sheet1 1

LAPORAN REKAP
Pasien KLAIM
Rawat - RS
Inap danBHAYANGKARA BRIMOB
Rawat Jalan, Periode Tanggal Pulang: 22 Feb 2019 s/d 22 Feb 2019
Filter: Metode Pembayaran = JKN / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TAR

No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien

1 22 Feb 2019 22 Feb 2019 03-09-33-73 MUKTINUR AFRIANTO
2 22 Feb 2019 22 Feb 2019 02-00-66-68 FITRIA HANDAYANI
3 22 Feb 2019 22 Feb 2019 01-01-15-60 LA'AI
4 22 Feb 2019 22 Feb 2019 03-10-21-97 SRI ULFA ALRIANI
5 22 Feb 2019 22 Feb 2019 03-10-02-29 SUHA ZANIA
6 22 Feb 2019 22 Feb 2019 03-11-42-65 ENCIK AMIEN FANRYES
7 22 Feb 2019 22 Feb 2019 03-11-23-81 ROSLIANA SITOMPUL
8 22 Feb 2019 22 Feb 2019 03-09-20-95 SUTINI
9 22 Feb 2019 22 Feb 2019 03-11-33-23 NETI HERAWATI
10 22 Feb 2019 22 Feb 2019 03-08-62-36 YULIA AZHARA
11 22 Feb 2019 22 Feb 2019 03-07-32-68 DASRIL JUNIA SESA
12 22 Feb 2019 22 Feb 2019 03-11-49-64 RATNAIDA NAPITUPULU
13 22 Feb 2019 22 Feb 2019 03-09-65-77 SUKINAH
14 22 Feb 2019 22 Feb 2019 03-11-82-51 DAVINA MAULIDA FARRAS
15 22 Feb 2019 22 Feb 2019 03-11-42-33 SITI ROHMAH
16 22 Feb 2019 22 Feb 2019 03-09-09-69 HAIKAL ARDIANSYAH
17 22 Feb 2019 22 Feb 2019 03-04-37-11 ANASTASIA HENNY SUGIARTI
18 22 Feb 2019 22 Feb 2019 03-09-21-59 MUHAMMAD ALMER FIRYAAL ARASHEL
19 22 Feb 2019 22 Feb 2019 03-05-34-89 SITI FATIMAH
20 22 Feb 2019 22 Feb 2019 04-00-87-59 JASMINE MAHESWARI
21 22 Feb 2019 22 Feb 2019 03-11-23-87 SUHADI
22 22 Feb 2019 22 Feb 2019 03-07-15-75 HIDAYAT MS
23 22 Feb 2019 22 Feb 2019 02-01-79-16 ALMIRA SYIFA BHAYANGKARI
24 22 Feb 2019 22 Feb 2019 03-07-31-70 HARTINI
25 22 Feb 2019 22 Feb 2019 03-11-82-52 SITI NURLAELA
26 22 Feb 2019 22 Feb 2019 02-01-52-37 NAFIS ROSIANA MAYA AKHLIMA, A.MKEP.
27 22 Feb 2019 22 Feb 2019 03-07-15-01 NURHENY
28 22 Feb 2019 22 Feb 2019 03-11-70-08 SRI HERLINAWATI
29 22 Feb 2019 22 Feb 2019 02-01-41-37 MAULIDIA ALEESYA AZZHRA
30 22 Feb 2019 22 Feb 2019 02-00-86-85 INDRIA SARI
31 22 Feb 2019 22 Feb 2019 03-11-82-26 GIYONO
32 22 Feb 2019 22 Feb 2019 03-11-80-65 RIZKI SETIA RAHANTON
33 22 Feb 2019 22 Feb 2019 03-11-78-21d NURASIH
34 22 Feb 2019 22 Feb 2019 03-10-29-09 SYNDI
35 22 Feb 2019 22 Feb 2019 03-11-82-43 NANIK JAMANIH
36 22 Feb 2019 22 Feb 2019 02-01-35-33 LAILAFITU SHAKILA N
37 22 Feb 2019 22 Feb 2019 03-11-76-30 JAMALUDIN
38 22 Feb 2019 22 Feb 2019 03-10-56-23 ROSYA EFELINA
39 22 Feb 2019 22 Feb 2019 03-07-18-63 HJ.EVA YANULITA
40 22 Feb 2019 22 Feb 2019 03-11-70-55 RAMDONI
41 22 Feb 2019 22 Feb 2019 03-11-39-30 KARLINA KUSTINANGINI
42 22 Feb 2019 22 Feb 2019 03-09-22-24 MUHAMMAD HASBI TANJUNG
43 22 Feb 2019 22 Feb 2019 03-11-78-32 LIDIA SUDARSI
44 22 Feb 2019 22 Feb 2019 02-01-18-84 KHOIRUN NISA
45 22 Feb 2019 22 Feb 2019 03-06-52-95 ANNISA BELLA MARIYANA
46 22 Feb 2019 22 Feb 2019 03-08-94-54 YENNY AGUSTIN
47 22 Feb 2019 22 Feb 2019 03-11-75-42 AHMADI
48 22 Feb 2019 22 Feb 2019 04-00-50-88 HJ. TRI YULIANTI,S.KEP
49 22 Feb 2019 22 Feb 2019 03-11-69-76 SASKIA DARA INDRAWATI

Page 1
 sheet1 1

50 22 Feb 2019 22 Feb 2019 03-11-82-42 NI LUH RUSMINI

51 22 Feb 2019 22 Feb 2019 03-11-73-56 MUHAMMAD ICHSAN BAISUNI
52 22 Feb 2019 22 Feb 2019 03-11-52-03 NURUL FAJRI
53 22 Feb 2019 22 Feb 2019 03-11-82-27 SOPIYAH SULASTRI
54 22 Feb 2019 22 Feb 2019 03-11-82-59 PETRA ARGATAMA SIMANJUNTAK
55 22 Feb 2019 22 Feb 2019 03-11-58-37 FAUZAN FATIH ASSOFAWAN
56 22 Feb 2019 22 Feb 2019 03-11-79-81D R MOELIANA SEKAR ASIH
57 22 Feb 2019 22 Feb 2019 03-10-12-35 SURIANA
58 22 Feb 2019 22 Feb 2019 03-07-03-46 DINA ANGGRAENY
59 22 Feb 2019 22 Feb 2019 03-11-80-41 ANASTASIA IKA DIANA
60 22 Feb 2019 22 Feb 2019 03-11-82-30 ERIE ERVIENA K
61 22 Feb 2019 22 Feb 2019 03-11-79-93 IKA USWATUN HASANAH
62 22 Feb 2019 22 Feb 2019 03-11-72-83 SAMIH
63 22 Feb 2019 22 Feb 2019 03-08-01-84 INA NAFIROH
64 22 Feb 2019 22 Feb 2019 04-01-02-10 CATUR WIDHI HASTUTI
65 22 Feb 2019 22 Feb 2019 03-11-07-24 IMAM RAHMAN
66 22 Feb 2019 22 Feb 2019 03-07-85-03 BEEFRHANNA ARRASY BUSYRA
67 22 Feb 2019 22 Feb 2019 03-11-78-16 RANI HANDAYANI
68 22 Feb 2019 22 Feb 2019 03-11-68-84 DEA ENJELINA
69 22 Feb 2019 22 Feb 2019 03-11-73-38 MARIA ONA LEWAR
70 22 Feb 2019 22 Feb 2019 03-11-67-77 BIMONO HERU FITRANTO
71 22 Feb 2019 22 Feb 2019 03-11-81-91 YUNI SINTAWATI
72 22 Feb 2019 22 Feb 2019 02-01-22-48 TAUFIQURRAYA ABIMANYU
73 22 Feb 2019 22 Feb 2019 03-11-59-57 M ABDUL QODIR JAELANI
74 22 Feb 2019 22 Feb 2019 03-11-70-11 SYUKUR NURROHMAN
75 22 Feb 2019 22 Feb 2019 03-11-58-06 AGUS HARTONO
76 22 Feb 2019 22 Feb 2019 03-11-82-45 IFEH FADHILAH
77 22 Feb 2019 22 Feb 2019 04-01-12-32 ANISA WULAN FAUZIAH
78 22 Feb 2019 22 Feb 2019 03-11-41-72 ERNA SETYANI
79 22 Feb 2019 22 Feb 2019 03-10-90-93 IIS
80 22 Feb 2019 22 Feb 2019 03-11-76-61 WAWAN SOFWAN
81 22 Feb 2019 22 Feb 2019 02-01-64-14 AULIA MARDIANA SAPUTRA
82 22 Feb 2019 22 Feb 2019 03-09-47-90 PASSA PRIHANDONO
83 22 Feb 2019 22 Feb 2019 03-07-29-63 SRI INDAH CAHYANI
84 22 Feb 2019 22 Feb 2019 03-11-82-57 NENG WELI WAHYUNI
85 22 Feb 2019 22 Feb 2019 03-11-70-20 EDWIN MULIA
86 22 Feb 2019 22 Feb 2019 03-08-41-27 CATHARINA SRI MAWARNI
87 22 Feb 2019 22 Feb 2019 03-06-86-63 SULASTRI
88 22 Feb 2019 22 Feb 2019 03-11-81-68 ANTRICE JUWITA ELPRANA
89 22 Feb 2019 22 Feb 2019 03-11-80-64 ARIANO SANTI
90 22 Feb 2019 22 Feb 2019 03-11-82-34 ALVIS ZAHRONAEN
91 22 Feb 2019 22 Feb 2019 03-07-68-34 MIN MAWAN DIPOWASITO MULYOSENTONO
92 22 Feb 2019 22 Feb 2019 04-01-10-17 HENGKI SUTARYO
93 22 Feb 2019 22 Feb 2019 03-11-73-42 RASYAD HAFIZH IZZUDIN
94 22 Feb 2019 22 Feb 2019 03-11-82-33 ANI SUMARNI
95 22 Feb 2019 22 Feb 2019 03-11-82-35 AIDIL HUSNI
96 22 Feb 2019 22 Feb 2019 02-01-12-38 TANTI LIA AGUSPRIANTI
97 22 Feb 2019 22 Feb 2019 02-01-58-01 ZAKIYA RAMADHANI ANDRIAN
98 22 Feb 2019 22 Feb 2019 03-10-68-25 BAYI NY. YULI YANI
99 22 Feb 2019 22 Feb 2019 03-07-50-29 IMRON ABDUL A
100 22 Feb 2019 22 Feb 2019 02-00-95-85 NABILLA LUTFI N P
101 22 Feb 2019 22 Feb 2019 03-11-78-61 BAYI NY NURUL AZIZAH
102 22 Feb 2019 22 Feb 2019 03-11-82-36 DAFFA ARYA GHAUSSAN

Page 2
 sheet1 1

103 22 Feb 2019 22 Feb 2019 03-07-00-04 ATHAYYA NAWWAF ZUHUDI

104 22 Feb 2019 22 Feb 2019 03-11-57-43 SUNARYO
105 22 Feb 2019 22 Feb 2019 03-11-02-59 SELPIJAH
106 22 Feb 2019 22 Feb 2019 03-11-72-29 SARWITI
107 22 Feb 2019 22 Feb 2019 03-10-51-89 NAQA NARYAMA MURAY
108 22 Feb 2019 22 Feb 2019 03-11-47-29 M. DAISY DIANA
109 22 Feb 2019 22 Feb 2019 03-09-90-98 MUHAMMAD DAFFA FAKHRYAN
110 22 Feb 2019 22 Feb 2019 03-11-76-40 NAURA YASMIN KAMILA SAKHI
111 22 Feb 2019 22 Feb 2019 03-11-65-36 RAYYAN DWI AL GHIFARI
112 22 Feb 2019 22 Feb 2019 03-11-77-71 MUHAMMAD HABIBI HIBATULLAH MUYASSAR
113 22 Feb 2019 22 Feb 2019 03-11-82-28 A.T LILIS KUSUMAYANI
114 22 Feb 2019 22 Feb 2019 03-08-55-86 SUNARTI
115 22 Feb 2019 22 Feb 2019 03-11-41-38 WAGIRAH
116 22 Feb 2019 22 Feb 2019 03-10-03-54 MEISNAWATI
117 22 Feb 2019 22 Feb 2019 03-11-40-10 NAHARA
118 22 Feb 2019 22 Feb 2019 03-10-20-61 MUHAMMAD RAFLI
119 22 Feb 2019 22 Feb 2019 03-11-16-28 ANNA PINONTOAN
120 22 Feb 2019 22 Feb 2019 03-10-39-96 TIMURIA PANJAITAN
121 22 Feb 2019 22 Feb 2019 03-08-33-37 SITI NGAISAH
122 22 Feb 2019 22 Feb 2019 03-08-49-91 PUJIATI
123 22 Feb 2019 22 Feb 2019 03-11-49-61 ROHANA
124 22 Feb 2019 22 Feb 2019 03-09-36-38 TIWI WIDAYATI
125 22 Feb 2019 22 Feb 2019 03-08-25-69 KAYA KASIH
126 22 Feb 2019 22 Feb 2019 03-11-79-49 LUMONGGA TOBING
127 22 Feb 2019 22 Feb 2019 03-11-82-29 DWI APRIYANTO
128 22 Feb 2019 22 Feb 2019 03-11-82-19 NANEH MUHANEH
129 22 Feb 2019 22 Feb 2019 03-11-76-69 TJASRO
130 22 Feb 2019 22 Feb 2019 03-11-82-18 F.X ARYO WICAKSONO
131 22 Feb 2019 22 Feb 2019 03-11-63-28 DARMANTO
132 22 Feb 2019 22 Feb 2019 03-08-12-33 NOORCHAMID A KAHAR
133 22 Feb 2019 22 Feb 2019 03-11-82-41 RINI MUSLIMAH
134 22 Feb 2019 22 Feb 2019 03-11-18-45 HJ. EVA AFRIYENI
135 22 Feb 2019 22 Feb 2019 03-11-36-65 RASMAN
136 22 Feb 2019 22 Feb 2019 03-11-82-40 IDA
137 22 Feb 2019 22 Feb 2019 03-06-97-35 SITI JUWARIAH
138 22 Feb 2019 22 Feb 2019 03-11-82-38 HENGKY LAWU PURNAMA
139 22 Feb 2019 22 Feb 2019 03-11-79-78 ISNAINI HINDUN
140 22 Feb 2019 22 Feb 2019 03-06-12-63 MARMI
141 22 Feb 2019 22 Feb 2019 03-11-82-14d SUKINI HARYATI
142 22 Feb 2019 22 Feb 2019 03-11-79-41 SABAR SAKSOMO
143 22 Feb 2019 22 Feb 2019 04-00-98-05 TITA ROSITA
144 22 Feb 2019 22 Feb 2019 01-01-04-24 BUDI PURNIAWAN
145 22 Feb 2019 22 Feb 2019 03-09-51-72 AMINAH
146 22 Feb 2019 22 Feb 2019 03-11-62-85 BAYI NYONYA SITI ROHMAH
147 22 Feb 2019 22 Feb 2019 03-11-64-58 EDDY SUMANTRI
148 22 Feb 2019 22 Feb 2019 03-11-82-20 AMIN LINAN
149 22 Feb 2019 22 Feb 2019 03-11-64-70 ANGKASA PUTRA WIRYAWAN
150 22 Feb 2019 22 Feb 2019 03-11-10-53 YUSMAIDA SIMANJUNTAK
151 22 Feb 2019 22 Feb 2019 03-09-51-69 MEILANI WIJAYANTI
152 22 Feb 2019 22 Feb 2019 03-11-64-36 ANNISA ADELYA KINANTI
153 22 Feb 2019 22 Feb 2019 03-11-82-21 SOBARIH
154 22 Feb 2019 22 Feb 2019 03-11-58-00 BUDI YUWONO
155 22 Feb 2019 22 Feb 2019 03-10-47-62 SUPRIADI

Page 3
 sheet1 1

156 22 Feb 2019 22 Feb 2019 03-11-31-84 MUHAMMAD LUHTFI ARIEL SATRIA
157 22 Feb 2019 22 Feb 2019 03-11-31-20 KARYATI
158 22 Feb 2019 22 Feb 2019 03-11-46-88 MELLA KATERINA
159 22 Feb 2019 22 Feb 2019 03-07-76-75 ENDANG MURTININGSIH
160 22 Feb 2019 22 Feb 2019 03-08-17-18 MARSIAH
161 22 Feb 2019 22 Feb 2019 03-08-44-72 TRI SULISTYOWATI R R
162 22 Feb 2019 22 Feb 2019 03-09-57-47 SITI AMINAH
163 22 Feb 2019 22 Feb 2019 03-11-57-03 JUNICA RATNAWATI IBRAMSYAH
164 22 Feb 2019 22 Feb 2019 03-08-02-59 DRS. YOGA A PRAMUDYA
165 22 Feb 2019 22 Feb 2019 04-01-04-79 MUHAMMAD ROMLI
166 22 Feb 2019 22 Feb 2019 03-11-45-08 HARIYONO
167 22 Feb 2019 22 Feb 2019 03-11-61-97 FITRIYANI
168 22 Feb 2019 22 Feb 2019 03-06-69-03 SITI JAENAP
169 22 Feb 2019 22 Feb 2019 03-05-73-55 DARMONO SP
170 22 Feb 2019 22 Feb 2019 03-09-66-09 SUMINARSIH
171 22 Feb 2019 22 Feb 2019 04-00-80-17 DWI RETNONINGSIH
172 22 Feb 2019 22 Feb 2019 03-11-02-48 DARSONO
173 22 Feb 2019 22 Feb 2019 03-07-72-81 SAODAH ARIS
174 22 Feb 2019 22 Feb 2019 03-07-73-28 SURIPTO
175 22 Feb 2019 22 Feb 2019 03-08-33-07 ARIS
176 22 Feb 2019 22 Feb 2019 03-10-89-63 MARLINA
177 22 Feb 2019 22 Feb 2019 03-10-73-10 M FAUZI
178 22 Feb 2019 22 Feb 2019 03-09-88-63 NUR CITRA KURNIA APRILLIYANTI
179 22 Feb 2019 22 Feb 2019 03-10-16-09 SRI SUMARIYAH
180 22 Feb 2019 22 Feb 2019 03-06-50-17 SUTARDI
181 22 Feb 2019 22 Feb 2019 03-11-78-47 ARBITIO BAGAS UTOMO
182 22 Feb 2019 22 Feb 2019 03-10-85-58 MARIYAM,NY.
183 22 Feb 2019 22 Feb 2019 03-07-95-17 ALYA LUTHFIYAWATI AGUSTIN
184 22 Feb 2019 22 Feb 2019 03-11-30-60 MACHDAR
185 22 Feb 2019 22 Feb 2019 03-10-67-66 PRIDA ARIS GUNAWAN
186 22 Feb 2019 22 Feb 2019 03-11-16-72 RATU FITRIANA
187 22 Feb 2019 22 Feb 2019 03-11-75-61 ZUSLIATI SANUSI
188 22 Feb 2019 22 Feb 2019 03-06-30-27 SULAIMAN ADI WIBOWO
189 22 Feb 2019 22 Feb 2019 03-10-77-76 DESY ANDRIYANI
190 22 Feb 2019 22 Feb 2019 03-10-61-47 WAHYUDI
191 22 Feb 2019 22 Feb 2019 03-08-72-91 JOHANNES TANGKILISAN
192 22 Feb 2019 22 Feb 2019 03-11-32-75 JEFRY MARTIN MARBUN
193 22 Feb 2019 22 Feb 2019 02-01-62-48 FRISHKA TYAS ILLACARTIKA SARY
194 22 Feb 2019 22 Feb 2019 03-11-73-76 IRFAN S
195 22 Feb 2019 22 Feb 2019 03-10-13-46 SOPAN SOPIANA
196 22 Feb 2019 22 Feb 2019 03-11-04-92 SUKARTI
197 22 Feb 2019 22 Feb 2019 03-11-26-38 KARMAN LIKET
198 22 Feb 2019 22 Feb 2019 03-11-62-30 M YUSUF
199 22 Feb 2019 22 Feb 2019 03-09-78-26 LILIS PURWANINGSIH
200 22 Feb 2019 22 Feb 2019 03-10-51-20 NANIH
201 22 Feb 2019 22 Feb 2019 03-11-04-66 FRANTHO MAJU VICTOR S.
202 22 Feb 2019 22 Feb 2019 03-11-43-95 SITI MUSIYAM, NY
203 22 Feb 2019 22 Feb 2019 03-08-46-60 SOEPAR
204 22 Feb 2019 22 Feb 2019 03-08-15-82 NGATINEM
205 22 Feb 2019 22 Feb 2019 03-09-38-78 SUTRISNO
206 22 Feb 2019 22 Feb 2019 01-00-19-07 VINCENTIUS ATMA. S
207 22 Feb 2019 22 Feb 2019 03-07-36-26 MASAGUS TADJUDDIN
208 22 Feb 2019 22 Feb 2019 03-11-46-43 ARI AMBARWATI

Page 4
 sheet1 1

209 22 Feb 2019 22 Feb 2019 03-11-44-36 AANG KURNIAWAN

210 22 Feb 2019 22 Feb 2019 03-07-82-68 ZAIRAL AKBAR
211 22 Feb 2019 22 Feb 2019 03-11-78-56 SURIP
212 22 Feb 2019 22 Feb 2019 03-09-67-36 WIA ADANI
213 22 Feb 2019 22 Feb 2019 03-10-67-47 RAFIF DWI SUKMA
214 22 Feb 2019 22 Feb 2019 03-11-16-84 TESA LONYKA GULTOM
215 22 Feb 2019 22 Feb 2019 03-11-75-02 SUMIYATI
216 22 Feb 2019 22 Feb 2019 03-11-31-88 TARISYA APRILIANA
217 22 Feb 2019 22 Feb 2019 03-10-45-79 JAENUDIN
218 22 Feb 2019 22 Feb 2019 03-06-81-77 SARMADA
219 22 Feb 2019 22 Feb 2019 03-08-96-85 ZAENABUN
220 22 Feb 2019 22 Feb 2019 03-10-38-40 OMSA MANAHARA,DRS
221 22 Feb 2019 22 Feb 2019 03-08-07-56 ZEHAN WIDIASTUTI
222 22 Feb 2019 22 Feb 2019 03-11-80-03 HERNI SRI RAHAJENG
223 22 Feb 2019 22 Feb 2019 03-11-12-37 SUTIJAH,NY
224 22 Feb 2019 22 Feb 2019 03107780 AMINAH
225 22 Feb 2019 22 Feb 2019 03-08-67-50 UCEN SUTISNA
226 22 Feb 2019 22 Feb 2019 03-06-58-62 E RATNA SARI
227 22 Feb 2019 22 Feb 2019 03-09-06-78 SITI MASLAH
228 22 Feb 2019 22 Feb 2019 03-10-26-61 TATI HAYATI
229 22 Feb 2019 22 Feb 2019 02-01-58-58d MUHDIYANTI
230 22 Feb 2019 22 Feb 2019 03-11-53-07 SURONTO
231 22 Feb 2019 22 Feb 2019 04-01-22-23 NARKO
232 22 Feb 2019 22 Feb 2019 03-11-22-87 MIENTJE ROEMOE
233 22 Feb 2019 22 Feb 2019 03-11-60-51 ARIYANTO ARDANI
234 22 Feb 2019 22 Feb 2019 01-00-58-26 TULUS PUJIANTO
235 22 Feb 2019 22 Feb 2019 03-08-43-76 MARIA FATIMA
236 22 Feb 2019 22 Feb 2019 03-11-53-47D SLAMET RIYADI
237 22 Feb 2019 22 Feb 2019 03-10-94-45 HIRY YANTO
238 22 Feb 2019 22 Feb 2019 03-06-12-51 CHAMISAH
239 22 Feb 2019 22 Feb 2019 03-06-10-55 NENI JUHAENI
240 22 Feb 2019 22 Feb 2019 03-08-02-67 INDAH SUSILOWATI
241 22 Feb 2019 22 Feb 2019 03-10-29-06 SUKADI, ST
242 22 Feb 2019 22 Feb 2019 03-11-51-47 FISYE KIPUW
243 22 Feb 2019 22 Feb 2019 03-08-90-51 KARSINI
244 22 Feb 2019 22 Feb 2019 03-08-81-82 R. ROZELLY BESILA
245 22 Feb 2019 22 Feb 2019 03-09-36-34 MAISAROH
246 22 Feb 2019 22 Feb 2019 03-06-76-40 TOTO ANGGRAHITO
247 22 Feb 2019 22 Feb 2019 03-07-26-26 LONGSERIA GULTOM
248 22 Feb 2019 22 Feb 2019 03-11-55-09 SANUSI. B
249 22 Feb 2019 22 Feb 2019 01-11-55-68 SUKASMIN
250 22 Feb 2019 22 Feb 2019 03-11-68-30 SOGINEM SARASWATI
251 22 Feb 2019 22 Feb 2019 03-08-60-59 SYOFIA WARDA
252 22 Feb 2019 22 Feb 2019 04-01-05-45 SUSSANTI
253 22 Feb 2019 22 Feb 2019 03-11-75-51 THAYEB ADAM
254 22 Feb 2019 22 Feb 2019 03-11-37-16 ELPANORA
255 22 Feb 2019 22 Feb 2019 03-11-33-16 SYARIF RAHMAN HASIBUAN
256 22 Feb 2019 22 Feb 2019 03-11-54-87 SUPRATMAN H. DARIMAN
257 22 Feb 2019 22 Feb 2019 03-11-67-59 TANISAH
258 22 Feb 2019 22 Feb 2019 04-00-23-93 HELNA ROSIYANI
259 22 Feb 2019 22 Feb 2019 02-01-80-79 DYAH RETNO LESTARI
260 22 Feb 2019 22 Feb 2019 02-01-85-15 SUCI AYUNDARI TUMIDJO
261 22 Feb 2019 22 Feb 2019 03-11-08-09 SOFIA LAURA

Page 5
 sheet1 1

262 22 Feb 2019 22 Feb 2019 03-09-19-64 ROHATI

263 22 Feb 2019 22 Feb 2019 02-00-61-51 SUPRIATIN
264 22 Feb 2019 22 Feb 2019 03-11-38-80 WINDI NUR UTAMI
265 22 Feb 2019 22 Feb 2019 02-01-63-17 SIANNE TANGKILISAN
266 22 Feb 2019 22 Feb 2019 03-10-87-60 LATIPAH
267 22 Feb 2019 22 Feb 2019 02-01-36-47 DWI YUNITASARI
268 22 Feb 2019 22 Feb 2019 02-01-86-67 SARY HARDIYANI
269 22 Feb 2019 22 Feb 2019 03-11-57-52 INTAN MAHARANI
270 22 Feb 2019 22 Feb 2019 03-10-07-44 ARIFIN LAIBU
271 22 Feb 2019 22 Feb 2019 03-07-61-02 MUCHTAR HASBALLAH
272 22 Feb 2019 22 Feb 2019 03-06-33-81 SARAH JULIANTI
273 22 Feb 2019 22 Feb 2019 03-06-19-36 FAKHRUL AMIN
274 22 Feb 2019 22 Feb 2019 03-09-34-95 SUPRIYATUN
275 22 Feb 2019 22 Feb 2019 03-07-29-20 SUKARWO
276 22 Feb 2019 22 Feb 2019 03-11-82-73 KUSPAJARIAYAH
277 22 Feb 2019 22 Feb 2019 01-01-04-54 YASRI ABDUL MAS
278 22 Feb 2019 22 Feb 2019 03-11-82-47 PURWANI
279 22 Feb 2019 22 Feb 2019 01-00-44-08 NEVY TAMAKA
280 22 Feb 2019 22 Feb 2019 03-09-18-76 HARRY PRIANTONO
281 22 Feb 2019 22 Feb 2019 02-01-84-68 TAMALA
282 22 Feb 2019 22 Feb 2019 03-11-82-65 DIANA ERMA SARI
283 22 Feb 2019 22 Feb 2019 02-01-35-75 PADMA WIDYA ARTIKA
284 22 Feb 2019 22 Feb 2019 02-01-82-59 INENSY DITA NAYLA DEVINOVA
285 22 Feb 2019 22 Feb 2019 03-09-31-65 RIZKY RANUTIRTA
286 22 Feb 2019 22 Feb 2019 02-00-13-74 FAUZIYAH ANAS TASYA
287 22 Feb 2019 22 Feb 2019 03-11-82-53 RITA SUSIANA
288 22 Feb 2019 22 Feb 2019 01-01-19-11 AIDIL MUTTAKIN
289 22 Feb 2019 22 Feb 2019 02-01-61-32 MUHAMMAD ABDUL ROUF
290 22 Feb 2019 22 Feb 2019 02-01-60-64 MOHAMMAD GHIFARI SYAKIIB
291 22 Feb 2019 22 Feb 2019 02-01-12-21 KHALID SHIRAZY MIRZA
292 22 Feb 2019 22 Feb 2019 02-01-73-75 NABILA ANINDYAWATI
293 22 Feb 2019 22 Feb 2019 02-01-78-07 ASMA SALSABILLAH MARSAOLI
294 22 Feb 2019 22 Feb 2019 04-01-06-23 RAMADHONA HANDAYANI
295 22 Feb 2019 22 Feb 2019 02-00-80-70 FITRIA DEWI
296 22 Feb 2019 22 Feb 2019 02-00-42-37 AFRAH RAIHANA HADI
297 22 Feb 2019 22 Feb 2019 04-00-91-09 ANGELYN PISCESHA
298 22 Feb 2019 22 Feb 2019 03-11-82-81 GIBRAN RAYYAN RAMADHAN
299 22 Feb 2019 22 Feb 2019 03-11-82-79 SUDIRAN
300 22 Feb 2019 22 Feb 2019 03-11-82-68 SUYATNO
301 22 Feb 2019 22 Feb 2019 04-00-89-59 BRYAN DAMORAH SIMANJUTAK
302 22 Feb 2019 22 Feb 2019 03-11-82-78 FERNANDA WICAKSONO
303 22 Feb 2019 22 Feb 2019 03-11-82-77 WAWAN RISWANA
304 22 Feb 2019 22 Feb 2019 04-01-11-90 NOPY NURATIH
305 22 Feb 2019 22 Feb 2019 03-11-82-80 MAIRIN
306 22 Feb 2019 22 Feb 2019 03-10-72-50 LATIFAH FARHANAH ACHMAD
307 22 Feb 2019 22 Feb 2019 02-01-73-36 ALDIAN MANNAF MIRZA
308 22 Feb 2019 22 Feb 2019 02-01-72-37 FIRA SURYA MULYATI
309 22 Feb 2019 22 Feb 2019 03108803 MICHAEL SEBASTIAN GINTING
310 22 Feb 2019 22 Feb 2019 02-01-48-99 FATTAN HASYA SUDIAR
311 22 Feb 2019 22 Feb 2019 03-08-66-56 MEGA HANDAYANI
Total
Kode RS: 3276039

Page 6
 sheet1 1

9
g = Semua / Jenis Tarif = TARIF RS KELAS C PEMERINTAH

No. SEP INACBG Top Up Total Tarif Tarif RS Jenis

0138R0150219V006576 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006424 J-3-13-0 308,500 185,000 RJ
0138R0150219V006520 Q-5-40-0 126,600 100,000 RJ
0138R0150219V006534 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006608 Q-5-43-0 262,000 95,000 RJ
0138R0150219V006686 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006455 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006453 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006466 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006575 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006437 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006557 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006430 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006658 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006635 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006439 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006660 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006578 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006632 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006498 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006691 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006593 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006639 Q-5-43-0 262,000 95,000 RJ
0138R0150219V006611 Q-5-42-0 182,600 140,000 RJ
0138R0150219V006656 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006650 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006525 U-3-16-0 283,800 200,000 RJ
0138R0150219V006677 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006619 U-3-16-0 283,800 285,000 RJ
0138R0150219V006628 U-3-16-0 283,800 285,000 RJ
0138R0150219V006475 K-5-18-0 242,100 95,000 RJ
0138R0150219V006585 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006571 U-3-16-0 283,800 285,000 RJ
0138R0150219V006580 U-3-16-0 283,800 285,000 RJ
0138R0150219V006616 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006630 U-3-16-0 283,800 285,000 RJ
0138R0150219V006606 Z-3-27-0 183,900 145,000 RJ
0138R0150219V006581 U-3-16-0 283,800 285,000 RJ
0138R0150219V006541 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006553 Z-3-27-0 183,900 145,000 RJ
0138R0150219V006598 U-3-16-0 283,800 285,000 RJ
0138R0150219V006652 Z-3-27-0 183,900 145,000 RJ
0138R0150219V006605 U-3-16-0 283,800 385,000 RJ
0138R0150219V006620 U-3-16-0 283,800 385,000 RJ
0138R0150219V006610 U-3-16-0 283,800 285,000 RJ
0138R0150219V006506 Z-3-27-0 183,900 145,000 RJ
0138R0150219V006547 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006679 U-3-16-0 283,800 285,000 RJ
0138R0150219V006671 U-3-16-0 283,800 285,000 RJ

Page 7
 sheet1 1

0138R0150219V006591 Q-5-18-0 131,600 185,000 RJ

0138R0150219V006680 U-3-16-0 283,800 360,000 RJ
0138R0150219V006682 U-3-16-0 283,800 285,000 RJ
0138R0150219V006479 Q-5-12-0 206,700 260,000 RJ
0138R0150219V006689 U-3-16-0 283,800 385,000 RJ
0138R0150219V006507 U-3-16-0 283,800 285,000 RJ
0138R0150219V006469 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006549 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006552 U-3-16-0 283,800 285,000 RJ
0138R0150219V006470 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006503 U-3-16-0 283,800 385,000 RJ
0138R0150219V006484 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006540 U-3-16-0 283,800 300,000 RJ
0138R0150219V006501 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006583 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006441 U-3-16-0 283,800 285,000 RJ
0138R0150219V006480 U-3-16-0 283,800 385,000 RJ
0138R0150219V006442 U-3-16-0 283,800 185,000 RJ
0138R0150219V006604 U-3-16-0 283,800 285,000 RJ
0138R0150219V006468 U-3-16-0 283,800 185,000 RJ
0138R0150219V006661 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006613 U-3-16-0 283,800 285,000 RJ
0138R0150219V006537 U-3-16-0 283,800 285,000 RJ
0138R0150219V006488 U-3-16-0 283,800 285,000 RJ
0138R0150219V006627 U-3-16-0 283,800 285,000 RJ
0138R0150219V006485 U-3-16-0 283,800 385,000 RJ
0138R0150219V006624 Q-5-12-0 206,700 185,000 RJ
0138R0150219V006675 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006634 U-3-16-0 283,800 385,000 RJ
0138R0150219V006492 U-3-16-0 283,800 285,000 RJ
0138R0150219V006518 U-3-16-0 283,800 385,000 RJ
0138R0150219V006655 U-3-16-0 283,800 360,000 RJ
0138R0150219V006524 U-3-16-0 283,800 285,000 RJ
0138R0150219V006555 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006674 Q-5-12-0 206,700 185,000 RJ
0138R0150219V006539 U-3-16-0 283,800 200,000 RJ
0138R0150219V006474 Q-5-18-0 131,600 185,000 RJ
0138R0150219V006676 U-3-16-0 283,800 285,000 RJ
0138R0150219V006548 U-3-16-0 283,800 360,000 RJ
0138R0150219V006678 U-3-16-0 283,800 285,000 RJ
0138R0150219V006550 U-3-16-0 283,800 285,000 RJ
0138R0150219V006542 U-3-16-0 283,800 285,000 RJ
0138R0150219V006528 U-3-16-0 283,800 285,000 RJ
0138R0150219V006505 U-3-16-0 283,800 285,000 RJ
0138R0150219V006531 Q-5-12-0 206,700 185,000 RJ
0138R0150219V006561 U-3-16-0 283,800 285,000 RJ
0138R0150219V006623 U-3-16-0 283,800 285,000 RJ
0138R0150219V006626 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006510 Q-5-42-0 182,600 155,000 RJ
0138R0150219V006544 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006642 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006643 Q-5-18-0 131,600 95,000 RJ
0138R0150219V006574 Q-5-26-0 192,500 95,000 RJ

Page 8
 sheet1 1

0138R0150219V006516 Q-5-44-0 181,400 95,000 RJ

0138R0150219V006530 Z-3-27-0 183,900 142,500 RJ
0138R0150219V006568 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006486 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006502 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006500 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006554 Q-5-44-0 181,400 155,000 RJ
0138R0150219V006603 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006567 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006458 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006496 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006560 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006463 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006523 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006449 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006438 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006428 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006443 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006433 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006457 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006432 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006621 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006477 Q-5-44-0 181,400 220,000 RJ
0138R0150219V006497 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006494 Q-5-25-0 135,700 95,000 RJ
0138R0150219V006429 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006512 Q-5-44-0 181,400 230,000 RJ
0138R0150219V006427 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006511 Q-5-44-0 181,400 120,000 RJ
0138R0150219V006600 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006586 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006504 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006514 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006584 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006519 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006579 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006532 Q-5-44-0 181,400 195,000 RJ
0138R0150219V006559 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006473 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006569 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006566 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006667 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006612 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006538 M-3-15-0 275,400 142,500 RJ
0138R0150219V006452 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006440 Q-5-31-0 129,600 95,000 RJ
0138R0150219V006465 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006487 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006467 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006478 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006445 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006562 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006454 Q-5-44-0 181,400 92,500 RJ

Page 9
 sheet1 1

0138R0150219V006665 F-5-16-0 262,800 95,000 RJ

0138R0150219V006654 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006481 Q-5-44-0 181,400 92,500 RJ
0138R0150219V006703 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006700 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006697 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006696 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006570 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006694 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006499 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006607 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006483 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006629 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006592 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006595 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006657 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006773 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006672 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006699 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006742 Q-5-44-0 181,400 190,000 RJ
0138R0150219V006720 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006729 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006715 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006711 Q-5-44-0 181,400 255,000 RJ
0138R0150219V006709 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006707 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006701 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006718 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006721 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006740 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006750 Q-5-44-0 181,400 180,000 RJ
0138R0150219V006749 Q-5-44-0 181,400 180,000 RJ
0138R0150219V006751 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006698 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006710 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006730 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006743 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006735 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006708 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006748 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006756 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006745 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006738 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006509 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006753 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006741 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006508 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006719 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006704 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006702 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006633 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006649 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006588 Q-5-44-0 181,400 95,000 RJ

Page 10
 sheet1 1

0138R0150219V006727 Q-5-44-0 181,400 95,000 RJ

0138R0150219V006716 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006714 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006759 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006662 Q-5-44-0 181,400 180,000 RJ
0138R0150219V006772 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006737 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006615 Q-5-44-0 181,400 180,000 RJ
0138R0150219V006693 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006668 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006695 Q-5-44-0 181,400 180,000 RJ
0138R0150219V006705 Q-5-42-0 182,600 95,000 RJ
0138R0150219V006713 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006712 Q-5-44-0 181,400 180,000 RJ
0138R0150219V006625 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006444 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006431 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006436 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006446 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006460 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006434 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006491 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006447 Z-3-12-0 138,400 135,000 RJ
0138R0150219V006589 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006515 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006529 Z-3-12-0 138,400 150,000 RJ
0138R0150219V006582 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006594 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006663 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006464 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006545 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006533 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006646 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006590 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006490 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006536 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006565 M-3-16-0 107,400 90,000 RJ
0138R0150219V006614 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006459 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006423 Z-3-12-0 138,400 150,000 RJ
0138R0150219V006527 Z-3-12-0 138,400 150,000 RJ
0138R0150219V006558 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006631 M-3-16-0 107,400 45,000 RJ
0138R0150219V006577 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006476 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006546 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006526 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006462 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006572 Z-3-12-0 138,400 90,000 RJ
0138R0150219V006640 Z-3-12-0 138,400 135,000 RJ
0138R0150219V006456 Z-3-25-0 296,400 177,500 RJ
0138R0150219V006670 Z-3-25-0 296,400 177,500 RJ
0138R0150219V006599 Z-3-25-0 296,400 177,500 RJ

Page 11
 sheet1 1

0138R0150219V006564 Z-3-25-0 296,400 177,500 RJ

0138R0150219V006551 Z-3-25-0 296,400 177,500 RJ
0138R0150219V006687 Z-3-27-0 183,900 152,500 RJ
0138R0150219V006744 Z-3-25-0 296,400 177,500 RJ
0138R0150219V006618 Z-3-25-0 296,400 177,500 RJ
0138R0150219V006669 Z-3-25-0 296,400 177,500 RJ
0138R0150219V006666 Z-3-25-0 296,400 177,500 RJ
0138R0150219V006722 Z-3-25-0 296,400 177,500 RJ
0138R0150219V006641 M-3-16-0 107,400 45,000 RJ
0138R0150219V006673 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006688 Z-3-25-0 296,400 177,500 RJ
0138R0150219V006597 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006706 Q-5-44-0 181,400 95,000 RJ
0138R0150219V006732 Q-5-44-0 181,400 225,000 RJ
0138R0150219V006796 K-5-18-0 242,100 420,000 RJ
0138R0150219V006587 Q-5-42-0 182,600 150,000 RJ
0138R0150219V006647 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006681 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006563 Q-5-44-0 181,400 545,000 RJ
0138R0150219V006622 Z-3-27-0 183,900 275,000 RJ
0138R0150219V006765 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006757 K-5-18-0 242,100 100,000 RJ
0138R0150219V006755 Q-5-25-0 135,700 100,000 RJ
0138R0150219V006752 Q-5-25-0 135,700 100,000 RJ
0138R0150219V006754 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006659 Q-5-25-0 135,700 100,000 RJ
0138R0150219V006779 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006780 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006781 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006790 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006792 Z-3-27-0 183,900 100,000 RJ
0138R0150219V006784 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006795 Q-5-42-0 182,600 150,000 RJ
0138R0150219V006794 Q-5-44-0 181,400 100,000 RJ
0138R0150219V006793 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006791 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006807 Q-5-41-0 289,400 130,000 RJ
0138R0150219V006802 J-3-13-0 308,500 185,000 RJ
0138R0150219V006786 Q-5-41-0 289,400 100,000 RJ
0138R0150219V006801 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006803 Q-5-42-0 182,600 335,000 RJ
0138R0150219V006800 Q-5-25-0 135,700 150,000 RJ
0138R0150219V006805 Q-5-25-0 135,700 100,000 RJ
0138R0150219V006804 Q-5-41-0 289,400 100,000 RJ
0138R0150219V006808 Q-5-42-0 182,600 150,000 RJ
0138R0150219V006810 Q-5-42-0 182,600 100,000 RJ
0138R0150219V006811 Q-5-42-0 182,600 150,000 RJ
0138R0150219V006809 Q-5-42-0 182,600 130,000 RJ
0138R0150219V006601 Q-5-25-0 135,700 200,000 RJ
0138R0150219V006797 Q-5-23-0 127,200 350,000 RJ
60,657,500 45,290,000

Page 12