TEGAR

No RM 121220

Tanggal Masuk 10.11.2019

Tanggal Keluar

Diagnosa EFUSI PLEURA DEKSTRA

Lama Rawat 3
DPJP
dr. Indah R, SpP
KELAS III

ADMINISTRASI - LAB - RADIOLOGI

Komponen Biaya Qty Harga (@) Jumlah

Administrasi IGD 1 10,000 10,000
Pemeriksaan dokter IGD
Tindakan Medis IGD
Tindakan Keperawatan IGD

Komponen Biaya Qty Harga (@) Jumlah

Radiologi
Thorak 1 75,000 75,000
USG THORAK 1 6,112 6,112

Komponen Biaya Qty Harga (@) Jumlah

Laboratorium
0
Paket II A (>4) 1 43,337 43,337
albumin 1 7,200 7,200
SGOT 1 9,229 9,229
SGPT 1 9229 9,229
0
0
0
0
 Kelas Real Cost
1 1,515,577

2 1,320,577

3 1,125,577

FARMASI /BHP ALKES

Komponen Biaya Qty Harga (@)

Aximed Syringe 10 mL luer lock (21Gx11/2) Disposible 2 1815
Paracetamol 500mg tab 1 248
Infus (Sodium Chloride) Nacl 500 ml 1 7095
Terumo Needle 25Gx1 1 1403
Aqua Otsu-WI (Sterilled Water for Injection) 25mL inj flabot 1 4125
Aximed Nasal Oxygen Adult 1 8993
Adult Identification Band (Blue) 1 1238
Aximed Radio-opaque IV-Cath NP 20Gx11/4 1 7755
Aximed Syringe 10 mL luer lock (21Gx11/2) Disposible 2 1815
Aximed Infusion set 20 drop/mL (dewasa) 1 6848
Paracetamol 500mg tab 3 248
Acetylcysteine 200mg cap 3 1238
Infus (Sodium Chloride) Nacl 500 ml 3 7095
Viccillin-SX 1500 (Ampicillin 1000mg, Sulbactam 500mg) 1500mg pulv inj vial 2 35063
Terasma Expectorant (Terbutaline Sulphate 1.5mg, Guaifenesin 50mg)per 5mL 60mL syr 1 13613
Infus (Sodium Chloride) Nacl 500 ml 2 7095
Leukomed I.V. Film 6X8 cm 1 4125
Antasida Doen (Alluminium Hidroksida 200mg, Magnesium Hidroksida 200mg) 60mL susp syr 1 3713
Viccillin-SX 1500 (Ampicillin 1000mg, Sulbactam 500mg) 1500mg pulv inj vial 2 35063
Paracetamol 500mg tab 3 248
Aqua Otsu-WI (Sterilled Water for Injection) 25mL inj flabot 1 4125
INACBG Selisih Farmasi 251,470
- (1,515,577) Laboratorium 68,995
- (1,515,577) Radiologi 81,112
- (1,515,577)
Administrasi 10,000
- (1,320,577)
- (1,320,577)
- (1,320,577)

3,440,500 2,314,923
(1,125,577)
(1,125,577)

Jumlah
3,630
248
7,095
1,403
4,125
8,993
1,238
7,755
3,630
6,848
744
3,714
21,285
70,126
13,613
14,190
4,125
3,713
70,126
744
4,125
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-