REKAPITULASI PENGAJUAN KLAIM PELAYANAN RAWAT INAP

PESERTA PROGRAM JAMINAN KESEHATAN NASIONAL

BULAN AGUSTUS 2017
JUMLAH BESARAN TARIF JUMLAH TAGIHAN
NO NAMA PASIEN NO KARTU PESERTA NO DIAGNOSA TGL MASUK TGL KELUAR HARI
ALAMAT TLP TINDAKAN YANG DIBERIKAN PAKET PAKET RITP
RAWAT
1 ANANG OOOO441171191 BUNIASIH GASTRITIS INF RL 7/29/2017 8/1/2017 3 600,000 600,000
2 EDAH SUHAEDAH OOOO441O44864 PASIRTAMIANG GASTRITIS INF RL 7/29/2017 8/1/2017 3 600,000 600,000
3 ILI USE OOOO4353O6666 CIKADU ASMA INF RL, O2 7/29/2017 8/1/2017 3 600,000 600,000
4 KUSNADI OOO22468682O2 CIJOHO GEA INF RL 7/31/2017 8/2/2017 2 400,000 400,000
5 FERI SUPRIATNA OOO2O818OO541 KERTASARI STOMATITIS INF RL 7/31/2017 7/2/2017 2 400,000 400,000
6 ADITYA NAUFAL R OOO2O6764O8O6 PASIRLANDAK DIARE AKUT INF RL 7/31/2017 7/2/2017 2 400,000 400,000
7 NUR ASIAH OOO1O8217O743 DUSUN DESA GEA INF RL 7/31/2017 8/2/2017 2 400,000 400,000
8 M FADLI OOO2O56764532 DEPOK THYPOID INF RL, CEK HEMRUT, WIDAL 8/1/2017 8/3/2017 2 400,000 400,000
9 ENZEN ZAENUDIN OOOO4412O8855 PASIRLANDAK PROSTAT INF RL 8/1/2017 8/3/2017 2 400,000 400,000
10 KOSIDIN OOO227O8O1485 SALAJAMBE BPH INF RL 8/2/2017 8/3/2017 1 200,000 200,000
11 KOMARUDIN OOOO44O799939 BUNIASIH GASTRITIS KRONIS INF RL 8/2/2017 8/5/2017 3 600,000 600,000
12 WARYATI OOOO441572O16 CIAWITALI HEG INF RL 8/4/2017 8/7/2017 3 600,000 600,000
13 HENI RUHAENI OOOO516952787 CIJULANG VOMITUS INF RL 8/5/2017 8/7/2017 2 400,000 400,000
14 RAHILI OOOO441894071 CIAWITALI HIPERTENSI INF RL 8/5/2017 8/7/2017 2 400,000 400,000
15 MAMAN OOOO44O7537O3 NANGGELA SUSPEC TBC INF RL 8/5/2017 8/6/2017 1 200,000 200,000
16 RIDWAN MAULANA OOOO44O134121 KERTASARI ASMA INF RL, O2 TERPASANG 8/5/2017 8/8/2017 3 600,000 600,000
17 AGUS SOBARLI OOOOO71436126 SUKAHAJI HIPERTENSI INF RL 8/5/2017 8/8/2017 3 600,000 600,000
18 ELITA WIDANINGSIH OOO2272716843 PST LNDH DIARE INF RL 7/6/2017 8/7/2017 1 200,000 200,000
19 MEY INDRIANI NUR OOO2249786441 PASIRTAMIANG DIARE INF RL 8/6/2017 8/8/2017 2 400,000 400,000
20 NUNUNG OOOO44O325494 DESA KALER GASTRITIS INF RL 8/6/2017 8/8/2017 2 400,000 400,000
21 RENA RUSMAYANTI OOO1OO615OO26 NANGGELA KALER TB PARU INF RL 8/7/2017 8/8/2017 1 200,000 200,000
22 IDIN OOOO4411O2969 PADAMULYA BPH INF RL 8/7/2017 8/8/2017 1 200,000 200,000
23 TATAN ROSDIANA OOOO44O598993 KERSAMENAK THYPOID INF RL, CEK HEMRUT, WIDAL 8/7/2017 8/11/2017 4 800,000 800,000
24 LILIS ISTIKOMAH OOOO441717311 DEPOK DIPEPSIA INF RL 8/10/2017 8/12/2017 2 400,000 400,000
25 AI SAADAH OOOO44O887544 CIGOROWONG GASTRITIS INF RL 8/10/2017 8/13/2017 3 600,000 600,000
26 EUTIK SITI HODIJAH OOOOO7O971726 SUKAHAJI DIARE INF RL 8/11/2017 8/13/2017 2 400,000 400,000
27 ANAH OOOO44O343314 CIURUG, CIJULANG HIPERTENSI INF RL 8/12/2017 8/14/2017 2 400,000 400,000
28 GITA LESTARI OOOO417327467 PAMOKOLAN DIARE INF RL 8/12/2017 8/14/2017 2 400,000 400,000
29 KODRAT JATNIKO OOOO44O798117 CIJOHO FEBRIS INF RL 8/13/2017 8/15/2017 2 400,000 400,000
30 SYAHRONI OOOO1O8959422O2SUKASETIA HEMOROID IUTEM INF RL 8/13/2017 8/15/2017 2 400,000 400,000
31 SARIPUDIN OOOO44O197997 NANGGELA HIPERTENSI INF RL 8/14/2017 8/16/2017 2 400,000 400,000
32 MIMI OOOO436486329 SUKAHENING DIARE, DM INF RL 8/14/2017 8/16/2017 2 400,000 400,000
33 YENI SURYARANI OOO2256386218 CIJULANG HEG INF RL 8/15/2017 8/18/2017 3 600,000 600,000
34 RANI ANGGRAENI OOOO440495032 KERSAMENAK FEBRIS, E.C ISPA INF RL 8/15/2017 8/17/2017 2 400,000 400,000
35 WAWANG OOOO441192246 PAMOKOLAN DISPEPSIA INF RL 8/16/2017 8/18/2017 2 400,000 400,000
36 ROGAYAH OOOO161246711 CIKAPOL DIARE INF RL 8/16/2017 8/20/2017 4 800,000 800,000
37 NIRWAN MAULANA OOO1911124034 CIGOROWONG VOMITUS INF RL 8/17/2017 8/19/2017 2 400,000 400,000
38 ABDUL ROJAK OOOO4413482O8 PADAMULYA HIPERTENSI INF RL 8/17/2017 8/19/2017 2 400,000 400,000
39 RIZZAL AKBAR OOOO41189718 SEDA KIDUL VOMITUS INF RL 8/18/2017 8/20/2017 2 400,000 400,000
40 MAMAR SUHANA OOOO44O358164 PADAMULYA FEVER INF RL 8/18/2017 8/20/2017 2 400,000 400,000
41 NINA KARTINA OOO148O957468 CIJULANG GEA INF RL 8/19/2017 8/21/2017 2 400,000 400,000
42 GINA SALAMAH OOOO44O645139 PASAJEN GEA, KARIES INF RL 8/19/2017 8/21/2017 2 400,000 400,000
43 TETI ROHAYATI OOOO44O533956 KERSAMENAK GASTRITIS INF RL 8/19/2017 8/21/2017 2 400,000 400,000
44 YUHAETI OOOO440511366 PASAJEN GASTRITIS KRONIS INF RL 8/19/2017 8/22/2017 3 600,000 600,000
45 GINA OOOO44O261796 SUMBERJAYA FEBRIS INF RL 8/19/2017 8/21/2017 2 400,000 400,000
46 RIYANA SURYANA OOOO44O912968 DSN. DESA DISPEPSIA INF RL 8/20/2017 8/22/2017 2 400,000 400,000
47 ENCENG WIDJAYA OOO22495OO432 CIDERES HIPERTENSI INF RL 8/21/2017 8/23/2017 2 400,000 400,000
48 RENI HERAWATI OOOO442431347 PANGLIGARAN GASTRITIS AKUT INF RL 8/21/2017 8/23/2017 2 400,000 400,000
49 MOHAMMAD RIFAL OOOO436302944 RAJAMANDALA, RJP GASTRITIS INF RL 8/21/2017 8/23/2017 2 400,000 400,000
50 TOMO OOOOO7166O935 PAMOKOLAN GASTRITIS INF RL 8/21/2017 8/22/2017 1 200,000 200,000
51 YEYE OOOOO71541685 BOJONG DIARE INF RL 8/21/2017 8/23/2017 2 400,000 400,000
52 UUN HOERUDIN OOOO441368188 JENGKOL PANDAK SUSPEC APENDIK INF RL 8/23/2017 8/24/2017 1 200,000 200,000
53 BUNYAMIN OOOOO71681218 DUSUN KALER DISPEPSIA INF RL 8/23/2017 8/25/2017 2 400,000 400,000
54 TITI OOOO44O5285O1 PASAJEN ISPA INF RL 8/24/2017 8/26/2017 2 400,000 400,000
55 DIAH OOOO44OO14116 KERTASARI GASTRITIS INF RL 8/25/2017 8/26/2017 1 200,000 200,000
56 KOSIDIN OOO227O8O1485 SALAJAMBE ANEMIS INF RL 8/26/2017 8/28/2017 2 400,000 400,000
57 ARKHAN YUSUF OOO1669112561 CIHAURBEUTI KEJANG DEMAM INF RL 8/26/2017 8/27/2017 1 200,000 200,000
58 LILIS HERYANI OOOO44O2174O4 SEDA KIDUL GASTRITIS INF RL 8/26/2017 8/28/2017 2 400,000 400,000
59 JAMILUDIN OOOO44O6O2391 SEDA KIDUL GASTRITIS INF RL 8/29/2017 8/31/2017 2 400,000 400,000
60 NURHAYADI OOOO44O886947 CIJULANG GASTRITIS INF RL 8/30/2017 8/31/2017 1 200,000 200,000
61 KARTIKA OOOO44O535442 TONJONG GASTRITIS INF RL 8/30/2017 8/31/2017 1 200,000 200,000
62 AI MAEMUNAH OOOO44O627887 PAMOKOLAN GASTRITIS INF RL 8/30/2017 8/31/2017 1 200,000 200,000
63 USMAN OOOO44O4986O8 CIPEUCEUK APENDIK INF RL 8/27/2017 8/28/2017 1 200,000 200,000
jumlah 25,400,000 25,400,000

Kepala UPTD PKM Cihaurbeut

 HARIS, S.Kep
NIP. 196302071986031015
JUMLAH SELURUH
TAGIHAN
600,000
600,000
600,000
400,000
400,000
400,000
400,000
400,000
400,000
200,000
600,000
600,000
400,000
400,000
200,000
600,000
600,000
200,000
400,000
400,000
200,000
200,000
800,000
400,000
600,000
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400,000
400,000
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 600,000
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400,000
800,000
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600,000
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200,000
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200,000
25,400,000