RINCIAN RAWAT INAP RSUD SIMO RINCIAN RAWAT INAP RSUD SIMO RINCIAN RAWAT INAP RSUD SIMO

KELAS I KELAS 2 KELAS 3

No CM 1005038951/Zal Cendana No CM : 1401076985/Zal Cendana No CM : 1407082665
Nama Tn Sauman 63 th Nama Ny Binem Nama : Tn Kerto Wirejo
Alamat Ngaliyan Pelem Alamat : Sumber Agung Klego Alamat : Krapyak Pelem
TGL masuk 4-May-12 TGL masuk : 28-Jan-14 TGL masuk : 26-Jul-14
Tgl Keluar 7-May-12 Tgl Keluar : 1-Feb-14 Tgl Keluar : 30-Jul-14

Biaya Kamar 0 x 45,000 - Biaya Kamar 5 x 30,000 150,000 Biaya Kamar 0 x - -

Rekam Medis 0 x 4,000 - Rekam Medis 1 x 4,000 4,000 Rekam Medis 0 x - -
Konsul gizi/ specialis 0 x 18,000 - Konsul gizi/ specialis 0 x 12,000 - Konsul gizi/ specialis 0 x - -
Makan+ minum 0 x 27,500 - Makan+ minum 5 x 25,000 125,000 Makan+ minum 0 x - -
Retribusi Kebersihan 4 x 100 400 Retribusi Kebersihan 5 x 100 500 Retribusi Kebersihan 5 x 100 500
Visit Dokter 0 x 27,000 - Visit Dokter 5 x 18,000 90,000 Visit Dokter 0 x - -
Askep 0 x 18,000 - Askep 5 x 12,000 60,000 Askep 0 x - -
Tindakan Medis Tindakan Medis 0 x - - Tindakan Medis 0 -
Injeksi 0 x 5,500 - Injeksi 19 x 4,000 76,000 Injeksi 0 x - -
Pasang infus 0 x 7,750 - Pasang infus 1 x 5,500 5,500 Pasang infus 0 x - -
Af Infus 0 x 5,500 - Af Infus 1 x 4,000 4,000 Af Infus 0 x - -
EKG EKG 19,000 EKG 0
Laboratorium Laboratorium 188,075 Laboratorium 0
Radiologi Radiologi/USG 40,000 Radiologi 0
Tindakan operasi Tindakan operasi - Tindakan operasi 0
Tindakan persalinan Tindakan persalinan - Tindakan persalinan
Resusitasi Pengawasan Transf 3 x 6,000 18,000 Resusitasi
Fisioterapi Fisioterapi - Fisioterapi 0
Obat Obat 851,594 Obat 0
Bahan habis Pakai Bahan habis Pakai 114,850 Bahan habis Pakai 0
Oksigen 0

Total Rp. 400 Total Rp. 1,746,519 Total Rp. 500

Petugas Petugas Petugas

Respati W Respati W Respati W

bhp od
7,500 7,500
15,000 2,500
2,500 2,200
2,500 400
4,500 4,200
1,250 1,100
4,500 450
2,500 5,000
5,000 30,000
15,000 6,600
2,500 450
4,500 6,600
3,000 450
4,500
1,100
15,000
5,000
30,000
13,200
2,000
450
3,150
14,000
 2,250
55,200
55,200

450
22,500
7,500
30,000
2,000
22,500
5,000
30,000
6,600
450
2,500
1,250
22,500
5,000
30,000

70,250 456,750
t
 RINCIAN RAWAT INAP RSUD SIMO RINCIAN RAWAT INAP RSUD SIMO
KELAS 3 KELAS 3
No CM : 1408082852 No CM : 1408082852
Nama : Gunanto Heri Santoso Nama : Gunanto Heri Santoso
Alamat : Pilang Bendo,Nogosari Alamat : Pilang Bendo,Nogosari
TGL masuk : 2-Aug-14 TGL masuk : 2-Aug-14
Tgl Keluar : 5-Aug-14 Tgl Keluar : 5-Aug-14

Biaya Kamar 4 x 45,000 180,000 Biaya Kamar 4 x 45,000 180,000

Rekam Medis 1 x 2,000 2,000 Rekam Medis 1 x 2,000 2,000
konsul Gizi/ Specialis x - - konsul Gizi/ Specialis 0 x - -
Makan+ minum 4 x 27,500 110,000 Makan+ minum 4 x 27,500 110,000
Retribusi Kebersihan 4 x 100 400 Retribusi Kebersihan 4 x 100 400
Visit Dokter 4 x 27,000 108,000 Visit Dokter 4 x 27,000 108,000
Askep 4 x 18,000 72,000 Askep 4 x 18,000 72,000
Tindakan Medis 0 - Tindakan Medis 0 - -
Injeksi 18 x 5,500 5,500 Injeksi 18 x 5,500 5,500
Pasang Infus 1 x 7,750 7,750 Pasang Infus 1 x 7,750 7,750
Af Infus 1 x 5,500 5,500 Af Infus 1 x 5,500 5,500
EKG 0 EKG 0
Laboratorium 43600 Laboratorium 43600
Radiologi 0 Radiologi 0
Tindakan operasi 0 Tindakan operasi 0
Tindakan persalinan Tindakan persalinan 0
Resusitasi Resusitasi 0
Fisioterapi 0 Fisioterapi 0
Obat 500000 Obat 500000
Bahan habis Pakai 0 Bahan habis Pakai 0
Oksigen 0 Oksigen 0

Total 1,034,750 Total 1,034,750

Petugas Petugas
Respati W Respati W