dr.

Edy
Operasi Tanggal Nama Pasien Jenis Operasi Bruto dr
1 05/10/15 245868 Siti Halimah 2,250,000
2 01/11/15 246410 Siti Umayah 2,000,000
3 01/11/15 246283 Supartini 3,430,000
4 08/11/15 246538 Mujiati 2,000,000
5 14/11/15 246664 Yanti 2,000,000
6 17/11/15 235567 Binti M 2,000,000
7 19/11/15 246765 Sulastri 2,550,000
8 22/11/15 246847 Jumiati 2,000,000
9 23/11/15 102650 Sri Lestari 2,000,000
10 24/11/15 246278 Sonya 2,000,000
11 29/11/15 246724 Elin Triana 2,000,000
12 30/11/15 246845 Fitri Umaisah 2,000,000

Poliklinik
Umum 6,720,000
BPJS 1,020,000
Visite & Konsul
BPJS Viskon 420,000
Umum Viskon 1,860,000
Paket Viskon 1,200,000
37,450,000

dr. Bobby SpBA

Tanggal Nama Pasien Jenis Operasi Bruto dr

Poliklinik
Umum
BPJS
Visite & Konsul
Umum
BPJS
0

dr. Putu
Tanggal Nama Pasien Jenis Operasi Bruto dr
 1 02/11/15 237253 Dewa Agung 1,142,857
2 30/11/15 246336 Siti Martiah 1,142,857
3 07/11/15 246472 Mundiyan 2,285,714
4 22/11/15 246772 Geger 2,285,714
5 04/11/15 246357 Giman 2,857,143
6 26/11/15 246920 Didik Setiawan 2,857,143
7 01/10/15 245767 Sunariyah 1,142,857
8 02/10/15 245806 Dasar 317,537
9 10/10/15 241887 Muntamah 300,448
10 23/10/15 246271 Suwarni 495,386
11 23/10/15 223975 Natanael F 445,907
12 25/10/15 246292 Sulistyowati 780,335

Poliklinik
Umum 7,850,000
BPJS 2,150,000
Visite & Konsul
Umum 4,465,000
BPJS 755,088
Jasa Raharja
31,273,986

dr. Yudi
Operasi Tanggal Nama Pasien Jenis Operasi Bruto dr
1 01/11/15 246410 Siti Umayah 450,000
2 08/11/15 246538 Mujiati 450,000
3 14/11/15 246664 Yanti 850,000
4 17/11/15 235567 Binti M 850,000
5 22/11/15 246847 Jumiati 450,000
6 23/11/15 102650 Sri Lestari 450,000
7 24/11/15 246278 Sonya 850,000
8 29/11/15 246724 Elin Triana 450,000
9 30/11/15 246845 Fitri Umaisah 450,000
10 19/11/15 246765 Sulastri 637,500
11 01/11/15 246283 Supartini 1,543,500
12 02/11/15 237253 Dewa Agung 285,714
13 30/11/15 246336 Siti Martiah 571,429
14 07/11/15 246472 Mundiyan 571,429
15 22/11/15 246772 Geger 571,429
16 04/11/15 246357 Giman 714,286
17 26/11/15 246920 Didik Setiawan 714,286
18 12/11/15 246652 M Nabil 555,500
19 10/11/15 246644 Fatkhul 277,750
20 10/11/15 246635 Arik Hendra 277,750
21 01/10/15 245767 Sunariyah 571,429
22 02/10/15 245806 Dasar 158,769
23 05/10/15 245868 Siti Halimah 562,500
24 10/10/15 241887 Muntamah 75,112
25 23/10/15 246271 Suwarni 247,693
 26 23/10/15 223975 Natanael F 222,954
27 25/10/15 246292 Sulistyowati 195,084

14,004,114

dr. Yasin
Poliklinik
Umum 4,740,000
BPJS 7,320,000
Visite & Konsul
BPJS 10,926,183
Viskon Umum 13,500,000
36,486,183

dr. Ira
Poliklinik
Umum 1,620,000
BPJS 5,340,000
Visite & Konsul
Umum 1,760,000
BPJS 1,162,103
9,882,103

dr. Emi
Poliklinik
Umum 900,000
BPJS 660,000
Visite & Konsul
Umum 7,992,500
BPJS 1,510,000
11,062,500

dr. Adi Djoko Sasono, Sp. THT

Operasi Tanggal Nama Pasien Jenis Operasi Bruto dr
1 10/11/15 Fatkhul TE 1,111,000
2 10/11/15 Arik Hendra TE 1,111,000

Poliklinik
Umum
BPJS
Visite & Konsul
BPJS
Viskon Umum
2,222,000

dr. Bobi Sp. EM

Poliklinik
Umum
BPJS
Visite & Konsul
BPJS 440,000
Viskon Umum 725,000
1,165,000
dr. Umi, Sp. THT
Operasi Tanggal Nama Pasien Jenis Operasi Bruto dr
1 12/11/15 M Nabil TE 1,111,000
2

Poliklinik
Umum 1,170,000
BPJS 440,000
Visite & Konsul
BPJS 180,000
Viskon Umum 65,000
2,966,000

dr. Jenar
Poliklinik
Umum 420,000
BPJS 2,100,000
Visite & Konsul
Umum 485,000
BPJS 916,125
3,921,125

dr. Rizal, Sp.B

Tanggal Nama Pasien Jenis Operasi Bruto dr

Poliklinik
Umum
BPJS
Visite & Konsul
Umum
BPJS
Jasa Raharja
0
NOPEMBER 2015
No Nama Dokter
1 dr. M. Jasin Jahja, Sp. PD
2 dr. Akhmad Suaidi, Sp. OG
3 dr. Martin Yudi Adenanto, Sp. An
4 dr. Dyah Irawati, Sp. S
5 dr. Emi Yuliati, Sp. A
6 dr. I Gusti Putu Sutiaksa, Sp. B
7 dr. Agustinus Bobby Boediono, Sp.B, Sp.BA
8 dr. Adi Djoko Sasono, Sp. THT
9 dr. Umi, Sp. THT
10 dr. Bobi Prabowo, Sp. EM
11 dr. Jenar, SpS.
12 dr. Rizal, Sp. B
Jumlah Tenaga Ahli 6 orang
SC kelas 1 BPJS
SC
Histerektomy
SC
SC
SC
SC MOW
SC
SC
SC
SC
SC

26,230,000

4,681,250

-
Reposisi + Gips
Insici
Hemoroidectomy
Apendictomy
Prostatectomy
Laparatomy
Amputasi BPJS
Herniatomy BPJS
Debridemen BPJS
Eksisi + Drainase BPJS
Herniatomy BPJS
Insisi BPJS

16,053,898

2,345,549

SC
SC
SC
SC
SC
SC
SC
SC
SC
SC MOW
Histerektomy
Reposisi + Gips
Insici
Hemoroidectomy
Apendictomy
Prostatectomy
Laparatomy
TE
TE
TE
Amputasi BPJS
Herniatomy BPJS
SC kelas 1 BPJS
Debridemen BPJS
Eksisi + Drainase BPJS
Herniatomy BPJS
Insisi BPJS

1,050,309

3,451,692

247,053

276,563

-
-

2,222,000

55,550
29,125

74,150

98,028

-
 Pajak
Pendapatan Bruto Potongan PPh
36,486,183 3,451,692
37,450,000 4,681,250
14,004,114 1,050,309
9,882,103 247,053
11,062,500 276,563
31,273,986 2,345,549
0 -
2,222,000 55,550
2,966,000 74,150
1,165,000 29,125
3,921,125 98,028
0 -
150,433,011 12,309,268