RSIA PURI BUNDA

Jl. Simpang Sulfat Utara No. 60 A, Malang, Jawa Timur

(0341) 480047
E-mail : puribunda.malang@yahoo.com

Detail Pemeriksaan Radiologi

No. No.Rawat No.R.M. Nama Pasien Status Kd.Prk Pemeriksaan Kode Dokter Dokter P.J. Rad NIP Petugas Radiologi Kd Perujuk Dokter Perujuk Tanggal Jam Cara Bayar Ruangan Jasa Sarana Paket BHP JM PJ Rad JM Petugas JM Perujuk KSO Menejemen Total
1 2022/06/29/000138 057261 ALYA SUKMA LAKSITA, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 9070009 dr. MOHAMMAD MUCHLIS, 01/07/2022 14:04:45 BPJS KS IGD 10 53,000 40,000 42,000 5,000 0 0 0 140,000
2 2022/07/01/000191 071781 M ABRIZAM REYNAND, AN Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 01/07/2022 18:39:16 UMUM ICU 3 50,900 40,000 41,100 5,000 0 0 0 137,000
3 2022/07/01/000165 067278 MUHAMMAD ASAD Ralan BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 01/07/2022 14:05:52 BPJS Poli Radiologi 113,500 39,500 42,000 5,000 0 0 0 200,000
4 2022/07/01/000163 003943 Margaretha, Ny Ralan UMUM. USG 4D Gemely 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 01/07/2022 16:16:39 UMUM Poli Radiologi 253,103 35,897 126,000 5,000 0 0 0 420,000
5 2022/07/01/000152 071765 AFRINA MAULIA, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 01/07/2022 14:03:27 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
6 2022/07/01/000149 016824 Arka Naufal Rajendra, An Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 01/07/2022 14:03:43 UMUM KS IGD 5 55,100 40,000 42,900 5,000 0 0 0 143,000
7 2022/07/01/000110 071755 ZAINAB, BY NY Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 01/07/2022 16:47:31 BPJS KS Fisol 23 53,000 40,000 42,000 5,000 0 0 0 140,000
8 2022/07/01/000085 071749 MELVIANO ARSYA GHAISAN W, Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 9070009 dr. MOHAMMAD MUCHLIS, 01/07/2022 16:47:46 BPJS KS Fisol 21 53,000 40,000 42,000 5,000 0 0 0 140,000
9 2022/07/01/000075 071472 NUR AIDA FAUZIAH, NY Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 01/07/2022 16:16:49 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
10 2022/06/29/000226 071684 TASIRAH, NY Ranap BPJS. USG Abdomen 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 4160205 dr. WAHYUDI JOKO SUSILO, 01/07/2022 15:52:15 BPJS KS Kamar Bersalin 103,143 23,857 88,000 5,000 0 0 0 220,000
11 2022/06/29/000226 071684 TASIRAH, NY Ranap BPJS. X-Ray BNO 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 4160205 dr. WAHYUDI JOKO SUSILO, 01/07/2022 15:52:50 BPJS KS Kamar Bersalin 53,000 40,000 42,000 5,000 0 0 0 140,000
12 2022/07/01/000043 033102 FAJRI NUGRAHENI SUNU, NY Ralan UMUM. USG Mamae 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 01/07/2022 15:06:48 UMUM Poli Radiologi 199,274 60,726 120,000 5,000 0 0 0 385,000
13 2022/07/01/000072 071746 DINA PRADIANA, BY NY Ranap BPJS. USG Abdomen 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 01/07/2022 17:04:46 BPJS KS NICU 9 103,143 23,857 88,000 5,000 0 0 0 220,000
14 2022/07/01/000072 071746 DINA PRADIANA, BY NY Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 01/07/2022 17:04:05 BPJS KS NICU 9 53,000 40,000 42,000 5,000 0 0 0 140,000
15 2022/07/02/000076 071802 JULIA DWI ANGGRAINI, AN Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 02/07/2022 15:58:25 BPJS NICU 2 53,000 40,000 42,000 5,000 0 0 0 140,000
16 2022/07/02/000168 071835 MAHESA ABIMANYU Ralan UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 02/07/2022 18:18:02 UMUM Poli Anak 113,500 39,500 42,000 5,000 0 0 0 200,000
17 2022/07/03/000138 104751 M. AFIF SARFARAZ AKHDAN, Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 03/07/2022 21:04:47 BPJS Dwarawati 53,000 40,000 42,000 5,000 0 0 0 140,000
18 2022/07/03/000132 078489 Kesya Syfa Abidah, An. Ralan UMUM. X-Ray ART CUBITI AP+LAT 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 03/07/2022 18:17:52 UMUM Poli Radiologi 145,800 39,500 67,200 7,500 0 0 0 260,000
19 2022/07/03/000063 011281 MUHAMMAD ARSYAD Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 03/07/2022 16:47:12 BPJS Pandawa 7 53,000 40,000 42,000 5,000 0 0 0 140,000
20 2022/07/03/000062 071870 FILZA ALIYA HILYA, AN Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 03/07/2022 16:46:56 UMUM KS IGD 1 50,900 40,000 41,100 5,000 0 0 0 137,000
21 2022/07/03/000058 056388 ALSHAMIRA KHAILEENA Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 03/07/2022 19:34:09 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
22 2022/07/03/000008 071396 AFIZA HAURA ALFARIZQIA Ralan UMUM. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 03/07/2022 21:06:19 UMUM Poli Anak 113,500 39,500 42,000 5,000 0 0 0 200,000
23 2022/07/01/000072 071746 DINA PRADIANA, BY NY Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 03/07/2022 16:46:13 BPJS KS NICU 9 53,000 40,000 42,000 5,000 0 0 0 140,000
24 2022/07/04/000199 071930 NOVITA SARI ASNUGRAHA, NY Ralan UMUM. USG Mamae 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 04/07/2022 16:42:51 UMUM Poli Radiologi 199,274 60,726 120,000 5,000 0 0 0 385,000
25 2022/07/04/000091 097521 EARLYTA FAYYOLA PUTRI Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 04/07/2022 17:25:44 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
26 2022/07/04/000085 071891 RISKA INDRAWATI, NY Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 04/07/2022 16:29:17 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
27 2022/07/04/000080 092732 Widya Kusuma Wardhani, Ny. Ralan UMUM. USG Mamae 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 04/07/2022 15:37:36 UMUM Poli Radiologi 199,274 60,726 120,000 5,000 0 0 0 385,000
28 2022/07/04/000072 064753 SUCI DWI ANDRIANA, NY Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 04/07/2022 16:19:52 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
29 2022/07/03/000146 060721 MUHAMMAD ZAYN HAZMI, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 05/07/2022 15:05:12 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
30 2022/07/04/000225 060107 MUHAMMAD ZIDAN ALFARISKY, Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 05/07/2022 17:41:58 BPJS Amarta 7A 53,000 40,000 42,000 5,000 0 0 0 140,000
31 2022/07/04/000228 071942 MUHAMMAD ABIZARD REYNDIA Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 05/07/2022 13:23:05 UMUM Pandawa 1 50,900 40,000 41,100 5,000 0 0 0 137,000
32 2022/07/04/000231 060657 HAN OMAR DEMIRAL, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 05/07/2022 13:23:30 BPJS Pandawa 3 53,000 40,000 42,000 5,000 0 0 0 140,000
33 2022/07/05/000147 071973 EKA IRVATUL L., BY NY Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 05/07/2022 13:24:56 BPJS KS NICU 10 53,000 40,000 42,000 5,000 0 0 0 140,000
34 2022/07/05/000211 071856 AYESHA PUTRI JULIAVIRA, AN Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 05/07/2022 20:38:33 BPJS ICU 1 53,000 40,000 42,000 5,000 0 0 0 140,000
35 2022/07/06/000176 082713 Nuzul Putri Diwanti, NY Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 06/07/2022 16:45:56 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
36 2022/07/06/000058 071980 SUPADI, TN Ralan UMUM. USG Abdomen 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 06/07/2022 17:05:40 UMUM Poli Radiologi 199,274 60,726 110,000 5,000 0 0 0 375,000
37 2022/07/06/000001 034896 R. AJ. Siti Fatimah Daniar Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 06/07/2022 16:18:52 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
38 2022/07/06/000180 072027 OKTAVIA ARNO, BY.NY. Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 9070009 dr. MOHAMMAD MUCHLIS, 07/07/2022 07:23:18 BPJS KS Fisol 27 53,000 40,000 42,000 5,000 0 0 0 140,000
39 2022/07/06/000224 072055 DINA ROSITA, NY Ralan UMUM. X-Ray CITO Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 09210381 dr. KIKI RIZKI RACHMAT 07/07/2022 07:22:02 UMUM IGD 82,400 40,000 54,600 5,000 0 0 0 182,000
40 2022/07/07/000047 012020 NAURA AQUINA Ralan BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 07/07/2022 15:00:58 BPJS Poli Anak 113,500 39,500 42,000 5,000 0 0 0 200,000
41 2022/07/08/000146 021550 DJOHAN OMMAR BITJISHAR, Ralan UMUM. X-Ray CLAVICULA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 09210381 dr. KIKI RIZKI RACHMAT 08/07/2022 20:27:13 UMUM IGD 113,500 39,500 42,000 5,000 0 0 0 200,000
42 2022/07/08/000100 104768 Anita Wijayanti, Ny Ralan ASKES. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 08/07/2022 17:16:52 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
43 2022/07/08/000099 064568 NIHAYAH AL HUSNA,AN Ralan BPJS. USG Abdomen 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 08/07/2022 16:11:54 BPJS Poli Radiologi 169,274 60,726 110,000 5,000 0 0 0 345,000
44 2022/07/08/000083 063826 ELLY MAULIDYAH ARIFIN, NY Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 08/07/2022 16:11:05 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000

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No. No.Rawat No.R.M. Nama Pasien Status Kd.Prk Pemeriksaan Kode Dokter Dokter P.J. Rad NIP Petugas Radiologi Kd Perujuk Dokter Perujuk Tanggal Jam Cara Bayar Ruangan Jasa Sarana Paket BHP JM PJ Rad JM Petugas JM Perujuk KSO Menejemen Total
45 2022/07/09/000105 044060 AQILA NURAINI IZMI, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 09/07/2022 13:53:17 BPJS KS IGD 7 53,000 40,000 42,000 5,000 0 0 0 140,000
46 2022/07/09/000100 033171 M. ARFA DHIYAULHAQ Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 1160202 dr. DEWI NURINDAH, Sp.A, 09/07/2022 13:10:16 BPJS KS IGD 5 53,000 40,000 42,000 5,000 0 0 0 140,000
47 2022/07/09/000092 072128 ARIFAH, NY Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 4150215 dr. DEWI INDIASTARI, 09/07/2022 13:55:53 BPJS KS IGD 2 53,000 40,000 42,000 5,000 0 0 0 140,000
48 2022/07/08/000154 068284 RAFADHAN ZHAFFARIZQI Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 09/07/2022 18:23:45 BPJS Dwarawati 53,000 40,000 42,000 5,000 0 0 0 140,000
49 2022/07/11/000218 072212 NAMIRA MEDINA PUTRI Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 11/07/2022 19:43:17 BPJS NICU 7 53,000 40,000 42,000 5,000 0 0 0 140,000
50 2022/07/11/000213 067976 AZIZAH HASNA NAJWA Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 11/07/2022 16:04:50 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
51 2022/07/11/000189 072201 PUTRI HAFLANI AL ANSORI, AN Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 11/07/2022 16:05:24 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
52 2022/07/11/000121 072175 BANYU SAGARA BIRU, AN Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 11/07/2022 02:25:35 BPJS KS NICU 14 53,000 40,000 42,000 5,000 0 0 0 140,000
53 2022/07/11/000112 101021 Auliya Aida Rahmi, , Ny Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 11/07/2022 16:21:48 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
54 2022/07/10/000046 030663 SYAUQI ALMAN, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 11/07/2022 22:33:45 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
55 2022/07/12/000284 049495 KENT ELENIO ARIOSHA Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 12/07/2022 20:50:37 BPJS Pandawa 7 53,000 40,000 42,000 5,000 0 0 0 140,000
56 2022/07/12/000282 072254 ARSHAKA KEVIN NUGRAHA, AN Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 1160202 dr. DEWI NURINDAH, Sp.A, 12/07/2022 17:46:13 UMUM KS IGD 10 55,100 40,000 42,900 5,000 0 0 0 143,000
57 2022/07/12/000129 045307 JAYANTI WIDI PROBORINI, Ny Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 4150215 dr. DEWI INDIASTARI, 12/07/2022 18:36:43 BPJS KS IGD 2 53,000 40,000 42,000 5,000 0 0 0 140,000
58 2022/07/12/000125 057639 KIRANA ISWARA DANTI, NN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 4150215 dr. DEWI INDIASTARI, 12/07/2022 16:07:27 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
59 2022/07/12/000121 068684 SYAUQI ATHAILLAH Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 1160202 dr. DEWI NURINDAH, Sp.A, 12/07/2022 13:23:51 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
60 2022/07/12/000103 062292 CHAIRA ARINA GULFAM, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 9070009 dr. MOHAMMAD MUCHLIS, 12/07/2022 13:23:24 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
61 2022/07/13/000177 072291 NONNY YOGHA PUSPITA, NY Ralan UMUM. USG Abdomen 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 13/07/2022 15:35:10 UMUM Poli Radiologi 199,274 60,726 110,000 5,000 0 0 0 375,000
62 2022/07/13/000173 072286 REMBATEN, NY Ralan UMUM. USG Abdomen 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 13/07/2022 17:07:40 UMUM Poli Radiologi 199,274 60,726 110,000 5,000 0 0 0 375,000
63 2022/07/13/000145 072248 WAHYUNING PRIMADINI,NY Ralan UMUM. USG Abdomen 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 13/07/2022 16:10:02 UMUM Poli Radiologi 199,274 60,726 110,000 5,000 0 0 0 375,000
64 2022/07/13/000072 027766 AYATIL MAISAROH, Ny Ralan BPJS. X-Ray BOF 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 13/07/2022 16:17:02 BPJS Poli Radiologi 113,500 39,500 42,000 5,000 0 0 0 200,000
65 2022/07/13/000055 064037 KATHARINA SINTHYA Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 13/07/2022 16:46:18 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
66 2022/07/12/000318 072260 MUHAMMAD ELFATHAN AL Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 13/07/2022 16:10:39 BPJS Pandawa 2 53,000 40,000 42,000 5,000 0 0 0 140,000
67 2022/07/12/000316 016863 ISABELLA YUANISA ANWAR, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 13/07/2022 16:10:55 BPJS Amarta 4A 53,000 40,000 42,000 5,000 0 0 0 140,000
68 2022/07/14/000050 043216 AISYAH AYUDIA INARA,AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 14/07/2022 15:26:09 BPJS KS IGD 8 53,000 40,000 42,000 5,000 0 0 0 140,000
69 2022/07/14/000099 029889 RAMADHAN DZAKY SYAFARY, Ralan UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 09210381 dr. KIKI RIZKI RACHMAT 14/07/2022 15:48:35 UMUM IGD 113,500 39,500 42,000 5,000 0 0 0 200,000
70 2022/07/14/000136 093859 Alifa Naufalyn Fikria Rabbani, An Ralan BPJS. X-Ray GENU AP/LAT 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 14/07/2022 18:12:58 BPJS Poli Anak 113,500 39,500 42,000 5,000 0 0 0 200,000
71 2022/07/15/000103 013436 AZZAHRA MECCAYLA SABIYA, Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 9070009 dr. MOHAMMAD MUCHLIS, 15/07/2022 18:32:03 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
72 2022/07/15/000069 003119 AMANDA NILAM SARI, AN Ralan BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 15/07/2022 16:29:15 BPJS Poli Anak 113,500 39,500 42,000 5,000 0 0 0 200,000
73 2022/07/15/000038 064621 ROUF KHUSNUL FIRDAUS, NY Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 15/07/2022 15:21:34 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
74 2022/07/13/000204 052768 AZQIARA CLAUZIA HAFLAIKA, Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 15/07/2022 15:23:01 BPJS Dwarawati 53,000 40,000 42,000 5,000 0 0 0 140,000
75 2022/07/16/000166 069275 MUHAMMAD ARKANANTA H., Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 9070009 dr. MOHAMMAD MUCHLIS, 16/07/2022 20:52:58 BPJS KS IGD 5 53,000 40,000 42,000 5,000 0 0 0 140,000
76 2022/07/16/000138 068115 KIRANIA SHAKILLA JENAKA, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 16/07/2022 15:44:11 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
77 2022/07/16/000122 072410 AL FATIH ABBAS Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 16/07/2022 15:32:57 UMUM KS IGD 1 55,100 40,000 42,900 5,000 0 0 0 143,000
78 2022/07/16/000076 057838 KENZO AZKA PUTRA AFFANDI, Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 17/07/2022 13:06:55 BPJS KS IGD 10 53,000 40,000 42,000 5,000 0 0 0 140,000
79 2022/07/17/000073 047484 TUSIANTI, NY Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 4160205 dr. WAHYUDI JOKO SUSILO, 17/07/2022 18:24:37 BPJS KS Amarta 3 53,000 40,000 42,000 5,000 0 0 0 140,000
80 2022/07/17/000055 085679 ALVIRA PUTRI ARILIA, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 1160202 dr. DEWI NURINDAH, Sp.A, 17/07/2022 13:05:47 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
81 2022/07/15/000130 072377 ACHMAD NAUFAL ALFAHRI, AN Ranap UMUM. X-Ray Thorax AP+LAT 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 1160202 dr. DEWI NURINDAH, Sp.A, 17/07/2022 13:08:27 UMUM KS IGD 2 122,300 40,000 71,700 5,000 0 0 0 239,000
82 2022/07/16/000142 027513 ARABELLA KHANSA PERMATA Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 17/07/2022 13:08:07 BPJS KS IGD 6 53,000 40,000 42,000 5,000 0 0 0 140,000
83 2022/07/17/000056 072437 SHEZA AULIA SALSABILA, AN Ranap UMUM. X-Ray Thorax AP+LAT 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 18/07/2022 17:54:48 UMUM KS IGD 2 115,300 40,000 68,700 5,000 0 0 0 229,000
84 2022/07/17/000098 051817 MIKAILA RAMADHANI, AN Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 18/07/2022 17:54:30 UMUM KS IGD 6 50,900 40,000 41,100 5,000 0 0 0 137,000
85 2022/07/18/000231 072489 M. FADHIL AL- FAJRI, AN Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 18/07/2022 19:09:50 UMUM Dwarawati 50,900 40,000 41,100 5,000 0 0 0 137,000
86 2022/07/19/000155 055273 ARKANA SADDAM HAMIZAN, Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 19/07/2022 15:59:28 BPJS KS IGD 7 53,000 40,000 42,000 5,000 0 0 0 140,000
87 2022/07/18/000257 072514 GANDA OKTAVARO, AN Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 19/07/2022 16:00:07 UMUM Amarta 1B 50,900 40,000 41,100 5,000 0 0 0 137,000
88 2022/07/18/000250 086890 LAILATUL MAHFIROH, NY Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 4150215 dr. DEWI INDIASTARI, 19/07/2022 16:00:30 UMUM Amarta 8B 50,900 40,000 41,100 5,000 0 0 0 137,000
89 2022/07/18/000244 056453 CHALIYATUL KARIMAH, AN Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 19/07/2022 15:51:58 UMUM KS IGD 6 60,000 40,000 45,000 5,000 0 0 0 150,000
90 2022/07/20/000180 072594 BELLVANIA APRILIA EFENDI, Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 20/07/2022 16:52:36 BPJS ICU 3 53,000 40,000 42,000 5,000 0 0 0 140,000
91 2022/07/20/000163 061596 SACHIO RYUGA AFRINDO, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 20/07/2022 16:50:41 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
92 2022/07/20/000142 069778 CAESAR EL ABRIZAL, AN Ralan BPJS. USG Testis 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 20/07/2022 15:51:04 BPJS Poli Anak 169,274 60,726 120,000 5,000 0 0 0 355,000
93 2022/07/20/000126 066552 CITRA AYU DIYAH PITALOKA, Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 20/07/2022 16:10:56 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
94 2022/07/20/000210 051462 Estika Mei Diana, Ny Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 20/07/2022 16:35:16 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000

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No. No.Rawat No.R.M. Nama Pasien Status Kd.Prk Pemeriksaan Kode Dokter Dokter P.J. Rad NIP Petugas Radiologi Kd Perujuk Dokter Perujuk Tanggal Jam Cara Bayar Ruangan Jasa Sarana Paket BHP JM PJ Rad JM Petugas JM Perujuk KSO Menejemen Total
95 2022/07/19/000190 099609 HERA NUR DUNIARTI, NY Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 4150215 dr. DEWI INDIASTARI, 20/07/2022 15:31:21 BPJS Hastina 5 53,000 40,000 42,000 5,000 0 0 0 140,000
96 2022/07/20/000214 017774 GIBRAN AZRIL, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 20/07/2022 22:56:46 BPJS Dwarawati 53,000 40,000 42,000 5,000 0 0 0 140,000
97 2022/07/17/000073 047484 TUSIANTI, NY Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 4160205 dr. WAHYUDI JOKO SUSILO, 20/07/2022 19:10:35 BPJS KS Amarta 3 53,000 40,000 42,000 5,000 0 0 0 140,000
98 2022/07/19/000074 072526 MARINDA MARE., BY NY Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 9070009 dr. MOHAMMAD MUCHLIS, 20/07/2022 21:26:36 BPJS KS Fisol 4 53,000 40,000 42,000 5,000 0 0 0 140,000
99 2022/07/20/000215 072609 MELLISA ARYUNANI, Ny Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 20/07/2022 16:35:05 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
100 2022/07/20/000205 072606 AYUSHITA KHIRANIA PUTRI, AN Ranap UMUM. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 09210381 dr. KIKI RIZKI RACHMAT 20/07/2022 21:22:46 UMUM IGD 113,500 39,500 42,000 5,000 0 0 0 200,000
101 2022/07/20/000205 072606 AYUSHITA KHIRANIA PUTRI, AN Ranap UMUM. X-Ray CITO BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 21/07/2022 00:50:55 UMUM KS IGD 10 79,600 40,000 53,400 5,000 0 0 0 178,000
102 2022/07/20/000114 050012 ABHINARA FAWWAZ Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 21/07/2022 17:55:02 BPJS Hastina 4 53,000 40,000 42,000 5,000 0 0 0 140,000
103 2022/07/19/000065 072522 SHERLY ALMAYRA PUTRI, An Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 21/07/2022 17:55:35 BPJS KS Fisol 31 53,000 40,000 42,000 5,000 0 0 0 140,000
104 2022/07/22/000125 072690 MELIA HERLINA, NY Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 22/07/2022 16:57:34 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
105 2022/07/22/000157 072696 RATIH MUSTIKANINGRUM, NY Ralan UMUM. USG Abdomen 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 22/07/2022 16:39:15 UMUM Poli Radiologi 199,274 60,726 110,000 5,000 0 0 0 375,000
106 2022/07/22/000037 072357 GEFANDA AFRISSA SYAFAZEA, Ralan BPJS. USG Kepala Bayi 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 22/07/2022 16:12:37 BPJS Poli Radiologi 169,274 60,726 110,000 5,000 0 0 0 345,000
107 2022/07/22/000004 072160 ARKANA ZAYYAN HABIBI, AN Ralan BPJS. USG Testis 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 22/07/2022 16:24:35 BPJS Poli Anak 169,274 60,726 120,000 5,000 0 0 0 355,000
108 2022/07/21/000160 072676 WENNY EKO, By Ny Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 9070009 dr. MOHAMMAD MUCHLIS, 22/07/2022 15:57:14 BPJS KS NICU 14 53,000 40,000 42,000 5,000 0 0 0 140,000
109 2022/07/20/000211 021527 ARSYANENDRA NATASENNA Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 22/07/2022 15:55:49 BPJS Pandawa 1 53,000 40,000 42,000 5,000 0 0 0 140,000
110 2022/07/19/000190 099609 HERA NUR DUNIARTI, NY Ranap BPJS. USG Abdomen 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 4150215 dr. DEWI INDIASTARI, 22/07/2022 15:57:58 BPJS Hastina 5 103,143 23,857 88,000 5,000 0 0 0 220,000
111 2022/07/24/000052 072759 AYLA FAUZIA AZZAHRA, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 7110046 YENI ELITA DWI 9070009 dr. MOHAMMAD MUCHLIS, 23/07/2022 15:12:59 UMUM KS IGD 1 113,500 39,500 42,000 5,000 0 0 0 200,000
112 2022/07/23/000141 042119 NADHIRA SAKHI ALMAHYRA, Ralan UMUM. X-Ray Thorax AP+LAT 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 23/07/2022 17:29:46 UMUM Poli Anak 145,800 39,500 67,200 7,500 0 0 0 260,000
113 2022/07/23/000139 072724 RULLY AITANA, BY NY Ranap BPJS. X-Ray BABY GRAM 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 23/07/2022 17:30:00 BPJS NICU 2 53,000 40,000 42,000 5,000 0 0 0 140,000
114 2022/07/24/000052 072759 AYLA FAUZIA AZZAHRA, AN Ranap BPJS. X-Ray CITO Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 9070009 dr. MOHAMMAD MUCHLIS, 24/07/2022 15:41:22 UMUM KS IGD 1 82,400 40,000 54,600 5,000 0 0 0 182,000
115 2022/07/25/000165 070885 REIGA MALIK AL FATHAN, AN Ralan UMUM. USG Testis 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 25/07/2022 16:48:23 UMUM Poli Radiologi 199,274 60,726 120,000 5,000 0 0 0 385,000
116 2022/07/25/000188 072804 SAHWIYAH, NY Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 25/07/2022 17:34:54 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
117 2022/07/25/000187 066166 FEBILIA YANUANTI Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 25/07/2022 16:25:46 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
118 2022/07/25/000178 075980 MUHAMMAD RAEYHAN HAIKAL Ralan UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 09210381 dr. KIKI RIZKI RACHMAT 25/07/2022 16:21:51 UMUM IGD 113,500 39,500 42,000 5,000 0 0 0 200,000
119 2022/07/25/000078 072784 SUKARMI, NY Ralan UMUM. X-Ray Thorax AP+LAT 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 09210381 dr. KIKI RIZKI RACHMAT 25/07/2022 18:06:00 UMUM IGD 145,800 39,500 67,200 7,500 0 0 0 260,000
120 2022/07/24/000083 073218 CHANIFAH, NY Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 09210381 dr. KIKI RIZKI RACHMAT 25/07/2022 06:34:22 BPJS IGD 113,500 39,500 42,000 5,000 0 0 0 200,000
121 2022/07/23/000096 030915 ALMAN HARUN ABDULLAH, AN Ranap BPJS. X-Ray GENU AP/LAT 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 25/07/2022 16:37:40 BPJS KS IGD 2 53,000 40,000 42,000 5,000 0 0 0 140,000
122 2022/07/23/000096 030915 ALMAN HARUN ABDULLAH, AN Ranap BPJS. X-Ray CRURIS AP/LAT 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 25/07/2022 18:11:24 BPJS KS IGD 2 53,000 40,000 42,000 5,000 0 0 0 140,000
123 2022/07/23/000096 030915 ALMAN HARUN ABDULLAH, AN Ranap BPJS. X-Ray CITO Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 26/07/2022 20:48:34 BPJS KS IGD 2 65,900 39,500 54,600 40,000 0 0 0 200,000
124 2022/07/26/000116 064450 Dikky Fanala, Ny Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150220 dr. IMELDA, Sp.OG. 26/07/2022 13:41:58 UMUM KS IGD 1 55,100 40,000 42,900 5,000 0 0 0 143,000
125 2022/07/26/000153 028926 ARSYILA FALISHA ALULA, AN Ralan UMUM. X-Ray BOF 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 26/07/2022 18:07:43 UMUM Poli Anak 113,500 39,500 42,000 5,000 0 0 0 200,000
126 2022/07/27/000168 072867 SOEKASIH, NY Ralan UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 09210381 dr. KIKI RIZKI RACHMAT 27/07/2022 15:16:37 BPJS IGD 113,500 39,500 42,000 5,000 0 0 0 200,000
127 2022/07/27/000173 002674 ACHMAD FAIZ AL ARKHAN, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 27/07/2022 17:44:51 BPJS Amarta 2 53,000 40,000 42,000 5,000 0 0 0 140,000
128 2022/07/27/000157 063280 SITI SUYATI, NY Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 09210381 dr. KIKI RIZKI RACHMAT 27/07/2022 15:16:15 BPJS IGD 113,500 39,500 42,000 5,000 0 0 0 200,000
129 2022/07/27/000154 072862 HAMDAN SIDKIL AMAL,AN Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 27/07/2022 20:36:48 UMUM ICU 1 55,100 40,000 42,900 5,000 0 0 0 143,000
130 2022/07/27/000074 052874 KLOTILDA ALICIAMAI PANDU, Ralan BPJS. USG Thyroid 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 27/07/2022 15:24:56 BPJS Poli Radiologi 159,274 60,726 120,000 5,000 0 0 0 345,000
131 2022/07/27/000023 067124 SUSAN KESUMA SARI, NY Ralan UMUM. USG 4D 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 27/07/2022 15:44:13 UMUM Poli Radiologi 156,889 73,111 150,000 5,000 0 0 0 385,000
132 2022/07/28/000187 043333 CAITA VIDYA SARASWATI, An. Ralan KYN. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 09210381 dr. KIKI RIZKI RACHMAT 28/07/2022 19:19:57 KARYAWAN IGD 39,000 40,000 42,000 5,000 0 0 0 126,000
133 2022/07/28/000171 036194 ZUHROTUS SOLICHAH, NY Ralan KYN. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 09210381 dr. KIKI RIZKI RACHMAT 28/07/2022 19:18:34 KARYAWAN IGD 39,000 40,000 42,000 5,000 0 0 0 126,000
134 2022/07/28/000170 104349 Rianto, Tn Ralan KYN. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 09210381 dr. KIKI RIZKI RACHMAT 28/07/2022 19:18:18 KARYAWAN IGD 39,000 40,000 42,000 5,000 0 0 0 126,000
135 2022/07/28/000161 107434 ARKANA SHAKA ALVARENDRA, Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 1160202 dr. DEWI NURINDAH, Sp.A, 28/07/2022 19:23:21 UMUM Amarta 1B 55,100 40,000 42,900 5,000 0 0 0 143,000
136 2022/07/28/000160 072036 NYJAH AYVY ROXALKA, AN Ralan UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 28/07/2022 20:06:35 UMUM Poli Anak 113,500 39,500 42,000 5,000 0 0 0 200,000
137 2022/07/28/000103 072896 TATIK, NY Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 4150215 dr. DEWI INDIASTARI, 28/07/2022 13:26:12 BPJS KS IGD 1 53,000 40,000 42,000 5,000 0 0 0 140,000
138 2022/07/29/000165 072214 MOH DUROTUN NASIKIN, Sdr Ralan UMUM. USG Abdomen 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 29/07/2022 16:03:58 UMUM Poli Radiologi 199,274 60,726 110,000 5,000 0 0 0 375,000
139 2022/07/29/000144 027712 NESYA KURNIAYANTI, NY Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 09210381 dr. KIKI RIZKI RACHMAT 29/07/2022 23:53:41 BPJS KS IGD 6 53,000 40,000 42,000 5,000 0 0 0 140,000
140 2022/07/29/000078 027471 SHIDQIA MAULIDIYAH, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 3150145 dr. ZAINUDDIN HAMIDI, 29/07/2022 23:53:24 BPJS Amarta 1A 53,000 40,000 42,000 5,000 0 0 0 140,000
141 2022/07/29/000059 055640 ARSYANA AISYAH MUSHOFFA, Ralan BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 29/07/2022 19:00:10 BPJS Poli Radiologi 113,500 39,500 42,000 5,000 0 0 0 200,000
142 2022/07/29/000057 071244 TUTIK, NY Ralan BPJS. X-Ray THORACOLUMBAL AP+LAT 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1180326 dr. SISWIDIYATI, Sp.RAD. 29/07/2022 18:59:27 BPJS Poli Radiologi 145,800 39,500 67,200 7,500 0 0 0 260,000
143 2022/07/23/000139 072724 RULLY AITANA, BY NY Ranap BPJS. USG Kepala Bayi 1180326 dr. SISWIDIYATI, Sp.RAD. 8180340 YULFATUL MUNIROH, 1160202 dr. DEWI NURINDAH, Sp.A, 29/07/2022 15:45:32 BPJS NICU 2 103,143 23,857 88,000 5,000 0 0 0 220,000
144 2022/07/30/000066 047238 MUHAMMAD HASAN AL FAQIH, Ranap BPJS. X-Ray Thorax AP+LAT 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 30/07/2022 15:55:07 BPJS KS IGD 8 111,800 40,000 67,200 5,000 0 0 0 224,000

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No. No.Rawat No.R.M. Nama Pasien Status Kd.Prk Pemeriksaan Kode Dokter Dokter P.J. Rad NIP Petugas Radiologi Kd Perujuk Dokter Perujuk Tanggal Jam Cara Bayar Ruangan Jasa Sarana Paket BHP JM PJ Rad JM Petugas JM Perujuk KSO Menejemen Total
145 2022/07/30/000079 029984 AZZAMIR BASIRA GHAYDA, AN Ranap BPJS. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 30/07/2022 17:23:34 BPJS KS IGD 9 53,000 40,000 42,000 5,000 0 0 0 140,000
146 2022/07/30/000080 107499 ADRYAN FIQRIE YR, AN Ranap UMUM. X-Ray Thorax AP/PA 1180326 dr. SISWIDIYATI, Sp.RAD. 05210435 ERINO ILHAM YUSUF 3150145 dr. ZAINUDDIN HAMIDI, 30/07/2022 16:00:07 UMUM KS IGD 10 60,000 40,000 45,000 5,000 0 0 0 150,000
Jumlah Total : 13,657,698 6,633,602 9,562,700 775,000 0 0 0 30,629,000

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