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LAPORAN PELAYANAN POLI ANAK YANG TIDAK ADA PADA KLAIM (Pending)

dr. ELZA DESDAMONA, Sp. A


BULAN JULI 2017
RUMAH SAKIT IBU DAN ANAK SAYANG IBU

TOTAL KET
NO NAMA PASIEN TANGGAL RUANG
BPJS Umum
1 an. M. fala 28/7/2017 VIP 80,000
2 an. M. Fala Nasution 27/7/2017 VIP 80,000
3 an. M. falla nasution 29/7/2017 VIP 80,000
4 an. Naila habibah putri 9/7/2017 III 80,000
5 an. Naila habibah putri 10/7/2017 III 80,000
6 an. nayla habiba putri 11/7/2017 III 80,000
7 an. nayla habiba putri 12/7/2017 III 80,000
8 by fatmawati 5/7/2017 III 80,000
9 by. Ana sari hasmira 6/7/2017 III 80,000
10 by. Anna sari 7/7/2017 III 80,000
11 by. Dewi afira 15/7/2017 III 300,000 cyto ok
12 by. Dewi afita 15/7/2017 III 80,000
13 by. Dewi afita 17/7/2017 III 80,000
14 by. Dewi lestari 6/7/2017 III 300,000 cyto ok
15 by. Dewi lestari 7/7/2017 III 80,000
16 by. Dewi lestari 8/7/2017 III 80,000
17 by. Dewi lestari 9/7/2017 III 80,000
18 by. Fatmawati 3/7/2017 III 300,000 cyto ok
19 by. Fatmawati 4/7/2017 III 80,000
20 by. Fatmawati 6/7/2017 III 80,000
21 by.fatmawati 15/7/2017 III 100,000 perina
22 by. Fatmawati 11/7/2017 III 100,000 perina
23 by. fatmawati 12/7/2017 III 100,000 perina
24 by. fatmawati 13/7/2017 III 100,000 perina
25 by. Fatmawati 14/7/2017 III 100,000 perina
26 by. M. falla nasution 31/72017 VIP 80,000
27 by. nelawati 2/7/2017 III 80,000
28 by. Rini mariani 2/7/2017 II 80,000
29 by. Rini mariani 3/7/2017 II 80,000
30 by. Riza febrina 2/7/2017 VIP 80,000
31 by. Riza febrina 3/7/2017 I 80,000
32 by. Riza febrina 4/7/2017 I 80,000
33 by. Sonya pratiwi 6/7/2017 II 315,000 cyto ok
34 by. Sonya pratiwi 7/7/2017 II 80,000
35 by. Sonya pratiwi 8/7/2017 II 80,000
36 by. Sonya pratiwi 9/7/2017 II 80,000
TOTAL KET
NO NAMA PASIEN TANGGAL RUANG
BPJS Umum
37 by. Sri wahyuni 6/7/2017 III 80,000
38 by. Sri wahyuni 7/7/2017 III 80,000
39 by. Sri wahyuni 8/7/2017 III 80,000
40 by. Sri wahyuni 9/7/2017 III 80,000
41 by. Yeni Rahman 27/7/2017 III 300,000 cyto ok
42 by. Yeni rahman 28/7/2017 III 100,000 perina
43 by. Yeni rahman 29/7/2017 III 80,000
44 by. Yeni rahman 31/72017 III 100,000 perina
45 by. Yosi fitri 29/7/2017 VIP 80,000
46 by. Yosi fitri 31/72017 VIP 80,000
4,935,000
PPH 5 % 246,750
JUMLAH 4,688,250

Dibuat Oleh : Diketahui Oleh

Selviranika,S. Pd Monaliza, SE

Disahkan Oleh
Plh. Direktur

dr. Doddy Pratama, SP. OG

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