Data Hunian Kamar Rawatan RS.

Cempaka Az-Zahra
Periode April 2014
01 April/d 30 April 2014

U
No. Kamar Tanggal Tanggal Jumlah Biaya Kamar Total Biaya
No. Nama Pasien Harga Dasar Harga Jual Keterangan G
Reg Rawatan Masuk Keluar Hari Rawatan Rawatan
D
1 146 Tn. Nazaruddin Edelweish 3/29/2014 4/13/2014 15 Rp 9,000,000 Rp 33,685,000 8,144,728 Rp 10,935,358
2 148 Tn. Rizky Juanda Melati 4/1/2014 4/6/2014 5 Rp 1,750,000 Rp 11,709,000 6,437,360 Rp 8,400,718
3 149 An. Raina Bog/mawar 4/3/2014 4/7/2014 4 Rp 1,200,000 Rp 5,305,000 Rp 1,789,412 Rp 2,229,590
4 150 Ny. Meliani Tulip 4/4/2014 4/5/2014 2 Rp 600,000 Rp 2,185,000 Rp 873,630 Rp 1,094,925
5 151 Ny. Ulfah Sundari Az-Zahra 4/4/2014 4/6/2014 2 Rp 1,260,000 Rp 8,388,000 Rp 1,024,175 Rp 1,461,306
6 152 Ny. Mutia Isnalia Dahlia 4/4/2014 4/5/2014 1 Rp 200,000 Rp 5,808,000 Rp 899,815 Rp 1,191,480
7 153 Tn. Eko Arianto Mawar 4/4/2014 4/5/2014 1 Rp 350,000 Rp 2,128,000 Rp 772,430 Rp 1,002,057
8 154 Ny. Hj. Syamsiar Flamboyan 4/4/2014 4/6/2014 2 Rp 360,000 Rp 2,215,000 682,250 Rp 865,057
9 155 Ny. Dian Primadara Az-Zahra 4/6/2014 4/8/2014 2 Rp 1,260,000 Rp 13,078,000 923,255 Rp 1,348,315
10 156 An. Adrian Bougenvile 4/6/2014 4/7/2014 1 Rp 250,000 Rp 4,883,000 452,441 Rp 781,160
11 157 Tn. Rossi Sentana Dahlia 4/6/2014 4/9/2014 3 Rp 600,000 Rp 3,757,000 1,718,523 Rp 2,255,297 PT. DJARUM
12 158 Nn. Enola Mawar 4/8/2014 4/12/2014 4 Rp 1,400,000 Rp 7,475,000 3,126,623 Rp 4,031,352 PT. TASPEN
13 159 An. Rasya Aditya Az-Zahra 4/9/2014 4/11/2014 2 Rp 1,260,000 Rp 2,896,000 Rp 474,354 Rp 631,169 FIF
14 160 Ny. Heany Melati 4/9/2014 4/11/2014 2 Rp 700,000 Rp 4,668,000 Rp 843,786 Rp 1,236,211 PAKET
15 161 Ny. Christine Tulip 4/10/2014 4/12/2014 2 Rp 600,000 Rp 11,758,000 Rp 989,083 Rp 1,427,393
16 162 Ny. Aja Khatijah Mawar 4/10/2014 4/12/2014 2 Rp 700,000 Rp 13,617,000 Rp 1,166,010 Rp 1,798,185
17 163 Ny. Rida Aslamsyah Dahlia 4/11/2014 4/14/2014 3 Rp 600,000 Rp 2,779,000 Rp 1,107,915 Rp 1,374,999
18 164 Tn. Mustafirin Teratai 4/11/2014 4/14/2014 3 Rp 390,000 Rp 2,277,000 Rp 901,629 Rp 1,149,628
19 165 An. T. Qohthon Melati 4/11/2014 4/15/2014 4 Rp 1,400,000 Rp 3,461,000 Rp 424,490 Rp 591,219
20 166 Ny. Marhaya Tulip 4/12/2014 4/15/2014 3 Rp 900,000 Rp 15,000,000 Rp 1,041,342 Rp 1,490,083 PAKET
21 167 Ny. Faridahani Bougenvile 4/12/2014 4/16/2014 4 Rp 1,000,000 Rp 10,170,000 Rp 1,725,298 Rp 2,417,371 PAKET
22 168 Ny. Fatimah Az-Zahra 4/14/2014 4/16/2014 2 Rp 1,260,000 Rp 4,453,000 Rp 1,390,738 Rp 2,216,167
23 169 Ny. Nina Suasanti Kenanga 4/14/2014 4/15/2014 1 Rp 250,000 Rp 4,780,000 Rp 1,390,738 Rp 2,216,167
24 170 Tn. Irvan Mirza Dahlia BPJS
25 171 Ny. Rosnimar Edelweish 4/14/2014 4/17/2014 3 Rp 1,800,000 Rp 11,993,000 Rp 932,538 Rp 1,382,889
26 172 Nn. Risfi Isnaini OPLOSAN
27 173 Nn. Naishiroh Maim BPJS
28 174 Ny. Novi Aryani Az-Zahra 4/17/2014 4/19/2014 2 Rp 1,260,000 Rp 9,864,000 Rp 1,408,683 Rp 1,964,336 PAKET
29 175 Nn.Ratih Putri Melati 4/17/2014 4/21/2014 4 Rp 1,400,000 Rp 2,724,000 Rp 147,978 Rp 376,950
30 176 Tn. Rizwan Edelweish 4/22/2014 4/24/2014 3 Rp 1,800,000 Rp 4,706,000 Rp 1,457,361 Rp 1,913,682
31 177 Ny. Maya Anggreani Tulip 4/23/2014 4/26/2014 3 Rp 900,000 Rp 3,337,000 Rp 1,356,133 Rp 1,777,288 PLN
32 178 Ny. Risma Rita Jeumpa 4/25/2014 4/28/2014 3 Rp 750,000 Rp 2,627,000 Rp 412,086 Rp 547,200
33 179 Tn. Siswadi Flamboyan 4/26/2014 4/28/2014 2 Rp 360,000 Rp 1,285,000 Rp 204,890 Rp 330,190
34 180
35 181 Ny. Derma Devi Mawar 4/26/2014 4/28/2014 2 Rp 700,000 Rp 6,700,000 Rp 842,141 Rp 1,253,709 PAKET(IUR)
36 182 Ny. Siti Rodhiah Tulip 4/26/2014 4/28/2014 2 Rp 600,000 Rp 2,826,000 Rp 848,359 Rp 1,114,454
37 183 Ny. Mawaddah Melati 4/27/2014 4/29/2014 2 Rp 700,000 Rp 13,037,000 Rp 1,015,592 Rp 1,356,893 PAKET
38 184 Ny. Helena Bougenvile 4/28/2014 4/29/2014 1 Rp 250,000 Rp 2,628,000 Rp 298,252 Rp 448,363
39 185 Tn. Sutrisnol MEI
40 186 MEI
41 187 MEI
42 188 Ny. Yusmahani OK 4/29/2014 4/29/2014 Rp 3,200,000 Rp 403,850 Rp 558,397 Curetage
1906 97 Rp 37,810,000 Rp 241,402,000 Rp 47,627,888 Rp 65,169,558
 Rumah Sakit Cempaka Az-Zahra
Data Hunian Kamar Rawatan dr. Bismedi, SpBP
Periode APRIL 2014
( 01 April - 30 April )

Jumla
No. Kamar Biaya Kamar
No Nama Pasien Tanggal Masuk Tanggal Keluar h Bagi Hasil
Registrasi Rawatan Setelah Disc 10%
Hari
1 150 Ny. Meliani Tulip 4/4/2014 4/5/2014 2 Rp 540,000 Rp 270,000
2 151 Ny. Ulfah Sundari Az-Zahra 4/4/2014 4/6/2014 2 Rp 1,134,000 Rp 567,000
3 155 Ny. Dian Primadara Az-Zahra 4/6/2014 4/8/2014 2 Rp 1,134,000 Rp 567,000
4 159 An. Rasya Aditya Az-Zahra 4/9/2014 4/11/2014 2 Rp 1,134,000 Rp 567,000
5 161 Ny. Christine Tulip 4/10/2014 4/12/2014 2 Rp 540,000 Rp 270,000
6 166 Ny. Marhaya Tulip 4/12/2014 4/15/2014 3 Rp 810,000 Rp 405,000
7 168 Ny. Fatimah Az-Zahra 4/14/2014 4/16/2014 2 Rp 1,134,000 Rp 567,000
8 174 Ny. Novi Aryani Az-Zahra 4/17/2014 4/19/2014 2 Rp 1,134,000 Rp 567,000
9 177 Ny. Maya Anggreani Tulip 4/23/2014 4/26/2014 3 Rp 810,000 Rp 405,000
10 182 Ny. Siti Rodhiah Tulip 4/26/2014 4/28/2014 2 Rp 540,000 Rp 270,000
Total 22 Rp 8,910,000 Rp 4,455,000
 Data Hunian Kamar Rawatan BPJS RS. Cempaka Az-Zahra
Periode April 2014
01 April/d 30 April 2014

Kamar Tanggal Tanggal Jumlah Biaya Kamar Total Biaya

No. No. Reg Nama Pasien Harga Dasar Harga Jual
Rawatan Masuk Keluar Hari Rawatan Rawatan
1 0143 Tn. M. Jafar Rasyid Anggrek 3/26/2014 4/1/2014 6 Rp 1,080,000 Rp 4,213,000 Rp 963,386 Rp 1,397,819
2 0150 Tn. Usman Teratai 3/28/2014 4/3/2014 6 Rp 780,000 Rp 2,970,000 Rp 371,795 Rp 497,013
3 0153 By. Ny. Nirna Riska NICU 3/29/2014 4/1/2014 3 Rp 1,200,000 Rp 2,228,000 Rp 117,128 Rp 208,072
4 0155 An. Nurul Najwa Bougenvile 3/31/2014 4/1/2014 2 Rp 500,000 Rp 1,563,537 Rp 265,768 Rp 358,537
5 0156 Ny. Marliza Az-Zahra 4/1/2014 4/3/2014 2 Rp 1,260,000 Rp 3,611,000 Rp 908,887 Rp 1,337,472
6 0157 Tn. Aditya Ali Ramadhan Kenanga 4/2/2014 4/5/2014 3 Rp 750,000 Rp 1,796,000 Rp 92,945 Rp 120,838
7 0158 Ny. Fitria Ulfah Lili 4/2/2014 4/5/2014 3 Rp 600,000 Rp 1,988,000 Rp 208,262 Rp 286,391
8 0159 Ny. Nova Haslina Jeumpa 4/2/2014 4/4/2014 2 Rp 500,000 Rp 1,848,000 Rp 137,657 Rp 190,290
9 0160 Nn. Siti Zahra Kenanga 4/5/2014 4/6/2014 1 Rp 250,000 Rp 709,000 Rp 167,220 Rp 213,686
10 0161 An. M. Nawwaf Al Faris Jeumpa 4/7/2014 4/9/2014 2 Rp 500,000 Rp 1,407,000 Rp 143,726 Rp 201,580
11 0162 Ny. Rahmawati Teratai 4/7/2014 4/8/2014 1 Rp 130,000 Rp 801,000 Rp 229,913 Rp 370,675
12 0163 Tn. Zefri Kurniawan Lili 4/7/2014 4/10/2014 3 Rp 600,000 Rp 1,775,000 Rp 176,874 Rp 245,100
13 0164 Tn. Khairul Munawar Flamboyan 4/7/2014 4/10/2014 3 Rp 540,000 Rp 1,706,000 Rp 72,413 Rp 101,945
14 0165 Ny. Mujiana Tulip 4/7/2014 4/9/2014 2 Rp 600,000 Rp 1,832,000 Rp 250,888 Rp 341,642
15 0166 Ny. Nurkiah Bougenvile 4/8/2014 4/10/2014 3 Rp 750,000 Rp 1,767,000 Rp 170,512 Rp 231,776
16 0167 An. Jennifer Anggrek 4/9/2014 4/11/2014 2 Rp 360,000 Rp 1,971,000 Rp 300,014 Rp 412,485
17 0167 Ny. Faridahani (status biru) Bougenvile 4/12/2014 4/16/2014 4 Rp 1,000,000 Rp 4,277,000 Rp 1,725,298 Rp 2,417,371
18 0168 Ny. Ervina Jeumpa 4/9/2014 4/13/2014 4 Rp 1,000,000 Rp 4,020,000 Rp 1,042,036 Rp 1,453,388
19 0169 Ny. Ima Hagisa Bougenvile 4/10/2014 4/12/2014 2 Rp 500,000 Rp 2,757,000 Rp 906,312 Rp 1,291,910
20 0170 Ny. Nurul Wahyuni Az-Zahra 4/11/2014 4/13/2014 2 Rp 1,260,000 Rp 3,484,000 Rp 923,206 Rp 1,330,201
21 0170 Tn. Ivan Mirza Dahlia 4/14/2014 4/18/2014 4 Rp 800,000 Rp 2,392,000 Rp 398,412 Rp 656,697
22 0171 By. Ny. Nurul Wahyuni NICU 4/11/2014 4/13/2014 2 Rp 800,000 Rp 1,867,000 Rp 97,649 Rp 216,658
23 0172 Tn. Ashabul Yamin Lili 4/11/2014 4/15/2014 4 Rp 800,000 Rp 2,564,000 Rp 183,961 Rp 257,465
24 0173 Nn. Naishiroh Maimanah Jeumpa 4/16/2014 4/20/2014 4 Rp 1,000,000 Rp 3,147,000 Rp 867,258 Rp 1,302,497
25 0173 Tn. Burhanuddin Lubis Mawar 4/13/2014 4/13/2014 1 Rp 350,000 Rp 759,000 Rp 54,840 Rp 88,854
26 0174 Ny. Cut Mutia Anggrek 4/13/2014 4/13/2014 1 Rp 180,000 Rp 898,427 Rp 258,314 Rp 398,427
27 0174 Ny. Novi Aryati (status biru) Az-Zahra 4/17/2014 4/19/2014 2 Rp 1,260,000 Rp 5,434,000 Rp 1,408,683 Rp 1,964,336
28 0175 Ny. Rahma Dewi Flamboyan 4/13/2014 4/15/2014 2 Rp 360,000 Rp 2,726,000 Rp 877,793 Rp 1,265,604
29 0176 An. Shinta Humaira Anggrek 4/13/2014 4/16/2014 3 Rp 540,000 Rp 1,767,000 Rp 233,476 Rp 322,635
30 0177 Nn. Nevi Frilly Ulfah Mawar 4/14/2014 4/17/2014 3 Rp 1,050,000 Rp 2,612,000 Rp 179,918 Rp 257,165
31 0178 Nn. Rahmi Muliana Teratai 4/15/2014 4/15/2014 1 Rp 130,000 Rp 634,000 Rp 131,718 Rp 183,890
32 0179 Ny. Muliana Flamboyan 4/17/2014 4/19/2014 2 Rp 360,000 Rp 2,156,000 Rp 607,249 Rp 951,307
33 0180 Ny. Ferawati Bougenvile 4/19/2014 4/22/2014 3 Rp 750,000 Rp 2,911,000 Rp 959,379 Rp 1,374,046
34 0181 Ny. Rosmini Teratai 4/19/2014 4/20/2014 1 Rp 130,000 Rp 980,000 Rp 356,920 Rp 530,188
35 0182 Ny. Nurhafiza Anggrek 4/19/2014 4/22/2014 3 Rp 540,000 Rp 1,802,816 Rp 158,800 Rp 228,816
36 0183 Ny. Aklia Tulip 4/20/2014 4/22/2014 2 Rp 600,000 Rp 3,057,000 Rp 943,218 Rp 1,336,637
37 0184 Tn. Rahmad Rizal Lili 4/20/2014 4/21/2014 1 Rp 200,000 Rp 1,105,000 Rp 360,503 Rp 484,567
38 0185 Tn. Anthoni Lili 4/20/2014 4/22/2014 2 Rp 400,000 Rp 1,606,000 Rp 81,906 Rp 119,364
39 0186 An. Sayyidatina Rahmah Flamboyan 4/20/2014 4/22/2014 2 Rp 360,000 Rp 1,070,000 Rp 122,211 Rp 169,968
40 0187
41 0188
42 0189 An. M. Al Fathir Melati 4/21/2014 4/24/2014 3 Rp 1,050,000 Rp 2,696,000 Rp 273,613 Rp 360,594
43 0190
44 0191 Tn. T. Hanafiah Anggrek 4/22/2014 4/24/2014 2 Rp 360,000 Rp 1,284,000 Rp 110,107 Rp 158,930
45 0192 Ny. Hayatun Flamboyan 4/23/2014 4/25/2014 2 Rp 360,000 Rp 2,596,000 Rp 1,017,416 Rp 1,471,642
46 0193 Ny. Azimar SP Mawar 4/23/2014 4/25/2014 2 Rp 700,000 Rp 3,662,000 Rp 1,523,345 Rp 2,111,533
47 0194 By. Ny. Azimar SP NICU 4/23/2014 4/25/2014 2 Rp 800,000 Rp 1,642,000 Rp 124,155 Rp 222,364
48 0195 By. Ny. Hayatun NICU 4/23/2014 4/25/2014 2 Rp 800,000 Rp 1,741,000 Rp 107,330 Rp 201,122
49 0196 Tn. YH Pohan Jeumpa 4/23/2014 4/25/2014 2 Rp 500,000 Rp 1,770,000 Rp 361,602 Rp 475,774
50 0197 Ny. Eka Junita Dahlia 4/24/2014 4/28/2014 4 Rp 800,000 Rp 2,223,060 Rp 281,551 Rp 386,060
51 0198 Tn. Bachtiar Harun Kenanga 4/24/2014 4/28/2014 4 Rp 1,000,000 Rp 2,371,000 Rp 109,794 Rp 199,450
52 0199 Ny. Nurul Fajar Bougenvile 4/25/2014 4/27/2014 2 Rp 500,000 Rp 12,581,000 Rp 1,069,634 Rp 1,511,291
53 0200 Tn. Alamsyah Lili 4/25/2014 4/28/2014 4 Rp 800,000 Rp 2,196,000 Rp 113,249 Rp 160,250
54 0201 Ny. Rahmatun Nisa Anggrek 4/26/2014 4/27/2014 1 Rp 180,000 Rp 995,000 Rp 229,898 Rp 318,164
55 0202 Mulia Hardi Teratai 4/26/2014 4/28/2014 2 Rp 260,000 Rp 1,849,000 Rp 904,043 Rp 1,269,222
56 0203 Ny. Devi Armita Edelweis 4/27/2014 4/29/2014 2 Rp 1,200,000 Rp 3,167,000 Rp 938,244 Rp 1,336,534

0 133 Rp 34,080,000 Rp 126,984,840 Rp 24,620,429 Rp 35,300,242

 Data Hunian Instansi RS. Cempaka Az-Zahra
Periode April 2014
01 April/d 30 April 2014

No. Kamar Tanggal Tanggal Jumlah Biaya Kamar Total Biaya

No. Nama Pasien Harga Dasar Harga Jual Keterangan
Reg Rawatan Masuk Keluar Hari Rawatan Rawatan
11 157 Tn. Rossi Sentana Dahlia 4/6/2014 4/9/2014 3 Rp 600,000 Rp 3,757,000 1,718,523 Rp 2,255,297 PT. DJARUM
12 158 Nn. Enola Mawar 4/8/2014 4/12/2014 4 Rp 1,400,000 Rp 7,475,000 3,126,623 Rp 4,031,352 PT. TASPEN
13 159 An. Rasya Aditya Az-Zahra 4/9/2014 4/11/2014 2 Rp 1,260,000 Rp 2,896,000 Rp 474,354 Rp 631,169 FIF
4
5
6
7
8
9
1906 9 Rp 3,260,000 Rp 14,128,000 Rp 5,319,500 Rp 6,917,818