LAPORAN PASIEN HEMODIALISA

BULAN SEPTEMBER 2014

JAMINAN BARU REUSE

NO TANGGAL NAMA PASIEN TARIF KSO SISA KET
UMUM BPJS JKD JPKMM UMUM JAMINAN UMUM JAMINAN
1 9/1/2014 Tn Nursaibi 800,000 264,000 536,000
2 Ny Sarintem 893,318 264,000 629,318
3 Ny Titin 800,000 264,000 475,000
4 Tn Abd Rohman 893,318 418,000 475,000 R. SAFA
5 Tn Montang 893,318 264,000 629,318
6 Tn Arifin 893,318 264,000 629,318
7 Ny Titi S 893,318 418,000 475,000
8 Ny Aat 893,318 264,000 629,318
9 9/2/2014 Tn Kasno 800,000 264,000 536,000
10 Tn Yandi 893,318 264,000 629,318
11 Tn Umar 800,000 264,000 536,000
12 Ny Amah 800,000 264,000 536,000
13 Tn Misna 893,318 264,000 629,318
14 Tn Karmita 893,318 264,000 629,318
15 Ny Tini 800,000 264,000 536,000
16 9/3/2014 Tn Dadang 893,318 264,000 629,318
17 Tn H Darsa 893,318 264,000 629,318
18 Tn Nandang 893,318 264,000 629,318
19 Tn Mica 800,000 264,000 536,000
20 Ny Ai W 893,318 264,000 629,318
21 Tn Wanda 893,318 264,000 629,318
22 Ny Endah 800,000 264,000 536,000
23 Ny Hj Odah 893,318 264,000 629,318
24 9/4/2014 Tn Nursaibi 800,000 264,000 536,000
25 Ny Sarintem 893,318 264,000 629,318
26 Ny Titin 800,000 418,000 382,000
27 Tn Abd Rohman 800,000 418,000 382,000
28 Ny Sopiah 893,318 418,000 475,000
29 Ny Titi S 893,318 264,000 629,318
30 Tn Arifin 893,318 264,000 629,318
31 Ny Aat 893,318 264,000 629,318
32 9/5/2014 Tn Kasno 800,000 264,000 536,000
33 Tn Yandi 893,318 264,000 629,318
34 Ny Amah 800,000 264,000 536,000
35 Tn Umar 800,000 264,000 536,000
36 Tn Karmita 893,318 418,000 475,000
37 Tn Misna 893,318 418,000 475,000
38 Ny Tini 893,318 418,000 475,000
39 Tn Mulyadi 800,000 264,000 536,000
40 9/6/2014 Tn Dadang 893,318 264,000 629,318
41 Tn H Darsa 893,318 264,000 629,318
42 Tn Mica 893,318 264,000 629,318
43 Ny Hj Odah 800,000 264,000 536,000
44 Ny Endah 893,318 264,000 629,318
45 Tn Wanda 893,318 264,000 629,318
46 Tn Nandang 893,318 264,000 629,318
47 Ny Ai W 800,000 264,000 536,000
48 9/8/2014 Tn Nursaibi 800,000 418,000 382,000
49 Tn Yandi 893,318 264,000 629,318
50 Ny Titin 800,000 264,000 536,000
51 Tn Abd Rohman 800,000 264,000 536,000
52 Tn Arifin 893,318 264,000 629,318
53 Tn Montang 893,318 264,000 629,318
54 Ny Aat 893,318 264,000 629,318
55 Ny Titi S 893,318 264,000 629,318
56 9/9/2014 Tn Kasno 800,000 264,000 536,000
57 Ny Sarintem 893,318 264,000 629,318
58 Ny Amah 800,000 264,000 536,000
59 Tn Umar 800,000 418,000 382,000
60 Tn Karmita 893,318 264,000 629,318
61 Tn Misna 893,318 264,000 629,318
62 Tn Mulyadi 893,318 264,000 629,318
63 Ny Tini 893,318 418,000 475,000
64 9/10/2014 Tn H Darsa 893,318 418,000 475,000
65 Tn Mica 893,318 264,000 629,318
66 Tn Nandang 800,000 264,000 536,000
67 Ny Ai W 893,318 418,000 475,000
68 Tn Wanda 893,318 264,000 629,318
69 Ny Hj Odah 893,318 264,000 629,318
70 Ny Endah 800,000 264,000 536,000
71 Tn Nasmo 800,000 264,000 536,000
72 9/11/2014 Tn Nursaibi 893,318 418,000 475,000
73 Ny Sarintem 800,000 264,000 536,000
74 Ny Titin 800,000 264,000 536,000
75 Tn Abd Rohman 893,318 264,000 629,318
76 Ny Sopiah 893,318 264,000 629,318
77 Ny Titi S 893,318 264,000 629,318
78 Ny Aat 800,000 264,000 536,000
79 Tn Arifin 893,318 264,000 629,318
80 9/12/2014 Tn Kasno 800,000 264,000 536,000
81 Tn Yandi 800,000 264,000 536,000
82 Ny Amah 893,318 264,000 629,318
83 Tn Umar 893,318 264,000 629,318
84 Ny Tini 893,318 264,000 629,318
85 Tn Mulyadi 800,000 264,000 536,000
86 Tn Misna 893,318 264,000 629,318
87 Tn Karmita 893,318 264,000 629,318
88 Tn Elim 893,318 264,000 629,318
89 Tn Nasmo 800,000 264,000 536,000
90 9/13/2014 Tn H Darsa 893,318 418,000 475,000 PB ( JN )
91 Tn Dadang 893,318 264,000 629,318
92 Ny Hj Odah 893,318 264,000 629,318
93 Tn Mica 800,000 264,000 536,000
94 Ny Endah 800,000 264,000 536,000
 95 Tn Wanda 893,318 264,000 629,318
96 Tn Nandang 800,000 264,000 536,000
97 Ny Ai W 800,000 264,000 536,000
98 9/15/2014 Tn Nursaibi 893,318 264,000 629,318
99 Ny Sarintem 893,318 264,000 629,318
100 Ny Titin 893,318 418,000 475,000
101 Tn Abd Rohman 893,318 264,000 629,318
102 Tn Montang 800,000 418,000 382,000
103 Ny Titi S 893,318 264,000 629,318
104 Tn Arifin 800,000 264,000 536,000
105 Ny Aat 800,000 264,000 536,000
106 9/16/2014 Tn Kasno 893,318 264,000 629,318
107 Tn Yandi 893,318 264,000 629,318
108 Ny Amah 800,000 418,000 382,000
109 Tn Umar 893,318 264,000 629,318
110 Ny Tini 893,318 264,000 629,318
111 Tn Mulyadi 893,318 264,000 629,318
112 Tn Misna 893,318 264,000 629,318
113 Tn Karmita 800,000 264,000 629,318
114 Tn Mulyadi 893,318 264,000 629,318
115 9/17/2014 Tn H Darsa 893,318 264,000 629,318
116 Tn Dadang 800,000 264,000 629,318
117 Tn Nandang 800,000 264,000 629,318
118 Tn Mica 893,318 264,000 629,318
119 Ny Endah 800,000 264,000 629,318
120 Tn Wanda 800,000 264,000 629,318
121 Ny Ai W 893,318 264,000 629,318
122 Ny Hj Odah 893,318 418,000 475,000
123 9/18/2014 Tn Nursaibi 893,318 264,000 629,318
124 Ny Sarintem 893,318 264,000 629,318
125 Ny Titin 893,318 264,000 629,318
126 Tn Abd Rohman 893,318 418,000 475,000
127 Tn Arifin 800,000 264,000 536,000
128 Ny Titi S 800,000 264,000 536,000
129 Ny Aat 893,318 264,000 629,318
130 Ny Sopiah 893,318 264,000 629,318
131 Tn Warta 800,000 264,000 536,000
132 9/19/2014 Tn Kasno 893,318 264,000 629,318
133 Tn Yandi 893,318 264,000 629,318
134 Ny Amah 893,318 418,000 475,000
135 Tn Umar 800,000 418,000 382,000
136 Ny Tini 893,318 264,000 629,318
137 Tn Mulyadi 893,318 264,000 629,318
138 Tn Misna 893,318 264,000 629,318
139 Tn Karmita 800,000 418,000 382,000
140 Tn Elim 800,000 264,000 536,000
141 9/20/2014 Tn Dadang 893,318 264,000 629,318
142 Tn H Darsa 800,000 264,000 536,000
143 Ny Hj Odah 800,000 264,000 536,000
144 Tn Mica 893,318 264,000 629,318
145 Tn Wanda 893,318 418,000 475,000
146 Tn Nandang 893,318 264,000 629,318
Ny Endah
Ny Ai W
Tn Nasmo
147 9/22/2014 Tn Nursaibi 800,000 264,000 536,000
148 Ny Sarintem 893,318 264,000 629,318
149 Ny Titin 800,000 264,000 536,000
150 Tn Abd Rohman 800,000 264,000 536,000
151 Tn Montang 893,318 418,000 475,000
152 Tn Arifin 893,318 418,000 475,000
153 Ny Titi S 800,000 264,000 536,000
154 Ny Aat 893,318 418,000 475,000
Tn Warta
Tn Sukardi
155 9/23/2014 Tn Kasno 893,318 264,000 629,318
156 Tn Yandi 893,318 264,000 629,318
157 Ny Amah 893,318 264,000 629,318
158 Tn Umar 800,000 264,000 536,000
159 Tn H Darsa 893,318 264,000 629,318
160 Tn Mulyadi 893,318 264,000 629,318
161 Ny Tini 893,318 418,000 475,000
162 Tn Karmita 800,000 264,000 536,000
Tn Misna
Tn Wanda
Tn Mica
Tn Nandang
163 9/25/2014 Tn Nursaibi 800,000 264,000 536,000
164 Ny Sarintem 893,318 264,000 629,318
165 Ny Titin 800,000 264,000 536,000
166 Tn Abd Rohman 800,000 264,000 536,000
167 Ny Aat 893,318 264,000 629,318
168 Ny Titi S 893,318 264,000 629,318
169 Ny Sopiah 893,318 264,000 629,318
Tn Arifin
Ny Endah
Ny Ai W
Ny Hj Odah
170 9/26/2014 Tn Kasno 800,000 264,000 536,000
171 Tn Yandi 893,318 264,000 629,318
172 Ny Amah 800,000 264,000 536,000
173 Tn Umar 800,000 264,000 536,000
174 Tn Misna 893,318 264,000 629,318
175 Tn Mulyadi 893,318 264,000 629,318
176 Ny Tini 893,318 264,000 629,318
177 Tn Karmita 800,000 264,000 536,000
Tn Warta
Tn Sukardi
Tn Nasmo
178 9/27/2014 Tn Dadang 893,318 418,000 475,000
179 Tn H Darsa 893,318 418,000 475,000
180 Ny Hj Odah 893,318 264,000 629,318
181 Tn Mica 800,000 264,000 536,000
182 Ny Ai W 893,318 264,000 629,318
183 Tn Nandang 893,318 264,000 629,318
184 Tn Wanda 800,000 264,000 536,000
185 Ny Endah 893,318 264,000 629,318
186 9/29/2014 Tn Nursaibi 800,000 418,000 382,000
187 Ny Sarintem 893,318 264,000 629,318
188 Ny Titin 800,000 264,000 536,000
189 Tn Abd Rohman 800,000 264,000 536,000
190 Tn Montang 893,318 264,000 629,318
191 Tn Arifin 893,318 264,000 629,318
192 Ny Aat 893,318 264,000 629,318
Ny Titi S
193 9/30/2014 Tn Kasno 800,000 264,000 536,000
194 Tn Yandi 893,318 264,000 629,318
195 Ny Amah 800,000 264,000 536,000
196 Tn Umar 800,000 264,000 536,000
197 Ny Tini 893,318 264,000 629,318
198 Tn Mulyadi 893,318 264,000 629,318
199 Tn Misna 893,318 264,000 629,318
200 Tn Karmita 893,318 264,000 629,318

201 Ny Endah
202 Tn Nursaibi
203 Ny Sarintem
204 Ny Titin
205 Tn Abd Rohman
206 Tn Montang
207 Tn Arifin
208 Ny Aat
209 Ny Titi S
210 Tn Kasno
211 Tn Yandi
212 Ny Amah
213 Tn Umar
214 Ny Tini
215 Tn Mulyadi
216 Tn Misna
217 Tn Karmita
218 Ny Hj Inoh
219 Tn Sukardi
220 Ny Hj Inoh
221 Tn Warta
222 Tn Nasmo
Total 200
JUMLAH 127 41 34 31 170 157,131,570 52,932,000 104,598,164
Tindakan

Karawang 01 September 2014

Ahmad Sujana, Amd.Kep