Anda di halaman 1dari 1182

1.

KUNJUNGAN PASIEN

NO INSTALASI
1
1 Instalasi Gawat Darurat 0
2 Instalasi Rawat Jalan 0
3 Kamar Bedah 0
4 Kamar Bersalin 0
5 Ruang Maternitas 0
6 Ruang Rawat Dewasa 9
7 Ruang Rawat Anak dan Perinatal 0
8 Ruang Eksklusif 0
TOTAL 9

2. PASIEN BERDASARKAN JENIS KELAMIN

NO PASIEN
1
1 Anak
Laki-laki0
Perempuan0
subtotal 0
2 Dewasa
Laki-laki5
Perempuan4
subtotal 9
TOTAL 9

3. REALISASI PENDAPATAN

NO INSTALASI
1
1 Instalasi Gawat Darurat 0
2 Instalasi Rawat Jalan 0
3 Kamar Bedah 0
4 Kamar Bersalin 0
5 Ruang Maternitas 0
6 Ruang Rawat Dewasa 0
7 Ruang Rawat Anak dan Perinatal 0
8 Ruang Eksklusif 0
TOTAL 0
4. CARA PEMBAYARAN

NO PEMBAYARAN
1
1 Umum 3
2 BPJS PBI 1
3 BPJS Non PBI 5
4 Karawang Sehat 0
5 Asuransi lain 0
6 Karyawan 0
TOTAL 9

5. KUNJUNGAN PASIEN LAMA / BARU

NO PASIEN
1
1 Pasien Baru 6
2 Pasien Lama 3
TOTAL 9

6. TRIASE PASIEN INSTALASI GAWAT DARURAT

NO TRIASE
1
1 Merah 0
2 Kuning 0
3 Hijau 0
4 Hitam 0
TOTAL 0

7. PASIEN DIRUJUK

NO ALASAN DIRUJUK
1
1 Ruangan full (laki-laki) 0
(Perempuan) 0
(Anak) 0
Subtotal 0
2 Ruangan isolasi (laki-laki) 0
(Perempuan) 0
(Anak) 0
Subtotal 0
3 ICU 0
4 NICU/PICU 0
5 Spesialis bedah anak 0
6 Sp.OG tidak praktek 0
Subtotal 0
7 Spesialis jantung paru
(Dewasa)
0
(Anak)
0
Subtotal 0
8 Spesialis orthopedi
(Dewasa)
0
(Anak)
0
Subtotal 0
9 Spesialis syaraf
(Dewasa)
0
(Anak)
0
Subtotal 0
10 Spesialis urologi
(Dewasa)
0
(Anak)
0
Subtotal 0
11 CT Scan
(Dewasa)
0
(Anak)
0
Subtotal 0
12 Spesialis kesehatan jiwa
(Dewasa)
0
(Anak)
0
Subtotal 0
13 Spesialis bedah mulut
(Dewasa)
0
(Anak)
0
Subtotal 0
14 Renovasi OK
(Dewasa)
0
(Anak)
0
Subtotal 0
15 THT
(Dewasa)
0
(Anak)
0
Subtotal 0
16 GIGI
(Dewasa)
0
(Anak)
0
Subtotal 0
17 Spesialis bedah onkologi
(Dewasa)
0
(Anak)
0
Subtotal 0
18 Spesialis kulit kelamin
(Dewasa)
0
(Anak)
0
Subtotal 0
19 Anti bisa ular
(Dewasa)
0
(Anak)
0
Subtotal 0
20 Atas permintaan sendiri (APS)
(Dewasa)
0
(Anak)
0
Subtotal 0
21 Hemodialisa
(Dewasa)
0
(Anak)
0
Subtotal 0
22 Isolasi luka bakar
(Dewasa)
0
(Anak)
0
Subtotal 0
TOTAL 0

8. JENIS OPERASI KAMAR BEDAH

NO JENIS OPERASI
1
1 Kecil 0
2 Sedang 0
3 Besar 0
4 Besar Khusus 0
TOTAL 0

9. KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

NO LAYANAN MEDIS
NO LAYANAN MEDIS
1
1 Penyakit Dalam 9
2 Bedah 0
3 Obstetri 0
4 Gynekologi 0
5 Anak 0
6 Mata 0
7 Paru 0
8 Kulit 0
9 Syaraf 0
10 Umum 0
11 Gigi 0
12 Lain - lain 0
TOTAL 9

10. LAMA HARI RAWAT

NO KAMAR
1
1 VIP 0
2 Kelas I 0
3 Kelas II Maternitas 0
4 Kelas II Perempuan Dewasa 4
5 Kelas II Laki-Laki Dewasa 8
6 Kelas II Perinatal 0
7 Kelas II Anak 0
8 Kelas II Isolasi Anak 0
9 Kelas III Anak 0
10 Kelas II Isolasi Perempuan 0
11 Kelas II Isolasi Laki-Laki 6
12 Kelas III Maternitas 0
13 Kelas III Perempuan Dewasa 6
14 Kelas III Laki-Laki Dewasa 3
TOTAL 27

11. CARA KELUAR PASIEN

NO KELUAR PASIEN
1
1 Izin dokter 9
2 Atas permintaan sendiri 0
3 Referal 0
4 Meninggal 0
5 Death On Arrive (DOA) 0
TOTAL 9

12. STANDAR PELAYANAN MINIMAL

NO INDIKATOR
Insiden Keselamatan Pasien, Karyawan & Keluarga 1
1 Pasien
a. Kejadian Potensial Cedera 0
b. Kejadian Nyaris Cedera 0
c. Kejadian Tidak Cedera 0
d. Kejadian Tidak Diharapkan 0
e. Kejadan Sentinel 0
SUB TOTAL 0
2 Angka Infeksi
a. Infeksi aliran darah 0
b. Infeksi luka operasi 0
c. Infeksi saluran kemih 0
SUB TOTAL 0
3 RL
a. Bed Of Rate (BOR) 90.00
b. Length of Stay (LOS) 3.00
c. Turn Of Interval (TOI) 27.00
d. Bed Turn Over (BTO) 0.30
e. Penanganan BBLR 0
f. Penanganan bayi asfiksia 0
g. Growth Death Rate (GDR) 0
h. Net Death Rate (NDR) 0
4 Time
a. Respon time IGD 0
b. On Time Delivery
1). Dr.Tripni P, SpA 0
2). Dr. Zahedi, SpA 0
3). Dr. Nurhayati, Sp P 0
4). Dr. Irvin A, SpOg 0
5). Dr Rithza, SpPD,FINASIM 0
6). Dr. Syafrudin, SpPD,FINASIM 0
7). Dr. Ridho A.S. SpB 0
8). Dr. Yudi, SpB 0

5 Kematian
a. Death On Emergency 0
b. Death On Room 0
13. BED OF RATE

NO RUANGAN
1
1 VIP 0
2 Kelas I 0
3 Kelas II Maternitas 0
4 Kelas II Perempuan Dewasa 200
5 Kelas II Laki-Laki Dewasa 400
6 Kelas II Perinatal 0
7 Kelas II Anak 0
8 Kelas II Isolasi Anak 0
9 Kelas III Anak 0
10 Kelas II Isolasi Perempuan 0
11 Kelas II Isolasi Laki-Laki 300
12 Kelas III Maternitas 0
13 Kelas III Perempuan Dewasa 300
14 Kelas III Laki-Laki Dewasa 150
TOTAL 135000%

14. JENIS TINDAKAN

NO TINDAKAN
1
1 Partus spontan 0
2 Partus spontan gemelli 0
3 Partus spontan sungsang 0
4 Vacuum 0
5 Sectio caesaria 0
6 Curretase 0
7 Gynekologi 0
TOTAL -

15. MASALAH
NO MASALAH
16. KESIMPULAN
1
2
3
4

17. REKOMENDASI
1
2
3
4
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
5 10 6 3 12
0 0 0 0 0
0 0 0 0 0
5 10 6 3 12

2 3 4 5 6

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

1 6 3 0 6
4 4 3 3 6
5 10 6 3 12
5 10 6 3 12

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 1 2 0 0
3 5 1 0 7
1 4 3 3 5
1 0 0 0 0
0 0 0 0 0
0 0 0 0 0
5 10 6 3 12

2 3 4 5 6
3 9 5 2 9
2 1 1 1 3
5 10 6 3 12

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
3 7 5 2 8
0 3 0 1 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 0 1 0 0
0 0 0 0 0
0 0 0 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
5 10 6 3 12

2 3 4 5 6
0 0 0 0 0
0 4 0 0 0
0 0 0 0 0
0 6 2 6 0
0 1 7 0 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 5 0 0 0
0 0 0 0 0
0 0 0 0 0
5 6 3 4 13
8 14 5 4 18
16 36 17 14 34

2 3 4 5 6
6 8 8 8 6
0 2 2 0 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
6 10 10 8 9

2 3 4 5 6

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

53.33 120.00 56.67 46.67 113.33


2.67 3.60 1.70 1.75 3.78
27.33 26.40 28.30 28.25 26.22
0.20 0.33 0.33 0.27 0.30
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
1 2 3 4 5
0 200 0 0 0
0 0 0 0 0
0 300 100 300 0
0 50 350 0 150
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
150 250 0 0 0
0 0 0 0 0
0 0 0 0 0
250 300 150 200 650
400 700 250 200 900
80100% 180200% 85300% 70400% 170500%

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

AKAR MASALAH
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
6 10 16 7 16
0 0 0 0 0
0 0 0 0 0
6 10 16 7 16

7 8 9 10 11

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

1 8 12 4 11
5 2 4 3 5
6 10 16 7 16
6 10 16 7 16

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 3 3 0
5 4 3 1 8
1 4 8 3 8
0 2 2 0 0
0 0 0 0 0
0 0 0 0 0
6 10 16 7 16

7 8 9 10 11
3 5 12 7 13
3 5 4 0 3
6 10 16 7 16

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
6 5 10 4 5
0 5 0 2 2
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 5 1 9
0 0 0 0 0
0 0 1 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
6 10 16 7 16

7 8 9 10 11
0 0 0 0 0
2 0 3 0 4
0 0 0 0 0
3 0 9 2 0
0 0 6 3 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 10 0 0
0 0 4 2 0
0 0 0 0 0
4 4 10 5 4
15 12 16 8 9
24 16 58 20 17

7 8 9 10 11
9 6 8 6 5
0 0 3 2 0
1 1 0 1 1
0 0 0 0 0
0 0 0 0 0
10 7 11 9 6

7 8 9 10 11

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

80.00 53.33 193.33 66.67 56.67


2.40 2.29 5.27 2.22 2.83
27.60 27.71 24.73 27.78 27.17
0.33 0.23 0.37 0.30 0.20
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
6 7 8 9 10
100 0 150 0 200
0 0 0 0 0
150 0 450 100 0
0 0 300 150 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 500 0 0
0 0 200 100 0
0 0 0 0 0
200 200 500 250 200
750 600 800 400 450
120600% 80700% 290800% 100900% 86000%

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

UNIT TERKAIT KETERANGAN


REALISASI
JANUARI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
15 13 7 8 10
0 0 0 0 0
0 0 0 0 0
15 13 7 8 10

REALISASI
JANUARI
12 13 14 15 16

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 7 4 5 5
8 6 3 3 5
15 13 7 8 10
15 13 7 8 10

REALISASI
JANUARI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
JANUARI
12 13 14 15 16
0 0 1 2 1
7 7 3 4 5
8 6 3 2 4
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
15 13 7 8 10

REALISASI
JANUARI
12 13 14 15 16
8 12 3 4 6
7 1 4 4 4
15 13 7 8 10

REALISASI
JANUARI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JANUARI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JANUARI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JANUARI
12 13 14 15 16
9 8 2 3 4
4 4 4 3 4
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 1 1 2 2
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
15 13 7 8 10

REALISASI
JANUARI
12 13 14 15 16
0 0 0 0 0
0 8 0 0 0
0 0 0 0 0
2 3 2 0 4
7 3 0 1 8
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 1 5
6 0 1 1 5
0 0 0 0 0
5 15 4 2 8
4 9 6 5 8
24 38 13 10 38

REALISASI
JANUARI
12 13 14 15 16
5 8 6 6 6
0 0 0 0 1
0 0 1 0 1
0 0 0 0 0
0 0 0 0 0
5 8 7 6 8

REALISASI
JANUARI
12 13 14 15 16

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

80.00 126.67 43.33 33.33 126.67


4.80 4.75 1.86 1.67 4.75
25.20 25.25 28.14 28.33 25.25
0.17 0.27 0.23 0.20 0.27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
REALISASI
JANUARI
12 13 14 15 16
11 12 13 14 15
0 400 0 0 0
0 0 0 0 0
100 150 100 0 200
350 150 0 50 400
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 50 250
300 0 50 50 250
0 0 0 0 0
250 750 200 100 400
200 450 300 250 400
121100% 191200% 66300% 51400% 191500%

REALISASI
JANUARI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
REALISASI
JANUARI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 7 13 9 6
0 0 0 0 0
0 0 0 0 0
8 7 13 9 6

REALISASI
JANUARI
17 18 19 20 21

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

4 4 9 4 2
4 3 4 5 4
8 7 13 9 6
8 7 13 9 6

REALISASI
JANUARI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
JANUARI
17 18 19 20 21
2 2 2 0 1
3 3 4 4 2
3 2 6 5 3
0 0 1 0 0
0 0 0 0 0
0 0 0 0 0
8 7 13 9 6

REALISASI
JANUARI
17 18 19 20 21
5 4 9 6 4
3 3 4 3 2
8 7 13 9 6

REALISASI
JANUARI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JANUARI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JANUARI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JANUARI
17 18 19 20 21
3 2 8 4 0
4 4 3 3 5
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 0 0 2 1
0 0 0 0 0
0 1 2 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 7 13 9 6

REALISASI
JANUARI
17 18 19 20 21
0 0 0 0 0
3 5 0 0 2
0 0 0 0 0
3 4 4 5 0
4 2 0 3 2
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 2 2 3 2
5 0 0 3 2
0 0 0 0 0
2 5 12 8 4
8 8 4 6 2
25 26 22 28 14

REALISASI
JANUARI
17 18 19 20 21
5 8 5 6 6
1 0 1 1 0
0 0 1 1 0
0 0 0 0 0
0 0 0 0 0
6 8 7 8 6

REALISASI
JANUARI
17 18 19 20 21

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

83.33 86.67 73.33 93.33 46.67


4.17 3.25 3.14 3.50 2.33
25.83 26.75 26.86 26.50 27.67
0.20 0.27 0.23 0.27 0.20
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
REALISASI
JANUARI
17 18 19 20 21
16 17 18 19 20
150 250 0 0 100
0 0 0 0 0
150 200 200 250 0
200 100 0 150 100
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 100 100 150 100
250 0 0 150 100
0 0 0 0 0
100 250 600 400 200
400 400 200 300 100
126600% 131700% 111800% 141900% 72000%

REALISASI
JANUARI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 4 6 13 11
0 0 0 0 0
0 0 0 0 0
8 4 6 13 11

22 23 24 25 26

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

6 2 2 9 7
2 2 4 4 4
8 4 6 13 11
8 4 6 13 11

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
6 1 0 7 1
1 2 3 5 4
1 0 1 1 5
0 1 2 0 1
0 0 0 0 0
0 0 0 0 0
8 4 6 13 11

22 23 24 25 26
5 2 2 10 8
3 2 4 3 3
8 4 6 13 11

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
4 0 3 8 6
4 4 2 4 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 1 1 3
0 0 0 0 0
0 0 0 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 4 6 13 11

22 23 24 25 26
0 0 0 0 0
1 0 0 0 4
0 0 0 0 0
1 0 0 10 8
1 0 0 2 4
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 2 2 0 4
0 0 4 0 2
0 0 0 0 0
5 6 2 10 4
2 9 3 7 5
12 17 11 29 31

22 23 24 25 26
7 5 6 5 6
2 0 1 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
9 5 7 5 7

22 23 24 25 26

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

40.00 56.67 36.67 96.67 103.33


1.33 3.40 1.57 5.80 4.43
28.67 26.60 28.43 24.20 25.57
0.30 0.17 0.23 0.17 0.23
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
21 22 23 24 25
50 0 0 0 200
0 0 0 0 0
50 0 0 500 400
50 0 0 100 200
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
100 100 100 0 200
0 0 200 0 100
0 0 0 0 0
250 300 100 500 200
100 450 150 350 250
62100% 87200% 57300% 147400% 157500%

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
6 4 5 8
0 0 0 0
0 0 0 0
6 4 5 8

27 28 29 30

0 0 0 0
0 0 0 0
0 0 0 0

3 0 3 6
3 4 2 2
6 4 5 8
6 4 5 8

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 1 1 2
4 2 1 2
2 0 3 4
0 1 0 0
0 0 0 0
0 0 0 0
6 4 5 8

27 28 29 30
6 3 4 3
0 1 1 5
6 4 5 8

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
4 0 5 2
2 4 0 5
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
6 4 5 8

27 28 29 30
0 0 0 0
3 0 2 1
0 0 0 0
0 0 1 0
2 2 2 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 0
7 6 5 4
6 4 3 5
18 12 13 11

27 28 29 30
8 7 8 5
0 1 0 0
0 1 0 0
1 0 0 0
0 0 0 0
9 9 8 5

27 28 29 30

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

60.00 40.00 43.33 36.67


2.00 1.33 1.63 2.20
28.00 28.67 28.38 27.80
0.30 0.30 0.27 0.17
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
27 28 29 30
26 27 28 29
150 0 100 50
0 0 0 0
0 0 50 0
100 100 100 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 50
0 0 0 0
350 300 250 200
300 200 150 250
92600% 62700% 67800% 57900%

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
- - - -
SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
1 262 100.00%
0 0 0.00%
0 0 0.00%
1 262 100.00%

SUBTOTAL
KETERANGAN
31 %

0 0
0 0
0 0 0%

1 147
0 115
1 262 100%
1 262 100%

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
SUBTOTAL
KETERANGAN
31 %
0 42 16.03%
0 104 39.69%
1 105 40.08%
0 11 4.20%
0 0 0.00%
0 0 0.00%
1 262 100.00%

SUBTOTAL
KETERANGAN
31 %
0 178 67.94%
1 84 32.06%
1 262 100.00%

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
#DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
#DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0
0 0
0 0
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
SUBTOTAL
KETERANGAN
31 %
0 139 53.05%
1 81 30.92%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 36 13.74%
0 0 0.00%
0 6 2.29%
0 0 0.00%
0 0 0.00%
0 0 0.00%
1 262 100.00%

SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
1 43 6.35%
0 0 0.00%
0 79 11.67%
0 71 10.49%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 43 6.35%
0 42 6.20%
0 0 0.00%
2 180 26.59%
3 219 32.35%
6 677 100.00%

SUBTOTAL KETERANGAN

31 %
8 205 86.86%
0 21 8.90%
0 9 3.81%
0 1 0.42%
0 0 0.00%
8 236 100.00% sisa pasien 26

SUBTOTAL TARGET
31 %

0 0 #DIV/0! 0
0 0 #DIV/0! 0
0 0 #DIV/0! 0
0 0 #DIV/0! 0
0 0 #DIV/0! 0
0 0

0 0 #DIV/0! 0
0 0 0
0 0 0
0 0

20.00 2256.6666666667 72.80 60 - 80%


0.75 90.1667748918 2.87 3 hari
29.25 839.8332251082 1.07 <3
0.27 7.8666666667 7.87 40-50
0 0 80.00%
0 0 80.00%
0 0 45/mil
0 0 45/mil

0 0 <5 '

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 < 2
0 0 0.00%
SUBTOTAL TARGET
31 %
30 46500% 1.36% 80.00%
50 215000% 6.27% 80.00%
0 0% 0.00% 80.00%
0 395000% 11.51% 80.00%
0 355000% 10.35% 80.00%
0 0% 0.00% 80.00%
0 0% 0.00% 80.00%
0 0% 0.00% 80.00%
0 0% 0.00% 80.00%
0 215000% 6.27% 80.00%
0 210000% 6.12% 80.00%
0 0% 0.00% 80.00%
100 900000% 26.23% 80.00%
150 1095000% 31.91% 80.00%
33000% 3431500% 100% 80.00%

SUBTOTAL
KETERANGAN
31 %
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
- - #DIV/0!
1. KUNJUNGAN PASIEN

NO

1
2
3
4
5
6
7
8
TOTAL

2. PASIEN BERDASARKAN JENIS KELAMIN

NO

TOTAL

3. REALISASI PENDAPATAN

NO

1
2
3
4
5
6
7
8
TOTAL
4. CARA PEMBAYARAN

NO

1
2
3
4
5
6
TOTAL

5. KUNJUNGAN PASIEN LAMA / BARU

NO

1
2
TOTAL

6. TRIASE PASIEN INSTALASI GAWAT DARURAT

NO

1
2
3
4
TOTAL

7. PASIEN DIRUJUK

NO

1
2

3
4
5
6

10

11

12

13

14

15
16

17

18

19

20

21

22

TOTAL

8. JENIS OPERASI KAMAR BEDAH

NO

1
2
3
4
TOTAL

9. KUNJUNGAN PASIEN TERHADAP LAYANAN ME

NO
NO

1
2
3
4
5
6
7
8
9
10
11
12
TOTAL

10. LAMA HARI RAWAT

NO

1
2
3
4
5
6
7
8
9
9
10
11
12
13
TOTAL

11. CARA KELUAR PASIEN

NO

1
2
3
4
5
TOTAL

12. STANDAR PELAYANAN MINIMAL


TARGET
KETERANGAN NO
%
1
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
SUB TO
2
#DIV/0!
#DIV/0!
#DIV/0!
SUB TO
3

#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
13. BED OF RATE

TARGET
KETERANGAN NO
%
0.17% 1
0.04% 2
#DIV/0! 3
0.02% 4
0.02% 5
#DIV/0! 6
#DIV/0! 7
#DIV/0! 8
#DIV/0! 9
0.04% 10
0.04% 11
#DIV/0! 12
0.01% 13
0.01% 14
0.00% TOTAL

14. JENIS TINDAKAN

NO

1
2
3
4
5
6
7
TOTAL

15. MASALAH
NO
16. KESIMPULAN
1
2
3
4

17. REKOMENDASI
1
2
3
4
KUNJUNGAN PASIEN

INSTALASI
1 2
Instalasi Gawat Darurat 0 0
Instalasi Rawat Jalan 0 0
Kamar Bedah 0 0
Kamar Bersalin 0 0
Ruang Maternitas 0 0
Ruang Rawat Dewasa 14 13
Ruang Rawat Anak dan Perinatal 0 0
Ruang Eksklusif 0 0
TOTAL 14 13

PASIEN BERDASARKAN JENIS KELAMIN

PASIEN
1 2
Anak
Laki-laki0 0
Perempuan0 0
subtotal 0 0
Dewasa
Laki-laki7 6
Perempuan7 7
subtotal 14 13
TOTAL 14 13

REALISASI PENDAPATAN

INSTALASI
1 2
Instalasi Gawat Darurat 0 0
Instalasi Rawat Jalan 0 0
Kamar Bedah 0 0
Kamar Bersalin 0 0
Ruang Maternitas 0 0
Ruang Rawat Dewasa 0 0
Ruang Rawat Anak dan Perinatal 0 0
Ruang Eksklusif 0 0
TOTAL 0 0
CARA PEMBAYARAN

PEMBAYARAN
1 2
Umum 0 1
BPJS PBI 6 7
BPJS Non PBI 8 5
Karawang Sehat 0 0
Asuransi lain 0 0
Karyawan 0 0
TOTAL 14 13

KUNJUNGAN PASIEN LAMA / BARU

PASIEN
1 2
Pasien Baru 11 11
Pasien Lama 3 2
TOTAL 14 13

TRIASE PASIEN INSTALASI GAWAT DARURAT

TRIASE
1 2
Merah 0 0
Kuning 0 0
Hijau 0 0
Hitam 0 0
TOTAL 0 0

PASIEN DIRUJUK

ALASAN DIRUJUK
1 2
Ruangan full (laki-laki) 0 0
(Perempuan) 0 0
(Anak) 0 0
Subtotal 0 0
Ruangan isolasi (laki-laki) 0 0
(Perempuan) 0 0
(Anak) 0 0
Subtotal 0 0
ICU 0 0
NICU/PICU 0 0
Spesialis bedah anak 0 0
Sp.OG tidak praktek 0 0
Subtotal 0 0
Spesialis jantung paru
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis orthopedi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis syaraf
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis urologi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
CT Scan
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis kesehatan jiwa
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis bedah mulut
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Renovasi OK
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
THT
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
GIGI
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis bedah onkologi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis kulit kelamin
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Anti bisa ular
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Atas permintaan sendiri (APS)
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Hemodialisa
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Isolasi luka bakar
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
TOTAL 0 0

JENIS OPERASI KAMAR BEDAH

JENIS OPERASI
1 2
Kecil 0 0
Sedang 0 0
Besar 0 0
Besar Khusus 0 0
TOTAL 0 0

KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

LAYANAN MEDIS
LAYANAN MEDIS
1 2
Penyakit Dalam 5 6
Bedah 5 4
Obstetri 0 0
Gynekologi 0 0
Anak 0 0
Mata 0 0
Paru 1 3
Kulit 0 0
Syaraf 1 0
Umum 0 0
Gigi 0 0
Lain - lain 0 0
TOTAL 12 13

. LAMA HARI RAWAT

KAMAR
1 2
VIP 0 0
Kelas I 0 0
Kelas II Maternitas 0 0
Kelas II Perempuan Dewasa 5 0
Kelas II Laki-Laki Dewasa 5 6
Kelas II Perinatal 0 0
Kelas II Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas III Anak 0 0
Kelas II Isolasi Perempuan 5 0
Kelas II Isolasi Laki-Laki 3 0
Kelas III Maternitas 0 0
Kelas III Perempuan Dewasa 18 4
Kelas III Laki-Laki Dewasa 15 4
TOTAL 51 14

. CARA KELUAR PASIEN

KELUAR PASIEN
1 2
Izin dokter 0 7
Atas permintaan sendiri 0 0
Referal 0 0
Meninggal 0 0
Death On Arrive (DOA) 0 0
TOTAL 0 7

. STANDAR PELAYANAN MINIMAL

INDIKATOR
Insiden Keselamatan Pasien, Karyawan & Keluarga 1 2
Pasien
a. Kejadian Potensial Cedera 0 0
b. Kejadian Nyaris Cedera 0 0
c. Kejadian Tidak Cedera 0 0
d. Kejadian Tidak Diharapkan 0 0
e. Kejadan Sentinel 0 0
SUB TOTAL 0 0
Angka Infeksi
a. Infeksi aliran darah 0 0
b. Infeksi luka operasi 0 0
c. Infeksi saluran kemih 0 0
SUB TOTAL 0 0
RL
a. Bed Of Rate 170.00 46.67
b. Length of Stay 0.00 2.00
c. Turn Of Interval 0.00 28.00
d. Bed Turn Over 0.00 0.23
e. Penanganan BBLR 0 0
f. Penanganan bayi asfiksia 0 0
g. Growth Death Rate (GDR) 0 0
h. Net Death Rate (NDR) 0 0
Time
a. Respon time IGD 0 0
b. On Time Delivery
1). Dr.Tripni P, SpA 0 0
2). Dr. Zahedi, SpA 0 0
3). Dr. Nurhayati, Sp P 0 0
4). Dr. Irvin A, SpOg 0 0
5). Dr Rithza, SpPD,FINASIM 0 0
6). Dr. Syafrudin, SpPD,FINASIM 0 0
7). Dr. Ridho A.S. SpB 0 0
8). Dr. Yudi, SpB 0 0

Kematian
a. Death On Emergency 0 0
b. Death On Room 0 0
. BED OF RATE

RUANGAN
1 2
VIP 0.00 0.00
Kelas I 0.00 0.00
Kelas II Maternitas 0.00 0.00
Kelas II Perempuan Dewasa 166.67 0.00
Kelas II Laki-Laki Dewasa 166.67 200.00
Kelas II Perinatal 0.00 0.00
Kelas II Anak 0.00 0.00
Kelas II Isolasi Anak 0.00 0.00
Kelas III Anak 0.00 0.00
Kelas II Isolasi Perempuan 250.00 0.00
Kelas II Isolasi Laki-Laki 100.00 0.00
Kelas III Maternitas 0.00 0.00
Kelas III Perempuan Dewasa 300.00 66.67
Kelas III Laki-Laki Dewasa 150.00 40.00
TOTAL 113333% 30667%

. JENIS TINDAKAN

TINDAKAN
1 2
Partus spontan 0 0
Partus spontan gemelli 0 0
Partus spontan sungsang 0 0
Vacuum 0 0
Sectio caesaria 0 0
Curretase 0 0
Gynekologi 0 0
TOTAL - -

. MASALAH
MASALAH AK
. KESIMPULAN

. REKOMENDASI
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 5 9 12 5
0 0 0 0 0
0 0 0 0 0
8 5 9 12 5

3 4 5 6 7

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 1 5 6 3
5 4 4 6 2
8 5 9 12 5
8 5 9 12 5

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
1 0 1 2 0
4 3 4 7 3
2 1 3 3 2
1 1 1 0 0
0 0 0 0 0
0 0 0 0 0
8 5 9 12 5

3 4 5 6 7
8 5 8 10 5
0 0 1 2 0
8 5 9 12 5

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
5 5 2 4 3
2 2 3 6 2
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 1 2 1 0
0 0 0 0 0
0 0 1 1 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 8 8 12 5

3 4 5 6 7
0 0 0 0 0
0 0 0 2 0
0 0 0 0 0
2 4 0 3 0
0 0 0 7 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 2 0 0
3 0 4 0 0
0 0 0 0 0
6 5 5 11 8
6 5 6 8 10
17 14 17 31 21

3 4 5 6 7
6 5 7 4 5
0 0 1 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
6 5 8 4 6

3 4 5 6 7

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

56.67 46.67 56.67 103.33 70.00


2.83 2.80 2.13 7.75 3.50
27.17 27.20 27.88 22.25 26.50
0.20 0.17 0.27 0.13 0.20
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 100.00 0.00
0.00 0.00 0.00 0.00 0.00
66.67 133.33 0.00 100.00 0.00
0.00 0.00 0.00 233.33 100.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 100.00 0.00 0.00
100.00 0.00 133.33 0.00 0.00
0.00 0.00 0.00 0.00 0.00
100.00 83.33 83.33 183.33 133.33
60.00 50.00 60.00 80.00 100.00
32667% 26667% 37667% 69667% 33333%

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

AKAR MASALAH
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
14 12 1 7 15
0 0 0 0 0
0 0 0 0 0
14 12 1 7 15

8 9 10 11 12

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

9 7 0 4 8
5 5 1 3 7
14 12 1 7 15
14 12 1 7 15

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
2 2 0 1 3
6 7 0 2 4
4 3 1 3 8
1 1 0 1 0
0 0 0 0 0
0 0 0 0 0
13 13 1 7 15

8 9 10 11 12
0 4 1 0 0
13 9 0 7 15
13 13 1 7 15

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
7 0 4 9 10
5 5 1 3 5
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
12 5 5 12 16

8 9 10 11 12
0 0 0 0 0
9 0 0 2 0
0 0 0 0 0
0 8 4 3 0
2 4 0 5 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 0 0 0 0
0 0 0 0 0
12 9 8 4 4
10 8 5 8 10
36 29 17 22 15

8 9 10 11 12
17 10 5 13 4
0 0 0 0 2
0 0 0 0 0
0 0 0 0 2
0 0 0 0 0
17 10 5 13 8

8 9 10 11 12

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

120.00 96.67 56.67 73.33 50.00


2.12 2.90 3.40 1.69 1.88
27.88 27.10 26.60 28.31 28.13
0.57 0.33 0.17 0.43 0.27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0.00 0.00 0.00 0.00 0.00
450.00 0.00 0.00 100.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 266.67 133.33 100.00 0.00
66.67 133.33 0.00 166.67 33.33
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
100.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
200.00 150.00 133.33 66.67 66.67
100.00 80.00 50.00 80.00 100.00
91667% 63000% 31667% 51333% 20000%

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

UNIT TERKAIT KETERANGAN


REALISASI
FEBRUARI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
5 4 3 18 8
0 0 0 0 0
0 0 0 0 0
5 4 3 18 8

REALISASI
FEBRUARI
13 14 15 16 17

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 2 2 10 4
3 2 1 8 4
5 4 3 18 8
5 4 3 18 8

REALISASI
FEBRUARI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
FEBRUARI
13 14 15 16 17
1 1 1 2 1
2 1 0 11 2
2 2 2 4 4
0 0 0 1 1
0 0 0 0 0
0 0 0 0 0
5 4 3 18 8

REALISASI
FEBRUARI
13 14 15 16 17
1 1 1 4 2
4 3 2 14 6
5 4 3 18 8

REALISASI
FEBRUARI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
FEBRUARI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
FEBRUARI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
FEBRUARI
13 14 15 16 17
3 2 11 2 4
1 1 1 3 2
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 0 0 3 1
0 0 0 0 0
0 0 0 1 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
5 3 12 9 8

REALISASI
FEBRUARI
13 14 15 16 17
0 0 0 0 0
2 0 7 0 6
0 0 0 0 0
5 2 0 4 7
4 0 0 16 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 4 7 0 0
0 0 0 0 0
5 8 8 13 8
8 8 11 8 8
24 22 33 41 29

REALISASI
FEBRUARI
13 14 15 16 17
11 6 4 7 10
1 1 0 0 0
0 0 0 0 1
0 0 0 0 0
0 0 0 0 0
12 7 4 7 11

REALISASI
FEBRUARI
13 14 15 16 17

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

80.00 73.33 110.00 136.67 96.67


2.00 3.14 8.25 5.86 2.64
28.00 26.86 21.75 24.14 27.36
0.40 0.23 0.13 0.23 0.37
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
REALISASI
FEBRUARI
13 14 15 16 17
0.00 0.00 0.00 0.00 0.00
100.00 0.00 350.00 0.00 300.00
0.00 0.00 0.00 0.00 0.00
166.67 66.67 0.00 133.33 233.33
133.33 0.00 0.00 533.33 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 133.33 233.33 0.00 0.00
0.00 0.00 0.00 0.00 0.00
83.33 133.33 133.33 216.67 133.33
80.00 80.00 110.00 80.00 80.00
56333% 41333% 82667% 96333% 74667%

REALISASI
FEBRUARI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
6 6 11 7 13
0 0 0 0 0
0 0 0 0 0
6 6 11 7 13

18 19 20 21 22

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 7 3 8
4 3 4 4 5
6 6 11 7 13
6 6 11 7 13

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
1 1 1 1 2
4 3 6 4 8
2 2 2 2 2
0 0 1 0 2
0 0 0 0 0
0 0 0 0 0
7 6 10 7 14

18 19 20 21 22
5 4 2 2 2
2 2 8 5 12
7 6 10 7 14

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
4 5 5 5 4
2 1 3 2 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 3 0 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
6 6 11 7 13

18 19 20 21 22
0 0 0 0 0
0 0 0 5 0
0 0 0 0 0
5 5 0 0 6
0 0 5 0 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 6 3 0
8 0 0 0 0
0 0 0 0 0
6 9 10 8 15
4 10 7 11 8
23 24 28 27 32

18 19 20 21 22
7 4 6 15 7
1 0 0 1 1
0 0 0 0 0
1 0 0 1 0
0 0 0 0 0
9 4 6 17 8

18 19 20 21 22

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

76.67 80.00 93.33 90.00 106.67


2.56 6.00 4.67 1.59 4.00
27.44 24.00 25.33 28.41 26.00
0.30 0.13 0.20 0.57 0.27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 250.00 0.00
0.00 0.00 0.00 0.00 0.00
166.67 166.67 0.00 0.00 200.00
0.00 0.00 166.67 0.00 100.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 300.00 150.00 0.00
266.67 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
100.00 150.00 166.67 133.33 250.00
40.00 100.00 70.00 110.00 80.00
57333% 41667% 70333% 64333% 63000%

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 13 8 2 10
0 0 0 0 0
0 0 0 0 0
8 13 8 2 10

23 24 25 26 27

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

4 8 4 1 5
4 5 4 1 5
8 13 8 2 10
8 13 8 2 10

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
1 2 1 0 3
3 5 5 2 5
4 4 2 2 4
0 2 0 0 0
0 0 0 0 0
0 0 0 0 0
8 13 8 4 12

23 24 25 26 27
3 3 3 1 2
5 10 5 3 10
8 13 8 4 12

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
5 3 4 5 8
4 6 0 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 2 0 0 1
0 0 0 0 0
1 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
11 11 4 5 10

23 24 25 26 27
0 0 0 0 0
0 4 9 0 0
0 0 0 0 0
4 6 3 0 2
0 2 8 0 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 5 0 0 0
6 5 4 0 0
0 0 0 0 0
8 10 10 12 7
8 7 10 8 6
26 39 44 20 18

23 24 25 26 27
11 8 12 4 9
0 0 1 1 1
0 0 0 0 0
0 0 0 1 0
0 0 0 0 0
11 8 13 6 10

23 24 25 26 27

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

86.67 130.00 146.67 66.67 60.00


2.36 4.88 3.38 3.33 1.80
27.64 25.13 26.62 26.67 28.20
0.37 0.27 0.43 0.20 0.33
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
0.00 0.00 0.00 0.00 0.00
0.00 200.00 450.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
133.33 200.00 100.00 0.00 66.67
0.00 66.67 266.67 0.00 100.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 250.00 0.00 0.00 0.00
200.00 166.67 133.33 0.00 0.00
0.00 0.00 0.00 0.00 0.00
133.33 166.67 166.67 200.00 116.67
80.00 70.00 100.00 80.00 60.00
54667% 112000% 121667% 28000% 34333%

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
28 29
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
11 0 0 0
0 0 0 0
0 0 0 0
11 0

28 29

0 0 0 0
0 0 0 0
0 0

7 0 0 0
4 0 0 0
11 0
11 0

28 29
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0
28 29
3 0 0 0
0 0 0 0
3 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
6 0

28 29
4 0 0 0
2 0 0 0
6 0

28 29
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0

28 29 30 31
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

28 29
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0
28 29 30 31
8 0 0 0
2 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
11 0 0 0

28 29
0 0 0 0
5 0 0 0
0 0 0 0
2 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
4 0 0 0
2 0 0 0
0 0 0 0
20 0 0 0
7 0 0 0
40 0

28 29
6 0 0 0
1 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
7 0

28 29

0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0

133.33 0.00
5.71 0.00
24.29 0.00
0.23 0.00
0 0
0 0
0 0
0 0
0
0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0
0 0
0 0
28 29
0.00 0
250.00 0
0.00 0
66.67 0
0.00 0
0.00 0
0.00 0
0.00 0
0.00 0
200.00 0
66.67 0
0.00 0
333.33 0
70.00 0
98667% 0%

28 29 30 31
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
- - - -
SUBTOTAL
KETERANGAN
%
0 0.00%
0 0.00%
0 0.00%
0 0.00%
0 0.00%
248 94.66%
0 0.00%
0 0.00%
248 94.66%

SUBTOTAL
KETERANGAN
%

0
0
0 0%

131
117
248 95%
248 95%

SUBTOTAL
KETERANGAN
%
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
SUBTOTAL
KETERANGAN
%
35 13.36%
114 43.51%
86 32.82%
13 4.96%
0 0.00%
0 0.00%
248 94.66%

SUBTOTAL
KETERANGAN
%
103 39.31%
145 55.34%
248 94.66%

SUBTOTAL
KETERANGAN
%
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

SUBTOTAL
KETERANGAN
%
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
#DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
#DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

SUBTOTAL
KETERANGAN
%
0 #DIV/0!
0
0
0
0 #DIV/0!

SUBTOTAL
KETERANGAN
SUBTOTAL
KETERANGAN
%
138 52.67%
78 29.77%
0 0.00%
0 0.00%
0 0.00%
0 0.00%
26 9.92%
0 0.00%
6 2.29%
0 0.00%
0 0.00%
0 0.00%
248 94.66%

SUBTOTAL
KETERANGAN
%
0 0.00%
51 7.53%
0 0.00%
80 11.82%
74 10.93%
0 0.00%
0 0.00%
0 0.00%
0 0.00%
25 3.69%
49 7.24%
0 0.00%
251 37.08%
224 33.09%
754 111.37%

SUBTOTAL KETERANGAN

%
210 88.98%
13 5.51%
1 0.42%
5 2.12%
0 0.00%
229 97.03% sisa pasien 19

SUBTOTAL TARGET
KETERANGAN
% %

0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0!
0

0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0

2513.33333333 89.76 60 - 80% #VALUE!


95.160980033 3.29 3 hari #VALUE!
714.839019967 0.38 <3 #VALUE!
7.6333333333 7.63 40-50 #VALUE!
0 80.00% 0.00%
0 80.00% 0.00%
0 45/mil #VALUE!
0 45/mil #VALUE!

0 <5 ' #VALUE!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 < 2 #VALUE!
0 0.00% #DIV/0!
SUBTOTAL TARGET
KETERANGAN
% %
0% 0.00% 80.00% #DIV/0!
255000% 7.43% 80.00% 0.03%
0% 0.00% 80.00% #DIV/0!
266667% 7.77% 80.00% 0.03%
246667% 7.19% 80.00% 0.03%
0% 0.00% 80.00% #DIV/0!
0% 0.00% 80.00% #DIV/0!
0% 0.00% 80.00% #DIV/0!
0% 0.00% 80.00% #DIV/0!
125000% 3.64% 80.00% 0.06%
163333% 4.76% 80.00% 0.05%
0% 0.00% 80.00% #DIV/0!
418333% 12.19% 80.00% 0.02%
224000% 6.53% 80.00% 0.04%
1699000% 49.51% 80.00% 0.00%

SUBTOTAL
KETERANGAN
%
- #DIV/0!
- #DIV/0!
- #DIV/0!
- #DIV/0!
- #DIV/0!
- #DIV/0!
- #DIV/0!
- #DIV/0!
1. KUNJUNGAN PASIEN

NO INSTALASI
1
1 Instalasi Gawat Darurat 0
2 Instalasi Rawat Jalan 0
3 Kamar Bedah 0
4 Kamar Bersalin 0
5 Ruang Maternitas 0
6 Ruang Rawat Dewasa 4
7 Ruang Rawat Anak dan Perinatal 0
8 Ruang Eksklusif 0
TOTAL 4

2. PASIEN BERDASARKAN JENIS KELAMIN

NO PASIEN
1
1 Anak
Laki-laki0
Perempuan0
subtotal 0
2 Dewasa
Laki-laki3
Perempuan1
subtotal 4
TOTAL 4

3. REALISASI PENDAPATAN

NO INSTALASI
1
1 Instalasi Gawat Darurat 0
2 Instalasi Rawat Jalan 0
3 Kamar Bedah 0
4 Kamar Bersalin 0
5 Ruang Maternitas 0
6 Ruang Rawat Dewasa 0
7 Ruang Rawat Anak dan Perinatal 0
8 Ruang Eksklusif 0
TOTAL 0
4. CARA PEMBAYARAN

NO PEMBAYARAN
1
1 Umum 0
2 BPJS PBI 1
3 BPJS Non PBI 3
4 Karawang Sehat 0
5 Asuransi lain 0
6 Karyawan 0
TOTAL 4

5. KUNJUNGAN PASIEN LAMA / BARU

NO PASIEN
1
1 Pasien Baru 1
2 Pasien Lama 3
TOTAL 4

6. TRIASE PASIEN INSTALASI GAWAT DARURAT

NO TRIASE
1
1 Merah 0
2 Kuning 0
3 Hijau 0
4 Hitam 0
TOTAL 0

7. PASIEN DIRUJUK

NO ALASAN DIRUJUK
1
1 Ruangan full (laki-laki) 0
(Perempuan) 0
(Anak) 0
Subtotal 0
2 Ruangan isolasi (laki-laki) 0
(Perempuan) 0
(Anak) 0
Subtotal 0
3 ICU 0
4 NICU/PICU 0
5 Spesialis bedah anak 0
6 Sp.OG tidak praktek 0
Subtotal 0
7 Spesialis jantung paru
(Dewasa)
0
(Anak)
0
Subtotal 0
8 Spesialis orthopedi
(Dewasa)
0
(Anak)
0
Subtotal 0
9 Spesialis syaraf
(Dewasa)
0
(Anak)
0
Subtotal 0
10 Spesialis urologi
(Dewasa)
0
(Anak)
0
Subtotal 0
11 CT Scan
(Dewasa)
0
(Anak)
0
Subtotal 0
12 Spesialis kesehatan jiwa
(Dewasa)
0
(Anak)
0
Subtotal 0
13 Spesialis bedah mulut
(Dewasa)
0
(Anak)
0
Subtotal 0
14 Renovasi OK
(Dewasa)
0
(Anak)
0
Subtotal 0
15 THT
(Dewasa)
0
(Anak)
0
Subtotal 0
16 GIGI
(Dewasa)
0
(Anak)
0
Subtotal 0
17 Spesialis bedah onkologi
(Dewasa)
0
(Anak)
0
Subtotal 0
18 Spesialis kulit kelamin
(Dewasa)
0
(Anak)
0
Subtotal 0
19 Anti bisa ular
(Dewasa)
0
(Anak)
0
Subtotal 0
20 Atas permintaan sendiri (APS)
(Dewasa)
0
(Anak)
0
Subtotal 0
21 Hemodialisa
(Dewasa)
0
(Anak)
0
Subtotal 0
22 Isolasi luka bakar
(Dewasa)
0
(Anak)
0
Subtotal 0
TOTAL 0

8. JENIS OPERASI KAMAR BEDAH

NO JENIS OPERASI
1
1 Kecil 0
2 Sedang 0
3 Besar 0
4 Besar Khusus 0
TOTAL 0

9. KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

NO LAYANAN MEDIS
NO LAYANAN MEDIS
1
1 Penyakit Dalam 2
2 Bedah 0
3 Obstetri 0
4 Gynekologi 0
5 Anak 0
6 Mata 0
7 Paru 2
8 Kulit 0
9 Syaraf 0
10 Umum 0
11 Gigi 0
12 Lain - lain 0
TOTAL 4

10. LAMA HARI RAWAT

NO KAMAR
1
1 VIP 0
2 Kelas I 3
3 Kelas II Maternitas 0
4 Kelas II Perempuan Dewasa 0
5 Kelas II Laki-Laki Dewasa 4
6 Kelas II Perinatal 0
7 Kelas II Anak 0
8 Kelas II Isolasi Anak 0
9 Kelas III Anak 0
9 Kelas II Isolasi Perempuan 0
10 Kelas II Isolasi Laki-Laki 4
11 Kelas III Maternitas 0
12 Kelas III Perempuan Dewasa 2
13 Kelas III Laki-Laki Dewasa 0
TOTAL 13

11. CARA KELUAR PASIEN

NO KELUAR PASIEN
1
1 Izin dokter 8
2 Atas permintaan sendiri 3
3 Referal 0
4 Meninggal 0
5 Death On Arrive (DOA) 0
TOTAL 11

12. STANDAR PELAYANAN MINIMAL

NO INDIKATOR
Insiden Keselamatan Pasien, Karyawan & Keluarga 1
1 Pasien
a. Kejadian Potensial Cedera 0
b. Kejadian Nyaris Cedera 0
c. Kejadian Tidak Cedera 0
d. Kejadian Tidak Diharapkan 0
e. Kejadan Sentinel 0
SUB TOTAL 0
2 Angka Infeksi
a. Infeksi aliran darah 0
b. Infeksi luka operasi 0
c. Infeksi saluran kemih 0
SUB TOTAL 0
3 RL
a. Bed Of Rate 43.33
b. Length of Stay 1.18
c. Turn Of Interval 28.82
d. Bed Turn Over 0.37
e. Penanganan BBLR
f. Penanganan bayi asfiksia
g. Growth Death Rate (GDR)
h. Net Death Rate (NDR)
4 Time
a. Respon time IGD
b. On Time Delivery
1). Dr.Tripni P, SpA
2). Dr. Zahedi, SpA
3). Dr. Nurhayati, Sp P
4). Dr. Irvin A, SpOg
5). Dr Rithza, SpPD,FINASIM
6). Dr. Syafrudin, SpPD,FINASIM
7). Dr. Ridho A.S. SpB
8). Dr. Yudi, SpB

5 Kematian
a. Death On Emergency
b. Death On Room
13. BED OF RATE

NO RUANGAN
1
1 VIP 0.00
2 Kelas I 150.00
3 Kelas II Maternitas 0.00
4 Kelas II Perempuan Dewasa 0.00
5 Kelas II Laki-Laki Dewasa 133.33
6 Kelas II Perinatal 0.00
7 Kelas II Anak 0.00
8 Kelas II Isolasi Anak 0.00
9 Kelas III Anak 0.00
10 Kelas II Isolasi Perempuan 0.00
11 Kelas II Isolasi Laki-Laki 133.33
12 Kelas III Maternitas 0.00
13 Kelas III Perempuan Dewasa 33.33
14 Kelas III Laki-Laki Dewasa 0.00
TOTAL 45000%

14. JENIS TINDAKAN

NO TINDAKAN
1
1 Partus spontan 0
2 Partus spontan gemelli 0
3 Partus spontan sungsang 0
4 Vacuum 0
5 Sectio caesaria 0
6 Curretase 0
7 Gynekologi 0
TOTAL -

15. MASALAH
NO MASALAH
1 Security
16. KESIMPULAN
1
2
3
4

17. REKOMENDASI
1
2
3
4
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
17 10 7 7 5
0 0 0 0 0
0 0 0 0 0
17 10 7 7 5

2 3 4 5 6

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 8 4 4 3
9 2 3 3 2
17 10 7 7 5
17 10 7 7 5

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
2 1 2 0 1
2 4 2 7 2
11 4 3 0 2
2 1 0 0 0
0 0 0 0 0
0 0 0 0 0
17 10 7 7 5

2 3 4 5 6
12 7 4 6 4
5 3 3 1 1
17 10 7 7 5

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
11 3 5 7 3
3 5 0 0 2
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 1 1 0 0
0 0 0 0 0
1 1 1 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
17 10 7 7 5

2 3 4 5 6
0 0 0 0 0
0 2 2 0 0
0 0 0 0 0
11 0 2 0 0
4 3 2 0 2
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
5 4 3 0 0
0 0 0 0 0
20 12 12 9 4
12 14 3 4 8
52 35 24 13 14

2 3 4 5 6
4 6 12 11 3
0 1 0 1 0
0 1 0 0 0
0 0 1 0 0
0 0 0 0 0
4 8 13 12 3

2 3 4 5 6

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

173.33 116.67 80.00 43.33 46.67


13.00 4.38 1.85 1.08 4.67
17.00 25.63 28.15 28.92 25.33
0.13 0.27 0.43 0.40 0.10
2 3 4 5 6
1.00 2.00 3.00 4.00 5.00
0.00 100.00 100.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
366.67 0.00 66.67 0.00 0.00
133.33 100.00 66.67 0.00 66.67
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
166.67 133.33 100.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
333.33 200.00 200.00 150.00 66.67
120.00 140.00 30.00 40.00 80.00
112100% 67533% 56633% 19400% 21833%

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

AKAR MASALAH
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
11 8 10 11 7
0 0 0 0 0
0 0 0 0 0
11 8 10 11 7

7 8 9 10 11

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 3 7 5 4
4 5 3 6 3
11 8 10 11 7
11 8 10 11 7

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
1 1 0 1 1
5 2 6 5 4
5 5 4 2 2
0 0 0 3 0
0 0 0 0 0
0 0 0 0 0
11 8 10 11 7

7 8 9 10 11
8 7 6 6 4
3 1 4 5 3
11 8 10 11 7

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
8 4 4 9 3
2 4 5 2 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 0 1 0 4
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
11 8 10 11 7

7 8 9 10 11
0 0 0 0 0
4 0 0 2 1
0 0 0 0 0
4 9 0 7 5
6 6 2 18 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
4 0 3 0 3
0 0 0 0 3
0 0 0 0 0
9 6 8 15 3
13 2 16 7 0
40 23 29 49 15

7 8 9 10 11
11 2 7 16 8
0 0 2 0 0
0 1 0 0 0
0 1 0 0 1
0 0 0 0 0
11 4 9 16 9

7 8 9 10 11

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

133.33 76.67 96.67 163.33 50.00


3.64 5.75 3.22 3.06 1.67
26.36 24.25 26.78 26.94 28.33
0.37 0.13 0.30 0.53 0.30
7 8 9 10 11
6.00 7.00 8.00 9.00 10.00
200.00 0.00 0.00 100.00 50.00
0.00 0.00 0.00 0.00 0.00
133.33 300.00 0.00 233.33 166.67
200.00 200.00 66.67 600.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
200.00 0.00 150.00 0.00 150.00
0.00 0.00 0.00 0.00 100.00
0.00 0.00 0.00 0.00 0.00
150.00 100.00 133.33 250.00 50.00
130.00 20.00 160.00 70.00 0.00
101933% 62700% 51800% 126233% 52667%

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

UNIT TERKAIT KETERANGAN


REALISASI
MARET
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
10 10 8 11 13
0 0 0 0 0
0 0 0 0 0
10 10 8 11 13

REALISASI
MARET
12 13 14 15 16

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

6 6 5 7 7
4 4 3 4 6
10 10 8 11 13
10 10 8 11 13

REALISASI
MARET
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
MARET
12 13 14 15 16
2 2 1 1 0
7 6 3 5 5
1 2 3 4 6
0 0 1 1 2
0 0 0 0 0
0 0 0 0 0
10 10 8 11 13

REALISASI
MARET
12 13 14 15 16
8 7 8 8 11
2 3 0 3 2
10 10 8 11 13

REALISASI
MARET
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MARET
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MARET
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MARET
12 13 14 15 16
4 3 6 6 5
5 5 1 5 5
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 1 0 0 3
0 0 0 0 0
1 1 1 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
10 10 8 11 13

REALISASI
MARET
12 13 14 15 16
0 0 0 0 0
2 0 0 0 4
0 0 0 0 0
0 0 6 6 2
4 0 2 2 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 4 0 0 4
0 0 6 0 0
0 0 0 0 0
8 12 11 9 12
11 8 10 10 10
25 24 35 27 35

REALISASI
MARET
12 13 14 15 16
2 10 15 4 12
0 1 0 0 0
0 0 0 0 0
0 1 0 0 0
0 0 0 0 0
2 12 15 4 12

REALISASI
MARET
12 13 14 15 16

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

83.33 80.00 116.67 90.00 116.67


12.50 2.00 2.33 6.75 2.92
17.50 28.00 27.67 23.25 27.08
0.07 0.40 0.50 0.13 0.40
REALISASI
MARET
12 13 14 15 16
11.00 12.00 13.00 14.00 15.00
100.00 0.00 0.00 0.00 200.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 200.00 200.00 66.67
133.33 0.00 66.67 66.67 100.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 200.00 0.00 0.00 200.00
0.00 0.00 200.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
133.33 200.00 183.33 150.00 200.00
110.00 80.00 100.00 100.00 100.00
48767% 49200% 76300% 53067% 88167%

REALISASI
MARET
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
REALISASI
MARET
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
4 7 7 8 4
0 0 0 0 0
0 0 0 0 0
4 7 7 8 4

REALISASI
MARET
17 18 19 20 21

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 3 7 3 2
1 4 0 5 2
4 7 7 8 4
4 7 7 8 4

REALISASI
MARET
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
MARET
17 18 19 20 21
0 1 0 2 0
1 3 3 4 4
2 2 3 2 0
1 1 1 0 0
0 0 0 0 0
0 0 0 0 0
4 7 7 8 4

REALISASI
MARET
17 18 19 20 21
2 6 3 5 0
2 1 4 3 4
4 7 7 8 4

REALISASI
MARET
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MARET
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MARET
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MARET
17 18 19 20 21
2 6 6 2 4
2 0 0 5 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 1 1 1 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
4 7 7 8 4

REALISASI
MARET
17 18 19 20 21
0 0 0 0 0
0 0 5 0 0
0 0 0 0 0
1 0 0 3 2
0 1 4 0 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 3
0 2 1 4 3
0 0 0 0 0
0 6 0 2 2
9 6 4 6 0
10 15 14 15 13

REALISASI
MARET
17 18 19 20 21
8 6 6 2 9
0 1 0 0 2
0 0 0 0 0
0 1 0 0 0
0 0 0 0 0
8 8 6 2 11

REALISASI
MARET
17 18 19 20 21

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

33.33 50.00 46.67 50.00 43.33


1.25 1.88 2.33 7.50 1.18
28.75 28.13 27.67 22.50 28.82
0.27 0.27 0.20 0.07 0.37
REALISASI
MARET
17 18 19 20 21
16.00 17.00 18.00 19.00 20.00
0.00 0.00 250.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
33.33 0.00 0.00 100.00 66.67
0.00 33.33 133.33 0.00 100.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 150.00
0.00 66.67 33.33 133.33 100.00
0.00 0.00 0.00 0.00 0.00
0.00 100.00 0.00 33.33 33.33
90.00 60.00 40.00 60.00 0.00
13933% 27700% 47467% 34567% 47000%

REALISASI
MARET
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
12 12 4 6 6
0 0 0 0 0
0 0 0 0 0
12 12 4 6 6

22 23 24 25 26

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 7 2 0 1
5 5 2 6 5
12 12 4 6 6
12 12 4 6 6

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 2 2 0 1
2 5 2 2 5
9 5 0 4 0
1 0 0 0 0
0 0 0 0 0
0 0 0 0 0
12 12 4 6 6

22 23 24 25 26
10 6 2 3 3
2 6 2 3 3
12 12 4 6 6

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
7 5 3 4 4
5 6 1 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 1 0 2 2
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
12 12 4 6 6

22 23 24 25 26
0 0 0 0 0
4 0 2 0 0
0 0 0 0 0
2 3 3 4 0
0 1 3 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 4 0 1 0
0 0 0 0 1
0 0 0 0 0
8 2 3 5 6
21 13 2 0 0
35 23 13 10 7

22 23 24 25 26
10 12 4 10 8
1 1 0 2 2
0 2 0 0 0
0 0 0 0 0
0 0 0 0 0
11 15 4 12 10

22 23 24 25 26

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

116.67 76.67 43.33 33.33 23.33


3.18 1.53 3.25 0.83 0.70
26.82 28.47 26.75 29.17 29.30
0.37 0.50 0.13 0.40 0.33
22 23 24 25 26
21.00 22.00 23.00 24.00 25.00
200.00 0.00 100.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
66.67 100.00 100.00 133.33 0.00
0.00 33.33 100.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00
0.00 200.00 0.00 50.00 0.00
0.00 0.00 0.00 0.00 33.33
0.00 0.00 0.00 0.00 0.00
133.33 33.33 50.00 83.33 100.00
210.00 130.00 20.00 0.00 0.00
63100% 51867% 39300% 29067% 15833%

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
10 8 5 14
0 0 0 0
0 0 0 0
10 8 5 14

27 28 29 30

0 0 0 0
0 0 0 0
0 0 0 0

8 4 1 9
2 4 4 5
10 8 5 14
10 8 5 14

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
2 3 3 0
4 3 2 8
4 2 0 6
0 0 0 0
0 0 0 0
0 0 0 0
10 8 5 14

27 28 29 30
8 7 2 8
2 1 3 6
10 8 5 14

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
6 3 2 8
4 3 3 3
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 2 0 3
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
10 8 5 14

27 28 29 30
0 0 0 0
2 0 2 4
0 0 0 0
3 4 2 0
4 2 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 3 0 4
0 0 0 2
0 0 0 0
5 7 9 7
19 7 0 13
33 23 13 30

27 28 29 30
8 3 4 7
0 0 0 0
0 0 0 0
1 0 0 0
0 0 0 0
9 3 4 7

27 28 29 30

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

110.00 76.67 43.33 100.00


3.67 7.67 3.25 4.29
26.33 22.33 26.75 25.71
0.30 0.10 0.13 0.23
27 28 29 30
26.00 27.00 28.00 29.00
100.00 0.00 100.00 200.00
0.00 0.00 0.00 0.00
100.00 133.33 66.67 0.00
133.33 66.67 0.00 0.00
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00
0.00 150.00 0.00 200.00
0.00 0.00 0.00 66.67
0.00 0.00 0.00 0.00
83.33 116.67 150.00 116.67
190.00 70.00 0.00 130.00
63267% 56367% 34467% 74233%

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
- - - -
SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
1 257 98.09%
0 0 0.00%
0 0 0.00%
1 257 98.09%

SUBTOTAL
KETERANGAN
31 %

0 0
0 0
0 0 0%

1 145
0 112
1 257 98%
1 257 98%

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
SUBTOTAL
KETERANGAN
31 %
1 33 12.60%
0 114 43.51%
0 96 36.64%
0 14 5.34%
0 0 0.00%
0 0 0.00%
1 257 98.09%

SUBTOTAL
KETERANGAN
31 %
1 173 66.03%
0 84 32.06%
1 257 98.09%

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
#DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
#DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0
0 0
0 0
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
SUBTOTAL
KETERANGAN
31 %
0 145 55.34%
1 77 29.39%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 29 11.07%
0 0 0.00%
0 6 2.29%
0 0 0.00%
0 0 0.00%
0 0 0.00%
1 257 98.09%

SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 39 5.76%
0 0 0.00%
0 79 11.67%
0 76 11.23%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 33 4.87%
0 38 5.61%
0 0 0.00%
1 215 31.76%
2 230 33.97%
3 710 104.87%

SUBTOTAL KETERANGAN

31 %
2 230 97.46%
0 17 7.20%
0 4 1.69%
0 6 2.54%
0 0 0.00%
2 257 108.90%

SUBTOTAL TARGET
31 % %

0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0

0 0 #DIV/0! 0 #DIV/0!
0 0 0 #DIV/0!
0 0 0 #DIV/0!
0 0

10.00 2366.6666666667 60 - 80%


1.50 113.9984085359 3 hari
28.50 816.0015914641 <3
0.07 8.5666666667 40-50
0 80.00% #DIV/0!
0 80.00% #DIV/0!
0 45/mil
0 45/mil

0 <5 '

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 < 2
0 0.00% #DIV/0!
SUBTOTAL TARGET
31 % %
30.00 46500% 1.36% 80.00% 0.17%
0.00 195000% 5.68% 80.00% 0.04%
0.00 0% 0.00% 80.00% #DIV/0!
0.00 263333% 7.67% 80.00% 0.03%
0.00 253333% 7.38% 80.00% 0.03%
0.00 0% 0.00% 80.00% #DIV/0!
0.00 0% 0.00% 80.00% #DIV/0!
0.00 0% 0.00% 80.00% #DIV/0!
0.00 0% 0.00% 80.00% #DIV/0!
0.00 165000% 4.81% 80.00% 0.05%
0.00 126667% 3.69% 80.00% 0.06%
0.00 0% 0.00% 80.00% #DIV/0!
16.67 358333% 10.44% 80.00% 0.02%
20.00 230000% 6.70% 80.00% 0.03%
6667% 1638167% 48% 80.00% 0.00%

SUBTOTAL
KETERANGAN
31 %
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
- - #DIV/0!
1. KUNJUNGAN PASIEN APRIL

NO

1
2
3
4
5
6
7
8
TOTAL

2. PASIEN BERDASARKAN JENIS KELAMIN

NO

TOTAL

3. REALISASI PENDAPATAN

NO

1
2
3
4
5
6
7
8
TOTAL
4. CARA PEMBAYARAN

NO

1
2
3
4
5
6
TOTAL

5. KUNJUNGAN PASIEN LAMA / BARU

NO

1
2
TOTAL

6. TRIASE PASIEN INSTALASI GAWAT DARURAT

NO

1
2
3
4
TOTAL

7. PASIEN DIRUJUK

NO

1
2

3
4
5
6

10

11

12

13

14

15
16

17

18

19

20

21

22

TOTAL

8. JENIS OPERASI KAMAR BEDAH

NO

1
2
3
4
TOTAL

9. KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

NO
NO

1
2
3
4
5
6
7
8
9
10
11
12
TOTAL

10. LAMA HARI RAWAT

NO

1
2
3
4
5
6
7
8
9
9
10
11
12
13
TOTAL

11. CARA KELUAR PASIEN

NO

1
2
3
4
5
TOTAL

12. STANDAR PELAYANAN MINIMAL

KETERANGAN NO

SUB TOTAL
2

SUB TOTAL
3

5
13. BED OF RATE

KETERANGAN NO

1
2
3
4
5
6
7
8
9
10
11
12
13
14
TOTAL

14. JENIS TINDAKAN

NO

1
2
3
4
5
6
7
TOTAL

15. MASALAH
NO
1
2
3
4
16. KESIMPULAN
1
2
3
4

17. REKOMENDASI
1
2
3
4
KUNJUNGAN PASIEN APRIL

INSTALASI
1 2
Instalasi Gawat Darurat 0 0
Instalasi Rawat Jalan 0 0
Kamar Bedah 0 0
Kamar Bersalin 0 0
Ruang Maternitas 0 0
Ruang Rawat Dewasa 10 4
Ruang Rawat Anak dan Perinatal 0 0
Ruang Eksklusif 0 0
TOTAL 10 4

PASIEN BERDASARKAN JENIS KELAMIN

PASIEN
1 2
Anak
Laki-laki0 0
Perempuan0 0
subtotal 0 0
Dewasa
Laki-laki4 3
Perempuan6 1
subtotal 10 4
TOTAL 10 4

REALISASI PENDAPATAN

INSTALASI
1 2
Instalasi Gawat Darurat 0 0
Instalasi Rawat Jalan 0 0
Kamar Bedah 0 0
Kamar Bersalin 0 0
Ruang Maternitas 0 0
Ruang Rawat Dewasa 0 0
Ruang Rawat Anak dan Perinatal 0 0
Ruang Eksklusif 0 0
TOTAL 0 0
CARA PEMBAYARAN

PEMBAYARAN
1 2
Umum 3 0
BPJS PBI 1 1
BPJS Non PBI 6 2
Karawang Sehat 0 1
Asuransi lain 0 0
Karyawan 0 0
TOTAL 10 4

KUNJUNGAN PASIEN LAMA / BARU

PASIEN
1 2
Pasien Baru 7 3
Pasien Lama 3 1
TOTAL 10 4

TRIASE PASIEN INSTALASI GAWAT DARURAT

TRIASE
1 2
Merah 0 0
Kuning 0 0
Hijau 0 0
Hitam 0 0
TOTAL 0 0

PASIEN DIRUJUK

ALASAN DIRUJUK
1 2
Ruangan full (laki-laki) 0 0
(Perempuan) 0 0
(Anak) 0 0
Subtotal 0 0
Ruangan isolasi (laki-laki) 0 0
(Perempuan) 0 0
(Anak) 0 0
Subtotal 0 0
ICU 0 0
NICU/PICU 0 0
Spesialis bedah anak 0 0
Sp.OG tidak praktek 0 0
Subtotal 0 0
Spesialis jantung paru
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis orthopedi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis syaraf
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis urologi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
CT Scan
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis kesehatan jiwa
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis bedah mulut
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Renovasi OK
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
THT
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
GIGI
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis bedah onkologi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis kulit kelamin
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Anti bisa ular
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Atas permintaan sendiri (APS)
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Hemodialisa
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Isolasi luka bakar
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
TOTAL 0 0

JENIS OPERASI KAMAR BEDAH

JENIS OPERASI
1 2
Kecil 0 0
Sedang 0 0
Besar 0 0
Besar Khusus 0 0
TOTAL 0 0

KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

LAYANAN MEDIS
LAYANAN MEDIS
1 2
Penyakit Dalam 9 4
Bedah 0 0
Obstetri 0 0
Gynekologi 0 0
Anak 0 0
Mata 0 0
Paru 1 0
Kulit 0 0
Syaraf 0 0
Umum 0 0
Gigi 0 0
Lain - lain 0 0
TOTAL 10 4

. LAMA HARI RAWAT

KAMAR
1 2
VIP 0 0
Kelas I 1 2
Kelas II Maternitas 0 0
Kelas II Perempuan Dewasa 2 2
Kelas II Laki-Laki Dewasa 1 2
Kelas II Perinatal 0 0
Kelas II Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas III Anak 0 0
Kelas II Isolasi Perempuan 0 0
Kelas II Isolasi Laki-Laki 1 1
Kelas III Maternitas 0 0
Kelas III Perempuan Dewasa 4 5
Kelas III Laki-Laki Dewasa 1 2
TOTAL 10 14

. CARA KELUAR PASIEN

KELUAR PASIEN
1 2
Izin dokter 11 0
Atas permintaan sendiri 1 0
Referal 0 0
Meninggal ( < 48 jam ) 0 0
Death On Arrive (DOA) 0 0
TOTAL 12 0

. STANDAR PELAYANAN MINIMAL

INDIKATOR
Insiden Keselamatan Pasien, Karyawan & Keluarga 1 2
Pasien
a. Kejadian Potensial Cedera 0 0
b. Kejadian Nyaris Cedera 0 0
c. Kejadian Tidak Cedera 0 0
d. Kejadian Tidak Diharapkan 0 0
e. Kejadan Sentinel 0 0
SUB TOTAL 0 0
Angka Infeksi
a. Infeksi aliran darah 0 0
b. Infeksi luka operasi 0 0
c. Infeksi saluran kemih 0 0
SUB TOTAL 0 0
RL
a. Bed Of Rate 32.00 46.67
b. Length of Stay 0.83 #DIV/0!
c. Turn Of Interval 29.17 #DIV/0!
d. Bed Turn Over 0.40 0.00
e. Penanganan BBLR
f. Penanganan bayi asfiksia
g. Growth Death Rate (GDR)
h. Net Death Rate (NDR)
Time
a. Respon time IGD
b. On Time Delivery
1). Dr.Tripni P, SpA
2). Dr. Zahedi, SpA
3). Dr. Nurhayati, Sp P
4). Dr. Irvin A, SpOg
5). Dr Rithza, SpPD,FINASIM
6). Dr. Syafrudin, SpPD,FINASIM
7). Dr. Ridho A.S. SpB
8). Dr. Yudi, SpB

Kematian
a. Death On Emergency
b. Death On Room
. BED OF RATE

RUANGAN
1 2
VIP 0 0
Kelas I 50.00 100.00
Kelas II Maternitas 0 0
Kelas II Perempuan Dewasa 66.67 66.67
Kelas II Laki-Laki Dewasa 33.33 66.67
Kelas II Perinatal 0 0
Kelas II Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas III Anak 0 0
Kelas II Isolasi Perempuan 0.00 0.00
Kelas II Isolasi Laki-Laki 33.33 33.33
Kelas III Maternitas 0 0
Kelas III Perempuan Dewasa 66.67 83.33
Kelas III Laki-Laki Dewasa 10.00 20.00
TOTAL 26000% 37000%

. JENIS TINDAKAN

TINDAKAN
1 2
Partus spontan 0 0
Partus spontan gemelli 0 0
Partus spontan sungsang 0 0
Vacuum 0 0
Sectio caesaria 0 0
Curretase 0 0
Gynekologi 0 0
TOTAL - -

. MASALAH
MASALAH AK
Alas bed pasien rusak (bolong )
Tidak ada CS
Security belum berjalan SPOnya
SDM tidak mencukupi
. KESIMPULAN

. REKOMENDASI
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
12 11 13 6 8
0 0 0 0 0
0 0 0 0 0
12 11 13 6 8

3 4 5 6 7

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 7 6 3 5
5 4 7 3 3
12 11 13 6 8
12 11 13 6 8

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 1 2 0
5 5 6 1 3
7 5 5 3 4
0 1 1 0 1
0 0 0 0 0
0 0 0 0 0
12 11 13 6 8

3 4 5 6 7
7 8 8 3 5
5 3 5 3 3
12 11 13 6 8

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
7 4 8 5 4
3 4 5 1 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 0 0 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
12 11 13 6 8

3 4 5 6 7
0 0 0 0 0
3 2 2 2 2
0 0 0 0 0
3 3 3 3 3
2 2 2 3 4
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 2 2 0 1
0 2 2 0 1
0 0 0 0 0
4 4 8 8 7
6 8 10 5 7
19 23 29 21 25

3 4 5 6 7
7 7 7 14 3
0 0 1 0 0
0 1 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 8 14 3

3 4 5 6 7

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

63.33 76.67 96.67 70.00 83.33


2.71 2.88 3.63 1.50 8.33
27.29 27.13 26.38 28.50 21.67
0.23 0.27 0.27 0.47 0.10
3 4 5 6 7
0 0 0 0 0
150.00 100.00 100.00 100.00 100.00
0 0 0 0 0
100.00 100.00 100.00 100.00 100.00
66.67 66.67 66.67 100.00 133.33
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
50.00 100.00 100.00 0.00 50.00
0.00 66.67 66.67 0.00 33.33
0 0 0 0 0
66.67 66.67 133.33 133.33 116.67
60.00 80.00 100.00 50.00 70.00
49333% 58000% 66667% 48333% 60333%

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

AKAR MASALAH
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
5 6 11 7 11
0 0 0 0 0
0 0 0 0 0
5 6 11 7 11

8 9 10 11 12

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 6 5 5
2 2 5 2 6
5 6 11 7 11
5 6 11 7 11

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0 3 3 0 1
3 2 3 2 6
2 1 4 5 3
0 0 1 0 1
0 0 0 0 0
0 0 0 0 0
5 6 11 7 11

8 9 10 11 12
2 3 8 5 9
3 3 3 2 2
5 6 11 7 11

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
2 4 5 4 6
0 0 3 3 5
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 2 3 0 0
0 0 0 0 0
1 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
5 6 11 7 11

8 9 10 11 12
0 0 0 0 0
3 2 1 1 1
0 0 0 0 0
4 4 5 4 5
2 3 4 4 4
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 1 1 0
2 2 2 1 1
0 0 0 0 0
7 7 8 7 10
5 6 7 8 9
23 24 28 26 30

8 9 10 11 12
5 5 4 7 5
1 0 0 2 1
0 0 2 0 0
0 0 0 0 1
0 0 0 0 0
6 5 6 9 7

8 9 10 11 12

0 0 0 0 0
0 0 0 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 1

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

76.67 80.00 93.33 86.67 100.00


3.83 4.80 4.67 2.89 4.29
26.17 25.20 25.33 27.11 25.71
0.20 0.17 0.20 0.30 0.23
8 9 10 11 12
0 0 0 0 0
150.00 100.00 50.00 50.00 50.00
0 0 0 0 0
133.33 133.33 166.67 133.33 166.67
66.67 100.00 133.33 133.33 133.33
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0.00 0.00 50.00 50.00 0.00
66.67 66.67 66.67 33.33 33.33
0 0 0 0 0
116.67 116.67 133.33 116.67 166.67
50.00 60.00 70.00 80.00 90.00
58333% 57667% 67000% 59667% 64000%

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

UNIT TERKAIT KETERANGAN


REALISASI
APRIL
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
9 8 12 2 7
0 0 0 0 0
0 0 0 0 0
9 8 12 2 7

REALISASI
APRIL
13 14 15 16 17

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

4 4 6 1 4
5 4 6 1 3
9 8 12 2 7
9 8 12 2 7

REALISASI
APRIL
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
APRIL
13 14 15 16 17
0 1 1 0 4
5 2 6 0 0
4 5 4 2 3
0 0 1 0 0
0 0 0 0 0
0 0 0 0 0
9 8 12 2 7

REALISASI
APRIL
13 14 15 16 17
6 6 6 2 5
3 2 6 0 2
9 8 12 2 7

REALISASI
APRIL
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
APRIL
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
APRIL
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
APRIL
13 14 15 16 17
4 7 6 2 5
1 0 3 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 0 3 0 1
0 0 0 0 0
1 1 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
9 8 12 2 7

REALISASI
APRIL
13 14 15 16 17
0 0 0 0 0
1 1 0 1 2
0 0 0 0 0
5 5 7 7 7
4 3 3 3 4
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 1 0 1 2
2 2 1 1 0
0 0 0 0 0
7 8 10 9 9
6 8 10 9 8
26 28 31 31 32

REALISASI
APRIL
13 14 15 16 17
13 5 10 3 6
0 0 0 0 1
0 0 0 0 0
0 0 0 1 0
0 0 0 0 0
13 5 10 4 7

REALISASI
APRIL
13 14 15 16 17

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

86.67 93.33 103.33 103.33 106.67


2.00 5.60 3.10 7.75 4.57
28.00 24.40 26.90 22.25 25.43
0.43 0.17 0.33 0.13 0.23
REALISASI
APRIL
13 14 15 16 17
0 0 0 0 0
50.00 50.00 0.00 50.00 100.00
0 0 0 0 0
166.67 166.67 233.33 233.33 233.33
133.33 100.00 100.00 100.00 133.33
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
50.00 50.00 0.00 50.00 100.00
66.67 66.67 33.33 33.33 0.00
0 0 0 0 0
116.67 133.33 166.67 150.00 150.00
60.00 80.00 100.00 90.00 80.00
64333% 64667% 63333% 70667% 79667%

REALISASI
APRIL
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
14 9 11 11 0
0 0 0 0 0
0 0 0 0 0
14 9 11 11 0

18 19 20 21 22

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 4 5 6 0
7 5 6 5 0
14 9 11 11 0
14 9 11 11 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
2 1 2 0 0
7 4 4 8 0
5 4 5 3 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
14 9 11 11 0

18 19 20 21 22
14 3 8 8 0
0 6 3 3 0
14 9 11 11 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
8 5 4 8 0
4 3 5 2 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 1 1 1 0
0 0 0 0 0
0 0 1 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
14 9 11 11 0

18 19 20 21 22
0 0 0 0 0
2 2 2 2 0
0 0 0 0 0
7 6 7 7 7
5 5 3 4 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 2 3 2
1 1 1 1 1
0 0 0 0 0
11 13 13 11 11
11 12 15 14 10
39 42 43 42 34

18 19 20 21 22
7 6 10 9 7
0 0 0 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 6 10 9 8

18 19 20 21 22

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

130.00 140.00 143.33 140.00 113.33


5.57 7.00 4.30 4.67 4.25
24.43 23.00 25.70 25.33 25.75
0.23 0.20 0.33 0.30 0.27
18 19 20 21 22
0 0 0 0 0
100.00 100.00 100.00 100.00 0.00
0 0 0 0 0
233.33 200.00 233.33 233.33 233.33
166.67 166.67 100.00 133.33 100.00
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
100.00 150.00 100.00 150.00 100.00
33.33 33.33 33.33 33.33 33.33
0 0 0 0 0
183.33 216.67 216.67 183.33 183.33
110.00 120.00 150.00 140.00 100.00
92667% 98667% 93333% 97333% 75000%

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
5 7 2 10 2
0 0 0 0 0
0 0 0 0 0
5 7 2 10 2

23 24 25 26 27

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 2 2 4 1
2 5 0 6 1
5 7 2 10 2
5 7 2 10 2

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
0 1 1 1 0
2 2 0 3 1
3 4 0 6 1
0 0 1 0 0
0 0 0 0 0
0 0 0 0 0
5 7 2 10 2

23 24 25 26 27
5 4 2 6 2
0 3 0 4 0
5 7 2 10 2

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
3 4 1 9 1
0 1 0 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 2 0 1 0
0 0 0 0 0
1 0 1 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
5 7 2 10 2

23 24 25 26 27
0 0 0 0 0
1 2 2 2 2
0 0 0 0 0
7 7 7 8 9
4 5 5 6 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 3 3 3 3
1 1 1 1 1
0 0 0 0 0
9 11 11 10 10
11 9 9 10 9
36 38 38 40 40

23 24 25 26 27
4 3 8 7 3
0 0 0 0 0
0 1 0 0 1
0 0 0 0 0
0 0 0 0 0
4 4 8 7 4

23 24 25 26 27

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

120.00 126.67 126.67 133.33 133.33


9.00 9.50 4.75 5.71 10.00
21.00 20.50 25.25 24.29 20.00
0.13 0.13 0.27 0.23 0.13
23 24 25 26 27
0 0 0 0 0
50.00 100.00 100.00 100.00 100.00
0 0 0 0 0
233.33 233.33 233.33 266.67 300.00
133.33 166.67 166.67 200.00 200.00
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
150.00 150.00 150.00 150.00 150.00
33.33 33.33 33.33 33.33 33.33
0 0 0 0 0
150.00 183.33 183.33 166.67 166.67
110.00 90.00 90.00 100.00 90.00
86000% 95667% 95667% 101667% 104000%

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
SUBTOTAL
28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
9 7 5 0 234
0 0 0 0 0
0 0 0 0 0
9 7 5 0 234

SUBTOTAL

28 29 30 31

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

6 5 2 0 124
3 2 3 0 110
9 7 5 0 234
9 7 5 0 234

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
SUBTOTAL
28 29 30 31
3 1 2 0 33
2 3 3 0 90
4 3 0 0 103
0 0 0 0 8
0 0 0 0 0
0 0 0 0 0
9 7 5 0 234

SUBTOTAL

28 29 30 31
7 5 4 0 161
2 2 1 0 73
9 7 5 0 234

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL
SUBTOTAL

28 29 30 31
7 3 3 0 142
2 1 1 0 50
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 2 1 0 35
0 0 0 0 0
0 1 0 0 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
9 7 5 0 234

SUBTOTAL

28 29 30 31
0 0 0 0 0
2 2 2 0 50
0 0 0 0 0
8 8 9 0 169
7 8 9 0 120
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 3 4 0 50
1 2 2 0 36
0 0 0 0 0
11 11 11 0 265
12 11 14 0 262
44 45 51 0 952

SUBTOTAL

28 29 30 31
5 5 7 0 193
2 1 0 0 11
0 0 0 0 5
0 0 0 0 2
0 0 0 0 0
7 6 7 0 211

SUBTOTAL
28 29 30 31

0 0 0 0 0
0 0 0 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 1

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

146.67 150.00 170.00 0.00 3172.00


6.29 7.50 7.29 #DIV/0! #DIV/0!
23.71 22.50 22.71 #DIV/0! #DIV/0!
0.23 0.20 0.23 0.00 7.03
0
0
0
0

0
0
0
0
0
0
0
0

0
0
SUBTOTAL
28 29 30 31
0 0 0 0 0%
100.00 100.00 100.00 0.00 250000%
0 0 0 0 0%
266.67 266.67 300.00 0.00 563333%
233.33 266.67 300.00 0.00 400000%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
150.00 150.00 200.00 0.00 250000%
33.33 66.67 66.67 0.00 120000%
0 0 0 0 0%
183.33 183.33 183.33 0.00 441667%
120.00 110.00 140.00 0.00 262000%
108667% 114333% 129000% 0% 2287000%

SUBTOTAL

28 29 30 31
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
- - - - -
SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
89.31%
0.00%
0.00%
89.31%

SUBTOTAL
KETERANGAN
%

0%

89%
89%

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
SUBTOTAL
KETERANGAN
%
12.60%
34.35%
39.31%
3.05%
0.00%
0.00%
89.31%

SUBTOTAL
KETERANGAN
%
61.45%
27.86%
89.31%

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

SUBTOTAL
KETERANGAN
%
#DIV/0!

#DIV/0!

SUBTOTAL
KETERANGAN
SUBTOTAL
KETERANGAN
%
54.20%
19.08%
0.00%
0.00%
0.00%
0.00%
13.36%
0.00%
2.67%
0.00%
0.00%
0.00%
89.31%

SUBTOTAL
KETERANGAN
%
0.00%
7.39%
0.00%
24.96%
17.73%
0.00%
0.00%
0.00%
0.00%
7.39%
5.32%
0.00%
39.14%
38.70%
140.62%

SUBTOTAL KETERANGAN

%
81.78%
4.66%
2.12%
0.85%
0.00%
89.41%

SUBTOTAL TARGET
KETERANGAN
% %

#DIV/0! 0 #DIV/0!
#DIV/0! 0 0.00%
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!

#DIV/0! 0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

60 - 80%
3 hari
<3
40-50
80.00% #DIV/0!
80.00% #DIV/0!
45/mil
45/mil

<5 '

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

< 2
0.00% #DIV/0!
SUBTOTAL TARGET
KETERANGAN
% %
0.00% 80.00% #DIV/0!
7.29% 80.00% 0.03%
0.00% 80.00% #DIV/0!
16.42% 80.00% 0.01%
11.66% 80.00% 0.02%
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
7.29% 80.00% 0.03%
3.50% 80.00% 0.07%
0.00% 80.00% #DIV/0!
12.87% 80.00% 0.02%
7.64% 80.00% 0.03%
67% 80.00% 0.00%

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
1. KUNJUNGAN PASIEN

NO INSTALASI
1
1 Instalasi Gawat Darurat 0
2 Instalasi Rawat Jalan 0
3 Kamar Bedah 0
4 Kamar Bersalin 0
5 Ruang Maternitas 0
6 Ruang Rawat Dewasa 9
7 Ruang Rawat Anak dan Perinatal 0
8 Ruang Eksklusif 0
TOTAL 9

2. PASIEN BERDASARKAN JENIS KELAMIN

NO PASIEN
1
1 Anak
Laki-laki0
Perempuan0
subtotal 0
2 Dewasa
Laki-laki3
Perempuan6
subtotal 9
TOTAL 9

3. REALISASI PENDAPATAN

NO INSTALASI
1
1 Instalasi Gawat Darurat 0
2 Instalasi Rawat Jalan 0
3 Kamar Bedah 0
4 Kamar Bersalin 0
5 Ruang Maternitas 0
6 Ruang Rawat Dewasa 0
7 Ruang Rawat Anak dan Perinatal 0
8 Ruang Eksklusif 0
TOTAL 0
4. CARA PEMBAYARAN

NO PEMBAYARAN
1
1 Umum 3
2 BPJS PBI 2
3 BPJS Non PBI 4
4 Karawang Sehat 0
5 Asuransi lain 0
6 Karyawan 0
TOTAL 9

5. KUNJUNGAN PASIEN LAMA / BARU

NO PASIEN
1
1 Pasien Baru 5
2 Pasien Lama 4
TOTAL 9

6. TRIASE PASIEN INSTALASI GAWAT DARURAT

NO TRIASE
1
1 Merah 0
2 Kuning 0
3 Hijau 0
4 Hitam 0
TOTAL 0

7. PASIEN DIRUJUK

NO ALASAN DIRUJUK
1
1 Ruangan full (laki-laki) 0
(Perempuan) 0
(Anak) 0
Subtotal 0
2 Ruangan isolasi (laki-laki) 0
(Perempuan) 0
(Anak) 0
Subtotal 0
3 ICU 0
4 NICU/PICU 0
5 Spesialis bedah anak 0
6 Sp.OG tidak praktek 0
Subtotal 0
7 Spesialis jantung paru
(Dewasa)
0
(Anak)
0
Subtotal 0
8 Spesialis orthopedi
(Dewasa)
0
(Anak)
0
Subtotal 0
9 Spesialis syaraf
(Dewasa)
0
(Anak)
0
Subtotal 0
10 Spesialis urologi
(Dewasa)
0
(Anak)
0
Subtotal 0
11 CT Scan
(Dewasa)
0
(Anak)
0
Subtotal 0
12 Spesialis kesehatan jiwa
(Dewasa)
0
(Anak)
0
Subtotal 0
13 Spesialis bedah mulut
(Dewasa)
0
(Anak)
0
Subtotal 0
14 Renovasi OK
(Dewasa)
0
(Anak)
0
Subtotal 0
15 THT
(Dewasa)
0
(Anak)
0
Subtotal 0
16 GIGI
(Dewasa)
0
(Anak)
0
Subtotal 0
17 Spesialis bedah onkologi
(Dewasa)
0
(Anak)
0
Subtotal 0
18 Spesialis kulit kelamin
(Dewasa)
0
(Anak)
0
Subtotal 0
19 Anti bisa ular
(Dewasa)
0
(Anak)
0
Subtotal 0
20 Atas permintaan sendiri (APS)
(Dewasa)
0
(Anak)
0
Subtotal 0
21 Hemodialisa
(Dewasa)
0
(Anak)
0
Subtotal 0
22 Isolasi luka bakar
(Dewasa)
0
(Anak)
0
Subtotal 0
TOTAL 0

8. JENIS OPERASI KAMAR BEDAH

NO JENIS OPERASI
1
1 Kecil 0
2 Sedang 0
3 Besar 0
4 Besar Khusus 0
TOTAL 0

9. KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

NO LAYANAN MEDIS
NO LAYANAN MEDIS
1
1 Penyakit Dalam 5
2 Bedah 0
3 Obstetri 0
4 Gynekologi 0
5 Anak 0
6 Mata 0
7 Paru 4
8 Kulit 0
9 Syaraf 0
10 Umum 0
11 Gigi 0
12 Lain - lain 0
TOTAL 9

10. LAMA HARI RAWAT

NO KAMAR
1
1 VIP 0
2 Kelas I 4
3 Kelas II Maternitas 0
4 Kelas II Perempuan Dewasa 8
5 Kelas II Laki-Laki Dewasa 9
6 Kelas II Perinatal 0
7 Kelas II Anak 0
8 Kelas II Isolasi Anak 0
9 Kelas III Anak 0
9 Kelas II Isolasi Perempuan 5
10 Kelas II Isolasi Laki-Laki 2
11 Kelas III Maternitas 0
12 Kelas III Perempuan Dewasa 11
13 Kelas III Laki-Laki Dewasa 14
TOTAL 53

11. CARA KELUAR PASIEN

NO KELUAR PASIEN
1
1 Izin dokter 5
2 Atas permintaan sendiri 1
3 Referal 1
4 Meninggal 0
5 Death On Arrive (DOA) 0
TOTAL 7

12. STANDAR PELAYANAN MINIMAL

NO INDIKATOR
Insiden Keselamatan Pasien, Karyawan & Keluarga 1
1 Pasien
a. Kejadian Potensial Cedera 0
b. Kejadian Nyaris Cedera 0
c. Kejadian Tidak Cedera 0
d. Kejadian Tidak Diharapkan 0
e. Kejadan Sentinel 0
SUB TOTAL 0
2 Angka Infeksi
a. Infeksi aliran darah 0
b. Infeksi luka operasi 0
c. Infeksi saluran kemih 0
SUB TOTAL 0
3 RL
a. Bed Of Rate
b. Length of Stay
c. Turn Of Interval
d. Bed Turn Over
e. Penanganan BBLR
f. Penanganan bayi asfiksia
g. Growth Death Rate (GDR)
h. Net Death Rate (NDR)
4 Time
a. Respon time IGD
b. On Time Delivery
1). Dr.Tripni P, SpA
2). Dr. Zahedi, SpA
3). Dr. Nurhayati, Sp P
4). Dr. Irvin A, SpOg
5). Dr Rithza, SpPD,FINASIM
6). Dr. Syafrudin, SpPD,FINASIM
7). Dr. Ridho A.S. SpB
8). Dr. Yudi, SpB

5 Kematian
a. Death On Emergency
b. Death On Room
13. BED OF RATE

NO RUANGAN
1
1 VIP 0
2 Kelas I 200.00
3 Kelas II Maternitas 0
4 Kelas II Perempuan Dewasa 266.67
5 Kelas II Laki-Laki Dewasa 300.00
6 Kelas II Perinatal 0
7 Kelas II Anak 0
8 Kelas II Isolasi Anak 0
9 Kelas III Anak 0
10 Kelas II Isolasi Perempuan 250.00
11 Kelas II Isolasi Laki-Laki 66.67
12 Kelas III Maternitas 0
13 Kelas III Perempuan Dewasa 183.33
14 Kelas III Laki-Laki Dewasa 140.00
TOTAL 140667%

14. JENIS TINDAKAN

NO TINDAKAN
1
1 Partus spontan 0
2 Partus spontan gemelli 0
3 Partus spontan sungsang 0
4 Vacuum 0
5 Sectio caesaria 0
6 Curretase 0
7 Gynekologi 0
TOTAL -

15. MASALAH
NO MASALAH
16. KESIMPULAN
1
2
3
4

17. REKOMENDASI
1
2
3
4
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

AKAR MASALAH
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

UNIT TERKAIT KETERANGAN


REALISASI
MEI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
12 13 14 15 16

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
MEI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
12 13 14 15 16

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
MEI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

REALISASI
MEI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
REALISASI
MEI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
17 18 19 20 21

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
MEI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
MEI
17 18 19 20 21

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
MEI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

REALISASI
MEI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0% 0% 0% 0%

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
- - - -
SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 9 3.44%
0 0 0.00%
0 0 0.00%
0 9 3.44%

SUBTOTAL
KETERANGAN
31 %

0 0
0 0
0 0 0%

0 3
0 6
0 9 3%
0 9 3%

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
SUBTOTAL
KETERANGAN
31 %
0 3 1.15%
0 2 0.76%
0 4 1.53%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 9 3.44%

SUBTOTAL
KETERANGAN
31 %
0 5 1.91%
0 4 1.53%
0 9 3.44%

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
#DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
#DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0
0 0
0 0
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
SUBTOTAL
KETERANGAN
31 %
0 5 1.91%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 4 1.53%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 9 3.44%

SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 4 0.59%
0 0 0.00%
0 8 1.18%
0 9 1.33%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 5 0.74%
0 2 0.30%
0 0 0.00%
0 11 1.62%
0 14 2.07%
0 53 7.83%

SUBTOTAL KETERANGAN

31 %
0 5 2.12%
0 1 0.42%
0 1 0.42%
0 0 0.00%
0 0 0.00%
0 7 2.97%

SUBTOTAL TARGET
31 % %

0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0

0 0 #DIV/0! 0 #DIV/0!
0 0 0 #DIV/0!
0 0 0 #DIV/0!
0 0

0 60 - 80%
0 3 hari
0 <3
0 40-50
0 80.00% #DIV/0!
0 80.00% #DIV/0!
0 45/mil
0 45/mil

0 <5 '

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 < 2
0 0.00% #DIV/0!
SUBTOTAL TARGET
31 % %
0 0% 0.00% 80.00% #DIV/0!
0 20000% 0.58% 80.00% 0.40%
0 0% 0.00% 80.00% #DIV/0!
0 26667% 0.78% 80.00% 0.30%
0 30000% 0.87% 80.00% 0.27%
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 25000% 0.73% 80.00% 0.32%
0 6667% 0.19% 80.00% 1.20%
0 0% 0.00% 80.00% #DIV/0!
0 18333% 0.53% 80.00% 0.44%
0 14000% 0.41% 80.00% 0.57%
0% 140667% 4% 80.00% 0.06%

SUBTOTAL
KETERANGAN
31 %
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
- - #DIV/0!
1. KUNJUNGAN PASIEN

NO

1
2
3
4
5
6
7
8
TOTAL

2. PASIEN BERDASARKAN JENIS KELAMIN

NO

TOTAL

3. REALISASI PENDAPATAN

NO

1
2
3
4
5
6
7
8
TOTAL
4. CARA PEMBAYARAN

NO

1
2
3
4
5
6
TOTAL

5. KUNJUNGAN PASIEN LAMA / BARU

NO

1
2
TOTAL

6. TRIASE PASIEN INSTALASI GAWAT DARURAT

NO

1
2
3
4
TOTAL

7. PASIEN DIRUJUK

NO

1
2

3
4
5
6

10

11

12

13

14

15
16

17

18

19

20

21

22

TOTAL

8. JENIS OPERASI KAMAR BEDAH

NO

1
2
3
4
TOTAL

9. KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

NO
NO

1
2
3
4
5
6
7
8
9
10
11
12
TOTAL

10. LAMA HARI RAWAT

NO

1
2
3
4
5
6
7
8
9
9
10
11
12
13
TOTAL

11. CARA KELUAR PASIEN

NO

1
2
3
4
5
TOTAL

12. STANDAR PELAYANAN MINIMAL

KETERANGAN NO

SUB TOTAL
2

SUB TOTAL
3

5
13. BED OF RATE

KETERANGAN NO

1
2
3
4
5
6
7
8
9
10
11
12
13
14
TOTAL

14. JENIS TINDAKAN

NO

1
2
3
4
5
6
7
TOTAL

15. MASALAH
NO
16. KESIMPULAN
1
2
3
4

17. REKOMENDASI
1
2
3
4
KUNJUNGAN PASIEN

INSTALASI
1 2
Instalasi Gawat Darurat 0 0
Instalasi Rawat Jalan 0 0
Kamar Bedah 0 0
Kamar Bersalin 0 0
Ruang Maternitas 0 0
Ruang Rawat Dewasa 0 0
Ruang Rawat Anak dan Perinatal 0 0
Ruang Eksklusif 0 0
TOTAL 0 0

PASIEN BERDASARKAN JENIS KELAMIN

PASIEN
1 2
Anak
Laki-laki0 0
Perempuan0 0
subtotal 0 0
Dewasa
Laki-laki0 0
Perempuan0 0
subtotal 0 0
TOTAL 0 0

REALISASI PENDAPATAN

INSTALASI
1 2
Instalasi Gawat Darurat 0 0
Instalasi Rawat Jalan 0 0
Kamar Bedah 0 0
Kamar Bersalin 0 0
Ruang Maternitas 0 0
Ruang Rawat Dewasa 0 0
Ruang Rawat Anak dan Perinatal 0 0
Ruang Eksklusif 0 0
TOTAL 0 0
CARA PEMBAYARAN

PEMBAYARAN
1 2
Umum 0 0
BPJS PBI 0 0
BPJS Non PBI 0 0
Karawang Sehat 0 0
Asuransi lain 0 0
Karyawan 0 0
TOTAL 0 0

KUNJUNGAN PASIEN LAMA / BARU

PASIEN
1 2
Pasien Baru 0 0
Pasien Lama 0 0
TOTAL 0 0

TRIASE PASIEN INSTALASI GAWAT DARURAT

TRIASE
1 2
Merah 0 0
Kuning 0 0
Hijau 0 0
Hitam 0 0
TOTAL 0 0

PASIEN DIRUJUK

ALASAN DIRUJUK
1 2
Ruangan full (laki-laki) 0 0
(Perempuan) 0 0
(Anak) 0 0
Subtotal 0 0
Ruangan isolasi (laki-laki) 0 0
(Perempuan) 0 0
(Anak) 0 0
Subtotal 0 0
ICU 0 0
NICU/PICU 0 0
Spesialis bedah anak 0 0
Sp.OG tidak praktek 0 0
Subtotal 0 0
Spesialis jantung paru
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis orthopedi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis syaraf
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis urologi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
CT Scan
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis kesehatan jiwa
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis bedah mulut
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Renovasi OK
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
THT
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
GIGI
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis bedah onkologi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis kulit kelamin
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Anti bisa ular
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Atas permintaan sendiri (APS)
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Hemodialisa
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Isolasi luka bakar
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
TOTAL 0 0

JENIS OPERASI KAMAR BEDAH

JENIS OPERASI
1 2
Kecil 0 0
Sedang 0 0
Besar 0 0
Besar Khusus 0 0
TOTAL 0 0

KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

LAYANAN MEDIS
LAYANAN MEDIS
1 2
Penyakit Dalam 0 0
Bedah 0 0
Obstetri 0 0
Gynekologi 0 0
Anak 0 0
Mata 0 0
Paru 0 0
Kulit 0 0
Syaraf 0 0
Umum 0 0
Gigi 0 0
Lain - lain 0 0
TOTAL 0 0

. LAMA HARI RAWAT

KAMAR
1 2
VIP 0 0
Kelas I 0 0
Kelas II Maternitas 0 0
Kelas II Perempuan Dewasa 0 0
Kelas II Laki-Laki Dewasa 0 0
Kelas II Perinatal 0 0
Kelas II Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas III Anak 0 0
Kelas II Isolasi Perempuan 0 0
Kelas II Isolasi Laki-Laki 0 0
Kelas III Maternitas 0 0
Kelas III Perempuan Dewasa 0 0
Kelas III Laki-Laki Dewasa 0 0
TOTAL 0 0

. CARA KELUAR PASIEN

KELUAR PASIEN
1 2
Izin dokter 0 0
Atas permintaan sendiri 0 0
Referal 0 0
Meninggal 0 0
Death On Arrive (DOA) 0 0
TOTAL 0 0

. STANDAR PELAYANAN MINIMAL

INDIKATOR
Insiden Keselamatan Pasien, Karyawan & Keluarga 1 2
Pasien
a. Kejadian Potensial Cedera 0 0
b. Kejadian Nyaris Cedera 0 0
c. Kejadian Tidak Cedera 0 0
d. Kejadian Tidak Diharapkan 0 0
e. Kejadan Sentinel 0 0
SUB TOTAL 0 0
Angka Infeksi
a. Infeksi aliran darah 0 0
b. Infeksi luka operasi 0 0
c. Infeksi saluran kemih 0 0
SUB TOTAL 0 0
RL
a. Bed Of Rate
b. Length of Stay
c. Turn Of Interval
d. Bed Turn Over
e. Penanganan BBLR
f. Penanganan bayi asfiksia
g. Growth Death Rate (GDR)
h. Net Death Rate (NDR)
Time
a. Respon time IGD
b. On Time Delivery
1). Dr.Tripni P, SpA
2). Dr. Zahedi, SpA
3). Dr. Nurhayati, Sp P
4). Dr. Irvin A, SpOg
5). Dr Rithza, SpPD,FINASIM
6). Dr. Syafrudin, SpPD,FINASIM
7). Dr. Ridho A.S. SpB
8). Dr. Yudi, SpB

Kematian
a. Death On Emergency
b. Death On Room
. BED OF RATE

RUANGAN
1 2
VIP 0 0
Kelas I 0 0
Kelas II Maternitas 0 0
Kelas II Perempuan Dewasa 0 0
Kelas II Laki-Laki Dewasa 0 0
Kelas II Perinatal 0 0
Kelas II Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas III Anak 0 0
Kelas II Isolasi Perempuan 0 0
Kelas II Isolasi Laki-Laki 0 0
Kelas III Maternitas 0 0
Kelas III Perempuan Dewasa 0 0
Kelas III Laki-Laki Dewasa 0 0
TOTAL 0% 0%

. JENIS TINDAKAN

TINDAKAN
1 2
Partus spontan 0 0
Partus spontan gemelli 0 0
Partus spontan sungsang 0 0
Vacuum 0 0
Sectio caesaria 0 0
Curretase 0 0
Gynekologi 0 0
TOTAL - -

. MASALAH
MASALAH AK
. KESIMPULAN

. REKOMENDASI
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

AKAR MASALAH
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

UNIT TERKAIT KETERANGAN


REALISASI
JUNI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JUNI
13 14 15 16 17

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JUNI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
JUNI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JUNI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JUNI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JUNI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JUNI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JUNI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JUNI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JUNI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JUNI
13 14 15 16 17

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
JUNI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

REALISASI
JUNI
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
SUBTOTAL
28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
SUBTOTAL
28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL
SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL
28 29 30 31

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0

0
0
SUBTOTAL
28 29 30 31
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0% 0% 0% 0% 0%

SUBTOTAL

28 29 30 31
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
- - - - -
SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL
KETERANGAN
%

0%

0%
0%

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

SUBTOTAL
KETERANGAN
%
#DIV/0!

#DIV/0!

SUBTOTAL
KETERANGAN
SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL KETERANGAN

%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL TARGET
KETERANGAN
% %

#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!

#DIV/0! 0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

60 - 80%
3 hari
<3
40-50
80.00% #DIV/0!
80.00% #DIV/0!
45/mil
45/mil

<5 '

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

< 2
0.00% #DIV/0!
SUBTOTAL TARGET
KETERANGAN
% %
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0% 80.00% #DIV/0!

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
1. KUNJUNGAN PASIEN

NO INSTALASI
1
1 Instalasi Gawat Darurat 0
2 Instalasi Rawat Jalan 0
3 Kamar Bedah 0
4 Kamar Bersalin 0
5 Ruang Maternitas 0
6 Ruang Rawat Dewasa 0
7 Ruang Rawat Anak dan Perinatal 0
8 Ruang Eksklusif 0
TOTAL 0

2. PASIEN BERDASARKAN JENIS KELAMIN

NO PASIEN
1
1 Anak
Laki-laki0
Perempuan0
subtotal 0
2 Dewasa
Laki-laki0
Perempuan0
subtotal 0
TOTAL 0

3. REALISASI PENDAPATAN

NO INSTALASI
1
1 Instalasi Gawat Darurat 0
2 Instalasi Rawat Jalan 0
3 Kamar Bedah 0
4 Kamar Bersalin 0
5 Ruang Maternitas 0
6 Ruang Rawat Dewasa 0
7 Ruang Rawat Anak dan Perinatal 0
8 Ruang Eksklusif 0
TOTAL 0
4. CARA PEMBAYARAN

NO PEMBAYARAN
1
1 Umum 0
2 BPJS PBI 0
3 BPJS Non PBI 0
4 Karawang Sehat 0
5 Asuransi lain 0
6 Karyawan 0
TOTAL 0

5. KUNJUNGAN PASIEN LAMA / BARU

NO PASIEN
1
1 Pasien Baru 0
2 Pasien Lama 0
TOTAL 0

6. TRIASE PASIEN INSTALASI GAWAT DARURAT

NO TRIASE
1
1 Merah 0
2 Kuning 0
3 Hijau 0
4 Hitam 0
TOTAL 0

7. PASIEN DIRUJUK

NO ALASAN DIRUJUK
1
1 Ruangan full (laki-laki) 0
(Perempuan) 0
(Anak) 0
Subtotal 0
2 Ruangan isolasi (laki-laki) 0
(Perempuan) 0
(Anak) 0
Subtotal 0
3 ICU 0
4 NICU/PICU 0
5 Spesialis bedah anak 0
6 Sp.OG tidak praktek 0
Subtotal 0
7 Spesialis jantung paru
(Dewasa)
0
(Anak)
0
Subtotal 0
8 Spesialis orthopedi
(Dewasa)
0
(Anak)
0
Subtotal 0
9 Spesialis syaraf
(Dewasa)
0
(Anak)
0
Subtotal 0
10 Spesialis urologi
(Dewasa)
0
(Anak)
0
Subtotal 0
11 CT Scan
(Dewasa)
0
(Anak)
0
Subtotal 0
12 Spesialis kesehatan jiwa
(Dewasa)
0
(Anak)
0
Subtotal 0
13 Spesialis bedah mulut
(Dewasa)
0
(Anak)
0
Subtotal 0
14 Renovasi OK
(Dewasa)
0
(Anak)
0
Subtotal 0
15 THT
(Dewasa)
0
(Anak)
0
Subtotal 0
16 GIGI
(Dewasa)
0
(Anak)
0
Subtotal 0
17 Spesialis bedah onkologi
(Dewasa)
0
(Anak)
0
Subtotal 0
18 Spesialis kulit kelamin
(Dewasa)
0
(Anak)
0
Subtotal 0
19 Anti bisa ular
(Dewasa)
0
(Anak)
0
Subtotal 0
20 Atas permintaan sendiri (APS)
(Dewasa)
0
(Anak)
0
Subtotal 0
21 Hemodialisa
(Dewasa)
0
(Anak)
0
Subtotal 0
22 Isolasi luka bakar
(Dewasa)
0
(Anak)
0
Subtotal 0
TOTAL 0

8. JENIS OPERASI KAMAR BEDAH

NO JENIS OPERASI
1
1 Kecil 0
2 Sedang 0
3 Besar 0
4 Besar Khusus 0
TOTAL 0

7. KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

NO LAYANAN MEDIS
NO LAYANAN MEDIS
1
1 Penyakit Dalam 0
2 Bedah 0
3 Obstetri 0
4 Gynekologi 0
5 Anak 0
6 Mata 0
7 Paru 0
8 Kulit 0
9 Syaraf 0
10 Umum 0
11 Gigi 0
12 Lain - lain 0
TOTAL 0

10. LAMA HARI RAWAT

NO KAMAR
1
1 VIP 0
2 Kelas I 0
3 Kelas II Maternitas 0
4 Kelas II Perempuan Dewasa 0
5 Kelas II Laki-Laki Dewasa 0
6 Kelas II Perinatal 0
7 Kelas II Anak 0
8 Kelas II Isolasi Anak 0
9 Kelas III Anak 0
9 Kelas II Isolasi Perempuan 0
10 Kelas II Isolasi Laki-Laki 0
11 Kelas III Maternitas 0
12 Kelas III Perempuan Dewasa 0
13 Kelas III Laki-Laki Dewasa 0
TOTAL 0

11. CARA KELUAR PASIEN

NO KELUAR PASIEN
1
1 Izin dokter 0
2 Atas permintaan sendiri 0
3 Referal 0
4 Meninggal 0
5 Death On Arrive (DOA) 0
TOTAL 0

12. STANDAR PELAYANAN MINIMAL

NO INDIKATOR
Insiden Keselamatan Pasien, Karyawan & Keluarga 1
1 Pasien
a. Kejadian Potensial Cedera 0
b. Kejadian Nyaris Cedera 0
c. Kejadian Tidak Cedera 0
d. Kejadian Tidak Diharapkan 0
e. Kejadan Sentinel 0
SUB TOTAL 0
2 Angka Infeksi
a. Infeksi aliran darah 0
b. Infeksi luka operasi 0
c. Infeksi saluran kemih 0
SUB TOTAL 0
3 RL
a. Bed Of Rate
b. Length of Stay
c. Turn Of Interval
d. Bed Turn Over
e. Penanganan BBLR
f. Penanganan bayi asfiksia
g. Growth Death Rate (GDR)
h. Net Death Rate (NDR)
4 Time
a. Respon time IGD
b. On Time Delivery
1). Dr.Tripni P, SpA
2). Dr. Zahedi, SpA
3). Dr. Nurhayati, Sp P
4). Dr. Irvin A, SpOg
5). Dr Rithza, SpPD,FINASIM
6). Dr. Syafrudin, SpPD,FINASIM
7). Dr. Ridho A.S. SpB
8). Dr. Yudi, SpB

5 Kematian
a. Death On Emergency
b. Death On Room
13. BED OF RATE

NO RUANGAN
1
1 VIP 0
2 Kelas I 0
3 Kelas II Maternitas 0
4 Kelas II Perempuan Dewasa 0
5 Kelas II Laki-Laki Dewasa 0
6 Kelas II Perinatal 0
7 Kelas II Anak 0
8 Kelas II Isolasi Anak 0
9 Kelas III Anak 0
10 Kelas II Isolasi Perempuan 0
11 Kelas II Isolasi Laki-Laki 0
12 Kelas III Maternitas 0
13 Kelas III Perempuan Dewasa 0
14 Kelas III Laki-Laki Dewasa 0
TOTAL 0%

14. JENIS TINDAKAN

NO TINDAKAN
1
1 Partus spontan 0
2 Partus spontan gemelli 0
3 Partus spontan sungsang 0
4 Vacuum 0
5 Sectio caesaria 0
6 Curretase 0
7 Gynekologi 0
TOTAL -

15. MASALAH
NO MASALAH
16. KESIMPULAN
1
2
3
4

17. REKOMENDASI
1
2
3
4
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

AKAR MASALAH
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

UNIT TERKAIT KETERANGAN


REALISASI
JULI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
12 13 14 15 16

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
JULI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
12 13 14 15 16

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
JULI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

REALISASI
JULI
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
REALISASI
JULI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
17 18 19 20 21

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
JULI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
JULI
17 18 19 20 21

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
JULI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

REALISASI
JULI
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0% 0% 0% 0%

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
- - - -
SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL
KETERANGAN
31 %

0 0
0 0
0 0 0%

0 0
0 0
0 0 0%
0 0 0%

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
#DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
#DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0
0 0
0 0
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL KETERANGAN

31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL TARGET
31 % %

0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0

0 0 #DIV/0! 0 #DIV/0!
0 0 0 #DIV/0!
0 0 0 #DIV/0!
0 0

0 60 - 80%
0 3 hari
0 <3
0 40-50
0 80.00% #DIV/0!
0 80.00% #DIV/0!
0 45/mil
0 45/mil

0 <5 '

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 < 2
0 0.00% #DIV/0!
SUBTOTAL TARGET
31 % %
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0% 0% 0% 80.00% #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
- - #DIV/0!
1. KUNJUNGAN PASIEN

NO

1
2
3
4
5
6
7
8
TOTAL

2. PASIEN BERDASARKAN JENIS KELAMIN

NO

TOTAL

3. REALISASI PENDAPATAN

NO

1
2
3
4
5
6
7
8
TOTAL
4. CARA PEMBAYARAN

NO

1
2
3
4
5
6
TOTAL

5. KUNJUNGAN PASIEN LAMA / BARU

NO

1
2
TOTAL

6. TRIASE PASIEN INSTALASI GAWAT DARURAT

NO

1
2
3
4
TOTAL

7. PASIEN DIRUJUK

NO

1
2

3
4
5
6

10

11

12

13

14

15
16

17

18

19

20

21

22

TOTAL

8. JENIS OPERASI KAMAR BEDAH

NO

1
2
3
4
TOTAL

9. KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

NO
NO

1
2
3
4
5
6
7
8
9
10
11
12
TOTAL

10. LAMA HARI RAWAT

NO

1
2
3
4
5
6
7
8
9
9
10
11
12
13
TOTAL

11. CARA KELUAR PASIEN

NO

1
2
3
4
5
TOTAL

12. STANDAR PELAYANAN MINIMAL

KETERANGAN NO

SUB TOTAL
2

SUB TOTAL
3

5
13. BED OF RATE

KETERANGAN NO

1
2
3
4
5
6
7
8
9
10
11
12
13
14
TOTAL

14. JENIS TINDAKAN

NO

1
2
3
4
5
6
7
TOTAL

15. MASALAH
NO
16. KESIMPULAN
1
2
3
4

17. REKOMENDASI
1
2
3
4
KUNJUNGAN PASIEN

INSTALASI
1 2
Instalasi Gawat Darurat 0 0
Instalasi Rawat Jalan 0 0
Kamar Bedah 0 0
Kamar Bersalin 0 0
Ruang Maternitas 0 0
Ruang Rawat Dewasa 0 0
Ruang Rawat Anak dan Perinatal 0 0
Ruang Eksklusif 0 0
TOTAL 0 0

PASIEN BERDASARKAN JENIS KELAMIN

PASIEN
1 2
Anak
Laki-laki0 0
Perempuan0 0
subtotal 0 0
Dewasa
Laki-laki0 0
Perempuan0 0
subtotal 0 0
TOTAL 0 0

REALISASI PENDAPATAN

INSTALASI
1 2
Instalasi Gawat Darurat 0 0
Instalasi Rawat Jalan 0 0
Kamar Bedah 0 0
Kamar Bersalin 0 0
Ruang Maternitas 0 0
Ruang Rawat Dewasa 0 0
Ruang Rawat Anak dan Perinatal 0 0
Ruang Eksklusif 0 0
TOTAL 0 0
CARA PEMBAYARAN

PEMBAYARAN
1 2
Umum 0 0
BPJS PBI 0 0
BPJS Non PBI 0 0
Karawang Sehat 0 0
Asuransi lain 0 0
Karyawan 0 0
TOTAL 0 0

KUNJUNGAN PASIEN LAMA / BARU

PASIEN
1 2
Pasien Baru 0 0
Pasien Lama 0 0
TOTAL 0 0

TRIASE PASIEN INSTALASI GAWAT DARURAT

TRIASE
1 2
Merah 0 0
Kuning 0 0
Hijau 0 0
Hitam 0 0
TOTAL 0 0

PASIEN DIRUJUK

ALASAN DIRUJUK
1 2
Ruangan full (laki-laki) 0 0
(Perempuan) 0 0
(Anak) 0 0
Subtotal 0 0
Ruangan isolasi (laki-laki) 0 0
(Perempuan) 0 0
(Anak) 0 0
Subtotal 0 0
ICU 0 0
NICU/PICU 0 0
Spesialis bedah anak 0 0
Sp.OG tidak praktek 0 0
Subtotal 0 0
Spesialis jantung paru
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis orthopedi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis syaraf
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis urologi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
CT Scan
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis kesehatan jiwa
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis bedah mulut
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Renovasi OK
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
THT
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
GIGI
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis bedah onkologi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis kulit kelamin
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Anti bisa ular
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Atas permintaan sendiri (APS)
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Hemodialisa
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Isolasi luka bakar
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
TOTAL 0 0

JENIS OPERASI KAMAR BEDAH

JENIS OPERASI
1 2
Kecil 0 0
Sedang 0 0
Besar 0 0
Besar Khusus 0 0
TOTAL 0 0

KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

LAYANAN MEDIS
LAYANAN MEDIS
1 2
Penyakit Dalam 0 0
Bedah 0 0
Obstetri 0 0
Gynekologi 0 0
Anak 0 0
Mata 0 0
Paru 0 0
Kulit 0 0
Syaraf 0 0
Umum 0 0
Gigi 0 0
Lain - lain 0 0
TOTAL 0 0

. LAMA HARI RAWAT

KAMAR
1 2
VIP 0 0
Kelas I 0 0
Kelas II Maternitas 0 0
Kelas II Perempuan Dewasa 0 0
Kelas II Laki-Laki Dewasa 0 0
Kelas II Perinatal 0 0
Kelas II Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas II Isolasi Perempuan 0 0
Kelas II Isolasi Laki-Laki 0 0
Kelas III Maternitas 0 0
Kelas III Perempuan Dewasa 0 0
Kelas III Laki-Laki Dewasa 0 0
TOTAL 0 0

. CARA KELUAR PASIEN

KELUAR PASIEN
1 2
Izin dokter 0 0
Atas permintaan sendiri 0 0
Referal 0 0
Meninggal 0 0
Death On Arrive (DOA) 0 0
TOTAL 0 0

. STANDAR PELAYANAN MINIMAL

INDIKATOR
Insiden Keselamatan Pasien, Karyawan & Keluarga 1 2
Pasien
a. Kejadian Potensial Cedera 0 0
b. Kejadian Nyaris Cedera 0 0
c. Kejadian Tidak Cedera 0 0
d. Kejadian Tidak Diharapkan 0 0
e. Kejadan Sentinel 0 0
SUB TOTAL 0 0
Angka Infeksi
a. Infeksi aliran darah 0 0
b. Infeksi luka operasi 0 0
c. Infeksi saluran kemih 0 0
SUB TOTAL 0 0
RL
a. Bed Of Rate
b. Length of Stay
c. Turn Of Interval
d. Bed Turn Over
e. Penanganan BBLR
f. Penanganan bayi asfiksia
g. Growth Death Rate (GDR)
h. Net Death Rate (NDR)
Time
a. Respon time IGD
b. On Time Delivery
1). Dr.Tripni P, SpA
2). Dr. Zahedi, SpA
3). Dr. Nurhayati, Sp P
4). Dr. Irvin A, SpOg
5). Dr Rithza, SpPD,FINASIM
6). Dr. Syafrudin, SpPD,FINASIM
7). Dr. Ridho A.S. SpB
8). Dr. Yudi, SpB

Kematian
a. Death On Emergency
b. Death On Room
. BED OF RATE

RUANGAN
1 2
VIP 0 0
Kelas I 0 0
Kelas II Maternitas 0 0
Kelas II Perempuan Dewasa 0 0
Kelas II Laki-Laki Dewasa 0 0
Kelas II Perinatal 0 0
Kelas II Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas III Anak 0 0
Kelas II Isolasi Perempuan 0 0
Kelas II Isolasi Laki-Laki 0 0
Kelas III Maternitas 0 0
Kelas III Perempuan Dewasa 0 0
Kelas III Laki-Laki Dewasa 0 0
TOTAL 0% 0%

. JENIS TINDAKAN

TINDAKAN
1 2
Partus spontan 0 0
Partus spontan gemelli 0 0
Partus spontan sungsang 0 0
Vacuum 0 0
Sectio caesaria 0 0
Curretase 0 0
Gynekologi 0 0
TOTAL - -

. MASALAH
MASALAH AK
. KESIMPULAN

. REKOMENDASI
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

AKAR MASALAH
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

UNIT TERKAIT KETERANGAN


REALISASI
AGUSTUS
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
AGUSTUS
13 14 15 16 17

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
AGUSTUS
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
AGUSTUS
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
AGUSTUS
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
AGUSTUS
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
AGUSTUS
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
AGUSTUS
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
AGUSTUS
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
AGUSTUS
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
AGUSTUS
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
AGUSTUS
13 14 15 16 17

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
AGUSTUS
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

REALISASI
AGUSTUS
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
SUBTOTAL
28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
SUBTOTAL
28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL
SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL
28 29 30 31

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0

0
0
SUBTOTAL
28 29 30 31
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0% 0% 0% 0% 0%

SUBTOTAL

28 29 30 31
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
- - - - -
SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL
KETERANGAN
%

0%

0%
0%

SUBTOTAL
KETERANGAN
%
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SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%

SUBTOTAL
KETERANGAN
%
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SUBTOTAL
KETERANGAN
%
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#DIV/0!
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#DIV/0!
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#DIV/0!
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#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
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#DIV/0!
#DIV/0!
#DIV/0!
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SUBTOTAL
KETERANGAN
%
#DIV/0!

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SUBTOTAL
KETERANGAN
SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL KETERANGAN

%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL TARGET
KETERANGAN
% %

#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!

#DIV/0! 0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

60 - 80%
3 hari
<3
40-50
80.00% #DIV/0!
80.00% #DIV/0!
45/mil
45/mil

<5 '

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

< 2
0.00% #DIV/0!
SUBTOTAL TARGET
KETERANGAN
% %
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0% 80.00% #DIV/0!

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
1. KUNJUNGAN PASIEN

NO INSTALASI
1
1 Instalasi Gawat Darurat 0
2 Instalasi Rawat Jalan 0
3 Kamar Bedah 0
4 Kamar Bersalin 0
5 Ruang Maternitas 0
6 Ruang Rawat Dewasa 0
7 Ruang Rawat Anak dan Perinatal 0
8 Ruang Eksklusif 0
TOTAL 0

2. PASIEN BERDASARKAN JENIS KELAMIN

NO PASIEN
1
1 Anak
Laki-laki0
Perempuan0
subtotal 0
2 Dewasa
Laki-laki0
Perempuan0
subtotal 0
TOTAL 0

3. REALISASI PENDAPATAN

NO INSTALASI
1
1 Instalasi Gawat Darurat 0
2 Instalasi Rawat Jalan 0
3 Kamar Bedah 0
4 Kamar Bersalin 0
5 Ruang Maternitas 0
6 Ruang Rawat Dewasa 0
7 Ruang Rawat Anak dan Perinatal 0
8 Ruang Eksklusif 0
TOTAL 0
4. CARA PEMBAYARAN

NO PEMBAYARAN
1
1 Umum 0
2 BPJS PBI 0
3 BPJS Non PBI 0
4 Karawang Sehat 0
5 Asuransi lain 0
6 Karyawan 0
TOTAL 0

5. KUNJUNGAN PASIEN LAMA / BARU

NO PASIEN
1
1 Pasien Baru 0
2 Pasien Lama 0
TOTAL 0

6. TRIASE PASIEN INSTALASI GAWAT DARURAT

NO TRIASE
1
1 Merah 0
2 Kuning 0
3 Hijau 0
4 Hitam 0
TOTAL 0

7. PASIEN DIRUJUK

NO ALASAN DIRUJUK
1
1 Ruangan full (laki-laki) 0
(Perempuan) 0
(Anak) 0
Subtotal 0
2 Ruangan isolasi (laki-laki) 0
(Perempuan) 0
(Anak) 0
Subtotal 0
3 ICU 0
4 NICU/PICU 0
5 Spesialis bedah anak 0
6 Sp.OG tidak praktek 0
Subtotal 0
7 Spesialis jantung paru
(Dewasa)
0
(Anak)
0
Subtotal 0
8 Spesialis orthopedi
(Dewasa)
0
(Anak)
0
Subtotal 0
9 Spesialis syaraf
(Dewasa)
0
(Anak)
0
Subtotal 0
10 Spesialis urologi
(Dewasa)
0
(Anak)
0
Subtotal 0
11 CT Scan
(Dewasa)
0
(Anak)
0
Subtotal 0
12 Spesialis kesehatan jiwa
(Dewasa)
0
(Anak)
0
Subtotal 0
13 Spesialis bedah mulut
(Dewasa)
0
(Anak)
0
Subtotal 0
14 Renovasi OK
(Dewasa)
0
(Anak)
0
Subtotal 0
15 THT
(Dewasa)
0
(Anak)
0
Subtotal 0
16 GIGI
(Dewasa)
0
(Anak)
0
Subtotal 0
17 Spesialis bedah onkologi
(Dewasa)
0
(Anak)
0
Subtotal 0
18 Spesialis kulit kelamin
(Dewasa)
0
(Anak)
0
Subtotal 0
19 Anti bisa ular
(Dewasa)
0
(Anak)
0
Subtotal 0
20 Atas permintaan sendiri (APS)
(Dewasa)
0
(Anak)
0
Subtotal 0
21 Hemodialisa
(Dewasa)
0
(Anak)
0
Subtotal 0
22 Isolasi luka bakar
(Dewasa)
0
(Anak)
0
Subtotal 0
TOTAL 0

8. JENIS OPERASI KAMAR BEDAH

NO JENIS OPERASI
1
1 Kecil 0
2 Sedang 0
3 Besar 0
4 Besar Khusus 0
TOTAL 0

9. KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

NO LAYANAN MEDIS
NO LAYANAN MEDIS
1
1 Penyakit Dalam 0
2 Bedah 0
3 Obstetri 0
4 Gynekologi 0
5 Anak 0
6 Mata 0
7 Paru 0
8 Kulit 0
9 Syaraf 0
10 Umum 0
11 Gigi 0
12 Lain - lain 0
TOTAL 0

10. LAMA HARI RAWAT

NO KAMAR
1
1 VIP 0
2 Kelas I 0
3 Kelas II Maternitas 0
4 Kelas II Perempuan Dewasa 0
5 Kelas II Laki-Laki Dewasa 0
6 Kelas II Perinatal 0
7 Kelas II Anak 0
8 Kelas II Isolasi Anak 0
9 Kelas II Isolasi Anak 0
9 Kelas II Isolasi Perempuan 0
10 Kelas II Isolasi Laki-Laki 0
11 Kelas III Maternitas 0
12 Kelas III Perempuan Dewasa 0
13 Kelas III Laki-Laki Dewasa 0
TOTAL 0

11. CARA KELUAR PASIEN

NO KELUAR PASIEN
1
1 Izin dokter 0
2 Atas permintaan sendiri 0
3 Referal 0
4 Meninggal 0
5 Death On Arrive (DOA) 0
TOTAL 0

12. STANDAR PELAYANAN MINIMAL

NO INDIKATOR
Insiden Keselamatan Pasien, Karyawan & Keluarga 1
1 Pasien
a. Kejadian Potensial Cedera 0
b. Kejadian Nyaris Cedera 0
c. Kejadian Tidak Cedera 0
d. Kejadian Tidak Diharapkan 0
e. Kejadan Sentinel 0
SUB TOTAL 0
2 Angka Infeksi
a. Infeksi aliran darah 0
b. Infeksi luka operasi 0
c. Infeksi saluran kemih 0
SUB TOTAL 0
3 RL
a. Bed Of Rate
b. Length of Stay
c. Turn Of Interval
d. Bed Turn Over
e. Penanganan BBLR
f. Penanganan bayi asfiksia
g. Growth Death Rate (GDR)
h. Net Death Rate (NDR)
4 Time
a. Respon time IGD
b. On Time Delivery
1). Dr.Tripni P, SpA
2). Dr. Zahedi, SpA
3). Dr. Nurhayati, Sp P
4). Dr. Irvin A, SpOg
5). Dr Rithza, SpPD,FINASIM
6). Dr. Syafrudin, SpPD,FINASIM
7). Dr. Ridho A.S. SpB
8). Dr. Yudi, SpB

5 Kematian
a. Death On Emergency
b. Death On Room
13. BED OF RATE

NO RUANGAN
1
1 VIP 0
2 Kelas I 0
3 Kelas II Maternitas 0
4 Kelas II Perempuan Dewasa 0
5 Kelas II Laki-Laki Dewasa 0
6 Kelas II Perinatal 0
7 Kelas II Anak 0
8 Kelas II Isolasi Anak 0
9 Kelas III Anak 0
10 Kelas II Isolasi Perempuan 0
11 Kelas II Isolasi Laki-Laki 0
12 Kelas III Maternitas 0
13 Kelas III Perempuan Dewasa 0
14 Kelas III Laki-Laki Dewasa 0
TOTAL 0%

14. JENIS TINDAKAN

NO TINDAKAN
1
1 Partus spontan 0
2 Partus spontan gemelli 0
3 Partus spontan sungsang 0
4 Vacuum 0
5 Sectio caesaria 0
6 Curretase 0
7 Gynekologi 0
TOTAL -

15. MASALAH
NO MASALAH
16. KESIMPULAN
1
2
3
4

17. REKOMENDASI
1
2
3
4
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

AKAR MASALAH
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

UNIT TERKAIT KETERANGAN


REALISASI
SEPTEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
SEPTEMBER
12 13 14 15 16

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
SEPTEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
SEPTEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
SEPTEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
SEPTEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
SEPTEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
SEPTEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
SEPTEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
SEPTEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
SEPTEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
SEPTEMBER
12 13 14 15 16

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
SEPTEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

REALISASI
SEPTEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
REALISASI
EPTEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
EPTEMBER
17 18 19 20 21

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
EPTEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
EPTEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
EPTEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
EPTEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
EPTEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
EPTEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
EPTEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
EPTEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
EPTEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
EPTEMBER
17 18 19 20 21

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
EPTEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

REALISASI
EPTEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0% 0% 0% 0%

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
- - - -
SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL
KETERANGAN
31 %

0 0
0 0
0 0 0%

0 0
0 0
0 0 0%
0 0 0%

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
#DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
#DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0
0 0
0 0
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL KETERANGAN

31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL TARGET
31 % %

0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0

0 0 #DIV/0! 0 #DIV/0!
0 0 0 #DIV/0!
0 0 0 #DIV/0!
0 0

0 60 - 80%
0 3 hari
0 <3
0 40-50
0 80.00% #DIV/0!
0 80.00% #DIV/0!
0 45/mil
0 45/mil

0 <5 '

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 < 2
0 0.00% #DIV/0!
SUBTOTAL TARGET
31 % %
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0% 0% 0% 80.00% #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
- - #DIV/0!
1. KUNJUNGAN PASIEN

NO

1
2
3
4
5
6
7
8
TOTAL

2. PASIEN BERDASARKAN JENIS KELAMIN

NO

TOTAL

3. REALISASI PENDAPATAN

NO

1
2
3
4
5
6
7
8
TOTAL
4. CARA PEMBAYARAN

NO

1
2
3
4
5
6
TOTAL

5. KUNJUNGAN PASIEN LAMA / BARU

NO

1
2
TOTAL

6. TRIASE PASIEN INSTALASI GAWAT DARURAT

NO

1
2
3
4
TOTAL

7. PASIEN DIRUJUK

NO

1
2

3
4
5
6

10

11

12

13

14

15
16

17

18

19

20

21

22

TOTAL

8. JENIS OPERASI KAMAR BEDAH

NO

1
2
3
4
TOTAL

9. KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

NO
NO

1
2
3
4
5
6
7
8
9
10
11
12
TOTAL

10. LAMA HARI RAWAT

NO

1
2
3
4
5
6
7
8
9
9
10
11
12
13
TOTAL

11. CARA KELUAR PASIEN

NO

1
2
3
4
5
TOTAL

12. STANDAR PELAYANAN MINIMAL

KETERANGAN NO

SUB TOTAL
2

SUB TOTAL
3

5
13. BED OF RATE

KETERANGAN NO

1
2
3
4
5
6
7
8
9
10
11
12
13
14
TOTAL

14. JENIS TINDAKAN

NO

1
2
3
4
5
6
7
TOTAL

15. MASALAH
NO
16. KESIMPULAN
1
2
3
4

17. REKOMENDASI
1
2
3
4
KUNJUNGAN PASIEN

INSTALASI
1 2
Instalasi Gawat Darurat 0 0
Instalasi Rawat Jalan 0 0
Kamar Bedah 0 0
Kamar Bersalin 0 0
Ruang Maternitas 0 0
Ruang Rawat Dewasa 0 0
Ruang Rawat Anak dan Perinatal 0 0
Ruang Eksklusif 0 0
TOTAL 0 0

PASIEN BERDASARKAN JENIS KELAMIN

PASIEN
1 2
Anak
Laki-laki0 0
Perempuan0 0
subtotal 0 0
Dewasa
Laki-laki0 0
Perempuan0 0
subtotal 0 0
TOTAL 0 0

REALISASI PENDAPATAN

INSTALASI
1 2
Instalasi Gawat Darurat 0 0
Instalasi Rawat Jalan 0 0
Kamar Bedah 0 0
Kamar Bersalin 0 0
Ruang Maternitas 0 0
Ruang Rawat Dewasa 0 0
Ruang Rawat Anak dan Perinatal 0 0
Ruang Eksklusif 0 0
TOTAL 0 0
CARA PEMBAYARAN

PEMBAYARAN
1 2
Umum 0 0
BPJS PBI 0 0
BPJS Non PBI 0 0
Karawang Sehat 0 0
Asuransi lain 0 0
Karyawan 0 0
TOTAL 0 0

KUNJUNGAN PASIEN LAMA / BARU

PASIEN
1 2
Pasien Baru 0 0
Pasien Lama 0 0
TOTAL 0 0

TRIASE PASIEN INSTALASI GAWAT DARURAT

TRIASE
1 2
Merah 0 0
Kuning 0 0
Hijau 0 0
Hitam 0 0
TOTAL 0 0

PASIEN DIRUJUK

ALASAN DIRUJUK
1 2
Ruangan full (laki-laki) 0 0
(Perempuan) 0 0
(Anak) 0 0
Subtotal 0 0
Ruangan isolasi (laki-laki) 0 0
(Perempuan) 0 0
(Anak) 0 0
Subtotal 0 0
ICU 0 0
NICU/PICU 0 0
Spesialis bedah anak 0 0
Sp.OG tidak praktek 0 0
Subtotal 0 0
Spesialis jantung paru
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis orthopedi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis syaraf
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis urologi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
CT Scan
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis kesehatan jiwa
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis bedah mulut
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Renovasi OK
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
THT
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
GIGI
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis bedah onkologi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis kulit kelamin
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Anti bisa ular
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Atas permintaan sendiri (APS)
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Hemodialisa
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Isolasi luka bakar
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
TOTAL 0 0

JENIS OPERASI KAMAR BEDAH

JENIS OPERASI
1 2
Kecil 0 0
Sedang 0 0
Besar 0 0
Besar Khusus 0 0
TOTAL 0 0

KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

LAYANAN MEDIS
LAYANAN MEDIS
1 2
Penyakit Dalam 0 0
Bedah 0 0
Obstetri 0 0
Gynekologi 0 0
Anak 0 0
Mata 0 0
Paru 0 0
Kulit 0 0
Syaraf 0 0
Umum 0 0
Gigi 0 0
Lain - lain 0 0
TOTAL 0 0

. LAMA HARI RAWAT

KAMAR
1 2
VIP 0 0
Kelas I 0 0
Kelas II Maternitas 0 0
Kelas II Perempuan Dewasa 0 0
Kelas II Laki-Laki Dewasa 0 0
Kelas II Perinatal 0 0
Kelas II Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas II Isolasi Perempuan 0 0
Kelas II Isolasi Laki-Laki 0 0
Kelas III Maternitas 0 0
Kelas III Perempuan Dewasa 0 0
Kelas III Laki-Laki Dewasa 0 0
TOTAL 0 0

. CARA KELUAR PASIEN

KELUAR PASIEN
1 2
Izin dokter 0 0
Atas permintaan sendiri 0 0
Referal 0 0
Meninggal 0 0
Death On Arrive (DOA) 0 0
TOTAL 0 0

. STANDAR PELAYANAN MINIMAL

INDIKATOR
Insiden Keselamatan Pasien, Karyawan & Keluarga 1 2
Pasien
a. Kejadian Potensial Cedera 0 0
b. Kejadian Nyaris Cedera 0 0
c. Kejadian Tidak Cedera 0 0
d. Kejadian Tidak Diharapkan 0 0
e. Kejadan Sentinel 0 0
SUB TOTAL 0 0
Angka Infeksi
a. Infeksi aliran darah 0 0
b. Infeksi luka operasi 0 0
c. Infeksi saluran kemih 0 0
SUB TOTAL 0 0
RL
a. Bed Of Rate
b. Length of Stay
c. Turn Of Interval
d. Bed Turn Over
e. Penanganan BBLR
f. Penanganan bayi asfiksia
g. Growth Death Rate (GDR)
h. Net Death Rate (NDR)
Time
a. Respon time IGD
b. On Time Delivery
1). Dr.Tripni P, SpA
2). Dr. Zahedi, SpA
3). Dr. Nurhayati, Sp P
4). Dr. Irvin A, SpOg
5). Dr Rithza, SpPD,FINASIM
6). Dr. Syafrudin, SpPD,FINASIM
7). Dr. Ridho A.S. SpB
8). Dr. Yudi, SpB

Kematian
a. Death On Emergency
b. Death On Room
. BED OF RATE

RUANGAN
1 2
VIP 0 0
Kelas I 0 0
Kelas II Maternitas 0 0
Kelas II Perempuan Dewasa 0 0
Kelas II Laki-Laki Dewasa 0 0
Kelas II Perinatal 0 0
Kelas II Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas III Anak 0 0
Kelas II Isolasi Perempuan 0 0
Kelas II Isolasi Laki-Laki 0 0
Kelas III Maternitas 0 0
Kelas III Perempuan Dewasa 0 0
Kelas III Laki-Laki Dewasa 0 0
TOTAL 0% 0%

. JENIS TINDAKAN

TINDAKAN
1 2
Partus spontan 0 0
Partus spontan gemelli 0 0
Partus spontan sungsang 0 0
Vacuum 0 0
Sectio caesaria 0 0
Curretase 0 0
Gynekologi 0 0
TOTAL - -

. MASALAH
MASALAH AK
. KESIMPULAN

. REKOMENDASI
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

AKAR MASALAH
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

UNIT TERKAIT KETERANGAN


REALISASI
OKTOBER
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
OKTOBER
13 14 15 16 17

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
OKTOBER
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
OKTOBER
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
OKTOBER
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
OKTOBER
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
OKTOBER
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
OKTOBER
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
OKTOBER
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
OKTOBER
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
OKTOBER
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
OKTOBER
13 14 15 16 17

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
OKTOBER
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

REALISASI
OKTOBER
13 14 15 16 17
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

18 19 20 21 22

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

18 19 20 21 22
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

23 24 25 26 27

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

23 24 25 26 27
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
SUBTOTAL
28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
SUBTOTAL
28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL
SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL

28 29 30 31
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

SUBTOTAL
28 29 30 31

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0

0
0
SUBTOTAL
28 29 30 31
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0 0 0 0 0%
0% 0% 0% 0% 0%

SUBTOTAL

28 29 30 31
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
0 0 0 0 -
- - - - -
SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL
KETERANGAN
%

0%

0%
0%

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

SUBTOTAL
KETERANGAN
%
#DIV/0!

#DIV/0!

SUBTOTAL
KETERANGAN
SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL
KETERANGAN
%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL KETERANGAN

%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%

SUBTOTAL TARGET
KETERANGAN
% %

#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!

#DIV/0! 0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

60 - 80%
3 hari
<3
40-50
80.00% #DIV/0!
80.00% #DIV/0!
45/mil
45/mil

<5 '

0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!
0 #DIV/0!

< 2
0.00% #DIV/0!
SUBTOTAL TARGET
KETERANGAN
% %
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0.00% 80.00% #DIV/0!
0% 80.00% #DIV/0!

SUBTOTAL
KETERANGAN
%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
1. KUNJUNGAN PASIEN

NO INSTALASI
1
1 Instalasi Gawat Darurat 0
2 Instalasi Rawat Jalan 0
3 Kamar Bedah 0
4 Kamar Bersalin 0
5 Ruang Maternitas 0
6 Ruang Rawat Dewasa 0
7 Ruang Rawat Anak dan Perinatal 0
8 Ruang Eksklusif 0
TOTAL 0

2. PASIEN BERDASARKAN JENIS KELAMIN

NO PASIEN
1
1 Anak
Laki-laki0
Perempuan0
subtotal 0
2 Dewasa
Laki-laki0
Perempuan0
subtotal 0
TOTAL 0

3. REALISASI PENDAPATAN

NO INSTALASI
1
1 Instalasi Gawat Darurat 0
2 Instalasi Rawat Jalan 0
3 Kamar Bedah 0
4 Kamar Bersalin 0
5 Ruang Maternitas 0
6 Ruang Rawat Dewasa 0
7 Ruang Rawat Anak dan Perinatal 0
8 Ruang Eksklusif 0
TOTAL 0
4. CARA PEMBAYARAN

NO PEMBAYARAN
1
1 Umum 0
2 BPJS PBI 0
3 BPJS Non PBI 0
4 Karawang Sehat 0
5 Asuransi lain 0
6 Karyawan 0
TOTAL 0

5. KUNJUNGAN PASIEN LAMA / BARU

NO PASIEN
1
1 Pasien Baru 0
2 Pasien Lama 0
TOTAL 0

6. TRIASE PASIEN INSTALASI GAWAT DARURAT

NO TRIASE
1
1 Merah 0
2 Kuning 0
3 Hijau 0
4 Hitam 0
TOTAL 0

7. PASIEN DIRUJUK

NO ALASAN DIRUJUK
1
1 Ruangan full (laki-laki) 0
(Perempuan) 0
(Anak) 0
Subtotal 0
2 Ruangan isolasi (laki-laki) 0
(Perempuan) 0
(Anak) 0
Subtotal 0
3 ICU 0
4 NICU/PICU 0
5 Spesialis bedah anak 0
6 Sp.OG tidak praktek 0
Subtotal 0
7 Spesialis jantung paru
(Dewasa)
0
(Anak)
0
Subtotal 0
8 Spesialis orthopedi
(Dewasa)
0
(Anak)
0
Subtotal 0
9 Spesialis syaraf
(Dewasa)
0
(Anak)
0
Subtotal 0
10 Spesialis urologi
(Dewasa)
0
(Anak)
0
Subtotal 0
11 CT Scan
(Dewasa)
0
(Anak)
0
Subtotal 0
12 Spesialis kesehatan jiwa
(Dewasa)
0
(Anak)
0
Subtotal 0
13 Spesialis bedah mulut
(Dewasa)
0
(Anak)
0
Subtotal 0
14 Renovasi OK
(Dewasa)
0
(Anak)
0
Subtotal 0
15 THT
(Dewasa)
0
(Anak)
0
Subtotal 0
16 GIGI
(Dewasa)
0
(Anak)
0
Subtotal 0
17 Spesialis bedah onkologi
(Dewasa)
0
(Anak)
0
Subtotal 0
18 Spesialis kulit kelamin
(Dewasa)
0
(Anak)
0
Subtotal 0
19 Anti bisa ular
(Dewasa)
0
(Anak)
0
Subtotal 0
20 Atas permintaan sendiri (APS)
(Dewasa)
0
(Anak)
0
Subtotal 0
21 Hemodialisa
(Dewasa)
0
(Anak)
0
Subtotal 0
22 Isolasi luka bakar
(Dewasa)
0
(Anak)
0
Subtotal 0
TOTAL 0

8. JENIS OPERASI KAMAR BEDAH

NO JENIS OPERASI
1
1 Kecil 0
2 Sedang 0
3 Besar 0
4 Besar Khusus 0
TOTAL 0

9. KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

NO LAYANAN MEDIS
NO LAYANAN MEDIS
1
1 Penyakit Dalam 0
2 Bedah 0
3 Obstetri 0
4 Gynekologi 0
5 Anak 0
6 Mata 0
7 Paru 0
8 Kulit 0
9 Syaraf 0
10 Umum 0
11 Gigi 0
12 Lain - lain 0
TOTAL 0

10. LAMA HARI RAWAT

NO KAMAR
1
1 VIP 0
2 Kelas I 0
3 Kelas II Maternitas 0
4 Kelas II Perempuan Dewasa 0
5 Kelas II Laki-Laki Dewasa 0
6 Kelas II Perinatal 0
7 Kelas II Anak 0
8 Kelas II Isolasi Anak 0
9 Kelas II Isolasi Anak 0
9 Kelas II Isolasi Perempuan 0
10 Kelas II Isolasi Laki-Laki 0
11 Kelas III Maternitas 0
12 Kelas III Perempuan Dewasa 0
13 Kelas III Laki-Laki Dewasa 0
TOTAL 0

11. CARA KELUAR PASIEN

NO KELUAR PASIEN
1
1 Izin dokter 0
2 Atas permintaan sendiri 0
3 Referal 0
4 Meninggal 0
5 Death On Arrive (DOA) 0
TOTAL 0

12. STANDAR PELAYANAN MINIMAL

NO INDIKATOR
Insiden Keselamatan Pasien, Karyawan & Keluarga 1
1 Pasien
a. Kejadian Potensial Cedera 0
b. Kejadian Nyaris Cedera 0
c. Kejadian Tidak Cedera 0
d. Kejadian Tidak Diharapkan 0
e. Kejadan Sentinel 0
SUB TOTAL 0
2 Angka Infeksi
a. Infeksi aliran darah 0
b. Infeksi luka operasi 0
c. Infeksi saluran kemih 0
SUB TOTAL 0
3 RL
a. Bed Of Rate
b. Length of Stay
c. Turn Of Interval
d. Bed Turn Over
e. Penanganan BBLR
f. Penanganan bayi asfiksia
g. Growth Death Rate (GDR)
h. Net Death Rate (NDR)
4 Time
a. Respon time IGD
b. On Time Delivery
1). Dr.Tripni P, SpA
2). Dr. Zahedi, SpA
3). Dr. Nurhayati, Sp P
4). Dr. Irvin A, SpOg
5). Dr Rithza, SpPD,FINASIM
6). Dr. Syafrudin, SpPD,FINASIM
7). Dr. Ridho A.S. SpB
8). Dr. Yudi, SpB

5 Kematian
a. Death On Emergency
b. Death On Room
13. BED OF RATE

NO RUANGAN
1
1 VIP 0
2 Kelas I 0
3 Kelas II Maternitas 0
4 Kelas II Perempuan Dewasa 0
5 Kelas II Laki-Laki Dewasa 0
6 Kelas II Perinatal 0
7 Kelas II Anak 0
8 Kelas II Isolasi Anak 0
9 Kelas III Anak 0
10 Kelas II Isolasi Perempuan 0
11 Kelas II Isolasi Laki-Laki 0
12 Kelas III Maternitas 0
13 Kelas III Perempuan Dewasa 0
14 Kelas III Laki-Laki Dewasa 0
TOTAL 0%

14. JENIS TINDAKAN

NO TINDAKAN
1
1 Partus spontan 0
2 Partus spontan gemelli 0
3 Partus spontan sungsang 0
4 Vacuum 0
5 Sectio caesaria 0
6 Curretase 0
7 Gynekologi 0
TOTAL -

15. MASALAH
NO MASALAH
16. KESIMPULAN
1
2
3
4

17. REKOMENDASI
1
2
3
4
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

2 3 4 5 6

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

2 3 4 5 6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

AKAR MASALAH
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

7 8 9 10 11

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

7 8 9 10 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

UNIT TERKAIT KETERANGAN


REALISASI
NOVEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
12 13 14 15 16

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
NOVEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
12 13 14 15 16

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
NOVEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

REALISASI
NOVEMBER
12 13 14 15 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
REALISASI
NOVEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
17 18 19 20 21

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
NOVEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

REALISASI
NOVEMBER
17 18 19 20 21

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
REALISASI
NOVEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

REALISASI
NOVEMBER
17 18 19 20 21
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

22 23 24 25 26

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

22 23 24 25 26
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27 28 29 30

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0% 0% 0% 0%

27 28 29 30
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
- - - -
SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL
KETERANGAN
31 %

0 0
0 0
0 0 0%

0 0
0 0
0 0 0%
0 0 0%

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
#DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
#DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 0 #DIV/0!
0 0
0 0
0 0
0 0 #DIV/0!

SUBTOTAL
KETERANGAN
SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL
KETERANGAN
31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL KETERANGAN

31 %
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%
0 0 0.00%

SUBTOTAL TARGET
31 % %

0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 #DIV/0!
0 0

0 0 #DIV/0! 0 #DIV/0!
0 0 0 #DIV/0!
0 0 0 #DIV/0!
0 0

0 60 - 80%
0 3 hari
0 <3
0 40-50
0 80.00% #DIV/0!
0 80.00% #DIV/0!
0 45/mil
0 45/mil

0 <5 '

0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!

0 < 2
0 0.00% #DIV/0!
SUBTOTAL TARGET
31 % %
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0 0% 0.00% 80.00% #DIV/0!
0% 0% 0% 80.00% #DIV/0!

SUBTOTAL
KETERANGAN
31 %
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
0 - #DIV/0!
- - #DIV/0!
1. KUNJUNGAN PASIEN

NO

1
2
3
4
5
6
7
8
TOTAL

2. PASIEN BERDASARKAN JENIS KELAMIN

NO

TOTAL

3. REALISASI PENDAPATAN

NO

1
2
3
4
5
6
7
8
TOTAL
4. CARA PEMBAYARAN

NO

1
2
3
4
5
6
TOTAL

5. KUNJUNGAN PASIEN LAMA / BARU

NO

1
2
TOTAL

6. TRIASE PASIEN INSTALASI GAWAT DARURAT

NO

1
2
3
4
TOTAL

7. PASIEN DIRUJUK

NO

1
2

3
4
5
6

10

11

12

13

14

15
16

17

18

19

20

21

22

TOTAL

8. JENIS OPERASI KAMAR BEDAH

NO

1
2
3
4
TOTAL

9. KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

NO
NO

1
2
3
4
5
6
7
8
9
10
11
12
TOTAL

10. LAMA HARI RAWAT

NO

1
2
3
4
5
6
7
8
9
9
10
11
12
13
TOTAL

11. CARA KELUAR PASIEN

NO

1
2
3
4
5
TOTAL

12. STANDAR PELAYANAN MINIMAL

KETERANGAN NO

SUB TOTAL
2

SUB TOTAL
3

5
13. BED OF RATE

KETERANGAN NO

1
2
3
4
5
6
7
8
9
10
11
12
13
14
TOTAL

14. JENIS TINDAKAN

NO

1
2
3
4
5
6
7
TOTAL

15. MASALAH
NO
16. KESIMPULAN
1
2
3
4

17. REKOMENDASI
1
2
3
4
KUNJUNGAN PASIEN

INSTALASI
1 2
Instalasi Gawat Darurat 0 0
Instalasi Rawat Jalan 0 0
Kamar Bedah 0 0
Kamar Bersalin 0 0
Ruang Maternitas 0 0
Ruang Rawat Dewasa 0 0
Ruang Rawat Anak dan Perinatal 0 0
Ruang Eksklusif 0 0
TOTAL 0 0

PASIEN BERDASARKAN JENIS KELAMIN

PASIEN
1 2
Anak
Laki-laki0 0
Perempuan0 0
subtotal 0 0
Dewasa
Laki-laki0 0
Perempuan0 0
subtotal 0 0
TOTAL 0 0

REALISASI PENDAPATAN

INSTALASI
1 2
Instalasi Gawat Darurat 0 0
Instalasi Rawat Jalan 0 0
Kamar Bedah 0 0
Kamar Bersalin 0 0
Ruang Maternitas 0 0
Ruang Rawat Dewasa 0 0
Ruang Rawat Anak dan Perinatal 0 0
Ruang Eksklusif 0 0
TOTAL 0 0
CARA PEMBAYARAN

PEMBAYARAN
1 2
Umum 0 0
BPJS PBI 0 0
BPJS Non PBI 0 0
Karawang Sehat 0 0
Asuransi lain 0 0
Karyawan 0 0
TOTAL 0 0

KUNJUNGAN PASIEN LAMA / BARU

PASIEN
1 2
Pasien Baru 0 0
Pasien Lama 0 0
TOTAL 0 0

TRIASE PASIEN INSTALASI GAWAT DARURAT

TRIASE
1 2
Merah 0 0
Kuning 0 0
Hijau 0 0
Hitam 0 0
TOTAL 0 0

PASIEN DIRUJUK

ALASAN DIRUJUK
1 2
Ruangan full (laki-laki) 0 0
(Perempuan) 0 0
(Anak) 0 0
Subtotal 0 0
Ruangan isolasi (laki-laki) 0 0
(Perempuan) 0 0
(Anak) 0 0
Subtotal 0 0
ICU 0 0
NICU/PICU 0 0
Spesialis bedah anak 0 0
Sp.OG tidak praktek 0 0
Subtotal 0 0
Spesialis jantung paru
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis orthopedi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis syaraf
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis urologi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
CT Scan
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis kesehatan jiwa
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis bedah mulut
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Renovasi OK
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
THT
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
GIGI
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis bedah onkologi
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Spesialis kulit kelamin
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Anti bisa ular
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Atas permintaan sendiri (APS)
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Hemodialisa
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
Isolasi luka bakar
(Dewasa)
0 0
(Anak)
0 0
Subtotal 0 0
TOTAL 0 0

JENIS OPERASI KAMAR BEDAH

JENIS OPERASI
1 2
Kecil 0 0
Sedang 0 0
Besar 0 0
Besar Khusus 0 0
TOTAL 0 0

KUNJUNGAN PASIEN TERHADAP LAYANAN MEDIS

LAYANAN MEDIS
LAYANAN MEDIS
1 2
Penyakit Dalam 0 0
Bedah 0 0
Obstetri 0 0
Gynekologi 0 0
Anak 0 0
Mata 0 0
Paru 0 0
Kulit 0 0
Syaraf 0 0
Umum 0 0
Gigi 0 0
Lain - lain 0 0
TOTAL 0 0

. LAMA HARI RAWAT

KAMAR
1 2
VIP 0 0
Kelas I 0 0
Kelas II Maternitas 0 0
Kelas II Perempuan Dewasa 0 0
Kelas II Laki-Laki Dewasa 0 0
Kelas II Perinatal 0 0
Kelas II Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas II Isolasi Perempuan 0 0
Kelas II Isolasi Laki-Laki 0 0
Kelas III Maternitas 0 0
Kelas III Perempuan Dewasa 0 0
Kelas III Laki-Laki Dewasa 0 0
TOTAL 0 0

. CARA KELUAR PASIEN

KELUAR PASIEN
1 2
Izin dokter 0 0
Atas permintaan sendiri 0 0
Referal 0 0
Meninggal 0 0
Death On Arrive (DOA) 0 0
TOTAL 0 0

. STANDAR PELAYANAN MINIMAL

INDIKATOR
Insiden Keselamatan Pasien, Karyawan & Keluarga 1 2
Pasien
a. Kejadian Potensial Cedera 0 0
b. Kejadian Nyaris Cedera 0 0
c. Kejadian Tidak Cedera 0 0
d. Kejadian Tidak Diharapkan 0 0
e. Kejadan Sentinel 0 0
SUB TOTAL 0 0
Angka Infeksi
a. Infeksi aliran darah 0 0
b. Infeksi luka operasi 0 0
c. Infeksi saluran kemih 0 0
SUB TOTAL 0 0
RL
a. Bed Of Rate 0 0
b. Length of Stay 0 0
c. Turn Of Interval 0 0
d. Bed Turn Over 0 0
e. Penanganan BBLR 0 0
f. Penanganan bayi asfiksia 0 0
g. Growth Death Rate (GDR) 0 0
h. Net Death Rate (NDR) 0 0
Time
a. Respon time IGD 0 0
b. On Time Delivery
1). Dr.Tripni P, SpA 0 0
2). Dr. Zahedi, SpA 0 0
3). Dr. Nurhayati, Sp P 0 0
4). Dr. Irvin A, SpOg 0 0
5). Dr Rithza, SpPD,FINASIM 0 0
6). Dr. Syafrudin, SpPD,FINASIM 0 0
7). Dr. Ridho A.S. SpB 0 0
8). Dr. Yudi, SpB 0 0

Kematian
a. Death On Emergency 0 0
b. Death On Room 0 0
. BED OF RATE

RUANGAN
1 2
VIP 0 0
Kelas I 0 0
Kelas II Maternitas 0 0
Kelas II Perempuan Dewasa 0 0
Kelas II Laki-Laki Dewasa 0 0
Kelas II Perinatal 0 0
Kelas II Anak 0 0
Kelas II Isolasi Anak 0 0
Kelas III Anak 0 0
Kelas II Isolasi Perempuan 0 0
Kelas II Isolasi Laki-Laki 0 0
Kelas III Maternitas 0 0
Kelas III Perempuan Dewasa 0 0
Kelas III Laki-Laki Dewasa 0 0
TOTAL 0% 0%

. JENIS TINDAKAN

TINDAKAN
1 2
Partus spontan 0 0
Partus spontan gemelli 0 0
Partus spontan sungsang 0 0
Vacuum 0 0
Sectio caesaria 0 0
Curretase 0 0
Gynekologi 0 0
TOTAL - -

. MASALAH
MASALAH AK
. KESIMPULAN

. REKOMENDASI
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

3 4 5 6 7

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0% 0% 0% 0% 0%

3 4 5 6 7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
- - - - -

AKAR MASALAH
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 9 10 11 12
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0