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LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

1 RAWAT INAP
R1901010005 LAB/190101/0001 106461 SYAMSUDIN SIRINGO BPJS KESEHATAN 01/01/2019 Paid 269.000
R1812300038 LAB/190101/0005 057338 RINGO.
ARIQ TN
ABQARI PT. ADMEDIKA 01/01/2019 Paid 65.000
R1812310023 LAB/190101/0006 104920 RAHANDIKA.AN
FERONIKA YARNIDA GENERALI
BPJS KESEHATAN 01/01/2019 Paid 323.000
R1812310092 LAB/190101/0007 106417 ZAGOTO.
EMMI NY LUBIS. NY BPJS KESEHATAN
KALSUM 01/01/2019 Paid 65.000
R1812300040 LAB/190101/0008 092293 ELIEZAR SIHOMBING. ANPT. ADMEDIKA 01/01/2019 Paid 65.000
R1812220115 LAB/190101/0009 105632 M. ZIKKI AMRULLAH .AN GENERALI
BPJS KESEHATAN 01/01/2019 Paid 33.000
R1812270319 LAB/190101/0010 106176 ABDUL KHALED BPJS KESEHATAN 01/01/2019 Paid 33.000
R1901010011 LAB/190101/0011 106464 ARRAZZAQ
YOGO RAYVANS.ANAN BPJS KESEHATAN
PAMUNGKAS. 01/01/2019 Paid 65.000
R1901010016 LAB/190101/0016 106467 NOVEL ARITONANG.TN PASIEN UMUM 01/01/2019 Paid 385.000
R1901010026 LAB/190101/0020 106473 YAUMI ISTIQLALIAH.AN PASIEN UMUM 01/01/2019 Paid 65.000
R1901010034 LAB/190101/0021 106474 YASINTA TUE. NY PASIEN UMUM 01/01/2019 Paid 348.000
R1901010033 LAB/190101/0022 047688 DWI HASTUTI.NY PASIEN UMUM 01/01/2019 Paid 65.000
R1901010040 LAB/190101/0024 106478 GLADYS ANASTASYA. NY PASIEN UMUM 01/01/2019 Paid 145.000
R1901010040 LAB/190102/0001 106478 GLADYS ANASTASYA. NY PASIEN UMUM 02/01/2019 Paid 350.000
R1812260232 LAB/190102/0002 106043 AIZA AZKIA .AN BPJS KESEHATAN 02/01/2019 Paid 65.000
R1901010016 LAB/190102/0003 106467 NOVEL ARITONANG.TN PASIEN UMUM 02/01/2019 Paid 151.000
R1901010005 LAB/190102/0004 106461 SYAMSUDIN SIRINGO BPJS KESEHATAN 02/01/2019 Paid 323.000
R1812290200 LAB/190102/0006 095832 RINGO.
ASNIZAR.TNNY BPJS KESEHATAN 02/01/2019 Paid 250.000
R1901020018 LAB/190102/0007 106485 NOVARIA.NY PASIEN UMUM 02/01/2019 Paid 470.000
R1812270319 LAB/190102/0009 106176 ABDUL KHALED BPJS KESEHATAN 02/01/2019 Paid 33.000
R1812220115 LAB/190102/0010 105632 ARRAZZAQ
M. RAYVANS..AN
ZIKKI AMRULLAH AN BPJS KESEHATAN 02/01/2019 Paid 33.000
R1901010026 LAB/190102/0014 106473 YAUMI ISTIQLALIAH.AN PASIEN UMUM 02/01/2019 Paid 65.000
R1901010011 LAB/190102/0022 106464 YOGO PAMUNGKAS. AN BPJS KESEHATAN 02/01/2019 Paid 500.000
R1901020091 LAB/190102/0023 018142 RUSMIN PANE,NY PASIEN UMUM 02/01/2019 Paid 428.000
R1901030002 LAB/190103/0001 103220 MAHENA BR GINTING.NY ASURANSI RELIANCE 03/01/2019 Paid 503.000
R1901010026 LAB/190103/0002 106473 YAUMI ISTIQLALIAH.AN PASIEN UMUM 03/01/2019 Paid 65.000
R1901010016 LAB/190103/0003 106467 NOVEL ARITONANG.TN PASIEN UMUM 03/01/2019 Paid 160.000
R1901030004 LAB/190103/0004 106520 RIKA WAHYUNI PASIEN UMUM 03/01/2019 Paid 410.000
R1812260232 LAB/190103/0005 106043 SIREGAR.
AIZA AZKIANY.AN BPJS KESEHATAN 03/01/2019 Paid 65.000
R1901030009 LAB/190103/0006 106523 UCI SUTRIYANI.NY PASIEN UMUM 03/01/2019 Paid 503.000
R1901030021 LAB/190103/0007 106521 RIKA WAHYUNI PASIEN UMUM 03/01/2019 Paid 103.000
R1812270319 LAB/190103/0010 106176 SIREGAR. BY NY
ABDUL KHALED BPJS KESEHATAN 03/01/2019 Paid 33.000
R1812220115 LAB/190103/0011 105632 ARRAZZAQ
M. RAYVANS..AN
ZIKKI AMRULLAH AN BPJS KESEHATAN 03/01/2019 Paid 33.000
R1901030002 LAB/190103/0014 103220 MAHENA BR GINTING.NY ASURANSI RELIANCE 03/01/2019 Paid 65.000
R1901030002 LAB/190103/0016 103220 MAHENA BR GINTING.NY ASURANSI RELIANCE 03/01/2019 Paid 40.000
R1812270319 LAB/190103/0020 106176 ABDUL KHALED BPJS KESEHATAN 03/01/2019 Paid 840.000
R1901010016 LAB/190103/0022 106467 ARRAZZAQ RAYVANS. AN PASIEN UMUM
NOVEL ARITONANG.TN 03/01/2019 Paid 350.000
R1901030009 LAB/190103/0023 106523 UCI SUTRIYANI.NY PASIEN UMUM 03/01/2019 Paid 65.000
R1901030141 LAB/190103/0025 101310 RUSMALA DEWI.NY PANTI ASUHAN 03/01/2019 Process 65.000
R1901030144 LAB/190103/0027 106562 ERWIN HASIBUAN. TN PASIEN UMUM 03/01/2019 Paid 958.000
R1901040004 LAB/190104/0001 031320 NURHABIBAH.NY ASURANSI RELIANCE 04/01/2019 Paid 410.000
R1901010026 LAB/190104/0002 106473 YAUMI ISTIQLALIAH.AN PASIEN UMUM 04/01/2019 Paid 65.000
R1812260232 LAB/190104/0003 106043 AIZA AZKIA .AN BPJS KESEHATAN 04/01/2019 Paid 65.000
R1901030144 LAB/190104/0004 106562 ERWIN HASIBUAN. TN PASIEN UMUM 04/01/2019 Paid 350.000
R1901040004 LAB/190104/0005 031320 NURHABIBAH.NY ASURANSI RELIANCE 04/01/2019 Paid 33.000
R1901040054 LAB/190104/0007 106582 HOTNIDA BR PASIEN UMUM 04/01/2019 Paid 315.000
R1812220115 LAB/190104/0008 105632 MANURUNG
M. .NY
ZIKKI AMRULLAH .AN BPJS KESEHATAN 04/01/2019 Paid 33.000
R1812270319 LAB/190104/0009 106176 ABDUL KHALED BPJS KESEHATAN 04/01/2019 Paid 33.000
R1901040105 LAB/190104/0016 074525 ARRAZZAQ
SISYANTO,TNRAYVANS. AN PASIEN UMUM 04/01/2019 Paid 65.000
R1901010016 LAB/190105/0002 106467 NOVEL ARITONANG.TN PASIEN UMUM 05/01/2019 Paid 151.000
R1812270319 LAB/190105/0010 106176 ABDUL KHALED BPJS KESEHATAN 05/01/2019 Paid 33.000
R1812170378 LAB/190105/0011 105345 ARRAZZAQ
NELLI RAYVANS. AN BPJS KESEHATAN
ULPATUNNISA 05/01/2019 Paid 406.600
R1812220115 LAB/190105/0012 105632 H.BY
M. ZIKKI AMRULLAH .AN BPJS KESEHATAN 05/01/2019 Paid 33.000
R1901050062 LAB/190105/0013 106620 NAJWA FARRAS. AN PASIEN UMUM 05/01/2019 Paid 295.000
R1901050065 LAB/190105/0014 106621 SITI FATHONAH.NN PASIEN UMUM 05/01/2019 Paid 295.000
R1812170378 LAB/190105/0016 105345 NELLI ULPATUNNISA BPJS KESEHATAN 05/01/2019 Paid 76.000
R1901050092 LAB/190105/0021 106632 H.BY
STANLEY TAYLOR.AN PASIEN UMUM 05/01/2019 Paid 798.000
R1901050092 LAB/190105/0022 106632 STANLEY TAYLOR.AN PASIEN UMUM 05/01/2019 Paid 40.000
R1812270319 LAB/190105/0023 106176 ABDUL KHALED BPJS KESEHATAN 05/01/2019 Paid 415.000
ARRAZZAQ RAYVANS. AN
PAGE : 1 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901060003 LAB/190106/0002 106638 OLIA MERSI.NY PT. INFINEON 06/01/2019 Paid 503.000
R1812260232 LAB/190106/0003 106043 AIZA AZKIA .AN TECHNOLOGIES
BPJS KESEHATAN 06/01/2019 Paid 65.000
R1901050092 LAB/190106/0004 106632 STANLEY TAYLOR.AN PASIEN UMUM 06/01/2019 Paid 250.000
R1901050065 LAB/190106/0009 106621 SITI FATHONAH.NN PASIEN UMUM 06/01/2019 Paid 65.000
R1901060003 LAB/190106/0010 106638 OLIA MERSI.NY PT. INFINEON 06/01/2019 Paid 65.000
R1812220115 LAB/190106/0013 105632 M. ZIKKI AMRULLAH .AN TECHNOLOGIES
BPJS KESEHATAN 06/01/2019 Paid 33.000
R1812270319 LAB/190106/0014 106176 ABDUL KHALED BPJS KESEHATAN 06/01/2019 Paid 33.000
R1901070003 LAB/190107/0001 023048 ARRAZZAQ
KAMAL RAYVANS.
HARIS ,TN AN PASIEN UMUM 07/01/2019 Paid 776.000
R1901070033 LAB/190107/0005 106666 SEPTI SAVITRI. NY PASIEN UMUM 07/01/2019 Paid 503.000
R1901070003 LAB/190107/0009 023048 KAMAL HARIS ,TN PASIEN UMUM 07/01/2019 Paid 33.000
R1901070077 LAB/190107/0013 103644 SARIMAN. TN PASIEN UMUM 07/01/2019 Paid 98.000
R1812270319 LAB/190107/0018 106176 ABDUL KHALED BPJS KESEHATAN 07/01/2019 Paid 488.000
R1812170378 LAB/190107/0023 105345 ARRAZZAQ
NELLI RAYVANS. AN BPJS KESEHATAN
ULPATUNNISA 07/01/2019 Paid 31.350
R1812170378 LAB/190107/0024 105345 H.BY ULPATUNNISA
NELLI BPJS KESEHATAN 07/01/2019 Paid 31.350
R1812170378 LAB/190108/0001 105345 H.BY ULPATUNNISA
NELLI BPJS KESEHATAN 08/01/2019 Paid 31.350
R1812170378 LAB/190108/0002 105345 H.BY
NELLI ULPATUNNISA BPJS KESEHATAN 08/01/2019 Paid 31.350
R1812260232 LAB/190108/0004 106043 H.BY
AIZA AZKIA .AN BPJS KESEHATAN 08/01/2019 Paid 65.000
R1812170378 LAB/190108/0005 105345 NELLI ULPATUNNISA BPJS KESEHATAN 08/01/2019 Paid 31.350
R1812170378 LAB/190108/0006 105345 H.BY ULPATUNNISA
NELLI BPJS KESEHATAN 08/01/2019 Paid 31.350
R1901070077 LAB/190108/0012 103644 H.BY
SARIMAN. TN PASIEN UMUM 08/01/2019 Paid 1.000.000
R1812270319 LAB/190108/0015 106176 ABDUL KHALED BPJS KESEHATAN 08/01/2019 Paid 80.000
R1901080059 LAB/190108/0016 049535 ARRAZZAQ RAYVANS. AN RUBYCON
RATNA WULANDARI.NY 08/01/2019 Paid 385.000
R1901080107 LAB/190108/0018 106720 ANITA SIMANJUNTAK PASIEN UMUM 08/01/2019 Paid 65.000
R1901080123 LAB/190108/0024 106725 .AN
DEVIKA SRUTHIYANTI. PASIEN UMUM 08/01/2019 Paid 40.000
R1901080123 LAB/190108/0026 106725 NN
DEVIKA SRUTHIYANTI. PASIEN UMUM 08/01/2019 Paid 70.000
R1901080124 LAB/190108/0027 106726 NN
MERINA KRISNAYANTI. PASIEN UMUM 08/01/2019 Paid 470.000
R1812270319 LAB/190108/0030 106176 NY
ABDUL KHALED BPJS KESEHATAN 08/01/2019 Paid 428.000
R1812270319 LAB/190108/0031 106176 ARRAZZAQ
ABDUL KHALEDRAYVANS. AN BPJS KESEHATAN 08/01/2019 Paid 33.000
R1812270319 LAB/190109/0001 106176 ARRAZZAQ
ABDUL KHALEDRAYVANS. AN BPJS KESEHATAN 09/01/2019 Paid 113.000
R1901090003 LAB/190109/0002 039506 ARRAZZAQ
ABBYASA KIANRAYVANS. AN PT. MITRA ENERGI 09/01/2019 Paid 65.000
R1901050092 LAB/190109/0003 106632 ALVARO.AN
STANLEY TAYLOR.AN PASIEN UMUM 09/01/2019 Paid 65.000
R1901090007 LAB/190109/0004 034231 ELMIDAWATI SIREGAR PT. MITRA ENERGI 09/01/2019 Paid 295.000
R1812270319 LAB/190109/0012 106176 ABDUL KHALED BPJS KESEHATAN 09/01/2019 Paid 33.000
R1901090044 LAB/190109/0016 106750 ARRAZZAQ RAYVANS. AN PASIEN UMUM
LILIS RUSMIATI.NY 09/01/2019 Paid 410.000
R1707260080 LAB/190109/0037 075715 DINI PUTRIANI.NY BPJS KESEHATAN 09/01/2019 Paid 80.000
R1901100002 LAB/190110/0001 028726 FADHILAH DHINI. NY PT. INFINEON 10/01/2019 Paid 503.000
R1812260232 LAB/190110/0002 106043 AIZA AZKIA .AN TECHNOLOGIES
BPJS KESEHATAN 10/01/2019 Paid 65.000
R1901100050 LAB/190110/0011 081660 DIRKA SOLIHAT. TN ASURANSI RELIANCE 10/01/2019 Paid 65.000
R1812270319 LAB/190110/0015 106176 ABDUL KHALED BPJS KESEHATAN 10/01/2019 Paid 33.000
R1901100072 LAB/190110/0016 106795 ARRAZZAQ RAYVANS. AN BPJS KESEHATAN
RIKA SRIYANI.NY 10/01/2019 Paid 470.000
R1901100002 LAB/190110/0018 028726 FADHILAH DHINI. NY PT. INFINEON 10/01/2019 Paid 65.000
R1901100085 LAB/190110/0019 084138 ANDREANSYAH. AN TECHNOLOGIES
BPJS KESEHATAN 10/01/2019 Paid 65.000
R1812200115 LAB/190110/0021 105587 RADIYATUL AFIF. AN BPJS KESEHATAN 10/01/2019 Paid 753.000
R1901100101 LAB/190110/0025 029700 ZIBRAN DIVO ALVARO BPJS KESEHATAN 10/01/2019 Paid 145.000
R1901100120 LAB/190110/0028 106807 LUBIS.AN
RIKA SRIYANI.BY.NY BPJS KESEHATAN 10/01/2019 Paid 33.000
R1901100103 LAB/190110/0030 104346 SUPARNADI . TN BPJS KESEHATAN 10/01/2019 Paid 873.000
R1812270319 LAB/190110/0033 106176 ABDUL KHALED BPJS KESEHATAN 10/01/2019 Paid 65.000
R1901110001 LAB/190111/0001 106822 ARRAZZAQ
SULASTRI.NY RAYVANS. AN PASIEN UMUM 11/01/2019 Paid 295.000
R1901110001 LAB/190111/0002 106822 SULASTRI.NY PASIEN UMUM 11/01/2019 Paid 40.000
R1901110003 LAB/190111/0003 079058 INDIRA CINDY MALLINI. BPJS KESEHATAN 11/01/2019 Paid 65.000
R1901110042 LAB/190111/0014 106834 AN PANI. NY
SRI BPJS KESEHATAN 11/01/2019 Paid 65.000
R1901110048 LAB/190111/0015 058645 MUHAMMAD AFANDI.TN PASIEN UMUM 11/01/2019 Paid 385.000
R1901110095 LAB/190111/0022 106854 DINA ULI BASA SIAGIAN. BPJS KESEHATAN 11/01/2019 Paid 503.000
R1901110098 LAB/190111/0027 106857 NY
ESLA NAIGGOLAN.NY PASIEN UMUM 11/01/2019 Paid 65.000
R1901110122 LAB/190111/0038 106864 RR. SRI UTAMI .NY BPJS KESEHATAN 11/01/2019 Paid 65.000
R1901110122 LAB/190111/0039 106864 RR. SRI UTAMI .NY BPJS KESEHATAN 11/01/2019 Paid 80.000
R1901110001 LAB/190111/0041 106822 SULASTRI.NY PASIEN UMUM 11/01/2019 Paid 65.000
R1901110147 LAB/190111/0042 106867 DINA ULI BASA SIAGIAN. BPJS KESEHATAN 11/01/2019 Paid 33.000
R1901110151 LAB/190111/0045 091825 BY NY
THERESA TULUS. NY BPJS KESEHATAN 11/01/2019 Paid 503.000
R1901110131 LAB/190111/0046 106866 MONICA NOVENA PUTRI BPJS KESEHATAN 11/01/2019 Paid 145.000
R1812270319 LAB/190111/0047 106176 MBATO.AN
ABDUL KHALED BPJS KESEHATAN 11/01/2019 Paid 33.000
ARRAZZAQ RAYVANS. AN
PAGE : 2 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901110164 LAB/190111/0050 003615 PUTRI ARDIYANI BPJS KESEHATAN 11/01/2019 Paid 65.000
R1901110095 LAB/190111/0051 106854 LESMANA,NY
DINA ULI BASA SIAGIAN. BPJS KESEHATAN 11/01/2019 Paid 65.000
R1901100103 LAB/190111/0052 104346 NY
SUPARNADI . TN BPJS KESEHATAN 11/01/2019 Paid 315.000
R1901100103 LAB/190111/0053 104346 SUPARNADI . TN BPJS KESEHATAN 11/01/2019 Paid 700.000
R1901110168 LAB/190111/0056 106879 MERY J HUTAURUK.NY BPJS KESEHATAN 11/01/2019 Paid 65.000
R1901110151 LAB/190111/0057 091825 THERESA TULUS. NY BPJS KESEHATAN 11/01/2019 Paid 44.100
R1901110180 LAB/190111/0058 106886 LUSIANA SILABAN.NY BPJS KESEHATAN 11/01/2019 Paid 65.000
R1901110028 LAB/190111/0060 093398 VERAWATI PASIEN UMUM 11/01/2019 Paid 470.000
R1901110188 LAB/190111/0063 106888 SIHOMBING.NY
POLTAK SILALAHI.TN PASIEN UMUM 11/01/2019 Paid 495.000
R1901110028 LAB/190112/0001 093398 VERAWATI PASIEN UMUM 12/01/2019 Paid 33.000
R1901110131 LAB/190112/0002 106866 SIHOMBING.NY
MONICA NOVENA PUTRI BPJS KESEHATAN 12/01/2019 Paid 65.000
R1901110001 LAB/190112/0003 106822 MBATO.AN
SULASTRI.NY PASIEN UMUM 12/01/2019 Paid 244.000
R1812190306 LAB/190112/0004 095089 LIM DJIT HAI.TN BPJS KESEHATAN 12/01/2019 Paid 65.000
R1812270319 LAB/190112/0006 106176 ABDUL KHALED BPJS KESEHATAN 12/01/2019 Paid 145.000
R1901120045 LAB/190112/0007 106902 ARRAZZAQTULUS.BY.
THERESA RAYVANS.NY
AN BPJS KESEHATAN 12/01/2019 Paid 33.000
R1901120050 LAB/190112/0010 080519 GRACESELLA BPJS KESEHATAN 12/01/2019 Paid 65.000
R1901120068 LAB/190112/0011 106914 SIHOMBING.AN
MUHAMMAD SOFYAN BPJS KESEHATAN 12/01/2019 Paid 145.000
R1901120079 LAB/190112/0012 054826 RIFAI. AN HUTAMA O.ANBPJS KESEHATAN
REYNALDI 12/01/2019 Paid 145.000
R1901120073 LAB/190112/0018 106917 IMAN BUDIMAN. TN BPJS KESEHATAN 12/01/2019 Paid 753.000
R1901110028 LAB/190112/0023 093398 VERAWATI PASIEN UMUM 12/01/2019 Paid 65.000
R1901110151 LAB/190112/0024 091825 SIHOMBING.NY
THERESA TULUS. NY BPJS KESEHATAN 12/01/2019 Paid 65.000
R1901120045 LAB/190112/0025 106902 THERESA TULUS.BY. NY BPJS KESEHATAN 12/01/2019 Paid 33.000
R1901110168 LAB/190112/0026 106879 MERY J HUTAURUK.NY BPJS KESEHATAN 12/01/2019 Paid 250.000
R1812190306 LAB/190112/0027 095089 LIM DJIT HAI.TN BPJS KESEHATAN 12/01/2019 Paid 65.000
R1812270319 LAB/190112/0030 106176 ABDUL KHALED BPJS KESEHATAN 12/01/2019 Paid 98.000
R1901120144 LAB/190112/0031 092080 ARRAZZAQPASARIBU.NY
ROMAULI RAYVANS. AN BPJS KESEHATAN 12/01/2019 Paid 410.000
R1901130006 LAB/190113/0002 038014 WESDIANA MUTIARA PT. INFINEON 13/01/2019 Paid 547.100
R1901110131 LAB/190113/0003 106866 SITOMPUL. NY
MONICA NOVENA PUTRI TECHNOLOGIES
BPJS KESEHATAN 13/01/2019 Paid 65.000
R1901120144 LAB/190113/0004 092080 MBATO.AN
ROMAULI PASARIBU.NY BPJS KESEHATAN 13/01/2019 Paid 93.000
R1901120092 LAB/190113/0005 037377 MILAWATI.NY BPJS KESEHATAN 13/01/2019 Paid 65.000
R1812190306 LAB/190113/0006 095089 LIM DJIT HAI.TN BPJS KESEHATAN 13/01/2019 Paid 65.000
R1901130006 LAB/190113/0007 038014 WESDIANA MUTIARA PT. INFINEON 13/01/2019 Paid 98.000
R1901110188 LAB/190113/0008 106888 SITOMPUL.
POLTAK NY
SILALAHI.TN TECHNOLOGIES
PASIEN UMUM 13/01/2019 Paid 151.000
R1901110164 LAB/190113/0009 003615 PUTRI ARDIYANI BPJS KESEHATAN 13/01/2019 Paid 230.000
R1901130011 LAB/190113/0010 106948 LESMANA,NY
ROMAULI PASARIBU. BY. BPJS KESEHATAN 13/01/2019 Paid 33.000
R1901120144 LAB/190113/0011 092080 NY
ROMAULI PASARIBU.NY BPJS KESEHATAN 13/01/2019 Paid 65.000
R1901130011 LAB/190113/0012 106948 ROMAULI PASARIBU. BY. BPJS KESEHATAN 13/01/2019 Paid 33.000
R1901130019 LAB/190113/0013 106951 NY LUTHFI ABDULLOH. BPJS KESEHATAN
M. 13/01/2019 Paid 183.000
R1901130019 LAB/190113/0014 106951 AN LUTHFI ABDULLOH. BPJS KESEHATAN
M. 13/01/2019 Paid 250.000
R1901130034 LAB/190113/0018 106956 AN
JUMIRAH. NY BPJS KESEHATAN 13/01/2019 Paid 65.000
R1901130037 LAB/190113/0019 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 13/01/2019 Paid 348.000
R1901130042 LAB/190113/0021 065465 GILANG PUTRA.F.AN BPJS KESEHATAN 13/01/2019 Paid 65.000
R1901130044 LAB/190113/0022 106960 LENNI MARLINA BPJS KESEHATAN 13/01/2019 Paid 65.000
R1901130037 LAB/190113/0023 101778 SIMBOLON.NY
SYAMSI MIRYANTI. NY BPJS KESEHATAN 13/01/2019 Paid 80.000
R1901130048 LAB/190113/0024 106963 NOFRI YENTI,NY BPJS KESEHATAN 13/01/2019 Paid 98.000
R1901130037 LAB/190114/0001 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 14/01/2019 Paid 283.000
R1901130037 LAB/190114/0002 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901130037 LAB/190114/0003 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901130037 LAB/190114/0004 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901130048 LAB/190114/0005 106963 NOFRI YENTI,NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901110131 LAB/190114/0006 106866 MONICA NOVENA PUTRI BPJS KESEHATAN 14/01/2019 Paid 65.000
R1901140012 LAB/190114/0007 106791 MBATO.AN
JULIANI.NY BPJS KESEHATAN 14/01/2019 Paid 503.000
R1901140042 LAB/190114/0010 106982 SAAT SIORIO LBN GAOL. PASIEN UMUM 14/01/2019 Paid 70.000
R1901140061 LAB/190114/0011 051909 TN
WICHE AGUSTRIANA.NY BPJS KESEHATAN 14/01/2019 Paid 527.300
R1901140090 LAB/190114/0013 107001 MASRUKI. TN BPJS KESEHATAN 14/01/2019 Paid 428.000
R1901130037 LAB/190114/0018 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901110107 LAB/190114/0020 055110 HAPPY OCTAVIANY BPJS KESEHATAN 14/01/2019 Paid 65.000
R1901140162 LAB/190114/0022 048241 MALAU.AN
RATNASARI BPJS KESEHATAN 14/01/2019 Paid 295.000
R1901140172 LAB/190114/0023 051755 TAMBUNAN.NY
LENDRAWATI.M.NY BPJS KESEHATAN 14/01/2019 Paid 384.750
R1901140042 LAB/190114/0024 106982 SAAT SIORIO LBN GAOL. PASIEN UMUM 14/01/2019 Paid 40.000
R1901140172 LAB/190114/0025 051755 TN
LENDRAWATI.M.NY BPJS KESEHATAN 14/01/2019 Paid 30.000

PAGE : 3 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901140180 LAB/190114/0026 107031 JULIANI BY NY BPJS KESEHATAN 14/01/2019 Paid 33.000


R1901130048 LAB/190114/0027 106963 NOFRI YENTI,NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901140178 LAB/190114/0028 107034 SAHRIDANI. TN BPJS KESEHATAN 14/01/2019 Paid 65.000
R1901140063 LAB/190114/0032 102213 SYILA RAMADANI.AN BPJS KESEHATAN 14/01/2019 Paid 753.000
R1901140210 LAB/190114/0037 107037 WICHE AGUSTRIANA BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901140190 LAB/190114/0044 106941 BY.NY
SHAQUEENA BPJS KESEHATAN 14/01/2019 Paid 145.000
R1901130048 LAB/190114/0045 106963 MAHESWARI
NOFRI YENTI,NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901140061 LAB/190114/0048 051909 ISKANDAR.AN
WICHE AGUSTRIANA.NY BPJS KESEHATAN 14/01/2019 Paid 65.000
R1901140090 LAB/190114/0049 107001 MASRUKI. TN BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901140213 LAB/190114/0050 102615 ABDULLAH MAHIDIN.TN BPJS KESEHATAN 14/01/2019 Paid 40.000
R1901140239 LAB/190114/0051 107048 M RIZKY YON PRATAMA BPJS KESEHATAN 14/01/2019 Paid 65.000
R1901140178 LAB/190114/0052 107034 .AN
SAHRIDANI. TN BPJS KESEHATAN 14/01/2019 Paid 80.000
R1901140178 LAB/190114/0054 107034 SAHRIDANI. TN BPJS KESEHATAN 14/01/2019 Paid 40.000
R1901130037 LAB/190114/0056 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901140042 LAB/190114/0057 106982 SAAT SIORIO LBN GAOL. PASIEN UMUM 14/01/2019 Paid 65.000
R1901140267 LAB/190114/0058 107058 TN
ERVIANI NASUTION. NY BPJS KESEHATAN 14/01/2019 Paid 470.000
R1901140268 LAB/190114/0060 107059 NOVIYANTI .NN BPJS KESEHATAN 14/01/2019 Paid 65.000
R1901140258 LAB/190114/0061 044946 MULYONO.TN PASIEN UMUM 14/01/2019 Paid 145.000
R1812270319 LAB/190114/0062 106176 ABDUL KHALED BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901140132 LAB/190114/0064 107019 ARRAZZAQ
RINA WATI.RAYVANS.
NY AN BPJS KESEHATAN 14/01/2019 Paid 65.000
R1901130048 LAB/190114/0065 106963 NOFRI YENTI,NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901140132 LAB/190114/0066 107019 RINA WATI. NY BPJS KESEHATAN 14/01/2019 Paid 40.000
R1901140274 LAB/190114/0067 107063 RUMIATI .NY BPJS KESEHATAN 14/01/2019 Paid 145.000
R1901140275 LAB/190114/0069 045011 IMAMA LUTHFIA.AN PT. ADMEDIKA AVRIST14/01/2019 Paid 65.000
R1901140281 LAB/190114/0070 107065 ANNES WILLIAM BARUS. BPJS KESEHATAN 14/01/2019 Paid 395.000
R1901140175 LAB/190114/0071 105819 AN
BONARIA NENGGOLAN, BPJS KESEHATAN 14/01/2019 Paid 793.000
R1901130048 LAB/190114/0072 106963 NY
NOFRI YENTI,NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901130019 LAB/190114/0073 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901150005 LAB/190115/0001 107069 AN
HENI FITRIANA. NY BPJS KESEHATAN 15/01/2019 Paid 543.000
R1901130037 LAB/190115/0002 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901130037 LAB/190115/0003 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 15/01/2019 Paid 283.000
R1901140090 LAB/190115/0004 107001 MASRUKI. TN BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901140090 LAB/190115/0005 107001 MASRUKI. TN BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901140267 LAB/190115/0006 107058 ERVIANI NASUTION. NY BPJS KESEHATAN 15/01/2019 Paid 1.000.000
R1901130048 LAB/190115/0007 106963 NOFRI YENTI,NY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150011 LAB/190115/0008 107070 HENI FITRIANA. BY. NY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150005 LAB/190115/0009 107069 HENI FITRIANA. NY BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901120092 LAB/190115/0010 037377 MILAWATI.NY BPJS KESEHATAN 15/01/2019 Paid 385.000
R1901110131 LAB/190115/0011 106866 MONICA NOVENA PUTRI BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901140239 LAB/190115/0012 107048 MBATO.AN
M RIZKY YON PRATAMA BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901120079 LAB/190115/0013 054826 .AN
REYNALDI HUTAMA O.ANBPJS KESEHATAN 15/01/2019 Paid 65.000
R1901150046 LAB/190115/0017 107077 SINTA GUSTIA.NY BPJS KESEHATAN 15/01/2019 Paid 410.000
R1812290034 LAB/190115/0019 106275 RICHARD RENDI MELODI BPJS KESEHATAN 15/01/2019 Paid 753.000
R1901140016 LAB/190115/0022 106971 .TN
ARPAN SANJAYA.TN BPJS KESEHATAN 15/01/2019 Paid 753.000
R1901150049 LAB/190115/0024 037692 AN.AIRA KANAYA BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901150075 LAB/190115/0025 107090 IRAWAN
VERAWATY SITORUS.NY BPJS KESEHATAN 15/01/2019 Paid 503.000
R1812280013 LAB/190115/0026 100491 YOSI ANAROSA BPJS KESEHATAN 15/01/2019 Paid 813.000
R1901150041 LAB/190115/0028 107075 HARAHAP.NY
SAURMA BR BPJS KESEHATAN 15/01/2019 Paid 98.000
R1901140132 LAB/190115/0035 107019 NAINGGOLAN.
RINA WATI. NYNY BPJS KESEHATAN 15/01/2019 Paid 688.000
R1901150075 LAB/190115/0037 107090 VERAWATY SITORUS.NY BPJS KESEHATAN 15/01/2019 Paid 24.300
R1901150114 LAB/190115/0038 088002 YESSY EKI FAJAR BNI LIFE INSURANCE 15/01/2019 Paid 385.000
R1901150071 LAB/190115/0043 107088 REKSI.NN
PRAMONO.TN PT. OWLEXA 15/01/2019 Paid 959.000
R1901140172 LAB/190115/0044 051755 LENDRAWATI.M.NY BPJS KESEHATAN 15/01/2019 Paid 315.000
R1901150124 LAB/190115/0045 107114 IPAH. NY BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901140079 LAB/190115/0046 103073 ROBIN PANJAITAN.TN BPJS KESEHATAN 15/01/2019 Paid 753.000
R1901130037 LAB/190115/0047 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901140090 LAB/190115/0048 107001 MASRUKI. TN BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901140213 LAB/190115/0049 102615 ABDULLAH MAHIDIN.TN BPJS KESEHATAN 15/01/2019 Paid 753.000
R1901150167 LAB/190115/0053 107122 VERAWATY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150118 LAB/190115/0054 034464 SITORUS.BY.NY
FENITA ANASTASIA BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901130019 LAB/190115/0056 106951 MARBUN,AN
M. LUTHFI ABDULLOH. BPJS KESEHATAN 15/01/2019 Paid 73.000
AN
PAGE : 4 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901140172 LAB/190115/0057 051755 LENDRAWATI.M.NY BPJS KESEHATAN 15/01/2019 Paid 86.000


R1901130037 LAB/190115/0059 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 15/01/2019 Paid 80.000
R1901140281 LAB/190115/0060 107065 ANNES WILLIAM BARUS. BPJS KESEHATAN 15/01/2019 Paid 86.000
R1901130048 LAB/190115/0061 106963 AN
NOFRI YENTI,NY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150005 LAB/190115/0063 107069 HENI FITRIANA. NY BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901150180 LAB/190115/0065 078552 MASRIDA.NY BPJS KESEHATAN 15/01/2019 Paid 295.000
R1901150183 LAB/190115/0066 072039 RIO FRANKY.TN BPJS KESEHATAN 15/01/2019 Paid 145.000
R1901150075 LAB/190115/0067 107090 VERAWATY SITORUS.NY BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901150188 LAB/190115/0069 067114 YARNI M. THAIB.NY PASIEN UMUM 15/01/2019 Paid 348.000
R1901150190 LAB/190115/0070 107130 RAHIMIN.TN BPJS KESEHATAN 15/01/2019 Paid 793.000
R1901150192 LAB/190115/0071 063846 FARREN AKMAL AZIZI.AN BPJS KESEHATAN COB15/01/2019 Paid 108.750
R1812280013 LAB/190115/0072 100491 YOSI ANAROSA INHEALTH
BPJS KESEHATAN 15/01/2019 Paid 700.000
R1901150219 LAB/190115/0073 056924 HARAHAP.NYREZKY
MUHAMMAD RUBYCON 15/01/2019 Paid 145.000
R1901150041 LAB/190115/0075 107075 ANUGRAHBR
SAURMA H.AN BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150210 LAB/190115/0077 107135 NAINGGOLAN.
CITRA NY
CLEARESTA.AN BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901150200 LAB/190115/0078 082592 ZULKARNAIN.TN BPJS KESEHATAN 15/01/2019 Paid 793.000
R1901140090 LAB/190115/0079 107001 MASRUKI. TN BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901130037 LAB/190115/0080 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150260 LAB/190115/0083 074644 DAHLIA SITINJAK. NY BPJS KESEHATAN 15/01/2019 Paid 503.000
R1901150260 LAB/190115/0084 074644 DAHLIA SITINJAK. NY BPJS KESEHATAN 15/01/2019 Paid 40.000
R1901130019 LAB/190115/0086 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 15/01/2019 Paid 350.000
R1901140175 LAB/190116/0001 105819 AN
BONARIA NENGGOLAN, BPJS KESEHATAN 16/01/2019 Paid 80.000
R1901160001 LAB/190116/0002 105944 NY
JOVANKO SEVENKEI BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901140239 LAB/190116/0003 107048 IMMANUEL
M RIZKY YONG.AN
PRATAMA BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901150118 LAB/190116/0004 034464 .AN
FENITA ANASTASIA BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901150041 LAB/190116/0005 107075 MARBUN,AN
SAURMA BR BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901130048 LAB/190116/0006 106963 NAINGGOLAN.
NOFRI NY
YENTI,NY BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901150124 LAB/190116/0007 107114 IPAH. NY BPJS KESEHATAN 16/01/2019 Paid 408.000
R1901150183 LAB/190116/0008 072039 RIO FRANKY.TN BPJS KESEHATAN 16/01/2019 Paid 561.000
R1901150071 LAB/190116/0009 107088 PRAMONO.TN PT. OWLEXA 16/01/2019 Paid 65.000
R1901150210 LAB/190116/0010 107135 CITRA CLEARESTA.AN BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901130037 LAB/190116/0011 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901130037 LAB/190116/0012 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901140090 LAB/190116/0013 107001 MASRUKI. TN BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901140090 LAB/190116/0014 107001 MASRUKI. TN BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901150260 LAB/190116/0015 074644 DAHLIA SITINJAK. NY BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901140172 LAB/190116/0016 051755 LENDRAWATI.M.NY BPJS KESEHATAN 16/01/2019 Paid 1.000.000
R1901130037 LAB/190116/0017 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 16/01/2019 Paid 80.000
R1901150100 LAB/190116/0019 107103 USWATUL HASANAH.NY BPJS KESEHATAN 16/01/2019 Paid 503.000
R1901160032 LAB/190116/0021 107154 DESKI LIANA.NY BPJS KESEHATAN 16/01/2019 Paid 503.000
R1901140035 LAB/190116/0022 106269 LIA SUSILAWATI. NY BPJS KESEHATAN 16/01/2019 Paid 813.000
R1901130037 LAB/190116/0024 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 16/01/2019 Paid 80.000
R1901140281 LAB/190116/0025 107065 ANNES WILLIAM BARUS. BPJS KESEHATAN 16/01/2019 Paid 900.000
R1901160063 LAB/190116/0026 080205 AN
ELFIARITA.NY PASIEN UMUM 16/01/2019 Paid 503.000
R1901160052 LAB/190116/0027 107162 HERAWATI RITONGA. NY BPJS KESEHATAN 16/01/2019 Paid 503.000
R1901130037 LAB/190116/0028 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 16/01/2019 Paid 330.000
R1901160084 LAB/190116/0029 100934 RIDWAN. TN BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901160095 LAB/190116/0030 107176 DESKI LIANA.BY.NY BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901140132 LAB/190116/0031 107019 RINA WATI. NY BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901160084 LAB/190116/0032 100934 RIDWAN. TN BPJS KESEHATAN 16/01/2019 Paid 113.000
R1901130037 LAB/190116/0036 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901140090 LAB/190116/0037 107001 MASRUKI. TN BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901150193 LAB/190116/0038 091075 KAKA MARIO BPJS KESEHATAN 16/01/2019 Paid 753.000
R1901160032 LAB/190116/0042 107154 DESKI LIANA.NY BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901140172 LAB/190116/0043 051755 LENDRAWATI.M.NY BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901160127 LAB/190116/0044 090810 MARLINA L LUBIS.NY BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901150071 LAB/190116/0045 107088 PRAMONO.TN PT. OWLEXA 16/01/2019 Paid 250.000
R1901160138 LAB/190116/0047 098071 ABDURROHMAN IBNU BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901160152 LAB/190116/0049 081582 Y.AN
AI NURHANDAYANI.NY ASURANSI RELIANCE 16/01/2019 Paid 410.000
R1901160052 LAB/190116/0050 107162 HERAWATI RITONGA. NY BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901160063 LAB/190116/0051 080205 ELFIARITA.NY PASIEN UMUM 16/01/2019 Paid 65.000

PAGE : 5 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901160167 LAB/190116/0052 107196 HERAWATI RITONGA. BY BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901160170 LAB/190116/0053 107204 NY
SINTA GUSTIA.BY.NY BPJS KESEHATAN 16/01/2019 Process 33.000
R1901160166 LAB/190116/0055 107203 ADEL LENORA.AN PASIEN UMUM 16/01/2019 Paid 548.000
R1901140162 LAB/190116/0056 048241 RATNASARI BPJS KESEHATAN 16/01/2019 Paid 40.000
R1901140035 LAB/190116/0058 106269 TAMBUNAN.NY
LIA SUSILAWATI. NY BPJS KESEHATAN 16/01/2019 Paid 600.000
R1901130037 LAB/190116/0060 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901130019 LAB/190116/0062 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901160184 LAB/190116/0063 072286 AN
MILZA KHANZA FADILAH.BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901150260 LAB/190116/0065 074644 AN
DAHLIA SITINJAK. NY BPJS KESEHATAN 16/01/2019 Paid 65.000
R1901160204 LAB/190116/0067 099778 RAYYAN SAUQY BPJS KESEHATAN 16/01/2019 Paid 98.000
R1901150190 LAB/190116/0069 107130 ALFRED.AN
RAHIMIN.TN BPJS KESEHATAN 16/01/2019 Paid 315.000
R1901150190 LAB/190116/0070 107130 RAHIMIN.TN BPJS KESEHATAN 16/01/2019 Paid 700.000
R1901140213 LAB/190116/0071 102615 ABDULLAH MAHIDIN.TN BPJS KESEHATAN 16/01/2019 Paid 315.000
R1901140213 LAB/190117/0001 102615 ABDULLAH MAHIDIN.TN BPJS KESEHATAN 17/01/2019 Paid 700.000
R1901150260 LAB/190117/0002 074644 DAHLIA SITINJAK. NY BPJS KESEHATAN 17/01/2019 Paid 700.000
R1901140132 LAB/190117/0003 107019 RINA WATI. NY BPJS KESEHATAN 17/01/2019 Paid 65.000
R1901170004 LAB/190117/0004 107218 ANIK SETYWATI.NY BPJS KESEHATAN 17/01/2019 Paid 503.000
R1901150210 LAB/190117/0005 107135 CITRA CLEARESTA.AN BPJS KESEHATAN 17/01/2019 Paid 65.000
R1901150071 LAB/190117/0006 107088 PRAMONO.TN PT. OWLEXA 17/01/2019 Paid 65.000
R1901150192 LAB/190117/0007 063846 FARREN AKMAL AZIZI.AN BPJS KESEHATAN COB17/01/2019 Paid 48.750
R1901140132 LAB/190117/0008 107019 RINA WATI. NY INHEALTH
BPJS KESEHATAN 17/01/2019 Paid 3.000.000
R1901130037 LAB/190117/0009 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901130037 LAB/190117/0010 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901150190 LAB/190117/0011 107130 RAHIMIN.TN BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901160152 LAB/190117/0012 081582 AI NURHANDAYANI.NY ASURANSI RELIANCE 17/01/2019 Paid 65.000
R1901130019 LAB/190117/0013 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 17/01/2019 Paid 80.000
R1901160078 LAB/190117/0016 107172 AN YUSNI. NY
IRA BPJS KESEHATAN 17/01/2019 Paid 813.000
R1901150089 LAB/190117/0019 107099 ISFAH HANUM.NY BPJS KESEHATAN 17/01/2019 Paid 813.000
R1901170041 LAB/190117/0020 107224 RIFDA OLIVE BPJS KESEHATAN 17/01/2019 Paid 395.000
R1807030214 LAB/190117/0023 093359 MAHARDIKA.AN
ASIA HARIANI.NY BPJS KESEHATAN 17/01/2019 Paid 813.000
R1901170079 LAB/190117/0024 107227 ANIK SETYWATI.BY.NY BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901170082 LAB/190117/0025 107160 MARTHA ASTRIATI BPJS KESEHATAN 17/01/2019 Paid 503.000
R1901160070 LAB/190117/0030 107171 GEMIS. NY
MURTIEM.NY BPJS KESEHATAN 17/01/2019 Paid 813.000
R1901130037 LAB/190117/0031 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901170004 LAB/190117/0034 107218 ANIK SETYWATI.NY BPJS KESEHATAN 17/01/2019 Paid 65.000
R1901140132 LAB/190117/0035 107019 RINA WATI. NY BPJS KESEHATAN 17/01/2019 Paid 65.000
R1901170146 LAB/190117/0036 107271 MARTHA ASTRATI BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901170137 LAB/190117/0038 107272 GEMIS.BY.NYVABREGAS BPJS KESEHATAN
FERDINAND 17/01/2019 Paid 145.000
R1901170144 LAB/190117/0039 059604 EDS.AN
JULIANI.NN BPJS KESEHATAN 17/01/2019 Paid 145.000
R1901170150 LAB/190117/0040 107278 LONGKOT P SIHOMBING BPJS KESEHATAN 17/01/2019 Paid 145.000
R1901170144 LAB/190117/0041 059604 .TN
JULIANI.NN BPJS KESEHATAN 17/01/2019 Paid 65.000
R1901150041 LAB/190117/0042 107075 SAURMA BR BPJS KESEHATAN 17/01/2019 Paid 753.000
R1901160084 LAB/190117/0043 100934 NAINGGOLAN.
RIDWAN. TN NY BPJS KESEHATAN 17/01/2019 Paid 80.000
R1901170160 LAB/190117/0044 078361 KHANSAVIA TARI BPJS KESEHATAN 17/01/2019 Paid 145.000
R1901170174 LAB/190117/0045 107281 WIBOWO.AN
SYAHIRA PUTRI BPJS KESEHATAN 17/01/2019 Paid 145.000
R1901170186 LAB/190117/0048 107284 AZZAHRA
PUTRI .AN .AN
AFIFAH BPJS KESEHATAN 17/01/2019 Paid 65.000
R1901170185 LAB/190117/0049 056297 JERICHO HIRACE BPJS KESEHATAN 17/01/2019 Paid 65.000
R1901160078 LAB/190117/0050 107172 PANGGABEAN.AN
IRA YUSNI. NY BPJS KESEHATAN 17/01/2019 Paid 1.000.000
R1901150089 LAB/190117/0051 107099 ISFAH HANUM.NY BPJS KESEHATAN 17/01/2019 Paid 1.000.000
R1901170212 LAB/190117/0053 107293 AHMAD GILANG BPJS KESEHATAN 17/01/2019 Paid 65.000
R1901130037 LAB/190117/0054 101778 FATHIRRIZQI.AN
SYAMSI MIRYANTI. NY BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901170198 LAB/190117/0056 107291 DIAH JUNAEDI PASIEN UMUM 17/01/2019 Process 641.000
R1901150071 LAB/190117/0057 107088 SAWAL.TN
PRAMONO.TN PT. OWLEXA 17/01/2019 Paid 65.000
R1901160166 LAB/190117/0058 107203 ADEL LENORA.AN PASIEN UMUM 17/01/2019 Paid 315.000
R1901170216 LAB/190117/0059 107295 JUNI SARTIKA.NY BPJS KESEHATAN 17/01/2019 Paid 425.000
R1901170024 LAB/190117/0060 081581 DAMEULI LUMBAN T.NY BPJS KESEHATAN 17/01/2019 Paid 425.000
R1901130019 LAB/190117/0061 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 17/01/2019 Paid 475.000
R1901170230 LAB/190118/0001 046869 AN TAMBUNAN.NY
TETY BPJS KESEHATAN 18/01/2019 Paid 410.000
R1901130037 LAB/190118/0002 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 18/01/2019 Paid 33.000
R1901180003 LAB/190118/0003 026079 KRISTINI SRI BPJS KESEHATAN COB18/01/2019 Paid 384.750
R1901150041 LAB/190118/0004 107075 MULYANI.NY
SAURMA BR INHEALTH
BPJS KESEHATAN 18/01/2019 Paid 33.000
NAINGGOLAN. NY
PAGE : 6 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901140090 LAB/190118/0005 107001 MASRUKI. TN BPJS KESEHATAN 18/01/2019 Paid 33.000


R1901170144 LAB/190118/0006 059604 JULIANI.NN BPJS KESEHATAN 18/01/2019 Paid 65.000
R1901170186 LAB/190118/0007 107284 PUTRI AFIFAH .AN BPJS KESEHATAN 18/01/2019 Paid 65.000
R1901130037 LAB/190118/0009 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 18/01/2019 Paid 33.000
R1901160138 LAB/190118/0011 098071 ABDURROHMAN IBNU BPJS KESEHATAN 18/01/2019 Paid 65.000
R1901160085 LAB/190118/0014 107177 Y.AN
YECY ARTHA BPJS KESEHATAN 18/01/2019 Paid 813.000
R1901180035 LAB/190118/0015 101966 SARAGIH.NN
RISLAN TIONA BPJS KESEHATAN 18/01/2019 Paid 813.000
R1901180071 LAB/190118/0019 103248 PAKPAHAN.
JONO. TN NY BPJS KESEHATAN 18/01/2019 Process 65.000
R1901180109 LAB/190118/0022 107316 KRISTINI SRI BPJS KESEHATAN COB18/01/2019 Paid 33.000
R1901180087 LAB/190118/0024 107328 MULYANI.BY.NY
JUNIATI. NY INHEALTH
BPJS KESEHATAN 18/01/2019 Paid 65.000
R1812270319 LAB/190118/0026 106176 ABDUL KHALED BPJS KESEHATAN 18/01/2019 Paid 428.000
R1901130037 LAB/190118/0029 101778 ARRAZZAQ RAYVANS.
SYAMSI MIRYANTI. NYAN BPJS KESEHATAN 18/01/2019 Paid 33.000
R1901180003 LAB/190118/0030 026079 KRISTINI SRI BPJS KESEHATAN COB18/01/2019 Paid 48.750
R1901180071 LAB/190118/0031 103248 MULYANI.NY
JONO. TN INHEALTH
BPJS KESEHATAN 18/01/2019 Process 40.000
R1901150197 LAB/190118/0032 107132 MURADI. TN BPJS KESEHATAN 18/01/2019 Paid 793.000
R1901180028 LAB/190118/0033 046132 YETTI ERNITA,NY BPJS KESEHATAN 18/01/2019 Paid 40.000
R1901150197 LAB/190118/0035 107132 MURADI. TN BPJS KESEHATAN 18/01/2019 Paid 40.000
R1901180136 LAB/190118/0037 107345 DANIA SOPHI BPJS KESEHATAN 18/01/2019 Paid 145.000
R1901150041 LAB/190118/0039 107075 ARWANDAWATI.
SAURMA BR NN BPJS KESEHATAN 18/01/2019 Paid 33.000
R1901180177 LAB/190118/0041 107354 NAINGGOLAN.
GHERY NY AN
SANDRIO. BPJS KESEHATAN 18/01/2019 Paid 65.000
R1901180209 LAB/190118/0042 107358 BILQIS INSYIRAH BPJS KESEHATAN 18/01/2019 Paid 65.000
R1901180211 LAB/190118/0043 094631 KINANTI. AN
NELLI S SIREGAR. NY BPJS KESEHATAN 18/01/2019 Paid 503.000
R1901170216 LAB/190118/0047 107295 JUNI SARTIKA.NY BPJS KESEHATAN 18/01/2019 Paid 65.000
R1901180219 LAB/190118/0049 107359 ARDI CANDRA. TN BPJS KESEHATAN 18/01/2019 Paid 145.000
R1901130037 LAB/190118/0050 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 18/01/2019 Paid 33.000
R1901150071 LAB/190118/0051 107088 PRAMONO.TN PT. OWLEXA 18/01/2019 Paid 65.000
R1901150071 LAB/190118/0054 107088 PRAMONO.TN PT. OWLEXA 18/01/2019 Paid 700.000
R1901160085 LAB/190118/0055 107177 YECY ARTHA BPJS KESEHATAN 18/01/2019 Paid 600.000
R1901180035 LAB/190118/0056 101966 SARAGIH.NN
RISLAN TIONA BPJS KESEHATAN 18/01/2019 Paid 700.000
R1901180250 LAB/190118/0058 034530 PAKPAHAN.
SRI PURYANI.NYNY BPJS KESEHATAN 18/01/2019 Paid 503.000
R1901190005 LAB/190119/0001 053246 LASRIA MARLINCE.S.NY BPJS KESEHATAN 19/01/2019 Paid 503.000
R1901190006 LAB/190119/0002 107369 SRI PURYANI.BY.NY BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901130037 LAB/190119/0003 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901190009 LAB/190119/0004 107372 PRIHATIN.NY BPJS KESEHATAN 19/01/2019 Paid 470.000
R1901180250 LAB/190119/0005 034530 SRI PURYANI. NY BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901130037 LAB/190119/0006 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901180026 LAB/190119/0007 099216 RIKARINI.NY BPJS KESEHATAN 19/01/2019 Paid 470.000
R1901180219 LAB/190119/0008 107359 ARDI CANDRA. TN BPJS KESEHATAN 19/01/2019 Paid 145.000
R1901170144 LAB/190119/0009 059604 JULIANI.NN BPJS KESEHATAN 19/01/2019 Paid 151.000
R1901190015 LAB/190119/0010 107141 KHALISHAH SILMI KAFFA BPJS KESEHATAN 19/01/2019 Paid 300.000
R1901150071 LAB/190119/0011 107088 P.AN
PRAMONO.TN PT. OWLEXA 19/01/2019 Paid 65.000
R1901170186 LAB/190119/0012 107284 PUTRI AFIFAH .AN BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901190038 LAB/190119/0014 107381 SUTARNI. NY BPJS KESEHATAN 19/01/2019 Paid 503.000
R1901130037 LAB/190119/0015 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 19/01/2019 Paid 315.000
R1901190063 LAB/190119/0019 107385 LASRIA MARLINCE. BY. BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901190082 LAB/190119/0022 107380 NY
NELLY S SIREGAR .BY. BPJS KESEHATAN 19/01/2019 Paid 98.000
R1901190084 LAB/190119/0024 107395 NY
IMAH. NY BPJS KESEHATAN 19/01/2019 Paid 503.000
R1901180026 LAB/190119/0026 099216 RIKARINI.NY BPJS KESEHATAN 19/01/2019 Paid 600.000
R1901190126 LAB/190119/0029 107416 JARTIK. NY BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901190095 LAB/190119/0031 088827 YUSTIANA.NY BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901130037 LAB/190119/0033 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901180211 LAB/190119/0034 094631 NELLI S SIREGAR. NY BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901190005 LAB/190119/0035 053246 LASRIA MARLINCE.S.NY BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901180177 LAB/190119/0036 107354 GHERY SANDRIO. AN BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901180209 LAB/190119/0037 107358 BILQIS INSYIRAH BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901190168 LAB/190119/0038 107423 KINANTI. AN
SUTARNI. BY NY BPJS KESEHATAN 19/01/2019 Paid 33.000
R1812270319 LAB/190119/0039 106176 ABDUL KHALED BPJS KESEHATAN 19/01/2019 Paid 80.000
R1901190173 LAB/190119/0043 107427 ARRAZZAQ
IMAH. RAYVANS. AN BPJS KESEHATAN
BY. NY 19/01/2019 Paid 33.000
R1901190180 LAB/190119/0047 107429 MUHAMAD DANISH.AN BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901190084 LAB/190119/0048 107395 IMAH. NY BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901190038 LAB/190119/0049 107381 SUTARNI. NY BPJS KESEHATAN 19/01/2019 Paid 65.000

PAGE : 7 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901170216 LAB/190119/0050 107295 JUNI SARTIKA.NY BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901190126 LAB/190119/0051 107416 JARTIK. NY BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901130037 LAB/190119/0052 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901190212 LAB/190119/0053 107440 BY NY. MONALESA BPJS KESEHATAN 19/01/2019 Paid 365.000
R1901170216 LAB/190119/0055 107295 JUNI SARTIKA.NY BPJS KESEHATAN 19/01/2019 Paid 120.000
R1901190028 LAB/190119/0056 107377 EGA PIONINGSIH BPJS KESEHATAN 19/01/2019 Paid 753.000
R1901190219 LAB/190119/0057 107442 PASARIBU.
BY.NY. NYAUDINA
RIZKY BPJS KESEHATAN 19/01/2019 Paid 878.000
R1901190028 LAB/190119/0058 107377 EGA PIONINGSIH BPJS KESEHATAN 19/01/2019 Paid 40.000
R1901190226 LAB/190119/0059 075627 PASARIBU.
BUENO NY
ELVANDEV BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901190224 LAB/190119/0060 097349 SARAGIH.AN
SUKRENY VICTORIA BPJS KESEHATAN 19/01/2019 Paid 503.000
R1901190191 LAB/190119/0061 094802 ARNOLD.NY
FRISKA NADEAK.NY BPJS KESEHATAN 19/01/2019 Paid 503.000
R1901190230 LAB/190119/0062 098931 HADIJAH.NY ADMEDIKA TAKAFUL 19/01/2019 Paid 295.000
R1901130037 LAB/190120/0001 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 20/01/2019 Paid 33.000
R1901200003 LAB/190120/0003 107444 FRISKA NADEAK,BY.NY BPJS KESEHATAN 20/01/2019 Paid 98.000
R1901200004 LAB/190120/0004 107445 DELON PAKPAHAN.AN BPJS KESEHATAN 20/01/2019 Paid 65.000
R1901190191 LAB/190120/0005 094802 FRISKA NADEAK.NY BPJS KESEHATAN 20/01/2019 Paid 65.000
R1901170144 LAB/190120/0006 059604 JULIANI.NN BPJS KESEHATAN 20/01/2019 Paid 65.000
R1901190126 LAB/190120/0007 107416 JARTIK. NY BPJS KESEHATAN 20/01/2019 Paid 113.000
R1901150197 LAB/190120/0008 107132 MURADI. TN BPJS KESEHATAN 20/01/2019 Paid 65.000
R1901180219 LAB/190120/0009 107359 ARDI CANDRA. TN BPJS KESEHATAN 20/01/2019 Paid 151.000
R1901180209 LAB/190120/0010 107358 BILQIS INSYIRAH BPJS KESEHATAN 20/01/2019 Paid 65.000
R1901130037 LAB/190120/0011 101778 KINANTI. AN
SYAMSI MIRYANTI. NY BPJS KESEHATAN 20/01/2019 Paid 33.000
R1901130019 LAB/190120/0012 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 20/01/2019 Paid 33.000
R1901190219 LAB/190120/0013 107442 AN
BY.NY. RIZKY AUDINA BPJS KESEHATAN 20/01/2019 Paid 33.000
R1901200007 LAB/190120/0014 098263 ROSLIN SIHITE.NY BPJS KESEHATAN 20/01/2019 Paid 410.000
R1901200008 LAB/190120/0015 103787 KEANDRA APRLIO BPJS KESEHATAN 20/01/2019 Paid 513.000
R1901200004 LAB/190120/0016 107445 DAFFANI.AN
DELON PAKPAHAN.AN BPJS KESEHATAN 20/01/2019 Paid 283.000
R1901200011 LAB/190120/0017 107446 MAHREEN HANANIA N, BPJS KESEHATAN 20/01/2019 Paid 33.000
R1901130037 LAB/190120/0021 101778 AN
SYAMSI MIRYANTI. NY BPJS KESEHATAN 20/01/2019 Paid 33.000
R1901190126 LAB/190120/0022 107416 JARTIK. NY BPJS KESEHATAN 20/01/2019 Paid 33.000
R1901200019 LAB/190120/0023 107448 DHIMAS PRAYOGI.AN BPJS KESEHATAN 20/01/2019 Paid 433.000
R1901150197 LAB/190120/0024 107132 MURADI. TN BPJS KESEHATAN 20/01/2019 Paid 348.000
R1901150197 LAB/190120/0025 107132 MURADI. TN BPJS KESEHATAN 20/01/2019 Paid 600.000
R1901130037 LAB/190120/0028 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 20/01/2019 Paid 33.000
R1901170216 LAB/190120/0030 107295 JUNI SARTIKA.NY BPJS KESEHATAN 20/01/2019 Paid 65.000
R1901210003 LAB/190121/0001 026343 SUMARMI.NY BPJS KESEHATAN 21/01/2019 Paid 503.000
R1901130037 LAB/190121/0002 101778 SYAMSI MIRYANTI. NY BPJS KESEHATAN 21/01/2019 Paid 33.000
R1901170041 LAB/190121/0003 107224 RIFDA OLIVE BPJS KESEHATAN 21/01/2019 Paid 65.000
R1901190180 LAB/190121/0004 107429 MAHARDIKA.AN
MUHAMAD DANISH.AN BPJS KESEHATAN 21/01/2019 Paid 65.000
R1901180209 LAB/190121/0005 107358 BILQIS INSYIRAH BPJS KESEHATAN 21/01/2019 Paid 65.000
R1901210011 LAB/190121/0007 102890 KINANTI. AN
OMCE ARITONANG.NY BPJS KESEHATAN 21/01/2019 Paid 813.000
R1901160061 LAB/190121/0008 107168 ABDUL HALIK.TN BPJS KESEHATAN 21/01/2019 Paid 753.000
R1901210047 LAB/190121/0010 107460 SUMARMI. BY NY BPJS KESEHATAN 21/01/2019 Paid 33.000
R1901210037 LAB/190121/0011 107166 MAJUDIN.TN BPJS KESEHATAN 21/01/2019 Paid 753.000
R1901210003 LAB/190121/0012 026343 SUMARMI.NY BPJS KESEHATAN 21/01/2019 Paid 65.000
R1901130019 LAB/190121/0013 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 21/01/2019 Paid 33.000
R1901190219 LAB/190121/0014 107442 AN
BY.NY. RIZKY AUDINA BPJS KESEHATAN 21/01/2019 Paid 33.000
R1901190212 LAB/190121/0015 107440 BY NY. MONALESA BPJS KESEHATAN 21/01/2019 Paid 300.000
R1901210093 LAB/190121/0020 107490 AKBAR BPJS KESEHATAN 21/01/2019 Paid 65.000
R1901160149 LAB/190121/0026 107200 NOVRIANSYAH.TN
AHMAD .TN BPJS KESEHATAN 21/01/2019 Paid 793.000
R1901210127 LAB/190121/0028 097205 JHONY FRANKI PT. OWLEXA 21/01/2019 Paid 65.000
R1901210135 LAB/190121/0029 102295 SIBARANI.TN
EVI KUSUMA BPJS KESEHATAN 21/01/2019 Paid 165.000
R1901200007 LAB/190121/0031 098263 DEWI,S.PDI. NY
ROSLIN SIHITE.NY BPJS KESEHATAN 21/01/2019 Paid 125.000
R1901180006 LAB/190121/0034 107301 DEFRIZON. TN BPJS KESEHATAN 21/01/2019 Paid 503.000
R1901180006 LAB/190121/0035 107301 DEFRIZON. TN BPJS KESEHATAN 21/01/2019 Paid 250.000
R1901190219 LAB/190121/0036 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 21/01/2019 Paid 745.000
R1901130019 LAB/190121/0037 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 21/01/2019 Paid 65.000
R1901130037 LAB/190121/0039 101778 AN
SYAMSI MIRYANTI. NY BPJS KESEHATAN 21/01/2019 Paid 33.000
R1901210192 LAB/190121/0040 101639 BERNADETA MERU.NY BPJS KESEHATAN 21/01/2019 Paid 503.000
R1901210196 LAB/190121/0041 102906 PAUL IGNATIUS.AN BPJS KESEHATAN 21/01/2019 Paid 295.000
R1901210201 LAB/190121/0044 107532 ARYA NATHA'S TAQWA BPJS KESEHATAN 21/01/2019 Paid 65.000
RASYIDIEN. AN
PAGE : 8 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901210122 LAB/190121/0046 094791 NATALIA ESTER BPJS KESEHATAN 21/01/2019 Paid 503.000
R1901210137 LAB/190121/0048 075250 NAPITUPULU.NY
SATRAWATI. NY BPJS KESEHATAN 21/01/2019 Paid 470.000
R1901210245 LAB/190121/0049 107537 BERNADETA MERU BPJS KESEHATAN 21/01/2019 Paid 33.000
R1901210192 LAB/190121/0050 101639 BY.NY
BERNADETA MERU.NY BPJS KESEHATAN 21/01/2019 Paid 65.000
R1901150197 LAB/190121/0051 107132 MURADI. TN BPJS KESEHATAN 21/01/2019 Paid 65.000
R1901180022 LAB/190121/0052 106202 MUHAMMAD GILANG BPJS KESEHATAN 21/01/2019 Paid 753.000
R1901200008 LAB/190121/0053 103787 PANGESTU.
KEANDRA AN
APRLIO BPJS KESEHATAN 21/01/2019 Paid 250.000
R1901210254 LAB/190121/0055 062484 DAFFANI.AN
RASYA ZAFIRA PT. MITRA ENERGI 21/01/2019 Paid 65.000
R1901150200 LAB/190121/0057 082592 BILQIS.AN
ZULKARNAIN.TN BPJS KESEHATAN 21/01/2019 Paid 315.000
R1901210037 LAB/190121/0058 107166 MAJUDIN.TN BPJS KESEHATAN 21/01/2019 Paid 700.000
R1901210270 LAB/190121/0059 107547 MAYINDAH SITINJAK.AN BPJS KESEHATAN 21/01/2019 Paid 295.000
R1901210137 LAB/190121/0060 075250 SATRAWATI. NY BPJS KESEHATAN 21/01/2019 Paid 65.000
R1901210287 LAB/190121/0063 107058 ERVIANI NASUTION. NY BPJS KESEHATAN 21/01/2019 Paid 125.000
R1901210273 LAB/190121/0064 061233 SUPIANTO. TN BPJS KESEHATAN 21/01/2019 Paid 183.000
R1901190219 LAB/190121/0066 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 21/01/2019 Paid 350.000
R1901220003 LAB/190122/0001 092844 MAWAR RAJA BNI LIFE INSURANCE 22/01/2019 Paid 503.000
R1901210201 LAB/190122/0002 107532 GUKGUK.NY
ARYA NATHA'S TAQWA BPJS KESEHATAN 22/01/2019 Paid 65.000
R1901220007 LAB/190122/0003 107554 RASYIDIEN. AN BY. NY BPJS KESEHATAN
JUNI SARTIKA. 22/01/2019 Paid 98.000
R1901220003 LAB/190122/0004 092844 MAWAR RAJA BNI LIFE INSURANCE 22/01/2019 Paid 33.000
R1812270319 LAB/190122/0005 106176 GUKGUK.NY
ABDUL KHALED BPJS KESEHATAN 22/01/2019 Paid 65.000
R1812270319 LAB/190122/0006 106176 ARRAZZAQ
ABDUL RAYVANS. AN BPJS KESEHATAN
KHALED 22/01/2019 Paid 65.000
R1901150054 LAB/190122/0008 101945 ARRAZZAQ RAYVANS. AN BPJS KESEHATAN
WIWIK AFIAH.NY 22/01/2019 Paid 753.000
R1901210290 LAB/190122/0015 107551 BERYL. AN PASIEN UMUM 22/01/2019 Paid 33.000
R1901220007 LAB/190122/0016 107554 JUNI SARTIKA. BY. NY BPJS KESEHATAN 22/01/2019 Paid 33.000
R1901220003 LAB/190122/0019 092844 MAWAR RAJA BNI LIFE INSURANCE 22/01/2019 Paid 65.000
R1901220141 LAB/190122/0021 107611 GUKGUK.NY
FITRI YANI RITONGA.NY BPJS KESEHATAN 22/01/2019 Paid 503.000
R1901220141 LAB/190122/0022 107611 FITRI YANI RITONGA.NY BPJS KESEHATAN 22/01/2019 Paid 40.000
R1901190219 LAB/190122/0024 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 22/01/2019 Paid 383.000
R1901220158 LAB/190122/0027 107302 ANUGRAH MAULANA PT. OWLEXA 22/01/2019 Paid 753.000
R1901220142 LAB/190122/0029 107613 RASYAD. TN
ERLINA SINAGA. NY BPJS KESEHATAN 22/01/2019 Paid 547.100
R1901220184 LAB/190122/0032 107628 JONATHAN ALFARO BPJS KESEHATAN 22/01/2019 Paid 145.000
R1901220177 LAB/190122/0037 107626 SIMAMORA.
PITRI AN
YENI. NY BPJS KESEHATAN 22/01/2019 Paid 271.000
R1901170216 LAB/190122/0038 107295 JUNI SARTIKA.NY BPJS KESEHATAN 22/01/2019 Paid 65.000
R1901220214 LAB/190122/0039 107634 RANDO VALENTINO BPJS KESEHATAN 22/01/2019 Paid 753.000
R1901220230 LAB/190122/0040 107640 FERNANDO TIDAYOH.
FADILLATURRAHMAH. BPJS KESEHATAN 22/01/2019 Paid 410.000
R1901220239 LAB/190122/0042 038641 TN
NY
ERMILA PANGGABEAN. BPJS KESEHATAN 22/01/2019 Paid 503.000
R1901130019 LAB/190122/0045 106951 NY LUTHFI ABDULLOH. BPJS KESEHATAN
M. 22/01/2019 Paid 80.000
R1901220217 LAB/190122/0046 107635 AN MAIDA KARTIKA
TIUR BPJS KESEHATAN 22/01/2019 Paid 480.000
R1901220219 LAB/190122/0047 107636 ANGGI.AN.TN
MASTUR BPJS KESEHATAN 22/01/2019 Paid 753.000
R1901220158 LAB/190122/0048 107302 ANUGRAH MAULANA PT. OWLEXA 22/01/2019 Paid 600.000
R1901220198 LAB/190122/0049 078868 RASYAD. TN
TIURLAS MANURUNG.NY BPJS KESEHATAN 22/01/2019 Paid 503.000
R1901220269 LAB/190122/0050 107653 RAJIDUN .TN BPJS KESEHATAN 22/01/2019 Paid 98.000
R1901220272 LAB/190122/0051 107655 ARUM JHONKLINTON.AN BPJS KESEHATAN COB22/01/2019 Paid 48.750
R1901220239 LAB/190122/0053 038641 ERMILA PANGGABEAN. BPJSINHEALTH
KESEHATAN 22/01/2019 Paid 600.000
R1901220271 LAB/190122/0054 107654 NY
SUTRIS DIANTO .TN PASIEN UMUM 22/01/2019 Paid 103.000
R1901160149 LAB/190122/0055 107200 AHMAD .TN BPJS KESEHATAN 22/01/2019 Paid 315.000
R1901160149 LAB/190122/0056 107200 AHMAD .TN BPJS KESEHATAN 22/01/2019 Paid 700.000
R1901220271 LAB/190122/0057 107654 SUTRIS DIANTO .TN PASIEN UMUM 22/01/2019 Paid 80.000
R1901220290 LAB/190122/0058 107441 TIURLAN SIMBOLON. NY PASIEN UMUM 22/01/2019 Paid 145.000
R1901230001 LAB/190123/0001 107658 TIURLAS BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901230005 LAB/190123/0002 107659 MANURUNG.BY.NY
TRIAYANA PUJI BPJS KESEHATAN 23/01/2019 Paid 145.000
R1901220198 LAB/190123/0004 078868 HARTINI.NY
TIURLAS MANURUNG.NY BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901230012 LAB/190123/0005 104745 ESPI ANITA BPJS KESEHATAN 23/01/2019 Paid 503.000
R1901230010 LAB/190123/0006 107661 NAPITUPULU.NY
SRI LESTARI.NY BPJS KESEHATAN 23/01/2019 Paid 503.000
R1901190015 LAB/190123/0007 107141 KHALISHAH SILMI KAFFA BPJS KESEHATAN 23/01/2019 Paid 70.000
R1901220269 LAB/190123/0008 107653 P.AN
RAJIDUN .TN BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901210201 LAB/190123/0009 107532 ARYA NATHA'S TAQWA BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901170216 LAB/190123/0010 107295 RASYIDIEN.
JUNI AN
SARTIKA.NY BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901230015 LAB/190123/0011 107225 TUGIMAN.TN BPJS KESEHATAN 23/01/2019 Paid 753.000
R1901230021 LAB/190123/0012 046173 AYU AYUNI.NY PASIEN UMUM 23/01/2019 Paid 813.000
R1901230044 LAB/190123/0014 042758 PUJI EKO .NY BPJS KESEHATAN 23/01/2019 Paid 503.000

PAGE : 9 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901190219 LAB/190123/0016 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901220007 LAB/190123/0017 107554 JUNI SARTIKA. BY. NY BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901230050 LAB/190123/0019 103050 RESSY LENGGOGENI.NY BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901230073 LAB/190123/0020 107666 SRI LESTRAI.BY.NY BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901130019 LAB/190123/0021 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 23/01/2019 Paid 178.000
R1901230067 LAB/190123/0022 107671 AN
SANTOSO. TN BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901230067 LAB/190123/0024 107671 SANTOSO. TN BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901230010 LAB/190123/0025 107661 SRI LESTARI.NY BPJS KESEHATAN 23/01/2019 Paid 40.000
R1901130019 LAB/190123/0026 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901220269 LAB/190123/0027 107653 AN
RAJIDUN .TN BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901220272 LAB/190123/0028 107655 ARUM JHONKLINTON.AN BPJS KESEHATAN COB23/01/2019 Paid 30.000
R1901230078 LAB/190123/0029 048198 NURMEI SIBARANI.NY INHEALTH
BNI LIFE INSURANCE 23/01/2019 Paid 110.000
R1901230126 LAB/190123/0034 100815 ENNIERAWATI.NY BPJS KESEHATAN 23/01/2019 Paid 40.000
R1901190219 LAB/190123/0038 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 23/01/2019 Paid 80.000
R1901230139 LAB/190123/0039 107684 ESPI ANITA BY NY 2 BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901230140 LAB/190123/0040 107683 ESPI ANITA BY.NY 1 BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901210230 LAB/190123/0042 104823 ENDANG SUBROTO. TN BPJS KESEHATAN 23/01/2019 Paid 80.000
R1901230147 LAB/190123/0043 107690 DJARMAN .TN BPJS KESEHATAN 23/01/2019 Paid 218.000
R1901230126 LAB/190123/0044 100815 ENNIERAWATI.NY BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901230147 LAB/190123/0045 107690 DJARMAN .TN BPJS KESEHATAN 23/01/2019 Paid 290.000
R1901210013 LAB/190123/0046 107461 MUHAMAD ZIAD.AN BPJS KESEHATAN 23/01/2019 Paid 753.000
R1901230012 LAB/190123/0047 104745 ESPI ANITA BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901190219 LAB/190123/0048 107442 NAPITUPULU.NY
BY.NY. RIZKY AUDINA BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901230164 LAB/190123/0049 107695 FITRI YANI RITONGA BY BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901230021 LAB/190123/0050 046173 NY AYUNI.NY
AYU PASIEN UMUM 23/01/2019 Paid 700.000
R1901230122 LAB/190123/0052 047462 WILDA FASIM BPJS KESEHATAN 23/01/2019 Paid 470.000
R1901230178 LAB/190123/0053 107698 HASIBUAN.NY
PUJI EKO.BY.NY BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901230113 LAB/190123/0057 056166 HASIANNA SINAGA .NY ASURANSI RELIANCE 23/01/2019 Paid 410.000
R1901230182 LAB/190123/0058 107703 SEFY LUHUKAI .TN PASIEN UMUM 23/01/2019 Paid 295.000
R1901230179 LAB/190123/0059 107702 ERIKA ABIGAEL SHARON.BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901230044 LAB/190123/0060 042758 AN EKO .NY
PUJI BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901220141 LAB/190123/0061 107611 FITRI YANI RITONGA.NY BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901190219 LAB/190123/0062 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 23/01/2019 Paid 350.000
R1901220219 LAB/190123/0064 107636 MASTUR .TN BPJS KESEHATAN 23/01/2019 Paid 600.000
R1901230097 LAB/190123/0065 107137 NOVERITA PASIEN UMUM 23/01/2019 Paid 410.000
R1901230010 LAB/190124/0001 107661 HUTAURUK.NY
SRI LESTARI.NY BPJS KESEHATAN 24/01/2019 Paid 65.000
R1901230179 LAB/190124/0002 107702 ERIKA ABIGAEL SHARON.BPJS KESEHATAN 24/01/2019 Paid 65.000
R1901230149 LAB/190124/0003 077117 AN
ARSYLIA ALFATHUNISA BPJS KESEHATAN 24/01/2019 Paid 65.000
R1901220219 LAB/190124/0004 107636 .AN
MASTUR .TN BPJS KESEHATAN 24/01/2019 Paid 315.000
R1901220290 LAB/190124/0005 107441 TIURLAN SIMBOLON. NY PASIEN UMUM 24/01/2019 Paid 65.000
R1901230067 LAB/190124/0006 107671 SANTOSO. TN BPJS KESEHATAN 24/01/2019 Paid 33.000
R1901230148 LAB/190124/0007 107691 EL ATHAR GHAISAN .AN BPJS KESEHATAN 24/01/2019 Paid 65.000
R1901220056 LAB/190124/0008 105984 ETI SUSANTI. NY BPJS KESEHATAN 24/01/2019 Paid 80.000
R1901230005 LAB/190124/0009 107659 TRIAYANA PUJI BPJS KESEHATAN 24/01/2019 Paid 151.000
R1901230113 LAB/190124/0012 056166 HARTINI.NYSINAGA .NY ASURANSI RELIANCE 24/01/2019
HASIANNA Paid 93.000
R1901190016 LAB/190124/0014 107373 AGNES TRIYANTI. NN BPJS KESEHATAN 24/01/2019 Paid 813.000
R1901200008 LAB/190124/0016 103787 KEANDRA APRLIO BPJS KESEHATAN 24/01/2019 Paid 105.000
R1901230019 LAB/190124/0017 107375 DAFFANI.AN
IMELDA LUPITA SARI BPJS KESEHATAN 24/01/2019 Paid 813.000
R1901240053 LAB/190124/0018 107721 SINAGA. NN
RIZKY.AN BPJS KESEHATAN 24/01/2019 Paid 65.000
R1901240045 LAB/190124/0019 088694 NURMALA SITORUS. NY BPJS KESEHATAN 24/01/2019 Paid 503.000
R1901240079 LAB/190124/0024 107618 ESTER MARLINA BPJS KESEHATAN 24/01/2019 Paid 70.000
R1901230113 LAB/190124/0025 056166 BUTARBUTAR.
HASIANNA NY .NY ASURANSI RELIANCE 24/01/2019
SINAGA Paid 33.000
R1901230147 LAB/190124/0029 107690 DJARMAN .TN BPJS KESEHATAN 24/01/2019 Paid 250.000
R1901240092 LAB/190124/0030 107735 M. GIBRAN PUTRA PASIEN UMUM 24/01/2019 Paid 65.000
R1901240116 LAB/190124/0032 107745 SETIAWAN.AN
QOFFAN RAFARDHAN BPJS KESEHATAN COB24/01/2019 Paid 48.750
R1901240090 LAB/190124/0033 107722 ATHALLA
FANNY MUSTOFA. AN BPJS
THERESIA INHEALTH
KESEHATAN 24/01/2019 Paid 385.000
R1901210201 LAB/190124/0034 107532 ANGGREINI
ARYA P. NN
NATHA'S TAQWA BPJS KESEHATAN 24/01/2019 Paid 65.000
R1901240139 LAB/190124/0035 107754 RASYIDIEN. AN
NURMALA BPJS KESEHATAN 24/01/2019 Paid 33.000
R1901240134 LAB/190124/0037 107551 SITORUS.BY.NY
BERYL. AN BPJS KESEHATAN 24/01/2019 Paid 80.000
R1901130019 LAB/190124/0038 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 24/01/2019 Paid 80.000
R1812270319 LAB/190124/0039 106176 AN
ABDUL KHALED BPJS KESEHATAN 24/01/2019 Paid 80.000
ARRAZZAQ RAYVANS. AN
PAGE : 10 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901240137 LAB/190124/0040 090979 ELY ULPA.NY BPJS KESEHATAN 24/01/2019 Paid 105.000
R1901230113 LAB/190124/0041 056166 HASIANNA SINAGA .NY ASURANSI RELIANCE 24/01/2019 Paid 65.000
R1901240137 LAB/190124/0042 090979 ELY ULPA.NY BPJS KESEHATAN 24/01/2019 Paid 40.000
R1901240165 LAB/190124/0043 107762 SUPRAPTI.NY BPJS KESEHATAN 24/01/2019 Paid 410.000
R1901230147 LAB/190124/0044 107690 DJARMAN .TN BPJS KESEHATAN 24/01/2019 Paid 80.000
R1901240045 LAB/190124/0045 088694 NURMALA SITORUS. NY BPJS KESEHATAN 24/01/2019 Paid 65.000
R1901240134 LAB/190124/0048 107551 BERYL. AN BPJS KESEHATAN 24/01/2019 Paid 98.000
R1901210013 LAB/190124/0049 107461 MUHAMAD ZIAD.AN BPJS KESEHATAN 24/01/2019 Paid 600.000
R1901240144 LAB/190124/0050 107756 MANGANTAR BPJS KESEHATAN 24/01/2019 Paid 428.000
R1901240134 LAB/190124/0051 107551 SIMANJUNTAK.TN
BERYL. AN BPJS KESEHATAN 24/01/2019 Paid 150.000
R1901130019 LAB/190124/0054 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 24/01/2019 Paid 561.000
R1901190219 LAB/190124/0055 107442 AN
BY.NY. RIZKY AUDINA BPJS KESEHATAN 24/01/2019 Paid 495.000
R1901220269 LAB/190124/0058 107653 RAJIDUN .TN BPJS KESEHATAN 24/01/2019 Paid 150.000
R1901220007 LAB/190125/0001 107554 JUNI SARTIKA. BY. NY BPJS KESEHATAN 25/01/2019 Paid 183.000
R1901240137 LAB/190125/0002 090979 ELY ULPA.NY BPJS KESEHATAN 25/01/2019 Paid 65.000
R1901240144 LAB/190125/0003 107756 MANGANTAR BPJS KESEHATAN 25/01/2019 Paid 40.000
R1901210273 LAB/190125/0004 061233 SIMANJUNTAK.TN
SUPIANTO. TN BPJS KESEHATAN 25/01/2019 Paid 275.000
R1901220290 LAB/190125/0005 107441 TIURLAN SIMBOLON. NY PASIEN UMUM 25/01/2019 Paid 65.000
R1901230179 LAB/190125/0007 107702 ERIKA ABIGAEL SHARON.BPJS KESEHATAN 25/01/2019 Paid 65.000
R1901240090 LAB/190125/0008 107722 AN
FANNY THERESIA BPJS KESEHATAN 25/01/2019 Paid 65.000
R1901240116 LAB/190125/0009 107745 ANGGREINI
QOFFAN P. NN
RAFARDHAN BPJS KESEHATAN COB25/01/2019 Paid 48.750
R1901230101 LAB/190125/0010 107678 ATHALLA MUSTOFA.
RIZQI NOVIAN AN INHEALTH
AZKA.AN ASURANSI RELIANCE 25/01/2019 Paid 65.000
R1901250027 LAB/190125/0013 107798 YOSSY FITRIANY BPJS KESEHATAN 25/01/2019 Paid 110.000
R1901250054 LAB/190125/0015 096071 PARHUSIP. AN
HALUS FARIDA.NY BPJS KESEHATAN 25/01/2019 Paid 503.000
R1901210043 LAB/190125/0016 095901 TARMIZON.TN BPJS KESEHATAN 25/01/2019 Paid 753.000
R1901220019 LAB/190125/0017 107555 MUNIANISA.NY BPJS KESEHATAN 25/01/2019 Paid 813.000
R1901250042 LAB/190125/0021 101379 EDI SUTRISNO. TN BPJS KESEHATAN 25/01/2019 Paid 105.000
R1901250075 LAB/190125/0023 084986 SOLIA RENTIA SIAHAAN. BPJS KESEHATAN 25/01/2019 Paid 503.000
R1901140175 LAB/190125/0024 105819 NY
BONARIA NENGGOLAN, BPJS KESEHATAN 25/01/2019 Paid 543.000
R1901250149 LAB/190125/0026 107837 NY
TARI M. UHDARMANIZA BPJS KESEHATAN 25/01/2019 Paid 470.000
R1901250149 LAB/190125/0027 107837 PURWANTO.
TARI NY
M. UHDARMANIZA BPJS KESEHATAN 25/01/2019 Paid 40.000
R1901230005 LAB/190125/0032 107659 PURWANTO.
TRIAYANA NY
PUJI BPJS KESEHATAN 25/01/2019 Paid 65.000
R1901130019 LAB/190125/0033 106951 HARTINI.NY
M. LUTHFI ABDULLOH. BPJS KESEHATAN 25/01/2019 Paid 33.000
R1901220007 LAB/190125/0034 107554 AN
JUNI SARTIKA. BY. NY BPJS KESEHATAN 25/01/2019 Paid 33.000
R1901240134 LAB/190125/0035 107551 BERYL. AN BPJS KESEHATAN 25/01/2019 Paid 33.000
R1901190219 LAB/190125/0036 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 25/01/2019 Paid 33.000
R1901130019 LAB/190125/0037 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 25/01/2019 Paid 65.000
R1901240025 LAB/190125/0038 101197 AN MAINAH.NY
SITI BPJS KESEHATAN 25/01/2019 Paid 600.000
R1901250045 LAB/190125/0039 103236 RATNA WATI. NY BPJS KESEHATAN 25/01/2019 Paid 326.000
R1901250193 LAB/190125/0040 107853 NOVA SILVIA DEWI N. BPJS KESEHATAN 25/01/2019 Paid 410.000
R1901250202 LAB/190125/0041 107852 NY
YEHEZKIEL BPJS KESEHATAN 25/01/2019 Paid 33.000
R1901250075 LAB/190125/0042 084986 PANJAITAN.AN
SOLIA RENTIA SIAHAAN. BPJS KESEHATAN 25/01/2019 Paid 65.000
R1901230179 LAB/190125/0044 107702 NY
ERIKA ABIGAEL SHARON.BPJS KESEHATAN 25/01/2019 Paid 65.000
R1901250177 LAB/190125/0045 104346 AN
SUPARNADI . TN BPJS KESEHATAN 25/01/2019 Paid 753.000
R1901250170 LAB/190125/0048 107829 LA ODE MUHAMMAD AL BPJS KESEHATAN 25/01/2019 Paid 150.000
R1901250193 LAB/190125/0049 107853 IKRAM.SILVIA
NOVA AN DEWI N. BPJS KESEHATAN 25/01/2019 Paid 60.000
R1901250213 LAB/190125/0051 107860 NY
FACHRI ADITYA SARDI. BPJS KESEHATAN 25/01/2019 Paid 145.000
R1901250215 LAB/190125/0052 073952 AN
FADHLY AMALUL BPJS KESEHATAN 25/01/2019 Paid 145.000
R1901250217 LAB/190125/0053 107861 SHLIHIN.AN
REZI SAPUTRA .TN BPJS KESEHATAN 25/01/2019 Paid 145.000
R1901250027 LAB/190125/0054 107798 YOSSY FITRIANY BPJS KESEHATAN 25/01/2019 Paid 60.000
R1901250027 LAB/190125/0055 107798 PARHUSIP.
YOSSY AN
FITRIANY BPJS KESEHATAN 25/01/2019 Paid 378.000
R1901250242 LAB/190125/0058 107700 PARHUSIP.
ZHORDY AN
SITUMEANG. BPJS KESEHATAN 25/01/2019 Paid 295.000
R1901250248 LAB/190125/0060 107857 AN
HALUS FARIDA. BY. NY BPJS KESEHATAN 25/01/2019 Paid 33.000
R1901250054 LAB/190125/0061 096071 HALUS FARIDA.NY BPJS KESEHATAN 25/01/2019 Paid 109.100
R1901250042 LAB/190125/0062 101379 EDI SUTRISNO. TN BPJS KESEHATAN 25/01/2019 Paid 65.000
R1901250177 LAB/190125/0063 104346 SUPARNADI . TN BPJS KESEHATAN 25/01/2019 Paid 40.000
R1901250247 LAB/190125/0064 107869 RIA ANITA .NY BPJS KESEHATAN 25/01/2019 Paid 587.100
R1901250252 LAB/190125/0065 107870 ENDA WILIZA. BY NY BPJS KESEHATAN 25/01/2019 Paid 255.000
R1901260001 LAB/190126/0001 107873 ENDRA DEWITA. NY BPJS KESEHATAN 26/01/2019 Paid 503.000
R1901250042 LAB/190126/0002 101379 EDI SUTRISNO. TN BPJS KESEHATAN 26/01/2019 Paid 166.000
R1901260003 LAB/190126/0003 107874 NIKE HARIANJA. NY BPJS KESEHATAN 26/01/2019 Paid 503.000

PAGE : 11 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901140175 LAB/190126/0004 105819 BONARIA NENGGOLAN, BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901250217 LAB/190126/0005 107861 NY SAPUTRA .TN
REZI BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901250105 LAB/190126/0006 078552 MASRIDA.NY BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901230067 LAB/190126/0007 107671 SANTOSO. TN BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901250215 LAB/190126/0008 073952 FADHLY AMALUL BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901230147 LAB/190126/0009 107690 SHLIHIN.AN
DJARMAN .TN BPJS KESEHATAN 26/01/2019 Paid 315.000
R1901240090 LAB/190126/0010 107722 FANNY THERESIA BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901260015 LAB/190126/0011 107876 ANGGREINI
NIKE P. NNBY NY BPJS KESEHATAN
HARIANJA. 26/01/2019 Paid 33.000
R1901230210 LAB/190126/0012 107708 ROMI YULIANDRI.NY BPJS KESEHATAN 26/01/2019 Paid 470.000
R1901260003 LAB/190126/0013 107874 NIKE HARIANJA. NY BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901250149 LAB/190126/0014 107837 TARI M. UHDARMANIZA BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901260058 LAB/190126/0016 107881 PURWANTO. NY 1
RIA ANITA.BY.NY BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901260060 LAB/190126/0017 107882 RIA NAITA BY.NY 2 BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901260067 LAB/190126/0018 107880 AGUSTINA WATI.BY.NY BPJS KESEHATAN 26/01/2019 Process 33.000
R1901230210 LAB/190126/0019 107708 ROMI YULIANDRI.NY BPJS KESEHATAN 26/01/2019 Paid 700.000
R1901220007 LAB/190126/0021 107554 JUNI SARTIKA. BY. NY BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901240134 LAB/190126/0022 107551 BERYL. AN BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901260018 LAB/190126/0025 107879 AGUSTINA WATI. NY BPJS KESEHATAN 26/01/2019 Paid 410.000
R1901260112 LAB/190126/0027 107911 ANGGIAT HUTAURUK.TN BPJS KESEHATAN 26/01/2019 Paid 70.000
R1901230045 LAB/190126/0029 105484 LAIZU. TN BPJS KESEHATAN 26/01/2019 Paid 753.000
R1901220007 LAB/190126/0030 107554 JUNI SARTIKA. BY. NY BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901140175 LAB/190126/0031 105819 BONARIA NENGGOLAN, BPJS KESEHATAN 26/01/2019 Paid 700.000
R1901260112 LAB/190126/0035 107911 NY
ANGGIAT HUTAURUK.TN BPJS KESEHATAN 26/01/2019 Paid 40.000
R1901260126 LAB/190126/0037 027796 JARIYAH.NY PASIEN UMUM 26/01/2019 Paid 468.000
R1901260112 LAB/190126/0039 107911 ANGGIAT HUTAURUK.TN BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901260127 LAB/190126/0040 107915 LAURA SILABAN .NY BPJS KESEHATAN 26/01/2019 Paid 315.000
R1901240215 LAB/190126/0041 043545 SURATI .NY BPJS KESEHATAN 26/01/2019 Paid 543.000
R1901260160 LAB/190126/0045 107751 JONATHAN PASIEN UMUM 26/01/2019 Paid 65.000
R1901260147 LAB/190126/0046 107923 SITUMORANG.AN
RANCAWATI .NY BPJS KESEHATAN 26/01/2019 Paid 503.000
R1901140175 LAB/190126/0047 105819 BONARIA NENGGOLAN, BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901240134 LAB/190126/0048 107551 NY
BERYL. AN BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901260165 LAB/190126/0049 107350 RUDI HARTONO. TN BPJS KESEHATAN 26/01/2019 Paid 178.000
R1901260167 LAB/190126/0051 107929 MARULI TUA .TN BPJS KESEHATAN 26/01/2019 Paid 178.000
R1901240215 LAB/190126/0052 043545 SURATI .NY BPJS KESEHATAN 26/01/2019 Paid 250.000
R1901240116 LAB/190126/0053 107745 QOFFAN RAFARDHAN BPJS KESEHATAN COB26/01/2019 Paid 48.750
R1901260141 LAB/190126/0054 107403 ATHALLA MUSTOFA.
SAUMI DARTO. NY AN INHEALTH
BPJS KESEHATAN 26/01/2019 Paid 813.000
R1901260193 LAB/190126/0055 107933 RANCAWATI.BY.NY BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901230179 LAB/190126/0056 107702 ERIKA ABIGAEL SHARON.BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901130019 LAB/190126/0057 106951 AN LUTHFI ABDULLOH. BPJS KESEHATAN
M. 26/01/2019 Paid 315.000
R1901250177 LAB/190126/0059 104346 AN
SUPARNADI . TN BPJS KESEHATAN 26/01/2019 Paid 283.000
R1901260210 LAB/190126/0060 107942 TAHI HALOMOAN PASIEN UMUM 26/01/2019 Paid 760.000
R1901260112 LAB/190126/0061 107911 PURBA.TN
ANGGIAT HUTAURUK.TN BPJS KESEHATAN 26/01/2019 Paid 695.000
R1901260218 LAB/190126/0063 085409 FAIZ FATHAR BPJS KESEHATAN 26/01/2019 Paid 315.000
R1901250177 LAB/190126/0064 104346 GHASSANI.AN
SUPARNADI . TN BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901250247 LAB/190126/0065 107869 RIA ANITA .NY BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901190219 LAB/190126/0066 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 26/01/2019 Paid 933.000
R1901260147 LAB/190126/0069 107923 RANCAWATI .NY BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901260221 LAB/190126/0070 107945 ERNITA ARITONANG. NY BPJS KESEHATAN 26/01/2019 Paid 410.000
R1901230179 LAB/190126/0071 107702 ERIKA ABIGAEL SHARON.BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901230179 LAB/190126/0072 107702 AN
ERIKA ABIGAEL SHARON.BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901260234 LAB/190126/0074 107952 AN PERMATA SARI. NY BPJS KESEHATAN
NIKE 26/01/2019 Paid 503.000
R1901260126 LAB/190127/0001 027796 JARIYAH.NY PASIEN UMUM 27/01/2019 Paid 33.000
R1901240116 LAB/190127/0002 107745 QOFFAN RAFARDHAN BPJS KESEHATAN COB27/01/2019 Paid 48.750
R1901260034 LAB/190127/0003 091555 ATHALLA MUSTOFA. AN INHEALTH
LENI FRANSISKA.NY BPJS KESEHATAN 27/01/2019 Paid 470.000
R1901260221 LAB/190127/0004 107945 ERNITA ARITONANG. NY BPJS KESEHATAN 27/01/2019 Paid 93.000
R1901190219 LAB/190127/0005 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 27/01/2019 Paid 330.000
R1901250085 LAB/190127/0006 107813 MELI AGUSTINA.NY BPJS KESEHATAN 27/01/2019 Paid 410.000
R1901270005 LAB/190127/0007 107953 ERNITA BPJS KESEHATAN 27/01/2019 Paid 98.000
R1901190219 LAB/190127/0008 107442 ARITONANG.BY.NY
BY.NY. RIZKY AUDINA BPJS KESEHATAN 27/01/2019 Paid 33.000
R1901130019 LAB/190127/0009 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 27/01/2019 Paid 33.000
R1901220007 LAB/190127/0010 107554 AN SARTIKA. BY. NY BPJS KESEHATAN
JUNI 27/01/2019 Paid 33.000

PAGE : 12 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901240134 LAB/190127/0011 107551 BERYL. AN BPJS KESEHATAN 27/01/2019 Paid 33.000


R1901250085 LAB/190127/0012 107813 MELI AGUSTINA.NY BPJS KESEHATAN 27/01/2019 Paid 24.300
R1901260126 LAB/190127/0014 027796 JARIYAH.NY PASIEN UMUM 27/01/2019 Paid 33.000
R1901260221 LAB/190127/0015 107945 ERNITA ARITONANG. NY BPJS KESEHATAN 27/01/2019 Paid 65.000
R1901270013 LAB/190127/0016 107958 M.ARIK RIZKULLAH.TN BPJS KESEHATAN 27/01/2019 Paid 145.000
R1901270014 LAB/190127/0017 107959 AYU YUNI BPJS KESEHATAN 27/01/2019 Paid 410.000
R1901220217 LAB/190127/0018 107635 SUPRIHATIN.NY
TIUR MAIDA KARTIKA BPJS KESEHATAN 27/01/2019 Paid 588.000
R1901220007 LAB/190127/0019 107554 ANGGI.AN
JUNI SARTIKA. BY. NY BPJS KESEHATAN 27/01/2019 Paid 33.000
R1901230179 LAB/190127/0020 107702 ERIKA ABIGAEL SHARON.BPJS KESEHATAN 27/01/2019 Paid 65.000
R1901250170 LAB/190127/0021 107829 AN
LA ODE MUHAMMAD AL BPJS KESEHATAN 27/01/2019 Paid 150.000
R1901270029 LAB/190127/0023 094232 IKRAM.
RINAWATYAN LUBIS.NY PASIEN UMUM 27/01/2019 Paid 503.000
R1901260126 LAB/190127/0025 027796 JARIYAH.NY PASIEN UMUM 27/01/2019 Paid 33.000
R1901220217 LAB/190127/0026 107635 TIUR MAIDA KARTIKA BPJS KESEHATAN 27/01/2019 Paid 250.000
R1901260232 LAB/190127/0027 107951 ANGGI.AN
RENGKI SAFRIAWAN. TN BPJS KESEHATAN 27/01/2019 Paid 65.000
R1901190219 LAB/190127/0028 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 27/01/2019 Paid 395.000
R1901260232 LAB/190127/0029 107951 RENGKI SAFRIAWAN. TN BPJS KESEHATAN 27/01/2019 Paid 40.000
R1901130019 LAB/190127/0030 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 27/01/2019 Paid 1.100.000
R1901270029 LAB/190127/0031 094232 AN
RINAWATY LUBIS.NY PASIEN UMUM 27/01/2019 Paid 65.000
R1901250085 LAB/190128/0001 107813 MELI AGUSTINA.NY BPJS KESEHATAN 28/01/2019 Paid 93.000
R1901260218 LAB/190128/0002 085409 FAIZ FATHAR BPJS KESEHATAN 28/01/2019 Paid 40.000
R1901260126 LAB/190128/0003 027796 GHASSANI.AN
JARIYAH.NY PASIEN UMUM 28/01/2019 Paid 33.000
R1901270013 LAB/190128/0004 107958 M.ARIK RIZKULLAH.TN BPJS KESEHATAN 28/01/2019 Paid 151.000
R1901280048 LAB/190128/0007 107978 MELI AGUSTINA.BY.NY BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901240116 LAB/190128/0008 107745 QOFFAN RAFARDHAN BPJS KESEHATAN COB28/01/2019 Paid 48.750
R1901280060 LAB/190128/0009 107382 ATHALLA
ADE MUSTOFA.
SHINTIA AN BPJS
ELPALINA INHEALTH
KESEHATAN 28/01/2019 Paid 813.000
R1901220146 LAB/190128/0010 107307 SIREGAR. VERNANDA
LINTANG NN BPJS KESEHATAN 28/01/2019 Paid 813.000
R1901280085 LAB/190128/0016 094079 RAHMADANI.
NG KHON SEN.NNTN PASIEN UMUM 28/01/2019 Paid 98.000
R1901260126 LAB/190128/0025 027796 JARIYAH.NY PASIEN UMUM 28/01/2019 Paid 33.000
R1901240003 LAB/190128/0027 107710 MIDA NURDIANA BPJS KESEHATAN 28/01/2019 Paid 563.000
R1901280012 LAB/190128/0028 062564 MARPAUNG. NY
KWONGLY SITANGGANG. BPJS KETENAGAKERJAAN
28/01/2019 Process 65.000
R1901280125 LAB/190128/0029 099688 TN
ROZIKAN. TN BPJS KESEHATAN 28/01/2019 Paid 65.000
R1901280021 LAB/190128/0031 107976 KENZIE PASIEN UMUM 28/01/2019 Paid 65.000
R1901250085 LAB/190128/0034 107813 NATHANAEL.M.AN
MELI AGUSTINA.NY BPJS KESEHATAN 28/01/2019 Paid 65.000
R1901280007 LAB/190128/0035 093925 WASINTA SAMOSIR.NY BPJS KESEHATAN 28/01/2019 Paid 503.000
R1901140175 LAB/190128/0038 105819 BONARIA NENGGOLAN, BPJS KESEHATAN 28/01/2019 Paid 65.000
R1901240134 LAB/190128/0045 107551 NY
BERYL. AN BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901220007 LAB/190128/0046 107554 JUNI SARTIKA. BY. NY BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901190219 LAB/190128/0047 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901130019 LAB/190128/0048 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901260048 LAB/190128/0050 087040 AN
DEWANTY EKA SARI BPJS KESEHATAN 28/01/2019 Paid 315.000
R1901250122 LAB/190128/0054 107573 SIREGAR.NY
LARA AMILIANI.AN BPJS KESEHATAN 28/01/2019 Paid 503.000
R1901280125 LAB/190128/0057 099688 ROZIKAN. TN BPJS KESEHATAN 28/01/2019 Paid 80.000
R1901280085 LAB/190128/0058 094079 NG KHON SEN. TN PASIEN UMUM 28/01/2019 Paid 33.000
R1901260126 LAB/190128/0059 027796 JARIYAH.NY PASIEN UMUM 28/01/2019 Paid 33.000
R1901280077 LAB/190128/0060 107990 ELINA .NY BPJS KESEHATAN 28/01/2019 Paid 468.000
R1901280266 LAB/190128/0066 032445 BALQIS.AN BPJS KESEHATAN 28/01/2019 Paid 70.000
R1901280268 LAB/190128/0067 061536 INDAH SYAWAL BPJS KESEHATAN 28/01/2019 Paid 145.000
R1901280314 LAB/190128/0068 108070 YUDISTRIA.AN
AYU WIRANATA .NY BPJS KESEHATAN 28/01/2019 Paid 315.000
R1901220146 LAB/190128/0069 107307 LINTANG VERNANDA BPJS KESEHATAN 28/01/2019 Paid 700.000
R1901280060 LAB/190128/0070 107382 RAHMADANI.
ADE SHINTIA NN
ELPALINA BPJS KESEHATAN 28/01/2019 Paid 1.000.000
R1901280354 LAB/190128/0072 104834 SIREGAR.NDURU
FALEATI NN .NY BPJS KESEHATAN 28/01/2019 Paid 65.000
R1901280351 LAB/190128/0073 108076 SANTI ANDRIANI .NY PASIEN UMUM 28/01/2019 Paid 470.000
R1901280363 LAB/190128/0075 108081 ELVANIANA .NY BPJS KESEHATAN 28/01/2019 Paid 503.000
R1901240134 LAB/190128/0076 107551 BERYL. AN BPJS KESEHATAN 28/01/2019 Paid 315.000
R1901280368 LAB/190128/0077 108082 WASINTA BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901280367 LAB/190128/0078 107640 SAMOSIR.BY.NY
FADILLATURRAHMAH. BPJS KESEHATAN 28/01/2019 Paid 65.000
R1901290002 LAB/190129/0001 108083 NY
ELVANIANA.BY.NY BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901280040 LAB/190129/0002 088217 CUT JULIATI.NY BPJS KESEHATAN 29/01/2019 Paid 503.000
R1901280040 LAB/190129/0003 088217 CUT JULIATI.NY BPJS KESEHATAN 29/01/2019 Paid 40.000
R1901280363 LAB/190129/0004 108081 ELVANIANA .NY BPJS KESEHATAN 29/01/2019 Paid 65.000
R1901280085 LAB/190129/0005 094079 NG KHON SEN. TN PASIEN UMUM 29/01/2019 Paid 33.000

PAGE : 13 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901260126 LAB/190129/0006 027796 JARIYAH.NY PASIEN UMUM 29/01/2019 Paid 283.000


R1901270013 LAB/190129/0007 107958 M.ARIK RIZKULLAH.TN BPJS KESEHATAN 29/01/2019 Paid 65.000
R1901280007 LAB/190129/0008 093925 WASINTA SAMOSIR.NY BPJS KESEHATAN 29/01/2019 Paid 65.000
R1901280128 LAB/190129/0009 108004 NUR AINI. AN BPJS KESEHATAN 29/01/2019 Paid 65.000
R1901260218 LAB/190129/0010 085409 FAIZ FATHAR BPJS KESEHATAN 29/01/2019 Paid 65.000
R1901240116 LAB/190129/0011 107745 GHASSANI.AN
QOFFAN RAFARDHAN BPJS KESEHATAN COB29/01/2019 Paid 48.750
R1901290062 LAB/190129/0012 108097 ATHALLA
CUT MUSTOFA. AN
JULIATI.BY.NY INHEALTH
BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901290076 LAB/190129/0013 107712 PENDI.TN BPJS KESEHATAN 29/01/2019 Paid 753.000
R1901220217 LAB/190129/0018 107635 TIUR MAIDA KARTIKA BPJS KESEHATAN 29/01/2019 Paid 405.000
R1901130019 LAB/190129/0024 106951 ANGGI.AN
M. LUTHFI ABDULLOH. BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901190219 LAB/190129/0025 107442 AN
BY.NY. RIZKY AUDINA BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901240134 LAB/190129/0026 107551 BERYL. AN BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901220007 LAB/190129/0027 107554 JUNI SARTIKA. BY. NY BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901280275 LAB/190129/0028 108054 RAMDANI MERE. TN BPJS KESEHATAN 29/01/2019 Paid 793.000
R1901290131 LAB/190129/0029 108129 SISKALENA SIBURIAN.NY BPJS KESEHATAN 29/01/2019 Paid 503.000
R1901260126 LAB/190129/0031 027796 JARIYAH.NY PASIEN UMUM 29/01/2019 Paid 33.000
R1901280085 LAB/190129/0032 094079 NG KHON SEN. TN PASIEN UMUM 29/01/2019 Paid 33.000
R1901290052 LAB/190129/0036 108101 MAHARDIKA WIDYA.AN BPJS KESEHATAN 29/01/2019 Paid 833.000
R1901290159 LAB/190129/0037 035682 DESMARIA HUTABALIAN. BPJS KESEHATAN 29/01/2019 Paid 170.000
R1901290164 LAB/190129/0040 094013 NY
MISNI WIDI YANTI.NY BPJS KESEHATAN 29/01/2019 Paid 547.100
R1901290134 LAB/190129/0042 108130 FADHILATUL HURYAH.TNBPJS KESEHATAN 29/01/2019 Paid 470.000
R1901190219 LAB/190129/0044 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 29/01/2019 Paid 495.000
R1901260026 LAB/190129/0045 107401 WIDIYA ADINDA. AN BPJS KESEHATAN 29/01/2019 Paid 813.000
R1901290187 LAB/190129/0046 081915 NAZIRA RIFA BPJS KESEHATAN 29/01/2019 Paid 70.000
R1901290190 LAB/190129/0047 108149 MAHESA.AN
RENATI SIAHAAN. NN BPJS KESEHATAN 29/01/2019 Paid 110.000
R1901290190 LAB/190129/0049 108149 RENATI SIAHAAN. NN BPJS KESEHATAN 29/01/2019 Paid 60.000
R1901290131 LAB/190129/0050 108129 SISKALENA SIBURIAN.NY BPJS KESEHATAN 29/01/2019 Paid 65.000
R1901280040 LAB/190129/0051 088217 CUT JULIATI.NY BPJS KESEHATAN 29/01/2019 Paid 65.000
R1901290217 LAB/190129/0052 108141 SISKALENA SIBURIAN BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901290221 LAB/190129/0053 108155 .BY.NY
MISNI WIDI YANTI.BY BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901290215 LAB/190129/0054 108154 NY
MARIA LARA SATI .NY BPJS KESEHATAN 29/01/2019 Paid 70.000
R1901290215 LAB/190129/0055 108154 MARIA LARA SATI .NY BPJS KESEHATAN 29/01/2019 Paid 40.000
R1901290219 LAB/190129/0056 108157 NENI .NY BPJS KESEHATAN 29/01/2019 Paid 410.000
R1901290052 LAB/190129/0058 108101 MAHARDIKA WIDYA.AN BPJS KESEHATAN 29/01/2019 Paid 80.000
R1901290215 LAB/190129/0059 108154 MARIA LARA SATI .NY BPJS KESEHATAN 29/01/2019 Paid 655.000
R1901290190 LAB/190129/0061 108149 RENATI SIAHAAN. NN BPJS KESEHATAN 29/01/2019 Paid 445.000
R1901280275 LAB/190129/0063 108054 RAMDANI MERE. TN BPJS KESEHATAN 29/01/2019 Paid 700.000
R1901300001 LAB/190130/0001 108162 ALOYSIUS OKTARIANO BPJS KESEHATAN 30/01/2019 Paid 555.000
R1901280085 LAB/190130/0004 094079 L.ANKHON SEN. TN
NG PASIEN UMUM 30/01/2019 Paid 33.000
R1901280275 LAB/190130/0005 108054 RAMDANI MERE. TN BPJS KESEHATAN 30/01/2019 Paid 315.000
R1901290196 LAB/190130/0006 108147 LIYANA JANEETA TAN. INHEALTH 30/01/2019 Process 48.750
R1901280128 LAB/190130/0007 108004 AN
NUR AINI. AN BPJS KESEHATAN 30/01/2019 Paid 65.000
R1901280146 LAB/190130/0008 107931 JAMILAH.NY BPJS KESEHATAN 30/01/2019 Paid 503.000
R1901250057 LAB/190130/0009 107805 ASNAWATI SIBURIAN.NN BPJS KESEHATAN 30/01/2019 Paid 813.000
R1901300021 LAB/190130/0010 107797 MUHARMEN.TN BPJS KESEHATAN 30/01/2019 Paid 503.000
R1901300019 LAB/190130/0011 092661 TETTY MONALISA BPJS KESEHATAN 30/01/2019 Paid 813.000
R1901130019 LAB/190130/0017 106951 TAMBUNAN. NN
M. LUTHFI ABDULLOH. BPJS KESEHATAN 30/01/2019 Paid 350.000
R1901220007 LAB/190130/0018 107554 AN
JUNI SARTIKA. BY. NY BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901190219 LAB/190130/0019 107442 BY.NY. RIZKY AUDINA BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901240134 LAB/190130/0020 107551 BERYL. AN BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901300107 LAB/190130/0021 108195 JAMILAH .NY.BY BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901130019 LAB/190130/0022 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901170216 LAB/190130/0023 107295 AN
JUNI SARTIKA.NY BPJS KESEHATAN 30/01/2019 Paid 428.000
R1901280085 LAB/190130/0025 094079 NG KHON SEN. TN PASIEN UMUM 30/01/2019 Paid 150.000
R1901260141 LAB/190130/0027 107403 SAUMI DARTO. NY BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901250031 LAB/190130/0028 107800 PANDI EFENDI.TN BPJS KESEHATAN 30/01/2019 Paid 503.000
R1901280146 LAB/190130/0033 107931 JAMILAH.NY BPJS KESEHATAN 30/01/2019 Paid 65.000
R1901290186 LAB/190130/0035 104345 JUWITA NARIA BPJS KESEHATAN 30/01/2019 Paid 80.000
R1901240134 LAB/190130/0036 107551 PURBA.NY
BERYL. AN BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901220007 LAB/190130/0037 107554 JUNI SARTIKA. BY. NY BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901300164 LAB/190130/0038 108219 AMRAN AMIRUDIN. TN BPJS KESEHATAN 30/01/2019 Paid 793.000

PAGE : 14 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901280021 LAB/190130/0040 107976 KENZIE PASIEN UMUM 30/01/2019 Paid 65.000


R1901130019 LAB/190130/0041 106951 NATHANAEL.M.AN
M. LUTHFI ABDULLOH. BPJS KESEHATAN 30/01/2019 Paid 145.000
R1901300178 LAB/190130/0042 108222 AN
KARTINI RIA BPJS KESEHATAN 30/01/2019 Paid 145.000
R1901300186 LAB/190130/0046 108228 SIMATUPANG.
ZASKIA KHIESHANNAZ BPJS KESEHATAN 30/01/2019 Paid 145.000
R1901300200 LAB/190130/0050 108231 ZAHRA.
RAYMONAN LIONEL BPJS KESEHATAN 30/01/2019 Paid 295.000
R1901300204 LAB/190130/0051 079125 SITIMORANG.
ABDUL AZIZ.ANAN BPJS KESEHATAN 30/01/2019 Paid 65.000
R1901300210 LAB/190130/0054 108233 FEBRINA OCTAVIANI BPJS KESEHATAN 30/01/2019 Paid 65.000
R1901220007 LAB/190130/0057 107554 HUTASOIT.
JUNI AN BY. NY BPJS KESEHATAN
SARTIKA. 30/01/2019 Paid 33.000
R1901250057 LAB/190130/0058 107805 ASNAWATI SIBURIAN.NN BPJS KESEHATAN 30/01/2019 Paid 700.000
R1901300019 LAB/190130/0059 092661 TETTY MONALISA BPJS KESEHATAN 30/01/2019 Paid 700.000
R1901260026 LAB/190130/0060 107401 TAMBUNAN. NN AN
WIDIYA ADINDA. BPJS KESEHATAN 30/01/2019 Paid 700.000
R1901290215 LAB/190130/0061 108154 MARIA LARA SATI .NY BPJS KESEHATAN 30/01/2019 Paid 1.000.000
R1901300225 LAB/190130/0062 107787 LELAWATI. NY BPJS KESEHATAN 30/01/2019 Paid 98.000
R1901300231 LAB/190131/0001 037728 NY.AGNES ANELINA BPJS KESEHATAN 31/01/2019 Paid 143.000
R1901300225 LAB/190131/0002 107787 DUHA
LELAWATI. NY BPJS KESEHATAN 31/01/2019 Paid 33.000
R1901300178 LAB/190131/0003 108222 KARTINI RIA BPJS KESEHATAN 31/01/2019 Paid 65.000
R1901280128 LAB/190131/0004 108004 SIMATUPANG.
NUR AINI. AN NN BPJS KESEHATAN 31/01/2019 Paid 65.000
R1901300188 LAB/190131/0005 104598 ARAHIM AKBAR .TN BPJS KESEHATAN 31/01/2019 Paid 80.000
R1901280125 LAB/190131/0006 099688 ROZIKAN. TN BPJS KESEHATAN 31/01/2019 Paid 40.000
R1901220007 LAB/190131/0007 107554 JUNI SARTIKA. BY. NY BPJS KESEHATAN 31/01/2019 Paid 33.000
R1901130019 LAB/190131/0008 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 31/01/2019 Paid 33.000
R1901310019 LAB/190131/0010 107884 AN
DODY FAUZI BPJS KESEHATAN 31/01/2019 Paid 753.000
R1901310010 LAB/190131/0013 071494 HASIBUAN.TN
BEZISOKHI DAELI. TN BPJS KESEHATAN 31/01/2019 Paid 753.000
R1901300161 LAB/190131/0015 108218 SERWINTA BR SIAHAAN. BPJS KESEHATAN 31/01/2019 Paid 503.000
R1901150233 LAB/190131/0016 035034 NY
CITRA YETRI ZULKA.NY ASURANSI RELIANCE 31/01/2019 Paid 410.000
R1901220007 LAB/190131/0019 107554 JUNI SARTIKA. BY. NY BPJS KESEHATAN 31/01/2019 Paid 33.000
R1901130019 LAB/190131/0020 106951 M. LUTHFI ABDULLOH. BPJS KESEHATAN 31/01/2019 Paid 33.000
R1901240134 LAB/190131/0021 107551 AN
BERYL. AN BPJS KESEHATAN 31/01/2019 Paid 33.000
R1901310122 LAB/190131/0023 108279 TERTIBMA PURBA. NY BPJS KESEHATAN 31/01/2019 Paid 470.000
R1901310150 LAB/190131/0025 091398 MARTA N NABABAN.NY BPJS KESEHATAN 31/01/2019 Paid 65.000
R1901310113 LAB/190131/0026 108260 NAFISAH SALSABILA.AN BPJS KESEHATAN COB31/01/2019 Paid 258.750
R1901310162 LAB/190131/0027 108295 INHEALTH
SERWINTA BR SIAHAAN. BPJS KESEHATAN 31/01/2019 Paid 33.000
R1901290159 LAB/190131/0028 035682 BY. NY
DESMARIA HUTABALIAN. BPJS KESEHATAN 31/01/2019 Paid 65.000
R1901310163 LAB/190131/0029 086156 NY
YENDRA YENI. NY BPJS KESEHATAN 31/01/2019 Paid 470.000
R1901300040 LAB/190131/0030 107311 ANNA ROMSANA. NY BPJS KESEHATAN 31/01/2019 Paid 813.000
R1901310172 LAB/190131/0032 108299 AYAHRUL ST PAMENAN. BPJS KESEHATAN 31/01/2019 Paid 65.000
R1901300164 LAB/190131/0033 108219 TN
AMRAN AMIRUDIN. TN BPJS KESEHATAN 31/01/2019 Paid 80.000
R1901310010 LAB/190131/0035 071494 BEZISOKHI DAELI. TN BPJS KESEHATAN 31/01/2019 Paid 80.000
R1901300001 LAB/190131/0036 108162 ALOYSIUS OKTARIANO BPJS KESEHATAN 31/01/2019 Paid 250.000
R1901310150 LAB/190131/0037 091398 L.AN
MARTA N NABABAN.NY BPJS KESEHATAN 31/01/2019 Paid 110.000
R1901310171 LAB/190131/0039 108298 ZAHRATUL HAYAH.AN BPJS KESEHATAN 31/01/2019 Paid 150.000
R1901300161 LAB/190131/0041 108218 SERWINTA BR SIAHAAN. BPJS KESEHATAN 31/01/2019 Paid 65.000
R1901310211 LAB/190131/0042 107034 NY
SAHRIDANI. TN BPJS KESEHATAN 31/01/2019 Paid 65.000
R1901150233 LAB/190131/0043 035034 CITRA YETRI ZULKA.NY ASURANSI RELIANCE 31/01/2019 Paid 33.000
R1901310230 LAB/190131/0044 108310 MUHAMMAD AL BPJS KESEHATAN 31/01/2019 Paid 65.000
R1901310134 LAB/190131/0048 069177 FATIHAH. ZULAIN.
ZAHIRAH AN AN BPJS KESEHATAN 31/01/2019 Paid 65.000
R1901300164 LAB/190131/0049 108219 AMRAN AMIRUDIN. TN BPJS KESEHATAN 31/01/2019 Paid 315.000
R1901310134 LAB/190131/0050 069177 ZAHIRAH ZULAIN. AN BPJS KESEHATAN 31/01/2019 Paid 40.000
R1901240134 LAB/190131/0051 107551 BERYL. AN BPJS KESEHATAN 31/01/2019 Paid 65.000
R1901240134 LAB/190131/0052 107551 BERYL. AN BPJS KESEHATAN 31/01/2019 Paid 125.000
R1901310240 LAB/190131/0053 108315 IMAS. NY BPJS KESEHATAN 31/01/2019 Paid 470.000
TOTAL PEMERIKSAAN : RAWAT INAP 206.928.700

2 RAWAT JALAN
R1901010007 LAB/190101/0002 106462 SITI ROHMAH. NY PASIEN UMUM 01/01/2019 Paid 183.000
R1901010007 LAB/190101/0003 106462 SITI ROHMAH. NY PASIEN UMUM 01/01/2019 Paid 33.000
R1901010007 LAB/190101/0004 106462 SITI ROHMAH. NY PASIEN UMUM 01/01/2019 Paid 33.000
R1901010010 LAB/190101/0012 106463 SHYVA DWI AMANDA. ANBPJS KESEHATAN 01/01/2019 Paid 65.000
R1901010014 LAB/190101/0014 095686 OKKY PRAMUDIA PASIEN UMUM 01/01/2019 Paid 98.000
R1901010012 LAB/190101/0015 106465 DEVI.NY
MONICA ANGGRAENI.NY PASIEN UMUM 01/01/2019 Paid 110.000
R1901010025 LAB/190101/0017 106472 MUSVIRATU ALVITA.NN YOKOHAMA INDUSTRIAL
01/01/2019 Paid 385.000

PAGE : 15 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901010023 LAB/190101/0018 106470 ADRIANSYAH.TN PASIEN UMUM 01/01/2019 Paid 348.000


R1901010024 LAB/190101/0019 106471 ADINDA.NN PASIEN UMUM 01/01/2019 Paid 348.000
R1901010037 LAB/190101/0023 106476 INDRA SURANTO. TN PASIEN UMUM 01/01/2019 Paid 385.000
R1901020047 LAB/190102/0008 EXT MARYO.TN PASIEN UMUM 02/01/2019 Paid 65.000
R1901020052 LAB/190102/0011 106498 NAZARUDIN.TN PASIEN UMUM 02/01/2019 Paid 70.000
R1901020030 LAB/190102/0012 106492 JUMIATI .NY PASIEN UMUM 02/01/2019 Paid 128.000
R1901020060 LAB/190102/0013 054542 INDAH WIDYAWATI.NY PT. MITRA ENERGI 02/01/2019 Paid 33.000
R1901020046 LAB/190102/0015 106496 AHMAD ROKHIM.TN PASIEN UMUM 02/01/2019 Paid 98.000
R1901020076 LAB/190102/0016 106242 AGUSTIARMAN PASIEN UMUM 02/01/2019 Paid 151.000
R1901020083 LAB/190102/0017 EXT EFENDI.TN
ARDIN SIMANJUNTAK.TN PASIEN UMUM 02/01/2019 Paid 40.000
R1901020087 LAB/190102/0018 106509 BENNY MANULLANG .TN PASIEN UMUM 02/01/2019 Paid 85.000
R1901020086 LAB/190102/0019 104560 CORINNA KELYN PASIEN UMUM 02/01/2019 Paid 145.000
R1901010009 LAB/190102/0020 090204 SILABAN. AN
SASMIATI.NY BNI LIFE INSURANCE 02/01/2019 Paid 80.000
R1901020093 LAB/190102/0021 099452 M.WILDAN ZAINI.AN PASIEN UMUM 02/01/2019 Paid 70.000
R1901020118 LAB/190102/0024 106517 RULY ABDILLAH. TN PASIEN UMUM 02/01/2019 Paid 65.000
R1901020027 LAB/190102/0025 106490 MULYATI.NY PASIEN UMUM 02/01/2019 Paid 60.000
R1901030047 LAB/190103/0008 097126 YUSA.TN PASIEN UMUM 03/01/2019 Paid 118.000
R1901030070 LAB/190103/0009 106535 MAHENA BR GINTING. ADMEDIKA RELIANCE 03/01/2019 Process 33.000
R1901030074 LAB/190103/0013 106543 BY NY
FOBRIANTO PEMANI PASIEN UMUM 03/01/2019 Process 110.000
R1901030093 LAB/190103/0015 106548 L.TN
NURFATIN RAHMATUL PASIEN UMUM 03/01/2019 Paid 70.000
R1901030104 LAB/190103/0017 106552 ADAWIYAH.
AISYAH AN
AULIA PASIEN UMUM 03/01/2019 Paid 95.000
R1901030110 LAB/190103/0018 090204 AZ-ZAHRA.
SASMIATI.NY AN BNI LIFE INSURANCE 03/01/2019 Paid 110.000
R1901030093 LAB/190103/0019 106548 NURFATIN RAHMATUL PASIEN UMUM 03/01/2019 Paid 100.000
R1901030136 LAB/190103/0024 044800 ADAWIYAH. AN
SRI AMPHITRI.NY PT. AVRIST INSURANCE
03/01/2019 Paid 118.000
R1901040019 LAB/190104/0006 082588 DEWI ASTUTI. NY PASIEN UMUM 04/01/2019 Paid 153.000
R1901040083 LAB/190104/0010 EXT RATMIN.TN PASIEN UMUM 04/01/2019 Paid 40.000
R1901040084 LAB/190104/0011 EXT DZURIYATI.NY PASIEN UMUM 04/01/2019 Paid 40.000
R1901040080 LAB/190104/0012 106238 DIAH NILAWATY.NY PASIEN UMUM 04/01/2019 Paid 40.000
R1901040096 LAB/190104/0013 EXT ANTONI.TN PASIEN UMUM 04/01/2019 Paid 40.000
R1901040095 LAB/190104/0014 106593 SALDEMAR CIBRO.TN PASIEN UMUM 04/01/2019 Paid 118.000
R1901040110 LAB/190104/0015 103612 FIKA ANDRIANI. AN PASIEN UMUM 04/01/2019 Paid 495.000
R1901050009 LAB/190105/0003 106598 FAISHOL PASIEN UMUM 05/01/2019 Paid 95.000
R1901050020 LAB/190105/0004 106601 ABDURROHMAN.
FATHIYYAH AN AN PASIEN UMUM
FARHAH. 05/01/2019 Paid 95.000
R1901050030 LAB/190105/0005 106603 MULYO PERMOND. TN PASIEN UMUM 05/01/2019 Paid 65.000
R1901050032 LAB/190105/0006 106605 ROFIDAH ARANTY H. AN PASIEN UMUM 05/01/2019 Paid 95.000
R1901050036 LAB/190105/0007 106607 M FACHRY ABDILLAH. ANPASIEN UMUM 05/01/2019 Paid 95.000
R1901050040 LAB/190105/0008 106610 YOSUA RITONGA. TN PASIEN UMUM 05/01/2019 Paid 315.000
R1901050015 LAB/190105/0009 098911 TIARA ALZASHY. AN ADMEDIKA RELIANCE 05/01/2019 Paid 65.000
R1901050068 LAB/190105/0015 106623 ADRIAND PRATAMA. AN PASIEN UMUM 05/01/2019 Paid 95.000
R1901050078 LAB/190105/0018 EXT MARIYAM PASIEN UMUM 05/01/2019 Paid 40.000
R1901050082 LAB/190105/0019 070597 ETI. NY PASIEN UMUM 05/01/2019 Paid 328.000
R1901050086 LAB/190105/0020 106630 AN.HASNA HAZIYA PASIEN UMUM 05/01/2019 Paid 95.000
R1901050106 LAB/190105/0024 042640 SABRINATAMPUBOLON. PASIEN UMUM
AMORA 05/01/2019 Paid 495.000
R1901010027 LAB/190106/0001 079526 AN
SATRIA ASNADI.TN KARYAWAN 06/01/2019 Process 65.000
R1901060011 LAB/190106/0005 EXT M.NABIL .AN PASIEN UMUM 06/01/2019 Paid 95.000
R1901060013 LAB/190106/0006 EXT KAUTSAR PASIEN UMUM 06/01/2019 Paid 95.000
R1901060012 LAB/190106/0007 106643 SAHROL. TN PASIEN UMUM 06/01/2019 Paid 118.000
R1901060016 LAB/190106/0011 106646 ADAM ADYA MAULANA. PASIEN UMUM 06/01/2019 Paid 95.000
R1901060018 LAB/190106/0012 106647 AN
BADRIYAH. NN PASIEN UMUM 06/01/2019 Paid 145.000
R1901060020 LAB/190106/0015 106648 MUHAMMAD ABDUL PASIEN UMUM 06/01/2019 Paid 95.000
R1901060033 LAB/190106/0016 053988 LATIEFZELZIA.AN
AZILA .AN PASIEN UMUM 06/01/2019 Paid 95.000
R1901060035 LAB/190106/0017 094388 FARID ATALLAH ADMEDIKA RELIANCE 06/01/2019 Paid 70.000
R1812290149 LAB/190106/0018 059765 TAMBUNAN.
ANNISA AULIA ANACHMAD. PASIEN UMUM 06/01/2019 Process 95.000
R1901060039 LAB/190106/0019 EXT AN PASIEN UMUM 06/01/2019 Paid 95.000
R1901070007 LAB/190107/0002 106656 ANNISA RAUDHAH.AN PASIEN UMUM 07/01/2019 Paid 95.000
R1901070006 LAB/190107/0003 106655 MUTHIA SYAWALLANI. PASIEN UMUM 07/01/2019 Paid 95.000
R1901070012 LAB/190107/0004 106657 AN
JONES. TN PASIEN UMUM 07/01/2019 Process 632.000
R1901070029 LAB/190107/0006 106665 M ABIYYU KAYANA PASIEN UMUM 07/01/2019 Paid 95.000
R1901070015 LAB/190107/0007 088531 RAMADHAN.
MARWANTO.TN AN PT. OWLEXA 07/01/2019 Paid 33.000
R1901070031 LAB/190107/0008 077331 ELPRIDA PURBA. NY ADMEDIKA RELIANCE 07/01/2019 Paid 33.000
R1901070051 LAB/190107/0010 106672 YULINAR. NY PASIEN UMUM 07/01/2019 Paid 65.000

PAGE : 16 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901070059 LAB/190107/0011 083961 FARHAN KURNIAWAN.AN PASIEN UMUM 07/01/2019 Paid 95.000
R1901070066 LAB/190107/0012 106677 RAFIFA WILDAN. AN PASIEN UMUM 07/01/2019 Paid 65.000
R1901070096 LAB/190107/0014 106685 INDAH JULIYANNI PASIEN UMUM 07/01/2019 Paid 95.000
R1901070101 LAB/190107/0015 106689 HABIBILLAH. AN
MAIMUNAH RAMADHANI. PASIEN UMUM 07/01/2019 Paid 95.000
R1901070117 LAB/190107/0016 106692 AN
FATIMAH AZZAHRO. AN PASIEN UMUM 07/01/2019 Paid 95.000
R1901070124 LAB/190107/0017 106695 ZASKIA NAILA.AN PASIEN UMUM 07/01/2019 Paid 95.000
R1901070128 LAB/190107/0021 EXT ELGA.NN KARYAWAN 07/01/2019 Process 70.000
R1901070129 LAB/190107/0022 106697 RAFI ADE PUTRA.TN PASIEN UMUM 07/01/2019 Paid 385.000
R1901080003 LAB/190108/0003 106649 REZA VIKIYANTO .TN YOKOHAMA INDUSTRIAL08/01/2019 Paid 145.000
R1901080007 LAB/190108/0007 106701 DHIYA F ULYA. AN PASIEN UMUM 08/01/2019 Paid 95.000
R1901080013 LAB/190108/0008 094503 MANGGALA FADHIL PASIEN UMUM 08/01/2019 Paid 385.000
R1901080017 LAB/190108/0009 106703 ELIYANTA.AN
FAIQAH NUR AFIT. AN PASIEN UMUM 08/01/2019 Paid 95.000
R1901080019 LAB/190108/0010 106704 MASLAN CARLESSULLI PASIEN UMUM 08/01/2019 Paid 40.000
R1901080037 LAB/190108/0011 106707 SINAGA. TN SALMAA. AN PASIEN UMUM
DZAKIYYAH 08/01/2019 Paid 95.000
R1901080042 LAB/190108/0013 106709 SAURIA MATANARI. NY PASIEN UMUM 08/01/2019 Paid 514.000
R1901080046 LAB/190108/0014 094132 QALBI AUFISSIDDIQ.AN PASIEN UMUM 08/01/2019 Paid 65.000
R1901080079 LAB/190108/0017 011140 BAYU TIRTHA PASIEN UMUM 08/01/2019 Paid 95.000
R1901080121 LAB/190108/0021 EXT NOVAYANTI.NY PASIEN UMUM 08/01/2019 Process 95.000
R1901080117 LAB/190108/0022 106722 AQILLA CEISYA PASIEN UMUM 08/01/2019 Paid 65.000
R1901080118 LAB/190108/0023 106723 SYAHFITRI
DINI SETYO.AN
N .AN PASIEN UMUM 08/01/2019 Paid 95.000
R1901080120 LAB/190108/0025 106724 RIAMIN TANJUNG. NY PT. ADMEDIKA AVRIST08/01/2019 Paid 388.000
R1901080128 LAB/190108/0028 093183 ROFIF ROBANI.AN PASIEN UMUM 08/01/2019 Paid 95.000
R1901080126 LAB/190108/0029 106727 AYU RIANA PUTRI. NN PASIEN UMUM 08/01/2019 Paid 65.000
R1901090008 LAB/190109/0005 106734 FARID PASIEN UMUM 09/01/2019 Paid 95.000
R1901090009 LAB/190109/0006 106733 ABDURRAHMAN.AN
RAFFY PRATAMA. AN PASIEN UMUM 09/01/2019 Paid 95.000
R1901090014 LAB/190109/0007 106735 GHEFIRA GHALIZA PASIEN UMUM 09/01/2019 Paid 95.000
R1901090018 LAB/190109/0008 106737 AMALIA.AN ZHAFRAN PASIEN UMUM
MUHAMMAD 09/01/2019 Paid 95.000
R1901090022 LAB/190109/0009 106739 SHADIQ.
MEGAWATI ANLIMBONG. PASIEN UMUM 09/01/2019 Paid 65.000
R1901090023 LAB/190109/0010 106740 NN
ERIN PUTRI PRICILLIA PASIEN UMUM 09/01/2019 Paid 65.000
R1901090026 LAB/190109/0011 106742 SIAGIAN. NN
HABIL KHOLID PASIEN UMUM 09/01/2019 Paid 95.000
R1901090032 LAB/190109/0013 106745 PELAWI.ANAMALIA.AN PASIEN UMUM
SYAHIDAH 09/01/2019 Paid 95.000
R1901090028 LAB/190109/0014 104823 ENDANG SUBROTO. TN PASIEN UMUM 09/01/2019 Paid 105.000
R1901090041 LAB/190109/0015 091738 DAUD MUNTE.TN BNI LIFE INSURANCE 09/01/2019 Paid 40.000
R1901090047 LAB/190109/0017 106751 KRISTINA DEBORA KARYAWAN 09/01/2019 Process 65.000
R1901090049 LAB/190109/0018 106753 KEMBAREN
FUAZ SUKARYA .TN PASIEN UMUM 09/01/2019 Paid 65.000
R1901090054 LAB/190109/0019 106755 AULIA AZ-ZAHRA. AN PASIEN UMUM 09/01/2019 Paid 95.000
R1901090049 LAB/190109/0020 106753 FUAZ SUKARYA .TN PASIEN UMUM 09/01/2019 Paid 150.000
R1901090055 LAB/190109/0021 083104 MUHAMMAD ERGI PASIEN UMUM 09/01/2019 Paid 95.000
R1901090058 LAB/190109/0022 106756 HAFIZ.AN
ALLFIL REZKY .AN PASIEN UMUM 09/01/2019 Paid 95.000
R1901090061 LAB/190109/0023 106758 NURHALIMAH.NN PASIEN UMUM 09/01/2019 Paid 205.000
R1901090063 LAB/190109/0024 106759 SITI PUTRI PASIEN UMUM 09/01/2019 Paid 95.000
R1901090060 LAB/190109/0025 106757 RAHMADHANI . AN
FAUZI RAHMAT.AN PASIEN UMUM 09/01/2019 Paid 95.000
R1901090067 LAB/190109/0026 047512 ZAIDAN ZIDNA PASIEN UMUM 09/01/2019 Paid 95.000
R1901090068 LAB/190109/0027 080826 CHUTUBI.AN
M.ABIYYU HAFIZH PASIEN UMUM 09/01/2019 Paid 95.000
R1901090066 LAB/190109/0028 106760 HARAHAP.AN
M. DEDE YUNUS .AN PASIEN UMUM 09/01/2019 Paid 95.000
R1901090069 LAB/190109/0029 106761 NAUFAL ARRIZAL .AN PASIEN UMUM 09/01/2019 Paid 95.000
R1901090080 LAB/190109/0030 106763 ALWI RIZKI PASIEN UMUM 09/01/2019 Paid 95.000
R1901090090 LAB/190109/0031 106766 RAMADANI.AN
SRI WAHYUNI. NY ASURANSI RELIANCE 09/01/2019 Paid 40.000
R1901090091 LAB/190109/0032 106767 M. HILMI .AN PASIEN UMUM 09/01/2019 Paid 95.000
R1901090093 LAB/190109/0033 079735 FACHRUL IHSAN PASIEN UMUM 09/01/2019 Paid 95.000
R1901090100 LAB/190109/0034 106771 ABQARI.AN
MIFZAL AWALUDDIN .AN PASIEN UMUM 09/01/2019 Paid 95.000
R1901090097 LAB/190109/0035 106769 NADIA ZAHRA. AN PASIEN UMUM 09/01/2019 Paid 95.000
R1901090098 LAB/190109/0036 106770 FARADIBA AZZAHRA PASIEN UMUM 09/01/2019 Paid 95.000
R1901100015 LAB/190110/0003 106776 RAMADHANI. AN AN
M KEVIN AZHARI. PASIEN UMUM 10/01/2019 Paid 95.000
R1901100019 LAB/190110/0004 106777 DIYAH AYU SHOFIYYAH. PASIEN UMUM 10/01/2019 Paid 95.000
R1901100033 LAB/190110/0005 104721 AN
HELMAN SIRINGO BPJS KESEHATAN 10/01/2019 Paid 33.000
R1901100032 LAB/190110/0006 106782 RINGO.TN UMAR
MUHAMMAD PASIEN UMUM 10/01/2019 Paid 95.000
R1901100036 LAB/190110/0007 106784 ABDILLAH.NAURA
ARTHYTA AN PASIEN UMUM 10/01/2019 Paid 95.000
R1901100041 LAB/190110/0008 106788 HANUM.AN
DAPA AMNI PASIEN UMUM 10/01/2019 Paid 95.000
R1901100046 LAB/190110/0009 099039 RAHMATULLAH.AN
AINI. NY BPJS KESEHATAN 10/01/2019 Paid 33.000
R1901100054 LAB/190110/0010 093225 VENITA. NY BPJS KESEHATAN 10/01/2019 Paid 33.000

PAGE : 17 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901100059 LAB/190110/0012 046739 KUWAT ISTIADI,TN PT. MITRA ENERGI 10/01/2019 Paid 98.000
R1901100062 LAB/190110/0013 098593 HASTATI.NY BPJS KESEHATAN 10/01/2019 Paid 33.000
R1901100060 LAB/190110/0014 106792 RUSMAN. TN PASIEN UMUM 10/01/2019 Paid 33.000
R1901100040 LAB/190110/0017 022511 M.NABIL WALY PASIEN UMUM 10/01/2019 Paid 65.000
R1901100023 LAB/190110/0020 106779 THOMSON SIANIPAR. TN PASIEN UMUM 10/01/2019 Paid 753.000
R1901100097 LAB/190110/0022 058765 WIDIYANTO. TN PT. ADMEDIKA SOMPO10/01/2019 Paid 250.000
R1901100104 LAB/190110/0023 EXT MARIANI.NY PASIEN UMUM 10/01/2019 Paid 180.000
R1901100105 LAB/190110/0024 EXT SUHANDAK.TN PASIEN UMUM 10/01/2019 Paid 180.000
R1901100107 LAB/190110/0027 106805 IFFAH SALSABIL.AN PASIEN UMUM 10/01/2019 Paid 95.000
R1901100121 LAB/190110/0029 106808 SITI RAMONA. AN PASIEN UMUM 10/01/2019 Paid 95.000
R1901100106 LAB/190110/0031 106804 FARZANA NUR HALIMAH. BPJS KESEHATAN 10/01/2019 Paid 65.000
R1901100132 LAB/190110/0032 106809 AN
TIOMA HITA.NY PASIEN UMUM 10/01/2019 Paid 150.000
R1901100142 LAB/190110/0034 026161 ALDO FAHMI MARTIN. PASIEN UMUM 10/01/2019 Paid 95.000
R1901100141 LAB/190110/0035 106812 AN
MUHAMMAD IHSAN. TN PASIEN UMUM 10/01/2019 Paid 95.000
R1901100161 LAB/190110/0036 106817 HUMNAH KAYYISAH.AN PASIEN UMUM 10/01/2019 Paid 95.000
R1901100160 LAB/190110/0037 106816 FAUZIAH MARHANAH PASIEN UMUM 10/01/2019 Paid 95.000
R1901100157 LAB/190110/0038 106815 N.AN
MU'AMAR IBRAHIM. TN PASIEN UMUM 10/01/2019 Paid 150.000
R1901100173 LAB/190110/0039 068238 PAMULARSIH.NY McDERMOTT 10/01/2019 Paid 304.000
R1901110012 LAB/190111/0004 077551 MIRA HARYANI.NY BPJS KESEHATAN 11/01/2019 Paid 33.000
R1901110017 LAB/190111/0007 106825 KHOLID SETIO.AN PASIEN UMUM 11/01/2019 Paid 95.000
R1901110029 LAB/190111/0008 106828 NABILAH RILMA PASIEN UMUM 11/01/2019 Paid 95.000
R1901110032 LAB/190111/0009 106830 PUTRI.AN
M.ABID UMRAN PASIEN UMUM 11/01/2019 Paid 95.000
R1901110031 LAB/190111/0010 106829 JAMIL.AN
ZAHRO PASIEN UMUM 11/01/2019 Paid 95.000
R1901110036 LAB/190111/0011 106831 HABIBURRAHMAN.AN
HASAN AL BASHRY.AN PASIEN UMUM 11/01/2019 Paid 95.000
R1901110021 LAB/190111/0012 106826 TAHARA LIVIA HARDI.AN PASIEN UMUM 11/01/2019 Paid 95.000
R1901110040 LAB/190111/0013 106832 MUHAMMAD ILYAS.AN PASIEN UMUM 11/01/2019 Paid 95.000
R1901110046 LAB/190111/0016 106836 ALIVIA AZZAHRA ARLES. PASIEN UMUM 11/01/2019 Paid 95.000
R1901110054 LAB/190111/0017 106839 AN
MUHAMMAD RIFDAN PASIEN UMUM 11/01/2019 Paid 95.000
R1901110065 LAB/190111/0018 EXT DEWANDRA.
NURMAWATI.NYAN PASIEN UMUM 11/01/2019 Paid 80.000
R1901110071 LAB/190111/0019 106845 RACEL YODHA NAVARO. PASIEN UMUM 11/01/2019 Paid 95.000
R1901110079 LAB/190111/0020 098821 AN
NGATINI.NY BPJS KESEHATAN 11/01/2019 Paid 33.000
R1901110093 LAB/190111/0021 093984 JUDANTO BPJS KESEHATAN 11/01/2019 Paid 33.000
R1901110061 LAB/190111/0023 106843 DOLOKSARIBU.
JASMINE NUR TN PASIEN UMUM 11/01/2019 Paid 145.000
R1901110063 LAB/190111/0024 106844 ANNISA.AN
BAYU AZIIZ DWI.AN PASIEN UMUM 11/01/2019 Paid 145.000
R1901110081 LAB/190111/0025 055110 HAPPY OCTAVIANY PASIEN UMUM 11/01/2019 Paid 145.000
R1901110101 LAB/190111/0026 106858 MALAU.AN
HAIDAR ALIIF PASIEN UMUM 11/01/2019 Paid 95.000
R1901110112 LAB/190111/0028 EXT BASTIAN.AN
LUSI.NY PASIEN UMUM 11/01/2019 Paid 250.000
R1901110114 LAB/190111/0032 EXT GUSMAWATI.NY PASIEN UMUM 11/01/2019 Paid 140.000
R1901110091 LAB/190111/0033 098883 GUSTINA. NY BPJS KESEHATAN 11/01/2019 Paid 33.000
R1901110094 LAB/190111/0034 037556 JUNIBEL S.NY BPJS KESEHATAN 11/01/2019 Paid 33.000
R1901110097 LAB/190111/0035 106856 RIDO RAHMAD BPJS KESEHATAN 11/01/2019 Paid 65.000
R1901110094 LAB/190111/0036 037556 PUTRA.TN
JUNIBEL S.NY BPJS KESEHATAN 11/01/2019 Paid 65.000
R1901110118 LAB/190111/0037 106863 MAULANA HANIF. AN PASIEN UMUM 11/01/2019 Paid 95.000
R1901110145 LAB/190111/0040 EXT SHERINNA.NN PASIEN UMUM 11/01/2019 Paid 40.000
R1901110150 LAB/190111/0043 106869 ASYIYAH FAHIRA.AN PASIEN UMUM 11/01/2019 Paid 95.000
R1901110128 LAB/190111/0044 106865 INDRAYANSYAH DEFFA BPJS KESEHATAN 11/01/2019 Paid 145.000
R1901110162 LAB/190111/0048 103832 .AN
PRABU ARYO.AN PASIEN UMUM 11/01/2019 Paid 70.000
R1812260337 LAB/190111/0049 105625 IMEL CAHYANI BPJS KESEHATAN 11/01/2019 Paid 543.000
R1901110173 LAB/190111/0054 106883 RITONGA. AN BIN
ABDURROZAQ PASIEN UMUM 11/01/2019 Paid 95.000
R1901110175 LAB/190111/0055 106884 ISMAIL.AN
NABILLA NAZWA PASIEN UMUM 11/01/2019 Paid 95.000
R1901110181 LAB/190111/0059 038170 AU;IA.AN
AN.HENOKH SITORUS PASIEN UMUM 11/01/2019 Paid 145.000
R1901110184 LAB/190111/0061 106718 ERNAWATI.NY PASIEN UMUM 11/01/2019 Paid 495.000
R1901110187 LAB/190111/0062 EXT MUH. RIZKY PASIEN UMUM 11/01/2019 Paid 250.000
R1901120027 LAB/190112/0005 104407 ETTY RUSMIATI. NY BPJS KESEHATAN 12/01/2019 Paid 33.000
R1901120052 LAB/190112/0008 095278 NELLU SAKINAH BPJS KESEHATAN 12/01/2019 Paid 60.000
R1901120072 LAB/190112/0009 017110 MEYFI.NN
NIKSON TARIGAN BPJS KESEHATAN 12/01/2019 Paid 33.000
R1901120086 LAB/190112/0013 EXT NY.LUSI D PASIEN UMUM 12/01/2019 Paid 250.000
R1901120094 LAB/190112/0014 103421 MUKTI WIDAYATI .NY BPJS KESEHATAN 12/01/2019 Paid 33.000
R1901120098 LAB/190112/0015 062206 INGGRID CHRISTA A.AN BPJS KESEHATAN 12/01/2019 Paid 65.000
R1901120101 LAB/190112/0017 EXT MISWAN.TN PASIEN UMUM 12/01/2019 Paid 250.000
R1901120082 LAB/190112/0019 106921 MISRIYANTI. NY BPJS KESEHATAN 12/01/2019 Paid 145.000

PAGE : 18 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901120043 LAB/190112/0020 106904 YURNIDAH. NY BPJS KESEHATAN 12/01/2019 Paid 33.000


R1901120105 LAB/190112/0021 EXT BANI.TN PASIEN UMUM 12/01/2019 Paid 250.000
R1901120104 LAB/190112/0022 106927 M. AYYASY. AN PASIEN UMUM 12/01/2019 Paid 95.000
R1901120106 LAB/190112/0028 106928 APEN .TN PASIEN UMUM 12/01/2019 Paid 303.000
R1901120109 LAB/190112/0029 106930 AZZA ALFIRANSYAH .AN PASIEN UMUM 12/01/2019 Paid 95.000
R1901130001 LAB/190113/0001 106941 SHAQUEENA BPJS KESEHATAN 13/01/2019 Paid 65.000
R1901130024 LAB/190113/0015 106954 MAHESWARI
WIJAYA KESUMA. TN PASIEN UMUM 13/01/2019 Paid 65.000
R1901130028 LAB/190113/0017 EXT ISKANDAR.AN
IWAN PASIEN UMUM 13/01/2019 Paid 250.000
R1901130051 LAB/190113/0025 106965 ZAHRATUL IZZA.AN PASIEN UMUM 13/01/2019 Paid 385.000
R1901140027 LAB/190114/0008 098009 HERLINA.NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901140036 LAB/190114/0009 082588 DEWI ASTUTI. NY BPJS KESEHATAN 14/01/2019 Paid 73.000
R1901140051 LAB/190114/0012 045973 NURHAYATI.NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901140096 LAB/190114/0014 094901 DULLES SIMBOLON. TN BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901140115 LAB/190114/0015 107011 BRAMSYAH.TN BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901140123 LAB/190114/0016 046241 MISBAH.NY PASIEN UMUM 14/01/2019 Paid 33.000
R1901140148 LAB/190114/0017 EXT ENDANG.TN PASIEN UMUM 14/01/2019 Paid 250.000
R1901140145 LAB/190114/0019 107023 MUKTI.TN PASIEN UMUM 14/01/2019 Paid 65.000
R1901140167 LAB/190114/0021 068174 ULFA M YASIN.NY BPJS KESEHATAN 14/01/2019 Paid 33.000
R1901140071 LAB/190114/0030 105707 LIANA PUTRI. AN BPJS KESEHATAN 14/01/2019 Paid 65.000
R1901140071 LAB/190114/0031 105707 LIANA PUTRI. AN BPJS KESEHATAN 14/01/2019 Paid 543.000
R1901140185 LAB/190114/0033 EXT ELYA.NY PASIEN UMUM 14/01/2019 Paid 180.000
R1901140186 LAB/190114/0034 EXT MELSON.TN PASIEN UMUM 14/01/2019 Paid 140.000
R1901140183 LAB/190114/0035 107035 RENA .NN PASIEN UMUM 14/01/2019 Paid 105.000
R1901140209 LAB/190114/0036 075862 THIMOTHY ANTONIO BPJS KESEHATAN 14/01/2019 Paid 65.000
R1901140211 LAB/190114/0038 EXT ARITONAG.AN
ALI MUKMIN HARAHAP PASIEN UMUM 14/01/2019 Paid 250.000
R1901140196 LAB/190114/0039 107039 MARIHOT .TN PASIEN UMUM 14/01/2019 Paid 105.000
R1901140218 LAB/190114/0040 101286 HENRI TAMBUNAN.TN BPJS KESEHATAN 14/01/2019 Paid 98.000
R1901140225 LAB/190114/0041 EXT M.FADEL PAHLEVA Y.TN PASIEN UMUM 14/01/2019 Paid 40.000
R1901140191 LAB/190114/0042 106043 AIZA AZKIA .AN BPJS KESEHATAN 14/01/2019 Paid 65.000
R1901140233 LAB/190114/0043 107046 ARIF JUMAIDI PUTRA.AN PASIEN UMUM 14/01/2019 Paid 95.000
R1901140195 LAB/190114/0046 104823 ENDANG SUBROTO. TN BPJS KESEHATAN 14/01/2019 Paid 80.000
R1901140192 LAB/190114/0047 107038 ELLYS KALYSTA LIEM BPJS KESEHATAN 14/01/2019 Paid 65.000
R1901140204 LAB/190114/0053 070087 H.AN BUNGA
JESIKA BPJS KESEHATAN 14/01/2019 Paid 70.000
R1901140254 LAB/190114/0055 107053 LESTARI.AN
DONI .TN PASIEN UMUM 14/01/2019 Paid 65.000
R1901140257 LAB/190114/0059 094545 MUHAMMAD RIZKY BPJS KESEHATAN 14/01/2019 Paid 40.000
R1812210264 LAB/190114/0063 104993 HIDAYAT
AKMAD ALTHALIB.
HAFIDHAN
V.AN BPJS KESEHATAN 14/01/2019 Paid 105.000
R1901140271 LAB/190114/0068 107060 FATIMAH. NY PASIEN UMUM 14/01/2019 Paid 145.000
R1901150031 LAB/190115/0014 102355 TIUR BR SILAEN.NY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150042 LAB/190115/0015 EXT UTARI HAFIZAH.NY PASIEN UMUM 15/01/2019 Paid 40.000
R1901150037 LAB/190115/0016 104563 YUSMA. NY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150040 LAB/190115/0018 100703 MARIA DERAN TUPEN. BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150038 LAB/190115/0020 026520 NY
FATMAWATI. NY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150021 LAB/190115/0021 095828 ELBRYAN.AN PASIEN UMUM 15/01/2019 Paid 264.000
R1901150012 LAB/190115/0023 088351 BALLEN PASARIBU.TN PASIEN UMUM 15/01/2019 Paid 150.000
R1901150059 LAB/190115/0027 102243 WIJIANTO. TN BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150063 LAB/190115/0029 107083 SULTON. TN PASIEN UMUM 15/01/2019 Paid 250.000
R1901150060 LAB/190115/0030 107081 ARNALDO.TN PASIEN UMUM 15/01/2019 Paid 250.000
R1901150065 LAB/190115/0031 107085 IBNU HAJAR.TN BPJS KESEHATAN 15/01/2019 Paid 98.000
R1901150067 LAB/190115/0032 107087 SAURI. TN PASIEN UMUM 15/01/2019 Paid 250.000
R1901150064 LAB/190115/0033 107084 MISNO. TN BPJS KESEHATAN 15/01/2019 Paid 80.000
R1901150120 LAB/190115/0034 080484 MINDO RAJAGUKGUK.NY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150021 LAB/190115/0036 095828 ELBRYAN.AN PASIEN UMUM 15/01/2019 Paid 150.000
R1901150133 LAB/190115/0039 EXT SALMAN.TN PASIEN UMUM 15/01/2019 Paid 180.000
R1901150137 LAB/190115/0040 EXT SAPNIDA.NY PASIEN UMUM 15/01/2019 Paid 140.000
R1901150138 LAB/190115/0041 EXT BAHRUMSYAH.TN PASIEN UMUM 15/01/2019 Paid 140.000
R1901150139 LAB/190115/0042 EXT ABU BAKAR.TN PASIEN UMUM 15/01/2019 Paid 180.000
R1901150057 LAB/190115/0050 021175 SITI SUNDARI. NY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150030 LAB/190115/0051 096985 ZAKIYA ASSYIFA.AN PASIEN UMUM 15/01/2019 Paid 145.000
R1901150026 LAB/190115/0052 096429 YUDO MAHARDIANTO. BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150029 LAB/190115/0055 102357 TN
ONAH BINTI RASWIT.NY BPJS KESEHATAN 15/01/2019 Paid 33.000
R1901150145 LAB/190115/0058 085489 YAHMAD.TN BPJS KESEHATAN 15/01/2019 Paid 33.000

PAGE : 19 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901150178 LAB/190115/0062 086667 ABEDNEGO SINAGA. AN BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901150187 LAB/190115/0064 EXT KOMARIAH.NY PASIEN UMUM 15/01/2019 Paid 40.000
R1901150191 LAB/190115/0068 107131 FERIANTO. TN BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901150201 LAB/190115/0074 086790 MONANG BPJS KESEHATAN 15/01/2019 Paid 80.000
R1901150220 LAB/190115/0076 068649 NAINGGOLAN.TN
MIKO BENGET MARTUA BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901150213 LAB/190115/0081 059189 HUTAPEA.AN
YEHEZKIEL MARLAS BPJS KESEHATAN 15/01/2019 Paid 65.000
R1901150259 LAB/190115/0082 107145 PURBA.AN
M. FAHRUDIN. TN PASIEN UMUM 15/01/2019 Paid 33.000
R1901150019 LAB/190115/0085 026343 SUMARMI.NY PT. INFINEON 15/01/2019 Paid 65.000
R1901160010 LAB/190116/0018 098113 NIAR SILALAHI.TN TECHNOLOGIES
BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901160051 LAB/190116/0023 065789 DEVI NASUTION. NY BPJS KESEHATAN 16/01/2019 Process 33.000
R1901160108 LAB/190116/0033 083269 DARWIN HAPOSAN P.TN BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901160105 LAB/190116/0034 025354 BIBIT,NY BPJS KESEHATAN 16/01/2019 Paid 160.000
R1901160110 LAB/190116/0035 084660 SRI SUNARTI.NY BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901160011 LAB/190116/0039 100104 AHADI KESUMA.TN BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901160118 LAB/190116/0040 107187 RAYA.NY BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901160128 LAB/190116/0041 EXT SAURMA.NY PASIEN UMUM 16/01/2019 Paid 140.000
R1901160136 LAB/190116/0046 057036 MD.MOZAMMAL BPJS KESEHATAN 16/01/2019 Paid 128.000
R1901160134 LAB/190116/0048 084042 HOSSAIN.TN
M.FADLI RONA. TNQ PASIEN UMUM 16/01/2019 Paid 295.000
R1901160161 LAB/190116/0054 095102 JON SINTARA BPJS KESEHATAN 16/01/2019 Paid 33.000
R1901160144 LAB/190116/0057 107198 SEMBIRING.TN
ARJUNA WIJAYA BPJS KESEHATAN 16/01/2019 Paid 145.000
R1901160188 LAB/190116/0059 103285 KUSUMA.AN
HAJDIJAH.NY ADMEDIKA TAKAFUL 16/01/2019 Paid 65.000
R1901160193 LAB/190116/0061 107210 MAI LIAN.NY PASIEN UMUM 16/01/2019 Paid 60.000
R1901160203 LAB/190116/0064 107214 LULU PRATIWI.NN PASIEN UMUM 16/01/2019 Paid 40.000
R1901160202 LAB/190116/0066 067791 KEYSHA SYAKIRA PT. ADMEDIKA JASINDO
16/01/2019 Paid 65.000
R1901160201 LAB/190116/0068 107213 BATRISYIA.AN
YUNASRI.TN BNI LIFE INSURANCE 16/01/2019 Paid 118.000
R1901170015 LAB/190117/0014 105286 SITI MARYAM.NY BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901170017 LAB/190117/0015 102256 HASNAN SAMOSIR. TN BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901170037 LAB/190117/0017 105368 SYAHRUL HAMID.TN BPJS KESEHATAN 17/01/2019 Paid 73.000
R1901170034 LAB/190117/0018 105366 ROSMAINI.NY BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901170064 LAB/190117/0021 091323 HENDRA ALIMIN.TN BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901170013 LAB/190117/0022 063051 BEY JENITA INHEALTH 17/01/2019 Paid 73.500
R1901170036 LAB/190117/0026 082412 TAMBUNAN.NY
DARWENTI. NY BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901170008 LAB/190117/0027 107219 HERYANTO SAMOSIR.TN BPJS KESEHATAN 17/01/2019 Paid 315.000
R1901170043 LAB/190117/0028 107226 NGADIRSAN SUSO BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901170086 LAB/190117/0029 107244 PRANOTO. TN
ALAM SYAHRIL.TN PASIEN UMUM 17/01/2019 Paid 323.000
R1901170105 LAB/190117/0032 105317 RAHMAWATY. NY BPJS KESEHATAN 17/01/2019 Paid 33.000
R1901170133 LAB/190117/0033 078342 OKKIE HARDIAN.TN BNI LIFE INSURANCE 17/01/2019 Paid 385.000
R1901170156 LAB/190117/0046 086401 ADEK OKTAVIA. BY. NY PASIEN UMUM 17/01/2019 Paid 65.000
R1901170196 LAB/190117/0047 022139 SINTA. AN PASIEN UMUM 17/01/2019 Paid 65.000
R1901170206 LAB/190117/0052 016442 AFREILIAN ALANA,AN PASIEN UMUM 17/01/2019 Paid 145.000
R1901170220 LAB/190117/0055 078439 DIAH WAHYUNI.NY YOKOHAMA INDUSTRIAL17/01/2019 Paid 385.000
R1901180018 LAB/190118/0010 104393 SUSWANINGSIH. NY BPJS KESEHATAN 18/01/2019 Paid 33.000
R1901180032 LAB/190118/0012 080620 ZAIDAL. TN BPJS KESEHATAN 18/01/2019 Paid 33.000
R1901180042 LAB/190118/0013 095700 TIUR LUBIS. NY BPJS KESEHATAN 18/01/2019 Paid 33.000
R1901180051 LAB/190118/0016 105377 LONTUNG ANTONIUS BPJS KESEHATAN 18/01/2019 Paid 33.000
R1901180069 LAB/190118/0017 107321 SITUMORANG.
ELISMEN TN
SIMARANGKIR. BPJS KESEHATAN 18/01/2019 Paid 86.000
R1901180102 LAB/190118/0018 095089 TN
LIM DJIT HAI.TN BPJS KESEHATAN 18/01/2019 Paid 111.000
R1901180052 LAB/190118/0020 091977 USNI. NY BPJS KESEHATAN 18/01/2019 Paid 33.000
R1901180107 LAB/190118/0021 107329 TETY TAMBUNAN .BY BPJS KESEHATAN 18/01/2019 Process 33.000
R1901180068 LAB/190118/0023 037986 .NY
JISMAN SITINJUAK.TN PASIEN UMUM 18/01/2019 Paid 33.000
R1901180099 LAB/190118/0025 107335 ROSINTA SIMANJUNTAK. BPJS KESEHATAN 18/01/2019 Paid 33.000
R1901180114 LAB/190118/0027 EXT NY
AHMAD RAHIM.TN PASIEN UMUM 18/01/2019 Paid 250.000
R1901180120 LAB/190118/0028 105983 SONTI BR MANURUNG. BPJS KESEHATAN 18/01/2019 Paid 65.000
R1901180151 LAB/190118/0034 104771 NY
TETTI DIANA T .NY BPJS KESEHATAN 18/01/2019 Paid 33.000
R1901180100 LAB/190118/0036 042020 NUR AINUN RUBYCON 18/01/2019 Paid 145.000
R1901180135 LAB/190118/0038 096863 SIPAHUTA.NN
RATNA JUITA.NY BPJS KESEHATAN 18/01/2019 Paid 78.000
R1901180161 LAB/190118/0040 106043 AIZA AZKIA .AN BPJS KESEHATAN 18/01/2019 Paid 65.000
R1901180215 LAB/190118/0044 EXT TIKIAN ANTONEUS.TN PASIEN UMUM 18/01/2019 Paid 40.000
R1901180210 LAB/190118/0046 054493 SYAHIRAH ANINDA BPJS KESEHATAN 18/01/2019 Paid 70.000
R1901180183 LAB/190118/0048 107356 RAHMAH.AN
STEVANUS LASRODO. ANBPJS KESEHATAN 18/01/2019 Paid 145.000
R1901180235 LAB/190118/0052 044160 DIAN SUCI ARTIYANTI PT. ADMEDIKA 18/01/2019 Paid 65.000
GENERALI
PAGE : 20 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901180223 LAB/190118/0053 098984 HERMON NABABAN.TN BNI LIFE INSURANCE 18/01/2019 Paid 33.000
R1901180248 LAB/190118/0057 056910 M WILDAN AL FAILSYAD. ADMEDIKA TAKAFUL 18/01/2019 Paid 145.000
R1901190040 LAB/190119/0016 100007 AN
KARIYATI.NY BPJS KESEHATAN 19/01/2019 Paid 283.000
R1901190047 LAB/190119/0017 096795 MAYA FARIDA.NY BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901190050 LAB/190119/0018 072501 EKO PURNOMO. TN BPJS KESEHATAN 19/01/2019 Paid 73.000
R1901190064 LAB/190119/0020 088457 RINA FATRIANA.NY BPJS KESEHATAN 19/01/2019 Paid 40.000
R1901190053 LAB/190119/0021 107383 AUNI AINAA AZHARI. NN BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901190077 LAB/190119/0023 104315 IDA ROZANA. NY BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901190099 LAB/190119/0025 105726 AQSHO MAULANA .AN BPJS KESEHATAN 19/01/2019 Paid 160.000
R1901190132 LAB/190119/0027 074331 SAHAT SINAGA.TN BPJS KESEHATAN 19/01/2019 Paid 145.000
R1901190055 LAB/190119/0030 093364 AUFA ABRAR BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901190134 LAB/190119/0032 054542 ANSHARA.AN
INDAH WIDYAWATI.NY PT. MITRA ENERGI 19/01/2019 Paid 113.000
R1901190037 LAB/190119/0040 099484 SONNY JOESNIARDIE. BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901190167 LAB/190119/0041 105507 TN
YUSARNI BINTI BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901190050 LAB/190119/0042 072501 H.MUHAMAD
EKO PURNOMO. RAIP.
TN NY BPJS KESEHATAN 19/01/2019 Paid 65.000
R1901190018 LAB/190119/0044 036049 NUR ASNIL.TN BPJS KESEHATAN 19/01/2019 Paid 33.000
R1901190176 LAB/190119/0045 107428 PRIHATIN. BY. NY BPJS KESEHATAN 19/01/2019 Process 33.000
R1901190052 LAB/190119/0046 074051 AHMAD FIKRI BPJS KESEHATAN 19/01/2019 Paid 86.000
R1901190214 LAB/190119/0054 107441 SYAHPUTRA.AN
TIURLAN SIMBOLON. NY PASIEN UMUM 19/01/2019 Paid 65.000
R1901200012 LAB/190120/0018 078439 DIAH WAHYUNI.NY YOKOHAMA INDUSTRIAL
20/01/2019 Paid 230.000
R1901200013 LAB/190120/0019 EXT DEWI YANTI.NY PASIEN UMUM 20/01/2019 Paid 80.000
R1901200015 LAB/190120/0020 EXT MISWAN.TN PASIEN UMUM 20/01/2019 Paid 40.000
R1901200023 LAB/190120/0026 107450 UMI .NY PASIEN UMUM 20/01/2019 Paid 65.000
R1901200031 LAB/190120/0027 035119 AHMAD JUNAIDI. TN RUBYCON 20/01/2019 Paid 645.000
R1901200034 LAB/190120/0029 107455 IRMA NABABAN.NY PASIEN UMUM 20/01/2019 Paid 73.000
R1901200041 LAB/190120/0031 107457 RINTO FRENKY BPJS KESEHATAN 20/01/2019 Paid 65.000
R1901210010 LAB/190121/0006 106634 SITORUS. TN
AGUSTINA PASIEN UMUM 21/01/2019 Paid 410.000
R1901210027 LAB/190121/0009 097595 PURWANINGTYAS.NY
YOHANES VIANEY BPJS KESEHATAN 21/01/2019 Paid 33.000
R1901210049 LAB/190121/0016 107472 AMING.TN
RAFI RIZKI BPJS KESEHATAN 21/01/2019 Paid 130.000
R1901210078 LAB/190121/0017 094901 RAMADHAN.AN
DULLES SIMBOLON. TN BPJS KESEHATAN 21/01/2019 Paid 33.000
R1901210056 LAB/190121/0018 088531 MARWANTO.TN PT. OWLEXA 21/01/2019 Paid 33.000
R1901190211 LAB/190121/0019 107439 NASWAN.TN BPJS KESEHATAN 21/01/2019 Paid 40.000
R1901210076 LAB/190121/0021 104932 RIFAI. TN BPJS KESEHATAN 21/01/2019 Paid 80.000
R1901210071 LAB/190121/0022 107482 ASIKIN.TN PASIEN UMUM 21/01/2019 Paid 70.000
R1901210121 LAB/190121/0023 107185 M. ALI. S.TN BPJS KESEHATAN 21/01/2019 Paid 40.000
R1901210115 LAB/190121/0024 107498 NINGSIH. NY BPJS KESEHATAN 21/01/2019 Paid 33.000
R1901210071 LAB/190121/0025 107482 ASIKIN.TN PASIEN UMUM 21/01/2019 Paid 150.000
R1901210131 LAB/190121/0027 103277 MAFTUKIN AFIF.TN BPJS KESEHATAN 21/01/2019 Paid 33.000
R1901210146 LAB/190121/0030 100398 FUTIHADDINIAH. NY BPJS KESEHATAN 21/01/2019 Paid 33.000
R1901210111 LAB/190121/0032 102356 INIM SITUMORANG. NY PASIEN UMUM 21/01/2019 Paid 70.000
R1901210185 LAB/190121/0038 107527 HARTATY,NY BPJS KESEHATAN 21/01/2019 Paid 65.000
R1901210184 LAB/190121/0042 107526 MAHARANI DITA BPJS KESEHATAN 21/01/2019 Process 65.000
R1901210204 LAB/190121/0043 EXT PUTRI.NN
LESTIA LESTARI.NY PASIEN UMUM 21/01/2019 Paid 40.000
R1901210208 LAB/190121/0045 EXT WISNU.TN PASIEN UMUM 21/01/2019 Paid 180.000
R1901190105 LAB/190121/0047 107405 ASNAWATI. NY BPJS KESEHATAN 21/01/2019 Paid 1.085.000
R1901210221 LAB/190121/0054 102618 BY NYONYA NIRYA BPJS KESEHATAN 21/01/2019 Paid 65.000
R1901210265 LAB/190121/0056 073874 SURYANI.AN
FATHIAH NAJAHI AZ PASIEN UMUM 21/01/2019 Paid 145.000
R1901210277 LAB/190121/0061 020987 ZAFIRA.AN
MARLIN SIAHAAN,AN BPJS KESEHATAN 21/01/2019 Paid 70.000
R1901210279 LAB/190121/0062 093270 ANA TOYYIBA P BPJS KESEHATAN 21/01/2019 Paid 65.000
R1901210097 LAB/190121/0065 063675 MAARUF.AN
AMBAR SETYOWATI. NY BPJS KESEHATAN 21/01/2019 Paid 60.000
R1901220012 LAB/190122/0007 029658 MARGARETHA.AN McDERMOTT 22/01/2019 Paid 289.750
R1901220042 LAB/190122/0009 103569 HENDRAWATI BPJS KESEHATAN 22/01/2019 Paid 33.000
R1901220034 LAB/190122/0010 104382 RINA WARTINI.NY BPJS KESEHATAN 22/01/2019 Paid 33.000
R1901220040 LAB/190122/0011 080246 DAMARIS ELYTA BPJS KESEHATAN 22/01/2019 Paid 33.000
R1901220069 LAB/190122/0012 107075 HUTAGALUNG.NY
SAURMA BR BPJS KESEHATAN 22/01/2019 Paid 33.000
R1901220098 LAB/190122/0013 107085 NAINGGOLAN.
IBNU HAJAR.TNNY BPJS KESEHATAN 22/01/2019 Paid 33.000
R1901220109 LAB/190122/0014 EXT BRIANTO.S .TN PASIEN UMUM 22/01/2019 Paid 33.000
R1901220091 LAB/190122/0017 107580 DONGAN SAIHUTAN BPJS KESEHATAN 22/01/2019 Paid 33.000
R1901220062 LAB/190122/0018 107569 SIHOMBING.
FIANTI MALA.NYTN PASIEN UMUM 22/01/2019 Paid 300.000
R1901220126 LAB/190122/0020 107603 RIZKI KHALISAH.NN KARYAWAN 22/01/2019 Process 65.000
R1901220132 LAB/190122/0023 034464 (ANAK DR
FENITA ILNA)
ANASTASIA BPJS KESEHATAN 22/01/2019 Paid 65.000
MARBUN,AN
PAGE : 21 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901220018 LAB/190122/0025 036209 NATHANIEL SITORUS.AN PASIEN UMUM 22/01/2019 Paid 65.000
R1901220149 LAB/190122/0026 062180 SAHARINA HUTAGAOL. BNI LIFE INSURANCE 22/01/2019 Paid 385.000
R1901220137 LAB/190122/0028 090059 NY RAHAYU.NY
SRI BPJS KESEHATAN 22/01/2019 Paid 33.000
R1812210018 LAB/190122/0030 105667 SULAIMAN YUNUS.TN BPJS KESEHATAN 22/01/2019 Paid 33.000
R1901220183 LAB/190122/0031 107627 YOSEVA HUTAGALUNG. BPJS KESEHATAN 22/01/2019 Paid 65.000
R1901220190 LAB/190122/0033 EXT NY
APRIANTO.TN PASIEN UMUM 22/01/2019 Paid 250.000
R1901220183 LAB/190122/0034 107627 YOSEVA HUTAGALUNG. BPJS KESEHATAN 22/01/2019 Paid 80.000
R1901220191 LAB/190122/0035 EXT NY
TN.YUSUF PASIEN UMUM 22/01/2019 Paid 130.000
R1901220193 LAB/190122/0036 EXT NY.SUI FONG PASIEN UMUM 22/01/2019 Paid 140.000
R1901220222 LAB/190122/0041 107638 RIYANTO .TN BPJS KESEHATAN 22/01/2019 Paid 40.000
R1901220253 LAB/190122/0043 107643 ERLINA SINAGA.BY.NY BPJS KESEHATAN 22/01/2019 Process 98.000
R1901220246 LAB/190122/0044 097317 IRWAN DARMA PASIEN UMUM 22/01/2019 Paid 388.000
R1901220247 LAB/190122/0052 092979 PUTYRA.TN
SAMSUL ARIFIN.TN BPJS KESEHATAN 22/01/2019 Paid 33.000
R1901230003 LAB/190123/0003 073281 ERNIWATI SIPAYUNG.NY BPJS KESEHATAN 23/01/2019 Paid 178.000
R1901230043 LAB/190123/0013 103535 BERTA E SIAHAAN. NY BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901230058 LAB/190123/0015 073952 FADHLY AMALUL BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901230070 LAB/190123/0018 088029 SHLIHIN.AN
ALDON SIRINGORINGO. BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901230074 LAB/190123/0023 105619 TN
VERI HUTAGALUNG. TN ADMEDIKA ALLIANZ 23/01/2019 Paid 40.000
R1901230123 LAB/190123/0030 EXT ARDIN SIMANJUNTAK.TN PASIEN UMUM 23/01/2019 Paid 73.000
R1901230111 LAB/190123/0031 107196 HERAWATI RITONGA. BY PASIEN UMUM 23/01/2019 Paid 300.000
R1901230090 LAB/190123/0032 099837 NY
KASENDA. TN BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901230125 LAB/190123/0033 EXT KRISTA.NY PASIEN UMUM 23/01/2019 Paid 220.000
R1901230131 LAB/190123/0035 095102 JON SINTARA BPJS KESEHATAN 23/01/2019 Paid 33.000
R1901230127 LAB/190123/0036 092278 SEMBIRING.TN
TIURNIARI PURBA.NY BPJS KESEHATAN 23/01/2019 Paid 105.000
R1901230135 LAB/190123/0037 085703 RAFIDA.NY BPJS KESEHATAN 23/01/2019 Process 33.000
R1901230138 LAB/190123/0041 098196 KARTINI.NY BPJS KESEHATAN 23/01/2019 Paid 33.000
R1602120037 LAB/190123/0051 EXT PASIEN UMUM 23/01/2019 Process 65.000
R1901230162 LAB/190123/0054 107696 AFIQAH SARI .AN BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901210225 LAB/190123/0055 106071 MUHAMMAD GURUH BPJS KESEHATAN 23/01/2019 Paid 40.000
R1901230170 LAB/190123/0056 107700 SAPUTRA. AN
ZHORDY SITUMEANG. BPJS KESEHATAN 23/01/2019 Paid 65.000
R1901230203 LAB/190123/0063 107707 AN
AHMAD AL KHALIS.AN BPJS KESEHATAN 23/01/2019 Paid 110.000
R1901240015 LAB/190124/0010 087966 MIRAWATI.NY BPJS KESEHATAN 24/01/2019 Paid 33.000
R1901240016 LAB/190124/0011 028603 MINDAWATI BPJS KESEHATAN 24/01/2019 Paid 33.000
R1901240024 LAB/190124/0013 097031 SEMBIRING.NY
RINALDI. TN BPJS KESEHATAN 24/01/2019 Paid 33.000
R1901240036 LAB/190124/0015 073831 TRI YATMI. NY BPJS KESEHATAN 24/01/2019 Paid 33.000
R1901240057 LAB/190124/0020 107722 FANNY THERESIA PASIEN UMUM 24/01/2019 Paid 385.000
R1901240070 LAB/190124/0021 103126 ANGGREINI
RUSPINA P. NN
LUMBAN BPJS KESEHATAN 24/01/2019 Paid 40.000
R1901240074 LAB/190124/0022 102978 GAOL.NY
KUSDIANTO. TN BPJS KESEHATAN 24/01/2019 Paid 40.000
R1901240064 LAB/190124/0023 019343 SUTARNO. TN ADMEDIKA TAKAFUL 24/01/2019 Paid 355.000
R1901240104 LAB/190124/0026 091758 SUKAWI.TN BPJS KESEHATAN 24/01/2019 Paid 33.000
R1901240115 LAB/190124/0028 EXT SIMAULI.TN PASIEN UMUM 24/01/2019 Paid 250.000
R1901240119 LAB/190124/0031 EXT ERMI.NY PASIEN UMUM 24/01/2019 Paid 70.000
R1901240012 LAB/190124/0036 107713 HATMINAH. NY BPJS KESEHATAN 24/01/2019 Paid 33.000
R1901240170 LAB/190124/0046 107766 BAGUS WIDHYATMO. TN BPJS KESEHATAN 24/01/2019 Paid 80.000
R1901240163 LAB/190124/0047 085234 QONITA ISMAN BPJS KESEHATAN 24/01/2019 Paid 65.000
R1901240027 LAB/190124/0052 027126 TAQIYYA.AN
TITIN MARTUTI.NY BPJS KESEHATAN 24/01/2019 Paid 60.000
R1901240145 LAB/190124/0053 088606 AULY AMALIA PUTRI.NY PASIEN UMUM 24/01/2019 Paid 60.000
R1901240224 LAB/190124/0056 107787 LELAWATI. NY BPJS KESEHATAN 24/01/2019 Paid 304.000
R1901240225 LAB/190124/0057 107788 ISNAINI. NY BPJS KESEHATAN 24/01/2019 Paid 283.000
R1901250004 LAB/190125/0006 107789 SUPRAPTI. BY NY BPJS KESEHATAN 25/01/2019 Process 33.000
R1901250028 LAB/190125/0011 006345 NURSIMA.NY KARYAWAN 25/01/2019 Process 468.000
R1901250036 LAB/190125/0018 098444 SUTIKYO.TN BPJS KESEHATAN 25/01/2019 Paid 33.000
R1901250051 LAB/190125/0019 100203 DESMAR DELVI .D. NY BPJS KESEHATAN 25/01/2019 Paid 33.000
R1901250081 LAB/190125/0020 037986 JISMAN SITINJUAK.TN PASIEN UMUM 25/01/2019 Paid 33.000
R1901250055 LAB/190125/0022 087523 SYOFRA NOVI.TN BPJS KESEHATAN 25/01/2019 Paid 73.000
R1901250115 LAB/190125/0025 107001 MASRUKI. TN BPJS KESEHATAN 25/01/2019 Paid 33.000
R1901250134 LAB/190125/0028 107829 LA ODE MUHAMMAD AL PASIEN UMUM 25/01/2019 Paid 150.000
R1901250148 LAB/190125/0029 107836 IKRAM. ANARITONANG. PASIEN UMUM
FRANATA 25/01/2019 Paid 70.000
R1901250163 LAB/190125/0030 107846 TN
ERNI BUNGA RIANTA.NY PASIEN UMUM 25/01/2019 Paid 295.000
R1901250133 LAB/190125/0031 086424 WITNARTI.NY BPJS KESEHATAN 25/01/2019 Paid 33.000
R1901250032 LAB/190125/0043 105701 VIVI WATI SARAGIH.NY BPJS KESEHATAN 25/01/2019 Paid 80.000

PAGE : 22 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901250087 LAB/190125/0046 107814 RAIN JOSES BPJS KESEHATAN 25/01/2019 Paid 536.000
R1901250173 LAB/190125/0047 107475 HUTAGALUNG.
SYAHRIL, AN
ST. TN BPJS KESEHATAN 25/01/2019 Paid 80.000
R1901250181 LAB/190125/0050 107091 YAHYA KURNIAWAN. AN BPJS KESEHATAN 25/01/2019 Paid 145.000
R1901250221 LAB/190125/0057 107361 ABDUL MUIS. TN BPJS KESEHATAN 25/01/2019 Paid 33.000
R1901260041 LAB/190126/0015 105560 IRMAGUSTI. NY BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901260062 LAB/190126/0020 105581 PORAMAN SIMAMORA. BPJS KESEHATAN 26/01/2019 Paid 160.000
R1802090152 LAB/190126/0023 085737 TN
VINSARI VRICILIA BPJS KESEHATAN 26/01/2019 Paid 70.000
R1901260074 LAB/190126/0024 107895 SILABAN.AN
EKO RAHMADI.TN BPJS KESEHATAN 26/01/2019 Paid 250.000
R1901260114 LAB/190126/0026 018390 AHMAD FAUZAN. AN PASIEN UMUM 26/01/2019 Paid 40.000
R1901260129 LAB/190126/0028 EXT TURMI.NY PASIEN UMUM 26/01/2019 Paid 40.000
R1901260104 LAB/190126/0032 107406 YARISJON SAMUEL BPJS KESEHATAN 26/01/2019 Paid 70.000
R1901260111 LAB/190126/0033 093752 SILALAHI.
MUHAMMAD ANFATHAN BPJS KESEHATAN 26/01/2019 Paid 145.000
R1901260116 LAB/190126/0034 024816 PRATAMA.AN
KEISHA ADARA AKIKO BPJS KESEHATAN 26/01/2019 Paid 65.000
R1901260143 LAB/190126/0036 079379 CORINNA
KIM GIBRAN ARAFAT.AN PASIEN UMUM 26/01/2019 Paid 65.000
R1901260145 LAB/190126/0038 107416 JARTIK. NY BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901260153 LAB/190126/0042 107926 SUTANTI.NY PASIEN UMUM 26/01/2019 Paid 138.000
R1901260040 LAB/190126/0043 090053 ANIDAR. NY BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901260164 LAB/190126/0044 095620 YAYA SUNARYA.TN BPJS KESEHATAN 26/01/2019 Paid 33.000
R1901260168 LAB/190126/0050 029368 LASINEM.NY PASIEN UMUM 26/01/2019 Paid 118.000
R1901260213 LAB/190126/0062 107943 RISDA PINTAULI BUTAR PASIEN UMUM 26/01/2019 Paid 125.000
R1901260189 LAB/190126/0067 091478 BUTAR.NY
ADI PRATAMA YOKOHAMA INDUSTRIAL26/01/2019 Paid 70.000
R1901260189 LAB/190126/0068 091478 ADI PRATAMA YOKOHAMA INDUSTRIAL26/01/2019 Paid 150.000
R1901260230 LAB/190126/0073 107950 FHATI RIBKA P. AN ADMEDIKA ALLIANZ 26/01/2019 Paid 110.000
R1901270007 LAB/190127/0013 107955 LASTRI SIRAIT.NY PASIEN UMUM 27/01/2019 Paid 40.000
R1901270026 LAB/190127/0022 100449 DEFI SUPARMAN.TN BNI LIFE INSURANCE 27/01/2019 Paid 474.000
R1901270027 LAB/190127/0024 107964 SRI WAHZUNI.NY PASIEN UMUM 27/01/2019 Paid 151.000
R1901270041 LAB/190127/0032 107970 AYU YUNI SUPRIHATIN. BPJS KESEHATAN 27/01/2019 Process 33.000
R1901280009 LAB/190128/0005 082358 BY. NY
WILIANTO SITORUS.TN PASIEN UMUM 28/01/2019 Paid 388.000
R1901280029 LAB/190128/0006 103928 HERMA JUMIATI.NY BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901280052 LAB/190128/0011 103441 JENNI TAMBUNAN. NY BPJS KESEHATAN 28/01/2019 Paid 73.000
R1901280066 LAB/190128/0012 103647 PECK LUAN. NY BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901150230 LAB/190128/0013 103421 MUKTI WIDAYATI .NY BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901280065 LAB/190128/0014 091269 SANTI YULIANA SARI. BPJS KESEHATAN 28/01/2019 Paid 65.000
R1901280086 LAB/190128/0015 103922 NY
JAYAN TOLLER BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901280105 LAB/190128/0017 067171 NAINGGOLAN.TN
RAHMAH. NY BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901260050 LAB/190128/0018 096565 DERNI.NY BPJS KESEHATAN 28/01/2019 Paid 80.000
R1901280101 LAB/190128/0019 107994 AJI FEBRIAN EFENDI.AN PASIEN UMUM 28/01/2019 Process 385.000
R1901280089 LAB/190128/0020 096775 GANDA MANGASI BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901280159 LAB/190128/0023 EXT SILABAN. TN
NURHAYATI.NY PASIEN UMUM 28/01/2019 Paid 140.000
R1901280162 LAB/190128/0024 EXT ARABALI.TN PASIEN UMUM 28/01/2019 Paid 140.000
R1901280120 LAB/190128/0026 107999 ALEXIUS DOURUS .TN BPJS KESEHATAN 28/01/2019 Paid 105.000
R1901280124 LAB/190128/0030 099637 TIARNA DERIANA.NY BPJS KESEHATAN 28/01/2019 Paid 40.000
R1901280139 LAB/190128/0032 108009 EVI NUROKHMIYATUL.NYBPJS KESEHATAN 28/01/2019 Paid 65.000
R1901280090 LAB/190128/0033 084335 RAMLAN BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901280205 LAB/190128/0036 088551 SIMATUPANG,TN
NARENDRA AMRAN ADMEDIKA RELIANCE 28/01/2019 Paid 65.000
R1901280154 LAB/190128/0037 090813 ELHAMSYAH.
JEFRI KADIR. AN
TN BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901280047 LAB/190128/0039 067788 YULIANA.NY BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901280209 LAB/190128/0040 077331 ELPRIDA PURBA. NY BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901280172 LAB/190128/0041 108018 HUSNI. NY BPJS KESEHATAN 28/01/2019 Paid 78.000
R1901280226 LAB/190128/0042 056434 WAHYUDIN.TN PT. MITRA ENERGI 28/01/2019 Paid 33.000
R1901280243 LAB/190128/0051 046683 APRIANSYAH.AN PASIEN UMUM 28/01/2019 Paid 70.000
R1901280225 LAB/190128/0052 108040 FIRMAN SYAHRANI.TN INHEALTH 28/01/2019 Paid 108.750
R1901280244 LAB/190128/0053 108045 SYAIFUL UMRI.AN PASIEN UMUM 28/01/2019 Paid 95.000
R1901280256 LAB/190128/0055 108050 MAINADOFAH.NY PASIEN UMUM 28/01/2019 Paid 80.000
R1901280261 LAB/190128/0056 107130 RAHIMIN.TN BPJS KESEHATAN 28/01/2019 Paid 33.000
R1901280277 LAB/190128/0061 108055 SABRAN.TN BPJS KESEHATAN 28/01/2019 Paid 80.000
R1901280262 LAB/190128/0062 107632 M. GILANG PRATAMA. BPJS KESEHATAN 28/01/2019 Paid 70.000
R1901280033 LAB/190128/0063 100908 AN
WIDA RETNO BPJS KESEHATAN 28/01/2019 Paid 80.000
R1901280274 LAB/190128/0064 105137 HUSODO.TN
ILYAS AUFAL MAROM. BPJS KESEHATAN 28/01/2019 Paid 65.000
R1901280284 LAB/190128/0065 108060 AN
MUZAFAR.AN PASIEN UMUM 28/01/2019 Paid 65.000
R1901280020 LAB/190128/0071 077537 JULITA SIMATUPANG.NYBPJS KESEHATAN 28/01/2019 Paid 60.000

PAGE : 23 of 24
LIST REKAP PASIEN LABORATORIUM -GROUP BY STATE

TANGGAL 01/01/2019 s/d 31/01/2019

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

R1901280359 LAB/190128/0074 104993 AKMAD AL HAFIDH V.AN BPJS KESEHATAN 28/01/2019 Paid 40.000
R1901290051 LAB/190129/0014 108100 ZAENAL ARIFIN M. BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901290048 LAB/190129/0015 043813 NOOR.TN
MARGARETA. NY RUBYCON 29/01/2019 Paid 138.000
R1901290066 LAB/190129/0016 108104 LINAWATI BR GINTING. BPJS KESEHATAN 29/01/2019 Paid 45.000
R1901290091 LAB/190129/0017 106283 NY
NORJANAH .NY BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901290098 LAB/190129/0019 103380 DESLELI MARNI.NY BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901290116 LAB/190129/0022 EXT ARMINA.NY PASIEN UMUM 29/01/2019 Paid 250.000
R1901290094 LAB/190129/0023 098578 JAN SIRAIT.TN BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901290155 LAB/190129/0033 EXT ABU BAKAR.TN PASIEN UMUM 29/01/2019 Paid 40.000
R1901290157 LAB/190129/0034 EXT MAIMURAH.NY PASIEN UMUM 29/01/2019 Paid 130.000
R1901290094 LAB/190129/0035 098578 JAN SIRAIT.TN BPJS KESEHATAN 29/01/2019 Paid 65.000
R1901290166 LAB/190129/0038 EXT KURNIA.NY PASIEN UMUM 29/01/2019 Paid 250.000
R1901290183 LAB/190129/0041 EXT RIVAL JUANDA PASIEN UMUM 29/01/2019 Paid 95.000
R1901290191 LAB/190129/0043 015292 TJHEN MIAU KHIUN,TN PASIEN UMUM 29/01/2019 Paid 220.000
R1901290169 LAB/190129/0048 092483 MUHAMMAD FAREL AL BPJS KESEHATAN 29/01/2019 Paid 65.000
R1901290200 LAB/190129/0057 100306 ADAM.AN
NILAWATI.NY BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901290227 LAB/190129/0060 107097 MARHAMIS. NY BPJS KESEHATAN 29/01/2019 Paid 33.000
R1901290239 LAB/190129/0062 059574 JULI J PURBA.TN PASIEN UMUM 29/01/2019 Paid 295.000
R1901300002 LAB/190130/0002 083315 YEN FANNY NATALIA BNI LIFE INSURANCE 30/01/2019 Paid 145.000
R1901300002 LAB/190130/0003 083315 EFENDY.
YEN TN NATALIA
FANNY BNI LIFE INSURANCE 30/01/2019 Paid 230.000
R1901300045 LAB/190130/0013 102657 EFENDY. TN
ROSLINDA.NY BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901300036 LAB/190130/0014 105368 SYAHRUL HAMID.TN BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901300053 LAB/190130/0015 103838 ARMILIS.TN BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901300038 LAB/190130/0016 107671 SANTOSO. TN BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901300112 LAB/190130/0026 068958 MASHURI BATUBARA.TN INHEALTH 30/01/2019 Paid 64.500
R1901300033 LAB/190130/0030 102752 PINTA SONDANG BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901300146 LAB/190130/0031 108187 SIMANUNGKALIT.
ROLMAN NY TN BPJS KESEHATAN
SIMAMORA. 30/01/2019 Paid 33.000
R1901300145 LAB/190130/0032 059228 RICO ADRIAL.TN BPJS KESEHATAN 30/01/2019 Paid 138.000
R1901300153 LAB/190130/0034 084345 YADI KARYADI. TN BPJS KESEHATAN 30/01/2019 Paid 33.000
R1901300170 LAB/190130/0039 108220 LIM KIM TJUI .TN PASIEN UMUM 30/01/2019 Paid 348.000
R1901300181 LAB/190130/0043 045927 ABEL SALMA PASIEN UMUM 30/01/2019 Paid 753.000
R1901300176 LAB/190130/0044 108221 RAIHANAH.AN
ANISA PUTRI S .AN BPJS KESEHATAN 30/01/2019 Paid 70.000
R1901300169 LAB/190130/0045 081338 ZAKI NURHILMI. AN BPJS KESEHATAN 30/01/2019 Paid 65.000
R1901300184 LAB/190130/0047 108226 KELITA RAHMA ALENA BPJS KESEHATAN 30/01/2019 Paid 65.000
R1901300185 LAB/190130/0048 108227 .AN
SAMUEL TRITAN .AN INHEALTH 30/01/2019 Paid 108.750
R1901300198 LAB/190130/0049 108230 ABYAN FAIZ AL ARKHAN. BPJS KESEHATAN 30/01/2019 Paid 70.000
R1901300207 LAB/190130/0052 052873 AN
INDRA.TN PT. MITRA ENERGI 30/01/2019 Paid 40.000
R1901300212 LAB/190130/0053 009488 EKA DARA PASIEN UMUM 30/01/2019 Paid 40.000
R1901300220 LAB/190130/0055 063564 RAHMAYATI.NY BPJS KESEHATAN 30/01/2019 Paid 145.000
R1901300219 LAB/190130/0056 108235 SALWA NUR HANIFAH. PASIEN UMUM 30/01/2019 Paid 145.000
R1901310006 LAB/190131/0009 108239 AN
ELFARIDAWATY M.S PASIEN UMUM 31/01/2019 Process 110.000
R1901310042 LAB/190131/0011 075027 SUMBAYAK.
KAMALUDIN.NYTN BPJS KESEHATAN 31/01/2019 Paid 33.000
R1901310059 LAB/190131/0012 106396 JAENUN.NY BPJS KESEHATAN 31/01/2019 Paid 33.000
R1901310075 LAB/190131/0014 100543 ABNEL GUSWATI. NY BPJS KESEHATAN 31/01/2019 Paid 33.000
R1901310077 LAB/190131/0017 108260 NAFISAH SALSABILA.AN PASIEN UMUM 31/01/2019 Paid 385.000
R1901310098 LAB/190131/0018 081781 ERLIS.NY BPJS KESEHATAN 31/01/2019 Paid 33.000
R1901310103 LAB/190131/0022 108271 DARWIS.TN BPJS KESEHATAN 31/01/2019 Paid 113.000
R1901310070 LAB/190131/0024 107772 GUSMANEDY .TN BPJS KESEHATAN 31/01/2019 Paid 250.000
R1901310168 LAB/190131/0034 107130 RAHIMIN.TN BPJS KESEHATAN 31/01/2019 Paid 40.000
R1901310175 LAB/190131/0038 108301 NABILA PUTRI KANIA.AN BPJS KESEHATAN 31/01/2019 Paid 65.000
R1901310216 LAB/190131/0040 108309 ANDIKA MAULANA.AN PASIEN UMUM 31/01/2019 Paid 95.000
R1901310232 LAB/190131/0046 108313 INTAN CAHAYA PASIEN UMUM 31/01/2019 Paid 385.000
R1901310237 LAB/190131/0047 097123 TOGATOROP.NN
SARAH TELLI SINURAT. BPJS KESEHATAN 31/01/2019 Paid 145.000
R1901310243 LAB/190131/0054 108314 NN
YENDRA YENI. BY NY BPJS KESEHATAN 31/01/2019 Process 98.000
TOTAL PEMERIKSAAN : RAWAT JALAN 61.795.250

GRAND TOTAL : 268.723.950

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