagi Resti 5,000 70,000
3 6/9/2013 Pagi Eneng Suhartini 5,000 70,000
4 6/9/2013 Pagi Pupu Marpuah 5,000 70,000
5 6/9/2013 Pagi D Najmudin 5,000 70,000
6 6/9/2013 Pagi Solihat 5,000 70,000
7 6/9/2013 Pagi Nn - -
8 6/9/2013 Pagi Neni - -
9 6/9/2013 Pagi Eneng Lilis - -
1 6/9/2013 Sore Roehiyat 5,000 70,000
2 6/9/2013 Sore Dedi Permana 5,000 70,000
3 6/9/2013 Sore Lilis 5,000 70,000
4 6/9/2013 Sore Tia Marlina 5,000 70,000
 5 6/9/2013 Sore Siti Zubaiqoh 5,000 70,000
6 6/9/2013 Sore Yenny 5,000 70,000
7 6/9/2013 Sore Nurazizah 5,000 70,000
8 6/9/2013 Sore Nn - -
9 6/9/2013 Sore Satukin - -
10 6/9/2013 Sore Haryono 5,000 70,000
11 6/9/2013 Sore Nn - -
12 6/9/2013 Sore Hermala Sari 5,000 70,000
13 6/9/2013 Sore Nunuh 5,000 70,000
14 6/9/2013 Sore Rani Susanti 5,000 70,000
15 6/9/2013 Sore Itje Yuningsih 5,000 70,000

90,000 1,260,000

1 7/9/2013 Pagi Mamah Mukrimah 5,000 70,000

2 7/9/2013 Pagi Nani Hendriana 5,000 70,000
3 7/9/2013 Pagi Asri - -
1 7/9/2013 Sore Nn - -
2 7/9/2013 Sore Dedi Ruhiyat 5,000 30,000
3 7/9/2013 Sore Zahra 5,000 30,000
4 7/9/2013 Sore Apo Kusmana 5,000 70,000
5 7/9/2013 Sore Nenden Kusnaningsih 5,000 70,000
6 7/9/2013 Sore Asri 5,000 70,000
7 7/9/2013 Sore Wiwi 5,000 70,000
1 7/9/2013 Malam Nn - -
2 7/9/2013 Malam Dani 5,000 70,000
3 7/9/2013 Malam Faisal 5,000 70,000

50,000 620,000
1 9/9/2013 Pagi Reni 5,000 70,000
2 9/9/2013 Pagi Mulina 5,000 70,000
3 9/9/2013 Pagi Arif Darma - -
4 9/9/2013 Pagi Eros - -
1 9/9/2013 Sore Munir 5,000 70,000
2 9/9/2013 Sore Rinrin 5,000 70,000
3 9/9/2013 Sore Jaya 5,000 70,000
4 9/9/2013 Sore Putri Zahra 5,000 70,000
5 9/9/2013 Sore Agus Komarudin 5,000 70,000
6 9/9/2013 Sore Sopia 5,000 70,000
7 9/9/2013 Sore Pupu 5,000 70,000
8 9/9/2013 Sore D Najdmudin - -
 9 9/9/2013 Sore Eti 5,000 70,000
10 9/9/2013 Sore Heli 5,000 70,000
11 9/9/2013 Sore Herlin 5,000 70,000
12 9/9/2013 Sore Hen Hen 5,000 70,000
13 9/9/2013 Sore Nunung 5,000 70,000
14 9/9/2013 Sore Sutisna 5,000 70,000
15 9/9/2013 Sore Nn - -
16 9/9/2013 Sore Alfarozian 5,000 30,000
17 9/9/2013 Sore Anjar 5,000 70,000
18 9/9/2013 Sore Ajudin 5,000 70,000

90,000 1,220,000

1 10/9/2013 Pagi Yeni - -

2 10/9/2013 Pagi Andri - -
3 10/9/2013 Pagi Astia 5,000 70,000
4 10/9/2013 Pagi Rahmat 5,000 70,000
5 10/9/2013 Pagi Nenden 5,000 70,000
6 10/9/2013 Pagi Rin Rin 5,000 70,000
7 10/9/2013 Pagi Nunuh - -
8 10/9/2013 Pagi Ridwan 5,000 70,000
1 10/9/2013 Sore Isep - -
2 10/9/2013 Sore Uum 5,000 70,000
3 10/9/2013 Sore Karnaen 5,000 70,000
4 10/9/2013 Sore Yenni 5,000 70,000
5 10/9/2013 Sore Ai Sumiati 5,000 70,000
6 10/9/2013 Sore Yana 5,000 70,000
7 10/9/2013 Sore Musa 5,000 70,000
8 10/9/2013 Sore Ela Lismawati 5,000 70,000
9 10/9/2013 Sore Solihat 5,000 70,000
10 10/9/2013 Sore Verawati 5,000 70,000
11 10/9/2013 Sore Ai Sumiati - -

70,000 980,000

1 11/9/2013 Pagi Karnaen - -

2 11/9/2013 Pagi Nana - -
3 11/9/2013 Pagi Erliawati 5,000 70,000
1 11/9/2013 Sore Eva - -
2 11/9/2013 Sore Eva - -
3 11/9/2013 Sore Maesaroh 5,000 70,000
4 11/9/2013 Sore Fatonah 5,000 70,000
5 11/9/2013 Sore Vidianatiti 5,000 30,000
6 11/9/2013 Sore Solihat 5,000 70,000
7 11/9/2013 Sore Endang 5,000 70,000
8 11/9/2013 Sore Ita Lestari 5,000 70,000
9 11/9/2013 Sore Indah 5,000 70,000

1 12/9/2013 Pagi Edward 5,000 70,000

2 12/9/2013 Pagi Yoyoh 5,000 70,000
3 12/9/2013 Pagi Afifa 5,000 70,000
4 12/9/2013 Pagi Fatimah 5,000 70,000

1 12/9/2013 Sore Wati Sonia 5,000 30,000

2 12/9/2013 Sore Sandi Iskandar 5,000 30,000
3 12/9/2013 Sore Sulistya Ningsih - -
4 12/9/2013 Sore Nn - -
5 12/9/2013 Sore D Najmudin 5,000 70,000
6 12/9/2013 Sore Farid 5,000 70,000
7 12/9/2013 Sore Suhadi 5,000 70,000
8 12/9/2013 Sore Uum Sumiati 5,000 70,000
9 12/9/2013 Sore Sulistya Ningsih - -
10 12/9/2013 Sore Rani 5,000 70,000
11 12/9/2013 Sore Deni 5,000 70,000
12 12/9/2013 Sore Syahreza - -
13 12/9/2013 Sore Mansyur 5,000 70,000

1 13-09-2013 Pagi Enung 5,000 70,000

2 13-09-2013 Pagi Mansyur 5,000 70,000
3 13-09-2013 Pagi Siti Hapsoh 5,000 70,000
4 13-09-2013 Pagi Santi 5,000 70,000
5 13-09-2013 Pagi Ridwan 5,000 70,000
6 13-09-2013 Pagi Nurul 5,000 70,000
7 13-09-2013 Pagi Nn - -
8 13-09-2013 Pagi Eva - -
1 13-09-2013 Sore Juhaeri - -
2 13-09-2013 Sore Lia Merliana 5,000 70,000
3 13-09-2013 Sore Piras Tilawah 5,000 70,000
 4 13-09-2013 Sore Rosi Fitrianingsih 5,000 70,000
5 13-09-2013 Sore Ajudin 5,000 70,000
6 13-09-2013 Sore Nani Rusyani 5,000 70,000
7 13-09-2013 Sore Asep Hasmi 5,000 70,000
8 13-09-2013 Sore Acep Thamrin 5,000 70,000
9 13-09-2013 Sore Nani Maryani 5,000 70,000
10 13-09-2013 Sore Yenni 5,000 70,000
11 13-09-2013 Sore Dede Rosita 5,000 70,000
12 13-09-2013 Sore Juhaeri - -
13 13-09-2013 Sore Ecin 5,000 30,000
14 13-09-2013 Sore Raisa 5,000 70,000
15 13-09-2013 Sore Nita 5,000 70,000
16 13-09-2013 Sore Wahyuni 5,000 70,000
17 13-09-2013 Sore Nn - -
18 13-09-2013 Sore Redi 5,000 70,000
19 13-09-2013 Sore Nn - -

1 13-09-2013 Malam Daniel 5,000 -

1 14-09-2013 Pagi Yenni - -
2 14-09-2013 Pagi Icah Aisyah 5,000 70,000
3 14-09-2013 Pagi Rahmat 5,000 70,000
4 14-09-2013 Pagi Yana 5,000 70,000
5 14-09-2013 Pagi Dede - -
1 14-09-2013 Sore Linda 5,000 70,000
2 14-09-2013 Sore Risna 5,000 70,000
3 14-09-2013 Sore Indah 5,000 70,000
1 14-09-2013 Malam Daniel 5,000 -
2 14-09-2013 Malam Asep 5,000 30,000
3 14-09-2013 Malam Ridwan 5,000 30,000

1 15-09-2013 Pagi Intan 5,000 45,000

2 15-09-2013 Pagi Fatimah 5,000 100,000
3 15-09-2013 Pagi Deri - -
4 15-09-2013 Pagi Lia 5,000 30,000
5 15-09-2013 Pagi Ece 5,000 30,000
6 15-09-2013 Pagi Nn - -
7 15-09-2013 Pagi Fatimah - -
8 15-09-2013 Pagi Nn - -
1 15-09-2013 Sore Robi - -
 2 15-09-2013 Sore Robi 5,000 30,000
3 15-09-2013 Sore M Rasyid 5,000 30,000

1 16-09-2013 Pagi Kusnadi 5,000 70,000

2 16-09-2013 Pagi Nani Maryani 5,000 70,000
3 16-09-2013 Pagi Wati 5,000 70,000
4 16-09-2013 Pagi Wati - -
5 16-09-2013 Pagi Suranto 5,000 70,000
6 16-09-2013 Pagi Yuliana Kusuma 5,000 70,000
1 16-09-2013 Sore Ipah Syaripah 5,000 70,000
2 16-09-2013 Sore Oktavia 5,000 70,000
3 16-09-2013 Sore Santi 5,000 70,000
4 16-09-2013 Sore Ade Suci 5,000 70,000
5 16-09-2013 Sore Cicoh 5,000 70,000
6 16-09-213 Sore Eni Nurlela 5,000 70,000
7 16-09-2013 Sore Anwar 5,000 70,000
8 16-09-2013 Sore Sofiyah 5,000 70,000
9 16-09-2013 Sore Ira 5,000 30,000
10 16-09-2013 Sore Sukimah 5,000 70,000
11 16-09-2013 Sore Nursida 5,000 70,000
12 16-09-2013 Sore Erna Jamilah 5,000 70,000

1 17-09-2013 Pagi Nanang 5,000 70,000

2 17-09-2013 Pagi Nandang - -
3 17-09-2013 Pagi Zulkarnaen 5,000 30,000
1 17-09-2013 Sore Dedeh 5,000 70,000
2 17-09-2013 Sore Eros Rostiati 5,000 70,000
3 17-09-2013 Sore Enung Sumiati 5,000 70,000
4 17-09-2013 Sore Holil 5,000 70,000
5 17-09-2013 Sore Karmilah 5,000 70,000
6 17-09-2013 Sore Ulfah 5,000 70,000
7 17-09-2013 Sore Arumi 5,000 30,000
8 17-09-2013 Sore Imas 5,000 70,000
9 17-09-2013 Sore Upit Fatimah 5,000 70,000
10 17-09-2013 Sore Marida 5,000 30,000
11 17-09-2013 Sore Rifki 5,000 30,000
12 17-09-2013 Sore Siti Maria 5,000 30,000
 1 18-09-2013 Pagi Yuliana - -
2 18-09-2013 Pagi Tan Eng Nio - -
3 18-09-2013 Pagi Edi Baehaki 5,000 70,000
4 18-09-2013 Pagi Erma Dwi 5,000 70,000
5 18-09-2013 Pagi Rinrin 5,000 70,000
1 18-09-2013 Sore Faridah Hj 5,000 70,000
2 18-09-2013 Sore Hendra 5,000 70,000
3 18-09-2013 Sore Berliana 5,000 70,000
4 18-09-2013 Sore Sumawinata 5,000 70,000
5 18-09-2013 Sore Sri Rahayu 5,000 70,000
6 18-09-2013 Sore Pujiawati 5,000 70,000
7 18-09-2013 Sore Runi 5,000 70,000
8 18-09-2013 Sore Ujang 5,000 70,000
9 18-09-2013 Sore Nur Indri 5,000 70,000
10 18-09-2013 Sore Empat 5,000 70,000
11 18-09-2013 Sore Nurul 5,000 70,000
12 18-09-2013 Sore Tan Eng Nio 5,000 70,000
13 18-09-2013 Sore Yudi Mulyadi 5,000 70,000
14 18-09-2013 Sore Nita 5,000 70,000
15 18-09-2013 Sore Yoyoh 5,000 70,000
16 18-09-2013 Sore Teti 5,000 70,000
17 18-09-2013 Sore Indah - -

1 19-09-2013 Pagi Tintin 5,000 70,000

2 19-09-2013 Pagi Nanang 5,000 30,000
1 19-09-2013 Sore Hermawan 5,000 30,000
2 19-09-2013 Sore Tien Rustiana 5,000 70,000
3 19-09-2013 Sore Suranto 5,000 70,000
4 19-09-2013 Sore Ida Farida 5,000 70,000
5 19-09-2013 Sore Filipus 5,000 30,000
6 19-09-2013 Sore Viddy 5,000 70,000

1 20-09-2013 Pagi Yusuf - -

2 20-09-2013 Pagi Enen 5,000 70,000
3 20-09-2013 Pagi Faris Raspati 5,000 70,000
4 20-09-2013 Pagi Nunuh 5,000 70,000
5 20-09-2013 Pagi Erliawati 5,000 70,000
 6 20-09-2013 Pagi Titin - -
7 20-09-2013 Pagi Shyna 5,000 30,000
8 20-09-2013 Pagi Faris Raspati - -
9 20-09-2013 Pagi Ahmad - -
10 20-09-2013 Pagi Ade Lina - -
11 20-09-2013 Pagi D Najmudin - -
1 20-09-2013 Sore Faris Raspati - -
2 20-09-2013 Sore Nn - -
3 20-09-2013 Sore Nn - -
4 20-09-2013 Sore Suranto - -
5 20-09-2013 Sore Apad - -
6 20-09-2013 Sore Aldi 5,000 70,000
7 20-09-2013 Sore Ita Suryati 5,000 70,000
8 20-09-2013 Sore Tjum Tjum - -
9 20-09-2013 Sore Dedeh 5,000 70,000
10 20-09-2013 Sore Arumi 5,000 30,000
11 20-09-2013 Sore Fitri Mulya 5,000 70,000
12 20-09-2013 Sore Aida 5,000 70,000
13 20-09-2013 Sore Ade Lina 5,000 70,000
14 20-09-2013 Sore Munir 5,000 30,000
15 20-09-2013 Sore Nita 5,000 30,000
16 20-09-2013 Sore Ginanjar 5,000 70,000
17 20-09-2013 Sore Ajam 5,000 70,000
18 20-09-2013 Sore Nazwa 5,000 30,000
19 20-09-2013 Sore Ermawati 5,000 70,000
20 20-09-2013 Sore Fatimah 5,000 70,000
21 20-09-2013 Sore Eti siagawati 5,000 70,000
22 20-09-2013 Sore Dadah 5,000 70,000

1 21-09-2013 Pagi D Najmudin - -

1 22-09-2013 Pagi Nn - -
2 22-09-2013 Sore Ayu 5,000 50,000

1 23-09-2013 Pagi Fadil 5,000 30,000

2 23-09-2013 Pagi Yudistira 5,000 30,000
3 23-09-2013 Pagi Adam 5,000 30,000
4 23-09-2013 Pagi Yuda 5,000 70,000
5 23-09-2013 Pagi Sutisna - -
 6 23-09-2013 Pagi Tatang 5,000 70,000
7 23-09-2013 Pagi Bayu - -
8 23-09-2013 Pagi Otih 5,000 70,000
9 23-09-2013 Pagi Imas 5,000 70,000
10 23-09-2013 Pagi Nurmala 5,000 70,000
11 23-09-2013 Pagi Maryati 5,000 70,000
12 23-09-2013 Pagi Sopyan 5,000 70,000
13 23-09-2013 Pagi Rusmana 5,000 70,000
14 23-09-2013 Pagi Wiwi 5,000 70,000
15 23-09-2013 Pagi Siti Maria 5,000 30,000
1 23-09-2013 Sore Dewi - -
2 23-09-2013 Sore Siti Suhaidah 5,000 70,000
3 23-09-2013 Sore Ayi Abdulah 5,000 70,000
4 23-09-2013 Sore Sutisna 5,000 70,000
5 23-09-2013 Sore Maman H 5,000 70,000
6 23-09-2013 Sore Dedy 5,000 70,000
7 23-09-2013 Sore Nani 5,000 70,000
8 23-09-2013 Sore Imas Masrupah 5,000 70,000
9 23-09-2013 Sore Dewi Nuryanti 5,000 70,000
10 23-09-2013 Sore Roehiyat Toha 5,000 70,000
11 23-09-2013 Sore Saepul Bahri 5,000 7,000
12 23-09-2013 Sore Nazwa 5,000 30,000
13 23-09-2013 Sore Heru Rustandi 5,000 70,000
14 23-09-2013 Sore Nn - -
15 23-09-2013 Sore Aria 5,000 70,000
16 23-09-2013 Sore Nursida 5,000 70,000
17 23-09-2013 Sore Rahayu 5,000 70,000
18 23-09-2013 Sore Deni Awal 5,000 70,000
19 23-09-2013 Sore Deri - -
20 23-09-2013 Sore Deden 5,000 70,000
21 23-09-2013 Sore Ujang - -
22 23-09-2013 Sore Nurlela 5,000 70,000

1 24-09-2013 Pagi Nn - -
2 24-09-2013 Pagi Ai Aisyah 5,000 70,000
3 24-09-20013 Pagi Ela 5,000 70,000
4 24-09-2013 Pagi Fitri 5,000 70,000
1 24-09-2013 Sore Hendra - -
2 24-09-2013 Sore Nn - -
 3 24-09-2013 Sore Ahmad 5,000 30,000
4 24-09-2013 Sore Fatimah 5,000 70,000
5 24-09-2013 Sore Fatimah - -
6 24-09-2013 Sore Jubaedah 5,000 70,000
7 24-09-2013 Sore Sutantio 5,000 70,000
8 24-09-2013 Sore Enung 5,000 70,000
9 24-09-2013 Sore Nn - -
10 24-09-2013 Sore Rodiah 5,000 70,000
11 24-09-2013 Sore A Harun 5,000 70,000
12 24-09-2013 Sore Ai Aisyah - -
13 24-09-2013 Sore Indah 5,000 70,000
14 24-09-2013 Sore Hendra - -
15 24-09-2013 Sore Zein 5,000 70,000
ORAN PERHARI KLINIK PERMATA
RAWAT JALAN

TINDAKAN OBAT LAB RONTGEN DISC

- 277,500 - ### -
- 246,500 - ### -
- - - ### -
20,000 - - ### -
- 143,900 - ### -
- 161,000 - ### -
- 233,000 - ### -
- 182,700 - ### -
- 69,000 - ### -
- 411,800 - ### -
- 316,500 - ### -
- 124,000 - ### -
- 326,200 - ### -
- 272,000 - ### -
- 404,700 - ### -
- 80,500 - ### -
20,000 26,500 - ### -

40,000 3,275,800

- - 160,000 - -
- 128,000 - ### -
- 200,500 - ### -
20,000 149,200 - ### -
- 184,500 - ### -
- 85,600 - ### -
- - - ### -
- - - ### -
- - - ### -
- 166,900 - ### -
- 109,000 - ### -
- 318,700 - ### -

1,342,400 160,000

- 132,800 - ### -
100,000 81,000
 - 34,800 - ### -
- 41,000 - ### -
- 99,200 - ### -
- 290,000 - ### -
- 196,300 - ### -
20,000 200,900 - ### -
- 400 - ### -
- 4,800 - ### -
- 125,500 - ### -
- 54,000 - ### -
- 11,300 - ### -
- 632,800 - ### -
- 204,600 - ### -

120,000 2,109,400 -

- - 141,000 - -
- 132,000 - ### -
- 124,500 - ### -
- 388,000 - ### 40,000
- 7,100 - ### -
20,000 42,200 - ### -
- 240,200 - ### -
- 97,300 - ### -
- 252,700 - ### -
20,000 138,700 - ### -
- 179,000 - ### -
- 12,900 - ### -
25,000 314,600 100,000 - -

65,000 1,929,200 241,000 - 40,000

- 184,500 - ### -
- 247,400 105,000 - -
- 151,500 - ### -
- 14,500 - ### -
- - 300,000 - -
20,000 233,500 - ### -
- 272,200 - ### -
- 201,700 - ### -
60,000 178,000 - ### -
 122,000
20,000 185,500 - ### -
- 165,700 - ### -
- 115,600 - ### -
20,000 319,000 - ### -
- 106,700 - ### -
- - - ### -
111,500 - ### -
0 199,500 90,000 - -
0 - - 60,000 -
0 194,500 - ### -
0 25,800 - ### -
0 - - ### -

120,000 3,029,100 495,000 60,000

- 673,000 - ### -
- - 60,000 - -
- 364,900 - ### -
20,000 199,000 - ### -
- 64,000 - ### 20,000
- 226,700 - ### -

20,000 1,527,600 60,000 - 20,000

20,000 142,100 - ### -

- - 60,000 - -
20,000 108,200 - ### -
- 41,700 - ### -
- - 300,000 - -
- - - ### -
- 94,000 - ### -
- 97,200 - ### -
- 149,200 - ### -
- 149,200 - ### -
- 217,000 - ### -
- 115,000 - ### -
- 37,000 35,000 - -
- 132,000 - ### -
- 104,800 - ### -
- 230,200 130,000 - -
 - 263,800 - ### -
- 110,300 90,000 - -
- 281,000 - ### -
- 138,000 - ### -
- 197,900 - ### -
- 10,000 - ### -
- 15,600 - ### -

40,000 2,634,200 615,000 - -

- 272,000 300,000 - -
- 135,000 - ### -
- 66,500 300,000 - -
- 15,500 - ### -
- - - ### -
- 155,200 150,000 - -
- 395,500 300,000 60,000 -
- 112,700 300,000 - -
- - - ### 50,000
- 150,000 - ### -

- 1,302,400 1,350,000 60,000 50,000

- 2,400 - ### -
- 107,500 - ### -
- 189,200 - ### -
- - 300,000 - -
- - 60,000 - -
- 10,400 - ### -
- 56,000 - ### -
100,000 169,900 218,000 - -
- 254,200 - ### -
- - - ### 70,000
- - - ### -
- - - ###
- - - ### -
- 13,500 - ### -
100,000 99,000 - ### 75,000
- 54,000 - ### -
- 47,500 - ### -
 - 144,200 - ### -
- 199,100 - ### -
20,000 450,100 - ### -
20,000 - - ### -
20,000 33,900 - ### -
- 89,000 - ### -
- 217,400 - ### -
- 107,200 - ### -
60,000 596,000 - ### -
- 2,500 - ### -

320,000 2,843,000 578,000 - 145,000

- 16,500 - ### -
- 13,800 - ### -
- - 300,000 - -
- - 413,000 - -
- - 300,000 - -
- 5,500 - ### -
100,000 160,000 - ### 20,000
- 377,000 - ### -
- - 60,000 - -
- 612,000 - ### -
- 163,200 - ### -
- 201,700 - ### -
- - - ### -
- 299,400 237,000 - -
146,100 - ### -

100,000 1,995,200 1,310,000 - 20,000

- 8,000 - ### -
- - - ### -
- 170,000 - ### -
- 183,500 - ### -
- 121,200 - ### -
- - - ### 70,000
- 19,000 - ### -
- 222,500 - 60,000 -
20,000 253,500 - ### -
- 230,400 - ### -
 - 27,500 - ### 70,000
- 192,600 - ### -
- - 135,000 - -
- 174,600 - ### -
- 88,000 - ### -
- 296,200 - ### -
- 24,000 - ### -
- 180,000 - ### -
- - - ### -
- 13,400 - ### -
- 62,200 - ### -

2,266,600 135,000 60,000 140,000

- 20,000 - ### -
- - - ### -
- 22,000 - ### -
- 150,000 - ### -
- 140,000 - ### -

332,000

20,000 24,000 - ### -

22,000 38,000 - ### -

42000 62,000

- 376,000 - ### -
- 158,200 - ### -
- - 300,000 - -
- 179,400 145,000 - -
- - 270,000 - -
- 130,900 - ### -
- 126,300 - ### -
- 505,000 460,000 - -
- 183,200 - 60,000 -
- 338,000 - ### -
- 285,500 - ### -
- 104,000 - ### -
 - - - ### -
- 168,400 - ### -
- - - ### -
- 75,200 300,000 - -
- 126,000 - ### -
- 6,000 - ### -
- - 300,000 - -
- 333,200 - ### -
- 183,000 - ### -
- 166,400 - ### -
- 176,200 - ### -
- 190,000 - 70,000 -
- 121,800 - ### -
- 145,000 - ### -

0 4,077,700 1,775,000 130,000 0

- 260,000 235,000 - -
- - - ### -
- 151,800 - ### -
20,000 597,100 - ### -
- 106,000 - ### -
20,000 203,400 - ### -
- 10,000 - ### -
- 620,000 - ### -
- 185,400 - ### -
- 153,200 - ### -
- 108,900 - ### -
20,000 - - ### -
- 69,200 - ### -
- 125,000 - ### -
- 58,600 - ### -
- 87,000 300,000 - -
- 442,200 - ### -

60,000 3,177,800 535,000 0 0

- 134,600 - ### -
- 159,000 - ### -
- 58,000 - ### -
- 47,500 - ### 50,000
 - 182,500 - 60,000 20,000
- 10,000 - ### -
- 251,000 - ### -
- - 300,000 - -
- 112,200 - ### -
20,000 114,600 - ### -
- 168,500 - ### 50,000
- 122,000 - 60,000 -
- 126,000 - ### -
- 89,000 - ### -
- 204,800 205,000 - -
- 146,200 - ### -
- 151,300 300,000 - -
- 10,000 - ### -

20000 2,087,200 805,000 120,000

- - 220,000 - -
- 2,000 - ### -
- 116,300 300,000 - -
100,000 240,600 287,000 - -
- 157,000 - 60,000 -
- 118,500 - 120,000 -
- 272,200 - ### -
- 63,800 205,000 - -

100,000 970,400 1,012,000 180,000 -

- 118,200 - ### -
- 139,200 - ### -
- 130,000 - ### -
- 111,700 - ### -
- 55,300 - ### -
- 129,400 105,000 - -
- 3,000 - ### -
- - 160,000 - -
- - 300,000 - -
- 39,000 - ### -
- 146,800 - ### -
- 80,200 - ### -
- 83,100 - ### -
- 136,000 - ### 30,000
- 67,500 - ### 30,000
- 116,800 20,000 - -
- 10,000 - ### -
- - 20,000 - -
- 361,000 - ### -
- 10,000 - ### -
- 205,000 - ### -
- 42,500 - ### -
- 165,600 - ### -
- 130,600 - 60,000 -

- 2,280,900 605,000 60,000 60,000

- 93,700 105,000 - -
- 166,100 - ### -
- - 300,000 - -
- 11,700 - ### -
- 46,000 - ### -
- 40,000 - ### -
- 400,500 - ### -
- 157,200 - ### -
- 257,000 - ### -
94,200 - ### -
- 2,000 - ### -
- 97,700 - ### -
- 168,400 - ### -

1,534,500 405,000 0 0
- 152,000 - ### -
- 248,500 413,000 - -
- - 300,000 - -
- 103,500 - ### -
- 118,000 142,000
- 62,200 405,000 - -
- 258,100 - -
- - - ### -
- - - ### -
- 174,000 - ### -
- 140,000 - ### 30,000
- - 132,000 - -
20,000 226,200 - ### -
- 31,000 - ### 50,000
- 174,000 - ### -
- 298,200 - ### -
- - - ### -
20,000 74,000 - ### -
- 13,000 - ### -
- 30,000 - ### -
20,000 - - ### -
- 226,500 - ### -

60,000 2,329,200 1,392,000 - 80,000

- - 145,000 - -
- - 15,000 - -
- 171,400 - ### -
- 197,000 - ### -
- 180,000 - ### -
- 286,000 - ### -
- 30,600 - ### -
- 129,700 175,000 - -
- - 300,000 - -
- 138,500 - ### -
- 33,100 - ### -
- 255,800 - ### -
- 210,600 300,000 - -
- 138,700 - ### -
- 194,100 - ### -
- 97,100 - ### -
- 106,200 - ### -
- 360,000 - 60,000 -
- 219,500 - ### -

- 2,748,300 935,000 60,000 -

- 134,800 - ### -
- - 158,000 - -
- 167,000 105,000 - -
- 2,500 - ### -
- 20,000 - ### -
 - 152,000 - ### -
20,000 275,600 - ### -
- 73,200 - ### -
60,000 121,500 - ### -
20,000 102,400 - ### -
- 167,600 - 120,000 -
- 157,200 - ### -

263,000

- - - ### -
- 134,000 - ### -
- 141,200 - ### -
- 92,000 - ### -

- 64,000 - ### -
- 34,000 - ### -
- - 300,000 - -
- 3,000 - ### -
- 185,000 - ### 35,000
- 98,000 - ### -
- 86,200 - ### -
- 130,000 - ### -
- 129,500 - ### -
- 219,300 - ### -
60,000 183,600 142,000 60,000 -
- 62,200 - ### -
100,000 82,000 162,000 180,000 -

604,000
- - - ### -
20,000 133,200 - ### 20,000
- 115,000 - ### -
- 293,200 105,000 - -
40,000 193,000 187,000 130,000 -
- 69,400 - ### 30,000
10,000 5,000 - ### -
- 8,400 - ### -
- - 300,000 - -
- 123,500 - ### -
- - - ### -
 - - - ### -
- 145,000 - ### -
- 529,200 - ### -
- 124,000 260,000 - -
- 118,200 - ### -
- 159,000 - ### -
20,000 327,000 300,000 - -
- - - ### -
- 98,000 - ### -
60,000 68,600 - ### -
- 82,000 300,000 - -
- 150,000 - 60,000 -
- 211,000 - ### -
- 10,000 - ### -
- 132,600 195,000 - 20,000
- 7,500 - ### -

1,647,000
10,000 - - ### -
- 98,000 - ### -
20,000 263,600 - ### -
- 100,000 - ### -
- 25,500 - ### -
- 73,000 - ### -
- 170,000 - ### -
- 142,400 105,000 - -
- 161,200 - ### -
10,000 - - ### -
- 39,600 155,000 60,000 -
- 20,000 - ### -

260,000
- 20,000 - ### -
- 85,000 - ### -
- 16,500 - ### -
- 24,000 - ### -
- 49,200 155,000 60,000 -
- 2,400 - ### -
- 125,800 - ### -
- 3,000 - ### -
- - - 120,000 -
 15,000 10,000 - ### -
- 32,200 - ### -

155,000
- 114,200 - ### 20,000
- 60,400 - ### 20,000
- 175,600 105,000 - -
- 25,500 - ### -
- 109,400 - ### -
- 261,800 - ### -
- 356,000 - ### -
- 178,500 - ### -
- 180,200 - ### -
- 314,000 - ### -
20,000 386,100 - ### -
- 129,000 - ### -
- 297,000 - ### -
- - - ### -
- 36,200 - ### -
20,000 236,200 - ### -
20,000 354,800 - ### -
- 334,700 377,000 - -

482,000
- 435,000 - ### -
- - 20,000 - -
- 70,800 - ### -
20,000 208,500 - ### -
- 55,500 300,000 - -
- 89,200 - ### -
- 237,400 - ### -
150,000 113,000 - ### -
- 182,200 - ### -
25,000 25,600 - ### -
- 74,500 315,000 - -
- 206,200 - ### -
- 23,000 - ### -
- 19,000 - ### -
- 56,300 - ### -

635,000
 - - 105,000 - -
- - 100,000 - -
- - - ### -
- - - ### -
- 139,200 - 60,000 -
- 664,000 185,000 - -
- 146,000 - ### -
- 112,600 - ### -
- - - ### -
20,000 267,700 - ### -
- 205,000 - ### -
- 66,500 - ### 70,000
- 231,000 - ### -
- 175,000 - ### -
- 91,600 - ### -
- 446,000 - ### -
20,000 482,000 - ### -
- 186,000 - ### -
- 707,600 - ### -
- 348,000 - ### -
151,000
- 151,000 - ### -

390,000

- 167,000 - ### -
- 6,000 - ### -
- - - ### -
- - - ### -
- 110,200 300,000 - -
20,000 633,600 - ### -
- 105,000 - ### -
- 165,000 - ### -

- - 260,000 - -
- 151,500 - ### -
- - - ### -
- 245,000 - ### -
- 99,200 - ### -
 - 52,000 - ### -
- 30,000 - ### -
- - 300,000 - -
- 19,500 - ### -
- - - 60,000 -
- - 285,000 - -
- 105,000 - ### -
- 22,800 - ### -
- 15,600 - ### -
- 188,000 - ### -
- 43,000 - ### -
- 159,000 - ### -
- 112,700 - ### -
- - 275,000 - -
- 72,000 - ### -
15,000 - - ### -
- 158,200 260,000 - -
- 180,100 - ### -
- 89,200 - ### -
- - 147,000 - -
- 27,000 - ### -
- - - ### -
- 344,000 - ### -
30,000 25,600 - ### -
- 278,000 - ### -
- 346,000 - ### -
- 552,000 - ### -
- 357,000 - ### -

- - - ###

- 11,000 - ### -
- 102,500 - ### -

- 10,000 - ### -
- 25,000 - ### -
- 10,000 - ### -
- 168,400 - ### -
- 13,000 - ### -
 - 276,000 112,000 - -
- - 60,000 - -
- 80,300 - ### -
163,500 - ### -
- 146,000 - ### -
- 227,000 50,000 - -
- 91,200 - ### -
- 300,000 - ### -
- 104,000 - ### -
- 25,000 - ### -
- - 300,000 - -
- - - ### -
- 340,800 - ### -
- 922,000 430,000 - -
- - - ### -
- 354,200 - ### -
- 261,000 - ### -
- - 300,000 - -
- - - ### -
20,000 46,800 - ### -
20,000 355,000 270,000 - -
15,000 - - ### -
60,000 174,000 - 60,000 -
- 5,500 - ### -
- 177,800 - ### -
20,000 - - ### -
- 100,000 - ### -
- - - ### -
- 16,000 - ### -
- 140,200 - ### -
- - 300,000 - -
170,000 177,600 - ### -

- 16,000 - ### -
- 156,600 116,000 - -
- 83,400 300,000 - -
- 110,700 - ### -
- - 300,000 - -
- 10,800 - ### -
 - - - ### -
- 222,000 - ### -
- 155,200 - ### -
- 374,400 - ### -
- 168,800 395,000 - -
- 80,200 300,000 - -
- 4,000 - ### -
- 130,000 - ### 20,000
60,000 172,400 - ### -
- 254,000 - ### -
- 113,000 - ### -
- 188,000 - ### -
- 116,000 - ### -
TOTAL
No Nama Pasien
352,500
321,500 1 Viddy
75,000 2 Ina Rustiana
95,000 3 Irni Heryani
218,900 4 Hermala
236,000 5 Nunuh
308,000 6 D Najmudin
257,700 7 Astia Nuralip
144,000 8 Enung
486,800 9 Tan Eng Nio
391,500 10 Nunuh
199,000 11 Kusnadi
401,200 Bebby Syaqila
347,000 Berliana
479,700 Nurjanah
155,500
121,500

4,590,800

160,000
203,000
275,500
244,200
259,500
160,600
75,000
75,000
75,000
241,900
184,000
393,700

2,347,400

207,800
256,000
 34,800
116,000
174,200
365,000
271,300
295,900
400
4,800
200,500
129,000
86,300
707,800
279,600

3,129,400

141,000
207,000
199,500
423,000
7,100
137,200
315,200
172,300
327,700
233,700
254,000
12,900
519,600

2,950,200

259,500
427,400
226,500
14,500
300,000
328,500
347,200
276,700
313,000
 197,000
280,500
240,700
190,600
414,000
181,700
75,000
186,500
364,500
135,000
269,500
100,800
75,000

5,204,100

748,000
60,000
439,900
294,000
119,000
301,700

1,962,600

237,100
135,000
203,200
41,700
300,000
75,000
169,000
172,200
224,200
224,200
292,000
190,000
147,000
207,000
179,800
435,200
 338,800
275,300
356,000
213,000
272,900
10,000
15,600

4,714,200

647,000
210,000
366,500
15,500
75,000
380,200
830,500
487,700
25,000
225,000

3,262,400

2,400
107,500
274,200
300,000
60,000
10,400
131,000
742,900
329,200
5,000
75,000
75,000
75,000
13,500
199,000
129,000
122,500
 219,200
274,100
545,100
95,000
128,900
89,000
292,400
182,200
731,000
2,500

5,211,000

16,500
13,800 1,043,300
300,000
413,000
300,000
5,500
315,000
452,000
60,000 2,941,900
687,000
238,200
276,700
75,000
611,400
221,100

3,985,200

8,000
75,000
245,000
183,500
121,200 632,700
5,000
94,000
357,500
348,500
305,400
 32,500
267,600
135,000 2,908,900
249,600
163,000
371,200
24,000
255,000
75,000
88,400
137,200

3,541,600

20,000
75,000 95,000
22,000
150,000 387,000
215,000

482,000

42,000
60,000 102,000

102,000

451,000
233,200
375,000 1,728,600
399,400
270,000
205,900
201,300
1,040,000
318,200
413,000
285,500
104,000
 75,000
243,400
75,000
450,200
126,000
6,000
300,000
408,200
258,000 5,337,300
241,400
251,200
335,000
201,800
225,000 426,800

7,492,700

495,000
75,000
226,800 1,488,900
692,100
181,000
298,400
85,000
695,000
260,400
228,200
183,900
95,000
144,200
200,000 3,408,900
58,600
462,000
517,200

4,897,800

209,600 1,207,600
234,000
133,000
72,500
 297,500
10,000
251,000
300,000
187,200
209,600
193,500
257,000
201,000
89,000
484,800 2,679,600
221,200
526,300
10,000

3,887,200

220,000
2,000
491,300
702,600
292,000
313,500 2,712,400
347,200
343,800 2,492,400

2,712,400

193,200
214,200
205,000
186,700 1,701,800
130,300
309,400
3,000
160,000
300,000
114,000
221,800
155,200
158,100
 181,000
112,500
211,800
10,000
20,000 2,534,100
436,000
10,000
280,000
117,500
240,600
265,600

4,235,900

273,700
241,100
300,000 814,800
11,700
81,000
75,000
475,500
232,200 1,376,600
332,000
169,200
2,000
172,700 418,100
243,400

2,609,500
227,000
736,500
300,000 1,367,000
103,500
335,000
542,200
333,100
75,000
75,000
249,000
185,000
132,000
 321,200
56,000
249,000
373,200
75,000
169,000
13,000 3,644,200
65,000
95,000
301,500

5,011,200 5,011,200

145,000
15,000
246,400
272,000
255,000
361,000
30,600 1,704,700
379,700
300,000
213,500
108,100
330,800
585,600
213,700
269,100
172,100 3,088,600
181,200
495,000
219,500

4,793,300

134,800
158,000 639,800
347,000
2,500
2,000
 227,000
370,600
108,200
256,500
197,400
362,600 1,759,000
232,200

2,398,800

75,000
209,000
216,200
167,000
667,200
99,000
69,000
300,000
3,000
225,000
173,000
161,200
205,000
129,500
294,300
520,600 2,840,800
62,200
599,000

3,508,000
75,000
208,200
190,000
473,200
625,000 1,709,200
114,400
15,000
8,400
300,000
198,500
75,000
 75,000
220,000
604,200
459,000
193,200
234,000
722,000
75,000
98,000
163,600
457,000 4,845,600
285,000
286,000
10,000
382,600
7,500

6,554,800
15,000
98,000
358,600
175,000
100,500
73,000 805,100
245,000
322,400
236,200 803,600
15,000
289,600
55,000 359,600

70,000
190,000
16,500
59,000
299,200
2,400
125,800 765,900
3,000
120,000
 60,000
70,200 250,200

169,200
115,400
355,600
25,500
184,400
336,800 1,186,900
431,000
253,500
255,200
389,000
481,100
204,000
372,000
75,000
71,200
331,200
449,800
786,700 4,099,700

5,286,600
510,000
20,000
105,800 635,800
303,500
430,500
164,200
312,400
338,000
257,200
85,600
464,500
281,200
58,000
54,000
91,300 2,840,400
3,476,200
 105,000
100,000
75,000
75,000
274,200 629,200
924,000
221,000
187,600
75,000
362,700
280,000
71,500
306,000
250,000
166,600
521,000
577,000
261,000
782,600
423,000
226,000
151,000 5,786,000

6,415,200

242,000
61,000 303,000
35,000
75,000
485,200
728,600
140,000
240,000 1,703,800

2,006,800

260,000
226,500
75,000
320,000
174,200
 52,000
65,000
300,000
19,500
60,000
285,000
105,000
22,800
15,600
188,000
43,000
234,000
187,700
275,000
147,000
50,000
493,200
255,100
164,200
182,000
62,000
75,000
419,000
90,600
353,000
721,000
627,000
432,000

11,000
157,500

45,000
60,000
45,000
243,400
13,000
 463,000
60,000
155,300
238,500
221,000
352,000
166,200
375,000
179,000
60,000 2,676,400
300,000
75,000
415,800
1,427,000
75,000
429,200
336,000
375,000
75,000
141,800
720,000
50,000
369,000
5,500
252,800
95,000
175,000
75,000
16,000
215,200
300,000
422,600 6,345,900

9,022,300

16,000
347,600
458,400
185,700 1,007,700
300,000
10,800
 35,000
297,000
155,200
449,400
638,800
455,200
4,000
185,000
307,400
254,000
188,000
188,000
191,000 3,658,800
4,666,500
 Rawat Jalan
Tgl Masuk Tgl Keluar Rawat Inap
Adm Dokter
19-08-2013 23-08-2013 5,000 70,000 600,000
24-08-2013 26-08-2013 0 0 700,000
28-08-2013 29-08-2013 5,000 70,000 400,000
27-08-2013 30-08-2013 5,000 70,000 1,300,000
29-08-2013 31-08-2013 5,000 70,000 500,000
30-08-2013 1/9/2013 5,000 70,000 500,000
30-08-2013 2/9/2013 5,000 70,000 700,000
2/9/2013 4/9/2013 10,000 100,000 537,500
28-08-2013 8/9/2013 5,000 70,000 4,025,000
6/9/2013 10/9/2013 - - 1,207,500
11/9/2013 Observasi 5,000 70,000 107,500
11/9/2013 12/9/2013 - - 500,000
10/9/2013 12/9/2013 - - 687,500
12/9/2013 14-09-2013 5,000 70,000
 Laporan Klinik Permata
Rawat Inap

Visite Dokter
Obat Laboratorium Radiologi
Visite Via Telp
50,000 15,000 1,576,000 345,000 -
### - 750,400 92,000 -
### - 1,147,500 452,000 66,000
- - 1,841,600 300,000 -
### - 1,247,300 297,000 -
### - 1,029,000 205,000 -
### - 1,319,800 280,000 -
120,000 - 856,000 358,000 -
### - 7,567,900 538,000 72,000
- - 3,287,500 178,000 -
### - 94,300 20,000 -
### - 1,130,800 316,000 -
### - 1,173,400 502,000 -

3,883,000
AKHP Tindakan Total Disc

264,000 312,000 3,237,000 -

127,500 100,000 1,769,900 -
330,000 305,000 2,775,500 -
351,500 150,000 4,018,100 -
163,000 80,000 2,362,300 -
233,000 120,000 2,162,000 -
240,000 330,000 2,944,800 -
177,000 60,000 2,218,500 -
766,000 895,000 13,938,900 -
374,000 180,000 5,227,000 100,000
14,000 235,000 545,800 -
111,000 235,000 2,292,800 -
256,000 320,000 2,938,900 -
Adm Materai Deposit Total Bayar

161,850 7,000 - 3,405,850

92,000 7,000 500,000 1,868,900
131,800 7,000 500,000 2,914,300
201,000 7,000 500,000 4,226,100
118,200 7,000 400,000 2,487,500
108,000 7,000 500,000 2,277,000
147,200 7,000 500,000 3,099,000
110,000 7,000 - 2,336,500
696,900 7,000 1,700,000 12,942,800
261,500 70,000 500,000 4,895,500
- - - 545,800
119,700 70,000 - 2,519,500
147,000 70,000 - 3,092,900
Ambulance

100,000
 Laporan Kasir
Tanggal : 29 Juli 2015 Pagi Rj pagi
Pemasukan Deposit :
Rawat Jalan :
Rawat Inap :

Total Rp -
Penerima Kasir
 KLINIK PERMATA
Jl.RA Kosasih No.112 Telp (0266) 219188
Sudah Di Terima Dari : Cepy Irawan.Tn
Usia : 37 Tahun
Ruangan : Ranah 2/Kls 1

Deposite Rp 1,000,000
Selisih Rp 335,000

Total Uang Kembali Rp 665,000

Sukabumi,24 juli 2015

 RINCIAN BIAYA RAWAT INAP
KLINIK RAWAT INAP PERMATA
JL.RA Kosasih No. 112 Sukabumi
Telp (0266) 219188 .Fax (0266) 6247781
No Rm : 0000-5969 Umur :
Nama Pasien : Cepy Irawan.Tn Tanggal Masuk :
Ruang Rawat : Ranah 2/Kls 1
Rawat jalan : dr.Yusra Dewita,Sp.PD Rp.
Rawat Inap : Ranah 2/Kls 1(3 x Rp.300.000) Rp.
Visite Dokter : dr.Yusra Dewita,Sp.PD (3xRp.85.000) Rp.
: dr.Husnan (2 xRp.20.000) Rp.
Farmasi / Obat : Rp.
Laboratorium : Rp.
AKHP + BHP : Rp.
Tindakan : Rp.
Total Rp.
Administrasi Rp.
Total Transaksi Rp.
Deposite Rp.
Sisa yang harus dibayar Rp.
Sukabumi,23 Juli 2015
ATA
37 Tahun
21/07/2015

87,000
900,000
255,000
40,000
2,402,658
694,900
103,120
181,950
4,664,628
404,656
5,069,284
-
5,069,284
2015
Admin
 Laboratorium
KLINIK RAWAT INAP PERMATA
Jl. RA Kosasih No.112 Telp (0266) 219188
Tanggal Masuk : 21/07/2015
Nama Pasien : Cepy Irawan.Tn Umur : 37 Tahun
Jenis Pemeriksaan : 22/07/2015
Hematologi Rutin Rp 68,600
Glukos sewaktu Rp 25,000
Cholesterol total Rp 25,000
Trigliserida Rp 25,000
SGOT Rp 25,000
SGPT Rp 25,000
Ureum Rp 25,000
Creatinin Rp 25,000
Asam urat Rp 33,300

Total Rp. 276,900

Sukabumi,22 Juli 2015
MATA
88

Umur : 37 Tahun
22/07/2015
68,600
25,000
25,000
25,000
25,000
25,000
25,000
25,000
33,300

276,900
Sukabumi,22 Juli 2015
 KLINIK RAWAT INAP PERMATA
Radiologi

Tanggal Pemeriksaan : 23 Juli 2015

Nama Pasien : Ujang Herdi Tn
Umur : 35 thn
Jenis Pemeriksaan :
Thorax Ap/PA Rp. 83,200

Total Rp. 83,200

83,200

83,200
 RINCIAN BIAYA TINDAKAN RAWAT INAP
KLINIK RAWAT INAP PERMATA
No. RM : 0000-5969 Umur :
Nama Pasien : Cepy Irawan.Tn Tanggal Masuk :
Ruang Rawat : Ranah 2/Kls 1
Infus 1 Rp 31,950
Inject 20 Rp 7,500

TOTAL
Sukabumi,23 Juli 2015
WAT INAP
MATA
37 Tahun
21/07/2015

Rp 31,950
Rp 150,000

Rp 181,950
abumi,23 Juli 2015
 RINCIAN BIAYA OBAT RAWAT INAP
KLINIK RAWAT INAP PERMATA
No. RM : 0000-0203
Nama Pasien : Nur Azizah.Ny Usia
Ruang Rawat : Sahai VIP 2
Tanggal Nama Obat Qty Harga
08/03/2015 dextrose 100cc 1 Rp 20,100
08/03/2015 RL 500ml 1 Rp 25,148
08/03/2015 terfacef 1 Rp 281,800
08/03/2015 Ranitidin 1 Rp 4,500
08/03/2015 ondansentron inj 1 Rp 7,000
08/03/2015 Pumpisel 1 Rp 179,600
08/03/2015 trixim200mg 6 Rp 28,875
08/03/2015 redusec 10 Rp 2,000
08/03/2015 mucosta 10 Rp 5,800
Total
: 36 Thn

Total
Rp 20,100
Rp 25,148
Rp 281,800
Rp 4,500
Rp 7,000
Rp 179,600
Rp 173,250
Rp 20,000
Rp 58,000
Rp 769,398
 RINCIAN BIAYA OBAT RAWAT INAP
KLINIK RAWAT INAP PERMATA
No. RM : 0000-5979 Umur :
Nama Pasien : Ujang Herdi.Tn Tanggal Masuk :
Ruang Rawat : Ranah 1/Kls 2
Tanggal Nama Obat Qty Harga
23/07/2015 Futrolit 3 Rp 68,595
23/07/2015 Intricef 2 Rp 210,411
23/07/2015 Metronidazol 3 Rp 50,521
23/07/2015 Ranitidin 2 Rp 7,105
23/07/2015 Ondansetron 2 Rp 4,568
23/07/2015 PCT 3 Rp 1,624
23/07/2015 Sanfuliq 3 Rp 6,597
23/07/2015 Pumpisel 1 Rp 182,394
23/07/2015 Patral 2 Rp 9,490
23/07/2015 NaCl 100 1 Rp 22,634
Total
NAP
A
35 Tahun
22/07/2015

Total
Rp 205,785
Rp 420,822
Rp 151,563
Rp 14,210
Rp 9,136
Rp 4,872
Rp 19,791
Rp 182,394
Rp 18,980
Rp 22,634
Rp 1,050,187
 RINCIAN BIAYA RAWAT INAP
KLINIK PERMATA
JL.RA Kosasih No. 112 Sukabumi
Telp (0266) 219188 .Fax (0266) 6247781
No Rm : 0000-5379
Nama Pasien : Engkan Tn Umur
Ruang Rawat : Ranah 2/kls 1 Tanggal Masuk
Rawat jalan :
Rawat Inap : 6 Hari x Rp.300.000
Visite Dokter : dr.Yusra Dewita,Sp.PD(6x85.000)
: dr.Husnan (5x20.000)
Farmasi / Obat :
Radiologi :
Laboratorium :
AKHP + BHP :
Tindakan :
Total
Administrasi
Total Transaksi
Deposite
Sisa yang harus dibayar
Sukabumi,26 juli 2015
P

: 54 Tahun
: 21/07/2015
Rp. 80,000
Rp. 1,800,000
Rp. 510,000
Rp. 100,000
Rp. 4,946,800
Rp. -
Rp. 865,000
Rp. 1,228,000
Rp. 324,000
Rp. 9,853,800
Rp. 492,200
Rp. 10,346,000
Rp. 1,000,000
Rp. 9,346,000
mi,26 juli 2015
 Laboratorium
KLINIK PERMATA
Jl. RA Kosasih No.112 Telp (0266) 219188
Tanggal Masuk : 21/07/2015
Nama Pasien : Engkan Tn Umur :54 Tahun
Jenis Pemeriksaan 24/07/2015
Hematologi rutin Rp. 64,000

Total Rp. 64,000

 RINCIAN BIAYA TINDAKAN RAWAT INAP
KLINIK PERMATA
No.RM : 0000-5734
Nama Pasien : Ginanjar Zaenudin Sdr Umur :
Ruang Rawat : Ranah 2 Tanggal Masuk :
Infus 1 Rp 30,000 Rp 30,000
Inject 22 Rp 7,000 Rp 154,000
EKG 1 Rp 125,000 Rp 125,000
GDS 1 Rp 20,000 Rp 20,000

Total Rp 329,000
Sukabumi,26 Juli 2015
INAP

25 Tahun
24/07/2015
Rp 30,000
Rp 154,000
Rp 125,000
Rp 20,000

Rp 329,000
2015
 KLINIK PERMATA
RADIOLOGI
Tanggal Pemeriksaan : 21/07/2015
Nama Pasien : Nani Hj.Ny
Umur : 70 Tahun
Jenis Pemeriksaan :
BNO Rp. 80,00

Total Rp. 80,00

80,000

80,000
 KLINIK PERMATA
Jl. RA.Kosasih No.112 Telp (0266) 219188
Tarif Radiologi
No Jenis Pemeriksaan
RJ/Kls II Kls I
Pemeriksaan Non Kontras
1 Thorax
a. Thorax AP/PA Rp 70,000 Rp 75,000
b. Thorax AP/PA + Lateral Rp 121,000 Rp 132,000
c. Top Lordotik Rp 55,000 Rp 60,000
2 BNO
a. Abdomen Polos / BNO Rp 80,000 Rp 85,000
b. Abdomen 2 Posisi Rp 143,000 Rp 156,000
c. Abdomen 3 Posisi Rp 220,000 Rp 250,000
3 Extremitas
a. Extremitas Atas Rp 75,000 Rp 80,000
b. Extremitas Bawah Rp 77,000 Rp 85,000
4 Schedel
a. Schedel AP & Lateral Rp 99,000 Rp 108,000
b. SPN Waters Rp 77,000 Rp 84,000
c. SPN Waters & Cadwell Rp 143,000 Rp 156,000
d. SPN Waters,Cadwell & Lateral Rp 220,000 Rp 240,000
e. Mandibula Rp 88,000 Rp 96,000
f. Cavum Orbita Rp 88,000 Rp 96,000
g. TMJ 1 Rp 99,000 Rp 108,000
h. TMJ 2 Rp 176,000 Rp 192,000
i. Maxilla/Arcus Zigomaticum Rp 88,000 Rp 96,000
j. Mastoid 2 Posisi Rp 110,000 Rp 120,000
k. Mastoid 4 Posisi Rp 198,000 Rp 216,000
l. Sella Turcica 1 Posisi Rp 77,000 Rp 84,000
m. Sella Turcica 2 Posisi Rp 132,000 Rp 144,000
n. Os Nasal Rp 88,000 Rp 96,000
5 Columna Vertebralis
a. Cervikal AP + Lateral Rp 110,000 Rp 120,000
b. Cervikal AP,Lateral & Oblique Rp 165,000 Rp 180,000
c. Thoracal AP & Lateral Rp 165,000 Rp 180,000
d. Thoracolumbal AP & Lateral Rp 220,000 Rp 240,000
e. Lumbosacral AP & Lateral Rp 150,000 Rp 165,000
f. Stermum PA + Oblique Rp 94,000 Rp 102,000
g. Sacrum / Coxxigis AP + Lateral Rp 138,000 Rp 150,000
6 Pelvis
a. Coxae dex + sin AP Rp 77,000 Rp 84,000
b. Coxae dex + sin AP + Lateral Rp 132,000 Rp 144,000
c. Coxae dex / sin AP Lateral Rp 132,000 Rp 144,000
 d. Pelvis AP Rp 83,000 Rp 90,000
e. Pelvis AP + Lateral Rp 154,000 Rp 168,000
7 Bone Survey
a. Bone Survey A Rp 418,000 Rp 456,000
b. Bone Survey B Rp 528,000 Rp 576,000
8 Artresiani Rp 110,000 Rp 120,000
TA
219188
adiologi
VIP

Rp 80,000
Rp 143,000
Rp 65,000

Rp 95,000
Rp 169,000
Rp 275,000

Rp 90,000
Rp 95,000

Rp 117,000
Rp 91,000
Rp 169,000
Rp 260,000
Rp 104,000
Rp 104,000
Rp 117,000
Rp 208,000
Rp 104,000
Rp 130,000
Rp 234,000
Rp 91,000
Rp 156,000
Rp 104,000

Rp 130,000
Rp 195,000
Rp 195,000
Rp 260,000
Rp 175,000
Rp 111,000
Rp 163,000

Rp 91,000
Rp 156,000
Rp 156,000
Rp 98,000
Rp 182,000

Rp 494,000
Rp 624,000
Rp 130,000
KLINIK RAWAT INAP PERMATA KWITANSI
JL.RA. Kosasih (ciaul) no.112 Sukabumi Tanggal Pelayanan :
Telp: (0266) 219188 Nomor Kwitansi :
Fax: (0266) 6247781 Nomor RM :

Nama Pasien : Gendis Widiya Sapti W.Ny Usia :

No.Polis : 10782054 Ruangan :

Total Tagihan Claim : Rp 7,097,268

Terbilang : Tujuh Juta Sembilan Puluh Tujuh Ribu Dua Ratus Enam Puluh Delapan Rupiah
 25-May-2015
0009
0000-4959
27 Tahun
Sahai VIP II

a Ratus Enam Puluh Delapan Rupiah

Admin
 KLINIK PERMATA
Jl.RA Kosasih No.112 Telp (0266) 219188
KWITANSI PEMBAYARAN RAWAT INAP
No.
Sudah terima dari : Tn. Ruswan
Banyaknya uang : Dua Juta delapan ratus dua puluh dua ribu rupiah
Untuk pembayaran : Rawat inap a/n Tn. Ruswan Tanggal 08/12/2014 s/d 10/12/2014

jumlah : Rp. 2.822.000,-

Sukabumi, 10 Desember 2014
penerima
TANGGAL HARGA HARI
16/07/2015 Rp 45,000 KAMIS
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