Laporan Kunj - Pasien Gratis PKG

LAPORAN KUNJUNGAN PASIEN UNIT GAWAT DARURAT (UGD)
PELAYANAN KESEHATAN GRATIS

KABUPATEN : PANGANDARAN
KECAMATAN : PADAHERANG
PUSKESMAS : PADAHERANG
BULAN/TAHUN : JANUARI 2016
QUANTY JASA PELAYANAN JUMLAH (Rp)
NO TANGGAL NAMA PASIEN UMUR NOMOR KTP/KK ALAMAT DIAGNOSA TINDAKAN
TINDAKAN TINDAKAN(Rp) JASPEL (9X10)
1 2 3 4 5 6 7 8 9 10 11
1 1/2/2016 Sulemi 60 3207201408540002 Paledah Ashma Pemberian Oxigen 6 9,000 54,000
Pelayanan UGD 1 6,000 6,000
2 1/2/2016 Rudi C 19 3207201607960001 Karangpawitan Vulnus Hecting 10 Jaitan 15.000+(7x1.200) 23,400
Debredemen Luka 3 6,000 18,000
3 1/4/2016 Samad 79 3207201705410001 Karangmulya Vulnus Hecting 8 Jaitan 15.000 +(5x1,200) 21,000
4 1/8/2016 Kundang 42 3207202909070040 Panyutran Vulnus Hecting 5 Jaitan 15000+(2x1.200) 17,400
5 1/21/2016 Endang Setiadi 52 3207200408590002 Kedungwuluh DOA Pemulasaran Jenajah 1 15,000 15,000
Penitipan<12 Jam
6 1/26/2016 Karningsih 38 3207200502090001 Panyutran Abses Debredemen Luka 2 6,000 12,000
7 1/26/2016 Oman 27 3207211507140001 Ciparakan Abses Debredemen Luka 1 6,000 6,000
JUMLAH 226,800
Mengetahui Padaherang, 5 Februari 2016

Kepala Puskesmas Padaherang Pengelola Pelayanan Kesehatan Gratis
Puskesmas Padaherang
H.Sugiharto,S.Kep,Ners Solihat Pujaningsih

Nip. 19680913 198902 1 001 Nip 19630811 198502 2 002
BULAN/TAHUN : Februari 2016
1 2 3 4 5 6 7 8 9 10 11
1 2/10/2016 Dela N 13 3207360609070600 Mangunjaya Vulnus Laseratum Debridemen luka 2 6,000 12,000
2 2/16/2016 Endang Turmini 24 3207206510910003 Karangpawitan Ashma Bronchiale Pemberian Oxigen 2 jam 9,000 18,000
3 2/22/2016 Iis Ismawati 33 3207204503800005 Karangsari Vulnus Laseratum Hecting 6 Jaitan 15000 (3x1200) 18,600
Debridemen luka 2 6,000 12,000
4 2/24/2016 Resa 49 3207206111670001 Karangsari Vulnus Laseratum Hecting 4 Jaitan 15000 (1x1200) 16,200
5 2/24/2016 Ghaziya HL 1.5 3207200501150005 Karangmulya GEA & Pemberian Oxigen 2 jam 9,000 18,000
Kejang Demam
6 2/26/2016 Andi Herdiana 22 3207202501940001 Karangsari Vulnus Laseratum Hecting 4 Jaitan 15000 (1x1200) 16,200
Debridemen luka 6,000 12,000
7 2/27/2016 Yeni Rohaeni 43 3207206711730001 Padaherang Vulnus Laseratum Hecting 25 Jaitan 15000 (22x1200) 41,400
8
JUMLAH 194,400
Mengetahui Padaherang, 5 Maret 2016

Nip. 19680913 198902 1 001 Nip 19630811 198502 2 002

BULAN/TAHUN : APRIL 2016
1 2 3 4 5 6 7 8 9 10 11
1 2/4/2016 Tisna Ramadhan 16 3207202801990001 Bojongsari Vulnus Laseratum Hecting 10 Jaitan 15000 (7x1200) 23,400
2 10/4/2016 Saminah 52 3207204303600003 Karangmulya Vulnus Laseratum Hecting 8 Jaitan 15000 (5x1200) 21,000
3 10/4/2016 Uta 52 3207201307600004 Karangmulya Vulnus Laseratum Hecting 30 Jaitan 15000 (27x1200) 47,400
4 12/4/2016 Nunu Nugroho 28 3207201208880001 Padaherang Vulnus Laseratum Hecting 15 Jaitan 15000 (12x1200) 29,400
JUMLAH 229,200
Mengetahui Padaherang, 4 Mei 2016


Nip. 19680913 198902 1 001 Nip 19630811 198502 2 002

BULAN/TAHUN : MEI 2016
1 2 3 4 5 6 7 8 9 10 11
JUMLAH 0
Mengetahui Padaherang, 4Juni 2016

Nip. 19680913 198902 1 001 Nip 19630811 198502 2 002
LAPORAN KUNJUNGAN PASIEN RAWAT JALAN DAN PENGUJIAN KESEHATAN
JUMLAH JASA TANDA TANGAN
NO TANGGAL NAMA PASIEN UMUR NOMOR KTP/KK ALAMAT DIAGNOSA KETERANGAN
PELAYANAN(Rp) PASIEN
1 2 3 4 5 6 7 8 9 10
1 1/4/2016 Erik Satrio 3207201210002 Sindangwangi Febris 3,000
2 1/5/2016 Akbar AF 3207202702090000 Karangpawitan Vulnus 3,000
3 Susi Herawati 30 3207205118500001 Padaherang Pulpitis revesible 21 3,000
4 1/6/2016 Fajar Wahyudi 3207201004910001 Karangmulya Kir dokter 3,000
5 Sri Astuti 3207205603800001 Pasirgeulis Suntik KB 3,000
6 1/7/2016 Aceng Yeyen 36 3207200707790006 Ciganjeng Gangren redix 46 3,000
7 1/8/2016 Sri Hardiyati 3207206011760006 Karangpawitan Kir dokter 3,000
8 Sinsa Susanti 3207260612110008 Pangandaran Vulnus 3,000
9 1/9/2016 Suyatman 3207200301920003 Karangpawitan Kir dokter 3,000
10 1/11/2016 Santi 3207204096500003 Panyutran Ulkus 3,000
11 Umi Kulsum 3207204205030003 Paledah Obs.Febris 3,000
12 Sri Masriah 28 3207205402830001 Padaherang Gangren radix 46 3,000
13 1/12/2016 Lilis 3207204507690001 Karangpawitan Dyspepsia 3,000
14 Ade Wartini 57 3207205106560003 Padaherang Abses Periodental 24,25,26 3,000
15 Sumarni 3207205509780002 Kedungwuluh Myalgia 3,000
16 1/13/2016 Suryati 3207206410640001 Padaherang Dyspepsia 3,000
17 Rima P 3207201501180001 Kedungwuluh Dyspepsia 3,000
18 Evan Rafa 7 3207202310090001 Padaherang Peristensi 61 3,000
19 1/14/2016 Sopiah Barzah 14 3207205305010007 Kedungwuluh Absses periapikal 36 3,000
20 Darsun 75 3207200207460001 Sindangwangi PMK 18 3,000
21 1/16/2016 Elin Muflihah 28 3207204606870003 Karangpawitan r8MP 3,000
22 Elsa Aulia 8 3207202508080015 Karangpawitan rIL 3,000
23 1/18/2016 Sopiah Barzah 14 3207205305010007 Kedungwuluh Post Abses 36 3,000
24 Enih Kurnaesih 30 3207206303820001 Sukanagara Gangren radix 36 3,000
25 Diman Adman 28 3207202211870001 Karangpawitwn Abses Peripikal 36 3,000
1 2 3 4 5 6 7 8 9 10
26 Rais A 3 3207202612110001 Karangpawitan pulpirrev 84 3,000
27 Anisa 3207204607480003 Karangsari Gastritis 3,000
28 Teti 3207205402800002 Karangmulya Kir dokter 3,000
29 1/19/2016 Hatiyan 3207208070002 Karangpawitan Dermatitis 3,000
Yuyun 42 3207205105740001 Kedungwuluh Nekrosis pulpa 28 3,000
30 1/20/2016 V .Parti 58 3207355312570002 Mangunjaya Gangren radix 25 3,000
31 1/21/2016 Tri Bakti 3207204900850004 Sindangwangi Susp.TB Paru 3,000
32 Jalaludin 3207200306500003 Karangpawitan HT 3,000
33 Ika Aulia 5 3207205610100001 Padaherang NP 84 3,000
34 Erick S F 7 3207201003080001 Karanghonje GR 51 3,000
35 Susi Herawati 30 3207205011850001 Karangsari Pulple II 3,000
36 1/22/2016 Wisnu Fauzi 6 3207201209090001 Sukanagara Peristensi 71 3,000
37 Jalaludin 3207200306500003 Karangpawitan HT Grade II 3,000
38 1/23/2016 Ny.Basrem 3207204311490001 Paledah Diare,HT 3,000
39 Rima Pangesti 3207205011880001 Kedungwuluh Gastritis 3,000
40 1/25/2016 Tete Susanti 50 3207204505530002 Padaherang pulpirrev 3,000
41 Nyi Ruwati 49 3207206505650001 Padaherang PMK II 3,000
42 Yuhana 3207206907790001 Karangpawitan Gastritis 3,000
43 Ny.Warsah 3207206908650001 Paledah Post Op hpon 3,000
44 Tn Patan 3207202001280001 Karangpawitan TB Paru 3,000
45 Rafka 3207202205130000 Padaherang Diare 3,000
46 Momoy 3207204107560004 Kedungwuluh Dyspepsia 3,000
47 Tn Abas 3207200507570004 Padaherang Dyspepsia 3,000
48 Diman Adman 28 3207202211870001 Karangpawitan Gangren radix 3,000
49 Ny.Yayah 50 3207205501660001 Paledah PMK 45 3,000
50 1/27/2016 Hipdi Hamdan 8 3207210606080001 Pamotan Stomatitis aftosa 3,000
51 Ny.Enih 3207205309520001 Kedungwuluh Gastritis 3,000
52 1/28/2016 Sutini 3207205906660003 Karangmulya Vulnus 3,000
53 Abdul 3207201507520002 Paledah Myalgia 3,000
54 Siti Hopsah 20 3207206108910002 Paledah Nekronis pulpa 46 3,000
55 1/29/2016 Anom Subagyo 36 3207201708790001 Padaherang Nekrosis pulpa 36 3,000
56 Karsih 3207205246100001 Kedungwuluh GEA 3,000
57 Necih 48 3207205112680003 Padaherang Dyspepsia 3,000
1 2 3 4 5 6 7 8 9 10
58 1/30/2016 Turno 62 3207200203530001 Karangmulya PMK 31 3,000
59 Tarman 3207200911930001 Padaherang Dyspepsia 3,000
60 Salvi 86 3207204107300017 Panyutran HT 3,000
61 Ruminah 71 3207204107440020 Karangpawitan Vulnus 3,000
62 Parni 50 3207207003640002 Karangpawitan Myalgia 3,000
63 Tarman 23 3207200911930001 Padaherang Kir dokter 3,000
JUMLAH : .......................................................................................................................................................... 189,000
Padaherang, 05 Januari 2016

Mengetahui Pengelola pelayanan kesehatan gratis
Kepala Puskesmas Padaherang Puskesmas Padaherang

Nip.19680913 198902 1 001 Nip. 19630811 198502 2 002
LAPORAN KUNJUNGAN PASIEN RAWAT JALAN DAN PENGUJIAN KESEHATAN
BULAN/TAHUN : 2016
JUMLAH JASA TANDA TANGAN
PELAYANAN(Rp) PASIEN
1 2 3 4 5 6 7 8 9 10
JUMLAH : .......................................................................................................................................................... 0
Padaherang, 2016

Nip.19680913 198902 1 001 Nip. 19630811 198502 2 002
LAPORAN KUNJUNGAN PASIEN RAWAT INAP
JASA JUMLAH JASAJML HR RAWATVISITE DOKTERJUMLAH JASA

TANGGAL TANGGAL QUANTYPELAYANANPELAYANAN (dikali dengan 1 hari/2 kali PELAYANAN
NO NAMA PASIENUMUR NOMOR KTP/KK ALAMAT DIAGNOSA TINDAKAN
MASUK KELUAR TINDAKA TINDAKAN TINDAKAN (Rp) Rp24,000 (Rp 20.000) ( Rp )
(Rp) (10X11) ( Rp ) (Rp) (12+13+14)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 Tati 50 320720650557000Karangmulya 1/5/2016 1/8/2016 Gastritis Pasang In 1 15,000 15,000 72,000 60,000 147,000
2 Puryono 62 320720070954000Maruyungsari 1/9/2016 1/12/2016 Ashma Pasang In 1 15,000 15,000 72,000 60,000 147,000
Oxigen 2 9,000 18,000 18,000
3 Navis D.R 6 BL 320720151214000Padaherang 1/11/2016 1/13/2016 GEA Pasang In 2 15,000 30,000 48,000 40,000 118,000
4 Hasby Rahma 18 bl 320720160913000Padaherang 1/12/2016 1/13/2016 Suspek DBD Pasang In 1 15,000 15,000 24,000 20,000 59,000
5 Sar'an 72 320720080554000Padaherang 1/10/2016 1/13/2016 Gastritis Pasang In 1 15,000 15,000 72,000 60,000 147,000
6 Kholis N Sidiq 5 320720020907076Panyutran 1/14/2016 1/15/2016 Diare Akut Pasang In 1 15,000 15,000 24,000 20,000 59,000
7 Tini Suhastini 56 320720500260000Padaherang 1/15/2016 1/16/2016 Susp Stroke Pasang In 1 15,000 15,000 24,000 20,000 59,000
Jumlah :................................................................................................................................................................ 138,000 336,000 280,000 754,000
Padaherang,05 Januari 2016


Nip.19680913 198902 1 001 Nip.19630811 198502 2 002
BULAN/TAHUN : FEBRUARI 2016
JASA JUMLAH JASAJML HR RAWAT VISITE DOKTER JUMLAH JASA
TANGGAL TANGGAL QUANTY PELAYANAN PELAYANAN (dikali dengan 1 hari/2 kali PELAYANAN
NO NAMA PASIEN UMUR NOMOR KTP/KK ALAMAT DIAGNOSA TINDAKAN
MASUK KELUAR TINDAKANTINDAKANTINDAKAN (Rp) Rp24,000 (Rp 20.000) ( Rp )
(Rp) (10X11) ( Rp ) (Rp) (12+13+14)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 Maman S 68 3207202505490001 Padaherang 2/3/2016 2/4/2016 DHF Grade II+CHF Infus 1 15,000 15,000 24,000 40,000 79,000
2 Nonok 60 3207204308550003 Paledah 2/5/2016 2/6/2016 GEA Infus 1 15,000 15,000 24,000 40,000 79,000
3 Samiah 46 3207206205690001 Padaherang 2/8/2016 2/10/2016 Susp.Typoid Fever Infus 1 15,000 15,000 48,000 80,000 143,000
4 Maemunah 24 3207184912910001 Karangpawitan 2/9/2016 2/11/2016 Syndrom Dyspepsia Infus 1 15,000 15,000 48,000 80,000 143,000
5 Darsum 75 3207201011400002 Kedungwuluh 2/14/2016 2/17/2016 GEA Infus 1 15,000 15,000 72,000 120,000 207,000
6 Dikri SM 9 3207200707060002 Karangpawitan 2/16/2016 2/17/2016 Paringitis Infus 1 15,000 15,000 24,000 40,000 79,000
7 Undit 63 3207200107430005 Karangsari 2/19/2016 2/22/2016 GEA Infus 1 15,000 15,000 24,000 40,000 79,000
8 Imas 36 3202174706800007 Karangpawitan 2/24/2016 2/25/2016 GEA Infus 1 15,000 15,000 24,000 40,000 79,000
9 Meti Sanistika 19 3208107105970001 Padaherang 2/24/2016 2/27/2016 Dyspepsia Infus 1 15,000 15,000 72,000 120,000 207,000
10 Marikin 35 3207203001580001 Karangpawitan 2/27/2016 2/27/2016 Dyspepsia Infus 1 15,000 15,000 72,000 120,000 207,000
Jumlah :................................................................................................................................................................ 150,000 150,000 432,000 720,000 1,302,000
Padaherang, 05 Maret 2016

Nip.19680913 198902 1 001 Nip.19630811 198502 2 002

BULAN/TAHUN : MARET 2016
(Rp) (10X11) ( Rp ) (Rp) (12+13+14)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 Nisem 56 3207206403600001 Karangsari 2/29/2016 3/2/2016 GEA Infus 1 15,000 15,000 72,000 120,000 207,000
2 Juariyah 58 3207204506570001 Paledah 2/29/2016 3/2/2016 GEA+Susp.Epilepsi Infus 1 15,000 15,000 72,000 120,000 207,000
3 ChaidarSyafiq 3 3207201902130001 Karangsari 3/4/2016 3/7/2016 GEA Infus 1 15,000 15,000 72,000 120,000 207,000
4 Risda N 18 Bln 3218074509140001 Maruyungsari 3/5/2016 3/7/2016 GEA Infus 1 15,000 15,000 48,000 80,000 143,000
5 Tati 53 3207204712530002 Padaherang 3/5/2016 3/7/2016 Dyspepsia+HT Grade II Infus 1 15,000 15,000 48,000 80,000 143,000
6 Suliah 41 3207205212750001 Maruyungsari 3/6/2016 3/8/2016 Dyspepsia+Susp.Typoid Infus 1 15,000 15,000 48,000 80,000 143,000
7 Samirah 62 3207205006540003 Sukanagara 3/8/2016 3/9/2016 Ashma Oksigen 1 9,000 9,000 24,000 40,000 73,000
8 Dedi 39 3207201911760003 Paledah 3/8/2016 3/10/2016 GEA Infus 1 15,000 15,000 48,000 80,000 143,000
9 Ai Rusmiati 49 3207205803680003 Padaherang 3/9/2016 3/10/2016 Dyspepsia Infus 1 15,000 15,000 24,000 40,000 79,000
10 Haerudin 68 3207200504480003 Karangsari 3/10/2016 3/11/2016 GEA Infus 1 15,000 15,000 24,000 40,000 79,000
11 Yuhanah 32 3207205502740003 Pasirgeulis 3/15/2016 3/18/2016 Dyspepsia+Susp.Typoid Infus 1 15,000 15,000 72,000 120,000 207,000
12 Jumsih 66 3207204507400001 Panyutran 3/15/2016 3/18/2016 GEA Infus 1 15,000 15,000 72,000 120,000 207,000
13 Basirin 64 3207202506420001 Karangmulya 3/16/2016 3/18/2016 GERD+ISPA Infus 1 15,000 15,000 48,000 80,000 143,000
14 Suliah 50 3207206504650003 Paledah 3/18/2016 3/20/2016 Dyspepsia+Typoid Fever Infus 1 15,000 15,000 48,000 80,000 143,000
15 Juni Maulana 14 3207203105020003 Maruyungsari 3/21/2016 3/23/2016 Susp.Typoid Fever Infus 1 15,000 15,000 48,000 80,000 143,000
16 Sarino 47 3207201501690001 Sukanagara 3/23/2016 3/25/2016 Susp.Typoid Fever Infus 1 15,000 15,000 48,000 80,000 143,000
17 Sukardi 60 3207202307550001 Karangpawitan 3/24/2016 3/25/2016 Dyspepsia Infus 1 15,000 15,000 24,000 40,000 79,000
18 M Suryadi 68 3207200803620003 Kedungwuluh 3/29/2016 3/31/2016 GEA Infus 1 15,000 15,000 48,000 80,000 143,000
Jumlah :................................................................................................................................................................ 264,000 264,000 888,000 1,480,000 2,632,000
Padaherang, 05 April 2016


Nip.19680913 198902 1 001 Nip.19630811 198502 2 002
(Rp) (10X11) ( Rp ) (Rp) (12+13+14)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 Ipit 62 3207204808530001 Karangpawitan 18/4/2016 19/4/2016 Gastritis Infus 1 15,000 15,000 24,000 20,000 59,000
2 Raswan 57 3207201104530001 Sukanagara 20/4/2016 21/4/2016 GEA Infus 1 15,000 15,000 24,000 20,000 59,000
3 Ika Fitri K 33 3471065107830001 Padaherang 20/4/2016 22/4/2016 GEA Infus 1 15,000 15,000 48,000 40,000 103,000
4 Utun 51 3207200107650016 Cobogo 21/4/2016 21/4/2016 Dyspepsia Infus 1 15,000 15,000 24,000 20,000 59,000
5 Restu Gilang 12 3207200108040002 Padaherang 21/4/2016 22/4/2016 Susp.Thypoid Infus 1 15,000 15,000 24,000 20,000 59,000
6 Kartamio 55 3207200010760027 Sukanagara 22/4/2016 23/4/2016 Of Hari I Infus 1 15,000 15,000 24,000 20,000 59,000
7 Sardi 61 3207200408540004 Sukanagara 25/4/2016 27/4/2016 GEA Infus 1 15,000 15,000 48,000 40,000 103,000
8 Santanom 75 3207201602370001 Sukanagara 27/4/2016 29/4/2016 GEA Infus 1 15,000 15,000 48,000 40,000 103,000
9 Rais 75 3207200107400011 Paledah 28/4/2016 30/4/2016 GEA Infus 1 15,000 15,000 48,000 40,000 103,000
10
Jumlah :................................................................................................................................................................ 135,000 135,000 312,000 260,000 707,000
Padaherang, 04 Mei 2016

Nip.19680913 198902 1 001 Nip.19630811 198502 2 002

(Rp) (10X11) ( Rp ) (Rp) (12+13+14)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1
2
3
4
5
6
7
8
9
10
Jumlah :................................................................................................................................................................ 0 0 0 0 0
Padaherang, 04 Juni 2016


Nip.19680913 198902 1 001 Nip.19630811 198502 2 002
LAPORAN KUNJUNGAN PASIEN PEMERIKSAAN LABORATORIUM
JENIS JUMLAH (Rp)

PEMERIKSAAN JASA PELAYANAN
1 2 3 4 5 6 7 8 9 10
1 1/8/2016 Basiem 39 3207204311490001 Paledah Diare Gula darah sewaktu 39,000 GDS : 9.000
Cholesterol Chol : 18.000
Asam Urat Au : 12.000
2 1/8/2016 Sri Hardiyati 42 3207206011760001 Karangpawitan Suspek DM Gula darah sewaktu 9,000
3 1/9/2016 Puryanto 58 3207200709544002 Maruyungsari Suspek Artritis GoutGula darah sewaktu 27,000
Cholesterol
4 1/11/2016 Umi Kulsum 48 3207204205030003 Paledah DM Gula darah sewaktu 9,000
5 1/11/2016 Sar'an 62 3207200805540002 Padaherang Gastritis Gula darah sewaktu 9,000

6 1/11/2016 Hasby Rahman 18 bl 3207201609140003 Padaherang Suspek DBD Hemoglobin 22,200 HB : 6.000
Leukosit LEU : 4.800
Hematokrit HT : 6.000
Trombosit Tromb : 5.400
7 1/12/2016 Acep Nugraha 21 3207210709930001 Kalipucang Suspek Rhematoid Gula darah sewaktu 39,000
Arthritis Cholesterol
Asam Urat
8 1/13/2016 Nasihun Hoenas 71 3207200206440001 Karangsari Hipo Glikemia Gula darah sewaktu 39,000
Cholesterol
Asam Urat
9 1/14/2016 Holis 5 3207200506110001 Panyutran Diare Hemoglobin 22,200
Leukosit
Hematokrit
Trombosit
1 2 3 4 5 6 7 8 9 10
10 1/14/2016 Sugandi 45 3207201011700005 Sukanagara Ispa Hemoglobin 22,200
Leukosit
Hematokrit
Trombosit
11 1/18/2016 Tete Sukatih 63 3207204505530002 Padaherang Artritis Gout Gula darah sewaktu 21,000
Asam Urat
12 1/25/2016 Nyi Ruwati 51 3207206505650001 Padaherang Pembekakan pd Gula darah sewaktu 21,000
sendi Asam Urat
13 1/25/2016 Warsah 51 3207206908650001 Paledah Post Up Lipom Gula darah sewaktu 21,000
Asam Urat
14 1/25/2016 Ikarman 38 3207231408790002 Bojongsari Suspek Artritis GoutGula darah sewaktu 21,000
Asam Urat
15 1/26/2016 Momoy 65 3207204107560004 Kedungwuluh Ispa Hemoglobin 22,200
Leukosit
Hematokrit
Trombosit
16 1/26/2016 Ahmad Tamyis 51 3207200102650005 Maruyungsari Suspek DM Gula darah sewaktu 39,000
Cholesterol
Asam Urat
JUMLAH :........................................................................................................................................................................................... 382,800


Nip.19680913 198902 1 001 Nip.19630811 198502 2 002
JENIS JUMLAH (Rp)

1 2 3 4 5 6 7 8 9 10
1 2/1/2016 Liah Sutimah 50 3207204206660003 Karangpawitan Diabetes Melitus Gula darah 9,000 GDS : 9000
AU : 12000
2 2/4/2016 Maman S 62 3207202505490001 Padaherang Demam Berdarah Haemoglobin 22,200 HB : 6000
Hematokrit HT : 6000
Leukosit LEU : 4800
Trombosit Tromb: 5400
Widal : 18000
3 2/5/2016 Entin Kartini 58 3207205110570001 Padaherang Diabetes Melitus Gula Darah 9,000
4 2/10/2016 Sutini 50 3207205906660003 Karangmulya Vulnus Gula darah 21,000

Asam Urat
5 2/10/2016 Ugan Sugandi 32 3207201005840004 Pasirgeulis Suspek DM Gula darah 9,000
6 2/10/2016 Suryati 29 3207204401870001 Kedungwuluh Diabetes Melitus Gula darah 21,000

Asam Urat
7 2/15/2016 Entin Kartini 58 3207205110570001 Padaherang Diabetes Melitus Gula darah 21,000
Asam Urat
8 2/23/2016 Lasmah 56 3207205709600003 Karangsari Diabetes Melitus Gula darah 21,000
Asam Urat
9 2/24/2016 Solihat 52 3207205108630001 Karangmulya Suspek DM Gula darah 21,000

Asam Urat
10 2/26/2016 Keken Kentarsih 49 3207204303670001 Karangpawitan Anemia Haemoglobin 40,200

Hematokrit
Leukosit
Trombosit
Widal
JUMLAH :........................................................................................................................................................................................... 194,400


Nip.19680913 198902 1 001 Nip.19630811 198502 2 002
JENIS JUMLAH (Rp)

1 2 3 4 5 6 7 8 9 10
1 3/2/2016 Munasaroh 40 3207204810760001 Padaherang Susp.DM Gula Darah sewaktu 9,000 Glu : 9.000
Cholesterol 18,000 AU : 12.000
Asam Urat 12,000 Chol : 18.000
DR : 21.000
2 3/7/2016 Liah Sutinah 50 3207204206660003 Karangpawitan DM Gula Darah sewaktu 9,000 Widal : 18000
Asam Urat 12,000
3 3/7/2016 Dian Maidiana 37 3207204505790002 Karangmulya suspek typoid Darah Rutin 21,000
Widal 18,000
4 3/7/2016 Siti Herdiana 25 3207204501910002 Kedungwuluh Rhematoid Gula darah 9,000

Cholesterol 18,000
Asam Urat 12,000
5 3/7/2016 Darmungi 60 3207201101560005 Sukanagara Susp.DM Gula Darah 9,000

Cholesterol 18,000
Asam Urat 12,000
6 3/10/2016 Suciati 33 3207205002620002 Maruyungsari DM Gula Darah 9,000
Asam Urat 12,000
7 3/12/2016 Maryati 40 3207204305760002 Pasirgeulis Susp.DM Gula Darah 9,000

Asam Urat 12,000
8 3/12/2016 Atmini 33 3207204603630006 Kedungwuluh Susp.DM Gula Darah 9,000

Cholesterol 18,000
Asam Urat 12,000
9 3/14/2016 Ikem 63 3207204105520001 Padaherang Rhematoid Gula Darah 9,000

Asam Urat 12,000
10 3/14/2016 Waslim 34 3207200509810002 Karangsari Rhematoid Gula Darah 9,000

Asam Urat 12,000
11 3/14/2016 Ruminah 65 3207204107500008 Karangsari Susp.DM Gula Darah 9,000

Asam Urat 12,000
12 3/15/2016 Ruslan 37 3207202304790002 Pasirgeulis Suspek Typoid Darah Rutin 21,000

Widal 18,000
13 3/17/2016 Ijah 59 3207205611570001 Kedungwuluh Susp.DM Gula Darah 9,000

Cholesterol 18,000
Asam Urat 12,000
14 3/17/2016 Tini 40 3207206307670001 Sukanagara Rhematoid Gula Darah 9,000

Asam Urat 12,000
15 3/17/2016 Sudarjo 69 3207202912470001 Maruyungsari Susp.DM Gula Darah 9,000

Asam Urat 12,000
16 3/21/2016 Imam Fauzi 34 3207201502820001 Karangmulya Rhematoid Cholesterol 18,000

Asam Urat 12,000
17 3/21/2016 Muhtori 67 3207202211490001 Paledah Rhematoid Gula Darah 9,000

Cholesterol 18,000
Asam Urat 12,000
18 3/22/2016 Yuhanah 42 3207205502740003 Pasirgeulis Suspek Typoid Darah Rutin 21,000

Widal 18,000
19 3/23/2016 Sarino 47 3207201501690001 Sukanagara Suspek Typoid Darah Rutin 21,000

Widal 18,000
20 3/23/2016 Sukardi 61 3207202307550001 Karangpawitan DM Gula Darah 9,000

Asam Urat 12,000
21 3/28/2016 Oman Rukmana 61 3207202508550002 Panyutran DM Gula Darah 9,000
JUMLAH :........................................................................................................................................................................................... 618,000
Padaherang, 05 April 2016


Nip.19680913 198902 1 001 Nip.19630811 198502 2 002
JENIS JUMLAH (Rp)

1 2 3 4 5 6 7 8 9 10
1 1/4/2016 Suciati 54 3207205002620002 Maruyungsari DM Gula darah 9,000
Asam Urat 12,000
2 5/4/2012 Sangidah 64 3207204704520001 Sukanagara Rhematoid Cholesterol 18,000

Asam Urat 12,000
3 5/4/2016 Iis Hanisah 35 3207206511830001 Karangpawitan Suspeck DM Gula darah sewaktu 9,000
Gula darah 2 jam pp 9,000
Gula darah Puasa 9,000
4 5/4/2016 Atmini 53 3207204603630006 Kedungwuluh - Golongan darah 6,000

Golongan darah rhesus 6,000
5 5/4/2016 Supinah 41 3207205007750003 Padaherang Rhematoid Cholesterol 18,000

6 5/4/2016 Haryati 47 3207204807690002 Karangmulya - Golongan darah 6,000
Golongan darah rhesus 6,000
7 12/4/2016 Selamet 34 3207200411820003 Padaherang Vertigo Gula darah 9,000

Asam Urat 12,000
8 12/4/2016 Sahim 63 3207200303530003 Padaherang Suspeck DM Gula darah 9,000

Cholesterol 18,000
Asam Urat 12,000
9 12/4/2016 Aswi 56 3207205501600001 Bojongsari Rhematoid Gula darah 9,000
Asam Urat 12,000
10 29/4/2016 Sobari 66 3207201011500002 Sukanagara Suspeck Vertigo Gula darah 9,000

Cholesterol 18,000
Asam Urat 12,000
JUMLAH :........................................................................................................................................................................................... 240,000

Nip.19680913 198902 1 001 Nip.19630811 198502 2 002

JENIS JUMLAH (Rp)

1 2 3 4 5 6 7 8 9 10
JUMLAH :........................................................................................................................................................................................... 0


Nip.19680913 198902 1 001 Nip.19630811 198502 2 002
LAPORAN KUNJUNGAN PASIEN DI POLI GIGI

NO TANGGAL NAMA PASIEN UMUR NOMOR KTP/KK ALAMAT DIAGNOSA TINDAKAN TINDAKAN TINDAKAN JASA PELAYANAN
( Rp ) ( 9X10 )
1 2 3 4 5 6 7 8 9 10 11
1 5-Jan-16 Susi Herawati 30 3207205118500001 Padaherang PulpitisRevisible 21 Tambalan Tetap Gigi dewasa 1 12,000 12,000
2 7-Jan-16 Aceng Yeyen 36 3207200707790000 Ciganjeng Gangren radix 46 Pencabutan Gigi Tetap 1 12,000 12,000
3 11-Jan-16 Sri Masriah 28 3207205402830001 Padaherang Gangren radix 46 Pencabutan gigi tetap 1 12,000 12,000
4 12-Jan-16 Ade Wartini 57 320720510656003 Padaherang Abses periodental 24,25,26 Premedikasi 1 10,000 10,000
5 13-Jan-16 Evan Rafa 7 3207202310090001 Padaherang Persistensi 61 Pencabutan gigi sulung 1 6,000 6,000
6 14-Jan-16 Sopiah B 14 3207205305010007 Kedungwuluh Abses periapikol 36 Premedikasi 1 10,000 10,000
7 Darsum 75 3207200207460001 Sindangwangi PMK 18 Pencabutan gigi tetap 1 12,000 12,000
8 16-Jan-16 Elin M 28 3207204606870003 Karangpawitan 8 NP Premedikasi 1 10,000 10,000
9 Elsa A 8 3207202508080015 Karangpawitan I persistesi Pencabutan gigi sulung 1 6,000 6,000
10 18-Jan-16 Sopiah B 14 3207205305010007 Kedungwuluh post Abses 36 Pencabutan gigi tetap 1 12,000 12,000
11 Enih K 30 3207206303820001 Padaherang Gangren radix 36 Premedikasi 1 10,000 10,000
12 Diman 28 3207202211870001 Karangpawitan Abses periapikol Premedikasi 1 24,000 24,000
13 Rais A 3 3207202612110001 Karangpawitan pulp irrev 84 Premedikasi 1 10,000 10,000
14 19-Jan-16 Yuyun 42 3207205105740001 Kedungwuluh Nekrosis pulpa 28 Pencabutan gigi tetap 1 18,000 18,000
15 20-Jan-16 V. Parti 58 3207355312570002 Mangunjaya Gangren radix 25 Pencabutan gigi tetap 1 12,000 12,000
16 21-Jan-16 Surati 45 3207355801710001 Mangunjaya GMKG RA RO Pengangkatan Karang Gigi 4 regio 12,000 48,000
17 Ika A 5 3207205610100001 Padaherang NP 84 Tambalan Smtara Gigi anak 1 6,000 6,000
18 Erick 7 3207201003080001 Karanghonje GR 51 Pencabutan gigi sulung 1 6,000 6,000
19 Susi Herawati 30 3207205118500001 Padaherang Pulp rev 11 Tambalan Tetai gigi dewasa 1 12,000 12,000
20 22-Jan-16 Wisnu F 6 3207201209090001 Sukanagara Persistensi 71 Pencabutan gigi sulung 1 6,000 6,000
21 25-Jan-16 Tete S 50 3207204505530002 Padaherang Pulp irrev 1 10,000 10,000
22 Nyi Ruwati 49 3207206505650001 Padaherang PMK 41 Pencabutan gigi tetap 1 12,000 12,000
23 Diman A 28 3207202211870001 Karangpawitan Gangren radix 36 Pencabutan gigi tetap 1 12,000 12,000
24 25-Jan-16 Ny.Yayah 50 3207205501660001 Paledah PMK 45 Pencabutan gigi tetap 1 12,000 12,000
25 27-Jan-16 Hipdi H 8 3207210606080001 Pamotan Stomatitis Aftosa Tambal smtara gigi dewasa 1 9,000 9,000
26 28-Jan-16 Siti Hapsah 20 3207206108910002 Paledah Nekrosis pulpa 46 Pencabutan gigi tetap 1 12,000 12,000
27 29-Jan-16 Anom Subagiyo 36 3207201708790001 Padaherang Nekrosis pulpa 36 1 10,000 10,000
28 30-Jan-16 Turno 62 3207200203530001 Karangmulya PMK 31 Pencabutan gigi tetap 1 12,000 12,000
JUMLAH : ............................................................................................................................................................................................................................................................................... 343,000

Nip.19680913 198902 1 001 Nip.19630811 198502 2 002

( Rp ) ( 9X10 )
1 2 3 4 5 6 7 8 9 10 11
1 1-Feb-16 Cidoh 39 3207206305760002 Kedungwuluh GR 25,26 Pencabutan Gigi Tetap 2 12,000 24,000
2 Embeng S 60 3207201002550001 Paledah PMK 38, PAK 18 Premedikasi 1 3,000 3,000
3 Tasmiati 32 3207205005820004 Paledah Pulp irrev 38 Tambalan Smtr gigi dewasa 1 9,000 9,000
4 Nasywa Nabilah 10 3207204308060001 Kedungwuluh Gangren Radix 64 Pencabutan Gigi sulung 1 6,000 6,000
5 2-Feb-16 Sarsih 32 3207206509810001 Kedungwuluh Gangren Radix 15 Pencabutan Gigi tetap+komp 1 18,000 18,000
6 3-Feb-16 Toton Sujarwo 45 3207200303690002 Paledah Abses Periapikal 38 Premedikasi 1 3,000 3,000
7 4-Feb-16 Adelia 7.5 3207205307080001 Karangmulya Nekrolis Pulpa 84,85 Tambalan Smtr gigi sulung 2 6,000 12,000
8 11-Feb-16 Adah 42 3207204502740003 Padaherang Nekrolis Pulpa 23 Konsultasi 1 3,000 3,000
9 Rasinah 41 3207365604770001 Sukamaju Nekrolis Pulpa 38 Premedikasi 1 3,000 3,000
10 Maryani Indah 13 3207206703020002 Karangpawitan Pulpitis Irrev Post Endo 24 Tambalan Tetap gigi dewasa 1 12,000 12,000
11 Kosim 31 3207202512850002 Karangsari Nekrolis Pulpa 48 Konsultasi 1 3,000 3,000
12 Viola 15 3207205008010003 Karangpawitan Nekrolis Pulpa 36,GR 46 Premedikasi 1 3,000 3,000
13 Isna Anika Aila 7 3207206007090004 Karangpawitan Resorpsi Fisiologis 51 Pencabutan Gigi sulung 1 6,000 6,000
14 12-Feb-16 Tri Bakti 30 3207204906850004 Sindangwangi PAK e.c NP 46 Premedikasi 1 3,000 3,000
15 Elvis Lutpiana 19 3207211808960001 Kalipucang Pulpitis reversible 46 Tambalan Tetap gigi dewasa 1 12,000 12,000
16 Ayut Suryati 56 3207206007680002 Sindangwangi Ekstrusi 38 Konsultasi 1 3,000 3,000
17 13-Feb-16 Ratika Rotisari 26 3207205103890001 Kedungwuluh Gangren Radix 18 Grinding Mahkota 1 3,000 3,000
18 Rasinah 41 3207365604770001 Mangunjaya PAK e.c NP 38 Pencabutan gigi tetap dewsa 1 12,000 12,000
19 15-Feb-16 Roma Handi 13 3207201709070203 Karangpawitan Abses Periapikal 36 Tambalan Smtr gigi dewasa 1 9,000 9,000
20 Asep Heryadi 42 3207201502720004 Karangpawitan Rjk Bjr Inpaksi 1 3,000 3,000
21 Viola Sansabila 15 3207206008010003 Karangpawitan Gangren Radix 46 Pencabutan gigi tetap dewsa 1 12,000 12,000
22 16-Feb-16 Enat Natricia 56 3207205204600004 Sindangherang Pulpitis Irreversible 36 Pencabutan gigi tetap dewsa 1 12,000 12,000
23 Umi Rohayati 39 3207205004790004 Sukanagara Pulpitis Irreversible 34 Tambalan Smtr gigi dewasa 1 9,000 9,000
24 Suparini 42 3207204104740004 Sukanagara PAK e.c NP 38 , NP 36 Premedikasi 2 3,000 6,000
25 Ipan Setiawan 15 3207201100600002 Banjarharja Fraktur Ellis kls.III Tambalan Smtr gigi dewasa 1 9,000 9,000
26 17-Feb-16 Tegar Nanda 10 3207210405050003 Kalipucang Persistensi 82 Pencabutan Gigi sulung 1 6,000 6,000
27 Titin 26 3207185407890004 Karangmulya Nekrolis Pulpa 46 Grinding Mahkota 1 3,000 3,000
28 Musli'ah Nurul 30 3207205110860003 Ciganjeng Pulpitis Irreversible 46 Tambalan Smtr gigi dewasa 1 9,000 9,000
29 18-Feb-16 Ujang Rendi 7.5 3207203006080003 Paledah Persistensi 61 Pencabutan Gigi sulung 1 6,000 6,000
30 Yuliana 33 3207206007830004 Karangsari PAK e.c GR 46 Pencabutan Gigi tetap 1 12,000 12,000
31 Irah Rahmiati 50 3207215005640001 Kalipucang Pulpitis reversible 48 Tambalan Tetap gigi dewasa 1 12,000 12,000
32 20-Feb-16 Ade Cahyo 53 3207200106200005 Sindangwangi Fraktur Ellis kls.II 38 Premedikasi 1 3,000 3,000
33 Nabila 9 3207204906070001 Paledah Polip pulpa 45 Premedikasi 1 3,000 3,000
34 22-Feb-16 Kheisa 7.5 3217106207080006 Sukanagara Gangren Radix 52 Pencabutan Gigi sulung 1 6,000 6,000
35 Munjiati 32 3207205807830001 Karangmulya Pulpitis Irreversible 46 Tambalan Smtr gigi dewasa 1 9,000 9,000
36 Toni Riyanto 29 3207210306870002 Kalipucang Pulpitis Irreversible 26 Tambalan Smtr gigi dewasa 1 9,000 9,000
37 Totong Hidayat 67 3207211708490001 Tunggilis Gangren Radix 21 Konsultasi 1 3,000 3,000
38 23-Feb-16 Musli'ah Nurul 30 3207205110860003 Ciganjeng Pulpitis Irreversible 47 Tambalan Smtr gigi dewasa 1 9,000 9,000
39 Ecin Kuraesin 36 3207215109790001 Kalipucang PAK e.c NP 46 Pencabutan Gigi tetap 1 12,000 12,000
40 Lasmah 55 3207205709600003 Karangsari PMK 31 Konsultasi 1 3,000 3,000

41 Umi Rohayati 39 3207205004790004 Sukanagara Pulpitis Irreversible 34 Tambalan Smtr gigi dewasa 1 9,000 9,000
42 25-Feb-16 Anggis Prasetio 28 3207202606870003 Paledah GMKG RA RB Pembersihan Karang gigi 4 regio 12,000 48,000
43 Totong Hidayat 67 3207211708490001 Tunggilis Gangren Radix 21 Pencabutan Gigi tetap 1 12,000 12,000
44 Umi Rohayati 39 3207205004790004 Sukanagara Pulpitis Irreversible 34 Tambalan Tetap gigi dewasa 1 12,000 12,000
45 Alpian Agustin 1.5 3218071808140001 Padaherang Fraktur Ellis kls.III Premedikasi 1 3,000 3,000
46 Sakti 7 3207202504080004 Paledah Persistensi 82 Pencabutan Gigi Sulung 1 6,000 6,000
47 26-Feb-16 Mira Romadona 8 3207205309080001 Pairgeulis Persistensi 71 Pencabutan Gigi Sulung 1 6,000 6,000
48 Enih Hunaesih 33 3207206303820001 Sukanagara Pulpitis Irreversible 16 Premedikasi 1 3,000 3,000
49 29-Feb-16 Undang 63 3207200101530002 Padaherang PMK 36 Konsultasi 1 3,000 3,000
50 Emar Mar'ah 43 3207204811720001 Paledah Abrasi ante RB Konsultasi 1 3,000 3,000
51 Karsinah 76 3207204211400002 Sindangwangi PKM 21 Pencabutan Gigi tetap 1 12,000 12,000
52 Akmal Nurhidayat 7.5 3207201712080001 Paledah Resorpsi fisiologis 62 Pencabutan Gigi Sulung 1 6,000 6,000
JUMLAH : ............................................................................................................................................................................................................................................................................... 426,000


Nip.19680913 198902 1 001 Nip.19630811 198502 2 002
BULAN/TAHUN : 2016

( Rp ) ( 9X10 )
1 2 3 4 5 6 7 8 9 10 11
JUMLAH : ............................................................................................................................................................................................................................................................................... 0
Padaherang, 2016

Nip.19680913 198902 1 001 Nip.19630811 198502 2 002
LAPORAN KUNJUNGAN PASIEN RUJUKAN
NO TANGGAL NAMA PASIEN UMUR NOMOR KTP/KK ALAMAT DIAGNOSA DIRUJUK KE TARIP ( Rp ) KETERANGAN
1 2 3 4 5 6 7 8 9 10
1 1/14/2016 Tini Suhartini 56 3207205002600005 Sindangherang Susp Stroke RSU Banjar 136,000
2 1/16/2016 Holis Nur Sidiq 5 3207200209010768 Panyutran Diare Akut RSU Banjar 136,000
3 1/31/2016 Adah 59 3207205408570001 Pasirgeulis CHF RSU Banjar 136,000
JUMLAH :............................................................................................................................................................................ 408,000
Padaherang, 05 Februari 2016


Nip.19680913 198902 1 001 Nip. 19630811 198502 2 002
1 2 3 4 5 6 7 8 9 10
1 2/1/2016 Tasmi 72 3207205709440002 Maruyungsari Anemia RSU Banjar 136,000
2 2/16/2016 Fanjri Nur Sidik 4 bln 3207200211110000 Karangmulya Kejang Demam RSU Banjar 136,000
3 2/22/2016 Marikin 42 3207201309070301 Paledah Post.KLL RSU Banjar 136,000
4 2/24/2016 Anah Nurhasanah 55 3207206612610001 Karangpawitan Susp. Apendix RSU Banjar 136,000
5 2/24/2016 Anisa Hoenas 68 3207204607480003 Karangsari Post.KLL RSUD Ciamis 240,000
JUMLAH :............................................................................................................................................................................ 784,000
Padaherang, 05 Februari 2016

Nip.19680913 198902 1 001 Nip. 19630811 198502 2 002
1 2 3 4 5 6 7 8 9 10
1 3/7/2016 Enung Komalasari 43 3207205806730001 Padaherang Hepatomegali RSU Banjar 136,000
2 3/8/2016 Karso 64 3207200107510001 Kedungwuluh Stroke RSU Banjar 136,000
3 3/10/2016 Entin Satini 53 3207205909630001 Karangpawitan Susp.Decompe RSU Banjar 136,000
4 3/14/2016 Kusmayanti 17 3207204104990002 Karangpawitan Hematoma RSU Banjar 136,000
5 3/15/2016 Dahyo 52 3207201211630001 Karangsari Ulkus Diabetikum RSU Banjar 136,000
JUMLAH :............................................................................................................................................................................ 680,000

Nip.19680913 198902 1 001 Nip. 19630811 198502 2 002
1 2 3 4 5 6 7 8 9 10
1 5/4/2016 Lisnawati 26 3207354101900006 Padaherang Susp Apendix RSU Banjar 136,000
2 8/4/2016 Tasem 57 3207205110590002 Maruyungsari Susp.Decom RSU Banjar 136,000
3 9/4/2016 Uta 56 3207201307600004 Karangmulya Frktr os.fibula/cruris RSU Siaga Medika 500,000
4 10/4/2016 Sarti 62 3207204304540002 Padaherang Obs.Febris RSU Banjar 136,000
5 17/4/2016 Aceng 49 3207230507670002 Sidamulih Pgdrn Frktr os Tibia RSU Banjar 136,000
6 22/4/2016 Jeo 27 3207200608930003 Panyutran Vlns morsum serpenti RSU Banjar 136,000
7 24/4/2016 Sodikin 68 3207200504480001 Kedungwuluh Frktr Tarsal Sinistra RSU Siaga Medika 500,000
terbuka,FTS tertutup Banyumas
8 29/4/2016 Sudarjo 69 3207202912470001 Maruyungsari Decom+Bronchopeno RSU Banjar 136,000
JUMLAH :............................................................................................................................................................................ 1,816,000

Nip.19680913 198902 1 001 Nip. 19630811 198502 2 002

1 2 3 4 5 6 7 8 9 10
JUMLAH :............................................................................................................................................................................ 0


Nip.19680913 198902 1 001 Nip. 19630811 198502 2 002
LAPORAN KUNJUNGAN PASIEN PERSALINAN
TINDAKAN JUMLAH
PERSALINAN ATONIA VACUM TINDAKAN JASA
NO TANGGAL NAMA PASIEN UMUR NOMOR KTP/KK ALAMAT DIAGNOSA KET.
KURET PLACENTA EKSTRASI DIGITAL PASCA PELAYANAN
NORMAL PATOLOGI
MANUAL SALIN Rp
1 1/16/2016 Nenih 34 3207206304820002 Karangmulya G2 P1 A0 v Rp 600,000
2 1/21/2016 Reni Murni Asih 21 3207204303850004 Karangpawitan G1 P0 A0 v Rp 600,000
3 1/21/2016 Rosimah 38 3207204501780002 Karangmulya G3 P1 A1 v Rp 600,000
J U M L A H :................................................................................................................................................................................ Rp 1,800,000
Padaherang, 5 Januari 2016

Mengetahui Pengelola Pelayanan Kesehatan Gratis

Nip.19680913 198902 1 001 Nip. 19630811 198502 2 002
TINDAKAN JUMLAH
NORMAL PATOLOGI
MANUAL SALIN Rp
1 2/26/2016 Marwiyah 29 3207185008870006 Karangpawitan G2 P1 A0 V Rp 600,000
2 2/27/2016 Ina Herlina 27 3207206104890007 Karangmulya G2 P1 A0 V Rp 600,000
J U M L A H :................................................................................................................................................................................ Rp 1,200,000


Nip.19680913 198902 1 001 Nip. 19630811 198502 2 002
TINDAKAN JUMLAH
NORMAL PATOLOGI
MANUAL SALIN Rp
J U M L A H :................................................................................................................................................................................ Rp -


Nip.19680913 198902 1 001 Nip. 19630811 198502 2 002
LAPORAN KUNJUNGAN PASIEN DI FISIOTERAPI
PUSKESMAS : pADAHERANG
KWANTITI JUMLAH (Rp)
NO TANGGAL NAMA PASIEN UMUR NOMOR KTP/KK ALAMAT DIAGNOSE MODALITAS KETERANGAN
MODALITAS JASA PELAYANAN
1 2 3 4 5 6 7 8 9 10 11


Nip.19680913 198902 1 001 Nip. 19630811 198502 2 002

Laporan Kunj - Pasien Gratis PKG

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LAPORAN KUNJUNGAN PASIEN UNIT GAWAT DARURAT (UGD)

PELAYANAN KESEHATAN GRATIS

Mengetahui Padaherang, 5 Februari 2016

H.Sugiharto,S.Kep,Ners Solihat Pujaningsih

Mengetahui Padaherang, 5 Maret 2016

LAPORAN KUNJUNGAN PASIEN UNIT GAWAT DARURAT (UGD)

Mengetahui Padaherang, 4 Mei 2016

H.Sugiharto,S.Kep,Ners Solihat Pujaningsih

LAPORAN KUNJUNGAN PASIEN UNIT GAWAT DARURAT (UGD)

H.Sugiharto,S.Kep,Ners Solihat Pujaningsih

JUMLAH : .......................................................................................................................................................... 189,000

Padaherang, 05 Januari 2016

H.Sugiharto,S.Kep,Ners Solihat Pujaningsih

H.Sugiharto,S.Kep,Ners Solihat Pujaningsih

JASA JUMLAH JASAJML HR RAWATVISITE DOKTERJUMLAH JASA

Jumlah :................................................................................................................................................................ 138,000 336,000 280,000 754,000

Padaherang,05 Januari 2016

H.Sugiharto,S.Kep,Ners Solihat Pujaningsih

Jumlah :................................................................................................................................................................ 150,000 150,000 432,000 720,000 1,302,000

Padaherang, 05 Maret 2016

LAPORAN KUNJUNGAN PASIEN RAWAT INAP

(Rp) (10X11) ( Rp ) (Rp) (12+13+14)

Jumlah :................................................................................................................................................................ 264,000 264,000 888,000 1,480,000 2,632,000

Padaherang, 05 April 2016

H.Sugiharto,S.Kep,Ners Solihat Pujaningsih

Jumlah :................................................................................................................................................................ 135,000 135,000 312,000 260,000 707,000

Padaherang, 04 Mei 2016

LAPORAN KUNJUNGAN PASIEN RAWAT INAP

Padaherang, 04 Juni 2016

H.Sugiharto,S.Kep,Ners Solihat Pujaningsih

JENIS JUMLAH (Rp)

5 1/11/2016 Sar'an 62 3207200805540002 Padaherang Gastritis Gula darah sewaktu 9,000

JUMLAH :........................................................................................................................................................................................... 382,800

Padaherang,05 Januari 2016

H.Sugiharto,S.Kep,Ners Solihat Pujaningsih

JENIS JUMLAH (Rp)

4 2/10/2016 Sutini 50 3207205906660003 Karangmulya Vulnus Gula darah 21,000

5 2/10/2016 Ugan Sugandi 32 3207201005840004 Pasirgeulis Suspek DM Gula darah 9,000

6 2/10/2016 Suryati 29 3207204401870001 Kedungwuluh Diabetes Melitus Gula darah 21,000

9 2/24/2016 Solihat 52 3207205108630001 Karangmulya Suspek DM Gula darah 21,000

10 2/26/2016 Keken Kentarsih 49 3207204303670001 Karangpawitan Anemia Haemoglobin 40,200

JUMLAH :........................................................................................................................................................................................... 194,400

Padaherang, 05 Maret 2016

H.Sugiharto,S.Kep,Ners Solihat Pujaningsih

JENIS JUMLAH (Rp)

4 3/7/2016 Siti Herdiana 25 3207204501910002 Kedungwuluh Rhematoid Gula darah 9,000

5 3/7/2016 Darmungi 60 3207201101560005 Sukanagara Susp.DM Gula Darah 9,000

7 3/12/2016 Maryati 40 3207204305760002 Pasirgeulis Susp.DM Gula Darah 9,000

8 3/12/2016 Atmini 33 3207204603630006 Kedungwuluh Susp.DM Gula Darah 9,000

9 3/14/2016 Ikem 63 3207204105520001 Padaherang Rhematoid Gula Darah 9,000

10 3/14/2016 Waslim 34 3207200509810002 Karangsari Rhematoid Gula Darah 9,000

11 3/14/2016 Ruminah 65 3207204107500008 Karangsari Susp.DM Gula Darah 9,000

12 3/15/2016 Ruslan 37 3207202304790002 Pasirgeulis Suspek Typoid Darah Rutin 21,000

13 3/17/2016 Ijah 59 3207205611570001 Kedungwuluh Susp.DM Gula Darah 9,000

14 3/17/2016 Tini 40 3207206307670001 Sukanagara Rhematoid Gula Darah 9,000

15 3/17/2016 Sudarjo 69 3207202912470001 Maruyungsari Susp.DM Gula Darah 9,000

16 3/21/2016 Imam Fauzi 34 3207201502820001 Karangmulya Rhematoid Cholesterol 18,000

17 3/21/2016 Muhtori 67 3207202211490001 Paledah Rhematoid Gula Darah 9,000

18 3/22/2016 Yuhanah 42 3207205502740003 Pasirgeulis Suspek Typoid Darah Rutin 21,000

19 3/23/2016 Sarino 47 3207201501690001 Sukanagara Suspek Typoid Darah Rutin 21,000

20 3/23/2016 Sukardi 61 3207202307550001 Karangpawitan DM Gula Darah 9,000

21 3/28/2016 Oman Rukmana 61 3207202508550002 Panyutran DM Gula Darah 9,000

JUMLAH :........................................................................................................................................................................................... 618,000