PASIEN BPJS PERIODE 1 November 2018

Hari Rawat Ke-

No. NO RM Nama Pasien Kelas Klaim
I II III
1 98963 ANWAR TN (32 Th) AG01 bed 7 ANGGREK Kelas III
2 97711 ROHADI TN (55 Th) AG01 bed 1 ANGGREK Kelas III Rp 2,005,782
3 97806 SARWO EDI, TN (64 Th) AG01 bed 8 ANGGREK Kelas III Rp 5,851,869
4 97745 SUTIYONO TN (63 Th) AG01 bed 2 ANGGREK Kelas III Rp 790,000
5 63692 SRI RAHAYU,NY (48 Th) A01 bed 1 ASTER Kelas VIP Rp 1,313,500
6 99067 JATIARI PAMUNGKAS LAWALATA AN (9 ThBO01 Bed 2 BOUGENVILE Kelas I Rp 1,020,913
7 98990 BY NY DEWI AMBARSARI (0 Hr) CA bed 11 CATLEYA 1 (Rawat Gabung) Rp 1,227,707
8 98989 BY NY NURMASARI (0 Hr) CA bed 10 CATLEYA 1 (Rawat Gabung) Rp 1,480,207
9 99034 BY NY SUKMA SUCI PERTIWI (0 Hr) CA bed 14 CATLEYA 1 (Rawat Gabung) Rp 603,989
10 99044 BY NY RATNA ROSANTININGRUM (0 Hr) CA bed 15 CATLEYA 1 (Rawat Gabung) Rp 603,989
11 99060 BY NY WIJARNI EKA PRATIWI (0 Hr) CA bed 3 CATLEYA 1 (Rawat Gabung) Rp 603,989
12 77789 SUYATMI NY (47 Th) CE01 bed 2 CEMPAKA Kelas II
13 96121 WIDODO, TN (36 Th) CE01 bed 4 CEMPAKA Kelas II Rp 7,694,999
14 99048 SUKARSONO TN (38 Th) CE01 bed 1 CEMPAKA Kelas II Rp 1,101,215
15 99007 CINTA AMALIA AN (14 Th) DA01 bed 2 DAHLIA Kelas III Rp 1,923,696
16 90910 ISTIQOMAH,NY (41 Th) DA01 bed 3 DAHLIA Kelas III Rp 2,336,650
17 98972 SURIP MULAYANI NY (51 Th) DA01 bed 5 DAHLIA Kelas III Rp 1,841,021
18 98274 SUMARI NY (42 Th) DA01 bed 4 DAHLIA Kelas III Rp 6,177,154
19 99016 SUTIYEM NY (78 Th) FL01 bed 1 FLAMBOYAN Kelas III Rp 2,973,464
20 98995 MUHAMMAD ADZAM NUR ILSAN, AN (11 TFL01 bed 2 FLAMBOYAN Kelas III Rp 6,099,943
21 98226 FERDI DWI NUGROHO, AN (13 Th) FL01 bed 5 FLAMBOYAN Kelas III Rp 7,075,326
22 99043 NAURA MARSHELIA NAFISA, AN (8 Th) FL01 bed 4 FLAMBOYAN Kelas III Rp 1,479,038
23 99040 AHYA FIDINA, NY (23 Th) KB01 bed 5 Kamar Bersalin Rp 1,107,444
24 81575 MARYO MARNO SUWITO TN (83 Th) IC01 bed 2 KAMAR ICU Rp 3,008,132
25 99063 ATI MARYATI, NY (55 Th) IC01 bed 3 KAMAR ICU Rp 2,766,317
26 98964 PARMI HADI WIYOTO NY (82 Th) KE01 Bed 2 KENANGA Kelas I
27 98374 SITI MARKAMAH, NY (50 Th) KE01 Bed 3 KENANGA Kelas I Rp 7,096,224
28 99000 SRI MULASIH NY (19 Th) LI01 bed 4 LILY Kelas II Rp 7,970,397
29 72694 RATNA ROSANTININGRUM NY (36 Th) LI01 bed 5 LILY Kelas II Rp 3,232,018
30 82908 RIYANTI, NY (66 Th) LI01 bed 1 LILY Kelas II Rp 1,068,238
31 77009 SUYATNO TN (50 Th) M101 Bed 1 MELATI 1 Kelas VIP Rp 6,963,698
32 98652 BY NY WIDATI (6 Hr) CA01 bed 1 PERISTI Rp 1,457,365
33 98629 BY NY RIZKY TIRAWATI (7 Hr) CA01 bed 13 PERISTI Rp 1,738,600
34 98580 BY NY WAKIYEM (7 Hr) CA01 bed 3 PERISTI Rp 1,519,159
35 98804 BY NY ITA (4 Hr) CA01 bed 4 PERISTI Rp 1,519,159
36 98801 BY NY SRI MULYATI (4 Hr) CA01 bed 15 PERISTI Rp 1,291,365
37 98802 BY NY RIKA KRISTIYANI (3 Hr) CA01 bed 14 PERISTI
38 98901 BY NY SRI ISPARTINI (2 Hr) CA01 bed 5 PERISTI Rp 677,400
39 98918 DEWI AMBARSARI, NY (29 Th) TR01.3 TERATAI Kelas III Rp 7,095,719
40 98932 NURMASARI, NY (25 Th) TR01.13 TERATAI Kelas III Rp 7,159,368
41 49198 SUKMA SUCI PERTIWI NY (24 Th) TR01.14 TERATAI Kelas III Rp 6,973,369
42 99042 WIJARNI EKA PRATIWI, NY (32 Th) TR01.1 TERATAI Kelas III Rp 6,700,729
43 99070 ANA SUSILOWATI NY (33 Th) TR01.10 TERATAI Kelas III Rp 900,000
44 99071 WAHYUNI NY (32 Th) TR01.11 TERATAI Kelas III Rp 900,000
45 98274 SUMARI NY (42 Th) TR01.17 TERATAI Kelas III Rp 6,177,154

PASIEN BPJS PERIODE 1 November 2018

PETUGAS KETERANGAN STATUS
No. NO RM Nama Pasien Kelas VISIT
VISIT LHB PASIEN
1 98963 ANWAR TN (32 Th) AG01 bed 7 ANGGREK Kelas III
2 97711 ROHADI TN (55 Th) AG01 bed 1 ANGGREK Kelas III
3 97806 SARWO EDI, TN (64 Th) AG01 bed 8 ANGGREK Kelas III
4 97745 SUTIYONO TN (63 Th) AG01 bed 2 ANGGREK Kelas III
5 63692 SRI RAHAYU,NY (48 Th) A01 bed 1 ASTER Kelas VIP
6 99067 JATIARI PAMUNGKAS LAWALATA AN (9 ThBO01 Bed 2 BOUGENVILE Kelas I
7 98990 BY NY DEWI AMBARSARI (0 Hr) CA bed 11 CATLEYA 1 (Rawat Gabung)
8 98989 BY NY NURMASARI (0 Hr) CA bed 10 CATLEYA 1 (Rawat Gabung)
9 99034 BY NY SUKMA SUCI PERTIWI (0 Hr) CA bed 14 CATLEYA 1 (Rawat Gabung)
10 99044 BY NY RATNA ROSANTININGRUM (0 Hr) CA bed 15 CATLEYA 1 (Rawat Gabung)
11 99060 BY NY WIJARNI EKA PRATIWI (0 Hr) CA bed 3 CATLEYA 1 (Rawat Gabung)
12 77789 SUYATMI NY (47 Th) CE01 bed 2 CEMPAKA Kelas II
13 96121 WIDODO, TN (36 Th) CE01 bed 4 CEMPAKA Kelas II
14 99048 SUKARSONO TN (38 Th) CE01 bed 1 CEMPAKA Kelas II
15 99007 CINTA AMALIA AN (14 Th) DA01 bed 2 DAHLIA Kelas III
16 90910 ISTIQOMAH,NY (41 Th) DA01 bed 3 DAHLIA Kelas III
17 98972 SURIP MULAYANI NY (51 Th) DA01 bed 5 DAHLIA Kelas III
18 98274 SUMARI NY (42 Th) DA01 bed 4 DAHLIA Kelas III
19 99016 SUTIYEM NY (78 Th) FL01 bed 1 FLAMBOYAN Kelas III
20 98995 MUHAMMAD ADZAM NUR ILSAN, AN (11 TFL01 bed 2 FLAMBOYAN Kelas III
21 98226 FERDI DWI NUGROHO, AN (13 Th) FL01 bed 5 FLAMBOYAN Kelas III
22 99043 NAURA MARSHELIA NAFISA, AN (8 Th) FL01 bed 4 FLAMBOYAN Kelas III
23 99040 AHYA FIDINA, NY (23 Th) KB01 bed 5 Kamar Bersalin
24 81575 MARYO MARNO SUWITO TN (83 Th) IC01 bed 2 KAMAR ICU
25 99063 ATI MARYATI, NY (55 Th) IC01 bed 3 KAMAR ICU
26 98964 PARMI HADI WIYOTO NY (82 Th) KE01 Bed 2 KENANGA Kelas I
27 98374 SITI MARKAMAH, NY (50 Th) KE01 Bed 3 KENANGA Kelas I
28 99000 SRI MULASIH NY (19 Th) LI01 bed 4 LILY Kelas II
29 72694 RATNA ROSANTININGRUM NY (36 Th) LI01 bed 5 LILY Kelas II
30 82908 RIYANTI, NY (66 Th) LI01 bed 1 LILY Kelas II
31 77009 SUYATNO TN (50 Th) M101 Bed 1 MELATI 1 Kelas VIP
32 98652 BY NY WIDATI (6 Hr) CA01 bed 1 PERISTI
33 98629 BY NY RIZKY TIRAWATI (7 Hr) CA01 bed 13 PERISTI
34 98580 BY NY WAKIYEM (7 Hr) CA01 bed 3 PERISTI
35 98804 BY NY ITA (4 Hr) CA01 bed 4 PERISTI
36 98801 BY NY SRI MULYATI (4 Hr) CA01 bed 15 PERISTI
37 98802 BY NY RIKA KRISTIYANI (3 Hr) CA01 bed 14 PERISTI
38 98901 BY NY SRI ISPARTINI (2 Hr) CA01 bed 5 PERISTI
39 98918 DEWI AMBARSARI, NY (29 Th) TR01.3 TERATAI Kelas III
40 98932 NURMASARI, NY (25 Th) TR01.13 TERATAI Kelas III
41 49198 SUKMA SUCI PERTIWI NY (24 Th) TR01.14 TERATAI Kelas III
42 99042 WIJARNI EKA PRATIWI, NY (32 Th) TR01.1 TERATAI Kelas III
43 99070 ANA SUSILOWATI NY (33 Th) TR01.10 TERATAI Kelas III
44 99071 WAHYUNI NY (32 Th) TR01.11 TERATAI Kelas III
45 98274 SUMARI NY (42 Th) TR01.17 TERATAI Kelas III

PASIEN UMUM PERIODE 1 November 2018

PETUGAS KETERANGAN STATUS

No. NO RM Nama Pasien Kelas VISIT
VISIT LHB PASIEN
1 99020 RIKA RAMADHANNIS NY (32 Th) AG01 bed 4 ANGGREK Kelas III
2 98799 TRIYANTO TN (59 Th) AN01 bed 2 ANYELIR (R. ISOLASI) Kelas III
3 98673 BY NY NITA KUSUMA NINGRUM (0 Hr) CA bed 4 CATLEYA 1 (Rawat Gabung)
4 98806 BY NY WIDYANINGRUM BERLIATI P (0 Hr)CA bed 12 CATLEYA 1 (Rawat Gabung)
5 99054 BY NY RETNO WIDOWATI (0 Hr) CA bed 2 CATLEYA 1 (Rawat Gabung)
6 99018 KURNIANTO TN (0 Hr) CE01 bed 3 CEMPAKA Kelas II
7 99053 TUKINEM / NGGUNIK NY (58 Th) CE01 bed 6 CEMPAKA Kelas II
8 99066 NGADIYEM MENTO IJOYO NY (84 Th) CE01 bed 7 CEMPAKA Kelas II
9 98816 BY NY ERNA WATI (0 Hr) IN01 bed 1 HCU Neonatus(Inkubator)
10 98397 PANUT ATMOMIHARJO, TN (77 Th) IC01 bed 1 KAMAR ICU
11 98766 WIDYANINGRUM BERLIATI P, NY (34 Th) LI01 bed 7 LILY Kelas II
12 98791 BY NY SUPADMI (4 Hr) CA01 bed 10 PERISTI
13 98350 DEA KARUNIA AN (1 Bl) CA01 bed 11 PERISTI
14 99017 BY NY SRI MULASIH (0 Hr) CA01 bed 12 PERISTI
15 98240 BY NY HASTUTIK (16 Hr) CA01 bed 6 PERISTI

PASIEN UMUM PERIODE 1 November 2018

Hari Rawat Ke-
No. NO RM Nama Pasien Kelas
I II III IV
1 99020 RIKA RAMADHANNIS NY (32 Th) AG01 bed 4 ANGGREK Kelas III Rp 1,601,580
2 98799 TRIYANTO TN (59 Th) AN01 bed 2 ANYELIR (R. ISOLASI) Kelas I Hari Ke - 7 Rp 6,845,528
5 99054 BY NY RETNO WIDOWATI (0 Hr) CA bed 2 CATLEYA 1 (Rawat Gabung) Rp 803,989
6 99018 KURNIANTO TN (0 Hr) CE01 bed 3 CEMPAKA Kelas II Rp 7,059,747
7 99053 TUKINEM / NGGUNIK NY (58 Th) CE01 bed 6 CEMPAKA Kelas II Rp 1,090,342
8 99066 NGADIYEM MENTO IJOYO NY (84 Th) CE01 bed 7 CEMPAKA Kelas II Rp 2,126,700
9 98816 BY NY ERNA WATI (0 Hr) IN01 bed 1 HCU Neonatus(Inkubator) Hari Ke - 6 Rp 5,279,260
10 98397 PANUT ATMOMIHARJO, TN (77 Th) IC01 bed 1 KAMAR ICU Hari Ke - 14 Rp 34,490,896
12 98791 BY NY SUPADMI (4 Hr) CA01 bed 10 PERISTI Rp 1,321,159
13 98350 DEA KARUNIA AN (1 Bl) CA01 bed 11 PERISTI Rp 1,663,199
14 99017 BY NY SRI MULASIH (0 Hr) CA01 bed 12 PERISTI Rp 1,379,239
15 98240 BY NY HASTUTIK (16 Hr) CA01 bed 6 PERISTI Rp 790,000
 IV V
Rp 2,807,580

Rp 2,902,657

Rp 4,480,428
Rp 2,088,800

KELENGKAPAN
BPJS
KELENGKAPAN
BERKAS
V
 PASIEN BPJS PERIODE 2 November 2018
Hari Rawat Ke-
No. NO RM Nama Pasien Kelas Klaim
I II III
1 97711 ROHADI TN (55 Th) AG01 bed 1 ANGGREK Kelas III
2 97745 SUTIYONO TN (63 Th) AG01 bed 2 ANGGREK Kelas III Rp 5,224,070
3 93848 WAGINEM, NY (55 Th) AG01 bed 6 ANGGREK Kelas III Rp 1,130,666
4 97357 SUKINI, NY (40 Th) AG01 bed 7 ANGGREK Kelas III Rp 3,166,038
5 63692 SRI RAHAYU,NY (48 Th) A01 bed 1 ASTER Kelas VIP Rp 2,343,629
6 99067 JATIARI PAMUNGKAS LAWALATA AN (9 ThBO01 Bed 2 BOUGENVILE Kelas I Rp 2,469,641
7 99034 BY NY SUKMA SUCI PERTIWI (0 Hr) CA bed 14 CATLEYA 1 (Rawat Gabung) Rp 603,989
8 99060 BY NY WIJARNI EKA PRATIWI (0 Hr) CA bed 3 CATLEYA 1 (Rawat Gabung) Rp 603,989
9 99091 BY NY ANA SUSILOWATI (0 Hr) CA bed 7 CATLEYA 1 (Rawat Gabung) Rp 603,989
10 99090 BY NY KUSNUL FATIMAH (0 Hr) CA bed 8 CATLEYA 1 (Rawat Gabung) Rp 603,989
11 77789 SUYATMI NY (47 Th) CE01 bed 2 CEMPAKA Kelas II
12 96121 WIDODO, TN (36 Th) CE01 bed 4 CEMPAKA Kelas II
13 99048 SUKARSONO TN (38 Th) CE01 bed 1 CEMPAKA Kelas II Rp 1,936,709
14 99063 ATI MARYATI, NY (55 Th) DA01 bed 4 DAHLIA Kelas III Rp 3,894,317
15 99115 SRI WARSITI NY (57 Th) DA01 bed 3 DAHLIA Kelas III Rp 1,290,553
16 99016 SUTIYEM NY (78 Th) FL01 bed 1 FLAMBOYAN Kelas III
17 98226 FERDI DWI NUGROHO, AN (13 Th) FL01 bed 5 FLAMBOYAN Kelas III
18 99043 NAURA MARSHELIA NAFISA, AN (8 Th) FL01 bed 4 FLAMBOYAN Kelas III Rp 1,836,650
19 98846 CELIO KENZIE SAPUTRA, AN (4 Bl) FL01 bed 6 FLAMBOYAN Kelas III Rp 1,386,000
20 99096 BY NY AHYA FADINA (0 Hr) KB01 bed 4 Kamar Bersalin Rp 623,989
21 99079 NIKEN SUNARSIH, NY (25 Th) KB01 bed 1 Kamar Bersalin Rp 3,801,403
22 99119 RETNO SRI MARYANI NY (31 Th) KB01 bed 4 Kamar Bersalin Rp 800,000
23 82908 RIYANTI, NY (66 Th) LI01 bed 1 LILY Kelas II Rp 1,630,564
24 99107 SUTIYEM NY (67 Th) LI01 bed 2 LILY Kelas II Rp 1,185,500
25 99092 MUH FAIZ AL MUTTAQIN, AN (9 Th) LI01 bed 3 LILY Kelas II Rp 997,000
26 98629 BY NY RIZKY TIRAWATI (7 Hr) CA01 bed 13 PERISTI
27 98580 BY NY WAKIYEM (7 Hr) CA01 bed 3 PERISTI
28 98804 BY NY ITA (4 Hr) CA01 bed 4 PERISTI
29 98801 BY NY SRI MULYATI (4 Hr) CA01 bed 15 PERISTI
30 98901 BY NY SRI ISPARTINI (2 Hr) CA01 bed 5 PERISTI Rp 677,400
31 49198 SUKMA SUCI PERTIWI NY (24 Th) TR01.14 TERATAI Kelas III Rp 6,973,369
32 99042 WIJARNI EKA PRATIWI, NY (32 Th) TR01.1 TERATAI Kelas III Rp 6,700,728
33 99070 ANA SUSILOWATI NY (33 Th) TR01.10 TERATAI Kelas III Rp 6,278,569
34 99038 KUSNUL FATIMAH, NY (24 Th)
35 99071 WAHYUNI NY (32 Th)
36 99040 AHYA FIDINA, NY (23 Th)
No. NO RM Nama Pasien
1 97711 ROHADI TN (55 Th)
2 97745 SUTIYONO TN (63 Th)
3 93848 WAGINEM, NY (55 Th)
4 97357 SUKINI, NY (40 Th)
5 63692 SRI RAHAYU,NY (48 Th)
6 99067 JATIARI PAMUNGKAS LAWALATA AN (9 ThBO01 Bed 2 BOUGENVILE Kelas I
7 99034 BY NY SUKMA SUCI PERTIWI (0 Hr)
8 99060 BY NY WIJARNI EKA PRATIWI (0 Hr)
9 99091 BY NY ANA SUSILOWATI (0 Hr)
10 99090 BY NY KUSNUL FATIMAH (0 Hr)
11 77789 SUYATMI NY (47 Th)
12 96121 WIDODO, TN (36 Th)
13 99048 SUKARSONO TN (38 Th)
14 99063 ATI MARYATI, NY (55 Th)
15 99115 SRI WARSITI NY (57 Th)
16 99016 SUTIYEM NY (78 Th)
17 98226 FERDI DWI NUGROHO, AN (13 Th)
18 99043 NAURA MARSHELIA NAFISA, AN (8 Th) FL01 bed 4 FLAMBOYAN Kelas III
19 98846 CELIO KENZIE SAPUTRA, AN (4 Bl)
20 99096 BY NY AHYA FADINA (0 Hr)
21 99079 NIKEN SUNARSIH, NY (25 Th)
22 99119 RETNO SRI MARYANI NY (31 Th)
23 82908 RIYANTI, NY (66 Th)
24 99107 SUTIYEM NY (67 Th)
TR01.12 TERATAI Kelas III Rp 6,510,893
TR01.15 TERATAI Kelas III Rp 6,482,102
TR01.16 TERATAI Kelas III Rp 4,088,444
PASIEN BPJS PERIODE 2 November 2018
PETUGAS KETERANGAN STATUS
Kelas VISIT
VISIT LHB PASIEN
AG01 bed 1 ANGGREK Kelas III
AG01 bed 2 ANGGREK Kelas III
AG01 bed 6 ANGGREK Kelas III
AG01 bed 7 ANGGREK Kelas III
A01 bed 1 ASTER Kelas VIP
CA bed 14 CATLEYA 1 (Rawat Gabung)
CA bed 3 CATLEYA 1 (Rawat Gabung)
CA bed 7 CATLEYA 1 (Rawat Gabung)
CA bed 8 CATLEYA 1 (Rawat Gabung)
CE01 bed 2 CEMPAKA Kelas II
CE01 bed 4 CEMPAKA Kelas II
CE01 bed 1 CEMPAKA Kelas II
DA01 bed 4 DAHLIA Kelas III
DA01 bed 3 DAHLIA Kelas III
FL01 bed 1 FLAMBOYAN Kelas III
FL01 bed 5 FLAMBOYAN Kelas III
FL01 bed 6 FLAMBOYAN Kelas III
KB01 bed 4 Kamar Bersalin
KB01 bed 1 Kamar Bersalin
KB01 bed 4 Kamar Bersalin
LI01 bed 1 LILY Kelas II
LI01 bed 2 LILY Kelas II
25 99092 MUH FAIZ AL MUTTAQIN, AN (9 Th)
26 98629 BY NY RIZKY TIRAWATI (7 Hr)
27 98580 BY NY WAKIYEM (7 Hr)
28 98804 BY NY ITA (4 Hr)
29 98801 BY NY SRI MULYATI (4 Hr)
30 98901 BY NY SRI ISPARTINI (2 Hr)
31 49198 SUKMA SUCI PERTIWI NY (24 Th)
32 99042 WIJARNI EKA PRATIWI, NY (32 Th)
33 99070 ANA SUSILOWATI NY (33 Th)
34 99038 KUSNUL FATIMAH, NY (24 Th)
35 99071 WAHYUNI NY (32 Th)
36 99040 AHYA FIDINA, NY (23 Th)
No. NO RM Nama Pasien
1 99020 RIKA RAMADHANNIS NY (32 Th)
2 98799 TRIYANTO TN (59 Th)
3 99054 BY NY RETNO WIDOWATI (0 Hr)
4 99113 BY NY NIKEN SUNARSIH (0 Hr)
5 99018 KURNIANTO TN (0 Hr)
6 99053 TUKINEM / NGGUNIK NY (58 Th)
7 99066 NGADIYEM MENTO IJOYO NY (84 Th)
8 98816 BY NY ERNA WATI (0 Hr)
9 98397 PANUT ATMOMIHARJO, TN (77 Th)
10 98791 BY NY SUPADMI (4 Hr)
11 98350 DEA KARUNIA AN (1 Bl)
12 98388 RETNO WIDOWATI NY (40 Th)
LI01 bed 3 LILY Kelas II
CA01 bed 13 PERISTI
CA01 bed 3 PERISTI
CA01 bed 4 PERISTI
CA01 bed 15 PERISTI
CA01 bed 5 PERISTI
TR01.14 TERATAI Kelas III
TR01.1 TERATAI Kelas III
TR01.10 TERATAI Kelas III
TR01.12 TERATAI Kelas III
TR01.15 TERATAI Kelas III
TR01.16 TERATAI Kelas III
PASIEN UMUM PERIODE 2 November 2018
PETUGAS KETERANGAN STATUS
Kelas VISIT
VISIT LHB PASIEN
AG01 bed 4 ANGGREK Kelas III
AN01 bed 2 ANYELIR (R. ISOLASI) Kelas III
CA bed 2 CATLEYA 1 (Rawat Gabung)
CA bed 12 CATLEYA 1 (Rawat Gabung)
CE01 bed 3 CEMPAKA Kelas II
CE01 bed 6 CEMPAKA Kelas II
CE01 bed 7 CEMPAKA Kelas II
IN01 bed 1 HCU Neonatus(Inkubator)
IC01 bed 1 KAMAR ICU
CA01 bed 10 PERISTI
CA01 bed 11 PERISTI
TR01.17 TERATAI Kelas III
 PASIEN UMUM PERIODE 2 November 2018
Hari Rawat Ke-
No. NO RM Nama Pasien Kelas
I II III IV
1 99020 RIKA RAMADHANNIS NY (32 Th) AG01 bed 4 ANGGREK Kelas III Rp 1,901,680
2 98799 TRIYANTO TN (59 Th) AN01 bed 2 ANYELIR (R. ISOLASI) Kelas I Hari Ke - 8 Rp 7,236,588
3 99054 BY NY RETNO WIDOWATI (0 Hr) CA bed 2 CATLEYA 1 (Rawat Gabung) Rp 803,989
4 99113 BY NY NIKEN SUNARSIH (0 Hr) CA bed 12 CATLEYA 1 (Rawat Gabung) Rp 780,000
5 99018 KURNIANTO TN (0 Hr) CE01 bed 3 CEMPAKA Kelas II Rp 7,564,484
6 99053 TUKINEM / NGGUNIK NY (58 Th) CE01 bed 6 CEMPAKA Kelas II Rp 1,828,101
7 99066 NGADIYEM MENTO IJOYO NY (84 Th) CE01 bed 7 CEMPAKA Kelas II Rp 3,184,348
8 98816 BY NY ERNA WATI (0 Hr) IN01 bed 1 HCU Neonatus(Inkubator) Hari Ke - 7 Rp 5,279,260
9 98397 PANUT ATMOMIHARJO, TN (77 Th) IC01 bed 1 KAMAR ICU Hari Ke - 15 Rp 35,192,896
10 98791 BY NY SUPADMI (4 Hr) CA01 bed 10 PERISTI Rp 1,321,159
11 98350 DEA KARUNIA AN (1 Bl) CA01 bed 11 PERISTI Rp 1,663,199
12 98388 RETNO WIDOWATI NY (40 Th) TR01.17 TERATAI Kelas III Rp 8,854,393
Ke-
IV V
Rp 2,221,782

Rp 3,223,357
Rp 8,740,588

Rp 2,989,414
Rp 7,974,035

Rp 1,738,600
Rp 1,519,159
Rp 1,699,159
Rp 1,291,365
KELENGKAPAN
BPJS
KELENGKAPAN
BERKAS
V
 PASIEN BPJS PERIODE 5 November 2018
Hari Rawat Ke-
No. NO RM Nama Pasien Kelas Klaim
I II III
1 93848 WAGINEM, NY (55 Th) AG01 bed 6 ANGGREK Kelas III
2 99162 SUMARNI, NY (75 Th) AG01 bed 1 ANGGREK Kelas III Rp 2,492,399
3 99161 SURATMI, NY (44 Th) AG01 bed 2 ANGGREK Kelas III Rp 1,730,101
4 99152 GUNADI, TN (59 Th) AG01 bed 8 ANGGREK Kelas III Rp 3,893,205
5 99154 PURWANTO TN (61 Th) BO01 Bed 4 BOUGENVILE Kelas I Rp 897,500
6 96121 WIDODO, TN (36 Th) CE01 bed 4 CEMPAKA Kelas II Hari Ke - 6 Rp 9,908,235
7 99048 SUKARSONO TN (38 Th) CE01 bed 1 CEMPAKA Kelas II
8 61262 MOHAMMAD RAKHA EL RIZKY, AN (5 Th) CE01 bed 7 CEMPAKA Kelas II Rp 1,995,716
9 90194 NAYYARA ADEVA MAULANA AN (8 Bl) CE01 bed 6 CEMPAKA Kelas II Rp 1,864,677
10 78500 HARTO WIYONO TN (78 Th) CE01 bed 2 CEMPAKA Kelas II Rp 870,684
11 99063 ATI MARYATI, NY (55 Th) DA01 bed 4 DAHLIA Kelas III
12 99115 SRI WARSITI NY (57 Th) DA01 bed 3 DAHLIA Kelas III
13 99153 WESTRI WULANDARI NY (26 Th) DA01 bed 5 DAHLIA Kelas III Rp 1,936,709
14 90916 SUPARTI,NY (54 Th) DA01 bed 2 DAHLIA Kelas III Rp 1,944,809
15 99016 SUTIYEM NY (78 Th) FL01 bed 1 FLAMBOYAN Kelas III Hari Ke - 6 Rp 4,156,438
16 98846 CELIO KENZIE SAPUTRA, AN (4 Bl) FL01 bed 6 FLAMBOYAN Kelas III
17 99150 APRILIA KUSUMA WATI, AN (17 Th) FL01 bed 2 FLAMBOYAN Kelas III Rp 1,828,004
18 97388 SUPARNO SASTRO WIYONO,TN (55 Th) IC01 bed 2 KAMAR ICU Rp 3,131,598
19 88013 SUMADI TN (53 Th) IC01 bed 3 KAMAR ICU Rp 4,254,675
20 99092 MUH FAIZ AL MUTTAQIN, AN (9 Th) LI01 bed 3 LILY Kelas II
21 98516 BY NY ANGELYCA MULYA KUMALA D (10 HrCA01 bed 12 PERISTI Rp 1,492,159
22 99160 GIYANTI, NY (25 Th) TR01.1 TERATAI Kelas III Rp 6,797,238
23 99174 WULAN FATMAWATI NY (19 Th) TR01.18 TERATAI Kelas III Rp 780,000
 PASIEN BPJS PERIODE 5 November 2018
PETUGAS KETERANGAN STATUS
No. NO RM Nama Pasien Kelas VISIT
VISIT LHB PASIEN
1 93848 WAGINEM, NY (55 Th) AG01 bed 6 ANGGREK Kelas III
2 99162 SUMARNI, NY (75 Th) AG01 bed 1 ANGGREK Kelas III
3 99161 SURATMI, NY (44 Th) AG01 bed 2 ANGGREK Kelas III
4 99152 GUNADI, TN (59 Th) AG01 bed 8 ANGGREK Kelas III
5 99154 PURWANTO TN (61 Th) BO01 Bed 4 BOUGENVILE Kelas I
6 96121 WIDODO, TN (36 Th) CE01 bed 4 CEMPAKA Kelas II
7 99048 SUKARSONO TN (38 Th) CE01 bed 1 CEMPAKA Kelas II
8 61262 MOHAMMAD RAKHA EL RIZKY, AN (5 Th) CE01 bed 7 CEMPAKA Kelas II
9 90194 NAYYARA ADEVA MAULANA AN (8 Bl) CE01 bed 6 CEMPAKA Kelas II
10 78500 HARTO WIYONO TN (78 Th) CE01 bed 2 CEMPAKA Kelas II
11 99063 ATI MARYATI, NY (55 Th) DA01 bed 4 DAHLIA Kelas III
12 99115 SRI WARSITI NY (57 Th) DA01 bed 3 DAHLIA Kelas III
13 99153 WESTRI WULANDARI NY (26 Th) DA01 bed 5 DAHLIA Kelas III
14 90916 SUPARTI,NY (54 Th) DA01 bed 2 DAHLIA Kelas III
15 99016 SUTIYEM NY (78 Th) FL01 bed 1 FLAMBOYAN Kelas III
16 98846 CELIO KENZIE SAPUTRA, AN (4 Bl) FL01 bed 6 FLAMBOYAN Kelas III
17 99150 APRILIA KUSUMA WATI, AN (17 Th) FL01 bed 2 FLAMBOYAN Kelas III
18 97388 SUPARNO SASTRO WIYONO,TN (55 Th) IC01 bed 2 KAMAR ICU
19 88013 SUMADI TN (53 Th) IC01 bed 3 KAMAR ICU
20 99092 MUH FAIZ AL MUTTAQIN, AN (9 Th) LI01 bed 3 LILY Kelas II
21 98516 BY NY ANGELYCA MULYA KUMALA D (10 HrCA01 bed 12 PERISTI
22 99160 GIYANTI, NY (25 Th) TR01.1 TERATAI Kelas III
23 99174 WULAN FATMAWATI NY (19 Th) TR01.18 TERATAI Kelas III
 PASIEN UMUM PERIODE 5 November 2018

PETUGAS KETERANGAN STATUS

No. NO RM Nama Pasien Kelas VISIT
VISIT LHB PASIEN
1 99166 WAHJIJI, TN (55 Th) BO01 Bed 2 BOUGENVILE Kelas I
2 99135 MUHAMMAD DAFFA KHOIRUL R, AN (11 BlFL01 bed 3 FLAMBOYAN Kelas III
3 98816 BY NY ERNA WATI (0 Hr) IN01 bed 1 HCU Neonatus(Inkubator)
4 98397 PANUT ATMOMIHARJO, TN (77 Th) IC01 bed 1 KAMAR ICU

PASIEN UMUM PERIODE 5 November 2018

Hari Rawat Ke-
No. NO RM Nama Pasien Kelas
No. NO RM Nama Pasien Kelas
I II III IV
1 99166 WAHJIJI, TN (55 Th) BO01 Bed 2 BOUGENVILE Kelas I Rp 1,610,161
2 99135 MUHAMMAD DAFFA KHOIRUL R, AN (11 BlFL01 bed 3 FLAMBOYAN Kelas III Rp 1,125,920
3 98816 BY NY ERNA WATI (0 Hr) IN01 bed 1 HCU Neonatus(Inkubator) Hari Rawat Ke- 9 Rp 11,243,868
4 98397 PANUT ATMOMIHARJO, TN (77 Th) IC01 bed 1 KAMAR ICU Hari Rawat Ke- 17 Rp 48,134,430
at Ke-
IV V
Rp 1,886,241

Rp 2,863,248

Rp 4,590,246
Rp 2,832,789

Rp 3,420,316

Rp 2,404,747
KELENGKAPAN
BPJS
KELENGKAPAN
BERKAS
V
 PASIEN BPJS PERIODE 6 November 2018
Hari Rawat Ke-
No. NO RM Nama Pasien Kelas Klaim
I II III
1 93848 WAGINEM, NY (55 Th) AG01 bed 6 ANGGREK Kelas III
2 99162 SUMARNI, NY (75 Th) AG01 bed 1 ANGGREK Kelas III Rp 2,675,399
3 88584 MEI SUSANTI NN (23 Th) AG01 bed 2 ANGGREK Kelas III Rp 1,772,328
4 99215 RUSDI PRAMONO TN (67 Th) AG01 bed 7 ANGGREK Kelas III Rp 1,564,500
5 94411 SISWOYO TN (58 Th) AG01 bed 8 ANGGREK Kelas III Rp 880,656
6 99226 SUHARTO, TN (70 Th) AG01 bed 9 ANGGREK Kelas III Rp 1,475,328
7 99154 PURWANTO TN (61 Th) BO01 Bed 4 BOUGENVILE Kelas I Rp 897,500
8 99164 BY NY GIYANTI (0 Hr) CA bed 11 CATLEYA 1 (Rawat Gabung) Rp 763,989
9 99202 BY NY HAMIDAH (0 Hr) CA bed 10 CATLEYA 1 (Rawat Gabung) Rp 1,090,796
10 99220 BY NY DYAH ANGGUN MAWAS (0 Hr) CA bed 12 CATLEYA 1 (Rawat Gabung) Rp 580,000
11 99237 BY NY YUNI NURHAYATI (0 Hr) CA bed 13 CATLEYA 1 (Rawat Gabung) Rp 580,000
12 99239 BY NY AYU NOVIANA DAMAYANTI (1 Hr) CA bed 14 CATLEYA 1 (Rawat Gabung) Rp 602,500
13 99240 BY NY EMA RAHMAWATI (0 Hr) CA bed 15 CATLEYA 1 (Rawat Gabung) Rp 580,000
14 61262 MOHAMMAD RAKHA EL RIZKY, AN (5 Th) CE01 bed 7 CEMPAKA Kelas II
15 90194 NAYYARA ADEVA MAULANA AN (8 Bl) CE01 bed 6 CEMPAKA Kelas II
16 78500 HARTO WIYONO TN (78 Th) CE01 bed 2 CEMPAKA Kelas II Rp 1,516,524
17 83856 DAFID YERY INDRIYANTO TN (30 Th) CE01 bed 1 CEMPAKA Kelas II Rp 985,491
18 99063 ATI MARYATI, NY (55 Th) DA01 bed 4 DAHLIA Kelas III Hari Ke - 6 Rp 4,877,246
19 99153 WESTRI WULANDARI NY (26 Th) DA01 bed 5 DAHLIA Kelas III
20 90916 SUPARTI,NY (54 Th) DA01 bed 2 DAHLIA Kelas III Rp 2,270,623
21 99039 SINEM, NY (80 Th) DA01 bed 3 DAHLIA Kelas III Rp 1,003,525
22 99150 APRILIA KUSUMA WATI, AN (17 Th) FL01 bed 2 FLAMBOYAN Kelas III
23 99205 SEPTIAN DAVIN ALVARO, AN (1 Th) FL01 bed 4 FLAMBOYAN Kelas III Rp 1,115,082
24 89433 GIYARTI, NY (49 Th) FL01 bed 5 FLAMBOYAN Kelas III Rp 1,641,000
25 99238 ALIKA NAILA PUTRI, AN (1 Th) FL01 bed 6 FLAMBOYAN Kelas III Rp 825,000
26 99236 BY NY WULAN FATMAWATI (0 Hr) IN01 bed 2 HCU Neonatus(Inkubator) Rp 772,500
27 97388 SUPARNO SASTRO WIYONO,TN (55 Th) IC01 bed 2 KAMAR ICU Rp 3,633,598
28 88013 SUMADI TN (53 Th) IC01 bed 3 KAMAR ICU Rp 4,536,675
29 99217 MUTI ARIZKA RANI P.M NN (27 Th) MN101 bed 1 MENUR 1 Kelas VVIP Rp 1,442,322
30 98940 BY NY ISWATUN HASANAH (6 Hr) CA01 bed 15 PERISTI Rp 682,400
31 99160 GIYANTI, NY (25 Th) TR01.1 TERATAI Kelas III Rp 7,475,498
32 96618 HAMIDAH NY (33 Th) TR01.10 TERATAI Kelas III Rp 3,529,559
33 99200 DYAH ANGGUN MAWASARI NY (19 Th) TR01.17 TERATAI Kelas III Rp 6,748,322
34 99174 WULAN FATMAWATI NY (19 Th)
35 98404 ARTI ROCHANI NY (25 Th)
36 98645 TURSINAH, NY (38 Th)
37 77556 YUNI NURHAYATI NY (33 Th)
38 99191 AYU NOVIANA DAMAYANTI NY (20 Th)
39 79137 EMA RAHMAWATI NY (34 Th)
PASIEN BPJS PERIODE 6 November 2018
No. NO RM Nama Pasien
1 93848 WAGINEM, NY (55 Th)
2 99162 SUMARNI, NY (75 Th)
3 88584 MEI SUSANTI NN (23 Th)
4 99215 RUSDI PRAMONO TN (67 Th)
5 94411 SISWOYO TN (58 Th)
6 99226 SUHARTO, TN (70 Th)
7 99154 PURWANTO TN (61 Th)
8 99164 BY NY GIYANTI (0 Hr)
9 99202 BY NY HAMIDAH (0 Hr)
10 99220 BY NY DYAH ANGGUN MAWAS (0 Hr)
11 99237 BY NY YUNI NURHAYATI (0 Hr)
12 99239 BY NY AYU NOVIANA DAMAYANTI (1 Hr)
13 99240 BY NY EMA RAHMAWATI (0 Hr)
14 61262 MOHAMMAD RAKHA EL RIZKY, AN (5 Th)
15 90194 NAYYARA ADEVA MAULANA AN (8 Bl)
16 78500 HARTO WIYONO TN (78 Th)
17 83856 DAFID YERY INDRIYANTO TN (30 Th)
18 99063 ATI MARYATI, NY (55 Th)
19 99153 WESTRI WULANDARI NY (26 Th)
20 90916 SUPARTI,NY (54 Th)
21 99039 SINEM, NY (80 Th)
TR01.12 TERATAI Kelas III Rp 8,131,835
TR01.11 TERATAI Kelas III Rp 1,606,431
TR01.13 TERATAI Kelas III Rp 1,544,367
TR01.6 TERATAI Kelas III Rp 3,279,895
TR01.5 TERATAI Kelas III Rp 3,651,442
TR01.14 TERATAI Kelas III Rp 4,412,182
PETUGAS KETERANGAN STATUS
Kelas VISIT
VISIT LHB PASIEN
AG01 bed 6 ANGGREK Kelas III
AG01 bed 1 ANGGREK Kelas III
AG01 bed 2 ANGGREK Kelas III
AG01 bed 7 ANGGREK Kelas III
AG01 bed 8 ANGGREK Kelas III
AG01 bed 9 ANGGREK Kelas III
BO01 Bed 4 BOUGENVILE Kelas I
CA bed 11 CATLEYA 1 (Rawat Gabung)
CA bed 10 CATLEYA 1 (Rawat Gabung)
CA bed 12 CATLEYA 1 (Rawat Gabung)
CA bed 13 CATLEYA 1 (Rawat Gabung)
CA bed 14 CATLEYA 1 (Rawat Gabung)
CA bed 15 CATLEYA 1 (Rawat Gabung)
CE01 bed 7 CEMPAKA Kelas II
CE01 bed 6 CEMPAKA Kelas II
CE01 bed 2 CEMPAKA Kelas II
CE01 bed 1 CEMPAKA Kelas II
DA01 bed 4 DAHLIA Kelas III
DA01 bed 5 DAHLIA Kelas III
DA01 bed 2 DAHLIA Kelas III
DA01 bed 3 DAHLIA Kelas III
22 99150 APRILIA KUSUMA WATI, AN (17 Th) FL01 bed 2 FLAMBOYAN Kelas III
23 99205 SEPTIAN DAVIN ALVARO, AN (1 Th) FL01 bed 4 FLAMBOYAN Kelas III
24 89433 GIYARTI, NY (49 Th) FL01 bed 5 FLAMBOYAN Kelas III
25 99238 ALIKA NAILA PUTRI, AN (1 Th) FL01 bed 6 FLAMBOYAN Kelas III
26 99236 BY NY WULAN FATMAWATI (0 Hr) IN01 bed 2 HCU Neonatus(Inkubator)
27 97388 SUPARNO SASTRO WIYONO,TN (55 Th) IC01 bed 2 KAMAR ICU
28 88013 SUMADI TN (53 Th) IC01 bed 3 KAMAR ICU
29 99217 MUTI ARIZKA RANI P.M NN (27 Th) MN101 bed 1 MENUR 1 Kelas VVIP
30 98940 BY NY ISWATUN HASANAH (6 Hr) CA01 bed 15 PERISTI
31 99160 GIYANTI, NY (25 Th) TR01.1 TERATAI Kelas III
32 96618 HAMIDAH NY (33 Th) TR01.10 TERATAI Kelas III
33 99200 DYAH ANGGUN MAWASARI NY (19 Th) TR01.17 TERATAI Kelas III
34 99174 WULAN FATMAWATI NY (19 Th) TR01.12 TERATAI Kelas III
35 98404 ARTI ROCHANI NY (25 Th) TR01.11 TERATAI Kelas III
36 98645 TURSINAH, NY (38 Th) TR01.13 TERATAI Kelas III
37 77556 YUNI NURHAYATI NY (33 Th) TR01.6 TERATAI Kelas III
38 99191 AYU NOVIANA DAMAYANTI NY (20 Th) TR01.5 TERATAI Kelas III
39 79137 EMA RAHMAWATI NY (34 Th) TR01.14 TERATAI Kelas III

PASIEN UMUM PERIODE 6 November 2018

PETUGAS KETERANGAN STATUS

No. NO RM Nama Pasien Kelas VISIT
VISIT LHB PASIEN
1 98659 TINI NY (49 Th) AG01 bed 4 ANGGREK Kelas III
2 83120 YUMNA MAYUMI, AN (1 Th) BO01 Bed 2 BOUGENVILE Kelas I
3 99135 MUHAMMAD DAFFA KHOIRUL R, AN (11 BlFL01 bed 3 FLAMBOYAN Kelas III
4 83907 BIMA SAPUTRA,AN (5 Th) FL01 bed 1 FLAMBOYAN Kelas III
5 98816 BY NY ERNA WATI (0 Hr) IN01 bed 1 HCU Neonatus(Inkubator)
6 98397 PANUT ATMOMIHARJO, TN (77 Th) IC01 bed 1 KAMAR ICU
 PASIEN UMUM PERIODE 6 November 2018
Hari Rawat Ke-
No. NO RM Nama Pasien Kelas
I II III IV
1 98659 TINI NY (49 Th) AG01 bed 4 ANGGREK Kelas III Rp 1,553,061
2 83120 YUMNA MAYUMI, AN (1 Th) BO01 Bed 2 BOUGENVILE Kelas I Rp 1,831,964
3 99135 MUHAMMAD DAFFA KHOIRUL R, AN (11 BlFL01 bed 3 FLAMBOYAN Kelas III Rp 1,855,597
4 83907 BIMA SAPUTRA,AN (5 Th) FL01 bed 1 FLAMBOYAN Kelas III Rp 1,161,678
5 98816 BY NY ERNA WATI (0 Hr) IN01 bed 1 HCU Neonatus(Inkubator) Hari Ke - 10 Rp 11,667,388
6 98397 PANUT ATMOMIHARJO, TN (77 Th) IC01 bed 1 KAMAR ICU Hari ke - 18 Rp 54,433,760
awat Ke-
IV V
Rp 2,052,241

Rp 2,425,716
Rp 2,204,677

Rp 2,189,566

Rp 2,226,105
KELENGKAPAN
BPJS
KELENGKAPAN
BERKAS
V
 PASIEN BPJS PERIODE 8 November 2018
Hari Rawat Ke-
No. NO RM Nama Pasien Kelas Klaim
I II III
1 99162 SUMARNI, NY (75 Th) AG01 bed 1 ANGGREK Kelas III
2 88584 MEI SUSANTI NN (23 Th) AG01 bed 2 ANGGREK Kelas III
3 94411 SISWOYO TN (58 Th) AG01 bed 8 ANGGREK Kelas III
4 99226 SUHARTO, TN (70 Th) AG01 bed 9 ANGGREK Kelas III
5 99279 NGATIYEM NY (68 Th) AG01 bed 7 ANGGREK Kelas III Rp 2,362,606
6 94200 SUMEDI, TN (54 Th) AG01 bed 10 ANGGREK Kelas III Rp 4,134,209
7 99382 SUKIYEM NY (48 Th) AN01 bed 1 ANYELIR (R. ISOLASI) Kelas III Rp 1,788,366
8 74426 RINI NUR PALITA NY (25 Th) A01 bed 1 ASTER Kelas VIP Rp 2,034,569
9 98840 WAHYU AZIS KUNCORO JATI AN (15 Th) BO01 Bed 4 BOUGENVILE Kelas I Rp 3,569,079
10 99380 SURATNO TN (73 Th) BO01 Bed 2 BOUGENVILE Kelas I Rp 1,623,550
11 99323 BY NY YULIANA NURWANINGSIH (0 Hr) CA bed 11 CATLEYA 1 (Rawat Gabung) Rp 1,054,037
12 99329 BY NY ARI KURNIA (0 Hr) CA bed 15 CATLEYA 1 (Rawat Gabung) Rp 1,157,505
13 99357 BY NY SRI HANDAYANI (0 Hr) CA bed 13 CATLEYA 1 (Rawat Gabung) Rp 638,500
14 99334 BY NY SRI MARDIYAH (0 Hr) CA bed 14 CATLEYA 1 (Rawat Gabung) Rp 667,802
15 99390 BY NY AYU WULANSARI (0 Hr) CA bed 15 CATLEYA 1 (Rawat Gabung) Rp 580,000
16 78500 HARTO WIYONO TN (78 Th) CE01 bed 2 CEMPAKA Kelas II
17 99263 DYAH UTOMO SURYAWATI NY (52 Th) CE01 bed 3 CEMPAKA Kelas II Rp 3,598,588
18 99271 ANINDITA KEISHA ZAHRA AN (3 Th) CE01 bed 4 CEMPAKA Kelas II Rp 1,553,000
19 99314 JUN SUGIARTO TN (36 Th) CE01 bed 6 CEMPAKA Kelas II Rp 1,635,140
20 70419 PAIYEM NY (50 Th) CE01 bed 7 CEMPAKA Kelas II Rp 2,532,665
21 99365 NGATRAWI TN (70 Th) CE01 bed 7 CEMPAKA Kelas II Rp 2,020,126
22 99153 WESTRI WULANDARI NY (26 Th) DA01 bed 5 DAHLIA Kelas III Hari Ke - 6 Rp 2,776,690
23 99039 SINEM, NY (80 Th) DA01 bed 3 DAHLIA Kelas III
24 99367 PARTO SEMITO TN (90 Th) DA01 bed 2 DAHLIA Kelas III Rp 1,531,351
25 99205 SEPTIAN DAVIN ALVARO, AN (1 Th) FL01 bed 4 FLAMBOYAN Kelas III
26 89433 GIYARTI, NY (49 Th) FL01 bed 5 FLAMBOYAN Kelas III
27 99238 ALIKA NAILA PUTRI, AN (1 Th) FL01 bed 6 FLAMBOYAN Kelas III
28 98716 PARJIMIN TN (36 Th) FL01 bed 2 FLAMBOYAN Kelas III Rp 6,456,720
29 98569 WAKINO KUAT TN (63 Th) FL01 bed 1 FLAMBOYAN Kelas III Rp 2,795,489
30 99236 BY NY WULAN FATMAWATI (0 Hr) IN01 bed 2 HCU Neonatus(Inkubator)
31 88013 SUMADI TN (53 Th) IC01 bed 3 KAMAR ICU
32 97711 ROHADI TN (55 Th) IC01 bed 2 KAMAR ICU Rp 3,235,844
33 88618 MADI WIYONO TN (70 Th) IC01 bed 5 KAMAR ICU Rp 3,625,852
34 99317 SRI MARDIYAH, NY (33 Th) IC01 bed 1 KAMAR ICU Rp 9,383,266
35 82541 SUKINAH NY (86 Th) LI01 bed 2 LILY Kelas II Rp 2,868,694
36 99217 MUTI ARIZKA RANI P.M NN (27 Th) MN101 bed 1 MENUR 1 Kelas VVIP
37 98940 BY NY ISWATUN HASANAH (6 Hr) CA01 bed 15 PERISTI
38 99316 BY NY SAWILAH (0 Hr) CA01 bed 1 PERISTI Rp 1,246,707
39 99044 BY NY RATNA ROSANTININGRUM (6 Hr) CA01 bed 10 PERISTI Rp 725,500
40 99278 SAWILAH NY (35 Th) TR01.13 TERATAI Kelas III Rp 6,949,398
41 99318 YULIANA NURWANINGSIH, NY (29 Th) TR01.10 TERATAI Kelas III Rp 6,419,476
42 99274 SRI HANDAYANI NY (34 Th) TR01.18 TERATAI Kelas III Rp 6,636,128
43 99379 WIJI NY (23 Th) TR01.1 TERATAI Kelas III Rp 4,637,002
44 99358 AYU WULANSARI NY (25 Th) TR01.11 TERATAI Kelas III Rp 3,325,894

PASIEN BPJS PERIODE 8 November 2018

No. NO RM Nama Pasien
1 99162 SUMARNI, NY (75 Th)
2 88584 MEI SUSANTI NN (23 Th)
3 94411 SISWOYO TN (58 Th)
4 99226 SUHARTO, TN (70 Th)
5 99279 NGATIYEM NY (68 Th)
6 94200 SUMEDI, TN (54 Th)
7 99382 SUKIYEM NY (48 Th)
8 74426 RINI NUR PALITA NY (25 Th)
9 98840 WAHYU AZIS KUNCORO JATI AN (15 Th)
10 99380 SURATNO TN (73 Th)
11 99323 BY NY YULIANA NURWANINGSIH (0 Hr)
12 99329 BY NY ARI KURNIA (0 Hr)
13 99357 BY NY SRI HANDAYANI (0 Hr)
14 99334 BY NY SRI MARDIYAH (0 Hr)
15 99390 BY NY AYU WULANSARI (0 Hr)
16 78500 HARTO WIYONO TN (78 Th)
17 99263 DYAH UTOMO SURYAWATI NY (52 Th)
18 99271 ANINDITA KEISHA ZAHRA AN (3 Th)
19 99314 JUN SUGIARTO TN (36 Th)
20 70419 PAIYEM NY (50 Th)
21 99365 NGATRAWI TN (70 Th)
22 99153 WESTRI WULANDARI NY (26 Th)
23 99039 SINEM, NY (80 Th)
24 99367 PARTO SEMITO TN (90 Th)
25 99205 SEPTIAN DAVIN ALVARO, AN (1 Th)
PETUGAS KETERANGAN STATUS
Kelas VISIT
VISIT LHB PASIEN
AG01 bed 1 ANGGREK Kelas III
AG01 bed 2 ANGGREK Kelas III
AG01 bed 8 ANGGREK Kelas III
AG01 bed 9 ANGGREK Kelas III
AG01 bed 7 ANGGREK Kelas III
AG01 bed 10 ANGGREK Kelas III
AN01 bed 1 ANYELIR (R. ISOLASI) Kelas III
A01 bed 1 ASTER Kelas VIP
BO01 Bed 4 BOUGENVILE Kelas I
BO01 Bed 2 BOUGENVILE Kelas I
CA bed 11 CATLEYA 1 (Rawat Gabung)
CA bed 15 CATLEYA 1 (Rawat Gabung)
CA bed 13 CATLEYA 1 (Rawat Gabung)
CA bed 14 CATLEYA 1 (Rawat Gabung)
CA bed 15 CATLEYA 1 (Rawat Gabung)
CE01 bed 2 CEMPAKA Kelas II
CE01 bed 3 CEMPAKA Kelas II
CE01 bed 4 CEMPAKA Kelas II
CE01 bed 6 CEMPAKA Kelas II
CE01 bed 7 CEMPAKA Kelas II
CE01 bed 7 CEMPAKA Kelas II
DA01 bed 5 DAHLIA Kelas III
DA01 bed 3 DAHLIA Kelas III
DA01 bed 2 DAHLIA Kelas III
FL01 bed 4 FLAMBOYAN Kelas III
26 89433 GIYARTI, NY (49 Th) FL01 bed 5 FLAMBOYAN Kelas III
27 99238 ALIKA NAILA PUTRI, AN (1 Th) FL01 bed 6 FLAMBOYAN Kelas III
28 98716 PARJIMIN TN (36 Th) FL01 bed 2 FLAMBOYAN Kelas III
29 98569 WAKINO KUAT TN (63 Th) FL01 bed 1 FLAMBOYAN Kelas III
30 99236 BY NY WULAN FATMAWATI (0 Hr) IN01 bed 2 HCU Neonatus(Inkubator)
31 88013 SUMADI TN (53 Th) IC01 bed 3 KAMAR ICU
32 97711 ROHADI TN (55 Th) IC01 bed 2 KAMAR ICU
33 88618 MADI WIYONO TN (70 Th) IC01 bed 5 KAMAR ICU
34 99317 SRI MARDIYAH, NY (33 Th) IC01 bed 1 KAMAR ICU
35 82541 SUKINAH NY (86 Th) LI01 bed 2 LILY Kelas II
36 99217 MUTI ARIZKA RANI P.M NN (27 Th) MN101 bed 1 MENUR 1 Kelas VVIP
37 98940 BY NY ISWATUN HASANAH (6 Hr) CA01 bed 15 PERISTI
38 99316 BY NY SAWILAH (0 Hr) CA01 bed 1 PERISTI
39 99044 BY NY RATNA ROSANTININGRUM (6 Hr) CA01 bed 10 PERISTI
40 99278 SAWILAH NY (35 Th) TR01.13 TERATAI Kelas III
41 99318 YULIANA NURWANINGSIH, NY (29 Th) TR01.10 TERATAI Kelas III
42 99274 SRI HANDAYANI NY (34 Th) TR01.18 TERATAI Kelas III
43 99379 WIJI NY (23 Th) TR01.1 TERATAI Kelas III
44 99358 AYU WULANSARI NY (25 Th) TR01.11 TERATAI Kelas III
PASIEN UMUM PERIODE 8 November 2018

PETUGAS KETERANGAN STATUS

No. NO RM Nama Pasien Kelas VISIT
VISIT LHB PASIEN
1 98659 TINI NY (49 Th) AG01 bed 4 ANGGREK Kelas III
2 99135 MUHAMMAD DAFFA KHOIRUL R, AN (11 BlFL01 bed 3 FLAMBOYAN Kelas III
3 81074 MUHAMMAD MUNFIQIN H SDR (23 Th) FL01 bed 7 FLAMBOYAN Kelas III
4 98816 BY NY ERNA WATI (0 Hr) IN01 bed 1 HCU Neonatus(Inkubator)
5 75001 CARNESIH NY (32 Th) KB01 bed 1 Kamar Bersalin
6 99315 ARI KURNIA, NY (28 Th) LI01 bed 1 LILY Kelas II
7 99391 BY NY WIJI (0 Hr) CA01 bed 11 PERISTI

PASIEN UMUM PERIODE 8 November 2018

 Hari Rawat Ke-
No. NO RM Nama Pasien Kelas
I II III IV
1 98659 TINI NY (49 Th) AG01 bed 4 ANGGREK Kelas III Rp 7,912,841
2 99135 MUHAMMAD DAFFA KHOIRUL R, AN (11 BlFL01 bed 3 FLAMBOYAN Kelas III
3 81074 MUHAMMAD MUNFIQIN H SDR (23 Th) FL01 bed 7 FLAMBOYAN Kelas III Rp 5,273,149
4 98816 BY NY ERNA WATI (0 Hr) IN01 bed 1 HCU Neonatus(Inkubator) Hari ke - 12 Rp 12,455,130
5 75001 CARNESIH NY (32 Th) KB01 bed 1 Kamar Bersalin Rp 900,000
6 99315 ARI KURNIA, NY (28 Th) LI01 bed 1 LILY Kelas II Rp 7,395,294
7 99391 BY NY WIJI (0 Hr) CA01 bed 11 PERISTI Rp 790,000
Ke-
IV V
Rp 3,567,428
Rp 2,866,835
Rp 2,792,455
Rp 2,918,853

Rp 4,147,095

Rp 1,972,726

Rp 2,268,664
Rp 3,376,028
Rp 2,071,336

Rp 3,018,774
Rp 6,541,692
Rp 3,678,077
Rp 1,694,659

KELENGKAPAN
BPJS
KELENGKAPAN
BERKAS
 V

Rp 2,608,938
 PASIEN BPJS PERIODE 9 November 2018
Hari Rawat Ke-
No. NO RM Nama Pasien Kelas Klaim
I II III
1 99162 SUMARNI, NY (75 Th) AG01 bed 1 ANGGREK Kelas III Hari Ke - 3 Rp 3,783,428
2 99226 SUHARTO, TN (70 Th) AG01 bed 9 ANGGREK Kelas III
3 94200 SUMEDI, TN (54 Th) AG01 bed 10 ANGGREK Kelas III
4 88618 MADI WIYONO TN (70 Th) AG01 bed 2 ANGGREK Kelas III
5 99420 SUKINO WIGNYO WIYONO, TN (71 Th) AG01 bed 4 ANGGREK Kelas III Rp 843,500
6 91283 DALIMAN PURWANTO, TN (59 Th) AG01 bed 8 ANGGREK Kelas III Rp 772,500
7 99382 SUKIYEM NY (48 Th) AN01 bed 1 ANYELIR (R. ISOLASI) Kelas III Rp 2,322,236
8 74426 RINI NUR PALITA NY (25 Th) A01 bed 1 ASTER Kelas VIP Rp 2,419,501
9 99380 SURATNO TN (73 Th) BO01 Bed 2 BOUGENVILE Kelas I Rp 2,605,322
10 56460 ROCH SUKEMI NY (85 Th) BO01 Bed 3 BOUGENVILE Kelas I Rp 1,172,000
12 99323 BY NY YULIANA NURWANINGSIH (0 Hr) CA bed 11 CATLEYA 1 (Rawat Gabung) Rp 1,229,537
13 99329 BY NY ARI KURNIA (0 Hr) CA bed 15 CATLEYA 1 (Rawat Gabung) Rp 1,427,005
14 99357 BY NY SRI HANDAYANI (0 Hr) CA bed 13 CATLEYA 1 (Rawat Gabung) Rp 779,280
15 99334 BY NY SRI MARDIYAH (0 Hr) CA bed 14 CATLEYA 1 (Rawat Gabung)
16 99448 BY NY REZA EKA PUTRI (0 Hr) CA bed 15 CATLEYA 1 (Rawat Gabung) Rp 580,000
17 99450 BY NY RETNO WULANDARI (0 Hr) CA bed 2 CATLEYA 1 (Rawat Gabung) Rp 580,000
18 99452 BY NY ENIK LISTYO (1 Hr) CA bed 3 CATLEYA 1 (Rawat Gabung) Rp 580,000
19 99453 BY NY SRI WAHYUNI (0 Hr) CA bed 4 CATLEYA 1 (Rawat Gabung) Rp 580,000
20 78500 HARTO WIYONO TN (78 Th) CE01 bed 2 CEMPAKA Kelas II Hari Ke - 6 Rp 4,624,095
21 99314 JUN SUGIARTO TN (36 Th) CE01 bed 6 CEMPAKA Kelas II
22 70419 PAIYEM NY (50 Th) CE01 bed 7 CEMPAKA Kelas II
23 99365 NGATRAWI TN (70 Th) CE01 bed 7 CEMPAKA Kelas II Rp 3,523,724
24 98395 AHMAD NUR HIDAYAH, AN (10 Th) CE01 bed 4 CEMPAKA Kelas II Rp 1,018,032
25 99367 PARTO SEMITO TN (90 Th) DA01 bed 2 DAHLIA Kelas III Rp 2,081,141
26 99440 SRI MULTATIK NY (68 Th) DA01 bed 3 DAHLIA Kelas III Rp 1,053,203
27 99205 SEPTIAN DAVIN ALVARO, AN (1 Th) FL01 bed 4 FLAMBOYAN Kelas III
28 99238 ALIKA NAILA PUTRI, AN (1 Th) FL01 bed 6 FLAMBOYAN Kelas III
29 98716 PARJIMIN TN (36 Th) FL01 bed 2 FLAMBOYAN Kelas III
30 99236 BY NY WULAN FATMAWATI (0 Hr) IN01 bed 2 HCU Neonatus(Inkubator)
32 97711 ROHADI TN (55 Th) IC01 bed 2 KAMAR ICU
33 99317 SRI MARDIYAH, NY (33 Th) IC01 bed 1 KAMAR ICU
34 99442 RETNO WULANDARI NY (26 Th) LI01 bed 2 LILY Kelas II Rp 3,871,387
35 99416 RESA EKA PUTRI A, NY (31 Th) LI01 bed 3 LILY Kelas II Rp 4,246,887
36 99217 MUTI ARIZKA RANI P.M NN (27 Th) MN101 bed 1 MENUR 1 Kelas VVIP
37 98890 CINTIYA AJENG PRAMESTI, AN (6 Th) MN201 bed 1 MENUR 2 Kelas VVIP Rp 1,690,000
38 98940 BY NY ISWATUN HASANAH (6 Hr)
39 99044 BY NY RATNA ROSANTININGRUM (6 Hr)
41 99318 YULIANA NURWANINGSIH, NY (29 Th)
42 99274 SRI HANDAYANI NY (34 Th)
43 99379 WIJI NY (23 Th)
44 99437 HANA ATIKAH NY (23 Th)
45 99439 SRI WAHYUNI NY (25 Th)
46 99447 ENIK LISTYO NY (31 Th)
No. NO RM Nama Pasien
1 99162 SUMARNI, NY (75 Th)
2 99226 SUHARTO, TN (70 Th)
3 94200 SUMEDI, TN (54 Th)
4 88618 MADI WIYONO TN (70 Th)
5 99420 SUKINO WIGNYO WIYONO, TN (71 Th)
6 91283 DALIMAN PURWANTO, TN (59 Th)
7 99382 SUKIYEM NY (48 Th)
8 74426 RINI NUR PALITA NY (25 Th)
9 99380 SURATNO TN (73 Th)
10 56460 ROCH SUKEMI NY (85 Th)
11 99202 BY NY HAMIDAH (0 Hr)
12 99323 BY NY YULIANA NURWANINGSIH (0 Hr)
13 99329 BY NY ARI KURNIA (0 Hr)
14 99357 BY NY SRI HANDAYANI (0 Hr)
15 99334 BY NY SRI MARDIYAH (0 Hr)
16 99448 BY NY REZA EKA PUTRI (0 Hr)
17 99450 BY NY RETNO WULANDARI (0 Hr)
18 99452 BY NY ENIK LISTYO (1 Hr)
19 99453 BY NY SRI WAHYUNI (0 Hr)
20 78500 HARTO WIYONO TN (78 Th)
21 99314 JUN SUGIARTO TN (36 Th)
CA01 bed 15 PERISTI
CA01 bed 10 PERISTI Rp 1,137,959
TR01.10 TERATAI Kelas III Rp 7,341,476
TR01.18 TERATAI Kelas III Rp 7,507,128
TR01.1 TERATAI Kelas III Rp 5,306,684
TR01.11 TERATAI Kelas III Rp 1,209,000
TR01.12 TERATAI Kelas III Rp 3,267,140
TR01.13 TERATAI Kelas III Rp 3,220,750
PASIEN BPJS PERIODE 9 November 2018
PETUGAS KETERANGAN STATUS
Kelas VISIT
VISIT LHB PASIEN
AG01 bed 1 ANGGREK Kelas III
AG01 bed 9 ANGGREK Kelas III
AG01 bed 10 ANGGREK Kelas III
AG01 bed 2 ANGGREK Kelas III
AG01 bed 4 ANGGREK Kelas III
AG01 bed 8 ANGGREK Kelas III
AN01 bed 1 ANYELIR (R. ISOLASI) Kelas III
A01 bed 1 ASTER Kelas VIP
BO01 Bed 2 BOUGENVILE Kelas I
BO01 Bed 3 BOUGENVILE Kelas I
CA bed 10 CATLEYA 1 (Rawat Gabung)
CA bed 11 CATLEYA 1 (Rawat Gabung)
CA bed 15 CATLEYA 1 (Rawat Gabung)
CA bed 13 CATLEYA 1 (Rawat Gabung)
CA bed 14 CATLEYA 1 (Rawat Gabung)
CA bed 15 CATLEYA 1 (Rawat Gabung)
CA bed 2 CATLEYA 1 (Rawat Gabung)
CA bed 3 CATLEYA 1 (Rawat Gabung)
CA bed 4 CATLEYA 1 (Rawat Gabung)
CE01 bed 2 CEMPAKA Kelas II
CE01 bed 6 CEMPAKA Kelas II
22 70419 PAIYEM NY (50 Th) CE01 bed 7 CEMPAKA Kelas II
23 99365 NGATRAWI TN (70 Th) CE01 bed 7 CEMPAKA Kelas II
24 98395 AHMAD NUR HIDAYAH, AN (10 Th) CE01 bed 4 CEMPAKA Kelas II
25 99367 PARTO SEMITO TN (90 Th) DA01 bed 2 DAHLIA Kelas III
26 99440 SRI MULTATIK NY (68 Th) DA01 bed 3 DAHLIA Kelas III
27 99205 SEPTIAN DAVIN ALVARO, AN (1 Th) FL01 bed 4 FLAMBOYAN Kelas III
28 99238 ALIKA NAILA PUTRI, AN (1 Th) FL01 bed 6 FLAMBOYAN Kelas III
29 98716 PARJIMIN TN (36 Th) FL01 bed 2 FLAMBOYAN Kelas III
30 99236 BY NY WULAN FATMAWATI (0 Hr) IN01 bed 2 HCU Neonatus(Inkubator)
31 99247 DWI HARTANTI NY (33 Th) KB01 bed 1 Kamar Bersalin
32 97711 ROHADI TN (55 Th) IC01 bed 2 KAMAR ICU
33 99317 SRI MARDIYAH, NY (33 Th) IC01 bed 1 KAMAR ICU
34 99442 RETNO WULANDARI NY (26 Th) LI01 bed 2 LILY Kelas II
35 99416 RESA EKA PUTRI A, NY (31 Th) LI01 bed 3 LILY Kelas II
36 99217 MUTI ARIZKA RANI P.M NN (27 Th) MN101 bed 1 MENUR 1 Kelas VVIP
37 98890 CINTIYA AJENG PRAMESTI, AN (6 Th) MN201 bed 1 MENUR 2 Kelas VVIP
38 98940 BY NY ISWATUN HASANAH (6 Hr) CA01 bed 15 PERISTI
39 99044 BY NY RATNA ROSANTININGRUM (6 Hr) CA01 bed 10 PERISTI
40 77556 YUNI NURHAYATI NY (33 Th) TR01.6 TERATAI Kelas III
41 99318 YULIANA NURWANINGSIH, NY (29 Th) TR01.10 TERATAI Kelas III
42 99274 SRI HANDAYANI NY (34 Th) TR01.18 TERATAI Kelas III
43 99379 WIJI NY (23 Th) TR01.1 TERATAI Kelas III
44 99437 HANA ATIKAH NY (23 Th) TR01.11 TERATAI Kelas III
45 99439 SRI WAHYUNI NY (25 Th) TR01.12 TERATAI Kelas III
46 99447 ENIK LISTYO NY (31 Th) TR01.13 TERATAI Kelas III

PASIEN UMUM PERIODE 9 November 2018

PETUGAS KETERANGAN STATUS

No. NO RM Nama Pasien Kelas VISIT
VISIT LHB PASIEN
1 99216 SUBIYANTO TN (48 Th) AG01 bed 6 ANGGREK Kelas III
2 99422 BY NY NOVIANA PURWANINGSIH (0 Hr) CA bed 12 CATLEYA 1 (Rawat Gabung)
3 99454 SUHARDI HARDI SANTOSO TN (57 Th) CE01 bed 3 CEMPAKA Kelas II
4 98816 BY NY ERNA WATI (0 Hr) IN01 bed 1 HCU Neonatus(Inkubator)
 5 99451 SUYADI TN (10 Th)
6 77147 TRIMO REJO AL PAINAH, NY (82 Th)
7 99449 RUMINTEN DARSO NY (59 Th)
8 99315 ARI KURNIA, NY (28 Th)
9 99391 BY NY WIJI (0 Hr)
10 52408 NOVIANA PURWANINGSIH, NY (30 Th)
IC01 bed 3 KAMAR ICU
KE01 Bed 1 KENANGA Kelas I
KE01 Bed 2 KENANGA Kelas I
LI01 bed 1 LILY Kelas II
CA01 bed 11 PERISTI
TR01.14 TERATAI Kelas III

PASIEN UMUM PERIODE 9 November 2018

Hari Rawat Ke-
No. NO RM Nama Pasien Kelas
I II III IV
1 99216 SUBIYANTO TN (48 Th) AG01 bed 6 ANGGREK Kelas III Rp 2,352,864
2 99422 BY NY NOVIANA PURWANINGSIH (0 Hr) CA bed 12 CATLEYA 1 (Rawat Gabung) Rp 1,274,709
3 99454 SUHARDI HARDI SANTOSO TN (57 Th) CE01 bed 3 CEMPAKA Kelas II Rp 997,500
4 98816 BY NY ERNA WATI (0 Hr) IN01 bed 1 HCU Neonatus(Inkubator) Hari ke - 13 Rp 13,106,783
5 99451 SUYADI TN (10 Th) IC01 bed 3 KAMAR ICU Rp 2,133,435
6 77147 TRIMO REJO AL PAINAH, NY (82 Th) KE01 Bed 1 KENANGA Kelas I Rp 1,355,097
7 99449 RUMINTEN DARSO NY (59 Th) KE01 Bed 2 KENANGA Kelas I Rp 1,547,255
8 99315 ARI KURNIA, NY (28 Th) LI01 bed 1 LILY Kelas II Rp 8,432,752
9 99391 BY NY WIJI (0 Hr) CA01 bed 11 PERISTI Rp 1,607,384
10 52408 NOVIANA PURWANINGSIH, NY (30 Th) TR01.14 TERATAI Kelas III Rp 9,267,490
Ke-
IV V

Rp 3,171,853
Rp 4,250,405
Rp 4,427,852

Rp 1,254,552

Rp 2,372,140
Rp 3,098,446

Rp 2,677,421
Rp 2,321,724
Rp 6,918,232
Rp 3,952,977
Rp 5,544,544
Rp 9,587,160

Rp 4,454,077
 Rp 1,874,559

KELENGKAPAN
BPJS
KELENGKAPAN
BERKAS
V
 PASIEN BPJS PERIODE 12 November 2018
Hari Rawat Ke-
No. NO RM Nama Pasien Kelas Klaim
I II III
1 99216 SUBIYANTO TN (48 Th) AG01 bed 6 ANGGREK Kelas III
2 91283 DALIMAN PURWANTO, TN (59 Th) AG01 bed 8 ANGGREK Kelas III
3 99543 PADMO WIYONO, TN (65 Th) AG01 bed 1 ANGGREK Kelas III Rp 1,845,471
4 99551 WAHYONO, TN (59 Th) AG01 bed 10 ANGGREK Kelas III Rp 1,520,095
5 99553 MIFTA FARID FATKHUROSI NUR HUDA, SDR
AG01 bed 4 ANGGREK Kelas III Rp 1,489,708
6 99511 PANIYEM NY (85 Th) AN01 bed 2 ANYELIR (R. ISOLASI) Kelas III Rp 3,491,968
7 84350 SAYOTO NOTO MIHARJO TN (66 Th) BO01 Bed 2 BOUGENVILE Kelas I Rp 1,873,387
8 99547 KARTIMIN HARJO WINOTO, TN (80 Th) BO01 Bed 4 BOUGENVILE Kelas I Rp 2,011,954
9 99537 BY NY UMUL CHOYR (0 Hr) CA bed 2 CATLEYA 1 (Rawat Gabung) Rp 1,191,707
10 99535 BY NY YUNI SETYAWAN (0 Hr) CA bed 3 CATLEYA 1 (Rawat Gabung) Rp 1,349,707
11 99552 BY NY DESI PUJI LESTARI (0 Hr) CA bed 11 CATLEYA 1 (Rawat Gabung) Rp 1,097,207
12 69328 WIYANTI NY (37 Th) CE01 bed 1 CEMPAKA Kelas II Rp 1,736,783
13 81098 SUMARDI,TN (53 Th) CE01 bed 4 CEMPAKA Kelas II Rp 1,423,133
14 99440 SRI MULTATIK NY (68 Th) DA01 bed 3 DAHLIA Kelas III
15 99506 WIJI NY (64 Th) DA01 bed 2 DAHLIA Kelas III
16 99544 INAYAH DWI KURNIASTUTI, AN (12 Th) FL01 bed 4 FLAMBOYAN Kelas III Rp 1,571,745
17 99539 UNTARI, NY (41 Th) KB01 bed 5 Kamar Bersalin Rp 1,221,006
18 99518 YUNI SETYAWAN NY (31 Th) LI01 bed 6 LILY Kelas II Rp 8,278,144
19 99538 PUTRI MARYATI, NY (37 Th) LI01 bed 1 LILY Kelas II Rp 8,089,528
20 73072 GONO SOEKARDJO TN (84 Th) M101 Bed 1 MELATI 1 Kelas VIP
21 63298 SRI MULYANI NY (50 Th) MN101 bed 1 MENUR 1 Kelas VVIP Rp 5,940,122
22 56460 ROCH SUKEMI NY (85 Th) MN201 bed 1 MENUR 2 Kelas VVIP
23 98920 UMUL CHOYR, NY (39 Th) TR01.17 TERATAI Kelas III Rp 9,572,901
24 99548 DESI PUJI LESTARI, NY (35 Th) TR01.11 TERATAI Kelas III Rp 7,449,287
25 99561 PURWANTININGSIH, NY (37 Th) TR01.1 TERATAI Kelas III Rp 900,000
 PASIEN BPJS PERIODE 12 November 2018
PETUGAS KETERANGAN STATUS
No. NO RM Nama Pasien Kelas VISIT
VISIT LHB PASIEN
1 99216 SUBIYANTO TN (48 Th) AG01 bed 6 ANGGREK Kelas III
2 91283 DALIMAN PURWANTO, TN (59 Th) AG01 bed 8 ANGGREK Kelas III
3 99543 PADMO WIYONO, TN (65 Th) AG01 bed 1 ANGGREK Kelas III
4 99551 WAHYONO, TN (59 Th) AG01 bed 10 ANGGREK Kelas III
5 99553 MIFTA FARID FATKHUROSI NUR HUDA, SDR
AG01 bed 4 ANGGREK Kelas III
6 99511 PANIYEM NY (85 Th) AN01 bed 2 ANYELIR (R. ISOLASI) Kelas III
7 84350 SAYOTO NOTO MIHARJO TN (66 Th) BO01 Bed 2 BOUGENVILE Kelas I
8 99547 KARTIMIN HARJO WINOTO, TN (80 Th) BO01 Bed 4 BOUGENVILE Kelas I
9 99202 BY NY HAMIDAH (0 Hr) CA bed 10 CATLEYA 1 (Rawat Gabung)
10 99537 BY NY UMUL CHOYR (0 Hr) CA bed 2 CATLEYA 1 (Rawat Gabung)
11 99535 BY NY YUNI SETYAWAN (0 Hr) CA bed 3 CATLEYA 1 (Rawat Gabung)
12 99552 BY NY DESI PUJI LESTARI (0 Hr) CA bed 11 CATLEYA 1 (Rawat Gabung)
13 99226 SUHARTO, TN (70 Th) CE01 bed 6 CEMPAKA Kelas II
14 69328 WIYANTI NY (37 Th) CE01 bed 1 CEMPAKA Kelas II
15 81098 SUMARDI,TN (53 Th) CE01 bed 4 CEMPAKA Kelas II
16 99440 SRI MULTATIK NY (68 Th) DA01 bed 3 DAHLIA Kelas III
17 99506 WIJI NY (64 Th) DA01 bed 2 DAHLIA Kelas III
18 99544 INAYAH DWI KURNIASTUTI, AN (12 Th) FL01 bed 4 FLAMBOYAN Kelas III
19 99247 DWI HARTANTI NY (33 Th) KB01 bed 1 Kamar Bersalin
20 99539 UNTARI, NY (41 Th) KB01 bed 5 Kamar Bersalin
21 99518 YUNI SETYAWAN NY (31 Th) LI01 bed 6 LILY Kelas II
22 99538 PUTRI MARYATI, NY (37 Th) LI01 bed 1 LILY Kelas II
23 73072 GONO SOEKARDJO TN (84 Th) M101 Bed 1 MELATI 1 Kelas VIP
24 63298 SRI MULYANI NY (50 Th) MN101 bed 1 MENUR 1 Kelas VVIP
25 56460 ROCH SUKEMI NY (85 Th) MN201 bed 1 MENUR 2 Kelas VVIP
26 99453 BY NY SRI WAHYUNI (0 Hr) CA01 bed 15 PERISTI
27 77556 YUNI NURHAYATI NY (33 Th) TR01.6 TERATAI Kelas III
28 98920 UMUL CHOYR, NY (39 Th) TR01.17 TERATAI Kelas III
29 99548 DESI PUJI LESTARI, NY (35 Th) TR01.11 TERATAI Kelas III
30 99561 PURWANTININGSIH, NY (37 Th) TR01.1 TERATAI Kelas III

PASIEN UMUM PERIODE 12 November 2018

PETUGAS KETERANGAN STATUS

No. NO RM Nama Pasien Kelas VISIT
VISIT LHB PASIEN
1 99554 RETNO HASTUTI, NY (36 Th) BO01 Bed 5 BOUGENVILE Kelas I
2 99564 BY NY RETNO HASTUTI (0 Hr) CA bed 12 CATLEYA 1 (Rawat Gabung)
3 99451 SUYADI TN (10 Th) CE01 bed 2 CEMPAKA Kelas II
4 68446 SAKIYEM NY (83 Th) CE01 bed 3 CEMPAKA Kelas II
5 99532 MARIANA PRATIWI, NN (20 Th) DA01 bed 4 DAHLIA Kelas III
6 99545 SAKTI ARIF NUR HIDAYAT, AN (5 Th) FL01 bed 3 FLAMBOYAN Kelas III
7 99297 BY NY AYU KUSWORO PUTRI (3 Hr) CA01 bed 1 PERISTI
8 99391 BY NY WIJI (3 Hr) CA01 bed 11 PERISTI
9 99534 NGATINEM NY (42 Th) TR01.4 TERATAI Kelas III
 PASIEN UMUM PERIODE 12 November 2018
Hari Rawat Ke-
No. NO RM Nama Pasien Kelas
I II III IV
1 99554 RETNO HASTUTI, NY (36 Th) BO01 Bed 5 BOUGENVILE Kelas I Rp 11,917,040
2 99564 BY NY RETNO HASTUTI (0 Hr) CA bed 12 CATLEYA 1 (Rawat Gabung) Rp 780,000
3 99451 SUYADI TN (10 Th) CE01 bed 2 CEMPAKA Kelas II Rp 5,100,700
4 68446 SAKIYEM NY (83 Th) CE01 bed 3 CEMPAKA Kelas II Rp 2,126,719
5 99532 MARIANA PRATIWI, NN (20 Th) DA01 bed 4 DAHLIA Kelas III Rp 5,609,946
6 99545 SAKTI ARIF NUR HIDAYAT, AN (5 Th) FL01 bed 3 FLAMBOYAN Kelas III Rp 1,419,291
8 99391 BY NY WIJI (3 Hr) CA01 bed 11 PERISTI Rp 1,816,972
9 99534 NGATINEM NY (42 Th) TR01.4 TERATAI Kelas III Rp 5,450,456
Ke-
IV V
Rp 4,844,876
Rp 2,806,548

Rp 4,147,296
Rp 3,240,338

Rp 4,200,681

Rp 6,703,620
KELENGKAPAN
BPJS
KELENGKAPAN
BERKAS
V
 PASIEN BPJS PERIODE 13 November 2018
Hari Rawat Ke-
No. NO RM Nama Pasien Kelas Klaim
I II III
1 99216 SUBIYANTO TN (48 Th) AG01 bed 6 ANGGREK Kelas III Hari Ke - 6 Rp 5,342,994
2 99543 PADMO WIYONO, TN (65 Th) AG01 bed 1 ANGGREK Kelas III Rp 2,436,752
3 99551 WAHYONO, TN (59 Th) AG01 bed 10 ANGGREK Kelas III Rp 1,992,533
4 99553 MIFTA FARID FATKHUROSI NUR HUDA, SDR
AG01 bed 4 ANGGREK Kelas III Rp 2,177,705
5 81381 SETU TN (42 Th) AG01 bed 2 ANGGREK Kelas III Rp 1,904,215
6 99624 SUNARTO TN (56 Th) AG01 bed 7 ANGGREK Kelas III Rp 2,294,340
7 99628 SUPADI TN (62 Th) AG01 bed 8 ANGGREK Kelas III Rp 1,394,421
8 99511 PANIYEM NY (85 Th) AN01 bed 2 ANYELIR (R. ISOLASI) Kelas III
9 84350 SAYOTO NOTO MIHARJO TN (66 Th) BO01 Bed 2 BOUGENVILE Kelas I Rp 2,508,387
10 99547 KARTIMIN HARJO WINOTO, TN (80 Th) BO01 Bed 4 BOUGENVILE Kelas I Rp 2,063,454
12 99552 BY NY DESI PUJI LESTARI (0 Hr) CA bed 11 CATLEYA 1 (Rawat Gabung) Rp 1,339,207
13 99603 BY NY DWI NURJAYANTI (0 Hr) CA bed 14 CATLEYA 1 (Rawat Gabung) Rp 603,989
14 99610 BY NY HILDA YULIASTUTI (0 Hr) CA bed 2 CATLEYA 1 (Rawat Gabung) Rp 606,457
15 99629 BY NY LIA HARYANTI (0 Hr) CA bed 15 CATLEYA 1 (Rawat Gabung) Rp 580,000
17 81098 SUMARDI,TN (53 Th) CE01 bed 4 CEMPAKA Kelas II Rp 2,402,899
18 99557 EVAN CHOIRULHUDA AN (4 Th) CE01 bed 7 CEMPAKA Kelas II Rp 1,386,689
19 99506 WIJI NY (64 Th) DA01 bed 2 DAHLIA Kelas III
20 72327 SRI MULYANI MULYO S, NY (58 Th) DA01 bed 3 DAHLIA Kelas III Rp 2,294,132
21 99567 UMI SHOLEHAH, NN (19 Th) DA01 bed 4 DAHLIA Kelas III Rp 9,802,730
22 99544 INAYAH DWI KURNIASTUTI, AN (12 Th) FL01 bed 4 FLAMBOYAN Kelas III Rp 1,787,745
24 84288 SRI SUNARSIH, NY (36 Th) KB01 bed 1 Kamar Bersalin Rp 700,000
25 98848 SULIKAH NY (31 Th) KB01 bed 4 Kamar Bersalin Rp 600,000
26 76260 SITI BARIYAH,NY (70 Th) KE01 Bed 1 KENANGA Kelas I Rp 3,339,963
27 99499 HILDA YULIASTUTI NY (24 Th) LI01 bed 2 LILY Kelas II Rp 7,149,607
28 95696 IKE RESITA FARADILA, NY (24 Th) LI01 bed 1 LILY Kelas II Rp 4,034,500
29 99329 BY NY ARI KURNIA (5 Hr) CA01 bed 3 PERISTI Rp 682,400
30 99548 DESI PUJI LESTARI, NY (35 Th) TR01.11 TERATAI Kelas III Rp 7,652,287
31 99561 PURWANTININGSIH, NY (37 Th) TR01.1 TERATAI Kelas III Rp 1,788,168
32 99563 DWI NURJAYANTI NY (26 Th) TR01.1 TERATAI Kelas III Rp 6,731,954
33 99558 TUMINI NY (36 Th) TR01.10 TERATAI Kelas III Rp 6,643,354
34 99627 LIA HARYANTI NY (27 Th) TR01.12 TERATAI Kelas III Rp 6,911,661
35 99573 TIWIK TANTINI NY (32 Th)
No. NO RM Nama Pasien
1 99216 SUBIYANTO TN (48 Th)
2 99543 PADMO WIYONO, TN (65 Th)
3 99551 WAHYONO, TN (59 Th)
4 99553 MIFTA FARID FATKHUROSI NUR HUDA, SDR
5 81381 SETU TN (42 Th)
6 99624 SUNARTO TN (56 Th)
7 99628 SUPADI TN (62 Th)
8 99511 PANIYEM NY (85 Th)
9 84350 SAYOTO NOTO MIHARJO TN (66 Th)
10 99547 KARTIMIN HARJO WINOTO, TN (80 Th) BO01 Bed 4 BOUGENVILE Kelas I
11 99202 BY NY HAMIDAH (0 Hr)
12 99552 BY NY DESI PUJI LESTARI (0 Hr)
13 99603 BY NY DWI NURJAYANTI (0 Hr)
14 99610 BY NY HILDA YULIASTUTI (0 Hr)
15 99629 BY NY LIA HARYANTI (0 Hr)
16 99226 SUHARTO, TN (70 Th)
17 81098 SUMARDI,TN (53 Th)
18 99557 EVAN CHOIRULHUDA AN (4 Th)
TR01.3 TERATAI Kelas III Rp 3,606,986
PASIEN BPJS PERIODE 13 November 2018
PETUGAS KETERANGAN STATUS
Kelas VISIT
VISIT LHB PASIEN
AG01 bed 6 ANGGREK Kelas III
AG01 bed 1 ANGGREK Kelas III
AG01 bed 10 ANGGREK Kelas III
AG01 bed 4 ANGGREK Kelas III
AG01 bed 2 ANGGREK Kelas III
AG01 bed 7 ANGGREK Kelas III
AG01 bed 8 ANGGREK Kelas III
AN01 bed 2 ANYELIR (R. ISOLASI) Kelas III
BO01 Bed 2 BOUGENVILE Kelas I
CA bed 10 CATLEYA 1 (Rawat Gabung)
CA bed 11 CATLEYA 1 (Rawat Gabung)
CA bed 14 CATLEYA 1 (Rawat Gabung)
CA bed 2 CATLEYA 1 (Rawat Gabung)
CA bed 15 CATLEYA 1 (Rawat Gabung)
CE01 bed 6 CEMPAKA Kelas II
CE01 bed 4 CEMPAKA Kelas II
CE01 bed 7 CEMPAKA Kelas II
19 99506 WIJI NY (64 Th) DA01 bed 2 DAHLIA Kelas III
20 72327 SRI MULYANI MULYO S, NY (58 Th) DA01 bed 3 DAHLIA Kelas III
21 99567 UMI SHOLEHAH, NN (19 Th) DA01 bed 4 DAHLIA Kelas III
22 99544 INAYAH DWI KURNIASTUTI, AN (12 Th) FL01 bed 4 FLAMBOYAN Kelas III
23 99247 DWI HARTANTI NY (33 Th) KB01 bed 1 Kamar Bersalin
24 84288 SRI SUNARSIH, NY (36 Th) KB01 bed 1 Kamar Bersalin
25 98848 SULIKAH NY (31 Th) KB01 bed 4 Kamar Bersalin
26 76260 SITI BARIYAH,NY (70 Th) KE01 Bed 1 KENANGA Kelas I
27 99499 HILDA YULIASTUTI NY (24 Th) LI01 bed 2 LILY Kelas II
28 95696 IKE RESITA FARADILA, NY (24 Th) LI01 bed 1 LILY Kelas II
29 99329 BY NY ARI KURNIA (5 Hr) CA01 bed 3 PERISTI
30 99548 DESI PUJI LESTARI, NY (35 Th) TR01.11 TERATAI Kelas III
31 99561 PURWANTININGSIH, NY (37 Th) TR01.1 TERATAI Kelas III
32 99563 DWI NURJAYANTI NY (26 Th) TR01.1 TERATAI Kelas III
33 99558 TUMINI NY (36 Th) TR01.10 TERATAI Kelas III
34 99627 LIA HARYANTI NY (27 Th) TR01.12 TERATAI Kelas III
35 99573 TIWIK TANTINI NY (32 Th) TR01.3 TERATAI Kelas III

PASIEN UMUM PERIODE 13 November 2018

PETUGAS KETERANGAN STATUS

No. NO RM Nama Pasien
1 99554 RETNO HASTUTI, NY (36 Th)
2 99564 BY NY RETNO HASTUTI (0 Hr)
3 99599 BY NY TUMINI (0 Hr)
4 68446 SAKIYEM NY (83 Th)
5 99562 SABRINA KHOIRUN NAFILA AN (2 Th)
6 99589 SAYEM, NY (79 Th)
Kelas VISIT
VISIT LHB PASIEN
BO01 Bed 5 BOUGENVILE Kelas I
CA bed 12 CATLEYA 1 (Rawat Gabung)
CA bed 13 CATLEYA 1 (Rawat Gabung)
CE01 bed 3 CEMPAKA Kelas II
CE01 bed 6 CEMPAKA Kelas II
CE01 bed 1 CEMPAKA Kelas II
 7 99625 GINEM NY (64 Th) CE01 bed 2 CEMPAKA Kelas II
8 82489 ZULIKHA MROATUN SHOLIKAH RAHAYU AN
FL01 bed 1 FLAMBOYAN Kelas III
9 99297 BY NY AYU KUSWORO PUTRI (3 Hr) CA01 bed 1 PERISTI
10 99357 BY NY SRI HANDAYANI (5 Hr) CA01 bed 4 PERISTI

PASIEN UMUM PERIODE 13 November 2018

Hari Rawat Ke-
No. NO RM Nama Pasien Kelas
I II III IV
1 99554 RETNO HASTUTI, NY (36 Th) BO01 Bed 5 BOUGENVILE Kelas I Rp 11,860,525
2 99564 BY NY RETNO HASTUTI (0 Hr) CA bed 12 CATLEYA 1 (Rawat Gabung) Rp 1,468,224
3 99599 BY NY TUMINI (0 Hr) CA bed 13 CATLEYA 1 (Rawat Gabung) Rp 803,989
4 68446 SAKIYEM NY (83 Th) CE01 bed 3 CEMPAKA Kelas II Hari Ke - 8 Rp 2,718,719
5 99562 SABRINA KHOIRUN NAFILA AN (2 Th) CE01 bed 6 CEMPAKA Kelas II Rp 2,081,000
6 99589 SAYEM, NY (79 Th) CE01 bed 1 CEMPAKA Kelas II Rp 3,374,349
7 99625 GINEM NY (64 Th) CE01 bed 2 CEMPAKA Kelas II Rp 1,576,386
8 82489 ZULIKHA MROATUN SHOLIKAH RAHAYU AN
FL01 bed 1 FLAMBOYAN Kelas III Rp 1,223,000
10 99357 BY NY SRI HANDAYANI (5 Hr) CA01 bed 4 PERISTI Rp 882,400
Ke-
IV V

Rp 4,300,830

Rp 3,528,458
KELENGKAPAN
BPJS
KELENGKAPAN
BERKAS
V
 PASIEN BPJS PERIODE 14 November 2018
Hari Rawat Ke-
No. NO RM Nama Pasien Kelas DIAGNOSIS Klaim
I II
1 99543 PADMO WIYONO, TN (65 Th) III CKD ST V, TF Rp. 3,933,800
2 99551 WAHYONO, TN (59 Th) III SNH, DM TP II Rp. 4,472,100
3 99553 MIFTA FARID FATKHUROSI NUR HUDA, SDR
III SUSP LEPTO, ISK, AKI Rp. 3,139,400
4 81381 SETU TN (42 Th) III CKD STG V, HT, HEMATURI Rp. 2,211,200
5 99624 SUNARTO TN (56 Th) III SNH, HT Rp. 3,345,100
6 99628 SUPADI TN (62 Th) III DM HIPERGLIKEMI Rp. 3,345,100
7 96675 SADIMAN KASTO SEMITO, TN (59 Th) III PPOK, DYSPEPSI, HT Rp. 2,461,400 Rp 712,500
8 99691 WIDODO, TN (58 Th) III FEBRIS Rp. 2,455,600 Rp 750,000
9 84350 SAYOTO NOTO MIHARJO TN (66 Th) I TF, ISK, VOMITUS, HT Rp. 3,662,700
10 99547 KARTIMIN HARJO WINOTO, TN (80 Th) I TF AKI Rp. 3,662,700
11 99603 BY NY DWI NURJAYANTI (0 Hr) RG BBLSC include
12 99610 BY NY HILDA YULIASTUTI (0 Hr) RG BBLSC include
13 99629 BY NY LIA HARYANTI (0 Hr) RG BBLSC include
14 81098 SUMARDI,TN (53 Th) II DM TP II, NEUROPATI, HT, CKD Rp. 6,808,300
15 99557 EVAN CHOIRULHUDA AN (4 Th) II FEBRIS DD DF, FIMOSIS Rp. 2,946,700
16 72327 SRI MULYANI MULYO S, NY (58 Th) III DM, CKD, HHD Rp. 2,466,100
17 99567 UMI SHOLEHAH, NN (19 Th) III CF. ANTEBRACHII Rp. 1,966,700
18 98047 SARMI NY (42 Th) III EDEM CEREBRI, GGN ELEKTROLIT Rp. 1,796,400
19 99552 BY NY DESI PUJI LESTARI (0 Hr) HCU NEO BBLSC HIPOGLIKEMI Rp. 2,265,400
20 99640 NANIK YULIASARI NY (22 Th) KB INDUKSI, KALSIFIKASI Rp. 1,511,600 Rp 689,000
21 76260 SITI BARIYAH,NY (70 Th) I SOL INTRACEREBRI Rp. 3,723,500
22 99499 HILDA YULIASTUTI NY (24 Th) II POST SC Rp. 5,306,800
23 99668 WIWIT NURTININGSIH, NY (31 Th) II TF Rp. 2,586,400 Rp 900,000
24 93678 GOGIK GALIH PRASOJO TN (34 Th) VIP CEDERA SPINE Rp. 3,957,100 Rp 1,683,862
25 99329 BY NY ARI KURNIA (5 Hr) III IKTERUS NEONATORUM Rp. 3.114.700
26 99649 BY NY SRI SUNARSIH (0 Hr) III BBLSC include Rp 998,750
27 99563 DWI NURJAYANTI NY (26 Th) III POST SC Rp. 4.422.400
28 99558 TUMINI NY (36 Th) III POST SC POSTDATE OLIGOHIDRMNIORp. 4.422.400
29 99627 LIA HARYANTI NY (27 Th) III POST SC KPD Rp. 4.422.400
30 84288 SRI SUNARSIH, NY (36 Th) III POST SC PP MARGINAL, DM Rp. 4.422.400 Rp 6,490,420
31 98848 SULIKAH NY (31 Th) III POST SC PRESBO, HT Rp. 4.422.400 Rp 6,421,420
32 67224 LULUK HIDAYANTI, NY (40 Th) III SPONTAN KPD Rp. 1,789,200 Rp 3,549,500
33 99697 WALIYANI NY (30 Th) III RETPLAS, KURETASE Rp. 1,489,100 Rp 780,000

PASIEN BPJS PERIODE 14 November 2018

PETUGAS KETERANGAN STATUS
No. NO RM Nama Pasien Kelas VISIT
VISIT LHB PASIEN
1 99543 PADMO WIYONO, TN (65 Th) III
2 99551 WAHYONO, TN (59 Th) III
3 99553 MIFTA FARID FATKHUROSI NUR HUDA, SDR
III
 4 81381 SETU TN (42 Th) III
5 99624 SUNARTO TN (56 Th) III
6 99628 SUPADI TN (62 Th) III
7 96675 SADIMAN KASTO SEMITO, TN (59 Th) III
8 99691 WIDODO, TN (58 Th) III
9 70419 PAIYEM NY (50 Th) III
10 84350 SAYOTO NOTO MIHARJO TN (66 Th) I
11 99547 KARTIMIN HARJO WINOTO, TN (80 Th) I
12 99202 BY NY HAMIDAH (0 Hr) RG
13 99603 BY NY DWI NURJAYANTI (0 Hr) RG
14 99610 BY NY HILDA YULIASTUTI (0 Hr) RG
15 99629 BY NY LIA HARYANTI (0 Hr) RG
16 99226 SUHARTO, TN (70 Th) II
17 81098 SUMARDI,TN (53 Th) II
18 99557 EVAN CHOIRULHUDA AN (4 Th) II
19 72327 SRI MULYANI MULYO S, NY (58 Th) III
20 99567 UMI SHOLEHAH, NN (19 Th) III
21 98047 SARMI NY (42 Th) III
22 99552 BY NY DESI PUJI LESTARI (0 Hr) HCU NEO
23 99247 DWI HARTANTI NY (33 Th) KB
24 99640 NANIK YULIASARI NY (22 Th) KB
25 76260 SITI BARIYAH,NY (70 Th) I
26 99499 HILDA YULIASTUTI NY (24 Th) II
27 71972 TUKIJEM NY (56 Th) II
28 99668 WIWIT NURTININGSIH, NY (31 Th) II
29 93678 GOGIK GALIH PRASOJO TN (34 Th) VIP
30 99329 BY NY ARI KURNIA (5 Hr) III
31 99649 BY NY SRI SUNARSIH (0 Hr) III
32 99563 DWI NURJAYANTI NY (26 Th) III
33 99558 TUMINI NY (36 Th) III
34 99627 LIA HARYANTI NY (27 Th) III
35 84288 SRI SUNARSIH, NY (36 Th) III
36 98848 SULIKAH NY (31 Th) III
37 67224 LULUK HIDAYANTI, NY (40 Th) III
38 99697 WALIYANI NY (30 Th) III
 PASIEN UMUM PERIODE 14 November 2018

PETUGAS KETERANGAN STATUS

No. NO RM Nama Pasien Kelas VISIT
VISIT LHB PASIEN
1 99554 RETNO HASTUTI, NY (36 Th) BO01 Bed 5 BOUGENVILE Kelas I
2 99564 BY NY RETNO HASTUTI (0 Hr) CA bed 12 CATLEYA 1 (Rawat Gabung)
3 99599 BY NY TUMINI (0 Hr) CA bed 13 CATLEYA 1 (Rawat Gabung)
4 99654 BY NY SULIKAH (0 Hr) CA bed 4 CATLEYA 1 (Rawat Gabung)
5 99562 SABRINA KHOIRUN NAFILA AN (2 Th) CE01 bed 6 CEMPAKA Kelas II
6 99589 SAYEM, NY (79 Th) CE01 bed 1 CEMPAKA Kelas II
7 99625 GINEM NY (64 Th) CE01 bed 2 CEMPAKA Kelas II
8 99623 FITRIA ANGGRAINI, NN (17 Th) DA01 bed 2 DAHLIA Kelas III
9 82489 ZULIKHA MROATUN SHOLIKAH RAHAYU AN
FL01 bed 1 FLAMBOYAN Kelas III
10 99690 CIPTO MULYONO, TN (66 Th) FL01 bed 2 FLAMBOYAN Kelas III
11 99667 PARTINI, NY (58 Th) IC01 bed 5 KAMAR ICU
12 99670 SUWARTI, NY (31 Th) LI01 bed 1 LILY Kelas II
13 99297 BY NY AYU KUSWORO PUTRI (3 Hr) CA01 bed 1 PERISTI
14 99357 BY NY SRI HANDAYANI (5 Hr) CA01 bed 4 PERISTI
15 99696 SRI LESTARI NY (37 Th) TR01.15 TERATAI Kelas III

PASIEN UMUM PERIODE 14 November 2018

Hari Rawat Ke-
No. NO RM Nama Pasien Kelas
I II III IV
1 99554 RETNO HASTUTI, NY (36 Th) BO01 Bed 5 BOUGENVILE Kelas I Rp 12,231,025
2 99564 BY NY RETNO HASTUTI (0 Hr) CA bed 12 CATLEYA 1 (Rawat Gabung) Rp 1,807,224
4 99654 BY NY SULIKAH (0 Hr) CA bed 4 CATLEYA 1 (Rawat Gabung) Rp 1,233,750
5 99562 SABRINA KHOIRUN NAFILA AN (2 Th) CE01 bed 6 CEMPAKA Kelas II Rp 1,870,320
6 99589 SAYEM, NY (79 Th) CE01 bed 1 CEMPAKA Kelas II Rp 3,780,849
7 99625 GINEM NY (64 Th) CE01 bed 2 CEMPAKA Kelas II Rp 1,970,061
8 99623 FITRIA ANGGRAINI, NN (17 Th) DA01 bed 2 DAHLIA Kelas III Rp 2,834,159
9 82489 ZULIKHA MROATUN SHOLIKAH RAHAYU AN
FL01 bed 1 FLAMBOYAN Kelas III Rp 1,438,000
10 99690 CIPTO MULYONO, TN (66 Th) FL01 bed 2 FLAMBOYAN Kelas III Rp 912,500
11 99667 PARTINI, NY (58 Th) IC01 bed 5 KAMAR ICU Rp 2,813,500
12 99670 SUWARTI, NY (31 Th) LI01 bed 1 LILY Kelas II Rp 1,132,500
14 99357 BY NY SRI HANDAYANI (5 Hr) CA01 bed 4 PERISTI Rp 1,239,400
15 99696 SRI LESTARI NY (37 Th) TR01.15 TERA Rp 6,860,970
Hari Rawat Ke-
III XII V
Rp 5,342,994
Rp 3,171,853

Rp 2,300,215
Rp 2,520,340 Rp 1,275,817
Rp 1,581,921
Rp 2,863,248

Rp 1,301,239
Rp 1,311,707
Rp 1,390,739
Rp 3,528,458
Rp 1,711,051
Rp 2,447,132
Rp 10,262,920
Rp 952,800

Rp 3,391,463
Rp 8,461,849

Rp 1,039,400

Rp 7,499,454
Rp 7,550,854
Rp 7,581,661
KELENGKAPAN
BPJS
KELENGKAPAN
BERKAS