DAFTAR PASIEN RUANGAN PAVILIUN ASSYFA

TANGGAL 01 S/D 30 APRIL 2013

TGL TGL HR NO. JK UMR KODEJ. PELY KET BIAYA

NO. KELAS NAMA A L A M A T KET UMUR DIAGNOSA PULANG DOKTER
MASUK KELUAR RWT REG THN ICD X RPULANG ALKES RESEP OPNAME PARAMEDISJ. SHIFT
Paramedis Yg
Jasa
di bagikan
Shift Yg di bagikan
PSG. INFUS FIKSASI CHATETER
1 01\04 06\04 5 10012636 Pav5 An.Farhan Vina Asri B L 3 Th ISPA + KP Anak Dr.Irwan E SPA Pk 1,988,453 697,724 2,875,000 144,000 96,000 144,000 96,000 - - -
2 06\04 11\04 3 12006564 Pav8 An.Raffi Al Jl.Sudirman L 5 Th Thypoid Fever Anak Dr.Irwan E SPA Pk 378,386 314,573 1,725,000 96,000 64,000 - - - - -
3 10\04 14\04 4 12003414 Pav7 An.Naupal Griya Dama L 6,8 Th ISPA Anak Dr.Netty SPA Pk 267,068 53,254 1,800,000 96,000 64,000 - - 25,000 35,000 -
4 10\04 13\04 3 7015542 Pav10 An.Raffi AtLr.Lematan L 10 Th Tonsilo Faringitis Anak Dr.Irwan E SPA Pk 1,500,852 347,658 1,725,000 96,000 64,000 - - - - -
5 10\04 11\04 1 13006393 Pav5 An.Vanya FJl.Basuki P 2,5 Bln KDS Anak Dr.Netty SPA Rujuk 73,046 16,938 575,000 24,000 16,000 - - - - -
6 11\04 12\04 1 12007262 Pav5 An.Adil Ha Ds.Gelumba L 2,10 Th Intosikasi super pel Anak Dr.Irwan E SPA Pk 238,983 244,119 575,000 48,000 32,000 - - - - -
7 12\04 15\04 3 10005252 Pav8 An.Fitria Jl.Perwira P 2 Th Thypoid Fever Anak Dr.Irwan E SPA Pk 791,873 245,470 1,725,000 96,000 64,000 - - - - -
8 17\04 19\04 2 12017746 Pav7 An.Arka N Prum Mahk L 6 Bln ISPA Anak Dr.Irwan E SPA Pk 421,312 295,397 1,725,000 96,000 64,000 96,000 64,000 - - -
9 22\04 23\04 2 9003300 Pav7 An.Adinda Prumnas 3 P 10 Th Asma Attack + ISPA Anak Dr.Irwan E SPA Pk 771,535 190,652 1,150,000 72,000 48,000 72,000 48,000 - - -
10 23\04 24\04 1 12003662 Pav9 An.Ledis VelVila Lingka P 9 Th Febris + Vomitus Anak Dr.Zul Amri SPA Pk 84,911 46,245 575,000 48,000 32,000 48,000 32,000 - - -
11 24\04 29\04 5 13007155 Pav9 An.Indah Pr Jl.Batu Raj P 11 Th DBD Anak Dr.Irwan E SPA Pk 3,384,607 278,729 2,875,000 120,000 96,000 - - 25,000 70,000 -

1 29\03 05\04 7 12019994 Pav8 Tn.Said AzmJl.May Zen L 43 Th Ischialgia Bedah Dr.Bujang SPB Pk 268,376 924,907 4,600,000 192,000 128,000 - - - - -
2 19\04 01\04 3 8003269 Pav12 Ny.Ismaniar Pendopa Jl. P 62 Th Gangren DM Dalam Dr.Bujang + Dr.Depta Pk 2,781,091 2,261,387 1,725,000 96,000 64,000 96,000 64,000 25,000 30,000 -
3 01\04 03\04 2 7006216 Pav9 Ny.Wiwik I Jl.Patra N0. P 48 Th Gastropaty Dalam Dr.Depta A SPPD Pk 1,939,781 1,756,103 1,725,000 96,000 64,000 - - - - -
4 01\04 04\04 3 10016364 Pav7 Tn.Timbul PJl.Kerinci V L 45 Th Gastropaty Dalam Dr.Depta A SPPD Pk 2,114,493 1,261,670 1,350,000 96,000 64,000 - - - - -
5 02\04 06\04 4 13005830 Pav10 Tn.Efri Oga Jl.Ank 45 G L 34 Th Thypoid Fever Dalam Dr.Depta A SPPD Pk 3,128,176 815,923 2,300,000 120,000 80,000 120,000 80,000 - - -
6 02\04 03\04 2 10014695 Pav12 Ny.Nurita D Jl.Jend Sud P 57 Th Gastropaty + DM Dalam Dr.Depta A SPPD Pk 464,985 471,339 575,000 48,000 32,000 48,000 32,000 - - -
7 02\04 05\04 3 9000259 Pav3 Tn.Agoes PaJl.Krakatau L 52 Th Inf Viral Akut Dalam Dr.Depta A SPPD Pk 1,941,992 795,259 1,725,000 96,000 64,000 - - - - -
8 03\04 06\04 3 9008812 Pav9 Ny.Tandok KJl.Kelekar L P 38 Th Gastropaty Dalam Dr.Depta A SPPD Pk 639,503 667,096 1,150,000 72,000 48,000 - - - - -
9 07\04 07\04 1 13006159 Pav8 Tn .M.Layu Ds.Tanah Ab L 57 Th Dyspnue + Efusi Fleura Dalam Dr.Depta A SPPD Rujuk 262,867 4,230 575,000 48,000 32,000 48,000 32,000 - - -
10 09\04 12\04 3 10008316 Pav9 Tn.Yusuf E Ds.Prabu M L 38 Th Dyspepsia + Hipertensi Dalam Dr.Depta A SPPD Pk 2,205,673 945,265 1,725,000 96,000 64,000 96,000 64,000 - - -
11 13\04 15\04 2 6001744 Pav7 Sdr.M.Wib Komp Bima L 15 Th Thypoid Fever Dalam Dr.Depta A SPPD Pk 1,170,852 203,586 575,000 48,000 32,000 - - - - -
12 15\04 16\04 1 13006585 Pav7 Tn.Didi Su Asrama Yon L 43 Th Vertigo Dalam Dr.Depta A SPPD Pk 278,013 663,081 575,000 48,000 32,000 48,000 32,000 - - -
13 15\04 18\04 3 8016923 Pav8 Ny.Asni NovJl.Bukit Bar P 37 Th DM + Dyspepsia Dalam Dr.Depta A SPPD Pk 2,055,903 1,088,020 1,350,000 96,000 64,000 - - - - -
14 22-Jul 22-Jul 2 11009422 Pav8 Tn.Alamsya Jl.Krakatau L 46 Th Rinitis + HT +Dyspepsia Dalam Dr.Depta A SPPD Pk 494,406 253,596 1,080,000 30,000 20,000 - - - - -
15 24\04 25\04 1 9012892 Pav7 Tn.Ahmad GJl..Jend su L 64 Th Stroke + Hemigplagi Dextra Dalam Dr.Tanu Rujuk 331,457 74,100 575,000 48,000 32,000 48,000 32,000 - - -
16 28\04 30\04 2 10001046 Pav7 Tn.Anuar Ds.Sindur K L 78 Th GEA + Dyspepsia Dalam Dr.Depta A SPPD Pk 1,490,680 747,402 1,150,000 72,000 48,000 72,000 48,000 - 30,000 -

1 05\04 08\04 3 13006101 Pav7 An.Alpindo Griya Sungk L 17 Th Post Ops Tonsilektomi THT Dr.Bimo Pk 948,631 240,695 1,350,000 96,000 64,000 - - 25,000 30,000 -
2 15\04 17\04 2 9005911 Pav9 An.Atika DwJl.Angkatan P 4 Th Post Ops Tonsilektomi THT Dr.Wita SPTHT Pk 294,004 163,132 1,150,000 72,000 48,000 72,000 48,000 - - -
3 16\04 18\04 2 6007864 Pav9 An.Abbas HJl.Angkatan L 7 Th Post Ops Tonsilektomi THT Dr.Wita SPTHT Pk 374,057 202,009 1,150,000 72,000 48,000 72,000 48,000 - - -

33,085,966 16,269,559 43,730,000 2,478,000 1,668,000 1,080,000 720,000 100,000 195,000 -

79

33,280,966
BIAYA
TOTAL SELISIH DISCOUNT
PERUSAHAAN
NGT INJEKSI SKINTEST
VIS. & KONSUL USG SELANG O2 ELEKTRIK
O2 TABUNG PA GV LAIN-LAIN ADM
- 90,000 2,500 525,000 - - - - - - - 100,000 6,758,677
- 72,000 2,500 355,000 - - - - - - - 100,000 3,107,459 752,543 GLOBAL
- - - 340,000 - - - - - - - 100,000 2,780,322 17,766 PT.TEL
- 54,000 2,500 355,000 - - - - - - - 200,000 4,345,010 GLOBAL
- 18,000 2,500 150,000 - 12,000 - 25,000 - - - 100,000 1,012,484 GLOBAL
- 18,000 - 170,000 - - - - - - - 150,000 1,476,102 BUMI PUTERA
- 54,000 2,500 305,000 - - - - - - - 150,000 3,433,843 GLOBAL
- 54,000 2,500 305,000 - - - - - - 100,000 3,223,209
- 36,000 2,500 220,000 - - - - - - - 50,000 2,660,687
- 18,000 5,000 135,000 - - - - - - - 50,000 1,074,156
- 90,000 2,500 525,000 - - - - - - - 150,000 7,616,836 LIPPO

- 6,000 - 680,000 - - - - - - - 150,000 6,949,283 SINAR MAS

- 54,000 - 340,000 - - - - - 180,000 - 150,000 7,866,478
- 72,000 2,500 425,000 - - - - - - - 250,000 6,330,384 PRATAMA
- 54,000 2,500 340,000 - - - - - - - 250,000 5,532,663 PT.TEL
- 72,000 25,000 425,000 - - - - - - - 100,000 7,266,099
- 36,000 - 170,000 - - - - - - - 50,000 1,927,324
- 54,000 2,500 205,000 - - - - - - - 150,000 5,033,751 GLOBAL
- 36,000 - 255,000 - - - - - - - 250,000 3,117,599 ABDA
- 18,000 25,000 50,000 - 12,000 - 25,000 - - - 50,000 1,182,097
- 54,000 2,500 305,000 - - - - - - - 100,000 5,657,438
- 18,000 2,500 135,000 - - - - - - - 100,000 2,284,938 BUMI PUTERA
- 18,000 - 245,000 - - - - - - - 100,000 2,039,094
- 72,000 2,500 340,000 - - - - - - 200,000 5,268,423 PT.TEL
- 30,000 - 80,000 - - - - - - - 40,000 2,028,002 2,423,347 PNS
- 36,000 - 185,000 - - - - - - - 50,000 1,411,557
- 36,000 2,500 220,000 - - - - - - - 50,000 3,966,582

- 36,000 2,500 170,000 - - - - - - - 200,000 3,162,826 PT.TEL

- 36,000 2,500 255,000 - - - - - - - 175,000 2,315,636 4,239,500
- 36,000 2,500 255,000 - - - - - - - 200,000 2,259,566 3,526,500

- 1,278,000 100,000 8,465,000 - 24,000 - 50,000 - 180,000 - 3,865,000 113,088,525 3,193,656 7,766,000
RUMAH SAKIT AR. BUNDA PRABUMULIH
DAFTAR PASIEN RAWAT INAP RUANG ANAK - ANAK
BULAN APRIL 2013

TGL TGL HR NO.

NO. KELAS NAMA A LA M AT
MASUK KELUAR RWT REG
1 24-Mar 2-Apr 9 13005335 II Abdul Karim Ds Tl akar
2 26-Mar 1-Apr 6 13005435 II Khalek Ds Prambatan
3 27-Mar 1-Apr 6 13005522 II Ovan Atha Mohan Jl Halmahera Gn Ibul
4 27-Mar 1-Apr 5 13005548 II M Al Fatturrahman Ds Paya Bakal
5 28-Mar 2-Apr 5 13005611 II Alaniez Ds Lubuk Raman
6 30-Mar 3-Apr 4 10004663 II A Raffi Jl Ra Kartini
7 30-Mar 3-Apr 4 11000854 II Ghali Jl Kop Toya
8 31-Mar 5-Apr 5 9015215 II Liana Ds Tj bunut
9 1-Apr 3-Apr 2 13005800 II Farah Mahendra Jl Bukit Lebar
10 2-Apr 05-Apl 3 13005889 II Bima Ds Lubuk Raman
11 4-Apr 5-Apr 2 13006012 II Rosa Cahyani Ds pelempang
12 4-Apr 9-Apr 5 13006022 II Chika Jl anggrek
13 5-Apr 6-Apr 1 13006078 II Nabela Jl alipatan
14 6-Apr 9-Apr 3 11001942 II Kasih Ira Ds Embacang
15 7-Apr 11-Apr 5 13006184 II Rasya Ds Purun
16 6-Apr 10-Apr 4 13006158 II Raid Danish Jl M Yamin
17 6-Apr 11-Apr 4 13006162 II Dzakira Perum Griya Medang
18 8-Apr 15-Apr 7 13006198 II Rifqa Prum Arda
19 10-Apr 13-Apr 4 13006374 II Regil Ds Teluk Lubuk
20 10-Apr 15-Apr 5 13006384 II Piki Andika Jl Padat Karya
21 11-Apr 15-Apr 4 13006171 II Auliya Ds Babat
22 12-Apr 15-Apr 3 12002201 II Azerel Jl Tanggamus
23 12-Apr 15-Apr 3 13006460 II Dzaki Ds Cinta Kasih
24 13-Apr 6-Apr 3 13006505 II Alvino Jl Pakjo
25 16-Apr 18-Apr 2 11004041 II Dava Prestya Ds Sialingan
26 17-Apr 21-Apr 4 13006171 II Aulia Ds Babat
27 17-Apr 22-Apr 5 13006807 II Aidil Ds Tebat Agung
28 19-Apr 24-Apr 5 13006910 II Akbar Mardotila Ds Beringin
29 19-Apr 23-Apr 5 10012539 II Fabrizio Jl Prawira
30 20-Apr 23-Apr 3 12009948 II Rendra Ds Sp Belimbing
31 21-Apr 26-Apr 5 13006994 II Riva Jl Perwira
131

1 25-Mar 1-Apr 7 9013998 III Joenatan Prumnas Griya sejahtera

2 27-Mar 2-Apr 6 13005549 III M Parel Ds Pagar Agung
3 28-Mar 1-Apr 4 13005586 III Al Aziz Ghafur Ds Sugihan
4 28-Mar 2-Apr 6 13005602 III Tri Ari wibowo Ds Talang Ubi
5 29-Mar 9-Apr 9 11020674 III M.firdaus Ds Beruge
6 1-Apr 4-Apr 3 13005808 III Egeano Ds Sumber Rahayu
7 1-Apr 9-Apr 8 8007250 III Miko Jl Mayor Iskandar
8 1-Apr 4-Apr 3 13005820 III M Dafa Jl Bangau
9 3-Apr 08-Apl 5 13005925 III Jipa Ds Jiwa baru
10 3-Apr 05-Apl 2 13005959 III Intania Ds Lubuk Raman
11 3-Apr 10-Apr 2 13005961 III M farel Jl anggrek
12 3-Apr 10-Apr 7 13005960 III Keisha Jl Anggrek
13 5-Apr 8 Azpril 3 13006073 III Yayang Jl gajah mada
14 5-Apr 13-Apr 8 13005988 III Ibel Aqilah Jl Aru
15 5-Apr 4-Apr 3 11021646 III Ranum Berlian Jl Baturaja
16 7-Apr 13-Apr 5 12016795 III Batiya Marga Mulya
17 8-Apr 10-Apr 3 13005961 III M Farel Jl Anggrek
18 8-Apr 11-Apr 4 13006270 III Callista Gelumbanng
19 8-Apr 13-Apr 5 13006260 III Risky Mahkota Prabu
20 9-Apr 13-Apr 4 12018016 III M Reno Ramadhan Ds Tj Miring
21 4-Apr 8-Apr 4 13006028 III Zaskiya Ds Muara Sungai
22 9-Apr 15-Apr 6 13006301 III Aurel Olivia Ds Marga Mulia
23 11-Apr 16-Apr 5 13006427 III Rafael Ds Lematang
24 11-Apr 17-Apr 7 10007010 III M Dzulhaidir Ds Tj Kemala
25 11-Apr 17-Apr 7 10011668 III A Zaki Ds Tj Kemala
26 12-Apr 15-Apr 3 7006836 III Metro Ds Embacang
27 13-Apr 17-Apr 4 13006534 III Alda Ds Modong
28 16-Apr 21-Apr 5 13006665 III Osil Ds Sungai Lematang
29 16-Apr 17-Apr 1 III Penunggu By Maryati
30 17-Apr 20-Apr 3 13006764 III Fanisa Ds Tanah Abang
31 18-Apr 24-Apr 6 11009430 III M Dava Jl Srikandi
32 20-Apr 22-Apr 2 7010073 III Zuhril Ds Sugiwaras
33 20-Apr 26-Apr 6 13006949 III Farhan Jl Bukit lebar
34 20-Apr 21-Apr 1 13006986 III Arif Jl Arjuna
35 21-Apr 23-Apr 2 13006990 III Anugrah Ds Sedupi
36 21-Apr 29-Apr 8 13006948 III Najia Jl M. Iskandar
37 23-Apr 27-Apr 4 13007112 III Lisa Umami Mess PT BSP
38 24-Apr 29-Apr 6 8010737 III Saskia Jl Pasar Bhayangkara
39 25-Apr 29-Apr 4 III Penunggu By Fanesa Ds Aur Kp 3
40 25-Apr 30-Apr 5 13007238 III Shafa Afifah Mess PT BSP
41 25-Apr 27-Apr 2 13007215 III Audia Vaalentina Ds Tj Bunut
42 26-Apr 27-Apr 1 III Penunggu By Alim Alif Tlg Ubi Pendopo
189

1 28-Mar 1-Apr 4 13005581 Neo Salsabila Pendopo

2 30-Mar 1-Apr 2 13005679 Neo Ahmad Azizan Jl Pranasib
3 1-Apr 4-Apr 4 13005792 Neo Wanda Jl Handayani Pendopo
4 28-Mar 30-Mar 2 13005598 Neo Tilawati Payu Putat
5 30-Mar 30-Mar 1 13004972 Neo Egi Pratama Tlg Bulang
6 3-Apr 5-Apr 2 13005920 Neo Kalisa Muara Sungai
7 3-Apr 06-Apl 4 13005939 Neo Sadewa Muara Emburung
8 3-Apr 8-Apr 5 13005956 Neo Luri Apriani Jl Angkatan 45
9 3-Apr 13-Apr 10 13005964 Neo Puspita Sari Ds Belimbing
10 15-Apr 16-Apr 1 13006650 Neo Nuri Putriana Ds Talang Taling
11 10-Apr 17-Apr 7 13006335 Neo Maryati Ds Tj Kurung
12 11-Apr 18-Apr 7 13006441 Neo Desi Sutriani 1 Ds Sugiwaras
13 11-Apr 16-Apr 5 13006442 Neo Desi Sutriani 2 Ds Sugiwaras
14 11-Apr 17-Apr 7 13006444 Neo Lista mini Ds Tj Rambang
15 15-Apr 20-Apr 5 13006634 Neo Septia Sefteni Ds Tj Kemala
16 16-Apr 18-Apr 3 13006717 Neo Rasikha Ds Banu Ayu
17 16-Apr 17-Apr 1 13006705 Neo Eka Septiana Pendopo
18 20-Apr 22-Apr 2 13006978 Neo Marisa Asrama Yonzipur
24-Apr 26-Apr 2 13007152 Neo M Arya Satya Jl A Yani
19 19-Apr 26-Apr 7 13006911 Neo Jata Dwi Ds Talang Taling
20 26-Apr 27-Apr 1 13007305 Neo Alif Albadawi Tlg Ubi Pendopo
21 26-Apr 27-Apr 1 13007306 Neo Alim Albadawi Tlg Ubi Pendopo
22 22 Ap;ril 25-Apr 3 13007054 Neo Desi Ristiana Jl Jend Sudirman
23 24-Apr 29-Apr 5 13007181 Neo Fanesa Ds Aur Kp 3
91

822
JK UMR KODE J. PELY KET
KET UMUR DIAGNOSA PULANG DOKTER
THN ICD X PULANG RESEP
L 32 Hari GEAD A09 Anak Irwan PK 392,388
L 3 bln BP J12 Anak Netty PK 116,232
L 6 bln Febris A78 Anak Netty PK
L 11 bln Vomitus R14 Anak Netty PK 58,634
P 2,4 th ISPA J06 Anak Irwan PK 52,754
L 3,10 th TDBD A90 Anak Zul PK
L 3,5 th ISPA J06 Anak Netty APS 130,710
P 4,9 th Febris A78 Anak Irwan PK 202,403
p 2 th ISPA + Vomitus J06 Anak Irwan Aps 72,600
L 1,2 th Febris + Gead A78 Anak Alip PK 132,456
P 1,10 thn KDS R25 Anak Nurlela APS 12,151
P 1,4 thn Febris A78 Anak Netty PK 121,559
P 1,3 thn Febris A78 Anak Lidrian Aps
P 2,5 thn Febris A78 Anak Zulamri APS 106,345
P 7 bln GEAD A09 Anak Lidrian PK 193,321
L 11 bln KDS R25 Anak Irwan PK 245,923
P 1.1 Th Febris A78 Anak Netty PK
P 1.4 Th KDS R25 Anak Zul PK 98,683
L 2,5 Th KDS R25 Anak Irwan PK 147,754
L 2,5 Th KDS R25 Anak Netty PK 235,887
P 3 bln Febris A78 Anak Irwan PK 160,914
L 1,7 Th GEAD A09 Anak Irwan PK 210,797
L 2,5 Th GEAD A09 Anak Netty APS 69,034
L 4 Th Febris A78 Anak Zul PK 119,107
L 1,6 Th GEAD A09 Anak Irwan APS
P 5 bln GEAD A09 Anak Irwan APS 364,939
L 8 bln GEAD A09 Anak Nurlela APS 131,300
L 7 Th DBD A91 Anak Zul APS 118,617
L 4,5 Th ISPA J06 Anak Irwan PK 12,272
L 10 bln Gead A09 Anak Irwan PK 207,171
L 11 bln Febris A78 Anak Irwan APS 316,523

L 4,3 th Febris A78 Anak Irwan PK 223,025

L 6 th Febris A78 Anak Zul PK 113,559
L 4 th Febris A78 Anak Zul PK 113,037
L 3,8 th ISPA J06 Anak Irwan PK 53,404
L 5 th TDBD A90 Anak Zul PK 111829
L 8 th KDS R25 Anak Netty PK 90,165
L 11 th Hepatitis Anak Netty PK
L 7 bln KDS R25 Anak Irwan PK
L 6 bln BP J12 Anak Netty PK 92,904
P 8 bln GEAD A09 Anak Harry APS 150,436
L 5,4 thn febris +vomitus A78 Anak Zulamri APS 85,467
P 8,6 thn Typoid A01 Anak Zulamri PK 38,943
P 7,6 thn DBD A90 Anak Lidrian Aps 134,478
L 7 thn Typoid fever A01 Anak Netty PK 72,585
P 6 thn Comtusio Cerebri Anak Zulamri PK 90,165
P 8 bln Bp J12 Anak Zul PK 200,235
L 5.4 Th Febris A78 Anak Zul Aps
P 5 Th DBD A90 Anak Irwan PK 41,802
L 8 Th TDBD A90 Anak Zul PK 139,377
L 8 bln GEAD A09 Anak Nurlela PK 358,926
P 3 Th GEAD A09 Anak Zul PK 93,832
P 4,4 Th Thypoid A01 Anak Netty PK 166,282
L 1 Th BP J12 Anak Netty PK 154,080
L 10 Th Febris A78 Anak Netty PK
L 6 Th Febris A78 Anak Netty PK
L 6 Th Hepatitis B15 Anak Irwan PK 230,746
P 2 bln BP J12 Anak Irwan APS 153,455
L 4 bln BP J12 Anak Irwan PK 34,147
UMUM PK
P 1 bln Low Intake Anak Zul PK 99,529
L 2 Th Kejang R25 Anak Irwan PK 38,687
L 6 Th Thalasemia D56 Anak Zul APS 30,895
L 7 bln Febris A78 Anak Irwan APS 182,808
L 8 bln Vomitus R14 Anak Harry APS
L 6 bln Gead A09 Anak Irwan APS 317,576
P 6 Th DBD A90 Anak Zul PK 149,841
P 9 Th ISK Anak Alip PK 147,839
P 6 Th DBD A91 Anak Irwan PK 49,451
UMUM
P 6 bln Imfetigo bulosa Anak Irwan PK 321,666
P 6 Th DBD A91 Anak Irwan APS 206,066
UMUM APS

P 9 Hari Hyperbilirubin P59 Anak Netty PK

L 21 Hari Teauma Capitis Anak Zul PK 25,007
P 8 Hari Hyperbilirubin P59 Anak Irwan PK 205,221
L 0 Hr Asfeksia Berat P21 Anak Zul Rujuk 13,110
L 16 Hr BBLR P07 Anak Irwan APS
P 6 Hr Go Anak Irdianto PK
L 5 Hr Gead A09 Anak Irwan PK 230,351
P 0 Hr BBLR P07 Anak Netty Meninggal
P 0 Hr Susp Infeksi Anak Netty PK 74,675
P 1 Hr Sepsis Anak Irwan RUJUK
P 0 Hr Asfeksia P21 Anak Irwan PK 205,640
P 0 Hr BBLR P07 Anak Irwan APS 118,444
P 0 Hr BBLR P07 Anak Irwan PK 118,444
P 0 Hr Cyanosis P21 Anak Irwan PK 142,535
L 0 Hr Susp Infeksi A33 Anak Netty PK 58,969
P 2 Hr Obs Kejang R25 Anak Irwan APS 97,679
L 0 Hr Vomitus R14 Anak Zul Rujuk 66,650
P 27 Hr Gead A09 Anak Irwan APS 61,650
L 13 Hr Perdarahan Tl Pusat Anak Zul Pindah Vip
P 10 Hr Bp + Bblr J12 Anak Irwan PK
L 4 Hr BBLR + Asfiksia P07 Anak Zul Rujuk Plg
L 4 Hr BBLR + Asfiksia P07 Anak Zul Rujuk Plg
P 0 hr BBLR P07 Anak Irwan PK 45,158
L 22 Hr Obs Kembung R14 Anak Irwan PK 153,583

10,134,827
ALKES OPNAME J. PARAMEDIS P.BAYI T.SHIFT PSG. INFUS CHATETER NGT
728,914 1,530,000 96,000 64,000 25,000 60,000
694,895 1,020,000 67,200 44,800 25,000
109,626 1,020,000 57,600 38,400 25,000
133,131 850,000 57,000 38,000 25,000
468,054 850,000 57,600 38,400 25,000
35,000 680,000 48,000 32,000 25,000
297,257 680,000 48,000 32,000 25,000
553,304 850,000 57,600 38,400 25,000
47,053 260,000 15,000 10,000
86,940 510,000 38,400 25,600
95,550 170,000 19,200 12,800
850,000 57,600 38,400
130,000 7,500 5,000
333,074 510,000 38,400 25,600
185,534 680,000 48,000 32,000 25,000
238,664 680,000 48,000 32,000
179,870 520,000 37,500 25,000 20,000
713,293 1,190,000 76,800 51,200 25,000
272,997 510,000 38,400 25,600
378,697 850,000 57,600 38,400 25,000
287,410 680,000 48,000 32,000 25,000
260,504 510,000 38,400 25,600 25,000
153,567 510,000 38,400 25,600 25,000
337,769 510,000 38,400 25,600
29,409 260,000 15,000 10,000
286,046 680,000 48,000 32,000 25,000
470,712 850,000 57,600 38,400 25,000
1,097,303 850,000 57,600 38,400 25,000
121,588 850,000 48,000 32,000 25,000
159,546 510,000 38,400 25,600 25,000
648,556 850,000 57,600 38,400 25,000

1,562,539 700,000 52,800 35,200 25,000

907,805 600,000 46,200 30,800
419,945 400,000 33,000 22,000
55,793 330,000 36,000 24,000 15,000
466,901 900,000 66,000 44,000 25,000
325,192 300,000 26,400 17,600
440,000 54,000 36,000
212,098 300,000 26,400 17,600 25,000
239,532 500,000 39,600 26,400 25,000
165,551 200,000 19,800 13,200 25,000
82,500 275,000 30,000 20,000 15,000
47,488 385,000 42,000 28,000 17,500
384,338 300,000 19,800 13,200
887,155 800,000 59,400 39,600 25,000
 325,186 300,000 26,400 17,600
208,079 600,000 46,200 30,800 25,000
165,000 24,000 16,000
596,218 300,000 26,400 17,600 25,000
962,292 500,000 39,600 26,400
302,940 400,000 33,000 22,000 25,000
574,193 400,000 33,000 22,000 25,000
380,869 600,000 46,200 30,800 25,000
256,615 500,000 39,600 26,400 25,000
55,000 385,000 42,000 28,000 15,000
27,500 385,000 42,000 28,000 15,000
346,332 300,000 26,400 17,600
283,240 400,000 33,000 22,000 25,000 60,000
336,368 500,000 39,600 26,400
100,000
102,886 300,000 26,400 17,600 25,000
596,500 600,000 39,600 26,400 25,000
162,448 200,000 19,800 13,200 25,000
999,236 600,000 46,200 30,800 25,000
13,957 100,000 13,200 8,800
80,850 200,000 19,800 13,200
1,221,347 800,000 59,400 39,600 25,000
325,241 400,000 26,400 17,600 25,000
194,499 330,000 36,000 24,000
400,000
473,257 500,000 33,000 22,000
105,837 200,000 19,800 13,200
100,000

400,000 25,500 ### 34,000

78,415 200,000 15,300 ### 20,400
440,000 25,500 ### 34,000
183,830 220,000 15,300 ### 20,400 25,000 60,000
119,963 110,000 5,100 ### 6,800 25,000 60,000
168,535 200,000 15,300 ### 20,400 25,000
182,858 440,000 25,500 ### 34,000
122,024 100,000 7,500 ### 10,000 60,000
641,537 1,100,000 56,100 ### 74,800 25,000 60,000
119,832 110,000 10,200 ### 13,600
574,820 770,000 40,800 ### 95,200 25,000
359,578 770,000 40,800 ### 95,200 25,000 60,000
146,720 550,000 30,600 ### 40,800 25,000
463,951 660,000 35,700 ### 47,600 25,000
1,299,915 550,000 30,600 ### 40,800 25,000 60,000
183,374 220,000 15,300 51,300 20,400 25,000
184,654 110,000 10,200 ### 13,600 25,000 60,000
185,597 200,000 15,300 ### 20,400 25,000
68,343 200,000 15,300 ### 20,400
406,426 770,000 40,800 ### 54,400 25,000 60,000
132,737 110,000 10,200 ### 13,600 25,000
121,019 110,000 10,200 ### 13,600 25,000
281,318 330,000 20,400 27,200 25,000 60,000
 407,638 500,000 30,600 ### 40,800 25,000 60,000

30,525,074 47,565,000 3,393,300 563,700 2,709,200 1,497,500 - 720,000

 BIAYA
SONDE INJEKSI SKINTESTVIS. & KONSUL SELANG O2
O2 ELEKTRIKO2 TABUNG FOTOTERAPI
144,000 2,500 940,000
108,000 2,500 420,000
108,000 2,500 360,000
72,000 2,500 330,000
54,000 2,500 330,000
72,000 2,500 270,000
30,000 2,500 240,000
108,000 5,000 360,000
25,000 132,500
24,000 2,500 220,000
18,000 2,500 90,000
30,000 2,500 270,000
15,000 2,000 33,000
72,000 2,500 180,000
72,000 2,500 280,000
90,000 2,500 290,000
### 2,000 195,000
126,000 2,500 450,000
54,000 310,000 12,000 125,000
90,000 2,500 360,000
72,000 2,500 320,000
72,000 2,500 260,000
24,000 2,500 240,000
72,000 2,500 210,000
10,000 2,000 132,500
345,000
90,000 2,500 350,000
108,000 2,500 295,000
90,000 2,500 315,000
36,000 2,500 175,000
90,000 2,500 330,000

126,000 2,500 525,000

108,000 2,500 355,000 12,000 12,500
72,000 2,500 275,000
54,000 2,000 260,000 7,500 10,000
144,000 2,500 550,000
72,000 2,500 220,000
2,000 320,000
54,000 2,500 190,000
108,000 2,500 330,000 12,000 250,000
12,000 2,500 110,000
45,000 2,000 220,000
63,000 2,000 300,000
72,000 2,500 165,000
144,000 465,000
 72,000 2,500 220,000
90,000 2,500 385,000 12,000 300,000
9,000 100,000
54,000 2,500 230,000
90,000 2,500 275,000
72,000 2,500 225,000
72,000 245,000
42,000 2,500 110,000
108,000 2,500 355,000 12,000 25,000
63,000 2,000 300,000
63,000 2,000 300,000
18,000 2,500 240,000
90,000 2,500 230,000 12,000 262,500
90,000 2,500 295,000 12,000 50,000

54,000 2,500 190,000

108,000 2,500 400,000 12,000 300,000
80,000
108,000 2,500 385,000 12,000 75,000
18,000 50,000
36,000 2,500 165,000
162,000 2,500 465,000
72,000 2,500 250,000
54,000 2,000 285,000

108,000 2,500 415,000

175,000

275,000 385,000
54,000 2,500 135,000
230,000
50,000 54,000 135,000 12,000 1,087,500
5,000 18,000 2,500 25,000 12,000 87,500
54,000 165,000
72,000 2,500 255,000 270,000
200,000 150,000 20,000
100,000 198,000 605,000 12,000 112,500
18,000 80,000 12,000 225,000
126,000 395,000 12,000 912,500 185,000
126,000 460,000
90,000 350,000
126,000 275,000 12,000 587,500
90,000 330,000 12,000 337,500 195,000
54,000 200,000
50,000 25,000 55,000
54,000 2,500 105,000 12,000 81,250
36,000 2,500 165,000
350,000 126,000 430,000 12,000 218,750
18,000 2,500 80,000
18,000 80,000 12,000 425,000
200,000 72,000 190,000 24,000 387,500
 108,000 2,500 405,000

955,000 6,260,000 167,500 25,263,000 259,500 - 5,892,500 1,035,000

 TOTAL SELISIH
BILAS LAMBUNGSEWA NEBU GV LAIN-LAIN PIJAT BAYI ADM
90,000 50,000 100,000 4,222,802
50,000 2,548,627
1,721,126 1,022,626
50,000 1,616,265
50,000 1,928,308
1,164,500 693,500
50,000 1,535,467
50,000 2,249,707
562,153
50,000 1,089,896
50,000 470,201
1,370,059 912,249
192,500 54,450
50,000 1,317,919
7,000 50,000 1,575,355
50,000 1,677,087
95,000 1,094,370
50,000 2,783,476
35,000 1,530,751
50,000 2,088,084
100,000 1,727,824
50,000 1,454,801
50,000 1,138,101
100,000 1,415,376
458,909 128,000
25,000 1,805,985
50,000 2,065,512
100,000 2,692,420
1,496,360 1,028,860
50,000 1,229,217
120,000 100,000 2,578,579 891,306

150,000 3,402,064 51,052

15,000 50,000 2,253,364
50,000 1,387,482
847,697
50,000 2,360,230
50,000 1,103,857
852,000
50,000 877,598
300,000 35,000 1,960,936
50,000 748,487
774,967 105,455
923,931 95,854
100,000 1,191,316 23,199
50,000 2,542,740
 1,053,851
50,000 1,949,814
314,000 137,844
50,000 1,343,520
50,000 2,085,169
150,000 1,591,366
100,000 1,565,025
50,000 1,453,651
180,000 80,000 1,764,195
890,000
862,500
50,000 1,231,578
20,000 35,000 1,628,695
### 1,436,015
100,000
50,000 867,915
100,000 2,248,687
35,000 566,343
50,000 2,516,544
### 253,957
50,000 884,926
100,000 3,024,688 33,200
50,000 1,316,580
974,950 262,324
400,000
50,000 1,925,423
50,000 769,903
100,000

20,000 50,000 1,215,000

20,000 50,000 615,922
20,000 30,000 1,010,221
15,000 50,000 1,956,440
5,000 50,000 536,963
75,000 100,000 838,535
20,000 50,000 1,607,709
25,000 ### 727,024 424,000
50,000 20,000 100,000 3,285,712
10,000 50,000 658,832
15,000 20,000 10,000 3,427,760
20,000 50,000 2,165,822
20,000 50,000 1,452,164
5,000 20,000 50,000 2,485,986
50,000 20,000 50,000 3,180,384
20,000 50,000 937,053
610,304
25,000 802,997
20,000 542,843
14,000 20,000 70,000 2,638,176
30,000 432,237
5,000 50,000 880,019
20,000 50,000 1,732,576
 20,000 100,000 1,883,721

- 695,000 90,000 341,000 320,000 4,385,000 142,772,101 5,863,919

1,356,000
DISCOUNT
PERUSAHAAN

JMT

JMT

ASKES

JMT
ASKES

ASKES

KAI
ASKES

JMT

TUMAN

TUMAN

JMT

JMT

JMT
JMT
TUMAN
JMT

BSP

JMT
JMT

TUMAN

TUMAN
BSP
JMT

BSP

PNS
RUMAH SAKIT AR. BUNDA PRABUMULIH
DAFTAR PASIEN RAWAT INAP RUANG VI ADDAWA
BULAN APRIL 2013

NO. TGL TGL HR NO. KELAS NAMA A LA M A T JK UMR KET UMUR DIAGNOSA PULANG
KODEJ. PELY DOKTER KET BIAYA
MASUK KELUAR RWT REG THN ICD X PULANG ALKES RESEP OPNAME J. PARAMEDISJ.P DIBAGIKAN J. SHIFT J.SHIFT DIBAGIPSG. INFUS
1 22/03/2013 03/04/2013 12 13001631 VIP NY DARYUNI COMP TEL P 41 TH DYSPEPSIA + DM PDL DEPTA RUJUK 9,622,270 1,220,275 3,550,000 214,500 214,500 143,000 143,000 50,000
2 27/03/2013 02/04/2013 5 13005533 VIP NN FITRI JL PADAT KARYA P 23 TH GEAD PDL DEPTA PK 3,165,242 1,096,926 1,750,000 99,000 99,000 66,000 66,000
3 28/03/2013 03/04/2013 6 13005600 VIP NY NURLELA DS BABAT P 49 TH DYSPEPSIA PDL DEPTA RUJUK 2,031,153 370,447 2,100,000 72,000 72,000 48,000 48,000
4 29/03/2013 02/04/2013 5 13005474 VIP TN PRIMA JL VINA ASRI L 36 TH FEBRIS PDL DEPTA PK 2,702,196 511,849 1,400,000 82,500 82,500 55,000 55,000 25,000
5 29/03/2013 01/04/2013 3 13002491 VIP NY HERIYANTI JL ALIPATAN P 48 TH DYSPEPSIA PDL DEPTA PK 611,443 318,680 1,050,000 66,000 66,000 44,000 44,000
6 30/03/2013 02/04/2013 3 13005703 VIP SDR.ARUNG PERUM.GN.IBUL L 16 TH DYSPEPSIA PDL DEPTA PK 1,313,248 460,869 1,050,000 66,000 66,000 44,000 44,000 25,000
7 30/03/2013 03/04/2013 4 12012902 VIP TN.JHONY JL.SRIKANDI L 25 TH ASMA BRONCHIALE PDL DEPTA PK 2,070,769 571,187 1,400,000 82,500 82,500 55,000 55,000 25,000
8 31/03/2013 06/04/2013 6 9009489 VIP SDR RIZKI KURNIAWAN JL FLAMBOYAN L 14 TH FEBRIS PDL DEPTA PK 3,062,921 776,101 2,100,000 115,500 115,500 77,000 77,000 25,000
31/03/2013 01/04/2013 1 13005716 VIP TN NAJAMUDIN JL ALIPATAN L 57 TH DYSPEPSIA PDL DEPTA PINDAH 231,712 350,000 12,000 12,000 8,000 8,000
9 01/04/2013 06/04/2013 4 12015002 VIP AN BELA JL PERINTIS P 13 TH DBD ANAK IRWAN PK 395,115 252,183 1,400,000 82,500 82,500 55,000 55,000
10 01/04/2013 02/04/2013 1 6004432 VIP TN AGUS JL TEBAT L 23 TH FEBRIS PDL DEPTA PK 150,000 64,130 350,000 12,000 12,000 8,000 8,000
11 02/04/2013 06/04/2013 4 13005839 VIP SDR ARDIANSYAH DS TAPUS L 23 TH DYSPEPSIA PDL DEPTA PK 1,736,151 625,920 1,400,000 82,500 82,500 55,000 55,000
12 02/04/2013 03/04/2013 1 6011755 VIP NY SUJI ASTUTI JL MASJID ALIKHWAN P 39 TH VERTIGO SYARAF DEPTA PK 188,156 567,985 350,000 33,000 33,000 22,000 22,000
13 02/04/2013 06/04/2013 5 11010963 VIP NY ROMIANA DS CINTAKASIH P 47 TH POST OPS SC KAND RAHMAN PK 1,353,506 735,315 1,500,000 99,000 99,000 66,000 66,000
14 02/04/2013 05/04/2013 3 8006638 VIP TN HARMUNANTO DS DUSUN DALAM L 47 TH HERFES ZOOSTER PDL DEPTA PK 1,746,872 816,558 875,000 66,000 66,000 44,000 44,000
15 02/04/2013 06/04/2013 4 11002961 VIP NY MISRAYANI DS AUR DURI P 30 TH CHEPALGIA SYARAF DEPTA PK 1,136,239 1,081,218 1,400,000 82,500 82,500 55,000 55,000 25,000
16 02/04/2013 07/04/2013 5 12019036 VIP NY WINTARA JL BUKIT LEBAR P 26 TH POST OPS SC KAND RAHMAN PK 1,151,832 403,333 1,750,000 99,000 99,000 66,000 66,000 25,000
17 02/04/2013 09/04/2013 7 13005892 VIP AN IPAN DS CAMBAI L 12 TH GASTRITIS PDL IRWAN PK 2,276,969 536,341 2,450,000 132,000 132,000 88,000 88,000 25,000
18 03/04/2013 08/04/2013 5 13005949 VIP TN ANDI IRIANTO JL BASUKI RAHMAT L 42 TH ABCES GINGGIVA GIGI BETHA PK 1,688,822 126,324 1,750,000 60,000 60,000 40,000 40,000
19 03/04/2013 06/04/2013 3 13005955 VIP TN HERIYADI DS KEMANG L 45 TH HIPERTENSI PDL DEPTA PK 1,432,662 919,841 1,050,000 66,000 66,000 44,000 44,000
20 05/04/2013 09/04/2013 4 13006061 VIP TN RAYA JL VCAMBAI L 48 TH DYSPEPSIA PDL DEPTA PK 1,934,941 509,751 1,400,000 82,500 82,500 55,000 55,000 25,000
21 05/04/2013 10/04/2013 5 13005534 VIP NY CIK NIA JL TL SAKO P 72 TH SYN DYSPEPSIA PDL DEPTA PK 838,329 1,418,902 1,750,000 99,000 99,000 66,000 66,000
22 05/04/2013 11/04/2013 6 9013129 VIP AN REYSEL JL DEMPO L 8 TH HEPATITIS ANAK NETTY PK 164,551 326,435 2,100,000 115,500 115,500 77,000 77,000
23 05/04/2013 11/04/2013 6 12008590 VIP AN ZHAFRAN VINA SEJKAHTERA L 1 TH DBD ANAK IRWAN PK 960,109 271,946 1,750,000 99,000 99,000 66,000 66,000 25,000
24 06/04/2013 08/04/2013 2 12009364 VIP NY DONA ASRAM YON ZIPUR P 28 TH DYSPEPSIA PDL DEPTA PK 674,855 525,910 700,000 49,500 49,500 33,000 33,000
25 07/04/2013 10/04/2013 3 13005839 VIP SDR ARDIANSYAH DS TAPUS L 23 TH COLIC ABD BDH DEPTA PK 2,639,688 477,087 1,050,000 66,000 66,000 44,000 44,000
26 07/04/2013 13/04/2013 6 9013817 VIP NY ELI DS JEMENANG P 35 TH ISPA PDL DEPTA PK 4,179,478 1,254,213 1,800,000 115,500 115,500 77,000 77,000 25,000
27 07/04/2013 13/04/2013 6 7013999 VIP AN ANDRIAN DS MANUNGGAL JAYA L 6 TH FEBRIS ANAK NETTY PK 677,821 65,240 2,100,000 115,500 115,500 77,000 77,000 25,000
28 07/04/2013 12/04/2013 5 12017070 VIP NY ZAITUN DS TB KELEKAR P 48 TH SYNCOPE PDL DEPTA PK 767,242 480,485 1,750,000 60,000 60,000 40,000 40,000
29 08/04/2013 11/04/2013 3 10018813 VIP TN DEKA JL TROMIL L 25 TH MALAISE PDL DEPTA PK 315,290 215,504 1,050,000 49,500 49,500 33,000 33,000
30 08/04/2013 11/04/2013 3 9010598 VIP TN WAWAN JL ANG 45 L 30 TH TB MILIER PDL DEPTA PK 681,692 430,313 1,050,000 66,000 66,000 44,000 44,000
31 08/04/2013 11/04/2013 3 13000170 VIP TN SULAIMAN DS SUNGAI MEDANG L 52 TH INSUFISIENSI NEURO PDL DEPTA PK 760,784 1,065,930 1,050,000 66,000 66,000 44,000 44,000
32 08/04/2013 12/04/2013 4 9004362 VIP SDR ARI DS MANUNGGAL JAYA L 17 TH HEPATITIS PDL DEPTA PK 1,178,813 797,970 700,000 82,500 82,500 55,000 55,000
33 09/04/2013 12/04/2013 3 12008402 VIP TN ERKO JL JEND SUDIRMAN L 28 TH DYSPNEU PDL DEPTA PK 1,057,884 1,055,668 1,050,000 66,000 66,000 44,000 44,000 25,000
34 09/04/2013 12/04/2013 3 12015705 VIP SDR BOBY DS SUMBER MULIA L 17 TH VOMITUS PDL DEPTA PK 997,338 535,460 1,050,000 66,000 66,000 44,000 44,000
35 10/04/2013 13/04/2013 3 13006395 VIP TN.SAPARUDIN DS.TEMPIRAI L 50 TH OBS.TC BDH NURLELA PK 2,240,339 280,112 1,050,000 66,000 66,000 44,000 44,000
36 11/04/2013 13/04/2013 2 8013850 VIP TN ABD MUTHOLIB PRUM SUKAJADI L 43 TH VERTIGO SYARAF BUDIMAN PK 490,759 583,093 700,000 49,500 49,500 33,000 33,000
37 11/04/2013 19/04/2013 8 13006446 VIP SDR BUDI JL JEND SUDIRMAN L 32 TH CUBUSTIO BDH BUJANG PK 2,840,510 827,900 2,800,000 148,000 148,000 99,000 99,000 50,000
38 12/04/2013 15/03/2013 3 13006455 VIP AN AZKA JL KH AHMAD DAHLAN L 1 TH DHF ANAK IRWAN PK 726,269 327,752 1,050,000 66,000 66,000 44,000 44,000
39 12/04/2013 18/04/2013 7 7012265 VIP TN DULYAMAN JL SINGGALANG L 47 TH ULKUS GASTER PDL DEPTA RUJUK 1,673,418 618,083 2,450,000 132,000 132,000 88,000 88,000 25,000
40 12/04/2013 15/04/2013 3 13006440 VIP NY MERUNEP DS MUARA DUA P 70 TH HIPERTENSI PDL DEPTA PK 1,288,498 1,231,545 1,050,000 66,000 66,000 44,000 44,000
41 12/04/2013 15/04/2013 3 8014459 VIP SDR RIZKI DS TB AGUNG L 19 TH POST OPS TONSIL THT BIMO PK 389,486 109,120 1,050,000 66,000 66,000 44,000 44,000
42 12/04/2013 15/04/2013 3 13006495 VIP TN SOPIAN JL ALIPATAN L 49 TH TRAUMACAPITIS BDH ATIK APS 2,331,321 456,814 1,050,000 66,000 66,000 44,000 44,000
43 13/04/2013 17/04/2013 4 13006445 VIP TN SARKOWI JL SAID MUARA DUA L 44 TH HEMIPARASE SYARAF DEPTA pk 1,624,910 1,286,782 1,400,000 82,500 82,500 55,000 55,000 25,000
44 13/04/2013 17/04/2013 3 13006569 VIP TN JUMIRSYAH DS GN RAJA L 32 TH CEPHALGIA SYARAF DEPTA pk 793,531 1,050,660 1,050,000 66,000 66,000 44,000 44,000
45 15/04/2012 16/04/2013 1 12006191 VIP NY FARIDA JL BUKITESAR P 28 TH POST PARTUM KAND RAHMAN pk 105,090 350,000
46 15/04/2013 17/04/2013 2 13006438 VIP TN INDRA DS CAMBAI L 37 TH HIDRONEFROSIS PDL DEPTA PK 906,502 681,908 700,000 49,500 49,500 33,000 33,000 25,000
47 16/04/2013 19/04/2013 3 11006784 VIP TN ARI JL ASAM PAYA L 34 TH HERFES ZOOSTER PDL DEPTA PK 2,073,103 795,355 300,000 66,000 66,000 44,000 44,000
48 16/04/2013 25/04/2013 9 6002947 VIP NY SITI RUKIAH DS MANUNGGAL JAYA P 52 TH HYDRONEFROSIS PDL DEPTA PK 5,533,691 814,931 3,150,000 165,000 165,000 110,000 110,000 25,000
49 17/04/2013 22/04/2013 5 13006774 VIP NY SALMAH JL PERWIRA P 60 TH ISCHALGIA PDL DEPTA PK 974,718 996,309 1,750,000 99,000 99,000 66,000 66,000
50 17/04/2013 20/04/2013 3 13006804 VIP AN DIRAJA DS TL LBUK L 6 BLN FEBRIS ANAK ZULAMRI PK 180,116 169,840 1,050,000 66,000 66,000 44,000 44,000
51 17/04/2013 20/04/2013 3 12013201 VIP SDR DIKI MANGGA BESAR L 27 TH TDBD PDL DEPTA PK 1,889,934 512,149 1,050,000 66,000 66,000 44,000 44,000
52 18/04/2013 23/04/2013 5 13006820 VIP AN M RIDHO JL KAP ABDULLAH L 4 TH DBD ANAK IRWAN PK 1,275,565 178,301 1,750,000 99,000 99,000 66,000 66,000
53 18/04/2013 20/04/2013 2 13006810 VIP AN TASYA PRUM GN IBUL P 1 TH KDS ANAK ZULAMRI PK 79,488 196,390 700,000 49,500 49,500 33,000 33,000
18/04/2013 19/04/2013 1 13006850 VIP NY MARNETI JL BATAM P 45 TH VERTIGO SYARAF DEPTA PINDAH 167,210 350,000 12,000 12,000 8,000 8,000
54 18/04/2013 20/04/2013 2 9013089 VIP NN AISYAH JL STASIUN P 18 TH COLIC ABD PDL DEPTA PK 610,665 929,329 600,000 49,500 49,500 33,000 33,000
55 19/04/2013 22/04/2013 3 8010993 VIP TN DWI JL JEND SUDIRMAN L 42 TH HIPERTENSI PDL DEPTA PK 1,122,057 1,090,992 1,050,000 66,000 66,000 44,000 44,000
56 19/04/2013 25/05/2013 6 9007573 VIP NY HERNAWATI DS KEMANG P 62 TH HIPERTENSI PDL DEPTA PK 846,863 713,461 2,100,000
57 20/04/2013 23/04/2013 3 13006963 VIP TN SUHARTONO JL TELAGA SAID L 54 TH COLIC ABD PDL DEPTA PK 77,136 15,730 920,000 60,000 60,000 40,000 40,000
58 20/04/2013 23/04/2013 3 12000443 VIP AN AHMAD UMAER JL NIAS L 1 TH STOMATITIS ANAK IRWAN PK 859,476 248,542 1,100,000 82,500 82,500 55,000 55,000 25,000
59 20/04/2013 24/04/2013 4 13006979 VIP NN RIZKI JL KRAKATAU P 12 TH FARINGITIS PDL DEPTA PK 2,161,342 243,131 1,400,000 82,500 82,500 55,000 55,000
60 21/04/2013 24/04/2013 3 9008809 VIP TN HENGKI JL SERELO L 53 TH FEBRIS PDL DEPTA PK 1,508,734 622,660 1,050,000 66,000 66,000 44,000 44,000
61 21/04/2013 25/05/2013 4 8003890 VIP NY SETRIYENI KAPT ABDULLAH P 45 TH CEPHALGIA SYARAF DEPTA PK 22,721 1,400,000 66,000 66,000 44,000 44,000
21/04/2013 21/04/2013 11019965 VIP TN SONI COMP TEL L 40 TH COLIC ABD BDH DEPTA PINDAH 251,959 16,500 16,500 11,000 11,000
62 21/04/2013 26/04/2013 5 13006995 VIP NN AISYAH JL MERDEKA P 15 TH TDBD PDL DEPTA PK 2,928,916 809,776 1,750,000 99,000 99,000 66,000 66,000 25,000
64 22/04/2013 27/04/2013 5 13007067 VIP AN HANIYAH JL GAJAH MADA P 11 BLN DIARE ANAK IRWAN PK 799,301 369,249 1,750,000 99,000 99,000 66,000 66,000
65 23/04/2013 25/04/2013 2 9013667 VIP NY. VERA JL.MERANTI PUTIH P 28 TH POST PARTUM SPONT KAND SUSI PK 369,494 310,839 275,000 33,000 33,000 22,000 22,000
66 23/04/2013 25/04/2013 2 11018128 VIP NY.RATIH DS.TAPUS P 27 TN POST PARTUM KAND RAHMAN PK 318,150 70,180 700,000 48,000 48,000 16,000 16,000
67 23/04/2013 24/04/2013 1 10013929 VIP TN HADIN DS MARGA MULYA L 75 TH PPOK PDL DEPTA RUJUK 377,814 60,683 350,000 33,000 33,000 22,000 22,000
68 23/04/2013 26/04/2013 3 13007140 VIP TN SAMARUDIN VCOMP TEL L 54 TH HIPERTENSI PDL DEPTA PK 1,393,544 1,226,795 900,000 66,000 66,000 44,000 44,000
69 24/04/2013 25/04/2013 1 13007113 VIP TN BADAWI DS AUR DURI L 56 TH TDC DGN HIPERTENSI PDL DEPTA PK 292,242 410,106 350,000 16,500 16,500 11,000 11,000
70 24/04/2013 29/04/2013 5 13007197 VIP AN PAJRI JL TUNGGAL L 43 TH ISPA ANAK IRWAN PK 1,583,506 246,706 1,750,000 99,000 99,000 66,000 66,000 25,000
71 25/04/2013 26/04/2013 1 12006780 VIP TN RUDI ISKANDAR PRM GN IBUL L 38 TH FEBRIS PDL DEPTA PK 85,834 350,000 33,000 33,000 22,000 22,000
72 25/04/2013 27/04/2013 2 13004671 VIP NY SRI PURWANINGSRI PRUM GN IBUL P 34 TH DYSPEPSIA PDL DEPTA PK 824,129 660,717 700,000 49,500 49,500 33,000 33,000
73 25/04/2013 27/04/2013 2 13007261 VIP NY ISHARYANTI JL NIAS P 33 TH DYSPEPSIA PDL DEPTA PK 304,356 145,805 700,000 24,000 24,000 16,000 16,000
74 26/04/2013 28/04/2013 3 13007152 VIP BY M ARYA JL A YANI L 15 HR PERDRHAN TL PSAT ANAK ZULAMRI PK 126,122 29,032 1,050,000 66,000 66,000 44,000 44,000 25,000
75 26/04/2013 30/04/2013 4 8006875 VIP NY SRI MARYANA DS PG GUNUNG P 25 TH VERTIGO PDL DEPTA PK 2,201,485 594,585 1,400,000 82,500 82,500 55,000 55,000 25,000
76 27/04/2013 29/04/2013 2 13003932 VIP NY SYAHRIATI JL PADAT KARYA P 28 T HEG KEB RAHMAN PK 233,862 409,554 1,050,000 66,000 66,000 44,000 44,000 25,000

JUMLAH DEWASA 288

VIP ADDAWA ANAK

1 27/03/2013 02/04/2013 6 13005543 VIP ANAK AN ARLI JL KENARI L 6 TH DBD ANAK ZULAMRI PK 134,654 44,923 600,000 18,000 18,000 12,000 12,000
2 28/03/2013 01/04/2013 4 13001896 VIP ANAK AN LETISYAH ASRAM YON ZIPUR P 11 BLN FEBRIS ANAK ZULAMRI PK 218,203 86,511 1,280,000 82,500 82,500 55,000 55,000
3 29/03/2013 02/04/2013 4 13005635 VIP ANAK AN ALMAIZA JL SUMATERA P 1 TH FEBRIS ANAK IRWAN PK 511,556 338,365 1,280,000 82,500 82,500 55,000 55,000
4 30/03/2013 04/04/2013 5 11017462 VIP ANAK AN NAUFAL JL SANGKURIANG L 1 TH FEBRIS ANAK ZULAMRI PK 520,330 94,018 1,600,000 99,000 99,000 66,000 66,000 25,000
5 31/03/2013 02/04/2013 2 10018958 VIP ANAK AN ELMIRA JL FLORES P 3 TH FEBRIS ANAK ZULAMRI PK 134,501 640,000 49,500 49,500 33,000 33,000
6 31/03/2013 03/04/2013 3 12005879 VIP ANAK AN ANUGERAH JL SANGKURIANG L 1 TH KDS ANAK IRWAN PK 43,750 112,880 300,000 9,000 9,000 6,000 6,000
7 01/04/2013 04/04/2013 3 10002871 VIP ANAK AN SHOFY JL NIAS P 9 TH DBD ANAK IRWAN PK 646,113 205,153 960,000 66,000 66,000 44,000 44,000 25,000
8 01/04/2013 06/04/2013 4 13000676 VIP ANAK AN NAZIFA JL BARU P 10 BLN DBD ANAK NETTY PK 231,064 195,282 400,000 12,000 12,000 8,000 8,000
9 02/04/2013 05/04/2013 3 9010735 VIP ANAK AN M FARIZ ASRAMA DKT L 4 TH TYPHOID ANAK IRWAN PK 1,021,626 390,977 825,000 66,000 66,000 44,000 44,000
10 02/04/2013 06/04/2013 4 13005878 VIP ANAK AN VANIA JL BASUKI RAHMAT P 3 BLN VOMITUS ANAK NETTY PK 365,778 145,830 1,280,000 82,500 82,500 55,000 55,000
11 02/04/2013 06/04/2013 4 13005880 VIP ANAK AN ICA JL SENULING P 13 TH DBD ANAK IRWAN PK 2,721,384 343,589 1,280,000 82,500 82,500 55,000 55,000
12 03/04/2013 10/04/2013 7 13005917 VIP ANAK AN DZAKY JL ARIMBI L 10 TH POST OPS APP BDH BUJANG PK 219,890 174,919 700,000 21,000 21,000 14,000 14,000
13 03/04/2013 08/04/2013 5 11004335 VIP ANAK AN FAIZ JL PADAT KARYA L 2 TH VOMITUS ANAK IRWAN PK 206,744 186,630 500,000 15,000 15,000 10,000 10,000
14 03/04/2013 08/04/2013 5 13005951 VIP ANAK AN FACHRI DS TN ABNG L 1 BLN ISPA ANAK IRWAN PK 289,352 303,930 1,600,000 99,000 99,000 66,000 66,000
15 04/04/2013 13/04/2013 9 13006029 VIP ANAK AN RAFI JL SEPATU L 3 TH FEBRIS ANAK NETTY PK 267,436 198,945 900,000 27,000 27,000 18,000 18,000
16 04/04/2013 06/04/2013 2 12010968 VIP ANAK AN FAUZAN DS LB RAMAN L 10 BLN STOMATITIS ANAK ALIP PK 63,259 69,035 504,000
17 04/04/2013 06/04/2013 1 13006035 VIP ANAK AN NAYELA JL BASUKI RAHMAT P 4 TH COLIC ABD ANAK NETTY PK 20,000 34,956 200,000 6,000 6,000 4,000 4,000
18 05/04/2013 14/04/2013 9 12016175 VIP ANAK AN AFIQA JL KOL DANI EFENDI P 9 BLN FEBRIS ANAK IRWAN PK 1,351,230 582,295 2,880,000 165,000 165,000 110,000 110,000 25,000
19 05/04/2013 09/04/2013 4 11021063 VIP ANAK AN FADHIL JL RAMA L 1 TH KDS ANAK IRWAN PK 901,217 156,673 1,280,000 82,500 82,500 55,000 55,000 25,000
20 06/04/2013 09/03/2013 3 12014957 VIP ANAK AN BAHIR ASRAMA YON ZIPUR L 10 BLN GE ANAK IRWAN PK 45,791 152,726 300,000 9,000 9,000 6,000 6,000
21 06/04/2013 09/04/2013 3 13006152 VIP ANAK AN RIZKI JL GAGAK L 9 TH VOMITUS ANAK IRWAN PK 30,000 53,011 300,000 9,000 9,000 6,000 6,000
22 06/04/2013 08/04/2013 2 12006592 VIP ANAK AN SATYA VINA SEJAHTERA L 4 TH THALASEMIA ANAK ZULAMRI PK 146,802 200,000 6,000 6,000 4,000 4,000
23 06/04/2013 08/04/2013 2 13006156 VIP ANAK AN RIZKI RAHMAD JL M YAMIN L 9 BLN FEBRIS ANAK ZULAMRI PK 119,119 640,000 49,500 49,500 33,000 33,000
24 06/04/2013 10/04/2013 3 13006155 VIP ANAK AN M AYDIN VINA LINGKAR L 10 BLN FEBRIS ANAK NETTY PK 161,917 57,572 300,000 9,000 9,000 6,000 6,000
25 08/04/2013 12/04/2013 4 13006197 VIP ANAK AN ZASKIA DS SEBAU P 1 TH GEAD ANAK NETTY PK 657,674 169,422 1,280,000 82,500 82,500 55,000 55,000
26 08/04/2013 13/04/2013 5 10016520 VIP ANAK AN PRINCES DS LB RAMAN P 3 TH GEAD SEDANG ANAK IRWAN PK 93,291 227,480 500,000 15,000 15,000 10,000 10,000
27 08/04/2013 16/04/2013 8 13006240 VIP ANAK AN NATANIEL DS LB RAMAN L 6 BLN FEBRIS ANAK NETTY PK 395,894 105,731 800,000 24,000 24,000 16,000 16,000
28 09/04/2013 12/04/2013 3 13006229 VIP ANAK AN M ARIB JL MASJID ALIKHWAN L 6 TH DBD ANAK IRWAN PK 274,821 214,888
29 09/04/2013 15/04/2013 6 13006306 VIP ANAK AN FIOLA DS KEMANG P 6 TH ISPA ANAK NETTY PK 1,699,257 92,889 1,920,000 115,500 115,500 77,000 77,000 25,000
30 11/04/2013 14/04/2013 4 6014887 VIP ANAK AN FIKRI TUGU KECIL L 7 TH DHF ANAK IRWAN PK 925,919 242,404 1,100,000 82,500 82,500 55,000 55,000
31 11/03/2013 15/04/2013 5 12013727 VIP ANAK AN GENIS DS LB RAMAN P 8 BLN KDS ANAK NETTY PK 175,252 179,047 1,600,000 99,000 99,000 66,000 66,000 25,000
32 11/04/2013 13/04/2013 2 13006473 VIP ANAK AN ARSA JL ANG 45 L 2 TH ASMA BRONCHIALE ANAK ZULAMRI PK 73,633 1,197 200,000 6,000 6,000 4,000 4,000
33 12/04/2013 14/04/2013 2 12009489 VIP ANAK AN JESICA JL STASIUN P 3 TH STOMATITIS ANAK IRWAN PK 279,836 202,355 600,000 49,500 49,500 33,000 33,000
34 12/04/2013 18/04/2013 6 12014901 VIP ANAK AN AFIFA PRUM GN IBUL P 8 BLN FEBRIS ANAK NETTY PK 306,941 165,069 1,920,000 115,500 115,500 77,000 77,000 25,000
35 13/04/2013 16/04/2013 3 13006502 VIP ANAK AN BINTANG JL BELITUNG P 5 TH TDBD ANAK NETTY APS 152,437 74,820 300,000 9,000 9,000 6,000 6,000
36 13/04/2013 16/04/2013 3 12003864 VIP ANAK AN AIKO DS PANGKUL L 1 TH BACTERIAL INF ANAK IRWAN PK 236,524 60,645 300,000 9,000 9,000 6,000 6,000
37 13/04/2013 17/04/2013 4 13006493 VIP ANAK AN HAZWAN JL JEND SUDIRMAN P 3 TH FEBRIS ANAK IRWAN pk 157,552 72,600 1,750,000 67,500 67,500 45,000 45,000
38 14/04/2013 17/04/2013 3 13006572 VIP ANAK AN HARYA ASPOL P 1 TH FEBRIS ANAK IRWAN PK 899,454 258,024 960,000 66,000 66,000 44,000 44,000
39 14/04/2013 20/04/2013 7 11005871 VIP ANAK AN AULIA DS TJ RAMAN P 3 TH VOMITUS ANAK NETTY PK 244,772 63,186 700,000 21,000 21,000 14,000 14,000
40 16/04/2013 21/04/2013 5 13006675 VIP ANAK AN FATIYAH PRUMNAS GN IBUL P 6 TH FEBRIS ANAK ZULAMRI PK 65,790 33,184 500,000 15,000 15,000 10,000 10,000
41 16/04/2013 21/04/2013 5 13006674 VIP ANAK AN ALIP PRUM GN IBUL L 7 TH FEBRIS ANAK ZULAMRI PK 131,282 124,539 500,000 15,000 15,000 10,000 10,000
42 16/04/2013 19/04/2013 3 13006713 VIP ANAK AN FADHIL JL PERWIRA L 1 TH FEBRIS ANAK ZULAMRI PK 63,184 960,000 49,500 49,500 33,000 33,000
43 16/04/2013 22/04/2013 6 13006666 VIP ANAK AN LUTFIAH JLPERINTIS P 8 TH DBD ANAK IRWAN PK 403,663 151,444 600,000 18,000 18,000 12,000 12,000
44 17/04/2013 20/04/2013 3 13006749 VIP ANAK AN FELDYRYA DS JEMENANG L 5 BLN ISPA ANAK IRWAN PK 729,107 348,163 825,000 66,000 66,000 44,000 44,000
45 17/04/2013 23/04/2013 6 13006762 VIP ANAK AN JULIANA JL KERINCI P 7 TH FEBRIS ANAK IRWAN PK 141,709 113,172 1,920,000 99,000 99,000 66,000 66,000 25,000
46 17/04/2013 24/04/2013 7 12002767 VIP ANAK AN ADLY JL NIAS L 1 TH FEBRIS ANAK IRWAN PK 1,705,802 265,444 2,240,000 132,000 132,000 88,000 88,000
47 17/04/2013 19/04/2013 2 12001797 VIP ANAK AN CAHYA COMP TEL P 12 TH FEBRIS ANAK DEPTA PK 1,365,113 696,344 550,000 49,500 49,500 33,000 33,000 25,000
48 17/04/2013 19/04/2013 2 13006800 VIP ANAK AN ADJI DS RAJA JAYA L 7 TH FEBRIS ANAK ZULAMRI PK 34,338 33,184 200,000 6,000 6,000 4,000 4,000
49 17/04/2013 20/04/2013 3 11009618 VIP ANAK AN REYHAN JL MENTAWAI L 6 TH TDBD ANAK IRWAN PK 137,607 39,930 300,000 9,000 9,000 6,000 6,000
50 18/04/2013 24/04/2013 6 11001456 VIP ANAK AN AFIQA DS TJ RAMAN P 6 TH FEBRIS ANAK IRWAN PK 481,169 121,969 600,000 18,000 18,000 12,000 12,000
51 18/04/2013 20/04/2013 2 8014065 VIP ANAK AN TIRTA COMP TEL L 7 TH FEBRIS ANAK IRWAN PK 334,439 550,000 49,500 49,500 33,000 33,000
52 19/04/2013 22/04/2013 3 9010374 VIP ANAK AN TIARA VINA ASRI P 12 TH COLIC ABD ANAK IRWAN PK 122,045 130,934 300,000 9,000 9,000 6,000 6,000
53 19/04/2013 23/04/2013 4 13006910 VIP ANAK AN RIDHO PRABUJAYA L 10 TH HEPATITIS ANAK IRWAN PK 123,245 100,000 400,000 12,000 12,000 8,000 8,000
54 20/04/2013 22/04/2013 2 12012778 VIP ANAK AN VICTORIUS JL PERINTIS L 1 TH VOMITUS ANAK IRWAN PK 103,520 114,345 200,000 6,000 6,000 4,000 4,000
55 20/04/2013 23/04/2013 3 13006900 VIP ANAK AN RAJABKI DS LB RAMAN L 6 TH FEBRIS ANAK IRWAN PK 58,272 109,202 300,000 9,000 9,000 6,000 6,000
56 21/04/2013 24/04/2013 3 12016662 VIP ANAK AN HAMLI DS MENANTI L 1 TH BP ANAK ZULAMRI PK 161,568 3,987 300,000 9,000 9,000 6,000 6,000 25,000
57 21/04/2013 22/04/2013 1 11009385 VIP ANAK AN BANU DS BABAT L 4 TH EPILEPSI ANAK ZULAMRI RUJUK 170,638 320,000 33,000 33,000 22,000 22,000
22/04/2013 24/04/2013 2 13007018 VIP ANAK AN INDRIANI DS BARU RAMBANG P 2 TH STOMATITIS ANAK IRWAN PINDAH 675,622 35,499 600,000 49,500 49,500 33,000 33,000
58 22/04/2013 26/04/2013 5 11016725 VIP ANAK AN BARKAH JL KAP DULHAK L 5 TH DBD ANAK IRWAN PK 225,991 67,430 500,000 15,000 15,000 10,000 10,000
59 22/04/2013 23/04/2013 1 12008393 VIP ANAK AN NAYPA JL PERINTIS P 11 BLN BACTERIAL INF ANAK IRWAN PK 84,811 70,998 320,000 33,000 33,000 22,000 22,000 25,000
60 22/04/2013 23/04/2013 1 10000834 VIP ANAK AN BUKHARI JL ALIPATAN L 7 TH VOMITUS ANAK IRWAN PK 565,973 155,257 275,000 33,000 33,000 22,000 22,000
61 23/04/2013 30/04/2013 7 13000003 VIP ANAK AN AZZAHRA DS BABAT P 10 BLN BP ANAK IRWAN PK 1,480,842 152,795 700,000 21,000 21,000 14,000 14,000 50,000
62 23/04/2013 28/04/2013 5 13007126 VIP ANAK AN.OLIVIA DS.KOTA BARU P 4 TH DBD ANAK ZULAMRI PK 187,587 2,723 500,000 15,000 15,000 10,000 10,000
63 23/04/2013 26/04/2013 3 13002393 VIP ANAK AN AFFAN DS PG AGUNG L 8 BLN DIARE ACUT ANAK IRWAN PK 624,182 168,502 960,000 66,000 66,000 44,000 44,000 25,000
64 25/04/2013 28/04/2013 4 8010450 VIP ANAK AN AMNDA COMP TEL P 7 TH TYPHOID ANAK IRWAN PK 1,769,438 267,166 1,100,000 82,500 82,500 55,000 55,000
65 25/04/2013 29/04/2013 4 12019304 VIP ANAK AN AQILAH PERUM BUNDA P 4 BLN FEBRIS ANAK IRWAN PK 400,000 43,865 400,000 12,000 12,000 8,000 8,000
66 26/04/2013 29/04/2013 3 13007263 VIP ANAK AN M RAIHAN PRUM GN IBUL L 1 TH KDS ANAK IRWAN PK 235,515 242,275 300,000 9,000 9,000 6,000 6,000
67 26/04/2013 29/04/2013 3 13007271 VIP ANAK AN NAZIHA COMP TEL P 6 TH TYPHOID ANAK IRWAN PK 1,494,278 268,079 825,000 66,000 66,000 44,000 44,000
68 26/04/2013 29/04/2013 3 10016557 VIP ANAK AN NADIA JL PRANASIB P 6 TH HEPATITIS ANAK IRWAN PK 30,000 100,100 300,000 9,000 9,000 6,000 6,000
69 27/04/2013 28/04/2013 1 13007355 VIP ANAK AN VIRGO DS PG GUNUNG L 4 TH GEAD SEDANG ANAK ZULAMRI PK 149,804 49,516 320,000 33,000 33,000 22,000 22,000
70 28/04/2013 30/04/2013 2 11016088 VIP ANAK AN ANDINI JL KERINCI P 3 TH SUSP POLIP RECTAL BDH BUJANG PK 267,832 77,100 640,000 49,500 49,500 33,000 33,000

JUMLAH ANAK 272

133,638,330 51,967,603 150,854,000 8,614,000 8,614,000 5,727,000 5,727,000 1,000,000

 TOTAL SELISIH DISCOUNT
PERUSAHAAN
CHATETER NGT INJEKSI SKINTEST
VIS. & KONSUL
SELANGBED
O2 DECUBITUS
O2 TABUNGDECUBITUS PA NEBULIZER GV LAIN-LAIN ADM
216,000 880,000 15,000 400,000 16,668,545 265,000 TEL
90,000 2,500 460,000 150,000 7,044,668 105,000 GLOBAL
300,000 90,000 120,000 5,251,600 4,289,264 PNS
72,000 2,500 320,000 100,000 5,408,545
54,000 195,000 150,000 2,599,123 450,000 GLOBAL
54,000 255,000 100,000 3,478,117
72,000 2,500 365,000 12,000 125,000 250,000 5,168,456 GLOBAL
108,000 2,500 490,000 100,000 7,049,522
50,000 15,000 20,000 706,712 PNS
72,000 2,500 390,000 150,000 2,936,798 150,242 GLOBAL
50,000 15,000 20,000 689,130 552,789 PNS
72,000 390,000 50,000 4,549,071
18,000 150,000 50,000 1,434,141 50,000 RS BUNDA
90,000 450,000 90,000 150,000 4,698,821 125,000 TEL
54,000 2,500 390,000 100,000 4,204,930 50,000 TEL
72,000 375,000 100,000 4,464,457
72,000 450,000 45,000 200,000 4,427,165
126,000 2,500 515,000 12,000 37,500 240,000 10,000 150,000 6,821,310 10,000 GLOBAL
250,000 75,000 100,000 4,190,146 3,448,611 PNS
54,000 2,500 225,000 50,000 3,954,003
78,000 365,000 100,000 4,687,692
90,000 395,000 12,000 50,000 120,000 5,004,231
525,000 100,000 3,600,986 300,000 PERTAMINA
90,000 2,500 405,000 150,000 3,984,555 32,788 GLOBAL
36,000 180,000 200,000 2,481,765 GLOBAL
54,000 2,500 265,000 150,000 4,858,275
126,000 2,500 565,000 300,000 8,637,191 150,000 TEL
108,000 2,500 565,000 100,000 4,028,561
250,000 75,000 100,000 3,622,727 3,228,518 PNS
54,000 2,500 315,000 2,117,294 1,437,505 JMT
60,000 430,000 12,000 200,000 50,000 3,134,005
54,000 240,000 60,000 3,450,714
72,000 300,000 100,000 3,423,783
54,000 265,000 12,000 12,500 150,000 3,902,052 GLOBAL
54,000 265,000 150,000 3,271,798 856,000 PTPN 7
72,000 2,500 195,000 135,000 100,000 4,294,951
54,000 170,000 100,000 2,262,852 MHP
144,000 2,500 675,000 540,000 125,000 8,498,910
36,000 2,500 315,000 150,000 2,827,521 BLUE DOT
60,000 60,000 138,000 2,500 980,000 12,000 37,500 50,000 6,546,501
54,000 215,000 100,000 4,159,043
54,000 2,500 180,000 12,000 62,500 150,000 2,229,606 300,000 TANGKAS
54,000 2,500 270,000 45,000 100,000 4,529,635
72,000 290,000 100,000 5,073,692
60,000 330,000 150,000 3,654,191 ASR SOS
75,000 530,090 236,901 RS BUNDA
54,000 2,500 295,000 50,000 2,879,910
54,000 2,500 300,000 200,000 3,944,958 SIMAS
162,000 770,000 12,000 75,000 200,000 11,292,622
90,000 445,000 100,000 4,686,027
54,000 2,500 265,000 65,000 2,006,456
54,000 2,500 290,000 150,000 4,168,583 GLOBAL
90,000 2,500 470,000 100,000 4,196,366
36,000 2,500 225,000 12,500 150,000 1,566,878 GLOBAl
50,000 20,000 627,210 PNS
 35,000 380,000 12,000 37,500 100,000 2,869,494 KAI
72,000 170,000 150,000 3,875,049
3,660,324
28,000 335,000 1,575,866 151,000 INHEALTH
72,000 2,500 320,000 150,000 3,052,518 74,686 GLOBAL
90,000 2,500 330,000 150,000 4,651,973 652,350 GLOBAL
60,000 2,500 265,000 150,000 3,878,894 104,350 GLOBAL
78,000 340,000 2,060,721 1,629,688 JMT
2,500 40,000 349,459 TEL
90,000 2,500 470,000 100,000 6,506,192 GLOBAL
72,000 2,500 465,000 150,000 3,938,050 GLOBAL
150,000 46,000 1,261,333 121,799 TEL
100,000 30,000 40,000 1,386,330 1,429,704 PNS
18,000 2,500 115,000 12,000 262,500 50,000 1,358,497
54,000 265,000 150,000 4,209,339 75,000 TEL
36,000 150,000 100,000 1,393,348
90,000 2,500 415,000 120,000 150,000 4,712,712 77,970 GLOBAL
18,000 2,500 165,000 731,334 574,834 JMT
42,000 315,000 150,000 2,856,846 GLOBAL
100,000 15,000 40,000 1,385,161 1,088,820 PNS
54,000 150,000 50,000 1,704,154
72,000 2,500 305,000 100,000 4,975,570
54,000 150,000 100,000 2,242,416 AVIVA

240,000 24,000 30,000 1,133,577 189,114 PNS

72,000 2,500 340,000 50,000 2,324,214
54,000 2,500 430,000 75,000 2,966,421
90,000 25,000 340,000 100,000 3,124,348 600,000 GLOBAL
36,000 190,000 50,000 1,215,501
120,000 12,000 15,000 633,630 290,569 PNS
54,000 2,500 315,000 100,000 2,527,766 KAI
225,000 16,000 20,000 1,127,346 497,389 PNS
54,000 2,500 390,000 100,000 3,004,103 TEL
72,000 2,500 450,000 150,000 2,741,108 GLOBAL
72,000 2,500 390,000 180,000 5,264,473 3,807,316 BSP
280,000 28,000 35,000 1,507,809 1,069,681 PNS
200,000 20,000 25,000 1,188,374 427,799 PNS
90,000 2,500 545,000 12,000 375,000 50,000 3,597,782
36,000 36,000 45,000 1,573,381 443,951 PNS
636,294 JMT
80,000 8,000 10,000 372,956 81,481 PNS
90,000 2,500 770,000 240,000 150,000 6,641,025 1,217,789 GLOBAL
72,000 2,500 380,000 100,000 3,192,390
120,000 12,000 15,000 675,517 230,441 PNS
120,000 12,000 15,000 560,011 166,962 PNS
80,000 8,000 10,000 464,802 208,803 PNS
36,000 2,500 190,000 50,000 1,202,619
120,000 12,000 15,000 696,489 223,912 PNS
72,000 2,500 375,000 50,000 2,881,596
200,000 20,000 25,000 1,115,771 317,295 PNS
320,000 32,000 40,000 1,773,625 505,604 PNS
489,709
108,000 2,500 465,000 100,000 4,797,646
72,000 2,500 315,000 150,000 3,082,823 TEL
 90,000 2,500 375,000 120,000 100,000 2,996,799
80,000 8,000 10,000 392,830 114,254 PNS
54,000 2,500 225,000 120,000 1,648,691 KAI
108,000 2,500 540,000 100,000 3,552,510 270,000 GARDAMEDIKA
120,000 12,000 15,000 704,257 231,681 PNS
120,000 12,000 15,000 774,169 301,592 PNS
25,000 2,000 359,500 2,591,652 1,289,599 INHEALTH
54,000 2,500 355,000 50,000 2,798,978
280,000 28,000 35,000 1,420,958 315,450 PNS
200,000 20,000 25,000 893,974 110,019 PNS
200,000 20,000 25,000 1,050,821 283,866 PNS
54,000 2,500 265,000 1,509,684 1,132,685 JMT
240,000 24,000 15,000 30,000 1,524,107 574,123 PNS
54,000 2,500 405,000 150,000 2,733,770 TEL
108,000 2,500 545,000 3,185,381 2,338,700 JMT
126,000 2,500 875,000 200,000 5,854,746 ALLIANZ
36,000 2,500 240,000 150,000 3,229,957 TEL
80,000 8,000 10,000 385,522 131,947 PNS
120,000 12,000 15,000 654,537 256,961 PNS
240,000 24,000 30,000 1,557,138 600,000 PNS
165,000 100,000 1,314,439 TEL
120,000 12,000 15,000 729,979 357,404 PNS
160,000 16,000 20,000 859,245 411,971 PNS
80,000 8,000 10,000 535,865 249,517 PNS
120,000 12,000 15,000 644,474 183,999 PNS
160,000 12,000 15,000 707,555 352,000 PNS
18,000 2,500 115,000 150,000 50,000 936,138
36,000 2,500 315,000 1,829,621 ABDA
200,000 20,000 25,000 1,088,421 379,944 PNS
165,000 100,000 875,809 GLOBAL
18,000 2,500 190,000 100,000 1,416,730 TEL
280,000 28,000 240,000 35,000 3,036,637 1,602,387 PNS
200,000 20,000 25,000 985,310 174,733 PNS
54,000 2,500 315,000 40,000 2,409,184
90,000 2,500 315,000 120,000 3,939,104 TEL
160,000 16,000 20,000 1,079,865 178,289 PNS
120,000 12,000 15,000 954,790 613,000 PNS
54,000 2,500 480,000 120,000 3,463,857 TEL
120,000 12,000 15,000 607,100 164,524 PNS
36,000 2,500 115,000 100,000 882,820 198,000 KAI
36,000 2,500 150,000 50,000 1,388,432

60,000 60,000 6,688,000 189,500 42,515,500 132,000 2,316,000 960,000 855,000 52,500 12,251,000 432,221,433 45,112,570

6,877,500
1,012,500
DAFTAR PASIEN RUANG MUSDALIFAH TAHUN 2013
PERIODE APRIL

TGL TGL HR NO KODE KET

NO. KELAS NAMA A LA M AT KET UMUR DIAGNOSA PULANG DOKTER
MASUK KELUAR RAWAT REGISRASI JK UMUR ICD J PELY R PULANG TPO 3 OBAT RESEP
1 18-Apr 22-Apr 4 13006862 IB Nadila,An Sukajadi P 7 TH Thypoid A 01 ANAK Irwan Non PK 31,185
2 4-Apr 6-Apr 2 12016676 IB Chicko,An Teluk Lubuk L 10 BL Bronkhitis ANAK Nety Non APS 183,102 37,129
3 7-Apr 12-Apr 6 9011403 IB Jasmine,An Perum Vina Sejahtera P 6 TH Bronkhitis ANAK Zul Non PK 533,924 185,918
4 16-Apr 17-Apr 1 6002470 IB Izatul,An Jl.Baru Sukajadi P 8 TH Infeksi Bakteri ANAK Irwan Non APS 143,802 160,425
5 21-Apr 24-Apr 3 12016310 IB M Kevin,An Jl.Rama L 2 TH Febris R 50 ANAK Zul Non PK 282,388 125,567
6 24-Apr 27-Apr 3 13007190 IB Dimas,An Jl.Sakura L 8 TH Infeksi Bakteri ANAK Nurlela Non PK 290,527 234,550
7 8-Apr 11-Apr 3 13006255 IB Juliana,Nn Ds.Suka Bangun P 23 TH Vulnus Laceratum BDH Bujang Non PK 897,777 365,287
8 11-Apr 13-Apr 2 13006410 IB Feri,Sdr Ds.Ujan Mas L 18 TH Post ops Vericokel Sinistra BDH Bujang Non PK 46,335
9 22-Apr 29-Apr 7 13000576 IB Ponian,Tn Jl.M Yamin L 72 TH Post ops apendik perforasi K 35 BDH Bujang Non PK 149,286
10 8-Apr 16-Apr 8 13006008 IB Yaunda,Ny Ds.Tanjung Raya P 75 TH Abses Pedis BDH Bujang Non PK 5,013,898 899,798
11 18-Apr 19-Apr 1 10007534 IB Soleka,Ny Komplek PT TEL P 30 TH Hiperemisis O 21 KEB Rahman Non PK 7,500 313,284
12 24-Apr 27-Apr 3 13007191 IB Sobirin,Sdr Ds.Air Limau L 20 TH Infeksi Viral A 08 PDL Depta Non PK 1,167,668 620,469
13 13-Apr 16-Apr 3 12007715 IB Evri,Sdr Ds.Lembak L 15 TH Demam Dengue A 91 PDL Alip Non PK 102,014
14 13-Apr 17-Apr 4 13006498 IB Faisal,Sdr Ds.Lembak L 15 TH Infeksi Viral A 08 PDL Depta Non PK 60,000 53,602
15 14-Apr 22-Apr 8 11008253 IB Iti,Ny Jl.Krakatau P 65 TH GE A 09 PDL Depta Non PK 1,175,000 123,430
16 16-Apr 17-Apr 1 13006714 IB Thamrin,Tn Jl.Pembangunan Muara L 49 TH Hidronefrosis PDL Depta Non Pindah RS M E 15,000 155,122
17 19-Apr 24-Apr 5 13006915 IB Rinto,Sdr Ds.Sukamerindu L 18 TH Varicela PDL Depta Non PK 1,262,851 269,247
18 22-Apr 24-Apr 2 13007051 IB Serliani,Ny Ds.Kuripan Kp.3 P 29 TH Vertigo R 51 PDL Depta Non PK 42,100 59,290
19 24-Apr 29-Apr 5 13004880 IB Anwar Dani,Tn Jl.Dian L 58 TH Asma J 45 PDL Depta Non PK 1,249,452 580,207
20 3-Apr 6-Apr 3 13005898 IB Mulyani,Ny Jl.Krisna P 25 TH Gastropathy K 29 PDL Depta Non PK 759,763 494,609
21 29-Apr 30-Apr 1 13007422 IB Rianti,Ny Jl.Arimbi P 37 TH Dyspepsia K 30 PDL Depta Non PK 325,821 619,964
22 29-Mar 1-Apr 3 13005633 IB Nabila,Ny Ds.Karang Agung P 21 TH Syncope PDL Depta Non APS 559,680 89,705
29-Mar 2-Apr 4 13001491 IB Ahmad Zarkasi,S Ds.Tambang Rambang L 32 TH Cephalgia R 41 PDL Depta Non Pindah Bedah
2-Apr 3-Apr 1 6008707 IB Luthfi,Tn Ds.Tangai L 49 TH Asma J 45 PDL Depta Non Pindah Bedah
2-Apr 3-Apr 1 10020100 IB Alamsyah,Tn Jl.C Simanjuntak L 50 TH Neuropati PDL Depta Non Pindah Bedah
5-Apr 6-Apr 1 13006086 IB Rahmi Suri,Nn Jl.Tromol No.72 P 53 TH Hipertensi I 10 PDL Depta Non Pindah Bedah
23 18-Apr 19-Apr 2 11002548 IB Rusni,Ny Ds.Sukamerindu P 15 TH DM E 11 PDL Depta Non PK 608,291 656,916
30-Mar 1-Apr 2 13005712 IB Masrik,Tn Ds.Karang Endah L 69 TH SNH I 64 Syaraf Tanudjaja DR Pindah Bedah
3-Apr 5-Apr 2 10014453 IB Rumaidi,Tn Jl.Perwira L 54 TH SNH I 64 Syaraf Depta Non Pindah Bedah
24 31-Mar 6-Apr 6 13005728 IB Hapsari,An Ds.Sukamaju P 12 TH Tonsilitis THT Nety Klinik PK 834,146 265,869
97

1 23-Apr 25-Apr 2 13007117 II Atika,An Jl.Sumatra P 10 TH DBD A 91 ANAK Irwan Non PK 17,105
2 18-Apr 22-Apr 4 8011579 II Fajri,An Jl.Dulmubin L 9 TH Febris R 50 ANAK Irwan Non PK 150,509 169,397
3 12-Apr 16-Apr 4 6011582 II Debi,An Jl.Shinta P 8 TH Febris R 50 ANAK Nety DR APS 371,013 17,136
4 18-Apr 23-Apr 5 13006866 II Engga,An Ds.Pagar Agung L 10 TH DBD A 91 ANAK Irwan Non PK 460,261 187,747
5 29-Mar 1-Apr 3 13005640 II Tia Uli,Ny Jl.Krakatau P 49 TH Colic Ureter BDH Bujang Non PK 594,466 108,288
6 26-Apr 29-Apr 3 13004694 II Novita,Ny Sukaraja P 26 TH Hamil+hematom orbita KEB Rahman Non PK 16,401 77,000
7 25-Apr 29-Apr 4 13007259 II Sutia,Ny Ds.Pangkul P 30 TH HEG O 21 KEB Rahman Non PK 771,918 500,397
8 13-Apr 16-Apr 3 11020322 II Siti Fatimah,Ny Ds.Simpang Tais P 40 TH Post ops up pen ORTOPEDIDedi Non PK 2,781,981 1,424,365
9 4-Apr 10-Apr 6 13006018 II Fatur,Sdr Jl.Anggrek L 14 TH Hepatitis B 15 PDL Nurlela Non PK 9,075 217,800
10 7-Apr 11-Apr 4 11020860 II Sepra,An Jl.Sepatu L 13 TH DBD A 91 PDL Lidrian Non PK 10,164
11 19-Apr 23-Apr 5 13006916 II Sendi,Nn Jl.Jenderal Sudirman P 12 TH Hepatitis B 15 PDL Depta Non PK 1,071,214 651,364
12 4-Apr 5-Apr 1 12005716 II Yetri,Ny Jl.Sialingan P 23 TH RHD PDL Depta Non Dirujuk
13 18-Apr 20-Apr 2 13006819 II Aswanto,Tn Ds.Muara Sungai L 36 TH Obs febris R 50 PDL Depta Non PK 72,075
14 5-Apr 8-Mar 3 13006091 II Rahmat,Sdr Jl.Baturaja L 20 TH Dyspepsia K 30 PDL Lidrian Klinik PK 430,033 136,159
15 29-Mar 1-Apr 3 12001837 II Yuspardan,Tn Jl.Mentawai No.47 L 53 TH Cardiomiopathy PDL Depta Non PK 72,000 65,720
16 1-Apr 2-Apr 1 7004259 II Elni,Ny Ds.Lubuk Raman P 44 TH GE A 09 PDL Depta Non PK 15,000 1,246
17 1-Apr 4-Apr 3 13005791 II Ahmad Erman,Tn Ds.Segayam L 51 TH Obs febris R 50 PDL Depta Non Mati > 24 81,314 266,805
18 10-Apr 12-Apr 2 11020015 II Iqbal,Sdr Prumnas Sukajadi L 14 TH Infeksi Viral A 08 PDL Depta Non PK 33,811
19 12-Apr 17-Apr 5 13006483 II Kasem,Ny Jl.Angkatan 45 P 80 TH GGK PDL Depta Non Mati > 24 1,659,199 87,120
20 12-Apr 15-Apr 3 12000107 II Djaimah,Tn Ds.Tebat Agung L 81 TH Dyspepsia K 30 PDL Depta Non PK 401,950 27,500
21 18-Apr 20-Apr 2 13006865 II M Dwi,Sdr Kost Bimo L 24 TH Infeksi Viral A 08 PDL Depta Non PK 30,000
22 25-Apr 29-Apr 4 9009855 II Sukastatik,Ny Jl.R A Kartini P 69 TH Hipertensi I 10 PDL Depta Non PK 691,353 353,925
23 1-Apr 4-Apr 3 13005770 II Widahlan,Tn Ds.Jemenang L 47 TH Colic Ureter PDL Lidrian Klinik PK 457,297 258,265
24 4-Apr 9-Apr 5 13006021 II Dyah,Nn Perum Gunung Ibul P 21 TH Hepatitis B 15 PDL Nurlela Non PK 2,507,216 1,172,688
25 25-Mar 2-Apr 8 13005408 II Robian,Ny Ds.Tanjung Tiga P 50 TH Hipertensi I 10 PDL Depta Non PK 1,893,998 895,822
26 27-Mar 2-Apr 6 9009521 II Rusmini,Ny Ds.Sungai Medang P 54 TH Gastropathy K 29 PDL Depta Non PK 1,664,294 621,461
27 28-Mar 2-Apr 5 9009849 II Yurdanila,Ny Ds.Baru Rambang P 48 TH Hipertensi I 10 PDL Depta Non PK 1,345,068 883,289
28 29-Mar 3-Apr 5 13005614 II Alipiah,Tn Ds.Sigam L 55 TH MCI PDL Depta Non PK 1,096,870 2,571,056
29 29-Mar 1-Apr 3 12012673 II Sentia,Nn Ds.Tebat Agung P 17 TH Hipokalemia PDL Depta Non PK 681,766 317,669
30 30-Mar 4-Apr 5 13005654 II Hj.Ayuma,Ny Ds.Gunung Raja P 86 TH TB Paru A 15 PDL Depta Non PK 1,210,752 1,804,730
31 30-Mar 2-Apr 3 13005708 II Toima,Ny Ds.Air Asam P 17 TH GE A 09 PDL Depta Non PK 310,101 330,331
32 1-Apr 5-Apr 4 12011612 II Nursula,Ny Ds.Menanti Kp.2 P 54 TH Cephalgia R 41 PDL Depta Non PK 1,443,906 526,417
33 1-Apr 3-Apr 2 10018058 II Asan Nawi,Tn Ds.Muara Sungai L 65 TH HHD I 11 PDL Depta Non PK 661,034 238,262
34 2-Apr 8-Apr 6 6014182 II Ngadiman,Tn Ds.Sumaja Makmur L 51 TH DM E 11 PDL Depta Non PK 3,617,913 630,288
35 2-Apr 7-Apr 5 9015346 II Aminur,Tn Ds.Sungai Duren L 56 TH OA PDL Nurlela Non PK 1,448,488 908,848
36 3-Apr 7-Apr 3 13005938 II Suhadi,Tn Prabu Indah L 35 TH GE A 09 PDL Nurlela Non PK 1,116,778 393,563
37 3-Apr 6-Apr 3 10006161 II Romena,Ny Jl.Tenggamus P 67 TH HHD I 11 PDL Depta Non Mati > 24 679,766 198,104
38 3-Apr 5-Apr 2 8004050 II Kartina,Ny Ds.Betung Abab P 37 TH RHD PDL Depta Non PK 821,942 204,606
39 5-Apr 8-Apr 3 13006036 II Hendri,Tn Ds.Karang Jaya L 35 TH DM E 11 PDL Depta Non PK 724,003 563,035
40 6-Apr 8-Apr 2 12006583 II Rusmada,Ny Ds.Tanjung Muning P 40 TH Vertigo R 52 PDL Harry Non PK 117,160 538,384
41 6-Apr 9-Apr 3 13006172 II Dahlia,Nn Lubuk Linggau P 21 TH GE A 09 PDL Lidrian Non PK 249,150 51,017
42 8-Apr 10-Apr 2 8000884 II Ajisa,Ny Ds.Tapus P 48 TH HHD I 11 PDL Depta Non PK 697,875 696,162
43 8-Apr 12-Apr 4 13006204 II Hardani,Sdr Ds.Pengabuan L 29 TH DBD A 91 PDL Depta Non PK 2,024,156 673,462
44 8-Apr 12-Apr 4 9007511 II Siti Halimah,Ny Ds.Baturaja P 71 TH Cephalgia R 41 PDL Nurlela Non PK 1,159,604 949,373
45 8-Apr 11-Apr 3 9005465 II Yarindum,Ny Ds.Lubuk Raman P 69 TH Syok Cardiogenik PDL Depta Non PK 995,599 367,275
46 9-Apr 12-Apr 3 11018802 II Waginem,Ny Jl.Makam Pahlawan P 63 TH HHD I 11 PDL Depta Non PK 1,206,520 556,940
47 9-Apr 11-Apr 2 13006280 II Hermawan,Tn Sungai Medang L 20 TH Infeksi Viral A 08 PDL Alip Non PK 203,789 109,500
48 9-Apr 11-Apr 2 10007585 II Titi,Ny Jl.Padat Karya P 24 TH Dyspepsia K 30 PDL Nurlela Non PK 931,770 383,770
49 10-Apr 12-Apr 2 6011356 II Sukati,Ny Jl.Urip Sumoharjo P 47 TH Febris R 50 PDL Lidrian Non PK 301,627 202,379
50 10-Apr 12-Apr 2 13006365 II Neni Haryani,Ny Ds.Gumai Kp.I P 35 TH Gead A 09 PDL Depta Non PK 704,884 338,451
51 10-Apr 12-Apr 2 13006380 II Abdullah,Tn Sungai Medang L 58 TH Anemia D 50 PDL Depta Non PK 341,402 755,575
52 10-Apr 13-Apr 2 13006398 II Siti Aisyah,Ny Ds.Tempirai P 75 TH Dyspepsia K 30 PDL Nurlela Non PK 730,111 854,537
53 11-Apr 13-Apr 2 13006438 II Indra,Tn Ds.Cambai L 37 TH Dyspepsia K 30 PDL Atik Non PK 167,097 389,249
54 12-Apr 14-Apr 2 13006467 II Maidia,Ny Jl.Alipatan P 78 TH Gead A 09 PDL Nurlela Non PK 112,167 334,258
55 12-Apr 19-Apr 7 13006471 II Gimin,Tn Ds.Raja L 80 TH Haematemisis PDL Depta Non PK 2,278,829 407,326
56 12-Apr 16-Apr 4 10014596 II Satria,Sdr Ds.Pagar Agung L 14 TH DBD A 91 PDL Lidrian PKM PK 441,744 474,286
57 12-Apr 15-Apr 3 13006496 II Helpiana,Nn Ds.Muara Sungai P 21 TH Dyspepsia K 30 PDL Atik Non PK 537,866 465,634
58 13-Apr 15-Apr 2 13005608 II Riandi,Tn Jl.Sungai Medang L 31 TH Dyspepsia K 30 PDL Harry Non PK 197,295 238,460
59 14-Apr 16-Apr 2 8016012 II Tumini,Ny Ds.Teluk Lubuk P 72 TH Hidronefrosis PDL Harry Non APS 406,594 255,185
60 14-Apr 17-Apr 3 13006579 II Budi Utomo,Tn Ds.Karang Agung L 48 TH Colic Abdomen N 27 PDL Harry Non PK 491,337 257,885
61 15-Apr 19-Apr 4 13006586 II Rukiyah,Ny Ds.Karang Jaya P 62 TH Hipertensi I 11 PDL Depta Non PK 1,227,172 994,497
62 15-Apr 16-Apr 1 6022475 II Reni,Ny Ds.Tanjung Dalam P 39 TH Cephalgia R 41 PDL Nurlela Non PK 141,599 485,858
63 15-Apr 17-Apr 2 13006639 II Selamet,Tn Jl.Baru L 35 TH Infeksi Bakteri PDL Nurlela Non PK 383,443 334,168
64 15-Apr 17-Apr 2 13006652 II Karnila,Ny Ds.Rukun Rahayu P 36 TH Dyspepsia K 30 PDL Depta Non PK 337,398 444,940
65 15-Apr 19-Apr 3 13006654 II Karyati,Ny Gelumbang P 49 TH Hipertensi I 10 PDL Depta Non PK 800,000 653,130
66 16-Apr 20-Apr 4 13006719 II Hotimah,Nn Ds.Curup P 31 TH Haematemisis+Melena PDL Depta Non PK 3,867,976 1,393,191
67 16-Apr 20-Apr 4 13006722 II Julia,Ny Ds.Raja Jaya P 27 TH Colic Abdomen N 27 PDL Nurlela Non PK 1,749,364 512,020
68 16-Apr 18-Apr 2 13006712 II Imam,Tn Ds.Karang Endah L 36 TH Infeksi Viral A 08 PDL Nurlela Non PK 271,943 290,281
69 16-Apr 22-Apr 6 13006672 II Nuriyah,Ny Asrama Yon Zipur P 58 TH Dyspepsia K 30 PDL Depta Non PK 2,967,271 814,091
18-Apr 19-Apr 1 12001750 II Yunizar,Tn Sukajadi L 48 TH Dyspnoe PDL Depta Non Pindah HCU 436,286
70 18-Apr 22-Apr 4 12001506 II Sulhani,Ny Ds.Pagar Agung P 54 TH LBP PDL Depta Non PK 600,042 404,875
71 19-Apr 20-Apr 1 13006898 II Roaini,Ny Ds.Mangku Negara P 54 TH Cephalgia R 41 PDL Depta Non PK 440,202 328,928
72 20-Apr 23-Apr 3 13006937 II Marfei,Tn Ds.Sukadana L 46 TH GOUT PDL Depta Non PK 1,597,068 426,750
73 20-Apr 23-Apr 3 13006982 II Mujio,Tn Rambang Dangku L 45 TH Colic Abdomen N 27 PDL Depta Non PK 790,378 874,384
74 21-Apr 23-Apr 2 12003721 II Mat Seho,Tn Ds.Lembak L 65 TH Dyspepsia K 30 PDL Depta Non PK 856,118 669,137
75 21-Apr 26-Apr 5 11019750 II Rusli,Tn Ds.Sukarami L 55 TH HHD I 11 PDL Depta Non PK 1,620,804 673,032
76 22-Apr 23-Apr 1 13007050 II Cik Siti,Ny Ds.Tanjung Menang P 70 TH Cholelitiasis PDL Depta Non Mati < 24 185,870 211,873
22-Apr 23-Apr 1 10009661 II Rodiah,Ny Ds.Tambang Kelekar P 63 TH HHD I 11 PDL Depta Non Pindah HCU 383,579
22-Apr 24-Apr 2 13007060 II Supandi,Tn Ds.Sungai Medang L 18 TH TB Paru A 15 PDL Depta Non Pindah Isolasi 750,790
77 23-Apr 24-Apr 1 13007130 II Surdin,Tn Ds.Babat L 30 TH Leukemia PDL Depta Non Dirujuk 321,043 84,342
78 23-Apr 25-Apr 2 13006970 II H Amzah,Tn Ds.Teluk Lubuk L 76 TH HHD I 11 PDL Depta Non Mati < 24 862,070 293,151
24-Apr 25-Apr 1 12018833 II Ferry,Tn Ds.Perjito L 28 TH PPH PDL Depta Non Pindah Bedah
79 24-Apr 26-Apr 2 12016012 II Siti Zumrotun,Ny Ds.Karang Mulya P 27 TH CHF PDL Depta Non Dirujuk 466,782 236,990
80 24-Apr 27-Apr 3 11018802 II Waginem,Ny Jl.Makam Pahlawan P 63 TH HHD I 11 PDL Depta Non PK 995,094 443,835
81 25-Apr 26-Apr 1 13006121 II Epra,Sdr Ds.Pagar Agung L 23 TH Hepatitis B 15 PDL Harry Non PK 232,666
82 26-Apr 28-Apr 2 11008888 II Muslimah,Ny Jl.Sumatra P 52 TH Vertigo R 51 PDL Atik Non PK 522,963 367,736
83 27-Apr 29-Apr 2 13007368 II Rusdi,Tn Jl.Arimbi L 45 TH Suspec DVT PDL Depta Non APS 811,104 75,603
84 2-Apr 3-Apr 1 11007281 II Wiji,Ny Ds.Karya Mulya P 68 TH SH Syaraf Depta Non Mati > 24 815,754 306,016
85 6-Apr 10-Apr 5 13005998 II Dulaman,Tn Jl.Baturaja L 68 TH SOL Syaraf Budiman Non Dirujuk 1,775,391
22-Apr 24-Apr 2 13007071 II Lili Marlin,Ny Jl.Jenderal Sudirman P 50 TH SNH I 64 Syaraf Depta Non Pindah HCU 137,675
86 24-Apr 27-Apr 3 13007196 II Heriyanto,Tn Jl.MAN 2 L 33 TH Faringitis THT Harry Non PK 29,589
87 31-Mar 1-Apr 1 13005730 II Parno,Tn Ds.Midar L 36 TH Vomitus R 11 UMUM Nurlela Non APS 46,724 305,637
88 1-Apr 2-Apr 1 12005721 II Suarli,Sdr Ds.Negri Agung L 20 TH Vomitus R 11 UMUM Lidrian Non APS 123,415 431,735
89 2-Apr 3-Apr 1 13005854 II Rusli,Tn Jl.Kerinci L 46 TH Obs febris R 50 UMUM Nurlela Non APS 144,716 58,503
5-Apr 6-Apr 1 13006087 II Septianti,Nn Jl.Surip P 16 TH Febris R 50 UMUM Depta Non Pindah Bedah
 281 87,745,654 44,941,357

321

119 831 175,491,308 89,882,714

120 175,491,308 89,882,714
90
91
92
93
94
95
96
97

98
99
100
101
102
103
104
105
 J PARAMEDIS J.SHIF
OPNAME J PARAMEDIS J.SHIF YG DIBAGIKAN YG DIBAGIKANPSG INFUSCHATETER NGT INJEKSI SKIN TES VISITE SLANG O2
S.DEKUBITUS
S.NEBULIZER O2 TABUNG BI LAIN GV PA ADM
1,140,000 57,600 38,400 72,000 2,000 330,000
500,000 43,200 28,800 25,000 36,000 195,000 50,000
1,500,000 100,800 67,200 108,000 2,500 360,000 100,000
250,000 28,800 19,200 28,800 19,200 25,000 140,000 20,000
750,000 57,600 38,400 57,600 38,400 25,000 36,000 2,500 260,000 50,000
750,000 57,600 38,400 57,600 38,400 54,000 2,500 250,000 50,000
750,000 57,600 38,400 57,600 38,400 54,000 2,500 245,000 45,000 50,000
200,000 9,600 6,400 75,000 75,000 8,000 45,000 10,000
700,000 33,600 22,400 150,000 28,000 35,000
2,000,000 129,600 86,400 129,600 86,400 25,000 126,000 5,000 645,000 360,000 150,000
250,000 14,400 9,600 18,000 65,000 50,000
750,000 57,600 38,400 25,000 54,000 230,000 100,000
750,000 43,200 28,800 54,000 180,000
400,000 19,200 12,800 100,000 20,000 25,000
800,000 38,400 25,600 250,000 32,000 40,000
100,000 4,800 3,200 25,000 4,000 5,000
500,000 24,000 16,000 115,000 20,000 25,000
200,000 9,600 6,400 75,000 8,000 10,000
500,000 24,000 16,000 115,000 20,000 25,000
750,000 57,600 38,400 54,000 270,000 150,000
250,000 28,800 19,200 18,000 135,000 50,000
750,000 57,600 38,400 57,600 38,400 54,000 185,000 50,000

250,000 28,800 19,200 28,800 19,200 18,000 140,000 50,000

1,500,000 100,800 67,200 25,000 108,000 2,500 480,000 150,000

260,000 15,000 10,000 20,000 2,000 85,000

680,000 48,000 32,000 72,000 305,000 50,000
680,000 48,000 32,000 48,000 32,000 72,000 2,500 300,000 35,000
850,000 57,600 38,400 57,600 38,400 25,000 90,000 2,500 310,000 50,000
510,000 38,400 25,600 38,400 25,600 25,000 54,000 210,000 50,000
390,000 22,500 15,000 5,000 160,000
680,000 48,000 32,000 48,000 32,000 72,000 230,000 100,000
510,000 38,400 25,600 25,000 54,000 5,000 180,000 45,000 200,000
780,000 52,500 35,000 25,000 197,000
520,000 37,500 25,000 20,000 2,000 132,000
680,000 48,000 32,000 25,000 72,000 140,000 150,000
170,000 19,200 12,800 18,000 70,000 150,000
340,000
510,000 38,400 25,600 54,000 2,500 165,000 100,000
270,000 9,000 6,000 40,000 12,000 15,000
90,000 3,000 2,000 15,000 4,000 5,000
360,000 12,000 8,000 60,000 16,000 20,000
200,000 9,600 6,400 50,000 8,000 10,000
375,000 15,000 10,000 100,000 20,000 25,000
270,000 9,000 6,000 50,000 12,000 15,000
180,000 6,000 4,000 40,000 8,000 10,000
360,000 12,000 8,000 70,000 16,000 20,000
510,000 38,400 25,600 54,000 2,500 125,000 100,000
850,000 57,600 38,400 60,000 2,500 275,000 100,000
1,360,000 86,400 57,600 86,400 57,600 25,000 144,000 540,000 100,000
1,020,000 67,200 44,800 67,200 44,800 108,000 410,000 125,000
850,000 57,600 38,400 57,600 38,400 25,000 90,000 315,000 12,000 225,000 110,000
850,000 57,600 38,400 57,600 38,400 90,000 295,000 12,000 87,500 80,000
510,000 38,400 25,600 38,400 25,600 54,000 200,000 50,000
 850,000 57,600 38,400 57,600 38,400 25,000 90,000 225,000 100,000
510,000 38,400 25,600 38,400 25,600 54,000 2,500 180,000 70,000
680,000 48,000 32,000 48,000 32,000 72,000 2,500 430,000 80,000
340,000 28,800 19,200 28,800 19,200 36,000 180,000 12,000 100,000 50,000
1,020,000 86,400 57,600 86,400 57,600 108,000 2,500 545,000 100,000
850,000 57,600 38,400 57,600 38,400 25,000 90,000 280,000 60,000
680,000 48,000 32,000 48,000 32,000 72,000 220,000 50,000
680,000 48,000 32,000 48,000 32,000 72,000 2,500 240,000 12,000 50,000
340,000 28,800 19,200 28,800 19,200 36,000 180,000 75,000
680,000 48,000 32,000 48,000 32,000 72,000 125,000 100,000
340,000 28,800 19,200 28,800 19,200 36,000 115,000 50,000
510,000 37,400 25,600 37,400 25,600 54,000 2,500 165,000 50,000
340,000 28,800 19,200 28,800 19,200 54,000 180,000 125,000 100,000
680,000 48,000 32,000 48,000 32,000 72,000 375,000 12,000 12,500 60,000
680,000 48,000 32,000 48,000 32,000 72,000 340,000 60,000
510,000 38,400 25,600 38,400 25,600 36,000 240,000 12,000 450,000 50,000
510,000 37,400 25,600 37,400 25,600 54,000 240,000 12,000 162,500 50,000
340,000 19,200 12,800 19,200 12,800 36,000 165,000 35,000
340,000 28,800 19,200 28,800 19,200 36,000 2,500 110,000 50,000
340,000 28,800 19,200 36,000 2,500 110,000 80,000
510,000 38,400 25,600 38,400 25,600 54,000 2,500 180,000 35,000
340,000 28,800 19,200 28,800 19,200 36,000 2,500 120,000 65,000
510,000 38,400 25,600 38,400 25,600 54,000 2,500 245,000 12,000 125,000 50,000
340,000 28,800 19,200 28,800 19,200 36,000 2,500 110,000 30,000
340,000 28,800 19,200 28,800 19,200 36,000 2,500 110,000 50,000
1,190,000 76,800 51,200 76,800 51,200 25,000 60,000 126,000 475,000 24,000 212,500 90,000 150,000
680,000 48,000 32,000 48,000 32,000 72,000 2,500 220,000 70,000
510,000 38,400 25,600 38,400 25,600 54,000 165,000 50,000
340,000 28,800 19,200 28,800 19,200 36,000 110,000 50,000
340,000 28,800 19,200 28,800 19,200 36,000 2,500 110,000 50,000
510,000 38,400 25,600 38,400 25,600 54,000 2,500 165,000 100,000
680,000 48,000 32,000 48,000 32,000 72,000 310,000 100,000
170,000 19,200 12,800 19,200 12,800 18,000 2,500 55,000 80,000
340,000 28,800 19,200 28,800 19,200 36,000 2,500 110,000 30,000
340,000 28,800 19,200 28,800 19,200 36,000 2,500 120,000 100,000
680,000 48,000 32,000 48,000 32,000 72,000 300,000 12,000 12,500 70,000
680,000 48,000 32,000 48,000 32,000 25,000 60000 72,000 2,500 310,000 12,000 125,000 100,000
680,000 48,000 32,000 48,000 32,000 72,000 2,500 110,000 100,000
340,000 28,800 19,200 28,800 19,200 36,000 2,500 110,000 50,000
1,020,000 67,200 44,800 67,200 44,800 25,000 108,000 2,500 355,000 70,000
170,000 9,600 6,400 25,000 18,000 125,000 12,000 112,500
680,000 48,000 32,000 48,000 32,000 72,000 290,000 50,000
170,000 19,200 12,800 19,200 12,800 18,000 125,000 50,000
510,000 38,400 25,600 38,400 25,600 54,000 2,500 205,000 50,000
510,000 37,400 25,600 25,000 54,000 205,000 100,000
340,000 28,800 19,200 28,800 19,200 36,000 150,000 35,000
850,000 57,600 38,400 57,600 38,400 90,000 330,000 12,000 37,500 80,000
170,000 19,200 12,800 19,200 12,800 18,000 90,000 50,000
170,000 19,200 12,800 19,200 12,800 60,000 18,000 130,000 12,000 250,000
340,000 19,200 12,800 19,200 12,800 24,000 2,500 190,000
170,000 19,200 12,800 19,200 12,800 18,000 5,000 90,000 50,000
340,000 28,800 19,200 28,800 19,200 60,000 36,000 180,000 12,000 337,500 50,000

340,000 28,800 19,200 28,800 19,200 25,000 36,000 190,000 12,000 437,500 50,000
510,000 38,400 25,600 38,400 25,600 54,000 250,000 12,000 362,500 50,000
170,000 19,200 12,800 19,200 12,800 18,000 55,000 50,000
340,000 28,800 19,200 28,800 19,200 36,000 110,000 40,000
340,000 28,800 19,200 28,800 19,200 25,000 60,000 36,000 2,500 265,000 100,000
170,000 19,200 12,800 19,200 12,800 25,000 18,000 60,000 12,000 275,000 100,000 150,000
850,000 57,600 38,400 57,600 38,400 25,000 280,000 100,000
340,000 28,800 19,200 28,800 19,200 60,000 60,000 36,000 220,000 12,000 100,000
390,000 22,500 15,000 30,000 99,000
170,000 19,200 12,800 19,200 12,800 18,000 115,000 30,000
170,000 19,200 12,800 19,200 12,800 18,000 110,000 12,000 37,500 30,000
170,000 19,200 12,800 19,200 12,800 18,000 2,500 55,000 50,000
 62,045,000 4,369,800 2,915,200 3,113,200 2,076,800 575,000 435,000 60,000 5,170,000 111,000 22,438,000 252,000 3,973,500 100,000 585,000 6,650,000

124,090,000 8,739,600 5,830,400 6,226,400 4,153,600 1,150,000 870,000 120,000 ### 222,000 44,876,000 504,000 7,947,000 200,000 1,170,000 ###
124,090,000 8,739,600 5,830,400 6,226,400 4,153,600 1,150,000 870,000 120,000 ### 222,000 44,876,000 504,000 7,947,000 200,000 1,170,000 ###
 DISCOUNT
TOTAL SELISIH PERUSAHAAN

1,671,185 840,000 ASKES

1,098,231 TANGKAS
2,958,342 TANGKAS
835,227
1,723,455
1,823,577
2,601,564 AVIVA
475,335 447,703 PNS
1,118,286 69,885 800,000 PNS
9,656,696
727,784 TEL
3,043,137 104,350 AIA
1,158,014 1,020,515 JMT
690,602 199,669 PNS
2,484,430 1,499,420 PNS
312,122 877,446 PNS
2,232,098 1,633,220 PNS
410,390 120,334 PNS
2,529,659 1,835,683 PNS
2,574,372 SIMAS
1,446,785 TANGKAS
1,880,385

1,819,207

3,533,515 KAI

409,105 ASKES
1,506,906 RS BUNDA
1,637,649
2,167,508
1,679,754
685,901 77,000 ASKES
2,514,315
5,289,346 SBAL
1,316,375 232,800 ASKES
746,664 ASKES
2,869,578 FRUDENTIAL
440,000 1,113,756 JMT
412,075 708,551 JMT
1,461,692 KAI
489,720 332,454 PNS
135,246 49,304 PNS
824,119 1,128,931 PNS
317,811 39,869 PNS
2,291,319 2,148,164 PNS
791,450 421,294 PNS
278,000 151,364 PNS
1,531,278 1,122,389 PNS
1,571,062 PTPN VII
5,063,404 TITIS SAMPURNA
5,246,820
4,172,755
4,047,357
5,274,426
1,941,435
4,497,482
1,584,932
3,394,823
1,713,296
6,311,701
3,854,336
2,692,341
2,094,370
1,753,548
2,424,038
1,292,544
1,207,667
2,289,037
4,069,118
3,420,977
2,788,874
2,917,960
953,289
1,950,040
1,120,506
1,952,835
1,756,477
2,711,148
1,170,846
1,080,925
5,294,655
2,120,530
1,910,500
1,067,755
1,296,279
1,708,722
3,543,669
1,016,957
1,332,111
1,476,838
2,759,630
6,807,667
3,385,884
1,196,724
5,585,862
914,786
2,256,917
1,196,130
2,973,318
2,621,762
2,182,255
3,885,336
789,743
1,087,579
1,371,290
802,385
2,266,721

1,890,272
2,805,429
589,666
1,512,699
1,811,207
1,995,770 1,836,948
3,222,391
1,061,675
586,089 ASKES
749,361
996,650
562,719
247,556,511 1,906,833 16,904,216

- -

254,735,396 16,904,216

495,113,022 3,813,666 50,712,648

495,113,022
DAFTAR PASIEN RUANG RAWAT INAP
BULAN APRIL 2013

NO. TGL TGL HR No KLS NAMA ALAMAT JK UMR THN DIAGNOSA J. PELY Dokter KET BIAYA TPO OPNAME J. PARAMEDIS J.SHIFT J. SHIFT PSG. INFUS CHATETER NGT
MASUK KELUAR RWT REGESTER THN PULANG PLG ALKES YANG DIBAGI YANG DIBAGI J. PARAMEDIS
1 27-Mar-13 6-Apr 9 9016390 VVIP SUKINI JL SERELOPR 54 THN CEPHALGIA PDL DEPTA PK 1,276,705 ### 4,500,000 264,000 176,000 264,000 176,000 75,000
2 29-Mar-13 1-Apr 3 9001193 VVIP NAUFAL TEL LK 12 THN VOMITUS ANAK NETI PK 70,148 290,762 1,350,000 96,000 64,000 96,000 64,000 25,000
3 29-Mar-13 31-MARET 2 6005487 VIP YANSI KAPTEN A LK 50 THN FEBRIS PDL HARRY PK 214,426 449,675 800,000 49,500 33,000 49,500 33,000
4 30-Mar-13 31-MARET 1 13005713 VIP AL FAZAH PALEMBANLK 4 THN DIARE ANAK NETI RUJUK 32,977 278,838 400,000 33,000 22,000 33,000 22,000
5 31-Mar-13 2-Apr 2 11009851 VIP ALMIRA Q JL BUKIT PR 3 THN ANAK NETI PK 257,652 329,106 800,000 49,500 33,000 49,500 33,000
6 1-Apr-13 2-Apr 1 11006240 VIP ERNI SUKAJADI PR 39 THN MATA IRDIANTO PK 31,928 400,000 33,000 22,000 33,000 22,000
7 1-Apr-13 4-Apr 3 13005736 VIP NUR HUDAJL PELANGLK 11 THN ANAK NETI PK 294,386 ### 1,200,000 66,000 44,000 66,000 44,000
8 2-Apr-13 3-Apr 1 10017690 VIP AS SYIFA JL AWAHA PR 3 BLN ANAK ZULAMRI APS 196,801 350,000 12,000 8,000 12,000 8,000
9 4-Apr-13 6-Apr 2 13005965 VIP ZAHIRA PR THN ANAK IRWAN PK 273,051 349,608 800,000 49,500 33,000 49,500 33,000
10 4-Apr-13 7-Apr 3 7005465 VIP YUDHA TANJUNG LK 6 THN ANAK IRWAN PK 327,639 471,429 1,200,000 66,000 44,000 66,000 44,000
11 5-Apr-13 10-Apr 5 10011278 VIP RENGKI LK THN PDL DEPTA PK 762,119 ### 2,000,000 99,000 66,000 99,000 66,000
12 5-Apr-13 7-Apr 2 12015227 VVIP SANTOSO LK THN PDL DEPTA PK 340,458 553,968 900,000 72,000 48,000 72,000 48,000
### 6-Apr 1E+007 VIP DONA PINDAH 224,296 16,500 11,000 16,500 11,000
13 7-Apr-13 8-Apr 1 10011339 VIP KRISBOY MUARA DULK 30 THN DECOMP PDL DEPTA PK 400,000 33,000 22,000 33,000 22,000
14 7-Apr-13 12-Apr 4 11011538 VVIP AZIZAH MABES PR 55 THN DYSPEPSIA PDL DEPTA PK 496,896 ### 1,800,000 120,000 80,000 120,000 80,000 75,000
15 7-Apr-13 11-Apr 4 9000741 VIP RIKA JL SIMANJ PR 35 THN DYSPEPSIA PDL DEPTA PK 1,600,000 82,500 55,000 82,500 55,000
### VIP SUMIATI PINDAH 15,000 140,000 4,800 3,200 4,800 3,200
16 8-Apr-13 12-Apr 4 8003370 VIP HASAN BA MANUNGGA
LK THN DYSPEPSIA PDL DEPTA PK 1,339,406 ### 1,600,000 82,500 55,000 82,500 55,000 25,000
17 8-Apr-13 12-Apr 4 9014322 VIP ZUL HAKIMDS TALINGLK 56 THN DYSPEPSIA PDL DEPTA PK 1,312,213 ### 1,600,000 82,500 55,000 82,500 55,000 25,000
18 8-Apr-13 12-Apr 4 13006109 VIP SRI OKTAVJL DEMPO PR 13 THN DBD PDL DEPTA PK 241,594 348,124 1,600,000 66,000 55,000 66,000 55,000
19 8-Apr-13 10-Apr 2 13006273 VIP ZHIEPAN DS SUKA LK 2 THN TDBD ANAK IRWAN PK 134,479 105,589 800,000 49,500 33,000 49,500 33,000 25,000
20 10-Apr-13 13-Apr 3 8012988 VIP ARIP W HADIN EFELK 8 THN TONSIL THT WITA PK 152,595 104,350 845,000
21 11-Apr-13 15-Apr 4 12018820 VVIP LINDY YON ZIPURPR 9 THN DBD ANAK NETTY PK 194,111 426,596 1,800,000 120,000 80,000 120,000 80,000 25,000
22 12-Apr-13 18-Apr 6 9010598 VIP WAWAN ANG 45 LK 30 THN TB PDL DEPTA PK ### 2,400,000 115,500 77,000 115,500 77,000
23 14-Apr-13 19-Apr 5 12013763 VIP DESY TEL PR 30 THN SECTIO SEC KEB RACHMAN PK ### 2,000,000 99,000 66,000 99,000 66,000 25,000
24 15-Apr-13 19-Apr 4 12007986 VVIP MIRZALIZAGUNUNG I LK 1 THN MORBILI ANAK IRWAN PK 172,213 693,269 1,800,000 120,000 80,000 120,000 80,000 25,000
25 17-Apr-13 23-Apr 6 8010347 VIP AHMAD LA GUNUNG I LK 5 THN DBD ANAK ZULAMRI PK 639,996 2,100,000 72,000 48,000 72,000 48,000
### 18-Apr 1 8013406 VIP SUMIATI KOMPLE PR 60 THN DM PDL DEPTA PINDAH 15,000 140,000 4,800 3,200 4,800 3,200
### 19-Apr 1 VIP NURMAYTEL PR 32 THN DYSPEPSI PDL DEPTA PINDAH 662,979 275,000 33,000 22,000 33,000 22,000
### 19-Apr 1 VIP NURMALGUNUNGPR 35 THN HEG KEB RACHMA PINDAH 113,643 275,000 33,000 22,000 33,000 22,000
### 20-Apr 1 1E+007 VIP AHMAD GUNUNGLK THN FEBRIS ANAK IRWAN PINDAH 417,726 400,000 33,000 22,000 33,000 22,000
### 22-Apr 3 VIP NOVIANTGUNUNGPR THN POST PAR KEB NOVIANT PINDAH 776,000 ### 36,000 24,000 36,000 24,000
26 19-Apr-13 21-Apr 2 6005829 VIP DESTIPUTRJL CENDR PR 55 THN KLL BEDAH BUJANG PK 479,852 700,000 24,000 16,000 24,000 16,000
27 20-Apr-13 22-Apr 2 13006931 VIP AZIZAH SUKA MEN PR THN DYSPEPSIA PDL DEPTA PK 488,311 ### 800,000 49,500 33,000 49,500 33,000
28 20-Apr-13 23-Apr 3 8010434 VIP BURHANUDHARAPAN LK 55 THN DIARE PDL DEPTA PK 552,923 ### 1,200,000 66,000 44,000 66,000 44,000 25,000
29 20-Apr-13 23-Apr 3 7003365 VIP FARIZ LUBUK RA LK 5 THN VOMITUS ANAK IRWAN PK 355,389 933,248 1,350,000 96,000 64,000 96,000 64,000
30 20-Apr-13 22-Apr 2 12000443 VIP LINA JL BATURAPR THN HEG KAND NOVIA PK 255,190 700,000 24,000 16,000 24,000 16,000
31 21-Apr-13 26-Apr 5 8010866 VIP ETTY JL BATURAPR 25 THN DBD PDL DEPTA PK 279,755 ### 2,000,000 99,000 66,000 99,000 66,000 25,000
32 21-Apr-13 24-Apr 3 11009301 VVIP SUPRIANTO LK THN DYSPEPSIA PDL DEPTA PK 715,558 ### 1,200,000 96,000 54,000 96,000 54,000
### 22-Apr 1 VIP NASRULLAH LK 13 THN VOMITUS PDL DEPTA PINDAH 360,831 350,000 12,000 8,000 12,000 8,000
33 22-Apr-13 27-Apr 5 10018578 VIP ELYADI DS GUNUNLK 50 THN SELULITIS BEDAH BUJANG PK 1,170,184 1,750,000 60,000 40,000 60,000 40,000
34 22-Apr-13 26-Apr 4 6009269 VIP SELO MANUNGGLK 50 THN POST OPS H BEDAH BUJANG PK 2,117,483 1,400,000 48,000 32,000 48,000 32,000
35 23-Apr-13 26-Apr 3 13007062 VIP MAY HAPP PALEMBANLK 45 THN DYSPEPSIA PDL DEPTA PK 742,480 ### 1,200,000 66,000 44,000 66,000 44,000
36 24-Apr-13 26-Apr 2 6013435 VIP MURLINA JL CENDR PR 63 THN SYOK KARDI PDL DEPTA PK 720,850 700,000 24,000 16,000 24,000 16,000
37 25-Apr-13 28-Apr 3 VVIP HARIANI PASAR PB PR 26 THN DBD KEB DEPTA APS 804,929 ### 1,800,000 120,000 80,000 120,000 80,000
38 26-Apr-13 30-Apr 4 13003390 VIP ISA DS DANGKPR 40 THN SECTIO SEC KEB RACHMAN PK 1,209,116 ### 2,400,000 82,500 55,000 82,500 55,000
39 26-Apr-13 29-Apr 3 VIP CITRA JL ALIPATA PR 25 THN AB IMINEN KEB RACHMAN PK 616,141 1,050,000 36,000 14,000 36,000 14,000
40 26-Apr-13 29-Apr 3 13006823 VIP ANA TELUK LU PR 30 THN TACHI CARDIPDL RACHMAN PK 61,187 146,231 1,200,000 66,000 44,000 66,000 44,000
41 28-Apr-13 29-Apr 1 11008237 VIP RENI JL ALIPATA PR 30 THN POST PARTU KEB RACHMAN PK 159,720 400,000 33,000 22,000 33,000 22,000

141 ### ### ### 3,095,100 2,054,400 3,095,100 2,054,400 375,000 - -

INJEKSI SKINTEST VIS. & KONSULSELANG O2
O2 ELEKTRIK
BED DECUBITUS
NEBULIZERO2 TBUNG PA GV LAIN-LAIN ADM TOTAL SELISIH DISCOUNT
PERUSAHAAN

180,000 1,115,000 150,000 ### GLOBAL

54,000 2,500 255,000 100,000 2,467,410 242,000 TEL
36,000 130,000 12,000 72,000 100,000 1,979,101 679,500 PTPN
18,000 2,500 40,000 12,000 50,000 944,315 982,000 ALLIANZ
18,000 2,500 190,000 150,000 1,912,258 SIMAS
150,000 250,000 941,928 MHP
54,000 2,500 265,000 100,000 3,782,252 TRAKINDO
50,000 15,000 20,000 671,801 581,225 PNS
36,000 2,500 190,000 50,000 1,866,159 MHP
54,000 2,500 190,000 50,000 2,515,568
90,000 2,500 395,000 150,000 6,614,955
36,000 200,000 80,000 2,350,426
279,296
18,000 528,000 BUNDA
72,000 2,500 3,900,000 12,000 18,000 200,000 ### 400,000 GLOBAL
72,000 300,000 12,000 18,000 100,000 2,377,000
35,000 4,000 - 5,000 215,000
72,000 2,500 390,000 100,000 6,249,653
72,000 2,500 390,000 12,000 9,000 100,000 5,617,207
54,000 2,500 315,000 2,803,218 2,286,728 JAMSOSTEK
18,000 150,000 30,000 1,428,068
1,101,945
72,000 2,500 340,000 150,000 3,410,207 473,887 GLOBAL
108,000 490,000 12,000 ### 150,000 4,826,192
72,000 2,500 450,000 45,000 500,000 6,023,672 625,000 TEL
72,000 2,500 440,000 150,000 3,754,982 33,000 GLOBAL
210,000 90,000 120,000 3,399,996 2,783,520 PNS
15,000 4,000 5,000 195,000
18,000 2,500 240,000 ###
18,000 2,500 75,000 594,143
36,000 2,500 180,000 ###
150,000 ### 60,000 ###
100,000 30,000 40,000 1,429,852 1,840,029 PNS
36,000 195,000 100,000 2,844,208 MHP
54,000 397,000 100,000 3,641,168
72,000 2,500 295,000 100,000 3,428,137 MHP
100,000 30,000 40,000 1,205,190 1,196,286 PNS
90,000 2,500 375,000 70,000 5,123,648
2,500 305,000 150,000 4,084,345 434,000 KAI
50,000 ### 20,000 835,831
300,000 75,000 ### 100,000 4,090,184 3,650,402 PNS
200,000 60,000 45,000 80,000 4,062,483 4,536,342 PNS
54,000 225,000 100,000 4,203,669
100,000 30,000 40,000 1,670,850 5,287,461 PNS
90,000 5,000 320,000 150,000 6,446,818 2,424,409 SOS
54,000 2,500 225,000 45,000 50,000 5,739,318
 150,000 45,000 60,000 2,021,141 1,517,376 PNS
115,000 12,000 ### 45,000 100,000 2,016,418 450,000 TANGKAS
75,000 744,720 515,926 ASKES

1,800,000 57,500 14,767,000 84,000 ### - - ### - ### - ###

A
DAFTAR PASIEN RAWAT INAP RUANG BEDAH ( IBNU SINA )
BULAN APRIL 2013
NO. TGL TGL HR NO. UMR KET KODE KET TPO 28 JS PARAMEDIS JS SHIFT
KELAS NAMA ALAMAT JK DIAGNOSA PULANG J. PELY DOKTER R OPNAME J. PARAMEDIS J. SHIFT PSG. INFUS CHATETER NGT INJEKSI SKINTEST VIS. & KONSUL
MASUK KELUAR RWT REG THN UMUR ICD X PULANG RESEP YG DIBAGIKANYG DIBAGIKAN
1 9\4\2013 15\4\2013 6 12002904 I A Aldo, An Ds Tebat Agung Ram L 14 Th TC Umum Nurlela PK 2,621,386 1,650,000 100,800 67,200 - ### 108,000 2,500 425,000
15\4\2013 24\4\2013 9 13004470 I A Rosmala Dewi, NyJl. Maharani P 61 Th TB Paru PDL Depta PK 1,740,440 900,000 43,200 28,800 - ### 360,000
2 15\4\2013 19\4\2013 5 11000657 I A Engelia, Ny Jl. Sangkuriang P 30 Th Cholesistitis PDL Depta PK 911,418 1,200,000 72,000 48,000 72,000 48,000 72,000 260,000
3 17\4\2013 22\4\2013 5 9001979 I A Aditya, An Jl. Jend Sudirman L 12 Th DBD PDL Depta PK 1,382,431 500,000 24,000 16,000 - ### 200,000
4 1\4\2013 6\4\2013 5 IA Ajrul, Sdr L 21 Th TC Bedah Bujang PK 557,277 1,500,000 86,400 57,600 - ### 108,000 2,500 325,000
5 24\4\2013 25\4\2013 1 IA Indriani, An P 2,5 Th GE Anak Irwan PK 49,579 300,000 28,800 19,200 - ### 18,000 65,000
6 15\4\2013 24\4\2013 9 9001113 II A Yuni, Nn Ds. Niru P 18 Th DBD PDL Depta PK 7,194,722 2,475,000 129,600 86,400 - ### 25,000 162,000 2,500 645,000
7 15\4\2013 19\4\2013 4 13006642 III Nasrul, Tn Ds. Sungai Medang L 27 Th PO Repair Hidung THT Wita PK 2,150,633 400,000 33,000 22,000 33,000 22,000 25,000 72,000 2,500 275,000
8 25\3\2013 1\4\2013 7 13005405 l A Rurenza, Sdr Jl. Nias L 14 Th PO Debridement Bedah Bujang PK 124,759 989,684 2,100,000 115,200 76,800 - ### 50,000 126,000 2,500 585,000
9 25\3\2013 4\4\2013 9 12020374 l A Ah. Saidin, Tn Jl. Hibrida L 63 Th Sirosis Hepatis PDL Depta PK 525,442 4,066,580 900,000 43,200 28,800 - ### 360,000
10 25\3\2013 1\4\2013 6 9015864 l A Zuhro, Ny Ds. Sugihan P 65 Th Febris PDL Depta PK 47,190 60,000 600,000 28,800 19,200 - ### 240,000
11 25\3\2013 31\4\2013 6 l A Aziar Fika, Ny P 31 Th SC Kebid Rachman PK 1,143,198 800,000 38,400 28,600 14,000 9,600 265,000
12 28\3\2013 1\4\2013 4 13002671 l A Andre, Sdr Ds. Ibul L 14 Th Obs Febris PDL Alip PK 77,667 157,706 1,200,000 72,000 48,000 72,000 48,000 72,000 2,500 300,000
13 28\3\2013 1\4\2013 4 13005599 l A Firsawati, Ny Ds. Sedupi P 26 Th Dyspepsia PDL Depta PK 510,543 3,172,151 1,000,000 72,000 48,000 - ### 72,000 280,000
14 29\3\2013 4\4\2013 6 7013401 l A Hesti, Ny Ds. Alai P 30 Th H 31 Mg Placenta Previa Kebid Rachman PK 66,823 408,189 600,000 4800*6 19,200 - ### 240,000
15 30\3\2013 4\4\2013 5 12014796 l A Helmanto, Tn Jl. Merak L 50 Th HT Maligna PDL Harry PK 10,109 3,749,699 500,000 24,000 16,000 - ### 200,000
16 30\3\2013 3\4\2013 4 8006009 l A Dede, Ny Talang Ubi Selatan P 29 Th SC Kebid Novia PK 144,336 918,833 1,200,000 72,000 48,000 72,000 48,000 25,000 54,000 325,000
17 31\3\2013 1\4\2013 1 13005733 l A Bahyudin, Tn Jl. Pendawa L 62 Th HHD PDL Depta PK 300,000 14,400 9,600 14,400 9,600 65,000
18 1\4\2013 2\4\2013 2 13005712 l A Masrik, Tn Ds. Kr Endah L 69 Th Stroke PDL Depta PK 293,472 44,520 300,000 14,400 9,600 - ### 325,000
2\4\2013 5\4\2013 3 6006911 l A Sayadi, Tn Ds. Beringin L 72 Th TC Bedah Lidrian PK 291,050 730,695 900,000 43,200 28,800 43,200 28,800 96,000 2,500 280,000
19 1\4\2013 3\4\2013 3 13005716 l A Najamudin, Tn Jl. Alipatan L 57 Th Dyspepsia PDL Depta PK 393,120 794,400 200,000 9,600 6,400 - ### 80,000
20 1\4\2013 2\4\2013 1 10010026 l A Listi, Ny Ds. Tl Subur P 27 Th Post Kuret Kebid Rachman PK 285,000 23,400 15,600 - ### 47,500
21 1\4\2013 6\4\2013 6 10004676 l A Rosyati, Ny Prumnas Gn Ibul P 52 Th Chest Pain PDL Depta PK 60,000 600,000 28,800 19,200 - ### 240,000
22 1\4\2013 5\4\2013 4 13005816 l A Ahmad Arbal, Tn Perum cendrawasih L 54 Th Cepalgia PDL Depta PK 134,915 44,520 300,000 14,400 9,600 - ### 120,000
23 2\4\2013 6\4\2013 4 13005745 l A Fitri, Ny Jl. RA Kartini P 32 Th PO Kistoma Kand Novia PK 690,971 400,000 19,200 12,800 - ### 60,000 160,000
24 2\4\2013 5\4\2013 3 13001491 l A Ahmad Zarkasi, T Ds. Tb Rambang L 32 Th Cefalgia PDL Depta PK 441,477 1,173,774 900,000 43,200 28,800 43,200 28,800 54,000 260,000
25 3\4\2013 8\4\2013 5 10020100 l A Alamsyah, Tn Jl. Simanjuntak L 50 Th Neuropati PDL Depta PK 546,920 609,240 500,000 24,000 16,000 - ### 200,000
26 3\4\2013 10\4\2013 7 l A Lutfi, Tn L 49 Th Asma B PDL Depta PK 1,501,644 700,000 33,600 22,400 - ### 280,000
27 4\4\2013 9\4\2013 5 13006014 l A Anshori, Tn Ds. Karta Mulya L 46 Th Tr. Punggung PDL Depta PK 61,314 500,000 24,000 16,000 - ### 200,000
28 4\4\2013 7\4\2013 3 9009936 l A Sukirman, Tn Ds. Gumawang L 71 Th Retensio Urine Bedah Bujang PK 292,816 157,617 1,200,000 72,000 48,000 72,000 48,000 90,000 2,500 310,000
29 5\4\2013 6\4\2013 1 11020851 l A Tugiman, Tn Ds. Cinta Kasih L 72 Th Dyspepsia PDL Depta Meninggal 353,086 100,000 4,800 3,200 - ### 40,000
30 5\4\2013 8\4\2013 3 13006076 l A Angely, An Jl. Tenggamus P 3 Th PO Debridement Bedah Bujang PK 93,282 265,477 900,000 57,600 38,400 57,600 38,400 36,000 325,000
31 5\4\2013 10\4\2013 5 l A Rumaidi, Tn L 54 Th SNH PDL Depta PK 1,320,984 500,000 24,000 16,000 - ### 200,000
32 6\4\2013 11\4\2013 6 13006087 l A Septianti, Nn Jl. Surip P 16 Th Obs Febris PDL Depta PK 634,750 600,000 24,000 16,000 - ### 240,000
33 6\4\2013 13\4\2013 7 13006136 l A Wahyu, Sdr Jl. Angkatan L 15 Th DBD PDL Depta PK 1,931,101 700,000 33,600 22,400 - ### 280,000
34 6\4\2013 8\4\2013 3 13006086 l A Rahmi Suri, Ny Jl. Tromol P 53 Th Hipertensi PDL Depta PK 20,000 200,000 9,600 6,400 - ### 80,000
35 6\4\2013 8\4\2013 1 7013401 l A Hesti, Ny Ds. Alai Kp 2 P 31 Th G2P1A0 Hamil Dgn Plasenta pr
Kebid Rachman Rujuk Muhamadiyah 52,307 200,000 9,600 6,400 - ### 80,000
36 7\4\2013 8\4\2013 1 9008924 l A Yusrin, Tn Jl. Graseta L 31 Th Colic Renal PDL Depta PK 105,348 100,000 4,800 3,200 - ### 40,000
37 7\4\2013 11\4\2013 4 9010185 l A Rahma, Nn Jl. Jend Sudirman P 15 Th Synd Dyspepsia PDL Depta PK 40,000 400,000 19,200 12,800 - ### 160,000
38 8\4\2013 10\4\2013 2 13006231 l A Sumiyati, Ny DS Kemang kp 1 Lem P 43 Th Cefalgia PDL Depta PK 20,000 200,000 9,600 6,400 - ### 80,000
39 8\4\2013 10\4\2013 1 13006276 l A Suratman, Tn Jl. Padat Karya L 37 Th Nyeri Perut PDL Depta PK 303,408 368,178 600,000 43,200 28,800 43,200 28,800 18,000 2,500 130,000
40 8\4\2013 13\4\2013 5 11011330 l A Nuryunisyah, Ny Jl. Tangkuban Perahu P 29 Th SC Kebid Rachman PK 704,972 500,000 24,000 16,000 - ### 200,000
41 9\4\2013 13\4\2013 4 13006310 l A Asbuan, Tn Ds Bulang kp1 L 43 Th Dyspepsia PDL Depta PK 2,783,018 1,100,000 72,000 48,000 - ### 72,000 2,500 335,000
42 10\4\2013 14\4\2013 4 12009842 l A Hasusila, Ny Jl. Pranasib L 32 Th SC Kebid Rachman PK 965,766 500,000 24,000 16,000 - ### 200,000
43 11\4\2013 15\4\2013 4 13006416 l A Ema Suryani, Ny Vila Sejahtera P 31 Th Sind. Dyspepsia PDL Depta PK 2,018,792 1,200,000 72,000 48,000 - ### 72,000 2,500 435,000
44 11\4\2013 15\4\2013 4 12018576 l A Anggi, Nn Jl. Melati P 19 Th Febris PDL Depta PK 40,000 400,000 19,200 12,800 - ### 160,000
45 11\4\2013 16\4\2013 5 l A Desi, Ny P 25 Th SC Kebid Rachman PK 236,697 1,500,000 86,400 57,600 86,400 57,600 25,000 54,000 325,000
46 13\4\2013 15\4\2013 2 6000889 l A Tien Dwi, Ny Ds. Lubuk Raman P 28 Th Kolic Abdomen PDL Depta PK 364,850 200,000 9,600 6,400 - ### 80,000
47 13\4\2013 15\4\2013 2 9017746 l A Istikomah, Ny Jl. Kerinci P 28 Th PP Kebid Rachman PK 20,000 200,000 9,600 6,400 - ### 80,000
48 14\4\2013 15\4\2013 1 13006580 l A Rahmat, Tn Jl. Mayor Iskandar L 34 Th Cefalgia PDL Depta PK 10,000 100,000 4,800 3,200 - ### 40,000
49 14\4\2013 19\4\2013 5 13006581 l A Zawawi, Tn Kopral Toya L 74 Th Melena PDL Depta PK 387,150 500,000 24,000 16,000 - ### 200,000
50 15\4\2013 18\4\2013 3 8008304 l A Reza, Sdr Ds Alai P 21 Th Dyspepsia PDL Depta PK 1,441,158 900,000 57,600 38,400 57,600 38,400 2,500 270,000
51 15\4\2013 17\4\2013 2 13006608 l A Murni, Ny Ds. Banu Ayu P 34 Th Vertigo PDL Depta PK 583,682 600,000 43,200 28,800 - ### 36,000 205,000
52 15\4\2013 16\4\2013 1 13006613 l A Meylin, Ny Jl. Sunda P 18 Th Alergi Makanan PDL Depta PK 65,270 300,000 28,800 19,200 28,800 19,200 18,000 140,000
53 15\4\2013 16\4\2013 1 13006649 l A Gunadi, Tn Jl. Halmahera P Th SNH Rujuk Depta PK 277,373 300,000 28,800 19,200 28,800 19,200 36,000 100,000
54 16\4\2013 19\4\2013 3 13006701 l A Yahuning, Ny Ds Teluk Limau P 62 Th Cefalgia PDL Bujang PK 269,682 900,000 38,400 25,600 38,400 25,600 72,000 270,000
55 16\4\2013 19\4\2013 3 13006715 l A Hilal, Tn Ds. Sukamerindu L 59 Th Hidronefrosis PDL Depta PK 614,320 300,000 14,400 9,600 - ### 120,000
56 17\4\2013 20\4\2013 4 13006790 l A Sudarmadi, Tn Perum Belitung L 36 Th GE PDL Depta PK 79,162 300,000 14,400 9,600 - ### 120,000
57 18\4\2013 21\4\2013 4 8013406 l A Sumiati, Ny Komp CPM P 68 Th DM + Susp TB paru PDL Depta PK 47,743 400,000 19,200 12,800 - ### 160,000
58 19\4\2013 22\4\2013 3 13006906 l A Hermanto, Tn Bakaran L 49 Th Synd Dyspepsia + DM PDL Depta PK 900,000 18,000 12,000 - ### 120,000
59 19\4\2013 22\4\2013 4 10006470 l A Nurmayana, Ny Ds. Jemenang P 32 Th Obs. Febris + Dyspepsia PDL Depta PK 2,451,929 825,000 57,600 38,400 - ### 54,000 125,000
60 19\4\2013 20\4\2013 1 11019903 l A Nurmalawati, Ny Jl. Cendrawasih P 37 Th HEG + GE Kebid Novi PK 97,897 275,000 28,800 19,200 - ### 18,000 65,000
61 19\4\2013 22\4\2013 4 13006850 l A Marneti, Ny Jl. Batam P 45 Th Vertigo + Dyspepsia PDL Depta PK 320,400 300,000 14,400 9,600 - ### 120,000
62 20\4\2013 22\4\2013 2 8016374 l A Awang, Sdr Perum Kepodang L 17 Th Obs. Febris Umum Lidrian PK 24,840 200,000 9,600 6,400 - ### 80,000
63 20\4\2013 24\4\2013 3 13006988 l A Edy Aswandi, Tn Ds. Alai L 28 Th Vulnus punctum punggung Bedah Bujang APS 526,064 400,000 33,000 22,000 33,000 22,000 54,000 220,000
64 21\4\2013 24\4\2013 3 11019965 l A Sony, Tn Griya Meranti Putih L 40 Th Obs LBP PDL Depta PK 1,407,462 825,000 43,200 28,800 - ### 54,000 2,500 260,000
65 21\4\2013 23\4\2013 2 l A Titien, Ny P 31 Th Post partum Kebid Rachman PK 20,000 500,000 24,000 16,000 14,400 9,600 155,000
66 22\4\2013 28\4\2013 7 9007072 l A Nasrullah, Sdr Jl. Relly L 13 Th DBD PDL Depta PK 535,926 700,000 33,600 22,400 - ### 280,000
67 22\4\2013 23\4\2013 1 l A Yunizar, Tn L 46 Th Cardio Megali PDL Depta Pindah HCU 990,422 170,000 14,400 9,600 - ### 25,000 24,000 -
68 22\4\2013 30\4\2013 8 l A Khotifah, Ny P 59 Th Hepatitis PDL Depta PK 575,495 800,000 38,400 25,600 - ### 320,000
69 22\4\2013 25\4\2013 3 9012552 lA Artati, Ny Ds. Kasih Dewa P Th PP PDL Depta PK 12,590 900,000 57,600 38,400 - ### 195,000
70 23\4\2013 28\4\2013 5 lA Zawawi, Tn L 74 Th Ulcus Duodenum PDL Depta Pindah HCU 612,565 500,000 24,000 16,000 - ### 275,000
71 23\4\2013 26\4\2013 3 9006093 lA Heryani, Ny Jl. Dempo P 40 Th PO Kista Kand Rachman PK 336,834 300,000 14,400 9,600 - ### 60,000 120,000
72 23\4\2013 25\4\2013 2 lA Nopiyanti, Ny P 26 Th SC Kebid Rachman PK 482,534 200,000 9,600 6,400 - ### 60,000 80,000
73 24\4\2013 24\4\2013 1 12020540 lA Suherman, Tn Jl. Telaga Said L 54 Th HHD PDL Depta Rujuk 257,310 250,000 14,400 9,600 - ### 60,000 18,000 65,000
74 24\4\2013 27\4\2013 3 6012340 lA Basiah, Ny Ds. Pangkalan Babat P 70 Th DM tipe 2 PDL Depta APS 30,000 300,000 14,400 9,600 - ### 120,000
75 25\4\2013 29\4\2013 4 6000666 lA Nilawati, Ny Ds. Banu Ayu P 35 Th SC Kebid Rachman PK 1,951,242 1,500,000 86,400 57,600 - ### 25,000 54,000 2,500 260,000
76 25\4\2013 27\4\2013 4 12018833 lA Feri, Tn Ds. Perjito L 28 Th HHD PDL Depta PK 385,850 600,000 43,200 28,800 43,200 28,800 36,000 130,000
77 25\4\2013 27\4\2013 2 10013714 lA Maria, Ny Jl. Diponegoro P 53 Th TB Paru PDL Depta PK 20,000 200,000 9,600 6,400 - ### 80,000
78 26\4\2013 28\4\2013 2 11007890 lA Endang SuhermanJl. Padat Karya L 47 Th Dyspepsia PDL Depta PK 1,211,851 600,000 43,200 28,800 43,200 28,800 35,000 2,500 155,000
79 26\4\2013 27\4\2013 1 9008935 lA Dwi, F, Nn Perum Gn Ibul P 18 Th Psikosomatis PDL Depta PK 300,000 28,800 19,200 28,800 19,200 95,000
80 27\4\2013 28\4\2013 1 8014760 lA Bahrul, An Ds. Manunggal Jaya L Th TC Bedah Harry PK 10,000 100,000 4,800 3,200 - ### 40,000
302

1 29\3\2013 2\4\2013 4 11014983 lB Dora, Nn Jl. RA Kartini P 24 Th TC THT Wita PK 23,947 641,907 750,000 57,600 38,400 57,600 38,400 54,000 2,500 195,000
2 31\3\2013 3\4\2013 3 13005724 lB Sulindawati, Ny Ds. Jirak P 30 Th Dyspepsia PDL Depta PK 259,486 835,838 750,000 57,600 38,400 57,600 38,400 54,000 260,000
3 3\4\2013 5\4\2013 3 9005170 lB Wardiaty, Ny Jl. Sinta L 53 Th Cefalgia PDL Depta PK 500,000 28,800 19,200 - - 25,000 36,000 195,000
4 3\4\2013 4\4\2013 1 13005937 lB Dani, Tn JL RA Kartini P 23 Th Infeksi Viral PDL Depta PK 61,603 250,000 28,800 19,200 28,800 19,200 18,000 2,500 130,000
5 4\4\2013 6\4\2013 2 13006033 lB Romli, Tn Ds. Suban Baru L 48 Th Colic Abd PDL Depta PK 130,075 782,361 500,000 43,200 28,800 43,200 28,800 36,000 195,000
6 5\4\2013 6\4\2013 2 11016592 lB Nurkiah, Ny Jl. Surip P 62 Th Susp Bell Palsy + HT Saraf Budiman PK 488,996 200,000 9,600 6,400 - ### 80,000
7 5\4\2013 6\4\2013 2 10006395 lB Anugrah, An Ds. Alai L 9 Th Asma Attack Anak Irwan PK 20,000 200,000 9,600 6,400 - ### 80,000
8 6\4\2013 9\4\2013 3 13005548 lB M. Faturrahman, Ds. Paya Bakal L 11 Bln Luka Bakar gr 1~II Bedah Bujang PK 154,651 144,263 750,000 57,600 38,400 25,000 54,000 2,500 191,000
9 7\4\2013 9\4\2013 2 13002250 lB Djuriah, Ny Ds. Kr Endah P 72 Th Syok Hypoglikemi PDL Depta PK 20,000 200,000 9,600 6,400 - ### 80,000
10 10\4\2013 11\4\2013 1 12000844 lB Adriansyah, Sdr L 25 Th Hemoroid Bedah Bujang PK 202,083 227,497 250,000 28,800 19,200 28,800 19,200 18,000 2,500 195,000
11 10\4\2013 12\4\2013 2 lB Rina Hartini, Ny P 29 Th HEG Kebid Rachman PK 92,976 500,000 43,200 28,800 - ### 36,000 130,000
12 10\4\2013 14\4\2013 4 8003630 lB Fatiyah, Ny Jl Bukit Barisan No11 P 48 Th Cefalgia PDL Depta PK 1,744,837 1,200,000 72,000 48,000 - ### 72,000 290,000
13 11\4\2013 13\4\2013 2 13006414 lB Erma Dalena, Ny Ds Beringin kp 4 P 21 Th Sind. Dyspepsia PDL Depta PK 885,796 500,000 43,200 28,800 43,200 28,800 54,000 205,000
14 11\4\2013 14\4\2013 3 11009714 lB Naufal, An Jl Kerrinci Rt 03/01 P L 2,3 Th KDS Anak Irwan PK 661,493 1,000,000 57,600 38,400 - ### 205,000
15 12\4\2013 15\4\2013 4 8009112 lB Ruel, Sdr Perum Belitung L 23 Th PO Up Orif Orthopedi Dedi PK 146,038 400,000 19,200 12,800 - ### 160,000
16 14\4\2013 18\4\2013 4 10018436 lB Syafa, An Jl. Madrasah P 3,1 Th DBD Anak Irwan PK 1,350,551 1,000,000 72,000 38,400 - ### 25,000 90,000 2,500 370,000
17 15\4\2013 17\4\2013 2 13006651 lB Misnawati, Ny Jl. A Yani P Th PDL Depta PK 44,254 500,000 43,200 28,800 43,200 28,800 36,000 130,000
18 15\4\2013 16\4\2013 1 12012190 lB Dery, Ny Jl. Singgalang P 39 Th Asma B PDL Depta PK 10,000 100,000 4,800 3,200 - ### 40,000
19 16\4\2013 19\4\2013 3 10016691 lB Nanung, Tn Jl. Kopral A Wahab L 90 Th Malaise PDL Depta PK 374,850 300,000 14,400 9,600 - ### 120,000
20 17\4\2013 18\4\2013 1 12010047 lB Dzikra, An Perum Vina Asri P 8 Th Susp App Bedah Bujang Rujuk 10,000 100,000 4,800 3,200 - ### 40,000
21 18\4\2013 25\4\2013 7 12008995 lB Adel, An Ds. Lubuk Raman P 7 Th DBD Irwan Anak PK 130,500 700,000 33,600 22,400 - ### 315,000
22 19\4\2013 26\4\2013 7 12018695 lB Teddy, An Ds. Beringin L 10 Th PO Laparotomi App Abses Bedah Bujang PK 3,806,013 1,750,000 115,200 76,800 115,200 76,800 25,000 126,000 2,500 520,000
23 19\4\2013 22\4\2013 3 13006909 lB Tasya, An Ds. Tanjung Menang P 8 Th TC Bedah Bujang PK 193,886 750,000 57,600 38,400 - ### 54,000 2,500 260,000
24 19\4\2013 22\4\2013 3 13006915 lB Lenny, Ny Jl. Samosir P 30 Th Hamil 19minggu dgn Tifoid Kebid Novi PK 70,535 300,000 14,400 28,800 - ### 120,000
25 22\4\2013 24\4\2013 2 8004488 lB Ali Mukmin, Tn Ds. Beringin L 39 Th Dyspepsia PDL Depta PK 457,254 500,000 43,200 28,800 43,200 28,800 36,000 280,000
26 24\4\2013 27\4\2013 3 lB Oktarina, Ny P 25 Th Yonsilitis THT Wita PK 750,000 43,200 28,800 - ### 54,000 2,500 250,000
27 25\4\2013 27\4\2013 3 13007249 lB Masdaria, Ny Ds. Kr Agung P 62 Th HHD PDL Depta PK 819,893 500,000 43,200 28,800 43,200 28,800 36,000 205,000
28 29\4\2013 30\4\2013 1 lB Rusdi, Tn L Th Colic Renal PDL Depta APS 124,950 100,000 4,800 3,200 0 0 40,000
78

22\3\2013 26\4\2013 4 ll Alvin, An Pindah Kls lll 680,000 48,000 32,000 48,000 32,000 550,000
1 1\4\2013 5\4\2013 5 13005788 ll Armi, Ny Ds. Jirak P 75 Th POST Prolap Kand Rachman PK 1,025,237 850,000 57,600 38,400 57,600 38,400 50,000 60,000 54,000 2,500 300,000
1\4\2013 2\4\2013 1 ll Sayadi, Tn Pindah Kls l A 170,000 19,200 12,800 19,200 12,800 55,000
2 2\4\2013 6\4\2013 3 13005893 ll Zalio, Tn Ds. Pagar Gunung L 60 Th Cholelitiasis Bedah Bujang PK 338,933 3,112,882 680,000 48,000 32,000 48,000 32,000 72,000 5,000 240,000
3 4\4\2013 9\4\2013 5 13005970 ll Hidayati, Tn Ds. Sumber Rejo L 94 Th Gangren , Selulitis Bedah Alip PK 102,833 1,519,776 850,000 57,600 38,400 57,600 38,400 25,000 90,000 2,500 330,000
4 6\4\2013 15\4\2013 9 13006141 ll Awang, Sdr Ds. Kr Endah L 14 Th TC Ringan THT Dwita APS 4,106,611 1,530,000 96,000 64,000 96,000 64,000 50,000 162,000 2,500 1,050,000
5 8\4\2013 9\4\2013 1 13006193 ll Sely Marselita, NnDs. Harapan Jaya P 18 Th Kolic Abdomen PDL Depta PK 70,054 393,749 170,000 19,200 12,800 19,200 12,800 18,000 2,500 120,000
6 8\4\2013 15\4\2013 7 13005616 ll Asri, Tn Ds. Menanti Kp l Kele L 67 Th PO Hernia Scrotalis Bedah Bujang PK 1,733,355 1,190,000 76,800 51,200 76,800 51,200 50,000 126,000 2,500 550,000
7 9\4\2013 13\4\2013 4 13000776 ll Mastoya, Ny Ds Prabu Menang kp1 P 67 Th Abces Pedis Bedah Bujang PK 2,043,539 680,000 48,000 32,000 48,000 32,000 25,000 60,000 90,000 2,500 535,000
8 10\4\2013 13\4\2013 3 12016190 ll Chelsea, An Ds Rejosari Pendopo P 6 Th PO Tonsil THT Dwita PK 120,923 390,000 31,200 20,800 - ### 20,000 10,000 2,000 217,500
9 13\4\2013 17\4\2013 4 13006537 ll Ferdinan, Tn Jl. Tromol L 37 Th PO Debridement Bedah Bujang PK 1,123,180 680,000 48,000 - ### 25,000 54,000 300,000
10 18\4\2013 23\4\2013 5 11010423 ll Napsi, Tn Ds. Kr Endah L 60 Th DM + Abses di punggung Bedah Bujang PK 2,390,174 850,000 57,600 38,400 57,600 38,400 25,000 90,000 5,000 610,000
11 23\4\2013 27\4\2013 4 ll Dwi, Ny P 29 Th Hml 26 Mg d Typoid Umum Rachman PK 546,707 680,000 48,000 32,000 - ### 72,000 240,000
12 23\4\2013 27\4\2013 4 10018309 ll M, Dwi, An Ds. Sumber Rejo L 3 Th Fr. Clavicula S, Fr. Tibia Fibul Bedah Bujang PK 520,000 39,000 26,000 - ### 195,000
13 25\4\2013 30\4\2013 5 6007177 ll Saim, Tn Sido Mulyo L 56 Th Ulcus Diabeticum PDL Depta PK 3,104,221 850,000 57,600 38,400 57,600 38,400 25,000 2,500 865,000
14 27\4\2013 28\4\2013 1 13007378 ll Firdaus, Sdr Jl. Melati L Th TC Bedah Harry PK 185,353 170,000 19,200 12,800 19,200 12,800 18,000 55,000
65

1 26\3\2013 2\4\2013 8 13005210 lll Alvin, An Ds. Aur L 14 Th PO App Perforasi Bedah Bujang PK 153,631 1,525,297 800,000 59,400 39,600 - ### 25,000 60,000 216,000 2,500 440,000
2 30\3\2013 4\4\2013 5 13005648 lll Khodiansih, Ny Ds. Sumber Rejo P 26 Th Susp App Bedah Bujang PK 52,135 2,688,384 500,000 39,600 26,400 39,600 26,400 60,000 90,000 2,500 330,000
3 1\4\2013 2\4\2013 1 13005699 lll Aresa, An Ds. Tj Tiga P 6 Th Corpus Alenum D THT Wita PK 103,475 250,272 100,000 13,200 8,800 13,200 8,800 18,000 2,500 55,000
4 2\4\2013 15\4\2013 13 12005067 lll Jhoni, Tn Jl KOP A Wahab L 57 Th Ulkus DM PDL Depta PK 715,000 92,400 61,600 - ### 7,500 2,000 960,000
5 3\4\2013 4\4\2013 1 12006200 lll Betty, Ny Ds. Jemenang P 46 Th Tumor Palpebra Mata iridianto PK 100,000 13,200 8,800 - ### 110,000
6 3\4\2013 6\4\2013 3 13005944 lll Hendri, Sdr Ds. Curup L 17 Th TC Saraf Budiman PK 294,577 1,559,004 300,000 26,400 17,600 26,400 17,600 135,000
7 3\4\2013 5\4\2013 2 13005950 lll Cindra, An Ds. Spantan L 12 Th PO Debridement Bedah Bujang PK 137,943 396,458 200,000 13,200 8,800 13,200 8,800 36,000 220,000
8 4\4\2013 5\4\2013 1 13006000 lll Komaria, Ny Ds. Gn Raja P 45 Th Vulnus Morsum Ular Bedah Nurlela PK 133,540 1,514,732 100,000 13,200 8,800 13,200 8,800 36,000 130,000
9 4\4\2013 12/4/2013 8 13006030 lll Daryono, Tn Senuling Indah PTPN L 35 Th Combutio Bedah Bujang PK 2,236,576 800,000 59,400 39,600 - ### 144,000 2,500 440,000
10 5\4\2013 13\4\2013 8 1300045 lll Asmadi, Tn Mess BSP Tanjumg Mi L 35 Th Abses Mandibula Bedah Bujang PK 2,376,141 800,000 59,400 39,600 - ### 144,000 2,500 495,000
11 5\4\2013 9\4\2013 4 lll Kohar, Tn L 41 Th Colic Renal Bedah Bujang PK 248,934 400,000 33,000 22,000 - ### 54,000 2,500 245,000
12 6\4\2013 7\4\2013 1 13006147 lll Novita, Nn Ds. Karya Mulya P 18 Th Obs Nyeri Perut Umum Harry PK 100,000 13,200 8,800 13,200 8,800 50,000
13 7\4\2013 11\4\2013 3 13006186 lll Marzuki, Tn Ds. Midar L 38 Th Colic Abd PDL Depta PK 100,987 567,332 400,000 33,000 22,000 33,000 22,000 72,000 2,500 265,000
14 8\4\2013 11\4\2013 3 9014014 lll Astuti, Ny Jl. Dul Mubin P 30 Th PO Soft Tisu Tumor Bedah Bujang PK 110,716 360,705 300,000 26,400 17,600 26,400 17,600 54,000 2,500 275,000
15 8\4\2013 15\4\2013 7 13006246 lll Hendri, Sdr Komp Surya Bumi Ag L 45 Th PO Hemoroid Bedah Bujang PK 1,745,775 700,000 52,800 35,200 - ### 25,000 126,000 2,500 515,000
16 8\4\2013 15\4\2013 7 13006254 lll Supriyanto, Tn Jl Arimbi No. 64C Pra L 45 Th TC Umum Nurlela APS 2,217,795 700,000 52,800 35,200 52,800 35,200 25,000 126,000 405,000
17 9\4\2013 11\4\2013 2 9017393 lll Hadi Suprapto, T Ds. Manunggal L 31 Th Nyeri Perut Bedah Bujang PK 196,629 594,353 200,000 19,800 13,200 19,800 13,200 36,000 2,500 155,000
18 9\4\2013 12\4\2013 4 13006325 lll Nopriyadi, Tn Jl. Bima L 26 Th PO Debridement Bedah Bujang PK 53,262 822,803 400,000 26,400 17,600 26,400 17,600 25,000 54,000 2,500 220,000
19 10\4\2013 16\4\2013 6 12017039 lll Sismayani, Nn Ds. Kahuripan P 28 Th Susp Peritonitis Bedah Bujang PK 3,511,735 600,000 46,200 30,800 46,200 30,800 50,000 60,000 108,000 5,000 495,000
20 11\4\2013 15\4\2013 4 13006433 lll Nani, Ny Ds Padang Bindu Ben P 28 Th Hipertyroid PDL Depta PK 89,688 100,000 13,200 8,800 - ### 25,000 18,000 2,500 175,000
21 12\4\2013 15\4\2013 3 13006489 lll Haris, Sdr Ds Sukamerindu kp5 L 18 Th TC Bedah Bujang PK 422,823 300,000 26,400 17,600 26,400 17,600 220,000
22 12\4\2013 15\4\2013 3 13006488 lll Ardi, Sdr Ds Sukamerindu kp5 L 18 Th Tr Tumpul Thorax Bedah Bujang PK 318,852 300,000 26,400 17,600 26,400 17,600 54,000 2,500 220,000
23 13\4\2013 13\4\2013 1 13006517 lll Devin Prabu, An Ds Pangkul kp4 Camb L 2 Th TC Umum Harry PK 10,395 100,000 6,600 4,400 6,600 4,400 6,000 55,000
24 13\4\2013 14\4\2013 1 13006543 lll Samsul, Tn L 55 Th TC Umum Harry PK 45,352 100,000 6,600 4,400 6,600 4,400 18,000 25,000
25 16\4\2013 20\4\2013 4 13006709 lll Amri, Tn Ds talang jawa talang L 36 Th PO Debridement Bedah Bujang PK 3,140,390 400,000 33,000 22,000 33,000 22,000 25,000 72,000 2,500 330,000
26 16\4\2013 20\4\2013 3 13006747 lll Cek Cik, Tn DS CURUP L 55 Th Susp App Bedah Bujang PK 640,782 400,000 33,000 22,000 33,000 22,000 72,000 2,500 275,000
27 17\4\2013 20\4\2013 3 13006789 lll Cik Seh, Tn Ds Gunung Raja L 44 Th Retensio Urine Bedah Bujang Rujuk RSMH 1,014,957 300,000 26,400 17,600 26,400 17,600 54,000 2,500 190,000
28 17\4\2013 20\4\2013 3 13006806 lll Susliyadi, Tn Ds Sebau kp1 L 17 Th PO Debridement Bedah Bujang PK 670,068 300,000 26,400 17,600 26,400 17,600 54,000 2,500 275,000
29 20\4\2013 29\4\2013 9 13006930 lll Nurhaya, Ny Ds. Br Rambang P 40 Th PO Debridement + Repair RupMata Iridianto PK 5,071,038 900,000 66,000 44,000 66,000 44,000 25,000 126,000 1,095,000
30 21\4\2013 23\4\2013 2 13006989 lll Bagas, An Sukajadi L 11 Bln Combustio grade ll 15% Bedah Bujang APS 165,405 200,000 19,800 13,200 - ### 2,500 165,000
31 21\4\2013 26\4\2013 5 13006903 lll Edi, Tn Sinar Rambang L 28 Th Trauma scrotalis Bedah Bujang PK 1,054,407 500,000 39,600 26,400 39,600 26,400 90,000 2,500 330,000
32 21\4\2013 23\4\2013 3 13006999 lll Heri, Tn Ds. Prambatan L 25 Th PO Debridement Bedah Bujang PK 364,696 200,000 19,800 13,200 19,800 13,200 54,000 165,000
33 21\4\2013 22\4\2013 1 13007003 lll Indra, Ny Ds Aur kp3 Lubai P 25 Th Obs Colic abdomen Bedah Bujang PK 210,500 100,000 13,200 8,800 13,200 8,800 2,500 110,000
34 22\4\2013 23\4\2013 1 13007012 lll Lembang, Tn Ds. Kr Endah L 38 Th Ca Gigi Palsu PDL Depta PK 384,414 100,000 13,200 8,800 13,200 8,800 18,000 2,500 110,000
35 24\4\2013 28\4\2013 5 13005853 lll Payanti, Ny Gelumbang P 38 Th SC Kebid Rachman PK 852,869 400,000 33,000 22,000 33,000 22,000 54,000 275,000
36 24\4\2013 25\4\2013 2 13007188 lll Budi Ahmad, An Ds. Sido Mulyo L 4 Th PO extraksi Baterei Jam THT Dwi PK 59,074 100,000 13,200 8,800 13,200 8,800 36,000 165,000
37 26\4\2013 27\4\2013 1 13007290 lll Sri Mulyani, Ny Ds. Kr Agung P 21 Th Susp Mioma Kand Rachman PK 100,000 6,600 4,400 6,600 4,400 55,000
38 26\4\2013 28\4\2013 2 13007302 lll Bito, Ny Prabu Menang P 38 Th PO Kuret Kebid Rachman PK 200,000 19,800 13,200 19,800 13,200 55,000
39 26\4\2013 28\4\2013 2 13007303 lll Tri Mulyani, Nn Ds. Penandingan P 21 Th Kistoma Ovari Kand Rachman PK 80,028 200,000 19,800 13,200 19,800 13,200 25,000 80,000
40 27\4\2013 29\4\2013 2 13007313 lll Sisni, Ny Ds. Babat P 25 Th HEG Kebid Rachman PK 175,437 200,000 19,800 13,200 19,800 13,200 36,000 55,000
41 29\4\2013 30\4\2013 1 13007405 lll Some, Tn Tj. Raman L Th Fr. Femur Bedah Bujang APS 313,466 100,000 13,200 8,800 13,200 8,800 60,000 2,500 110,000
148

1186 6,916,286 137,554,453 91,753,180 6,495,200 3,956,600 2,833,400 1,889,200 852,500 600,000 0 5,661,000 149,000 38,341,000

5,810,000
138,907,453
 elektrik Kasur
SELANG O2 FIKSASI O2 TABUNG PA GV LAIN-LAIN ADM TOTAL SELISIH DISCOUNT PERUSAHAAN
Dekubitus
135,000 150,000 5,259,886 TEL
12,000 261,000 45,000 3,390,440
50,000 2,733,418
20,000 25,000 2,167,431 1,944,090 PNS
90,000 100,000 2,826,777 728,000
150,000 630,579 ABDA
30,000 500,000 11,250,222
12,000 30,000 100,000 90,000 80,000 3,347,133
90,000 135,000 20,000 180,000 4,594,943 KAI
36,000 45,000 6,005,022 4,742,063 PNS
24,000 30,000 1,049,190 371,646 PNS
12,000 82,500 45,000 25,000 2,463,298 2,752,500 PNS
50,000 2,099,873
200,000 5,354,694 Garda Medika
24,000 30,000 1,388,212 1,379,210 PNS
20,000 25,000 4,544,808 4,831,474 PNS
30,000 45,000 200,000 3,182,169
12,000 62,500 50,000 537,500
12,000 15,000 1,013,992 995,654 PNS
90,000 50,000 2,584,245
8,000 10,000 1,501,520 1,986,995 PNS
- 371,500 Inhealth
24,000 30,000 1,002,000 274,014 PNS
12,000 15,000 650,435 407,830 PNS
12,000 25,000 345,000 45,000 20,000 1,789,971 1,975,506 PNS
100,000 3,073,251
20,000 25,000 1,941,160 1,462,104 PNS
28,000 360,000 35,000 2,960,644 1,250,000 PNS
20,000 90,000 8,000 25,000 944,314 PNS
80,000 2,372,933
4,000 5,000 510,086 1,189,611 PNS
90,000 100,000 2,001,759
20,000 25,000 2,105,984 550,000 PNS
24,000 30,000 1,568,750 727,579 PNS
28,000 35,000 3,030,101 2,488,630 PNS
8,000 10,000 334,000 36,844 PNS
8,000 10,000 366,307 1,761,472 PNS
4,000 5,000 262,348 585,862 PNS
16,000 20,000 668,000 181,439 PNS
8,000 10,000 334,000 321,194 PNS
80,000 1,646,086
20,000 25,000 1,489,972 1,992,085 PNS
150,000 4,562,518 TEL
20,000 45,000 15,000 25,000 1,810,766 1,972,548 PNS
100,000 3,948,292 Global
16,000 20,000 668,000 77,984 PNS
30,000 45,000 200,000 2,703,697
8,000 10,000 678,850 454,294 PNS
8,000 10,000 334,000 1,052,219 PNS
4,000 5,000 167,000 105,572 PNS
20,000 25,000 1,172,150 1,461,024 PNS
80,000 2,885,658
100,000 1,596,682 100,000 Tangkas
60,000 679,270
12,000 50,000 871,373
70,000 1,709,682
12,000 15,000 1,085,320 1,180,789 PNS
12,000 15,000 550,162 215,000 PNS
16,000 20,000 675,743 337,948 PNS
- 1,050,000 900,000 Jamsostek
100,000 3,651,929 TEL
100,000 603,897 TEL
12,000 15,000 791,400 1,303,663 PNS
8,000 10,000 338,840 143,484 PNS
12,000 162,500 135,000 50,000 1,669,564
200,000 2,820,962 TEL
8,000 10,000 757,000 125,000 PNS
28,000 35,000 1,634,926 2,600,000 PNS
12,000 30,000 12,500 - 1,287,922
32,000 40,000 1,831,495 1,750,000 PNS
 50,000 1,253,590 231,900 Tangkas
95,000 40,000 25,000 1,587,565
12,000 87,000 345,000 15,000 15,000 1,314,834 1,377,967 PNS
8,000 45,000 30,000 10,000 931,534 2,999,560 PNS
12,000 30,000 287,500 100,000 1,103,810 MHP
12,000 15,000 501,000 87,336 PNS
30,000 45,000 200,000 4,211,742 200,000 Tangkas
50,000 1,345,850
8,000 10,000 334,000 56,844 PNS
12,000 50,000 50,000 2,260,351
12,000 50,000 50,000 603,000
4,000 5,000 167,000 269,472 PNS

50,000 1,909,354 650,000

80,000 2,431,324
30,000 - 834,000 654,926 Jamsostek
50,000 608,103
50,000 1,837,436
8,000 10,000 802,996 624,305 PNS
8,000 10,000 334,000 261,639 PNS
35,000 225,000 50,000 1,727,414
8,000 5,000 329,000 125,000 PNS
50,000 1,041,080
50,000 880,976 Simas
12,000 212,500 100,000 3,751,337 TANGKAS
50,000 1,838,796
100,000 2,062,493 THE
16,000 20,000 774,038 975,589 PNS
35,000 100,000 3,083,451 SIMAS
50,000 904,254
4,000 5,000 167,000 36,166 PNS
12,000 15,000 845,850 755,000 PNS
4,000 5,000 167,000 216,524 PNS
28,000 35,000 1,264,500 185,887 PNS
12,000 70,000 75,000 135,000 8,000 150,000 7,063,513
90,000 100,000 1,546,386 Tangkas
12,000 15,000 560,735 372,691 PNS
12,000 125,000 70,000 1,624,254
- 1,128,500 137,000 Jamsostek
80,000 1,784,893
4,000 5,000 281,950 520,000 PNS

200,000 1,590,000
12,000 60,000 87,500 540,000 45,000 150,000 3,428,237
50,000 339,000
100,000 4,708,815
30,000 495,000 100,000 3,737,109
12,000 60,000 175,000 135,000 8,000 100,000 7,711,111
50,000 888,303
60,000 45,000 150,000 4,162,855
30,000 360,000 130,000 4,116,039
9,500 22,500 20,000 - 864,423 72,600 Inhealth
150,000 45,000 200,000 2,625,180 1,000,000 309,955 MNC Life
30,000 450,000 150,000 4,792,174
150,000 1,768,707 Titis Sampurna
- 780,000 20,715 Inhealth
30,000 112,500 495,000 100,000 5,776,221
12,000 15,000 25,000 544,353

12,000 35,000 37,500 135,000 20,000 180,000 3,740,928

12,000 50,000 135,000 150,000 4,202,019
12,000 37,500 75,000 697,747
7,500 67,500 470,000 780,000 360,000 - 3,523,500 615,000 Jamsostek
50,000 282,000 PTPN 7
12,000 12,500 50,000 2,451,081
62,500 200,000 1,296,901
50,000 2,008,272
315,000 105,000 4,142,076 PTPN 7
180,000 200,000 4,296,641 BSP
150,000 1,155,434 BSP
25,000 219,000
40,000 1,557,819
 90,000 150,000 1,430,921
30,000 150,000 3,382,275 SA
30,000 16,000 100,000 3,795,795
10,000 50,000 1,310,482
12,000 30,000 62,500 45,000 50,000 1,865,065
60,000 100,000 5,143,735
30,000 150,000 612,188 SA
90,000 100,000 1,220,823
90,000 100,000 1,173,352
50,000 243,395
20,000 230,352
30,000 135,000 150,000 4,394,890
100,000 1,600,282
100,000 1,749,457
12,000 62,500 90,000 150,000 1,704,068
12,000 60,000 412,500 135,000 48,000 200,000 8,304,538
135,000 50,000 750,905
12,000 75,000 50,000 2,245,907
45,000 150,000 1,044,696
30,000 497,000
35,000 693,914
45,000 92,000 1,828,869
50,000 454,074
20,000 197,000
350,000 50,000 721,000
30,000 50,000 531,028
50,000 582,437
50,000 679,966

329,000 0 1,353,000 4,100,500 1,580,000 6,135,000 360,000 598,000 11,422,000 322,879,319 60,511,448 959,955

958,000
DAFTAR PASIEN RAWAT INAP KELAS III DWS
BULAN
BULAN APRIL 2013

TGL TGL HR NO. JK

NO. KELAS NAMA A LA M AT
MASUK KELUAR RWT REG
1 19-Apr 22-Apr 3 13006912 III An Rehan saputra Ds Embacang L

2 1-Apr 3-Apr 3 13005741 III Tn Mawan Prum prabu indah L

3 8-Apr 15-Apr 8 6005001 III Sdr M yusuf Vina sejahtera L
4 23-Apr Apr-28 6 13006980 III Ny Suprianti Gunung ibul P

1 22-Mar 2-Apr 11 8015303 III Ny Karlenawati Jl Kemuning cambai P

2 26-Mar 1-Apr 7 9009450 III Tn Omar Jl Jen sudirman L
3 28-Mar 1-Apr 4 13005607 III Ny Susriana Ds Pagar jati P
28-Mar 29-Mar 1 13005614 III Tn Alipah Ds Sigam kp 1 L
4 30-Mar 1-Apr 2 13005705 III Tn Indra suharman Ds Baru rambang L
5 31-Mar 6-Apr 7 12006795 III Ny Rusila Ds Bangun sari kp 4 P
6 31-Mar 1-Apr 1 13005717 III Tn Cik noni Ds Sukarami kp 3 L
7 31-Mar 2-Apr 2 11021450 III Tn Amron Ds Muara sungai L
8 31-Mar 1-Apr 1 13005722 III Ny Asiam Ds Talang ogan P
9 31-Mar 1-Apr 1 12005723 III Tn Rudi hartono Jl Purwodadi L
10 31-Mar 3-Apr 3 13005726 III Sdr Zetra Jl Gajah mada L
11 31-Mar 2-Apr 3 13005729 III Tn Zulkarnaen Ds Purun kp 1 L
12 31-Mar 1-Apr 1 13005738 III Tn Darwin Ds Sugihan L
13 1-Apr 5-Apr 4 10010503 III Ny Yutiha Ds Talang beliung L
1-Apr 4-Apr 3 13005821 III Tn Yusup Ds Jambu kp 2 L
14 2-Apr 5-Apr 4 13005827 III Nn Ririn Jl A rasyid P
15 2-Apr 6-Apr 4 13005847 III Tn Suad Jl Padat karya L
16 3-Apr 6-Apr 3 13005954 III Tn Dede supandi Komplek PTPN VII L
17 3-Apr 6-Apr 3 13005957 III Sdr Suprapto Ds Gemawang kp 1 L
18 4-Apr 8-Apr 4 11018250 III Ny Winda Sukajadi prabumulih P
19 5-Apr 7-Apr 2 13006064 III An Komeng tiara Ds Jiwa baru P
20 5-Apr 8-Apr 3 13006100 III Tn Benu Ds Menanti L
21 6-Apr 11-Apr 5 13005954 III Tn Dede supandi Komplek PTPN VII L
22 7-Apr 10-Apr 3 13006169 III Tn Simin Ds Muara sungai L
23 8-Apr 12-Apr 4 13006272 III Sdr Joko sutrisno Ds Karangmulya L
24 9-Apr 12-Apr 3 12005623 III Nn Reka Komplek PTPN VII P
25 9-Apr 10-Apr 1 13005996 III Ny Winda Ds Prambatan P
26 9-Apr 11-Apr 2 13006329 III Ny Surinah Ds Pagar agung P
27 10-Apr 14-Apr 4 13006334 III Tn Dedi aksan Ds Muara sungai L
28 10-Apr 13-Apr 3 10013778 III Ny Hayana Gunung kemala P
29 11-Apr 13-Apr 2 13006408 III Ny Yulianti Ds Pagar dewa P
11-Apr 13-Apr 2 13006445 III Tn Sarkowi Jl Said muara dua L
30 11-Apr 13-Apr 3 13006469 III Ny Yuliana Jl Baru sukajadi P
31 12-Apr 14-Apr 2 10009074 III Tn Mat yuni Ds Belitung L
32 12-Apr 15-Apr 3 13006497 III Ny Ristika Komplek PTPN VII P
33 12-Apr 15-Apr 2 13006499 III Tn Ahmad sukni Ds Sedupi L
34 12-Apr 17-Apr 5 11011371 III Tn Rosadi Ds Rambang kuang L
35 13-Apr 19-Apr 6 13006513 III Ny Heriana Ds Dalam P
36 13-Apr 17-Apr 4 13006533 III An Rista juwita Ds Sialingan P
37 14-Apr 15-Apr 1 13006570 III Tn Rumadani Jl Arimbi no 28 L
38 16-Apr 18-Apr 2 13006708 III Nn Ami suci Jl Cendrawasih gn ibu P
39 16-Apr 18-Apr 2 13006571 III Tn Faisal Ds Kemang kp 2 L
40 16-Apr 20-Apr 4 12018454 III Tn Junaidi Ds Midar kp 1 L
41 16-Apr 22-Apr 6 13006746 III Tn Hasan basri Ds Babat penukal L
42 17-Apr 20-Apr 3 13006752 III Tn Sepri heryadi Perum sungai medang L
43 18-Apr 20-Apr 2 13006827 III Ny Matiya Jl Madura gn ibul P
44 18-Apr 18-Apr 1 13006811 III Nn Devi pertiwi Asrama akbid P
45 18-Apr 19-Apr 2 12004172 III Ny Megariya Prumnas vina sejahter P
46 18-Apr 22-Apr 4 13006871 III Tn Sutrisno Ds Tanjung miring L
47 18-Apr 24-Apr 7 13006867 III Sdr Rio rinaldi Jl Jend sudirman L
48 18-Apr 19-Apr 1 11004055 III Ny Komariah Ds Karta mulya kp 2 P
49 18-Apr 20-Apr 2 13006868 III Tn Surmanedi Ds Lubai persada L
50 18-Apr 20-Apr 3 13006870 III Tn Badi usman Ds Alai kp 1 L
51 19-Apr 20-Apr 1 13006878 III Tn Mashur Ds Karang agung L
52 20-Apr 22-Apr 2 13006980 III Ny Suprihatin Kelurahan gunung ibul P
53 21-Apr 22-Apr 1 11014888 III Tn Anwar Ds Lubuk getam L
54 22-Apr 25-Apr 3 6001177 III Ny Endang Mess BSP P
55 22-Apr Apr-26 4 13007073 III Ny Suharyani Ds Tanjung dalam P
23-Apr 25-Apr 2 13006121 III Sdr Efran Ds Pagar agung L
56 23-Apr Apr-30 7 13007131 III Ny Nuryana Ds Suban jeriji P
57 24-Apr 26-Apr 2 13007162 III Tn Daerah Ds Mangku negara L
58 24-Apr 25-Apr 1 13007171 III Tn Sahrul Infeksi viral akut L
59 24-Apr 26-Apr 2 9016480 III Tn Irwan Jl Mayor iskandar L
60 Apr-25 Apr-26 2 13007244 III Tn Kuswanto Ds Tebat agung L
61 Apr-25 Apr-29 4 12016124 III Tn Isroil harahap Komplek PTPN VII L
62 Apr-25 Apr-27 2 13007247 III Ny Jarosa Ds Tangai kp1 P
63 Apr-25 Apr-28 3 13007257 III Tn Tukirin Ds Sugihan L
64 Apr-25 Apr-27 2 13007260 III Ny Nurhasanah Asrama balakarta P
65 Apr-26 Apr-29 3 11014094 III Tn Ck umar Jl Raya sugiwaras L
66 Apr-27 Apr-29 2 13007312 III Tn Damri Ds Gunung raja L
67 4-Apr 5-Apr 1 13005821 iso Tn Yusup Ds Jambu kp 2 L
68 3-Apr 5-Apr 2 13004904 Iso Tn Badawi Jl Veteran L
69 15-Apr 18-Apr 3 13006233 Iso Tn Suparmin Ds Sigam L
70 16-Apr 20-Apr 4 13006693 Iso Tn Selamat periyadi Jl Jen sudirman L
71 18-Apr 20-Apr 2 13006836 Iso Tn Nabasir Ds Belida barat L
72 18-Apr 22-Apr 4 13003098 Iso Tn Mat liman Ds Gemawang L
73 19-Apr 22-Apr 3 13006905 Iso Tn Al akhiron Ds Karang agung L
74 24-Apr 26-Apr 2 13007060 Iso Sdr Supandi Ds Sungai medang L
75 24-Apr Apr-29 6 12000300 Iso Ny Desi Jl M yamin P

1 28-Mar 30-Mar 3 13001247 III Sdr Winarno Ds Sukamenang L

2 1-Apr 2-Apr 1 13005825 III Tn Jumardi Prum sukajadi L

1 1-Apr 3-Apr 2 13005810 III Tn Paino Ds Sukamenang L

2 5-Apr 9-Apr 4 13006099 III Tn Yamin Ds Suka damai L
8 223
9

244
UMR J. PELY KET BIAYA
KET UMUR DIAGNOSA PULANG DOKTER
THN PULANG ALKES OBAT RESEP
9 Th Hepatitis Anak Irwan PK 191,283 161,299

33 Th Hydroneprosis Bedah Bujang PK - -

14 Th Ilius adekvite Bedah Bujang PK 22,500 -
43 Th Cholilithiasis Bedah Bujang PK 2,056,544 213,266

35 Th Hepatitis PDL Depta PK 67,500 -

53 Th Anemia PDL Depta PK 257,248 -
33 Th Dispepsia PDL Depta PK 1,076,757 611,933
55 Th MCI PDL Depta Pindah kls 1,106,860 -
33 Th Cephalgia PDL Harry PK 517,987 245,243
60 Th Gastropaty PDL Depta PK 2,923,815 1,310,205
63 Th Konstipasi PDL Harry PK 373,562 125,127
60 Th Dispepsia PDL Harry PK 616,158 246,511
52 Th Melena PDL Harry Meninggal 386,906 84,725
42 Th GERD PDL Harry PK 440,992 244,724
13 Th Dyspepsia PDL Harry PK 108,885 115,484
27 Th Colic abdomen PDL Depta PK - -
55 Th Sincope PDL Depta PK 2,122 144,366
50 Th HHD PDL Depta PK 848,685 444,339
80 Th TB paru PDL Depta Pindah iso -
22 Th Gea+dispepsia PDL Depta PK - -
71 Th Anemia PDL Depta PK 886,728 396,879
51 Th Chest pain PDL Harry PK 440,638 281,458
21 Th Febris PDL Harry PK 146,235 438,511
23 Th Febris+Dispepsia PDL Depta PK 1,385,073 412,810
9 Th Febris PDL Lidrian PK 236,708 6,710
60 Th Vomitus PDL Depta PK 649,945 467,168
51 Th Colic abdomen PDL Depta PK 1,267,606 934,320
47 Th Hipertensi PDL Harry PK 601,754 812,291
17 Th DBD PDL Harry PK 975,290 400,776
16 Th Dispepsia PDL Nurlela PK 356,025 164,683
31 Th Colic renal PDL Depta PK 291,260 855,702
58 Th Ht+vomitus PDL Harry PK 666,684 459,757
28 Th DBD PDL Lidrian PK 370,036 453,067
60 Th Colic renal PDL Depta PK 614,230 726,451
20 Th Thyfoid PDL Alip PK 248,550 104,095
44 Th Hemiparese dextra PDL Depta Pindah vip 711,394 -
47 Th Hydroneprosis PDL Depta PK 179,094 548,309
42 Th Dispepsia PDL Atik PK 692,175 367,914
30 Th Dispepsia PDL Atik PK 417,510 251,760
60 Th GE PDL Atik APS 565,340 264,101
35 Th Astma attack PDL Depta PK 1,091,248 707,369
36 Th Dispepsia+low intake PDL Depta PK 1,658,312 673,835
12 Th Asma bronchiale PDL Harry PK 853,350 276,394
50 Th Colic abdomen PDL Nurlela PK 392,152 178,854
16 Th Infeksi viral akut PDL Nurlela PK 234,148 183,435
25 Th DBD PDL Nurlela APS 385,605 367,818
44 Th Myalgia+Dispepsia PDL Depta PK 1,549,571 1,462,354
67 Th Konstipasi+pararerase PDL Depta PK 2,528,431 487,532
27 Th Thyfoid PDL Lidrian PK 317,808 96,599
70 Th PPOK+dispepsia PDL Depta PK 811,187 355,502
17 Th Febris+vomitus PDL Nurlela APS 81,710 72,075
36 Th Syncope PDL Depta PK - -
32 Th Infeksi viral akut PDL Lidrian PK 471,558 301,239
23 Th Hepatitis A PDL Depta PK 22,500 -
49 Th HHD PDL Depta PK 486,468 466,640
35 Th Kolic abdomen PDL Lidrian APS 305,559 466,640
43 Th Thyfoid PDL Lidrian PK 359,975 522,284
71 Th HHD+OA PDL Depta PK 255,929 506,861
43 Th Dispepsia PDL Depta PK 749,519 608,926
56 Th Vomitus+colic abd PDL Depta APS 428,957 159,797
36 Th LBP+ISK PDL Depta PK 998,890 979,916
61 Th anemia+dispepsia PDL Nurlela PK 1,547,659 584,547
23 Th Hepatitis PDL Harry Pindah kls 500,220 -
50 Th Stroke haemorargi PDL Depta PK 3,634,025 686,886
59 Th Dispepsia PDL Nurlela PK 855,794 498,392
31 Th Infeksi viral akut PDL Depta PK 461,192 883,461
45 Th Colic renal PDL Nurlela PK 22,879 526,346
37 Th Dispepsia PDL Atik PK 446,085 302,518
51 Th Dispepsia PDL atik PK 1,108,919 407,100
37 Th Dispepsia+hipertiroid PDL Depta PK 646,448 474,091
70 Th HHD decom PDL Depta PK 194,061 405,835
45 Th Dispepsia+vertigo PDL Harry PK 153,803 142,344
86 Th Dispepsia+DM PDL Atik APS 570,719 343,003
45 Th Dispepsia PDL Depta PK 656,238 415,326
80 Th TB paru PDL Depta PK 2,110,636 593,438
76 Th TB paru PDL Depta PK 89,536 -
61 Th TB paru PDL Depta PK 817,206 460,319
22 Th TB paru PDL Depta PK 1,430,112 611,153
65 Th TB paru PDL Depta PK 499,617 745,366
59 Th Atelaktis paru kiri PDL Depta PK 1,888,264 924,548
30 Th TB paru PDL Depta PK 479,860 340,248
18 Th TB paru PDL Depta PK 733,553 602,229
25 Th Febris PDL Depta PK - -

23 Th Cephalgia Syaraf Depta PK - -

43 Th Vertigo ferifer Syaraf Atik PK 12,749 -

43 Th Tonsilfaringitis akut THT wita PK 958,613 324,715

56 Th Faringitis THT Wita PK 1,522,162 489,310

58,023,306 31,929,229
 BIAYA
OPNAME J.PARAMEDIS J.SHIF NEBULIZER
BED DECUBITUS
PSG.INFUSCHATETER NGT INJEKSI
300,000 26,400 17,600 54,000

165,000 24,000 16,000 27,000

440,000 48,000 32,000 15,000 30,000 72,000
600,000 46,200 30,800 25,000 108,000

605,000 72,000 48,000 15,000 99,000

385,000 42,000 28,000 15,000 63,000
400,000 33,000 22,000 72,000
100,000 13,200 8,800 18,000
200,000 19,800 13,200 36,000
700,000 52,800 35,200 60,000 126,000
100,000 13,200 8,800 18,000
200,000 19,800 13,200 36,000
100,000 13,200 8,800 60,000 18,000
100,000 13,200 8,800 18,000
300,000 26,400 17,600 54,000
165,000 18,000 12,000 27,000
100,000 13,200 8,800 -
400,000 33,000 22,000 72,000
300,000 - - 54,000
220,000 24,000 16,000 36,000
400,000 33,000 22,000 25,000 112,000
300,000 26,400 17,600 54,000
300,000 26,400 17,600 54,000
400,000 33,000 22,000 72,000
200,000 19,800 13,200 36,000
300,000 26,400 17,600 54,000
500,000 39,600 26,400 90,000
300,000 26,400 17,600 36,000
400,000 33,000 22,000 72,000
300,000 26,400 17,600 54,000
100,000 13,200 8,800 18,000
200,000 19,800 13,200 36,000
400,000 33,000 22,000 72,000
300,000 26,400 17,600 54,000
200,000 19,800 13,200 36,000
200,000 13,200 8,800 36,000
300,000 26,400 17,600 36,000
200,000 19,800 13,200 36,000
300,000 26,400 17,600 25,000 54,000
200,000 19,800 13,200 36,000
500,000 39,600 26,400 90,000
600,000 46,200 30,800 25,000 108,000
400,000 33,000 22,000 120,000 50,000 72,000
100,000 13,200 8,800 54,000
 200,000 19,800 13,200 36,000
200,000 19,800 13,200 36,000
400,000 33,000 22,000 25,000 72,000
600,000 46,200 30,800 25,000 60,000 108,000
300,000 26,400 17,600 72,000
200,000 19,800 13,200 36,000
50,000 6,600 4,400 18,000
110,000 12,000 8,000 18,000
400,000 33,000 22,000 72,000
385,000 42,000 28,000 15,000 63,000
100,000 13,200 8,800 18,000
200,000 19,800 13,200 36,000
300,000 26,400 17,600 53,000
100,000 13,200 8,800 18,000
200,000 19,800 13,200 36,000
100,000 13,200 8,800 18,000
300,000 26,400 17,600 54,000
400,000 33,000 22,000 25,000 102,000
200,000 19,800 13,200 36,000
700,000 52,800 35,200 25,000 60,000 126,000
200,000 19,800 13,200 36,000
100,000 13,200 8,800 18,000
200,000 19,800 13,200 36,000
200,000 19,800 13,200 180,000
400,000 33,000 22,000 72,000
200,000 19,800 13,200 36,000
300,000 26,400 17,600 60,000 54,000
200,000 19,800 13,200 36,000
300,000 26,400 17,600 54,000
200,000 19,800 13,200 36,000
130,000 48,000 32,000 18,000
180,000 6,000 4,000 -
390,000 38,400 25,600 25,000 72,000
520,000 48,000 32,000 25,000 72,000
260,000 28,800 19,200 36,000
520,000 48,000 32,000 82,000
390,000 38,400 25,600 54,000
260,000 28,800 19,200 36,000
330,000 36,000 24,000 54,000

165,000 18,000 12,000 27,000

75,000 10,200 6,800 15,000

200,000 19,800 13,200 240,000 36,000

215,000 33,000 22,000 25,000 72,000

24,660,000 2,307,000 1,538,000 360,000 385,000 300,000 30,000 4,540,000

SKINTESTVIS.&KONSULSELANG O2O2 TABUNG PA GV LAIN-LAIN ADM
225,000 50,000

2,000 120,000 -
2,000 445,000 -
2,500 385,000 12,000 12,500 100,000

2,000 360,000 -
300,000 -
200,000 100,000
75,000 12,000 87,500
2,500 100,000 50,000
2,500 440,000 12,000 125,000 100,000
2,500 50,000 50,000
100,000 50,000
2,500 - 62,500 25,000
50,000 12,000 12,500 50,000
2,500 150,000 50,000
100,000 -
### 55,000 50,000
285,000 12,000 50,000 50,000
2,500 165,000 -
160,000 -
285,000 100,000
2,500 205,000 12,000 37,500 100,000
2,500 150,000 50,000
2,500 280,000 12,000 112,500 100,000
2,500 100,000 30,000
180,000 350,000
295,000 150,000
2,500 265,000 100,000
200,000 50,000
2,500 150,000 50,000
110,000 50,000
160,000 40,000
2,500 200,000 50,000
2,500 150,000 36,000
2,500 150,000 30,000
220,000 12,000 50,000 -
2,500 170,000 50,000
100,000 50,000
2,500 150,000 100,000
2,500 150,000 50,000
2,500 290,000 100,000
360,000 80,000
200,000 12,000 187,500 50,000
2,500 100,000 50,000
 2,500 100,000 100,000
100,000 30,000
285,000 12,000 62,500 100,000
380,000 100,000
2,500 150,000 150,000
165,000 35,000
2,500 - 20,000
90,000 -
2,500 200,000 100,000
270,000 -
175,000 12,000 200,000 50,000
2,500 100,000 150,000
2,500 100,000 50,000
65,000 12,000 100,000 50,000
130,000 350,000
110,000 35,000
2,500 230,000 100,000
2,500 240,000 65,000
100,000 -
495,000 12,000 312,500 100,000
2,500 100,000 35,000
120,000 70,000
100,000 300,000
50,000 50,000
200,000 100,000
175,000 12,000 100,000 50,000
160,000 12,000 200,000 50,000
100,000 50,000
2,500 150,000 50,000
130,000 50,000
60,000 50,000
- 60,000 6,000 10,000
240,000 100,000
2,500 310,000 150,000
2,500 190,000 50,000
2,500 305,000 12,000 225,000 70,000
245,000 50,000
120,000 65,000
2,000 205,000 -

85,000 -
28,500 -

110,000 50,000
2,500 215,000 100,000

95,500 15,328,500 192,000 1,943,500 5,626,000

TOTAL SELISIH DISCOUNT
PERUSAHAAN

1,025,582

354,000 JMT
1,106,500 JMT
3,591,810

1,268,500 JMT
1,090,248 234,748 JMT
2,515,690 SBAL
1,421,360
1,184,730
5,887,520
741,189
1,281,669
761,631
950,216
824,869 76,586 TUGU MANDIRI
322,000 JMT
373,488
2,217,024
521,500
456,000 JMT
2,260,607
1,477,096 PTPN VII
1,185,246
2,831,883
644,918
2,045,113
3,302,926 PTPN VI
2,161,545
2,153,066
1,121,208 PTPN VII
1,446,962
1,595,441
1,602,603
1,927,181
804,145
1,251,394
1,329,903
1,479,089
1,344,770 PTPN VII
1,300,941
2,847,117 BSP
3,582,147
2,276,244
899,506
 889,083 PTPN VII
1,152,423
4,023,425
4,365,963
1,132,907 3,985 TUGU MANDIRI
1,635,689
255,285
238,000 JMT
1,602,297 BSP
825,500 155,000 JMT
1,530,108
1,293,699
1,431,759
1,129,790
2,107,445
873,754
2,709,306 BSP
3,021,706
869,220
6,239,411
1,760,686
1,674,653 BSP
1,218,225
1,261,603
2,343,019 PTPN VII
1,726,539
1,479,896
715,147
1,514,222
1,520,564
3,042,074
355,536 856,380 PNS
2,168,525
3,200,765 13,952 MULTI ARTHA GUNA
1,831,483
4,109,312
1,623,108
1,864,782
651,000 50,600 JMT

307,000 150,000
148,249 ASKES INHEALTH

1,952,328
2,695,972

147,258,035 1,541,251
 REKAP PENDAPATAN RAWAT INAP BULAN FEBRUARI 2013
NO RUANGAN ALKES OPNAME PARAMEDIS J. SHIFT P INFUS KATETER
1 PAVILIUN 33,280,966 43,730,000 2,478,000 1,668,000 100,000 -

2 VIP 133,638,330 150,854,000 8,614,000 5,727,000 1,000,000 60,000

3 BEDAH 138,907,453 91,753,180 6,495,200 3,956,600 852,500 600,000

4 ANAK 30,525,074 47,565,000 3,393,300 2,709,200 1,497,500

5 KELAS II 87,745,654 62,045,000 4,369,800 2,915,200 575,000 435,000

6 KELAS III 58,023,306 24,660,000 2,307,000 1,538,000 385,000 300,000

7 ARAFAH 38,530,803 57,525,000 3,095,100 2,054,400 375,000 -

8 KEBIDANAN

520,651,586 478,132,180 30,752,400 20,568,400 4,785,000 1,395,000

S O2 ELKTRIK TABUNG PA GV LAIN-LAIN

1 PAVILIUN 24,000 - 50,000 - 180,000 -

2 VIP 132,000 - 2,316,000 - 855,000 1,012,500

3 BEDAH 329,000 - 4,100,500 1,580,000 6,135,000 958,000

4 ANAK 259,500 - 5,892,500 0 90,000 1,356,000

5 KELAS II 252,000 - 3,973,500 - 585,000 100,000

6 KELAS III 192,000 1,943,500 360,000

7 ARAFAH 84,000 421,500 443,000 - 675,000 -

PERUSAHAAN JUMLAH HR. RAWAT PENDAPATAN SELISIH KASUS

VIP TEL 14 53 62,214,401 786,799
BSP 1 4 5,264,473 3,807,316
AVIVA 1 2 2,242,416
ASKES INHEALTH 2 7 4,167,518 1,440,599
SOS 1 3 3,654,191
ABDA 2 1,829,621 ANAK
GLOBAL 21 85 83,653,663 3,475,175 BDH
SIMAS 1 3 3,944,958 GIGI
KAI 4 8 7,928,771 198,000 KAND
JAMSOSTEK 6 19 10,240,708 7,113,412 KEB
MHP 1 2 2,262,852 PDL
PERTAMINA 1 6 3,600,986 300,000 SYARAF
ALLIANZ 1 7 5,854,746 THT
PNS 40 166 51,269,858 26,278,368
PTPN 7 1 3 3,271,798 856,000 TOTAL
BLUE DOT 1 3 2,827,521
GARDA MEDIKA 1 6 3,552,510 270,000
TANGKAS 1 3 2,229,606 300,000

BEDAH ABDA 1 1 630,579

BSP 2 12 5,452,075 ANAK
GARDA MEDIKA 1 4 5,354,694 BEDAH
GLOBAL 1 4 3,948,292 KAND
ASKES 3 8 2,015,923 93,315 KEB
JAMSOSTEK 4 22 6,536,000 2,306,926 MATA
 KAI 1 7 4,594,943 ORTOPEDI
MHP 1 1 1,103,810 PDL
MNC LIFE 1 4 2,625,180 1,000,000 SYARAF
PNS 53 197 61,362,634 55,851,307 THT
PTPTN 7 2 9 4,424,076 UMUM
SURYA AGROLANGGENG 2 11 3,994,463
SIMAS 2 6 3,964,427
TANGKAS 5 16 12,359,737 531,900
TEL 5 18 16,899,192
TITIS SAMPURNA 1 4 1,768,707
THE 1 3 2,062,493

KLS II
AVIVA 1 3 2,601,564 ANAK
ASKES INHEALTH 6 22 5,415,319 1,149,800 BDH
ASKES SOSIAL 16 57 16,911,865 12,807,244 KEB
JAMS 3 6 2,010,089 2,842,822 ORTOPEDI
TEL 1 1 727,784 PDL
SIMAS 1 3 2,574,372 SYARAF
TITIS SAMPURNA 1 5 5,063,404 THT
AIA 1 3 3,043,137 UMUM
SURYA BUMI ANGRO 1 3 5,289,346
GLOBAL FRUDENTIAL
TANGKAS 3 9 5,503,358
KAI 2 9 4,995,207
PTPN VII 1 3 1,571,062
MHP
SOS FRUDENTIAL 1 5 2,869,578

KLS III BSP 4 13 8,833,373 THT

JAMSOSTEK 9 51 6,311,748 440,348 SYARAF
PNS 1 2 355,536 856,380 ANAK
PT PN7 6 20 10,478,102 BEDAH
SBAL 1 4 2,515,690 PDL
TUMAN 2 6 1,957,776 80,571
ASKES 1 1 148,249
MULTI ARTHA GUNA 1 4 3,200,765 13,952

ANAK ASKES INHEALTH 4 9 2,307,932 182,450 UMUM

BSP 3 13 4,833,369 ANAK
JMT 12 66 12,192,090 4,258,712 NEO
KAI 1 3 1,415,376
PNS 1 5 727,024 424,000
TUMAN 5 29 12,445,334 998,157
GARDA MEDIKA
MADILLUM
KAI

PAVILIUN
TEL 4 12 29,556,862 17,766 ANAK
LIPPO 1 5 8,415,383 PDL
SINAR MAS 1 7 9,523,464 THT
BUMI PUTRA 2 2 4,386,646
PNS 1 2 3,874,347 2,423,347
ABDA 1 3 5,212,942 TOTAL
PRATAMA 1 2 7,078,000
GLOBAL 5 13 21,475,068 752,543

KEB ASKES SOSIAL 6 13 20,811,287 7,075,764 KAN

JAMS 8 27 23,217,051 16,546,449 KEB
ASKES INHEALTH 3 6 8,379,639 282,042
 TEL
KAI
GARDA MEDIKA
GOLDEN BLOOSOM
TITIS 325,689
PTPN 7 1 3 2,337,972 45,000
LIPPO
PERTAMINA 1 4 9,006,114 445,000
SBAL
PSDA
JAPFA COMFEED IN TBK ( JCI )
SIMAS 1 1 2,049,499
TANGKAS 1 5 11,706,713 1,161,467
WINTHERTUR
TEL 1 2 16,196,124 810,397
BSP 2 7 4,782,490 263,143
BUMI PUTRA
ABDA
GLOBAL
AXA 1 5,495,972 2,163,973
PAN PASIFIK 1 3 3,064,780 383,353
ELNUSA 1 2 4,213,799 139,504
ADMEDIKA 2 5 9,104,900 2,547,326

ARAFAH MHP 4 8 9,080,432 A

ASKES PNS 8 25 18,551,497 21,392,641 ANAK
TRAKINDO 1 3 3,782,252 BEDAH
TANGKAS 1 3 2,016,418 450,000 KAND
TEL 2 8 8,491,082 867,000 KEB
GLOBAL 4 21 29,927,247 906,887 MATA
ALLIANZ 1 1 944,315 982,000 PDL
SIMAS 1 2 1,912,258 THT
SOS 1 3 6,446,818 2,424,409
ASKES 1 1 744,720 515,926
JAMSOSTEK 1 4 2,803,218 2,286,728
PTPN 1 2 1,979,101 679,500
KAI 1 3 4,084,345 434,000
ALLIANZ

HCU PNS 1 1 KEB

BSP 1 1 PDL
INHEALT 2 2 SYARAF
TITIS 1 3 BEDAH
826,384,715 194,659,718
 REKAP KEB DESEMBER 2011
NGT SKINTES INJEKSI VISITE RUANGA ALKES OPNAME
K TINDAKAN
- 100,000 1,278,000 8,465,000 1,378,000 KEBIDANAN

60,000 189,500 6,688,000 42,515,500 6,877,500

ELKTRIKTABUNG PA
- 149,000 5,661,000 38,341,000 5,810,000
Jasa dokter Kep
720,000 167,500 6,260,000 25,263,000 6,427,500 kurang 12 visite dokter

60,000 111,000 5,170,000 22,438,000 5,281,000

- ini adalah visite setelah dikurangi dr depta
30,000 95,500 4,540,000 15,328,500 4,635,500

- 57,500 1,800,000 14,767,000 1,857,500

-
( V. dr. nuTotal biaya dokter

870,000 Total visite di kurang visite dr. depta ( peng

870,000 870,000

ADM SONDE PRWTAN BY Fototerapi BON PASIEN UMUM

3,865,000 - ### - THT & jasa paramedik mulai bln Agustus
TOTAL JASA PARAMEDIS DARI MBAK
12,251,000 - ### - JASA SHIFT
THT ( 50 % dari total JP di kurang jasa shif
11,422,000 JASA PRWT YANG DIBAGI ( 70 % dari J
JASA UNTUK BONUS UMUM ( 30 % da
4,385,000 955,000 563,700 1,035,000 JASA PRWT BAYI NEO
JASA PRWT BAYI YANG DIBAGI
6,650,000

5,626,000

4,220,000

Jika terjadi selisih pendapatan di di rekap d

INI ADAL O2 dan selang UGD & VK

JUMLAH DISCOUNT DATA DARI RU RUANGAJ. PARA

1 PAVILIUN

3 BEDAH

80
6
1
5
1
45
6
1

145

5
43
5
18
2
 1
73
2
7
7
163

10
5
3
1
87
2
2
3
113

2
2
1
3
75
83

3
70
23
96

11
16 DISC=7766000
3

18 OKSIGEN 3055000
80
12
3
1
5
1
18
1
41

1
6
5
2
14
 T DOKTERT BIDAN
PARAMEDISP INFUS KATETER NGT SKINTES INJEKSI VISITE USG S O2
-

GP VISUM LAIN-LAIN ADM RESUSITASISENAM R BAYI TINDIKPRWTAN BY

IMUNISASI PIJAT
- -

- Jasa dokter kebidanan bulan Februari

kurang 12 visite dokter visite dokter
kurang 50 USG USG
kurangi dr depta - kurang 12 tindakan dokter tindakan dokter
kurang 12 Resusitasi Resusitasi

..>>>>>>
ter - ini total visite yang dibayarkan ke dokter

e dr. depta ( pengeluarannya dari Melati )

ulai bln Agustus diambil d Mulai Agustus 2008 :

DIS DARI MBAK NUR 1. BCG diakui Kebidanan
2. Resusitasi ( keb kui Kebidanan
i kurang jasa shift ) 3. Jasa paramedik & Adm Keb diakui Kep
AGI ( 70 % dari JP )
UMUM ( 30 % dari JP )
8. PA, total Pa yang dikirim pendapatannya di kuranag 10 rb per orang
G DIBAGI
Sept : 2. Resusitasi ( keb & Kep ) diakui Keb

atan di di rekap dengan Januari 20Oksigen UGD & VK ( Selang & O2 ) masuk ke Kep
Lap Keb Pisah
UGD & VK

J. SHIFT O2

KEBIDANAN UGD
O2 TAB ### O2 tab UGD
O2 ELEKTRIK
#REF!

Slang O2 UGD + VK :
 BULAN APRIL 2013
NO RUANGAN PARAMEDIS J. SHIFT Perawat yan melahirkan/PHK/mengundurkan diri :
1 PAVILIUN 1,249,920 2,237,952

2 VIP 4,969,755 8,898,228

3 BEDAH 2,887,185 5,169,436

4 ANAK 1,838,760 3,292,256

Pembagian Shift :
5 KELAS II 1,987,335 3,558,276 Kasi 1
Shift 3
6 KELAS III 1,083,600 1,940,160 Bedah 16
Kls II 13
7 KEBIDANAN 2,502,192 4,480,115 Kls III 10
Anak & Neonatus 15
8 KEBIDANAN RJL 49,934 89,405 Vip 15
Paviliun 9
9 ARAFAH 1,592,850 2,851,960 Arafah 10
Kamar Bersalin 21
113
18,161,531 32,517,788
 DAFTAR NAMA PERAWAT PERUANGAN
BULAN JANUARI 2013

NO NAMA PERAWAT RUANGAN KETERANGAN POINT JASA SHIFT JUMLAH UANG DITERIMA

###
1 Fitriatul Auda AS Syifa Ka. Ruangan 3 117,787 353,361
2 Sabaria AS Syifa PJ 2.5 117,787 294,468
3 Armarena AS Syifa PJ 2.5 117,787 294,468
4 Heni Maryana AS Syifa PJ 2.5 117,787 294,468
5 Pajaria Dilha AS Syifa PJ 2.5 117,787 294,468
6 Riana Utami AS Syifa PELAKSANA 2 117,787 235,574
7 Diana Suryani AS Syifa PELAKSANA 2 117,787 235,574
8 Herawati AS Syifa PELAKSANA 2 117,787 235,574
9 Serli AS Syifa PELAKSANA 0 117,787 -
19 2,237,954

###
1 Delpiana Ibnu Sina Ka. Ruangan 3 166,756 500,268
2 Riri Puspita Ibnu Sina PJ 2.5 166,756 416,890
3 Ernawati Ibnu Sina PJ 2.5 166,756 416,890
4 Dewi Novita Endini Ibnu Sina PJ 2.5 166,756 416,890
5 Nopita Sari Ibnu Sina PJ 2.5 166,756 416,890
6 Rosmala Dewi Ibnu Sina PELAKSANA 2 166,756 333,512
7 Desca Anggraini Ibnu Sina PELAKSANA 2 166,756 333,512
8 Dwi Ayu Barini Ibnu Sina PELAKSANA 0 166,756 -
9 Sepri Ibnu Sina PELAKSANA 0 166,756 -
10 yuliana Ibnu Sina PELAKSANA 2 166,756 333,512
11 Sri Astuti Ibnu Sina PELAKSANA 2 166,756 333,512
12 Neli Ibnu Sina PELAKSANA 2 166,756 333,512
13 Merina Dwi K Ibnu Sina PELAKSANA 2 166,756 333,512
14 Sri Hartati Ibnu Sina PELAKSANA 2 166,756 333,512
15 Riana Utami Ibnu Sina PELAKSANA 2 166,756 333,512
16 Ibnu Sina PELAKSANA 166,756 -
17 Eka Mailan Ibnu Sina PELAKSANA 2 166,756 333,512
31 5,169,436

###
1 Sundarti Al Wardah Ka. Ruangan 3 104,874 314,621
2 Novita Andriani Al Wardah PJ 2.5 104,874 262,184
3 Heryeti Al Wardah PJ 104,874 -
4 Lusi Fitriani Al Wardah PJ 2.5 104,874 262,184
5 Malasari Al Wardah PJ 2.5 104,874 262,184
6 Mustaqim Al Wardah PELAKSANA 2 104,874 209,747
7 Eva Susanti Al Wardah PELAKSANA 2 104,874 209,747
8 Riska Wahyuni Al Wardah PELAKSANA 2 104,874 209,747
9 risa 0
10 Meylan Susanti Al Wardah PELAKSANA 2 104,874 209,747
18.5 1,940,160

###
1 Arda Paulina Ad Dawa Ka. Ruangan 3 269,643 808,929
2 Mira Septirina Ad Dawa PJ 2.5 269,643 674,108
3 Mardiana Ad Dawa PJ 2.5 269,643 674,108
4 Anna Yuliana Ad Dawa PJ 2.5 269,643 674,108
5 lusiana Ad Dawa PJ 2.5 269,643 674,108
6 nurul fadilah Ad Dawa PELAKSANA 2 269,643 539,287
7 Dewi Endah Ad Dawa PELAKSANA 2 269,643 539,287
8 Farida Ad Dawa PELAKSANA 2 269,643 539,287
9 Puspa Reni Ad Dawa PELAKSANA 2 269,643 539,287
10 Yulita Ad Dawa PELAKSANA 2 269,643 539,287
11 Puput Ad Dawa PELAKSANA 2 269,643 539,287
12 mia dwi lestari Ad Dawa PELAKSANA 2 269,643 539,287
13 Ad Dawa PELAKSANA 269,643 -
14 Milranti Ad Dawa PELAKSANA 2 269,643 539,287
15 Ratna Oktavia Ad Dawa PELAKSANA 2 269,643 539,287
16 Lia Hisdareni Ad Dawa PELAKSANA 2 269,643 539,287
17 Nurleni Ad Dawa PELAKSANA 269,643 -
33 8,898,229
 DAFTAR NAMA PERAWAT PERUANGAN
BULAN JANUARI 2013

NO NAMA PERAWAT RUANGAN KETERANGAN POINT JASA SHIFT JUMLAH UANG DITERIMA

###
1 Yusriyanti Al Wildan Ka. Ruangan 3 98,276 294,828
2 Nisa Susila Al Wildan PJ 2.5 98,276 245,691
3 Elvi Oktavia Al Wildan PJ 2.5 98,276 245,691
4 Metiyana Al Wildan PJ 2.5 98,276 245,691
5 Cica Puspita Al Wildan PJ 2.5 98,276 245,691
6 Molin Al Wildan PJ 2.5 98,276 245,691
7 Lestari Dewi Al Wildan PELAKSANA 2 98,276 196,553
8 Yeni Erni Al Wildan PELAKSANA 2 98,276 196,553
9 Indah Ratri Putri Al Wildan PELAKSANA 2 98,276 196,553
10 Nasmi Eka Al Wildan PELAKSANA 2 98,276 196,553
11 Nursepni Al Wildan PELAKSANA 2 98,276 196,553
12 Septy Maya Sari Al Wildan PELAKSANA 2 98,276 196,553
13 Yosita Rani Al Wildan PELAKSANA 2 98,276 196,553
14 Ayu Wahyuni Al Wildan PELAKSANA 2 98,276 196,553
15 Delfi Al Wildan PELAKSANA 2 98,276 196,553
33.5 3,292,260

###
1 Sri Wilidiawati Arafah Ka. Ruangan 3 135,808 407,423
2 Metti Ambar Sari Arafah PJ 2.5 135,808 339,519
3 Yossi Ervalina Arafah PJ 2.5 135,808 339,519
4 Tenny Arafah PJ 2.5 135,808 339,519
5 Desi Arsianti Arafah PJ 2.5 135,808 339,519
6 Hanif Arafah PELAKSANA 0 135,808 -
7 Andika Wulan Dari Arafah PELAKSANA 2 135,808 271,615
8 Nichi Salistyawati Arafah PELAKSANA 2 135,808 271,615
9 Wahyuni Amelia Arafah PELAKSANA 2 135,808 271,615
10 Tesa Arafah PELAKSANA 2 135,808 271,615
21 2,851,959

###
1 Wiwin Winarti Musdalifah Ka. Ruangan 3 122,699 368,098
2 Taufira Musdalifah PJ 2.5 122,699 306,748
3 Evida Musdalifah PJ 2.5 122,699 306,748
4 Ida Rizky Musdalifah PJ 2.5 122,699 306,748
5 Rini Sagita Musdalifah PJ 2.5 122,699 306,748
6 Dewi Puspita Musdalifah PELAKSANA 2 122,699 245,398
7 Desni Musdalifah PELAKSANA 2 122,699 245,398
8 Herawati Lestari Musdalifah PELAKSANA 2 122,699 245,398
9 septi windasari Musdalifah PELAKSANA 2 122,699 245,398
10 cindy emilia Musdalifah PELAKSANA 2 122,699 245,398
11 Yurice Netria Musdalifah PELAKSANA 2 122,699 245,398
12 Nurhayati Musdalifah PELAKSANA 2 122,699 245,398
13 Dian Triana Sari Musdalifah PELAKSANA 2 122,699 245,398
29 3,558,272

###
1 Rita Ervina Al Wiladah Ka. Ruangan 3 101,545 304,635
2 Merry Anggraini Al Wiladah PJ 2.5 101,545 253,863
3 Rosnita Oktavia Al Wiladah PJ 2.5 101,545 253,863
4 Dewi Anggraini Al Wiladah PJ 2.5 101,545 253,863
5 Neni Evionita Al Wiladah PJ 2.5 101,545 253,863
6 Trisnawati Al Wiladah PELAKSANA 2 101,545 203,090
7 Yelli Vicca Al Wiladah PELAKSANA 2 101,545 203,090
8 Marina Ria Andini Al Wiladah PELAKSANA 2 101,545 203,090
9 Fitriyana Al Wiladah PELAKSANA 2 101,545 203,090
10 Vini Kusliantari Al Wiladah PELAKSANA 2 101,545 203,090
11 Reni Yunita Sari Al Wiladah PELAKSANA 2 101,545 203,090
12 Yohana Aria Al Wiladah PELAKSANA 2 101,545 203,090
13 Sri Marweni Al Wiladah PELAKSANA 2 101,545 203,090
14 Vera Damayanti Al Wiladah PELAKSANA 2 101,545 203,090
15 Yeni Silvia Al Wiladah PELAKSANA 2 101,545 203,090
16 Weli Al Wiladah PELAKSANA 2 101,545 203,090
17 Septa Ria Maya Sari Al Wiladah PELAKSANA 2 101,545 203,090
 DAFTAR NAMA PERAWAT PERUANGAN
BULAN JANUARI 2013

NO NAMA PERAWAT RUANGAN KETERANGAN POINT JASA SHIFT JUMLAH UANG DITERIMA

18 Anggun Nierbela Al Wiladah PELAKSANA 2 101,545 203,090

19 Fitri Yuliani Al Wiladah PELAKSANA 2 101,545 203,090
20 Novi Nurhidayati Al Wiladah PELAKSANA 2 101,545 203,090
21 Ismaryani Al Wiladah PELAKSANA 2 101,545 203,090
22 Ayu Wahyuni Al Wiladah PELAKSANA 0 101,545 -
45 4,569,525

###
1 Riny widyastuti Kasie Ranap 8 50,285 402,278
2 Ganda Ridho Porter 4 50,285 201,139
3 Febrialdie Porter 4 50,285 201,139
4 Sailani Effendi Porter 4 50,285 201,139
5 Herman Porter 4 50,285 201,139
6 Dodi Pranata Porter 4 50,285 201,139
7 Mardani Porter 4 50,285 201,139
8 Heri Susanto Porter 4 50,285 201,139
9 Erik Ricardo Porter 4 50,285 201,139
10 M Agus Setiawan Porter 4 50,285 201,139
11 Lisnidia SS 3 50,285 150,854
12 Yenny Nopiyanti SS 3 50,285 150,854
13 Leli Yuliani SS 3 50,285 150,854
53 2,665,095

Total--->>> ### 35,182,890

Kasie. Ranap & Rajal,

RINY WIDYASTUTI, S.Kep Ners

RUMAH SAKIT AR. BUNDA PRABUMULIH
DAFTAR PASIEN RAWAT INAP RUANG HCU
BULAN APRIL 2013

NO. TGL TGL HR NO. KELAS NAMA A LA M AT

MASUK KELUAR RAWAT REG
5
15-Apr 15-Apr 1 12-00-76-60 VIP Suharto, Tn Mess BPS Tjg Miring

14 17-Apr 18-Apr 1 06-01-49-87 VIP Bambang Iswahyudi, TJl. Tangkuban Perahu

5-Apr 6-Apr 1 09-01-38-74 VIP Edi Riono, Tn Perumnas Perabu Indah

1 26-Apr 27-Apr 1 13006581 VIP zawawi.tn jl.kopral toya

23-Apr 24-Apr 1 13-00-97-13 VIP Badawi, Tn Ds. Trans Aur

2 28-Apr 30-Apr 2 13007381 VIP yusmala desa jemenang
3
6 3-Apr 3-Apr 1 13005963 VIP Puspita Sari, Ny Ds. Belimbing up IV
7
19-Apr 22-Apr 3 12-00-17-50 VIP Yunizar, Tn Jl. Melati Raya Sukajadi
8 20-Apr 20-Apr 1 13-00-69-77 VIP Malisi, Tn Ds. Pagar Gunung
12 21-Apr 24-Apr 3 06-01-34-58 VIP Murlina, Ny Jl. Pendawa Lima
23-Apr 23-Apr 1 10-00-56-61 VIP Rodiah, Ny Ds. Tambang Kelekar
4
9 16-Apr 17-Apr 1 13-00-66-55 VIP Indra Darmawan, Tn Ds. Karang Endah
10 24-Apr 25-Apr 1 13-00-70-71 VIP Lili Marlin, Ny Jl. Jend. Sudirman
24-Apr 24-Apr 1 10-01-83-50 VIP Aswanto, Tn Gunung Ibul
11 28-Mar 2-Apr 5 11007281 VIP Wiji lestari.ny ds. Karya mulya
13 25-Apr 25-Apr 1 VIP ela.ny desa lembak
26-Apr 28-Apr 2 13006581 VIP rusminah JL.let sumanto tl ubi
6-Apr 7-Apr 1 VIP Krisboy, Tn Jln Lingkar
11-Apr 12-Apr 1 13-00-64-40 VIP Merunip, Ny Ds Muara Dua
12-Apr 13-Apr 1 13-00-64-37 VIP Alip Som, Tn Ds. Jemenang

30
JK UMR
DIAGNOSA
KET UMUR PULANG J. PELY DOKTER KET BIAYA BIAYA
PLG ALKES RESEP
14 - -
L 47 PDL syok cardiogenik dr. Depta NINGGAL 347,570

L 49 BEDAH app dr. Depta/dr. Bujang RUJUK 190,761

L 42 PDL syok cardiogenik dr. Depta NINGGAL 463,201

L 74 PDL melena,anemia dr depta RUJUK 593,527

L 60 tc dr. Depta PINDAH 471,392

p 50 BEDAH trauma drdepta NINGGAL 1,370,203

P 18 KEB post sc dr. Rahman NINGGAL 527,587

L 46 PDL cardiomegali dr. Depta RUJUK 3,398,062

L 70 PDL melena,anemia dr. Depta NINGGAL 842,703
P 63 PDL syok cardiogenik dr. Depta PINDAH 421,775
P 66 PDL hhd dr. Depta NINGGAL 834,636

L 54 SYARAF stroke dr. Depta NINGGAL 4,322,718

P 59 SYARAF ich dr. Depta/dr. Budi NINGGAL 1,059,023
L 45 SYARAF cvd dr. Depta/dr. Budi NINGGAL 23,001
p 52 SYARAF stroke dr depta PINDAH 4,343,465
p 45 SYARAF stroke dr depta NINGGAL 34,498
P 75 SYARAF stroke drdepta NINGGAL 3,938,330
L 33 hhd dr. Depta PINDAH 149,526
P 70 ht,stroke dr. Depta PINDAH 347,570
L 65 syok cardiogenik dr. Depta PINDAH 3,432,015
 BIAYA BIAYA BIAYA JS SHIFT JP BIAYA BIAYA BIAYA BIAYA
OPNAME JP JASA SHIFT DIBAGIKANDIBAGIKAN IVFD SKIN TESTMONITORINFUS PUMP
- - - - - - - - -
350,000 70,000 30,000 100,000 75,000

350,000 35,000 15,000 2,000 75,000 75,000

350,000 35,000 15,000 100,000 75,000

650,000 35,000 15000 100000

350,000 70,000 30,000 100,000

700,000 105,000 45000 25000 200000 150000

150,000 35,000 15,000 50,000

1,050,000 140,000 60,000 25,000 300,000

350,000 70,000 30,000 100,000 75,000
1,350,000 105,000 45,000 300,000
350,000 70,000 30,000 100,000

700,000 105,000 45,000 25,000 200,000 150,000

350,000 70,000 30,000 100,000 75,000
450,000 70,000 30,000 100,000
1,750,000 420,000 18000 50000 2500 500000 375000

700,000 105,000 45000 25000 200000 150000

100,000 35,000 15,000 50,000
350,000 70,000 30,000 100,000 75,000
700,000 105,000 45,000 50,000 200,000 150,000
 BIAYA BIAYA BIAYA VISITE SLANG OKSIGEN BIAYA BIAYA BIAYA
BED DECU CATETER NGT KONSUL OKSIGEN TABUNG EKG GV/TELP ADM
- - - - - - - - -
30,000 75,000 12,000

30,000 90,000 9,500 250,000

30,000 75,000 140,000 50,000

30000 ### 975,000

30,000 200,000
60000 60,000 ### 12,000 125,000

30,000 25,000

90,000 60,000 425,000 800,000 150,000

30,000 105,000 225,000 35,000
90,000 265,000 275,000
30,000 140,000 237,500 75,000

60,000 60,000 230,000 400,000 50,000

30,000 75,000 237,500 200,000
30,000 75,000 100,000
150000 ### 12,000 837,500 ###
75,000 50,000
60000 60,000 ### 562,500 ###
30,000
30,000 75,000
60,000 60,000 574,500 12,000 687,500 50,000 120,000
BIAYA BIAYA RESUSITASI SELISIH DISCOUNT
PERUSAHAAN
INJ SONDE
- - - - - -
18,000 BSP

18,000 1,007,500 INHEALTH

18,000 445,000 993,000 INHEALTH

28,000 2526522 PNS

18,000
36,000

18,000

54,000 TITIS
18,000 165,000

18,000

36,000 10,000
18,000

90,000 ###

36,000 50,000

18,000
36,000
 DAFTAR NAMA PERAWAT PERUANGAN
BULAN April 2013

NO NAMA PERAWAT RUANGAN KETERANGAN POINT

1 Fitriatul Auda AS Syifa Ka. Ruangan 3
2 Sabaria AS Syifa PJ 2.5
3 Armarena AS Syifa PJ 2.5
4 Heni Maryana AS Syifa PJ 2.5
5 Pajaria Dilha AS Syifa PJ 2.5
6 Dewi Pariska AS Syifa PELAKSANA 2
7 Diana Suryani AS Syifa PELAKSANA 2
8 Herawati AS Syifa PELAKSANA 2
9 Serli AS Syifa PELAKSANA bln ke 3 br dpt jp
19

1 Delpiana Ibnu Sina Ka. Ruangan 3

2 Riri Pusphita Ibnu Sina PJ 2.5
3 Ernawati Ibnu Sina PJ 2.5
4 Dewi Novita Endini Ibnu Sina PJ 2.5
5 Nopita Sari Ibnu Sina PJ 2.5
6 Rosmala Dewi Ibnu Sina PELAKSANA 2
7 Desca Anggraini Ibnu Sina PELAKSANA 2
8 Dwi Ayu Barini Ibnu Sina PELAKSANA april n mei tdk dpt jp
9 Riana Utami Ibnu Sina PELAKSANA 2
10 Sepri Ibnu Sina PELAKSANA bln ke 3 br dpt jp
11 Sri Astuti Ibnu Sina PELAKSANA 2
12 Neli Oktarina Ibnu Sina PELAKSANA 2
13 Merina Dwi K Ibnu Sina PELAKSANA 2
14 Sri Hartati Ibnu Sina PELAKSANA 2
15 Yuliana Ibnu Sina PELAKSANA 2
16 Eka Mailan Ibnu Sina PELAKSANA 2
17
31

1 Sundarti Al Wardah Ka. Ruangan 3

2 Novita Andriani Al Wardah PJ 2.5
3 Heryeti Al Wardah PJ 2.5
4 Lusi Fitriani Al Wardah PJ 2.5
5 Malasari Al Wardah PJ 2.5
6 Mustaqim Al Wardah PELAKSANA 2
7 Eva Susanti Al Wardah PELAKSANA 2
8 Meylan Susanti Al Wardah PELAKSANA 2
9 Riska wahyuni Al Wardah PELAKSANA 2
10 Risa Al Wardah PELAKSANA bln ke 3 br dpt jp
21

1 Arda Paulina Ad Dawa Ka. Ruangan 3

2 Mira Septirina Ad Dawa PJ 2.5
3 Mardiana Ad Dawa PJ 2.5
4 Anna Yuliana Ad Dawa PJ 2.5
5 Lusiana Ad Dawa PJ 2.5
6 Nurul Fadila Ad Dawa PELAKSANA 2
7 Dewi Endah Ad Dawa PELAKSANA 2
8 Farida Ad Dawa PELAKSANA 2 Bln Mei n Juni tdk dpt jp
9 Puspa Reni Ad Dawa PELAKSANA 2
10 Yulita Ad Dawa PELAKSANA 2
11 Selvi Fitria Ad Dawa PELAKSANA 2
12 Mia Dwi Lestari Ad Dawa PELAKSANA 2
13 Milranti Ad Dawa PELAKSANA 2
14 Ratna Oktavia Ad Dawa PELAKSANA 2
15 Lia Hisdareni Ad Dawa PELAKSANA 2
16 Ad Dawa PELAKSANA
17 Ad Dawa PELAKSANA
33

1 Yusriyanti Al Wildan Ka. Ruangan 3

2 Molin Al Wildan PJ 2.5
3 Elvi Oktavia Al Wildan PJ 2.5
4 Metiyana Al Wildan PJ 2.5
5 Cica Puspita Al Wildan PJ 2.5
6 Lestari Dewi Al Wildan PJ 2.5
7 Yeni Erni Al Wildan PELAKSANA 2
8 Nisa Susila Al Wildan PELAKSANA 2
9 Indah Ratri Putri Al Wildan PELAKSANA 2
10 Nasmi Eka Al Wildan PELAKSANA 2
11 Nursepni Al Wildan PELAKSANA 2
12 Septy Maya Sari Al Wildan PELAKSANA 2
13 Yosita Rani Al Wildan PELAKSANA 2
14 Ayu Wahyuni Al Wildan PELAKSANA 2
15 Delvi Ria Al Wildan PELAKSANA 2
33.5
 1 Sri Wilidiawati Arafah Ka. Ruangan 3
2 Metti Ambar Sari Arafah PJ 2.5
3 Yossi Ervalina Arafah PJ 2.5
4 Tenny Arafah PJ 2.5
5 Desi Arsianti Arafah PJ 2.5
6
7 Andika Wulan Dari Arafah PELAKSANA 2
8 Nichi Salistyawati Arafah PELAKSANA 2
9 Wahyuni Arafah PELAKSANA 2
10 Tesa Arafah PELAKSANA 2
11 Hanif Arafah PELAKSANA bln ke 3 br dpt jp
21

1 Wiwin Winarti Musdalifah Ka. Ruangan 3

2 Taufira Musdalifah PJ 2.5
3 Evida Musdalifah PJ 2.5
4 Ida Rizky Musdalifah PJ 2.5
5 Rini Sagita Musdalifah PJ 2.5
6 Dewi Puspita Musdalifah PELAKSANA 2
7 Desni Musdalifah PELAKSANA 2
8 Herawati Lestari Musdalifah PELAKSANA 2
9 Yurice Netria Musdalifah PELAKSANA 2
10 Cindy Emilia Musdalifah PELAKSANA 2
11 Septi Windasari Musdalifah PELAKSANA 2
12 Nurhayati Musdalifah PELAKSANA 2
13 Dian Triana Sari Musdalifah PELAKSANA 2
29

1 Rita Ervina Al Wiladah Ka. Ruangan 3

2 Meri Anggraini Al Wiladah PJ 2.5
3 Rosnita Oktavia Al Wiladah PJ 2.5
4 Dewi Anggraini Al Wiladah PJ 2.5
5 Neni Evionita Al Wiladah PJ 2.5
6 Trisnawati Al Wiladah PELAKSANA 2
7 Yeli Vicca Al Wiladah PELAKSANA 2
8 Marina Ria Andini Al Wiladah PELAKSANA 2
9 Fitriyana Al Wiladah PELAKSANA 2
10 Vini Kusliantari Al Wiladah PELAKSANA 2
11 Reni Yunita Sari Al Wiladah PELAKSANA 2
12 Yohana Aria Al Wiladah PELAKSANA 2
13 Sri Marweni Al Wiladah PELAKSANA 2
14 Vera Damayanti Al Wiladah PELAKSANA 2
15 Yeni Silvia Al Wiladah PELAKSANA 2
16 Weli Al Wiladah PELAKSANA 2
17 Anggun Niarbela Al Wiladah PELAKSANA 2
18 Iis Maryani Al Wiladah PELAKSANA 2
19 Fitri Yuliani Al Wiladah PELAKSANA 2
20 Novi Nurhidayani Al Wiladah PELAKSANA 2
21 Septa Ria Mayasari Al Wiladah PELAKSANA 2
22 Al Wiladah PELAKSANA
45

1 Riny widyastuti Kasie Ranap 8

2 Ganda Ridho Porter 4
3 Febrialdie Porter 4
4 Sailani Effendi Porter 4
5 Herman Porter 4
6 Dodi Pranata Porter 4
7 Mardani Porter 4
8 Heri Susanto Porter 4
9 Erik Ricardo Porter 4
10 M Agus Setiawan Porter 4
11 Lisnidia SS 3
12 Yenny Nopiyanti SS 3
13 Leli Yuliani SS 3
53

Total--->>>

Kasie. Ranap & Rajal,

RINY WIDYASTUTI, AmKp

PERUSAHAAN JUMLAH HR. RAWAT

ABDA 2
ABDA 1 1
ABDA 1 3
2 6

ADMEDIKA 2 5

AIA 1 3

ALLIANZ 1 7
ALLIANZ 1 1
2 8

ASKES 3 8
ASKES 1 1
ASKES 1 1
ASKES INHEAL 2 7
ASKES INHEAL 6 22
ASKES INHEAL 4 9
ASKES INHEAL 3 6
INHEALT 2 2
22 56

AVIVA 1 2
AVIVA 1 3
2 5

BLUE DOT 1 3

BSP 1 4
BSP 2 12
BSP 4 13
BSP 3 13
BSP 2 7
BSP 1 1
13 50

BUMI PUTRA 2 2

ELNUSA 1 2

GARDA MEDIK 1 6
GARDA MEDIK 1 4
2 10

GLOBAL 21 85
GLOBAL 1 4
GLOBAL 5 13
GLOBAL 4 21
31 123

JAMS 3 6
JAMS 8 27
JAMSOSTEK 6 19
JAMSOSTEK 4 22
JAMSOSTEK 9 51
JAMSOSTEK 1 4
JMT 12 66
43 195

KAI 4 8
KAI 1 7
KAI 2 9
KAI 1 3
KAI 1 3
9 30

LIPPO 1 5

MHP 1 2
MHP 1 1
MHP 4 8
 6 11

MNC LIFE 1 4

MULTI ARTHA 1 4

PERTAMINA 1 6
PERTAMINA 1 4
2 10

PNS 40 166
PNS 53 197
PNS 1 2
PNS 1 5
PNS 1 2
PNS 1 1
ASKES PNS 8 25
ASKES SOSIAL 16 57
ASKES SOSIAL 6 13
127 468

PRATAMA 1 2

PT PN7 6 20
PTPN 1 2
PTPN 7 1 3
PTPN 7 1 3
PTPN VII 1 3
PTPTN 7 2 9
12 40

SBAL 1 4

SIMAS 1 3
SIMAS 2 6
SIMAS 1 3
SIMAS 1 1
SIMAS 1 2
SINAR MAS 1 7
7 22

SOS 1 3
SOS 1 3
2 6

SOS FRUDENTI 1 5

SURYA AGROL 2 11
SURYA BUMI A 1 3
3 14

TANGKAS 1 3
TANGKAS 5 16
TANGKAS 3 9
TANGKAS 1 5
TANGKAS 1 3
11 36

TEL 5 18
TEL 1 1
TEL 4 12
TEL 1 2
TEL 2 8
TEL 14 53
27 94

THE 1 3

TITIS SAMPUR 1 4
TITIS SAMPUR 1 5
2 9

TRAKINDO 1 3

TUMAN 2 6
TUMAN 5 29
7 35
 KASUS JUMLAH

A
ANAK 80
ANAK 5
ANAK 10
ANAK 1
ANAK 70
ANAK 13
ANAK 12

BDH 6
BDH 5
BDH 1
BEDAH 43
BEDAH 3
BEDAH 3
BEDAH 2

GIGI 1

KAN 18
KAND 5
KAND 5
KAND 1

KEB 1
KEB 18
KEB 3
KEB 80
KEB 5
KEB 1

MATA 2
MATA 1

NEO 23
ORTOPEDI 1
ORTOPEDI 1

PDL 45
PDL 73
PDL 87
PDL 75
PDL 17
PDL 18
PDL 6
SYARAF 6
SYARAF 2
SYARAF 2
SYARAF 2
SYARAF 5
THT 1
THT 7
THT 2
THT 2
THT 3
THT 1
UMUM 7
UMUM 3
UMUM 3