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REKAPITULASI PEMBIAYAAN RAWAT JALAN JAMKESDA SAMARINDA BULAN MEI 2015

No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1 Misran 676699 0049/ Bph 4-May-15 Urologi 50,000 - 139,175 189,175
2 Herin Pratiw 562592 0237/ Post Sc 04-May-15 Kandungan 50,000 35,000 120,500 649,500 153,638 1,008,638
3 Hasisah 667930 0490/ S/ App 4-May-15 Bedah Umum 50,000 35,000 335,000 8,648 428,648
4 Sulaiman 542510 0024/ Dm Ii 4-May-15 Peny.Dalam 50,000 - 313,350 363,350
5 Asmini 466833 0340/ Pjk 4-May-15 Jantung 50,000 - 252,500 288,811 591,311
6 Sudirman 828549 0429/ Kontrol 4-May-15 Bedah Umum 50,000 - 125,000 8,363 183,363
7 Asma 834892 0387/ Dada Sakit, 04-May-15 Paru 50,000 - 20,850 70,850
8 Nur Apriyan 604631 0143/ Nyeri Tengk 4-May-15 Syaraf 50,000 - 86,888 136,888
9 Ardiah 727276 0203/ Dm+Post St 4-May-15 Saraf+Dalam 50,000 35,000 36,588 121,588
10 Lesiman 767362 0399/ Post Abses C 4-May-15 Ortopedi+Dal 50,000 70,000 80,000 197,161 397,161
11 Sarahealti 835367 0336/ Kontrol 4-May-15 Saraf+Dalam 50,000 35,000 997,700 30,088 1,112,788
12 Honny Kusb 653592 0172/ Fisiotherapy 4-May-15 R.Medik 50,000 35,000 71,500 284,288 440,788
13 Panirah 822928 0058/ Terapi+Kont 04-May-15 R.Medik+Syar 50,000 35,000 71,500 227,700 22,500 406,700
14 Rusli Sirega 440192 0412/ Hipertyroid 4-May-15 Peny.Dalam 50,000 - 16,838 66,838
15 Nur Anisa 835313 0367/ Oma 4-May-15 Tht 50,000 - 6,075 56,075
16 Wiwin Novia 834881 0341/ Terapi 04-May-15 Rehab Medik 50,000 35,000 71,500 23,141 179,641
17 Masni 835387 0259/ Dm 4-May-15 Dalam 50,000 - 632,250 26,275 708,525
18 Herlina 817022 0408/ Kontrol 4-May-15 Saraf & R Med 50,000 35,000 21,205 106,205
19 Maryati 528573 0175/ Dm+Ht 4-May-15 Jantung 50,000 - 110,250 157,763 318,013
20 Norma 776861 0371/ Ca Mamae 04-May-15 Onkologi 50,000 - 525,250 3,811 579,061
21 Elisabeth M 634235 0368/ Kontrol 4-May-15 Kandungan 50,000 - 60,000 18,975 128,975
22 Krisyanti El 805101 0364/ Tu Mamae 4-May-15 Bedah Umum 50,000 35,000 353,250 24,713 462,963
23 Muchsin We 738482 0236/ Bph 04-May-15 Urologi 50,000 - 1,687,313 1,737,313
24 Sumarfuah 479348 0375/ Isk 04-May-15 Urologi 50,000 - 335,000 8,125 393,125
25 Haling 821591 0268/ Terapi 04-May-15 Rehab Medik 50,000 35,000 71,500 160,250 125,400 21,713 463,863
26 Suci Asrina 835393 0349/ Colik Renal 4-May-15 Peny.Dalam 50,000 - 227,700 5,163 282,863
27 Rezki Maul 835385 0257/ Otitis Media 4-May-15 Tht 50,000 - 12,669 62,669
28 Siti Nafsiah 760092 0107/ Kontrol 4-May-15 Orthopedy 50,000 - 80,000 5,881 135,881
29 Ari Rachma 834064 0119/ Cf Femur 04-May-15 Orthopedi 50,000 - 80,000 5,881 135,881
30 Rusdiana 372137 0489/ Hnp 4-May-15 Syaraf 50,000 - 29,440 79,440
31 Abdurrahma 612733 0531/ Konjungtivit 4-May-15 Mata 50,000 - 15,960 65,960
32 Am. Mitia782792/780575
R 0044/ Ca Paru 04-May-15 Paru 50,000 - 286,950 125,400 14,231 476,581
33 Musni Arwat 801752 0270/ Dm 04-May-15 Penyakit Dala 50,000 - 429,500 42,675 522,175
34 Murhan 799495 0170/ Pjk 4-May-15 Jantung 50,000 - 462,500 277,350 789,850
35 Norma Yulia 771982 0344/ Cad+Chf 04-May-15 Jantung 50,000 - 172,425 222,425
36 Hj.Mutiara 614069 0445/ Perdarahan 4-May-15 Kandungan 50,000 - 60,000 305,000 18,600 433,600
37 Larassati 835370 0384/ Pupl 4-May-15 Gigi&Mulut 50,000 - 115,408 160,600 550 326,558
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
38 Wiji Riani 834543 0442/ Struma 4-May-15 Bedah Umum 50,000 - 125,000 9,125 184,125
39 Suyanto 835378 0472/ Angina Pec 4-May-15 Jantung 50,000 - 457,250 187,000 7,913 702,163
40 Isransyah 835388 0386/ Ht 04-May-15 Jantung 50,000 - 462,500 174,225 686,725
41 Hariono 835380 0473/ Selulitis 4-May-15 Kulit Kelamin 50,000 - 66,000 25,500 141,500
42 Misdian 835375 0430/ Ht 4-May-15 Jantung 50,000 - 649,500 15,919 715,419
43 Ahmad Fauj 835374 0428/ Teling Bern 4-May-15 Tht 50,000 - 3,771 53,771
44 Mochtar 837363 0397/ Kontrol 4-May-15 Jantung 50,000 - 523,250 187,000 183,661 943,911
45 M. Effendi 835372 0328/ Chest Pain 04-May-15 Jantung 50,000 - 523,250 187,000 1,525 761,775
46 Rusdi 765437 0241/ Chf 4-May-15 Jantung 50,000 - 187,000 161,475 398,475
47 Jainun 467356 0405/ Status Asma 04-May-15 Paru 50,000 - 161,694 211,694
48 Faizah Rahm 833000 0356/ Bronkhopne 04-May-15 Anak 50,000 - 5,038 55,038
49 M.Rafandi I 837267 0459/ Kontrol 4-May-15 Anak 50,000 - 80,984 130,984
50 Hj. Dahliani 725416 0293/ Kontrol 4-May-15 Peny.Dalam 50,000 - 496,100 12,919 559,019
51 Siah Sudars 835500 0393/ G2P1A0 Dgn 4-May-15 Paru 50,000 - 29,788 79,788
52 Sinta Rahay 393283 0417/ Sinusitis 04-May-15 Tht 50,000 - 35,425 85,425
53 Nur Muspia 505035 0214/ Chf 4-May-15 Jantung 50,000 - 523,250 187,000 14,419 774,669
54 M. Kiki 835336 0163/ Susp Fr Man 04-May-15 Orthopedi 50,000 - 4,025 54,025
55 Munira 752752 0266/ Kontrol 04-May-15 Kandungan 50,000 - 4,800 54,800
56 M Naufal 541319 0125/ Epilepsi 4-May-15 Saraf 50,000 - 60,000 324,788 434,788
57 Amat 828525 0457/ Dispepsia 4-May-15 Peny.Dalam 50,000 - 36,288 86,288
58 Sumarno 834803 0249/ Kontrol 4-May-15 Bedah Umum 50,000 - 125,000 8,363 183,363
59 Juwariyah 834558 0250/ Dm 4-May-15 Peny.Dalam 50,000 - 402,500 12,500 465,000
60 Iis Hastuti 835363 0116/ Synd Dispep 04-May-15 Penyakit Dala 50,000 70,000 227,700 26,806 374,506
61 Karmo 837013 0269/ Acs Nstemi 04-May-15 Jantung 50,000 - 187,000 332,363 569,363
62 Eko Budi S 829994 0244/ Gastritis 4-May-15 Dalam 50,000 - 24,563 74,563
63 Sem Saroin 720664 0299/ 7 Gangren 04-May-15 Gigi&Mulut 50,000 35,000 245,275 330,275
64 Aminah 835323 0208/ Synd Dispep 04-May-15 Penyakit Dala 50,000 35,000 64,070 149,070
65 Djohariansy 770295 0110/ Pjk 4-May-15 Jantung 50,000 - 628,950 55,538 734,488
66 Sabariah 837074 0152/ Kontrol 4-May-15 Kandungan 50,000 - 60,000 18,600 128,600
67 Mariana 777781 0186/ Kontrol 4-May-15 Syaraf 50,000 - 50,431 100,431
68 Feti Fatima 836210 0300/ Gastritis Er 04-May-15 Penyakit Dala 50,000 - 34,237 84,237
69 Rumiatun 562394 0024/ Ht 4-May-15 Peny.Dalam 50,000 - 262,481 312,481
70 Hj. Sapiah 434334 0383/ Dm Ii 4-May-15 Dalam 50,000 - 185,681 235,681
71 M Yunus 779549 0094/ Kontrol 4-May-15 Jantung 50,000 - 342,600 392,600
72 Bunga Wati 834855 0200/ Kontrol 4-May-15 Dalam 50,000 - 38,825 88,825
73 Sriatun 257601 0045/ Terapi+Kont 04-May-15 R.Medik+Orth 50,000 35,000 151,500 4,025 240,525
74 Nurvina Wid 837502 0357/ S/ Isk 04-May-15 Urologi 50,000 35,000 335,000 51,681 471,681
75 Mulyono 787453 0048/ Lbp 4-May-15 Saraf 50,000 - 14,900 64,900
76 Rosmini 664921 0338/ Gigitan Kuc 4-May-15 Syaraf 50,000 - 57,000 173,938 280,938
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
77 Dewi Nur Ok835368 0285/ Susp Dermat 04-May-15 Kulit Kelamin 50,000 - 23,213 73,213
78 Arni 209353 0233/ 16 Radix 4-May-15 Gigi&Mulut 50,000 - 91,340 7,350 148,690
79 Walimbo 837394 0162/ Dm+Gea 04-May-15 Penyakit Dala 50,000 - 21,013 71,013
80 Sudarsono 835371 0313/ Angina Pec 04-May-15 Jantung 50,000 - 628,950 187,000 169,125 1,035,075
81 M.Naufal Af 834891 0310/ Hernia Scrot 4-May-15 Bedah Anak 50,000 35,000 19,157 104,157
82 Jumatul Has 651762 0213/ Sinusitis 4-May-15 Tht 50,000 - 142,472 192,472
83 Kartini 335295 0197/ Cad 4-May-15 Jantung 50,000 - 41,610 91,610
84 Siram 390676 0385/ Bph 4-May-15 Urologi 50,000 - 138,194 188,194
85 Arda 704204 0089/ Pjk 04-May-15 Jantung 50,000 - 178,350 228,350
86 Dominikus H093979 0315/ Bph 04-May-15 Urologi 50,000 - 137,213 187,213
87 H Yansyah 478969 0109/ Kontrol 4-May-15 Jantung 50,000 - 47,336 97,336
88 Masrah 490827 0130/ Pjk Ht 4-May-15 Jantung 50,000 - 181,613 231,613
89 Sumarni 832575 0204/ Kontrol 4-May-15 Kandungan 50,000 - 60,000 17,813 127,813
90 Sulawati 485553 0101/ Ht 04-May-15 Jantung 50,000 - 284,288 334,288
91 Nurmiaty 437223 0281/ Gastritis+Ht 04-May-15 Penyakit Dala 50,000 - 31,950 81,950
92 Sri Natun 840175 0151/ Obs Dermati 4-May-15 Kulit Kelamin 50,000 - 24,500 74,500
93 M. Saleh 458143 0102/ Terapi+Kont 04-May-15 R.Medik+P.Da 50,000 35,000 71,500 8,775 165,275
94 Supadmi 510730 0171/ Acites + Dm 4-May-15 Peny.Dalam 50,000 - 98,556 148,556
95 Ida Kuswati 773708 0166/ Glukoma 4-May-15 Mata 50,000 - 60,000 41,938 151,938
96 Heni Puspo 781723 0400/ Glaukoma 4-May-15 Mata 50,000 - 60,000 3,000 113,000
97 Vera Nur Kh 693860 0121/ Penodentitis 4-May-15 Gigi & Mulut 50,000 - 207,443 7,938 265,381
98 Jumairi 751990 0010/ Kontrol 4-May-15 Dalam+Jantun 50,000 35,000 418,250 41,225 544,475
99 Sarmin 832473 0115/ Kontrol 4-May-15 Bedah Umum 50,000 - 125,000 1,988 176,988
100 Atha Aisyaf 563549 0142/ 5 Period 4-May-15 Gigi&Mulut 50,000 - 478,041 2,871 530,912
101 Sumarsih 791535 0099/ Dyspepsia 4-May-15 Peny.Dalam 50,000 - 18,700 68,700
102 Rizky Arif 806443 0067/ Tu Axila D 4-May-15 Bedah Umum 50,000 - 953,175 1,003,175
103 Eddy Norya 811381 0147/ Kontrol+11 04-May-15 Penyakit Dala 50,000 - 1,563 51,563
104 Nanang 835503 0409/ Dermatitis 4-May-15 Kulit Kelamin 50,000 - 51,595 101,595
105 Anisa Nastit 591823 0195/ Kontrol 04-May-15 Onkologi 50,000 - 31,875 81,875
106 Wagino 653021 0398/ Kontrol 4-May-15 Bedah Umum 50,000 35,000 242,100 611,600 137,213 1,075,913
107 Fatimah Azz 677382 0361/ 36 Abses 4-May-15 Gigi & Mulut 50,000 - 91,340 17,678 159,018
108 Sukri 463499 0015/ Terapi+Lbp 04-May-15 R.Medik+Syar 50,000 35,000 159,500 22,675 267,175
109 H. M. Kosi 750140 0014/ Terapi+Kont 04-May-15 R.Medik+Syar 50,000 35,000 159,500 7,894 252,394
110 Dasih 812541 0012/ Dm+Ht 04-May-15 P.Dalam+Jant 50,000 35,000 110,250 320,419 515,669
111 Rubaya 433028 0242/ Vertigo 4-May-15 Saraf 50,000 - 19,105 69,105
112 Darni 802316 0238/ Susp Hnp 04-May-15 Syaraf 50,000 35,000 14,261 99,261
113 Junaidi 767384 0296/ Susp Bph 04-May-15 Urologi 50,000 - 335,000 44,250 8,125 437,375
114 Wafdan 657787 0419/ Kontrol 04-May-15 Kulit Kelamin 50,000 - 16,700 66,700
115 Rusnah 492777 0518/ Kontrol 4-May-15 Dalam+Jantun 50,000 35,000 271,968 356,968
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
116 Amiruddin 828259 0321/ Kontrol 4-May-15 Urologi 50,000 - 470,996 520,996
117 Nurhadiyant 320110 0327/ Terapi+Ceph 04-May-15 R.Medik+Syar 50,000 35,000 71,500 10,388 166,888
118 Kusmiyatun 586812 0407/ Kontrol 4-May-15 Syaraf 50,000 - 7,500 57,500
119 Natsha Dara 783069 0292/ Serumen 4-May-15 Tht 50,000 - 310,500 6,250 366,750
120 Hasni 790976 0334/ Struma 4-May-15 Peny.Dalam 50,000 - 352,100 15,938 418,038
121 Farid Rasya 753303 0332/ Epilepsi 4-May-15 Syaraf 50,000 - 209,900 259,900
122 Nur Hasana 397672 0265/ Kontrol 4-May-15 Rehab Medik+ 50,000 35,000 470,000 8,338 563,338
123 Rama Wulan 835384 0256/ Chepalgia 4-May-15 Saraf 50,000 - 8,688 58,688
124 Anisah 351623 0311/ Nefrolitiasis 04-May-15 Urologi 50,000 - 8,125 58,125
125 Sariyah 828930 0474/ Cepalgia 4-May-15 Syaraf 50,000 - 165,763 215,763
126 Nurhaeda 837265 0278/ Kontrol 4-May-15 Kandungan 50,000 - 248,000 14,444 312,444
127 Samsiah 835347 0416/ Batu Salura 04-May-15 Bedah Umum 50,000 35,000 117,000 5,600 207,600
128 Rufiatun 834847 0342/ 12 Caries 04-May-15 Gigi&Mulut 50,000 - 115,408 1,525 166,933
129 Aliyah Purw 737784 0225/ Lbp 04-May-15 Syaraf 50,000 - 11,830 61,830
130 Ariyono 686430 0261/ Post Stroke 4-May-15 Syaraf 50,000 - 54,738 104,738
131 Sarpani 304570 0532/ Kontrol 4-May-15 Jantung 50,000 - 324,975 374,975
132 Sulaiman D 683033 0179/ Multiple Fr 04-May-15 Orthopedi 50,000 - 160,000 2,655 212,655
133 Suyatmi 758666 0169/ Kontrol 4-May-15 Kandungan 50,000 - 60,000 20,100 130,100
134 Agus Lindar 835394 0277/ S/ Tb 4-May-15 Paru 50,000 - 160,250 125,400 18,563 354,213
135 Muprika Ha 840132 0360/ S. Gout 04-May-15 Penyakit Dala 50,000 - 462,500 11,350 523,850
136 Adriono 577900 0144/ Kontrol 4-May-15 Ortophedi 50,000 - 80,000 4,138 134,138
137 Hasriani 667152 0382/ Kontrol 4-May-15 Bedah Umum 50,000 - 125,000 9,125 184,125
138 Maryani 604915 0255/ Cad 04-May-15 Jantung 50,000 - 279,700 329,700
139 M.Natori 455522 0475/ Bph 4-May-15 Urologi 50,000 - 139,175 189,175
140 Maidah 741269 0218/ Migrain 4-May-15 Syaraf 50,000 35,000 603,276 42,784 731,060
141 Nor Asikin 639313 0079/ Terapi + Kon 4-May-15 R Medis +Sara 50,000 35,000 71,500 232,594 389,094
142 Erni Susanti 834218 0153/ Chepalgia 4-May-15 Saraf 50,000 - 88,493 138,493
143 Umar 820533 0185/ Kontrol 4-May-15 Paru 50,000 - 32,025 82,025
144 M. Rizky 836929 0177/ Cp+Epilepsi 04-May-15 Anak 50,000 - 96,367 146,367
145 Marsini 776825 0157/ Ht 4-May-15 Peny.Dalam 50,000 - 150,213 200,213
146 Tiara Nalian 835364 0194/ Susp Tyfoid 04-May-15 Penyakit Dala 50,000 - 159,750 11,463 221,213
147 Achmad Jun 835303 0246/ Gangren Ped 4-May-15 Peny.Dalam 50,000 - 402,500 239,138 691,638
148 Susi Susanti 834846 0247/ 1 Period 4-May-15 Gigi&Mulut 50,000 - 341,392 12,544 403,936
149 Udin 705780 0032/ Terapi 4-May-15 R Medis 50,000 35,000 220,000 33,935 338,935
150 Pakinem 481661 0103/ Ht+Ischial 04-May-15 Penyakit Dala 50,000 - 21,325 71,325
151 Nurul Hidya 828221 0209/ Dermatitis 04-May-15 Kulit Kelamin 50,000 35,000 78,836 163,836
152 Erni Wati 833567 0178/ Post Sc 04-May-15 Kandungan 50,000 - 120,500 5,288 175,788
153 Yuni 416680 0145/ Ht 4-May-15 Jantung 50,000 - 301,013 351,013
154 Herlin Bule 840136 0337/ Cepalgia 4-May-15 Syaraf 50,000 - 47,915 97,915
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
155 Hafidh Al M 837464 0138/ Kontrol 4-May-15 Anak 50,000 - 21,931 71,931
156 Joni 751338 0339/ Varices Eso 4-May-15 Peny.Dalam 50,000 - 140,850 190,850
157 Iskandar As 155954 0071/ Terapi+Kont 04-May-15 R.Medik+P.Da 50,000 35,000 71,500 207,394 363,894
158 Endang Sula 633292 0135/ Dm+Cad 04-May-15 Penyakit Dala 50,000 - 153,925 203,925
159 Ahmad Ardi 829954 0309/ Kontrol 4-May-15 Tht 50,000 - 112,500 8,464 170,964
160 Kasdari 800722 0222/ Post Op Chol 04-May-15 Bedah Umum 50,000 - 125,000 9,113 184,113
161 Titus Ahma 820014 0410/ Kontrol 4-May-15 Saraf 50,000 - 162,069 212,069
162 Paiman Peh 835365 0248/ Chest Pain 4-May-15 Jantung 50,000 - 391,250 649,500 301,163 1,391,913
163 Mashoed 647749 0098/ Osteoartritis 4-May-15 Syaraf 50,000 - 29,250 79,250
164 Sabutung 836912 0117/ Chf+Sirosis 04-May-15 Jantung+P.Da 50,000 35,000 649,500 196,860 931,360
165 M.Saddam M836329 0376/ Kontrol 4-May-15 Bedah Umum 50,000 - 125,000 9,125 184,125
166 Tarmikan Ca 835391 0402/ Corpus Ale 04-May-15 Tht 50,000 - 38,918 88,918
167 St Noor Kha 835330 0260/ Tb 4-May-15 Paru 50,000 - 18,563 68,563
168 Martinah 835396 0319/ Dispepsia 4-May-15 Peny.Dalam 50,000 - 258,738 308,738
169 Sayuti 439443 0358/ Kontrol Pos 04-May-15 Jantung 50,000 - 54,143 104,143
170 Afriadi Les 835382 0486/ S/ Pneumon 4-May-15 Paru 50,000 - 160,250 125,400 18,563 354,213
171 Devi W 837117 0230/ Kontrol 4-May-15 Bedah Umum 50,000 - 125,000 1,525 176,525
172 Sutoyo 836953 0167/ Kontrol 4-May-15 Saraf 50,000 35,000 258,638 343,638
173 Herlina S 607237 0427/ Kontrol 4-May-15 Peny.Dalam 50,000 - 105,600 119,019 274,619
174 Sujadi 795226 0120/ Glukoma 04-May-15 Mata 50,000 - 120,000 2,400 172,400
175 M.Alif Maul 767118 0187/ S/ Bronkitis 4-May-15 Anak 50,000 - 17,912 67,912
176 M,Rusli Ga 533374 0069/ Kontrol 4-May-15 Mata 50,000 35,000 149,973 234,973
177 Kasminah 348099 0070/ Kontrol 4-May-15 Mata 50,000 - 4,000 54,000
178 Ismail As 822983 0114/ Dermatitis A 4-May-15 Kulit Kelamin 50,000 - 13,541 63,541
179 M. Alif Hida 826937 0118/ Bronkhopne 04-May-15 Anak 50,000 - 38,500 88,500
180 Yulius Taya 828254 0323/ C/ Ca Nasof 4-May-15 Tht 50,000 - 15,999 65,999
181 Ali Munafri 820162 0458/ Telinga Kan 4-May-15 Tht 50,000 - 6,694 56,694
182 Juraydah 500699 0413/ S/ Kista Ov 4-May-15 Kandungan 50,000 - 60,000 3,000 113,000
183 Rusna Yulid 835369 0370/ Oma 4-May-15 Tht 50,000 - 9,663 59,663
184 Ahmad Yani 835381 0374/ Dm 04-May-15 Penyakit Dala 50,000 - 37,275 87,275
185 Fajar Satya 835383 0243/ Susp Myalgi 4-May-15 Anak 50,000 - 4,048 54,048
186 Kartini (Jln 625663 0211/ Angina Pect 4-May-15 Jantung 50,000 - 59,950 109,950
187 Hemi 835300 0283/ Susp Oa 04-May-15 Orthopedi 50,000 35,000 4,025 89,025
188 Citra Ameep 802942 0460/ Kontrol 4-May-15 Anak 50,000 - 29,110 79,110
189 Iskandar 077736 0159/ Kontrol 4-May-15 Rehab Medik+ 50,000 35,000 22,768 107,768
190 M Ilyas Ak 474905 0251/ Chf+Dm 04-May-15 Jantung 50,000 - 40,538 90,538
191 Siti Rahmah 776854 0146/ Pjk 04-May-15 Jantung 50,000 - 207,825 257,825
192 Kamakko R 666972 0369/ Terapi 4-May-15 R.Medik 50,000 35,000 159,500 24,430 268,930
193 Nurhayati 825912 0136/ Fisioterapi 4-May-15 R Medis +Sara 50,000 35,000 71,500 23,149 179,649
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
194 Andi Dwika 835395 0317/ Omp Kronik 4-May-15 Tht 50,000 - 8,863 58,863
195 Fadhil Rah 835389 0487/ Scabies 4-May-15 Kulit Kelamin 50,000 - 38,543 88,543
196 Dion Aditya 797017 0505/ Hard Tisue 4-May-15 Onkologi 50,000 - 69,300 119,300
197 Siti Maemu 780549 0291/ Post Stroke 4-May-15 Saraf 50,000 - 75,240 125,240
198 Irus 686554 0401/ Riw Snh 04-May-15 Syaraf 50,000 70,000 649,500 396,728 1,166,228
199 Jarniah 278754 0519/ Kontrol 4-May-15 Kandungan+B 50,000 - 60,000 10,125 120,125
200 Anugrah 734720 0520/ Kolik Abd 4-May-15 Anak 50,000 - 22,333 72,333
201 Nani Kariya 234987 0228/ Chepalgia K 4-May-15 Saraf 50,000 - 27,539 77,539
202 Ary Soesant 713049 0395/ Kontrol 4-May-15 Syaraf 50,000 - 35,626 85,626
203 Supini 835361 0139/ Kontrol 4-May-15 Orthopedy 50,000 - 105,600 2,400 158,000
204 Asmarani 730346 0359/ S/ Hernia In 04-May-15 Bedah Umum 50,000 - 438,400 125,400 613,800
205 Wisnu Arie 837168 0122/ Kontrol 4-May-15 Orthopedy 50,000 - 105,600 155,600
206 Naila Azmi 835366 0239/ Labio R 04-May-15 Gigi&Mulut 50,000 - 160,600 210,600
207 Nur Zaini 833245 0535/ Kontrol 4-May-15 Ortopedi 50,000 70,000 495,000 745,800 361,590 1,722,390
208 Topan 837427 0104/ Bsk 04-May-15 Urologi 50,000 - 335,000 145,200 530,200
209 Wahidah 725319 0308/ Ca Mamae 4-May-15 Onkologi 50,000 - 727,750 125,400 903,150
210 Nurdiansya 648288 0517/ S/ Bph 4-May-15 Urologi 50,000 - 335,000 66,000 745,800 1,196,800
211 Rukiah 276075 0061/ Cek Lab 4-May-15 Laboratorium 50,000 - 209,250 259,250
212 Sri Rusmiati 524368 0282/ 8 Impaksi 04-May-15 Gigi&Mulut 50,000 35,000 213,000 298,000
213 Aminah Bed 834445 0348/ Kontrol 4-May-15 Onkologi 50,000 - 525,250 430,400 1,005,650
214 Zulfikar 835377 0471/ 36 37 Perio 4-May-15 Gigi&Mulut 50,000 - 160,600 210,600
215 Royani Gun 626844 0174/ Kontrol 4-May-15 Bedah Umum 50,000 - 305,000 355,000
216 Iliyawati 681163 0182/ Obs Osteopo 4-May-15 Orthopedy 50,000 - 227,700 277,700
217 Suwati 706124 0088/ Terapi+Kont 04-May-15 R.Medik+P.Da 50,000 35,000 71,500 305,000 461,500
218 Anwari 835501 0394/ Lbp 4-May-15 Syaraf 50,000 - 227,700 277,700
219 Rina Mardia 835392 0404/ Fix Mandibu 04-May-15 Gigi&Mulut 50,000 - 579,150 286,000 915,150
220 M.Santri Ka 810571 0295/ Ulkus D 4-May-15 Penyakit Dala 50,000 - 43,250 305,000 398,250
221 Ponisih 835360 0080/ Negieted Fra 4-May-15 Orthopedy 50,000 - 250,800 300,800
222 Paini 835342 0235/ Struma 4-May-15 Bedah Umum 50,000 - 394,150 377,500 125,400 947,050
223 Rizki Indra 835373 0414/ Benjolan Di 4-May-15 Bedah Umum 50,000 - 438,400 377,500 125,400 991,300
224 Ida Rusanti 834549 0124/ Kontrol 4-May-15 Gigi & Mulut 50,000 - 579,150 125,400 754,550
225 Rahmatun N 835337 0254/ Kontrol 04-May-15 Kandungan 50,000 - 60,000 125,400 235,400
226 Krisyanti El 805101 0013/ Tu Mamae S 04-May-15 Bedah Umum 50,000 - 438,400 377,500 125,400 991,300
227 Sapariyah 796076 0284/ Ca Mamae 04-May-15 Onkologi 50,000 - 513,150 125,400 688,550
228 Lisa Yuliant 472817 0298/ 47 Pulpitis 04-May-15 Gigi&Mulut 50,000 - 579,150 125,400 754,550
229 Danang Azis 821805 0418/ Post Op Fr C 04-May-15 Orthopedi 50,000 - 105,600 155,600
230 M.Leonand 835376 0441/ Lipoma 4-May-15 Bedah Umum 50,000 - 438,400 377,500 125,400 991,300
231 Idawati 835379 0372/ Rematoid A 04-May-15 Orthopedi 50,000 - 333,300 383,300
232 Nur Idah 835359 0312/ App 04-May-15 Bedah Umum 50,000 - 438,400 125,400 613,800
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
233 Supriadi 790949 0054/ Tu Parotis 4-May-15 Bedah Umum 50,000 35,000 377,500 125,400 187,000 774,900
234 M. Azka San 837459 0504/ Pneumonia 4-May-15 Anak 50,000 - 134,500 184,500
235 Fransisca Wi 835349 0456/ Chest Pain 4-May-15 Jantung 50,000 - 809,350 859,350
236 Arbain 835351 0326/ Acs 04-May-15 Jantung 50,000 - 703,750 753,750
237 Ali Janji 640504 0201/ Dm Ii 4-May-15 Peny.Dalam 50,000 - 500,250 550,250
238 Amas Megaw822082 0267/ Hhd+Cad+ 04-May-15 Jantung+P.Da 50,000 - 110,250 160,250
239 Ani Kurnia 644416 0415/ Thalasemia 4-May-15 Peny.Dalam 50,000 - 109,250 159,250
240 Asnawai 670665 0141/ Dm 4-May-15 Peny.Dalam 50,000 - 110,250 160,250
241 Norhasanah 727081 0390/ Kontrol 04-May-15 Penyakit Dala 50,000 - 396,500 187,000 633,500
242 M.Fandy No 630915 0183/ Cek Lab 4-May-15 Laboratorium 50,000 - 334,500 384,500
243 Sutini 822724 0190/ Ca Cervik 4-May-15 Kandungan 50,000 - 60,000 672,750 782,750
244 Siti Rahmah 776854 0318/ Kontrol 4-May-15 Onkologi 50,000 - 892,050 942,050
245 Dorothy Car 192634 0092/ Cek Lab 4-May-15 Laboratorium 50,000 - 500,250 550,250
246 Ernawati 428296 0264/ Ca Mamae 4-May-15 Onkologi 50,000 - 525,250 575,250
247 Hanisa 681735 0087/ Hipertiroid 04-May-15 Penyakit Dala 50,000 - 352,100 402,100
248 Harbia 829916 0322/ S/ Hepatitis 4-May-15 Peny.Dalam 50,000 - 317,000 367,000
249 Husni Kadri 829396 0123/ Cek Lab 4-May-15 Laboratorium 50,000 - 208,250 258,250
250 Isna 748610 0150/ Ca Mamae S 04-May-15 Onkologi 50,000 - 525,250 575,250
251 Johanes Mal 561617 0035/ Cek Lab 4-May-15 Laboratorium 50,000 - 110,250 160,250
252 Jumiati 726403 0112/ Dm Ii 4-May-15 Peny.Dalam 50,000 - 110,250 160,250
253 Karsuni 825954 0028/ Terapi 04-May-15 Rehab Medik 50,000 35,000 220,000 110,250 415,250
254 Khoirunnisa 837016 0181/ Cek Lab 4-May-15 Laboratorium 50,000 - 87,500 137,500
255 Kristina Les 268880 0053/ Ht Gr Ii 4-May-15 Jantung 50,000 - 110,250 160,250
256 H.M Yusuf 103086 0205/ Kontrol 4-May-15 Saraf+P.Dalam 50,000 - 110,250 160,250
257 Marlina 680794 0106/ Cek Lab 4-May-15 Laboratorium 50,000 - 110,250 160,250
258 Martuti 547009 0105/ Dm 04-May-15 Penyakit Dala 50,000 - 110,250 160,250
259 Masratu 268538 0064/ Cek Lab 4-May-15 Laboratorium 50,000 - 457,250 507,250
260 Mastaniah 492000 0097/ Dm Type Ii 4-May-15 Peny.Dalam 50,000 - 110,250 160,250
261 Mastora 711248 0075/ Dm 04-May-15 Penyakit Dala 50,000 - 500,250 550,250
262 Mulyati 569554 0176/ Dm 04-May-15 Penyakit Dala 50,000 - 110,250 160,250
263 Ngadimin 425516 0082/ Terapi 4-May-15 R.Medik 50,000 - 604,250 654,250
264 Norsiah 169699 0165/ Dm 04-May-15 Penyakit Dala 50,000 - 500,250 550,250
265 Nur Indayat 184988 0132/ Dm 04-May-15 Penyakit Dala 50,000 - 500,250 550,250
266 Oktavia Rab 261325 0297/ Tumor 04-May-15 Onkologi 50,000 - 902,850 952,850
267 Painten 414086 0207/ Dm 04-May-15 Penyakit Dala 50,000 - 500,250 550,250
268 Priyo Hoet 263217 0127/ Terapi 4-May-15 R.Medik 50,000 35,000 71,500 110,250 266,750
269 Puspa Helit 765679 0113/ Terapi 4-May-15 R.Medik 50,000 35,000 220,000 467,250 772,250
270 Rani Aprila 835362 0154/ Abortus Ink 4-May-15 Kandungan 50,000 - 60,000 372,400 482,400
271 Rusmilawati 518614 0057/ Dm 04-May-15 Penyakit Dala 50,000 - 543,250 593,250
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
272 Rusmini 821169 0100/ Dm Ii 4-May-15 Peny.Dalam 50,000 - 135,000 500,250 685,250
273 Sami 776860 0502/ Ca Cervik 4-May-15 Kandungan 50,000 - 60,000 422,000 532,000
274 Suhaidah 360485 0066/ Dm 4-May-15 Peny.Dalam 50,000 - 110,250 160,250
275 Suhendro 834271 0227/ Cek Lab 4-May-15 Laboratorium 50,000 - 231,000 281,000
276 Suyanto 834295 0253/ Kontrol 04-May-15 Bedah Umum 50,000 - 394,150 444,150
277 Wainten Sam 604851 0093/ Kontrol 4-May-15 Onkologi 50,000 - 525,250 575,250
278 Wildan Reh 834871 0426/ Kontrol 4-May-15 Anak 50,000 - 162,250 212,250
279 Sugianto Ru 487872 0081/ Terapi 4-May-15 R.Medik 50,000 - 440,000 490,000
280 Siti Liza 768432 0008/ Terapi 4-May-15 R.Medik 50,000 - 440,000 490,000
281 Nasywa Qon 706135 0019/ Terapi 4-May-15 R Medis 50,000 - 440,000 490,000
282 Rahmatulla 462170 0005/ Terapi 4-May-15 Rehab Medis 50,000 - 440,000 490,000
283 Ahmad Khoi 671879 0006/ Terapi 4-May-15 R,.Medik 50,000 - 440,000 490,000
284 M. Atallah 607935 0003/ Fisiotherapy 4-May-15 R Medik 50,000 - 440,000 490,000
285 Danang Zak 726353 0022/ Terapi 4-May-15 R.Medik 50,000 - 440,000 490,000
286 M.Sefianto 729676 0202/ Terapi 4-May-15 R.Medik 50,000 - 440,000 490,000
287 Shannaz Dw 677115 0002/ Fisiotherapy 4-May-15 R. Medik 50,000 - 440,000 490,000
288 Andhara Aul 613425 0004/ Fisiotherapy 4-May-15 R Medik 50,000 - 440,000 490,000
289 Jasmani 822971 0346/ Terapi 4-May-15 R Medis 50,000 - 71,500 121,500
290 Hayatun Nis 703100 0365/ Terapi 4-May-15 R.Medik 50,000 - 71,500 121,500
291 Sri Kuswati 834801 0396/ Terapi 4-May-15 R.Medik 50,000 - 159,500 209,500
292 Kartini Dg 835401 0443/ Terapi 4-May-15 R.Medik 50,000 - 71,500 121,500
293 Ernawati 124241 0212/ Terapi + Kon 4-May-15 R Medis +Sara 50,000 - 159,500 209,500
294 Paulus Lai 243271 0362/ Terapi 4-May-15 Rehab Medis 50,000 - 71,500 121,500
295 Bandi Batha 738114 0421/ Terapi 4-May-15 R Medik 50,000 - 159,500 209,500
296 Agus Widod 315861 0223/ Terapi 04-May-15 Rehab Medik 50,000 - 159,500 209,500
297 Donatianus 811513 0329/ Terapi 04-May-15 Rehab Medik 50,000 - 379,500 429,500
298 Ammi Wiyan748900 0391/ Terapi 4-May-15 Rehab Medis 50,000 - 159,500 209,500
299 Tri Mailani 806796 0161/ Terapi 04-May-15 Rehab Medik 50,000 - 71,500 121,500
300 Siti Ainah 438360 0231/ Terapi 4-May-15 R.Medik 50,000 - 71,500 121,500
301 Erni Setiawa 132775 0232/ Terapi 4-May-15 Rehab Medis 50,000 - 71,500 121,500
302 Suparmi 810191 0191/ Terapi 04-May-15 Rehab Medik 50,000 - 71,500 121,500
303 Asih Sunars 829585 0306/ Terapi 4-May-15 R.Medik 50,000 - 71,500 121,500
304 Erniwati 443296 0240/ Terapi 04-May-15 Rehab Medik 50,000 - 71,500 121,500
305 Kasdi 834604 0198/ Terapi 4-May-15 R Medis 50,000 - 71,500 121,500
306 M.Rizky Ra 828577 0007/ Terapi 4-May-15 R.Medik 50,000 - 440,000 490,000
307 M. Sandy 677507 0011/ Fisioterapi 04-May-15 Rehab Medik 50,000 - 440,000 490,000
308 Surya Mangi 541180 0018/ Terapi 4-May-15 Rhb Medis 50,000 - 440,000 490,000
309 Hendrawati 821842 0059/ Terapi 04-May-15 Rehab Medik 50,000 - 220,000 270,000
310 Asrak 802477 0128/ Terapi 4-May-15 R.Medik 50,000 - 159,500 209,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
311 Ponijem 659169 0023/ Fisiotherapy 4-May-15 R.Medik 50,000 - 440,000 490,000
312 Abdillah Fik 488012 0280/ Terapi 4-May-15 R.Medik 50,000 - 440,000 490,000
313 Aisyah Uzm 796280 0016/ Fisiotherapy 4-May-15 Rhb Medis 50,000 - 220,000 270,000
314 Masrun Maj 639948 0333/ Fisioterapi 4-May-15 Rhb Medis 50,000 - 71,500 121,500
315 Siti Kalsum 783907 0363/ Terapi 4-May-15 Rehab Medik 50,000 - 159,500 209,500
316 Annisa Dewi 826044 0031/ Fisioterapi 4-May-15 R Medis 50,000 - 440,000 490,000
317 Kasemi 801303 0189/ Terapi 4-May-15 R.Medik 50,000 - 220,000 270,000
318 Ngantin 834243 0343/ Terapi 04-May-15 Rehab Medik 50,000 - 440,000 490,000
319 Sarminto 796814 0083/ Terapi 4-May-15 Rehab Medis 50,000 - 440,000 490,000
320 Imam Muh S 190433 0033/ Terapi 4-May-15 R Medis 50,000 - 440,000 490,000
321 Raudah 826607 0027/ Terapi 04-May-15 Rehab Medik 50,000 - 440,000 490,000
322 Hamdanah 790973 0086/ Terapi 04-May-15 Rehab Medik 50,000 - 440,000 490,000
323 Nanang Isma 813793 0381/ Terapi 4-May-15 R.Medik 50,000 - 440,000 490,000
324 Rudiansyah 424444 0036/ Terapi 4-May-15 R.Medik 50,000 - 220,000 270,000
325 Abdul Nurdi 464739 0051/ Fisioterapi 4-May-15 R.Medik 50,000 - 440,000 490,000
326 Hasnawati 762606 0085/ Fisioterapi 4-May-15 R.Medik 50,000 - 440,000 490,000
327 Kusnan 721341 0026/ Terapi 04-May-15 Rehab Medik 50,000 - 440,000 490,000
328 Siti Rahmah 742670 0037/ Terapi 4-May-15 R.Medik 50,000 - 71,500 121,500
329 Aisjah Joha 796894 0078/ Fisiotherapy 4-May-15 R. Medik 50,000 - 71,500 121,500
330 Damaris Ria 410331 0072/ Terapi 04-May-15 Rehab Medik 50,000 - 71,500 121,500
331 Kujainul 835312 0133/ Terapi 04-May-15 Rehab Medik 50,000 - 71,500 121,500
332 Nelly 598921 0076/ Terapi 4-May-15 Rehab Medik 50,000 - 159,500 209,500
333 Amanat Lail 828568 0180/ Terapi 04-May-15 Rehab Medik 50,000 - 159,500 209,500
334 Nurdin Doni 712854 0148/ Fisioterapi 04-May-15 Rehab Medik 50,000 - 71,500 121,500
335 Darsiah 740936 0164/ Terapi 04-May-15 Rehab Medik 50,000 - 71,500 121,500
336 Parmin 821532 0188/ Terapi 4-May-15 R.Medik 50,000 - 159,500 209,500
337 Mardiana 575579 0137/ Terapi 4-May-15 R Medis 50,000 - 159,500 209,500
338 Kisnan 431632 0134/ Fisioterapi 04-May-15 Rehab Medik 50,000 - 159,500 209,500
339 Siti Murni 687026 0210/ Terapi 04-May-15 Rehab Medik 50,000 - 71,500 121,500
340 Slamet 829326 0217/ Terapi 4-May-15 R.Medik 50,000 - 159,500 209,500
341 Aswin 598995 0077/ Terapi 4-May-15 Rehab Medis 50,000 - 71,500 121,500
342 Jumiati 264734 0156/ Terapi 4-May-15 R.Medik 50,000 - 159,500 209,500
343 Jumiyah 743749 0056/ Fisioterapi 04-May-15 Rehab Medik 50,000 - 71,500 121,500
344 Tinna 821536 0039/ Terapi 4-May-15 R.Medik 50,000 - 71,500 121,500
345 Marsidi 720910 0216/ Terapi 4-May-15 R.Medik 50,000 - 159,500 209,500
346 Suyati 213400 0111/ Terapi 4-May-15 R.Medik 50,000 - 71,500 121,500
347 Sumarwati 829352 0234/ Terapi 4-May-15 R.Medik 50,000 - 159,500 209,500
348 Sakdiah 822982 0040/ Terapi 4-May-15 R.Medik 50,000 - 159,500 209,500
349 Annisa Arh 829550 0193/ Terapi 04-May-15 Rehab Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
350 Juwariyah 729629 0060/ Terapi 04-May-15 Rehab Medik 50,000 - 159,500 209,500
351 Sarman 759016 0068/ Fisiotherapy 4-May-15 R.Medik 50,000 - 71,500 121,500
352 Matrup 345802 0041/ Fisioterapi 04-May-15 Rehab Medik 50,000 - 159,500 209,500
353 M. Aini 729644 0025/ Terapi 4-May-15 R.Medik 50,000 - 71,500 121,500
354 Supatmi 805133 0063/ Terapi 4-May-15 Rehab Medis 50,000 - 71,500 121,500
355 M. Jufri 764121 0030/ Fisioterapi 04-May-15 Rehab Medik 50,000 - 71,500 121,500
356 Kornelis Na 810504 0090/ Terapi 04-May-15 Rehab Medik 50,000 - 159,500 209,500
357 Ita Rosita G 759051 0055/ Terapi 4-May-15 Rehab Medik 50,000 - 71,500 121,500
358 Sadariah 419296 0047/ Terapi 4-May-15 Rehab Medis 50,000 - 71,500 121,500
359 Syaridayanti 185518 0034/ Terapi 4-May-15 R Medis 50,000 - 159,500 209,500
360 Jasmah 434885 0074/ Terapi 04-May-15 Rehab Medik 50,000 - 71,500 121,500
361 Putri 833840 0126/ Terapi 4-May-15 R.Medik 50,000 - 71,500 121,500
362 Hj. Ernawat 710875 0042/ Fisioterapi 04-May-15 Rehab Medik 50,000 - 159,500 209,500
363 Sumiati 671273 0043/ Terapi 04-May-15 Rehab Medik 50,000 - 159,500 209,500
364 Nurdin Baru 390697 0021/ Terapi 4-May-15 R. Medik 50,000 - 71,500 121,500
365 Salamah 748488 0038/ Fisioterapi 4-May-15 R.Medik 50,000 - 159,500 209,500
366 Sujarni 800848 0084/ Terapi 4-May-15 Rehab Medik 50,000 - 71,500 121,500
367 Anton Septi 834585 0052/ Terapi 4-May-15 R.Medik 50,000 - 71,500 121,500
368 Wahyu Hand 697153 0096/ Terapi 4-May-15 R.Medik 50,000 - 220,000 270,000
369 Gho Kim Ho 739437 0149/ Terapi 04-May-15 Rehab Medik 50,000 - 220,000 270,000
370 Rusdiana 806016 0029/ Terapi 04-May-15 Rehab Medik 50,000 - 220,000 270,000
371 Hamdanah 563909 0046/ Terapi 4-May-15 Rehab Medis 50,000 - 220,000 270,000
372 Rusmini 607352 0140/ Terapi 4-May-15 R Medis 50,000 - 220,000 270,000
373 Musningsih 549641 0192/ Terapi 04-May-15 Rehab Medik 50,000 - 220,000 270,000
374 Ratnawati 770672 0320/ Terapi 4-May-15 R.Medik 50,000 - 71,500 121,500
375 Radeng 560193 0331/ Terapi 4-May-15 R.Medik 50,000 - 71,500 121,500
376 Ida Ropidah 496479 0050/ Terapi+Kont 4-May-15 R Medis +Sara 50,000 35,000 159,500 10,863 255,363
377 Supiah 475816 0168/ Lbp 4-May-15 Saraf 50,000 - 159,500 209,500
378 Sumami 834534 0129/ Obs Struma 4-May-15 Onkologi 50,000 - 50,000
379 Sundiyah 787741 0533/ Pro Kemo Vi 4-May-15 Kandungan 50,000 - 60,000 110,000
380 Ernawati 701208 0199/ Ht 4-May-15 Jantung 50,000 - 462,500 512,500
381 Erda Linawa 460499 0062/ Pjk 4-May-15 Jantung 50,000 - 50,000
382 M. Alif Ra 808609 0330/ Obs Febris 04-May-15 Anak 50,000 - 50,000
383 Aulia Ijatun 794028 0444/ S/ Disentri 4-May-15 Anak 50,000 - 50,000
384 Devan Reyal 835502 0406/ Obs Febris 4-May-15 Anak 50,000 - 50,000
385 M. Asyari 312560 0224/ Susp Choleli 04-May-15 Bedah Umum 50,000 35,000 187,000 272,000
386 Radiman 835306 0388/ Hernia Ingui 04-May-15 Bedah Umum 50,000 - 50,000
387 Rohani 829597 0366/ Kontrol 4-May-15 Bedah Umum 50,000 - 125,000 175,000
388 Bilqis Ayara 837422 0245/ Kontrol 4-May-15 Bedah Umum 50,000 - 125,000 175,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
389 Lilik Indraw 837010 0173/ Isk 4-May-15 Peny.Dalam 50,000 - 50,000
390 Prawoto 835398 0377/ Dislokasi 4-May-15 Orthopedy 50,000 - 50,000
391 Rizki Herla 773447 0184/ Kontrol 4-May-15 Bedah Anak 50,000 - 67,900 117,900
392 Haikal Ward 836325 0252/ Phymosis 04-May-15 Bedah Anak 50,000 - 50,000
393 Savira Hern 835357 0501/ Veruka 4-May-15 Bedah Anak 50,000 - 50,000
394 Alya Nur Za 779471 0422/ Kontrol 4-May-15 Bedah Anak 50,000 - 50,000
395 Michael Piet 810122 0262/ Kontrol 4-May-15 Vct 50,000 - 50,000
396 Santi 752116 0131/ 112 04-May-15 Vct 50,000 - 50,000
397 Irfan 832516 0263/ Kontrol 4-May-15 Vct 50,000 - 50,000
398 Lamsidar Ar 829501 0324/ B 24 4-May-15 Vct 50,000 - 50,000
399 Rani Marbu 829502 0325/ B 24 4-May-15 Vct 50,000 - 50,000
400 Puspytasari 781176 0279/ Kontrol 4-May-15 Vct 50,000 - 50,000
401 Katimi 829362 0206/ Kontrol 04-May-15 Vct 50,000 - 50,000
402 M Hanapiah 720245 0001/ Ca Prostat 4-May-15 Urologi 50,000 - 50,000
403 Syukri 833924 0226/ Colik Abdo 4-May-15 Urologi 50,000 - 50,000
404 A.Harsani 811301 0307/ Bph 4-May-15 Urologi 50,000 - 50,000
405 Makdiel Sit 816149 0229/ Kontrol 4-May-15 Urologi 50,000 - 50,000
406 Adhityastuti 820118 0347/ Ca Mamae 4-May-15 Onkologi 50,000 - 50,000
407 Erni Yulita828797/831554
S 0345/ Ca Mamae 04-May-15 Onkologi 50,000 - 50,000
408 Yeni Winarn 801341 0091/ Ca Mamae 4-May-15 Onkologi 50,000 - 50,000
409 Mayang Syah697785 0392/ Kontrol 4-May-15 Bedah Umum 50,000 - 125,000 175,000
410 Eny Ernawat 835386 0258/ G6 P3 A2 Le 4-May-15 Kandungan 50,000 - 120,500 170,500
411 Arbainah 417433 0411/ Kontrol 4-May-15 Perawatan Luk 50,000 - 402,500 452,500
412 Rizal Nur W 060460 0380/ Kontrol 4-May-15 Tht 50,000 - 63,000 113,000
413 Abi Gurdi 726480 0220/ Kontrol 4-May-15 Tht 50,000 - 50,000
414 Az Zahra R 324506 0155/ Kontrol 4-May-15 Tht 50,000 - 50,000
415 Mariatini 185288 0294/ Kontrol 4-May-15 Jantung 50,000 - 50,000
416 Angellica Ga 834848 0073/ 1 Fr 04-May-15 Gigi&Mulut 50,000 - 272,703 322,703
417 Hj.Suwarni 783590 0160/ Kontrol 4-May-15 Gigi&Mulut 50,000 - 91,340 141,340
418 Fatmawati 776294 0158/ 6 Pulp 4-May-15 Gigi&Mulut 50,000 - 456,700 506,700
419 Marsuti 835390 0488/ 8 Impaksi 4-May-15 Gigi&Mulut 50,000 - 50,000
420 Meiske Yola 764221 0316/ 1 Fraktur 4-May-15 Gigi & Mulut 50,000 - 450,253 500,253
421 M.Anugrah 801741 0516/ Labio Palat 4-May-15 Bedah Mulut 50,000 - 50,000
422 Indriani Li 795456 0403/ 1 Gp 04-May-15 Gigi&Mulut 50,000 - 115,408 165,408
423 Gusti Nikm 720146 0534/ Post Orif 4-May-15 Ortophedi 50,000 - 50,000
424 Rizky Sulist 748957 0108/ Tu Colli 4-May-15 Onkologi 50,000 - 50,000
425 Harmi 828564 0503/ Ca Mamae 4-May-15 Onkologi 50,000 - 50,000
426 Sularsih 797024 0095/ Ca Mamae 4-May-15 Onkologi 50,000 - 50,000
427 Devi Ratna 718763 0378/ Epilepsi 4-May-15 Syaraf 50,000 - 98,026 148,026
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
428 Salasiah 298164 0556/ Kontrol 5-May-15 Syaraf 50,000 35,000 71,500 8,716 165,216
429 Sistio Febri 553445 0585/ Epilepsi 5-May-15 Syaraf 50,000 - 211,275 261,275
430 Irma Karmi 351477 0511/ Kontrol 5-May-15 P. Dalam 50,000 35,000 562,100 649,500 40,450 1,337,050
431 Akhmad Kho781499 0629/ Tb Ekstra P 5-May-15 Bedah Umum 50,000 - 58,713 108,713
432 H.M Yusuf 103086 0625/ Kontrol 5-May-15 P. Dalam 50,000 35,000 216,919 301,919
433 Fatimah 748924 0594/ Obs Lbp 5-May-15 Syaraf 50,000 - 227,700 8,716 286,416
434 Fitriyani Re 380759 0498/ Kontrol 5-May-15 Gigi & Mulut 50,000 - 821,467 19,026 890,493
435 Bima Abima 329927 0759/ Epilepsi 5-May-15 Syaraf 50,000 - 300,675 350,675
436 Subakir 837382 0483/ Kontrol 5-May-15 Orthopedy + J 50,000 35,000 407,500 187,000 328,093 1,007,593
437 Juwariyah 828552 0633/ Susp Lupus 5-May-15 Anak 50,000 - 38,500 88,500
438 Sari Widiart 748263 0558/ 24 Pulp 5-May-15 Gigi & Mulut 50,000 35,000 93,875 178,875
439 Herlina S 607237 0589/ Hipertiroid 5-May-15 P. Dalam 50,000 35,000 1,563 86,563
440 Fatimah Sar 780682 0560/ Kontrol 5-May-15 Bedah Umum 50,000 35,000 2,288 87,288
441 Rusmilawati 518614 0607/ Dm+Cad 5-May-15 Dalam+Jantng 50,000 35,000 343,443 428,443
442 Zema Riski 739218 0547/ Epilepsi 5-May-15 Syaraf 50,000 - 169,731 219,731
443 Sukarno 739513 0624/ Pjk 5-May-15 Jantung 50,000 - 523,250 401,288 974,538
444 Asmarani 730346 0698/ S/ Hernia In 5-May-15 Bedah Umum 50,000 35,000 187,000 243,750 515,750
445 Paridah 460620 0731/ Hipertiroid 5-May-15 P. Dalam 50,000 - 41,963 91,963
446 Sopian 571963 0720/ Hipertiroid 5-May-15 P. Dalam 50,000 - 41,963 91,963
447 Murtini 757462 0667/ Terapi 5-May-15 R.Medik 50,000 35,000 71,500 220,250 227,700 14,555 619,005
448 Suhaidah 360485 0552/ Dm 5-May-15 P. Dalam 50,000 35,000 335,000 420,900 1,472,900 168,056 2,481,856
449 Suci Asrina 835393 0574/ Colik Renal 5-May-15 P. Dalam 50,000 35,000 11,218 96,218
450 Mukayanah 835507 0628/ Ht 5-May-15 Jantung 50,000 - 649,500 258,388 957,888
451 Siti Roikah 663235 0668/ Kontrol 5-May-15 Jantung 50,000 - 188,313 238,313
452 Ronny Hern 809381 0597/ Post Stroke 5-May-15 Syaraf 50,000 - 22,505 72,505
453 Mahrita 670657 0512/ Kontrol 5-May-15 Jantung + Dal 50,000 35,000 187,000 167,888 439,888
454 Sugianto 748332 0436/ Terapi 5-May-15 R.Medik 50,000 - 220,000 550,250 13,388 833,638
455 Aliyah 730090 0437/ Terapi 5-May-15 R.Medik 50,000 35,000 169,755 254,755
456 Nurdian 625597 0697/ Tonsilitis K 5-May-15 Tht 50,000 35,000 125,400 3,663 214,063
457 Kadrie Sula 604747 0491/ Pjk 5-May-15 Jantung 50,000 - 63,423 113,423
458 Nilawati 427661 0685/ Kontrol 5-May-15 Jantung 50,000 - 79,013 129,013
459 Mujiati 317474 0546/ Ht 5-May-15 Jantung 50,000 - 178,875 228,875
460 Achmad Jah 835512 0658/ Susp Acs 5-May-15 Jantung 50,000 - 649,500 152,250 851,750
461 Tukiman 835525 0588/ Kontrol 5-May-15 P. Dalam 50,000 - 305,000 7,656 362,656
462 Norsiah 169699 0540/ Dm 5-May-15 P. Dalam 50,000 35,000 235,100 320,100
463 Mulyati 569554 0551/ Dm 5-May-15 P. Dalam 50,000 - 53,513 103,513
464 Hayati 702223 0499/ Kontrol 5-May-15 Bedah Umum 50,000 35,000 125,000 45,038 255,038
465 Suhendro 834271 0716/ Susp Hepatit 5-May-15 P. Dalam 50,000 - 305,000 1,063 356,063
466 Anwari 835501 0747/ Lbp 5-May-15 Syaraf 50,000 - 10,098 60,098
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
467 Priyo Hoet 263217 0469/ Dm 5-May-15 P. Dalam 50,000 35,000 188,800 273,800
468 Supriyono 836993 0732/ Dm Tipe Ii 5-May-15 P. Dalam 50,000 - 94,124 144,124
469 Sujarwati 835510 0682/ Ckd 5-May-15 P. Dalam 50,000 - 219,500 6,919 276,419
470 Lebbe 695755 0655/ Bsk 5-May-15 Urologi 50,000 - 335,000 137,213 522,213
471 Mislan 824667 0544/ Kontrol 5-May-15 Bedah Saraf 50,000 35,000 79,500 438,250 1,598,300 553,126 2,754,176
472 Zulkifli 610918 0771/ Hipertiroid 5-May-15 P. Dalam 50,000 - 26,463 76,463
473 Zainul Shol 796423 0660/ Terapi+Vert 5-May-15 R.Medik+Syar 50,000 35,000 71,500 16,785 173,285
474 Kanutus 832928 0479/ Bph Post Tu 5-May-15 Urologi 50,000 35,000 335,000 156,311 576,311
475 Janiah 821140 0450/ Terapi 5-May-15 R.medik 50,000 70,000 71,500 61,179 252,679
476 Jatimin 411817 0584/ Cad 5-May-15 Jantung 50,000 - 83,663 133,663
477 Hartuti 547009 0615/ Dm 5-May-15 P. Dalam 50,000 - 67,674 117,674
478 Saifullah 836957 0730/ Kontrol 5-May-15 Orthopedi 50,000 - 80,000 8,363 138,363
479 Joni Gunaw 492645 0637/ Obs Chest P 5-May-15 Jantung 50,000 - 188,381 238,381
480 Ardiansyah 145369 0671/ Pjk 5-May-15 Jantung 50,000 - 60,488 110,488
481 Siti Asiah 631418 0702/ Pjk+Dm 5-May-15 Jantung+P.Da 50,000 35,000 326,263 411,263
482 Yaminah 666973 0631/ Hipertiroid 5-May-15 P. Dalam 50,000 - 89,725 139,725
483 Juray Mahdi 524839 0653/ Kontrol 5-May-15 Syaraf 50,000 - 997,700 5,030 1,052,730
484 Khoirunnisa 837016 0500/ Susp Kondi 5-May-15 Kulit Kelamin 50,000 35,000 11,906 96,906
485 Eddy Abu B 776754 0656/ Hipertiroid 5-May-15 P. Dalam 50,000 - 58,250 108,250
486 Ratu Langsi 811076 0466/ Kontrol 5-May-15 Bedah Saraf 50,000 35,000 71,500 3,000 159,500
487 Lahuseng 834859 0623/ Nyeri Saat 5-May-15 Urologi 50,000 - 704,900 270,600 137,213 1,162,713
488 Zulkifli Hs 753308 0672/ Ht 5-May-15 P. Dalam 50,000 - 252,638 302,638
489 Parenrengi 098847 0684/ Dm Ht 5-May-15 P. Dalam 50,000 - 500,250 146,250 696,500
490 Padiah 575564 0569/ Dm Tipe Ii 5-May-15 P. Dalam 50,000 - 491,713 541,713
491 Achmad Sop 380654 0605/ Pjk 5-May-15 Jantung 50,000 - 183,038 233,038
492 Hana Indraw 829924 0688/ Ht Dlam Ke 5-May-15 Kandungan 50,000 - 120,500 12,938 183,438
493 Kamba 823138 0566/ Terapi 5-May-15 R.medik 50,000 35,000 220,000 26,938 331,938
494 Juremi Ngar 620711 0673/ Pjk 5-May-15 Jantung 50,000 - 74,423 124,423
495 Kasmijan 829312 0669/ Kontrol 5-May-15 Saraf+Rehab 50,000 35,000 71,500 18,366 174,866
496 Antung Erna 419059 0555/ Dm+Dermati 5-May-15 P.Dalam+Kulit 50,000 35,000 183,979 268,979
497 Nuril 630333 0579/ Kontrol 5-May-15 Bedah Tulang 50,000 - 160,000 4,325 214,325
498 Parno 630939 0561/ Kontrol 5-May-15 Urologi 50,000 - 185,000 139,175 374,175
499 Puji Astuti 835504 0446/ Susp Bsk 5-May-15 Urologi 50,000 - 335,000 186,500 1,963 573,463
500 Sumartini 837362 0644/ Ckr 5-May-15 Bedah Syaraf 50,000 - 9,453 59,453
501 Supatrah 447679 0454/ Bph 5-May-15 Urologi 50,000 - 335,000 611,600 137,213 1,133,813
502 Abdul Rahm 641669 0508/ Bph 5-May-15 Urologi 50,000 35,000 444,630 529,630
503 Yenni Purwa 631789 0496/ Terapi + Kon 5-May-15 R Medik +Sara 50,000 35,000 71,500 14,304 170,804
504 Desrianti E 835508 0526/ Ckr 5-May-15 Bedah Saraf 50,000 - 7,819 57,819
505 Aslam Al Uz 835522 0758/ Obs Febris 5-May-15 Anak 50,000 - 23,698 73,698
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
506 Fathiyah 547447 0742/ Kontrol 5-May-15 Jantung 50,000 - 164,813 214,813
507 Aminoto 754053 0756/ Tb Paru 5-May-15 Paru 50,000 - 43,422 93,422
508 Puspa Helit 765679 0572/ Kontrol 5-May-15 P. Dalam 50,000 35,000 166,031 251,031
509 Nur Idah 835359 0748/ App 5-May-15 Bedah Umum 50,000 35,000 187,000 10,913 282,913
510 Arif Sujayad 836168 0602/ Kontrol 5-May-15 Ortophedy 50,000 - 80,000 13,400 143,400
511 Topan 837427 0733/ Bsk 5-May-15 Urologi 50,000 - 335,000 12,051 397,051
512 Iliyawati 681163 0587/ Obs Osteopo 5-May-15 Orthopedy 50,000 - 3,963 53,963
513 Lorensius 835521 0745/ Mata Kabur 5-May-15 Mata 50,000 35,000 60,000 691,150 187,000 251,138 1,274,288
514 Marlina 680794 0440/ Dm 5-May-15 P. Dalam 50,000 - 289,031 339,031
515 Sumarto 756435 0652/ Kontrol 5-May-15 Bedah Umum 50,000 - 525,250 3,811 579,061
516 Jumiati 726403 0568/ Dm 5-May-15 P. Dalam 50,000 - 143,956 193,956
517 H Sumarna 441491 0485/ Pjk 5-May-15 Jantung 50,000 - 160,688 210,688
518 Sri Wahyuni 837374 0559/ Kontrol 5-May-15 Kandungan 50,000 - 17,825 67,825
519 Andhy Nurt 722833 0514/ Pjk 5-May-15 Jantung 50,000 - 185,738 235,738
520 Harsah 348911 0523/ Ht+Dispepsi 5-May-15 P. Dalam 50,000 - 407,469 457,469
521 Daud 835506 0622/ Dermatitis A 5-May-15 Kulit Kelamin 50,000 - 49,208 99,208
522 Hanisa 681735 0591/ Hipertyroid 5-May-15 P. Dalam 50,000 - 53,000 103,000
523 Rusdiana 734000 0553/ Impaksi Mul 5-May-15 Gigi&Mulut 50,000 - 274,020 8,488 332,508
524 Dasiran 706099 0570/ Gna 5-May-15 Urologi 50,000 - 137,213 187,213
525 M Munif 730078 0470/ Kontrol 5-May-15 Orthopedy 50,000 - 80,000 8,363 138,363
526 Siti Hasana 697396 0435/ Kontrol 5-May-15 P. Dalam 50,000 - 260,738 310,738
527 Painten 414086 0536/ Dm 5-May-15 P. Dalam 50,000 - 58,906 108,906
528 Karmidi 619224 0578/ Ht 5-May-15 Syaraf 50,000 35,000 71,500 16,450 172,950
529 M.Ilham 835509 0700/ I Ulkus Dek 5-May-15 Gigi&Mulut 50,000 - 207,443 2,871 260,314
530 Abdul Khair 780503 0537/ Terapi+Hnp 5-May-15 R.Medik+Orth 50,000 35,000 1,595,000 12,006 1,692,006
531 Zaeni 469838 0564/ Kontrol 5-May-15 Dalam+Jantun 50,000 70,000 561,706 681,706
532 Suyanto 445829 0576/ Kontrol 5-May-15 Rehab Medik+ 50,000 35,000 71,500 8,235 164,735
533 Slamet Arifi 463575 0651/ Pjk 5-May-15 Jantung 50,000 - 423,531 473,531
534 Purwati 421172 0636/ Cad 5-May-15 Jantung 50,000 - 177,925 227,925
535 Nurlinda Yun 835523 0760/ Omp 5-May-15 Tht 50,000 - 63,000 40,233 153,233
536 Yudi Gunars 725539 0420/ Kontrol 5-May-15 Syaraf 50,000 35,000 12,672 97,672
537 Nur Asiah 817162 0542/ Aws 5-May-15 Kandungan 50,000 - 120,500 12,944 183,444
538 Cecep Syari 828211 0481/ Angina Pec 5-May-15 Jantung 50,000 - 457,250 294,600 801,850
539 Mujiati 739381 0726/ Scabies 5-May-15 Kulit Kelamin 50,000 - 42,224 92,224
540 Susila Yanti 386562 0626/ Epilepsi 5-May-15 Syaraf 50,000 - 85,388 135,388
541 Asiah 746663 0580/ Kontrol 5-May-15 Jantung+Dala 50,000 - 203,700 253,700
542 Joya Baya P 504630 0484/ Susp Limpha 5-May-15 Anak 50,000 - 59,374 109,374
543 H. Mansyah 664376 0657/ Ods Pseud 5-May-15 Mata 50,000 - 13,793 63,793
544 Darmiah 445717 0507/ Chf 5-May-15 Jantung 50,000 - 33,788 83,788
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
545 Arbain 621293 0513/ Cad 5-May-15 Jantung 50,000 - 195,463 245,463
546 Dorothy Car 192634 0543/ Kontrol 5-May-15 P. Dalam 50,000 - 305,000 104,581 459,581
547 Marina Tira 445312 0583/ Jantung Ba 5-May-15 Jantung 50,000 - 25,875 75,875
548 Sarijan 531742 0567/ Ht 5-May-15 Jantung 50,000 - 83,963 133,963
549 Afdaliansya 525850 0563/ Dm Ii 5-May-15 P. Dalam 50,000 35,000 125,000 493,150 125,400 143,844 972,394
550 Musa Kileal 795989 0608/ Chf 5-May-15 Jantung 50,000 - 55,425 105,425
551 Kartika Dew 640012 0675/ Kontrol 5-May-15 Kandungan 50,000 - 120,500 2,288 172,788
552 Muhardians 829319 0757/ Benjolan Di 5-May-15 Bedah Umum 50,000 - 209,468 259,468
553 J.Marni 664975 0455/ Terapi 5-May-15 R.medis 50,000 35,000 71,500 20,343 176,843
554 Norliana 521951 0696/ S/ Hnp 5-May-15 Syaraf 50,000 - 44,250 227,700 13,660 335,610
555 Darmiati 667292 0641/ Terapi 5-May-15 R.medik 50,000 35,000 71,500 17,586 174,086
556 Dede Rohm 835511 0699/ Obs Cepalgi 5-May-15 Syaraf 50,000 - 207,900 12,280 270,180
557 Sarniwia 378185 0610/ Kontrol 5-May-15 Tht 50,000 - 21,580 71,580
558 Zainun 795458 0577/ Ht Dm 5-May-15 Jantung 50,000 - 281,213 331,213
559 Intan Jakran 835333 0670/ Kontrol 5-May-15 Paru 50,000 - 26,006 76,006
560 Masliyah 453712 0609/ Cepalgia 5-May-15 Syaraf 50,000 - 284,879 334,879
561 Abdul Azis 444863 0687/ Kontrol 5-May-15 Syaraf 50,000 - 85,388 135,388
562 Asnawi 670665 0497/ Dm 5-May-15 P. Dalam 50,000 - 164,738 214,738
563 Rukiyah 834190 0639/ Kontrol 5-May-15 Bedah Umum 50,000 - 125,000 1,525 176,525
564 Supri 829952 0592/ Kontrol 5-May-15 Tht 50,000 - 112,500 17,938 180,438
565 Johanes Mal 561617 0468/ Dm 5-May-15 P. Dalam 50,000 - 1,456,338 1,506,338
566 Erwin Setia 554562 0581/ Pjk 5-May-15 Jantung 50,000 - 216,923 266,923
567 M. Firmans 829583 0611/ Omsk 5-May-15 Tht 50,000 - 60,000 19,103 129,103
568 Siti Maimun 822088 0476/ Terapi 5-May-15 R.medik 50,000 35,000 159,500 166,286 410,786
569 Musawab 336543 0638/ Parkinson 5-May-15 Syaraf 50,000 - 200,238 250,238
570 Bambang Ab 786495 0506/ Ht 5-May-15 Jantung 50,000 - 59,025 109,025
571 Kasiyatun 664486 0522/ Ca Mamae 5-May-15 Bedah Umum 50,000 - 657,750 707,750
572 Mastora 711248 0521/ Dm 5-May-15 P. Dalam 50,000 - 39,938 89,938
573 Nico Mangu 784719 0431/ Kontrol 5-May-15 Jantung 50,000 - 110,700 66,879 227,579
574 Mahwiyah 808441 0524/ Post Snh 5-May-15 Syaraf 50,000 - 29,118 79,118
575 Rusmini 821169 0494/ Dm Tipe Ii 5-May-15 P. Dalam 50,000 - 712,121 762,121
576 Mastaniah 492000 0562/ Dm Type Ii 5-May-15 P. Dalam 50,000 - 385,763 435,763
577 Siti Mariam 757464 0621/ Ht 5-May-15 Syaraf 50,000 - 258,616 308,616
578 Mahrita 834539 0613/ Terapi+Lbp 5-May-15 R.Medik+Syar 50,000 35,000 159,500 11,541 256,041
579 Masratu 268538 0538/ Cad 5-May-15 Jantung 50,000 - 462,500 321,550 834,050
580 Rose 835505 0439/ Nyeri Tulan 5-May-15 P. Dalam 50,000 - 500,250 105,600 8,419 664,269
581 Devi Juni Pe 676755 0467/ Tu Mamae 5-May-15 Onkologi 50,000 - 377,500 427,500
582 Wahyudi 835524 0772/ Tumor 5-May-15 Bedah Umum 50,000 - 438,400 377,500 865,900
583 Nurjanah 532108 0705/ Struma 5-May-15 P. Dalam 50,000 - 499,250 549,250
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
584 Ahmadi 497689 0554/ Dm+Pjk 5-May-15 P. Dalam 50,000 - 500,250 550,250
585 Fatmawati 776294 0701/ Dm 5-May-15 P. Dalam 50,000 - 110,250 160,250
586 Watini 835518 0689/ S/ Appendici 5-May-15 Bedah Umum 50,000 - 438,400 305,000 793,400
587 Tutik Rahay 742172 0510/ Terapi+Kelo 5-May-15 R. medis 50,000 35,000 192,000 110,250 387,250
588 Uci Yumina 743954 0529/ Cek Lab 5-May-15 P. Dalam 50,000 - 352,100 402,100
589 Suparti 487344 0509/ Terapi 5-May-15 P. Dalam 50,000 35,000 71,500 500,250 656,750
590 Salmo 805122 0595/ Dermatitis 5-May-15 P. Dalam 50,000 - 110,250 160,250
591 Paini 835342 0654/ Struma 5-May-15 Bedah Umum 50,000 - 352,100 402,100
592 Royani Gun 626844 0715/ Kontrol 5-May-15 Bedah Umum 50,000 - 711,150 125,400 886,550
593 Nurlaila 701243 0447/ Dm+Ht 5-May-15 P. Dalam 50,000 - 456,000 506,000
594 Masitah 828986 0612/ Dm 5-May-15 P. Dalam 50,000 - 110,250 160,250
595 Halidah 476766 0482/ Cek Lab 5-May-15 P. Dalam 50,000 - 500,250 550,250
596 Idawati 835379 0690/ Rematoid A 5-May-15 Orthopedi 50,000 - 153,250 203,250
597 Karmiani 548727 0717/ Snnt 5-May-15 P. Dalam 50,000 - 505,600 555,600
598 Kartini Dae 835401 0515/ Terapi 5-May-15 R.medis 50,000 35,000 71,500 394,150 125,400 676,050
599 Hairunnisa 268925 0477/ Dm 5-May-15 P. Dalam 50,000 - 500,250 550,250
600 Arkaniyah 686642 0598/ Dm Tipe Ii 5-May-15 P. Dalam 50,000 - 110,250 160,250
601 Chotimah 566089 0465/ Pjk 5-May-15 Jantung 50,000 - 110,700 160,700
602 Asmaniah 769335 0640/ Ca Cervix 5-May-15 Kandungan 50,000 - 60,000 305,000 415,000
603 Muliyana 835513 0541/ 1 |Gr 5-May-15 Gigi & Mulut 50,000 - 93,115 143,115
604 Suyanto 834295 0596/ Kontrol 5-May-15 Bedah Umum 50,000 35,000 125,400 187,000 397,400
605 Suryanti 835517 0545/ Dermatitis 5-May-15 Kulit Kelamin 50,000 35,000 160,600 245,600
606 Indo Mase 835520 0703/ G2P1A0 5-May-15 Kandungan 50,000 - 120,500 305,000 475,500
607 Meydly Tan 835516 0674/ Susp Hepatit 5-May-15 P. Dalam 50,000 - 305,000 214,513 569,513
608 Zahra Putri 816567 0438/ Kolik Abdo 5-May-15 P. Dalam 50,000 - 305,000 355,000
609 Abd Salam 364953 0582/ Post Op Tur 5-May-15 Urologi 50,000 35,000 185,000 745,800 457,772 1,473,572
610 Rezki 840447 0616/ G4P2A1 Kp 5-May-15 Kandungan 50,000 - 120,500 305,000 475,500
611 Ratna 821500 0549/ Terapi 5-May-15 R.Medik 50,000 - 159,500 209,500
612 Helwinda 573781 0464/ Terapi 5-May-15 R.Medik 50,000 - 71,500 121,500
613 Sriani 346142 0480/ Terapi 5-May-15 R.Medik 50,000 - 71,500 121,500
614 Sabariyah 016859 0461/ Fisioterapi 5-May-15 R.Medik 50,000 - 159,500 209,500
615 Iis Hastuti 835363 0593/ Terapi 5-May-15 R.Medik 50,000 - 159,500 209,500
616 Sri Widya As 829377 0453/ Terapi 5-May-15 R Medik 50,000 - 159,500 209,500
617 Marida 647710 0424/ Terapi 5-May-15 R Medik 50,000 - 159,500 209,500
618 Erna Samun 569637 0462/ Terapi 5-May-15 R Medik 50,000 - 159,500 209,500
619 Hervia 816478 0525/ Terapi 5-May-15 R Medik 50,000 - 71,500 121,500
620 Anton Septi 834585 0452/ Terapi 5-May-15 R Medik 50,000 - 71,500 121,500
621 Asliansyah 591446 0714/ Fisioterapi 5-May-15 R Medik 50,000 35,000 159,500 27,196 271,696
622 Rosdiana Fa 805742 0548/ Terapi 5-May-15 R Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
623 Sumiati 663502 0550/ Terapi 5-May-15 R.Medik 50,000 - 159,500 209,500
624 Inem 534202 0683/ Terapi 5-May-15 R.Medik 50,000 - 71,500 121,500
625 Supatmi 801314 0565/ Terapi 5-May-15 R.Medik 50,000 - 71,500 121,500
626 Sumiyati 821102 0539/ Terapi 5-May-15 R.Medik 50,000 - 159,500 209,500
627 Rita Sahara 734234 0493/ Terapi 5-May-15 R.Medik 50,000 - 71,500 121,500
628 Kornelis Na 810504 0645/ Terapi 5-May-15 R.Medik 50,000 - 159,500 209,500
629 M Solihin 795185 0423/ Terapi 5-May-15 R Medik 50,000 - 159,500 209,500
630 Nani Widyaw486597 0643/ Terapi 5-May-15 R Medik 50,000 - 440,000 490,000
631 Rushel Satri 819393 0463/ Terapi 5-May-15 R Medik 50,000 - 220,000 270,000
632 M. Azylillah 744048 0433/ Ot+Tw 5-May-15 R Medik 50,000 - 440,000 490,000
633 H. Bambang 829576 0478/ Terapi 5-May-15 R Medik 50,000 - 440,000 490,000
634 Andri K.P. 706211 0575/ Fisioterapi 5-May-15 R Medik 50,000 - 71,500 121,500
635 Asmini 795280 0620/ Fisioterapi 5-May-15 R Medik 50,000 - 159,500 209,500
636 Rohanah 522050 0718/ Terapi+Kont 5-May-15 R.Medik+Syar 50,000 - 71,500 121,500
637 Sumiaty 429003 0604/ Fisiotherapy 5-May-15 R Medis 50,000 - 71,500 121,500
638 Subeli 238930 0603/ Fisiotherapy 5-May-15 R Medis 50,000 - 71,500 121,500
639 Dewi Kartik 824703 0632/ Terapi 5-May-15 R Medis 50,000 - 71,500 121,500
640 Rudi Herma 743463 0571/ Terapi 5-May-15 R Medis 50,000 - 159,500 209,500
641 Febrian Satr 753688 0432/ Fisioterapi 5-May-15 R Medis 50,000 - 440,000 490,000
642 Nabila Syifa 330529 0492/ Ft+Ot 5-May-15 R Medis 50,000 - 440,000 490,000
643 Izzati Fadhi 706890 0451/ Terapi 5-May-15 R Medis 50,000 - 440,000 490,000
644 Afif Piliang 781444 0425/ Fisioterapi 5-May-15 R Medis 50,000 - 220,000 270,000
645 Ahmad Sida 581234 0434/ Terapi 5-May-15 R Medis 50,000 - 220,000 270,000
646 Isnaniah 453917 0746/ Terapi 5-May-15 R Medis 50,000 - 71,500 121,500
647 Tri Apsah 796454 0743/ Terapi 5-May-15 R Medis 50,000 - 159,500 209,500
648 Nani 683573 0601/ Terapi 5-May-15 R Medis 50,000 - 159,500 209,500
649 Rachmah 264555 0449/ Ft+Tw 5-May-15 R Medis 50,000 - 440,000 490,000
650 Annisa Rifq 634858 0614/ Ot+Tw 5-May-15 R Medis 50,000 - 220,000 270,000
651 Mariam Ulfa 834596 0681/ Terapi 5-May-15 R.Medik 50,000 - 220,000 270,000
652 Dafa Tri Nal 829331 0741/ Terapi 5-May-15 R.Medik 50,000 - 220,000 270,000
653 Atikah 806471 0448/ Omsk 5-May-15 Tht 50,000 35,000 165,113 250,113
654 Fitri Hartati 800400 0619/ Keratitis 5-May-15 Mata 50,000 - 50,000
655 Sami 776860 0557/ S/ Ca Cervi 5-May-15 Jantung 50,000 - 60,000 110,000
656 Endang Sri 821113 0686/ Post Sc 5-May-15 Kandungan 50,000 - 60,000 110,000
657 Hj.Mutiara 614069 0727/ Perdarahan 5-May-15 Kandungan 50,000 - 60,000 110,000
658 Yuni Mustik 835514 0711/ Kontrol 5-May-15 Kandungan 50,000 - 120,500 170,500
659 Jusnaini 835515 0712/ G1P0A0 Hml 5-May-15 Kandungan 50,000 - 120,500 170,500
660 Hamidah 837480 0735/ Ab Incomple 5-May-15 Kandungan 50,000 - 60,000 110,000
661 Rheyhan Sak 803586 0495/ Post Reposis 5-May-15 Kandungan 50,000 - 125,000 175,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
662 Tamiran 562557 0599/ Kontrol Luk 5-May-15 Bedah Umum 50,000 - 125,000 175,000
663 Supriadi 790949 0528/ Tumor Parot 5-May-15 Bedah Umum 50,000 - 50,000
664 Lisa Yuliant 472817 0627/ 47 Pulpitis 5-May-15 Gigi&Mulut 50,000 - 50,000
665 Warsi 789865 0630/ Dm 5-May-15 P. Dalam 50,000 - 135,000 185,000
666 Yuniar 559994 0530/ Kontrol 5-May-15 Kandungan 50,000 - 120,500 170,500
667 Rehana 834,563 0527/ G3P2A0 38 5-May-15 Kandungan 50,000 - 120,500 170,500
668 Bagja Nugr 836950 0573/ Kontrol 5-May-15 Orthopedy 50,000 - 80,000 130,000
669 Chenzy Nivi 743888 0734/ Kontrol 5-May-15 Bedah Thorax 50,000 - 50,000
670 Sarlota Mas 834594 0666/ S/ Tu Otak 5-May-15 Bedah Syaraf 50,000 - 50,000
671 Prawoto 840373 0617/ Dislokasi 5-May-15 Orthopedi 50,000 - 50,000
672 Rizki Kurni 800800 0590/ Kontrol 5-May-15 Orthopedi 50,000 - 50,000
673 Rusdiana 745347 0729/ Neprolitiasi 5-May-15 Urologi 50,000 - 141,500 191,500
674 Alana Aftar 834879 0713/ Abses 5-May-15 Anak 50,000 35,000 85,000
675 Syarifah Sa 596154 0719/ Retensio Ur 5-May-15 Urologi 50,000 - 50,000
676 Jie Mie Tjo 685750 0586/ Gangguan Uj 5-May-15 R.medis 50,000 - 71,500 121,500
677 Sri Untung 725367 0958/ Ht+Dm 06-May-15 Penyakit Dala 50,000 - 350,625 400,625
678 Adaniah 423779 1075/ Ht 6-May-15 Peny.Dalam 50,000 - 191,913 241,913
679 Am. Mitia R 782792 0844/ Kontrol 6-May-15 Paru 50,000 - 30,375 80,375
680 Bahtiar 832842 0783/ Dm + Ht 6-May-15 Dalam 50,000 - 110,250 283,368 443,618
681 Jefri 835550 0989/ Sinusitis D 06-May-15 Tht 50,000 70,000 241,250 158,269 519,519
682 Ineke Asrini 813296 0781/ Kontrol 6-May-15 Dalam 50,000 - 1,882,575 1,932,575
683 Armada 726975 0860/ Epilepsi 6-May-15 Saraf 50,000 35,000 66,674 151,674
684 Kasim 607957 0871/ Kontrol 6-May-15 Saraf 50,000 - 14,420 64,420
685 Hadiyah 720865 0930/ Kontrol 06-May-15 Kandungan 50,000 - 373,000 12,613 435,613
686 Debby Cand 835556 1223/ Obs Flour A 6-May-15 Kandungan 50,000 - 245,500 175,000 6,838 477,338
687 Masriah 208228 0926/ Pjk 06-May-15 Jantung 50,000 - 280,300 330,300
688 Supardin 815687 1003/ 8 6 06-May-15 Gigi&Mulut 50,000 - 7,350 57,350
689 Ulpah Heraw 764214 1064/ Ht 06-May-15 Jantung 50,000 - 276,300 326,300
690 Abdul Mali 423380 1043/ Pjk 6-May-15 Jantung 50,000 - 336,975 386,975
691 Zephyrina Tr 582219 1107/ Kontrol 06-May-15 Jantung 50,000 - 179,550 229,550
692 Ayra Saifa S 835561 1267/ Gatal2 6-May-15 Kulit Kelamin 50,000 - 42,847 92,847
693 Syaridayanti 185518 0849/ Vertigo 6-May-15 Syaraf 50,000 35,000 60,000 175,000 19,859 339,859
694 Jumri Noor 697349 1224/ Pjk 6-May-15 Jantung 50,000 - 284,288 334,288
695 Moesrian Da 288987 0880/ Pjk 6-May-15 Jantung 50,000 - 781,560 831,560
696 Juwatim 835555 1020/ Chest Pain 06-May-15 Jantung 50,000 - 457,250 187,000 2,400 696,650
697 Wahidah 725319 1102/ Ca Mamae 6-May-15 Onkologi 50,000 35,000 30,356 115,356
698 Ningsih 835542 1060/ Ht Gr Ii 6-May-15 Jantung 50,000 - 187,000 2,288 239,288
699 Mariani 528526 1191/ Kontrol 6-May-15 Syaraf 50,000 - 29,274 79,274
700 Tri Retnowa 576849 1093/ Susp Hnp 06-May-15 Syaraf 50,000 - 34,905 84,905
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
701 Marsiati 796806 0706/ 38 Radix 6-May-15 Gigi & Mulut 50,000 - 3,848,276 23,765 3,922,041
702 Salamah 748488 0833/ Fisioterapi 6-May-15 R.Medik 50,000 35,000 71,500 28,875 185,375
703 Misrah 792616 0648/ Cad 6-May-15 Jantung 50,000 - 457,250 187,000 8,800 703,050
704 Heni Mulya 478123 1002/ Ht 06-May-15 Jantung+Syara 50,000 - 159,518 209,518
705 Eko Minarn 810163 1236/ Ht Gr Ii 6-May-15 Syaraf 50,000 35,000 277,575 362,575
706 Abu Hanifa 805165 0841/ Kontrol 6-May-15 Saraf 50,000 - 220,613 270,613
707 Indra Alexa 757040 0826/ Myopia 6-May-15 Mata 50,000 - 60,000 12,293 122,293
708 Arkaniyah 686642 0837/ Kontrol 06-May-15 Penyakit Dala 50,000 35,000 60,000 37,075 182,075
709 Sunarsih 548384 1079/ Kardiomegal 06-May-15 Jantung 50,000 - 279,188 329,188
710 Maruasas Hu 555075 1078/ Pjk 06-May-15 Jantung 50,000 - 330,475 380,475
711 Rahmawati 410420 0811/ Kontrol 6-May-15 P. Dalam 50,000 - 254,860 304,860
712 Rosdiana 455212 1225/ Obs Battuk 6-May-15 Paru 50,000 - 11,500 61,500
713 Meri Periant 833150 1073/ Pusing 6-May-15 Peny.Dalam 50,000 35,000 88,250 51,425 224,675
714 Siti Rahmah 776854 0938/ S/ Struma 6-May-15 Onkologi 50,000 - 11,138 61,138
715 M Gazhali 712031 0874/ 36 Nekrosis 6-May-15 Gigi & Mulut 50,000 - 1,648,276 11,535 1,709,811
716 Nina Indria 706022 1086/ Kontrol 6-May-15 Dalam 50,000 - 920,000 62,150 1,032,150
717 Andi Nila 566679 1041/ Cepalgia 6-May-15 Syaraf 50,000 - 20,139 70,139
718 Iraja 394950 1072/ Ht 6-May-15 Jantung 50,000 - 251,238 301,238
719 Bakri S. 707771 1077/ Pjk 06-May-15 Jantung 50,000 - 194,025 244,025
720 Agustin 815419 1047/ Ht 06-May-15 Penyakit Dala 50,000 70,000 35,513 155,513
721 Hernianti 582982 1031/ Sarcoma 06-May-15 Onkologi 50,000 - 402,500 525,250 125,400 3,663 1,106,813
722 Ifan Saputra 835537 0814/ Mucocelle 6-May-15 Gigi & Mulut 50,000 - 483,450 4,369 537,819
723 Amas Megaw822082 0751/ Hhd,Cad + 6-May-15 Jantung + Dal 50,000 35,000 477,400 562,400
724 Meydly Tan 835516 1046/ Susp Hepatit 06-May-15 Penyakit Dala 50,000 - 566,650 15,238 631,888
725 Syarifuddin 387895 1032/ Ht 06-May-15 Jantung 50,000 - 321,525 371,525
726 Hariyono 743713 0921/ Ht+Melena 6-May-15 Peny.Dalam 50,000 35,000 13,494 98,494
727 Septua Riko 667283 1030/ Dermatitis A 6-May-15 Kulit Kelamin 50,000 - 22,828 72,828
728 Mashur 571952 0891/ Ht 6-May-15 Jantung 50,000 - 54,188 104,188
729 Idawati 835379 0945/ Rematoid A 06-May-15 Orthopedi 50,000 - 2,400 52,400
730 Harbia 829916 1074/ S/ Hepatitis 6-May-15 Peny.Dalam 50,000 - 954,375 1,004,375
731 Fazrul 532132 0983/ Kontrol Post 6-May-15 Rehab Medik+ 50,000 35,000 220,000 338,963 643,963
732 Reza Aprial 623709 0913/ Epilepsi 06-May-15 Syaraf 50,000 - 551,513 601,513
733 Tiara Nalian 835364 1057/ Obs Febris 6-May-15 Peny.Dalam 50,000 - 2,381 52,381
734 Abdullah 821861 0646/ Pjk 6-May-15 Jantung 50,000 - 197,850 247,850
735 Misti Anawa 639823 1088/ Stroke 6-May-15 Syaraf 50,000 - 39,850 89,850
736 Ester Biu 634357 0736/ Kpp 7|7 6-May-15 Gigi & Mulut 50,000 - 207,443 7,350 264,793
737 Ignatius He 795636 1029/ Nefrotik Si 6-May-15 Peny.Dalam 50,000 - 69,788 119,788
738 Subito Suw 731631 0879/ Post Stroke 6-May-15 Syaraf 50,000 - 60,675 110,675
739 Endang Sula 633292 0911/ Oa 06-May-15 Syaraf 50,000 35,000 71,500 110,250 20,911 287,661
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
740 Alvalen Ibr 835544 0927/ Anemia+Feb 06-May-15 Anak 50,000 - 9,246 59,246
741 M Azka Sand837459 0766/ Pneomonia 6-May-15 Anak 50,000 - 11,342 61,342
742 Sumargi 787513 0680/ Pjk 6-May-15 Jantung 50,000 - 292,300 342,300
743 Murni 733575 1087/ S/ Gastritis 6-May-15 Peny.Dalam 50,000 - 27,619 77,619
744 Nina Martin 813429 0709/ Kontrol 6-May-15 Saraf 50,000 - 257,138 307,138
745 Nasifah 726356 0876/ Ht 6-May-15 Jantung 50,000 - 352,650 402,650
746 Husni Kadri 829396 1044/ Alergi 6-May-15 Kulit Kelamin 50,000 - 68,344 118,344
747 Rendy Iraw 835301 0799/ Kontrol 6-May-15 Paru 50,000 - 30,375 80,375
748 Erda Linawa 460499 0677/ Pjk 6-May-15 Jantung 50,000 - 705 50,705
749 Diadi 790955 0761/ Ht 06-May-15 Jantung 50,000 - 562,950 178,350 791,300
750 Indo Ake 571949 0797/ Kontrol 6-May-15 Saraf 50,000 - 87,188 137,188
751 Satriyo Baga 796818 0803/ Epilepsi 6-May-15 Saraf 50,000 - 224,315 274,315
752 Amir Lapag 840370 0877/ S/ Chf 6-May-15 Jantung 50,000 - 187,000 185,850 422,850
753 Chotimah 566089 0647/ Kontrol 6-May-15 Jantung 50,000 - 86,723 136,723
754 Adiyatama Y 335533 1012/ Obs Dispeps 6-May-15 Anak 50,000 - 10,275 60,275
755 Karmiani 548727 1252/ Snnt 6-May-15 Peny.Dalam 50,000 - 15,413 65,413
756 Suryati 368717 0740/ Chf 6-May-15 Jantung 50,000 35,000 49,676 134,676
757 Masitah 346426 0796/ Kontrol 6-May-15 Jantung 50,000 - 171,843 221,843
758 Pinta Sirega 347171 0800/ Pjk 6-May-15 Jantung 50,000 - 32,288 82,288
759 Slamet Hary 773911 0972/ Decomp Cor 06-May-15 Jantung 50,000 - 301,223 351,223
760 Abdul Gani 419560 0959/ Gastropati+ 06-May-15 P.Dalam+Jant 50,000 35,000 182,135 267,135
761 Rusiah 485526 1193/ Pjk 6-May-15 Jantung 50,000 - 158,813 208,813
762 Nurjannah 835560 1255/ S/ Hipertiro 6-May-15 Peny.Dalam 50,000 - 352,100 9,135 411,235
763 Norliana 521951 0887/ Susp Hnp 6-May-15 Saraf 50,000 35,000 32,283 117,283
764 Heldi Ahma 835565 0875/ Nyeri Telap 6-May-15 Kulit Kelamin 50,000 - 8,000 58,000
765 Bandi Batha 738114 1239/ Post Snh 6-May-15 Syaraf 50,000 35,000 159,500 33,788 278,288
766 Rusdiana 835563 1091/ Angina Pec 06-May-15 Jantung 50,000 - 457,250 187,000 189,900 884,150
767 Kartini Dae 835401 0987/ Terapi 06-May-15 Rehab Medik 50,000 35,000 159,500 17,500 262,000
768 Asnun Zain 002193 1194/ Glaukoma 6-May-15 Mata 50,000 - 60,000 82,643 192,643
769 Munsyarifa 548782 1176/ Kontrol 6-May-15 Peny.Dalam 50,000 - 12,293 62,293
770 Nur M. Ikhs 829497 1121/ Impaksi Mul 06-May-15 Gigi&Mulut 50,000 - 365,360 7,350 422,710
771 Effendi 458722 0821/ 4 Fraktur 06-May-15 Gigi&Mulut 50,000 - 253,715 1,588 305,303
772 M.Arif 401877 1222/ Kontrol 6-May-15 Gigi&Mulut 50,000 - 3,848,276 45,238 3,943,514
773 Sutini 822724 1000/ Ca Cervik 6-May-15 Kandungan 50,000 105,000 120,000 187,000 32,316 494,316
774 Alisya Yufa 661915 0889/ Benjolan Dp 6-May-15 Anak 50,000 - 19,886 69,886
775 Koesnadi 840457 0888/ Pjk + Susp 6-May-15 Jantung+Paru 50,000 - 457,250 462,500 185,850 1,155,600
776 Rahmania 835564 0873/ G2 P1 A0 1 6-May-15 Kandungan 50,000 35,000 60,000 105,600 13,425 264,025
777 Irawati 787815 0859/ Ca Mamae 6-May-15 Onkologi 50,000 - 525,250 377,500 125,400 6,881 1,085,031
778 M. Rasya Fi 737529 1080/ Hipokalemi 06-May-15 Anak 50,000 - 26,286 76,286
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
779 Sunarsih 640572 0854/ Ht+Gastritis 06-May-15 Penyakit Dala 50,000 - 125,400 9,625 185,025
780 Armiah 584602 0737/ Pjk 6-May-15 Jantung 50,000 - 462,500 55,900 568,400
781 Indo Putri 835549 1134/ Dermatitis A 6-May-15 Kulit Kelamin 50,000 - 25,633 75,633
782 Nursidin 528848 0988/ Cml 06-May-15 Jantung 50,000 - 162,975 212,975
783 Arbain 835351 0785/ Kontrol 6-May-15 Jantung 50,000 - 18,000 68,000
784 Supian 806445 0909/ Cefalgia 6-May-15 Syaraf 50,000 - 132,399 182,399
785 Sukatmi 781888 0892/ Pro Op Kata 6-May-15 Mata 50,000 - 82,330 132,330
786 Ahmad Suda 581234 0804/ Terapi 6-May-15 R.Medik 50,000 - 110,250 139,175 299,425
787 Jenni Ambar 516065 0691/ Sinusitis 6-May-15 Tht 50,000 - 114,075 164,075
788 Marlina 739303 0825/ Omsk 06-May-15 Tht 50,000 - 1,788 51,788
789 Aditya Iraw 608989 0649/ Cml 6-May-15 Dalam 50,000 - 5,278,350 5,328,350
790 Nurliana 330972 0836/ Impaksi Mul 06-May-15 Gigi&Mulut 50,000 - 8,425 58,425
791 M. H. Husni 711750 0793/ Susp Bph 06-May-15 Urologi 50,000 - 139,175 189,175
792 Prila Sari 146825 0907/ Cepalgia 6-May-15 Syaraf 50,000 35,000 60,000 25,143 170,143
793 Budiwati 690259 0755/ Faringitis 6-May-15 Tht 50,000 - 20,516 70,516
794 Sarjono 796456 1013/ Dm 6-May-15 Peny.Dalam 50,000 - 273,788 323,788
795 Hoesine Ma 378820 0866/ Ht 06-May-15 Penyakit Dala 50,000 - 79,713 129,713
796 M. Rosihan 740691 0853/ Vertigo 06-May-15 Syaraf 50,000 - 27,888 77,888
797 Amanah 480979 0855/ Ischialgia 06-May-15 Syaraf 50,000 - 54,300 104,300
798 Anwar 793702 0942/ Kontrol 06-May-15 Penyakit Dala 50,000 - 21,955 71,955
799 Affraiza 835559 1033/ Dermatitis I 06-May-15 Kulit Kelamin 50,000 - 17,091 67,091
800 Heni Indriya 828952 1132/ Getah Benin 6-May-15 Bedah Umum 50,000 - 695,138 745,138
801 Salbiah 614094 1027/ Gastritis 6-May-15 Peny.Dalam 50,000 - 194,719 244,719
802 Bahrian 829168 0908/ Kontrol 6-May-15 Bedah Umum 50,000 - 125,000 4,413 179,413
803 M. Amin Ass 571309 0851/ Fr 1/3 Os Cl 06-May-15 Orthopedi 50,000 - 1,413 51,413
804 Tri Nafsiatu 835350 0765/ Oa 06-May-15 Orthopedi 50,000 - 105,600 3,600 159,200
805 Mulyono 787453 0865/ Kontrol 6-May-15 Jantung 50,000 - 304,388 354,388
806 Suparman 812236 1059/ Post Stroke 6-May-15 Syaraf 50,000 - 14,888 64,888
807 Yosi Charism838180 1071/ Kontrol 6-May-15 Bedah Umum 50,000 35,000 1,202,533 160,600 9,525 1,457,658
808 Suwarto 533616 0770/ Glukoma 6-May-15 Mata 50,000 - 95,515 145,515
809 Ida Kuswati 773708 0973/ Gastritis Kr 06-May-15 Penyakit Dala 50,000 - 10,450 60,450
810 Suryani 835557 0845/ Susp Otitis 6-May-15 Tht 50,000 - 310,500 102,081 462,581
811 Asmah 801455 0974/ Cephalgia 06-May-15 Syaraf 50,000 35,000 10,768 95,768
812 Darsiah 740936 0996/ Kontrol 6-May-15 Rehab Nedik+S 50,000 35,000 71,500 18,703 175,203
813 Kornelis Na 810504 0764/ Hnp+Ht 06-May-15 Syaraf 50,000 35,000 335,000 255,000 675,000
814 Desi Noor A 835539 0829/ 6|6 Gp 6-May-15 Gigi & Mulut 50,000 - 8,488 58,488
815 Halidah 476766 0910/ Dm Ii 6-May-15 Peny.Dalam 50,000 - 47,036 97,036
816 Ramlah Has 619115 1026/ Pjk 6-May-15 Jantung 50,000 - 67,200 117,200
817 M Hanapiah 720245 0815/ Ca Prostat 6-May-15 Urologi 50,000 - 53,625 103,625
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
818 Vini Apriani 736295 1195/ Hipokalemi 6-May-15 Peny.Dalam 50,000 - 158,000 36,131 244,131
819 Sulis Setiow 812857 0661/ Mialgia 6-May-15 Saraf 50,000 - 32,719 82,719
820 Pariem 802992 0824/ Ht 06-May-15 Penyakit Dala 50,000 - 314,500 364,500
821 Ishak 835535 0710/ Otitis Media 6-May-15 Tht 50,000 - 63,000 2,288 115,288
822 Rosanah 736528 0870/ Limfadeniti 06-May-15 Bedah Umum 50,000 - 926,850 976,850
823 Jamin Mana 584570 0951/ Myalgia 6-May-15 Peny.Dalam 50,000 - 500,250 3,025 553,275
824 Manahan Par 048929 0937/ Kontrol 6-May-15 Peny.Dalam 50,000 - 11,088 61,088
825 M.Said 087071 0985/ Katarak 6-May-15 Mata 50,000 - 12,293 62,293
826 Uyang Imau 403920 0939/ Jari Kelingk 6-May-15 Bedah Umum 50,000 - 525,250 4,838 580,088
827 Bukrowati 686617 0725/ Hypertiroid 6-May-15 Penyakit Dala 50,000 - 51,175 101,175
828 Rusmini 607352 0679/ Chepalgia 6-May-15 Saraf 50,000 - 22,343 72,343
829 Hamidah 765193 0838/ Sindrom Nef 06-May-15 Penyakit Dala 50,000 - 64,688 114,688
830 Masni 835387 0952/ Dm Ii 6-May-15 Peny.Dalam 50,000 - 21,313 71,313
831 Saniah 663474 0820/ Ht 6-May-15 Peny.Dalam 50,000 - 52,881 102,881
832 Anindya Ilm 834822 1015/ Laceratum P 6-May-15 Bedah Umum 50,000 - 125,000 24,219 199,219
833 Nurhidayah 712385 1133/ Iscialgia 6-May-15 Syaraf 50,000 35,000 71,500 29,123 185,623
834 A Fahrizal P 536094 0812/ Susp Hiperti 6-May-15 Anak 50,000 - 352,100 12,325 414,425
835 Saanih 835562 0872/ Ispa 6-May-15 Paru 50,000 - 40,100 90,100
836 Nasaruddin 840470 0856/ Mata Kabur 6-May-15 Mata 50,000 - 35,219 85,219
837 Chintia H 835322 0843/ Ikterus Neo 6-May-15 Anak 50,000 - 50,960 100,960
838 Aslamiah 835529 0794/ Arthalgia 06-May-15 Orthopedi 50,000 - 125,400 2,400 177,800
839 Noor Jannah 754735 1177/ Oma 6-May-15 Tht 50,000 - 31,975 81,975
840 Theresia Lau 725340 0762/ Cad 06-May-15 Jantung 50,000 - 49,688 99,688
841 M.Basri 828571 1178/ Oma 6-May-15 Tht 50,000 - 114,209 164,209
842 Efendy 507950 0750/ Terapi+Hnp 06-May-15 R.Medik+Syar 50,000 35,000 159,500 25,630 270,130
843 M Azis Fikr 840422 0784/ Susp Demam 6-May-15 Dalam 50,000 - 19,300 69,300
844 Sugianto Ru 487872 0924/ Kontrol 6-May-15 Saraf+R.Medi 50,000 70,000 220,000 144,600 484,600
845 Tamrin 319921 0776/ Terapi+Susp 06-May-15 R.Medik+Urol 50,000 35,000 494,500 278,200 255,000 1,112,700
846 Riffadin 706341 0739/ Chf 6-May-15 Jantung 50,000 35,000 216,150 301,150
847 Sri Miswati 747396 1119/ Kontrol 6-May-15 Bedah Umum 50,000 - 31,875 81,875
848 Margareta Sa 626808 1018/ Dermatopyti 06-May-15 Kulit Kelamin 50,000 - 3,974 53,974
849 Sanah 835536 1146/ 8 Gr 6-May-15 Gigi&Mulut 50,000 - 160,600 6,713 217,313
850 Maming 835343 0798/ Susp Tb 6-May-15 Paru 50,000 - 28,875 78,875
851 Suminah 610649 1089/ Sle 6-May-15 Penyakit Dala 50,000 - 36,638 86,638
852 Kartini 828531 1105/ S/ Epilepsi 6-May-15 Syaraf 50,000 - 87,188 137,188
853 Suwarni 625110 1048/ Kontrol 06-May-15 Urologi 50,000 - 6,600 56,600
854 Velix Gatot 815678 1117/ Pjk 6-May-15 Jantung 50,000 - 186,038 236,038
855 Gusti Ardia 627694 0782/ Pjk 6-May-15 Jantung 50,000 - 333,750 383,750
856 Bakti Bahtia 686466 1045/ Cad 6-May-15 Jantung 50,000 - 187,500 237,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
857 Muslihah 835307 1238/ Tu Colli 6-May-15 Onkologi 50,000 35,000 1,024,050 377,500 1,598,300 526,717 3,611,567
858 Nurjanah 532108 1076/ Struma 06-May-15 Onkologi 50,000 35,000 1,763,300 526,717 2,375,017
859 Fatimah 748924 0806/ Obs Lbp 06-May-15 Syaraf 50,000 35,000 85,000
860 Aminah 447319 0763/ Dm Tipe Ii 06-May-15 Penyakit Dala 50,000 - 500,250 125,400 675,650
861 Dwi Puspita 708534 1034/ G8P5A2+Let 06-May-15 Kandungan 50,000 - 60,000 305,000 415,000
862 Yuliana 625938 1011/ Dm Ii 6-May-15 Peny.Dalam 50,000 - 500,250 550,250
863 Nurrachmann831092 1063/ Flour Albus 06-May-15 Kulit Kelamin 50,000 - 207,000 257,000
864 Martini 835546 1116/ Tu Mamae S 6-May-15 Bedah Tumor 50,000 - 525,250 377,500 125,400 1,078,150
865 Edwin Noor 669130 0828/ 1|1,2 Karies 6-May-15 Gigi & Mulut 50,000 - 93,115 143,115
866 Alberta Airl 835325 1120/ 8 Impaksi 6-May-15 Gigi&Mulut 50,000 - 579,150 125,400 754,550
867 Bahriah 835548 0957/ Tb Paru 06-May-15 Paru 50,000 - 160,250 125,400 335,650
868 Selvia Oktav 744370 0842/ Kontrol 6-May-15 Gigi & Mulut 50,000 - 160,600 210,600
869 Siti Mukar 810150 0986/ S/ Kista Cap 06-May-15 Bedah Anak 50,000 - 701,550 188,100 939,650
870 M. Ali Akba 835554 1019/ Pulpitis 8 06-May-15 Gigi&Mulut 50,000 - 867,150 286,000 1,203,150
871 Herliyana 835528 0925/ 27 Nekrosis 6-May-15 Gigi&Mulut 50,000 - 748,892 160,600 959,492
872 Tri Yani Kur 594804 1016/ 8 Impaksi 06-May-15 Gigi&Mulut 50,000 35,000 579,150 286,000 950,150
873 M. Rifqi Ra 835541 0900/ Hernia Ingui 06-May-15 Bedah Anak 50,000 - 701,550 105,600 857,150
874 Darwih Gerr 835527 0895/ Colik Ureter 6-May-15 Urologi 50,000 35,000 335,000 109,250 745,800 569,438 1,844,488
875 Suparno 810560 1001/ Non Union F 06-May-15 Orthopedi 50,000 - 80,000 207,900 337,900
876 Aliah 758679 0694/ Nyeri Kepal 6-May-15 Saraf 50,000 - 319,250 997,700 1,366,950
877 Indrayani 834548 1062/ Ab Imminen 06-May-15 Kandungan 50,000 - 60,000 305,000 415,000
878 Wa Sania 512982 1254/ G5P3A1 6-May-15 Kandungan 50,000 - 60,000 305,000 415,000
879 Yatini 835580 1108/ G5P3A1+Plr 06-May-15 Kandungan 50,000 - 60,000 305,000 415,000
880 Fida Fathim 555041 1266/ G1P0A0 6-May-15 Kandungan 50,000 - 60,000 305,000 415,000
881 Nor Ummi F 632340 1149/ Kontrol 6-May-15 Peny.Dalam 50,000 35,000 997,700 1,082,700
882 Fitriani 837503 1268/ Kontrol 6-May-15 Kandungan 50,000 - 60,000 305,000 415,000
883 Wiwik Hand 437996 0852/ Hamil Dg He 06-May-15 Kandungan 50,000 - 120,500 305,000 475,500
884 Ariah 835540 0884/ Susp Hipert 06-May-15 Kandungan 50,000 35,000 352,100 305,000 742,100
885 Sapta Harian 835530 0940/ Haid Terlam 6-May-15 Kandungan 50,000 - 60,000 305,000 415,000
886 Christin Nat 634732 0960/ Ca Mamae 06-May-15 Onkologi 50,000 - 1,076,954 105,600 1,232,554
887 Vonny Tinek 567447 1162/ Pjk Ht 6-May-15 Jantung 50,000 - 457,250 507,250
888 Supinah 769897 0899/ Kontrol 06-May-15 Penyakit Dala 50,000 - 500,250 550,250
889 Jeffrey Godf 622250 1163/ Pjk 6-May-15 Jantung 50,000 - 457,250 507,250
890 Indo Masse 828264 0975/ Dm Tipe Ii 06-May-15 Penyakit Dala 50,000 - 110,250 160,250
891 Ayudha Sari 835533 0822/ Obs Chest P 06-May-15 Jantung 50,000 - 457,250 187,000 694,250
892 Erlisa 748232 1147/ Dm 6-May-15 Peny.Dalam 50,000 - 110,250 160,250
893 Mochtar 837363 1042/ Kontrol 6-May-15 Jantung 50,000 - 231,400 462,500 743,900
894 Syahrin 761752 0955/ Leukimia 6-May-15 Peny.Dalam 50,000 - 76,250 126,250
895 Wariati 582263 0967/ Dm Ht 6-May-15 Peny.Dalam 50,000 - 110,250 160,250
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
896 Yayuk S 626398 0663/ Cek Lab 6-May-15 Laboratorium 50,000 - 110,250 160,250
897 Yeti Mahdal 817963 0869/ Tu Mamae 06-May-15 Onkologi 50,000 - 525,250 575,250
898 Yulia Dewi 456972 0662/ Cek Lab 6-May-15 Laboratorium 50,000 - 500,250 550,250
899 Tumini 610772 0805/ Dm 6-May-15 Peny.Dalam 50,000 - 110,250 160,250
900 Siti Fatimah 821565 0708/ Cek Lab 6-May-15 Laboratorium 50,000 - 457,250 507,250
901 Sri Gusnawa 524578 0906/ Nyeri Tulan 6-May-15 Peny.Dalam 50,000 - 543,500 593,500
902 Nadiya Nur 814037 0956/ Hernia Ingui 06-May-15 Anak 50,000 - 119,000 169,000
903 Megawati 496833 0665/ Cek Lab 6-May-15 Laboratorium 50,000 - 110,250 160,250
904 Janariah 463441 0780/ Dm 06-May-15 Penyakit Dala 50,000 - 500,250 550,250
905 Hartawan 446291 0692/ Cek Lab 6-May-15 Laboratorium 50,000 - 110,250 160,250
906 Fitriansyah 835553 1221/ Lipoma 6-May-15 Bedah Umum 50,000 - 394,150 444,150
907 Darham 463315 0863/ Dm 6-May-15 Peny.Dalam 50,000 - 543,500 593,500
908 Darto 440365 0922/ Dm 6-May-15 Peny.Dalam 50,000 - 110,250 160,250
909 Emi Wati 822911 1061/ G2P1A0+Ge 06-May-15 Kandungan 50,000 - 120,500 372,400 542,900
910 Erni Kursan 732415 1131/ Kontrol 6-May-15 Peny.Dalam 50,000 - 333,500 383,500
911 Anny Maisy 420866 1028/ Dm Type Ii 6-May-15 Peny.Dalam 50,000 - 110,250 160,250
912 Darisem 827918 0676/ Terapi 6-May-15 R Medis 50,000 - 440,000 490,000
913 Imam Muha 190433 0802/ Terapi 6-May-15 R.Medik 50,000 - 440,000 490,000
914 Kusnan 721341 0801/ Terapi 6-May-15 R.Medik 50,000 - 440,000 490,000
915 Udin 705780 0790/ Terapi 6-May-15 R.Medik 50,000 - 440,000 490,000
916 Rudiansyah 424444 0835/ Terapi 6-May-15 R.Medik 50,000 - 220,000 270,000
917 H.Haerah 834016 0834/ Terapi 6-May-15 R.Medik 50,000 - 220,000 270,000
918 Tunikah 796098 0883/ Terapi 06-May-15 Rehab Medik 50,000 - 220,000 270,000
919 Abdul Nurdi 464739 0847/ Fisioterapi 6-May-15 R.Medik 50,000 - 440,000 490,000
920 Ngantin 834243 1035/ Ft Stroke 06-May-15 Rehab Medik 50,000 - 440,000 490,000
921 Abu Hanifa 805165 1049/ Fisioterapi 06-May-15 Rehab Medik 50,000 - 220,000 270,000
922 Mukid Muly 697376 0897/ Terapi 06-May-15 Rehab Medik 50,000 - 220,000 270,000
923 Sarminto 796814 0848/ Terapi 6-May-15 Rehab Medis 50,000 - 440,000 490,000
924 Sutoyo 836953 1005/ Ft Stroke 06-May-15 Rehab Medik 50,000 - 440,000 490,000
925 Imalasari Pu 571238 0817/ Terapi 6-May-15 R.Medik 50,000 - 440,000 490,000
926 M. Rizki R 707750 0777/ Ot+Tw 06-May-15 Rehab Medik 50,000 - 440,000 490,000
927 M Ridwan Ri397186 0818/ Terapi 6-May-15 R.Medik 50,000 - 440,000 490,000
928 Humairah 622151 0850/ Terapi 6-May-15 Rehab Medik 50,000 - 440,000 490,000
929 Grace Cabri 828527 0775/ Terapi 6-May-15 R.Medik 50,000 - 440,000 490,000
930 Mailiyanti 755386 0862/ Terapi 6-May-15 R.Medik 50,000 - 440,000 490,000
931 Titus Ahma 820014 0997/ Terapi 6-May-15 Rehab Medik 50,000 - 440,000 490,000
932 Herlina 817022 1123/ Terapi 06-May-15 Rehab Medik 50,000 - 159,500 209,500
933 Sahnaz Dwi 677115 0773/ Terapi 6-May-15 Rehab Medis 50,000 - 440,000 490,000
934 Hafiz Nur 811861 0816/ Terapi 6-May-15 R.Medik 50,000 - 220,000 270,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
935 Andhara 613425 0786/ Fisioterapi 6-May-15 Rehab Medis 50,000 - 440,000 490,000
936 Izni Almadi 835545 1090/ Delay Deve 6-May-15 Anak 50,000 35,000 220,000 305,000
937 Aisyah Uzma796280 0789/ Terapi 6-May-15 R.Medik 50,000 - 440,000 490,000
938 M. Atallah 607935 0774/ Terapi 6-May-15 R.Medik 50,000 - 440,000 490,000
939 Ridho Abrar 779669 0881/ Terapi+Post 06-May-15 R.Medik+Orth 50,000 - 220,000 270,000
940 Zahra Arsen 725126 1253/ Terapi 6-May-15 R.Medik 50,000 - 440,000 490,000
941 Aurelia Okt 644812 0819/ Terapi 6-May-15 R.Medik 50,000 - 440,000 490,000
942 M.Dwifa Ca 816594 0861/ Terapi 6-May-15 Rehab Medik 50,000 - 440,000 490,000
943 Ahmad Safa 658272 0831/ Terapi 6-May-15 Rehab Medik 50,000 - 440,000 490,000
944 Damaris Ria 410331 0808/ Terapi 06-May-15 Rehab Medik 50,000 - 159,500 209,500
945 Anton Septi 834585 0864/ Terapi 6-May-15 R.Medik 50,000 - 71,500 121,500
946 Sadariah 419296 0923/ Fisioterapi 6-May-15 Rehab Medis 50,000 - 71,500 121,500
947 Aswin 598995 0664/ Terapi 6-May-15 Rehab Medis 50,000 - 159,500 209,500
948 Hervia 816478 0981/ Terapi 6-May-15 R.Medik 50,000 - 71,500 121,500
949 Hamdanah 563909 0878/ Fisiotherapy 6-May-15 R.Medik 50,000 - 159,500 209,500
950 Marjuki 492002 0695/ Terapi 6-May-15 R Medik 50,000 - 159,500 209,500
951 Sakdiah 822982 0846/ Terapi 6-May-15 R.Medik 50,000 - 159,500 209,500
952 Srianah 834560 0999/ Terapi 6-May-15 R.Medik 50,000 - 71,500 121,500
953 Sano Eriant 054932 0867/ Fisioterapi 06-May-15 Rehab Medik 50,000 - 159,500 209,500
954 Hemi 835300 0944/ Terapi 06-May-15 Rehab Medik 50,000 - 71,500 121,500
955 Hayatun Nis 703100 1104/ Terapi 6-May-15 R.Medik 50,000 - 159,500 209,500
956 Fatmawati 701043 0738/ Terapi 6-May-15 R Medis 50,000 - 71,500 121,500
957 Supiah 475816 0868/ Terapi 06-May-15 Rehab Medik 50,000 35,000 71,500 11,760 168,260
958 Rosma Lela 829922 0722/ Terapi 6-May-15 R Medis 50,000 - 159,500 209,500
959 Gho Kim Ho 739437 0807/ Terapi 06-May-15 Rehab Medik 50,000 - 159,500 209,500
960 Supriani 639809 0998/ Terapi 6-May-15 R.Medik 50,000 - 159,500 209,500
961 Kujainul 835312 0839/ Terapi 06-May-15 Rehab Medik 50,000 - 71,500 121,500
962 M. Abib Aqi 835543 0914/ Gangg. Bica 06-May-15 Anak 50,000 70,000 63,000 183,000
963 Ernawaty 525416 0754/ Terapi 6-May-15 Rehab Medis 50,000 - 71,500 121,500
964 Elisabeth E 492673 0896/ Terapi 06-May-15 Rehab Medik 50,000 - 159,500 209,500
965 Tri Apsah 796454 0943/ Terapi 06-May-15 Rehab Medik 50,000 - 159,500 209,500
966 H.A Moeis 810554 1109/ Terapi 06-May-15 Rehab Medik 50,000 - 71,500 121,500
967 Nurdin 816128 0885/ Terapi 06-May-15 Rehab Medik 50,000 - 71,500 121,500
968 Vicauli Abd 791029 1122/ Terapi 06-May-15 Rehab Medik 50,000 - 71,500 121,500
969 Rustaniah 797036 0635/ Terapi 6-May-15 R Medis 50,000 - 71,500 121,500
970 Tinna 821536 0832/ Terapi 6-May-15 R.Medik 50,000 - 71,500 121,500
971 Susiatin 337059 0707/ Terapi 6-May-15 R Medik 50,000 - 159,500 209,500
972 Maryani 086352 0970/ Terapi 6-May-15 R.Medik 50,000 - 71,500 121,500
973 Fatma 433683 0723/ Terapi 6-May-15 R Medis 50,000 - 159,500 209,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
974 Murikah 598534 0724/ Terapi 6-May-15 R Medik 50,000 - 71,500 121,500
975 Siti Rahmah 742670 0634/ Ft Stroke 6-May-15 Rehab Medis 50,000 - 71,500 121,500
976 Wakiem 701255 0936/ Terapi 6-May-15 R.Medik 50,000 - 71,500 121,500
977 M. Irwan Wi 700898 0791/ Terapi 06-May-15 Rehab Medik 50,000 - 159,500 209,500
978 Ahmad Djai 644885 0778/ Terapi 06-May-15 Rehab Medik 50,000 - 159,500 209,500
979 Asni 816792 0795/ Terapi 06-May-15 Rehab Medik 50,000 - 71,500 121,500
980 Patang Tom 613407 0752/ Kontrol 6-May-15 Mata 50,000 - 50,000
981 Sulami … 1179/ Tumor 6-May-15 Onkologi 50,000 - 50,000
982 M Efffendi 835372 0858/ Chest Pain 6-May-15 Jantung 50,000 - 462,500 512,500
983 Isna 748610 1065/ Ca Mamae S 06-May-15 Onkologi 50,000 35,000 85,000
984 Jean Sarinah 711150 1092/ Ca Mamae 06-May-15 Onkologi 50,000 - 50,000
985 Sri Rusmiati 524368 0721/ 8|Impaksi 6-May-15 Gigi & Mulut 50,000 - 187,000 237,000
986 Esther Sher 835538 0827/ Myopia 6-May-15 Mata 50,000 - 60,000 110,000
987 Sudarsono 835371 0912/ Angina Pec 06-May-15 Jantung 50,000 - 50,000
988 Rina Mardia 835392 1110/ Fix Mandibu 06-May-15 Gigi&Mulut 50,000 - 338,745 6,588 395,333
989 Marinda Fri 840199 1150/ Kontrol 6-May-15 Jantung 50,000 - 649,500 699,500
990 M.Leonand 835376 1192/ Lipoma 6-May-15 Bedah Umum 50,000 - 50,000
991 Nur Azizah 835534 0968/ Tuli 6-May-15 Tht 50,000 - 63,000 113,000
992 Naumi Adeli 676623 0882/ Susp Ruptu 06-May-15 Tht 50,000 - 50,000
993 Ahmad Fauj 835374 1135/ Teling Bern 6-May-15 Tht 50,000 - 50,000
994 Sapariyah 796076 1148/ Ca Mamae 6-May-15 Onkologi 50,000 - 50,000
995 Ropiah 811653 1164/ Tu Mamae S 6-May-15 Onkologi 50,000 - 50,000
996 Adhityastut 820118 1095/ Ca Mamae S 06-May-15 Onkologi 50,000 - 50,000
997 Ernawati 428296 0953/ Kontrol 6-May-15 Bedah Onkolo 50,000 - 50,000
998 Samini 835552 1017/ Susp Disloka 06-May-15 Orthopedi 50,000 - 50,000
999 Watini 835518 0966/ S/ App 6-May-15 Bedah Umum 50,000 35,000 60,000 145,000
1000 Isnawati 837432 1161/ Kontrol 6-May-15 Bedah Umum 50,000 - 125,000 175,000
1001 Nasir 837639 1106/ Retensio Ur 06-May-15 Urologi 50,000 - 187,000 237,000
1002 Risky Syaza 837533 1004/ Multiple Vul 06-May-15 Bedah Anak 50,000 - 79,500 129,500
1003 Edelwais Pa 625315 1014/ 7 7 Gp 6-May-15 Gigi&Mulut 50,000 - 50,000
1004 Witarti 829537 1101/ Imunocompr 6-May-15 Vct 50,000 - 50,000
1005 Tirta Hafiz 835532 0810/ 112 06-May-15 Vct 50,000 - 50,000
1006 Asmuran 675177 0749/ 112 06-May-15 Vct 50,000 - 50,000
1007 Noor Hanifa 611737 1103/ Kontrol 6-May-15 Gigi&Mulut 50,000 - 91,340 141,340
1008 Agus Hariya 835531 0809/ 112 06-May-15 Vct 50,000 - 50,000
1009 Uci Yumina 743954 0915/ Hipertiroid 06-May-15 Penyakit Dala 50,000 - 50,000
1010 Ani Kurnia 644416 0830/ Thalasemia 6-May-15 Dalam 50,000 - 50,000
1011 Sarno 835572 1050/ Gea 06-May-15 Penyakit Dala 50,000 - 50,000
1012 Abd Salim 835547 1118/ Asma 6-May-15 Paru 50,000 - 50,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1013 Rahmatun N 835337 0941/ Kontrol 06-May-15 Kandungan 50,000 - 60,000 110,000
1014 M. Akhyar 734880 0823/ Post Plat R 06-May-15 Orthopedi 50,000 - 50,000
1015 M.Suleman 829942 1240/ Ctev 6-May-15 Ortophedi 50,000 - 212,750 262,750
1016 Fahri Rama 832124 1094/ Post Orif 06-May-15 Orthopedi 50,000 - 50,000
1017 Wisnu Arie 837168 0971/ Fr Humerus 06-May-15 Orthopedi 50,000 - 50,000
1018 M Zacky Al 810859 0767/ Ctev 6-May-15 Orthopedy 50,000 - 50,000
1019 Norma 776861 0813/ Kontrol 6-May-15 Bedah Umum 50,000 - 50,000
1020 Nurhayati 563933 0779/ Post Op Str 06-May-15 Bedah Umum 50,000 - 50,000
1021 Rizki Angga 837059 1251/ Kontrol 6-May-15 Bedah Anak 50,000 - 50,000
1022 M.Alvini Sh 781547 0969/ Hernia Scrot 6-May-15 Bedah Anak 50,000 - 50,000
1023 Fitriyani Res 380759 1056/ Kontrol 6-May-15 Gigi&Mulut 50,000 - 347,490 397,490
1024 Fransisca W 835349 0693/ Chest Pain 6-May-15 Jantung 50,000 - 462,500 512,500
1025 M Saddam 836329 0886/ Kontrol 6-May-15 Bedah Umum 50,000 - 125,000 175,000
1026 Paini 835342 0792/ Struma 06-May-15 Bedah Umum 50,000 35,000 187,000 272,000
1027 Sundarri 828543 1180/ Struma 6-May-15 Bedah Umum 50,000 - 50,000
1028 Wildan Reh 834871 1237/ Kontrol 6-May-15 Anak 50,000 35,000 85,000
1029 Srianah 829935 0982/ Kontrol 6-May-15 Kandungan 50,000 - 60,000 110,000
1030 Rama Inda S 834262 0840/ G2P1A0+Ri 06-May-15 Kandungan 50,000 - 120,500 170,500
1031 Siti Sulimah 835339 0768/ Kontrol 6-May-15 Kandungan 50,000 - 120,500 170,500
1032 Puji Astuti 835504 0678/ Susp Bsu 6-May-15 Urologi 50,000 - 335,000 385,000
1033 Surya Mangi 541180 0787/ Terapi 6-May-15 R.Medik 50,000 - 440,000 490,000
1034 Honny Kusb 653592 0898/ Terapi 06-May-15 Rehab Medik 50,000 - 220,000 270,000
1035 Ernawati 124241 1058/ Kontrol 6-May-15 Rehab Medik+ 50,000 - 220,000 270,000
1036 Ida Ropidah 496479 0650/ Terapi 6-May-15 R Medik 50,000 - 220,000 270,000
1037 Herlinda Yu 805100 0954/ Terapi 6-May-15 R.Medik 50,000 - 220,000 270,000
1038 Nelly 598921 0893/ Terapi 6-May-15 R.Medik 50,000 - 220,000 270,000
1039 Siti Ainah 438360 0928/ Fisioterapi 06-May-15 Rehab Medik 50,000 - 220,000 270,000
1040 Erni Setiawa 132775 0929/ Fisioterapi 06-May-15 Rehab Medik 50,000 - 220,000 270,000
1041 J.Marni 664975 0894/ Fisioterapi 6-May-15 Rehab Medik 50,000 - 220,000 270,000
1042 Juni Ekawti 520388 1642/ G2P1A0 7-May-15 Kandungan 50,000 - 120,500 305,000 7,631 483,131
1043 Sopiah 655365 1333/ Tendonitis 7-May-15 Orthopedi 50,000 35,000 9,106 94,106
1044 Sadirin 835340 1299/ Kontrol 7-May-15 Gigi&Mulut 50,000 - 14,375 64,375
1045 Rajidin 821567 1407/ Abses Perito 7-May-15 Tht 50,000 - 328,150 11,050 389,200
1046 Susarmi 352247 1629/ Kontrol 7-May-15 Bedah Umum 50,000 35,000 60,000 305,000 1,525 451,525
1047 Alberta Airl 835325 1478/ 8 Impaksi 7-May-15 Gigi&Mulut 50,000 35,000 576,400 211,750 873,150
1048 H Zamansya 787675 1037/ Rhinitis Ale 7-May-15 Tht + Saraf 50,000 70,000 12,569 132,569
1049 Maraitang 828230 1484/ S/ Isk 7-May-15 Urologi 50,000 - 40,538 90,538
1050 Satria Dg C 787528 1378/ Dm 7-May-15 P. Dalam 50,000 - 31,050 81,050
1051 Umar Faruq 742451 1155/ Epilepsi 7-May-15 Syaraf 50,000 - 156,750 206,750
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1052 Nabila Anis 791542 1098/ Tb Paru 7-May-15 Anak 50,000 - 1,500 51,500
1053 Dias Ainurr 713482 1568/ Post Op 7-May-15 Bedah Syaraf 50,000 - 1,200 51,200
1054 M.Badri 423957 1507/ Cad+Bph 7-May-15 Jtng+Urologi 50,000 35,000 321,263 406,263
1055 Paidi 700205 1344/ Decom 7-May-15 Jantung 50,000 35,000 647,650 163,013 895,663
1056 Syafrudin Ch 647395 1476/ Oma 7-May-15 Tht 50,000 - 6,419 56,419
1057 Syahrani 832492 1379/ Haematuri 7-May-15 Urologi 50,000 - 335,000 44,250 34,819 464,069
1058 Elisa Marsi 534269 1552/ Lbp 7-May-15 P. Dalam 50,000 - 1,525 51,525
1059 Mursidah 529314 1380/ Pjk 7-May-15 Jantung 50,000 - 457,250 40,300 547,550
1060 Syakkawi 775119 1416/ Pjk 7-May-15 Jantung 50,000 - 185,613 235,613
1061 Lahuseng 834859 1614/ Nyeri Saat 7-May-15 Urologi 50,000 - 319,689 369,689
1062 Irwan Naba 648833 1569/ Kontrol 7-May-15 Anak 50,000 - 38,500 88,500
1063 Hairul Gani 659801 1097/ Pjk 7-May-15 Jantung 50,000 - 61,838 111,838
1064 Marlis Afri 476457 0904/ Kontrol 7-May-15 Syaraf 50,000 - 16,774 66,774
1065 Karni 772413 1453/ Pjk 7-May-15 Jantung 50,000 - 66,150 116,150
1066 Masriani 834225 1115/ 8 Linguo Ve 7-May-15 Gigi & Mulut 50,000 - 274,020 7,753 331,773
1067 Sumarsih 835588 1317/ Abd Discomf 7-May-15 P. Dalam 50,000 35,000 335,000 219,500 1,472,900 1,963 2,114,363
1068 Zahra Aseni 725126 0919/ Hidrocepalu 7-May-15 Bedah Saraf 50,000 - 1,740 51,740
1069 Herlina Efen 770064 1626/ Cepalgia 7-May-15 Syaraf 50,000 - 43,398 93,398
1070 Juwatim 835555 1158/ Chest Pain 7-May-15 Jantung 50,000 - 462,500 19,788 532,288
1071 Annisa Resk 835597 1612/ 21 12 Gingiv 7-May-15 Gigi&Mulut 50,000 - 579,150 10,969 640,119
1072 Rukiah 276075 1285/ Ht+Dm 7-May-15 Dalam+Jantun 50,000 35,000 1,326,309 1,411,309
1073 Maimunah 190312 1346/ Parkinson 7-May-15 Syaraf 50,000 - 189,375 239,375
1074 Erliani 835594 1582/ Bell Palsy 7-May-15 Ortophedi 50,000 - 9,106 59,106
1075 Sujarwati 835510 1495/ Ckd 7-May-15 P. Dalam 50,000 - 72,225 122,225
1076 Nur Alang 821890 1422/ Hipertiroid 7-May-15 P. Dalam 50,000 - 58,929 108,929
1077 Nur Indayat 184988 1364/ Dm 7-May-15 P. Dalam 50,000 - 481,550 531,550
1078 Ramos M Sa 821826 1036/ Bsk 7-May-15 Urologi 50,000 - 122,925 172,925
1079 Yohana Dom 333227 1423/ Ht 7-May-15 P. Dalam 50,000 - 1,650 51,650
1080 H Nanang 712131 1083/ Post Tb 7-May-15 Paru 50,000 - 160,250 125,400 45,188 380,838
1081 Sudirman 781427 1376/ Hipertiroid 7-May-15 P. Dalam 50,000 - 16,838 66,838
1082 Syamsuddin 835595 1425/ Kontrol 7-May-15 Bedah Umum 50,000 - 438,400 377,500 125,400 11,225 1,002,525
1083 Sunarsih 640572 1130/ Ht 7-May-15 P. Dalam 50,000 - 13,938 63,938
1084 Masda'In 186089 1365/ Pjk 7-May-15 Jantung 50,000 - 49,850 99,850
1085 Supatrah 447679 0920/ Bph 7-May-15 Urologi 50,000 35,000 251,138 336,138
1086 Siti Fatimah 828538 1536/ Kontrol 7-May-15 Bedah Umum 50,000 - 125,000 12,325 187,325
1087 Ahmadi 497689 1196/ Dm+Pjk 7-May-15 P.Dalam+Jant 50,000 35,000 187,000 366,903 638,903
1088 Suhendro 834271 1067/ Susp Hepatit 7-May-15 P. Dalam 50,000 70,000 1,763,300 571,212 2,454,512
1089 Fatimah 427648 1597/ Nyeri Kaki K 7-May-15 Ortophedi 50,000 - 501,600 7,938 559,538
1090 Sulasih 830644 1070/ Dm 7-May-15 P. Dalam 50,000 35,000 82,919 167,919
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1091 Juniarti Nu 650321 1313/ 11 21 Karie 7-May-15 Gigi&Mulut 50,000 - 115,408 550 165,958
1092 M. Azzam 835901 1470/ Mimisan 7-May-15 Tht 50,000 - 6,071 56,071
1093 M.Hatta 480715 1508/ Pjk 7-May-15 Jantung 50,000 - 49,438 99,438
1094 Kipli 835581 1169/ Susp Bph 7-May-15 Urologi 50,000 - 335,000 628,200 137,213 1,150,413
1095 Bahrudin 835566 1055/ Sindrum Dis 7-May-15 P. Dalam 50,000 - 102,200 152,200
1096 Giva Aurel 822526 1644/ Hematemesi 7-May-15 P. Dalam 50,000 - 29,469 79,469
1097 Rahman Ban 662272 0963/ Mikrohematu 7-May-15 Urologi 50,000 - 335,000 365,950 1,472,900 140,375 2,364,225
1098 Sumilah 515961 1305/ Pjk+Pseudof 7-May-15 Mata 50,000 - 60,000 110,250 41,666 261,916
1099 Zahra Putri 816567 0917/ Kontrol 7-May-15 P. Dalam 50,000 - 153,500 1,472,900 18,488 1,694,888
1100 Eny Tyas Pu 479521 1659/ Kontrol 7-May-15 Kandungan 50,000 - 120,500 21,088 191,588
1101 Mukag 135247 1645/ Ht 7-May-15 P. Dalam 50,000 - 14,275 64,275
1102 Ariani 833374 1491/ Open Fr Dig 7-May-15 Ortophedi 50,000 - 80,000 3,638 133,638
1103 Sy. Nur Kho 575298 1492/ Epilepsi 7-May-15 Syaraf 50,000 - 105,338 155,338
1104 Anwar 811063 1023/ Kontrol 7-May-15 Mata 50,000 - 60,000 54,035 164,035
1105 Suhaidah 360485 1360/ Dm 7-May-15 P. Dalam 50,000 35,000 335,000 1,963 421,963
1106 Maria Goret
835592/8370881553/ Kontrol 7-May-15 Kulit Kelamin 50,000 35,000 57,539 142,539
1107 Karsuni 825954 1181/ Post Snh+H 7-May-15 Syaraf+P.Dala 50,000 35,000 22,013 107,013
1108 Anny Maisy 420866 1021/ Dm 7-May-15 P. Dalam 50,000 - 1,013,644 1,063,644
1109 Sugiyanto 748332 1282/ Fisioterapi 7-May-15 R. Medik 50,000 - 220,000 14,888 284,888
1110 Imelda Helm 526849 1437/ Tb Paru+Tons 7-May-15 Anak 50,000 - 17,788 67,788
1111 Asrak 802477 1418/ Kontrol 7-May-15 Jantung 50,000 35,000 423,563 508,563
1112 Megawati 496833 1212/ Dm+Ht 7-May-15 P. Dalam 50,000 - 271,575 321,575
1113 Sudarni 702032 1342/ Hipertiroid 7-May-15 P. Dalam 50,000 - 27,975 77,975
1114 Sarifuddin 835589 1332/ Shoulder Pa 7-May-15 Syaraf 50,000 - 14,595 64,595
1115 Parenrengi 098847 1599/ Dm Ht 7-May-15 P. Dalam 50,000 - 19,150 69,150
1116 Maskur Ham 835586 1273/ Bph 7-May-15 Urologi 50,000 - 335,000 567,350 145,200 137,213 1,234,763
1117 Janariah 463441 0905/ Kontrol 7-May-15 P. Dalam 50,000 35,000 71,500 227,700 393,094 777,294
1118 Zulkifli Hg 837630 1524/ Kontrol 7-May-15 P. Dalam 50,000 - 402,500 38,200 490,700
1119 Idarsiah 430638 1393/ Kontrol 7-May-15 Syaraf 50,000 - 16,315 66,315
1120 Iskandar As 155954 1372/ Kontrol+Ter 7-May-15 Rehab Medis+ 50,000 35,000 159,500 95,550 340,050
1121 Fardiyansyah795469 1053/ Tb Paru 7-May-15 Paru 50,000 - 27,746 77,746
1122 Sukri 463499 1155/ Terapi+Disl 7-May-15 R.Medik+Orth 50,000 35,000 159,500 9,919 254,419
1123 Sri Wahidah 811078 1431/ Dermatitis A 7-May-15 Tht 50,000 - 92,938 142,938
1124 Abdul Hami 604790 1341/ Pjk 7-May-15 Jantung 50,000 - 418,250 68,535 536,785
1125 Jemu 651641 1286/ Hemaptoe 7-May-15 Paru 50,000 - 84,000 28,875 162,875
1126 Wariati 582263 1243/ Dm 7-May-15 P. Dalam 50,000 - 153,638 203,638
1127 Umarlin 226700 1464/ Ht 7-May-15 Jantung 50,000 - 262,825 312,825
1128 Jumansyah 836773 1417/ Kontrol 7-May-15 P. Dalam 50,000 - 320,963 370,963
1129 Hairunnisa 268925 1214/ Dm 7-May-15 P. Dalam 50,000 35,000 208,391 293,391
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1130 Koko Majoy 744577 1198/ Dm 7-May-15 P. Dalam 50,000 - 15,218 65,218
1131 Zainudin 739858 1242/ Ppok 7-May-15 Paru 50,000 - 76,819 126,819
1132 Tumini 610772 0902/ Dm 7-May-15 P. Dalam 50,000 - 178,924 228,924
1133 Darto 440365 0935/ Dm 7-May-15 P. Dalam 50,000 - 442,838 492,838
1134 Nurhadiyant 320110 1230/ Terapi+Ceph 7-May-15 Syaraf+R.Med 50,000 35,000 71,500 25,055 181,555
1135 Suhaimi 757922 1258/ Chd 7-May-15 Jantung 50,000 - 462,500 301,163 813,663
1136 Dhyni Atika 648895 1510/ Epilepsi 7-May-15 Syaraf 50,000 - 38,880 88,880
1137 Hadijah 832263 1349/ Melena 7-May-15 P. Dalam 50,000 - 64,463 114,463
1138 Erni Kursan 732415 0980/ Ckd 7-May-15 P. Dalam 50,000 - 101,850 151,850
1139 Ernawati 834207 1328/ Ht 7-May-15 P. Dalam 50,000 - 274,313 324,313
1140 Nur Soffiya 826786 0931/ Kontrol 7-May-15 Anak 50,000 - 57,567 107,567
1141 Suriansyah 483367 0991/ Konstipasi 7-May-15 P. Dalam 50,000 - 102,200 152,200
1142 Raudah 826607 1168/ Post Snh 7-May-15 Syaraf 50,000 - 39,788 89,788
1143 Kristina Les 268880 1284/ Ht Gr Ii 7-May-15 Jantung 50,000 35,000 173,569 258,569
1144 Suparti 487344 0947/ Kontrol 7-May-15 Dalam + Tht 50,000 35,000 225,000 182,463 492,463
1145 Nurlela 835582 0949/ Shoulder Pa 7-May-15 Syaraf 50,000 - 6,231 56,231
1146 Azis M. 821833 1227/ Artralgia 7-May-15 P. Dalam 50,000 - 61,098 111,098
1147 Ahmad Khoi 671879 1269/ Terapi 7-May-15 R,.Medik 50,000 35,000 71,500 20,228 176,728
1148 Elinda Ayu 835583 0962/ Sakit Kepala 7-May-15 Anak 50,000 - 10,674 60,674
1149 Rustinah 836364 1404/ Melena 7-May-15 P. Dalam 50,000 - 920,000 60,725 1,030,725
1150 Asnan Nurd 757693 0979/ Kontrol 7-May-15 Syaraf 50,000 - 15,833 65,833
1151 Juli Rahman 706197 1259/ Sn 7-May-15 Anak 50,000 - 44,250 7,848 102,098
1152 M. Rojani 834841 1350/ Kontrol 7-May-15 Bedah Syaraf 50,000 - 39,848 89,848
1153 Pasri 835570 1100/ Corpus Alie 7-May-15 Mata 50,000 - 120,000 2,050 172,050
1154 Anita 837299 1084/ Kontrol 7-May-15 Kandungan 50,000 - 60,000 3,563 113,563
1155 Abdul Khair 780503 0950/ Terapi + Kon 7-May-15 R Medis + Ort 50,000 35,000 159,500 36,738 281,238
1156 Warni 753983 1288/ Spondilitis 7-May-15 Orthopedi 50,000 35,000 159,500 3,204,300 8,794 3,457,594
1157 Munifah 835590 1522/ Serumen 7-May-15 Tht 50,000 - 63,000 30,883 143,883
1158 Supiah 419718 1395/ Post Op 7-May-15 Orthopedi 50,000 - 80,000 125,400 7,631 263,031
1159 Vita Seri Ya 570063 1066/ Kontrol 7-May-15 Anak 50,000 - 43,250 9,180 102,430
1160 Noorida Hid 835569 1082/ Kontrol 7-May-15 Gigi & Mulut 50,000 - 8,363 58,363
1161 Muliati Iton 445152 1584/ Chest Pain 7-May-15 Jantung 50,000 - 58,875 108,875
1162 Hamdiah 787800 1081/ Katarak + H 7-May-15 Mata 50,000 - 20,810 70,810
1163 Zainal Abidi 113381 1025/ Epilepsi 7-May-15 Syaraf 50,000 - 294,863 344,863
1164 Nijamudin 532167 1303/ Pjk 7-May-15 Jantung 50,000 - 61,823 111,823
1165 Muryanto 141158 1596/ Kontrol 7-May-15 Ortophedi 50,000 - 11,906 61,906
1166 Hartawan 446291 1371/ Dm Type Ii 7-May-15 P. Dalam 50,000 35,000 186,713 271,713
1167 Wagino 653021 1318/ Bph 7-May-15 Urologi 50,000 - 292,875 342,875
1168 Asni 789224 1419/ Pjk 7-May-15 Jantung 50,000 - 422,100 472,100
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1169 Elsya Nur K 787811 1583/ Spendilitis 7-May-15 Ortopedi 50,000 - 22,463 72,463
1170 Siti Saimah 511245 1424/ Epilepsi 7-May-15 Syaraf 50,000 - 96,536 146,536
1171 Nor Aida 740986 1440/ Epilepsi 7-May-15 Syaraf 50,000 - 56,925 106,925
1172 Megawati 695482 1171/ Menometror 7-May-15 Kandungan 50,000 - 60,000 305,000 29,800 444,800
1173 Dwi Meiono 648647 1085/ Lbp 7-May-15 Syaraf 50,000 - 5,463 55,463
1174 Andi Suhae 835321 1436/ Obs Cephalg 7-May-15 Syaraf 50,000 - 10,048 60,048
1175 Karmila Sar 705994 1481/ G4P3A0+Ht 7-May-15 Kandungan 50,000 - 120,500 37,475 207,975
1176 Afdaliansya 525850 1387/ Dm Ii 7-May-15 P. Dalam 50,000 35,000 5,450 90,450
1177 Djufri Supa 769385 1024/ Gastritis 7-May-15 P. Dalam 50,000 35,000 325,331 410,331
1178 Bayu Purwa 817403 1671/ Post Ckr 7-May-15 Syaraf 50,000 - 7,960 57,960
1179 Fahrun Nisa 800899 1126/ Kista Coklat 7-May-15 Kandungan 50,000 - 60,000 757,390 867,390
1180 Gafar Kasim 634814 1439/ Cad+Ht 7-May-15 Jantung 50,000 - 199,050 249,050
1181 Hairullah 711298 1447/ Cepalgia 7-May-15 Syaraf 50,000 35,000 71,500 3,900 160,400
1182 Sahlan 835320 1660/ Faringitis 7-May-15 Anak 50,000 - 16,918 66,918
1183 Muryati 764196 1628/ Ht 7-May-15 Jantung 50,000 - 65,413 115,413
1184 Muhammad 475590 1096/ Ht Cad 7-May-15 Jantung 50,000 - 42,713 92,713
1185 Kartini Dg 835401 1585/ Terapi 7-May-15 R.Medik 50,000 35,000 71,500 7,313 163,813
1186 Rita Sulisty 834222 1506/ Ulkus Pepti 7-May-15 P. Dalam 50,000 35,000 62,531 147,531
1187 Siti Fatimah 821565 1113/ Kontrol 7-May-15 Jantung 50,000 - 462,500 38,681 551,181
1188 Lindra Waty 676698 0916/ Lbp 7-May-15 Orthopedi 50,000 - 9,756 59,756
1189 Pahrin Ak 739331 1314/ S/ Bph 7-May-15 Urologi 50,000 - 430,088 480,088
1190 Effendi 458722 1343/ 4 Tekstur Ma 7-May-15 Gigi & Mulut 50,000 - 1,923,276 20,200 1,993,476
1191 Fauziah 671898 1200/ Pjk 7-May-15 Jantung 50,000 - 171,663 221,663
1192 Mangarpen 712829 1274/ Psoriasis 7-May-15 Kulit Kelamin 50,000 - 38,499 88,499
1193 Sayid Abdu 833353 1226/ Efusi Pleur 7-May-15 Paru+Jantung 50,000 - 20,063 70,063
1194 Ahmad Suda 581234 0903/ Dm 7-May-15 P. Dalam 50,000 - 41,036 91,036
1195 Yulia Dewi 456972 1154/ Dm+Ht 7-May-15 P. Dalam 50,000 - 64,163 114,163
1196 Nurlaila 701243 1138/ Dm+Ht 7-May-15 P. Dalam 50,000 - 405,724 455,724
1197 Maryati 528573 1125/ Dm 7-May-15 P. Dalam 50,000 - 424,050 474,050
1198 Nilam Wati 790928 1483/ Mioma Uter 7-May-15 Kandungan 50,000 - 60,000 14,250 124,250
1199 Jariah 676633 1446/ Spendilitis 7-May-15 Ortophedi 50,000 35,000 71,500 6,263 162,763
1200 Hasanudin 835568 1069/ Susp Tb Par 7-May-15 Paru 50,000 - 160,250 29,788 240,038
1201 Aisyah 498186 1327/ Kontrol 7-May-15 Jantung 50,000 - 75,650 125,650
1202 Herawati 604721 0993/ Kontrol 7-May-15 Syaraf 50,000 - 39,788 89,788
1203 Haling 821591 1361/ Kontrol 7-May-15 Tht 50,000 35,000 63,000 70,983 218,983
1204 Aisjah Joha 796894 0932/ Fisiotherapy 7-May-15 R. Medik 50,000 35,000 71,500 12,850 169,350
1205 Muprika Ha 840132 1434/ S Gout 7-May-15 P. Dalam 50,000 - 44,000 188,100 20,063 302,163
1206 M. Raffa Ag 835341 1363/ Serumen 7-May-15 Tht 50,000 - 63,000 30,883 143,883
1207 Fatmawati 776294 1283/ Dm Ii 7-May-15 P. Dalam 50,000 35,000 60,000 305,000 41,913 491,913
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1208 Afriadi Les 835382 1525/ S/ Pneumon 7-May-15 Paru 50,000 - 116,500 12,731 179,231
1209 H. Rusdi 766010 1290/ Epilepsi 7-May-15 Syaraf 50,000 - 87,188 137,188
1210 Achmad Taja 825641 1375/ Pjk 7-May-15 Jantung 50,000 - 184,875 234,875
1211 H.Abd.Kadi 509183 1329/ Neralgia 7-May-15 Syaraf 50,000 - 26,063 76,063
1212 Hasnah 292220 1374/ Pjk 7-May-15 Jantung 50,000 35,000 227,700 220,255 532,955
1213 Anton Septi 834585 1167/ Terapi 7-May-15 R.medik 50,000 35,000 159,500 3,000 247,500
1214 Rabbi Julian 840113 1348/ Ket+Anemia 7-May-15 Kandungan 50,000 - 60,000 21,088 131,088
1215 Kurnia 810141 1185/ Hhd 7-May-15 Jantung 50,000 - 462,500 258,938 771,438
1216 Isna 211945 1326/ Ht 7-May-15 Jantung 50,000 - 41,100 91,100
1217 Darham 463315 1315/ Dm 7-May-15 P. Dalam 50,000 - 331,350 381,350
1218 Tutik Rahay 742172 0946/ Fisioterapi 7-May-15 R Medik+Dal 50,000 35,000 220,000 25,463 330,463
1219 Dahlan 446630 1462/ S/ Kp 7-May-15 Paru 50,000 - 120,525 170,525
1220 Salmo 805122 1386/ Dermatitis 7-May-15 Kulit Kelami 50,000 35,000 189,448 274,448
1221 Dwi Oktoria 575686 0890/ Epilepsi 7-May-15 Syaraf 50,000 - 294,863 344,863
1222 Huzway Aks 625669 1420/ Vertigo 7-May-15 P. Dalam 50,000 - 23,369 73,369
1223 Achmad Jun 835303 1390/ Gangren Ped 7-May-15 P. Dalam 50,000 - 500,250 550,250
1224 A Rifai 691136 0977/ Cek Lab 7-May-15 P. Dalam 50,000 - 252,500 302,500
1225 Usmi Rotu 835585 1401/ G4P2A1 Pe 7-May-15 Kandungan 50,000 - 60,000 526,150 636,150
1226 Tawakal 542542 1256/ Post Hemoro 7-May-15 Bedah Umum 50,000 - 821,400 871,400
1227 Tohir 835596 1438/ Hernia Scrot 7-May-15 Bedah Umum 50,000 - 394,150 125,400 569,550
1228 Sahadiah 686529 1330/ Dm 7-May-15 P. Dalam 50,000 - 500,250 550,250
1229 Siti Nur Kh 821126 1335/ G2P1A0+Le 7-May-15 Kandungan 50,000 - 120,500 438,400 305,000 913,900
1230 Painah 829959 1469/ Soft Tissue 7-May-15 Bedah Umum 50,000 - 394,150 444,150
1231 Muhammad 458143 1389/ Terapi 7-May-15 Syaraf 50,000 - 462,500 512,500
1232 Mesran 177503 1345/ Dm Type Ii+ 7-May-15 Jantung 50,000 - 418,250 468,250
1233 Mariyana 775232 1521/ Hipertiroid 7-May-15 P. Dalam 50,000 - 498,800 548,800
1234 Mariyana 711299 1302/ Isk 7-May-15 P. Dalam 50,000 35,000 60,000 44,250 189,250
1235 Fitri Sahwa 574388 1388/ Kontrol 7-May-15 Bedah Umum 50,000 - 438,400 377,500 865,900
1236 Harisa 820131 1275/ Kontrol 7-May-15 P. Dalam 50,000 - 110,250 160,250
1237 Daslan 532268 1334/ Dm 7-May-15 P. Dalam 50,000 - 500,250 550,250
1238 Chelsea Ana 686816 1112/ Kontrol 7-May-15 Bedah Umum 50,000 - 728,300 778,300
1239 Anwarye 763816 1509/ Tumor Jinak 7-May-15 Bedah Umum 50,000 - 746,250 377,500 125,400 1,299,150
1240 Syahrina 821166 1301/ Post Kuret 7-May-15 Kandungan 50,000 - 60,000 1,119,800 1,229,800
1241 Tasya Firma 764297 1454/ Pandangan 7-May-15 Mata 50,000 - 483,450 533,450
1242 Tukiman 835525 1347/ Kontrol 7-May-15 P. Dalam 50,000 35,000 985,100 1,070,100
1243 M.Imran 774215 1555/ S/ Tu Nasal 7-May-15 Tht 50,000 - 394,150 105,600 549,750
1244 Mardayah 835584 1054/ Dm 7-May-15 P. Dalam 50,000 35,000 110,250 195,250
1245 Mahdaleni 816570 1656/ Nyeri Pingg 7-May-15 P. Dalam 50,000 - 500,250 550,250
1246 Erhamsyah 835900 1657/ Dm 7-May-15 P. Dalam 50,000 - 500,250 550,250
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1247 Gafar Kasim 634814 1439/ Cad+Ht 7-May-15 Jantung 50,000 - 500,250 550,250
1248 Aminah 447319 1228/ Mucocele 7-May-15 Gigi&Mulut 50,000 35,000 579,150 187,000 243,750 1,094,900
1249 Septia Nur 835902 1482/ Anemia Sek 7-May-15 Kandungan 50,000 - 305,000 355,000
1250 Shopiah 835591 1539/ G4P3A0 7-May-15 Kandungan 50,000 - 120,500 305,000 475,500
1251 Ike Niarawat 835587 1289/ Palatoschisi 7-May-15 Gigi&Mulut 50,000 - 160,600 210,600
1252 Anisah Mufi 670042 0995/ 1|Np 7-May-15 Gigi & Mulut 50,000 - 341,392 93,115 484,507
1253 Nur Muspia 505035 1099/ Chf 7-May-15 Jantung 50,000 - 980,000 1,030,000
1254 Esri Sirende 813465 1581/ Haid Tidak 7-May-15 Kandungan 50,000 - 175,000 225,000
1255 Nurhayati 825912 0992/ Terapi 7-May-15 R Medik 50,000 - 71,500 121,500
1256 Siti Masnah 184204 1271/ Fisioterapi 7-May-15 R Medik 50,000 - 71,500 121,500
1257 Musningsih 549641 1448/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1258 Yenni Purwa 631789 1007/ Terapi 7-May-15 R Medik 50,000 - 71,500 121,500
1259 Kasdi 834604 0976/ Terapi 7-May-15 R Medik 50,000 - 159,500 209,500
1260 Amanat Lail 828568 1260/ Terapi 7-May-15 R Medik 50,000 - 159,500 209,500
1261 Viknatul Lei 829364 1039/ Terapi 7-May-15 R Medik 50,000 - 71,500 121,500
1262 Suhery 822948 1567/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1263 Agus 671123 1673/ Terapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1264 Pasha Dika 730129 1554/ Terapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1265 Aisyah Nabi 485975 1142/ Terapi 7-May-15 R.Medik 50,000 - 440,000 490,000
1266 Sujarni 800848 1241/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1267 M.Sefianto 729676 1480/ Terapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1268 M.Hasby 485975 1141/ Terapi 7-May-15 R.Medik 50,000 - 440,000 490,000
1269 Abdillah Fik 488012 1128/ Terapi 7-May-15 R.Medik 50,000 - 440,000 490,000
1270 Wahab Nur 799076 1391/ Terapi 7-May-15 R.Medik 50,000 - 440,000 490,000
1271 Amira 821585 1184/ Terapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1272 Iqbal Amru 399588 1551/ Terapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1273 Mariam Ulfa 834596 1331/ Terapi 7-May-15 R.Medik 50,000 - 440,000 490,000
1274 Siti Liza 768432 1038/ Fisiotherapy 7-May-15 R.Medik 50,000 - 440,000 490,000
1275 Annisa Dewi 326044 1540/ Terapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1276 Muhammadn666097 1270/ Terapi 7-May-15 R.Medik 50,000 - 440,000 490,000
1277 Rafael Ham 757444 1137/ Ot+Tw 7-May-15 R.Medik 50,000 - 440,000 490,000
1278 Aly Syawal 810107 1136/ Tw+Ot 7-May-15 R.Medik 50,000 - 440,000 490,000
1279 M. Kenzie 679791 1357/ Terapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1280 M Yusuf 781487 1068/ Terapi 7-May-15 R Medik 50,000 - 220,000 270,000
1281 Dewi Kartik 824703 1129/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1282 Yiyin Sumar 740906 1143/ Fisiotherapy 7-May-15 R.Medik 50,000 - 71,500 121,500
1283 Miftahul Ja 615499 1160/ Terapi 7-May-15 R Medik 50,000 - 71,500 121,500
1284 Masrun Maj 639948 1156/ Fisioterapi 7-May-15 R Medik 50,000 - 159,500 209,500
1285 Asmini 795280 1145/ Fisioterapi 7-May-15 R Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1286 Noor Patima 622484 1672/ Terapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1287 Buatik 824550 1449/ Terapi 7-May-15 R.Medik 50,000 - 379,500 429,500
1288 Kasmijan 829312 1010/ Terapi 7-May-15 R Medik 50,000 - 159,500 209,500
1289 Rafid Charl 736801 1356/ Terapi 7-May-15 R Medik 50,000 - 440,000 490,000
1290 Ponijem 659169 0901/ Fisiotherapy 7-May-15 R Medik 50,000 - 440,000 490,000
1291 M. Rizky R 828577 1152/ Ot+Tw 7-May-15 R Medik 50,000 - 440,000 490,000
1292 Muryati 731325 1006/ Fisiotherapy 7-May-15 R Medik 50,000 - 440,000 490,000
1293 Aris Rahman 784378 1197/ Terapi 7-May-15 R Medik 50,000 - 440,000 490,000
1294 Sarman 759016 1304/ Fisioterapi 7-May-15 R Medik 50,000 - 220,000 270,000
1295 Hasnawati 762606 1151/ Terapi 7-May-15 R Medik 50,000 - 440,000 490,000
1296 Siti Kalsum 783907 1144/ Terapi 7-May-15 R Medik 50,000 - 71,500 121,500
1297 Marsidi 720910 0948/ Terapi 7-May-15 R Medik 50,000 - 159,500 209,500
1298 Sri Kuswati 834801 1450/ Terapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1299 Iskandar 077736 0964/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1300 Supatmi 801314 1199/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1301 Rosma Lela 829922 0994/ Terapi 7-May-15 R Medis 50,000 - 71,500 121,500
1302 Nurdin Doni 712854 1244/ Fisioterapi 7-May-15 R Medis 50,000 - 159,500 209,500
1303 Parmin 821532 0965/ Terapi 7-May-15 R Medis 50,000 - 159,500 209,500
1304 Juwariyah 729629 1373/ Terapi 7-May-15 R Medis 50,000 - 159,500 209,500
1305 Eko Minarn 810163 1410/ Terapi 7-May-15 R Medis 50,000 - 71,500 121,500
1306 Rose 835505 0918/ Nyeri Tulan 7-May-15 R Medis 50,000 - 71,500 121,500
1307 Ernie Bs 815417 1566/ Terapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1308 Suyati 213400 0934/ Terapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1309 Norliana 521951 1421/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1310 Ngatemi 565526 1257/ Terapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1311 Suwati 706124 1139/ Terapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1312 Putri 833840 1402/ Terapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1313 Kujainul 835312 1215/ Terapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1314 Rusdiana 806016 1182/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1315 Asni 816792 1287/ Terapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1316 Sakdiah 822982 1166/J Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1317 Panirah 822928 1298/ Terapi 7-May-15 R.Medik 50,000 35,000 71,500 156,500
1318 Sumiyat 821102 1297/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1319 Sumiati 671273 1213/ Terapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1320 Aliyah 730090 1281/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1321 H. M. Kosi 750140 1153/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1322 Jasmah 434885 1312/ Terapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1323 Supatmi 805133 1358/ Terapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1324 NoR Hidaya 631443 1359/ Fisiotherapy 7-May-15 R.Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1325 Mastora 565491 1124/ Fisioterapi 7-May-15 R.Medik 50,000 - 71,500 121,500
1326 Hartini Joha 769333 0933/ Fisiotherapy 7-May-15 R.Medik 50,000 - 159,500 209,500
1327 Marliana 822596 1432/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1328 Inem 534202 1463/ Terapi 7-May-15 R.Medik 50,000 - 159,500 209,500
1329 Tamrin 734971 1643/ 8 Karies 7-May-15 Gigi&Mulut 50,000 - 50,000
1330 Raden Roro S834296 1316/ 8 Impaksi 7-May-15 Gigi&Mulut 50,000 - 50,000
1331 Sujianti 786751 1008/ Susp Limph 7-May-15 Bedah 50,000 - 50,000
1332 Ariah 835540 1377/ Susp Hipert 7-May-15 Kandungan 50,000 35,000 120,500 205,500
1333 Maulidiya Pu834588 1523/ Kejang De 7-May-15 Anak 50,000 35,000 85,000
1334 Mantulangi 828341 1537/ Keloid 7-May-15 Bedah Umum 50,000 - 120,500 170,500
1335 Syifa Aldha 776823 1362/ Fam 7-May-15 Bedah Umum 50,000 - 50,000
1336 Hj.Nursiah 835598 1613/ Kontrol 7-May-15 Bedah Umum+ 50,000 - 50,000
1337 Uyang Imau 403920 1433/ Jari Kelingk 7-May-15 Bedah Umum 50,000 - 50,000
1338 Fitriansyah 835553 1641/ Lipoma 7-May-15 Bedah Umum 50,000 - 50,000
1339 Hasriani 607152 1408/ Tumor 7-May-15 Bedah Umum 50,000 - 125,000 175,000
1340 Sumarno 834803 1403/ Kontrol 7-May-15 Bedah Umum 50,000 - 125,000 175,000
1341 Jumiyati 828964 1538/ 7 Nekrose 7-May-15 Gigi&Mulut 50,000 - 91,340 141,340
1342 M. Betrand 164054 1467/ 21 Period 7-May-15 Gigi&Mulut 50,000 - 50,000
1343 Juwariyah 834558 1406/ Dm Tipe Ii 7-May-15 P. Dalam 50,000 - 402,500 452,500
1344 Aulia Anggr 835338 0961/ Oma 7-May-15 Tht 50,000 - 63,000 113,000
1345 Wahyu Ruli 829826 1570/ Post Debrid 7-May-15 Ortophedi 50,000 - 80,000 130,000
1346 Salamah 644075 1615/ Kontrol 7-May-15 Tht 50,000 - 50,000
1347 Sri Maryant 816167 1493/ Kontrol 7-May-15 Tht 50,000 - 50,000
1348 Nur Sifa 829314 1319/ Serumen+O 7-May-15 Tht 50,000 - 63,000 113,000
1349 Meri Periant 833150 1311/ Kontrol 7-May-15 Saraf+Dalam 50,000 - 355,000 405,000
1350 Nadia Nurma814037 1494/ Hernia Ingui 7-May-15 Anak 50,000 35,000 85,000
1351 Rupiatun 834847 1479/ 12 Caries 7-May-15 Gigi&Mulut 50,000 - 115,408 165,408
1352 Susi Susanti 834846 1477/ 1 Period 7-May-15 Gigi&Mulut 50,000 - 115,408 165,408
1353 Fitri Elok S. 798058 1468/ Kontrol 7-May-15 Vct 50,000 - 50,000
1354 Anas Maruf 829345 1435/ Arv 7-May-15 Vct 50,000 - 50,000
1355 Rachel Ama 821849 0978/ Kontrol 7-May-15 Syaraf 50,000 - 50,000
1356 M.Untung B 826529 1598/ Kontrol 7-May-15 Bedah Syaraf 50,000 - 50,000
1357 Purnomo 829573 1052/ Hiv 7-May-15 Vct 50,000 - 50,000
1358 Soegiyanto 830104 1009/ 112 7-May-15 Vct 50,000 - 50,000
1359 Yermia Lim 763369 1630/ 112 7-May-15 Vct 50,000 - 50,000
1360 Musinah 835319 1114/ Kontrol 7-May-15 Jantung 50,000 - 462,500 512,500
1361 Agung Okta 827159 1600/ Kontrol 7-May-15 Anak 50,000 - 50,000
1362 Ningsih 835542 1320/ Ht Gr Ii 7-May-15 Jantung 50,000 - 462,500 512,500
1363 A Fahrizal P 536094 1040/ Susp Hiperti 7-May-15 Anak 50,000 - 50,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1364 M.Abiezar 795905 1300/ Katarak 7-May-15 Mata 50,000 - 50,000
1365 Larassati 835370 1405/ Pupl 7-May-15 Gigi&Mulut 50,000 - 545,406 595,406
1366 Linda Nurha 834870 1229/ 11 Pulpitis 7-May-15 Gigi&Mulut 50,000 - 341,392 391,392
1367 Isya 835324 1409/ Ulkus Decub 7-May-15 Gigi&Mulut 50,000 - 115,408 165,408
1368 Masnur Assa 816864 1157/ Post Op 7-May-15 Gigi & Mulut 50,000 - 450,253 500,253
1369 Wiwik Hand 437996 1051/ Bumil Dng H 7-May-15 Kandungan 50,000 - 120,500 170,500
1370 Sapta Harian 835530 1272/ G5P4A0+Per 7-May-15 Kandungan 50,000 - 60,000 110,000
1371 Indo Mase 835520 1392/ G2P1A0 7-May-15 Kandungan 50,000 - 120,500 170,500
1372 Rezki 840447 1455/ G4P2A1+Kp 7-May-15 Kandungan 50,000 - 480,500 530,500
1373 Emi Wati 822911 1127/ G2 P1 A0 D 7-May-15 Kandungan 50,000 - 120,500 170,500
1374 Nina Indria 706022 1452/ Gastritis 7-May-15 Kandungan 50,000 - 26,225 76,225
1375 Norhasanah 727081 1627/ Kontrol 7-May-15 Kandungan 50,000 35,000 43,272 128,272
1376 M. Aini 729644 1296/ Terapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1377 Ilham 701960 1211/ Fisioterapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1378 M. Jufri 764121 1183/ Fisioterapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1379 Matrup 345802 1170/ Fisioterapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1380 Nurdin Baru 390697 1140/ Terapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1381 Rudi Herma 743463 1159/ Terapi 7-May-15 R.Medik 50,000 - 220,000 270,000
1382 Yuliana Surt 837217 1611/ Kontrol 7-May-15 B. Syaraf 50,000 - 50,000
1383 Masitah 828986 1465/ Dm 7-May-15 P. Dalam 50,000 - 142,118 192,118
1384 Faridah Aria 734861 1220/ Ca Mamae 8-May-15 Onkologi 50,000 - 2,646,000 2,696,000
1385 Sumarsih 835588 1809/ Abd Discomf 8-May-15 Peny.Dalam 50,000 - 29,283 79,283
1386 Yatini 835580 1265/ G5P3A1 + P 8-May-15 Kandungan 50,000 - 60,000 36,650 146,650
1387 Tukiman 835525 1822/ Kontrol 8-May-15 Peny.Dalam 50,000 35,000 145,200 3,663 233,863
1388 Maryono G 835931 1957/ Isk 8-May-15 Urologi 50,000 - 694,200 125,400 8,125 877,725
1389 Radiyanto 706781 1247/ Fisioterapi 8-May-15 Rhb Medis 50,000 35,000 220,000 147,461 452,461
1390 Faridah 712256 1793/ Post Stroke 8-May-15 Syaraf 50,000 - 29,591 79,591
1391 M.Fandy N 630915 1943/ Dm 8-May-15 Peny.Dalam 50,000 - 9,555 59,555
1392 M. Darma H 613045 1631/ Epilepsi 08-May-15 Syaraf 50,000 - 122,738 172,738
1393 Ahmad Dan 837475 1749/ Kontrol 8-May-15 Anak 50,000 - 6,400 56,400
1394 Tri Mailani 806796 1705/ Epilepsi 8-May-15 Syaraf 50,000 - 20,430 70,430
1395 Endah Prati 822977 1633/ Soft Tissue 08-May-15 Onkologi 50,000 - 16,488 66,488
1396 Selvia Oktav 744370 1770/ 36 46 Pulp 08-May-15 Gigi&Mulut 50,000 - 115,408 1,525 166,933
1397 Amat 828525 2016/ Dispepsia 8-May-15 Peny.Dalam 50,000 35,000 32,938 117,938
1398 Sujarni 800848 1972/ Ht 8-May-15 Peny.Dalam 50,000 - 170,944 220,944
1399 Sumarni 835932 1974/ Dm Ii 8-May-15 Peny.Dalam 50,000 - 110,250 14,513 174,763
1400 Sri Hartati 801708 1616/ Cephalgia 08-May-15 Syaraf 50,000 - 227,700 3,900 281,600
1401 Junaidi 767384 1306/ Pjk 8-May-15 Jantung 50,000 - 57,975 107,975
1402 Syamsuddin 458829 1913/ Dm Ii 8-May-15 Peny.Dalam 50,000 - 42,600 92,600
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1403 Rustaniah 797036 1733/ S/ Ra Hnp 8-May-15 Syaraf 50,000 35,000 71,500 16,729 173,229
1404 Desi Surayan 220089 1927/ Kontrol 8-May-15 Syaraf 50,000 - 105,543 155,543
1405 M. Sholeh 825485 1692/ Kontrol 08-May-15 Jantung 50,000 - 29,700 79,700
1406 Supriani 639809 1748/ Terapi 8-May-15 R.Medik 50,000 35,000 159,500 15,669 260,169
1407 Nur Risa F 829910 1776/ Tumor 8-May-15 Tht 50,000 - 8,913 58,913
1408 Yuliana 691481 1603/ Kontrol 08-May-15 Mata 50,000 - 120,000 39,181 209,181
1409 Machrus 700176 1986/ Bph 8-May-15 Urologi 50,000 - 138,713 188,713
1410 Syaifullah 835929 1646/ 44 08-May-15 Gigi&Mulut 50,000 - 207,443 8,425 265,868
1411 Uswatun Ha 791413 1201/ Ht 8-May-15 Jantung 50,000 - 153,638 203,638
1412 Muryanti 740413 1559/ Migrain 08-May-15 Syaraf 50,000 - 40,493 90,493
1413 Fitri Hartati 800400 2003/ Keratitis 8-May-15 Mata 50,000 - 60,000 13,238 123,238
1414 Chelsea Ana 686816 1263/ Kontrol 8-May-15 Bedah Umum 50,000 - 10,418 60,418
1415 Annisa Nas 802856 1340/ Tb 8-May-15 Anak 50,000 - 53,638 103,638
1416 Harwati 835921 1309/ Kontrol 8-May-15 Dalam 50,000 - 404,500 9,899 464,399
1417 M Akyas A 837685 1233/ Kontrol 8-May-15 Saraf 50,000 - 57,000 173,938 280,938
1418 Royani Gun 626844 1618/ Kontrol 08-May-15 Bedah Umum 50,000 35,000 21,900 106,900
1419 Mulianto 800811 1752/ Mh+Rhinitis 08-May-15 Kulit Kelamin 50,000 - 61,375 111,375
1420 Rakhmad Bu 232250 1989/ Kontrol 8-May-15 Peny.Dalam 50,000 - 22,869 72,869
1421 Mustini 384213 1235/ Pjk 8-May-15 Jantung 50,000 - 168,625 218,625
1422 M Hatta 573905 1234/ Post Struke 8-May-15 Saraf 50,000 - 18,950 68,950
1423 M.Ashar 609950 1734/ Kontrol 8-May-15 Tht 50,000 - 24,386 74,386
1424 Asrawati 364985 1896/ Epilepsi 8-May-15 Syaraf 50,000 - 407,813 457,813
1425 Barlian 840180 1604/ Dm+Ht+Oa 08-May-15 Penyakit Dala 50,000 - 500,250 12,375 562,625
1426 Ipansyah 837697 1203/ Kontrol 8-May-15 Bedah Umum 50,000 35,000 125,000 38,076 248,076
1427 Suherlina 429487 1249/ Ht + Pjk 8-May-15 Jantung 50,000 - 57,313 107,313
1428 Nurrachmann831092 1736/ Flour Albus 08-May-15 Kulit Kelamin 50,000 - 135,700 12,331 198,031
1429 Isti Qamari 834833 1988/ Kontrol 8-May-15 Kandungan 50,000 - 60,000 3,400 113,400
1430 Asmini 466833 1277/ Dm 8-May-15 Dalam 50,000 - 67,109 117,109
1431 Yusri 803320 1246/ Kontrol 8-May-15 Jantung 50,000 - 256,313 306,313
1432 M.Maraaswi 404677 1838/ Bronkitis 8-May-15 Paru 50,000 35,000 27,349 112,349
1433 Mariyana 775232 1885/ Hipertiroid 8-May-15 Peny.Dalam 50,000 - 39,113 89,113
1434 Rafiah 816544 1691/ Diffuse Larg 08-May-15 Mata 50,000 - 305,000 12,293 367,293
1435 Basuki 748340 1836/ Pjk 8-May-15 Jantung 50,000 - 55,163 105,163
1436 Akhmad Mun441709 1661/ Kontrol 08-May-15 Jiwa 50,000 - 75,563 125,563
1437 Ernawati 224011 1956/ Asma Bronk 8-May-15 Paru 50,000 - 65,025 115,025
1438 Rohana 549682 1588/ Kista 08-May-15 Penyakit Dala 50,000 - 707,269 757,269
1439 Ali Munafri 820162 1634/ Ggk 08-May-15 Penyakit Dala 50,000 - 44,250 305,000 1,650 400,900
1440 Ahmad Al Gh821571 1310/ Ada Benjola 8-May-15 Anak 50,000 - 21,349 71,349
1441 Ida 640001 1662/ Susp Dermat 08-May-15 Kulit Kelamin 50,000 - 13,541 63,541
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1442 Martha Ban 787713 1709/ Limfadeniti 08-May-15 Tht 50,000 35,000 109,250 1,598,300 298,105 2,090,655
1443 Sri Mulyati 431246 1926/ Ht 8-May-15 Jantung 50,000 - 158,950 208,950
1444 Yuliani 393961 1307/ Kontrol 8-May-15 Mata 50,000 - 120,000 12,855 182,855
1445 M. Ibrahim 835934 1738/ Kontrol 08-May-15 Tht 50,000 - 4,209 54,209
1446 Syafruddin 730156 1250/ Ht + Pjk 8-May-15 Jantung 50,000 - 291,175 341,175
1447 Harisa 820131 1352/ Dm Ht 8-May-15 Peny.Dalam 50,000 - 180,285 230,285
1448 Saniwatun 835930 1664/ Furunkel 08-May-15 Kulit Kelamin 50,000 - 33,000 34,154 117,154
1449 Wa Dia 281130 1294/ Ht 8-May-15 Dalam 50,000 - 428,500 125,400 44,888 648,788
1450 Afifah Nur 835935 1739/ Obs Febris 08-May-15 Anak 50,000 - 134,500 23,415 207,915
1451 Rachma Win 835924 1575/ Dermatitis 08-May-15 Kulit Kelamin 50,000 - 8,422 58,422
1452 Mas Ud 840110 1883/ Kontrol 8-May-15 Bedah Umum 50,000 - 125,000 12,750 187,750
1453 Baharuddin 837209 1710/ Chf 08-May-15 Jantung 50,000 - 187,000 32,756 269,756
1454 Hairiah 835905 1308/ Ht 8-May-15 Jantung 50,000 - 187,000 243,750 480,750
1455 Gereta 835927 1605/ Dm Tipe Ii 08-May-15 Penyakit Dala 50,000 70,000 207,000 462,500 31,510 821,010
1456 Jantin 571967 1676/ Cad 08-May-15 Jantung 50,000 - 59,013 109,013
1457 Supinah 769897 1867/ Dm 8-May-15 Peny.Dalam 50,000 35,000 83,843 168,843
1458 Nuzirwan 691465 1853/ Dm Ckd 8-May-15 Peny.Dalam 50,000 35,000 396,500 17,385 498,885
1459 Wahyu Dian 143593 1987/ Epilepsi 8-May-15 Syaraf 50,000 - 239,400 289,400
1460 Maasmuliah 647731 1338/ Hhd 8-May-15 Jantung 50,000 - 45,394 95,394
1461 Tohir 835596 1751/ Hernia Scrot 08-May-15 Bedah Umum 50,000 35,000 187,000 7,388 279,388
1462 Syamsuddin 835595 1767/ Kontrol 08-May-15 Bedah Umum 50,000 35,000 187,000 11,663 283,663
1463 Painah 829959 1737/ Soft Tissue 08-May-15 Bedah Umum 50,000 35,000 187,000 27,975 299,975
1464 St Yuliani 835579 1295/ Dispepsi 8-May-15 Dalam 50,000 - 1,650 51,650
1465 Erfan Darma 389282 1768/ Epilepsi 08-May-15 Syaraf 50,000 - 725,175 775,175
1466 Murtini 757462 1960/ Kontrol 8-May-15 Syaraf 50,000 35,000 71,500 61,855 218,355
1467 Nurdian 625597 1944/ Tonsilitis K 8-May-15 Bedah Tumor 50,000 - 3,656 53,656
1468 Sarah 835367 1783/ Tangan Dan 08-May-15 Syaraf 50,000 35,000 15,929 100,929
1469 Azzahra Nab 659329 1882/ Talasemia 8-May-15 Anak 50,000 - 1,520,814 1,570,814
1470 Rochmadi H 584875 1784/ Parkinson 08-May-15 Syaraf 50,000 - 468,263 518,263
1471 Suroso Mug 836455 1812/ Vertigo+Ht 08-May-15 Syaraf 50,000 - 31,155 81,155
1472 Jefri 835550 1291/ Sinusitis 8-May-15 Tht 50,000 35,000 2,563 87,563
1473 Mashuda 179532 1806/ Kontrol 8-May-15 Syaraf 50,000 - 20,193 70,193
1474 Adiyatama Y 335533 1866/ Obs Dispeps 8-May-15 Anak 50,000 - 148,250 3,250 201,500
1475 Nuridah 826915 1174/ Chf 8-May-15 Jantung 50,000 - 187,000 26,756 263,756
1476 Patima 351685 1928/ S/ Hnp 8-May-15 Syaraf 50,000 35,000 71,500 17,393 173,893
1477 Yudi Gunars 725539 1496/ Kontrol 08-May-15 Saraf + Tht 50,000 35,000 54,832 139,832
1478 Mayang Savi 697785 1781/ Post Debrid 08-May-15 Bedah Umum 50,000 - 125,000 11,344 186,344
1479 Nurjannah 835560 1722/ Susp Hipert 08-May-15 Penyakit Dala 50,000 - 46,238 96,238
1480 Ainun Jaria 835926 1824/ Ht 8-May-15 Jantung 50,000 - 264,263 314,263
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1481 Udin 705780 1217/ Kontrol 8-May-15 Paru 50,000 - 33,935 83,935
1482 Suhaeti 686960 1732/ Obs Nyeri A 8-May-15 Peny.Dalam 50,000 - 215,750 1,650 267,400
1483 Lakuri 597907 1777/ Ppok 8-May-15 Paru 50,000 - 30,247 80,247
1484 Satiman 475913 1187/ Susp Ppok 8-May-15 Paru 50,000 - 24,675 74,675
1485 Abdul Hasa 754029 1514/ Gastritis+O 08-May-15 Penyakit Dala 50,000 - 16,313 66,313
1486 Yulius Taya 828254 1572/ Ca Nasofari 08-May-15 Tht 50,000 - 25,949 75,949
1487 Wiji 772064 1823/ Pjk 8-May-15 Jantung 50,000 - 280,688 330,688
1488 Asnawi 284032 1720/ Pjk 8-May-15 Jantung 50,000 - 63,188 113,188
1489 Mastidah 213612 1731/ Ht 8-May-15 Jantung 50,000 - 52,238 102,238
1490 Aminah 644814 1573/ Acut Tonsili 08-May-15 Tht 50,000 - 328,150 8,488 386,638
1491 Oskar Sinag 631948 1261/ Bph 8-May-15 Urologi 50,000 - 137,213 187,213
1492 Ramlah Has 619115 1707/ Crs+Ht 08-May-15 Syaraf 50,000 - 415,800 10,279 476,079
1493 Tamun 840833 1336/ Pjk 8-May-15 Jantung 50,000 - 183,063 233,063
1494 M. Nur Hida 382836 1706/ Epilepsi 08-May-15 Syaraf 50,000 - 85,388 135,388
1495 Syahrin 761752 1571/ Leukimia 08-May-15 Penyakit Dala 50,000 - 906,900 956,900
1496 Titik Yunani 506287 1718/ Hemiparase 8-May-15 Syaraf 50,000 - 11,973 61,973
1497 Anita Tory 814675 1791/ Ht 8-May-15 Jantung 50,000 - 281,213 331,213
1498 Nurjannah 559938 1837/ Obs Massa A 8-May-15 Bedah Umum 50,000 - 2,400 52,400
1499 M.Mirzah 829527 1884/ Kontrol 8-May-15 Bedah Umum 50,000 - 273,450 323,450
1500 Linda Yani 725580 1202/ Epilepsi 8-May-15 Saraf 50,000 - 209,475 259,475
1501 H. Mansyur 697236 1557/ Parkinson 08-May-15 Syaraf 50,000 - 563,913 613,913
1502 Hayati 702223 1761/ Limfadenopa 8-May-15 Peny.Dalam 50,000 - 3,000 53,000
1503 Kornelius R 835928 1635/ Pendengaran 08-May-15 Tht 50,000 - 112,500 12,353 174,853
1504 Damini 821139 1560/ Cephalgia 08-May-15 Syaraf 50,000 - 14,180 64,180
1505 Sudirman 835903 1189/ Gastritis + 8-May-15 Dalam 50,000 - 116,750 22,475 189,225
1506 Mardiansya 800448 1839/ Obs Dispne 8-May-15 Paru 50,000 - 84,000 37,850 171,850
1507 Sulasiyah 836263 1586/ S/ Kista Mul 08-May-15 Bedah Umum 50,000 35,000 1,763,300 542,967 2,391,267
1508 Afriadi Les 835382 1869/ S/ Pneumon 8-May-15 Paru 50,000 35,000 402,500 1,763,300 267,621 2,518,421
1509 Hety Erliani 835593 1590/ Susp Tumor 08-May-15 Onkologi 50,000 - 377,500 427,500
1510 Muchammad 483216 1693/ 38 Impaksi 08-May-15 Gigi&Mulut 50,000 35,000 503,400 286,000 874,400
1511 Rina Wati 796209 2004/ S/ Ulkus Pe 8-May-15 Peny.Dalam 50,000 - 305,000 355,000
1512 Suriansyah 835823 1754/ Lipoma 08-May-15 Bedah Umum 50,000 - 394,150 377,500 821,650
1513 Yani 835933 2005/ S/ Struma 8-May-15 Bedah Umum 50,000 - 746,250 377,500 125,400 1,299,150
1514 Sunarti 835925 1601/ Chest Pain 08-May-15 Jantung+Bed 50,000 35,000 394,150 377,500 187,000 1,043,650
1515 Supardi 835923 1574/ Struma 08-May-15 Bedah Umum 50,000 - 746,250 377,500 125,400 1,299,150
1516 Romlah 532116 1587/ Post Kuret 08-May-15 Kandungan 50,000 - 60,000 1,088,850 125,400 1,324,250
1517 Ria 770256 1650/ 27 Gp 08-May-15 Gigi&Mulut 50,000 - 579,150 125,400 754,550
1518 Mahrita 834539 1765/ Kontrol 8-May-15 Rehab Medik+ 50,000 35,000 159,500 227,700 12,529 484,729
1519 Winona Dest 337477 1680/ Cephalgia 08-May-15 Syaraf 50,000 - 997,700 1,047,700
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1520 Jainatul Ad 795657 1617/ Migrain 08-May-15 Syaraf 50,000 - 997,700 1,047,700
1521 Kapsah 791022 1512/ Obs Vertigo 08-May-15 Syaraf 50,000 - 207,900 257,900
1522 Raysa Mifta 706677 1602/ Thymoma Ca 08-May-15 Paru 50,000 - 76,250 125,400 251,650
1523 Salmiah 806446 1543/ Ca Mamae 08-May-15 Bedah Umum 50,000 - 525,250 207,900 783,150
1524 Alif Zami F 835567 1175/ Bab Tdk Lan 8-May-15 Bedah Anak 50,000 - 105,600 155,600
1525 Feni Elitasar 593157 1740/ G3P2A0 08-May-15 Kandungan 50,000 - 60,000 305,000 415,000
1526 Badrotul Mu 602724 1990/ Pud 8-May-15 Kandungan 50,000 - 60,000 305,000 415,000
1527 Miladiah 835824 1753/ G1P0A0 08-May-15 Kandungan 50,000 - 120,500 305,000 475,500
1528 Santi 646149 2002/ 7 Gr Abses 8-May-15 Gigi&Mulut 50,000 - 160,600 210,600
1529 Herlina S 607237 1205/ Kontrol 8-May-15 Saraf 50,000 - 1,472,900 1,522,900
1530 Syahrina 821166 1219/ Kontrol 8-May-15 Kandungan 50,000 - 60,000 125,400 235,400
1531 Andi Siraju 670639 1545/ Ht+Dm 08-May-15 Penyakit Dala 50,000 - 110,250 160,250
1532 Thekat Harj 252472 1663/ Susp Batu G 08-May-15 Urologi 50,000 - 343,650 393,650
1533 Hardianto 835904 1264/ Colic Abdo 8-May-15 Bedah Umum 50,000 - 438,400 488,400
1534 Ratna Wati 815625 1868/ S/ Hepatitis 8-May-15 Peny.Dalam 50,000 - 66,000 116,000
1535 Sarutik 461777 1542/ Dm 08-May-15 Penyakit Dala 50,000 - 110,250 160,250
1536 Sugiharti 290388 1172/ Cek Lab 8-May-15 Laboratorium 50,000 - 110,250 160,250
1537 Sulis Setiow 812857 1515/ Dm+Pjk 08-May-15 Penyakit Dala 50,000 - 110,250 160,250
1538 Usmi Rotu 835585 1204/ G4P2A1Dng 8-May-15 Kandungan 50,000 - 120,500 44,250 214,750
1539 Yuni 681215 1526/ Dm Type Ii 08-May-15 Penyakit Dala 50,000 - 500,250 550,250
1540 Khusnul Kh 805745 1695/ Keputihan+ 08-May-15 Kandungan 50,000 - 60,000 717,000 827,000
1541 Miranda Feb 758696 1355/ Kontrol 8-May-15 Bedah Umum 50,000 - 444,650 494,650
1542 Rukiah 832918 1589/ Ca Cerviks 08-May-15 Kandungan 50,000 - 60,000 1,245,500 1,355,500
1543 Setyo Budi 564792 1511/ Pjk 08-May-15 Jantung 50,000 - 457,250 187,000 331,000 1,025,250
1544 Jean Sarina 711150 1337/ Ca Mamae 8-May-15 Onkologi 50,000 - 525,250 575,250
1545 Siti Maimun 822088 1173/ Terapi 8-May-15 Rehab Medik 50,000 - 71,500 121,500
1546 Wakiyem 701255 1541/ Terapi 08-May-15 Rehab Medik 50,000 - 71,500 121,500
1547 Afif Piliang 781444 1701/ Fisioterapi 8-May-15 R. Medik 50,000 - 71,500 121,500
1548 Suyanto 445829 1528/ Fisioterapi 08-May-15 Rehab Medik 50,000 - 71,500 121,500
1549 Asrak 802477 1945/ Terapi 8-May-15 R.Medik 50,000 - 71,500 121,500
1550 Eko Minarn 810163 1556/ Terapi 08-May-15 Rehab Medik 50,000 - 71,500 121,500
1551 Nurhaidah 061430 1795/ Terapi 8-May-15 R.Medik 50,000 - 71,500 121,500
1552 Sumiati 663502 1544/ Terapi 08-May-15 Rehab Medik 50,000 - 71,500 121,500
1553 Hamdanah 563909 1735/ Fisiotherapy 8-May-15 R.Medik 50,000 - 71,500 121,500
1554 Asih Sunars 829585 1688/ Terapi 8-May-15 R.Medik 50,000 - 159,500 209,500
1555 Nico Mangu 784719 1674/ Terapi 8-May-15 R Medik 50,000 - 159,500 209,500
1556 H.Zamansya 787675 1840/ Terapi 8-May-15 R.Medik 50,000 - 71,500 121,500
1557 Murikah 598534 1780/ Terapi 8-May-15 R.Medik 50,000 - 71,500 121,500
1558 Susiatin 337059 1719/ Terapi 8-May-15 R.Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1559 Herman Edw 829512 1808/ Terapi 8-May-15 R.Medik 50,000 - 159,500 209,500
1560 Suriansyah 401198 1779/ Fisioterapi 8-May-15 Rehab Medis 50,000 - 71,500 121,500
1561 Marjuki 492002 1794/ Terapi 8-May-15 R.Medik 50,000 - 159,500 209,500
1562 Marida 647710 1702/ Fisiotherapy 8-May-15 R.Medik 50,000 - 159,500 209,500
1563 Viknatul Lei 829364 1911/ Terapi 8-May-15 R.Medik 50,000 - 71,500 121,500
1564 Darmiati 667292 1558/ Terapi 08-May-15 Rehab Medik 50,000 - 71,500 121,500
1565 Nur Hasana 397672 1750/ Terapi 8-May-15 R.Medik 50,000 - 159,500 209,500
1566 J.Marni 664975 1747/ Fisioterapi 8-May-15 Rehab Medik 50,000 - 71,500 121,500
1567 Rosdiana Fa 805742 1530/ Fisioterapi 08-May-15 Rehab Medik 50,000 - 159,500 209,500
1568 Ahmad Suda 581234 1690/ Terapi 8-May-15 R.Medik 50,000 - 159,500 209,500
1569 Sriani 346142 1717/ Terapi 8-May-15 R.Medik 50,000 - 71,500 121,500
1570 Buatik 824550 1764/ Terapi 8-May-15 R.Medik 50,000 - 379,500 429,500
1571 Andy K P 706211 1755/ Fisioterapi 08-May-15 Rehab Medik 50,000 - 159,500 209,500
1572 Kamakko R 666972 1915/ Terapi 8-May-15 R.Medik 50,000 - 159,500 209,500
1573 Lina Mellya 796892 1724/ Terapi 08-May-15 Rehab Medik 50,000 - 159,500 209,500
1574 Zema Riski 739218 1686/ Terapi 8-May-15 R Medik 50,000 - 440,000 490,000
1575 Annisa Hima 781563 1687/ Terapi 8-May-15 R.Medik 50,000 - 440,000 490,000
1576 Riduansyah 450111 1897/ Terapi 8-May-15 R.Medik 50,000 - 440,000 490,000
1577 Ernawaty 525416 1293/ Terapi 8-May-15 Rehab Medis 50,000 - 71,500 121,500
1578 Nurjanah 532108 1325/ Terapi 8-May-15 R.Medik 50,000 - 71,500 121,500
1579 Nurdin 816128 1855/ Terapi 8-May-15 Rehab Medik 50,000 - 159,500 209,500
1580 Hj.Masnawa 718846 1353/ Terapi 8-May-15 Rehab Medis 50,000 - 71,500 121,500
1581 Devi Miran 829914 1807/ Terapi 8-May-15 R.Medik 50,000 - 159,500 209,500
1582 Salasiah 298164 1279/ Terapi 8-May-15 R Medik 50,000 - 71,500 121,500
1583 H.A. Moeis 810554 1339/ Terapi 8-May-15 R.Medik 50,000 - 71,500 121,500
1584 Radeng 560193 1769/ Terapi 08-May-15 Rehab Medik 50,000 - 71,500 121,500
1585 Kartini Dae 835401 1278/ Terapi 8-May-15 R Medis 50,000 - 159,500 209,500
1586 Hemi 835300 1852/ Terapi 8-May-15 R.Medik 50,000 - 71,500 121,500
1587 Rohanah 522050 1292/ Terapi 8-May-15 R Medik 50,000 - 71,500 121,500
1588 Nani 683573 1351/ Terapi 8-May-15 R.Medik 50,000 - 159,500 209,500
1589 Ernawati 124241 1912/ Terapi 8-May-15 R.Medik 50,000 - 71,500 121,500
1590 Zahra Arsen 725126 1958/ Terapi 8-May-15 R.Medik 50,000 - 220,000 270,000
1591 Gimun 695987 1500/ Terapi 08-May-15 Rehab Medik 50,000 - 440,000 490,000
1592 H. Bambang 829576 1746/ Kontrol 8-May-15 R.Medik 50,000 - 440,000 490,000
1593 Titus Ahma 820014 1825/ Terapi 8-May-15 Rehab Medik 50,000 - 440,000 490,000
1594 Dheva Rayza 821735 1811/ Terapi 08-May-15 Rehab Medik 50,000 - 220,000 270,000
1595 Tunikah 796098 1854/ Terapi 8-May-15 R.Medik 50,000 - 440,000 490,000
1596 Abu Hanifa 805165 1647/ Fisioterapi 08-May-15 Rehab Medik 50,000 - 220,000 270,000
1597 Donatinus S 811513 1898/ Terapi 8-May-15 Rehab Medik 50,000 - 379,500 429,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1598 Febrian Satr 753688 1675/ Terapi 8-May-15 R.Medik 50,000 - 440,000 490,000
1599 M.Ramadan 575485 1716/ Terapi 8-May-15 R.Medik 50,000 - 440,000 490,000
1600 Marsha C 481040 2017/ Terapi 8-May-15 R.Medik 50,000 - 440,000 490,000
1601 Nasywa Qon706135 1703/ Fisioterapi 8-May-15 Rehab Medis 50,000 - 440,000 490,000
1602 Rakavino Yu 528783 1498/ Fisioterapi 08-May-15 Rehab Medik 50,000 - 220,000 270,000
1603 M Haykal Il 500328 1218/ Terapi 8-May-15 R Medik 50,000 - 440,000 490,000
1604 Siti Naida 822934 1280/ Terapi 8-May-15 R Medis 50,000 - 440,000 490,000
1605 Elisa Mersi 534269 1619/ Terapi 08-May-15 Rehab Medik 50,000 35,000 71,500 156,500
1606 Jasmani 822971 1499/ Terapi 08-May-15 Rehab Medik 50,000 - 159,500 209,500
1607 La Ode S 675210 1796/ 112 08-May-15 Vct 50,000 - 50,000
1608 Wiji 772064 1823/ Pjk 8-May-15 Orthopedy 50,000 - 16,000 66,000
1609 Ernawati 815876 1799/ 6 Tumpat Le 08-May-15 Gigi&Mulut 50,000 - 272,703 322,703
1610 Beti Susanti 764238 1971/ 46 Abses 8-May-15 Gigi&Mulut 50,000 - 50,000
1611 Ayudha Sari 835533 1689/ Chest Pain 8-May-15 Jantung 50,000 - 462,500 512,500
1612 Elsa Yuanita 835936 1782/ G2P1A0 Hm 08-May-15 Kandungan 50,000 - 120,500 170,500
1613 Indrayani 834548 2001 Abortus Imi 8-May-15 Kandungan 50,000 - 60,000 110,000
1614 Fida Fathim 555041 1975/ G1P0A0 8-May-15 Kandungan 50,000 - 120,500 170,500
1615 Fitriani 837503 1723/ Hipokalemi 08-May-15 Kandungan 50,000 - 120,500 170,500
1616 Dwi Puspita 708534 1678/ G8P5A2+Let 08-May-15 Kandungan 50,000 - 120,500 170,500
1617 Darmawati 781666 1942/ Kontrol 8-May-15 Kandungan 50,000 - 120,500 170,500
1618 Martini 835546 1973/ Tu Mamae S 8-May-15 Bedah Tumor 50,000 35,000 187,000 272,000
1619 Fitri Sahwa 574388 1811/ Kontrol 8-May-15 Bedah Umum 50,000 - 50,000
1620 Tawakkal 542542 1881/ Kontrol 8-May-15 Bedah Umum 50,000 - 50,000
1621 Anwarye 763816 1262/ Benjolan Pd 8-May-15 Bedah Umum 50,000 - 50,000
1622 Andy Herm 836850 1721/ Kontrol 08-May-15 Bedah Umum 50,000 - 125,000 175,000
1623 Santi Aprili 835922 1792/ G2P1A0 Hm 8-May-15 Kandungan 50,000 - 120,500 170,500
1624 Siti Mukka 810150 1324/ S/ Kista Kap 8-May-15 Bedah Anak 50,000 35,000 85,000
1625 M Rifqi R 835541 1704/ Hernia Ingui 8-May-15 Bedah Anak 50,000 35,000 85,000
1626 Tri Yani K 594804 1276/ 8 Impaksi 8-May-15 Gigi & Mulut 50,000 - 50,000
1627 Christin N S 634732 1232/ Ca Mamae 8-May-15 Onkologi 50,000 - 50,000
1628 Devi Juni P 676755 1810/ S/ Fam 8-May-15 Onkologi 50,000 - 50,000
1629 Sulaiman 826815 1323/ Ulkus Ca 8-May-15 Onkologi 50,000 - 50,000
1630 Yeti Mahdal 817963 1899/ Tu Mamae S 8-May-15 Onkologi 50,000 - 50,000
1631 Bahriah 835548 1677/ Tb Paru 08-May-15 Paru 50,000 - 50,000
1632 Rubiantono 829911 1785/ 16 Caries 08-May-15 Gigi&Mulut 50,000 - 384,437 434,437
1633 M.Erza Kur 755314 1914/ 46 Pulp 8-May-15 Gigi&Mulut 50,000 - 272,703 322,703
1634 Mislan 824667 1248/ Kontrol 8-May-15 Saraf 50,000 - 50,000
1635 Asmawati 763622 1797/ 112 08-May-15 Vct 50,000 - 50,000
1636 Muslihah 835307 1725/ Tumor Colli 08-May-15 Onkologi 50,000 - 50,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1637 Adaniah 423779 1851/ Ht 8-May-15 Jantung 50,000 - 50,000
1638 Irawati 787815 1322/ Ca Mamae 8-May-15 Onkologi 50,000 35,000 85,000
1639 Fatmawati 776294 1190/ Amenore Sk 8-May-15 Kandungan 50,000 - 60,000 110,000
1640 M. Farrizar 535139 1694/ Serumen As 08-May-15 Tht 50,000 - 63,000 113,000
1641 Arbainah 729366 1708/ Dm 08-May-15 Perawatan Lu 50,000 - 402,500 452,500
1642 Achmad Jun 835303 1778/ Gangren Ped 8-May-15 Peny.Dalam 50,000 - 402,500 452,500
1643 M. Ali Akba 835554 1679/ Pulpitis 8 08-May-15 Gigi&Mulut 50,000 - 50,000
1644 Annisa Resk 835597 1649/ Ginggivitis 08-May-15 Gigi&Mulut 50,000 - 347,490 397,490
1645 Ifan Saputra 835537 1216/ Mucocelle 8-May-15 Gigi & Mulut 50,000 - 1,642,934 1,692,934
1646 Safira Diya 664735 1929/ Kontrol 8-May-15 Gigi&Mulut 50,000 - 272,703 322,703
1647 Antini May 840238 1798/ Ikterus 08-May-15 Anak 50,000 - 50,000
1648 Linda Nurha 834870 1529/ 11 Pulpitis 08-May-15 Gigi&Mulut 50,000 - 539,025 589,025
1649 Zulfikar 835577 1870/ 36 37 Perio 8-May-15 Gigi&Mulut 50,000 - 50,000
1650 Adhityastuti 820118 1354/ Ca Mamae 8-May-15 Onkologi 50,000 - 50,000
1651 Aminah Bed 834445 1941/ Adenokarsi 8-May-15 Onkologi 50,000 - 50,000
1652 Alim Ikbal 823124 1321/ Kontrol 8-May-15 Bedah Umum 50,000 - 125,000 175,000
1653 Wahyudi 835524 1665/ Tumor 08-May-15 Bedah Umum 50,000 - 50,000
1654 Sandra Ariy 633293 1959/ Kontrol 8-May-15 Bedah Umum 50,000 - 125,000 175,000
1655 Jamin Mana 584570 1186/ Tengkuk Te 8-May-15 Dalam 50,000 - 50,000
1656 Raysa Putri 827764 1930/ Kejang De 8-May-15 Anak 50,000 - 50,000
1657 Ratna 821500 1763/ Terapi 8-May-15 R.Medik 50,000 - 220,000 270,000
1658 Saider Lina 770653 1188/ Terapi 8-May-15 Rehab Medis 50,000 - 220,000 270,000
1659 Indrawati 680655 1762/ Terapi 8-May-15 Rehab Medik 50,000 - 220,000 270,000
1660 Hj. Ernawat 710875 1513/ Fisioterapi 08-May-15 Rehab Medik 50,000 - 220,000 270,000
1661 Kipli 835581 1527/ Susp Bph 08-May-15 Urologi 50,000 - 430,088 480,088
1662 Julius 835953 2485/ Kontrol 11-May-15 Paru 50,000 - 3,000 53,000
1663 Rizky Sulist 748957 2212/ Tu Colli D 11-May-15 Onkologi 50,000 - 12,000 62,000
1664 Haron 506987 2156/ Fluidopneum 11-May-15 Paru 50,000 35,000 139,100 3,063 227,163
1665 Yuliani 285668 2144/ Cts 11-May-15 Syaraf 50,000 - 20,506 70,506
1666 Sofyan Nur 828582 2541/ Kontrol 11-May-15 Jantung 50,000 - 184,863 234,863
1667 Wiwin 430340 1964/ Kontrol 11-May-15 Tht 50,000 35,000 266,200 12,750 363,950
1668 Jashen Rafh 835429 1532/ Kontrol 11-May-15 Anak 50,000 - 38,500 88,500
1669 J.Marni 664975 2152/ Fisioterapi 11-May-15 R.medis 50,000 35,000 71,500 24,850 181,350
1670 Hartati 701162 2219/ 8 Gr 11-May-15 P. Dalam 50,000 - 14,513 64,513
1671 Jasmah 434885 2196/ Terapi 11-May-15 R.Medik 50,000 35,000 71,500 106,238 262,738
1672 Suto 288461 2007/ Parkinson 11-May-15 Syaraf 50,000 - 287,963 337,963
1673 Agus Sofian 392280 2114/ Ht 11-May-15 Jantung 50,000 - 161,813 211,813
1674 Saniwatun 835930 2246/ Furunkel 11-May-15 Kulit Kelamin 50,000 35,000 24,713 109,713
1675 Rini 837880 2145/ Susp Ileus 11-May-15 P. Dalam 50,000 - 15,288 65,288
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1676 Faridah 835958 2174/ Dm 11-May-15 P. Dalam 50,000 - 55,538 105,538
1677 Nasir 835910 2187/ Kontrol 11-May-15 Gigi&mulut 50,000 - 3,848,276 160,600 24,676 4,083,552
1678 Inem 534202 2213/ Kontrol 11-May-15 Rehab Medik+ 50,000 35,000 71,500 12,579 169,079
1679 Syaikhah Sy 829521 2096/ Tinea I 11-May-15 Kulit Kelamin 50,000 - 14,888 64,888
1680 Iza Rakli Ap 835939 2258/ Post Orif 11-May-15 Ortophedi 50,000 - 80,000 5,438 135,438
1681 Supardi 825923 2409/ Struma 11-May-15 Bedah 50,000 70,000 187,000 9,938 316,938
1682 Nurlinda Yun 835523 2235/J Omp 11-May-15 Tht 50,000 - 99,951 149,951
1683 Gusti Azifu 685874 2024/ Cad 11-May-15 Jantung 50,000 - 207,825 257,825
1684 Susanti Inda 583438 1625/ Kontrol 11-May-15 Kandungan 50,000 - 60,000 145,931 255,931
1685 Marnah 816097 1610/ Ht 11-May-15 Jantung 50,000 - 284,288 334,288
1686 Azlan Darma 792114 2316/ Kontrol 11-May-15 Anak 50,000 - 11,353 61,353
1687 Sukri 483499/4634992049/ Kontrol 11-May-15 R.medik 50,000 35,000 159,500 10,705 255,205
1688 H.M.Kasim 750140 2048/ Kontrol 11-May-15 R.medik 50,000 35,000 159,500 29,488 273,988
1689 Siti Maemu 780549 1920/ Post Stroke 11-May-15 Syaraf 50,000 - 16,043 66,043
1690 Eny Ernawat 840416 1591/ Kontrol 11-May-15 Kandungan 50,000 - 120,500 3,025 173,525
1691 Rahmat Rah 835327 2173/ Basalioma 11-May-15 Kulit Kelamin 50,000 - 60,600 6,838 117,438
1692 Iis Hastuti 835363 2166/ Terapi 11-May-15 R.medik 50,000 70,000 71,500 23,143 214,643
1693 Yohana Dom 333237 2453/ Obs Nyeri D 11-May-15 Jantung 50,000 35,000 270,413 355,413
1694 Sayem 835998 2220/ Hnp 11-May-15 Syaraf 50,000 35,000 10,925 95,925
1695 Suci Permata 485459 2512/ Pjk 11-May-15 Jantung 50,000 - 40,013 90,013
1696 Samsuri 166057 1875/ Chf 11-May-15 Jantung 50,000 - 194,125 244,125
1697 Nirwana Pra 755986 2363/ Epilepsi 11-May-15 Anak 50,000 - 104,500 154,500
1698 Diana 373950 2168/ Chf 11-May-15 Jantung 50,000 - 78,675 128,675
1699 Supardi 757487 2275/ Batuk 1 Bln 11-May-15 Paru 50,000 - 23,466 73,466
1700 Mariana 691436 2082/ Corpus Ale 11-May-15 Tht 50,000 - 15,150 65,150
1701 Sri Hartati 801708 2037/ Cephalgia 11-May-15 Syaraf 50,000 35,000 9,238 94,238
1702 Susilowati 837698 1961/ G3P2A0 11-May-15 Kandungan 50,000 - 120,000 18,563 188,563
1703 Aansyah 514714 2392/ Kontrol 11-May-15 Syaraf 50,000 - 232,500 282,500
1704 Maymunah 835571 1501/ Myalgia 11-May-15 Syaraf 50,000 - 22,768 72,768
1705 Hasnawati 302208 2380/ Epilepsi 11-May-15 Syaraf 50,000 - 140,963 190,963
1706 Iliyawati 681163 1933/ Obs Oa 11-May-15 Ortophedi 50,000 - 704,900 1,950 756,850
1707 Husaini Ar 691952 2438/ Ht 11-May-15 Jantung 50,000 - 50,850 100,850
1708 Nurhaini 729687 2470/ Kontrol 11-May-15 Kandungan 50,000 - 60,000 305,000 3,025 418,025
1709 Eddy Nayan 642026 1962/ Dm+Ckd+C 11-May-15 P. Dalam 50,000 35,000 65,256 150,256
1710 Hasiah 816042 1576/ Kontrol 11-May-15 Kandungan 50,000 - 120,500 1,525 172,025
1711 Sulaiman 834557 1563/ Kontrol 11-May-15 Ortophedi 50,000 35,000 125,000 7,938 217,938
1712 Tuti Wati 525101 1593/ Kontrol 11-May-15 P. Dalam 50,000 - 6,963 56,963
1713 Mastura 442993 2021/ Kontrol 11-May-15 Jantung 50,000 - 294,713 344,713
1714 Buniman 686914 2421/ Katarak Od 11-May-15 Mata 50,000 - 4,000 54,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1715 Arsad 835951 2481/ Kontrol 11-May-15 Kulit Kelamin 50,000 - 39,000 89,000
1716 Mastur 276077 1917/ Pjk 11-May-15 Jantung 50,000 - 304,088 354,088
1717 Rini 063529 2230/ Post Svt 11-May-15 Jantung 50,000 - 41,910 91,910
1718 Junaidi 834238 2199/ Vertigo 11-May-15 Syaraf 50,000 - 25,731 75,731
1719 Siti Rohania 386245 1979/ Hipertiroid 11-May-15 P. Dalam 50,000 - 14,394 64,394
1720 Ari Rachma 834064 2155/ Kontrol 11-May-15 Ortophedi 50,000 - 160,000 1,300 211,300
1721 Suyanto 834295 1441/ Kontrol 11-May-15 Bedah Umum 50,000 - 125,000 8,363 183,363
1722 Aji Juhran 783609 2170/ Ht Cad 11-May-15 Jantung 50,000 - 216,675 266,675
1723 Tesalonika S 835955 2157/ Dog Bite 11-May-15 Syaraf 50,000 - 57,000 173,938 280,938
1724 Hasmi 835908 1624/ Susp Bronkh 11-May-15 Paru 50,000 - 160,250 125,400 12,375 348,025
1725 Syahrul Taj 257595 2039/ Kontrol 11-May-15 Jantung 50,000 - 457,250 194,025 701,275
1726 Manasang 805427 2350/ Kontrol 11-May-15 Jantung 50,000 - 562,950 65,125 678,075
1727 Murni 538123 1550/ Hhd 11-May-15 Jantung 50,000 - 308,175 358,175
1728 Alfrida Para 835959 2175/ Gastritis Ak 11-May-15 P. Dalam 50,000 - 11,313 61,313
1729 Rusdiana 836879 2214/ Kontrol 11-May-15 Syaraf 50,000 35,000 16,825 101,825
1730 Yurliansyah 835573 1505/ Ht + Strouk 11-May-15 Jantung 50,000 - 649,500 36,375 735,875
1731 Haniah 659017 2391/ Kontrol 11-May-15 Jantung 50,000 - 320,288 370,288
1732 M. Fajrin M 763845 2231/ Kontrol 11-May-15 Kulit Kelamin 50,000 - 34,338 84,338
1733 Sayid Muha 492689 1946/ Bph 11-May-15 Urologi 50,000 - 185,000 545,600 137,213 917,813
1734 Dahrin 833847 2143/ Stroke 11-May-15 Syaraf 50,000 - 34,785 84,785
1735 Syahrun 835954 2497/ Kontrol 11-May-15 P. Dalam 50,000 - 305,000 8,225 363,225
1736 Rita Yuslian 834898 2211/ Nyeri Abdo 11-May-15 P. Dalam 50,000 - 543,500 6,500 600,000
1737 Sarutik 461777 1904/ Dm 11-May-15 P. Dalam 50,000 - 39,938 89,938
1738 Mesran 177503 1856/ Dm+Pjk 11-May-15 P. Dalam 50,000 35,000 89,450 174,450
1739 Citra Ameep 802942 2528/ Pro Kontrol 11-May-15 Anak 50,000 - 14,844 64,844
1740 Nurhanifah 711251 1947/ Pjk 11-May-15 Jantung 50,000 - 37,463 87,463
1741 Jum Ekawat 520388 2335/ G2P1A0 11-May-15 Kandungan 50,000 - 120,500 1,800 172,300
1742 Fatimah 427648 1579/ Nyeri Kaki K 11-May-15 Ortophedi 50,000 - 650 50,650
1743 Hasmawati 478664 2332/ G4P2A1 11-May-15 Kandungan 50,000 - 60,000 7,550 117,550
1744 Septianur 835902 2406/ Amenorea S 11-May-15 Kandungan 50,000 - 60,000 16,363 126,363
1745 Kamakko R 666972 2362/ Kontrol 11-May-15 Jantung 50,000 - 11,013 61,013
1746 Ayu Wulanda835575 1608/ Kontrol 11-May-15 Kandungan 50,000 - 120,500 2,288 172,788
1747 Stevi Indart 483174 2468/ Asma Bronk 11-May-15 Paru 50,000 - 50,588 100,588
1748 Sutilah 835909 2186/ Pre Stroke 11-May-15 Syaraf 50,000 - 66,000 7,388 123,388
1749 Sri Kuswati 834801 2290/ Kontrol 11-May-15 R.medis 50,000 35,000 159,500 10,925 255,425
1750 Savira Hern 835357 2379/ Veruka 11-May-15 Bedah Anak 50,000 - 67,900 8,425 126,325
1751 Shopia Sapu 759055 2204/ Oma S Oms 11-May-15 Tht 50,000 - 310,500 11,700 372,200
1752 Abd Hamid 434773 2437/ Pjk 11-May-15 Jantung 50,000 - 187,000 239,513 476,513
1753 Arifin 811379 2066/ Kontrol 11-May-15 Jantung 50,000 - 337,725 387,725
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1754 S Jiwanto 332814 1547/ Ppok+ Chf 11-May-15 Paru 50,000 35,000 345,225 430,225
1755 Emi 394720 1535/ Terapi 11-May-15 R.medis 50,000 35,000 71,500 68,738 225,238
1756 Ayu Lestari 835574 1519/ 6 Pulpitis 11-May-15 Gigi & Mulut 50,000 - 115,408 93,115 1,525 260,048
1757 Nurdiansya 648288 2349/ Ht 11-May-15 Syaraf 50,000 35,000 594,638 679,638
1758 Nurhadiyant 320110 1860/ Terapi+Ceph 11-May-15 Syaraf 50,000 35,000 71,500 24,855 181,355
1759 Rubiyanti 667223 2514/ Obs Menome 11-May-15 Kandungan 50,000 - 60,000 17,606 127,606
1760 Jono 821519 2395/ Bph 11-May-15 Urologi 50,000 - 255,000 305,000
1761 Sarmauli Si 780923 2126/ Ab Inkomple 11-May-15 Kandungan 50,000 - 60,000 4,525 114,525
1762 Wardah 262093 2113/ G6P5+Ansie 11-May-15 Kandungan 50,000 - 60,000 305,000 13,763 428,763
1763 Indo Miru 835906 1978/ Susp Fraktu 11-May-15 Orthopedi 50,000 - 105,600 1,525 157,125
1764 Jali 835577 1623/ Herpes Zost 11-May-15 Kulit Kelamin 50,000 - 23,241 73,241
1765 Ramlah Has 619115 2051/ Crs+Ht 11-May-15 Syaraf 50,000 35,000 10,925 95,925
1766 Supiah 475816 1890/ Terapi+Lbp 11-May-15 R.medik 50,000 35,000 71,500 10,925 167,425
1767 Bambang Su 631623 1963/ Pjk 11-May-15 Jantung 50,000 - 523,250 419,025 992,275
1768 Surianto 478281 1918/ Riw Vertigo 11-May-15 Syaraf 50,000 35,000 71,500 159,669 316,169
1769 M. Imran 774215 2130/ Susp Tu Nas 11-May-15 Tht 50,000 35,000 470,000 66,000 377,500 1,598,300 543,469 3,140,269
1770 Asni 834511 2233/ Kontrol 11-May-15 Orthopedi 50,000 - 60,000 8,363 118,363
1771 Sahreza 670699 1621/ Epilepsi 11-May-15 Syaraf 50,000 - 63,800 113,800
1772 Rina Wati 796209 2498/ Kontrol 11-May-15 Kandungan 50,000 - 60,000 2,288 112,288
1773 Sanawi 835957 2526/ Obs Retensi 11-May-15 Urologi 50,000 - 335,000 832,900 137,213 1,355,113
1774 M.Ihsan 763338 2513/ Kontrol 11-May-15 Syaraf 50,000 - 330,488 380,488
1775 Asnawati 834209 2484/ Kontrol 11-May-15 Bedah Umum 50,000 - 125,000 12,750 187,750
1776 Saanih 835562 2202/ Ispa 11-May-15 Paru 50,000 - 160,250 125,400 2,613 338,263
1777 Suleman M 826968 2530/ Kontrol 11-May-15 Jantung 50,000 - 462,500 192,363 704,863
1778 Sutopo 834864 1457/ Susp Straum 11-May-15 Bedah Umum 50,000 - 9,770 59,770
1779 Arifin 811663 1411/ Kontrol 11-May-15 Syaraf 50,000 - 608,175 658,175
1780 Mashudi Wi 510618 1428/ Kontrol 11-May-15 Orthopedi 50,000 - 80,000 5,231 135,231
1781 Abdul Rauf 765270 1460/ Hepatomegal 11-May-15 P. Dalam 50,000 - 41,250 91,250
1782 Ester Biu 634357 2091/ 8 Kpp 11-May-15 Gigi&Mulut 50,000 - 603,276 8,425 661,701
1783 Rubaya 433028 1564/ Obs Chest P 11-May-15 Jantung 50,000 - 262,825 312,825
1784 Nor Asikin 639313 1415/ Terapi + Kon 11-May-15 R.medis 50,000 35,000 71,500 38,749 195,249
1785 Misnawati 577110 1872/ Kontrol 11-May-15 Kandungan 50,000 - 120,500 1,525 172,025
1786 Hadijah 308257 1873/ Pjk 11-May-15 Jantung 50,000 - 290,738 340,738
1787 Mashoed 647749 1842/ Oa 11-May-15 Syaraf 50,000 - 23,229 73,229
1788 Asriany 700728 2317/ Epilepsi 11-May-15 Syaraf 50,000 - 115,313 165,313
1789 Hardianto 835904 1549/ Colic Abdo 11-May-15 Bedah 50,000 - 145,200 1,563 196,763
1790 Farida Agus 795467 2454/ Melanoma M 11-May-15 Kulit Kelamin 50,000 - 11,344 61,344
1791 Oktavia Rab 261325 1992/ Tumor 11-May-15 Onkologi 50,000 - 23,175 73,175
1792 Jemu 651641 1565/ Susp Tb Par 11-May-15 Paru 50,000 - 33,861 83,861
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1793 Sumilah 533310 2348/ Post Stroke 11-May-15 Syaraf 50,000 - 23,320 73,320
1794 Nery Herlin 654885 1427/ Kontrol 11-May-15 Kandungan 50,000 - 60,000 7,506 117,506
1795 Muthmainah 353128 2423/ Dm Ii 11-May-15 P. Dalam 50,000 35,000 58,573 143,573
1796 Aslamiah 835529 2245/ Artalgia 11-May-15 Ortophedi 50,000 - 1,300 51,300
1797 Daslan 532268 2410/ Dm Ii 11-May-15 P. Dalam 50,000 - 155,100 205,100
1798 Ratna Wati 815625 2098/ Susp Hepatit 11-May-15 P. Dalam 50,000 - 11,344 61,344
1799 Suriansyah 836571 1443/ Kontrol + Te 11-May-15 Syaraf 50,000 35,000 380,413 465,413
1800 Heni Mulya 478123 1577/ Kontrol 11-May-15 P. Dalam 50,000 - 9,813 59,813
1801 Dorothy Car 192634 2259/ Kontrol 11-May-15 P. Dalam 50,000 35,000 60,000 10,089 155,089
1802 Hayati 702223 1400/ Kontrol 11-May-15 Bedah Umum 50,000 - 125,000 1,100 176,100
1803 Andi Siraju 670639 1950/ Ht+Dm 11-May-15 P. Dalam 50,000 - 268,988 318,988
1804 Samsiah 280664 2154/ Trauma Pedi 11-May-15 Orthopedi 50,000 - 2,075 52,075
1805 Rusdiana 676761 1931/ Vertigo 11-May-15 Syaraf 50,000 - 314,475 364,475
1806 Khotimatuz 830433 1916/ Ispa 11-May-15 Anak 50,000 - 127,250 188,100 10,546 375,896
1807 Putri 833840 2243/ Terapi 11-May-15 R.medik 50,000 35,000 71,500 13,493 169,993
1808 Suwoto 822974 2215/ Hemiparase 11-May-15 Syaraf 50,000 - 536,588 586,588
1809 Masram 837631 2183/ Kontrol 11-May-15 Jantung 50,000 - 531,784 581,784
1810 Asih Sari 581548 2347/ Cad 11-May-15 Jantung 50,000 - 80,753 130,753
1811 Reva Gayatr 833043 2527/ Kontrol 11-May-15 Anak 50,000 - 13,626 63,626
1812 Susarmi 352247 1502/ Kontrol 11-May-15 Bedah Umum 50,000 35,000 60,000 17,119 162,119
1813 Radiman 835306 2115/ Hernia Ingui 11-May-15 Bedah Umum 50,000 - 125,000 7,938 182,938
1814 Krisyanti El 805101 2140/ Tu Mamae S 11-May-15 Bedah Umum 50,000 35,000 187,000 24,713 296,713
1815 Yoga Oetam 678267 1976/ Kontrol 11-May-15 Jantung 50,000 - 110,700 67,575 228,275
1816 Aleksius He 802017 1609/ Kontrol 11-May-15 Orthopedy 50,000 - 4,080 54,080
1817 Sulis Setiow 812857 1841/ Dm+Pjk 11-May-15 P. Dalam 50,000 35,000 343,075 428,075
1818 Burhan 503605 1934/ Ht 11-May-15 Jantung 50,000 - 279,113 329,113
1819 Siti Fatimah 806720 1561/ Kontrol 11-May-15 Paru 50,000 - 18,413 68,413
1820 Sanah 835536 1474/ 8|Gr 11-May-15 Gigi&Mulut 50,000 - 603,276 8,363 661,639
1821 Fareza Dwi 593804 2289/ Epilepsi 11-May-15 Syaraf 50,000 - 74,835 124,835
1822 Paidi 700205 1844/ Copd 11-May-15 Paru 50,000 - 24,129 74,129
1823 Sugiharti 290388 2065/ Dm Type Ii 11-May-15 P. Dalam 50,000 - 461,656 511,656
1824 M. Saleh 458143 1857/ Terapi+Kont 11-May-15 R.medis 50,000 35,000 71,500 13,138 169,638
1825 Darsiah 740936 2185/ Kontrol 11-May-15 R.medis 50,000 35,000 71,500 22,375 178,875
1826 Feby F 834044 1490/ Kontrol 11-May-15 Anak 50,000 - 17,600 67,600
1827 Kundari 654819 2361/ Hipertiroid 11-May-15 P. Dalam 50,000 - 153,710 203,710
1828 Sari 567006 2242/ Kontrol 11-May-15 Syaraf 50,000 - 42,149 92,149
1829 Parmiati 408455 1858/ Ca Mamae S 11-May-15 Onkologi 50,000 - 525,250 3,963 579,213
1830 Achmad Dj 298982 1518/ Ht 11-May-15 P. Dalam 50,000 - 153,638 203,638
1831 Yohanes Ka 720887 1471/ Susp Bronkh 11-May-15 Paru 50,000 - 72,765 122,765
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1832 Ida Kuswati 773708 2274/ Galukoma 11-May-15 Mata 50,000 - 60,000 35,355 145,355
1833 Siti Madina 570096 2303/ Ca Mamae 11-May-15 Bedah Umum 50,000 - 656,250 706,250
1834 Ade Reza S 835907 2200/ Hnp 11-May-15 Orthopedi 50,000 - 189,200 353,100 794 593,094
1835 Siti Nasriah 348453 1546/ Kontrol 11-May-15 P. Dalam 50,000 - 16,714 66,714
1836 Aisjah Joha 796894 1426/ Fisiotherapy 11-May-15 R.medik 50,000 35,000 159,500 12,293 256,793
1837 Abdul Sala 834231 2257/ S/ Kelainan 11-May-15 Syaraf 50,000 - 183,845 233,845
1838 Mardayani 835584 2333/ Dm 11-May-15 P. Dalam 50,000 - 136,088 186,088
1839 Sya'Diah 439539 1475/ Kontrol 11-May-15 Syaraf 50,000 - 15,070 65,070
1840 Aliyah 737784 2302/ Kontrol 11-May-15 Syaraf 50,000 - 20,880 70,880
1841 Parhusoran 835999 2046/ Lbp 11-May-15 Syaraf 50,000 - 11,830 61,830
1842 Takat 447665 1905/ Susp Kista 11-May-15 Tht 50,000 - 115,000 5,231 170,231
1843 Yusuf 694840 1965/ Tb Paru 11-May-15 Paru 50,000 - 32,316 82,316
1844 Nilam Cahy 375199 1949/ Epilepsi 11-May-15 Syaraf 50,000 - 116,906 166,906
1845 Nurmiah 828938 2006/ 8 Gp 11-May-15 Gigi 50,000 - 160,600 8,975 219,575
1846 Dalle 056134 2052/ Susp Bph 11-May-15 Urologi 50,000 - 430,088 480,088
1847 Aswin 598995 2136/ Kontrol 11-May-15 R.medik 50,000 35,000 71,500 36,386 192,886
1848 Aliah 758679 2244/ Ht 11-May-15 Syaraf 50,000 - 53,353 103,353
1849 Imam Riyad 431397 2184/ Post Orif 11-May-15 Orthopedi 50,000 - 80,000 975 130,975
1850 Tarra Daeng 835950 2142/ 7 11-May-15 Gigi&Mulut 50,000 - 579,150 286,000 915,150
1851 Riza Ashadi 803462 2054/ Niddm+Ht 11-May-15 P. Dalam 50,000 - 500,250 550,250
1852 Panirah 822928 2123/ Kontrol 11-May-15 R.medis 50,000 35,000 71,500 423,000 579,500
1853 Mariyam 775137 2053/ Dm 11-May-15 P. Dalam 50,000 - 500,250 550,250
1854 La Upe 813270 1977/ Ht 11-May-15 P. Dalam 50,000 - 252,500 302,500
1855 Ibas 835912 1636/ Benjolan Di 11-May-15 Bedah Umum 50,000 - 394,150 377,500 821,650
1856 Ida Mardian 703995 2346/ Dm 11-May-15 P. Dalam 50,000 - 110,250 160,250
1857 M Yusuf Md 763821 2063/ Terapi 11-May-15 P. Dalam 50,000 - 110,250 160,250
1858 Mitha Diana 835938 1874/ Susp Fam 11-May-15 Onkologi 50,000 - 779,650 377,500 125,400 1,332,550
1859 Murni 753392 2167/ Benjolan D 11-May-15 Bedah Umum 50,000 35,000 394,150 377,500 125,400 41,263 1,023,313
1860 Yospina Sa 610566 1548/ Kontrol 11-May-15 Onkologi 50,000 - 525,250 575,250
1861 Susanti 648967 2440/ S/ Stt 11-May-15 Bedah Umum 50,000 - 394,150 444,150
1862 Suyanto 743813 1991/ Ca Recti 11-May-15 Bedah Umum 50,000 - 492,250 542,250
1863 Syahroni 686457 1578/ Cek Lab 11-May-15 P. Dalam 50,000 - 498,800 548,800
1864 Tuti Maryan 623256 2122/ Terapi 11-May-15 P. Dalam 50,000 35,000 110,250 195,250
1865 Nuraeni 796400 1830/ Tb 11-May-15 Paru 50,000 - 160,250 125,400 335,650
1866 Sirajuddin 835944 2067/ Tumor 11-May-15 Bedah Umum 50,000 - 427,150 377,500 854,650
1867 Siti Ainah 438360 2010/ Dm 11-May-15 P. Dalam 50,000 - 110,250 160,250
1868 Siti Patimah 795244 2226/ Dm 11-May-15 P. Dalam 50,000 - 110,250 160,250
1869 St Masliatin 541849 1473/ Cek Lab 11-May-15 P. Dalam 50,000 - 177,000 227,000
1870 Sulaiman 542510 1932/ Dm+Ht 11-May-15 P. Dalam 50,000 - 110,250 160,250
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1871 Suliyah 430000 2107/ Dm 11-May-15 P. Dalam 50,000 - 566,250 616,250
1872 Panca Agust 472575 2151/ Dm+Ht 11-May-15 P. Dalam 50,000 - 110,250 160,250
1873 Sahriyah 712815 2129/ Kontrol 11-May-15 P. Dalam 50,000 - 352,100 402,100
1874 Samaria 821856 2377/ Sle 11-May-15 P. Dalam 50,000 - 43,250 93,250
1875 Sanna 801402 2286/ Ca Mamae 11-May-15 Bedah Umum 50,000 - 525,250 575,250
1876 Purwo Setiy 679826 1886/ Dm Tipe Ii 11-May-15 P. Dalam 50,000 - 110,250 160,250
1877 Rabiatul Ad 602715 1430/ Cek Lab 11-May-15 P. Dalam 50,000 - 110,250 160,250
1878 Juwariyah 648734 2229/ Dm+Ht 11-May-15 P. Dalam 50,000 - 110,250 160,250
1879 Kanti Emi 370635 2108/ Dm Ii 11-May-15 P. Dalam 50,000 - 159,500 110,250 319,750
1880 Kustiah 720823 2228/ Niddm 11-May-15 P. Dalam 50,000 - 500,250 550,250
1881 Mat Ali 683053 1919/ Dm+Ht 11-May-15 P. Dalam 50,000 - 110,250 160,250
1882 Karim 623228 1444/ Exostosis 11-May-15 Gigi 50,000 - 579,150 286,000 915,150
1883 Dewi Harum 835947 2451/ Fam 11-May-15 Bedah Umum 50,000 - 394,150 377,500 821,650
1884 Djaini 335210 2080/ Terapi 11-May-15 P. Dalam 50,000 - 500,250 550,250
1885 Elisabeth Po 278342 2158/ Susp App Kr 11-May-15 Bedah Umum 50,000 - 469,400 305,000 824,400
1886 Serly Yusuf 725420 2234/ 6 Infected 11-May-15 Gigi&Mulut 50,000 - 579,150 125,400 754,550
1887 Shieang Sart 720714 2439/ Dm 11-May-15 P. Dalam 50,000 - 599,250 649,250
1888 Jumaiti 816137 2271/ Chf 11-May-15 Jantung 50,000 - 490,250 540,250
1889 Alby Naufal 799488 2436/ Kontrol 11-May-15 B. Anak 50,000 - 701,550 105,600 857,150
1890 Abdul Harto 792176 2111/ Fr Os Mandi 11-May-15 Gigi 50,000 - 579,150 286,000 915,150
1891 Abdul Agus 835942 2022/ 48 Gp 11-May-15 Gigi 50,000 - 579,150 286,000 915,150
1892 Dimas Hend 824915 2407/ Kontrol 11-May-15 P. Dalam 50,000 - 110,250 160,250
1893 Abd Hamid 776504 2256/ Ht Gr Ii 11-May-15 P. Dalam 50,000 - 353,250 403,250
1894 Amelia 535304 2068/ Susp Limfad 11-May-15 Paru 50,000 - 160,250 377,500 125,400 713,150
1895 Arbayah 615626 2109/ Dm Tipe Ii 11-May-15 P. Dalam 50,000 - 110,250 160,250
1896 Asmawati 280882 1995/ Dm 11-May-15 P. Dalam 50,000 - 110,250 160,250
1897 Asmirawati 815123 1592/ Cek Lab 11-May-15 P. Dalam 50,000 - 352,100 402,100
1898 Sayem 835998 2077/ Hnp 11-May-15 Syaraf 50,000 - 227,700 277,700
1899 Rudy Rary 789214 1531/ Kontrol 11-May-15 Bedah Tulang 50,000 - 125,400 1,950 177,350
1900 Tita Ernawat 727043 2055/ Lbp 11-May-15 Syaraf 50,000 - 227,700 277,700
1901 Arief Rahm 840475 1504/ Susp Hepatit 11-May-15 P. Dalam 50,000 - 125,400 175,400
1902 Wahyudi 293721 2394/ Kontrol 11-May-15 Jantung 50,000 - 305,000 169,038 524,038
1903 Nurhayadi 834514 1562/ Kontrol 11-May-15 Urologi 50,000 - 145,200 195,200
1904 Norma Awal 835941 2305/ Nyeri Perut 11-May-15 Kandungan 50,000 - 60,000 305,000 415,000
1905 Yuyun Wina 827091 1456/ G3P2A0 Dng 11-May-15 Kandungan 50,000 - 120,500 305,000 475,500
1906 M.Mislan H 835937 2093/ Snh 11-May-15 Syaraf 50,000 - 997,700 1,047,700
1907 Sayyid M. A 525533 2097/ 56 11-May-15 Gigi&Mulut 50,000 - 160,600 210,600
1908 Kasmiah 835913 2218/ Susp Kista 11-May-15 Patologi Anat 50,000 - 175,000 225,000
1909 Ridho Abrar 779669 1800/ Terapi 11-May-15 R.medik 50,000 - 220,000 270,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1910 M. Almadan 835945 2070/ Serumen As 11-May-15 Tht 50,000 - 63,000 113,000
1911 Idah 529314 1414/ Pjk 11-May-15 Jantung 50,000 - 50,000
1912 Hety Erliani 835593 2190/J Susp Tumor 11-May-15 Onkologi 50,000 - 50,000
1913 Sofyan Hadi 834541 1607/ Kontrol 11-May-15 P. Dalam 50,000 35,000 85,000
1914 Sumardji 056833 2009/ Ret Urin 11-May-15 Urologi 50,000 - 335,000 385,000
1915 Mahdalena 535427 2023/ Isk 11-May-15 Urologi 50,000 - 50,000
1916 Syahbidin M 560446 2100/ Urolithiasis 11-May-15 Urologi 50,000 - 50,000
1917 Tasiyem 828995 2227/ Tu Mamae S 11-May-15 Onkologi 50,000 - 50,000
1918 Marzuki 835310 2378/ Nail Infecti 11-May-15 Bedah 50,000 - 50,000
1919 Andy Herm 836850 2085/ Kontrol 11-May-15 Bedah Umum 50,000 - 125,000 175,000
1920 Beti Lestari 695645 1487/ Kontrol 11-May-15 Bedah Umum 50,000 - 125,000 175,000
1921 Imelda Berl 834818 2217/ Trauma Taj 11-May-15 Mata 50,000 - 50,000
1922 Rusdiana 509339 2182/ Chest Pain 11-May-15 Jantung 50,000 - 462,500 512,500
1923 Lilik Malik 822017 2172/ Struma 11-May-15 Onkologi 50,000 - 50,000
1924 M.Naufal Af 834891 2515/ Hernia Scrot 11-May-15 B. Anak 50,000 35,000 85,000
1925 Jihan Naura 835949 2466/ Obs Benjol 11-May-15 B. Anak 50,000 - 50,000
1926 Indy Aninda 826706 2099/ Post Op Col 11-May-15 B. Anak 50,000 - 50,000
1927 Alana Aftar 834879 1637/ Kontrol 11-May-15 B. Anak 50,000 - 50,000
1928 Hadiyah 720865 2025/ Kontrol 11-May-15 Kandungan 50,000 - 373,500 21,175 444,675
1929 Aminah 644814 1948/ Acut Tonsili 11-May-15 Tht 50,000 - 50,000
1930 Rajidin 821567 2038/ Abses Perito 11-May-15 Tht 50,000 - 50,000
1931 Novita Sari 835956 2160/ Kontrol 11-May-15 Tht 50,000 - 225,000 275,000
1932 M Raffa Agu 835341 1533/ Serumen 11-May-15 Tht 50,000 - 63,000 113,000
1933 Yudha Nugr 835948 2455/ Pro Removl 11-May-15 Orthopedi 50,000 - 50,000
1934 Liani Hamza 671272 2061/ G3P1A1 11-May-15 Kandungan 50,000 - 60,000 110,000
1935 Asmaniah 769335 2334/ Ca Cervix 11-May-15 Kandungan 50,000 - 60,000 110,000
1936 Rita 829542 1595/ G4 P3 A0 D 11-May-15 Kandungan 50,000 - 120,500 170,500
1937 Shopiah 835591 2500/ G4P3A0 11-May-15 Kandungan 50,000 - 120,500 170,500
1938 Salmiah 806446 1845/ Ca Mamae 11-May-15 Bedah 50,000 - 462,500 512,500
1939 Hamdanah 563909 1398/ Terapi 11-May-15 R.medis 50,000 - 220,000 270,000
1940 Murad 740117 2511/ Anemia 11-May-15 P. Dalam 50,000 - 50,000
1941 Wati Nurain 822559 1580/ Kontrol 11-May-15 P. Dalam 50,000 - 50,000
1942 Rudianto 830814 2083/ Sol, 112 11-May-15 P. Dalam 50,000 - 50,000
1943 Galih Suset 829503 1606/ 112 11-May-15 P. Dalam 50,000 - 50,000
1944 Atha Isyafir 563549 1889/ V Period Ak 11-May-15 Gigi&Mulut 50,000 - 561,392 611,392
1945 Aminah 447319 2301/ Mucocele 11-May-15 Gigi&Mulut 50,000 - 50,000
1946 Ria 770256 2529/ 27 Gp 11-May-15 Gigi&Mulut 50,000 35,000 187,000 272,000
1947 Maryono Gu 835931 2188/ Isk 11-May-15 Urologi 50,000 - 50,000
1948 Dimas Resky 756904 2205/ Hernia S 11-May-15 Bedah Anak 50,000 35,000 85,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1949 Hj.Maiseng 840167 2288/ Post Ckr 11-May-15 Ortophedi 50,000 - 50,000
1950 Ayudha Sari 835533 1859/ Obs Chest P 11-May-15 Jantung 50,000 - 50,000
1951 Nur Hanifah 776816 2171/ Post Op Ca 11-May-15 Onkologi 50,000 - 50,000
1952 Sriatun 257601 1826/ Terapi+Kont 11-May-15 R.medik 50,000 35,000 71,500 156,500
1953 Megawati 695482 2542/ Menometora 11-May-15 Kandungan 50,000 - 60,000 49,088 159,088
1954 Mirna 835946 2408/ G2P1A0 11-May-15 Kandungan 50,000 - 120,500 170,500
1955 Anisah Mufi 670042 1458/ 1|Np 11-May-15 Gigi & Mulut 50,000 - 115,408 165,408
1956 Lia Safira 834293 2159/ 6 Pulpitis 11-May-15 Gigi&Mulut 50,000 - 368,287 418,287
1957 Sudarsono 835371 2272/ Angina Pec 11-May-15 Jantung 50,000 - 50,000
1958 Indriani Li 795456 2040/ 1 Gp 11-May-15 Gigi&Mulut 50,000 - 115,408 165,408
1959 Ummul Khai 815127 2318/ Cp 11-May-15 Anak 50,000 - 50,000
1960 Warsi 789865 1993/ Dm 11-May-15 P. Dalam 50,000 - 402,500 452,500
1961 Zulkifli Hg 837630 2469/ Kontrol 11-May-15 P. Dalam 50,000 - 402,500 452,500
1962 Siti Nur Kh 821126 2069/ G2P1A0+Le 11-May-15 Kandungan 50,000 - 480,500 530,500
1963 Indo Mase 835520 2496/ G2P1A0 11-May-15 Kandungan 50,000 - 120,500 170,500
1964 Arifiyanti 764139 1445/ G3 P2 A0 R 11-May-15 Kandungan 50,000 - 120,500 170,500
1965 Wiwiek Dwi 835940 2260/ Kontrol 11-May-15 Kandungan 50,000 - 120,500 170,500
1966 Cristian Nat 634732 2139/ Ca Mamae 11-May-15 Bedah Tumor 50,000 35,000 85,000
1967 Halimah 232201 1486/ Cad +Ht 11-May-15 Jantung 50,000 - 43,463 93,463
1968 Ernawati 124241 1520/ Kontrol + Te 11-May-15 Saraf + R Med 50,000 35,000 71,500 11,186 167,686
1969 Mustammia 625447 2250/ Pjk 11-May-15 Jantung 50,000 - 49,163 99,163
1970 Nuzirwan 691465 1843/ Dm+Ckd 11-May-15 P. Dalam 50,000 - 371,450 421,450
1971 Suliyanti 835943 2036/ Nyeri Kepal 11-May-15 Syaraf 50,000 - 279,705 329,705
1972 Misrah 792616 2124/ Cad 11-May-15 Jantung 50,000 - 18,213 68,213
1973 Siti Patimah 682973 1594/ Kontrol + Te 11-May-15 Syaraf 50,000 35,000 71,500 34,926 191,426
1974 Karmilah 835576 1622/ Tangan Kiri 11-May-15 P. Dalam 50,000 70,000 105,125 225,125
1975 Ernie Bs 815417 2128/ Post Stroke 11-May-15 Syaraf 50,000 - 235,355 285,355
1976 Janariah 463441 2425/ Kontrol 11-May-15 P. Dalam 50,000 35,000 41,063 126,063
1977 Kapsah 791022 2393/ Obs Vertigo 11-May-15 Syaraf 50,000 35,000 71,500 13,954 170,454
1978 Rubiyanti 835952 2483/ Bell Palsy 11-May-15 Syaraf 50,000 35,000 223,438 308,438
1979 Yani 835933 2189/ Susp Struma 11-May-15 Bedah 50,000 35,000 85,000
1980 Sakdiah 822982 2079/ Terapi 11-May-15 R.Medik 50,000 - 159,500 209,500
1981 Sumiati 671273 1384/ Fisioterapi 11-May-15 R.Medik 50,000 - 159,500 209,500
1982 Fatmawati 701043 1396/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
1983 Tinna 821536 2034/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
1984 Rusdiana 806016 2094/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
1985 Hj.Ernawati 710875 1397/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
1986 Siti Rahmah 742670 2035/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
1987 M. Aini 729644 2092/ Terapi 11-May-15 R.Medik 50,000 - 159,500 209,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
1988 Asni 816792 1887/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
1989 Suyati 213400 1828/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
1990 Sumiyati 821102 1815/ Terapi 11-May-15 R.Medik 50,000 - 159,500 209,500
1991 Sadariah 419296 2137/ Fisioterapi 11-May-15 R.Medik 50,000 - 71,500 121,500
1992 Eko Minarn 810163 2169/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
1993 Rosdiana Fa 805742 2153/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
1994 Aisyah 734989 2121/ Fisioterapi 11-May-15 R.Medik 50,000 - 71,500 121,500
1995 Nurdin Doni 712854 1829/ Fisioterapi 11-May-15 R.Medik 50,000 - 159,500 209,500
1996 Suryanti 720793 1413/ Fisioterapi 11-May-15 R.Medik 50,000 - 71,500 121,500
1997 Matrup 345802 2106/ Fisiotherapy 11-May-15 R.Medik 50,000 - 159,500 209,500
1998 Nelly 598921 2125/ Terapi 11-May-15 R.Medik 50,000 - 159,500 209,500
1999 Suyanto 445829 1442/ Fisioterapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2000 Karmidi 619224 1397/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2001 Dumiatun 669083 1516/ Fisioterapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2002 Amanat Lail 828568 1903/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2003 Jariah 676633 2198/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2004 Suharti 537870 1459/ Terapi 11-May-15 R Medik 50,000 - 71,500 121,500
2005 Warti 691974 2304/ Terapi 11-May-15 R Medik 50,000 - 159,500 209,500
2006 Rustaniah 797036 2078/ Terapi 11-May-15 R Medik 50,000 - 71,500 121,500
2007 Merry Taby 314620 2241 Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2008 Murikah 598534 1901/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2009 Elisa Mersi 534269 1902/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2010 Supatmi 805133 1488/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2011 Tri Mailani 806796 2320/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2012 Kornelis Na 810504 1871/ Terapi 11-May-15 R.Medik 50,000 - 159,500 209,500
2013 Kasdi 834604 1935/ Terapi 11-May-15 R.Medik 50,000 - 159,500 209,500
2014 H.Zamansya 787675 2287/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2015 Kartini Dg 835401 2422/ Terapi 11-May-15 R.Medik 50,000 - 159,500 209,500
2016 Asmini 795280 2248/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2017 Herlinda Yu 805100 2062/ Terapi 11-May-15 R.Medik 50,000 - 71,500 121,500
2018 Ijum 775736 2064/ Terapi 11-May-15 R.Medik 50,000 - 159,500 209,500
2019 Siti Ainah 438360 2364/ Fisioterapi 11-May-15 R.Medik 50,000 - 159,500 209,500
2020 Nur Hasana 397672 2482/ Terapi 11-May-15 R.Medik 50,000 - 159,500 209,500
2021 Ahmad Khoi 671879 2110/ Terapi 11-May-15 R.Medik 50,000 - 440,000 490,000
2022 M. Atallah 607935 1367/ Fisiotherapy 11-May-15 R Medik 50,000 - 440,000 490,000
2023 Rahmatulla 462170 1369/ Terapi 11-May-15 R Medik 50,000 - 440,000 490,000
2024 Nasywa Qon 706135 1381/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2025 Andhara Aul 613425 1368/ Fisiotherapy 11-May-15 R Medis 50,000 - 440,000 490,000
2026 Shannaz Dw 677115 1366/ Fisiotherapy 11-May-15 R Medis 50,000 - 440,000 490,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2027 Danang Zak 726353 2033/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2028 Izni Almadi 835545 1517/ Terapi 11-May-15 R Medis 50,000 - 220,000 270,000
2029 Donatianus 811513 1994/ Terapi 11-May-15 R Medis 50,000 - 159,500 209,500
2030 Salamah 748488 2019/ Fisioterapi 11-May-15 R Medis 50,000 - 220,000 270,000
2031 Hemi 835300 2084/ Terapi 11-May-15 R Medis 50,000 - 71,500 121,500
2032 Karsuni 825954 1814/ Terapi 11-May-15 R Medis 50,000 - 220,000 270,000
2033 Raudah 826607 1813/ Terapi 11-May-15 R Medis 50,000 - 220,000 270,000
2034 M. Sandy 677507 2050/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2035 M Abid Aqil 835543 1489/ Terapi 11-May-15 R Medis 50,000 - 220,000 270,000
2036 M.Rizky Ra 828577 2047/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2037 Cantika An 757599 2032/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2038 Asih Sunars 829585 2376/ Terapi 11-May-15 R Medis 50,000 - 71,500 121,500
2039 Erni Setiawa 132775 2365/ Terapi 11-May-15 R Medis 50,000 - 159,500 209,500
2040 Masrun Maj 639948 2081/ Terapi 11-May-15 R Medis 50,000 - 71,500 121,500
2041 Bandi Batha 738114 2261/ Fisioterapi 11-May-15 R Medis 50,000 - 159,500 209,500
2042 Iskandar 077736 2499/ Terapi 11-May-15 R Medis 50,000 - 159,500 209,500
2043 Rohanah 522050 2201/ Terapi 11-May-15 R Medis 50,000 - 71,500 121,500
2044 A. Fikri Pra 488012 2203/ Ft+Ot 11-May-15 R Medis 50,000 - 440,000 490,000
2045 Siti Liza 768432 2319/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2046 Herlina 817022 2247/ Terapi 11-May-15 R Medis 50,000 - 159,500 209,500
2047 Yiyin Sumar 740906 2249/ Terapi 11-May-15 R Medis 50,000 - 71,500 121,500
2048 Hasnawati 762606 1827/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2049 Ngatin 834243 1534/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2050 Ponijem 659169 1399/ Fisiotherapy 11-May-15 R Medis 50,000 - 440,000 490,000
2051 Hamdanah 790973 2181/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2052 Sarminto 796814 2197/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2053 Sugianto Ru 487872 1888/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2054 Rudiansyah 424444 2018/ Terapi 11-May-15 R Medis 50,000 - 220,000 270,000
2055 Gimun 695987 1412/ Fisiotherapy 11-May-15 R Medis 50,000 - 440,000 490,000
2056 Kusnan 721341 2020/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2057 Imam Muha 190433 2031/ Terapi 11-May-15 R Medis 50,000 - 440,000 490,000
2058 Kasemi 801303 2273/ Terapi 11-May-15 R Medis 50,000 - 220,000 270,000
2059 Sutoyo 836953 1472/ Terapi 11-May-15 R Medis 50,000 - 220,000 270,000
2060 Rey Tanizar 817073 2467/ Terapi 11-May-15 R Medis 50,000 - 159,500 209,500
2061 Ammi Wiyan748900 2232/ Terapi 11-May-15 R Medis 50,000 - 159,500 209,500
2062 Suhery 822948 2127/ Terapi 11-May-15 R Medis 50,000 - 71,500 121,500
2063 Suparmi 810191 2112/ Terapi 11-May-15 R Medis 50,000 - 71,500 121,500
2064 M. Jufri 764121 2095/ Fisioterapi 11-May-15 R Medis 50,000 - 71,500 121,500
2065 Sopiah 655365 2141/ Terapi 11-May-15 R Medis 50,000 - 159,500 209,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2066 Sarifuddin 835589 2331/ Shoulder Pa 11-May-15 R Medis 50,000 - 71,500 121,500
2067 Zuliatin 664628 2076/ Fisiotherapy 11-May-15 R Medis 50,000 - 220,000 270,000
2068 Wahyu Hand 697153 2138/ Terapi 11-May-15 R Medis 50,000 - 220,000 270,000
2069 Rusmini 607352 1429/ Terapi 11-May-15 R Medis 50,000 - 220,000 270,000
2070 Istiyah 835919 2412/ Susp Spinal 12-May-15 Syaraf+Urolog 50,000 35,000 71,500 7,225 163,725
2071 Jumari 644441 2351/ Terapi+Kont 12-May-15 R.Medik+Syar 50,000 70,000 71,500 49,830 241,330
2072 Lina 822580 2655/ Lbp 12-May-15 Syaraf 50,000 - 227,700 10,279 287,979
2073 Wa Nuru 835977 2800/ S/ Sinusitis 12-May-15 Tht 50,000 - 105,600 10,300 165,900
2074 Suryani 837572 2859/ Kontrol 12-May-15 Syaraf 50,000 - 12,455 62,455
2075 Feni Elita Sa 593157 1835/ Kontrol 12-May-15 Kandungan 50,000 - 120,500 17,813 188,313
2076 Sujitno 835911 2648/ Skoliosis 12-May-15 Ortophedi 50,000 35,000 71,500 1,637,900 10,406 1,804,806
2077 Nila Wati 346646 1849/ Lbp 12-May-15 Orthopedy 50,000 35,000 71,500 2,400 158,900
2078 Rabiatul Ad 602715 2631/ Kontrol 12-May-15 Rehab Medik 50,000 35,000 71,500 146,269 302,769
2079 Afryan 663654 2695/ Epilepsi 12-May-15 Syaraf 50,000 - 47,419 97,419
2080 Rusdiana 745347 2709/ Neprolitiasi 12-May-15 Urologi 50,000 - 1,963 51,963
2081 Akiyadi Arie 671198 2619/ Dm Ii 12-May-15 Peny.Dalam 50,000 - 609,500 7,388 666,888
2082 Atmardians 835989 2639/ Kontrol 12-May-15 Penyakit Dala 50,000 - 116,750 115,450 282,200
2083 Panca Agust 472575 2616/ Dm+Ht 12-May-15 Penyakit Dala 50,000 - 759,309 809,309
2084 Sujoko 434368 2740/ Kontrol 12-May-15 Syaraf 50,000 - 10,744 60,744
2085 Rusnita Arr 562367 2516/ Epilepsi 12-May-15 Syaraf 50,000 - 531,713 581,713
2086 Mirsa Nur 755424 2724/ Tiroidisme 12-May-15 Peny.Dalam 50,000 - 608,050 8,000 666,050
2087 Sutanto 835918 2400/ Susp Dki 12-May-15 Kulit Kelamin 50,000 - 3,849 53,849
2088 Ngatemi 565526 2444/ Terapi+Kont 12-May-15 R.Medik+Syar 50,000 35,000 71,500 997,700 10,324 1,164,524
2089 Semi 457503 2707/ Post Stroke 12-May-15 Syaraf 50,000 - 47,956 97,956
2090 Suryani 835976 1805/ Kontrol 12-May-15 Bedah Saraf 50,000 35,000 79,500 17,433 181,933
2091 Arbayah 615626 2323/ Dm 12-May-15 Penyakit Dala 50,000 - 177,456 227,456
2092 Sumindar 802144 2634/ Pjk 12-May-15 Jantung 50,000 - 235,950 285,950
2093 Muhammad 763821 2307/ Artritis 12-May-15 Penyakit Dala 50,000 - 35,275 85,275
2094 Hanafi Alhad 835974 1787/ Tonsilitis 12-May-15 Tht 50,000 - 295,150 7,101 352,251
2095 Ida Mardian 703995 2383/ Dm 12-May-15 Penyakit Dala 50,000 - 142,575 192,575
2096 Suliyah 430000 1667/ Dm Ii 12-May-15 Peny.Dalam 50,000 - 180,750 230,750
2097 Selamat 673670 1696/ Cad 12-May-15 Jantung 50,000 - 58,238 108,238
2098 Herlina 665308 2310/ Post Stroke 12-May-15 Syaraf 50,000 - 25,611 75,611
2099 Siti Mujinah 308754 2411/ Pjk+Dm 12-May-15 Jantung+P.Da 50,000 35,000 110,250 41,013 236,263
2100 Mirna Wati 541613 2429/ Susp Sinusit 12-May-15 Tht 50,000 35,000 328,150 105,600 9,528 528,278
2101 La Ahmad D 835983 2607/ Susp Bp 12-May-15 Anak 50,000 - 20,826 70,826
2102 Santi Aisya 140680 2830/ Kontrol 12-May-15 Bedah Thorax 50,000 - 40,675 90,675
2103 Kharuddin Y 644883 1670/ Keloid 12-May-15 Kulit Kelamin 50,000 - 115,000 49,781 214,781
2104 Nurul Aini 835915 2559/ Cervik Pain 12-May-15 Syaraf 50,000 35,000 71,500 20,518 177,018
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2105 Asran Hasa 740658 2738/ Ht 12-May-15 Syaraf 50,000 - 460,475 510,475
2106 Masliyah 453712 2443/ Cephalgia 12-May-15 Syaraf 50,000 - 23,593 73,593
2107 Imam Syafi' 829947 2638/ Chf 12-May-15 Jantung 50,000 - 158,363 208,363
2108 Azis Andi 837689 2531/ Cardiomega 12-May-15 Jantung+Paru 50,000 35,000 187,000 43,700 315,700
2109 Nasmah 663137 2676/ Iscialgia 12-May-15 Syaraf 50,000 35,000 20,291 105,291
2110 Djufrianto 770010 2666/ Hhd 12-May-15 Jantung 50,000 - 196,350 246,350
2111 Ajerin Nor 726538 2430/ Mh 12-May-15 Kulit Kelamin 50,000 - 14,075 64,075
2112 Mahrita 834539 2427/ Terapi+Lbp 12-May-15 R.Medik+Syar 50,000 35,000 71,500 8,204 164,704
2113 Hasri 835965 1728/ Susp Fr Pate 12-May-15 Orthopedy 50,000 - 250,800 5,263 306,063
2114 Salawati Dh 748257 2736/ Tic Facialis 12-May-15 Syaraf 50,000 - 52,088 102,088
2115 Setiawan 770224 1820/ Epilepsi 12-May-15 Saraf 50,000 - 410,550 460,550
2116 Marjani 103800 2632/ Gastritis Kr 12-May-15 Peny.Dalam 50,000 - 21,169 71,169
2117 Sumiaty 429003 2369/ Terapi+Lbp 12-May-15 R.Medik+Syar 50,000 35,000 71,500 9,704 166,204
2118 Sukarti P. 835988 2636/ Lbp 12-May-15 Syaraf 50,000 - 227,700 4,654 282,354
2119 Milawati 700100 2562/ Spondilitis 12-May-15 Orthopedi 50,000 - 80,000 19,313 149,313
2120 M. Syaidi 488484 2784/ Pjk 12-May-15 Jantung 50,000 35,000 160,250 125,400 462,500 201,563 1,034,713
2121 Ali Munafri 820162 2608/ Ggk 12-May-15 Penyakit Dala 50,000 - 3,663 53,663
2122 Siti Fatimah 499974 1846/ Lbp 12-May-15 Saraf 50,000 - 15,091 65,091
2123 Rusdiana 372137 2783/ Kontrol 12-May-15 Jantung+Saraf 50,000 35,000 77,208 162,208
2124 Harni 788776 1726/ Kontrol 12-May-15 Kandungan 50,000 - 60,000 3,788 113,788
2125 Irfan 832516 2828/ Kontrol 12-May-15 Ortophedi 50,000 - 160,000 74,766 284,766
2126 Asmawati 280882 2693/ Dm 12-May-15 Dalam 50,000 - 415,925 465,925
2127 Nurhasan 835994 1864/ Hidrokell 12-May-15 Urologi 50,000 - 394,150 1,963 446,113
2128 M.Robby 840389 2604/ Kontrol 12-May-15 Anak 50,000 - 38,500 88,500
2129 Khusnul Kh 805745 2550/ Keputihan+ 12-May-15 Kandungan 50,000 35,000 60,000 649,500 256,313 1,050,813
2130 Riswan Hak 833349 2486/ Post Gips 12-May-15 Orthopedi 50,000 - 135,000 3,050 188,050
2131 M. Rafianur 661631 2549/ Epilepsi 12-May-15 Anak 50,000 - 156,750 206,750
2132 Casmudi 598687 1759/ Bhp 12-May-15 Urologi 50,000 - 137,213 187,213
2133 Abd Rauf 721224 1771/ Bph 12-May-15 Urologi 50,000 - 430,088 480,088
2134 Tuti Maryan 623256 2324/ Dm+Ht 12-May-15 Penyakit Dala 50,000 - 280,388 330,388
2135 Yuni 681215 1685/ Ht 12-May-15 Dalam 50,000 - 153,975 203,975
2136 Supatmi 801314 2588/ Kontrol 12-May-15 Dalam+R.Med 50,000 35,000 71,500 146,961 303,461
2137 Abd Khair 780503 2602/ Kontrol 12-May-15 Rehab Medik+ 50,000 35,000 71,500 15,561 172,061
2138 Arief Rahm 840475 2573/ Abd Pain 12-May-15 Peny.Dalam 50,000 35,000 22,866 107,866
2139 Yusran 835963 2677/ Rinitis Alerg 12-May-15 Tht 50,000 - 105,600 21,756 177,356
2140 Maria Goret
835592/8370882739/ Kontrol 12-May-15 Kulit Kelamin 50,000 - 29,310 79,310
2141 Nurdin Baru 390697 2293/ Cad 12-May-15 Jantung 50,000 35,000 196,050 281,050
2142 Toni 558843 2601/ Epilepsi 12-May-15 Syaraf 50,000 - 246,488 296,488
2143 Endang Sula 633292 2617/ Kontrol 12-May-15 Jantung+Dala 50,000 - 114,875 164,875
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2144 Mona 579400 2590/ Myalgia 12-May-15 Syaraf 50,000 - 29,199 79,199
2145 Elija Sugen 336775 2458/ Lbp 12-May-15 Syaraf 50,000 - 13,541 63,541
2146 Asliansyah 591446 2399/ Terapi+Hnp 12-May-15 R.Medik+Syar 50,000 35,000 159,500 27,054 271,554
2147 Endang Sula 633292 2617/ Kontrol 12-May-15 Jantung+Dala 50,000 - 309,788 359,788
2148 Ijum 775736 2308/ Kontrol 12-May-15 Syaraf 50,000 - 17,655 67,655
2149 Sahadiah 686529 2586/ Dm 12-May-15 Penyakit Dala 50,000 - 93,410 143,410
2150 Farlan Said 589207 2442/ Bph 12-May-15 Urologi 50,000 - 137,213 187,213
2151 Atikah 806471 2337/ Omsk 12-May-15 Tht 50,000 - 4,963 54,963
2152 Kanti Emi 370635 2322/ Dm Tipe 2 12-May-15 Penyakit Dala 50,000 - 330,419 380,419
2153 M. Firgiawa 836391 2338/ Kontrol 12-May-15 Orthopedi 50,000 - 135,000 3,375 188,375
2154 Lamanto 822930 2505/ Pjk 12-May-15 Jantung 50,000 - 53,663 103,663
2155 Mat Ali 683053 2692/ Dm Ii 12-May-15 Peny.Dalam 50,000 - 268,449 318,449
2156 Syarifuden 093622 2902/ Epilepsi 12-May-15 Syaraf 50,000 - 516,988 566,988
2157 Syafrudin C 647395 2519/ Otitis Media 12-May-15 Tht 50,000 - 310,500 3,463 363,963
2158 Ronny Hern 809381 2340/ Post Stroke 12-May-15 Syaraf 50,000 - 144,000 997,700 17,380 1,209,080
2159 Romlah 532116 2663/ Post Kuret 12-May-15 Kandungan 50,000 35,000 60,000 187,000 285,788 617,788
2160 Siti Ulfa 840719 2814/ Migrain 12-May-15 Syaraf 50,000 - 15,218 65,218
2161 Nani Widyan 486597 2706/ Kontrol 12-May-15 Rehab Medik/S 50,000 35,000 220,000 30,911 335,911
2162 Fidiah Biant 840148 1831/ Kontrol 12-May-15 Bedah Umum 50,000 35,000 12,469 97,469
2163 Sudirman 835903 2547/ Gastritis+S 12-May-15 Penyakit Dala 50,000 - 24,069 74,069
2164 M.Saddam M836329 2904/ Post Op Lap 12-May-15 Bedah Umum 50,000 - 125,000 3,063 178,063
2165 Annur Mega 834809 2845/ Kontrol 12-May-15 Kandungan 50,000 - 60,000 17,838 127,838
2166 Murni 733575 2708/ S/ Gastritis 12-May-15 Peny.Dalam 50,000 - 19,856 69,856
2167 Achmadsya 465433 2381/ Terapi+Post 12-May-15 R.Medik+Syar 50,000 35,000 159,500 30,535 275,035
2168 Zaka Firza 685069 2903/ Abses Femor 12-May-15 Anak 50,000 - 21,018 71,018
2169 Hj.Maiseng 840167 2812/ Post Ckr 12-May-15 Ortophedi 50,000 - 79,500 7,804 137,304
2170 Abd Salam 364953 2502/ Post Op Tur 12-May-15 Urologi 50,000 - 234,950 1,963 286,913
2171 Maulidiya Pu834588 2797/ Kejang De 12-May-15 Anak 50,000 - 85,865 135,865
2172 Djaini 335210 2355/ Niddm 12-May-15 Penyakit Dala 50,000 35,000 353,100 149,469 587,569
2173 Arbainah 531576 1816/ Tonsilitis K 12-May-15 Tht 50,000 35,000 509,750 187,000 7,938 789,688
2174 Mariyam 775137 2843/ Kontrol 12-May-15 Jantung+Dala 50,000 - 197,100 247,100
2175 Darmadi 645791 1847/ Bph 12-May-15 Urologi 50,000 - 377,200 137,213 564,413
2176 Lilis 537857 2489/ Ht 12-May-15 Syaraf 50,000 - 10,136 60,136
2177 Eddy Nayan 642026 2652/ Ckd 12-May-15 Bedah Thorak 50,000 - 11,225 61,225
2178 Sabariyah 016859 2295/ Fisioterapi 12-May-15 Rehab Medik 50,000 35,000 159,500 15,016 259,516
2179 Sali 787723 2664/ Kontrol 12-May-15 Rehab Medik+ 50,000 35,000 220,000 21,918 326,918
2180 Sri Rawit 489115 2769/ Ht 12-May-15 Syaraf 50,000 - 12,941 62,941
2181 Aflus 494551 1833/ Kontrol 12-May-15 Saraf 50,000 - 19,950 69,950
2182 Aditia Saput 638973 1895/ Vsd 12-Mar-15 Bedah Thorax 50,000 - 1,835 51,835
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2183 Dewi Kartik 824703 1850/ Kontrol 12-May-15 Mata 50,000 35,000 71,500 26,230 182,730
2184 Asnawati 597952 2548/ Hnp 12-May-15 Syaraf 50,000 - 435,600 11,290 496,890
2185 Ratna 821500 2560/ Kontrol 12-May-15 Rehab Medik+ 50,000 35,000 71,500 16,729 173,229
2186 Harwati 835921 1804/ Kontrol 12-May-15 Dalam 50,000 - 2,763 52,763
2187 Dewi Madur 835985 2621/ Fraktur Dig 12-May-15 Bedah Umum 50,000 - 625,000 2,871 677,871
2188 Sakka 796840 1790/ Dispepsi 12-May-15 Dalam 50,000 35,000 22,630 107,630
2189 Nurul Izzah 835972 1774/ 47 Pulpitis 12-May-15 Gigi & Mulut 50,000 - 207,443 160,600 8,363 426,406
2190 Minog 648247 1741/ Ht 12-May-15 P.Dalam 50,000 70,000 286,669 406,669
2191 Fitriansyah 835967 2473/ Bells Palsy 12-May-15 Syaraf 50,000 - 997,700 14,888 1,062,588
2192 Siti Prihatin 743842 2796/ Parkinson 12-May-15 Syaraf 50,000 - 523,875 573,875
2193 Tita Ernawat 727043 2534/ Lbp 12-May-15 Syaraf 50,000 - 22,041 72,041
2194 Asmirawati 815123 1715/ Kontrol 12-May-15 Dalam 50,000 - 265,050 315,050
2195 Iqbal Irfans 499512 2561/ Obs Vomitin 12-May-15 Penyakit Dala 50,000 - 11,313 61,313
2196 Ngatiyem 771064 1847/ Kontrol 12-May-15 Paru 50,000 - 31,043 81,043
2197 Emmy Rita 840236 2460/ Sol 12-May-15 Bedah Syaraf 50,000 - 79,500 26,138 155,638
2198 Saidi 835987 2622/ Hemapoe 12-May-15 Paru 50,000 - 160,250 21,725 231,975
2199 Siti Patimah 795244 2751/ Dm 12-May-15 Peny.Dalam 50,000 - 169,531 219,531
2200 Rama Indra 834262 2620/ Kontrol 12-May-15 Kandungan 50,000 - 120,500 3,788 174,288
2201 Utuh Sadri 544000 2721/ Decom 12-May-15 Jantung 50,000 - 289,435 339,435
2202 Gafar Kasim 634814 2610/ Oa 12-May-15 Penyakit Dala 50,000 - 14,663 64,663
2203 Sabran Rico 835978 2813/ 24 25 Perio 12-May-15 Gigi&Mulut 50,000 - 160,600 11,781 222,381
2204 Chairani 760854 2811/ Tiroid 12-May-15 Peny.Dalam 50,000 - 51,785 101,785
2205 Rosmi Fitri 835986 2875/ Oma 12-May-15 Tht 50,000 - 63,000 9,988 122,988
2206 Linawati 840321 2856/ Dermatitis A 12-May-15 Kulit Kelamin 50,000 - 23,739 73,739
2207 Ernawati 349360 2680/ Ht Gr Iii 12-May-15 Jantung 50,000 - 51,450 101,450
2208 Saifullah 836957 2504/ Post Orif 12-May-15 Orthopedi 50,000 - 160,000 25,825 235,825
2209 Rusdiah 835916 1683/ Nyeri Pung 12-May-15 Saraf 50,000 - 227,700 10,279 287,979
2210 Sunarti 821535 1744/ Kontrol 12-May-15 Kandungan 50,000 - 60,000 3,000 113,000
2211 Umar Usma 828900 2841/ Kontrol 12-May-15 Bedah Umum 50,000 - 4,588 54,588
2212 Abd Azis 834524 1775/ Ht 12-May-15 Dalam 50,000 - 263,269 313,269
2213 Badrotul Mu 602724 2595/ Menometror 12-May-15 Kandungan 50,000 - 60,000 154,088 264,088
2214 Sunarto 517386 2829/ Chest Pain 12-May-15 Jantung 50,000 - 89,438 139,438
2215 Hamsiah 796558 2844/ Kontrol 12-May-15 Jantung 50,000 - 462,500 43,938 556,438
2216 Rosdiana H. 805742 1681/ Kontrol 12-May-15 Jantung + Sara 50,000 35,000 194,636 279,636
2217 Juray Mahdi 524839 2766/ Kontrol 12-May-15 Syaraf 50,000 - 15,218 65,218
2218 Yusni 775190 1789/ Bph 12-May-15 Urologi 50,000 - 137,213 187,213
2219 Wahyudi 641055 2753/ Epilepsi 12-May-15 Syaraf 50,000 - 529,430 579,430
2220 Alif Aprian 840200 2920/ Kontrol 12-May-15 Bedah Syaraf 50,000 - 997,700 240 1,047,940
2221 Junaidi 835990 1834/ Susp Dermat 12-May-15 Kulit Kelamin 50,000 - 17,613 67,613
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2222 Hj. Nurhayat 777438 2591/ Dm+Ht 12-May-15 Penyakit Dala 50,000 - 350,494 400,494
2223 Heni Mulya 478123 2414/ Kontrol 12-May-15 Syaraf 50,000 - 24,830 74,830
2224 Yudi Gunars 725539 2262/ Snh 12-May-15 Syaraf 50,000 - 24,341 74,341
2225 Sahriyah 712815 1745/ Kontrol 12-May-15 Dalam 50,000 - 37,106 87,106
2226 Thabri Dahr 739359 2874/ Asma Bronk 12-May-15 Paru 50,000 - 24,671 74,671
2227 Sunaryo 711809 2546/ Post Orif 12-May-15 Orthopedi 50,000 - 125,400 8,263 183,663
2228 Ponijem 659169 1666/ Fisiotherapy 12-May-15 Rehab Medis 50,000 35,000 220,000 32,830 337,830
2229 Kustiah 720823 2472/ Dm 12-May-15 Penyakit Dala 50,000 - 257,475 307,475
2230 Kamsiah 835917 2398/ Obs Cephalg 12-May-15 Syaraf 50,000 - 207,900 22,105 280,005
2231 Isvianti Nur 552267 1684/ Epilepsi 12-May-15 Saraf 50,000 - 45,898 95,898
2232 Idris 718717 2563/ Pjk 12-May-15 Jantung 50,000 - 46,163 96,163
2233 M Khaidir 835920 1712/ Kontrol 12-May-15 Gigi & Mulut 50,000 - 8,488 58,488
2234 Cecep Syari 828211 2905/ Nyeri Dada 12-May-15 Jantung 50,000 - 478,500 528,500
2235 Hasannudin 835568 2798/ S/ Tb Paru 12-May-15 Paru 50,000 - 18,563 68,563
2236 Jamir 459337 2723/ Bph 12-May-15 Urologi 50,000 - 139,175 189,175
2237 Emi Rokaya 835991 2917/ Oma 12-May-15 Tht 50,000 - 63,000 9,988 122,988
2238 Mahmudah 268599 2339/ Terapi+Ht 12-May-15 R.Medik+Syar 50,000 35,000 71,500 43,005 199,505
2239 Mukag 135247 2694/ Migrain 12-May-15 Syaraf 50,000 - 17,768 67,768
2240 Syahroni 686457 2799/ Hiertiroid 12-May-15 Peny.Dalam 50,000 - 40,613 90,613
2241 Siti Ainah 438360 2691/ Dm 12-May-15 Peny.Dalam 50,000 - 282,518 332,518
2242 Indra Suryad 838114 1743/ Ht 12-May-15 Jantung 50,000 - 523,250 187,000 282,788 1,043,038
2243 Bagus Fahri 666822 1727/ Susp Close 12-May-15 Orthopedy 50,000 - 105,600 2,871 158,471
2244 Ahmad Idru 820029 2532/ Pjk 12-May-15 Jantung 50,000 - 284,738 334,738
2245 Aiwan 247220 1832/ Kontrol 12-May-15 Saraf 50,000 - 57,000 173,938 280,938
2246 Nur Hasana 835962 2457/ Susp Adenoc 12-May-15 Penyakit Dala 50,000 - 11,844 61,844
2247 Tilah 748210 1714/ Parasev Neru 12-May-15 Saraf 50,000 - 20,430 70,430
2248 Nur Idah 835359 2501/ App Kronis 12-May-15 Bedah Umum 50,000 - 125,000 9,925 184,925
2249 Rudi Herma 743463 1756/ Terapi 12-May-15 Rehab Medis 50,000 35,000 71,500 254,394 410,894
2250 Kadri 293278 2710/ Pjk 12-May-15 Jantung 50,000 - 52,413 102,413
2251 Adityatama 335533 2366/ Obs Dispeps 12-May-15 Anak 50,000 - 57,700 4,368 112,068
2252 Mahnunah 490564 1699/ Post Snh 12-May-15 Saraf 50,000 - 14,888 64,888
2253 Is Johan 584239 2487/ Pjk 12-May-15 Jantung 50,000 - 69,600 119,600
2254 Junaidi 835973 1772/ Tonsilitis 12-May-15 Tht 50,000 - 295,150 9,969 355,119
2255 Purwo Setiy 679826 1711/ Dm Ii 12-May-15 Dalam 50,000 - 666,475 716,475
2256 Reza Kurni 496249 1638/ Epilepsi 12-May-15 Saraf 50,000 - 514,088 564,088
2257 Sinta Rahay 393283 2665/ S/ Sinusitis 12-May-15 Tht 50,000 - 125,400 31,390 206,790
2258 Yuni Johan 796059 2471/ Ht+Dm 12-May-15 Penyakit Dala 50,000 - 209,250 259,250
2259 Wiwin 430340 2755/ Kontrol 12-May-15 Tht+Gigi 50,000 - 328,150 378,150
2260 Zainal Bada 635055 2544/ Dm Ht 12-May-15 Peny.Dalam 50,000 - 110,250 160,250
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2261 Widya Agust 527699 1669/ Cek Lab 12-May-15 Laboratorium 50,000 - 87,500 137,500
2262 Sukarti 810573 2428/ Dm 12-May-15 Penyakit Dala 50,000 - 500,250 550,250
2263 Sumarni 835984 2871/ Kontrol 12-May-15 Kandungan 50,000 - 60,000 438,400 125,400 673,800
2264 Suratun 625396 2385/ Dm 12-May-15 Penyakit Dala 50,000 - 110,250 160,250
2265 Sutarti 648815 2384/ Dm 12-May-15 Penyakit Dala 50,000 - 110,250 160,250
2266 Ramadhan 835971 2785/ Obs Orchitis 12-May-15 Anak 50,000 - 44,250 94,250
2267 Nursidin 528848 2572/ Cml Kardio 12-May-15 Jantung 50,000 - 43,250 93,250
2268 Nursari 619272 1652/ Cek Lab 12-May-15 Laboratorium 50,000 - 110,250 160,250
2269 Nurhadi 823460 1773/ Kontrol 12-May-15 Urologi 50,000 - 438,400 488,400
2270 Nurasanah 764281 2653/ Sle 12-May-15 Penyakit Dala 50,000 - 43,250 93,250
2271 Nur Chosia' 630834 2321/ Dm 12-May-15 Penyakit Dala 50,000 - 110,250 160,250
2272 Nanang Isma 813793 2587/ Kontrol 12-May-15 Tht 50,000 - 582,450 632,450
2273 Minalia 724238 2517/ Snnt 12-May-15 Bedah Umum 50,000 - 352,100 402,100
2274 Masrawan 652250 1729/ Cek Lab 12-May-15 Laboratorium 50,000 - 110,250 160,250
2275 Sinem 558073 2605/ Parkinson 12-May-15 Syaraf 50,000 - 500,250 550,250
2276 Sapri Usma 835969 2520/ Haemorhoid 12-May-15 Bedah Umum 50,000 - 711,150 125,400 886,550
2277 Jamidin 049116 1668/ Cek Lab 12-May-15 Laboratorium 50,000 - 110,250 160,250
2278 Jum'Ah 236188 2309/ Dm 12-May-15 Penyakit Dala 50,000 - 110,250 160,250
2279 Hadinata 834216 2654/ Kontrol 12-May-15 Orthopedi 50,000 - 295,150 345,150
2280 Diah Prawita 835914 1653/ Ganglion 12-May-15 Bedah Umum 50,000 - 181,950 231,950
2281 Aris Priwah 835964 2678/ Kontrol 12-May-15 Paru 50,000 - 160,250 125,400 335,650
2282 Asmaran Ga 712196 2367/ Dm 12-May-15 Penyakit Dala 50,000 - 500,250 550,250
2283 Andre Prata 835578 1713/ Benjolan Di 12-May-15 Bedah Umum 50,000 - 438,400 377,500 865,900
2284 Sulastri 835993 1862/ Susp Limfo 12-May-15 Bedah Umum 50,000 - 394,150 125,400 569,550
2285 Sirajuddin 835944 2609/ Tumor 12-May-15 Bedah Umum 50,000 - 84,000 125,400 259,400
2286 Siti Mahira 835981 2580/ Tu Axilla D 12-May-15 Bedah Umum 50,000 - 438,400 377,500 125,400 991,300
2287 Harianto 835961 2456/ Tu Axillaris 12-May-15 Bedah Umum 50,000 - 711,150 377,500 125,400 1,264,050
2288 Agus Trisna 835992 1848/ Kista Tiroid 12-May-15 Dalam 50,000 - 538,600 588,600
2289 Umi Jazaroh 487186 1801/ Abses Axill 12-May-15 Bedah Umum 50,000 - 377,500 427,500
2290 Junnu 775213 2633/ Cek Lab 12-May-15 Patologi Anat 50,000 - 325,250 375,250
2291 Ade Reza Sa 835907 2577/ Hnp 12-May-15 Orthopedi 50,000 - 1,472,900 1,522,900
2292 M Arga 835975 1803/ Susp Dislok 12-May-15 Orthopedy 50,000 - 105,600 155,600
2293 Ibas 835912 2640/ Tumor 12-May-15 Bedah Umum 50,000 35,000 125,400 187,000 397,400
2294 Hamdiansya 835982 2826/ Kontrol 12-May-15 Gigi&Mulut 50,000 35,000 160,600 245,600
2295 Rusmiati 550670 2575/ Perdarahan 12-May-15 Kandungan 50,000 - 60,000 305,000 415,000
2296 Siti Halima 494343 2637/ Hnp 12-May-15 Orthopedi 50,000 - 227,700 277,700
2297 Hardianto 835904 1863/ Colic Abdo 12-May-15 Bedah Umum 50,000 - 305,000 355,000
2298 Sriani 346142 2545/ Terapi 12-May-15 R.Medik 50,000 - 159,500 209,500
2299 Hervia 816478 2354/ Terapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2300 Helwinda 577381 2278/ Terapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
2301 Suparti 487344 2557/ Terapi 12-May-15 R.Medik 50,000 - 71,500 121,500
2302 Nico Mangu 784719 2263/ Terapi 12-May-15 Rehab Medik 50,000 - 159,500 209,500
2303 Marida 647710 2294/ Fisioterapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
2304 Erna Samun 569637 1640/ Fisioterapi 12-May-15 Rhb Medis 50,000 - 159,500 209,500
2305 Subeli 238930 2370/ Terapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
2306 Supriyatin 778830 1682/ Terapi 12-May-15 Rehab Medis 50,000 - 71,500 121,500
2307 Siti Maimun 822088 2603/ Terapi 12-May-15 R.Medik 50,000 - 71,500 121,500
2308 Wakiyem 701255 1700/ Terapi 12-May-15 R Medik 50,000 - 71,500 121,500
2309 Yuliana 625938 2353/ Terapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
2310 M Solihin 795185 1655/ Terapi 12-May-15 R Medik 50,000 - 159,500 209,500
2311 Fatimah 380727 2382/ Terapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
2312 Rubiyanti 839552 1697/ Terapi 12-May-15 R Medik 50,000 - 71,500 121,500
2313 Marsidi 720910 1698/ Terapi 12-May-15 R Medis 50,000 - 159,500 209,500
2314 Musningsih 549641 2662/ Terapi 12-May-15 R.Medik 50,000 - 159,500 209,500
2315 Susiatin 337059 2474/ Terapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
2316 Fatma 433683 1742/ Terapi 12-May-15 R Medis 50,000 - 71,500 121,500
2317 Sayem 835998 1757/ Terapi 12-May-15 R Medik 50,000 - 71,500 121,500
2318 Yuliani 285668 2306/ Terapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
2319 Kornelis Na 810504 2426/ Terapi 12-May-15 Rehab Medik 50,000 - 159,500 209,500
2320 Kisnan 431632 2618/ Terapi 12-May-15 R.Medik 50,000 - 159,500 209,500
2321 Priyo Hoet 263217 2647/ Terapi 12-May-15 R.Medik 50,000 - 71,500 121,500
2322 Sujarni 800848 2650/ Terapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
2323 Siti Yulaina 670596 2368/ Terapi 12-May-15 Rehab Medik 50,000 - 159,500 209,500
2324 Yenni Purwa 631789 2441/ Terapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
2325 Murtini 757462 2646/ Terapi 12-May-15 R.Medik 50,000 - 71,500 121,500
2326 Nurhaidah 061430 2679/ Terapi 12-May-15 R.Medik 50,000 - 71,500 121,500
2327 Ida Rachma 764193 2781/ Fisioterapi 12-May-15 Rehab Medis 50,000 - 159,500 209,500
2328 Sarahealti 835367 2767/ Kontrol 12-May-15 Rehab Medik+ 50,000 - 71,500 121,500
2329 Viknatul Lei 829364 1758/ Terapi 12-May-15 R Medik 50,000 - 71,500 121,500
2330 Helda Indri 828550 2579/ Terapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
2331 Hj.Aminah 759005 2919/ Terapi 12-May-15 R.Medik 50,000 - 159,500 209,500
2332 M. Irwan Wi 700898 2593/ Terapi 12-May-15 Rehab Medik 50,000 - 159,500 209,500
2333 Norliana 521951 2624/ Terapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
2334 Paulus Lai P 243271 2872/ Terapi 12-May-15 R.Medik 50,000 - 71,500 121,500
2335 H. Bambang 829576 2397/ Terapi 12-May-15 Rehab Medik 50,000 - 440,000 490,000
2336 Aris Rahman 784378 2336/ Terapi 12-May-15 Rehab Medik 50,000 - 440,000 490,000
2337 Sugiyanto 748332 2280/ Terapi 12-May-15 Rehab Medik 50,000 - 440,000 490,000
2338 Muryati 731325 2518/ Fisioterapi 12-May-15 Rehab Medik 50,000 - 440,000 490,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2339 Rachmah 264555 2325/ Ft+Tw 12-May-15 Rehab Medik 50,000 - 440,000 490,000
2340 M.Yusuf 781487 2901/ Terapi 12-May-15 R.Medik 50,000 - 220,000 270,000
2341 Kamba 823138 2661/ Terapi 12-May-15 R.Medik 50,000 - 220,000 270,000
2342 Rushel Satri 819393 2276/ Terapi 12-May-15 Rehab Medik 50,000 - 220,000 270,000
2343 Prima Dwi 390935 2265/ Ot+Tw 12-May-15 Rehab Medik 50,000 - 440,000 490,000
2344 M. Azylillah 744048 2264/ Ot+Tw 12-May-15 Rehab Medik 50,000 - 440,000 490,000
2345 Miftahul Ja 615499 2858/ Fisioterapi 12-May-15 R. Medik 50,000 - 71,500 121,500
2346 Andri K.P. 706211 1865/ Fisioterapi 12-May-15 Rehab Medis 50,000 - 159,500 209,500
2347 Karmilah 835576 2623/ Terapi 12-May-15 Rehab Medik 50,000 - 71,500 121,500
2348 Faricha Boe 658224 2860/ Terapi 12-May-15 R.Medik 50,000 - 71,500 121,500
2349 Ahmad Sida 581234 2279/ Terapi 12-May-15 Rehab Medik 50,000 - 220,000 270,000
2350 Afif Piliang 781444 1651/ Fisioterapi 12-May-15 Rehab Medis 50,000 - 220,000 270,000
2351 Haryanto 654864 2888/ Terapi 12-May-15 R.Medik 50,000 - 220,000 270,000
2352 Nabila Syif 330529 2827/ Terapi 12-May-15 R.Medik 50,000 - 440,000 490,000
2353 Wahab Nur 799076 2725/ Terapi 12-May-15 R.Medik 50,000 - 220,000 270,000
2354 M.Haykal Il 500328 2649/ Terapi 12-May-15 R.Medik 50,000 - 440,000 490,000
2355 Hanifah Kho738963 2857/ Terapi 12-May-15 R.Medik 50,000 - 440,000 490,000
2356 Mariam Ulfa 834596 2752/ Terapi 12-May-15 R.Medik 50,000 - 220,000 270,000
2357 Dafa Tri Nal 829331 2770/ Terapi 12-May-15 R.Medik 50,000 - 220,000 270,000
2358 Amira 821585 2352/ Terapi 12-May-15 Rehab Medik 50,000 - 220,000 270,000
2359 Febrian Satr 753688 2277/ Fisioterapi 12-May-15 Rehab Medik 50,000 - 440,000 490,000
2360 Siti Naida 822934 2475/ Terapi 12-May-15 Rehab Medik 50,000 - 440,000 490,000
2361 Muhammadn666097 2574/ Terapi 12-May-15 R.Medik 50,000 - 440,000 490,000
2362 Annisa Rifq 634858 2415/ Ot+Tw 12-May-15 Rehab Medik 50,000 - 440,000 490,000
2363 Tutik Rahay 742172 2558/ Kontrol 12-May-15 Rehab Medik 50,000 35,000 340,500 425,500
2364 Kartini Dae 835401 1817/ Terapi 12-May-15 R Medis 50,000 35,000 71,500 156,500
2365 Ita Rosita G 759051 2592/ Terapi+Obs 12-May-15 R.Medik+Kan 50,000 35,000 71,500 156,500
2366 Karolius Kia 800751 2815/ Imunoincom 12-May-15 Vct 50,000 - 50,000
2367 Paino 795440 1639/ Kontrol 12-May-15 Bedah Thorax 50,000 - 50,000
2368 Yuyu Yuhan 254067 2916/ Vertigo 12-May-15 Syaraf 50,000 - 50,000
2369 Selvia Oktav 744370 1861/ Kontrol 12-May-15 Gigi & Mulut 50,000 - 362,633 412,633
2370 Karim 623228 2594/ Exostosis 12-May-15 Gigi&Mulut 50,000 35,000 187,000 272,000
2371 Fatimah M. 835968 2503/ V V 12-May-15 Gigi&Mulut 50,000 - 115,408 165,408
2372 Johan Dania 834568 2737/ 8 Impaksi 12-May-15 Gigi&Mulut 50,000 - 50,000
2373 Linda Nurha 834870 2292/ 11 Pulpitis 12-May-15 Gigi&Mulut 50,000 - 420,990 470,990
2374 Vivi Antika 775178 2490/ G5P3A1+Pe 12-May-15 Kandungan 50,000 - 120,500 170,500
2375 Yani 835933 2668/ Susp Struma 12-May-15 Bedah Umum 50,000 35,000 187,000 272,000
2376 Rukiyah 832918 2589/ Carsinoma 12-May-15 Kandungan 50,000 35,000 60,000 649,500 794,500
2377 Hana Indraw 829924 2887/ Hamil Dgn 12-May-15 Kandungan 50,000 - 120,500 170,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2378 Miladiah 835824 2667/ G1P0A0 12-May-15 Kandungan 50,000 - 120,500 170,500
2379 Yuyun Wina 827091 2754/ Plasenta Le 12-May-15 Kandungan 50,000 - 120,500 170,500
2380 Norma Awal 835941 2890/ Nyeri Perut 12-May-15 Kandungan 50,000 - 60,000 110,000
2381 M.Untung B 826529 2873/ Kontrol 12-May-15 Bedah Syaraf 50,000 - 85,800 135,800
2382 Painah 829959 2535/ Soft Tissue 12-May-15 Bedah Umum 50,000 - 50,000
2383 Chenzy Nivi 743888 2651/ Kontrol 12-May-15 Bedah Thorak 50,000 - 50,000
2384 Suyanto 835378 2635/ Angina Pec 12-May-15 Jantung 50,000 - 462,500 512,500
2385 Miranda Feb 798696 2918/ Limpadeniti 12-May-15 Bedah Umum 50,000 - 50,000
2386 Dewi Harum 835947 2889/ Fam 12-May-15 Bedah Umum 50,000 - 50,000
2387 Sunarti 835925 2625/ Tu Mamae 12-May-15 Bedah Umum 50,000 - 50,000
2388 Sandra Ariy 633293 2886/ Kontrol 12-May-15 Bedah Umum 50,000 - 125,000 175,000
2389 Eva Elisa 136903 1819/ Kontrol 12-May-15 Bedah Umum 50,000 - 50,000
2390 Paini 835342 2768/ Struma 12-May-15 Bedah Umum 50,000 - 50,000
2391 Susanti 648967 2565/ Susp Stt 12-May-15 Bedah Umum 50,000 - 50,000
2392 Wiji Riani 834543 2564/ Post Op Str 12-May-15 Bedah Umum 50,000 - 50,000
2393 Siti Aminah 835979 2576/ Mata Nyeri+ 12-May-15 Mata 50,000 - 120,000 170,000
2394 Lorensius 835521 2842/ Mata Kabur 12-May-15 Mata 50,000 - 50,000
2395 Sudarsono 647894 1760/ Kontrol 12-May-15 Urologi 50,000 - 50,000
2396 Juwariyah 834558 2459/ Dm Tipe Ii 12-May-15 Penyakit Dala 50,000 - 402,500 452,500
2397 Achmad Jun 835303 2556/ Gangren Ped 12-May-15 Peny.Dalam 50,000 - 402,500 452,500
2398 Sukardanu W817421 1730/ Kontrol 12-May-15 Orthopedy 50,000 - 80,000 130,000
2399 Aryanti 626406 2543/ Mh 12-May-15 Kulit Kelamin 50,000 - 50,000
2400 Vita Seri Ya 570063 1786/ Kontrol 12-May-15 Anak 50,000 - 50,000
2401 Raysa Mifta 706677 2488/ Thymoma Ca 12-May-15 Paru 50,000 - 50,000
2402 Rian Pratam 474354 2606/ Epilepsi 12-May-15 Syaraf 50,000 - 156,750 206,750
2403 Aliyah 730090 2291/ Terapi 12-May-15 Rehab Medik 50,000 - 159,500 209,500
2404 Mustadil Wa 835960 2445/ Susp Prostat 12-May-15 Urologi 50,000 - 145,200 195,200
2405 Minalia 724238 3000/ Snnt 13-May-15 Bedah Umum 50,000 35,000 73,238 158,238
2406 Saleh Samit 838301 2876/ Myalgia 13-May-15 Syaraf 50,000 35,000 159,500 26,674 271,174
2407 Susi Setyow 806494 2847/ Keloid 13-May-15 Kulit Kelamin 50,000 - 115,000 12,479 177,479
2408 Pramugito 838310 2951/ Kontrol 13-May-15 Tht 50,000 - 310,500 13,150 373,650
2409 Najwa Lothi 787088 3143/ Trauma Taja 13-May-15 Mata 50,000 - 25,053 75,053
2410 Suratun 625396 2744/ Kontrol 13-May-15 P. Dalam 50,000 - 39,788 89,788
2411 M. Jamri 773089 2910/ Vertigo 13-May-15 Syaraf 50,000 - 12,971 62,971
2412 Sumarni 835984 2191/ Obs Tumor 13-May-15 Kandungan 50,000 35,000 586,200 19,913 691,113
2413 I Dariati 840508 2209/ Post Sc 13-May-15 Kandungan 50,000 - 120,500 21,425 191,925
2414 Anggun Yuli 740915 2120/ Epilepsi 13-May-15 Syaraf 50,000 - 266,400 316,400
2415 Syachri 815438 3249/ Chf 13-May-15 Jantung 50,000 - 298,088 348,088
2416 Sumarsih 835588 2786/ Abd Discomf 13-May-15 P. Dalam 50,000 70,000 60,000 3,236,200 534,763 3,950,963
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2417 Norhasanah 727081 2087/ Kontrol 13-May-15 Jantung 50,000 - 462,500 27,975 540,475
2418 M Said Fata 698061 2030/ Chd 13-May-15 Jantung 50,000 - 58,238 108,238
2419 M Daffa Arif 824246 2072/ Epilepsi 13-May-15 Syaraf 50,000 - 293,584 343,584
2420 Anggi Tiono 577082 2952/ Cad 13-May-15 Jantung 50,000 - 56,725 106,725
2421 Nur Chosiah 630834 3111/ Dm 13-May-15 P. Dalam 50,000 35,000 361,150 172,550 618,700
2422 Hafizh Hari 828771 2864/ Post Lapara 13-May-15 Anak 50,000 - 294,250 23,415 367,665
2423 Sri Wahyuni 757458 2146/ Lupus 13-May-15 P. Dalam 50,000 - 988,500 1,038,500
2424 Sri Wahyuni 838311 3218/ S/DM 13-May-15 P. Dalam 50,000 - 500,250 3,000 553,250
2425 Suryanti 835517 2968/ 11 Gr 13-May-15 Gigi&Mulut 50,000 35,000 603,276 27,141 715,417
2426 M. Halimu 816735 2981/ Tb Ekstra P 13-May-15 Anak 50,000 - 43,023 93,023
2427 Herlina 817022 2163/ Kontrol 13-May-15 R.Medik+Sara 50,000 35,000 71,500 13,493 169,993
2428 M. Ilhan Nu 604888 2984/ Asma Attac 13-May-15 Paru 50,000 - 4,361 54,361
2429 Meri Periant 833150 3188/ Pusing 13-May-15 P. Dalam 50,000 - 26,225 76,225
2430 Nurasanah 764281 3029/ Sle 13-May-15 P. Dalam 50,000 - 73,750 123,750
2431 Nurliana 330972 2164/ 8 Pericorniti 13-May-15 Gigi&Mulut 50,000 - 91,340 9,863 151,203
2432 Yuni Johan 796059 3158/ Ht 13-May-15 P. Dalam 50,000 - 20,250 70,250
2433 Mariyam 775137 2056/ Dm 13-May-15 P. Dalam 50,000 - 147,019 197,019
2434 Nurbaya 838309 2924/ Kontrol 13-May-15 Syaraf 50,000 35,000 243,000 287,090 615,090
2435 Humaidi Zub 395852 3067/ Hhd 13-May-15 Jantung 50,000 - 425,250 475,250
2436 Nursitah 634145 3216/ Angina Pec 13-May-15 Jantung 50,000 - 462,500 444,825 957,325
2437 Umi Jazaroh 487186 1907/ Abses Axill 13-May-15 Bedah Umum 50,000 - 394,150 235,133 679,283
2438 Sumiati 396889 3022/ Rematoid Art 13-May-15 P. Dalam 50,000 35,000 609,500 23,016 717,516
2439 Samaria 821856 3276/ Sle 13-May-15 P. Dalam 50,000 - 487,169 537,169
2440 Shieang Sart 720714 3202/ Dm 13-May-15 P. Dalam 50,000 - 58,463 108,463
2441 Muhlis 838312 3231/ Dermatitis A 13-May-15 Kulit Kelamin 50,000 - 17,525 67,525
2442 Dimas Hend 824915 2000/ Kontrol 13-May-15 P. Dalam 50,000 - 666,345 716,345
2443 Tamrin 319921 2774/ Terapi+Susp 13-May-15 R.Medik+Urol 50,000 35,000 71,500 1,563 158,063
2444 Radina Halo 787550 3262/ Kemo 13-May-15 Bedah Umum 50,000 - 735,950 2,400 788,350
2445 Rusdiani 281201 2895/ Diare Kroni 13-May-15 P. Dalam 50,000 35,000 71,138 156,138
2446 Sumarlin 840687 2042/ Kontrol 13-May-15 Kandungan 50,000 - 120,500 8,381 178,881
2447 H.A. Moeis 810554 2149/ Kontrol 13-May-15 Syaraf 50,000 - 20,585 70,585
2448 Ayira Saufa 835561 2074/ Gatal2 13-May-15 Kulit Kelamin 50,000 - 34,321 84,321
2449 M. Jufri 764121 2946/ Kontrol 13-May-15 R.medik 50,000 35,000 159,500 457,250 187,000 8,800 897,550
2450 Abd Mutali 667808 3051/ Pjk 13-May-15 Jantung 50,000 - 309,188 359,188
2451 Darzen 483905 3114/ Cad 13-May-15 Jantung 50,000 - 185,850 235,850
2452 Anwar Maul 676686 3012/ Ca Nasofari 13-May-15 Onkologi 50,000 - 1,994,300 2,044,300
2453 Warsinem 831801 3081/ Kontrol 13-May-15 P. Dalam 50,000 35,000 462,500 206,369 753,869
2454 Panirah 822928 3024/ Kontrol 13-May-15 R.medik 50,000 35,000 71,500 31,125 187,625
2455 Muzzammil 819027 1996/ Cad 13-May-15 Jantung 50,000 - 300,436 350,436
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2456 Evan Sanjay 800410 3175/ Limfadeniti 13-May-15 Paru 50,000 - 213,100 263,100
2457 Riza Sahadi 803462 3115/ Niddm+Ht 13-May-15 P. Dalam 50,000 35,000 335,250 420,250
2458 Asmini 466833 2044/ Dm 13-May-15 P. Dalam 50,000 - 58,238 108,238
2459 Ernawati 795292 3112/ Gastritis Ak 13-May-15 P. Dalam 50,000 - 305,000 339,669 694,669
2460 M.Noor 838313 3233/ Karies 13-May-15 Gigi&Mulut 50,000 - 207,443 10,925 268,368
2461 Sulaiman 542510 2892/ Dm+Ht 13-May-15 P. Dalam 50,000 - 76,575 126,575
2462 Rita Yuslian 834898 3128/ Nyeri Abdo 13-May-15 P. Dalam 50,000 - 11,875 61,875
2463 Ani Kurnia 644416 3190/ Thalasemia 13-May-15 P. Dalam 50,000 - 3,300 53,300
2464 Wagino 834561/6530212726/ Post Op 13-May-15 Urologi 50,000 35,000 141,500 187,000 48,906 462,406
2465 Umrohtul H 828249 3113/ Limfadeniti 13-May-15 Anak 50,000 - 126,168 176,168
2466 Siti Saupah 815891 2772/ Pjk 13-May-15 Jantung 50,000 - 286,313 336,313
2467 Runiati 439027 3173/ Ompk 13-May-15 Tht 50,000 - 15,663 65,663
2468 Diah Ayu Wu 838303 3156/ S/ Mastitis 13-May-15 Bedah Umum 50,000 - 394,150 12,325 456,475
2469 Wiwin 430340 3159/ Kontrol 13-May-15 Gigi&Mulut 50,000 35,000 23,883 108,883
2470 Irwansyah 838315 2075/ Serumen 13-May-15 Tht 50,000 - 38,401 88,401
2471 Laila 759001 2697/ Terapi 13-May-15 R.medik 50,000 35,000 159,500 28,043 272,543
2472 Achmad U 808718 3009/ Ht 13-May-15 Jantung 50,000 - 442,636 492,636
2473 Ashuri 631463 3100/ Angina Pec 13-May-15 Jantung 50,000 - 562,950 39,885 652,835
2474 Sutiny 186336 2962/ Kontrol 13-May-15 Jantung 50,000 - 185,438 235,438
2475 M. Alfian 838323 3057/ Gea 13-May-15 Anak 50,000 - 26,286 76,286
2476 Mohammad 828910 1938/ Hopertiroid 13-May-15 P. Dalam 50,000 - 39,188 89,188
2477 Widya Agust 527699 1909/ Lupus 13-May-15 P. Dalam 50,000 - 1,875,913 1,925,913
2478 Sutarti 648815 2977/ Dm 13-May-15 P. Dalam 50,000 - 183,299 233,299
2479 Tasniah 769103 2818/ Struma 13-May-15 P. Dalam 50,000 - 39,825 89,825
2480 Arjinah 615691 1908/ Kontrol 13-May-15 Jantung 50,000 - 282,038 332,038
2481 Nasywa Qon706135 2931/ Epilepsi 13-May-15 Anak 50,000 - 104,500 154,500
2482 Herlina 585202 1940/ Epilepsi 13-May-15 Syaraf 50,000 - 327,188 377,188
2483 Fatiah 834800 3021/ Kontrol 13-May-15 Kandungan 50,000 - 120,500 8,981 179,481
2484 Mahdaleni 816570 2979/ Nyeri Pingg 13-May-15 P. Dalam 50,000 - 227,700 2,400 280,100
2485 Erhamsyah 835900 2980/ Dm 13-May-15 P. Dalam 50,000 - 157,281 207,281
2486 Siti 834264 2862/ Kontrol 13-May-15 Kandungan 50,000 - 120,500 8,625 179,125
2487 Nur Aini H. 681975 2775/ Epilepsi 13-May-15 Syaraf 50,000 - 430,125 480,125
2488 Hadiah 277981 2757/ Epilepsi 13-May-15 Syaraf 50,000 - 58,725 108,725
2489 Minem 840649 2801/ Tia 13-May-15 Syaraf 50,000 - 275,138 325,138
2490 La Upe 813270 2745/ Ht 13-May-15 P. Dalam 50,000 - 100,181 150,181
2491 Syafruddin 790675 3040/ 37 Period 13-May-15 Gigi&Mulut 50,000 - 10,563 60,563
2492 Patang Tom 613407 3037/ Kontrol 13-May-15 Mata 50,000 - 60,000 28,085 138,085
2493 Akmal Huze 829353 2771/ Kontrol 13-May-15 Tht 50,000 - 295,150 9,895 355,045
2494 Kartini Dae 835401 2819/ Terapi 13-May-15 Rehab Medik 50,000 35,000 71,500 13,750 170,250
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2495 Nursidin 528848 3174/ Kontrol 13-May-15 P. Dalam 50,000 - 5,278,350 5,328,350
2496 Aminoto 754053 3157/ Tb Paru 13-May-15 Paru 50,000 - 22,986 72,986
2497 Erlisa 748232 2832/ Dm 13-May-15 P. Dalam 50,000 - 36,831 86,831
2498 Hairul Gun 838318 3247/ Kontrol 13-May-15 Tht 50,000 - 13,093 63,093
2499 Siti Chairiy 597371 3010/ Ht 13-May-15 Jantung 50,000 - 44,575 94,575
2500 Johan Junaid 620269 2965/ Kontrol 13-May-15 Jantung 50,000 - 110,250 172,950 333,200
2501 A Rifai 691136 1966/ Dm 13-May-15 P. Dalam 50,000 35,000 60,000 515,868 660,868
2502 Timbul Wah 780633 3144/ Ht 13-May-15 Jantung 50,000 - 283,350 333,350
2503 Abd Racman 764332 1954/ Pjk 13-May-15 Jantung 50,000 - 312,925 362,925
2504 Mitha Diana 835938 2760/ Susp Fam 13-May-15 Onkologi 50,000 - 3,313 53,313
2505 Amelia 535307 3189/ S/ Limfadeni 13-May-15 Paru 50,000 - 15,823 65,823
2506 Suyanto 445829 2758/ Terapi+Ceph 13-May-15 R.Medik+Syar 50,000 35,000 71,500 31,818 188,318
2507 Ema Rosant 524191 2727/ Ht 13-May-15 Syaraf 50,000 - 252,613 302,613
2508 Muh. Tahir 711151 2742/ Obs Oedem+ 13-May-15 Orthopedi 50,000 - 465,000 105,600 238,508 859,108
2509 Edgar Efendi 623282 3160/ Epilepsi 13-May-15 Syaraf 50,000 - 321,488 371,488
2510 Sukatmi 781888 3055/ Pro Op Kata 13-May-15 Mata 50,000 - 59,830 109,830
2511 Supiyah 480355 2835/ Gastritis 13-May-15 P. Dalam 50,000 - 175,250 305,000 26,213 556,463
2512 Sukarti 810573 1952/ Hd +Dm 13-May-15 P. Dalam 50,000 35,000 60,000 30,038 175,038
2513 Kasno 686525 1923/ Cad 13-May-15 Jantung 50,000 - 562,950 429,488 1,042,438
2514 Rakimun 773239 3171/ Pjk 13-May-15 Jantung 50,000 - 429,863 479,863
2515 Darni 802316 2831/ Terapi 13-May-15 R.medik 50,000 35,000 71,500 13,493 169,993
2516 Devi Regina 566429 2817/ Epilepsi 13-May-15 Anak 50,000 - 73,525 123,525
2517 Siti Naida 667702 3096/ Obs Dispne 13-May-15 Anak 50,000 - 21,845 71,845
2518 Nizam Khair 337418 1921/ Kontrol 13-May-15 Anak 50,000 - 23,086 73,086
2519 Abdul Rahm 641669 2714/ Pjk 13-May-15 Jantung 50,000 - 340,050 390,050
2520 Yulius Taya 828254 2011/ Ca Nasofari 13-May-15 Tht 50,000 - 21,205 71,205
2521 Asnan Muh 697342 2947/ Pjk 13-May-15 Jantung 50,000 - 339,750 389,750
2522 Abdul Hami 776504 2940/ Ht Gr Iii 13-May-15 P. Dalam 50,000 - 158,813 208,813
2523 Kornelis Na 810504 2966/ Bph 13-May-15 Urologi 50,000 - 256,563 306,563
2524 Ibnu Riski 747841 3026/ Kontrol 13-May-15 Syaraf 50,000 - 15,961 65,961
2525 Arif Sujayad 836168 2102/ Kontrol 13-May-15 Ortophedy 50,000 - 160,000 650 210,650
2526 Parlin Sina 468536 2134/ Bph 13-May-15 Urologi 50,000 - 137,213 187,213
2527 Aminah Bed 834445 2045/ Kontrol 13-May-15 Onkologi 50,000 35,000 187,000 243,750 515,750
2528 Wa Nuru 835977 3265/ S/ Sinusitis 13-May-15 Tht 50,000 35,000 160,600 7,938 253,538
2529 Arlina 838306 2059/ Lbp 13-May-15 Syaraf 50,000 - 28,698 78,698
2530 M. Luqman 838300 2848/ Susp 112 13-May-15 Vct 50,000 - 255,250 11,225 316,475
2531 Tara Dg Er 835950 3220/ 7 Abses 13-May-15 Gigi&Mulut 50,000 35,000 187,000 1,570 273,570
2532 Rachmad Bu 793891 2908/ Dm+Dermati 13-May-15 P. Dalam 50,000 35,000 763,966 848,966
2533 Berlian 840180 2147/ Hipoglikemi 13-May-15 P. Dalam 50,000 - 500,250 12,225 562,475
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2534 Sri Yanti 834851 2983/ 8 8 Radices 13-May-15 Gigi&Mulut 50,000 - 1,923,276 19,089 1,992,365
2535 Mastiah 774333 3127/ Pjk 13-May-15 Jantung 50,000 - 187,238 237,238
2536 Erifadin Sab 775537 3014/ Dm 13-May-15 P. Dalam 50,000 - 500,250 6,813 557,063
2537 Ahmad Juan 838326 2178/ S/ Bsk 13-May-15 Urologi 50,000 - 335,000 219,463 604,463
2538 Bagus Fahri 666822 2922/ S/ Cf Reg Br 13-May-15 Orthopedi 50,000 - 763 50,763
2539 Rusnah 737666 2105/ Kontrol 13-May-15 Jantung 50,000 - 628,950 178,350 857,300
2540 St Masliatin 541849 2058/ Kontrol 13-May-15 P. Dalam 50,000 - 37,325 87,325
2541 Denik K 388166 2116/ Kontrol 13-May-15 Syaraf 50,000 - 21,118 71,118
2542 Sugiyanto 840140 3011/ Peritonitis D 13-May-15 Bedah Umum 50,000 - 125,000 12,750 187,750
2543 Ainun Aziza 744475 3219/ Cepalgia 13-May-15 Syaraf 50,000 - 218,013 268,013
2544 Fadillah Al 579725 3277/ Serumen 13-May-15 Tht 50,000 - 63,000 12,405 125,405
2545 Nursari 619272 2027/ Kontrol 13-May-15 P. Dalam 50,000 - 19,950 69,950
2546 Sapri Usma 835969 3217/ Hemoroid 13-May-15 Bedah Umum 50,000 - 48,125 98,125
2547 Wellang 838324 2135/ Batuk Lama 13-May-15 P. Dalam 50,000 35,000 25,611 110,611
2548 Noraidah 503324 1939/ Chf 13-May-15 Jantung 50,000 - 43,250 294,531 387,781
2549 Khasanah 066045 2992/ Ht 13-May-15 Jantung 50,000 35,000 424,013 509,013
2550 Heri Supraw 821179 3084/ Pjk 13-May-15 Jantung 50,000 - 207,825 257,825
2551 Jumilah 440110 2013/ Pjk 13-May-15 Jantung 50,000 - 189,038 239,038
2552 Ismul Izmi 496487 2014/ Nyeri Tanga 13-May-15 Syaraf 50,000 - 159,500 105,600 26,556 341,656
2553 Iwan Setiaw 630319 2997/ Epilepsi 13-May-15 Syaraf 50,000 - 85,388 135,388
2554 La Salipa 749462 1910/ Cad 13-May-15 Jantung 50,000 - 296,625 346,625
2555 Rusidah 255488 2923/ Multiple Sto 13-May-15 Gigi&Mulut 50,000 - 56,479 106,479
2556 Rusdiana 806201 2939/ Epilepsi 13-May-15 Syaraf 50,000 - 85,388 135,388
2557 Mirsa Nur 725424 1997/ Kontrol 13-May-15 P. Dalam 50,000 - 18,063 68,063
2558 M.Nuhri 422196 3234/ Kontrol 13-May-15 P. Dalam 50,000 - 1,977,269 2,027,269
2559 Samirah 836282 2090/ Post Strouk 13-May-15 Syaraf 50,000 - 43,650 93,650
2560 Meilicia Cri 770011 2162/ 1 Fraktur 13-May-15 Gigi & Mulut 50,000 - 91,340 18,863 160,203
2561 Nur Asiah 817162 3097/ Kontrol 13-May-15 Kandungan 50,000 35,000 60,000 360,600 505,600
2562 Suliwaty M 534393 2967/ Ht 13-May-15 P. Dalam 50,000 - 176,475 226,475
2563 Nurman Tuo 782327 3141/ Ht Grade Ii 13-May-15 Jantung 50,000 - 332,363 382,363
2564 Taufik 754114 2057/ Ht 13-May-15 Jantung 50,000 - 311,850 361,850
2565 Wagini 720872 3203/ Obs Dispne 13-May-15 Jantung 50,000 - 649,500 31,413 730,913
2566 Mario Ade P 840751 2970/ Post Amputa 13-May-15 Bedah Umum 50,000 - 125,000 12,750 187,750
2567 Masrawan 622250 3008/ Ht 13-May-15 Jantung 50,000 - 314,813 364,813
2568 Marsuti 835390 3186/ 8 Impaksi 13-May-15 Gigi&Mulut 50,000 - 365,360 29,450 444,810
2569 Dodi Maula 437363 1982/ Epilepsi 13-May-15 Syaraf 50,000 - 115,720 165,720
2570 Rukiyah 832918 3279/ Carsinoma 13-May-15 Kandungan 50,000 - 3,338 53,338
2571 Manasang 805427 2894/ Kontrol 13-May-15 Jantung 50,000 35,000 60,525 145,525
2572 Afrizal M. A 838322 3056/ Obs Febris 13-May-15 Anak 50,000 - 429,363 20,810 500,173
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2573 M Saad 534237 2029/ Ca Prostat 13-May-15 Urologi 50,000 - 137,213 187,213
2574 Edi Marlian 787009 2949/ Pjk 13-May-15 Jantung 50,000 - 187,000 324,600 561,600
2575 Sukatrin 591289 2933/ S/ Hnp 13-May-15 Syaraf 50,000 - 25,489 75,489
2576 Warni 753983 1951/ Terapi 13-May-15 R.medik 50,000 35,000 159,500 131,300 375,800
2577 Syahroni 632886 2934/ Vertigo 13-May-15 Syaraf 50,000 - 21,589 71,589
2578 Rita Agusti 518629 3039/ Hnp 13-May-15 Syaraf 50,000 - 26,164 76,164
2579 Nor Asikin 639313 2978/ Kontrol 13-May-15 R.medik 50,000 35,000 71,500 17,985 174,485
2580 Kastono 806701 2820/ Ca Paru 13-May-15 Paru 50,000 - 3,000 53,000
2581 Suhaeti 686960 2730/ Obs Nyeri A 13-May-15 P. Dalam 50,000 - 305,000 19,606 374,606
2582 Emanuel La 273835 2878/ Vertigo 13-May-15 Syaraf 50,000 35,000 266,325 351,325
2583 Djaurah Hi. 355389 2756/ Obs Struma 13-May-15 P. Dalam 50,000 70,000 103,300 223,300
2584 Robinson 841508 2165/ Kontrol 13-May-15 Bedah Umum 50,000 - 125,000 4,838 179,838
2585 Salmiah 770269 2192/ Sopt 13-May-15 Paru 50,000 - 78,490 128,490
2586 Siti Maemu 834252 2071/ Keloid 13-May-15 Kulit Kelamin 50,000 - 115,000 122,925 287,925
2587 Gibran Azha 667295 2206/ Epilepsi 13-May-15 Syaraf 50,000 - 121,881 171,881
2588 Asmini 795280 2906/ Terapi+Lbp 13-May-15 R.Medik+Orth 50,000 35,000 71,500 6,600 163,100
2589 Aliansyah 829559 2865/ Fr Humerus 13-May-15 Orthopedi 50,000 - 105,600 108,775 264,375
2590 Parpunguan 838320 2103/ Limpoma 13-May-15 Bedah Umum 50,000 - 438,400 377,500 125,400 12,750 1,004,050
2591 Rusmiati 550670 2060/ Perdarahan 13-May-15 Kandungan 50,000 - 60,000 71,500 181,500
2592 Edy Kulon 838316 2088/ Ht 13-May-15 Syaraf 50,000 - 51,653 101,653
2593 Syarifah Nu 681242 1922/ Hipertiroid 13-May-15 P. Dalam 50,000 - 31,331 81,331
2594 Arbainah 397390 2833/ Ht+Pjk 13-May-15 Jantung 50,000 - 292,300 342,300
2595 Luat Alui 838319 3248/ Bph 13-May-15 Urologi 50,000 - 335,000 567,350 137,213 1,089,563
2596 Leni M 841463 1955/ Ht 13-May-15 Jantung 50,000 - 187,000 290,800 527,800
2597 Ida 736617 3082/ Cad 13-May-15 Jantung 50,000 - 177,400 227,400
2598 Aslan Al Uz 835522 2028/ Obs Febris 13-May-15 Anak 50,000 - 23,415 73,415
2599 Retno Heriy 076678 2963/ Epilepsi 13-May-15 Syaraf 50,000 - 4,988 54,988
2600 Jayadi 796482 3201/ Keloid 13-May-15 Kulit Kelamin 50,000 - 115,000 8,438 173,438
2601 M.Madjdy A 681701 2131/ Bronkitis 13-May-15 Anak 50,000 - 294,250 188,100 532,350
2602 Suparti 502027 2995/ Dm 13-May-15 P. Dalam 50,000 - 500,250 550,250
2603 Supriatin 769041 2834/ Susp Struma 13-May-15 Onkologi 50,000 - 525,250 377,500 125,400 1,078,150
2604 Siti Musrian 819397 2759/ Ulcus Ca M 13-May-15 Onkologi 50,000 - 525,250 575,250
2605 Sudarmini 587746 3023/ Ht 13-May-15 P. Dalam 50,000 - 110,250 160,250
2606 Rudi Harton 745451 3083/ Kontrol 13-May-15 P. Dalam 50,000 - 110,250 160,250
2607 Mulyana 838302 2877/ Fam Mamae 13-May-15 Bedah Umum 50,000 - 438,400 125,400 613,800
2608 Mariyana 711299 2816/ Isk 13-May-15 P. Dalam 50,000 35,000 60,000 44,250 189,250
2609 Marilah 805195 1969/ Cek Lab 13-May-15 P. Dalam 50,000 - 110,250 160,250
2610 Jum'Ah 468535 3099/ Gout 13-May-15 P. Dalam 50,000 - 110,250 160,250
2611 Cici Damaya 625654 2969/ Hipertiroid 13-May-15 P. Dalam 50,000 - 352,100 402,100
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2612 Edi Kusyadi 838307 2909/ Hemoroid 13-May-15 Bedah Umum 50,000 - 117,100 394,150 561,250
2613 Eka Suciati 838305 2026/ G1P0A0 13-May-15 Kandungan 50,000 - 120,500 438,400 305,000 913,900
2614 Hajar Rahm 776543 2893/ Dm 13-May-15 P. Dalam 50,000 - 110,250 160,250
2615 Halimah Wa 835995 2964/ S/ Ca Mama 13-May-15 Onkologi 50,000 - 525,250 377,500 125,400 1,078,150
2616 Susanti 380487 2907/ G4P3A0+Le 13-May-15 Kandungan 50,000 - 120,500 438,400 608,900
2617 Sri Wati 832293 3126/ Kontrol 13-May-15 P. Dalam 50,000 - 500,250 550,250
2618 Rusdiana 806016 2935/ Terapi 13-May-15 R.medik 50,000 35,000 71,500 286,250 442,750
2619 Nita Badriat 563344 2117/ G4P2A1 13-May-15 Kandungan 50,000 - 120,500 438,400 305,000 913,900
2620 Ismail 473748 1999/ Kontrol 13-May-15 Orthopedi 50,000 - 93,750 105,600 249,350
2621 Salasiah 298164 2891/ Terapi+Kont 13-May-15 Kandungan+R 50,000 - 60,000 286,900 305,000 701,900
2622 Syayid M A 442927 2179/ Kontrol 13-May-15 Bedah Anak 50,000 - 767,550 105,600 923,150
2623 Wiwin Indah 497060 2985/ Kontrol 13-May-15 Gigi&Mulut 50,000 - 160,600 24,654 235,254
2624 Kahang 816463 2955/ Kontrol 13-May-15 Vct 50,000 - 125,400 175,400
2625 Rika Sartila 838321 2104/ G2 P1 A0 D 13-May-15 Kandungan 50,000 - 120,500 305,000 475,500
2626 Jainab 838314 2086/ G5 P4 A0 H 13-May-15 Kandungan 50,000 - 120,500 305,000 475,500
2627 Yuli Astutik 462539 2982/ G4P3A1 13-May-15 Kandungan 50,000 - 120,500 305,000 475,500
2628 Misbahul Ja 606357 2012/ G2P1A0 Dng 13-May-15 Kandungan 50,000 - 60,000 305,000 415,000
2629 Hairul Fani 810148 1981/ Kontrol 13-May-15 Gigi & Mulut 50,000 - 160,600 210,600
2630 Wawi Mona 838325 2161/ 6 Parsial Ga 13-May-15 Gigi & Mulut 50,000 - 223,293 93,115 366,408
2631 Go Ing Min 835997 3038/ Tu Colli 13-May-15 Onkologi 50,000 - 377,500 427,500
2632 Alby Naufal 799488 2850/ Kontrol 13-May-15 Bedah Anak 50,000 35,000 85,000
2633 Nur Halifah 838317 3235/ G1P0A0 Pro 13-May-15 Kandungan 50,000 - 120,500 170,500
2634 Sri Wahyuni 558975 2954/ Pud 13-May-15 Kandungan 50,000 - 60,000 110,000
2635 Nurhaini 729687 3187/ Kontrol 13-May-15 Kandungan 50,000 - 60,000 110,000
2636 Sri Karyati 535919 3042/ G3P2A0 13-May-15 Kandungan 50,000 - 360,000 410,000
2637 Thekat Harj 252472 3142/ S/ Batu Ginj 13-May-15 Urologi 50,000 35,000 187,000 272,000
2638 Reyhan Ram 776549 2993/ Fraktur 13-May-15 Bedah Umum 50,000 - 50,000
2639 M Arga 835975 2015/ Susp Dislok 13-May-15 Orthopedi 50,000 - 50,000
2640 Andi Aisyah 771517 2953/ Terapi 13-May-15 Orthopedi 50,000 - 50,000
2641 Hadinata 834216 2998/ Kontrol 13-May-15 Orthopedi 50,000 - 50,000
2642 Romlah 532116 3066/ Post Kuret 13-May-15 Kandungan 50,000 35,000 60,000 145,000
2643 Bambang Su 631623 3015/ Pjk 13-May-15 Jantung 50,000 - 50,000
2644 Slamet Riad 834277 2089/ Kontrol 13-May-15 Vct 50,000 - 50,000
2645 Syahrun 835954 2148/ Gastritis 13-May-15 P. Dalam 50,000 - 50,000
2646 Martono 840326 3041/ Ckd 13-May-15 P. Dalam 50,000 - 50,000
2647 Nanang Isma 813793 1970/ Kontrol 13-May-15 Tht 50,000 70,000 187,000 307,000
2648 M.Rizal Ra 832097 3130/ Kontrol 13-May-15 Orthopedy 50,000 - 80,000 130,000
2649 Gerald C 836284 1998/ Kontrol 13-May-15 Orthopedy 50,000 - 80,000 130,000
2650 Rahmad 836143 3129/ Kontrol 13-May-15 Orthopedy 50,000 - 215,000 265,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2651 M. Suleman 829942 3043/ Ctev 13-May-15 Orthopedy 50,000 - 212,750 262,750
2652 Hernianti 582982 2999/ Sarcoma 13-May-15 Onkologi 50,000 35,000 402,500 487,500
2653 Abdul Harto 792176 3204/ Fr Os Mandi 13-May-15 Gigi&Mulut 50,000 - 50,000
2654 Serly Yusup 725420 3232/ 6 Imapkted 13-May-15 Gigi&Mulut 50,000 - 50,000
2655 Lia Safira 834293 3028/ 6 Pulpitis 13-May-15 Gigi&Mulut 50,000 - 50,000
2656 Wahyu Rahm840103 3027/ Fr Nasal 13-May-15 Bedah Umum 50,000 - 50,000
2657 Sulaiman 834557 2043/ Kontrol 13-May-15 Bedah Umum 50,000 - 125,000 175,000
2658 Andre Prata 835578 3145/ Tumor 13-May-15 Bedah Umum 50,000 - 50,000
2659 Elisabeth Po 582288 3098/ S/ App 13-May-15 Bedah Umum 50,000 - 50,000
2660 Oktavia Rab 261225 2937/ Tumor 13-May-15 Onkologi 50,000 - 134,500 184,500
2661 Samsu 835996 2787/ Kontrol 13-May-15 Onkologi 50,000 - 50,000
2662 Yospina Sa 610566 3250/ Pro Kemo 13-May-15 Onkologi 50,000 - 50,000
2663 Parmiati 408455 2938/ Ca Mamae S 13-May-15 Onkologi 50,000 - 50,000
2664 Della Irawan 829837 3052/ Kontrol 13-May-15 Onkologi 50,000 - 50,000
2665 Dina Yusfira 681148 2805/ Limfoma 13-May-15 Onkologi 50,000 - 50,000
2666 Basuki Tri A 795295 1906/ Nyeri Tlg B 13-May-15 Syaraf 50,000 - 50,000
2667 Khotimatuz 830433 2802/ Ispa 13-May-15 Anak 50,000 - 62,000 112,000
2668 Abdul Agus 835942 2101/ 48 Gp 13-May-15 Gigi&Mulut 50,000 - 50,000
2669 Hanafi Alhad 835974 2073/ Tonsilitis 13-May-15 Tht 50,000 - 50,000
2670 Suryani 835557 3205/ S/ Om 13-May-15 Tht 50,000 - 310,500 360,500
2671 Anryani 838327 2210/ Obs Striae 13-May-15 Kulit & Kelam 50,000 - 50,000
2672 Ayu Wulanda840663 2221/ G1P0A0+Kp 13-May-15 Kandungan 50,000 - 120,500 170,500
2673 Sulastri 835993 2207/ S/ Limpoma 13-May-15 Bedah Umum 50,000 35,000 85,000
2674 Sirajuddin 835944 3030/ Tumor 13-May-15 Bedah Umum 50,000 35,000 85,000
2675 Danang Zak 726353 2669/ Terapi 13-May-15 R.medis 50,000 - 440,000 490,000
2676 Humairah 622151 2729/J Terapi 13-May-15 R.medis 50,000 - 220,000 270,000
2677 Sadariah 419296 2994/ Fisioterapi 13-May-15 R.medis 50,000 - 220,000 270,000
2678 Erni Setiawa 132775 3044/ Fisioterapi 13-May-15 R.medis 50,000 - 220,000 270,000
2679 Siti Ainah 438360 3045/ Fisioterapi 13-May-15 R.medis 50,000 - 220,000 270,000
2680 Sakdiah 822982 2976/ Terapi 13-May-15 R.medis 50,000 - 159,500 209,500
2681 Mirah 142607 2195/ Fisioterapi 13-May-15 R.medis 50,000 - 71,500 121,500
2682 Salamah 748488 2684/ Fisioterapi 13-May-15 R.medis 50,000 - 220,000 270,000
2683 Udin 705780 2682/ Fisioterapi 13-May-15 R.medis 50,000 - 220,000 270,000
2684 Imam M. Sh 190433 2681/ Terapi 13-May-15 R.medis 50,000 - 220,000 270,000
2685 Rudiansyah 424444 2685/ Terapi 13-May-15 R.medis 50,000 - 220,000 270,000
2686 Ngatin 834243 3172/ Terapi 13-May-15 R.medis 50,000 - 440,000 490,000
2687 Kusnan 721341 2670/ Terapi 13-May-15 R.medis 50,000 - 440,000 490,000
2688 Darisem Nur 827918 2743/ Ft Stroke 13-May-15 R.medis 50,000 - 440,000 490,000
2689 Abdul Nurd 464739 2741/ Fisioterapi 13-May-15 R.medis 50,000 - 440,000 490,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2690 Sugianto Ru 487872 3006/ Terapi 13-May-15 R.medis 50,000 - 440,000 490,000
2691 Sarminto 796814 2788/ Fisioterapi 13-May-15 R.medis 50,000 - 440,000 490,000
2692 Tunikah 796098 2861/ Terapi 13-May-15 R.medis 50,000 - 440,000 490,000
2693 Kasemi 801303 3085/ Terapi 13-May-15 R.medis 50,000 - 440,000 490,000
2694 Imalasari Pu 571238 2700/ Ot+Tw 13-May-15 R.medis 50,000 - 440,000 490,000
2695 M. Irsyad 743701 2713/ Fisioterapi 13-May-15 R.medis 50,000 - 440,000 490,000
2696 Ahmad Safa 658272 2712/ Ot+Tw 13-May-15 R.medis 50,000 - 440,000 490,000
2697 Aurelia Octa 644812 2698/ Fisioterapi 13-May-15 R.medis 50,000 - 440,000 490,000
2698 M.Ridwan Al397186 2711/ Terapi 13-May-15 R.medis 50,000 - 440,000 490,000
2699 Jasmani 822971 2041/ Terapi 13-May-15 R.medis 50,000 - 159,500 209,500
2700 Jumiati 780608 2194/ Fisioterapi 13-May-15 R.medis 50,000 - 71,500 121,500
2701 Sopiah 655365 2996/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2702 Ratnawati 770672 2150/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2703 Rey Tanizar 817073 2925/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2704 Agustin 815419 2133/ Fisioterapi 13-May-15 R.medis 50,000 - 71,500 121,500
2705 Radeng 560193 2176/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2706 Sinar 158345 2193/ Fisioterapi 13-May-15 R.medis 50,000 - 71,500 121,500
2707 Nurjanah 532108 2132/ Terapi 13-May-15 R.medis 50,000 - 159,500 209,500
2708 Jie Mie Tjo 685750 2119/ Terapi 13-May-15 R.medis 50,000 - 159,500 209,500
2709 Ridho Abrar 779669 2118/ Terapi 13-May-15 R.medis 50,000 - 220,000 270,000
2710 Andhara Aul 613425 1878/ Fisiotherapy 13-May-15 R.medis 50,000 - 440,000 490,000
2711 Shannaz Dw 677115 1876/ Fisiotherapy 13-May-15 R.medis 50,000 - 440,000 490,000
2712 Izni Almadi 835545 1985/ Terapi 13-May-15 R.medis 50,000 - 440,000 490,000
2713 Rafa Al Fika 587094 3007/ Terapi 13-May-15 R.medis 50,000 - 220,000 270,000
2714 M Rizky Ra 707750 1953/ Terapi 13-May-15 R.medis 50,000 - 220,000 270,000
2715 M. Dwifa C 816594 2728/ Terapi 13-May-15 R.medis 50,000 - 220,000 270,000
2716 Grace Cabri 828527 2804/ Terapi 13-May-15 R.medis 50,000 - 220,000 270,000
2717 J.Marni 664975 1924/ Terapi 13-May-15 R.medis 50,000 - 220,000 270,000
2718 Sumiati 663502 2790/ Terapi 13-May-15 R.medis 50,000 - 159,500 209,500
2719 Yuliani 285668 1893/ Terapi 13-May-15 R.medis 50,000 - 220,000 270,000
2720 Merry Tabi 314620 2773/ Terapi 13-May-15 R.medis 50,000 - 220,000 270,000
2721 Ernawati 124241 3068/ Terapi 13-May-15 R.medis 50,000 - 220,000 270,000
2722 Hamdanah 563909 2699/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2723 Ammi Wiyan748900 1925/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2724 Erna Samun 569637 2696/ Terapi 13-May-15 R.medis 50,000 - 159,500 209,500
2725 Siti Hasana 697396 2948/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2726 Aisyah 734989 2991/ Fisioterapi 13-May-15 R.medis 50,000 - 71,500 121,500
2727 Supriani 639809 3036/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2728 Darmiati 667292 2846/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2729 Hervia 816478 2789/ Terapi 13-May-15 R.medis 50,000 - 159,500 209,500
2730 Rubiyanti 839552 2715/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2731 Rosma Lela 829922 3025/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2732 Gho Kim Ho 739437 2849/ Terapi 13-May-15 R.medis 50,000 - 159,500 209,500
2733 Marliana 822596 2803/ Terapi 13-May-15 R.medis 50,000 - 159,500 209,500
2734 Elisa Mersi 534269 2879/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2735 Honny Kusb 653592 3070/ Fisiotherapy 13-May-15 R.medis 50,000 - 71,500 121,500
2736 Eko Minarn 810163 3069/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2737 M.Reyhan M 829505 3263/ Kontrol 13-May-15 R.medis 50,000 - 50,000
2738 Ade Warsa 791835 2950/ Terapi 13-May-15 R.medis 50,000 - 159,500 209,500
2739 Tinna 821536 2683/ Terapi 13-May-15 R.medis 50,000 - 159,500 209,500
2740 Indrawati 680655 2880/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2741 Marjuki 492002 1968/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2742 Ernawaty 525416 1983/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2743 Siti Rahmah 742670 2932/ Terapi 13-May-15 R.medis 50,000 - 71,500 121,500
2744 Kamsiah 835917 2180/ Obs Cephalg 13-May-15 Syaraf 50,000 35,000 85,000
2745 Sukarti 835988 2177/ Lbp 13-May-15 Syaraf 50,000 35,000 85,000
2746 Asnawati 597952 2208/ Hnp 13-May-15 Syaraf 50,000 35,000 85,000
2747 Rahmatulla 462170 1879/ Terapi 13-May-15 R.medis 50,000 - 440,000 490,000
2748 M. Atallah 607935 1877/ Fisiotherapy 13-May-15 R.medis 50,000 - 440,000 490,000
2749 Aisyah Uzm 796280 1880/ Fisiotherapy 13-May-15 R.medis 50,000 - 440,000 490,000
2750 Aswin 598995 1936/ Terapi 13-May-15 R.medis 50,000 - 159,500 209,500
2751 Jumaiti 816137 2936/ Ht 13-May-15 Jantung 50,000 35,000 304,238 389,238
2752 Winona Dest 337477 3297/ Cephalgia 15-May-15 Syaraf 50,000 35,000 71,500 24,093 180,593
2753 Maulana Mal 705125 2345/ Kontrol 15-May-15 Anak 50,000 - 41,868 91,868
2754 Lina 822580 3502/ Lbp 15-May-15 Syaraf 50,000 35,000 71,500 15,566 172,066
2755 Akhmad Kur 542884 3270/ Stroke 15-May-15 Syaraf 50,000 - 282,038 332,038
2756 Hayah 414190 3396/ Ht+Struma 15-May-15 P. Dalam 50,000 35,000 344,013 429,013
2757 Ayu Amelia 841163 3427/ Kontrol 15-May-15 Kandungan 50,000 - 120,500 4,911 175,411
2758 Debby Cand 835556 3487/ Obs Flour A 15-May-15 Kandungan 50,000 - 60,000 4,625 114,625
2759 Suhaeti 686960 3292/ Obs Nyeri A 15-May-15 P. Dalam 50,000 35,000 60,000 1,525 146,525
2760 Yuli Astutik 462539 2268/ Kontrol 15-May-15 Kandungan 50,000 - 60,000 14,433 124,433
2761 Zafrullah A 800814 3473/ Kontrol 15-May-15 Anak 50,000 - 109,685 159,685
2762 Siti Layu 599852 3315/ Parkinson 15-May-15 Syaraf 50,000 - 194,131 244,131
2763 Noraidah 503324 3338/ Chf 15-May-15 Jantung 50,000 35,000 3,000 88,000
2764 Zahra Putri 816567 2389/ Kontrol 15-May-15 P. Dalam 50,000 - 66,000 1,100 117,100
2765 Mirna Wati 541613 3385/ S/ Sinusitis 15-May-15 Tht 50,000 35,000 160,600 6,163 251,763
2766 Zainal Bada 635055 3426/ Dm Ht 15-May-15 P. Dalam 50,000 - 492,003 542,003
2767 Sukri 838336 3400/ S/ Bak S/ D 15-May-15 P. Dalam 50,000 - 31,050 81,050
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2768 Masrah 432222 3285/ Cephalgia 15-May-15 Syaraf 50,000 - 38,840 88,840
2769 Rani Aprila 835362 2359/ Kontrol 15-May-15 Kandungan 50,000 - 60,000 59,606 169,606
2770 M.Yuda Syar 841395 3342/ Kontrol 15-May-15 Anak 50,000 - 21,274 71,274
2771 Rival Putra 838340 3236/ Abses Dig Ii 15-May-15 Bedah Umum 50,000 - 394,150 15,531 459,681
2772 Nor Ummi F 632340 3445/ Kontrol 15-May-15 Syaraf 50,000 - 20,049 70,049
2773 Zainul Shol 796423 3148/ Terapi+Vert 15-May-15 R.Medik+Syar 50,000 35,000 71,500 227,700 28,454 412,654
2774 Siti 834264 3146/ Kontrol 15-May-15 Kandungan 50,000 - 120,500 7,725 178,225
2775 Gereta 835927 3223/ Dm Tipe Ii 15-May-15 P. Dalam 50,000 35,000 18,299 103,299
2776 Paiman Peh 835365 3443/ Chest Pain 15-May-15 Jantung 50,000 35,000 51,649 136,649
2777 Tati 600456 3329/ Post Op Tiro 15-May-15 Bedah Umum 50,000 - 31,875 81,875
2778 Sarahealti 835367 3381/ Kontrol 15-May-15 R.medis 50,000 35,000 71,500 19,280 175,780
2779 Mei Selvian 796421 2266/ Kontrol 15-May-15 P. Dalam 50,000 - 305,000 158,688 513,688
2780 Noor Khaira 644852 3428/ Epilepsi 15-May-15 Syaraf 50,000 - 122,813 172,813
2781 Salkas 423306 2327/ Pjk 15-May-15 Jantung 50,000 - 50,725 100,725
2782 Masliah 796210 2326/ Pjk 15-May-15 Jantung 50,000 - 192,798 242,798
2783 H Bambang 829576 2236/ Terapi +Kon 15-May-15 R Medik + Sar 50,000 35,000 220,000 14,888 319,888
2784 Rahmat Ram 840528 3533/ Kontrol 15-May-15 Anak 50,000 - 42,897 92,897
2785 Fatmawaty 770659 3520/ Obs Cepalgi 15-May-15 Syaraf 50,000 - 997,700 10,268 1,057,968
2786 Sopiah Hadi 838330 2311/ Ht + Dm 15-May-15 P. Dalam 50,000 35,000 60,000 113,711 258,711
2787 Suhery 822948 3505/ Kontrol 15-May-15 Rehab Medik+ 50,000 35,000 71,500 16,135 172,635
2788 Maksum 841192 3192/ Post Op Her 15-May-15 Bedah Umum 50,000 - 8,363 58,363
2789 Baihaqi Zid 506432 3298/ Kontrol Epil 15-May-15 Syaraf 50,000 - 19,808 69,808
2790 Fitri Hartati 800400 2404/ Keratitis 15-May-15 Mata 50,000 - 60,000 22,063 132,063
2791 Istiqomah 615676 3255/ Limfadeniti 15-May-15 Bedah Umum 50,000 - 6,625 56,625
2792 Mardiansya 800448 2296/ Kontrol 15-May-15 Paru 50,000 - 75,163 125,163
2793 Rusdiana No 810566 3430/ S/ Tb Paru 15-May-15 Paru 50,000 - 111,713 161,713
2794 Arbainah 531576 3516/ Tonsilitis K 15-May-15 Tht 50,000 - 7,938 57,938
2795 Surayatmi 787551 2251/ Mata Nyeri 15-May-15 Mata 50,000 - 14,260 64,260
2796 Siti Hairunn 775120 3384/ D Tumor Re 15-May-15 Bedah Umum 50,000 - 125,000 3,313 178,313
2797 Atik Setyow 838334 3354/ Omsk 15-May-15 Tht 50,000 - 310,500 8,363 368,863
2798 Joko Widod 835519 3225/ 37 P 15-May-15 Gigi&Mulut 50,000 - 160,600 1,963 212,563
2799 Sutikno 550049 2283/ Kontrol 15-May-15 P. Dalam 50,000 - 48,275 98,275
2800 Anang Suria 764164 3489/ Pjk 15-May-15 Jantung 50,000 - 277,050 327,050
2801 Luat Alui 838319 3503/ Bph 15-May-15 Urologi 50,000 - 301,125 351,125
2802 Yudha Yudist 480756 3475/ Epilepsi 15-May-15 Syaraf 50,000 - 39,311 89,311
2803 Jainatul Ad 795657 3253/ Migrain 15-May-15 Syaraf 50,000 - 16,718 66,718
2804 Hisabil Ami 614125 2343/ Epilepsi 15-May-15 Anak 50,000 - 156,750 206,750
2805 M. Ilyas Ak 474905 3266/ Chf+Dm+G 15-May-15 Jiwa 50,000 - 20,538 70,538
2806 Mariani 423982 2358/ Ht 15-May-15 Jantung 50,000 - 281,213 331,213
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2807 Mas'Ud Riza 764236 3486/ Ht 15-May-15 Jantung 50,000 - 233,513 283,513
2808 Sudirman 838343 2374/ Telinga Me 15-May-15 Tht 50,000 - 7,000 57,000
2809 Murtini 757462 3472/ Terapi 15-May-15 R.Medik 50,000 35,000 71,500 35,654 192,154
2810 Thamrin 802053 3281/ Terapi+Kont 15-May-15 R.Medik+Syar 50,000 35,000 71,500 20,585 177,085
2811 Rusman 712967 3532/ Lbp 15-May-15 Syaraf 50,000 - 227,700 15,566 293,266
2812 Rakhmad Bu 232250 2344/ Post Stroke 15-May-15 Syaraf 50,000 - 20,980 70,980
2813 Nurul Afifa 834589 3330/ 12 11 Nekro 15-May-15 Gigi&Mulut 50,000 - 207,443 11,938 269,381
2814 Rudy Anant 837429 3457/ Kontrol 15-May-15 P. Dalam 50,000 35,000 68,625 153,625
2815 Arbainah 729366 3149/ Dm 15-May-15 P. Dalam 50,000 - 402,500 847,640 1,300,140
2816 Syamsuddin 829524 3325/ Ggn Tidur 15-May-15 Jiwa 50,000 - 17,531 67,531
2817 Suparti 502027 3337/ Dm 15-May-15 P. Dalam 50,000 - 157,313 207,313
2818 Marilah 805195 3119/ Kontrol 15-May-15 P. Dalam 50,000 - 141,200 191,200
2819 Ishack Iskan 797027 3118/ Gastritis 15-May-15 P. Dalam 50,000 - 396,500 39,581 486,081
2820 Dahrin 833842 3355/ Stroke 15-May-15 Syaraf 50,000 - 27,481 77,481
2821 Heri Sarjon 838335 3193/ Hepatema 15-May-15 P. Dalam 50,000 - 297,975 347,975
2822 M.Riyadi 149645 3296/ Epilepsi 15-May-15 Syaraf 50,000 - 551,963 601,963
2823 Sarpin 838341 3240/ Ht Gr I 15-May-15 Jantung 50,000 - 649,500 48,900 748,400
2824 Herliansari 474038 3351/ Mastitis 15-May-15 Bedah Umum 50,000 - 564,062 614,062
2825 Wa Dia 281130 2224/ Ht 15-May-15 P. Dalam 50,000 - 50,156 100,156
2826 Rizky Sulist 748957 3352/ Tu Colli D 15-May-15 Onkologi 50,000 - 134,500 12,000 196,500
2827 Sulastri 616670 3072/ Decomp Cor 15-May-15 Jantung 50,000 - 202,650 252,650
2828 Bahrudin 835566 2252/ Sindrum Dis 15-May-15 P. Dalam 50,000 - 894,200 430,400 114,313 1,488,913
2829 Marzuki 835310 3191/ Nail Infecti 15-May-15 Bedah Umum 50,000 - 125,000 1,525 176,525
2830 Hj. Syamsin 525903 3120/ Rhinitis A 15-May-15 Paru 50,000 - 160,250 125,400 25,313 360,963
2831 Isneny Wahy 838342 2373/ Tonsilitis 15-May-15 Tht 50,000 - 328,150 9,613 387,763
2832 Hasmi 835908 3311/ Susp Bronkh 15-May-15 Paru 50,000 - 28,875 78,875
2833 Masriah 293217 3328/ Kontrol 15-May-15 Kandungan 50,000 - 373,000 5,063 428,063
2834 Kornelis Na 810504 3150/ Hnp 15-May-15 Syaraf 50,000 - 22,379 72,379
2835 Isnawati 840628 3238/ Kontrol 15-May-15 Jantung 50,000 - 187,000 24,900 261,900
2836 La Irano 831811 3399/ Kontrol 15-May-15 P. Dalam 50,000 - 1,073,375 1,123,375
2837 Andi Heru B 838333 3207/ Ginggivitis 15-May-15 Gigi&Mulut 50,000 - 160,600 3,969 214,569
2838 Khotimatuz 830433 3162/ Ispa 15-May-15 Anak 50,000 - 17,994 67,994
2839 Hajar Rahm 776543 3165/ Dm 15-May-15 P. Dalam 50,000 - 56,679 106,679
2840 Saanih 835562 3209/ Ispa 15-May-15 Paru 50,000 - 43,250 93,250
2841 Achmad Roh 516226 3178/ Ht 15-May-15 Jantung 50,000 - 80,463 130,463
2842 H. Yarhan 547553 2357/ Cad 15-May-15 Jantung 50,000 - 46,538 96,538
2843 Mustamin 841123 2313/ Kontrol 15-May-15 Paru 50,000 - 20,636 70,636
2844 Yuliana 691481 3179/ Kontrol 15-May-15 Mata 50,000 - 38,438 88,438
2845 Yudi Gunars 725539 3058/ Snh+Dm 15-May-15 Syaraf+P.Dala 50,000 - 110,250 27,106 187,356
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2846 Puspa Farad 697321 3459/ Omsk 15-May-15 Tht 50,000 - 63,000 5,413 118,413
2847 Abd Hakim 730174 3340/ Terapi 15-May-15 R.Medik+Syar 50,000 35,000 220,000 170,775 475,775
2848 Satria Baga 841309 3546/ Kontrol 15-May-15 Anak 50,000 - 9,740 59,740
2849 Iis Hastuti 835363 3444/ Kontrol 15-May-15 R.medis 50,000 105,000 71,500 160,600 8,363 395,463
2850 Alimuddin 600457 3414/ Pjk 15-May-15 Jantung 50,000 - 76,673 126,673
2851 Suardi 744455 3415/ Pjk 15-May-15 Jantung 50,000 - 64,088 114,088
2852 Mulyono 787453 3293/ Lbp 15-May-15 Syaraf 50,000 - 5,000 55,000
2853 Takat 447665 3208/ Susp Kista 15-May-15 Tht 50,000 - 115,000 10,960 175,960
2854 Indra Suryad 838114 2270/ Ht 15-May-15 Jantung 50,000 - 18,000 68,000
2855 M.Fuad Sud 659839 3456/ S/ Omsk 15-May-15 Tht 50,000 - 32,408 82,408
2856 Sumiati 838345 3326/ Abses 15-May-15 Bedah Umum 50,000 - 438,400 377,500 125,400 991,300
2857 Saniah 838344 2386/ Susp Apendic 15-May-15 Bedah Umum 50,000 - 387,900 305,000 742,900
2858 Rubaedah 838346 2388/ Nyeri Perut 15-May-15 Bedah Umum 50,000 - 387,900 305,000 742,900
2859 Nani Fitriya 841294 3343/ Kontrol 15-May-15 Bedah Umum 50,000 - 117,100 394,150 125,400 686,650
2860 M.Santri Ka 810571 2493/ Ulkus D 15-May-15 P. Dalam 50,000 - 352,950 402,950
2861 Jansen Rapa 671347 2372/ Konstipasi 15-May-15 P. Dalam 50,000 - 633,000 305,000 988,000
2862 Karnadi 757912 2341/ Cek Lab 15-May-15 P. Dalam 50,000 - 500,250 550,250
2863 Syahraeni 753170 3412/ Hipertiroid 15-May-15 P. Dalam 50,000 - 498,800 548,800
2864 Sujinem 648725 2239/ Cek Lab 15-May-15 P. Dalam 50,000 - 110,250 160,250
2865 Sakdiah 822982 3059/ Terapi 15-May-15 P. Dalam 50,000 - 159,500 110,250 319,750
2866 Santi Nurdi 838338 3221/ Abses Mama 15-May-15 Bedah Umum 50,000 - 438,400 488,400
2867 Siti Salma 781893 3413/ Ca Mamae 15-May-15 Onkologi 50,000 - 525,250 575,250
2868 Mistiani 527415 3135/ Dm Tipe Ii 15-May-15 P. Dalam 50,000 - 110,250 160,250
2869 Krisyanti El 805101 3194/ Tu Mamae S 15-May-15 P. Dalam 50,000 - 110,250 160,250
2870 Lukman 775211 3299/ Hipertiroid 15-May-15 P. Dalam 50,000 - 352,100 402,100
2871 Ani Farwati 815476 3339/ Obs Tu Mam 15-May-15 Onkologi 50,000 - 525,250 575,250
2872 Indo Upe 447663 3267/ Hemoroid 15-May-15 Bedah Umum 50,000 - 117,100 438,400 605,500
2873 May Rita 838329 2328/ Tu Jinak Col 15-May-15 Bedah Umum 50,000 - 438,400 377,500 125,400 991,300
2874 St Azizah Au 838337 2285/ Gigi Tdk T 15-May-15 Gigi & Mulut 50,000 - 160,600 210,600
2875 Siti Zuraida 841246 3323/ Kontrol 15-May-15 Bedah Umum 50,000 - 1,472,900 1,522,900
2876 Yoggi Adam 829594 3460/ Ompk 15-May-15 Tht 50,000 - 1,472,900 1,522,900
2877 Siti Fatimah 387828 3254/ Ht 15-May-15 Jantung 50,000 35,000 227,700 184,116 496,816
2878 Katarina Da 838339 3222/ Amenorea 15-May-15 Kandungan 50,000 - 60,000 305,000 415,000
2879 Mulyana 838302 3471/ Fam D 15-May-15 Bedah Umum 50,000 - 377,500 427,500
2880 Agus Trisna 835992 3210/ Kista Tiroid 15-May-15 P. Dalam 50,000 35,000 377,500 462,500
2881 Habibah Nu 838331 3313/ Susp Hiperp 15-May-15 Patologi Anat 50,000 - 258,750 308,750
2882 Hemi 835300 3284/ Susp Oa 15-May-15 Orthopedi 50,000 - 50,000
2883 Supriatin 769041 2401/ Kontrol 15-May-15 Onkologi 50,000 - 50,000
2884 Muslihah 835307 3327/ Tumor Colli 15-May-15 Onkologi 50,000 - 50,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2885 Lahuseng 834359 3490/ Nyeri Saat 15-May-15 Urologi 50,000 - 50,000
2886 Yurisna Okt 841343 3518/ S/ Isk 15-May-15 Urologi 50,000 - 50,000
2887 Dimas Resky 756904 3382/ Hernia 15-May-15 Bedah Anak 50,000 35,000 85,000
2888 Sabariyah 016859 3101/ Fisioterapi 15-May-15 R.Medik+Syar 50,000 - 220,000 270,000
2889 Hj. Ernawat 710875 3102/ Fisioterapi 15-May-15 R.Medik 50,000 - 220,000 270,000
2890 Hariyanto 835961 3306/ Tu Axialis 15-May-15 Bedah Umum 50,000 - 50,000
2891 Rukiyah 834190 3224/ Tu Colli 15-May-15 Bedah Umum 50,000 - 125,000 175,000
2892 Wahyudi 835524 3283/ Tumor 15-May-15 Bedah Umum 50,000 - 125,000 175,000
2893 Umar Usma 828900 3458/ Kontrol 15-May-15 Bedah Umum 50,000 - 50,000
2894 Siti Mahira 835981 2418/ Tu Axila 15-May-15 Bedah Umum 50,000 - 50,000
2895 Rus Megawa 781244 2402/ Kontrol 15-May-15 P. Dalam 50,000 35,000 85,000
2896 Supriadi 790949 3252/ Tu Parotis 15-May-15 Bedah Umum 50,000 - 125,000 175,000
2897 Hardianto 835904 2375/ Colic Abdo 15-May-15 Bedah Umum 50,000 - 50,000
2898 Tiara Nalian 835364 2360/ Susp Apendic 15-May-15 Bedah Umum 50,000 - 50,000
2899 Maksum 841192 3192/ Post Op Her 15-May-15 Bedah Umum 50,000 - 125,000 175,000
2900 Asnawati 834209 2315/ Kontrol 15-May-15 Bedah Umum 50,000 - 125,000 175,000
2901 Hayati 702223 2329/ Kontrol 15-May-15 Bedah Umum 50,000 - 125,000 175,000
2902 Halimah Wa 835995 3488/ S/ Ca Mama 15-May-15 Onkologi 50,000 35,000 649,500 734,500
2903 Rika Sartila 838321 2371/ G2 P1 A0 D 15-May-15 Kandungan 50,000 - 120,500 170,500
2904 Misbahul Ja 606357 2298/ G2P1A0 Dng 15-May-15 Kandungan 50,000 - 60,000 110,000
2905 Masitah Best 806602 3344/ G5P2A2 40 15-May-15 Kandungan 50,000 - 120,500 170,500
2906 Lilik Jumiat 838348 2433/ G4 P3 A0 Dn 15-May-15 Kandungan 50,000 - 50,000
2907 Syahrina 821166 3251/ Post Kuret 15-May-15 Kandungan 50,000 35,000 60,000 462,500 607,500
2908 Leni M 841463 2254/ Ht 15-May-15 Jantung 50,000 - 462,500 512,500
2909 Wulan Fady 788384 2403/ Susp Dhf 15-May-15 P. Dalam 50,000 - 50,000
2910 Hafizh Hari 828771 3397/ Post Lapara 15-May-15 Anak 50,000 - 50,000
2911 Supiyah 480355 3398/ Gastritis Ak 15-May-15 P. Dalam 50,000 - 50,000
2912 Afrizal M. A 838322 3206/ Obs Febris 15-May-15 Anak 50,000 - 50,000
2913 Sekar Widra 841133 3535/ Kontrol 15-May-15 Anak 50,000 - 50,000
2914 Syaqila Ram 635011 2330/ Batuk Pilek 15-May-15 Anak 50,000 - 50,000
2915 Edelwais Pa 625315 3519/ 7 7 Gp 15-May-15 Gigi&Mulut 50,000 - 274,020 324,020
2916 Annisa Resk 835597 3237/ 21 12 G 15-May-15 Gigi&Mulut 50,000 - 347,490 397,490
2917 Atha Isyafir 563549 3268/ V Period Ak 15-May-15 Gigi&Mulut 50,000 - 561,392 611,392
2918 Jumaidah 770069 3517/ 8 Pericor 15-May-15 Gigi&Mulut 50,000 - 50,000
2919 Sultan 778908 3547/ Imunokompr 15-May-15 Vct 50,000 - 50,000
2920 Linda Nurha 834870 3104/ Nekrose 26 15-May-15 Gigi&Mulut 50,000 - 355,730 405,730
2921 Syaina Arka 828585 3239/ Iv Karies 15-May-15 Gigi&Mulut 50,000 - 561,392 611,392
2922 Lelly J. 630935 2342/ Keloid 15-May-15 Kulit 50,000 - 115,000 165,000
2923 H. M. Kosi 750140 3073/ Terapi+Kont 15-May-15 R.Medik+Syar 50,000 35,000 159,500 244,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2924 Sukri 463499 3074/ Terapi+Lbp 15-May-15 R.Medik+Syar 50,000 35,000 159,500 244,500
2925 Nanang Isma 813793 3310/ Terapi 15-May-15 R.Medik+Syar 50,000 - 220,000 270,000
2926 Wa Nuru 835977 3442/ S/ Sinusitis 15-May-15 Tht 50,000 35,000 207,443 292,443
2927 Samsu 835996 3280/ Kontrol 15-May-15 Onkologi 50,000 - 50,000
2928 Heny 840463 2314/ Kontrol 15-May-15 Kandungan 50,000 - 120,500 170,500
2929 Go Ing Min 835997 3441/ Tu Colli 15-May-15 Onkologi 50,000 - 50,000
2930 Siti Musrian 819397 2240/ Kontrol 15-May-15 Onkologi 50,000 - 50,000
2931 Jainab 838314 3341/ G5P4A0 15-May-15 Kandungan 50,000 - 60,000 110,000
2932 Eka Suciati 838305 3195/ G1P0A0 15-May-15 Kandungan 50,000 - 120,500 170,500
2933 Rukiah 832918 3132/ Carcinoma 15-May-15 Kandungan 50,000 - 60,000 110,000
2934 Edi Kusyadi 838307 2255/ Hemaroid Gr 15-May-15 Bedah Umum 50,000 - 50,000
2935 Jasmah 434885 3336/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2936 Rusdiana 806016 3324/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2937 Minog 648247 2300/ Terapi 15-May-15 R.Medik 50,000 - 159,500 209,500
2938 Sujitno 835911 3370/ Terapi 15-May-15 R.Medik 50,000 - 159,500 209,500
2939 Ramlan Has 619115 3429/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2940 Kasmijan 829312 2299/ Terapi 15-May-15 R Medik 50,000 - 71,500 121,500
2941 Marsidi 720910 2269/ Terapi 15-May-15 R Medik 50,000 - 159,500 209,500
2942 Sarifuddin 835589 3368/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2943 Nor Hidaya 631443 3164/ Fisioterapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2944 Marjuki 492002 3366/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2945 Ernawaty 525416 2253/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2946 Jasmani 822971 3180/ Terapi 15-May-15 R.Medik 50,000 - 159,500 209,500
2947 Fatimah 380727 3321/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2948 Achmadsya 465433 3322/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2949 Hamdanah 563909 3117/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2950 Murikah 598534 3147/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2951 Wakiem 701255 3353/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2952 Nurul Aini 835915 3369/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2953 Sujarni 800848 3367/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2954 Erniwati 443296 3176/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2955 Suyati 213400 2225/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2956 H.Mudaring 585074 2223/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2957 Sayem 835998 3309/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2958 Kapsah 791022 3291/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2959 Warni 753983 2267/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2960 Marida 647710 3087/ Fisioterapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2961 Buatik 824550 3133/ Terapi 15-May-15 R.Medik 50,000 - 159,500 209,500
2962 Rubiyanti 839552 3134/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
2963 Ahmad Sida 581234 3086/ Terapi 15-May-15 R.Medik 50,000 - 159,500 209,500
2964 Subeli 238930 3116/ Terapi 15-May-15 R.Medik 50,000 - 159,500 209,500
2965 Sumiaty 429003 3105/ Terapi 15-May-15 R.Medik 50,000 - 159,500 209,500
2966 Suryanti 720793 3295/ Fisioterapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2967 J.Marni 664975 3307/ Fisioterapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2968 Sumiati 737893 3308/ Fisioterapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2969 Nani 683573 2416/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2970 Kartini Dae 835401 3300/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2971 Darmiati 667292 2281/ Terapi 15-May-15 R Medik 50,000 - 71,500 121,500
2972 Viknatul Lei 829364 2282/ Terapi 15-May-15 R Medik 50,000 - 71,500 121,500
2973 Rohanah 522050 2284/ Terapi 15-May-15 R Medik 50,000 - 71,500 121,500
2974 Rina Musfaw509293 3474/ Fisiotherapy 15-May-15 R.Medik 50,000 - 71,500 121,500
2975 Yenni Purwa 631789 2297/ Terapi 15-May-15 R Medik 50,000 - 71,500 121,500
2976 Ernie Bs 815417 3504/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2977 Gimun 695987 3294/ Fisioterapi 15-May-15 R.Medik 50,000 - 440,000 490,000
2978 Zema Riski 739218 3075/ Terapi 15-May-15 R.Medik 50,000 - 440,000 490,000
2979 M.Ihsan 764779 3177/ Tw 15-May-15 R.Medik 50,000 - 220,000 270,000
2980 Annisa Hima 781563 3071/ Ot+Tw 15-May-15 R.Medik 50,000 - 440,000 490,000
2981 Risa Ifana 829483 3282/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2982 Norliana 521951 3314/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2983 Nila Wati 346646 2356/ Terapi 15-May-15 R Medik 50,000 - 71,500 121,500
2984 Karmilah 835576 3534/ Terapi 15-May-15 R Medik 50,000 - 71,500 121,500
2985 Sumiyat 821102 3411/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2986 Dewi Kartik 824703 2432/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2987 Priyo Hoet 263217 3501/ Terapi 15-May-15 R.Medik 50,000 - 159,500 209,500
2988 Ismul Izmi 496487 2387/ Terapi 15-May-15 R Medik 50,000 - 159,500 209,500
2989 Andri K.P. 706211 2405/ Fisioterapi 15-May-15 R Medik 50,000 - 159,500 209,500
2990 Donatianus 811513 3312/ Terapi 15-May-15 R Medik 50,000 - 379,500 429,500
2991 Febrian Satr 753688 3060/ Fisioterapi 15-May-15 R Medik 50,000 - 440,000 490,000
2992 Syahira 790826 3088/ Terapi 15-May-15 R Medik 50,000 - 220,000 270,000
2993 Ridho Abrar 779669 2419/ Terapi 15-May-15 R Medik 50,000 - 220,000 270,000
2994 Dafa Tri Nal 829331 3163/ Ft 15-May-15 R Medik 50,000 - 220,000 270,000
2995 Nasywa Qon 706135 3090/ Fisioterapi 15-May-15 R Medik 50,000 - 440,000 490,000
2996 M Haykal Il 500328 2238/ Terapi 15-May-15 R Medik 50,000 - 440,000 490,000
2997 Zahra Aseni 725126 2420/ Terapi 15-May-15 R.Medik 50,000 - 220,000 270,000
2998 Herlinda Yus 805100 3161/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
2999 Hj.Masnawa 718846 2417/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
3000 Asih Sunars 829585 3089/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
3001 Ijum 775736 3131/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3002 H.A. Moeis 810554 2390/ Terapi 15-May-15 R.Medik 50,000 - 71,500 121,500
3003 M. Alif Ra 808609 3687/ Bp+Kdk 18-May-15 Anak 50,000 - 74,005 124,005
3004 Sriati 740994 3940/ Katarak Ods 18-May-15 Mata 50,000 35,000 60,000 649,500 14,363 808,863
3005 Nella Agust 686572 3611/ Polip Nasal 18-May-15 Tht 50,000 - 138,147 188,147
3006 Asni 816792 3477/ Terapi 18-May-15 Rehab Medik 50,000 35,000 319,500 1,950 406,450
3007 Suryani 781855 2705/ Myalgia 18-May-15 Syaraf 50,000 - 47,580 97,580
3008 Hariyani 838379 3719/ Benjolan 18-May-15 Kulit Kelamin 50,000 - 377,500 10,960 438,460
3009 Nody F A 838369 2671/ Benjolan Di 18-May-15 Bedah Umum 50,000 - 2,550 52,550
3010 Darminto 781108 2735/ Kontrol 18-May-15 Peny.Dalam 50,000 - 653,500 10,088 713,588
3011 Henny Harta 664991 3907/ Post Orif 18-May-15 Ortopedi 50,000 35,000 71,500 1,950 158,450
3012 Farizal 838381 3734/ Kontrol 18-May-15 Gigi&Mulut 50,000 - 341,392 93,115 1,525 486,032
3013 Hairin Darm 834261 2686/ Kontrol 18-May-15 Bedah Umum 50,000 - 125,000 6,519 181,519
3014 Wawi Mona 838325 2478/ 6 Parsial Ga 18-May-15 Gigi & Mulut 50,000 35,000 1,648,276 17,623 1,750,899
3015 Erni Susanti 834218 3656/ Cephalgia 18-May-15 Syaraf 50,000 - 439,250 77,576 566,826
3016 Jum'Ah 236188 3404/ Dm 18-May-15 Penyakit Dala 50,000 35,000 192,588 277,588
3017 Henny Yulia 372707 2718/ Hipertiroid 18-May-15 Peny.Dalam 50,000 35,000 529,100 305,000 158,700 1,077,800
3018 Rahmat Rah 835327 3645/ Post Op 18-May-15 Kulit Kelamin 50,000 - 5,938 55,938
3019 Sukri 483499/4634993563/ Kontrol 18-May-15 R.Medik+Sara 50,000 35,000 159,500 11,079 255,579
3020 Dumiatun 669083 3579/ Kontrol 18-May-15 Rehab Medik+ 50,000 35,000 71,500 1,300 157,800
3021 Srini 712090 3716/ Kontrol 18-May-15 Paru 50,000 - 3,700 53,700
3022 Novita Sari 838371 3922/ Hearing Los 18-May-15 Tht 50,000 - 63,000 10,694 123,694
3023 Andi Ahmad 551166 3966/ S/ Gerd 18-May-15 Peny.Dalam 50,000 - 353,250 42,563 445,813
3024 Agustina 838384 2704/ 2 Fraktur 18-May-15 Gigi & Mulut 50,000 - 93,115 8,425 151,540
3025 H.M.Kasim 750140 3562/ Kontrol 18-May-15 Rehab Medik/S 50,000 35,000 159,500 29,641 274,141
3026 Janariah 463441 2615/ Hnp 18-May-15 Saraf 50,000 35,000 71,500 10,618 167,118
3027 Siti Sarah 453440 3880/ Neuralgia 18-May-15 Syaraf 50,000 - 66,459 116,459
3028 Ahmad Toba 838376 3717/ Hemiparesis 18-May-15 Syaraf 50,000 - 142,763 192,763
3029 Ponidi 838367 3892/ Bsk 18-May-15 Urologi 50,000 35,000 745,800 318,834 1,149,634
3030 Ernawati 124241 3756/ Kontrol 18-May-15 R.Medik+Sara 50,000 35,000 71,500 13,493 169,993
3031 M.Asrani 648975 2719/ Kontrol 18-May-15 Saraf 50,000 35,000 17,063 102,063
3032 Sutaji 838374 3936/ Glaukoma O 18-May-15 Mata 50,000 - 50,000
3033 Malika Febr 684175 3817/ Tb Anak 18-May-15 Anak 50,000 - 64,110 114,110
3034 Kamakko R 666972 3683/ Kontrol 18-May-15 Jantung 50,000 35,000 442,376 527,376
3035 Supiah 475816 3682/ Kontrol 18-May-15 R.Medik+Sara 50,000 35,000 159,500 227,700 12,895 485,095
3036 Emi Wati 822911 3863/ Kontrol 18-May-15 Kandungan 50,000 - 480,500 21,088 551,588
3037 Noraidah 503324 2522/ Chf 18-May-15 Jantung 50,000 35,000 439,400 25,425 549,825
3038 Murni 753392 2539/ Kontrol 18-May-15 Dalam 50,000 - 3,313 53,313
3039 Dhara Risky 563443 3924/ S/ Tb 18-May-15 Anak 50,000 - 24,698 74,698
3040 Sariyah 828930 3849/ Cepalgia 18-May-15 Syaraf 50,000 - 65,926 115,926
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3041 Kasilan 790400 3628/ Cad+Chf 18-May-15 Jantung 50,000 - 321,525 371,525
3042 Masniah 565801 3893/ Ht 18-May-15 Jantung 50,000 - 289,630 339,630
3043 M. Jufri 764121 3416/ Fisioterapi 18-May-15 Rehab Medik 50,000 35,000 159,500 462,500 51,600 758,600
3044 Ely Susanti 541802 2716/ Tb Kelenja 18-May-15 Bedah Umum 50,000 - 274,980 324,980
3045 Radeng 560193 2703/ Post Snh 18-May-15 Syaraf 50,000 - 36,575 86,575
3046 M.Amin 832843 2746/ Post Orif 18-May-15 Orthopedy 50,000 - 105,600 2,400 158,000
3047 Dina Oktavi 217226 2687/ Kontrol 18-May-15 Kandungan 50,000 - 7,675 57,675
3048 Masminah 761179 3675/ Ht+Dm 18-May-15 Penyakit Dala 50,000 - 38,100 88,100
3049 Yusuf 694840 3732/ Tb Paru 18-May-15 Paru 50,000 - 33,588 83,588
3050 Rusmiati 547718 3659/ Kontrol 18-May-15 Syaraf 50,000 - 260,260 310,260
3051 Rasmini 494650 3877/ Kontrol 18-May-15 Syaraf 50,000 - 98,026 148,026
3052 Dwi Atmodj 362174 2582/ Ht 18-May-15 Jantung 50,000 - 273,188 323,188
3053 Fatkhul Ro 785004 3742/ Cad 18-May-15 Jantung 50,000 - 412,125 462,125
3054 Suciarti 430125 3771/ Chf 18-May-15 Jantung 50,000 - 795,735 845,735
3055 Yunita Sari 450272 2660/ Epilepsi 18-May-15 Anak 50,000 - 633,550 683,550
3056 Noor Jennah 754735 3582/ Oma 18-May-15 Tht 50,000 - 119,045 169,045
3057 Ismul Izmi 496487 2749/ Nyeri Tanga 18-May-15 Saraf 50,000 - 22,768 72,768
3058 Agustina Sr 811689 3909/ Ispa 18-May-15 Anak 50,000 - 6,742 56,742
3059 Verja Prata 838385 3749/ Hipospendia 18-May-15 Bedah Anak 50,000 - 305,000 18,956 373,956
3060 Sanawi 835957 2656/ Retensio Ur 18-May-15 Urologi 50,000 - 132,500 292,875 475,375
3061 Fadhylulwan 838358 3552/ Oma 18-May-15 Tht 50,000 - 63,000 9,382 122,382
3062 St Aminah 723041 2645/ Kontrol 18-May-15 Paru 50,000 - 83,413 133,413
3063 Amat 828525 3862/ Dispepsia 18-May-15 Peny.Dalam 50,000 - 32,938 82,938
3064 Mario Ade P 840751 3847/ Post Amputa 18-May-15 Bedah Umum 50,000 - 125,000 14,431 189,431
3065 Mustafa Om 515986 3465/ Pjk+Retensi 18-May-15 Jantung+Urolo 50,000 35,000 415,450 500,450
3066 Srini 712090 3716/ Kontrol 18-May-15 Paru 50,000 - 20,138 70,138
3067 Titik Yunani 506287 3688/ Kontrol 18-May-15 Kandungan 50,000 - 60,000 305,000 83,463 498,463
3068 M. Haris 810119 3495/ Kardiomegal 18-May-15 Jantung 50,000 - 462,500 162,975 675,475
3069 Katarina Da 841669 3910/ Amenorea 18-May-15 Kandungan 50,000 - 60,000 32,725 142,725
3070 Ahmad 836814 3921/ Post Op 18-May-15 Bedah Umum 50,000 - 125,000 13,625 188,625
3071 Majedi 729774 3712/ Ht 18-May-15 Jantung 50,000 - 69,699 119,699
3072 Nurbainah 707145 3702/ Susp Mastit 18-May-15 Bedah Umum 50,000 - 8,175 58,175
3073 Siti Munawa 841146 2731/ Kontrol 18-May-15 Kandungan 50,000 - 60,000 42,738 152,738
3074 Supriati 838378 3939/ Kontrol 18-May-15 Gigi&Mulut 50,000 - 9,538 59,538
3075 Mukti Ali 833844 3357/ Kontrol 18-May-15 Orthopedi 50,000 - 215,000 1,200 266,200
3076 Ida Kuswati 773708 3666/ Glaukoma 18-May-15 Mata 50,000 - 57,855 107,855
3077 Muktin 617864 2641/ Dm 18-May-15 Dalam 50,000 - 305,420 355,420
3078 Supiah 419718 3522/ Post Op 18-May-15 Orthopedi 50,000 - 144,950 1,431 196,381
3079 Prila Sari 146825 3730/ Cepalgia 18-May-15 Syaraf 50,000 - 13,100 63,100
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3080 Susanti 838362 3629/ Tonsilitis 18-May-15 Tht 50,000 - 31,919 81,919
3081 Thomy Mand828387 3774/ Cap 18-May-15 Anak 50,000 - 1,379 51,379
3082 Yulius Taya 828254 2555/ Ca Nasofari 18-May-15 Tht 50,000 - 24,799 74,799
3083 M. Said 087071 3524/ Katarak 18-May-15 Mata 50,000 - 12,293 62,293
3084 Ayu Aryani 411859 3670/ Kontrol 18-May-15 Kandungan 50,000 - 60,000 1,563 111,563
3085 Sarminto 796814 3462/ Snh 18-May-15 Syaraf 50,000 - 27,250 77,250
3086 Yohanes Ka 720887 3711/ Kontrol 18-May-15 Paru 50,000 - 67,068 117,068
3087 Dahrin 833842 3606/ Stroke 18-May-15 Syaraf 50,000 - 32,454 82,454
3088 Sumiati 396889 3654/ Rematoid Art 18-May-15 Peny.Dalam 50,000 - 30,713 80,713
3089 Nurdin Mus 753691 3536/ Post Tb 18-May-15 Paru 50,000 - 185,453 235,453
3090 Akhmad Sya 763738 3525/ Lbp 18-May-15 Syaraf 50,000 - 227,700 13,079 290,779
3091 M.Luqman S 838300 3757/ S/ 112 18-May-15 Vct 50,000 - 352,100 125,400 14,675 542,175
3092 M.Nur 838357 3741/ S/ Tu Paru 18-May-15 Paru 50,000 - 764,150 30,525 844,675
3093 Imam Riyad 431397 3596/ Post Op Ori 18-May-15 Orthopedi 50,000 - 80,000 10,100 140,100
3094 Wa Nuriani 438773 3773/ Menometora 18-May-15 Kandungan 50,000 - 60,000 537,400 55,913 703,313
3095 Alda Safiqa 842102 3521/ Polip 18-May-15 Tht 50,000 - 9,086 59,086
3096 Hidayatul I 740872 3540/ Struma 18-May-15 Penyakit Dala 50,000 - 33,413 83,413
3097 Sukarji 815850 3833/ Cad 18-May-15 Jantung 50,000 - 288,975 338,975
3098 Santi Nurdi 838338 3507/ Abses Mama 18-May-15 Bedah Umum 50,000 - 12,750 62,750
3099 Ahmad Rus 796832 2569/ Obs Konstip 18-May-15 P. Dalam 50,000 - 26,619 76,619
3100 Sri Natun 840175 3816/ Obs Dermati 18-May-15 Kulit Kelamin 50,000 - 13,563 63,563
3101 Kahang 816463 3569/ Kontrol 18-May-15 Vct 50,000 35,000 40,100 125,100
3102 Asniah 482228 2585/ Ht 18-May-15 Dalam 50,000 - 13,888 63,888
3103 Maritza Alm 579465 3537/ Dhf Gr I 18-May-15 Anak 50,000 - 38,500 88,500
3104 Yosi Carisma 837110 3652/ Kontrol 18-May-15 Bedah Umum 50,000 70,000 91,340 105,600 8,663 325,603
3105 Siti Ainah 438360 2553/ Kontrol + Te 18-May-15 Paru + R Medi 50,000 - 33,169 83,169
3106 Siti Saidah 682130 3510/ G1P0A0+Pos 18-May-15 Kandungan 50,000 - 120,500 305,000 7,931 483,431
3107 Nurhayati 563933 3509/ Post Op Str 18-May-15 Bedah Umum 50,000 - 3,963 53,963
3108 Jali 834810 2688/ Kontrol 18-May-15 Kulit + Beda 50,000 35,000 105,600 18,060 208,660
3109 M. Fadilah 798066 3614/ Epilepsi 18-May-15 Anak 50,000 - 86,870 136,870
3110 Evi Kristina 825348 2629/ Kontrol 18-May-15 Dalam 50,000 - 8,900 58,900
3111 M. Ibrahim 778458 3672/ Kontrol 18-May-15 Syaraf 50,000 - 25,763 75,763
3112 Mashoed 647749 2525/ Osteoartritis 18-May-15 Saraf 50,000 - 20,363 70,363
3113 Andi Tenri 677040 3597/ Myalgia 18-May-15 Syaraf 50,000 - 198,954 248,954
3114 Nur Indah 835359 2596/ Kontrol 18-May-15 Bedah Umum 50,000 - 125,000 15,188 190,188
3115 Rahmatun N 835337 3831/ Kontrol 18-May-15 Kandungan 50,000 - 60,000 55,913 165,913
3116 Yeni Wahyu 838349 3565/ Chest Pain 18-May-15 Jantung 50,000 - 649,500 37,513 737,013
3117 Bukhari Mu 841241 2599/ Kontrol 18-May-15 Mata 50,000 - 2,050 52,050
3118 Mawarsyah 838363 3641/ Kontrol 18-May-15 Jantung 50,000 - 628,950 649,500 295,913 1,624,363
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3119 Sutamin 614882 3700/ Bph 18-May-15 Urologi 50,000 - 137,213 187,213
3120 Elly Wahyun 411882 3894/ Cad 18-May-15 Jantung 50,000 - 209,125 259,125
3121 M.Rizky 836929 3818/ Kontrol 18-May-15 Anak 50,000 - 110,542 160,542
3122 Faizah Rahm 833000 3758/ Bp+Pjb 18-May-15 Anak 50,000 - 7,065 57,065
3123 Asnawi 838383 3748/ Corpal D 18-May-15 Mata 50,000 - 15,738 65,738
3124 Lilih 804547 3626/ Chd+Dm 18-May-15 Jantung 50,000 - 462,500 305,325 817,825
3125 Ambarani 694065 2626/ Kontrol 18-May-15 Jantung 50,000 - 187,000 331,575 568,575
3126 Jumansyah 159732 3627/ Cad+Ht 18-May-15 Jantung 50,000 - 523,250 649,500 266,715 1,489,465
3127 Yusman 841949 3728/ Dispepsia 18-May-15 Peny.Dalam 50,000 35,000 462,500 263,581 811,081
3128 Usni 833517 3864/ Acs Temi 18-May-15 Jantung 50,000 - 500,250 68,850 619,100
3129 Wahyu Seti 806437 3690/ Dyspepsia 18-May-15 Anak 50,000 - 22,388 72,388
3130 Sri Munah 841516 2644/ Kontrol 18-May-15 Kandungan 50,000 - 60,000 4,556 114,556
3131 Dina Andini 840796 3895/ Kontrol 18-May-15 Kandungan 50,000 - 120,500 24,506 195,006
3132 Rais 841191 3449/ Acs Nstemi 18-May-15 Jantung 50,000 - 649,500 394,125 1,093,625
3133 Suharti 416468 3642/ Ht+Dm 18-May-15 Penyakit Dala 50,000 - 94,088 144,088
3134 Desi Kartina 665189 2630/ Menometror 18-May-15 Kandungan 50,000 - 60,000 305,000 73,025 488,025
3135 Rusdi 837538 2611/ Kontrol 18-May-15 Dalam 50,000 - 87,444 137,444
3136 Diah Ayu Wu 838303 3819/ S/ Mastitis 18-May-15 Bedah Umum 50,000 - 2,400 52,400
3137 Rusmini 821169 3448/ Dm+Lbp 18-May-15 P.Dalam+Syara 50,000 70,000 135,000 21,345 276,345
3138 Agus Trisna 835992 3735/ Kista Tiroid 18-May-15 Penyakit Dala 50,000 - 3,000 53,000
3139 Shopia Sapu 759055 3954/ Oma 18-May-15 Tht 50,000 - 1,383 51,383
3140 M. Syaidi 488484 3718/ Susp Tb 18-May-15 Paru 50,000 - 31,781 81,781
3141 Hariyati 780643 3733/ Hipertiroid 18-May-15 Penyakit Dala 50,000 - 15,413 65,413
3142 Hartinah 816155 3848/ Kontrol 18-May-15 Gigi&Mulut 50,000 - 14,970 64,970
3143 Murwani 658613 3731/ Asma Bronk 18-May-15 Paru 50,000 - 72,372 122,372
3144 Sri Asih 364934 3657/ Ht 18-May-15 Syaraf 50,000 - 47,826 97,826
3145 M. Mislan H 835937 3644/ Snh 18-May-15 Syaraf 50,000 35,000 220,000 13,388 318,388
3146 Asmawi 787812 3747/ Kontrol 18-May-15 Jantung 50,000 35,000 24,113 109,113
3147 M. Khaidir 835920 3492/ 46 18-May-15 Gigi&Mulut 50,000 - 207,443 6,594 264,037
3148 Lili Mufida 269910 3508/ Omsa Ad 18-May-15 Tht 50,000 - 14,100 64,100
3149 Adi Purnomo834289 3506/ Epilepsi 18-May-15 Syaraf 50,000 - 58,725 108,725
3150 Yuyu Yuhan 254067 3743/ Kontrol 18-May-15 Tht+Saraf 50,000 35,000 207,900 32,869 325,769
3151 Rakhmad Bu 232250 2552/ Kontrol 18-May-15 Dalam 50,000 - 22,869 72,869
3152 Urbanus 800804 3478/ Bph 18-May-15 Urologi 50,000 - 137,213 187,213
3153 Kornelis Na 810504 3493/ Pengliahata 18-May-15 Mata 50,000 - 20,366 70,366
3154 M. Arianto 834896 3450/ Cf Clavicul 18-May-15 Orthopedi 50,000 - 80,000 8,363 138,363
3155 Akiyadi Arie 671198 3433/ Dm 18-May-15 Penyakit Dala 50,000 - 21,713 71,713
3156 Juraidah Af 321558 3727/ Kontrol 18-May-15 Kulit Kelamin 50,000 - 19,706 69,706
3157 Sri Wahyuni 838311 3685/ S/ Dm 18-May-15 Peny.Dalam 50,000 - 24,713 74,713
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3158 Sujinem 648725 3434/ Dm Tipe Ii 18-May-15 Penyakit Dala 50,000 - 48,400 98,400
3159 Jamidin 049116 3403/ Dm 18-May-15 Penyakit Dala 50,000 - 43,238 93,238
3160 M. Yusfi Dzi 841206 3390/ Bronkhopne 18-May-15 Anak 50,000 - 1,718 51,718
3161 Mistiani 527415 3624/ Dm 18-May-15 Peny.Dalam 50,000 - 456,975 506,975
3162 Badrun 823005 3446/ Post Op Bph 18-May-15 Urologi 50,000 - 1,687,313 1,737,313
3163 Sakdiah 822982 3374/ Terapi + Kon 18-May-15 R.Medik+ Dal 50,000 35,000 159,500 16,013 260,513
3164 Udin 705780 3375/ Kontrol 18-May-15 Paru 50,000 - 33,935 83,935
3165 Sudarmini 587746 3402/ Ht 18-May-15 Penyakit Dala 50,000 - 24,713 74,713
3166 Gereta 835927 2524/ Dm 18-May-15 Dalam 50,000 35,000 5,288 90,288
3167 Nor Asikin 639313 3607/ Kontrol 18-May-15 R.Medik+Syar 50,000 35,000 71,500 43,410 199,910
3168 Aisjah Joha 796894 3608/ Kontrol 18-May-15 Rehab Medik+ 50,000 35,000 71,500 23,781 180,281
3169 Ilyas Comb 838370 3701/ Dermatitis 18-May-15 Kulit Kelamin 50,000 - 13,541 63,541
3170 Daffa Hasto 841291 3613/ Gea 18-May-15 Anak 50,000 - 38,500 88,500
3171 Santi 539093 3861/ Keloid 18-May-15 Kulit Kelamin 50,000 - 3,499 53,499
3172 Sri Wati 832293 3891/ Kontrol 18-May-15 Peny.Dalam 50,000 - 48,713 98,713
3173 Isnah 777745 3570/ Pjk 18-May-15 Jantung 50,000 - 314,813 364,813
3174 Tawiyah 232405 3879/ Isk 18-May-15 Peny.Dalam 50,000 - 34,194 84,194
3175 Sirajuddin 835944 3820/ Tumor 18-May-15 Bedah Umum 50,000 35,000 163,740 248,740
3176 Nurhadiyant 320110 3463/ Terapi+Ceph 18-May-15 Syaraf+R.Med 50,000 35,000 71,500 76,176 232,676
3177 Basniarti 677022 3686/ Dm+Ht 18-May-15 Penyakit Dala 50,000 - 54,888 104,888
3178 Suyanto 839295 3568/ Lipoma 18-May-15 Bedah Umum 50,000 - 125,000 13,625 188,625
3179 Wana Astuti 782395 2583/ G3 P2 A0 D 18-May-15 Paru 50,000 - 91,125 141,125
3180 Subaidah 824126 3726/ Kontrol 18-May-15 Ortopedi 50,000 - 125,400 1,950 177,350
3181 Winona Dest 337477 3555/ Sinusitis M 18-May-15 Tht 50,000 - 141,973 191,973
3182 Nur Chosia' 630834 3660/ Dm+Abses 18-May-15 Bedah Umum 50,000 - 13,625 63,625
3183 Sukoharti 309149 3600/ Otalgia 18-May-15 Tht 50,000 - 10,283 60,283
3184 Musli 757521 3615/ Bell Palsy 18-May-15 Syaraf 50,000 - 143,663 193,663
3185 Arifin 806103 2435/ Kontrol 18-May-15 Jantung 50,000 - 462,500 188,318 700,818
3186 Ahmad Yani 838363 2613/ Susp Strouk 18-May-15 Saraf 50,000 35,000 88,525 173,525
3187 Sanusi 840621 3729/ Asma 18-May-15 Paru 50,000 - 160,250 18,563 228,813
3188 Wahyuni 838365 3865/ Lbp 18-May-15 Syaraf 50,000 - 21,855 71,855
3189 Hj. Roslan 841381 3599/ Dispepsia S 18-May-15 Penyakit Dala 50,000 - 31,063 81,063
3190 Asfian Nur 838359 3581/ 36 Gp 18-May-15 Gigi&Mulut 50,000 - 93,115 8,425 151,540
3191 Radina Halo 787550 3640/ Kemo 18-May-15 Bedah Umum 50,000 35,000 117,100 1,684,100 492,839 2,379,039
3192 Eni Muzaiya 698016 2568/ Tu Dibahu K 18-May-15 Onkologi 50,000 - 377,500 427,500
3193 Rizka Mawa 800440 3658/ Limfadeniti 18-May-15 Bedah Umum 50,000 - 377,500 427,500
3194 Rohani Mok 801740 3580/ Tu Colli 18-May-15 Bedah Umum 50,000 - 438,400 377,500 125,400 991,300
3195 Dimas Facr 838350 2507/ Hernia 18-May-15 Bedah Anak 50,000 - 701,550 105,600 857,150
3196 Hayani 827636 2628/ Kontrol 18-May-15 Orthopedy 50,000 - 125,400 175,400
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3197 Noor Fitri 838351 2540/ Benjolan Di 18-May-15 Gigi & Mulut 50,000 - 160,600 210,600
3198 Sriyatin 838354 2642/ Lbp 18-May-15 Saraf 50,000 - 227,700 277,700
3199 Diah Ratna 475501 3705/ Post Cf Clav 18-May-15 Orthopedi 50,000 - 105,600 155,600
3200 Sulasiyah 836263 3745/ S/ Kista 18-May-15 Bedah Umum 50,000 35,000 207,900 187,000 479,900
3201 Isnawati 838364 3846/ 67 Karies Td 18-May-15 Gigi&Mulut 50,000 - 93,115 143,115
3202 Uyang Imau 403920 2597/ Kontrol 18-May-15 Bedah Umum 50,000 - 105,600 155,600
3203 Mursalim D 739407 2672/ Susp Tb Par 18-May-15 Paru 50,000 - 160,250 125,400 335,650
3204 Mu'Ati 838110 3937/ 4 Gp 18-May-15 Gigi&Mulut 50,000 35,000 579,150 286,000 187,000 1,137,150
3205 Nurdian 625597 3523/ Kontrol 18-May-15 Gigi&Mulut 50,000 35,000 160,600 245,600
3206 Rosmin 829574 2675/ Benjolan Di 18-May-15 Peny.Dalam 50,000 35,000 60,000 1,119,800 125,400 1,390,200
3207 Iswansyah 700052 3689/ 8 Impaksi 18-May-15 Gigi&Mulut 50,000 - 579,150 286,000 915,150
3208 M.Rasyied A 838382 3967/ Scizoprenia 18-May-15 Syaraf 50,000 - 997,700 1,047,700
3209 Putra Giat 838368 3908/ Kontrol 18-May-15 Syaraf 50,000 - 997,700 1,047,700
3210 Darmadi 645791 2643/ Bph 18-May-15 Urologi 50,000 35,000 335,000 251,900 125,400 797,300
3211 Vinsensia A 838366 3673/ Kontrol 18-May-15 Kandungan 50,000 - 60,000 305,000 415,000
3212 Ndari 838361 3805/ G5P4A0 Dg 18-May-15 Kandungan 50,000 - 120,500 305,000 475,500
3213 Herlia 838380 3720/ Hernia Femu 18-May-15 Bedah Umum 50,000 - 87,500 125,400 262,900
3214 M.Ulil Aeid 466184 3968/ Kontrol 18-May-15 Gigi&Mulut 50,000 - 160,600 210,600
3215 Rafasya Zid 829917 3643/ Hidrokel T 18-May-15 Bedah Anak 50,000 - 701,550 105,600 857,150
3216 Zahirah Nu 838353 2658/ C3Elah Pal 18-May-15 Gigi & Mulut 50,000 - 579,150 105,600 734,750
3217 Krisyanti El 805101 3401/JK Tu Mamae S 18-May-15 Bedah Umum 50,000 35,000 33,000 118,000
3218 Zainab Utam 765467 3464/ Dm 18-May-15 Penyakit Dala 50,000 - 110,250 160,250
3219 Zakiah 811672 3567/ Kontrol 18-May-15 Penyakit Dala 50,000 - 498,800 548,800
3220 Sri Suharnin 829370 3674/ G2P1A0+Ht 18-May-15 Kandungan 50,000 - 120,500 44,250 214,750
3221 Sri Hendriya 821552 3878/ Kontrol 18-May-15 Onkologi 50,000 - 525,250 575,250
3222 Salsa 838372 3923/ Tonsilitis K 18-May-15 Tht 50,000 - 295,150 345,150
3223 Nurlinda 434340 3699/ Ht Gr Ii 18-May-15 Peny.Dalam 50,000 - 396,500 446,500
3224 Rahimah 569991 3564/ Leukimia 18-May-15 Peny.Dalam 50,000 - 76,250 126,250
3225 Marhamah 832464 3703/ Snnt+Ht 18-May-15 Penyakit Dala 50,000 - 352,100 402,100
3226 Muchlis 744398 3612/ Kontrol 18-May-15 Penyakit Dala 50,000 - 102,250 152,250
3227 Murni Asih 361477 3447/ Dm Tipe Ii 18-May-15 Penyakit Dala 50,000 - 110,250 160,250
3228 Musrifah 145616 3550/ Dm 18-May-15 Dalam 50,000 - 110,250 160,250
3229 Karyani 453416 3638/ Dm 18-May-15 Peny.Dalam 50,000 - 110,250 160,250
3230 Iwan Sunart 771568 3538/ Ckd 18-May-15 Penyakit Dala 50,000 - 142,250 192,250
3231 Ijum 775736 2446/ Cek Lab 18-May-15 Laboratorium 50,000 - 110,250 160,250
3232 Ardiansyah 726433 2510/ Cek Lab 18-May-15 Laboratorium 50,000 - 500,250 550,250
3233 Siti Ma'Ani 796017 3651/ Kontrol 18-May-15 Kandungan+Pa 50,000 35,000 60,000 1,119,800 1,264,800
3234 Siti Maimun 822088 3593/ Terapi 18-May-15 R.Medik 50,000 35,000 71,500 110,250 266,750
3235 Suhendro 834271 3789/ Kontrol 18-May-15 Peny.Dalam 50,000 105,000 262,400 187,000 604,400
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3236 Rita Susanti 457348 2612/ Cek Lab 18-May-15 Laboratorium 50,000 - 209,250 259,250
3237 M.Abdul Jal 769111 3953/ Undensus Te 18-May-15 Bedah Anak 50,000 - 353,400 403,400
3238 Wahdiah 658140 3476/ Ht 18-May-15 Penyakit Dala 50,000 - 609,500 659,500
3239 Valetta Qelo 838377 3938/ Caries 18-May-15 Gigi&Mulut 50,000 - 50,000
3240 Sayyid M. A 525533 3584/ 56 18-May-15 Gigi&Mulut 50,000 - 50,000
3241 S Jiwanto 332814 3790/ Kontrol 18-May-15 Jantung 50,000 - 462,500 512,500
3242 Siti Sarah 838387 2717/ G2P1A0 Kel 18-May-15 Kandungan 50,000 - 360,000 410,000
3243 M. Munif 730078 3418/ Post Op Fr T 18-May-15 Orthopedi 50,000 - 50,000
3244 Wiwin 430340 2581/ Kontrol 18-May-15 Tht 50,000 - 112,500 162,500
3245 Sonia Pratiw 841987 2659/ Oma 18-May-15 Tht 50,000 - 63,000 113,000
3246 Rasya Arpen 838389 2733/ Telinga Ber 18-May-15 Tht 50,000 - 50,000
3247 Akmal Huze 829553 3653/ Kontrol 18-May-15 Tht 50,000 - 50,000
3248 Kastini 837650 3787/ Kontrol 18-May-15 Jantung+Dala 50,000 - 50,000
3249 Kasno 686525 2614/ Cad 18-May-15 Jantung 50,000 - 50,000
3250 Amiruddin 828259 3803/ Kontrol 18-May-15 Urologi 50,000 - 50,000
3251 Suriansyah 483367 3684/ Hil D 18-May-15 Bedah Umum 50,000 35,000 85,000
3252 Anisa Ariati 838375 2434/ Susp Tu Col 18-May-15 Onkologi 50,000 - 50,000
3253 Sumiaty 838345 2465/ Abses 18-May-15 Bedah Umum 50,000 35,000 85,000
3254 Savira Hern 835357 3786/ Veruka 18-May-15 Bedah Anak 50,000 - 79,500 129,500
3255 Siti Mukar 810150 3832/ Kontrol 18-May-15 Bedah Anak 50,000 - 67,900 117,900
3256 M.Yusuf 721770 3952/ Undensus Te 18-May-15 Bedah Anak 50,000 - 50,000
3257 M. Rifqi Ra 835541 3480/ Hssr 18-May-15 Bedah Anak 50,000 - 50,000
3258 Juwariyah 834558 3696/ Dm 18-May-15 Peny.Dalam 50,000 - 402,500 452,500
3259 Iqbal Irfans 499512 3850/ Obs Vomitin 18-May-15 Peny.Dalam 50,000 - 50,000
3260 Khummayra 838386 3750/ Obs Febris 18-May-15 Anak 50,000 - 50,000
3261 Zihan Anisa 841993 3969/ Gea Dehidra 18-May-15 Anak 50,000 - 50,000
3262 Fatimah M. 835968 3583/ V V 18-May-15 Gigi&Mulut 50,000 - 272,703 322,703
3263 Christin Nat 634732 3553/ Dequervan 18-May-15 Orthopedi 50,000 - 80,000 130,000
3264 Ira Puspa Sa 838352 2567/ G1 P0 A0 D 18-May-15 Mata +Kandun 50,000 35,000 180,500 265,500
3265 Nico Mangu 784719 3561/ Katarak 18-May-15 Mata 50,000 - 60,000 110,000
3266 Rusman 712967 2732/ Lbp 18-May-15 Syaraf 50,000 - 50,000
3267 Budiyono 842096 2673/ Kontrol 18-May-15 Saraf 50,000 - 50,000
3268 Kusmiyatun 586812 2720/ Snh 18-May-15 Syaraf 50,000 - 50,000
3269 Boyadi 838390 2734/ Digigit Mon 18-May-15 Syaraf 50,000 - 50,000
3270 Anifarwati 815476 3491/ Tu Mamae 18-May-15 Onkologi 50,000 - 50,000
3271 Siti Salma 781893 3760/ Ca Mamae 18-May-15 Onkologi 50,000 - 50,000
3272 Suriansyah 835823 3566/ Lipoma 18-May-15 Bedah Umum 50,000 - 50,000
3273 Beti Lestari 695645 2657/ Kontrol 18-May-15 Bedah Umum 50,000 - 125,000 175,000
3274 Marzuki 835310 3554/ Nail Infecti 18-May-15 Bedah Umum 50,000 - 125,000 175,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3275 Siti Fatimah 828538 3598/ Post Op App 18-May-15 Bedah Umum 50,000 - 125,000 175,000
3276 Syamsuddin 835595 3671/ Kontrol 18-May-15 Bedah Umum 50,000 - 50,000
3277 Parpunguan 838320 3835/ Lipoma 18-May-15 Bedah Umum 50,000 35,000 187,000 272,000
3278 Fitri Sahwa 574382 3714/ Kontrol 18-May-15 Bedah Umum 50,000 - 125,000 175,000
3279 Maksum 841192 3951/ Post Op 18-May-15 Bedah Umum 50,000 - 125,000 175,000
3280 Malwa Suha 690379 2570/ Post Coital 18-May-15 Kandungan 50,000 - 60,000 110,000
3281 Susanti 380487 2554/ G4 P3 A0 Dn 18-May-15 Kandungan 50,000 - 60,000 110,000
3282 Tenri Dian 838347 2431/ G4 P2 Ai Dn 18-May-15 Kandungan 50,000 - 420,000 470,000
3283 Indra Suryad
838114 /8359662447/ Ht 18-May-15 Jantung 50,000 - 462,500 512,500
3284 Afriadi Les 835382 3681/ S/ Pneumon 18-May-15 Paru 50,000 - 50,000
3285 Andi Heru B 838333 3630/ Ginggivitis 18-May-15 Gigi&Mulut 50,000 - 347,490 397,490
3286 Abd Salam 364953 3698/ Post Op Tur 18-May-15 Urologi 50,000 - 50,000
3287 Viknatul Lei 829364 3906/ Terapi 18-May-15 R.Medik 50,000 - 71,500 121,500
3288 Mochsin Hb 410398 2480/ Terapi 18-May-15 Rehab Medis 50,000 - 159,500 209,500
3289 Rohanah 522050 2701/ Terapi 18-May-15 R Medik 50,000 - 71,500 121,500
3290 Sukarti 835988 2491/ Terapi 18-May-15 R Medik 50,000 - 71,500 121,500
3291 Diah Ratna 475501 3705/ Post Cf Clav 18-May-15 Orthopedi 50,000 - 71,500 121,500
3292 Ramlah Has 619115 2566/ Terapi 18-May-15 R Medik 50,000 - 71,500 121,500
3293 Aisyah Uzm 796280 2463/ Fisiotherapy 18-May-15 Rhb Medis 50,000 - 440,000 490,000
3294 Izni Almadi 835545 3697/ Terapi 18-May-15 R.Medik 50,000 - 379,500 429,500
3295 Shannaz Dw 677115 2449/ Fisiotherapy 18-May-15 R. Medik 50,000 - 440,000 490,000
3296 Andhara Aul 613425 2461/ Fisiotherapy 18-May-15 R Medik 50,000 - 440,000 490,000
3297 Danang Zak 726353 3549/ Terapi 18-May-15 R.Medik 50,000 - 440,000 490,000
3298 Ahmad Khoi 671879 3359/ Fisioterapi 18-May-15 Rehab Medik 50,000 - 440,000 490,000
3299 Rahmatulla 462170 2462/ Terapi 18-May-15 Rehab Medis 50,000 - 440,000 490,000
3300 M. Atallah 607935 2450/ Fisiotherapy 18-May-15 R Medik 50,000 - 440,000 490,000
3301 Cantika An 757599 2494/ Terapi 18-May-15 Rhb Medis 50,000 - 440,000 490,000
3302 M. Rizky R 828577 3345/ Ot+Tw 18-May-15 Rehab Medik 50,000 - 379,500 429,500
3303 Salamah 748488 3371/ Fisioterapi 18-May-15 Rehab Medik 50,000 - 440,000 490,000
3304 Winona 337477 3955/ Terapi 18-May-15 R.Medik 50,000 - 71,500 121,500
3305 Asnawati 597952 2627/ Terapi 18-May-15 R Medik 50,000 - 71,500 121,500
3306 Rey Tanizar 817073 3834/ Terapi 18-May-15 R.Medik 50,000 - 71,500 121,500
3307 Herlinda Yu 805100 2448/ Terapi 18-May-15 Rehab Medis 50,000 - 71,500 121,500
3308 M. Sandy 677507 3387/ Fisioterapi 18-May-15 Rehab Medik 50,000 - 440,000 490,000
3309 Surya Mangi 541180 2495/ Terapi 18-May-15 Rhb Medis 50,000 - 440,000 490,000
3310 Nasywa Qon 706135 2464/ Terapi 18-May-15 R Medis 50,000 - 440,000 490,000
3311 Gimun 695987 3595/ Fisioterapi 18-May-15 R.Medik 50,000 - 440,000 490,000
3312 Ponijem 659169 2492/ Fisiotherapy 18-May-15 Rehab Medis 50,000 - 379,500 429,500
3313 Raudah 826607 3388/ Terapi 18-May-15 Rehab Medik 50,000 - 220,000 270,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3314 Karsuni 825954 3389/ Terapi 18-May-15 Rehab Medik 50,000 - 220,000 270,000
3315 Kusnan 721341 3372/ Terapi 18-May-15 Rehab Medik 50,000 - 440,000 490,000
3316 Hasnawati 762606 3356/ Terapi 18-May-15 Rehab Medik 50,000 - 440,000 490,000
3317 Bandi Batha 738114 2748/ Terapi 18-May-15 R Medik 50,000 - 231,000 281,000
3318 Siti Fatimah 387828 3804/ Ht 18-May-15 Jantung 50,000 35,000 159,500 244,500
3319 Subeli 238930 2689/ Fisiotherapy 18-May-15 Rhb Medis 50,000 - 71,500 121,500
3320 Sumiaty 429003 2690/ Fisiotherapy 18-May-15 R Medis 50,000 - 71,500 121,500
3321 Erniwati 443296 3746/ Terapi 18-May-15 Rehab Medik 50,000 - 71,500 121,500
3322 Dewi Kartik 824703 2702/ Terapi 18-May-15 R.Medik 50,000 - 159,500 209,500
3323 Hamdanah 563909 3420/ Terapi 18-May-15 Rehab Medik 50,000 - 220,000 270,000
3324 Musningsih 549641 3636/ Terapi 18-May-15 R.Medik 50,000 - 220,000 270,000
3325 Rusmini 607352 2537/ Terapi 18-May-15 R Medis 50,000 - 220,000 270,000
3326 Rabiatul Ad 602715 3655/ Terapi 18-May-15 R.Medik 50,000 - 220,000 270,000
3327 Marsidi 720910 2522/ Terapi 18-May-15 R Medis 50,000 - 159,500 209,500
3328 Turyatman 528172 3432/ Terapi 18-May-15 Rehab Medik 50,000 - 159,500 209,500
3329 Supatmi 805133 2521/ Terapi 18-May-15 Rehab Medis 50,000 - 159,500 209,500
3330 Suparti 487344 2506/ Terapi 18-May-15 R Medik 50,000 - 71,500 121,500
3331 Kamsiah 835917 3435/ Terapi 18-May-15 Rehab Medik 50,000 - 159,500 209,500
3332 Hj.Ernawati 710875 3548/ Terapi 18-May-15 R.Medik 50,000 - 159,500 209,500
3333 Sumiati 671273 3419/ Terapi 18-May-15 Rehab Medik 50,000 - 71,500 121,500
3334 Suryanti 720793 2509/ Fisioterapi 18-May-15 Rehab Medis 50,000 - 159,500 209,500
3335 Nelly 598921 3576/ Terapi 18-May-15 R.Medik 50,000 - 159,500 209,500
3336 Aswin 598995 3577/ Terapi 18-May-15 R.Medik 50,000 - 71,500 121,500
3337 Siti Rahmah 742670 3386/ Fisioterapi 18-May-15 Rehab Medik 50,000 - 71,500 121,500
3338 Tinna 821536 3360/ Terapi 18-May-15 Rehab Medik 50,000 - 71,500 121,500
3339 Sadariah 419296 3591/ Fisioterapi 18-May-15 Rehab Medis 50,000 - 71,500 121,500
3340 Rudiansyah 424444 3358/ Terapi 18-May-15 Rehab Medik 50,000 - 71,500 121,500
3341 Elisabeth E 492673 3621/ Terapi 18-May-15 R.Medik 50,000 - 159,500 209,500
3342 Saleh Samit 838301 3610/ Terapi 18-May-15 R.Medik 50,000 - 159,500 209,500
3343 Aisyah 734989 3625/ Fisioterapi 18-May-15 R.Medik 50,000 - 71,500 121,500
3344 Hemi 835300 3585/ Terapi 18-May-15 Rehab Medik 50,000 - 71,500 121,500
3345 Erni Setiawa 132775 2551/ Terapi 18-May-15 Rehab Medis 50,000 - 71,500 121,500
3346 Rubiyanti 839552 2508/ Terapi 18-May-15 R Medik 50,000 - 71,500 121,500
3347 Sarman 759016 3479/ Fisioterapi 18-May-15 Rehab Medik 50,000 - 71,500 121,500
3348 Darsiah 740936 3715/ Terapi 18-May-15 R.Medik 50,000 - 71,500 121,500
3349 Indrawati 680655 2584/ Terapi 18-May-15 Rehab Medis 50,000 - 71,500 121,500
3350 Siti Murni 687026 3759/ Terapi 18-May-15 R.Medik 50,000 - 71,500 121,500
3351 Ngatemi 565526 3539/ Terapi 18-May-15 Rehab Medik 50,000 - 71,500 121,500
3352 Jariah 676633 2598/ Fisioterapi 18-May-15 Rhb Medis 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3353 Iskandar 077736 3637/ Terapi 18-May-15 R.Medik 50,000 - 159,500 209,500
3354 Nurdin Doni 712854 3461/ Fisioterapi 18-May-15 Rehab Medik 50,000 - 159,500 209,500
3355 Karmidi 619224 3667/ Terapi 18-May-15 R.Medik 50,000 - 71,500 121,500
3356 Kasmijan 829312 3802/ Terapi 18-May-15 R.Medik 50,000 - 71,500 121,500
3357 Elisa Marsi 534269 2600/ Terapi 18-May-15 R Medik 50,000 - 71,500 121,500
3358 Suharti Eric 537870 3494/ Terapi 18-May-15 Rehab Medik 50,000 - 71,500 121,500
3359 Asmi 461341 3592/ Terapi 18-May-15 R.Medik 50,000 - 159,500 209,500
3360 Suyanto 445829 2536/ Fisioterapi 18-May-15 R Medis 50,000 - 159,500 209,500
3361 Kisnan 431632 2538/ Terapi 18-May-15 Rehab Medis 50,000 - 159,500 209,500
3362 Matrup 345802 3417/ Fisioterapi 18-May-15 Rehab Medik 50,000 - 159,500 209,500
3363 Erna Samun 569637 3431/ Terapi 18-May-15 Rehab Medik 50,000 - 159,500 209,500
3364 Amanat Lail 828568 3623/ Terapi 18-May-15 R.Medik 50,000 - 159,500 209,500
3365 Sri Kuswati 834801 3639/ Terapi 18-May-15 R.Medik 50,000 - 159,500 209,500
3366 Tutik Rahay 742172 2477/ Terapi 18-May-15 R Medik 50,000 - 220,000 270,000
3367 Nurhayati 825912 3551/ Terapi 18-May-15 Rehab Medik 50,000 - 71,500 121,500
3368 Kasdi 834604 3622/ Terapi 18-May-15 R.Medik 50,000 - 159,500 209,500
3369 Istiyah 835919 3801/ Terapi 18-May-15 R.Medik 50,000 - 71,500 121,500
3370 H.Syamsudd 775795 3772/ Sinusitis 18-May-15 R.Medik 50,000 - 220,000 270,000
3371 Merry Taby 314620 3594/ Terapi 18-May-15 R.Medik 50,000 - 220,000 270,000
3372 Rusdiana 806016 3405/ Terapi 18-May-15 Rehab Medik 50,000 - 220,000 270,000
3373 Donatinus S 811513 3744/ Kontrol 18-May-15 Rehab Medik+ 50,000 - 159,500 209,500
3374 Abdul Nurdi 464739 3578/ Fisioterapi 18-May-15 R.Medik 50,000 - 440,000 490,000
3375 Imam M. Sh 190433 3373/ Terapi 18-May-15 Rehab Medik 50,000 - 440,000 490,000
3376 Sugianto Ru 487872 3609/ Terapi 18-May-15 R.Medik 50,000 - 440,000 490,000
3377 M.Santri Ka 810571 2493/ Ulkus D 18-May-15 Penyakit Dala 50,000 - 18,381 68,381
3378 Mariyam 839908 2884/ 8 Gp Pulpa 19-May-15 Gigi & Mulut 50,000 35,000 3,848,276 241,250 160,600 144,689 4,479,815
3379 Mahrita 834539 3806/ Terapi+Lbp 19-May-15 R.medik 50,000 35,000 159,500 12,289 256,789
3380 Isnawati 840628 4137/ Pjr 19-May-15 Jantung 50,000 35,000 32,700 117,700
3381 Tan Lan Tju 810556 4121/ Kontrol 19-May-15 Syaraf 50,000 - 28,334 78,334
3382 Nur Janah 532108 4103/ Kontrol 19-May-15 R.medik 50,000 70,000 241,500 20,784 382,284
3383 Bahtiar 839920 4402/ Kontrol 19-May-15 P. Dalam 50,000 35,000 500,250 187,000 247,653 1,019,903
3384 M.Nasir 594648 4179/ Kontrol 19-May-15 Syaraf 50,000 35,000 71,500 18,879 175,379
3385 Suparmi 532171 4180/ Kontrol 19-May-15 Syaraf 50,000 35,000 71,500 214,538 371,038
3386 Patima 351685 4109/ Susp Hnp 19-May-15 Syaraf 50,000 - 10,279 60,279
3387 Jumatul Has 651782 4446/ Sinusitis 19-May-15 Tht 50,000 - 105,600 11,700 167,300
3388 Nurjaati 795415 4047/ 6 Gr 19-May-15 Gigi&Mulut 50,000 - 286,000 13,593 349,593
3389 Eva Kusliya 354456 4091/ Epilepsi 19-May-15 Syaraf 50,000 - 105,654 155,654
3390 Mirna 835946 4357/ Kontrol 19-May-15 Kandungan 50,000 - 120,500 3,788 174,288
3391 Norma 839915 4341/ Dm 19-May-15 P. Dalam 50,000 35,000 543,500 166,479 794,979
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3392 Hamiah 801794 4048/ Cephalgia 19-May-15 Syaraf 50,000 - 207,900 10,279 268,179
3393 Aditia Saput 638973 3960/ Vsd 19-May-15 Syaraf 50,000 35,000 139,100 11,649 235,749
3394 Ilansyah 472824 4343/ Post Snh 19-May-15 Syaraf 50,000 - 352,250 997,700 8,888 1,408,838
3395 Harry Ilfant 839902 2838/ Gangguan M 19-May-15 Syaraf 50,000 - 355,000 85,388 490,388
3396 Richi Budi 839904 2851/ Perut Kemb 19-May-15 Anak 50,000 - 62,715 112,715
3397 Romelan 730001 3914/ Decomp Cor 19-May-15 Jantung 50,000 - 45,450 95,450
3398 Ananda Tria 721481 4375/ Tb Paru 19-May-15 Anak 50,000 - 72,238 122,238
3399 Syafrudin Ch 647395 4029/ Kontrol 19-May-15 Jantung+Tht 50,000 35,000 72,219 157,219
3400 Adisti Marta 730876 4390/ S/ Dispepsia 19-May-15 P. Dalam 50,000 - 457,800 18,388 526,188
3401 Suriansyah 468561 3763/ Nhl 19-May-15 Syaraf 50,000 35,000 150,421 235,421
3402 Iza Rakli Ap 835939 4434/ Post Orif 19-May-15 Ortophedi 50,000 - 4,300 54,300
3403 Rey Tanizar 817073 2810/ Kontrol 19-May-15 Ortophedi 50,000 - 21,675 71,675
3404 Ahmad Khoi 781499 4476/ Tb Kelenjar 19-May-15 Bedah Umum 50,000 - 103,950 153,950
3405 Nur Syifa 691472 4342/ Kontrol 19-May-15 Anak 50,000 - 352,100 4,005 406,105
3406 Fariyani 689427 3942/ Chf 19-May-15 Jantung 50,000 - 633,950 87,810 771,760
3407 Eko Winarsi 838399 4207/ Rinitis Alerg 19-May-15 Tht 50,000 - 295,150 105,600 10,713 461,463
3408 Jariyah 775188 4330/ Kontrol 19-May-15 Jantung 50,000 - 224,000 649,500 302,138 1,225,638
3409 Khuswatul 467668 4312/ Epilepsi 19-May-15 Syaraf 50,000 - 107,138 157,138
3410 Miftahul Ja 615499 4003/ Myalgia 19-May-15 Syaraf 50,000 - 10,279 60,279
3411 Hj.Raniah 741112 4420/ Iscialgia 19-May-15 Syaraf 50,000 - 227,700 10,633 288,333
3412 M.Dennis M 811627 3896/ Limfadeniti 19-May-15 Anak 50,000 - 63,675 113,675
3413 Maita Ratna 839927 4465/ Lbp 19-May-15 Syaraf 50,000 - 14,629 64,629
3414 Yenni Purwa 631789 4080/ Terapi 19-May-15 Syaraf 50,000 - 10,595 60,595
3415 Arifiyanti 764139 2806/ Kontrol 19-May-15 Kandungan 50,000 - 120,500 2,604 173,104
3416 Rusdi 812285 2898/ Kontrol 19-May-15 Ortophedi 50,000 - 80,000 26,783 156,783
3417 Nursiah 706603 3927/ Cephalgia 19-May-15 Syaraf 50,000 - 333,300 18,824 402,124
3418 M. Alby 556376 4063/ Epilepsi 19-May-15 B. Syaraf 50,000 - 237,490 287,490
3419 Subariah 637874 2837/ Post Strouk 19-May-15 Syaraf 50,000 - 48,941 98,941
3420 Lissanti 095073 2839/ Hipertiroid 19-May-15 P. Dalam 50,000 - 27,975 77,975
3421 Yuliani 285668 4075/ Cts+Terapi 19-May-15 Syaraf 50,000 - 34,895 84,895
3422 Paridah 646528 4360/ Hnp 19-May-15 Syaraf 50,000 - 15,568 65,568
3423 Mashudi Wi 510618 4253/ Kontrol 19-May-15 Ortophedi 50,000 - 160,000 4,413 214,413
3424 Susilowati 786745 3821/ Vitiligo 19-May-15 Kulit Kelamin 50,000 - 12,801 62,801
3425 Zainab Utam 765467 3778/ Ht 19-May-15 P. Dalam 50,000 - 16,075 66,075
3426 Nurlinda 434340 4043/ Ht Gr Ii 19-May-15 P. Dalam 50,000 - 9,788 59,788
3427 Ali Nursyaf 674563 3776/ Ht Gr Ii 19-May-15 P. Dalam 50,000 - 81,113 131,113
3428 Mirah 142607 4139/ Terapi 19-May-15 R.medik 50,000 70,000 534,400 8,673 663,073
3429 Suharti 776816 4001/ Decomp Cor 19-May-15 Jantung 50,000 - 57,663 107,663
3430 Kamba 823138 2807/ Fisioterapi 19-May-15 R.medik 50,000 35,000 71,500 24,659 181,159
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3431 Rahmat 832273 4356/ Kontrol 19-May-15 Syaraf 50,000 - 291,929 341,929
3432 Norpiani 839939 4107/ Ht 19-May-15 Jantung 50,000 - 649,500 156,029 855,529
3433 Melly Asyla 839930 4462/ Kontrol 19-May-15 Anak 50,000 - 6,071 56,071
3434 Wiwin Susan 839936 4078/ Gp 19-May-15 Gigi&Mulut 50,000 - 579,150 286,000 1,588 916,738
3435 Lehana 839924 4035/ Kista Uteri 19-May-15 Kandungan 50,000 - 60,000 125,400 56,229 291,629
3436 Adityatama 335533 4153/ Obs Dispeps 19-May-15 Anak 50,000 - 87,500 305,000 1,381 443,881
3437 M.Luqman S 838300 4416/ S/ 112 19-May-15 P. Dalam 50,000 35,000 633 85,633
3438 Asliansyah 591446 4017/ Terapi+Hnp 19-May-15 R.Medik+Syar 50,000 35,000 159,500 11,240 255,740
3439 Sumiyat 821102 4071/ Kontrol 19-May-15 R.Medik+Sara 50,000 35,000 159,500 15,229 259,729
3440 Rusma Santi 839926 4046/ 8 Impaksi 19-May-15 Gigi&Mulut 50,000 - 160,600 7,350 217,950
3441 Supriatin 839935 4076/ Susp Ovari 19-May-15 Kandungan 50,000 35,000 60,000 305,000 2,050 452,050
3442 Nani 683573 4092/ Dispesia+O 19-May-15 P. Dalam 50,000 - 49,456 99,456
3443 Rahmi Yanti 839940 4125/ Gravid 7 Hri 19-May-15 Kulit Kelamin 50,000 - 1,063 51,063
3444 Slamet 693234 3911/ Vertigo 19-May-15 Syaraf 50,000 - 18,634 68,634
3445 Hairunnisa 268925 4045/ Dm Ii 19-May-15 P. Dalam 50,000 - 21,319 71,319
3446 Nawiyah 494525 4065/ Snh 19-May-15 Syaraf 50,000 - 15,371 65,371
3447 Wardah 262093 4124/ G6P5+Ansie 19-May-15 Kandungan 50,000 35,000 60,000 187,000 104,129 436,129
3448 Ronny Hern 809381 2777/ Post Struke 19-May-15 Syaraf 50,000 - 16,924 66,924
3449 Nur Khasan 839929 2911/ Abses 19-May-15 Bedah Umum 50,000 - 15,715 65,715
3450 Ratna 821500 3866/ Fisioterapi 19-May-15 R.medik 50,000 35,000 159,500 10,595 255,095
3451 Rusdiah 835916 2836/ Nyeri Pung 19-May-15 Syaraf 50,000 - 10,933 60,933
3452 Widya Astut 839932 2926/ Kontrol 19-May-15 Mata 50,000 - 16,938 66,938
3453 Rayhan Octa 727424 4077/ Epilepsi 19-May-15 Anak 50,000 - 104,500 154,500
3454 Sri Suharnin 829370 4311/ G2P1A0 19-May-15 Kandungan 50,000 - 120,500 305,000 3,000 478,500
3455 M.Yunan 246666 4461/ Pjk 19-May-15 Jantung 50,000 - 94,523 144,523
3456 Abdul Rahm 641669 4206/ Lbp 19-May-15 Syaraf 50,000 - 15,566 65,566
3457 Amelia 589386 3928/ Susp Limfad 19-May-15 Paru 50,000 - 160,250 125,400 18,563 354,213
3458 Suparti 870748 4268/ Kontrol 19-May-15 P. Dalam 50,000 35,000 117,100 780,200 24,575 1,006,875
3459 Andi Laiya 769035 4372/ Chf 19-May-15 Jantung 50,000 - 231,560 281,560
3460 Usfa Zazkia 839937 4079/ Gatal2 19-May-15 Kulit Kelamin 50,000 - 31,635 81,635
3461 Tri Wahyuni 763772 4374/ Aff Iud 19-May-15 Kandungan 50,000 - 451,500 633 502,133
3462 Oktariani 839938 4095/ Tonsilitis K 19-May-15 Tht 50,000 - 295,150 8,925 354,075
3463 M.Untung B 826529 4148/ Kontrol 19-May-15 B. Syaraf 50,000 70,000 220,000 46,873 386,873
3464 Sinem 558073 4105/ Dm Ht 19-May-15 P. Dalam 50,000 35,000 212,354 297,354
3465 Rofi Amati 729712 3867/ 48 Pulpitis 19-May-15 Gigi&Mulut 50,000 - 3,848,276 160,600 13,675 4,072,551
3466 Sudarti 828917 4108/ Kontrol +Te 19-May-15 R.medis 50,000 35,000 71,500 177,000 7,910 341,410
3467 Milawati 700100 3870/ Lbp 19-May-15 Orthopedi 50,000 - 160,000 7,975 217,975
3468 Nurhayati 522975 3926/ Acs 19-May-15 Jantung 50,000 - 40,300 90,300
3469 Abdul Raza 189913 3913/ Ht Gr I 19-May-15 Jantung 50,000 - 186,113 236,113
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3470 Mahmudah 839923 4417/ Dermatitis A 19-May-15 Kulit Kelamin 50,000 - 13,541 63,541
3471 Idrus 838398 3810/ Kontrol 19-May-15 Mata 50,000 - 60,000 58,530 168,530
3472 Yudi Gunars 725539 3983/ Dm 19-May-15 P. Dalam 50,000 - 16,013 66,013
3473 Istika 834278 4146/ Tu Colli 19-May-15 Bedah Umum 50,000 - 1,900 51,900
3474 Ijum 775736 4027/ Kontrol 19-May-15 P. Dalam 50,000 - 50,031 100,031
3475 Said 607938 2776/ Kontrol 19-May-15 Jantung 50,000 - 186,700 236,700
3476 H. Zaeni 469838 3794/ Dyspepsia 19-May-15 P. Dalam 50,000 - 300,500 34,194 384,694
3477 Nuril 630333 4089/ Kontrol 19-May-15 Orthopedi 50,000 - 8,088 58,088
3478 Kadimun 656538 4119/ Cad 19-May-15 Jantung 50,000 - 302,363 352,363
3479 Musrifah 145616 4028/ Dm 19-May-15 P. Dalam 50,000 - 161,625 211,625
3480 Murni Asih 361477 3765/ Dm Tipe Ii 19-May-15 P. Dalam 50,000 - 101,356 151,356
3481 Adiman 838392 2778/ Kontrol 19-May-15 Orthopedi 50,000 - 227,700 11,744 289,444
3482 Idham 841876 3807/ Susp Hep 19-May-15 P. Dalam 50,000 - 280,400 3,725 334,125
3483 Jansen Rapa 671347 2765/ Konstipasi 19-May-15 P. Dalam 50,000 - 17,119 67,119
3484 Purwasih 841448 2793/ Kontrol 19-May-15 P. Dalam 50,000 - 128,400 178,400
3485 Rajidin 821567 3900/ Tonsilitis K 19-May-15 Tht 50,000 - 5,400 55,400
3486 Edy Susanto 757608 4240/ Pjk 19-May-15 Jantung 50,000 - 327,188 377,188
3487 Mustofa 640054 3882/ Bph 19-May-15 Urologi 50,000 - 139,175 189,175
3488 Dahliana 524534 3897/ Ht 19-May-15 Jantung 50,000 - 32,288 82,288
3489 Jawi Tanur 674530 3885/ Anemia+Ht 19-May-15 P. Dalam 50,000 - 35,206 85,206
3490 Musinah 663427 4005/ Pjk 19-May-15 Jantung 50,000 - 37,650 87,650
3491 Aspiansyah 797010 2870/ Omsk Ad 19-May-15 Tht 50,000 - 310,500 10,413 370,913
3492 Sujitno 835911 4403/ Skoliosis 19-May-15 Ortophedi 50,000 - 10,406 60,406
3493 Susmiro 839913 3944/ Susp Otitis 19-May-15 Tht 50,000 - 11,700 61,700
3494 Ibnu Hajar 837356 4358/ Kontrol 19-May-15 Bedah Umum 50,000 - 125,000 12,325 187,325
3495 Tri Mailani 806796 4059/ Epilepsi 19-May-15 Syaraf 50,000 - 19,118 69,118
3496 Rudianto 830814 4387/ Kontrol 19-May-15 P. Dalam 50,000 - 5,313 55,313
3497 Zakiah 811672 3959/ Tyroid 19-May-15 P. Dalam 50,000 - 15,938 65,938
3498 Ghina Nafis 294444 3824/ Epilepsi 19-May-15 Syaraf 50,000 - 158,550 208,550
3499 Darwis 841629 4326/ Kontrol 19-May-15 Bedah Umum 50,000 - 125,000 12,325 187,325
3500 Erifadin Sab 775537 3989/ Dm 19-May-15 P. Dalam 50,000 - 128,513 178,513
3501 Ngatemi 565526 4134/ Kontrol 19-May-15 Syaraf 50,000 - 20,574 70,574
3502 Eriani Susan 623765 4118/ Cepalgia 19-May-15 Syaraf 50,000 - 24,030 74,030
3503 Nora Amelia 838394 3777/ S/ Tb 19-May-15 Anak 50,000 - 4,305 54,305
3504 Amanah 480979 4238/ Ht 19-May-15 P. Dalam 50,000 - 46,375 96,375
3505 Sripah 634302 4192/ Iscialgia 19-May-15 Syaraf 50,000 - 227,700 13,473 291,173
3506 M. Fadjrian 771353 3764/ Ft+Tw 19-May-15 R.Medik+Ana 50,000 35,000 104,692 189,692
3507 Narisca Auri 623600 4267/ Tonsilitis K 19-May-15 Tht 50,000 - 377,500 105,600 8,178 541,278
3508 M. Fuad Sid 659839 3929/ Susp Omsk 19-May-15 Tht 50,000 - 63,000 8,888 121,888
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3509 Daud Ngang 194499 3943/ Epilepsi 19-May-15 Bedah Syaraf 50,000 - 85,388 135,388
3510 Sri Mulyati 431246 4255/ Ht 19-May-15 Jantung 50,000 - 48,525 98,525
3511 M.Azka Ver 839928 4447/ Oma 19-May-15 Tht 50,000 - 2,324 52,324
3512 Rudi Herma 743463 2824/ Terapi 19-May-15 R.medis 50,000 70,000 159,500 198,463 477,963
3513 Wartini 838356 2914/ Dm 19-May-15 P. Dalam 50,000 - 14,881 64,881
3514 M Yusuf Md 763821 4026/ Kontrol 19-May-15 Urologi 50,000 - 335,000 137,213 522,213
3515 Sri Wahyuni 558975 3974/ Pud 19-May-15 Kandungan 50,000 - 60,000 3,000 113,000
3516 M.Ulil Aeid 466184 4389/ Kontrol 19-May-15 Gigi&Mulut 50,000 - 6,071 56,071
3517 Ngaliyem 318326 3840/ Ht 19-May-15 P. Dalam 50,000 35,000 335,000 176,250 17,525 613,775
3518 Asni 775111 4314/ S/ Bph 19-May-15 Urologi 50,000 - 335,000 137,213 522,213
3519 Sayid Muha 492689 4034/ Niddm 19-May-15 P. Dalam 50,000 - 21,569 71,569
3520 Musmulyadi 839933 4061/ Bsk 19-May-15 Urologi 50,000 - 335,000 66,000 745,800 1,963 1,198,763
3521 Likah Handa 791848 4386/ Hipertiroid 19-May-15 Jantung 50,000 - 24,900 74,900
3522 Joko Purwan 813533 4208/ Sinusitis 19-May-15 Tht 50,000 - 20,916 70,916
3523 Idarsiah 430638 4225/ Ulkus 19-May-15 P. Dalam 50,000 - 28,688 78,688
3524 Rini Darmaw839916 3971/ Dermatitis 19-May-15 Kulit Kelamin 50,000 - 4,613 54,613
3525 Murjiah 838395 4135/ Kontrol 19-May-15 Jantung 50,000 35,000 649,500 27,750 762,250
3526 Aulia Nur Y 835716 3915/ 11 21 19-May-15 Gigi&Mulut 50,000 - 93,115 12,006 155,121
3527 Rinjani 697307 4266/ Kontrol 19-May-15 Jantung 50,000 - 72,731 122,731
3528 Wahida Fatm 188670 3941/ Hidrocephal 19-May-15 B. Syaraf 50,000 - 19,950 69,950
3529 Ratnawati 556263 4282/ Kontrol 19-May-15 Jantung 50,000 - 61,838 111,838
3530 Hoesine Ma 378820 4239/ Hnp 19-May-15 Syaraf 50,000 - 227,700 45,475 323,175
3531 Iis Hastuti 835363 3883/ Terapi 19-May-15 R.medik 50,000 70,000 71,500 15,566 207,066
3532 M.Fardiansy 831398 4104/ Epilepsi 19-May-15 Anak 50,000 - 4,003 54,003
3533 Khusnul Kh 826586 4086/ Dm Ii 19-May-15 P. Dalam 50,000 - 110,250 31,275 191,525
3534 Kasdi 834604 2763/ Kontrol 19-May-15 Orthopedy 50,000 - 11,256 61,256
3535 Aminah 644814 3854/ Acut Tonsili 19-May-15 Tht 50,000 - 9,338 59,338
3536 Wargie 678802 4193/ Pjk 19-May-15 Jantung 50,000 - 185,738 235,738
3537 Ardiansyah 726433 2762/ Dm 19-May-15 P. Dalam 50,000 - 67,730 117,730
3538 Rusdiana 817278 4133/ Dm 19-May-15 P. Dalam 50,000 - 31,736 81,736
3539 Atikah 806471 4042/ Kontrol 19-May-15 Tht 50,000 - 310,500 4,963 365,463
3540 Saenab 787582 2780/ Susp Chf 19-May-15 Jantung 50,000 - 280,750 330,750
3541 Hj.Maiseng 840167 4237/ Kontrol 19-May-15 Orthopedy 50,000 35,000 60,000 19,125 164,125
3542 Muhammad A765648 3988/ Hidrochepal 19-May-15 B. Syaraf 50,000 35,000 42,311 127,311
3543 M.Rahayu 185447 4270/ Chf 19-May-15 Jantung 50,000 - 161,588 211,588
3544 Maimunah 818398 3990/ Kontrol 19-May-15 Mata 50,000 - 25,053 75,053
3545 Ade Desia R 839912 4281/ Kontrol 19-May-15 Tht 50,000 - 22,491 72,491
3546 Abd Latif 445993 3881/ Kontrol 19-May-15 Jantung 50,000 35,000 3,824 88,824
3547 Sulaiman 808554 4283/ Ht 19-May-15 Jantung 50,000 - 183,113 233,113
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3548 Masrani 142848 4296/ Ht Dm 19-May-15 Jantung 50,000 - 71,363 121,363
3549 Zahra Putri 816567 2779/ Kontrol 19-May-15 P. Dalam 50,000 - 6,375 56,375
3550 Lindra Waty 676698 3984/ Lbp 19-May-15 Orthopedy 50,000 - 375,950 11,256 437,206
3551 Hj. Farida 833378 3851/ Kontrol 19-May-15 Jantung 50,000 - 42,319 92,319
3552 Susmiati 839900 2808/ Oma 19-May-15 Tht 50,000 - 9,238 59,238
3553 Budimansya 665681 4044/ Fr Femur 19-May-15 Orthopedy 50,000 - 80,000 26,038 156,038
3554 Supiyati 681778 4224/ Ht 19-May-15 Jantung 50,000 - 39,025 89,025
3555 Abdul Khair 780503 3780/ Terapi+Hnp 19-May-15 R.medik 50,000 35,000 71,500 14,247 170,747
3556 Warsidi 352853 4132/ Hipertiroid 19-May-15 P. Dalam 50,000 - 36,263 86,263
3557 Wahidah 478130 4090/ Ht 19-May-15 Jantung 50,000 - 37,463 87,463
3558 Siti Naidah 753347 4162/ Kontrol 19-May-15 Jantung 50,000 - 320,175 370,175
3559 Asmaran Ga 712196 4120/ Dm Ii 19-May-15 P. Dalam 50,000 - 164,375 214,375
3560 Barlian 840180 4328/ Hipoglikemi 19-May-15 P. Dalam 50,000 - 56,100 106,100
3561 Wijayanti 839925 4435/ Serumen 19-May-15 Tht 50,000 - 9,988 59,988
3562 Marhamah 832464 4344/ Snnt 19-May-15 P. Dalam 50,000 - 41,963 91,963
3563 Mahdalena 458621 4062/ Dm 19-May-15 P. Dalam 50,000 - 879,029 929,029
3564 Ramadan 516240 4064/ Kontrol 19-May-15 Orthopedi 50,000 - 8,931 58,931
3565 Hasmi 835908 4019/ Dm 19-May-15 P. Dalam 50,000 - 45,563 95,563
3566 Aliyah Purw 737784 2791/ Lbp 19-May-15 Syaraf 50,000 35,000 71,500 35,766 192,266
3567 Gutik Setiy 331686 4049/ Struma 19-May-15 P. Dalam 50,000 - 715,600 43,075 808,675
3568 M.Riski Agu 839934 4450/ S/ Tb Paru 19-May-15 Anak 50,000 35,000 19,441 104,441
3569 Rustaniah 797036 3852/ Susp Ra+Hn 19-May-15 Syaraf 50,000 - 16,821 66,821
3570 Fransisca M 838396 4164/ Struma 19-May-15 P. Dalam 50,000 35,000 428,350 187,000 4,455 704,805
3571 Sumarto 756435 4315/ Kontrol 19-May-15 Bedah 50,000 - 3,400 53,400
3572 Ilham Zakar 839903 2840/ Oma 19-May-15 Tht 50,000 - 8,584 58,584
3573 Juhani 841515 4373/ Kontrol 19-May-15 P. Dalam 50,000 - 551,338 601,338
3574 Huzway Aks 625669 3986/ Kontrol 19-May-15 Paru 50,000 - 125,400 30,356 205,756
3575 Murniah 822941 3987/ Limfadeniti 19-May-15 Paru 50,000 - 163,200 213,200
3576 Prawoto 810373 2900/ Kontrol 19-May-15 Orthopedy 50,000 - 160,000 25,563 235,563
3577 Cyndhanita 840774 4448/ Kontrol 19-May-15 B. Syaraf 50,000 - 15,881 65,881
3578 Sie Moij 610206 4418/ Pjk 19-May-15 Jantung 50,000 - 68,550 118,550
3579 Mukaram 790881 4131/ Ht 19-May-15 Jantung 50,000 - 523,250 12,563 585,813
3580 Anang Dj 729360 4254/ Pjk 19-May-15 Jantung 50,000 - 198,413 248,413
3581 Djaini 335210 4297/ Kontrol 19-May-15 Orthopedy 50,000 35,000 159,500 11,906 256,406
3582 St Halimah 494343 2823/ Hnp 19-May-15 Orthopedy 50,000 - 7,406 57,406
3583 Resmi Ms B 676749 3957/ Bph 19-May-15 Urologi 50,000 - 137,213 187,213
3584 Bahrudin 835566 4221/ S/ Dispepsia 19-May-15 P. Dalam 50,000 - 117,556 167,556
3585 Saniah 838344 2897/ Susp Apendic 19-May-15 Bedah Umum 50,000 35,000 485,250 7,238 577,488
3586 Asiah 821192 3762/ Dm 19-May-15 P. Dalam 50,000 - 110,250 160,250
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3587 Ati 633262 3823/ Hipertiroid 19-May-15 P. Dalam 50,000 - 498,800 548,800
3588 Barmi 838397 3809/ Lipoma 19-May-15 Bedah 50,000 - 394,150 377,500 353,100 1,174,750
3589 Sudjono 805105 4060/ Dm 19-May-15 P. Dalam 50,000 - 287,250 337,250
3590 Fadly Adria 839918 4004/ Abses+Ht 19-May-15 Bedah Umum 50,000 - 471,400 377,500 898,900
3591 Rohani Mok 801740 4300/ Tu Colli 19-May-15 Bedah Umum 50,000 35,000 352,100 187,000 624,100
3592 Karmila 839901 2821/ Tu Mamae 19-May-15 Bedah Umum 50,000 - 438,400 377,500 125,400 991,300
3593 Gusman 494639 3825/ Dm 19-May-15 P. Dalam 50,000 - 110,250 160,250
3594 Zulkifli 838134 3973/ Obs Dispneu 19-May-15 Vct 50,000 35,000 160,250 245,250
3595 Mochsin Hb 410398 3808/ Dm+Ht 19-May-15 P. Dalam 50,000 - 110,250 160,250
3596 Sumarni 835984 2792/ Obs Tumor 19-May-15 Kandungan 50,000 35,000 138,000 305,000 187,000 715,000
3597 Supiyah 549762 3779/ Susp Kista 19-May-15 Bedah Umum 50,000 - 394,150 125,400 569,550
3598 Wa Hari 816734 3869/ Kontrol 19-May-15 P. Dalam 50,000 - 110,250 160,250
3599 Suyat 821729 4058/ Kontrol 19-May-15 P. Dalam 50,000 - 43,250 93,250
3600 Syarifah Sa 596154 4177/ Kontrol 19-May-15 P. Dalam 50,000 - 186,500 236,500
3601 Hamdanah 790973 3791/ Stroke+Dm 19-May-15 P. Dalam 50,000 - 500,250 550,250
3602 Husni Fuad 594427 4163/ Dm Type Ii 19-May-15 P. Dalam 50,000 - 110,250 160,250
3603 Jonny 805137 4149/ Dm Ht 19-May-15 P. Dalam 50,000 - 110,250 160,250
3604 Naswa Febri 839911 3868/ Hemangiom 19-May-15 Anak 50,000 35,000 43,250 128,250
3605 May Rita 838329 2881/ Tu Jinak Col 19-May-15 Bedah Umum 50,000 - 352,100 402,100
3606 Salasiah 839910 2899/ Tumor Di K 19-May-15 Bedah Umum 50,000 - 394,150 377,500 821,650
3607 Norma Chas 669384 4110/ Hemoroid 19-May-15 Bedah Umum 50,000 - 117,100 438,400 605,500
3608 Norman 588718 4210/ Niddm 19-May-15 P. Dalam 50,000 - 110,250 160,250
3609 Ernawati 828943 2885/ Dm 19-May-15 P. Dalam 50,000 - 396,500 446,500
3610 Fatmawati 839905 2869/ Dislokasi T 19-May-15 Gigi & Mulut 50,000 - 368,500 418,500
3611 Widia Ning 839914 3945/ Susp Kista 19-May-15 Kandungan 50,000 - 60,000 305,000 415,000
3612 Herlina Ang 839922 4020/ G1P0A0+Kis 19-May-15 Kandungan 50,000 - 60,000 305,000 415,000
3613 Syafruddin 790675 2855/ 19-May-15 Gigi & Mulut 50,000 35,000 160,600 7,388 252,988
3614 Ruriyah 648748 3899/ Susp Ablasi 19-May-15 Mata 50,000 35,000 60,000 1,472,900 1,617,900
3615 Jali 834810 2868/ Kontrol 19-May-15 Bedah Umum 50,000 35,000 250,800 335,800
3616 Rubaidah 838346 4449/ Kontrol 19-May-15 Bedah Umum 50,000 - 145,200 195,200
3617 Chistinawati 839909 2896/ G2P1A0 Posi 19-May-15 Kandungan 50,000 - 120,500 305,000 3,000 478,500
3618 Ernie Bs 815417 4432/ Kontrol 19-May-15 Kandungan 50,000 - 60,000 305,000 415,000
3619 Dwi Wahyu 269046 4388/ Dismenorea 19-May-15 Kandungan 50,000 - 125,500 175,000 350,500
3620 Buatik 824550 4223/ Terapi 19-May-15 R.Medik 50,000 35,000 159,500 14,020 258,520
3621 Suryadi 839921 2883/ Sesak 19-May-15 Jantung 50,000 - 649,500 27,975 727,475
3622 Sanah 835536 4284/ 8 Gr 19-May-15 Gigi&Mulut 50,000 - 91,340 141,340
3623 Andi Heru B 838333 4151/ Ginggivitis 19-May-15 Gigi&Mulut 50,000 - 450,253 500,253
3624 Mirna Wati 541613 3884/ Susp Sinusit 19-May-15 Tht 50,000 - 50,000
3625 Linda Nurha 834870 3761/ 11 Pulpitis 19-May-15 Gigi&Mulut 50,000 - 207,443 257,443
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3626 Siska Oktav 839917 4371/ Kontrol 19-May-15 Gigi&Mulut 50,000 - 50,000
3627 Iwan Sunart 771568 4222/ Ckd 19-May-15 P. Dalam 50,000 - 50,000
3628 Suradmi 510730 4463/ Acites 19-May-15 P. Dalam 50,000 - 50,000
3629 Achmad Jun 835303 4150/ Gangren Ped 19-May-15 P. Dalam 50,000 - 402,500 452,500
3630 Wakiem 701255 4116/ Kontrol 19-May-15 Rehab Medik+ 50,000 35,000 71,500 156,500
3631 Sriatun 257601 4087/ Kontrol 19-May-15 R.Medik+Orto 50,000 35,000 159,500 244,500
3632 Akbar Alfari 841603 2867/ Kontrol 19-May-15 Bedah Saraf 50,000 - 50,000
3633 Eva Susilaw 841536 2866/ Kontrol 19-May-15 Kandungan 50,000 - 120,500 170,500
3634 Hasiah 816042 4405/ Post Op 19-May-15 Kandungan 50,000 - 120,500 3,788 174,288
3635 Masriah 293217 4359/ Kontrol 19-May-15 Kandungan 50,000 - 373,500 423,500
3636 Armiyah 776045 3958/ G3P2A0+Pos 19-May-15 Kandungan 50,000 - 120,500 170,500
3637 Asmarani 730346 4327/ Kontrol 19-May-15 Bedah Umum 50,000 - 125,000 175,000
3638 Nurbainah 763714 4176/ S/ Mastitis 19-May-15 Bedah Umum 50,000 - 50,000
3639 Asnawati 834209 3972/ Kontrol 19-May-15 Bedah Umum 50,000 - 50,000
3640 Nani Fitrian 841294 2882/ Hemoroid 19-May-15 Bedah Umum 50,000 - 309,500 359,500
3641 Tohir 835596 4032/ Hil D 19-May-15 Bedah Umum 50,000 - 125,000 175,000
3642 Mayang Savi 697785 4138/ Post Debrid 19-May-15 Bedah Umum 50,000 - 125,000 175,000
3643 Susilowati 837698 2927/ G3 P2 A0 Ri 19-May-15 Kandungan 50,000 - 120,500 170,500
3644 Emdan Nasr 411869 3898/ Kontrol 19-May-15 Tht 50,000 - 63,000 113,000
3645 Rivandi Fahr 653540 4033/ Serumen Ob 19-May-15 Tht 50,000 - 63,000 113,000
3646 Nur Hanifah 776818 4001/ Decomp Cor 19-May-15 Jantung 50,000 - 50,000
3647 Panidi 801366 3975/ Kontrol 19-May-15 Vct 50,000 - 50,000
3648 Sudarminto 734806 4252/ Kontrol 19-May-15 Urologi 50,000 - 132,500 182,500
3649 Dewi Puspit 838393 2795/ Sakit Pingg 19-May-15 Urologi 50,000 - 335,000 385,000
3650 Nurzaini 833245 4031/ Bph 19-May-15 Urologi 50,000 - 50,000
3651 Nur Hidayat 831484 2915/ Kontrol 19-May-15 Urologi 50,000 - 335,000 385,000
3652 M Solihin 795185 2822/ Terapi 19-May-15 R.medik 50,000 35,000 159,500 244,500
3653 Mislan 8246763 2750/ Kontrol 19-May-15 Syaraf 50,000 - 50,000
3654 Liston Man 801747 2809/ Terapi 19-May-15 R.medik 50,000 - 159,500 209,500
3655 M.Madjdy A 681701 4329/ Bronkitis 19-May-15 Anak 50,000 - 62,000 112,000
3656 Johansyah 791879 4401/ Kontrol 19-May-15 Vct 50,000 - 50,000
3657 Andy K P 706211 4136/ Fisioterapi 19-May-15 R.medik 50,000 - 71,500 121,500
3658 Masrun Maj 639948 4106/ Terapi 19-May-15 R.medik 50,000 - 71,500 121,500
3659 Ahmad Toba 838376 4018/ Terapi 19-May-15 R.medik 50,000 - 71,500 121,500
3660 Emi 394720 4122/ Terapi 19-May-15 R.medik 50,000 - 71,500 121,500
3661 Sarah 835367 4093/ Terapi 19-May-15 R.medik 50,000 - 71,500 121,500
3662 Winona Dest 337477 4155/ Tepapi 19-May-15 R Medik 50,000 - 220,000 270,000
3663 Kamakko R 666972 4313/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3664 Nurul Aini 835915 3838/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3665 Dafa Tri Nal 829331 4088/ Terapi 19-May-15 R.Medik 50,000 - 220,000 270,000
3666 Hanifah Kho 738963 4002/ Terapi 19-May-15 R.Medik 50,000 - 440,000 490,000
3667 Ahmad Suda 581234 4012/ Terapi 19-May-15 R.Medik 50,000 - 220,000 270,000
3668 M.Haykal Il 500328 4298/ Terapi 19-May-15 R.Medik 50,000 - 440,000 490,000
3669 Wahab Nur 799076 4050/ Terapi 19-May-15 R.Medik 50,000 - 440,000 490,000
3670 M. Azylillah 744048 3970/ Fisioterapi 19-May-15 R.Medik 50,000 - 440,000 490,000
3671 M.Fikri Far 677527 4419/ Terapi 19-May-15 R.Medik 50,000 - 220,000 270,000
3672 M.Yusuf 781487 4404/ Terapi 19-May-15 R.Medik 50,000 - 220,000 270,000
3673 Prima D 390935 3981/ Fisioterapi 19-May-15 R. Medik 50,000 - 440,000 490,000
3674 Ponijem 659169 4014/ Fisiotherapy 19-May-15 R. Medik 50,000 - 220,000 270,000
3675 H. Bambang 829576 4074/ Kontrol 19-May-15 R. Medik 50,000 - 440,000 490,000
3676 Sugiyanto 748332 3999/ Fisioterapi 19-May-15 R. Medik 50,000 - 440,000 490,000
3677 Sali 787723 4117/ Terapi 19-May-15 R.Medik 50,000 - 440,000 490,000
3678 Asih Sunars 829585 4140/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3679 Risa Ifana 829483 4152/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3680 M.Asrani 648975 4464/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3681 Suhery 822948 4433/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3682 Masrah 677735 2912/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3683 Noor Hayan 838198 4154/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3684 Alfiansyah 834821 3822/ Ot+Tw 19-May-15 R.Medik 50,000 - 440,000 490,000
3685 Rushel Satr 819393 4000/ Terapi 19-May-15 R.Medik 50,000 - 220,000 270,000
3686 Syahira 790826 4011/ Terapi 19-May-15 R.Medik 50,000 - 440,000 490,000
3687 Febrian Satr 753688 3982/ Terapi 19-May-15 R.Medik 50,000 - 440,000 490,000
3688 Azlan Darma 792114 4072/ Terapi 19-May-15 R.Medik 50,000 - 440,000 490,000
3689 Jasmani 822971 2764/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3690 Kornelis Na 810504 4161/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3691 Sujitno 835911 4102/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3692 Sabariyah 016859 4073/ Fisioterapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3693 Jumiyah 3792/ Fisioterapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3694 Marida 647710 3997/ Fisiotherapy 19-May-15 R.Medik 50,000 - 71,500 121,500
3695 Murikah 598534 3837/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3696 Wahyu Hand 697153 4101/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3697 Sujarni 800848 4251/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3698 Mahmudah 268599 4030/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3699 Rubiyanti 835952 4194/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3700 Darmiati 667292 3839/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3701 Jasmah 434885 4165/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3702 Inem 534202 4178/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3703 Nico Mangu 784719 3996/ Terapi 19-May-15 R Medik 50,000 - 159,500 209,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3704 Aliyah 730090 3998/ Terapi 19-May-15 R Medik 50,000 - 71,500 121,500
3705 Helwinda 577381 4015/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3706 Supatmi 801314 3793/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3707 Sriani 346142 4041/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3708 Nurhaidah 061430 4209/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3709 Sayem 835998 4191/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3710 Kanti Emi 370635 3985/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3711 Herman Edw 829512 4195/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3712 Minong 648247 4299/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3713 Sahrudin 466971 3930/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3714 Sri Yayuk R 801710 3912/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3715 Nila Wati 346646 3956/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3716 Supriani 639809 3855/ Fisioterapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3717 H. Syamsud 775495 3836/ Terapi 19-May-15 R.Medik 50,000 - 220,000 270,000
3718 Fatma 433683 2854/ Terapi 19-May-15 R.Medik 50,000 - 71,500 121,500
3719 Susiatin 337059 3853/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3720 M. Irwan Wi 700898 4236/ Terapi 19-May-15 R.Medik 50,000 - 159,500 209,500
3721 Mariam Ulfa 834596 4269/ Terapi 19-May-15 R.Medik 50,000 - 440,000 490,000
3722 Annisa Rifq 634858 4345/ Terapi 19-May-15 R.Medik 50,000 - 220,000 270,000
3723 Muhammad 666097 3795/ Terapi 19-May-15 R.Medik 50,000 - 440,000 490,000
3724 Yuliani 285668 4075/ Cts+Terapi 19-May-15 R.Medik 50,000 - 220,000 270,000
3725 Rachmah 264555 4056/ Terapi 19-May-15 R.Medik 50,000 - 440,000 490,000
3726 Aris Rahman 784378 4057/ Terapi 19-May-15 R.Medik 50,000 - 440,000 490,000
3727 Muryati 731325 2825/ Fisiotherapy 19-May-15 R.Medik 50,000 - 440,000 490,000
3728 Laila 759001 4013/ Terapi 19-May-15 R.Medik 50,000 - 220,000 270,000
3729 Siti Mujinah 308754 4147/ Dm Ht 19-May-15 P. Dalam 50,000 - 59,938 109,938
3730 Karnadi 757912 2794/ Dm 19-May-15 P. Dalam 50,000 - 45,075 95,075
3731 Aminoto 754053 2852/ Kontrol 19-May-15 Paru 50,000 - 24,207 74,207
3732 Supardi 757487 2853/ Kontrol 19-May-15 Paru 50,000 - 33,506 83,506
3733 Vasih Fristia 633295 4808/ Lvh 20-May-15 Jantung 50,000 - 308,363 358,363
3734 Noor Patima 622484 3166/ Epilepsi 20-May-15 Saraf 50,000 - 474,363 524,363
3735 Herlina 817022 3182/ Hnp 20-May-15 Saraf 50,000 - 24,430 74,430
3736 Hj.Siti Aina 251090 4523/ Pjk 20-May-15 Jantung 50,000 - 418,300 468,300
3737 Supiah 475816 3017/ Lbp 20-May-15 Saraf 50,000 - 15,875 65,875
3738 Anitasari 839931 2956/ Tu Colli 20-May-15 Bedah Umum 50,000 35,000 377,500 125,400 1,963 589,863
3739 Edy Purwan 301086 4393/ Pjk 20-May-15 Jantung 50,000 - 286,300 336,300
3740 Sulistyo 640914 4495/ Post Stroke 20-May-15 Saraf 50,000 - 177,713 227,713
3741 Indrawati 680655 4304/ Terapi 20-May-15 Rehab Medik 50,000 35,000 71,500 3,004 159,504
3742 Muhammad N811366 4469/ Pjk 20-May-15 Jantung 50,000 - 390,505 440,505
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3743 Sefira Febri 839960 4764/ Ispa Kronis 20-May-15 Anak 50,000 - 14,042 64,042
3744 Zainul Aksi 167352 4377/ S. Bph 20-May-15 Urologi 50,000 - 205,538 255,538
3745 Mawarsyah 838363 4642/ Angina Pec 20-May-15 Jantung 50,000 - 138,825 188,825
3746 Ponisih 835360 4482/ Post Orif 20-May-15 Orthopedi 50,000 - 80,000 9,775 139,775
3747 Aminah 004096 4733/ Migrain 20-May-15 Syaraf 50,000 - 43,914 93,914
3748 Wahyu Kur 797011 4761/ Epilepsi 20-May-15 Syaraf 50,000 - 87,188 137,188
3749 Ummul Khai 815127 4287/ Cp 20-May-15 Anak 50,000 35,000 220,000 35,810 340,810
3750 Mochsin Hb 410398 2975/ Kontrol 20-May-15 Dalam 50,000 35,000 125,000 126,204 336,204
3751 Dyah Ayu An796069 4376/ Gastritis 20-May-15 Penyakit Dala 50,000 - 153,500 28,919 232,419
3752 Supiyah 549762 4273/ Susp Kista 20-May-15 Bedah Umum 50,000 35,000 187,000 243,750 515,750
3753 Rizki 839973 4794/ Kontrol 20-May-15 Tht 50,000 - 63,000 14,422 127,422
3754 David Adity 821580 4317/ Epilepsi 20-May-15 Anak 50,000 - 104,500 154,500
3755 Wa Hari 816734 4599/ Kontrol 20-May-15 Peny.Dalam 50,000 - 17,079 67,079
3756 Widia Ning 839914 4289/ Susp Kista 20-May-15 Kandungan 50,000 - 60,000 2,288 112,288
3757 Syarifah Sa 596154 4585/ Dm Ckd 20-May-15 Peny.Dalam 50,000 - 68,531 118,531
3758 Syarifuddin 748276 4301/ Dm+Ht 20-May-15 Penyakit Dala 50,000 35,000 500,250 40,100 625,350
3759 Ati 633262 4613/ Hipertiroid 20-May-15 Peny.Dalam 50,000 - 39,825 89,825
3760 Irwan 788185 3031/ Pjk 20-May-15 Jantung 50,000 - 60,393 110,393
3761 Muchlis 744398 4718/ Kontrol 20-May-15 Penyakit Dala 50,000 - 447,616 497,616
3762 Usni 833517 3001/ Acs Stemi 20-May-15 Jantung 50,000 - 31,591 81,591
3763 Risnatul Hij 839963 4437/ 12 Gp 20-May-15 Gigi&Mulut 50,000 - 160,600 8,425 219,025
3764 Sasmo Wiyo 838426 4641/ S/ Bph 20-May-15 Urologi 50,000 - 335,000 567,350 178,410 1,130,760
3765 Mardiah 496326 3005/ Ca Mamae 20-May-15 Bedah Umum 50,000 - 657,750 707,750
3766 Ahmad Zainu263779 4702/ Artritis Reu 20-May-15 Peny.Dalam 50,000 - 114,500 101,311 265,811
3767 Rubaedah 838346 3181/ Nyeri Perut 20-May-15 Bedah Umum 50,000 - 5,713 55,713
3768 Yahmi 839969 3121/ Leokusitisis 20-May-15 Dalam 50,000 - 102,250 9,000 161,250
3769 Sunarti 811334 4567/ Tb Kelenjar 20-May-15 Bedah Umum 50,000 - 224,940 274,940
3770 Patang Tom 613407 4778/ Kontrol 20-May-15 Mata 50,000 - 21,673 71,673
3771 Rita Susanti 457348 2987/ Kontrol 20-May-15 Dalam 50,000 - 178,950 101,690 330,640
3772 Paiman 720295 4731/ Epilepsi 20-May-15 Syaraf 50,000 - 314,813 364,813
3773 Johnny V. L 805137 4258/ Dm 20-May-15 Penyakit Dala 50,000 - 31,591 81,591
3774 Abyan Putra 828993 4392/ Ikterik 20-May-15 Anak 50,000 - 360,250 187,110 597,360
3775 Zulkifli 838134 4394/ Obs Dispneu 20-May-15 Paru 50,000 - 32,075 82,075
3776 Riduan 824664 3003/ Kontrol 20-May-15 Orthopedy 50,000 - 4,238 54,238
3777 Kurniah 836387 4335/ S. Ca Ovaria 20-May-15 Kandungan 50,000 - 60,000 5,494 115,494
3778 H.Taslihan 597722 4537/ Bph 20-May-15 Urologi 50,000 - 137,529 187,529
3779 La Upe 813270 4540/ Ht 20-May-15 Peny.Dalam 50,000 - 326,831 376,831
3780 Moh Rosyad 775198 2972/ Crf + Chf 20-May-15 Dalam 50,000 - 543,500 1,440 594,940
3781 Ade 484635 4272/ Epilepsi 20-May-15 Syaraf 50,000 - 104,500 154,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3782 Saidi 835987 4305/ Hemapoe 20-May-15 Paru 50,000 - 40,100 90,100
3783 M Fachri 821487 3061/ Kontrol 20-May-15 Anak 50,000 - 104,500 154,500
3784 Idham 841876 4792/ S/ Hepatitis 20-May-15 Peny.Dalam 50,000 - 66,000 3,000 119,000
3785 Abdul Hadi 839977 4809/ Serumen 20-May-15 Tht 50,000 - 10,863 60,863
3786 Titik Yunani 506287 4791/ Kontrol 20-May-15 Kandungan 50,000 - 60,000 65,450 175,450
3787 Budiwati 690259 3049/ Faringitis 20-May-15 Tht 50,000 - 60,356 110,356
3788 Asnun Zain 002193 4584/ Glaukoma 20-May-15 Mata 50,000 - 60,000 198,480 308,480
3789 Meri Periant 833150 4332/ Kontrol 20-May-15 Penyakit Dala 50,000 - 177,179 227,179
3790 Nazwa Cind 839944 3046/ Rhinitis Ale 20-May-15 Tht 50,000 - 1,206 51,206
3791 Narisca Auri 623600 2986/ Tonsilitis K 20-May-15 Tht 50,000 - 34,030 84,030
3792 Abdul Maji 573285 4583/ Kontrol 20-May-15 Jantung 50,000 - 164,253 214,253
3793 Tual Arjan 839942 3019/ Dissuria 20-May-15 Urologi 50,000 - 335,000 515,900 145,200 137,213 1,183,313
3794 Sukoco 694587 4539/ Cad 20-May-15 Jantung 50,000 - 55,813 105,813
3795 Yuliana Surt 839978 4500/ Susp Anosm 20-May-15 Tht 50,000 - 9,866 59,866
3796 Nur Ulima 842001 3122/ Gatal Sekur 20-May-15 Kulit+ Kelami 50,000 - 4,738 54,738
3797 Sunarti 703681 4704/ Obs Palpitas 20-May-15 Jantung 50,000 - 457,250 649,500 50,850 1,207,600
3798 Mariani 503609 4485/ 17 18 Nekro 20-May-15 Gigi&Mulut 50,000 - 160,600 10,563 221,163
3799 Saniah 828246 4611/ Chf 20-May-15 Jantung 50,000 - 283,350 333,350
3800 Muslimat 839961 4425/ Riw Pjk 20-May-15 Jantung 50,000 - 258,600 308,600
3801 Jumriah 753613 4438/ Ht 20-May-15 Penyakit Dala 50,000 35,000 187,000 281,213 553,213
3802 Achmad 494601 4746/ Pjk 20-May-15 Jantung 50,000 - 421,013 471,013
3803 Herlina 839922 3064/ G1 P0 A0 Dn 20-May-15 Kandungan 50,000 35,000 125,000 41,750 251,750
3804 Fadly Adria 839918 4362/ Abses+Ht 20-May-15 Bedah Umum 50,000 35,000 8,800 93,800
3805 Noor Diana 570064 4452/ Hearing Los 20-May-15 Tht 50,000 35,000 187,000 20,595 292,595
3806 Abdul Gani
818139 /4195603063/ Ulcer Duod 20-May-15 Dalam 50,000 35,000 14,923 99,923
3807 Rusdiana 745347 3167/ Dm 20-May-15 Penyakit Dala 50,000 - 261,950 3,831 315,781
3808 Ratnawaty 790972 4671/ Obs Chest P 20-May-15 Jantung 50,000 - 523,250 649,500 50,850 1,273,600
3809 Masyati 838444 4423/ Dispepsia F 20-May-15 Penyakit Dala 50,000 35,000 125,400 187,000 157,225 554,625
3810 Fransisca M 838396 4837/ Struma 20-May-15 Peny.Dalam 50,000 - 22,035 72,035
3811 Abdul Rahm 839979 3137/ Sering Kenc 20-May-15 Urologi 50,000 - 335,000 2,075 387,075
3812 Asiah 821192 4494/ Dm 20-May-15 Peny.Dalam 50,000 - 8,063 58,063
3813 Rahimah 569991 4198/ Leukimia 20-May-15 Penyakit Dala 50,000 - 5,285,954 5,335,954
3814 Mariani 528526 4763/ Kontrol 20-May-15 Syaraf 50,000 - 29,160 79,160
3815 M.Fardiansy 831398 4596/ Epilepsi 20-May-15 Anak 50,000 - 52,250 102,250
3816 Sunaryo 711809 4409/ Post Orif 20-May-15 Orthopedi 50,000 - 80,000 4,238 134,238
3817 Surya Laha 620609 4660/ Kontrol 20-May-15 Jantung 50,000 - 110,700 126,498 287,198
3818 Murni 407980 4568/ Kontrol 20-May-15 Peny.Dalam 50,000 - 43,325 93,325
3819 Sudjono 805105 4553/ Dm 20-May-15 Peny.Dalam 50,000 - 175,714 225,714
3820 Herlina 780660 3034/ 35 Pulpitis 20-May-15 Gigi & Mulut 50,000 - 207,443 8,363 265,806
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3821 Am. Mitia782792/780575
R 4212/ Ca Paru 20-May-15 Paru 50,000 - 5,941 55,941
3822 Suyat 821729 4480/ Kontrol 20-May-15 Peny.Dalam 50,000 - 12,279 62,279
3823 Abdul Latif 839975 4806/ S/ Sinusitis 20-May-15 Tht 50,000 - 105,600 2,483 158,083
3824 Tukiyah 236600 4380/ Ht+Myalgia 20-May-15 Penyakit Dala 50,000 - 28,238 78,238
3825 Hamdanah 790973 4260/ Stroke+Dm 20-May-15 P.Dalam+Syara 50,000 35,000 80,385 165,385
3826 Jurhan 836162 4566/ Pjk 20-May-15 Jantung 50,000 - 185,850 235,850
3827 Sanusi 840621 4643/ Asma 20-May-15 Paru 50,000 - 28,875 78,875
3828 Sumiraheny 502873 3080/ Hnp 20-May-15 Saraf 50,000 - 41,550 91,550
3829 Neni Fatima 839962 4436/ 8 Pericoroni 20-May-15 Gigi&Mulut 50,000 - 160,600 8,425 219,025
3830 Arlina 838306 4614/ Lbp 20-May-15 Syaraf 50,000 - 23,413 73,413
3831 Suwadi 406531 3048/ Kontrol 20-May-15 Dalam 50,000 - 61,500 111,500
3832 Panirah 822928 4241/ Terapi+Kont 20-May-15 R.Medik+Syar 50,000 35,000 159,500 27,293 271,793
3833 Muryati 525319 4510/ 321 123 Kar 20-May-15 Gigi&Mulut 50,000 - 115,408 160,600 1,525 327,533
3834 Gusen Widiy 639821 4748/ Kontrol 20-May-15 Tht 50,000 - 24,908 74,908
3835 Aminah 447319 4333/ Impaksi Mul 20-May-15 Gigi&Mulut 50,000 - 91,340 8,425 149,765
3836 Suhendro 834271 3047/ Kontrol 20-May-15 Dalam 50,000 - 511,950 305,000 4,806 871,756
3837 Muriani 473021 4349/ Kontrol 20-May-15 Penyakit Dala 50,000 - 195,250 680 245,930
3838 Nur Hasana 805740 4259/ Ht+Ablasio 20-May-15 P.Dalam+Mata 50,000 35,000 60,000 277,953 422,953
3839 Rahmawati 839948 4538/ G1P0A0 20-May-15 Kandungan 50,000 - 120,500 19,463 189,963
3840 J. Marni 664975 4213/ Fisioterapi 20-May-15 Rehab Medik 50,000 35,000 71,500 29,884 186,384
3841 Jumini 618478 2971/ Kontrol 20-May-15 Jantung 50,000 - 324,600 374,600
3842 Zaitun Fati 804614 4600/ Kontrol 20-May-15 Peny.Dalam 50,000 - 500,250 473,756 1,024,006
3843 Liani Hamza 671272 4478/ G3P1A1 20-May-15 Kandungan 50,000 - 60,000 1,525 111,525
3844 Iwansyah 496288 4509/ Ht 20-May-15 Jantung 50,000 - 38,168 88,168
3845 Asni 775111 4555/ S/ Bph 20-May-15 Urologi 50,000 - 292,875 342,875
3846 Enny Ipmaw 841540 4350/ Post Sc 20-May-15 Kandungan 50,000 - 120,500 600 171,100
3847 Nurhayati 839966 4454/ Sinusitis 20-May-15 Tht 50,000 35,000 266,200 8,313 359,513
3848 M Saleh 458143 2989/ Terapi + Kon 20-May-15 Rhb Medis + 50,000 35,000 71,500 41,694 198,194
3849 Indah Guspi 840501 4378/ Cf Femur 20-May-15 Orthopedi 50,000 - 80,000 4,938 134,938
3850 Jayadi 475972 4507/ Post Stroke 20-May-15 Syaraf 50,000 - 72,000 122,000
3851 Sunyoto 839955 4421/ Susp Bsk 20-May-15 Urologi 50,000 35,000 335,000 66,000 745,800 576,700 1,808,500
3852 Bambang Pr 739236 4795/ Hhd 20-May-15 Jantung 50,000 - 212,925 262,925
3853 Abdul Kadir 392616 4615/ Kontrol 20-May-15 Jantng+Paru 50,000 35,000 58,713 143,713
3854 Jaliah 828000 3018/ Decomp Cor 20-May-15 Jantung 50,000 - 313,350 363,350
3855 Ida Hayati 839956 3091/ Keputihan B 20-May-15 Kandungan 50,000 - 60,000 9,636 119,636
3856 Ibrahim 597927 4673/ Hhd 20-May-15 Jantung 50,000 - 36,925 86,925
3857 Alwiyah 815854 4732/ Struma 20-May-15 Peny.Dalam 50,000 - 42,448 92,448
3858 Heri Iwanto 839941 2990/ Benjolan Di 20-May-15 Oncologi 50,000 35,000 57,758 142,758
3859 Hana Indraw 829924 4467/ Post Sc 20-May-15 Kandungan 50,000 - 120,500 4,463 174,963
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3860 Sriyatin 838354 3032/ Lbp 20-May-15 Saraf 50,000 35,000 7,781 92,781
3861 Jali 834810 3107/ Kontrol 20-May-15 Orthopedy 50,000 35,000 633 85,633
3862 Hadiyah 720865 4483/ Kontrol 20-May-15 Kandungan 50,000 - 60,000 11,463 121,463
3863 Darisem Nur 827918 4242/ Ft Stroke 20-May-15 Rehab Medik 50,000 70,000 220,000 269,854 609,854
3864 Sampan Buc 839965 4765/ Kelainan Re 20-May-15 Mata 50,000 - 60,000 171,893 281,893
3865 Wa Runting 830848 4496/ Post Lapara 20-May-15 Kandungan 50,000 - 120,500 14,250 184,750
3866 Sariwati 451942 3152/ Pjk 20-May-15 Jantung 50,000 - 211,375 261,375
3867 Darwih Gerr 835527 4836/ Colik Ureter 20-May-15 Urologi 50,000 - 335,000 1,963 386,963
3868 Marsianah 839968 3108/ Dislokasi 20-May-15 Orthopedy 50,000 - 105,600 3,700 159,300
3869 Laila 679827 3154/ Susp Kista 20-May-15 Kandungan 50,000 - 60,000 9,888 119,888
3870 Sukimin 385914 4408/ Cad 20-May-15 Jantung 50,000 - 410,738 460,738
3871 Juanda 459741 4364/ Pjk 20-May-15 Jantung 50,000 - 431,800 481,800
3872 Syarifuddin 402080 4439/ Cad 20-May-15 Jantung 50,000 - 141,997 191,997
3873 Juhariyah 839945 3078/ Dm 20-May-15 Dalam 50,000 - 110,250 8,675 168,925
3874 Linda Astuti
794222/5225214582/ Kontrol 20-May-15 Syaraf 50,000 35,000 296,306 381,306
3875 M.Yusra 326441 4823/ Bph+Hhd 20-May-15 Urologi+Jantu 50,000 35,000 316,950 401,950
3876 Suswati 839954 4717/ Bells Palsy 20-May-15 Syaraf 50,000 35,000 84,563 169,563
3877 Siti Rahmah 638133 3168/ Kontrol 20-May-15 Saraf 50,000 - 207,900 9,679 267,579
3878 Ernawati 525416 4303/ Fisioterapi 20-May-15 Rehab Medik 50,000 35,000 71,500 6,694 163,194
3879 Misni Arwat 531533 4406/ 112+Kontro 20-May-15 Vct+Kulit Kel 50,000 35,000 32,654 117,654
3880 Siti Ma'Ani 796017 4331/ Ca Ovarium 20-May-15 Kandungan 50,000 35,000 60,000 187,000 332,000
3881 A. Ghozi Al 604893 4701/ 1 Fr Pulpa 20-May-15 Gigi&Mulut 50,000 - 599,257 160,600 809,857
3882 Muhammad 838357 4451/ Susp Tu Par 20-May-15 Paru 50,000 35,000 1,598,300 516,750 2,200,050
3883 Anisa Ariati 838375 2957/ Susp Tu Col 20-May-15 Onkologi 50,000 - 377,500 427,500
3884 Laminem 839953 4705/ Hemoptitis 20-May-15 Paru 50,000 - 125,400 175,400
3885 M.Raffi 812492 4657/ Post Op 20-May-15 Ortophedi 50,000 - 105,600 155,600
3886 Ramajis 740667 3094/ Cabut Gigi 20-May-15 Gigi & Mulut 50,000 35,000 93,115 178,115
3887 Sutarti 457467 4656/ Tu Mamae 20-May-15 Bedah Umum 50,000 - 394,150 377,500 125,400 947,050
3888 Kusasi 492196 4779/ Tu Dada S 20-May-15 Onkologi 50,000 - 377,500 125,400 552,900
3889 Mariani 839951 4395/ Lipoma 20-May-15 Bedah Umum 50,000 - 755,400 125,400 930,800
3890 Melkianto 602789 4391/ 7 Gp 20-May-15 Gigi&Mulut 50,000 35,000 645,150 286,000 1,016,150
3891 Sainem 839947 4256/ 2 Pulpitis 20-May-15 Gigi&Mulut 50,000 - 160,600 210,600
3892 Indra J 839952 4690/ Kontrol 20-May-15 Gigi&Mulut 50,000 - 160,600 210,600
3893 Sriyaningsih 839972 4824/ Fam D 20-May-15 Bedah Umum 50,000 - 744,150 377,500 125,400 1,297,050
3894 Verja Prata 838385 4825/ Kontrol 20-May-15 Bedah Anak 50,000 - 701,550 105,600 857,150
3895 Titin Ari Wi 839974 4807/ Fam D 20-May-15 Bedah Umum 50,000 - 755,400 377,500 125,400 1,308,300
3896 Jumatul Has 667881 3136/ Sinusitis 20-May-15 Tht 50,000 - 160,600 210,600
3897 Hafizn Hari 828771 3062/ Kontrol 20-May-15 Anak 50,000 35,000 239,500 293,700 618,200
3898 Taufik Nugr 839970 3124/ Benjolan Pe 20-May-15 Bedah Umum 50,000 - 777,150 125,400 952,550
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3899 M Hasan Bil 839907 3109/ Hernia 20-May-15 Bedah Anak 50,000 - 701,550 105,600 857,150
3900 Syarifuddin 839971 3125/ Multiple Li 20-May-15 Bedah Umum 50,000 - 394,150 125,400 569,550
3901 Rosita 839985 3183/ Benjolan Pd 20-May-15 Bedah Umum 50,000 - 332,700 125,400 508,100
3902 Nur Suci R 822515 4626/ Ganglion 20-May-15 Bedah Anak 50,000 - 162,250 212,250
3903 Wagisah 712044 4674/ Dm 20-May-15 Peny.Dalam 50,000 - 110,250 160,250
3904 Sulasiyah 836263 4346/ S/ Kista Mul 20-May-15 Bedah Umum 50,000 - 29,250 79,250
3905 Sumiaty 429003 4243/ Dm 20-May-15 Penyakit Dala 50,000 - 110,250 160,250
3906 Supriyatin 778830 4491/ Fisioterapi 20-May-15 Rehab Medis 50,000 - 110,250 160,250
3907 Suwati 706124 4214/ Dm+Ht 20-May-15 Penyakit Dala 50,000 - 110,250 160,250
3908 Sya'Diah 439539 2958/ Cek Lab 20-May-15 Laboratorium 50,000 - 500,250 550,250
3909 Subeli 238930 4244/ Dm 20-May-15 Penyakit Dala 50,000 - 110,250 160,250
3910 Nurhayati 510570 4424/ Dm 20-May-15 Penyakit Dala 50,000 - 110,250 160,250
3911 Leny Susila 440602 4554/ Dm 20-May-15 Peny.Dalam 50,000 - 500,250 550,250
3912 Lenywati 750017 4506/ Hipertiroid 20-May-15 Peny.Dalam 50,000 - 352,100 402,100
3913 Kartini 556654 4477/ Dm 20-May-15 Peny.Dalam 50,000 - 500,250 550,250
3914 Herlina Wat 658294 4629/ Hemoroid 20-May-15 Bedah Umum 50,000 - 117,100 438,400 605,500
3915 Annimenna 446025 2988/ Cek Lab 20-May-15 Laboratorium 50,000 - 110,250 160,250
3916 Aspul 770059 4271/ Dm+Ht 20-May-15 Penyakit Dala 50,000 - 110,250 160,250
3917 Adhisty Fitr 634348 4525/ Sindrom Nef 20-May-15 Anak 50,000 - 44,250 94,250
3918 Hj Salbiah 758941 3093/ Jantung Kor 20-May-15 Jantung 50,000 - 490,250 540,250
3919 Prawati 839950 4379/ Akd 20-May-15 Penyakit Dala 50,000 - 495,500 545,500
3920 Norpiani 839939 3170/ Ht 20-May-15 Jantung 50,000 - 523,250 573,250
3921 Fatmawati 839905 3154/ Dislokasi T 20-May-15 Gigi & Mulut 50,000 - 579,150 125,400 754,550
3922 Erlin Jaya 779455 3123/ Hemaroid Gr 20-May-15 Bedah Umum 50,000 - 117,100 413,150 580,250
3923 Rosmin 829574 3155/ Benjolan Di 20-May-15 Peny.Dalam 50,000 70,000 60,000 187,000 367,000
3924 Sukatmi 781888 4288/ Katarak Os 20-May-15 Mata 50,000 - 50,000
3925 Karsuni 842297 4498/ G2P1A0+Pos 20-May-15 Kandungan 50,000 - 120,500 170,500
3926 Siti Zuraida
841246/8415754229/ Cholelithias 20-May-15 Penyakit Dala 50,000 - 50,000
3927 Rusmiati 550670 3004/ Perdarahan 20-May-15 Kandungan 50,000 - 420,000 470,000
3928 Hartini 839981 3139/ Obs Tumor C 20-May-15 Oncologi 50,000 - 377,500 427,500
3929 Divo Aprill 839964 4453/ Serumen P 20-May-15 Tht 50,000 - 63,000 113,000
3930 Ngaliyem 318326 4511/ Ht 20-May-15 Penyakit Dala 50,000 - 50,000
3931 Oktavia Rab 261325 4645/ Tu Parotis 20-May-15 Onkologi 50,000 - 50,000
3932 Suhartatik 654862 4658/ Ca Palatum 20-May-15 Onkologi 50,000 - 50,000
3933 Hernianti 582982 4776/ Kontrol 20-May-15 Onkologi 50,000 35,000 402,500 187,000 674,500
3934 M Solihin 795185 2945/ Kontrol 20-May-15 Saraf 50,000 - 50,000
3935 Boyadi 838390 4302/ Vulnus Mon 20-May-15 Bedah Umum 50,000 35,000 125,000 210,000
3936 Indo Upe 447663 4320/ Hemoroid 20-May-15 Bedah Umum 50,000 - 117,100 167,100
3937 Wahyudi 835524 4440/ Tumor 20-May-15 Bedah Umum 50,000 - 125,000 175,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3938 Mulyana 838302 3076/ Fam Mamae 20-May-15 Bedah Umum 50,000 - 50,000
3939 Rizka Mawa 800440 4497/ Limfadeniti 20-May-15 Bedah Umum 50,000 - 50,000
3940 Karmila 839901 4719/ S/ Tu Mama 20-May-15 Bedah Umum 50,000 - 50,000
3941 Natalia 775122 4481/ Kontrol 20-May-15 Bedah Umum 50,000 - 50,000
3942 Ahmad 836814 4777/ Post Op 20-May-15 Bedah Umum 50,000 - 125,000 175,000
3943 Rafasya Zid 829917 4274/ Hidrokel T 20-May-15 Bedah Anak 50,000 35,000 85,000
3944 Sulistiawati 841620 3095/ Kontrol 20-May-15 Kandungan 50,000 - 120,500 170,500
3945 Dimas Fachr 838350 4508/ Hernia Scrot 20-May-15 Bedah Anak 50,000 35,000 85,000
3946 Ndari 838361 4499/ G5P4A0+An 20-May-15 Kandungan 50,000 - 120,500 170,500
3947 M Abdul Jal 769111 3153/ Kontrol 20-May-15 Bedah Anak 50,000 - 50,000
3948 M Nasrullah 839906 3110/ Hernia 20-May-15 Bedah Anak 50,000 - 50,000
3949 Wa Nuriani 438773 4522/ Menometora 20-May-15 Kandungan 50,000 70,000 60,000 180,000
3950 Desi Kartina 665189 3106/ Menometror 20-May-15 Kandungan 50,000 - 60,000 110,000
3951 Riska Yanty 833128 4810/ Kontrol 20-May-15 Kandungan 50,000 - 120,500 170,500
3952 Djohan Roz 515515 4551/ Kontrol 20-May-15 Onkologi 50,000 - 50,000
3953 Sri Hendriya 821552 4762/ Kontrol 20-May-15 Onkologi 50,000 - 50,000
3954 Vinsensia A 838366 4470/ Kontrol 20-May-15 Kandungan 50,000 - 120,500 170,500
3955 Siti Holipah 839980 3138/ G3 P2 A0 20-May-15 Kandungan 50,000 - 120,500 170,500
3956 Fatimah 839967 4466/ G4P3A0+Hi 20-May-15 Kandungan 50,000 35,000 85,000
3957 Masnah 790676 4822/ 112 20-May-15 Vct 50,000 - 50,000
3958 Sumariyono 025081 4410/ Immuno C 20-May-15 Vct 50,000 - 50,000
3959 Warsi 789865 4659/ Dm 20-May-15 Peny.Dalam 50,000 - 135,000 185,000
3960 Mursalim D 739407 4720/ S/ Tb Paru 20-May-15 Paru 50,000 - 50,000
3961 Rafiah 816544 4675/ Tu Palpebra 20-May-15 Peny.Dalam 50,000 - 50,000
3962 Santi 646149 4627/ Gastritis 20-May-15 Peny.Dalam 50,000 - 50,000
3963 Daffa Naufa 664149 4644/ Veruka 20-May-15 Kulit Kelamin 50,000 - 50,000
3964 Linda Nurha 834870 2942/ Kontrol 20-May-15 Gigi & Mulut 50,000 - 722,956 772,956
3965 M. Agus Bra 828790 4689/ Kontrol 20-May-15 Gigi&Mulut 50,000 - 603,276 653,276
3966 Sira 839957 4735/ Sumbing 20-May-15 Gigi&Mulut 50,000 - 50,000
3967 Zahirah Nu 838353 4750/ Celah Palat 20-May-15 Gigi&Mulut 50,000 - 50,000
3968 Akhmadi Ha 839983 3166/ Kontrol 20-May-15 Gigi & Mulut 50,000 - 50,000
3969 Sunariah 583038 4703/ 1 2 Bag Dis 20-May-15 Gigi&Mulut 50,000 - 50,000
3970 M.Nizam Da 839858 4734/ Hidrocefalu 20-May-15 Anak 50,000 - 50,000
3971 Sayyid Rahm841592 4361/ Kontrol 20-May-15 Anak 50,000 - 50,000
3972 Andi Heru B 838333 3153/ Caries 6 20-May-15 Gigi&Mulut 50,000 - 900,506 950,506
3973 Samuel Arie 841590 4749/ Fraktur Clav 20-May-15 Ortophedi 50,000 - 50,000
3974 Jesica Meila 631416 4612/ Kontrol 20-May-15 Ortophedi 50,000 - 50,000
3975 M. Suleman 829942 4422/ Ctev 20-May-15 Orthopedi 50,000 - 212,750 262,750
3976 Bunga Wati 834855 4347/ Kontrol 20-May-15 Mata 50,000 - 60,000 110,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
3977 Susi 816519 4628/ Kontrol 20-May-15 Mata 50,000 - 130,000 180,000
3978 Maimunah 818398 4455/ Katarak 20-May-15 Mata 50,000 - 130,000 180,000
3979 Kismawati 839976 4484/ Ht 20-May-15 Jantung 50,000 - 187,000 237,000
3980 Imalasari Pu 571238 4479/ Terapi 20-May-15 R.Medik 50,000 - 440,000 490,000
3981 Imam M. Sh 190433 4181/ Terapi 20-May-15 Rehab Medik 50,000 - 440,000 490,000
3982 Udin 705780 4182/ Fisioterapi 20-May-15 Rehab Medik 50,000 - 220,000 270,000
3983 Rudiansyah 424444 2943/ Terapi 20-May-15 R Medis 50,000 - 220,000 270,000
3984 Maili Yanti 755386 4197/ Terapi 20-May-15 Rehab Medik 50,000 - 440,000 490,000
3985 Sugianto Ru 487872 4215/ Terapi 20-May-15 Rehab Medik 50,000 - 440,000 490,000
3986 Abdul Nurd 464739 4196/ Fisioterapi 20-May-15 Rehab Medik 50,000 - 440,000 490,000
3987 Tunikah 796098 4318/ Terapi 20-May-15 Rehab Medik 50,000 - 440,000 490,000
3988 H.Haerah 834016 4552/ Terapi 20-May-15 R.Medik 50,000 - 440,000 490,000
3989 Kusnan 721341 4170/ Terapi 20-May-15 Rehab Medik 50,000 - 220,000 270,000
3990 Salamah 748488 2930/ Fisiotherapy 20-May-15 Rehab Medis 50,000 - 440,000 490,000
3991 Winona 337477 4780/ Terapi 20-May-15 R.Medik 50,000 - 220,000 270,000
3992 Suriansyah 468561 4228/ Terapi 20-May-15 Rehab Medik 50,000 - 71,500 121,500
3993 Nurdin 816128 4319/ Terapi 20-May-15 Rehab Medik 50,000 - 159,500 209,500
3994 Sopiah 655365 3169/ Terapi 20-May-15 R.Medik 50,000 - 71,500 121,500
3995 M.Romli 806719 4821/ Terapi 20-May-15 R.Medik 50,000 - 159,500 209,500
3996 Mariana 777781 4407/ Kontrol 20-May-15 Syaraf 50,000 35,000 159,500 244,500
3997 Nawiyah 494525 4468/ Terapi 20-May-15 Rehab Medik 50,000 - 159,500 209,500
3998 M. Dwifa C 816594 4226/ Terapi 20-May-15 Rehab Medik 50,000 - 440,000 490,000
3999 Humairah 622151 4227/ Terapi 20-May-15 Rehab Medik 50,000 - 440,000 490,000
4000 Ridho Abrar 779669 3151/ Terapi 20-May-15 R.Medik 50,000 - 220,000 270,000
4001 Hafiz Nur 811861 4524/ Terapi 20-May-15 R.Medik 50,000 - 220,000 270,000
4002 Aiysah Uzim 796280 4316/ Terapi 20-May-15 Rehab Medik 50,000 - 440,000 490,000
4003 Rahmatulla 462170 2928/ Terapi 20-May-15 Rehab Medis 50,000 - 440,000 490,000
4004 M. Atallah 607935 2929/ Fisiotherapy 20-May-15 R Medik 50,000 - 440,000 490,000
4005 Danang Zak 726353 4169/ Terapi 20-May-15 Rehab Medik 50,000 - 440,000 490,000
4006 Shanaz Dwi 677115 4167/ Terapi 20-May-15 Rehab Medik 50,000 - 440,000 490,000
4007 Andhara 613425 4166/ Terapi 20-May-15 Rehab Medik 50,000 - 440,000 490,000
4008 Zahra Arsen 725126 4536/ Terapi 20-May-15 R.Medik 50,000 - 440,000 490,000
4009 Izni Almadi 835545 3033/ Terapi 20-May-15 R Medik 50,000 - 440,000 490,000
4010 M.Rizki Ra 707750 4570/ Terapi 20-May-15 R.Medik 50,000 - 220,000 270,000
4011 Ahmad Safa 658272 4184/ Ot+Tw 20-May-15 Rehab Medik 50,000 - 440,000 490,000
4012 Sakdiah 822982 2959/ Terapi 20-May-15 R Medis 50,000 - 159,500 209,500
4013 Rafa Al Fika 587094 4493/ Terapi 20-May-15 Rehab Medis 50,000 - 440,000 490,000
4014 M. Irsyad 743701 4185/ Fisioterapi 20-May-15 Rehab Medik 50,000 - 440,000 490,000
4015 Karmilah 835576 4688/ Terapi 20-May-15 R.Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4016 Miftahul Ja 615499 3050/ Terapi 20-May-15 R Medik 50,000 - 220,000 270,000
4017 Nelly 598921 2973/ Terapi 20-May-15 Rehab Medik 50,000 - 220,000 270,000
4018 Siti Ainah 438360 4686/ Terapi 20-May-15 R.Medik 50,000 - 220,000 270,000
4019 M.Reyhan M 829505 4793/ Kontrol 20-May-15 Ortophedi 50,000 35,000 85,000
4020 Sarminto 796814 4521/ Terapi 20-May-15 Rehab Medis 50,000 - 440,000 490,000
4021 Ngatin 834243 4716/ Terapi 20-May-15 R.Medik 50,000 - 440,000 490,000
4022 Erni Setiawa 132775 4687/ Terapi 20-May-15 Rehab Medis 50,000 - 220,000 270,000
4023 Siti Rahmah 742670 4183/ Fisioterapi 20-May-15 Rehab Medik 50,000 - 71,500 121,500
4024 Tinna 821536 2941/ Terapi 20-May-15 R Medik 50,000 - 71,500 121,500
4025 Merry Tabi 314620 4200/ Terapi 20-May-15 Rehab Medik 50,000 - 71,500 121,500
4026 Paridah 646528 4286/ Terapi 20-May-15 Rehab Medik 50,000 - 71,500 121,500
4027 Rosma Lela 829922 3020/ Terapi 20-May-15 R Medis 50,000 - 71,500 121,500
4028 Norliana 521951 3035/ Terapi 20-May-15 R Medik 50,000 - 159,500 209,500
4029 Honny Kusb 653592 3016/ Terapi 20-May-15 Rehab Medis 50,000 - 71,500 121,500
4030 Rubiyanti 839552 2960/ Terapi 20-May-15 R Medik 50,000 - 159,500 209,500
4031 Kasmijan 829312 4630/ Terapi 20-May-15 R.Medik 50,000 - 159,500 209,500
4032 Marsidi 720910 3002/ Terapi 20-May-15 R Medis 50,000 - 159,500 209,500
4033 H. Syamsud 775495 4363/ Terapi 20-May-15 Rehab Medik 50,000 - 220,000 270,000
4034 Hamdanah 563909 4245/ Terapi 20-May-15 Rehab Medik 50,000 - 71,500 121,500
4035 Farica B 658224 3065/ Terapi 20-May-15 R Medik 50,000 - 71,500 121,500
4036 Aswin 598995 4275/ Terapi 20-May-15 Rehab Medik 50,000 - 159,500 209,500
4037 Nunuk Puspi 805145 4365/ Terapi 20-May-15 Rehab Medik 50,000 - 71,500 121,500
4038 Kornelis Na 810504 4290/ Terapi 20-May-15 Rehab Medik 50,000 - 71,500 121,500
4039 Paulus Lai P 243271 4672/ Terapi 20-May-15 R.Medik 50,000 - 71,500 121,500
4040 Turyatman 528172 4492/ Terapi 20-May-15 R.Medik 50,000 - 159,500 209,500
4041 Endang Sula 633292 4597/ Terapi 20-May-15 R.Medik 50,000 - 71,500 121,500
4042 Marjuki 492002 4569/ Terapi 20-May-15 R.Medik 50,000 - 159,500 209,500
4043 Karmidi 619224 2944/ Terapi 20-May-15 R Medik 50,000 - 71,500 121,500
4044 Dumiatun 0 4211/ Terapi 20-May-15 Rehab Medik 50,000 - 71,500 121,500
4045 Siti Fatimah 387828 4598/ Terapi 20-May-15 R.Medik 50,000 - 159,500 209,500
4046 Erna Samun 569637 4199/ Terapi 20-May-15 Rehab Medik 50,000 - 159,500 209,500
4047 Rusmini 821169 4230/ Terapi 20-May-15 Rehab Medik 50,000 - 71,500 121,500
4048 Kamsiah 835917 4257/ Terapi 20-May-15 Rehab Medik 50,000 - 159,500 209,500
4049 Hamiah 801794 4348/ Cephalgia 20-May-15 Syaraf 50,000 - 71,500 121,500
4050 Nursiah 706603 3077/ Kontrol 20-May-15 Saraf 50,000 35,000 71,500 156,500
4051 Sripah 634302 3155/ Aschialgia 20-May-15 Saraf 50,000 35,000 159,500 244,500
4052 Yasir Am 534466 2974/ Pjk 20-May-15 Jantung 50,000 - 295,988 345,988
4053 Fatimah Az 677382 3363/ Glaukoma K 21-May-15 Mata 50,000 - 20,810 70,810
4054 Devi Pebrian 539786 5244/ G2P1A0 S/ 21-May-15 Bedah Umum 50,000 35,000 60,000 557,400 610,000 1,300 1,313,700
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4055 Cici Damaya 625654 5229/ Hipertiroid 21-May-15 P. Dalam 50,000 - 35,519 85,519
4056 Solikin 839989 3271/ Sakit Pingg 21-May-15 Urologi 50,000 - 410,200 145,200 1,963 607,363
4057 M.Santri Ka 810571 3421/ Ulkus D 21-May-15 P. Dalam 50,000 - 11,723 61,723
4058 Saniah 838344 3290/ Susp Apendic 21-May-15 P. Dalam 50,000 35,000 649,500 146,250 880,750
4059 Diah Prawita 835914 4588/ Ganglion Cy 21-May-15 Bedah Umum 50,000 - 125,000 9,125 184,125
4060 Nurdin Doni 712854 4663/ Fisioterapi 21-May-15 R.medik 50,000 35,000 71,500 649,500 24,675 830,675
4061 Sumiaty 429003 3197/ Fisiotherap 21-May-15 R Medik +Dal 50,000 35,000 159,500 18,546 263,046
4062 Asnawati 597952 3305/ Terapi + Kon 21-May-15 R Medik +Sara 50,000 35,000 71,500 5,048 161,548
4063 Subeli 238930 3196/ Fisiotherap 21-May-15 R Medik 50,000 35,000 159,500 158,063 402,563
4064 Masriah 583063 5230/ Kontrol 21-May-15 P. Dalam 50,000 - 31,481 81,481
4065 Olivia 547717 4826/ Cp+Susp Pn 21-May-15 B. Syaraf 50,000 - 17,168 67,168
4066 Sartina 797475 5196/ Epilepsi 21-May-15 Syaraf 50,000 - 85,388 135,388
4067 Sindy Aulia 838706 5168/ Batuk 2 Bln 21-May-15 Anak 50,000 - 53,017 103,017
4068 Aulia Az Za 838705 5167/ Benjolan 21-May-15 Anak 50,000 - 377,500 39,178 466,678
4069 Ida Ropidah 496479 4602/ Cephalgia 21-May-15 Syaraf 50,000 - 15,750 65,750
4070 Siti Maimun 740846 4769/ Kontrol 21-May-15 Jantung 50,000 - 281,213 331,213
4071 Ernawati 593831 5184/ Kontrol 21-May-15 Syaraf 50,000 - 14,974 64,974
4072 Siti Maimun 822088 3200/ Terapi 21-May-15 R.medik 50,000 35,000 71,500 151,468 307,968
4073 Arbayah 375329 5033/ Kontrol 21-May-15 Jantung 50,000 - 60,250 110,250
4074 Kurnia 839995 4661/ Obs Palpasi 21-May-15 Jantung 50,000 - 418,250 187,000 39,419 694,669
4075 Sulaiman 542510 4740/ Susp B 21-May-15 Paru 50,000 - 23,447 73,447
4076 M. Rosad Se 839992 4601/ Pulp. Irrever 21-May-15 Gigi&Mulut 50,000 - 115,408 93,115 2,288 260,811
4077 Ahmad Ma'R 630828 3286/ Epilepsi 21-May-15 Syaraf 50,000 - 45,094 95,094
4078 Mukaram 790881 3244/ Ht 21-May-15 Jantung 50,000 35,000 25,575 110,575
4079 Rusdiana 745347 4709/ Dm 21-May-15 P. Dalam 50,000 - 51,806 101,806
4080 Ali Akmal 482279 3245/ Asma 21-May-15 Anak 50,000 - 270,586 320,586
4081 Zubaidah 754087 5228/ Chf+Anemi 21-May-15 Jantung 50,000 - 649,500 347,800 1,047,300
4082 Supriyatin 778830 4897/ Fisioterapi 21-May-15 R.medik 50,000 35,000 71,500 305,000 10,598 472,098
4083 Rita Sahara 734234 4647/ Terapi+Susp 21-May-15 R.Medik+Bed 50,000 35,000 305,000 6,838 396,838
4084 Fakhrina R 800338 4724/ Tb Anak 21-May-15 Anak 50,000 - 43,250 188,100 14,268 295,618
4085 Nanik Nursy 829921 3259/ Kontrol 21-May-15 Gigi 50,000 35,000 33,000 160,600 31,275 309,875
4086 Rafid Charl 736801 3320/ Tw-Ot 21-May-15 R.medis 50,000 35,000 220,000 52,250 357,250
4087 Nelly Dear S 832304 5065/ Kontrol Aki 21-May-15 P. Dalam 50,000 35,000 755,400 125,400 78,603 1,044,403
4088 Kadri 604939 5079/ Pjk 21-May-15 Jantung 50,000 - 216,738 266,738
4089 Rahmatulla 814768 4736/ Spondilitis 21-May-15 Orthopedi 50,000 - 1,933 51,933
4090 Suwati 706124 4870/ Kontrol 21-May-15 Rehab Medik 50,000 35,000 159,500 703,313 947,813
4091 Zahrotunnis 576192 5169/ Hand Foot M 21-May-15 Kulit 50,000 - 33,043 83,043
4092 Anwar 811063 3273/ Kontrol 21-May-15 Mata 50,000 - 17,185 67,185
4093 Hamdiah 787800 4800/ Katarak 21-May-15 Mata 50,000 - 12,293 62,293
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4094 Sastro Saidi 327574 4677/ Dm 21-May-15 P. Dalam 50,000 - 28,575 78,575
4095 Tamrin 319921 4618/ Terapi+Ischi 21-May-15 R.medik 50,000 35,000 159,500 5,660 250,160
4096 Krisyanti El 805101 4852/ Tu Mamae S 21-May-15 Bedah Umum 50,000 35,000 27,000 112,000
4097 Rudi Harton 840568 4710/ Akd+Post S 21-May-15 P. Dalam 50,000 35,000 107,423 192,423
4098 Siti Hajrah 838703 4797/ Kontrol 21-May-15 Gigi&Mulut 50,000 - 160,600 9,125 219,725
4099 Rosma Lela 829922 4975/ Terapi 21-May-15 Syaraf 50,000 - 4,279 54,279
4100 Kasirin 648977 4785/ Myalgia 21-May-15 Syaraf 50,000 - 5,379 55,379
4101 Junaidi 834238 5140/ Vertigo 21-May-15 Syaraf 50,000 - 27,216 77,216
4102 Slamet Riya 200293 5182/ Kontrol 21-May-15 Bedah Umum 50,000 - 74,594 124,594
4103 Abdullah 775717 5214/ Kontrol 21-May-15 Mata 50,000 - 16,073 66,073
4104 Sudarti 782253 3199/ Kontrol 21-May-15 Syaraf 50,000 - 1,113 51,113
4105 Sukarno 739513 5212/ Bph 21-May-15 Urologi 50,000 - 498,413 548,413
4106 Mukhtar 691485 4781/ Kontrol 21-May-15 Mata 50,000 - 12,293 62,293
4107 Sukardi 841789 4783/ Hil D 21-May-15 Bedah Umum 50,000 - 10,800 60,800
4108 Fransisca M 838396 5153/ Struma 21-May-15 P. Dalam 50,000 - 33,413 83,413
4109 Bakri 771626 5020/ Ht 21-May-15 Jantung 50,000 - 265,963 315,963
4110 Muhammad Z840616 4695/ Dislokasi G 21-May-15 Orthopedi 50,000 - 5,308 55,308
4111 Munsyarifa 548782 5032/ Presbiopi 21-May-15 Mata 50,000 - 12,293 62,293
4112 Syahraeni 753170 4676/ Hipertiroid 21-May-15 P. Dalam 50,000 - 16,838 66,838
4113 Jariah 676633 5018/ Spendilitis 21-May-15 R.Medik+Paru 50,000 35,000 71,500 212,250 368,750
4114 Antung Ade 614841 4944/ Epilepsi 21-May-15 Syaraf 50,000 - 229,425 279,425
4115 M.Ulil Aeid 466184 5078/ Kontrol 21-May-15 Gigi&Mulut 50,000 - 207,443 3,969 261,412
4116 Rusdiana 806016 4574/ Terapi 21-May-15 R.medik 50,000 35,000 278,943 7,688 371,631
4117 Syamsinar A 840273 4814/ Orif Platting 21-May-15 Orthopedi 50,000 - 160,000 3,570 213,570
4118 Muchtar 770261 5061/ Kontrol 21-May-15 Bedah Umum 50,000 35,000 125,000 436,463 646,463
4119 Sutarti 457467 5181/ Tu Mamae 21-May-15 Bedah Umum 50,000 - 17,313 67,313
4120 Syadiah 439539 4974/ Dm 21-May-15 P. Dalam 50,000 - 886,359 936,359
4121 Rani Nopian 838709 4827/ Kontrol 21-May-15 Anak 50,000 - 8,656 58,656
4122 M. Madjdy 681701 4842/ Bronkhitis 21-May-15 Anak 50,000 - 43,024 93,024
4123 Annisa Dewi 326044 5004/ Kontrol 21-May-15 Bedah Saraf+ 50,000 35,000 220,000 105,590 410,590
4124 M.Rehan Ak 531932 5139/ Ispa Kronis 21-May-15 Anak 50,000 - 43,250 188,100 4,524 285,874
4125 Mailiyanti 755386 4942/ Post Cranio 21-May-15 B. Syaraf 50,000 35,000 187,000 309,713 581,713
4126 Sunhaji 483676 5049/ Pjk 21-May-15 Paru+Jantung 50,000 35,000 220,000 353,700 658,700
4127 Mahmudah 838707 4812/ Kontrol 21-May-15 Orthopedi 50,000 - 250,800 5,361 306,161
4128 Aspul 770059 4927/ Dm Ht 21-May-15 P. Dalam 50,000 35,000 228,936 313,936
4129 M.Reza Pah 841989 5198/ Kontrol 21-May-15 Bedah Umum 50,000 - 125,000 13,423 188,423
4130 Megawati 637197 5122/ Ht 21-May-15 Jantung 50,000 - 313,563 363,563
4131 Rokayah 834537 5092/ Kontrol 21-May-15 Kandungan 50,000 35,000 360,000 12,563 457,563
4132 Ida Hartati 394186 3260/ Chf 21-May-15 Jantung 50,000 - 87,810 137,810
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4133 Ponisah 304851 4721/ Ht Gr Ii+Di 21-May-15 Jantung 50,000 - 649,500 27,450 726,950
4134 Octa Maula 838718 5241/ Kontrol 21-May-15 Kulit 50,000 - 50,647 100,647
4135 Raihana Sal 838700 4869/ S/ Tb 21-May-15 Anak 50,000 35,000 115,000 942 200,942
4136 Ragil Fadila 822963 4739/ Bronkhopne 21-May-15 Anak 50,000 35,000 63,000 7,125 155,125
4137 Azlan Darma 792114 4929/ Terapi 21-May-15 R.medik 50,000 35,000 120,998 205,998
4138 Eko Winarsi 838399 4896/ Rinitis Alerg 21-May-15 Tht 50,000 35,000 187,000 27,975 299,975
4139 Evan Sanjay 800410 4738/ Tb Extra Pa 21-May-15 Paru+Bedah 50,000 35,000 215,456 300,456
4140 Sulaiman 831768 3350/ Tu Ileum Per 21-May-15 Bedah 50,000 35,000 125,000 12,000 222,000
4141 H.Sumiran P 695104 5154/ Kontrol 21-May-15 P. Dalam 50,000 35,000 500,250 312,916 898,166
4142 Yourdhan Fa 836415 3365/ Abses 21-May-15 Gigi & Mulut 50,000 - 3,969 53,969
4143 Karyani 453416 3407/ Dm 21-May-15 P. Dalam 50,000 - 310,513 360,513
4144 Abidin Hali 762554 4815/ Susp Chf 21-May-15 Jantung 50,000 - 334,650 384,650
4145 Masyati 838444 4874/ Chest Pain 21-May-15 Jantung 50,000 - 462,500 155,438 667,938
4146 Abdul Latif 839975 3319/ Konterol 21-May-15 Tht 50,000 - 7,448 57,448
4147 Sriyatin 838354 4987/ Lbp 21-May-15 Syaraf 50,000 35,000 4,938 89,938
4148 Sukarman 842042 4828/ Dyspepsia 21-May-15 P. Dalam 50,000 35,000 210,163 295,163
4149 Helmi 616275 4813/ Chf 21-May-15 Jantung 50,000 - 77,575 127,575
4150 Annimenna S446025 5166/ Dm Type Ii 21-May-15 P. Dalam 50,000 - 125,400 253,913 429,313
4151 Sri Usminiw 838713 3395/ Oa 21-May-15 Orthopedi 50,000 - 125,400 4,595 179,995
4152 Lina Faruki 836834 4858/ Dm+Abses 21-May-15 P.Dalam+Bed 50,000 - 797,516 847,516
4153 Lukman 775211 4845/ Hipertiroid 21-May-15 P. Dalam 50,000 - 7,639 57,639
4154 Fitri Sahwa 574388 4691/ Kontrol 21-May-15 Bedah Umum 50,000 - 125,000 86,933 261,933
4155 Suriansyah 836571 4545/ Kontrol +Te 21-May-15 Syaraf+R.Med 50,000 35,000 220,000 3,725 308,725
4156 Kartina 841529 3408/ Kontrol 21-May-15 Kandungan 50,000 - 120,500 10,573 181,073
4157 Masdar 660423 3380/ Post Stroke 21-May-15 Syaraf 50,000 - 17,666 67,666
4158 Damayanti 838717 4872/ Oma 21-May-15 Tht 50,000 - 310,500 2,261 362,761
4159 Fitra Qirann 838701 4796/ Kontrol 21-May-15 Anak 50,000 - 18,483 68,483
4160 Indra Hendr 628601 4830/ S/ Cts 21-May-15 Syaraf 50,000 - 2,716 52,716
4161 Watir Nur 838702 4798/ S Oma 21-May-15 Tht 50,000 - 35,720 85,720
4162 Nuryanti 670554 5110/ Epitaksis 21-May-15 Tht 50,000 - 8,089 58,089
4163 Lasiyem 136683 5227/ Kontrol 21-May-15 Ortophedi 50,000 35,000 215,708 300,708
4164 Sri Kusuma 494164 5200/ S/ Bronkitis 21-May-15 Paru 50,000 - 160,250 125,400 18,563 354,213
4165 Sarifudin 827535 4706/ Susp Cardio 21-May-15 Jantung 50,000 - 30,956 80,956
4166 Syaifullah 200323 5170/ Kontrol 21-May-15 Syaraf 50,000 - 49,910 99,910
4167 Raja Arrais 841173 3422/ Gea 21-May-15 Anak 50,000 - 5,658 55,658
4168 Syahrin 546131 5151/ Pjk 21-May-15 Jantung 50,000 - 185,850 235,850
4169 Kusmiyatun 586812 3391/ Snh 21-May-15 Syaraf 50,000 - 7,879 57,879
4170 Nunik Kiswa 832062 3303/ Kontrol 21-May-15 Orthopedi 50,000 - 60,000 26,543 136,543
4171 Norma Chas 669384 4856/ Hemoroid 21-May-15 Bedah Umum 50,000 - 21,244 71,244
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4172 Leny Susila 440602 3287/ Kontrol 21-May-15 P. Dalam 50,000 - 1,069,828 1,119,828
4173 Siti Nasriah 348453 3347/ Kontrol 21-May-15 Kulit+ Kelami 50,000 - 22,388 72,388
4174 Nurhayati 510570 4843/ Dm 21-May-15 P. Dalam 50,000 - 99,204 149,204
4175 Awi Am 841567 5002/ Kontrol 21-May-15 P. Dalam 50,000 35,000 401,000 305,000 57,225 848,225
4176 Darsiah 740936 4678/ Frozen Shou 21-May-15 Syaraf 50,000 35,000 71,500 3,498 159,998
4177 Inem 534202 5019/ Kontrol 21-May-15 Saraf+R.Medi 50,000 35,000 159,500 4,279 248,779
4178 Robin 508018 3333/ Dermatitis 21-May-15 Kulit+ Kelami 50,000 - 15,950 65,950
4179 Sugeng 800460 4751/ Dm+Tb 21-May-15 P. Dalam 50,000 - 765,254 815,254
4180 Wagisah 712044 4766/ Dm 21-May-15 P. Dalam 50,000 - 141,300 191,300
4181 Mochtar 837363 5048/ Kontrol 21-May-15 Jantung 50,000 - 298,388 348,388
4182 Atik Setyow 838334 3241/ Omsk 21-May-15 Tht 50,000 - 310,500 10,450 370,950
4183 Marini 416010 4631/ Cad 21-May-15 Jantung 50,000 - 60,338 110,338
4184 M. Kadri 421245 5152/ Kontrol 21-May-15 Jantung 50,000 - 96,938 146,938
4185 Juwariyah 834558 4971/ Dm 21-May-15 P. Dalam 50,000 - 402,500 635,950 28,019 1,116,469
4186 Huzway Aks 625659 4989/ Pengobatan 21-May-15 Paru 50,000 - 23,593 73,593
4187 Abdul Muin 681352 4941/ Chest Pain 21-May-15 Jantung 50,000 - 129,754 179,754
4188 Leniwaty 750017 4560/ Hipertiroid 21-May-15 P. Dalam 50,000 - 26,550 76,550
4189 Sugimin 787057 3288/ Susp Bph 21-May-15 Urologi 50,000 - 205,538 255,538
4190 Herlina Wat 658294 4928/ Hemoroid 21-May-15 Bedah 50,000 - 4,125 54,125
4191 Rustam Efen 376440 3272/ Bph 21-May-15 Urologi 50,000 - 207,500 257,500
4192 Harianto 835961 4589/ Ruptur Abse 21-May-15 Bedah Umum 50,000 - 125,000 15,206 190,206
4193 Bambang Ab 786495 4855/ Ht 21-May-15 Jantung 50,000 - 23,475 73,475
4194 Kaspul 681793 4911/ Cad+ Ht+ C 21-May-15 Jantung 50,000 - 86,400 136,400
4195 Sulastri 671941 4664/ Kontrol 21-May-15 Kandungan 50,000 - 60,000 1,513 111,513
4196 Imam Supar 839997 5063/ Iscialgia S/ 21-May-15 Syaraf 50,000 - 5,048 55,048
4197 Zainudin 739858 4990/ Ppok 21-May-15 Paru 50,000 - 28,294 78,294
4198 Rati 281072 5005/ Kontrol Ht 21-May-15 Jantung 50,000 - 251,138 301,138
4199 Amelia 535307 4617/ Susp Limfad 21-May-15 Paru 50,000 - 16,910 66,910
4200 April Liyant 806447 4543/ Trb Kelenja 21-May-15 Bedah 50,000 - 125,000 88,735 263,735
4201 Maksum 841192 4649/ Post Op Her 21-May-15 Bedah Umum 50,000 - 125,000 12,000 187,000
4202 Karessa 841170 4753/ Post Deb+Re 21-May-15 Orthopedi 50,000 - 160,000 20,074 230,074
4203 Abdul Munto614066 5035/ Nhs 21-May-15 Syaraf 50,000 - 15,266 65,266
4204 Prila Sari 146825 4956/ Kontrol 21-May-15 P. Dalam 50,000 - 18,888 68,888
4205 Desi Rusday 563820 4943/ Pjk 21-May-15 Jantung 50,000 - 59,888 109,888
4206 Darmadi 645791 3167/ Bph 21-May-15 Bedah 50,000 35,000 187,000 158,813 430,813
4207 Norsam 452574 4900/ Mata Bengk 21-May-15 Mata 50,000 - 15,623 65,623
4208 Emmy Rita 840236 5016/ Hidrocefalu 21-May-15 B. Syaraf 50,000 - 134,500 87,038 271,538
4209 Agung Suha 696610 4603/ Ht 21-May-15 Syaraf 50,000 - 280,316 330,316
4210 Sari Yatun 468588 4722/ G3P2A0+Ha 21-May-15 Kandungan 50,000 - 120,500 7,281 177,781
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4211 Wahdiah 658140 4559/ Ht 21-May-15 P. Dalam 50,000 - 12,879 62,879
4212 H. Zaeni 469838 4586/ Dyspepsia 21-May-15 P. Dalam 50,000 - 402,500 39,831 492,331
4213 Asnan Gani 549225 4768/ Bph 21-May-15 Urologi 50,000 - 205,538 255,538
4214 Gutik Setiy 331686 4868/ Struma 21-May-15 P. Dalam 50,000 - 26,581 76,581
4215 Kumala 644466 5017/ Benjolan Di 21-May-15 P. Dalam 50,000 - 500,250 50,900 601,150
4216 Tutik Rahay 742172 3214/ Kontrol 21-May-15 Saraf + Beda 50,000 35,000 120,500 14,690 220,190
4217 Parno 630939 5123/ Kontrol 21-May-15 Urologi 50,000 - 498,413 548,413
4218 Mei Selvian 796421 4854/ Cholestiasis 21-May-15 P. Dalam 50,000 - 7,656 57,656
4219 Pakkemme 839993 4945/ Triger Digit 21-May-15 Orthopedi 50,000 - 5,361 55,361
4220 Adhisty Fitr 634348 4665/ Sind Nefroti 21-May-15 Anak 50,000 - 10,200 60,200
4221 Awie Susant 438729 3227/ Pjk 21-May-15 Jantung 50,000 - 56,400 106,400
4222 Hanun Hami 702092 3242/ Gatal Selur 21-May-15 Kulit&kelami 50,000 - 15,501 65,501
4223 Juli Rahman 706197 4662/ Sn 21-May-15 Anak 50,000 - 44,250 89,775 184,025
4224 Kaminem 832943 5047/ Kontrol 21-May-15 Bedah 50,000 - 227,700 10,688 288,388
4225 Puspa Helit 765679 4898/ Nht 21-May-15 Syaraf 50,000 - 36,604 86,604
4226 Kartini 556654 4912/ Dm 21-May-15 P. Dalam 50,000 - 1,464,213 1,514,213
4227 Supiati 462546 4648/ Pjk 21-May-15 Jantung 50,000 - 67,538 117,538
4228 Juanda Fern 687081 4841/ Cerumen Ob 21-May-15 Tht 50,000 - 47,380 97,380
4229 Husni Fuadt 594427 3230/ Dm 21-May-15 P. Dalam 50,000 35,000 158,600 243,600
4230 Kasiati 477443 4770/ Susp Ca Ma 21-May-15 Bedah Umum 50,000 - 1,200,000 1,250,000
4231 Juniah 575791 5106/ Neuralgia T 21-May-15 Syaraf 50,000 - 5,656 55,656
4232 Yuni Ismawa 757299 4635/ Tb Colon 21-May-15 P. Dalam 50,000 - 78,638 128,638
4233 Gusman 494639 4957/ Dm 21-May-15 P. Dalam 50,000 - 56,813 106,813
4234 Abdul Rokh 811086 3302/ Dermatitis 21-May-15 Kulit+ Kelami 50,000 - 33,276 83,276
4235 Marieng Ap 380653 3243/ Post Snh 21-May-15 Syaraf 50,000 - 26,616 76,616
4236 Devilia Angr 772452 4725/ Sn 21-May-15 Anak 50,000 - 44,250 16,200 110,450
4237 Norman 588718 4527/ Dm + Ht 21-May-15 P. Dalam 50,000 - 60,000 110,000
4238 Tri Iswari 711664 4926/ Artritis Gou 21-May-15 Syaraf 50,000 - 9,914 59,914
4239 Ikwan Fauji 839996 5031/ Omsk 21-May-15 Tht 50,000 - 310,500 7,238 367,738
4240 Dewi Yuni L 839986 3185/ Susp Goat 21-May-15 P. Dalam 50,000 35,000 159,500 125,400 156,038 525,938
4241 Abdul Khair 780503 4619/ Terapi+Hnp 21-May-15 R.Medik+Orth 50,000 35,000 159,500 33,146 277,646
4242 Ernawati 828943 3212/ Dm 21-May-15 P. Dalam 50,000 - 60,000 110,000
4243 Supardi 825923 5107/ Struma 21-May-15 P. Dalam 50,000 - 110,250 160,250
4244 Nurlaila 336594 4707/ Tirotoksikos 21-May-15 P. Dalam 50,000 - 352,100 402,100
4245 Imelda Helm 526849 4693/ Tonsilitis 21-May-15 Tht 50,000 - 328,150 378,150
4246 Asbullah 838714 4844/ Hernia Ingui 21-May-15 Bedah Umum 50,000 - 711,150 125,400 886,550
4247 Abd Samad 716327 4913/ Cek Darah 21-May-15 P. Dalam 50,000 - 208,250 258,250
4248 Abdul Kadir 839999 5108/ Labioscizis 21-May-15 Bedah Umum 50,000 - 711,150 125,400 886,550
4249 Srianna 582160 3318/ Ht 21-May-15 P. Dalam 50,000 - 342,000 392,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4250 Masrumi 434051 5199/ Kontrol 21-May-15 P. Dalam 50,000 - 171,700 221,700
4251 Kartika Dew 640012 5062/ Kontrol 21-May-15 Kandungan 50,000 - 60,000 1,075,550 1,185,550
4252 Lehana 839924 4871/ Kista Uteri 21-May-15 Kandungan 50,000 - 60,000 1,119,800 305,000 1,534,800
4253 Evie Mansy 838712 3349/ Sup Sindrum 21-May-15 P. Dalam 50,000 - 349,000 399,000
4254 Hairul Fani 810148 4853/ Pancabutan 21-May-15 Gigi&Mulut 50,000 - 160,600 210,600
4255 Zubaidah 839990 4755/ 18 48 21-May-15 Gigi&Mulut 50,000 - 160,600 210,600
4256 David Satya 839988 3257/ Ckr 21-May-15 Bedah 50,000 - 1,248,500 1,525 1,300,025
4257 Stevi Indart 483174 4915/ Kontrol 21-May-15 Orthopedi 50,000 - 227,700 277,700
4258 Nur Rochma 839994 4972/ G3P2A0 21-May-15 Kandungan 50,000 - 120,500 305,000 475,500
4259 Candra Kasi 839987 3226/ G4 P2 A1 D 21-May-15 Kandungan 50,000 - 120,500 305,000 475,500
4260 Dika Suhary 791873 4679/ G2P1A0+Ser 21-May-15 Kandungan 50,000 - 120,500 305,000 475,500
4261 Tari Septian 671587 4799/ Menometror 21-May-15 Kandungan 50,000 - 60,000 305,000 415,000
4262 Sutrami 839991 3275/ Haid Tdk Be 21-May-15 Kandungan 50,000 - 60,000 305,000 415,000
4263 Sri Karyati 535919 4754/ Post Ab Spo 21-May-15 Kandungan 50,000 - 60,500 305,000 415,500
4264 Rukkimah 364856 3332/ G3 P2 A0 Ny 21-May-15 Kandungan 50,000 - 60,000 305,000 415,000
4265 Astri Ariest 629107 5093/ G2P1A0 21-May-15 Kandungan 50,000 - 60,000 305,000 415,000
4266 Nirmala 671467 5080/ Kontrol 21-May-15 Kandungan 50,000 - 125,500 175,000 350,500
4267 Rafliansyah 838710 3334/ Abses 21-May-15 Kandungan 50,000 - 377,500 427,500
4268 M. Said Sya 839998 4752/ Cf M 21-May-15 Anak 50,000 - 377,500 427,500
4269 Radiathan M 757684 4620/ Kontrol 21-May-15 Kandungan 50,000 - 125,500 175,000 350,500
4270 Ernawati 838720 3410/ Cek Lab 21-May-15 Patologi Anat 50,000 - 258,750 308,750
4271 Henny Yulia 613452 3377/ Hipertiroid 21-May-15 P. Dalam 50,000 - 377,500 427,500
4272 Linda Nurha 834870 4544/ 11 Pulpitis 21-May-15 Gigi&Mulut 50,000 - 722,956 772,956
4273 Taufik Nugr 839970 3451/ Benjolan Pe 21-May-15 Bedah Umum 50,000 - 50,000
4274 Nurhana 791587 5185/ Serumen 21-May-15 Tht 50,000 - 63,000 113,000
4275 Jasmah 434885 3198/ Terapi 21-May-15 Syaraf 50,000 - 159,500 209,500
4276 Mas Ud 444012 5034/ Niddm 21-May-15 Paru 50,000 - 50,000
4277 Arifin 806103 3215/ Kontrol 21-May-15 Jantung 50,000 - 50,000
4278 Ramos M. S 821826 4708/ Susp Benign 21-May-15 Urologi 50,000 - 50,000
4279 Erlin Jaya 779455 3289/ Hemaroid Gr 21-May-15 Bedah Umum 50,000 - 117,100 167,100
4280 Nurhaeda 837265 4680/ Post Sc+Ret 21-May-15 Urologi 50,000 - 132,500 182,500
4281 M Anugrah 801741 3228/ Labiopalatos 21-May-15 Gigi & Mulut 50,000 - 50,000
4282 Ika Iis Warti 584682 5243/ Kontrol 21-May-15 Gigi&Mulut 50,000 - 50,000
4283 Rufiatun 834847 4737/ 12 Caries 21-May-15 Gigi&Mulut 50,000 - 341,392 391,392
4284 Susi Susanti 834846 4692/ 1 Period 21-May-15 Gigi&Mulut 50,000 - 341,392 391,392
4285 Nia Ramadh 805154 5109/ Keloid 21-May-15 Kulit 50,000 - 115,000 165,000
4286 Barmi 838397 4829/ Lipoma 21-May-15 Bedah 50,000 35,000 187,000 272,000
4287 Suhendro 834271 3229/ Susp Hepatit 21-May-15 P. Dalam 50,000 35,000 85,000
4288 Mariani 839951 3361/ Lipoma 21-May-15 Bedah Umum 50,000 - 50,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4289 Budiono 838716 4860/ Vl Pedis 21-May-15 Bedah Umum 50,000 - 50,000
4290 Sulasiayah 836263 3304/ S Kista Mult 21-May-15 Bedah Umum 50,000 - 50,000
4291 Evan Sanjay 800410 4738/ Tb Extra Pa 21-May-15 Paru+Bedah 50,000 - 125,000 175,000
4292 Salasiah 839910 5155/ Tumor Dike 21-May-15 Bedah 50,000 - 50,000
4293 Murdiana 725568 5094/ Keloid 21-May-15 Bedah 50,000 - 120,500 170,500
4294 Suyanto 839295 5050/ Lipoma 21-May-15 Bedah 50,000 - 125,000 175,000
4295 Mantulangi 828341 4723/ Keloid 21-May-15 Bedah 50,000 - 120,500 170,500
4296 Andi Heru B 838333 5077/ Caries 6 21-May-15 Gigi&Mulut 50,000 - 722,956 772,956
4297 Sabran Rico 835978 5046/ 24 25 Perio 21-May-15 Gigi&Mulut 50,000 - 603,276 653,276
4298 Johan Dania 834568 5091/ Kontrol 21-May-15 Gigi&Mulut 50,000 - 365,360 415,360
4299 Wiwin Susan 839936 4859/ Gp 21-May-15 Gigi&Mulut 50,000 - 50,000
4300 Hariyati 780643 5211/ Kontrol 21-May-15 Mata 50,000 - 50,000
4301 Syafira Rizk 594651 3256/ Miopi 21-May-15 Mata 50,000 - 60,000 110,000
4302 M Haris 810119 3301/ Kardiomegal 21-May-15 Jantung 50,000 - 50,000
4303 Yusman 841944 4634/ Dispepsia D 21-May-15 Jantung 50,000 - 187,000 237,000
4304 Chistinawati 839909 3348/ G2P1A0 Posi 21-May-15 Kandungan 50,000 - 120,500 170,500
4305 Hersita Nov 838719 3406/ G1P0A0 S/ 21-May-15 Kandungan 50,000 - 120,500 170,500
4306 Ice Domi 838722 3423/ Ab Incomple 21-May-15 Kandungan 50,000 - 60,000 110,000
4307 Suryani 681105 5124/ Hml 38 Mgg 21-May-15 Kandungan 50,000 - 120,500 170,500
4308 Supriatin 839935 4873/ Susp Ovariu 21-May-15 Kandungan 50,000 - 60,000 110,000
4309 Merry 841522 3317/ Kontrol 21-May-15 Kandungan 50,000 - 60,000 110,000
4310 Siti Ma'Ani 796017 4694/ Ca Ovarium 21-May-15 Kandungan 50,000 - 60,000 110,000
4311 Marsianah 839968 5226/ Dislokasi 21-May-15 Orthopedi 50,000 - 50,000
4312 Sukri 463499 4515/ Terapi+ Kon 21-May-15 R.Medik+Orth 50,000 35,000 159,500 244,500
4313 Maulidiya Pu834588 5121/ Kontrol 21-May-15 B. Syaraf 50,000 - 50,000
4314 Yahmi 839969 3335/ Leokusitisis 21-May-15 P. Dalam 50,000 - 50,000
4315 Asnah 838715 4857/ Obs Febris 21-May-15 P. Dalam 50,000 - 50,000
4316 Adisti Marta 730876 3258/ Sindrom Dis 21-May-15 P. Dalam 50,000 - 50,000
4317 Adiyatama Y 335533 5183/ Obs Dispeps 21-May-15 Anak 50,000 - 4,813 54,813
4318 Rani Astuti 838704 4811/ Pterigium 21-May-15 Mata 50,000 - 12,293 62,293
4319 M.Untung B 826529 5213/ Terapi 21-May-15 R.Medik 50,000 - 220,000 270,000
4320 Yanti Sudiro 814543 5215/ Terapi 21-May-15 R.Medik 50,000 - 220,000 270,000
4321 Salwa Aulia 810576 4650/ Ft+Ot 21-May-15 R.Medik 50,000 - 440,000 490,000
4322 Ahmad Khoi 671879 4528/ Fisioterapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4323 Mariam Ulfa 834596 4899/ Terapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4324 M.Sefianto 729676 5242/ Terapi 21-May-15 R.Medik 50,000 - 220,000 270,000
4325 Muhammadn666097 4883/ Terapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4326 M.Fahri Ibr 729530 4839/ Terapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4327 Nabila Syifa 330529 4646/ Terapi 21-May-15 R.Medik 50,000 - 220,000 270,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4328 Nabila Tasy 828519 4914/ Terapi 21-May-15 R.Medik 50,000 - 220,000 270,000
4329 Sarman 759016 4604/ Fisioterapi 21-May-15 R.Medik 50,000 - 220,000 270,000
4330 M.Yusuf 781487 5138/ Terapi 21-May-15 R.Medik 50,000 - 220,000 270,000
4331 M. Kenzie A 679791 3331/ Fisioterapi 21-May-15 R.Medik 50,000 - 220,000 270,000
4332 Tazkiah Aul 838494 3316/ Terapi 21-May-15 R Medik 50,000 - 440,000 490,000
4333 Aisyah Nabi 485975 3437/ Terapi 21-May-15 R Medik 50,000 - 440,000 490,000
4334 M.Hasby 485975 3436/ Terapi 21-May-15 R Medik 50,000 - 440,000 490,000
4335 Abdillah Fik 488012 3364/ Terapi 21-May-15 R Medik 50,000 - 220,000 270,000
4336 Winona 337477 5197/ Terapi 21-May-15 R Medik 50,000 - 220,000 270,000
4337 H. Syamsud 775495 4782/ Terapi+Sinu 21-May-15 Tht 50,000 35,000 220,000 305,000
4338 Risa Ifana 829483 3392/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4339 Suswati 839954 5136/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4340 Tan Lan Tju 810556 3394/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4341 Bandi Batha 738114 3440/ Terapi 21-May-15 R Medik 50,000 - 159,500 209,500
4342 Siti Kalsum 783907 3393/ Terapi 21-May-15 R Medik 50,000 - 159,500 209,500
4343 Mirah 142607 3438/ Fisioterapi 21-May-15 R Medik 50,000 - 71,500 121,500
4344 Rohanah 522050 3362/ Terapi 21-May-15 R Medik 50,000 - 71,500 121,500
4345 Dewi Kartik 824703 3378/ Terapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4346 Masrun Maj 639948 3376/ Fisioterapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4347 Jasmani 822971 3439/ Terapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4348 Kasmijan 829312 5095/ Terapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4349 Ida Rachma 764193 5137/ Fisioterapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4350 Noor Patima 622484 3424/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4351 Vicauli Abd 791029 3379/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4352 Ismul Izmi 496487 3425/ Terapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4353 Ahmad Toba 838376 4767/ Terapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4354 Masrianah 757620 5125/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4355 Murtini 757462 3346/ Fisioterapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4356 Ilham 701960 4784/ Fisioterapi 21-May-15 R.Medik 50,000 - 220,000 270,000
4357 Nurdin Baru 390697 4542/ Terapi 21-May-15 R.Medik 50,000 - 220,000 270,000
4358 Maini 729644 4556/ Fisioterapi 21-May-15 R.Medik 50,000 - 220,000 270,000
4359 Matrup 345802 4573/ Fisioterapi 21-May-15 R.Medik 50,000 - 220,000 270,000
4360 Rudi Herma 743463 3409/ Terapi 21-May-15 R.Medik 50,000 - 220,000 270,000
4361 Norliana 521951 5001/ Terapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4362 Sri Kuswati 834801 4959/ Terapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4363 Yuliana 625938 4973/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4364 Kapsah 791022 4960/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4365 Aisjah Joha 796894 4840/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4366 Hartini Joha 769333 4851/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4367 Suparmi 532171 4605/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4368 M. Nasir 594648 4616/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4369 Kasdi 834604 4884/ Terapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4370 Aisyah 734989 4885/ Fisioterapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4371 H. M. Kosi 750140 4514/ Terapi 21-May-15 R Medik 50,000 - 159,500 209,500
4372 Murni Asih 361477 4587/ Terapi 21-May-15 R Medik 50,000 - 159,500 209,500
4373 Yuliani 285668 4882/ Terapi 21-May-15 R Medik 50,000 - 159,500 209,500
4374 Fatma 433683 3274/ Terapi 21-May-15 R Medik 50,000 - 71,500 121,500
4375 Sukartini 835988 5064/ Terapi 21-May-15 R Medik 50,000 - 159,500 209,500
4376 Suparti 487344 3213/ Terapi 21-May-15 R Medik 50,000 - 71,500 121,500
4377 Ngatemi 565526 4632/ Terapi 21-May-15 R Medik 50,000 - 159,500 209,500
4378 Hemi 835300 4986/ Terapi 21-May-15 R Medik 50,000 - 71,500 121,500
4379 H. Mudarin 585074 4590/ Terapi 21-May-15 R Medik 50,000 - 71,500 121,500
4380 Nurhadiyant 320110 4633/ Terapi 21-May-15 R Medik 50,000 - 71,500 121,500
4381 Norma 839915 4958/ Terapi 21-May-15 R Medik 50,000 - 71,500 121,500
4382 Buatik 824550 4988/ Terapi 21-May-15 R Medik 50,000 - 159,500 209,500
4383 Rubiyanti 835952 4881/ Terapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4384 Supatmi 705133 3211/ Terapi 21-May-15 R.Medik 50,000 - 159,500 209,500
4385 Iskandar 077736 4930/ Terapi 21-May-15 R.Medik 50,000 - 71,500 121,500
4386 Nur Soffiyy 826786 4571/ Terapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4387 Aly Syawal 810107 4529/ Tw+Ot 21-May-15 R.Medik 50,000 - 440,000 490,000
4388 Izzati Fadhi 706890 4541/ Terapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4389 M. Rizky R 828577 4526/ Ot+Tw 21-May-15 R.Medik 50,000 - 440,000 490,000
4390 Rafael Ham 757444 4530/ Ot+Tw 21-May-15 R.Medik 50,000 - 440,000 490,000
4391 Aris Rahman 784378 4867/ Terapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4392 Raudah 826607 4557/ Terapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4393 Sugiyanto 748332 4866/ Fisioterapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4394 Hasnawati 762606 4512/ Terapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4395 Hamdanah 790973 4572/ Terapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4396 Karsuni 825954 4558/ Terapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4397 Ponijem 659169 4513/ Fisioterapi 21-May-15 R.Medik 50,000 - 440,000 490,000
4398 Abd. Latif 709856 5575/ Bph 22-May-15 Urologi 50,000 - 335,000 205,538 590,538
4399 Iban Asa 316023 4917/ Pjk 22-May-15 Jantung 50,000 - 204,225 254,225
4400 Masrumi 434051 5392/ Kontrol 22-May-15 Peny.Dalam 50,000 35,000 12,293 97,293
4401 Mahrita 834539 5332/ Kontrol 22-May-15 Rehab Medik+ 50,000 35,000 71,500 16,345 172,845
4402 Sulastri 835993 5096/ Ganglion Cys 22-May-15 Bedah Umum 50,000 - 125,000 8,363 183,363
4403 Yulius Taya 828254 5406/ C/ Ca Nasof 22-May-15 Tht 50,000 - 25,945 75,945
4404 Akhmad Mun441709 4962/ Kontrol 22-May-15 Jiwa 50,000 - 194,250 244,250
4405 Syarifuddin 748276 4887/ Dm+Ht 22-May-15 Penyakit Dala 50,000 - 171,263 221,263
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4406 Dg Tompo 763716 5496/ Susah Bak 22-May-15 Urologi 50,000 - 205,538 255,538
4407 Reni 842197 5084/ Post Sc 22-May-15 Kandungan 50,000 - 122,000 10,399 182,399
4408 Antika Sari 841982 3543/ Kontrol 22-May-15 Kandungan 50,000 - 120,500 3,663 174,163
4409 Nanda Yola 257610 5362/ Kontrol 22-May-15 Kulit Kelamin 50,000 - 55,163 105,163
4410 Yadi 841666 5391/ Kontrol 22-May-15 Urologi 50,000 - 5,275 55,275
4411 Rizky Sulist 748957 3527/ Tu Colli 22-May-15 Onkologi 50,000 - 134,500 6,625 191,125
4412 Nita Larasat 425542 5378/ Kontrol 22-May-15 Peny.Dalam 50,000 - 987,808 1,037,808
4413 Jibril Nash 838733 5500/ Kontrol 22-May-15 Kulit Kelamin 50,000 - 16,950 66,950
4414 Martha Ban 787713 5051/ Limfadeniti 22-May-15 Tht 50,000 - 8,763 58,763
4415 Tual Arjan 839942 5407/ Bph 22-May-15 Urologi 50,000 - 205,538 255,538
4416 Yusuf 439803/3362795513/ Decom 22-May-15 Jantung 50,000 - 168,563 218,563
4417 Syahidin 0 3466/ Kontrol 22-May-15 Saraf 50,000 - 20,681 70,681
4418 Marjuki 492002 5316/ Kontrol 22-May-15 R.Medik+Jant 50,000 35,000 71,500 78,654 235,154
4419 Hajirin 816795 5055/ Post Op Kat 22-May-15 Mata 50,000 - 12,760 62,760
4420 Linda Nurha 834870 5347/ 11 Pulp Irev 22-May-15 Gigi&Mulut 50,000 - 207,443 7,938 265,381
4421 H.Syahrul T 486010 5258/ Pjk 22-May-15 Jantung 50,000 35,000 219,500 305,000 326,888 936,388
4422 Hasmiati 838739 3590/ Ada Benjola 22-May-15 Tht 50,000 - 122,500 9,963 182,463
4423 Sujarni 800848 5361/ Kontrol 22-May-15 R.Medik+Sara 50,000 35,000 71,500 26,291 182,791
4424 Eko Budi S. 829994 5099/ Gastritis 22-May-15 Penyakit Dala 50,000 - 7,069 57,069
4425 Nur Asiah 817162 5177/ Post Op My 22-May-15 Kandungan 50,000 - 120,500 6,588 177,088
4426 Faisri Fatma 841715 4979/ Snh 22-May-15 Syaraf 50,000 35,000 71,500 22,093 178,593
4427 Zainul Shol 796423 4889/ Terapi+Vert 22-May-15 R.Medik+Syar 50,000 35,000 71,500 15,729 172,229
4428 Rusmini 821169 5260/ Terapi 22-May-15 R.Medik 50,000 35,000 159,500 15,091 259,591
4429 Suyanto 445829 4886/ Terapi+Ceph 22-May-15 R.Medik+Syar 50,000 35,000 71,500 28,916 185,416
4430 Ibnu Riski 747841 5070/ Snh 22-May-15 Syaraf 50,000 - 122,041 172,041
4431 Hari Pujiant 632567 5066/ Epilepsi 22-May-15 Syaraf 50,000 - 355,000 28,463 433,463
4432 Ponidi 838736 5541/ Bsk 22-May-15 Urologi 50,000 - 1,963 51,963
4433 Lisnawati 786215 3574/ Kontrol 22-May-15 Tht 50,000 - 722,250 56,100 828,350
4434 Misnan 641204 5543/ Chd 22-May-15 Jantung 50,000 - 74,138 124,138
4435 Juhariyah 839945 5010/ Kontrol 22-May-15 Penyakit Dala 50,000 - 14,513 64,513
4436 Nursiana 409046 5052/ Post Stroke 22-May-15 Syaraf 50,000 - 22,666 72,666
4437 M.Afren Ag 743287 5529/ Kontrol 22-May-15 Syaraf 50,000 - 997,700 87,588 1,135,288
4438 Ngatiri 681620 3571/ Susp Dispep 22-May-15 Dalam 50,000 35,000 159,500 5,494 249,994
4439 Verja Prata
838385/4418094978/ Hipospendia 22-May-15 Bedah Anak 50,000 35,000 20,826 105,826
4440 M Arafah 838755 5206/ Ht 22-May-15 Jantung 50,000 - 1,167,000 23,813 1,240,813
4441 Puspari Had 834815 5069/ Ht+Dm 22-May-15 Jantung 50,000 - 158,813 208,813
4442 Leyla Anjan 042505 3542/ Susp Epileps 22-May-15 Saraf 50,000 - 87,188 137,188
4443 Sumiarsih 677525 5006/ Ca Mamae S 22-May-15 Onkologi 50,000 - 327,000 492,250 125,400 8,600 1,003,250
4444 Aflus 494551 5022/ Kontrol 22-May-15 Syaraf 50,000 - 7,836 57,836
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4445 Sasmo Wijo 838426 5114/ Susp Bph 22-May-15 Urologi 50,000 - 292,875 342,875
4446 Endah Setia 838730 3589/ Kontrol 22-May-15 Kandungan 50,000 - 60,000 438,400 305,000 53,625 907,025
4447 M.Untung B 826529 5422/ Kontrol 22-May-15 Urologi 50,000 - 335,000 33,132 418,132
4448 Masliyah 453712 4949/ Cephalgia 22-May-15 Syaraf 50,000 - 48,684 98,684
4449 Laminem 839953 5527/ Hemoptitis 22-May-15 Paru 50,000 - 63,938 113,938
4450 Mujiono 421947 5025/ Post Op Byp 22-May-15 Jantung 50,000 35,000 87,438 172,438
4451 M. Nasir Fad 626522 5098/ Chf 22-May-15 Jantung 50,000 35,000 160,250 190,400 435,650
4452 Rubaya 433028 5497/ Obs Chest P 22-May-15 Jantung 50,000 - 276,438 326,438
4453 Prawati 839950 4948/ Akd 22-May-15 Penyakit Dala 50,000 - 227,250 277,250
4454 Yordan Hr 829703 4933/ Obs Nyeri A 22-May-15 Penyakit Dala 50,000 35,000 1,963 86,963
4455 Supian 806445 4977/ Cephalgia 22-May-15 Syaraf 50,000 - 46,548 96,548
4456 Fitri 633209 4890/ Chf 22-May-15 Jantung 50,000 - 190,950 240,950
4457 Eddy L 764183 5395/ Oedem 22-May-15 Peny.Dalam 50,000 - 14,325 64,325
4458 Hj.Syamsina 525903 5289/ Rhinitis Ale 22-May-15 Paru 50,000 - 16,449 66,449
4459 Kornelis Na 810504 4932/ Hnp+Ht 22-May-15 Syaraf 50,000 - 19,193 69,193
4460 Yayuk Puji 841493 3528/ Kontrol 22-May-15 Kandungan 50,000 - 60,000 14,433 124,433
4461 Rini Dwi Ast 838724 5380/ Asma Bronk 22-May-15 Paru 50,000 - 170,000 164,525 384,525
4462 Rusdiana No 810566 5038/ Ppok+Susp 22-May-15 Paru 50,000 - 28,013 78,013
4463 Candra Kasi 839982 5144/ G4P2A1 22-May-15 Kandungan 50,000 - 120,500 7,931 178,431
4464 Ibas 835912 5526/ Tumor 22-May-15 Bedah Umum 50,000 - 7,938 57,938
4465 Moh Rosyad 775198 3498/ Crf + Chf 22-May-15 Dalam 50,000 35,000 305,000 368,400 758,400
4466 Bachrun Al 826949 3572/ Kontrol 22-May-15 Dalam 50,000 - 51,706 101,706
4467 Marlinda Sur 841652 5128/ Post Sc 22-May-15 Kandungan 50,000 - 120,500 8,806 179,306
4468 Agustina R 842097 3605/ Kontrol 22-May-15 Kandungan 50,000 - 120,500 12,569 183,069
4469 Anitasari 839931 3619/ Tu Colli 22-May-15 Bedah Umum 50,000 - 4,413 54,413
4470 St Mariam 757464 3512/ Ishelgia + H 22-May-15 Saraf +Jantun 50,000 35,000 280,093 365,093
4471 Rina Anisa 840600 5112/ Kontrol 22-May-15 Kandungan 50,000 - 60,000 8,269 118,269
4472 Edy Asmaun 841601 5511/ Kontrol 22-May-15 Bedah Umum 50,000 - 2,400 52,400
4473 Rusmini 607352 3557/ Kontrol 22-May-15 Saraf 50,000 - 36,779 86,779
4474 Suwarni 828558 3556/ Lbp 22-May-15 Saraf 50,000 - 22,410 72,410
4475 Naswa Febri 839911 4976/ Hemangiom 22-May-15 Anak 50,000 35,000 2,004 87,004
4476 Siti Rahmah 776854 5163/ Susp Struma 22-May-15 Onkologi 50,000 35,000 46,238 131,238
4477 La Kunnu 836504 5542/ Hemiparase 22-May-15 Peny.Dalam 50,000 - 633 50,633
4478 Dewi Kartik 824703 5176/ Fr Wajah+Or 22-May-15 Mata 50,000 35,000 71,500 25,956 182,456
4479 Anita Tursia 800434 5021/ Epilepsi 22-May-15 Syaraf 50,000 - 75,975 125,975
4480 Asniawati 409171 3620/ Nddm + Gan 22-May-15 Dalam + Bed 50,000 - 110,250 142,741 302,991
4481 Rahmatika 838752 5156/ Kontrol 22-May-15 Penyakit Dala 50,000 - 456,500 105,600 5,163 617,263
4482 Iis Hastuti 835363 5468/ Terapi 22-May-15 R.Medik 50,000 35,000 71,500 7,700 164,200
4483 M.Ishak Dj 628589 5424/ Kontrol 22-May-15 Peny.Dalam 50,000 - 90,306 140,306
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4484 Zahra Dewi 796473 3575/ 4 6 |Pulpitis 22-May-15 Gigi & Mulut 50,000 - 23,180 73,180
4485 Yauce Mane 768879 4902/ Pjk 22-May-15 Jantung 50,000 - 283,113 333,113
4486 Ijum 775736 5275/ Kontrol 22-May-15 Syaraf 50,000 70,000 37,885 157,885
4487 Bagus Derm 841729 3499/ Kontrol 22-May-15 Anak 50,000 - 6,400 56,400
4488 Cholid Dan 775106 5365/ Cholelitiasis 22-May-15 Peny.Dalam 50,000 - 983,400 1,033,400
4489 Neneng Dam 472843 4918/ Kolik Abd 22-May-15 Penyakit Dala 50,000 - 215,750 3,663 269,413
4490 M.Andy Sudr828560 5571/ Epilepsi 22-May-15 Syaraf 50,000 - 14,535 64,535
4491 Sumiati 838715 5129/ Vertigo 22-May-15 Syaraf 50,000 - 997,700 71,330 1,119,030
4492 M Rasyid Ar 838382 5180/ Kontrol 22-May-15 Saraf 50,000 - 10,905 60,905
4493 Tuti Indrawa 828979 5452/ Cepalgia 22-May-15 Syaraf 50,000 - 997,700 18,355 1,066,055
4494 Alana Aftar 834879 3601/ Kontrol 22-May-15 Bedah Anak 50,000 35,000 94,475 179,475
4495 M Iksan Had 702252 5194/ Epilepsi 22-May-15 Saraf 50,000 - 156,750 206,750
4496 Yudi Gunars 725539 5245/ Kontrol 22-May-15 Syaraf 50,000 - 18,629 68,629
4497 Daifah Nur 697251 5115/ Abses 22-May-15 Gigi&Mulut 50,000 - 362,633 160,600 5,606 578,839
4498 Akbar Alfari 841603 3618/ Kontrol 22-May-15 Anak 50,000 - 7,291 57,291
4499 Karmila Sar 462492 3633/ Bumil Dng H 22-May-15 Kandungan 50,000 - 120,500 438,400 34,563 643,463
4500 Sumiati 715110 3501/ Kontrol 22-May-15 Dalam 50,000 35,000 64,605 149,605
4501 Sarah 835367 4993/ Terapi+Kont 22-May-15 R.Medik+Syar 50,000 35,000 71,500 8,705 165,205
4502 Darmiati 667292 4919/ Terapi 22-May-15 Rehab Medik 50,000 35,000 71,500 10,133 166,633
4503 Masniah 441498 5559/ Myalgia 22-May-15 Syaraf 50,000 - 997,700 10,268 1,057,968
4504 Agustina Wu 811689 5161/ Ispa 22-May-15 Anak 50,000 - 27,384 77,384
4505 Ana Muryan 842062 3587/ Kontrol 22-May-15 Jantung 50,000 35,000 187,000 430,838 702,838
4506 Rusma Santi 839926 5037/ 8 Impaksi 22-May-15 Gigi&Mulut 50,000 - 8,363 58,363
4507 Supardi 835923 4992/ Struma 22-May-15 Bedah Umum 50,000 35,000 24,713 109,713
4508 Warni Safrie 248798 5145/ Hypertiroid 22-May-15 Penyakit Dala 50,000 - 16,838 66,838
4509 Jumansyah 159732 3485/ Cad 22-May-15 Jantung 50,000 35,000 41,238 126,238
4510 Heni 838753 5159/ Obs Abd Pai 22-May-15 Kandungan 50,000 - 466,000 1,119,800 258,750 430,400 38,156 2,363,106
4511 Tiara Nalian 841850 5409/ Kontrol 22-May-15 Bedah Umum 50,000 35,000 11,500 96,500
4512 Aslan Al Uz 835522 3617/ Diare Lama 22-May-15 Anak 50,000 - 62,897 112,897
4513 Susmiro 839913 5024/ Susp Otitis 22-May-15 Tht 50,000 - 310,500 102,338 462,838
4514 Rusmiati 714771 4963/ Ht+Dm 22-May-15 Penyakit Dala 50,000 - 252,500 9,188 311,688
4515 Misah 558245 5334/ Dm Ht 22-May-15 Peny.Dalam 50,000 35,000 649,500 149,004 883,504
4516 Jubert Yani 788966 4980/ Pjk 22-May-15 Jantung 50,000 - 462,500 210,413 722,913
4517 Zubir Usma 609415 4920/ Pjk 22-May-15 Jantung 50,000 - 62,138 112,138
4518 Siti Aisyah 451373 5331/ Snh 22-May-15 Syaraf 50,000 - 59,641 109,641
4519 Afrizal M. A 838322 5067/ Demam Typ 22-May-15 Anak 50,000 - 56,890 106,890
4520 Yati 841880 5376/ Kontrol 22-May-15 Jantung 50,000 - 462,500 17,831 530,331
4521 Hj.Syamsina 525903 5289/ Rhinitis Ale 22-May-15 Paru 50,000 - 24,429 74,429
4522 Indarwati 138856 5379/ Hipertiroid 22-May-15 Peny.Dalam 50,000 35,000 498,638 583,638
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4523 Yoggi Adam 829594 5514/ Ompk 22-May-15 Tht 50,000 - 10,400 60,400
4524 Bahruddin 711460 5036/ Kista M 22-May-15 Bedah Umum 50,000 - 125,000 6,838 181,838
4525 Turyatman 528172 5318/ Kontrol 22-May-15 Tht 50,000 - 310,500 7,794 368,294
4526 Satber 800313 5317/ S/ Colealitia 22-May-15 Peny.Dalam 50,000 - 8,150 58,150
4527 M. Akyas Ar 837685 4904/ Kontrol 22-May-15 Syaraf 50,000 - 57,000 173,938 280,938
4528 Andre Prata 835578 4901/ Kista Epide 22-May-15 Bedah Umum 50,000 - 125,000 6,838 181,838
4529 Meilan Novi 838726 5410/ S/ Fam 22-May-15 Onkologi 50,000 - 377,500 427,500
4530 Rika Fitrian 584936 4888/ Hipertiroid+ 22-May-15 Tht 50,000 - 377,500 427,500
4531 Sawiyah 734239 3588/ Bumil Uk 3 22-May-15 Kandungan 50,000 - 120,500 305,000 475,500
4532 Adiyatama Y 335533 5483/ Obs Dispeps 22-May-15 Anak 50,000 - 997,700 1,047,700
4533 Rukini 838723 5350/ Lipoma 22-May-15 Bedah Umum 50,000 - 394,150 377,500 125,400 947,050
4534 Hasitah 838727 3541/ Susp Limpo 22-May-15 Bedah Umum 50,000 - 394,150 125,400 569,550
4535 Samsiah 835347 5008/ Obs Kista O 22-May-15 Kandungan 50,000 - 60,000 305,000 415,000
4536 Sri Mulyani 838738 5085/ 46 Caries 22-May-15 Gigi&Mulut 50,000 - 91,340 93,115 234,455
4537 Khairun Nis 838725 4934/ 2 Gp 22-May-15 Gigi&Mulut 50,000 - 93,115 143,115
4538 Rusna 227288 5455/ Gromulomat 22-May-15 Bedah Umum 50,000 - 109,250 125,400 284,650
4539 Maslamah 445474 5439/ Stt 22-May-15 Bedah Umum 50,000 - 394,150 125,400 569,550
4540 Ummi Kult 838708 5436/ S/ Hernia In 22-May-15 Bedah Anak 50,000 - 343,650 105,600 499,250
4541 Sumarsih 835588 5466/ Abd Discomf 22-May-15 Peny.Dalam 50,000 35,000 60,000 1,617,400 125,400 1,887,800
4542 Hendra Abdu 838731 5023/ Susp Isk 22-May-15 Kulit Kelamin 50,000 - 113,250 163,250
4543 Tika Saitun 838737 5082/ Susp Kista 22-May-15 Bedah Umum 50,000 - 460,150 510,150
4544 Tukinah 800459 4991/ Ca Mamae 22-May-15 Bedah Umum 50,000 - 426,250 476,250
4545 Uci Yumina 743954 5039/ Hipertiroid 22-May-15 Penyakit Dala 50,000 - 352,100 402,100
4546 Sulaikah 654489 5290/ Kontrol 22-May-15 Peny.Dalam 50,000 - 110,250 160,250
4547 Said Muhtar 265409 4935/ Gea+Hemor 22-May-15 Bedah Umum 50,000 - 117,100 502,450 669,550
4548 Siti Fatimah 806720 5586/ Ca Paru Sd 22-May-15 Paru 50,000 - 76,250 126,250
4549 Siti Mujiati 797048 5083/ 112 22-May-15 Vct 50,000 - 162,320 212,320
4550 Rafliansyah 838710 5097/ Abses 22-May-15 Bedah Umum 50,000 - 711,150 761,150
4551 Rika Sartika 838321 5009/ G2P1A0+He 22-May-15 Kandungan 50,000 - 120,500 438,400 608,900
4552 Norsehan 841416 5394/ Kontrol 22-May-15 Peny.Dalam 50,000 35,000 60,000 438,400 583,400
4553 Nur Rochma 839994 5111/ G3P2A0+An 22-May-15 Kandungan 50,000 - 120,500 438,400 608,900
4554 Nurzaini 833245 4947/ Bph 22-May-15 Urologi 50,000 - 361,150 411,150
4555 Munira 752752 4961/ Hep B 22-May-15 Penyakit Dala 50,000 - 66,000 116,000
4556 Mega Karin 838728 3559/ G3 P1 A1 Dng22-May-15 Kandungan 50,000 - 120,500 438,400 608,900
4557 Megah Br M 838754 5178/ Snt+Pro Kur 22-May-15 Laboratorium 50,000 - 498,800 548,800
4558 Islamidah 515794 3468/ Cek Lab 22-May-15 Laboratorium 50,000 - 110,250 160,250
4559 Kastono 806701 5453/ Ca Paru 22-May-15 Paru 50,000 - 76,250 126,250
4560 Anisa Nastit 591823 3530/ Ca Thiroid 22-May-15 Onkologi 50,000 - 120,700 170,700
4561 Arjinah 615691 5437/ Dm 22-May-15 Peny.Dalam 50,000 - 110,250 160,250
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4562 Asnan Gani 549225 4994/ Bph 22-May-15 Urologi 50,000 - 335,000 430,200 815,200
4563 Shella Angg 554945 5544/ Gatal2 22-May-15 Kulit Kelamin 50,000 - 207,000 257,000
4564 Musningsih 549641 4916/ Terapi 22-May-15 Rehab Medik 50,000 - 71,500 121,500
4565 Ratna 821500 5335/ Terapi 22-May-15 R.Medik 50,000 - 159,500 209,500
4566 Sujitno 835911 5319/ Terapi 22-May-15 R.Medik 50,000 - 159,500 209,500
4567 Merry Taby 314620 5287/ Terapi 22-May-15 R.Medik 50,000 - 71,500 121,500
4568 Wahyu Hand 697153 3481/ Terapi 22-May-15 Rhb Medis 50,000 - 71,500 121,500
4569 Sumiati 671273 3469/ Fisioterapi 22-May-15 Rhb Medis 50,000 - 71,500 121,500
4570 Afif Piliang 781444 3453/ Fisioterapi 22-May-15 Rehab Medis 50,000 - 71,500 121,500
4571 Asih Sunars 829585 5273/ Terapi 22-May-15 R.Medik 50,000 - 71,500 121,500
4572 Ernawaty 525416 3482/ Terapi 22-May-15 Rehab Medis 50,000 - 159,500 209,500
4573 Fatimah 380727 5363/ Terapi 22-May-15 R.Medik 50,000 - 71,500 121,500
4574 Achmadsya 465433 5364/ Terapi 22-May-15 R.Medik 50,000 - 71,500 121,500
4575 Siti Fatimah 387828 5346/ Terapi 22-May-15 R.Medik 50,000 - 71,500 121,500
4576 Sayem 835998 3497/ Terapi 22-May-15 R Medik 50,000 - 71,500 121,500
4577 Sakdiah 822982 5256/ Terapi 22-May-15 R.Medik 50,000 - 159,500 209,500
4578 Kisnan 431632 5333/ Terapi 22-May-15 R.Medik 50,000 - 71,500 121,500
4579 Supiah 475816 4903/ Terapi 22-May-15 Rehab Medik 50,000 - 159,500 209,500
4580 Murikah 598534 5320/ Terapi 22-May-15 R.Medik 50,000 - 71,500 121,500
4581 H Syamsudd 775495 3500/ Terapi 22-May-15 R Medik 50,000 - 71,500 121,500
4582 Yenni Purwa 631789 4946/ Terapi 22-May-15 Rehab Medik 50,000 - 159,500 209,500
4583 Minong 648247 5454/ Terapi 22-May-15 R.Medik 50,000 - 159,500 209,500
4584 Nurhaidah 061430 3526/ Terapi 22-May-15 R Medis 50,000 - 159,500 209,500
4585 J.Marni 664975 5305/ Fisioterapi 22-May-15 Rehab Medik 50,000 - 159,500 209,500
4586 Ahmad Suda 581234 3455/ Terapi 22-May-15 R Medijk 50,000 - 159,500 209,500
4587 Suryanti 720793 3454/ Fisioterapi 22-May-15 Rehab Medis 50,000 - 159,500 209,500
4588 Sabariyah 016859 5301/ Fisioterapi 22-May-15 Rehab Medis 50,000 - 159,500 209,500
4589 Sriani 346142 5303/ Terapi 22-May-15 R.Medik 50,000 - 159,500 209,500
4590 Rubiyanti 835952 3467/ Terapi 22-May-15 R Medik 50,000 - 159,500 209,500
4591 Sumiati 663502 5304/ Terapi 22-May-15 R.Medik 50,000 - 159,500 209,500
4592 Marida 647710 3452/ Terapi 22-May-15 Rehab Medis 50,000 - 159,500 209,500
4593 Hamdanah 563909 3470/ Terapi 22-May-15 Rehab Medis 50,000 - 159,500 209,500
4594 Warni 753983 3496/ Terapi 22-May-15 R Medik 50,000 - 159,500 209,500
4595 Masrah 677735 5421/ Terapi 22-May-15 R.Medik 50,000 - 71,500 121,500
4596 Supriani 639809 4964/ Fisioterapi 22-May-15 Rehab Medik 50,000 - 159,500 209,500
4597 Wakiyem 701255 4965/ Terapi 22-May-15 Rehab Medik 50,000 - 71,500 121,500
4598 Ramlah Has 619115 5467/ Terapi 22-May-15 R.Medik 50,000 - 71,500 121,500
4599 Rabiatul Ad 602715 5451/ Terapi 22-May-15 R.Mdik 50,000 - 159,500 209,500
4600 Sumiyat 821102 5556/ Terapi 22-May-15 R.Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4601 Winona Dest 337477 5162/ Terapi 22-May-15 Rehab Medik 50,000 - 71,500 121,500
4602 Abdul Latif 839975 5560/ Terapi 22-May-15 R.Medik 50,000 - 71,500 121,500
4603 Hasnawati 718846 5165/ Terapi 22-May-15 Rehab Medik 50,000 - 159,500 209,500
4604 Kamakko R 666972 5469/ Terapi 22-May-15 R.Medik 50,000 - 159,500 209,500
4605 Ernawaty 124241 5054/ Terapi 22-May-15 Rehab Medik 50,000 - 71,500 121,500
4606 Paridah 646528 5158/ Terapi 22-May-15 Rehab Medik 50,000 - 71,500 121,500
4607 Norhidayah 712385 5126/ Terapi 22-May-15 Rehab Medik 50,000 - 159,500 209,500
4608 Akhmad Sya 763738 5423/ Lbp 22-May-15 Syaraf 50,000 35,000 159,500 244,500
4609 Nani 683573 5157/ Terapi 22-May-15 Rehab Medik 50,000 - 159,500 209,500
4610 Rakavino Yu 528783 5288/ Terapi 22-May-15 R.Medik 50,000 - 220,000 270,000
4611 Annisa Hima 781563 5274/ Terapi 22-May-15 R.Medik 50,000 - 440,000 490,000
4612 Zema Riski 739218 5271/ Terapi 22-May-15 R.Medik 50,000 - 440,000 490,000
4613 Andy K P 706211 5193/ Fisioterapi 22-May-15 Rehab Medik 50,000 - 159,500 209,500
4614 Radeng 560193 5195/ Terapi 22-May-15 Rehab Medik 50,000 - 159,500 209,500
4615 Donatianus 811513 5007/ Terapi 22-May-15 Rehab Medik 50,000 - 379,500 429,500
4616 Gimun 695987 5272/ Fisioterapi 22-May-15 R.Medik 50,000 - 440,000 490,000
4617 H Bambang 829576 3484/ Terapi 22-May-15 R Medik 50,000 - 440,000 490,000
4618 Tunikah 796098 5040/ Terapi 22-May-15 Rehab Medik 50,000 - 440,000 490,000
4619 Nasywa Qon 706135 4995/ Fisioterapi 22-May-15 Rehab Medik 50,000 - 440,000 490,000
4620 Ridho Abrar 779669 5141/ Terapi 22-May-15 Rehab Medik 50,000 - 220,000 270,000
4621 Marsya Chel 481040 5130/ Ft+Ot 22-May-15 Rehab Medik 50,000 - 220,000 270,000
4622 Hafiz Nur 811861 5286/ Terapi 22-May-15 R.Medik 50,000 - 220,000 270,000
4623 Febrian Satr 753688 5257/ Terapi 22-May-15 R.Medik 50,000 - 379,500 429,500
4624 Syahira 790826 5259/ Terapi 22-May-15 R.Medik 50,000 - 379,500 429,500
4625 M. Haykal I 500328 4950/ Terapi 22-May-15 Rehab Medik 50,000 - 220,000 270,000
4626 Riduansyah 450111 4905/ Tw-Ot 22-May-15 Rehab Medik 50,000 - 220,000 270,000
4627 Nurul Aini 835915 5302/ Terapi 22-May-15 R.Medik 50,000 35,000 159,500 244,500
4628 Ratna 838391 3515/ Tb Payudara 22-May-15 Paru 50,000 - 50,000
4629 Zainuddin 842255 5192/ Susp Isk 22-May-15 Urologi 50,000 - 50,000
4630 Fitriansyah 835553 5179/ Kontrol 22-May-15 Bedah Umum 50,000 - 125,000 175,000
4631 Abdul Kadir 839999 5545/ Labioscizis 22-May-15 Bedah Umum 50,000 - 50,000
4632 May Rita 838329 3631/ Tu Jinak Col 22-May-15 Bedah Umum 50,000 35,000 187,000 272,000
4633 Lehana 839924 5558/ Kista Uteri 22-May-15 Kandungan 50,000 - 60,000 110,000
4634 Sita Larasart 791011 5100/ Hemangiom 22-May-15 Bedah Anak 50,000 - 50,000
4635 Dimas Resky 756904 5081/ Hidrocele D 22-May-15 Bedah Anak 50,000 - 50,000
4636 Febrianto 841846 3514/ Kontrol 22-May-15 Bedah Anak 50,000 - 115,700 165,700
4637 Siti Mukar 810150 5573/ Kontrol 22-May-15 Bedah Anak 50,000 - 115,700 165,700
4638 Hafizn Hari 828771 3544/ Kontrol 22-May-15 Bedah Anak 50,000 - 50,000
4639 Atha Aisyaf 563549 3573/ Kontrol 22-May-15 Gigi & Mulut 50,000 - 203,287 253,287
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4640 Nurul Asma 787572 3586/ Kontrol 22-May-15 Gigi & Mulut 50,000 - 347,490 397,490
4641 Andi Heru B 838333 5377/ Caries 6 22-May-15 Gigi&Mulut 50,000 - 450,253 500,253
4642 Anisah Mufi 670042 3545/ 1|Np 22-May-15 Gigi & Mulut 50,000 - 148,287 198,287
4643 Indar 838735 5528/ Submandibula22-May-15 Gigi&Mulut 50,000 - 50,000
4644 Fatmawati 839905 5440/ Dislokasi T 22-May-15 Gigi&Mulut 50,000 - 50,000
4645 Bintang Sals 838732 5498/ Kontrol 22-May-15 Anak 50,000 35,000 85,000
4646 Meilicia Cri 770011 3604/ Kontrol 22-May-15 Gigi & Mulut 50,000 - 115,408 165,408
4647 M Rehan A 531932 5191/ Ispa Kronis 22-May-15 Anak 50,000 - 50,000
4648 Arbainah 729366 5348/ Dm 22-May-15 Peny.Dalam 50,000 - 402,500 452,500
4649 Syarifuddin 839971 5485/ Multiple Li 22-May-15 Bedah Umum 50,000 - 50,000
4650 Sriyaningsih 839972 3558/ Benjolan Di 22-May-15 Bedah Umum 50,000 - 50,000
4651 Titin Ari Wi 839974 5484/ Fam D 22-May-15 Bedah Umum 50,000 - 50,000
4652 Asmarani 730346 5425/ Kontrol 22-May-15 Bedah Umum 50,000 - 125,000 175,000
4653 Nelly Dear 832304 3616/ Kontrol 22-May-15 Dalam 50,000 - 50,000
4654 Yoel Aditya 831909 5530/ Kontrol 22-May-15 Bedah Umum 50,000 - 50,000
4655 Suparti 667196 5557/ S/ Ca 22-May-15 Bedah Umum 50,000 - 50,000
4656 Sabran Rico 835978 3513/ Kontrol 22-May-15 Gigi & Mulut 50,000 - 207,443 257,443
4657 M. Amir 780588 5127/ 112 22-May-15 Vct 50,000 - 50,000
4658 M.Ermansya 838121 5499/ Kontrol 22-May-15 Bedah Umum 50,000 - 50,000
4659 Syaina Arka 828585 4931/ Iv Karies 22-May-15 Gigi&Mulut 50,000 - 203,287 253,287
4660 Rio Nur Ich 838734 5515/ 1 1 Np 22-May-15 Gigi&Mulut 50,000 - 50,000
4661 Sukmala Ne 838750 5574/ G2P1A0 Riw 22-May-15 Kandungan 50,000 - 120,500 170,500
4662 Linda Maria 841785 3632/ Kontrol 22-May-15 Kandungan 50,000 - 120,500 170,500
4663 Salasiah 298164 3529/ Kontrol 22-May-15 Kandungan 50,000 - 60,000 110,000
4664 Masitah Best 806602 5142/ G5P2A2 40 22-May-15 Kandungan 50,000 - 120,500 170,500
4665 Siti 834264 5068/ Kontrol 22-May-15 Kandungan 50,000 - 60,000 110,000
4666 Yuriyati 842517 5160/ G4P2A1+Ri 22-May-15 Kandungan 50,000 - 120,500 170,500
4667 David Satya 839988 5470/ Ckr 22-May-15 Bedah Umum 50,000 35,000 85,000
4668 Jean Sarina 711150 5512/ Ca Maame 22-May-15 Onkologi 50,000 - 50,000
4669 Kusasi 492196 3560/ Tumor Dida 22-May-15 Onkologi 50,000 - 50,000
4670 Maryati Kris 781103 5143/ 1 Post Peraw 22-May-15 Gigi&Mulut 50,000 - 341,392 391,392
4671 Rusdiana 525751 3603/ Sakit Lutut 22-May-15 Dalam 50,000 - 50,000
4672 Norma 839915 5481/ Dm 22-May-15 Peny.Dalam 50,000 - 50,000
4673 Yuliana 625938 5482/ Dm Ii 22-May-15 Peny.Dalam 50,000 - 50,000
4674 Mirna Wati 541613 5053/ Susp Sinusit 22-May-15 Tht 50,000 - 50,000
4675 Sri Rusmiati 524368 5393/ 8 Impaksi 22-May-15 Gigi&Mulut 50,000 - 50,000
4676 Sainem 839947 5349/ 2 Pulp Irev 22-May-15 Gigi&Mulut 50,000 - 3,848,276 3,898,276
4677 Berlin Limb 838763 5886/ Ckd 25-May-15 P. Dalam 50,000 35,000 346,950 73,531 505,481
4678 Laila 679827 3916/ Susp Kista 25-May-15 Kandungan 50,000 - 60,000 10,925 120,925
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4679 Supiani 838758 5342/ Acne V 25-May-15 Kulit Kelamin 50,000 - 16,875 66,875
4680 Dahrin 833847 3905/ Stroke 25-May-15 Syaraf 50,000 - 155,325 205,325
4681 Sariyah 828930 5901/ Cepalgia 25-May-15 Syaraf 50,000 - 61,631 111,631
4682 Abdul Mutal 842415 3920/ Kontrol 25-May-15 Bedah Umum 50,000 - 8,363 58,363
4683 Sutilah 841550 5329/ Snh, Dm+Ht 25-May-15 P.Dalam+Syar 50,000 70,000 159,500 33,000 192,773 505,273
4684 Arwinsyah 842718 5905/ Kontrol 25-May-15 Urologi 50,000 - 335,000 8,125 393,125
4685 Dewi Arum S496358 5933/ Epilepsi 25-May-15 Syaraf 50,000 - 587,256 637,256
4686 Fitri 548321 5418/ Toxoplasmos 25-May-15 Kandungan+Sy 50,000 35,000 60,000 192,188 337,188
4687 Endang Suli 761092 5446/ Vertigo+Dm 25-May-15 P. Dalam 50,000 70,000 500,250 107,949 728,199
4688 Hadi 842312 5992/ Kontrol 25-May-15 Syaraf 50,000 35,000 21,223 106,223
4689 Sainem 841926 5551/ Kontrol 25-May-15 Orthopedi 50,000 - 135,000 650 185,650
4690 Uyang Imau 403920 5948/ Kontrol 25-May-15 Bedah Umum 50,000 - 125,000 8,363 183,363
4691 Siti Amelia 811087 3844/ Tu Mamae 25-May-15 Bedah Umum 50,000 - 313,253 363,253
4692 Petrus Pake 682964 5768/ Post Orif 25-May-15 Ortophedi 50,000 - 1,950 51,950
4693 Syamsuddin 835595 5979/ Ganglion 25-May-15 Bedah Umum 50,000 - 125,000 8,363 183,363
4694 Djumiati 725601 5552/ Appendiciti 25-May-15 Bedah Umum 50,000 - 125,000 12,750 187,750
4695 Nanang Ab 712286 6009/ Post Tb 25-May-15 Paru 50,000 35,000 73,781 158,781
4696 Hadinata 834216 5961/ Kontrol 25-May-15 Orthopedi 50,000 - 80,000 5,881 135,881
4697 Nurkholis 653705 5480/ Post Op Ori 25-May-15 Orthopedi 50,000 - 160,000 650 210,650
4698 Santari Wah 841833 5935/ Kontrol 25-May-15 Orthopedi 50,000 - 135,000 78,745 263,745
4699 Mei Irawati 838759 5357/ Abd Pain Dd 25-May-15 Urologi 50,000 - 335,000 8,125 393,125
4700 Isneny Wahy 838744 3933/ Tonsilitis 25-May-15 Tht 50,000 - 29,531 79,531
4701 Darmawati 842274 5510/ Post Sc 25-May-15 Kandungan 50,000 - 120,500 1,525 172,025
4702 Suparman 577743 5965/ Tic Facialis 25-May-15 Syaraf 50,000 - 34,538 84,538
4703 Nurdian 625597 5676/ S/ Tisuue T 25-May-15 Onkologi 50,000 - 27,850 77,850
4704 Masdaliah 884814 5934/ Kontrol 25-May-15 Bedah Umum 50,000 35,000 402,500 102,525 590,025
4705 Sumiyati 628757 5890/ Ht 25-May-15 Syaraf 50,000 - 254,975 304,975
4706 Masrani Hh 487758 5889/ Post Stroke 25-May-15 Syaraf 50,000 - 46,905 96,905
4707 Bambang Su 631623 5976/ Kontrol 25-May-15 Paru 50,000 - 54,203 104,203
4708 Tri Mailani 806796 5281/ Epilepsi 25-May-15 Syaraf 50,000 - 21,189 71,189
4709 Aryes Nico 841495 5707/ Kontrol 25-May-15 Kulit Kelamin 50,000 70,000 649,500 109,081 878,581
4710 Patima 351685 5464/ Susp Hnp+T 25-May-15 Syaraf 50,000 - 14,693 64,693
4711 Mardiana 575579 3710/ Terapi + Kon 25-May-15 R Medik + Sar 50,000 35,000 71,500 12,205 168,705
4712 Sri Rahayu 815110 5312/ Glaucoma 25-May-15 Mata 50,000 - 60,000 12,855 122,855
4713 M.Roni 472505 5888/ Epilepsi 25-May-15 Syaraf 50,000 - 152,738 202,738
4714 Nurhidayant 320110 5724/ Terapi 25-May-15 R Medik + Sar 50,000 35,000 159,500 71,886 316,386
4715 M Irvan Ans 739341 3842/ Kontrol 25-May-15 Orthopedi 50,000 - 80,000 5,881 135,881
4716 Rachman 838743 3872/ Sakit Perut 25-May-15 P. Dalam 50,000 35,000 427,000 90,225 602,225
4717 Ratni 582625 3693/ Ht + Strok 25-May-15 Jantung 50,000 70,000 787,129 907,129
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4718 Sri Usminiw 838713 5902/ Oa 25-May-15 Orthopedi 50,000 35,000 71,500 2,075 158,575
4719 Misdian 835375 5419/ Ht 25-May-15 Jantung 50,000 35,000 5,711 90,711
4720 Zainab 307218 5420/ Dm+Post St 25-May-15 Syaraf 50,000 - 110,250 10,924 171,174
4721 Ambo Kaka 768323 3935/ Ht 25-May-15 Jantung 50,000 - 304,088 354,088
4722 Sumiaty 838345 3814/ Kontrol 25-May-15 Onkologi 50,000 35,000 997,700 743,514 1,826,214
4723 Hartati 619739 5506/ Ht+Dyspeps 25-May-15 P. Dalam 50,000 35,000 560,350 125,400 310,893 1,081,643
4724 Umah 842642 5581/ Kontrol 25-May-15 Urologi 50,000 35,000 335,000 420,900 745,800 527,200 2,113,900
4725 Ranoveri 747668 5417/ 7 6 Gp 25-May-15 Gigi&Mulut 50,000 - 603,276 11,650 664,926
4726 Sumiaty 429003 5619/ Kontrol 25-May-15 R.medik 50,000 35,000 71,500 21,341 177,841
4727 Subeli 238930 5618/ Kontrol 25-May-15 R.Medik+Sara 50,000 35,000 159,500 34,683 279,183
4728 Nurbaya 838309 5739/ Badan Sebel 25-May-15 Syaraf 50,000 35,000 23,400 108,400
4729 Masrumi 434051 5994/ Kontrol 25-May-15 P. Dalam 50,000 - 24,575 74,575
4730 Minuk 769155 5477/ Cephalgia 25-May-15 Syaraf 50,000 - 56,963 106,963
4731 Hasri 835965 3737/ Susp Fr Pate 25-May-15 Orthopedi 50,000 - 2,725 52,725
4732 Sripah 634302 5284/ Terapi 25-May-15 R.medik 50,000 35,000 71,500 13,800 170,300
4733 Budi Santos 838774 6038/ S/ Ppok 25-May-15 Paru 50,000 - 125,400 19,773 195,173
4734 Herliansari 760641 5751/ Kontrol 25-May-15 Onkologi 50,000 - 1,203,112 1,253,112
4735 Harsonon K 563496 3753/ Susp Isk 25-May-15 Urologi 50,000 - 335,000 332,950 255,000 972,950
4736 Agustin 815419 5978/ Ht 25-May-15 P. Dalam 50,000 - 171,638 221,638
4737 Hasni 790976 5508/ Hipertiroid 25-May-15 P. Dalam 50,000 - 15,938 65,938
4738 Suyanto 839295 5431/ Lipoma 25-May-15 Bedah Umum 50,000 - 125,000 175,000
4739 Painah 829959 5434/ Soft Tissue 25-May-15 Bedah Umum 50,000 - 125,000 175,000
4740 Kusasi 492196 3873/ Tumor Dida 25-May-15 Onkologi 50,000 - 24,940 74,940
4741 Muslihah 835307 3902/ Tu Coli 25-May-15 Onkologi 50,000 35,000 294,700 18,563 398,263
4742 Putra Giat G 838368 5524/ Kontrol 25-May-15 Syaraf 50,000 - 355,000 4,518 409,518
4743 H. Iriansyah 838757 5326/ Laringitis 25-May-15 Tht 50,000 - 66,000 1,598,300 529,125 2,243,425
4744 Asbullah 838714 5521/ Hernia Ingui 25-May-15 Bedah Umum 50,000 35,000 187,000 35,363 307,363
4745 Hairani 634971 3708/ Kontrol 25-May-15 Jantung 50,000 - 649,500 2,288 701,788
4746 Edi Marlian 787009 5679/ Pjk 25-May-15 Jantung 50,000 - 33,000 215,740 298,740
4747 Andi Ahmad 551166 5567/ Susp Gerd 25-May-15 P. Dalam 50,000 - 920,000 39,600 1,009,600
4748 Sukri 463499 5225/ Terapi+Lbp 25-May-15 R.medik 50,000 35,000 159,500 15,981 260,481
4749 Firman 794905 3946/ Batuk Lama 25-May-15 Paru 50,000 - 65,211 115,211
4750 Arpiani 274614 5297/ Dm+Ht+Tb 25-May-15 P. Dalam 50,000 35,000 187,000 215,930 487,930
4751 M. Rizky Ha 838760 5360/ Benjolan Di 25-May-15 Anak 50,000 - 377,500 14,215 441,715
4752 Aminatun 607575 3755/ Pjk 25-May-15 Jantung 50,000 - 184,950 234,950
4753 Mahlansyah 834570 3829/ 18 48 Inpaks 25-May-15 Gigi&Mulut 50,000 - 579,150 125,400 6,588 761,138
4754 Hafifi 520581 3799/ Susp Pjk 25-May-15 Jantung 50,000 - 462,500 191,100 703,600
4755 Rukkimah 364856 5463/ G3P2A0 25-May-15 Kandungan 50,000 - 60,000 600 110,600
4756 Norsehan 841416 5462/ Menometror 25-May-15 Kandungan 50,000 - 60,000 1,650 111,650
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4757 Abdul Latif 797757 3751/ Chf 25-May-15 Jantung 50,000 - 462,500 39,900 552,400
4758 Zahra Dewi 796473 3784/ 4 6 |Pulpitis 25-May-15 Gigi&Mulut 50,000 - 207,443 9,463 266,906
4759 Wiji 842163 5931/ Kontrol 25-May-15 Ortophedi 50,000 - 80,000 7,625 137,625
4760 Dimas Risk 756904 3724/ Kontrol 25-May-15 B. Anak 50,000 - 11,344 61,344
4761 Cholifah 838768 6006/ Varicela 25-May-15 Kulit Kelamin 50,000 - 15,850 65,850
4762 M Hasan Bil 839907 3859/ Hernia 25-May-15 B. Anak 50,000 35,000 3,916 88,916
4763 Kaminem 832943 3767/ Kontrol 25-May-15 Bedah Umum 50,000 - 4,295 54,295
4764 Srianna 582160 3694/ Ht 25-May-15 P. Dalam 50,000 35,000 187,000 329,131 601,131
4765 Koko Majoy 744577 6023/ Pjk 25-May-15 Jantung 50,000 - 675,950 462,500 324,600 1,513,050
4766 H.Sumiran P 695104 5856/ Kontrol 25-May-15 P. Dalam 50,000 - 39,188 89,188
4767 Mata Batara 752340 3903/ Bph 25-May-15 Urologi 50,000 - 205,538 255,538
4768 Sunarti 838741 3815/ Nyeri Pingg 25-May-15 P. Dalam 50,000 - 227,700 14,963 292,663
4769 Abdul Gani
818139 /4195603888/ Bph 25-May-15 Urologi 50,000 - 205,538 255,538
4770 Budiono 842096 5680/ Kontrol 25-May-15 Syaraf 50,000 - 29,021 79,021
4771 Said Muhtar 265409 5782/ Hemoroid Gr 25-May-15 Bedah Umum 50,000 35,000 187,000 3,811 275,811
4772 Arbayah 823341 5770/ Kontrol 25-May-15 Paru 50,000 - 2,623 52,623
4773 Richi Budi 839904 3725/ Perut Kemb 25-May-15 Anak 50,000 - 38,488 88,488
4774 Mukahar 653123 5285/ Ppok 25-May-15 Paru 50,000 - 74,038 124,038
4775 Rumiatik 648907 3707/ Kontrol 25-May-15 P. Dalam 50,000 - 500,250 70,023 620,273
4776 Sarifuddin 835589 3736/ Sholder Pai 25-May-15 Syaraf 50,000 - 33,406 83,406
4777 Abd Samad 663176 5736/ Post Stroke 25-May-15 Syaraf 50,000 - 21,255 71,255
4778 Arbaiyah 478160 5919/ Kontrol 25-May-15 Kulit Kelamin 50,000 35,000 324,500 194,481 603,981
4779 Rezki 840447 5495/ Post Sc 25-May-15 Kandungan 50,000 - 120,500 7,350 177,850
4780 Reni 842107 5843/ Post Sc 25-May-15 Kandungan 50,000 - 120,500 6,588 177,088
4781 Lilis Sariya 430337 5920/ Myalgia 25-May-15 P. Dalam 50,000 - 252,500 227,700 2,400 532,600
4782 Rusmini 802746 3858/ Pjh 25-May-15 Jantung 50,000 - 40,000 90,000
4783 Tari Septian 671587 3845/ Menometror 25-May-15 Kandungan 50,000 - 60,000 1,525 111,525
4784 Dahlia 834518 5525/ Cardiomegal 25-May-15 Jantung 50,000 - 187,000 8,038 245,038
4785 Ratna Juwita 631025 5769/ Batuk 3 Bln 25-May-15 Paru 50,000 - 160,250 125,400 12,375 348,025
4786 Nur Fitriani 841731 5949/ Kontrol 25-May-15 P. Dalam 50,000 - 12,279 62,279
4787 Saniah 838748 3875/ Menometror 25-May-15 Kandungan 50,000 - 60,000 305,000 37,275 452,275
4788 Sumiyati 840534 3798/ Kontrol 25-May-15 Kandungan 50,000 - 60,000 1,119,800 125,400 5,494 1,360,694
4789 Masrun Maj 639948 5465/ Ht 25-May-15 Jantung 50,000 - 562,950 71,538 684,488
4790 Ummi Kult 838708 3768/ Susp Hernia 25-May-15 Bedah Anak 50,000 35,000 18,551 103,551
4791 Rania Fidela 791078 3722/ Epilepsi 25-May-15 Syaraf 50,000 - 213,063 263,063
4792 Sunarti 791776 5537/ Veruka Vulg 25-May-15 Kulit Kelamin 50,000 35,000 44,622 129,622
4793 H. M. Kosi 750140 5224/ Terapi+Kont 25-May-15 R.medik 50,000 35,000 159,500 31,150 275,650
4794 Neneng Dam 472843 3739/ Kolik Abdo 25-May-15 P. Dalam 50,000 - 28,225 78,225
4795 Ade Setiawa 633474 5753/ Ht 25-May-15 Jantung 50,000 - 55,823 105,823
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4796 Elisabeth Po 582288 5725/ Kontrol 25-May-15 Bedah 50,000 - 125,000 12,750 187,750
4797 Jali 834810 3828/ Kontrol 25-May-15 Kulit Kelamin 50,000 - 5,141 55,141
4798 Yuni 416680 5737/ Ht 25-May-15 Jantung 50,000 - 307,525 357,525
4799 Eny Noorliy 769789 5388/ Vertigo 25-May-15 Jantung 50,000 - 19,918 69,918
4800 Az Zahra R 324506 5859/ Kontrol 25-May-15 Tht 50,000 - 20,939 70,939
4801 Setber Hery 800313 3692/ Gastritis Ak 25-May-15 P. Dalam 50,000 - 252,500 305,000 24,575 632,075
4802 M. Nizam Fa 756666 5448/ Kontrol 25-May-15 Kulit Kelamin 50,000 - 3,750 53,750
4803 Ali Janji 640504 5633/ Dm Ii 25-May-15 P. Dalam 50,000 - 500,250 46,554 596,804
4804 Asmawati 022190 5296/ Dm 25-May-15 P. Dalam 50,000 - 500,250 3,638 553,888
4805 Desi Mariati 821190 5677/ Epilepsi 25-May-15 Syaraf 50,000 - 87,188 137,188
4806 Khummayra 838770 6022/ Obs Febris 25-May-15 Anak 50,000 - 38,500 88,500
4807 Nurul Amin 805535 3874/ Kontrol 25-May-15 Anak 50,000 - 41,128 91,128
4808 Mashoed 647749 5282/ Oa 25-May-15 Syaraf 50,000 - 29,944 79,944
4809 Sudhirno 823626 5330/ Kontrol 25-May-15 Jantung 50,000 - 408,938 458,938
4810 Satinem 838761 5386/ Susp Tb Par 25-May-15 Paru 50,000 - 160,250 125,400 21,725 357,375
4811 Halijah 838721 3650/ Obs Oedem 25-May-15 Orthopedi 50,000 - 125,400 5,063 180,463
4812 Surianto 478281 3752/ Sakit Kepal 25-May-15 Syaraf 50,000 - 165,279 215,279
4813 Samil Amali 712246 5374/ Tumor 25-May-15 Onkologi 50,000 - - 50,000
4814 M. Nur Ichs 842082 5447/ 112+Hipoka 25-May-15 P. Dalam 50,000 - 175,250 329,219 554,469
4815 H Yansyah 478969 3648/ Kontrol 25-May-15 Jantung 50,000 - 189,938 239,938
4816 Mulyono 787453 5266/ Obs Chest P 25-May-15 Jantung 50,000 - 775,950 326,363 1,152,313
4817 Jairin Jain E 686672 5315/ Acs 25-May-15 Jantung 50,000 - 315,713 365,713
4818 Ira Puspa Sa 838352 5661/ Kontrol 25-May-15 Kandungan 50,000 - 120,500 1,525 172,025
4819 Abdul Ghof 841819 5435/ Post Op Ori 25-May-15 Orthopedi 50,000 - 80,000 325 130,325
4820 Abdul Sala 834231 5797/ S/ Kelainan 25-May-15 Syaraf 50,000 - 88,240 138,240
4821 Ade Ibrahim 821501 5236/ Condiloma 25-May-15 Urologi 50,000 - 205,538 255,538
4822 Marsinah 798670 5650/ Pjk 25-May-15 Jantung 50,000 - 274,013 324,013
4823 Nurhayani 277553 5798/ 8 Gr 25-May-15 Gigi&Mulut 50,000 - 207,443 11,938 269,381
4824 M.Imran 774215 5977/ S/ Tu Nasal 25-May-15 Tht 50,000 - 4,294 54,294
4825 Suparno 781817 5740/ Kontrol 25-May-15 Syaraf 50,000 - 18,836 68,836
4826 Sutrami 839991 3738/ Haid Tdk Be 25-May-15 Kandungan 50,000 - 60,000 121,363 231,363
4827 Desy Tabiran 458826 5449/ Hipertiroid 25-May-15 P. Dalam 50,000 - 20,004 70,004
4828 Juraidah Af 321558 5932/ Kontrol 25-May-15 Kulit Kelamin 50,000 - 12,869 62,869
4829 Nur Afinda A532150 3770/ Epilepsi 25-May-15 Syaraf 50,000 - 314,813 364,813
4830 Farida Wati 815857 3827/ Netropasi Di 25-May-15 Mata 50,000 35,000 60,000 50,224 195,224
4831 Hartini Joha 769333 5604/ Tinitus 25-May-15 Tht 50,000 - 310,500 38,704 399,204
4832 M.Samokrod 842690 3800/ Obs Dispeps 25-May-15 Paru 50,000 - 20,378 70,378
4833 Juniah 451658 3841/ Neuralgia 25-May-15 Syaraf 50,000 - 26,744 76,744
4834 Murni 753392 5648/ Benjolan D 25-May-15 Bedah 50,000 - 3,313 53,313
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4835 Darmi 812483 5356/ Pjb 25-May-15 Jantung 50,000 - 176,963 226,963
4836 Edi Kusyadi 838307 5373/ Hemoroid 25-May-15 Bedah 50,000 - 125,000 14,163 189,163
4837 Nikma Ibra 838566 5450/ Pjb 25-May-15 Jantung 50,000 - 125,400 649,500 3,811 828,711
4838 Arifin 811379 5695/ Kontrol 25-May-15 Jantung 50,000 - 337,725 387,725
4839 Nor Asikin 639313 5254/ Terapi+Vert 25-May-15 Syaraf 50,000 35,000 159,500 221,368 465,868
4840 M.Alief Hid 836197 5962/ Kontrol 25-May-15 Anak 50,000 - 7,549 57,549
4841 Aisjah Joha 796894 5603/ Kontrol 25-May-15 R.medik 50,000 35,000 159,500 27,418 271,918
4842 Nurlaila 594704 6008/ Dispepsia 25-May-15 P. Dalam 50,000 - 44,250 305,000 3,313 402,563
4843 Sulaikah 654489 5601/ Kontrol 25-May-15 P. Dalam 50,000 - 308,250 358,250
4844 Jamal Kahar 842554 5345/ Susp Synd. 25-May-15 P. Dalam 50,000 - 14,600 64,600
4845 Juanda 666988 5358/ Epilepsi 25-May-15 Syaraf 50,000 - 103,200 153,200
4846 Ida Kuswati 773708 5887/ Galukoma 25-May-15 Mata 50,000 - 60,000 117,355 227,355
4847 Tesalonika S 835955 5402/ Dog Bite 25-May-15 Syaraf 50,000 - 57,000 173,938 280,938
4848 Nur Rahma D665597 5871/ Rinitis 25-May-15 Tht 50,000 - 17,013 67,013
4849 Arya Putra P 838756 5298/ Oa 25-May-15 Kulit Kelamin 50,000 - 4,245 54,245
4850 Udin 705780 5222/ Fisioterapi 25-May-15 R.medik 50,000 35,000 220,000 21,651 326,651
4851 M.Ariyanto 834896 5647/ Post Op 25-May-15 Orthopedi 50,000 - 160,000 1,950 211,950
4852 Mariyam 194178 3649/ Kontrol 25-May-15 Syaraf 50,000 - 79,050 129,050
4853 Ainanoorya 405509 5694/ Kontrol 25-May-15 Orthopedi 50,000 - 80,000 1,300 131,300
4854 Ismail 473748 5709/ Post Orif 25-May-15 Orthopedi 50,000 - 80,000 1,300 131,300
4855 Suyanto 445829 5662/ Kontrol 25-May-15 Syaraf 50,000 - 138,000 188,000
4856 Tri Turiyati 696670 3721/ Cek Lab 25-May-15 P. Dalam 50,000 - 186,500 236,500
4857 Wa Riso 810144 3740/ Cek Lab 25-May-15 P. Dalam 50,000 - 500,250 550,250
4858 Zainuddin 842255 3887/ Susp Isk 25-May-15 Urologi 50,000 - 335,000 219,500 145,200 749,700
4859 Sabariah 667290 5649/ Ht Dm 25-May-15 P. Dalam 50,000 - 110,250 160,250
4860 Sapariyah 796076 5478/ Ca Mamae 25-May-15 Onkologi 50,000 35,000 726,650 811,650
4861 Siti Nurhaya 662269 5461/ Sle 25-May-15 P. Dalam 50,000 - 43,250 93,250
4862 Sumarlin 446076 3754/ Cek Lab 25-May-15 P. Dalam 50,000 - 609,500 659,500
4863 Ruslan 372773 5299/ Dm Tipe Ii 25-May-15 P. Dalam 50,000 - 110,250 160,250
4864 Rahmatun N 835337 5845/ Kontrol 25-May-15 Kandungan 50,000 - 60,000 230,200 340,200
4865 Mulyani 484332 5620/ Niddm 25-May-15 P. Dalam 50,000 - 110,250 160,250
4866 Nanik Nurya 829921 5830/ 8 Gp 25-May-15 P. Dalam 50,000 - 99,000 149,000
4867 Nasiman 404532 3706/ Cek Lab 25-May-15 P. Dalam 50,000 - 110,250 160,250
4868 Noor Jannah 754735 5904/ Isk 25-May-15 Kulit Kelamin 50,000 - 207,000 257,000
4869 Nor Anita 838742 3826/ 48 Inpaksi 25-May-15 Gigi & Mulut 50,000 - 579,150 286,000 915,150
4870 Masriyani 664641 5554/ Ruptur Vagi 25-May-15 Kandungan 50,000 - 60,000 438,400 548,400
4871 Mudma'Inah 556618 5493/ Tyroid 25-May-15 P. Dalam 50,000 - 352,100 402,100
4872 M.Alfian 727354 5872/ Kontrol Tal 25-May-15 Anak 50,000 - 43,250 93,250
4873 Ida Mardian 703995 5678/ Dm 25-May-15 P. Dalam 50,000 - 110,250 160,250
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4874 Junaini 791090 5372/ Dm 25-May-15 P. Dalam 50,000 - 500,250 550,250
4875 Siti Mudaw 838766 5523/ Frozen Shou 25-May-15 Syaraf 50,000 - 44,250 1,205,600 1,299,850
4876 Saleha 772857 5827/ Struma 25-May-15 Bedah 50,000 - 814,750 377,500 125,400 1,367,650
4877 Samiyem 732163 5494/ Dm Tipe 2 25-May-15 P. Dalam 50,000 - 110,250 160,250
4878 M Muhsi 838740 3782/ Kontrol 25-May-15 Orthopedi 50,000 35,000 69,000 154,000
4879 Luat Alui 838319 5947/ Bph 25-May-15 Urologi 50,000 - 132,500 567,350 341,976 1,091,826
4880 M Arif 401877 3917/ Kontr0L 25-May-15 P. Dalam 50,000 - 209,250 259,250
4881 Herawati Ru 838773 6036/ Hemoroid 25-May-15 Bedah Umum 50,000 - 387,900 305,000 742,900
4882 Hasan 691429 5903/ Bph 25-May-15 Urologi 50,000 - 335,000 611,600 996,600
4883 Fitri Hartati 800400 5858/ Keratitis 25-May-15 P. Dalam 50,000 - 110,250 160,250
4884 Kurniah 836387 3830/ Susp Ca Ov 25-May-15 Kandungan 50,000 - 60,000 1,406,700 125,400 1,642,100
4885 M Khoirudi 838744 3932/ Ganglion 25-May-15 Bedah Umum 50,000 - 394,150 125,400 569,550
4886 Dina Fitrian 815041 3860/ Tb Paru 25-May-15 Paru 50,000 - 160,250 125,400 335,650
4887 Eko Siswor 810534 5752/ Dm 25-May-15 P. Dalam 50,000 - 110,250 160,250
4888 Hadijah 583765 5873/ Pro Aff Impl 25-May-15 Kandungan 50,000 - 60,000 105,600 215,600
4889 Jumsiah 838765 5509/ Kontrol 25-May-15 Bedah 50,000 - 368,500 418,500
4890 Dewi Susant 834564 5570/ Chest Pain 25-May-15 Bedah 50,000 - 600,600 650,600
4891 Ivaen Dwi S 838764 5950/ Union Fr Ti 25-May-15 Orthopedi 50,000 - 125,400 175,400
4892 Suparti 838762 5844/ Cek Lab 25-May-15 Patologi Anat 50,000 - 258,750 308,750
4893 Suhartatik 654862 5812/ Ca Palatum 25-May-15 Onkologi 50,000 - 377,500 427,500
4894 Bandi Batha 738114 5597/ Fisioterapi 25-May-15 R.medik 50,000 - 71,500 121,500
4895 Sopiah 655365 3919/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4896 M.Romli 806719 6025/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4897 Sukarti 835988 5963/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4898 Marsidi 720910 5416/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4899 H Syamsudd 775495 3783/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4900 Sujarti Erica 537870 5800/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4901 Ramlah Has 619115 5842/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4902 Annisa Dewi
326044/8260445405/ Kontrol 25-May-15 R.medik 50,000 - 220,000 270,000
4903 Cantika An 757599 5207/ Terapi 25-May-15 R.medik 50,000 - 220,000 270,000
4904 M Sandy 677507 3680/ Terapi 25-May-15 R.medik 50,000 - 220,000 270,000
4905 M. Rizky R 828577 5209/ Ot+Tw 25-May-15 R.medik 50,000 - 220,000 270,000
4906 Ponijem 659169 3635/ Fisiotherapy 25-May-15 R.medik 50,000 - 220,000 270,000
4907 Surya Mangi 541180 5223/ Fisioterapi 25-May-15 R.medik 50,000 - 220,000 270,000
4908 Abdillah Fik 488012 3904/ Terapi 25-May-15 R.medik 50,000 - 220,000 270,000
4909 Nurdin Doni 712854 5267/ Fisioterapi 25-May-15 R.medik 50,000 - 71,500 121,500
4910 Nursiah 706603 5946/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4911 Mariana 777781 5401/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4912 Asih Sunars 829585 5387/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4913 Viknatul Lei 829364 5522/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4914 Sual Fiqsati 691428 3889/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4915 Faisri Fatma 841715 3769/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4916 Ahmad Djai 644885 3918/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4917 Suriansyah 468561 5389/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4918 M Abid Aqil 835543 3766/ Terapi 25-May-15 R.medik 50,000 - 220,000 270,000
4919 Donatinus S 811513 5710/ Terapi 25-May-15 R.medik 50,000 - 379,500 429,500
4920 Kusnan 721341 5210/ Terapi 25-May-15 R.medik 50,000 - 440,000 490,000
4921 Imam M. Sh 190433 5221/ Terapi 25-May-15 R.medik 50,000 - 440,000 490,000
4922 Raudah 826607 5269/ Terapi 25-May-15 R.medik 50,000 - 220,000 270,000
4923 Karsuni 825954 5270/ Terapi 25-May-15 R.medik 50,000 - 220,000 270,000
4924 Sarminto 796814 3695/ Terapi 25-May-15 R.medik 50,000 - 440,000 490,000
4925 Suriansyah 836571 3691/ Terapi 25-May-15 R.medik 50,000 - 440,000 490,000
4926 Hamdanah 790973 5664/ Terapi 25-May-15 R.medik 50,000 - 440,000 490,000
4927 Gimun 695987 5605/ Fisioterapi 25-May-15 R.medik 50,000 - 440,000 490,000
4928 Sugianto Ru 487872 5646/ Terapi 25-May-15 R.medik 50,000 - 440,000 490,000
4929 Nanang Isma 813793 5663/ Terapi 25-May-15 R.medik 50,000 - 440,000 490,000
4930 Abdul Nurdi 464739 5631/ Fisioterapi 25-May-15 R.medik 50,000 - 440,000 490,000
4931 Ngatin 834243 5860/ Terapi 25-May-15 R.medik 50,000 - 440,000 490,000
4932 Tazkiah Aul 838494 5785/ Terapi 25-May-15 R.medik 50,000 - 220,000 270,000
4933 Sriatun 257601 3663/ Terapi + Kon 25-May-15 R.medik 50,000 35,000 71,500 156,500
4934 Musningsih 549641 5754/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4935 M.Sefianto 729676 5721/ Terapi 25-May-15 R.medik 50,000 - 440,000 490,000
4936 M. Hanif Ily 838304 5432/ Terapi 25-May-15 R.medik 50,000 - 220,000 270,000
4937 Rahmatulla 462170 3677/ Terapi + Kon 25-May-15 Anak 50,000 35,000 220,000 52,250 357,250
4938 Izni Almadi 835545 5343/ Terapi 25-May-15 R.medik 50,000 - 220,000 270,000
4939 M. Atallah 607935 3665/ Fisiotherapy 25-May-15 R.medik 50,000 - 220,000 270,000
4940 Ahmad Khoi 671879 5587/ Terapi 25-May-15 R.medik 50,000 - 220,000 270,000
4941 Danang Zak 726353 5208/ Terapi 25-May-15 R.medik 50,000 - 220,000 270,000
4942 Andhara Aul 613425 3676/ Fisiotherapy 25-May-15 R.medik 50,000 - 440,000 490,000
4943 Murtini 757462 5874/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4944 Norma 839915 5692/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4945 Panirah 822928 5723/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4946 Sri Kuswati 834801 5327/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4947 Iskandar 077736 5314/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4948 Kornelis Na 810504 5311/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4949 Amanat Lail 828568 5359/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4950 Rubiyanti 835952 5632/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4951 Hj.Ernawati 710875 3662/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4952 Kapsah 791022 3709/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4953 Siti Maimun 822088 5691/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4954 Sadariah 419296 5253/ Fisioterapi 25-May-15 R.medik 50,000 - 71,500 121,500
4955 Merry Tabi 314620 5238/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4956 Suryanti 720793 5616/ Fisioterapi 25-May-15 R.medik 50,000 - 159,500 209,500
4957 Supatmi 705133/8051335283/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4958 Hamdanah 563909 5239/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4959 M. Jufri 764121 5252/ Fisioterapi 25-May-15 R.medik 50,000 - 71,500 121,500
4960 Matrup 345802 5251/ Fisioterapi 25-May-15 R.medik 50,000 - 71,500 121,500
4961 Nurdin Baru 390697 3646/ Fisiotherapy 25-May-15 R.medik 50,000 - 71,500 121,500
4962 Kasdi 834604 5588/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4963 Turyatman 528172 5589/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4964 Rusdiana 806016 5240/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
4965 Aisyah 734989 5255/ Terapi 25-May-15 R.medik 50,000 - 159,500 209,500
4966 Kamsiah 835917 5268/ Fisioterapi 25-May-15 R.medik 50,000 - 159,500 209,500
4967 Siti Rahmah 742670 5590/ Terapi 25-May-15 R.Medik 50,000 - 159,500 209,500
4968 Dumiatun 669083 3661/ Kontrol 25-May-15 Orthopedi 50,000 - 1,950 51,950
4969 Ernawati 124241 5829/ Kontrol 25-May-15 Syaraf 50,000 - 29,663 79,663
4970 Elizabeth M 634235 3812/ Riwayat Kis 25-May-15 Kandungan 50,000 - 60,000 6,150 116,150
4971 Warti 691974 5828/ Terapi 25-May-15 R.medik 50,000 35,000 159,500 7,705 252,205
4972 Sumarsih 838769 5553/ S. Tik 25-May-15 Syaraf 50,000 35,000 60,000 43,838 188,838
4973 Musmulyadi 839933 6037/ Bsk 25-May-15 Urologi 50,000 - 335,000 385,000
4974 Ponidi 494129 3890/ Bsk 25-May-15 Urologi 50,000 - 50,000
4975 Tika Saitun 838737 5476/ Susp Kista 25-May-15 Bedah 50,000 - 50,000
4976 Santi Andria 677541 3857/ 22 Gr 25-May-15 Gigi & Mulut 50,000 - 50,000
4977 Rubiantono 829911 5964/ 16 Caries 25-May-15 Gigi & Mulut 50,000 - 362,633 412,633
4978 Syaina Arka 828585 5403/ Iv Karies 25-May-15 Gigi & Mulut 50,000 - 384,437 434,437
4979 Jeimah 838767 5993/ 1 1 Koriks 25-May-15 Gigi&Mulut 50,000 - 223,293 273,293
4980 Muryati 525319 5568/ Kp 25-May-15 Gigi&Mulut 50,000 - 362,633 412,633
4981 Marlian 838771 5566/ Kontrol 25-May-15 Gigi&Mulut 50,000 - 347,490 397,490
4982 Ayu Lestari 835574 3934/ 6 Pulpitis 25-May-15 Gigi & Mulut 50,000 - 362,633 412,633
4983 Atha Aisyaf 563549 3856/ Kontrol 25-May-15 Gigi & Mulut 50,000 - 272,703 322,703
4984 M. Rehan A 531932 5491/ Ispa Kronis 25-May-15 Anak 50,000 - 62,000 112,000
4985 Andi Hendr 838772 6024/ Muntah Dar 25-May-15 Anak 50,000 - 50,000
4986 Rahmat Rah 835327 5371/ Post Op Nev 25-May-15 Kulit Kelamin 50,000 - 50,000
4987 Hety Erliani 835593 5980/ S/ Tumor 25-May-15 Onkologi 50,000 - 50,000
4988 Eni Muzaiya 698016 5708/ Stt Dd Sarc 25-May-15 Onkologi 50,000 - 50,000
4989 Meilan Novi 838726 5722/ S/ Fam 25-May-15 Onkologi 50,000 - 50,000
4990 Harmi 828564 5536/ Ca Mamae 25-May-15 Onkologi 50,000 - 50,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
4991 Mitha Diana 835938 5313/ Susp Fam 25-May-15 Onkologi 50,000 - 50,000
4992 Eva Susilaw 841536 5781/ Kontrol 25-May-15 Syaraf 50,000 - 120,500 170,500
4993 Masniah 441498 5796/ Myalgia 25-May-15 Syaraf 50,000 - 50,000
4994 Suriansyah 835823 3886/ Kontrol 25-May-15 Bedah Umum 50,000 - 125,000 175,000
4995 Kartika Dew 640012 5404/ Kontrol 25-May-15 Kandungan 50,000 35,000 60,000 462,500 607,500
4996 Siti Nur Kh 821126 5433/ G2P1A0+An 25-May-15 Kandungan 50,000 - 120,500 170,500
4997 Astri Ariest 629107 5991/ G2P1A0 25-May-15 Kandungan 50,000 - 120,500 170,500
4998 Mega Karin 838728 5390/ G3P1A1 25-May-15 Kandungan 50,000 - 120,500 170,500
4999 Sri Karyati 535919 3871/ G3P2A0 Dng 25-May-15 Kandungan 50,000 - 60,000 110,000
5000 Lehana 839924 5784/ Kista Uteri 25-May-15 Kandungan 50,000 35,000 60,000 145,000
5001 Shopiah 835591 5826/ G4P3A0 25-May-15 Kandungan 50,000 - 120,500 170,500
5002 Dika Suhary 791873 5693/ G2P1A0 Uk 25-May-15 Kandungan 50,000 - 120,500 170,500
5003 M.Reauld P. 674527 5995/ Kontrol 25-May-15 B. Anak 50,000 - 50,000
5004 Susanti 380487 3723/ G4 P3 A0 Dn 25-May-15 Kandungan 50,000 - 120,500 170,500
5005 Dimas Fach 838350 5300/ Hernia S 25-May-15 B. Anak 50,000 - 50,000
5006 Rafasya Zid 829917 5540/ Hydrocele T 25-May-15 Bedah Anak 50,000 - 50,000
5007 Rukini 838723 5665/ Lipoma 25-May-15 Bedah 50,000 - 50,000
5008 M Dede Has 577632 3901/ Abses 25-May-15 Bedah 50,000 - 50,000
5009 Parpunguan 838320 3797/ Kontrol 25-May-15 Bedah 50,000 - 125,000 175,000
5010 Elis Setyawa 801336 5841/ Mastitis 25-May-15 Bedah 50,000 - 50,000
5011 Suparti 667196 5815/ S/ Ca 25-May-15 Bedah 50,000 35,000 187,000 272,000
5012 Maslamah 445474 5811/ Stt 25-May-15 Bedah 50,000 35,000 187,000 272,000
5013 Diah Prawita 835914 5237/ Ganglion Cy 25-May-15 Bedah 50,000 - 125,000 175,000
5014 Nur Idah 835359 5857/ Post Op 25-May-15 Bedah 50,000 - 125,000 175,000
5015 Sukardi 841789 3811/ Kontrol 25-May-15 Bedah 50,000 - 125,000 175,000
5016 Paini 835342 3813/ Strauma 25-May-15 Bedah 50,000 - 125,000 175,000
5017 Rafliansyah 838710 6010/ Abses 25-May-15 Bedah 50,000 - 50,000
5018 Oktariani 839938 5344/ Tonsilitis K 25-May-15 Tht 50,000 - 50,000
5019 Damayanti 838717 5539/ Oma 25-May-15 Tht 50,000 - 50,000
5020 Hasmiati 838739 5569/ Kontrol 25-May-15 Tht 50,000 - 63,000 113,000
5021 M Muchtar 757463 3931/ Kontrol 25-May-15 Vct 50,000 - 50,000
5022 Sulistyo 821720 5916/ 112 25-May-15 Vct 50,000 - 50,000
5023 Heryani 794790 6021/ B24 25-May-15 Vct 50,000 - 50,000
5024 Juwariyah 834558 5766/ Dm 25-May-15 P. Dalam 50,000 - 402,500 452,500
5025 Simon 833940 3796/ Kontrol 25-May-15 P. Dalam 50,000 - 75,000 125,000
5026 Wiwin 430340 5706/ Kontrol 25-May-15 Gigi&Mulut 50,000 - 365,360 415,360
5027 Sadariyah 686723 5328/ 21 14 Pulpit 25-May-15 Gigi&Mulut 50,000 - 450,253 500,253
5028 Mu'Ati 838110 5738/ 4 Gp 25-May-15 Gigi&Mulut 50,000 - 50,000
5029 Lisa Yuliant 472817 5917/ 47 Pulp 25-May-15 Gigi&Mulut 50,000 - 50,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5030 Hasitah 838727 5918/ S/ Lipoma 25-May-15 Bedah 50,000 - 50,000
5031 Nurrifa Zahi 617717 5479/ Finger Tip 25-May-15 Orthopedi 50,000 - 80,000 130,000
5032 Mahlinda Saf726865 5538/ Pro Remova 25-May-15 Orthopedi 50,000 - 50,000
5033 Iliyawati 681163 5767/ Kontrol 25-May-15 Ortophedi 50,000 - 50,000
5034 Mahmudah 838707 5755/ Oa 25-May-15 Ortophedi 50,000 - 50,000
5035 Andi Heru B 838333 5602/ Caries 6 25-May-15 Gigi&Mulut 50,000 - 272,703 322,703
5036 Fida Fatima 555041 5492/ G1P0A0 25-May-15 Kandungan 50,000 35,000 85,000
5037 Tijah 515481 5875/ Katarak 25-May-15 Mata 50,000 - 60,000 110,000
5038 Nur Rochma 839994 5634/ G3P2A0 25-May-15 Kandungan 50,000 - 120,500 170,500
5039 Sumiarsih 677525 6007/ Ca Mamae 25-May-15 Bedah 50,000 - 50,000
5040 Suswati 839954 3785/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
5041 Sujarni 800848 5617/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
5042 Ratnawati 770672 5507/ Terapi 25-May-15 R.medik 50,000 - 71,500 121,500
5043 Arjinah 615691 5375/ Dm 25-May-15 P. Dalam 50,000 - 902,850 185,063 1,137,913
5044 Mahrita 834539 5690/ Terapi+Lbp 26-May-15 R.Medik+Syar 50,000 35,000 159,500 18,198 262,698
5045 Susiatin 337059 6203/ Terapi 26-May-15 R.Medik 50,000 35,000 71,500 18,273 174,773
5046 Suriyah 438796 5596/ Kontrol 26-May-15 Penyakit Dala 50,000 - 568,100 633 618,733
5047 Safaruddin 838747 5584/ Kontrol 26-May-15 Gigi&Mulut 50,000 - 160,600 10,556 221,156
5048 Nur Asiah 817162 5585/ Post Op My 26-May-15 Kandungan 50,000 - 60,000 10,669 120,669
5049 Suminem 838798 6385/ Melena 26-May-15 Peny.Dalam 50,000 - 153,638 203,638
5050 Samsiah 835347 5927/ Obs Kista O 26-May-15 Kandungan 50,000 - 60,000 11,854 121,854
5051 Chairil Lab 362860 5914/ Ht 26-May-15 Jantung 50,000 - 39,025 89,025
5052 Heny Winant 833012 6309/ Kontrol 26-May-15 Ortophedi 50,000 - 135,000 4,613 189,613
5053 Heni 838753 4114/ Obs Abdomin 26-May-15 Kandungan 50,000 - 60,000 2,604 112,604
5054 Endah Setya
522500/8387305930/ Kontrol 26-May-15 Kandungan 50,000 - 60,000 55,913 165,913
5055 Islamidah 515794 6081/ Dm Ii 26-May-15 Peny.Dalam 50,000 - 481,550 531,550
5056 Susmiati 839900 6142/ Oma 26-May-15 Tht 50,000 - 9,000 59,000
5057 M Arafah 838755 5942/ Ht 26-May-15 Jantung 50,000 - 151,275 201,275
5058 Susilowati 837698 6340/ Kontrol 26-May-15 Kandungan 50,000 - 120,500 2,604 173,104
5059 Yohanes Ka 720887 5776/ Bronkhitis+ 26-May-15 Paru+Jantung 50,000 35,000 344,121 429,121
5060 Anisha 842051 4007/ Kontrol 26-May-15 Bedah Umum 50,000 35,000 125,000 191,175 401,175
5061 Syamsiah 834832 4083/ Ht +Ves 26-May-15 Jantung 50,000 - 462,500 42,459 554,959
5062 Nur Asiah 585093 6292/ Ht 26-May-15 Peny.Dalam 50,000 - 8,950 58,950
5063 Achmad Sury838794 4128/ Alergi 26-May-15 Kulit & Kelam 50,000 - 35,948 85,948
5064 M Rosihan 740691 4009/ Kontrol 26-May-15 Saraf 50,000 - 16,184 66,184
5065 Mud Maina 556618 6264/ Kontrol 26-May-15 Peny.Dalam 50,000 - 22,673 72,673
5066 Minong 648247 6175/ Terapi 26-May-15 R.Medik 50,000 - 244,350 294,350
5067 Rusdi 812285 4126/ Kontrol 26-May-15 Ortopedi 50,000 35,000 301,500 49,755 436,255
5068 Rina Adriya 673492 4129/ Hiperthiroid 26-May-15 Dalam 50,000 - 46,238 96,238
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5069 Aji Isnawati 838788 5839/ Urtikaria 26-May-15 Kulit Kelamin 50,000 - 17,216 67,216
5070 Mas'Ud Riza 764236 6322/ Kontrol 26-May-15 Paru 50,000 - 61,875 111,875
5071 M Zaini 842258 3977/ Kontrol 26-May-15 Bedah Syaraf 50,000 - 107,250 157,250
5072 Kurni 842115 6367/ Kontrol 26-May-15 Jantung 50,000 - 649,500 266,625 966,125
5073 Radina Halo 787550 3992/ Ca Colon 26-May-15 Bedah Umum 50,000 - 1,925,000 1,975,000
5074 Echa Ameli 837022 6396/ Tonsilitisa 26-May-15 Tht 50,000 - 295,150 8,925 354,075
5075 Karmila Rik 653692 5825/ Sesak Nafas 26-May-15 Jantung 50,000 - 980,000 1,563 1,031,563
5076 Asniawati 654580 6276/ Ganglion 26-May-15 Bedah Umum 50,000 - 1,525 51,525
5077 M.Fajar Dir 838795 6413/ Takikardia+ 26-May-15 Jantung 50,000 - 187,000 11,348 248,348
5078 Slamet 693234 5929/ Ht 26-May-15 Jantung 50,000 - 168,647 218,647
5079 Sarehat 838775 5660/ Serumen P 26-May-15 Tht 50,000 - 10,492 60,492
5080 Nur Wandi 838779 4010/ Kontrol 26-May-15 Tht 50,000 - 295,150 8,375 353,525
5081 Tjutiani Sri 545193 6141/ Kontrol 26-May-15 Orthopedi 50,000 - 227,700 7,530 285,230
5082 Intan Jakran 835333 5807/ Kontrol 26-May-15 Paru 50,000 - 28,013 78,013
5083 Dibyono 589260 6130/ Dm + Ht 26-May-15 Dalam 50,000 - 42,488 92,488
5084 Siti Rosmaw 816198 5732/ Ulkus Pepti 26-May-15 Penyakit Dala 50,000 - 26,025 76,025
5085 Nanang Isma 813793 5675/ Post Op 26-May-15 Tht 50,000 - 115,000 13,463 178,463
5086 Ernie Bs 815417 5885/ Dismenorea 26-May-15 Kandungan 50,000 - 60,000 438,400 316 548,716
5087 Nur Abandi 498112 5703/ Chd 26-May-15 Jantung 50,000 - 202,441 252,441
5088 Muhammad 763821 5626/ Kontrol 26-May-15 Penyakit Dala 50,000 - 49,206 99,206
5089 Rumiatun 562394 6051/ Ht 26-May-15 Peny.Dalam 50,000 - 32,604 82,604
5090 Mulyani 484332 6055/ Niddm 26-May-15 Dalam 50,000 - 35,238 85,238
5091 Yuyu Yuhan 254067 6291/ Kontrol 26-May-15 Tht 50,000 - 310,500 8,338 368,838
5092 Idrus 838398 5687/ Kontrol 26-May-15 Mata 50,000 - 60,000 751,699 861,699
5093 Vinsensia A 838366 6126/ Kontrol 26-May-15 Kandungan 50,000 - 120,500 2,604 173,104
5094 Imam Chamb838460 5734/ Osteoporosis 26-May-15 Orthopedi 50,000 - 8,843 58,843
5095 Wa Riso 810144 4021/ Kontrol 26-May-15 Dalam 50,000 - 21,388 71,388
5096 Nasiman 404532 6186/ Dm Ii Ht 26-May-15 Peny.Dalam 50,000 - 44,438 94,438
5097 M.Sani Perd 692827 6261/ Serumen Ob 26-May-15 Tht 50,000 - 30,883 80,883
5098 Bunga 829577 5836/ Katarak Os 26-May-15 Mata 50,000 - 20,810 70,810
5099 Kamakko R 666972 6219/ Kontrol 26-May-15 Jantung 50,000 - 173,379 223,379
5100 Salbiah 838782 6220/ G1P0A0 + Fl 26-May-15 Kandungan 50,000 - 120,500 3,616 174,116
5101 Ngadio 403431 6145/ Pjk 26-May-15 Jantung 50,000 - 185,476 235,476
5102 Siti Holipah 839380 5852/ Post Sc 26-May-15 Kandungan 50,000 - 120,500 2,604 173,104
5103 Mariana 476352 5629/ 15 Nekrosis 26-May-15 Gigi&Mulut 50,000 - 207,443 93,115 8,363 358,921
5104 Ruslan 372773 5705/ Dm Tipe Ii 26-May-15 Penyakit Dala 50,000 - 32,100 82,100
5105 Sumini 834276 3980/ Nodle Tiroi 26-May-15 Dalam 50,000 - 178,213 228,213
5106 Masmur 808953 3979/ Pjk 26-May-15 Jantung 50,000 35,000 60,000 324,150 469,150
5107 Junaini 791090 3994/ Kontrol 26-May-15 Dalam 50,000 - 30,713 80,713
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5108 Susmiro 839913 4038/ Susp Oma 26-May-15 Tht 50,000 - 310,500 7,763 368,263
5109 Indah Guspi 840501 4006/ Post Of Fem 26-May-15 Orthopedy 50,000 - 160,000 16,411 226,411
5110 H Syahrul T 486010 5611/ Kontrol 26-May-15 Dalam 50,000 - 315,106 365,106
5111 Sri Maryant 816167 6070/ Kontrol 26-May-15 Tht 50,000 - 783,150 430,400 14,640 1,278,190
5112 Suhery 822948 5896/ Terapi+Lbp 26-May-15 R.Medik+Syar 50,000 35,000 71,500 11,233 167,733
5113 M Rojani 834841 4054/ Kontrol 26-May-15 Bedah Saraf 50,000 - 85,388 135,388
5114 Hamnah Sud 681390 4157/ Kontrol 26-May-15 Syaraf 50,000 35,000 19,280 104,280
5115 Fatimah 815025 6189/ Dm Ii+Cad 26-May-15 Dalam+Jantun 50,000 35,000 63,475 148,475
5116 Sunarti 838741 5915/ Nyeri Bag P 26-May-15 Penyakit Dala 50,000 70,000 20,518 140,518
5117 Adiman 838392 5941/ Kontrol 26-May-15 Orthopedi 50,000 35,000 159,500 8,843 253,343
5118 Ngatiyem 771064 4172/ Dyspepsi, H 26-May-15 Peny.Dalam 50,000 35,000 179,310 264,310
5119 Mariyati 841610 5821/ Abses Mand 26-May-15 Gigi&Mulut 50,000 - 91,340 17,678 159,018
5120 Asliansyah 591446 4051/ Terapi + Kon 26-May-15 R Medik + Sar 50,000 35,000 159,500 14,615 259,115
5121 Suparno 810560 5928/ Non Union F 26-May-15 Orthopedi 50,000 - 80,000 8,843 138,843
5122 Indrawati 680655 5838/ Terapi 26-May-15 Bedah Thorak 50,000 35,000 159,500 238,343 482,843
5123 Fitri 697298 5882/ Chf 26-May-15 Jantung 50,000 - 110,700 48,713 209,413
5124 M. Salim Ma 563143 5883/ Epilepsi 26-May-15 Syaraf 50,000 - 294,863 344,863
5125 Wiyoto 485531 4055/ Chf 26-May-15 Jantung 50,000 - 433,350 483,350
5126 Saifullah 836957 4024/ Kontrol 26-May-15 Orthopedy 50,000 35,000 151,500 5,579 242,079
5127 Ina Pratiwi 779411 4085/ Post Snh 26-May-15 Saraf 50,000 - 17,821 67,821
5128 Yuliana 625938 6069/ Dm Ii 26-May-15 R.Medik+Dal 50,000 70,000 71,500 633 192,133
5129 Fatiah 834800 5777/ Post Op 26-May-15 Kandungan 50,000 - 60,000 2,604 112,604
5130 Harsono Ki 563496 5748/ Vertigo 26-May-15 Syaraf 50,000 35,000 159,500 9,546 254,046
5131 Andi Ahmad 551166 5884/ Susp Gerd 26-May-15 Penyakit Dala 50,000 35,000 465,138 550,138
5132 M.Ramadan 575485 6201/ Terapi 26-May-15 R.Medik 50,000 35,000 220,000 108,311 413,311
5133 Djamin 457035 6216/ Frozen Shou 26-May-15 Syaraf 50,000 35,000 71,500 14,330 170,830
5134 M. Aspianur 842811 5912/ Colic Abd S 26-May-15 Urologi 50,000 35,000 335,000 745,800 567,205 1,733,005
5135 Nur Jannah 838790 5855/ Myalgia 26-May-15 Syaraf 50,000 - 8,529 58,529
5136 Ainun 838784 5823/ Abses Mama 26-May-15 Bedah Umum 50,000 - 777,150 377,500 125,400 4,963 1,335,013
5137 Yessi Pratiw 731916 6398/ Demam > Se 26-May-15 Peny.Dalam 50,000 - 19,165 69,165
5138 Dahriani 636419 6369/ Kontrol 26-May-15 Jantung+Dala 50,000 35,000 132,300 217,300
5139 Yunanik 790619 4112/ Cad + Nidd 26-May-15 Jantung 50,000 35,000 309,488 394,488
5140 Irawati 533561 5822/ Cerebral Tb 26-May-15 Bedah Syaraf 50,000 - 30,263 80,263
5141 Ade Reza Sa 835907 4025/ Hnp 26-May-15 Orthopedy 50,000 35,000 125,400 9,478 219,878
5142 Noor Jennah 754735 5899/ Isk 26-May-15 Kulit Kelamin 50,000 - 26,675 76,675
5143 Hendra Abdu 838731 5898/ Susp Isk 26-May-15 Kulit Kelamin 50,000 - 33,983 83,983
5144 Nurjannah 835560 4159/ Hiperthiroid 26-May-15 P. Dalam 50,000 - 46,238 96,238
5145 Nur Bia 838901 5944/ Hemoroid+ 26-May-15 Penyakit Dala 50,000 - 730,700 15,585 796,285
5146 Lamidi 816779 4115/ Kontrol 26-May-15 Dalam 50,000 - 16,219 66,219
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5147 Arbain 835351 6232/ Kontrol 26-May-15 Jantung 50,000 - 462,500 316,088 828,588
5148 Feti Fatima 836210 6159/ Kontrol 26-May-15 Peny.Dalam 50,000 35,000 997,700 36,856 1,119,556
5149 Tika Purnam 566216 6370/ Iscialgia 26-May-15 Syaraf 50,000 - 16,205 66,205
5150 Sawiyah 634790 6400/ Hamil 33 M 26-May-15 Kandungan 50,000 - 120,500 633 171,133
5151 Norhan Kusa 842182 6115/ Kontrol 26-May-15 Bedah Syaraf 50,000 35,000 689,076 15,539 789,615
5152 Hariyati 780643 5911/ Hipertiroid 26-May-15 Mata 50,000 - 8,050 58,050
5153 Muh Azka A 838792 4096/ Oma 26-May-15 Tht 50,000 - 310,500 2,363 362,863
5154 Ida Mardian 703995 6040/ Dm 26-May-15 Peny.Dalam 50,000 - 142,425 192,425
5155 Nurhadiyant 320110 5686/ Kontrol 26-May-15 Kulit Kelamin 50,000 - 17,613 67,613
5156 M.Basri 529381 6084/ Angina Pec 26-May-15 Jantung 50,000 - 337,013 387,013
5157 Yudi Gunars 725539 5598/ Kontrol 26-May-15 Tht 50,000 - 9,208 59,208
5158 Megawati 637197 5793/ Dm 26-May-15 Penyakit Dala 50,000 - 47,344 97,344
5159 Nurul Aini 835915 6112/ Terapi 26-May-15 R.Medik 50,000 35,000 159,500 227,700 15,229 487,429
5160 Juliansyah 836346 6246/ Kds 26-May-15 Anak 50,000 - 22,761 72,761
5161 Nano 838778 5733/ Ulkus 26-May-15 Gigi&Mulut 50,000 - 160,600 10,938 221,538
5162 Eko Siswori 810534 5746/ Dm Tipe Ii 26-May-15 Penyakit Dala 50,000 - 773,050 823,050
5163 Usman 709277 4069/ Chd 26-May-15 Jantung 50,000 - 38,438 88,438
5164 Henny Yulia 372707 4160/ Hipertiroid 26-May-15 Peny.Dalam 50,000 35,000 11,950 96,950
5165 Ratnawaty 790972 6128/ Obs Chest P 26-May-15 Jantung 50,000 - 25,688 75,688
5166 Sukardanu W817421 5837/ Post Orif Ti 26-May-15 Orthopedi 50,000 - 160,000 15,436 225,436
5167 Nurpaidah 747898 4067/ Limfadenitis 26-May-15 Paru 50,000 - 160,250 212,250 422,500
5168 Abdul Rahm 641669 5731/ Riw Lbp 26-May-15 Syaraf 50,000 - 11,233 61,233
5169 Marni 641072 5735/ Oa 26-May-15 Syaraf 50,000 - 227,700 15,905 293,605
5170 Juhairiyah 205929 6295/ Lbp 26-May-15 Syaraf 50,000 - 741,950 227,700 10,129 1,029,779
5171 Sabariah 667290 6083/ Ht Dm 26-May-15 Penyakit Dala 50,000 - 277,325 327,325
5172 Norjanah 842337 5749/ Hipoglikem 26-May-15 Penyakit Dala 50,000 - 5,154 55,154
5173 Arbainah 531576 4097/ Tonsilitis K 26-May-15 Tht 50,000 - 17,325 67,325
5174 M. Mahfud 838797 5897/ Pyoderma 26-May-15 Kulit Kelamin 50,000 - 51,843 101,843
5175 Fatmawati 810152 6249/ Nyeri Ulu H 26-May-15 Peny.Dalam 50,000 - 87,500 23,721 161,221
5176 Hasanah 838787 6280/ Dm 26-May-15 Peny.Dalam 50,000 - 30,713 80,713
5177 Rahmatun N 835337 6250/ Kontrol 26-May-15 Kandungan 50,000 - 60,000 316 110,316
5178 Kasdi 834604 5716/ Paraplegia 26-May-15 Orthopedi 50,000 - 2,506,350 7,723 2,564,073
5179 Imam Supar 839993 5851/ Ischialgia 26-May-15 Syaraf 50,000 - 227,700 10,595 288,295
5180 Asnan Gani 549225 5824/ Bph 26-May-15 Urologi 50,000 35,000 29,784 114,784
5181 Djamaiyah 770843 6325/ Dm 26-May-15 Peny.Dalam 50,000 - 462,500 125,400 29,788 667,688
5182 Rafliansyah 838710 4082/ Abses 26-May-15 Bedah Umum 50,000 - 27,149 77,149
5183 Nurani 740962 6352/ Kontrol 26-May-15 Jantung 50,000 - 204,738 254,738
5184 Arni 209353 4084/ 68 Radix 26-May-15 Gigi & Mulut 50,000 - 603,276 8,363 661,639
5185 Ade Desia R 839912 6324/ Kontrol 26-May-15 Tht 50,000 - 7,103 57,103
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5186 Abdul Khair 780503 5701/ Terapi+Hnp 26-May-15 R.Medik+Orth 50,000 35,000 159,500 12,014 256,514
5187 Marjuki 492002 6174/ Stoke 26-May-15 Syaraf 50,000 - 186,500 19,920 256,420
5188 Hanafi Alha 835974 5779/ Post Op 26-May-15 Tht 50,000 - 22,822 72,822
5189 Abdl Samad 836288 6188/ Pjb 26-May-15 Jantung 50,000 - 18,750 68,750
5190 M. Aidil Fitr 838791 5868/ Ispa 26-May-15 Anak 50,000 - 23,994 73,994
5191 Maseuwara 838789 5854/ Trauma Pedi 26-May-15 Orthopedi 50,000 - 5,263 55,263
5192 Kusasi 492196 6355/ Bronkopneu 26-May-15 Paru 50,000 - 19,836 69,836
5193 Mila Sulastr 838786 4068/ Disminore 26-May-15 Kandungan 50,000 - 60,000 305,000 316 415,316
5194 Moh. Rosyd 775198 5900/ Chf+Crf 26-May-15 Penyakit Dala 50,000 - 40,475 90,475
5195 Sufian Hami 838785 4066/ Snh 26-May-15 Saraf 50,000 - 997,700 23,971 1,071,671
5196 M. Rasyidi 476777 5778/ Ischialgia 26-May-15 Syaraf 50,000 - 227,700 11,254 288,954
5197 Zainab 307218 5795/ Terapi+Dm 26-May-15 R.Medik+P.Da 50,000 35,000 71,500 25,856 182,356
5198 Evi Kristina 842196 6278/ Kontrol 26-May-15 Peny.Dalam 50,000 - 29,469 79,469
5199 Dwi Lestari 591156 4111/ Asma Brinch 26-May-15 Paru 50,000 - 125,400 21,411 196,811
5200 Sopyan Nur 838900 6397/ Isk 26-May-15 Urologi 50,000 35,000 335,000 410,200 745,800 531,050 2,107,050
5201 Jumsiah 838765 5945/ Kontrol 26-May-15 Bedah Umum 50,000 - 997,700 1,047,700
5202 Nurhaidah 838776 5702/ Limpadenop 26-May-15 Bedah Umum 50,000 - 713,250 377,500 125,400 1,266,150
5203 M Rizky Har 838760 3964/ Benjolan Di 26-May-15 Anak 50,000 35,000 701,550 105,600 892,150
5204 Nur Indah 393938 4036/ G4 P2 A1 Dn 26-May-15 Kandungan 50,000 35,000 60,000 305,000 34,158 484,158
5205 Muslifah 838777 5704/ Amenorrea 26-May-15 Kandungan 50,000 - 120,500 305,000 475,500
5206 Atu Tajuli 828272 6382/ 7 Fraktur 26-May-15 Gigi&Mulut 50,000 - 160,600 210,600
5207 Nadito 808034 6218/ Kontrol 26-May-15 Kardiovaskule 50,000 - 207,900 257,900
5208 Emi Sukmaw838745 3950/ Sering Pusi 26-May-15 Saraf 50,000 - 997,700 1,047,700
5209 Wilfa Zumh 838799 5926/ Post Trauma 26-May-15 Syaraf 50,000 - 997,700 1,047,700
5210 Sudirman 835903 5761/ Susp Bsk 26-May-15 Urologi 50,000 - 335,000 153,500 145,200 683,700
5211 Rusma Santi 839926 5765/ 8 Impaksi 26-May-15 Gigi&Mulut 50,000 - 723,150 125,400 898,550
5212 Zubaidah 753389 6187/ S/ Tb Paru 26-May-15 Paru 50,000 - 160,250 125,400 335,650
5213 Dani Kusdwi 838746 6158/ Hernia Ingui 26-May-15 Bedah Umum 50,000 - 394,150 125,400 569,550
5214 Amansyah 828082 6097/ Dm Ii 26-May-15 Peny.Dalam 50,000 - 110,250 160,250
5215 Sunarti 838741 6339/ Nyeri Pingg 26-May-15 Peny.Dalam 50,000 - 363,500 413,500
5216 Yuliana Tan 634176 6217/ Myalgia 26-May-15 Peny.Dalam 50,000 - 609,500 659,500
5217 Siti Zubaida 796802 6306/ Dm 26-May-15 Penyakit Dala 50,000 - 500,250 550,250
5218 Hermawati 763814 5794/ Dm 26-May-15 Penyakit Dala 50,000 - 132,000 182,000
5219 Hamidah 765193 4099/ Cek Lab 26-May-15 Laboratorium 50,000 - 87,500 137,500
5220 Darsiah 440282 6129/ Cf Radius S 26-May-15 Ortophedi 50,000 - 110,250 160,250
5221 Dayang Tiar 679442 6233/ Dm Ii 26-May-15 Peny.Dalam 50,000 - 110,250 160,250
5222 Sri Winatin 743848 6143/ Dm 26-May-15 Peny.Dalam 50,000 - 500,250 550,250
5223 Supiansyah 583067 4127/ Cek Lab 26-May-15 Laboratorium 50,000 - 43,250 93,250
5224 Syamsuriant 569355 5657/ Dm 26-May-15 Penyakit Dala 50,000 - 500,250 550,250
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5225 Rusna 227288 4039/ Granulomat 26-May-15 Bedah Umum 50,000 - 33,000 83,000
5226 Ratna 838391 3949/ Tb Payudara 26-May-15 Paru 50,000 - 160,250 210,250
5227 Nurani 780699 3978/ Cek Lab 26-May-15 Laboratorium 50,000 - 353,250 403,250
5228 Muriah 776281 3976/ Cek Lab 26-May-15 Laboratorium 50,000 - 110,250 160,250
5229 Lisnawati 786215 6351/ S/ Ca Nasof 26-May-15 Tht 50,000 - 44,000 94,000
5230 Kurniaty 654500 6231/ Dm 26-May-15 Peny.Dalam 50,000 - 110,250 160,250
5231 Irmawanti 720246 4113/ Tpha 26-May-15 Kulit & Kelam 50,000 - 44,000 94,000
5232 Rahmatika 838752 6202/ Sakit Pingg 26-May-15 Peny.Dalam 50,000 35,000 71,500 156,500
5233 Herlinda Yus 805100 5628/ Terapi 26-May-15 Rehab Medik 50,000 - 71,500 121,500
5234 Lina 822580 6411/ Terapi 26-May-15 R.Medik 50,000 - 71,500 121,500
5235 Abdul Latif 839975 6279/ Terapi 26-May-15 R.Medik 50,000 - 71,500 121,500
5236 Dewi Kartik 824703 4143/ Terapi 26-May-15 R.Medik 50,000 - 71,500 121,500
5237 Tan Lan Tju 810556 4158/ Terapi 26-May-15 Rehab Medik 50,000 - 71,500 121,500
5238 Risa Ifana 829483 4141/ Terapi 26-May-15 R.Medik 50,000 - 71,500 121,500
5239 Andy K P 706211 5943/ Fisioterapi 26-May-15 Rehab Medik 50,000 - 159,500 209,500
5240 Siti Hasanah 697396 4130/ Terapi 26-May-15 R.Medik 50,000 - 159,500 209,500
5241 Rudi Herma 743463 4174/ Terapi 26-May-15 Rehab Medis 50,000 - 71,500 121,500
5242 Paulus Lai P 243271 6384/ Terapi 26-May-15 R.Medik 50,000 - 71,500 121,500
5243 Paridah 646528 4142/ Terapi 26-May-15 R.Medik 50,000 - 71,500 121,500
5244 Miftahul Ja 615499 6321/ Fisioterapi 26-May-15 R. Medik 50,000 - 71,500 121,500
5245 Sarahhealti 835367 4144/ Terapi 26-May-15 R.Medik 50,000 - 71,500 121,500
5246 Nabila Tasy 828519 6096/ Terapi 26-May-15 R.Medik 50,000 - 220,000 270,000
5247 Anisa Rifqa 634858 3995/ Terapi 26-May-15 Rhb Medis 50,000 - 220,000 270,000
5248 M. Haykal I 500328 5806/ Terapi 26-May-15 Rehab Medik 50,000 - 440,000 490,000
5249 Hanifah Kho738963 6310/ Terapi 26-May-15 R.Medik 50,000 - 440,000 490,000
5250 Ummul Khai 815127 5808/ Terapi+Cp 26-May-15 R.Medik+Ana 50,000 - 440,000 490,000
5251 Muhammadn666097 6066/ Terapi 26-May-15 R.Medik 50,000 - 220,000 270,000
5252 Dafa Tri Nal 829331 6204/ Terapi 26-May-15 R.Medik 50,000 - 220,000 270,000
5253 Nabila Syif 330529 6085/ Terapi 26-May-15 R.Medik 50,000 - 440,000 490,000
5254 Azlan Darma 792114 6067/ Terapi 26-May-15 R.Medik 50,000 - 440,000 490,000
5255 Amira 821585 6068/ Terapi 26-May-15 R.Medik 50,000 - 440,000 490,000
5256 Syahira 790826 5642/ Terapi 26-May-15 Rehab Medik 50,000 - 440,000 490,000
5257 Febrian Satr 753688 5599/ Fisioterapi 26-May-15 Rehab Medik 50,000 - 440,000 490,000
5258 M. Azylillah 744048 5630/ Ot+Tw 26-May-15 Rehab Medik 50,000 - 220,000 270,000
5259 Rushel Satri 819393 5641/ Terapi 26-May-15 Rehab Medik 50,000 - 220,000 270,000
5260 Wahab Nur 799076 6235/ Terapi 26-May-15 R.Medik 50,000 - 440,000 490,000
5261 Prima Dwi 390935 5600/ Ot+Tw 26-May-15 Rehab Medik 50,000 - 440,000 490,000
5262 Mariam Ulfa 834596 6262/ Terapi 26-May-15 R.Medik 50,000 - 220,000 270,000
5263 Siti Naida 822934 6265/ Terapi 26-May-15 R Medik 50,000 - 220,000 270,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5264 Nani Widyaw486597 5809/ Terapi 26-May-15 Rehab Medik 50,000 - 440,000 490,000
5265 Rachmah 264555 6111/ Terapi 26-May-15 R.Medik 50,000 - 220,000 270,000
5266 H Bambang 829576 3991/ Terapi 26-May-15 R Medik 50,000 - 440,000 490,000
5267 Laila 759001 5612/ Terapi 26-May-15 Rehab Medik 50,000 - 440,000 490,000
5268 Sugiyanto 748332 6053/ Fisioterapi 26-May-15 R. Medik 50,000 - 440,000 490,000
5269 Ahmad Toba 838376 6293/ Terapi 26-May-15 R.Medik 50,000 - 220,000 270,000
5270 Sali 787723 6205/ Terapi 26-May-15 R.Medik 50,000 - 440,000 490,000
5271 Aris Rahma 784378 3961/ Terapi 26-May-15 R Medik 50,000 - 440,000 490,000
5272 Fatma 433683 4081/ Terapi 26-May-15 R Medis 50,000 - 159,500 209,500
5273 Darmiati 667292 5867/ Terapi 26-May-15 Rehab Medik 50,000 - 71,500 121,500
5274 Sumiati 663502 6338/ Terapi 26-May-15 R.Medik 50,000 - 159,500 209,500
5275 Norliana 521951 5840/ Terapi 26-May-15 Rehab Medik 50,000 - 159,500 209,500
5276 Nilawati 346646 6368/ Terapi 26-May-15 R.Medik 50,000 - 159,500 209,500
5277 Jasmani 822971 4022/ Terapi 26-May-15 R Medis 50,000 - 159,500 209,500
5278 Winona 337477 6263/ Terapi 26-May-15 R.Medik 50,000 - 220,000 270,000
5279 Warni 753983 5780/ Terapi 26-May-15 Rehab Medik 50,000 - 71,500 121,500
5280 H. Syamsud 775495 5791/ Terapi 26-May-15 Rehab Medik 50,000 - 220,000 270,000
5281 Akhmad Sya 763738 5764/ Terapi 26-May-15 Rehab Medik 50,000 - 159,500 209,500
5282 Priyo Hoet 263217 5762/ Terapi 26-May-15 Rehab Medik 50,000 - 71,500 121,500
5283 Rabiatul Ad 602715 6171/ Terapi 26-May-15 R.Medik 50,000 - 159,500 209,500
5284 Yuliani 285668 5688/ Terapi 26-May-15 Rehab Medik 50,000 - 159,500 209,500
5285 Sayem 835998 3993/ Terapi 26-May-15 R Medik 50,000 - 159,500 209,500
5286 Nurhaidah 061430 5750/ Terapi 26-May-15 Rehab Medik 50,000 - 71,500 121,500
5287 Wakiem 701255 6156/ Terapi 26-May-15 R.Medik 50,000 - 71,500 121,500
5288 Jasmah 434885 6113/ Terapi 26-May-15 R.Medik 50,000 - 71,500 121,500
5289 Yenni Purwa 631789 4008/ Terapi 26-May-15 R Medik 50,000 - 159,500 209,500
5290 Iis Hastuti 835363 6173/ Terapi 26-May-15 R.Medik 50,000 - 159,500 209,500
5291 Inem 534202 6160/ Terapi 26-May-15 R.Medik 50,000 - 159,500 209,500
5292 Yetty Pm Pa 691424 6127/ Terapi 26-May-15 R.Medik 50,000 - 159,500 209,500
5293 Kornelis Na 810504 5717/ Terapi 26-May-15 Rehab Medik 50,000 - 159,500 209,500
5294 Sujitno 835911 3965/ Terapi 26-May-15 R Medik 50,000 - 159,500 209,500
5295 Kamba 823138 6172/ Terapi 26-May-15 R.Medik 50,000 - 71,500 121,500
5296 Supriani 639809 6114/ Terapi 26-May-15 R.Medik 50,000 - 159,500 209,500
5297 Ratna 821500 5658/ Terapi 26-May-15 Rehab Medik 50,000 - 71,500 121,500
5298 Achmadsya 465433 6100/ Terapi 26-May-15 R.Medik 50,000 - 159,500 209,500
5299 Ijum 775736 5627/ Terapi 26-May-15 Rehab Medik 50,000 - 71,500 121,500
5300 Helwinda 577381 5689/ Terapi 26-May-15 Rehab Medik 50,000 - 159,500 209,500
5301 Asni 816792 5719/ Terapi 26-May-15 Rehab Medik 50,000 - 71,500 121,500
5302 Sriani 346142 5645/ Terapi 26-May-15 Rehab Medik 50,000 - 159,500 209,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5303 Darwisah 743878 3948/ Fisioterapi 26-May-15 Rhb Medis 50,000 - 71,500 121,500
5304 Fatimah 380727 6099/ Terapi 26-May-15 R.Medik 50,000 - 71,500 121,500
5305 Iis Soleh 796820 6054/ Fisioterapi 26-May-15 Rehab Medis 50,000 - 71,500 121,500
5306 Suyanto 445829 5671/ Fisioterapi 26-May-15 Rehab Medik 50,000 - 71,500 121,500
5307 H.Mudaring 585074 3947/ Terapi 26-May-15 R Medis 50,000 - 71,500 121,500
5308 Kamsiah 835917 5656/ Fisioterapi 26-May-15 Rehab Medik 50,000 - 71,500 121,500
5309 Supatmi 801314 5673/ Terapi 26-May-15 Rehab Medik 50,000 - 71,500 121,500
5310 Erna Samun 569637 5643/ Terapi 26-May-15 Rehab Medik 50,000 - 159,500 209,500
5311 Marida 647710 5615/ Fisioterapi 26-May-15 Rehab Medik 50,000 - 159,500 209,500
5312 Sumiati 715110 6098/ Terapi 26-May-15 R.Medik 50,000 - 159,500 209,500
5313 Sabariyah 016859 5659/ Fisioterapi 26-May-15 Rehab Medik 50,000 - 159,500 209,500
5314 Marni 740828 3963/ Fisiotherapy 26-May-15 Rehab Medis 50,000 35,000 159,500 18,304 262,804
5315 Mahmudah 268599 6039/ Terapi 26-May-15 R.Medik 50,000 35,000 159,500 14,441 258,941
5316 Rubiyanti 835952 3962/ Terapi 26-May-15 R Medik 50,000 35,000 159,500 13,121 257,621
5317 Rita Sahara 734234 5810/ Terapi+Susp 26-May-15 R.Medik+Bed 50,000 35,000 71,500 156,500
5318 Tri Mailani 806796 5644/ Epilepsi 26-May-15 Syaraf 50,000 - 234,903 284,903
5319 Helmi Subh 760094 4053/ Kontrol 26-May-15 Jantung 50,000 - 178,200 228,200
5320 Maulidiya Pu834588 6277/ Hidrocefalu 26-May-15 Bedah Syaraf 50,000 35,000 6,323 91,323
5321 Ganip Wijay 691283 6381/ Myalgia 26-May-15 Syaraf 50,000 - 15,330 65,330
5322 Indo Kemah 619375 5870/ Epilepsi 26-May-15 Syaraf 50,000 - 464,775 514,775
5323 Nurlinda Yun 835523 6412/ Omp 26-May-15 Tht 50,000 - 310,500 8,925 369,425
5324 Aryani 682266 4175/ Cad+Ht 26-May-15 Jantung 50,000 - 311,438 361,438
5325 Akbar Alfari 841603 5763/ Hidrocephal 26-May-15 Anak 50,000 35,000 85,000
5326 Eddy Nayan 642026 4070/ Kontrol 26-May-15 Bedah Thorax 50,000 - 50,000
5327 Hasitah 838727 5881/ Susp Lipom 26-May-15 Bedah Umum 50,000 35,000 187,000 272,000
5328 Nurjanah 532108 5582/ Struma 26-May-15 Onkologi 50,000 - 50,000
5329 Rusman 840633 4023/ Kontrol 26-May-15 Bedah Saraf 50,000 - 79,500 129,500
5330 Ratna Juwita 631025 6082/ Batuk 3 Bln 26-May-15 Paru 50,000 - 50,000
5331 Berlin Limb 838763 6307/ Ckd 26-May-15 Peny.Dalam 50,000 - 50,000
5332 Awi Am 841567 5913/ Dm+Ht 26-May-15 Penyakit Dala 50,000 - 50,000
5333 Dalenna 770013 5747/ Involusi Ute 26-May-15 Kandungan 50,000 - 746,500 796,500
5334 Mahlinda Saf726865 6294/ Pre Removal 26-May-15 Ortophedi 50,000 - 50,000
5335 Bahruddin 711460 6383/ Kista 26-May-15 Bedah Umum 50,000 - 125,000 175,000
5336 April Liyant 806447 6144/ Limfadeniti 26-May-15 Bedah Umum 50,000 - 125,000 175,000
5337 M. Rosad Se 839992 5674/ Pulp. Irrever 26-May-15 Gigi&Mulut 50,000 - 362,633 412,633
5338 Nor Anita 838742 5866/ 48 Impaksi 26-May-15 Gigi&Mulut 50,000 - 50,000
5339 Andre Prata 835578 5718/ Kontrol Pos 26-May-15 Bedah Umum 50,000 - 125,000 175,000
5340 M. Imafatik 767678 5869/ Post Orif 26-May-15 Orthopedi 50,000 - 50,000
5341 Nurbainah 763714 4171/ Abses Mama 26-May-15 Bedah Umum 50,000 - 125,000 175,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5342 Suwarno 838796 6366/ Abses Paroti 26-May-15 Bedah Umum 50,000 - 50,000
5343 Susanti 648967 5853/ Post Op Gan 26-May-15 Bedah Umum 50,000 - 125,000 175,000
5344 Ibas 835912 4992/ Tumor 26-May-15 Bedah Umum 50,000 - 125,000 175,000
5345 Syukri 833924 6323/ Kontrol 26-May-15 Urologi 50,000 - 50,000
5346 Sunyoto 839955 4100/ Susp Bsk 26-May-15 Urologi 50,000 - 50,000
5347 Abd. Latif 709856 6354/ Bph 26-May-15 Urologi 50,000 - 265,000 315,000
5348 Murjani 838783 6248/ Mata Kiri K 26-May-15 Mata 50,000 - 130,000 180,000
5349 Suwarto 533616 4186/ Glukoma 26-May-15 Mata 50,000 - 50,000
5350 Jeimah 838767 6157/ 1 1 Koriks 26-May-15 Gigi&Mulut 50,000 - 272,703 322,703
5351 Karmila Sar 462492 6399/ G4P3A0 Ht 26-May-15 Kandungan 50,000 - 120,500 170,500
5352 Sulami 835351 6232/ Kontrol 26-May-15 Jantung 50,000 - 50,000
5353 Natsir Fahru 838793 4098/ Corpal Mae 26-May-15 Tht 50,000 - 50,000
5354 H. Iriansyah 838757 5720/ Laringitis 26-May-15 Tht 50,000 - 50,000
5355 M.Fuad Sud 659839 6308/ S/ Omsk 26-May-15 Tht 50,000 - 63,000 113,000
5356 Murni Asih 361477 5583/ Terapi 26-May-15 R.Medik 50,000 - 159,500 209,500
5357 Sumarsih 835588 4040/ Tumor Di Pe 26-May-15 Kandungan 50,000 - 60,000 110,000
5358 Sunawati 838780 4037/ G5P3Ai Hph 26-May-15 Kandungan 50,000 - 480,500 530,500
5359 Lehana 839924 6234/ Kista Uteri 26-May-15 Kandungan 50,000 - 60,000 110,000
5360 Ahmad Sida 581234 5613/ Terapi 26-May-15 Rehab Medik 50,000 - 220,000 270,000
5361 Afif Pliang 781444 5614/ Terapi 26-May-15 Rehab Medik 50,000 - 220,000 270,000
5362 Ade Warsa 791835 6052/ Terapi 26-May-15 R.Medik 50,000 - 220,000 270,000
5363 Murjiati 378659 6651/ Kontrol 27-May-15 Onkologi 50,000 - 1,925,000 1,975,000
5364 Ernawati 428296 6140/ Ca Mamae 27-May-15 Onkologi 50,000 - 611,250 10,366 671,616
5365 Idris 838909 6577/ Obs Cardiom 27-May-15 Jantung 50,000 - 649,500 44,865 744,365
5366 Dani Kusdwi 838746 6199/ Hernia 27-May-15 Bedah 50,000 35,000 649,500 10,890 745,390
5367 Hermawati 763814 6168/ Dm Periodic 27-May-15 P. Dalam 50,000 35,000 120,500 305,000 370,013 880,513
5368 Lasiyem 136683 4173/ Post Op 27-May-15 Orthopedi 50,000 - 27,636 77,636
5369 Sudirman 835903 6607/ Susp Bsk 27-May-15 Urologi 50,000 - 50,000
5370 Aspiansyah 744601 6319/ Limfadeniti 27-May-15 Paru 50,000 - 212,250 262,250
5371 Mahmudah 836831 6242/ Hipertiroid 27-May-15 P. Dalam 50,000 - 352,100 6,729 408,829
5372 Amas Megaw822082 6576/ Hhd 27-May-15 Jantung+P.Da 50,000 - 174,134 224,134
5373 Ardheapiram 670678 6001/ Kontrol 27-May-15 Bedah Anak 50,000 - 43,250 6,584 99,834
5374 Bagus Dwi J 782836 4369/ Gangguan K 27-May-15 Anak 50,000 - 395,350 38,500 483,850
5375 Rahmawati 410420 6257/ Sle 27-May-15 P. Dalam 50,000 - 294,913 344,913
5376 Dian Nopita 842871 4322/ Haid Tdk La 27-May-15 Kandungan 50,000 - 60,000 44,250 1,525 155,775
5377 Darsiah 402979 4264/ Decomp Cor 27-May-15 Jantung 50,000 35,000 168,107 253,107
5378 Ali Rizani 787738 4248/ Pjk 27-May-15 Jantung 50,000 - 374,978 424,978
5379 M.Rasyied A 838382 6653/ Scizoprenia 27-May-15 Syaraf 50,000 - 126,391 176,391
5380 Radiathan M 757684 6109/ Kontrol 27-May-15 Kandungan 50,000 - 60,000 6,506 116,506
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5381 Abdul Nurd 464739 6034/ Post Stroke 27-May-15 Syaraf+R. Med 50,000 70,000 220,000 43,250 13,729 396,979
5382 Norpiani 839939 6334/ Ht 27-May-15 Jantung 50,000 - 40,275 90,275
5383 Utuh Sadri 544000 6124/ Chf 27-May-15 Jantung 50,000 - 267,348 317,348
5384 Maryani 086352 6458/ Terapi+Ht 27-May-15 R.Medik+Jant 50,000 35,000 71,500 110,250 257,513 524,263
5385 Sonia Pratiw 841987 6592/ Oma 27-May-15 Tht 50,000 - 12,510 62,510
5386 Syaridayanti 185518 5989/ Kontrol 27-May-15 Kandungan 50,000 35,000 60,000 70,958 215,958
5387 Herlina 817022 4413/ Kontrol 27-May-15 Syaraf 50,000 - 24,430 74,430
5388 Elly Yuliawa 842740 6302/ Fr Avulsi 27-May-15 Orthopedi 50,000 - 1,300 51,300
5389 Rallinawati 621170 6290/ Cad+Dm 27-May-15 Jantung+Dala 50,000 - 251,250 301,250
5390 Abdul Haris 636491 6305/ Psoriasis 27-May-15 Kulit Kelamin 50,000 - 40,059 90,059
5391 Darsiah 440282 6078/ Pjk 27-May-15 Jantung 50,000 - 180,940 230,940
5392 Tri Turiyani 696670 6460/ Dm+Decomp 27-May-15 P. Dalam 50,000 35,000 316,291 401,291
5393 Abd Samad 716327 4202/ Kontrol 27-May-15 P. Dalam 50,000 - 49,875 99,875
5394 M.Rehan Ak 531932 6215/ Ispa Kronis 27-May-15 Anak 50,000 - 4,350 54,350
5395 Tenri Angka 781495 6637/ Limfadeniti 27-May-15 Paru 50,000 - 212,250 262,250
5396 Wiwi Siti Ar 806761 6062/ Dm Tipe Ii+ 27-May-15 P. Dalam 50,000 - 312,375 362,375
5397 Paulus K 639626 6639/ Epilepsi 27-May-15 Syaraf 50,000 - 98,629 148,629
5398 Hj.Salbiah 758941 6609/ Cad 27-May-15 Jantung 50,000 - 176,838 226,838
5399 Ali Munafri 820162 4383/ Kontrol 27-May-15 P. Dalam 50,000 - 10,131 60,131
5400 Sukarman 842042 6288/ Dispepsia+R 27-May-15 Urologi 50,000 - 547,875 597,875
5401 Siti Aisyah 838918 4216/ Decomp Cor 27-May-15 Jantung 50,000 - 649,500 18,000 717,500
5402 Suwarni 828984 4218/ Kontrol 27-May-15 Syaraf 50,000 - 48,013 98,013
5403 Wahida 631245 6563/ Kontrol 27-May-15 Kandungan 50,000 35,000 133,500 160,338 378,838
5404 Rika Fitriya 584936 6580/ Hipertiroid 27-May-15 P. Dalam 50,000 - 34,738 84,738
5405 Syayid M A 442927 4381/ Kontrol 27-May-15 B. Anak 50,000 - 5,508 55,508
5406 Ivaen Dwi S 838764 6593/ Union Fr Ti 27-May-15 Orthopedi 50,000 - 2,716 52,716
5407 Aida Ruslia 657671 6243/ Angina Pect 27-May-15 Jantung 50,000 - 193,500 243,500
5408 Lina Melya 796892 6621/ Terapi 27-May-15 R.Medik 50,000 35,000 71,500 215,754 372,254
5409 Otowiryo D 707745 4295/ Pjk 27-May-15 Jantung 50,000 - 335,963 385,963
5410 Jumbrie 803120 6229/ Cad 27-May-15 Jantung 50,000 - 275,325 325,325
5411 Jamitun 830722 6091/ Pjk=Niddm 27-May-15 Jantung 50,000 35,000 252,500 274,475 611,975
5412 Ardiansyah S354433 6197/ Ht 27-May-15 Jantung 50,000 - 44,291 94,291
5413 Riatun 280595 6415/ Ht 27-May-15 P. Dalam 50,000 35,000 46,253 131,253
5414 Siram 390676 6170/ Bph 27-May-15 Urologi 50,000 - 139,175 189,175
5415 Chinta Nur 734840 4385/ Susp Bronch 27-May-15 Anak 50,000 - 18,662 68,662
5416 Asmiran 427148 6152/ Obs Nyeri D 27-May-15 Jantung 50,000 - 416,100 466,100
5417 Junaidi 597143 4265/ Pjk 27-May-15 Jantung 50,000 - 207,825 257,825
5418 Herlinawati 842170 4368/ Kontrol 27-May-15 Kandungan 50,000 35,000 60,000 370,570 7,983 523,553
5419 Andi 380665 6625/ Epilepsi 27-May-15 Syaraf 50,000 - 199,238 249,238
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5420 Susati 841733 6245/ Chf 27-May-15 Jantung 50,000 - 649,500 38,925 738,425
5421 Ngadimin 425516 6711/ Pjk 27-May-15 Jantung 50,000 - 54,409 104,409
5422 Zainuddin 842255 6332/ Susp Isk 27-May-15 Urologi 50,000 35,000 335,000 149,741 569,741
5423 Iwella 838911 6303/ Menometrar 27-May-15 Kandungan 50,000 35,000 60,000 17,475 162,475
5424 Endrita 531204 6714/ Cad+Chh 27-May-15 Jantung 50,000 - 558,255 608,255
5425 Budiyanti 818665 6241/ Heasrt Failu 27-May-15 Jantung 50,000 - 17,041 67,041
5426 Ningsih 489584 6047/ Asma Bronk 27-May-15 Paru+Jantung 50,000 35,000 315,895 400,895
5427 Muryati 445426 6181/ Ht 27-May-15 Jantung 50,000 - 304,925 354,925
5428 M Arif 401877 4310/ Kontr0L 27-May-15 Jantung 50,000 35,000 281,334 366,334
5429 Dwi Dili Ari 775332 4412/ Kontrol 27-May-15 Tht 50,000 - 295,150 18,913 364,063
5430 Nurdin 835256 4324/ Kontrol + Te 27-May-15 Dalam +R Med 50,000 35,000 159,500 103,088 347,588
5431 M Izehar 653539 4276/ Parkinson 27-May-15 Syaraf 50,000 - 232,816 282,816
5432 H Zaini 458101 4261/ Post Snh 27-May-15 Syaraf 50,000 - 221,390 271,390
5433 Nurani 780699 4205/ Kontrol 27-May-15 P. Dalam 50,000 - 14,861 64,861
5434 Aminoto 754053 6198/ Susp Kp 27-May-15 Paru 50,000 - 22,986 72,986
5435 Yulius Taya 828254 6125/ Ca Nasofari 27-May-15 Tht 50,000 - 26,361 76,361
5436 Marjuki 492002 4204/ Terapi + Kon 27-May-15 R Medik + Da 50,000 35,000 159,500 61,238 305,738
5437 Amat 828525 6608/ Dispepsia 27-May-15 Paru 50,000 - 30,726 80,726
5438 Wahidah 725319 6547/ Ca Mamae 27-May-15 Paru 50,000 - 20,173 70,173
5439 Dian Putra 838916 6682/ Corpal 27-May-15 Tht 50,000 - 63,000 12,706 125,706
5440 Sakdiah 822982 5971/ Terapi + Kon 27-May-15 R Medik + Da 50,000 35,000 294,500 76,188 455,688
5441 Sri Winatin 743848 4280/ Dm 27-May-15 P. Dalam 50,000 35,000 225,000 200,516 510,516
5442 Siti Nurhaya 662269 6595/ Sle 27-May-15 P. Dalam 50,000 - 127,676 177,676
5443 Tawiyah 232405 6502/ Synd Dispep 27-May-15 P. Dalam 50,000 35,000 187,000 174,750 446,750
5444 Endang Sula 633292 4219/ Terapi + Kon 27-May-15 R Medik +Sara 50,000 35,000 71,500 27,718 184,218
5445 Nuriyah Fat 816508 6228/ Epilepsi 27-May-15 Anak 50,000 - 52,829 102,829
5446 Amansyah 828082 6445/ Kontrol 27-May-15 Syaraf+P.Dala 50,000 35,000 284,853 369,853
5447 Ruriyah 648748 6548/ Susp Ablasia 27-May-15 Mata 50,000 35,000 60,000 12,199 157,199
5448 Suminah 838906 6549/ Dermatitis 27-May-15 Kulit Kelamin 50,000 - 13,541 63,541
5449 Idarsiah 430638 6504/ Cephalgia 27-May-15 Syaraf 50,000 - 20,291 70,291
5450 M. Ibrahim 560205 6121/ Serumen Pr 27-May-15 Tht 50,000 - 9,375 59,375
5451 Shorea Chic 758658 4294/ Seizure 27-May-15 Syaraf 50,000 - 96,784 146,784
5452 Diana Novit 838921 6137/ Scalvoss 27-May-15 Orthopedi 50,000 - 455,400 3,963 509,363
5453 Reni 842159 4189/ Kontrol 27-May-15 Kandungan 50,000 - 122,000 12,569 184,569
5454 Suswantoro 828208 6064/ Post Op Hae 27-May-15 Bedah 50,000 - 117,100 20,625 187,725
5455 Muriani 473021 4263/ Kontrol 27-May-15 P. Dalam 50,000 - 12,879 62,879
5456 Mugni 783660 6184/ Post Kp 27-May-15 Paru 50,000 - 19,836 69,836
5457 Sri Dewi 487343 6486/ Ht+Pjk 27-May-15 Jantung 50,000 - 41,313 91,313
5458 Khusnul Kh 826586 4190/ Kontrol 27-May-15 P. Dalam 50,000 - 3,705 53,705
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5459 Saniah 838748 4367/ Menometror 27-May-15 Kandungan 50,000 - 60,000 65,450 175,450
5460 Alfrida Tula 472348 6226/ Susp Dispep 27-May-15 P. Dalam 50,000 - 15,250 65,250
5461 Sumami 834534 4249/ Ht 27-May-15 P. Dalam 50,000 - 250,066 300,066
5462 Dwi Puji Les 591156 6272/ Asma Bronk 27-May-15 Paru 50,000 - 2,863 52,863
5463 Hamidah 765193 4325/ Sindrom Nef 27-May-15 P. Dalam 50,000 - 65,004 115,004
5464 Siti Yana 769339 4188/ Hhd 27-May-15 Jantung 50,000 - 313,675 363,675
5465 Joko Purwan 813533 6182/ Serumen 27-May-15 Tht 50,000 - 125,400 23,645 199,045
5466 Rakhmad Bu 232250 6578/ Kontrol 27-May-15 P. Dalam 50,000 - 22,869 72,869
5467 Rapiq Ahma 511815 6427/ Pjk 27-May-15 Jantung 50,000 - 314,925 364,925
5468 Murniati 143512 5988/ Ht 27-May-15 Jantung 50,000 - 280,316 330,316
5469 Anwari 835501 6154/ Lbp+Neurop 27-May-15 Syaraf 50,000 - 210,000 13,091 273,091
5470 Retno Heriy 076678 6517/ Epilepsi 27-May-15 Syaraf 50,000 - 29,925 79,925
5471 Susi 816519 4291/ Kontrol 27-May-15 Mata 50,000 - 19,598 69,598
5472 M Arga 835975 4233/ Susp Dislok 27-May-15 Orthopedy 50,000 - 38,500 88,500
5473 Suriansyah 835823 6139/ Lipoma 27-May-15 Bedah 50,000 - 125,000 12,750 187,750
5474 Farlan Said 589270 6106/ Bph 27-May-15 Urologi 50,000 - 137,213 187,213
5475 Abdul Mutta 677574 6005/ Kontrol Sya 27-May-15 Syaraf 50,000 - 60,148 110,148
5476 Jumriah 838903 4217/ Neorodermat 27-May-15 Kulit Kelamin 50,000 - 26,342 76,342
5477 Sumiati 396404 6169/ Epilepsi 27-May-15 Syaraf 50,000 - 296,663 346,663
5478 Doni Chand 781424 6213/ Epilepsi 27-May-15 Syaraf 50,000 - 87,188 137,188
5479 Samiyem 732163 6080/ Dm 27-May-15 P. Dalam 50,000 - 178,650 228,650
5480 Iwan Sunart 771568 4234/ Kontrol 27-May-15 P. Dalam 50,000 - 78,138 128,138
5481 Ratna Juwita 631025 6503/ Obs Batuk 27-May-15 Paru 50,000 - 20,138 70,138
5482 Pakkemme 839993 6122/ Cervical 27-May-15 Orthopedi 50,000 - 207,900 4,279 262,179
5483 Bima Abima 329927 6579/ Epilepsi 27-May-15 Syaraf 50,000 - 285,613 335,613
5484 Satinem 838761 6153/ Susp Tb Par 27-May-15 Paru 50,000 - 19,836 69,836
5485 Sumarsih 791535 6501/ Dyspepsia 27-May-15 P. Dalam 50,000 - 12,469 62,469
5486 M.Injin 622234 6518/ Parkinson 27-May-15 Syaraf 50,000 - 1,011,691 1,061,691
5487 Ainul Yaqin 802136 6107/ Snt 27-May-15 Syaraf 50,000 35,000 159,500 248,379 492,879
5488 Ramlah 390081 4323/ Kontrol 27-May-15 Syaraf 50,000 - 16,185 66,185
5489 Panirah 822928 6079/ Terapi+Kont 27-May-15 R.Medik+Syar 50,000 35,000 159,500 15,860 260,360
5490 Sulaiman D 683033 6200/ Multiple Fr 27-May-15 Orthopedi 50,000 - 3,600 53,600
5491 Juriani 838923 6230/ Myalgia 27-May-15 Syaraf 50,000 - 125,400 20,369 195,769
5492 Nugraha Sur 838749 4351/ Susp Demam 27-May-15 P. Dalam 50,000 - 24,563 74,563
5493 Suyatno 838907 6561/ Synd Dispep 27-May-15 P. Dalam 50,000 - 11,406 61,406
5494 Emy Rianti 838922 6212/ Perdarahan 27-May-15 Kandungan 50,000 - 60,000 305,000 37,275 452,275
5495 Harun 836347 6487/ Chf 27-May-15 Jantung 50,000 - 780,323 830,323
5496 Rusmegawat 841857 6273/ Abdominal 27-May-15 P. Dalam 50,000 - 9,706 59,706
5497 Hartati 619739 4353/ Ht Urgency 27-May-15 P. Dalam 50,000 - 41,456 91,456
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5498 Abdul Kadir 838924 6260/ Omsk 27-May-15 Tht 50,000 - 105,775 155,775
5499 Sari Wati 780623 6636/ Kontrol 27-May-15 P. Dalam 50,000 35,000 35,923 120,923
5500 H. Haerah 834016 6032/ Terapi 27-May-15 R.Medik+Syar 50,000 35,000 220,000 272,925 577,925
5501 Erwin Setia 554562 6505/ Pjk 27-May-15 Jantung 50,000 - 315,625 365,625
5502 Syarifuddin 558594 6457/ Ht 27-May-15 Jantung 50,000 - 203,781 253,781
5503 Hj.Warti 808482 6546/ Ht 27-May-15 Jantung 50,000 - 267,863 317,863
5504 Nur Ratnadil 779518 6713/ Sakit Kepal 27-May-15 Syaraf 50,000 - 47,216 97,216
5505 L. Frida T. 525771 6331/ Hhd 27-May-15 Jantung 50,000 - 409,515 459,515
5506 Indo Terang 838927 4397/ Pjk 27-May-15 Jantung 50,000 - 27,975 77,975
5507 Hj. Norma 838905 6520/ Ganglion 27-May-15 Bedah Umum 50,000 35,000 207,900 4,613 297,513
5508 Herawati Ru 838773 4382/ Abdomen Pa 27-May-15 Bedah Umum 50,000 35,000 60,000 35,025 180,025
5509 Syafa Rahm 614316 4399/ Pioderma 27-May-15 Kulit & Kelam 50,000 - 59,812 109,812
5510 Lilis Sarian 430337 6061/ Myalgia 27-May-15 P. Dalam 50,000 35,000 159,500 9,046 253,546
5511 Junaidi 835990 6683/ Susp Dermat 27-May-15 Kulit Kelamin 50,000 - 13,863 63,863
5512 H.A. Moeis 810554 4400/ Osteopor0Si 27-May-15 Syaraf 50,000 35,000 159,500 9,303 253,803
5513 Ashuri 631463 6166/ Angina Pect 27-May-15 Jantung 50,000 - 25,688 75,688
5514 Meilan Novi 838726 6183/ Susp Fam 27-May-15 Bedah Tumor 50,000 - 19,594 69,594
5515 Muhammad 838179 6335/ Susp Chf 27-May-15 P. Dalam 50,000 35,000 649,500 269,438 1,003,938
5516 Joni Husin 676677 4231/ Kontrol 27-May-15 Jantung 50,000 - 27,975 77,975
5517 Rusna 227288 6534/ Gromulomat 27-May-15 Bedah 50,000 35,000 22,236 107,236
5518 Desdwita An 562269 6317/ Vsd 27-May-15 Jantung 50,000 - 602,988 652,988
5519 Srini 841916 4337/ Kontrol 27-May-15 Jantung + Dal 50,000 35,000 649,500 223,544 958,044
5520 Sanuri Arta 608194 6227/ Chf 27-May-15 Jantung 50,000 - 175,488 225,488
5521 Arbayah 590622 6214/ Chd 27-May-15 Jantung 50,000 - 316,914 366,914
5522 Muriah 776281 4336/ Kontrol 27-May-15 P. Dalam 50,000 35,000 50,504 135,504
5523 Emi 394720 6167/ Terapi 27-May-15 R.medik 50,000 35,000 71,500 63,676 220,176
5524 Rusmiaty 474858 6256/ Chepalgia 27-May-15 Syaraf 50,000 35,000 227,700 20,369 333,069
5525 Asmawati 022190 6077/ Dm 27-May-15 P. Dalam 50,000 - 34,122 84,122
5526 Kamariah 842073 4340/ Kontrol 27-May-15 Bedah Umum 50,000 - 125,000 12,750 187,750
5527 Beddu 795250 6472/ Parkinson 27-May-15 Syaraf 50,000 - 6,472 56,472
5528 Ney Fatmaw 838902 6471/ Epistaksis 27-May-15 Tht 50,000 - 105,600 1,583 157,183
5529 Wiyatun 838913 4366/ Hemaroid 27-May-15 Bedah Umum 50,000 - 117,100 394,150 125,400 686,650
5530 Siti Sarah 685764 4339/ Hemoroid 27-May-15 Bedah Umum 50,000 - 394,150 125,400 569,550
5531 Sitti Suwarn 842715 6349/ Kontrol 27-May-15 Urologi 50,000 35,000 420,900 187,000 692,900
5532 Siti Fatimah 838926 6700/ Kontrol 27-May-15 P. Dalam 50,000 - 742,600 792,600
5533 Indra J 839952 6622/ Kontrol 27-May-15 Gigi 50,000 - 579,150 125,400 754,550
5534 Juhairah 511725 6474/ Kontrol 27-May-15 Urologi 50,000 - 420,900 470,900
5535 Jumairi 751990 6347/ Dm 27-May-15 P. Dalam 50,000 - 797,650 847,650
5536 Hartini 839981 6289/ Obs Tumor C 27-May-15 Onkologi 50,000 35,000 160,250 125,400 370,650
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5537 Etty Susilaw 696648 6259/ Tu Axilla S 27-May-15 Onkologi 50,000 - 558,250 377,500 125,400 1,111,150
5538 Wainten Sam 604851 4293/ Kontrol 27-May-15 Onkologi 50,000 - 525,250 575,250
5539 Warsi 789865 6473/ Dm 27-May-15 P. Dalam 50,000 - 75,000 110,250 235,250
5540 Ramli 758618 6050/ Mh Nib 27-May-15 Kulit 50,000 - 69,000 119,000
5541 Mukayan 691347 6031/ Dm 27-May-15 P. Dalam 50,000 - 110,250 160,250
5542 Choiriyah 706351 6063/ Ht+Dm 27-May-15 P. Dalam 50,000 - 110,250 160,250
5543 Agustinus 610586 6697/ Chd 27-May-15 P. Dalam 50,000 - 363,500 413,500
5544 Fitria Anhar 842947 6488/ G2P1A0 27-May-15 Kandungan 50,000 - 60,000 305,000 415,000
5545 Gusti Gama 816166 4250/ Kontrol 27-May-15 Kandungan 50,000 - 60,000 305,000 415,000
5546 Imam Muha 190433 6550/ Kontrol 27-May-15 B. Syaraf 50,000 - 2,725,800 2,775,800
5547 Nurhadi 823460 6610/ Post Aff Dj 27-May-15 Urologi 50,000 - 335,000 125,400 510,400
5548 Dina Fitrian 815041 4307/ Tb Paru 27-May-15 Paru 50,000 35,000 305,000 1,800 391,800
5549 Aswin 598995 6429/ Terapi+Kont 27-May-15 R.medik 50,000 35,000 71,500 333,300 489,800
5550 Wibowo Joy 838917 4370/ Post Trauma 27-May-15 Orthopedi 50,000 - 105,600 155,600
5551 Nur Muh Faz 748475 4308/ Hisprung Di 27-May-15 Bedah Anak 50,000 - 105,600 155,600
5552 Sofiyan Nur 838925 6696/ 38 27-May-15 Gigi&Mulut 50,000 - 160,600 210,600
5553 Katiyah 476210 6304/ Kelainan Tm 27-May-15 Gigi 50,000 - 160,600 210,600
5554 Sunartin 820661/2907946654/ Susp Cf Sca 27-May-15 Orthopedi 50,000 - 105,600 155,600
5555 Siti Rahmah 638133 6316/ Hemiparese 27-May-15 Syaraf 50,000 - 997,700 1,047,700
5556 Tendri 771029 4352/ Hiperkoleste 27-May-15 P. Dalam 50,000 - 305,000 355,000
5557 Suhartatik 654862 6606/ Ca Palatum 27-May-15 Onkologi 50,000 - 525,250 125,400 700,650
5558 Wahab 842523 6258/ Cad 27-May-15 Jantung 50,000 - 187,000 237,000
5559 M. Luqmanu 838912 6652/ 6 Gp 27-May-15 Gigi&Mulut 50,000 - 50,000
5560 Rusmana Sar 842492 6666/ G3P2A0 27-May-15 Kandungan 50,000 - 120,500 170,500
5561 Tenri Dian 838347 6533/ Kontrol 27-May-15 Kandungan 50,000 - 60,000 110,000
5562 Ernie Bs 815417 4355/ Haid Tdk Te 27-May-15 Kandungan 50,000 - 60,000 110,000
5563 Herlia 838380 4384/ Kontrol 27-May-15 Bedah Umum 50,000 - 125,000 175,000
5564 Fatmawati 806321 6346/ Post Kll 27-May-15 Bedah Umum 50,000 - 50,000
5565 Marioade Pu 840751 6286/ Post Amputas 27-May-15 Bedah Umum 50,000 - 125,000 175,000
5566 Mardani 841160 4235/ Kontrol 27-May-15 Bedah Umum 50,000 - 125,000 175,000
5567 Fitri Sahwa 574382 6138/ Susp Gynuc 27-May-15 Bedah Umum 50,000 - 125,000 175,000
5568 M.Irwan 700898 4247/ Dm + Abses 27-May-15 Bedah Umum 50,000 - 50,000
5569 Indrayani 597931 6516/ Abses 27-May-15 Bedah Umum 50,000 - 50,000
5570 Parpunguan 838320 6562/ Lipoma 27-May-15 Bedah Umum 50,000 - 125,000 175,000
5571 Mujiono 822574 6110/ Ca Gasta 27-May-15 Bedah Umum 50,000 - 50,000
5572 Rohani Mok 801740 6475/ Snnt 27-May-15 Bedah Umum 50,000 - 125,000 175,000
5573 Supiansyah 583067 6095/ Thalasemia 27-May-15 P. Dalam 50,000 - 50,000
5574 Sumarlin 446076 6065/ Pilipidemia 27-May-15 P. Dalam 50,000 - 50,000
5575 Hernianti 582982 6685/ Sarcoma 27-May-15 Onkologi 50,000 - 135,000 185,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5576 Rustam Isma 841500 6151/ Sh 27-May-15 Syaraf 50,000 - 50,000
5577 Tri Mailani 806796 5986/ Epilepsi 27-May-15 Syaraf 50,000 - 50,000
5578 Irmawanti 720246 6350/ Tpha 27-May-15 Kulit 50,000 - 50,000
5579 Linda Nurha 834870 6002/ 12 Karies De 27-May-15 Gigi&Mulut 50,000 - 450,253 500,253
5580 Andi Heru B 838333 6426/ Caries 6 27-May-15 Gigi&Mulut 50,000 - 450,253 500,253
5581 Masriyani 664641 6715/ Kontrol 27-May-15 Kandungan 50,000 70,000 193,500 313,500
5582 Supriatin 769041 6519/ Susp Struma 27-May-15 Onkologi 50,000 - 50,000
5583 Djohan Roz 515515 6459/ Obs Massa 27-May-15 Onkologi 50,000 - 50,000
5584 Luat Alui 838319 6489/ Bph 27-May-15 Urologi 50,000 - 335,000 385,000
5585 Reni Fitrian 838781 4306/ Susp Fam D 27-May-15 Oncologi 50,000 - 50,000
5586 Saleha 772857 6019/ Struma 27-May-15 Bedah Umum 50,000 - 50,000
5587 Ehca Ameli 834854 6591/ Tonsilitisa 27-May-15 Tht 50,000 - 50,000
5588 Nur Wandi 838779 6092/ Tonsilitis 27-May-15 Tht 50,000 - 50,000
5589 Muryati 525319 6712/ 321 123 Kar 27-May-15 Gigi&Mulut 50,000 - 362,633 412,633
5590 Khairun Nis 838725 6532/ 2 Gp 27-May-15 Gigi&Mulut 50,000 - 395,266 445,266
5591 Jayadi 796482 4246/ Keloid 27-May-15 Kulit Kelamin 50,000 - 115,000 165,000
5592 M. Muhsi 838740 6274/ D/ Hipoertes 27-May-15 Orthopedi 50,000 35,000 85,000
5593 Nurlaila 594704 6301/ Dispepsia 27-May-15 Kandungan 50,000 - 60,000 110,000
5594 Yatini 835580 4292/ Kontrol 27-May-15 Kandungan 50,000 - 60,000 110,000
5595 Sugiono 838908 6564/ Celullitis A 27-May-15 P. Dalam 50,000 - 50,000
5596 Anang Murn 838914 6669/ Tb Paru 27-May-15 Paru 50,000 35,000 85,000
5597 Sukatmi 781888 6430/ Pro Op Kata 27-May-15 Mata 50,000 - 130,000 180,000
5598 Nizam Andri 842440 6640/ Kontrol 27-May-15 Anak+Orthope 50,000 35,000 85,000
5599 Ainun 838784 6244/ Abses Mama 27-May-15 Bedah Umum 50,000 35,000 85,000
5600 Anwar 838919 6108/ Susp Kp 27-May-15 Paru 50,000 - 50,000
5601 Setber Hery 800313 6490/ S/ Colealitia 27-May-15 P. Dalam 50,000 35,000 85,000
5602 M.Suleman 829942 6681/ Ctev 27-May-15 Orthopedi 50,000 - 212,750 262,750
5603 Christin N S 634732 4232/ Kontrol 27-May-15 Orthopedi 50,000 - 160,000 210,000
5604 Daryatun 615461 4338/ Ganglion 27-May-15 Bedah Umum 50,000 35,000 85,000
5605 M.Rizal Ra 832097 6441/ Post Op Fr 27-May-15 Orthopedi 50,000 - 50,000
5606 Ade Reza Sa 835907 6155/ Hnp 27-May-15 R.Medis+Orto 50,000 35,000 71,500 156,500
5607 M.Reyhan M 829505 6684/ Ctev Post At 27-May-15 Orthopedi 50,000 - 50,000
5608 Juwariyah 834558 6565/ Dm 27-May-15 P. Dalam 50,000 - 402,500 452,500
5609 Ipah 838910 4309/ Ht 27-May-15 Jantung 50,000 - 187,000 237,000
5610 Sulistiani 834826 4321/ Kontrol 27-May-15 Bedah Anak 50,000 - 50,000
5611 Hesti 838920 6136/ Susp Kista 27-May-15 Bedah Anak 50,000 - 50,000
5612 Alya Nur Z. 779471 6668/ Post Lapara 27-May-15 Bedah Anak 50,000 - 50,000
5613 Naomi Anggi750692 6271/ Post Op Tep 27-May-15 Bedah Anak 50,000 - 50,000
5614 Rubiyanti 835952 4187/ Terapi 27-May-15 R Medik 50,000 - 159,500 209,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5615 Masrun Maj 639948 4396/ Fisioterapi 27-May-15 R Medik 50,000 - 159,500 209,500
5616 Yiyin Sumar 740906 4411/ Fisiotherapy 27-May-15 R Medik 50,000 - 71,500 121,500
5617 Sopiah 655365 6348/ Terapi 27-May-15 R Medik 50,000 - 159,500 209,500
5618 Sri Usminiw 838713 6594/ Terapi+Oa 27-May-15 R Medik 50,000 - 159,500 209,500
5619 Dewi Yuni L 839986 4398/ Terapi 27-May-15 R Medik 50,000 - 159,500 209,500
5620 M. Rizki R 707750 6094/ Ot+Tw 27-May-15 R Medik 50,000 - 440,000 490,000
5621 Imalasari Pu 571238 5973/ Ot+Tw 27-May-15 R Medik 50,000 - 440,000 490,000
5622 Maili Yanti 755386 6033/ Terapi 27-May-15 R Medik 50,000 - 440,000 490,000
5623 Sugianto Ru 487872 6048/ Terapi 27-May-15 R Medik 50,000 - 379,500 429,500
5624 Tunikah 796098 4278/ Terapi 27-May-15 R Medik 50,000 - 440,000 490,000
5625 Sarminto 796814 5975/ Fisioterapi 27-May-15 R Medik 50,000 - 440,000 490,000
5626 Titus Ahma 820014 6535/ Terapi 27-May-15 R Medik 50,000 - 440,000 490,000
5627 Darisem Nur 827918 6443/ Terapi 27-May-15 R Medik 50,000 - 440,000 490,000
5628 Winona Dest 337477 6318/ Terapi 27-May-15 R Medik 50,000 - 220,000 270,000
5629 Abdul Latif 839975 6320/ Terapi 27-May-15 R Medik 50,000 - 71,500 121,500
5630 Juhairiyah 205929 6623/ Lbp 27-May-15 Syaraf 50,000 35,000 71,500 156,500
5631 Erniwati 443296 6123/ Terapi 27-May-15 R.Medis 50,000 - 71,500 121,500
5632 Hafiz Nur 811861 5972/ Terapi 27-May-15 R.Medis 50,000 - 220,000 270,000
5633 M. Attallah 607935 5958/ Terapi 27-May-15 R.Medis 50,000 - 440,000 490,000
5634 Rahmatulla 462170 5959/ Fisioterapi 27-May-15 R.Medis 50,000 - 440,000 490,000
5635 Ngatin 834243 6624/ Terapi 27-May-15 R.Medis 50,000 - 220,000 270,000
5636 Shanaz Dwi 677115 5956/ Terapi 27-May-15 R.Medis 50,000 - 379,500 429,500
5637 Danang Zak 726353 5960/ Terapi 27-May-15 R.Medis 50,000 - 440,000 490,000
5638 Izni Almadi 835545 4277/ Terapi 27-May-15 R.Medis 50,000 - 440,000 490,000
5639 Ridho Abrar 779669 6456/ Ft+Post Op 27-May-15 R.Medik 50,000 - 220,000 270,000
5640 Aiysah Uzim 796280 6049/ Terapi 27-May-15 R.Medik 50,000 - 440,000 490,000
5641 Siti Rahmah 742670 5974/ Fisioterapi 27-May-15 R.Medik 50,000 - 71,500 121,500
5642 Hamdanah 563909 6035/ Terapi 27-May-15 R.Medik 50,000 - 71,500 121,500
5643 Turyatman 528172 6017/ Terapi 27-May-15 R.Medik 50,000 - 159,500 209,500
5644 Murikah 598534 6046/ Terapi 27-May-15 R.Medik 50,000 - 159,500 209,500
5645 Erna Samun 569637 6016/ Terapi 27-May-15 R.Medik 50,000 - 159,500 209,500
5646 Rosma Lela 829922 4220/ Terapi 27-May-15 R.Medik 50,000 - 71,500 121,500
5647 Nurhadiyant 320110 6093/ Terapi+Ceph 27-May-15 R.Medik 50,000 - 159,500 209,500
5648 Marsidi 720910 6211/ Terapi 27-May-15 R.Medik 50,000 - 159,500 209,500
5649 H. Syamsud 775495 6531/ Terapi 27-May-15 R.Medik 50,000 - 71,500 121,500
5650 Ernawati 525416 6444/ Terapi 27-May-15 R.Medik 50,000 - 71,500 121,500
5651 Dumiatun 669083 6020/ Terapi 27-May-15 R.Medik 50,000 - 159,500 209,500
5652 Nurdin 816128 4279/ Terapi 27-May-15 R.Medik 50,000 - 159,500 209,500
5653 Yuliani 285668 6076/ Terapi 27-May-15 R.Medik 50,000 - 220,000 270,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5654 Zahra Arsen 725126 6698/ Terapi 27-May-15 R.Medik 50,000 - 440,000 490,000
5655 M.Dwifa Ca 816594 6442/ Terapi 27-May-15 R.Medik 50,000 - 220,000 270,000
5656 Humairah 622151 4201/ Poli 27-May-15 R Medik 50,000 - 220,000 270,000
5657 Andhara 613425 5957/ Terapi 27-May-15 R Medik 50,000 - 440,000 490,000
5658 Merry Tabi 314620 6003/ Terapi 27-May-15 R Medik 50,000 - 220,000 270,000
5659 Nelly 598921 6428/ Terapi 27-May-15 R Medik 50,000 - 220,000 270,000
5660 J. Marni 664975 6004/ Fisioterapi 27-May-15 R Medik 50,000 - 220,000 270,000
5661 Marni 740828 5987/ Terapi 27-May-15 R Medik 50,000 - 220,000 270,000
5662 Siti Ainah 438360 6185/ Fisioterapi 27-May-15 R Medik 50,000 - 220,000 270,000
5663 Erni Setiawa 132775 6196/ Fisioterapi 27-May-15 R Medik 50,000 - 220,000 270,000
5664 Najwa Lothi 787088 6638/ Kontrol 27-May-15 Mata 50,000 - 50,000
5665 Kharuddin Y 644883 6018/ Keloid 27-May-15 Kulit Kelamin 50,000 - 50,000
5666 Murni 753392 6760/ Benjolan D 28-May-15 Bedah Umum 50,000 35,000 187,000 142,475 414,475
5667 Dayang Tiar 679442 7029/ Kontrol 28-May-15 Dalam+Kandu 50,000 - 1,093,070 1,143,070
5668 Chelsea Ana 688816 6560/ Palatoschizi 28-May-15 Bedah Umum 50,000 - 9,478 59,478
5669 Munik Kisw 832062 6661/ Post Op 28-May-15 Orthopedi 50,000 - 80,000 12,375 142,375
5670 David Satya 839988 6955/ Ckr 28-May-15 Bedah Umum 50,000 35,000 1,525 86,525
5671 Ronny Hern 809381 6467/ Post Stroke 28-May-15 Syaraf 50,000 - 13,408 63,408
5672 Arsyfa Ram 838952 6633/ Obs Ikterik 28-May-15 Anak 50,000 - 38,500 88,500
5673 Amas Megaw822082 6953/ Gastritis + 28-May-15 Peny.Dalam 50,000 - 31,956 81,956
5674 Fakhrina R 800338 6982/ Tb Anak 28-May-15 Anak 50,000 - 50,644 100,644
5675 Norsehan 522014 6832/ Dm 28-May-15 Peny.Dalam 50,000 - 290,500 340,500
5676 Ahmad Zam 352205 7045/ Bph 28-May-15 Urologi 50,000 - 137,529 187,529
5677 H,Syamsudi 775795 4592/ Kontrol 28-May-15 Tht 50,000 35,000 1,472,900 12,293 1,570,193
5678 Tjutiani Sri 545193 4548/ Kontrol 28-May-15 Orthopedy 50,000 - 966 50,966
5679 Fatmawati 810152 6878/ Nyeri Ulu H 28-May-15 Peny.Dalam 50,000 - 5,191 55,191
5680 Rohati 676669 6910/ Atralgia 28-May-15 Syaraf 50,000 - 15,750 65,750
5681 Darsiah 440282 6756/ Dm Ii 28-May-15 Peny.Dalam 50,000 - 987,949 1,037,949
5682 Dahri Ahma 838959 6662/ Post Op 28-May-15 Jantung 50,000 - 418,250 187,000 33,975 689,225
5683 M.Imran 774215 6880/ S/ Tu Nasal 28-May-15 Tht 50,000 35,000 187,000 139,194 411,194
5684 Juraidah 831730 6603/ Dm+Ht+Chf 28-May-15 Penyakit Dala 50,000 35,000 187,000 174,016 446,016
5685 Ernawati 758007 6605/ G4P3A0+He 28-May-15 Kandungan 50,000 - 60,000 603,400 305,000 1,800 1,020,200
5686 Muprika Ha 840132 6968/ S Gout 28-May-15 Peny.Dalam 50,000 - 224,650 125,400 247,388 647,438
5687 Yuriyati 842517 6648/ Post Sc 28-May-15 Kandungan 50,000 - 120,500 21,088 191,588
5688 Suprapto 300668 6925/ Hipertiroid 28-May-15 Peny.Dalam 50,000 - 402,100 926,800 37,838 1,416,738
5689 Saleha 772857 6861/ Struma 28-May-15 Bedah Umum 50,000 35,000 40,141 125,141
5690 Kornelis Na 810504 4444/ Bph 28-May-15 Urologi 50,000 - 255,000 305,000
5691 Juray Mahdi 524839 6726/ Kontrol 28-May-15 Syaraf 50,000 - 11,926 61,926
5692 Zubaidah 753389 6891/ S/ Tb Paru 28-May-15 Paru 50,000 - 21,711 71,711
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5693 Maryani 086352 6743/ Kontrol 28-May-15 Dalam+R.Med 50,000 35,000 194,314 279,314
5694 Kasyati 838949 6966/ Tension Hea 28-May-15 Syaraf 50,000 - 20,138 70,138
5695 Murtini 757462 6587/ Terapi 28-May-15 Rehab Medik 50,000 35,000 71,500 16,410 172,910
5696 Ahmad Rija 838954 6997/ V. Ictum+Ab 28-May-15 Bedah Umum 50,000 - 704,900 125,400 3,663 883,963
5697 Ramli 758618 4471/ Mh Nib 28-May-15 Kulit & Kelam 50,000 - 633 50,633
5698 Idah 529314 6787/ Pjk 28-May-15 Jantung 50,000 - 39,000 89,000
5699 Kasniwati 838944 6530/ Corpus Ale 28-May-15 Tht 50,000 - 1,188 51,188
5700 Syaifuddin 344155 6790/ Pjk 28-May-15 Jantung 50,000 - 421,515 471,515
5701 Aditya Nug 838938 6455/ Riw Epileps 28-May-15 Anak 50,000 - 104,500 154,500
5702 H.Asnawi A 725942 6906/ Keloid 28-May-15 Kulit Kelamin 50,000 - 115,000 130,625 295,625
5703 Nurdin Doni 712854 6379/ Fisioterapi 28-May-15 Rehab Medik 50,000 70,000 159,500 377,200 145,200 265,163 1,067,063
5704 M Fajar Dir 390956 4564/ Obs Febris 28-May-15 Anak 50,000 - 10,693 60,693
5705 Indra Perdan 594578 6543/ Epilepsi 28-May-15 Syaraf 50,000 - 85,388 135,388
5706 Faisal Wijay 791580 6634/ Tb Tulang 28-May-15 Orthopedi 50,000 35,000 212,250 297,250
5707 Itte 838961 6692/ Kontrol 28-May-15 Tht 50,000 - 12,275 62,275
5708 Ruslan 838941 6512/ Susp Isk 28-May-15 Bedah Umum 50,000 35,000 335,000 662,100 145,200 1,963 1,229,263
5709 Sukarmi 559877 6969/ Kontrol 28-May-15 Peny.Dalam 50,000 - 182,338 232,338
5710 Agustinus M 610586 6632/ Susp Hipoa 28-May-15 Penyakit Dala 50,000 - 151,650 201,650
5711 Djumiati 725601 6998/ Post Op App 28-May-15 Bedah Umum 50,000 - 125,000 16,450 191,450
5712 Nur Asiah 817162 7058/ Kontrol 28-May-15 Kandungan 50,000 - 60,000 4,188 114,188
5713 Barmi 838397 4475/ Kontrol 28-May-15 Bedah Umum 50,000 - 125,000 14,888 189,888
5714 Mila Sulastr 838786 6631/ Dismenorhe 28-May-15 Kandungan 50,000 - 60,000 3,850 113,850
5715 Siti Zubaida 796802 4459/ Dm 28-May-15 P. Dalam 50,000 35,000 71,500 19,825 176,325
5716 Yani Henday 838953 4577/ Susp Artritis 28-May-15 Saraf 50,000 - 105,600 3,963 159,563
5717 Rohani 840546 6526/ Pbeumonia+G28-May-15 P.Dalam+Paru 50,000 35,000 305,000 41,154 431,154
5718 Syarifuddin 790675 6619/ 37 28-May-15 Gigi&Mulut 50,000 35,000 207,443 20,925 313,368
5719 Suriyah 438796 6846/ Kontrol 28-May-15 Peny.Dalam 50,000 35,000 71,500 7,244 163,744
5720 Dina Fitrian 815041 4591/ Tb Paru 28-May-15 Paru 50,000 35,000 3,020 88,020
5721 Nurhaidah 838776 6542/ Limpadenop 28-May-15 Bedah Umum 50,000 - 42,131 92,131
5722 Sem Saroin 720664 6601/ 7 Gangren 28-May-15 Gigi&Mulut 50,000 - 8,363 58,363
5723 Idham 841876/8418786647/ Susp Hep 28-May-15 Penyakit Dala 50,000 35,000 60,000 390,000 633 535,633
5724 Atu Tajuli 828272 4505/ 7 Fraktur 28-May-15 Gigi & Mulut 50,000 - 3,848,276 20,651 3,918,927
5725 Ardi Yurian 838928 6451/ 6 Gp 28-May-15 Gigi&Mulut 50,000 - 603,276 160,600 10,163 824,039
5726 Iskandar 077736 6758/ Kontrol 28-May-15 Rehab Medik+ 50,000 35,000 159,500 8,048 252,548
5727 Nurhidayat 836869 6617/ Gangren 28-May-15 Bedah Umum 50,000 - 125,000 14,888 189,888
5728 Yadi 838937 6454/ Ekc 28-May-15 Jantung 50,000 - 649,500 268,028 967,528
5729 Juraidin 492151 6801/ Hhf+Chf 28-May-15 Jantung 50,000 - 271,365 321,365
5730 Arman Maul 787972 6556/ Epilepsi 28-May-15 Anak 50,000 - 52,250 102,250
5731 Uyang Imau 403920 6425/ Post Eksplor 28-May-15 Bedah Umum 50,000 - 125,000 16,450 191,450
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5732 Supardi 822540 6849/ Dispepsia 28-May-15 Peny.Dalam 50,000 - 58,906 108,906
5733 Djamaiyah 770843 6892/ Dm 28-May-15 Peny.Dalam 50,000 - 162,750 212,750
5734 La Ode Saba 330583 4532/ Susp Asma 28-May-15 Paru 50,000 - 23,873 73,873
5735 Udin 705780 4426/ Kontrol 28-May-15 Saraf 50,000 - 23,048 73,048
5736 Jamian 726494 6557/ Decomp Cor 28-May-15 Jantung 50,000 - 340,088 390,088
5737 Leonard Ni 206262 4504/ Epilepsi 28-May-15 Saraf 50,000 - 19,950 69,950
5738 Wahyu Abdu 053652 6862/ Spasme Oto 28-May-15 Syaraf 50,000 - 227,700 4,279 281,979
5739 Ratu Langsi 811076 4473/ Kontrol 28-May-15 Bedah Saraf 50,000 35,000 5,494 90,494
5740 Masni 592555 4520/ Dm 28-May-15 Dalam 50,000 - 609,500 15,575 675,075
5741 A Rahim Wa 701049 4456/ Susp Bph 28-May-15 Urologi 50,000 - 410,200 255,000 715,200
5742 Syamsuriant 569355 6741/ Kontrol 28-May-15 Peny.Dalam 50,000 - 446,288 496,288
5743 Asmu'I 635950 6468/ Ht 28-May-15 Jantung 50,000 - 20,715 70,715
5744 Erda Linaw 460499 6410/ Pjk 28-May-15 Jantung 50,000 - 56,428 106,428
5745 Maskunah 806186 6466/ Kontrol 28-May-15 Jantung 50,000 - 253,558 303,558
5746 Sukran 597369 4503/ Bph 28-May-15 Urologi 50,000 - 137,213 187,213
5747 Susi Anda F 838958 6650/ Frozen Shou 28-May-15 Syaraf 50,000 - 4,279 54,279
5748 Yurliansyah 835573 6544/ Ht 28-May-15 Jantung 50,000 35,000 402,500 88,161 575,661
5749 Misnem 838930 4490/ Ht 28-May-15 Jantung 50,000 - 462,500 3,825 516,325
5750 Muhammad 458143 6775/ Kontrol 28-May-15 R.Medis+Dal 50,000 35,000 71,500 24,744 181,244
5751 Hj Nurhayat 777438 4531/ Dm + Ht 28-May-15 Dalam 50,000 - 513,913 563,913
5752 Kayla Riski 734402 6938/ Kontrol 28-May-15 Anak 50,000 - 1,453 51,453
5753 Misdian 835375 4550/ Kontrol 28-May-15 Paru 50,000 - 33,738 83,738
5754 Harit Nasar 838951 6996/ Oma 28-May-15 Tht 50,000 - 26,485 76,485
5755 M.Nur 838357 6895/ S/ Tu Paru 28-May-15 Paru 50,000 - 23,899 73,899
5756 Yelah P 841963 4486/ Kontrol 28-May-15 Bedah Saraf 50,000 - 85,800 7,938 143,738
5757 Sumarni 838945 6908/ S/ Snh 28-May-15 Syaraf 50,000 - 14,441 64,441
5758 Mahyuddin 034309 6573/ Pjk 28-May-15 Jantung 50,000 - 174,453 224,453
5759 M Fahri Ibr 729530 6395/ Tw+Ot 28-May-15 Rehab Medik 50,000 35,000 220,000 7,900 312,900
5760 Masniah 441498 4519/ Kontrol 28-May-15 Saraf 50,000 - 22,078 72,078
5761 Siti Nur Kh 821126 4517/ Kontrol 28-May-15 Kandungan 50,000 - 120,500 12,650 183,150
5762 Aditia Saput 638973 7042/ Vsd 28-May-15 Bedah Thorax 50,000 - 2,260 52,260
5763 Mathilda Ku 838957 7014/ Niddm 28-May-15 Peny.Dalam 50,000 - 54,763 104,763
5764 M.Rizki 708740 6952/ Epilepsi 28-May-15 Syaraf 50,000 - 159,621 209,621
5765 Sumiati 838946 6572/ Dm+Ht 28-May-15 Penyakit Dala 50,000 - 609,500 38,663 698,163
5766 Siti Saupah 415233 4458/ Kontrol 28-May-15 Paru +Jantung 50,000 35,000 232,500 317,500
5767 Nur Bia 838901 6575/ Hemoroid+ 28-May-15 Penyakit Dala 50,000 - 18,000 68,000
5768 Syakira F 842249 4579/ Kontrol 28-May-15 Saraf 50,000 - 57,000 173,938 280,938
5769 Supriyatin 778830 4415/ Terapi 28-May-15 Rehab Medis 50,000 35,000 71,500 8,813 165,313
5770 S Jiwanto 332814 6820/ Kontrol 28-May-15 Paru+Jantung 50,000 35,000 93,690 178,690
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5771 Ernawati 701208 6951/ Ht 28-May-15 Jantung 50,000 35,000 252,713 337,713
5772 Nurbainah 763714 6983/ S/ Mastitis 28-May-15 Bedah Umum 50,000 - 125,000 12,750 187,750
5773 Wahyuni 838365 6909/ Lbp 28-May-15 Syaraf 50,000 - 4,279 54,279
5774 Fadly Herm 200477 4547/ Epilepsi 28-May-15 Syaraf 50,000 - 29,925 79,925
5775 Abdullah 749544 6620/ Epilepsi 28-May-15 Syaraf 50,000 - 85,388 135,388
5776 Koko Majoy 744577 6730/ Pjk 28-May-15 Jantung 50,000 35,000 110,250 35,888 231,138
5777 Ardi Has 838940 6484/ Ht 28-May-15 Penyakit Dala 50,000 - 377,500 11,050 438,550
5778 Sion Lian 438733 6498/ Ht Gr Ii 28-May-15 Jantung 50,000 - 187,000 256,313 493,313
5779 Unal 787505 4442/ Kontrol 28-May-15 Paru 50,000 - 72,765 122,765
5780 Yuliana Tan 634176 6818/ Myalgia 28-May-15 Peny.Dalam 50,000 - 21,906 71,906
5781 Lismiyati 588575 6499/ Svt 28-May-15 Jantung 50,000 - 187,000 50,850 287,850
5782 Fitri Aulia 755453 6819/ Kontrol 28-May-15 Anak 50,000 - 5,502 55,502
5783 Sholeh Al U 838950 6981/ Omp 28-May-15 Tht 50,000 - 310,500 14,265 374,765
5784 Afdaliansya 525850 6378/ Dm 28-May-15 Penyakit Dala 50,000 - 402,500 135,700 124,081 712,281
5785 Isna 641060 6529/ Ht 28-May-15 Jantung 50,000 - 435,850 485,850
5786 Edwar 709016 6438/ Pjk 28-May-15 Jantung 50,000 - 155,228 205,228
5787 M. Try Ram 838947 6574/ Post Trauma 28-May-15 Syaraf 50,000 35,000 8,363 93,363
5788 Bakri 671915 6877/ Ht 28-May-15 Jantung 50,000 - 649,500 5,083 704,583
5789 Johny Lasut 805137 6786/ Kontrol 28-May-15 Syaraf 50,000 - 9,954 59,954
5790 Abdul Haki 838939 6803/ 27 Period 28-May-15 Gigi&Mulut 50,000 - 6,588 56,588
5791 Yuliana Fitr 554453 4443/ Dm 28-May-15 P. Dalam 50,000 - 476,269 526,269
5792 Nurjaati 795415 6500/ 6 Gr 28-May-15 Gigi&Mulut 50,000 - 603,276 11,328 664,604
5793 Watir Nur 838702 6421/ S Oma 28-May-15 Tht 50,000 - 63,000 65,975 178,975
5794 H Muslich 542206 4429/ Pjk 28-May-15 Jantung 50,000 - 65,265 115,265
5795 Mursidah 503223 6424/ Anemia Ec G 28-May-15 Penyakit Dala 50,000 - 43,250 22,969 116,219
5796 Aisjah Joha 796894 6423/ Terapi+Kont 28-May-15 R.Medik+Mat 50,000 35,000 71,500 27,850 184,350
5797 Bambang Er 800430 6802/ Ht 28-May-15 Jantung 50,000 - 138,878 188,878
5798 Sumilah 515961 6834/ Post Op Kat 28-May-15 Mata+Jantung 50,000 35,000 184,005 269,005
5799 Mukayan 691347 6436/ Dm 28-May-15 Penyakit Dala 50,000 - 160,531 210,531
5800 Kristina 245448 6921/ Gatal Pada 28-May-15 Kandungan 50,000 - 125,500 175,000 350,500
5801 Ummai 785502 4533/ Nyeri Tanga 28-May-15 Orthopedy 50,000 - 160,000 125,400 335,400
5802 Sofiyanti 730315 6848/ Menometora 28-May-15 Kandungan 50,000 - 60,000 305,000 415,000
5803 Zaenah 778048 6663/ Dm Dg Ulku 28-May-15 Bedah Umum 50,000 - 438,400 231,000 719,400
5804 Puspita Ayu 772956 4487/ Kontrol 28-May-15 Gigi & Mulut 50,000 - 450,253 93,115 593,368
5805 Ahmad Suya 838929 4430/ Ada Benjola 28-May-15 Bedah Umum 50,000 - 711,150 125,400 886,550
5806 Rachman 838743 6804/ Dm 28-May-15 Peny.Dalam 50,000 - 227,700 277,700
5807 Jaylani 838931 4501/ Neoralgia 28-May-15 Saraf 50,000 - 125,400 175,400
5808 Safaruddin 838747 6588/ Kontrol 28-May-15 Gigi&Mulut 50,000 - 579,150 125,400 754,550
5809 Mildawati 769332 6922/ Post Orif 28-May-15 Ortophedi 50,000 - 105,600 155,600
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5810 Budiono 838960 4606/ Post Trauma 28-May-15 Bedah Saraf 50,000 - 220,250 997,700 1,267,950
5811 Nilawati 346646 7043/ Kontrol 28-May-15 Ortophedi 50,000 - 105,600 155,600
5812 Suanwar 838943 6876/ Kontrol 28-May-15 Ortophedi 50,000 - 295,150 345,150
5813 Mujiatun 714813 6924/ Menometora 28-May-15 Kandungan 50,000 - 110,250 160,250
5814 Norma 776861 6558/ Ca Mamae 28-May-15 Bedah Umum 50,000 - 525,250 575,250
5815 Masdaliah 834814 7013/ Post Op 28-May-15 Bedah Umum 50,000 - 402,500 135,700 588,200
5816 Masriyani 664641 7026/ Kontrol 28-May-15 Kandungan 50,000 - 66,000 116,000
5817 Huzway Aks 625669 6907/ Post Tb Par 28-May-15 Paru 50,000 - 497,650 547,650
5818 Elis Suaisti 842546 6879/ Dyspepsia 28-May-15 Peny.Dalam 50,000 - 976,000 1,026,000
5819 Sutini 822724 6481/ Kontrol 28-May-15 Kandungan 50,000 - 60,000 1,169,800 1,279,800
5820 Sami 776860 4576/ Kontrol 28-May-15 Kandungan 50,000 - 60,000 1,119,800 1,229,800
5821 Nur Indah 393938 4565/ G4 P2 A1 Dn 28-May-15 Kandungan 50,000 35,000 60,000 459,250 604,250
5822 Rahmatika 838752 6835/ Terapi 28-May-15 R.Medik 50,000 - 71,500 121,500
5823 Fatma 433683 4561/ Terapi 28-May-15 R Medis 50,000 - 159,500 209,500
5824 Bandi Batha 738114 4578/ Terapi 28-May-15 R Medik 50,000 - 159,500 209,500
5825 Rosma Lela 829922 4488/ Terapi 28-May-15 R Medis 50,000 - 71,500 121,500
5826 Darsiah 740936 6496/ Terapi 28-May-15 Rehab Medik 50,000 - 71,500 121,500
5827 Ramlah Has 619115 6483/ Terapi 28-May-15 Rehab Medik 50,000 - 159,500 209,500
5828 Ngatemi 565526 6470/ Terapi 28-May-15 Rehab Medik 50,000 - 71,500 121,500
5829 Warti 691974 6469/ Terapi 28-May-15 Rehab Medik 50,000 - 159,500 209,500
5830 Murni Asih 361477 4414/ Terapi 28-May-15 R Medik 50,000 - 159,500 209,500
5831 Wahyu Hand 697153 6788/ Terapi 28-May-15 R.Medik 50,000 - 159,500 209,500
5832 Sri Kuswati 834801 6789/ Terapi 28-May-15 R.Medik 50,000 - 159,500 209,500
5833 Supatmi 801314 6440/ Terapi 28-May-15 Rehab Medik 50,000 - 71,500 121,500
5834 Suparmi 532171 6437/ Terapi 28-May-15 Rehab Medik 50,000 - 71,500 121,500
5835 Aliyah 730090 6729/ Terapi 28-May-15 Rehab Medik 50,000 - 159,500 209,500
5836 Supatmi 705133 6744/ Terapi 28-May-15 R.Medik 50,000 - 159,500 209,500
5837 Sukri 463499 6453/ Terapi 28-May-15 Rehab Medik 50,000 - 159,500 209,500
5838 H. M. Kosi 750140 6362/ Terapi 28-May-15 Rehab Medik 50,000 - 159,500 209,500
5839 Rubiyanti 835952 6742/ Terapi 28-May-15 R.Medik 50,000 - 159,500 209,500
5840 Hartini Joha 769333 6422/ Terapi 28-May-15 Rehab Medik 50,000 - 159,500 209,500
5841 Jasmah 434885 6757/ Terapi 28-May-15 R.Medik 50,000 - 71,500 121,500
5842 Viknatul Lei 829364 6482/ Terapi 28-May-15 Rehab Medik 50,000 - 159,500 209,500
5843 Laila 759001 6377/ Terapi 28-May-15 Rehab Medik 50,000 - 379,500 429,500
5844 Djamin 457035 4472/ Terapi 28-May-15 R Medik 50,000 - 159,500 209,500
5845 Sripah 634302 6485/ Terapi 28-May-15 Rehab Medik 50,000 - 71,500 121,500
5846 Nurhayati 825912 6816/ Terapi 28-May-15 R.Medik 50,000 - 71,500 121,500
5847 Nursiah 706603 6850/ Terapi 28-May-15 R.Medik 50,000 - 71,500 121,500
5848 Kasdi 834604 6380/ Terapi 28-May-15 Rehab Medik 50,000 - 159,500 209,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5849 Siti Maimun 822088 6514/ Terapi 28-May-15 Rehab Medik 50,000 - 159,500 209,500
5850 Liston Man 801747 4518/ Terapi 28-May-15 Rehab Medik 50,000 - 71,500 121,500
5851 Winona 337477 6967/ Terapi 28-May-15 R.Medik 50,000 - 220,000 270,000
5852 M.Romli 806719 7030/ Terapi 28-May-15 R.Medik 50,000 - 159,500 209,500
5853 Marni 641072 6528/ Oa 28-May-15 Syaraf 50,000 35,000 159,500 244,500
5854 Miftahul Ja 615499 7028/ Fisioterapi 28-May-15 R. Medik 50,000 - 71,500 121,500
5855 Ismul Izmi 496487 4608/ Terapi 28-May-15 R Medik 50,000 - 159,500 209,500
5856 Nur Janah 532108 7044/ Terapi 28-May-15 R.Medik 50,000 - 71,500 121,500
5857 Sumiaty 429003 6691/ Terapi 28-May-15 R Medik 50,000 - 159,500 209,500
5858 Noor Patima 622484 4621/ Terapi 28-May-15 R Medik 50,000 - 71,500 121,500
5859 Ahmad Djai 644885 4625/ Terapi 28-May-15 R Medik 50,000 - 159,500 209,500
5860 Subeli 238930 7056/ Terapi 28-May-15 R.Medik 50,000 - 159,500 209,500
5861 Vicauli Abd 791029 4623/ Terapi 28-May-15 R.Medik 50,000 - 71,500 121,500
5862 Siti Hasana 697396 6677/ Terapi 28-May-15 R.Medik 50,000 - 71,500 121,500
5863 Karsuni 825954 6407/ Terapi 28-May-15 Rehab Medik 50,000 - 220,000 270,000
5864 Hamdanah 790973 6452/ Terapi 28-May-15 Rehab Medik 50,000 - 440,000 490,000
5865 Ponijem 659169 6364/ Fisioterapi 28-May-15 Rehab Medik 50,000 - 220,000 270,000
5866 Muryati 731325 4489/ Fisiotherapy 28-May-15 Rehab Medis 50,000 - 440,000 490,000
5867 Hasnawati 762606 6391/ Terapi 28-May-15 Rehab Medik 50,000 - 440,000 490,000
5868 Aris Rahman 784378 6728/ Terapi 28-May-15 R.Medik 50,000 - 440,000 490,000
5869 Sugiyanto 748332 6727/ Fisioterapi 28-May-15 R. Medik 50,000 - 440,000 490,000
5870 Suriansyah 836571 6394/ Fisioterapi 28-May-15 Rehab Medik 50,000 - 440,000 490,000
5871 Sumiyat 821102 6954/ Terapi 28-May-15 R.Medik 50,000 - 159,500 209,500
5872 Aminah 759005 4594/ Terapi 28-May-15 R Medik 50,000 - 159,500 209,500
5873 Sarah 835367 6680/ Terapi 28-May-15 R Medik 50,000 - 71,500 121,500
5874 Risa Ifana 829483 6678/ Terapi 28-May-15 Rehab Medik 50,000 - 71,500 121,500
5875 Sinar 158345 4609/ Fisioterapi 28-May-15 Rhb Medis 50,000 - 71,500 121,500
5876 Tan Lan Tju 810556 7057/ Terapi 28-May-15 R.Medik 50,000 - 71,500 121,500
5877 Sunarti 838741 4563/ Terapi 28-May-15 R Medik 50,000 - 71,500 121,500
5878 Abdul Latif 839975 7012/ Terapi 28-May-15 R.Medik 50,000 - 71,500 121,500
5879 Annisa Dewi
326044/8260446604/ Terapi 28-May-15 Rehab Medik 50,000 - 220,000 270,000
5880 M. Kenzie 679791 6985/ Terapi 28-May-15 Rehab Medik 50,000 - 220,000 270,000
5881 M. Rizky R 828577 6361/ Ot+Tw 28-May-15 Rehab Medik 50,000 - 440,000 490,000
5882 Rafael Ham 757444 6409/ Ot+Tw 28-May-15 Rehab Medik 50,000 - 440,000 490,000
5883 Izzati Fadhi 706890 6363/ Terapi 28-May-15 Rehab Medik 50,000 - 440,000 490,000
5884 Wahab Nur 799076 6541/ Terapi 28-May-15 Rehab Medik 50,000 - 220,000 270,000
5885 Siti Liza 768432 6665/ Terapi 28-May-15 Rehab Medik 50,000 - 440,000 490,000
5886 Naufal Gani 574855 6940/ Terapi 28-May-15 R.Medik 50,000 - 220,000 270,000
5887 Salwa Aulia 810576 6923/ Terapi 28-May-15 Rehab Medik 50,000 - 440,000 490,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5888 Amira 821585 6771/ Terapi 28-May-15 R.Medik 50,000 - 220,000 270,000
5889 Hanifah Kho738963 7027/ Terapi 28-May-15 R.Medik 50,000 - 220,000 270,000
5890 Azlan Darma 792114 6759/ Terapi 28-May-15 R.Medik 50,000 - 440,000 490,000
5891 A. Fikri Pra 488012 6676/ Ft+Tw 28-May-15 Rehab Medik 50,000 - 220,000 270,000
5892 Aly Syawal 810107 6408/ Tw+Ot 28-May-15 Rehab Medik 50,000 - 440,000 490,000
5893 Tazkiah Aul 838494 4502/ Terapi 28-May-15 R Medik 50,000 - 440,000 490,000
5894 M.Sefianto 729676 6893/ Terapi 28-May-15 R.Medik 50,000 - 220,000 270,000
5895 Rafid Charl 736801 6984/ Terapi 28-May-15 Rehab Medik 50,000 - 220,000 270,000
5896 Muhammad 666097 6439/ Terapi 28-May-15 Rehab Medik 50,000 - 440,000 490,000
5897 Muhammad F771353 6774/ Terapi 28-May-15 R.Medik 50,000 - 440,000 490,000
5898 Ahmad Khoi 671879 6376/ Fisioterapi 28-May-15 Rehab Medik 50,000 - 440,000 490,000
5899 Mariam Ulfa 834596 6863/ Terapi 28-May-15 R.Medik 50,000 - 440,000 490,000
5900 Nurdin Baru 390697 6365/ Fisioterapi 28-May-15 Rehab Medik 50,000 - 220,000 270,000
5901 Rudi Herma 743463 4474/ Terapi 28-May-15 Rehab Medis 50,000 - 220,000 270,000
5902 M. Jufri 764121 6392/ Fisioterapi 28-May-15 Rehab Medik 50,000 - 220,000 270,000
5903 Matrup 345802 6393/ Fisioterapi 28-May-15 Rehab Medik 50,000 - 220,000 270,000
5904 Indrawati 680655 6513/ Terapi+Vari 28-May-15 R.Medik+Beda 50,000 35,000 71,500 156,500
5905 Warni 753983 4516/ Terapi 28-May-15 R Medik 50,000 35,000 159,500 244,500
5906 Yuliana 625938 6772/ Kontrol 28-May-15 R.Medik+Dal 50,000 35,000 159,500 44,113 288,613
5907 Hairani 634971 4445/ Kontrol 28-May-15 Jantung 50,000 - 50,000
5908 Badrotul Mu 602724 6571/ Menometror 28-May-15 Kandungan 50,000 - 60,000 110,000
5909 Rahmawati 667666 6865/ Kontrol 28-May-15 Kandungan 50,000 - 60,000 110,000
5910 Katarina Da 838339 6511/ Amenorea 28-May-15 Kandungan 50,000 - 60,000 110,000
5911 Eny Risnawa 838942 6527/ Pro Pap Sme 28-May-15 Kandungan 50,000 - 60,000 110,000
5912 Gusti Cama 816166 6833/ Kontrol 28-May-15 Kandungan 50,000 - 60,000 110,000
5913 Tuti Indrawa 828979 6847/ Cepalgia 28-May-15 Syaraf 50,000 - 50,000
5914 Martono 840326 6589/ Ckd 28-May-15 Bedah Thorak 50,000 - 50,000
5915 Syarifah Sa 596154 6864/ Kontrol 28-May-15 Bedah Thorax 50,000 - 50,000
5916 Rudy Ananta 837429 4549/ Kontrol 28-May-15 Bedah Thorax 50,000 - 50,000
5917 Rusma Santi 839926 6559/ 8 Impaksi 28-May-15 Gigi&Mulut 50,000 - 50,000
5918 Melkianto 602789 6515/ 7 Gp 28-May-15 Gigi&Mulut 50,000 35,000 85,000
5919 Iswansyah 700052 6646/ 8 Impaksi 28-May-15 Gigi&Mulut 50,000 - 50,000
5920 Mulyadi 801704 4624/ 8 Impaksi 28-May-15 Gigi & Mulut 50,000 - 50,000
5921 Maryati Kris 781103 6679/ 1 Post Peraw 28-May-15 Gigi&Mulut 50,000 - 341,392 391,392
5922 Indriani Li 795456 6618/ 1 Gp 28-May-15 Gigi&Mulut 50,000 - 341,392 391,392
5923 Ratna 838391 4427/ Tb Payudara 28-May-15 Paru + Kulit 50,000 - 50,000
5924 Nurpaidah 747898 4580/ Limfadenitis 28-May-15 Paru 50,000 - 50,000
5925 Syahbirin M 564446 4534/ Kontrol 28-May-15 Urologi 50,000 - 138,000 188,000
5926 M. Erza Ku 399725 6590/ 46 Pulpitis 28-May-15 Gigi&Mulut 50,000 - 272,703 322,703
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5927 Muslihah 835307 7015/ Batuk Lama 28-May-15 Paru 50,000 70,000 649,500 769,500
5928 Nandito 808034 6616/ Post Op 28-May-15 Bedah Thorak 50,000 - 50,000
5929 Eddy Nayan 642026 6497/ Ckd 28-May-15 Bedah Thorak 50,000 - 50,000
5930 Sumarsih 838769 6586/ S. Tik 28-May-15 Syaraf 50,000 - 50,000
5931 Adiyatama Y 335533 6773/ Obs Dispeps 28-May-15 Anak 50,000 35,000 85,000
5932 Asma Az Za 706168 4610/ Scabies 28-May-15 Anak 50,000 - 50,000
5933 Andi Heru B 838333 6745/ Caries 6 28-May-15 Gigi&Mulut 50,000 - 450,253 500,253
5934 Eddy Norya 811381 6894/ Kontrol 28-May-15 Vct 50,000 - 50,000
5935 Painah 829959 6805/ Kontrol 28-May-15 Bedah Umum 50,000 - 125,000 175,000
5936 Paini 835342 4460/ Strauma 28-May-15 Bedah Umum 50,000 - 125,000 175,000
5937 Bahrian 829168 4428/ Kontrol 28-May-15 Bedah Umum 50,000 - 125,000 175,000
5938 Andre Prata 835578 6725/ Tumor 28-May-15 Bedah Umum 50,000 - 125,000 175,000
5939 M.Ermansya 838121 6937/ Kontrol 28-May-15 Bedah Umum 50,000 - 50,000
5940 Fitria Anhar 842947 7000/ G2P1A0 28-May-15 Kandungan 50,000 - 60,000 110,000
5941 Harsya Nur 838948 6602/ Serumen Ob 28-May-15 Tht 50,000 - 63,000 113,000
5942 Sumiyati 840534 4593/ Kontrol 28-May-15 Kandungan 50,000 - 60,000 110,000
5943 Arifin 806103 4457/ Kontrol 28-May-15 Jantung 50,000 - 50,000
5944 Sofiyan Nur 838925 6831/ 38 28-May-15 Gigi&Mulut 50,000 - 3,848,276 31,274 3,929,550
5945 Wa Abe 518834 4535/ Prolab Uteri 28-May-15 Kandungan 50,000 - 133,500 183,500
5946 Badrudinsya 563343 4546/ 37 ,38 Pulpi 28-May-15 Gigi & Mulut 50,000 - 50,000
5947 Rusidah 838932 4607/ Pjk 28-May-15 Jantung 50,000 - 649,500 699,500
5948 Firdaus Sya 838955 6635/ Kontrol 28-May-15 Bedah Umum 50,000 - 50,000
5949 Siti Maemu 834252 6545/ Keloid 28-May-15 Kulit Kelamin 50,000 - 115,000 165,000
5950 Bambang Ir 806135 6664/ Dermatitis S 28-May-15 Kulit Kelamin 50,000 - 50,000
5951 Stevi A 483174 4595/ Kontrol 28-May-15 Orthopedy 50,000 - 50,000
5952 Jariah 676633 6817/ Spendilitis 28-May-15 Ortophedi 50,000 - 50,000
5953 Alif Aprian 840200 7041/ Subdural H 28-May-15 Bedah Syaraf 50,000 - 50,000
5954 Maulidiya Pu834588 6936/ Kontrol 28-May-15 Bedah Syaraf 50,000 - 79,500 129,500
5955 Antonius 834933/833105
Alf 6649/ Konstipasi 28-May-15 Anak 50,000 - 255 50,255
5956 Sri Kusuma 494164 6999/ S/ Bronkitis 28-May-15 Paru 50,000 - 50,000
5957 Hana Cantik 838956 7011/ Konstipasi 28-May-15 Anak 50,000 - 50,000
5958 Kamarudin 787743 6939/ Kontrol 28-May-15 Syaraf 50,000 - 24,563 74,563
5959 Raudah 826607 6406/ Terapi 28-May-15 Rehab Medik 50,000 - 440,000 490,000
5960 Choiriyah 706351 4441/ Dm 28-May-15 Dalam 50,000 - 150,281 200,281
5961 M. Putra 679366 6860/ Epilepsi 29-May-15 Anak 50,000 35,000 60,000 104,500 249,500
5962 Suyanto 445829 4651/ Fisioterapi 29-May-15 R Medis 50,000 35,000 71,500 25,508 182,008
5963 Indriyana R 510063 7134/ Kontrol 29-May-15 Kulit Kelamin 50,000 - 17,738 67,738
5964 Sumiati 384475 6917/ Pjk 29-May-15 Jantung 50,000 - 57,038 107,038
5965 Jumairi 751990 6721/ Dm 29-May-15 P. Dalam 50,000 - 88,041 138,041
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
5966 M. Riduans 779224 6829/ Angina Pect 29-May-15 Jantung 50,000 - 462,500 282,615 795,115
5967 Muliati 839371 7254/ 11 Hperemia 29-May-15 Gigi&mulut 50,000 - 450,253 1,525 501,778
5968 Maslamah 445474 7147/ Stt 29-May-15 Bedah Umum 50,000 - 125,000 7,938 182,938
5969 Akiyan 699215 7148/ Chf 29-May-15 Jantung 50,000 - 277,128 327,128
5970 Erni Wati 537194 6812/ Kontrol 29-May-15 Kandungan 50,000 - 60,000 8,044 118,044
5971 Latifah Ham 838970 6889/ Oma 29-May-15 Tht 50,000 - 310,500 70,391 430,891
5972 Siti Fatimah 838926 4638/ Kontrol 29-May-15 P. Dalam 50,000 - 22,963 72,963
5973 Alianur 414076 4655/ Hhd 29-May-15 Jantung 50,000 - 63,150 113,150
5974 Jaliansyah 817222 4666/ Kontrol 29-May-15 Jantung 50,000 - 29,640 79,640
5975 M.Ryo Ichi 838967 7240/ Batuk Dgn 29-May-15 Anak 50,000 - 21,217 71,217
5976 Mahmudah 836831 6888/ Hipertiroid 29-May-15 P. Dalam 50,000 - 11,138 61,138
5977 Hairin Dar 834261 7225/ Kontrol 29-May-15 Bedah Umum 50,000 - 125,000 7,275 182,275
5978 Safaruddin 838747 7239/ Kontrol 29-May-15 Gigi&mulut 50,000 - 6,588 56,588
5979 Syafruddin 384583 7131/ Pjk 29-May-15 Jantung 50,000 - 68,828 118,828
5980 Masniah 833954 7236/ Ht 29-May-15 Jantung 50,000 - 151,860 201,860
5981 Yani 835933 7192/ S/ Struma 29-May-15 Bedah Umum 50,000 - 125,000 12,325 187,325
5982 Arianto 843028 6826/ Susp Bronkh 29-May-15 Paru 50,000 - 6,581 56,581
5983 Rusdiana 197203 6796/ Susp Bronkh 29-May-15 Paru 50,000 - 22,698 72,698
5984 Alpius Rum 791531 6798/ Pjk 29-May-15 Jantung 50,000 - 284,469 334,469
5985 Herlina 665308 6766/ Post Stroke 29-May-15 Syaraf 50,000 - 48,815 98,815
5986 Armiah 838975 4743/ Dm 29-May-15 P. Dalam 50,000 - 33,000 64,594 147,594
5987 M. Ibrahim 778458 6843/ Terapi+Kont 29-May-15 R.medik 50,000 35,000 220,500 55,109 360,609
5988 Selvia Oktav 744370 4801/ Kontrol 29-May-15 Gigi&mulut 50,000 - 368,287 1,525 419,812
5989 Tendri 771029 6933/ Hiperkoleste 29-May-15 P.Dalam+R.Me 50,000 - 22,969 72,969
5990 Yudi Gunars 725539 6693/ Kontrol 29-May-15 Syaraf 50,000 - 15,986 65,986
5991 Ahmad Busa 766115 4699/ Folipdng Ko 29-May-15 P. Dalam 50,000 - 579,150 629,150
5992 Siti Masitah 838963 7164/ 38 Impacted 29-May-15 Gigi&mulut 50,000 - 9,125 59,125
5993 Sukoharti 309149 6815/ Otalgia 29-May-15 Tht 50,000 - 63,000 9,538 122,538
5994 Muhamadin 787021 6901/ Bph 29-May-15 Urologi 50,000 - 256,700 137,213 443,913
5995 M. Ibrahim 560205 6916/ Serumen 29-May-15 Tht 50,000 - 10,156 60,156
5996 Susmiro 839913 4727/ Susp Oma 29-May-15 Tht 50,000 - 310,500 5,388 365,888
5997 Joko Purwan 813533 7193/ Sinusitis 29-May-15 Tht 50,000 35,000 220,000 3,263 308,263
5998 Ridho Abrar 779669 7222/ Terapi 29-May-15 R.medik 50,000 35,000 220,000 4,556 309,556
5999 Siti Sarah 685764 4682/ Hemoroid 29-May-15 Bedah Umum 50,000 35,000 186,349 271,349
6000 Sumiati 838751 4742/ Vertigo 29-May-15 Syaraf 50,000 - 20,543 70,543
6001 Rizqi Aryas 842921 4715/ Kontrol 29-May-15 B. Anak 50,000 - 67,900 7,233 125,133
6002 Dewi Kartik 824703 7177/ Bell Palsy 29-May-15 Syaraf 50,000 - 8,904 58,904
6003 M Sigit Ism 838965 4714/ Susp Remat 29-May-15 Syaraf 50,000 - 29,941 79,941
6004 Abdu 828380 7269/ Pjk 29-May-15 Jantung 50,000 - 462,500 2,138,726 2,651,226
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
6005 Mashuda 179532 7117/ Kontrol 29-May-15 Syaraf 50,000 35,000 326,593 411,593
6006 Kornelis Na 810504 6797/ Kontrol 29-May-15 Syaraf 50,000 - 13,154 63,154
6007 Sampan Buc 839965 7221/ Kelainan Re 29-May-15 Mata 50,000 35,000 250,000 187,000 13,171 535,171
6008 Jamitun 819391 6767/ Pjk 29-May-15 Jantung 50,000 35,000 357,240 442,240
6009 Rusmiati 550670 4684/ Perdarahan 29-May-15 Kandungan 50,000 - 60,000 1,513 111,513
6010 Fitri Hartaty 800400 6875/ Keratitis Os 29-May-15 Mata 50,000 70,000 60,000 154,480 334,480
6011 Huzway Aks 625669 6856/ Kontrol 29-May-15 Paru 50,000 - 633 50,633
6012 M. Akhyarul 842914 6830/ Post Debrid 29-May-15 B. Anak 50,000 - 67,900 11,344 129,244
6013 Muchtar 770261 6842/ Post Debrid 29-May-15 Bedah Umum 50,000 - 125,000 51,138 226,138
6014 Samin 838976 7270/ Obs Dispneu 29-May-15 Jantung 50,000 - 523,250 649,500 20,925 1,243,675
6015 Iis Hastuti 835363 7090/ Terapi 29-May-15 R.medik 50,000 35,000 159,500 8,190 252,690
6016 Nirmala 671467 4789/ Pap Smear 29-May-15 Kandungan 50,000 - 60,000 10,138 120,138
6017 Fatimah 843102 4713/ Kontrol 29-May-15 P. Dalam 50,000 - 26,213 76,213
6018 Yudi Mulian 554925 6799/ Hnp 29-May-15 Syaraf 50,000 - 10,279 60,279
6019 Mirna Wati 541613 6904/ Post Op Naw 29-May-15 Tht 50,000 - 63,000 113,000
6020 Isak 776811 4670/ Strouke 29-May-15 Syaraf 50,000 - 17,766 67,766
6021 Iwan Setiaw 839187 4831/ Os.Tuna Ru 29-May-15 P. Dalam 50,000 - 34,656 84,656
6022 Akmal Huze 829353 6873/ Adenotonsili 29-May-15 Tht 50,000 - 10,156 60,156
6023 Shinta Noor 838977 7282/ S/ Dhf 29-May-15 P. Dalam 50,000 - 43,250 14,379 107,629
6024 M.Bayu Bahr651663 4774/ Ispa 29-May-15 Anak 50,000 - 7,313 57,313
6025 Yani Henday 838953 4817/ Susp Artritis 29-May-15 Syaraf 50,000 - 14,321 64,321
6026 Arlina 838306 7206/ Lbp 29-May-15 Syaraf 50,000 - 24,173 74,173
6027 Fadliah Dah 430090 6886/ Ht 29-May-15 Syaraf 50,000 - 997,700 20,041 1,067,741
6028 Aflus 494551 6844/ Kontrol 29-May-15 Syaraf 50,000 - 997,700 17,316 1,065,016
6029 Thamrin 802053 6920/ Terapi+Kont 29-May-15 R.medik 50,000 35,000 71,500 22,733 179,233
6030 Samsul Basr 739354 4685/ Terapi 29-May-15 R.medik 50,000 35,000 71,500 15,546 172,046
6031 Winona 337477 7256/ Terapi 29-May-15 R.medik 50,000 35,000 220,000 15,218 320,218
6032 Lasmi 487736 6874/ Ht 29-May-15 Jantung 50,000 - 50,450 100,450
6033 Samsuri 670664 7178/ Ht 29-May-15 P. Dalam 50,000 - 500,250 13,844 564,094
6034 Adaniah 423779 7150/ Ht 29-May-15 Tht 50,000 - 63,000 186,788 299,788
6035 M. Ardiansy 466879 6841/ Epilepsi 29-May-15 Syaraf 50,000 - 438,675 488,675
6036 Nisma 842401 7195/ Kontrol 29-May-15 Syaraf 50,000 - 21,055 71,055
6037 Warseno 762748 6722/ Terapi 29-May-15 R.medik 50,000 35,000 13,704 98,704
6038 Lelly J. 630935 6903/ Keloid 29-May-15 Kulit Kelamin 50,000 - 115,000 9,625 174,625
6039 Zainul Shol 796423 6783/ Terapi+Vert 29-May-15 R.medik 50,000 35,000 71,500 19,230 175,730
6040 Jaylani 838931 6947/ Neuralgia 29-May-15 Syaraf 50,000 - 227,700 20,518 298,218
6041 Rusman 712967 7253/ Kontrol 29-May-15 Syaraf 50,000 - 10,279 60,279
6042 Siti Mudaw 838766 6919/ Frozen Shou 29-May-15 Syaraf 50,000 - 14,843 64,843
6043 Noor Diana 570064 6872/ Hearing Los 29-May-15 Tht 50,000 - 112,500 39,313 201,813
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
6044 Sri Maryant 816167 7161/ Kontrol 29-May-15 Tht 50,000 - 119,000 169,000
6045 Sularsih 797024 7087/ Ca Mamae 29-May-15 Onkologi 50,000 - 525,250 575,250
6046 Nur Rohhma 559368 7284/ Obs Melena 29-May-15 P. Dalam 50,000 - 294,500 344,500
6047 M.Dzaky 785334 7149/ Phymosis 29-May-15 Bedah Anak 50,000 - 201,400 251,400
6048 Jumaiyah 727024 6858/ Ca Parotis S 29-May-15 Onkologi 50,000 - 525,250 575,250
6049 Herlina 838973 6890/ Susp Fam 29-May-15 Bedah Umum 50,000 - 394,150 377,500 125,400 947,050
6050 Edi Junaidi 549437 7119/ Kontrol 29-May-15 Bedah Umum 50,000 35,000 394,150 377,500 649,500 36,938 1,543,088
6051 Caswati 838968 6887/ Susp Bsk 29-May-15 Urologi 50,000 - 219,500 125,400 394,900
6052 Tasya Ramad838972 7267/ 12,11,21,22 29-May-15 Gigi&Mulut 50,000 - 220,000 160,600 430,600
6053 Hadijah 583765 4832/ Pro Aff Impl 29-May-15 Kandungan 50,000 - 60,000 105,600 215,600
6054 Sundari 671173 4711/ Susp Pid 29-May-15 Kandungan 50,000 - 60,000 305,000 415,000
6055 Sari Yatun 468588 7180/ G3P2A0 Plas 29-May-15 Kandungan 50,000 - 120,500 305,000 475,500
6056 Firdaus Sya 838955 4745/ Pro Ttp Col 29-May-15 Bedah Umum 50,000 - 701,550 250,800 1,002,350
6057 Sachpana 534541 7132/ Kontrol 29-May-15 Kandungan 50,000 35,000 125,500 175,000 305,000 690,500
6058 Triyas Rism 838964 6813/ G2P1A0 29-May-15 Kandungan 50,000 - 60,000 305,000 415,000
6059 Hafiz Nur 811861 7105/ Terapi 29-May-15 R.Medik 50,000 - 220,000 270,000
6060 Dafa Tri Nal 829331 6800/ Ft 29-May-15 R.Medik 50,000 - 220,000 270,000
6061 Saider Lina 770653 4640/ Terapi 29-May-15 R.Medik 50,000 - 220,000 270,000
6062 Hj.Ernawati 710875 4636/ Terapi 29-May-15 R.Medik 50,000 - 220,000 270,000
6063 Indrawati 680655 6725/ Terapi 29-May-15 R.Medik 50,000 - 220,000 270,000
6064 Hamdanah 563909 6739/ Terapi 29-May-15 R.Medik 50,000 - 220,000 270,000
6065 Sabariyah 016859 6724/ Fisioterapi 29-May-15 R.Medik 50,000 - 220,000 270,000
6066 Ade Warsa 791835 7103/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6067 Sumiati 671273 4637/ Fisioterapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6068 Marsidi 720910 6768/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6069 Marida 647710 6737/ Fisioterapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6070 H.Mudaring 585074 7072/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6071 Marni 740828 6751/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6072 Nurul Aini 835915 6752/ Terapi 29-May-15 R.Medik 50,000 35,000 159,500 244,500
6073 Nur Hasana 397672 7116/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6074 Murikah 598534 7088/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6075 Musningsih 549641 7135/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6076 Dewi Yuni L 839986 4652/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6077 J.Marni 664975 7075/ Fisioterapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6078 Sakdiah 822982 6709/ Terapi 29-May-15 R.Medik 50,000 - 294,500 344,500
6079 Susiatin 337059 7176/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6080 Sumiati 715110 7165/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6081 Wakiyem 701255 6770/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6082 Suswati 839954 7194/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
6083 Norliana 521951 7179/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6084 Nurdin 835256 7238/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6085 Sayem 835998 7146/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6086 Mahrita 834539 7074/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6087 Darmiati 667292 7120/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6088 Ernawati 525416 7089/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6089 Afif Pliang 781444 6736/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6090 Nico Mangu 784719 6707/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6091 Yenni Purwa 631789 7086/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6092 Mahmudah 268599 7060/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6093 Yuliani 285668 6931/ Cts 29-May-15 R.Medik 50,000 35,000 71,500 15,545 172,045
6094 Saifullah 836957 6828/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6095 Supriani 639809 6769/ Fisioterapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6096 Kisnan 431632 7102/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6097 Ahmad Sida 581234 6723/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6098 Rubiyanti 835952 6740/ Terapi 29-May-15 R Medik 50,000 - 71,500 121,500
6099 Akhmad Sya 763738 6811/ Terapi 29-May-15 R Medik 50,000 - 159,500 209,500
6100 Iis Soleh 796820 7104/ Fisioterapi 29-May-15 R Medik 50,000 - 71,500 121,500
6101 Hj.Darwisah 743878 7073/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6102 Nurdin Doni 712854 6781/ Fisioterapi 29-May-15 R.Medik 50,000 35,000 159,500 244,500
6103 Achmadsya 465433 4654/ Fisioterapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6104 Fatimah 380727 4653/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6105 Sano Eriant 054932 7163/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6106 Masrah 677735 4669/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6107 Sujarni 800848 6753/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6108 Annisa Hima 781563 6706/ Ot+Tw 29-May-15 R.Medik 50,000 - 440,000 490,000
6109 Asih Sunars 829585 6710/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6110 Norma 839915 7133/ Terapi 29-May-15 R.Medik 50,000 - 440,000 490,000
6111 Gimun 695987 6754/ Terapi 29-May-15 R.Medik 50,000 - 220,000 270,000
6112 H. Bambang 829576 7101/ Terapi 29-May-15 R.Medik 50,000 - 440,000 490,000
6113 M.Ihsan 764779 6782/ Tw 29-May-15 R.Medik 50,000 - 220,000 270,000
6114 Bagus Dwi J 782836 4728/ Gangguan K 29-May-15 Anak 50,000 35,000 220,000 305,000
6115 Zema Riski 739218 6695/ Terapi 29-May-15 R.Medik 50,000 - 440,000 490,000
6116 Rakavino Yu 528783 7059/ Terapi 29-May-15 R.Medik 50,000 - 440,000 490,000
6117 Hamnah Sud 681390 4802/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6118 Nasywa Qon706135 7224/ Fisioterapi 29-May-15 R.Medik 50,000 - 440,000 490,000
6119 Marsya Chel 481040 6948/ Ft+Ot 29-May-15 R.Medik 50,000 - 220,000 270,000
6120 M. Haykal I 500328 6785/ Terapi 29-May-15 R.Medik 50,000 - 220,000 270,000
6121 Jasmani 822971 4820/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
6122 M.Asrani 648975 4759/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6123 Herlina 817022 4805/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6124 Suriansyah 468561 6784/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6125 Andri K.P. 706211 4803/ Fisioterapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6126 Donatius S 811513 4757/ Terapi 29-May-15 R.Medik 50,000 - 379,500 429,500
6127 Ratnawati 770672 6934/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6128 Nani 683573 4775/ Terapi 29-May-15 R.Medik 50,000 - 159,500 209,500
6129 Hj.Masnawa 718846 4818/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6130 Kapsah 791022 7118/ Kontrol 29-May-15 R.Medik 50,000 - 159,500 209,500
6131 Riduansyah 450111 4639/ Terapi 29-May-15 R.Medik 50,000 - 440,000 490,000
6132 Febrian Satr 753688 6708/ Fisioterapi 29-May-15 R.Medik 50,000 - 440,000 490,000
6133 Syahira 790826 6738/ Terapi 29-May-15 R.Medik 50,000 - 440,000 490,000
6134 Sual Fiqsati 691428 4804/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6135 Suparti 487344 4744/ Kontrol 29-May-15 R.Medik 50,000 - 71,500 121,500
6136 Ijum 775736 6694/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6137 Paridah 646528 4786/ Terapi 29-May-15 R.Medik 50,000 - 71,500 121,500
6138 Abdul Latif 839975 4787/ Terapi 29-May-15 R.Medik 50,000 - 220,000 270,000
6139 Winda Nurit 828970 7281/ Feruca 29-May-15 R.Medik 50,000 - 374,900 424,900
6140 Ice Domi 838722 7209/ Kontrol 29-May-15 R.Medik 50,000 - 60,000 110,000
6141 Reni 842197 4697/ Kontrol 29-May-15 Kandungan 50,000 - 120,500 170,500
6142 Endah Prati 822977 6845/ Soft Tissue 29-May-15 Onkologi 50,000 - 50,000
6143 Wainten Sam 604851 4667/ Kontrol 29-May-15 Onkologi 50,000 - 50,000
6144 Supian Ham 838785 6946/ Snh 29-May-15 Syaraf 50,000 - 50,000
6145 Albertino 839103 4790/ Kontrol 29-May-15 Jantung 50,000 - 187,000 237,000
6146 Dahlia 834518 4683/ Kontrol 29-May-15 Jantung 50,000 - 462,500 512,500
6147 Wiyatun 838913 7191/ Hemoroid Gr 29-May-15 Bedah Umum 50,000 35,000 125,000 187,000 397,000
6148 Siti Nasriah 348453 4788/ Tinea Corpo 29-May-15 Mata 50,000 - 60,000 110,000
6149 Endang Suli 761092 7283/ S/ Glaukoma 29-May-15 Mata 50,000 - 190,000 240,000
6150 Saidi 838969 4729/ Kontrol 29-May-15 Tht 50,000 - 225,000 275,000
6151 Ahmad Suya 838929 7237/ Benjolan Pa 29-May-15 Bedah Umum 50,000 - 50,000
6152 Nurhayati 563933 6871/ Post Op Str 29-May-15 Bedah Umum 50,000 - 50,000
6153 Rupiatun 834847 7268/ 12 Caries 29-May-15 Gigi&Mulut 50,000 - 341,392 391,392
6154 M.Rizky Har 838760 7207/ Ada Benjola 29-May-15 Anak 50,000 35,000 85,000
6155 Tutik Rahay 742172 4756/ Keloid 29-May-15 Bedah Umum 50,000 - 120,500 170,500
6156 Supiyah 549762 7208/ Kontrol 29-May-15 Bedah Umum 50,000 - 125,000 12,325 187,325
6157 Mario Ade P 840751 6859/ Post Amputa 29-May-15 Bedah Umum 50,000 - 125,000 175,000
6158 Hairuddin A 838962 7162/ 7 Karies Me 29-May-15 Gigi&Mulut 50,000 - 450,253 500,253
6159 Siti Chotima 842599 4712/ Kontrol 29-May-15 Anak 50,000 - 50,000
6160 Asma Az Za 706168 4833/ Scabies 29-May-15 Anak 50,000 - 50,000
No Nama No RM No SJP Diagnosa Tgl Poliklinik Pelayanan Konsul Biaya Tindakan Lab PA Lab PK Radiologi Elektromedik Obat Total
Kunjungan
6161 Dwi Dili Ari 775332 4771/ Kontrol 29-May-15 Tht 50,000 - 50,000
6162 Emy Rianti 838922 4758/ Perdarahan 29-May-15 Kandungan 50,000 - 60,000 110,000
6163 Dewi R. Put 838980 4772/ G3P2A0 +Ma 29-May-15 Kandungan 50,000 - 120,500 170,500
6164 M.Aspiannu 842811 7223/ Kolik Abd S 29-May-15 Urologi 50,000 - 50,000
6165 Tri Yani K 594804 4741/ 8 Impaksi 29-May-15 Gigi&Mulut 50,000 - 50,000
6166 Indra J 839952 7251/ Kontrol 29-May-15 Gigi&Mulut 50,000 - 50,000
6167 Anisah Mufi 670042 4696/ 1|Np 29-May-15 Gigi&Mulut 50,000 - 272,703 322,703
6168 Susi Susanti 834846 6905/ 1 Period 29-May-15 Gigi&Mulut 50,000 - 341,392 391,392
6169 Eni 831194 4681/ Kontrol 29-May-15 P. Dalam 50,000 - 402,500 72,723 525,223
6170 A Rahim Wa 701049 4668/ Susp Bph 29-May-15 Urologi 50,000 - 50,000
6171 Suryani 681105 4726/ Bumil 38 M 29-May-15 Kandungan 50,000 - 120,500 170,500
6172 Nelly Novit 838966 4730/ G3P2A0 Dng 29-May-15 Kandungan 50,000 - 120,500 170,500
6173 M.Khoirudd 838744 7255/ Ganglion 29-May-15 Bedah Umum 50,000 35,000 257,250 342,250
6174 Armiah 838975 6918/ Dm 29-May-15 P. Dalam 50,000 - 402,500 452,500
6175 Puji Priyono 647016 6857/ 112 29-May-15 Vct 50,000 - 50,000
6176 Rusdiana 843183 4773/ G4P3A0 +Pla 29-May-15 Kandungan 50,000 - 120,500 170,500
6177 Paridah 838974 6902/ Dm Tipe Ii 29-May-15 P. Dalam 50,000 - 50,000
6178 Wahyuni 838978 6935/ G2P1A0+Ri 29-May-15 Kandungan 50,000 - 120,500 170,500
6179 Rusmini 821169 7071/ Dm Ii 29-May-15 P. Dalam 50,000 - 75,000 125,000
6180 Sofianti 730315 4760/ Menometora 29-May-15 Kandungan 50,000 - 60,000 110,000
6181 Sunti 828281 7252/ Abd Pain 29-May-15 Kandungan 50,000 - 60,000 110,000
6182 Wa Abe 518834 4700/ Prolab Uteri 29-May-15 Kandungan 50,000 - 373,500 423,500
6183 Sukiman 697280 6814/ Ca Bulli 29-May-15 Urologi 50,000 - 280,500 330,500
6184 Tunikah 796098 6932/ Post Stroke 29-May-15 Syaraf 50,000 - 265,498 315,498
6185 Titus Ahma 820014 4816/ Snh 29-May-15 Jantung 50,000 - 162,069 212,069
6186 Lisnawati 786215 7210/ S/ Ca Nasof 29-May-15 Tht 50,000 - 50,000
TOTAL 309,300,000 30,800,000 531,251,792 302,130,357 29,385,250 183,359,805 75,844,600 342,967,771 1,805,039,575

Mengetahui

Petugas Klaim
Ketua Tim Pengelola JPKM Terpadu

dr. Cisca Helen Nelwan, M.Kes Elliyana Rizka Indah Melasari, SE


NIP. 19650921 199803 2 005 19861128 201201 2 C1 571 19900825 201306 2 D1 063

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