UTILISASI ALAT

1 2 3 4 5 6 7 8 9 10 11
EKG 2 5 2 5 4 8 8 6 5
Bedsite Monitor 1 2 1 1
Defibrilator
Nebulizer 1 1 1 1 2
Laryngoscope Dewasa
Laryngoscope Anak
Suction 1 1
Inkubator Portable

PENERIMAAN PASIEN
1 2 3 4 5 6 7 8 9 10 11
Rawat Inap Biasa 9 11 13 29 18 13 14 23 21 14 26
Rawat Kebidanana (VK)
Rawat Perina Sehat
Rawat Perina Sakit
Rawat Intensif 1 1 2 1 1
Dead On Resusitation
Dead On Arrival
Rawat Jalan/ Pulang 7 10 4 7 10 6 8 5 8 8 3
Pulang Paksa 1 2 1 1 1
Rujuk 1 1
Instalasi Bedah Sentral
Hemodialisa
Total 18 23 18 39 30 20 22 28 30 23 30

PRODUKTIVITAS
1 2 3 4 5 6 7 8 9 10 11
Resusitasi
Emergent 1 1 2 1 1
Urgent 9 12 14 29 17 14 14 23 23 15 26
Non Urgent 7 9 2 7 10 3 6 4 7 6 3
False Emergency 1 2 1 1 2 3 2 1 2
Total 18 23 18 39 30 20 22 28 30 23 30

JENIS PEMBAYARAN
1 2 3 4 5 6 7 8 9 10 11
UMUM 10 15 9 11 13 9 5 7 8 11 6
BPJS 7 8 9 27 16 10 16 18 22 12 19
JASA RAHARJA 4
ASURANSI LAIN 1 1 1 1 1 3 1
Total 18 23 18 39 30 20 22 28 30 23 30
BPJS NAIK KELAS 1 2
Total 0 0 0 0 0 0 1 0 0 2 0

UTILISASI RUANGAN
1 2 3 4 5 6 7 8 9 10 11
Ruang Resusitasi
Ruang Tindakan
Ruang IGD Umum
Ruang Observasi
Total 0 0 0 0 0 0 0 0 0 0 0

PENGELUARAN IGD BHP MEDIS

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryant tule steril sach 10 gr
Handscoon Non Steril S 500
Handscoon Non Steril M 300
Hydrogen Peroxide Onemed 100
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil 720
Kertas EKG 63 x 30 2
KY Jelly 50 g
Masker Earloop 50
Masker Tie On 50
Micropore 1/2 inch ###
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru Bayi 100
Peneng biru Dewasa 200
Peneng pink Bayi 100
peneng pink Dewasa 200
Pisau cukur single Dahlhausen
Povidone 1 Liter ###
Softpad 60 x 90 Onemed
Spatel Kayu
UnderPad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m ###
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR 20
SAFETY BOX 5 L (DOCARE) 2
SAFETY BOX 12.5 L (DOCARE) 2
Pisau Cukur Doubel

PEMASUKAN DARI BHP

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa 7
Accu Check Active
Alkohol 70%
Alkohol swab 578
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med 7
Daryantule steril sach 10 gr 70
Handscoon Non Steril S 397
Handscoon Non Steril M 232
Hydrogen Peroxide 85
Hypafix 5 cm x 5 cm ###
Hypafix 10 cm x 5 m 140
Kassa Verband 5 cm
Kassa Verband 10 cm 1
Kassa Hidrofil 155
Kertas EKG 63 x 30
KY Jelly 50 gram 22
Masker earloop 2
Masker Tie On 89
Micropore 1/2 inch ###
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru bayi 13
Peneng biru dewasa 72
peneng pink bayi 12
peneng pink dewasa 76
Pisau Cukur Sigle Daelhausen
Povidone 1 Liter 197
Softpad 60 x 90 Onemed
Spatel Kayu 2
Under Pad AMS
Water Irrigation 1000 mL 460
Xylocain Spray
ultrafix 10 cm x 5 m ###
odex 5 L
Penanda Resiko Fall Risk-Kuning 1
Penanda Alergi Merah 1
Under Pad NR 6
Nacl 0,9 % 1000 ML ###

PERMINTAAN FORM DAN ATK

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Form Surat Persetujuan Pulang
Form Surat Sakit
Form Hasil EKG 50
Form Resep 2
Form Persetujuan Tindakan Kedokteran
Form Penolakan Tindakan
Form Perintah Lisan/SBAR 1
Form Transfer Pasien 5
Form Persetujuan Umum
Form Observasi Khusus
Form Pengkajian Medis Rawat Inap
Form Pengkajian Medis IGD 5
Form Pengkajian Keperawatan IGD 5
Form Triase
Isi Staples
Isi Cutter
Kertas Label 107 50
Kertas Buram
Lem Stick
Form Permintaan Radiologi 1
Form Permintaan Laboratorium 2
Refill Printer LaserJet
Ballpoint 12
Form Pemberian Informasi Tindakan Kedokteran
Resep BPJS 5
Form Persetujuan Restrain
Form Pengkajian Keperawatan Pasien Ranap
Form Pengkajian Awal Medis Pasien Rawat Inap
Form Pengantar Untuk Rawat Inap (2 Rangkap)
Form Catatan Pemberian Edukasi Informasi
Isolatip
Amplop 95x152 mm 80 gsm
Amplop 110 x 230 mm, logo permata
Buku Dobel Folio
Clear Holder isi 40
Cable Tie UK 25 cm
Box File Bantex
Buku Folio 100 lembar
Buku Ekspedisi
Gunting Sedang
Kartu Stok RSPC
Form Daftar Kunjungan Dokter
Batu Batere Type C
Double Tape 1/2"
Buku Kwarto 200 Lembar
Form Surat Rujukan
Form Surat Ket. Meninggal
Keranjang Obat Hawai
Form Discount
Form Kontrol 1
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2 2 8 3 7 5 6 3 2 2 4 3 2 5 5 2 3 7 4 3
1 1 1 2 1 1 2 2 1

3 1 1 1 1 1 1 1 1 3 1

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
12 12 17 19 19 20 17 18 12 9 16 15 17 25 8 16 12 15 17 16
1

1 1 1 1 2 1

1 1
8 5 9 10 9 2 10 4 4 7 10 12 6 5 6 3 18 21 10 4
2 1 2 1
1 1 2 1

20 18 26 29 30 24 27 22 17 17 28 29 23 32 16 21 30 39 28 20

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 1 1
1 1 1 1 1 3
13 13 21 19 22 22 17 19 12 10 18 15 21 29 9 18 16 20 17 16
5 5 5 10 3 8 2 4 6 3 8 1 2 4 2 7 9 3
2 4 1 2 1 1 7 6 1 1 7 7 7 4
20 18 26 29 30 24 27 22 17 17 28 29 23 32 16 21 30 39 28 20

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
8 6 11 10 8 6 12 7 6 9 10 12 8 6 7 5 17 21 6 5
10 11 14 17 20 14 12 12 9 8 15 17 14 25 8 15 11 16 22 15
2 1 2 2 2
1 1 2 2 3 3 1 1 1 1 1 1 2 2
20 18 26 29 30 24 27 22 17 17 28 29 23 32 16 21 30 39 28 20
 1 1 2
0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 2

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

###

###
900
900

###
###

100
100
###
###

100
 ###

Tanggal
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
11

500
###
2

13
920
855
720
100
###
350
19
7
904

56
140
80
###
###
 20
134
19
177
3
745

###

###

3
5
31

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
5
3
110
10

7
2

5
35

10

15

60
 Harga Sewa Alat Total
TOTAL

123 Rp 50,000 Rp 6,150,000

17 Rp 109,350 Rp 1,858,950
0 Rp 145,800 Rp -
21 Rp 35,000 Rp 735,000
0 Rp - Rp -
0 Rp - Rp -
3 Rp 15,000 Rp 45,000
0 Rp - Rp -
Rp - Rp -
Rp 8,788,950
TOTAL

503
1
0
0
13
0
2
239
12
7
0
0
777

TOTAL

3
14
543
151
66
777

TOTAL

284
449
13
31
777
 7
7

TOTAL

0
0
0
0
0

TOTAL HPP Grand Total

0 Rp 5,040 Rp -
0 Rp 5,981 Rp -
0 Rp 30.466 Rp -
2200 Rp 128.43 Rp 282,546
0 Rp 3,006.00 Rp -
0 Rp 32,000 Rp -
0 Rp 17.320 Rp -
1000 Rp 150 Rp 150,000
1400 Rp 482.26 Rp 675,164
1200 Rp 483.31 Rp 579,972
100 Rp 36.00 Rp 3,600
5000 Rp 19.86 Rp 99,300
10000 Rp 19.41 Rp 194,100
0 Rp 847 Rp -
0 Rp 1,667.66 Rp -
720 Rp 397.74 Rp 286,373
5 Rp 60,000 Rp 300,000
0 Rp 538 Rp -
150 Rp 405 Rp 60,750
150 Rp 575.58 Rp 86,337
15470 Rp 4.53 Rp 70,079
10920 Rp 23.25 Rp 253,890
0 Rp 11.65 Rp -
0 Rp 50.40 Rp -
100 Rp 800 Rp 80,000
200 Rp 800 Rp 160,000
100 Rp 800 Rp 80,000
300 Rp 800 Rp 240,000
0 Rp 2,860 Rp -
1000 Rp 62.4 Rp 62,400
0 Rp 3,200 Rp -
 0 Rp 290 Rp -
0 Rp 3,836.74 Rp -
0 Rp 18.4 Rp -
0 Rp 54.3 Rp -
30000 Rp 9.2 Rp 276,300
0 Rp 193.1 Rp -
0 Rp - Rp -
0 Rp - Rp -
20 Rp 3,222.46 Rp 64,449
2 Rp 24,080.00 Rp 48,160.00
2 Rp 35,530.71 Rp 71,061.42
0 Rp 3,100.00 Rp -

Total Pengeluaran Rp 3,940,811

Terpakai Harga Jual Grand Total

18 Rp 10,530 Rp 189,540
0 Rp 9,450 Rp -
500 Rp 46.50 Rp 23,250.00
1768 Rp 346.50 Rp 612,612.00
2 Rp 8,910.00 Rp 17,820.00
0 Rp 32,000.00 Rp -
20 Rp 371.25 Rp 7,425.00
990 Rp 222.75 Rp 220,522.50
1252 Rp 965.25 Rp 1,208,493.00
952 Rp 965.25 Rp 918,918.00
185 Rp 53.46 Rp 9,890.10
12160 Rp 35.15 Rp 427,424.00
490 Rp 33.48 Rp 16,405.20
19 Rp 1,419.00 Rp 26,961.00
8 Rp 2,838.00 Rp 22,704.00
1059 Rp 701.25 Rp 742,623.75
0 Rp 60,000.00 Rp -
78 Rp 798.00 Rp 62,244.00
142 Rp 990.00 Rp 140,580.00
169 Rp 1,336.50 Rp 225,868.50
12585 Rp 21.45 Rp 269,948.25
8285 Rp 41.91 Rp 347,224.35
 0 Rp 17.34 Rp -
0 Rp 74.80 Rp -
33 Rp 2,392.50 Rp 78,952.50
206 Rp 1,485.00 Rp 305,910.00
31 Rp 2,392.50 Rp 74,167.50
253 Rp 1,485.00 Rp 375,705.00
3 Rp 4,247.10 Rp 12,741.30
942 Rp 98.01 Rp 92,325.42
0 Rp 5,940.00 Rp -
2 Rp 478.00 Rp 956.00
0 Rp 10,395.00 Rp -
4015 Rp 25.74 Rp 103,346.10
0 Rp 806.36 Rp -
32790 Rp 9.2 Rp 301,995.90
0 Rp 193.1 Rp -
4 Rp 1,700.00 Rp 6,800.00
6 Rp 2,775.00 Rp 16,650.00
37 Rp 5,400.00 Rp 199,800.00
1020 Rp 16.00 Rp 16,320.00

TOTAL PEMASUKAN Rp 7,076,123.37

LABA/RUGI Rp 3,135,312.47

Terpakai HPP Grand Total

5 Rp 3,666.49 Rp 18,332.45
3 Rp 4,500.00 Rp 13,500.00
160 Rp 500.00 Rp 80,000.00
12 Rp 4,500.00 Rp 54,000.00
0 Rp 9,000.00 Rp -
0 Rp 9,000.00 Rp -
8 Rp 9,000.00 Rp 72,000.00
7 Rp 12,000.00 Rp 84,000.00
0 Rp 11,500.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 9,000.00 Rp -
10 Rp 12,000.00 Rp 120,000.00
5 Rp 12,000.00 Rp 60,000.00
5 Rp 35,000.00 Rp 175,000.00
 0 Rp 1,100.00 Rp -
0 Rp 1,500.00 Rp -
85 Rp 2,500.00 Rp 212,500.00
0 Rp 18,000.00 Rp -
10 Rp 4,500.00 Rp 45,000.00
1 Rp 15,000.00 Rp 15,000.00
2 Rp 15,000.00 Rp 30,000.00
0 Rp 150,000.00 Rp -
12 Rp 1,200.00 Rp 14,400.00
0 Rp 9,000.00 Rp -
20 Rp 5,500.00 Rp 110,000.00
0 Rp 9,000.00 Rp -
0 Rp 16,500.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 13,200.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 10,000.00 Rp -
0 Rp 35,000.00 Rp -
1 Rp 25,300.00 Rp 25,300.00
0 Rp 15,000.00 Rp -
0 Rp 215.00 Rp -
0 Rp 24,750.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 5,807.69 Rp -
60 Rp 300.00 Rp 18,000.00
0 Rp 9,000.00 Rp -
0 Rp 2,325.00 Rp -
0 Rp 3,000.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 5,750.00 Rp -
0 Rp 7,278.43 Rp -
0 Rp 6,000.00 Rp -

Rp 1,147,032.45
 UTILISASI ALAT
1 2 3 4 5 6 7 8 9 10 11
EKG 2 3 6 5 6 4 11 8 7 6 4
Bedsite Monitor 1 2 1 1 1
Defibrilator
Nebulizer 1 1 2 1 1 1 1 1 1
Laryngoscope Dewasa
Laryngoscope Anak
Suction 1 1 1
Inkubator Portable

PENERIMAAN PASIEN
1 2 3 4 5 6 7 8 9 10 11
Rawat Inap Biasa 14 20 21 21 17 19 19 16 19 12 13
Rawat Kebidanana (VK) 1 1 3 1 1 2 1
Rawat Perina Sehat
Rawat Perina Sakit
Rawat Intensif 2 1 2 1 1
Dead On Resusitation 1 1 1 1
Dead On Arrival
Rawat Jalan/ Pulang 10 10 6 12 5 6 6 5 13 8
Pulang Paksa 1 1 2 1 1 3
Rujuk 1
Instalasi Bedah Sentral
Hemodialisa
Total 26 34 28 24 33 27 29 26 24 27 25

PRODUKTIVITAS
1 2 3 4 5 6 7 8 9 10 11
Resusitasi 1 1 1 1
Emergent 1 2 1 1 3 1 1
Urgent 14 24 22 20 25 24 18 18 21 18 18
Non Urgent 8 4 5 2 7 2 5 6 2 7 2
False Emergency 3 3 1 2 1 1 1 5
Total 26 34 28 24 33 27 29 26 24 27 25

JENIS PEMBAYARAN
1 2 3 4 5 6 7 8 9 10 11
UMUM 11 16 9 5 8 7 7 9 5 14 11
BPJS 15 17 17 17 21 18 22 15 18 10 13
JASA RAHARJA 1
ASURANSI LAIN 1 2 2 4 1 2 1 3 1
Total 26 34 28 24 33 27 29 26 24 27 25
BPJS NAIK KELAS 1 3 1
Total 0 0 1 0 0 0 3 0 0 0 1

UTILISASI RUANGAN
1 2 3 4 5 6 7 8 9 10 11
Ruang Resusitasi
Ruang Tindakan
Ruang IGD Umum
Ruang Observasi
Total 0 0 0 0 0 0 0 0 0 0 0

PENGELUARAN IGD BHP MEDIS

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryant tule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide Onemed
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 g
Masker Earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru Bayi
Peneng biru Dewasa
Peneng pink Bayi
peneng pink Dewasa
Pisau cukur single Dahlhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
UnderPad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel
Penanda Ungu DNR

PEMASUKAN DARI BHP

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryantule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 gram
Masker earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % 1000 ml
Opsite Flexifix
Peneng biru bayi
Peneng biru dewasa
peneng pink bayi
peneng pink dewasa
Pisau Cukur Sigle Daelhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
Under Pad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR

PERMINTAAN FORM DAN ATK

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Form Surat Persetujuan Pulang
Form Surat Sakit
Form Hasil EKG
Form Resep
Form Persetujuan Tindakan Kedokteran
Form Penolakan Tindakan
Form Perintah Lisan/SBAR
Form Transfer Pasien
Form Persetujuan Umum
Form Observasi Khusus
Form Pengkajian Medis Rawat Inap
Form Pengkajian Medis IGD
Form Pengkajian Keperawatan IGD
Form Triase
Isi Staples
Isi Cutter
Kertas Label 107
Kertas Buram
Lem Stick
Form Permintaan Radiologi
Form Permintaan Laboratorium
Refill Printer LaserJet
Ballpoint
Form Pemberian Informasi Tindakan Kedokteran
Resep BPJS
Form Persetujuan Restrain
Form Pengkajian Keperawatan Pasien Ranap
Form Pengkajian Awal Medis Pasien Rawat Inap
Form Pengantar Untuk Rawat Inap (2 Rangkap)
Form Catatan Pemberian Edukasi Informasi
Isolatip
Amplop 95x152 mm 80 gsm
Amplop 110 x 230 mm, logo permata
Buku Dobel Folio
Clear Holder isi 40
Cable Tie UK 25 cm
Box File Bantex
Buku Folio 100 lembar
Buku Ekspedisi
Gunting Sedang
Kartu Stok RSPC
Form Daftar Kunjungan Dokter
Batu Batere Type C
Double Tape 1/2"
Buku Kwarto 200 Lembar
Form Surat Rujukan
Form Surat Ket. Meninggal
Keranjang Obat Hawai
Form Discount
Form Permintaan Darah
Form Permintaan Kamar Operasi
Kertas HVS Putih
Papan Ujian
Penggaris Plastik
Tipe Ek
Spidol Kecil
Form Asuhan Keperawatan Perioperatif
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
5 6 4 3 7 4 5 9 6 10 10 6 5 5 5 5 4
1 1 1 1 1 1 1

2 2 1 1 1 1 2 1 2

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
12 19 17 12 17 17 13 19 15 26 17 12 14 15 18 14 15
1 2 1 1 1 1 1 2

1 1 1 1 1 1 1 3 1 1
1 2

6 10 5 8 3 10 11 6 9 11 7 3 10 9 8 5
1 1 1 2 5 2 7 1

1 3

20 32 24 24 26 30 24 27 23 37 30 20 23 26 32 22 22 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2
1 1 1 1 1 1 1 2 1
17 23 18 15 20 18 13 19 17 29 19 17 20 18 28 20 19
2 8 6 6 2 10 11 2 4 7 9 1 3 3 2 2
1 1 2 3 2 5 1 1 1 3 1
20 32 24 24 26 30 24 27 23 37 30 20 23 26 32 22 22 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
6 8 4 11 8 11 12 11 7 9 10 7 5 9 8 4 6
14 21 19 13 18 18 12 15 15 24 19 13 18 17 24 17 15
1 2
3 1 1 1 2 1 1 1
20 32 24 24 26 30 24 27 23 37 30 20 23 26 32 22 22 0 0 0
 2 1 2 1 2 1
0 0 2 0 0 0 0 0 1 2 0 0 1 0 2 0 1 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
100

###
### 600 200

###
600 200
400 200

2 2

200
300

100
100
100
100
 10
10
10

Tanggal
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
10 14

### ### 603

10 13 3
165 300 50
160 727 322
703 459 96
75 70 15
495 360 45
725 685 160
2
2
370 270 165

99 28
62 28 35
26 32 28
### ###
### ### ###
 760 845
50
13 9 8
99 65 32
11 4 5
138 80 39

395 440 140

4
3
760 590 175
10
### ### ###

6 1 2
2 2
4

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

150 50
5
3
1
2 2
3 2

2
7 2
5 2
5
8

50 25 25

2 2
9
1
7
3
5

1
1

2
2
1
5
1
1
1
2
 Harga Sewa Alat Total
TOTAL

161 Rp 50,000 Rp 8,050,000

13 Rp 109,350 Rp 1,421,550
0 Rp 145,800 Rp -
23 Rp 35,000 Rp 805,000
0 Rp - Rp -
0 Rp - Rp -
3 Rp 15,000 Rp 45,000
0 Rp - Rp -
Rp - Rp -
Rp 10,321,550
TOTAL

463
20
0
0
19
5
2
202
29
1
4
0
745

TOTAL

7
20
552
128
38
745

TOTAL

238
475
4
28
745
 14
14

TOTAL

0
0
0
0
0

TOTAL HPP Grand Total

100 Rp 5,040 Rp 504,000

0 Rp 5,981 Rp -
1000 Rp 30.466 Rp 30,466
1800 Rp 128.43 Rp 231,174
0 Rp 3,006.00 Rp -
0 Rp 32,000 Rp -
0 Rp 17.320 Rp -
1000 Rp 150 Rp 150,000
800 Rp 482.26 Rp 385,808
600 Rp 483.31 Rp 289,986
0 Rp 36.00 Rp -
0 Rp 19.86 Rp -
0 Rp 19.41 Rp -
0 Rp 847 Rp -
0 Rp 1,667.66 Rp -
0 Rp 397.74 Rp -
4 Rp 60,000 Rp 240,000
0 Rp 538 Rp -
200 Rp 405 Rp 81,000
300 Rp 575.58 Rp 172,674
0 Rp 4.53 Rp -
0 Rp 23.25 Rp -
0 Rp 11.65 Rp -
0 Rp 50.40 Rp -
100 Rp 800 Rp 80,000
100 Rp 800 Rp 80,000
100 Rp 800 Rp 80,000
100 Rp 800 Rp 80,000
0 Rp 2,860 Rp -
0 Rp 62.4 Rp -
0 Rp 3,200 Rp -
 0 Rp 290 Rp -
0 Rp 3,836.74 Rp -
0 Rp 18.4 Rp -
0 Rp 54.3 Rp -
0 Rp 9.2 Rp -
0 Rp 193.1 Rp -
10 Rp - Rp -
10 Rp - Rp -
10 Rp 3,222.46 Rp 32,225
0 Rp 24,080.00 Rp -
0 Rp 35,530.71 Rp -
0 Rp 3,100.00 Rp -
5 Rp 1,850.00 Rp 9,250.00

Total Pengeluaran Rp 2,405,108

Terpakai Harga Jual Grand Total

24 Rp 10,530 Rp 252,720
0 Rp 9,450 Rp -
0 Rp 46.50 Rp -
2770 Rp 346.50 Rp 959,805.00
0 Rp 8,910.00 Rp -
0 Rp 32,000.00 Rp -
26 Rp 371.25 Rp 9,652.50
515 Rp 222.75 Rp 114,716.25
1209 Rp 965.25 Rp 1,166,987.25
1258 Rp 965.25 Rp 1,214,284.50
160 Rp 53.46 Rp 8,553.60
900 Rp 35.15 Rp 31,635.00
1570 Rp 33.48 Rp 52,563.60
2 Rp 1,419.00 Rp 2,838.00
2 Rp 2,838.00 Rp 5,676.00
805 Rp 701.25 Rp 564,506.25
0 Rp 60,000.00 Rp -
127 Rp 798.00 Rp 101,346.00
125 Rp 990.00 Rp 123,750.00
86 Rp 1,336.50 Rp 114,939.00
11560 Rp 21.45 Rp 247,962.00
7705 Rp 41.91 Rp 322,916.55
 1605 Rp 18.00 Rp 28,890.00
50 Rp 74.80 Rp 3,740.00
30 Rp 2,392.50 Rp 71,775.00
196 Rp 1,485.00 Rp 291,060.00
20 Rp 2,392.50 Rp 47,850.00
257 Rp 1,485.00 Rp 381,645.00
0 Rp 4,247.10 Rp -
975 Rp 98.01 Rp 95,559.75
0 Rp 5,940.00 Rp -
4 Rp 478.00 Rp 1,912.00
3 Rp 10,395.00 Rp 31,185.00
1525 Rp 25.74 Rp 39,253.50
10 Rp 806.36 Rp 8,063.60
24770 Rp 9.2 Rp 228,131.70
0 Rp 193.1 Rp -
9 Rp 1,700.00 Rp 15,300.00
4 Rp 2,775.00 Rp 11,100.00
4 Rp 5,400.00 Rp 21,600.00

TOTAL PEMASUKAN Rp 6,523,917.05

LABA/RUGI Rp 4,118,809.05

Terpakai HPP Grand Total

0 Rp 3,666.49 Rp -
0 Rp 4,500.00 Rp -
200 Rp 500.00 Rp 100,000.00
5 Rp 4,500.00 Rp 22,500.00
3 Rp 9,000.00 Rp 27,000.00
1 Rp 9,000.00 Rp 9,000.00
4 Rp 9,000.00 Rp 36,000.00
5 Rp 12,000.00 Rp 60,000.00
0 Rp 11,500.00 Rp -
0 Rp 9,000.00 Rp -
2 Rp 9,000.00 Rp 18,000.00
9 Rp 12,000.00 Rp 108,000.00
7 Rp 12,000.00 Rp 84,000.00
5 Rp 35,000.00 Rp 175,000.00
 8 Rp 1,100.00 Rp 8,800.00
0 Rp 1,500.00 Rp -
100 Rp 2,500.00 Rp 250,000.00
0 Rp 18,000.00 Rp -
0 Rp 4,500.00 Rp -
4 Rp 15,000.00 Rp 60,000.00
9 Rp 15,000.00 Rp 135,000.00
1 Rp 150,000.00 Rp 150,000.00
7 Rp 1,200.00 Rp 8,400.00
3 Rp 9,000.00 Rp 27,000.00
5 Rp 5,500.00 Rp 27,500.00
0 Rp 9,000.00 Rp -
0 Rp 16,500.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 13,200.00 Rp -
0 Rp 5,500.00 Rp -
1 Rp 10,000.00 Rp 10,000.00
1 Rp 35,000.00 Rp 35,000.00
0 Rp 25,300.00 Rp -
0 Rp 15,000.00 Rp -
0 Rp 215.00 Rp -
0 Rp 24,750.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 5,500.00 Rp -
2 Rp 5,807.69 Rp 11,615.38
0 Rp 300.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 2,325.00 Rp -
0 Rp 3,000.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 9,000.00 Rp -
2 Rp 5,750.00 Rp 11,500.00
0 Rp 7,278.43 Rp -
0 Rp 6,000.00 Rp -
2 Rp 6,000.00 Rp 12,000.00
2 Rp 9,000.00 Rp 18,000.00
1 Rp 29,500.00 Rp 29,500.00
5 Rp 4,000.00 Rp 20,000.00
1 Rp 895.80 Rp 895.80
1 Rp 4,312.96 Rp 4,312.96
1 Rp 1,200.00 Rp 1,200.00
2 Rp 18,000.00 Rp 36,000.00
0 Rp - Rp -
Rp 1,374,315.38
 UTILISASI ALAT
1 2 3 4 5 6 7 8 9 10 11
EKG 7 4 3 5 3 1 3 4 4 1 1
Bedsite Monitor 2 1 2 2 1 1 2
Defibrilator
Nebulizer 1 1 1 3 1 1 2 1
Laryngoscope Dewasa
Laryngoscope Anak
Suction 1 1 1
Inkubator Portable

PENERIMAAN PASIEN
1 2 3 4 5 6 7 8 9 10 11
Rawat Inap Biasa 19 18 16 12 15 17 19 15 22 11 15
Rawat Kebidanana (VK)
Rawat Perina Sehat
Rawat Perina Sakit 1 1
Rawat Intensif 1 2 1 2 1
Dead On Resusitation
Dead On Arrival 1
Rawat Jalan/ Pulang 7 6 11 11 7 10 8 7 4 9 13
Pulang Paksa 1
Rujuk 1 1 1 2 1
Instalasi Bedah Sentral 1 1 1
Hemodialisa
Total 28 25 29 25 24 31 29 22 26 23 30

PRODUKTIVITAS
1 2 3 4 5 6 7 8 9 10 11
Resusitasi 1
Emergent 2 2 1 1 1
Urgent 22 18 24 19 21 19 21 17 17
Non Urgent 4 5 5 5 2 4 4 13
False Emergency 1 3 2 1 2
Total 28 25 29 25 0 0 29 22 26 23 30

JENIS PEMBAYARAN
1 2 3 4 5 6 7 8 9 10 11
UMUM
BPJS
JASA RAHARJA
ASURANSI LAIN
Total 0 0 0 0 0 0 0 0 0 0 0
BPJS NAIK KELAS
Total 0 0 0 0 0 0 0 0 0 0 0

UTILISASI RUANGAN
1 2 3 4 5 6 7 8 9 10 11
Ruang Resusitasi
Ruang Tindakan
Ruang IGD Umum
Ruang Observasi
Total 0 0 0 0 0 0 0 0 0 0 0

PENGELUARAN IGD BHP MEDIS

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryant tule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide Onemed
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 g
Masker Earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru Bayi
Peneng biru Dewasa
Peneng pink Bayi
peneng pink Dewasa
Pisau cukur single Dahlhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
UnderPad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel

PEMASUKAN DARI BHP

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryantule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 gram
Masker earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru bayi
Peneng biru dewasa
peneng pink bayi
peneng pink dewasa
Pisau Cukur Sigle Daelhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
Under Pad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel
Penanda Ungu DNR

PERMINTAAN FORM DAN ATK

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Form Surat Persetujuan Pulang
Form Surat Sakit
Form Hasil EKG
Form Resep
Form Persetujuan Tindakan Kedokteran
Form Penolakan Tindakan
Form Perintah Lisan/SBAR
Form Transfer Pasien
Form Persetujuan Umum
Form Observasi Khusus
Form Pengkajian Medis Rawat Inap
Form Pengkajian Medis IGD
Form Pengkajian Keperawatan IGD
Form Triase
Isi Staples
Isi Cutter
Kertas Label 107
Kertas Buram
Lem Stick
Form Permintaan Radiologi
Form Permintaan Laboratorium
Refill Printer LaserJet
Ballpoint
Form Pemberian Informasi Tindakan Kedokteran
Resep BPJS
Form Persetujuan Restrain
Form Pengkajian Keperawatan Pasien Ranap
Form Pengkajian Awal Medis Pasien Rawat Inap
Form Pengantar Untuk Rawat Inap (2 Rangkap)
Form Catatan Pemberian Edukasi Informasi
Isolatip
Amplop 95x152 mm 80 gsm
Amplop 110 x 230 mm, logo permata
Buku Dobel Folio
Clear Holder isi 40
Cable Tie UK 25 cm
Box File Bantex
Buku Folio 100 lembar
Buku Ekspedisi
Gunting Sedang
Kartu Stok RSPC
Form Daftar Kunjungan Dokter
Batu Batere Type C
Double Tape 1/2"
Buku Kwarto 200 Lembar
Form Surat Rujukan
Form Surat Ket. Meninggal
Keranjang Obat Hawai
Form Discount
Batu Batere AA
Surat Kontrol
Cutter
Lembar Coding BPJS Rawat Jalan
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2 8 4 8 10 4 4 6 9 4 3 7 4 2 4 3 2 9 5 5
1 1 1 1 1 1 1 2 3

1 1 1 2 1 3 2

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
8 21 20 17 22 12 12 15 19 15 14 17 24 11 13 14 13 23 16 23
25

1 1
1 1 1 2
1 1
1 2
9 6 1 9 15 8 8 8 6 6 7 13 13 8 13 1 18 13 10 8
1 1 2 1

1
17 27 21 27 38 21 21 23 27 21 21 31 38 19 27 15 31 41 29 57

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 1 1
1 1 1 2 3
8 24 21 19 31 15 15 15 21 22 27 11 13 14 13 30 22 19
9 3 6 4 5 5 5 1 8 8 8 13 10 10 4 4 3
2 2 3 3 1 3 6 8 5
17 27 21 27 38 21 21 23 27 0 0 31 38 19 27 30 31 41 29 22

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
 Tanggal
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
 Harga Sewa Alat Total
TOTAL

139 Rp 50,000 Rp 6,950,000

23 Rp 109,350 Rp 2,515,050
0 Rp 145,800 Rp -
22 Rp 35,000 Rp 770,000
0 Rp - Rp -
0 Rp - Rp -
3 Rp 15,000 Rp 45,000
0 Rp - Rp -
Rp - Rp -
Rp 10,280,050
TOTAL

483
25
0
4
12
2
4
273
6
6
3
1
844

TOTAL

4
15
518
148
42
727

TOTAL

0
0
0
0
0
 0
0

TOTAL

0
0
0
0
0

TOTAL HPP Grand Total

0 Rp 5,040 Rp -
0 Rp 5,981 Rp -
1000 Rp 30.466 Rp 30,466
2100 Rp 128.43 Rp 269,703
0 Rp 3,006.00 Rp -
0 Rp 32,000 Rp -
5 Rp 17.320 Rp 87
1000 Rp 150 Rp 150,000
1600 Rp 482.26 Rp 771,616
1000 Rp 483.31 Rp 483,310
100 Rp 36.00 Rp 3,600
0 Rp 19.86 Rp -
0 Rp 19.41 Rp -
0 Rp 847 Rp -
0 Rp 1,667.66 Rp -
1440 Rp 397.74 Rp 572,746
4 Rp 60,000 Rp 240,000
200 Rp 538 Rp 107,600
0 Rp 405 Rp -
200 Rp 575.58 Rp 115,116
15470 Rp 4.53 Rp 70,079
8190 Rp 23.25 Rp 190,418
0 Rp 11.65 Rp -
5000 Rp 50.40 Rp 252,000
0 Rp 800 Rp -
300 Rp 800 Rp 240,000
0 Rp 800 Rp -
200 Rp 800 Rp 160,000
0 Rp 2,860 Rp -
1000 Rp 62.4 Rp 62,400
0 Rp 3,200 Rp -
 0 Rp 290 Rp -
0 Rp 3,836.74 Rp -
4000 Rp 18.4 Rp 73,600
0 Rp 54.3 Rp -
10000 Rp 9.2 Rp 92,100
0 Rp 193.1 Rp -
0 Rp - Rp -
0 Rp - Rp -
20 Rp 3,222.46 Rp 64,449
0 Rp 24,080.00 Rp -
0 Rp 35,530.71 Rp -
0 Rp 3,100.00 Rp -

Total Pengeluaran Rp 3,884,840

Terpakai Harga Jual Grand Total

23 Rp 10,530 Rp 242,190
0 Rp 9,450 Rp -
4 Rp 46.50 Rp 186.00
1515 Rp 346.50 Rp 524,947.50
2 Rp 8,910.00 Rp 17,820.00
0 Rp 32,000.00 Rp -
83 Rp 371.25 Rp 30,813.75
1035 Rp 222.75 Rp 230,546.25
2987 Rp 965.25 Rp 2,883,201.75
0 Rp 965.25 Rp -
0 Rp 53.46 Rp -
0 Rp 35.15 Rp -
0 Rp 33.48 Rp -
1 Rp 1,419.00 Rp 1,419.00
9 Rp 2,838.00 Rp 25,542.00
2131 Rp 701.25 Rp 1,494,363.75
0 Rp 60,000.00 Rp -
181 Rp 798.00 Rp 144,438.00
146 Rp 990.00 Rp 144,540.00
248 Rp 1,336.50 Rp 331,452.00
13660 Rp 21.45 Rp 293,007.00
7841 Rp 41.91 Rp 328,616.31
 0 Rp 17.34 Rp -
4000 Rp 74.80 Rp 299,200.00
44 Rp 2,392.50 Rp 105,270.00
297 Rp 1,485.00 Rp 441,045.00
32 Rp 2,392.50 Rp 76,560.00
241 Rp 1,485.00 Rp 357,885.00
0 Rp 4,247.10 Rp -
1105 Rp 98.01 Rp 108,301.05
0 Rp 5,940.00 Rp -
27 Rp 478.00 Rp 12,906.00
5 Rp 10,395.00 Rp 51,975.00
3605 Rp 25.74 Rp 92,792.70
0 Rp 806.36 Rp -
24615 Rp 9.2 Rp 226,704.15
0 Rp 193.1 Rp -
4 Rp 1,700.00 Rp 6,800.00
17 Rp 2,775.00 Rp 47,175.00
20 Rp 5,400.00 Rp 108,000.00
5 Rp 24,080.00 Rp 120,400.00
Rp 35,530.71 Rp -
Rp 3,100.00 Rp -
Rp 1,850.00 Rp -

TOTAL PEMASUKAN Rp 8,465,722.21

LABA/RUGI Rp 4,580,882.41

Terpakai HPP Grand Total

4 Rp 3,666.49 Rp 14,665.96
190 Rp 4,500.00 Rp 855,000.00
0 Rp 500.00 Rp -
10 Rp 4,500.00 Rp 45,000.00
2 Rp 9,000.00 Rp 18,000.00
0 Rp 9,000.00 Rp -
5 Rp 9,000.00 Rp 45,000.00
4 Rp 12,000.00 Rp 48,000.00
0 Rp 11,500.00 Rp -
0 Rp 9,000.00 Rp -
3 Rp 9,000.00 Rp 27,000.00
7 Rp 12,000.00 Rp 84,000.00
12 Rp 12,000.00 Rp 144,000.00
12 Rp 35,000.00 Rp 420,000.00
 0 Rp 1,100.00 Rp -
1 Rp 1,500.00 Rp 1,500.00
69 Rp 2,500.00 Rp 172,500.00
0 Rp 18,000.00 Rp -
0 Rp 4,500.00 Rp -
4 Rp 15,000.00 Rp 60,000.00
0 Rp 15,000.00 Rp -
0 Rp 150,000.00 Rp -
11 Rp 1,200.00 Rp 13,200.00
0 Rp 9,000.00 Rp -
4 Rp 5,500.00 Rp 22,000.00
0 Rp 9,000.00 Rp -
0 Rp 16,500.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 13,200.00 Rp -
2 Rp 5,500.00 Rp 11,000.00
1 Rp 10,000.00 Rp 10,000.00
1 Rp 35,000.00 Rp 35,000.00
1 Rp 25,300.00 Rp 25,300.00
0 Rp 15,000.00 Rp -
0 Rp 215.00 Rp -
0 Rp 24,750.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 5,807.69 Rp -
0 Rp 300.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 2,325.00 Rp -
0 Rp 3,000.00 Rp -
1 Rp 11,000.00 Rp 11,000.00
0 Rp 9,000.00 Rp -
0 Rp 5,750.00 Rp -
0 Rp 7,278.43 Rp -
0 Rp 6,000.00 Rp -
0 Rp 1,750.00 Rp -
3 Rp 9,000.00 Rp 27,000.00
1 Rp 3,500.00 Rp 3,500.00
5 Rp 1,375.00 Rp 6,875.00
0 Rp - Rp -
0 Rp - Rp -
0 Rp - Rp -

Rp 2,099,540.96
 UTILISASI ALAT
1 2 3 4 5 6 7 8 9 10 11
EKG 1 6 7 3 7 2 5 4 3 7 5
Bedsite Monitor 2 1 2 2
Defibrilator
Nebulizer 1 1 2 1 2 1 2 1 2
Laryngoscope Dewasa
Laryngoscope Anak
Suction
Inkubator Portable

PENERIMAAN PASIEN
1 2 3 4 5 6 7 8 9 10 11
Rawat Inap Biasa 12 21 22 28 15 19 19 9 14 16 20
Rawat Kebidanana (VK) 1 1
Rawat Perina Sehat
Rawat Perina Sakit 1
Rawat Intensif 3 1 1 3
Dead On Resusitation
Dead On Arrival 1 1
Rawat Jalan/ Pulang 10 9 8 8 4 5 7 8 8 14 4
Pulang Paksa 1 1 1
Rujuk 3 3 1
Instalasi Bedah Sentral 1
Hemodialisa 1
Total 23 35 33 37 20 25 27 22 24 31 27

PRODUKTIVITAS
1 2 3 4 5 6 7 8 9 10 11
Resusitasi 1 1 1
Emergent 1 1 2
Urgent 17 28 30 32 16 23 24 17 17 26 24
Non Urgent 2 6 3 1 1 1 1 7 2
False Emergency 4 3 3 1 3 4 1
Total 23 35 33 37 20 25 27 22 24 31 27

JENIS PEMBAYARAN
1 2 3 4 5 6 7 8 9 10 11
UMUM 9 14 10 8 8 5 10 9 7 9 6
BPJS 14 18 22 29 12 20 17 13 15 20 21
JASA RAHARJA
ASURANSI LAIN 3 1 2 2
Total 23 35 33 37 20 25 27 22 24 31 27
BPJS NAIK KELAS 1 1
Total 0 1 1 0 0 0 0 0 0 0 0

UTILISASI RUANGAN
1 2 3 4 5 6 7 8 9 10 11
Ruang Resusitasi
Ruang Tindakan
Ruang IGD Umum
Ruang Observasi
Total 0 0 0 0 0 0 0 0 0 0 0

PENGELUARAN IGD BHP MEDIS

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryant tule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide Onemed
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 g
Masker Earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru Bayi
Peneng biru Dewasa
Peneng pink Bayi
peneng pink Dewasa
Pisau cukur single Dahlhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
UnderPad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel
Masker Tie On Dispro

PEMASUKAN DARI BHP

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryantule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 gram
Masker earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru bayi
Peneng biru dewasa
peneng pink bayi
peneng pink dewasa
Pisau Cukur Sigle Daelhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
Under Pad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel
Penanda Ungu DNR

PERMINTAAN FORM DAN ATK

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Form Surat Persetujuan Pulang
Form Surat Sakit
Form Hasil EKG
Form Resep
Form Persetujuan Tindakan Kedokteran
Form Penolakan Tindakan
Form Perintah Lisan/SBAR
Form Transfer Pasien
Form Persetujuan Umum
Form Observasi Khusus
Form Pengkajian Medis Rawat Inap
Form Pengkajian Medis IGD
Form Pengkajian Keperawatan IGD
Form Triase
Isi Staples
Isi Cutter
Kertas Label 107
Kertas Buram
Lem Stick
Form Permintaan Radiologi
Form Permintaan Laboratorium
Refill Printer LaserJet
Ballpoint
Form Pemberian Informasi Tindakan Kedokteran
Resep BPJS
Form Persetujuan Restrain
Form Pengkajian Keperawatan Pasien Ranap
Form Pengkajian Awal Medis Pasien Rawat Inap
Form Pengantar Untuk Rawat Inap (2 Rangkap)
Form Catatan Pemberian Edukasi Informasi
Isolatip
Amplop 95x152 mm 80 gsm
Amplop 110 x 230 mm, logo permata
Buku Dobel Folio
Clear Holder isi 40
Cable Tie UK 25 cm
Box File Bantex
Buku Folio 100 lembar
Buku Ekspedisi
Gunting Sedang
Kartu Stok RSPC
Form Daftar Kunjungan Dokter
Batu Batere Type C
Double Tape 1/2"
Buku Kwarto 200 Lembar
Form Surat Rujukan
Form Surat Ket. Meninggal
Keranjang Obat Hawai
Form Discount
Batu Batere AA
Surat Kontrol
Cutter
Lembar Coding BPJS Rawat Jalan
Form Konsultasi Antar DPJP
Isi Pulpen
Map Plastik Berkancing
 TANGGAL
TOTAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
3 11 6 5 4 4 5 9 2 8 7 3 6 4 4 2 6 7 146
2 1 1 1 1 1 1 2 1 1 2 21
0
1 3 2 3 4 1 1 2 2 3 2 37
0
0
0
0

TANGGAL
TOTAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
16 17 17 18 13 18 21 25 23 21 17 14 19 18 18 13 15 15 10 479
28
0
1 1 1 1 5
1 2 1 1 1 1 1 16
1 1 1 1 4
2
8 13 13 11 15 11 3 9 8 5 11 6 15 10 11 4 8 12 13 271
1 1 1 6
1 1 1 1 2 1 1 1 1 17
1 2
1
27 32 30 29 28 31 27 37 34 28 32 20 35 30 30 20 24 27 23 848

TANGGAL
TOTAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 1 5
1 1 2 1 1 1 1 2 14
21 20 19 20 17 24 24 27 28 25 25 18 24 25 23 18 15 18 14 659
5 10 6 8 8 5 2 9 5 2 3 1 4 3 6 2 7 8 8 126
1 5 1 3 1 3 1 6 1 1 1 1 44
27 32 30 29 28 31 27 37 34 28 32 20 35 30 30 20 24 27 23 848

TANGGAL
TOTAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
10 13 15 9 11 9 5 10 16 5 13 2 13 11 6 4 10 11 11 279
17 19 13 18 16 20 18 27 18 23 18 16 19 19 20 10 14 16 9 531
3 3
2 2 1 2 1 1 2 3 4 6 3 35
27 32 30 29 28 31 27 37 34 28 32 20 35 30 30 20 24 27 23 848
 1 2 4 9
0 0 0 0 0 0 0 0 1 0 0 0 2 0 4 0 0 0 0 9

TANGGAL
TOTAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
0
0
0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
TOTAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
100

2000

100
1000
1900
1400
200

10
720
6

100

10920
16380

400

300
 50
10
3000

10000

15

100

Tanggal
Terpakai
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
77

2220
3

42
305
1677
1062
190

1934
16
7
617

81
84
198
14486
11895
 41
256
40
259

1067

8
11
3325

26925

2
6
21

TANGGAL
Terpakai
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
9
0
130
3
1
0
5
7
0
0
0
10
10
8
 3
1
73
0
6
2
5
0
16
3
9
0
0
0
0
0
0
0
0
1
0
0
0
0
1
0
0
0
0
0
1
2
0
0
0
0
3
1
5
1
6
2
Harga Sewa Alat Total

Rp 50,000 Rp 7,300,000
Rp 109,350 Rp 2,296,350
Rp 145,800 Rp -
Rp 35,000 Rp 1,295,000
Rp - Rp -
Rp - Rp -
Rp 15,000 Rp -
Rp - Rp -
Rp - Rp -
Rp 10,891,350
 HPP Grand Total

Rp 5,040 Rp 504,000
Rp 5,981 Rp -
Rp 30.466 Rp -
Rp 128.43 Rp 256,860
Rp 3,006.00 Rp -
Rp 32,000 Rp -
Rp 17.320 Rp 1,732
Rp 150 Rp 150,000
Rp 482.26 Rp 916,294
Rp 483.31 Rp 676,634
Rp 36.00 Rp 7,200
Rp 19.86 Rp -
Rp 19.41 Rp -
Rp 847 Rp -
Rp 1,667.66 Rp 16,677
Rp 397.74 Rp 286,373
Rp 60,000 Rp 360,000
Rp 538 Rp -
Rp 405 Rp 40,500
Rp 575.58 Rp -
Rp 4.53 Rp 49,468
Rp 23.25 Rp 380,835
Rp 11.65 Rp -
Rp 50.40 Rp -
Rp 800 Rp -
Rp 800 Rp 320,000
Rp 800 Rp -
Rp 800 Rp 240,000
Rp 2,860 Rp -
Rp 62.4 Rp -
Rp 3,200 Rp -
Rp 290 Rp 14,500
Rp 3,836.74 Rp 38,367
Rp 18.4 Rp 55,200
Rp 54.3 Rp -
Rp 9.2 Rp 92,100
Rp 193.1 Rp -
Rp - Rp -
Rp - Rp -
Rp 3,222.46 Rp -
Rp 24,080.00 Rp -
Rp 35,530.71 Rp 71,061.42
Rp 3,100.00 Rp -
Rp 473.60 Rp 47,360.00
Rp - Rp -

Total Pengeluaran Rp 4,406,739

Harga Jual Grand Total

Rp 10,530 Rp 810,810
Rp 9,450 Rp -
Rp 46.50 Rp -
Rp 346.50 Rp 769,230.00
Rp 8,910.00 Rp 26,730.00
Rp 32,000.00 Rp -
Rp 371.25 Rp 15,592.50
Rp 222.75 Rp 67,938.75
Rp 965.25 Rp 1,618,724.25
Rp 965.25 Rp 1,025,095.50
Rp 53.46 Rp 10,157.40
Rp 35.15 Rp -
Rp 33.48 Rp 64,750.32
Rp 1,419.00 Rp 22,704.00
Rp 2,838.00 Rp 19,866.00
Rp 701.25 Rp 432,671.25
Rp 60,000.00 Rp -
Rp 798.00 Rp 64,638.00
Rp 990.00 Rp 83,160.00
Rp 1,336.50 Rp 264,627.00
Rp 21.45 Rp 310,724.70
Rp 41.91 Rp 498,519.45
Rp 17.34 Rp -
Rp 74.80 Rp -
Rp 2,392.50 Rp 98,092.50
Rp 1,485.00 Rp 380,160.00
Rp 2,392.50 Rp 95,700.00
Rp 1,485.00 Rp 384,615.00
Rp 4,247.10 Rp -
Rp 98.01 Rp 104,576.67
Rp 5,940.00 Rp -
Rp 478.00 Rp 3,824.00
Rp 10,395.00 Rp 114,345.00
Rp 25.74 Rp 85,585.50
Rp 806.36 Rp -
Rp 9.2 Rp 247,979.25
Rp 193.1 Rp -
Rp 1,700.00 Rp 3,400.00
Rp 2,775.00 Rp 16,650.00
Rp 5,400.00 Rp 113,400.00
Rp 24,080.00 Rp -
Rp 35,530.71 Rp 35,530.71
Rp 3,100.00 Rp -
Rp 1,850.00 Rp 3,700.00

TOTAL PEMASUKAN Rp 7,620,817.04

LABA/RUGI Rp 3,214,077.64

HPP Grand Total

Rp 3,666.49 Rp 32,998.41
Rp 4,500.00 Rp -
Rp 500.00 Rp 65,000.00
Rp 4,500.00 Rp 13,500.00
Rp 9,000.00 Rp 9,000.00
Rp 9,000.00 Rp -
Rp 9,000.00 Rp 45,000.00
Rp 12,000.00 Rp 84,000.00
Rp 11,500.00 Rp -
Rp 9,000.00 Rp -
Rp 9,000.00 Rp -
Rp 12,000.00 Rp 120,000.00
Rp 12,000.00 Rp 120,000.00
Rp 35,000.00 Rp 280,000.00
Rp 1,100.00 Rp 3,300.00
Rp 1,500.00 Rp 1,500.00
Rp 2,500.00 Rp 182,500.00
Rp 18,000.00 Rp -
Rp 4,500.00 Rp 27,000.00
Rp 15,000.00 Rp 30,000.00
Rp 15,000.00 Rp 75,000.00
Rp 150,000.00 Rp -
Rp 1,200.00 Rp 19,200.00
Rp 9,000.00 Rp 27,000.00
Rp 5,500.00 Rp 49,500.00
Rp 9,000.00 Rp -
Rp 16,500.00 Rp -
Rp 9,000.00 Rp -
Rp 11,000.00 Rp -
Rp 13,200.00 Rp -
Rp 5,500.00 Rp -
Rp 10,000.00 Rp -
Rp 35,000.00 Rp -
Rp 25,300.00 Rp 25,300.00
Rp 15,000.00 Rp -
Rp 215.00 Rp -
Rp 24,750.00 Rp -
Rp 11,000.00 Rp -
Rp 5,500.00 Rp 5,500.00
Rp 5,807.69 Rp -
Rp 300.00 Rp -
Rp 9,000.00 Rp -
Rp 2,325.00 Rp -
Rp 3,000.00 Rp -
Rp 11,000.00 Rp 11,000.00
Rp 9,000.00 Rp 18,000.00
Rp 5,750.00 Rp -
Rp 7,278.43 Rp -
Rp 6,000.00 Rp -
Rp 1,750.00 Rp -
Rp 9,000.00 Rp 27,000.00
Rp 3,500.00 Rp 3,500.00
Rp 1,375.00 Rp 6,875.00
Rp 9,000.00 Rp 9,000.00
Rp 9,500.00 Rp 57,000.00
Rp 2,000.00 Rp 4,000.00

Rp 1,351,673.41
 UTILISASI ALAT
1 2 3 4 5 6 7 8 9 10 11
EKG 7 6 6 7 4 5 4 5 3 1
Bedsite Monitor 3 2 1 1
Defibrilator
Nebulizer 1 1 1 2 1 1 1 1 2
Laryngoscope Dewasa
Laryngoscope Anak
Suction
Inkubator Portable

PENERIMAAN PASIEN
1 2 3 4 5 6 7 8 9 10 11
Rawat Inap Biasa 14 19 22 21 11 12 20 14 14 13 13
Rawat Kebidanana (VK)
Rawat Perina Sehat
Rawat Perina Sakit 1 1
Rawat Intensif 1 3 1 7 1 1
Dead On Resusitation
Dead On Arrival 1
Rawat Jalan/ Pulang 11 8 12 10 9 10 9 7 6 15
Pulang Paksa 1
Rujuk 1 1 1 1
Instalasi Bedah Sentral
Hemodialisa
Total 27 30 35 31 23 19 30 24 21 22 30

PRODUKTIVITAS
1 2 3 4 5 6 7 8 9 10 11
Resusitasi 1
Emergent 1 3 1 1 1 1
Urgent 20 24 31 24 16 14 26 14 16 18 19
Non Urgent 4 3 4 6 3 4 7 4 3 5
False Emergency 2 3 1 4 2 1 5
Total 27 30 35 31 23 19 30 24 21 22 30

JENIS PEMBAYARAN
1 2 3 4 5 6 7 8 9 10 11
UMUM
BPJS
JASA RAHARJA
ASURANSI LAIN
Total 0 0 0 0 0 0 0 0 0 0 0
BPJS NAIK KELAS
Total 0 0 0 0 0 0 0 0 0 0 0

UTILISASI RUANGAN
1 2 3 4 5 6 7 8 9 10 11
Ruang Resusitasi
Ruang Tindakan
Ruang IGD Umum
Ruang Observasi
Total 0 0 0 0 0 0 0 0 0 0 0

PENGELUARAN IGD BHP MEDIS

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryant tule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide Onemed
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 g
Masker Earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru Bayi
Peneng biru Dewasa
Peneng pink Bayi
peneng pink Dewasa
Pisau cukur single Dahlhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
UnderPad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel
Penanda Ungu DNR
Pisau Cukur Amsafe Super 2
Masker Tie On Dispro
Jarum Hecting No 24 Cutting 3/8
Infus Nacal 0,9 % 500 ML
NR. Infus Nacl 0.9% 1000 B.BRAUN
T-ROLL Cromic 3-0 100M (RC9)
T-ROLL SILK 3-0 100M (RS2)
T-ROLL SILK 2-0 100M (RS3)
Termometer Raksa Safety

PEMASUKAN DARI BHP

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryantule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 gram
Masker earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru bayi
Peneng biru dewasa
peneng pink bayi
peneng pink dewasa
Pisau Cukur Sigle Daelhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
Under Pad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel
Penanda Ungu DNR
Pisau Cukur Amsafe Super 2
Masker Tie On Dispro
Jarum Hecting No 24 Cutting 3/8
Infus Nacal 0,9 % 500 ML
NR. Infus Nacl 0.9% 1000 B.BRAUN
T-ROLL Cromic 3-0 100M (RC9)
T-ROLL SILK 3-0 100M (RS2)
T-ROLL SILK 2-0 100M (RS3)
Termometer Raksa Safety

PERMINTAAN FORM DAN ATK

 Nama Barang TANGGAL
1 2 3 4 5 6 7 8 9 10 11
Form Surat Persetujuan Pulang
Form Surat Sakit
Form Hasil EKG
Form Resep
Form Persetujuan Tindakan Kedokteran
Form Penolakan Tindakan
Form Perintah Lisan/SBAR
Form Transfer Pasien
Form Persetujuan Umum
Form Observasi Khusus
Form Pengkajian Medis Rawat Inap
Form Pengkajian Medis IGD
Form Pengkajian Keperawatan IGD
Form Triase
Isi Staples
Isi Cutter
Kertas Label 107
Kertas Buram
Lem Stick
Form Permintaan Radiologi
Form Permintaan Laboratorium
Refill Printer LaserJet
Ballpoint
Form Pemberian Informasi Tindakan Kedokteran
Resep BPJS
Form Persetujuan Restrain
Form Pengkajian Keperawatan Pasien Ranap
Form Pengkajian Awal Medis Pasien Rawat Inap
Form Pengantar Untuk Rawat Inap (2 Rangkap)
Form Catatan Pemberian Edukasi Informasi
Isolatip
Amplop 95x152 mm 80 gsm
Amplop 110 x 230 mm, logo permata
Buku Dobel Folio
Clear Holder isi 40
Cable Tie UK 25 cm
Box File Bantex
Buku Folio 100 lembar
Buku Ekspedisi
Gunting Sedang
Kartu Stok RSPC
Form Daftar Kunjungan Dokter
Batu Batere Type C
Double Tape 1/2"
Buku Kwarto 200 Lembar
Form Surat Rujukan
Form Surat Ket. Meninggal
Keranjang Obat Hawai
Form Discount
Batu Batere AA
Surat Kontrol
Cutter
Lembar Coding BPJS Rawat Jalan
Form Konsultasi Antar DPJP
Isi Pulpen
Map Plastik Berkancing
Isi Pulpen
Kertas HVS F4 70 gram
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
4 5 6 10 4 2 6 6 4 10 9 5 16 3 8 5 4 7 5 10
1 3 1 1 2 1 1 1

1 3 1 1 2 1 1 1 3

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
14 18 11 27 15 14 15 22 7 22 22 20 20 13 17 8 11 19 18 18
1 1

1 2 1
1 1 1 2 1 2 1 2
1 1 1

6 7 10 8 9 5 7 7 10 4 9 10 9 7 2 3 13 9 4 8
1 1 1 2 1 1 1
2 1 1 2 2
1

21 26 22 36 26 23 22 30 21 27 31 32 33 23 21 11 27 32 22 29

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 1 1
1 2 2 1 2 1 1
17 19 16 29 22 20 20 27 14 24 28 31 24 17 20 9 20 22 20 23
3 2 5 2 4 1 2 1 4 3 3 1 7 4 1 2 4 7 2 4
3 3 1 2 1 1 2 2 1 2
21 26 22 36 26 23 22 30 21 27 31 32 33 23 21 11 27 32 22 29

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
221
538

48
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 807
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
100

200

600
900

10000

360
5
150
200

9100
2730

100

400
 6000

10000

50
50
60

10

10
7000
1000
1000
1000
2

Tanggal
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
21

2128

14
105
934
1250
40
1335
2930
 3
6
664

117
97
26
13285
3170

36
169
28
284

840

1490

17695

5
22

6
125
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2
3

8
5

10
10
8
3

77
1
3

15

1
5
1
 Harga Sewa Alat Total
TOTAL

177 Rp 50,000 Rp 8,850,000

18 Rp 109,350 Rp 1,968,300
0 Rp 145,800 Rp -
25 Rp 35,000 Rp 875,000
0 Rp - Rp -
0 Rp - Rp -
1 Rp 15,000 Rp 15,000
0 Rp - Rp -
Rp - Rp -
Rp 11,708,300
TOTAL

504
2
0
6
25
3
1
244
9
12
1
0
807

TOTAL

4
18
644
105
34
807

TOTAL

221
538
0
48
807
 0
0

TOTAL

0
0
0
0
0

TOTAL HPP Grand Total

100 Rp 5,040 Rp 504,000

0 Rp 5,981 Rp -
0 Rp 30.466 Rp -
1100 Rp 128.43 Rp 141,273
0 Rp 3,006.00 Rp -
0 Rp 32,000 Rp -
200 Rp 17.320 Rp 3,464
0 Rp 150 Rp -
600 Rp 422.85 Rp 253,710
900 Rp 429.95 Rp 386,955
0 Rp 36.00 Rp -
10000 Rp 19.86 Rp 198,600
0 Rp 19.41 Rp -
0 Rp 847 Rp -
0 Rp 1,667.66 Rp -
360 Rp 397.74 Rp 143,186
5 Rp 60,000 Rp 300,000
150 Rp 538 Rp 80,700
200 Rp 405 Rp 81,000
0 Rp 575.58 Rp -
9100 Rp 4.53 Rp 41,223
2730 Rp 23.25 Rp 63,473
0 Rp 11.65 Rp -
0 Rp 50.40 Rp -
0 Rp 800 Rp -
100 Rp 986 Rp 98,645
0 Rp 800 Rp -
400 Rp 986 Rp 394,580
0 Rp 2,860 Rp -
0 Rp 62.4 Rp -
0 Rp 3,200 Rp -
 0 Rp 290 Rp -
0 Rp 3,836.74 Rp -
6000 Rp 17.9 Rp 107,520
0 Rp 54.3 Rp -
10000 Rp 9.2 Rp 92,100
0 Rp 193.1 Rp -
50 Rp 1,700.00 Rp 85,000
50 Rp 2,775.00 Rp 138,750
60 Rp 3,222.46 Rp 193,348
0 Rp 24,080.00 Rp -
0 Rp 35,530.71 Rp -
0 Rp 3,400.00 Rp -
0 Rp 1,700.00 Rp -
10 Rp 3,409.00 Rp 34,090
0 Rp 346.36 Rp -
0 Rp 7,666.67 Rp -
10 Rp 5,832.30 Rp 58,323
7000 Rp 13.00 Rp 91,000
1000 Rp 1,125.00 Rp 1,125,000
1000 Rp 600.00 Rp 600,000
1000 Rp 600.00 Rp 600,000
2 Rp 11,336.00 Rp 22,672

Total Pengeluaran Rp 5,838,612

Terpakai Harga Jual Grand Total

21 Rp 10,530 Rp 221,130
0 Rp 9,450 Rp -
0 Rp 46.50 Rp -
2128 Rp 346.50 Rp 737,352.00
0 Rp 8,910.00 Rp -
0 Rp 32,000.00 Rp -
14 Rp 371.25 Rp 5,197.50
105 Rp 222.75 Rp 23,388.75
934 Rp 965.25 Rp 901,543.50
1250 Rp 965.25 Rp 1,206,562.50
40 Rp 53.46 Rp 2,138.40
1335 Rp 35.15 Rp 46,925.25
2930 Rp 33.48 Rp 98,096.40
 3 Rp 1,419.00 Rp 4,257.00
6 Rp 2,838.00 Rp 17,028.00
664 Rp 701.25 Rp 465,630.00
0 Rp 60,000.00 Rp -
117 Rp 798.00 Rp 93,366.00
97 Rp 990.00 Rp 96,030.00
26 Rp 1,336.50 Rp 34,749.00
13285 Rp 21.45 Rp 284,963.25
3170 Rp 41.91 Rp 132,854.70
0 Rp 17.34 Rp -
0 Rp 74.80 Rp -
36 Rp 2,392.50 Rp 86,130.00
169 Rp 1,485.00 Rp 250,965.00
28 Rp 2,392.50 Rp 66,990.00
284 Rp 1,485.00 Rp 421,740.00
0 Rp 4,247.10 Rp -
840 Rp 98.01 Rp 82,328.40
0 Rp 5,940.00 Rp -
0 Rp 478.00 Rp -
0 Rp 10,395.00 Rp -
1490 Rp 25.74 Rp 38,352.60
0 Rp 806.36 Rp -
17695 Rp 9.2 Rp 162,970.95
0 Rp 193.1 Rp -
0 Rp 1,700.00 Rp -
5 Rp 2,775.00 Rp 13,875.00
22 Rp 5,400.00 Rp 118,800.00
0 Rp 24,080.00 Rp -
0 Rp 35,530.71 Rp -
0 Rp 3,100.00 Rp -
0 Rp 1,850.00 Rp -
0 Rp 1,850.00 Rp -
0 Rp 450.00 Rp -
2 Rp 11,800.00 Rp 23,600.00
0 Rp 1,850.00 Rp -
1410 Rp 24.50 Rp 34,545.00
0 Rp 1,850.00 Rp -
6 Rp 1,850.00 Rp 11,100.00
125 Rp 1,850.00 Rp 231,250.00
0 Rp 1,850.00 Rp -

TOTAL PEMASUKAN Rp 5,480,689.20

LABA/RUGI Rp (357,922.30)
Terpakai HPP Grand Total

0 Rp 3,666.49 Rp -
0 Rp 4,500.00 Rp -
0 Rp 500.00 Rp -
2 Rp 4,500.00 Rp 9,000.00
3 Rp 9,000.00 Rp 27,000.00
0 Rp 9,000.00 Rp -
8 Rp 9,000.00 Rp 72,000.00
5 Rp 12,000.00 Rp 60,000.00
0 Rp 11,500.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 9,000.00 Rp -
10 Rp 12,000.00 Rp 120,000.00
10 Rp 12,000.00 Rp 120,000.00
8 Rp 35,000.00 Rp 280,000.00
3 Rp 1,100.00 Rp 3,300.00
0 Rp 1,500.00 Rp -
77 Rp 2,500.00 Rp 192,500.00
1 Rp 18,000.00 Rp 18,000.00
3 Rp 4,500.00 Rp 13,500.00
0 Rp 15,000.00 Rp -
4 Rp 15,000.00 Rp 60,000.00
0 Rp 150,000.00 Rp -
0 Rp 1,200.00 Rp -
0 Rp 9,000.00 Rp -
15 Rp 5,500.00 Rp 82,500.00
0 Rp 9,000.00 Rp -
0 Rp 16,500.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 13,200.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 10,000.00 Rp -
1 Rp 35,000.00 Rp 35,000.00
0 Rp 25,300.00 Rp -
0 Rp 15,000.00 Rp -
0 Rp 215.00 Rp -
0 Rp 24,750.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 5,807.69 Rp -
0 Rp 300.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 2,325.00 Rp -
0 Rp 3,000.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 5,750.00 Rp -
0 Rp 7,278.43 Rp -
0 Rp 6,000.00 Rp -
0 Rp 1,750.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 3,500.00 Rp -
0 Rp 1,375.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 9,500.00 Rp -
0 Rp 2,000.00 Rp -
5 Rp 3,958.33 Rp 19,791.65
1 Rp 29,500.00 Rp 29,500.00

Rp 1,092,800.00
 UTILISASI ALAT
1 2 3 4 5 6 7 8 9 10 11
EKG 3 6 5 5 5 8 8 7 2 6 8
Bedsite Monitor 2 3 1 4 1 2
Defibrilator
Nebulizer 1 1 2 1 2
Laryngoscope Dewasa
Laryngoscope Anak
Suction
Inkubator Portable

PENERIMAAN PASIEN
1 2 3 4 5 6 7 8 9 10 11
Rawat Inap Biasa 13 19 10 11 9 18 19 16 11 16 14
Rawat Kebidanana (VK) 1 1
Rawat Perina Sehat
Rawat Perina Sakit 1
Rawat Intensif 1 2 1 1
Dead On Resusitation 1
Dead On Arrival
Rawat Jalan/ Pulang 6 5 8 7 9 8 7 4 7 1 16
Pulang Paksa 1 1 1 1 1
Rujuk 1
Instalasi Bedah Sentral 1
Hemodialisa 1
Total 21 25 23 18 18 27 27 20 22 17 33

PRODUKTIVITAS
1 2 3 4 5 6 7 8 9 10 11
Resusitasi 1
Emergent 2 3 2 2
Urgent 16 19 15 13 14 25 21 16 17 16 21
Non Urgent 3 2 5 2 4 2 3 4 3 1 6
False Emergency 2 2 3 1 1 4
Total 21 25 23 18 18 27 27 20 22 17 33

JENIS PEMBAYARAN
1 2 3 4 5 6 7 8 9 10 11
UMUM
BPJS
JASA RAHARJA
ASURANSI LAIN
Total 0 0 0 0 0 0 0 0 0 0 0
BPJS NAIK KELAS
Total 0 0 0 0 0 0 0 0 0 0 0

UTILISASI RUANGAN
1 2 3 4 5 6 7 8 9 10 11
Ruang Resusitasi
Ruang Tindakan
Ruang IGD Umum
Ruang Observasi
Total 0 0 0 0 0 0 0 0 0 0 0

PENGELUARAN IGD BHP MEDIS

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryant tule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide Onemed
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 g
Masker Earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru Bayi
Peneng biru Dewasa
Peneng pink Bayi
peneng pink Dewasa
Pisau cukur single Dahlhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
UnderPad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel
Penanda Ungu DNR
Pisau Cukur Amsafe Super 2
Masker Tie On Dispro
Jarum Hecting No 24 Cutting 3/8
Infus Nacal 0,9 % 500 ML
NR. Infus Nacl 0.9% 1000 B.BRAUN
T-ROLL Cromic 3-0 100M (RC9)
T-ROLL SILK 3-0 100M (RS2)
T-ROLL SILK 2-0 100M (RS3)
Termometer Raksa Safety
JARUM HECTING NO 21 CUTTING 1/2
JARUM HECTING NO 24 CUTTING 3/8

PEMASUKAN DARI BHP

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryantule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 gram
Masker earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru bayi
Peneng biru dewasa
peneng pink bayi
peneng pink dewasa
Pisau Cukur Sigle Daelhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
Under Pad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel
Penanda Ungu DNR
Pisau Cukur Amsafe Super 2
Masker Tie On Dispro
Jarum Hecting No 24 Cutting 3/8
Infus Nacal 0,9 % 500 ML
NR. Infus Nacl 0.9% 1000 B.BRAUN
T-ROLL Cromic 3-0 100M (RC9)
T-ROLL SILK 3-0 100M (RS2)
T-ROLL SILK 2-0 100M (RS3)
Termometer Raksa Safety
JARUM HECTING NO 21 CUTTING 1/2
JARUM HECTING NO 24 CUTTING 3/8
PERMINTAAN FORM DAN ATK
Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Form Surat Persetujuan Pulang
Form Surat Sakit
Form Hasil EKG
Form Resep
Form Persetujuan Tindakan Kedokteran
Form Penolakan Tindakan
Form Perintah Lisan/SBAR
Form Transfer Pasien
Form Persetujuan Umum
Form Observasi Khusus
Form Pengkajian Medis Rawat Inap
Form Pengkajian Medis IGD
Form Pengkajian Keperawatan IGD
Form Triase
Isi Staples
Isi Cutter
Kertas Label 107
Kertas Buram
Lem Stick
Form Permintaan Radiologi
Form Permintaan Laboratorium
Refill Printer LaserJet
Ballpoint

Form Pemberian Informasi Tindakan Kedokteran

Resep BPJS
Form Persetujuan Restrain
Form Pengkajian Keperawatan Pasien Ranap
Form Pengkajian Awal Medis Pasien Rawat Inap
Form Pengantar Untuk Rawat Inap (2 Rangkap)
Form Catatan Pemberian Edukasi Informasi
Isolatip
Amplop 95x152 mm 80 gsm
Amplop 110 x 230 mm, logo permata
Buku Dobel Folio
Clear Holder isi 40
Cable Tie UK 25 cm
Box File Bantex
Buku Folio 100 lembar
Buku Ekspedisi
Gunting Sedang
Kartu Stok RSPC
Form Daftar Kunjungan Dokter
Batu Batere Type C
Double Tape 1/2"
Buku Kwarto 200 Lembar
Form Surat Rujukan
Form Surat Ket. Meninggal
Keranjang Obat Hawai
Form Discount
Batu Batere AA
Surat Kontrol
Cutter
Lembar Coding BPJS Rawat Jalan
Form Konsultasi Antar DPJP
Isi Pulpen
Map Plastik Berkancing
Isi Pulpen
Kertas HVS F4 70 gram
Form IRM formulir permintaan kamar operasi
Form IRM asuhan keperwatan perioperatif
Form IRM catatan perkembangan pasien terintegrasi
(CPPT)
Lakban Hitam
Spidol Kecil
Tipe-x
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
10 6 6 6 3 4 3 8 7 7 4 2 4 1 3 2 3
1 1 1 1 1 1 4 1 1 1 1 2 1

1 1 2 2 2 1 1 1 4 2

1 1 1 1

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
21 15 15 12 10 13 12 24 20 12 6 4 3 5 8 15 19 19 13
1

1 1
1 1 1 2
1 1 1
1 1 1
5 5 8 5 13 6 9 6 5 7 13 16 18 14 25 27 22 21 20
1 1 1
1 2 1 1

28 20 23 18 23 21 21 30 27 23 19 21 22 22 34 43 42 43 33

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 1 1 1
1 1 1 2 1 1 2
24 20 20 14 12 17 15 28 24 18 16 16 19 22 27 31 38 36 28
1 3 2 5 3 4 2 1 2 2 1 4 7 4 3 5
1 1 6 2 2 1 1 2 2 2 4 2
28 20 23 18 23 21 21 30 27 23 19 21 22 22 34 43 42 43 33

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

400

1200
1900

2930
 38

Tanggal
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

215 396

5
860
518 468 458 104 238
28 390 400

205
13105 350 1260
3402 147

185

6686
7730

7
34
5
75

85 1089

13590

5045 8170

48

12800 200
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
 Harga Sewa Alat Total
TOTAL
31
142 Rp 50,000 Rp 7,100,000
30 Rp 109,350 Rp 3,280,500
0 Rp 145,800 Rp -
24 Rp 35,000 Rp 840,000
0 Rp - Rp -
0 Rp - Rp -
4 Rp 15,000 Rp 60,000
0 Rp - Rp -
Rp - Rp -
Rp 11,280,500
TOTAL
31
402
3
0
3
10
4
3
323
8
6
1
1
0 764

TOTAL
31
5
18
618
84
39
0 764

TOTAL
31
0
0
0
0
0 0
 0
6 0

TOTAL
31
0
0
0
0
0 0

TOTAL HPP Grand Total

31
100 100 Rp 5,040 Rp 504,000
0 Rp 5,981 Rp -
1000 1000 Rp 30.466 Rp 30,466
2092 2492 Rp 128.43 Rp 320,048
0 Rp 3,006.00 Rp -
0 Rp 32,000 Rp -
100 100 Rp 17.320 Rp 1,732
900 2100 Rp 150 Rp 315,000
200 2100 Rp 422.85 Rp 887,985
1100 1100 Rp 429.95 Rp 472,945
240 240 Rp 36.00 Rp 8,640
5000 5000 Rp 19.86 Rp 99,300
10000 12930 Rp 19.41 Rp 250,971
20 20 Rp 847 Rp 16,950
0 Rp 1,667.66 Rp -
2659 2659 Rp 397.74 Rp 1,057,591
9 Rp 60,000 Rp 540,000
50 50 Rp 538 Rp 26,900
197 197 Rp 405 Rp 79,785
100 100 Rp 575.58 Rp 57,558
9724 9724 Rp 4.53 Rp 44,050
4889 4889 Rp 23.25 Rp 113,669
0 Rp 11.65 Rp -
0 Rp 50.40 Rp -
100 100 Rp 800 Rp 80,000
100 100 Rp 986 Rp 98,645
100 100 Rp 800 Rp 80,000
100 100 Rp 986 Rp 98,645
0 Rp 2,860 Rp -
589 589 Rp 62.4 Rp 36,754
0 Rp 3,200 Rp -
 0 Rp 290 Rp -
0 Rp 3,836.74 Rp -
3000 3000 Rp 17.9 Rp 53,760
0 Rp 54.3 Rp -
20000 20000 Rp 9.2 Rp 184,200
0 Rp 193.1 Rp -
0 Rp 1,700.00 Rp -
0 Rp 2,775.00 Rp -
20 58 Rp 3,222.46 Rp 186,903
0 Rp 24,080.00 Rp -
0 Rp 35,530.71 Rp -
0 Rp 3,400.00 Rp -
0 Rp 1,700.00 Rp -
0 Rp 3,409.00 Rp -
0 Rp 346.36 Rp -
0 Rp 7,666.67 Rp -
0 Rp 5,832.30 Rp -
10100 10100 Rp 13.00 Rp 131,300
0 Rp 1,125.00 Rp -
0 Rp 600.00 Rp -
0 Rp 600.00 Rp -
0 Rp 11,336.00 Rp -
12 12 Rp 7,666.00 Rp 91,992
0 Rp 7,666.00 Rp -

Total Pengeluaran Rp 5,777,795

Terpakai Harga Jual Grand Total

31
107 107 Rp 10,530 Rp 1,126,710
0 Rp 9,450 Rp -
2998 2998 Rp 46.50 Rp 139,407.00
1182 1793 Rp 346.50 Rp 621,274.50
0 Rp 8,910.00 Rp -
0 Rp 32,000.00 Rp -
66 71 Rp 371.25 Rp 26,358.75
80 940 Rp 222.75 Rp 209,385.00
148 1934 Rp 965.25 Rp 1,866,793.50
134 952 Rp 965.25 Rp 918,918.00
500 500 Rp 53.46 Rp 26,730.00
1565 1770 Rp 35.15 Rp 62,215.50
175 14890 Rp 33.48 Rp 498,517.20
 2 2 Rp 1,419.00 Rp 2,838.00
17 17 Rp 2,838.00 Rp 48,246.00
123 3672 Rp 701.25 Rp 2,574,990.00
0 Rp 60,000.00 Rp -
50 50 Rp 798.00 Rp 39,900.00
50 235 Rp 990.00 Rp 232,650.00
6 6 Rp 1,336.50 Rp 8,019.00
4489 11175 Rp 21.45 Rp 239,703.75
1185 8915 Rp 41.91 Rp 373,627.65
0 Rp 17.34 Rp -
5000 5000 Rp 74.80 Rp 374,000.00
31 38 Rp 2,392.50 Rp 90,915.00
90 124 Rp 1,485.00 Rp 184,140.00
15 20 Rp 2,392.50 Rp 47,850.00
147 222 Rp 1,485.00 Rp 329,670.00
0 Rp 4,247.10 Rp -
320 1494 Rp 98.01 Rp 146,426.94
0 Rp 5,940.00 Rp -
33 33 Rp 478.00 Rp 15,774.00
0 Rp 10,395.00 Rp -
675 14265 Rp 25.74 Rp 367,181.10
0 Rp 806.36 Rp -
1830 15045 Rp 9.2 Rp 138,564.45
0 Rp 193.1 Rp -
4 4 Rp 1,700.00 Rp 6,800.00
16 16 Rp 2,775.00 Rp 44,400.00
8 56 Rp 5,400.00 Rp 302,400.00
0 Rp 24,080.00 Rp -
0 Rp 35,530.71 Rp -
0 Rp 3,100.00 Rp -
0 Rp 1,850.00 Rp -
5 5 Rp 1,850.00 Rp 9,250.00
78 78 Rp 450.00 Rp 35,100.00
2 Rp 11,800.00 Rp 23,600.00
0 Rp 1,850.00 Rp -
245 1410 Rp 24.50 Rp 34,545.00
62 62 Rp 1,850.00 Rp 114,700.00
70 70 Rp 1,850.00 Rp 129,500.00
206 206 Rp 1,850.00 Rp 381,100.00
3 3 Rp 1,850.00 Rp 5,550.00
0 Rp 8,160.00 Rp -
17 17 Rp 8,160.00 Rp 138,720.00
 TOTAL PEMASUKAN Rp 10,710,805.34

LABA/RUGI Rp 4,933,009.97

Terpakai HPP Grand Total

31
10 10 Rp 3,666.49 Rp 36,664.90
0 Rp 4,500.00 Rp -
150 150 Rp 500.00 Rp 75,000.00
8 8 Rp 4,500.00 Rp 36,000.00
0 Rp 9,000.00 Rp -
0 Rp 9,000.00 Rp -
5 5 Rp 9,000.00 Rp 45,000.00
7 7 Rp 12,000.00 Rp 84,000.00
0 Rp 11,500.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 9,000.00 Rp -
5 5 Rp 12,000.00 Rp 60,000.00
9 9 Rp 12,000.00 Rp 108,000.00
11 11 Rp 35,000.00 Rp 385,000.00
1 1 Rp 1,100.00 Rp 1,100.00
0 Rp 1,500.00 Rp -
76 76 Rp 2,500.00 Rp 190,000.00
0 Rp 18,000.00 Rp -
5 5 Rp 4,500.00 Rp 22,500.00
4 4 Rp 15,000.00 Rp 60,000.00
6 6 Rp 15,000.00 Rp 90,000.00
0 Rp 150,000.00 Rp -
2 2 Rp 1,200.00 Rp 2,400.00

6 6 Rp 9,000.00 Rp 54,000.00
10 10 Rp 5,500.00 Rp 55,000.00
0 Rp 9,000.00 Rp -
0 Rp 16,500.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 11,000.00 Rp -
4 4 Rp 13,200.00 Rp 52,800.00
0 Rp 5,500.00 Rp -
1 1 Rp 10,000.00 Rp 10,000.00
1 1 Rp 35,000.00 Rp 35,000.00
1 1 Rp 25,300.00 Rp 25,300.00
0 Rp 15,000.00 Rp -
0 Rp 215.00 Rp -
0 Rp 24,750.00 Rp -
1 1 Rp 11,000.00 Rp 11,000.00
0 Rp 5,500.00 Rp -
0 Rp 5,807.69 Rp -
0 Rp 300.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 2,325.00 Rp -
0 Rp 3,000.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 5,750.00 Rp -
0 Rp 7,278.43 Rp -
0 Rp 6,000.00 Rp -
0 Rp 1,750.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 3,500.00 Rp -
0 Rp 1,375.00 Rp -
0 Rp 9,000.00 Rp -
5 5 Rp 9,500.00 Rp 47,500.00
0 Rp 2,000.00 Rp -
0 Rp 3,958.33 Rp -
0 Rp 29,500.00 Rp -
1 1 Rp 18,000.00 Rp 18,000.00
3 3 Rp 18,000.00 Rp 54,000.00

1 1 Rp 18,000.00 Rp 18,000.00
1 1 Rp 10,500.00 Rp 10,500.00
2 2 Rp 1,200.00 Rp 2,400.00
1 1 Rp 1,200.00 Rp 1,200.00

Rp 1,486,264.90
 UTILISASI ALAT
1 2 3 4 5 6 7 8 9 10 11
EKG
Bedsite Monitor
Defibrilator
Nebulizer
Laryngoscope Dewasa
Laryngoscope Anak
Suction
Inkubator Portable

PENERIMAAN PASIEN
1 2 3 4 5 6 7 8 9 10 11
Rawat Inap Biasa
Rawat Kebidanana (VK)
Rawat Perina Sehat
Rawat Perina Sakit
Rawat Intensif
Dead On Resusitation
Dead On Arrival
Rawat Jalan/ Pulang
Pulang Paksa
Rujuk
Instalasi Bedah Sentral
Hemodialisa
Total 0 0 0 0 0 0 0 0 0 0 0

PRODUKTIVITAS
1 2 3 4 5 6 7 8 9 10 11
Resusitasi
Emergent
Urgent
Non Urgent
False Emergency
Total 0 0 0 0 0 0 0 0 0 0 0

JENIS PEMBAYARAN
1 2 3 4 5 6 7 8 9 10 11
UMUM
BPJS
JASA RAHARJA
ASURANSI LAIN
Total 0 0 0 0 0 0 0 0 0 0 0
BPJS NAIK KELAS
Total 0 0 0 0 0 0 0 0 0 0 0

UTILISASI RUANGAN
1 2 3 4 5 6 7 8 9 10 11
Ruang Resusitasi
Ruang Tindakan
Ruang IGD Umum
Ruang Observasi
Total 0 0 0 0 0 0 0 0 0 0 0

PENGELUARAN IGD BHP MEDIS

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryant tule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide Onemed
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 g
Masker Earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru Bayi
Peneng biru Dewasa
Peneng pink Bayi
peneng pink Dewasa
Pisau cukur single Dahlhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
UnderPad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel

PEMASUKAN DARI BHP

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryantule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 gram
Masker earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru bayi
Peneng biru dewasa
peneng pink bayi
peneng pink dewasa
Pisau Cukur Sigle Daelhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
Under Pad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR

PERMINTAAN FORM DAN ATK

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Form Surat Persetujuan Pulang 5
Form Surat Sakit
Form Hasil EKG 100
Form Resep
Form Persetujuan Tindakan Kedokteran
Form Penolakan Tindakan
Form Perintah Lisan/SBAR
Form Transfer Pasien
Form Persetujuan Umum
Form Observasi Khusus
Form Pengkajian Medis Rawat Inap
Form Pengkajian Medis IGD
Form Pengkajian Keperawatan IGD
Form Triase
Isi Staples
Isi Cutter
Kertas Label 107
Kertas Buram
Lem Stick
Form Permintaan Radiologi
Form Permintaan Laboratorium
Refill Printer LaserJet
Ballpoint
Form Pemberian Informasi Tindakan Kedokteran
Resep BPJS
Form Persetujuan Restrain
Form Pengkajian Keperawatan Pasien Ranap
Form Pengkajian Awal Medis Pasien Rawat Inap
Form Pengantar Untuk Rawat Inap (2 Rangkap)
Form Catatan Pemberian Edukasi Informasi
Isolatip
Amplop 95x152 mm 80 gsm
Amplop 110 x 230 mm, logo permata
Buku Dobel Folio
Clear Holder isi 40
Cable Tie UK 25 cm
Box File Bantex
Buku Folio 100 lembar
Buku Ekspedisi
Gunting Sedang
Kartu Stok RSPC
Form Daftar Kunjungan Dokter
Batu Batere Type C
Double Tape 1/2"
Buku Kwarto 200 Lembar
Form Surat Rujukan
Form Surat Ket. Meninggal
Keranjang Obat Hawai
Form Discount
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
 Tanggal
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
10

50
3

3
3 1

5 3
5 3
12
22 25 42
1
2

1 2

1 8

5 5 1

1
1

1
2
1
12
1
 Harga Sewa Alat Total
TOTAL

0 Rp 50,000 Rp -
0 Rp 109,350 Rp -
0 Rp 145,800 Rp -
0 Rp 35,000 Rp -
0 Rp - Rp -
0 Rp - Rp -
0 Rp 15,000 Rp -
0 Rp - Rp -
Rp - Rp -
Rp -
TOTAL

0
0
0
0
0
0
0
0
0
0
0
0
0

TOTAL

0
0
0
0
0
0

TOTAL

0
0
0
0
0
 0
0

TOTAL

0
0
0
0
0

TOTAL HPP Grand Total

0 Rp 5,040 Rp -
0 Rp 5,981 Rp -
0 Rp 30.466 Rp -
0 Rp 128.43 Rp -
0 Rp 3,006.00 Rp -
0 Rp 32,000 Rp -
0 Rp 17.320 Rp -
0 Rp 150 Rp -
0 Rp 482.26 Rp -
0 Rp 483.31 Rp -
0 Rp 36.00 Rp -
0 Rp 19.86 Rp -
0 Rp 19.41 Rp -
0 Rp 847 Rp -
0 Rp 1,667.66 Rp -
0 Rp 397.74 Rp -
0 Rp 60,000 Rp -
0 Rp 538 Rp -
0 Rp 405 Rp -
0 Rp 575.58 Rp -
0 Rp 4.53 Rp -
0 Rp 23.25 Rp -
0 Rp 11.65 Rp -
0 Rp 50.40 Rp -
0 Rp 800 Rp -
0 Rp 800 Rp -
0 Rp 800 Rp -
0 Rp 800 Rp -
0 Rp 2,860 Rp -
0 Rp 62.4 Rp -
0 Rp 3,200 Rp -
 0 Rp 290 Rp -
0 Rp 3,836.74 Rp -
0 Rp 18.4 Rp -
0 Rp 54.3 Rp -
0 Rp 9.2 Rp -
0 Rp 193.1 Rp -
0 Rp - Rp -
0 Rp - Rp -
0 Rp 3,222.46 Rp -
0 Rp 24,080.00 Rp -
0 Rp 35,530.71 Rp -
0 Rp 3,100.00 Rp -

Total Pengeluaran Rp -

Terpakai Harga Jual Grand Total

0 Rp 10,530 Rp -
0 Rp 9,450 Rp -
0 Rp 46.50 Rp -
0 Rp 346.50 Rp -
0 Rp 8,910.00 Rp -
0 Rp 32,000.00 Rp -
0 Rp 371.25 Rp -
0 Rp 222.75 Rp -
0 Rp 965.25 Rp -
0 Rp 965.25 Rp -
0 Rp 53.46 Rp -
0 Rp 35.15 Rp -
0 Rp 33.48 Rp -
0 Rp 1,419.00 Rp -
0 Rp 2,838.00 Rp -
0 Rp 701.25 Rp -
0 Rp 60,000.00 Rp -
0 Rp 798.00 Rp -
0 Rp 990.00 Rp -
0 Rp 1,336.50 Rp -
0 Rp 21.45 Rp -
0 Rp 41.91 Rp -
 0 Rp 17.34 Rp -
0 Rp 74.80 Rp -
0 Rp 2,392.50 Rp -
0 Rp 1,485.00 Rp -
0 Rp 2,392.50 Rp -
0 Rp 1,485.00 Rp -
0 Rp 4,247.10 Rp -
0 Rp 98.01 Rp -
0 Rp 5,940.00 Rp -
0 Rp 478.00 Rp -
0 Rp 10,395.00 Rp -
0 Rp 25.74 Rp -
0 Rp 806.36 Rp -
0 Rp 9.2 Rp -
0 Rp 193.1 Rp -
0 Rp 1,700.00 Rp -
0 Rp 2,775.00 Rp -
0 Rp 5,400.00 Rp -

TOTAL PEMASUKAN Rp -

LABA/RUGI Rp -

Terpakai HPP Grand Total

15 Rp 3,666.49 Rp 54,997.35
0 Rp 4,500.00 Rp -
150 Rp 500.00 Rp 75,000.00
3 Rp 4,500.00 Rp 13,500.00
0 Rp 9,000.00 Rp -
0 Rp 9,000.00 Rp -
3 Rp 9,000.00 Rp 27,000.00
4 Rp 12,000.00 Rp 48,000.00
0 Rp 11,500.00 Rp -
2 Rp 9,000.00 Rp 18,000.00
0 Rp 9,000.00 Rp -
8 Rp 12,000.00 Rp 96,000.00
8 Rp 12,000.00 Rp 96,000.00
12 Rp 35,000.00 Rp 420,000.00
 0 Rp 1,100.00 Rp -
0 Rp 1,500.00 Rp -
89 Rp 2,500.00 Rp 222,500.00
1 Rp 18,000.00 Rp 18,000.00
2 Rp 4,500.00 Rp 9,000.00
0 Rp 15,000.00 Rp -
3 Rp 15,000.00 Rp 45,000.00
0 Rp 150,000.00 Rp -
9 Rp 1,200.00 Rp 10,800.00
0 Rp 9,000.00 Rp -
11 Rp 5,500.00 Rp 60,500.00
0 Rp 9,000.00 Rp -
0 Rp 16,500.00 Rp -
1 Rp 9,000.00 Rp 9,000.00
1 Rp 11,000.00 Rp 11,000.00
0 Rp 13,200.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 10,000.00 Rp -
0 Rp 35,000.00 Rp -
0 Rp 25,300.00 Rp -
0 Rp 15,000.00 Rp -
0 Rp 215.00 Rp -
0 Rp 24,750.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 5,807.69 Rp -
0 Rp 300.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 2,325.00 Rp -
0 Rp 3,000.00 Rp -
1 Rp 11,000.00 Rp 11,000.00
2 Rp 9,000.00 Rp 18,000.00
1 Rp 5,750.00 Rp 5,750.00
12 Rp 7,278.43 Rp 87,341.16
1 Rp 6,000.00 Rp 6,000.00

Rp 1,356,388.51
 TANGGAL
UTILISASI ALAT
1 2 3 4 5 6 7 8 9 10 11 12 13 14
EKG 3 4 7 8 4 6 7 2 11 6 2 4 6 5
Bedsite Monitor 1 1 1 1 1 1 1
Defibrilator
Nebulizer 1 1 2 1 1 2 2
Laryngoscope Dewasa 1
Laryngoscope Anak
Suction 1 1 1
Inkubator Portable

TANGGAL
PENERIMAAN PASIEN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Rawat Inap Biasa
Rawat Kebidanana (VK)
Rawat Perina Sehat
Rawat Perina Sakit
Rawat Intensif
Dead On Resusitation
Dead On Arrival
Rawat Jalan/ Pulang
Pulang Paksa
Rujuk
Instalasi Bedah Sentral
Hemodialisa
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
PRODUKTIVITAS
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Resusitasi
Emergent
Urgent
Non Urgent
False Emergency
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
JENIS PEMBAYARAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
UMUM
BPJS
JASA RAHARJA
ASURANSI LAIN
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BPJS NAIK KELAS
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
UTILISASI RUANGAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Ruang Resusitasi
Ruang Tindakan
Ruang IGD Umum
Ruang Observasi
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0

PENGELUARAN IGD BHP MEDIS

TANGGAL
Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryant tule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide Onemed
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 g
Masker Earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru Bayi
Peneng biru Dewasa
Peneng pink Bayi
peneng pink Dewasa
Pisau cukur single Dahlhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
UnderPad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel

PEMASUKAN DARI BHP

Tanggal
Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryantule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 gram
Masker earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru bayi
Peneng biru dewasa
peneng pink bayi
peneng pink dewasa
Pisau Cukur Sigle Daelhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
Under Pad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR

PERMINTAAN FORM DAN ATK

TANGGAL
Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Form Surat Persetujuan Pulang 5
Form Surat Sakit
Form Hasil EKG 100
Form Resep
Form Persetujuan Tindakan Kedokteran
Form Penolakan Tindakan
Form Perintah Lisan/SBAR
Form Transfer Pasien 3
Form Persetujuan Umum
Form Observasi Khusus
Form Pengkajian Medis Rawat Inap
Form Pengkajian Medis IGD 5
Form Pengkajian Keperawatan IGD 5
Form Triase 12
Isi Staples
Isi Cutter
Kertas Label 107 22
Kertas Buram
Lem Stick
Form Permintaan Radiologi
Form Permintaan Laboratorium 1
Refill Printer LaserJet
Ballpoint
Form Pemberian Informasi Tindakan Kedokteran
Resep BPJS 5
Form Persetujuan Restrain
Form Pengkajian Keperawatan Pasien Ranap
Form Pengkajian Awal Medis Pasien Rawat Inap 1
Form Pengantar Untuk Rawat Inap (2 Rangkap) 1
Form Catatan Pemberian Edukasi Informasi
Isolatip
Amplop 95x152 mm 80 gsm
Amplop 110 x 230 mm, logo permata
Buku Dobel Folio
Clear Holder isi 40
Cable Tie UK 25 cm
Box File Bantex
Buku Folio 100 lembar
Buku Ekspedisi
Gunting Sedang
Kartu Stok RSPC
Form Daftar Kunjungan Dokter
Batu Batere Type C
Double Tape 1/2"
Buku Kwarto 200 Lembar
Form Surat Rujukan
Form Surat Ket. Meninggal
Keranjang Obat Hawai
Form Discount
 TANGGAL
TOTAL
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
3 5 6 8 3 6 10 6 6 4 14 6 3 10 7 6 6 184
3 1 1 1 1 1 2 1 1 19
0
1 2 2 2 3 1 1 3 2 1 2 30
1
0
1 4
0

TANGGAL
TOTAL
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
TOTAL
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
TOTAL
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
TOTAL
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
TOTAL
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 0
0
0
0
0
0
0
0
0
0
0
0

Tanggal
Terpakai
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

TANGGAL
Terpakai
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
10 15
0
50 150
3 3
0
0
3 3
1 4
0
2 2
0
3 8
3 8
12
 0
0
25 42 89
1 1
2 2
0
2 3
0
1 8 9
0
5 1 11
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1 1
2 2
1 1
12 12
1 1
Harga Sewa Alat Total

Rp 50,000 Rp 9,200,000
Rp 109,350 Rp 2,077,650
Rp 145,800 Rp -
Rp 35,000 Rp 1,050,000
Rp - Rp -
Rp - Rp -
Rp 15,000 Rp 60,000
Rp - Rp -
Rp - Rp -
Rp 12,387,650
 HPP Grand Total

Rp 5,040 Rp -
Rp 5,981 Rp -
Rp 30.466 Rp -
Rp 128.43 Rp -
Rp 3,006.00 Rp -
Rp 32,000 Rp -
Rp 17.320 Rp -
Rp 150 Rp -
Rp 482.26 Rp -
Rp 483.31 Rp -
Rp 36.00 Rp -
Rp 19.86 Rp -
Rp 19.41 Rp -
Rp 847 Rp -
Rp 1,667.66 Rp -
Rp 397.74 Rp -
Rp 60,000 Rp -
Rp 538 Rp -
Rp 405 Rp -
Rp 575.58 Rp -
Rp 4.53 Rp -
Rp 23.25 Rp -
Rp 11.65 Rp -
Rp 50.40 Rp -
Rp 800 Rp -
Rp 800 Rp -
Rp 800 Rp -
Rp 800 Rp -
Rp 2,860 Rp -
Rp 62.4 Rp -
Rp 3,200 Rp -
Rp 290 Rp -
Rp 3,836.74 Rp -
Rp 18.4 Rp -
Rp 54.3 Rp -
Rp 9.2 Rp -
Rp 193.1 Rp -
Rp - Rp -
Rp - Rp -
Rp 3,222.46 Rp -
Rp 24,080.00 Rp -
Rp 35,530.71 Rp -
Rp 3,100.00 Rp -

Total Pengeluaran Rp -

Harga Jual Grand Total

Rp 10,530 Rp -
Rp 9,450 Rp -
Rp 46.50 Rp -
Rp 346.50 Rp -
Rp 8,910.00 Rp -
Rp 32,000.00 Rp -
Rp 371.25 Rp -
Rp 222.75 Rp -
Rp 965.25 Rp -
Rp 965.25 Rp -
Rp 53.46 Rp -
Rp 35.15 Rp -
Rp 33.48 Rp -
Rp 1,419.00 Rp -
Rp 2,838.00 Rp -
Rp 701.25 Rp -
Rp 60,000.00 Rp -
Rp 798.00 Rp -
Rp 990.00 Rp -
Rp 1,336.50 Rp -
Rp 21.45 Rp -
Rp 41.91 Rp -
Rp 17.34 Rp -
Rp 74.80 Rp -
Rp 2,392.50 Rp -
Rp 1,485.00 Rp -
Rp 2,392.50 Rp -
Rp 1,485.00 Rp -
Rp 4,247.10 Rp -
Rp 98.01 Rp -
Rp 5,940.00 Rp -
Rp 478.00 Rp -
Rp 10,395.00 Rp -
Rp 25.74 Rp -
Rp 806.36 Rp -
Rp 9.2 Rp -
Rp 193.1 Rp -
Rp 1,700.00 Rp -
Rp 2,775.00 Rp -
Rp 5,400.00 Rp -

TOTAL PEMASUKA Rp -

LABA/RUGI Rp -

HPP Grand Total

Rp 3,666.49 Rp 54,997.35
Rp 4,500.00 Rp -
Rp 500.00 Rp 75,000.00
Rp 4,500.00 Rp 13,500.00
Rp 9,000.00 Rp -
Rp 9,000.00 Rp -
Rp 9,000.00 Rp 27,000.00
Rp 12,000.00 Rp 48,000.00
Rp 11,500.00 Rp -
Rp 9,000.00 Rp 18,000.00
Rp 9,000.00 Rp -
Rp 12,000.00 Rp 96,000.00
Rp 12,000.00 Rp 96,000.00
Rp 35,000.00 Rp 420,000.00
Rp 1,100.00 Rp -
Rp 1,500.00 Rp -
Rp 2,500.00 Rp 222,500.00
Rp 18,000.00 Rp 18,000.00
Rp 4,500.00 Rp 9,000.00
Rp 15,000.00 Rp -
Rp 15,000.00 Rp 45,000.00
Rp 150,000.00 Rp -
Rp 1,200.00 Rp 10,800.00
Rp 9,000.00 Rp -
Rp 5,500.00 Rp 60,500.00
Rp 9,000.00 Rp -
Rp 16,500.00 Rp -
Rp 9,000.00 Rp 9,000.00
Rp 11,000.00 Rp 11,000.00
Rp 13,200.00 Rp -
Rp 5,500.00 Rp -
Rp 10,000.00 Rp -
Rp 35,000.00 Rp -
Rp 25,300.00 Rp -
Rp 15,000.00 Rp -
Rp 215.00 Rp -
Rp 24,750.00 Rp -
Rp 11,000.00 Rp -
Rp 5,500.00 Rp -
Rp 5,807.69 Rp -
Rp 300.00 Rp -
Rp 9,000.00 Rp -
Rp 2,325.00 Rp -
Rp 3,000.00 Rp -
Rp 11,000.00 Rp 11,000.00
Rp 9,000.00 Rp 18,000.00
Rp 5,750.00 Rp 5,750.00
Rp 7,278.43 Rp 87,341.16
Rp 6,000.00 Rp 6,000.00

Rp 1,356,388.51
 TANGGAL
UTILISASI ALAT
1 2 3 4 5 6 7 8 9 10 11 12 13 14
EKG
Bedsite Monitor
Defibrilator
Nebulizer
Laryngoscope Dewasa
Laryngoscope Anak
Suction
Inkubator Portable

TANGGAL
PENERIMAAN PASIEN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Rawat Inap Biasa
Rawat Kebidanana (VK)
Rawat Perina Sehat
Rawat Perina Sakit
Rawat Intensif
Dead On Resusitation
Dead On Arrival
Rawat Jalan/ Pulang
Pulang Paksa
Rujuk
Instalasi Bedah Sentral
Hemodialisa
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
PRODUKTIVITAS
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Resusitasi
Emergent
Urgent
Non Urgent
False Emergency
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
JENIS PEMBAYARAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
UMUM
BPJS
JASA RAHARJA
ASURANSI LAIN
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BPJS NAIK KELAS
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
UTILISASI RUANGAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Ruang Resusitasi
Ruang Tindakan
Ruang IGD Umum
Ruang Observasi
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0

PENGELUARAN IGD BHP MEDIS

TANGGAL
Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryant tule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide Onemed
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 g
Masker Earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru Bayi
Peneng biru Dewasa
Peneng pink Bayi
peneng pink Dewasa
Pisau cukur single Dahlhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
UnderPad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel

PEMASUKAN DARI BHP

Tanggal
Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Accu Check Performa 7
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryantule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 gram
Masker earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru bayi
Peneng biru dewasa
peneng pink bayi
peneng pink dewasa
Pisau Cukur Sigle Daelhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
Under Pad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR

PERMINTAAN FORM DAN ATK

TANGGAL
Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Form Surat Persetujuan Pulang 5
Form Surat Sakit
Form Hasil EKG 200
Form Resep
Form Persetujuan Tindakan Kedokteran
Form Penolakan Tindakan
Form Perintah Lisan/SBAR
Form Transfer Pasien
Form Persetujuan Umum
Form Observasi Khusus
Form Pengkajian Medis Rawat Inap
Form Pengkajian Medis IGD
Form Pengkajian Keperawatan IGD
Form Triase
Isi Staples
Isi Cutter
Kertas Label 107
Kertas Buram
Lem Stick
Form Permintaan Radiologi
Form Permintaan Laboratorium
Refill Printer LaserJet
Ballpoint
Form Pemberian Informasi Tindakan Kedokteran
Resep BPJS 5
Form Persetujuan Restrain
Form Pengkajian Keperawatan Pasien Ranap
Form Pengkajian Awal Medis Pasien Rawat Inap
Form Pengantar Untuk Rawat Inap (2 Rangkap)
Form Catatan Pemberian Edukasi Informasi
Isolatip
Amplop 95x152 mm 80 gsm
Amplop 110 x 230 mm, logo permata
Buku Dobel Folio
Clear Holder isi 40
Cable Tie UK 25 cm
Box File Bantex
Buku Folio 100 lembar
Buku Ekspedisi
Gunting Sedang
Kartu Stok RSPC
Form Daftar Kunjungan Dokter
Batu Batere Type C
Double Tape 1/2"
Buku Kwarto 200 Lembar
Form Surat Rujukan
Form Surat Ket. Meninggal
Keranjang Obat Hawai
Form Discount
 TANGGAL
TOTAL
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0
0
0

TANGGAL
TOTAL
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
TOTAL
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
TOTAL
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
TOTAL
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
TOTAL
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 0
0
0
0
0
0
0
0
0
0
0
0

Tanggal
Terpakai
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
7
0
0
228 401 629
0
0
7 7
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

TANGGAL
Terpakai
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
5
0
200
0
0
0
0
0
0
0
0
0
0
0
 0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1 1
0
0
0
0
Harga Sewa Alat Total

Rp 50,000 Rp -
Rp 109,350 Rp -
Rp 145,800 Rp -
Rp 35,000 Rp -
Rp - Rp -
Rp - Rp -
Rp 15,000 Rp -
Rp - Rp -
Rp - Rp -
Rp -
 HPP Grand Total

Rp 5,040 Rp -
Rp 5,981 Rp -
Rp 30.466 Rp -
Rp 128.43 Rp -
Rp 3,006.00 Rp -
Rp 32,000 Rp -
Rp 17.320 Rp -
Rp 150 Rp -
Rp 482.26 Rp -
Rp 483.31 Rp -
Rp 36.00 Rp -
Rp 19.86 Rp -
Rp 19.41 Rp -
Rp 847 Rp -
Rp 1,667.66 Rp -
Rp 397.74 Rp -
Rp 60,000 Rp -
Rp 538 Rp -
Rp 405 Rp -
Rp 575.58 Rp -
Rp 4.53 Rp -
Rp 23.25 Rp -
Rp 11.65 Rp -
Rp 50.40 Rp -
Rp 800 Rp -
Rp 800 Rp -
Rp 800 Rp -
Rp 800 Rp -
Rp 2,860 Rp -
Rp 62.4 Rp -
Rp 3,200 Rp -
Rp 290 Rp -
Rp 3,836.74 Rp -
Rp 18.4 Rp -
Rp 54.3 Rp -
Rp 9.2 Rp -
Rp 193.1 Rp -
Rp - Rp -
Rp - Rp -
Rp 3,222.46 Rp -
Rp 24,080.00 Rp -
Rp 35,530.71 Rp -
Rp 3,100.00 Rp -

Total Pengeluaran Rp -

Harga Jual Grand Total

Rp 10,530 Rp 73,710
Rp 9,450 Rp -
Rp 46.50 Rp -
Rp 346.50 Rp 217,948.50
Rp 8,910.00 Rp -
Rp 32,000.00 Rp -
Rp 371.25 Rp 2,598.75
Rp 222.75 Rp -
Rp 965.25 Rp -
Rp 965.25 Rp -
Rp 53.46 Rp -
Rp 35.15 Rp -
Rp 33.48 Rp -
Rp 1,419.00 Rp -
Rp 2,838.00 Rp -
Rp 701.25 Rp -
Rp 60,000.00 Rp -
Rp 798.00 Rp -
Rp 990.00 Rp -
Rp 1,336.50 Rp -
Rp 21.45 Rp -
Rp 41.91 Rp -
Rp 17.34 Rp -
Rp 74.80 Rp -
Rp 2,392.50 Rp -
Rp 1,485.00 Rp -
Rp 2,392.50 Rp -
Rp 1,485.00 Rp -
Rp 4,247.10 Rp -
Rp 98.01 Rp -
Rp 5,940.00 Rp -
Rp 478.00 Rp -
Rp 10,395.00 Rp -
Rp 25.74 Rp -
Rp 806.36 Rp -
Rp 9.2 Rp -
Rp 193.1 Rp -
Rp 1,700.00 Rp -
Rp 2,775.00 Rp -
Rp 5,400.00 Rp -

TOTAL PEMASUKAN Rp 294,257.25

LABA/RUGI Rp 294,257.25

HPP Grand Total

Rp 3,666.49 Rp 18,332.45
Rp 4,500.00 Rp -
Rp 500.00 Rp 100,000.00
Rp 4,500.00 Rp -
Rp 9,000.00 Rp -
Rp 9,000.00 Rp -
Rp 9,000.00 Rp -
Rp 12,000.00 Rp -
Rp 11,500.00 Rp -
Rp 9,000.00 Rp -
Rp 9,000.00 Rp -
Rp 12,000.00 Rp -
Rp 12,000.00 Rp -
Rp 35,000.00 Rp -
Rp 1,100.00 Rp -
Rp 1,500.00 Rp -
Rp 2,500.00 Rp -
Rp 18,000.00 Rp -
Rp 4,500.00 Rp -
Rp 15,000.00 Rp -
Rp 15,000.00 Rp -
Rp 150,000.00 Rp -
Rp 1,200.00 Rp -
Rp 9,000.00 Rp -
Rp 5,500.00 Rp 27,500.00
Rp 9,000.00 Rp -
Rp 16,500.00 Rp -
Rp 9,000.00 Rp -
Rp 11,000.00 Rp -
Rp 13,200.00 Rp -
Rp 5,500.00 Rp -
Rp 10,000.00 Rp -
Rp 35,000.00 Rp -
Rp 25,300.00 Rp -
Rp 15,000.00 Rp -
Rp 215.00 Rp -
Rp 24,750.00 Rp -
Rp 11,000.00 Rp -
Rp 5,500.00 Rp -
Rp 5,807.69 Rp -
Rp 300.00 Rp -
Rp 9,000.00 Rp -
Rp 2,325.00 Rp -
Rp 3,000.00 Rp -
Rp 11,000.00 Rp 11,000.00
Rp 9,000.00 Rp -
Rp 5,750.00 Rp -
Rp 7,278.43 Rp -
Rp 6,000.00 Rp -

Rp 156,832.45
 UTILISASI ALAT
1 2 3 4 5 6 7 8 9 10 11
EKG
Bedsite Monitor
Defibrilator
Nebulizer
Laryngoscope Dewasa
Laryngoscope Anak
Suction
Inkubator Portable

PENERIMAAN PASIEN
1 2 3 4 5 6 7 8 9 10 11
Rawat Inap Biasa
Rawat Kebidanana (VK)
Rawat Perina Sehat
Rawat Perina Sakit
Rawat Intensif
Dead On Resusitation
Dead On Arrival
Rawat Jalan/ Pulang
Pulang Paksa
Rujuk
Instalasi Bedah Sentral
Hemodialisa
Total 0 0 0 0 0 0 0 0 0 0 0

PRODUKTIVITAS
1 2 3 4 5 6 7 8 9 10 11
Resusitasi
Emergent
Urgent
Non Urgent
False Emergency
Total 0 0 0 0 0 0 0 0 0 0 0

JENIS PEMBAYARAN
1 2 3 4 5 6 7 8 9 10 11
UMUM
BPJS
JASA RAHARJA
ASURANSI LAIN
Total 0 0 0 0 0 0 0 0 0 0 0
BPJS NAIK KELAS
Total 0 0 0 0 0 0 0 0 0 0 0

UTILISASI RUANGAN
1 2 3 4 5 6 7 8 9 10 11
Ruang Resusitasi
Ruang Tindakan
Ruang IGD Umum
Ruang Observasi
Total 0 0 0 0 0 0 0 0 0 0 0

PENGELUARAN IGD BHP MEDIS

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryant tule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide Onemed
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 g
Masker Earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru Bayi
Peneng biru Dewasa
Peneng pink Bayi
peneng pink Dewasa
Pisau cukur single Dahlhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
UnderPad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel

PEMASUKAN DARI BHP

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryantule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 gram
Masker earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru bayi
Peneng biru dewasa
peneng pink bayi
peneng pink dewasa
Pisau Cukur Sigle Daelhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
Under Pad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR

PERMINTAAN FORM DAN ATK

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Form Surat Persetujuan Pulang 5
Form Surat Sakit
Form Hasil EKG 100
Form Resep
Form Persetujuan Tindakan Kedokteran
Form Penolakan Tindakan
Form Perintah Lisan/SBAR
Form Transfer Pasien
Form Persetujuan Umum
Form Observasi Khusus
Form Pengkajian Medis Rawat Inap
Form Pengkajian Medis IGD
Form Pengkajian Keperawatan IGD
Form Triase
Isi Staples
Isi Cutter
Kertas Label 107
Kertas Buram
Lem Stick
Form Permintaan Radiologi
Form Permintaan Laboratorium
Refill Printer LaserJet
Ballpoint
Form Pemberian Informasi Tindakan Kedokteran
Resep BPJS
Form Persetujuan Restrain
Form Pengkajian Keperawatan Pasien Ranap
Form Pengkajian Awal Medis Pasien Rawat Inap
Form Pengantar Untuk Rawat Inap (2 Rangkap)
Form Catatan Pemberian Edukasi Informasi
Isolatip
Amplop 95x152 mm 80 gsm
Amplop 110 x 230 mm, logo permata
Buku Dobel Folio
Clear Holder isi 40
Cable Tie UK 25 cm
Box File Bantex
Buku Folio 100 lembar
Buku Ekspedisi
Gunting Sedang
Kartu Stok RSPC
Form Daftar Kunjungan Dokter
Batu Batere Type C
Double Tape 1/2"
Buku Kwarto 200 Lembar
Form Surat Rujukan
Form Surat Ket. Meninggal
Keranjang Obat Hawai
Form Discount
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
 Tanggal
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
10

50
3

3
3 1

5 3
5 3
12
22 25 42
1
2

1 2

1 8

5 5 1

1
1

1
2
1
12
1
 Harga Sewa Alat Total
TOTAL

0 Rp 50,000 Rp -
0 Rp 109,350 Rp -
0 Rp 145,800 Rp -
0 Rp 35,000 Rp -
0 Rp - Rp -
0 Rp - Rp -
0 Rp 15,000 Rp -
0 Rp - Rp -
Rp - Rp -
Rp -
TOTAL

0
0
0
0
0
0
0
0
0
0
0
0
0

TOTAL

0
0
0
0
0
0

TOTAL

0
0
0
0
0
 0
0

TOTAL

0
0
0
0
0

TOTAL HPP Grand Total

0 Rp 5,040 Rp -
0 Rp 5,981 Rp -
0 Rp 30.466 Rp -
0 Rp 128.43 Rp -
0 Rp 3,006.00 Rp -
0 Rp 32,000 Rp -
0 Rp 17.320 Rp -
0 Rp 150 Rp -
0 Rp 482.26 Rp -
0 Rp 483.31 Rp -
0 Rp 36.00 Rp -
0 Rp 19.86 Rp -
0 Rp 19.41 Rp -
0 Rp 847 Rp -
0 Rp 1,667.66 Rp -
0 Rp 397.74 Rp -
0 Rp 60,000 Rp -
0 Rp 538 Rp -
0 Rp 405 Rp -
0 Rp 575.58 Rp -
0 Rp 4.53 Rp -
0 Rp 23.25 Rp -
0 Rp 11.65 Rp -
0 Rp 50.40 Rp -
0 Rp 800 Rp -
0 Rp 800 Rp -
0 Rp 800 Rp -
0 Rp 800 Rp -
0 Rp 2,860 Rp -
0 Rp 62.4 Rp -
0 Rp 3,200 Rp -
 0 Rp 290 Rp -
0 Rp 3,836.74 Rp -
0 Rp 18.4 Rp -
0 Rp 54.3 Rp -
0 Rp 9.2 Rp -
0 Rp 193.1 Rp -
0 Rp - Rp -
0 Rp - Rp -
0 Rp 3,222.46 Rp -
0 Rp 24,080.00 Rp -
0 Rp 35,530.71 Rp -
0 Rp 3,100.00 Rp -

Total Pengeluaran Rp -

Terpakai Harga Jual Grand Total

0 Rp 10,530 Rp -
0 Rp 9,450 Rp -
0 Rp 46.50 Rp -
0 Rp 346.50 Rp -
0 Rp 8,910.00 Rp -
0 Rp 32,000.00 Rp -
0 Rp 371.25 Rp -
0 Rp 222.75 Rp -
0 Rp 965.25 Rp -
0 Rp 965.25 Rp -
0 Rp 53.46 Rp -
0 Rp 35.15 Rp -
0 Rp 33.48 Rp -
0 Rp 1,419.00 Rp -
0 Rp 2,838.00 Rp -
0 Rp 701.25 Rp -
0 Rp 60,000.00 Rp -
0 Rp 798.00 Rp -
0 Rp 990.00 Rp -
0 Rp 1,336.50 Rp -
0 Rp 21.45 Rp -
0 Rp 41.91 Rp -
 0 Rp 17.34 Rp -
0 Rp 74.80 Rp -
0 Rp 2,392.50 Rp -
0 Rp 1,485.00 Rp -
0 Rp 2,392.50 Rp -
0 Rp 1,485.00 Rp -
0 Rp 4,247.10 Rp -
0 Rp 98.01 Rp -
0 Rp 5,940.00 Rp -
0 Rp 478.00 Rp -
0 Rp 10,395.00 Rp -
0 Rp 25.74 Rp -
0 Rp 806.36 Rp -
0 Rp 9.2 Rp -
0 Rp 193.1 Rp -
0 Rp 1,700.00 Rp -
0 Rp 2,775.00 Rp -
0 Rp 5,400.00 Rp -

TOTAL PEMASUKAN Rp -

LABA/RUGI Rp -

Terpakai HPP Grand Total

15 Rp 3,666.49 Rp 54,997.35
0 Rp 4,500.00 Rp -
150 Rp 500.00 Rp 75,000.00
3 Rp 4,500.00 Rp 13,500.00
0 Rp 9,000.00 Rp -
0 Rp 9,000.00 Rp -
3 Rp 9,000.00 Rp 27,000.00
4 Rp 12,000.00 Rp 48,000.00
0 Rp 11,500.00 Rp -
2 Rp 9,000.00 Rp 18,000.00
0 Rp 9,000.00 Rp -
8 Rp 12,000.00 Rp 96,000.00
8 Rp 12,000.00 Rp 96,000.00
12 Rp 35,000.00 Rp 420,000.00
 0 Rp 1,100.00 Rp -
0 Rp 1,500.00 Rp -
89 Rp 2,500.00 Rp 222,500.00
1 Rp 18,000.00 Rp 18,000.00
2 Rp 4,500.00 Rp 9,000.00
0 Rp 15,000.00 Rp -
3 Rp 15,000.00 Rp 45,000.00
0 Rp 150,000.00 Rp -
9 Rp 1,200.00 Rp 10,800.00
0 Rp 9,000.00 Rp -
11 Rp 5,500.00 Rp 60,500.00
0 Rp 9,000.00 Rp -
0 Rp 16,500.00 Rp -
1 Rp 9,000.00 Rp 9,000.00
1 Rp 11,000.00 Rp 11,000.00
0 Rp 13,200.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 10,000.00 Rp -
0 Rp 35,000.00 Rp -
0 Rp 25,300.00 Rp -
0 Rp 15,000.00 Rp -
0 Rp 215.00 Rp -
0 Rp 24,750.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 5,807.69 Rp -
0 Rp 300.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 2,325.00 Rp -
0 Rp 3,000.00 Rp -
1 Rp 11,000.00 Rp 11,000.00
2 Rp 9,000.00 Rp 18,000.00
1 Rp 5,750.00 Rp 5,750.00
12 Rp 7,278.43 Rp 87,341.16
1 Rp 6,000.00 Rp 6,000.00

Rp 1,356,388.51
 UTILISASI ALAT
1 2 3 4 5 6 7 8 9 10 11
EKG
Bedsite Monitor
Defibrilator
Nebulizer
Laryngoscope Dewasa
Laryngoscope Anak
Suction
Inkubator Portable

PENERIMAAN PASIEN
1 2 3 4 5 6 7 8 9 10 11
Rawat Inap Biasa
Rawat Kebidanana (VK)
Rawat Perina Sehat
Rawat Perina Sakit
Rawat Intensif
Dead On Resusitation
Dead On Arrival
Rawat Jalan/ Pulang
Pulang Paksa
Rujuk
Instalasi Bedah Sentral
Hemodialisa
Total 0 0 0 0 0 0 0 0 0 0 0

PRODUKTIVITAS
1 2 3 4 5 6 7 8 9 10 11
Resusitasi
Emergent
Urgent
Non Urgent
False Emergency
Total 0 0 0 0 0 0 0 0 0 0 0

JENIS PEMBAYARAN
1 2 3 4 5 6 7 8 9 10 11
UMUM
BPJS
JASA RAHARJA
ASURANSI LAIN
Total 0 0 0 0 0 0 0 0 0 0 0
BPJS NAIK KELAS
Total 0 0 0 0 0 0 0 0 0 0 0

UTILISASI RUANGAN
1 2 3 4 5 6 7 8 9 10 11
Ruang Resusitasi
Ruang Tindakan
Ruang IGD Umum
Ruang Observasi
Total 0 0 0 0 0 0 0 0 0 0 0

PENGELUARAN IGD BHP MEDIS

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryant tule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide Onemed
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 g
Masker Earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru Bayi
Peneng biru Dewasa
Peneng pink Bayi
peneng pink Dewasa
Pisau cukur single Dahlhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
UnderPad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel

PEMASUKAN DARI BHP

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryantule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 gram
Masker earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru bayi
Peneng biru dewasa
peneng pink bayi
peneng pink dewasa
Pisau Cukur Sigle Daelhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
Under Pad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR

PERMINTAAN FORM DAN ATK

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Form Surat Persetujuan Pulang 5
Form Surat Sakit
Form Hasil EKG 100
Form Resep
Form Persetujuan Tindakan Kedokteran
Form Penolakan Tindakan
Form Perintah Lisan/SBAR
Form Transfer Pasien
Form Persetujuan Umum
Form Observasi Khusus
Form Pengkajian Medis Rawat Inap
Form Pengkajian Medis IGD
Form Pengkajian Keperawatan IGD
Form Triase
Isi Staples
Isi Cutter
Kertas Label 107
Kertas Buram
Lem Stick
Form Permintaan Radiologi
Form Permintaan Laboratorium
Refill Printer LaserJet
Ballpoint
Form Pemberian Informasi Tindakan Kedokteran
Resep BPJS
Form Persetujuan Restrain
Form Pengkajian Keperawatan Pasien Ranap
Form Pengkajian Awal Medis Pasien Rawat Inap
Form Pengantar Untuk Rawat Inap (2 Rangkap)
Form Catatan Pemberian Edukasi Informasi
Isolatip
Amplop 95x152 mm 80 gsm
Amplop 110 x 230 mm, logo permata
Buku Dobel Folio
Clear Holder isi 40
Cable Tie UK 25 cm
Box File Bantex
Buku Folio 100 lembar
Buku Ekspedisi
Gunting Sedang
Kartu Stok RSPC
Form Daftar Kunjungan Dokter
Batu Batere Type C
Double Tape 1/2"
Buku Kwarto 200 Lembar
Form Surat Rujukan
Form Surat Ket. Meninggal
Keranjang Obat Hawai
Form Discount
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
 Tanggal
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
10

50
3

3
3 1

5 3
5 3
12
22 25 42
1
2

1 2

1 8

5 5 1

1
1

1
2
1
12
1
 Harga Sewa Alat Total
TOTAL

0 Rp 50,000 Rp -
0 Rp 109,350 Rp -
0 Rp 145,800 Rp -
0 Rp 35,000 Rp -
0 Rp - Rp -
0 Rp - Rp -
0 Rp 15,000 Rp -
0 Rp - Rp -
Rp - Rp -
Rp -
TOTAL

0
0
0
0
0
0
0
0
0
0
0
0
0

TOTAL

0
0
0
0
0
0

TOTAL

0
0
0
0
0
 0
0

TOTAL

0
0
0
0
0

TOTAL HPP Grand Total

0 Rp 5,040 Rp -
0 Rp 5,981 Rp -
0 Rp 30.466 Rp -
0 Rp 128.43 Rp -
0 Rp 3,006.00 Rp -
0 Rp 32,000 Rp -
0 Rp 17.320 Rp -
0 Rp 150 Rp -
0 Rp 482.26 Rp -
0 Rp 483.31 Rp -
0 Rp 36.00 Rp -
0 Rp 19.86 Rp -
0 Rp 19.41 Rp -
0 Rp 847 Rp -
0 Rp 1,667.66 Rp -
0 Rp 397.74 Rp -
0 Rp 60,000 Rp -
0 Rp 538 Rp -
0 Rp 405 Rp -
0 Rp 575.58 Rp -
0 Rp 4.53 Rp -
0 Rp 23.25 Rp -
0 Rp 11.65 Rp -
0 Rp 50.40 Rp -
0 Rp 800 Rp -
0 Rp 800 Rp -
0 Rp 800 Rp -
0 Rp 800 Rp -
0 Rp 2,860 Rp -
0 Rp 62.4 Rp -
0 Rp 3,200 Rp -
 0 Rp 290 Rp -
0 Rp 3,836.74 Rp -
0 Rp 18.4 Rp -
0 Rp 54.3 Rp -
0 Rp 9.2 Rp -
0 Rp 193.1 Rp -
0 Rp - Rp -
0 Rp - Rp -
0 Rp 3,222.46 Rp -
0 Rp 24,080.00 Rp -
0 Rp 35,530.71 Rp -
0 Rp 3,100.00 Rp -

Total Pengeluaran Rp -

Terpakai Harga Jual Grand Total

0 Rp 10,530 Rp -
0 Rp 9,450 Rp -
0 Rp 46.50 Rp -
0 Rp 346.50 Rp -
0 Rp 8,910.00 Rp -
0 Rp 32,000.00 Rp -
0 Rp 371.25 Rp -
0 Rp 222.75 Rp -
0 Rp 965.25 Rp -
0 Rp 965.25 Rp -
0 Rp 53.46 Rp -
0 Rp 35.15 Rp -
0 Rp 33.48 Rp -
0 Rp 1,419.00 Rp -
0 Rp 2,838.00 Rp -
0 Rp 701.25 Rp -
0 Rp 60,000.00 Rp -
0 Rp 798.00 Rp -
0 Rp 990.00 Rp -
0 Rp 1,336.50 Rp -
0 Rp 21.45 Rp -
0 Rp 41.91 Rp -
 0 Rp 17.34 Rp -
0 Rp 74.80 Rp -
0 Rp 2,392.50 Rp -
0 Rp 1,485.00 Rp -
0 Rp 2,392.50 Rp -
0 Rp 1,485.00 Rp -
0 Rp 4,247.10 Rp -
0 Rp 98.01 Rp -
0 Rp 5,940.00 Rp -
0 Rp 478.00 Rp -
0 Rp 10,395.00 Rp -
0 Rp 25.74 Rp -
0 Rp 806.36 Rp -
0 Rp 9.2 Rp -
0 Rp 193.1 Rp -
0 Rp 1,700.00 Rp -
0 Rp 2,775.00 Rp -
0 Rp 5,400.00 Rp -

TOTAL PEMASUKAN Rp -

LABA/RUGI Rp -

Terpakai HPP Grand Total

15 Rp 3,666.49 Rp 54,997.35
0 Rp 4,500.00 Rp -
150 Rp 500.00 Rp 75,000.00
3 Rp 4,500.00 Rp 13,500.00
0 Rp 9,000.00 Rp -
0 Rp 9,000.00 Rp -
3 Rp 9,000.00 Rp 27,000.00
4 Rp 12,000.00 Rp 48,000.00
0 Rp 11,500.00 Rp -
2 Rp 9,000.00 Rp 18,000.00
0 Rp 9,000.00 Rp -
8 Rp 12,000.00 Rp 96,000.00
8 Rp 12,000.00 Rp 96,000.00
12 Rp 35,000.00 Rp 420,000.00
 0 Rp 1,100.00 Rp -
0 Rp 1,500.00 Rp -
89 Rp 2,500.00 Rp 222,500.00
1 Rp 18,000.00 Rp 18,000.00
2 Rp 4,500.00 Rp 9,000.00
0 Rp 15,000.00 Rp -
3 Rp 15,000.00 Rp 45,000.00
0 Rp 150,000.00 Rp -
9 Rp 1,200.00 Rp 10,800.00
0 Rp 9,000.00 Rp -
11 Rp 5,500.00 Rp 60,500.00
0 Rp 9,000.00 Rp -
0 Rp 16,500.00 Rp -
1 Rp 9,000.00 Rp 9,000.00
1 Rp 11,000.00 Rp 11,000.00
0 Rp 13,200.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 10,000.00 Rp -
0 Rp 35,000.00 Rp -
0 Rp 25,300.00 Rp -
0 Rp 15,000.00 Rp -
0 Rp 215.00 Rp -
0 Rp 24,750.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 5,807.69 Rp -
0 Rp 300.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 2,325.00 Rp -
0 Rp 3,000.00 Rp -
1 Rp 11,000.00 Rp 11,000.00
2 Rp 9,000.00 Rp 18,000.00
1 Rp 5,750.00 Rp 5,750.00
12 Rp 7,278.43 Rp 87,341.16
1 Rp 6,000.00 Rp 6,000.00

Rp 1,356,388.51
 UTILISASI ALAT
1 2 3 4 5 6 7 8 9 10 11
EKG
Bedsite Monitor
Defibrilator
Nebulizer
Laryngoscope Dewasa
Laryngoscope Anak
Suction
Inkubator Portable

PENERIMAAN PASIEN
1 2 3 4 5 6 7 8 9 10 11
Rawat Inap Biasa
Rawat Kebidanana (VK)
Rawat Perina Sehat
Rawat Perina Sakit
Rawat Intensif
Dead On Resusitation
Dead On Arrival
Rawat Jalan/ Pulang
Pulang Paksa
Rujuk
Instalasi Bedah Sentral
Hemodialisa
Total 0 0 0 0 0 0 0 0 0 0 0

PRODUKTIVITAS
1 2 3 4 5 6 7 8 9 10 11
Resusitasi
Emergent
Urgent
Non Urgent
False Emergency
Total 0 0 0 0 0 0 0 0 0 0 0

JENIS PEMBAYARAN
1 2 3 4 5 6 7 8 9 10 11
UMUM
BPJS
JASA RAHARJA
ASURANSI LAIN
Total 0 0 0 0 0 0 0 0 0 0 0
BPJS NAIK KELAS
Total 0 0 0 0 0 0 0 0 0 0 0

UTILISASI RUANGAN
1 2 3 4 5 6 7 8 9 10 11
Ruang Resusitasi
Ruang Tindakan
Ruang IGD Umum
Ruang Observasi
Total 0 0 0 0 0 0 0 0 0 0 0

PENGELUARAN IGD BHP MEDIS

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryant tule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide Onemed
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 g
Masker Earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru Bayi
Peneng biru Dewasa
Peneng pink Bayi
peneng pink Dewasa
Pisau cukur single Dahlhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
UnderPad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR
SAFETY BOX 5 L (DOCARE)
SAFETY BOX 12.5 L (DOCARE)
Pisau Cukur Doubel

PEMASUKAN DARI BHP

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Accu Check Performa
Accu Check Active
Alkohol 70%
Alkohol swab
Apron Plastik Disposible
Aseptic Gel
Blood Lancet One Med
Daryantule steril sach 10 gr
Handscoon Non Steril S
Handscoon Non Steril M
Hydrogen Peroxide
Hypafix 5 cm x 5 cm
Hypafix 10 cm x 5 m
Kassa Verband 5 cm
Kassa Verband 10 cm
Kassa Hidrofil
Kertas EKG 63 x 30
KY Jelly 50 gram
Masker earloop
Masker Tie On
Micropore 1/2 inch
Micropore 1 Inch
Nacl 0,9 % Widatra
Opsite Flexifix
Peneng biru bayi
Peneng biru dewasa
peneng pink bayi
peneng pink dewasa
Pisau Cukur Sigle Daelhausen
Povidone 1 Liter
Softpad 60 x 90 Onemed
Spatel Kayu
Under Pad AMS
Water Irrigation 1000 mL
Xylocain Spray
ultrafix 10 cm x 5 m
odex 5 L
Penanda Resiko Fall Risk-Kuning
Penanda Alergi Merah
Under Pad NR

PERMINTAAN FORM DAN ATK

Nama Barang
1 2 3 4 5 6 7 8 9 10 11
Form Surat Persetujuan Pulang 5
Form Surat Sakit
Form Hasil EKG 100
Form Resep
Form Persetujuan Tindakan Kedokteran
Form Penolakan Tindakan
Form Perintah Lisan/SBAR
Form Transfer Pasien
Form Persetujuan Umum
Form Observasi Khusus
Form Pengkajian Medis Rawat Inap
Form Pengkajian Medis IGD
Form Pengkajian Keperawatan IGD
Form Triase
Isi Staples
Isi Cutter
Kertas Label 107
Kertas Buram
Lem Stick
Form Permintaan Radiologi
Form Permintaan Laboratorium
Refill Printer LaserJet
Ballpoint
Form Pemberian Informasi Tindakan Kedokteran
Resep BPJS
Form Persetujuan Restrain
Form Pengkajian Keperawatan Pasien Ranap
Form Pengkajian Awal Medis Pasien Rawat Inap
Form Pengantar Untuk Rawat Inap (2 Rangkap)
Form Catatan Pemberian Edukasi Informasi
Isolatip
Amplop 95x152 mm 80 gsm
Amplop 110 x 230 mm, logo permata
Buku Dobel Folio
Clear Holder isi 40
Cable Tie UK 25 cm
Box File Bantex
Buku Folio 100 lembar
Buku Ekspedisi
Gunting Sedang
Kartu Stok RSPC
Form Daftar Kunjungan Dokter
Batu Batere Type C
Double Tape 1/2"
Buku Kwarto 200 Lembar
Form Surat Rujukan
Form Surat Ket. Meninggal
Keranjang Obat Hawai
Form Discount
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
 Tanggal
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
 TANGGAL
12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
10

50
3

3
3 1

5 3
5 3
12
22 25 42
1
2

1 2

1 8

5 5 1

1
1

1
2
1
12
1
 Harga Sewa Alat Total
TOTAL

0 Rp 50,000 Rp -
0 Rp 109,350 Rp -
0 Rp 145,800 Rp -
0 Rp 35,000 Rp -
0 Rp - Rp -
0 Rp - Rp -
0 Rp 15,000 Rp -
0 Rp - Rp -
Rp - Rp -
Rp -
TOTAL

0
0
0
0
0
0
0
0
0
0
0
0
0

TOTAL

0
0
0
0
0
0

TOTAL

0
0
0
0
0
 0
0

TOTAL

0
0
0
0
0

TOTAL HPP Grand Total

0 Rp 5,040 Rp -
0 Rp 5,981 Rp -
0 Rp 30.466 Rp -
0 Rp 128.43 Rp -
0 Rp 3,006.00 Rp -
0 Rp 32,000 Rp -
0 Rp 17.320 Rp -
0 Rp 150 Rp -
0 Rp 482.26 Rp -
0 Rp 483.31 Rp -
0 Rp 36.00 Rp -
0 Rp 19.86 Rp -
0 Rp 19.41 Rp -
0 Rp 847 Rp -
0 Rp 1,667.66 Rp -
0 Rp 397.74 Rp -
0 Rp 60,000 Rp -
0 Rp 538 Rp -
0 Rp 405 Rp -
0 Rp 575.58 Rp -
0 Rp 4.53 Rp -
0 Rp 23.25 Rp -
0 Rp 11.65 Rp -
0 Rp 50.40 Rp -
0 Rp 800 Rp -
0 Rp 800 Rp -
0 Rp 800 Rp -
0 Rp 800 Rp -
0 Rp 2,860 Rp -
0 Rp 62.4 Rp -
0 Rp 3,200 Rp -
 0 Rp 290 Rp -
0 Rp 3,836.74 Rp -
0 Rp 18.4 Rp -
0 Rp 54.3 Rp -
0 Rp 9.2 Rp -
0 Rp 193.1 Rp -
0 Rp - Rp -
0 Rp - Rp -
0 Rp 3,222.46 Rp -
0 Rp 24,080.00 Rp -
0 Rp 35,530.71 Rp -
0 Rp 3,100.00 Rp -

Total Pengeluaran Rp -

Terpakai Harga Jual Grand Total

0 Rp 10,530 Rp -
0 Rp 9,450 Rp -
0 Rp 46.50 Rp -
0 Rp 346.50 Rp -
0 Rp 8,910.00 Rp -
0 Rp 32,000.00 Rp -
0 Rp 371.25 Rp -
0 Rp 222.75 Rp -
0 Rp 965.25 Rp -
0 Rp 965.25 Rp -
0 Rp 53.46 Rp -
0 Rp 35.15 Rp -
0 Rp 33.48 Rp -
0 Rp 1,419.00 Rp -
0 Rp 2,838.00 Rp -
0 Rp 701.25 Rp -
0 Rp 60,000.00 Rp -
0 Rp 798.00 Rp -
0 Rp 990.00 Rp -
0 Rp 1,336.50 Rp -
0 Rp 21.45 Rp -
0 Rp 41.91 Rp -
 0 Rp 17.34 Rp -
0 Rp 74.80 Rp -
0 Rp 2,392.50 Rp -
0 Rp 1,485.00 Rp -
0 Rp 2,392.50 Rp -
0 Rp 1,485.00 Rp -
0 Rp 4,247.10 Rp -
0 Rp 98.01 Rp -
0 Rp 5,940.00 Rp -
0 Rp 478.00 Rp -
0 Rp 10,395.00 Rp -
0 Rp 25.74 Rp -
0 Rp 806.36 Rp -
0 Rp 9.2 Rp -
0 Rp 193.1 Rp -
0 Rp 1,700.00 Rp -
0 Rp 2,775.00 Rp -
0 Rp 5,400.00 Rp -

TOTAL PEMASUKAN Rp -

LABA/RUGI Rp -

Terpakai HPP Grand Total

15 Rp 3,666.49 Rp 54,997.35
0 Rp 4,500.00 Rp -
150 Rp 500.00 Rp 75,000.00
3 Rp 4,500.00 Rp 13,500.00
0 Rp 9,000.00 Rp -
0 Rp 9,000.00 Rp -
3 Rp 9,000.00 Rp 27,000.00
4 Rp 12,000.00 Rp 48,000.00
0 Rp 11,500.00 Rp -
2 Rp 9,000.00 Rp 18,000.00
0 Rp 9,000.00 Rp -
8 Rp 12,000.00 Rp 96,000.00
8 Rp 12,000.00 Rp 96,000.00
12 Rp 35,000.00 Rp 420,000.00
 0 Rp 1,100.00 Rp -
0 Rp 1,500.00 Rp -
89 Rp 2,500.00 Rp 222,500.00
1 Rp 18,000.00 Rp 18,000.00
2 Rp 4,500.00 Rp 9,000.00
0 Rp 15,000.00 Rp -
3 Rp 15,000.00 Rp 45,000.00
0 Rp 150,000.00 Rp -
9 Rp 1,200.00 Rp 10,800.00
0 Rp 9,000.00 Rp -
11 Rp 5,500.00 Rp 60,500.00
0 Rp 9,000.00 Rp -
0 Rp 16,500.00 Rp -
1 Rp 9,000.00 Rp 9,000.00
1 Rp 11,000.00 Rp 11,000.00
0 Rp 13,200.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 10,000.00 Rp -
0 Rp 35,000.00 Rp -
0 Rp 25,300.00 Rp -
0 Rp 15,000.00 Rp -
0 Rp 215.00 Rp -
0 Rp 24,750.00 Rp -
0 Rp 11,000.00 Rp -
0 Rp 5,500.00 Rp -
0 Rp 5,807.69 Rp -
0 Rp 300.00 Rp -
0 Rp 9,000.00 Rp -
0 Rp 2,325.00 Rp -
0 Rp 3,000.00 Rp -
1 Rp 11,000.00 Rp 11,000.00
2 Rp 9,000.00 Rp 18,000.00
1 Rp 5,750.00 Rp 5,750.00
12 Rp 7,278.43 Rp 87,341.16
1 Rp 6,000.00 Rp 6,000.00

Rp 1,356,388.51