LAPORAN PASIEN HEMODIALISA

BULAN AGUSTUS 2014

JAMINAN BARU REUSE

NO TANGGAL NAMA PASIEN TARIF KSO
UMUM BPJS JKD JPKMM UMUM JAMINAN UMUM JAMINAN
1 8/1/2014 Tn Kasno 800,000 264,000
2 Tn Yandi 893,318 264,000
3 Ny Amah 800,000 264,000
4 Tn Arifin 893,318 418,000
5 Tn Karmita 893,318 264,000
6 Ny Tini 893,318 264,000
7 Tn Misna 893,318 418,000
8 Ny Odah 893,318 264,000
9 8/2/2014 Tn Dadang 800,000 264,000
10 Tn H Darsa 893,318 264,000
11 Ny Hj Odah 800,000 264,000
12 Tn Mica 800,000 264,000
13 Tn H Wanda 893,318 264,000
14 Ny Endah 893,318 264,000
15 Tn Nandang 800,000 264,000
16 8/4/2014 Tn Nursaibi 893,318 264,000
17 Ny Sarintem 893,318 264,000
18 Ny Titin 893,318 264,000
19 Tn Abd Rohman 800,000 264,000
20 Tn Montang 893,318 264,000
21 Tn Arifin 893,318 264,000
22 Ny Aat 800,000 264,000
23 Ny Titi S 893,318 264,000
24 8/5/2014 Tn Kasno 800,000 264,000
25 Tn Yandi 893,318 264,000
26 Ny Amah 800,000 418,000
27 Tn Umar 800,000 418,000
28 Ny Tini 893,318 418,000
29 Tn Misna 893,318 264,000
30 Ny Odah 893,318 264,000
31 Tn Karmita 893,318 264,000
32 8/6/2014 Tn Dadang 800,000 264,000
33 Tn H Darsa 893,318 264,000
34 Tn Nandang 800,000 264,000
35 Tn Mica 800,000 264,000
36 Ny Ai W 893,318 418,000
37 Tn H Wanda 893,318 418,000
38 Ny Endah 893,318 418,000
39 Ny Hj Odah 800,000 264,000
40 8/7/2014 Tn Nursaibi 893,318 264,000
41 Ny Sarintem 893,318 264,000
42 Ny Titin 893,318 264,000
43 Tn Abd Rohman 800,000 264,000
44 Tn Montang 893,318 264,000
45 Tn Arifin 893,318 264,000
46 Ny Titi S 893,318 264,000
47 Ny Aat 800,000 264,000
48 8/8/2014 Tn Kasno 800,000 418,000
49 Tn Yandi 893,318 264,000
50 Ny Amah 800,000 264,000
51 Tn Umar 800,000 264,000
52 Tn Karmita 893,318 264,000
53 Tn Misna 893,318 264,000
54 Ny Odah 893,318 264,000
55 Ny Tini 893,318 264,000
56 8/9/2014 Ny Hj Odah 800,000 264,000
57 Tn H Darsa 893,318 264,000
58 Tn Nandang 800,000 264,000
59 Tn Mica 800,000 418,000
60 Ny Endah 893,318 264,000
61 Tn H Wanda 893,318 264,000
62 Ny Ai W 893,318 264,000
63 8/11/2014 Tn Nursaibi 893,318 418,000
64 Ny Sarintem 893,318 418,000
65 Ny Titi S 893,318 264,000
66 Tn Abd Rohman 800,000 264,000
67 Tn Montang 893,318 418,000
68 Tn Arifin 893,318 264,000
69 Ny Titin 893,318 264,000
70 Ny Aat 800,000 264,000
71 8/12/2014 Tn Kasno 800,000 264,000
72 Tn Yandi 893,318 418,000
73 Ny Amah 800,000 264,000
74 Tn Umar 800,000 264,000
75 Ny Tini 893,318 264,000
76 Tn Misna 893,318 264,000
77 Tn Karmita 893,318 264,000
78 8/13/2014 Tn Dadang 800,000 264,000
79 Tn H Darsa 893,318 264,000
80 Tn Nandang 800,000 264,000
81 Tn Mica 800,000 264,000
82 Ny Ai W 893,318 264,000
83 Ny Endah 893,318 264,000
84 Tn H Wanda 893,318 264,000
85 Ny Hj Odah 800,000 264,000
86 8/14/2014 Tn Nursaibi 893,318 264,000
87 Ny Sarintem 893,318 264,000
88 Ny Titin 893,318 264,000
89 Tn Abd Rohman 800,000 264,000
90 Ny Sopiah 893,318 418,000
91 Ny Titi S 893,318 264,000
92 Tn Arifin 893,318 264,000
93 Ny Aat 800,000 264,000
94 8/15/2014 Tn Kasno 800,000 264,000
 95 Tn Yandi 893,318 264,000
96 Ny Amah 800,000 264,000
97 Tn Umar 800,000 264,000
98 Ny Tini 893,318 264,000
99 Tn Misna 893,318 264,000
100 Tn Karmita 893,318 418,000
101 Ny Odah 893,318 264,000
102 8/16/2014 Tn Dadang 800,000 418,000
103 Tn H Darsa 893,318 264,000
104 Ny Hj Odah 800,000 264,000
105 Tn Mica 800,000 264,000
106 Ny Endah 893,318 264,000
107 Tn H Wanda 893,318 264,000
108 Tn Nandang 800,000 418,000
109 Ny Ai W 893,318 264,000
110 8/18/2014 Tn Nursaibi 893,318 264,000
111 Ny Sarintem 893,318 264,000
112 Ny Titin 893,318 264,000
113 Tn Abd Rohman 800,000 264,000
114 Tn Montang 893,318 264,000
115 Tn Arifin 893,318 264,000
116 Ny Aat 800,000 264,000
117 8/19/2014 Tn Kasno 800,000 264,000
118 Tn Yandi 893,318 264,000
119 Ny Amah 800,000 264,000
120 Tn Umar 800,000 264,000
121 Tn Karmita 893,318 264,000
122 Tn Misna 893,318 418,000
123 Ny Odah 893,318 264,000
124 Ny Tini 893,318 264,000
125 8/20/2014 Tn H Wanda 893,318 264,000
126 Tn H Darsa 893,318 418,000
127 Tn Nandang 800,000 264,000
128 Tn Mica 800,000 264,000
129 Ny Ai W 893,318 264,000
130 Ny Endah 893,318 264,000
131 Ny Hj Odah 800,000 264,000
132 8/21/2014 Tn Nursaibi 893,318 264,000
133 Ny Sarintem 893,318 264,000
134 Ny Titin 893,318 418,000
135 Tn Abd Rohman 800,000 418,000
136 Ny Sopiah 893,318 264,000
137 Ny Titi S 893,318 264,000
138 Tn Arifin 893,318 264,000
139 Ny Aat 800,000 418,000
140 8/22/2014 Tn Kasno 800,000 264,000
141 Tn Yandi 893,318 264,000
142 Ny Amah 800,000 264,000
143 Tn Umar 800,000 264,000
144 Tn Misna 893,318 264,000
145 Ny Tini 893,318 418,000
146 Tn Karmita 893,318 264,000
147 8/23/2014 Tn Dadang 800,000 264,000
148 Tn H Darsa 893,318 264,000
149 Ny Hj Odah 800,000 264,000
150 Tn Mica 800,000 264,000
151 Ny Ai W 893,318 418,000
152 Tn H Wanda 893,318 418,000
153 Tn Nandang 800,000 264,000
154 Ny Endah 893,318 418,000
155 8/25/2014 Tn Nursaibi 893,318 264,000
156 Ny Sarintem 893,318 264,000
157 Ny Titin 893,318 264,000
158 Tn Abd Rohman 800,000 264,000
159 Ny Titi S 893,318 264,000
160 Tn Montang 893,318 264,000
161 Tn Arifin 893,318 418,000
162 Ny Aat 800,000 264,000
163 8/26/2014 Tn Kasno 800,000 264,000
164 Tn Yandi 893,318 264,000
165 Ny Amah 800,000 264,000
166 Tn Umar 800,000 264,000
167 Tn Misna 893,318 264,000
168 Ny Tini 893,318 264,000
169 Tn Karmita 893,318 264,000
170 8/27/2014 Tn Dadang 800,000 264,000
171 Tn H Darsa 893,318 264,000
172 Tn Mica 800,000 264,000
173 Tn Nandang 800,000 264,000
174 Ny Ai W 893,318 264,000
175 Ny Endah 893,318 264,000
176 Tn H Wanda 893,318 264,000
177 Ny Hj Odah 800,000 264,000
178 8/28/2014 Tn Nursaibi 893,318 418,000
179 Ny Sarintem 893,318 418,000
180 Ny Titin 893,318 264,000
181 Tn Abd Rohman 800,000 264,000
182 Tn Arifin 893,318 264,000
183 Ny Sopiah 893,318 264,000
184 Ny Aat 800,000 264,000
185 Ny Titi S 893,318 264,000
186 8/29/2014 Tn Kasno 800,000 418,000
187 Tn Yandi 893,318 264,000
188 Ny Amah 800,000 264,000
189 Tn Umar 800,000 264,000
190 Tn Misna 893,318 264,000
191 Ny Tini 893,318 264,000
192 Tn Karmita 893,318 264,000
193 8/30/2014 Tn Nandang 800,000 264,000
194 Tn H Darsa 893,318 264,000
195 Ny Hj Odah 800,000 264,000
196 Tn Mica 800,000 264,000
197 Tn H Wanda 893,318 264,000
198 Ny Endah 893,318 264,000
199 Ny Ai W 893,318 264,000
200 Ny Sarintem 893,318 264,000

201 Ny Endah
202 Tn Nursaibi
203 Ny Sarintem
204 Ny Titin
205 Tn Abd Rohman
206 Tn Montang
207 Tn Arifin
208 Ny Aat
209 Ny Titi S
210 Tn Kasno
211 Tn Yandi
212 Ny Amah
213 Tn Umar
214 Ny Tini
215 Tn Mulyadi
216 Tn Misna
217 Tn Karmita
218 Ny Hj Inoh
219 Tn Sukardi
220 Ny Hj Inoh
221 Tn Warta
222 Tn Nasmo

JUMLAH 127 41 34 31 170 157,131,570 52,932,000

Karawang 01 September 2014

Ahmad Sujana, Amd.Kep

SISA KET
536,000
629,318
475,000
475,000 R. SAFA
629,318
629,318
475,000
629,318
536,000
629,318
536,000
536,000
629,318
629,318
536,000
629,318
629,318
629,318
536,000
629,318
629,318
536,000
629,318
536,000
629,318
382,000
382,000
475,000
629,318
629,318
629,318
536,000
629,318
536,000
536,000
475,000
475,000
475,000
536,000
629,318
629,318
629,318
536,000
629,318
629,318
629,318
536,000
382,000
629,318
536,000
536,000
629,318
629,318
629,318
629,318
536,000
629,318
536,000
382,000
629,318
629,318
629,318
475,000
475,000
629,318
536,000
475,000
629,318
629,318
536,000
536,000
475,000
536,000
536,000
629,318
629,318
629,318
536,000
629,318
536,000
536,000
629,318
629,318
629,318
536,000
629,318
629,318
629,318
536,000
475,000 PB ( JN )
629,318
629,318
536,000
536,000
629,318
536,000
536,000
629,318
629,318
475,000
629,318
382,000
629,318
536,000
536,000
629,318
629,318
382,000
629,318
629,318
629,318
629,318
629,318
629,318
629,318
629,318
629,318
629,318
629,318
629,318
629,318
475,000
629,318
629,318
629,318
475,000
536,000
536,000
629,318
629,318
536,000
629,318
629,318
475,000
382,000
629,318
629,318
629,318
382,000
536,000
629,318
536,000
536,000
629,318
475,000
629,318
536,000
629,318
536,000
536,000
475,000
475,000
536,000
475,000
629,318
629,318
629,318
536,000
629,318
629,318
475,000
536,000
536,000
629,318
536,000
536,000
629,318
629,318
629,318
536,000
629,318
536,000
536,000
629,318
629,318
629,318
536,000
475,000
475,000
629,318
536,000
629,318
629,318
536,000
629,318
382,000
629,318
536,000
536,000
629,318
629,318
629,318
536,000
 629,318
536,000
536,000
629,318
629,318
629,318
629,318

Total 200
104,598,164
Tindakan
1 September 2014

ujana, Amd.Kep