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LAPORAN REKAP KLAIM - RSIA AL-IHSAN

Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Jun 2019 s/d 30 Jun 2019
Filter: Metode Pembayaran = Semua / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS C SWASTA
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. SEP INACBG Total Tarif Tarif RS Jenis
1 30 Mei 2019 2 Jun 2019 008923 BAYI NYONYA RITA ANDRI YANI 0406R0050519V000747 P-8-08-II 5,665,100 3,500,000 RI
2 31 Mei 2019 2 Jun 2019 008940 RATNA NINGSIH 0406R0050519V000750 O-6-10-II 5,302,400 8,500,000 RI
3 31 Mei 2019 2 Jun 2019 008932 BAYI NYONYA ZAIDAR.A 0406R0050519V000754 P-8-13-I 5,185,500 3,500,000 RI
4 30 Mei 2019 3 Jun 2019 008931 BAYI NYONYA ENDRAWILIS 0406R0050519V000755 P-8-12-II 10,300,200 4,000,000 RI
5 31 Mei 2019 2 Jun 2019 008941 BAYI NYONYA RATNA NINGSIH 0406R0050519V000776 P-8-13-I 5,185,500 3,500,000 RI
6 31 Mei 2019 2 Jun 2019 008934 BAYI NYONYA NOLA KARMILA 0406R0050519V000777 P-8-13-I 5,185,500 3,500,000 RI
7 31 Mei 2019 2 Jun 2019 008938 BAYI NYONYA NOLA KARMILA 0406R0050519V000778 P-8-13-I 5,185,500 3,500,000 RI
8 31 Mei 2019 2 Jun 2019 008953 BAYI NYONYA SITI GUMALAI 0406R0050519V000781 P-8-13-II 8,089,400 3,500,000 RI
9 2 Jun 2019 4 Jun 2019 0008115 BY SYAMSINAR 0406R0050619V000014 P-8-16-II 3,568,600 3,500,000 RI
10 2 Jun 2019 5 Jun 2019 008987 BAYI NYONYA ZELVI ARINA 0406R0050619V000016 P-8-08-II 5,665,100 3,500,000 RI
11 4 Jun 2019 5 Jun 2019 008915 RINA GUMALA SARI 0406R0050619V000034 O-6-13-II 2,280,300 4,500,000 RI
12 4 Jun 2019 5 Jun 2019 0009006 BAYI NYONYA OSNI 0406R0050619V000046 P-8-13-I 7,259,800 4,500,000 RI
13 4 Jun 2019 5 Jun 2019 006665 NINI ADRIANI 0406R0050619V000049 O-6-12-I 1,878,400 3,500,000 RI
14 5 Jun 2019 6 Jun 2019 009025 RISKI DEBIANTY, SE 0406R0050619V000053 O-6-12-I 2,254,100 4,000,000 RI
15 5 Jun 2019 6 Jun 2019 008430 MAHYUNI SUFITRI 0406R0050619V000054 O-6-12-I 2,254,100 4,000,000 RI
16 6 Jun 2019 8 Jun 2019 009046 MASNILAM 0406R0050619V000063 O-6-13-I 1,605,500 4,500,000 RI
17 6 Jun 2019 8 Jun 2019 009049 BAYI NYONYA INGRIANI 0406R0050619V000093 P-8-08-I 3,992,400 3,500,000 RI
18 6 Jun 2019 8 Jun 2019 009045 BAYI NYONYA SYURIANI SYAFITRI 0406R0050619V000095 P-8-08-II 6,798,100 4,000,000 RI
19 8 Jun 2019 9 Jun 2019 009094 SUTRA AFRIANI 0406R0050619V000111 O-6-13-II 1,900,300 3,500,000 RI
20 8 Jun 2019 10 Jun 2019 009102 EVA NOVRIANI 0406R0050619V000119 O-6-10-I 5,019,900 8,500,000 RI
21 9 Jun 2019 10 Jun 2019 009106 NOVA SUSANTI 0406R0050619V000128 O-6-11-I 2,651,300 3,500,000 RI
22 9 Jun 2019 11 Jun 2019 008954 ERLIN PUTRI SARI 0406R0050619V000129 O-6-10-II 5,302,400 8,500,000 RI
23 8 Jun 2019 10 Jun 2019 009096 BAYI NYONYA SUMIATI 0406R0050619V000139 P-8-13-II 8,089,400 3,500,000 RI
24 6 Jun 2019 13 Jun 2019 009052 BAYI NYONYA YUS 'AIDA 0406R0050619V000142 P-8-11-II 12,360,300 3,500,000 RI
25 5 Jun 2019 11 Jun 2019 009035 BAYI NYONYA UPI SATINA SARI LAIA 0406R0050619V000147 P-8-17-II 7,467,200 4,000,000 RI
26 7 Jun 2019 9 Jun 2019 009073 BAYI NYONYA FITA PUTRI 0406R0050619V000149 P-8-13-I 6,222,600 4,000,000 RI
27 7 Jun 2019 9 Jun 2019 009081 BAYI NYONYA SERLIN NOVIA DEWI 0406R0050619V000155 P-8-12-I 6,036,800 3,500,000 RI
28 7 Jun 2019 9 Jun 2019 009090 BAYI NYONYA MARTA DEWI 0406R0050619V000156 P-8-08-I 3,992,400 3,500,000 RI
29 8 Jun 2019 17 Jun 2019 009104 BAYI NYONYA EVA NOFRIANTI 0406R0050619V000159 P-8-11-I 6,942,400 3,500,000 RI
30 7 Jun 2019 9 Jun 2019 009071 BAYI NYONYA JURIAH 0406R0050619V000183 P-8-08-I 3,992,400 3,500,000 RI
31 7 Jun 2019 9 Jun 2019 007883 ASNITA DELFI 0406R0050619V000205 O-6-10-I 7,027,900 9,500,000 RI
32 10 Jun 2019 12 Jun 2019 009142 BAYI NYONYA NOVRIA WANTI 0406R0050619V000206 P-8-13-II 9,707,300 4,000,000 RI
33 11 Jun 2019 13 Jun 2019 009171 IFAN KRISNA WATI ZEBUA 0406R0050619V000211 O-6-10-II 6,362,800 9,000,000 RI
34 12 Jun 2019 14 Jun 2019 005791 LINDA RANTI 0406R0050619V000231 O-6-10-I 5,019,900 8,500,000 RI
35 12 Jun 2019 14 Jun 2019 008117 SAMIAH 0406R0050619V000240 O-6-10-II 5,302,400 8,500,000 RI
36 13 Jun 2019 15 Jun 2019 0009229 BAYI NYONYA MARSYA 0406R0050619V000283 P-8-13-I 5,185,500 3,500,000 RI
37 13 Jun 2019 15 Jun 2019 009227 BAYI NYONYA IRAWANI 0406R0050619V000284 P-8-12-II 8,583,500 3,500,000 RI
38 14 Jun 2019 16 Jun 2019 008889 FITRI ANDESI 0406R0050619V000302 O-6-10-I 5,019,900 8,500,000 RI
39 14 Jun 2019 16 Jun 2019 008837 DESLIANA 0406R0050619V000305 O-6-10-I 5,019,900 8,500,000 RI
40 14 Jun 2019 17 Jun 2019 009248 BAYI NYONYA SUMIATI RAHAYU 0406R0050619V000314 P-8-08-II 6,798,100 4,000,000 RI

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41 14 Jun 2019 17 Jun 2019 009249 BAYI NYONYA FRIANI 0406R0050619V000316 P-8-08-II 5,665,100 3,500,000 RI
42 14 Jun 2019 15 Jun 2019 005889 DINA NURHAYATI 0406R0050619V000320 O-6-13-I 1,605,500 4,500,000 RI
43 15 Jun 2019 17 Jun 2019 006631 HERDA LENI 0406R0050619V000339 O-6-10-I 6,023,900 9,000,000 RI
44 17 Jun 2019 18 Jun 2019 009316 FITRI ANA 0406R0050619V000396 W-4-16-I 2,494,100 3,500,000 RI
45 17 Jun 2019 18 Jun 2019 009309 AKIFA NAYARA AYFI BTR 0406R0050619V000398 K-4-17-I 1,753,800 2,500,000 RI
46 18 Jun 2019 19 Jun 2019 008723 SARIAMAN 0406R0050619V000416 W-4-17-I 1,533,600 2,500,000 RI
47 17 Jun 2019 20 Jun 2019 0009312 BAYI NYONYA SAFRIDA 0406R0050619V000443 P-8-13-II 9,707,300 4,000,000 RI
48 18 Jun 2019 20 Jun 2019 009348 BAYI NYONYA TARI ANDRIYANI 0406R0050619V000447 P-8-13-II 8,089,400 3,500,000 RI
49 18 Jun 2019 20 Jun 2019 009349 BAYI NYONYA TARI ANDRIYANI 0406R0050619V000448 P-8-13-I 5,185,500 3,500,000 RI
50 20 Jun 2019 22 Jun 2019 008731 YULMIATI 0406R0050619V000467 O-6-10-I 6,023,900 9,000,000 RI
51 20 Jun 2019 21 Jun 2019 008769 YELFI YANTI 0406R0050619V000472 O-6-12-I 1,878,400 4,500,000 RI
52 20 Jun 2019 24 Jun 2019 009370 BAYI NYONYA MELZA FITRI 0406R0050619V000515 P-8-17-II 6,222,600 2,500,000 RI
53 21 Jun 2019 22 Jun 2019 009403 DESI SALFITRI 0406R0050619V000524 W-4-14-I 1,539,300 4,500,000 RI
54 21 Jun 2019 23 Jun 2019 008278 ROSITA 0406R0050619V000525 O-6-10-I 5,019,900 8,500,000 RI
55 22 Jun 2019 24 Jun 2019 009412 BAYI NYONYA RAHMADONA AKBAR 0406R0050619V000572 P-8-13-II 11,325,200 4,500,000 RI
56 22 Jun 2019 26 Jun 2019 009404 AURELIA ALFATUNISA 0406R0050619V000573 P-8-08-II 5,665,100 3,500,000 RI
57 24 Jun 2019 26 Jun 2019 009448 MARIYATI 0406R0050619V000588 O-6-10-I 5,019,900 8,500,000 RI
58 25 Jun 2019 27 Jun 2019 008603 TALENA 0406R0050619V000593 O-6-10-II 5,302,400 8,500,000 RI
59 25 Jun 2019 27 Jun 2019 009457 BAYI NYONYA MASLIA BATU BARA 0406R0050619V000599 P-8-13-II 8,089,400 3,500,000 RI
60 25 Jun 2019 28 Jun 2019 009461 BAYI NYONYA YULIA 0406R0050619V000604 P-8-08-II 5,665,100 3,500,000 RI
61 26 Jun 2019 27 Jun 2019 009481 KHAYRUL NIZAM 0406R0050619V000637 K-4-17-I 1,461,500 3,000,000 RI
62 28 Jun 2019 30 Jun 2019 008077 NOVI HERLINDA 0406R0050619V000657 O-6-10-I 5,019,900 8,500,000 RI
63 28 Jun 2019 30 Jun 2019 009207 NOFI MALISA 0406R0050619V000658 O-6-10-I 5,019,900 8,500,000 RI
64 28 Jun 2019 29 Jun 2019 009482 LILI MARLINA 0406R0050619V000683 W-4-17-I 1,533,600 3,500,000 RI
65 29 Jun 2019 29 Jun 2019 009528 BAYI NYONYA NIA SUSI YENTI 0406R0050619V000708 P-8-08-II 5,665,100 3,500,000 RI
Total 344,169,500 318,000,000
Kode RS: 1312025

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