LAPORAN REKAP KLAIM - RSUD GANDUS

Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Agu 2021 s/d 31 Agu 2021
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D PEMERINTAH
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. Klaim / SEP INACBG Top Up Total Tarif Tarif RS Jenis
1 2 Agu 2021 2 Agu 2021 005906 ROZANA 0090R0540821V000001 Q-5-42-0 175.000 214.000 RJ
2 3 Agu 2021 3 Agu 2021 001212 FANNY CITRA DEWI, SSI 0090R0540821V000002 Q-5-42-0 175.000 367.297 RJ
3 4 Agu 2021 4 Agu 2021 005911 NUR ZILA 0090R0540821V000004 J-3-13-0 295.500 152.185 RJ
4 5 Agu 2021 5 Agu 2021 000235 REPALIA SEIVEN PUTRI 0090R0540821V000005 Q-5-25-0 126.600 233.299 RJ
5 7 Agu 2021 7 Agu 2021 005915 M HALDIS NAUFAL 0090R0540821V000006 J-3-13-0 295.500 269.575 RJ
6 7 Agu 2021 7 Agu 2021 005986 MSY RADA ALULIYA TAMARA 0090R0540821V000007 Q-5-42-0 175.000 388.200 RJ
7 9 Agu 2021 9 Agu 2021 005918 NYAYU DIAN KOMALASARI 0090R0540821V000008 Q-5-23-0 118.700 235.494 RJ
8 9 Agu 2021 9 Agu 2021 005920 AHMAD GIBRAN RAMADHAN 0090R0540821V000010 Q-5-41-0 277.300 116.492 RJ
9 9 Agu 2021 9 Agu 2021 005919 FAUZANIATY 0090R0540821V000009 L-3-12-0 196.100 227.510 RJ
10 11 Agu 2021 11 Agu 2021 002654 IVO MAYANG SARI 0090R0540821V000011 Q-5-44-0 177.800 238.550 RJ
11 14 Agu 2021 14 Agu 2021 003990 FITRIANI 0090R0540821V000012 J-3-13-0 295.500 262.034 RJ
12 14 Agu 2021 14 Agu 2021 005968 THERESIA MIRANDA 0090R0540821V000013 J-3-13-0 295.500 259.554 RJ
13 14 Agu 2021 14 Agu 2021 002962 INDAH PURNAMASARI 0090R0540821V000014 Q-5-42-0 175.000 240.878 RJ
14 14 Agu 2021 14 Agu 2021 001017 MAIMUNAH 0090R0540821V000015 Q-5-44-0 177.800 236.740 RJ
15 14 Agu 2021 14 Agu 2021 003101 NURSAIDAYANTI 0090R0540821V000016 Q-5-42-0 175.000 248.387 RJ
16 14 Agu 2021 14 Agu 2021 005964 PUTRI MAHARANI 0090R0540821V000018 Q-5-42-0 175.000 388.515 RJ
17 14 Agu 2021 14 Agu 2021 005965 MARLINI 0090R0540821V000017 J-3-13-0 295.500 164.240 RJ
18 21 Agu 2021 21 Agu 2021 005974 DEVI SARTIKA DIWIDIYANTI 0090R0540821V000019 Q-5-44-0 177.800 140.476 RJ
19 22 Agu 2021 22 Agu 2021 002563 DESWITA AULIA RAHMADANTI 0090R0540821V000020 K-5-18-0 231.900 258.320 RJ
20 24 Agu 2021 24 Agu 2021 005891 MARYONO 0090R0540821V000021 L-3-12-0 196.100 368.033 RJ
21 24 Agu 2021 24 Agu 2021 002657 SEFTIYA ANGGRAINI 0090R0540821V000022 Q-5-42-0 175.000 379.105 RJ
22 25 Agu 2021 25 Agu 2021 005983 SITI JUNAYA 0090R0540821V000030 Q-5-41-0 277.300 98.000 RJ
23 26 Agu 2021 26 Agu 2021 002666 MUHAMMAD REYNALDI 0090R0540821V000028 L-3-12-0 196.100 250.272 RJ
24 26 Agu 2021 26 Agu 2021 005879 HJ. ERMAWATI SH MH 0090R0540821V000023 Q-5-44-0 177.800 266.460 RJ
25 28 Agu 2021 28 Agu 2021 003518 TRI REDO KURNIAWAN 0090R0540821V000029 K-5-18-0 231.900 345.227 RJ
26 29 Agu 2021 29 Agu 2021 005889 NORMALIATY FITHRI 0090R0540821V000025 J-3-13-0 295.500 387.165 RJ
27 30 Agu 2021 30 Agu 2021 003501 EMA SURYANI 0090R0540821V000031 Q-5-42-0 175.000 233.539 RJ
28 30 Agu 2021 30 Agu 2021 005904 DEDI HERIYANTO 0090R0540821V000026 J-3-13-0 295.500 275.270 RJ
29 30 Agu 2021 30 Agu 2021 003804 SISMA YULITA 0090R0540821V000024 Q-5-42-0 175.000 223.019 RJ
Total 6.206.700 7.467.836

Kode RS: 1671350 Halaman 1/1