POLI DALAM

LAPORAN DIAGNOSA BLN AGUSTUS 201

TGL. TGL.
NO. RM NAMA PASIEN
MASUK PULANG
7/27/2019 8/1/2019 67751 PARDIMIN PARTO
7/29/2019 8/1/2019 62877 MUJIRAH
7/27/2019 7/29/2019 67958 SIH YULIYANTO
PURWANING
8/1/2019 8/1/2019 43920 RAHAYU
8/3/2019 8/6/2019 68355 SUHARDI HARTO
8/5/2019 8/7/2019 470 SUWARSINI

8/5/2019 8/7/2019 56703 ALFIO DWI

8/10/2019 8/13/2019 68708 SUHARNO
8/11/2019 8/13/2019 68781 GHOFUR ARIFIN
8/3/2019 8/5/2019 68338 SUBAGYO
8/11/2019 8/14/2019 1939 SUMIYEM
8/13/2019 8/17/2019 5775 RUBINEM
8/12/2019 8/15/2019 31416 DWI PURWANTO
8/16/2019 8/19/2019 62460 SURANI

8/12/2019 8/15/2019 11945 SISTANTO RAHARJO

8/16/2019 8/19/2019 69044 SITI AMNAN
8/16/2019 8/19/2019 49252 SURATMI MANTO
8/18/2019 8/21/2019 1681 SUWANTI
8/13/2019 8/15/2019 23238 SRI MULYANI

8/14/2019 8/14/2019 68958 DWI HAYATI

8/20/2019 8/24/2019 69131 SOFINA ASYIAH

8/19/2019 8/22/2019 470 SUWARSINI
8/18/2019 8/21/2019 49569 MUJIMIN
8/22/2019 8/24/2019 69263 SUKATI
8/12/2019 8/15/2019 68834 NGADINAH

8/9/2019 8/11/2019 68293 PURWO MIHARJO

8/21/2019 8/24/2019 69212 WIDODO MULYONO

ACHMAD RAGIL
### 8/21/2019 8/24/2019 69318 PAMUNGKAS

8/23/2019 8/26/2019 34202 WIDODO

8/22/2019 8/24/2019 20689 NANDA FADILLA

 8/12/2019 8/14/2019 31482 ENI SUSILOWATI
8/27/2019 8/28/2019 28543 SURIPTO TARU
8/26/2019 8/28/2019 69609 SUHADI
8/22/2019 8/25/2019 69263 SUKATI HARJO
8/25/2019 8/27/2019 69532 EQUIN SIANA

8/24/2019 8/26/2019 69460 MARYATUN MARNA

8/20/2019 8/23/2019 69248 TINI
8/25/2019 8/27/2019 69547 TRI RAHAYU

8/25/2019 8/27/2019 69228 TRI DWI

### 8/24/2019 8/28/2019 69468 PARMI
8/24/2019 8/27/2019 69501 SUPRIYANTO
8/25/2019 8/30/2019 44871 DARSONO
8/26/2019 8/30/2019 38826 SUPRIYONO
8/27/2019 8/30/2019 68355 SUHARDI HARTO

8/29/2019 8/31/2019 69730 HARTO SUWARNO

8/26/2019 8/30/2019 69361 PANIYEM

8/25/2019 8/31/2019 19440 SLAMET
8/8/2019 8/9/2019 68629 WALUYO YASA

8/14/2019 8/16/2019 68980 KASMI

8/28/2019 8/31/2019 59842 SITI MARKAMAH

###
 POLI DALAM

LAPORAN DIAGNOSA BLN AGUSTUS 2019

CARA
DIAGNOSA TINDAKAN TARIF BPJS
PULANG
COPD EX ACUT, CHF APD 2947600
ANEMIA, DYSPEPSIA TRANSFUSI APD 1993100
TF APD 3017400

ACUT CORONARY SINDROM RUJUK 1403700

ANEMIA GRAVIS APD 2391700
DM, DYSPEPSIA APD 4562600

TROMBOCYTOPENIA, DBD APD 7991200

HT, SNH APD 3365600
DYSPEPSIA, BRONCHITIS APD 1116600
DM, LBP APD 3910800
DM, HT, DYSLIPIDEMIA APD 3259000
DM2NO, HYPERTENSI APD 3259000
DM2NO, PNEUMONIA APD 5652200
ANEMIA, CARDIOMEGALY TRANSFUSI APD 1993100

DYSPEPSIA, CHF APD 2221400

DM, CHF APD 2314400
TF, HT APD 2155300
HT APD 1720800
DM, HYPERGLYCEMIA APD 3259000
CHF, SVT, SHOCK
CARDIOGENIC MENINGGAL 3863000

TROMBOCYTOPENIA,
FEBRIS INFRKSI VIRAL LAIN APD 2240300
DM, ISK APD 6375400
HEPATOMA APD 3252800
HT, DYSPEPSIA, OA GENU RUJUK 2409100
CHF, EFUSI PLEURA APD 3219200
DM, DYSPEPSIA, TUMOR
MEDIASTINUM APD 4562600

DYSPEPSIA APD 1116600

DYSPEPSIA APD 1116600

CHF, PSVT, RENAL
INSUFICIENCY APD 3219200

FEBRIS INFEKSI VIRAL LAIN APD 3437900

HYPOGLYCEMIACOMA, HT,
POST STROKE APD 2467000
HT URGENCY APD 1720800
DM, DYSPEPSIA APD 3259000
HT, DYSPEPSIA, OA RUJUK 2409100
GEA APD 1334400

GEA APD 1112000

ANEMIA, HEMATURIA TRANSFUSI APD 2391700
COLIC RENAL, HT APD 4451700

FEBRIS INFEKSI VIRAL LAIN APD 2946700

PARMI APD 3259000
BRONCHITIS ACUT APD 2603800
HT, DYSPEPSIA, OA GENU APD 1720800
CYSTITIS APD 2397600
ANEMIA APLASTIC TRANSFUSI APD 2391700
DM, BRONCHITIS ACUT,
SYOK HYPOVALEMIK APD 5652200

HEMATEMASIS, GINGIVITIS APD 1116600

DYSPEPSIA, VERTIGO APD 1116600
DM APD 3259000
ANOREXIA GERIARTI,
SEPSIS, SHOCK SEPSIS MENINGGAL 3259000
ANEMIA BERAT, CA BULI TRANSFUSI APD
TARIF RS
5555500
2587100
2580800

977000
3193800
3374000

1348000
3810300
1449800
3794800
1828300
3066300
4128000 GRADE 3
3090600

2619500
1974500
2032800
1813800
2149800

1703000

4847600
2702000
1593000
3513000
4556500

3419300

1456500

1052000

1854500

1882500
2424800
974800
1180300
3513000
1724500

1181300
3651300
1307500

2411800
2414300
1770000
2374500
3136000
3048500

1534800

2389000
2991000
1532800

2902000
2764600
 POLI BEDAH

LAPORAN DIAGNOSA BLN AGUSTU

TGL. TGL.
NO. RM NAMA PASIEN DIAGNOSA
MASUK PULANG
7/31/2019 8/1/2019 68073 LAZIM TRI TUMOR PEDIS
8/1/2019 8/2/2019 68134 ENENG MULYANI TUMOR HUMERUS
7/31/2019 8/2/2019 68095 WARNO SUWITO HIL
8/1/2019 8/2/2019 68173 ROHMADI TUMOR HUMERUS
8/1/2019 8/2/2019 68178 FITRIYANI TUMOR NASSAL

7/31/2019 8/2/2019 68061 HARTO MULYONO HIL

8/2/2019 8/4/2019 57096 RETNO SARI TUMOR MAMAE
WULAN
8/6/2019 8/7/2019 68308 MUHARAM TUMOR MAMAE
8/9/2019 8/11/2019 68529 DANI BUDI TUMOR PEDIS

RTUMOR GENU,
8/9/2019 8/11/2019 68514 SUTARNO BAKERCYST POPOLITEAL
8/6/2019 8/7/2019 68511 SUMIYEM CORPAL INJURY HAND
8/14/2019 8/15/2019 58884 YAYUK TUMOR MANUS

8/13/2019 8/14/2019 68659 APRILIA WIDATI TUMOR MAMAE, TB PARU

8/5/2019 8/9/2019 63228 SUWARSINI ULCUS DM

8/16/2019 8/17/2019 69005 ARIYANI SUSANTI TUMOR MAMAE

8/16/2019 8/18/2019 68962 MURNI TUMOR MAMAE
8/16/2019 8/17/2019 68937 WARSI TUMOR PEDIS
8/16/2019 8/18/2019 14233 GITO SUWARNO HIL

8/15/2019 8/18/2019 68946 ROHMAT RAHAYU HAEMORID INTERNA

8/7/2019 8/9/2019 68542 MARTINI ULCUS DM
8/16/2019 8/19/2019 68542 MARTINI ULCUS DM

TUMOR COLLI,
8/21/2019 8/24/2019 5874 MUSIYEM PNEMONIA, MASSA PARU
8/23/2019 8/24/2019 50294 HADI SUMARTO HIL
8/20/2019 8/22/2019 69043 NOVIA NURAINI LYMPHADENITIS COLLI
8/22/2019 8/25/2019 40062 MULYADI HEMOROID INTERNA
8/23/2019 8/24/2019 69448 SRI ASTATI ABDOMINAL PAIN
8/28/2019 8/30/2019 69079 YETI CANDRA APP
8/26/2019 8/30/2019 18794 SUMIYATI ULCUS DM, ANEMIA, SNH
8/29/2019 8/30/2019 69715 SARWANA TUMOR PEDIS
8/29/2019 8/31/2019 53626 SUPRAPTI TUMOR MAMAE
8/29/2019 8/31/2019 69620 WIDADA WIYANA HIL
 SETIYO MULYONO HIL
8/29/2019 8/31/2019 69611
8/28/2019 8/31/2019 67829 ENDANG YUNIARTI ULCUS DM,
8/20/2019 8/21/2019 69246 SRI MULYANI TUMOR MANUS
8/4/2019 8/8/2019 68145 BUDI YANTO HEMOROID INTERNA
POLI BEDAH

AGNOSA BLN AGUSTUS 2019

CARA
TINDAKAN TARIF BPJS TARIF RS
PULANG
EXCISI BIOPSY APD 3322000 4784100
EXCISI BIOPSY APD 3322000 4405800
HERNIA REPAIR DGN MAS APD 4069600 4426800
EXCISI BIOPSY APD 3322000 4166300
EXCISI BIOPSY APD 3322000 4165300

HERNIA REPAIR DGN MAS APD 4069600 4833300

EXCISI BIOPSY APD 4361100 4435800

EXCISI BIOPSY APD 4361100 4619500

EXCISI BIOPSY APD 3322000 3597600

EXCISI BIOPSY APD 3322000 4361300

EVAKUASI CORPAL APD 1970100 3564800
EXCISI BIOPSY APD 3322000 3588300

EXCISI BIOPSY APD 7018700 5577800

DEBRIDEMEN APD 4170400 4799300

EXCISI BIOPSY APD 4361100 4261500

EXCISI BIOPSY APD 4361100 4023000
EXCISI BIOPSY APD 3322000 3840000
HERNIA REPAIR DGN MAS APD 4883500 4746800

HAEMOROIDECTOMY APD 3973100 5051300

DEBRIDEMEN APD 4170400 3857800
DEBRIDEMEN APD 4170400 4344300

EXCISI BIOPSY APD 11215600 4663800

HERNIA REPAIR DGN MAS APD 4069600 4667300
EXCISI BIOPSY APD 3322000 4074300
HEMOROIDECTOMY APD 4767700 5980000
RUJUK 1334400 1370000
APPENDECTOMY APD 2507700 4382800
DEBRIDEMEN, TRANSFUSI APD 5673600 7284600
EXCISI BIOPSY APD 3986400 4402300
EXCISI BIOPSY APD 5233300 5242800
HERNIA REPAIR DGN MAS APD 4069600 4091800
HERNIA REPAIR DGN MAS APD 4069600 3985300
DEBRIDEMEN APD 4170400 3612800
EXCISI BIOPSY APD 3322000 3616300
HEMOROIDECTOMY APD Rp3,973,100 4400800
 POLI ORT

LAPORAN DIAGNOSA BLN AGUSTUS 2019

TGL. TGL.
NO. RM NAMA PASIEN DIAGNOSA
MASUK PULANG
CF DISTAL
8/3/2019 8/4/2019 63574 HAWILDAN CAHYA RADIUS

8/6/2019 8/7/2019 57176 SRI WIJI CF RADIUS ULNA

8/12/2019 8/13/2019 68805 MUH FAHMI CF RADIUS ULNA

CF DISTAL
8/13/2019 8/14/2019 68908 BELLA ANDRIA RADIUS
8/13/2019 8/14/2019 66876 ANDRIAN ALDI CF MALLEOLUS
DISLOCATION
8/13/2019 8/14/2019 26749 BONANTO SHOULDER, HT

8/23/2019 8/24/2019 65450 SHOFIYANA UMI CF METACARPAL

8/26/2019 8/28/2019 69571 RAHMANTO CELLULITIS

8/20/2019 8/22/2019 69031 ONGKY KURNIA AJI CF METACARPAL

CF DISTAL
8/29/2019 8/30/2019 67871 SANIA ALFIATU RADIUS
 ORT

A BLN AGUSTUS 2019

CARA
TINDAKAN TARIF BPJS TARIF RS
PULANG

ROI APD 2879700 4498300

ROI APD 2879700 4556000

ORIF APD 5612900 5723800

GIPS APD 2753300 4654800

GIPS APD 1966700 3830300
REDUCTION
SHOULDER APD 1966700 3923300

ROI APD 2879700 4441300

DEBRIDEMEN APD 1134400 4842500

DEBRIDEMEN, GIPS APD 5612900 5479800

ROI APD 2879700 4548300

 POLI SARAF

LAPORAN DIAGNOSA BLN AGUSTUS 2019

TGL. TGL.
NO. RM NAMA PASIEN DIAGNOSA
MASUK PULANG
8/7/2019 8/10/2019 68354 PARINEM VERTIGO, LBP, DM
8/12/2019 8/14/2019 34422 TUMIYEM VERTIGO
NINDIYO
8/21/2019 8/25/2019 69329 PRATOMO SNH, HT
8/30/2019 8/31/2019 44751 SURIP SURYANI VERTIGO, HT
ARAF

BLN AGUSTUS 2019

CARA
TINDAKAN TARIF BPJS TARIF RS
PULANG
APD 1178700 1482500
APD 1178700 657000

APD 2733200 2194300

APD 1178700 647000
 POLI PARU

LAPORAN DIAGNOSA BLN AGUSTUS 2019

TGL. TGL.
NO. RM NAMA PASIEN DIAGNOSA
MASUK PULANG
SHOCK
HYPOVALEMIK,
7/29/2019 8/1/2019 30421 SARDIYEM SOPT, CHF
7/31/2019 8/2/2019 68194 MANGUN DIONO HEMAPTOE, COPD
7/31/2019 8/3/2019 11500 JUMINO COPD EX ACUT, IHD

8/2/2019 8/6/2019 68330 SARIMAN MANTO COPD EX ACUT,HHD

PNEMONIA, CHF,
SHOC
HYPOVALEMIC,
7/29/2019 8/1/2019 30421 SARDIYEM BEKAS TB
TB PARU, SEQUELE
8/9/2019 8/12/2019 51071 PARIYEM HARTO TB, STROKE
8/16/2019 8/19/2019 49362 PAIMO YATNO COPD EX ACUT
8/10/2019 8/11/2019 59543 LEGIYO EFUSI PLEURA
8/21/2019 8/23/2019 3523 SRIATUN PLEURAPNEMONIA
EFUSI PLEURA,
8/24/2019 8/28/2019 68140 MENTO SUTRISNO ATELEKTASIS PARU
TB PARU, PNEMONIA,
8/23/2019 8/27/2019 66453 SUMARNI CHF
PARU

BLN AGUSTUS 2019

CARA
TINDAKAN TARIF BPJS TARIF RS
PULANG

APD 2889500 4949000

APD 2603800 1933500
APD 2461400 4495500

APD 2461400 3630500

APD 5793800 4949000

APD 6290800 3777000

APD 2461400 3751000
RUJUK 3440500 1683000
APD 3260900 2419000

APD 4767200 3075500

APD 4675800 4570000

 POLI JIWA

LAPORAN DIAGNOSA BLN JULI 2019

TGL. TGL.
NO. RM NAMA PASIEN DIAGNOSA
MASUK PULANG
JULI 2019

CARA TARIF
TINDAKAN TARIF RS
PULANG BPJS