Anda di halaman 1dari 6

REKAPITULASI PELAYANAN RAWAT INAP TINGKAT PERTAMA

FASILITAS KESEHATAN TINGKAT PERTAMA


Nama Faskes : Puskesmas Perawatan Batupanga
Bulan Pelayanan : Januari 2021

TANGGAL JUMLAH BESARAN


NO NAMA PASIEN NO. KARTU BPJS NO. TELP DIAGNOSA JUMLAH
MASUK KELUAR HARI RAWAT TARIF PAKET
1 ANDIKA SAPUTRA 0000962630998 DYSPEPSIA + FEBRIS 1/1/2020 1/4/2020 3 Hari Rp 140,000 Rp 420,000
2 JAMALIA 0000963132096 ISPA + DYSPEPSIA + DIARE AKUT 1/1/2020 1/5/2020 4 Hari Rp 140,000 Rp 560,000
3 RAHMA 0000204758302 DYSPEPSIA 1/3/2020 1/4/2020 1 Hari Rp 140,000 Rp 140,000
4 MUH.ELSYAHRAWI 0002405004557 TYPHOID FEVER 1/5/2020 1/9/2020 4 Hari Rp 140,000 Rp 560,000
5 DASAR 0002641203955 HYPERURICEMIA + HYPERCHOLESTEROL 1/7/2020 1/8/2020 1 Hari Rp 140,000 Rp 140,000
6 MUH.QADLI ZAKA 0002903734269 FEBRIS + DIARE 1/7/2020 1/9/2020 2 Hari Rp 140,000 Rp 280,000
7 SIRENG 0000961987465 HERNIA INGUINALIS (S) 1/8/2020 1/9/2020 1 Hari Rp 140,000 Rp 140,000
HEMOPTOE EC SUSP TB PARU + DYSPNEU
8 MUH.AFANDI HASAN 0002828867051 1/10/2020 1/12/2020 2 Hari Rp 140,000 Rp 280,000
9 SUMAILA 0000963077916 FEBRIS + MYALGIA 1/10/2020 1/12/2020 2 Hari Rp 140,000 Rp 280,000
10 HERMAN 0000961903631 DYSPEPSIA 1/11/2020 1/12/2020 1 Hari Rp 140,000 Rp 140,000
11 ST. SULEHA 0000961219067 DYSPEPSIA 1/11/2020 1/13/2020 2 Hari Rp 140,000 Rp 280,000
12 SANGKAL 0001964228016 ISPA 1/13/2020 1/16/2020 3 Hari Rp 140,000 Rp 420,000
13 SALJU 0000962715666 DYSPEPSIA 1/18/2020 1/19/2020 1 Hari Rp 140,000 Rp 140,000
14 H.MUH.AMIN DUPPA 0000131187655 DYSPNEU EC. PPOK 1/18/2020 1/21/2020 3 Hari Rp 140,000 Rp 420,000
15 SISKAYANTI 0002427856121 ISPA + DYSPEPSIA 1/19/2020 1/25/2020 6 Hari Rp 140,000 Rp 840,000
16 MUSLIHA 0000961844703 DYSPEPSIA 1/20/2020 1/22/2020 2 Hari Rp 140,000 Rp 280,000
17 SAENI 0001829711125 ABDOMINAL PAIN 1/22/2020 1/24/2020 2 Hari Rp 140,000 Rp 280,000
18 ADIAKSA AMRULLAH 0002898267693 DIARE AKUT 1/27/2020 1/28/2020 1 Hari Rp 140,000 Rp 140,000
19 HELMALIA DARWIS 0002919825538 DYSPEPSIA + TDBD 1/27/2020 1/29/2020 2 Hari Rp 140,000 Rp 280,000
20 HJ.ST.MARYAM 0000130947445 CEPHALGIA + DYSPEPSIA 1/27/2020 1/30/2020 3 Hari Rp 140,000 Rp 420,000
21 PUTRI 0000963859825 DYSPEPSIA 1/28/2020 1/29/2020 1 Hari Rp 140,000 Rp 140,000
22 MUH.ISHAQ 0002828867411 VULNUS LACERATUM 1/29/2020 1/30/2020 1 Hari Rp 140,000 Rp 140,000
Total Hari Rawat 48 Hari Rp 6,720,000
Bukti - bukti penunjang terlampir
Batupanga, 30 Januari 2021
Ka. UPTD PKM Perawatan Batupanga

H.SUYUTI, SKM.M.M.Kes
Nip. 19661231 198602 1 065
REKAPITULASI PELAYANAN RAWAT INAP TINGKAT PERTAMA
FASILITAS KESEHATAN TINGKAT PERTAMA
Nama Faskes : Puskesmas Perawatan Batupanga
Bulan Pelayanan : Februari 2021

TANGGAL JUMLAH BESARAN


NO NAMA PASIEN NO. KARTU BPJS NO. TELP DIAGNOSA JUMLAH
MASUK KELUAR HARI RAWAT TARIF PAKET
1 NURASIA 0000962730898 DYSPEPSIA 2/8/2021 2/11/2021 3 Hari Rp 140,000 Rp 420,000
2 MUSLIMIN 0001076344288 DYSPEPSIA 2/8/2021 2/12/2021 3 Hari Rp 140,000 Rp 420,000
3 RAMLI 0000963100056 ABDOMINAL PAIN 2/11/2021 2/13/2021 2 Hari Rp 140,000 Rp 280,000
4 RAHMA RAMADHANI 0000961219743 DYSPEPSIA 2/12/2021 2/14/2021 2 Hari Rp 140,000 Rp 280,000
5 KACO 0000963352078 DYSPNEU 2/12/2021 2/15/2021 3 Hari Rp 140,000 Rp 420,000
6 IRFAN 0000963902002 ABDOMINAL PAIN + DYSPEPSIA 2/15/2021 2/19/2021 4 Hari Rp 140,000 Rp 560,000
7 DIRGANTARA 0003061827988 GASTRO ENTERITIS AKUT 2/16/2021 2/20/2021 4 Hari Rp 140,000 Rp 560,000
8 SALMA 0000963799558 EPISTAXIS 2/17/2021 2/19/2021 2 Hari Rp 140,000 Rp 280,000
GASTRO ENTERITIS AKUT +
9 SITTI 0002603434926 2/18/2021 2/20/2021 2 Hari Rp 140,000 Rp 280,000
DYSPEPSIA
10 ILHAM 0000963088806 SUSP. TUMOR ABDOMEN 2/24/2021 2/27/2021 3 Hari Rp 140,000 Rp 420,000
11 NURASIA 0000962730898 DYSPEPSIA 2/24/2021 2/25/2021 1 Hari Rp 140,000 Rp 140,000
12 NAHLA DAUD 0000962171976 DYSPEPSIA 2/26/2021 2/27/2021 1 Hari Rp 140,000 Rp 140,000
Total Hari Rawat 30 Hari Rp 4,200,000
Bukti - bukti penunjang terlampir
Batupanga, 27 Februari 2021
Ka. UPTD PKM Perawatan Batupanga

H.SUYUTI, SKM.M.M.Kes
Nip. 19661231 198602 1 065
REKAPITULASI PELAYANAN RAWAT INAP TINGKAT PERTAMA
FASILITAS KESEHATAN TINGKAT PERTAMA
Nama Faskes : Puskesmas Perawatan Batupanga
Bulan Pelayanan : Maret 2021

TANGGAL JUMLAH BESARAN


NO NAMA PASIEN NO. KARTU BPJS NO. TELP DIAGNOSA JUMLAH
MASUK KELUAR HARI RAWAT TARIF PAKET
1 MAHYUDDIN 0000962816229 SUSP. FRAKTUR OF FEMUR 3/1/2020 3/2/2020 1 Hari Rp 140,000 Rp 140,000
2 SALMI 0002117054891 POSTPARTUM HAEMORRAGE 3/2/2020 3/4/2020 2 Hari Rp 140,000 Rp 280,000
3 ROSNA DIAN. W 0001076330349 VOMITUS 3/3/2020 3/5/2020 2 Hari Rp 140,000 Rp 280,000
4 SALMA 0002405004129 OBS.VOMIT EC. HT 3/5/2020 3/6/2020 1 Hari Rp 140,000 Rp 140,000
5 ABDUL KARIM 0002872083835 KONSTIPASI 3/5/2020 3/7/2020 2 Hari Rp 140,000 Rp 280,000
6 JAISA 0000962394737 MILD HIPEREMESIS GRAVIDARUM 3/6/2020 3/10/2020 4 Hari Rp 140,000 Rp 560,000
7 ASYIFAH 0002613304844 GEA 3/8/2020 3/10/2020 2 Hari Rp 140,000 Rp 280,000
8 MASTURA 0000962228913 ISK 3/8/2020 3/10/2020 2 Hari Rp 140,000 Rp 280,000
9 HADIRA 0002828785048 VULNUS LAC.EC. KLL 3/8/2020 3/10/2020 2 Hari Rp 140,000 Rp 280,000
10 MAHAMU 0000962386356 DYSPNEU 3/8/2020 3/12/2020 4 Hari Rp 140,000 Rp 560,000
11 MUKTAR 0002258079737 ASTHMA 3/11/2020 3/14/2020 3 Hari Rp 140,000 Rp 420,000
12 JAISA 0000962394737 SUSPEK TB PARU 3/12/2020 3/13/2020 1 Hari Rp 140,000 Rp 140,000
13 JALAL 0002609081796 CHEST PAIN 3/13/2020 3/14/2020 1 Hari Rp 140,000 Rp 140,000
14 CA'MEANG 0002258621291 VERTIGO + ISPA 3/13/2020 3/14/2020 1 Hari Rp 140,000 Rp 140,000
15 SURIA 0000962592052 GEA 3/15/2020 3/16/2020 1 Hari Rp 140,000 Rp 140,000
16 NURFAQIA ABIDA 0002769034252 DIARE AKUT 3/15/2020 3/18/2020 3 Hari Rp 140,000 Rp 420,000
17 SARINA 0000961078083 TCR GCS 15 + VOMITUS 3/16/2020 3/17/2020 1 Hari Rp 140,000 Rp 140,000
18 AMRI RAMADAN 0000962375354 VOMITING EC. TTH 3/16/2020 3/17/2020 1 Hari Rp 140,000 Rp 140,000
19 MASITA ACO 0002747946418 FEBRIS + DIARE AKUT 3/16/2020 3/18/2020 1 Hari Rp 140,000 Rp 140,000
20 MUH.KADLI ZAKA 0002903734269 DIARE AKUT + VOMITUS 3/17/2020 3/18/2020 2 Hari Rp 140,000 Rp 280,000
21 AMIRUDDIN 0000962373789 MYALGIA 3/18/2020 3/19/2020 1 Hari Rp 140,000 Rp 140,000
22 RAHMANIA '0002275208728 DYSPEPSIA 3/18/2020 3/20/2020 2 Hari Rp 140,000 Rp 280,000
23 SALMIA 0000964265815 GEA 3/19/2020 3/20/2020 1 Hari Rp 140,000 Rp 140,000
24 MUNAWANG 0001439659855 DYSPEPSIA + VERTIGO 3/19/2020 3/22/2020 3 Hari Rp 140,000 Rp 420,000
25 MUH.ARIFIN.R 0000131015171 DYSPEPSIA + POST OP BATU GINJAL 3/20/2020 3/23/2020 3 Hari Rp 140,000 Rp 420,000
26 HASRI 0000961878159 CEPHALGIA + VOMITING 3/21/2020 3/23/2020 2 Hari Rp 140,000 Rp 280,000
27 SERLI 0000963256634 ABDOMINAL PAIN 3/21/2020 3/22/2020 1 Hari Rp 140,000 Rp 140,000
28 SURYANI 0002260431933 ABDOMINAL PAIN 3/21/2020 3/22/2020 1 Hari Rp 140,000 Rp 140,000
29 MEGAWATI 0002250209799 HIPERTENSI 3/22/2020 3/24/2020 2 Hari Rp 140,000 Rp 280,000
30 SAEHA 0000962706892 DYSPNEU + ISPA 3/22/2020 3/25/2020 3 Hari Rp 140,000 Rp 420,000
31 USRI 0000962345125 FEBRIS 3/22/2020 3/27/2020 5 Hari Rp 140,000 Rp 700,000
32 SAPPE 0000962238497 DYSPEPSIA + ARTRITIS GENU 3/23/2020 3/24/2020 1 Hari Rp 140,000 Rp 140,000
33 HAMPRI 0002404951931 ABDOMINAL PAIN 3/23/2020 3/24/2020 1 Hari Rp 140,000 Rp 140,000
34 DARMI 0000963460045 DYSPEPSIA + ISPA 3/23/2020 3/24/2020 1 Hari Rp 140,000 Rp 140,000
35 MUNIRA 0000962219531 DYSPEPSIA + HT URGENCY 3/24/2020 3/27/2020 3 Hari Rp 140,000 Rp 420,000
36 SA'DA 0000961221227 DYSPEPSIA + MALAISE 3/25/2020 3/30/2020 5 Hari Rp 140,000 Rp 700,000
37 NURMA 0000963299283 TRAUMA FACIAL + HEMATOM ORBITA 3/28/2020 3/30/2020 2 Hari Rp 140,000 Rp 280,000
38 FAISAL 0000963277975 TRAUMA FACIAL + HEMATOM ORBITA 3/29/2020 3/30/2020 1 Hari Rp 140,000 Rp 140,000
Total Hari Rawat 75 Hari Rp 10,500,000
Bukti - bukti penunjang terlampir
Batupanga, 31 Maret 2021
Ka. UPTD PKM Perawatan Batupanga

H.SUYUTI, SKM.M.M.Kes
Nip. 19661231 198602 1 065
REKAPITULASI PELAYANAN RAWAT INAP TINGKAT PERTAMA
FASILITAS KESEHATAN TINGKAT PERTAMA
Nama Faskes : Puskesmas Perawatan Batupanga
Bulan Pelayanan : Maret 2021

TANGGAL JUMLAH BESARAN


NO NAMA PASIEN NO. KARTU BPJS NO. TELP DIAGNOSA JUMLAH
MASUK KELUAR HARI RAWAT TARIF PAKET
1 MAHYUDDIN 0000962816229 SUSP. FRAKTUR OF FEMUR 3/1/2020 3/2/2020 1 Hari Rp 140,000 Rp 140,000
2 SALMI 0002117054891 POSTPARTUM HAEMORRAGE 3/2/2020 3/4/2020 2 Hari Rp 140,000 Rp 280,000
3 ROSNA DIAN. W 0001076330349 VOMITUS 3/3/2020 3/5/2020 2 Hari Rp 140,000 Rp 280,000
4 SALMA 0002405004129 OBS.VOMIT EC. HT 3/5/2020 3/6/2020 1 Hari Rp 140,000 Rp 140,000
5 ABDUL KARIM 0002872083835 KONSTIPASI 3/5/2020 3/7/2020 2 Hari Rp 140,000 Rp 280,000
6 JAISA 0000962394737 MILD HIPEREMESIS GRAVIDARUM 3/6/2020 3/10/2020 4 Hari Rp 140,000 Rp 560,000
7 ASYIFAH 0002613304844 GEA 3/8/2020 3/10/2020 2 Hari Rp 140,000 Rp 280,000
8 MASTURA 0000962228913 ISK 3/8/2020 3/10/2020 2 Hari Rp 140,000 Rp 280,000
9 HADIRA 0002828785048 VULNUS LAC.EC. KLL 3/8/2020 3/10/2020 2 Hari Rp 140,000 Rp 280,000
10 MAHAMU 0000962386356 DYSPNEU 3/8/2020 3/12/2020 4 Hari Rp 140,000 Rp 560,000
11 MUKTAR 0002258079737 ASTHMA 3/11/2020 3/14/2020 3 Hari Rp 140,000 Rp 420,000
12 JAISA 0000962394737 SUSPEK TB PARU 3/12/2020 3/13/2020 1 Hari Rp 140,000 Rp 140,000
13 JALAL 0002609081796 CHEST PAIN 3/13/2020 3/14/2020 1 Hari Rp 140,000 Rp 140,000
14 CA'MEANG 0002258621291 VERTIGO + ISPA 3/13/2020 3/14/2020 1 Hari Rp 140,000 Rp 140,000
15 SURIA 0000962592052 GEA 3/15/2020 3/16/2020 1 Hari Rp 140,000 Rp 140,000
16 NURFAQIA ABIDA 0002769034252 DIARE AKUT 3/15/2020 3/18/2020 3 Hari Rp 140,000 Rp 420,000
17 SARINA 0000961078083 TCR GCS 15 + VOMITUS 3/16/2020 3/17/2020 1 Hari Rp 140,000 Rp 140,000
18 AMRI RAMADAN 0000962375354 VOMITING EC. TTH 3/16/2020 3/17/2020 1 Hari Rp 140,000 Rp 140,000
19 MASITA ACO 0002747946418 FEBRIS + DIARE AKUT 3/16/2020 3/18/2020 2 Hari Rp 140,000 Rp 280,000
20 MUH.KADLI ZAKA 0002903734269 DIARE AKUT + VOMITUS 3/17/2020 3/18/2020 2 Hari Rp 140,000 Rp 280,000
21 AMIRUDDIN 0000962373789 MYALGIA 3/18/2020 3/19/2020 1 Hari Rp 140,000 Rp 140,000
22 RAHMANIA '0002275208728 DYSPEPSIA 3/18/2020 3/20/2020 2 Hari Rp 140,000 Rp 280,000
23 SALMIA 0000964265815 GEA 3/19/2020 3/20/2020 1 Hari Rp 140,000 Rp 140,000
24 MUNAWANG 0001439659855 DYSPEPSIA + VERTIGO 3/19/2020 3/22/2020 3 Hari Rp 140,000 Rp 420,000
25 MUH.ARIFIN.R 0000131015171 DYSPEPSIA + POST OP BATU GINJAL 3/20/2020 3/23/2020 3 Hari Rp 140,000 Rp 420,000
26 HASRI 0000961878159 CEPHALGIA + VOMITING 3/21/2020 3/23/2020 2 Hari Rp 140,000 Rp 280,000
27 SERLI 0000963256634 ABDOMINAL PAIN 3/21/2020 3/22/2020 1 Hari Rp 140,000 Rp 140,000
28 SURYANI 0002260431933 ABDOMINAL PAIN 3/21/2020 3/22/2020 1 Hari Rp 140,000 Rp 140,000
29 MEGAWATI 0002250209799 HIPERTENSI 3/22/2020 3/24/2020 2 Hari Rp 140,000 Rp 280,000
30 SAEHA 0000962706892 DYSPNEU + ISPA 3/22/2020 3/25/2020 3 Hari Rp 140,000 Rp 420,000
31 USRI 0000962345125 FEBRIS 3/22/2020 3/27/2020 5 Hari Rp 140,000 Rp 700,000
32 SAPPE 0000962238497 DYSPEPSIA + ARTRITIS GENU 3/23/2020 3/24/2020 1 Hari Rp 140,000 Rp 140,000
33 HAMPRI 0002404951931 ABDOMINAL PAIN 3/23/2020 3/24/2020 1 Hari Rp 140,000 Rp 140,000
34 DARMI 0000963460045 DYSPEPSIA + ISPA 3/23/2020 3/24/2020 1 Hari Rp 140,000 Rp 140,000
35 MUNIRA 0000962219531 DYSPEPSIA + HT URGENCY 3/24/2020 3/27/2020 3 Hari Rp 140,000 Rp 420,000
36 SA'DA 0000961221227 DYSPEPSIA + MALAISE 3/25/2020 3/30/2020 5 Hari Rp 140,000 Rp 700,000
37 NURMA 0000963299283 TRAUMA FACIAL + HEMATOM ORBITA 3/28/2020 3/30/2020 2 Hari Rp 140,000 Rp 280,000
38 FAISAL 0000963277975 TRAUMA FACIAL + HEMATOM ORBITA 3/29/2020 3/30/2020 1 Hari Rp 140,000 Rp 140,000
Total Hari Rawat 76 Hari Rp 10,640,000
Bukti - bukti penunjang terlampir
Batupanga, 31 Maret 2021
Ka. UPTD PKM Perawatan Batupanga

H.SUYUTI, SKM.M.M.Kes
Nip. 19661231 198602 1 065