RS.

BaliMed Karangasem
Jl. Nenas Kecicang, Bungaya Kangin, Karangasem

RINCIAN OBAT :
No.Registrasi / MR : RG00099831 / 03.14.85 Nama Pasien : REMAYANTI NI KETUT (NY)
Jaminan : BPJS KESEHATAN Alamat : BD TENGAH, BEBANDEM, BEBANDEM
No.Peserta : 0001872582715
Tgl Masuk : 14-01-2019 Ruangan : RM0034 / TITIPAN DARI JEPUN B
Tgl Keluar : 17-01-2019 Sex / Umur : Perempuan / 46 Tahun 17 Hari
Dokter : dr. Gede Parwata Yasa, Sp. OG Diagnosa : MIOMA UTERI PASCA TOTAL ABDOMINAL
HISTEREKTOMI + BILATERAL SALPHINGO
OFEREKTOMY
No. Tgl No. Bill Nama Obat Qty Harga Diskon
1. 14-01-2019 RI-158976
WIDA RL 500 ML (BP) 1 11361
INFUSET DARAH STERA (BP) 1 8180
THREE WAY STOP COCK BEREKOR HOSPITECH 1 19505
INFLO 18 G OM (BP) 1 8580
ID BAND PINK ADULT 1 3249
SPUIT 1 ONE MED (BP) 1 1573
SPUIT 10 CC ONEMED (BP) 1 2360
CEFTRIAXONE HEXPHARM INJ (BP) 1 14300
AQUA INJ 25 ML 1 8294
Sub Total : 9
2. 14-01-2019 RI-159019
INFLO 22 G OM (BP) 1 8580
Sub Total : 1
3. 14-01-2019 RI-159053
PISAU CUKUR 2 SISI 1 11798
CEFTRIAXONE HEXPHARM INJ (BP) 2 14300
SPUIT 10 CC KIMSMED 2 1859
Sub Total : 5
4. 14-01-2019 RI-159078
NURSE CUP (MAS) 1 2288
Sub Total : 1
Total Harian : 16
1. 15-01-2019 RI-159303
CEFADROXIL 500 TAB 10 1017
ASAM MEFENAMAT 500 MG 15 386
SIOBION TAB 10 422
Sub Total : 35
2. 15-01-2019 RI-159305
ANESFAR INJ 1 22880
Sub Total : 1
3. 15-01-2019 RI-159306
ALKOHOL 70% / ML 10 107
CHLORO TULLE 1 16281
COUTER PEN 1 135849
POLYMED YANKUAR SUCTION 1 78650
MEDIC - DENT STERIL SURG GLOVE 7.0 4 14300
MAS DHD PF SURGICAL GLOVE 7,5 1 22880
MESS 20 1 5663
MONOSYN 0 HR 40 VIOLET 1 213316
BETADINE ONE MED/ml 100 250
CATGUT CHROMIC 1 ROLL 5 23834
T MONO 3-0 76 CM REVERSE CUTTING 1 160160
No. Tgl No. Bill Nama Obat Qty Harga Diskon
TRANSOFIX /TUSUKAN INFUS 1 9867
UNDERPAD NON STERIL OM 1 7150
T SILK 1 5 11440
TOPLES 20 L 1 28600
FORMALIN CAIR 37% 200 573
Sub Total : 334
4. 15-01-2019 RI-159308
AQUA INJ 25 ML 1 8294
BUNASCAN SPINAL 0.5% 1 90090
DEXKETOPROFEN INJ 2 34320
ELEKTRODE 3 6435
EPHEDRINE HCL INJ 1 71500
LIDOCAIN INJ 2% (BP) 1 2242
WIDA NACL 500 ML (BP) 3 10184
PARACETAMOL INFUS (BERNO) 1 43355
WIDA RL 500 ML (BP) 2 11361
SPUIT 1 CC INSULIN TERUMO 1 9152
SPUIT 10 CC TERUMO 1 10439
SPUIT 5 CC KIMSMED 1 1359
SPUIT 5 CC TERUMO 1 8809
Sub Total : 19
Total Harian : 389
1. 16-01-2019 RI-159321
ANTASIDA DOEN SUSP 60 ML (INH) 1 5710
WIDA RL 500 ML (BP) 4 11361
Sub Total : 5
2. 16-01-2019 RI-159390
ANTASIDA DOEN SUSP 60 ML (INH) 1 5710
FASIDOL FORTE TAB (BP) 15 313
Sub Total : 16
Total Harian : 21
1. 17-01-2019 RT-10493
WIDA RL 500 ML (BP) -1 11361
CEFTRIAXONE HEXPHARM INJ (BP) -1 14300
INFLO 18 G OM (BP) -1 8580
SPUIT 1 ONE MED (BP) -1 1573
Sub Total : -4
Total Harian : -4

Grand Total : 422

DENPASAR, 21-01-2019 PETUGAS,

PENERIMA,

REMAYANTI NI KETUT (NY) DR. I WAYAN YOGI PRIMASATYA

T (NY)
DEM, BEBANDEM

RI JEPUN B
17 Hari
TOTAL ABDOMINAL
TERAL SALPHINGO
Total

11361.35
8179.6
19505.2
8580
3248.96
1573
2359.5
14300
8294
77401.61

8580
8580

11797.5
28600
3718
44115.5

2288
2288
132385.11

10167.3
5791.5
4218.5
20177.3

22880
22880

1072.5
16280.55
135848.57
78650
57200
22880
5662.8
213315.96
25025
119169.05
160160
 Total
9867
7150
57200
28600
114660
1052741.43

8294
90090
68640
19305
71500
2242.24
30553.38
43354.74
22722.7
9152
10439
1358.5
8808.8
386460.36
1482259.09

5709.99
45445.4
51155.39

5709.99
4697.55
10407.54
61562.93

-11361.35
-14300
-8580
-1573
-35814.35
-35814.35

1640392.78

N YOGI PRIMASATYA