USULAN TINDAKAN PASIEN UMUM

ADMIN USULAN
NO NAMA TINDAKAN BHP & UC DPJP POLI JML TARIF
1 PEMERIKSAAN DOKTER SPESIALIS 100,000 30,000 100,000 130,000

2 USG GUIDANCE 35,000 15,000 50,000 65,000

3 INJEKSI INTRA ARTICULAR TRILAC 142,354 75,000 217,354 300,000
3 INJEKSI INTRA ARTICULAR OSLEX 301,854 75,000 376,854 500,000
4 PERIDURAL 643,000 1,000,000 1,643,000 2,000,000
5 AKUPUNTUR 21,000 50,000 71,000 100,000

`
no nama bhp VOL HARGA B JML
TRILAC 1 110,000 110,000 OSLEX
LIDOCAIN INJ 1 1,650 1,650
ALKOHOL 1 5,000 5,000
BETADIN 1 5,000 5,000
KASA STERIL 1 7,000 7,000
UNDERPAD 1 3,630 3,630
SPUIT 10CC 2 1,287 2,574
NEDDLE NO 25 2 1,500 3,000
HANDSCOUND NO 7,5 1 4,500 4,500

142,354

no nama bhp VOL HARGA B JML

TRILAC 1 269,500 269,500
LIDOCAIN INJ 1 1,650 1,650
ALKOHOL 1 5,000 5,000
BETADIN 1 5,000 5,000
KASA STERIL 1 7,000 7,000
UNDERPAD 1 3,630 3,630
SPUIT 10CC 2 1,287 2,574
NEDDLE NO 25 2 1,500 3,000
HANDSCOUND NO 7,5 1 4,500 4,500

301,854
269,500.00
no nama bhp vol harga jumlah
cvc 1 550,000 550,000
Kasa steril 1 7,000 7,000
Underpad 1 6,000 6,000
Handscoen steril 1 5,000 5,000
INJEKSI (LIDODEX/ BUPIVA) 1 75,000 75,000.00

643,000
no nama bhp vol Harga jumlah

jarum 15 400 6,000 100

kapas alkohol 10 500 5,000
alat 1 10000 10,000

21,000
30000 300
KLAIM BPJS UMUM ERAC NON BPJS 4,975,000 995,000
3 4,975,000
2 5,970,000
1 6,965,000

PEMAKAIAN OBAT OBATAN ANTI MUAL

OBAT DI FARMASI 956,000 956,000
OBAT DI OK 998,000 998,000 1,954,000

JASA PELAYANAN
DPJP DAN TIM 3,717,500 1,990,000 ANTI NYERI
370,000

JRS
OK 1,700,000 787,000
PERWATAN 502,500

PENUNJANG
LAB 244,000 244,000

8,488,000 4,975,000
 5,970,000

METO 1
ONDAN/GRANISENTRON 1
DEXAMETHASON 1
HALOPERIDON 1

PARACET TAB 18
KETO INJ 3
ASMEF 10
MORPHIN INJ 0,1 MG
BUPIVACAIN / LEVICA 1