Anda di halaman 1dari 1
KEMENTERIAN KESEHATAN REPUBLIK INDONESIA Laporan Individual Pasien

KEMENTERIAN KESEHATAN REPUBLIK INDONESIA Laporan Individual Pasien

Nomor Kode RS

:

5208002

Kelas RS

:

D

Nama RS

:

RSU TANJUNG

Tanggal Keluar

:

26/02/2016

Nomor Rekam Medis

:

045658

Nomor SEP

:

0509R00002160000825

Umur (tahun)

:

45

Tgl Masuk

:

23/02/2016

Umur (hari)

:

16520

Jenis Perawatan

:

1 - Rawat Inap

Tgl Lahir

:

01/12/1970

Cara Pulang

:

1 - Sembuh

Jenis Kelamin

:

2 - Perempuan

LOS

:

4 hari

Kelas Perawatan

:

3 - Kelas 3

Berat Lahir

:

-

Diagnosa Utama

:

N832 (Other and unspecified ovarian cysts)

Diagnosa Sekunder

:

N858 (Other specified noninflammatory disorders of uterus)

Prosedur

:

6849 (Other and unspecified total abdominal hysterectomy)

9921

(Injection of antibiotic)

 

6541

(Laparoscopic unilateral salpingo-oophorectomy)

8878

(Diagnostic ultrasound of gravid uterus)

()

9929

(Injection or infusion of other therapeutic or prophylactic substance)

 

9918

(Injection or infusion of electrolytes)

9357

(Application of other wound dressing)

5749

(Other transurethral excision or destruction of lesion or tissue of bladder)

9059

(Other microscopic examination of blood)

 

9912

(Immunization for allergy)

9139

(Other microscopic examination of specimen from bladder, urethra, prostate, seminal vesicle, perivesical tissue, and o

ADL

:

0

Hasil Grouping

INA-CBG

:

W-1-20-I

Deskripsi

:

PROSEDUR PADA RAHIM & ADNEKSA RINGAN

Special CMG

:

Tariff Top Up

:

Rp.0,00

Tarif RS

:

Rp 6.882.500,00

Total Tarif

:

Rp 4.039.700,00