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ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

256RA1112 K7 IF IH An. Sabila Kaisya P. 11/26/2012

257RB1112 B1 IF DH Ny. Lisa 11/26/2012


264RB1112 RN 11/26/2012

258RB1112 C9 IF HR Ny. Masrifah 11/26/2012


259RA1112 K12 DT/RN IH An. Kent 11/26/2012

261RA1112 K2 RN IH By. Ny. Masrifah 11/26/2012


287RA1112 IF 11/29/2012

262RB1112 A6 RN AA Ny. Tia Rahmawat 11/26/2012


263RA1112 K3 RN SY An. Ghina (an.dr.syarifah) 11/26/2012
265RB1112 C7 DC AA Ny. Kholifah 11/26/2012

268RB1112 A4 DT/EM RY Ny. Yusnita 11/27/2012


279RB1112 DT/RN 11/28/2012

269RA1112 K7 IF SF An. Felicia 11/27/2012


280RA1112 K3 EM 11/28/2012

270RA1112 K11 IF DY An. M. Febrian 11/27/2012


311RA1112 K5 IF 11/30/2012
018RA1212 RN 12/2/2012

271RB1112 C10 IF DH Ny. Mulyana 11/27/2012


276RB1112 DT/RN 11/28/2012
288RB1112 IF 11/29/2012

273RA1112 K4 RN IH An. M. Faza 11/27/2012


274RB1112 C8 DC HR Ny. Helmiat 11/28/2012
275RB1112 C8 DT/RN RY Ny. Widyawat 11/28/2012
278RA1112 K11 DT/RN DY An. Gina Aulia 11/28/2012
281RA1112 K2 EM DY By. Ny. Helmiat I 11/28/2012
282RB1112 K2 EM DY By. Ny. Helmiat II 11/28/2012

284RB1112 C7 IF/EM DH Ny. Rifiana 11/28/2012


294RB1112 A3 IF/EM 11/29/2012
302RB1112 DT 11/30/2012
310RB1112 RN 11/30/2012

285RA1112 K10 IF/EM PR An. A. Rasyid 11/29/2012


301RA1112 DT 11/30/2012
291RA1112 K12 DT hafiz An. Amelia Nadia 11/29/2012

292RA1112 K7 IF/EM IH AN. M. Zhafa 11/29/2012


008RA1212 EM 12/1/2012

293RA1112 K8 IF/EM DY An. M. Alpiannur 11/29/2012


305RA1112 DT 11/30/2012

295RA1112 K12 IF SF An. Gt. Nur Salsabila 11/29/2012


304RA1112 K1 DT 11/30/2012

296RA1112 IF SF An. M. Alifya 11/29/2012


299RA1112 K6 EM SF An. Irhas Khansa 11/30/2012
300RB1112 A4 EM RY Ny. Elfi 11/30/2012

303RB1112 C7 DT NN Nn. Risa Amalia 11/30/2012


001RB1212 IF 12/1/2012

306RA1112 K12 DT RZ An. M. Alifa 11/30/2012

307RB1112 A6 DT RY Ny. Neneng 11/30/2012


003RB1212 IF 12/1/2012
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

309RA1112 K3 RN DY An. Rahmawat 11/30/2012


015RA1212 IF 12/2/2012
021RA1212 DT 12/3/2012
024RA1212 EM 12/3/2012
028RA1212 IF 12/4/2012

002RA1212 K6 IF PR An. Arif rahman 12/1/2012


004RB1212 C9 EM HR Ny. Ika 12/1/2012
005RB1212 A5 EM RY Ny. Erlinda 12/1/2012
006RA1212 K2 EM DY By. Ny. Elfi 12/1/2012
007RB1212 B1 EM BD Ny. Tit Noviant 12/1/2012
009RA1212 K13 EM/RN DY An. Ibnu Abdillah 12/1/2012
010RA1212 K2 RN SF by. Ny. Ika 12/1/2012
011RA1212 K2 DT DY By. Ny. Elfi 12/1/2012
012RB1212 B1 DT DBD Ny. Weli 12/1/2012
014RB1212 A4 IF BD Ny. Helminah 12/2/2012

017RA1212 K7 RN SF An. Ahmad fawaz 12/2/2012


020RA1212 EM 12/3/2012
029RA1212 IF 12/4/2012
045RA1212 EM 12/5/2012
061RA1212 RN 12/7/2012

022RB1212 A6 DT DY By. Ny. Neneng 12/3/2012


023RA1212 K6 EM iskdr An. M. Ridha 12/3/2012
026RA1212 K8 EM iskdr An. Rahmah 12/3/2012

027RA1212 K4 IF IH An. M. Nur Haikal 12/4/2012


039RA1212 RN 12/4/2012

032RB1212 A5 DT RY Ny. Yugairu 12/4/2012


033RB1212 C7 DT RZ Tn. Eddy 12/4/2012
035RB1212 C8 RN YM Tn. Aris Dwi Cahyano 12/4/2012
037RA1212 K1 RN SF An. Yudhi 12/4/2012

041RA1212 K5 RN SF An. Faisal 12/5/2012


046RA1212 DT 12/6/2012
059RA1212 DT 12/7/2012

042RA1212 K12 RN IH An. M. Amin Fadhi 12/5/2012


048RA1212 EM 12/6/2012
058RA1212 DT 12/7/2012
043RB1212 B2 RN RY Ny. Yasmin 12/5/2012
047RB1212 A6 EM AA Ny. Citra Auliana 12/6/2012
049RA1212 K8 EM hafiz An. Nafisah Rahmah 12/6/2012

052RB1212 A3 RN DH Ny. Sinta 12/6/2012


068RB1212 EM 12/7/2012
080RB1212 DT 12/8/2012

054RB1212 A4 RN/DT RY Ny. Listya 12/6/2012


055RB1212 B1 RN/DT RY Ny. Masneng Ratna 12/6/2012

056RB1212 C9 DT rully Ny. Heni (istri om basuki) 12/6/2012


063RB1212 RN 12/7/2012

057RB1212 A5 DT RY Ny. Veronica 12/6/2012

060RA1212 K1 DT SF An. Restu 12/7/2012


062RA1212 RN 12/7/2012
081RA1212 RN 12/8/2012
096RA1212 DT 12/10/2012

064RA1212 K6 RN SF An. Rohimah 12/7/2012

066RB1212 C7 EM YM Ny. Nur Rahmayant 12/7/2012


074RB1212 IF 12/8/2012
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

067RA1212 K12 EM DY An. Rifky Agung 12/7/2012


073RA1212 IF 12/8/2012
097RA1212 K5 DT 12/10/2012
113RA1212 IF 12/11/2012

069RB1212 B2 EM BD Ny. Nina Indri Astut 12/7/2012


072RA1212 K4 EM IH An. Aviceina 12/7/2012

076RB1212 A6 DT RY Ny. Rahmawat 12/8/2012


098RB1212 RN 12/10/2012
110RB1212 IF 12/10/2012

077RB1212 B1 DT RY Ny. Rusmini 12/8/2012

078RA1212 K3 DT DY An. Ryan A. 12/8/2012


089RA1212 IF 12/9/2012
095RA1212 DT 12/10/2012

079RA1212 K7 DT SF An. Novel Irvan 12/8/2012


082RB1212 A4 RN SF Ny. Mavizatun 12/8/2012

083RB1212 A5 RN/EM BD Ny. Novi 12/8/2012


087RB1212 EM 12/9/2012

084RA1212 K4 EM DY An. Aura 12/8/2012


085RA1212 K2 EM SF By.Ny. Rahmawat 12/9/2012
086RA1212 K12 EM felita An. St. Fauzia 12/9/2012

090RA1212 K6 IF DY An. Syifa 12/9/2012


117RA1212 DT 12/11/2012

091RB1212 C8 IF rully Tn. Hendra 12/9/2012


092RB1212 RN 12/9/2012

093RA1212 K7 RN DY An. Keyra Azura 12/9/2012


118RA1212 K4 DT 12/11/2012

100RA1212 K3 RN DY An. M. Rafi'i 12/10/2012


112RA1212 IF 12/11/2012
121RA1212 IF 12/11/2012
134RA1212 DT 12/13/2012

106RB1212 A4 RN HR Ny. Norhayat 12/10/2012


114RB1212 IF 12/11/2012

107RA1212 K8 RN DY An. Ammara 12/10/2012


108RA1212 EM 12/10/2012
115RA1212 IF 12/10/2012

109RB1212 B2 EM RY Ny. Atmi Sugiart 12/10/2012


111RB1212 vk IF DH Ny. Sit Kalsum 12/11/2012
119RB1212 B2 DT RY Ny. Dewi Hanifah 12/11/2012
120RB1212 C8 DT AA Ny. Irine 12/11/2012
122RB1212 C9 EM RY Ny. Heni Fitriani 12/12/2012

124RB1212 A6 RN RY Ny. Raihana 12/12/2012


128RB1212 RN 12/12/2012
136RB1212 DT 12/13/2012

125RB1212 A5 RN AA Ny. Susi 12/12/2012


126RA1212 K3 RN SF An. Ahmad Syafiq 12/12/2012

127RB1212 B2 RN RY Ny. Endang Utari 12/12/2012


140RB1212 RN 12/13/2012
150RB1212 EM 2/14/2012

129RB1212 C7 RN AA Ny. Katarina 12/12/2012


ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

132RA1212 K10 DT SF An. Nadia 12/12/2012


135RA1212 DT 12/13/2012
139RA1212 EM 12/13/2012
148RA1212 EM 12/14/2012
158RA1212 IF 12/15/2012
173RA1212 IF 12/16/2012
185RA1212 EM 12/17/2012

133RA1212 K4 DT SF An. Kholis 12/13/2012


147RA1212 EM 12/14/2012

138RB1212 C8 EM RZ Tn. Ahmad Rifa'i 12/13/2012


156RB1212 RN 12/14/2012
162RB1212 RN 12/15/2012

142RA1212 K1 DT SF An. M. Noor Rafli 12/13/2012


160RA1212 IF 12/15/2012

143RB1212 C9 DT RY Ny. Yuniart 12/13/2012


144RB1212 C10 DT RY Ny. Nurhani 12/13/2012

149RA1212 K6 EM DY An. M. Fathullah 12/14/2012


161RA1212 IF 12/15/2012
172RA1212 IF 12/16/2012

152RB1212 C9 EM DY By. Ny. Yuniart 12/14/2012


153RB1212 B1 EM RY Ny. Sahriyah 12/14/2012
154RB1212 A4 EM/RN iqbal Nn. Nur Amalia (dr.RY) 12/14/2012

155RB1212 A5 RN RY Ny. Fitriani 12/14/2012


169RB1212 IF 12/15/2012

157RA1212 K2 RN SF By. Sit 12/14/2012


159RA1212 K5 IF SF An. Aisya Azaria 12/15/2012
164RB1212 A6 RN RY Ny. Noor Sant 12/15/2012

165RA1212 K9 RN hafiz An. Razitha 12/15/2012


182RA1212 RN 12/16/2012

166RA1212 K1 EM Hafiz An. Maulida (Pa'de warsidi) 12/15/2012


171RA1212 IF 12/16/2012
174RA1212 DT 12/16/2012
186RA1212 EM 12/17/2012
194RA1212 IF 12/18/2012

167RA1212 K4 EM Hafiz An. Maulana 12/15/2012

168RB1212 C7 EM Hafiz Tn. H. Hasbullah 12/15/2012


188RB1212 EM 12/17/2012

170RB1212 C8 IF NN Nn. Nurida 12/16/2012


187RB1212 EM 12/17/2012
193RB1212 IF 12/18/2012

175RB1212 A4 DT RY Ny. Selki 12/16/2012


178RB1212 B2 DT RY Ny. Khusnul G. 12/16/2012

179RA1212 K3 DT SF An. Nayla 12/16/2012


184RA1212 EM 12/17/2012
195RA1212 IF 12/18/2012
213RA1212 IF 12/19/2012

180RB1212 C9 DT RY Ny. Sofa 12/16/2012


183RA1212 K12 RN SF An. Ar Raudah 12/16/2012
200RA1212 K6 RN DY An. Naila 12/18/2012

204RA1212 K10 RN DY An. Adinda 12/18/2012


237RA1212 RN 12/20/2012
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

209RB1212 C9 DT RY Ny. Syariah 12/18/2012


210RB1212 B2 IF RY Ny. Nurul Wadah 12/18/2012

211RA1212 K8 IF DY An. Selvi 12/19/2012


239RA1212 RN 12/20/2012
255RA1212 EM 12/20/2012
268RA1212 DT 12/21/2012

212RA1212 K4 IF SF An. Defla 12/19/2012


238RA1212 RN 12/20/2012
259RA1212 IF 12/21/2012
281RA1212 EM 12/22/2012

214RA1212 K10 IF SF An. M. Rizky 12/19/2012


260RA1212 IF 12/21/2012

222RB1212 A5 EM HR Ny. Retno Wintari 12/19/2012


234RB1212 IF 12/19/2012

223RB1212 C7 EM NN Tn. H. Billy 12/19/2012


241RB1212 RN 12/20/2012
258RB1212 IF 12/21/2012

224RB1212 B1 EM RY Ny. Kurnia 12/19/2012


242RB1212 RN 12/20/2012

225RB1212 C8 EM DN Ny. Susana Dewi 12/19/2012


252RB1212 RN 12/20/2012

226RB1212 A4 EM HR Ny. Susmiat 12/19/2012


228RA1212 K9 EM SF An. Latfah 12/19/2012
233RA1212 K2 IF DY By. Ny. Retno 12/19/2012

235RA1212 K10 DT ridha An. Ghaisan 12/19/2012


270RA1212 DT 12/21/2012
277RA1212 EM 12/21/2012

240RA1212 K5 RN DY An. M. Zamzani 12/19/2012


269RA1212 K11 DT DY An. M. Kaysan 12/21/2012

271RB1212 C8 DT NN Tn. Kurrain 12/21/2012


274RB1212 RN 12/21/2012
279RB1212 EM 12/22/2012
291RB1212 RN 12/23/2012

276RB1212 C7 EM BD Ny. Irmayant 12/21/2012


278RB1212 EM 12/21/2012
284RB1212 DT 12/22/2012

280RA1212 EM SF An. St. Muflinah 12/22/2012


282RB1212 C7 DT DY By. Ny. Irmayant 12/22/2012
287RB1212 A4 RN RY Ny. Theresia 12/22/2012
288RB1212 B1 RN RY Ny. Ajeng 12/22/2012

289RA1212 K7 RN SY An. M. Jova 12/22/2012


297RA1212 EM 12/23/2012
318RA1212 EM 12/24/2012

290RB1212 A5 RN RY Ny. Desi Amalia 12/23/2012


292RB1212 A3 RN RY Ny. Novia 12/23/2012
293RA1212 K4 RN SF An. Nataniel 12/23/2012

295RB1212 B2 RN RY Ny. Milia Atmi 12/23/2012


303RB1212 EM 12/23/2012

298RB1212 A4 EM DY By. Ny. Theresia 12/23/2012


299RA1212 B2 EM SF By. Ny. Milia Atmi 12/23/2012
301RA1212 K6 EM SF An. Qori 12/23/2012
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

304RA1212 K10 DT SF An. M. Aufa 12/23/2012


308RA1212 IF 12/24/2012
325RA1212 RN 12/25/2012

306RA1212 K8 IF DY An. Asep Rahmad R. 12/23/2012


329RA1212 IF 12/25/2012

320RA1212 K5 EM ridha An. M. Lutfhi 12/24/2012

313RB1212 A6 DT BD Ny. Sit Maryat 12/24/2012


322RB1212 EM 12/24/2012

314RA1212 K11 DT SF An. Mita Aulia 12/24/2012


315RA1212 K11 DT DY An. Husna 12/24/2012

316RA1212 K13 EM/IF ridha An. Nurlaila N. 12/24/2012


326RA1212 RN 12/25/2012

317RA1212 K12 EM/IF ridha An. Nurhana 12/24/2012


327RA1212 RN 12/25/2012

321RA1212 K6 EM SF An. Fairuz 12/24/2012

323RA1212 K3 RN SF An. M. Nazerian 12/24/2012


328RA1212 RN 12/25/2012

324RB1212 A4 RN BD Ny. Vera 12/24/2012


331RB1212 IF 12/25/2012

332RB1212 C9 IF RY Ny. Sahrida 12/25/2012


335RB1212 RN 12/25/2012

333RA1212 K5 IF SF An. M. Suriansyah 12/25/2012


336RB1212 C8 IF NN Tn. Sabar 12/25/2012
RATORIUM KLINIK RSIA MUTIARA BUNDA

Jenis pemeriksaan Jumlah Biaya Total

hb,al,at,ht Rp 45,000 Rp 45,000

DLO Rp 65,000
DLO Rp 65,000 Rp 130,000

DLO Rp 65,000 Rp 65,000


DL,led Rp 75,000 Rp 75,000

hb,al,at,ht,gd,gds Rp 70,000
DLO,led,crp Rp 110,000 Rp 180,000

DLO Rp 65,000 Rp 65,000


DLO (25%) Rp 49,000 Rp 49,000
DLO,led, gds,ot,pt,HBs.Ag Rp 190,000 Rp 190,000

DLO,led,gds,ur,cr,ot,pt,Hbs.Ag Rp 230,000
hb,al,dif,wdl Rp 70,000 Rp 300,000

DLO,led,gd Rp 85,000
FL Rp 35,000 Rp 120,000

DLO,led,wdl,ot,pt Rp 145,000
DLO Rp 65,000
UL Rp 25,000 Rp 235,000

DLO,gd,gds,ur,cr,ot,pt,Hbs.Ag Rp 210,000
DLO,wdl,UL Rp 125,000
UL Rp 25,000 Rp 360,000

DLO Rp 65,000 Rp 65,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,IgG,IgM dengue Rp 215,000 Rp 215,000
DLO,led,gd,crp,gds Rp 125,000 Rp 125,000
DLO,led,gd,crp,gds Rp 125,000 Rp 125,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
DLO Rp 65,000
DLO Rp 65,000
hb Rp 15,000 Rp 375,000

DLO,led Rp 75,000
DLO Rp 65,000 Rp 140,000
FL Rp 35,000 Rp 35,000

hb,al,at,ht Rp 45,000
FL Rp 35,000 Rp 80,000

DLO,led,wdl,gds Rp 125,000
FL Rp 35,000 Rp 160,000

DLO,led,wdl Rp 110,000
FL Rp 35,000 Rp 145,000

DLO,led Rp 75,000 Rp 75,000


DLO Rp 65,000 Rp 65,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000

DLO,mal,wdl,ot,pt Rp 155,000
DLO Rp 65,000 Rp 220,000

DLO,mal,wdl,gds,ot,pt Rp 170,000 Rp 170,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
DLO Rp 65,000 Rp 295,000

Total Rp 4,814,000
RATORIUM KLINIK RSIA MUTIARA BUNDA

Jenis pemeriksaan Jumlah Biaya Total

DLO,wdl,gds,ot,pt Rp 135,000
hb,al,at,ht Rp 45,000
IgG,IgM dengue Rp 150,000
hb,at,ht Rp 35,000
hb,al,at,ht Rp 45,000 Rp 410,000

DLO Rp 65,000 Rp 65,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000
DLO,gd,gds,crp Rp 125,000 Rp 125,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000
DLO Rp 65,000 Rp 65,000
DLO,led,gd,gds,crp Rp 135,000 Rp 135,000
gds Rp 15,000 Rp 15,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,gd,Hbs.Ag Rp 120,000 Rp 120,000

DLO,mal,wdl,ot,pt Rp 155,000
hb,at,ht,IgG,IgM dengue Rp 185,000
hb,al,at,ht,gd Rp 55,000
hb,al,at,ht Rp 45,000
hb,at,ht Rp 35,000 Rp 475,000

DLO,gd,gds,crp,bt,bd,bid Rp 185,000 Rp 185,000


DLO,gd,wdl,ot,pt Rp 145,000 Rp 145,000
DLO,wdl,gds,ot,pt Rp 150,000 Rp 150,000

DLO,led, Rp 75,000
FL Rp 35,000 Rp 110,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,ct,bt Rp 85,000 Rp 85,000
DLO,led,ct,bt,gds,ur,cr,ot,pt Rp 195,000 Rp 195,000
DLO,gds,ot,pt Rp 125,000 Rp 125,000

hb,al,at,ht Rp 45,000
hb,al,at,ht Rp 45,000
hb,al,at,ht Rp 45,000

hb,at,ht Rp 35,000
hb,al,at,ht Rp 45,000
hb,al,at,ht,gd Rp 55,000 Rp 135,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,wdl Rp 265,000 Rp 265,000
DLO,wdl,gds,ot,pt Rp 150,000 Rp 150,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO Rp 65,000
DLO Rp 65,000 Rp 370,000

DLO,gd,wdl,hbs.Ag,UL Rp 180,000 Rp 180,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000

DLO,wdl,gds,ur,cr,ot,pt,au (25%) Rp 157,500


FL (25%) Rp 26,000 Rp 183,500

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000

hb,al,at,ht Rp 45,000
UL,FL Rp 60,000
hb,at,ht,IgG,IgM dengue Rp 185,000
hb,al,at,ht Rp 45,000 Rp 335,000

DLO,led,mal,wdl,ot,pt Rp 165,000 Rp 165,000

DLO,gds,ur,cr,ot,pt Rp 155,000
DLO Rp 65,000 Rp 220,000

Total Rp 6,278,500
RATORIUM KLINIK RSIA MUTIARA BUNDA

Jenis pemeriksaan Jumlah Biaya Total

DLO,wdl,ot,pt,bt,bd,bid Rp 195,000
UL Rp 25,000
UL Rp 25,000
ot,pt,bt,bd,bid Rp 95,000 Rp 340,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000


DLO,led,ct,bt Rp 95,000 Rp 95,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO,ct,bt Rp 85,000
DLO Rp 65,000 Rp 390,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000

DLO,wdl,ot,pt Rp 135,000
DLO Rp 65,000
hb,al,at,ht Rp 45,000 Rp 245,000

DLO,wdl Rp 100,000 Rp 100,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
DLO Rp 65,000 Rp 295,000

DLO,wdl,ot,pt Rp 135,000 Rp 135,000


DLO,gd,gds,crp Rp 125,000 Rp 125,000
DLO,wdl,gds,ot,pt Rp 150,000 Rp 150,000

DLO,led,wdl,ot,pt Rp 145,000
DLO Rp 65,000 Rp 210,000

DLO,led,wdl,gds,ur,cr,ot,pt,ch,tg,au Rp 265,000
FL Rp 35,000 Rp 300,000

DLO,led Rp 75,000
hb,al,a,t,ht Rp 45,000 Rp 120,000

DLO,led,wdl,ot,pt Rp 145,000
hb,at,ht,IgG,IgM dengue Rp 185,000
hb,at,ht Rp 35,000
hb,al,at,ht Rp 45,000 Rp 410,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO Rp 65,000 Rp 305,000

DLO,wdl,ot,pt Rp 135,000
UL Rp 25,000
FL Rp 35,000 Rp 195,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000

DLO,wdl Rp 100,000
DLO Rp 65,000
DLO Rp 65,000 Rp 230,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,led,wdl Rp 110,000 Rp 110,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO Rp 65,000
DLO Rp 65,000 Rp 370,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000

Total Rp 6,495,000
RATORIUM KLINIK RSIA MUTIARA BUNDA

Jenis pemeriksaan Jumlah Biaya Total

DLO,IgG,IgM dengue Rp 215,000


hb,al,at,ht Rp 45,000
golda Rp 10,000
hb,al,at,ht Rp 45,000
hb,al,at,ht Rp 45,000
hb,al,at,ht Rp 45,000
hb,at,ht Rp 35,000 Rp 440,000

DLO,wdl,ot,pt,IgG,IgM degue Rp 285,000


hb,al,at,ht Rp 45,000 Rp 330,000

DLO,wdl,ot,pt,mal Rp 155,000
FL Rp 35,000
ot,pt,HBs.Ag Rp 80,000 Rp 270,000

DLO,wdl Rp 100,000
hb,al,at,ht Rp 45,000 Rp 145,000

DLO,led,gd,gds,ur,cr,ot,pt,hbs.Ag Rp 220,000 Rp 220,000


DLO,led,gd,gds,ur,cr,ot,pt,hbs.Ag Rp 220,000 Rp 220,000

hb,at,ht Rp 35,000
hb,al,at,ht,mal,IgG,IgM dengue Rp 215,000
hb,al,at,ht Rp 45,000 Rp 295,000

DLO,gds,crp Rp 125,000 Rp 125,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000
DLO,led,ct,bt,gds,tp (25%) Rp 110,000 Rp 110,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO Rp 65,000 Rp 305,000

DLO,led,gd,crp Rp 120,000 Rp 120,000


hb,al,at,ht Rp 45,000 Rp 45,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000

DLO,mal,wdl Rp 120,000
FL Rp 35,000 Rp 155,000

DLO,wdl (25%) Rp 75,000


hb,al,at,ht (25%) Rp 33,000
IgG,IgM dengue (25%) Rp 112,500
hb,at,ht (25%) Rp 25,000
hb,al,at,ht (25%) Rp 33,000 Rp 278,500

DLO,wdl Rp 100,000 Rp 100,000

DLO,gds,ur,cr,ot,pt Rp 155,000
gds Rp 15,000 Rp 170,000

DLO,led,wdl,ot,pt Rp 145,000
DLO Rp 65,000
DLO Rp 65,000 Rp 275,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000

DLO Rp 65,000
hb,al,at Rp 35,000
hb,al,at,ht Rp 45,000
hb,al,at,ht,wdl Rp 80,000 Rp 225,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,wdl Rp 265,000 Rp 265,000


DLO,led,wdl,ot,pt Rp 110,000 Rp 110,000
DL,wdl,ot,pt Rp 145,000 Rp 145,000

DL,wdl,ot,pt Rp 145,000
hb,at,ht Rp 35,000 Rp 180,000

Total Rp 5,478,500
RATORIUM KLINIK RSIA MUTIARA BUNDA

Jenis pemeriksaan Jumlah Biaya Total

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000

hb,al,at,ht Rp 45,000
hb,at,ht Rp 35,000
hb,at,ht,IgG,IgM dengue Rp 185,000
hb,al,at,ht Rp 45,000 Rp 310,000

hb,al,at,ht Rp 45,000
hb,at,ht Rp 35,000
hb,al,at,ht Rp 45,000
hb,al,at,ht Rp 45,000 Rp 170,000

DLO,led Rp 75,000
hb,al,at,ht,IgG,IgM dengue Rp 195,000 Rp 270,000

DLO,gd,ct,bt,Hbs.Ag Rp 140,000
DLO Rp 65,000 Rp 205,000

DLO Rp 65,000
DLO Rp 65,000
DLO Rp 65,000 Rp 195,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
DLO Rp 65,000 Rp 295,000

gds,ur,cr,ch,tg,hdl,ldl,au,UL Rp 186,000
FL Rp 35,000 Rp 221,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000


DLO,led,mal,wdl Rp 130,000 Rp 130,000
DLO,gd,gds,crp Rp 125,000 Rp 125,000

DLO,wdl Rp 100,000
hb,al,at,ht Rp 45,000
IgG, IgM dengue Rp 150,000 Rp 295,000

DLO,ot,pt Rp 100,000 Rp 100,000


hb,al,at,ht Rp 45,000 Rp 45,000

DLO,gds,ur,cr,ot,pt,ch,tg,hdl,ldl,au Rp 261,000
FL Rp 35,000
DLO Rp 65,000
DLO Rp 65,000 Rp 426,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
UL Rp 25,000
DLO Rp 65,000 Rp 320,000

DLO,led Rp 75,000 Rp 75,000


DLO,gds,crp Rp 115,000 Rp 115,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,led,gd,gds,ur,cr,ot,pt,hbs.Ag Rp 220,000 Rp 220,000

DLO,wdl,gds Rp 115,000
FL Rp 35,000
FL Rp 35,000 Rp 185,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
hb,at,ht,IgG,IgM dengue Rp 185,000 Rp 185,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
DLO Rp 65,000 Rp 295,000

DLO,gd,crp,gds Rp 125,000 Rp 125,000


DLO,gd,crp,gds Rp 125,000 Rp 125,000
DLO,wdl,gds,ot,pt Rp 150,000 Rp 150,000

Total Rp 6,002,000
RATORIUM KLINIK RSIA MUTIARA BUNDA

Jenis pemeriksaan Jumlah Biaya Total

DLO,wdl,ot,pt Rp 135,000
hb,al,at,ht Rp 45,000
hb,at,ht Rp 35,000 Rp 215,000

DLO,wdl,ot,pt Rp 145,000
hb,at,ht Rp 35,000 Rp 180,000

DLO,ot,pt Rp 100,000 Rp 100,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO Rp 65,000 Rp 305,000

DLO,led,wdl,ot,pt Rp 145,000 Rp 145,000


DLO,FL Rp 100,000 Rp 100,000

DLO,wdl,ot,pt Rp 135,000
hb,al,at,ht Rp 45,000 Rp 180,000

DLO,wdl,ot,pt Rp 135,000
hb,al,at,ht Rp 45,000 Rp 180,000

UL Rp 25,000 Rp 25,000

DLO,led,wdl Rp 110,000
FL Rp 35,000 Rp 145,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO Rp 65,000 Rp 305,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO Rp 65,000 Rp 305,000

DLO,led,wdl,gds Rp 125,000 Rp 125,000


DLO,led,wdl,gds,ur,cr,ot,pt,ch,tg,au Rp 275,000 Rp 275,000
Total Rp 2,585,000
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA SEPTEMBER-O

No. Lab Kamar Analis dr. Nama Pasien Tanggal

172RB0913 B2 RN RY Ny. Sri Iswahyuningsih 9/26/2013

173RB0913 C8 RN/EM AA Ny. Diah Dwi Kusuma w. 9/26/2013


174RB0913 TA 9/26/2013
177RB0913 IF 9/27/2013

175RB0913 A5 TA RY Ny. Merzawat 9/26/2013

176RA0913 K8 IF SY An. Rahmawat 9/27/2013


178RA0913 IF 9/28/2013

179RA0913 K12 IF RW Tn. Gt. Khoirudin 9/27/2013


182RA0913 TA 9/28/2013

183RB0913 A6 RN AA Ny. Mellyana Dwi P. 9/28/2013


186RB0913 IF 9/29/2013
194RB0913 TA 9/29/2013

184RA0913 K2 RN SF By. Ny. Mellyana 9/28/2013


185RA0913 K1 IF SF An. Azka 9/28/2013

187RA0913 K3 IF/RN SF An. Khansa 9/29/2013


191RA0913 RN 9/29/2013

189RA0913 K8 RN SF An. Gt. Najmi Safira 9/29/2013


190RA0913 K6 RN IH An. Austn 9/29/2013

192RA0913 K4 RN ifiq An. M. Iqbal Ramdhan 9/29/2013


193RA0913 TA 9/29/2013

195RA0913 K10 TA isd An. Alya Salsabila 9/29/2013


196RA0913 TA 9/29/2013

197RB0913 C8 TA DH Ny. Aminah 9/29/2013


198RA0913 K9 TA ifiq An. Dio Ananta wijaya 9/29/2013

199RA0913 K11 TA ifiq An. Noor Nafi'ah 9/29/2013


201RA0913 RN 9/30/2013
206RA0913 EM 9/30/2013

200RA0913 K12 TA SF An. M. Farhan 9/30/2013


207RB0913 C7 IF/EM DH Ny. Gt. Hanisah 9/30/2013
001RB0913 A5 IF/EM BD Ny. Putri 10/1/2013
002RB1013 C9 IF/EM RY Ny. Raida 10/1/2013
003RA1013 K10 EM isd Tn. Munjirin 10/1/2013

004RB1013 C7 RN RZ Ny. Rusmaniah (ortu zaki) 10/1/2013


008RB1013 TA 10/2/2013

005RA1013 K8 RN RZ An. Haritsa 10/1/2013

009RB1013 A4 TA RY ny. Ratna Budiart 10/2/2013


017RB1013 IF 10/3/2013
021RB1013 EM 10/4/2013

010RB1013 C8 EM HL Tn. Triyanto 10/2/2013


034RB1013 TA 10/6/2013

013RA1013 K5 RN IH An. Bintang 10/3/2013


014RB1013 vk RN RY Ny. Sri wafini 10/3/2013
015RA1013 K1 RN IH An. Afifa Firni 10/3/2013

018RA1013 K7 IF RZ An. Sherly Diant 10/3/2013


020RA1013 EM 10/4/2013

022RA1013 K10 RN SF An. Hanifa Salma 10/4/2013


ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA SEPTEMBER-O

No. Lab Kamar Analis dr. Nama Pasien Tanggal

023RA1013 K3 TA ifiq An. Daffa 10/4/2013


024RA1013 TA SF 10/4/2013
044RA1013 EM 10/6/2013

026RA1013 K2 TA isd by. Putri 10/4/2013


032RA1013 RN SF 10/5/2013

028RB1013 B2 EM RY Ny. Khairunnisa 10/5/2013


035RB1013 IF 10/6/2013

029RB1013 C7 EM RY Ny. Nor Jaidah 10/5/2013

030RB1013 A5 EM BD Ny. Suparniawat 10/5/2013


042RB1013 EM 10/6/2013
048RB1013 RN 10/7/2013
055RB1013 EM 10/7/2013

031RB1013 C9 EM RZ Ny. Ruliana 10/5/2013

033RA1013 K12 RN RZ Nn. Maulida 10/5/2013


039RA1013 EM 10/6/2013
052RA1013 TA 10/7/2013

037RA1013 K5 IF SF An. Aura Zafira 10/6/2013

038RB1013 A6 IF RY Ny. Adinda 10/6/2013


041RB1013 EM 10/6/2013
056RB1013 EM 10/7/2013
060RB1013 EM 10/8/2013

043RB1013 C8 EM RY Ny. Fara l. 10/6/2013


049RB1013 RN 10/7/2013

046RB1013 C8 RN/EM SF By. Ny. Fara L. 10/6/2013


064RB1013 TA 10/8/2013
080RA1013 K2 IF 10/10/2013

047RB1013 A4 RN/EM RY Ny. Putri 10/6/2013

050RB1013 C7 RN RY Ny. Nur Aida 10/7/2013


072RB1013 IF 10/8/2013
079RB1013 IF 10/10/2013
083RB1013 EM 10/10/2013

051RB1013 C9 TA DH Ny. Indri 10/7/2013


059RB1013 EM 10/8/2013

058RB1013 B2 EM AA Ny. Rosi 10/8/2013


063RB1013 TA 10/8/2013

062RA1013 K1 TA RZ An. M. Amin 10/8/2013


065RA1013 TA 10/8/2013

066RA1013 K2 TA DN by. Ny. Maria Ulfah 10/8/2013


081RA1013 IF SF 10/10/2013

067RA1013 K12 TA DN Nn. Risna Sofia 10/8/2013


068RA1013 RN RW 10/8/2013

070RB1013 C10 RN DH Ny. Ike 10/8/2013


075RB1013 RN 10/9/2013

074RB1013 B2 RN DH Ny. Rina ermona 10/9/2013


088RB1013 IF 10/11/2013
092RB1013 RN 10/12/2013
098RB1013 IF 10/12/2013
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA SEPTEMBER-O

No. Lab Kamar Analis dr. Nama Pasien Tanggal

076RA1013 K4 RN RZ An. Gracia 10/9/2013


077RA1013 TA PR 10/9/2013
089RA1013 TA 10/11/2013
090RA1013 TA 10/11/2013

084RB1013 A4 EM RY Ny. Fitra 10/10/2013


086RB1013 EM 10/10/2013

091RB1013 A6 EM DH Ny. Syahriat 10/11/2013


096RB1013 IF 10/12/2013

093RB1013 A5 RN/TA RY Ny. Fatn 10/12/2013


100RB1013 EM 10/13/2013

094RA1013 K1 TA RZ An. M. Syaroni 10/12/2013


095RB1013 C8 TA RZ Ny. Mia 10/12/2013
097RB1013 C7 IF RZ Tn. Daso Ami 10/12/2013
101RA1013 K3 IF ifiq An. Nazhirela Hadi 10/13/2013
102RA1013 K8 IF Ifiq An. M. Nazwan Hanif 10/13/2013
107RA1013 K4 EM ISD An. Andra 10/15/2013
108RA1013 K1 IF isd An. Ahmad Ilham 10/15/2013

109RB1013 C8 IF isd Tn. Asikin 10/15/2013


112RB1013 RN rully 10/16/2013
119RB1013 IF 10/17/2013

110RA1013 K5 RN isd An. M. Michel 10/15/2013


111RA1013 RN 10/16/2013

122RA1013 K8 TA/EM RZ An. Nita Arlita 10/17/2013


125RA1013 TA SF 10/18/2013

123RA1013 K7 RN/TA RZ An. M. Daffa 10/18/2013

128RA1013 K5 RN/TA ifiq An. Putri Aulia R. 10/18/2013


138RA1013 IF 10/20/2013

132RA1013 K6 IF PR An. Gabriel Praka 10/19/2013


133RB1013 B2 IF RY Ny. Nur Heppy 10/19/2013
142RB1013 C8 RN isd Tn. H. Arifin 10/21/2013
144RB1013 C7 EM RZ Tn. Misbahul Anwar 10/21/2013
146RB1013 TA RW 10/21/2013

145RA1013 K1 EM RZ Tn. M. Irfan (ortu talita) 10/21/2013

147RB1013 B2 EM RY Ny. Fitriani 10/22/2013


155RB1013 EM 10/23/2013

151RA1013 K4 RN RZ An. Yusuf 10/23/2013


152RB1013 A4 RN DH Ny. Retno 10/23/2013

153RA1013 K5 EM SF An. Laura R. 10/23/2013


157RA1013 IF 10/24/2013

156RB1013 A5 EM RY Ny. Monica 10/23/2013

161RB1013 A6 IF RY Ny. Tri Mursini 10/24/2013


174RB1013 EM 10/25/2013

162RB1013 A5 RN RY Ny. Murtni 10/24/2013


165RB1013 IF 10/24/2013

163RB1013 C8 IF RY Ny. Anita 10/24/2013


166RB1013 IF 10/24/2013
168RB1013 TA 10/24/2013
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA SEPTEMBER-O

No. Lab Kamar Analis dr. Nama Pasien Tanggal

164RB1013 C9 IF AA Ny. Ummi Hani 10/24/2013


167RA1013 K8 TA ifiq An. Afika April Jasmine 10/24/2013
170RB1013 A4 TA/EM BD Ny. Ririn 10/25/2013
177RB1013 C7 EM AA Ny. Linda 10/25/2013

Total
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA OKTOBER-NO

No. Lab Kamar Analis dr. Nama Pasien Tanggal

178RB1013 C10 RN BD Ny. Nur Padillah 10/26/2013


179RB1013 B2 RN RY Ny. Murtni 2 10/26/2013
180RB1013 C7 RN AA Ny. Lindda 10/26/2013

181RA1013 K4 RN SF An. A. Yusuf 10/26/2013


190RB1013 IF 10/27/2013

184RB1013 B2 TA RY Ny. Dyah 10/26/2013


189RB1013 IF 10/27/2013

186RA1013 K1 IF IH An. Ayra 10/26/2013


197RB1013 IF 10/27/2013

187RA1013 K3 IF ifiq An. Naqib 10/26/2013


191RA1013 IF 10/27/2013

188RA1013 K7 IF SF An. Rizky Fadilah 10/27/2013


196RB1013 C7 IF RY Ny. Mellyana 10/27/2013
198RA1013 K5 TA ifiq An. Naiza 10/27/2013
199RA1013 K4 EM ifiq An. Nailisa (k'asniah) 10/27/2013

201RA1013 K12 RN ISD An. Yanda 10/28/2013


218RA1013 K6 IF HL 10/31/2013
024RA1113 TA 11/4/2013

202RB1013 C8 RN RY Ny. Sit Masrofah 10/28/2013


207RB1013 IF 10/29/2013

203RB1013 A4 RN RY Ny. Mahrida 10/28/2013


210RB1013 TA 10/30/2013

204RB1013 A5 TA RY Ny. Sit Khadijah 10/28/2013

205RB1013 C9 IF DH Ny. Eni 10/28/2013


004RB1013 IF wahyu 11/1/2013
012RB1113 EM 11/2/2013

206RB1013 C8 IF SF By. Ny.Sit Masrofah 10/29/2013


208RA1013 K3 RN ifiq An. Sanah 10/29/2013
209RB1013 C7 TA yusran Tn. H. Murjani 10/30/2013
214RB1013 EM 10/30/2013
222RB1013 RN 10/31/2013

211RB1013 B2 EM RY Ny. Masitah 10/30/2013


225RB1013 EM 10/31/2013

212RA1013 K8 EM ISD An. M. Naufal 10/30/2013


216RA1013 EM 10/30/2013

213RB1013 A5 EM RY Ny. Nadiatul 10/30/2013


220RB1013 IF 10/31/2013

221RA1013 K5 RN IH An. Nazia 10/31/2013

224RA1013 K5 RN ifiq An. M. Ali Ashgan 10/31/2013


017RAS1113 roy IH 11/3/2013

226RB1013 C8 EM RW Ny. Desi 10/31/2013


228RB1013 EM 10/31/2013

003RB1113 vk EM ISD Ny. Nor Hana 11/1/2013

005RA1113 K8 IF SF An. Alea 11/2/2013


015RA1113 K1 roy 11/3/2013
025RA1113 TA 11/4/2013
032RA1113 EM 11/5/2013
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA OKTOBER-NO

No. Lab Kamar Analis dr. Nama Pasien Tanggal

006RA1113 K7 RN ISD An. Darraz Faiqh 11/2/2013

008RA1113 K13 RN ISD Tn. Tri Susanto 11/2/2013


014RA1113 IF RW 11/3/2013
023RA1113 TA 11/4/2013
036RA1113 RN 11/5/2013
040RA1113 IF 11/6/2013

010RB1113 vk RN DH Ny. Erni Erawat 11/2/2013


011RA1113 ra EM hafiz An. Rizka Aulia Putri 11/2/2013

016RB1113 A6 roy RY Ny. Desma 11/3/2013


019RB1113 RN 11/3/2013

018RB1113 vk RN BD Ny. Reka Damayant 11/3/2013


022RB1113 vk TA RY Ny. Sri Suhartna 11/3/2013

028RA1113 K4 EM DY An. Tri andin 11/4/2013


030RA1113 EM 11/4/2013

029RB1113 C8 EM wahyu Nn, Mia 11/4/2013

037RA1113 K1 RN SF An. Arini Nur Hikmah 11/5/2013


041RA1113 IF 11/6/2013

039RA1113 K7 RN ISD AN. Arissa 11/5/2013


043RB1113 A6 RN DH Ny. Yuliant 11/6/2013
044RA1113 K3 IF ISD An. Keysa 11/6/2013

045RA1113 K5 IF DY An. Hanifa 11/6/2013


047RA113 IF 11/6/2013

046RB1113 vk IF RY An. Heldia 11/6/2013


049RB1113 IF 11/7/2013
053RB1113 EM 11/7/2013

052RA1113 K6 RN DN An. M. Azzam 11/7/2013

057RB1113 A4 TA RY Ny. Ummi (bidan ) 11/8/2013


060RB1113 IF 11/8/2013
065RA1113 K7 EM ifiq An. Azka K 11/10/2013
066RA1113 RN IH 11/10/2013

068RA1113 K6 TA hafiz An. Rofi Akbar 11/10/2013


069RB1113 A5 TA RY Ny. Siska Dewi 11/11/2013
070RA1113 K1 RN SF An. M. Daffa Fitri Aretna 11/11/2013
071RB1113 C7 RN RY Ny. Hj. Elisa 11/11/2013
074RB1113 A6 TA BD Ny. Silvia Renata 11/12/2013

075RB1113 C7 RN ISD Ny. Hanisah 11/12/2013


081RB1113 EM RW 11/13/2013

077RA1113 K4 RN SF An. M. Adly 11/12/2013

078RA1113 K4 RN SF An. M. Adyaksa R.A 11/12/2013


080RA1113 IF 11/13/2013

079RB1113 B2 IF RY Ny. Sit Fatmah 11/12/2013


082RB1113 C9 EM RY Nn. Ika 11/13/2013
085RA1113 K6 RN hafiz An. Salsabila Q. 11/13/2013

088RA1113 K3 TA RZ An. M. Avisena 11/14/2013


090RA1113 TA 11/14/2013

089RB1113 A5 TA RY Ny. Ina Wangsih 11/14/2013


091RB1113 TA 11/14/2013
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA OKTOBER-NO

No. Lab Kamar Analis dr. Nama Pasien Tanggal

092RB1113 C8 TA DH Ny. Hj. Maulidah 11/14/2013


094RA1113 K12 IF ifiq An. Olivia 11/14/2013
095RA1113 K1 RN ISD An. Wulan 11/15/2013

099RB1113 A6 EM RY Ny. Mastuah 11/15/2013


101RB1113 RN 11/16/2013

100RA1113 K2 EM DY By. Abisatya 11/16/2013

102RB1113 C7 TA Ifiq Tn. Aliansyah 11/16/2013


103RB1113 IF RW 11/16/2013
110RB1113 IF 11/17/2013
112RB1113 TA 11/18/2013
130RB1113 IF 11/19/2013
137RB1113 EM 11/20/2013
141RB1113 RN 11/21/2013
148RB1113 IF 11/22/2013
161RB1113 IF 11/23/2013
173RB1113 IF 11/24/2013
176RB1113 TA 11/25/2013

105RB1113 A5 IF RY Ny. Anita Maulida 11/17/2013


114RB1113 TA 11/18/2013

106RA1113 K2 IF DY By. Ny. Mastuah 11/17/2013

111RB1113 C8 RN ifiq Ny. Wiwit H. 11/17/2013


132RB1113 TA HL 11/19/2013

118RB1113 A4 RN RY Ny. Sri Damasari 11/18/2013


119RB1113 B2 RN RY Ny. Ria Susant 11/18/2013
120RA1113 K9 RN Rully Ny. Ludi W. 11/18/2013

121RB1113 C9 RN BD Ny. Rabiatul Adawiyah 11/18/2013


125RB1113 EM 11/18/2013

122RA1113 K2 RN DY By. NY. Anita 11/18/2013


123RB1113 C9 RN DY By. Ny. Rabiatul A. 11/18/2013
126RA1113 K4 EM DY An. Callista 11/18/2013
128RA1113 K5 EM DY An. Kalista 11/18/2013
133RA1113 TA 11/19/2013

134RB1113 B2 RN RY Ny. Qusina Sari 11/19/2013


136RB1113 vk RN DH Ny. Eva 11/19/2013

138RB1113 A4 TA RY NY. Halimah 11/20/2013


143RB1113 TA 11/21/2013
147RB1113 IF 11/22/2013
159RB1113 TA 11/22/2013

139RB1113 A6 TA RY Ny. Ratna Ningsih 11/20/2013


140RB1113 RN 11/21/2013

144RA1113 K8 TA ifiq An. Melda S. 11/21/2013


145RA1113 K6 IF ifiq An. M. Aqil 11/21/2013

146RA1113 K5 IF ifiq An. Ahla Putri 11/22/2013


169RA1113 EM IH 11/23/2013

149RB1113 A5 IF RY Ny. Ellis 11/22/2013


153RB1113 TA 11/22/2013
155RB1113 TA 11/22/2013

152RB1113 A5 TA ifiq By. Ny. Ellis Appe 11/22/2013

154RA1113 K3 TA ifiq An. Vanessa 11/22/2013


157RA1113 TA 11/22/2013
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA OKTOBER-NO

No. Lab Kamar Analis dr. Nama Pasien Tanggal

156RA1113 K7 TA ifiq An. Nadifa Aqia 11/22/2013


158RA1113 TA ifiq 11/22/2013

160RB1113 C8 IF RY Ny. Nunung 11/22/2013


163RB1113 B2 EM RY Ny. Fani 11/23/2013
164RA1113 K10 EM RZ An. Azka 11/23/2013
168RB1113 A6 EM RY Ny. Riani Ayu 11/23/2013
172RA1113 K5 IF IH An. Ihsan Aditya 11/23/2013
174RB1113 vk EM RY Ny. Maria 11/24/2013

179RA1113 K12 EM IH An. Cyndi 11/25/2013


181RA1113 EM 11/25/2013

183RA1113 K4 EM hafiz An. Azfar Aiman W. 11/25/2013


184RB1113 C8 EM RY Ny. Juraidah 11/25/2013
185RB1113 C7 EM DH Ny. Zakiah 11/25/2013
186RA1113 K6 EM ifiq An. Cleodora 11/25/2013

Total
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA NOVEMBER-D

No. Lab Kamar Analis dr. Nama Pasien Tanggal

187RB1113 C7 RN DH Ny. Zakiah 11/26/2013

188RB1113 A4 RN DH NY. Juaeriyah 11/26/2013


190RB1113 RN 11/26/2013

191RB1113 A6 RN RY Ny. Anita Amelina 11/26/2013


192RB1113 A5 RN RY Ny. Melina 11/26/2013
194RA1113 K8 IF ifiq An. M. Afif W. 11/26/2013

195RB1113 A4 IF RY Ny. khairani Fatma 11/27/2013


203RB1113 IF 11/27/2013
206RB1113 EM 11/28/2013
218RB1113 RN 11/29/2013

200RB1113 B2 EM DH Ny. Sariyah 11/27/2013


215RB1113 RN 11/29/2013
227RB1113 EM 11/29/2013
231RB1113 TA 11/30/2013
006RB1213 RN 12/1/2013
011RB1213 EM 12/2/2013

201RA1113 K12 EM IH An. Cyndi 11/27/2013


202RB1113 A4 IF RZ By. Ny. Chairani Fatma 11/27/2013

205RB1113 C8 EM RY Ny. Erna 11/28/2013


212RB1113 IF 11/28/2013

207RB1113 C9 EM RY Ny. Ayu 11/28/2013


208RA1113 K2 IF hfz Bny. Ny. Erna 11/28/2013

209RA1113 K5 IF RZ Nn. Nia 11/28/2013


217RA1113 RN Sf 11/29/2013
228RA1113 EM An. Nia Ramadhani 11/30/2013
003RA1213 IF 12/1/2013

210RA1113 K2 IF SF By. Ny. Sariyah 1 11/28/2013


211RA1113 K2 IF SF By. Ny. Sariyah 2 11/28/2013
213RB1113 A5 RN RY Ny. Anggie Thesa 11/28/2013

214RA1113 K1 RN ISD An. M. Nasuha 11/29/2013


220RA1113 TA DY 11/29/2013

216RB1113 C9 RN AA Ny. Syefi 11/29/2013


219RA1113 K12 RN IH An. Marcelinus 11/29/2013
226RB1113 A6 EM RY Ny. Nikade 11/29/2013

229RA1113 K7 RN RZ An. M. Alvin 11/30/2013


001RA1213 K3 IF SF An. Noor Fajri 12/1/2013

007RA1213 K10 RN Ridha An. M. Widodo 12/1/2013


020RA1213 IF SF 12/3/2013

008RB1213 C7 TA RW Nn. Rifka 12/2/2013


009RB1213 A5 TA BD Ny. dr. Rahma 12/2/2013
010RA1213 K6 EM hafiz An. Azizah 12/2/2013

014RB1213 C7 EM hfz Nn. Putri Pancar Indah 12/2/2013


018RB1213 RN RW 12/2/2013

019RA1213 K3 RN IH An. M. Ragam 12/2/2013


023RA1213 K8 TA DY An. M. Afrizal 12/3/2013

024RB1213 A4 RN DH Ny. Ika Andriani 12/3/2013


027RB1213 EM 12/4/2013

025RA1213 K12 RN PR An. Adelia Putri 12/3/2013


026RB1213 C8 TA DH Ny. Hj. Maulidah 12/4/2013
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA NOVEMBER-D

No. Lab Kamar Analis dr. Nama Pasien Tanggal

028RB1213 B2 EM DH Ny. Abidah 12/4/2013

024RB1213 C7 IF DH Ny. Rabiatul 12/4/2013


026RB1213 IF 12/5/2013

025RB1213 A6 IF DH Ny. Syarifah nur farah 12/5/2013


031RB1213 TA 12/5/2013

028RA1213 K5 RN hfz An. M. Wildan 12/5/2013


032RA1213 TA 12/5/2013

029RB1213 A5 RN RY Ny. Helmiyat 12/5/2013


033RB1213 B2 TA BD Ny. Iriana Lestari 12/5/2013

035RA1213 K3 IF DY An. Gina Rahmatka 12/6/2013


046RA1213 RN 12/8/2013

036RB1213 A6 EM IH By. Ny. Syarifah Nur Farah 12/6/2013


037RB1213 A4 RN IH By. Ny. Ika Andriani 12/6/2013

038RB1213 A6 IF DH Ny. Jamilah 12/6/2013


042RB1213 IF 12/7/2013
044RB1213 TA 12/7/2013
055RB1213 RN 12/9/2013

041RB1213 rb IF felita Tn. M. Feri Mahmud 12/7/2013


043RB1213 B2 TA RY Ny. Hiliwatn Nazwa 12/7/2013

045RA1213 K2 RN IH By. Ny. Jamilah 12/8/2013


069RA1213 TA 12/13/2013

047RB1213 vk IF RY Ny. Ledy Tia Saputry 12/8/2013


048RA1213 K3 IF DY An. Nazira 12/8/2013
049RB1213 A4 TA wahyu Ny. Norhasanah 12/8/2013
050RB1213 C9 TA AA Ny. Windi 12/8/2013
051RB1213 C9 EM hfz By. Ny. Windi 12/9/2013

054RA1213 K8 RN ISD An. M. Naufal 12/9/2013


064RA1213 RN SF 12/11/2013
056RA1213 K10 RN ISD An. Rasya nabil 12/9/2013
059RB1213 B2 IF RY Ny. Sholehah 12/9/2013
060RA1213 K5 RN RZ An. Vigor Hanasta Sinaga 12/10/2013
062RA1213 K6 TA RZ An. Sweety 12/11/2013
065RB1213 C9 RN DH Ny. Toyibah (om dadang) 12/11/2013
066RA1213 K4 EM SY An. M. Zaki 12/12/2013
068RB1213 A5 IF RY Ny. Rezeki Damayant 12/13/2013
070RB1213 C7 TA AA Ny. Fatma 12/13/2013
071RB1213 A6 TA RY Ny. Rini Indrawat 12/13/2013

074RB1213 B2 RN AA Ny. Sahdiah 12/13/2013


076RB1213 IF 12/14/2013

077RA1213 ra TA SY An. Naja 12/14/2013


081RA1213 K7 TA hfz An. Syifa Azkia 12/16/2013

082RA1213 K8 TA hfz An. Ayyas Fiqri 12/16/2013


089RA1213 TA DY 12/17/2013
097RB1213 EM 12/18/2013

084RB1213 C8 TA RY Ny. Muliana Ulfah 12/16/2013


086RB1213 C9 RN RY Ny. Erna Setyawat 12/16/2013

087RB1213 C7 IF DH Ny. Aini 12/17/2013


090RB1213 TA 12/17/2013

088RA1213 K2 TA SF By. Ny. Muliana Ulfah 12/17/2013


ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA NOVEMBER-D

No. Lab Kamar Analis dr. Nama Pasien Tanggal

093RA1213 K2 RN hfz An. Sit Munawarah 12/17/2013


094RB1213 A4 EM RY Ny. Tika 12/18/2013

095RA1213 K11 EM ifiq An. Naufal 12/18/2013


111RA1213 IF DY 12/19/2013

098RB1213 A6 RN BD Ny. Hevi 12/18/2013


099RB1213 B2 RN AA Ny. Sri Rezeki 12/18/2013
105RA1213 K2 IF SF By. Ny. Hevi 12/18/2013
106RA1213 K4 IF ridha An. Kamil Zaidan 12/18/2013
109RB1213 vk RN RY Ny. Rahmatul 12/19/2013
110RB1213 C9 IF DH Ny. Mariatul 12/19/2013

112RA1213 K5 TA ISD By. Aditya 12/20/2013


113RA1213 EM 12/20/2013

114RB1213 A5 EM RY Ny. Qurratul 12/20/2013


118RA1213 K3 EM ISD An. Syafa 12/20/2013
123RB1213 A4 RN RY Ny. Fatmawat 12/21/2013
125RA1213 K6 TA ISD An. Rifki Azka 12/21/2013

126RB1213 A5 IF RY Ny. Masitoh 12/22/2013


131RB1213 EM 12/23/2013

129RB1213 A4 RN AA Ny. Debby 12/23/2013


134RA1213 K3 TA Ridha An. Nurhayah 12/23/2013
138RB1213 A6 TA RY Ny. Endang 12/25/2013
Total
KLINIK RSIA MUTIARA BUNDA SEPTEMBER-OKTOBER 2013

Jenis pemeriksaan Jumlah Biaya Total

DLO Rp 65,000 Rp 65,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000
DLO Rp 65,000
DLO Rp 65,000 Rp 395,000

DLO Rp 65,000 Rp 65,000

DLO,wdl,gds, Rp 115,000
FL Rp 35,000 Rp 150,000

gds Rp 15,000
gds Rp 15,000 Rp 30,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO Rp 65,000
DLO Rp 65,000 Rp 370,000

DLO,gd,gds,crp Rp 125,000 Rp 125,000


DLO,wdl,ot,pt Rp 135,000 Rp 135,000

DLO,wdl,gds Rp 120,000
FL Rp 35,000 Rp 155,000

DLO,wdl Rp 100,000 Rp 100,000


DLO,gd,wdl Rp 110,000 Rp 110,000

DLO,gd,wdl Rp 75,000
FL Rp 35,000 Rp 110,000

DLO,wdl,ot,pt Rp 135,000
FL Rp 35,000 Rp 170,000

DLO,gd,gds,ur,cr,ot,pt,hbs.Ag Rp 210,000 Rp 210,000


DLO,mal,wdl Rp 120,000 Rp 120,000

DLO Rp 65,000
FL Rp 35,000
FL Rp 35,000 Rp 135,000

DLO,wdl,ot,pt Rp 135,000 Rp 135,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000 Rp 265,000
DLO,wdl Rp 100,000 Rp 100,000

DLO,led,mal,gds,ur,cr,ot,pt,au (25%) Rp 153,750


hb,at,ht,gds (25%) Rp 37,500 Rp 191,250

DLO,mal,wdl,ot,pt Rp 155,000 Rp 155,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 255,000
DLO Rp 65,000
DLO Rp 65,000 Rp 385,000

DLO,ur,cr,ot,pt,au Rp 160,000
UL Rp 25,000 Rp 185,000

DLO,led Rp 75,000 Rp 75,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,fl Rp 100,000 Rp 100,000

DLO,led,wdl,ot,pt Rp 145,000
FL Rp 35,000 Rp 180,000

DLO,mal,wdl,gds Rp 135,000 Rp 135,000

Total Rp 5,061,250
KLINIK RSIA MUTIARA BUNDA SEPTEMBER-OKTOBER 2013

Jenis pemeriksaan Jumlah Biaya Total

DLO,wdl Rp 100,000
FL Rp 35,000
FL Rp 35,000 Rp 170,000

Dlo,bt,bd,bid,crp Rp 160,000
bt,bd,bid Rp 60,000 Rp 220,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000
DLO Rp 65,000 Rp 330,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 255,000 Rp 255,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
DLO Rp 65,000
DLO Rp 65,000
DLO Rp 65,000 Rp 425,000

DLO,mal,wdl,ot,pt,bt,bd,bid Rp 215,000 Rp 215,000

DLO,gd Rp 75,000
DLO Rp 65,000
DLO Rp 65,000 Rp 205,000

DLO,wdl,ot,pt Rp 135,000 Rp 135,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
UL Rp 25,000
DLO Rp 65,000
DLO Rp 65,000 Rp 395,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
DLO Rp 65,000 Rp 295,000

DLO,gd,grp Rp 110,000
DLO,gds,bt,bd,bid,crp Rp 175,000
bt,bd,bid Rp 60,000 Rp 345,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO Rp 65,000
DLO,gds,ur,cr,ot,pt,bt,bd,bid Rp 215,000
DLO Rp 65,000 Rp 585,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
DLO Rp 65,000 Rp 295,000

DLO,gd,ct,bt,hbs.Ag Rp 140,000
wdl Rp 35,000 Rp 175,000

DLO,wdl,ot,pt Rp 135,000
FL Rp 35,000 Rp 170,000

DLO,gds,ot,pt,bt,bd,bid Rp 175,000
bt,bd,bid Rp 60,000 Rp 235,000

DLO,gds Rp 80,000
wdl,UL Rp 60,000 Rp 140,000

DLO,led,gd,ct,bt,hbs.Ag Rp 150,000
DLO Rp 65,000 Rp 215,000

DLO,led,gd,ct,bt,hbs.Ag,gds Rp 165,000
DLO Rp 65,000
DLO Rp 65,000
DLO Rp 65,000 Rp 360,000

Total Rp 5,405,000
KLINIK RSIA MUTIARA BUNDA SEPTEMBER-OKTOBER 2013

Jenis pemeriksaan Jumlah Biaya Total

DLO,led,gd,wdl Rp 120,000
FL Rp 35,000
FL Rp 35,000
DLO,led,wdl Rp 110,000 Rp 300,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
UL Rp 25,000 Rp 265,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
DLO Rp 65,000 Rp 295,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000
DLO Rp 65,000 Rp 330,000

DLO,mal,wdl,ot,pt Rp 155,000 Rp 155,000


DLO,wdl,gds,ot,pt Rp 150,000 Rp 150,000
DLO,led,gds,ur,cr,ot,pt,ch,tg,hdl,ldl,au Rp 271,000 Rp 271,000
DLO,wdl Rp 100,000 Rp 100,000
DLO,wdl Rp 100,000 Rp 100,000
DLO,mal,wdl,ot,pt,crp Rp 190,000 Rp 190,000
DLO,mal,wdl,ot,pt, Rp 155,000 Rp 155,000

DLO,led,gds,ur,cr,ot,pt,ch,tg,hdl,ldl,au Rp 271,000
gds Rp 15,000
DLO Rp 65,000 Rp 351,000

DLO Rp 65,000
FL Rp 35,000 Rp 100,000

DLO,wdl,ot,pt Rp 135,000
FL Rp 35,000 Rp 170,000

DLO,mal,wdl,ot,pt Rp 155,000 Rp 155,000

DLO,wdl,ot,pt Rp 135,000
FL Rp 35,000 Rp 170,000

DLO,led,wdl Rp 120,000 Rp 120,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000 Rp 265,000
DLO,gds,ur,cr,ot,pt,UL Rp 180,000 Rp 180,000
DLO,mal,wdl,ot,pt,bt,bd,bid Rp 215,000
UL Rp 25,000 Rp 240,000

DLO,wdl,ot,pt,mal Rp 155,000 Rp 155,000

DLO,ct,bt,gd,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 255,000
DLO Rp 65,000 Rp 320,000

DLO,mal,wdl,ot,pt Rp 155,000 Rp 155,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000

DLO Rp 65,000
FL Rp 35,000 Rp 100,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000
DLO Rp 65,000 Rp 330,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000
DLO Rp 65,000 Rp 330,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
UL Rp 25,000
FL Rp 35,000 Rp 300,000

Total Rp 6,222,000
KLINIK RSIA MUTIARA BUNDA SEPTEMBER-OKTOBER 2013

Jenis pemeriksaan Jumlah Biaya Total

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,led,gd,wdl Rp 120,000 Rp 120,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000
DLO,gd,gds,ur,cr,ot,pt,hbs.Ag Rp 210,000 Rp 210,000

Rp 5,061,250
Rp 5,405,000
Rp 6,222,000
Rp 800,000

Rp 17,488,250
Total Rp 800,000
KLINIK RSIA MUTIARA BUNDA OKTOBER-NOVEMBER 2013

Jenis pemeriksaan Jumlah Biaya Total

DLO,led,gd,ct,bt,hbs.Ag Rp 150,000 Rp 150,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO Rp 65,000 Rp 65,000

DLO,led,mal,wdl,ot,pt,ul Rp 190,000
FL Rp 35,000 Rp 225,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 255,000
DLO Rp 65,000 Rp 320,000

DLO Rp 65,000
FL Rp 35,000 Rp 100,000

DLO Rp 65,000
FL Rp 35,000 Rp 100,000

DLO,wdl Rp 100,000 Rp 100,000


DLO,hbs.Ag,UL Rp 135,000 Rp 135,000
DLO Rp 65,000 Rp 65,000
FL (25%) Rp 26,250 Rp 26,250

DLO,mal,wdl,ot,pt Rp 155,000
widal test Rp 35,000
widal test Rp 35,000 Rp 225,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000
DLO Rp 65,000 Rp 330,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000
DLO Rp 65,000 Rp 330,000

DLO,ct,bt,gd,bs.Ag Rp 140,000 Rp 140,000

Dlo,ct,bt,gd (25%) Rp 71,000


DLO,ct,bt,gd,gds,hbs.Ag (25%) Rp 116,250
DLO (25%) Rp 48,750 Rp 236,000

DLO,gd,gds,crp Rp 125,000 Rp 125,000


DLO,wdl Rp 100,000 Rp 100,000
DLO Rp 65,000
hb Rp 15,000
DLO Rp 65,000 Rp 145,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000
DLO Rp 65,000 Rp 330,000

DLO,wdl,ot,pt Rp 135,000
FL Rp 35,000 Rp 170,000

widal Rp 35,000
DLO Rp 65,000 Rp 100,000

DLO Rp 65,000 Rp 65,000

DLO,wdl Rp 100,000
DLO Rp 65,000 Rp 165,000

DLO,cr,ot,pt Rp 120,000
FL Rp 35,000 Rp 155,000

DLO,wdl,gds,ur,cr,ot,pt Rp 190,000 Rp 190,000

DLO,gd Rp 75,000
DLO Rp 65,000
DLO Rp 65,000
DLO Rp 65,000 Rp 270,000

Total Rp 4,602,250
KLINIK RSIA MUTIARA BUNDA OKTOBER-NOVEMBER 2013

Jenis pemeriksaan Jumlah Biaya Total

DLO,wdl Rp 100,000 Rp 100,000

DLO,wdl,gds,ur,cr,ot,pt Rp 190,000
DLO,mal,IgG IgM dengue Rp 235,000
DLO Rp 65,000
mal,wdl,UL Rp 80,000
DLO,mal Rp 85,000 Rp 655,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,wdl Rp 100,000 Rp 100,000

DLO,gds,ur,cr,ot,pt,hbs.Ag Rp 200,000
DLO Rp 65,000 Rp 265,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000 Rp 265,000

DLO,wdl,ur,cr,ot,pt Rp 175,000
UL Rp 25,000 Rp 200,000

DLO Rp 65,000 Rp 65,000

DLO,wdl Rp 100,000
FL Rp 35,000 Rp 135,000

DLO,wdl,ot,pt Rp 135,000 Rp 135,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,mal,wdl,ot,pt Rp 155,000 Rp 155,000

DLO,wdl,gds Rp 115,000
FL Rp 35,000 Rp 150,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
UL Rp 25,000
DLO Rp 65,000 Rp 330,000

DLO,mal,wdl,ot,pt Rp 155,000 Rp 155,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL (25%) Rp 198,750


DLO (25%) Rp 48,750 Rp 247,500
DLO Rp 65,000
FL Rp 35,000 Rp 100,000

DLO Rp 65,000 Rp 65,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000 Rp 265,000
DLO,wdl,mal,ot,pt Rp 155,000 Rp 155,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,gd,ct,bt,hbs.Ag Rp 140,000 Rp 140,000

DLO,wdl Rp 100,000
FL Rp 35,000 Rp 135,000

DLO,wdl,ot,pt Rp 135,000 Rp 135,000

DLO,wdl Rp 100,000
FL Rp 35,000 Rp 135,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 255,000 Rp 255,000


DLO,gd,ct,bt,hbs.Ag Rp 140,000 Rp 140,000
DLO,wdl,ot,pt Rp 135,000 Rp 135,000

DLO,wdl,gds Rp 115,000
FL Rp 35,000 Rp 150,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
UL Rp 25,000 Rp 265,000

Total Rp 5,992,500
KLINIK RSIA MUTIARA BUNDA OKTOBER-NOVEMBER 2013

Jenis pemeriksaan Jumlah Biaya Total

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,wdl,ot,pt Rp 135,000 Rp 135,000
DLO,gds,ot,pt Rp 135,000 Rp 135,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 255,000
DLO Rp 65,000 Rp 320,000

bt,bd,bbid Rp 60,000 Rp 60,000

DLO,gds,ch,tg,ot,pt,ur,cr Rp 197,000
gds Rp 15,000
gds Rp 15,000
gds Rp 15,000
gds Rp 15,000
gds Rp 15,000
gds Rp 15,000
gds Rp 15,000
gds Rp 15,000
gds Rp 15,000
gds Rp 15,000 Rp 347,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000
DLO Rp 65,000 Rp 330,000

DLO,gd,gds,crp Rp 125,000 Rp 125,000

DLO,wdl,ot,pt,UL Rp 160,000
UL Rp 25,000 Rp 185,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,gds,cj,tg,au,ur,cr,ot,pt Rp 217,000 Rp 217,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO Rp 65,000 Rp 305,000

DLO,gd,gds,crp Rp 125,000 Rp 125,000


DLO,gd,gds,crp Rp 125,000 Rp 125,000
DLO,mal,wdl,ot,pt Rp 155,000 Rp 155,000
DLO,wdl,gds Rp 115,000
FL Rp 35,000 Rp 150,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000 Rp 265,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000
DLO Rp 65,000
DLO Rp 65,000
DLO Rp 65,000 Rp 460,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000
DLO Rp 65,000 Rp 330,000

DLO,wdl Rp 100,000 Rp 100,000


DLO,wdl Rp 100,000 Rp 100,000

DLO Rp 65,000
FL Rp 35,000 Rp 100,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000
hb,ht Rp 25,000
hb,ht Rp 25,000 Rp 315,000

DLO,gd,gds,crp Rp 125,000 Rp 125,000

DLO,wdl,gds Rp 115,000
FL Rp 35,000 Rp 150,000

Total Rp 5,619,000
KLINIK RSIA MUTIARA BUNDA OKTOBER-NOVEMBER 2013

Jenis pemeriksaan Jumlah Biaya Total

DLO Rp 65,000
FL Rp 35,000 Rp 100,000

DLO,gd,ct,bt,hbs.Ag,UL Rp 170,000 Rp 170,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 255,000 Rp 255,000
DLO,mal,wdl,ot,pt Rp 155,000 Rp 155,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 255,000 Rp 255,000
DLO Rp 65,000 Rp 65,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 255,000 Rp 255,000

DLO Rp 65,000
FL Rp 35,000 Rp 100,000

DLO,FL Rp 100,000 Rp 100,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 265,000 Rp 265,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,wdl Rp 100,000 Rp 100,000

Rp 4,602,250
Rp 5,992,500
Rp 5,619,000
Rp 2,060,000

Rp 18,273,750
Total Rp 2,060,000
KLINIK RSIA MUTIARA BUNDA NOVEMBER-DESEMBER 2013

Jenis pemeriksaan Jumlah Biaya Total

DLO Rp 65,000 Rp 65,000

DLO,led,ct,bt,gd,hbs.Ag Rp 150,000
DLO Rp 65,000 Rp 215,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hs.Ag,ul Rp 265,000 Rp 265,000
DLO,wdl Rp 100,000 Rp 100,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hs.Ag,ul Rp 265,000
DLO Rp 65,000
DLO Rp 65,000
hb,ht Rp 25,000 Rp 420,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hs.Ag,ul Rp 255,000
DLO Rp 65,000
DLO Rp 65,000
DLO,UL Rp 90,000
DLO Rp 65,000
UL Rp 25,000 Rp 565,000

FL Rp 35,000 Rp 35,000
DLO,gd,gds,crp Rp 125,000 Rp 125,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hs.Ag,ul Rp 255,000
DLO Rp 65,000 Rp 320,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000


DLO,gd,crp Rp 110,000 Rp 110,000

DLO,wdl,gds,ot,pt,mal Rp 170,000
hb,al,at,ht,ae,igG,IgM dengue Rp 205,000
DLO Rp 65,000
DLO Rp 65,000 Rp 505,000

DLO,gd,crp Rp 110,000 Rp 110,000


DLO,gd,crp Rp 110,000 Rp 110,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000

DLO,wdl,ot,pt Rp 135,000
FL Rp 35,000 Rp 170,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hs.Ag,ul Rp 265,000 Rp 265,000


FL Rp 35,000 Rp 35,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000

DLO,mal,wdl,ot,pt Rp 155,000 Rp 155,000


DLO,wdl,gds,ot,pt Rp 150,000 Rp 150,000

DLO Rp 65,000
DLO,mal,wdl,ot,pt Rp 155,000 Rp 220,000

FL Rp 35,000 Rp 35,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000
DLO,crp Rp 100,000 Rp 100,000

DLO,ur,cr,ot,pt Rp 140,000
UL Rp 25,000 Rp 165,000

DLO Rp 65,000 Rp 65,000


DLO,wdl,crp Rp 135,000 Rp 135,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO Rp 65,000 Rp 305,000

DLO,led,wdl Rp 110,000 Rp 110,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000

Total Rp 6,245,000
KLINIK RSIA MUTIARA BUNDA NOVEMBER-DESEMBER 2013

Jenis pemeriksaan Jumlah Biaya Total

DLO,ct,bt Rp 95,000 Rp 95,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
DLO Rp 65,000 Rp 295,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
DLO Rp 65,000 Rp 295,000

DLO,wdl Rp 100,000
FL Rp 35,000 Rp 135,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000

DLO,ur,cr,ot,pt,IgG,IgM dengue Rp 290,000


hb,at,ht Rp 35,000 Rp 325,000

hb,al,gd,bt,bd,bid Rp 95,000 Rp 95,000


DLO,gd,bt,bd,bid Rp 135,000 Rp 135,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000
DLO Rp 65,000
DLO Rp 65,000
DLO Rp 65,000 Rp 435,000

DLO,wdl,gds,ot,pt,UL Rp 175,000 Rp 175,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hs.Ag,ul Rp 265,000 Rp 265,000

DLO,gd Rp 75,000
DLO,crp Rp 100,000 Rp 175,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hs.Ag,ul Rp 265,000 Rp 265,000


DLO,wdl,ot,pt Rp 135,000 Rp 135,000
DLO Rp 65,000 Rp 65,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000
DLO,gd,gds Rp 90,000 Rp 90,000

DLO,wdl,ot,pt Rp 135,000
FL Rp 35,000 Rp 170,000
DLO,wdl,gds,ot,pt Rp 150,000 Rp 150,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hs.Ag,ul Rp 265,000 Rp 265,000
DLO,wdl,ot,pt Rp 135,000 Rp 135,000
DLO,wd,ot,pt,FL Rp 170,000 Rp 170,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag(25%) Rp 172,500 Rp 172,500
DLO,wdl,ot,pt Rp 135,000 Rp 135,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 255,000 Rp 255,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hs.Ag,ul Rp 265,000
DLO Rp 65,000 Rp 330,000

DLO,wdl,ot,pt Rp 135,000 Rp 135,000


DLO,gd,wdl,ot,pt Rp 145,000 Rp 145,000

DLO,wdl,ot,pt Rp 135,000
DLO,IgG,IgM dengue Rp 215,000
hb,at,ht Rp 35,000 Rp 385,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hs.Ag,ul Rp 265,000 Rp 265,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag, Rp 240,000 Rp 240,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000
DLO Rp 65,000 Rp 295,000

DLO,gd,crp Rp 110,000 Rp 110,000

Total Rp 7,507,500
KLINIK RSIA MUTIARA BUNDA NOVEMBER-DESEMBER 2013

Jenis pemeriksaan Jumlah Biaya Total

DLO Rp 65,000 Rp 65,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 255,000 Rp 255,000

DLO,wdl Rp 100,000
DLO,IgG,IgM dengue Rp 215,000 Rp 315,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,gd,crp Rp 110,000 Rp 110,000
DLO,wdl,gds Rp 115,000 Rp 115,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000

DLO,gds Rp 80,000
FL Rp 35,000 Rp 115,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 230,000 Rp 230,000


DLO,gd,wdl,ot,pt Rp 145,000 Rp 145,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000
DLO,mal,wdl,ot,pt Rp 155,000 Rp 155,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 255,000
DLO Rp 65,000 Rp 320,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 240,000 Rp 240,000


DLO,led,wdl Rp 110,000 Rp 110,000
DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hs.Ag,ul Rp 265,000 Rp 265,000

Rp 6,245,000
Rp 7,507,500
Rp 3,630,000
Rp 17,382,500

Total Rp 3,630,000
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA

No. Lab Kamar Analis dr. Nama Pasien Tanggal Sampling

005RA0115 K6 DN ISD An. M. Ridho 1/1/2015 fatur


016RA0115 TA DY 1/3/2015 ervina

006RB0115 A6 DN DH Ny. Yunnisa 1/1/2015 lita


012RA0115 A4 EM/RT RY Ny. Yusnita 1/2/2015 vk?
015RA1214 K3 TA HFZ An. Gt. Nelam 1/2/2015 ervina

017RA0115 K5 TA DY An. M. Fadly 1/3/2015 ervina


024RA0115 DN 1/4/2015 dhoni
041RA0115 RN 1/5/2015 ????
057RA0115 EM/RT 1/6/2015 novi
064RA0115 DN 1/7/2015 dhoni

029RB1214 vk DN RY Ny. Elvy Supiat 1/4/2015 marta

032RA0115 K7 DN DY An. Putri Nayla 1/4/2015 dhoni


042RA0115 RN/RT 1/5/2015 ????

034RB0115 C10 RN RL Nn. Pratwi 1/4/2015 x


035RB0115 K4 RN HFZ Tn. Winarto (ortu An. M. Ridho) 1/4/2015 lutfi

036RB0115 C8 RN HFZ Ny. Aina 1/4/2015 lutfi


045RB0115 DN/RT RL 1/5/2015 dhoni
055RB0115 TA 1/6/2015 ta

039RA0115 K6 RN ISD An. Haidar 1/4/2015 fatur


048RB0115 B2 DN/RT RY Ny. Amah 1/5/2015 umi
049RA0115 K8 DN/RT DY An. Aufar 1/5/2015 olla

050RB0115 C9 TA DH Ny. Helmiah 1/5/2015 linda


096RB0115 TA 1/9/2015 ta

051RA0115 K7 TA DY An. Rezqiya Khair A. 1/5/2015 fatur


052RA0115 K12 TA SF An. Azka 1/5/2015 fatur
053RA0115 K2 TA ifiq An. Naura 1/5/2015 fatur

054RA0115 K1 TA SF An. Nayla Salsabila 1/6/2015 fatur


058RA0115 EM/RT 1/6/2015 sisa sampel
065RA0115 DN 1/7/2015 dhoni
077RA0115 EM 1/8/2015 mawaddah
088RA0115 DN/RT 1/9/2015 dhoni
100RA0115 TA 1/10/2015 ta
059RA0115 K10 DN SF An. Alifa Hijriya 1/6/2015 hafizah
066RA0115 DN 1/7/2015 dhoni
078RA0115 EM 1/8/2015 mawaddah

060RB0115 A6 DN DH Ny. Wida Sintya Putri 1/6/2015 icha


062RB0115 DN 1/7/2015 dhoni
084RB0115 TA 1/8/2015 linda

061RA0115 K3 DN SF An. Saufia Zafira 1/6/2015 R/Anak


063RB0115 A4 DN RY Ny. Agusta 1/7/2015 icha
067RA0115 K4 DN DY An. Haidar 1/7/2015 retno

069RA0115 K5 RT/TA ifiq An. Nayla 1/7/2015 taufik


070RA0115 EM 1/7/2015 x

073RB0115 C7 EM DH Ny. Rizki Purnama Sari 1/7/2015 k'asniah


095RB0115 TA 1/9/2015 ta

075RB0115 C8 EM RY Ny. Dian 1/7/2015 susan


076RA0115 K6 EM SF An. Zahira P.K. 1/8/2015 desy
079RB0115 A4 TA DH Ny. Ade Febriani 1/8/2015 linda
NIK RSIA MUTIARA BUNDA DESEMBER 2014 - JANUARI 2015

Jenis pemeriksaan Jumlah Biaya Total

DLO,wdl,ot,pt,gds Rp 155,000
hb,al,at,ht Rp 45,000

DLO,gd,bt,ct,hbs.Ag,ot,pt,ur,cr Rp 215,000
DLO,gd,bt,ct,hbs.Ag,gds,ot,pt,ur,cr Rp 230,000
DLO,wdl,ot,pt Rp 140,000

DLO,ot,pt,igG,igM Rp 250,000
hb,at,ht Rp 35,000
hb,al,at,ht Rp 45,000
hb,al,at,ht Rp 45,000
hb,at,ht Rp 35,000

DLO,gd,bt,ct Rp 105,000

DLO,ot,pt Rp 100,000
hb,al,at,ht Rp 45,000

PP tes, UL Rp 45,000
DLO,wdl,ot,pt Rp 140,000

DLO,gds,ot,pt,ur,cr,ua Rp 175,000
gd,gds Rp 25,000
gds Rp 15,000

DLO,wdl,gds,ot,pt Rp 155,000
DLO,led,gd,bt,ct,hbs.Ag,ot,pt,ur,cr,UL Rp 250,000
DLO,wdl,ot,pt Rp 140,000

DLO,led,gd,bt,ct,hbs.Ag,gds,ot,pt,ur,cr Rp 240,000
DLO Rp 65,000

DLO,wdl,gds,ot,pt Rp 155,000
DLO,crp Rp 100,000
DLO,crp Rp 100,000

DLO,wdl Rp 105,000
gd Rp 10,000
DLO Rp 65,000
DLO Rp 65,000
DLO Rp 65,000
DLO Rp 65,000
DLO Rp 65,000
hb,at,ht Rp 35,000
hb,al,at,ht Rp 45,000

DLO,led,gd,bt,ct,hbs.Ag,ot,pt,ur,cr Rp 225,000
DLO Rp 65,000
DLO Rp 65,000

DLO,wdl,gds,mal Rp 140,000
DLO,led,gd,bt,ct,hbs.Ag,ot,pt,ur,cr Rp 225,000
DLO,gd Rp 75,000

DLO,wdl,ot,pt Rp 140,000
FL Rp 35,000

DLO,gd,bt,ct,hbs.Ag,gds,ot,pt,ur,cr,UL Rp 255,000
DLO Rp 65,000

DLO,gd,bt,ct,wdl,ot,pt Rp 215,000
DLO Rp 65,000
DLO,gd,bt,ct,hbs.Ag,gds,ot,pt,ur,cr Rp 230,000
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

147RB1115 C8 DN anin Ny. Norhana 11/26/2015


150RB1115 RN RL 11/26/2015
154RB1115 RN 11/27/2015

148RA1115 K12 DN NN Ny. Diana Rahman 11/26/2015


153RA1115 RN 11/27/2015

149RA1115 K5 RT IH An. Shabiq 11/26/2015

152RA1115 K1 RN anin An. Nadia Khairunnisa 11/27/2015


177RA1115 EM DY 11/29/2015

156RB1115 C7 EM ifiq Tn. Arif Rahman 11/27/2015


160RA1115 K6 RT ifiq An. Nabilah Sihombing 11/27/2015
161RA1115 K7 RT isd An. M. Rasyid Widodo 11/27/2015

162RB1115 A5 RT RY Ny. Anggi Setawat 11/27/2015


165RB1115 RT 11/27/2015

164RA1115 K4 RT hafz An. Halwa Adelia Putri 11/27/2015


187RA1115 RT DY 11/30/2015

170RB1115 vk DN RY Ny. Nururl Komariah 11/28/2015


171RA1115 K8 DN anin An. Qurratu'ain 11/28/2015
172RA1115 K9 EM ifiq An. Immanuel Dimas 11/28/2015

173RA1115 K12 EM SY An. M. Raihan Firdaus 11/28/2015


190RA1115 K8 RT DY 11/30/2015
007RA1215 EM 12/1/2015

174RA1115 K7 EM SY An. Sulaiman Effendi 11/28/2015


176RA1115 EM 11/28/2015

175RA1115 K6 EM cynta An. Dimas fadhillah 11/28/2015


186RA1115 RT DY 11/30/2015
004RA1215 EM 12/1/2015
008RA1215 EM 12/1/2015
021RA1215 RN/RT 12/2/2015
032RA1215 EM 12/3/2015
040RA1215 RN 12/4/2015

179RA1115 K2 DN/RN DY By. Ny. Nurrojaniat 11/29/2015


022RA1215 RN 12/2/2015
180RB1115 C8 DN/RN AA Ny. Leni Sit Nurlaini 11/29/2015
194RB1115 A6 DN 11/30/2015
009RB1215 EM 12/1/2015

185RA1115 K4 RT hfz An. Nadifa Fatarani 11/30/2015


020RA1215 K5 RT DY 12/2/2015
024RA1215 RN 12/2/2015

189RB1115 C9 RT AA Ny. Hj. St. Raudah 11/30/2015

001RB1215 A4 DN DH Ny. Rini Oliviant 12/1/2015


006RB1215 EM 12/1/2015

013RA1215 K1 RT ifiq An. M. Malik Arkaan 12/1/2015

015RA1215 K4 RT DY An. Rengganis 12/1/2015


039RA1215 RN IH 12/4/2015

016RB1215 A5 RT RY Ny. Paramitha Cynta 12/2/2015


025RA1215 K2 EM ifiq By. Ny. Paramita 12/2/2015
029RB1215 A6 EM RY Ny. Fitriani 12/3/2015
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

030RA1215 K8 EM hfz An. Sifatus Salma 12/3/2015


033RB1215 C7 DN RY Ny. Rizky Sartaningrum 12/3/2015
034RB1215 C8 DN RY Ny. Khusnul Hatmah 12/3/2015
037RA1215 K10 RN SF An. M. Rafa 12/3/2015
041RB1215 C7 RN SF By. Ny. Rizky Sataningrum 12/4/2015
042RB1215 C8 RT RY Ny. Nurul Azizah 12/4/2015
043RB1215 B1 RT hfz Ny. Sri wahyuni 12/4/2015
044RA1215 K4 DN anin An. Ainiya Faida Azmi 12/4/2015

046RA1215 K12 DN anin An. M. Jova 12/5/2015


064RA1215 EM DY 12/7/2015

047RB1215 A6 DN AA Ny. Endang Sri. P 12/5/2015


049RB1215 RT 12/5/2015

050RA1215 K6 RT IH An. Ziadah Zulfa 12/5/2015


051RA1215 K13 RT IH An. Zahra Aqisya 12/5/2015
052RA1215 K13 RT DY An. M. Hilman 12/6/2015

055RB1215 C9 RN FT Ny. Yuliana bint Sidiq 12/6/2015


060RB1215 EM 12/6/2015

056RA1215 K10 RN SY An. Haili Rahman 12/6/2015


065RA1215 EM 12/7/2015

058RB1215 C9 RN SF By. Ny. Yuliana 12/6/2015


063RA1215 K4 RN SF An. Theresia 12/7/2015

069RA1215 K4 RN DY An. Rafael Emeraldi 12/7/2015


072RA1215 RT 12/8/2015
083RA1215 EM 12/9/2015

073RB1215 C7 RT hfz Tn. A. Nahafi Hariri 12/8/2015


074RB1215 RT NN 12/8/2015

078RA1215 K3 DN SF An. Muhammad bin fahrurozi 12/8/2015


085RA1215 EM 12/9/2015
087RB1215 RT 12/10/2015
090RA1215 EM 12/10/2015
095RA1215 EM 12/11/2015
107RA1215 DN 12/12/2015
123RA1215 RN 12/13/2015
144RA1215 RT 12/14/2015

079RA1215 K5 DN ifiq An. Muhammad Aiman 12/8/2015

080RA1215 K8 DN ifiq An. Ahmad Hafidz 12/8/2015


082RA1215 EM 12/9/2015

081RA1215 vk DN RY Ny. Elya Agustn 12/9/2015


086RB1215 A6 RT AA Ny. Diana Anggraini 12/10/2015
088RB1215 A5 DN AA Ny. Dewi Ratna sari 12/10/2015
091RA1215 K5 EM DY An. Rubby Nakita 12/10/2015

097RB1215 B1 RT RL Tn. Yunus (ka yulida) 12/11/2015


098RB1215 RT 12/11/2015
099RB1215 RT 12/11/2015
108RB1215 DN 12/12/2015

102RB1215 A5 DN FT Ny. Veri Mardiani 12/11/2015


104RA1215 K1 DN DY An. Rengganis M. Putri 12/12/2015
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

105RB1215 C7 DN FT Ny. Desita Tirta Ningrum 12/12/2015


121RB1215 RN 12/13/2015
149RB1215 DN 12/14/2015
152RB1215 EM 12/15/2015
161RB1215 DN 12/15/2015

106RB1215 A4 DN FT Ny. Indah Ayu 12/12/2015

110RA1215 K12 RT ifiq An. M. Teguh 12/12/2015


114RA1215 RT 12/12/2015

111RA1215 K7 RT ifiq An. Sherly 12/12/2015


112RB1215 C8 RT FT Ny. Nina calina 12/12/2015

116RB1215 C9 RT AA Ny. Erliant bint Darmawi 12/12/2015


120RB1215 RN 12/13/2015
135RB1215 RT 12/13/2015

119RA1215 K5 RN RD An. Abdul Qodir Hasan 12/13/2015


122RA1215 K4 RN SF An. M. Garry Prataka 12/13/2015
127RA1215 K8 EM cynta An. M. Syahid 12/13/2015

128RB1215 A6 EM RL Ny. Nurul Husna (bidan vk) 12/13/2015


153RB1215 EM 12/15/2015
164RB1215 DN 12/15/2015
177RB1215 RT 12/18/2015

148RA1215 K6 DN ifiq An. M. Haikal Nazib 12/14/2015


159RA1215 K4 RN ifiq An. M. Rifqi Zaidan 12/15/2015
160RB1215 C8 RN RY Ny. Kartni bint Rahmani 12/15/2015

165RB1215 A4 DN DH Ny. Sri Suwart 12/15/2015


171RB1215 RN 12/16/2015

172RB1215 C7 RN RY NY. Sit Zulfa 12/16/2015


174RA1215 K8 EM ifiq An. Mikaela Zahragina 12/17/2015

175RA1215 K1 RT SF An. Gt. Sabrina 12/17/2015


192RA1215 EM 12/19/2015
203RA1215 RN 12/20/2015

176RB1215 C9 RT DH Nn. Nabila 12/18/2015


179RA1215 K5 RT ifiq An. M. Reno 12/18/2015
193RA1215 EM DY 12/19/2015
204RA1215 RN 12/20/2015

181RB1215 C8 DN BD Ny. Ndari Retnaning 12/18/2015

182RA1215 K7 DN Naila An. Alfia Saukina Putri 12/18/2015


185RA1215 EM 12/18/2015

184RB1215 C7 EM RY Ny. Sri Hastut 12/18/2015


187RB1215 EM 12/18/2015

186RA1215 K3 EM DY An. Ahmad Azri 12/18/2015

189RA1215 K4 EM anin An. Oktabara Winggit 12/18/2015


190RA1215 EM DY 12/18/2015
216RA1215 EM 12/21/2015

191RB1215 A6 EM RY Ny. Irma Sari 12/19/2015

196RA1215 K10 DN ifiq An. Ruby Rahma Nabila 12/19/2015


198RA1215 RN DY 12/19/2015
218RA1215 EM 12/21/2015
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA BUNDA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

201RA1215 K7 RN DY An. Nadira Tafana Putri 12/19/2015


219RA1215 EM 12/21/2015

208RA1215 K3 DN isd An. A. Hafiz Ramadhan 12/21/2015


210RA1215 DN DY 12/21/2015
231RA1215 RT 12/22/2015
250RA1215 RT 12/24/2015

214RB1215 A6 EM RY Ny. Zainab 12/21/2015


220RA1215 K6 EM DY An. M. Faiz 12/21/2015
223RB1215 A4 EM RY Ny. Halimatus S'adiah 12/21/2015
229RA1215 K2 RN SF By. Ny. Halimatus Sa'diah 12/22/2015

232RA1215 K4 RT DY An. Rengganis 12/22/2015


234RA1215 RT 12/22/2015
255RA1215 RT 12/24/2015

235RA1215 K5 RT SF An. Nur Salasabila 12/22/2015


249RA1215 DN 12/24/2015

238RA1215 K1 RN DY An. Amira Helwa 12/23/2015

242RA1215 K8 RN ifiq An. Dimas Ehza Erlangga 12/23/2015


271RA1215 EM DY 12/24/2015

244RA1215 K10 DN IH An. Ahmad Baidawi 12/23/2015

245RB1215 B1 DN DH Ny. Novi Setawat (koperasi) 12/23/2015


257RB1215 RT 12/24/2015

251RB1215 A5 RT RY Ny. Maria Ulfah (perawat) 12/24/2015


252RB1215 C7 RT AA Ny. Maulifia 12/24/2015
253RA1215 K6 RT ifiq An. M. Ihza Saputra 12/24/2015
258RB1215 C9 RT RY Ny. Nur Hasanah 12/24/2015
261RA1215 K5 RN hfz An. Nur Salsabila 12/24/2015
265RA1215 K12 RN ifiq An. M. Al-Hasan 12/25/2015

267RB1215 C8 RN NN Tn. Ahmad Hanafi 12/25/2015


269RB1215 EM 12/25/2015

268RB1215 A6 EM RY Ny. Desi Afrina 12/25/2015


273RA1215 K7 EM DY An. M. Rizky Aqlan 12/25/2015
Total

Ttd,

Renny Sislia
ORIUM KLINIK RSIA MUTIARA BUNDA DESEMBER 2015

Jenis pemeriksaan Jumlah Biaya Total

DLO,wdl,gds,ot,pt Rp 215,000
UL Rp 32,500
DLO,mal Rp 125,000 Rp 372,500

DLO Rp 90,000
DLO Rp 90,000 Rp 180,000

DLO Rp 90,000 Rp 90,000

DLO,wdl,gds,ot,pt Rp 215,000
DLO Rp 90,000 Rp 305,000

DLO,wdl,gds,ur,cr,ot,pt,ch,tg,au Rp 355,000 Rp 355,000


DLO,gd Rp 105,000 Rp 105,000
DLO,mal,wdl,ot,pt Rp 230,000 Rp 230,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000
UL Rp 32,500 Rp 337,500

DLO,wdl,gds,ot,pt,crp Rp 265,000
DLO Rp 90,000 Rp 355,000

DLO,ct,bt,gd,ot,pt,hbs.Ag Rp 235,000 Rp 235,000


DLO,mal,wdl,ot,pt Rp 230,000 Rp 230,000
DLO,wdl,ot,pt Rp 195,000 Rp 195,000

DLO,mal,wdl,gds,ot,pt Rp 250,000
DLO Rp 90,000
DLO Rp 90,000 Rp 430,000

DLO Rp 90,000
FL Rp 45,000 Rp 135,000

DLO,wdl,gds,ot,pt,crp Rp 265,000
DLO Rp 90,000
DLO,mal,IgG IgM dengue Rp 350,000
UL Rp 32,500
DLO Rp 90,000
hb,at,ht Rp 62,500
DLO Rp 90,000 Rp 980,000

DLO,bilirubin Rp 172,500
bt,bd,bid Rp 92,500 Rp 265,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000
DLO Rp 90,000
DLO Rp 90,000 Rp 485,000

DLO,gd,wdl,gds,ot,pt Rp 230,000
DLO Rp 90,000
IgG,IgM dengue Rp 225,000 Rp 545,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000
UL Rp 32,500 Rp 337,500

DLO Rp 90,000 Rp 90,000

DLO,wdl,gds,ot,pt,crp Rp 265,000
DLO Rp 90,000 Rp 355,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000


DLO,gd,gds,crp Rp 175,000 Rp 175,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000

Rp 7,702,500
ORIUM KLINIK RSIA MUTIARA BUNDA DESEMBER 2015

Jenis pemeriksaan Jumlah Biaya Total

DLO, Rp 90,000 Rp 90,000


DLO,gd,ct,bt,ur,cr,ot,pt,hbs.Ag Rp 285,000 Rp 285,000
DLO,gd,ct,bt,ur,cr,ot,pt,hbs.Ag Rp 285,000 Rp 285,000
DLO,crp Rp 140,000 Rp 140,000
DLO,gd,crp Rp 155,000 Rp 155,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000
DLO,gds,ur,cr,ot,pt,hbs.Ag Rp 260,000 Rp 260,000
DLO,wdl,ot,pt Rp 195,000 Rp 195,000

DLO,wdl,ot,pt, Rp 195,000
DLO Rp 90,000 Rp 285,000

DLO,gd,ct,bt,ur,cr,ot,pt,hbs.Ag Rp 285,000
hb Rp 27,500 Rp 312,500

gds Rp 25,000 Rp 25,000


FL Rp 45,000 Rp 45,000
DLO,wdl,ot,pt Rp 195,000 Rp 195,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag,UL Rp 337,500
DLO Rp 90,000 Rp 427,500

DLO,wdl,ot,pt Rp 145,000
FL Rp 45,000 Rp 190,000

DLO,gd,gds,crp Rp 175,000 Rp 175,000


DLO Rp 90,000 Rp 90,000

hb,al,at,ht Rp 77,500
hb,al,at,ht Rp 77,500
DLO Rp 90,000 Rp 245,000

DLO,gds,ur,cr,ot,pt Rp 210,000
UL Rp 32,500 Rp 242,500

FL Rp 45,000
DLO,IgG,IgM dengue Rp 315,000
DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000 Rp 900,000

DLO,wdl Rp 145,000 Rp 145,000

DLO,wdl Rp 145,000
FL Rp 45,000 Rp 190,000

DLO,gd,ct,bt,ur,cr,ot,pt,hbs.Ag Rp 285,000 Rp 285,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000
DLO,led,gds Rp 125,000 Rp 125,000

DLO,wdl,gds,ur,cr,ot,pt (15%) Rp 225,250


UL (15%) Rp 27,650
hbs.Ag (15%) Rp 42,500
DLO (15%) Rp 78,000 Rp 373,400

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000


DLO,wdl,gds,crp Rp 215,000 Rp 215,000

Rp 7,095,900
ORIUM KLINIK RSIA MUTIARA BUNDA DESEMBER 2015

Jenis pemeriksaan Jumlah Biaya Total

DLO,gd,ct,bt,ur,cr,ot,pt,hbs.Ag Rp 285,000
DLO Rp 90,000
DLO,ur,cr,ot,pt Rp 190,000
DLO Rp 90,000
DLO Rp 90,000 Rp 745,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000

DLO,mal,wdl,ot,pt Rp 230,000
FL Rp 45,000 Rp 275,000

DLO,wdl,ot,pt Rp 195,000 Rp 195,000


DLO,hbs.Ag Rp 140,000 Rp 140,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000
DLO Rp 90,000
DLO Rp 90,000 Rp 485,000

DLO Rp 90,000 Rp 90,000


DLO,gds Rp 145,000 Rp 145,000
DLO,wdl,gds,ot,pt Rp 215,000 Rp 215,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,wdl (25%) Rp 270,000


DLO (25%) Rp 67,500
mal (25%) Rp 27,300
DLO (25%) Rp 67,500 Rp 432,300

DLO,wdl,ot,pt Rp 195,000 Rp 195,000


DLO,gd,wdl,ot,pt Rp 210,000 Rp 210,000
DLO,ct,bt,gd,ot,pt,hbs.Ag Rp 235,000 Rp 235,000

DLO,gd,ct,bt,ur,cr,ot,pt,hbs.Ag Rp 285,000
DLO Rp 90,000 Rp 375,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000


DLO,wdl,gds,ot,pt Rp 215,000 Rp 215,000

DLO,mal,wdl,ot,pt Rp 230,000
DLO,IgG,IgM dengue Rp 315,000
DLO Rp 90,000 Rp 635,000

DLO,gd,gds,ur,cr,ot,pt,hbs.Ag Rp 275,000 Rp 275,000


DLO,IgG,IgM dengue Rp 315,000
hb,at,ht,ot,pt Rp 112,500
hb,at,ht Rp 62,500 Rp 490,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000

DLO Rp 90,000
UL Rp 32,500 Rp 122,500

DLO,gd,gds,ur,cr,ot,pt,hbs.Ag Rp 275,000
UL Rp 32,500 Rp 307,500

DLO,wdl,ot,pt,crp Rp 245,000 Rp 245,000

DLO,wdl,gds,crp Rp 215,000
FL Rp 45,000
FL Rp 45,000 Rp 305,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000

DLO,wdl,ot,pt Rp 195,000
gd,gds Rp 45,000
DLO Rp 90,000 Rp 330,000

Rp 7,882,300
ORIUM KLINIK RSIA MUTIARA BUNDA DESEMBER 2015

Jenis pemeriksaan Jumlah Biaya Total

DLO,gd,gdp,ot,pt,crp Rp 225,000
DLO Rp 90,000 Rp 315,000

DLO,wdl,ot,pt Rp 195,000
FL Rp 45,000
FL Rp 45,000
FL Rp 45,000 Rp 330,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000


DLO,ot,pt,crp Rp 190,000 Rp 190,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000
DLO,gd,gdp,crp Rp 175,000 Rp 175,000

DLO,wdl,ot,pt,crp Rp 245,000
FL Rp 45,000
FL Rp 45,000 Rp 335,000

DLO,wdl,ot,pt,ur,cr Rp 245,000
DLO Rp 90,000 Rp 335,000

FL Rp 45,000 Rp 45,000

DLO,wdl,ot,pt Rp 195,000
DLO,ot,pt,IgG,IgM dengue Rp 365,000 Rp 560,000

DLO,gd Rp 105,000 Rp 105,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag (25%) Rp 229,000


DLO (25%) Rp 67,500 Rp 296,500

DLO,gd,gds,ur,cr,ot,pt,hbs.Ag (25%) Rp 206,250 Rp 206,250


DLO,gd,gds,ur,cr,ot,pt,hbs.Ag Rp 275,000 Rp 275,000
FL Rp 45,000 Rp 45,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000
DLO,wdl,ot,pt Rp 195,000 Rp 195,000
DLO,gd,gds,crp Rp 175,000 Rp 175,000

DLO,gds,ur,cr,ot,pt Rp 210,000
UL Rp 32,500 Rp 242,500

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000


DLO,wdl,gd,crp Rp 215,000 Rp 215,000
Rp 7,702,500
Rp 7,095,900
Rp 7,882,300
Rp 5,260,250

Rp 27,940,950

Rp 5,260,250

Mengetahui,
Kepala Ruangan Laboratorium

dr. M. Hafidz maulana


ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

276RA1215 K5 DN DY An. Nur Salsabila 12/26/2015

277RA1215 K8 DN DY An. Dimas Ehza Erlangga 12/26/2015


284RA1215 EM hfz 12/26/2015
287RA1215 EM anin 12/26/2015

278RA1215 K2 RN DY By. Ny. Halimatussa'diah 12/26/2015


331RA1215 EM 12/28/2015

283RB1215 A6 RN RY Ny. Desi Afrina 12/26/2015

286RA1215 K5 EM DY An. Ahmad Muhajir 12/26/2015


320RA1215 EM 12/28/2015
358RA1215 DN 12/29/2015

293RA1215 K6 EM ifiq An. Dzaki Muhammad Rasyid 12/27/2015


312RA1215 EM DY 12/28/2015
359RA1215 DN 12/29/2015
367RA1215 RN 12/30/2015

294RA1215 K10 EM ifiq An. Annisa Az Zalfa 12/27/2015


321RA1215 EM DY 12/28/2015
357RA1215 K8 DN 12/29/2015
368RA1215 RN 12/30/2015

295RA1215 K1 RN anin An. Hafis Azka 12/27/2015


314RA1215 DN DY 12/28/2015

298RB1215 C8 RN FT Ny. Mariany bint Mahlianor 12/27/2015

303RA1215 K3 DN ifiq An. Ahmad Ridhoni 12/27/2015


319RA1215 EM DY 12/28/2015

310RA1215 K10 DN anin An. M. Danish 12/28/2015


364RA1215 DN DY 12/30/2015

311RA1215 K11 DN anin An. Ade Abdullah 12/28/2015


363RA1215 DN DY 12/30/2015

317RA1215 K4 DN ifiq An. Dimas Astraditya 12/28/2015


329RA1215 EM 12/28/2015

324RA1215 K7 EM DY An. M. Rizky Aqlan 12/28/2015


330RA1215 K12 EM DY An. M. Al-Hasan 12/28/2015
336RA1215 EM 12/28/2015
352RA1215 RT 12/29/2015
362RA1215 DN 12/30/2015
382RA1215 RN IH 12/31/2015

345RB1215 C8 RT RL Tn. Ahmad Hanafi 12/29/2015


361RB1215 DN RL 12/30/2015

347RB1215 B1 RT ifiq An. M. Zavier Evano Riyu 12/29/2015


379RA1215 K5 RN DY 12/31/2015
003RA0116 RT IH 1/1/2016
011RA0116 RN 1/2/2016
016RA0116 DN 1/3/2016
027RA0116 EM 1/4/2016

353RB1215 A4 RT DH/RY Ny. Sri Rejeki 12/29/2015


356RB1215 A5 DN RY Ny. Rindu Hanast 12/29/2015
370RA1215 K1 RN hfz An. Nadira Asmarani 12/30/2015
375RA1215 K10 EM hfz An. Lina Amalia 1/30/2015
385RA1215 K7 RN anin An. Alifa Rasya Danish 12/31/2015
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

387RB1215 A5 RT RY Ny. Nina Fitriana 12/31/2015


007RB0116 DN 1/1/2016

388RA1215 K8 RT ifiq An. Abdul Halim 12/31/2015


002RA0116 RT IH 1/1/2015
010RA0116 RN 1/2/2016
017RA0116 DN 1/3/2016
025RA0116 EM 1/4/2016

389RB1215 A6 RT RY Ny. Khairunnisa 12/31/2015

001RB1215 A4 RT RY Ny. Syarifah Mazida 1/1/2016


004RB0116 DN 1/1/2016

006RA0116 K6 DN isd An. M. Rozky. R 1/1/2016


009RA0116 K3 RN anin An. Nabila Meidina Putri 1/2/2016

012RA0116 K11 EM ifiq Ny. Widia 1/2/2016


021RA0116 RT 1/3/2016
026RA0116 EM 1/4/2016
047RA0116 K11 RN 1/5/2016
013RA0216 K10 EM An. Zahrah Devi 1/2/2016

014RB0116 A6 EM RY Ny. Ira Lisnawat 1/2/2016

015RA0116 K7 DN hfz An. Sit Rahmah 1/2/2016


036RA0116 K3 RN IH 1/4/2016

018RA0116 K12 DN hfz An. M. Ifni 1/3/2016


045RA0116 RN DY 1/5/2016

019RA0116 K7 DN hfz An. Khalila bint Lucky F.H 1/3/2016


020RA0116 C7 RT RY Ny. Titn 1/3/2016

022RA0116 K4 RT DY An. M. Wildan Amin 1/3/2016


046RA0116 RN DY 1/5/2016

024RB0116 A5 EM RY Ny. Eka Yusnida 1/3/2016


028RB0116 A5 EM DY By. Ny. Eka Yusnida 1/4/2016

030RA0116 K6 RT IH An. A. Daffa 1/4/2016


031RA0116 K12 RT hfz Ny. Marita 1/4/2016
033RA0116 K1 RT IH An. Nur Zaini 1/4/2016
052RA0116 EM 1/5/2016
054RA0116 EM 1/6/2016

035RA0116 K7 RN DY An. Ghina Maliya 1/4/2016

037RB0116 C9 RN AA Ny. Sit Fatmah 1/4/2016


041RB0116 RN 1/4/2016
044RB0116 RN 1/5/2016

039RA0116 K8 RN ifiq An. M. Rizky 1/4/2016


055RA0116 RT SF 1/6/2016
068RA0116 DN SF 1/7/2016

042RA0116 K? RN RD An. M. Zaki Mubarok 1/5/2016

049RB0116 C7 EM RY Ny. Mariani 1/5/2016


071RB0116 C7 DN RY 1/7/2006

056RB0116 C8 EM ifiq Ny. Surahwa 1/6/2016


057RB0116 EM ifiq 1/6/2016
067RB0116 DN ifiq 1/7/2016
069RB0116 DN ifiq 1/7/2016
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

058RB0116 A4 EM ifiq Ny. Asniah (disk 25 %) 1/6/2016


060RB0116 A6 EM RY Ny. Erma Yuspita Sari 1/6/2016
066RB0116 B1 EM RY Ny. Annisa Nurhasanah 1/7/2016

070RA0116 K5 DN SF An. A. Yusril 1/7/2016


092RA0116 K5 RT SF 1/9/2016

072RA0116 K4 DN ifiq An. Aidan Syam Al Hamidi 1/7/2016


083RA0116 RT IH 1/8/2016
094RA0116 RT IH 1/9/2016

073RA0116 K12 DN ifiq An. Azka Zaidan Noor 1/7/2016

075RB0116 C9 RT/RN ifiq Tn. Ahmad Saini 1/7/2016


081RB0116 RT anin Tn. Ahmad saini 1/8/2016
084RB0116 RT anin 1/8/2016
085RA0116 RT rully 1/8/2016

076RA0116 K6 RT ifiq An. Keyhan Dalisha Sadira 1/7/2016

077RA0116 K13 RN hfz An. Nurul Adha 1/7/2016


097RA0116 RN DY 1/9/2016
120RB0116 RN DY 1/11/2016
134RA0116 RN DY 1/12/2016

087RB0116 B1 RT RY Ny. St. Zakiroh 1/8/2016


088RA0116 K7 RT isd An. Fajar Ramadani 1/8/2016

089RB0116 C7 RT isd Tn. Muhidin 1/9/2016


100RB0116 RN isd 1/9/2016
113RB0116 EM isd 1/10/2016
119RB0116 RT isd 1/11/2016

090RA0116 K8 RT isd An. Fitria Rahma 1/9/2016


121RA0116 RT DY 1/11/2016
132RA0116 RT DY 1/12/2016
139RA0116 DN DY 1/13/2016
148RA0116 RT DY 1/14/2016

091RA0116 K3 RT isd An. Khanza Latfah 1/9/2016


096RA0116 RN DY 1/9/2016
103RA0116 DN 1/9/2016
109RA0116 DN 1/10/2016
118RA0116 RT 1/11/2016
129RA0116 EM 1/12/2016
137RA0116 RN 1/13/2016
152RA0116 RT 1/14/2016

093RA0116 K1 RT SF An. M. Iqbal Qudratullah Hamimi 1/9/2016


108RA0116 DN SF 1/10/2016

098RB0116 C8 RN DY An. M. Rizki Naufal Abqory 1/9/2016


099RB0116 C8 RN APS Ny. Fitria Naufal Bint Harun 1/9/2016

101RB0116 B2 RN RY Ny. Suprapt 1/9/2016

104RA0116 K7 DN DY An. Syarifah Zahra 1/9/2016


110RA0116 EM 1/10/2016

105RB0116 A5 DN RY Ny. Indah Tri Susant 1/9/2016


106RA0116 K6 DN ifiq An. Deona Afiqa 1/10/2016

107RA0116 K5 DN IH An. Nasywa Rizka Salsabila 1/10/2016


130RA0116 EM 1/12/2016
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

111RB0116 C8 EM ifiq Ny. Liawat 1/10/2016

115RA0116 K1 RT ifiq An.M.Royyan Fahrur Razi 1/10/2016


122RA0116 RN DY 1/11/2016
141RA0116 DN 1/13/2016
156RA0116 DN 1/14/2016
166RA0116 DN 1/15/2016

123RB0116 A5 RN RY Ny. Fauziana Bint H.Bahrun 1/11/2016


126RB0116 EM 1/11/2016

125RA0116 K10 EM DY An. M. Kamil 1/11/2016


136RA0116 RN 1/13/2016

127RB0116 C8 EM RD Nn. Millatna Aulia 1/11/2016


133RB0116 RN NN 1/12/2016

128RA0116 K4 EM IH An. Yasir Riswan Abdullah 1/12/2016

135RB0116 B2 RN isd An. M. Fahmi 1/13/2016


162RA0116 K7 DN DY 1/14/2016

138RB0116 A6 RN RY Ny. Rahma Tamini 1/13/2016

142RA0116 K5 DN PR An. Yoshifa Batrisya Adeyan 1/13/2016


153RA0116 RT 1/14/2016

144RB0116 A4 DN RY Ny. Ratriana 1/13/2016


145RB0116 C7 DN hfz Ny. Gust Rismilawat 1/13/2016

146RA0116 K11 DN hfz An. Rio Ferdinand 1/13/2016


151RA0116 RT DY 1/14/2016
165RA0116 DN 1/15/2016
186RA0116 EM 1/16/2016
192RA0116 RT An. M. Akmal Firdaus (adik Rio) 1/16/2016

147RA0116 K6 RT SY An. Asraf 1/13/2016

149RA0116 K10 RT IH An. Ahmad Nazan 1/14/2016


170RA0116 RN 1/15/2016
184RA0116 EM 1/16/2016
191RA0116 RT 1/16/2016
150RA0116 K12 RT DY An. Nabila Zahra 1/14/2016
164RA0116 K8 DN 1/15/2016

155RB0116 C7 DN ifiq Ny. Anggelianita Roesandi 1/14/2016

157RB0116 VIP3 DN DY An. Ali Uraidie 1/14/2016


168RB0116 DN 1/15/2016
180RB0116 EM 1/15/1900
198RB0116 RN 1/17/2016

158RB0116 B2 DN anin An. M. Daffa Fajriannur 1/14/2016


197RB0116 RN DY 1/17/2016
207RA0116 RT 1/18/2016
163RA0116 K13 DN isd An. Nurul Shoubah 1/15/2016
173RA0116 RN IH 1/15/2016

167RA0116 K4 DN SF An. M. Arif 1/15/2016


187RA0116 EM 1/16/2016

169RA0116 K6 DN DY An. M. Rifqi 1/15/2016


189RA0116 EM 1/16/2016
201RA0116 RN 1/17/2016
208RA0116 RT 1/18/2016
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

172RA0116 K12 RN DY An. Raihan Bin Hasanudin 1/15/2016


188RA0116 EM 1/16/2016

174RA0116 K11 RN anin An. Geisha Aurelia 1/15/2016


183RA0116 K8 EM DY 1/16/2016
205RA0116 RT 1/18/2016

176RA0116 VIP II EM IH An. M. Nafis Fazrillas Syukur 1/15/2016


202RA0116 EM 1/17/2016
218RA0116 RT 1/19/2016

177RA0116 C7 EM SF An. M. Adzka 1/15/2016


178RB0116 A5 EM RY Ny. Mega Budi Rahayu 1/16/2016
179RB0116 B1 EM DY An. Ainaya Fahriza Putri 1/16/2016

182RB0116 A6 EM SF An. Kinan Shanum Anandy 1/16/2016


200RB0116 RN 1/17/2016
206RB0116 RT 1/18/2016
219RB0116 RT 1/19/2016
227RB0116 EM 1/19/2016

194RA0116 K5 RN/RT SY An. Aisya Talita 1/16/2016

196RA0116 K1 RN RD An. Annisa Norrahmi 1/16/2016


222RA0116 RN DY 1/19/2016

199RA0116 K4 RN DY An. Oktabara Winggit 1/17/2016


210RA0116 EM 1/18/2016
220RA0116 RT 1/19/2016

204RA0116 K2 EM IH By. Ny. Mega Budi Rahayu 1/17/2016

211RB0116 V3 EM anin An. Fahriansyah 1/18/2016


213RB0116 EM 1/18/2016

214RB0116 C7 EM RY Ny. Dina Kartka 1/18/2016

209RA0116 K8 RT isd An. Hafi Irawan 1/19/2016


221RA0116 RT SF 1/19/2016

229RA0116 K1 EM idola An. Revan Yaksa 1/19/2016


234RB0116 C8 EM FT Ny. Evi Arinai 1/19/2016
260RB0116 RN 1/21/2016

235RB0116 V11 EM anin An. M. Fahrul Rozi 1/19/2016


283RB0116 RT SF 1/22/2016

236RB0116 V15 EM anin An. Firan bint Busran 1/20/2016

237RA0116 K8 EM SF An. Nur Amelia Syafira 1/20/2016


263RA0116 RN 1/21/2016
280RA0116 RT 1/22/2016

238RA0116 K2 EM IH By. Ny. Mega Budi Rahayu 1/20/2016

240RA0116 K5 RT ifiq An. Shema Alfan 1/20/2016


288RA0116 EM DY 1/22/2016
302RA0116 DN 1/23/2016
337RA0116 EM 1/24/2016
356RA0116 RN 1/25/2016

241RA0115 K12 RT ifiq An. M. Noor Kholimi 1/20/2016


262RA0116 RN PR 1/21/2016
277RA0116 RT 1/22/2016
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

242RB0116 B1 RT anin Tn. M. Chairil Anwar 1/20/2016


245RB0116 RN RL 1/20/2016
284RB0116 RT 1/22/2016

243RA0116 K6 RT ifiq An. M. Abrisan 1/20/2016


217RA0116 K7 DN DY An. Fahryzal bin Turiono 1/18/2016
248RA0116 RN 1/20/2016
294RA0116 EM 1/22/2016

226RB0116 A5 RN RY Ny. Raihatul Auliani 1/19/2016


249RB0116 RN 1/20/2016

250RB0116 B2 RN SY An. Linggar Maifirla Ayu 1/20/2016


257RB0116 RN DY 1/21/2016
287RB0116 EM 1/22/2016
305RB0116 DN 1/23/2016

251RB0116 B2 RN SY An. Jauza Anindya Malik 1/20/2016


252RB0116 C7 RN RY Ny. Fitriana 1/20/2016

254RB0116 A4 RN RY Ny. Noor fadila 1/20/2016


255RB0116 RN 1/20/2016
273RB0116 RT 1/21/2016

256RB0116 C9 RN RY Ny. Halimatus 6/21/2016


268RB0116 DN 6/21/2016

258RB0116 V3 RN DY An. Dini Izatunisa 6/21/2016


282RB0116 RT 1/22/2016
303RB0116 DN 1/23/2016

259RB0116 V16 RN NN Tn. M. Samhan 6/21/2015


279RB0116 RT 1/22/2016
304RB0116 DN 1/23/2016

261RA0116 K4 RN DY An. Farhana Nur Afifa 6/21/2016


286RA0116 EM 1/22/2016
310RA0116 RN 1/23/2016
336RA0116 EM 1/24/2016

265RA0116 K10 DN SF AN. Farsya Azalia 1/21/2016


281RA0116 RT 1/22/2016
301RA0116 DN 1/23/2016

270RB0116 C10 DN ifiq NY. Noor Khadijah 1/21/2016


271RB0116 A4 DN SF By. Ny. Noor fadilla 1/21/2016
272RA0116 K3 DN/RT ifiq An. M. Ali 1/21/2016

276RB0116 A6 RT RY Ny. Aprilisa 1/21/2016


278RB0116 RT 1/22/2016

295RB0116 V15 DN ifiq Tn. M. Aminuddin 1/22/2016


309RB0116 RN NN 1/23/2016
328RB0116 EM 1/24/2016
350RB0116 RN 1/25/2016

296RA0116 K7 DN ifiq An. M. Raffa 1/22/2016


299RA0116 DN 1/22/2016
306RA0116 DN DY 1/23/2016
333RA0116 EM 1/24/2016
354RA0116 RN 1/25/2016

297RB0116 C7 DN RY Ny. Diah kartka 1/22/2016


300RB0116 DN 1/23/2016
ADMINISTRASI RAWAT INAP LABORATORIUM KLINIK RSIA MUTIARA

No. Lab Kamar Analis dr. Nama Pasien Tanggal

298RA0116 K3 DN DY An. M. Ali Ridho 1/22/2016


332RA0116 EM 1/24/2016
341RA0116 RT 1/24/2016

301RA0116 K1 DN SF An. Farsya Azelia 1/23/2016


340RA0116 EM 1/24/2016

308RA0116 K12 DN ifiq An. Aulia Rahmah 1/23/2016


318RA0116 EM IH 1/23/2016
335RA0116 EM IH 1/24/2016
343RA0116 RN 1/24/2016
351RA0116 RN 1/25/2016
374RA0116 RT 1/25/2016

311RA0116 K8 RN DY An. M. Zaini 1/23/2016


338RA0116 K11 EM 1/24/2016
342RA0116 RT 1/24/2016
352RA0116 RN 1/25/2016

313RA0116 K8 RN DY An.M. Zainal Radhi 1/23/2016


339RA0116 K10 EM 1/24/2016
360RA0116 DN 1/25/2016
362RA0116 DN 1/25/2016

312RB0116 V11 RN DY Ny. Eliana 1/23/2016

320RA0116 K6 EM SF An. M. Ilyas 1/23/2016


322RA0116 EM 1/23/2016
329RA0116 EM 1/24/2016
355RA0116 RN 1/25/2016

321RB0116 C10 EM RY Ny. Nerry 1/23/2016

326RB0116 B2 EM SY An. Gina Martau Saleha 1/23/2016


331RB0116 K4 EM DY 1/24/2016
358RB0116 RN 1/25/2016
360RA0116 DN 1/25/2016

327RB0116 B2 EM anin An. Sultan Gading 1/23/2016

330RB0116 V16 EM IH An. Tya Maharani 1/24/2016


357RB0116 RN 1/25/2016
334RA0116 K8 EM SF An. Melia Nurul Huda 1/24/2016
353RA0116 RN 1/25/2016

346RB0116 A5 RN DH Ny. dr. Cintya Maharanni 1/24/2016


369RB0116 DN 1/25/2016

348RB0116 V3 RN ifiq An. Hanunah bint Afif 1/24/2016


359RA0116 K2 DN DY by. Ny. dr Cintya 1/25/2016
368RB0116 V3 DN ifiq An. Sit Anisyahara 1/25/2016
370RB0116 C7 RT ifiq Tn. Muhidin 1/25/2016
373RB0116 B1 RT RL Ny. Hj. Fauziah 1/25/2016

Total

Ttd,

Renny Sislia
KLINIK RSIA MUTIARA BUNDA JANUARI 2016

Jenis pemeriksaan Jumlah Biaya Total

DLO Rp 90,000 Rp 90,000

DLO,IgG-IgM dengue Rp 315,000


DLO Rp 90,000
gd Rp 15,000 Rp 420,000

BT,BD,BIN Rp 92,500
BT,BD,BIN Rp 92,500 Rp 185,000

DLO Rp 90,000 Rp 90,000

DLO,mal,wdl,gds,ot,pt Rp 250,000
DLO Rp 90,000
DLO,IgG-IgM dengue Rp 315,000 Rp 655,000

DLO,wdl Rp 145,000
DLO Rp 90,000
DLO,IgG-IgM dengue Rp 315,000
hb,at,ht Rp 62,500 Rp 612,500

DLO,wdl Rp 145,000
DLO Rp 90,000
DLO,IgG-IgM dengue Rp 315,000
DLO Rp 90,000 Rp 640,000

DLO,wdl,gds,ot,pt Rp 215,000
FL Rp 45,000 Rp 260,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 320,000 Rp 320,000

DLO,gd,wdl,ot,pt Rp 210,000
UL Rp 32,500 Rp 242,500

DLO,wdl,gds,ot,pt Rp 215,000
DLO Rp 90,000 Rp 305,000

DLO,wdl,gds,ot,pt Rp 215,000
DLO Rp 90,000 Rp 305,000

DLO,gds Rp 110,000
FL Rp 45,000 Rp 155,000

DLO Rp 90,000 Rp 90,000


DLO,crp Rp 140,000
DLO,IgG-IgM dengue Rp 315,000
DLO Rp 90,000
hb,at,ht Rp 52,500
ahb,at,ht Rp 62,500 Rp 660,000

DLO,ur,cr Rp 140,000
ur,cr Rp 60,000 Rp 200,000

DLO,wdl,ot,pt Rp 195,000
DLO Rp 90,000
hb,al,at,ht,IgG-IgM dengue Rp 302,500
hb,al,at,ht Rp 77,500
hb,al,at,ht Rp 77,500
hb,al,at,ht Rp 77,500 Rp 820,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000
DLO Rp 90,000 Rp 90,000
DLO,gd Rp 105,000 Rp 105,000
DLO,wdl,gds,ot,pt Rp 215,000 Rp 215,000

Total Rp 7,070,000
KLINIK RSIA MUTIARA BUNDA JANUARI 2016

Jenis pemeriksaan Jumlah Biaya Total

DLO,gd,gds,ur,cr,ot,pt,hbs.Ag Rp 275,000
DLO Rp 90,000 Rp 365,000

DLO,wdl Rp 145,000
hb,al,at,ht Rp 77,500
hb,al,at,ht Rp 77,500
hb,al,at,ht Rp 77,500
hb,al,at,ht Rp 77,500 Rp 455,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000
DLO Rp 90,000 Rp 395,000

DLO Rp 90,000 Rp 90,000


FL Rp 45,000 Rp 45,000

DLO,wdl Rp 145,000
DLO,ot,pt,IgG-IgM dengue Rp 365,000
DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000 Rp 780,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000

DLO Rp 90,000
FL Rp 45,000 Rp 135,000

DLO Rp 90,000
DLO Rp 90,000 Rp 180,000

DLO,gds Rp 110,000 Rp 110,000


DLO,gd,gds,ur,cr,ot,pt,hbs.Ag Rp 275,000 Rp 275,000

DLO,wdl,ot,pt Rp 195,000
DLO Rp 90,000 Rp 285,000

DLO,gd,gds,ur,cr,ot,pt,hbs.Ag Rp 275,000
DLO,gd,gds,crp Rp 175,000 Rp 450,000

FL Rp 45,000 Rp 45,000
DLO,wdl,ot,pt Rp 195,000 Rp 195,000
hb,al,at,ht Rp 77,500
hb Rp 27,500
hb Rp 27,500 Rp 132,500

DLO,wdl,ot,pt Rp 195,000 Rp 195,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000
DLO Rp 90,000
hb,ht Rp 42,500 Rp 437,500

DLO,gd,wdl,IgG-IgM dengue Rp 395,000


DLO Rp 90,000
DLO Rp 90,000 Rp 575,000

DLO Rp 90,000 Rp 90,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000
HB Rp 27,500 Rp 332,500

GDS Rp 25,000
DLO,chol,tg,au,ot,pt,ur,cr Rp 280,000
GDP Rp 25,000
GDP2 JPP Rp 25,000 Rp 355,000

Total Rp 6,532,500
KLINIK RSIA MUTIARA BUNDA JANUARI 2016

Jenis pemeriksaan Jumlah Biaya Total

DLO,chol,tg,hdl,ldl,au,ur,cr,ot,pt Rp 255,000 Rp 255,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000
DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000

DLO Rp 90,000
DLO Rp 90,000 Rp 180,000

DLO Rp 90,000
FL Rp 45,000
hb,al,at,ht Rp 77,500 Rp 212,500

FL Rp 45,000 Rp 45,000

DLO,gds,wdl,ur,cr,ot,pt, Rp 265,000
DLO,gds,ur,cr,ot,pt,albm,hbs.Ag Rp 295,000
UL Rp 32,500
DLO,chol,tg Rp 180,000 Rp 772,500

DLO Rp 90,000 Rp 90,000

DLO,wdl,ot,pt Rp 195,000
DLO,IgG-IgM dengue Rp 315,000
DLO Rp 90,000
DLO Rp 90,000 Rp 690,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000


DLO,gds Rp 110,000 Rp 110,000

DLO,gds,wdl,ur,cr,ot,pt,hbs.Ag Rp 315,000
hb,al,at,ht Rp 77,500
hb,al,at,ht Rp 77,500
hb,al,at,ht Rp 77,500 Rp 547,500

DLO,wdl,ot,pt Rp 195,000
DLO,IgG-IgM dengue Rp 315,000
DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000 Rp 780,000

DLO,wdl,ot,pt Rp 195,000
IgG-IgM dengue Rp 225,000
DLO Rp 90,000
DLO,ot,pt Rp 140,000
DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000 Rp 1,010,000

DLO Rp 90,000
DLO Rp 90,000 Rp 180,000

DLO,wdl,ot,pt Rp 195,000
DLO,wdl,ot,pt Rp 195,000 Rp 390,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000

DLO,gds,wdl,ot,pt,crp Rp 265,000
FL Rp 45,000 Rp 310,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000


DLO,wdl,ot,pt Rp 195,000 Rp 195,000

hb,at,ht Rp 62,500
hb,al,at,ht Rp 77,500 Rp 140,000

Rp 7,432,500
KLINIK RSIA MUTIARA BUNDA JANUARI 2016

Jenis pemeriksaan Jumlah Biaya Total

DLO,wdl,ur,cr,ot,pt Rp 245,000 Rp 245,000

DLO,wdl,ot,pt Rp 195,000
FL Rp 45,000
DLO,ct,bt Rp 120,000
UL Rp 32,500
DLO,crp Rp 140,000 Rp 532,500

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000
DLO Rp 90,000 Rp 395,000

DLO,wdl Rp 145,000
DLO Rp 90,000 Rp 235,000

DLO,wdl,ur,cr,ot,pt,hbs.Ag Rp 295,000
UL Rp 32,500 Rp 327,500

DLO Rp 90,000 Rp 90,000

DLO,wdl,ot,pt Rp 195,000
DLO,bt,bd,bin Rp 172,500 Rp 367,500

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000

DLO Rp 90,000
DLO Rp 90,000 Rp 180,000

DLO,gd,ct,bt,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000


DLO,gd,gds,chol,tg,ua,ur,cr,ot,pt Rp 335,000 Rp 335,000

DLO,gd,wdl,ot,pt Rp 210,000
DLO Rp 90,000
DLO,ot,pt Rp 140,000
DLO Rp 90,000
DLO,wdl,ot,pt Rp 195,000 Rp 725,000

DLO,gd,wdl,ot,pt,bt,bd,bin,IgG-IgM Rp 292,500 Rp 292,500

hb,at,ht Rp 62,500
hb,al,at,ht,IgG-IgM dengue Rp 302,500
hb,at,ht,fl Rp 107,500
gds Rp 25,000 Rp 497,500
DLO Rp 90,000
hb,at,ht Rp 62,500 Rp 152,500

DLO,gds,wdl,ot,pt,hbs.Ag Rp 265,000 Rp 265,000

DLO,IgG-IgM dengue Rp 315,000


DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000 Rp 585,000

DLO,gds,wdl,ot,pt Rp 215,000
DLO,IgG-IgM dengue Rp 315,000
DLO Rp 90,000 Rp 620,000
DLO,gd Rp 105,000
FL Rp 45,000 Rp 150,000

DLO Rp 90,000
DLO Rp 90,000 Rp 180,000

DLO,wdl,ot,pt,IgG-IgM dengue Rp 420,000


DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000 Rp 690,000

Rp 7,475,000
KLINIK RSIA MUTIARA BUNDA JANUARI 2016

Jenis pemeriksaan Jumlah Biaya Total

DLO,gds,crp,ot,pt Rp 210,000
DLO,IgG-IgM dengue Rp 315,000 Rp 525,000

DLO,gds,wdl,ot,pt Rp 215,000
UL Rp 32,500
DLO Rp 90,000 Rp 337,500

DLO Rp 90,000
DLO Rp 90,000
hb,al,at,ht Rp 77,500 Rp 257,500

DLO,gd,crp Rp 155,000 Rp 155,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000
DLO Rp 90,000 Rp 90,000

DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000 Rp 450,000

DLO,gd,gds,wdl,ot,pt Rp 230,000 Rp 230,000

DLO,wdl Rp 145,000
DLO Rp 90,000 Rp 235,000

DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000 Rp 270,000

DLO,gd Rp 105,000 Rp 105,000

DLO,gd,mal,wdl,gds,ot,pt Rp 265,000
FL Rp 45,000 Rp 310,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000 Rp 305,000

DLO,mal,wdl,ot,pt, Rp 230,000
DLO Rp 90,000 Rp 320,000

DLO,wdl,,ot,pt Rp 195,000 Rp 195,000


DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000
DLO Rp 90,000 Rp 395,000

DLO,mal,wdl,gds,ot,pt,IgG,IgM dengue Rp 475,000


DLO Rp 90,000 Rp 565,000

DLO,mal,wdl,gds,ot,pt,IgG,IgM dengue Rp 475,000 Rp 475,000

DLO,IgG,IgM dengue Rp 315,000


DLO Rp 90,000
DLO Rp 90,000 Rp 495,000

hb,al,at,ht Rp 77,500 Rp 77,500

DLO,wdl,gds,ot,pt Rp 215,000
DLO Rp 90,000
DLO,IgG,IgM dengue Rp 315,000
DLO Rp 90,000
DLO Rp 90,000 Rp 800,000

DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000 Rp 270,000

Rp 7,167,500
KLINIK RSIA MUTIARA BUNDA JANUARI 2016

Jenis pemeriksaan Jumlah Biaya Total

DLO,wdl,gds,ur,cr,ot,pt,ch,tg,hbs.Ag Rp 365,000
UL Rp 32,500
DLO Rp 90,000 Rp 487,500

DLO,gd,wdl,ot,pt Rp 210,000 Rp 210,000


DLO,wdl,gds,ot,pt Rp 215,000
DLO Rp 90,000
DLO,IgG,IgM dengue Rp 315,000 Rp 830,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag Rp 305,000
DLO Rp 90,000 Rp 395,000

DLO,gd,wdl,ot,pt Rp 210,000
DLO,IgG,IgM dengue Rp 315,000
hb,at,ht Rp 62,500
DLO Rp 90,000 Rp 677,500

DLO,gd,wdl,ot,pt Rp 210,000 Rp 210,000


DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag, Rp 320,000 Rp 320,000

DLO,led,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag, Rp 320,000
UL Rp 32,500
DLO Rp 90,000 Rp 442,500

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag, Rp 305,000
DLO Rp 90,000 Rp 395,000

DLO,IgG,IgM dengue Rp 315,000


hb,at,ht Rp 62,500
DLO Rp 90,000 Rp 467,500

DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000 Rp 270,000

hb,at,ht,IgG,IgM dengue Rp 287,500


DLO Rp 90,000
DLO Rp 90,000
hb,at,ht, Rp 62,500 Rp 530,000

DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000 Rp 270,000

DLO,gds,ur,cr,ot,pt,ch,tg,hbs.Ag Rp 320,000 Rp 320,000


DLO,gd,gds,crp Rp 175,000 Rp 175,000
DLO,gd,mal,wdl,gds,ot,pt,IgG,IgM Rp 490,000 Rp 490,000

DLO,gd,gds,ur,cr,ot,pt,hbs.Ag, Rp 275,000
DLO Rp 90,000 Rp 365,000

DLO,wdl,ur,cr,ot,pt Rp 245,000
DLO Rp 90,000
DLO Rp 90,000
DLO Rp 90,000 Rp 515,000

DLO,wdl,gds,ot,pt Rp 215,000
IgG,IgM dengue Rp 225,000
DLO Rp 90,000
hb,al,at,ht Rp 77,500
hb,al,at,ht Rp 77,500 Rp 685,000

DLO,gds,ur,cr,ot,pt,hbs.Ag Rp 260,000
UL Rp 32,500 Rp 292,500

Rp 8,137,500
KLINIK RSIA MUTIARA BUNDA JANUARI 2016

Jenis pemeriksaan Jumlah Biaya Total

DLO Rp 90,000
DLO Rp 90,000
UL Rp 32,500 Rp 212,500

DLO Rp 90,000
DLO Rp 90,000 Rp 180,000

DLO,wdl,ot,pt,(K'helny dapur disc 15%) Rp 167,750


hb,at,ht (15%) Rp 53,100
hb,al,at,ht (15%) Rp 65,900
hb,al,at,ht (15%) Rp 65,900
hb,al,at,ht (15%) Rp 65,900
hb,al,at,ht (15%) Rp 65,900 Rp 484,450

hb,at,ht,IgG,IgM dengue Rp 287,500


DLO Rp 90,000
FL Rp 45,000
hb,al,at,ht Rp 62,500 Rp 485,000

DLO,wdl,ot,pt Rp 195,000
DLO Rp 90,000
hb,at,ht, IgG,IgM dengue Rp 287,500
gd Rp 20,000 Rp 592,500

DLO,gd,gds,ur,cr,ot,pthbs.Ag Rp 275,000 Rp 275,000

DLO Rp 90,000
gd Rp 15,000
DLO Rp 90,000
DLO Rp 90,000 Rp 285,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag, Rp 305,000 Rp 305,000

DLO,gds,ot,pt,IgG,IgM dengue,crp Rp 435,000


DLO Rp 90,000
DLO Rp 90,000
gd Rp 20,000 Rp 635,000

DLO,wdl,ot,pt Rp 195,000 Rp 195,000

DLO Rp 90,000
hb,al,at,ht Rp 77,500 Rp 167,500
DLO Rp 90,000
DLO Rp 90,000 Rp 180,000

DLO,gd,ct,bt,gds,ur,cr,ot,pt,hbs.Ag, (25%) Rp 228,750


DLO (25%) Rp 70,000 Rp 298,750

DLO,wdl,ot,pt Rp 195,000 Rp 195,000


DLO,gd,gds,crp Rp 175,000 Rp 175,000
DLO,wdl,ot,pt,IgG,IgM dengue Rp 420,000 Rp 420,000
DLO,wdl,ot,pt Rp 195,000 Rp 195,000
DLO,mal,wdl,gds,ur,cr,ot,pthbs.Ag Rp 335,000 Rp 335,000

Rp 7,070,000
Rp 6,532,500
Rp 7,432,500
Rp 7,475,000
Rp 7,167,500
Rp 8,137,500
Rp 5,615,700

Rp 49,430,700

Rp 5,615,700

Mengetahui,
Kepala Ruangan Laboratorium

dr. M. Hafidz maulana