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REKAPITULASI TINDAKAN IGD PASIEN RAWAT JALAN RUMAH SAKIT JIWA SAMBANG LIHUM

BULAN: Agustus 2014

PEMERIKSAAN
NO NAMA NO CM TGL MASUK
DOKTER Tindakan lain Jumlah

Nama tindakan Volume


1 M. Saleh 01 10 95 1/8/2014 Rp 30,000.00 Rp 30,000.00
2 Salamah 00 82 56 Rp 30,000.00 Rp 30,000.00
3 Suroto 00 68 52 Rp 30,000.00 Rp 30,000.00
4 Jubair 00 77 68 Rp 30,000.00 Rp 30,000.00
5 Nukman 00 75 76 Rp 30,000.00 Rp 30,000.00
6 Iin Parlina 01 68 19 Rp 30,000.00 Rp 30,000.00
7 Busairi 01 24 66 Rp 30,000.00 Rp 30,000.00
8 Anang Bahrudin 00 54 97 Rp 30,000.00 Rp 30,000.00
9 Raudah 01 68 52 Rp 30,000.00 Rp 30,000.00
10 Norhayati 01 24 20 Rp 30,000.00 Rp 30,000.00
11 Noviana 00 89 53 Rp 30,000.00 Rp 30,000.00
12 Suharwandi 01 69 23 Rp 30,000.00 Rp 30,000.00
13 Kamsiah 01 38 26 Rp 30,000.00 Rp 30,000.00
14 Slamet Riyadi 00 98 58 Rp 30,000.00 Rp 30,000.00
15 Ardiansyah 00 80 51 Rp 30,000.00 Rp 30,000.00
16 Ashani 01 69 13 Rp 30,000.00 Rp 30,000.00
17 Masruniah 01 69 45 Rp 30,000.00 Rp 30,000.00
18 Maidi Hambali 00 93 57 2/8/2014 Rp 30,000.00 Rp 30,000.00
19 Kaspuddin 01 00 04 Rp 30,000.00 Rp 30,000.00
20 Hardiansyah 01 60 84 Rp 30,000.00 Rp 30,000.00
21 Fajar Budiman 00 68 15 Rp 30,000.00 Rp 30,000.00
22 Humaidi 00 97 39 Rp 30,000.00 Rp 30,000.00
23 M. Lutf 00 90 20 Rp 30,000.00 Rp 30,000.00
24 Anggiat Selamat 00 90 51 Rp 30,000.00 Rp 30,000.00
25 Rusminah 01 59 63 Rp 30,000.00 Rp 30,000.00
26 M. Faizal 00 67 44 Rp 30,000.00 Rp 30,000.00
27 Risnawati 00 44 21 Rp 30,000.00 Rp 30,000.00
28 Henda Wijaya 01 18 72 Rp 30,000.00 Rp 30,000.00
29 Hasnah 00 69 53 Rp 30,000.00 Rp 30,000.00
30 Mulyani 01 28 70 Rp 30,000.00 Rp 30,000.00
31 Syaiful Rahman 01 20 18 Rp 30,000.00 Rp 30,000.00
32 Maskiah 01 55 20 Rp 30,000.00 Rp 30,000.00
33 Lamsiah 00 84 60 Rp 30,000.00 Rp 30,000.00
34 Fahmi Amrozi 00 97 57 Rp 30,000.00 Rp 30,000.00
35 Supian Sauri 01 37 06 Rp 30,000.00 Rp 30,000.00
36 Normilawati 01 67 32 Rp 30,000.00 Rp 30,000.00
37 Muchlis 01 19 86 Rp 30,000.00 Rp 30,000.00
38 Misdah 00 73 57 Rp 30,000.00 Rp 30,000.00
39 M. Zaini 01 22 07 Rp 30,000.00 Rp 30,000.00
40 Sri Ratna 01 69 48 Rp 30,000.00 Rp 30,000.00
41 Nordiani 01 28 97 Rp 30,000.00 Rp 30,000.00
42 Guruh 01 33 03 Rp 30,000.00 Rp 30,000.00
43 Mr. X (Yoga) 01 17 39 Rp 30,000.00 Rp 30,000.00
44 Yusup 01 64 85 Rp 30,000.00 Rp 30,000.00
45 Mr. X (Zainudin) 01 21 95 Rp 30,000.00 Rp 30,000.00
46 Yatrio 01 02 78 Rp 30,000.00 Rp 30,000.00
47 Pariani 01 18 26 Rp 30,000.00 Rp 30,000.00
48 Humaidi Syukri 01 69 46 Rp 30,000.00 Rp 30,000.00
49 Sri Maisyarah 01 66 47 Rp 30,000.00 Rp 30,000.00
50 Hamberani 01 12 68 Rp 30,000.00 Rp 30,000.00
51 Rahman 01 62 52 Rp 30,000.00 Rp 30,000.00
52 Sarkani 01 12 67 Rp 30,000.00 Rp 30,000.00
53 Ika Nurwalimah 01 09 22 Rp 30,000.00 Rp 30,000.00
54 Aan Kristian 01 66 37 Rp 30,000.00 Rp 30,000.00
55 Arif Rahman 01 52 85 Rp 30,000.00 Rp 30,000.00
56 Syamsul Bahran 00 94 06 Rp 30,000.00 Rp 30,000.00
57 Sriyati 01 21 83 Rp 30,000.00 Rp 30,000.00
58 Zuraidi 01 69 40 Rp 30,000.00 Rp 30,000.00
59 Abdul Qadir Jailani 01 12 89 Rp 30,000.00 Rp 30,000.00
60 M. Sukradudin 01 18 63 Rp 30,000.00 Rp 30,000.00
61 Arul 01 19 30 Rp 30,000.00 Rp 30,000.00
62 Aspian 00 83 46 Rp 30,000.00 Rp 30,000.00
63 Arif Budiman 00 77 61 Rp 30,000.00 Rp 30,000.00
64 M. Noor 00 98 84 Rp 30,000.00 Rp 30,000.00
65 I Gusti HGK 01 69 42 Rp 30,000.00 Rp 30,000.00
66 Padram 01 26 58 Rp 30,000.00 Rp 30,000.00
67 Alfradi 01 69 50 Rp 30,000.00 Rp 30,000.00
68 Inyadillah 01 69 51 Rp 30,000.00 Rp 30,000.00
69 Zaini 01 69 52 Rp 30,000.00 Rp 30,000.00
70 Supian. H 01 69 54 Rp 30,000.00 Rp 30,000.00
71 M. faisal 01 69 56 3/8/2014 Rp 30,000.00 Rp 30,000.00
72 Zainal Abidin 01 69 57 Rp 30,000.00 Rp 30,000.00
73 Heri Irawan 00 87 10 Rp 30,000.00 Rp 30,000.00
74 Anita 01 29 68 Rp 30,000.00 Rp 30,000.00
75 M. Khairudin 01 18 37 5/8/2014 Rp 30,000.00 Rp 30,000.00
76 Riswannor 01 18 96 Rp 30,000.00 Rp 30,000.00
77 A. Yani 01 69 72 6/8/2014 Rp 30,000.00 Rp 30,000.00
78 Saidah 01 69 74 Rp 30,000.00 Rp 30,000.00
79 Safrudin 01 28 18 Rp 30,000.00 Rp 30,000.00
80 Herliansyah 01 69 75 Rp 30,000.00 Rp 30,000.00
81 Udut. M 01 15 70 7/8/2014 Rp 30,000.00 Rp 30,000.00
82 Iwie Hindu 01 65 41 8/8/2014 Rp 30,000.00 Rp 30,000.00
83 Hasanudin 01 57 25 Rp 30,000.00 Rp 30,000.00
84 Hanapiah 01 69 12 Rp 30,000.00 Rp 30,000.00
85 Akhmad Khairiansyah 00 56 85 Rp 30,000.00 Rp 30,000.00
86 Rahmat Hidayat 01 69 96 9/8/2014 Rp 30,000.00 Rp 30,000.00
87 Suhardi 00 95 37 Rp 30,000.00 Rp 30,000.00
88 St. Maisarah 01 66 74 10/8/2014 Rp 30,000.00 Rp 30,000.00
89 Ika. N 01 09 22 Rp 30,000.00 Rp 30,000.00
90 Fathurrahman 01 01 82 Rp 30,000.00 Rp 30,000.00
91 Eni lestari 01 45 32 11/8/2014 Rp 30,000.00 Rp 30,000.00
92 Syarkawi 01 70 05 12/8/2014 Rp 30,000.00 Rp 30,000.00
93 Supian Sauri 01 00 11 Rp 30,000.00 Rp 30,000.00
94 Muna Hasanah 01 29 28 13/08/2014 Rp 30,000.00 Rp 30,000.00
95 Khairul Muis 01 64 37 Rp 30,000.00 Rp 30,000.00
96 Hardiman 01 70 14 14/8/2014 Rp 30,000.00 Rp 30,000.00
97 Marhawi 00 90 36 15/8/2014 Rp 30,000.00 Rp 30,000.00
98 Rahmad 01 68 91 16/8/2014 Rp 30,000.00 Rp 30,000.00
99 Ralubah 01 70 26 Rp 30,000.00 Rp 30,000.00
100 Zainal Abidin 01 69 57 Rp 30,000.00 Rp 30,000.00
101 Rahmad Pirdaus 01 68 91 Rp 30,000.00 Rp 30,000.00
102 Ahmad Humaidi 01 70 28 Rp 30,000.00 Rp 30,000.00
103 Slamet 01 09 68 18/8/2014 Rp 30,000.00 Rp 30,000.00
104 Taufk 01 34 86 Rp 30,000.00 Rp 30,000.00
105 khairul muis 01 64 73 Rp 30,000.00 Rp 30,000.00
106 Jusman Mangga Barane 01 07 47 19/8/2014 Rp 30,000.00 Rp 30,000.00
107 Suraya 01 70 44 20/8/2014 Rp 30,000.00 Rp 30,000.00
108 Zubaidah 00 69 76 21/8/2014 Rp 30,000.00 Rp 30,000.00
109 Sarmin 01 70 49 Rp 30,000.00 Rp 30,000.00
110 Aan Kristian 01 66 73 Rp 30,000.00 Rp 30,000.00
111 Salihin 01 67 16 Rp 30,000.00 Rp 30,000.00
112 Evy sri wahyuni 01 63 29 Rp 30,000.00 Rp 30,000.00
113 Rahmat Firdaus 01 68 91 22/08/2014 Rp 30,000.00 Rp 30,000.00
114 Munif 01 60 16 Rp 30,000.00 Rp 30,000.00
115 Arif. R. H 00 47 79 Rp 30,000.00 Rp 30,000.00
116 Saubari 01 70 51 Rp 30,000.00 Rp 30,000.00
117 Kumar 01 70 58 24/08/2014 Rp 30,000.00 Rp 30,000.00
118 Septian 01 70 59 Rp 30,000.00 Rp 30,000.00
119 Lilik Yulaikha 01 70 64 25/08/2014 Rp 30,000.00 Rp 30,000.00
120 Yani 01 53 73 Rp 30,000.00 Rp 30,000.00
121 M. Pandri 01 70 66 Rp 30,000.00 Rp 30,000.00
122 Rp -
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
Rp 3,630,000.00 Rp - Rp 3,630,000.00
STATUS

Umum
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BPJS
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BPJS
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Umum
Umum
Umum
Umum
BPJS
BPJS
BPJS
Umum
Umum
BPJS
Umum
Umum
JKD
Umum
BPJS
JKD
JKV
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
Umum
Umum
BPJS
BPJS
BPJS
BPJS
BPJS
Umum
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
Umum
Umum
BPJS
BPJS
BPJS
Umum
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BPJS
BPJS
Umum
BPJS
BPJS
BPJS
Umum
JKV
BPJS
Umum
Umum
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Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
JKV
Umum
JKV
BPJS
Umum
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BPJS
Umum
JKV
BPJS
BPJS
Umum
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BPJS
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REKAPITULASI TINDAKAN IGD PASIEN RAWAT JALAN RUMAH SAKIT JIWA SAMBANG LIHUM
BULAN: JULI 2014

PEMERIKSAAN
NO NAMA NO CM TGL MASUK
DOKTER Tindakan lain Jumlah

Nama tindakan Volume


1 Jumriah 01 67 73 1/7/2014 Rp 30,000.00 Rp 30,000.00
2 Sri W 01 63 29 Rp 30,000.00 Rp 30,000.00
3 Syarifudin 00 92 21 Rp 30,000.00 Rp 30,000.00
4 Syahrin 00 99 24 Rp 30,000.00 Rp 30,000.00
5 Laila 00 81 74 Rp 30,000.00 Rp 30,000.00
6 Rabiatul 00 58 60 Rp 30,000.00 Rp 30,000.00
7 Mujahidin Rp 30,000.00 Rp 30,000.00
8 Sutarjo 00 97 46 Rp 30,000.00 Rp 30,000.00
9 Helda Oktaviani 01 70 00 Rp 30,000.00 Rp 30,000.00
10 Sigit Andrianto 01 13 11 2/7/2014 Rp 30,000.00 Rp 30,000.00
11 Iyan 01 67 88 3/7/2014 Rp 30,000.00 injeksi Rp 10,000.00 1 Rp 40,000.00
12 Mukarno 01 67 89 Rp 30,000.00 Rp 30,000.00
13 Sarip 01 15 39 Rp 30,000.00 Rp 30,000.00
14 jono 01 05 45 Rp 30,000.00 Rp 30,000.00
15 abd hadi 01 27 56 Rp 30,000.00 Rp 30,000.00
16 Amrullah 00 85 10 Rp 30,000.00 Rp 30,000.00
17 Hendra 00 94 33 4/7/2014 Rp 30,000.00 Rp 30,000.00
18 M.Aliansyah 01 67 91 Rp 30,000.00 Injeksi + day care Rp 70,000.00 1+1 Rp 100,000.00
19 joko sudiarjo 01 67 92 Rp 30,000.00 Rp 30,000.00
20 sarman 01 67 94 Rp 30,000.00 Rp 30,000.00
21 Yustinah 01 67 93 Rp 30,000.00 Rp 30,000.00
22 Hasanudin 01 50 83 Rp 30,000.00 Rp 30,000.00
23 Nurhayati 01 61 83 5/7/2014 Rp 30,000.00 Rp 30,000.00
24 Mahrita (Ita) 01 67 99 Rp 30,000.00 Rp 30,000.00
25 Khairiah 00 86 41 6/7/2014 Rp 30,000.00 Rp 30,000.00
26 Samsul Rajak 01 68 00 Rp 30,000.00 Rp 30,000.00
27 Yudi M 01 24 23 Rp 30,000.00 Rp 30,000.00
28 Rasmadi 01 44 44 Rp 30,000.00 Rp 30,000.00
29 Rahmat 01 68 01 Rp 30,000.00 Rp 30,000.00
30 Abdul gani 01 68 04 7/7/2014 Rp 30,000.00 Rp 30,000.00
31 Jumanto 01 65 93 8/7/2014 Rp 30,000.00 Rp 30,000.00
32 Said abdul Rahman 01 55 71 Rp 30,000.00 Rp 30,000.00
33 M.Bahrudin Yusuf 01 10 63 Rp 30,000.00 Rp 30,000.00
34 Ratna 01 14 38 10/7/2014 Rp 30,000.00 Rp 30,000.00
35 M.raf'i 01 68 13 Rp 30,000.00 Rp 30,000.00
36 Abid 01 68 12 Rp 30,000.00 Rp 30,000.00
37 Adi irawan 01 68 21 12/7/2014 Rp 30,000.00 Rp 30,000.00
38 M.Buhariani 01 21 27 13/7/2014 Rp 30,000.00 Rp 30,000.00
39 Taufk Rahman 00 95 16 Rp 30,000.00 Rp 30,000.00
40 Iriani 01 12 65 14/7/2014 Rp 30,000.00 Rp 30,000.00
41 Zainal 01 66 85 Rp 30,000.00 Rp 30,000.00
42 Arif Rahman 01 68 30 Rp 30,000.00 Rp 30,000.00
43 Ratna Dewi 01 56 40 Rp 30,000.00 Rp 30,000.00
44 Mahesa 00 74 07 15/7/2014 Rp 30,000.00 Rp 30,000.00
45 Hairani 01 68 31 Rp 30,000.00 Rp 30,000.00
46 Nurkhamin 01 47 27 Rp 30,000.00 Rp 30,000.00
47 Mahdalena 01 36 12 Rp 30,000.00 Rp 30,000.00
48 Aprianto 01 02 51 17/07/2014 Rp 30,000.00 Rp 30,000.00
49 M. Masruri 01 25 62 Rp 30,000.00 Rp 30,000.00
50 M. Ali 00 71 49 Rp 30,000.00 Rp 30,000.00
51 Rahmat Firdaus 00 68 91 Rp 30,000.00 Rp 30,000.00
52 Munif 01 60 16 Rp 30,000.00 Rp 30,000.00
53 Wahyu 00 79 24 Rp 30,000.00 Rp 30,000.00
54 Nahdian 01 68 93 Rp 30,000.00 Rp 30,000.00
55 Norhayati 01 24 20 Rp 30,000.00 Rp 30,000.00
56 Susiana 01 68 94 Rp 30,000.00 Rp 30,000.00
57 Armadi 00 80 91 Rp 30,000.00 Rp 30,000.00
58 Sairaji 01 68 95 18/07/2014 Rp 30,000.00 Rp 30,000.00
59 I Nyoman 00 94 76 Rp 30,000.00 Rp 30,000.00
60 Suaib 01 68 96 Rp 30,000.00 Rp 30,000.00
61 M. Hasnan 01 65 17 Rp 30,000.00 Rp 30,000.00
62 Mahrida 01 29 18 19/07/2014 Rp 30,000.00 Rp 30,000.00
63 Gt. Riduan Syahrani 01 51 02 Rp 30,000.00 Rp 30,000.00
64 Norliana 01 69 00 Rp 30,000.00 Rp 30,000.00
65 Nurul Hidayat 01 69 01 Rp 30,000.00 Rp 30,000.00
66 Syarkani 01 35 17 Rp 30,000.00 Rp 30,000.00
67 Ashani 01 69 13 22/07/2014 Rp 30,000.00 Rp 30,000.00
68 Hanapiah 01 69 12 Rp 30,000.00 Rp 30,000.00
69 Soleh. D 01 51 79 Rp 30,000.00 Rp 30,000.00
70 Fahriadi 00 60 62 23/7/2014 Rp 30,000.00 Rp 30,000.00
71 M.albar 00 40 18 Rp 30,000.00 Rp 30,000.00
72 Heriyanto 00 90 91 Rp 30,000.00 Rp 30,000.00
73 Suharwandi 01 69 23 24/7/2014 Rp 30,000.00 Rp 30,000.00
74 Yenny 01 66 36 25/7/2014 Rp 30,000.00 Rp 30,000.00
75 alfan 00 79 15 Rp 30,000.00 Rp 30,000.00
76 M.Solihin 01 67 16 Rp 30,000.00 Rp 30,000.00
77 Noor hasanah 01 69 26 Rp 30,000.00 Rp 30,000.00
78 M.noor fasrin 01 69 25 Rp 30,000.00 Rp 30,000.00
79 Halil 01 55 11 26/7/2014 Rp 30,000.00 Rp 30,000.00
80 Jayadi 01 06 24 Rp 30,000.00 Rp 30,000.00
81 Hendra jaya 01 06 23 Rp 30,000.00 Rp 30,000.00
82 Hudari 01 27 11 Rp 30,000.00 Rp 30,000.00
83 Laili Sopiana 01 55 13 Rp 30,000.00 Rp 30,000.00
84 Ika Winardi 00 28 61 Rp 30,000.00 Rp 30,000.00
85 Ahmad Syaruji 01 23 81 Rp 30,000.00 Rp 30,000.00
86 Ratna Dewi 01 56 40 Rp 30,000.00 Rp 30,000.00
87 Dwi Lestari 01 26 21 Rp 30,000.00 Rp 30,000.00
88 Norasmah 00 85 66 Rp 30,000.00 Rp 30,000.00
89 Evi Sri Wahyuni 01 63 29 Rp 30,000.00 Rp 30,000.00
90 Syahril Ramadhan 01 69 29 28/07/2014 Rp 30,000.00 Rp 30,000.00
91 Iene Kula 01 69 30 Rp 30,000.00 Rp 30,000.00
92 M. Syahrudin 01 08 58 29/07/2014 Rp 30,000.00 Rp 30,000.00
93 Salimi 01 20 66 Rp 30,000.00 Rp 30,000.00
94 Maya Islamiah 01 47 73 Rp 30,000.00 Rp 30,000.00
95 Taufqurrahman 01 62 38 Rp 30,000.00 Rp 30,000.00
96 Markamah 01 69 32 Rp 30,000.00 Rp 30,000.00
97 Junaid 00 35 37 30/07/2014 Rp 30,000.00 Rp 30,000.00
98 M. Yusuf 01 50 81 Rp 30,000.00 Rp 30,000.00
99 Didi Hariadi 01 14 54 Rp 30,000.00 Rp 30,000.00
100 Wahidah 00 70 13 Rp 30,000.00 Rp 30,000.00
101 M. Fadlan 00 82 53 Rp 30,000.00 Rp 30,000.00
102 Ahmad 01 55 23 Rp 30,000.00 Rp 30,000.00
103 Slamet Raharjo 01 32 20 Rp 30,000.00 Rp 30,000.00
104 Nurjenah 01 32 65 Rp 30,000.00 Rp 30,000.00
105 Supian 01 33 50 Rp 30,000.00 Rp 30,000.00
106 Saibi 01 67 37 Rp 30,000.00 Rp 30,000.00
107 Septian 01 66 99 Rp 30,000.00 Rp 30,000.00
108 Rafi Hamdi 01 08 03 Rp 30,000.00 Rp 30,000.00
109 Sigit. A 01 13 11 Rp 30,000.00 Rp 30,000.00
110 Wahyudin 00 97 43 Rp 30,000.00 Rp 30,000.00
111 Nurhasanah 01 32 26 31/07/2014 Rp 30,000.00 Rp 30,000.00
112 Sri Agustina 01 48 12 Rp 30,000.00 Rp 30,000.00
113 Taufk Rahman 00 67 97 Rp 30,000.00 Rp 30,000.00
114 Sugian 01 57 77 Rp 30,000.00 Rp 30,000.00
115 Ahmad Holwah 00 84 92 Rp 30,000.00 Rp 30,000.00
116 Iswadi 00 71 70 Rp 30,000.00 Rp 30,000.00
117 A. Rifa'i 01 63 27 Rp 30,000.00 Rp 30,000.00
118 Tri. W 01 24 81 Rp 30,000.00 Rp 30,000.00
119 Salasiah 01 65 42 Rp 30,000.00 Rp 30,000.00
120 Siti Aisyah 00 96 63 Rp 30,000.00 Rp 30,000.00
121 Sairaji 01 68 95 Rp 30,000.00 Rp 30,000.00
122 Sri Wahyuni 01 69 39 Rp 30,000.00 Rp 30,000.00
123 Murhan 01 69 40 Rp 30,000.00 Rp 30,000.00
124 Isnawati 01 54 21 Rp 30,000.00 Rp 30,000.00
125 Ardiansyah 00 14 30 Rp 30,000.00 Rp 30,000.00
126 Puah 01 67 12 Rp 30,000.00 Rp 30,000.00
127 Rusiannor 00 97 27 Rp 30,000.00 Rp 30,000.00
128 Budiannor 01 50 30 Rp 30,000.00 Rp 30,000.00
129 Ny. X H (Sumi) 00 90 62 Rp 30,000.00 Rp 30,000.00
130 Nuraini 01 12 15 Rp 30,000.00 Rp 30,000.00
131 Mr.X (Udin) 01 56 74 Rp 30,000.00 Rp 30,000.00
132 Abdul Muin 01 06 04 Rp 30,000.00 Rp 30,000.00
133 Wahidah 01 06 76 Rp 30,000.00 Rp 30,000.00
134 Rahmadi 01 54 80 Rp 30,000.00 Rp 30,000.00
135 Hamdani 01 67 13 Rp 30,000.00 Rp 30,000.00
136 I Gusti N O K 01 69 42 Rp 30,000.00 Rp 30,000.00
137 Miftahussalam 01 68 61 Rp 30,000.00 Rp 30,000.00
138 Baidatussalimah 01 63 51 Rp 30,000.00 Rp 30,000.00
139 Yusriani 01 05 17 Rp 30,000.00 Rp 30,000.00
Rp 4,170,000.00 Rp 80,000.00 Rp 4,250,000.00
STATUS

Umum
BPJS
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BPJS
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BPJS
Umum
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BPJS
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BPJS
BPJS
Umum
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JKV
Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
BPJS
Umum
Umum
Umum
Umum
Umum
Umum
BPJS
Umum
Umum
JKD
BPJS
Umum
BPJS
Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
BPJS
Umum
Umum
BPJS
BPJS
Umum
Umum
Umum
BPJS
BPJS
Umum
JKV
Umum
Umum
Umum
BPJS
Umum
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BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
Umum
JKV
Umum
Umum
BPJS
Umum
Umum
BPJS
Umum
BPJS
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Umum
Umum
Umum
Umum
BPJS
Umum
BPJS
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BPJS
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BPJS
BPJS
Umum
BPJS
Umum
JKV
BPJS
Umum
BPJS
JKV
BPJS
BPJS
BPJS
BPJS
Umum
Umum
Umum
BPJS
JKV
JKV
JKV
BPJS
JKV
JKV
JKV
JKV
JKV
JKV
JKV
Umum
Umum
BPJS
Umum
REKAPITULASI TINDAKAN IGD PASIEN RAWAT JALAN RUMAH SAKIT JIWA SAMBANG LIHUM
BULAN: JUNI 2014

PEMERIKSAAN
NO NAMA NO CM TGL MASUK
DOKTER Tindakan lain Jumlah

Nama tindakan Volume


1 Slamet Riyadi 00 98 55 1/6/2014 Rp 30,000.00 Rp 30,000.00
2 Hesti 01 14 70 Rp 30,000.00 Rp 30,000.00
3 Husnul Janatul Husna 01 52 35 Rp 30,000.00 Rp 30,000.00
4 M.Noor 00 98 84 Rp 30,000.00 Rp 30,000.00
5 M.Ali 00 76 25 Rp 30,000.00 Rp 30,000.00
6 M.Ali 00 71 49 Rp 30,000.00 Rp 30,000.00
7 Anggiat Selamet 00 90 51 Rp 30,000.00 Rp 30,000.00
8 Hamsan 01 00 81 Rp 30,000.00 Rp 30,000.00
9 M.Amroji 01 66 13 Rp 30,000.00 Rp 30,000.00
10 Juhansyah 01 51 59 2/6/2014 Rp 30,000.00 Rp 30,000.00
11 Nur L 01 47 27 Rp 30,000.00 Rp 30,000.00
12 Gusti Husnul 01 63 15 Rp 30,000.00 Rp 30,000.00
13 Hermansyah 01 62 90 Rp 30,000.00 Rp 30,000.00
14 Lukman 01 63 08 Rp 30,000.00 Rp 30,000.00
15 Rosdiana 00 98 46 Rp 30,000.00 Rp 30,000.00
16 Norhawi 01 66 18 Rp 30,000.00 one day care Rp 60,000.00 Rp 90,000.00
17 Jurmiah 01 59 64 3/6/2014 Rp 30,000.00 Rp 30,000.00
18 Syarwani 01 58 06 Rp 30,000.00 Rp 30,000.00
19 Muhammad 00 48 80 Rp 30,000.00 Rp 30,000.00
20 Edi santoso 00 68 59 4/6/2014 Rp 30,000.00 Rp 30,000.00
21 Wibisono 01 22 22 Rp 30,000.00 Rp 30,000.00
22 Bambang Erwanto 01 48 73 Rp 30,000.00 Rp 30,000.00
23 Masdar 01 66 31 Rp 30,000.00 Rp 30,000.00
24 Katiyem 01 66 30 Rp 30,000.00 Rp 30,000.00
25 Rajudinnor 00 98 04 Rp 30,000.00 Rp 30,000.00
26 Halifah 01 14 68 Rp 30,000.00 Rp 30,000.00
27 Yuli Ansari 00 70 37 5/6/2014 Rp 30,000.00 Rp 30,000.00
28 Zainal M 00 14 34 Rp 30,000.00 Rp 30,000.00
29 Wahyudi 01 61 87 Rp 30,000.00 Rp 30,000.00
30 Farid 01 66 35 Rp 30,000.00 Rp 30,000.00
31 Arpani 01 66 37 6/6/2014 Rp 30,000.00 Rp 30,000.00
32 Harto 00 82 77 Rp 30,000.00 Rp 30,000.00
33 M.Isra 01 31 92 Rp 30,000.00 Rp 30,000.00
34 Ahmad 01 26 14 Rp 30,000.00 Rp 30,000.00
35 Mailin 01 17 54 Rp 30,000.00 Rp 30,000.00
36 Rusita 00 94 81 Rp 30,000.00 Rp 30,000.00
37 Nur H 01 53 10 Rp 30,000.00 Rp 30,000.00
38 Rasman 01 59 77 Rp 30,000.00 Rp 30,000.00
39 Jamil M 01 07 88 Rp 30,000.00 Rp 30,000.00
40 Rusni 00 91 87 Rp 30,000.00 Rp 30,000.00
41 M.Bahariani 01 21 37 Rp 30,000.00 Rp 30,000.00
42 Husin Rijali 01 66 38 Rp 30,000.00 Rp 30,000.00
43 Rustam Efendi 01 28 46 7/6/2014 Rp 30,000.00 Rp 30,000.00
44 said abdul rahman 01 55 71 Rp 30,000.00 Rp 30,000.00
45 Rabialnur 00 84 14 Rp 30,000.00 Rp 30,000.00
46 salasiah 00 86 70 Rp 30,000.00 Rp 30,000.00
47 salmansyah 01 47 26 Rp 30,000.00 Rp 30,000.00
48 Syahriati 00 97 99 8/6/2014 Rp 30,000.00 Rp 30,000.00
49 Saman 01 07 99 Rp 30,000.00 Rp 30,000.00
50 Feriyadi 01 65 40 9/6/2014 Rp 30,000.00 Rp 30,000.00
51 Aspani 00 85 81 Rp 30,000.00 Rp 30,000.00
52 Asep Rizal 00 91 90 Rp 30,000.00 Rp 30,000.00
53 Heldayanti 01 66 49 Rp 30,000.00 Rp 30,000.00
54 Umi Nurhayati 00 68 04 Rp 30,000.00 Rp 30,000.00
55 Khairul. M 01 64 73 10/6/2014 Rp 30,000.00 Rp 30,000.00
56 Ahm. Darul 01 06 10 Rp 30,000.00 Rp 30,000.00
57 M. Said 01 06 56 Rp 30,000.00 Rp 30,000.00
58 Puspa. A 01 60 44 Rp 30,000.00 Rp 30,000.00
59 Muna Hasanah 01 29 28 Rp 30,000.00 Rp 30,000.00
60 Norhasanah 01 66 70 11/6/2014 Rp 30,000.00 Rp 30,000.00
61 Junaidi 01 52 86 12/6/2014 Rp 30,000.00 Rp 30,000.00
62 Saripudin 01 28 41 13/6/2014 Rp 30,000.00 Rp 30,000.00
63 Malik Ibrahim 01 66 78 Rp 30,000.00 Rp 30,000.00
64 Sarpriansyah 01 21 84 Rp 30,000.00 Rp 30,000.00
65 Ahmad 01 56 75 Rp 30,000.00 Rp 30,000.00
66 St.Aisyah 00 96 63 Rp 30,000.00 Rp 30,000.00
67 Mesa 01 66 81 Rp 30,000.00 Rp 30,000.00
68 Pahmi 01 22 43 Rp 30,000.00 Rp 30,000.00
69 Laili Sopiana 01 55 13 Rp 30,000.00 Rp 30,000.00
70 Adi P 00 88 98 Rp 30,000.00 Rp 30,000.00
71 Anshar 01 66 82 Rp 30,000.00 Rp 30,000.00
72 Norbain 01 32 17 14/6/2014 Rp 30,000.00 Rp 30,000.00
73 Adi Heru 01 34 25 Rp 30,000.00 Rp 30,000.00
74 Dwi Lestari 01 26 21 Rp 30,000.00 Rp 30,000.00
75 M.Dzuraini 01 66 88 Rp 30,000.00 Rp 30,000.00
76 A.Maulana 01 13 64 Rp 30,000.00 Rp 30,000.00
77 Ahdarinoor 01 01 12 Rp 30,000.00 Rp 30,000.00
78 Ana Komsiah 00 94 80 Rp 30,000.00 Rp 30,000.00
79 Bahrudin 01 16 69 Rp 30,000.00 Rp 30,000.00
80 St.Bariah 00 68 32 Rp 30,000.00 Rp 30,000.00
81 Marluwi 01 66 87 Rp 30,000.00 Rp 30,000.00
82 Maswiah 01 66 32 Rp 30,000.00 Rp 30,000.00
83 Gt.Ihsan 01 14 18 Rp 30,000.00 Rp 30,000.00
84 Sariyati 01 13 91 Rp 30,000.00 Rp 30,000.00
85 Kartasiah 01 36 58 15/6/2014 Rp 30,000.00 Rp 30,000.00
86 Hamisah 01 14 35 Rp 30,000.00 Rp 30,000.00
87 Mulia Rahman 01 26 71 Rp 30,000.00 Rp 30,000.00
88 Bahrani 00 99 57 Rp 30,000.00 Rp 30,000.00
89 Wartini 01 66 90 Rp 30,000.00 Rp 30,000.00
90 Nurtinah 01 49 31 Rp 30,000.00 Rp 30,000.00
91 Lamsani 00 75 66 16/6/2014 Rp 30,000.00 Rp 30,000.00
92 Ujun 01 05 45 Rp 30,000.00 Rp 30,000.00
93 Hatijah 01 05 51 Rp 30,000.00 Rp 30,000.00
94 A.Musaddah 01 58 03 Rp 30,000.00 Rp 30,000.00
95 Pariani 01 18 26 17/06/2014 Rp 30,000.00 Rp 30,000.00
96 Rajudinnor 00 98 04 Rp 30,000.00 Rp 30,000.00
97 Bahtimi 00 28 49 Rp 30,000.00 Rp 30,000.00
98 Maysarah 01 67 04 Rp 30,000.00 Rp 30,000.00
99 Soleh Darmono 01 56 84 Rp 30,000.00 Rp 30,000.00
100 Sri Agustina 01 48 12 Rp 30,000.00 Rp 30,000.00
101 Sri Wulanda 01 09 25 Rp 30,000.00 Rp 30,000.00
102 Abdul kadir 01 10 11 18/06/2014 Rp 30,000.00 Rp 30,000.00
103 Supian Suri 01 00 11 Rp 30,000.00 Rp 30,000.00
104 Ardiansyah 00 80 51 Rp 30,000.00 Rp 30,000.00
105 Marhawi 00 90 36 Rp 30,000.00 Rp 30,000.00
106 Randika Fantra 01 67 11 Rp 30,000.00 Rp 30,000.00
107 Dedy Ari 01 57 75 19/06/2014 Rp 30,000.00 Rp 30,000.00
108 Norasmah 00 85 66 Rp 30,000.00 Rp 30,000.00
109 Fitri 01 60 74 Rp 30,000.00 Rp 30,000.00
110 Akhmad 00 83 53 Rp 30,000.00 Rp 30,000.00
111 Alfansyah 01 45 61 Rp 30,000.00 Rp 30,000.00
112 Hermansyah 01 62 50 20/6/2014 Rp 30,000.00 Rp 30,000.00
113 Wardah 01 67 18 Rp 30,000.00 Rp 30,000.00
114 M. Rahmadi 00 92 07 Rp 30,000.00 Rp 30,000.00
115 Rahman 01 07 93 Rp 30,000.00 Rp 30,000.00
116 Gt. Riduan Syairan 01 51 02 Rp 30,000.00 Rp 30,000.00
117 Aluh 01 57 69 Rp 30,000.00 Rp 30,000.00
118 Hasan Basri 01 20 02 21/6/2014 Rp 30,000.00 Rp 30,000.00
119 Juhansyah 01 51 59 Rp 30,000.00 Rp 30,000.00
120 Purwito 01 19 42 Rp 30,000.00 Rp 30,000.00
121 Norma 00 87 37 Rp 30,000.00 Rp 30,000.00
122 Arsadi 00 93 31 Rp 30,000.00 Rp 30,000.00
123 Linda sari 00 84 54 Rp 30,000.00 Rp 30,000.00
124 Ismail 00 95 42 Rp 30,000.00 Rp 30,000.00
125 Adi rahman 00 98 70 Rp 30,000.00 Rp 30,000.00
126 Humaidi 01 63 06 Rp 30,000.00 Rp 30,000.00
127 Zainal Abidin 00 88 35 Rp 30,000.00 Rp 30,000.00
128 Mesa 01 66 01 22/6/2014 Rp 30,000.00 Rp 30,000.00
129 A.Busairi 01 24 66 Rp 30,000.00 Rp 30,000.00
130 marijan 01 11 14 Rp 30,000.00 Rp 30,000.00
131 Juami 01 51 00 Rp 30,000.00 Rp 30,000.00
132 Saprudin 01 28 18 Rp 30,000.00 Rp 30,000.00
133 Jumiati 01 19 62 Rp 30,000.00 Rp 30,000.00
134 Waluyo 01 19 83 Rp 30,000.00 Rp 30,000.00
135 Fathurahman 01 01 82 Rp 30,000.00 Rp 30,000.00
136 Juami 01 51 00 Rp 30,000.00 Rp 30,000.00
137 Arif Rahman 01 67 23 Rp 30,000.00 Rp 30,000.00
138 Lahuddin 00 86 09 Rp 30,000.00 Rp 30,000.00
139 M.Yunus 01 47 92 Rp 30,000.00 Rp 30,000.00
140 Kasran Efendi 00 95 45 23/6/2014 Rp 30,000.00 Rp 30,000.00
141 Syarwani 01 58 06 Rp 30,000.00 Rp 30,000.00
142 Norlian 01 27 05 Rp 30,000.00 Rp 30,000.00
143 Herkani 01 59 83 Rp 30,000.00 Rp 30,000.00
144 Kamsiah 01 38 26 Rp 30,000.00 Rp 30,000.00
145 Mochamad Alkiyal 01 67 35 Rp 30,000.00 Rp 30,000.00
146 Munif 01 60 16 24/6/2014 Rp 30,000.00 Rp 30,000.00
147 Ahmad syaifulah 00 98 59 Rp 30,000.00 Rp 30,000.00
148 Zubaidah 00 69 76 Rp 30,000.00 Rp 30,000.00
149 Sri Haryati 00 91 82 Rp 30,000.00 Rp 30,000.00
150 Sahudin 01 18 82 Rp 30,000.00 Rp 30,000.00
151 Hamsah 01 67 39 Rp 30,000.00 Rp 30,000.00
152 H.Mas'ud 01 57 60 Rp 30,000.00 Rp 30,000.00
153 Nuriah 00 59 61 25/6/2014 Rp 30,000.00 Rp 30,000.00
154 Mustafa 01 52 97 Rp 30,000.00 Rp 30,000.00
155 fery suyono 01 67 47 Rp 30,000.00 Rp 30,000.00
156 Aan Kristian 01 66 73 26/6/2014 Rp 30,000.00 Rp 30,000.00
157 Wibisono 01 22 22 Rp 30,000.00 Rp 30,000.00
158 Adil Mubarak 01 55 28 Rp 30,000.00 Rp 30,000.00
159 Nurlela 01 48 92 Rp 30,000.00 Rp 30,000.00
160 Hambali 01 57 68 Rp 30,000.00 Rp 30,000.00
161 Mahenda Rp 30,000.00 Fixasi Rp 30,000.00 Rp 60,000.00
162 Noor Hatati 01 59 18 27/6/2014 Rp 30,000.00 Rp 30,000.00
163 Kurniansyah 01 57 20 Rp 30,000.00 Rp 30,000.00
164 Yusran 00 95 41 Rp 30,000.00 Rp 30,000.00
165 Khairani 01 33 38 Rp 30,000.00 Rp 30,000.00
166 Hardiansyah 01 60 48 Rp 30,000.00 Rp 30,000.00
167 Noor Latifah 01 53 13 Rp 30,000.00 Rp 30,000.00
168 Halil 01 55 11 Rp 30,000.00 Rp 30,000.00
169 Mahyuni 00 68 40 Rp 30,000.00 Rp 30,000.00
170 Sawiyah 01 48 18 Rp 30,000.00 Rp 30,000.00
171 Puspa annisa 01 60 44 Rp 30,000.00 Rp 30,000.00
172 Dahlia 00 84 59 Rp 30,000.00 Rp 30,000.00
173 M.Arsyad 01 67 68 Rp 30,000.00 Rp 30,000.00
174 Prianto 00 81 88 28/6/2014 Rp 30,000.00 Rp 30,000.00
175 M.taufk 01 34 86 Rp 30,000.00 Rp 30,000.00
176 Umar Ali 01 18 21 Rp 30,000.00 Rp 30,000.00
177 Salasiah 00 86 70 Rp 30,000.00 Rp 30,000.00
178 Fauzan 00 93 88 Rp 30,000.00 Rp 30,000.00
179 Dwi Yatrimi 00 39 18 29/6/2014 Rp 30,000.00 Rp 30,000.00
180 A.Rasiyan H 01 56 29 Rp 30,000.00 Rp 30,000.00
181 Kartaniah 01 36 58 Rp 30,000.00 Rp 30,000.00
182 Anang 01 19 39 Rp 30,000.00 Rp 30,000.00
183 Hasbullah 01 17 50 Rp 30,000.00 Rp 30,000.00
184 Samiah 00 68 13 Rp 30,000.00 Rp 30,000.00
185 junaid 00 35 37 Rp 30,000.00 Rp 30,000.00
186 Saplani 01 66 55 30/6/2014 Rp 30,000.00 Rp 30,000.00
187 Samsul 00 99 33 Rp 30,000.00 Rp 30,000.00
188 Mahliyana 00 99 36 Rp 30,000.00 Rp 30,000.00
189 Misnawati 01 62 77 Rp 30,000.00 Rp 30,000.00
Rp 5,670,000.00 Rp 90,000.00 Rp 5,760,000.00
STATUS

DP
JKV
BPJS
BPJS
BPJS
Umum
JKD
Umum
Umum
Umum
BPJS
Umum
BPJS

Umum
Umum
BPJS
BPJS
BPJS
Umum
JKV
Umum
Umum
Umum
BPJS
Umum
BPJS
Umum
JKV
Umum
Umum
BPJS
BPJS
BPJS
DP
JKD
BPJS
JKV
BPJS
Umum
Umum
Umum
BPJS
Umum
JKD
BPJS
Umum
BPJS
BPJS
Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
BPJS
Umum
Umum
BPJS
BPJS
Umum
BPJS
DP
BPJS
BPJS
BPJS
BPJS
Umum
Umum
JKD
JKV
Umum
Umum
Umum
BPJS
Umum
Umum
Umum
Umum
Umum
Umum
Umum
BPJS
Umum
Umum
BPJS
Umum
Umum
BPJS
BPJS
Umum
Umum
BPJS
BPJS
BPJS
Umum
Umum
JKV
JKD
Umum
JKD
BPJS
JKV
Umum
Umum
JKV
BPJS
BPJS
JKD
BPJS
Umum
Umum
Umum
Umum
Umum
BPJS
BPJS
BPJS
Umum
BPJS
Umum
Umum
Umum
BPJS
Umum
BPJS
Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
Umum
BPJS
Umum
BPJS
BPJS
Umum
Umum
BPJS
Umum
Umum
JKD
Umum
BPJS
Umum
Umum
Umum
BPJS
BPJS
Umum
BPJS
BPJS
JKD
BPJS
BPJS
Umum
BPJS
BPJS
BPJS
JKV
Umum
BPJS
BPJS
Umum
BPJS
BPJS
Umum
Umum
BPJS
Umum
BPJS
BPJS
BPJS
Umum
BPJS
BPJS
Umum
BPJS
BPJS
Umum
Umum
Umum
BPJS
Umum
REKAPITULASI TINDAKAN IGD PASIEN RAWAT JALAN RUMAH SAKIT JIWA SAMBANG LIHUM
BULAN: MEI 2014

PEMERIKSAAN
NO NAMA NO CM TGL MASUK
DOKTER Tindakan lain Jumlah

Nama tindakan Volume


1 M.Saputra 01 25 13 1/5/2014 Rp 30,000.00 Rp 30,000.00
2 Kastasiah 01 36 58 Rp 30,000.00 Rp 30,000.00
3 H.Dulah 01 49 39 Rp 30,000.00 Rp 30,000.00
4 Abd fatah 00 56 20 Rp 30,000.00 Rp 30,000.00
5 Nor ainah 01 11 67 Rp 30,000.00 Rp 30,000.00
6 ida susanto 01 55 90 Rp 30,000.00 Rp 30,000.00
7 Mahyuni 01 08 04 Rp 30,000.00 Rp 30,000.00
8 M.Noor 00 98 84 Rp 30,000.00 Rp 30,000.00
9 Zaitun 01 54 15 Rp 30,000.00 Rp 30,000.00
10 Arbainah 01 54 14 Rp 30,000.00 Rp 30,000.00
11 Yana Yulianti 01 64 18 Rp 30,000.00 Rp 30,000.00
12 Ika winardi 00 88 61 Rp 30,000.00 Rp 30,000.00
13 Rahdian 01 64 21 Rp 30,000.00 Rp 30,000.00
14 Noviana 00 89 53 2/5/2014 Rp 30,000.00 Rp 30,000.00
15 Hatnah 00 69 53 Rp 30,000.00 Rp 30,000.00
16 Hasbiah 01 43 66 Rp 30,000.00 Rp 30,000.00
17 Hamsan 01 00 81 Rp 30,000.00 Rp 30,000.00
18 M.Syarbani 01 53 75 Rp 30,000.00 Rp 30,000.00
19 Aminah 01 61 12 Rp 30,000.00 Rp 30,000.00
20 Jono 01 05 45 Rp 30,000.00 Rp 30,000.00
21 Didik S 01 64 24 Rp 30,000.00 Rp 30,000.00
22 M.Syamsudin 01 08 58 Rp 30,000.00 Rp 30,000.00
23 Ratna sari 01 00 20 Rp 30,000.00 Rp 30,000.00
24 Norbayah 01 32 15 Rp 30,000.00 Rp 30,000.00
25 M.Arifn 00 79 45 Rp 30,000.00 Rp 30,000.00
26 Kasmawati 00 86 24 3/5/2014 Rp 30,000.00 Rp 30,000.00
27 Muhammad 00 48 80 Rp 30,000.00 Rp 30,000.00
28 Rustam E 01 28 46 Rp 30,000.00 Rp 30,000.00
29 Idrus 01 26 69 Rp 30,000.00 Rp 30,000.00
30 Purwito 01 19 42 Rp 30,000.00 Rp 30,000.00
31 Husnul Janatul 01 52 35 4/5/2014 Rp 30,000.00 Rp 30,000.00
32 Titin Sumarni 01 64 28 Rp 30,000.00 Rp 30,000.00
33 Bahrani 00 99 57 Rp 30,000.00 Rp 30,000.00
34 Abd Rasyid 01 63 00 Rp 30,000.00 Rp 30,000.00
35 Anggiat Selamat 00 90 51 Rp 30,000.00 Rp 30,000.00
36 Siam Rosida 01 24 57 5/5/2014 Rp 30,000.00 Rp 30,000.00
37 Salimi 01 02 96 Rp 30,000.00 Rp 30,000.00
38 Husni 00 75 77 Rp 30,000.00 Rp 30,000.00
39 Kursani 01 29 71 Rp 30,000.00 Rp 30,000.00
40 saman 01 18 99 6/5/2014 Rp 30,000.00 Rp 30,000.00
41 Rahman 01 07 93 Rp 30,000.00 Rp 30,000.00
42 Kasrani 00 95 45 Rp 30,000.00 Rp 30,000.00
43 Aluh 01 57 69 Rp 30,000.00 Rp 30,000.00
44 Alifansyah 01 45 61 Rp 30,000.00 Rp 30,000.00
45 Taufkurahman 01 61 38 7/5/2014 Rp 30,000.00 Rp 30,000.00
46 Syamsi 00 96 06 Rp 30,000.00 Rp 30,000.00
47 Juhansyah 01 51 59 Rp 30,000.00 Rp 30,000.00
48 Sarip rahman 01 15 39 Rp 30,000.00 Rp 30,000.00
49 M.Syarbani 01 53 75 Rp 30,000.00 Rp 30,000.00
50 Fahriah 01 64 43 Rp 30,000.00 Rp 30,000.00
51 M.Imron 00 84 98 Rp 30,000.00 Rp 30,000.00
52 Juleha 01 48 08 Rp 30,000.00 Rp 30,000.00
53 M.yunus 01 47 92 Rp 30,000.00 Rp 30,000.00
54 Mustafa A 01 52 97 8/5/2014 Rp 30,000.00 Rp 30,000.00
55 Aslamiah 01 64 51 Rp 30,000.00 Rp 30,000.00
56 St.Nurhamidah 01 25 09 9/5/2014 Rp 30,000.00 Rp 30,000.00
57 Jamiyah 01 25 30 Rp 30,000.00 Rp 30,000.00
58 samsudin 01 24 30 Rp 30,000.00 Rp 30,000.00
59 Salamiah 01 53 83 Rp 30,000.00 Rp 30,000.00
60 ardiansyah 01 29 20 Rp 30,000.00 Rp 30,000.00
61 St.Aminah 01 49 79 Rp 30,000.00 Rp 30,000.00
62 M.Harun 01 31 91 Rp 30,000.00 Rp 30,000.00
63 Dodi Anwar 00 79 98 Rp 30,000.00 Rp 30,000.00
64 Sarbani 01 51 76 Rp 30,000.00 Rp 30,000.00
65 Jami 01 64 59 Rp 30,000.00 Rp 30,000.00
66 Mariyani 01 53 71 Rp 30,000.00 Rp 30,000.00
67 Komang 01 64 63 Rp 30,000.00 Rp 30,000.00
68 Muliadi 01 25 53 Rp 30,000.00 Rp 30,000.00
69 Fahul janah 01 30 02 Rp 30,000.00 Rp 30,000.00
70 Junaidi 01 52 86 Rp 30,000.00 Rp 30,000.00
71 Edy Fahri 01 19 97 Rp 30,000.00 Rp 30,000.00
72 M.Budi Setiawan 01 64 66 Rp 30,000.00 Rp 30,000.00
73 Muhlis 01 19 86 10/5/2014 Rp 30,000.00 Rp 30,000.00
74 Norasmah 00 85 66 Rp 30,000.00 Rp 30,000.00
75 Ratnadewi 01 56 40 Rp 30,000.00 Rp 30,000.00
76 Goe yang ching 00 14 13 Rp 30,000.00 Rp 30,000.00
77 Tarmiji 00 76 06 Rp 30,000.00 Rp 30,000.00
78 Sariansyah 01 48 77 Rp 30,000.00 Rp 30,000.00
79 Ahmad 01 16 26 Rp 30,000.00 Rp 30,000.00
80 M.Ali 00 76 25 11/5/2014 Rp 30,000.00 Rp 30,000.00
81 Syahriati 00 97 99 Rp 30,000.00 Rp 30,000.00
82 Fatharrahman 01 01 82 Rp 30,000.00 Rp 30,000.00
83 Khairulmuis 01 64 73 Rp 30,000.00 Rp 30,000.00
84 St Asmunah 01 23 45 Rp 30,000.00 Rp 30,000.00
85 Muhammad Huzairin 01 64 79 12/5/2014 Rp 30,000.00 Rp 30,000.00
86 Yasir Arafat 01 33 08 Rp 30,000.00 Rp 30,000.00
87 Abdi 01 05 84 Rp 30,000.00 Rp 30,000.00
88 Saymsul 00 88 94 Rp 30,000.00 Rp 30,000.00
89 Wawan F 00 76 53 Rp 30,000.00 Rp 30,000.00
90 Alex Praja 01 62 89 Rp 30,000.00 Rp 30,000.00
91 Taufk Akbar 01 64 81 13/5/2014 Rp 30,000.00 Fixasi + obs Rp 90,000.00 Rp 120,000.00
92 Soleh Darmono 01 51 79 Rp 30,000.00 Rp 30,000.00
93 Jasmani 00 71 54 Rp 30,000.00 Rp 30,000.00
94 Salasiah 00 86 70 Rp 30,000.00 Rp 30,000.00
95 Irawati 01 28 51 Rp 30,000.00 Rp 30,000.00
96 Hasan Basri 01 20 02 Rp 30,000.00 Rp 30,000.00
97 Syarwani 01 58 06 Rp 30,000.00 Rp 30,000.00
98 Wahyudi 00 86 04 Rp 30,000.00 Rp 30,000.00
99 Ujun 01 05 45 Rp 30,000.00 Rp 30,000.00
100 Hasanudin 01 57 25 Rp 30,000.00 Rp 30,000.00
101 Razudinoor 01 98 04 14/5/2014 Rp 30,000.00 Rp 30,000.00
102 Niliani 01 30 99 Rp 30,000.00 Rp 30,000.00
103 Supriyadi 00 58 45 Rp 30,000.00 Rp 30,000.00
104 A.Yani 01 19 10 Rp 30,000.00 Rp 30,000.00
105 A.Khairil 00 85 50 Rp 30,000.00 Rp 30,000.00
106 Alfan noor 01 41 90 15/5/2014 Rp 30,000.00 Rp 30,000.00
107 And Fatah 00 56 20 Rp 30,000.00 Rp 30,000.00
108 M.Zurqoni 01 24 09 Rp 30,000.00 Rp 30,000.00
109 Mahyani 00 89 94 Rp 30,000.00 Rp 30,000.00
110 Didik Supriyono 01 64 24 Rp 30,000.00 Rp 30,000.00
111 Fahriani 01 47 02 Rp 30,000.00 Rp 30,000.00
112 Titin Sumarni 01 64 28 Rp 30,000.00 Rp 30,000.00
113 Herwan Fariza 00 88 56 Rp 30,000.00 Rp 30,000.00
114 Safrudin 01 28 18 Rp 30,000.00 Rp 30,000.00
115 Yamani 01 26 79 Rp 30,000.00 Rp 30,000.00
116 Mulia 00 64 82 Rp 30,000.00 Rp 30,000.00
117 Ardiansyah 00 80 51 Rp 30,000.00 Rp 30,000.00
118 Abdul Halim 01 59 92 Rp 30,000.00 Rp 30,000.00
119 M.Rasyid 01 19 38 16/5/2014 Rp 30,000.00 Rp 30,000.00
120 Nurjenah 01 32 65 Rp 30,000.00 Rp 30,000.00
121 Norainah 01 11 67 Rp 30,000.00 Rp 30,000.00
122 Samsudinor 00 97 81 Rp 30,000.00 Rp 30,000.00
123 Rian hidayat 00 69 87 Rp 30,000.00 Rp 30,000.00
124 laila Sopiana 01 55 13 Rp 30,000.00 Rp 30,000.00
125 Mastur 01 08 60 Rp 30,000.00 Rp 30,000.00
126 St Rusnadirah 00 71 71 Rp 30,000.00 Rp 30,000.00
127 Bayu Tejo 01 24 43 Rp 30,000.00 Rp 30,000.00
128 Wibisono 01 22 22 Rp 30,000.00 Rp 30,000.00
129 Agus Arianto 01 55 55 Rp 30,000.00 Rp 30,000.00
130 Umiah 01 36 44 Rp 30,000.00 Rp 30,000.00
131 Kamsiah 01 38 26 Rp 30,000.00 Rp 30,000.00
132 Saman 01 07 99 Rp 30,000.00 Rp 30,000.00
133 Mulyani 01 28 70 Rp 30,000.00 Rp 30,000.00
134 M. Arifn 00 79 45 Rp 30,000.00 Rp 30,000.00
135 Juli Ansari 00 70 37 Rp 30,000.00 Rp 30,000.00
136 Kasran Effendi 00 95 45 17/05/2014 Rp 30,000.00 Rp 30,000.00
137 Ryan Hidayat 01 62 47 Rp 30,000.00 Rp 30,000.00
138 Rustam Effendi 01 28 46 Rp 30,000.00 Rp 30,000.00
139 Yudi Mulyadi 01 24 23 Rp 30,000.00 Rp 30,000.00
140 M. Syahrudin 01 08 58 Rp 30,000.00 Rp 30,000.00
141 Linier Fauzi 01 03 43 Rp 30,000.00 Rp 30,000.00
142 Rahman 01 59 77 18/05/2014 Rp 30,000.00 Rp 30,000.00
143 Husnul 01 52 35 Rp 30,000.00 Rp 30,000.00
144 Sarbaini 01 52 76 Rp 30,000.00 Rp 30,000.00
145 Yuliana 00 68 90 Rp 30,000.00 Rp 30,000.00
146 Zainal Anwar 01 62 33 Rp 30,000.00 Rp 30,000.00
147 Jumiati 01 19 62 Rp 30,000.00 Rp 30,000.00
148 Abd. Bakri 01 57 34 Rp 30,000.00 Rp 30,000.00
149 Muna Hasanah 01 29 28 19/5/2014 Rp 30,000.00 Rp 30,000.00
150 A.Yusuf 0129 42 Rp 30,000.00 Rp 30,000.00
151 Purwito 01 19 42 Rp 30,000.00 Rp 30,000.00
152 Marliawah 01 57 91 Rp 30,000.00 Rp 30,000.00
153 Badarudin 01 30 67 20/5/2014 Rp 30,000.00 Rp 30,000.00
154 Yusuf 01 51 66 Rp 30,000.00 Rp 30,000.00
155 Rahman 01 07 93 Rp 30,000.00 Rp 30,000.00
156 Zuharsyah 01 51 59 Rp 30,000.00 Rp 30,000.00
157 Masrawan 01 65 12 Rp 30,000.00 Rp 30,000.00
158 M.Yusuf 01 31 69 Rp 30,000.00 Rp 30,000.00
159 Lina 01 14 66 Rp 30,000.00 Rp 30,000.00
160 Taufk 01 16 06 Rp 30,000.00 Rp 30,000.00
161 Alui 01 34 02 21/5/2014 Rp 30,000.00 Rp 30,000.00
162 Syamsudin N 00 86 16 Rp 30,000.00 Rp 30,000.00
163 Munif 01 60 16 Rp 30,000.00 Rp 30,000.00
164 Kurniansyah 01 57 20 Rp 30,000.00 Rp 30,000.00
165 M.Thaha 01 65 20 Rp 30,000.00 Rp 30,000.00
166 Agus Suriani 01 65 21 Rp 30,000.00 Rp 30,000.00
167 Septi 01 06 66 Rp 30,000.00 Rp 30,000.00
168 Amat / Ahmad 01 55 23 22/5/2014 Rp 30,000.00 Rp 30,000.00
169 Gita 01 61 35 Rp 30,000.00 Rp 30,000.00
170 M.Zaini 01 22 07 23/5/2014 Rp 30,000.00 Rp 30,000.00
171 Bahurudin 00 85 96 Rp 30,000.00 Rp 30,000.00
172 Edy Fahri 01 19 97 Rp 30,000.00 Rp 30,000.00
173 Feri Yadi 01 65 40 Rp 30,000.00 Rp 30,000.00
174 Hardiansyah 01 60 48 Rp 30,000.00 Rp 30,000.00
175 Irvan 00 89 41 Rp 30,000.00 Rp 30,000.00
176 Hasan Basri 01 20 02 24/5/2014 Rp 30,000.00 Rp 30,000.00
177 Muchlis 01 19 86 Rp 30,000.00 Rp 30,000.00
178 Norhani 00 84 68 Rp 30,000.00 Rp 30,000.00
179 M.Budi Setiawan 01 64 66 25/5/2014 Rp 30,000.00 Rp 30,000.00
180 Mulia rahman 01 26 71 Rp 30,000.00 Rp 30,000.00
181 Masliyana 00 99 36 Rp 30,000.00 Rp 30,000.00
182 Muhlis 01 16 44 Rp 30,000.00 Rp 30,000.00
183 Sefti 01 06 66 Rp 30,000.00 Rp 30,000.00
184 Norhayati 01 65 92 26/5/2014 Rp 30,000.00 Injeksi Rp 20,000.00 2 Rp 50,000.00
185 Wardiansyah 00 92 70 Rp 30,000.00 Rp 30,000.00
186 Jainal Ilmi 01 49 75 Rp 30,000.00 Rp 30,000.00
187 Najuai 01 60 49 Rp 30,000.00 Rp 30,000.00
188 Jumanto 01 65 93 Rp 30,000.00 Rp 30,000.00
189 Rabialnur 00 84 14 Rp 30,000.00 Rp 30,000.00
190 M.Rizani 01 01 94 27/5/2014 Rp 30,000.00 Rp 30,000.00
191 Junaidi 01 57 86 Rp 30,000.00 Rp 30,000.00
192 Mulyadi 01 11 22 Rp 30,000.00 Rp 30,000.00
193 Qurjani 00 79 25 Rp 30,000.00 Rp 30,000.00
194 Iswani 01 50 84 Rp 30,000.00 Rp 30,000.00
195 Wahyudi 00 86 04 Rp 30,000.00 Rp 30,000.00
196 Ningsih 00 81 83 Rp 30,000.00 Rp 30,000.00
197 Dwi Lestari 01 26 21 Rp 30,000.00 Rp 30,000.00
198 H.Suriansyah 01 65 96 Rp 30,000.00 Rp 30,000.00
199 Supriadi 00 58 45 28/5/2014 Rp 30,000.00 Rp 30,000.00
200 Muhammad Noor 01 65 93 Rp 30,000.00 Rp 30,000.00
201 Taslim 01 65 98 Rp 30,000.00 Rp 30,000.00
202 M.Taufq 01 65 95 Rp 30,000.00 Rp 30,000.00
203 Sigit Purwanto 01 65 96 Rp 30,000.00 Rp 30,000.00
204 Mulia 00 64 82 Rp 30,000.00 Rp 30,000.00
205 Fauzan 00 93 86 Rp 30,000.00 Rp 30,000.00
206 A.Nasir 00 72 67 29/5/2014 Rp 30,000.00 Rp 30,000.00
207 Rusmani 01 65 22 Rp 30,000.00 Rp 30,000.00
208 Norainah 01 11 67 Rp 30,000.00 Rp 30,000.00
209 Ardiansyah 00 80 51 Rp 30,000.00 Rp 30,000.00
210 Deni Hervianto 01 65 99 Rp 30,000.00 Rp 30,000.00
211 Suyono 01 19 18 Rp 30,000.00 Rp 30,000.00
212 Junaid 00 35 37 Rp 30,000.00 Rp 30,000.00
213 Jaitun 01 54 15 Rp 30,000.00 Rp 30,000.00
214 Arbainah 01 54 14 Rp 30,000.00 Rp 30,000.00
215 M.Saputra 01 25 13 Rp 30,000.00 Rp 30,000.00
216 Iskandar 00 98 11 Rp 30,000.00 Rp 30,000.00
217 Syamsul Izhar 01 66 00 Rp 30,000.00 Rp 30,000.00
218 Irvani 00 89 41 30/5/2014 Rp 30,000.00 Rp 30,000.00
219 M.Isa 00 79 36 Rp 30,000.00 Rp 30,000.00
220 Suriansyah 01 64 09 Rp 30,000.00 Rp 30,000.00
221 Agus Arianto 01 55 58 Rp 30,000.00 Rp 30,000.00
222 Ahmad 01 16 26 Rp 30,000.00 Rp 30,000.00
223 Syamsudinoor 00 97 81 Rp 30,000.00 Rp 30,000.00
224 Amelia 01 64 90 Rp 30,000.00 Rp 30,000.00
225 Tarmiji 00 76 06 Rp 30,000.00 Rp 30,000.00
226 Abdul halim 01 59 92 Rp 30,000.00 Rp 30,000.00
227 Fatmawati 01 25 07 Rp 30,000.00 Rp 30,000.00
228 Darham 01 59 14 Rp 30,000.00 Rp 30,000.00
229 laili S 01 55 13 Rp 30,000.00 Rp 30,000.00
230 taufk 01 16 06 Rp 30,000.00 Rp 30,000.00
231 Irwan 01 34 39 Rp 30,000.00 Rp 30,000.00
232 Suprianto 01 47 57 Rp 30,000.00 Rp 30,000.00
233 Idrus 01 26 69 31/5/2014 Rp 30,000.00 Rp 30,000.00
234 Rian Hidayat 00 69 87 Rp 30,000.00 Rp 30,000.00
235 Mahyuni 01 08 04 Rp 30,000.00 Rp 30,000.00
236 Didit / Akh Mujadit 01 33 32 Rp 30,000.00 Rp 30,000.00
237 Aidil Mubarak 01 55 28 Rp 30,000.00 Rp 30,000.00
238 Sopran 01 50 59 Rp 30,000.00 Rp 30,000.00
239 Umpung 01 06 37 Rp 30,000.00 Rp 30,000.00
240 Alex Praja 01 62 89 Rp 30,000.00 Rp 30,000.00
241 M.Syahrudin 01 08 58 Rp 30,000.00 Rp 30,000.00
Rp 7,230,000.00 Rp 110,000.00 Rp 7,340,000.00
STATUS

JKD
BPJS
Umum
BPJS
BPJS
BPJS
DP
BPJS
BPJS
DP
Umum
Umum
Umum
Umum
BPJS
JKV
Umum
BPJS
BPJS
DP
DP
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
Umum
JKD
Umum
BPJS
Umum
Umum
BPJS
Umum
BPJS
Umum
Umum
Umum
BPJS
BPJS
Umum
JKD
Umum
Umum
Umum
JKD
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
Umum
DP
BPJS
BPJS
BPJS
JKV
JKV
Umum
BPJS
JKV
JKD
Umum
BPJS
BPJS
JKD
BPJS
BPJS
Umum
Umum
Umum
Umum
BPJS
BPJS
Umum
Umum
Umum
Umum
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
JKD
BPJS
Umum
BPJS
BPJS
JKD
BPJS
JKV
Umum
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
Umum
Umum
BPJS
JKV
BPJS
BPJS
BPJS
BPJS
BPJS
Umum
BPJS
BPJS
BPJS
BPJS
BPJS
JKV
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
BPJS
Umum
BPJS
Umum
BPJS
BPJS
BPJS
BPJS
BPJS
Umum
Umum
Umum
BPJS
Umum
JKV
BPJS
BPJS
BPJS
BPJS
Umum
BPJS
Umum
Umum
BPJS
Umum
BPJS
Umum
Umum
BPJS
BPJS
BPJS
Umum
BPJS
Umum
BPJS
DP
JKV
Umum
Umum
Umum
BPJS
BPJS
BPJS
Umum
Umum
BPJS
BPJS
Umum
BPJS
BPJS
BPJS
BPJS
Umum
JKD
BPJS
JKV
Umum
Umum
Umum
JKD
BPJS
Umum
Umum
JKD
Umum
DP
Umum
DP
JKV
DP
JKV
Umum
BPJS
BPJS
BPJS
Umum
Umum
BPJS
BPJS
JKD
BPJS
Umum
BPJS
BPJS
BPJS
BPJS
JKD
BPJS
Umum
BPJS
BPJS
JKV
Umum
BPJS
BPJS
Umum
Umum
BPJS
BPJS
BPJS
BPJS
JKD
Umum
Umum
Umum
Umum
REKAPITULASI TINDAKAN IGD PASIEN RAWAT JALAN RUMAH SAKIT JIWA SAMBANG LIHUM
BULAN: APRIL 2014

PEMERIKSAAN
NO NAMA NO CM TGL MASUK
DOKTER Tindakan lain Jumlah

Nama tindakan Volume


1 Maisarah 01 62 59 1/4/2014 Rp 30,000.00 Rp 30,000.00
2 Juhansyah 01 51 59 Rp 30,000.00 Rp 30,000.00
3 Aluh 01 57 69 2/4/2014 Rp 30,000.00 Rp 30,000.00
4 Rajudinoor 00 98 04 Rp 30,000.00 Rp 30,000.00
5 Mulia 00 64 82 Rp 30,000.00 Rp 30,000.00
6 Salman 01 07 99 Rp 30,000.00 Rp 30,000.00
7 M.Yusuf 01 31 69 Rp 30,000.00 Rp 30,000.00
8 M.Abdul Rahman 01 62 67 Rp 30,000.00 Rp 30,000.00
9 Rabianur 00 84 14 3/4/2014 Rp 30,000.00 Rp 30,000.00
10 Jasmani 00 71 54 Rp 30,000.00 Rp 30,000.00
11 Rahman 01 07 93 Rp 30,000.00 Rp 30,000.00
12 Mustapa 01 52 97 Rp 30,000.00 Rp 30,000.00
13 Safrudin 01 28 18 Rp 30,000.00 Rp 30,000.00
14 A.Nureyah 01 56 29 Rp 30,000.00 Rp 30,000.00
15 Lamsani 00 75 66 Rp 30,000.00 Rp 30,000.00
16 Supian S 01 00 11 Rp 30,000.00 Rp 30,000.00
17 Gt Nurdin 01 56 73 4/4/2014 Rp 30,000.00 Rp 30,000.00
18 Guruh 01 33 03 Rp 30,000.00 Rp 30,000.00
19 Mr.X / Kapuas 01 17 39 Rp 30,000.00 Rp 30,000.00
20 Mr.X / Zainudin 01 21 95 Rp 30,000.00 Rp 30,000.00
21 Yatno/johan 01 02 78 Rp 30,000.00 Rp 30,000.00
22 Fatimah 01 49 47 Rp 30,000.00 Rp 30,000.00
23 Rusita 00 94 81 Rp 30,000.00 Rp 30,000.00
24 Abdulah 01 62 10 Rp 30,000.00 Rp 30,000.00
25 Jayadi 01 06 24 Rp 30,000.00 Rp 30,000.00
26 Hendra Jaya 01 06 23 Rp 30,000.00 Rp 30,000.00
27 Halifah 01 14 68 Rp 30,000.00 Rp 30,000.00
28 M.Arifn 00 79 45 Rp 30,000.00 Rp 30,000.00
29 Fatmawati 01 25 07 Rp 30,000.00 Rp 30,000.00
30 Norhani 00 84 68 Rp 30,000.00 Rp 30,000.00
31 Wahyudi 00 86 04 Rp 30,000.00 Rp 30,000.00
32 M.Yunus 01 47 92 Rp 30,000.00 Rp 30,000.00
33 M.Yusuf 01 56 73 Rp 30,000.00 Rp 30,000.00
34 M.Zaini 01 22 07 5/4/2014 Rp 30,000.00 Rp 30,000.00
35 Dodi anwar 00 79 98 Rp 30,000.00 Rp 30,000.00
36 M.Taufk 01 34 86 Rp 30,000.00 Rp 30,000.00
37 Hidayatullah 00 75 83 Rp 30,000.00 Rp 30,000.00
38 Darham 01 59 14 Rp 30,000.00 Rp 30,000.00
39 Hj.Hamdah 01 62 02 Rp 30,000.00 Rp 30,000.00
40 Hamsan 01 60 61 Rp 30,000.00 Rp 30,000.00
41 M.Syahrudin 01 08 58 Rp 30,000.00 Rp 30,000.00
42 Soleh Darmono 01 51 79 Rp 30,000.00 Rp 30,000.00
43 Edi santoso 00 68 59 Rp 30,000.00 Rp 30,000.00
44 Sahran 00 71 11 6/4/2014 Rp 30,000.00 Rp 30,000.00
45 Syahriati 00 97 99 Rp 30,000.00 Rp 30,000.00
46 bahrani 00 99 57 Rp 30,000.00 Rp 30,000.00
47 hamzah 01 62 73 Rp 30,000.00 Rp 30,000.00
48 M.alfannor 01 62 74 Rp 30,000.00 Rp 30,000.00
49 Ramlah 00 71 23 7/4/2014 Rp 30,000.00 Rp 30,000.00
50 Ratna dewi 01 56 40 Rp 30,000.00 Rp 30,000.00
51 Edy Fahri 01 19 97 Rp 30,000.00 Rp 30,000.00
52 Masturi atur 01 08 60 Rp 30,000.00 Rp 30,000.00
53 Gazali R 00 86 02 Rp 30,000.00 Rp 30,000.00
54 I Nyoman 00 94 76 Rp 30,000.00 Rp 30,000.00
55 A yani 01 19 10 Rp 30,000.00 Rp 30,000.00
56 Misrullah 01 27 37 Rp 30,000.00 Rp 30,000.00
57 Khairunisa 01 62 82 Rp 30,000.00 Rp 30,000.00
58 Wibisono 01 22 22 Rp 30,000.00 Rp 30,000.00
59 M.Yunus 01 47 92 Rp 30,000.00 Rp 30,000.00
60 Nurhartati 01 62 84 Rp 30,000.00 Rp 30,000.00
61 Saifullah 01 62 85 8/4/2014 Rp 30,000.00 Injeksi + Day Care + Obs Rp 155,000.00 2+1+1 Rp 185,000.00
62 Dahlia 00 84 59 Rp 30,000.00 Rp 30,000.00
63 Alex praja pura 01 62 89 Rp 30,000.00 Rp 30,000.00
64 Kurniansyah 01 57 20 Rp 30,000.00 Rp 30,000.00
65 Hendri 01 26 75 Rp 30,000.00 Rp 30,000.00
66 Nurjanah 01 32 65 Rp 30,000.00 Rp 30,000.00
67 Amat 01 60 08 9/4/2014 Rp 30,000.00 Rp 30,000.00
68 Arif 00 47 79 Rp 30,000.00 Rp 30,000.00
69 Mulyani 01 28 70 Rp 30,000.00 Rp 30,000.00
70 Hermansyah 01 62 90 Rp 30,000.00 Rp 30,000.00
71 Nurul H 01 62 91 10/4/2014 Rp 30,000.00 Rp 30,000.00
72 Murhan 01 62 92 Rp 30,000.00 Rp 30,000.00
73 M.Rizki 01 32 37 Rp 30,000.00 Rp 30,000.00
74 Syamsul 00 88 94 Rp 30,000.00 Rp 30,000.00
75 Andi Heru Hermawan 01 34 25 Rp 30,000.00 Rp 30,000.00
76 Mulyadi 01 62 95 Rp 30,000.00 Injeksi Rp 10,000.00 1 Rp 40,000.00
77 Sapriansyah 01 21 84 11/4/2014 Rp 30,000.00 Rp 30,000.00
78 Aisyah 01 53 06 Rp 30,000.00 Rp 30,000.00
79 Sulistiyo 01 61 24 Rp 30,000.00 Rp 30,000.00
80 Arba'i 01 10 98 Rp 30,000.00 Rp 30,000.00
81 Rahmawati 01 49 56 Rp 30,000.00 Rp 30,000.00
82 bahrah 01 21 79 Rp 30,000.00 Rp 30,000.00
83 Herelanadi 01 30 62 Rp 30,000.00 Rp 30,000.00
84 M.Syarbani 01 5 75 Rp 30,000.00 Rp 30,000.00
85 Alui 01 34 02 Rp 30,000.00 Rp 30,000.00
86 Lisa megawati 01 62 97 Rp 30,000.00 Rp 30,000.00
87 Siti Aminah 01 62 99 Rp 30,000.00 Rp 30,000.00
88 Lina / Elin 01 14 66 Rp 30,000.00 Rp 30,000.00
89 Kamsiah 01 38 26 12/4/2014 Rp 30,000.00 Rp 30,000.00
90 A.Hairani 01 63 03 Rp 30,000.00 Rp 30,000.00
91 Hildawati 00 96 81 Rp 30,000.00 Rp 30,000.00
92 M.Saputra 01 25 13 Rp 30,000.00 Rp 30,000.00
93 Nukman 00 75 76 Rp 30,000.00 Rp 30,000.00
94 Aminah 01 61 12 Rp 30,000.00 Rp 30,000.00
95 Bain 01 63 04 Rp 30,000.00 Rp 30,000.00
96 Rusadi 01 63 05 Rp 30,000.00 Rp 30,000.00
97 Agus krianto 01 55 58 13/4/2014 Rp 30,000.00 Rp 30,000.00
98 Nur rahmat 01 49 74 Rp 30,000.00 Rp 30,000.00
99 ardiansyah 00 80 51 Rp 30,000.00 Rp 30,000.00
100 siti Rahmi 01 60 39 Rp 30,000.00 Rp 30,000.00
101 nuriyah 00 59 6 14/4/2014 Rp 30,000.00 Rp 30,000.00
102 Herman 01 19 37 Rp 30,000.00 Rp 30,000.00
103 Salman 01 02 99 Rp 30,000.00 Rp 30,000.00
104 Sefti W 01 06 66 Rp 30,000.00 Rp 30,000.00
105 RabialNur 00 84 14 Rp 30,000.00 Rp 30,000.00
106 edi Purwanto 01 63 10 Rp 30,000.00 Rp 30,000.00
107 Muhlis 01 16 44 Rp 30,000.00 Rp 30,000.00
108 yuli Ansari 00 70 37 Rp 30,000.00 Rp 30,000.00
109 Herkani 01 59 83 Rp 30,000.00 Rp 30,000.00
110 Kisroh 01 63 12 15/4/2014 Rp 30,000.00 Rp 30,000.00
111 M. Arsyad 01 63 16 Rp 30,000.00 Rp 30,000.00
112 pariani 01 18 26 Rp 30,000.00 Rp 30,000.00
113 Supian S 01 00 11 Rp 30,000.00 Rp 30,000.00
114 Syarwani 01 38 06 Rp 30,000.00 Rp 30,000.00
115 Basni 00 68 91 Rp 30,000.00 Rp 30,000.00
116 Ika Winardi 00 88 61 Rp 30,000.00 Rp 30,000.00
117 Siti Sarah 01 63 17 Rp 30,000.00 Rp 30,000.00
118 hakim 01 18 59 16/4/2014 Rp 30,000.00 Rp 30,000.00
119 Nur Khamin 01 47 27 Rp 30,000.00 Rp 30,000.00
120 M. Arifn 00 79 45 Rp 30,000.00 Rp 30,000.00
121 Sigit Andrianto 01 13 11 Rp 30,000.00 Rp 30,000.00
122 Fitriadi 01 53 24 Rp 30,000.00 Rp 30,000.00
123 Hamisah 01 14 35 Rp 30,000.00 Rp 30,000.00
124 Umi Nurhayati 00 68 04 Rp 30,000.00 injeksi Rp 20,000.00 2 Rp 50,000.00
125 A. Rifai 01 63 27 Rp 30,000.00 injeksi Rp 10,000.00 1 Rp 40,000.00
126 Juhairiah 01 63 26 Rp 30,000.00 Rp 30,000.00
127 Faturrahman 01 63 28 17/4/2014 Rp 30,000.00 Rp 30,000.00
128 Ary Mujiatin 01 63 30 Rp 30,000.00 Rp 30,000.00
129 Mustapa Arifn 01 53 97 Rp 30,000.00 Rp 30,000.00
130 Hamdah 01 62 02 Rp 30,000.00 Rp 30,000.00
131 M.Ali 00 71 49 Rp 30,000.00 Rp 30,000.00
132 Hermansyah 01 62 90 Rp 30,000.00 Rp 30,000.00
133 Norjatul 01 27 17 Rp 30,000.00 Rp 30,000.00
134 Iwan 00 78 97 Rp 30,000.00 Rp 30,000.00
135 Jukaeni 01 63 33 Rp 30,000.00 Rp 30,000.00
136 M.Syahrudin 01 08 58 Rp 30,000.00 Rp 30,000.00
137 Noor Efendi 01 13 70 4/18/2014 Rp 30,000.00 Rp 30,000.00
138 Amat 01 60 08 Rp 30,000.00 Rp 30,000.00
139 M.Apriadi 00 75 75 4/19/2014 Rp 30,000.00 Rp 30,000.00
140 A.Yusuf 01 29 42 Rp 30,000.00 Rp 30,000.00
141 Sri Hartati 00 68 65 Rp 30,000.00 Rp 30,000.00
142 Noriman 01 31 86 Rp 30,000.00 Rp 30,000.00
143 M.Hanaf 00 83 11 Rp 30,000.00 Rp 30,000.00
144 Baramalani 01 23 77 Rp 30,000.00 Rp 30,000.00
145 Subli 00 85 15 Rp 30,000.00 Rp 30,000.00
146 A.Busari 01 24 66 Rp 30,000.00 Rp 30,000.00
147 Siti Aisyah 00 96 63 Rp 30,000.00 Rp 30,000.00
148 A.Khairi 00 85 50 Rp 30,000.00 Rp 30,000.00
149 M.Isnansyah 00 81 10 Rp 30,000.00 Rp 30,000.00
150 Abdullah 00 85 44 Rp 30,000.00 Rp 30,000.00
151 Norlaila 01 35 20 Rp 30,000.00 Rp 30,000.00
152 Yophi 00 83 59 Rp 30,000.00 Rp 30,000.00
153 Fahruroji 00 70 74 Rp 30,000.00 Rp 30,000.00
154 Hasnah 01 33 61 Rp 30,000.00 Rp 30,000.00
155 Muhlisin 00 93 20 Rp 30,000.00 Rp 30,000.00
156 Rustam E 01 28 46 Rp 30,000.00 Rp 30,000.00
157 Syahbani 01 49 97 Rp 30,000.00 Rp 30,000.00
158 Sulaiman 01 60 19 Rp 30,000.00 Rp 30,000.00
159 Salamiah 01 53 83 Rp 30,000.00 Rp 30,000.00
160 Lahli s 01 35 13 Rp 30,000.00 Rp 30,000.00
161 Supiati 01 45 94 Rp 30,000.00 Rp 30,000.00
162 Hasanudin 01 50 83 Rp 30,000.00 Rp 30,000.00
163 Dodi Anwari 00 79 98 Rp 30,000.00 Rp 30,000.00
164 wahab 01 23 95 Rp 30,000.00 Rp 30,000.00
165 saimah 01 36 50 Rp 30,000.00 Rp 30,000.00
166 Yuliana 00 68 90 Rp 30,000.00 Rp 30,000.00
167 Rian D 00 77 51 Rp 30,000.00 Rp 30,000.00
168 Marpuah 01 14 79 Rp 30,000.00 Rp 30,000.00
169 Yusran 01 14 78 Rp 30,000.00 Rp 30,000.00
170 Habibi 01 14 77 Rp 30,000.00 Rp 30,000.00
171 Umar 01 16 88 Rp 30,000.00 Rp 30,000.00
172 Erwin 01 33 75 Rp 30,000.00 Rp 30,000.00
173 Gazali 01 33 79 Rp 30,000.00 Rp 30,000.00
174 Zainudin 01 33 76 Rp 30,000.00 Rp 30,000.00
175 lasiyem 01 16 90 Rp 30,000.00 Rp 30,000.00
176 Rusdi 01 56 71 Rp 30,000.00 Rp 30,000.00
177 Egi Minggo 01 49 11 Rp 30,000.00 Rp 30,000.00
178 Muhamad 00 48 80 Rp 30,000.00 Rp 30,000.00
179 Riska atminanta 00 99 63 Rp 30,000.00 Rp 30,000.00
180 A.Juhairi 00 93 82 Rp 30,000.00 Rp 30,000.00
181 Kasran 00 95 45 Rp 30,000.00 Rp 30,000.00
182 Gita 01 61 35 Rp 30,000.00 Rp 30,000.00
183 M.Zaini 01 22 07 Rp 30,000.00 Rp 30,000.00
184 Alamsyah 01 63 41 Rp 30,000.00 Rp 30,000.00
185 Husnul janatul 01 52 35 Rp 30,000.00 Rp 30,000.00
186 Salasiah 00 86 70 Rp 30,000.00 Rp 30,000.00
187 Anaomisah 00 94 80 Rp 30,000.00 Rp 30,000.00
188 Arif Budiman 00 77 61 Rp 30,000.00 Rp 30,000.00
189 Saprudin 01 60 92 Rp 30,000.00 Rp 30,000.00
190 Kholis 01 05 38 Rp 30,000.00 Rp 30,000.00
191 Nursehan 01 63 40 Rp 30,000.00 Rp 30,000.00
192 Juhansyah 01 51 89 Rp 30,000.00 Rp 30,000.00
193 M.Yusuf 01 63 42 Rp 30,000.00 Rp 30,000.00
194 Abd salam 01 06 55 4/20/2014 Rp 30,000.00 Rp 30,000.00
195 Tarmiji 00 76 06 Rp 30,000.00 Rp 30,000.00
196 Rosdiana 00 98 40 Rp 30,000.00 Rp 30,000.00
197 M.rizani 01 63 45 Rp 30,000.00 Rp 30,000.00
198 Gt Riduan 01 51 02 Rp 30,000.00 Rp 30,000.00
199 Suyanto 01 44 11 4/21/2014 Rp 30,000.00 Rp 30,000.00
200 Marliawati 01 57 91 Rp 30,000.00 Rp 30,000.00
201 Ahmad Nasir 00 72 67 Rp 30,000.00 Rp 30,000.00
202 Rahman 01 07 93 Rp 30,000.00 Rp 30,000.00
203 Jasmani 00 71 54 Rp 30,000.00 Rp 30,000.00
204 Marhawi 00 90 36 Rp 30,000.00 Rp 30,000.00
205 Heny agustina 01 22 10 Rp 30,000.00 Rp 30,000.00
206 Syarwani 01 58 06 4/22/2014 Rp 30,000.00 Rp 30,000.00
207 Kurniansyah 01 57 20 Rp 30,000.00 Rp 30,000.00
208 Hardiansyah 01 60 48 Rp 30,000.00 Rp 30,000.00
209 Wahyudi 00 86 04 Rp 30,000.00 Rp 30,000.00
210 Yeti 00 63 09 23/4/2014 Rp 30,000.00 Rp 30,000.00
211 Norhayati 01 61 83 Rp 30,000.00 Rp 30,000.00
212 Masdiana 01 63 64 Rp 30,000.00 Rp 30,000.00
213 Masyudi 00 90 52 Rp 30,000.00 Rp 30,000.00
214 Supian 01 03 94 Rp 30,000.00 Rp 30,000.00
215 Yulia N 00 76 21 Rp 30,000.00 Rp 30,000.00
216 Saipullah 01 18 54 24/4/2014 Rp 30,000.00 Rp 30,000.00
217 Hamdanah 00 26 42 Rp 30,000.00 Rp 30,000.00
218 Muna Hasanah 01 29 28 Rp 30,000.00 Rp 30,000.00
219 Ratna dewi 01 56 40 Rp 30,000.00 Rp 30,000.00
220 Rahmat Kurniawan 01 25 20 Rp 30,000.00 Rp 30,000.00
221 Mahrita 01 60 84 Rp 30,000.00 Rp 30,000.00
222 Bustani 01 63 70 Rp 30,000.00 Rp 30,000.00
223 Syamsidah 00 94 92 Rp 30,000.00 Rp 30,000.00
224 Zubaidah 00 69 76 25/4/2014 Rp 30,000.00 Rp 30,000.00
225 Wibisono 01 22 22 Rp 30,000.00 Rp 30,000.00
226 Rahmawati 01 49 56 Rp 30,000.00 Rp 30,000.00
227 Iswani 01 50 84 Rp 30,000.00 Rp 30,000.00
228 Sapriansyah 01 21 84 Rp 30,000.00 Rp 30,000.00
229 Iwan 00 78 97 Rp 30,000.00 Rp 30,000.00
230 Endi Rijani 01 63 74 Rp 30,000.00 Rp 30,000.00
231 Kamsiah 01 38 26 26/4/2014 Rp 30,000.00 Rp 30,000.00
232 Muchlis 01 19 86 Rp 30,000.00 Rp 30,000.00
233 Nurrahmat 01 49 74 Rp 30,000.00 Rp 30,000.00
234 Nengsih 00 81 83 Rp 30,000.00 Rp 30,000.00
235 Supian suri 01 00 11 Rp 30,000.00 Rp 30,000.00
236 Munif 01 60 16 Rp 30,000.00 Rp 30,000.00
237 Arbiatul adawiyah 01 59 39 Rp 30,000.00 Rp 30,000.00
238 Fauzan 00 93 88 Rp 30,000.00 Rp 30,000.00
239 Halil 01 55 11 27/4/2014 Rp 30,000.00 Rp 30,000.00
240 M.Agas 01 55 44 Rp 30,000.00 Rp 30,000.00
241 Bambang Erwanto 01 48 73 Rp 30,000.00 Rp 30,000.00
242 Sarula 00 72 34 Rp 30,000.00 Rp 30,000.00
243 Salimi 01 20 66 Rp 30,000.00 Rp 30,000.00
244 Andi Heru Hermawan 01 34 25 Rp 30,000.00 Rp 30,000.00
245 Ardiansyah 00 80 51 Rp 30,000.00 Rp 30,000.00
246 Diyan susanto 01 63 86 Rp 30,000.00 Rp 30,000.00
247 Ngayomi 01 33 44 28/4/2014 Rp 30,000.00 Rp 30,000.00
248 Bainah 00 74 73 Rp 30,000.00 Rp 30,000.00
249 Fitriadi 01 64 00 Rp 30,000.00 Rp 30,000.00
250 Sahrani 01 54 89 Rp 30,000.00 Rp 30,000.00
251 Maimunah 01 64 02 29/4/2014 Rp 30,000.00 Rp 30,000.00
252 Khairunisa 01 26 41 Rp 30,000.00 Rp 30,000.00
253 Saipurahman 01 64 07 Rp 30,000.00 Rp 30,000.00
254 Syamsudinor 00 97 81 Rp 30,000.00 Rp 30,000.00
255 lamsani 00 75 66 Rp 30,000.00 Rp 30,000.00
256 syarwani 01 58 06 Rp 30,000.00 Rp 30,000.00
257 Rajudinoor 00 98 04 Rp 30,000.00 Rp 30,000.00
258 H.Mas'ud 01 57 60 Rp 30,000.00 Rp 30,000.00
259 Masliyana 00 99 36 30/4/2014 Rp 30,000.00 Rp 30,000.00
260 Alui 01 34 02 Rp 30,000.00 Rp 30,000.00
261 idrus 01 26 69 Rp 30,000.00 Rp 30,000.00
262 Iwan 00 78 97 Rp 30,000.00 Rp 30,000.00
263 A.Yani 01 19 10 Rp 30,000.00 Rp 30,000.00
Rp 7,890,000.00 Rp 195,000.00 Rp 8,085,000.00
STATUS

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BPJS
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JKD
Umum

BPJS
DP
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Umum
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BPJS
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JKV
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BPJS
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BPJS
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JKD
JKD
JKD
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JKD
JKD
JKD
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BPJS
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JKV
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BPJS
REKAPITULASI TINDAKAN IGD PASIEN RAWAT JALAN RUMAH SA
BULAN: FEBRUARI 2014

PEMERIKSAAN
NO NAMA NO CM TGL MASUK
DOKTER

1 Iman 00 84 16 1/2/2014 Rp 30,000.00


2 M.Rizky 01 26 46 Rp 30,000.00
3 Sawiyah 01 48 18 Rp 30,000.00
4 St.Rafah 01 30 43 Rp 30,000.00
5 Yusuf 00 92 00 Rp 30,000.00
6 Hamdi 00 80 83 Rp 30,000.00
7 M.Agus 01 55 44 Rp 30,000.00
8 A.Mukrim 00 71 16 Rp 30,000.00
9 Rahma 01 59 90 Rp 30,000.00
10 St.Aminah 01 49 77 Rp 30,000.00
11 Norif 01 49 76 Rp 30,000.00
12 Hasbullah 01 17 50 Rp 30,000.00
13 Abd Aini 01 52 95 Rp 30,000.00
14 Mairani 00 87 80 Rp 30,000.00
15 Muhammad 01 48 80 Rp 30,000.00
16 Fadliannor 00 50 46 Rp 30,000.00
17 Maya Ismaliah 01 47 73 Rp 30,000.00
18 Hudari 01 27 11 Rp 30,000.00
19 Yayan 01 33 42 Rp 30,000.00
20 Sahibunnar 00 77 72 Rp 30,000.00
21 Maidi Hambali 00 93 57 Rp 30,000.00
22 Made murtiasih 00 85 90 Rp 30,000.00
23 I Nyoman Mula 00 94 76 Rp 30,000.00
24 Sari Fitriani 01 60 23 Rp 30,000.00
25 Husni Tamrin 00 75 77 Rp 30,000.00
26 Husnul Janatul 01 52 35 2/2/2014 Rp 30,000.00
27 Junaid 00 35 37 Rp 30,000.00
28 M.Zaini 01 22 07 Rp 30,000.00
29 Norlian 01 27 05 Rp 30,000.00
30 Aluh 01 57 69 Rp 30,000.00
31 Fathurrahman 01 01 82 Rp 30,000.00
32 Rafdi Apriannor 01 41 43 Rp 30,000.00
33 Tri K 01 31 31 3/2/2014 Rp 30,000.00
34 Ardian 01 13 32 Rp 30,000.00
35 Dian R 01 59 58 Rp 30,000.00
36 Said Abdul Rahman 01 55 71 Rp 30,000.00
37 Faridah 00 80 39 Rp 30,000.00
38 Ahmad 01 16 26 Rp 30,000.00
39 M.Rizkyi 01 32 37 4/2/2014 Rp 30,000.00
40 Saidillah 01 60 33 Rp 30,000.00
41 Fahriah 01 44 42 Rp 30,000.00
42 Efendi 01 22 74 Rp 30,000.00
43 Johan 01 16 21 Rp 30,000.00
44 M.Saputra 01 25 13 Rp 30,000.00
45 M.Ikhwan 01 04 53 Rp 30,000.00
46 Yuliana 01 60 25 Rp 75,000.00
47 Herwani 00 88 56 5/2/2014 Rp 30,000.00
48 Jumransyah 00 70 27 Rp 30,000.00
49 Basran 00 87 05 Rp 30,000.00
50 Wahyudi 00 86 04 Rp 30,000.00
51 Mauliawati 01 57 91 Rp 30,000.00
52 Siti aminah 01 59 28 Rp 30,000.00
53 Hasbiah 01 43 66 6/2/2014 Rp 30,000.00
54 Hadiyana 01 60 17 Rp 30,000.00
55 Ahmad Rijani 01 60 40 Rp 30,000.00
56 Yayan iriani 01 48 26 7/2/2014 Rp 30,000.00
57 Kartini 01 57 21 Rp 30,000.00
58 Salaniah 01 53 83 Rp 30,000.00
59 Syammudinoor 00 97 81 Rp 30,000.00
60 Hadijah 01 05 51 Rp 30,000.00
61 Halil 01 35 11 Rp 30,000.00
62 Irfan R 01 35 69 Rp 30,000.00
63 Anang 01 19 39 Rp 30,000.00
64 Sapriani 01 60 43 Rp 30,000.00
65 GT.Riduan 01 51 02 Rp 30,000.00
66 Suharyani 01 30 85 Rp 30,000.00
67 St.Aminah 01 08 69 Rp 30,000.00
68 Hardiansyah 01 60 48 8/2/2014 Rp 30,000.00
69 Masliana 00 99 36 Rp 30,000.00
70 A.Solikin 00 86 84 Rp 30,000.00
71 Salimi 01 20 66 Rp 30,000.00
72 Noor Ilham 01 55 66 9/2/2014 Rp 30,000.00
73 Syahriati 00 97 99 Rp 30,000.00
74 Slamet riadi 00 98 58 Rp 30,000.00
75 Dahlia 00 84 59 10/2/2014 Rp 30,000.00
76 Jusran 01 41 45 Rp 30,000.00
77 Ira Rustinda 01 60 56 Rp 30,000.00
78 Masiam 01 22 08 Rp 30,000.00
79 Supiansuri 01 00 11 12/2/2014 Rp 30,000.00
80 Edi santoso 00 68 59 13/2/2014 Rp 30,000.00
81 Imis 01 58 17 Rp 30,000.00
82 Faridah 00 80 39 Rp 30,000.00
83 Mustafa Arifn 01 52 97 Rp 30,000.00
84 Razudinor 00 98 04 Rp 30,000.00
85 Barun 01 60 72 14/2/2014 Rp 30,000.00
86 Bawaihi 01 49 08 Rp 30,000.00
87 Rahmani 01 42 41 Rp 30,000.00
88 Madi 00 99 22 Rp 30,000.00
89 Subu 01 55 03 Rp 30,000.00
90 Mariani 01 60 73 Rp 30,000.00
91 A.Sairi 01 23 36 Rp 30,000.00
92 Nukman 00 75 76 Rp 30,000.00
93 Sauqi 00 90 48 Rp 30,000.00
94 Marhani 00 90 36 Rp 30,000.00
95 Sahil 01 12 46 Rp 30,000.00
96 Anang S 01 28 06 Rp 30,000.00
97 Sariansyah 01 48 77 15/2/2014 Rp 30,000.00
98 Husnul Janatul 01 52 35 Rp 30,000.00
99 Syarbani 01 53 75 Rp 30,000.00
100 Norhani 00 84 68 Rp 30,000.00
101 Banbang Erwanto 01 48 73 16/2/2014 Rp 30,000.00
102 Jumiati 01 19 62 Rp 30,000.00
103 Abdul wahid 01 56 49 Rp 30,000.00
104 Heri Irawan 00 87 10 Rp 30,000.00
105 M.Yusuf 01 31 69 Rp 30,000.00
106 Muhammad Hendra 01 43 73 Rp 30,000.00
107 Hasanudin 01 57 75 17/2/2014 Rp 30,000.00
108 Samsul 00 99 33 Rp 30,000.00
109 Rusita 00 94 81 Rp 30,000.00
110 M.Saputra 01 25 13 Rp 30,000.00
111 Mahrita 01 60 84 Rp 30,000.00
112 Yuli Ansari 00 70 37 Rp 30,000.00
113 Hasbiah 01 43 66 18/2/2014 Rp 30,000.00
114 Yetti 00 63 09 Rp 30,000.00
115 Hamisah 01 14 35 Rp 30,000.00
116 Halil 01 55 11 Rp 30,000.00
117 Mursalim 01 60 93 19/2/2014 Rp 30,000.00
118 saleh darmono 01 51 79 Rp 30,000.00
119 Badariyah 01 50 44 Rp 30,000.00
120 Jamiyah 01 25 30 Rp 30,000.00
121 ahmad 01 23 36 Rp 30,000.00
122 Ramliansyah 00 67 83 20/2/2014 Rp 30,000.00
123 Irwansyah 01 60 96 Rp 30,000.00
124 Safrudin 01 28 18 Rp 30,000.00
125 Fitriadi 01 53 24 Rp 30,000.00
126 Zainal Arifn 01 60 97 Rp 30,000.00
127 Rahmadi 01 61 01 21/2/2014 Rp 30,000.00
128 syahrin 00 99 24 Rp 30,000.00
129 hamdiah 01 50 57 Rp 30,000.00
130 mariah 00 86 28 Rp 30,000.00
131 mahyuni 00 79 60 Rp 30,000.00
132 A.kurniawati 01 61 03 Rp 30,000.00
133 Hasbullah 01 57 15 Rp 30,000.00
134 Ratnasari 01 06 20 Rp 30,000.00
135 Norbaya 01 32 15 Rp 30,000.00
136 Fahriyadi 01 57 46 22/2/2014 Rp 30,000.00
137 Misrullah 01 27 37 Rp 30,000.00
138 Hadriansyah 01 60 48 Rp 30,000.00
139 Mahrita 01 60 84 Rp 30,000.00
140 Munif 01 60 16 Rp 30,000.00
141 Mardi 01 48 19 Rp 30,000.00
142 HJ.Aminah 01 61 12 Rp 30,000.00
143 Manijan 01 11 14 Rp 30,000.00
144 Supiansuri 01 00 11 23/2/2014 Rp 30,000.00
145 Munawarah 01 54 78 Rp 30,000.00
146 Nurtinah 01 49 31 Rp 30,000.00
147 Saniah 00 68 13 Rp 30,000.00
148 Henda saputra 01 49 53 24/2/2014 Rp 30,000.00
149 Hasbulah 01 17 50 Rp 30,000.00
150 junaidi 01 05 16 Rp 30,000.00
151 Jadri 01 49 85 Rp 30,000.00
152 Yudi Mulyadi 01 24 23 Rp 30,000.00
153 masnurul shafa 01 57 06 Rp 30,000.00
154 Anang bin syahrani 01 19 39 Rp 30,000.00
155 M.Rizky habibi 01 32 37 Rp 30,000.00
156 Mariadai 01 61 18 Rp 30,000.00
157 Arbiatul 01 59 39 25/2/2014 Rp 30,000.00
158 A.Rusiyah 01 56 29 Rp 30,000.00
159 Rafudinor 00 98 04 Rp 30,000.00
160 M.Nasar 01 33 45 26/2/2014 Rp 30,000.00
161 Ningsih 00 81 83 Rp 30,000.00
162 Fauzan 00 93 88 Rp 30,000.00
163 Faizah 00 82 58 Rp 30,000.00
164 Ardiansyah 00 80 51 Rp 30,000.00
165 Salapudin 01 29 50 27/2/2014 Rp 30,000.00
166 Nuraini 01 12 15 Rp 30,000.00
167 Fitri 01 26 25 Rp 30,000.00
168 Rusiannoor 00 97 07 Rp 30,000.00
169 Misransyah 01 07 35 Rp 30,000.00
170 Ny.x 00 70 60 Rp 30,000.00
171 Wahidah 01 06 76 Rp 30,000.00
172 Abdul Muin 01 06 04 Rp 30,000.00
173 Rusli 00 97 40 Rp 30,000.00
174 Ameliana 01 16 37 Rp 30,000.00
175 Gt. Nurdin 01 56 72 Rp 30,000.00
176 Dahlia 01 14 59 Rp 30,000.00
177 Mx / Udin 01 56 74 Rp 30,000.00
178 Rahmadi 01 54 80 Rp 30,000.00
179 Munazirah 01 61 29 Rp 30,000.00
180 Juhansyah 01 51 59 Rp 30,000.00
181 Mustofa 01 52 97 Rp 30,000.00
182 Aminah 01 61 12 Rp 30,000.00
183 Wahyudi 00 86 04 Rp 30,000.00
184 M.Ahyar 01 61 30 Rp 30,000.00
185 Humaidi 01 03 99 28/2/2014 Rp 30,000.00
186 M.Ikhsan 00 89 70 Rp 30,000.00
187 Halil 01 55 11 Rp 30,000.00
188 Jayadi 01 06 24 Rp 30,000.00
189 Hendra 01 06 23 Rp 30,000.00
190 Rarmawati 01 49 56 Rp 30,000.00
191 Jurmiah 01 59 64 Rp 30,000.00
192 Agus 01 55 58 Rp 30,000.00
193 Bainah 00 74 73 Rp 30,000.00
Rp 5,565,000.00

umum 88
jamkesmas 43
jamkesda 17
jamkesprov 14
DP 9
BPJS 20
ASIEN RAWAT JALAN RUMAH SAKIT JIWA SAMBANG LIHUM
BULAN: FEBRUARI 2014

STATUS
Tindakan lain Jumlah

Nama tindakan Volume


Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 DP
Rp 30,000.00 Umum
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Rp 30,000.00 BPJS
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 jkporv
Rp 30,000.00 jkm
Rp 30,000.00 Umum
Rp 30,000.00 jkporv
Rp 30,000.00 BPJS
Rp 30,000.00 Umum
Rp 30,000.00 jkporv
Rp 30,000.00 jkm
Rp 30,000.00 Umum
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Rp 30,000.00 jkporv
Rp 30,000.00 Umum
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Rp 30,000.00 Umum
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Rp 30,000.00 Umum
Rp 30,000.00 jkporv
Rp 30,000.00 Umum
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Rp 30,000.00 Umum
Rp 30,000.00 Umum
Injeksi Rp 10,000.00 1 Rp 40,000.00 Umum
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Rp 30,000.00 jkm
Rp 30,000.00 jkd
Rp 30,000.00 DP
Rp 30,000.00 Umum
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Rp 75,000.00 Umum
Rp 30,000.00 Umum
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Rp 30,000.00 Umum
Rp 30,000.00 jkd
Rp 30,000.00 BPJS
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Rp 30,000.00 jkporv
Rp 30,000.00 Umum
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Rp 30,000.00 DP
Rp 30,000.00 Umum
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Rp 30,000.00 Umum
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Rp 30,000.00 Umum
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Injeksi Rp 10,000.00 1 Rp 40,000.00 Umum
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Injeksi Rp 20,000.00 2 Rp 50,000.00 Umum
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Rp 30,000.00 Umum
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Rp 30,000.00 jkm
Rp 30,000.00 DP
Rp 30,000.00 BPJS
Fisaxi + injeksi Rp 40,000.00 1+1 Rp 70,000.00 Umum
Rp 30,000.00 jkm
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Rp 30,000.00 Umum
Rp 30,000.00 Umum
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Rp 30,000.00 Umum
Rp 30,000.00 jkm
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 jkd
Rp 30,000.00 jkporv
Rp 30,000.00 BPJS
Rp 30,000.00 jkm
Rp 30,000.00 jkm
Rp 30,000.00 jkm
Rp 30,000.00 Umum
Rp 30,000.00 jkm
Rp 30,000.00 BPJS
Rp 30,000.00 DP
Rp 30,000.00 Umum
Rp 30,000.00 BPJS
Rp 30,000.00 jkporv
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 jkm
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 jkm
Rp 30,000.00 Umum
Rp 30,000.00 jkd
Rp 30,000.00 Umum
Rp 30,000.00 BPJS
Rp 30,000.00 jkm
Rp 30,000.00 jkm
Rp 30,000.00 DP
Rp 30,000.00 BPJS
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 DP
Rp 30,000.00 Umum
Rp 30,000.00 jkporv
Rp 30,000.00 Umum
Rp 30,000.00 jkm
Rp 30,000.00 jkm
Rp 30,000.00 Umum
Rp 30,000.00 jkm
Rp 30,000.00 jkm
Rp 30,000.00 BPJS
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 BPJS
fsaxi+inj+infus+DC Rp 135,000.00 1+2+1+1 Rp 165,000.00 umum
Rp 30,000.00 Umum
Rp 30,000.00 BPJS
Rp 30,000.00 jkm
Rp 30,000.00 jkm
Rp 30,000.00 BPJS
Rp 30,000.00 BPJS
Rp 30,000.00 jkporv
Rp 30,000.00 BPJS
Rp 30,000.00 jkd
Rp 30,000.00 jkd
Rp 30,000.00 jkd
Rp 30,000.00 jkd
Rp 30,000.00 jkd
Rp 30,000.00 jkd
Rp 30,000.00 jkd
Rp 30,000.00 jkd
Rp 30,000.00 jkd
Rp 30,000.00 jkd
Rp 30,000.00 jkd
Rp 30,000.00 DP
Rp 30,000.00 jkd
Rp 30,000.00 DP
Rp 30,000.00 Umum
Rp 30,000.00 BPJS
Rp 30,000.00 BPJS
Rp 30,000.00 jkm
Rp 30,000.00 jkd
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 Umum
Rp 30,000.00 jkm
Rp 30,000.00 jkm
Rp 30,000.00 jkm
Rp 30,000.00 jkm
Rp 30,000.00 jkm
Rp 30,000.00 jkm
Rp 30,000.00 jkm
Rp 215,000.00 4 Rp 6,050,000.00
REKAPITULASI TINDAKAN IGD PASIEN RAWAT JALAN RUMAH SAKIT JIWA SAMBANG LIHUM
BULAN: JANUARI 2014

PEMERIKSAAN
NO NAMA NO CM TGL MASUK
DOKTER Tindakan lain Jumlah

Nama tindakan Volume


1 Erisliane 00 75 10 2/1/2014 Rp 30,000.00 Rp 30,000.00
2 Maskuriah 01 29 84 Rp 30,000.00 Rp 30,000.00
3 Ika Winardi 00 88 61 Rp 30,000.00 Rp 30,000.00
4 Ufk 00 67 97 3/1/2014 Rp 30,000.00 Rp 30,000.00
5 Eka wati 01 13 79 Rp 30,000.00 Rp 30,000.00
6 Rahmadi 01 26 17 Rp 30,000.00 Rp 30,000.00
7 Ratnasari 01 00 20 4/1/2014 Rp 30,000.00 Rp 30,000.00
8 Ratmi 01 09 71 Rp 30,000.00 Rp 30,000.00
9 Irwandi 00 74 90 Rp 30,000.00 Rp 30,000.00
10 Norhidayatullah 00 77 82 5/1/2014 Rp 30,000.00 Rp 30,000.00
11 suharyani 01 30 85 Rp 30,000.00 Rp 30,000.00
12 Limai 01 48 93 Rp 30,000.00 Rp 30,000.00
13 Junaidi 01 52 86 6/1/2014 Rp 30,000.00 Rp 30,000.00
14 Jamrah 01 54 42 Rp 30,000.00 Rp 30,000.00
15 ST.Sarah 01 48 28 Rp 30,000.00 Rp 30,000.00
16 Nurul Huda 01 23 59 Rp 30,000.00 Rp 30,000.00
17 Ani Mariani 01 08 13 Rp 30,000.00 Rp 30,000.00
18 Heni Agustani 01 22 10 Rp 30,000.00 Rp 30,000.00
19 Gt.Riduan 01 51 02 Rp 30,000.00 Rp 30,000.00
20 Jasran 01 41 45 Rp 30,000.00 Rp 30,000.00
21 M.Syarbani 01 53 75 7/1/2014 Rp 30,000.00 Rp 30,000.00
22 Wibisono 01 22 22 Rp 30,000.00 Rp 30,000.00
23 Kadariah 01 11 47 Rp 30,000.00 Rp 30,000.00
24 Rifani 01 27 71 Rp 30,000.00 Rp 30,000.00
25 Mahfuni 01 22 75 Rp 30,000.00 Rp 30,000.00
26 Hamsah 00 78 93 Rp 30,000.00 Rp 30,000.00
27 Supiansuri 01 00 11 Rp 30,000.00 Rp 30,000.00
28 Darham 01 59 14 Rp 30,000.00 injeksi Rp 10,000.00 1 Rp 40,000.00
29 Rahmad Hidayat 01 10 93 8/1/2014 Rp 30,000.00 Rp 30,000.00
30 Norman 00 70 56 Rp 30,000.00 Rp 30,000.00
31 Abdul khalik 00 84 35 Rp 30,000.00 Rp 30,000.00
32 Abdullah 01 59 25 Rp 30,000.00 Rp 30,000.00
33 M.nor 01 59 29 9/1/2014 Rp 30,000.00 Rp 30,000.00
34 Sigit 01 13 11 Rp 30,000.00 Rp 30,000.00
35 Hendra 01 06 23 Rp 30,000.00 Rp 30,000.00
36 Jayadi 01 06 24 Rp 30,000.00 Rp 30,000.00
37 M.nor 01 59 31 Rp 30,000.00 Rp 30,000.00
38 Abd Syukur 01 59 33 Rp 30,000.00 Rp 30,000.00
39 Masiam 01 22 08 10/1/2014 Rp 30,000.00 Rp 30,000.00
40 Syarwani 01 58 06 Rp 30,000.00 Rp 30,000.00
41 Hamdani 00 70 49 Rp 30,000.00 Rp 30,000.00
42 St.Aisyah 00 96 63 Rp 30,000.00 Rp 30,000.00
43 M.Zainal Alqi 01 44 34 Rp 30,000.00 Rp 30,000.00
44 Tri Kusyandi 01 31 31 Rp 30,000.00 Rp 30,000.00
45 Ahmad Yusuf 01 29 42 Rp 30,000.00 Rp 30,000.00
46 M.Zaini 01 05 65 Rp 30,000.00 Rp 30,000.00
47 Safrudin 01 28 18 Rp 30,000.00 Rp 30,000.00
48 Alui 01 34 02 Rp 30,000.00 Rp 30,000.00
49 Megawati 01 59 36 Rp 30,000.00 Rp 30,000.00
50 M.Noor 01 59 31 Rp 30,000.00 Rp 30,000.00
51 Winda yuni 01 07 13 11/1/2014 Rp 30,000.00 Rp 30,000.00
52 Bastasiah 01 54 23 Rp 30,000.00 Rp 30,000.00
53 Feni Hermawan 01 59 38 Rp 30,000.00 Rp 30,000.00
54 Siti muawanah 01 08 37 Rp 30,000.00 injeksi Rp 10,000.00 1 Rp 40,000.00
55 Noresah 01 06 21 12/1/2014 Rp 30,000.00 injeksi Rp 10,000.00 1 Rp 40,000.00
56 Syamsul 00 88 94 Rp 30,000.00 Rp 30,000.00
57 Arbiatul 00 59 39 Rp 30,000.00 Rp 30,000.00
58 salmansyah 01 47 26 Rp 30,000.00 Rp 30,000.00
59 baihaki 00 81 42 Rp 30,000.00 Rp 30,000.00
60 Mahrian F 01 27 50 Rp 30,000.00 Rp 30,000.00
61 Anang 01 19 39 Rp 30,000.00 Rp 30,000.00
62 Ujun 01 05 45 Rp 30,000.00 Rp 30,000.00
63 Jumbri 00 86 22 Rp 30,000.00 Rp 30,000.00
64 Akh Khairil 00 85 50 13/1/2014 Rp 30,000.00 Rp 30,000.00
65 Ibramsyah 01 56 43 Rp 30,000.00 Rp 30,000.00
66 M.Fadli 00 83 30 Rp 30,000.00 Rp 30,000.00
67 Supian 00 96 89 Rp 30,000.00 Rp 30,000.00
68 Tarmiji 00 76 06 Rp 30,000.00 Rp 30,000.00
69 Nadi 00 98 78 Rp 30,000.00 Rp 30,000.00
70 Wahyudi 00 86 09 Rp 30,000.00 Rp 30,000.00
71 Yatmini 01 59 45 Rp 30,000.00 Rp 30,000.00
72 Sahil 01 12 46 Rp 30,000.00 Rp 30,000.00
73 Ahmad hairiansyah 00 56 85 14/1/2014 Rp 30,000.00 Rp 30,000.00
74 A. Rusihan helmi 01 56 29 Rp 30,000.00 Rp 30,000.00
75 Miswan 01 19 49 Rp 30,000.00 Rp 30,000.00
76 M.Zaini 01 51 41 Rp 30,000.00 Rp 30,000.00
77 Slamet Riadi 00 98 58 Rp 30,000.00 Rp 30,000.00
78 Sahruni 01 54 89 Rp 30,000.00 Rp 30,000.00
79 M.Ali 00 76 25 Rp 30,000.00 Rp 30,000.00
80 Limai 01 48 98 Rp 30,000.00 Rp 30,000.00
81 Zainal 00 88 35 15/1/2014 Rp 30,000.00 Rp 30,000.00
82 Darham 01 59 14 Rp 30,000.00 Rp 30,000.00
83 yuliani 01 54 20 16/1/2014 Rp 30,000.00 Rp 30,000.00
84 Lamsani 00 75 66 Rp 30,000.00 Rp 30,000.00
85 Juhansyah 01 51 59 Rp 30,000.00 Rp 30,000.00
86 Abdul syukur 01 59 33 Rp 30,000.00 Rp 30,000.00
87 Hasanudin 01 57 25 Rp 30,000.00 Rp 30,000.00
88 Mustafa aripin 01 52 97 Rp 30,000.00 Rp 30,000.00
89 Saleh darmono 01 51 79 Rp 30,000.00 Rp 30,000.00
90 aminah 00 69 73 17/1/2014 Rp 30,000.00 Rp 30,000.00
91 yulianti 00 68 90 Rp 30,000.00 Rp 30,000.00
92 yuswardi 00 79 30 Rp 30,000.00 Rp 30,000.00
93 Dian cahyadi 01 59 57 Rp 30,000.00 Rp 30,000.00
94 Nurtinah 01 49 31 Rp 30,000.00 Rp 30,000.00
95 Hasbiah 01 43 66 Rp 30,000.00 Rp 30,000.00
96 M.Ali 00 71 49 Rp 30,000.00 Rp 30,000.00
97 Rusmini 00 79 32 Rp 30,000.00 Rp 30,000.00
98 Irfan Rasyid 01 35 69 Rp 30,000.00 Rp 30,000.00
99 Ahmad 01 66 75 18/1/2014 Rp 30,000.00 Rp 30,000.00
100 Fahmi 01 22 43 Rp 30,000.00 Rp 30,000.00
101 Mulia 01 26 71 Rp 30,000.00 Rp 30,000.00
102 Acmad 01 46 09 Rp 30,000.00 Rp 30,000.00
103 Aidil 01 55 28 Rp 30,000.00 Rp 30,000.00
104 Arbiatul 01 59 39 Rp 30,000.00 Rp 30,000.00
105 Syarkawi 01 59 59 Rp 30,000.00 Rp 30,000.00
106 hamid 01 01 59 Rp 30,000.00 Rp 30,000.00
107 Hamsyah 01 33 73 19/1/2014 Rp 30,000.00 Rp 30,000.00
108 Bahrani 00 99 57 Rp 30,000.00 Rp 30,000.00
109 Hamsiah 01 14 35 Rp 30,000.00 Rp 30,000.00
110 Abdul malik 01 59 62 Rp 30,000.00 Rp 30,000.00
111 Halil 01 55 11 20/1/2014 Rp 30,000.00 Rp 30,000.00
112 M.jakpar 01 59 66 Rp 30,000.00 Rp 30,000.00
113 M.ramadhan 01 59 67 Rp 30,000.00 Rp 30,000.00
114 M.Ridho 00 80 62 Rp 30,000.00 Rp 30,000.00
115 Norjahil 01 27 17 Rp 30,000.00 Rp 30,000.00
116 Kamarullah 01 34 47 Rp 30,000.00 Rp 30,000.00
117 Saiful Rahman 01 20 18 Rp 30,000.00 Rp 30,000.00
118 Herman 01 19 37 Rp 30,000.00 Rp 30,000.00
119 Ripani 01 59 65 Rp 30,000.00 Rp 30,000.00
120 Rizali 00 68 16 21/1/2014 Rp 30,000.00 Rp 30,000.00
121 Supriadi 00 58 45 Rp 30,000.00 Rp 30,000.00
122 Rajudinor 00 98 04 Rp 30,000.00 Rp 30,000.00
123 Supian suri 01 00 11 23/1/2014 Rp 30,000.00 Rp 30,000.00
124 M.Rajudin 01 59 80 Rp 30,000.00 Rp 30,000.00
125 Fitri 01 26 25 Rp 30,000.00 Rp 30,000.00
126 Dahlia 01 14 59 Rp 30,000.00 Rp 30,000.00
127 rusli 00 97 40 Rp 30,000.00 Rp 30,000.00
128 wahidah 01 06 76 Rp 30,000.00 Rp 30,000.00
129 nuraini 01 12 15 Rp 30,000.00 Rp 30,000.00
130 muhlis 01 16 44 Rp 30,000.00 Rp 30,000.00
131 rusiannor 0097 27 Rp 30,000.00 Rp 30,000.00
132 munawarah 01 54 78 Rp 30,000.00 Rp 30,000.00
133 NY.X (sumi) 00 90 62 Rp 30,000.00 Rp 30,000.00
134 Mr.x Udin 01 56 74 Rp 30,000.00 Rp 30,000.00
135 Gt.Nurdin 01 56 73 Rp 30,000.00 Rp 30,000.00
136 Abdul Muin 01 06 04 Rp 30,000.00 Rp 30,000.00
137 Rahmzali 01 54 80 Rp 30,000.00 Rp 30,000.00
138 Ameliana 01 16 37 Rp 30,000.00 Rp 30,000.00
139 Salafuddin 01 29 50 Rp 30,000.00 Rp 30,000.00
140 Said Qasim 01 59 82 Rp 30,000.00 Rp 30,000.00
141 Asmail 01 54 58 Rp 30,000.00 Rp 30,000.00
142 Sahran 01 54 58 Rp 30,000.00 Rp 30,000.00
143 Samsul Bahri 00 94 06 24/1/2014 Rp 30,000.00 Rp 30,000.00
144 Fahrurazi 00 70 74 Rp 30,000.00 Rp 30,000.00
145 bahrudin 01 59 85 Rp 30,000.00 injeksi Rp 10,000.00 1 Rp 40,000.00
146 Sairani 01 57 78 Rp 30,000.00 Rp 30,000.00
147 Aliansyah 01 55 88 Rp 30,000.00 Rp 30,000.00
148 Budi Iskandar 01 43 71 Rp 30,000.00 Rp 30,000.00
149 Rahmawati 01 49 56 Rp 30,000.00 Rp 30,000.00
150 Maskiah 01 52 20 Rp 30,000.00 Rp 30,000.00
151 Sadah 0159 87 Rp 30,000.00 Rp 30,000.00
152 Khairiah hajah 00 86 46 Rp 30,000.00 Rp 30,000.00
153 Milo 01 59 86 25/1/2014 Rp 30,000.00 Rp 30,000.00
154 Mawardi 00 81 70 Rp 30,000.00 Rp 30,000.00
155 Nurnormin 01 47 27 Rp 30,000.00 Rp 30,000.00
156 Arsadi 00 93 31 Rp 30,000.00 Rp 30,000.00
157 Andi heru 01 34 25 Rp 30,000.00 Rp 30,000.00
158 Dedy Arianto 01 57 75 Rp 30,000.00 Rp 30,000.00
159 Abdul halim 01 59 92 Rp 30,000.00 Rp 30,000.00
160 H.suni 01 59 94 26/1/2014 Rp 30,000.00 Rp 30,000.00
161 Mulyani 01 28 70 Rp 30,000.00 Rp 30,000.00
162 Mandi 01 04 41 Rp 30,000.00 Rp 30,000.00
163 Hj.Masriah 01 59 95 Rp 30,000.00 Rp 30,000.00
164 Lina 01 14 66 Rp 30,000.00 Rp 30,000.00
165 Rahmat 01 59 96 Rp 30,000.00 Rp 30,000.00
166 Masyuni 00 68 40 27/1/2014 Rp 30,000.00 Rp 30,000.00
167 Makpuzi 01 22 75 Rp 30,000.00 Rp 30,000.00
168 M.Nasir 01 30 76 Rp 30,000.00 Rp 30,000.00
169 Supian Suri 01 00 11 Rp 30,000.00 Rp 30,000.00
170 Fahriani 01 47 02 Rp 30,000.00 Rp 30,000.00
171 Herlianadi 00 93 43 Rp 30,000.00 Rp 30,000.00
172 Saifullah 01 18 54 28/1/2014 Rp 30,000.00 Rp 30,000.00
173 Hamdanah 00 26 42 Rp 30,000.00 Rp 30,000.00
174 Nengsih 00 81 83 Rp 30,000.00 Rp 30,000.00
175 M.Noor 00 98 84 Rp 30,000.00 Rp 30,000.00
176 m.Husni 01 49 12 29/1/2014 Rp 30,000.00 Rp 30,000.00
177 A.Darul Mutakin 01 06 10 30/1/2014 Rp 30,000.00 Rp 30,000.00
178 Hadiana 01 60 17 Rp 30,000.00 Rp 30,000.00
179 Munif 01 60 16 Rp 30,000.00 Rp 30,000.00
180 Budianto 01 60 18 Rp 30,000.00 Rp 30,000.00
181 Fauzan 00 93 88 Rp 30,000.00 Rp 30,000.00
182 Siti Fatimah 01 29 75 Rp 30,000.00 Rp 30,000.00
183 Mawaddah 00 78 67 31/1/2014 Rp 30,000.00 Rp 30,000.00
184 M.Isa ansari 00 79 36 Rp 30,000.00 Rp 30,000.00
185 Norman 00 87 37 Rp 30,000.00 Rp 30,000.00
186 Norhani 00 84 68 Rp 30,000.00 Rp 30,000.00
Rp 5,580,000.00 Rp 40,000.00 4 Rp 5,620,000.00

umum 84
Jamkesmas 34 Kepala Ruangan IGD
DP 21
Jamkesprov 31
BPJS 5 Muhammad Baihaki, S.Kep, Ners
Dinsos 2
Jamkesda 9
STATUS

Bayar
Bayar
Bayar
JKM
Bayar
Bayar
JKM
Bayar
Bayar
Bayar
DP
Bayar
DP
JKV
DP
Bayar
JKM
JKV
Bayar
JKM
DP
Bayar
JKM
Bayar
DP
Bayar
DP
Bayar
DP
JKM
Bayar
Bayar
Bayar
Bayar
JKM
JKM
Bayar
Bayar
JKM
DP
jKD
JKM
JKV
DP
DP
Bayar
Bayar
JKM
Bayar
Bayar
Bayar
Bayar
Bayar
JKM
Bayar
Bayar
Bayar
Bayar
JKM
JKM
Bayar
JKM
Bayar
JKV
Bayar
JKV
Bayar
Bayar
JKM
jKD
Bayar
JKV
Bayar
JKM
JKM
Bayar
JKM
Bayar
DP
Bayar
Bayar
Bayar
JKV
DP
DP
Bayar
Bayar
DP
DP
BPJS
Bayar
Bayar
Bayar
Bayar
JKV
Bayar
Bayar
BPJS
jKD
jKD
Bayar
JKM
Bayar
Bayar
Bayar
JKV
DP
JKM
Bayar
Bayar
JKM
Bayar
Bayar
Bayar
jKD
JKM
jKD
jKD
DP
JKV
jKD
JKM
DP
Bayar
JKV
JKV
JKV
JKV
JKV
JKM
JKV
Bayar
JKV
JKV
JKV
JKV
JKV
JKV
JKV
Bayar
DP
JKV
JKM
Bayar
Bayar
Bayar
DP
DP
JKV
JKV
Bayar
Bayar
Bayar
BPJS
BPJS
JKV
Bayar
Bayar
JKM
BPJS
JKV
Bayar
Bayar
JKM
Bayar
Bayar
JKV
Bayar
JKV
JKV
JKM
JKM
JKM
JKM
JKM
jKD
Bayar
Bayar
Bayar
Bayar
Dinsos
Dinsos
Bayar
Bayar
Bayar
JKM

ngan IGD
aki, S.Kep, Ners
REKAPITULASI TINDAKAN IGD PASIEN RAWAT JALAN RUMAH SAKIT JIWA SAMBANG LIHUM
BULAN: MARET 2014

PEMERIKSAAN
NO NAMA NO CM TGL MASUK STATUS
DOKTER Tindakan lain Jumlah

Nama tindakan Volume


1 Dwi Yatrini 00 39 18 1/3/2014 Rp 30,000.00 Umum
2 Hadiana 01 60 17 Rp 30,000.00 Umum
3 Mutmainah 00 86 92 Rp 30,000.00 JKM
4 juami 01 51 00 Rp 30,000.00 JKM
5 Sarkani 01 12 67 2/3/2014 Rp 30,000.00 JKM
6 Hamberani 01 12 68 Rp 30,000.00 Umum
7 Maidi 01 04 41 Rp 30,000.00 BPJS
8 M.Ali 00 76 23 Rp 30,000.00 umum
9 Halifah 01 14 68 Rp 30,000.00 JKM
10 M.Arifn 00 79 45 Rp 30,000.00 umum
11 M.Yunus 01 61 37 Rp 30,000.00 Umum
12 M.Saputra 01 25 13 Rp 30,000.00 JKV
13 Jumiati 01 51 00 Rp 30,000.00
14 Zubaidah 00 69 76 3/3/2014 Rp 30,000.00 Umum
15 Yasir Arafat 01 33 08 Rp 30,000.00 JKV
16 Saidah 01 59 24 Rp 30,000.00 JKV
17 M.Hendra 01 43 73 Rp 30,000.00 Umum
18 Juhansyah 01 51 59 Rp 30,000.00
19 Syarif Hidayatullah 01 61 41 4/3/2014 Rp 30,000.00 Umum
20 Suyatno 01 48 80 Rp 30,000.00 Umum
21 Rasbini 01 43 77 Rp 30,000.00 Umum
22 Aidil Mubarak 01 55 28 Rp 30,000.00 JKD
23 Supian Suri 01 00 11 Rp 30,000.00 JKV
24 Supiani 01 61 42 Rp 30,000.00 Umum
25 Suharyani 01 30 89 5/3/2014 Rp 30,000.00 Umum
26 Saipullah 01 18 54 Rp 30,000.00 BPJS
27 Hamdanah 00 26 42 Rp 30,000.00 BPJS
28 Nor'ah 01 61 47 Rp 30,000.00 JKM
29 I nyoman Mulastawa 00 94 76 6/3/2014 Rp 30,000.00 Umum
30 Made murtiasih 00 85 90 Rp 30,000.00 Umum
31 Rian hidayat 00 69 87 Rp 30,000.00 Umum
32 Husni T 00 75 77 Rp 30,000.00 Umum
33 imada 00 84 98 Rp 30,000.00 Umum
34 rajudinor 00 98 04 Rp 30,000.00 BPJS
35 Dalini 01 06 71 Rp 30,000.00 Umum
36 Yuliana 01 54 20 7/3/2014 Rp 30,000.00 JKV
37 Barahim 01 32 66 Rp 30,000.00 Umum
38 Ahmad Rifai 01 26 14 Rp 30,000.00 BPJS
39 Siti Rahmah 00 76 55 Rp 30,000.00 BPJS
40 Abdullah 01 32 11 Rp 30,000.00 JKV
41 Kursani 00 86 29 Rp 30,000.00 BPJS
42 Abdul Halim 01 59 92 Rp 30,000.00 BPJS
43 Ratmi 01 09 71 Rp 30,000.00 Umum
44 Syamsi 00 96 06 Rp 30,000.00
45 Aspiani 00 83 46 8/3/2014 Rp 30,000.00 Umum
46 Alui 01 34 02 Rp 30,000.00 JKM
47 Syamsidah 00 94 92 Rp 30,000.00 JKM
48 Saidillah 01 60 33 9/3/2014 Rp 30,000.00 Umum
49 Faturahman 00 91 13 Rp 30,000.00 Umum
50 Bahrani 00 99 57 Rp 30,000.00 BPJS
51 Didit 01 33 32 Rp 30,000.00 Umum
52 Mahyuni 01 08 04 Rp 30,000.00 BPJS
53 M.Ikhwan 01 04 53 Rp 30,000.00 Umum
54 Arsah 01 61 65 Rp 30,000.00 Umum
55 Hasanah Rp 30,000.00
56 Elmiati 01 61 52 10/3/2014 Rp 30,000.00 Umum
57 Abdi 01 05 84 Rp 30,000.00 BPJS
58 Ratna Dewi 01 56 40 Rp 30,000.00 JKD
59 Hamsan 01 57 64 Rp 30,000.00 JKM
60 Salamiah 01 53 83 Rp 30,000.00 BPJS
61 Yuli Ansari 00 70 37 Rp 30,000.00 JKM
62 Lamsani 00 75 66 Rp 30,000.00 BPJS
63 Kalimi 01 08 30 11/3/2014 Rp 30,000.00 BPJS
64 Rizki Habibi 01 32 37 Rp 30,000.00 DP
65 Jumransyah 00 70 27 Rp 30,000.00 BPJS
66 M.Zainal Fadilah 01 05 65 Rp 30,000.00 Umum
67 M.Heriyadi 01 48 01 Rp 30,000.00 JKV
68 Supriansyah 01 21 84 Rp 30,000.00 BPJS
69 Munif 01 60 16 Rp 30,000.00 Umum
70 M.Amin 01 61 72 Rp 30,000.00 Umum
71 Junaidi 01 52 86 12/3/2014 Rp 30,000.00 DP
72 Juhansyah 01 51 59 Rp 30,000.00 JKV
73 Abdul Jabar 00 95 15 Rp 30,000.00 DP
74 M.Arifn 00 79 45 Rp 30,000.00 JKM
75 Kurniansyah 01 57 00 Rp 30,000.00 JKM
76 Umiah 01 36 44 Rp 30,000.00 JKM
77 Halimatussadiah 01 12 03 Rp 30,000.00 Umum
78 Supian suri 01 00 11 Rp 30,000.00 JKV
79 Arsah 01 61 65 Rp 30,000.00 Umum
80 Abd muin 01 06 04 13/3/2014 Rp 30,000.00 JKV
81 Rusli 00 97 40 Rp 30,000.00 JKV
82 Salafudin 01 29 50 Rp 30,000.00 JKV
83 Sarimi 00 90 03 Rp 30,000.00 Umum
84 almuna 01 61 84 Rp 30,000.00 JKV
85 Nuraini 01 12 15 Rp 30,000.00 JKV
86 Mxs Sumi 00 90 62 Rp 30,000.00 JKV
87 Mr.X Udin 01 56 74 Rp 30,000.00 JKV
88 Rahmadi 01 54 80 Rp 30,000.00 JKV
89 Dahlia 01 14 59 Rp 30,000.00 JKV
90 Wahidah 01 06 76 Rp 30,000.00 JKV
91 Rusiannor 00 97 27 Rp 30,000.00 JKV
92 Jubaidah 01 26 81 14/3/2014 Rp 30,000.00 BPJS
93 Aminah 00 69 73 Rp 30,000.00 JKM
94 Norwahidah 00 78 67 Rp 30,000.00 BPJS
95 Yaumi 01 45 53 Rp 30,000.00 Umum
96 Madi 00 99 22 Rp 30,000.00 JKM
97 M.Syahrudin 01 08 58 Rp 30,000.00 BPJS
98 Rahmawati 01 49 56 Rp 30,000.00 JKV
99 Saiful rahman 01 41 44 Rp 30,000.00 DP
100 Ujun 01 05 45 Rp 30,000.00 JKM
101 Ningsih 00 81 83 Rp 30,000.00 BPJS
102 M.Amin 01 61 72 Rp 30,000.00 Umum
103 Kamsiah 01 38 26 Rp 30,000.00 BPJS
104 Dedy.A 01 57 75 15/3/2014 Rp 30,000.00 Umum
105 Sahruni 00 98 37 Rp 30,000.00 DP
106 Gt.Riduan Syahrani 01 51 02 Rp 30,000.00 Umum
107 Rabilnoor 00 84 14 Rp 30,000.00 JKD
108 Gusti Ihsan 01 14 18 16/3/2014 Rp 30,000.00 Umum
109 Hamsah 01 33 73 Rp 30,000.00 Umum
110 Eni lastari 01 45 32 Rp 30,000.00 Umum
111 Sarkani 01 12 67 Rp 30,000.00 JKM
112 Hamberani 01 12 68 Rp 30,000.00 JKM
113 Faturahman 01 01 82 Rp 30,000.00 Umum
114 Farid A 01 34 66 17/3/2014 Rp 30,000.00 BPJS
115 Salmawati 01 51 78 Rp 30,000.00 BPJS
116 Sarbani 01 51 77 Rp 30,000.00 BPJS
117 Sapruddin 01 61 92 Rp 30,000.00 BPJS
118 Bahrah 01 21 79 Rp 30,000.00 BPJS
119 M.Hafz 01 61 91 Rp 30,000.00 Umum
120 Razudinor 00 98 04 Rp 30,000.00 BPJS
121 Alifansyah 01 45 61 Rp 30,000.00 Umum
122 Muhlis 01 16 44 18/3/2014 Rp 30,000.00 BPJS
123 Aulia Rahman 01 62 03 Rp 30,000.00 Umum
124 Ramli 01 48 85 Rp 30,000.00 Umum
125 Ahmad 01 16 26 Rp 30,000.00 JKD
126 Wahyudi 00 86 04 Rp 30,000.00 JKD
127 Agus Arianto 01 55 58 Rp 30,000.00 BPJS
128 Syamsidah 00 94 92 19/3/2014 Rp 30,000.00 JKM
129 Mustafa Arifn 01 52 97 Rp 30,000.00 BPJS
130 M.Rizky Habibi 01 32 37 Rp 30,000.00 BPJS
131 Yuli ami 01 62 05 Rp 30,000.00 Umum
132 Halil 01 55 11 20/3/2014 Rp 30,000.00 JKM
133 M.Rico P 01 60 57 Rp 30,000.00 BPJS
134 Novi andi irawan 01 62 11 Rp 30,000.00 Umum
135 Taufk 01 22 51 Rp 30,000.00 JKM
136 Satrio Pamungkas 01 60 12 21/3/2014 Rp 30,000.00 BPJS
137 Siti aminah 01 59 28 Rp 30,000.00 Umum
138 Norsehat 01 45 67 Rp 30,000.00 Umum
139 marhawi 00 90 36 Rp 30,000.00 JKV
140 Masiam 01 22 08 Rp 30,000.00 BPJS
141 Esti R 01 14 70 Rp 30,000.00 JKV
142 Fitri 01 26 25 Rp 30,000.00 Umum
143 Saprudin 01 60 92 Rp 30,000.00 Umum
144 M.Arifn 00 79 45 Rp 30,000.00 JKM
145 Syarifudin 00 92 21 Rp 30,000.00 Umum
146 Aidil 01 55 28 22/3/2014 Rp 30,000.00 JKD
147 Sadillah 01 60 33 Rp 30,000.00 Umum
148 Aisyah 01 53 06 Rp 30,000.00 BPJS
149 Lamsani 00 75 66 Rp 30,000.00 BPJS
150 mahyuni 01 08 04 23/3/2014 Rp 30,000.00 JKM
151 husnul jannatul 01 52 35 Rp 30,000.00 DP
152 Mulia rahman 01 26 71 Rp 30,000.00 Umum
153 Hakim 01 18 59 Rp 30,000.00 JKM
154 Hasan 01 60 07 Rp 30,000.00 Umum
155 Syamsianor 01 17 45 Rp 30,000.00 Umum
156 Supian Suri 01 00 11 Rp 30,000.00 JKV
157 Munawarah 01 54 78 Rp 30,000.00 Umum
158 Samsul Kamar 00 99 33 24/3/2014 Rp 30,000.00 Umum
159 Misra 01 60 10 Rp 30,000.00 BPJS
160 Alpiansyah 01 01 61 Rp 30,000.00 BPJS
161 Ahong 01 62 22 Rp 30,000.00 Umum
162 Junaidi 01 52 86 25/3/2014 Rp 30,000.00 JKV
163 Mahrita 01 60 84 Rp 30,000.00 BPJS
164 Zainal A 01 62 33 Rp 30,000.00 Umum
165 Sapransyah 01 21 84 Rp 30,000.00 JKM
166 Alui 01 34 02 Rp 30,000.00 JKM
167 Yuliani 01 56 60 26/3/2014 Rp 30,000.00 BPJS
168 Saiful 01 43 69 Rp 30,000.00 BPJS
169 Edy Fahrin 01 19 97 Rp 30,000.00 JKV
170 Wati 01 06 03 Rp 30,000.00 Umum
171 Salmansyah 01 47 26 Rp 30,000.00 Umum
172 Rabianur 00 84 14 Rp 30,000.00 JKD
173 Bayah 01 08 22 Rp 30,000.00 BPJS
174 Kurniansyah 01 57 20 Rp 30,000.00 JKM
175 Masnurul 01 57 06 Rp 30,000.00 Umum
176 Muhammad Renaldi 01 62 39 Rp 30,000.00 Umum
177 Ahmad Yani 01 19 10 Rp 30,000.00 BPJS
178 M.Saputra 01 25 13 Rp 30,000.00 JKV
179 Harliani 01 57 94 27/3/2014 Rp 30,000.00 JKM
180 Taufku rahman 01 61 38 Rp 30,000.00 Umum
181 Fauzan 00 93 88 Rp 30,000.00 BPJS
182 Bainah 00 74 73 Rp 30,000.00 Umum
183 Gusti Yuliana 01 62 43 Rp 30,000.00 Umum
184 M.Rizani 01 01 94 28/3/2014 Rp 30,000.00 BPJS
185 Jurmiah 01 59 64 Rp 30,000.00 BPJS
186 Miswan 01 19 49 Rp 30,000.00 BPJS
187 M.Syahbani 01 53 75 Rp 30,000.00 BPJS
188 Syamsudinoor 00 97 81 Rp 30,000.00 JKM
189 M.Aini 00 94 51 Rp 30,000.00 BPJS
190 Hasan Basri 01 20 02 Rp 30,000.00 BPJS
191 Asbullah 01 31 34 Rp 30,000.00 BPJS
192 M.Soleh 01 61 02 Rp 30,000.00 BPJS
193 Poniman 01 62 45 Rp 30,000.00 Umum
194 Gisnay Taaufk 01 62 46 Rp 30,000.00 DP
195 Rahmawati 01 49 56 Rp 30,000.00 JKV
196 A.Rifa'i 01 26 14 Rp 30,000.00 BPJS
197 Ika Winardi 00 88 61 Rp 30,000.00 Umum
198 Munif 01 60 16 Rp 30,000.00 Umum
199 suriyani 01 62 48 Rp 30,000.00 JKM
200 Hasanuddin 01 57 25 29/3/2014 Rp 30,000.00 Umum
201 Nurtinah 01 49 31 Rp 30,000.00 BPJS
202 Aminah 01 61 12 Rp 30,000.00 BPJS
203 Syahruzi 01 12 76 Rp 30,000.00 DP
204 Hatizah 01 05 51 Rp 30,000.00 Umum
205 Iswani 01 50 84 Rp 30,000.00 BPJS
206 Gt.Ihsan 01 14 18 Rp 30,000.00 Umum
207 Kornelius 01 62 50 Rp 30,000.00 Umum
208 Siti Ramlah 01 61 46 Rp 30,000.00 JKV
209 M.Yusuf 01 47 92 Rp 30,000.00 Umum
210 Hendra W 01 18 72 30/3/2014 Rp 30,000.00 BPJS
211 Norhidayatullah 00 77 82 Rp 30,000.00
212 Syarkani 01 12 67 Rp 30,000.00 JKM
213 Hamberani 01 12 68 Rp 30,000.00 JKM
214 Bambang 01 48 73 Rp 30,000.00 Umum
215 Halil 01 55 11 Rp 30,000.00 JKM
216 Ardiansyah 00 80 51 Rp 30,000.00 BPJS
217 H.Mas'ud 01 57 60 Rp 30,000.00 Umum
218 Syahrin 00 99 24 31/3/2014 Rp 30,000.00 Umum
219 Zainal A 01 62 33 Rp 30,000.00 Umum
220 Edi P 00 88 98 Rp 30,000.00 Umum
221 M.Isa 00 79 36 Rp 30,000.00 Umum
222 Hadiana 01 60 17 Rp 30,000.00 Umum
Rp 5,820,000.00 Rp - 0 Rp -