Tabel 1.

Pendapatan Rawat Inap Bulan Februari 2017

NO Tanggal Nama Pasien

ADM
INFUS INJEK
1 01 Februari 2017 Carsinah.Ny 20,000 15,000 10,000
2 01 Februari 2017 Suharto.Tn 20,000 15,000 10,000
3 02 Februari 2017 Tata.Tn 20,000 15,000 10,000
4 04 Februari 2017 Iroh.Ny 20,000 15,000
5 04 Februari 2017 Rakim.Tn 20,000 15,000
6 06 Februari 2017 Radit.An 20,000 20,000
7 08 Februari 2017 Rohman.Tn 20,000 15,000 10,000
8 09 Februari 2017 Egi.Tn 20,000 15,000
9 09 Februari 2017 Siti Karsiti.Ny 20,000 15,000 10,000
10 10 Februari 2017 Juhana.Tn 20,000 15,000 20,000
11 11 Februari 2017 Iceu. Ny 20,000 15,000
12 12 Februari 2017 Emma. Ny 20,000 15,000
13 13 Februari 2017 Dartiah.Ny 20,000 30,000
14 14 Februari 2017 Sanah.Ny 20,000 15,000
15 15 Februari 2017 Dari.Ny 20,000 15,000 10,000
16 16 Februari 2017 Kusniah.Ny 20,000 15,000
17 18 Februari 2017 M Daffa .AN 20,000 25,000
18 18 Februari 2017 Ulfa Ulpian.Nn 20,000 15,000
19 18 Februari 2017 Anjun.Tn 20,000 30,000 40,000
20 20 Februari 2017 Jumiah.Ny 20,000 15,000 10,000
21 23 Februari 2017 Tioh.Ny 20,000 15,000
22 24 Februari 2017 Tita.Nn 20,000 15,000
23 26 Februari 2017 Ajimi Nursaefudin.An 20,000 20,000
24 27 Februari 2017 Neneng Uhar. Ny 20,000 15,000
25 28 Februari 2017 Nunu Nurnasih.Ny 20,000 15,000
26 28 Februari 2017 Watimah.Ny 20,000 15,000
27 28 Februari 2017 Iroh Sukirah. Ny 20,000 15,000
28 28 Februari 2017 Aan.Ny 20,000 15,000 10,000
29 02 Februari 2017 Eni.Ny 20,000 15,000 10,000
30 06 Februari 2017 Herry Gunadai. Tn 20,000 15,000 10,000
31
32
33
34
35
JUMLAH 600,000.00 500,000.00 160,000.00
JASA YANG DITERIMA

CATATAN : KALO ADA PENAMBAHAN KOLOM ATO BARIS LAPOR....!!!!

53

Tambahan Kolom : dr.Meri,dr.Eha,dr.Sigit SpPD

 3172900

ADMINISTRASI, TINDAKAN DAN PENUNJANG MEDIS DI IGD

TINDAKAN IGD
/ Hecting/ EKG Monitor Tin.Suction/Rectal TubeCuci Luka NEBU/spalk Catheter NGT/Incici

40,000 40,000

15,000

40,000 40,000

40,000 40,000

25,000

5,000

- - 40,000.00 - 120,000.00 125,000.00

r.Sigit SpPD
 =1700*2

RUANGAN
PENUNJANG MEDIS JASMED
GDS O2 Observasi EKG ADRU KAS
10,000 15,000 281,000 60,000
10,000 17,000 15,000 55,000 126,000 30,000
10,000 17,000 15,000 55,000 217,000 40,000
10,000 17,000 15,000 55,000 448,000 100,000
10,000 15,000 281,000 50,000
15,000 143,000 39,000
15,000 39,000 30,000
15,000 108,000 30,000
10,000 15,000 55,000 194,000 40,000
10,000 15,000 115,000 30,000
15,000 180,000 30,000
15,000 203,000 40,000
17,000 15,000 306,000 70,000
10,000 17,000 15,000 55,000 369,000 40,000
15,000 196,000 30,000
15,000 55,000 238,000 50,000
15,000 146,000 30,000
15,000 318,000 120,000
10,000 17,000 15,000 130,000 30,000
15,000 55,000 161,000 30,000
10,000 15,000 191,000 60,000
15,000 173,000 40,000
15,000 115,000 30,000
15,000 209,000 40,000
17,000 15,000 85,000 50,000
10,000 15,000 67,000 25,000
15,000 195,000 50,000
10,000 15,000 123,000 30,000
15,000 146,000 30,000
10,000 15,000 55,000 80,000

130,000.00 119,000.00 450,000.00 440,000.00 5,583,000.00 1,274,000.00 -

8.00
 (0.20)
(2,800.00)
RUANGAN JPRS
OBAT
RPU OK JPRS KAS OBAT TUSLAG
900,000 189,500 10,500 2,117,000 26,000
142,000 85,500 9,500 878,000 18,000
280,000 107,500 9,500 1,978,000 30,000
2,100,000 258,500 11,500 3,101,000 20,000
325,000 130,500 9,500 1,219,000 15,000
195,000 85,500 9,500 351,000 15,000
65,000 55,500 9,500 292,000 15,000
140,000 80,500 9,500 381,500
600,000 141,500 10,500 1,093,000 22,000
130,000 80,500 9,500 1,126,000 25,000
660,000 90,500 9,500 812,000
600,000 141,500 10,500 559,000 20,000
770,000 177,000 10,500 2,983,000 35,000
260,000 107,500 9,500 1,707,000 21,000
450,000 117,000 10,500 1,327,000 25,000
350,000 115,500 9,500 1,505,000 30,000
195,000 85,500 9,500 594,000 15,000
2,124,000 278,500 11,500 2,598,000 50,000
105,000 55,500 9,500 1,431,000 30,000
450,000 116,500 10,500 964,000 20,000
708,000 173,500 11,500 1,138,000 20,000
260,000 107,500 9,500 1,029,000 40,000
130,000 80,500 9,500 531,000 20,000
600,000 141,500 10,500 1,059,000 -
750,000 200,500 9,500 1,948,000 25,000
130,000 40,500 9,500 592,000
440,000 130,500 9,500 335,000 10,000
300,000 109,500 10,500 919,000 20,000
210,000 85,500 9,500 454,000 17,000
40,000 60,500 4,500 217,000

14,409,000.00 - 3,630,000.00 294,000.00 35,238,500.00 584,000.00

 584,000.00

486,200
486,200
22,800

811000
 TINDAKAN PENUNJANG MEDIS RUANGAN
Prodia
LAB GDS EKG EKG MONITOR RO

642,000 100,000.00
209,000 442,000 60,000 80,000
325,000 80,000
425,000
278,000 80,000 80,000
113,000
60,000
137,500
623,000
175,000
257,000
233,000
907,000 80,000
610,000 60,000
446,000 40,000
790,000 20,000
137,000
758,000
452,500 100,000
282,000
270,000
233,000 80,000
77,000
498,000 236,000
864,000 267,000 80,000
306,000 80,000
879,000 312,000 80,000
192,000 160,000
395,000
115,000

2,450,000.00 10,496,000.00 360,000.00 - 100,000.00 800,000.00

22,377,500.00 -
Rp12 Rp0
 Rp168,000

10,496,000.00
RUANGAN
TINDAKAN R
GIZI
USG URM O2
GIZI Konsul Gizi KAS NEBU /GV
481,500 30,000 7,500
185,000.00 173,500 20,000 4,500 120,000.00
125,000 220,000 25,000 6,000 100,000
819,500 35,000 7,500 400,000
125,000 289,500 20,000 7,500
173,500 20,000 4,500
35,000.00 47,500 20,000 1,500
120,000 20,000 3,000
125,000 321,500 30,000 4,500
116,000 20,000 3,000
225,000 20,000 6,000
320,000 30,000 6,000
125,000 500,000 30,000 10,500
232,000 20,000 6,000
282,000 30,000 4,500 200,000
324,500 20,000 7,500
173,500 20,000 4,500
768,000 35,000 9,000
43,000 25,000 1,500 110,000
281,500 30,000 4,500
385,000 35,000 3,000
232,000 20,000 6,000
116,000 20,000 3,000
320,000 30,000 6,000
399,500 30,000 7,500 650,000
77,000 20,000 3,000
65,000 269,500 25,000 7,500
545,000 188,000 30,000 3,000
173,500 20,000 4,500
61,500 1,500

1,295,000.00 35,000.00 8,134,000.00 730,000.00 154,500.00 1,580,000.00 -

1.17

Rp160,000
 dr. Emma

TINDAKAN RUANGAN
TRANSPORT dr.Elly,SpPD
Infuspum Lampusorot IGD Tanggal Visite VISIT
28.30.31.1 265,000.00
30.31.1 160,000
30 75,000
50,000
31.1.2.3.4 250,000.00

100,000.00 8 70,000
9 75,000
7,8,9 205,000

100,000.00 9,10 125,000

9,10 145,000
7.8.9.10.13 325,000
50,000 13,14 115,000
13.14.15 264,000
60,000 13,14,15.16 250,000

14.15.16.17.18 380,000
18 70,000
22,23 130,000
22,23 170,000
22.23.24 160,000

24.25.25.27 265,000
24.25.26.27.28 340,000
28 70,000
25.26.27.28 237,000
27,28 145,000
31,01,02 160,000

- - 160,000.00 200,000.00 - 4,451,000.00

160,000.00 3,560,800.00
3,560,800.00
- -
Rp160,000 Rp3,560,800
40,000.00 890,200.00
-
HD

dr. Rio.SpPD dr.Sigit.SpPD

TINDAKAN IGD Tanggal Visite VISIT

- - - - -
- - -
-
 dr.shinta,SpA
TINDAKAN IGD Tanggal Visite VISIT TINDAKAN

6 70,000

17,18 115,000

25.00 70,000

- - 31.00 255,000.00 -
- - 204,000.00 -
-
204,000.00
- 255,000.00 -
-
 dr.Irwan,SpB dr. Uun. SpP
IGD Tanggal Visite VISIT TINDAKAN IGD

9,10 115,000.00

27,28 145,000.00

- - 260,000.00 - -
- 208,000.00 - -
- 260,000.00 - -
 PEMERIKSAAN, VISIT & TIN
dr. Uun. SpP dr.Nursyamsi,SpOG
Tanggal Visite VISIT TINDAKAN IGD Tanggal Visite

25.00

- - - - 25.00
- - -
- - -
 PEMERIKSAAN, VISIT & TINDAKAN DOKTER AHLI IGD
dr.Nursyamsi,SpOG dr.Yadi SpOG
VISIT TINDAKAN IGD Tanggal Visite VISIT

75,000.00

75,000.00 - - - -
60,000.00 - - -
75,000.00 - - -
 dr. Erni. SpM
TINDAKAN IGD Tanggal Visite VISIT TINDAKAN

- - - - -
- - - -
- - - -
 dr.shanti,Sp.Rad dr.Guntur,Sp.Rad
IGD VISIT TINDAKAN IGD VISIT

- - - - -
- - - - -
- - - - -
tur,Sp.Rad dr.Awaludin,SpS
TINDAKAN IGD Tanggal Visite VISIT TINDAKAN
31.0 85,000.00

31.00 75,000.00
31.00 132,000.00

11.00 85,000.00
70,000.00

18.00 70,000.00

- - 122.00 517,000.00 -
- - 413,600.00 -
- - 517,000.00 -
 drg.Intan
dr.Abu,SpKK dr.Luhur,SpKJ
tgl Visite IGD VISIT

- - - - -
- -

tolong diingatkan ke nia. Pas drg. Intan asa ada yg dikonsulkan

- - - -
 ektrasi 34 Asisten 2NY 2 orng
TINDAKAN KRU OK
g.Intan
dr.Rezka Dian,SpAn PENATA ASS 1 ASS2
TINDAKAN

- - - - -
- - - -

as drg. Intan asa ada yg dikonsulkan -

- - - - -
 VCT

dr.Herlina dr. Meriyanah

ON LOOP
IGD tgl Visite VISIT IGD
31 30,000.00
50,000.00 31 15,000.00
50,000.00 31 20,000.00
31 60,000.00

40,000.00
7 30,000.00

11 20,000.00
11 30,000
11 30,000
40,000.00
14 36,000
14 15,000

14 45,000

21 35,000

21 20,000

40,000.00

28 35,000

- 220,000.00 - 421,000.00 -
- 132,000.00 252,600.00 -
220,000.00
132,000.00 -
- 220,000.00 421,000.00 -
-
Karyawan

400000 1,185,000.00
 =

dr. Meriyanah dr.Guruh

tgl visite VISIT IGD tgl Visite VISIT
40,000

3 54,000
3 15,000
40,000

12.0 37,000
12.0 18,000

12.0 25,000
17.00 15,000
40,000 17.00 40,000

26.0 18,000
24.0 35,000
24.0 35,000

27.0 20,000

- - 120,000.00 312,000.00
- 72,000.00 187,200.00
-
- 120,000.00 312,000.00
-

187,200.00
 PEMERIKSAAN,VISIT & TINDAKAN DOKTER UMUM IGD
dr.Nurudin
TINDAKAN IGD tgl Visite VISIT TINDAKAN

40,000

40,000
40,000

16 20,000
16 40,000
18 20,000

40,000 21 45,000
40,000

40,000

- 240,000.00 - 125,000.00 -
- 144,000.00 75,000.00 -
240,000.00 125,000.00
 vct ferus
SIT & TINDAKAN DOKTER UMUM IGD
VCT dr. Sopi
IGD tgl Visite VISIT IGD VISIT

- - - - -
- - - -
-
- -
- -
 Anaknya dr. Herlina salma

dr.Wiwi dr.Eha
IGD TGL VISITE VISIT IGD Tgl Visite
29 30,000 29
30,1
2 20,000 30,1
2 54,000 1
1
4,5 38,000

8
40,000.00 8
40,000
10 20,000 8
9,10 65,000 12
35,000 8,12
12
40,000
40,000 12,15
40,000
13 45,000 15
18 15,000
22
20
22
40,000 25 15,000 25
25 30,000 40,000
24.25 60,000
40,000
40,000 25 20,000 24
40,000
1
40,000

160,000.00 - 447,000.00 280,000.00 -

96,000.00 268,200.00 168,000.00
-
168,000.00
160,000.00 447,000.00 280,000.00
 5000 Karyawan

r.Eha dr.Armi dr.Lodry

VISIT IGD Tgl Visite VISIT IGD
30,000.00
35,000.00
45,000.00
54,000.00 40,000
15,000.00

25,000.00
30,000.00

25,000.00
37,000.00
67,000.00
18,000.00

30,000

40,000
40,000.00
30,000 40,000.00
40,000
15,000
20,000

25,000

20,000

601,000.00 - - - 120,000.00
360,600.00 - - 72,000.00
672,000.00 72,000.00
-
601,000.00 - - 120,000.00
 TOTAL
dr.Lodry dr.Yati IGD
Tgl Visite VISIT IGD Tgl Visite VISIT
27.28.30 95,000 110,000
30 15,000 192,000
30 20,000 192,000
31 54,000.00 1 54,000.00 252,000
31,1 35,000.00 100,000
5 18,000 95,000
160,000
9 20,000.00 90,000
6 35,000 30,000.00 165,000
9 20,000.00 135,000
9 20,000.00 150,000
11 30,000 9 30,000.00 90,000
11 30,000 7,9 65,000.00 122,000
11,13 35,000 252,000
13 42,000 100,000
13 15,000 145,000
100,000
90,000
252,000
23 30,000.00 155,000
40,000.00 100,000
23 15,000.00 90,000
95,000
26 30,000 90,000
26.27 67,000 132,000
27 20,000 100,000
26 25,000 90,000
27 35,000 110,000
31 25,000.00 100,000
170,000
-
-
-
-
-
- 566,000.00 - - 384,000.00 4,024,000.00
339,600.00 - 230,400.00
- - -
230,400.00
Rp339,600 Rp99,745,000
226,400.00 - 384,000.00
TOTAL
RPU GRAN TOTAL KELAS
VVIP VIP Kls.1 Kls.2 Kls.3
5,380,000 5,490,000 6
2,808,000 3,000,000 3
3,798,000 3,990,000 4
8,238,000 8,490,000 5
3,225,000 3,325,000 5
1,275,000 1,370,000 3
740,000 900,000 1
1,150,000 1,240,000 2
3,535,000 3,700,000 4
1,965,000 2,100,000 2
2,500,000 2,650,000 4
2,500,000 2,590,000 4
6,678,000 6,800,000 7
3,748,000 4,000,000 4
3,500,000 3,600,000 3
3,855,000 4,000,000 5
1,560,000 1,660,000 3
7,660,000 7,750,000 6
2,698,000 2,950,000 1
2,575,000 2,730,000 3
3,290,000 3,390,000 2
2,440,000 2,530,000 4
1,255,000 1,350,000 2
3,510,000 3,600,000 4
5,868,000 6,000,000 5
1,440,000 1,540,000 2
3,210,000 3,300,000 5
2,990,000 3,100,000 2
1,750,000 1,850,000 3
580,000 750,000 - 1
- -
- -
- -
- -
- -
95,721,000.00 99,745,000.00 7.00 6.00 38.00 9.00 45.00
14 12 76 18 90
-
99,745,000.00
Rp0
 690000
259 563
 KETERANGAN
PERAWATAN
ICU PENYAKIT DALAM ANAK Kebidanan BEDAH Syaraf JIWA
5,490,000
3,000,000
3,990,000
8,490,000
3,325,000
1,370,000
900,000
1,240,000
3,700,000
2,100,000
2,650,000
2,590,000
6,800,000
4,000,000
3,600,000
4,000,000
1,660,000
7,750,000
2,950,000
2,730,000
3,390,000
2,530,000
1,350,000
3,600,000
6,000,000
1,540,000
3,300,000
3,100,000
1,850,000
750,000

- 84,775,000.00 4,380,000.00 - 2,100,000.00 8,490,000.00 -

4,730,000.00
 2220

Unit Hemodialisa Retur obat Retur oksigen

SpP

286,800 80000
196,000
258,400

8,000
19,200
84,400

246,000
36,800

33,200
384,800 90000

156,400
59200

56000

28000
105600

- - 1,710,000.00 418,800.00
99,745,000.00
-
 Tabel 1. Pendapatan Rawat Jalan Bulan Februari 2017

NO Tanggal Keterangan PRODIA

OBAT ADM APTK

1 Wednesday, February 01, 2017 Rajal 1,389,000 8,000

2 Thursday, February 02, 2017 Rajal 2,071,000 3,000 394,000
3 Friday, February 03, 2017 Rajal 1,768,000 7,000
4 Saturday, February 04, 2017 Rajal 1,428,400 1,000
5 Sunday, February 05, 2017 Rajal 357,000
6 Monday, February 06, 2017 Rajal 1,387,000 4,000
7 Tuesday, February 07, 2017 Rajal 1,663,800 4,000
8 Wednesday, February 08, 2017 Rajal 1,491,000 8,000
9 Thursday, February 09, 2017 Rajal 570,500 3,000 980,000
10 Friday, February 10, 2017 Rajal 896,000 7,000
11 Saturday, February 11, 2017 Rajal 854,000 1,000
12 Sunday, February 12, 2017 Rajal 226,100
13 Monday, February 13, 2017 Rajal 436,500 4,000 732,000
14 Tuesday, February 14, 2017 Rajal 700,000 1,000
15 Wednesday, February 15, 2017 Rajal 855,000
16 Thursday, February 16, 2017 Rajal 918,500 7,000
17 Friday, February 17, 2017 Rajal 1,137,000 4,000
18 Saturday, February 18, 2017 Rajal
Sunday, February 19, 2017 Rajal 906,000 1,000
19 Monday, February 20, 2017 Rajal 1,941,000 7,000
20 Tuesday, February 21, 2017 Rajal 1,518,000 3,000
21 Wednesday, February 22, 2017 Rajal 1,010,500 4,000
22 Thursday, February 23, 2017 Rajal 1,469,800 3,000 864,000
23 Friday, February 24, 2017 Rajal 487,000 2,000
24 Saturday, February 25, 2017 Rajal
25 Sunday, February 26, 2017 Rajal 839,000 1,000
26 Monday, February 27, 2017 Rajal 1,326,000 3,000
27 Tuesday, February 28, 2017 Rajal 1,587,500 5,000
28
29
30
31
Jumlah 29,233,600 91,000 2,970,000
Terima Jasa 91,000.00

Tambahan Kolom Dr.Guntur

69
 -Rp45,299
TINDAKAN PENUNJANG MEDIS
EKG
LAB GDS EKG MONITOR JPRS RO' USG

365,000 80,000 185,000

335,000 10,000
275,000 10,000 55,000 320,000
315,000
360,000
395,000 20,000 55,000 320,000
285,000 180,000
50,000 160,000
645,000 10,000
595,000 20,000
10,000 80,000

535,000 10,000 55,000 80,000

760,000 80,000
335,000
250,000 240,000 245,000
60,000 20,000
335,000
285,000
60,000 20,000 240,000
921,500 20,000
875,000 10,000 80,000
60,000 320,000
335,000 55,000 80,000

80,000
85,000 160,000
395,000 20,000 160,000 250,000

8,911,500 180,000 220,000 - - 2,480,000 860,000

4 31 13

4
4
 TINDAK
Pasang
FISIOTERAPY GIZI O2 TRANSPORT NEBU Spalk/Suction/Chatete
r/NGT
35,000 335,000
35,000 25,000 75,000
175,000 25,000 296,000
70,000 557,000
125,000
140,000 25,000
175,000
35,000 50,000
70,000 306,000
35,000
35,000 400,000

105,000 105,000
70,000 855,000
70,000 190,000
35,000 1,500,000
140,000 700,000
200,000 65,000

35,000 25,000
125,000
70,000 25,000 345,000
35,000
35,000
35,000 1,400,000
95,000
70,000 25,000
70,000 25,000 50,000

1,575,000 175,000 200,000 7,574,000 - -

-
45
45 7
70,000
26 rajal
 Insisi 250000
Extrasi Kuku 170000
TINDAKAN MEDIS POLI

OBSERVASI/ADM IGD/UP CUCI LUKA/ GANTI VERBAN TINDAKAN IGD

Hecting INJEK/ Infus
BEDAH MINOR
10,000

15,000

- 15,000 10,000 -
12,000.00 -

Tindakan Amputasi (dr. Nurudin, Fera) 8/6/2016

RS
Jasa Medis
dr.Nurudin
PerawatFera

TGL 13 jan 2016

RS
Jasa Medis
dr. Nurudin
Perawat Sule
 dr. Nurudin,Ida ,Yadi

JASA TINDAKAN
JASA RS Perawat (IGD) dr.Elly,SpPD dr.shinta,SpA
PERAWAT & RADIOLOGI
400,000 100,000
100,000
700,000

200,000
200,000
350,000
200,000
400,000 100,000

200,000
100,000

600,000
200,000

600,000
200,000
300,000
200,000
200,000

200,000
450,000

- - - 5,800,000 200,000
- - 4,640,000.00 160,000.00
0
mputasi (dr. Nurudin, Fera) 8/6/2016 85
100,000 34000
400,000 136000
280,000 95200 dr. Guruh
120,000 40800 Frenki
 30,000
120,000
84,000
36,000
 Rp258,002 drg. Angsuran Leli ( ke drg.Intan s
PEMERIKSAAN MEDIS DOKTER AHLI
dr.Irwan,SpB
dr. Mahyudin.SPBdr.Nursyamsi,SpOG dr. Erni Sp M dr.Abu,SpKK
TINDAKAN POLI

100,000

- 100,000 - - - -
80,000.00 - - - -
Angsuran Leli ( ke drg.Intan sdh dibayar bln September)

dr.Herlina
dr.Luhur,SpKJ dr.Guntur Sp.Rad drg.Intan
TINDAKNA POLI Visum
120,000

35,000

70,000

80,000

35,000

35,000

80,000

- - - - 455,000 -
- - - 318,500 -
a
dr.Wiwi dr.MeriYana dr.G
KIR POLI Visum KIR POLI Visum KIR TINDAKNA

35,000

40,000

35,000

- 110,000 - - - - - -
- 77,000.00 - - - - - -
 PEMERIKSAAN MEDIS DOKTER

dr.Guruh dr. Army dr.Nurudin

POLI Visum KIR POLI Visum KIR TINDAKAN

35,000

44,000

35,000

35,000

149,000 - - - - - -
104,300.00 - - - - -
0

RS 350,000
Jasa Medis 280,000
dr. 196,000
Perawat 58,800
PEMERIKSAAN MEDIS DOKTER UMUM
dr.Eha
dr.Nurudin
POLI Visum KIR Tindakan POLI Visum KIR

35,000

70,000

35,000

35,000

44,000

40,000

70,000 - - - 189,000 - -
49,000.00 - - - 132,300.00 - -
 dr.Aji dr.loudry dr
POLI Visum KIR TINDAKAN POLI Visum KIR TINDAKAN

40,000

- - - - - - 40,000 -
- - - - - 24,000.00
0
 1065000

TOTAL
dr.Yati
POLI Visum KIR DLL
3,027,000
3,118,000
100,000 3,731,000
2,406,400
842,000
2,616,000
2,577,800
35,000 2,214,000
2,824,500 4,204,500
2,133,000 2,133,000
1,415,000 1,415,000
226,100
2,306,500 2306500
2,606,000
1,450,000
3,830,500
2,446,000
600,000
1,236,000
2,963,000
2,787,500
2,799,500
2,986,800
1,194,000 -
1,435,000
1,050,000
1,909,000 -
3,012,500
-
-
-
-
35,000 100,000 - - 61,743,100
28,000.00 56,000.00 - 5,772,100
1
 Tabel 1. Pendapatan Inap Kebidanan April 2016

ADMINISTRASI, TINDA
TINDAKAN IGD
NO Tanggal Nama Pasien
ADM
INFUS INJEK

1
2
3
4
5
6
7
JUMLAH - - -
JASA YANG DITERIMA
 ADMINISTRASI, TINDAKAN DAN PENUNJANG MEDIS DI IGD
TINDAKAN IGD PENUNJANG MEDIS
NEBU NGT/cather GDS O2 Observasi EKG

- - - - - -
 RUANGAN JPRS
JASMED
ADRU KAS RPU OK / VK JPRS

- - - - - -
 TINDAKAN PENUNJAN
JPRS
OBAT
LAB GDS EKG
KAS OBAT TUSLAG

- - - - - -

-
-
 TINDAKAN PENUNJANG MEDIS RUANGAN
GIZI
EKG MONITOR RO USG URM
GIZI Konsul Gizi

- - - - - -

20000
 TINDAKAN RUANGAN
GIZI
O2
KAS NEBU CUCI LUKA NGT B/P CHATETER B/P

- - - - - -
 dr.Elly,SpPD dr.shinta,SpA
TRANSPORT
IGD VISIT TINDAKAN IGD VISIT

- - - - - -
- - - - -
 PEMERIKSAAN, VISIT & TINDAKAN DO
hinta,SpA dr.Irwan,SpB dr.Asep,SpB
TINDAKAN IGD VISIT TINDAKAN IGD VISIT

- - - - - -
- - - - - -
ERIKSAAN, VISIT & TINDAKAN DOKTER AHLI
Asep,SpB dr.Nursyamsi,SpOG dr.Yadi SpOG
TINDAKAN IGD VISIT TINDAKAN IGD VISIT

- - - - - -
- - - - - -
60,000.00
2,112,000.00
.Yadi SpOG drg.Intan
dr.Abu,SpKK dr.Luhur,SpKJ
TINDAKAN IGD VISIT TINDAKAN

- - - - - -
- - -
 TINDAKAN KRU OK TINDAKAN
PARTUS
dr.Acep,SpAn PENATA ASS 1 ASS2 ON LOOP BIDAN
RS

- - - - - -
- - - - -
SC 200000 80000
Curet 200000
TINDAKAN PEMERIKSAAN,VISIT
PARTUS dr.Herlina dr. Eha
BIDAN IGD VISIT PARTUS IGD VISIT
BIDAN

- - - - - -
- - - -

karyawan
 PEMERIKSAAN,VISIT & TINDAKAN DOKTER UMUM IGD
dr. Eha dr. Army dr.Yati
PARTUS IGD VISIT PARTUS IGD VISIT

- - - - - -
- - - -
-
dr.Yati dr. Nurudin dr.Lodry
PARTUS IGD VISIT PARTUS IGD VISIT

- - - - - -
- - - -
 PERINATOLOGI
r.Lodry dr.Guruh
PARTUS IGD VISIT PARTUS ADM RUANGAN

- - - - - -
- - - -

187,200.00
NATOLOGI

JASMED dr. Guruh dr. Eha

RS PERI SpA dr. Guruh RS

- - - - - -
 RESUS TANPA SpA
dr. Eha dr. Yati
PERI SpA dr. Eha RS PERI SpA

- - - - - -
-
SpA
dr.lodry dr. Nurudin
dr.Yati RS PERI SpA dr.lodry RS

- - - - - -
 KELAS
GRAN TOTAL
dr. Nurudin
PERI SpA dr. Nurudin VVIP VIP Kls.1
-

-
-
-
-
- - - - - - -
-

99,745,000.00
KELAS
keterangan
Kls.2 Kls.3
3

\
3.00 - -
 PARTUS BIDAN

BIDAN 300,000
NO NAMA JENIS PARTUS
RS BIDAN SPOG
20% 36% 44%
60,000 108,000
1
2
3
4
TOTAL 0 0 0
- - -

132000
 jika VIP
RESUSITASI
S BIDAN
SPONTAN SC
750,000 TANPA SpA 150,000 TANPA SpA
DOKTER UMUM RS SpA DR.UMUM PERI RS SpA
44% 20% 30% 40% 10% 20% 30%
132,000 30,000 45,000 60,000 15,000 50,000 75,000

0 0 0 0 0 0 0
- - - - - - -
 SC
PA SpA 250,000 250,000
DR.UMUM PERI
40% 10%
100,000 25,000

0 0
- -
Tabel Pembagian Jasa Kebidanan Resus dan Tindakan Partus

NO Uraian Pembagian
I Resus Spontan RS 20%
Tindakan 80%
Dokter Umum 70%
Veri 30%

II Resus Sc (SpA tidak ada) 250,000 200,000

RS 20% 50,000
SPA dr.Shinta) 40% 80,000 80,000
Dr.Umum 50% 100,000 100,000
Veri (Kas) 10% 20,000 20,000

III Jasa Partus 250,000

RS 20% 20% 50,000
Bidan 45% (kas) 45% 90,000 200,000
dr.Umum 55% 55% 110,000

Iv Resus Spontan (SpA tidak ada) 150,000

RS 20% 30,000 120,000
SPA dr.Shinta) 40% 48,000
Dr.Umum 50% 60,000
Veri (Kas) 10% 12,000
 Ranap
No Uraian Rajal HD Total
IGD RPU
1 Obat 29,324,600 5,324,658 35,822,500 70,471,758
2 Laboratorium 11,881,500 649,000 12,946,000 25,476,500
3 GDS 180,000 - 130,000 360,000 670,000
4 EKG 220,000 440,000 - 660,000
5 EKG Monitor - 100,000 100,000
6 Rontgent 2,480,000 800,000 3,280,000
7 URM 1,575,000 35,000 1,610,000
8 Gizi 175,000 48,000 9,018,500 9,241,500
9 USG 860,000 1,295,000 2,155,000
10 Oksigen 200,000 192,000 119,000 1,580,000 2,091,000
11 IGD (tindakan) 25,000 1,395,000 - 1,420,000
12 Trasnport 7,574,000 160,000 7,734,000
13 dr.Elly Wijaya N,SpPD 5,800,000 360,000 200,000 4,451,000 10,811,000
14 dr.Shinta,SpA 200,000 - 255,000 455,000
15 dr.Irwan,SpB 100,000 260,000 360,000
16 dr.Nursyamsi,Sp.Og - 75,000 75,000
17 dr.Awaludin,Sp.S 517,000 517,000
18 dr.Herlina 455,000 220,000 421,000 1,096,000
19 dr,. Wiwi 110,000 160,000 447,000 717,000
20 dr.Yati 135,000 - 384,000 519,000
21 dr.Eha 189,000 280,000 601,000 1,070,000
22 dr.Lodry 40,000 120,000 566,000 726,000
23 dr.Guruh 149,000 110,000 120,000 312,000 691,000
24 dr.Nurudin 70,000 110,000 240,000 125,000 545,000
25 Jasa medis 1,092,250 3,722,000 4,814,250
26 Jasa non Medis 1,861,000 1,861,000
27 Ruangan 2437750 14,409,000 16,846,750
28 adm ruangan 600,000 1,274,000 1,874,000
29 JPRS - 3,924,000 3,924,000
Total 61,743,100 10,323,658 4,024,000 95,721,000 171,811,758
LAMPIRAN 1. JASA MEDIS DOKTER UMUM,DOKTER AHLI & KRU OK BULA
RAJAL RANAP
NO NAMA DOKTER JASA POLI VISUM KIR IGD
Rp 56,000 12,000
1 dr.Elly Wijaya N,SpPD 4,640,000 160,000
2 dr.Shinta,SpA 160,000 -
3 dr.Irwan,SpB 80,000 -
4 dr. Mahyudin.SpB - -
5 dr.Yadi,SpOg - -
6 dr.Nursyamsi,Sp.Og - -
7 dr. Rezka.SpAN -
8 dr,Abu,SpKK -
9 dr. Sigit .SpPD -
10 dr. Yanti,SpRAD -
11 dr.Guntur,Sp.Rad - -
12 dr.Awaludin,Sp.S - -
13 dr.Luhur,Sp.KJ -
14 drg.Intan - - -
15 dr.Herlina 318,500 - - 132,000
16 dr. Wiwi 77,000 - - 96,000
17 dr. Eha 132,300 - - 168,000
18 dr.Yati 28,000 56,000 - -
19 dr.Meri - - - -
20 dr.Guruh 104,300 - - 72,000
21 VCT Fersus - - - -
22 dr.Nurudin 49,000 - - 144,000
24 dr,Army - - - -
25 dr.Lodry - - 24,000 72,000
26 Penata
27 Asisten 1
28 Asisten 2
On Loop
Total 5,589,100 56,000 24,000 844,000
AHLI & KRU OK BULAN OKTOBER 2015
Rp (3,017,600) dr. Emma

VISIT TINDAKAN ( HD ) EKG USG RONTEGENT

RPU RKB Rp 14,000 Rp 20,000 Rp 18,000
3,560,800 360,000 - 168,000
204,000 - -
208,000 -
- -
- - -
60,000 - - 21,000
- -
-
- -
- - 1,974,000 735,000
- 357,000 1,911,000
413,600
-
- -
252,600 -
268,200 - -
360,600 -
230,400 -
- -
187,200 110,000 -
- -
75,000 110,000 -
- -
339,600 -
- -
- -
- -
- -
6,160,000 580,000 - 168,000 2,352,000 2,646,000
 486000

TOTAL

8,888,800
364,000
288,000
-
-
81,000
-
-
-
2,709,000
2,268,000
413,600
-
-
703,100
441,200
660,900
314,400
-
473,500
- Sudah Masuk ke JMT Karyawan
378,000
-
435,600
-
-
-
-
18,419,100
LAMPIRAN 1. JASA MEDIS DOKTER UMUM,DOKTER AHLI & KRU OK BULAN O
RAJAL
NO NAMA DOKTER KIR VISUM IGD VISIT
JASA POLI
Rp 12,000 56,000
1 dr.Elly Wijaya N,SpPD
2 dr.Shinta,SpA
3 dr.Irwan,SpB
4 dr.Asep,SpB
5 dr.Yadi,SpOg
6 dr.Nursyamsi,Sp.Og Rp -
7 dr.Acep,SpAn
8 dr,Abu,SpKK
9 dr.Santi,Sp.Rad
10 dr.Guntur,Sp.Rad
11 dr.Awaludin,Sp.S
12 dr.Luhur,Sp.KJ
13 drg.Intan
14 dr.Herlina
15 dr.Indah
16 dr.Taufan
17 dr.Yati
18 dr.Meri
19 dr.Ema
20 dr.Ade ria
21 dr.Resti
22 dr.Arini
23 dr.Aji
24 dr.Lodry
25 Ustori ( Penata)
26 H. Udin ( Penata)
27 Yayan ( Penata)
28 Asisten 1
29 Asisten 2
30 Dedi ( Assisten 2)
31 On Loop

Total
RU OK BULAN Oktober 2014
RANAP
TINDAKAN EKG USG RONTEGENT TOTAL
Rp 14,000 Rp 20,000 Rp 18,000

Rp 52,401,999
 TINDAKAN PENUNJANG MEDIS RUANGAN
RUANGAN
NO Tanggal Nama Pasien JASMED OBAT
LAB GDS EKG PMI RO
Snack OBAT TUSLAG
1 01 Februari 2017 Asimah.Ny Rp 128,500 Rp 290,000 6,000 653,658
2 02 Februari 2017 Suminah.Ny Rp 128,500 Rp 290,000 6,000 621,000
3 07 Februari 2017 Yulianengsih.Ny Rp 128,500 Rp 290,000 6,000 621,500
4 04 Februari 2017 Agung.Sdr Rp 192,750 Rp 407,750 6,000 621,000
5 15 Februari 2017 Pudin.Tn Rp 128,500 Rp 290,000 6,000 621,000
6 21 Februari 2017 Ini . NY Rp 128,500 Rp 290,000 6,000 621,500
7 21 Februari 2017 Ny.Darsini Rp 128,500 Rp 290,000 6,000 782,500 324,500
8 21 Februari 2017 Ny.Erah Rp 128,500 Rp 290,000 6,000 782,500 324,500
9
10
11
12

1,092,250 2,437,750 48,000 5,324,658 - 649,000 - - - -

Ny.Suminah Bayar di bln Februari

Ny.Asimah Bayar di bln Februari
 dr.Elly,SpPD dr. Nurudin] dr. Guruh GRAN TOTAL
USG Oksigen
VISIT VISIT
45,000 27500 1,150,658 -
45,000 27,500 1,118,000
45,000 27,500 1,118,500
45,000 27,500 1,300,000 -
45,000 27500 1,118,000
45,000 27500 1,118,500 -
96,000.00 45,000 27,500.00 1,700,000 -
96,000.00 45,000 27,500.00 1,700,000 -
-
- (1,150,157)
-
-

-
- 192,000 360,000 110,000 110,000 10,323,658
NO TANGGAL NAMA PASIEN KLS JENIS PELAYANAN

1 1-Feb-17 Asimah.Ny
2 3-Feb-17 Narsiti.Ny II-VIP
3 6-Feb-17 Rizky.An II-I
7-Feb-17 Ella.Ny II-I
4 8-Feb-17 Fitriyani.Ny II-VIP
5 10-Feb-17 Een Eni. Ny Debridement Bangub
6 12-Feb-17 Rohemah,Ny I-VIP
7 14-Feb-17 Encum Sumiah.Ny I-VIP
8 15-Feb-17 Eti,Ny II-I
9 17-Feb-17 Tn.Asep Setiyana II-VIP
10 17-Feb-17 Juariah.Ny I-VIP
11 17-Feb-17 Samhari.Tn II-I
12 18-Feb-17 Majaji.Tn II-VIP
13 21-Feb-17 Ny.wasih II-I
14 22-Feb-17 Tn.Oyo Waluyo I-VIP
15 24-Feb-17 Ny.Emih Damilah I-VIP
16 24-Feb-17 Ny. Eha I-VIP
17 28-Feb-17 Nenti
27-Feb-17 Tn.Nana
BIAYA PENAMBAHAN Tarif RS taRIF inacbgS TOTAL PENDAPATAN Sia Piutang

1,069,800
958,800
215,000
460,000
568,000
3,350,000
408,000
2,460,000
400,000
3,700,000
1,330,000
652,200
1,220,000
317,300
450,000
600,000
2,367,800
980,000
1,500,000

23,006,900