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LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

1 ADMEDIKA AIA
R1902100021 LAB/190210/0014 050836 ATHIFA Rawat Inap 10/02/2019 Paid 110.000
IZZATUNNISA.AN
TOTAL PEMERIKSAAN : ADMEDIKA AIA 110.000

2 ADMEDIKA ALLIANZ
R1902070006 LAB/190207/0001 046730 MICAH RONA M Rawat Jalan 07/02/2019 Paid 295.000
R1902270079 LAB/190227/0028 110000 PAKPAHAN.AN
MONA KRISTINA.NY Rawat Jalan 27/02/2019 Paid 110.000
TOTAL PEMERIKSAAN : ADMEDIKA ALLIANZ 405.000

3 ADMEDIKA BNI LIFE INSURANCE


R1902030002 LAB/190203/0003 107249 FITRIYANI.NY Rawat Inap 03/02/2019 Paid 410.000
R1902030002 LAB/190203/0011 107249 FITRIYANI.NY Rawat Inap 03/02/2019 Paid 33.000
R1902120259 LAB/190212/0041 103177 JOE SAMUEL .AN Rawat Inap 12/02/2019 Paid 465.000
R1902120259 LAB/190213/0011 103177 JOE SAMUEL .AN Rawat Inap 13/02/2019 Paid 65.000
R1902120259 LAB/190214/0003 103177 JOE SAMUEL .AN Rawat Inap 14/02/2019 Paid 65.000
R1902120259 LAB/190215/0021 103177 JOE SAMUEL .AN Rawat Inap 15/02/2019 Paid 65.000
R1902120259 LAB/190217/0006 103177 JOE SAMUEL .AN Rawat Inap 17/02/2019 Paid 65.000
R1902120093 LAB/190212/0021 045871 ANDHIKA Rawat Jalan 12/02/2019 Paid 465.000
R1902130261 LAB/190213/0069 085277 AUGUSTINDO.AN
ZEFANYA E.I. Rawat Jalan 13/02/2019 Paid 65.000
R1902160014 LAB/190216/0010 088405 PANJAITAN. AN
HEPRIA NALDI.TN Rawat Jalan 16/02/2019 Paid 109.000
R1902270160 LAB/190227/0051 110024 RETDA FELNI.NY Rawat Jalan 27/02/2019 Paid 56.000
R1902270209 LAB/190227/0060 109880 ABDUL MUFI Rawat Jalan 27/02/2019 Paid 295.000
IBRAHIM.AN
TOTAL PEMERIKSAAN : ADMEDIKA BNI LIFE INSURANCE 2.158.000

4 ADMEDIKA RELIANCE
R1902010057 LAB/190201/0025 104681 RASHKA AQILA ZAHRA Rawat Jalan 01/02/2019 Paid 70.000
R1902080094 LAB/190208/0017 106576 .AN
MUHAMMAD RIZKI Rawat Jalan 08/02/2019 Paid 65.000
R1902080194 LAB/190208/0037 108828 ARDIANYSAH
FEISAL AKBAR.AN Rawat Jalan 08/02/2019 Paid 420.000
R1902130222 LAB/190213/0052 042600 PANDAPOTAN
NANANG H .TN
ELHAMSYAH. Rawat Jalan 13/02/2019 Paid 375.000
R1902140083 LAB/190214/0019 077331 TN
ELPRIDA PURBA. NY Rawat Jalan 14/02/2019 Paid 33.000
R1902150140 LAB/190215/0038 109269 VERAWATI.NY Rawat Jalan 15/02/2019 Paid 33.000
R1902160083 LAB/190216/0017 068376 RAHMATSYAH.TN Rawat Jalan 16/02/2019 Paid 33.000
R1902220219 LAB/190222/0064 109740 GERALD B. DOVISIOZO Rawat Jalan 22/02/2019 Paid 65.000
SITUMORANG. AN
TOTAL PEMERIKSAAN : ADMEDIKA RELIANCE 1.094.000

5 ASURANSI RELIANCE
R1902030007 LAB/190203/0005 107047 SAM AH.NY Rawat Inap 03/02/2019 Paid 470.000
R1902050016 LAB/190205/0034 106066 ABIZAR ARFAN Rawat Inap 05/02/2019 Paid 98.000
R1902050016 LAB/190206/0022 106066 RAQQILLA. AN
ABIZAR ARFAN Rawat Inap 06/02/2019 Paid 33.000
R1902050016 LAB/190206/0047 106066 RAQQILLA.
ABIZAR AN
ARFAN Rawat Inap 06/02/2019 Paid 40.000
R1902060212 LAB/190206/0064 075627 RAQQILLA.
BUENO AN
ELVANDEV Rawat Inap 06/02/2019 Paid 145.000
R1902050016 LAB/190206/0067 106066 SARAGIH.AN
ABIZAR ARFAN Rawat Inap 06/02/2019 Paid 250.000
R1902050016 LAB/190207/0027 106066 RAQQILLA. AN
ABIZAR ARFAN Rawat Inap 07/02/2019 Paid 33.000
R1902050016 LAB/190207/0028 106066 RAQQILLA. AN
ABIZAR ARFAN Rawat Inap 07/02/2019 Paid 65.000
R1902060212 LAB/190208/0020 075627 RAQQILLA. AN
BUENO ELVANDEV Rawat Inap 08/02/2019 Paid 65.000
R1902050016 LAB/190209/0016 106066 SARAGIH.AN
ABIZAR ARFAN Rawat Inap 09/02/2019 Paid 33.000
R1902050016 LAB/190211/0016 106066 RAQQILLA.
ABIZAR AN
ARFAN Rawat Inap 11/02/2019 Paid 98.000
R1902120258 LAB/190213/0038 034561 RAQQILLA.
NILA SANDRAAN Rawat Inap 13/02/2019 Paid 70.000
R1902130260 LAB/190213/0074 106066 RAHAYU.NY
ABIZAR ARFAN Rawat Inap 13/02/2019 Paid 478.000
R1902130260 LAB/190215/0036 106066 RAQQILLA. AN
ABIZAR ARFAN Rawat Inap 15/02/2019 Paid 65.000
R1902130260 LAB/190217/0018 106066 RAQQILLA. AN
ABIZAR ARFAN Rawat Inap 17/02/2019 Paid 65.000
R1902180053 LAB/190218/0028 109408 RAQQILLA.
SITI AN
SYARAH.NY Rawat Inap 18/02/2019 Paid 911.000
R1902180053 LAB/190218/0085 109408 SITI SYARAH.NY Rawat Inap 18/02/2019 Paid 98.000
R1902180053 LAB/190219/0005 109408 SITI SYARAH.NY Rawat Inap 19/02/2019 Paid 65.000
R1902130260 LAB/190219/0029 106066 ABIZAR ARFAN Rawat Inap 19/02/2019 Paid 65.000
R1902260211 LAB/190226/0028 106592 RAQQILLA. AN
SUCI KURNIAWITA.NY Rawat Inap 26/02/2019 Paid 410.000
R1902280275 LAB/190228/0064 073270 JOKO JULYAN WIBOWO. Rawat Inap 28/02/2019 Paid 65.000
R1902280275 LAB/190228/0066 073270 TN JULYAN WIBOWO. Rawat
JOKO Inap 28/02/2019 Paid 40.000
TN
TOTAL PEMERIKSAAN : ASURANSI RELIANCE 3.662.000

PAGE : 1 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

6 BNI LIFE INSURANCE


R1902110117 LAB/190211/0026 061053 BIAN BENJANA Rawat Inap 11/02/2019 Paid 80.000
R1902140002 LAB/190214/0002 044258 TETTY AMRIANI S.NY Rawat Inap 14/02/2019 Paid 743.000
R1902140002 LAB/190214/0030 044258 TETTY AMRIANI S.NY Rawat Inap 14/02/2019 Paid 65.000
TOTAL PEMERIKSAAN : BNI LIFE INSURANCE 888.000

7 BPJS KESEHATAN
R1901310244 LAB/190201/0001 108317 TINA NUGROHO Rawat Inap 01/02/2019 Paid 410.000
R1901310241 LAB/190201/0002 108316 CAHYANI.
RUSDIA NY
MARBUN. BY NY Rawat Inap 01/02/2019 Paid 98.000
R1901240134 LAB/190201/0003 107551 BERYL. AN Rawat Inap 01/02/2019 Paid 40.000
R1901300040 LAB/190201/0004 107311 ANNA ROMSANA. NY Rawat Inap 01/02/2019 Paid 283.000
R1901310172 LAB/190201/0006 108299 AYAHRUL ST PAMENAN. Rawat Inap 01/02/2019 Paid 45.000
R1901300178 LAB/190201/0008 108222 TN
KARTINI RIA Rawat Inap 01/02/2019 Paid 151.000
R1901290159 LAB/190201/0009 035682 SIMATUPANG. NN
DESMARIA HUTABALIAN. Rawat Inap 01/02/2019 Paid 151.000
R1901310241 LAB/190201/0011 108316 NY
RUSDIA MARBUN. BY NY Rawat Inap 01/02/2019 Paid 33.000
R1901240134 LAB/190201/0012 107551 BERYL. AN Rawat Inap 01/02/2019 Paid 33.000
R1902010005 LAB/190201/0014 107714 SARMUDIN DARIAHMAN Rawat Inap 01/02/2019 Paid 503.000
R1901260141 LAB/190201/0015 107403 SINAGA.TN
SAUMI DARTO. NY Rawat Inap 01/02/2019 Paid 348.000
R1902010025 LAB/190201/0016 108325 LISTRA ANGELIA H.NY Rawat Inap 01/02/2019 Paid 470.000
R1901300001 LAB/190201/0018 108162 ALOYSIUS OKTARIANO Rawat Inap 01/02/2019 Paid 1.000.000
R1901300164 LAB/190201/0019 108219 L.AN
AMRAN AMIRUDIN. TN Rawat Inap 01/02/2019 Paid 700.000
R1901220007 LAB/190201/0020 107554 JUNI SARTIKA. BY. NY Rawat Inap 01/02/2019 Paid 138.000
R1901130019 LAB/190201/0021 106951 M. LUTHFI ABDULLOH. Rawat Inap 01/02/2019 Paid 764.000
R1902010076 LAB/190201/0023 108342 AN
PETRIADI.TN Rawat Inap 01/02/2019 Paid 65.000
R1901310134 LAB/190201/0024 069177 ZAHIRAH ZULAIN. AN Rawat Inap 01/02/2019 Paid 345.000
R1901130019 LAB/190201/0027 106951 M. LUTHFI ABDULLOH. Rawat Inap 01/02/2019 Paid 125.000
R1902010072 LAB/190201/0029 047691 AN
YUSMATINA.NY Rawat Inap 01/02/2019 Paid 415.000
R1901260141 LAB/190201/0031 107403 SAUMI DARTO. NY Rawat Inap 01/02/2019 Paid 33.000
R1901160168 LAB/190201/0032 058462 DIAH TRI WAHYUNI.NY Rawat Inap 01/02/2019 Paid 758.000
R1901300164 LAB/190201/0033 108219 AMRAN AMIRUDIN. TN Rawat Inap 01/02/2019 Paid 315.000
R1902010009 LAB/190201/0037 098642 YUSNI.NY Rawat Inap 01/02/2019 Paid 813.000
R1902010168 LAB/190201/0039 104400 HAZIZAH. NY Rawat Inap 01/02/2019 Paid 813.000
R1901310244 LAB/190201/0040 108317 TINA NUGROHO Rawat Inap 01/02/2019 Paid 65.000
R1902010206 LAB/190201/0041 092581 CAHYANI. NY
ROZANNA. NN Rawat Inap 01/02/2019 Paid 65.000
R1902010185 LAB/190201/0042 108388 RADEN MANURUNG .TN Rawat Inap 01/02/2019 Paid 80.000
R1902010213 LAB/190201/0043 108395 VANAYA HEREN Rawat Inap 01/02/2019 Paid 65.000
R1901280037 LAB/190201/0044 107462 MANURUNG.AN
INTAN FADHILA. AN Rawat Inap 01/02/2019 Paid 753.000
R1902010242 LAB/190201/0047 108403 MARLINA ZENNADA.AN Rawat Inap 01/02/2019 Paid 65.000
R1901130019 LAB/190201/0050 106951 M. LUTHFI ABDULLOH. Rawat Inap 01/02/2019 Paid 80.000
R1901310241 LAB/190201/0051 108316 AN
RUSDIA MARBUN. BY NY Rawat Inap 01/02/2019 Paid 350.000
R1902010253 LAB/190201/0052 078334 RICA ARDIANTI Rawat Inap 01/02/2019 Paid 454.100
R1901310022 LAB/190201/0055 107988 MANGUNSONG.NY
JULIATI. NY Rawat Inap 01/02/2019 Paid 543.000
R1901310022 LAB/190201/0056 107988 JULIATI. NY Rawat Inap 01/02/2019 Paid 60.000
R1901310022 LAB/190201/0057 107988 JULIATI. NY Rawat Inap 01/02/2019 Paid 330.000
R1902020003 LAB/190202/0001 107837 TARI M. UHDARMANIZA Rawat Inap 02/02/2019 Paid 410.000
R1901310022 LAB/190202/0002 107988 PURWANTO.
JULIATI. NY NY Rawat Inap 02/02/2019 Paid 33.000
R1901310134 LAB/190202/0003 069177 ZAHIRAH ZULAIN. AN Rawat Inap 02/02/2019 Paid 65.000
R1902020010 LAB/190202/0004 045194 EVIKA PARHUSIP.NY Rawat Inap 02/02/2019 Paid 503.000
R1902020009 LAB/190202/0005 050260 MAMIH NUR Rawat Inap 02/02/2019 Paid 503.000
R1901310022 LAB/190202/0006 107988 HOTIMAH.NY
JULIATI. NY Rawat Inap 02/02/2019 Paid 33.000
R1901300225 LAB/190202/0007 107787 LELAWATI. NY Rawat Inap 02/02/2019 Paid 33.000
R1901300178 LAB/190202/0008 108222 KARTINI RIA Rawat Inap 02/02/2019 Paid 65.000
R1901290159 LAB/190202/0009 035682 SIMATUPANG.
DESMARIA NN
HUTABALIAN. Rawat Inap 02/02/2019 Paid 65.000
R1901310238 LAB/190202/0010 108313 NY
INTAN CAHAYA Rawat Inap 02/02/2019 Paid 65.000
R1902010213 LAB/190202/0011 108395 TOGATOROP.NN
VANAYA HEREN Rawat Inap 02/02/2019 Paid 65.000
R1902020031 LAB/190202/0014 108415 MANURUNG.AN
EVIKA PARHUSIP. BY NY Rawat Inap 02/02/2019 Paid 33.000
R1901310241 LAB/190202/0016 108316 RUSDIA MARBUN. BY NY Rawat Inap 02/02/2019 Paid 350.000
R1901310022 LAB/190202/0017 107988 JULIATI. NY Rawat Inap 02/02/2019 Paid 33.000
R1902020078 LAB/190202/0019 108427 MAMIH NUR Rawat Inap 02/02/2019 Paid 33.000
R1901310241 LAB/190202/0021 108316 HOTIMAH.BY.NY
RUSDIA MARBUN. BY NY Rawat Inap 02/02/2019 Paid 33.000

PAGE : 2 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1901220007 LAB/190202/0022 107554 JUNI SARTIKA. BY. NY Rawat Inap 02/02/2019 Paid 33.000
R1902010176 LAB/190202/0023 108380 HUSNATUL AFIFAH.NY Rawat Inap 02/02/2019 Paid 410.000
R1902010180 LAB/190202/0024 103243 TAHAN BUTAR BUTAR. Rawat Inap 02/02/2019 Paid 793.000
R1902020090 LAB/190202/0026 108447 TN
JIT HUN.TN Rawat Inap 02/02/2019 Process 435.000
R1902020009 LAB/190202/0027 050260 MAMIH NUR Rawat Inap 02/02/2019 Paid 65.000
R1902020010 LAB/190202/0028 045194 HOTIMAH.NY
EVIKA PARHUSIP.NY Rawat Inap 02/02/2019 Paid 65.000
R1902010072 LAB/190202/0030 047691 YUSMATINA.NY Rawat Inap 02/02/2019 Paid 65.000
R1902010076 LAB/190202/0031 108342 PETRIADI.TN Rawat Inap 02/02/2019 Paid 65.000
R1902020035 LAB/190202/0034 097403 HAFIZHOTUN NI'MAH. Rawat Inap 02/02/2019 Paid 167.000
R1901130019 LAB/190202/0036 106951 NN
M. LUTHFI ABDULLOH. Rawat Inap 02/02/2019 Paid 428.000
R1902020141 LAB/190202/0039 108461 AN
TARI MUHDARMANIZA Rawat Inap 02/02/2019 Process 33.000
R1902020116 LAB/190202/0041 108455 P.BY.NY
TUWANTI.NY Rawat Inap 02/02/2019 Paid 563.000
R1902020133 LAB/190202/0042 095768 NISA AMIRUL . NN Rawat Inap 02/02/2019 Paid 295.000
R1902020126 LAB/190202/0043 108457 HERRI SITORUS.NY Rawat Inap 02/02/2019 Paid 286.000
R1902020173 LAB/190202/0045 108473 MASTIKA SITUMEANG.NYRawat Inap 02/02/2019 Paid 503.000
R1901310171 LAB/190202/0046 108298 ZAHRATUL HAYAH.AN Rawat Inap 02/02/2019 Paid 150.000
R1902020141 LAB/190202/0049 108461 TARI MUHDARMANIZA Rawat Inap 02/02/2019 Process 33.000
R1902010180 LAB/190202/0051 103243 P.BY.NY
TAHAN BUTAR BUTAR. Rawat Inap 02/02/2019 Paid 65.000
R1902020186 LAB/190202/0052 108478 TN
AMBROSIUS NGGADHO. Rawat Inap 02/02/2019 Paid 145.000
R1902020187 LAB/190202/0053 108479 TN
LENRIANI SILITONGA. Rawat Inap 02/02/2019 Paid 110.000
R1902010009 LAB/190202/0056 098642 AN
YUSNI.NY Rawat Inap 02/02/2019 Paid 700.000
R1902020116 LAB/190202/0057 108455 TUWANTI.NY Rawat Inap 02/02/2019 Paid 700.000
R1901130019 LAB/190203/0001 106951 M. LUTHFI ABDULLOH. Rawat Inap 03/02/2019 Paid 85.000
R1902030001 LAB/190203/0002 108484 AN
MASTIKA SITUMEANG. Rawat Inap 03/02/2019 Paid 33.000
R1902020173 LAB/190203/0006 108473 BY. NY SITUMEANG.NYRawat
MASTIKA Inap 03/02/2019 Paid 65.000
R1901300178 LAB/190203/0007 108222 KARTINI RIA Rawat Inap 03/02/2019 Paid 65.000
R1902010213 LAB/190203/0008 108395 SIMATUPANG.
VANAYA HERENNN Rawat Inap 03/02/2019 Paid 65.000
R1902020185 LAB/190203/0010 108477 MANURUNG.AN
SUNYANTO SIPAHUTAR. Rawat Inap 03/02/2019 Paid 70.000
R1902030005 LAB/190203/0012 108487 TN
VIVI HERY ANDIKA. NY Rawat Inap 03/02/2019 Paid 547.100
R1901220007 LAB/190203/0014 107554 JUNI SARTIKA. BY. NY Rawat Inap 03/02/2019 Paid 263.000
R1901310241 LAB/190203/0015 108316 RUSDIA MARBUN. BY NY Rawat Inap 03/02/2019 Paid 33.000
R1902030014 LAB/190203/0016 108491 VIVI HENRY ANDIKA Rawat Inap 03/02/2019 Paid 33.000
R1901310241 LAB/190203/0017 108316 BY.NY MARBUN. BY NY Rawat
RUSDIA Inap 03/02/2019 Paid 350.000
R1902010072 LAB/190203/0020 047691 YUSMATINA.NY Rawat Inap 03/02/2019 Paid 65.000
R1901290052 LAB/190203/0023 108101 MAHARDIKA WIDYA.AN Rawat Inap 03/02/2019 Paid 318.000
R1901240134 LAB/190203/0025 107551 BERYL. AN Rawat Inap 03/02/2019 Paid 145.000
R1902030005 LAB/190203/0026 108487 VIVI HERY ANDIKA. NY Rawat Inap 03/02/2019 Paid 65.000
R1901220007 LAB/190203/0027 107554 JUNI SARTIKA. BY. NY Rawat Inap 03/02/2019 Paid 150.000
R1902020035 LAB/190203/0029 097403 HAFIZHOTUN NI'MAH. Rawat Inap 03/02/2019 Paid 199.000
R1902040006 LAB/190204/0001 039366 NN
MESRA MARLINI.NY Rawat Inap 04/02/2019 Paid 503.000
R1902040006 LAB/190204/0002 039366 MESRA MARLINI.NY Rawat Inap 04/02/2019 Paid 40.000
R1902040007 LAB/190204/0003 108506 FATMAWATI BHOKA.NY Rawat Inap 04/02/2019 Paid 503.000
R1901300178 LAB/190204/0004 108222 KARTINI RIA Rawat Inap 04/02/2019 Paid 65.000
R1902020126 LAB/190204/0005 108457 SIMATUPANG.
HERRI NN
SITORUS.NY Rawat Inap 04/02/2019 Paid 33.000
R1902010076 LAB/190204/0006 108342 PETRIADI.TN Rawat Inap 04/02/2019 Paid 65.000
R1902010213 LAB/190204/0007 108395 VANAYA HEREN Rawat Inap 04/02/2019 Paid 65.000
R1902020185 LAB/190204/0009 108477 MANURUNG.AN
SUNYANTO SIPAHUTAR. Rawat Inap 04/02/2019 Paid 151.000
R1902020126 LAB/190204/0012 108457 TN
HERRI SITORUS.NY Rawat Inap 04/02/2019 Paid 33.000
R1902040020 LAB/190204/0013 108507 MESRA MARLINI.BY.NY Rawat Inap 04/02/2019 Paid 33.000
R1902040015 LAB/190204/0014 108509 SUCIATI.NY Rawat Inap 04/02/2019 Paid 503.000
R1902020091 LAB/190204/0015 108448 SUCIPTO.TN Rawat Inap 04/02/2019 Paid 503.000
R1902030020 LAB/190204/0016 079990 PRIYANTI MEINATI. NY Rawat Inap 04/02/2019 Paid 65.000
R1902040045 LAB/190204/0018 066586 ARINA LISA. NY Rawat Inap 04/02/2019 Paid 503.000
R1901130019 LAB/190204/0020 106951 M. LUTHFI ABDULLOH. Rawat Inap 04/02/2019 Paid 33.000
R1901310241 LAB/190204/0021 108316 AN
RUSDIA MARBUN. BY NY Rawat Inap 04/02/2019 Paid 33.000
R1901220007 LAB/190204/0022 107554 JUNI SARTIKA. BY. NY Rawat Inap 04/02/2019 Paid 33.000
R1902040098 LAB/190204/0025 108523 FATMAWATI Rawat Inap 04/02/2019 Paid 33.000
R1901290190 LAB/190204/0028 108149 BHOKA.BY.NY
RENATI SIAHAAN. NN Rawat Inap 04/02/2019 Paid 65.000
R1902040122 LAB/190204/0029 108084 YULIANTO.TN Rawat Inap 04/02/2019 Paid 503.000
R1902010076 LAB/190204/0032 108342 PETRIADI.TN Rawat Inap 04/02/2019 Paid 350.000
R1902040147 LAB/190204/0035 099286 DEVI MARCELINA. NY Rawat Inap 04/02/2019 Paid 503.000

PAGE : 3 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902010168 LAB/190204/0036 104400 HAZIZAH. NY Rawat Inap 04/02/2019 Paid 33.000


R1902040150 LAB/190204/0037 105526 NATHAN TRISTAN Rawat Inap 04/02/2019 Paid 105.000
R1902040180 LAB/190204/0038 077636 GEOFANO
JUDIKA RIANDA Rawat Inap 04/02/2019 Paid 65.000
R1902040007 LAB/190204/0040 108506 BUTAR-BUTAR.AN
ALEXANDER.AN
FATMAWATI BHOKA.NY Rawat Inap 04/02/2019 Paid 65.000
R1902020187 LAB/190204/0041 108479 LENRIANI SILITONGA. Rawat Inap 04/02/2019 Paid 250.000
R1902040150 LAB/190204/0042 105526 AN
NATHAN TRISTAN Rawat Inap 04/02/2019 Paid 75.000
R1901220007 LAB/190204/0045 107554 GEOFANO
JUNI SARTIKA. BY. NY Rawat Inap 04/02/2019 Paid 231.000
R1902030027 LAB/190204/0046 055124 BUTAR-BUTAR.AN
BAGA Rawat Inap 04/02/2019 Paid 145.000
R1902040154 LAB/190204/0047 108552 SIMANGUNSONG.TN
DARA.NY Rawat Inap 04/02/2019 Paid 264.000
R1902040231 LAB/190204/0048 108565 SUCIATI. BY NY Rawat Inap 04/02/2019 Paid 33.000
R1902040117 LAB/190204/0049 099442 MUHAMMAD AMIN. TN Rawat Inap 04/02/2019 Paid 344.000
R1902040235 LAB/190204/0050 108578 DEVI MARCELINA .BY NY Rawat Inap 04/02/2019 Paid 33.000
R1902040252 LAB/190204/0051 108584 ARINA LISA BY.NY Rawat Inap 04/02/2019 Paid 33.000
R1902040015 LAB/190204/0052 108509 SUCIATI.NY Rawat Inap 04/02/2019 Paid 65.000
R1902040117 LAB/190204/0053 099442 MUHAMMAD AMIN. TN Rawat Inap 04/02/2019 Paid 40.000
R1902040199 LAB/190204/0057 108566 SITI AISYAH. NY Rawat Inap 04/02/2019 Paid 433.000
R1902040006 LAB/190204/0062 039366 MESRA MARLINI.NY Rawat Inap 04/02/2019 Paid 65.000
R1902040045 LAB/190204/0063 066586 ARINA LISA. NY Rawat Inap 04/02/2019 Paid 65.000
R1902040147 LAB/190204/0064 099286 DEVI MARCELINA. NY Rawat Inap 04/02/2019 Paid 65.000
R1901140063 LAB/190204/0065 102213 SYILA RAMADANI.AN Rawat Inap 04/02/2019 Paid 408.000
R1902040290 LAB/190204/0068 108597 NASARUDDIN Y.TN Rawat Inap 04/02/2019 Paid 235.000
R1902040150 LAB/190205/0001 105526 NATHAN TRISTAN Rawat Inap 05/02/2019 Paid 65.000
R1901280037 LAB/190205/0002 107462 GEOFANO
INTAN FADHILA. AN Rawat Inap 05/02/2019 Paid 600.000
R1902050003 LAB/190205/0004 082877 BUTAR-BUTAR.AN
RATIH MASTAULINA Rawat Inap 05/02/2019 Paid 503.000
R1902020185 LAB/190205/0006 108477 GIRSANG.NYSIPAHUTAR. Rawat
SUNYANTO Inap 05/02/2019 Paid 65.000
R1902040290 LAB/190205/0007 108597 TN
NASARUDDIN Y.TN Rawat Inap 05/02/2019 Paid 65.000
R1902040180 LAB/190205/0008 077636 JUDIKA RIANDA Rawat Inap 05/02/2019 Paid 65.000
R1902010168 LAB/190205/0009 104400 ALEXANDER.AN
HAZIZAH. NY Rawat Inap 05/02/2019 Paid 33.000
R1902050006 LAB/190205/0011 108577 NOVI MARLINA. NY Rawat Inap 05/02/2019 Paid 503.000
R1902010206 LAB/190205/0012 092581 ROZANNA. NN Rawat Inap 05/02/2019 Paid 65.000
R1902050008 LAB/190205/0013 108601 NENY SURYATI. NY Rawat Inap 05/02/2019 Paid 65.000
R1902010168 LAB/190205/0014 104400 HAZIZAH. NY Rawat Inap 05/02/2019 Paid 33.000
R1901240134 LAB/190205/0015 107551 BERYL. AN Rawat Inap 05/02/2019 Paid 33.000
R1901220007 LAB/190205/0016 107554 JUNI SARTIKA. BY. NY Rawat Inap 05/02/2019 Paid 33.000
R1901130019 LAB/190205/0017 106951 M. LUTHFI ABDULLOH. Rawat Inap 05/02/2019 Paid 33.000
R1901310241 LAB/190205/0018 108316 AN
RUSDIA MARBUN. BY NY Rawat Inap 05/02/2019 Paid 33.000
R1902050012 LAB/190205/0019 108600 RATIH MASTAULINA Rawat Inap 05/02/2019 Paid 33.000
R1902050013 LAB/190205/0020 085585 GIRSANG. BY. NY
ERNAWATY.NY Rawat Inap 05/02/2019 Paid 65.000
R1902050010 LAB/190205/0021 105159 AFRUL NALDI. TN Rawat Inap 05/02/2019 Paid 65.000
R1902050017 LAB/190205/0023 108602 SRI NATEN. NY Rawat Inap 05/02/2019 Paid 65.000
R1902050003 LAB/190205/0025 082877 RATIH MASTAULINA Rawat Inap 05/02/2019 Paid 65.000
R1902040180 LAB/190205/0027 077636 GIRSANG.NY
JUDIKA RIANDA Rawat Inap 05/02/2019 Paid 40.000
R1902040154 LAB/190205/0031 108552 ALEXANDER.AN
DARA.NY Rawat Inap 05/02/2019 Paid 40.000
R1902050013 LAB/190205/0032 085585 ERNAWATY.NY Rawat Inap 05/02/2019 Paid 40.000
R1902040154 LAB/190205/0033 108552 DARA.NY Rawat Inap 05/02/2019 Paid 40.000
R1902010168 LAB/190205/0037 104400 HAZIZAH. NY Rawat Inap 05/02/2019 Paid 33.000
R1902050033 LAB/190205/0038 087440 JONAM ASRIL WARUHU. Rawat Inap 05/02/2019 Paid 65.000
R1902050040 LAB/190205/0039 108608 AN
TIAMINAH SIREGAR. NY Rawat Inap 05/02/2019 Paid 184.000
R1902060001 LAB/190206/0001 108610 JUNAIDAH. NY Rawat Inap 06/02/2019 Paid 470.000
R1902060001 LAB/190206/0002 108610 JUNAIDAH. NY Rawat Inap 06/02/2019 Paid 44.100
R1902060005 LAB/190206/0003 095714 GOK MAULI Rawat Inap 06/02/2019 Paid 503.000
R1902010168 LAB/190206/0004 104400 SIBURIAN.NY
HAZIZAH. NY Rawat Inap 06/02/2019 Paid 33.000
R1902050040 LAB/190206/0005 108608 TIAMINAH SIREGAR. NY Rawat Inap 06/02/2019 Paid 33.000
R1902020185 LAB/190206/0006 108477 SUNYANTO SIPAHUTAR. Rawat Inap 06/02/2019 Paid 65.000
R1902010242 LAB/190206/0007 108403 TN
MARLINA ZENNADA.AN Rawat Inap 06/02/2019 Paid 65.000
R1902040290 LAB/190206/0008 108597 NASARUDDIN Y.TN Rawat Inap 06/02/2019 Paid 151.000
R1902040180 LAB/190206/0009 077636 JUDIKA RIANDA Rawat Inap 06/02/2019 Paid 65.000
R1902010168 LAB/190206/0011 104400 ALEXANDER.AN
HAZIZAH. NY Rawat Inap 06/02/2019 Paid 65.000
R1901290052 LAB/190206/0012 108101 MAHARDIKA WIDYA.AN Rawat Inap 06/02/2019 Paid 348.000
R1902040154 LAB/190206/0013 108552 DARA.NY Rawat Inap 06/02/2019 Paid 305.000
R1902060023 LAB/190206/0014 108611 JUNAIDAH. BY NY Rawat Inap 06/02/2019 Paid 33.000

PAGE : 4 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902040059 LAB/190206/0015 108519 PERDAMEN SEMBIRING. Rawat Inap 06/02/2019 Paid 40.000
R1901190095 LAB/190206/0016 088827 TN
YUSTIANA.NY Rawat Inap 06/02/2019 Paid 33.000
R1902060048 LAB/190206/0017 108620 GOK MAULI Rawat Inap 06/02/2019 Paid 33.000
R1901190028 LAB/190206/0019 107377 SIBURIAN.BY.NY
EGA PIONINGSIH Rawat Inap 06/02/2019 Paid 158.000
R1901220007 LAB/190206/0021 107554 PASARIBU. NY BY. NY Rawat Inap
JUNI SARTIKA. 06/02/2019 Paid 33.000
R1901130019 LAB/190206/0023 106951 M. LUTHFI ABDULLOH. Rawat Inap 06/02/2019 Paid 98.000
R1902040150 LAB/190206/0024 105526 AN
NATHAN TRISTAN Rawat Inap 06/02/2019 Paid 65.000
R1902060001 LAB/190206/0028 108610 GEOFANO NY
JUNAIDAH. Rawat Inap 06/02/2019 Paid 65.000
R1902060035 LAB/190206/0029 108618 BUTAR-BUTAR.AN
AHMAD WIRA NANDA.TN Rawat Inap 06/02/2019 Paid 245.000
R1902050040 LAB/190206/0033 108608 TIAMINAH SIREGAR. NY Rawat Inap 06/02/2019 Paid 33.000
R1902060005 LAB/190206/0041 095714 GOK MAULI Rawat Inap 06/02/2019 Paid 65.000
R1803060159 LAB/190206/0043 071422 SIBURIAN.NY
ELFRIDA SIANTURI.NY Rawat Inap 06/02/2019 Paid 470.000
R1902060101 LAB/190206/0044 108648 IDRIS.TN Rawat Inap 06/02/2019 Paid 178.000
R1902040150 LAB/190206/0045 105526 NATHAN TRISTAN Rawat Inap 06/02/2019 Paid 150.000
R1902060140 LAB/190206/0046 108662 GEOFANO
PUJI NURWIJAYANTI. NY Rawat Inap 06/02/2019 Paid 110.000
R1902060161 LAB/190206/0049 108672 BUTAR-BUTAR.AN
ROSNIAR.NY Rawat Inap 06/02/2019 Paid 145.000
R1902060157 LAB/190206/0050 108669 VANNY. NN Rawat Inap 06/02/2019 Paid 145.000
R1902060139 LAB/190206/0051 094629 MARIA BULAN SINAGA. Rawat Inap 06/02/2019 Paid 105.000
R1902020061 LAB/190206/0052 103666 NY
DESMA DEWI. NY Rawat Inap 06/02/2019 Paid 138.000
R1901220007 LAB/190206/0053 107554 JUNI SARTIKA. BY. NY Rawat Inap 06/02/2019 Paid 150.000
R1902050040 LAB/190206/0055 108608 TIAMINAH SIREGAR. NY Rawat Inap 06/02/2019 Paid 33.000
R1902060193 LAB/190206/0057 108683 BAYI NYONYA ASMA Rawat Inap 06/02/2019 Process 150.000
R1902010168 LAB/190206/0063 104400 WANTI
HAZIZAH. NY Rawat Inap 06/02/2019 Paid 33.000
R1901190028 LAB/190206/0066 107377 EGA PIONINGSIH Rawat Inap 06/02/2019 Paid 65.000
R1902060217 LAB/190206/0068 108691 PASARIBU.
RIAN NY
MUTARIADI.TN Rawat Inap 06/02/2019 Paid 145.000
R1902060219 LAB/190206/0069 108692 LUSIANI MARLINA Rawat Inap 06/02/2019 Paid 547.100
R1902060221 LAB/190206/0070 108635 MATANARI.
SARTIKA NY
LENTINA Rawat Inap 06/02/2019 Paid 503.000
R1902070009 LAB/190207/0002 108696 NABABAN.NY
MURNIATI SIMAMORA. Rawat Inap 07/02/2019 Paid 503.000
R1902050040 LAB/190207/0003 108608 NY
TIAMINAH SIREGAR. NY Rawat Inap 07/02/2019 Paid 33.000
R1902010168 LAB/190207/0004 104400 HAZIZAH. NY Rawat Inap 07/02/2019 Paid 33.000
R1902040180 LAB/190207/0005 077636 JUDIKA RIANDA Rawat Inap 07/02/2019 Paid 65.000
R1902050033 LAB/190207/0006 087440 ALEXANDER.AN
JONAM ASRIL WARUHU. Rawat Inap 07/02/2019 Paid 65.000
R1901190028 LAB/190207/0008 107377 AN PIONINGSIH
EGA Rawat Inap 07/02/2019 Paid 3.300.000
R1902060089 LAB/190207/0012 094756 PASARIBU.
SABRI.TN NY Rawat Inap 07/02/2019 Paid 881.000
R1902010168 LAB/190207/0016 104400 HAZIZAH. NY Rawat Inap 07/02/2019 Paid 33.000
R1902050040 LAB/190207/0017 108608 TIAMINAH SIREGAR. NY Rawat Inap 07/02/2019 Paid 33.000
R1901190028 LAB/190207/0019 107377 EGA PIONINGSIH Rawat Inap 07/02/2019 Paid 65.000
R1902060157 LAB/190207/0020 108669 PASARIBU.
VANNY. NN NY Rawat Inap 07/02/2019 Paid 65.000
R1902070148 LAB/190207/0021 108734 MURNIATI Rawat Inap 07/02/2019 Paid 33.000
R1902060035 LAB/190207/0023 108618 SIMAMORA.BY.NY
AHMAD WIRA NANDA.TN Rawat Inap 07/02/2019 Paid 150.000
R1902010185 LAB/190207/0024 108388 RADEN MANURUNG .TN Rawat Inap 07/02/2019 Paid 80.000
R1901220007 LAB/190207/0025 107554 JUNI SARTIKA. BY. NY Rawat Inap 07/02/2019 Paid 110.000
R1902060035 LAB/190207/0026 108618 AHMAD WIRA NANDA.TN Rawat Inap 07/02/2019 Paid 800.000
R1902070009 LAB/190207/0033 108696 MURNIATI SIMAMORA. Rawat Inap 07/02/2019 Paid 65.000
R1902070193 LAB/190207/0034 108749 NY
LUSIANI MARLINA Rawat Inap 07/02/2019 Paid 33.000
R1902070172 LAB/190207/0036 108746 M.BY.NY SIMANULLANG Rawat Inap
MARKUEZ 07/02/2019 Paid 65.000
R1902050013 LAB/190207/0038 085585 .AN
ERNAWATY.NY Rawat Inap 07/02/2019 Paid 80.000
R1902060219 LAB/190207/0041 108692 LUSIANI MARLINA Rawat Inap 07/02/2019 Paid 65.000
R1902070179 LAB/190207/0042 108748 MATANARI. NY
RINDIANI.AN Rawat Inap 07/02/2019 Paid 428.000
R1902070216 LAB/190207/0044 094006 ASMIDA OKVITASARI. NYRawat Inap 07/02/2019 Paid 503.000
R1902070216 LAB/190208/0001 094006 ASMIDA OKVITASARI. NYRawat Inap 08/02/2019 Paid 600.000
R1902050040 LAB/190208/0003 108608 TIAMINAH SIREGAR. NY Rawat Inap 08/02/2019 Paid 33.000
R1902060157 LAB/190208/0004 108669 VANNY. NN Rawat Inap 08/02/2019 Paid 65.000
R1902060217 LAB/190208/0005 108691 RIAN MUTARIADI.TN Rawat Inap 08/02/2019 Paid 241.000
R1902040117 LAB/190208/0006 099442 MUHAMMAD AMIN. TN Rawat Inap 08/02/2019 Paid 85.000
R1902070178 LAB/190208/0007 108747 LUTHFI FARHANSYAH.AN Rawat Inap 08/02/2019 Paid 65.000
R1902080061 LAB/190208/0013 108784 ROLEND SINAGA.TN Rawat Inap 08/02/2019 Paid 65.000
R1902050040 LAB/190208/0019 108608 TIAMINAH SIREGAR. NY Rawat Inap 08/02/2019 Paid 33.000
R1902080123 LAB/190208/0023 108803 TOGI PRATAMA Rawat Inap 08/02/2019 Paid 33.000
R1902080141 LAB/190208/0024 108809 SAMOSIR.TN
DESI ELIZA.NY Rawat Inap 08/02/2019 Paid 503.000
R1902080181 LAB/190208/0026 108825 GILANG Rawat Inap 08/02/2019 Paid 65.000
OKTARIANSYAH.AN
PAGE : 5 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902080159 LAB/190208/0027 108816 ABU BAKAR SADIO Rawat Inap 08/02/2019 Paid 145.000
R1902080145 LAB/190208/0028 108811 RAMADAN.AN
FADHIL MIFTAHUDIN.AN Rawat Inap 08/02/2019 Paid 65.000
R1901300010 LAB/190208/0030 107663 FABIAN ALIVIA Rawat Inap 08/02/2019 Paid 753.000
R1902080150 LAB/190208/0033 108812 KINASIH.AN
FERDINAN PUTRA Rawat Inap 08/02/2019 Paid 65.000
R1902080197 LAB/190208/0039 108829 SINAGA.AN
DESI ELIZA. BY. NY Rawat Inap 08/02/2019 Paid 98.000
R1902080141 LAB/190209/0001 108809 DESI ELIZA.NY Rawat Inap 09/02/2019 Paid 65.000
R1902090002 LAB/190209/0002 108830 INDRAYATI. NY Rawat Inap 09/02/2019 Paid 503.000
R1902090004 LAB/190209/0003 108831 INDRAWATI.BY. NY Rawat Inap 09/02/2019 Process 33.000
R1902050040 LAB/190209/0004 108608 TIAMINAH SIREGAR. NY Rawat Inap 09/02/2019 Paid 33.000
R1902060217 LAB/190209/0005 108691 RIAN MUTARIADI.TN Rawat Inap 09/02/2019 Paid 65.000
R1902080159 LAB/190209/0006 108816 ABU BAKAR SADIO Rawat Inap 09/02/2019 Paid 65.000
R1902060157 LAB/190209/0007 108669 RAMADAN.AN
VANNY. NN Rawat Inap 09/02/2019 Paid 65.000
R1902080181 LAB/190209/0008 108825 GILANG Rawat Inap 09/02/2019 Paid 65.000
R1902080123 LAB/190209/0009 108803 OKTARIANSYAH.AN
TOGI PRATAMA Rawat Inap 09/02/2019 Paid 200.000
R1902070178 LAB/190209/0010 108747 SAMOSIR.TN
LUTHFI FARHANSYAH.AN Rawat Inap 09/02/2019 Paid 65.000
R1902080145 LAB/190209/0011 108811 FADHIL MIFTAHUDIN.AN Rawat Inap 09/02/2019 Paid 65.000
R1902080150 LAB/190209/0012 108812 FERDINAN PUTRA Rawat Inap 09/02/2019 Paid 65.000
R1901220007 LAB/190209/0013 107554 SINAGA.AN
JUNI SARTIKA. BY. NY Rawat Inap 09/02/2019 Paid 33.000
R1902090017 LAB/190209/0014 108834 REMNITA PAKPAHAN. NY Rawat Inap 09/02/2019 Paid 503.000
R1902090013 LAB/190209/0015 108833 DONNA YOANIBAH Rawat Inap 09/02/2019 Paid 470.000
R1901130019 LAB/190209/0017 106951 SAHPUTRI.
M. NY
LUTHFI ABDULLOH. Rawat Inap 09/02/2019 Paid 33.000
R1902060035 LAB/190209/0018 108618 AN
AHMAD WIRA NANDA.TN Rawat Inap 09/02/2019 Paid 86.000
R1902080123 LAB/190209/0019 108803 TOGI PRATAMA Rawat Inap 09/02/2019 Paid 40.000
R1902090039 LAB/190209/0021 095525 SAMOSIR.TN
SUSY LAMSIHAR M.NY Rawat Inap 09/02/2019 Paid 503.000
R1902090033 LAB/190209/0022 108837 RASMITA BR Rawat Inap 09/02/2019 Process 428.000
R1902090043 LAB/190209/0023 108838 SINULINGGA.
ZESS STEVEN NYOWEN Rawat Inap 09/02/2019 Paid 65.000
R1902050040 LAB/190209/0024 108608 SIBAGARIAN.TN
TIAMINAH SIREGAR. NY Rawat Inap 09/02/2019 Paid 33.000
R1902090095 LAB/190209/0027 108857 REMNITA Rawat Inap 09/02/2019 Paid 33.000
R1902090097 LAB/190209/0029 108858 PAKPAHAN.BY.NY
SUSY LAMSIHAR M.BY Rawat Inap 09/02/2019 Paid 33.000
R1902090086 LAB/190209/0030 108853 NY
LEDI SANDRY.NY Rawat Inap 09/02/2019 Paid 105.000
R1902090085 LAB/190209/0031 108852 AGRI WARDANA PUTRA. Rawat Inap 09/02/2019 Paid 145.000
R1902090042 LAB/190209/0032 101277 TN TARIGAN. TN
ASLI Rawat Inap 09/02/2019 Paid 143.000
R1902090017 LAB/190209/0037 108834 REMNITA PAKPAHAN. NY Rawat Inap 09/02/2019 Paid 65.000
R1902090039 LAB/190209/0038 095525 SUSY LAMSIHAR M.NY Rawat Inap 09/02/2019 Paid 65.000
R1901220007 LAB/190209/0039 107554 JUNI SARTIKA. BY. NY Rawat Inap 09/02/2019 Paid 215.000
R1901130019 LAB/190209/0041 106951 M. LUTHFI ABDULLOH. Rawat Inap 09/02/2019 Paid 731.000
R1902090128 LAB/190209/0042 108874 AN
FONEGA FRENTINA .NY Rawat Inap 09/02/2019 Paid 503.000
R1902090138 LAB/190209/0043 100867 LEON ALEXANDRO Rawat Inap 09/02/2019 Paid 65.000
R1902090144 LAB/190209/0045 108879 BUTAR-BUTAR.AN
FONEGA FRETINA.BY.NY Rawat Inap 09/02/2019 Paid 33.000
R1902100001 LAB/190210/0001 060455 OKTAVANI Rawat Inap 10/02/2019 Paid 348.000
R1902090128 LAB/190210/0002 108874 SINAMBELA.AN
FONEGA FRENTINA .NY Rawat Inap 10/02/2019 Paid 65.000
R1902080123 LAB/190210/0003 108803 TOGI PRATAMA Rawat Inap 10/02/2019 Paid 33.000
R1902100006 LAB/190210/0004 108881 SAMOSIR.TN
FATMA RESTI.NY Rawat Inap 10/02/2019 Paid 410.000
R1902060217 LAB/190210/0005 108691 RIAN MUTARIADI.TN Rawat Inap 10/02/2019 Paid 65.000
R1902090050 LAB/190210/0006 108840 ANDRIANSYAH.AN Rawat Inap 10/02/2019 Paid 65.000
R1902080181 LAB/190210/0007 108825 GILANG Rawat Inap 10/02/2019 Paid 65.000
R1902080159 LAB/190210/0008 108816 OKTARIANSYAH.AN
ABU BAKAR SADIO Rawat Inap 10/02/2019 Paid 65.000
R1902080145 LAB/190210/0009 108811 RAMADAN.AN
FADHIL MIFTAHUDIN.AN Rawat Inap 10/02/2019 Paid 65.000
R1902100009 LAB/190210/0010 108882 FATMA RESTI.BY.NY Rawat Inap 10/02/2019 Process 33.000
R1902080061 LAB/190210/0011 108784 ROLEND SINAGA.TN Rawat Inap 10/02/2019 Paid 280.000
R1902090138 LAB/190210/0012 100867 LEON ALEXANDRO Rawat Inap 10/02/2019 Paid 65.000
R1902070178 LAB/190210/0013 108747 BUTAR-BUTAR.AN
LUTHFI FARHANSYAH.AN Rawat Inap 10/02/2019 Paid 65.000
R1902100020 LAB/190210/0015 073723 POLTAK SIREGAR,TN Rawat Inap 10/02/2019 Paid 543.000
R1902090043 LAB/190210/0018 108838 ZESS STEVEN OWEN Rawat Inap 10/02/2019 Paid 65.000
R1902100028 LAB/190210/0019 108888 SIBAGARIAN.TN
NADYA ALYSSA AZAHRA. Rawat Inap 10/02/2019 Paid 516.000
R1902090026 LAB/190211/0001 072489 AN
TITIN ANDRIYANI. NY Rawat Inap 11/02/2019 Paid 384.750
R1902070178 LAB/190211/0002 108747 LUTHFI FARHANSYAH.AN Rawat Inap 11/02/2019 Paid 65.000
R1902080181 LAB/190211/0003 108825 GILANG Rawat Inap 11/02/2019 Paid 65.000
R1902100001 LAB/190211/0004 060455 OKTARIANSYAH.AN
OKTAVANI Rawat Inap 11/02/2019 Paid 355.000
R1902090050 LAB/190211/0005 108840 SINAMBELA.AN
ANDRIANSYAH.AN Rawat Inap 11/02/2019 Paid 65.000
R1902080145 LAB/190211/0006 108811 FADHIL MIFTAHUDIN.AN Rawat Inap 11/02/2019 Paid 65.000

PAGE : 6 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902080159 LAB/190211/0007 108816 ABU BAKAR SADIO Rawat Inap 11/02/2019 Paid 65.000
R1902100028 LAB/190211/0017 108888 RAMADAN.AN
NADYA ALYSSA AZAHRA. Rawat Inap 11/02/2019 Paid 33.000
R1902110052 LAB/190211/0019 108107 AN
HARTA TIANNA.NY Rawat Inap 11/02/2019 Paid 563.000
R1902110065 LAB/190211/0020 108904 MITRAWATI Rawat Inap 11/02/2019 Paid 503.000
R1902110087 LAB/190211/0021 108913 NAINGGOLAN. NY NY Rawat
AWALIAH NURSIAM. Inap 11/02/2019 Paid 410.000
R1902110128 LAB/190211/0027 106337 FEBY .NY Rawat Inap 11/02/2019 Paid 503.000
R1902110147 LAB/190211/0030 108778 YUNINIS.NY Rawat Inap 11/02/2019 Paid 410.000
R1902110112 LAB/190211/0034 085865 HERAMAWANTI.NY Rawat Inap 11/02/2019 Paid 295.000
R1902110038 LAB/190211/0039 066535 URSULA BAREK BOLI. NY Rawat Inap 11/02/2019 Paid 326.000
R1902110250 LAB/190211/0044 108960 MITRAWATI Rawat Inap 11/02/2019 Paid 33.000
R1902010206 LAB/190211/0050 092581 NAINGGOLAN.
ROZANNA. NN BY. NY Rawat Inap 11/02/2019 Paid 86.000
R1902110246 LAB/190211/0052 069306 FIRZA AINI SYAM. NN Rawat Inap 11/02/2019 Paid 165.000
R1902090026 LAB/190211/0054 072489 TITIN ANDRIYANI. NY Rawat Inap 11/02/2019 Paid 65.000
R1902110282 LAB/190211/0055 108967 FEBY. BY. NY Rawat Inap 11/02/2019 Paid 33.000
R1902010206 LAB/190211/0056 092581 ROZANNA. NN Rawat Inap 11/02/2019 Paid 65.000
R1902110253 LAB/190211/0059 067301 FICHA NADYA. AN Rawat Inap 11/02/2019 Paid 145.000
R1902110266 LAB/190211/0060 108970 ALIZA SYAFA .AN Rawat Inap 11/02/2019 Paid 145.000
R1901130019 LAB/190211/0061 106951 M. LUTHFI ABDULLOH. Rawat Inap 11/02/2019 Paid 65.000
R1902110255 LAB/190211/0062 108868 AN
YUMNA AINA Rawat Inap 11/02/2019 Paid 65.000
R1902090138 LAB/190211/0063 100867 SALSABIYLA
LEON .AN
ALEXANDRO Rawat Inap 11/02/2019 Paid 65.000
R1902110065 LAB/190211/0065 108904 BUTAR-BUTAR.AN
MITRAWATI Rawat Inap 11/02/2019 Paid 65.000
R1902110128 LAB/190211/0066 106337 NAINGGOLAN.
FEBY .NY NY Rawat Inap 11/02/2019 Paid 65.000
R1902110328 LAB/190211/0068 108982 MUCHAMMAD ICHSAN Rawat Inap 11/02/2019 Paid 295.000
R1902110353 LAB/190211/0069 108984 SACHIY .AN
TITIN ANDRIYANI. BY. Rawat Inap 11/02/2019 Paid 98.000
R1901220007 LAB/190211/0073 107554 NY SARTIKA. BY. NY Rawat
JUNI Inap 11/02/2019 Paid 65.000
R1902110355 LAB/190211/0074 098888 NURMALA DEWI.NY Rawat Inap 11/02/2019 Paid 65.000
R1902110359 LAB/190211/0075 108989 RATNA. NY Rawat Inap 11/02/2019 Paid 65.000
R1902090026 LAB/190211/0076 072489 TITIN ANDRIYANI. NY Rawat Inap 11/02/2019 Paid 65.000
R1902110322 LAB/190211/0077 089242 EMELY QEENETH Rawat Inap 11/02/2019 Paid 753.000
R1902110358 LAB/190211/0078 108988 LIMBONG.AN
YULIATI. NY Rawat Inap 11/02/2019 Paid 65.000
R1902010206 LAB/190211/0079 092581 ROZANNA. NN Rawat Inap 11/02/2019 Paid 700.000
R1902110052 LAB/190211/0080 108107 HARTA TIANNA.NY Rawat Inap 11/02/2019 Paid 700.000
R1902110409 LAB/190211/0082 103287 LESDIANA NADAPDAP Rawat Inap 11/02/2019 Paid 503.000
R1902120001 LAB/190212/0001 108992 .NY
LESDIANA NADAPDAP. Rawat Inap 12/02/2019 Paid 33.000
R1901130019 LAB/190212/0002 106951 BY NY
M. LUTHFI ABDULLOH. Rawat Inap 12/02/2019 Paid 65.000
R1902120002 LAB/190212/0003 108993 AN
DINAR. NY Rawat Inap 12/02/2019 Paid 503.000
R1902090050 LAB/190212/0004 108840 ANDRIANSYAH.AN Rawat Inap 12/02/2019 Paid 65.000
R1902110409 LAB/190212/0005 103287 LESDIANA NADAPDAP Rawat Inap 12/02/2019 Paid 65.000
R1902080145 LAB/190212/0006 108811 .NY
FADHIL MIFTAHUDIN.AN Rawat Inap 12/02/2019 Paid 65.000
R1902090043 LAB/190212/0007 108838 ZESS STEVEN OWEN Rawat Inap 12/02/2019 Paid 280.000
R1902050013 LAB/190212/0009 085585 SIBAGARIAN.TN
ERNAWATY.NY Rawat Inap 12/02/2019 Paid 80.000
R1901220007 LAB/190212/0010 107554 JUNI SARTIKA. BY. NY Rawat Inap 12/02/2019 Paid 65.000
R1902100028 LAB/190212/0011 108888 NADYA ALYSSA AZAHRA. Rawat Inap 12/02/2019 Paid 65.000
R1902120005 LAB/190212/0012 108995 AN
AFRIZAL.TN Rawat Inap 12/02/2019 Paid 65.000
R1902120004 LAB/190212/0013 097288 BEAUTY WOMEN Rawat Inap 12/02/2019 Paid 813.000
R1902120040 LAB/190212/0015 108994 SIHALOHO.
DINAR. BY NYNY Rawat Inap 12/02/2019 Paid 33.000
R1902110322 LAB/190212/0016 089242 EMELY QEENETH Rawat Inap 12/02/2019 Paid 40.000
R1902120035 LAB/190212/0019 109004 LIMBONG.AN
KUSDIANTO.TN Rawat Inap 12/02/2019 Paid 769.000
R1902120037 LAB/190212/0024 109006 NURDIN ARPAN.TN Rawat Inap 12/02/2019 Paid 80.000
R1902120002 LAB/190212/0026 108993 DINAR. NY Rawat Inap 12/02/2019 Paid 65.000
R1902110067 LAB/190212/0028 108862 WIHELMUS. TN Rawat Inap 12/02/2019 Paid 873.000
R1902100028 LAB/190212/0029 108888 NADYA ALYSSA AZAHRA. Rawat Inap 12/02/2019 Paid 653.000
R1902100028 LAB/190212/0030 108888 AN
NADYA ALYSSA AZAHRA. Rawat Inap 12/02/2019 Paid 110.000
R1901310029 LAB/190212/0031 105683 AN
SOFYAN EFENDI.TN Rawat Inap 12/02/2019 Paid 503.000
R1902120195 LAB/190212/0032 057700 SELFIA. AN Rawat Inap 12/02/2019 Paid 145.000
R1902120175 LAB/190212/0034 055732 AL MUJADILAH.NY Rawat Inap 12/02/2019 Paid 503.000
R1902100001 LAB/190212/0036 060455 OKTAVANI Rawat Inap 12/02/2019 Paid 250.000
R1902110322 LAB/190212/0037 089242 SINAMBELA.AN
EMELY QEENETH Rawat Inap 12/02/2019 Paid 65.000
R1902120257 LAB/190212/0040 101878 LIMBONG.AN
ANA NUGRAHAENY.NY Rawat Inap 12/02/2019 Paid 48.750
R1902110067 LAB/190212/0042 108862 WIHELMUS. TN Rawat Inap 12/02/2019 Paid 315.000
R1902110067 LAB/190212/0043 108862 WIHELMUS. TN Rawat Inap 12/02/2019 Paid 700.000

PAGE : 7 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902120004 LAB/190212/0044 097288 BEAUTY WOMEN Rawat Inap 12/02/2019 Paid 1.000.000
R1902110322 LAB/190212/0045 089242 SIHALOHO.
EMELY NY
QEENETH Rawat Inap 12/02/2019 Paid 1.000.000
R1902120268 LAB/190213/0002 109085 LIMBONG.AN
NAHDA ALIFAH. AN Rawat Inap 13/02/2019 Paid 145.000
R1902130002 LAB/190213/0004 109088 AL MUJADILAH.BY NY Rawat Inap 13/02/2019 Paid 98.000
R1902130006 LAB/190213/0005 109090 APRIYENI. NY Rawat Inap 13/02/2019 Paid 503.000
R1902120257 LAB/190213/0006 101878 ANA NUGRAHAENY.NY Rawat Inap 13/02/2019 Paid 65.000
R1902110253 LAB/190213/0007 067301 FICHA NADYA. AN Rawat Inap 13/02/2019 Paid 65.000
R1902090050 LAB/190213/0008 108840 ANDRIANSYAH.AN Rawat Inap 13/02/2019 Paid 65.000
R1902110266 LAB/190213/0009 108970 ALIZA SYAFA .AN Rawat Inap 13/02/2019 Paid 65.000
R1902110255 LAB/190213/0010 108868 YUMNA AINA Rawat Inap 13/02/2019 Paid 65.000
R1902110322 LAB/190213/0012 089242 SALSABIYLA .AN
EMELY QEENETH Rawat Inap 13/02/2019 Paid 65.000
R1902120005 LAB/190213/0013 108995 LIMBONG.AN
AFRIZAL.TN Rawat Inap 13/02/2019 Paid 335.000
R1902110246 LAB/190213/0014 069306 FIRZA AINI SYAM. NN Rawat Inap 13/02/2019 Paid 320.000
R1902110355 LAB/190213/0015 098888 NURMALA DEWI.NY Rawat Inap 13/02/2019 Paid 230.000
R1902110359 LAB/190213/0016 108989 RATNA. NY Rawat Inap 13/02/2019 Paid 230.000
R1902120257 LAB/190213/0017 101878 ANA NUGRAHAENY.NY Rawat Inap 13/02/2019 Paid 1.000.000
R1902130012 LAB/190213/0018 108320 RIO PURBA.TN Rawat Inap 13/02/2019 Paid 503.000
R1902130002 LAB/190213/0019 109088 AL MUJADILAH.BY NY Rawat Inap 13/02/2019 Paid 33.000
R1901190095 LAB/190213/0020 088827 YUSTIANA.NY Rawat Inap 13/02/2019 Paid 33.000
R1902120027 LAB/190213/0022 108999 DEARY FAMILYADI Rawat Inap 13/02/2019 Paid 80.000
R1902120037 LAB/190213/0024 109006 PAILA.TNARPAN.TN
NURDIN Rawat Inap 13/02/2019 Paid 80.000
R1902130021 LAB/190213/0027 108265 NURYARTA MARBUN.NN Rawat Inap 13/02/2019 Paid 563.000
R1902130073 LAB/190213/0028 109097 APRIYENI.BY.NY Rawat Inap 13/02/2019 Paid 33.000
R1902040021 LAB/190213/0029 107557 RASTAULI SIADARI. NY Rawat Inap 13/02/2019 Paid 813.000
R1902130061 LAB/190213/0030 102755 SANGGAM Rawat Inap 13/02/2019 Paid 355.000
R1902130117 LAB/190213/0035 094779 PANDAPOTAN.TN
RITA.NY Rawat Inap 13/02/2019 Paid 503.000
R1902130006 LAB/190213/0039 109090 APRIYENI. NY Rawat Inap 13/02/2019 Paid 65.000
R1902130133 LAB/190213/0041 109134 SUPIYATI.NY Rawat Inap 13/02/2019 Paid 98.000
R1901190095 LAB/190213/0043 088827 YUSTIANA.NY Rawat Inap 13/02/2019 Paid 326.000
R1901130019 LAB/190213/0053 106951 M. LUTHFI ABDULLOH. Rawat Inap 13/02/2019 Paid 348.000
R1902130234 LAB/190213/0057 101277 AN TARIGAN. TN
ASLI Rawat Inap 13/02/2019 Paid 468.000
R1902130247 LAB/190213/0062 109166 MARLINA NABABAN.NY Rawat Inap 13/02/2019 Paid 547.100
R1902130256 LAB/190213/0063 092833 SRI MARYATI.NY Rawat Inap 13/02/2019 Paid 410.000
R1902130033 LAB/190213/0064 081581 DAMEULI LUMBAN T.NY Rawat Inap 13/02/2019 Paid 425.000
R1902130250 LAB/190213/0065 099996 NICHOLAS APRILLIO. AN Rawat Inap 13/02/2019 Paid 315.000
R1902130245 LAB/190213/0066 109002 BAIK MARTUNAS Rawat Inap 13/02/2019 Paid 264.000
R1902130251 LAB/190213/0068 100071 PURBA.TN ULIA ESTER. Rawat
NATHANIA Inap 13/02/2019 Paid 315.000
R1902130234 LAB/190213/0070 101277 AN TARIGAN. TN
ASLI Rawat Inap 13/02/2019 Paid 40.000
R1902130244 LAB/190213/0071 109165 JULI LAMBANRAJA.NY Rawat Inap 13/02/2019 Paid 410.000
R1902130244 LAB/190213/0072 109165 JULI LAMBANRAJA.NY Rawat Inap 13/02/2019 Paid 15.000
R1902130033 LAB/190214/0001 081581 DAMEULI LUMBAN T.NY Rawat Inap 14/02/2019 Paid 15.000
R1902090050 LAB/190214/0004 108840 ANDRIANSYAH.AN Rawat Inap 14/02/2019 Paid 65.000
R1902110112 LAB/190214/0005 085865 HERAMAWANTI.NY Rawat Inap 14/02/2019 Paid 65.000
R1902110246 LAB/190214/0006 069306 FIRZA AINI SYAM. NN Rawat Inap 14/02/2019 Paid 250.000
R1901190095 LAB/190214/0007 088827 YUSTIANA.NY Rawat Inap 14/02/2019 Paid 33.000
R1902040021 LAB/190214/0008 107557 RASTAULI SIADARI. NY Rawat Inap 14/02/2019 Paid 415.000
R1902140009 LAB/190214/0009 108330 BROHIM FIRLI.TN Rawat Inap 14/02/2019 Paid 753.000
R1902140017 LAB/190214/0010 108368 ARIES SYAFRIZAL.TN Rawat Inap 14/02/2019 Paid 503.000
R1902140039 LAB/190214/0011 109171 MARLINA Rawat Inap 14/02/2019 Paid 33.000
R1902140045 LAB/190214/0013 100087 NABABAN.BY.NY
HARI RAHESTU.AN Rawat Inap 14/02/2019 Paid 145.000
R1902130221 LAB/190214/0014 109162 RAISYA RATU Rawat Inap 14/02/2019 Paid 145.000
R1902140059 LAB/190214/0015 029815 ANJALEE.AN PURBA,NY Rawat
REMMAWATY Inap 14/02/2019 Paid 503.000
R1902140068 LAB/190214/0016 069564 BERNIKA Rawat Inap 14/02/2019 Paid 503.000
R1902140068 LAB/190214/0017 069564 OMPUSUNGGU.NY
BERNIKA Rawat Inap 14/02/2019 Paid 44.100
R1902040126 LAB/190214/0018 107711 OMPUSUNGGU.NY
NURMI. NY Rawat Inap 14/02/2019 Paid 813.000
R1902140093 LAB/190214/0020 075001 LENA. NY Rawat Inap 14/02/2019 Paid 503.000
R1902140093 LAB/190214/0022 075001 LENA. NY Rawat Inap 14/02/2019 Paid 40.000
R1902100028 LAB/190214/0024 108888 NADYA ALYSSA AZAHRA. Rawat Inap 14/02/2019 Paid 33.000
R1902130002 LAB/190214/0025 109088 AN
AL MUJADILAH.BY NY Rawat Inap 14/02/2019 Paid 33.000
R1902010066 LAB/190214/0026 108337 NASRUN IDRIS.TN Rawat Inap 14/02/2019 Paid 503.000
R1902130247 LAB/190214/0031 109166 MARLINA NABABAN.NY Rawat Inap 14/02/2019 Paid 65.000

PAGE : 8 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902140140 LAB/190214/0032 109205 REMMAWATY Rawat Inap 14/02/2019 Paid 33.000


R1902140148 LAB/190214/0035 109210 PURBA.BY.NY
BERNIKA Rawat Inap 14/02/2019 Paid 33.000
R1902100028 LAB/190214/0036 108888 OMPUSUNGGU.BY.NY
NADYA ALYSSA AZAHRA. Rawat Inap 14/02/2019 Paid 350.000
R1902140029 LAB/190214/0039 101197 AN
SITI MAINAH.NY Rawat Inap 14/02/2019 Paid 80.000
R1902120035 LAB/190214/0044 109004 KUSDIANTO.TN Rawat Inap 14/02/2019 Paid 250.000
R1902140178 LAB/190214/0045 104773 DUMA TAMPUBOLON.NY Rawat Inap 14/02/2019 Paid 65.000
R1902140059 LAB/190214/0046 029815 REMMAWATY PURBA,NY Rawat Inap 14/02/2019 Paid 65.000
R1902140068 LAB/190214/0047 069564 BERNIKA Rawat Inap 14/02/2019 Paid 65.000
R1902140171 LAB/190214/0048 109219 OMPUSUNGGU.NY
PUAN GHALIYAH DIPA Rawat Inap 14/02/2019 Paid 65.000
R1902140207 LAB/190214/0049 069037 FAIZAH.AN
JUNITA MAHARANI.NY Rawat Inap 14/02/2019 Paid 105.000
R1902140211 LAB/190214/0050 109086 POLORIDA MARPAUNG. Rawat Inap 14/02/2019 Paid 65.000
R1901220007 LAB/190214/0051 107554 NY
JUNI SARTIKA. BY. NY Rawat Inap 14/02/2019 Paid 65.000
R1902140210 LAB/190214/0052 109188 RATI WIDYTIA Rawat Inap 14/02/2019 Paid 110.000
R1902140093 LAB/190214/0053 075001 MUNTHE.NN
LENA. NY Rawat Inap 14/02/2019 Paid 65.000
R1902140211 LAB/190214/0054 109086 POLORIDA MARPAUNG. Rawat Inap 14/02/2019 Paid 80.000
R1902130002 LAB/190214/0057 109088 NY
AL MUJADILAH.BY NY Rawat Inap 14/02/2019 Paid 98.000
R1902040126 LAB/190214/0058 107711 NURMI. NY Rawat Inap 14/02/2019 Paid 700.000
R1902140210 LAB/190214/0059 109188 RATI WIDYTIA Rawat Inap 14/02/2019 Paid 250.000
R1902130002 LAB/190214/0060 109088 MUNTHE.NN
AL MUJADILAH.BY NY Rawat Inap 14/02/2019 Paid 125.000
R1902140093 LAB/190215/0002 075001 LENA. NY Rawat Inap 15/02/2019 Paid 65.000
R1902130002 LAB/190215/0003 109088 AL MUJADILAH.BY NY Rawat Inap 15/02/2019 Paid 350.000
R1902140207 LAB/190215/0004 069037 JUNITA MAHARANI.NY Rawat Inap 15/02/2019 Paid 700.000
R1902140207 LAB/190215/0005 069037 JUNITA MAHARANI.NY Rawat Inap 15/02/2019 Paid 600.000
R1902140207 LAB/190215/0006 069037 JUNITA MAHARANI.NY Rawat Inap 15/02/2019 Paid 1.000.000
R1902130002 LAB/190215/0007 109088 AL MUJADILAH.BY NY Rawat Inap 15/02/2019 Paid 33.000
R1902150017 LAB/190215/0015 109231 ITA MANDA SARI Rawat Inap 15/02/2019 Paid 503.000
R1902140219 LAB/190215/0016 108402 SIAHAAN. NY
CLAYRINE ALISIA .AN Rawat Inap 15/02/2019 Paid 65.000
R1902110255 LAB/190215/0017 108868 YUMNA AINA Rawat Inap 15/02/2019 Paid 65.000
R1902130221 LAB/190215/0018 109162 SALSABIYLA
RAISYA RATU.AN Rawat Inap 15/02/2019 Paid 65.000
R1902040021 LAB/190215/0019 107557 ANJALEE.AN
RASTAULI SIADARI. NY Rawat Inap 15/02/2019 Paid 65.000
R1902130133 LAB/190215/0020 109134 SUPIYATI.NY Rawat Inap 15/02/2019 Paid 65.000
R1902140211 LAB/190215/0022 109086 POLORIDA MARPAUNG. Rawat Inap 15/02/2019 Paid 65.000
R1902150086 LAB/190215/0024 109250 NY
MARULITUA Rawat Inap 15/02/2019 Paid 65.000
R1902120268 LAB/190215/0025 109085 NAINGGOLAN.TN
NAHDA ALIFAH. AN Rawat Inap 15/02/2019 Paid 65.000
R1902140171 LAB/190215/0026 109219 PUAN GHALIYAH DIPA Rawat Inap 15/02/2019 Paid 65.000
R1902040059 LAB/190215/0027 108519 FAIZAH.AN
PERDAMEN SEMBIRING. Rawat Inap 15/02/2019 Paid 503.000
R1902130002 LAB/190215/0028 109088 TN MUJADILAH.BY NY
AL Rawat Inap 15/02/2019 Paid 350.000
R1902120037 LAB/190215/0031 109006 NURDIN ARPAN.TN Rawat Inap 15/02/2019 Paid 388.000
R1902120035 LAB/190215/0033 109004 KUSDIANTO.TN Rawat Inap 15/02/2019 Paid 250.000
R1902140171 LAB/190215/0034 109219 PUAN GHALIYAH DIPA Rawat Inap 15/02/2019 Paid 65.000
R1902150117 LAB/190215/0035 109259 FAIZAH.AN
JOKO SANTOSO. TN Rawat Inap 15/02/2019 Paid 415.000
R1902140207 LAB/190215/0037 069037 JUNITA MAHARANI.NY Rawat Inap 15/02/2019 Paid 65.000
R1902140033 LAB/190215/0040 108948 ROKIYAH.NY Rawat Inap 15/02/2019 Process 813.000
R1902140219 LAB/190215/0042 108402 CLAYRINE ALISIA .AN Rawat Inap 15/02/2019 Paid 80.000
R1902150157 LAB/190215/0044 109277 ANWAR. TN Rawat Inap 15/02/2019 Paid 145.000
R1902150218 LAB/190215/0052 109298 RAFA ADITYA PRATAMA Rawat Inap 15/02/2019 Paid 230.000
R1902150222 LAB/190215/0053 109299 .AN
GILBERT HAPOSAN Rawat Inap 15/02/2019 Paid 98.000
R1902150222 LAB/190215/0054 109299 SIMAMORA.AN
GILBERT HAPOSAN Rawat Inap 15/02/2019 Paid 250.000
R1902120037 LAB/190216/0002 109006 SIMAMORA.AN
NURDIN ARPAN.TN Rawat Inap 16/02/2019 Paid 65.000
R1902140171 LAB/190216/0003 109219 PUAN GHALIYAH DIPA Rawat Inap 16/02/2019 Paid 65.000
R1902140045 LAB/190216/0004 100087 FAIZAH.AN
HARI RAHESTU.AN Rawat Inap 16/02/2019 Paid 65.000
R1902150071 LAB/190216/0005 109248 YUYUN WIJAYANTI. NY Rawat Inap 16/02/2019 Paid 470.000
R1902100028 LAB/190216/0006 108888 NADYA ALYSSA AZAHRA. Rawat Inap 16/02/2019 Paid 543.000
R1902160012 LAB/190216/0007 109304 AN
NUR LAELA. NY Rawat Inap 16/02/2019 Paid 503.000
R1902160005 LAB/190216/0008 109302 NURAFNI ALIFIA.NY Rawat Inap 16/02/2019 Paid 503.000
R1902160015 LAB/190216/0009 084057 SANTI MANIK. NY Rawat Inap 16/02/2019 Paid 503.000
R1902160034 LAB/190216/0018 107474 AMIRULLAH. TN Rawat Inap 16/02/2019 Paid 408.000
R1902100028 LAB/190216/0024 108888 NADYA ALYSSA AZAHRA. Rawat Inap 16/02/2019 Paid 65.000
R1902160126 LAB/190216/0027 109346 AN
NURAFNI ALIFIA.BY NY Rawat Inap 16/02/2019 Paid 33.000
R1902160072 LAB/190216/0029 108435 ASMIATI YUSUF.NY Rawat Inap 16/02/2019 Paid 348.000
R1901130019 LAB/190216/0030 106951 M. LUTHFI ABDULLOH. Rawat Inap 16/02/2019 Paid 448.000
AN
PAGE : 9 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902160100 LAB/190216/0031 109337 EVA SUSANTI. NY Rawat Inap 16/02/2019 Paid 105.000
R1902160132 LAB/190216/0032 109354 BY NY.NUR LAELA Rawat Inap 16/02/2019 Paid 33.000
R1902160133 LAB/190216/0033 109351 SANTI MANIK. BY NY Rawat Inap 16/02/2019 Paid 33.000
R1902160005 LAB/190216/0036 109302 NURAFNI ALIFIA.NY Rawat Inap 16/02/2019 Paid 65.000
R1902160015 LAB/190216/0037 084057 SANTI MANIK. NY Rawat Inap 16/02/2019 Paid 65.000
R1902160012 LAB/190216/0038 109304 NUR LAELA. NY Rawat Inap 16/02/2019 Paid 65.000
R1902140210 LAB/190216/0039 109188 RATI WIDYTIA Rawat Inap 16/02/2019 Paid 813.000
R1902160158 LAB/190216/0040 031040 MUNTHE.NN
SUSI KRISTANTI. NY Rawat Inap 16/02/2019 Paid 503.000
R1902160095 LAB/190216/0041 109334 SUMIATI. NY Rawat Inap 16/02/2019 Paid 470.000
R1902160085 LAB/190216/0042 074031 JENNI HUTASOIT.NY Rawat Inap 16/02/2019 Paid 503.000
R1902160167 LAB/190216/0043 064567 NANIK WIDYASTUTI.NY Rawat Inap 16/02/2019 Paid 503.000
R1902120037 LAB/190216/0045 109006 NURDIN ARPAN.TN Rawat Inap 16/02/2019 Paid 65.000
R1902170001 LAB/190217/0001 109361 SUSI KRISTANTI.BY.NY Rawat Inap 17/02/2019 Paid 33.000
R1902140137 LAB/190217/0002 105526 NATHAN TRISTAN Rawat Inap 17/02/2019 Paid 65.000
R1902170005 LAB/190217/0003 109363 GEOFANO
NANIK Rawat Inap 17/02/2019 Paid 33.000
R1902170006 LAB/190217/0004 109362 BUTAR-BUTAR.AN
WIDYASTUTI.BY.NY
JENNI HUTSOIT.BY.NY Rawat Inap 17/02/2019 Paid 33.000
R1902140171 LAB/190217/0005 109219 PUAN GHALIYAH DIPA Rawat Inap 17/02/2019 Paid 65.000
R1902150196 LAB/190217/0007 109284 FAIZAH.AN
NAJYA QIRANI ARIFA. Rawat Inap 17/02/2019 Paid 65.000
R1902150086 LAB/190217/0008 109250 AN
MARULITUA Rawat Inap 17/02/2019 Paid 350.000
R1902160085 LAB/190217/0009 074031 NAINGGOLAN.TN
JENNI HUTASOIT.NY Rawat Inap 17/02/2019 Paid 65.000
R1902160167 LAB/190217/0010 064567 NANIK WIDYASTUTI.NY Rawat Inap 17/02/2019 Paid 65.000
R1902160158 LAB/190217/0011 031040 SUSI KRISTANTI. NY Rawat Inap 17/02/2019 Paid 65.000
R1902140210 LAB/190217/0013 109188 RATI WIDYTIA Rawat Inap 17/02/2019 Paid 700.000
R1902150117 LAB/190217/0014 109259 MUNTHE.NN
JOKO SANTOSO. TN Rawat Inap 17/02/2019 Paid 340.000
R1902170009 LAB/190217/0015 053202 IRMA SURYANI.NY Rawat Inap 17/02/2019 Paid 454.100
R1902110255 LAB/190217/0017 108868 YUMNA AINA Rawat Inap 17/02/2019 Paid 65.000
R1902150017 LAB/190217/0019 109231 SALSABIYLA
ITA .AN
MANDA SARI Rawat Inap 17/02/2019 Paid 65.000
R1902160088 LAB/190217/0020 086810 SIAHAAN. NY
KARTINA SARAGIH. NY Rawat Inap 17/02/2019 Paid 503.000
R1902170021 LAB/190217/0024 109367 ITA MANDA SARI Rawat Inap 17/02/2019 Process 65.000
R1902170023 LAB/190217/0025 109371 SIAHAAN,
MACHMUDBY. NYTN
ZEN. Rawat Inap 17/02/2019 Paid 65.000
R1902140137 LAB/190217/0026 105526 NATHAN TRISTAN Rawat Inap 17/02/2019 Paid 433.000
R1902170021 LAB/190217/0027 109367 GEOFANO
ITA MANDA SARI Rawat Inap 17/02/2019 Process 33.000
R1902170026 LAB/190217/0028 109373 BUTAR-BUTAR.AN
SIAHAAN,
ENI BY. NY
MUHROMI.NY Rawat Inap 17/02/2019 Paid 410.000
R1902170016 LAB/190217/0029 109365 M. AL FATIH. AN Rawat Inap 17/02/2019 Paid 65.000
R1902160088 LAB/190217/0030 086810 KARTINA SARAGIH. NY Rawat Inap 17/02/2019 Paid 65.000
R1902140137 LAB/190217/0032 105526 NATHAN TRISTAN Rawat Inap 17/02/2019 Paid 40.000
R1902170016 LAB/190217/0033 109365 GEOFANO
M. AL FATIH. AN Rawat Inap 17/02/2019 Paid 873.000
R1902170039 LAB/190217/0034 109377 BUTAR-BUTAR.AN
IRMA SURYANI. BY. NY Rawat Inap 17/02/2019 Process 33.000
R1902170040 LAB/190217/0035 109375 KARTINA SARAGIH. BY. Rawat Inap 17/02/2019 Paid 33.000
R1902170039 LAB/190217/0037 109377 NY
IRMA SURYANI. BY. NY Rawat Inap 17/02/2019 Process 65.000
R1902170054 LAB/190217/0040 109383 PIKO.TN Rawat Inap 17/02/2019 Paid 145.000
R1902170026 LAB/190217/0042 109373 ENI MUHROMI.NY Rawat Inap 17/02/2019 Paid 93.000
R1902170061 LAB/190217/0043 109386 BINTI. NY Rawat Inap 17/02/2019 Paid 503.000
R1902180005 LAB/190218/0001 109389 LISNUR J BUTAR BUTAR. Rawat Inap 18/02/2019 Paid 503.000
R1902180006 LAB/190218/0002 060786 NY
DELVIANA RIZKI. NY Rawat Inap 18/02/2019 Paid 63.750
R1902170021 LAB/190218/0003 109367 ITA MANDA SARI Rawat Inap 18/02/2019 Process 33.000
R1902180007 LAB/190218/0005 109390 SIAHAAN, BY. NY
BINTI. BY NY Rawat Inap 18/02/2019 Paid 33.000
R1902180008 LAB/190218/0006 109388 ENI MUHROMI. BY NY Rawat Inap 18/02/2019 Paid 33.000
R1902180006 LAB/190218/0007 060786 DELVIANA RIZKI. NY Rawat Inap 18/02/2019 Paid 266.250
R1902170061 LAB/190218/0009 109386 BINTI. NY Rawat Inap 18/02/2019 Paid 65.000
R1902170026 LAB/190218/0010 109373 ENI MUHROMI.NY Rawat Inap 18/02/2019 Paid 65.000
R1902130221 LAB/190218/0012 109162 RAISYA RATU Rawat Inap 18/02/2019 Paid 65.000
R1902140137 LAB/190218/0013 105526 ANJALEE.AN
NATHAN TRISTAN Rawat Inap 18/02/2019 Paid 65.000
R1902140171 LAB/190218/0014 109219 GEOFANO
PUAN GHALIYAH DIPA Rawat Inap 18/02/2019 Paid 65.000
R1902180014 LAB/190218/0018 010168 BUTAR-BUTAR.AN
FAIZAH.AN
ROMASTA GULTOM Rawat Inap 18/02/2019 Paid 65.000
R1902140034 LAB/190218/0019 109178 FAHMI SUSANA.NY Rawat Inap 18/02/2019 Paid 813.000
R1902180011 LAB/190218/0020 094903 HOTNIDA RIA Rawat Inap 18/02/2019 Paid 563.000
R1902180012 LAB/190218/0021 105862 SIDABUTAR.NN
SISWANTO PUTRA.TN Rawat Inap 18/02/2019 Paid 753.000
R1902180040 LAB/190218/0023 108671 EKA PUTRA PILIANG.TN Rawat Inap 18/02/2019 Paid 753.000
R1902180035 LAB/190218/0024 109399 LENI SAIDA Rawat Inap 18/02/2019 Paid 503.000
R1902180084 LAB/190218/0030 046927 MANURUNG.NY
MEGA HOTTARIDA.NY Rawat Inap 18/02/2019 Paid 503.000

PAGE : 10 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902180128 LAB/190218/0033 109400 BY NY.LISNUR J BUTAR Rawat Inap 18/02/2019 Paid 98.000
R1902180005 LAB/190218/0034 109389 BUTAR J BUTAR BUTAR. Rawat Inap
LISNUR 18/02/2019 Paid 65.000
R1902110093 LAB/190218/0044 066666 NY
CASMARA. TN Rawat Inap 18/02/2019 Paid 753.000
R1902170016 LAB/190218/0048 109365 M. AL FATIH. AN Rawat Inap 18/02/2019 Paid 33.000
R1902170021 LAB/190218/0049 109367 ITA MANDA SARI Rawat Inap 18/02/2019 Process 33.000
R1902180170 LAB/190218/0051 109442 SIAHAAN, BY. NYNN
PUTRI ROBI'AH. Rawat Inap 18/02/2019 Paid 65.000
R1902180184 LAB/190218/0052 013842 YULIANA Rawat Inap 18/02/2019 Paid 151.000
R1902180189 LAB/190218/0053 051296 RINDU RONI Rawat Inap 18/02/2019 Paid 151.000
R1902090135 LAB/190218/0055 101998 SIMANJUNTAK.TN
JERRY RAHMAN.TN Rawat Inap 18/02/2019 Paid 753.000
R1902180216 LAB/190218/0059 078552 MASRIDA.NY Rawat Inap 18/02/2019 Paid 65.000
R1902140033 LAB/190218/0060 108948 ROKIYAH.NY Rawat Inap 18/02/2019 Process 33.000
R1902180236 LAB/190218/0063 109460 LENI SAIDA Rawat Inap 18/02/2019 Paid 33.000
R1902180009 LAB/190218/0065 096958 MANURUNG.BY.NY
ELVI RIAMIN BATU Rawat Inap 18/02/2019 Paid 304.000
R1902180035 LAB/190218/0067 109399 BARA.SAIDA
LENI NY Rawat Inap 18/02/2019 Paid 65.000
R1902180254 LAB/190218/0070 109472 MANURUNG.NY
VINCENT JAE LUMBAN Rawat Inap 18/02/2019 Paid 145.000
R1902180247 LAB/190218/0073 109470 TORUAN. AN
LIZYANA HAFIZ. AN Rawat Inap 18/02/2019 Paid 145.000
R1902110017 LAB/190218/0076 108896 MUHAMAD FAUZAN. AN Rawat Inap 18/02/2019 Paid 753.000
R1902180278 LAB/190218/0078 086984 ARKAN SAID.AN Rawat Inap 18/02/2019 Paid 315.000
R1902180306 LAB/190218/0081 102354 NUR HASNA. NY Rawat Inap 18/02/2019 Paid 98.000
R1902180305 LAB/190218/0083 057941 BARNABA Rawat Inap 18/02/2019 Paid 98.000
R1902170021 LAB/190218/0084 109367 LANGGINUS.TN
ITA MANDA SARI Rawat Inap 18/02/2019 Process 33.000
R1902190002 LAB/190219/0001 109489 SIAHAAN,
SARIANTI BY. NY BY Rawat Inap
SIAGIAN. 19/02/2019 Paid 33.000
R1902190008 LAB/190219/0002 082006 NY
RAJESCO AFANDY.AN Rawat Inap 19/02/2019 Paid 145.000
R1902190013 LAB/190219/0003 095474 DENI MUSTIKA. NY Rawat Inap 19/02/2019 Paid 503.000
R1902130221 LAB/190219/0006 109162 RAISYA RATU Rawat Inap 19/02/2019 Paid 65.000
R1902140171 LAB/190219/0008 109219 ANJALEE.AN
PUAN GHALIYAH DIPA Rawat Inap 19/02/2019 Paid 65.000
R1902170016 LAB/190219/0010 109365 FAIZAH.AN
M. AL FATIH. AN Rawat Inap 19/02/2019 Paid 33.000
R1902170021 LAB/190219/0011 109367 ITA MANDA SARI Rawat Inap 19/02/2019 Process 33.000
R1901140063 LAB/190219/0015 102213 SIAHAAN, BY. NY
SYILA RAMADANI.AN Rawat Inap 19/02/2019 Paid 158.000
R1902180306 LAB/190219/0021 102354 NUR HASNA. NY Rawat Inap 19/02/2019 Paid 113.000
R1902110255 LAB/190219/0022 108868 YUMNA AINA Rawat Inap 19/02/2019 Paid 65.000
R1902110027 LAB/190219/0025 108898 SALSABIYLA
ELVINA .AN BINTI Rawat Inap
SYAHARA 19/02/2019 Process 813.000
R1902180009 LAB/190219/0026 096958 ZARNEFIRIZON.
ELVI RIAMIN BATUNN Rawat Inap 19/02/2019 Paid 283.000
R1902190016 LAB/190219/0028 094428 BARA.
NAKMANNYPULUNGAN.TN Rawat Inap 19/02/2019 Process 753.000
R1902190093 LAB/190219/0032 106906 HENI NONI. NY Rawat Inap 19/02/2019 Paid 503.000
R1902190013 LAB/190219/0035 095474 DENI MUSTIKA. NY Rawat Inap 19/02/2019 Paid 65.000
R1902190168 LAB/190219/0037 109495 DENI MUSTIKA.BY.NY Rawat Inap 19/02/2019 Paid 33.000
R1902190105 LAB/190219/0040 109519 LEGAYANTI SITORUS.NY Rawat Inap 19/02/2019 Paid 410.000
R1902190197 LAB/190219/0052 109549 HEN NONI.BY.NY Rawat Inap 19/02/2019 Process 33.000
R1902190177 LAB/190219/0054 109542 EVA NOVITA NATALIA Rawat Inap 19/02/2019 Paid 105.000
R1902140137 LAB/190219/0055 105526 SIMANJUNTAK.NY
NATHAN TRISTAN Rawat Inap 19/02/2019 Paid 150.000
R1901130019 LAB/190219/0056 106951 GEOFANO
M. LUTHFI ABDULLOH. Rawat Inap 19/02/2019 Paid 415.000
R1902190181 LAB/190219/0057 109546 BUTAR-BUTAR.AN
AN
MARIANI.NY Rawat Inap 19/02/2019 Paid 264.000
R1902190217 LAB/190219/0060 090269 YOHANES BEDA. TN Rawat Inap 19/02/2019 Paid 793.000
R1902190218 LAB/190219/0061 099925 ADEEVA UFAIRAH Rawat Inap 19/02/2019 Paid 65.000
R1902190207 LAB/190219/0062 109556 LUBIS.AN
AQILA PUTRI KAMILA AN Rawat Inap 19/02/2019 Paid 65.000
R1902190249 LAB/190219/0063 109563 MAIZAR GINDO Rawat Inap 19/02/2019 Paid 105.000
R1902190249 LAB/190219/0064 109563 TANAMEH TN
MAIZAR GINDO Rawat Inap 19/02/2019 Paid 40.000
R1902190264 LAB/190219/0065 092255 TANAMEH
RIKO FRENTNKI. AN Rawat Inap 19/02/2019 Paid 65.000
R1902110017 LAB/190219/0066 108896 MUHAMAD FAUZAN. AN Rawat Inap 19/02/2019 Paid 600.000
R1902110093 LAB/190219/0067 066666 CASMARA. TN Rawat Inap 19/02/2019 Paid 600.000
R1902190271 LAB/190219/0068 097626 KHANZA NAZNEEN Rawat Inap 19/02/2019 Paid 65.000
R1902190272 LAB/190219/0069 109567 HP.AN
SUTARMAN. TN Rawat Inap 19/02/2019 Paid 65.000
R1901130019 LAB/190219/0070 106951 M. LUTHFI ABDULLOH. Rawat Inap 19/02/2019 Paid 65.000
R1902170021 LAB/190219/0072 109367 AN MANDA SARI
ITA Rawat Inap 19/02/2019 Process 33.000
R1902190272 LAB/190219/0073 109567 SIAHAAN, BY.TNNY
SUTARMAN. Rawat Inap 19/02/2019 Paid 199.000
R1902200004 LAB/190220/0003 109572 SHYFA AMELIA PUTRI. Rawat Inap 20/02/2019 Paid 65.000
R1902170023 LAB/190220/0004 109371 AN
MACHMUD ZEN. TN Rawat Inap 20/02/2019 Paid 230.000
R1902130221 LAB/190220/0005 109162 RAISYA RATU Rawat Inap 20/02/2019 Paid 65.000
R1902200004 LAB/190220/0007 109572 ANJALEE.AN
SHYFA AMELIA PUTRI. Rawat Inap 20/02/2019 Paid 80.000
R1902190272 LAB/190220/0008 109567 AN
SUTARMAN. TN Rawat Inap 20/02/2019 Paid 128.000

PAGE : 11 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902190181 LAB/190220/0009 109546 MARIANI.NY Rawat Inap 20/02/2019 Paid 283.000


R1902200005 LAB/190220/0010 047677 SUSI LINDIA WATI.NY Rawat Inap 20/02/2019 Paid 543.000
R1902200001 LAB/190220/0012 109571 NUR HAPIPAH. AN Rawat Inap 20/02/2019 Paid 383.000
R1902140137 LAB/190220/0013 105526 NATHAN TRISTAN Rawat Inap 20/02/2019 Paid 65.000
R1902190008 LAB/190220/0014 082006 GEOFANO
RAJESCO AFANDY.AN Rawat Inap 20/02/2019 Paid 65.000
R1902200009 LAB/190220/0015 108697 BUTAR-BUTAR.AN
JEFRI.TN Rawat Inap 20/02/2019 Paid 753.000
R1902200016 LAB/190220/0017 088192 RITA YULFIANTI.NY Rawat Inap 20/02/2019 Paid 813.000
R1902040026 LAB/190220/0018 107556 LUSINI. NY Rawat Inap 20/02/2019 Paid 813.000
R1902200013 LAB/190220/0020 109573 JANUARI SAMOSIR.TN Rawat Inap 20/02/2019 Paid 415.000
R1902190249 LAB/190220/0023 109563 MAIZAR GINDO Rawat Inap 20/02/2019 Paid 65.000
R1902170021 LAB/190220/0024 109367 TANAMEH
ITA MANDATNSARI Rawat Inap 20/02/2019 Process 33.000
R1902200001 LAB/190220/0025 109571 SIAHAAN, BY. NY
NUR HAPIPAH. AN Rawat Inap 20/02/2019 Paid 33.000
R1902190234 LAB/190220/0027 098071 ABDURROHMAN IBNU Rawat Inap 20/02/2019 Paid 65.000
R1902200084 LAB/190220/0030 109587 Y.AN
ROHIMAH PULUNGAN.NY Rawat Inap 20/02/2019 Paid 470.000
R1902200062 LAB/190220/0031 107201 MUHAMMAD RIFKI AL Rawat Inap 20/02/2019 Paid 65.000
R1902200090 LAB/190220/0033 109588 HABSY.AN
AHMAD ARFAN.AN Rawat Inap 20/02/2019 Paid 65.000
R1902130035 LAB/190220/0034 108421 AZHAR BIN HARUN. TN Rawat Inap 20/02/2019 Paid 753.000
R1902060075 LAB/190220/0035 009737 LELA HAPPY Rawat Inap 20/02/2019 Paid 65.000
R1902190218 LAB/190220/0038 099925 ADEEVA UFAIRAH Rawat Inap 20/02/2019 Paid 86.000
R1902120027 LAB/190220/0039 108999 LUBIS.AN
DEARY FAMILYADI Rawat Inap 20/02/2019 Paid 80.000
R1902200123 LAB/190220/0040 109596 PAILA.TN
SUSI LINDIA WATI. Rawat Inap 20/02/2019 Paid 33.000
R1902200001 LAB/190220/0041 109571 BY.NY
NUR HAPIPAH. AN Rawat Inap 20/02/2019 Paid 350.000
R1902200141 LAB/190220/0042 095052 NOYA NOVIANTI. NY Rawat Inap 20/02/2019 Paid 503.000
R1902200005 LAB/190220/0047 047677 SUSI LINDIA WATI.NY Rawat Inap 20/02/2019 Paid 65.000
R1902200009 LAB/190220/0048 108697 JEFRI.TN Rawat Inap 20/02/2019 Paid 600.000
R1902040026 LAB/190220/0049 107556 LUSINI. NY Rawat Inap 20/02/2019 Paid 700.000
R1902200188 LAB/190220/0051 109616 ANISA SRI REJEKI.AN Rawat Inap 20/02/2019 Paid 65.000
R1902200195 LAB/190220/0052 109615 HUMAIRA NAZIYA A.AN Rawat Inap 20/02/2019 Paid 33.000
R1902200158 LAB/190220/0056 109609 SUKARTI.TN Rawat Inap 20/02/2019 Paid 433.000
R1902190234 LAB/190220/0060 098071 ABDURROHMAN IBNU Rawat Inap 20/02/2019 Paid 80.000
R1902200206 LAB/190220/0061 081854 Y.AN
RENATA VALENCIA Rawat Inap 20/02/2019 Paid 65.000
R1902200141 LAB/190220/0062 095052 SIAHAAN.
NOYA AN
NOVIANTI. NY Rawat Inap 20/02/2019 Paid 65.000
R1902190249 LAB/190221/0003 109563 MAIZAR GINDO Rawat Inap 21/02/2019 Paid 753.000
R1902110255 LAB/190221/0006 108868 TANAMEH
YUMNA AINATN Rawat Inap 21/02/2019 Paid 65.000
R1902190218 LAB/190221/0007 099925 SALSABIYLA .AN
ADEEVA UFAIRAH Rawat Inap 21/02/2019 Paid 65.000
R1902200004 LAB/190221/0008 109572 LUBIS.AN
SHYFA AMELIA PUTRI. Rawat Inap 21/02/2019 Paid 545.000
R1902210011 LAB/190221/0010 108936 AN
TESSA ANGGI PUTRI.NY Rawat Inap 21/02/2019 Paid 813.000
R1902210032 LAB/190221/0016 108649 VERA SUSANTI Rawat Inap 21/02/2019 Paid 813.000
R1902130035 LAB/190221/0017 108421 SIREGAR.NN
AZHAR BIN HARUN. TN Rawat Inap 21/02/2019 Paid 105.000
R1901130019 LAB/190221/0018 106951 M. LUTHFI ABDULLOH. Rawat Inap 21/02/2019 Paid 283.000
R1902200001 LAB/190221/0019 109571 AN
NUR HAPIPAH. AN Rawat Inap 21/02/2019 Paid 33.000
R1902170021 LAB/190221/0020 109367 ITA MANDA SARI Rawat Inap 21/02/2019 Process 33.000
R1902150075 LAB/190221/0025 108957 SIAHAAN, BY. NY
ZULMAENAH.NY Rawat Inap 21/02/2019 Paid 813.000
R1902210168 LAB/190221/0029 109646 BUNGA.NY Rawat Inap 21/02/2019 Paid 503.000
R1902210168 LAB/190221/0031 109646 BUNGA.NY Rawat Inap 21/02/2019 Paid 40.000
R1902210171 LAB/190221/0033 109218 ALWI RIANSYAH.AN Rawat Inap 21/02/2019 Paid 65.000
R1902200062 LAB/190221/0037 107201 MUHAMMAD RIFKI AL Rawat Inap 21/02/2019 Paid 65.000
R1902200062 LAB/190221/0038 107201 HABSY.AN
MUHAMMAD RIFKI AL Rawat Inap 21/02/2019 Paid 40.000
R1902210168 LAB/190221/0040 109646 HABSY.AN
BUNGA.NY Rawat Inap 21/02/2019 Paid 65.000
R1902210168 LAB/190221/0043 109646 BUNGA.NY Rawat Inap 21/02/2019 Paid 65.000
R1902210168 LAB/190221/0046 109646 BUNGA.NY Rawat Inap 21/02/2019 Paid 65.000
R1902200001 LAB/190221/0050 109571 NUR HAPIPAH. AN Rawat Inap 21/02/2019 Paid 33.000
R1902210308 LAB/190221/0052 082518 DJAULI DESTHEO. AN Rawat Inap 21/02/2019 Paid 65.000
R1902210111 LAB/190221/0053 109652 SHARBEL MARTUA Rawat Inap 21/02/2019 Process 548.000
R1902210313 LAB/190221/0055 109340 SITUMORANG.AN
ANGEL VALLERIN.NN Rawat Inap 21/02/2019 Paid 65.000
R1902210111 LAB/190221/0056 109652 SHARBEL MARTUA Rawat Inap 21/02/2019 Process 330.000
R1902210032 LAB/190222/0001 108649 SITUMORANG.AN
VERA SUSANTI Rawat Inap 22/02/2019 Paid 700.000
R1902210011 LAB/190222/0002 108936 SIREGAR.NN
TESSA ANGGI PUTRI.NY Rawat Inap 22/02/2019 Paid 600.000
R1902130035 LAB/190222/0003 108421 AZHAR BIN HARUN. TN Rawat Inap 22/02/2019 Paid 65.000
R1902220006 LAB/190222/0004 109279 MASRIDAWATI HARAHAP Rawat Inap 22/02/2019 Paid 503.000
R1902220006 LAB/190222/0005 109279 NY
MASRIDAWATI HARAHAP Rawat Inap 22/02/2019 Paid 40.000
NY
PAGE : 12 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902220007 LAB/190222/0006 095929 FITRIA VUSVA SARY Rawat Inap 22/02/2019 Paid 503.000
R1902210168 LAB/190222/0007 109646 M.NY
BUNGA.NY Rawat Inap 22/02/2019 Paid 65.000
R1902140137 LAB/190222/0008 105526 NATHAN TRISTAN Rawat Inap 22/02/2019 Paid 65.000
R1902200062 LAB/190222/0009 107201 GEOFANO
MUHAMMAD RIFKI AL Rawat Inap 22/02/2019 Paid 65.000
R1902210313 LAB/190222/0010 109340 BUTAR-BUTAR.AN
HABSY.AN
ANGEL VALLERIN.NN Rawat Inap 22/02/2019 Paid 65.000
R1902200188 LAB/190222/0011 109616 ANISA SRI REJEKI.AN Rawat Inap 22/02/2019 Paid 65.000
R1902200062 LAB/190222/0012 107201 MUHAMMAD RIFKI AL Rawat Inap 22/02/2019 Paid 40.000
R1902220007 LAB/190222/0013 095929 HABSY.AN
FITRIA VUSVA SARY Rawat Inap 22/02/2019 Paid 44.100
R1902220011 LAB/190222/0015 090646 M.NY
M. RONI NASUTION.TN Rawat Inap 22/02/2019 Paid 753.000
R1902160013 LAB/190222/0016 108090 JEFERSON MANALU. TN Rawat Inap 22/02/2019 Paid 753.000
R1902220045 LAB/190222/0017 098665 KRISTIANA SRIWATY Rawat Inap 22/02/2019 Paid 503.000
R1902220048 LAB/190222/0018 109699 SITUMORANG.
MASYURITA SRG. NY NY Rawat Inap 22/02/2019 Paid 503.000
R1902210111 LAB/190222/0020 109652 SHARBEL MARTUA Rawat Inap 22/02/2019 Process 283.000
R1902220056 LAB/190222/0022 109147 SITUMORANG.AN
RITA ERITA.NY Rawat Inap 22/02/2019 Paid 503.000
R1902220050 LAB/190222/0023 101377 NINGOT SIHOTANG.TN Rawat Inap 22/02/2019 Paid 65.000
R1902220081 LAB/190222/0026 109697 MASRIDAWATI Rawat Inap 22/02/2019 Paid 33.000
R1902220060 LAB/190222/0027 109702 HARAHAP.BY.NY
ERLAWATI. NY Rawat Inap 22/02/2019 Paid 65.000
R1902220056 LAB/190222/0028 109147 RITA ERITA.NY Rawat Inap 22/02/2019 Paid 40.000
R1902220006 LAB/190222/0029 109279 MASRIDAWATI HARAHAP Rawat Inap 22/02/2019 Paid 65.000
R1902200001 LAB/190222/0030 109571 NY HAPIPAH. AN
NUR Rawat Inap 22/02/2019 Paid 33.000
R1902180031 LAB/190222/0034 109397 SALIMIN.TN Rawat Inap 22/02/2019 Paid 753.000
R1902220089 LAB/190222/0035 109710 RENI SARTIKA.NY Rawat Inap 22/02/2019 Paid 470.000
R1902190217 LAB/190222/0037 090269 YOHANES BEDA. TN Rawat Inap 22/02/2019 Paid 33.000
R1902170021 LAB/190222/0038 109367 ITA MANDA SARI Rawat Inap 22/02/2019 Process 183.000
R1902220045 LAB/190222/0040 098665 SIAHAAN, BY.
KRISTIANA NY
SRIWATY Rawat Inap 22/02/2019 Paid 65.000
R1902220059 LAB/190222/0041 108317 SITUMORANG.
TINA NUGROHONY Rawat Inap 22/02/2019 Paid 65.000
R1902220131 LAB/190222/0044 109718 CAHYANI. NY
KRISTIANA SRIWATY Rawat Inap 22/02/2019 Paid 33.000
R1902210111 LAB/190222/0045 109652 SITUMORANG.
SHARBEL MARTUA BY NY Rawat Inap 22/02/2019 Process 250.000
R1902220146 LAB/190222/0046 109732 SITUMORANG.AN
BY NY MASYURITA Rawat Inap 22/02/2019 Paid 33.000
R1902220149 LAB/190222/0047 109727 RITA ERITA BY.NY Rawat Inap 22/02/2019 Paid 33.000
R1902220129 LAB/190222/0051 109726 LIE TJANG HENG.TN Rawat Inap 22/02/2019 Paid 760.000
R1902220137 LAB/190222/0056 098593 HASTATI.NY Rawat Inap 22/02/2019 Paid 138.000
R1902200004 LAB/190222/0058 109572 SHYFA AMELIA PUTRI. Rawat Inap 22/02/2019 Paid 65.000
R1902220123 LAB/190222/0065 109723 AN
SURIA GINTING.TN Rawat Inap 22/02/2019 Paid 183.000
R1902220048 LAB/190222/0066 109699 MASYURITA SRG. NY Rawat Inap 22/02/2019 Paid 65.000
R1902220123 LAB/190222/0069 109723 SURIA GINTING.TN Rawat Inap 22/02/2019 Paid 40.000
R1902150075 LAB/190222/0070 108957 ZULMAENAH.NY Rawat Inap 22/02/2019 Paid 600.000
R1902200062 LAB/190222/0072 107201 MUHAMMAD RIFKI AL Rawat Inap 22/02/2019 Paid 65.000
R1902230002 LAB/190223/0001 109744 HABSY.AN
ANDINI TRI SANDHY.NY Rawat Inap 23/02/2019 Paid 503.000
R1902220056 LAB/190223/0002 109147 RITA ERITA.NY Rawat Inap 23/02/2019 Paid 65.000
R1902230003 LAB/190223/0003 109745 FITRIA VUSVA SARY Rawat Inap 23/02/2019 Paid 33.000
R1902230002 LAB/190223/0004 109744 M.BY.NY
ANDINI TRI SANDHY.NY Rawat Inap 23/02/2019 Paid 80.000
R1902230002 LAB/190223/0005 109744 ANDINI TRI SANDHY.NY Rawat Inap 23/02/2019 Paid 65.000
R1902230002 LAB/190223/0006 109744 ANDINI TRI SANDHY.NY Rawat Inap 23/02/2019 Paid 65.000
R1902230004 LAB/190223/0007 109746 SUSRIANI.NY Rawat Inap 23/02/2019 Paid 503.000
R1902230004 LAB/190223/0008 109746 SUSRIANI.NY Rawat Inap 23/02/2019 Paid 44.100
R1902220132 LAB/190223/0009 108867 JULIYANTI SINAGA .NY Rawat Inap 23/02/2019 Paid 503.000
R1902220007 LAB/190223/0010 095929 FITRIA VUSVA SARY Rawat Inap 23/02/2019 Paid 65.000
R1902210171 LAB/190223/0011 109218 M.NY RIANSYAH.AN
ALWI Rawat Inap 23/02/2019 Paid 65.000
R1902210308 LAB/190223/0012 082518 DJAULI DESTHEO. AN Rawat Inap 23/02/2019 Paid 65.000
R1902200004 LAB/190223/0014 109572 SHYFA AMELIA PUTRI. Rawat Inap 23/02/2019 Paid 65.000
R1902220092 LAB/190223/0015 109713 AN
DEFRITA NUR ANISA.AN Rawat Inap 23/02/2019 Paid 65.000
R1902220060 LAB/190223/0016 109702 ERLAWATI. NY Rawat Inap 23/02/2019 Paid 350.000
R1902110255 LAB/190223/0017 108868 YUMNA AINA Rawat Inap 23/02/2019 Paid 65.000
R1902200062 LAB/190223/0018 107201 SALSABIYLA .AN
MUHAMMAD RIFKI AL Rawat Inap 23/02/2019 Paid 65.000
R1902170021 LAB/190223/0019 109367 HABSY.AN
ITA MANDA SARI Rawat Inap 23/02/2019 Process 33.000
R1902200001 LAB/190223/0020 109571 SIAHAAN,
NUR BY. NY
HAPIPAH. AN Rawat Inap 23/02/2019 Paid 33.000
R1902210111 LAB/190223/0021 109652 SHARBEL MARTUA Rawat Inap 23/02/2019 Process 33.000
R1902230025 LAB/190223/0023 109750 SITUMORANG.AN
HENNY ANSARI. NY Rawat Inap 23/02/2019 Paid 503.000
R1902230014 LAB/190223/0024 109748 ERLIMA DANI RAHMA. Rawat Inap 23/02/2019 Paid 65.000
R1902210313 LAB/190223/0026 109340 NY
ANGEL VALLERIN.NN Rawat Inap 23/02/2019 Paid 731.000

PAGE : 13 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902190249 LAB/190223/0027 109563 MAIZAR GINDO Rawat Inap 23/02/2019 Paid 591.000
R1902230040 LAB/190223/0028 109756 TANAMEH
NUR TN NY
HIDAYAH. Rawat Inap 23/02/2019 Paid 503.000
R1902230030 LAB/190223/0030 109752 AFDIL HANIF.TN Rawat Inap 23/02/2019 Paid 295.000
R1902230066 LAB/190223/0031 109754 JULIYANTI Rawat Inap 23/02/2019 Paid 98.000
R1902230069 LAB/190223/0033 107661 SINAGA.BY.NY
SRI LESTARI.NY Rawat Inap 23/02/2019 Paid 65.000
R1902200004 LAB/190223/0034 109572 SHYFA AMELIA PUTRI. Rawat Inap 23/02/2019 Paid 40.000
R1902230076 LAB/190223/0035 109763 AN
LINDA ARSIANTI.NY Rawat Inap 23/02/2019 Paid 503.000
R1902230052 LAB/190223/0037 099724 TITIN SUNARTI. NY Rawat Inap 23/02/2019 Paid 236.000
R1902230087 LAB/190223/0038 080514 NATASHA PARAMITA Rawat Inap 23/02/2019 Paid 145.000
R1902230086 LAB/190223/0039 109767 DANISAWARI. AN
DIANA EVA OKTAVIA Rawat Inap 23/02/2019 Paid 145.000
R1902160036 LAB/190223/0040 109001 PANGGABEAN.NY
SUYANTO.TN Rawat Inap 23/02/2019 Paid 753.000
R1902230004 LAB/190223/0044 109746 SUSRIANI.NY Rawat Inap 23/02/2019 Paid 65.000
R1902220132 LAB/190223/0045 108867 JULIYANTI SINAGA .NY Rawat Inap 23/02/2019 Paid 65.000
R1902230108 LAB/190223/0046 109762 SUSRIANI. BY NY Rawat Inap 23/02/2019 Paid 33.000
R1902230111 LAB/190223/0047 109766 HENNY ANSARI.BY.NY Rawat Inap 23/02/2019 Paid 33.000
R1902200062 LAB/190223/0048 107201 MUHAMMAD RIFKI AL Rawat Inap 23/02/2019 Paid 65.000
R1902230013 LAB/190223/0049 105286 HABSY.AN
SITI MARYAM.NY Rawat Inap 23/02/2019 Paid 98.000
R1902230120 LAB/190223/0050 109769 NUR HIDAYAH .BY NY Rawat Inap 23/02/2019 Paid 33.000
R1902230121 LAB/190223/0051 109772 NURMALA SIMAREMARE Rawat Inap 23/02/2019 Process 65.000
R1902230025 LAB/190223/0052 109750 .NY
HENNY ANSARI. NY Rawat Inap 23/02/2019 Paid 65.000
R1902230126 LAB/190223/0054 109773 BY NY LINDA ARSIANTI Rawat Inap 23/02/2019 Paid 33.000
R1902170021 LAB/190223/0056 109367 ITA MANDA SARI Rawat Inap 23/02/2019 Process 33.000
R1902230126 LAB/190223/0057 109773 SIAHAAN, BY.ARSIANTI
BY NY LINDA NY Rawat Inap 23/02/2019 Paid 65.000
R1902190249 LAB/190223/0058 109563 MAIZAR GINDO Rawat Inap 23/02/2019 Paid 80.000
R1902230040 LAB/190223/0063 109756 TANAMEH
NUR TN NY
HIDAYAH. Rawat Inap 23/02/2019 Paid 65.000
R1902230076 LAB/190223/0064 109763 LINDA ARSIANTI.NY Rawat Inap 23/02/2019 Paid 65.000
R1902220137 LAB/190223/0066 098593 HASTATI.NY Rawat Inap 23/02/2019 Paid 33.000
R1902190217 LAB/190223/0067 090269 YOHANES BEDA. TN Rawat Inap 23/02/2019 Paid 700.000
R1902190217 LAB/190223/0068 090269 YOHANES BEDA. TN Rawat Inap 23/02/2019 Paid 315.000
R1902200004 LAB/190223/0069 109572 SHYFA AMELIA PUTRI. Rawat Inap 23/02/2019 Paid 65.000
R1902230155 LAB/190224/0001 081131 AN
RISKI MAHARANI.NN Rawat Inap 24/02/2019 Paid 98.000
R1902170021 LAB/190224/0003 109367 ITA MANDA SARI Rawat Inap 24/02/2019 Process 33.000
R1902230078 LAB/190224/0005 095057 SIAHAAN,
SRI BY. NY
HERDIANTI Rawat Inap 24/02/2019 Paid 503.000
R1902220137 LAB/190224/0006 098593 GULTOM.
HASTATI.NYNY Rawat Inap 24/02/2019 Paid 33.000
R1902220092 LAB/190224/0007 109713 DEFRITA NUR ANISA.AN Rawat Inap 24/02/2019 Paid 65.000
R1902110255 LAB/190224/0012 108868 YUMNA AINA Rawat Inap 24/02/2019 Paid 65.000
R1902240011 LAB/190224/0015 109783 SALSABIYLA
SRI .AN
HERDIANTI Rawat Inap 24/02/2019 Paid 33.000
R1902240014 LAB/190224/0016 109784 GULTOM. BY. NY
MEDINAR Rawat Inap 24/02/2019 Paid 503.000
R1902200004 LAB/190224/0017 109572 SIMANULLANG.NY
SHYFA AMELIA PUTRI. Rawat Inap 24/02/2019 Paid 65.000
R1902170021 LAB/190224/0018 109367 AN
ITA MANDA SARI Rawat Inap 24/02/2019 Process 33.000
R1902200001 LAB/190224/0019 109571 SIAHAAN, BY. NY
NUR HAPIPAH. AN Rawat Inap 24/02/2019 Paid 33.000
R1902230066 LAB/190224/0020 109754 JULIYANTI Rawat Inap 24/02/2019 Paid 33.000
R1902210111 LAB/190224/0021 109652 SINAGA.BY.NY
SHARBEL MARTUA Rawat Inap 24/02/2019 Process 33.000
R1902230078 LAB/190224/0022 095057 SITUMORANG.AN
SRI HERDIANTI Rawat Inap 24/02/2019 Paid 65.000
R1902240023 LAB/190224/0023 109786 GULTOM.
BY NY
NY MEDINAR Rawat Inap 24/02/2019 Paid 33.000
R1902240014 LAB/190224/0025 109784 SIMANULLANG
MEDINAR Rawat Inap 24/02/2019 Paid 65.000
R1902140137 LAB/190224/0026 105526 SIMANULLANG.NY
NATHAN TRISTAN Rawat Inap 24/02/2019 Paid 65.000
R1902240043 LAB/190224/0028 053389 GEOFANO
HERLINA PASARIBU.NY Rawat Inap 24/02/2019 Paid 425.000
R1902230053 LAB/190225/0001 094541 BUTAR-BUTAR.AN
AFNI SARI HSB. NY Rawat Inap 25/02/2019 Paid 503.000
R1902200001 LAB/190225/0002 109571 NUR HAPIPAH. AN Rawat Inap 25/02/2019 Paid 65.000
R1902200001 LAB/190225/0003 109571 NUR HAPIPAH. AN Rawat Inap 25/02/2019 Paid 125.000
R1902220092 LAB/190225/0005 109713 DEFRITA NUR ANISA.AN Rawat Inap 25/02/2019 Paid 65.000
R1902200062 LAB/190225/0006 107201 MUHAMMAD RIFKI AL Rawat Inap 25/02/2019 Paid 65.000
R1902250005 LAB/190225/0008 108271 HABSY.AN
DARWIS.TN Rawat Inap 25/02/2019 Paid 80.000
R1902250012 LAB/190225/0010 039712 RUSYANTI APELINA Rawat Inap 25/02/2019 Paid 503.000
R1902180165 LAB/190225/0011 109439 MANURUNG.NY
TOMBANG Rawat Inap 25/02/2019 Paid 503.000
R1902250073 LAB/190225/0013 109800 TAMPUBOLON.TN
AFNI SARI HSB.BY.NY Rawat Inap 25/02/2019 Paid 33.000
R1902230013 LAB/190225/0016 105286 SITI MARYAM.NY Rawat Inap 25/02/2019 Paid 33.000
R1902230066 LAB/190225/0017 109754 JULIYANTI Rawat Inap 25/02/2019 Paid 98.000
R1902170021 LAB/190225/0018 109367 SINAGA.BY.NY
ITA MANDA SARI Rawat Inap 25/02/2019 Process 248.000
R1902250135 LAB/190225/0020 109829 SIAHAAN, BY. NY
ELISA.NY Rawat Inap 25/02/2019 Paid 65.000

PAGE : 14 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902250135 LAB/190225/0022 109829 ELISA.NY Rawat Inap 25/02/2019 Paid 70.000


R1902230053 LAB/190225/0023 094541 AFNI SARI HSB. NY Rawat Inap 25/02/2019 Paid 65.000
R1902190022 LAB/190225/0024 107557 RASTAULI SIADARI. NY Rawat Inap 25/02/2019 Paid 158.000
R1902250135 LAB/190225/0025 109829 ELISA.NY Rawat Inap 25/02/2019 Paid 60.000
R1902250135 LAB/190225/0033 109829 ELISA.NY Rawat Inap 25/02/2019 Paid 20.000
R1902250207 LAB/190225/0034 109850 RONSON SIANTURI.TN Rawat Inap 25/02/2019 Paid 98.000
R1902250156 LAB/190225/0035 109842 RUBBI SYAHPUTRA.TN Rawat Inap 25/02/2019 Paid 264.000
R1902250229 LAB/190225/0036 070529 MARTUA MANURUNG. NYRawat Inap 25/02/2019 Paid 105.000
R1902250231 LAB/190225/0037 109861 RUSKAM.TN Rawat Inap 25/02/2019 Paid 326.000
R1902250012 LAB/190225/0043 039712 RUSYANTI APELINA Rawat Inap 25/02/2019 Paid 65.000
R1902250298 LAB/190225/0044 109867 MANURUNG.NY
RUSIANTI.NY BY Rawat Inap 25/02/2019 Paid 33.000
R1902250263 LAB/190225/0045 105545 MIKE NURVIANTY.NY Rawat Inap 25/02/2019 Paid 410.000
R1902250296 LAB/190225/0046 109882 MUHAMMAD HANAFI Rawat Inap 25/02/2019 Paid 65.000
R1902250310 LAB/190225/0047 081875 RAMADHAN.ANN
FINITTA SIREGAR.NY Rawat Inap 25/02/2019 Paid 410.000
R1902250305 LAB/190225/0048 009737 LELA HAPPY Rawat Inap 25/02/2019 Paid 410.000
R1902250227 LAB/190226/0001 109859 NURAISYAH.NY Rawat Inap 26/02/2019 Paid 470.000
R1902250095 LAB/190226/0002 109813 LAWANI HASIBUAN.NY Rawat Inap 26/02/2019 Paid 470.000
R1902110255 LAB/190226/0003 108868 YUMNA AINA Rawat Inap 26/02/2019 Paid 65.000
R1902250156 LAB/190226/0004 109842 SALSABIYLA
RUBBI .AN
SYAHPUTRA.TN Rawat Inap 26/02/2019 Paid 283.000
R1902140137 LAB/190226/0005 105526 NATHAN TRISTAN Rawat Inap 26/02/2019 Paid 65.000
R1902260011 LAB/190226/0006 109905 GEOFANO
DESI AMALIA.NY Rawat Inap 26/02/2019 Paid 503.000
R1902250229 LAB/190226/0008 070529 BUTAR-BUTAR.AN
MARTUA MANURUNG. NYRawat Inap 26/02/2019 Paid 178.000
R1902250257 LAB/190226/0010 097178 NUR AINI. NY Rawat Inap 26/02/2019 Paid 503.000
R1902250257 LAB/190226/0011 097178 NUR AINI. NY Rawat Inap 26/02/2019 Paid 40.000
R1902260079 LAB/190226/0013 109917 NUR AINI DAHULAY.NY Rawat Inap 26/02/2019 Paid 470.000
R1902230066 LAB/190226/0014 109754 JULIYANTI Rawat Inap 26/02/2019 Paid 183.000
R1902170021 LAB/190226/0015 109367 SINAGA.BY.NY
ITA MANDA SARI Rawat Inap 26/02/2019 Process 33.000
R1902260134 LAB/190226/0016 109937 SIAHAAN,
MARLENA.NYBY. NY Rawat Inap 26/02/2019 Paid 328.000
R1902190249 LAB/190226/0020 109563 MAIZAR GINDO Rawat Inap 26/02/2019 Paid 348.000
R1902260056 LAB/190226/0022 055776 TANAMEH
MURNI.NY TN Rawat Inap 26/02/2019 Paid 225.000
R1902260011 LAB/190226/0023 109905 DESI AMALIA.NY Rawat Inap 26/02/2019 Paid 65.000
R1902260209 LAB/190226/0027 109959 NUR AINI. BY NY Rawat Inap 26/02/2019 Paid 98.000
R1902260221 LAB/190226/0030 109023 SRI ENDAH KARTIKA Rawat Inap 26/02/2019 Paid 503.000
R1902260216 LAB/190226/0031 109963 SARI.NY
RASYID ZAHIRUL Rawat Inap 26/02/2019 Paid 65.000
R1902260221 LAB/190226/0033 109023 AZFAR.AN
SRI ENDAH KARTIKA Rawat Inap 26/02/2019 Paid 44.100
R1902190022 LAB/190226/0037 107557 SARI.NY
RASTAULI SIADARI. NY Rawat Inap 26/02/2019 Paid 600.000
R1902260242 LAB/190227/0001 108608 TIAMINAH SIREGAR. NY Rawat Inap 27/02/2019 Paid 393.000
R1902250257 LAB/190227/0002 097178 NUR AINI. NY Rawat Inap 27/02/2019 Paid 65.000
R1902260242 LAB/190227/0003 108608 TIAMINAH SIREGAR. NY Rawat Inap 27/02/2019 Paid 33.000
R1902270006 LAB/190227/0004 058634 RANI KURNIATI.NY Rawat Inap 27/02/2019 Paid 503.000
R1902260056 LAB/190227/0005 055776 MURNI.NY Rawat Inap 27/02/2019 Paid 65.000
R1902140137 LAB/190227/0006 105526 NATHAN TRISTAN Rawat Inap 27/02/2019 Paid 65.000
R1902260242 LAB/190227/0008 108608 GEOFANO SIREGAR. NY Rawat
TIAMINAH Inap 27/02/2019 Paid 33.000
R1902170021 LAB/190227/0009 109367 BUTAR-BUTAR.AN
ITA MANDA SARI Rawat Inap 27/02/2019 Process 33.000
R1902200001 LAB/190227/0010 109571 SIAHAAN,
NUR BY. NY
HAPIPAH. AN Rawat Inap 27/02/2019 Paid 215.000
R1902270016 LAB/190227/0012 109976 MEI LESTARI. NY Rawat Inap 27/02/2019 Paid 503.000
R1902260037 LAB/190227/0013 109907 JUNI HERIANTI Rawat Inap 27/02/2019 Paid 718.000
R1902270016 LAB/190227/0014 109976 SIREGAR.NY
MEI LESTARI. NY Rawat Inap 27/02/2019 Paid 40.000
R1902140034 LAB/190227/0015 109178 FAHMI SUSANA.NY Rawat Inap 27/02/2019 Paid 753.000
R1902270071 LAB/190227/0018 109977 SRI ENDAH KARTIKA Rawat Inap 27/02/2019 Paid 33.000
R1902270073 LAB/190227/0019 109973 SARI.BY.NY
RANI KURNIATI .BY NY Rawat Inap 27/02/2019 Paid 33.000
R1812280164 LAB/190227/0020 097500 FEBRI SUCI ANDANI MY. Rawat Inap 27/02/2019 Paid 503.000
R1902270088 LAB/190227/0021 109998 NY
MEI LESTARI. BY. NY Rawat Inap 27/02/2019 Paid 33.000
R1902260242 LAB/190227/0022 108608 TIAMINAH SIREGAR. NY Rawat Inap 27/02/2019 Paid 33.000
R1902220122 LAB/190227/0024 096089 FAHRI IRAWAN.AN Rawat Inap 27/02/2019 Paid 503.000
R1902230080 LAB/190227/0026 056431 MIKHAEL ALVARO Rawat Inap 27/02/2019 Paid 503.000
R1902270044 LAB/190227/0027 036502 NATAJAYA.AN
ELFRIDA SRI RAYANI.NY Rawat Inap 27/02/2019 Paid 70.000
R1902270050 LAB/190227/0033 109987 IRAWATI. NY Rawat Inap 27/02/2019 Paid 900.000
R1902250051 LAB/190227/0035 109801 LULUK ASADIYAH.NY Rawat Inap 27/02/2019 Paid 563.000
R1902270130 LAB/190227/0037 110017 ELMA.NY Rawat Inap 27/02/2019 Paid 143.000
R1902260221 LAB/190227/0038 109023 SRI ENDAH KARTIKA Rawat Inap 27/02/2019 Paid 65.000
SARI.NY
PAGE : 15 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902260079 LAB/190227/0039 109917 NUR AINI DAHULAY.NY Rawat Inap 27/02/2019 Paid 65.000
R1902270006 LAB/190227/0040 058634 RANI KURNIATI.NY Rawat Inap 27/02/2019 Paid 65.000
R1902270124 LAB/190227/0042 073235 DIAN DAMAYANTI.NY Rawat Inap 27/02/2019 Paid 65.000
R1902270082 LAB/190227/0043 110001 REDINA SITOHANG.NY Rawat Inap 27/02/2019 Paid 44.100
R1902270114 LAB/190227/0045 110013 SUSY SETYAWATI. NY Rawat Inap 27/02/2019 Paid 33.000
R1902270050 LAB/190227/0046 109987 IRAWATI. NY Rawat Inap 27/02/2019 Paid 33.000
R1902250051 LAB/190227/0047 109801 LULUK ASADIYAH.NY Rawat Inap 28/02/2019 Paid 700.000
R1902250051 LAB/190227/0048 109801 LULUK ASADIYAH.NY Rawat Inap 27/02/2019 Paid 33.000
R1902270082 LAB/190227/0049 110001 REDINA SITOHANG.NY Rawat Inap 27/02/2019 Paid 410.000
R1902270134 LAB/190227/0050 090436 YUHERWATI.NY Rawat Inap 27/02/2019 Paid 105.000
R1902260134 LAB/190227/0052 109937 MARLENA.NY Rawat Inap 27/02/2019 Paid 40.000
R1902260242 LAB/190227/0057 108608 TIAMINAH SIREGAR. NY Rawat Inap 27/02/2019 Paid 33.000
R1902270159 LAB/190227/0058 077132 HANA ZAHRA UZMA .AN Rawat Inap 27/02/2019 Paid 65.000
R1902270205 LAB/190227/0059 109972 NOWELA AMORA .AN Rawat Inap 27/02/2019 Paid 145.000
R1902270016 LAB/190227/0064 109976 MEI LESTARI. NY Rawat Inap 27/02/2019 Paid 65.000
R1902270044 LAB/190227/0065 036502 ELFRIDA SRI RAYANI.NY Rawat Inap 27/02/2019 Paid 170.000
R1902270234 LAB/190227/0067 110045 ATSILAH PUTRI AKSA.AN Rawat Inap 27/02/2019 Paid 65.000
R1902270234 LAB/190227/0069 110045 ATSILAH PUTRI AKSA.AN Rawat Inap 27/02/2019 Paid 110.000
R1902280001 LAB/190228/0002 110050 FEBRI SUCI ANDANI MY. Rawat Inap 28/02/2019 Paid 33.000
R1902280004 LAB/190228/0003 067975 BY NY SILALAHI.NY
DEBORA Rawat Inap 28/02/2019 Paid 693.000
R1902280006 LAB/190228/0004 108870 MELDA WATI SIAHAAN. Rawat Inap 28/02/2019 Paid 503.000
R1902260134 LAB/190228/0005 109937 NY
MARLENA.NY Rawat Inap 28/02/2019 Paid 65.000
R1902250207 LAB/190228/0006 109850 RONSON SIANTURI.TN Rawat Inap 28/02/2019 Paid 65.000
R1812280164 LAB/190228/0007 097500 FEBRI SUCI ANDANI MY. Rawat Inap 28/02/2019 Paid 65.000
R1902260242 LAB/190228/0008 108608 NY
TIAMINAH SIREGAR. NY Rawat Inap 28/02/2019 Paid 145.000
R1902270114 LAB/190228/0009 110013 SUSY SETYAWATI. NY Rawat Inap 28/02/2019 Paid 148.000
R1902280002 LAB/190228/0010 077131 HANI YASMIN KHAILAH. Rawat Inap 28/02/2019 Paid 65.000
R1902280032 LAB/190228/0011 110053 AN
DEBORA SILALAHI.BY.NY Rawat Inap 28/02/2019 Paid 33.000
R1902260209 LAB/190228/0013 109959 NUR AINI. BY NY Rawat Inap 28/02/2019 Paid 33.000
R1902170021 LAB/190228/0014 109367 ITA MANDA SARI Rawat Inap 28/02/2019 Process 33.000
R1902280050 LAB/190228/0016 051954 SIAHAAN,
SRI BY. NY
YUNARTI.NY Rawat Inap 28/02/2019 Paid 503.000
R1902280084 LAB/190228/0021 110057 MELDA WATI SIAHAAN Rawat Inap 28/02/2019 Paid 33.000
R1902140034 LAB/190228/0022 109178 BY.NY SUSANA.NY
FAHMI Rawat Inap 28/02/2019 Paid 600.000
R1902280097 LAB/190228/0025 109515 EMMI DAULAE.NY Rawat Inap 28/02/2019 Paid 527.300
R1902270171 LAB/190228/0027 110029 AMIN.TN Rawat Inap 28/02/2019 Paid 873.000
R1902260242 LAB/190228/0030 108608 TIAMINAH SIREGAR. NY Rawat Inap 28/02/2019 Paid 73.000
R1902280006 LAB/190228/0032 108870 MELDA WATI SIAHAAN. Rawat Inap 28/02/2019 Paid 65.000
R1902280004 LAB/190228/0033 067975 NY
DEBORA SILALAHI.NY Rawat Inap 28/02/2019 Paid 65.000
R1902280159 LAB/190228/0034 110092 RIZA NURBAITA Rawat Inap 28/02/2019 Paid 503.000
R1902280084 LAB/190228/0042 110057 RAHMAWATI.NY
MELDA WATI SIAHAAN Rawat Inap 28/02/2019 Paid 65.000
R1902280191 LAB/190228/0043 110076 BY.NY
SRI YUNARTI BY.NY Rawat Inap 28/02/2019 Paid 33.000
R1902270082 LAB/190228/0046 110001 REDINA SITOHANG.NY Rawat Inap 28/02/2019 Paid 44.100
R1902280050 LAB/190228/0048 051954 SRI YUNARTI.NY Rawat Inap 28/02/2019 Paid 65.000
R1902280097 LAB/190228/0049 109515 EMMI DAULAE.NY Rawat Inap 28/02/2019 Paid 65.000
R1902280205 LAB/190228/0050 109790 NURSYAH PURBA.NY Rawat Inap 28/02/2019 Process 315.000
R1902280216 LAB/190228/0054 110102 EMI DAULAE BY .NY Rawat Inap 28/02/2019 Process 98.000
R1902280235 LAB/190228/0055 110115 NELLY MEGAWATI BR Rawat Inap 28/02/2019 Paid 410.000
R1902280243 LAB/190228/0057 110117 LUBIS
SURYA AGUNG Rawat Inap 28/02/2019 Paid 65.000
R1902280257 LAB/190228/0058 110022 TAMBUNAN.AN
HARIYANTI Rawat Inap 28/02/2019 Paid 503.000
R1902280269 LAB/190228/0060 077967 SIMARMATA.NY
IRA JUWITA Rawat Inap 28/02/2019 Paid 503.000
R1902280268 LAB/190228/0061 049837 KUSUMADEWI.
RENITA NY
HANDAYANI.NY Rawat Inap 28/02/2019 Paid 503.000
R1902280271 LAB/190228/0062 105545 MIKE NURVIANTY.NY Rawat Inap 28/02/2019 Paid 158.000
R1902270171 LAB/190228/0065 110029 AMIN.TN Rawat Inap 28/02/2019 Paid 315.000
R1902280235 LAB/190228/0067 110115 NELLY MEGAWATI BR Rawat Inap 28/02/2019 Paid 93.000
R1902010014 LAB/190201/0010 067095 LUBIS
CHADIJAH.NY Rawat Jalan 01/02/2019 Paid 33.000
R1902010112 LAB/190201/0026 078500 ISRAEL SAMOSIR.TN Rawat Jalan 01/02/2019 Paid 33.000
R1902010105 LAB/190201/0030 108353 MENRIS Rawat Jalan 01/02/2019 Process 131.000
R1902010111 LAB/190201/0034 103118 PANDIANGAN.TN
MARIA MAGDALENA.NY Rawat Jalan 01/02/2019 Paid 33.000
R1902010151 LAB/190201/0035 108373 ROSTINA.NY Rawat Jalan 01/02/2019 Paid 33.000
R1902010190 LAB/190201/0045 108390 AFRIDA MAIYULITA .NY Rawat Jalan 01/02/2019 Paid 80.000
R1902010246 LAB/190201/0049 108405 LUBBINA ANANDA Rawat Jalan 01/02/2019 Paid 65.000
YOLFENI.AN
PAGE : 16 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902010257 LAB/190201/0054 108409 ERNITA SIMATUPANG. Rawat Jalan 01/02/2019 Process 65.000
R1902020011 LAB/190202/0013 108411 NY ARDIANTI
RICA Rawat Jalan 02/02/2019 Process 33.000
R1902020013 LAB/190202/0015 108414 MANGUNSONG.
NIFTIA FATIHA. BY.
AN NY Rawat Jalan 02/02/2019 Paid 33.000
R1902020060 LAB/190202/0018 081893 SRI WIDIANA.NY Rawat Jalan 02/02/2019 Paid 86.000
R1902020083 LAB/190202/0020 108442 DIAN AGUSTIN.NY Rawat Jalan 02/02/2019 Paid 60.000
R1902020081 LAB/190202/0025 086333 ADZKIA AQILATUNNISA. Rawat Jalan 02/02/2019 Paid 65.000
R1902020022 LAB/190202/0029 064826 AN LASDIANA.NY
RENI Rawat Jalan 02/02/2019 Process 33.000
R1902020059 LAB/190202/0032 108431 SILVANUS KAMDIYAT. Rawat Jalan 02/02/2019 Paid 33.000
R1902020040 LAB/190202/0033 064808 TN
ANRE LEO.TN Rawat Jalan 02/02/2019 Paid 145.000
R1902020092 LAB/190202/0040 108449 LAMHOT SITINJAK.TN Rawat Jalan 02/02/2019 Paid 145.000
R1902020160 LAB/190202/0044 108469 MOH. WILLYANTO ARIF Rawat Jalan 02/02/2019 Paid 80.000
R1902040033 LAB/190204/0017 103625 F.TN
PAINAN PASARIBU. TN Rawat Jalan 04/02/2019 Paid 33.000
R1902040078 LAB/190204/0026 108529 WARNALISMAN.TN Rawat Jalan 04/02/2019 Paid 70.000
R1902040120 LAB/190204/0030 105581 PORAMAN SIMAMORA. Rawat Jalan 04/02/2019 Paid 40.000
R1902020022 LAB/190204/0031 064826 TN LASDIANA.NY
RENI Rawat Jalan 04/02/2019 Process 66.000
R1902040136 LAB/190204/0034 104537 JONI EFRIZAL. TN Rawat Jalan 04/02/2019 Paid 33.000
R1902030018 LAB/190204/0054 108493 JUAN FASCO LUMBAN Rawat Jalan 04/02/2019 Paid 65.000
R1902040238 LAB/190204/0055 108579 TOBING.AN
ZURAINI. NY Rawat Jalan 04/02/2019 Paid 60.000
R1902040246 LAB/190204/0058 078490 JANLY BOY.M Rawat Jalan 04/02/2019 Process 40.000
R1902040267 LAB/190204/0059 108502 NICHOLAS .AN Rawat Jalan 04/02/2019 Paid 65.000
R1902040219 LAB/190204/0060 108574 BINTARLI SITANGGANG. Rawat Jalan 04/02/2019 Paid 80.000
R1902030018 LAB/190204/0066 108493 NY
JUAN FASCO LUMBAN Rawat Jalan 04/02/2019 Paid 798.000
R1902060006 LAB/190206/0018 108612 TOBING.AN
HARIDA YARNI. NY Rawat Jalan 06/02/2019 Paid 33.000
R1902030004 LAB/190206/0025 108486 SENO. TN Rawat Jalan 06/02/2019 Process 80.000
R1902020082 LAB/190206/0026 108441 N. ROSMAIDA Rawat Jalan 06/02/2019 Process 40.000
R1902040234 LAB/190206/0027 105245 HUTASOIT.NY
ALVIN PRATISTA Rawat Jalan 06/02/2019 Paid 145.000
R1902060077 LAB/190206/0030 094079 HAMIZAN.
NG AN TN
KHON SEN. Rawat Jalan 06/02/2019 Paid 33.000
R1902060043 LAB/190206/0034 108624 HENDRA SHITELO. TN Rawat Jalan 06/02/2019 Paid 33.000
R1902060105 LAB/190206/0038 105245 ALVIN PRATISTA Rawat Jalan 06/02/2019 Paid 145.000
R1902060197 LAB/190206/0056 108686 HAMIZAN.
ROCOSIOMI ANDAMANIK. Rawat Jalan 06/02/2019 Paid 60.000
R1902070102 LAB/190207/0009 105667 NY
SULAIMAN YUNUS.TN Rawat Jalan 07/02/2019 Paid 33.000
R1902070075 LAB/190207/0010 025879 MARIO ALVARO GAVRIEL Rawat Jalan 07/02/2019 Paid 65.000
R1902060208 LAB/190207/0011 097012 SIAGIAN.AN
ARSYAD.AN Rawat Jalan 07/02/2019 Paid 65.000
R1902070104 LAB/190207/0013 108720 FARIZAL.TN Rawat Jalan 07/02/2019 Paid 456.000
R1902070104 LAB/190207/0014 108720 FARIZAL.TN Rawat Jalan 07/02/2019 Paid 2.500.000
R1902070157 LAB/190207/0030 094781 DWI PRAMONO Rawat Jalan 07/02/2019 Paid 80.000
R1902070173 LAB/190207/0035 012954 KUNCORO.TN
INDAH FADILLAH Rawat Jalan 07/02/2019 Paid 145.000
R1902080015 LAB/190208/0010 108373 ROSTINA.NY Rawat Jalan 08/02/2019 Process 33.000
R1902080028 LAB/190208/0011 108769 NOVA SURYANI.NY Rawat Jalan 08/02/2019 Paid 40.000
R1902080025 LAB/190208/0012 085514 RASIWEN. NY Rawat Jalan 08/02/2019 Paid 45.000
R1902080074 LAB/190208/0014 098593 HASTATI.NY Rawat Jalan 08/02/2019 Paid 33.000
R1902080052 LAB/190208/0016 108780 RONNY SETIAWAN Rawat Jalan 08/02/2019 Paid 33.000
R1902080007 LAB/190208/0021 098750 LOEN.TN
JUSNI.NY Rawat Jalan 08/02/2019 Paid 33.000
R1902080153 LAB/190208/0025 096055 BASRI BUHARI.TN Rawat Jalan 08/02/2019 Paid 33.000
R1902080154 LAB/190208/0031 108813 TARTI EFRI.NY Rawat Jalan 08/02/2019 Paid 80.000
R1902080173 LAB/190208/0032 108588 SELVINA YURISHA. AN Rawat Jalan 08/02/2019 Paid 70.000
R1902080179 LAB/190208/0034 108824 DODY RIVEMBER.TN Rawat Jalan 08/02/2019 Paid 80.000
R1902080177 LAB/190208/0035 108823 JOSUA MATONDANG .AN Rawat Jalan 08/02/2019 Paid 65.000
R1902090040 LAB/190209/0020 100028 HORIZAL.TN Rawat Jalan 09/02/2019 Paid 33.000
R1902090034 LAB/190209/0028 021175 SITI SUNDARI. NY Rawat Jalan 09/02/2019 Paid 33.000
R1902090137 LAB/190209/0044 100866 CKRISTIAN DAMERO.AN Rawat Jalan 09/02/2019 Process 295.000
R1902110023 LAB/190211/0012 077551 MIRA HARYANI.NY Rawat Jalan 11/02/2019 Paid 33.000
R1902110020 LAB/190211/0013 099637 TIARNA DERIANA.NY Rawat Jalan 11/02/2019 Paid 40.000
R1902110024 LAB/190211/0018 091675 RIKI.TN Rawat Jalan 11/02/2019 Paid 33.000
R1902110048 LAB/190211/0022 104105 A. AKMAR NUR. TN Rawat Jalan 11/02/2019 Paid 250.000
R1902110078 LAB/190211/0023 104831 WIWIEK PURWANTINI. Rawat Jalan 11/02/2019 Paid 33.000
R1902110110 LAB/190211/0024 094124 NY
YOSIA GULO.TN Rawat Jalan 11/02/2019 Paid 78.000
R1902040096 LAB/190211/0025 087523 SYOFRA NOVI.TN Rawat Jalan 11/02/2019 Process 40.000
R1902110145 LAB/190211/0031 108431 SILVANUS KAMDIYAT. Rawat Jalan 11/02/2019 Paid 33.000
R1902110132 LAB/190211/0033 099039 TN
AINI. NY Rawat Jalan 11/02/2019 Paid 33.000
R1901310015 LAB/190211/0036 107474 AMIRULLAH. TN Rawat Jalan 11/02/2019 Paid 753.000

PAGE : 17 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902110221 LAB/190211/0037 088386 ERNAWATI. NY Rawat Jalan 11/02/2019 Paid 33.000


R1902020022 LAB/190211/0038 064826 RENI LASDIANA.NY Rawat Jalan 11/02/2019 Process 33.000
R1902080015 LAB/190211/0040 108373 ROSTINA.NY Rawat Jalan 11/02/2019 Process 33.000
R1902110144 LAB/190211/0041 099354 TARMIZI.TN Rawat Jalan 11/02/2019 Paid 33.000
R1902110145 LAB/190211/0042 108431 SILVANUS KAMDIYAT. Rawat Jalan 11/02/2019 Paid 33.000
R1902110153 LAB/190211/0043 108928 TN
ROSDIANA Rawat Jalan 11/02/2019 Paid 73.000
R1902110160 LAB/190211/0045 072612 NAINGGOLAN.NY
HERLINA.NY Rawat Jalan 11/02/2019 Paid 145.000
R1902020022 LAB/190211/0046 064826 RENI LASDIANA.NY Rawat Jalan 11/02/2019 Process 65.000
R1901310057 LAB/190211/0047 104130 LILIS.NY Rawat Jalan 11/02/2019 Paid 563.000
R1902110219 LAB/190211/0048 108950 SORLIANA PURBA. NY Rawat Jalan 11/02/2019 Paid 33.000
R1902110207 LAB/190211/0049 108945 DEMRI AMBARITA. NY Rawat Jalan 11/02/2019 Paid 33.000
R1902110223 LAB/190211/0051 101134 RATNA. NY Rawat Jalan 11/02/2019 Paid 80.000
R1902110068 LAB/190211/0058 108905 YANI SAPUTRI Rawat Jalan 11/02/2019 Paid 60.000
R1902110268 LAB/190211/0064 108972 NASUTION.NN
SITI ASIYAH. NY Rawat Jalan 11/02/2019 Paid 80.000
R1902110293 LAB/190211/0067 071285 CHRISTOHER Rawat Jalan 11/02/2019 Paid 65.000
R1902110415 LAB/190211/0081 108991 SALVADOR.AN
AWALIAH NURSIAM Rawat Jalan 11/02/2019 Process 33.000
R1902120030 LAB/190212/0014 102342 BY.NY
WIJI ASTUTI.NY Rawat Jalan 12/02/2019 Paid 65.000
R1902120006 LAB/190212/0017 077925 MAZNAH.NY Rawat Jalan 12/02/2019 Paid 33.000
R1902120059 LAB/190212/0018 104407 ETTY RUSMIATI. NY Rawat Jalan 12/02/2019 Paid 33.000
R1902120080 LAB/190212/0020 109026 RIAWATI. NY Rawat Jalan 12/02/2019 Paid 60.000
R1902120115 LAB/190212/0022 105581 PORAMAN SIMAMORA. Rawat Jalan 12/02/2019 Paid 40.000
R1902120111 LAB/190212/0023 093225 TN
VENITA. NY Rawat Jalan 12/02/2019 Paid 33.000
R1901290130 LAB/190212/0025 104410 SYARIFAH. NY Rawat Jalan 12/02/2019 Paid 33.000
R1902120202 LAB/190212/0033 108219 AMRAN AMIRUDIN. TN Rawat Jalan 12/02/2019 Paid 40.000
R1902120242 LAB/190212/0039 089509 REFNETI. NY Rawat Jalan 12/02/2019 Paid 40.000
R1902120029 LAB/190213/0021 109000 ASHARI. TN Rawat Jalan 13/02/2019 Process 80.000
R1902130026 LAB/190213/0025 108766 EKO HARTANTO.TN Rawat Jalan 13/02/2019 Paid 290.000
R1902120065 LAB/190213/0026 069037 JUNITA MAHARANI.NY Rawat Jalan 13/02/2019 Paid 813.000
R1902130057 LAB/190213/0031 109106 SANTY MANALU.NY Rawat Jalan 13/02/2019 Paid 33.000
R1902130045 LAB/190213/0032 108579 ZURAINI. NY Rawat Jalan 13/02/2019 Paid 60.000
R1902130104 LAB/190213/0034 101032 ERMAYETTI. NY Rawat Jalan 13/02/2019 Paid 33.000
R1902130100 LAB/190213/0036 109122 HAYANI.NY Rawat Jalan 13/02/2019 Paid 65.000
R1902130144 LAB/190213/0040 057036 MD.MOZAMMAL Rawat Jalan 13/02/2019 Paid 406.000
R1902130165 LAB/190213/0042 106904 HOSSAIN.TN
YURNIDAH. NY Rawat Jalan 13/02/2019 Paid 33.000
R1902130169 LAB/190213/0045 090979 ELY ULPA.NY Rawat Jalan 13/02/2019 Paid 80.000
R1902130156 LAB/190213/0046 109146 SUSANTI.NY Rawat Jalan 13/02/2019 Paid 98.000
R1902130169 LAB/190213/0048 090979 ELY ULPA.NY Rawat Jalan 13/02/2019 Paid 65.000
R1902130041 LAB/190213/0049 109103 ZULFETRA.NY Rawat Jalan 13/02/2019 Paid 80.000
R1902120203 LAB/190213/0050 047882 CATHERINE EMILILY Rawat Jalan 13/02/2019 Paid 80.000
R1902130194 LAB/190213/0051 033950 EARIN.AN
HANIFA.AN Rawat Jalan 13/02/2019 Paid 70.000
R1902130204 LAB/190213/0055 109160 JAMES YOSEPH Rawat Jalan 13/02/2019 Paid 220.000
R1902130208 LAB/190213/0056 086855 SAMUEL.AN
ITA ASNITA.NY Rawat Jalan 13/02/2019 Paid 80.000
R1902130228 LAB/190213/0058 108817 ALEXANDER GABRIANO Rawat Jalan 13/02/2019 Paid 70.000
R1902130215 LAB/190213/0059 109161 SIDABUTAR.AN
CHOKY PANJAITAN.AN Rawat Jalan 13/02/2019 Paid 70.000
R1902130246 LAB/190213/0060 109164 RITA.BY.NY Rawat Jalan 13/02/2019 Process 98.000
R1902140076 LAB/190214/0021 109189 ROBEKKA PURBA.NY Rawat Jalan 14/02/2019 Paid 98.000
R1712170048 LAB/190214/0023 029234 MINTA MINARIA. NY Rawat Jalan 14/02/2019 Paid 33.000
R1902140012 LAB/190214/0027 096429 YUDO MAHARDIANTO. Rawat Jalan 14/02/2019 Paid 33.000
R1902140133 LAB/190214/0028 102138 TN
GOKMAULIATE Rawat Jalan 14/02/2019 Paid 323.000
R1902140126 LAB/190214/0029 109206 HUTAGALUNG.
UNAISAH TN
LATIFAH Rawat Jalan 14/02/2019 Paid 40.000
R1902140144 LAB/190214/0033 068174 ASRIDONI.AN
ULFA M YASIN.NY Rawat Jalan 14/02/2019 Paid 33.000
R1902140012 LAB/190214/0034 096429 YUDO MAHARDIANTO. Rawat Jalan 14/02/2019 Paid 80.000
R1902140124 LAB/190214/0038 091977 TN
USNI. NY Rawat Jalan 14/02/2019 Paid 33.000
R1902140118 LAB/190214/0040 109203 PUTRIA JUWITA.NY Rawat Jalan 14/02/2019 Paid 250.000
R1902140177 LAB/190214/0043 108161 ROSLINA MANURUNG.NY Rawat Jalan 14/02/2019 Paid 33.000
R1902140228 LAB/190214/0056 088330 ZAHWA AMELIA Rawat Jalan 14/02/2019 Paid 65.000
R1902150003 LAB/190215/0001 109229 GARMIZON.AN
SYA SYA TRI PUSPITA Rawat Jalan 15/02/2019 Paid 65.000
R1902150042 LAB/190215/0008 098009 DEWI. AN
HERLINA.NY Rawat Jalan 15/02/2019 Paid 33.000
R1902150077 LAB/190215/0011 107295 JUNI SARTIKA.NY Rawat Jalan 15/02/2019 Paid 428.000
R1902150080 LAB/190215/0014 080484 MINDO RAJAGUKGUK.NY Rawat Jalan 15/02/2019 Paid 33.000
R1902150054 LAB/190215/0030 109242 RUSWANTO.TN Rawat Jalan 15/02/2019 Paid 86.000

PAGE : 18 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902150036 LAB/190215/0039 102357 ONAH BINTI RASWIT.NY Rawat Jalan 15/02/2019 Paid 33.000
R1902150057 LAB/190215/0043 093299 ISTIA YOLANDA. NN Rawat Jalan 15/02/2019 Paid 40.000
R1902150203 LAB/190215/0048 060455 OKTAVANI Rawat Jalan 15/02/2019 Paid 250.000
R1902160025 LAB/190216/0011 105776 SINAMBELA.AN
H.FAUZI BN.TN Rawat Jalan 16/02/2019 Paid 33.000
R1902160063 LAB/190216/0012 105368 SYAHRUL HAMID.TN Rawat Jalan 16/02/2019 Paid 33.000
R1902160065 LAB/190216/0013 105366 ROSMAINI.NY Rawat Jalan 16/02/2019 Paid 33.000
R1902160077 LAB/190216/0014 068007 RIAMA ADELINA.NY Rawat Jalan 16/02/2019 Paid 45.000
R1902160059 LAB/190216/0015 109326 WILDA RAHMA Rawat Jalan 16/02/2019 Paid 65.000
R1902160096 LAB/190216/0019 109335 JAYANI.NN
HARMIZON.TN Rawat Jalan 16/02/2019 Paid 40.000
R1902160102 LAB/190216/0021 109339 RASMI.NY Rawat Jalan 16/02/2019 Paid 33.000
R1902160090 LAB/190216/0023 105317 RAHMAWATY. NY Rawat Jalan 16/02/2019 Paid 33.000
R1902160020 LAB/190216/0026 084037 SAURMA TAMBUNAN.NY Rawat Jalan 16/02/2019 Paid 33.000
R1902160138 LAB/190216/0035 103748 MUHAMMAD AN NUZLIL Rawat Jalan 16/02/2019 Paid 33.000
R1902160066 LAB/190216/0044 109328 F.TN
ATHIFAH NUR ASJAD.NN Rawat Jalan 16/02/2019 Paid 65.000
R1902180025 LAB/190218/0015 098113 NIAR SILALAHI.TN Rawat Jalan 18/02/2019 Paid 33.000
R1902180028 LAB/190218/0016 104393 SUSWANINGSIH. NY Rawat Jalan 18/02/2019 Paid 33.000
R1902180018 LAB/190218/0017 105286 SITI MARYAM.NY Rawat Jalan 18/02/2019 Paid 33.000
R1902180013 LAB/190218/0022 081422 WEDYA BASYURI. TN Rawat Jalan 18/02/2019 Paid 65.000
R1902180052 LAB/190218/0025 104105 A. AKMAR NUR. TN Rawat Jalan 18/02/2019 Paid 33.000
R1902180062 LAB/190218/0026 105377 LONTUNG ANTONIUS Rawat Jalan 18/02/2019 Paid 33.000
R1902180090 LAB/190218/0032 095700 SITUMORANG.
TIUR LUBIS. NYTN Rawat Jalan 18/02/2019 Paid 113.000
R1902180124 LAB/190218/0035 107335 ROSINTA SIMANJUNTAK. Rawat Jalan 18/02/2019 Paid 33.000
R1902180130 LAB/190218/0043 108586 NY
MUTIA HAMIDAH .NY Rawat Jalan 18/02/2019 Paid 113.000
R1902180046 LAB/190218/0045 100104 AHADI KESUMA.TN Rawat Jalan 18/02/2019 Process 33.000
R1902180133 LAB/190218/0046 080036 LENNI FERONIKA Rawat Jalan 18/02/2019 Paid 145.000
R1902180021 LAB/190218/0050 105667 SITOHANG.BY.NY
SULAIMAN YUNUS.TN Rawat Jalan 18/02/2019 Paid 33.000
R1901230135 LAB/190218/0054 085703 RAFIDA.NY Rawat Jalan 18/02/2019 Process 33.000
R1901230135 LAB/190218/0056 085703 RAFIDA.NY Rawat Jalan 18/02/2019 Process 33.000
R1902180186 LAB/190218/0058 108950 SORLIANA PURBA. NY Rawat Jalan 18/02/2019 Paid 33.000
R1902180225 LAB/190218/0061 109463 ANNISA PUTRI Rawat Jalan 18/02/2019 Paid 145.000
R1902180227 LAB/190218/0064 109465 AZZAHRA.NN
JUNI FITRI ELIZA.NY Rawat Jalan 18/02/2019 Paid 86.000
R1902180246 LAB/190218/0066 109467 MEGA HOTTARIDA. Rawat Jalan 18/02/2019 Process 33.000
R1902180214 LAB/190218/0068 109458 BY.NY BR
REHNA Rawat Jalan 18/02/2019 Paid 60.000
R1902180263 LAB/190218/0069 109475 PERANGINANGIN.NY
PAULINA SIMANJUNTAK Rawat Jalan 18/02/2019 Paid 40.000
R1902180275 LAB/190218/0072 109478 NY
NUR HALIMAH HASANA. Rawat Jalan 18/02/2019 Paid 65.000
R1902180286 LAB/190218/0080 107045 AN
KASINAH.NY Rawat Jalan 18/02/2019 Paid 33.000
R1902190037 LAB/190219/0012 109017 DWI ATMAJA Rawat Jalan 19/02/2019 Process 45.000
R1902190047 LAB/190219/0014 102256 SEMBIRING.TN
HASNAN SAMOSIR. TN Rawat Jalan 19/02/2019 Paid 33.000
R1902190067 LAB/190219/0018 107226 NGADIRSAN SUSO Rawat Jalan 19/02/2019 Paid 33.000
R1902190104 LAB/190219/0023 100309 PRANOTO. TN
ANY SRI SUSILOWATI.NY Rawat Jalan 19/02/2019 Paid
R1902190109 LAB/190219/0024 104771 TETTI DIANA T .NY Rawat Jalan 19/02/2019 Paid 33.000
R1902190131 LAB/190219/0027 088457 RINA FATRIANA.NY Rawat Jalan 19/02/2019 Paid 40.000
R1902190075 LAB/190219/0033 055776 MURNI.NY Rawat Jalan 19/02/2019 Paid 225.000
R1902190098 LAB/190219/0041 065284 ROHAYATI.NY Rawat Jalan 19/02/2019 Paid 33.000
R1902190108 LAB/190219/0042 109520 MARWAH PUTRI Rawat Jalan 19/02/2019 Paid 145.000
R1902190140 LAB/190219/0043 109530 ANJANI.AN
SYILVIA.NY Rawat Jalan 19/02/2019 Paid 65.000
R1902190173 LAB/190219/0044 069086 IHSAN RADITYA. AN Rawat Jalan 19/02/2019 Paid 65.000
R1902190148 LAB/190219/0047 036049 NUR ASNIL.TN Rawat Jalan 19/02/2019 Paid 33.000
R1902190191 LAB/190219/0048 105507 YUSARNI BINTI Rawat Jalan 19/02/2019 Paid 33.000
R1902180112 LAB/190219/0049 099941 H.MUHAMAD RAIP. NY Rawat
PAINI.NY Jalan 19/02/2019 Paid 33.000
R1902190188 LAB/190219/0050 052360 SRI HARTUTI.NY Rawat Jalan 19/02/2019 Paid 235.000
R1902190021 LAB/190219/0058 108568 ALVIAN MAULANA Rawat Jalan 19/02/2019 Paid 793.000
R1902120017 LAB/190219/0059 086711 SUWANTO.
DZAKY ARYOGOAN Rawat Jalan 19/02/2019 Process 793.000
R1902200008 LAB/190220/0011 107988 ARYANTO.
JULIATI. NYAN Rawat Jalan 20/02/2019 Paid 33.000
R1902200024 LAB/190220/0016 091323 HENDRA ALIMIN.TN Rawat Jalan 20/02/2019 Paid 33.000
R1902200040 LAB/190220/0019 109189 ROBEKKA PURBA.NY Rawat Jalan 20/02/2019 Paid 33.000
R1902200043 LAB/190220/0021 045973 NURHAYATI.NY Rawat Jalan 20/02/2019 Paid 33.000
R1902200044 LAB/190220/0022 109106 SANTY MANALU.NY Rawat Jalan 20/02/2019 Paid 33.000
R1902200055 LAB/190220/0026 109128 SUPINA.NY Rawat Jalan 20/02/2019 Paid 33.000
R1902140010 LAB/190220/0036 109173 ALI SAMBI.TN Rawat Jalan 20/02/2019 Paid 753.000
R1902200073 LAB/190220/0037 085489 YAHMAD.TN Rawat Jalan 20/02/2019 Paid 73.000

PAGE : 19 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902200118 LAB/190220/0043 109600 BRIAN ADVEN Rawat Jalan 20/02/2019 Paid 65.000
R1902200137 LAB/190220/0044 075980 SAMOSIR.ANALFARO
CHRESANO Rawat Jalan 20/02/2019 Paid 65.000
R1902200134 LAB/190220/0045 088934 SIDABUTAR.AN
AHMAD YON.TN Rawat Jalan 20/02/2019 Paid 145.000
R1902200179 LAB/190220/0050 036027 ADHEEVA KHANZA Rawat Jalan 20/02/2019 Paid 40.000
R1902200030 LAB/190220/0054 109575 AZZAHRA.AN
REYNAND AL Rawat Jalan 20/02/2019 Process 80.000
R1902200109 LAB/190220/0055 109574 GHIFARI.AN
JUNAWATI SAMOSIR.NY Rawat Jalan 20/02/2019 Paid 80.000
R1902200160 LAB/190220/0057 098042 ENDANG OKTAVIA.NY Rawat Jalan 20/02/2019 Paid 33.000
R1902200087 LAB/190220/0058 089293 ESRY SIBURIAN.NY Rawat Jalan 20/02/2019 Paid 65.000
R1902200204 LAB/190220/0059 109622 ALIEF SYAH PUTRA AN Rawat Jalan 20/02/2019 Paid 65.000
R1902200209 LAB/190221/0001 107788 ISNAINI. NY Rawat Jalan 21/02/2019 Paid 143.000
R1902200205 LAB/190221/0002 089688 JABHARI.TN Rawat Jalan 21/02/2019 Paid 519.000
R1902210017 LAB/190221/0011 107498 NINGSIH. NY Rawat Jalan 21/02/2019 Paid 33.000
R1902210081 LAB/190221/0021 094901 DULLES SIMBOLON. TN Rawat Jalan 21/02/2019 Paid 33.000
R1902210093 LAB/190221/0023 107580 DONGAN SAIHUTAN Rawat Jalan 21/02/2019 Paid 33.000
R1902210131 LAB/190221/0024 109004 SIHOMBING. TN
KUSDIANTO.TN Rawat Jalan 21/02/2019 Paid 285.000
R1902210092 LAB/190221/0026 108724 TITI SUNARSIH.NY Rawat Jalan 21/02/2019 Paid 33.000
R1902210167 LAB/190221/0030 075980 CHRESANO ALFARO Rawat Jalan 21/02/2019 Paid 65.000
R1902210169 LAB/190221/0041 106244 SIDABUTAR.AN
BUNASI SUSANTO .TN Rawat Jalan 21/02/2019 Paid 80.000
R1902210219 LAB/190221/0042 109678 LIM ENG HOCK. TN Rawat Jalan 21/02/2019 Paid 80.000
R1902210208 LAB/190221/0044 056366 AIKO FATIMAH Rawat Jalan 21/02/2019 Paid 65.000
R1902210216 LAB/190221/0045 022016 AYUDIA.AN
ELSA HANA.AN Rawat Jalan 21/02/2019 Paid 65.000
R1902210248 LAB/190221/0047 091777 ARYAN SEFA.AN Rawat Jalan 21/02/2019 Paid 87.000
R1902220026 LAB/190222/0019 107075 SAURMA BR Rawat Jalan 22/02/2019 Paid 33.000
R1902220090 LAB/190222/0031 109711 NAINGGOLAN. NY
SYAFIRA NUR AFIFAH.AN Rawat Jalan 22/02/2019 Paid 65.000
R1902220099 LAB/190222/0032 071477 HENI MULIANI.NY Rawat Jalan 22/02/2019 Paid 33.000
R1902220114 LAB/190222/0043 109721 HARTI.NY Rawat Jalan 22/02/2019 Paid 40.000
R1902220049 LAB/190222/0048 097769 WARINAH. NY Rawat Jalan 22/02/2019 Paid 40.000
R1902220035 LAB/190222/0049 109698 LAILATUL KHADRI.TN Rawat Jalan 22/02/2019 Paid 80.000
R1902180039 LAB/190222/0050 109402 MUHAMMAD AFIF Rawat Jalan 22/02/2019 Paid 503.000
R1902220139 LAB/190222/0052 109730 SYAKIB. AN
TAMRIN.TN Rawat Jalan 22/02/2019 Paid 80.000
R1902220152 LAB/190222/0053 095351 AGUS SETIA LUKMAN. Rawat Jalan 22/02/2019 Paid 80.000
R1902220100 LAB/190222/0054 079243 TN
ZULARDI Rawat Jalan 22/02/2019 Paid 80.000
R1902220135 LAB/190222/0055 109728 SUKARNO .TN Rawat Jalan 22/02/2019 Paid 80.000
R1902220198 LAB/190222/0062 106071 MUHAMMAD GURUH Rawat Jalan 22/02/2019 Paid 40.000
R1902050038 LAB/190222/0067 104876 SAPUTRA. AN
SURIYANI SYAHRUSA.NY Rawat Jalan 22/02/2019 Process 33.000
R1902230012 LAB/190223/0022 072501 EKO PURNOMO. TN Rawat Jalan 23/02/2019 Paid 33.000
R1902230027 LAB/190223/0025 014449 MARTINI.NY Rawat Jalan 23/02/2019 Paid 33.000
R1902230101 LAB/190223/0041 095102 JON SINTARA Rawat Jalan 23/02/2019 Paid 33.000
R1902230092 LAB/190223/0042 098967 SEMBIRING.TN
IRBAR. TN Rawat Jalan 23/02/2019 Paid 33.000
R1902230123 LAB/190223/0055 094224 LAMEANNA HUTAPEA.NY Rawat Jalan 23/02/2019 Paid 33.000
R1902230116 LAB/190223/0059 109771 ELISA DWI AFIANTI.NY Rawat Jalan 23/02/2019 Paid 60.000
R1902230125 LAB/190223/0060 101286 HENRI TAMBUNAN.TN Rawat Jalan 23/02/2019 Paid 40.000
R1902230124 LAB/190223/0061 092945 MULIA NAPITUPULU.TN Rawat Jalan 23/02/2019 Paid 40.000
R1902230105 LAB/190223/0062 070529 MARTUA MANURUNG. NYRawat Jalan 23/02/2019 Paid 125.000
R1902250018 LAB/190225/0009 028603 MINDAWATI Rawat Jalan 25/02/2019 Paid 33.000
R1902250039 LAB/190225/0012 090143 SEMBIRING.NY
PARJOK.TN Rawat Jalan 25/02/2019 Paid 33.000
R1902250079 LAB/190225/0014 097031 RINALDI. TN Rawat Jalan 25/02/2019 Paid 33.000
R1902250128 LAB/190225/0019 107085 IBNU HAJAR.TN Rawat Jalan 25/02/2019 Paid 33.000
R1902250120 LAB/190225/0021 109825 SAMSUL BAHRI.TN Rawat Jalan 25/02/2019 Paid 65.000
R1902250116 LAB/190225/0027 084037 SAURMA TAMBUNAN.NY Rawat Jalan 25/02/2019 Paid 33.000
R1902250204 LAB/190225/0029 091758 SUKAWI.TN Rawat Jalan 25/02/2019 Paid 33.000
R1902250192 LAB/190225/0030 107001 MASRUKI. TN Rawat Jalan 25/02/2019 Paid 33.000
R1902250201 LAB/190225/0031 088827 YUSTIANA.NY Rawat Jalan 25/02/2019 Paid 33.000
R1902250224 LAB/190225/0032 109858 TAUFIK ISMAIL Rawat Jalan 25/02/2019 Paid 98.000
R1902250187 LAB/190225/0038 109721 SITOMPUL.TN
HARTI.NY Rawat Jalan 25/02/2019 Paid 80.000
R1902250238 LAB/190225/0039 109865 ROYAN SIALLANGAN.TN Rawat Jalan 25/02/2019 Paid 80.000
R1902250249 LAB/190225/0040 109871 ZHAHIRA AL JANNAH.AN Rawat Jalan 25/02/2019 Paid 40.000
R1902250273 LAB/190225/0041 105704 DESI GRACIA Rawat Jalan 25/02/2019 Paid 70.000
R1902250246 LAB/190225/0042 109870 SIAHAAN.AN
FITRI ADRIELLA Rawat Jalan 25/02/2019 Paid 65.000
R1902260035 LAB/190226/0009 104382 SIREGAR.AN
RINA WARTINI.NY Rawat Jalan 26/02/2019 Paid 33.000
R1902200017 LAB/190226/0012 105452 BUNYAMIN WOLIO. TN Rawat Jalan 26/02/2019 Paid 753.000

PAGE : 20 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902260151 LAB/190226/0017 109944 TALENTA Rawat Jalan 26/02/2019 Paid 73.000


R1902260167 LAB/190226/0021 108219 HUTABARAT.NY
AMRAN AMIRUDIN. TN Rawat Jalan 26/02/2019 Paid 40.000
R1902220036 LAB/190226/0024 105557 SUFHIZA ANANDA. AN Rawat Jalan 26/02/2019 Paid 753.000
R1902260192 LAB/190226/0025 109851 CLARA CONI Rawat Jalan 26/02/2019 Paid 60.000
R1902270026 LAB/190227/0011 103928 CONSTANTYA BR.NN
HERMA JUMIATI.NY Rawat Jalan 27/02/2019 Paid 33.000
R1902270060 LAB/190227/0016 091269 SANTI YULIANA SARI. Rawat Jalan 27/02/2019 Paid 65.000
R1902270061 LAB/190227/0017 087966 NY
MIRAWATI.NY Rawat Jalan 27/02/2019 Paid 33.000
R1902270083 LAB/190227/0023 110002 IBNU AMIRUDIN. TN Rawat Jalan 27/02/2019 Paid 33.000
R1902270090 LAB/190227/0025 110005 MELIA OKTA Rawat Jalan 27/02/2019 Paid 33.000
R1902270064 LAB/190227/0029 109994 SURYANIS.NY
MUHAMMAD FADLI.TN Rawat Jalan 27/02/2019 Paid 80.000
R1902270013 LAB/190227/0031 109975 LESTON.TN Rawat Jalan 27/02/2019 Paid 514.000
R1902270075 LAB/190227/0032 109997 MUHAMMAD ARSYAH.AN Rawat Jalan 27/02/2019 Paid 65.000
R1902180046 LAB/190227/0041 100104 AHADI KESUMA.TN Rawat Jalan 27/02/2019 Process 33.000
R1902270097 LAB/190227/0053 088437 M. HANANN AL FATIH. Rawat Jalan 27/02/2019 Process 753.000
R1902270162 LAB/190227/0055 110025 AN
SYARI'AH. NY Rawat Jalan 27/02/2019 Paid 80.000
R1902270024 LAB/190227/0066 089509 REFNETI. NY Rawat Jalan 27/02/2019 Paid 60.000
R1902270246 LAB/190227/0071 086000 ADOL FITER SIHOTANG. Rawat Jalan 27/02/2019 Paid 145.000
R1902270246 LAB/190228/0001 086000 TN
ADOL FITER SIHOTANG. Rawat Jalan 28/02/2019 Paid 40.000
R1902280046 LAB/190228/0018 106283 TN
NORJANAH .NY Rawat Jalan 28/02/2019 Paid 33.000
R1902280076 LAB/190228/0019 096775 GANDA MANGASI Rawat Jalan 28/02/2019 Paid 33.000
R1902280042 LAB/190228/0020 094774 SILABAN.
LUGIA TN
TAMPUBOLON.NY Rawat Jalan 28/02/2019 Paid 33.000
R1902280075 LAB/190228/0023 102086 YOSEPHA NANIK Rawat Jalan 28/02/2019 Paid 33.000
R1902280081 LAB/190228/0024 103647 KUSBANDIYAH.NY
PECK LUAN. NY Rawat Jalan 28/02/2019 Paid 33.000
R1902280114 LAB/190228/0028 103380 DESLELI MARNI.NY Rawat Jalan 28/02/2019 Paid 33.000
R1902280120 LAB/190228/0031 063223 DIAN AURELIA.AN Rawat Jalan 28/02/2019 Paid 65.000
R1902280122 LAB/190228/0035 084709 HERLIN LUMBAN Rawat Jalan 28/02/2019 Paid 65.000
R1902280132 LAB/190228/0036 105551 GAOL.AN
NELDA MAULIA Rawat Jalan 28/02/2019 Paid 65.000
R1902280146 LAB/190228/0037 072104 SALSABILAH.AN
MUHAMMAD RAFIF.AN Rawat Jalan 28/02/2019 Paid 145.000
R1902280079 LAB/190228/0039 084335 RAMLAN Rawat Jalan 28/02/2019 Paid 33.000
R1902280116 LAB/190228/0040 106850 SIMATUPANG,TN
MARYATI PASARIBU. NY Rawat Jalan 28/02/2019 Paid 33.000
R1902280187 LAB/190228/0041 104410 SYARIFAH. NY Rawat Jalan 28/02/2019 Paid 33.000
R1902280034 LAB/190228/0044 090813 JEFRI KADIR. TN Rawat Jalan 28/02/2019 Paid 33.000
R1902280196 LAB/190228/0045 088827 YUSTIANA.NY Rawat Jalan 28/02/2019 Paid 33.000
R1902280211 LAB/190228/0051 107215 SAAFIA Rawat Jalan 28/02/2019 Paid 40.000
R1902280206 LAB/190228/0052 105667 QATRUNNADA.AN
SULAIMAN YUNUS.TN Rawat Jalan 28/02/2019 Paid 33.000
R1901170161 LAB/190228/0053 100063 BARKAH UTAMA AULIA Rawat Jalan 28/02/2019 Paid 65.000
R1902280233 LAB/190228/0056 109636 ISHAK.AN
PUJA SELANY MAY Rawat Jalan 28/02/2019 Paid 40.000
SITORUS.NY
TOTAL PEMERIKSAAN : BPJS KESEHATAN 227.540.000

8 BPJS KESEHATAN COB INHEALTH


R1901310113 LAB/190201/0005 108260NAFISAH SALSABILA.AN Rawat Inap 01/02/2019 Paid 48.750
R1901310113 LAB/190202/0012 108260NAFISAH SALSABILA.AN Rawat Inap 02/02/2019 Paid 48.750
R1901310113 LAB/190203/0009 108260NAFISAH SALSABILA.AN Rawat Inap 03/02/2019 Paid 48.750
R1902030051 LAB/190203/0034 108503SUCI MARCELINA Rawat Inap 03/02/2019 Paid 48.750
R1901310113 LAB/190204/0008 108260EFENDI.NN
NAFISAH SALSABILA.AN Rawat Inap 04/02/2019 Paid 48.750
R1902030051 LAB/190204/0010 108503SUCI MARCELINA Rawat Inap 04/02/2019 Paid 48.750
R1902030051 LAB/190205/0005 108503EFENDI.NN
SUCI MARCELINA Rawat Inap 05/02/2019 Paid 113.250
R1902030051 LAB/190206/0010 108503EFENDI.NN
SUCI MARCELINA Rawat Inap 06/02/2019 Paid 48.750
R1902180034 LAB/190218/0027 094799EFENDI.NNSIAGIAN.NY
SARIANTI Rawat Inap 18/02/2019 Paid 384.750
R1902180034 LAB/190219/0004 094799SARIANTI SIAGIAN.NY Rawat Inap 19/02/2019 Paid 48.750
R1902220164 LAB/190222/0059 025858KRISTINI SRI Rawat Inap 22/02/2019 Paid 48.750
R1902220164 LAB/190222/0061 025858MULYANI.NY
KRISTINI SRI Rawat Inap 22/02/2019 Paid 24.750
R1902220164 LAB/190224/0009 025858MULYANI.NY
KRISTINI SRI Rawat Inap 24/02/2019 Paid 48.750
R1902220164 LAB/190225/0007 025858MULYANI.NY
KRISTINI SRI Rawat Inap 25/02/2019 Paid 311.250
R1902220164 LAB/190225/0028 025858MULYANI.NY
KRISTINI SRI Rawat Inap 25/02/2019 Paid 289.500
MULYANI.NY
TOTAL PEMERIKSAAN : BPJS KESEHATAN COB INHEALTH 1.611.000

9 BPJS KETENAGAKERJAAN
R1902120233 LAB/190212/0038 100334 PINE SUSILAWATI. NN Rawat Inap 12/02/2019 Process 65.000
R1902180015 LAB/190218/0057 109391 SUHARDI Rawat Inap 18/02/2019 Process 65.000
SIHOMBINGH.TN

PAGE : 21 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

TOTAL PEMERIKSAAN : BPJS KETENAGAKERJAAN 130.000

10 HANWHA LIFE
R1902030011 LAB/190203/0013 082021 YAFIQ AHMAD YUSUF Rawat Jalan 03/02/2019 Paid 295.000
NASUTION. AN
TOTAL PEMERIKSAAN : HANWHA LIFE 295.000

11 INHEALTH
R1902220125 LAB/190222/0042 109724 MOCH REHAN Rawat Inap 22/02/2019 Paid 235.000
R1902220181 LAB/190222/0057 109736 DIANSYAH.AN
RASYA ANARGHYA .AN Rawat Inap 22/02/2019 Paid 218.750
R1902220125 LAB/190223/0013 109724 MOCH REHAN Rawat Inap 23/02/2019 Paid 65.000
R1902220125 LAB/190224/0011 109724 DIANSYAH.AN
MOCH REHAN Rawat Inap 24/02/2019 Paid 65.000
R1902220181 LAB/190224/0013 109736 DIANSYAH.AN
RASYA ANARGHYA .AN Rawat Inap 24/02/2019 Paid 48.750
R1902220125 LAB/190225/0004 109724 MOCH REHAN Rawat Inap 25/02/2019 Paid 48.750
R1902260224 LAB/190226/0034 076627 DIANSYAH.AN
NUR PUJI DWI Rawat Inap 26/02/2019 Paid 315.000
R1902020020 LAB/190204/0019 101878 ASTUTI.NY
ANA NUGRAHAENY.NY Rawat Jalan 04/02/2019 Paid 444.750
R1902200063 LAB/190220/0029 092833 SRI MARYATI.NY Rawat Jalan 20/02/2019 Paid 86.000
R1902220204 LAB/190222/0060 109738 HANIN AINAYYA Rawat Jalan 22/02/2019 Paid 48.750
R1902230081 LAB/190223/0036 109738 ZIASRIWAN.AN
HANIN AINAYYA Rawat Jalan 23/02/2019 Paid 48.750
ZIASRIWAN.AN
TOTAL PEMERIKSAAN : INHEALTH 1.624.500

12 JAMPERSAL
R1902230079 LAB/190223/0043 109764 BASITINE LATURE. Rawat Inap 23/02/2019 Process 215.000
R1902230079 LAB/190224/0024 109764 BY.NY
BASITINE LATURE. Rawat Inap 24/02/2019 Process 395.000
R1902230079 LAB/190226/0036 109764 BY.NY
BASITINE LATURE. Rawat Inap 26/02/2019 Process 683.000
R1902230079 LAB/190227/0007 109764 BY.NY
BASITINE LATURE. Rawat Inap 27/02/2019 Process 33.000
R1902230079 LAB/190227/0061 109764 BY.NY
BASITINE LATURE. Rawat Inap 27/02/2019 Process 958.000
R1902230079 LAB/190227/0070 109764 BY.NY
BASITINE LATURE. Rawat Inap 27/02/2019 Process 80.000
R1902230079 LAB/190228/0015 109764 BY.NY
BASITINE LATURE. Rawat Inap 28/02/2019 Process 33.000
BY.NY
TOTAL PEMERIKSAAN : JAMPERSAL 2.397.000

13 KARYAWAN
R1902190170 LAB/190219/0038 EXT DRG ILNA Rawat Jalan 19/02/2019 Process 65.000
TOTAL PEMERIKSAAN : KARYAWAN 65.000

14 PASIEN UMUM
R1901280085 LAB/190201/0007 094079 NG KHON SEN. TN Rawat Inap 01/02/2019 Paid 33.000
R1902010033 LAB/190201/0013 101143 RAHADATUL HALWA. AN Rawat Inap 01/02/2019 Paid 645.000
R1902010054 LAB/190201/0017 108333 LIDYA.NY Rawat Inap 01/02/2019 Paid 410.000
R1901280021 LAB/190202/0038 107976 KENZIE Rawat Inap 02/02/2019 Paid 65.000
R1902020191 LAB/190202/0055 108482 NATHANAEL.M.AN
MECCA VANIA PUTRI. AN Rawat Inap 02/02/2019 Paid 645.000
R1902030032 LAB/190203/0021 054610 SUTRISNO ,TN Rawat Inap 03/02/2019 Paid 98.000
R1902030032 LAB/190203/0022 054610 SUTRISNO ,TN Rawat Inap 03/02/2019 Paid 95.000
R1902030036 LAB/190203/0024 085524 LAURA FEBRIYANI Rawat Inap 03/02/2019 Paid 98.000
R1901280021 LAB/190204/0011 107976 MANURUNG.AN
KENZIE Rawat Inap 04/02/2019 Paid 65.000
R1902040017 LAB/190204/0023 108510 NATHANAEL.M.AN
MAIMUNAH.NY Rawat Inap 04/02/2019 Paid 320.000
R1902050001 LAB/190205/0003 108459 CATHERINE SITOMPUL Rawat Inap 05/02/2019 Paid 898.000
R1902050001 LAB/190205/0010 108459 CATHERINE SITOMPUL Rawat Inap 05/02/2019 Paid 65.000
R1902050011 LAB/190205/0022 101983 INDO TANG. NY Rawat Inap 05/02/2019 Paid 239.000
R1902050019 LAB/190205/0024 108603 YOLANDA Rawat Inap 05/02/2019 Paid 231.000
R1902050021 LAB/190205/0026 108604 SIMANJUNTAK. NN
RAGIL.AN Rawat Inap 05/02/2019 Paid 465.000
R1902050011 LAB/190205/0028 101983 INDO TANG. NY Rawat Inap 05/02/2019 Paid 810.000
R1902050011 LAB/190205/0030 101983 INDO TANG. NY Rawat Inap 05/02/2019 Paid 33.000
R1902050011 LAB/190206/0020 101983 INDO TANG. NY Rawat Inap 06/02/2019 Paid 65.000
R1902050021 LAB/190206/0042 108604 RAGIL.AN Rawat Inap 06/02/2019 Paid 65.000
R1902050021 LAB/190207/0007 108604 RAGIL.AN Rawat Inap 07/02/2019 Paid 65.000
R1902050011 LAB/190207/0015 101983 INDO TANG. NY Rawat Inap 07/02/2019 Paid 65.000
R1902070133 LAB/190207/0022 108508 DIAN KARTIKA SARI.NN Rawat Inap 07/02/2019 Paid 64.000
R1902050021 LAB/190208/0008 108604 RAGIL.AN Rawat Inap 08/02/2019 Paid 65.000
R1902070133 LAB/190208/0009 108508 DIAN KARTIKA SARI.NN Rawat Inap 08/02/2019 Paid 65.000
R1902070133 LAB/190208/0040 108508 DIAN KARTIKA SARI.NN Rawat Inap 08/02/2019 Paid 65.000
R1902100033 LAB/190210/0016 108889 TATI SULASTRI.NY Rawat Inap 10/02/2019 Paid 956.000

PAGE : 22 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902100033 LAB/190210/0017 108889 TATI SULASTRI.NY Rawat Inap 10/02/2019 Paid 64.000
R1902100033 LAB/190211/0014 108889 TATI SULASTRI.NY Rawat Inap 11/02/2019 Paid 65.000
R1902110104 LAB/190212/0008 062083 SURYANTO.TN Rawat Inap 12/02/2019 Paid 645.000
R1902120220 LAB/190212/0035 109074 ALYA CALISTA. AN Rawat Inap 12/02/2019 Paid 235.000
R1902130179 LAB/190213/0047 109156 SUROTO.TN Rawat Inap 13/02/2019 Paid 154.000
R1902130264 LAB/190213/0073 108402 CLAYRINE ALISIA .AN Rawat Inap 13/02/2019 Paid 235.000
R1902130179 LAB/190214/0042 109156 SUROTO.TN Rawat Inap 14/02/2019 Paid 110.000
R1902110104 LAB/190216/0001 062083 SURYANTO.TN Rawat Inap 16/02/2019 Paid 65.000
R1902160080 LAB/190216/0016 109209 MEITRICIA.NY Rawat Inap 16/02/2019 Paid 1.291.000
R1902110104 LAB/190216/0025 062083 SURYANTO.TN Rawat Inap 16/02/2019 Paid 225.000
R1902160123 LAB/190216/0028 109350 INA CASINAH. NY Rawat Inap 16/02/2019 Paid 235.000
R1902160080 LAB/190217/0012 109209 MEITRICIA.NY Rawat Inap 17/02/2019 Paid 700.000
R1902170010 LAB/190217/0016 097779 RAHMADIAH.NY Rawat Inap 17/02/2019 Paid 955.100
R1902160123 LAB/190217/0022 109350 INA CASINAH. NY Rawat Inap 17/02/2019 Paid 65.000
R1902170010 LAB/190217/0023 097779 RAHMADIAH.NY Rawat Inap 17/02/2019 Paid 33.000
R1902170010 LAB/190217/0031 097779 RAHMADIAH.NY Rawat Inap 17/02/2019 Paid 65.000
R1902170037 LAB/190217/0041 109378 GUNAWAN SIREGAR.TN Rawat Inap 17/02/2019 Process 199.000
R1902170037 LAB/190218/0004 109378 GUNAWAN SIREGAR.TN Rawat Inap 18/02/2019 Process 33.000
R1902170037 LAB/190218/0008 109378 GUNAWAN SIREGAR.TN Rawat Inap 18/02/2019 Process 33.000
R1902160123 LAB/190218/0011 109350 INA CASINAH. NY Rawat Inap 18/02/2019 Paid 65.000
R1902170037 LAB/190218/0038 109378 GUNAWAN SIREGAR.TN Rawat Inap 18/02/2019 Process 33.000
R1902170037 LAB/190218/0039 109378 GUNAWAN SIREGAR.TN Rawat Inap 18/02/2019 Process 33.000
R1902170037 LAB/190218/0040 109378 GUNAWAN SIREGAR.TN Rawat Inap 18/02/2019 Process 33.000
R1902170037 LAB/190218/0041 109378 GUNAWAN SIREGAR.TN Rawat Inap 18/02/2019 Process 33.000
R1902170037 LAB/190218/0042 109378 GUNAWAN SIREGAR.TN Rawat Inap 18/02/2019 Process 703.000
R1902170037 LAB/190218/0047 109378 GUNAWAN SIREGAR.TN Rawat Inap 18/02/2019 Process 33.000
R1902170037 LAB/190218/0074 109378 GUNAWAN SIREGAR.TN Rawat Inap 18/02/2019 Process 33.000
R1902170037 LAB/190219/0007 109378 GUNAWAN SIREGAR.TN Rawat Inap 19/02/2019 Process 33.000
R1902110104 LAB/190219/0009 062083 SURYANTO.TN Rawat Inap 19/02/2019 Paid 86.000
R1902170037 LAB/190219/0017 109378 GUNAWAN SIREGAR.TN Rawat Inap 19/02/2019 Process 33.000
R1902190135 LAB/190219/0045 109527 KEYSIA NORFAHHIKA.AN Rawat Inap 19/02/2019 Paid 235.000
R1902170037 LAB/190219/0051 109378 GUNAWAN SIREGAR.TN Rawat Inap 19/02/2019 Process 33.000
R1902170037 LAB/190219/0053 109378 GUNAWAN SIREGAR.TN Rawat Inap 19/02/2019 Process 588.000
R1902170037 LAB/190220/0002 109378 GUNAWAN SIREGAR.TN Rawat Inap 20/02/2019 Process 33.000
R1902110104 LAB/190220/0006 062083 SURYANTO.TN Rawat Inap 20/02/2019 Paid 445.000
R1902170037 LAB/190220/0032 109378 GUNAWAN SIREGAR.TN Rawat Inap 20/02/2019 Process 33.000
R1902200164 LAB/190220/0046 109610 MEDINA JUANSAFA.AN Rawat Inap 20/02/2019 Paid 98.000
R1902170037 LAB/190220/0053 109378 GUNAWAN SIREGAR.TN Rawat Inap 20/02/2019 Process 33.000
R1902190135 LAB/190221/0004 109527 KEYSIA NORFAHHIKA.AN Rawat Inap 21/02/2019 Paid 65.000
R1902170037 LAB/190221/0005 109378 GUNAWAN SIREGAR.TN Rawat Inap 21/02/2019 Process 33.000
R1902170037 LAB/190221/0013 109378 GUNAWAN SIREGAR.TN Rawat Inap 21/02/2019 Process 380.000
R1902200164 LAB/190221/0015 109610 MEDINA JUANSAFA.AN Rawat Inap 21/02/2019 Paid 65.000
R1902110104 LAB/190221/0034 062083 SURYANTO.TN Rawat Inap 21/02/2019 Paid 418.000
R1902210301 LAB/190221/0051 109690 MUTTAMIMATU NY Rawat Inap 21/02/2019 Paid 768.000
R1902220009 LAB/190222/0014 056377 LAMRIA PURBA.NY Rawat Inap 22/02/2019 Paid 600.000
R1902220104 LAB/190222/0036 109716 RENNY LESTARI Rawat Inap 22/02/2019 Paid 600.000
R1902230026 LAB/190223/0032 109751 BUTAR-BUTAR.NY
LEONARD LEDO.TN Rawat Inap 23/02/2019 Paid 412.000
R1902260155 LAB/190226/0018 109945 BY NY DESI AMALIA Rawat Inap 26/02/2019 Paid 33.000
R1902260158 LAB/190226/0019 064633 MAYA YULIANA NST.NY Rawat Inap 26/02/2019 Paid 600.000
R1902260214 LAB/190226/0032 109962 AGUSTINO MARYANO.AN Rawat Inap 26/02/2019 Paid 65.000
R1902270241 LAB/190227/0068 019109 DINA RAHMANIA.AN Rawat Inap 27/02/2019 Paid 455.000
R1902270241 LAB/190228/0059 019109 DINA RAHMANIA.AN Rawat Inap 28/02/2019 Paid 65.000
R1902280256 LAB/190228/0063 109868 ZAKIR RAHMAN.AN Rawat Inap 28/02/2019 Paid 65.000
R1902010063 LAB/190201/0022 108336 ALFIAN KASWARA.TN Rawat Jalan 01/02/2019 Paid 65.000
R1902010108 LAB/190201/0028 054610 SUTRISNO ,TN Rawat Jalan 01/02/2019 Paid 103.000
R1902010161 LAB/190201/0036 EXT NURYANTI Rawat Jalan 01/02/2019 Paid 140.000
R1902010164 LAB/190201/0038 108379 LUKMAN HAKIM.TN Rawat Jalan 01/02/2019 Paid 118.000
R1902010229 LAB/190201/0046 108387 PARIDA.NN Rawat Jalan 01/02/2019 Paid 80.000
R1902010249 LAB/190201/0048 108408 SRI WAHYUNI .NY Rawat Jalan 01/02/2019 Paid 60.000
R1902010235 LAB/190201/0053 108401 SUSANTRI.NY Rawat Jalan 01/02/2019 Paid 60.000
R1902020052 LAB/190202/0035 108429 FATCHUR RAHMAN. TN Rawat Jalan 02/02/2019 Paid 181.000

PAGE : 23 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902020177 LAB/190202/0047 108474 RIRIS ELORIDA Rawat Jalan 02/02/2019 Paid 60.000
R1902020182 LAB/190202/0048 108475 SITOMPUL.NY
HAFIZH ABIYANIQBAL Rawat Jalan 02/02/2019 Paid 145.000
R1809300004 LAB/190202/0050 098991 H.AN TN
SAED. Rawat Jalan 02/02/2019 Paid 45.000
R1902020189 LAB/190202/0054 108480 AHZAREL PAKPAHAN. AN Rawat Jalan 02/02/2019 Paid 415.000
R1902030010 LAB/190203/0018 079990 PRIYANTI MEINATI. NY Rawat Jalan 03/02/2019 Paid 410.000
R1902030026 LAB/190203/0019 108497 SITI NUR SALINAH.NN Rawat Jalan 03/02/2019 Paid 65.000
R1902030044 LAB/190203/0028 108502 NICHOLAS .AN Rawat Jalan 03/02/2019 Paid 415.000
R1902030046 LAB/190203/0030 EXT DEDE WAHYUDIN.TN Rawat Jalan 03/02/2019 Paid 40.000
R1902030047 LAB/190203/0031 EXT SITI HOPSA.NY Rawat Jalan 03/02/2019 Paid 40.000
R1902030045 LAB/190203/0032 104912 HALIJAH. NY Rawat Jalan 03/02/2019 Paid 65.000
R1902030048 LAB/190203/0033 108483 CHAIRANI. NN Rawat Jalan 03/02/2019 Paid 40.000
R1902040095 LAB/190204/0027 108537 SUDIRMAN.TN Rawat Jalan 04/02/2019 Paid 465.000
R1902040188 LAB/190204/0039 EXT MARIANA. NY Rawat Jalan 04/02/2019 Paid 110.000
R1902040193 LAB/190204/0044 108564 MASDA SIREGAR.NY Rawat Jalan 04/02/2019 Paid 40.000
R1902040260 LAB/190204/0056 101669 SYARIFAH FATHIYA Rawat Jalan 04/02/2019 Paid 65.000
R1902040271 LAB/190204/0061 EXT AQILA
NABILA SHAHMINA Rawat Jalan 04/02/2019 Paid 64.000
R1902040291 LAB/190204/0067 108598 ELISABETH Rawat Jalan 04/02/2019 Paid 235.000
R1902050023 LAB/190205/0029 EXT HUTABARAT.AN
RISBON. TN Rawat Jalan 05/02/2019 Paid 64.000
R1902050025 LAB/190205/0035 108606 ZAINAL ARIFIN.TN Rawat Jalan 05/02/2019 Paid 335.000
R1902050027 LAB/190205/0036 EXT RAZZAN ZAKY K.AN Rawat Jalan 05/02/2019 Paid 64.000
R1902050042 LAB/190205/0040 108609 ATTAR RAYYAN Rawat Jalan 05/02/2019 Paid 65.000
R1902060115 LAB/190206/0031 EXT ALFAHRUZI.
ALOYSIUS.TNAN Rawat Jalan 06/02/2019 Paid 60.000
R1902060121 LAB/190206/0032 EXT SEMI.NY Rawat Jalan 06/02/2019 Paid 224.000
R1902060131 LAB/190206/0035 EXT DEWI SARTIKA.NY (DR Rawat Jalan 06/02/2019 Process 885.000
R1902060133 LAB/190206/0036 EXT GUNAWAN )
MANAON.TN Rawat Jalan 06/02/2019 Paid 164.000
R1902060135 LAB/190206/0037 EXT NORAMAH.NY Rawat Jalan 06/02/2019 Paid 224.000
R1902060142 LAB/190206/0039 108664 LUTHER Rawat Jalan 06/02/2019 Paid 33.000
R1902060144 LAB/190206/0040 108665 SIMANUNGKALIT.
ADAM RIANTO. ANTN Rawat Jalan 06/02/2019 Paid 65.000
R1902060132 LAB/190206/0048 029368 LASINEM.NY Rawat Jalan 06/02/2019 Paid 89.000
R1902060188 LAB/190206/0054 108681 TUTI WISNALOISA .NY Rawat Jalan 06/02/2019 Paid 100.000
R1902060184 LAB/190206/0059 108678 KENZI BINTANG Rawat Jalan 06/02/2019 Paid 65.000
R1902060194 LAB/190206/0060 108685 RAMADHAN.HANIFAH
TSURAYYA AN .AN Rawat Jalan 06/02/2019 Process 166.000
R1902060213 LAB/190206/0062 EXT TSURAYYA HANIFAH.AN Rawat Jalan 06/02/2019 Paid 285.000
R1902060214 LAB/190206/0065 108691 RIAN MUTARIADI.TN Rawat Jalan 06/02/2019 Paid 65.000
R1902070137 LAB/190207/0018 108728 AKBAR SULAIMAN Rawat Jalan 07/02/2019 Paid 348.000
R1902070183 LAB/190207/0029 EXT SAMOSIR.TN
MUSLIMMEGI.TN Rawat Jalan 07/02/2019 Process 166.000
R1902070160 LAB/190207/0031 108739 DOHAR.TN Rawat Jalan 07/02/2019 Paid 56.000
R1902070184 LAB/190207/0032 052180 FACRY ADSKA Rawat Jalan 07/02/2019 Paid 65.000
R1902070209 LAB/190207/0040 EXT ARDANI.AN
FLORENTIUS.TN Rawat Jalan 07/02/2019 Paid 380.000
R1902070155 LAB/190207/0045 108241 RAMA.NY Rawat Jalan 07/02/2019 Paid 100.000
R1902080080 LAB/190208/0015 EXT TN.M.YUDI Rawat Jalan 08/02/2019 Paid 350.000
R1902080134 LAB/190208/0022 108807 AFNI HERTAWATI.NN Rawat Jalan 08/02/2019 Paid 65.000
R1902080185 LAB/190208/0029 108826 EMILIA SUSIANA.NY Rawat Jalan 08/02/2019 Paid 65.000
R1902080195 LAB/190208/0038 019240 MAULANA A WALY. AN Rawat Jalan 08/02/2019 Paid 280.000
R1902090072 LAB/190209/0026 108847 ABSON BIN SIDIN.TN Rawat Jalan 09/02/2019 Paid 33.000
R1902090093 LAB/190209/0033 108856 MU'AZ. TN Rawat Jalan 09/02/2019 Paid 33.000
R1902090099 LAB/190209/0034 108860 RINTA YULIATI. NN Rawat Jalan 09/02/2019 Paid 285.000
R1902090109 LAB/190209/0035 EXT RISWANDI. TN Rawat Jalan 09/02/2019 Paid 56.000
R1902090111 LAB/190209/0036 108866 MOHAMMAD AFANDI .TN Rawat Jalan 09/02/2019 Paid 65.000
R1902110039 LAB/190211/0015 108664 LUTHER Rawat Jalan 11/02/2019 Paid 33.000
R1902110091 LAB/190211/0028 108915 SIMANUNGKALIT.
MAHMUD TN
BIN USMAN.TN Rawat Jalan 11/02/2019 Paid 445.000
R1902110012 LAB/190211/0032 047575 MHD.THORIQ Rawat Jalan 11/02/2019 Paid 65.000
R1902110169 LAB/190211/0035 046781 YUDIWANTARA.AN
MARADOP Rawat Jalan 11/02/2019 Paid 125.000
R1902110249 LAB/190211/0053 091263 SIDABUTAR.TN
GALANG SONDANG S TN. Rawat Jalan 11/02/2019 Paid 151.000
R1902110294 LAB/190211/0057 064426 ERLINDA DELIANA Rawat Jalan 11/02/2019 Paid 266.000
R1902110347 LAB/190211/0070 069551 GULTOM,KIRANA.AN
ASSYIFA NY Rawat Jalan 11/02/2019 Paid 375.000
R1902110349 LAB/190211/0072 108890 HENI KUSWITA D.NY Rawat Jalan 11/02/2019 Paid 56.000
R1902120128 LAB/190212/0027 108665 ADAM RIANTO. AN Rawat Jalan 12/02/2019 Paid 65.000
R1902120269 LAB/190213/0003 109086 POLORIDA MARPAUNG. Rawat Jalan 13/02/2019 Paid 280.000
R1902130101 LAB/190213/0037 109123 NY
DEVI EKA SUSANTI.NY Rawat Jalan 13/02/2019 Paid 60.000
R1902130231 LAB/190213/0054 109163 HASNAWATI .NY Rawat Jalan 13/02/2019 Paid 100.000

PAGE : 24 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902130248 LAB/190213/0061 EXT JENRO NABABAN.TN Rawat Jalan 13/02/2019 Paid 350.000
R1902130258 LAB/190213/0067 109168 ARIFIN.TN Rawat Jalan 13/02/2019 Paid 56.000
R1902140051 LAB/190214/0012 EXT AHMAD SUDARMADI.TN Rawat Jalan 14/02/2019 Paid 64.000
R1902140139 LAB/190214/0037 087330 DAVID KALVIN.TN Rawat Jalan 14/02/2019 Paid 33.000
R1902140160 LAB/190214/0041 EXT ADRIAYEL FITA.NY Rawat Jalan 14/02/2019 Paid 202.000
R1902140222 LAB/190214/0055 109225 ENDANG MULYANI.NY Rawat Jalan 14/02/2019 Paid 146.000
R1902150045 LAB/190215/0010 013114 TJEN MAN LIE Rawat Jalan 15/02/2019 Paid 40.000
R1902150139 LAB/190215/0029 075033 RIKA HASPA JUWETI.NY Rawat Jalan 15/02/2019 Paid 711.000
R1902150118 LAB/190215/0032 109260 SYAFRIZAL TN Rawat Jalan 15/02/2019 Paid 33.000
R1902150166 LAB/190215/0041 109280 DARMAWAN TN Rawat Jalan 15/02/2019 Paid 33.000
R1902150182 LAB/190215/0046 109284 NAJYA QIRANI ARIFA. Rawat Jalan 15/02/2019 Paid 235.000
R1902150186 LAB/190215/0047 034290 AN
ZULFITRI. NY Rawat Jalan 15/02/2019 Paid 380.000
R1902150220 LAB/190215/0050 EXT DESMAWATI Rawat Jalan 15/02/2019 Paid 832.000
R1902150221 LAB/190215/0051 EXT YUSHENDRA Rawat Jalan 15/02/2019 Paid 64.000
R1902160084 LAB/190216/0020 109331 FARAH AZZAHRA Rawat Jalan 16/02/2019 Paid 341.000
R1902160087 LAB/190216/0022 109332 AMADHINA AN NY
RETNO DUMILAH Rawat Jalan 16/02/2019 Paid 56.000
R1902170020 LAB/190217/0021 109369 NABIL ANUGRAH. AN Rawat Jalan 17/02/2019 Paid 65.000
R1902170045 LAB/190217/0038 109380 TAMRIN. TN Rawat Jalan 17/02/2019 Paid 146.000
R1902170046 LAB/190217/0039 015389 FIRMAN LESMANA, TN Rawat Jalan 17/02/2019 Paid 235.000
R1902180092 LAB/190218/0029 EXT MARDINUPU.TN Rawat Jalan 18/02/2019 Paid 350.000
R1902180135 LAB/190218/0036 EXT ELYA.S.NY Rawat Jalan 18/02/2019 Paid 56.000
R1902180100 LAB/190218/0037 090143 PARJOK.TN Rawat Jalan 18/02/2019 Paid 98.000
R1902180273 LAB/190218/0071 109477 ABIYYU YUSUF. AN Rawat Jalan 18/02/2019 Paid 235.000
R1902180279 LAB/190218/0077 109479 WARSI. NY Rawat Jalan 18/02/2019 Paid 65.000
R1902180307 LAB/190218/0082 043035 SITI MUTMAINNAH. NN Rawat Jalan 18/02/2019 Paid 595.000
R1902190063 LAB/190219/0016 109504 NAFISAH ZASKIA Rawat Jalan 19/02/2019 Paid 285.000
R1902190065 LAB/190219/0019 109505 ALFATH.AN
SANUSI.TN Rawat Jalan 19/02/2019 Paid 103.000
R1902190078 LAB/190219/0031 109509 KALIMUDA SINAGA.TN Rawat Jalan 19/02/2019 Paid 121.000
R1902190096 LAB/190219/0034 109517 HENDRY MANFEK.TN Rawat Jalan 19/02/2019 Paid 287.000
R1902190040 LAB/190219/0036 109496 VERONICA.AN Rawat Jalan 19/02/2019 Paid 65.000
R1902190138 LAB/190219/0039 109529 ALBERK Rawat Jalan 19/02/2019 Paid 65.000
R1902190103 LAB/190219/0046 109518 SIMANJUNTAK.AN
WANIA ULFA.AN Rawat Jalan 19/02/2019 Paid 235.000
R1902190275 LAB/190219/0071 109569 ZAIDIL FADLI. TN Rawat Jalan 19/02/2019 Paid 250.000
R1902200058 LAB/190220/0028 109584 ARIDAH.NY Rawat Jalan 20/02/2019 Paid 100.000
R1902210009 LAB/190221/0012 109624 SRI MEI Rawat Jalan 21/02/2019 Paid 100.000
R1902210009 LAB/190221/0014 109624 YUDIHERVIANA.NY
SRI MEI Rawat Jalan 21/02/2019 Paid 65.000
R1902210091 LAB/190221/0028 109646 YUDIHERVIANA.NY
BUNGA.NY Rawat Jalan 21/02/2019 Paid 100.000
R1902210175 LAB/190221/0035 EXT ROHANA Rawat Jalan 21/02/2019 Paid 60.000
R1902210178 LAB/190221/0036 EXT YETI DURYATI Rawat Jalan 21/02/2019 Paid 164.000
R1902210189 LAB/190221/0039 109673 SUSI SANTI SITOMPUL. Rawat Jalan 21/02/2019 Paid 65.000
R1902210283 LAB/190221/0048 109686 NY
GINTA WIRANANDA. NY Rawat Jalan 21/02/2019 Paid 100.000
R1902210294 LAB/190221/0049 EXT ASNEL MUIS.NY Rawat Jalan 21/02/2019 Paid 380.000
R1902210309 LAB/190221/0054 099249 DHEA ASIH TRIANI.NY Rawat Jalan 21/02/2019 Paid 235.000
R1902220051 LAB/190222/0024 109700 KAHAR.TN Rawat Jalan 22/02/2019 Paid 98.000
R1902220079 LAB/190222/0025 EXT EDISON.TN Rawat Jalan 22/02/2019 Paid 224.000
R1902220091 LAB/190222/0033 109712 MUHAMMAD ZARIL . AN Rawat Jalan 22/02/2019 Paid 699.000
R1902220110 LAB/190222/0039 EXT DAVID KALVIN.TN Rawat Jalan 22/02/2019 Paid 33.000
R1902220224 LAB/190222/0063 EXT ATIKA RAHMA DINI.AN Rawat Jalan 22/02/2019 Paid 65.000
R1902220230 LAB/190222/0068 EXT SOPIA NUR AKILA.AN Rawat Jalan 22/02/2019 Paid 380.000
R1902220145 LAB/190222/0071 031295 LESTINA HUTA Rawat Jalan 22/02/2019 Paid 100.000
R1902220233 LAB/190222/0073 109742 GALUNG.NY TANDUK.TN
ALEXANDER Rawat Jalan 22/02/2019 Paid 813.000
R1902230115 LAB/190223/0053 109770 GLEN NABABAN.AN Rawat Jalan 23/02/2019 Paid 65.000
R1902230144 LAB/190223/0065 EXT SUGIARTO. TN Rawat Jalan 23/02/2019 Paid 350.000
R1902240010 LAB/190224/0014 EXT DAVID KALVIN.TN Rawat Jalan 24/02/2019 Paid 33.000
R1902240041 LAB/190224/0027 109790 NURSYAH PURBA.NY Rawat Jalan 24/02/2019 Paid 330.000
R1902250202 LAB/190225/0026 087330 DAVID KALVIN.TN Rawat Jalan 25/02/2019 Paid 33.000
R1902250015 LAB/190225/0049 035249 LINA .NY Rawat Jalan 25/02/2019 Paid 100.000
R1902260202 LAB/190226/0026 EXT AJIRNI NY Rawat Jalan 26/02/2019 Paid 380.000
R1902260217 LAB/190226/0029 109964 OSTINA TAMBUNAN. NY Rawat Jalan 26/02/2019 Paid 98.000
R1902270104 LAB/190227/0034 110010 HERLINA MANULLANG Rawat Jalan 27/02/2019 Paid 65.000
R1902270151 LAB/190227/0036 EXT NUR PUJI DWI Rawat Jalan 27/02/2019 Paid 535.000
ASTUTI.NY
PAGE : 25 of 26
LIST REKAP PASIEN LABORATORIUM -GROUP JAMINAN

TANGGAL 01/02/2019 s/d 28/02/2019

NO. REGNO NO.LAB MEDREC NAMA PASIEN KATEGORI TGL PERIKSA STATUS BIAYA

R1902270226 LAB/190227/0062 110041 DUKI.TN Rawat Jalan 27/02/2019 Paid 478.000


R1902270228 LAB/190227/0063 110043 FANIA AULIA.AN Rawat Jalan 27/02/2019 Paid 235.000
R1902280037 LAB/190228/0012 EXT DAVID KALVIN.TN Rawat Jalan 28/02/2019 Paid 33.000
R1902280068 LAB/190228/0017 EXT BAKRI.TN Rawat Jalan 28/02/2019 Paid 33.000
R1902280063 LAB/190228/0026 110060 CIPTA ARTA.NY Rawat Jalan 28/02/2019 Paid 225.000
R1902280153 LAB/190228/0029 EXT SUNIR.TN Rawat Jalan 28/02/2019 Paid 350.000
R1902280161 LAB/190228/0038 110094 ULYA IZZATUNNISA. AN Rawat Jalan 28/02/2019 Paid 65.000
R1902280134 LAB/190228/0047 110079 SYURA ASYAKTIYANI.AN Rawat Jalan 28/02/2019 Paid 221.000
TOTAL PEMERIKSAAN : PASIEN UMUM 44.426.100

15 PT. ADMEDIKA SOMPO


R1902150205 LAB/190215/0049 095686 OKKY PRAMUDIA Rawat Inap 15/02/2019 Paid 768.000
DEVI.NY
TOTAL PEMERIKSAAN : PT. ADMEDIKA SOMPO 768.000

16 PT. AJ CENTRAL ASIA RAYA


R1902150181 LAB/190215/0045 062041 ALFINA LAHAL. NY Rawat Jalan 15/02/2019 Paid 380.000
TOTAL PEMERIKSAAN : PT. AJ CENTRAL ASIA RAYA 380.000

17 PT. FWD LIFE INDONESIA


R1902110080 LAB/190211/0029 080749 NINIK SUNARSIH.NY Rawat Jalan 11/02/2019 Paid 445.000
TOTAL PEMERIKSAAN : PT. FWD LIFE INDONESIA 445.000

18 PT. JASA RAHARJA


R1902190010 LAB/190219/0020 109492 DIAN ADINATA Rawat Inap 19/02/2019 Paid 65.000
PAKPAHAN. TN
TOTAL PEMERIKSAAN : PT. JASA RAHARJA 65.000

19 PT. KIMIA FARMA


R1902230137 LAB/190224/0002 098404 RIYA ANGGRAENI.NY Rawat Inap 24/02/2019 Paid 410.000
R1902230137 LAB/190224/0004 098404 RIYA ANGGRAENI.NY Rawat Inap 24/02/2019 Paid 15.500
R1902230137 LAB/190224/0008 098404 RIYA ANGGRAENI.NY Rawat Inap 24/02/2019 Paid 98.000
TOTAL PEMERIKSAAN : PT. KIMIA FARMA 523.500

20 PT. MITRA ENERGI


R1902200003 LAB/190220/0001 050759 VIONA ANA MARIA S.AN Rawat Inap 20/02/2019 Paid 65.000
R1902210012 LAB/190221/0027 044502 MARVEL REZA .AN Rawat Inap 21/02/2019 Paid 65.000
R1902270183 LAB/190227/0054 083060 SURYANI CHRISTINE. AN Rawat Inap 27/02/2019 Paid 65.000
R1902040035 LAB/190204/0043 046852 JUMAIYAH.NY Rawat Jalan 04/02/2019 Paid 389.000
R1902190074 LAB/190219/0030 083060 SURYANI CHRISTINE. AN Rawat Jalan 19/02/2019 Paid 465.000
R1902230039 LAB/190223/0029 039391 RATIH ZULAIKA. NY Rawat Jalan 23/02/2019 Paid 65.000
TOTAL PEMERIKSAAN : PT. MITRA ENERGI 1.114.000

21 PT. OWLEXA
R1902260032 LAB/190226/0007 049667 NOEL ADRIAN Rawat Inap 26/02/2019 Paid 753.000
R1902270121 LAB/190227/0030 086651 SIMANJUNTAK.AN
SUPARMANTO. TN Rawat Jalan 27/02/2019 Paid 235.000
TOTAL PEMERIKSAAN : PT. OWLEXA 988.000

22 RUBYCON
R1902170036 LAB/190217/0036 052390 DANIEL TIGOR.TN Rawat Jalan 17/02/2019 Paid 287.000
TOTAL PEMERIKSAAN : RUBYCON 287.000

23 YOKOHAMA INDUSTRIAL
R1902070197 LAB/190207/0037 108704 NIKMAWATI.NY Rawat Inap 07/02/2019 Paid 600.000
R1902070197 LAB/190207/0039 108704 NIKMAWATI.NY Rawat Inap 07/02/2019 Paid 64.000
R1902070197 LAB/190208/0002 108704 NIKMAWATI.NY Rawat Inap 08/02/2019 Paid 65.000
R1902070197 LAB/190208/0018 108704 NIKMAWATI.NY Rawat Inap 08/02/2019 Paid 33.000
R1902040116 LAB/190204/0033 108544 MOCHAMMAD Rawat Jalan 04/02/2019 Paid 465.000
FIRMANSYAH
TOTAL PEMERIKSAAN : YOKOHAMA INDUSTRIAL 1.227.000

GRAND TOTAL : 292.203.100

PAGE : 26 of 26