sheet1 -1

LAPORAN REKAP KL
Pasien Rawat Inap dan Rawat Jalan, Peri
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara
No. Tgl. Masuk Tgl. Pulang No. RM
1 2 Agu 2021 2 Agu 2021 005906
2 3 Agu 2021 3 Agu 2021 001212
3 4 Agu 2021 4 Agu 2021 005911
4 5 Agu 2021 5 Agu 2021 000235
5 7 Agu 2021 7 Agu 2021 005915
6 7 Agu 2021 7 Agu 2021 005986
7 9 Agu 2021 9 Agu 2021 005918
8 9 Agu 2021 9 Agu 2021 005920
9 9 Agu 2021 9 Agu 2021 005919
10 11 Agu 2021 11 Agu 2021 002654
11 14 Agu 2021 14 Agu 2021 003990
12 14 Agu 2021 14 Agu 2021 005968
13 14 Agu 2021 14 Agu 2021 002962
14 14 Agu 2021 14 Agu 2021 001017
15 14 Agu 2021 14 Agu 2021 003101
16 14 Agu 2021 14 Agu 2021 005964
17 14 Agu 2021 14 Agu 2021 005965
18 21 Agu 2021 21 Agu 2021 005974
19 22 Agu 2021 22 Agu 2021 002563
20 24 Agu 2021 24 Agu 2021 005891
21 24 Agu 2021 24 Agu 2021 002657
22 25 Agu 2021 25 Agu 2021 005983
23 26 Agu 2021 26 Agu 2021 002666
24 26 Agu 2021 26 Agu 2021 005879
25 28 Agu 2021 28 Agu 2021 003518
26 29 Agu 2021 29 Agu 2021 005889
27 30 Agu 2021 30 Agu 2021 003501
28 30 Agu 2021 30 Agu 2021 005904
29 30 Agu 2021 30 Agu 2021 003804

Kode RS: 1671350

Page 1
 sheet1 -1

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
Nama Pasien No. Klaim / SEP INACBG
ROZANA 0090R0540821V000001 Q-5-42-0
FANNY CITRA DEWI, SSI 0090R0540821V000002 Q-5-42-0
NUR ZILA 0090R0540821V000004 J-3-13-0
REPALIA SEIVEN PUTRI 0090R0540821V000005 Q-5-25-0
M HALDIS NAUFAL 0090R0540821V000006 J-3-13-0
MSY RADA ALULIYA TAMARA 0090R0540821V000007 Q-5-42-0
NYAYU DIAN KOMALASARI 0090R0540821V000008 Q-5-23-0
AHMAD GIBRAN RAMADHAN 0090R0540821V000010 Q-5-41-0
FAUZANIATY 0090R0540821V000009 L-3-12-0
IVO MAYANG SARI 0090R0540821V000011 Q-5-44-0
FITRIANI 0090R0540821V000012 J-3-13-0
THERESIA MIRANDA 0090R0540821V000013 J-3-13-0
INDAH PURNAMASARI 0090R0540821V000014 Q-5-42-0
MAIMUNAH 0090R0540821V000015 Q-5-44-0
NURSAIDAYANTI 0090R0540821V000016 Q-5-42-0
PUTRI MAHARANI 0090R0540821V000018 Q-5-42-0
MARLINI 0090R0540821V000017 J-3-13-0
DEVI SARTIKA DIWIDIYANTI 0090R0540821V000019 Q-5-44-0
DESWITA AULIA RAHMADANTI 0090R0540821V000020 K-5-18-0
MARYONO 0090R0540821V000021 L-3-12-0
SEFTIYA ANGGRAINI 0090R0540821V000022 Q-5-42-0
SITI JUNAYA 0090R0540821V000030 Q-5-41-0
MUHAMMAD REYNALDI 0090R0540821V000028 L-3-12-0
HJ. ERMAWATI SH MH 0090R0540821V000023 Q-5-44-0
TRI REDO KURNIAWAN 0090R0540821V000029 K-5-18-0
NORMALIATY FITHRI 0090R0540821V000025 J-3-13-0
EMA SURYANI 0090R0540821V000031 Q-5-42-0
DEDI HERIYANTO 0090R0540821V000026 J-3-13-0
SISMA YULITA 0090R0540821V000024 Q-5-42-0
T

Page 2
 sheet1 -1

gu 2021
KELAS D PEMERINTAH
Top Up Total Tarif Tarif RS Jenis
175,000 214,000 RJ
175,000 367,297 RJ
295,500 152,185 RJ
126,600 233,299 RJ
295,500 269,575 RJ
175,000 388,200 RJ
118,700 235,494 RJ
277,300 116,492 RJ
196,100 227,510 RJ
177,800 238,550 RJ
295,500 262,034 RJ
295,500 259,554 RJ
175,000 240,878 RJ
177,800 236,740 RJ
175,000 248,387 RJ
175,000 388,515 RJ
295,500 164,240 RJ
177,800 140,476 RJ
231,900 258,320 RJ
196,100 368,033 RJ
175,000 379,105 RJ
277,300 98,000 RJ
196,100 250,272 RJ
177,800 266,460 RJ
231,900 345,227 RJ
295,500 387,165 RJ
175,000 233,539 RJ
295,500 275,270 RJ
175,000 223,019 RJ
Total 6,206,700 7,467,836

Page 3