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TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-01-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI11034420 0000576283 ADE PRASETYAWATI 10-09-1994 17 P Jl Taman Kenten Lr Wajar Kota Palembang JAMSOSKES(SUMSEL 409 III K56.6 Other & Unspecified Appendiktomi Dr.Efman E.U.M, Dr.Rose Mafiana, 3,565,900
No.301 Kel.Duku SEMESTA) Intestinal Obstruction M.Kes,SpB-KBD SpAn

2 RI11034394 0000576199 IDAWATI ARDIANSYAH 31-12-1973 38 P Jl Syakyakirti Kel. Karang JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr. Firmansyah, SpOG Dr.Rose Mafiana, 6,223,750
Anyar Kec. Gandus Caesarean Section, SpAn
Unspecified

3 RI12000129 0000576352 ISMA YULIANA 20 L Ds.Talang Kelapa Rt.48/05 JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr. Firmansyah, SpOG Dr.Rose Mafiana, 3,017,300
Kec.Alang-Alang Lebar Incomplete,With Other And SpAn
Unspecified Complications

4 RI11034432 0000576317 MUHAMMAD PRABOWO 13 L Desa Keban Agung Kab. Muara Enim PT. Batubara Bukit Asam 103 UT C Z09 Follow-Up Examination Amputasi Dr.H.Muzakkie, SpBO Dr. Arliansah, 8,795,150
Kec.Lawang Kidul Tanjung Enim After Treatment For FICS M.Si, Sp.An
Kab.Muara Enim Conditions Other Than
Malignant Neoplasm
5 RI12000045 0000576438 NELI AKMAL 36 P Lrg Teladan Desa Susang Iii JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Abadi, SpOG Dr.Rose Mafiana, 6,223,750
Caesarean Section, SpAn
Unspecified

6 RI11034443 0000576333 NURAINI BASUKARNO 18-07-1984 27 P Jl.Irigasi Lr.Sehat Kel.Srijaya Kota Palembang JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr. Firmansyah, SpOG Dr. Arliansah, 6,223,750
Kec.Alang-Alang Lebar Plg Caesarean Section, M.Si, Sp.An
Unspecified

7 RI12000031 0000576422 NY YAYUK YULIANTI 26 P Jl Kedukan JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Kuretase Dr.Abadi, SpOG Dr.Rose Mafiana, 3,017,300
Delivery, Unspecified SpAn

8 RI12000011 0000576379 SELFI BINTI SABTU 6 L Ds.Cengal Kec.Cengal Kab. Ogan Komering UMUM 403 II B T14.1 Open Wound (Luka Tusuk, Explorasi ( Non Thorax ) Dr.Bermansyah, SpB Dr.Rose Mafiana, 16,066,050
Kab.Oki Ilir Lecet, Potong, Gigit SpAn
Binatang)

9 RI11033888 0000573472 SOPIAH BT UMAR 10-10-1959 52 P Dsn 3 Bangun Sar Im. Enim JAMKESMAS PUSAT 406 III K56.6 Other & Unspecified Nefrostomy Dr. Martha Hendry,SpU Dr.Rose Mafiana, 3,286,400
Intestinal Obstruction SpAn

10 RI11034418 0000576299 SUSANTI MUSYAIRI 06-05-1983 28 P Jl.Srinanti Sungai Gerong JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr. Firmansyah, SpOG Dr.Rose Mafiana, 3,017,300
Incomplete,With Other And SpAn
Unspecified Complications

Sub T o t a l Rp.: 59,436,650


JLH TINDAKAN KAMAR OPERASI IBS : 10
Tgl Operasi : 01-01-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12000061 0000576472 ASRONI BIN SAMIT 45 L Jl Dusun Ii Kuang Dalam JAMSOSKES(SUMSEL 702 III J33 Nasal Polyp Pemasangan WSD Dr.Bermansyah, SpB 3,950,500
SEMESTA)
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-01-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

2 RI12000036 0000576396 FERDIANSYAH KRISMAN 19 L Jl Gunung Agung Merapi Kab. Lahat JAMSOSKES(SUMSEL 702 III S42.3 Fracture Of Shaft Of Debridement dr. Ismail Bastomi, Dr.Rose Mafiana, 3,546,400
Lahat SEMESTA) Humerus SpOT SpAn

3 RI11034446 0000576334 GUMANTI BIN USMAN 12-06-1972 39 L Jl.Naskah Iii Lr.Sikam Kota Palembang JAMSOSKES(SUMSEL 702 III S92.2 Fracture Of Other Tarsal Debridement dr. Ismail Bastomi, Dr.Rose Mafiana, 3,546,400
Sukarami Palembang SEMESTA) Bone [S] SpOT SpAn

4 RI11034424 0000576318 HELMI BIN EDI YANTO 16 L Lk Ii Tanjung Raja Ogan Ilir Kab. Ogan Ilir JAMSOSKES(SUMSEL 702 III S09.7 Multiple Injuries Of Head Reposisi Tertutup Dr.H.Muzakkie, SpBO Dr. Arliansah, 3,559,400
SEMESTA) (Trauma Capitis) FICS M.Si, Sp.An

5 RI12000068 0000576474 M.BASRI 01-01-1952 60 L Jlsekip Bendung Dalam No Kota Palembang JAMSOSKES(SUMSEL 702 III J44.9 Chronic Obstructive Laparatomi Dr.Sarup Singh,SpB Dr.Rose Mafiana, 5,109,000
23 SEMESTA) Pulmonary Disease, SpAn
Unspecified

6 RI11034454 0000576350 NURHAYATI BINTI TAPIB 7 P Komp.Sangkuriang Blok K JAMSOSKES(SUMSEL 702 III T30 Burn & Corrosion, Body Debridement Dr.Iqmal Perlianta, Sp Dr.Rose Mafiana, 3,546,400
No.03 Rt.60 SEMESTA) Region Unspecified BP SpAn

7 RI11034431 0000576327 TOMI BIN SAIDI 8 L Jl.H.Agustjik Ayin No 38 Kab. Banyuasin JAMKESMAS PUSAT 702 III T31.1 Burn Involving 10 - 19% Of Debridement Dr.Iqmal Perlianta, Sp Dr.Rose Mafiana, 3,546,400
Kenten Laut Talang Kelapa Body Surface BP SpAn
Banyuasin

Sub T o t a l Rp.: 26,804,500


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 7
Tgl Operasi : 01-02-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12002827 0000584935 ABDUL GOPAR 20-03-1963 48 L Desa Meranjat I Indralaya Kab. Ogan Ilir JAMSOSKES(SUMSEL 404 III N40 Hyperplasia Of Prostate TUR Prostat Dr.Arizal Agoes, SpB Dr.Rose Mafiana, 6,297,000
Selatan Ogan Ilir SEMESTA) SpU SpAn

2 RI12002701 0000584866 ANDRI BAGUSSAPUTRO 06-03-1993 18 L Ds. Lumpangkuwik UMUM 402 IA Z09.9 Follow-Up Examination STSG / Skingrafting yang Luas Dr.Rendra Leonard, Dr.Rose Mafiana, 6,265,500
After Unspecified Treatment SpOT SpAn
For Other Conditions

3 RI12003500 0000587533 ASNIAH 22 P Komp Megah Asri 2 Rt 32 JAMKESMAS PUSAT 203 III O36.9 Maternal Care For Fetal Sectio Cesarea tanpa penyulit Dr. Peby Maulina Dr.Rose Mafiana, 6,223,750
Kel Sukajadi Kec Talang Problem, Unspecified Lestari,SpOG SpAn
Kelapa

4 RI12001841 0000580068 AULIA SALSABILA 05-09-2011 0 P Jl. Kenari 2 Lahat Tengah, Kab. Lahat JAMSOSKES(SUMSEL 409 III Q03.9 Congenital VP Shunt (shuting) / Pemasangan Dr.Trijoso Dr.Rose Mafiana, 6,820,000
Lahat SEMESTA) Hidrocephalus,Unspecified Pintasan Permono,SpBS SpAn

5 RI12002807 0000579843 BAIHAKI.HB 14-06-1938 73 L Kayu Agung Kel Sidakarsa Kab. Ogan Komering ASKES 402 IB N40 Hyperplasia Of Prostate TUR Prostat Dr.Arizal Agoes, SpB Dr.Rose Mafiana, 9,315,500
Ilir SpU SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-02-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

6 RI12003406 0000587159 ERNAWATI 05-04-1986 25 P Sel Rengit Banyuasin Kab. Banyuasin JAMKESMAS PUSAT 203 III O72 Psot Partum Haemorrhage Manual Placenta Dr. Peby Maulina Dr.Rose Mafiana, 3,064,100
Lestari,SpOG SpAn

7 RI12003203 0000460366 FARHAH KHALIFAH 22-07-2010 1 P Pam Bukit Lama Lr. Hiba I Kota Palembang ASKES 401 IB Q35.9 Cleft Palate, Unspecified, Palatoplasty Dr.Iqmal Perlianta, Sp Dr.Rose Mafiana, 6,349,500
No. 830 Unilateral BP SpAn

8 RI12003496 0000587549 FITRIYANAH 03-03-1977 34 P Dusun Ii Desa Burai Kab. Ogan Komering JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Rizal Sanif, SpOG- Dr.Rose Mafiana, 6,223,750
Ilir Caesarean Section Konk SpAn

9 RI12003208 0000580683 FLORENCE LIDA 17-01-1992 20 P Desa Tanjung Seteko Kab. Ogan Ilir ASKES 105 IA D24 Benign Neoplasm Of Breast Wide Excisi Dr.Benny Kusuma, SpB Dr.Rose Mafiana, 5,537,500
TRISNAWATI (K) Onk SpAn

10 RI12003046 0000231297 HARTI NINGSIH 01-01-1966 46 P Jl.Sekip Tengah Kebon Kota Palembang JAMSOSKES(SUMSEL 405 III N13.9 Obstructive And Reflux Colostomi / lleostomi Dr.Efman E.U.M, Dr.Rose Mafiana, 3,901,000
Semai No.05 SEMESTA) Uropathy, Unspecified M.Kes,SpB-KBD SpAn

11 RI12003503 0000587541 HERI RISWANTO 36 L Ds Lubuk Kepayang Merapi Kab. Lahat UMUM 407 IA S52.8 Fracture Of Other Parts Of Reposisi Tertutup Dr.H.Muzakkie, SpBO Dr.Rose Mafiana, 4,697,550
Lahat Forearm FICS SpAn

12 RI12002564 0000579123 INDAH CAHYANI 19-07-1998 13 P Lomba Jaya No 1682 JAMSOSKES(SUMSEL 409 III C85.9 Non-Hodgkin'S Lymphoma, Wide Excisi Dr.Benny Kusuma, SpB Dr.Rose Mafiana, 3,513,000
SEMESTA) Unspecified Type (K) Onk SpAn

13 RI12003238 0000519511 ISMAIL AM RAMBANG 09-06-1953 58 L Dusun 2 Ds/Kel. Luar Kota ASKES 402 IA K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.Sarup Singh,SpB Dr.Rose Mafiana, 16,875,000
Penyadinagn Kec. Teluk SpAn
Gelam Kab. Oki

14 RI12003078 0000586106 M.REZA EFFENDI 02-11-2000 11 L Jl Di Panjaitan PT.ASURANSI JIWA 408 II B S02.2 Fracture Of Nasal Bones Reposisi Hidung Dr.Sofyan Dr.Rose Mafiana, 4,012,000
INHEALTH INDONESIA Effendi,SpTHT SpAn

15 RI12003367 0000581964 MARLINA EFENDI 12-03-1983 28 P Jl. Pimpong Blok F 1 Kota Palembang JAMSOSKES(SUMSEL 203 III N85.1 Endometritis Glandular Laparascopi Diagnostik Dr.Rizal Sanif, SpOG- Dr.Rose Mafiana, 2,357,000
SEMESTA) Hyperplasia Konk SpAn

16 RI12002787 0000585141 MARSINI 50 P Sungai Landai Rt 5 Rw 2 UMUM 401 IA S72.9 Fracture Of Femur, Part Nos Debridement Dr. Mgs Roni Saleh, Sp Dr.Rizal Zanial, 3,603,500
Kec Mestong Kab Muaro BP SpAn
Jambi

17 RI12003331 0000586814 MERRY YETI 14-02-1956 56 P Perum Opi Blok J No.62-63 ASKES 104 UT D K60.3 Anal Fistula Explorasi Kavumnasi Dr.Efman E.U.M, Dr.Rose Mafiana, 4,064,000
M.Kes,SpB-KBD SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-02-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

18 RI12003386 0000587107 MUHAMMAD FAIGAN 16-09-2008 3 L Jl Nusa Tenggara 1 No 07 Kota Palembang ASKES 104 UT C T14.1 Open Wound (Luka Tusuk, Rekonstruksi Post Ekstirpasi Dr. Mgs Roni Saleh, Sp Dr.Rose Mafiana, 5,202,000
Lecet, Potong, Gigit Tumor BP SpAn
Binatang)

19 RI12003506 0000158724 MUHAMMAD TAMSIR 11-06-1958 53 L Desa Suka Rajo Lama Kab. Ogan Ilir ASKES 404 II B N21.1 Calculus In Urethra Meatotomi / Meatoplasi Dr. Martha Hendry,SpU Dr.Rose Mafiana, 4,445,350
SpAn

20 RI11034015 0000568694 NURLAELA BT MAKMUN 31-12-1966 45 P Sukarela No 276 B JAMSOSKES(SUMSEL 407 III D23.4 Other Benign Neoplasm Of Wide Excisi Dr.Benny Kusuma, SpB Dr.Rose Mafiana, 3,513,000
SEMESTA) Skin Of Scalp And Neck (K) Onk SpAn

21 RI12003445 0000587229 RA SISKA MARDIA 25 P Jl Mayor Ruslan No.508 Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Rizal Sanif, SpOG- Dr.Rose Mafiana, 6,223,750
Caesarean Section Konk SpAn

22 RI12002137 0000583265 RETNO JUWITA SARI 31-07-1984 27 P Jl Siaran Komp Griya Musi JAMKESMAS PUSAT 203 III O07.0 Failed Medical Abortion, Kuretase Dr.Kms.Yusuf E.SpOG Dr.Rose Mafiana, 3,017,300
F.16 Complicated By Genital SpAn
Tract & Pelvic Infection

23 RI12002279 0000583683 ROZILA WATI 26-01-1975 37 P Jl Pipa Pusri Gg Keluarga Kota Palembang JAMKESMAS PUSAT 203 III O01.9 Hydatidiform Mole, Laparatomy Explorasi Dr.Kms.Yusuf E.SpOG Dr.Rose Mafiana, 8,238,100
Unspecified SpAn

24 RI12002601 0000581630 SAFRUDIN BIN KUSNAN 15-04-2001 10 L Dusun 3 (Jl Lintas Timur) JAMSOSKES(SUMSEL 404 III Z47.0 Folow-Up Care Involving Angkat K-Nail / Remove Flat Screw Dr.H.Muzakkie, SpBO Dr.Rose Mafiana, 2,730,000
Desa Muara Burnai I SEMESTA) Removal Of Fracture Plate & FICS SpAn
Other Internal Fixation
Device
25 RI11034314 0000568098 SARNUBI 15-02-1975 36 L Jl. Desa Langkan No. Kab. Banyuasin JAMSOSKES(SUMSEL 409 III D11.7 Benign Neoplasm Of Other Wide Excisi Dr.Benny Kusuma, SpB Dr.Rose Mafiana, 3,513,000
Langkan Banyuasin Iii SEMESTA) Major Salivary Glands (K) Onk SpAn

26 RI12002580 0000516478 SITI AMINAH ABDULROZAK 03-07-1946 65 P Musi Raya No 69 Kel Kota Palembang ASKES 401 IA C18 Malignant Neoplasm Of Low Ant.Resection / Pullthrough Dr.Efman E.U.M, Dr.Rose Mafiana, 9,206,500
Sialang Sako Colon M.Kes,SpB-KBD SpAn

27 RI12003275 0000580592 SOFIAH MARMAWAN 26-01-1954 58 P Macan Kumbang ASKES 104 UT D D24 Benign Neoplasm Of Breast Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Rose Mafiana, 3,397,500
(K) Onk SpAn

28 RI12003317 0000586841 SULAILA BINTI SATAR 07-01-1982 29 P Dusun Ii Ds/Kel. Pulau JAMKESMAS PUSAT 603 III D46 Myelodysplastic Sindromes Sectio Cesarea tanpa penyulit Dr. Peby Maulina Dr.Rose Mafiana, 8,680,100
Negara Kec. Prabumulih Lestari,SpOG SpAn
Darat Kab. Oi

29 RI12003242 0000586694 TRIWAHYUNI 05-01-2002 10 L Dusun 1 Desa Sebubus JAMKESMAS PUSAT 409 III S02.6 Fracture Mandible Orif Mandibula Dr.Iqmal Perlianta, Sp Dr.Rose Mafiana, 4,749,000
BP SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-02-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

30 RI12003212 0000579813 UMU MANAZILAWATI 19-05-1981 30 P Desa Sipang Saga Muara Kab. Ogan Komering ASKES 201 IB D25.9 Leiomyoma Of Uterus, Laparatomy Explorasi Dr.Efman E.U.M, 9,355,500
Duo Uku Selatan Ulu Selatan Unspecified M.Kes,SpB-KBD

31 RI12003212 0000579813 UMU MANAZILAWATI 19-05-1981 30 P Desa Sipang Saga Muara Kab. Ogan Komering ASKES 201 IB D25.9 Leiomyoma Of Uterus, Penambahan Jasa Dokter Dr.Kms.Yusuf E.SpOG Dr.Rose Mafiana, 2,017,000
Duo Uku Selatan Ulu Selatan Unspecified SpAn

Sub T o t a l Rp.: 173,407,750


JLH TINDAKAN KAMAR OPERASI IBS : 31
Tgl Operasi : 01-02-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12003405 0000587142 ADIYANTO 28 L Jl Tanah Mas Sukajadi JAMSOSKES(SUMSEL 702 III S09.7 Multiple Injuries Of Head Craniotomi Dr.Sahat Dr.Rose Mafiana, 6,832,000
SEMESTA) (Trauma Capitis) Edison.S,SpBS SpAn

2 RI12003379 0000587116 SEPTA EFLIYANI 23-09-1983 28 P Jl Komplek Uka Ii Kota Palembang JAMSOSKES(SUMSEL 702 III N83.2 Other & Unspecified Ovarian Penambahan Jasa Dokter Dr.M.Alsen Dr.Rose Mafiana, 949,000
SEMESTA) Cyst Arlan,SPBO SpAn

3 RI12003379 0000587116 SEPTA EFLIYANI 23-09-1983 28 P Jl Komplek Uka Ii Kota Palembang JAMSOSKES(SUMSEL 702 III N83.2 Other & Unspecified Ovarian Salfingo Oovarectomi Dr. Peby Maulina 5,066,100
SEMESTA) Cyst Lestari,SpOG

Sub T o t a l Rp.: 12,847,100


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 3
Tgl Operasi : 01-03-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12005757 0000582887 A. MALIK 08-04-1941 70 L Dsn Ii Seri Banding JAMSOSKES(SUMSEL 408 III J33 Nasal Polyp Fess Dr.Denny SU,SpTHT- Dr.Zulkipli, SpAn 5,957,000
SEMESTA) KL,MSiMed

2 RI12006212 0000595689 A.ROZAK 12-06-1940 71 L Jl Amoniak No 3 Komp Kota Palembang ASKES 401 IA I84.9 Unspecified Haemorrhoids Reheacting Dr.Sarup Singh,SpB Dr.Rose Mafiana, 4,748,250
Pusri Kbn Siri Without Complications SpAn

3 RI12006540 0000596789 ADINDA CRISTIE SHEILLA 07-02-1982 30 P Jl Bank Raya No 1 A Kota Palembang ASKES 201 UT A O36.9 Maternal Care For Fetal Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Zulkipli, SpAn 6,677,000
Palembang Problem, Unspecified SpOG

4 RI12006185 0000550441 AFIFA PUTRI SYAHIRA 03-02-2011 1 P Jl Puncak Sekuning Timun Kota Palembang ASKES 403 II B Q35.9 Cleft Palate, Unspecified, Palatoplasty Dr.Iqmal Perlianta, Sp Dr.Zulkipli, SpAn 6,349,500
No.205 Unilateral BP
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-03-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

5 RI12006517 0000596573 AHMED REZA PAHLEWI 21 L Jl Sentosa Lr Sriraya Plaju ASKES 402 II A T14.1 Open Wound (Luka Tusuk, Biopsi Insisi Dr.Bermansyah, SpB 5,562,000
Lecet, Potong, Gigit
Binatang)

6 RI12006474 0000596495 AJI HADI SETIAWAN 8 L Jl Sungai Kedukan Rt 12 Rw Kab. Banyuasin JAMKESMAS PUSAT 302 III J45 Asthma Pemasangan WSD Dr.Bermansyah, SpB 3,950,500
1 Kec Banyuasin

7 RI12006468 0000591635 ANITA YUSUF 28-02-1954 58 P Jl Panca No 2728 A Kota Palembang UMUM 102 UT B K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.Efman E.U.M, Dr.Zulkipli, SpAn 16,875,000
M.Kes,SpB-KBD

8 RI12004672 0000590816 ASMISAR 04-06-1986 25 L Desa Tegal Rejo Muara Kab. Muara Enim JAMKESMAS PUSAT 407 III R55 Syncope And Collapse Orif Mandibula Dr.Iqmal Perlianta, Sp Dr.Zulkipli, SpAn 4,749,000
Enim BP

9 RI12006494 0000579893 DEWI FITRIANI 18 P Jl Letnan Simanjuntak JAMSOSKES(SUMSEL 203 III N93.9 Abnormal Uterine And Operasi Septum Vagina Dr. Patiyus Dr.Rose Mafiana, 3,064,100
SEMESTA) Vaginal Bleeding, Agustiansyah, SpOG SpAn
Unspecified

10 RI12006179 0000029340 DRA DARMINAWATI 23-04-1960 51 L Rusun Blok 45 Lt 3 Kota Palembang ASKES 105 IA D21.9 Benign Neoplasm Of Eksisi Tumor Jar Lunak Kecil Dr.Iqmal Perlianta, Sp Dr.Zulkipli, SpAn 3,397,500
Connective And Other Soft BP
Tissue, Unspecified

11 RI12006039 0000586449 FAREL PUTRA.P 06-02-2010 2 L P Selsa Lr Suratin No 1911 JAMSOSKES(SUMSEL 407 III K40.9 Unilateral Or Unspecified Laparatomi Dr.Sindu Dr.Zulkipli, SpAn 3,930,000
SEMESTA) Inguinal Hernia, Without Saksono,SpBA
Obstruction Or Gangrene

12 RI12006457 0000596453 H. ALI SAAD 08-10-1955 56 L Dusun 111 Tulung Selapan UMUM 405 II B I84.9 Unspecified Haemorrhoids Hemoroidektomi Parsialis / Dr.Sarup Singh,SpB Dr.Fredi Heru 3,616,500
Without Complications Hemoroidektomi Irwanto, Sp.An

13 RI12005787 0000005282 IR. DIRMANSYAH 05-11-1946 65 L Jl.Slamet Riadi No. 1534 Kota Palembang ASKES 402 IA K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.Efman E.U.M, Dr.Zulkipli, SpAn 16,875,000
Lawang Kidul M.Kes,SpB-KBD

14 RI12003603 0000557582 KODIRBIN HASAN 10-10-1950 61 L Ki Merogan Lr Bacang JAMKESMAS PUSAT 406 III D36.1 Benign Neoplasm Peripheral Rekonstruksi Dr.Benny Kusuma, SpB 6,319,000
Nerves & Autonomic (K) Onk
Nervous System

15 RI12003603 0000557582 KODIRBIN HASAN 10-10-1950 61 L Ki Merogan Lr Bacang JAMKESMAS PUSAT 406 III D36.1 Benign Neoplasm Peripheral Penambahan Jasa Dokter Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 920,000
Nerves & Autonomic (K) Onk
Nervous System

16 RI12006241 0000496910 MARIYU 27-03-1957 54 P Kh Syech Yahya Kab. Muara Enim JAMSOSKES(SUMSEL 203 III C56 Malignant Neoplasm Of Surgical Staging Dr.Agustria Z,SpOG- 6,213,000
SEMESTA) Ovary KFM
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-03-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

17 RI12006241 0000496910 MARIYU 27-03-1957 54 P Kh Syech Yahya Kab. Muara Enim JAMSOSKES(SUMSEL 203 III C56 Malignant Neoplasm Of Penambahan Jasa Dokter Dr.Sarup Singh,SpB Dr.Zulkipli, SpAn 1,058,000
SEMESTA) Ovary

18 RI12005154 0000592420 MUH ABDUL ROZAK BIN 29-12-1994 17 L Desa Nusa Maju-Belitang Kab. Ogan Komering JAMSOSKES(SUMSEL 500 III C91.0 Acute Lymphoblastic Bius Umum /Spinali untuk Dr.Zulkipli, SpAn 2,114,000
SUTARSO Iii-Oku Timur Ulu Timur SEMESTA) Leukaemia menentukan diagnostik

19 RI12006194 0000592138 MUNAZZAHAH S.PARMAN 26-02-1969 43 P Griya Hero Abadi Blok I 11 Kab. Musi Banyuasin ASKES 401 IA T14.3 Dislocation, Sprain And Fraktur Kompleks Dr.H.Muzakkie, SpBO Dr.Zulkipli, SpAn 9,644,500
Talang Kelapa Train Of Unspecified Body FICS
Region

20 RI12006090 0000595244 MURNI 37 L Jl Palembang Betung Kota Palembang JAMKESMAS PUSAT 203 III O72 Psot Partum Haemorrhage Kuretase Dr. Peby Maulina Dr.Zulkipli, SpAn 3,017,300
Lestari,SpOG

21 RI12006224 0000335755 NOVITA SARI HARYANTI 21-11-1984 27 P Jl.Super Semar Lr.Amal V Kota Palembang ASKES 403 II B D24 Benign Neoplasm Of Breast Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 3,397,500
No.1263 Kemuning (K) Onk

22 RI12005652 0000581795 PRANDIKA OXEL SAPUTRA 24-07-2011 0 P Desa 2 Lumpatan Muba MUBA SEMESTA 404 II B D18.0 Haemangioma, Any Site Reheacting Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 3,652,500
(Angioma Nos) (K) Onk

23 RI12006583 0000596863 ROBANI 42 L Jl Let Jen Harun Sohar Rt JAMKESMAS PUSAT 409 III K40.9 Unilateral Or Unspecified Hernioraphy Dewasa Dr.Efman E.U.M, Dr.Zulkipli, SpAn 3,512,600
45 Rw 10 Kebun Bunga Inguinal Hernia, Without M.Kes,SpB-KBD
Sukarami Obstruction Or Gangrene

24 RI12006371 0000596129 RUSNIA 23 P Desa Sungai Lumpur Oki Kab. Ogan Komering JAMKESMAS PUSAT 203 III O72 Psot Partum Haemorrhage Kuretase Dr. Peby Maulina Dr.Zulkipli, SpAn 3,017,300
Ilir Lestari,SpOG

25 RI12006448 0000531386 SARUMIYATI 18-11-1951 60 L Jl Letnan Murod Lr Damar Kota Palembang ASKES 408 II B J01 Acute Sinusitis Fess Dr.Denny SU,SpTHT- Dr.Zulkipli, SpAn 9,646,000
KL,MSiMed

26 RI12006425 0000596301 SITA MULYADI 05-03-1995 17 P Gasing Laut No. UMUM 403 II B Q43.6 Congenital Fistula Of Fistulektomi / High Anal Dr.Efman E.U.M, Dr.Zulkipli, SpAn 6,011,500
Rectum And Anus M.Kes,SpB-KBD

27 RI12002873 0000585492 SITI MARIAM 41 P Sumber Baru Mesuji Raya JAMSOSKES(SUMSEL 601 III M51.2 Displacement Intervertebral Laminektomi Kompleks Dr.Trijoso Dr.Zulkipli, SpAn 9,865,500
SEMESTA) Disk /Hnp Permono,SpBS

28 RI12004345 0000553736 SITI ZAKIAH 12-03-2005 6 P Lr.Sentosa Jaya JAMSOSKES(SUMSEL 409 III K56.7 Ileus, Unspecified Laparatomy Explorasi Dr.Sindu Dr.Zulkipli, SpAn 8,238,100
Kel.Tangga Takat SEMESTA) Saksono,SpBA
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-03-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

29 RI12006343 0000586878 SULASTRI BIN SAPAWI 07-01-1994 18 P Gotong Royong Desa Merah Kab. Banyuasin JAMKESMAS PUSAT 407 III D36.7 Benign Neoplasm Of Other Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 2,519,000
Mata Banyuasin Specified Sites (Nose Nos) (K) Onk

30 RI12003601 0000586683 SUNAN 21-02-1956 55 L Terlukis Martaputra No. ASKES 403 II B S72.9 Fracture Of Femur, Part Nos Fraktur Kompleks dr. Ismail Bastomi, Dr.Zulkipli, SpAn 9,644,500
5449 SpOT

31 RI12005782 0000594295 TANTRI 0 P Paldas Banyuasin Kab. Banyuasin JAMSOSKES(SUMSEL 302 II K56.6 Other & Unspecified Laparatomi Dr.Sindu Dr.Zulkipli, SpAn 5,109,000
SEMESTA) Intestinal Obstruction Saksono,SpBA

32 RI12006446 0000588072 TIARA FADHILAH 06-02-1998 14 P Jl.Kh.Asyik Lr.Melati No.107 Kota Palembang JAMSOSKES(SUMSEL 203 III N83.2 Other & Unspecified Ovarian Kistektomi Dr.Rizani A.SpOG- Dr.Zulkipli, SpAn 4,760,000
SEMESTA) Cyst KFER

33 RI12006586 0000596870 YULIA 32 P Jl Dr M.Isa Lr Bintara Rt 17 JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr. Firmansyah, SpOG Dr.Zulkipli, SpAn 6,223,750
Rw 5 Kuto Batu Kec It 2 Delivery, Unspecified

Sub T o t a l Rp.: 190,634,400


JLH TINDAKAN KAMAR OPERASI IBS : 33
Tgl Operasi : 01-03-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12006587 0000596823 ANDHINI 6 P Jl Segaran Lr Kemas I Kota Palembang JAMSOSKES(SUMSEL 702 III K35.1 Acute Appendicitis With Laparatomi Dr.Sindu Dr.Zulkipli, SpAn 5,109,000
Tembok Baru No.596 SEMESTA) Peritoneal Abscess Saksono,SpBA

2 RI12009662 0000606710 TRI AGUSTINA 11-08-1995 16 P Bayat Ilir Kec.Bayung Lencir MUBA SEMESTA 702 III K65.9 Peritonitis, Unspecified Laparatomi Dr.Sarup Singh,SpB Dr. Yusni Puspita, 5,109,000
Muba SpAn

Sub T o t a l Rp.: 10,218,000


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 2
Tgl Operasi : 01-04-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12009650 0000606656 AHMAD TOYIB 08-07-2003 8 L Sri Agung Kel.Pangkalan Kab. Ogan Komering JAMKESMAS PUSAT 406 III K65.9 Peritonitis, Unspecified Laparatomi Dr.Sindu Dr.Rizal Zanial, 5,109,000
Sakti Kab.Oki Ilir Saksono,SpBA SpAn

2 RI12009682 0000606731 ERNAWATI BT AZIS 22 P Komp.Afd Iii Lk.Vii Beka JAMKESMAS PUSAT 203 III O42 Premature Rupture Of Sectio Cesarea tanpa penyulit Dr.Kms.Yusuf E.SpOG Dr. Yusni Puspita, 6,223,750
WALUYO Kel.Betung Kec.Betung Membranes SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-04-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

3 RI12009659 0000606705 LILIS SETIAWATI 27 P Jl.Suka Bangun Ii Komplek UMUM 203 III O72 Psot Partum Haemorrhage Manual Placenta Dr.H.Ferry Dr.Rizal Zanial, 3,064,100
Polantas No.31 Yusrizal,Spog SpAn

4 RI12009680 0000606726 M.DANU MIRWANDO,SH 25-04-1985 26 L Jl.Jumpo No.793 Kota Palembang UMUM 106 UT B T14.1 Open Wound (Luka Tusuk, Repair Tendo Penyulit/Arteri dr. Ismail Bastomi, Dr. Yusni Puspita, 12,613,250
Kel.Sukabangun Lecet, Potong, Gigit Carotis/Arteri renalis stenosis SpOT SpAn
Kec.Sukarami Binatang)

5 RI12009657 0000606695 ROSI SILFIANI BT IBRAHIM 16-09-1981 31 P Komplek Maskerebet Kota Palembang UMUM 403 UT C T09 Other Injuries Of Spine And Debridement dr. Ismail Bastomi, Dr.Rizal Zanial, 4,684,550
Jl.Sedap Malam Ii Blok B 13 Trunk, Level Unspecified SpOT SpAn
Sukarami

6 RI12009658 0000606698 SUMANTI 15-03-1973 39 P Jl Jen Sudirman Lr Perapen Kota Palembang JAMKESMAS PUSAT 203 III O00.9 Ectopic Pregnancy, Sectio Cesarea tanpa penyulit Dr. Peby Maulina Dr.Rizal Zanial, 6,223,750
No 158 /224 Unspecified Lestari,SpOG SpAn

Sub T o t a l Rp.: 37,918,400


JLH TINDAKAN KAMAR OPERASI IBS : 6
Tgl Operasi : 01-04-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12009646 0000606666 DENI 01-01-1997 15 L Desa Talang Srinanti Kab. Lahat JAMKESMAS PUSAT 702 III K37 Unspecified Appendicitis Appendiktomi Dr.Sarup Singh,SpB Dr.Rizal Zanial, 3,565,900
Kel.Gunung Gajah SpAn
Kec.Lahat

2 RI12009660 0000606707 EKO SAPUTRA 20 L Tanjung Raja Oi JAMSOSKES(SUMSEL 701 III S09.7 Multiple Injuries Of Head Craniotomi Dr.Trijoso Dr. Yusni Puspita, 12,805,650
SEMESTA) (Trauma Capitis) Permono,SpBS SpAn

Sub T o t a l Rp.: 16,371,550


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 2
Tgl Operasi : 01-05-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12010419 0000601112 AHMAD HERMANTO 03-03-2009 3 L Kota Negara Madang Suku JAMSOSKES(SUMSEL 407 III N43.3 Hydrocele, Unspecified Wide Excisi Dr.Sindu Dr.Kusuma 3,513,000
WIJAYA Ii Okut SEMESTA) Saksono,SpBA Harimin, SpAn

2 RI12011917 0000599039 AISYAH BT WASMA 23-01-1964 48 P Rambutan Dalam JAMKESMAS PUSAT 405 III D21.9 Benign Neoplasm Of Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Kusuma 2,522,000
Connective And Other Soft (K) Onk Harimin, SpAn
Tissue, Unspecified

3 RI12009892 0000536343 ANTONI. R BIN ARIPUSIN 24-02-1995 17 L Ds Tanjung Lontar Kec. Kab. Lahat JAMSOSKES(SUMSEL 405 III N36.8 Other Specified Disorders Of Ureterolitotomi Dr.Didit Pramudhito, Dr.Kusuma 3,730,000
Merapi Timur Lahat SEMESTA) Urethra SPO Harimin, SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

4 RI12012144 0000504591 ARIA BAKARUDDIN 10-08-1973 38 P Indralaya Prum Permata ASKES 201 II A C53.9 Malignant Neoplasm Of Nefrostomy Dr.Didit Pramudhito, Dr.Kusuma 3,403,500
Duma Bloc B 12 Cervix Uteri, Unspecified SPO Harimin, SpAn

5 RI12012651 0000613358 ARWANI 12-05-1936 76 P Inspektur Marzuki Lr Damai Kota Palembang ASKES 201 IA C53.9 Malignant Neoplasm Of Laparascopy Operatif - Dr.Rizal Sanif, SpOG- Dr.Kusuma 3,125,000
2 No 46 Cervix Uteri, Unspecified Histeroskopi Konk Harimin, SpAn

6 RI12011016 0000506333 AZZIRA BT M. ZIYAD 26-04-2011 0 P Desa [Penantian Kab. Ogan Komering JAMSOSKES(SUMSEL 407 III Q42.3 Congenital Absence, Atresia Tutup Colostomi / Pro Rotating Dr.Sindu Dr.Kusuma 3,892,000
Kec.Banding Agung Oku Ulu Selatan SEMESTA) & Stenosis Of Anus Without Saksono,SpBA Harimin, SpAn
Selatan Fistula [Imperfoarte Anus]

7 RI12012750 0000616016 FATIMAH 22 P Desa Suka Damai-Tanjung UMUM 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Abadi, SpOG Dr.Kusuma 6,223,750
Lago Caesarean Section Harimin, SpAn

8 RI12012246 0000600298 FIDYA AFRIANI BT SULIAN. 25-04-1995 17 P Lubuk Layang Ilir Kikim Kab. Lahat JAMKESMAS PUSAT 407 III D36.7 Benign Neoplasm Of Other Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Kusuma 2,522,000
E Timur Lahat Specified Sites (Nose Nos) (K) Onk Harimin, SpAn

9 RI12011476 0000575517 HENDRI BIN KOPLI 10-02-1992 20 L Ds Tl Sawah Lahat Kab. Lahat JAMKESMAS PUSAT 409 III D21.9 Benign Neoplasm Of Wide Excisi Dr.Benny Kusuma, SpB Dr.Kusuma 3,513,000
Connective And Other Soft (K) Onk Harimin, SpAn
Tissue, Unspecified

10 RI12012746 0000616039 HENI AFRIANI 28 P Perum Bukit Sejahtera Blok UMUM 201 UT A O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Abadi, SpOG Dr.Kusuma 8,680,100
Bq Rt 14 Rw 4 Karang Jaya Caesarean Section Harimin, SpAn
Gandus

11 RI12012710 0000615971 KARTINI 22 P Desa Makarti Jaya Kab Kab. Banyuasin JAMKESMAS PUSAT 410 III K36 Other Appendicitis (Chronic, Appendiktomi Dr.Sarup Singh,SpB Dr.Kusuma 3,565,900
Banyuasin Reccurent) Harimin, SpAn

12 RI12012534 0000615448 M. AFFANDI 38 L Jl. Gubah 2 Kota Palembang JAMKESMAS PUSAT 405 III N36.8 Other Specified Disorders Of Insersi Kateter Double Luman HD Dr.Kusuma Harimin, 2,349,000
Urethra Semi Permanen SpAn

13 RI12011743 0000599395 M. FAREL YOLANDA 11-06-2007 4 L Jl. Swadaya Lr. Terpadu Kota Palembang JAMSOSKES(SUMSEL 409 III N20.1 Calculus Of Ureter (Ureteric Orchidectomy Dr.Sindu 3,633,000
Srijaya SEMESTA) Stone) Saksono,SpBA

14 RI12011743 0000599395 M. FAREL YOLANDA 11-06-2007 4 L Jl. Swadaya Lr. Terpadu Kota Palembang JAMSOSKES(SUMSEL 409 III N20.1 Calculus Of Ureter (Ureteric Penambahan Jasa Dokter Dr.Sindu Dr.Kusuma 730,000
Srijaya SEMESTA) Stone) Saksono,SpBA Harimin, SpAn

15 RI12012237 0000614493 MAMAT 12-01-1963 49 L Dusun 1 Desa Simpang Kab. Ogan Komering JAMKESMAS PUSAT 406 III H16.0 Keratitis Of Corneal Ulcer Blefaroplasty Dr.Anang Tribowo, 3,226,000
Empat Kec.Jejawi Kab.Oki Ilir SpM
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

16 RI12012768 0000616029 MARINI 32 P Jl Demang Lebar Daun No Pangkal Pinang JAMKESMAS PUSAT 203 III O83.1 Breech Delivery Sectio Cesarea tanpa penyulit Dr.Asrol Byrin,SpOG Dr.Kusuma 6,223,750
0586 Harimin, SpAn

17 RI12012717 0000616005 MARTINA 31-03-1967 45 P Gang Damai Karang Endah Kab. Muara Enim ASKES 105 IA S09.7 Multiple Injuries Of Head Closed Reduction dan dr. Ismail Bastomi, Dr.Kusuma 3,125,000
(Trauma Capitis) pemasangan gips fraktur femur SpOT Harimin, SpAn
pada anak

18 RI12012247 0000578217 MASHUDA BT SAHMIT 24-01-1963 49 P Lr. Terusan I No. 1672 Kota Palembang JAMSOSKES(SUMSEL 407 III D21.3 Benign Neoplasm Of Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Agustina Br.H, 2,522,000
SEMESTA) Connective And Other Soft (K) Onk SpAn, M.Kes
Tissue Of Thorax

19 RI12012188 0000609491 MUHAMMAD AL FAHREZI 28-11-2011 0 L Belakang Sma N 1 Pagar Kota Pagar Alam JAMSOSKES(SUMSEL 407 III G91.9 Hydrocephalus,Unspecified VP Shunt (shuting) / Pemasangan Dr.Sahat Dr.Kusuma 6,820,000
Alam SEMESTA) Pintasan Edison.S,SpBS Harimin, SpAn

20 RI12011122 0000607123 MUHAMMAD ALIF ZAKI 13-03-2012 0 L Jl.Pendawa No 27 Karang Kota Prabumulih JAMSOSKES(SUMSEL 301 III Q43.1 Hirschprung'S Disease Colostomi / lleostomi Dr.Sindu Dr.Kusuma 3,901,000
DARSA Raja Prabumulih Timur SEMESTA) Saksono,SpBA Harimin, SpAn

21 RI12012708 0000563754 NYIMAS RIA ANGGRAINI/TB 28-06-1987 24 P Jl Kadir Tkr No. Tg Buntung JAMSOSKES(SUMSEL 410 III K35.9 Acute Appendicitis, Appendiktomi Dr.Sarup Singh,SpB Dr.Kusuma 3,565,900
SEMESTA) Unspecified Harimin, SpAn

22 RI12008850 0000604125 ROMIANA BINTI SOLEH 12-06-1940 71 P Desa Jati Kec.Pendopo Kab. Empat Lawang JAMSOSKES(SUMSEL 203 III C53.9 Malignant Neoplasm Of Nefrostomy Dr.Didit Pramudhito, Dr.Kusuma 2,528,000
Keb.Empat Lawang SEMESTA) Cervix Uteri, Unspecified SPO Harimin, SpAn

23 RI12012707 0000615983 ROY HIKMAH BIN SARYAN 10-08-1992 19 L Dusun 1 Kel Talang JAMSOSKES(SUMSEL 410 III K35.9 Acute Appendicitis, Appendiktomi Dr.Sarup Singh,SpB Dr.Agustina Br.H, 3,565,900
Pangeran Ulu Kec SEMESTA) Unspecified SpAn, M.Kes
Pemulutan Barat

24 RI12012189 0000614481 SAIFUL ANWAR BIN MUSOLI 06-04-1994 18 L Dusun Iii Kel.Tebing Suluh Kab. Ogan Komering JAMSOSKES(SUMSEL 406 III S09.7 Multiple Injuries Of Head Orif Dr.Iqmal Perlianta, Sp Dr.Kusuma 4,741,000
Kab.Oki Ilir SEMESTA) (Trauma Capitis) BP Harimin, SpAn

25 RI12012712 0000615998 SARIPPUDIN SUAIDI 26-06-2001 11 L Bangun Rejo Lingkungan Iv Kab. Banyuasin JAMSOSKES(SUMSEL 410 III N36.8 Other Specified Disorders Of Sistostomi Dr. Martha Hendry,SpU Dr.Kusuma 3,042,000
SEMESTA) Urethra Harimin, SpAn

26 RI12012371 0000600835 SODIQ AKBAR BIN 30-12-2007 4 L Tl Andong JAMKESMAS PUSAT 405 III D21.9 Benign Neoplasm Of Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Kusuma 2,522,000
ZULKARNAIN Connective And Other Soft (K) Onk Harimin, SpAn
Tissue, Unspecified

27 RI12011967 0000613779 SUHARDI 45 L Lebong Siarang Kemuning ASKES 404 IB T30 Burn & Corrosion, Body Debridement Dr.Iqmal Perlianta, Sp Dr.Kusuma 3,603,500
Region Unspecified BP Harimin, SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

28 RI12011797 0000613230 SULHANI BIN HAMASIN 06-08-1971 40 L Dusun Ii Desa/Kel.Gunung Kab. Muara Enim JAMSOSKES(SUMSEL 409 III Z47.0 Folow-Up Care Involving Orif Dr.Iqmal Perlianta, Sp Dr.Kusuma 4,741,000
Megang Kec.Gunung SEMESTA) Removal Of Fracture Plate & BP Harimin, SpAn
Megamg Kab. M.Enim Other Internal Fixation
Device
29 RI12012696 0000615964 SURYATI 10-08-1977 34 P Dusun Ii Kel Suka Merindu JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Rizani A.SpOG- Dr.Kusuma 6,223,750
Kec Pemulutan Barat Kab Oi Caesarean Section KFER Harimin, SpAn

30 RI12010925 0000610533 YANUARI HAMID 20-07-1959 52 P Lr Amal No 27 Kota Palembang JAMSOSKES(SUMSEL 203 III R18 Ascites Laparatomi Dr.Agustria Z,SpOG- Dr.Kusuma 4,499,000
SEMESTA) KFM Harimin, SpAn

31 RI12011932 0000613647 YUZUNI BIN M. ASO 11-09-1957 54 L Dsn Iii Ulak Bedil Indralaya Kab. Ogan Ilir JAMSOSKES(SUMSEL 406 III H18.0 Corneal Pigmentations And Repair Soket Dr.Linda Trisna, SpM 3,184,000
Ogan Ilir SEMESTA) Deposits

Sub T o t a l Rp.: 119,436,050


JLH TINDAKAN KAMAR OPERASI IBS : 31
Tgl Operasi : 01-06-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12014578 0000621731 ALI MUHTAR BIN 60 L Desa Prabu Menang UMUM 403 II B R33 Retention Of Urine Sache / Litotripsi Dr.Didit Pramudhito, Dr. Yusni Puspita, 5,738,500
DULHADAT Kec.Lubai Kab.Muaraenim SPO SpAn

2 RI12013137 0000614590 AR PARDOSI 02-05-1946 66 L Lr Asrama Ling Iv Tl Ubi JAMSOSKES(SUMSEL 404 III S72.9 Fracture Of Femur, Part Nos Open Reduksi Fraktur / Dislokasi Dr.H.Muzakkie, SpBO Dr. Yusni Puspita, 6,885,000
SEMESTA) Lama FICS SpAn

3 RI12015801 0000625316 DINA OKTAVIANI 27 P Jl Sri Jaya No 986 Komplek Kota Palembang ASKES 106 UT B N97.1 Female Infertility Of Tubal Laparascopy Operatif Dr. Patiyus Dr.Zulkipli, SpAn 9,244,000
Permata Punti Kayu Blok D Origin Agustiansyah, SpOG
8 Plg( Tp Kk/Ktp )

4 RI12015827 0000625361 DWI SAPUTRA 06-07-1994 17 L Muba Keluang Cipta Praja Kab. Musi Banyuasin UMUM 401 IA S42.0 Fracture Of Clavicle Orif Dr.H.Muzakkie, SpBO Dr. Yusni Puspita, 6,765,500
Banyuasin FICS SpAn

5 RI12016015 0000626090 ERLAN AFRIADI 38 L Jl Arjuna No 10 Kel Labuh UMUM 601 UT A K63.1 Perforation Of Intestine Reseksi Usus Anastomosis Dr.Sarup Singh,SpB Dr. Yusni Puspita, 12,075,050
Baru Timur Kec Payung (Nontraumatic) SpAn
Sekaki Pekan Baru Riau

6 RI12013696 0000619145 FARINA BUSTON 08-11-1959 52 P Jl Baung Raya Perum Pusri Kota Palembang JAMSOSKES(SUMSEL 405 III D24 Benign Neoplasm Of Breast Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB 2,276,000
Sako SEMESTA) (K) Onk

7 RI12014977 0000607839 FELIP SUSANTO 14-09-1990 21 L Jl. Ogan Gg. Mandiri No. Kota Palembang JAMSOSKES(SUMSEL 404 III N61 Inflammatory Disorders Of Sub Cutaneus Mastectomi Dr.Benny Kusuma, SpB Dr. Yusni Puspita, 4,145,000
2868 Bukit Lama Plg SEMESTA) Breast [Abscess Of (K) Onk SpAn
Areola,Breast] [Carbuncle Of
Breast] [ Mastitis (Acute,
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-06-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

Subacute,Nonpuerperal)

8 RI12016004 0000626066 GATOT BAKAR 02-09-1933 78 L Jl. Meriam Lr. Karya Ii Kota Palembang JAMKESMAS PUSAT 601 II K56.6 Other & Unspecified Laparatomi Dr.Efman E.U.M, Dr. Yusni Puspita, 7,740,850
Intestinal Obstruction M.Kes,SpB-KBD SpAn

9 RI12015919 0000504784 HJ DARSIAH 22-05-1960 52 L Llb Linggau Kota Lubuk Linggau UMUM 104 UT D K60.3 Anal Fistula Fistulektomi / High Anal Dr.Sarup Singh,SpB Dr. Yusni Puspita, 6,011,500
SpAn

10 RI12015892 0000621515 HUSNIYATI 04-04-1964 48 P Desa Tj Wulan. Rambang ASKES 401 IB D36.7 Benign Neoplasm Of Other Laparatomi Dr.Efman E.U.M, Dr. Yusni Puspita, 5,954,500
Kuang. Oi Specified Sites (Nose Nos) M.Kes,SpB-KBD SpAn

11 RI12016047 0000626218 JUMIAH ALI MUKMIN 26-10-1979 32 P Jl.Harapan Jaya I Lr.Puli JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr. Yusni Puspita, 6,223,750
No.061 Kel.Sei Selayur Caesarean Section SpOG SpAn
Kec.Kalidoni

12 RI12015617 0000613904 M.GUNTUR BIN IBRAHIM 27-06-1960 51 L Jl Lubuk Linggau No 59 Kota Lubuk Linggau ASKES 402 IA N20.0 Calculus Of Kidney URS Dr.Didit Pramudhito, Dr. Yusni Puspita, 9,307,500
(Nephrolithiasis Nos)(Renal SPO SpAn
Calculus Or
Stone)(Staghorn
Calculus)(Stone In Kidney)
13 RI12015956 0000285207 M.ZACKY AQILA 04-10-2008 3 L Pemiri Kom Pkenten Hill UMUM 401 IB H50.9 Strabimus, Unspecified Koreksi Strabismus Dr.Linda Trisna, SpM 8,417,000
Blok G 14

14 RI12015649 0000619816 MARZUAN 25-05-1956 56 L Gelumbang Muara Enim Kab. Muara Enim UMUM 403 II B C18.7 Malignant Neoplasm Of Low Ant.Resection / Pullthrough Dr.Sarup Singh,SpB Dr. Yusni Puspita, 9,206,500
Sigmoid Colon SpAn

15 RI12015929 0000623322 METALIANA NUFIS 21-03-1992 20 P Rss Sembawa Indah Nodi Kab. Banyuasin ASKES 408 II B J03.9 Acute Tonsillitis, Unspecified Tonsilektomi Dr.Denny SU,SpTHT- Dr. Yusni Puspita, 3,125,000
(Follicular) (Gangrenous) KL,MSiMed SpAn
(Infective) (Ulcerative)

16 RI12016079 0000626275 PAINI BADRI 36 P Jl.Sukomoro Kel.Air Batu Kab. Banyuasin UMUM 410 III Z09.0 Follow-Up Examination Debridement Dr.H.Muzakkie, SpBO Dr. Yusni Puspita, 3,546,400
Kec.Talang Kelapa After Surgery For Other FICS SpAn
Kab.Banyuasin Conditions

17 RI12010125 0000608284 PUTRI BULAN SUCI 13-06-2004 7 P Desa Cinta Manis Baru Kel. Kab. Banyuasin JAMSOSKES(SUMSEL 404 III T31.2 Burn Involving 20 - 29% Of STSG / Skingrafting yang Luas Dr.Iqmal Perlianta, Sp 3,997,000
Cinta Manis Baru Kec. SEMESTA) Body Surface BP
Banyuasin 1 .

18 RI12010125 0000608284 PUTRI BULAN SUCI 13-06-2004 7 P Desa Cinta Manis Baru Kel. Kab. Banyuasin JAMSOSKES(SUMSEL 404 III T31.2 Burn Involving 20 - 29% Of Penambahan alat Pisau Skin Dr.Iqmal Perlianta, Sp Dr. Yusni Puspita, 500,000
Cinta Manis Baru Kec. SEMESTA) Body Surface Dermato BP SpAn
Banyuasin 1 .
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-06-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

19 RI12016078 0000626299 RIA NOPITASARI 06-01-1987 25 P Komp.Pangeran Permai Kota Palembang JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Nuswil Bernollan, Dr. Yusni Puspita, 2,321,000
Blok A No.7 Incomplete,With Other And SpOG SpAn
Unspecified Complications

20 RI12015910 0000625577 ROMAIDA . S. 12-06-1960 52 P Pt Tel Meranti Merah F 4 Kab. Muara Enim Tanjung Enim Lestari (PT. 102 UT B D21.9 Benign Neoplasm Of Eksisi multiple FAM Dr.K.Yamin Alsoph Dr. Yusni Puspita, 4,375,000
HERMES.SIBUEA No 10 TEL) Connective And Other Soft SpBOnk SpAn
Tissue, Unspecified

21 RI12015767 0000624691 RUDI HARTONO 10-08-1994 17 L Keluang Musi Banyuasin Kab. Musi Banyuasin UMUM 403 II B S72.9 Fracture Of Femur, Part Nos Osteotomy jari, deformities Dr.H.Muzakkie, SpBO Dr. Yusni Puspita, 4,375,000
Cipta Praja FICS SpAn

22 RI12016013 0000626080 SARMAN BIN KAMTARIP 32 L Jl Kertapati Lr Remipa Kota Palembang JAMSOSKES(SUMSEL 410 III T14.1 Open Wound (Luka Tusuk, Repair Tendo Penyulit/Arteri Dr.H.Muzakkie, SpBO Dr.Fredi Heru 8,689,200
SEMESTA) Lecet, Potong, Gigit Carotis/Arteri renalis stenosis FICS Irwanto, Sp.An
Binatang)

23 RI12017298 0000629656 SATRYANGGA BIN 23 L Jl.Kasnariansyah No.1392 Kota Palembang ASKES 601 UT D S27.9 Injury Of Unspecified Biopsi Insisi Dr.Bermansyah, SpB 5,562,000
SARWOKO Km.4.5 Intrathoracic Organs

24 RI12015879 0000240491 SUJADI BIN MUHADI SUKRI 15-08-1963 49 L Jl. Mandala No.A15 Tanjun Kab. Muara Enim PT. Batubara Bukit Asam 103 UT C K40.9 Unilateral Or Unspecified Hernioraphy dgn prolenemesh / Dr.Sarup Singh,SpB Dr. Yusni Puspita, 6,026,500
Enim Tanjung Enim Inguinal Hernia, Without Komplikasi SpAn
Obstruction Or Gangrene

25 RI12015873 0000529140 SUMARNO HADI SOBIRIN 10-10-1955 56 L Suka Damai Plakat Tinggi MUBA SEMESTA 405 III K37 Unspecified Appendicitis Remove Tent / Lepas Tent Dr.Didit Pramudhito, Dr. Yusni Puspita, 2,592,000
Muba SPO SpAn

26 RI12015849 0000583151 SUMIATI BT BASRIN 08-12-1954 57 P Ki Azhari No. 535 Kota Palembang ASKES 402 IA D21.9 Benign Neoplasm Of Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr. Yusni Puspita, 3,397,500
Connective And Other Soft (K) Onk SpAn
Tissue, Unspecified

27 RI12015850 0000622509 TRI BUDIARTO 24-06-1997 14 L Jl E Ningsih No 1011 Kota Palembang ASKES 105 IA D21.9 Benign Neoplasm Of Ekstirpasi Tumor Dr.Yuli Doris Memy, Dr. Yusni Puspita, 4,064,000
Connective And Other Soft Sp.THT-KL SpAn
Tissue, Unspecified

28 RI12015670 0000624885 WIDODO 25-07-1958 53 L Jl Embancang No.75 Kota Palembang ASKES 403 II B S82.2 Fracture Of Shaft Of Tibia Multiple FR + Plat dr. Ismail Bastomi, Dr. Yusni Puspita, 9,622,500
SpOT SpAn

29 RI12016027 0000626113 YULIA AMIR HAMZAH 30 L Jl.Talang Kerangga Kota Palembang JAMKESMAS PUSAT 203 III O83.1 Breech Delivery Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG Dr. Yusni Puspita, 6,223,750
Lr.Pribadi No.620/15 SpAn

30 RI12016039 0000626141 YUSMIATI CIPTO 25 P Desa Sungai Lilin Kamp.Iii Kab. Musi Banyuasin UMUM 201 IB O06.3 Unsp.Abortion Kuretase Dr.Iskandar Z, SpOG Dr. Yusni Puspita, 3,196,500
Kec.Sungai Lilin Kab.Musi Incomplete,With Other And SpAn
Banyuasin Unspecified Complications
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-06-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

31 RI12015882 0000625465 ZURLITA SUPARMAN 03-09-1966 45 L Bukit Sejatra Ef 06/07 Kota Palembang PT Pos (Persero) Divrepos 102 UT A N93.9 Abnormal Uterine And Laparascopy Operatif - Dr.Rizal Sanif, SpOG- Dr.Zulkipli, SpAn 3,125,000
III Palembang Vaginal Bleeding, Histeroskopi Konk
Unspecified

Sub T o t a l Rp.: 174,729,000


JLH TINDAKAN KAMAR OPERASI IBS : 31
Tgl Operasi : 01-07-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12019307 0000635344 ENDANG MUGIARSIH 10-02-1973 39 P Jl.Ariodillah Iii No.2474 Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Agustria Z,SpOG- SMF ANESTESI 6,223,750
Caesarean Section KFM

2 RI12019220 0000635401 HARLINA RUSTAM.E 24-05-1982 30 P Ds Ii Desa Tanjung Pinang I Kab. Ogan Ilir JAMKESMAS PUSAT 203 III Sectio Cesarea tanpa penyulit Dr. Patiyus SMF ANESTESI 6,223,750
Tanjung Batu Ogan Ilir Agustiansyah, SpOG

3 RI12019187 0000635335 KARTINA BT IAN 28 P Dusun Iii Kel.Pancawarna Kab. Ogan Komering JAMKESMAS PUSAT 203 III Sectio Cesarea tanpa penyulit Dr.Agustria Z,SpOG- SMF ANESTESI 6,223,750
Kec.Pedamaran Timur Ilir KFM
Kab.Oki

4 RI12019192 0000635340 SEDI AMRI BIN SUHAIMI 06-08-1989 22 L Dusun Ii Kel.Ibul Besar Ii JAMKESMAS PUSAT 406 III S72.9 Fracture Of Femur, Part Nos Debridement dr. Ismail Bastomi, SMF ANESTESI 3,546,400
Kec.Pemulutan Kab.Oi SpOT

5 RI12019186 0000635331 SRI WAHYUNI 04-01-1983 29 P Dusun Iv Kel.Meranti Kab. Banyuasin JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Agustria Z,SpOG- SMF ANESTESI 2,321,000
Kec.Betung Kab.Banyuasin Incomplete,With Other And KFM
Unspecified Complications

6 RI12019517 0000635369 SUMAYA BIN JANI 31 P Jl Syakyakirti Kel Karang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Patiyus 6,223,750
Anyar Kec Gandus Caesarean Section Agustiansyah, SpOG

7 RI12018341 0000632838 ZARKONI BIN CIK OLAH 22 L Jl Wedana Pangku Kec Kab. Ogan Komering JAMSOSKES(SUMSEL 601 III S09.7 Multiple Injuries Of Head Tracheostomi Dr.Trijoso 4,661,800
Muara Kuang Oku Selatan Ulu Selatan SEMESTA) (Trauma Capitis) Permono,SpBS

Sub T o t a l Rp.: 35,424,200


JLH TINDAKAN KAMAR OPERASI IBS : 7
Tgl Operasi : 01-07-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12019206 0000635383 ABDUL MULTOLIP 19 L Jl May Zen Kemayoran Kel JAMKESMAS PUSAT 701 III S39.9 Unspecified Injury Of Laparatomi Dr.Sarup Singh,SpB SMF ANESTESI 7,740,850
Sungai Selayur Kec Kalidoni Abdomen, Lower Back &
(T Kk/T Ktp) Pelvis
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-07-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

2 RI12019194 0000635347 AGAM PATRIANSYAH 17 L Jl.Hulu Balang Kota Palembang JAMKESMAS PUSAT 701 II A T14.7 Crusshing Injury & Debridement dr. Ismail Bastomi, SMF ANESTESI 4,684,550
Traumatic Amputation SpOT
Unspecified Body Region

3 RI12019196 0000635367 MR.X (FERRY) 35 L Oki Palembang (T Kk/T Ktp) Kota Palembang JAMKESMAS PUSAT 700 III S09.7 Multiple Injuries Of Head Jahit Plastik Wajah > 10 cm Dr.Iqmal Perlianta, Sp SMF ANESTESI 8,255,650
(Trauma Capitis) BP

Sub T o t a l Rp.: 20,681,050


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 3
Tgl Operasi : 01-08-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12018464 0000633122 AMIR BIN MUROD 50 L Sp Padang Kab Kayu Agung Kab. Ogan Komering JAMKESMAS PUSAT 410 III D13.4 Benign Neoplasm Of Liver Laparatomi Dr.Sarup Singh,SpB SMF ANESTESI 3,930,000
Ilir (Intrahepatic Bile Duct)

2 RI12022350 0000644913 ANDREAS STEVEN 11-03-2006 6 L Base Camp Riam Indah Kota Lubuk Linggau PP London Sumatra Tbk 103 UT C D21.0 Benign Neoplasm Of Biopsi Incisional dalam narkose Dr.Benny Kusuma, SpB Dr.Kusuma 3,125,000
Estate Lubuk Linggau (LONSUM) Connective And Other Soft (K) Onk Harimin, SpAn
Tissue Of Head, Face And
Neck
3 RI12022283 0000645185 ARMELIA LEVANA 15-05-1996 16 P Jl Batu Karang Blik J 9 No Ii Kota Palembang ASKES 106 UT B S82.2 Fracture Of Shaft Of Tibia Orif Dr.H.Muzakkie, SpBO Dr.Kusuma 6,765,500
Palembang FICS Harimin, SpAn

4 RI12021237 0000641855 ASMAH BT PITURUNG 41 P Desa Sugih Waras Kab. Ogan Komering UMUM 102 UT B D24 Benign Neoplasm Of Breast Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB Dr.Kusuma 3,394,500
ASING Kec.Cempaka Kab.Oku Ulu Timur (K) Onk Harimin, SpAn
Timur

5 RI12022247 0000614360 BIMA SANDI P BIN A. 16-05-2005 7 L Desa Purwodadi Jalur 20 Kab. Musi Banyuasin JAMSOSKES(SUMSEL 302 III Q25.0 Patent Ductus Arteriosus Ligasi PDA Dr.Bermansyah, SpB 37,355,000
RAHMAN SEMESTA)

6 RI12022247 0000614360 BIMA SANDI P BIN A. 16-05-2005 7 L Desa Purwodadi Jalur 20 Kab. Musi Banyuasin JAMSOSKES(SUMSEL 302 III Q25.0 Patent Ductus Arteriosus Penambahan Jasa Dokter Dr.Bermansyah, SpB SMF ANESTESI 3,104,000
RAHMAN SEMESTA)

7 RI12021676 0000643168 BOY YATI 06-08-1962 50 P Jl Angkatan 66 Lr Jambu No Kota Palembang UMUM 401 IB D13.1 Benign Neoplasm Of Laparatomy Explorasi Dr.Sarup Singh,SpB Dr.Kusuma 9,355,500
437 Stomach Harimin, SpAn

8 RI12022525 0000645557 DARPIN BIN KARIMUN 58 L Jl Belanti Lr Kelapa Muda Kab. Ogan Komering UMUM 403 II B K40.9 Unilateral Or Unspecified Hernioraphy dgn prolenemesh / Dr.Sarup Singh,SpB Dr. Yusni Puspita, 7,834,450
Kec Oi Ilir Inguinal Hernia, Without Komplikasi SpAn
Obstruction Or Gangrene

9 RI12019934 0000637384 DIANA BT PRAJO MIGO 05-06-1983 29 P Jl Mayor Ruslan Rt 31 Rw Kota Palembang JAMKESMAS PUSAT 203 III O00.0 Abdominal Pregnancy Laparatomi Dr. Irawan SMF ANESTESI 4,499,000
08 Kel Duku Sastradinata, SpOG
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-08-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

10 RI12022336 0000645279 H.BAKAR 19-08-1936 76 L Pagar Alam Bangun Rejo Kota Pagar Alam UMUM 102 UT A K40.9 Unilateral Or Unspecified Hernioraphy dgn prolenemesh / Dr.Sarup Singh,SpB Dr.Kusuma 6,026,500
Inguinal Hernia, Without Komplikasi Harimin, SpAn
Obstruction Or Gangrene

11 RI12022358 0000641674 HERMIANAH BT YAHIMA 13-04-1958 54 P Jl Sersan Kko Badarudin Kota Palembang ASKES 104 UT D H26.9 Catarac, Unspecified Katarak (ICCE / ECCE) Dr.Fidalia, SpM 4,612,500
No.1288 Sei Buah

12 RI12021877 0000643870 M. FAJRI BIN HM. HAFIS 30-10-2004 7 L Jl. Sungai Tawar Kota Palembang JAMSOSKES(SUMSEL 406 III Z47.0 Folow-Up Care Involving Open Reduksi Fraktur / Dislokasi Dr.Kgs Zulkarnain SMF ANESTESI 6,885,000
SEMESTA) Removal Of Fracture Plate & Lama Muslim,Sp.OT
Other Internal Fixation
Device
13 RI12022468 0000645605 M. RAFI BIN NURDIN 28-02-1944 73 L Jl. Ujung Landasan Kebun Kota Palembang JAMSOSKES(SUMSEL 409 III S92.5 Fracture Of Other Toe Orif Dr.Kgs Zulkarnain SMF ANESTESI 6,163,300
Bunga Sukarami Plg SEMESTA) Muslim,Sp.OT

14 RI12021407 0000032761 M. SOLEH 47 L Jl. Inspektur Selamat Kab. Muara Enim ASKES 402 IB C67.9 Malignant Neoplasm Of TUR Buli Buli Dr.Didit Pramudhito, Dr.Kusuma 9,375,500
Lr.Tungkal Ulu No.258 Bladder, Unspecified SPO Harimin, SpAn

15 RI12022471 0000645800 M. ZAKKY BIN M. TASLIM 15 L Komp Griya Cipta Pratama Kota Palembang UMUM 403 II B T14.1 Open Wound (Luka Tusuk, Repair Tendo Penyulit/Arteri Dr.Kgs Zulkarnain Dr.Zulkipli, SpAn 12,613,250
Jl. Anggur Ii Blok-08 Lecet, Potong, Gigit Carotis/Arteri renalis stenosis Muslim,Sp.OT
Binatang)

16 RI12022204 0000632028 M.RIZAL 27-06-1984 28 L Desa Kp Laut Kec Kuala ASKES 409 III L91.0 Keloid Scar Eksisi Tumor Jar Lunak Kecil Dr.Iqmal Perlianta, Sp SMF ANESTESI 2,522,000
Jambi Kab Tj Jabung BP
Timur Jambi

17 RI12022519 0000645551 MALIK BIN BATIN 30 L Desa Kijang Kec Sp Padang Kab. Ogan Komering JAMKESMAS PUSAT 601 III S09.7 Multiple Injuries Of Head Craniotomi Dr.Trijoso SMF ANESTESI 12,805,650
Kab Oki ( T Kk /T Ktp) Ilir (Trauma Capitis) Permono,SpBS

18 RI12022202 0000640278 MASAYU MAR YAM 28-07-1966 46 P Jl Kebon Jahe 18 Ilir No 541 Kota Palembang ASKES 106 UT B K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.Efman E.U.M, Dr.Fredi Heru 16,875,000
M.Kes,SpB-KBD Irwanto, Sp.An

19 RI12022368 0000645324 MUHAMMAD 02-01-2001 11 L Mayor Laut Wiratno Lr Kota Palembang UMUM 403 II B S09.7 Multiple Injuries Of Head Rekonstruktion wajah/hidung Dr.Iqmal Perlianta, Sp Dr.Kusuma 10,502,000
ANDREANSYAH Albaroka No (Trauma Capitis) BP Harimin, SpAn

20 RI12020403 0000630112 NAPSIAH BT SERBI 07-05-1950 62 P Dsn Iii Tj Raja Selatan JAMKESMAS PUSAT 406 III C50.9 Malignant Neoplasm Of Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB SMF ANESTESI 2,519,000
Breast, Unspecified (K) Onk

21 RI12022351 0000645459 NARAZITA BT KUKU 1 P Jl. Kh. Azhari Komplek Yuka Kota Palembang JAMSOSKES(SUMSEL 410 III T30 Burn & Corrosion, Body Debridement Dr.Iqmal Perlianta, Sp SMF ANESTESI 3,546,400
SATRIAWAN 2 No. 19 SEMESTA) Region Unspecified BP
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-08-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

22 RI12021394 0000642361 NING DOP 91 P Jl Irirgasi Lr Sehat No 3266 Kota Palembang UMUM 102 UT B K30 Dyspepsia Pengurang Jasa Dokter Dr.M.Alsen -4,860,000
Arlan,SPBO

23 RI12021394 0000642361 NING DOP 91 P Jl Irirgasi Lr Sehat No 3266 Kota Palembang UMUM 102 UT B K30 Dyspepsia Laparaskopik Kolesistektomi Dr.M.Alsen Dr.Rizal Zanial, 16,875,000
Arlan,SPBO SpAn

24 RI12022466 0000645814 NUR AZIZAH 23-03-1982 30 P Komp Sangkuriang Indah T- Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG SMF ANESTESI 6,223,750
1/3374 Caesarean Section

25 RI12022459 0000645555 ROSITA WATI 32 P Jl Tanah Merah Kota Palembang JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Azhari, SpOG SMF ANESTESI 2,321,000
Incomplete,With Other And
Unspecified Complications

26 RI12019956 0000637628 SADIR BIN RUSTAM 15-04-1940 72 L Jl Sei Itam-Putri Rambut Kota Palembang JAMSOSKES(SUMSEL 410 III C67 Malignant Neoplasm Of TUR Buli Buli Dr.Arizal Agoes, SpB SMF ANESTESI 6,357,000
Selako No 43/1658 SEMESTA) Bladder SpU

27 RI12022172 0000640136 SUARDI BIN MUKTARIDI 20-12-1973 38 L Dusun Iii Desa Ulak Kerbau Kab. Ogan Komering UMUM 103 UT C E14.4 Unspecified Diabetes Insersi Kateter Double Luman HD Dr.Zulkipli, SpAn 3,038,500
Lama Kec.Tanjung Raja Ilir Mellitus With Neurological Semi Permanen
Kab.Ogan Ilir Complications

28 RI12013236 0000580307 SUMIATI SUDARMAN 13-12-1966 45 P B Rahmat Lr Zuriah JAMKESMAS PUSAT 407 III Q83.8 Other Congenital Mastektomi Radikal Dr.Benny Kusuma, SpB SMF ANESTESI 6,342,000
Malformations Of Breast (K) Onk

29 RI12012195 0000614499 SUWANDI BIN HASIM 01-07-1987 25 L Kel.Sido Mulyo Sungai Kab. Ogan Komering JAMSOSKES(SUMSEL 409 III S72.9 Fracture Of Femur, Part Nos Debridement Dr.Iqmal Perlianta, Sp SMF ANESTESI 2,728,000
Menang Oki Ilir SEMESTA) BP

30 RI12022354 0000645489 WULANDARI BT SOPHIAN 33 P Jl. Soak Palembang Kota Palembang ASKES 201 IA N94.8 Other Specified Sectio Cesarea tanpa penyulit Dr.Kms.Yusuf E.SpOG Dr.Kusuma 6,677,000
BAMIN (AL (Tkk/Tktp/T.Keluarga) Harimin, SpAn

31 RI12022511 0000645858 YENI HENDRAYANI BT 03-01-1987 25 P Jl. Hikmah Sukorejo Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr. Yusni Puspita, 6,223,750
PUNGUT Caesarean Section SpOG SpAn

32 RI12022544 0000645530 ZARO'I BIN JOHAN 70 L Desa Tanjung Agas Kec Kab. Ogan Komering JAMSOSKES(SUMSEL 409 III K65 Peritonitis Laparatomi Dr.Sarup Singh,SpB SMF ANESTESI 3,930,000
Tanjung Raja Kab Oki Ilir SEMESTA)

Sub T o t a l Rp.: 229,665,050


JLH TINDAKAN KAMAR OPERASI IBS : 32
Tgl Operasi : 01-08-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-08-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12022462 0000645732 SYAILA FEBRIYANI 1 P Jl. Muajirin No 4 Kota Palembang JAMSOSKES(SUMSEL 703 III K56.6 Other & Unspecified Colostomi / lleostomi Dr.Sindu SMF ANESTESI 7,703,150
SEMESTA) Intestinal Obstruction Saksono,SpBA

Sub T o t a l Rp.: 7,703,150


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 1
Tgl Operasi : 01-09-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12025061 0000652833 CIK NAYAH BT TULIYAN 45 P Lingkungan Iii Kec Tanjung Kab. Ogan Komering JAMSOSKES(SUMSEL 409 III K56.6 Other & Unspecified Penambahan Jasa Dokter Dr.Sarup Singh,SpB SMF ANESTESI 1,196,000
Raja Ilir SEMESTA) Intestinal Obstruction

2 RI12025061 0000652833 CIK NAYAH BT TULIYAN 45 P Lingkungan Iii Kec Tanjung Kab. Ogan Komering JAMSOSKES(SUMSEL 409 III K56.6 Other & Unspecified Laparatomi Dr.Sarup Singh,SpB 5,109,000
Raja Ilir SEMESTA) Intestinal Obstruction

3 RI12025332 0000653717 DARKIM BIN RUKIMAN 55 L Desa Daya Kesuma Kab. Banyuasin UMUM 403 II B N36.8 Other Specified Disorders Of Sistostomi Dr.Didit Pramudhito, Dr.Rizal Zanial, 4,180,150
Kec.Muara Sugihan Urethra SPO SpAn
Kab.Banyuasin

4 RI12025353 0000653506 DEDI MALKISWA 22-07-2011 1 L Desa Mangsang Komp Kab. Musi Banyuasin PT. Pinang Witmas Sejati 404 III T30.2 Burn Of Second Degree Debridement Dr.Iqmal Perlianta, Sp SMF ANESTESI 3,546,400
Perum Pws Kec Bayung Body Region, Unspecified BP
Kab Muba (T.Kk/Ktp)

5 RI12024877 0000652153 DERI BIN DIMAN 01-03-1996 16 L Ds Muara Megang Kec Kota Lubuk Linggau UMUM 403 II B S37.0 Injury Of Kidney Sistoscopi Dr. Martha Hendry,SpU Dr.Rizal Zanial, 4,375,000
Megang Sakti Lubuk SpAn
Linggau

6 RI12025274 0000653484 DESI BT HOLIDI 12-06-1996 15 P Desa Lingkis Kel.Lingkis Kab. Ogan Komering JAMSOSKES(SUMSEL 405 III K35 Acute Appendicitis Appendiktomi Dr.Efman E.U.M, SMF ANESTESI 3,565,900
Kec.Jejawi Kab.Oki Ilir SEMESTA) M.Kes,SpB-KBD

7 RI12025340 0000653735 ERNAWATI BT M.SAID ALI 04-06-1974 38 P Jl.Ra Abusamah Kom.Bi Kota Palembang JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Iskandar Z, SpOG SMF ANESTESI 2,321,000
Lr.Lebong Siareng Incomplete,With Other And
Unspecified Complications

8 RI12024233 0000650256 H SAHRUL BIN SOMAD 31-12-1950 63 L Dsn Ii Desa Sirah Pulau Kilip Kab. Ogan Ilir UMUM 402 IB R31 Unspecified Hematuria TUR Prostat Dr. Martha Hendry,SpU Dr.Rizal Zanial, 9,315,500
Kec Rantau Alai Oi SpAn

9 RI12024930 0000652405 LAILA BT SUDIRMAN 07-03-1992 20 P Dsn I Tebing Gerinting JAMKESMAS PUSAT 203 III O01.9 Hydatidiform Mole, Kuretase Dr. Irawan SMF ANESTESI 2,321,000
Selatan Unspecified Sastradinata, SpOG

10 RI12025154 0000653156 LATIP M 13-07-1991 21 L Jl. Kol. Wahid Udin Balai Kab. Musi Banyuasin UMUM 403 II B C41.9 Malignant Neoplasm Of Amputasi Dr.Kgs Zulkarnain Dr.Rizal Zanial, 6,765,500
Agung Sekayu Bone And Cartilage, Muslim,Sp.OT SpAn
Unspecified
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-09-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

11 RI12025285 0000653522 LISNAWATI BT SUHARDI 21-04-1986 26 P Jl Sekip Mandi Aur No 722 Kota Palembang JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, SMF ANESTESI 6,223,750
Delivery, Unspecified SpOG

12 RI12024903 0000019173 M.DAHLAN 64 L Sultan Saril.Rg Anggrek No Kota Palembang ASKES 402 IA K40 Inguinal Hernia Hernioraphy dgn prolenemesh / Dr.M.Alsen Dr.Rizal Zanial, 6,026,500
1888 Komplikasi Arlan,SPBO SpAn

13 RI12025099 0000652938 MONIKA BT MERI 2 P Jl.Pipa Rejano.801 Kota Palembang JAMSOSKES(SUMSEL 410 III T09.6 Traumatic Amputation Of Debridement Dr.Iqmal Perlianta, Sp SMF ANESTESI 3,546,400
SEMESTA) Trunk, Level Unspecified BP

14 RI12025143 0000652001 NURHAYATI BINTI 14-09-1942 70 P Jl. Palembang Jambi No. Kab. Musi Banyuasin UMUM 401 II A C07 Malignant Neoplasm Of Biopsi Kelenjar/Jar Mamae Dr.K.Yamin Alsoph Dr.Rizal Zanial, 3,394,500
MUHAROM 303 Betung Banyuasin Parotid Gland SpBOnk SpAn

15 RI12025213 0000652310 PUJI WAHYUNI 06-10-1974 37 P Jl. Mayor Abdul Barie Lr. Kota Palembang UMUM 201 IA N80.9 Endometriosis, Unspecified Laparascopy Operatif Dr.Abadi, SpOG Dr.Rizal Zanial, 9,244,000
Inggil SpAn

16 RI12025279 0000653516 RELLAH BANESKA 20-10-1988 23 P Sekip Lr.Lomba Jaya No Kota Palembang JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, SMF ANESTESI 6,223,750
650 Delivery, Unspecified SpOG

17 RI12025312 0000165375 TITIN SHIRLIANI 10-02-1992 20 P Mega Asri Ii Blok H No 7 Kab. Musi Banyuasin UMUM 401 IB K37 Unspecified Appendicitis Appendiktomi Dr.Sarup Singh,SpB Dr.Rizal Zanial, 4,704,050
SpAn

18 RI12025137 0000442293 TRINA KHAIRITA 24-08-1966 46 P R Soekamto No 321 Kota Palembang PT.ASURANSI JIWA 201 IA N93.9 Abnormal Uterine And Laparascopy Operatif - Dr.Rizal Sanif, SpOG- Dr.Rizal Zanial, 3,125,000
INHEALTH INDONESIA Vaginal Bleeding, Histeroskopi Konk SpAn
Unspecified

19 RI12025254 0000653471 USMAN BIN H.HIDIN 73 L Jl.Angkatan 66 Lr.Jambu Kota Palembang UMUM 104 UT D S02.6 Fracture Mandible Reposisi Hidung Dr.Iqmal Perlianta, Sp Dr.Rizal Zanial, 5,215,600
Gagng Famili No.616 BP SpAn

20 RI12025266 0000653486 YOGA RAMADHAN 16 L Jl Selamet Riadi Lr Kidul UMUM 104 UT C T14.1 Open Wound (Luka Tusuk, Jahit Plastik Wajah > 10 cm Dr.Iqmal Perlianta, Sp Dr.Rizal Zanial, 8,255,650
Darat Kel Lawang Kidul Kec Lecet, Potong, Gigit BP SpAn
Ilir Timur Ii Binatang)

Sub T o t a l Rp.: 98,654,650


JLH TINDAKAN KAMAR OPERASI IBS : 20
Tgl Operasi : 01-09-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12025275 0000653507 ALIAN SITI ROHANA 01-07-1946 66 L Jl. Aguscik Ayin Dusun Ii Kota Palembang JAMSOSKES(SUMSEL 700 III K40 Inguinal Hernia Penambahan Jasa Dokter Dr.Efman E.U.M, SMF ANESTESI 1,673,100
Kenten Laut SEMESTA) M.Kes,SpB-KBD
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-09-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

2 RI12025275 0000653507 ALIAN SITI ROHANA 01-07-1946 66 L Jl. Aguscik Ayin Dusun Ii Kota Palembang JAMSOSKES(SUMSEL 700 III K40 Inguinal Hernia Laparatomi Dr.Efman E.U.M, 7,740,850
Kenten Laut SEMESTA) M.Kes,SpB-KBD

3 RI12025258 0000653469 ASROPI BIN SOPAN 07-07-1974 38 L Lr.Prajurit Nangyu Kota Palembang JAMSOSKES(SUMSEL 700 III K35 Acute Appendicitis Appendiktomi Dr.Efman E.U.M, SMF ANESTESI 4,704,050
SEMESTA) M.Kes,SpB-KBD

4 RI12025336 0000653728 SIMON SIMANJUNTAK 70 L Bukit (Tanpa Keterangan ) JAMSOSKES(SUMSEL 700 II A S09.7 Multiple Injuries Of Head Biopsi Insisi Dr.Bermansyah, SpB 5,562,000
SEMESTA) (Trauma Capitis)

5 RI12028307 0000662588 SUHERMAN BIN CIK AMIN 16-09-1964 48 L Komplek Garuda Putra Iic Kota Palembang JAMKESMAS PUSAT 700 II A K40.9 Unilateral Or Unspecified Hernioraphy Dewasa Dr.Efman E.U.M, Dr.Zulkipli, SpAn 4,650,750
No 44 Inguinal Hernia, Without M.Kes,SpB-KBD
Obstruction Or Gangrene

6 RI12025245 0000653449 TASMIN BIN HARJO 21-12-1982 29 L Lr Kelurahan No 905 Kota Palembang JAMSOSKES(SUMSEL 703 III K35 Acute Appendicitis Appendiktomi Dr.Efman E.U.M, SMF ANESTESI 4,704,050
SEMESTA) M.Kes,SpB-KBD

Sub T o t a l Rp.: 29,034,800


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 6
Tgl Operasi : 01-10-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12025681 0000654711 ALETA KHOIRUNISWA 04-09-2012 0 P Jl.Sosial Lr.Kebun Jati Kota Palembang JAMKESMAS PUSAT 301 III VP Shunt (shuting) / Pemasangan Dr.Trijoso SMF ANESTESI 6,820,000
Pintasan Permono,SpBS

2 RI12028049 0000661999 ARI ISWANTO 14 L Jl Pati Mura Kel Mesat Jaya UMUM 102 UT B T14.2 Fracture Of Unspecified Orif Dr.H.Muzakkie, SpBO Dr.Rose Mafiana, 6,765,500
Kec Lubuk Linggaw Body Region FICS SpAn

3 RI12028083 0000662145 DRA SUHARNI 55 P Jl R Sukamto Komp ASKES 401 IA Z09.9 Follow-Up Examination Arthoplasty dr. Ismail Bastomi, Dr.Rose Mafiana, 18,125,000
Permata Griya No.B.1 After Unspecified Treatment SpOT SpAn
For Other Conditions

4 RI12028302 0000662559 EDO SAPRIYONO 21-09-2001 11 L Jl Negara No 84 Desa JAMSOSKES(SUMSEL 408 III T16 Foreign Body In Ear Penambahan Jasa Dokter Dr. Yoan Levia Magdi, SMF ANESTESI 730,000
Gunung Megang Kec SEMESTA) Sp THT
Gunung Megang Muaraenim

5 RI12028302 0000662559 EDO SAPRIYONO 21-09-2001 11 L Jl Negara No 84 Desa JAMSOSKES(SUMSEL 408 III T16 Foreign Body In Ear Bronkoskopi Dr. Yoan Levia Magdi, 3,742,000
Gunung Megang Kec SEMESTA) Sp THT
Gunung Megang Muaraenim

6 RI12028397 0000662979 EKO TRI YUNI,AMD 10-06-1974 38 L Jl Kapten Ceksyeh Lr Kota Palembang JAMKESMAS PUSAT 203 III Z34.0 Supervision Of Normal Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, 6,223,750
Sekolah No 145 Pierst Pregnancy SpOG
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-10-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

7 RI12028397 0000662979 EKO TRI YUNI,AMD 10-06-1974 38 L Jl Kapten Ceksyeh Lr Kota Palembang JAMKESMAS PUSAT 203 III Z34.0 Supervision Of Normal Penambahan Jasa Dokter Dr.Nuswil Bernollan, SMF ANESTESI 949,000
Sekolah No 145 Pierst Pregnancy SpOG

8 RI12028276 0000662528 EMI FARIDA 33 P Jl Mojopahit No 657 Kota Palembang ASKES 201 IB N80.0 Adenomyosis Laparascopy Operatif - Dr.Rizal Sanif, SpOG- Dr.Agustina Br.H, 3,125,000
(Endometriosisof Uterus) Histeroskopi Konk SpAn, M.Kes

9 RI12028273 0000596354 EVA WAHYUNI 07-03-1984 28 P Jl. Sentosa Plaju Kota Palembang UMUM 201 II A Z34.0 Supervision Of Normal Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr.Rose Mafiana, 6,677,000
Pierst Pregnancy SpAn

10 RI12028395 0000662605 HABIB FIRDAUS 0 L Kampung 2 Desa Pulau Kab. Muara Enim JAMSOSKES(SUMSEL 604 II A09 Diarrhoea & Gastroenteritis Biopsi Insisi Dr.Bermansyah, SpB 5,562,000
Panggung Enim Kec SEMESTA) Of Presumed Infectious
Tanjung Agung Origin

11 RI12026196 0000608122 HASAN BASRI BIN UNUS. E 15-01-1977 35 L Dsn Ii Desa Karang Endah Kab. Muara Enim JAMSOSKES(SUMSEL 406 III N20.0 Calculus Of Kidney Pyelolitomie Dr. Martha Hendry,SpU SMF ANESTESI 3,772,000
Gelumbang SEMESTA) (Nephrolithiasis Nos)(Renal
Calculus Or
Stone)(Staghorn
Calculus)(Stone In Kidney)
12 RI12027430 0000652870 IRAWATI 07-08-1930 82 P Muara Dua Ds Padang Lay JAMSOSKES(SUMSEL 406 III H13.8* Other Disorders Of Rekonstruksi Dr.Riani Erna, SpM 6,762,000
SEMESTA) Conjuntiva In Diseases
Classified Elsewhere

13 RI12027430 0000652870 IRAWATI 07-08-1930 82 P Muara Dua Ds Padang Lay JAMSOSKES(SUMSEL 406 III H13.8* Other Disorders Of Penambahan Jasa Dokter Dr.Ibrahim, SpM SMF ANESTESI 920,000
SEMESTA) Conjuntiva In Diseases
Classified Elsewhere

14 RI12028410 0000662966 IYA BT MERIDEN 06-08-1936 65 P Dusun Ii Desa Parit Kec Kab. Ogan Ilir JAMSOSKES(SUMSEL 406 III D36.7 Benign Neoplasm Of Other Biopsi / Insisi Dr. Devi Azri Wahyuni, SMF ANESTESI 3,538,600
Indralaya Utara Kab Oi SEMESTA) Specified Sites (Nose Nos) SpM

15 RI12028356 0000662888 MARDIANA BINTI AMIR 09-10-1981 31 L Jl Melati No 6639 Kota Palembang UMUM 201 II A N85.8 Cyst Endometrium Laparascopy Operatif - Dr.Kms.Yusuf E.SpOG Dr.Agustina Br.H, 3,125,000
HAMZA Histeroskopi SpAn, M.Kes

16 RI12027648 0000660599 MARSI IDRUS 12-10-1942 70 L Jl Lintas Sumatera Pasar Tb Kab. Lahat UMUM 402 II A I84.9 Unspecified Haemorrhoids Haemorroidektomi Stappler Dr.Efman E.U.M, Dr.Rose Mafiana, 6,016,500
Tinggi 4 Lawang No 29 Without Complications M.Kes,SpB-KBD SpAn

17 RI12028019 0000661922 MASAGUS H FADDIL 09-07-1960 52 L Jl Datuk M Akib No 43 Kota Palembang ASKES 105 IA H33.2 Serous Retinal Detachment Foto Koagulasi Laser Dr. Ramzi Amin, SpM 2,562,500

18 RI12027903 0000656112 MAT DERIS BIN AJER 01-07-1940 72 L Pahlawan Xii Petaling JAMKESMAS PUSAT 404 III K30 Dyspepsia TUR Prostat Dr.Arizal Agoes, SpB SMF ANESTESI 6,297,000
SpU
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-10-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

19 RI12028255 0000655436 MINHAR BIN MUCHTAR 19-09-1967 45 L Ds/Kel. Gunung Raya Dusun Kab. Lahat JAMSOSKES(SUMSEL 408 III D14.0 Benign Neoplasm Of Middle Cardwel Luc Dr.Puspa Zuleika, 3,698,000
Ii Kec Tanjung Sakti Kumu SEMESTA) Ear,Nasal Cavity And SpTHT,M.Kes
Kab. Lahat Accessory Sinuses

20 RI12028255 0000655436 MINHAR BIN MUCHTAR 19-09-1967 45 L Ds/Kel. Gunung Raya Dusun Kab. Lahat JAMSOSKES(SUMSEL 408 III D14.0 Benign Neoplasm Of Middle Penambahan Jasa Dokter Dr.Puspa Zuleika, SMF ANESTESI 730,000
Ii Kec Tanjung Sakti Kumu SEMESTA) Ear,Nasal Cavity And SpTHT,M.Kes
Kab. Lahat Accessory Sinuses

21 RI12022355 0000645475 MUGIYONO ANWAR C 13-04-1969 38 L Kp Warung Petai Sk Bumi JAMKESMAS PUSAT 404 III T30 Burn & Corrosion, Body STSG / Skingrafting yang Luas Dr.Iqmal Perlianta, Sp 3,997,000
Jawa Barat Region Unspecified BP

22 RI12022355 0000645475 MUGIYONO ANWAR C 13-04-1969 38 L Kp Warung Petai Sk Bumi JAMKESMAS PUSAT 404 III T30 Burn & Corrosion, Body Penambahan alat Pisau Skin Dr.Iqmal Perlianta, Sp SMF ANESTESI 500,000
Jawa Barat Region Unspecified Dermato BP

23 RI12028236 0000662470 MUHAMMAD ALIF FIKRI 0 L Jl Sarolangun Kel Kampung UMUM 408 II B T16 Foreign Body In Ear Laparatomi Dr.Sindu 7,740,850
Baru Kec Muara Tembesi Saksono,SpBA
Kab Batang Hari - Jambi

24 RI12026440 0000654440 MUKHLISIN BIN M. JALI 10-03-1964 48 L Dsn Iii Tanjung Terang Kab. Muara Enim JAMSOSKES(SUMSEL 407 III D30.3 Benign Neoplasm Of TUR Buli Buli Dr. Martha Hendry,SpU SMF ANESTESI 6,357,000
SEMESTA) Bladder

25 RI12028127 0000662227 MUSRIA BT PAIMUN 26-08-1976 36 P Jl Tegal Binangun No 262 Kota Palembang UMUM 401 II A D24 Benign Neoplasm Of Breast Mastektomi Radikal Dr.K.Yamin Alsoph Dr.Rose Mafiana, 10,625,000
SpBOnk SpAn

26 RI12025474 0000654133 NANDA AKBARI BIN 11-06-2010 2 P Lr Perguruan No 10 Kota Palembang JAMSOSKES(SUMSEL 302 III Penambahan Jasa Dokter Dr. Martha Hendry,SpU SMF ANESTESI 730,000
ENDANG. Y SEMESTA)

27 RI12025474 0000654133 NANDA AKBARI BIN 11-06-2010 2 P Lr Perguruan No 10 Kota Palembang JAMSOSKES(SUMSEL 302 III Nefrostomy Dr. Martha Hendry,SpU 2,528,000
ENDANG. Y SEMESTA)

28 RI12028084 0000637867 PADLIN BIN SUHAYA 09-04-1981 31 L Ds Muara Maung Kab. Lahat JAMSOSKES(SUMSEL 406 III N35.9 Urethral Syndrome, Uretrotomi Eksterna Dr. Martha Hendry,SpU SMF ANESTESI 3,691,000
SEMESTA) Unspecified (Pinhole
Meatus)

29 RI12028078 0000636429 PAULUS SUSINTO 15-04-1965 47 L Jl. Letda Arojak Lr. Satya Kota Palembang JAMSOSKES(SUMSEL 408 III C32 Malignant Neoplasm Of Ganti Kanul Dr.Denny SU,SpTHT- 2,317,000
Warga No. 26 Plg. SEMESTA) Larynx KL,MSiMed

30 RI12028321 0000662614 RIANA DIARTI 28-07-1982 30 P Jl Jend Sudirman Lr H. Aziz Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG SMF ANESTESI 6,223,750
No 1692-29 Caesarean Section
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-10-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

31 RI12028271 0000661201 ROHMAWATI BT MALU 20-08-1984 28 P Radial Lr Melati I No Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. RM.Aerul Cakra SMF ANESTESI 4,787,500
1144/51 Caesarean Section Hamid, SpOG

32 RI12028272 0000459040 TITIN NURHAYATI 29 P Jl Ponerogo No 4985 Kota Palembang ASKES 201 II A N85.8 Cyst Endometrium Adenolisis Dr.Abadi, SpOG Dr.Agustina Br.H, 9,194,000
SpAn, M.Kes

33 RI12028175 0000657393 YULITA SARI BT CIK JON 17-07-1988 24 P Kelurahan Sukomaro / JAMSOSKES(SUMSEL 408 III J33.9 Nasal Polyp, Unspecified Penambahan Jasa Dokter Dr.Puspa Zuleika, SMF ANESTESI 730,000
SEMESTA) SpTHT,M.Kes

34 RI12028175 0000657393 YULITA SARI BT CIK JON 17-07-1988 24 P Kelurahan Sukomaro / JAMSOSKES(SUMSEL 408 III J33.9 Nasal Polyp, Unspecified Ekstrasi Polip Nasi Dr.Puspa Zuleika, 2,487,000
SEMESTA) SpTHT,M.Kes

35 RI12027992 0000661761 ZUZNA BINTI ZAILI 19-06-1956 56 P Jl. Lettu Zulkifli No.46 Luar Kota ASKES 105 IA Arthoplasty Dr.H.Muzakkie, SpBO Dr.Rose Mafiana, 18,125,000
Bengkulu FICS SpAn

Sub T o t a l Rp.: 176,173,950


JLH TINDAKAN KAMAR OPERASI IBS : 35
Tgl Operasi : 01-10-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12028376 0000662937 AL KEMI BIN SAKARUDIN 30 L Dsn I Spantan Jaya Kec Kab. Muara Enim JAMSOSKES(SUMSEL 703 III S09.7 Multiple Injuries Of Head Biopsi Insisi Dr.Bermansyah, SpB 5,562,000
Penukal Muara Enim SEMESTA) (Trauma Capitis)

2 RI12028329 0000662596 MUHAMMAD NOPRIANSYAH 18 L Jl Kh Azhari No 361 Kota Palembang JAMKESMAS PUSAT 701 II S39.9 Unspecified Injury Of Laparatomi Dr.Efman E.U.M, SMF ANESTESI 7,740,850
Abdomen, Lower Back & M.Kes,SpB-KBD
Pelvis

Sub T o t a l Rp.: 13,302,850


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 2
Tgl Operasi : 01-11-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12028803 0000620499 ABDILLAH SAID R 14-08-2011 0 L Kap Abdulah Gg.Saleh Kota Palembang JAMSOSKES(SUMSEL 302 III D13.1 Benign Neoplasm Of Laparatomy Explorasi Dr.Sindu SMF ANESTESI 6,337,000
No.41 Plaju SEMESTA) Stomach Saksono,SpBA

2 RI12030014 0000663852 ABU BAKAR BIN ABU SARIM 23-04-1952 60 L May Zen Lr Kedua Kota Palembang JAMKESMAS PUSAT 407 III N40 Hyperplasia Of Prostate TUR Prostat Dr. Martha Hendry,SpU SMF ANESTESI 6,297,000
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-11-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

3 RI12031233 0000671102 AHMAD LUTHFI HUWAIDA 19-10-2012 0 L Jl Pemuda Kel Rengas ASKES 603 II Z09.9 Follow-Up Examination Operasi Hartman Dr.Sindu Dr.Zulkipli, SpAn 9,275,500
Condong Kab Muara Bulian After Unspecified Treatment Saksono,SpBA
Kab Batang Hari For Other Conditions

4 RI12028197 0000661410 BADILAH RATNA ANJANI 12-05-2012 0 P Jl. Tanjung Barangan Bukit Pangkal Pinang JAMSOSKES(SUMSEL 409 III Eksisi Luas Radikal / Skin Cancer + Dr.Iqmal Perlianta, Sp SMF ANESTESI 6,338,000
Baru Plg SEMESTA) Rekonstruksi BP

5 RI12031477 0000671849 EKA BT EFFENDI 26-11-1991 20 P Jl Guru Nangcik Dusun Iii Kab. Banyuasin JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Abadi, SpOG SMF ANESTESI 2,321,000
Desa Lubuk Lancang Incomplete,With Other And
Banyuasin Unspecified Complications

6 RI12031314 0000670533 EKA YULISTIANA 08-11-1973 39 P Prabumulih Kab. Muara Enim ASKES 102 UT A I62.0 Subdural Haemorrhage Kraniotomi / trenpanasi Dr.Trijoso Dr.Zulkipli, SpAn 17,500,000
(Acute) (Non Traumatic) konvensional Permono,SpBS

7 RI12031035 0000665842 ELIA NORA BINTI RASUAN 03-06-1983 29 P Desa Srikaton Buay Madang Kab. Ogan Komering JAMSOSKES(SUMSEL 405 III D24 Benign Neoplasm Of Breast Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB SMF ANESTESI 2,519,000
Timur Oku Timur Ulu Timur SEMESTA) (K) Onk

8 RI12029188 0000665043 FAIZ MUAZIB 0 L Desa Indikal Ilir Kec Umbai Kab. Lahat JAMSOSKES(SUMSEL 302 III Colostomi / lleostomi Dr.Sindu SMF ANESTESI 5,071,300
Talang Kab Lahat SEMESTA) Saksono,SpBA

9 RI12030889 0000414673 H. ZAIRIN USMAN 30-11-1953 58 L Jl.Musi Raya Barat ASKES 105 IA Hernioraphy dgn prolenemesh / Dr.M.Alsen Dr.Zulkipli, SpAn 6,026,500
Ketapang 4 No 321 Komplikasi Arlan,SPBO
Perumnas

10 RI12031398 0000671561 HAWA BT ASIM 17-07-1981 31 P Dusun Iii Kel Patra Tani Kec Kab. Muara Enim JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG 6,223,750
Muara Belida Delivery, Unspecified

11 RI12031398 0000671561 HAWA BT ASIM 17-07-1981 31 P Dusun Iii Kel Patra Tani Kec Kab. Muara Enim JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Penambahan Jasa Dokter Dr.Iskandar Z, SpOG SMF ANESTESI 949,000
Muara Belida Delivery, Unspecified

12 RI12031396 0000671555 HUSWATUN HASANAH 3 P Desa Lubuk Tuang Kec Kab. Musi Rawas JAMSOSKES(SUMSEL 406 III S05.3 Ocular Leceration Without Blefaroplasty Dr. Devi Azri Wahyuni, SMF ANESTESI 3,533,000
Muara Gelingi Kab Musi SEMESTA) Prolapse Or Loss Of SpM
Rawas Intraocular Tissue

13 RI12031377 0000217130 IDA YUSNAINI 30 P Jl Ali Gatmir Lr.Sei Bayas Kota Palembang JAMKESMAS PUSAT 203 III Z34.0 Supervision Of Normal Penambahan Jasa Dokter Dr.Awan SMF ANESTESI 949,000
No 8 Pierst Pregnancy Nurtjachyo,SpOG(=B88
)

14 RI12031377 0000217130 IDA YUSNAINI 30 P Jl Ali Gatmir Lr.Sei Bayas Kota Palembang JAMKESMAS PUSAT 203 III Z34.0 Supervision Of Normal Penambahan Jasa Dokter Dr.Agustina Br.H, SMF ANESTESI 949,000
No 8 Pierst Pregnancy SpAn, M.Kes
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-11-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

15 RI12031377 0000217130 IDA YUSNAINI 30 P Jl Ali Gatmir Lr.Sei Bayas Kota Palembang JAMKESMAS PUSAT 203 III Z34.0 Supervision Of Normal Sectio Cesarea tanpa penyulit Dr.Awan 6,223,750
No 8 Pierst Pregnancy Nurtjachyo,SpOG(=B88
)

16 RI12031299 0000028574 IRMA APRIANTI 28-04-1978 34 P Dr Hakim N0 1124 Kota Palembang ASKES 408 II B J03.9 Acute Tonsillitis, Unspecified Tonsilektomi Dr.Puspa Zuleika, Dr.Zulkipli, SpAn 3,125,000
(Follicular) (Gangrenous) SpTHT,M.Kes
(Infective) (Ulcerative)

17 RI12031183 0000670969 M. RISKY BIN JAILANI 21-10-2008 4 L Pulau Salah Nama Kab. Banyuasin JAMSOSKES(SUMSEL 406 III S05.3 Ocular Leceration Without Blefaroplasty Dr. Ramzi Amin, SpM SMF ANESTESI 3,533,000
SEMESTA) Prolapse Or Loss Of
Intraocular Tissue

18 RI12031006 0000670301 MARLINA BT UDIN 37 P Desa Suka Mulyo Kec Kab. Banyuasin JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Tubektomi Dr.Awan SMF ANESTESI 2,357,000
Betung Kab Banyuasin Delivery, Unspecified Nurtjachyo,SpOG(=B88
)

19 RI12031270 0000648210 MERI BINTI AHMAD TOHA 14-06-1977 35 P Jl. Merdeka No. 40 Kab. Musi Banyuasin ASKES 102 UT B O80 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Rizal Sanif, SpOG- Dr.Zulkipli, SpAn 6,677,000
Pangkalan Balai Delivery Konk

20 RI12031359 0000671511 MERRI BT SUBAGIO 28-02-1985 27 P Jl Ki Gede Ing Suro Lr Pmd Kota Palembang JAMKESMAS PUSAT 203 III Z34.0 Supervision Of Normal Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, SMF ANESTESI 6,223,750
No 100/300 Pierst Pregnancy SpOG

21 RI12031364 0000671510 MUHAMMAD FAUZI 32 L Desa Prambatan Kec Abab Kab. Muara Enim PT. SWARNADWIPA 403 II B R33 Retention Of Urine Vescolithotomi Dr. Martha Hendry,SpU Dr.Fredi Heru 7,443,150
Kab Muaraenim DERMAGA JAYA Irwanto, Sp.An

22 RI12030078 0000667877 MUHAMMAD YAHYA 09-12-1991 21 L Jl Ratu Sianum No 31 Kota Palembang JAMSOSKES(SUMSEL 404 III S02.6 Fracture Mandible Orif Mandibula Dr.Iqmal Perlianta, Sp SMF ANESTESI 4,749,000
SEMESTA) BP

23 RI12028593 0000646408 NANANG KOSIM 12-04-1989 23 L Sukodadi Buay Madang Kab. Ogan Komering JAMSOSKES(SUMSEL 404 III D16.5 Benign Neoplasm Of Lower Penambahan Jasa Dokter Dr.Benny Kusuma, SpB SMF ANESTESI 1,068,000
Timur Oku Timur Ulu Timur SEMESTA) Jaw Bone (K) Onk

24 RI12028593 0000646408 NANANG KOSIM 12-04-1989 23 L Sukodadi Buay Madang Kab. Ogan Komering JAMSOSKES(SUMSEL 404 III D16.5 Benign Neoplasm Of Lower Mandibulektomi Dr.Benny Kusuma, SpB 6,295,000
Timur Oku Timur Ulu Timur SEMESTA) Jaw Bone (K) Onk

25 RI12031360 0000671496 NANDA MELISA 25 P Jl. Kadir Tkr Lr. Terusan No. Kota Palembang JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Awan SMF ANESTESI 6,223,750
410 Tangga Buntung Plg. Caesarean Section, Nurtjachyo,SpOG(=B88
Unspecified )

26 RI12031094 0000670753 NUJUM BIN HARIM 12-12-1949 60 L Ds/Kel. Kemang Kampung 4 Kab. Musi Banyuasin UMUM 401 IA S09.7 Multiple Injuries Of Head Craniotomi Dr.Sahat Dr.Zulkipli, SpAn 12,805,650
Kec. Sanga Desa Kab. Musi (Trauma Capitis) Edison.S,SpBS
Banyuasin
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-11-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

27 RI12031170 0000670906 NUR LELA BT SAHRUDIN 16-11-1945 67 P Jl. Hibrida Raya No.26 Luar Kota UMUM 102 UT B Laparaskopik Kolesistektomi Dr.M.Alsen Dr.Zulkipli, SpAn 16,875,000
Sidomulyo Bengkulu Arlan,SPBO

28 RI12031030 0000667004 NURI JAWATI 30-11-1987 24 P Tanjung Bulan Rambang Kab. Ogan Komering UMUM 201 UT A N83.2 Other & Unspecified Ovarian NephroUreterektomi Dr. Martha Hendry,SpU 9,375,000
Kuang Oi Ilir Cyst

29 RI12031030 0000667004 NURI JAWATI 30-11-1987 24 P Tanjung Bulan Rambang Kab. Ogan Komering UMUM 201 UT A N83.2 Other & Unspecified Ovarian Penambahan Jasa Dokter Dr. Irawan Dr.Zulkipli, SpAn 2,017,000
Kuang Oi Ilir Cyst Sastradinata, SpOG

30 RI12031444 0000671804 NURONA 10-10-1989 23 P Jl Pelita Kel Setrio Banyu JAMKESMAS PUSAT 203 III Z34.0 Supervision Of Normal Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG SMF ANESTESI 6,223,750
Asin Iii Pierst Pregnancy

31 RI12030681 0000669615 REDI YANTO BIN HOLDEN 18-08-1971 41 L Komp Maskrebet B.4 No.3 Kota Palembang JAMSOSKES(SUMSEL 409 III Amputasi Digiti Dr.Kgs Zulkarnain SMF ANESTESI 2,738,000
Kel Tlg Kelapa SEMESTA) Muslim,Sp.OT

32 RI12027181 0000656929 RINI MARTONO 27-03-1994 18 L Ds/Kel. Berlian Jaya Bayung Kab. Musi Banyuasin MUBA SEMESTA 409 III Q54.1 Hypospadias, Penile Chordectomi / Chordeksisi Dr. Martha Hendry,SpU SMF ANESTESI 2,804,000
Lincir Kec. Tungakal Jaya
Kab. Musi Banyuasin

33 RI12031268 0000665469 ROHMAH BINTI MADNI 08-10-1957 45 P Pagar Agung Tanjung Kab. Lahat UMUM 401 IA N20.0 Calculus Of Kidney Longitudinal Neprolitotomi Dr. Martha Hendry,SpU Dr.Zulkipli, SpAn 9,375,500
Agung Pagar Alam Selatan (Nephrolithiasis Nos)(Renal (KADET)
Calculus Or
Stone)(Staghorn
Calculus)(Stone In Kidney)
34 RI12031315 0000670665 SANTI BINTI MUCHTAR 05-11-1981 31 P Jl.Slamet Riadi Lr.Kemas JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Agustria Z,SpOG- SMF ANESTESI 4,787,500
Gg.Rosidi No.345a Ilir Timur Caesarean Section, KFM
Ii Unspecified

35 RI12031079 0000670049 SATAHUDDIN BIN SAHAQ 12-06-1934 78 L Ds. Mangkenang Mulak Ulu Kab. Lahat ASKES 402 IA R33 Retention Of Urine TUR Prostat Dr. Martha Hendry,SpU Dr.Zulkipli, SpAn 9,315,500
Lahat

36 RI12031277 0000654016 SETIAWATI DJAMAN NURI 03-09-1974 38 P Jl Hbr Motik Griya Asri Kota Palembang ASKES 201 IA D25.9 Leiomyoma Of Uterus, Laparascopy Operatif Dr. RM.Aerul Cakra Dr.Zulkipli, SpAn 9,244,000
Mandiri Blok S 7 Unspecified Hamid, SpOG

37 RI12029619 0000603285 SRI YANTI BAHRIN 10-10-1966 46 P Lg Tajur No 203 Kota Palembang JAMSOSKES(SUMSEL 405 III D32.9 Benign Neoplasm Of Craniotomi Dr.Trijoso SMF ANESTESI 6,832,000
SEMESTA) Meninges, Unspecified Permono,SpBS

38 RI12030579 0000089679 TAMSIA 25-06-1963 43 L Jl P. Balai U. Tanjung Kab. Musi Banyuasin ASKES 103 UT C Laparascopy Operatif - Dr.Rizal Sanif, SpOG- Dr.Zulkipli, SpAn 3,125,000
Histeroskopi Konk
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-11-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

39 RI12031335 0000671031 TRI PRATAMA 04-11-1994 18 L Hulu Balang 2 No.3549 Plg Kota Palembang UMUM 408 II B J03.9 Acute Tonsillitis, Unspecified Tonsilektomi Dr. Lisa Apri Yanti, Dr.Zulkipli, SpAn 3,125,000
(Follicular) (Gangrenous) Sp.THT-KL
(Infective) (Ulcerative)

40 RI12031395 0000671559 YUKAESIH BT SYAMSUDIN 12-04-1972 40 P Jl Sosial No 344 Kota Palembang JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr. RM.Aerul Cakra SMF ANESTESI 6,223,750
Caesarean Section, Hamid, SpOG
Unspecified

41 RI12031460 0000671826 YUSMITA BT BADRI 28 P Desa Dusun Gajah Mati JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Abadi, SpOG SMF ANESTESI 6,223,750
Caesarean Section,
Unspecified

Sub T o t a l Rp.: 239,297,850


JLH TINDAKAN KAMAR OPERASI IBS : 41
Tgl Operasi : 01-11-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12031457 0000671818 DARUL BIN M NUR 10-11-1958 54 L Dusun Iv Desa Tebing Kab. Ogan Komering JAMSOSKES(SUMSEL 703 III K40.9 Unilateral Or Unspecified Hernioraphy Dewasa Dr.Sarup Singh,SpB SMF ANESTESI 4,650,750
Gerinting Selatan Ogan Ilir Ilir SEMESTA) Inguinal Hernia, Without
Obstruction Or Gangrene

2 RI12031397 0000671554 JAMIATUN NURLAILA P 16-08-1985 27 P Jl Angkatan 66 No 563 Kota Palembang ASKES 703 II B K35 Acute Appendicitis Appendiktomi Dr.M.Alsen Dr.Zulkipli, SpAn 4,704,050
Arlan,SPBO

3 RI12031389 0000671550 MUKHLIS BIN KORIANA 16 L Desa Kijang Ulu Kec Kayu Kab. Ogan Komering JAMSOSKES(SUMSEL 700 III Debridement Dr.Nur Rachmat Lubis, SMF ANESTESI 4,684,550
Agung Kab Ogan Komering Ilir SEMESTA) SpOT
Ilir

Sub T o t a l Rp.: 14,039,350


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 3
Tgl Operasi : 01-12-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12034032 0000679389 DARSINI SUDIRMAN 21-05-1948 64 P Jl Mayor Zen Lr Abadi No 56 Kota Palembang Telkom 406 II B h35.8 Edema Retina Ablatio Retina Dr. Ramzi Amin, SpM Dr.Rizal Zanial, 5,251,000
SpAn

2 RI12034450 0000680615 DENI YUSNITA BT M. 17-07-1984 28 P Dusun 3 Desa Jirak Kec Kab. Musi Banyuasin JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG SMF ANESTESI 6,223,750
SAHIDIN Sungai Keruh Caesarean Section

3 RI12034471 0000680727 DESI ANJANI BT MGS. ENG 15-12-1988 23 P Jl Pepera Sei Baung Lr Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Hj. Fatimah Usman, SMF ANESTESI 6,223,750
Serma Ismail No 2261 Caesarean Section SpOG
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-12-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

4 RI12033576 0000677168 ELLY SOEKAISI BIN SAIPUL 19-07-1974 38 P Lubuk Linggau No 01 Kota Lubuk Linggau ASKES 106 UT B Multiple Meomectomi Dr.Agustria Z,SpOG- Dr.Rizal Zanial, 9,244,000
A KFM SpAn

5 RI12034421 0000426121 HAFSAH MARDIAN BT 14-09-1983 29 P Jl Musyawarah I No 340 Kota Palembang ASKES 201 UT A O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr.Rizal Zanial, 8,680,100
ANSORI Delivery, Unspecified SpAn

6 RI12034247 0000593415 HAMID RAHMAN BIN 22-08-1963 49 L Lr.Setia 1 JAMKESMAS PUSAT 406 III H25.0 Senile Incipient Cataract Katarak (ICCE / ECCE) Dr.Alie Solahudin, SpM 3,162,000
RAHMAN

7 RI12032696 0000675426 HELENAWATI BT A.KARIM 07-03-1952 60 P Jl R Suprapto No.151 Pagar Kab. Lahat ASKES 103 UT C C53.9 Malignant Neoplasm Of Nefrostomi Open Dr.Didit Pramudhito, Dr.Rizal Zanial, 5,729,500
SUNARI Alam Cervix Uteri, Unspecified SPO SpAn

8 RI12032858 0000675893 IMAM BIN BAHARUDIN 29-08-1996 16 L Dusun Vi Desa Talang Aur Kab. Ogan Komering JAMSOSKES(SUMSEL 601 III S37.0 Injury Of Kidney Trakheostomi / Striping Dr.Bermansyah, SpB 6,568,000
Kec Indralaya Kab Ogan Ilir Ilir SEMESTA)

9 RI12034440 0000680619 KARTINA SURYANI 02-04-1984 28 P Jl Pipa No 50 Kota Palembang JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Iskandar Z, SpOG SMF ANESTESI 3,017,300
Incomplete,With Other And
Unspecified Complications

10 RI12034383 0000680506 LIDYA AGUSTINI 27-08-1981 31 P Jl Batang Hari Iii No 2720 Kota Palembang JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG SMF ANESTESI 6,223,750
Delivery, Unspecified

11 RI12034399 0000680494 M.ROZALI BIN ZAINURI 31 L Gg Tani No 265 Kota Palembang JAMSOSKES(SUMSEL 405 III T14.1 Open Wound (Luka Tusuk, Repair Tendo Penyulit/Arteri Dr.Kgs Zulkarnain SMF ANESTESI 8,689,200
SEMESTA) Lecet, Potong, Gigit Carotis/Arteri renalis stenosis Muslim,Sp.OT
Binatang)

12 RI12034488 0000680736 MARDANI BIN HASAN 02-02-1973 39 L Jl Dr M Isa Lr Fajar No 1050 JAMSOSKES(SUMSEL 410 III S42.3 Fracture Of Shaft Of Debridement Dr.Kgs Zulkarnain SMF ANESTESI 3,546,400
Kel Kuto Batu Kec Ilir Timur SEMESTA) Humerus Muslim,Sp.OT
Ii

13 RI12034454 0000680717 MUHAMMAD REZA 24-01-1994 18 L Desa Petanan Kec Lembak Kab. Muara Enim ASKES 402 IB S09.7 Multiple Injuries Of Head Craniotomi Dr.Sahat Dr.Rizal Zanial, 12,805,650
PAHLAWAN (Trauma Capitis) Edison.S,SpBS SpAn

14 RI12033790 0000675550 MUHAMMAD SALEH 25-11-1952 60 L Jl.Laskar Samsudin Lahat Kab. Lahat ASKES 106 II K56.6 Other & Unspecified Penambahan Jasa Dokter Dr.Sarup Singh,SpB Dr.Agustina Br.H, 3,117,000
Intestinal Obstruction SpAn, M.Kes

15 RI12033790 0000675550 MUHAMMAD SALEH 25-11-1952 60 L Jl.Laskar Samsudin Lahat Kab. Lahat ASKES 106 II K56.6 Other & Unspecified Laparatomy Explorasi Dr.Sarup Singh,SpB 9,355,500
Intestinal Obstruction
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 01-12-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

16 RI12034435 0000680638 NOVI YULIANI 23-11-1994 18 P Jl May Jen Yusuf Kota Palembang JAMKESMAS PUSAT 405 III K37 Unspecified Appendicitis Appendiktomi Dr.Sarup Singh,SpB SMF ANESTESI 3,565,900
Singadekane Lr Hj Daisyah

17 RI12034414 0000680527 TIFHE SULTAN 20 L Ds/Kel. Air Pedara Kec. Kota Palembang JAMSOSKES(SUMSEL 409 III Appendiktomi Dr.M.Alsen SMF ANESTESI 3,565,900
Pangkalan Lampam Kab. SEMESTA) Arlan,SPBO
Oki

18 RI12034716 0000680746 YULIANTI BT NURDIN 30 P Jl Sungai Gerong No 17 Kota Palembang JAMKESMAS PUSAT 203 III O00.9 Ectopic Pregnancy, Laparatomi Dr. Hj. Fatimah Usman, SMF ANESTESI 5,848,700
Unspecified SpOG

19 RI12034105 0000666485 ZUN HARISTIANSYAH 10-04-1978 34 L Ds/Kel. Bumi Agung Kec. Kota Pagar Alam UMUM 408 II B H66.4 Supurative Otitis Media, Timpanoplasti / Dr.Abla Ghanie,SpTHT Dr.Rizal Zanial, 9,585,000
Dempo Utara Kab. Pagar Unspecified Timpanomastoidektomi SpAn
Alam

Sub T o t a l Rp.: 120,402,400


JLH TINDAKAN KAMAR OPERASI IBS : 19
Tgl Operasi : 02-01-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI11034311 0000575873 ABDUL AZIZ 16-08-1946 65 L Sei Hitam Lr Angkatan 66 Kota Palembang UMUM 405 II B D13.1 Benign Neoplasm Of Laparatomy Explorasi Dr.Efman E.U.M, Dr.Fredi Heru 9,355,500
No 27 Stomach M.Kes,SpB-KBD Irwanto, Sp.An

2 RI11034272 0000567985 ASMA BINTI M.YUNUS 17-02-1960 51 P Kampung I Way Halom JAMKESMAS PUSAT 405 III D13.1 Benign Neoplasm Of Laparatomy Explorasi Dr.Efman E.U.M, Dr.Fredi Heru 6,337,000
Buay Madang Stomach M.Kes,SpB-KBD Irwanto, Sp.An

3 RI11034032 0000571758 BAHNIAR HARLON 18-04-1968 43 P Ds Kandang Seberang ASKES 201 IB C53.9 Malignant Neoplasm Of Radikal Histerektomi Dr.Agustria Z,SpOG- Dr.Fredi Heru 12,500,000
Musa Cervix Uteri, Unspecified KFM Irwanto, Sp.An

4 RI11032244 0000566634 BOBBY SAPUTRA PRATAMA 25-05-2004 7 L Jl. Swadaya No. 3376 Kota Palembang JAMSOSKES(SUMSEL 407 III E04.9 Nontoxic Goitre, Unspecified Biopsi drg.Adi Prabowo Dr.Fredi Heru 2,030,000
Sukabangun Sukarami Plg SEMESTA) J,SpBM Irwanto, Sp.An

5 RI12000174 0000576905 DAHARUDIN 40 L Bertak-Banyuasin Kab. Banyuasin UMUM 403 II B S82.2 Fracture Of Shaft Of Tibia Debridement Dr.H.Muzakkie, SpBO Dr.Fredi Heru 4,684,550
FICS Irwanto, Sp.An

6 RI11034282 0000574288 FACHRI HUZAINI 30-12-1997 14 L Desa Pekalongan Kepayang Bengkulu ASKES 403 II B K09.1 Developmental CL drg.Adi Prabowo Dr.Fredi Heru 5,693,500
(Nonodontogenic) Cyst Of J,SpBM Irwanto, Sp.An
Oral Region

7 RI11034255 0000575731 HAMZAH GANDA YUDHA 0 L Jl Parluhutan Lubis No.31 ASKES 301 III K31.5 Obstruction Of Duodenum Laparatomy Explorasi Dr.Sindu Dr.Fredi Heru 6,337,000
Kec Telanai Pura Jambi Saksono,SpBA Irwanto, Sp.An
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-01-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

8 RI11033992 0000574780 IR HIMYAR MAZALI 29-05-1959 52 L Jl Serma Jenis No 53 Kel Kab. Lahat ASKES 402 IA C67.9 Malignant Neoplasm Of Evakuasi Bekuan Darah (clot) Dr. Martha Hendry,SpU Dr.Fredi Heru 5,625,000
Pasar Baru Kec Lahat Kab Bladder, Unspecified Irwanto, Sp.An
Lahat

9 RI11033131 0000571953 KAMSI BIN ARPAI 16-04-1967 44 L Desa Nanjungan Kec.Kikim Kab. Lahat JAMSOSKES(SUMSEL 405 III K56.7 Ileus, Unspecified Laparatomi Dr.Sarup Singh,SpB Dr.Fredi Heru 5,109,000
Selatan Kab.Lahat SEMESTA) Irwanto, Sp.An

10 RI11033554 0000573602 KHODIJAH 30-06-1932 70 P Gunung Gajah Gang Mawar Kab. Lahat ASKES 401 II A R31 Unspecified Hematuria TUR Buli Buli Dr. Martha Hendry,SpU Dr.Fredi Heru 9,375,500
Kec Lahat Kab Lahat Irwanto, Sp.An

11 RI11033507 0000563464 M. HARIS SAPUTRA 27-09-1995 16 L Jl. Pangeran Ratu Kota Palembang JAMSOSKES(SUMSEL 407 III S12.9 Fracture Of Neck, Part Open Reduksi Fraktur / Dislokasi Dr.H.Muzakkie, SpBO Dr.Fredi Heru 6,885,000
SEMESTA) Unspecified Lama FICS Irwanto, Sp.An

12 RI11032651 0000570187 M. ZUHRI 26-12-1963 48 L Darmapal No.32 Kota Palembang ASKES 102 UT B I11.9 Hypertensive Heart Disease Laminectomy (1 Level) pada simple Dr.Rendra Leonard, Dr.Fredi Heru 5,625,000
Without (Congestive) Heart spine stenosis SpOT Irwanto, Sp.An
Failure

13 RI12000076 0000576504 MALIA USMAN 09-07-1983 28 P Jl.Balap Sepeda Lr.Muhajirin Kota Palembang JAMKESMAS PUSAT 203 III O42 Premature Rupture Of Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Fredi Heru 6,223,750
Membranes SpOG Irwanto, Sp.An

14 RI12000204 0000576979 MARYANA BT.M.DAPIT 17-02-1990 21 P Jl.Kadir Tkr No.1240 Kota Palembang JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr. Peby Maulina Dr.Fredi Heru 6,223,750
Caesarean Section, Lestari,SpOG Irwanto, Sp.An
Unspecified

15 RI11033943 0000569100 NUR PARIDA 54 P Komp.Kencana Damai Blok Kota Palembang ASKES 402 IB E14.9 Unspecified Diabetes Amputasi Dr.H.Muzakkie, SpBO Dr.Fredi Heru 6,765,500
Ad 15 Kenten Sukamaju Plg Mellitus Without FICS Irwanto, Sp.An
Complications

16 RI11034291 0000575466 ORLANDO 02-01-1995 17 L Komp Bogenvil Km 7,5 Kota Palembang ASKES 401 IA N44 Torsion Of Testis [Torsion Orchidektomy / Undecensus Testis Dr. Martha Hendry,SpU Dr.Fredi Heru 5,709,500
Of Epididymis, Spermatic Irwanto, Sp.An
Cord, Terticle]

17 RI11034325 0000546153 RILO. JP 16 L Karang Gelumbang Muara Kab. Muara Enim UMUM 404 IA C41.9 Malignant Neoplasm Of Osteotomi Dr.Nur Rachmat Lubis, Dr.Fredi Heru 3,603,500
Enim Bone And Cartilage, SpOT Irwanto, Sp.An
Unspecified

18 RI12000033 0000576426 RITA APRIANI 30-04-1982 29 P Jl Kh Dahlan No 1347 Kota Palembang ASKES 201 IB O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Fredi Heru 8,680,100
Delivery, Unspecified SpOG Irwanto, Sp.An

19 RI11032978 0000571454 SARIFAH AHMAD SONI 48 P Desa Berlian Makmur Kec. JAMSOSKES(SUMSEL 404 III T30 Burn & Corrosion, Body Debridement Dr. Mgs Roni Saleh, Sp Dr.Fredi Heru 2,728,000
Sungai Lilin Kab. Muba SEMESTA) Region Unspecified BP Irwanto, Sp.An
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-01-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

20 RI12000078 0000576500 SUDARMAN 55 L Jl.Perumahan Sukajadi Kota Lubuk Linggau ASKES 401 IA K65 Peritonitis Laparatomi Dr.Sarup Singh,SpB Dr.Rose Mafiana, 7,740,850
Indah SpAn

21 RI11034049 0000574965 SUNARYA 09-01-1962 50 P Lampung Lampung UMUM 501 II B E85.3 Swecondary Systemic Terapi Laser Dr. Ramzi Amin, SpM 3,608,500
Amyloidosis

22 RI12000021 0000563538 SUNYATI BT M. ROMLI 19-09-1960 51 P Desa Labuhan Jaya Dusun Kab. Ogan Komering UMUM 201 UT A C56 Malignant Neoplasm Of Surgical Staging Dr.Rizal Sanif, SpOG- Dr.Fredi Heru 11,250,000
Ii Ilir Ovary Konk Irwanto, Sp.An

23 RI11034011 0000563813 WAYUNO SAHRI 17-11-1967 44 L Rawa Bening Bki Iii Okut ASKES 401 IB N21.1 Calculus In Urethra URS Dr. Martha Hendry,SpU Dr.Fredi Heru 9,307,500
Irwanto, Sp.An

Sub T o t a l Rp.: 151,398,000


JLH TINDAKAN KAMAR OPERASI IBS : 23
Tgl Operasi : 02-01-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12000185 0000576939 KHOIRULIHWAN AMANIK 03-09-1985 26 L Jl Betawi I Lr Cemara No JAMKESMAS PUSAT 702 II S09.7 Multiple Injuries Of Head Laparatomi Dr.Efman E.U.M, Dr.Fredi Heru 5,109,000
1836b (Trauma Capitis) M.Kes,SpB-KBD Irwanto, Sp.An

2 RI12000087 0000576515 RIDWAN 25 L Jl.Semuntul UMUM 701 III S68.8 Trumatic Amputation Of Amputasi Digiti dr. Ismail Bastomi, Dr.Rose Mafiana, 4,697,550
Other Parts Of Wrist And SpOT SpAn
Hand

3 RI11034260 0000575738 YUSNAN 34 L Jl P Ayin No.45 Kenten Laut Kab. Banyuasin JAMKESMAS PUSAT 701 III K40.9 Unilateral Or Unspecified Penambahan Jasa Dokter Dr.Efman E.U.M, Dr.Fredi Heru 1,287,000
Link I Inguinal Hernia, Without M.Kes,SpB-KBD Irwanto, Sp.An
Obstruction Or Gangrene

4 RI11034260 0000575738 YUSNAN 34 L Jl P Ayin No.45 Kenten Laut Kab. Banyuasin JAMKESMAS PUSAT 701 III K40.9 Unilateral Or Unspecified Orchidektomy / Undecensus Testis Dr. Martha Hendry,SpU 5,709,500
Link I Inguinal Hernia, Without
Obstruction Or Gangrene

Sub T o t a l Rp.: 16,803,050


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 4
Tgl Operasi : 02-02-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12002858 0000584220 AMA RUKMI 24 L Desa Melilian Gelumbang Kab. Muara Enim JAMSOSKES(SUMSEL 405 III T14.2 Fracture Of Unspecified Orif Mandibula Dr.Iqmal Perlianta, Sp Dr.Zulkipli, SpAn 4,749,000
Kampung 1 SEMESTA) Body Region BP
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-02-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

2 RI12003467 0000587441 AYUNA MAT HARUS 19-02-1937 75 L Desa Sungai Naik Sembawa UMUM 201 II A N81.4 Uterovaginal Prolapse, Hystrectomi Pervagina (TVH) Dr.Amir Fauzi, SpOG Dr.Zulkipli, SpAn 9,195,000
Unspecified

3 RI12003466 0000578735 BAHRUDIN BIN BAGUS 22-01-1952 60 L Jl Wahid Hasyim No 1576 JAMSOSKES(SUMSEL 406 III H43.1 Vitreous Haemorrhage Vitrektomi + Posterior Dr. Ramzi Amin, SpM Dr.Zulkipli, SpAn 5,505,000
NAWI SEMESTA)

4 RI12003561 0000587651 CHENG CHENG 07-03-1986 25 P Rusun Blok 44 Lt 1 No 01 Kota Palembang UMUM 404 II B S09.7 Multiple Injuries Of Head Closed Reduksi dengan anestesi Dr.H.Muzakkie, SpBO Dr.Zulkipli, SpAn 5,687,500
(Trauma Capitis) umum FICS

5 RI12003266 0000586731 CHRISTIAN RONALDO 0 L Desa Ujung Tanjung Kec JAMSOSKES(SUMSEL 302 III I61.9 Intracerebral Haemorrhage, Craniotomi Dr.Trijoso Dr.Zulkipli, SpAn 8,881,600
Tulung Selatan SEMESTA) Unspecified Permono,SpBS

6 RI12003545 0000587628 DANISH TIAN. I BIN M VERY 31-01-2012 0 L Jl Peritis Kemerdekaan Lr Kota Palembang JAMKESMAS PUSAT 301 III Q42.3 Congenital Absence, Atresia Colostomi / lleostomi Dr.Sindu Dr.Zulkipli, SpAn 5,071,300
Pasundan No 276 Kel & Stenosis Of Anus Without Saksono,SpBA
Lawang Kidul Fistula [Imperfoarte Anus]

7 RI12003244 0000536505 DIKI GUNAWAN 23-11-2001 10 L Komp Sukarame Indah Blok Kota Palembang UMUM 106 UT B D31.6 Benign Neoplasm Of Orbit, Wide Excisi Dr.Benny Kusuma, SpB 5,537,500
B4 No 4 Unspecified (K) Onk

8 RI12003244 0000536505 DIKI GUNAWAN 23-11-2001 10 L Komp Sukarame Indah Blok Kota Palembang UMUM 106 UT B D31.6 Benign Neoplasm Of Orbit, Penambahan Jasa Dokter Dr.Iqmal Perlianta, Sp Dr.Zulkipli, SpAn 2,083,500
B4 No 4 Unspecified BP

9 RI12002673 0000584348 DRS SULAIMAN JUPRI 18-02-1935 72 L Ariodilah No 4548 Kota Palembang ASKES 402 IB N40 Hyperplasia Of Prostate TUR Prostat Dr. Martha Hendry,SpU Dr.Zulkipli, SpAn 9,315,500

10 RI12003416 0000587173 DRS.ALIPATAN 28-02-1943 68 L Jl Kenten Permai Blok F No Kota Palembang ASKES 105 IA J03.9 Acute Tonsillitis, Unspecified Ekstrasi Polip Nasi Dr.Puspa Zuleika, Dr.Zulkipli, SpAn 3,991,000
2 (Follicular) (Gangrenous) SpTHT,M.Kes
(Infective) (Ulcerative)

11 RI12001874 0000582522 EDO BIN KARMA 06-12-2011 0 L Desa Lebung Gajah Oki Kab. Ogan Komering JAMSOSKES(SUMSEL 302 III Q43.1 Hirschprung'S Disease Colostomi / lleostomi Dr.Sindu Dr.Zulkipli, SpAn 3,901,000
Ilir SEMESTA) Saksono,SpBA

12 RI12002243 0000583367 EMI ERIATI 51 P Muara Dua Kab.Oku Selatan Kab. Ogan Komering UMUM 504 UT B J45.9 Asthma Unspecified Biopsi Incisional dalam narkose Dr.Benny Kusuma, SpB 3,125,000
Ulu Selatan (K) Onk

13 RI12002243 0000583367 EMI ERIATI 51 P Muara Dua Kab.Oku Selatan Kab. Ogan Komering UMUM 504 UT B J45.9 Asthma Unspecified Penambahan Jasa Dokter Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 1,125,000
Ulu Selatan (K) Onk
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-02-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

14 RI12003451 0000377886 EVA SURY NAPIANTI SH 08-11-1970 41 P Jl.Sungai Tawar No.563 Ilir Kota Palembang ASKES 402 IB D21.9 Benign Neoplasm Of Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 3,397,500
Barat Ii Plg Connective And Other Soft (K) Onk
Tissue, Unspecified

15 RI12002114 0000583295 FIKRI 23 L Tepi Sungai Gudukan 34 Kota Palembang PT. PINAGO UTAMA 405 III S72.9 Fracture Of Femur, Part Nos Orif / Reffraturisasi fraktur + Orif Dr.Rendra Leonard, Dr.Zulkipli, SpAn 6,885,000
Ulu SpOT

16 RI12003488 0000430617 H. SJARIFUDDIN AS 06-06-1942 69 L Sersan Sani No 2162 Kota Palembang ASKES 104 UT D C11.9 Malignant Neoplasm Of Adenoidektomi Dr.Denny SU,SpTHT- 4,064,000
Nasopharynx, Unspecified KL,MSiMed

17 RI12003488 0000430617 H. SJARIFUDDIN AS 06-06-1942 69 L Sersan Sani No 2162 Kota Palembang ASKES 104 UT D C11.9 Malignant Neoplasm Of Penambahan Jasa Dokter Dr.Zulkipli, SpAn 1,833,500
Nasopharynx, Unspecified

18 RI12003503 0000587541 HERI RISWANTO 36 L Ds Lubuk Kepayang Merapi Kab. Lahat UMUM 407 IA S52.8 Fracture Of Other Parts Of Revisi Orif Dr.H.Muzakkie, SpBO Dr.Zulkipli, SpAn 4,697,550
Lahat Forearm FICS

19 RI12002945 0000556251 IRWANTO BIN ALIDIN 01-07-1974 37 L Jl. Macan Kumbang Vii Kab. Muara Enim JAMSOSKES(SUMSEL 406 III S52.7 Multiple Fracture Of Angkat K-Nail / Remove Flat Screw Dr.Rendra Leonard, Dr.Zulkipli, SpAn 2,730,000
Muara Enim SEMESTA) Forearm SpOT

20 RI12003195 0000574257 MARWIYAH BT NAWAWI 12-06-1974 37 P Jl Plg Bentung Langkan Kab. Musi Banyuasin ASKES 403 II B D24 Benign Neoplasm Of Breast Wide Excisi Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 5,537,500
Banyu Asin 3 (K) Onk

21 RI12003609 0000587923 MULYADI 52 L Lingk 2 Balai Agung Sekayu UMUM 403 II B S09.7 Multiple Injuries Of Head Pemasangan WSD Dr.Bermansyah, SpB 5,562,000
Muba (Trauma Capitis)

22 RI12003588 0000587815 NELLY BT ANDI SAPUTRA 01-05-1981 30 P Jl. Syeh Abd. Somad Kota Palembang JAMKESMAS PUSAT 203 III O14.1 Severe Pre-Eclampsia Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG Dr.Zulkipli, SpAn 6,223,750
No.277 22 Ilir Bukit Kecil

23 RI12003382 0000556508 NILA WATI HARTONO 20-04-1970 0 P Lr Sepakat No 987 JAMSOSKES(SUMSEL 203 III C53.9 Malignant Neoplasm Of Radikal Histerektomi Dr.Agustria Z,SpOG- Dr.Zulkipli, SpAn 6,187,000
SEMESTA) Cervix Uteri, Unspecified KFM

24 RI12002796 0000585174 NURIAM 60 P Jl Prabumulih UMUM 403 II B N13.9 Obstructive And Reflux Insersi Kateter Double Luman HD Dr.Zulkipli, SpAn 3,038,500
Uropathy, Unspecified Semi Permanen

25 RI12003571 0000587759 NY MEGAWATI 37 P Komp. Mega Asri Blok I 6 JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr.Zulkipli, SpAn 6,223,750
No 12a Kel Sukajadi Kec Caesarean Section
Talang Kelapa
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-02-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

26 RI12000363 0000570265 RM IHSAN ADLI 27-08-2010 1 L Lr. Sei Tawar No 355 Kota Palembang JAMSOSKES(SUMSEL 409 III N21.1 Calculus In Urethra Orchidectomy Dr. Martha Hendry,SpU Dr.Zulkipli, SpAn 3,633,000
SEMESTA)

27 RI12003211 0000577059 ROSITA ZAINAL ARIFIN 12-01-1975 37 P Kenten Azhar C5 No 17 Kab. Banyuasin JAMSOSKES(SUMSEL 203 III D25.9 Leiomyoma Of Uterus, Multiple Meomectomi Dr.Abadi, SpOG Dr.Zulkipli, SpAn 6,277,000
SEMESTA) Unspecified

28 RI12003440 0000586588 SADIYO 03-06-1951 60 L Songo Makmur Kab. Musi Banyuasin UMUM 403 II B N40 Hyperplasia Of Prostate TUR Prostat Dr. Martha Hendry,SpU Dr.Zulkipli, SpAn 9,315,500

29 RI11034116 0000575202 SAUYAH 61 P Bali Makmur Merah Mata Kab. Banyuasin JAMKESMAS PUSAT 405 III C67.9 Malignant Neoplasm Of TUR Prostat Dr. Martha Hendry,SpU Dr.Zulkipli, SpAn 6,297,000
Kec.Banyuasin I Bladder, Unspecified
Kab.Banyuasin

30 RI12003565 0000587657 SITI RAHMA INDRIASARI, 13-02-1981 30 P Jl Hokki Lr Renang D 26 Kota Palembang ASKES 201 UT A O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Kms.Yusuf E.SpOG Dr.Zulkipli, SpAn 8,680,100
SE Caesarean Section

31 RI12003483 0000571083 SUNARNI ARIFIN 15-02-1968 43 P Jl.Suka Bangun Kota Palembang JAMSOSKES(SUMSEL 406 III H33.0 Retinal Detachments & Vitrektomi + Posterior Dr. Ramzi Amin, SpM Dr.Zulkipli, SpAn 5,505,000
Komp.Hasuri Garden SEMESTA) Breaks

32 RI12002722 0000569653 TASIA BINTI CIKMAN 03-03-1968 43 P Sering Kembang Kel. Seri Kab. Ogan Ilir JAMSOSKES(SUMSEL 406 III H16.0 Keratitis Of Corneal Ulcer Repair Soket Dr.Anang Tribowo, 3,184,000
Kembang Kec. Muara SEMESTA) SpM
Kuang Ogan Ilir

33 RI12002385 0000583962 TN. SLAMET 40 L Pulau Rimau Selat Kuningan JAMSOSKES(SUMSEL 407 III S68.1 Traumatic Amputation Of Orif Dr.Rendra Leonard, 4,741,000
SEMESTA) Other Single Finger SpOT
[Complete] [Partial]

34 RI12002385 0000583962 TN. SLAMET 40 L Pulau Rimau Selat Kuningan JAMSOSKES(SUMSEL 407 III S68.1 Traumatic Amputation Of Penambahan Jasa Dokter Dr.Rendra Leonard, Dr.Zulkipli, SpAn 920,000
SEMESTA) Other Single Finger SpOT
[Complete] [Partial]

Sub T o t a l Rp.: 173,100,550


JLH TINDAKAN KAMAR OPERASI IBS : 34
Tgl Operasi : 02-02-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12003542 0000587625 AGUNG AJI PRAYOGO 0 L Jl Pipa Lr Sersan Sulher No JAMSOSKES(SUMSEL 702 III K40.9 Unilateral Or Unspecified Hernioraphy Anak Dr.Sindu Dr.Rose Mafiana, 3,450,200
1031 SEMESTA) Inguinal Hernia, Without Saksono,SpBA SpAn
Obstruction Or Gangrene

2 RI12003640 0000587953 BOERHA 27-02-1959 53 L Jl Sersan Kko Badarudin Rt Kota Palembang JAMKESMAS PUSAT 702 III K65.0 Acute Peritonitis Laparatomi Dr.Efman E.U.M, Dr.Zulkipli, SpAn 5,109,000
25 Rw 4 Kel Sungai Buah M.Kes,SpB-KBD
Kec It 2
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-02-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

3 RI12003007 0000585864 HENI ISMARINA 39 P Gedung Sako 2 Kec Kaur JAMKESMAS PUSAT 702 III K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.Efman E.U.M, Dr.Zulkipli, SpAn 16,875,000
Selatan Kab Bengkulu M.Kes,SpB-KBD

4 RI12003557 0000587640 KOMALA 19 L Desa Bukit-Betung UMUM 702 III S09.7 Multiple Injuries Of Head Pemasangan WSD Dr.Bermansyah, SpB 3,950,500
(Trauma Capitis)

5 RI12003557 0000587640 KOMALA 19 L Desa Bukit-Betung UMUM 702 III S09.7 Multiple Injuries Of Head Reposisi Tertutup Dr.H.Muzakkie, SpBO Dr.Zulkipli, SpAn 3,559,400
(Trauma Capitis) FICS

Sub T o t a l Rp.: 32,944,100


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 5
Tgl Operasi : 02-03-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12005550 0000593466 ADI KUSMIRAN 16-04-1983 28 L Tangga Takat Laut No.26 JAMSOSKES(SUMSEL 500 III P59 Nenonatal Jaundice From Cimino Dr.H.Muzakkie, SpBO Dr. Yusni Puspita, 8,196,500
SEMESTA) Other & Unspecified Causes FICS SpAn

2 RI12003194 0000573759 APRISANTIKA BT CEK 01-04-2007 4 P Lubuk Pandan Muara JAMSOSKES(SUMSEL 406 III T14.3 Dislocation, Sprain And STSG / Skingrafting yang Luas Dr.Iqmal Perlianta, Sp 3,997,000
MAMAT Lakitan Mura SEMESTA) Train Of Unspecified Body BP
Region

3 RI12003194 0000573759 APRISANTIKA BT CEK 01-04-2007 4 P Lubuk Pandan Muara JAMSOSKES(SUMSEL 406 III T14.3 Dislocation, Sprain And Penambahan alat Pisau Skin Dr.Iqmal Perlianta, Sp Dr. Yusni Puspita, 500,000
MAMAT Lakitan Mura SEMESTA) Train Of Unspecified Body Dermato BP SpAn
Region

4 RI12005994 0000594930 ASMAWATI 42 L Jl Sakyakirti Lr Pancasila Kota Palembang UMUM 403 II B D13.1 Benign Neoplasm Of Eksisi Luas Tumor Retroperitoneal / Dr.Sarup Singh,SpB Dr. Yusni Puspita, 9,275,500
Stomach Rad. Nefrektomi SpAn

5 RI12006558 0000596769 DWI AGUSTIANNINGSIH 08-03-1984 28 P Tanjung Raya No 1563 Kota Palembang ASKES 201 IB O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr. Yusni Puspita, 6,677,000
Caesarean Section SpOG SpAn

6 RI12006334 0000320743 FRENGKI. S 30-07-1990 21 L Ds Tj Agung JAMSOSKES(SUMSEL 409 III S72.9 Fracture Of Femur, Part Nos Angkat K-Nail / Remove Flat Screw Dr.Rendra Leonard, Dr. Yusni Puspita, 2,730,000
SEMESTA) SpOT SpAn

7 RI12006640 0000596988 HENITI 17 P Jl Tunas Harapan Lr Kota Palembang JAMSOSKES(SUMSEL 203 III K37 Unspecified Appendicitis Laparatomy Explorasi Dr.Sarup Singh,SpB 8,238,100
Sepakat SEMESTA)

8 RI12006640 0000596988 HENITI 17 P Jl Tunas Harapan Lr Kota Palembang JAMSOSKES(SUMSEL 203 III K37 Unspecified Appendicitis Penambahan Jasa Dokter Dr.Abadi, SpOG Dr. Yusni Puspita, 949,000
Sepakat SEMESTA) SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-03-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

9 RI12006562 0000596756 HJ ZUBAIDAH 72 P Desa Sumangus Lubuk Kota Lubuk Linggau UMUM 403 II B D34 Benign Neoplasm Of Tyroid Thyroidektomi / Isthmolobectomy Dr.Benny Kusuma, SpB Dr. Yusni Puspita, 9,331,500
Linggau Gland (K) Onk SpAn

10 RI12006024 0000595014 IRIANTI 51 P Jl.Abdl Gatap Kel.Pasir ASKES 504 II B E14.9 Unspecified Diabetes Cimino Dr.H.Muzakkie, SpBO 8,637,500
Putih Kec.Jambi Selatan Mellitus Without FICS
Complications

11 RI12006591 0000596878 LESI SIANTI 25 P Ds Sri Kembang Kec JAMKESMAS PUSAT 203 III O42 Premature Rupture Of Sectio Cesarea tanpa penyulit Dr. Firmansyah, SpOG Dr. Yusni Puspita, 6,223,750
Payaraman Oi Membranes SpAn

12 RI12006542 0000596272 LETI HERLINA 01-10-1977 34 P Jl. Kebun Bunga Lr. Dolah Kota Palembang JAMKESMAS PUSAT 203 III O07.0 Failed Medical Abortion, Kuretase Dr.Kms.Yusuf E.SpOG Dr. Yusni Puspita, 3,017,300
Kasturi Sukarami Complicated By Genital SpAn
Tract & Pelvic Infection

13 RI12004098 0000537195 MINA HAMDAN 12-03-1960 51 P Desa Pulau Betung Kab. Ogan Komering JAMSOSKES(SUMSEL 409 III C50.9 Malignant Neoplasm Of Simple Mastektomi Dr.Benny Kusuma, SpB Dr. Yusni Puspita, 4,077,000
Pampangan Oki Ilir SEMESTA) Breast, Unspecified (K) Onk SpAn

14 RI12006573 0000595255 MURANTI BT BUNYANI 28-01-1980 30 P Dusun Lalang Sembawa JAMSOSKES(SUMSEL 407 III S82.2 Fracture Of Shaft Of Tibia Amputasi dr. Ismail Bastomi, Dr. Yusni Puspita, 4,741,000
SEMESTA) SpOT SpAn

15 RI12005732 0000592508 MUSLEHA BT YUNUS 23-09-1967 44 P Sidorejo Pagar Alam Kota Pagar Alam JAMSOSKES(SUMSEL 409 III D24 Benign Neoplasm Of Breast Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB Dr. Yusni Puspita, 2,519,000
Selatan SEMESTA) (K) Onk SpAn

16 RI12004765 0000591215 NAWAWI 12-07-1942 69 L Lrg.Sederhana Kota Palembang JAMSOSKES(SUMSEL 407 III S82.2 Fracture Of Shaft Of Tibia Amputasi Dr.H.Muzakkie, SpBO Dr. Yusni Puspita, 4,741,000
SEMESTA) FICS SpAn

17 RI12006522 0000394858 PARIANI BT PARDI 01-04-1968 42 P Tanjung Enim Kec. Lawang Kab. Muara Enim PT. Batubara Bukit Asam 201 IA N93.9 Abnormal Uterine And Laparascopy Operatif - Dr.Rizal Sanif, SpOG- Dr. Yusni Puspita, 3,125,000
Kidul Tanjung Enim Vaginal Bleeding, Histeroskopi Konk SpAn
Unspecified

18 RI12004810 0000591294 RAYENDRA 17 L Ds Taja Mulya Betung Plg Kab. Banyuasin JAMSOSKES(SUMSEL 404 III S02.6 Fracture Mandible Orif Dr.H.Muzakkie, SpBO Dr. Yusni Puspita, 4,741,000
Banyuasin SEMESTA) FICS SpAn

19 RI12006508 0000596163 RUMAI NURIAH 39 P Jl Melati 2 No 35- Kab. Muara Enim UMUM 401 II A J86.9 Pyothorax Without Fistula Penambahan Jasa Dokter Dr.Bermansyah, SpB Dr. Yusni Puspita, 2,531,000
Prabumulih SpAn

20 RI12006508 0000596163 RUMAI NURIAH 39 P Jl Melati 2 No 35- Kab. Muara Enim UMUM 401 II A J86.9 Pyothorax Without Fistula Explorasi ( Non Thorax ) Dr.Bermansyah, SpB 12,358,500
Prabumulih
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-03-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

21 RI12006620 0000596920 SULASTRI 04-04-1978 33 P Jl Supersemar Lr Sp Raya Kota Palembang JAMKESMAS PUSAT 202 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr. Firmansyah, SpOG Dr.Zulkipli, SpAn 6,223,750
Caesarean Section,
Unspecified

22 RI12006576 0000587425 TITIN SERI UTAMI 05-02-1993 19 P Desa Gelumbang Kab. Muara Enim ASKES 408 II B J03.9 Acute Tonsillitis, Unspecified Tonsilektomi Dr.Puspa Zuleika, Dr. Yusni Puspita, 3,125,000
(Follicular) (Gangrenous) SpTHT,M.Kes SpAn
(Infective) (Ulcerative)

23 RI12006618 0000596913 WARLINA ILMAN 24-03-1973 29 P Ds.Perambatan Kota Palembang JAMKESMAS PUSAT 203 III O42 Premature Rupture Of Sectio Cesarea tanpa penyulit Dr. Firmansyah, SpOG Dr.Zulkipli, SpAn 6,223,750
Kel.Perambatan Kec.Abab - Membranes
Muaraenim

24 RI12006568 0000593316 YULIANI ROBINSON 11-11-1975 36 P Dusun 1 Sukarela UMUM 201 II A N97.9 Female Infertility Unsp Laparascopy Operatif Dr.Agustria Z,SpOG- Dr. Yusni Puspita, 9,244,000
KFM SpAn

25 RI12006619 0000596914 ZULKARNAIN 32 L Jl Kopi 1 Blok T No 12 Kota Palembang UMUM 405 II B K40.9 Unilateral Or Unspecified Laparatomy Explorasi Dr.Sarup Singh,SpB Dr.Fredi Heru 12,162,150
Komplek Pusri Sako Inguinal Hernia, Without Irwanto, Sp.An
Obstruction Or Gangrene

Sub T o t a l Rp.: 143,585,300


JLH TINDAKAN KAMAR OPERASI IBS : 25
Tgl Operasi : 02-03-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12006632 0000596938 DEA 07-02-1992 19 P Jk Suka Karya JAMSOSKES(SUMSEL 702 III S09.7 Multiple Injuries Of Head Craniotomi Dr.Trijoso Dr. Yusni Puspita, 8,881,600
SEMESTA) (Trauma Capitis) Permono,SpBS SpAn

2 RI12006456 0000596480 DERI DAMAYANTI 05-01-2002 10 P Desa Mangsang MUBA SEMESTA 701 III I51.9 Heart Disease Unspecified Pericardiostomi Dr.Bermansyah, SpB Dr. Yusni Puspita, 16,066,050
Kec.Bayung Lencir (Decompensasi Cordis) SpAn

3 RI12006602 0000596892 FATIMA 62 P Jl Sei Hitam Lr Famili Rt 3 JAMSOSKES(SUMSEL 702 III K56.6 Other & Unspecified Laparatomy Explorasi Dr.Efman E.U.M, Dr.Zulkipli, SpAn 8,238,100
Rw 6 Siring Agung Ib 1 SEMESTA) Intestinal Obstruction M.Kes,SpB-KBD

4 RI12006699 0000597189 JONI RAMADHAN 31 L Jl.Rokan Iv No.2338 JAMSOSKES(SUMSEL 702 III K40.9 Unilateral Or Unspecified Hernioraphy Dewasa Dr.Sarup Singh,SpB Dr. Yusni Puspita, 3,512,600
SEMESTA) Inguinal Hernia, Without SpAn
Obstruction Or Gangrene

5 RI12006667 0000597130 RANI 6 P Jl Talang Keramat Lr Kota Palembang JAMSOSKES(SUMSEL 701 III T14.1 Open Wound (Luka Tusuk, Penambahan Jasa Dokter Dr. Martha Hendry,SpU Dr. Yusni Puspita, 1,673,100
Kemuning SEMESTA) Lecet, Potong, Gigit SpAn
Binatang)

6 RI12006667 0000597130 RANI 6 P Jl Talang Keramat Lr Kota Palembang JAMSOSKES(SUMSEL 701 III T14.1 Open Wound (Luka Tusuk, Penambahan Jasa Dokter dr. Ismail Bastomi, Dr. Yusni Puspita, 1,673,100
Kemuning SEMESTA) Lecet, Potong, Gigit SpOT SpAn
Binatang)
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-03-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

7 RI12006667 0000597130 RANI 6 P Jl Talang Keramat Lr Kota Palembang JAMSOSKES(SUMSEL 701 III T14.1 Open Wound (Luka Tusuk, Laparatomi Dr.Sindu 10,709,400
Kemuning SEMESTA) Lecet, Potong, Gigit Saksono,SpBA
Binatang)

8 RI12006538 0000333955 RODIAH BT SARJU 11-11-1965 48 P Jl Tl Keramat Lr. Bidan No. Kab. Musi Banyuasin JAMSOSKES(SUMSEL 702 III S09.7 Multiple Injuries Of Head A-V Shunt Dr.Bermansyah, SpB 6,801,500
21 Kec. Tl Kelapa SEMESTA) (Trauma Capitis)

9 RI12006697 0000597179 SYARIF HIDAYATULLAH 03-06-2003 8 L Dusun Ii Sungai Lilin MUBA SEMESTA 702 III Z47.0 Folow-Up Care Involving Pericardiostomi Dr.Bermansyah, SpB 9,985,950
Kel.Suka Maju Kab.Muba Removal Of Fracture Plate &
Other Internal Fixation
Device

Sub T o t a l Rp.: 67,541,400


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 9
Tgl Operasi : 02-04-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12007715 0000540697 ABEL BT JUNAIDI 11-03-2008 3 P Desa Penanggoan Duren Kab. Ogan Komering JAMSOSKES(SUMSEL 409 III M24.5 Contracture Of Joint STSG / Skingrafting yang Luas Dr.Iqmal Perlianta, Sp 3,997,000
Dns.Iii Kec.Tulung Selapan Ilir SEMESTA) BP
Oki

2 RI12007715 0000540697 ABEL BT JUNAIDI 11-03-2008 3 P Desa Penanggoan Duren Kab. Ogan Komering JAMSOSKES(SUMSEL 409 III M24.5 Contracture Of Joint Penambahan Jasa Dokter Dr.Iqmal Perlianta, Sp 1,000,000
Dns.Iii Kec.Tulung Selapan Ilir SEMESTA) BP
Oki

3 RI12007715 0000540697 ABEL BT JUNAIDI 11-03-2008 3 P Desa Penanggoan Duren Kab. Ogan Komering JAMSOSKES(SUMSEL 409 III M24.5 Contracture Of Joint Penambahan alat Pisau Skin Dr.Iqmal Perlianta, Sp Dr.Kusuma 500,000
Dns.Iii Kec.Tulung Selapan Ilir SEMESTA) Dermato BP Harimin, SpAn
Oki

4 RI12008102 0000601705 AGUS TRI DARMINAH 6 P Dusun 03 Desa Berlian MUBA SEMESTA 404 III T31.2 Burn Involving 20 - 29% Of Debridement Dr.Iqmal Perlianta, Sp Dr.Agustina Br.H, 2,728,000
Makmur Sungai Lili Muba Body Surface BP SpAn, M.Kes

5 RI12008826 0000602204 ALDI ALFIANSYAH 10 L Desa Sri Mulyo-Kec Kab. Ogan Komering JAMSOSKES(SUMSEL 409 III S09.7 Multiple Injuries Of Head Craniotomi Dr.Sahat Dr.Kusuma 6,832,000
Madang Suku 2-Oku Timur Ulu Timur SEMESTA) (Trauma Capitis) Edison.S,SpBS Harimin, SpAn

6 RI12009730 0000606795 ALLAN DEDES PUTRA 14 P Desa Tanjung Kelang JAMSOSKES(SUMSEL 410 III S09.7 Multiple Injuries Of Head Craniotomi Dr.Sahat Dr.Kusuma 6,832,000
Prabumulih SEMESTA) (Trauma Capitis) Edison.S,SpBS Harimin, SpAn

7 RI12009831 0000607184 AMIR HAMZAH 08-06-1969 42 L Jl. Tanjung Rawo Np 3975 Kota Palembang JAMSOSKES(SUMSEL 410 III S09.7 Multiple Injuries Of Head Reposisi Hidung Dr.Iqmal Perlianta, Sp Dr.Kusuma 3,260,400
SEMESTA) (Trauma Capitis) BP Harimin, SpAn

8 RI12009853 0000607237 ARMAN 24 L Desa Seri Tanjung JAMSOSKES(SUMSEL 407 III S72.9 Fracture Of Femur, Part Nos Debridement dr. Ismail Bastomi, Dr.Kusuma 3,546,400
Kec.Tanjung Batu - Oi SEMESTA) SpOT Harimin, SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-04-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

9 RI12009727 0000606792 ASMAH BT MADIA 20 P Desa Batun Baru Kec.Jejawi Kab. Ogan Komering JAMKESMAS PUSAT 203 III O06.4 Unsp.Abortion Incomplete, Kuretase Dr.Kms.Yusuf E.SpOG Dr. Yusni Puspita, 3,017,300
Oki Ilir Without Complication SpAn

10 RI12009750 0000606825 DARHI KASMINI 10-04-1982 30 P Sungai Lilin Banyuasin Kab. Musi Banyuasin UMUM 401 II A K61.0 Anal Abscess Debridement Dr.Efman E.U.M, Dr.Kusuma 4,684,550
M.Kes,SpB-KBD Harimin, SpAn

11 RI12009589 0000603768 EMI YUSNANI 02-04-1969 43 P Kompl. Gha Blok 41 No. 19 Kota Palembang ASKES 402 IB N20.0 Calculus Of Kidney NephroUreterektomi Dr. Martha Hendry,SpU Dr.Kusuma 9,375,000
(Nephrolithiasis Nos)(Renal Harimin, SpAn
Calculus Or
Stone)(Staghorn
Calculus)(Stone In Kidney)
12 RI12009072 0000604911 FATMAWATI 53 P Jl Sultan Agung No.154 Kota Palembang UMUM 503 IB E14.9 Unspecified Diabetes Pasang Drainase dr. Ismail Bastomi, Dr.Kusuma 3,652,500
Mellitus Without SpOT Harimin, SpAn
Complications

13 RI12006033 0000594986 HJ.ABDUL MUTOLIP 51 L Jl.Dr.Purwadi Perumahan ASKES 103 UT C N03 Chronic Nephritic Syndrome Lapartomi untuk pemasangan Dr.Efman E.U.M, Dr.Kusuma 6,026,500
Permata Kenali CAPD M.Kes,SpB-KBD Harimin, SpAn

14 RI12009320 0000553707 HUDAYA A DASUKI 28-03-1963 49 P Lubuk Makmur Oki Kab. Ogan Komering ASKES 106 UT B M19.9 Arthrosis (Osteoarthritis) Total HIP / Replecement Knee Dr.Rendra Leonard, Dr.Kusuma 9,815,500
Ilir SpOT Harimin, SpAn

15 RI12006549 0000592147 IKHSAN RAMADHAN 30-11-2008 3 L Jl. Inpres Penjara Serasan MUBA SEMESTA 409 III Q66 Congenital Deformity Of CTEV dr. Ismail Bastomi, Dr.Kusuma 6,665,000
Jaya Sekayu Muba Feet SpOT Harimin, SpAn

16 RI12009783 0000607126 INDRIANI 30 P Desa Penanggoan Duren Kab. Ogan Komering JAMKESMAS PUSAT 203 III O83.1 Breech Delivery Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr.Kusuma 6,223,750
Kec.Tulung Selapan Oki Ilir Harimin, SpAn

17 RI12009600 0000606578 KHOLIDAH 04-02-1986 26 P Pangkalan Sakti Air Sugihan Kab. Ogan Komering JAMKESMAS PUSAT 203 III N93.9 Abnormal Uterine And Kuretase Dr.Kms.Yusuf E.SpOG Dr.Kusuma 3,017,300
Oki Ilir Vaginal Bleeding, Harimin, SpAn
Unspecified

18 RI12008710 0000603887 KOMA E 04-04-1963 49 L Desa Karang Endah Kab. Ogan Komering ASKES 403 UT D N20.0 Calculus Of Kidney Longitudinal Neprolitotomi Dr. Martha Hendry,SpU Dr.Kusuma 9,375,500
Ulu Timur (Nephrolithiasis Nos)(Renal (KADET) Harimin, SpAn
Calculus Or
Stone)(Staghorn
Calculus)(Stone In Kidney)
19 RI12009562 0000606419 KURNIADI 12-08-1986 25 L Dusun Ii Saka Tiga UMUM 401 IA S42.2 Fracture Of Upper End Of Fraktur Kompleks dr. Ismail Bastomi, Dr.Kusuma 9,644,500
Seberang Kec.Indralaya Humerus SpOT Harimin, SpAn
Kab.Oi

20 RI12009408 0000605731 NINGSIH BINTI SENIN 04-04-1993 18 P Jl. Kh. Azhari Lrng. Siliwangi Kota Palembang JAMKESMAS PUSAT 406 III S05.3 Ocular Leceration Without Repair Soket Dr.Linda Trisna, SpM Dr.Kusuma 3,491,000
No. 34 Prolapse Or Loss Of Harimin, SpAn
Intraocular Tissue
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-04-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

21 RI12009065 0000603673 NOVIANTI MUZAKIR 01-04-1973 39 P Talang Jawa Lahat Gang Kab. Lahat UMUM 201 UT A D25.9 Leiomyoma Of Uterus, Multiple Meomectomi Dr.Kms.Yusuf E.SpOG Dr.Kusuma 9,244,000
Pendawa No 19 Unspecified Harimin, SpAn

22 RI12007332 0000590248 PRATAMA 02-09-1995 16 L Kh Sulaiman Ujung Tanjung JAMKESMAS PUSAT 409 III N20.9 Urinary Calculus, Longitudinal Neprolitotomi Dr. Martha Hendry,SpU Dr.Kusuma 6,357,000
Unspecified (Calculous (KADET) Harimin, SpAn
Pyelonephritis)

23 RI12008479 0000373018 RAIHAN FERDIAN S 23-02-2010 0 L Sukajadi B Asin JAMSOSKES(SUMSEL 409 III Z09.9 Follow-Up Examination Palatoplasty Dr.Iqmal Perlianta, Sp Dr.Kusuma 4,081,000
SEMESTA) After Unspecified Treatment BP Harimin, SpAn
For Other Conditions

24 RI12009513 0000561294 RIZKI APRIANTI SE 21-11-1986 25 P Kayu Awet No 76 Kota Palembang ASKES 402 IA K04.7 Periapical Abscess Without Odontektomy > 3 el drg.Adi Prabowo Dr.Kusuma 5,693,500
Sinus (Dental, J,SpBM Harimin, SpAn
Dentoalveolar, Periapical --
>Abscess Nos)
25 RI12009539 0000588515 SAKBANI BIN ARIPIN 14-02-1972 40 L Rantau Bayur Muba Kab. Musi Banyuasin UMUM 402 IB D21.9 Benign Neoplasm Of Eksisi Tumor Jar Lunak Kecil drg.Adi Prabowo Dr.Kusuma 3,397,500
Connective And Other Soft J,SpBM Harimin, SpAn
Tissue, Unspecified

26 RI12009736 0000606798 SALMAH 63 P Jl.Pala Wija Ii Komplek Pusri PT.ASURANSI JIWA 407 II B S09.7 Multiple Injuries Of Head Jahit Plastik < 10 cm Dr. Mgs Roni Saleh, Sp Dr.Kusuma 3,147,300
Sako INHEALTH INDONESIA (Trauma Capitis) BP Harimin, SpAn

27 RI12009677 0000601543 SANIA SUPRIYONO 29-03-1960 52 L Jl. Sematang Borang Kota Palembang ASKES 102 UT B N83.2 Other & Unspecified Ovarian Histerektomi Dr.Syakroni Daud Dr.Kusuma 5,625,000
Komplek Griya Harapan Cyst Ttl,Salp.OfortmiBilateral/Hist.Ttl Rusdi Harimin, SpAn
Blok E1 Salp.OfortmiSinistra

28 RI12008541 0000384589 SUHARTO BIN JONO 08-07-1966 44 L Jl. Prof. Supomo No. 555 Kota Palembang ASKES 103 UT C K74.6 Other & Unspecified Spleenektomy Dr.Efman E.U.M, Dr.Kusuma 9,265,500
Pahlawan Cirrhosis Of Liver M.Kes,SpB-KBD Harimin, SpAn

29 RI12008984 0000604466 SUTARMO 43 L Dusun 3 Talang Balai Baru Kab. Ogan Komering UMUM 402 II A S72.9 Fracture Of Femur, Part Nos Debridement dr. Ismail Bastomi, Dr.Kusuma 3,603,500
Ilir SpOT Harimin, SpAn

30 RI12008627 0000603169 SYAHLAN 01-01-1951 61 L Bengkulu ASKES 104 UT D K60.3 Anal Fistula Reheacting Dr. Martha Hendry,SpU Dr.Kusuma 3,652,500
Harimin, SpAn

31 RI12009802 0000607174 THRSESYANA APRILIA 32 P Jl Serda Kko Usman Ali No UMUM 201 UT A O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr.Kusuma 8,680,100
HITIPEUW 38b Caesarean Section Harimin, SpAn

32 RI12009719 0000606769 WARTI 23-02-1983 29 P Lk. Iii- Makarti Jaya Kab. Musi Banyuasin JAMKESMAS PUSAT 203 III P36.9 Bacterial Sepsis Of Newborn Sectio Cesarea tanpa penyulit Dr.Kms.Yusuf E.SpOG Dr. Yusni Puspita, 6,223,750
=> Unspecified SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-04-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

33 RI12008583 0000603319 YUDI HASBIANTO BIN 21-01-1984 28 L Dsn Meranjat Indralaya Oi JAMSOSKES(SUMSEL 404 III T31.1 Burn Involving 10 - 19% Of Amputasi Digiti Dr.Iqmal Perlianta, Sp Dr.Kusuma 2,738,000
MARDAWA SEMESTA) Body Surface BP Harimin, SpAn

Sub T o t a l Rp.: 175,392,850


JLH TINDAKAN KAMAR OPERASI IBS : 33
Tgl Operasi : 02-04-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12008883 0000604293 LINDA M TEGUH 30 P Ds Lebung Kec. Rantau JAMKESMAS PUSAT 701 III O82.0 Delivery By Elective Laparatomi Dr.Amir Fauzi, SpOG Dr.Kusuma 7,948,850
Bayur Banyu Asin Caesarean Section Harimin, SpAn

2 RI12009690 0000606739 MUHAMMAD ALI MAHMUDI 17 L Jl.Depati Rahmat Kel.Rimba Kab. Banyuasin JAMKESMAS PUSAT 701 III S09.7 Multiple Injuries Of Head Pemasangan WSD Dr.Bermansyah, SpB 5,562,000
Asam Kec.Betung (Trauma Capitis)
Banyuasin

Sub T o t a l Rp.: 13,510,850


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 2
Tgl Operasi : 02-05-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12012168 0000606494 ACHMAD SAUGI 16-08-1986 25 L Lr Kelingi No 668/1215 JAMSOSKES(SUMSEL 409 III K61.0 Anal Abscess Fistulektomi / High Anal Dr.Sarup Singh,SpB Dr.Kusuma 3,987,000
SEMESTA) Harimin, SpAn

2 RI12012257 0000614654 AMANDA FATHURRAHMAN 08-07-2003 8 P Jl. Kh. Sulaiman Banyuasin Kab. Musi Banyuasin ASKES 402 IA S62.8 Fracture Of Other And Orif Dr.H.Muzakkie, SpBO Dr.Kusuma 6,765,500
No. 35 Unspecified Parts Of Wrist FICS Harimin, SpAn
And Hand

3 RI12012662 0000565935 AMRIZAL 10-12-1971 40 L Jl. Rahayu Lubuk Linggau Kota Lubuk Linggau UMUM 402 IA R17 Unspecified Jaundice [ Penambahan Jasa Dokter Dr.Efman E.U.M, Dr.Kusuma 3,117,000
Exclude : Neonatal Janudice M.Kes,SpB-KBD Harimin, SpAn
)P55, P57-P59)

4 RI12012662 0000565935 AMRIZAL 10-12-1971 40 L Jl. Rahayu Lubuk Linggau Kota Lubuk Linggau UMUM 402 IA R17 Unspecified Jaundice [ Kolesistektomi Dr.Efman E.U.M, 9,336,500
Exclude : Neonatal Janudice M.Kes,SpB-KBD
)P55, P57-P59)

5 RI12012843 0000616350 ANGGI ARMAN 0 P Jl 1 Ulu Laut Despan Aspol Kota Palembang JAMSOSKES(SUMSEL 410 III T30 Burn & Corrosion, Body Debridement Dr.Iqmal Perlianta, Sp Dr.Kusuma 3,546,400
SEMESTA) Region Unspecified BP Harimin, SpAn

6 RI12012539 0000615437 ARIF SUNARDI 50 L Jl Sosial No 120- JAMSOSKES(SUMSEL 404 III T30 Burn & Corrosion, Body Debridement Dr.Iqmal Perlianta, Sp Dr.Kusuma 2,728,000
Sukabangun SEMESTA) Region Unspecified BP Harimin, SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

7 RI12012863 0000616384 BAGUS PUJA RAKASIWI 14-03-1997 15 L Sukajadi Bk-9 Kota Lubuk Linggau ASKES 103 UT C D23 Other Benign Neoplasm Of Penambahan alat Pisau Skin Dr.Iqmal Perlianta, Sp Dr.Kusuma 500,000
Skin Dermato BP Harimin, SpAn

8 RI12012863 0000616384 BAGUS PUJA RAKASIWI 14-03-1997 15 L Sukajadi Bk-9 Kota Lubuk Linggau ASKES 103 UT C D23 Other Benign Neoplasm Of STSG / Skingrafting yang Luas Dr.Iqmal Perlianta, Sp 6,265,500
Skin BP

9 RI12012316 0000614885 BE SIU LIAN 15-08-1946 64 P Jl Wira Karya No 100 Lubuk Kota Lubuk Linggau UMUM 102 UT B S72.9 Fracture Of Femur, Part Nos Arthoplasty Dr.H.Muzakkie, SpBO Dr.Kusuma 18,125,000
Linggau FICS Harimin, SpAn

10 RI12012511 0000615426 BEJO 08-07-1942 69 L Jl. Abikusno Cs No 127 Kota Palembang JAMKESMAS PUSAT 406 III K40.9 Unilateral Or Unspecified Hernioraphy dgn prolenemesh / Dr.Sarup Singh,SpB Dr.Kusuma 4,002,000
Inguinal Hernia, Without Komplikasi Harimin, SpAn
Obstruction Or Gangrene

11 RI12012771 0000541694 DEDE RAN NINGSIH 16-09-1992 19 P Ds Mekarjadi Muba MUBA SEMESTA 406 III H33.2 Serous Retinal Detachment Repair Ruptur Palpebra + Dr.Riani Erna, SpM 5,152,000
Rekonstruksi

12 RI12012859 0000616386 DIAH MARDIANA WATI 26 P Jl R Sukamto Lr Masjid No Kota Palembang UMUM 201 II A O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr.Kusuma 8,680,100
35 Caesarean Section Harimin, SpAn

13 RI12012295 0000614836 ERNI YULIANTI BT 31-07-1974 37 P Jl. Tegal Binanggun Kota Palembang JAMSOSKES(SUMSEL 405 III S52.8 Fracture Of Other Parts Of Open Reduksi Fraktur / Dislokasi Dr.H.Muzakkie, SpBO Dr.Kusuma 6,885,000
BADARUDIN SEMESTA) Forearm Lama FICS Harimin, SpAn

14 RI12012777 0000616071 HASIMAH 16-05-1954 58 P Gunung Meru Kota Palembang UMUM 201 IB N35 Urethral Stricture Buginasi dan Dilatasi Dr.Amir Fauzi, SpOG Dr.Kusuma 3,652,500
Harimin, SpAn

15 RI12012943 0000616783 IIS SRIMELDA 23 P Jl Sidonig Lautan Rt 14 Rw Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Kusuma 6,223,750
4 Kel 35 Ilir Kec Ib 2 Caesarean Section SpOG Harimin, SpAn

16 RI12011591 0000594363 IRWANTO 12-01-1968 44 L Perum Palm Ratya Oi JAMSOSKES(SUMSEL 404 III Z47.0 Folow-Up Care Involving Angkat K-Nail / Remove Flat Screw Dr.Rendra Leonard, Dr.Kusuma 2,730,000
SEMESTA) Removal Of Fracture Plate & SpOT Harimin, SpAn
Other Internal Fixation
Device
17 RI12012855 0000616382 JULMANA 04-07-1980 31 P Jl. Remifa Kota Palembang JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Abadi, SpOG Dr.Kusuma 2,321,000
Incomplete,With Other And Harimin, SpAn
Unspecified Complications

18 RI12010754 0000609768 KARTINI BT MATRAWI 20-04-1942 73 P Jl.Gotong Royong Kec JAMSOSKES(SUMSEL 409 III R17 Unspecified Jaundice [ Kolesistektomi Dr.Sarup Singh,SpB 6,318,000
Sukarami SEMESTA) Exclude : Neonatal Janudice
)P55, P57-P59)
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

19 RI12010754 0000609768 KARTINI BT MATRAWI 20-04-1942 73 P Jl.Gotong Royong Kec JAMSOSKES(SUMSEL 409 III R17 Unspecified Jaundice [ Penambahan Jasa Dokter Dr.Sarup Singh,SpB Dr.Kusuma 0
Sukarami SEMESTA) Exclude : Neonatal Janudice Harimin, SpAn
)P55, P57-P59)

20 RI12012565 0000612659 KATEMI 10-02-1969 43 P Ds Suka Maju Muba MUBA SEMESTA 203 III D25.9 Leiomyoma Of Uterus, Salfingo Oovarectomi Dr.Syakroni Daud Dr.Kusuma 3,897,000
Unspecified Rusdi Harimin, SpAn

21 RI12012812 0000563483 KMS. M RIFQI 10-11-2005 6 L Jl Pangeran Sido Ing Lautan Kota Palembang ASKES 104 UT D D21.9 Benign Neoplasm Of Wide Excisi Dr. Mgs Roni Saleh, Sp Dr.Kusuma 5,537,500
No 97 Connective And Other Soft BP Harimin, SpAn
Tissue, Unspecified

22 RI12012468 0000615365 LILIK YEFIATIN 25 P Ds Talang Mukti Kec Lalan MUBA SEMESTA 201 II A O01.9 Hydatidiform Mole, Radikal Histerektomi Dr.Rizal Sanif, SpOG- Dr.Kusuma 12,500,000
Sekayu Muba Unspecified Konk Harimin, SpAn

23 RI12012667 0000479648 M.DANIEL ALBARI 25-02-1998 14 L Citra Damai Blok G 17 Kel Kota Palembang ASKES 402 IB D21.9 Benign Neoplasm Of Wide Excisi Dr.Iqmal Perlianta, Sp Dr.Kusuma 5,537,500
Bukit Sangkal Connective And Other Soft BP Harimin, SpAn
Tissue, Unspecified

24 RI12012748 0000592574 MARIYAM BINTI ABU BAKAR 10-02-1979 33 P Campang Tiga JAMSOSKES(SUMSEL 408 III J03.9 Acute Tonsillitis, Unspecified Tonsil Dr.Sofyan Dr.Kusuma 2,530,000
Ulu,Cempaka SEMESTA) (Follicular) (Gangrenous) Effendi,SpTHT Harimin, SpAn
(Infective) (Ulcerative)

25 RI12012800 0000006896 MARLIA JAKPAR 07-07-1954 57 P Perindustrian No. 52 Kota Palembang ASKES 201 IA N85.0 Endometritis Glandular Histerektomi Dr.Amir Fauzi, SpOG Dr.Kusuma 5,625,000
Hyperplasia Ttl,Salp.OfortmiBilateral/Hist.Ttl Harimin, SpAn
Salp.OfortmiSinistra

26 RI12012248 0000571632 MARLITA PUSPITA SARI 02-01-1989 23 P Kel Durian Depun JAMKESMAS PUSAT 407 III D21.9 Benign Neoplasm Of Wide Excisi Dr.Benny Kusuma, SpB Dr.Kusuma 3,513,000
Connective And Other Soft (K) Onk Harimin, SpAn
Tissue, Unspecified

27 RI12012877 0000616421 MISNAWATI 10-06-1976 35 P Lr Perguruan No 23-Talang Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Kusuma 6,223,750
Buruk Caesarean Section SpOG Harimin, SpAn

28 RI12012655 0000615862 NOVA ARISTA SAPRIANA 05-11-1988 23 P Dsn.I Rantau Bayur Kec. JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Azhari, SpOG Dr.Kusuma 6,223,750
Rantau Bayur Banyua Sin Caesarean Section Harimin, SpAn

29 RI12011316 0000591875 NURLINA TAMARUDDIN 07-06-1975 36 P Desa Tanjung Puinang Kab. Ogan Komering JAMSOSKES(SUMSEL 406 III D21.0 Benign Neoplasm Of Wide Excisi Dr.Benny Kusuma, SpB Dr.Kusuma 3,513,000
Mrajat Oi Ilir SEMESTA) Connective And Other Soft (K) Onk Harimin, SpAn
Tissue Of Head, Face And
Neck
30 RI12012898 0000616438 NURMILA WATI 42 P Jl Letkol Adrian Komplek Kota Palembang PT.ASURANSI JIWA 201 IA C11.9 Malignant Neoplasm Of Kuretase Dr.Amir Fauzi, SpOG Dr.Kusuma 3,196,500
Puri Impian 2 Blok G 12 INHEALTH INDONESIA Nasopharynx, Unspecified Harimin, SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

31 RI12012665 0000364168 PUTRI NURMALIA 14-01-2010 0 P Jl.Pahlawan No 73 ASKES 403 II B Q03.9 Congenital VP Shunt (shuting) / Pemasangan Dr.Trijoso Dr.Kusuma 9,838,500
Kayuagung Hidrocephalus,Unspecified Pintasan Permono,SpBS Harimin, SpAn

32 RI12012828 0000616341 RIKA PARAMITA 26 P Desa Rantau Alai Kab Ogan Kab. Ogan Ilir UMUM 407 II B S09.7 Multiple Injuries Of Head Craniotomi Dr.Sahat Dr.Kusuma 12,805,650
Ilir (Trauma Capitis) Edison.S,SpBS Harimin, SpAn

33 RI12012366 0000613430 RIKA SUSANTI 01-05-1982 30 P Jl. Sri Panji No.69 Kab. Musi Banyuasin UMUM 402 IA N21.1 Calculus In Urethra Extracorporeal Shock Wave Dr. Martha Hendry,SpU 6,637,500
Litotripsi

34 RI12012767 0000596329 RUSMIATI BT SARKOWI 05-05-1962 50 P Kampung 1 Desa Gunung Kab. Muara Enim JAMSOSKES(SUMSEL 203 III C56 Malignant Neoplasm Of Histrectomi Total Dr.Rizal Sanif, SpOG- Dr.Kusuma 6,277,000
Megang Dalam Muara Enim SEMESTA) Ovary Konk Harimin, SpAn

35 RI12012370 0000596442 SALBIYAH 05-11-1976 35 P Tebing Gerinting Utara Oi JAMSOSKES(SUMSEL 405 III E05.9 Thyrotoxic Heart Isthobektomi Dr.Benny Kusuma, SpB Dr.Kusuma 6,292,000
SEMESTA) Disease(Thd)/Thyrotoxicosis/ (K) Onk Harimin, SpAn
Unsspecified

36 RI12012067 0000612622 SITI ZALEHA 16-02-1950 62 P Mangun Jaya JAMKESMAS PUSAT 405 III C20 Malignant Neoplasm Of Definitif + Miles Dr.Sarup Singh,SpB Dr.Kusuma 6,329,000
Rectum > Rectal Ampulla Harimin, SpAn

37 RI12012694 0000615965 SOPLI 24-02-1942 70 L Dusun Ii Tanjung Raya Kec Kab. Muara Enim JAMKESMAS PUSAT 406 III K40.9 Unilateral Or Unspecified Hernioraphy dgn prolenemesh / Dr.Sarup Singh,SpB Dr.Kusuma 4,002,000
Ramabang Lubai Kab Muara Inguinal Hernia, Without Komplikasi Harimin, SpAn
Enim Obstruction Or Gangrene

38 RI12011756 0000612476 SUMADI BIN YUSIR 26-09-1955 56 L Desa Negri Kaya Tanjung Kab. Lahat JAMSOSKES(SUMSEL 405 III D21.9 Benign Neoplasm Of Angkat K-Nail / Remove Flat Screw Dr.H.Muzakkie, SpBO Dr.Kusuma 2,730,000
Sakti Pumu Lahat SEMESTA) Connective And Other Soft FICS Harimin, SpAn
Tissue, Unspecified

39 RI12012780 0000616269 SUSI MASLYNA LUBIS 35 P Jl Ki Anwar Mangku ASKES 201 IA O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr.Kusuma 6,677,000
No.1337 Caesarean Section Harimin, SpAn

40 RI12013001 0000616411 TETRI RAHMAWATI 27-05-1989 22 P Jl Talang Semut No 242 Kab. Ogan Komering ASKES 201 UT A O41.0 Oligohydramnions Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Agustina Br.H, 8,680,100
Ilir SpOG SpAn, M.Kes

41 RI12012783 0000474404 ZULKIPLI BIN A. RONI 16-06-1958 53 L Lk 1 Kedayon JAMSOSKES(SUMSEL 410 III N03 Chronic Nephritic Syndrome A-V Shunt Dr.Bermansyah, SpB 6,801,500
SEMESTA)

Sub T o t a l Rp.: 235,702,500


JLH TINDAKAN KAMAR OPERASI IBS : 41
Tgl Operasi : 02-05-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12012842 0000616362 NURLELA 24-01-1961 51 P Komp Sangkuriang Blok Bb Kota Palembang ASKES 701 II A K63.1 Perforation Of Intestine Laparatomi Dr.Sarup Singh,SpB Dr.Kusuma 7,740,850
7 (Nontraumatic) Harimin, SpAn

Sub T o t a l Rp.: 7,740,850


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 1
Tgl Operasi : 02-06-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12016033 0000626158 AFRINDA REFI 12 P Ds.Tanjung Kemala UMUM 201 II A N83.2 Other & Unspecified Ovarian Vaginal Plastik Dr.Kms.Yusuf E.SpOG Dr.Rizal Zanial, 6,157,500
Kec.Prabumulih Cyst SpAn
Kab.Prabumulih

2 RI12016151 0000626371 AIS SUMARSIH 45 P Ds Karang Agung P 2 Kec Kab. Musi Banyuasin JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Nuswil Bernollan, Dr.Rizal Zanial, 2,321,000
Lalan Kab Muba Incomplete,With Other And SpOG SpAn
Unspecified Complications

3 RI12015721 0000624973 AMOY BT TJOK LAI SING 13-09-1980 31 P Jl Rimba Kemuning Lr Kota Palembang JAMKESMAS PUSAT 203 III O14.1 Severe Pre-Eclampsia Tubektomi Dr.Rizani A.SpOG- Dr. Yusni Puspita, 2,357,000
Bhakti No 1592 KFER SpAn

4 RI12016190 0000626600 ATIKA SARI SUBAHA 18 P Jl.Simpang Tenang Kab. Banyuasin JAMKESMAS PUSAT 203 III C53.9 Malignant Neoplasm Of Kuretase Dr. Peby Maulina Dr.Rizal Zanial, 2,321,000
Kel.Seterio Kec. Banyuasin Cervix Uteri, Unspecified Lestari,SpOG SpAn
Iii

5 RI12015870 0000624992 DEDE IRWAN SAMSUDIN 04-04-1959 53 L Jl Sepakat No 44 Kota Palembang JAMSOSKES(SUMSEL 404 III T31.8 Burn Involving 80 - 89% Of Debridement Dr.Iqmal Perlianta, Sp Dr.Rizal Zanial, 3,546,400
SEMESTA) Body Surface BP SpAn

6 RI12016163 0000626568 DR.RULI FITRI AMELIA 23-06-1985 27 P Jl. Inspektur Marzuki Lr. Sei Bengkulu ASKES 201 UT A O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr.Rizal Zanial, 8,680,100
Rawas No.09c Caesarean Section SpAn

7 RI12015921 0000625750 IDA WATI 12-04-1973 39 P Jn.Ratu Sianum Lr.Rh Umar Kota Palembang JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Tubektomi Dr.Rizani A.SpOG- Dr.Rizal Zanial, 2,357,000
No.54d Delivery, Unspecified KFER SpAn

8 RI12016022 0000617972 JAZILAH FADOLI 23-05-1949 63 P Desa Cempedak I Kab. Ogan Ilir ASKES 103 UT C D21.9 Benign Neoplasm Of Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Rizal Zanial, 3,397,500
Connective And Other Soft (K) Onk SpAn
Tissue, Unspecified

9 RI12015725 0000327856 JUSROH BINTI H. 16-07-1953 58 P Jl.Beringin Perumnas Blok Kab. Musi Banyuasin ASKES 104 UT D C20 Malignant Neoplasm Of Miles Operation Dr.Sarup Singh,SpB Dr.Rizal Zanial, 13,125,000
ABDULLAH HAMID A.16 Rectum > Rectal Ampulla SpAn

10 RI12016158 0000626369 LINDA SARI 16-06-1986 25 P Jl Ps Ing Kenayan No 81 Kota Palembang JAMKESMAS PUSAT 203 III O42 Premature Rupture Of Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Rizal Zanial, 6,223,750
Membranes SpOG SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-06-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

11 RI12015862 0000625519 MARLENI 22-05-1965 47 L Prum Prabumulih No. 5 ASKES 105 IA K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.Efman E.U.M, Dr. Yusni Puspita, 16,875,000
M.Kes,SpB-KBD SpAn

12 RI12016167 0000626004 MASNIAH BT M NASIR 01-06-1979 33 P Perum Top Jl Nusa Bakti Kota Palembang JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Iskandar Z, SpOG Dr.Rizal Zanial, 2,321,000
A.12 No.23 Incomplete,With Other And SpAn
Unspecified Complications

13 RI12016118 0000626365 MEHARLIN JANITA 13-01-1991 21 P Jl Sersan Sani Lr Patal No R Kota Palembang ASKES 402 IB K37 Unspecified Appendicitis Appendiktomi Dr.Sarup Singh,SpB Dr.Rizal Zanial, 4,704,050
9 808 SpAn

14 RI12013595 0000618842 MUHAMMAD RIZKY BIN 4 L Desa Sukaraja Kec.Babat UMUM 401 IB S72.9 Fracture Of Femur, Part Nos Orif dr. Ismail Bastomi, Dr. Arliansah, 6,765,500
UMAR DANI Kab.Muaraenim (T.Kk/T.Ktp) SpOT M.Si, Sp.An

15 RI12015936 0000617013 NONAYU BINTI M. TEGUH 05-10-1941 70 P Jl. Kikim Iii Blok R No. 14 Kota Palembang ASKES 102 UT A K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.M.Alsen Dr. Arliansah, 16,875,000
Arlan,SPBO M.Si, Sp.An

16 RI12016185 0000626582 NURHIDAYATI SOPAN 10-08-1982 29 L Komplek Pt.Remco Kota Palembang JAMKESMAS PUSAT 203 III N93.9 Abnormal Uterine And Sectio Cesarea tanpa penyulit Dr. Peby Maulina Dr.Rizal Zanial, 6,223,750
SOPIAN Vaginal Bleeding, Lestari,SpOG SpAn
Unspecified

17 RI12016253 0000626384 NURMAYANA BT RISWANDI 12-08-1982 29 P Jl. Aiptu A Wahab Kota Palembang JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Iskandar Z, SpOG Dr.Rizal Zanial, 2,321,000
Incomplete,With Other And SpAn
Unspecified Complications

18 RI12016054 0000626137 PAJARIAH SURATMAN 27-08-1988 23 P Desun Curup Air Puti Gg. ASKES 201 IB O20.0 Threatened Abortion Kuretase Dr.Nuswil Bernollan, 4,155,450
Guru-Guru SpOG

19 RI12016026 0000625784 RABIL FAIRUZ PRADHITA 11-04-2008 4 L Sinta No. 27 Kab. Muara Enim ASKES 102 UT B H26.9 Catarac, Unspecified Koreksi Strabismus Dr.Linda Trisna, SpM Dr.Rizal Zanial, 8,417,000
SpAn

20 RI12015893 0000625705 SITI HIWANI 18-04-1972 40 P Jl. Nagaswidak Lr. Kicong Kota Palembang JAMKESMAS PUSAT 203 III O83.1 Breech Delivery Tubektomi Dr.Rizani A.SpOG- Dr. Yusni Puspita, 2,357,000
KFER SpAn

21 RI12016107 0000626350 SITI ROHMA 10-10-1982 29 P Jl.Sukarno Hatta Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr. Yusni Puspita, 6,223,750
Lr.Serumpun Caesarean Section SpAn

22 RI12014775 0000622150 TAJUDIN 12-12-1963 48 L Jl.Musi V Blok D-109 Kota Palembang ASKES 401 IA S09.7 Multiple Injuries Of Head Reheacting dr. Ismail Bastomi, Dr.Rizal Zanial, 3,652,500
No.109 (Trauma Capitis) SpOT SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-06-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

23 RI12016214 0000626360 WARISA BT JAIS 01-07-1983 28 P Lk 1 Talang Ilir Kel Kab. Banyuasin JAMSOSKES(SUMSEL 406 III K35 Acute Appendicitis Appendiktomi Dr.Sarup Singh,SpB Dr.Rizal Zanial, 3,565,900
Sukamoro Kec Talang SEMESTA) SpAn
Kelapa Banyuasin

24 RI12016174 0000626464 YENI HARTATI 07-01-1983 29 P Dusun Iii Desa Lebung Kec Kab. Musi Banyuasin JAMKESMAS PUSAT 410 III K35 Acute Appendicitis Appendiktomi Dr.Efman E.U.M, Dr.Rizal Zanial, 3,565,900
Rantau Bayur M.Kes,SpB-KBD SpAn

25 RI12015958 0000173745 YOKE . M. TAREGAN 28-07-1936 75 L Waitam. Pakjo. No. . Jl. Kota Palembang ASKES 402 IB R31 Unspecified Hematuria Penambahan Jasa Dokter Dr.Didit Pramudhito, Dr.Rizal Zanial, 2,283,500
Musi. Blok. N. 17 SPO SpAn

26 RI12015958 0000173745 YOKE . M. TAREGAN 28-07-1936 75 L Waitam. Pakjo. No. . Jl. Kota Palembang ASKES 402 IB R31 Unspecified Hematuria TUR Prostat Dr.Didit Pramudhito, 9,315,500
Musi. Blok. N. 17 SPO

27 RI12015878 0000066381 YUSRIL DWI ANUGRAH 27-07-2001 10 L Jl.Sei Betung Pakjo No 47 Kota Palembang ASKES 402 IA T14.2 Fracture Of Unspecified Orif Dr.Rendra Leonard, Dr. Arliansah, 6,765,500
Body Region SpOT M.Si, Sp.An

28 RI12015872 0000625671 ZAINIMA 16-06-1947 65 P Jl Palembang Jambi Ds Kota Palembang UMUM 401 II A Z09.9 Follow-Up Examination Penambahan Jasa Dokter Dr. Martha Hendry,SpU Dr.Rizal Zanial, 1,125,000
Supat S Lilin After Unspecified Treatment SpAn
For Other Conditions

29 RI12015872 0000625671 ZAINIMA 16-06-1947 65 P Jl Palembang Jambi Ds Kota Palembang UMUM 401 II A Z09.9 Follow-Up Examination URS Dr. Martha Hendry,SpU 9,307,500
Supat S Lilin After Unspecified Treatment
For Other Conditions

Sub T o t a l Rp.: 167,306,050


JLH TINDAKAN KAMAR OPERASI IBS : 29
Tgl Operasi : 02-07-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12016553 0000627533 BUHARI BIN SUHADI 22-08-1979 32 L Jl Karya Jaya No 1405 Kel Kota Palembang JAMSOSKES(SUMSEL 500 III N04.9 Nephrotic Syndrom Amputasi Dr.Kgs Zulkarnain SMF ANESTESI 4,741,000
Lebong Gajah Kec SEMESTA) Muslim,Sp.OT
Sematang Borang
Palembang
2 RI12019360 0000635879 DIAN KOMALA SARI 29-10-1982 30 P Jl Makrayu No 44 Lr Masjid Kota Palembang JAMSOSKES(SUMSEL 405 III S02.2 Fracture Of Nasal Bones Reposisi Hidung Dr.Iqmal Perlianta, Sp SMF ANESTESI 3,260,400
Assalam SEMESTA) BP

3 RI12019239 0000635423 ERMAWATI KEMAS EFENDI 43 P Jlmakrayu Lr.Masjid Asalam Kota Palembang JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr. Patiyus SMF ANESTESI 6,223,750
No 253 Delivery, Unspecified Agustiansyah, SpOG

4 RI12019259 0000635448 HENGKI 14-11-1975 36 L Jl.Lintas Sumatera Kab. Empat Lawang UMUM 401 IA S02.4 Fracture Of Amlar And Repair luka robek sederhana pada Dr.Iqmal Perlianta, Sp Dr.Agustina Br.H, 5,687,500
Kec.Tebing Tinggi Maxillary Bones wajah BP SpAn, M.Kes
Kab.Empat Lawang
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-07-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

5 RI12019246 0000635402 IMACIK AMIRUDIN 33 P Karya Jaya Kec.Kertapati Kota Palembang JAMKESMAS PUSAT 203 III Laparatomi Dr. Patiyus SMF ANESTESI 5,848,700
Palembang(T.Kk/T.Ktp) Agustiansyah, SpOG

6 RI12019275 0000635480 JOHAN BIN MAS. AGUS M 10-08-1969 42 L Jl. Jendrl Sudirman Kampng Kota Lubuk Linggau UMUM 402 II A K60.3 Anal Fistula Fistulektomi / High Anal Dr.Efman E.U.M, Dr.Kusuma 6,011,500
YUNUS D Tegal Rejo Mura M.Kes,SpB-KBD Harimin, SpAn

7 RI12019008 0000634498 JUMADI BIN DAYAT 50 L Desa Sidompo Kec Betung Kab. Banyuasin JAMSOSKES(SUMSEL 410 III Hernioraphy dgn prolenemesh / Dr.Efman E.U.M, SMF ANESTESI 4,002,000
Banyuasin( Tp Kk/Ktp/Td SEMESTA) Komplikasi M.Kes,SpB-KBD
Ada Disimrs )

8 RI12019117 0000635191 LABORA SINAGA BINTI 09-07-1978 34 P Komp.Tri Dharma Permai Kab. Musi Banyuasin JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr. Hj. Fatimah Usman, SMF ANESTESI 6,223,750
T.SINAGA Caesarean Section, SpOG
Unspecified

9 RI12019006 0000633536 MUHALLA PATRIA BIN 23-12-1977 34 P Ds Tj Serian M. Enim Kab. Muara Enim JAMKESMAS PUSAT 409 III K09.2 Other Cyst Of Jaw Exterpasi tumor < 1 cm / 2 el drg.Adi Prabowo SMF ANESTESI 2,030,000
A.RAHMAN J,SpBM

10 RI12019207 0000635387 MURSIDA ARPAN 44 P Bali Makmur Kel.Merah Kab. Banyuasin JAMKESMAS PUSAT 203 III O06.4 Unsp.Abortion Incomplete, Kuretase Dr.Azhari, SpOG SMF ANESTESI 2,321,000
Mata Banyuasin I Banyuasin Without Complication

11 RI12019033 0000632522 MUTMAINAH BINTI 07-01-1991 21 P Jl.Sabar Jaya Mariana Ilir JAMKESMAS PUSAT 404 III D21.9 Benign Neoplasm Of Eksisi drg.Adi Prabowo SMF ANESTESI 3,698,000
MUJIONO Connective And Other Soft J,SpBM
Tissue, Unspecified

12 RI12018875 0000634480 NAZHIFFA AULIA PUTRI 02-10-2011 0 P Jl Merak No 07 Kel Tugu Kab. Muara Enim JAMSOSKES(SUMSEL 407 III K56.1 Intussusception Reseksi Usus Anastomosis Dr.Sindu SMF ANESTESI 8,151,000
Kecil Kec Prabumulih Timur SEMESTA) Saksono,SpBA
Kab Prabumulih

13 RI12017559 0000630647 NOVI RISKA WATI 19-11-1999 12 P Jl Pule Besar Kota Palembang JAMSOSKES(SUMSEL 410 III M86.9 Unspecified (Infection Of Penambahan alat Pisau Skin Dr. Mgs Roni Saleh, Sp SMF ANESTESI 500,000
SEMESTA) Bone Nos) (Periostitis Dermato BP
Without Mention Of
Osteomyelitis)
14 RI12017559 0000630647 NOVI RISKA WATI 19-11-1999 12 P Jl Pule Besar Kota Palembang JAMSOSKES(SUMSEL 410 III M86.9 Unspecified (Infection Of STSG / Skingrafting yang Luas Dr. Mgs Roni Saleh, Sp 3,997,000
SEMESTA) Bone Nos) (Periostitis BP
Without Mention Of
Osteomyelitis)
15 RI12019019 0000634316 PRA YITNO 05-07-1982 30 L Prabahanm Cinta Manis UMUM 403 II B N21.0 Calculus In Bladder URS Dr. Martha Hendry,SpU Dr.Agustina Br.H, 9,307,500
SpAn, M.Kes

16 RI12018943 0000633303 RISKI RIDA UTAMI 16 P Jambi Luar Kota ASKES 105 IA S72.9 Fracture Of Femur, Part Nos Open Reduksi Fraktur / Dislokasi Dr.H.Muzakkie, SpBO Dr.Agustina Br.H, 9,903,500
Lama FICS SpAn, M.Kes
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-07-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

17 RI12019170 0000514289 RISMALARITA BT ROZALI 01-06-1962 50 P Jl Sosial No.640 Kota Palembang PT.ASURANSI JIWA 102 UT B E14.9 Unspecified Diabetes Foto Koagulasi Laser Dr. Ramzi Amin, SpM 2,562,500
INHEALTH INDONESIA Mellitus Without
Complications

18 RI12019085 0000635011 RISYA AURELIA 15-04-2011 1 P Pembangunan No 2460 Kota Palembang UMUM 106 UT B Q35 Cleft Palate Palatoplasty Dr. Mgs Roni Saleh, Sp Dr.Agustina Br.H, 6,349,500
Pakjo BP SpAn, M.Kes

19 RI12017577 0000630669 ROBAYA BT UJANG 13-07-1967 44 P Talang Jambi Kota Palembang UMUM 403 II B D36.7 Benign Neoplasm Of Other Radikal Nephrectomi Dr. Martha Hendry,SpU Dr.Agustina Br.H, 9,275,500
Specified Sites (Nose Nos) SpAn, M.Kes

20 RI12019155 0000635294 SAHRONI RASYA 03-10-2006 5 L Lr Sederhana Kel Sungsang Kab. Musi Banyuasin JAMSOSKES(SUMSEL 408 III T16 Foreign Body In Ear Oesophaguscopi Dr.Sofyan SMF ANESTESI 2,507,000
I SEMESTA) Diagnostik/Broncoscopy Rigit Effendi,SpTHT

21 RI12015465 0000598384 SAHUD BIN KEMIK 29-01-1942 70 L Jl Talang Keramat No 01 Kota Palembang JAMSOSKES(SUMSEL 405 III N40 Hyperplasia Of Prostate Penambahan Jasa Dokter Dr. Martha Hendry,SpU SMF ANESTESI 730,000
SEMESTA)

22 RI12015465 0000598384 SAHUD BIN KEMIK 29-01-1942 70 L Jl Talang Keramat No 01 Kota Palembang JAMSOSKES(SUMSEL 405 III N40 Hyperplasia Of Prostate TUR Prostat Dr. Martha Hendry,SpU 6,297,000
SEMESTA)

23 RI12018763 0000629762 SAPAK BIN MATCIK 20-11-1957 54 L Pelita Ba Iii JAMSOSKES(SUMSEL 405 III K40.9 Unilateral Or Unspecified Hernioraphy dgn prolenemesh / Dr.Efman E.U.M, SMF ANESTESI 4,002,000
SEMESTA) Inguinal Hernia, Without Komplikasi M.Kes,SpB-KBD
Obstruction Or Gangrene

24 RI12018663 0000631194 SATIMAH 07-07-1936 76 P Jl Di Panjaitan Lr Abadi Kota Palembang JAMKESMAS PUSAT 406 III A66.6 Bone And Joint Lesions Of Ganglion Poplitea dr. Ismail Bastomi, SMF ANESTESI 2,730,000
Yaws SpOT

25 RI12018689 0000633986 SUPARNI BIN WIRYO 42 P Ds Keluang Muba Kab. Musi Banyuasin UMUM 403 II B E14.5 Unspecified Diabetes Amputasi Digiti Dr.Rendra Leonard, Dr.Agustina Br.H, 3,613,500
SUNARTO Mellitus With Peripheral SpOT SpAn, M.Kes
Circulatory Complications

26 RI12019049 0000580081 TIUS TU BAGUS 12-01-2006 6 L Kab. Lahat ASKES 403 II B Q54 Hypospadias Uretroplasty Dr. Mgs Roni Saleh, Sp Dr.Agustina Br.H, 10,515,000
Lahat BP SpAn, M.Kes

27 RI12019234 0000635416 ULI SURYANI 33 P Komp.Pdk Blok C No 5 Kota Palembang UMUM 201 II A O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Patiyus Dr.Agustina Br.H, 8,680,100
Caesarean Section Agustiansyah, SpOG SpAn, M.Kes

28 RI12018916 0000633442 YULI MANSYUR 09-07-1957 55 L Rambutan Dalam Kota Palembang UMUM 406 II B H26.9 Catarac, Unspecified Katarak (ICCE / ECCE) Dr. Ramzi Amin, SpM 4,612,500

Sub T o t a l Rp.: 143,781,200


JLH TINDAKAN KAMAR OPERASI IBS : 28
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-07-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12018657 0000036417 SITI AISYAH, NY. 65 P Jl. Sh. Wardoyo 832 Kota Palembang UMUM 706 UT B K80 Cholelithiasis Laparatomy Explorasi Dr.Efman E.U.M, Dr.Agustina Br.H, 9,355,500
M.Kes,SpB-KBD SpAn, M.Kes

2 RI12018657 0000036417 SITI AISYAH, NY. 65 P Jl. Sh. Wardoyo 832 Kota Palembang UMUM 706 UT B K80 Cholelithiasis Pengurangan Jasa Anastesi Dr.Agustina Br.H, -831,200
SpAn, M.Kes

3 RI12018657 0000036417 SITI AISYAH, NY. 65 P Jl. Sh. Wardoyo 832 Kota Palembang UMUM 706 UT B K80 Cholelithiasis Pengurang Jasa Dokter Dr.Efman E.U.M, -2,493,600
M.Kes,SpB-KBD

Sub T o t a l Rp.: 6,030,700


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 3
Tgl Operasi : 02-08-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12022506 0000645861 AL PUTRA BN HERMAN 28 L Jl. Radial No. 05 (Tkk/Tktp) Kota Palembang JAMSOSKES(SUMSEL 407 III K35 Acute Appendicitis Appendiktomi Dr.Efman E.U.M, SMF ANESTESI 3,565,900
SEMESTA) M.Kes,SpB-KBD

2 RI12021239 0000641851 ARIFIN BIN ABDUL ROHIM 18 L Desa Tugu Agung Kab.Oki JAMSOSKES(SUMSEL 407 III S72.9 Fracture Of Femur, Part Nos Orif Dr.H.Muzakkie, SpBO SMF ANESTESI 4,741,000
(T.Kk/T.Ktp) SEMESTA) FICS

3 RI12020687 0000640087 ATAMAL RAMADON 25 L Perumnas Lubuk Tanjung Kota Lubuk Linggau UMUM 402 IA S92.3 Fracture Of Metatarsal Bone Debridement Dr.Iqmal Perlianta, Sp Dr.Zulkipli, SpAn 3,603,500
Kec Sukajadi Kota Lubuk BP
Linggau

4 RI12022413 0000645538 BUDIMAN BIN RUSDI 01-12-1993 18 L Lr Sati Ii Kota Palembang JAMSOSKES(SUMSEL 408 III K12.2 Cellulitis & Abscess Of Biopsi Dr. Lisa Apri Yanti, SMF ANESTESI 2,515,000
SEMESTA) Mouth Sp.THT-KL

5 RI12022068 0000641273 BUNAYAH BT AMANUDIN 12-05-1952 60 P Dsn Iii Muara Gula Lama JAMSOSKES(SUMSEL 405 III K80 Cholelithiasis Kolesistektomi Dr.Sarup Singh,SpB SMF ANESTESI 6,318,000
Ujan Mas M. Enim SEMESTA)

6 RI12022170 0000644826 FAHMI BIN SUDIRMAN 8 L Dsa Tanjung Kerang Kec Kab. Banyuasin JAMSOSKES(SUMSEL 404 III T31.0 Burn Involving Less Than Debridement Dr.Iqmal Perlianta, Sp SMF ANESTESI 2,728,000
Rambutan Kab Banyuasin SEMESTA) 10% Of Body Surface BP

7 RI12022579 0000646105 FARIDA AR 21-06-1978 34 P Jl.Rama Jaya Lr.Rama 10 Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.H.Ferry SMF ANESTESI 6,223,750
No.62 Km.10,5 Smb Ii Caesarean Section Yusrizal,Spog

8 RI12022025 0000644400 GUSMIATI BT SUMITRO 17-08-1969 42 P Lk Iii Kel Sukamoro Kab. Musi Banyuasin JAMSOSKES(SUMSEL 203 III N93.9 Abnormal Uterine And Laparascopy Operatif Dr. Irawan SMF ANESTESI 6,277,000
SEMESTA) Vaginal Bleeding, Sastradinata, SpOG
Unspecified
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-08-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

9 RI12022332 0000645267 H.ASBULAH 19-08-1939 73 L May Mahidin No.200 Plg Kota Palembang UMUM 401 IA K40.9 Unilateral Or Unspecified Hernioraphy dgn prolenemesh / Dr.Sarup Singh,SpB Dr.Zulkipli, SpAn 6,026,500
Inguinal Hernia, Without Komplikasi
Obstruction Or Gangrene

10 RI12022217 0000027722 H.MUSLIM NURDIN 19-10-1937 74 L Mayor Ruslan Lr Nanjungan Kota Palembang ASKES 401 IA S72.9 Fracture Of Femur, Part Nos Orif + Bone Grant dr. Ismail Bastomi, Dr.Zulkipli, SpAn 9,903,500
SpOT

11 RI12021651 0000637198 HALIMAH BT SUKU BALI 25-06-1965 47 P Desa Pengarayan Tanjung Kab. Ogan Komering JAMSOSKES(SUMSEL 404 III C50.9 Malignant Neoplasm Of Biopsi / Insisi Dr.Benny Kusuma, SpB SMF ANESTESI 2,722,000
Lubuk Oki Ilir SEMESTA) Breast, Unspecified (K) Onk

12 RI12022340 0000643810 HOSINA BINTI USMAN 05-08-1972 40 P Pangkalan Balai Banyuasin Kab. Musi Banyuasin UMUM 402 IA I84.9 Unspecified Haemorrhoids Haemorroidektomi Stappler Dr.Efman E.U.M, Dr.Zulkipli, SpAn 6,016,500
Without Complications M.Kes,SpB-KBD

13 RI12021876 0000643577 ICHWAN JUNIAR BIN 21-01-1970 42 L Jl. Sukabangun Ii No. 4858 Kota Palembang JAMSOSKES(SUMSEL 406 III S82.2 Fracture Of Shaft Of Tibia Penambahan Jasa Dokter Dr.Rendra Leonard, SMF ANESTESI 730,000
MARZUKI Sukajaya Sukarami Plg SEMESTA) SpOT

14 RI12021876 0000643577 ICHWAN JUNIAR BIN 21-01-1970 42 L Jl. Sukabangun Ii No. 4858 Kota Palembang JAMSOSKES(SUMSEL 406 III S82.2 Fracture Of Shaft Of Tibia External Fixasi Dr.Rendra Leonard, 4,717,000
MARZUKI Sukajaya Sukarami Plg SEMESTA) SpOT

15 RI12022367 0000639562 ISKANDAR BIN ABDUL MUIT 16-06-1971 41 L Kopi No 17 Taba Lestari Kota Lubuk Linggau ASKES 105 IA K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.M.Alsen Dr.Zulkipli, SpAn 16,875,000
Lubuk Linggau Timur Arlan,SPBO

16 RI12022530 0000645895 LIDIA WATI 21 P Desa Tanjung Dalam Kec Kab. Musi Banyuasin UMUM 201 II A O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Zulkipli, SpAn 8,680,100
Keluang Kab Musi Caesarean Section SpOG
Banyuasin

17 RI12019833 0000557739 M. SATRIA MANDALA 15-04-2010 2 L Jl. Sempayo Gg. Tirtonadi Kota Palembang JAMSOSKES(SUMSEL 409 III Q42.3 Congenital Absence, Atresia Colostomi / lleostomi Dr.Sindu SMF ANESTESI 3,901,000
PUTRA No. 72-85 Kemang Manis SEMESTA) & Stenosis Of Anus Without Saksono,SpBA
Ib. Ii Plg Fistula [Imperfoarte Anus]

18 RI12021866 0000636718 M.SOLEH BIN TOHIR 10-09-1944 67 L Jl Kol H Burlian Lr Peristiwa Kota Palembang JAMSOSKES(SUMSEL 404 III N40 Hyperplasia Of Prostate TUR Prostat Dr.Didit Pramudhito, SMF ANESTESI 6,297,000
No 235 Kel Srijaya Kec SEMESTA) SPO
Sukarami Plg

19 RI12022322 0000638825 MARZUKI AS 15-02-1951 61 L Sentosa No. 05 Kota Palembang ASKES 401 IA R33 Retention Of Urine Penambahan Jasa Dokter Dr.Didit Pramudhito, Dr.Zulkipli, SpAn 3,117,000
SPO

20 RI12022322 0000638825 MARZUKI AS 15-02-1951 61 L Sentosa No. 05 Kota Palembang ASKES 401 IA R33 Retention Of Urine URS Dr.Didit Pramudhito, 9,307,500
SPO
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-08-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

21 RI12022230 0000639153 MAT WAHIT 23-05-1965 47 L Dusun 4 Sungai Medang Kab. Muara Enim UMUM 402 II A H16.0 Keratitis Of Corneal Ulcer Repair Soket Dr.Alie Solahudin, SpM Dr.Zulkipli, SpAn 5,209,000
Cambai

22 RI12021378 0000642269 MUHAMMAD RIZKY 11-05-2012 0 L Jl. Tembok Baru Lr. Sepakat Kota Palembang JAMSOSKES(SUMSEL 203 III P59.9 Neonatal Jaundice Eksplorasi Duktus Dr.Sindu SMF ANESTESI 6,257,000
No. 500 SEMESTA) Unspecified Saksono,SpBA

23 RI12017838 0000594509 NAHAYA BT TOHA 08-01-1940 72 P Desa Muara Abab Rantau Kab. Banyuasin JAMSOSKES(SUMSEL 409 III C50.9 Malignant Neoplasm Of Simple Mastektomi Dr.K.Yamin Alsoph SMF ANESTESI 4,077,000
Bayur Banyuasin SEMESTA) Breast, Unspecified SpBOnk

24 RI12022559 0000646016 NIRWANTO BIN KASMUSRI 21-04-1982 30 L Jl Tnjung Masjid Kel.Tlg Kota Palembang JAMSOSKES(SUMSEL 406 III H18.3 Changes In Corneal Blefaroplasty Dr. Petty Purwanita, SMF ANESTESI 4,592,900
Kelapa Kec. Alang-Alang SEMESTA) Membranes SpM
Lebar Palembang

25 RI12022365 0000640819 NURAINI 05-09-1956 55 P Puskes Katu Agung Kel ASKES 201 IA N83.2 Other & Unspecified Ovarian Radikal Histerektomi Dr.Rizal Sanif, SpOG- Dr.Zulkipli, SpAn 12,500,000
Dana Cyst Konk

26 RI12016614 0000624910 NURIAH BINTI CIK OLA 20-02-1962 50 P Desa Padang Sari Buay JAMSOSKES(SUMSEL 405 III D32.9 Benign Neoplasm Of Craniotomi Dr.Trijoso SMF ANESTESI 6,832,000
Runjung Okus SEMESTA) Meninges, Unspecified Permono,SpBS

27 RI12022077 0000639104 RADITYA PRATAMA PUTRA 27-06-2010 2 L Jl. Sinar Raga Lr. Manggar I Kota Palembang JAMSOSKES(SUMSEL 409 III Q43.1 Hirschprung'S Disease Biopsi / Insisi Dr.Sindu 2,479,000
No. 122 SEMESTA) Saksono,SpBA

28 RI12021573 0000642937 REVALDO BIN SADIMAN 03-03-2012 0 L Jl. Karya Masa Kel Taba Kota Lubuk Linggau JAMSOSKES(SUMSEL 302 III Q43.1 Hirschprung'S Disease Biopsi / Insisi Dr.Sindu 2,479,000
Koji Kec L. Linggau Timur I SEMESTA) Saksono,SpBA

29 RI12022257 0000421092 SUBHAN PARDI 29-08-1969 42 L Letnan Murod No 17 Kota Palembang ASKES 401 IB D36.7 Benign Neoplasm Of Other Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 3,397,500
Specified Sites (Nose Nos) (K) Onk

30 RI12022223 0000125944 YULIANA BINTI MUHTAR 15-02-1958 54 P Km.14 No.L5 02 Perumahan Kab. Banyuasin ASKES 401 II A D21.9 Benign Neoplasm Of Eksisi Tumor Jinak Kiste Ateroma Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 3,398,500
Azhar Permai Connective And Other Soft (K) Onk
Tissue, Unspecified

Sub T o t a l Rp.: 165,487,150


JLH TINDAKAN KAMAR OPERASI IBS : 30
Tgl Operasi : 02-08-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12022510 0000645868 ELMARIO TORA BIN NOVI 2 L Jl Letn Karim Kadir No 515 Kota Palembang JAMSOSKES(SUMSEL 703 III A00.1 Cholera Due To Vibrio Debridement Dr.Iqmal Perlianta, Sp SMF ANESTESI 4,684,550
ANDIKA Kec Gandus (T Kk/ T Ktp) SEMESTA) Cholerae 01, Biovar Eltor BP
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-08-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

2 RI12022507 0000645863 ERWIN PANCA PUTRA 17 L Lr Sabar No 1422 8 Ulu Kota Palembang JAMSOSKES(SUMSEL 703 III S21 Open Wound Of Thorax Pemasangan WSD Dr.Bermansyah, SpB 5,562,000
SEMESTA)

3 RI12022574 0000646097 MASTUTI BT SAIBUL 48 P Talang Andong Kel. Sungai JAMSOSKES(SUMSEL 703 III K65 Peritonitis Laparatomy Explorasi Dr.Sarup Singh,SpB SMF ANESTESI 12,162,150
Rebo Rk.3 Banyu Asin I SEMESTA)

Sub T o t a l Rp.: 22,408,700


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 3
Tgl Operasi : 02-09-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12025248 0000653456 ABDUL AZIZ 64 L Jl Papera Gg Harapan No Kota Palembang UMUM 106 II A K66.0 Peritoneal Adhesions Laparatomi Dr.Sarup Singh,SpB Dr.Fredi Heru 7,740,850
456 Irwanto, Sp.An

2 RI12025377 0000653775 ANDIKA BIN ZAINI 16 L Desa Pagun Dalm Kec Kab. Ogan Ilir JAMSOSKES(SUMSEL 409 III R55 Syncope And Collapse Rekonstruksi Dr.Iqmal Perlianta, Sp SMF ANESTESI 8,214,700
Pemulutan Kab Ogan Ilir SEMESTA) BP

3 RI12025366 0000653771 ARSANDI BIN NASIAT 18 L Desa Tanjung Agung Kab. Ogan Komering UMUM 403 II B T14.1 Open Wound (Luka Tusuk, Biopsi Insisi Dr.Bermansyah, SpB 5,562,000
Kampung 2 Kel Indralaya Ilir Lecet, Potong, Gigit
Kab Ogan Ilir Binatang)

4 RI12025365 0000653764 BUSTAN BIN SAHARUDIN 10-04-1981 31 L Desa Tanjung Dalam Kec Kab. Lahat JAMSOSKES(SUMSEL 410 III S72 Fracture Of Fremur Rekonstruksi Dr.Iqmal Perlianta, Sp SMF ANESTESI 8,214,700
Gumay Talang Kab Lahat SEMESTA) BP

5 RI12025403 0000653815 FAUZIAH LUTFI 1 P Lr Amal No 1377 Kota Palembang JAMSOSKES(SUMSEL 410 III T30 Burn & Corrosion, Body Debridement Dr.Iqmal Perlianta, Sp SMF ANESTESI 3,546,400
RAMADAHANI SEMESTA) Region Unspecified BP

6 RI12025368 0000653783 FITRIANI BT SUKIMAN 34 P Prum Mendala Jl Kimiakec ASKES 201 IB O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Abadi, SpOG Dr.Fredi Heru 8,680,100
Incra Utara Kab Oi Delivery, Unspecified Irwanto, Sp.An

7 RI12025400 0000653835 RINDA PERMATA SARI 07-12-1990 21 P Jl.Ins Marzuki Lr.Bakti Ii Kota Palembang JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG SMF ANESTESI 6,223,750
No.2138 Delivery, Unspecified

8 RI12025552 0000653785 SAIDI PUTRA 12-09-1991 20 L Desa Paku Kec Kayuagung JAMSOSKES(SUMSEL 410 III S09.7 Multiple Injuries Of Head Jahit Plastik Wajah > 10 cm Dr.Iqmal Perlianta, Sp SMF ANESTESI 5,306,600
Kab Oi SEMESTA) (Trauma Capitis) BP

9 RI12025361 0000653766 SITI BADRIAYAH 23 P Dusun Ii Perambahan Baru Kab. Musi Banyuasin JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Iskandar Z, SpOG SMF ANESTESI 2,321,000
Incomplete,With Other And
Unspecified Complications
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-09-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

10 RI12025379 0000649330 SUTINI BT SUJANA 15-08-1977 35 P Jl Padat Karya Perum Griya Kota Palembang JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr. Hj. Fatimah Usman, SMF ANESTESI 6,223,750
Srimulya Blok G 18 Delivery, Unspecified SpOG

11 RI12025371 0000653792 TATIEK RATIN 05-08-1980 32 P Jl Sentosa Lr Talang Kota Palembang ASKES 201 II A O72 Psot Partum Haemorrhage Kuretase Dr.Nuswil Bernollan, Dr.Rizal Zanial, 3,196,500
Kemang No 1434 SpOG SpAn

Sub T o t a l Rp.: 65,230,350


JLH TINDAKAN KAMAR OPERASI IBS : 11
Tgl Operasi : 02-09-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12025370 0000653782 DONI AFRIYANTO 20-04-1989 23 L Lr Binjai No 1537 Kota Palembang JAMSOSKES(SUMSEL 703 III J93 Pneumothorax Biopsi Insisi Dr.Bermansyah, SpB 5,562,000
SEMESTA)

2 RI12025396 0000653751 SOBIRIN BIN SUKAIMI 01-01-1978 34 L Desa Lubuk Atung Kec.Sek Kab. Lahat JAMKESMAS PUSAT 701 III K35 Acute Appendicitis Appendiktomi Dr.Efman E.U.M, SMF ANESTESI 4,704,050
Sung Kab.Lahat M.Kes,SpB-KBD

Sub T o t a l Rp.: 10,266,050


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 2
Tgl Operasi : 02-10-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12028196 0000653302 A. DARMAWAN BIN ... 08-12-1953 58 L Pasar Bawah Lahat Kab. Lahat JAMSOSKES(SUMSEL 409 III C06.9 Malignant Neoplasm Of Eksisi Tumor Jinak Ganglion Dr.Benny Kusuma, SpB SMF ANESTESI 2,551,000
SEMESTA) Mouth, Unspecified (K) Onk

2 RI12024529 0000641515 ABDUL RASYID 20-10-1939 72 L Lesung Batu Muda Kab. Musi Rawas JAMSOSKES(SUMSEL 404 III N35.0 Post-Traumatic Urethral Sache / Litotripsi Dr.Didit Pramudhito, SMF ANESTESI 3,714,000
SEMESTA) Stricture (Childbirth, Injury) SPO

3 RI12025284 0000627371 ANWAR BIN PANI 10-01-1953 59 L Pengabun Dsn I JAMSOSKES(SUMSEL 405 III N35.9 Urethral Syndrome, Sache / Litotripsi Dr.Didit Pramudhito, SMF ANESTESI 3,714,000
SEMESTA) Unspecified (Pinhole SPO
Meatus)

4 RI12028165 0000001949 ASJIAH BINTI SAHNAN 17-08-1952 60 P Jl.Kh.Dahlan No.46 Kota Palembang ASKES 403 II B D21.9 Benign Neoplasm Of Ganglion Poplitea Dr.Iqmal Perlianta, Sp Dr.Agustina Br.H, 3,605,500
Connective And Other Soft BP SpAn, M.Kes
Tissue, Unspecified

5 RI12028385 0000662108 ASMADI BIN TOLAL 10-05-1987 25 L Dsn Iii Muara Batun Jejawi Kab. Ogan Komering JAMSOSKES(SUMSEL 410 III D36.7 Benign Neoplasm Of Other Penambahan Jasa Dokter Dr. Yoan Levia Magdi, SMF ANESTESI 920,000
Oki Ilir SEMESTA) Specified Sites (Nose Nos) Sp THT
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-10-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

6 RI12028385 0000662108 ASMADI BIN TOLAL 10-05-1987 25 L Dsn Iii Muara Batun Jejawi Kab. Ogan Komering JAMSOSKES(SUMSEL 410 III D36.7 Benign Neoplasm Of Other Eksterpasi Kista Dr. Yoan Levia Magdi, 3,742,000
Oki Ilir SEMESTA) Specified Sites (Nose Nos) Sp THT

7 RI12024921 0000651635 AULIA SARI BT BENI 01-09-2011 0 P Jl. Palembang-Jambi Lk Vii Kab. Musi Banyuasin JAMSOSKES(SUMSEL 302 III D68.0 Von Willebrand'S Disease Laparatomi Dr.Didit Pramudhito, SMF ANESTESI 3,930,000
SAPUTRA Kel. Betung Kec. Betung SEMESTA) SPO

8 RI12025644 0000654642 FERA ASTI KESUMA 06-03-1982 30 P Jl Kp Bali Sungai Gerong Jl ASKES 404 II A T30.2 Burn Of Second Degree Debridement Dr.Iqmal Perlianta, Sp Dr.Agustina Br.H, 3,603,500
Tangkil No 1217 Body Region, Unspecified BP SpAn, M.Kes

9 RI12028418 0000663000 HAMIDAH BT HASANUDIN 83 L Jl Ki Azahri Lr Sungai Kota Palembang UMUM 104 UT C Laparaskopik Kolesistektomi Dr.M.Alsen Dr.Agustina Br.H, 16,875,000
Semajit No 53 Arlan,SPBO SpAn, M.Kes

10 RI12028418 0000663000 HAMIDAH BT HASANUDIN 83 L Jl Ki Azahri Lr Sungai Kota Palembang UMUM 104 UT C Pengurang Jasa Dokter Dr.M.Alsen -4,860,000
Semajit No 53 Arlan,SPBO

11 RI12028219 0000661246 HASANUDDIN KT BIN ALWI 05-12-1957 54 L Jl Yuda Yuka No 18 Kota Palembang ASKES 402 IB D21.9 Benign Neoplasm Of Eksisi Tumor Jar Lunak Kecil Dr.Iqmal Perlianta, Sp Dr.Agustina Br.H, 3,397,500
Connective And Other Soft BP SpAn, M.Kes
Tissue, Unspecified

12 RI12027577 0000644154 KARSUDIN BIN AGUSCIK 06-06-1959 53 L Jl.Eka May No.21 Lk.I Kab. Ogan Komering ASKES 102 UT A K80 Cholelithiasis Kolesistektomi Dr.Efman E.U.M, Dr.Agustina Br.H, 9,336,500
Kayuagung Oki Ilir M.Kes,SpB-KBD SpAn, M.Kes

13 RI12027425 0000659247 KMS ABDULLAH PARUJI 05-11-1994 17 L Sultan Agung No 331 Kota Palembang JAMSOSKES(SUMSEL 406 III Z47.0 Folow-Up Care Involving Removal Implant / Remove Flat Dr.H.Muzakkie, SpBO SMF ANESTESI 2,738,000
SEMESTA) Removal Of Fracture Plate & Screw FICS
Other Internal Fixation
Device
14 RI12028447 0000663030 LIANI BT MUSLIM 20 P Desa Ulak Kembahang Ii Kab. Ogan Komering JAMKESMAS PUSAT 203 III Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG SMF ANESTESI 6,223,750
Dusun Ii Ilir

15 RI12028433 0000663018 M. GILANG PRADITYA 12-03-2009 3 L Jl H Aguscik Ayin Dusun Ii Kota Palembang JAMSOSKES(SUMSEL 604 III S39.9 Unspecified Injury Of Laparatomi Dr.Sindu Dr.Kusuma 7,740,850
ALRASYID SEMESTA) Abdomen, Lower Back & Saksono,SpBA Harimin, SpAn
Pelvis

16 RI12028433 0000663018 M. GILANG PRADITYA 12-03-2009 3 L Jl H Aguscik Ayin Dusun Ii Kota Palembang JAMSOSKES(SUMSEL 604 III S39.9 Unspecified Injury Of Laparatomi Dr.Sindu SMF ANESTESI 7,740,850
ALRASYID SEMESTA) Abdomen, Lower Back & Saksono,SpBA
Pelvis

17 RI12028392 0000662962 M. RIZKY RAMADANI 07-09-2010 2 L Jl Tegal Binangun No 76 JAMSOSKES(SUMSEL 302 III Laparatomi Dr.Sindu SMF ANESTESI 5,109,000
Keltalang Bubuk Kec Palju SEMESTA) Saksono,SpBA
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-10-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

18 RI12028383 0000659360 MAULITIA NUR HASANAH 08-07-1999 13 P Ds/Kel. Bumi Makmur Kec. Kab. Ogan Komering JAMSOSKES(SUMSEL 406 III H26.0 Inflantile, Juvenile And Iridektomi Dr.Rusdianto SpM 2,733,000
Mesuji Raya Kab. Oki Ilir SEMESTA) Presenile Catarac

19 RI12028383 0000659360 MAULITIA NUR HASANAH 08-07-1999 13 P Ds/Kel. Bumi Makmur Kec. Kab. Ogan Komering JAMSOSKES(SUMSEL 406 III H26.0 Inflantile, Juvenile And Penambahan Jasa Dokter Dr.Rusdianto SpM SMF ANESTESI 730,000
Mesuji Raya Kab. Oki Ilir SEMESTA) Presenile Catarac

20 RI12028426 0000663011 MAYESI BT ISKANDAR 18 P Jl Makrayu Lr Komp I No 61 Kota Palembang JAMKESMAS PUSAT 203 III N93.9 Abnormal Uterine And Kuretase Dr.Rizani A.SpOG- SMF ANESTESI 2,321,000
Vaginal Bleeding, KFER
Unspecified

21 RI12027623 0000660420 MUHAMMAD RAMANDA 04-06-2001 11 L Jl Sukawinatan Lr Asoka Kota Palembang JAMSOSKES(SUMSEL 406 III Z47.0 Folow-Up Care Involving Orif dr. Ismail Bastomi, 4,741,000
EDIYANSYAH SEMESTA) Removal Of Fracture Plate & SpOT
Other Internal Fixation
Device
22 RI12027623 0000660420 MUHAMMAD RAMANDA 04-06-2001 11 L Jl Sukawinatan Lr Asoka Kota Palembang JAMSOSKES(SUMSEL 406 III Z47.0 Folow-Up Care Involving Penambahan Jasa Dokter dr. Ismail Bastomi, SMF ANESTESI 730,000
EDIYANSYAH SEMESTA) Removal Of Fracture Plate & SpOT
Other Internal Fixation
Device
23 RI12027328 0000246795 MUNDIROH,AR 05-04-1958 54 P Baung 4 No.224 Kota Palembang ASKES 401 IB Z47.0 Folow-Up Care Involving Removal Implant / Remove Flat dr. Ismail Bastomi, Dr.Agustina Br.H, 3,613,500
Removal Of Fracture Plate & Screw SpOT SpAn, M.Kes
Other Internal Fixation
Device
24 RI12028512 0000663341 NENENG BT IPON 26 P Jl Puncak Sekuning No 97 Kota Palembang UMUM 201 IB Z34.0 Supervision Of Normal Sectio Cesarea tanpa penyulit Dr.Zaimursyaf Aziz, Dr.Agustina Br.H, 8,680,100
Pierst Pregnancy SpOG SpAn, M.Kes

25 RI12028362 0000660928 NENGAH SENTAWAN 07-05-1985 27 L Jl. Karya Bakti Desa/Kel. Kab. Musi Banyuasin UMUM 106 UT B Penambahan Jasa Dokter Dr.Abla Ghanie,SpTHT Dr.Agustina Br.H, 1,833,500
Karya Makmur Kec. Nibung SpAn, M.Kes

26 RI12028362 0000660928 NENGAH SENTAWAN 07-05-1985 27 L Jl. Karya Bakti Desa/Kel. Kab. Musi Banyuasin UMUM 106 UT B Fess Dr.Abla Ghanie,SpTHT 9,646,000
Karya Makmur Kec. Nibung

27 RI12028434 0000663019 NUR HAYATI BT TARMAT 20 P Desa Sukaraja Kec Tungkal Kab. Banyuasin JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, SMF ANESTESI 6,223,750
Ilir Kab Banyuasin Caesarean Section SpOG

28 RI12028064 0000421075 NURHAYATI 01-12-1961 50 P Dusun I Rantau Panjang MUBA SEMESTA 409 III C50.9 Malignant Neoplasm Of Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB SMF ANESTESI 2,519,000
Babat Toman Muba Breast, Unspecified (K) Onk

29 RI12024205 0000614803 RANI OKTARI BT 31-10-2004 7 P Tl Keramat Lr Kemuning Kota Palembang JAMSOSKES(SUMSEL 409 III S37.3 Injury Of Urethra Tutup Colostomi / Pro Rotating Dr.Sindu SMF ANESTESI 3,892,000
MUHAMMAD JALI SEMESTA) Saksono,SpBA
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-10-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

30 RI12028347 0000662707 ROGAYA BT SA'AD (ALM) 05-06-1947 65 P Jl Kapten Arivai Lk I Kab. Musi Banyuasin ASKES 401 IB I84.9 Unspecified Haemorrhoids Hernioraphy dgn prolenemesh / Dr.Sarup Singh,SpB Dr.Agustina Br.H, 6,026,500
Without Complications Komplikasi SpAn, M.Kes

31 RI12024851 0000602890 ROKIAH BT MUSTOPA 12-01-1962 50 P Dsn 3 Tl Bungin JAMKESMAS PUSAT 409 III C73 Malignant Neoplasm Of Thyroidektomi / Isthmolobectomy Dr.Benny Kusuma, SpB SMF ANESTESI 6,343,000
Tyroid Gland (K) Onk

32 RI12028430 0000659880 RUSLAH BINTI SANI 11-11-1974 37 P Jl. Pahlawan 12 Ds/Kel Kab. Musi Banyuasin JAMKESMAS PUSAT 203 III O14.1 Severe Pre-Eclampsia Sectio Cesarea tanpa penyulit Dr. Hj. Fatimah Usman, SMF ANESTESI 6,223,750
Petaling Kec. Banyuasin Iii SpOG
Kab. Banyu Asin

33 RI12026613 0000657547 SITI NURYATI 01-08-1960 52 P Dusun 5 Desa Mangsang Kab. Musi Banyuasin MUBA SEMESTA 203 III D27 Benign Neoplasm Of Ovary Surgical Staging Dr. Irawan SMF ANESTESI 6,213,000
Kec Bayung Lincir Sastradinata, SpOG

34 RI12028345 0000655431 SRI DAMAYANTI BT 28-10-1974 37 P Jl Baung Ii No 234 Kota Palembang JAMSOSKES(SUMSEL 203 III N93.9 Abnormal Uterine And Laparascopy Operatif Dr.Abadi, SpOG SMF ANESTESI 6,277,000
HAMDAN. H SEMESTA) Vaginal Bleeding,
Unspecified

35 RI12028508 0000663325 SUTARTI BT SURATMIN 15-06-1969 43 P Desa Iv Pendowoharjo Kel Kab. Banyuasin JAMSOSKES(SUMSEL 406 III H11.0 Other Disolders Of Extirpasi Pterigium + graft ( lokal ) Dr.Ibrahim, SpM 2,470,000
Makaerti Jaya Kab SEMESTA) Conjuctivitas Of Pterygium
Banyuasin

36 RI12026195 0000475320 SYAIRA AULIA BT M. YUSUF 22-08-2007 5 P Gang Kencana Ii Kota Palembang JAMSOSKES(SUMSEL 404 III Q43.1 Hirschprung'S Disease Miomektomi Dr.Sindu SMF ANESTESI 4,525,000
SEMESTA) Saksono,SpBA

37 RI12028389 0000662729 YESSI SILVIANI 08-01-1993 19 P Bengkulu Luar Kota ASKES 402 IA K60.3 Anal Fistula Fistulektomi / High Anal Dr.Sarup Singh,SpB Dr.Agustina Br.H, 6,011,500
SpAn, M.Kes

Sub T o t a l Rp.: 171,834,050


JLH TINDAKAN KAMAR OPERASI IBS : 37
Tgl Operasi : 02-10-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12028498 0000663125 DONI SAPUTRA 12-12-1981 30 L Jl Jend. Sudirman Gg Pelita Kota Palembang JAMSOSKES(SUMSEL 700 II A S68.9 Trumatic Amputation Of Amputasi Dr.Iqmal Perlianta, Sp 7,805,850
No 996 SEMESTA) Wrist And Hand, Level BP
Unspecified

2 RI12028436 0000663023 MUHAMMAD NAJAMUDDIN 31-07-1979 33 L Lr Setia Kawan No 434 Kota Palembang JAMSOSKES(SUMSEL 703 II T14.1 Open Wound (Luka Tusuk, Repair Tendo Penyulit/Arteri dr. Ismail Bastomi, SMF ANESTESI 12,613,250
SEMESTA) Lecet, Potong, Gigit Carotis/Arteri renalis stenosis SpOT
Binatang)

Sub T o t a l Rp.: 20,419,100


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 2
Tgl Operasi : 02-11-2012
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-11-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12031060 0000668018 A.SURHANI,BA 10-08-1939 73 L Banjar Sari Lahat Kab. Lahat ASKES 402 IB N40 Hyperplasia Of Prostate TUR Prostat Dr.Didit Pramudhito, Dr. Yusni Puspita, 9,315,500
SPO SpAn

2 RI12031520 0000672032 ARITA 01-08-1981 31 P Dusun 4 Desa Tanjung Kab. Ogan Ilir JAMKESMAS PUSAT 203 III O00.9 Ectopic Pregnancy, Laparatomi Dr.Iskandar Z, SpOG SMF ANESTESI 5,848,700
Seteko Kec Indra Laya Kab Unspecified
Ogan Ilir

3 RI12031485 0000671863 DIANA BT HAMBALI 09-03-1986 26 P Lk Vi No 98 Kel Jua Jua Kec JAMSOSKES(SUMSEL 410 III K35 Acute Appendicitis Appendiktomi Dr.Sarup Singh,SpB SMF ANESTESI 3,565,900
Kayuagung Kab Ogan SEMESTA)
Komering Ilir

4 RI12031302 0000667993 DIKKI MORPALOKA 04-03-1992 20 L Jl.Opi Cendana No Blok C Kota Palembang ASKES 102 UT B S69.9 Unspecified Injury Of Wrist & STSG / Skingrafting yang Luas Dr.Iqmal Perlianta, Sp Dr. Yusni Puspita, 6,265,500
02 Hand BP SpAn

5 RI12030113 0000648132 ERIKA CORNELLYA 26-08-1964 48 P Curup Bengkulu Luar Kota ASKES 403 II B C50.9 Malignant Neoplasm Of Mastektomi Radikal Dr.Benny Kusuma, SpB Dr. Yusni Puspita, 10,625,000
Breast, Unspecified (K) Onk SpAn

6 RI12031267 0000637160 GUSTINI BIN HM SOHE 18-07-1964 48 P Perumahan Patra Sriwijaya Kota Palembang ASKES 105 IA Sistoscopi Dr.Didit Pramudhito, Dr. Yusni Puspita, 4,375,000
MUNAB Blok Fd 07 SPO SpAn

7 RI12031122 0000438777 HAFIS SUNI PRATAMA 11 L Btn. Mandala Tanjung Enim PT. Batubara Bukit Asam 103 UT C J93 Pneumothorax Orif Dr.Rendra Leonard, Dr. Yusni Puspita, 6,765,500
Tanjung Enim SpOT SpAn

8 RI12031557 0000672091 KARTINI BT ALI FUDIN 27 P Jl Muhajirin 4 No 5090 Kota Palembang JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Azhari, SpOG SMF ANESTESI 6,223,750
Caesarean Section,
Unspecified

9 RI12031218 0000671061 M. LUBIS BIN .... 05-03-1971 41 L Dusun I Desa Sukamulya Kab. Ogan Komering JAMKESMAS PUSAT 405 III C20 Malignant Neoplasm Of Biopsi / Insisi Dr.M.Alsen SMF ANESTESI 2,722,000
Kec Tanjung Lubuk Kab Oki Ilir Rectum > Rectal Ampulla Arlan,SPBO

10 RI12031048 0000304845 MARO BT HASAN 04-06-1975 37 P Pemulutan Selatan JAMKESMAS PUSAT 407 III C50.9 Malignant Neoplasm Of Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB SMF ANESTESI 2,519,000
Breast, Unspecified (K) Onk

11 RI12031511 0000671970 MARWIYAH BT AHMAD 01-03-1971 41 P Lr. Lebak Rejo No 845 Sekip Kota Palembang JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG SMF ANESTESI 6,223,750
Plg. Caesarean Section,
Unspecified

12 RI12030542 0000669143 NELSON SIHOMBING 05-07-1972 40 L Griya Enten Damai F-13 Kota Palembang JAMSOSKES(SUMSEL 410 III S09.7 Multiple Injuries Of Head Penambahan Jasa Dokter Dr.Bermansyah, SpB SMF ANESTESI 3,104,000
SEMESTA) (Trauma Capitis)
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-11-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

13 RI12030542 0000669143 NELSON SIHOMBING 05-07-1972 40 L Griya Enten Damai F-13 Kota Palembang JAMSOSKES(SUMSEL 410 III S09.7 Multiple Injuries Of Head Torakotomi/Torakoplasti Dr.Bermansyah, SpB 10,898,000
SEMESTA) (Trauma Capitis)

14 RI12031042 0000666870 NUNGTJIK DANI 03-09-1948 64 L Jl Azhari 13 Ulu Lr Sentral Kota Palembang ASKES 402 IB N40 Hyperplasia Of Prostate TUR Prostat Dr.Didit Pramudhito, Dr. Yusni Puspita, 9,315,500
Rt 02 Rw 01 SPO SpAn

15 RI12031543 0000672026 REDHO AFKARA SYACH 15-04-2001 11 L Jl Selatan Sungai Rebo Kab. Musi Banyuasin UMUM 106 UT B Orkhidopeksi (Torsio testis) Dr.Didit Pramudhito, Dr. Yusni Puspita, 7,312,500
REZA IBRAHI SPO SpAn

16 RI12031540 0000672066 SAJIYO JOYITNO 63 L Jl Veteran Lk 111 Sida Kab. Ogan Komering PT Pos (Persero) Divrepos 402 II A K40.9 Unilateral Or Unspecified Hernioraphy Dewasa Dr.Efman E.U.M, Dr. Yusni Puspita, 4,650,750
Kersa Kec Kayu Agung Kab Ilir III Palembang Inguinal Hernia, Without M.Kes,SpB-KBD SpAn
Oki Obstruction Or Gangrene

17 RI12031367 0000670602 SAMIJAN BIN FAISO 09-11-1945 67 L Desa Saleh Mulya Muba Kab. Banyuasin UMUM 403 II B R31 Unspecified Hematuria TUR Buli Buli Dr.Didit Pramudhito, Dr. Yusni Puspita, 9,375,500
SPO SpAn

18 RI12031358 0000671493 SERIATI BT SHOLEH 01-06-1965 47 P Desa Ulu Danau Kec Kab. Ogan Komering JAMKESMAS PUSAT 203 III N93.9 Abnormal Uterine And Kuretase Dr.Rizani A.SpOG- SMF ANESTESI 2,321,000
Sindang Danau Kab Oku Ulu Selatan Vaginal Bleeding, KFER
Selatan Unspecified

19 RI12031053 0000665204 SITI ANIS SOLEHA 06-07-1995 17 P Dusun 3 Ds/Kel. Argo Muilyo Kab. Banyuasin JAMKESMAS PUSAT 406 III D16.9 Benign Neoplasm Of Bone Wide Excisi Dr.H.Muzakkie, SpBO SMF ANESTESI 3,513,000
Kec. Muarasugihan Kab. And Articular Cartilage, FICS
Banyuasin Unspecified

20 RI12031420 0000670526 SITI NURJAMILAH. L 05-01-1955 57 P Jl Gotong Royong Ds/Kel. Kota Palembang JAMSOSKES(SUMSEL 406 III H35.6 Retinal Haemmorhage Injeksi Intravitreal Dr. Ramzi Amin, SpM 2,490,000
Purwodadi Kec. Talang SEMESTA)
Kelapa Plg

21 RI12031298 0000667727 SITI SUMA BT SUMRAN 01-07-1947 65 P Ds/Kel. Batu Surau Dusun 1 Kab. Muara Enim JAMSOSKES(SUMSEL 406 III H25.1 Senile Nuclear Cataract Katarak (ICCE / ECCE) Dr.Alie Solahudin, SpM SMF ANESTESI 3,469,000
HADI Kec. Semendo Tengah Kab. SEMESTA)
Muara Enim

22 RI12031410 0000664837 SIYANTO BIN WIRYO.S 13-01-1958 L Desa Tirta Mulya JAMKESMAS PUSAT 408 III C10 Malignant Neoplasm Of Tracheostomi Dr.Sofyan 2,511,000
Oropharynx Effendi,SpTHT

23 RI12031410 0000664837 SIYANTO BIN WIRYO.S 13-01-1958 L Desa Tirta Mulya JAMKESMAS PUSAT 408 III C10 Malignant Neoplasm Of Penambahan Jasa Dokter Dr. Lisa Apri Yanti, SMF ANESTESI 730,000
Oropharynx Sp.THT-KL

24 RI12028966 0000664561 SUCI BT AZAM 19-08-2006 6 P Dusun 2 Desa Ibul Besar Kab. Ogan Ilir JAMSOSKES(SUMSEL 404 III T31.2 Burn Involving 20 - 29% Of STSG / Skingrafting yang Luas Dr.Iqmal Perlianta, Sp SMF ANESTESI 3,997,000
Tiga Kec Pemulutan Kab SEMESTA) Body Surface BP
Ogan Ilir
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-11-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

25 RI12031432 0000663114 TINA YUSDIATI 19-10-1969 43 P Jl Sersan Zaini No 3282 Kota Palembang UMUM 201 UT A C53.9 Malignant Neoplasm Of Miomektomi Dr.Agustria Z,SpOG- Dr. Yusni Puspita, 6,140,500
Cervix Uteri, Unspecified KFM SpAn

26 RI12019385 0000635355 TRI PUJIONO SUTARJO 15 L Desa Muara Burnain I Kab. Ogan Komering JAMSOSKES(SUMSEL 405 III S09.7 Multiple Injuries Of Head Craniotomi Dr.Trijoso SMF ANESTESI 6,832,000
Kec.Lempuingjaya Kab.Oki Ilir SEMESTA) (Trauma Capitis) Permono,SpBS

27 RI12031486 0000671867 UMMI KALSUM 24-11-1990 21 P Rusun Blok 15 Lt 1 No 16 Kota Palembang JAMKESMAS PUSAT 203 III Z34.0 Supervision Of Normal Sectio Cesarea tanpa penyulit Dr.Azhari, SpOG SMF ANESTESI 6,223,750
Pierst Pregnancy

28 RI12030740 0000669718 WAHYU BIN UJANG RENO 25-08-1996 17 L Desa Sri Geni Lama Kec Kab. Ogan Komering JAMKESMAS PUSAT 405 III S72.9 Fracture Of Femur, Part Nos Orif Dr.Kgs Zulkarnain SMF ANESTESI 4,741,000
Kayu Agung Kab Ogan Ilir Muslim,Sp.OT
Komering Ilir

29 RI12031211 0000670978 ZAITUN BINTI SAFA ATNU 22-08-1973 39 P Demang Lebar Daun Pangkal Pinang PT.ASURANSI JIWA 102 UT B Kuretase Dr.Rizal Sanif, SpOG- Dr. Yusni Puspita, 3,196,500
Gg.Damai No 1 INHEALTH INDONESIA Konk SpAn

Sub T o t a l Rp.: 155,270,600


JLH TINDAKAN KAMAR OPERASI IBS : 29
Tgl Operasi : 02-11-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12031495 0000671854 HOIRI BIN SAMSUDIN 27 L Jl Maskrebet Perumahah Kota Palembang JAMKESMAS PUSAT 701 III S21 Open Wound Of Thorax Biopsi Insisi Dr.Bermansyah, SpB 5,562,000
Hero Blok F ( Tanpa Kk N
Ktp )

2 RI12031448 0000671814 SARINAH 45 P Jl May Zen Lr Margoyoso Kota Palembang JAMKESMAS PUSAT 700 III I62.0 Subdural Haemorrhage Craniotomi Dr.Sahat SMF ANESTESI 12,805,650
Kel Sei Selayur Kec Kalidoni (Acute) (Non Traumatic) Edison.S,SpBS

Sub T o t a l Rp.: 18,367,650


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 2
Tgl Operasi : 02-12-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12034475 0000680739 POPO RIZKI GANESHA 30-11-2012 0 L Dusun 05 Ds/Kel. Kab. Ogan Komering JAMKESMAS PUSAT 301 III Q42.3 Congenital Absence, Atresia Colostomi / lleostomi Dr.Sindu SMF ANESTESI 5,071,300
Gumawang Kec. Belitang Ulu Timur & Stenosis Of Anus Without Saksono,SpBA
Kab. Oku Timur Fistula [Imperfoarte Anus]

2 RI12034522 0000680816 ALIAS BIN OKILI 41 L Lr Kelinci No. 05 Kel. Talang Kota Palembang JAMSOSKES(SUMSEL 410 III T14.1 Open Wound (Luka Tusuk, Torakotomi/Torakoplasti Dr.Bermansyah, SpB 10,898,000
Putri Kec. Plaju Plg. SEMESTA) Lecet, Potong, Gigit
Binatang)
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-12-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

3 RI12034522 0000680816 ALIAS BIN OKILI 41 L Lr Kelinci No. 05 Kel. Talang Kota Palembang JAMSOSKES(SUMSEL 410 III T14.1 Open Wound (Luka Tusuk, Penambahan Jasa Dokter Dr.Bermansyah, SpB SMF ANESTESI 3,104,000
Putri Kec. Plaju Plg. SEMESTA) Lecet, Potong, Gigit
Binatang)

4 RI12034550 0000680862 ANDRE BIN INDRAWANI 16 L Jl Sosial No 116 Kel Kota Palembang JAMSOSKES(SUMSEL 405 III T14.6 Injury Of Tendons And Repair Tendo Penyulit/Arteri Dr.Kgs Zulkarnain SMF ANESTESI 8,689,200
Sukabangun SEMESTA) Muscles Of Unspecified Carotis/Arteri renalis stenosis Muslim,Sp.OT
Body Region

5 RI12034506 0000680782 EMILDA BT MURNI 11-03-1973 39 P Jl Merajat Raja Lr Cendana Kota Palembang JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr. Hj. Fatimah Usman, SMF ANESTESI 2,321,000
3 No. 1350 Incomplete,With Other And SpOG
Unspecified Complications

6 RI12034505 0000680786 ISTIQOMAH BIN SUPRIADI 12-11-1994 18 P Jl Merante Kota Palembang JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr. Hj. Fatimah Usman, SMF ANESTESI 6,223,750
Caesarean Section, SpOG
Unspecified

7 RI12033981 0000679261 KRISTIAN OKTAFIA SARI 20 P Jl.Pertanian JAMKESMAS PUSAT 203 III D69.3 Idiophatic Trombo Kuretase Dr. Hj. Fatimah Usman, SMF ANESTESI 2,321,000
Komplk.Sinarosa Badi Blok Cytoppenic Purpura SpOG
E No.1 Kel.Talang Jambi

8 RI12034527 0000680815 M.YUSUF BIN HAJIAN 09-09-1945 67 L Komp Azhar Blok Bb I No 8 Kota Palembang JAMKESMAS PUSAT 410 III K63.1 Perforation Of Intestine Laparatomy Explorasi Dr.Efman E.U.M, SMF ANESTESI 8,238,100
(Nontraumatic) M.Kes,SpB-KBD

9 RI12034714 0000680861 RA.LINDA WATI 07-09-1980 32 P Jl Angkasa No 2574 Kec Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG SMF ANESTESI 6,223,750
Alang2 Lebar Caesarean Section

10 RI12034732 0000680831 RIKA RAHAYU 06-12-1982 30 P Jl Abikusno Cokrosuyso Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr.Rizal Zanial, 6,223,750
Caesarean Section SpAn

11 RI12034495 0000680765 RIKA RAHIM 20 P Jl Macan Lindungan Lr Pangkal Pinang JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG SMF ANESTESI 6,223,750
Tunggal V Delivery, Unspecified

12 RI12034477 0000680732 RIVA KURNIAWAN 6 L Desa Tugu Jaya Kec Kab. Ogan Komering JAMSOSKES(SUMSEL 410 III S09.7 Multiple Injuries Of Head Laparatomi Dr.Sindu SMF ANESTESI 5,109,000
Lempuing Kab Oki Ilir SEMESTA) (Trauma Capitis) Saksono,SpBA

13 RI12034508 0000680785 SURYANI 01-07-1970 42 P Desa Merah Mata Kec Kab. Banyuasin JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Penambahan Jasa Dokter Dr. Hj. Fatimah Usman, SMF ANESTESI 949,000
Banyuasin Kab Banyuasin Caesarean Section SpOG

14 RI12034508 0000680785 SURYANI 01-07-1970 42 P Desa Merah Mata Kec Kab. Banyuasin JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Hj. Fatimah Usman, 6,223,750
Banyuasin Kab Banyuasin Caesarean Section SpOG
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 02-12-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

15 RI12034715 0000680846 YUNA BT ABDUL KADIR 06-07-1991 21 P Jl Ki Marogan Kec JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG SMF ANESTESI 6,223,750
Pemulutan Kab Oi Delivery, Unspecified

16 RI12034307 0000680240 YUSMERI BT HAKI 01-01-1977 35 P Jl Maju Bersama 1 Lr Musi Kab. Musi Banyuasin JAMKESMAS PUSAT 203 III O36.4 Maternal Care For Kuretase Dr.Awan SMF ANESTESI 2,321,000
Intrauterine Death Nurtjachyo,SpOG(=B88
)

Sub T o t a l Rp.: 86,364,100


JLH TINDAKAN KAMAR OPERASI IBS : 16
Tgl Operasi : 03-01-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12000141 0000576177 ANGGI DESTRIYANI 13-12-2001 10 P Betung Banyuasin Kab. Banyuasin ASKES 402 IA J03.9 Acute Tonsillitis, Unspecified Tonsilektomi Dr.Denny SU,SpTHT- 3,125,000
(Follicular) (Gangrenous) KL,MSiMed
(Infective) (Ulcerative)

2 RI12000141 0000576177 ANGGI DESTRIYANI 13-12-2001 10 P Betung Banyuasin Kab. Banyuasin ASKES 402 IA J03.9 Acute Tonsillitis, Unspecified Penambahan Jasa Dokter Dr.Denny SU,SpTHT- Dr.Rose Mafiana, 1,833,500
(Follicular) (Gangrenous) KL,MSiMed SpAn
(Infective) (Ulcerative)

3 RI11034165 0000575510 DESTIANA BT AGUS J 27-12-2011 0 P Jl A.Yani Lrng Mangis No 28 JAMKESMAS PUSAT 301 III Laparatomy Explorasi Dr.Sindu Dr.Rose Mafiana, 6,337,000
Kel. Silaberanti Saksono,SpBA SpAn

4 RI12000135 0000576641 ERLI SETIA BUDI, ST 25-08-1977 34 L Jl. Rawa Jaya Lr. Pmd No ASKES 402 IA S42.0 Fracture Of Clavicle Orif Dr.H.Muzakkie, SpBO Dr.Rose Mafiana, 6,765,500
665 FICS SpAn

5 RI11034395 0000576146 ERMAWATI JUNAIDI 25-11-1953 58 P Jl Ogan Raya No 260 Kota Palembang PLN UB.S2JB Cabang 105 IA E14.9 Unspecified Diabetes Amputasi Dr.Rendra Leonard, Dr.Rose Mafiana, 6,765,500
Perumnas Palembang Mellitus Without SpOT SpAn
Complications

6 RI12000103 0000573297 FITTRI BT RUSTAM 27-06-1984 27 P Desa Terusan Menang Kec Kab. Ogan Komering JAMKESMAS PUSAT 408 III J03 Acute Tonsillitis Tonsil Dr.Puspa Zuleika, Dr.Rose Mafiana, 2,530,000
Sp Padang Kab Oki Ilir SpTHT,M.Kes SpAn

7 RI11034171 0000575378 H. SUBLI AJIS 16-01-1937 75 L Sukarajo Baru Oi ASKES 103 UT C N40 Hyperplasia Of Prostate TUR Prostat Dr. Martha Hendry,SpU Dr.Kusuma 9,315,500
Harimin, SpAn

8 RI12000080 0000576508 IPAN IRAWAN 21 L Jl.Thi Tanjung Siapi Api W JAMSOSKES(SUMSEL 406 III S30.9 Suprficial Injuries Of Pancreotomi / Pankreaktekomi Dr.Efman E.U.M, Dr.Rose Mafiana, 9,538,100
16 SEMESTA) Abdomen, Lower Back & M.Kes,SpB-KBD SpAn
Pelvis, Part Unspecified

9 RI12000200 0000576975 KULIYA BT YUSNANI 24 P Dudun Ii Desa Batu Kucing JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr. Peby Maulina Dr.Fredi Heru 6,223,750
Caesarean Section, Lestari,SpOG Irwanto, Sp.An
Unspecified
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-01-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

10 RI11034280 0000560856 LILI HARYANI 14-10-1969 42 P Ds. Pulau Panggung Kab. Muara Enim JAMSOSKES(SUMSEL 406 III N16* Renal Tubulo-Interstitial Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Rose Mafiana, 2,522,000
Tanjung Agung Muara Enim SEMESTA) Disorders In Diseases (K) Onk SpAn
Classified Elsewhere (Dce)

11 RI12000126 0000575777 M. HARIS 02-01-1998 14 L Jl Baru No 49 Prabumulih ASKES 106 UT B Z47.0 Folow-Up Care Involving Orif Dr.Nur Rachmat Lubis, Dr.Rose Mafiana, 6,765,500
Removal Of Fracture Plate & SpOT SpAn
Other Internal Fixation
Device
12 RI12000112 0000560321 M. NAUVAL ZAKI 07-08-2008 39 L Jl.Sukarela Rt.17 Kota Palembang JAMSOSKES(SUMSEL 406 III H25 Senile Cataract Katarak (ICCE / ECCE) Dr.Rusdianto SpM 3,469,000
SEMESTA)

13 RI12000112 0000560321 M. NAUVAL ZAKI 07-08-2008 39 L Jl.Sukarela Rt.17 Kota Palembang JAMSOSKES(SUMSEL 406 III H25 Senile Cataract Penambahan Jasa Dokter Dr.Rusdianto SpM Dr.Rose Mafiana, 920,000
SEMESTA) SpAn

14 RI11032888 0000279128 M.FAHRI SAPUTRA BIN 26-05-2009 2 L Jl.Kh.Azhari Lrng.Mangdin Kota Palembang JAMKESMAS PUSAT 407 III Q43.1 Hirschprung'S Disease Low Ant.Resection / Pullthrough Dr.Sindu Dr.Rose Mafiana, 6,188,000
FERI. N No.9 Saksono,SpBA SpAn

15 RI11033962 0000574743 M.RIDO PRADANA 20-11-2011 0 L Sri Nanti Sungai Gerong Kab. Musi Banyuasin JAMSOSKES(SUMSEL 302 III I61.9 Intracerebral Haemorrhage, Craniotomi Dr.Sahat Dr.Rose Mafiana, 6,832,000
Banyuasin SEMESTA) Unspecified Edison.S,SpBS SpAn

16 RI12000232 0000577116 MARIZAH SUPARDI 35 P Jl Ali Gatmir Lr Hijriah No.43 Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG 6,223,750
A Caesarean Section

17 RI12000232 0000577116 MARIZAH SUPARDI 35 P Jl Ali Gatmir Lr Hijriah No.43 Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Penambahan Jasa Dokter Dr.Iskandar Z, SpOG Dr.Rose Mafiana, 949,000
A Caesarean Section SpAn

18 RI12000132 0000576879 MISDA 13-01-1965 47 P Jl Proklamasi No 7 UMUM 203 III C50.9 Malignant Neoplasm Of Pengurang Jasa Dokter Dr.Benny Kusuma, SpB -854,400
Breast, Unspecified (K) Onk

19 RI12000132 0000576879 MISDA 13-01-1965 47 P Jl Proklamasi No 7 UMUM 203 III C50.9 Malignant Neoplasm Of Mastektomi Radikal Dr.Benny Kusuma, SpB Dr.Rose Mafiana, 6,342,000
Breast, Unspecified (K) Onk SpAn

20 RI11033382 0000572964 MUHAMMAD ADZANU 10-07-2011 0 L Jl Kenten No 329 Kota Palembang JAMSOSKES(SUMSEL 302 III J18.0 Bronchopneumonia, Hernioraphy Anak Dr.Sindu Dr.Rose Mafiana, 2,654,000
SEMESTA) Unspecified Saksono,SpBA SpAn

21 RI11033349 0000572904 MUR SARDIAH 02-10-1983 28 P Desa Sri Tanjung Kab. Ogan Komering ASKES 201 IB O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Kms.Yusuf E.SpOG Dr.Rose Mafiana, 8,680,100
Ulu Timur Delivery, Unspecified SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-01-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

22 RI11033936 0000574705 MUSTIKA DEWI 41 P Pagar Alam Kota Pagar Alam ASKES 201 IB O80 Single Spontaneous Debulking Dr.Rizal Sanif, SpOG- Dr.Kusuma 9,198,000
Delivery Konk Harimin, SpAn

23 RI12000152 0000576894 PARIDA ALIONG 28 P Jl Di Panjaitan Lr Krluarga JAMKESMAS PUSAT 203 III O60 Preterm Delivery [Onset Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Rose Mafiana, 6,223,750
No.529 (Spontaneous) Of Delivery SpOG SpAn
Before 37 Completed Weeks
Of Gestation]
24 RI12000019 0000576390 PUTERI KUSUMA 11-06-1988 23 P Jl.Punai Ii No27a 8 Ilir Kota Palembang ASKES 102 UT A L02.9 Cutaneous Abscess, URS Dr. Martha Hendry,SpU Dr.Rose Mafiana, 9,307,500
WARDHANI Furuncle And Carbuncle, SpAn
Unspecified

25 RI11034326 0000557694 ROSMALIA BINTI AHMAD 07-11-1989 22 P Sentosa Kota Palembang UMUM 102 UT B O80.9 Single Spontaneous Laparatomi Dr.Rizal Sanif, SpOG- Dr.Kusuma 5,954,500
MAHLI Delivery, Unspecified Konk Harimin, SpAn

26 RI12000142 0000576821 SAKARIA BT KEAMAT 05-06-1947 70 P Ds Awal Terusan Kec. Sp Kab. Ogan Komering JAMKESMAS PUSAT 406 III H16.0 Keratitis Of Corneal Ulcer Krato Plastie Lamelar Dr.Anang Tribowo, Dr.Rose Mafiana, 4,592,900
Padang Oki Ilir SpM SpAn

27 RI12000136 0000576748 SAPTONO SISWANTO 05-02-1969 42 L Betung No. 56 Betung ASKES 401 IB K40.9 Unilateral Or Unspecified Hernioraphy dgn prolenemesh / Dr.Efman E.U.M, Dr.Rose Mafiana, 6,026,500
Inguinal Hernia, Without Komplikasi M.Kes,SpB-KBD SpAn
Obstruction Or Gangrene

28 RI12000215 0000577000 SOLEH 42 L Desa Tanjung Kerang Kab. Banyuasin UMUM 405 II B T14.1 Open Wound (Luka Tusuk, Explorasi ( Non Thorax ) Dr.Bermansyah, SpB Dr.Fredi Heru 16,066,050
Rambutan Banyuasin Lecet, Potong, Gigit Irwanto, Sp.An
Binatang)

29 RI11031340 0000564203 SRI HANDAYANI 20-12-1976 34 P Lk. I Sukajadi JAMSOSKES(SUMSEL 409 III D21.9 Benign Neoplasm Of Rekonstruksi Dr.Benny Kusuma, SpB Dr.Rose Mafiana, 6,319,000
SEMESTA) Connective And Other Soft (K) Onk SpAn
Tissue, Unspecified

30 RI11033805 0000574178 SULASTRI MULYADI 18-08-1976 35 P Dusun Ii Rt.08 Muara JAMKESMAS PUSAT 203 III O72 Psot Partum Haemorrhage Laparascopi Diagnostik Dr.Rizal Sanif, SpOG- Dr.Rose Mafiana, 2,357,000
Teladan Kec.Sekayu Konk SpAn
Kab.Muba

31 RI12000308 0000577350 SUMAYATI RUSLI 47 L Desa Segayang-Kec Kab. Muara Enim UMUM 405 II B D24 Benign Neoplasm Of Breast Biopsi Insisi Dr.Bermansyah, SpB 6,568,000
Gelumbang Muara Enim

32 RI11034038 0000553640 TITI SURYANI 28-10-1975 36 L Desa Tanjung Menang Luar Kota UMUM 403 II B N21.1 Calculus In Urethra Extracorporeal Shock Wave Dr. Martha Hendry,SpU 6,637,500
Litotripsi

33 RI11032149 0000567663 UMAYA BT SERMA 17-05-1955 56 P Desa Ramah Kasih Muara Kab. Ogan Ilir JAMSOSKES(SUMSEL 203 III C56 Malignant Neoplasm Of Biopsi Insisi Dr.Bermansyah, SpB 3,950,500
Kuang Ogan Ilir SEMESTA) Ovary
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-01-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

34 RI12000253 0000577281 YANTI RUSMIN 23 P Betung Banyu Asin JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Iskandar Z, SpOG Dr.Rose Mafiana, 3,017,300
Incomplete,With Other And SpAn
Unspecified Complications

35 RI12000220 0000577004 YULIAWATI BINTI MARSUP 13-07-1981 30 P Jl Sei Tawar Iii No 168 Kota Palembang JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr. Peby Maulina Dr.Fredi Heru 6,223,750
Delivery, Unspecified Lestari,SpOG Irwanto, Sp.An

Sub T o t a l Rp.: 195,567,050


JLH TINDAKAN KAMAR OPERASI IBS : 35
Tgl Operasi : 03-01-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12000314 0000577379 RIAN FAROKA 20 L Indralaya-Ogan Ilir Kab. Ogan Ilir JAMSOSKES(SUMSEL 701 II S42.0 Fracture Of Clavicle Biopsi Insisi Dr.Bermansyah, SpB 5,562,000
SEMESTA)

2 RI12000314 0000577379 RIAN FAROKA 20 L Indralaya-Ogan Ilir Kab. Ogan Ilir JAMSOSKES(SUMSEL 701 II S42.0 Fracture Of Clavicle Penambahan Jasa Dokter dr. Ismail Bastomi, 1,287,000
SEMESTA) SpOT

3 RI12000210 0000576989 SAMSUAR 42 L Jl.Desa Lebung Gajah Kab. Ogan Komering JAMKESMAS PUSAT 702 III S82.9 Fracture Of Lower Leg,Part Debridement Dr.H.Muzakkie, SpBO Dr.Rose Mafiana, 3,546,400
Kecamatan Tulung Selapan Ilir Unspecified FICS SpAn
Oki

4 RI12000196 0000576973 TN. THAMRIN 51 L Jl K.H Azhari Lr Sungai JAMKESMAS PUSAT 702 III K40.9 Unilateral Or Unspecified Hernioraphy Dewasa Dr.Efman E.U.M, Dr.Fredi Heru 3,512,600
Lumpur Darat No 47 Inguinal Hernia, Without M.Kes,SpB-KBD Irwanto, Sp.An
Obstruction Or Gangrene

Sub T o t a l Rp.: 13,908,000


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 4
Tgl Operasi : 03-02-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12003438 0000587044 DEWI RATNA 08-01-1976 36 P Jl. May. Zen Lr. Perintis Sei Kota Palembang JAMSOSKES(SUMSEL 406 III K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.Efman E.U.M, Dr. Yusni Puspita, 16,875,000
Selincah Kalidoni SEMESTA) M.Kes,SpB-KBD SpAn

2 RI12003363 0000582291 DIAN TRI ANTARI 26-01-1974 38 P Kap Dulhak No 356 Kab. Muara Enim Pertamina EP (Limau) 102 UT B J93 Pneumothorax Penambahan Jasa Dokter Dr.Bermansyah, SpB Dr. Yusni Puspita, 5,502,000
Prabumulih SpAn

3 RI12003363 0000582291 DIAN TRI ANTARI 26-01-1974 38 P Kap Dulhak No 356 Kab. Muara Enim Pertamina EP (Limau) 102 UT B J93 Pneumothorax sternotomi Dr.Bermansyah, SpB 16,175,500
Prabumulih
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-02-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

4 RI12003361 0000585277 DIKI ZULKARNAIN 28-08-2000 11 L Padat Karya JAMSOSKES(SUMSEL 406 III D36.7 Benign Neoplasm Of Other Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr. Yusni Puspita, 2,522,000
SEMESTA) Specified Sites (Nose Nos) (K) Onk SpAn

5 RI12003625 0000378174 ERNANI 40 P Desa Ulak Jeremun Sp Kab. Ogan Komering ASKES 201 IB N93.9 Abnormal Uterine And Laparascopy Operatif - Dr.Rizal Sanif, SpOG- Dr. Yusni Puspita, 3,125,000
Padang Oki Ilir Vaginal Bleeding, Histeroskopi Konk SpAn
Unspecified

6 RI12002726 0000582464 FARIDA BT NANANG 13-02-1970 41 P Lr Perigi Darat No 354 JAMKESMAS PUSAT 404 III K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.Efman E.U.M, Dr.Zulkipli, SpAn 16,875,000
M.Kes,SpB-KBD

7 RI12002857 0000583139 FESTY CLARA 03-12-1982 29 P Jl Mawar No. 18 Talang Kota Palembang ASKES 403 II B T14.3 Dislocation, Sprain And Orif Dr.H.Muzakkie, SpBO Dr. Yusni Puspita, 6,765,500
Ratu Lr.Tanjung Train Of Unspecified Body FICS SpAn
Region

8 RI12003243 0000582882 H.M JOHAN 03-02-1947 65 L Jl. Perguruan Dalam Kota Palembang UMUM 406 II B H40.1 Primary Open-Angle Trabekulektomi Dr.Fidalia, SpM 4,544,500
No.1860 Glaucoma

9 RI12001688 0000580688 HAMIDAH BT M. ARIF 06-06-1970 41 P P Griya Nulya Blok C No 03 JAMSOSKES(SUMSEL 408 III S11.2 Open Wound Involving Ganti Kanul Dr.Sofyan 2,317,000
SEMESTA) Pharynx And Cervical Effendi,SpTHT
Oesophaggus

10 RI12003481 0000587416 HARSINI DRA 14-07-1958 53 P Komplek Mutiara Gandus Kota Palembang ASKES 408 II B T16 Foreign Body In Ear Oesophaguscopi Dr. Yoan Levia Magdi, Dr. Yusni Puspita, 4,011,000
Blok B 06 Diagnostik/Broncoscopy Rigit Sp THT SpAn

11 RI12003439 0000252143 HARTONO RAJIKIN 08-08-1946 65 L Putri Rambut Selako Kota Palembang ASKES 402 II A K40.9 Unilateral Or Unspecified Hernioraphy dgn prolenemesh / Dr.Efman E.U.M, Dr. Yusni Puspita, 6,026,500
No.1711 Inguinal Hernia, Without Komplikasi M.Kes,SpB-KBD SpAn
Obstruction Or Gangrene

12 RI12003278 0000586754 HENDRI 28-10-1996 15 L Ds Suka Damai JAMSOSKES(SUMSEL 505 III D14.3 Benign Neoplasm Of Biopsi Insisi Dr.Bermansyah, SpB 3,950,500
SEMESTA) Bronchus And Lung

13 RI12003726 0000588205 JAMALUDIN 48 L Btn Air Paku Kuara Enim UMUM 402 IA S82.2 Fracture Of Shaft Of Tibia Orif Dr.Rendra Leonard, Dr. Yusni Puspita, 8,795,150
SpOT SpAn

14 RI12003341 0000563464 M. HARIS SAPUTRA 27-09-1995 16 L Jl. Pangeran Ratu Kota Palembang JAMSOSKES(SUMSEL 407 III Z47.0 Folow-Up Care Involving Angkat K-Nail / Remove Flat Screw Dr.H.Muzakkie, SpBO Dr. Yusni Puspita, 2,730,000
SEMESTA) Removal Of Fracture Plate & FICS SpAn
Other Internal Fixation
Device
15 RI12003477 0000579196 MARTINI BT WARSIDO 02-10-1938 73 P Rsn Blok 06 Lt I No 06 JAMKESMAS PUSAT 203 III N81.4 Uterovaginal Prolapse, Hystrectomi Pervagina (TVH) Dr.Amir Fauzi, SpOG Dr. Yusni Puspita, 6,228,000
Unspecified SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-02-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

16 RI12001758 0000582154 NY NUR HAYATI 50 P Jl Dwikora 2 No 11 JAMSOSKES(SUMSEL 404 III S82.2 Fracture Of Shaft Of Tibia Reposisi Tertutup Dr.Rendra Leonard, Dr. Yusni Puspita, 2,738,000
SEMESTA) SpOT SpAn

17 RI12001942 0000577464 RESKI HERDIANSYAH 10-05-2002 9 L Kota Padang Bengkulu JAMKESMAS PUSAT 406 III Q54.9 Hypospadias, Unspecified Uretroplasty Dr. Mgs Roni Saleh, Sp Dr. Yusni Puspita, 7,806,000
BP SpAn

18 RI11034313 0000575484 SARIJAN BIN RASMO 13-01-1949 70 L Jl.Kimerogan Lr.Pendawa Kota Palembang JAMSOSKES(SUMSEL 405 III N40 Hyperplasia Of Prostate Prostatectomi Dr. Martha Hendry,SpU Dr. Martha 3,692,000
Kel.Kemas Rindo Kec.Su I SEMESTA) Hendry,SpU

19 RI12003574 0000587540 SHINTA NURUL HASANAH 27-01-1986 26 P Palembang Kota Palembang Bank Mandiri No. 419 201 IA D25.9 Leiomyoma Of Uterus, Miomektomi Dr.Amir Fauzi, SpOG Dr. Yusni Puspita, 6,140,500
Palembang Unspecified SpAn

20 RI12003535 0000587571 SITI PATIMA 01-03-1983 28 P Desa Tanjung Lago Kab. Banyuasin JAMKESMAS PUSAT 203 III O07.0 Failed Medical Abortion, Kuretase Dr.Kms.Yusuf E.SpOG Dr. Yusni Puspita, 3,017,300
Banyuasin Complicated By Genital SpAn
Tract & Pelvic Infection

21 RI12001769 0000582184 SITI ROHANA 39 P Jl Desa Noman Baru JAMSOSKES(SUMSEL 408 III T36 Poisoning By Sistemic Oesophaguscopi Dr. Yoan Levia Magdi, Dr. Yusni Puspita, 2,507,000
SEMESTA) Antibiotics Diagnostik/Broncoscopy Rigit Sp THT SpAn

22 RI12001812 0000549570 YANTI EMARIYANTO 22-12-1975 36 P Lr Pegagan No 2366 JAMSOSKES(SUMSEL 405 III C50.9 Malignant Neoplasm Of Simple Mastektomi Dr.Benny Kusuma, SpB Dr. Yusni Puspita, 4,077,000
SEMESTA) Breast, Unspecified (K) Onk SpAn

23 RI12003644 0000587971 ZALNA SAHIRA 23 P Jl Sriwijaya Negara Rt 33 JAMKESMAS PUSAT 203 III O42 Premature Rupture Of Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG Dr.Zulkipli, SpAn 6,223,750
Rw 11 Lr Hasan As Kec Ib 1 Membranes

Sub T o t a l Rp.: 142,644,200


JLH TINDAKAN KAMAR OPERASI IBS : 23
Tgl Operasi : 03-02-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12003687 0000588001 ABDUL 7 L Desa Cempaka Kec Kab. Ogan Komering JAMSOSKES(SUMSEL 702 III S52.8 Fracture Of Other Parts Of Debridement Dr.H.Muzakkie, SpBO Dr.Zulkipli, SpAn 3,546,400
Cempaka-Oku Timur Ulu Timur SEMESTA) Forearm FICS

2 RI12003620 0000587934 JIHAN AZZAHRA 1 P Ds 2 Rengas 2 Payaraman JAMSOSKES(SUMSEL 702 III T31.1 Burn Involving 10 - 19% Of Debridement Dr.Iqmal Perlianta, Sp 3,230,500
Oi SEMESTA) Body Surface BP

3 RI12003657 0000587978 M. CHAIR SUHENDRA 15 L Jl Gubah Atas Rt 28 29 Ilir Kota Palembang JAMSOSKES(SUMSEL 702 III J94.2 Haemothorax Penambahan Jasa Dokter Dr.Bermansyah, SpB 3,104,000
Ib 2 SEMESTA)
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-02-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

4 RI12003657 0000587978 M. CHAIR SUHENDRA 15 L Jl Gubah Atas Rt 28 29 Ilir Kota Palembang JAMSOSKES(SUMSEL 702 III J94.2 Haemothorax Torakotomi/Torakoplasti Dr.Bermansyah, SpB Dr.Fredi Heru 14,167,400
Ib 2 SEMESTA) Irwanto, Sp.An

5 RI12003683 0000588009 NAWAWI 70 L Jl Jakabaring Kota Palembang JAMSOSKES(SUMSEL 702 III S72.0 Fracture Of Neck Of Femur Debridement dr. Ismail Bastomi, Dr. Yusni Puspita, 2,728,000
SEMESTA) SpOT SpAn

Sub T o t a l Rp.: 26,776,300


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 5
Tgl Operasi : 03-03-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12006679 0000592566 ANDRIANA BT 14-05-1986 25 P Lr. Swadaya No. 43 Kota Palembang JAMKESMAS PUSAT 203 III O00.9 Ectopic Pregnancy, Sectio Cesarea tanpa penyulit Dr.Abadi, SpOG Dr. Yusni Puspita, 6,223,750
SUPRIANSYAH Unspecified SpAn

2 RI12006531 0000596727 ANIMAR MUSTAFA 17-04-1947 64 P Jl Way Hitam Musi 7 No 12 Kota Palembang ASKES 404 IB S42.3 Fracture Of Shaft Of Arthoplasty dr. Ismail Bastomi, Dr.Fredi Heru 18,125,000
Humerus SpOT Irwanto, Sp.An

3 RI12006792 0000597453 H.ABDULLAH SUGANDA 85 L Jl.Lingkar Barat No.55 ASKES 601 UT A K63.1 Perforation Of Intestine Laparatomi Dr.Efman E.U.M, Dr.Rizal Zanial, 7,740,850
(Nontraumatic) M.Kes,SpB-KBD SpAn

4 RI12006730 0000597254 HAMIDA BT ABDUL HAMID 38 P Jl Kh. Azhari Lr Agung 1 No Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Penambahan Jasa Dokter Dr.Iskandar Z, SpOG Dr.Rizal Zanial, 949,000
10 Caesarean Section SpAn

5 RI12006730 0000597254 HAMIDA BT ABDUL HAMID 38 P Jl Kh. Azhari Lr Agung 1 No Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG 6,223,750
10 Caesarean Section

6 RI12006661 0000597087 ISTI ROKAH BT M.HARUN 25 P Jl Ki Kemas Rindo Lr Kota Palembang UMUM 201 IA O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr. Yusni Puspita, 8,680,100
Sepupu Caesarean Section, SpOG SpAn
Unspecified

7 RI12006624 0000596929 MAHMUDIN 53 L Jl Yos Sudarso Lubuk Kota Lubuk Linggau ASKES 407 II B S42.4 Fracture Of Lower End Of Fraktur Kompleks Dr.H.Muzakkie, SpBO Dr.Rizal Zanial, 9,644,500
Linggau Humerus FICS SpAn

8 RI12006721 0000597231 NURHASANAH 24 P Jl Sosial Rt 4 Rw 1 JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Abadi, SpOG Dr.Rizal Zanial, 2,321,000
Sukabngun Sukarami Incomplete,With Other And SpAn
Unspecified Complications

9 RI12005980 0000594935 ROMI SATRIA PUTRA 19 L Jl Sabar Jaya Kel Perajen Kab. Banyuasin JAMSOSKES(SUMSEL 407 III K65 Peritonitis Laparatomi Dr.Sarup Singh,SpB Dr.Rizal Zanial, 5,109,000
Banyuasin I SEMESTA) SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-03-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

10 RI12006712 0000597216 ROSITA 23 P Ds Talang Tengah Kec Kab. Banyuasin JAMKESMAS PUSAT 203 III O72 Psot Partum Haemorrhage Manual Placenta Dr.Abadi, SpOG Dr. Yusni Puspita, 3,064,100
Rambutan Banyuasin SpAn

11 RI12006592 0000120931 ROY ISKANDAR 14-02-1986 26 L Pt Pws Kebun Sungai PT. Pinang Witmas Sejati 403 II B Z47.0 Folow-Up Care Involving Angkat K-Nail / Remove Flat Screw dr. Ismail Bastomi, Dr.Rizal Zanial, 3,605,500
Melayu Removal Of Fracture Plate & SpOT SpAn
Other Internal Fixation
Device
12 RI12006680 0000597155 SUGIANI BT MAHFUD 22 P Desa Sukatani Kec Tanjung Kab. Banyuasin JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Rizal Zanial, 6,223,750
Lago Banyuasin Caesarean Section, SpOG SpAn
Unspecified

Sub T o t a l Rp.: 77,910,300


JLH TINDAKAN KAMAR OPERASI IBS : 12
Tgl Operasi : 03-03-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12006937 0000597948 DEDI GUSTOMI 32 L Jl.Mangkubumi Lr.Jadi No Kota Palembang JAMKESMAS PUSAT 702 III K36 Other Appendicitis (Chronic, Appendiktomi Dr.Sarup Singh,SpB Dr.Rizal Zanial, 2,743,000
02 Reccurent) SpAn

2 RI12006706 0000597204 M.FAIZ 1 L Lrg Manggis Rt 18 Rw 4 Kel JAMSOSKES(SUMSEL 702 III K40.9 Unilateral Or Unspecified Hernioraphy Dewasa Dr.Sindu Dr. Yusni Puspita, 3,512,600
Seleberanti Kec Su 1 SEMESTA) Inguinal Hernia, Without Saksono,SpBA SpAn
Obstruction Or Gangrene

3 RI12006697 0000597179 SYARIF HIDAYATULLAH 03-06-2003 8 L Dusun Ii Sungai Lilin MUBA SEMESTA 702 III Z47.0 Folow-Up Care Involving Debridement dr. Ismail Bastomi, Dr. Yusni Puspita, 3,546,400
Kel.Suka Maju Kab.Muba Removal Of Fracture Plate & SpOT SpAn
Other Internal Fixation
Device
4 RI12006759 0000597342 WULANDARI 16 P Jl Desa Sukaraja - Kab. Banyuasin JAMSOSKES(SUMSEL 701 III S62.4 Multiple Fractures Of Debridement dr. Ismail Bastomi, Dr.Rizal Zanial, 4,684,550
Banyuasin Iii SEMESTA) Metacarpal Bones SpOT SpAn

Sub T o t a l Rp.: 14,486,550


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 4
Tgl Operasi : 03-04-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12006359 0000596119 ZUBAIDAH A .HAMID 10-07-1945 66 P Jl Lebak Rejo Lr Bahagia No Kota Palembang ASKES 401 IB T14.2 Fracture Of Unspecified Arthoplasty Dr.Nur Rachmat Lubis, Dr.Rose Mafiana, 18,125,000
1048 Body Region SpOT SpAn

2 RI12008187 0000530115 BANI HETI 02-02-1989 23 L Mataram Ujung JAMSOSKES(SUMSEL 409 III C85.9 Non-Hodgkin'S Lymphoma, Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB Dr.Rose Mafiana, 2,519,000
SEMESTA) Unspecified Type (K) Onk SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-04-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

3 RI12008210 0000602035 BINTORO 42 L Desa Simpang Sari Kec MUBA SEMESTA 404 III T31.7 Burn Involving 70 - 79% Of Debridement Dr.Iqmal Perlianta, Sp Dr.Rose Mafiana, 2,728,000
Babat Toman Keb Muba Body Surface BP SpAn

4 RI12008956 0000416068 BUDI ONO DEBBY 15-09-1973 38 L Lingkungan Mandala T. Kab. Muara Enim JAMSOSKES(SUMSEL 500 III D68.0 Von Willebrand'S Disease Bius Umum /Spinali untuk Dr.Rose Mafiana, SpAn 2,114,000
WARDIAN DINI Enim SEMESTA) menentukan diagnostik

5 RI12008569 0000603195 BY.MELIANI 0 P Jl.Way Hitam Lr.Family 1 Kota Palembang JAMKESMAS PUSAT 603 III P22.0 Respiratory Distress Thoracotomi Dr.Sindu 9,224,500
No.1374 Syndrome Of Newborn Saksono,SpBA

6 RI12008569 0000603195 BY.MELIANI 0 P Jl.Way Hitam Lr.Family 1 Kota Palembang JAMKESMAS PUSAT 603 III P22.0 Respiratory Distress Penambahan Jasa Dokter Dr.Sindu Dr.Rose Mafiana, 3,117,000
No.1374 Syndrome Of Newborn Saksono,SpBA SpAn

7 RI12009744 0000601050 DESMAWATI BT H 21-03-1985 27 P Jl.Hulubalang Ii. 66 Lebak Pangkal Pinang JAMSOSKES(SUMSEL 203 III N85.8 Cyst Endometrium Penambahan Jasa Dokter Dr.Kms.Yusuf E.SpOG Dr.Rose Mafiana, 730,000
SUDIRMAN Sari No.3512 SEMESTA) SpAn

8 RI12009744 0000601050 DESMAWATI BT H 21-03-1985 27 P Jl.Hulubalang Ii. 66 Lebak Pangkal Pinang JAMSOSKES(SUMSEL 203 III N85.8 Cyst Endometrium Penambahan Jasa Dokter Dr.Kms.Yusuf E.SpOG Dr.Rose Mafiana, 730,000
SUDIRMAN Sari No.3512 SEMESTA) SpAn

9 RI12009744 0000601050 DESMAWATI BT H 21-03-1985 27 P Jl.Hulubalang Ii. 66 Lebak Pangkal Pinang JAMSOSKES(SUMSEL 203 III N85.8 Cyst Endometrium Laparascopy Operatif Dr.Abadi, SpOG 6,277,000
SUDIRMAN Sari No.3512 SEMESTA)

10 RI12009792 0000607148 EMALILIAN 28-02-1982 30 P Jl. Singedekane Ll Vi No Kab. Ogan Komering ASKES 201 II A O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr.Rose Mafiana, 8,680,100
22-Jua Jua-Kayu Agung Ilir Delivery, Unspecified SpAn

11 RI12004932 0000591711 ENDANG 04-05-1994 18 L Ds Banjar Sari Kec Merapi Kab. Lahat JAMSOSKES(SUMSEL 406 III S34.1 Other Injury Of Lumbar Revisi Orif Dr.Rendra Leonard, Dr.Rose Mafiana, 2,738,000
Timur Lahat SEMESTA) Spinal Cord SpOT SpAn

12 RI12009501 0000603172 FIRMA YUDHI 27-08-1965 46 L Sei Hitam No. 95 Kota Palembang ASKES 403 II B D21.9 Benign Neoplasm Of Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB Dr.Rose Mafiana, 3,394,500
Connective And Other Soft (K) Onk SpAn
Tissue, Unspecified

13 RI12009007 0000604500 FIRMANSYAH 20 L Desa Benuang Kec.Talang JAMSOSKES(SUMSEL 410 III S09.9 Unspecified Injury Of Head Craniotomi Dr.Sahat Dr.Rose Mafiana, 6,832,000
Ubi Kab.Muaraenim SEMESTA) Edison.S,SpBS SpAn

14 RI12009759 0000606541 HERI YANTO 06-04-1990 22 L May Surbi Bustam No 3921 Kota Palembang UMUM 402 II A Q43.6 Congenital Fistula Of Eksisi Tumor Jar Lunak Kecil Dr.Sarup Singh,SpB Dr.Rose Mafiana, 3,397,500
Plg Rectum And Anus SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-04-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

15 RI12009584 0000606428 IBRAHIM LIEM 13-08-1960 51 L Talang Jawa No.23 Muara Kab. Muara Enim ASKES 503 II B E14.9 Unspecified Diabetes Debridement dr. Ismail Bastomi, Dr.Rose Mafiana, 3,603,500
Enim Mellitus Without SpOT SpAn
Complications

16 RI12008188 0000598074 IDA LAIALAH 14-03-1972 40 P Rama Raya No 067 Km 10.5 JAMSOSKES(SUMSEL 405 III D24 Benign Neoplasm Of Breast Wide Excisi Dr.Benny Kusuma, SpB Dr.Rose Mafiana, 3,513,000
SEMESTA) (K) Onk SpAn

17 RI12009713 0000599686 ILAWATI BT DAMIRI 11-01-1968 44 P Pedamaran Vi JAMKESMAS PUSAT 203 III N83.2 Other & Unspecified Ovarian Histerektomi Dr.Rizal Sanif, SpOG- Dr. Yusni Puspita, 4,547,000
Cyst Konk SpAn

18 RI12008329 0000602202 ISMU DARMANI 12-04-1952 59 P Desa Sukajadi Lingkungan Ii Kab. Musi Banyuasin ASKES 501 II B N03 Chronic Nephritic Syndrome Cimino Dr.H.Muzakkie, SpBO Dr.Rose Mafiana, 8,637,500
FICS SpAn

19 RI12009336 0000600603 LENI HARTINI BT SAPRAN. 19-02-1984 28 P Lk. Iii Tanjung Rancing Oki Kab. Ogan Komering JAMSOSKES(SUMSEL 203 III D25.9 Leiomyoma Of Uterus, Adenolisis Dr.Abadi, SpOG Dr. Yusni Puspita, 6,227,000
E Ilir SEMESTA) Unspecified SpAn

20 RI12008490 0000587705 LENI MARLINA BT CIK ONI 08-01-1981 31 P Jl Depati Suud Dusun Ii Kab. Banyuasin JAMKESMAS PUSAT 409 III C50.9 Malignant Neoplasm Of Mastektomi Radikal Dr.Benny Kusuma, SpB Dr.Rose Mafiana, 6,342,000
Desa Lubuk Karet Kec Breast, Unspecified (K) Onk SpAn
Betung

21 RI12009758 0000603356 M.DAFFA IZUDDIN 26-11-2003 8 L Vila Sukarami Permai Blok Kota Palembang ASKES 401 IB D21.9 Benign Neoplasm Of Penambahan Jasa Dokter Dr.Linda Trisna, SpM Dr.Rose Mafiana, 3,083,500
B14 Connective And Other Soft SpAn
Tissue, Unspecified

22 RI12009758 0000603356 M.DAFFA IZUDDIN 26-11-2003 8 L Vila Sukarami Permai Blok Kota Palembang ASKES 401 IB D21.9 Benign Neoplasm Of Koreksi Strabismus Dr.Linda Trisna, SpM 8,417,000
B14 Connective And Other Soft
Tissue, Unspecified

23 RI12009413 0000602524 MUHAMMAD ALIEF 28-08-2006 5 L Jl. Arimbi No. 16 Marga JAMSOSKES(SUMSEL 404 III K40.9 Unilateral Or Unspecified Hernioraphy Anak Dr.Sindu Dr.Rose Mafiana, 2,654,000
NOVIANSYAH Mulya Llg Selatan SEMESTA) Inguinal Hernia, Without Saksono,SpBA SpAn
Obstruction Or Gangrene

24 RI12009711 0000158724 MUHAMMAD TAMSIR 11-06-1958 53 L Desa Suka Rajo Lama Kab. Ogan Ilir ASKES 401 IA N35.9 Urethral Syndrome, Penambahan Jasa Dokter Dr. Martha Hendry,SpU Dr.Kusuma 1,287,000
Unspecified (Pinhole Harimin, SpAn
Meatus)

25 RI12009711 0000158724 MUHAMMAD TAMSIR 11-06-1958 53 L Desa Suka Rajo Lama Kab. Ogan Ilir ASKES 401 IA N35.9 Urethral Syndrome, Meatotomi / Meatoplasi Dr. Martha Hendry,SpU 3,419,500
Unspecified (Pinhole
Meatus)

26 RI12009364 0000116842 MUHAMMAD ZEN S.PD 10-02-1956 56 L Tanjung Api Api No 2878 Kota Palembang ASKES 104 UT D N40 Hyperplasia Of Prostate TUR Prostat Dr. Martha Hendry,SpU Dr.Kusuma 9,315,500
Harimin, SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-04-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

27 RI12009318 0000549026 NURIMAH 10-07-1974 37 P Simpang Priuk Lubuk Kota Lubuk Linggau JAMKESMAS PUSAT 203 III D25.9 Leiomyoma Of Uterus, Histerektomi Dr.Agustria Z,SpOG- Dr.Rose Mafiana, 4,547,000
Linggau Unspecified KFM SpAn

28 RI12005956 0000594914 PADLI 01-07-1960 51 L Jalur 3 Telang-Sumber Jaya Kab. Musi Banyuasin JAMSOSKES(SUMSEL 500 III E14.9 Unspecified Diabetes Debridement Dr.H.Muzakkie, SpBO Dr.Rose Mafiana, 2,728,000
SEMESTA) Mellitus Without FICS SpAn
Complications

29 RI12007542 0000599867 SOPARUDIN BIN 03-08-1948 63 L Jl.Pdam Lr.Air Tawar Kota Palembang JAMKESMAS PUSAT 601 II K62.8 Other Specified Tracheostomi Dr.Bermansyah, SpB 4,661,800
HASANSORRY No.1595

30 RI12009907 0000607511 SUHAIBAH 60 P Tanjung Serang Kec. Kayu Kab. Ogan Komering JAMKESMAS PUSAT 407 III S09.7 Multiple Injuries Of Head External Fixasi Dr.Rendra Leonard, Dr.Rose Mafiana, 6,132,100
Agung Oki Ilir (Trauma Capitis) SpOT SpAn

31 RI12008557 0000603151 SYARIFUDIN BIN 28-04-1986 20 L Kota Bumi Kec Tanjung Kab. Ogan Komering JAMSOSKES(SUMSEL 406 III S72 Fracture Of Fremur Orif Mandibula Dr.Iqmal Perlianta, Sp Dr.Rose Mafiana, 4,749,000
ROBINSON Lubuk Oki Ilir SEMESTA) BP SpAn

Sub T o t a l Rp.: 154,471,000


JLH TINDAKAN KAMAR OPERASI IBS : 31
Tgl Operasi : 03-04-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12009912 0000607545 ALEXANDER 30 L Kp. Bali Sungai Rebo Banyu JAMSOSKES(SUMSEL 701 II A S62.3 Fracture Of Other Penambahan Jasa Dokter Dr.H.Muzakkie, SpBO Dr.Rose Mafiana, 2,968,550
Asin SEMESTA) Metacarpal Bone FICS SpAn

2 RI12009912 0000607545 ALEXANDER 30 L Kp. Bali Sungai Rebo Banyu JAMSOSKES(SUMSEL 701 II A S62.3 Fracture Of Other Repair Tendo Penyulit/Arteri Dr.H.Muzakkie, SpBO 12,613,250
Asin SEMESTA) Metacarpal Bone Carotis/Arteri renalis stenosis FICS

Sub T o t a l Rp.: 15,581,800


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 2
Tgl Operasi : 03-05-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12012654 0000615888 AHMAD BAHRI JONI 10-07-1960 51 L Perum Politeknik No 22 Kota Palembang ASKES 402 IB K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.M.Alsen Dr.Zulkipli, SpAn 16,875,000
MALYAM Arlan,SPBO

2 RI12012903 0000080160 ALI AL HABSYI 07-12-1952 L Jl. A.Yani Lr. Fuad No 760 Kota Palembang UMUM 105 UT D N40 Hyperplasia Of Prostate TUR Prostat Dr.Didit Pramudhito, Dr.Zulkipli, SpAn 9,315,500
Plaju SPO
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

3 RI12008501 0000602784 ALI SAMBRON 31-03-1970 42 L Perumnas Sukajadi Kab. Muara Enim ASKES 403 II B Z47.0 Folow-Up Care Involving Open Reduksi Fraktur / Dislokasi Dr.H.Muzakkie, SpBO Dr.Zulkipli, SpAn 9,903,500
Prabumulih Removal Of Fracture Plate & Lama FICS
Other Internal Fixation
Device
4 RI12012839 0000616356 BY ARMAYANTI 01-05-2012 0 P Jl Kol H Burlian Lr Kawat No JAMSOSKES(SUMSEL 301 III Q42.2 Congenital Absence, Atresia Biopsi / Insisi Dr.Sindu 2,479,000
91 SEMESTA) & Stenosis Of Anus With Saksono,SpBA
Fistula

5 RI12012907 0000616589 ENI RUSYATI 03-01-1969 43 P Jl. Sersan Zaini. No 88 Kota Palembang ASKES 201 IB N93.9 Abnormal Uterine And Laparascopy Operatif - Dr.Rizal Zanial, SpAn Dr.Zulkipli, SpAn 3,125,000
Vaginal Bleeding, Histeroskopi
Unspecified

6 RI12012964 0000616827 EVI SORAYA 24 P Jl Lebak Rejo Rt 16 Rw 5 Kota Palembang ASKES 201 UT A O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Peby Maulina Dr.Zulkipli, SpAn 6,677,000
Kel Sekip Jaya Kec Caesarean Section Lestari,SpOG
Kemuning

7 RI12012801 0000613065 FARIDA HARIYANI BT ALI 21-07-1967 44 P Desa Merapi Kec Merapi JAMSOSKES(SUMSEL 409 III D36.7 Benign Neoplasm Of Other Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 2,519,000
CITAL Barat SEMESTA) Specified Sites (Nose Nos) (K) Onk

8 RI12012823 0000616333 FATIMAH 47 P Jl Alidaya No 94 Sembawa RS Siti Khodijah 601 II D32.9 Benign Neoplasm Of Kraniotomi + Bedah Mikro Dr.Trijoso Dr.Zulkipli, SpAn 21,875,000
Meninges, Unspecified Permono,SpBS

9 RI12012957 0000616807 FITRIA ANITA 22 P Kebun Bunga Km 9 ASKES 102 UT B S72.9 Fracture Of Femur, Part Nos Removal Implant / Remove Flat dr. Ismail Bastomi, Dr.Zulkipli, SpAn 3,613,500
Screw SpOT

10 RI12012872 0000616413 HAMDANI 10-12-1989 22 L Dusun Iv-Pedang-Muara Kab. Musi Rawas JAMKESMAS PUSAT 410 III J32.0 Chronic Maxilary Sinusitis Laparatomi Dr.Sarup Singh,SpB Dr.Zulkipli, SpAn 5,109,000
Beliti.Kec-Musi Rawas

11 RI12012962 0000614640 HASANANI BA 14-05-1943 69 L Seduduk Putih No Kota Palembang ASKES 102 UT B H26.9 Catarac, Unspecified Vitrektomi + Endo Laser + SB + Dr. Ramzi Amin, SpM Dr.Zulkipli, SpAn 23,750,000
Palembang Silikon Oil / Gas

12 RI12005244 0000592703 HELEN BUTAR BUTAR 2 P Jl Mayor Ruslan Prum Blok Kab. Muara Enim PT. PN VII (PERSERO) 404 III T30 Burn & Corrosion, Body Penambahan alat Pisau Skin Dr.Iqmal Perlianta, Sp Dr.Zulkipli, SpAn 500,000
E 1 No. 3 Kel.Air Lintang DISTRIK BANYU ASIN Region Unspecified Dermato BP
Kec.M. Emin Kab.M.Enim

13 RI12005244 0000592703 HELEN BUTAR BUTAR 2 P Jl Mayor Ruslan Prum Blok Kab. Muara Enim PT. PN VII (PERSERO) 404 III T30 Burn & Corrosion, Body STSG / Skingrafting yang Luas Dr.Iqmal Perlianta, Sp 3,997,000
E 1 No. 3 Kel.Air Lintang DISTRIK BANYU ASIN Region Unspecified BP
Kec.M. Emin Kab.M.Enim

14 RI12012813 0000596972 IDA FAUZIAH 13-01-1960 52 P Aga Makmur No. 43 ASKES 102 UT B N21.1 Calculus In Urethra Longitudinal Neprolitotomi Dr. Martha Hendry,SpU Dr.Zulkipli, SpAn 9,375,500
(KADET)
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

15 RI12012929 0000616365 IRA SYARIF 19-12-1987 24 P Lr Tanjung Kota Palembang JAMSOSKES(SUMSEL 408 III L02.9 Cutaneous Abscess, Insisi Abses Dr. Lisa Apri Yanti, Dr.Zulkipli, SpAn 2,733,000
SEMESTA) Furuncle And Carbuncle, Sp.THT-KL
Unspecified

16 RI12013051 0000617166 IRAWAN SANDI 35 L Jl Kapten Abdullah Rt 15 Rw JAMSOSKES(SUMSEL 410 III K40.9 Unilateral Or Unspecified Appendiktomi Dr.Sarup Singh,SpB Dr.Zulkipli, SpAn 2,743,000
4 Talang Bubuk Plaju SEMESTA) Inguinal Hernia, Without
Obstruction Or Gangrene

17 RI12012805 0000281397 KASIRAH BINTI KADI 01-05-1955 57 P Taqwa Talang Suburb Kecil JAMSOSKES(SUMSEL 409 III C50.9 Malignant Neoplasm Of Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 2,519,000
SEMESTA) Breast, Unspecified (K) Onk

18 RI12012787 0000613589 KUNI LESTARI 09-03-1984 28 P Tl Selapan Ilir JAMSOSKES(SUMSEL 407 III D24 Benign Neoplasm Of Breast FAM Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 2,531,000
SEMESTA) (K) Onk

19 RI12011887 0000585985 LAHPAN BIN MUCHTAR 15-06-1945 66 P Isp Slamet No 15 JAMKESMAS PUSAT 409 III D23 Other Benign Neoplasm Of Penambahan alat Pisau Skin Dr.Iqmal Perlianta, Sp Dr.Zulkipli, SpAn 500,000
Skin Dermato BP

20 RI12011887 0000585985 LAHPAN BIN MUCHTAR 15-06-1945 66 P Isp Slamet No 15 JAMKESMAS PUSAT 409 III D23 Other Benign Neoplasm Of STSG / Skingrafting yang Luas Dr.Iqmal Perlianta, Sp 3,997,000
Skin BP

21 RI12013060 0000616779 LINDAWATI SUWINTO 29 P Jl Keramasan Rt 17 Rw 4 Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Seksio Secarea + Histerektomi* Dr.Nuswil Bernollan, Dr.Zulkipli, SpAn 8,503,950
Kertapati Caesarean Section SpOG

22 RI12013045 0000588274 M YUSUF 15-02-1961 51 L Bangka Selatan ASKES 102 UT A G91.9 Hydrocephalus,Unspecified VP Shunt (shuting) / Pemasangan Dr.Trijoso Dr.Zulkipli, SpAn 9,838,500
Pintasan Permono,SpBS

23 RI12013114 0000616841 MARDILLA 21 P Desa Durian Hijau Kec Kab. Banyuasin JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Kusuma 6,223,750
Banyuasin Kab Banyasin I Caesarean Section, SpOG Harimin, SpAn
Unspecified

24 RI12011122 0000607123 MUHAMMAD ALIF ZAKI 13-03-2012 0 L Jl.Pendawa No 27 Karang Kota Prabumulih JAMSOSKES(SUMSEL 301 III Q43.1 Hirschprung'S Disease Colostomi / lleostomi Dr.Sindu Dr.Zulkipli, SpAn 3,901,000
DARSA Raja Prabumulih Timur SEMESTA) Saksono,SpBA

25 RI12012687 0000615879 MUHAMMAD ERLANGGA 11-11-1982 29 L Komp. Ykp 1 No. 45 Kota Palembang UMUM 402 II A I84.9 Unspecified Haemorrhoids Haemorroidektomi Stappler Dr.Efman E.U.M, Dr.Zulkipli, SpAn 6,016,500
Without Complications M.Kes,SpB-KBD

26 RI12011033 0000525402 MUHAMMAD UJANG 29-12-2007 4 L Jl. Waringin Puncak Kota Lubuk Linggau JAMSOSKES(SUMSEL 409 III Q43.1 Hirschprung'S Disease Low Ant.Resection / Pullthrough Dr.Sindu Dr.Zulkipli, SpAn 6,188,000
Kemuning Lubuk Linggau SEMESTA) Saksono,SpBA
Utara Ii
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

27 RI12012474 0000615265 MURHAMAH 13-06-1950 61 P Jl Depati Barin Lubuk Kab. Musi Banyuasin ASKES 401 IB K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.M.Alsen Dr.Zulkipli, SpAn 16,875,000
Balang Lk 1 Kenten Arlan,SPBO

28 RI12011550 0000591478 PAWANAH BT SYAWAL 21-02-1982 30 P Talang Pandang Oku Kab. Ogan Komering JAMSOSKES(SUMSEL 409 III D21.9 Benign Neoplasm Of Atroscopy dr. Ismail Bastomi, Dr.Zulkipli, SpAn 6,885,000
Selatan Ulu Selatan SEMESTA) Connective And Other Soft SpOT
Tissue, Unspecified

29 RI12013083 0000617228 RADEN DENTCIK 64 L Jl Blakng Aspol Gang Katu JAMSOSKES(SUMSEL 406 III H22.8* Other Disorders Of Iris And Blefaroplasty Dr.Linda Trisna, SpM Dr.Zulkipli, SpAn 3,533,000
No 223 Rt 1 Rw 1 Tanjungb SEMESTA) Ciliary Body In Diseases
Enim M.Enim Classified Elsewhere

30 RI12012615 0000602778 RAHMAWATI POHAN 30-07-1950 61 P Puncak Sekuning No. 49 Kota Palembang ASKES 401 IB D34 Benign Neoplasm Of Tyroid Isthobektomi Dr.Benny Kusuma, SpB Dr.Zulkipli, SpAn 9,280,500
Gland (K) Onk

31 RI12012404 0000615156 RIRIN PUTRI ARIYANI 19-07-2006 5 P Jl.Sapta Marga Lr.Kelapa Kota Palembang JAMSOSKES(SUMSEL 406 III T14.2 Fracture Of Unspecified Fraktur Kompleks dr. Ismail Bastomi, Dr.Zulkipli, SpAn 6,626,000
Muda Kel.Bukit Sangkal SEMESTA) Body Region SpOT
Kec.Kalidoni Plg

32 RI12012827 0000607847 SALMA BIN ZAWAWI 31-10-1960 51 P Desa Tanjung Raja Oi JAMSOSKES(SUMSEL 203 III N83.2 Other & Unspecified Ovarian Kuretase Dr. Patiyus Dr.Zulkipli, SpAn 2,321,000
SEMESTA) Cyst Agustiansyah, SpOG

33 RI12012753 0000593707 SOKIB BIN SUNARYAK 31-08-1954 57 L Gg Teratai No 590karang JAMKESMAS PUSAT 406 III H02.0 Entropion And Trichiasis Of Penambahan Jasa Dokter Dr.Riani Erna, SpM 1,058,000
Raja Eyelid

34 RI12012753 0000593707 SOKIB BIN SUNARYAK 31-08-1954 57 L Gg Teratai No 590karang JAMKESMAS PUSAT 406 III H02.0 Entropion And Trichiasis Of Repair Ruptur Palpebra + Dr.Riani Erna, SpM 5,152,000
Raja Eyelid Rekonstruksi

35 RI12013054 0000617173 SUMIANI MUHADIN 60 P Jl Ki Maerogan Lr Wijaya No Kota Palembang JAMKESMAS PUSAT 410 III K65.0 Acute Peritonitis Laparatomi Dr.Sarup Singh,SpB Dr.Zulkipli, SpAn 5,109,000
2232 Rt 37 Rw 7 Kel
Kemang Agung Kertapati

36 RI12012871 0000616412 TAMSIL 08-10-1952 59 L Jl Sudirman-Bengkulu ASKES 402 IA N40 Hyperplasia Of Prostate TUR Prostat Dr.Didit Pramudhito, Dr.Zulkipli, SpAn 9,315,500
Selatan SPO

37 RI12011721 0000612981 WARTO 05-10-1977 34 L Dusun I C. Nawangsasi- Kab. Musi Rawas JAMSOSKES(SUMSEL 405 III S09.7 Multiple Injuries Of Head Rekonstruktion wajah/hidung Dr.Iqmal Perlianta, Sp Dr.Zulkipli, SpAn 7,793,000
Tugumulyo-Musi Rawas SEMESTA) (Trauma Capitis) BP

38 RI12012961 0000616821 WILBERT TULUS 5 L Jl Ratna No 2 Rt 25 Rw 11 Kota Palembang UMUM 403 II B S82.2 Fracture Of Shaft Of Tibia Reposisi tertutup dan gips pada dr. Ismail Bastomi, Dr.Kusuma 3,125,000
TAMPUBOLON Kel 29 Ilir fraktur anak kecuali fraktur femur SpOT Harimin, SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

39 RI12012924 0000613682 YELKEN GARESI 25-04-2006 6 L Jl. Dwikora 2 No. 18 Kota Palembang JAMSOSKES(SUMSEL 406 III J35.0 Chronic Tonsillitis Tonsil Dr.Puspa Zuleika, Dr.Zulkipli, SpAn 2,530,000
SEMESTA) SpTHT,M.Kes

40 RI12012974 0000616840 YUAN PARMILAWATY 06-01-1977 35 P Jl Putri Kembang Dadar No Kota Palembang JAMKESMAS PUSAT 203 III O84.2 Multiple Delivery All By Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Zulkipli, SpAn 6,223,750
117 Caesarean Section SpOG

41 RI12013066 0000617183 YULINDA ROJULA 38 P Jl Ratu Sianum Lr H Umar Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Seksio Secarea + Histerektomi* Dr. Peby Maulina Dr.Zulkipli, SpAn 8,503,950
Rt 19 Rw 4 Kel 1 Ilir It 2 Caesarean Section Lestari,SpOG

42 RI12011697 0000612968 ZAINAB 26-09-1958 53 P Jl.Smb Iii Lr Sebimbing- Kab. Ogan Komering ASKES 503 IA N03 Chronic Nephritic Syndrome CAPD ( continous Ambulatori Dr.Efman E.U.M, Dr.Zulkipli, SpAn 3,652,500
Sukaraya Ulu Peritoneal Dialisis ) M.Kes,SpB-KBD

43 RI12012825 0000616331 ZASKIA VIKA APRILIA 0 P Desa Babat Kampung 3 UMUM 301 III Q42.3 Congenital Absence, Atresia Colostomi / lleostomi Dr.Sindu Dr.Zulkipli, SpAn 3,901,000
Perukal Kab Muaraenim & Stenosis Of Anus Without Saksono,SpBA
Fistula [Imperfoarte Anus]

Sub T o t a l Rp.: 276,692,900


JLH TINDAKAN KAMAR OPERASI IBS : 43
Tgl Operasi : 03-06-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12016249 0000626699 BAHARUDIN 16-09-1959 52 L Desa Ulak Balam Kec ASKES 401 IA T14.1 Open Wound (Luka Tusuk, Rekonstruktion wajah/hidung Dr.Iqmal Perlianta, Sp Dr.Rizal Zanial, 13,652,600
Tanjung Lubuk Lecet, Potong, Gigit BP SpAn
Binatang)

2 RI12016305 0000626666 BY TINA WATI 0 P Jl Pertahanan Ujung Kota Palembang JAMKESMAS PUSAT 603 III J93 Pneumothorax Pemasangan WSD Dr.Bermansyah, SpB 5,562,000

3 RI12016172 0000626577 BY. WEILY MARPIN 0 L Gunung Gajah Kec.Lahat Kab. Lahat UMUM 301 III Q42.3 Congenital Absence, Atresia Colostomi / lleostomi Dr.Sindu Dr.Rizal Zanial, 5,071,300
Kab.Lahat & Stenosis Of Anus Without Saksono,SpBA SpAn
Fistula [Imperfoarte Anus]

4 RI12016194 0000626609 BY.TRI MURTINI 0 P Desa P 1 Mardiharjo Kab. Musi Rawas JAMKESMAS PUSAT 603 II P21.9 Birth Asphyxia, Unspecified Omfalokel / Repair Defex Dr.Sindu Dr. Yusni Puspita, 12,162,150
Kec.Purwodadi Kab.Musi Saksono,SpBA SpAn
Rawas

5 RI12016244 0000626662 FITRIYANTI BT HASAN 19-06-1985 26 P Komp Pepaya Indah No 283 Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Agustina Br.H, Dr.Rizal Zanial, 6,223,750
SULAIMAN Caesarean Section SpAn, M.Kes SpAn

6 RI12016093 0000626325 HALIMAH BT SARBANI 28-02-1970 42 P Jl.Gotong Royong Ds Ii JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Peby Maulina Dr.Rizal Zanial, 6,223,750
Kel.Seri Kembang Caesarean Section Lestari,SpOG SpAn
Kec.Payaraman-Oi
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-06-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

7 RI12016236 0000626652 MEVI PITA BELA 13 P Desa Lubuk Tapang Lintang UMUM 403 II B S09.7 Multiple Injuries Of Head Kraniotomi / trenpanasi Dr.Trijoso Dr. Yusni Puspita, 22,750,000
(T.Kk/Ktp) (Trauma Capitis) konvensional Permono,SpBS SpAn

8 RI12016233 0000626677 NIMIRA BT FUADI 06-01-1985 27 P Desa Bangsal Kec Kab. Ogan Komering ASKES 201 IB O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Firmansyah, SpOG Dr.Rizal Zanial, 8,680,100
Papangan Kab Oki Ilir Caesarean Section SpAn

9 RI12016064 0000177191 RENI DARMAWATI 28-07-1981 30 L Pt. Pinang Witmas Sejati Kota Palembang PT. Pinang Witmas Sejati 201 II A O20.0 Threatened Abortion Kuretase Dr.Kms.Yusuf E.SpOG Dr.Rizal Zanial, 4,155,450
SpAn

10 RI12016299 0000626711 SRI YANA 25 P Tanjung Laut Kab Kab. Banyuasin JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr.Rizal Zanial, 6,223,750
Pangkalan Balai-Banyuasin Caesarean Section SpAn

11 RI12016227 0000626651 UNI BIN BACOK 36 L Tl Keramat Perum Elok JAMSOSKES(SUMSEL 405 III K63.1 Perforation Of Intestine Laparatomi Dr.Efman E.U.M, Dr.Rizal Zanial, 5,109,000
Persada No. D 15 SEMESTA) (Nontraumatic) M.Kes,SpB-KBD SpAn

12 RI12016189 0000626592 WIWIN SURYANI 16 P Jl.Sakti Wiratama No.09 Kota Palembang JAMSOSKES(SUMSEL 410 III T14.1 Open Wound (Luka Tusuk, Jahit Plastik Wajah > 10 cm Dr.Iqmal Perlianta, Sp Dr.Rizal Zanial, 5,306,600
SEMESTA) Lecet, Potong, Gigit BP SpAn
Binatang)

13 RI12016094 0000626329 YUNITA PUSPITASARI 27-06-1990 21 P Jl.Bendungan Lr.Musi Ii Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Peby Maulina Dr.Rizal Zanial, 6,223,750
No.43 Caesarean Section Lestari,SpOG SpAn

Sub T o t a l Rp.: 107,344,200


JLH TINDAKAN KAMAR OPERASI IBS : 13
Tgl Operasi : 03-07-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12019303 0000635671 A. GONI 16-05-1966 46 L Desa Sikarami Jaya ASKES 402 IB T14.2 Fracture Of Unspecified Repair Nerve dr. Ismail Bastomi, Dr.Kusuma 9,815,500
Sumber Harta Body Region SpOT Harimin, SpAn

2 RI12019451 0000635895 AKBAR RIZKI 9 L Perumda Blok F 4 No 12 Kab. Musi Banyuasin JAMSOSKES(SUMSEL 410 III T14.1 Open Wound (Luka Tusuk, Repair Tendo Penyulit/Arteri Dr.H.Muzakkie, SpBO SMF ANESTESI 8,689,200
SEMESTA) Lecet, Potong, Gigit Carotis/Arteri renalis stenosis FICS
Binatang)

3 RI12018637 0000633673 ALIHAN YASIN 03-11-1972 39 L Jl Pepera No 2410 /2411 Kota Palembang UMUM 403 II B N36.8 Other Specified Disorders Of Sistoscopi Dr. Martha Hendry,SpU Dr.Rose Mafiana, 4,375,000
Urethra SpAn

4 RI12019088 0000635094 AMI ZULFINA 22-01-1994 17 L Jl. Kancil Putih I No. 10 B Kota Palembang ASKES 402 IA S09.7 Multiple Injuries Of Head Orif Dr.H.Muzakkie, SpBO Dr.Kusuma 6,765,500
(T.Askes) (Trauma Capitis) FICS Harimin, SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-07-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

5 RI12018856 0000634449 ANTON PRABOWO 14 L Tl. Jambi Kel Tl. Jambi Kec JAMSOSKES(SUMSEL 409 III S09.7 Multiple Injuries Of Head Orif Mandibula Dr.Iqmal Perlianta, Sp SMF ANESTESI 4,749,000
Sukarami (T.Kk/Ktp) SEMESTA) (Trauma Capitis) BP

6 RI12019127 0000614353 ARIFIN BIN SUROTO 03-05-1981 31 L Sekojo Blok Seni Kota Palembang JAMSOSKES(SUMSEL 406 III H43.8 Other Disorders Of Vitreous Vitrektomi Dr. Ramzi Amin, SpM SMF ANESTESI 3,533,000
SEMESTA) Body

7 RI12018922 0000501820 ASNAWI BIN UMAR 12-12-1959 52 L Kebun Bunga Sukarami Kota Palembang ASKES 105 IA S42.0 Fracture Of Clavicle Removal Implant / Remove Flat dr. Ismail Bastomi, Dr.Kusuma 3,613,500
Lr.Cemara No.1950 Screw SpOT Harimin, SpAn

8 RI12018514 0000632624 AZITA HALZW MAYESA 23-02-2012 0 P Jl. Angkatan 66 Lr. Jambu Kota Palembang JAMSOSKES(SUMSEL 407 III Q42.3 Congenital Absence, Atresia Colostomi / lleostomi Dr.Sindu SMF ANESTESI 3,901,000
No. 627 Pipa Reja SEMESTA) & Stenosis Of Anus Without Saksono,SpBA
Kemuning Fistula [Imperfoarte Anus]

9 RI12019078 0000635086 BELLA RIA ASTUTI 11-05-1992 20 P Jl.Kancil Putih 1 No.10 Kota Palembang ASKES 402 IA S09.7 Multiple Injuries Of Head Multiple FR + Plat Dr.Nur Rachmat Lubis, Dr.Kusuma 9,622,500
(Trauma Capitis) SpOT Harimin, SpAn

10 RI12018853 0000628204 ELIYANA BINTI BUDI 18-06-1970 42 P Ds Lais Kec Muba Kab. Musi Banyuasin UMUM 403 II B C50.9 Malignant Neoplasm Of Sub Cutaneus Mastectomi Dr.K.Yamin Alsoph Dr.Kusuma 6,169,500
Breast, Unspecified SpBOnk Harimin, SpAn

11 RI12014924 0000622615 ENI MUSLELI 25 P Dsn 6 Kel Tumas Jaya Kec Kab. Ogan Komering JAMSOSKES(SUMSEL 601 III D32.9 Benign Neoplasm Of Craniotomi SMF ANESTESI 6,832,000
Buana Pemaca Oku Selatan Ulu Selatan SEMESTA) Meninges, Unspecified

12 RI12019395 0000635942 ERNI APRIANTI 31 P Jl.Malaka Ii No 59 Bukit Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG SMF ANESTESI 6,223,750
Sangkal Kalidoni Palembang Caesarean Section

13 RI12005256 0000590939 FATIMAH SUKARMO 20-02-1983 29 P Jl. Cempaka No.42 Kab. Muara Enim UMUM 401 II A S82.2 Fracture Of Shaft Of Tibia Penambahan Jasa Dokter Dr.Iqmal Perlianta, Sp 3,000,000
Kel.Tanjung Enim Selatan BP
Tanjung Enim

14 RI12005256 0000590939 FATIMAH SUKARMO 20-02-1983 29 P Jl. Cempaka No.42 Kab. Muara Enim UMUM 401 II A S82.2 Fracture Of Shaft Of Tibia Penambahan alat Pisau Skin Dr.Iqmal Perlianta, Sp Dr.Kusuma 500,000
Kel.Tanjung Enim Selatan Dermato BP Harimin, SpAn
Tanjung Enim

15 RI12005256 0000590939 FATIMAH SUKARMO 20-02-1983 29 P Jl. Cempaka No.42 Kab. Muara Enim UMUM 401 II A S82.2 Fracture Of Shaft Of Tibia Rotation Flab Rekonstruktion Dr.Iqmal Perlianta, Sp 10,515,000
Kel.Tanjung Enim Selatan BP
Tanjung Enim

16 RI12019376 0000635907 HARIANTO BIN BAJURI 37 L Jl.Komunikasi No 69 Air Kab. Banyuasin UMUM 401 IB K37 Unspecified Appendicitis Lap.Appendiks Pervorasi Dr.Sarup Singh,SpB Dr.Kusuma 7,834,450
Batu Kec.Tl.Kelapa Harimin, SpAn
Banyuasin
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-07-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

17 RI12016274 0000619241 HARMIDI BIN MATURI 17-08-1960 51 L Ds. Bandu Agunng Muara Kab. Lahat JAMSOSKES(SUMSEL 404 III N43.3 Hydrocele, Unspecified Excisi Scrotum Dr. Martha Hendry,SpU SMF ANESTESI 2,592,000
Payang Lahat SEMESTA)

18 RI12019260 0000635229 HOMSANUR 05-05-1971 41 P Sukorjo No. 2225 Kota Palembang ASKES 403 II B D21.9 Benign Neoplasm Of Eksisi Tumor Jar Lunak Kecil Dr.K.Yamin Alsoph Dr.Kusuma 3,397,500
Connective And Other Soft SpBOnk Harimin, SpAn
Tissue, Unspecified

19 RI12017448 0000628658 JUNED BIN ARJANI 24-06-1994 17 L Komp Yuka Blok L No 07 Kota Palembang JAMSOSKES(SUMSEL 405 III S72.9 Fracture Of Femur, Part Nos Orif + Bone Grant Dr.Rendra Leonard, SMF ANESTESI 6,885,000
SEMESTA) SpOT

20 RI12018177 0000632446 LEO SAPUTRA BIN OKA 1 L Ds Jua-Jua Kec. Kota Kayu Kab. Ogan Komering JAMSOSKES(SUMSEL 404 III S09.7 Multiple Injuries Of Head Jahit Plastik Wajah > 10 cm Dr.Iqmal Perlianta, Sp SMF ANESTESI 4,082,000
SETIAWAN Agung Oki Ilir SEMESTA) (Trauma Capitis) BP

21 RI12019373 0000635898 M. SYANAWI BIN M. HASAN 09-10-1989 22 L Sugiwaras Talang Betutu Kota Palembang JAMKESMAS PUSAT 410 III S09.7 Multiple Injuries Of Head Pemasangan WSD Dr.Bermansyah, SpB 3,950,500
(Trauma Capitis)

22 RI12019014 0000634918 M.ARIEF SYAH PUTRA 24-06-1998 14 L Jl A.Yani No 53 Rt 24 Kota Palembang UMUM 402 II A Q35.9 Cleft Palate, Unspecified, Palatoplasty Dr. Mgs Roni Saleh, Sp Dr.Kusuma 6,349,500
Palembang Unilateral BP Harimin, SpAn

23 RI12019442 0000636268 M.RIAN BIN HELMI 25-06-2004 8 L Jl Pangeran Ratu Kel 8 Ulu Kota Palembang JAMSOSKES(SUMSEL 406 III S05.3 Ocular Leceration Without Blefaroplasty Dr.Ibrahim, SpM Dr.Kusuma 4,592,900
Kec Su I Plg SEMESTA) Prolapse Or Loss Of Harimin, SpAn
Intraocular Tissue

24 RI12019238 0000635424 NOPIRANINGRUM 25 P Jl.Jeruk Blok K No.I ASKES 102 UT A J01.9 Acute Sinusitis, Unspecified Fess Dr.Abla Ghanie,SpTHT Dr.Kusuma 9,646,000
Harimin, SpAn

25 RI12019443 0000633150 OKTARINI HAULI BT A. 28-10-1983 28 P Jl Kh Burlian Komp Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Irawan SMF ANESTESI 6,223,750
HAMID Bougenville Blok J N 26 Kel Caesarean Section Sastradinata, SpOG
Karya Baru Kec Sukarami
[Plg
26 RI12019400 0000636065 RATIH PRANACITRA 19-11-1980 31 P Perum Taman Indah Tlng Kota Palembang ASKES 201 IB O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr.Kusuma 8,680,100
JUANDA,SP Kelapa Blok B 7 No 12 Kel Caesarean Section Harimin, SpAn
Talang Kelapa Kec Alang Le

27 RI12017803 0000621347 RIBUWATI 30-08-1977 34 P Beltang Oku Timus Kpg Iii ASKES 402 IB D24 Benign Neoplasm Of Breast Eksisi Fambilateral Dr.Benny Kusuma, SpB Dr.Kusuma 6,276,500
(K) Onk Harimin, SpAn

28 RI12019333 0000529183 RIO SAVERO ARANOV 08-11-1995 16 L Komp Jaya Indah Kota Palembang PT.ASURANSI JIWA 102 UT B J03.9 Acute Tonsillitis, Unspecified Tonsilektomi Dr.Abla Ghanie,SpTHT Dr.Kusuma 3,125,000
INHEALTH INDONESIA (Follicular) (Gangrenous) Harimin, SpAn
(Infective) (Ulcerative)
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-07-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

29 RI12019170 0000514289 RISMALARITA BT ROZALI 01-06-1962 50 P Jl Sosial No.640 Kota Palembang PT.ASURANSI JIWA 102 UT B E14.9 Unspecified Diabetes Foto Koagulasi Laser Dr. Ramzi Amin, SpM 2,562,500
INHEALTH INDONESIA Mellitus Without
Complications

30 RI12019424 0000636224 ROHANA BINTI ROZAK 13-09-1974 37 P Jl Supersemar Lr Kota Palembang JAMKESMAS PUSAT 203 III O06.4 Unsp.Abortion Incomplete, Kuretase Dr.Iskandar Z, SpOG SMF ANESTESI 2,321,000
Musyawarah I No 1025 Without Complication

31 RI12018809 0000632453 RUSMALA DEWI 15-04-1963 49 P Bambang Otoyo No. 62 Kota Palembang ASKES 402 IB J86.9 Pyothorax Without Fistula Wide Excisi Dr.Benny Kusuma, SpB Dr.Kusuma 5,537,500
(K) Onk Harimin, SpAn

32 RI12019379 0000635918 SOLHA RONAL 35 P Asrama Tni Pintu Besi No Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG SMF ANESTESI 6,223,750
61 Plaju Ilir Palembang Caesarean Section

33 RI12019011 0000629760 SUMIATY BINTI KGS.A 26-06-1962 50 P Komp.Rss Blok C No.19 Kota Palembang JAMSOSKES(SUMSEL 404 III D24 Benign Neoplasm Of Breast Biopsi / Insisi Dr.Benny Kusuma, SpB SMF ANESTESI 2,722,000
HAMID SEMESTA) (K) Onk

34 RI12019984 0000636274 YANTO WIJAYA 20 L Palembang Kota Palembang JAMKESMAS PUSAT 409 III S21 Open Wound Of Thorax Biopsi Insisi Dr.Bermansyah, SpB 3,950,500

Sub T o t a l Rp.: 185,256,900


JLH TINDAKAN KAMAR OPERASI IBS : 34
Tgl Operasi : 03-08-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12022592 0000645171 ABRAR DEANTI BINTI ARDI 23-10-1987 24 P Sutan M Mansyur Kota Palembang PT. Batubara Bukit Asam 106 UT B D24 Benign Neoplasm Of Breast Eksisi multiple FAM Dr.K.Yamin Alsoph Dr.Zulkipli, SpAn 4,375,000
Tanjung Enim SpBOnk

2 RI12022604 0000646132 ACHMAD SOFYAN BN 17-02-1951 61 L Jl. Kopral Ramin Kota Palembang JAMSOSKES(SUMSEL 410 III K65 Peritonitis Laparatomi Dr.Sarup Singh,SpB SMF ANESTESI 5,109,000
ABDULLAH SEMESTA)

3 RI12021500 0000642452 ASEP SUGIARTO 26-08-1991 20 L Gg Pahlawan V Blok 38 No. Kota Palembang JAMSOSKES(SUMSEL 409 III S72.9 Fracture Of Femur, Part Nos Penambahan Jasa Dokter Dr.H.Muzakkie, SpBO SMF ANESTESI 920,000
13 SEMESTA) FICS

4 RI12021500 0000642452 ASEP SUGIARTO 26-08-1991 20 L Gg Pahlawan V Blok 38 No. Kota Palembang JAMSOSKES(SUMSEL 409 III S72.9 Fracture Of Femur, Part Nos Open Reduksi Fraktur / Dislokasi Dr.H.Muzakkie, SpBO 6,885,000
13 SEMESTA) Lama FICS

5 RI12022708 0000646334 DEWI SARTIKA 09-11-1991 20 P Jl. Tanah Merah Kota Palembang JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr. Hj. Fatimah Usman, SMF ANESTESI 2,321,000
Incomplete,With Other And SpOG
Unspecified Complications
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-08-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

6 RI12022715 0000646359 DIAN PRANATA 19 L Jl. Kediman No. 84 Dusun I Kab. Ogan Komering UMUM 406 II B T04.9 Multiple Crushing Injuries, Debridement Dr.Rendra Leonard, Dr. Yusni Puspita, 4,684,550
Seri Bandung Kec Tanjung Ilir Unspecified SpOT SpAn
Batu (T.Kk/Ktp)

7 RI12022387 0000003975 DRA.MARHAMAH 10-07-1943 69 P Jl.Padang Selasa No.1402 Kota Palembang ASKES 105 IA I84.9 Unspecified Haemorrhoids Hemoroidektomi Parsialis / Dr.Sarup Singh,SpB Dr. Yusni Puspita, 3,616,500
Without Complications Hemoroidektomi SpAn

8 RI12022303 0000645228 ELYZABET BT ABDUL 21-06-1963 49 P Desa Air Rambai Kec Curup ASKES 104 UT D K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.M.Alsen Dr. Yusni Puspita, 16,875,000
KADIR Arlan,SPBO SpAn

9 RI12022346 0000645343 ERWIN WIJAYA 10-08-1975 37 P Mujahidin No 19 Kota Palembang UMUM 402 IA K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.Efman E.U.M, Dr. Yusni Puspita, 16,875,000
M.Kes,SpB-KBD SpAn

10 RI12005256 0000590939 FATIMAH SUKARMO 20-02-1983 29 P Jl. Cempaka No.42 Kab. Muara Enim UMUM 401 II A S82.2 Fracture Of Shaft Of Tibia Amputasi dr. Ismail Bastomi, Dr. Yusni Puspita, 6,765,500
Kel.Tanjung Enim Selatan SpOT SpAn
Tanjung Enim

11 RI12022362 0000583797 HAIRUL QUITNI BIN HAYIL 19-08-1967 44 L Jl Dusun 111 Kab. Ogan Komering JAMSOSKES(SUMSEL 405 III K63.1 Perforation Of Intestine Tutup Colostomi / Pro Rotating Dr.Sarup Singh,SpB SMF ANESTESI 3,892,000
Ilir SEMESTA) (Nontraumatic)

12 RI12021008 0000641021 HALIMAH SOBIHIN 25-07-1962 50 P Komp Sembaja Indah Jl. Kota Palembang ASKES 104 UT D E11 Non Insulin Dependent Debridement Dr.Rendra Leonard, Dr. Yusni Puspita, 3,603,500
Batu Kakur No 05 Diabetes Mellitus SpOT SpAn

13 RI12022636 0000641777 HUSNITA BT MAHMUD 04-05-1975 37 P Dusun Viii Kel Tanjung Baru Kab. Muara Enim JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Hj. Fatimah Usman, SMF ANESTESI 6,223,750
Kec Muara Belida Kab Caesarean Section SpOG
Muara Enim

14 RI12022347 0000643926 JAWALUDIN BIN MAJID 45 L Ds Penandingan Muara Kab. Muara Enim UMUM 402 IB D36.7 Benign Neoplasm Of Other Penambahan Jasa Dokter Dr.Bermansyah, SpB Dr. Yusni Puspita, 2,531,000
Enim Specified Sites (Nose Nos) SpAn

15 RI12022347 0000643926 JAWALUDIN BIN MAJID 45 L Ds Penandingan Muara Kab. Muara Enim UMUM 402 IB D36.7 Benign Neoplasm Of Other Torakoplasty Dr.Bermansyah, SpB 16,175,500
Enim Specified Sites (Nose Nos)

16 RI12022798 0000646343 MULYADI BIN MURNI 07-06-1973 39 L Dusun Ii Kel.Tanjung Gelam Kab. Ogan Komering JAMSOSKES(SUMSEL 407 III S21.7 Multiple Open Wount Of Biopsi Insisi Dr.Bermansyah, SpB 3,950,500
Kec.Indralaya Kab.Oi Ilir SEMESTA) Thoraxic Wall

17 RI12022239 0000231304 NURBAYA 21-01-1952 60 P Puncak Sekuning No 89 Kota Palembang ASKES 404 IB D21.3 Benign Neoplasm Of Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr. Yusni Puspita, 3,397,500
Connective And Other Soft (K) Onk SpAn
Tissue Of Thorax
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-08-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

18 RI12022899 0000646169 NURMALA 24 P Jl Balap Sepeda Lr Kota Palembang JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr. Peby Maulina SMF ANESTESI 2,321,000
Sudaraya No. Incomplete,With Other And Lestari,SpOG
Unspecified Complications

19 RI12010237 0000608471 PARYONO 29 L Jl Dr Hamkah Lr Manggis JAMSOSKES(SUMSEL 404 III T31.5 Burn Involving 50 - 59% Of Debridement Dr.Iqmal Perlianta, Sp SMF ANESTESI 2,728,000
No 588 Sukaraya Kab SEMESTA) Body Surface BP
Baturaja

20 RI12018098 0000619638 RISATI BT MASRI 07-11-1968 43 P Kuang Dalam Barat Ogn Ilir Kab. Ogan Komering JAMSOSKES(SUMSEL 407 III N82.1 Other Female Urinary- Sistoscopi Dr. Martha Hendry,SpU SMF ANESTESI 2,541,000
Ilir SEMESTA) Genital Tract Fistulae

21 RI12021780 0000641881 SEPRIDA TORIYANI 04-09-1987 24 P Jl. Yos Sudarso Tanah Kota Lubuk Linggau ASKES 201 IA D25.9 Leiomyoma Of Uterus, Laparascopi Diagnostik Dr. Irawan Dr. Yusni Puspita, 3,232,500
Periok Lubuk Linggau Unspecified Sastradinata, SpOG SpAn

22 RI12021662 0000605439 SITI SULAIHA BT 23-03-1991 21 P Ds Karang Agung Pagar Kab. Lahat JAMSOSKES(SUMSEL 203 III D27 Benign Neoplasm Of Ovary Pemasangan WSD Dr.Bermansyah, SpB 3,950,500
KADARMAN Agung Lahat SEMESTA)

23 RI12022410 0000645562 SUNARSIH BT LAN 04-04-1982 30 P Komp Griya Keramat Indah I Kota Palembang JAMKESMAS PUSAT 203 III O41.0 Oligohydramnions Embriotomi pervaginam Dr.H.Ferry SMF ANESTESI 3,064,100
Blok F No 06 Yusrizal,Spog

24 RI12022250 0000644363 SURYA HARTATI 28-05-1961 51 P Opi 2 Perm Bogenville Blok Kota Palembang ASKES 402 IA D21.9 Benign Neoplasm Of Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr. Yusni Puspita, 3,397,500
E No 1jakabaring Connective And Other Soft (K) Onk SpAn
Tissue, Unspecified

25 RI12022478 0000643823 SYAWALUDIN BIN MADRIS 16-01-1942 70 L Desa Mulak Ulu Lahat Kab. Lahat UMUM 403 II B N40 Hyperplasia Of Prostate TUR Prostat Dr. Martha Hendry,SpU Dr. Yusni Puspita, 9,315,500
SpAn

26 RI12020378 0000639070 WITO BIN SOLEMAN 08-01-1978 34 L Desa Sukamulia Kec Kab. Banyuasin JAMKESMAS PUSAT 500 III K29.6 Other Gastritis Laparatomy Explorasi Dr.Sarup Singh,SpB 6,337,000
Tungkal Ilir Kab Banyuasin

27 RI12020378 0000639070 WITO BIN SOLEMAN 08-01-1978 34 L Desa Sukamulia Kec Kab. Banyuasin JAMKESMAS PUSAT 500 III K29.6 Other Gastritis Penambahan Jasa Dokter Dr. Martha Hendry,SpU 920,000
Tungkal Ilir Kab Banyuasin

28 RI12017631 0000595130 ZAIDAR BT AMINUDDIN 21-05-1939 73 P Jl. P. Kemerdekaan Lr. Kota Palembang JAMSOSKES(SUMSEL 406 III L72.0 Epidermal Cyst Eksisi Tumor Jinak Kiste Ateroma Dr.Benny Kusuma, SpB SMF ANESTESI 2,523,000
Pasundan No. 312 Lawang SEMESTA) (K) Onk
Kidul Plg

Sub T o t a l Rp.: 148,530,400


JLH TINDAKAN KAMAR OPERASI IBS : 28
Tgl Operasi : 03-08-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-08-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12022902 0000646168 ADAM BT MUJIAT 45 L Bengkulu -Curup UMUM 700 II A S09.7 Multiple Injuries Of Head Biopsi Insisi Dr.Bermansyah, SpB 5,562,000
(Trauma Capitis)

2 RI12022751 0000646322 KOTENG BIN MUKTI 18-03-1958 54 L Dusun 04 Desa Tirto Kab. Banyuasin JAMKESMAS PUSAT 701 III D36.7 Benign Neoplasm Of Other Biopsi Insisi Dr.Bermansyah, SpB 5,562,000
Raharjo Kec.Muara Padang Specified Sites (Nose Nos)
Kab.Banyuasin

3 RI12022520 0000645874 MARSANAH 16-04-1960 52 P Jl Papera No.2502 Kota Palembang JAMSOSKES(SUMSEL 700 II A C50.9 Malignant Neoplasm Of Biopsi Insisi Dr.Bermansyah, SpB SMF ANESTESI 5,562,000
SEMESTA) Breast, Unspecified

Sub T o t a l Rp.: 16,686,000


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 3
Tgl Operasi : 03-09-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12025431 0000653871 ALDO BIN NASRUN 4 L Lr.Tersoda Sungsang Iv Kab. Banyuasin JAMSOSKES(SUMSEL 406 III S05.8 Other Injuries Of Eye And Penambahan Jasa Dokter Dr.Linda Trisna, SpM SMF ANESTESI 1,196,000
Banyuasin SEMESTA) Orbit

2 RI12025431 0000653871 ALDO BIN NASRUN 4 L Lr.Tersoda Sungsang Iv Kab. Banyuasin JAMSOSKES(SUMSEL 406 III S05.8 Other Injuries Of Eye And Rekonstruksi Post Ekstirpasi Dr.Linda Trisna, SpM 4,529,200
Banyuasin SEMESTA) Orbit Tumor

3 RI12020897 0000640630 ANGGA SAPUTRA 14 L Desa Air Itam Kam P 5 Kec Kab. Banyuasin JAMSOSKES(SUMSEL 409 III T14.2 Fracture Of Unspecified Orif Dr.Nur Rachmat Lubis, SMF ANESTESI 4,741,000
Penungkal Kab Banyuasin SEMESTA) Body Region SpOT

4 RI12025311 0000653406 ARPAN ABDULLAH 15-09-1955 57 L Raya Desa Keman Kab. Ogan Komering ASKES 102 UT B R33 Retention Of Urine Hernioraphy dgn prolenemesh / Dr.Efman E.U.M, 6,026,500
Pampangan Oki Ilir Komplikasi M.Kes,SpB-KBD

5 RI12025311 0000653406 ARPAN ABDULLAH 15-09-1955 57 L Raya Desa Keman Kab. Ogan Komering ASKES 102 UT B R33 Retention Of Urine TUR Prostat Dr. Martha Hendry,SpU 9,315,500
Pampangan Oki Ilir

6 RI12025131 0000640087 ATAMAL RAMADON 25 L Perumnas Lubuk Tanjung Kota Lubuk Linggau UMUM 402 IA S92.3 Fracture Of Metatarsal Bone Debridement Dr.H.Muzakkie, SpBO Dr.Agustina Br.H, 3,603,500
Kec Sukajadi Kota Lubuk FICS SpAn, M.Kes
Linggau

7 RI12025184 0000653249 AYESHA DZAKIAT UNNISA 24-09-2005 6 P Desa Belitar Seberang Kec JAMKESMAS PUSAT 410 III S09.7 Multiple Injuries Of Head Craniotomi Dr.Trijoso SMF ANESTESI 6,832,000
Sindang Kelingi Kab Rejang (Trauma Capitis) Permono,SpBS
Lebong

8 RI12024767 0000643313 BETTI SIBURIAN 22-09-1954 57 P Perumnas Kota Palembang ASKES 401 IA D24 Benign Neoplasm Of Breast Mastektomi Radikal Dr.Benny Kusuma, SpB Dr.Agustina Br.H, 10,625,000
(K) Onk SpAn, M.Kes
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-09-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

9 RI12025544 0000654299 DEASY TRIANA BT 23-12-1991 20 P Lr Hanan No 1265b Kota Palembang JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.M.Hatta A.SpOG- SMF ANESTESI 6,223,750
SUPARMAN Delivery, Unspecified KFM

10 RI12025409 0000653801 EDDY ARFANDI 07-01-1951 61 L Gang Keluarga I No 66-977 Kota Palembang UMUM 406 II B S09.7 Multiple Injuries Of Head Jahit Plastik Wajah > 10 cm Dr.Iqmal Perlianta, Sp Dr.Agustina Br.H, 8,255,650
(Trauma Capitis) BP SpAn, M.Kes

11 RI12024264 0000650329 FARUK BIN ANWAR HUSIN 26-07-1989 23 L Jl Kebun Bunga Komp Villa ASKES 103 UT C S02.6 Fracture Mandible Orif Mandibula Dr.Iqmal Perlianta, Sp Dr.Agustina Br.H, 6,773,500
UMRI Abgkasa Permai Blok B.1 BP SpAn, M.Kes
No.3050

12 RI12025239 0000008412 H. ABDULLAH ZAINUDDIN 29-07-1938 74 L Jl Sitraman Jaya No 21 Kota Palembang ASKES 104 UT D R33 Retention Of Urine TUR Prostat Dr. Martha Hendry,SpU Dr.Agustina Br.H, 9,315,500
SpAn, M.Kes

13 RI12025208 0000653260 H. M IDRUS 20-09-1932 80 L Pangkalan Balai No 21 Kab. Musi Banyuasin UMUM 402 II A N40 Hyperplasia Of Prostate TUR Prostat Dr. Martha Hendry,SpU Dr.Agustina Br.H, 9,315,500
SpAn, M.Kes

14 RI12025506 0000654232 HARYATI BT SUDIRUN 25 P Jl Merdeka Pangkalan Balai JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG SMF ANESTESI 6,223,750
Banyu Asin Delivery, Unspecified

15 RI12024789 0000652035 HASANUDIN BIN ANSORI 25-09-2006 5 L Lingkungan Iii Kec Kayu Kab. Ogan Komering JAMSOSKES(SUMSEL 302 III G81.9 Hemiplegia (Hemiparalysis) VP Shunt (shuting) / Pemasangan Dr.Trijoso SMF ANESTESI 6,820,000
Agung Ilir SEMESTA) Pintasan Permono,SpBS

16 RI12024842 0000652086 HERI SETIAWAN 9 L Desa Muara Burnai Ii Kec Kab. Ogan Komering UMUM 403 II B S09.7 Multiple Injuries Of Head Orif dr. Ismail Bastomi, Dr.Agustina Br.H, 6,765,500
Lempuing Kab Oki Ilir (Trauma Capitis) SpOT SpAn, M.Kes

17 RI12025443 0000653906 IIS SURYA NINGSIH 27-06-1981 31 P Jl Akbp H Umar Lr Maju No Kota Palembang JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Zaimursyaf Aziz, SMF ANESTESI 6,223,750
1270 Delivery, Unspecified SpOG

18 RI12025520 0000654258 JAYATRI PUSPASARI 15-12-1982 29 P Dusun I Desa Widodo Kec Kab. Musi Rawas ASKES 201 IB O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Agustina Br.H, 8,680,100
Tugu Mulyo Kab Musi Caesarean Section SpOG SpAn, M.Kes
Rawas

19 RI12024175 0000650194 KARTINI BINTI ALI 14-07-1959 53 P Jl. M Zen Lr. Tana Abang Kota Palembang ASKES 501 II B D13.1 Benign Neoplasm Of Laparatomy Explorasi Dr.Efman E.U.M, Dr.Agustina Br.H, 9,355,500
No. 144 Stomach M.Kes,SpB-KBD SpAn, M.Kes

20 RI12025212 0000650841 LALU UBAI ABDILAH 15-04-1992 20 L Puncak Sekuning No. 1196 Kota Palembang ASKES 402 IA M67.4 Ganglion (Ganglion Of Joint Ganglion Poplitea Dr.Iqmal Perlianta, Sp Dr.Agustina Br.H, 3,605,500
Or Tendon (Sheath) BP SpAn, M.Kes
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-09-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

21 RI12025388 0000653818 MUTIRA JUMRIA, SIP 25-08-1981 31 P Perum Pujangga Alam UMUM 201 IA N85.8 Cyst Endometrium Laparascopy Operatif Dr.Abadi, SpOG Dr.Agustina Br.H, 9,244,000
Garden Blok H No 03 Kec SpAn, M.Kes
Kedaton

22 RI12025283 0000651192 NGADINO BIN A JUFRI 12-09-1943 69 L Jokja Lebong Siareng No Kota Palembang ASKES 403 II B N40 Hyperplasia Of Prostate TUR Prostat Dr. Martha Hendry,SpU Dr.Agustina Br.H, 9,315,500
3967 SpAn, M.Kes

23 RI12025398 0000653828 NOVIANTO BIN MACIK 11-11-1983 28 L Dusun Ii Kel.Pulau JAMSOSKES(SUMSEL 408 III T18.1 Foreign Body In Oesophaguscopi Dr.Sofyan SMF ANESTESI 2,507,000
Semambu Kec.Indralaya SEMESTA) Oesophagus Diagnostik/Broncoscopy Rigit Effendi,SpTHT
Utara Kab.Oi

24 RI12025290 0000551974 RIMPA GAYA 30-12-1963 48 P Muara Enim Kab. Muara Enim ASKES 402 IB N49.0 Of Seminal Vesicle Litotripsi Dr. Martha Hendry,SpU Dr.Agustina Br.H, 5,488,500
SpAn, M.Kes

25 RI12024751 0000528238 RUMIYANTI BINTI MARJO 16-04-1967 45 P Suka Jaya Lr Sido Mulyo Kota Palembang JAMKESMAS PUSAT 405 III K80 Cholelithiasis Kolesistektomi Dr.M.Alsen SMF ANESTESI 6,318,000
Sukawintan Arlan,SPBO

26 RI12025460 0000654107 SULSIA BT MUNTAHAR 23-08-1986 26 P Perum Mega Asri Ii Blok D.2 Kab. Musi Banyuasin JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG SMF ANESTESI 6,223,750
No 9 Delivery, Unspecified

27 RI12025498 0000654225 ZALNA BT ANUARDIN 10-01-1978 34 L Dusun Iii Kel Palem Raya Kab. Ogan Komering JAMKESMAS PUSAT 203 III O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG SMF ANESTESI 6,223,750
Ilir Delivery, Unspecified

Sub T o t a l Rp.: 179,747,200


JLH TINDAKAN KAMAR OPERASI IBS : 27
Tgl Operasi : 03-10-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12028532 0000663355 ANDRIAN PRATAMA 3 L Dusun Ii Kel Pinang Mas Kab. Ogan Ilir JAMSOSKES(SUMSEL 409 III Debridement Dr.Kgs Zulkarnain SMF ANESTESI 3,546,400
Kec Sungai Pinang Kab SEMESTA) Muslim,Sp.OT
Ogan Ilir

2 RI12028615 0000663669 ANTON SUJARWO 27-05-1990 22 L Jl Angkatan 66 Kota Palembang PLN Pembangkitan 104 UT D K40.9 Unilateral Or Unspecified Hernioraphy dgn prolenemesh / Dr.Sarup Singh,SpB 7,834,450
Sumbagsel Inguinal Hernia, Without Komplikasi
Obstruction Or Gangrene

3 RI12028615 0000663669 ANTON SUJARWO 27-05-1990 22 L Jl Angkatan 66 Kota Palembang PLN Pembangkitan 104 UT D K40.9 Unilateral Or Unspecified Penambahan Jasa Dokter Dr. Martha Hendry,SpU 2,968,550
Sumbagsel Inguinal Hernia, Without
Obstruction Or Gangrene

4 RI12028138 0000661716 ARI SANDI 27 L Desa/Kel. Talang Balai Baru JAMSOSKES(SUMSEL 407 III Biopsi Insisi Dr.Bermansyah, SpB 3,950,500
1 Dusun V Kec. Tanjung SEMESTA)
Raja Kab.Oi
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-10-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

5 RI12028455 0000662860 ASRIL BIN M. ILYAS 15-10-1958 54 L Tanjung Enim Kab. Muara Kab. Muara Enim PT. Batubara Bukit Asam 402 IA S62.6 Fracture Of Other Finger Removal Implant / Remove Flat Dr.Kgs Zulkarnain Dr.Kusuma 3,613,500
Enim Tanjung Enim Screw Muslim,Sp.OT Harimin, SpAn

6 RI12025102 0000626756 AWALUDIN BIN ABU HASAN 13-10-1935 76 L Jl. Kerinci Prabu Jaya JAMSOSKES(SUMSEL 406 III N35.8 Other Urethral Stricture Sache / Litotripsi Dr.Arizal Agoes, SpB SMF ANESTESI 3,714,000
Praumulih Timur SEMESTA) SpU

7 RI12028511 0000653962 BAYANI BINTI KOHAR 17-05-1968 44 P Desa Raja Kec Tanah Kab. Muara Enim ASKES 201 II A D25.9 Leiomyoma Of Uterus, Salfingo Oovarectomi Dr.Iskandar Z, SpOG Dr.Kusuma 5,512,500
Abang Unspecified Harimin, SpAn

8 RI12028105 0000661132 BERNALIS BIN SANUSI 13-10-1977 34 L Jl.Dr.M.Hatta No.880 Batu ASKES 402 IB S42.0 Fracture Of Clavicle Orif + Bone Grant dr. Ismail Bastomi, Dr.Kusuma 9,903,500
Raja SpOT Harimin, SpAn

9 RI12028533 0000663372 DESPA RIA AGUSTINA 04-07-1993 20 P Dusun Iii Pagar Bulan Desa Kab. Musi Banyuasin JAMKESMAS PUSAT 203 III O72 Psot Partum Haemorrhage Kuretase Dr. Hj. Fatimah Usman, SMF ANESTESI 2,321,000
Pagar Bulan Kec Rantau SpOG
Bayur Kab Muba

10 RI12028525 0000663368 DEWI AFRIANI,SE 24-04-1980 32 P Jl Mega Mendung Lr Talang Kota Palembang ASKES 201 IB Z34.0 Supervision Of Normal Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Agustina Br.H, 8,680,100
Kemang Pierst Pregnancy SpOG SpAn, M.Kes

11 RI12027994 0000661940 ERMAWATI 47 P Jl Srijaya Negara Lr Jaya ASKES 201 UT A R33 Retention Of Urine Ekterpasi Kista Bartholin Dr.Amir Fauzi, SpOG Dr.Kusuma 3,125,000
Sempurna No.58 Harimin, SpAn

12 RI12028336 0000353670 FAIZAH MADANI 30-03-1950 62 P Kota Palembang ASKES 402 IA T14.2 Fracture Of Unspecified Angkat K-Nail / Remove Flat Screw Dr.H.Muzakkie, SpBO Dr.Kusuma 3,605,500
Jln. Musi Raya Timur No. Body Region FICS Harimin, SpAn
544 Sialang Sako

13 RI12028352 0000659617 H MUHAMMMAD BIN 06-10-1950 62 L Tanjung Pinang No 27 Kab. Ogan Komering UMUM 402 IA D12.6 Benign Neoplasm Of Colon, Hemikolektomi Dr.Sarup Singh,SpB Dr.Kusuma 9,355,500
SULAIMAN Indralaya Ogan Ilir Ilir Unspecified (Adenomatosis Harimin, SpAn
Of Colon, Large Intestine
Nos, Polyposis Of Colon)
14 RI12028373 0000339239 JAYANI BT ABU BAKAR 10-06-1963 49 P May Mahidin No. 1191 Kec Kota Palembang ASKES 401 IB R59.1 Generalized Enlarged Biopsi Eksisional dalam narkose Dr.Benny Kusuma, SpB Dr.Kusuma 3,125,000
Kemunig Lymph Nodes (K) Onk Harimin, SpAn

15 RI12028195 0000638428 LETI HARTATI BT SARIPIN 10-11-1974 37 P Ngulak Iii Sanga Desa Muba MUBA SEMESTA 203 III C56 Malignant Neoplasm Of Surgical Staging Dr.Agustria Z,SpOG- SMF ANESTESI 6,213,000
Ovary KFM

16 RI12028516 0000632677 LULUK FAUZIA 02-12-1995 16 P Jl Bagelan Rt 017 Kota Palembang UMUM 105 IA Timpanoplasti / Dr.Yuli Doris Memy, Dr.Kusuma 9,585,000
Timpanomastoidektomi Sp.THT-KL Harimin, SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-10-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

17 RI12028537 0000663345 M.RAHMA SIGIT 31-08-1990 22 L Komp Griya Maharani Blok Kota Palembang PT. Sumatera Prima 403 II B K35 Acute Appendicitis Appendiktomi Dr.Sarup Singh,SpB 4,704,050
PURWANTO A No 4 Fibreboard

18 RI12028522 0000645603 MARDANI BN JAKATRA 10-08-1976 36 L Ds 1 Desa Epil Sekayu Kab. Musi Banyuasin Central Asia Raya 403 II B N21.1 Calculus In Urethra URS Dr.Arizal Agoes, SpB Dr.Kusuma 9,307,500
HealthiCARe SpU Harimin, SpAn

19 RI12028242 0000662482 MARTINI BT DUADI 10-10-1985 26 P Jl Bukit Baru I Lr Bukit Kota Palembang JAMKESMAS PUSAT 203 III O01.9 Hydatidiform Mole, Laparascopi Diagnostik Dr. Irawan SMF ANESTESI 2,357,000
Permai Gg Bukit Indah Unspecified Sastradinata, SpOG

20 RI12028459 0000657711 MIA DAMAYANTI 07-10-1984 28 P Komplek Griya Maharani Kota Palembang UMUM 201 II A N85.8 Cyst Endometrium Laparascopy Operatif Dr.Abadi, SpOG Dr.Rose Mafiana, 9,244,000
Blok C/2 SpAn

21 RI12028296 0000662540 OSKAR YERI 48 L Jl Inspektur Lr Saadah Kota Palembang ASKES 105 IA Laparaskopik Kolesistektomi Dr.Efman E.U.M, Dr.Rose Mafiana, 16,875,000
M.Kes,SpB-KBD SpAn

22 RI12028634 0000663726 RASMIANA BT AL HAR HUM 29-07-1971 41 P Rusun Blok Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG SMF ANESTESI 6,223,750
Caesarean Section

23 RI12028457 0000663120 RIKI RIYAN SARI 07-08-1986 26 P Dusun Panca Desa Kel Kab. Banyuasin JAMKESMAS PUSAT 203 III Z34.0 Supervision Of Normal Sectio Cesarea tanpa penyulit Dr. Hj. Fatimah Usman, SMF ANESTESI 6,223,750
Teluk Tenggirik Kec Pierst Pregnancy SpOG
Bantyuasin Kab Banyuasin

24 RI12026710 0000657868 SANIM BT ..... 50 P Desa Karang Agung Kec Kab. Musi Banyuasin JAMKESMAS PUSAT 602 III I11.9 Hypertensive Heart Disease STSG / Skingrafting yang Luas Dr.Iqmal Perlianta, Sp SMF ANESTESI 3,997,000
Tungkal Ilir Without (Congestive) Heart BP
Failure

25 RI12028386 0000661950 SAWALIA MAISARO 27-04-1993 19 P Jl. Hajo Duliman,.. Tamjumh JAMKESMAS PUSAT 407 III D24 Benign Neoplasm Of Breast Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB SMF ANESTESI 2,522,000
Beringin (K) Onk

Sub T o t a l Rp.: 148,507,550


JLH TINDAKAN KAMAR OPERASI IBS : 25
Tgl Operasi : 03-10-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12028579 0000663587 DARWISI BIN BASTARI 25 L Desa Perigi Talang Nangka Kab. Ogan Komering JAMSOSKES(SUMSEL 703 III S09.7 Multiple Injuries Of Head Penambahan Jasa Dokter Dr. Devi Azri Wahyuni, SMF ANESTESI 2,708,550
Kec Pangkalan Lampan Kab Ilir SEMESTA) (Trauma Capitis) SpM
Oki

2 RI12028579 0000663587 DARWISI BIN BASTARI 25 L Desa Perigi Talang Nangka Kab. Ogan Komering JAMSOSKES(SUMSEL 703 III S09.7 Multiple Injuries Of Head Explorasi/Angkat Peluruh Dr.Sahat 7,161,050
Kec Pangkalan Lampan Kab Ilir SEMESTA) (Trauma Capitis) Edison.S,SpBS
Oki
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-10-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

3 RI12028546 0000663369 EKO HANDOKO 04-05-1989 23 L Jl. Abikusno Cokrosuyoso Kota Palembang UMUM 703 II B S36.8 Injury Of Other Intra - Sistostomi Dr.Didit Pramudhito, Dr.Agustina Br.H, 3,215,500
Lr. Kapandean No. 23 Abdominal Organs SPO SpAn, M.Kes

Sub T o t a l Rp.: 13,085,100


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 3
Tgl Operasi : 03-11-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12031409 0000671588 ARLAN BIN NANGCIK 29-12-1942 69 L Jl Belida Raya Blok Jj No 6 Kota Palembang ASKES 401 IB N40 Hyperplasia Of Prostate TUR Prostat Dr.Didit Pramudhito, Dr.Rizal Zanial, 9,315,500
SPO SpAn

2 RI12031572 0000672113 JAGUK YAHYA 31-12-1946 65 L Dusun Ii Desa Tl Pangeran Kab. Ogan Komering JAMSOSKES(SUMSEL 406 III S05.2 Ocular Leceration And Symblepharon Dr. Ramzi Amin, SpM SMF ANESTESI 4,592,900
Ulu Kab Ogan Ilir Ilir SEMESTA) Rupture With Prolapse Or
Loss Of Intraocular Tissue

3 RI12031538 0000602424 LAILA MAGDALENA 30-03-1968 44 P Bangkapangkal Pinang Bangka UMUM 402 IB J62.8 Pneumoconiosis Due To Eksisi Fibroma Dr.Iqmal Perlianta, Sp Dr. Arliansah, 3,125,000
Other Dust Containingsilica BP M.Si, Sp.An

4 RI12031513 0000671347 MARYUNIARTI BINTI H.M 11-09-1966 46 P Jl. Kopral Kko Harun Said Kota Palembang ASKES 201 IA N85.8 Cyst Endometrium Laparascopy Operatif - Dr.Agustria Z,SpOG- Dr.Rizal Zanial, 3,125,000
ZEN ALI Said No 36 Histeroskopi KFM SpAn

5 RI12031332 0000671159 PRATAMA SUJAYA 03-11-2003 9 L Dsn 3 Desa Talang Tengah Kab. Ogan Ilir JAMSOSKES(SUMSEL 406 III I05.0 Mitral Stenosis Uretroplasty Dr.Didit Pramudhito, SMF ANESTESI 10,147,800
Darat Lubuk Keliat Ogan Ilir SEMESTA) SPO

6 RI12031616 0000672292 SIARIM 73 L Jl Bangun 5 No 13 Kota Palembang UMUM 103 UT C K65 Peritonitis Laparatomi Dr.Sarup Singh,SpB Dr. Arliansah, 7,740,850
M.Si, Sp.An

7 RI12031564 0000672106 SOPIA BT SARING 16-04-1972 40 P Jl Pangeran Ayin No 55 Kota Palembang JAMKESMAS PUSAT 203 III Z34.0 Supervision Of Normal Sectio Cesarea tanpa penyulit Dr.Azhari, SpOG SMF ANESTESI 6,223,750
Pierst Pregnancy

8 RI12031604 0000672242 SUHAILA 15-08-1979 33 P Jl Sri Panji No 03 Desa Kab. Banyuasin JAMKESMAS PUSAT 203 III Z34.0 Supervision Of Normal Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG SMF ANESTESI 6,223,750
Pangkalan Panji Kec Pierst Pregnancy
Banyuasin 3 Kab Banyuasin

9 RI12029586 0000666384 SUMARNI BT .... 21-02-1973 39 L Desa Lebung Itam Kab JAMSOSKES(SUMSEL 203 III C53.9 Malignant Neoplasm Of Insersi Kateter Double Luman HD Dr. Arliansah, M.Si, SMF ANESTESI 2,349,000
Ogan Komering Ilir Kec SEMESTA) Cervix Uteri, Unspecified Semi Permanen Sp.An
Tl.Selapan

10 RI12031632 0000672263 WENIAR SI SIANA 25-10-1979 33 P Ds/Kel. Guci Dusun 2 Kec. Kab. Muara Enim JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Iskandar Z, SpOG SMF ANESTESI 2,321,000
Ujan Mas Kab. Muara Enim Incomplete,With Other And
Unspecified Complications
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-11-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

11 RI12031629 0000672320 YUSMI BT GONI 06-09-1984 28 P Ds Teluk Tenggirik Kec. JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, SMF ANESTESI 6,223,750
Banyu Asin I Caesarean Section, SpOG
Unspecified

Sub T o t a l Rp.: 61,388,300


JLH TINDAKAN KAMAR OPERASI IBS : 11
Tgl Operasi : 03-11-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12031581 0000672122 NY.SOMA 60 P Jl.Ki Merogan UMUM 701 IB M92.5 Of Tibia & Fibula Debridement Dr.Rendra Leonard, Dr. Yusni Puspita, 4,684,550
Kec.Pemulutan Desa Ibul SpOT SpAn
Besar Oi

Sub T o t a l Rp.: 4,684,550


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 1
Tgl Operasi : 03-12-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12033883 0000679023 M. FIKRI 31-10-2012 0 L Ds/Kel. Air Hitam Dusun Kab. Ogan Komering JAMKESMAS PUSAT 301 III VP Shunt (shuting) / Pemasangan Dr.Sahat SMF ANESTESI 6,820,000
1kec. Jejawi Kab. Oki Ilir Pintasan Edison.S,SpBS

2 RI12034744 0000681130 AAS HASANAH 23-04-1982 30 P Kom Kt Azhar Blok I Iii No Kab. Banyuasin JAMKESMAS PUSAT 601 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, SMF ANESTESI 8,680,100
08 Kt Laut Caesarean Section, SpOG
Unspecified

3 RI12033435 0000673533 ABDULLAH ABUN 25-03-1925 87 L Lk Ii No 45 Kab. Ogan Komering JAMSOSKES(SUMSEL 405 III N40 Hyperplasia Of Prostate TUR Prostat Dr. Martha Hendry,SpU SMF ANESTESI 6,297,000
Ilir SEMESTA)

4 RI12033486 0000677839 AHMAD TAUFIK 40 L Jl Sosial Kota Palembang JAMSOSKES(SUMSEL 410 III M92.1 Of Radius & Ulna Orif Dr.Kgs Zulkarnain SMF ANESTESI 4,741,000
SEMESTA) Muslim,Sp.OT

5 RI12034415 0000680546 ALI AMAN 68 L Jl. S Bustomi Rekap Ds/Kel. Kab. Ogan Komering JAMSOSKES(SUMSEL 406 III K40.9 Unilateral Or Unspecified Hernioraphy dgn prolenemesh / Dr.Sarup Singh,SpB SMF ANESTESI 4,002,000
Pedamaran Vi Kec. Ilir SEMESTA) Inguinal Hernia, Without Komplikasi
Pedamaran Kab. Oki Obstruction Or Gangrene

6 RI12034150 0000677651 ALMER ABIYU JAMAIL 25-02-2009 3 L Bukit Lama,.. Jl,.Poli Tehnik Kota Palembang JAMSOSKES(SUMSEL 404 III Orchidectomy Dr. Martha Hendry,SpU SMF ANESTESI 3,633,000
SEMESTA)

7 RI12034721 0000681235 DIANA WATI 20-09-1981 31 P Jl. Mujahidin Lr. Soak Bato Kota Palembang UMUM 201 IB O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Agustina Br.H, 6,677,000
No. 448 Plg. Kel. Talang Caesarean Section, SpOG SpAn, M.Kes
Semut Unspecified
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-12-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

8 RI12034721 0000681235 DIANA WATI 20-09-1981 31 P Jl. Mujahidin Lr. Soak Bato Kota Palembang UMUM 201 IB O82.9 Single Delivery By Pengurang Jasa Dokter Dr.Nuswil Bernollan, -2,017,200
No. 448 Plg. Kel. Talang Caesarean Section, SpOG
Semut Unspecified

9 RI12034523 0000680819 DRG.DINA KRISNA WATI 09-10-1983 29 P Jl Letn H Nur Lk Iii Kel ASKES 201 UT A C53 Malignant Neoplasm Of Laparascopy Operatif - Dr. RM.Aerul Cakra Dr.Rose Mafiana, 3,125,000
Sersan Jaya Kec Muba Cervix Uteri Histeroskopi Hamid, SpOG SpAn

10 RI12034449 0000680683 FATIMAH MISKA 03-06-2003 9 P Slamet Riadi 8 Ilir Kota Palembang UMUM 102 UT A J03.9 Acute Tonsillitis, Unspecified Pengurang Jasa Dokter Dr.Denny SU,SpTHT- -1,466,800
(Follicular) (Gangrenous) KL,MSiMed
(Infective) (Ulcerative)

11 RI12034449 0000680683 FATIMAH MISKA 03-06-2003 9 P Slamet Riadi 8 Ilir Kota Palembang UMUM 102 UT A J03.9 Acute Tonsillitis, Unspecified Tonsil Dr.Denny SU,SpTHT- Dr.Agustina Br.H, 4,034,000
(Follicular) (Gangrenous) KL,MSiMed SpAn, M.Kes
(Infective) (Ulcerative)

12 RI12033334 0000677310 FATMAWATI BT H JAMAN 20-06-1975 37 P Lk.Iii Mangun Jaya Kec. MUBA SEMESTA 502 III N18.9 Chronic Renal Insersi Kateter Double Luman HD Dr.Agustina Br.H, 2,349,000
Babat Toman Muba Failure,Unspecified Semi Permanen SpAn, M.Kes

13 RI12034658 0000681266 HABIBURRAHMAN AL- 30-11-2012 0 L Dsn Iii Desa Karang Kab. Musi Banyuasin JAMKESMAS PUSAT 301 II Q42.3 Congenital Absence, Atresia Colostomi / lleostomi Dr.Sindu Dr.Agustina Br.H, 5,071,300
FARIS Manunggal Kec Pulau & Stenosis Of Anus Without Saksono,SpBA SpAn, M.Kes
Rimau Fistula [Imperfoarte Anus]

14 RI12034265 0000672777 HENDRIK EKO 33 L Jl Di Panjaitan No 130 Plaju Kota Palembang ASKES 401 II A I84.9 Unspecified Haemorrhoids Fistula Ani Sederhana / Polip Rekti Dr.Sarup Singh,SpB Dr.Agustina Br.H, 3,629,500
Without Complications SpAn, M.Kes

15 RI12032790 0000672672 HERMAN BIN AHMAD 13-06-1975 37 L Dsn I Desa Kertamulia Kab. Muara Enim JAMSOSKES(SUMSEL 409 III N35.9 Urethral Syndrome, Sache / Litotripsi Dr. Martha Hendry,SpU SMF ANESTESI 3,714,000
Gelumbangmuara Enim SEMESTA) Unspecified (Pinhole
Meatus)

16 RI12034426 0000646126 IDHA PRAYITNO BIN 10-03-1982 30 L Asrama Brimob No. 13 Jl. Bangka UMUM 105 IA Insersi Kateter Double Luman HD Dr.Zulkipli, SpAn 3,038,500
SARIMAN Tapak Dewa Batu Belubang Semi Permanen
Kec Pangkalan Baru Bangka

17 RI12032800 0000672685 KARYADI BIN COSARNI 17-10-1963 49 L Perum Griya Asri Blok M. Kota Palembang JAMSOSKES(SUMSEL 409 III N40 Hyperplasia Of Prostate TUR Prostat Dr. Martha Hendry,SpU SMF ANESTESI 6,297,000
No. 14 Pulo Kerto Gandus SEMESTA)
Plg

18 RI12034757 0000679340 KRISTINA DIMAS FEBRIANTI 03-02-1986 26 P Blok E Dusun Iii Desa Kab. Ogan Komering JAMSOSKES(SUMSEL 203 III O72 Psot Partum Haemorrhage Biopsi / Insisi Dr.Amir Fauzi, SpOG SMF ANESTESI 2,722,000
Sukamulya Kec Lempuing Ilir SEMESTA)
Oki

19 RI12034329 0000677948 LENA BINTI HABIB 03-12-1969 43 P Desa Talang Jaya Oki No Kab. Ogan Komering UMUM 201 II A O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Kms.Yusuf E.SpOG Dr.Agustina Br.H, 8,680,100
30 Ilir Caesarean Section, SpAn, M.Kes
Unspecified
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-12-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

20 RI12034758 0000620797 LENI APRIYANI BT 17-04-1987 25 P Lingkungan V Kel.Kutaraya Kab. Ogan Komering JAMSOSKES(SUMSEL 203 III O72 Psot Partum Haemorrhage Operasi Plastik Perineum Dr.Amir Fauzi, SpOG SMF ANESTESI 2,327,000
HABIBULLAH Kec.Kayu Agung Kab.Oki Ilir SEMESTA)

21 RI12034578 0000680917 LIA SARI BT MUSLIM 15-12-1985 26 L Jl Pdam Lr Hibah Ii Kota Palembang JAMKESMAS PUSAT 203 III O82 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG SMF ANESTESI 6,223,750
Caesarean Section

22 RI12034453 0000673127 LINA NUR SYARIAH BIN 17-03-1997 15 L Upt Ii Sungai Rambutan JAMSOSKES(SUMSEL 408 III D10.6 Benign Neoplasm Of Ekstirpasi Tumor Dr. Yoan Levia Magdi, SMF ANESTESI 2,560,000
KAMIN SEMESTA) Nasopharynx Sp THT

23 RI12034433 0000665226 LISMAWATI BT M. ARSAD 29-05-1954 58 P Insp Marzuki No 2245 Kota Palembang JAMSOSKES(SUMSEL 405 III D21.9 Benign Neoplasm Of Eksisi drg.Adi Prabowo SMF ANESTESI 3,698,000
SEMESTA) Connective And Other Soft J,SpBM
Tissue, Unspecified

24 RI12034577 0000680912 LUSI BT JUMADI 6 P Jl Garuda No 01 Kel Watas Kota Lubuk Linggau UMUM 408 II B T16 Foreign Body In Ear Penambahan Jasa Dokter Dr.Puspa Zuleika, Dr.Agustina Br.H, 1,833,500
Lubuk Durian Kec Lubuk SpTHT,M.Kes SpAn, M.Kes
Linggau

25 RI12034577 0000680912 LUSI BT JUMADI 6 P Jl Garuda No 01 Kel Watas Kota Lubuk Linggau UMUM 408 II B T16 Foreign Body In Ear Oesophaguscopi Dr.Puspa Zuleika, 4,011,000
Lubuk Durian Kec Lubuk Diagnostik/Broncoscopy Rigit SpTHT,M.Kes
Linggau

26 RI12034706 0000681279 LUSIANA BT TARISUN 12-01-1992 20 P Desa Gentawangi Kota Palembang JAMKESMAS PUSAT 203 III O44.1 Placenta Praevia With Kuretase Dr.Nuswil Bernollan, SMF ANESTESI 2,321,000
Kec.Jatilawang Haemorrhage SpOG
Kab.Banyumas

27 RI12034230 0000630843 LYQUITHA VYANDRA F 10-04-2008 4 P Kol Animan Achyat No Kota Palembang ASKES 402 IB Z47.0 Folow-Up Care Involving Angkat K-Nail / Remove Flat Screw Dr.H.Muzakkie, SpBO Dr.Agustina Br.H, 3,605,500
Removal Of Fracture Plate & FICS SpAn, M.Kes
Other Internal Fixation
Device
28 RI12034535 0000680616 MARGARETA BT ANAS 04-03-1984 28 P Jl Jaya Lr Mandiri No.20 Kota Palembang Rumah Sakit Hermina 201 IA N85.8 Cyst Endometrium Laparascopy Operatif Dr.Abadi, SpOG Dr.Rose Mafiana, 9,244,000
Palembang SpAn

29 RI12034375 0000677967 PARADILLAH BINTI ANWAR 02-05-1981 31 P Jl Letnan Alamsyah Lahat Kab. Lahat ASKES 103 UT C Laparaskopik Kolesistektomi Dr.Sarup Singh,SpB Dr.Rose Mafiana, 16,875,000
MIRZA SpAn

30 RI12032219 0000596155 RAMDANI BIN BAHARUDDIN 31-12-2002 9 L Jl Sultan Syahril No 1644 Kota Palembang JAMSOSKES(SUMSEL 404 III I25.1 Atherosclerotic Heart Release Dr. Mgs Roni Saleh, Sp SMF ANESTESI 2,804,000
SEMESTA) Disease (Cad) BP

31 RI12034241 0000679998 RASMALINDA BINTI 05-08-1960 52 P Jl Guru-Guru 2 No 60 Kab. Ogan Komering ASKES 201 IA C53.9 Malignant Neoplasm Of Radikal Histerektomi Dr.Agustria Z,SpOG- Dr.Agustina Br.H, 12,500,000
MARASIN Ilir Cervix Uteri, Unspecified KFM SpAn, M.Kes
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 03-12-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

32 RI12034366 0000671205 RIRIN BT AMILUDIN 06-11-1988 24 P Lahat Kab. Lahat ASKES 401 IB L91.0 Keloid Scar Wide Excisi Dr.Iqmal Perlianta, Sp Dr.Agustina Br.H, 5,537,500
BP SpAn, M.Kes

33 RI12034248 0000680016 RUSLAN BIN SANAP 01-07-1949 63 L Desa Sukaraja Pajar Bulan Kab. Lahat JAMSOSKES(SUMSEL 408 III D34 Benign Neoplasm Of Tyroid Tracheostomi Dr. Lisa Apri Yanti, 3,264,300
Lahat SEMESTA) Gland Sp.THT-KL

34 RI12034248 0000680016 RUSLAN BIN SANAP 01-07-1949 63 L Desa Sukaraja Pajar Bulan Kab. Lahat JAMSOSKES(SUMSEL 408 III D34 Benign Neoplasm Of Tyroid Penambahan Jasa Dokter Dr. Lisa Apri Yanti, SMF ANESTESI 949,000
Lahat SEMESTA) Gland Sp.THT-KL

35 RI12034236 0000679985 SAIJAH BINTI AMUDIN 12-08-1954 58 P Ds. Tanda Raja Kec. Kikim Kab. Lahat ASKES 403 IA K80 Cholelithiasis Laparaskopik Kolesistektomi Dr.Efman E.U.M, Dr.Agustina Br.H, 16,875,000
Timur Lahat M.Kes,SpB-KBD SpAn, M.Kes

36 RI12034345 0000678864 SOKDIN PARDEDE 18-02-1961 51 L Lapa Bangka Barat Kota ASKES 401 IB Z47.0 Folow-Up Care Involving Reposisi Tertutup dr. Ismail Bastomi, Dr.Agustina Br.H, 3,613,500
Bangka Removal Of Fracture Plate & SpOT SpAn, M.Kes
Other Internal Fixation
Device
37 RI12033058 0000668705 SYARIFAH JULIAH 31-07-1939 73 P Jl. Lebak Mulyo Gg Sada Kota Palembang ASKES 105 IA Arthoplasty dr. Ismail Bastomi, Dr.Agustina Br.H, 18,125,000
No. 188 SpOT SpAn, M.Kes

38 RI12034627 0000680963 TRI SUSANTI 12-01-1988 24 P Komp. Griya Purnawira Asri Kota Palembang JAMSOSKES(SUMSEL 410 III S09.7 Multiple Injuries Of Head Reposisi Hidung Dr.Iqmal Perlianta, Sp SMF ANESTESI 3,260,400
Blok B.3 No. 13 Plg. Kel. SEMESTA) (Trauma Capitis) BP
Suka Jadi

39 RI12033772 0000652327 YAHYA EFENDI 14-01-1955 57 L Jl Kapten Arifai No. 58 Kota Palembang ASKES 105 IA D20.1 Benign Neoplasm Of Soft Eks.Tumor > 10 cm / Retro Dr.Sarup Singh,SpB Dr.Agustina Br.H, 9,295,500
Tissue Of Peritoneum SpAn, M.Kes

40 RI12034529 0000678002 YUNITA BIN H HAMID 13-06-1972 40 P Jl Puskesmas Suka Rame ASKES 201 IB N93.9 Abnormal Uterine And Laparascopy Operatif - Dr.Rizal Sanif, SpOG- Dr.Rose Mafiana, 3,125,000
No Vaginal Bleeding, Histeroskopi Konk SpAn
Unspecified

Sub T o t a l Rp.: 212,074,450


JLH TINDAKAN KAMAR OPERASI IBS : 40
Tgl Operasi : 03-12-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12034552 0000680867 SUPARMAN BIN SHIMON 02-02-1972 40 L Jl.Ps Ing Kenayan Kota Palembang JAMSOSKES(SUMSEL 702 III T14.1 Open Wound (Luka Tusuk, Repair Tendo Penyulit/Arteri Dr.Kgs Zulkarnain SMF ANESTESI 12,613,250
Kec.Gandus SEMESTA) Lecet, Potong, Gigit Carotis/Arteri renalis stenosis Muslim,Sp.OT
Binatang)

Sub T o t a l Rp.: 12,613,250


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 1
Tgl Operasi : 04-01-2012
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 04-01-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI11032886 0000540697 ABEL BT JUNAIDI 11-03-2008 3 P Desa Penanggoan Duren Kab. Ogan Komering JAMSOSKES(SUMSEL 409 III M24.5 Contracture Of Joint STSG / Skingrafting yang Luas Dr. Mgs Roni Saleh, Sp 3,997,000
Dns.Iii Kec.Tulung Selapan Ilir SEMESTA) BP
Oki

2 RI11032886 0000540697 ABEL BT JUNAIDI 11-03-2008 3 P Desa Penanggoan Duren Kab. Ogan Komering JAMSOSKES(SUMSEL 409 III M24.5 Contracture Of Joint Penambahan alat Pisau Skin Dr. Mgs Roni Saleh, Sp Dr.Kusuma 500,000
Dns.Iii Kec.Tulung Selapan Ilir SEMESTA) Dermato BP Harimin, SpAn
Oki

3 RI11033566 0000573614 ACHMAD BURSYAH 73 L Harun Sohar Komp,.Pdk Kota Palembang ASKES 504 IB I50.0 Congestive Heart Failure Insersi Kateter Double Luman HD Dr.Kusuma Harimin, 3,038,500
Plg (Chf) Semi Permanen SpAn

4 RI12000114 0000573027 AGIS ARINA 27-12-1991 20 P Gt Royong No Kota Palembang JAMKESMAS PUSAT 406 III D24 Benign Neoplasm Of Breast EKsisi Luas Sarcoma / Jaringan Dr.Benny Kusuma, SpB Dr.Kusuma 4,154,000
Lunak (K) Onk Harimin, SpAn

5 RI11032502 0000569754 AMRULLAH 19 L Simpang Gardu Sekayu Kab. Musi Banyuasin MUBA SEMESTA 407 III S09.7 Multiple Injuries Of Head Craniotomi Dr.Sahat Dr.Kusuma 6,832,000
(Trauma Capitis) Edison.S,SpBS Harimin, SpAn

6 RI12000252 0000549624 CANDRA APRIADI BIN 13-10-1983 28 L Jl.Ariodillah Ii. No.58/220 JAMSOSKES(SUMSEL 408 III J34.2 Deviated Nasal Septum SMR (Sub Mucus Resection) Dr.Abla Ghanie,SpTHT Dr.Kusuma 3,742,000
RAJAB SEMESTA) Harimin, SpAn

7 RI12000279 0000449293 DODY AKBAR 26-11-1996 15 L Jl Sei Sehang No 03 ASKES 401 IA S72.9 Fracture Of Femur, Part Nos Removal Implant / Remove Flat Dr.Nur Rachmat Lubis, Dr.Kusuma 3,613,500
Demang Lebar Daun Screw SpOT Harimin, SpAn

8 RI12000324 0000577394 EPA BINTI A. HASIM 14-12-1987 24 P Jl Suak Permai Kota Palembang JAMKESMAS PUSAT 203 III G70.0 Myasthenia Gravis Sectio Cesarea tanpa penyulit Dr.Azhari, SpOG Dr.Kusuma 6,223,750
Harimin, SpAn

9 RI12000247 0000577276 H.N YULIANA HERI 21 P Jl M Akip Lr Manisan No.90 JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Firmansyah, SpOG Dr.Kusuma 6,223,750
Caesarean Section Harimin, SpAn

10 RI12000115 0000572160 HELENA SUSANTI 24-11-1980 31 P Komp. Megaf Asri Blok Cno. Kab. Banyuasin JAMSOSKES(SUMSEL 404 III D24 Benign Neoplasm Of Breast Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Kusuma 2,522,000
20 Sukajadi Talang Kelapa SEMESTA) (K) Onk Harimin, SpAn
Banyuasin

11 RI12000117 0000523496 INDAH RAMADHANI 11-07-1999 12 P Suka Bangun 2 Komp Kota Palembang ASKES 402 IB S42.0 Fracture Of Clavicle Angkat K-Nail / Remove Flat Screw Dr.Rendra Leonard, Dr.Kusuma 3,605,500
Pepaya Indah SpOT Harimin, SpAn
Blok E No 2103

12 RI12000278 0000577234 M.SAID SALIM 17-08-1991 20 L Banten No 20 Kota Palembang ASKES 103 UT C K40.9 Unilateral Or Unspecified Hernioraphy dgn prolenemesh / Dr.Sarup Singh,SpB Dr.Kusuma 6,026,500
Inguinal Hernia, Without Komplikasi Harimin, SpAn
Obstruction Or Gangrene
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 04-01-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

13 RI11034138 0000575276 MARTIN SUPONO 9 L Ds Purba Mas Kec Kekem Kab. Lahat JAMKESMAS PUSAT 302 III G91.9 Hydrocephalus,Unspecified Craniotomi Dr.Sahat Dr.Kusuma 6,832,000
Tengah Lahat Edison.S,SpBS Harimin, SpAn

14 RI12000093 0000575026 NARDI BIN TAM KELAT 13-01-1947 65 L Tanjung Lalang Payaraman Kab. Ogan Komering UMUM 401 IA C19 Malignant Neoplasm Of Low Ant.Resection / Pullthrough Dr.Efman E.U.M, Dr.Kusuma 9,206,500
Oi Ilir Rectosigmoid Juntion M.Kes,SpB-KBD Harimin, SpAn

15 RI12000121 0000570581 NIRWATI M NASIR 02-02-1970 41 P Lrg Kades Betung No 33 JAMSOSKES(SUMSEL 404 III D24 Benign Neoplasm Of Breast Biopsi Kelenjar/Jar Mamae Dr.Benny Kusuma, SpB Dr.Kusuma 2,519,000
SEMESTA) (K) Onk Harimin, SpAn

16 RI11032015 0000568296 NOPIANTI 38 P Lrg Pamili Let Murod JAMSOSKES(SUMSEL 405 III D21.9 Benign Neoplasm Of Gastrektomi / Gastroschizis Dr.Sarup Singh,SpB Dr.Kusuma 6,281,000
Rt.10/4 Sri Jaya Alang SEMESTA) Connective And Other Soft Harimin, SpAn
Lebar Tissue, Unspecified

17 RI12000240 0000577261 NY.MUSTIKA WATI 11-01-1979 33 P Griya Hero Blok.I.N0.1 Plg Kota Palembang UMUM 201 IA N84.0 Polyp Of Corpus Uteri Laparascopy Operatif - Dr.Nuswil Bernollan, Dr.Kusuma 3,125,000
Histeroskopi SpOG Harimin, SpAn

18 RI12000369 0000256961 RAHMAWATI HASANAH, NY. 29-03-1970 41 P Griya Permata Blok. D-14 Kota Palembang UMUM 201 IA O80.9 Single Spontaneous Sectio Cesarea tanpa penyulit Dr.Azhari, SpOG Dr.Kusuma 6,677,000
Pakjo Delivery, Unspecified Harimin, SpAn

19 RI12000109 0000576646 RENO TAMPANI 01-10-1995 16 L JAMKESMAS PUSAT 406 III E04.9 Nontoxic Goitre, Unspecified Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Kusuma 2,522,000
(K) Onk Harimin, SpAn

20 RI12000075 0000576503 ROSLENI BT SARTONO 09-02-1976 35 P Jl.Petaling No.49 Kab. Banyuasin JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Multiple Meomectomi Dr.Abadi, SpOG Dr.Kusuma 8,160,100
Caesarean Section Harimin, SpAn

21 RI12000044 0000566672 RUSMALA DEWI 01-01-1974 38 P JAMKESMAS PUSAT 203 III D26.9 Other Benign Neoplasm Of Laparatomi Dr.Kusuma 4,499,000
Uterus, Unspecified Harimin, SpAn

22 RI12000277 0000492390 SAFITRI 5 P Jl Kasnariansah Lr Pu Rt 17 Kota Palembang UMUM 408 II B J35.0 Chronic Tonsillitis Tonsilektomi Dr.Puspa Zuleika, Dr.Kusuma 3,125,000
Rw9 Kel Aryo Kemuning SpTHT,M.Kes Harimin, SpAn
Kec It 1 Plg

23 RI12000276 0000577315 SUGIMAN BIN SUPADI 22 L Desa Purwo Sari Kab. Banyuasin UMUM 407 II B S42.0 Fracture Of Clavicle Orif Dr.H.Muzakkie, SpBO Dr.Kusuma 6,765,500
Kec.Sumbawa FICS Harimin, SpAn
Kab.Banyuasin

24 RI11034201 0000563803 SUMIYATUN 05-12-1963 48 P Desa Marga Bakti Kab. Ogan Komering ASKES 403 II B D34 Benign Neoplasm Of Tyroid Isthobektomi Dr.Benny Kusuma, SpB Dr.Kusuma 9,280,500
Kec.Mesuji Kab.Oki Ilir Gland (K) Onk Harimin, SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 04-01-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

25 RI11034049 0000574965 SUNARYA 09-01-1962 50 P Lampung Lampung UMUM 501 II B E85.3 Swecondary Systemic Terapi Laser Dr. Ramzi Amin, SpM 3,608,500
Amyloidosis

26 RI11033598 0000564192 TOMI BE'AH 09-09-1940 71 L Komp Gmp Balai Agung MUBA SEMESTA 407 III N40 Hyperplasia Of Prostate TUR Prostat Dr.Arizal Agoes, SpB Dr.Kusuma 6,297,000
SpU Harimin, SpAn

27 RI11032430 0000569096 YOPI BIN SYAMSUDIN FILLI 06-01-1992 19 L Jl.Slame Riady Lr.Lebuk Kota Palembang JAMSOSKES(SUMSEL 408 III R60.9 Oedema, Unspecified Bronkoskopi Dr.M.Yusuf Hanafiah Dr. Yusni Puspita, 3,742,000
Lawang Kidul It Ii Plg SEMESTA) Pohan,Sp.P SpAn

28 RI12000361 0000577472 YUSNIMAH JONI YUSUF 54 P Komplek Ppi Blok.D.5 UMUM 201 II A N83.2 Other & Unspecified Ovarian Laparatomi Dr.Rizal Sanif, SpOG- Dr.Kusuma 7,948,850
Cyst Konk Harimin, SpAn

Sub T o t a l Rp.: 141,067,450


JLH TINDAKAN KAMAR OPERASI IBS : 28
Tgl Operasi : 04-01-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12000426 0000577769 ABDI MARTA 27 L Jl Mojo Pahit 6 No.02 Kota Palembang JAMSOSKES(SUMSEL 702 III K67.3* Tuberculous Peritonitis Laparatomi Dr.Efman E.U.M, Dr.Kusuma 5,109,000
SEMESTA) (A18.3+) M.Kes,SpB-KBD Harimin, SpAn

2 RI12000397 0000577725 M.SANDI 30 L Mega Makmur Kayu Agung Kab. Ogan Komering JAMKESMAS PUSAT 701 III S29.9 Unspecified Injuryof Thorax Biopsi Insisi Dr.Bermansyah, SpB 5,562,000
Ilir

Sub T o t a l Rp.: 10,671,000


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 2
Tgl Operasi : 04-02-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12003050 0000584333 ARNI GUNAWATI 04-02-1966 46 P Abu Bakar Pakjo No. Kota Palembang ASKES 401 II A N21.0 Calculus In Bladder Litotripsi Dr. Martha Hendry,SpU Dr.Fredi Heru 5,488,500
Irwanto, Sp.An

2 RI12003527 0000557406 HJ. HUDAYA BT MANAP 15-11-1955 56 P Ulak Pandan Oku Batu Raja Kab. Ogan Komering UMUM 103 UT C N20.0 Calculus Of Kidney Longitudinal Neprolitotomi Dr. Martha Hendry,SpU Dr.Rizal Zanial, 9,375,500
Ulu (Nephrolithiasis Nos)(Renal (KADET) SpAn
Calculus Or
Stone)(Staghorn
Calculus)(Stone In Kidney)
3 RI12003546 0000587631 JANIAH SURIP 16-04-1975 36 P Desa Rantau Karya Dusun 3 Kab. Ogan Komering JAMKESMAS PUSAT 203 III O42 Premature Rupture Of Operasi Septum Vagina Dr. Peby Maulina Dr.Fredi Heru 2,357,000
Panggung Harjo-Oki Ilir Membranes Lestari,SpOG Irwanto, Sp.An
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 04-02-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

4 RI12003495 0000587522 JUMIAT ABDAN 48 L Kel Talang Bulan Kec Kab. Muara Enim UMUM 405 II B Z09.9 Follow-Up Examination URS Dr. Martha Hendry,SpU Dr.Rizal Zanial, 9,307,500
Talang Ubi After Unspecified Treatment SpAn
For Other Conditions

5 RI12003722 0000579330 M. TH YULIASTUTI 31-07-1976 35 L Jl Kh Wahid Hasyim No Kota Palembang UMUM 201 IA D27 Benign Neoplasm Of Ovary Histerektomi Dr.Rizal Sanif, SpOG- Dr.Rizal Zanial, 5,625,000
1018 Kertapati Ttl,Salp.OfortmiBilateral/Hist.Ttl Konk SpAn
Salp.OfortmiSinistra

6 RI12003700 0000567244 M. ZAKI ALFARIZI 24-01-2007 5 L Pagar Alam Lahat Kab. Lahat UMUM 404 II B D22.9 Melanocytic Naevi Of, Wide Excisi Dr. Mgs Roni Saleh, Sp 5,537,500
Unspecified BP

7 RI12003700 0000567244 M. ZAKI ALFARIZI 24-01-2007 5 L Pagar Alam Lahat Kab. Lahat UMUM 404 II B D22.9 Melanocytic Naevi Of, Penambahan Jasa Dokter Dr. Mgs Roni Saleh, Sp Dr.Rizal Zanial, 3,000,000
Unspecified BP SpAn

8 RI11028164 0000556214 MARWATIHA 52 P Tanjung Sirih Pulau Kab. Lahat JAMSOSKES(SUMSEL 203 III N93.9 Abnormal Uterine And Reheacting Dr. Amirah Novaliani, Dr.Rizal Zanial, 3,610,100
Pinang Lahat SEMESTA) Vaginal Bleeding, SpOG SpAn
Unspecified

9 RI12002973 0000585807 MUHAMMAD TAUFIK 14 L Desa Langkan Kampung Ii UMUM 402 II A S68.9 Trumatic Amputation Of Repair Perinium Grade III - IV dr. Ismail Bastomi, Dr.Rizal Zanial, 3,125,000
Wrist And Hand, Level Pasca Persalinan SpOT SpAn
Unspecified

10 RI12003609 0000587923 MULYADI 52 L Lingk 2 Balai Agung Sekayu UMUM 403 II B S09.7 Multiple Injuries Of Head Craniotomi Dr.Sahat 12,805,650
Muba (Trauma Capitis) Edison.S,SpBS

11 RI12003760 0000588280 PEBRIANTI 30 P Jl Tulang Baang 5 No 78 / JAMKESMAS PUSAT 203 III O42 Premature Rupture Of Sectio Cesarea tanpa penyulit Dr.Amir Fauzi, SpOG Dr. Yusni Puspita, 6,223,750
2193 Kec Sematang Borang Membranes SpAn

12 RI12003662 0000582454 ROSSI BT PETARI 28-01-1967 45 P Desa Parit Sungi Batan Kab. Musi Banyuasin UMUM 201 II A C54.1 Malignant Neoplasm Of Radikal Histerektomi Dr.Rizal Sanif, SpOG- Dr.Rizal Zanial, 12,500,000
Sungsang Endometrium Konk SpAn

13 RI12003454 0000587286 SAFNILCON 30 L Komp Griya Permai Blok M Kota Palembang UMUM 401 IA N20.1 Calculus Of Ureter (Ureteric Litotripsi Dr.Arizal Agoes, SpB 4,727,500
No.3 Plg Stone) SpU

14 RI12003654 0000587989 SRI KUMALA DEWI 31 P Perumahan Opi Jl UMUM 201 II A O02.0 Bligted Ovum & Kuretase Dr.Amir Fauzi, SpOG Dr.Rizal Zanial, 4,155,450
Cendrawasi 4 Blok I No 19 Nonhydatidiform Mole SpAn

15 RI12003650 0000587988 SUKIR BIN SOMOREJO 70 L Talang Bandung Sungsang Kab. Musi Banyuasin UMUM 403 II B N40 Hyperplasia Of Prostate TUR Prostat Dr. Martha Hendry,SpU Dr.Fredi Heru 9,315,500
Banyuasin Irwanto, Sp.An
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 04-02-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

16 RI12003703 0000558028 SULASMI 11-11-1979 32 P Pt Melania Melania Indonesia 405 II B M19.9 Arthrosis (Osteoarthritis) Atroscopy dr. Ismail Bastomi, Dr.Rizal Zanial, 9,903,500
SpOT SpAn

17 RI12003806 0000588509 TITIK PUSAKA KHASANAH 04-02-1983 29 P Jl Blok Airport No 566 Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Iskandar Z, SpOG Dr.Rizal Zanial, 6,223,750
Caesarean Section SpAn

Sub T o t a l Rp.: 113,281,200


JLH TINDAKAN KAMAR OPERASI IBS : 17
Tgl Operasi : 04-02-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12003766 0000588300 HERI ASMAWI 21 L Ds Babatan Saudagar JAMSOSKES(SUMSEL 702 III S29.9 Unspecified Injuryof Thorax Pemasangan WSD Dr.Bermansyah, SpB Apoteker 5,135,650
Pemulutan SEMESTA)

2 RI12003768 0000588298 RIO DWI SAPUTRA 19 L Jl Sultansyahril No.1022 Kota Palembang JAMKESMAS PUSAT 702 III K35.1 Acute Appendicitis With Appendiktomi Dr.Sarup Singh,SpB Dr. Yusni Puspita, 3,565,900
Peritoneal Abscess SpAn

Sub T o t a l Rp.: 8,701,550


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 2
Tgl Operasi : 04-03-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12006841 0000597523 ELIS BT ASWAN 20-04-1987 24 P Penopo Lintang - Empat Kab. Lahat ASKES 201 II A O06.4 Unsp.Abortion Incomplete, Kuretase Dr.Azhari, SpOG Dr.Rizal Zanial, 3,196,500
Lawang Without Complication SpAn

2 RI12006812 0000597493 FARHAN BIN NUR HOLIS 01-03-2012 0 L Ds Cipta Sari Skpd 3 Mesuji Kab. Ogan Komering JAMKESMAS PUSAT 301 III Q42.3 Congenital Absence, Atresia Colostomi / lleostomi Dr.Sindu Dr.Rizal Zanial, 5,071,300
Raya Oki Ilir & Stenosis Of Anus Without Saksono,SpBA SpAn
Fistula [Imperfoarte Anus]

3 RI12006562 0000596756 HJ ZUBAIDAH 72 P Desa Sumangus Lubuk Kota Lubuk Linggau UMUM 403 II B D34 Benign Neoplasm Of Tyroid Tracheostomi Dr.Benny Kusuma, SpB 4,661,800
Linggau Gland (K) Onk

4 RI12006848 0000597541 NURTI BT SUARDI 26 P Jl.Swadaya No.2542 JAMKESMAS PUSAT 203 III N93.9 Abnormal Uterine And Sectio Cesarea tanpa penyulit Dr.Azhari, SpOG Dr.Rizal Zanial, 6,223,750
Kel.Srijaya Kec.Alang-Alang Vaginal Bleeding, SpAn
Lebar Unspecified

5 RI12006835 0000597522 SITI AMINAH 65 P Jl Faqih Usman No 2145 Kota Palembang JAMSOSKES(SUMSEL 409 III K63.1 Perforation Of Intestine Laparatomi Dr.Efman E.U.M, Dr.Rizal Zanial, 5,109,000
SEMESTA) (Nontraumatic) M.Kes,SpB-KBD SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 04-03-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

6 RI12006691 0000597164 YENI SUZANA 25-05-1981 30 P Jl.Ratu Sianum Lr.Asam Kota Palembang JAMKESMAS PUSAT 203 III O06.3 Unsp.Abortion Kuretase Dr.Kms.Yusuf E.SpOG Dr.Rizal Zanial, 3,017,300
No.50 Ilir Timur Ii Incomplete,With Other And SpAn
Unspecified Complications

Sub T o t a l Rp.: 27,279,650


JLH TINDAKAN KAMAR OPERASI IBS : 6
Tgl Operasi : 04-03-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12006808 0000597466 ANTONI STEPEN 18 L Musi Raya Lr.Musawarah In JAMKESMAS PUSAT 701 II S67.0 Crussing Injury Of Thumb & Debridement dr. Ismail Bastomi, Dr.Rizal Zanial, 4,684,550
No 92 A Other Finger [S] SpOT SpAn

2 RI12006814 0000597494 GANDA PUTRA 17 L Tidak Jelas JAMKESMAS PUSAT 701 III T14.1 Open Wound (Luka Tusuk, Pemasangan WSD Dr.Bermansyah, SpB 5,562,000
Lecet, Potong, Gigit
Binatang)

Sub T o t a l Rp.: 10,246,550


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 2
Tgl Operasi : 04-04-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12009776 0000601271 AHAMAD HARIS 25-03-1972 40 L Veteran No 654 Kota Palembang ASKES 401 IB D17.9 Benign Lipomatous Eksisi Tumor Jar Lunak Kecil Dr.Benny Kusuma, SpB Dr.Kusuma 3,397,500
Neoplasm, Unspecified (K) Onk Harimin, SpAn
(Lipoma Nos)

2 RI12010039 0000607975 ANGGI 21-10-1965 46 L Lr Manggar Ii No 1471 Kel JAMKESMAS PUSAT 410 III J93.9 Pneumothorax, Unspecified Pemasangan WSD Dr.Bermansyah, SpB 3,950,500
Lawang Kidul Kec Ilir Timur
Ii

3 RI12009696 0000581919 BASRIAH MALJANI 06-01-1967 45 P Jl Harjo Mulya Belitang Kab. Ogan Komering UMUM 102 UT A K36 Other Appendicitis (Chronic, Laparaskopik Kolesistektomi Dr.Sarup Singh,SpB Dr.Rose Mafiana, 16,875,000
Ulu Timur Reccurent) SpAn

4 RI12009959 0000607642 BY. FARIDA 0 L Desa Muara Teladan- Kab. Musi Banyuasin JAMKESMAS PUSAT 603 II K91.4 Colostomy & Enterostomy Colostomi / lleostomi Dr.Sindu Dr.Rose Mafiana, 7,703,150
Sekayu Malfunction Saksono,SpBA SpAn

5 RI12009821 0000603046 CERIS TANTO 11-03-1981 31 L Komp. Pu Jl. Air Saleh No. Kota Palembang JAMSOSKES(SUMSEL 405 III K60.2 Anal Fissure, Unspecified Fistulektomi / High Anal Dr.Efman E.U.M, Dr.Kusuma 3,987,000
771 Sukamaju Sako Plg SEMESTA) M.Kes,SpB-KBD Harimin, SpAn

6 RI12008657 0000603601 CIK UJANG 21-07-1956 55 L Desa Sialingan Kec.Lembak Kab. Muara Enim JAMSOSKES(SUMSEL 406 III H16.0 Keratitis Of Corneal Ulcer Repair Soket Dr.Anang Tribowo, 3,184,000
Kab.Muara Enim SEMESTA) SpM
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 04-04-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

7 RI12009900 0000573090 DESI SUSANTI 20-02-1981 31 P Jl.Cempaka Dalam Kel.26 Kota Palembang JAMSOSKES(SUMSEL 203 III D25.9 Leiomyoma Of Uterus, Kuretase Dr.Kms.Yusuf E.SpOG Dr.Kusuma 2,321,000
Ilir Kec.B,Kecil SEMESTA) Unspecified Harimin, SpAn

8 RI12009439 0000606089 DULHAJAD 02-04-1940 72 L Sukajadi Iii No.69 ASKES 104 UT C C34 Malignant Neoplasm Of Penambahan Jasa Dokter Dr.Efman E.U.M, Dr.Kusuma 3,117,000
Bronchus And Lung M.Kes,SpB-KBD Harimin, SpAn

9 RI12009439 0000606089 DULHAJAD 02-04-1940 72 L Sukajadi Iii No.69 ASKES 104 UT C C34 Malignant Neoplasm Of Kolesistektomi Dr.Efman E.U.M, 9,336,500
Bronchus And Lung M.Kes,SpB-KBD

10 RI12009917 0000603869 ELIAH WULANDARI 22-06-1977 34 P Jl. Psi Lautan Lr. Kota Palembang JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Kusuma 6,223,750
Pmino.1360 Caesarean Section, SpOG Harimin, SpAn
Unspecified

11 RI12007639 0000597624 FAUZAN BIN SALIM 17-07-1972 39 L Banding Agung Ranau UMUM 404 II A T30 Burn & Corrosion, Body Penambahan alat Pisau Skin Dr.Iqmal Perlianta, Sp Dr.Kusuma 500,000
Region Unspecified Dermato BP Harimin, SpAn

12 RI12007639 0000597624 FAUZAN BIN SALIM 17-07-1972 39 L Banding Agung Ranau UMUM 404 II A T30 Burn & Corrosion, Body Rotation Flab Rekonstruktion Dr.Iqmal Perlianta, Sp 10,515,000
Region Unspecified BP

13 RI12007639 0000597624 FAUZAN BIN SALIM 17-07-1972 39 L Banding Agung Ranau UMUM 404 II A T30 Burn & Corrosion, Body Penambahan Jasa Dokter Dr.Iqmal Perlianta, Sp 3,000,000
Region Unspecified BP

14 RI12010095 0000607654 FERA WATI MARZUKI 16-04-1983 28 P Desa Muara Batun Kab. Ogan Komering JAMKESMAS PUSAT 203 III O72 Psot Partum Haemorrhage Kuretase Dr.Abadi, SpOG Dr.Rose Mafiana, 2,321,000
Kec.Jejawi Oki Ilir SpAn

15 RI12009515 0000606362 GHAITSYAH UZWATTUN S. 02-11-2011 0 L Rss Blok 33 Lt.4 Kota Palembang JAMSOSKES(SUMSEL 407 III K56.6 Other & Unspecified Laparatomi Dr.Sindu Dr.Kusuma 3,930,000
SEMESTA) Intestinal Obstruction Saksono,SpBA Harimin, SpAn

16 RI12003779 0000559352 HARTAWAN BIN SUHI 01-01-1971 41 L Kel.Jarai JAMKESMAS PUSAT 407 III D36.7 Benign Neoplasm Of Other Biopsi / Insisi Dr.Benny Kusuma, SpB Dr.Kusuma 2,722,000
Specified Sites (Nose Nos) (K) Onk Harimin, SpAn

17 RI12010012 0000607911 IBRAHIM 35 L Ds Payukabung Kec JAMSOSKES(SUMSEL 406 III H16.0 Keratitis Of Corneal Ulcer Krato Plastie Lamelar Dr.A.K.Ansyori, SpM Dr.Kusuma 4,592,900
Indralaya Oi SEMESTA) Harimin, SpAn

18 RI12009773 0000605846 M. RASYA REYMOUN HADI 02-04-2011 0 L Dusun Iv Desa Banuayu JAMSOSKES(SUMSEL 404 III Q36 Cleft Lip Palatoplasty Dr.Iqmal Perlianta, Sp Dr.Kusuma 4,081,000
Rambang Dangku SEMESTA) BP Harimin, SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 04-04-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

19 RI12009697 0000592138 MUNAZZAHAH S.PARMAN 26-02-1969 43 P Griya Hero Abadi Blok I 11 Kab. Musi Banyuasin ASKES 402 IA Z47.0 Folow-Up Care Involving Angkat K-Nail / Remove Flat Screw Dr.H.Muzakkie, SpBO Dr.Kusuma 3,605,500
Talang Kelapa Removal Of Fracture Plate & FICS Harimin, SpAn
Other Internal Fixation
Device
20 RI12009774 0000605706 MUSLIMAH NGATULUSI 11-04-1957 55 P Petanggan Belitang UMUM 401 II A R17 Unspecified Jaundice [ Kolesistektomi Dr.Efman E.U.M, 9,336,500
Exclude : Neonatal Janudice M.Kes,SpB-KBD
)P55, P57-P59)

21 RI12009774 0000605706 MUSLIMAH NGATULUSI 11-04-1957 55 P Petanggan Belitang UMUM 401 II A R17 Unspecified Jaundice [ Penambahan Jasa Dokter Dr.Efman E.U.M, Dr.Kusuma 3,117,000
Exclude : Neonatal Janudice M.Kes,SpB-KBD Harimin, SpAn
)P55, P57-P59)

22 RI12008332 0000574963 NURLELA BT HALIL 10-06-1965 46 P Jl. Cempaka Kel. B. Srikaton Kab. Musi Rawas JAMSOSKES(SUMSEL 409 III D16.5 Benign Neoplasm Of Lower Penambahan Jasa Dokter Dr.Benny Kusuma, SpB Dr.Kusuma 1,068,000
Kec. Tugu Mulyo Kab. Musi SEMESTA) Jaw Bone (K) Onk Harimin, SpAn
Rawas

23 RI12008332 0000574963 NURLELA BT HALIL 10-06-1965 46 P Jl. Cempaka Kel. B. Srikaton Kab. Musi Rawas JAMSOSKES(SUMSEL 409 III D16.5 Benign Neoplasm Of Lower Mandibulektomi Dr.Benny Kusuma, SpB 6,295,000
Kec. Tugu Mulyo Kab. Musi SEMESTA) Jaw Bone (K) Onk
Rawas

24 RI12009879 0000607398 NY.ELIANA 12-04-1977 35 P Palembang Kota Palembang UMUM 201 IB N93.9 Abnormal Uterine And Histerektomi Dr.Agustria Z,SpOG- Dr.Kusuma 6,162,500
Vaginal Bleeding, KFM Harimin, SpAn
Unspecified

25 RI12008653 0000603585 NYIMAS ROSNAH 01-01-1950 50 P Jl.Angkatan 66 Sekip Ujung Kota Palembang ASKES 403 II B S82.2 Fracture Of Shaft Of Tibia Fiksasi Hemispika / Long Leg dr. Ismail Bastomi, Dr.Kusuma 3,613,500
Pipa Reja No 1398 SpOT Harimin, SpAn

26 RI12008179 0000572115 RAMBAT BT REPON 01-02-1954 58 P Dsn 2 Dana Mulya JAMKESMAS PUSAT 406 III D35.1 Benign Neoplasm Of Isthobektomi Dr.Benny Kusuma, SpB Dr.Kusuma 6,292,000
Parathyroid Gland (K) Onk Harimin, SpAn

27 RI12009890 0000607228 RESI HANDAYANI BT NUR 29-11-1993 18 P Jl.Masjid Dusun Ii Kab. Ogan Ilir JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr.Nuswil Bernollan, Dr.Kusuma 6,223,750
SALIM Kec.Tanjung Batu - Ogan Caesarean Section, SpOG Harimin, SpAn
Ilir Unspecified

28 RI12009967 0000607652 RISKA MULYANI BT SEPTA 21 P Jl.Mahameru No.851 Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr.Abadi, SpOG Dr.Rose Mafiana, 6,223,750
Caesarean Section SpAn

29 RI12009787 0000603186 SAMBUDIMAN 07-11-1967 44 L Jl Sila Beranti No 7 Kota Palembang UMUM 103 UT C D13.1 Benign Neoplasm Of By Pass Billio Digestive Dr.Efman E.U.M, Dr.Kusuma 9,225,500
Stomach M.Kes,SpB-KBD Harimin, SpAn

30 RI12009954 0000607633 SANDRA 23 L Jl. Basuki Rahmat Kota Palembang UMUM 410 III T30 Burn & Corrosion, Body Debridement Dr.Iqmal Perlianta, Sp Dr.Rose Mafiana, 3,546,400
Palembang Region Unspecified BP SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 04-04-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

31 RI12009807 0000595844 SUSI SIMATUPANG 09-03-1975 37 P Betung UMUM 201 UT A D25.9 Leiomyoma Of Uterus, Multiple Meomectomi Dr.Abadi, SpOG Dr.Kusuma 9,244,000
Unspecified Harimin, SpAn

32 RI12009872 0000603350 TARIF ZANKAMIL 01-04-1969 43 L Kebun Tirta Agung Bayung Kab. Musi Banyuasin PP London Sumatra Tbk 401 IB N20.9 Urinary Calculus, Extracorporeal Shock Wave Dr.Arizal Agoes, SpB 6,637,500
Lincir (LONSUM) Unspecified (Calculous Litotripsi SpU
Pyelonephritis)

33 RI12009751 0000474156 VERSSHITA BSC 01-12-1961 50 L Jl.Air Gegas Komp.Pu Kota Palembang ASKES 402 IA Z47.0 Folow-Up Care Involving Angkat K-Nail / Remove Flat Screw Dr.H.Muzakkie, SpBO Dr.Kusuma 3,605,500
Pengairan No.782 Removal Of Fracture Plate & FICS Harimin, SpAn
Other Internal Fixation
Device
34 RI12009893 0000604825 YUZARNAH 11-05-1966 45 P Sukaraya Baturaja Kab ASKES 201 IB N93.9 Abnormal Uterine And Laparascopy Operatif - Dr.Rizal Sanif, SpOG- Dr.Rose Mafiana, 3,125,000
Baturaja Oku Induk Vaginal Bleeding, Histeroskopi Konk SpAn
Unspecified

35 RI12009770 0000443041 ZAINUDIN 40 L Sungai Lilin UMUM 103 UT C M19.9 Arthrosis (Osteoarthritis) Debridement Dr.Nur Rachmat Lubis, Dr.Kusuma 3,603,500
SpOT Harimin, SpAn

Sub T o t a l Rp.: 182,682,200


JLH TINDAKAN KAMAR OPERASI IBS : 35
Tgl Operasi : 04-04-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12009968 0000607649 DESI INDERIANI BIN NEDI 15 P Desa Wonosari Kota Prabumulih UMUM 701 II S09.7 Multiple Injuries Of Head Craniotomi Dr.Trijoso Dr.Kusuma 9,850,500
Kec.Prabumulih Utara - (Trauma Capitis) Permono,SpBS Harimin, SpAn
Prabumulih

Sub T o t a l Rp.: 9,850,500


JLH TINDAKAN KAMAR OPERASI IGD ( NON IBS ) : 1
Tgl Operasi : 04-05-2012
No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

1 RI12012968 0000443423 A ANSYORI 15-11-1957 54 L Komp Kenten Permai Blok Kota Palembang ASKES 104 UT D E04.9 Nontoxic Goitre, Unspecified Thyroidektomi / Isthmolobectomy Dr.K.Yamin Alsoph Dr. Yusni Puspita, 9,331,500
E1 No 14 SpBOnk SpAn

2 RI12013013 0000615602 ABDUR RAHMAN 15-11-1958 53 L Lrng. Terusan No. 1876 Kota Palembang UMUM 401 IA N21.0 Calculus In Bladder Litotripsi Dr.Didit Pramudhito, Dr. Yusni Puspita, 5,488,500
SPO SpAn

3 RI12012198 0000614509 ASNAWI BIN ZAINI 03-08-1999 13 L Desa Muara Dua Kab.Oki Kab. Ogan Komering JAMSOSKES(SUMSEL 410 III S09.7 Multiple Injuries Of Head Orif Mandibula Dr.Iqmal Perlianta, Sp Dr. Yusni Puspita, 4,749,000
Ilir SEMESTA) (Trauma Capitis) BP SpAn
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 04-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

4 RI12012466 0000563245 BEJO WIYONO 04-01-1980 32 L Perumdam Lebong Siareng Kab. Musi Banyuasin UMUM 403 II B D16.9 Benign Neoplasm Of Bone Arthoplasty Dr.H.Muzakkie, SpBO Dr. Yusni Puspita, 18,125,000
Blok G No.9 And Articular Cartilage, FICS SpAn
Unspecified

5 RI12012758 0000605828 BURNAWI BIN DAHLAN 13-04-1955 57 L Pagar Alam Kab. Lahat UMUM 408 II B D11.0 Benign Neoplasm Of Parotid Biopsi Dr.Sofyan 4,019,000
Gland Effendi,SpTHT

6 RI12012758 0000605828 BURNAWI BIN DAHLAN 13-04-1955 57 L Pagar Alam Kab. Lahat UMUM 408 II B D11.0 Benign Neoplasm Of Parotid Penambahan Jasa Dokter Dr.Sofyan Dr. Yusni Puspita, 1,833,500
Gland Effendi,SpTHT SpAn

7 RI12013140 0000617420 DIANA SARI 30-07-1980 31 P Jl.Kapten A.Rivai Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Penambahan Jasa Dokter Dr. Firmansyah, SpOG Dr. Yusni Puspita, 949,000
Lr.Tembusan No.70 Caesarean Section SpAn

8 RI12013140 0000617420 DIANA SARI 30-07-1980 31 P Jl.Kapten A.Rivai Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Firmansyah, SpOG 6,223,750
Lr.Tembusan No.70 Caesarean Section

9 RI12013098 0000617242 DIRA OKTASARI 09-10-1980 31 P Lr Bayangkara Kota Palembang JAMKESMAS PUSAT 203 III O82.9 Single Delivery By Sectio Cesarea tanpa penyulit Dr. Peby Maulina Dr.Zulkipli, SpAn 6,223,750
Caesarean Section, Lestari,SpOG
Unspecified

10 RI12012781 0000615565 DODI YANTO 11-11-1975 36 L Lrg. Sei Semajid Kota Palembang JAMSOSKES(SUMSEL 406 III J86.9 Pyothorax Without Fistula Necrotomi / Debridement Luas Dr.Bermansyah, SpB Dr. Yusni Puspita, 4,317,500
SEMESTA) SpAn

11 RI12013170 0000617439 EKA BT MUHAMMAD 17-04-1997 15 P Dusun Ii Kel.Ibul Besar Iii JAMSOSKES(SUMSEL 410 III K65.9 Peritonitis, Unspecified Penambahan Jasa Dokter Dr.Efman E.U.M, Dr. Yusni Puspita, 1,196,000
Kec.Pemulutan Kab.Oi SEMESTA) M.Kes,SpB-KBD SpAn

12 RI12013170 0000617439 EKA BT MUHAMMAD 17-04-1997 15 P Dusun Ii Kel.Ibul Besar Iii JAMSOSKES(SUMSEL 410 III K65.9 Peritonitis, Unspecified Kistektomi Dr. Firmansyah, SpOG 6,188,000
Kec.Pemulutan Kab.Oi SEMESTA)

13 RI12013071 0000617196 HARI YULIS 32 P Ds 4 Pncur Pungah Muara Kab. Ogan Komering JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Peby Maulina Dr.Zulkipli, SpAn 6,223,750
Dua Oku Selatan Ulu Selatan Caesarean Section Lestari,SpOG

14 RI12013085 0000617190 HARTONO MARSODO 40 L Jl Di Panjaitan Rt 32 Rw 11 JAMKESMAS PUSAT 405 III K37 Unspecified Appendicitis Appendiktomi Dr.Sarup Singh,SpB Dr. Yusni Puspita, 3,565,900
Kel Plaju Ulu Kec Plaju SpAn

15 RI12012962 0000614640 HASANANI BA 14-05-1943 69 L Seduduk Putih No Kota Palembang ASKES 102 UT B H26.9 Catarac, Unspecified Pengurang Jasa Dokter Dr. Ramzi Amin, SpM -1,029,600
Palembang
TINDAKAN BEDAH SENTRAL - PASIEN RAWAT INAP

RSUP Dr MOHAMMAD HOESIN PALEMBANG PERIODE 01-01-2012 S.D 31-12-2012


JL. JEND. SUDIRMAN KM 3,5 TOTAL TINDAKAN : **** BUAH

Tgl Operasi : 04-05-2012


No No Reg No Medrec Nama Tgl Lahir Umur JK Alamat Kota / Kab. Penjamin Asal Kls Diagnosa Nama Tindakan Operator Anestesi Biaya
Thn Ruang ( Rp. )

16 RI12012962 0000614640 HASANANI BA 14-05-1943 69 L Seduduk Putih No Kota Palembang ASKES 102 UT B H26.9 Catarac, Unspecified Terapi Laser Dr. Ramzi Amin, SpM 3,179,500
Palembang

17 RI12013036 0000616800 HASIAH KHOHAR 39 P Jl Pemiri 12 B Rt 37 Rw 13 Kota Palembang JAMKESMAS PUSAT 203 III O82.0 Delivery By Elective Sectio Cesarea tanpa penyulit Dr. Firmansyah, SpOG Dr. Yusni Puspita, 6,223,750
Kel 8 Ilir Kec It 2 Caesarean Section SpAn

18 RI12012639 0000614922 HERI YANSYAH 24-02-1981 31 L Desa Tanjung Agung Kec. JAMSOSKES(SUMSEL 406 III S05.2 Ocular Leceration And Repair Soket Dr.Anang Tribowo, 3,184,000
Tanjung Agung SEMESTA) Rupture With Prolapse Or SpM
Loss Of Intraocular Tissue

19 RI12013010 0000616929 HJ. MAZIYAH 08-08-1970 41 P Perumnas Talang Kelapa Kab. Musi Banyuasin ASKES 201 IA O00.9 Ectopic Pregnancy, Salfingo Oovarectomi Dr. Peby Maulina 5,512,500
Blok 4 No. 51 B Unspecified Lestari,SpOG

20 RI12013010 0000616929 HJ. MAZIYAH 08-08-1970 41 P Perumnas Talang Kelapa Kab. Musi Banyuasin ASKES 201 IA O00.9 Ectopic Pregnancy, Penambahan Jasa Dokter Dr. Peby Maulina Dr. Yusni Puspita, 1,287,000
Blok 4 No. 51 B Unspecified Lestari,SpOG SpAn

21 RI12012260 0000612624 JON KENEDI 03-08-1975 36 L Macan Kumbang Raya No JAMKESMAS PUSAT 407 III S72.9 Fracture Of Femur, Part Nos Angkat K-Nail / Remove Flat Screw Dr.H.Muzakkie, SpBO Dr. Yusni Puspita, 2,730,000
M27 FICS SpAn

22 RI12012992 0000616945 KAILA NUR ASIRA 28-11-2010 1 P Jl Paqih Usman Lr Prajurit Kota Palembang JAMSOSKES(SUMSEL 604 III T30 Burn & Corrosion, Body Debridement Dr.Iqmal Perlianta, Sp Dr.Zulkipli, SpAn 4,684,550
Nangyu SEMESTA) Region Unspecified BP

23 RI12013097 0000617239 M FAIZ ISYAD 1 L Jl Opi Jakabaring Kota Palembang UMUM 102 UT A T30.0 Burn Of Unspecified Body Pengurang Jasa Dokter Dr.Iqmal Perlianta, Sp -1,029,600
Region, Unspecified Degree BP

24 RI12013097 0000617239 M FAIZ ISYAD 1 L Jl Opi Jakabaring Kota Palembang UMUM 102 UT A T30.0 Burn Of Unspecified Body Debridement Dr.Iqmal Perlianta, Sp Dr. Yusni Puspita, 3,603,500
Region, Unspecified Degree BP SpAn

25 RI12011392 0000611980 M.W.SRI ANJARIN 18-03-1968 44 P Lahat Tengah Kab.Lahat Kab. Lahat ASKES 106 UT B J93 Pneumothorax Torakotomi/Torakoplasti Dr.Bermansyah, SpB Dr. Yusni Puspita, 16,175,500
SpAn

26 RI12013059 0000616485 MISINEM BINTI DASRSI 01-01-1979 33 P Jl Gotong Royong I Np.05 Kota Palembang JAMKESMAS PUSAT 203 III N93.9 Abnormal Uterine And Laparascopy Operatif Dr.Rizal Sanif, SpOG- Dr. Yusni Puspita, 6,277,000
Vaginal Bleeding, Konk SpAn
Unspecified

27 RI12013012 0000617048 NURBAITI 07-09-1957 54 P Jl. Residen A. Rozak No.138 Kota Palembang PT.ASURANSI JIWA