XYZ A B C D E F G H
Sharing Fee Sharing Biaya Total No Rekening Nama Bank
Tunjangan
Uang Duduk Sharing Fee Pasien Sharing Fee Fee KSO Listrik
No Nama Dokter Penanggung
Dokter Pasien Umum Asuransi BPJS Mandiri (jika (jika ada)
Jawab
Komersial Inhealth ada)
UMUM
UMUM
GIGI
OBGYN
OBGYN
OBGYN
OBGYN
OBGYN
OBGYN
OBGYN
OBGYN
OBGYN
OBGYN
OBGYN
OBGYN
RUMAT
HALOBUMIL
ULI 2022
Klinik Jakarta
arto)
LAPORAN PEMERIKSAAN COVID KIMIA FARMA MALAKASARI
BULAN JUNI 2022
NO. DOKTER JUMLAH PASIEN TARIF TOTAL DOKTER
1 DR. DWI 24 85,000 2,040,000 72,000
2 DR. JAYANTI 24 85,000 2,040,000 72,000
3 DR. MARTWIN 26 85,000 2,210,000 78,000
50 4,250,000 150,000
KF (80%) 4,742,400
Dokter(20%) 1,185,600
KF (30%) 592,800
Dokter (70%) 1,383,200
JUMLAH PASIEN
NO. NAMA DOKTER 2D 4D TOTAL
TV PASIEN TOTAL FEE BANK
1 dr. Hani 11 22 9 42 3,980,000.00 MANDIRI
2 dr. Agatha 0 2 1 3 300,000.00 MANDIRI
3 dr. Satrya 3 8 2 13 1,240,000.00 BNI
4 dr. Putut 4 17 2 23 2,220,000.00 MANDIRI
5 dr. Elisia 2 1 0 3 260,000.00 BTPN
6 dr. Harry 0 3 0 3 300,000.00 MANDIRI
7 dr. Andrew 0 1 0 1 100,000.00 BNI
8 dr. Simon 0 2 0 2 200,000.00 BCA
9 dr. Jemmy 0 3 0 3 300,000.00 BCA
10 dr. Atikah 1 1 1 3 280,000.00 BNI
11 dr. Chakti 2 7 0 9 860,000.00 MANDIRI
12 dr. Nurul 4 2 0 6 520,000.00 MANDIRI
TOTAL FEE Dokter JUNI 27 69 15 111 10,560,000.00
HALOBUMIL BPH 2,180,000.00
HALOBUMIL FEE bulan JUNI 2022 5,078,750.00
PENGURANGAN FEE DOKTER DAN FEE KF DARI VOUCHER 300,000.00
TOTAL FEE HALOBUMIL BULAN JUNI 2022 6,958,750.00 MANDIRI A/N CIPTA KELUARGA MANDIRI :
6,958,750.00
MENGETAHUI
BAMBANG YUNIARTO
E DR. OBGYN HALOBUMIL DUREN SAWIT BULAN JUNI 2022
ANY OKTAVIA
NO
TGL & JAM PRAKTEK NAMA PASIEN JENIS USG TARIF USG FEE DOKTER
1 2-Jun-22 FITRIANA WULANDARI 4D 220,000.00 100,000.00
PAGI PUTRI CAHYANI 4D 220,000.00 100,000.00
440,000.00 200,000.00
SORE RETNO SRI WULAN 2D 175,000.00 80,000.00
PIPIT ARYANI 2D 175,000.00 80,000.00
DITA VISKA PURNAMA 4D 220,000.00 100,000.00
SITI MARYAMAH 2D 175,000.00 80,000.00
APRILIANY 2D 175,000.00 80,000.00
920,000.00 420,000.00
2 4-Jun-22 ANNA SRI PUJI ASTUTI 4D 220,000.00 100,000.00
SORE NABILAH FARRAS 4D 220,000.00 100,000.00
RESTU DIAH RAHAYU TV 220,000.00 100,000.00
PUTRI DHINI ROSSANTI TV 220,000.00 100,000.00
DEFI ROHMAWATI TV 220,000.00 100,000.00
SARI DEWI TV 220,000.00 100,000.00
ERIKA DESI SETYANI 4D 220,000.00 100,000.00
SARAH RIZKA NOVIANTI 2D 175,000.00 80,000.00
1,715,000.00 780,000.00
3 5-Jun-22 DEWI AYU TRI ASTUTI 4D 220,000.00 100,000.00
SORE NURHASANAH 4D 220,000.00 100,000.00
SARTIKA WULANDARI 4D 220,000.00 100,000.00
NIA YUSNIAR 4D 220,000.00 100,000.00
RIANA CITRA DEWI 4D 220,000.00 100,000.00
SRI RAHAYU 4D 220,000.00 100,000.00
1,320,000.00 600,000.00
4 7-Jun-22 RINA SAPUTRI 4D 220,000.00 100,000.00
SORE HANNI 4D 220,000.00 100,000.00
SANNY CARMILA 4D 220,000.00 100,000.00
660,000.00 300,000.00
5 8-Jun-22 NUR ISLAMIAH 4D 220,000.00 100,000.00
SORE
220,000.00 100,000.00
6 9-Jun-22 MILA JUANITA 4D 220,000.00 100,000.00
SORE NOVI RIZKI 4D 220,000.00 100,000.00
440,000.00 200,000.00
7 11-Jun-22 LINA 2D 175,000.00 80,000.00
PAGI PUJI RAHAYU 4D 220,000.00 100,000.00
PUTRI UTAMI 2D 175,000.00 80,000.00
AFIDATU SHOLIKHAH 4D 220,000.00 100,000.00
MEYLIA CYNDHIANA DEW 4D 220,000.00 100,000.00
SUCI ANJARSARI 4D 220,000.00 100,000.00
NITA WINDY ASTUTI TV 220,000.00 100,000.00
DEFI ROHMAWATI TV 220,000.00 100,000.00
WINDA AYU 4D 220,000.00 100,000.00
1,890,000.00 860,000.00
SORE NOVIA SUGIHARTATI 4D 220,000.00 100,000.00
WINDY OKSYLAFIYAH 4D 220,000.00 100,000.00
AZIZA YULQAEDAH 4D 220,000.00 100,000.00
FITRI AMALIA 4D 220,000.00 100,000.00
ERMI TV 220,000.00 100,000.00
SULFI NILASARI 2D 175,000.00 80,000.00
VINKA 2D 175,000.00 80,000.00
1,450,000.00 660,000.00
8 12-Jun-22 RACHEL MARLYN ASSA TV 220,000.00 100,000.00
SORE RIMA GUSTIANI 2D 175,000.00 80,000.00
SINDI GUSTIANI 4D 220,000.00 100,000.00
WINDY 2D 175,000.00 80,000.00
MELAN TV 220,000.00 100,000.00
NUR SYIFA FAUZIAH 2D 175,000.00 80,000.00
1,185,000.00 540,000.00
9 13-Jun-22 ERNI HERAWATI 4D 220,000.00 100,000.00
PAGI ERIKA DESI SETYANI 2D 175,000.00 80,000.00
395,000.00 180,000.00
SORE EVI YULIANTI 4D 220,000.00 100,000.00
FEBRIANA SARI TV 220,000.00 100,000.00
INSAN RACHMI KUSUMAL 4D 220,000.00 100,000.00
660,000.00 300,000.00
10 15-Jun-22 NISPA 4D 220,000.00 100,000.00
SORE ROKAYA TV 220,000.00 100,000.00
DWI KURNIA SARI 2D 175,000.00 80,000.00
615,000.00 280,000.00
11 18-Jun-22 MAEFA NANDA 4D 220,000.00 100,000.00
SORE RIVANI RAHMADANI 4D 220,000.00 100,000.00
MAULIDA NUR ALIFAH TV 220,000.00 100,000.00
MARLINA 2D 175,000.00 80,000.00
NABILA AISYAH 4D 220,000.00 100,000.00
NUR ISLAMIAH 4D 220,000.00 100,000.00
1,275,000.00 580,000.00
12 19-Jun-22 YASINTA LARASSATY TV 220,000.00 100,000.00
PAGI AZIZAH WIDIASMARA 4D 220,000.00 100,000.00
LITANIA DWI DESVIANY 2D 175,000.00 80,000.00
DEWI SUKMAWATI 2D 175,000.00 80,000.00
NUR ANISAH SAFITRI 2D 175,000.00 80,000.00
KRISTIANINGSIH 4D 220,000.00 100,000.00
1,185,000.00 540,000.00
13 21-Jun-22 MUTIARA SAKINAH 4D 220,000.00 100,000.00
SORE DEWI SETIANINGSIH 4D 220,000.00 100,000.00
DIAN 4D 220,000.00 100,000.00
YULI 4D 220,000.00 100,000.00
ISNAINI YULIANA TV 220,000.00 100,000.00
NIAR TAMALA 2D 175,000.00 80,000.00
1,275,000.00 580,000.00
14 23-Jun-22 SURYATI 2D 175,000.00 80,000.00
PAGI
175,000.00 80,000.00
SORE LATIFA 4D 220,000.00 100,000.00
AINUN NURUL ROHMAH 4D 220,000.00 100,000.00
NOVITASARI TIRTAJAYA 4D 220,000.00 100,000.00
660,000.00 300,000.00
15 25-Jun-22 DESI RIMANDA SARI 2D 175,000.00 80,000.00
PAGI ERLIANA GITA 2D 175,000.00 80,000.00
ARIENI JULIANDA 4D 220,000.00 100,000.00
570,000.00 260,000.00
SORE APRILIA WULANDARI 4D 220,000.00 100,000.00
FEBRIANI 2D 175,000.00 80,000.00
YENIANA 4D 220,000.00 100,000.00
NOVITA KOMALA DEWI 4D 220,000.00 100,000.00
835,000.00 380,000.00
16 26-Jun-22 FALMUGI 4D 220,000.00 100,000.00
PAGI LIS SAKDIYAH 4D 220,000.00 100,000.00
NUR'AVIA DAYANA YULM 2D 175,000.00 80,000.00
HUSNI ATIKA 4D 220,000.00 100,000.00
NADYA KARIMAH 4D 220,000.00 100,000.00
MUTIA KHANZAH 2D 175,000.00 80,000.00
1,230,000.00 560,000.00
17 27-Jun-22 MAYANG ANJAR RIZKY TV 220,000.00 100,000.00
PAGI FARHAH FAUZIYYAH TV 220,000.00 100,000.00
440,000.00 200,000.00
18 28-Jun-22 DWI SAFITRI APRIYANTI 2D 175,000.00 80,000.00
SORE SILAH CHOIRIA KHOLID 4D 220,000.00 100,000.00
MULIA NURHAWANI 4D 220,000.00 100,000.00
615,000.00 280,000.00
19 29-Jun-22 SITI DAHLIA 4D 220,000.00 100,000.00
SORE WAHIDA MUMTAZA 4D 220,000.00 100,000.00
NOPIZA 4D 220,000.00 100,000.00
INTARI 4D 220,000.00 100,000.00
SRI MARYATI 4D 220,000.00 100,000.00
DHEA ANANDA 4D 220,000.00 100,000.00
DESI RAHMAWATI 4D 220,000.00 100,000.00
1,540,000.00 700,000.00
20 30-Jun-22 NURMALA SARI 4D 220,000.00 100,000.00
PAGI ANI MUSNGINAH 2D 175,000.00 80,000.00
LIA ANDINI 4D 220,000.00 100,000.00
615,000.00 280,000.00
SORE 4D 220,000.00 100,000.00
4D 220,000.00 100,000.00
440,000.00 200,000.00
TOTAL BULAN JUNI 2022 22,765,000.00 10,360,000.00
NO
TGL & JAM PRAKTEK NAMA PASIEN JENIS USG TARIF USG FEE DOKTER
1 2-Jun-22 RESTU YAFI'AH 4D 220,000.00 100,000.00
2 5-Jun-22 SITI FATIMAH 4D 220,000.00 100,000.00
TOTAL BULAN JUNI 2022 440,000.00 200,000.00
HALOBUMIL BPH KF DOKTER
50,000.00 20,000.00 50,000.00
dr. Putut
50,000.00 20,000.00 50,000.00
100,000.00 40,000.00 100,000.00
36,250.00 20,000.00 38,750.00
36,250.00 20,000.00 38,750.00
50,000.00 20,000.00 50,000.00 dr. Nurul
36,250.00 20,000.00 38,750.00
36,250.00 20,000.00 38,750.00
195,000.00 100,000.00 205,000.00
50,000.00 20,000.00 50,000.00
50,000.00 20,000.00 50,000.00
50,000.00 20,000.00 50,000.00
50,000.00 20,000.00 50,000.00
dr. Hani
50,000.00 20,000.00 50,000.00
50,000.00 20,000.00 50,000.00
50,000.00 20,000.00 50,000.00
36,250.00 20,000.00 38,750.00
386,250.00 160,000.00 388,750.00
50,000.00 20,000.00 50,000.00
50,000.00 20,000.00 50,000.00
50,000.00 20,000.00 50,000.00
dr. Satrya
50,000.00 20,000.00 50,000.00
50,000.00 20,000.00 50,000.00
50,000.00 20,000.00 50,000.00
300,000.00 120,000.00 300,000.00
50,000.00 20,000.00 50,000.00
50,000.00 20,000.00 50,000.00 dr. Harry
50,000.00 20,000.00 50,000.00
150,000.00 60,000.00 150,000.00
50,000.00 20,000.00 50,000.00
dr. Andrew
JUMLAH
KUNJUNGAN PERHITUNGAN
46 12,400,000
TOTAL 12,400,000
KASARI