5 6102750933903474983

RSIA BUNDA NONI
Jln. Srijaya Negara No. 1 Rt. 75 Rw. 11 Kel. Bukit Lama Kec. Ilir Barat 1
Palembang 30139 Telp. 0711-441952 Email : rsia.bundanoni@yahoo.co.id
PERINCIAN PEMBAYARAN
No. Reg : 007889

Nama Pasien : Ramayulis Total Seluruh : Rp 10,763,400
Tgl. Lahir : 01 Juli 1998 Diskon :
Alamat : Jl. Putri Kembang dadar Palembang Tagihan :
Perawatan : RAWAT INAP Dibayar :
Kelas : TIGA Kemalian :
No TANGGAL URAIAN KELAS TARIF QTY BRUTO

1 6/10/2020 Jasa dr OP SC Tiga Rp 1,400,000 1 Rp 1,400,000
2 6/10/2020 Jasa dr Ant SC Tiga Rp 600,000 1 Rp 600,000
3 6/10/2020 Penata Ant SC Tiga Rp 300,000 1 Rp 300,000
4 6/10/2020 Jasa dr Anak SC Tiga Rp 300,000 1 Rp 300,000
5 6/10/2020 Asisten dr OP Tiga Rp 250,000 1 Rp 250,000
6 6/10/2020 Intrumen dr Tiga Rp 150,000 1 Rp 150,000
7 6/10/2020 Konsultasi dr Penyakit Dalam Tiga Rp 150,000 1 Rp 150,000
8 6/10/2020 Asisten dr Anak Tiga Rp 260,000 1 Rp 260,000
9 6/10/2020 Kamar Operasi Tiga Rp 2,000,000 1 Rp 2,000,000
10 6/10/2020 Oksigen Tiga Rp 200,000 1 Rp 200,000
11 6/10/2020 ABOCATH NO 18 Tiga Rp 17,500 1 Rp 17,500
12 6/10/2020 ALKOHOL AWABS Tiga Rp 1,500 2 Rp 3,000
13 6/10/2020 AQUA PRO INJ (OTSUKA) Tiga Rp 11,500 4 Rp 46,000
14 6/10/2020 ASAM MEFENAMAT CAP Tiga Rp 1,000 9 Rp 9,000
15 6/10/2020 ASAM TRANEKSAMAT 100 MG/ML Tiga Rp 9,500 2 Rp 19,000
16 6/10/2020 BLOOD SET Tiga Rp 29,000 1 Rp 29,000
17 6/10/2020 CATETER NO 16 Tiga Rp 40,500 1 Rp 40,500
18 6/10/2020 CEFOTAXIM VIAL Tiga Rp 21,000 2 Rp 42,000
19 6/10/2020 CIPROFLOXACIN 500 MG Tiga Rp 1,500 6 Rp 9,000
20 6/10/2020 D5% 500 ML Tiga Rp 17,500 1 Rp 17,500
21 6/10/2020 DEXAMETHASONE AMP Tiga Rp 4,500 2 Rp 9,000
22 6/10/2020 EPEDRIN HCL AMP Tiga Rp 57,500 1 Rp 57,500
23 6/10/2020 GELANG IBU Tiga Rp 7,000 1 Rp 7,000
24 6/10/2020 GELANG BAYI PEREMPUAN Tiga Rp 6,900 1 Rp 6,900
25 6/10/2020 HANDSPLAST BIASA Tiga Rp 1,000 1 Rp 1,000
26 6/10/2020 HANDSCOON GAMEX NO 6.5 Tiga Rp 20,000 6 Rp 120,000
28 6/10/2020 KASSA STERIL 16X16MH Tiga Rp 17,000 3 Rp 51,000
29 6/10/2020 METRONIDAZOLE 500MG TAB Tiga Rp 1,000 9 Rp 9,000
30 6/10/2020 METRONIDAZOLE INFUS 100ML Tiga Rp 66,700 3 Rp 200,100
31 6/10/2020 MYOTONIC INJ 1 ML Tiga Rp 12,700 1 Rp 12,700
32 6/10/2020 NACL 500 ML Tiga Rp 20,000 1 Rp 20,000
33 6/10/2020 NALD NO 23 Tiga Rp 15,000 1 Rp 15,000
34 6/10/2020 ONDANSENTRON 4 ML AMP Tiga Rp 11,500 2 Rp 23,000
35 6/10/2020 OXYTOCIN AMP Tiga Rp 19,500 5 Rp 97,500
36 6/10/2020 PHYTOMENADION Tiga Rp 6,900 1 Rp 6,900
37 6/10/2020 RL 500 ML Tiga Rp 18,000 6 Rp 108,000
38 6/10/2020 SOFRATULLE Tiga Rp 32,500 1 Rp 32,500
39 6/10/2020 SPINOCAN NO 27 Tiga Rp 63,500 1 Rp 63,500
40 6/10/2020 SPUIT 1 ML Tiga Rp 1,800 4 Rp 7,200
42 6/10/2020 Nifedipine 10 MG Tiga Rp 1,000 10 Rp 10,000
45 6/10/2020 STIK BSS Tiga Rp 37,000 1 Rp 37,000
46 6/10/2020 STIK HB Tiga Rp 36,000 1 Rp 36,000
47 6/10/2020 SUCTION CATHETER NO 8 Tiga Rp 14,000 1 Rp 14,000
48 6/10/2020 SURGICAL BLADS NO 21 Tiga Rp 17,500 1 Rp 17,500
49 6/10/2020 T-PLAIN CATGUT 0 Tiga Rp 73,000 1 Rp 73,000
50 6/10/2020 T-PLAIN CATGUT 2-0 Tiga Rp 77,500 1 Rp 77,500
51 6/10/2020 TRAMADOL INJ 100MG/2ML Tiga Rp 9,800 2 Rp 19,600
52 6/10/2020 T-VIO 3-0 Tiga Rp 103,500 1 Rp 103,500
53 6/10/2020 UMBILLICAL Tiga Rp 6,000 1 Rp 6,000
54 6/10/2020 UNDERPAD Tiga Rp 29,000 1 Rp 29,000
55 6/10/2020 URINE BAG Tiga Rp 11,500 1 Rp 11,500
56 6/10/2020 HANDSAPLAS ROLL Tiga Rp 8,500 1 Rp 8,500
57 6/10/2020 T-VIO 1 PGA 100 Tiga Rp 130,000 2 Rp 260,000
58 6/10/2020 SUPRAFENID SUPP Tiga Rp 17,500 3 Rp 52,500
60 6/10/2020 HANDSCOON BIASA Tiga Rp 6,500 6 Rp 39,000
61 6/10/2020 LEVICA Tiga Rp 70,000 1 Rp 70,000
62 6/10/2020 Vagina Thouvher Tiga Rp 50,000 1 Rp 50,000
63 6/10/2020 Electro Kardiographi (EKG) Tiga Rp 80,000 1 Rp 80,000
64 6/10/2020 Doppler Tiga Rp 25,000 1 Rp 25,000
66 6/10/2020 Darah Rutin Tiga Rp 100,000 1 Rp 100,000
67 6/10/2020 BSS Manual Tiga Rp 31,000 1 Rp 31,000
68 6/10/2020 Hemoglobin Manual Tiga Rp 28,000 1 Rp 28,000
69 6/10/2020 Kamar Ruang Perawatan Tiga Rp 300,000 1 Rp 300,000
73 6/10/2020 Washen Tiga Rp 20,000 1 Rp 20,000
74 6/10/2020 Pasang Infus Tiga Rp 40,000 1 Rp 40,000
75 6/10/2020 Injeksi Tiga Rp 20,000 1 Rp 20,000
77 6/10/2020 Vulva Hygiene Tiga Rp 20,000 1 Rp 20,000
79 6/10/2020 Cukur Tiga Rp 30,000 1 Rp 30,000
80 6/10/2020 Supositoria Tiga Rp 20,000 1 Rp 20,000
83 6/10/2020 Ganti Balut Tiga Rp 30,000 1 Rp 30,000
84 6/10/2020 Up Chateter/Infus Tiga Rp 25,000 1 Rp 25,000
85 6/10/2020 Biaya Pendaftaran Rawat Inap Tiga Rp 100,000 1 Rp 100,000
86 6/10/2020 Jasa Dokter Kebidanan Visite Ke Ruangan Tiga Rp 100,000 1 Rp 100,000
90 6/11/2020 Jasa Dokter Anak Visite Ke Ruangan Tiga Rp 100,000 1 Rp 100,000
92 6/10/2020 Perawatan Ibu Tiga Rp 150,000 1 Rp 150,000
96 6/10/2020 Perawatan Anak/Bayi Tiga Rp 150,000 1 Rp 150,000
98 6/10/2020 Pasang Chateter Tiga Rp 70,000 1 Rp 70,000
99 6/10/2020 Suction Tiga Rp 40,000 1 Rp 40,000
Terbilang : Sebelas juta dua ratus tiga belas ribu empat ratus rupiah Total Seluruh : Rp 10,763,400
Diskon :
Tagihan :
Palembang,
Rini Aprilianti
RSIA BUNDA NONI
No. Reg : 007980

Nama Pasien : Bayi Nyonya Inne Kartini Total Seluruh : Rp 4,809,800
Alamat : Palembang Tagihan :
Perawatan : Rawat Inap Dibayar :
Kelas : Dua Kemalian :

1 7/14/2020 ALKOHOL SWABS Dua Rp 1,500 1 Rp 1,500
2 7/14/2020 AQUA PRO INJ (OTSUKA) Dua Rp 11,500 2 Rp 23,000
3 7/14/2020 GELANG BAYI PEREMPUAN Dua Rp 7,000 1 Rp 7,000
4 7/14/2020 HANDSCOON GAMEX NO 6.5 Dua Rp 20,000 2 Rp 40,000
5 7/14/2020 KASSA STERIL 16X16 MH Dua Rp 17,000 1 Rp 17,000
6 7/14/2020 NALD NO 27 Dua Rp 1,500 15 Rp 22,500
7 7/14/2020 PHYTOMEHADION Dua Rp 6,900 1 Rp 6,900
8 7/14/2020 Jasa Dokter Anak SC Dua Rp 420,000 1 Rp 420,000
9 7/14/2020 SPUIT 1 ML Dua Rp 1,800 2 Rp 3,600
10 7/14/2020 SPUIT 1 ML Dua Rp 1,800 6 Rp 10,800
11 7/14/2020 SPUIT 3 ML Dua Rp 3,000 2 Rp 6,000
12 7/14/2020 SUCTION CATHETER NO.6 Dua Rp 14,000 1 Rp 14,000
13 7/14/2020 UMBILLICAL Dua Rp 6,000 1 Rp 6,000
14 7/14/2020 CEFTAZIDIME VIAL 1G Dua Rp 120,000 2 Rp 240,000
15 7/14/2020 Vaksin Hepatitis B Dua Rp 1,500 1 Rp 1,500
16 7/14/2020 Darah Rutin Dua Rp 100,000 1 Rp 100,000
17 7/14/2020 CRP Kuantitatif (P) Dua Rp 230,000 1 Rp 230,000
19 7/14/2020 Kamar Ruang Perawatan Dua Rp 375,000 1 Rp 375,000
24 7/14/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
25 7/15/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
26 7/16/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
27 7/17/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
28 7/18/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
29 7/14/2020 Biaya Pendaftaran Rawat Inap Dua Rp 100,000 1 Rp 100,000
30 7/15/2020 Jasa Dokter Anak Visite Ke Ruangan Dua Rp 110,000 1 Rp 110,000
34 7/14/2020 Perawatan Anak/Bayi Dua Rp 175,000 1 Rp 175,000
39 7/14/2020 Suction Dua Rp 40,000 1 Rp 40,000
Terbilang : Empat juta delapan ratus sembilan ribu Total Seluruh : Rp 4,809,800
delapan ratus rupiah
Palembang,18 juli 2020
Rini Aprilianti
RSIA BUNDA NONI
No. Reg : 007253

Nama Pasien : Susi Astuti Total Seluruh : #REF!
Tgl. Lahir : 09 Januari 1992 Diskon :
Alamat : Jl. Rambutan dalam palembang Tagihan :
Kelas : TIGA Kemalian :

4 6/12/2020 Jasa dr Anak SC Tiga Rp 300,000 1 Rp 300,000
8 6/12/2020 Asisten dr Anak Tiga Rp 260,000 1 Rp 260,000
20 6/12/2020 D5% 500 ML Tiga Rp 17,500 1 Rp 17,500
24 6/12/2020 GELANG BAYI LAKI LAKI Tiga Rp 6,900 1 Rp 6,900
31 6/12/2020 MYOTONIC INJ 1 ML Tiga Rp 12,700 1 Rp 12,700
32 6/12/2020 NACL 500 ML Tiga Rp 20,000 1 Rp 20,000
33 6/12/2020 NALD NO 23 Tiga Rp 15,000 1 Rp 15,000
37 6/12/2020 RL 500 ML Tiga Rp 18,000 6 Rp 108,000
46 6/12/2020 STIK HB Tiga Rp 36,000 1 Rp 36,000
47 6/12/2020 STIK HB Tiga Rp 36,000 1 Rp 36,000
53 6/12/2020 T-VIO 3-0 Tiga Rp 103,500 1 Rp 103,500
62 6/12/2020 LEVICA Tiga Rp 70,000 1 Rp 70,000
63 6/12/2020 Vagina Thouvher Tiga Rp 50,000 1 Rp 50,000
69 6/12/2020 CRP Kuantitatif (P) Tiga Rp 230,000 1 Rp 230,000
72 6/12/2020 Protein urine Tiga Rp 57,000 1 Rp 57,000
76 6/12/2020 Washen Tiga Rp 20,000 1 Rp 20,000
82 6/12/2020 Cukur Tiga Rp 30,000 1 Rp 30,000
86 6/12/2020 Ganti Balut Tiga Rp 30,000 1 Rp 30,000
Terbilang : Sebelas juta seratus enam puluh lima ribu tujuh ratus rupiah Total Seluruh : Rp 11,165,700
Diskon :
Tagihan :
Palembang, 14 juni 2020
Rini Aprilianti, Amd.keb

RSIA BUNDA NONI
No. RM : 007889
Nama Pasien : Rama Yulis Total Seluruh: Rp 2,312,800
Alamat : Jl. Putri Kembang dadar Palembang Tagihan :
Kelas : Tiga Kemalian :

1 6/10/2020 ABOCATH 20 Tiga Rp 17,500 1 Rp 17,500
3 6/10/2020 NIFEDIPINE 10 MG Tiga Rp 1,000 10 Rp 10,000
4 6/10/2020 RL 500 ML Tiga Rp 6,900 3 Rp 20,700
6 6/10/2020 D5% 500 ML Tiga Rp 17,500 1 Rp 17,500
8 6/10/2020 MERSIBION AMP Tiga Rp 7,500 2 Rp 15,000
13 6/10/2020 UTROGESTAN 100 MG Tiga Rp 18,000 6 Rp 36,000
14 6/10/2020 Print USG 3D @1 Tiga Rp 75,000 1 Rp 75,000
20 6/10/2020 Lepas Infus Tiga Rp 45,000 1 Rp 45,000
Terbilang : Dua juta tiga ratus dua belas ribu delapan ratus rupiah Total Seluruh: Rp 2,312,800
Diskon :
Tagihan :
Rini Aprilianti, Amd

RSIA BUNDA NONI
No. Reg : 007865

Nama Pasien : Machpiro Total Seluruh :
Alamat : Jl Padang selasa Palembang Tagihan :
Kelas Tiga Kemalian :
No TANGGAL URAIAN KELAS TARIF QTY

1 6/6/2020 Jasa dr Kuret Bius Umum Tiga Rp 1,000,000 1
2 6/6/2020 Jasa dr Ant Kuret Tiga Rp 180,000 1
3 6/6/2020 Penata Ant Kuret Tiga Rp 120,000 1
4 6/6/2020 Oksigen Tiga Rp 200,000 1
5 6/6/2020 Asisten dr Tiga Rp 200,000 1
6 6/6/2020 RUANG KURET Tiga Rp 700,000 1
7 6/6/2020 ABOCATH NO 20 Tiga Rp 17,500 1
8 6/6/2020 AQUA PRO INJ (OTSUKA) Tiga Rp 11,500 1
10 6/6/2020 BLOOD SET Tiga Rp 29,000 1
11 6/6/2020 CEFOTAXIM VIAL Tiga Rp 21,000 1
12 6/6/2020 D5% 500 ML Tiga Rp 17,500 1
13 6/6/2020 FENTANYL AMP Tiga Rp 57,500 1
14 6/6/2020 GELANG IBU Tiga Rp 7,000 1
15 6/6/2020 MERSIBION AMP Tiga Rp 7,500 1
16 6/6/2020 ONDANSENTRON 4 ML AMP Tiga Rp 11,500 1
17 6/6/2020 RECOFOL N Tiga Rp 118,000 1
18 6/6/2020 RL 500 ML Tiga Rp 18,000 1
19 6/6/2020 RL 500 ML Tiga Rp 18,000 2
20 6/6/2020 SPUIT 1 ML Tiga Rp 1,800 1
21 6/6/2020 SPUIT 10 ML Tiga Rp 4,500 1
22 6/6/2020 SPUIT 10 ML Tiga Rp 4,500 1
23 6/6/2020 SPUIT 3 ML Tiga Rp 3,000 1
24 6/6/2020 SPUIT 5 ML Tiga Rp 3,500 1
25 6/6/2020 STIK BSS Tiga Rp 37,000 1
26 6/6/2020 STIK HB Tiga Rp 36,000 1
27 6/6/2020 SUPRAFENID SUPP Tiga Rp 17,500 1
28 6/6/2020 HANDSCOON BIASA Tiga Rp 6,500 2
29 6/6/2020 UTROGESTAN 100 MG Tiga Rp 18,000 2
30 6/6/2020 Darah Rutin Tiga Rp 100,000 1
31 6/6/2020 BSS Manual Tiga Rp 31,000 1
32 6/5/2020 Kamar Ruang Perawatan Tiga Rp 300,000 1
34 6/5/2020 Pasang Infus Tiga Rp 40,000 1
35 6/5/2020 Injeksi Tiga Rp 20,000 1
36 6/6/2020 Injeksi Tiga Rp 20,000 1
37 6/5/2020 Vulva Hygiene Tiga Rp 20,000 1
38 6/5/2020 Up Chateter/Infus Tiga Rp 25,000 1
39 6/5/2020 Biaya Pendaftaran Rawat Inap Tiga Rp 100,000 1
40 6/5/2020 Jasa Dokter Kebidanan Visite Ke Ruang Tiga Rp 100,000 1
41 6/6/2020 Jasa Dokter Kebidanan Visite Ke Ruang Tiga Rp 100,000 1
42 6/5/2020 Perawatan Ibu Tiga Rp 150,000 1
Terbilang : Empat juta delapan ratus dua puluh enam ribu Total Seluruh :
tiga ratus rupiah Diskon :
Tagihan :
Palembang,
Rini Aprilianti
Rp 4,826,300
BRUTO
Rp 1,000,000
Rp 180,000
Rp 120,000
Rp 200,000
Rp 200,000
Rp 700,000
Rp 17,500
Rp 11,500
Rp 11,500
Rp 29,000
Rp 21,000
Rp 17,500
Rp 57,500
Rp 7,000
Rp 7,500
Rp 11,500
Rp 118,000
Rp 18,000
Rp 36,000
Rp 1,800
Rp 4,500
Rp 4,500
Rp 3,000
Rp 3,500
Rp 37,000
Rp 36,000
Rp 17,500
Rp 13,000
Rp 36,000
Rp 100,000
Rp 31,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 40,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 25,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 150,000
Rp 150,000
Rp 150,000
BRUTO
Rp 4,826,300
RSIA BUNDA NONI
No. Reg :
Nama Pasien : Total Seluruh : Rp 4,483,300
Tgl. Lahir : Diskon :
Alamat : Tagihan :
Perawatan : Dibayar :
Kelas Kemalian :
No URAIAN KELAS TARIF QTY BRUTO

1 ALKOHOL AWABS Tiga Rp 1,500 1 Rp 1,500
2 AQUA PRO INJ (OTSUKA) Tiga Rp 11,500 2 Rp 23,000
3 CEFOTAXIM VIAL Tiga Rp 21,000 2 Rp 42,000
4 GELANG BAYI LAKI-LAKI Tiga Rp 6,900 1 Rp 6,900
5 KASSA STERIL 16X16MH Tiga Rp 17,000 1 Rp 17,000
6 NALD NO 23 Tiga Rp 15,000 15 Rp 225,000
7 PHYTOMENADION Tiga Rp 6,900 1 Rp 6,900
8 SPUIT 1 ML Tiga Rp 1,800 3 Rp 5,400
12 SUCTION CATHETER NO 8 Tiga Rp 14,000 1 Rp 14,000
13 UMBILLICAL Tiga Rp 6,000 1 Rp 6,000
14 Darah Rutin Tiga Rp 100,000 1 Rp 100,000
15 CRP Kuantitatif (P) Tiga Rp 230,000 1 Rp 230,000
16 CRP Kuantitatif (P) Tiga Rp 230,000 1 Rp 230,000
17 Kamar Ruang Perawatan Tiga Rp 300,000 1 Rp 300,000
23 Washen Tiga Rp 20,000 1 Rp 20,000
24 Washen Tiga Rp 20,000 1 Rp 20,000
25 Washen Tiga Rp 20,000 1 Rp 20,000
26 Washen Tiga Rp 20,000 1 Rp 20,000
27 Washen Tiga Rp 20,000 1 Rp 20,000
28 Injeksi Tiga Rp 20,000 1 Rp 20,000
34 Biaya Pendaftaran Rawat Inap Tiga Rp 100,000 1 Rp 100,000
35 Jasa Dokter Anak Visite Ke Ruangan Tiga Rp 100,000 1 Rp 100,000
40 Perawatan Anak/Bayi Tiga Rp 150,000 1 Rp 150,000
46 Suction Tiga Rp 40,000 1 Rp 40,000
No URAIAN KELAS TARIF QTY BRUTO
Terbilang : Total Seluruh : Rp 4,483,300
Diskon :
Tagihan :
Palembang,

RSIA BUNDA NONI
No. Reg : 007837

Nama Pasien : Ristin Manda Sari Total Seluruh : Rp 4,395,534
Tgl. Lahir : 21/03/1986 Diskon :
Alamat : Palembang
Perawatan : Rawat Inap
Kelas : Dua

1 7/10/2020 Jasa dr Partus Normal Dua Rp 1,100,000 1 Rp 1,100,000
2 7/10/2020 Jasa dr Anak Partus Dua Rp 110,000 1 Rp 110,000
3 7/10/2020 Kamar Bersalin Dua Rp 460,000 1 Rp 460,000
4 7/10/2020 Heacting Perinium Dua Rp 230,000 1 Rp 230,000
5 7/10/2020 Oksigen Dua Rp 200,000 1 Rp 200,000
6 7/10/2020 ABOCATH NO 20 Dua Rp 17,500 1 Rp 17,500
7 7/10/2020 ALKOHOL SWABS Dua Rp 1,500 2 Rp 3,000
8 7/10/2020 BLOOD SET Dua Rp 29,000 1 Rp 29,000
9 7/10/2020 CUTGUT CROMIC 3/0 Dua Rp 65,100 1 Rp 65,100
10 7/10/2020 GELANG IBU DAN BAYI Dua Rp 4,620 2 Rp 9,240
12 7/10/2020 KASSA STERIL 16X16MH Dua Rp 1,650 10 Rp 16,500
13 7/10/2020 LIDOCAIN 2% AMP Dua Rp 3,696 1 Rp 3,696
14 7/10/2020 CEFOTAXIME VIAL Dua Rp 19,404 2 Rp 38,808
15 7/10/2020 OXYTOCIN AMP Dua Rp 13,002 4 Rp 52,008
16 7/10/2020 RL 500 ML Dua Rp 11,880 2 Rp 23,760
17 7/10/2020 SPUIT 3 ML Dua Rp 2,503 2 Rp 5,006
18 7/10/2020 SPUIT 10 ML Dua Rp 3,780 1 Rp 3,780
20 7/10/2020 STIK HB Dua Rp 1,650 1 Rp 1,650
21 7/10/2020 SUCTION CATHETER NO 8 Dua Rp 14,000 1 Rp 14,000
23 7/10/2020 UNDERPAD Dua Rp 24,360 1 Rp 24,360
24 7/10/2020 Aquadest Dua Rp 10,626 1 Rp 10,626
25 7/10/2020 HANDSCOON BIASA Dua Rp 2,750 4 Rp 11,000
27 7/10/2020 BSS Manual Dua Rp 31,000 1 Rp 31,000
30 7/10/2020 Tindakan Infus Dua Rp 236,000 1 Rp 236,000
32 7/10/2020 Jasa Dokter Kebidanan Visite Ke Ruangan Dua Rp 125,000 1 Rp 125,000
35 7/10/2020 Perawatan Ibu Dua Rp 202,000 1 Rp 202,000
37 7/10/2020 Perawatan Anak Dua Rp 202,000 1 Rp 202,000
38 7/11/2020 Perawatan Anak Dua Rp 202,000 1 Rp 202,000
Terbilang :Empat juta tiga ratus sembilan puluh lima ribu Total Seluruh : Rp 4,395,534
lima ratus tiga puluh empat rupiah
Palembang, 11 juli 2020
Rini Aprilianti
RSIA BUNDA NONI
No. Reg : 007888

Nama Pasien : Veni Agriantini Total Seluruh : Rp 11,772,540
Tgl. Lahir : 10 Mei 1993 Diskon :
Alamat : Jl. Kol. H. Sulaiman Amin Tagihan :
Kelas : Dua Kembalian :

1 7/17/2020 Jasa dr OP SC Dua Rp 1,888,000 1 Rp 1,888,000
2 7/17/2020 Jasa dr Ant SC Dua Rp 650,000 1 Rp 650,000
3 7/17/2020 Penata Ant SC Dua Rp 420,000 1 Rp 420,000
5 7/17/2020 Asisten dr OP Dua Rp 250,000 1 Rp 250,000
6 7/17/2020 Intrumen dr Dua Rp 180,000 1 Rp 180,000
7 7/17/2020 Konsultasi dr Penyakit Dalam Dua Rp 150,000 1 Rp 150,000
8 7/17/2020 Kamar Operasi Dua Rp 2,520,000 1 Rp 2,520,000
9 7/17/2020 Oksigen Dua Rp 300,000 1 Rp 300,000
10 7/17/2020 ABOCATH NO 20 Dua Rp 17,500 1 Rp 17,500
11 7/17/2020 ALKOHOL AWABS Dua Rp 1,500 1 Rp 1,500
13 7/17/2020 ASAM MEFENAMAT CAP Dua Rp 1,000 9 Rp 9,000
14 7/17/2020 ASAM TRANEKSAMAT 100 MG/ML Dua Rp 9,500 2 Rp 19,000
15 7/17/2020 BLOOD SET Dua Rp 29,000 1 Rp 29,000
16 7/17/2020 CATETER NO 16 Dua Rp 40,500 1 Rp 40,500
17 7/17/2020 CEFOTAXIM VIAL Dua Rp 19,404 2 Rp 38,808
18 7/17/2020 CIPROFLOXACIN 500 MG Dua Rp 1,500 6 Rp 9,000
19 7/17/2020 D5% 500 ML Dua Rp 17,500 2 Rp 35,000
20 7/17/2020 DEXAMETHASONE AMP Dua Rp 4,500 8 Rp 36,000
21 7/17/2020 EPEDRIN HCL AMP Dua Rp 57,500 1 Rp 57,500
22 7/17/2020 GELANG IBU Dua Rp 4,620 1 Rp 4,620
23 7/17/2020 HANDSPLAST BIASA Dua Rp 1,000 1 Rp 1,000
27 7/17/2020 METRONIDAZOLE 500MG TAB Dua Rp 1,000 9 Rp 9,000
28 7/17/2020 METRONIDAZOLE INFUS 100ML Dua Rp 66,700 3 Rp 200,100
29 7/17/2020 MYOTONIC INJ 1 ML Dua Rp 12,700 2 Rp 25,400
30 7/17/2020 NACL 500 ML Dua Rp 20,000 2 Rp 40,000
31 7/17/2020 NALD NO 23 Dua Rp 1,500 2 Rp 3,000
32 7/17/2020 ONDANSENTRON 4 ML AMP Dua Rp 11,500 2 Rp 23,000
33 7/17/2020 OXYTOCIN AMP Dua Rp 13,002 6 Rp 78,012
34 7/17/2020 RL 500 ML Dua Rp 11,880 5 Rp 59,400
35 7/17/2020 SOFRATULLE Dua Rp 32,500 1 Rp 32,500
36 7/17/2020 SPINOCAN NO 27 Dua Rp 63,500 1 Rp 63,500
37 7/17/2020 SPUIT 1 ML Dua Rp 1,800 1 Rp 1,800
38 7/17/2020 SPUIT 10 ML Dua Rp 4,500 2 Rp 9,000
39 7/17/2020 SPUIT 3 ML Dua Rp 3,000 3 Rp 9,000
40 7/17/2020 SPUIT 5 ML Dua Rp 3,500 2 Rp 7,000
41 7/17/2020 STIK BSS Dua Rp 37,000 1 Rp 37,000
42 7/17/2020 STIK HB Dua Rp 36,000 2 Rp 72,000
43 7/17/2020 SURGICAL BLADS NO 21 Dua Rp 17,500 1 Rp 17,500
44 7/17/2020 T-PLAIN CATGUT 0 Dua Rp 73,000 1 Rp 73,000
45 7/17/2020 T-PLAIN CATGUT 2-0 Dua Rp 77,500 1 Rp 77,500
46 7/17/2020 TRAMADOL INJ 100MG/2ML Dua Rp 9,800 3 Rp 29,400
47 7/17/2020 T-VIO 3-0 Dua Rp 103,500 1 Rp 103,500
48 7/17/2020 UNDERPAD Dua Rp 29,000 1 Rp 29,000
49 7/17/2020 URINE BAG Dua Rp 11,500 1 Rp 11,500
50 7/17/2020 HANDSAPLAS ROLL Dua Rp 8,500 1 Rp 8,500
51 7/17/2020 T-VIO 1 PGA 100 Dua Rp 130,000 2 Rp 260,000
52 7/17/2020 SUPRAFENID SUPP Dua Rp 17,500 3 Rp 52,500
53 7/17/2020 HANDSCOON BIASA Dua Rp 6,500 8 Rp 52,000
54 7/17/2020 LEVICA Dua Rp 70,000 1 Rp 70,000
55 7/17/2020 Electro Kardiographi (EKG) Dua Rp 80,000 1 Rp 80,000
56 7/17/2020 Doppler Dua Rp 25,000 1 Rp 25,000
58 7/17/2020 BSS Manual Dua Rp 31,000 1 Rp 31,000
59 7/17/2020 Hemoglobin Manual Dua Rp 28,000 1 Rp 28,000
60 7/17/2020 Protein urine Dua Rp 57,000 1 Rp 57,000
64 7/17/2020 Tindakan Infus Dua Rp 45,000 1 Rp 45,000
65 7/17/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
66 7/18/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
67 7/17/2020 Supositoria Dua Rp 20,000 1 Rp 20,000
68 7/18/2020 Supositoria Dua Rp 20,000 1 Rp 20,000
76 7/17/2020 Perawatan HCU Dua Rp 500,000 1 Rp 500,000
NO TANGGAL URAIAN KELAS TARIF QTY BRUTO
Terbilang : Sebelas juta tujuh ratus tujuh puluh dua ribu Total Seluruh : Rp 11,772,540
Lima ratus empat puluh rupiah Diskon :
Tagihan :
Palembang,19 Juli 2020
Rini Aprilianti
RSIA BUNDA NONI
No. Reg : 007343

Nama Pasien : Bayi Ny. Mista Meriyani Total Seluruh : Rp 5,567,140
Tgl. Lahir : 04 juli 2020 Diskon :
Alamat : Jl. Rambutan dalam Palembang Tagihan :
Perawatan : Tiga Dibayar :
Kelas Kemalian :

3 7/4/2020 Ceftazidine Tiga Rp 120,000 2 Rp 240,000
4 7/4/2020 GELANG IBU DAN BAYI Tiga Rp 4,620 2 Rp 9,240
6 7/4/2020 NALD NO 23 Tiga Rp 15,000 1 Rp 15,000
9 7/4/2020 RL Tiga Rp 18,000 5 Rp 90,000
13 7/4/2020 Abbocath no.24 Tiga Rp 29,000 1 Rp 29,000
18 7/4/2020 Billirubin total Tiga Rp 100,000 1 Rp 100,000
19 7/4/2020 Kamar Perawatan Tiga Rp 330,000 1 Rp 330,000
Terbilang : Lima juta lima ratus enam puluh tujuh ribu Total Seluruh : Rp 5,567,140
seratus empat puluh rupiah
Palembang, 10 Juli 2020
Rini Aprilianti
RSIA BUNDA NONI
No. RM : 007946
Nama Pasien : Siti Habsyah Total Seluruh : Rp 4,261,316
Tgl. Lahir : 02 September 1994 Diskon :
Alamat : Jl. Bukit Baru I No. 153 Tagihan :
Kelas Kemalian :

1 7/4/2020 Jasa dr Partus Normal Tiga Rp 1,000,000 1 Rp 1,000,000
2 7/4/2020 Kamar Bersalin Tiga Rp 385,000 1 Rp 385,000
3 7/4/2020 Heacting Perinium Tiga Rp 220,000 1 Rp 220,000
6 7/4/2020 ALKOHOL SWABS Tiga Rp 1,500 1 Rp 1,500
10 7/4/2020 CUTGUT CROMIC 3/0 Tiga Rp 16,500 2 Rp 33,000
11 7/4/2020 GELANG IBU DAN BAYI Tiga Rp 4,620 2 Rp 9,240
15 7/4/2020 LIDOCAIN 2% AMP Tiga Rp 3,696 1 Rp 3,696
18 7/4/2020 RL 500 ML Tiga Rp 10,880 2 Rp 21,760
26 7/4/2020 Vaginal Thoucher Tiga Rp 50,000 1 Rp 50,000
27 7/4/2020 DoppLer Tiga Rp 25,000 1 Rp 25,000
30 7/4/2020 RL 500 ML Tiga Rp 18,000 2 Rp 36,000
33 7/4/2020 Tindakan infus Tiga Rp 220,000 1 Rp 220,000
41 7/4/2020 Perawatan anak Tiga Rp 165,000 1 Rp 165,000
41 7/5/2020 Perawatan anak Tiga Rp 165,000 1 Rp 165,000
Terbilang : Empat juta dua ratus enam puluh satu ribu Total Seluruh : Rp 4,261,316
tiga ratus enam belas rupiah Diskon :
Tagihan :
Palembang,06 juli 2020
Rini Aprilianti
RSIA BUNDA NONI
No. Reg : 007875

Nama Pasien : Khu Irene Total Seluruh : Rp 15,268,412
Alamat : Jl. Sei Itam palembang Tagihan :
Kelas : Satu Kemalian :

1 7/7/2020 Jasa dr OP SC Satu Rp 2,160,000 1 Rp 2,160,000
2 7/7/2020 Jasa dr Ant SC Satu Rp 720,000 1 Rp 720,000
3 7/7/2020 Penata Ant SC Satu Rp 400,000 1 Rp 400,000
4 7/7/2020 Asisten dr OP Satu Rp 250,000 1 Rp 250,000
5 7/7/2020 Intrumen dr Satu Rp 191,250 1 Rp 191,250
6 7/7/2020 Konsultasi dr Penyakit Dalam Satu Rp 204,000 1 Rp 204,000
7 7/7/2020 Jasa dr Anak SC Satu Rp 480,000 1 Rp 480,000
8 7/7/2020 Kamar Operasi Satu Rp 2,805,000 1 Rp 2,805,000
9 7/7/2020 Oksigen Satu Rp 382,500 1 Rp 382,500
10 7/7/2020 ABOCATH NO 20 Satu Rp 17,500 2 Rp 35,000
11 7/7/2020 ALKOHOL SWAB Satu Rp 1,500 1 Rp 1,500
12 7/7/2020 AQUA PRO INJ (OTSUKA) Satu Rp 10,626 4 Rp 42,504
13 7/7/2020 ASAM MEFENAMAT CAP Satu Rp 1,000 9 Rp 9,000
14 7/7/2020 ASAM TRANEKSAMAT 100 MG/ML Satu Rp 9,500 2 Rp 19,000
15 7/7/2020 BLOOD SET Satu Rp 29,000 1 Rp 29,000
16 7/7/2020 CATETER NO 16 Satu Rp 40,500 1 Rp 40,500
17 7/7/2020 CEFOTAXIM VIAL Satu Rp 19,404 4 Rp 77,616
18 7/7/2020 CIPROFLOXACIN 500 MG Satu Rp 1,500 10 Rp 15,000
19 7/7/2020 D5% 500 ML Satu Rp 17,500 2 Rp 35,000
20 7/7/2020 DEXAMETHASONE AMP Satu Rp 4,500 8 Rp 36,000
21 7/7/2020 EPEDRIN HCL AMP Satu Rp 57,500 1 Rp 57,500
22 7/7/2020 GELANG IDENTITAS Satu Rp 4,620 2 Rp 9,240
23 7/7/2020 HANDSPLAST BIASA Satu Rp 1,000 1 Rp 1,000
24 7/7/2020 HANDSCOON GAMEX NO 6.5 Satu Rp 20,000 3 Rp 60,000
26 7/7/2020 KASSA STERIL 16X16MH Satu Rp 1,650 10 Rp 16,500
27 7/7/2020 METRONIDAZOLE 500MG TAB Satu Rp 1,000 9 Rp 9,000
28 7/7/2020 METRONIDAZOLE INFUS 100ML Satu Rp 66,700 3 Rp 200,100
29 7/7/2020 MYOTONIC INJ 1 ML Satu Rp 12,700 1 Rp 12,700
30 7/7/2020 NACL 500 ML Satu Rp 20,000 2 Rp 40,000
31 7/7/2020 NALD NO 23 Satu Rp 1,500 1 Rp 1,500
32 7/7/2020 ONDANSENTRON 4 ML AMP Satu Rp 11,500 2 Rp 23,000
33 7/7/2020 OXYTOCIN AMP Satu Rp 13,002 6 Rp 78,012
34 7/7/2020 RL 500 ML Satu Rp 11,880 6 Rp 71,280
35 7/7/2020 SOFRATULLE Satu Rp 32,500 1 Rp 32,500
36 7/7/2020 SPINOCAN NO 27 Satu Rp 63,500 1 Rp 63,500
37 7/7/2020 SPUIT 1 ML Satu Rp 1,800 1 Rp 1,800
41 7/7/2020 STIK BSS Satu Rp 37,000 1 Rp 37,000
42 7/7/2020 STIK HB Satu Rp 36,000 2 Rp 72,000
43 7/7/2020 SURGICAL BLADS NO 21 Satu Rp 17,500 1 Rp 17,500
44 7/7/2020 T-PLAIN CATGUT 0 Satu Rp 73,000 1 Rp 73,000
45 7/7/2020 T-PLAIN CATGUT 2-0 Satu Rp 77,500 1 Rp 77,500
46 7/7/2020 TRAMADOL INJ 100MG/2ML Satu Rp 9,800 1 Rp 9,800
47 7/7/2020 T-VIO 3-0 Satu Rp 103,500 1 Rp 103,500
48 7/7/2020 UNDERPAD Satu Rp 24,360 1 Rp 24,360
49 7/7/2020 URINE BAG Satu Rp 11,500 1 Rp 11,500
50 7/7/2020 HANDSAPLAS ROLL Satu Rp 8,500 1 Rp 8,500
51 7/7/2020 T-VIO 1 PGA 100 Satu Rp 130,000 1 Rp 130,000
52 7/7/2020 SUPRAFENID SUPP Satu Rp 17,500 3 Rp 52,500
53 7/7/2020 HANDSCOON BIASA Satu Rp 6,500 6 Rp 39,000
54 7/7/2020 LEVICA Satu Rp 70,000 1 Rp 70,000
55 7/7/2020 Vagina Thoucher Satu Rp 50,000 2 Rp 100,000
56 7/7/2020 Electro Kardiographi (EKG) Satu Rp 80,000 1 Rp 80,000
57 7/7/2020 Doppler Satu Rp 25,000 1 Rp 25,000
58 7/7/2020 Darah Rutin Satu Rp 100,000 1 Rp 100,000
59 7/7/2020 BSS Manual Satu Rp 31,000 1 Rp 31,000
60 7/7/2020 Hemoglobin Manual Satu Rp 28,000 1 Rp 28,000
61 7/7/2020 Protein urine Satu Rp 57,000 1 Rp 57,000
62 7/7/2020 Kamar Ruang Perawatan Satu Rp 575,000 1 Rp 575,000
65 7/7/2020 Tindakan infus Satu Rp 318,750 1 Rp 318,750
66 7/7/2020 Injeksi Satu Rp 30,000 1 Rp 30,000
68 7/7/2020 Vulva Hygiene Satu Rp 30,000 1 Rp 30,000
69 7/7/2020 Skin Test Satu Rp 30,000 1 Rp 30,000
70 7/7/2020 Pre Operatif Satu Rp 892,500 1 Rp 892,500
71 7/7/2020 Biaya Pendaftaran Rawat Inap Satu Rp 127,500 1 Rp 127,500
72 7/7/2020 Jasa Dokter Kebidanan Visite Ke Ruangan Satu Rp 204,000 1 Rp 204,000
75 7/7/2020 Perawatan Ibu Satu Rp 340,000 1 Rp 340,000
78 7/7/2020 Suction Satu Rp 40,000 1 Rp 40,000
79 7/7/2020 Perawatan HCU Satu Rp 500,000 1 Rp 500,000
80 7/7/2020 Pasang Chateter Satu Rp 70,000 1 Rp 70,000
Terbilang : Lima belas juta dua ratus enam puluh delapan ribu Total Seluruh : Rp 15,268,412
empat ratus dua belas rupiah Diskon :
Tagihan :
Rini Aprilianti
RSIA BUNDA NONI
No. RM : 007818
Nama Pasien : Malenah Total Seluruh :
Tgl. Lahir : 25 Juni 1992 Diskon :
Alamat : Jl. Tanjung Aur Tagihan :

1 5/22/2020 Jasa dr Partus Normal Tiga Rp 1,000,000 1
2 5/22/2020 Jasa dr Anak Partus Tiga Rp 100,000 1
3 5/22/2020 Kamar Bersalin Tiga Rp 450,000 1
4 5/22/2020 Asisten dr Anak Tiga Rp 260,000 1
5 5/22/2020 Hecting Perinium Tiga Rp 200,000 1
8 5/22/2020 ALKOHOL SWABS Tiga Rp 1,500 1
9 5/22/2020 ASAM MEFENAMAT CAP Tiga Rp 1,000 9
10 5/22/2020 BLOOD SET Tiga Rp 29,000 1
11 5/22/2020 CIPROFLOXACIN 500 MG Tiga Rp 1,500 10
12 5/22/2020 CUTGUT CROMIC 3/0 Tiga Rp 16,500 1
13 5/22/2020 GELANG BAYI Tiga Rp 7,000 1
15 5/22/2020 HANDSCOON GAMEX NO 6.5 Tiga Rp 20,000 2
16 5/22/2020 HANDSCOON GAMEX NO 7 Tiga Rp 20,000 1
17 5/22/2020 KASSA STERIL 16X16MH Tiga Rp 17,000 2
18 5/22/2020 LIDOCAIN 2% AMP Tiga Rp 4,000 1
19 5/22/2020 OXYTOCIN AMP Tiga Rp 19,500 1
21 5/22/2020 PHYTOMENADION Tiga Rp 6,900 1
22 5/22/2020 RL 500 ML Tiga Rp 18,000 2
23 5/22/2020 SPUIT 1 ML Tiga Rp 1,800 1
24 5/22/2020 SPUIT 3 ML Tiga Rp 3,000 2
25 5/22/2020 SPUIT 5 ML Tiga Rp 3,500 1
26 5/22/2020 STIK BSS Tiga Rp 37,000 1
27 5/22/2020 SUCTION CATHETER NO 8 Tiga Rp 14,000 1
28 5/22/2020 UMBILLICAL Tiga Rp 6,000 1
29 5/22/2020 UNDERPAD Tiga Rp 29,000 1
30 5/22/2020 Vaksin Hepatitis B Tiga Rp 1,500 1
32 5/22/2020 Vaginal Thoucher Tiga Rp 50,000 1
33 5/22/2020 DoppLer Tiga Rp 25,000 1
36 5/22/2020 RL 500 ML Tiga Rp 18,000 2
39 5/22/2020 Washen Tiga Rp 20,000 1
41 5/22/2020 Injeksi Tiga Rp 20,000 1
42 5/22/2020 Injeksi Tiga Rp 20,000 1
46 5/23/2020 Jasa Dokter Kebidanan Visite Ke Ruangan Tiga Rp 100,000 1
47 5/23/2020 Jasa Dokter Anak Visite Ke Ruangan Tiga Rp 100,000 1
50 5/22/2020 Perawatan Anak/Bayi Tiga Rp 150,000 1
52 5/22/2020 Suction Tiga Rp 40,000 1
Terbilang : Empat juta lima ratus empat puluh empat ribu Total Seluruh :
dua ratus rupiah Diskon :
Tagihan :
Palembang, 24 Mei 2020
Rini Aprilianti
Rp 4,544,200
BRUTO
Rp 1,000,000
Rp 100,000
Rp 450,000
Rp 260,000
Rp 200,000
Rp 200,000
Rp 17,500
Rp 1,500
Rp 9,000
Rp 29,000
Rp 15,000
Rp 16,500
Rp 7,000
Rp 7,000
Rp 40,000
Rp 20,000
Rp 34,000
Rp 4,000
Rp 19,500
Rp 19,500
Rp 6,900
Rp 36,000
Rp 1,800
Rp 6,000
Rp 3,500
Rp 37,000
Rp 14,000
Rp 6,000
Rp 29,000
Rp 1,500
Rp 26,000
Rp 50,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 36,000
Rp 300,000
Rp 300,000
Rp 20,000
Rp 40,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 25,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 40,000
BRUTO
Rp 4,544,200
, 24 Mei 2020
RSIA BUNDA NONI
No. Reg : 004543

Nama Pasien : Lily Aryani Total Seluruh :
Tgl. Lahir : 04 Oktober 1993 Diskon :
Alamat : Jl. Putri kembang dadar Palembang Tagihan :

1 7/4/2020 Jasa dr OP SC Dua Rp 1,888,000 1
2 7/4/2020 Jasa dr Ant SC Dua Rp 650,000 1
3 7/4/2020 Penata Ant SC Dua Rp 420,000 1
4 7/4/2020 Jasa dr Anak SC Dua Rp 300,000 1
5 7/4/2020 Asisten dr OP Dua Rp 250,000 1
6 7/4/2020 Intrumen dr Dua Rp 180,000 1
7 7/4/2020 Konsultasi dr Penyakit Dalam Dua Rp 150,000 1
9 7/4/2020 Kamar Operasi Dua Rp 2,520,000 1
10 7/4/2020 Oksigen Dua Rp 300,000 1
11 7/3/2020 ABOCATH NO 20 Dua Rp 17,500 1
12 7/4/2020 ALKOHOL AWABS Dua Rp 1,500 1
13 7/4/2020 AQUA PRO INJ (OTSUKA) Dua Rp 11,500 4
14 7/4/2020 ASAM MEFENAMAT CAP Dua Rp 1,000 9
15 7/4/2020 ASAM TRANEKSAMAT 100 MG/ML Dua Rp 9,500 2
16 7/4/2020 BLOOD SET Dua Rp 29,000 1
17 7/4/2020 CATETER NO 16 Dua Rp 40,500 1
18 7/4/2020 CEFOTAXIM VIAL Dua Rp 19,404 2
19 7/4/2020 CIPROFLOXACIN 500 MG Dua Rp 1,500 6
20 7/3/2020 D5% 500 ML Dua Rp 17,500 2
21 7/4/2020 DEXAMETHASONE AMP Dua Rp 4,500 8
22 7/4/2020 EPEDRIN HCL AMP Dua Rp 57,500 1
23 7/3/2020 GELANG IBU DAN ANAK Dua Rp 4,620 2
24 7/4/2020 HANDSPLAST BIASA Dua Rp 1,000 1
25 7/4/2020 HANDSCOON GAMEX NO 6.5 Dua Rp 20,000 3
27 7/4/2020 KASSA STERIL 16X16MH Dua Rp 17,000 2
28 7/4/2020 METRONIDAZOLE 500MG TAB Dua Rp 1,000 9
29 7/4/2020 METRONIDAZOLE INFUS 100ML Dua Rp 66,700 3
30 7/4/2020 MYOTONIC INJ 1 ML Dua Rp 12,700 2
31 7/4/2020 NACL 500 ML Dua Rp 20,000 2
32 7/4/2020 NALD NO 23 Dua Rp 1,500 2
33 7/4/2020 ONDANSENTRON 4 ML AMP Dua Rp 11,500 2
34 7/4/2020 OXYTOCIN AMP Dua Rp 13,002 6
35 7/4/2020 RL 500 ML Dua Rp 11,880 5
36 7/4/2020 SOFRATULLE Dua Rp 32,500 1
37 7/4/2020 SPINOCAN NO 27 Dua Rp 63,500 1
38 7/4/2020 SPUIT 1 ML Dua Rp 1,800 1
39 7/4/2020 SPUIT 10 ML Dua Rp 4,500 2
40 7/4/2020 SPUIT 3 ML Dua Rp 3,000 3
41 7/4/2020 SPUIT 5 ML Dua Rp 3,500 2
42 7/4/2020 STIK BSS Dua Rp 37,000 1
43 7/4/2020 STIK HB Dua Rp 36,000 2
44 7/4/2020 SURGICAL BLADS NO 21 Dua Rp 17,500 1
45 7/4/2020 T-PLAIN CATGUT 0 Dua Rp 73,000 1
46 7/4/2020 T-PLAIN CATGUT 2-0 Dua Rp 77,500 1
47 7/4/2020 TRAMADOL INJ 100MG/2ML Dua Rp 9,800 3
48 7/4/2020 T-VIO 3-0 Dua Rp 103,500 1
49 7/4/2020 UNDERPAD Dua Rp 29,000 1
50 7/4/2020 URINE BAG Dua Rp 11,500 1
51 7/4/2020 HANDSAPLAS ROLL Dua Rp 8,500 1
52 7/4/2020 T-VIO 1 PGA 100 Dua Rp 130,000 2
53 7/4/2020 SUPRAFENID SUPP Dua Rp 17,500 3
54 7/4/2020 HANDSCOON BIASA Dua Rp 6,500 8
55 7/4/2020 LEVICA Dua Rp 70,000 1
56 7/3/2020 Electro Kardiographi (EKG) Dua Rp 80,000 1
57 7/3/2020 Doppler Dua Rp 25,000 1
58 7/3/2020 Darah Rutin Dua Rp 100,000 1
59 7/3/2020 BSS Manual Dua Rp 31,000 1
60 7/3/2020 Hemoglobin Manual Dua Rp 28,000 1
61 7/3/2020 Protein urine Dua Rp 57,000 1
62 7/3/2020 Kamar Ruang Perawatan Dua Rp 450,000 1
66 7/3/2020 Tindakan Infus Dua Rp 45,000 1
67 7/4/2020 Injeksi Dua Rp 20,000 1
68 7/5/2020 Injeksi Dua Rp 20,000 1
69 7/3/2020 Supositoria Dua Rp 20,000 1
71 7/3/2020 Biaya Pendaftaran Rawat Inap Dua Rp 120,000 1
72 7/4/2020 Jasa Dokter Kebidanan Visite Ke Ruangan Dua Rp 132,000 1
75 7/4/2020 Perawatan Anak Dua Rp 210,000 1
78 7/5/2020 Jasa Dokter Anak Visite Ke Ruangan Dua Rp 132,000 1
80 7/3/2020 Perawatan Ibu Dua Rp 210,000 1
84 7/3/2020 Perawatan HCU Dua Rp 500,000 1
Terbilang : Tiga belas juta enam ratus tiga puluh satu ribu Total Seluruh :
seratus enam puluh rupiah Diskon :
Tagihan :
Rini Aprilianti
Rp 13,631,160
BRUTO
Rp 1,888,000
Rp 650,000
Rp 420,000
Rp 300,000
Rp 250,000
Rp 180,000
Rp 150,000
Rp 2,520,000
Rp 300,000
Rp 17,500
Rp 1,500
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 38,808
Rp 9,000
Rp 35,000
Rp 36,000
Rp 57,500
Rp 9,240
Rp 1,000
Rp 60,000
Rp 80,000
Rp 34,000
Rp 9,000
Rp 200,100
Rp 25,400
Rp 40,000
Rp 3,000
Rp 23,000
Rp 78,012
Rp 59,400
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 9,000
Rp 7,000
Rp 37,000
Rp 72,000
Rp 17,500
Rp 73,000
Rp 77,500
Rp 29,400
Rp 103,500
Rp 29,000
Rp 11,500
Rp 8,500
Rp 260,000
Rp 52,500
Rp 52,000
Rp 70,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 57,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 45,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 120,000
Rp 132,000
Rp 132,000
Rp 132,000
Rp 210,000
Rp 210,000
Rp 210,000
Rp 132,000
Rp 132,000
Rp 210,000
Rp 210,000
Rp 210,000
Rp 210,000
Rp 500,000
BRUTO
Rp 13,631,160
g,06 Juli 2020

RSIA BUNDA NONI
No. Reg : 007873

Nama Pasien : Betaria Total Seluruh :
Alamat : Keramasan Palembang Tagihan :

10 7/7/2020 Oksigen Dua Rp 300,000 1
11 7/7/2020 ABOCATH NO 20 Dua Rp 17,500 1
16 7/7/2020 BLOOD SET Dua Rp 29,000 1
17 7/7/2020 CATETER NO 16 Dua Rp 40,500 1
20 7/7/2020 D5% 500 ML Dua Rp 17,500 2
23 7/7/2020 GELANG IBU DAN ANAK Dua Rp 4,620 2
31 7/7/2020 NACL 500 ML Dua Rp 20,000 2
32 7/7/2020 NALD NO 23 Dua Rp 1,500 2
35 7/7/2020 RL 500 ML Dua Rp 11,880 5
38 7/7/2020 SPUIT 1 ML Dua Rp 1,800 1
39 7/7/2020 SPUIT 10 ML Dua Rp 4,500 2
40 7/7/2020 SPUIT 3 ML Dua Rp 3,000 3
41 7/7/2020 SPUIT 5 ML Dua Rp 3,500 2
42 7/7/2020 STIK BSS Dua Rp 37,000 1
43 7/7/2020 STIK HB Dua Rp 36,000 2
48 7/7/2020 T-VIO 3-0 Dua Rp 103,500 1
49 7/7/2020 UNDERPAD Dua Rp 29,000 1
50 7/7/2020 URINE BAG Dua Rp 11,500 1
52 7/7/2020 T-VIO 1 PGA 100 Dua Rp 130,000 2
55 7/7/2020 LEVICA Dua Rp 70,000 1
57 7/7/2020 Doppler Dua Rp 25,000 1
59 7/7/2020 BSS Manual Dua Rp 31,000 1
65 7/7/2020 Pasang Infus Dua Rp 45,000 1
66 7/7/2020 Injeksi Dua Rp 20,000 1
67 7/7/2020 Injeksi Dua Rp 20,000 1
68 7/7/2020 Nifedipine 10 Mg Dua Rp 1,000 1
Terbilang : Dua belas juta sembilan ratus tujuh puluh dua ribu Total Seluruh :
seratus enam puluh rupiah Diskon :
Tagihan :
Rini Aprilianti
Rp 12,972,160
BRUTO
Rp 1,888,000
Rp 650,000
Rp 420,000
Rp 300,000
Rp 250,000
Rp 180,000
Rp 150,000
Rp 2,520,000
Rp 300,000
Rp 17,500
Rp 1,500
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 38,808
Rp 9,000
Rp 35,000
Rp 36,000
Rp 57,500
Rp 9,240
Rp 1,000
Rp 60,000
Rp 80,000
Rp 34,000
Rp 9,000
Rp 200,100
Rp 25,400
Rp 40,000
Rp 3,000
Rp 23,000
Rp 78,012
Rp 59,400
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 9,000
Rp 7,000
Rp 37,000
Rp 72,000
Rp 17,500
Rp 73,000
Rp 77,500
Rp 29,400
Rp 103,500
Rp 29,000
Rp 11,500
Rp 8,500
Rp 260,000
Rp 52,500
Rp 52,000
Rp 70,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 57,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 45,000
Rp 20,000
Rp 20,000
Rp 1,000
Rp 20,000
Rp 20,000
Rp 120,000
Rp 132,000
Rp 132,000
Rp 132,000
Rp 210,000
Rp 210,000
Rp 210,000
Rp 132,000
Rp 132,000
Rp 210,000
Rp 210,000
Rp 210,000
Rp 500,000
BRUTO
Rp 12,972,160
09 Juli 2020
RSIA BUNDA NONI
No. Reg : 007341

Nama Pasien : Sri Mardona Total Seluruh :
Tgl. Lahir : 15 maret 1980 Diskon :
Alamat : Jl. Gotong Royong Tagihan :

1 7/6/2020 Jasa dr OP SC Tiga Rp 1,540,000 1
2 7/6/2020 Jasa dr Ant SC Tiga Rp 600,000 1
3 7/6/2020 Penata Ant SC Tiga Rp 300,000 1
4 7/6/2020 Asisten dr OP Tiga Rp 250,000 1
5 7/6/2020 Intrumen dr Tiga Rp 150,000 1
6 7/6/2020 Konsultasi dr Penyakit Dalam Tiga Rp 150,000 1
7 7/6/2020 Kamar Operasi Tiga Rp 2,200,000 1
8 7/6/2020 Oksigen Tiga Rp 275,000 1
10 7/6/2020 ALKOHOL AWABS Tiga Rp 1,500 2
13 7/6/2020 ASAM TRANEKSAMAT 100 MG/ML Tiga Rp 9,500 2
14 7/6/2020 BLOOD SET Tiga Rp 29,000 1
15 7/6/2020 CATETER NO 16 Tiga Rp 40,500 1
18 7/6/2020 D5% 500 ML Tiga Rp 17,500 1
19 7/6/2020 NIFEDIPINE 10 MG Tiga Rp 1,000 10
20 7/6/2020 EPEDRIN HCL AMP Tiga Rp 57,500 1
23 7/6/2020 HANDSPLAST BIASA Tiga Rp 1,000 1
27 7/6/2020 METRONIDAZOLE 500MG TAB Tiga Rp 1,000 9
28 7/6/2020 METRONIDAZOLE INFUS 100ML Tiga Rp 66,700 3
29 7/6/2020 DOPAMET Tiga Rp 1,500 10
30 7/6/2020 NACL 500 ML Tiga Rp 20,000 1
31 7/6/2020 NALD NO 23 Tiga Rp 15,000 1
35 7/6/2020 RL 500 ML Tiga Rp 11,880 6
36 7/6/2020 SOFRATULLE Tiga Rp 32,500 1
37 7/6/2020 SPINOCAN NO 27 Tiga Rp 63,500 1
38 7/6/2020 SPUIT 1 ML Tiga Rp 1,800 1
39 7/6/2020 SPUIT 10 ML Tiga Rp 4,500 2
40 7/6/2020 Jasa Dokter Anak SC Tiga Rp 330,000 1
41 7/6/2020 SPUIT 3 ML Tiga Rp 2,503 6
42 7/6/2020 SPUIT 5 ML Tiga Rp 3,500 2
43 7/6/2020 STIK BSS Tiga Rp 37,000 1
44 7/6/2020 STIK HB Tiga Rp 1,650 1
46 7/6/2020 SURGICAL BLADS NO 21 Tiga Rp 17,500 1
47 7/6/2020 T-PLAIN CATGUT 0 Tiga Rp 73,000 1
48 7/6/2020 T-PLAIN CATGUT 2-0 Tiga Rp 77,500 1
49 7/6/2020 TRAMADOL INJ 100MG/2ML Tiga Rp 9,800 3
50 7/6/2020 T-VIO 3-0 Tiga Rp 103,500 1
52 7/6/2020 UNDERPAD Tiga Rp 24,360 1
53 7/6/2020 URINE BAG Tiga Rp 11,500 1
54 7/6/2020 HANDSAPLAS ROLL Tiga Rp 8,500 1
55 7/6/2020 T-VIO 1 PGA 100 Tiga Rp 130,000 1
59 7/6/2020 LEVICA Tiga Rp 70,000 1
60 7/6/2020 Vagina Thoucher Tiga Rp 50,000 1
61 7/6/2020 Electro Kardiographi (EKG) Tiga Rp 80,000 1
62 7/6/2020 Doppler Tiga Rp 25,000 1
65 7/6/2020 Hemoglobin Manual Tiga Rp 28,000 1
70 7/6/2020 Tindakan Infus Tiga Rp 275,000 1
71 7/6/2020 Injeksi Tiga Rp 20,000 1
72 7/7/2020 Injeksi Tiga Rp 20,000 1
75 7/6/2020 Cukur Tiga Rp 30,000 1
76 7/6/2020 Supositoria Tiga Rp 20,000 1
87 7/8/2020 Perawatan Anak Tiga Rp 165,000 1
90 7/6/2020 Pasang Chateter Tiga Rp 70,000 1
91 7/6/2020 Suction Tiga Rp 40,000 1
NO TANGGAL URAIAN KELAS TARIF QTY
Terbilang : Sepuluh juta sembilan ratus enam belas ribu Total Seluruh :
tujuh ratus tujuh puluh rupiah Diskon :
Tagihan :
Rini Aprilianti, Amd.

Rp 10,916,770
BRUTO
Rp 1,540,000
Rp 600,000
Rp 300,000
Rp 250,000
Rp 150,000
Rp 150,000
Rp 2,200,000
Rp 275,000
Rp 14,700
Rp 3,000
Rp 42,504
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 38,808
Rp 15,000
Rp 17,500
Rp 10,000
Rp 57,500
Rp 4,620
Rp 4,620
Rp 1,000
Rp 80,000
Rp 51,000
Rp 9,000
Rp 200,100
Rp 15,000
Rp 20,000
Rp 15,000
Rp 23,000
Rp 65,010
Rp 6,900
Rp 71,280
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 330,000
Rp 15,018
Rp 7,000
Rp 37,000
Rp 1,650
Rp 14,000
Rp 17,500
Rp 73,000
Rp 77,500
Rp 29,400
Rp 103,500
Rp 6,000
Rp 24,360
Rp 11,500
Rp 8,500
Rp 130,000
Rp 35,000
Rp 5,500
Rp 16,500
Rp 70,000
Rp 50,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 330,000
Rp 330,000
Rp 330,000
Rp 275,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 20,000
Rp 20,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 165,000
Rp 165,000
Rp 165,000
Rp 165,000
Rp 165,000
Rp 165,000
Rp 70,000
Rp 40,000
BRUTO
Rp 10,916,770
g, 08 Juli 2020
RSIA BUNDA NONI
No. Reg : 007255

Nama Pasien : Mista Meriyani Total Seluruh :
Alamat : Jl. Rambutan Dalam Tagihan :

8 7/4/2020 Oksigen Tiga Rp 275,000 1
14 7/4/2020 BLOOD SET Tiga Rp 29,000 1
18 7/4/2020 D5% 500 ML Tiga Rp 17,500 1
29 7/4/2020 DOPAMET Tiga Rp 1,500 10
30 7/4/2020 NACL 500 ML Tiga Rp 20,000 1
31 7/4/2020 NALD NO 23 Tiga Rp 15,000 1
35 7/4/2020 RL 500 ML Tiga Rp 11,880 6
38 7/4/2020 SPUIT 1 ML Tiga Rp 1,800 1
39 7/4/2020 SPUIT 10 ML Tiga Rp 4,500 2
40 7/4/2020 SPUIT 3 ML Tiga Rp 2,503 1
41 7/4/2020 SPUIT 3 ML Tiga Rp 2,503 5
42 7/4/2020 SPUIT 5 ML Tiga Rp 3,500 2
43 7/4/2020 STIK BSS Tiga Rp 37,000 1
44 7/4/2020 STIK HB Tiga Rp 1,650 1
50 7/4/2020 T-VIO 3-0 Tiga Rp 103,500 1
52 7/4/2020 UNDERPAD Tiga Rp 24,360 1
53 7/4/2020 URINE BAG Tiga Rp 11,500 1
55 7/4/2020 T-VIO 1 PGA 100 Tiga Rp 130,000 1
59 7/4/2020 LEVICA Tiga Rp 70,000 1
60 7/4/2020 Vagina Thoucher Tiga Rp 50,000 1
62 7/4/2020 Doppler Tiga Rp 25,000 1
70 7/4/2020 Tindakan Infus Tiga Rp 275,000 1
71 7/4/2020 Injeksi Tiga Rp 20,000 1
72 7/4/2020 Injeksi Tiga Rp 20,000 1
73 7/4/2020 Cukur Tiga Rp 30,000 1
85 7/4/2020 Suction Tiga Rp 40,000 1
Terbilang : Sepuluh juta tiga ratus empat puluh enam ribu Total Seluruh :
tujuh ratus tujuh puluh rupiah Diskon :
Tagihan :
Rini Aprilianti, Amd.ke

Rp 10,346,770
BRUTO
Rp 1,540,000
Rp 600,000
Rp 300,000
Rp 250,000
Rp 150,000
Rp 150,000
Rp 2,200,000
Rp 275,000
Rp 14,700
Rp 3,000
Rp 42,504
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 38,808
Rp 15,000
Rp 17,500
Rp 10,000
Rp 57,500
Rp 4,620
Rp 4,620
Rp 1,000
Rp 80,000
Rp 51,000
Rp 9,000
Rp 200,100
Rp 15,000
Rp 20,000
Rp 15,000
Rp 23,000
Rp 65,010
Rp 6,900
Rp 71,280
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 2,503
Rp 12,515
Rp 7,000
Rp 37,000
Rp 1,650
Rp 14,000
Rp 17,500
Rp 73,000
Rp 77,500
Rp 29,400
Rp 103,500
Rp 6,000
Rp 24,360
Rp 11,500
Rp 8,500
Rp 130,000
Rp 35,000
Rp 5,500
Rp 16,500
Rp 70,000
Rp 50,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 330,000
Rp 330,000
Rp 330,000
Rp 330,000
Rp 275,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 20,000
Rp 20,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 165,000
Rp 165,000
Rp 165,000
Rp 165,000
Rp 70,000
Rp 40,000
BRUTO
Rp 10,346,770
07 Juli 2020
RSIA BUNDA NONI
No. RM : 007808
Nama Pasien : Dwi Oki Mayang Sari Total Seluruh :
Alamat : Jl. Sult.M.Mansyur Palembang Tagihan :

1 6/2/2020 Jasa dr Partus Normal Satu Rp 1,200,000 1
2 6/2/2020 Jasa dr Anak Partus Satu Rp 120,000 1
3 6/2/2020 Kamar Bersalin Satu Rp 1,000,000 1
4 6/2/2020 Asisten dr Anak Satu Rp 270,000 1
5 6/2/2020 Hecting Perinium Satu Rp 200,000 1
6 6/2/2020 ABOCATH NO 18 Satu Rp 17,500 1
7 6/2/2020 ALKOHOL SWABS Satu Rp 1,500 1
8 6/2/2020 BLOOD SET Satu Rp 29,000 1
9 6/2/2020 CUTGUT CROMIC 3/0 Satu Rp 16,500 1
10 6/2/2020 GELANG BAYI Satu Rp 7,000 1
11 6/2/2020 GELANG IBU Satu Rp 7,000 1
12 6/2/2020 HANDSCOON GAMEX NO 6.5 Satu Rp 20,000 4
14 6/2/2020 KASSA STERIK 16X16MH Satu Rp 17,000 1
15 6/2/2020 LIDOCAIN 2% AMP Satu Rp 4,000 1
16 6/2/2020 OXYTOCIN AMP Satu Rp 19,500 3
17 6/2/2020 PHYTOMENADION Satu Rp 6,900 1
18 6/2/2020 RL 500 ML Satu Rp 18,000 2
19 6/2/2020 SPUIT 1 ML Satu Rp 1,800 1
20 6/2/2020 SPUIT 1 ML Satu Rp 1,800 2
21 6/2/2020 SPUIT 3 ML Satu Rp 3,000 1
22 6/2/2020 SPUIT 5 ML Satu Rp 3,500 1
23 6/2/2020 STIK BSS Satu Rp 37,000 1
24 6/2/2020 STIK HB Satu Rp 36,000 1
25 6/2/2020 SUCTION CATHETER NO 8 Satu Rp 14,000 1
26 6/2/2020 UMBILLICAL Satu Rp 6,000 1
27 6/2/2020 UNDERPAD Satu Rp 29,000 1
28 6/2/2020 Vaksin Hepatitis B Satu Rp 1,500 1
29 6/2/2020 HANDSCOON BIASA Satu Rp 6,500 4
30 6/2/2020 Vaginal Thoucher Satu Rp 50,000 1
31 6/2/2020 Doppler Satu Rp 25,000 1
32 6/2/2020 Darah Rutin Satu Rp 100,000 1
35 6/2/2020 BSS Manual Satu Rp 31,000 1
36 6/2/2020 Kamar Ruang Perawatan Satu Rp 450,000 1
38 6/2/2020 Pasang Infus Satu Rp 45,000 1
39 6/2/2020 Injeksi Satu Rp 30,000 1
40 6/2/2020 Vulva Hygiene Satu Rp 30,000 1
41 6/2/2020 Up Chateter/Infus Satu Rp 35,000 1
42 6/2/2020 Biaya Pendaftaran Rawat Inap Satu Rp 100,000 1
43 6/3/2020 Jasa Dokter Kebidanan Visite Ke Ruangan Satu Rp 120,000 1
44 6/3/2020 Jasa Dokter Anak Visite Ke Ruangan Satu Rp 120,000 1
45 6/2/2020 Perawatan Ibu Satu Rp 200,000 2
47 6/2/2020 Asam Mefenamat Cap Satu Rp 1,000 9
48 6/2/2020 Ciprofloxacin 500 MG Satu Rp 1,500 10
49 6/2/2020 Perawatan Anak/Bayi Satu Rp 200,000 1
51 6/2/2020 Suction Satu Rp 50,000 1
Terbilang : Lima juta sembilan ratus dua belas ribu tiga ratus rupiah Total Seluruh :
Diskon :
Tagihan :
Palembang,

Rp 5,912,300
BRUTO
Rp 1,200,000
Rp 120,000
Rp 1,000,000
Rp 270,000
Rp 200,000
Rp 17,500
Rp 1,500
Rp 29,000
Rp 16,500
Rp 7,000
Rp 7,000
Rp 80,000
Rp 20,000
Rp 17,000
Rp 4,000
Rp 58,500
Rp 6,900
Rp 36,000
Rp 1,800
Rp 3,600
Rp 3,000
Rp 3,500
Rp 37,000
Rp 36,000
Rp 14,000
Rp 6,000
Rp 29,000
Rp 1,500
Rp 26,000
Rp 50,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 450,000
Rp 450,000
Rp 45,000
Rp 30,000
Rp 30,000
Rp 35,000
Rp 100,000
Rp 120,000
Rp 120,000
Rp 400,000
Rp 200,000
Rp 9,000
Rp 15,000
Rp 200,000
Rp 200,000
Rp 50,000
BRUTO
Rp 5,912,300
RSIA BUNDA NONI
No. Reg : 007252

Nama Pasien : Elya Mahandika Total Seluruh : Rp 15,643,412
Alamat : Asmil Yonif 200 palembang Tagihan :

1 7/3/2020 Jasa dr OP SC Satu Rp 2,160,000 1 Rp 2,160,000
2 7/3/2020 Jasa dr Ant SC Satu Rp 720,000 1 Rp 720,000
3 7/3/2020 Penata Ant SC Satu Rp 400,000 1 Rp 400,000
4 7/3/2020 Asisten dr OP Satu Rp 250,000 1 Rp 250,000
5 7/3/2020 Intrumen dr Satu Rp 191,250 1 Rp 191,250
6 7/3/2020 Konsultasi dr Penyakit Dalam Satu Rp 204,000 1 Rp 204,000
8 7/3/2020 Kamar Operasi Satu Rp 2,805,000 1 Rp 2,805,000
9 7/3/2020 Oksigen Satu Rp 382,500 1 Rp 382,500
11 7/3/2020 ALKOHOL SWAB Satu Rp 1,500 1 Rp 1,500
13 7/3/2020 ASAM MEFENAMAT CAP Satu Rp 1,000 9 Rp 9,000
14 7/3/2020 ASAM TRANEKSAMAT 100 MG/ML Satu Rp 9,500 2 Rp 19,000
16 7/3/2020 CATETER NO 16 Satu Rp 40,500 1 Rp 40,500
17 7/3/2020 CEFOTAXIM VIAL Satu Rp 19,404 4 Rp 77,616
18 7/3/2020 CIPROFLOXACIN 500 MG Satu Rp 1,500 10 Rp 15,000
19 7/3/2020 D5% 500 ML Satu Rp 17,500 2 Rp 35,000
20 7/3/2020 DEXAMETHASONE AMP Satu Rp 4,500 8 Rp 36,000
21 7/3/2020 EPEDRIN HCL AMP Satu Rp 57,500 1 Rp 57,500
22 7/3/2020 GELANG IDENTITAS Satu Rp 4,620 2 Rp 9,240
23 7/3/2020 HANDSPLAST BIASA Satu Rp 1,000 1 Rp 1,000
27 7/3/2020 METRONIDAZOLE 500MG TAB Satu Rp 1,000 9 Rp 9,000
28 7/3/2020 METRONIDAZOLE INFUS 100ML Satu Rp 66,700 3 Rp 200,100
29 7/3/2020 MYOTONIC INJ 1 ML Satu Rp 12,700 1 Rp 12,700
30 7/3/2020 NACL 500 ML Satu Rp 20,000 2 Rp 40,000
31 7/3/2020 NALD NO 23 Satu Rp 1,500 1 Rp 1,500
32 7/3/2020 ONDANSENTRON 4 ML AMP Satu Rp 11,500 2 Rp 23,000
34 7/3/2020 RL 500 ML Satu Rp 11,880 6 Rp 71,280
35 7/3/2020 SOFRATULLE Satu Rp 32,500 1 Rp 32,500
36 7/3/2020 SPINOCAN NO 27 Satu Rp 63,500 1 Rp 63,500
42 7/3/2020 STIK HB Satu Rp 36,000 2 Rp 72,000
43 7/3/2020 SURGICAL BLADS NO 21 Satu Rp 17,500 1 Rp 17,500
44 7/3/2020 T-PLAIN CATGUT 0 Satu Rp 73,000 1 Rp 73,000
45 7/3/2020 T-PLAIN CATGUT 2-0 Satu Rp 77,500 1 Rp 77,500
46 7/3/2020 TRAMADOL INJ 100MG/2ML Satu Rp 9,800 1 Rp 9,800
47 7/3/2020 T-VIO 3-0 Satu Rp 103,500 1 Rp 103,500
49 7/3/2020 URINE BAG Satu Rp 11,500 1 Rp 11,500
50 7/3/2020 HANDSAPLAS ROLL Satu Rp 8,500 1 Rp 8,500
51 7/3/2020 T-VIO 1 PGA 100 Satu Rp 130,000 1 Rp 130,000
52 7/3/2020 SUPRAFENID SUPP Satu Rp 17,500 3 Rp 52,500
54 7/3/2020 LEVICA Satu Rp 70,000 1 Rp 70,000
55 7/3/2020 Vagina Thoucher Satu Rp 50,000 2 Rp 100,000
56 7/3/2020 Electro Kardiographi (EKG) Satu Rp 80,000 1 Rp 80,000
60 7/3/2020 Hemoglobin Manual Satu Rp 28,000 1 Rp 28,000
61 7/3/2020 Protein urine Satu Rp 57,000 1 Rp 57,000
66 7/3/2020 Tindakan infus Satu Rp 318,750 1 Rp 318,750
69 7/3/2020 Pre Operatif Satu Rp 892,500 1 Rp 892,500
71 7/4/2020 Jasa Dokter Kebidanan Visite Ke Satu Rp 204,000 1 Rp 204,000
79 7/3/2020 Perawatan HCU Satu Rp 500,000 1 Rp 500,000
80 7/3/2020 Pasang Chateter Satu Rp 70,000 1 Rp 70,000
Terbilang : Lima belas juta enam ratus empat puluh tiga ribu Total Seluruh : Rp 15,643,412
empat ratus dua belas rupiah Diskon :
Tagihan :
Rini Aprilianti
RSIA BUNDA NONI
No. Reg : 007941

Nama Pasien : Yuni Seriani Total Seluruh
Tgl. Lahir : 25 Mei 1995 Diskon
Alamat : Jl. Lettu Karim Kadir Tagihan
Perawatan : Rawat Inap Dibayar
Kelas : Tiga Kemalian
No TANGGAL URAIAN KELAS TARIF

1 7/1/2020 Jasa dr OP SC Tiga Rp 1,540,000
2 7/1/2020 Jasa dr Ant SC Tiga Rp 600,000
3 7/1/2020 Penata Ant SC Tiga Rp 300,000
4 7/1/2020 Asisten dr OP Tiga Rp 250,000
5 7/1/2020 Intrumen dr Tiga Rp 150,000
6 7/1/2020 Konsultasi dr Penyakit Dalam Tiga Rp 150,000
7 7/1/2020 Kamar Operasi Tiga Rp 2,200,000
8 7/1/2020 Oksigen Tiga Rp 275,000
9 7/1/2020 ABOCATH NO 18 Tiga Rp 14,700
10 7/1/2020 ALKOHOL AWABS Tiga Rp 1,500
11 7/1/2020 AQUA PRO INJ (OTSUKA) Tiga Rp 10,626
12 7/1/2020 ASAM MEFENAMAT CAP Tiga Rp 1,000
13 7/1/2020 ASAM TRANEKSAMAT 100 MG/ML Tiga Rp 9,500
14 7/1/2020 BLOOD SET Tiga Rp 29,000
15 7/1/2020 CATETER NO 16 Tiga Rp 40,500
16 7/1/2020 CEFOTAXIM VIAL Tiga Rp 19,404
17 7/1/2020 CIPROFLOXACIN 500 MG Tiga Rp 1,500
18 7/1/2020 D5% 500 ML Tiga Rp 17,500
19 7/1/2020 Jasa Dokter Anak SC Tiga Rp 420,000
20 7/1/2020 EPEDRIN HCL AMP Tiga Rp 57,500
21 7/1/2020 GELANG IBU Tiga Rp 4,620
22 7/1/2020 GELANG BAYI Tiga Rp 4,620
23 7/1/2020 HANDSPLAST BIASA Tiga Rp 1,000
25 7/1/2020 HANDSCOON GAMEX NO 7.5 Tiga Rp 20,000
26 7/1/2020 KASSA STERIL 16X16MH Tiga Rp 17,000
27 7/1/2020 METRONIDAZOLE 500MG TAB Tiga Rp 1,000
28 7/1/2020 METRONIDAZOLE INFUS 100ML Tiga Rp 66,700
29 7/1/2020 Cek CRP Bayi Tiga Rp 230,000
30 7/1/2020 NACL 500 ML Tiga Rp 20,000
31 7/1/2020 NALD NO 23 Tiga Rp 15,000
32 7/1/2020 ONDANSENTRON 4 ML AMP Tiga Rp 11,500
33 7/1/2020 OXYTOCIN AMP Tiga Rp 13,002
34 7/1/2020 PHYTOMENADION Tiga Rp 6,900
35 7/1/2020 RL 500 ML Tiga Rp 11,880
36 7/1/2020 SOFRATULLE Tiga Rp 32,500
37 7/1/2020 SPINOCAN NO 27 Tiga Rp 63,500
38 7/1/2020 SPUIT 1 ML Tiga Rp 1,800
39 7/1/2020 SPUIT 10 ML Tiga Rp 4,500
40 7/1/2020 SPUIT 3 ML Tiga Rp 2,503
41 7/1/2020 SPUIT 3 ML Tiga Rp 2,503
42 7/1/2020 SPUIT 5 ML Tiga Rp 3,500
43 7/1/2020 STIK BSS Tiga Rp 37,000
44 7/1/2020 STIK HB Tiga Rp 1,650
45 7/1/2020 SUCTION CATHETER NO 8 Tiga Rp 14,000
46 7/1/2020 SURGICAL BLADS NO 21 Tiga Rp 17,500
47 7/1/2020 T-PLAIN CATGUT 0 Tiga Rp 73,000
48 7/1/2020 T-PLAIN CATGUT 2-0 Tiga Rp 77,500
49 7/1/2020 TRAMADOL INJ 100MG/2ML Tiga Rp 9,800
50 7/1/2020 T-VIO 3-0 Tiga Rp 103,500
51 7/1/2020 UMBILLICAL Tiga Rp 6,000
52 7/1/2020 UNDERPAD Tiga Rp 24,360
53 7/1/2020 URINE BAG Tiga Rp 11,500
54 7/1/2020 HANDSAPLAS ROLL Tiga Rp 8,500
55 7/1/2020 T-VIO 1 PGA 100 Tiga Rp 130,000
56 7/1/2020 SUPRAFENID SUPP Tiga Rp 17,500
57 7/1/2020 HANDSCOON BIASA Tiga Rp 2,750
58 7/1/2020 HANDSCOON BIASA Tiga Rp 2,750
59 7/1/2020 LEVICA Tiga Rp 70,000
60 7/1/2020 Vagina Thoucher Tiga Rp 50,000
61 7/1/2020 Electro Kardiographi (EKG) Tiga Rp 80,000
62 7/1/2020 Doppler Tiga Rp 25,000
63 7/1/2020 Darah Rutin Tiga Rp 100,000
64 7/1/2020 BSS Manual Tiga Rp 31,000
65 7/1/2020 Hemoglobin Manual Tiga Rp 28,000
66 7/1/2020 Kamar Ruang Perawatan Tiga Rp 330,000
69 7/1/2020 Tindakan Infus Tiga Rp 275,000
70 7/1/2020 Injeksi Tiga Rp 20,000
71 7/2/2020 Injeksi Tiga Rp 20,000
72 7/1/2020 Supositoria Tiga Rp 20,000
73 7/2/2020 Supositoria Tiga Rp 20,000
74 7/1/2020 Biaya Pendaftaran Rawat Inap Tiga Rp 110,000
75 7/1/2020 Jasa Dokter Kebidanan Visite Ke Ruangan Tiga Rp 110,000
78 7/3/2020 Jasa Dokter Anak Visite Ke Ruangan Tiga Rp 110,000
79 7/3/2020 Jasa Dokter Anak Visite Ke Ruangan Tiga Rp 110,000
80 7/1/2020 Perawatan Ibu Tiga Rp 165,000
83 7/1/2020 Perawatan Anak Tiga Rp 165,000
86 7/1/2020 Pasang Chateter Tiga Rp 70,000
87 7/1/2020 Suction Tiga Rp 40,000
NO TANGGAL URAIAN KELAS TARIF
Terbilang : Sebelas juta seratus delapan puluh enam ribu Total Seluruh
seratus tiga puluh rupiah Diskon
Tagihan

: Rp 11,186,130
:
:
:
:
QTY BRUTO
1 Rp 1,540,000
1 Rp 600,000
1 Rp 300,000
1 Rp 250,000
1 Rp 150,000
1 Rp 150,000
1 Rp 2,200,000
1 Rp 275,000
1 Rp 14,700
2 Rp 3,000
4 Rp 42,504
9 Rp 9,000
2 Rp 19,000
1 Rp 29,000
1 Rp 40,500
2 Rp 38,808
10 Rp 15,000
1 Rp 17,500
1 Rp 420,000
1 Rp 57,500
1 Rp 4,620
1 Rp 4,620
1 Rp 1,000
4 Rp 80,000
3 Rp 51,000
9 Rp 9,000
3 Rp 200,100
1 Rp 230,000
1 Rp 20,000
1 Rp 15,000
2 Rp 23,000
5 Rp 65,010
1 Rp 6,900
6 Rp 71,280
1 Rp 32,500
1 Rp 63,500
1 Rp 1,800
2 Rp 9,000
1 Rp 2,503
5 Rp 12,515
2 Rp 7,000
1 Rp 37,000
1 Rp 1,650
1 Rp 14,000
1 Rp 17,500
1 Rp 73,000
1 Rp 77,500
3 Rp 29,400
1 Rp 103,500
1 Rp 6,000
2 Rp 48,720
1 Rp 11,500
1 Rp 8,500
1 Rp 130,000
2 Rp 35,000
2 Rp 5,500
6 Rp 16,500
1 Rp 70,000
1 Rp 50,000
1 Rp 80,000
1 Rp 25,000
1 Rp 100,000
1 Rp 31,000
1 Rp 28,000
1 Rp 330,000
1 Rp 330,000
1 Rp 330,000
1 Rp 275,000
1 Rp 20,000
1 Rp 20,000
1 Rp 20,000
1 Rp 20,000
1 Rp 110,000
1 Rp 110,000
1 Rp 110,000
1 Rp 110,000
1 Rp 110,000
1 Rp 110,000
1 Rp 165,000
1 Rp 165,000
1 Rp 165,000
1 Rp 165,000
1 Rp 165,000
1 Rp 165,000
1 Rp 70,000
1 Rp 40,000
QTY BRUTO
: Rp 11,186,130
:
:
mbang, 03 Juli 2020
Aprilianti, Amd.keb
RSIA BUNDA NONI
No. Reg : 006342

Nama Pasien : Nyayu Ratih Mahesa Total Seluruh : Rp 11,215,130
Tgl. Lahir : 10 Desember 1997 Diskon :
Alamat : Jl. Dharmapala No.38 Tagihan :

18 7/1/2020 D5% 500 ML Tiga Rp 17,500 1 Rp 17,500
19 7/1/2020 Jasa Dokter Anak SC Tiga Rp 420,000 1 Rp 420,000
22 7/1/2020 GELANG BAYI Tiga Rp 4,620 1 Rp 4,620
29 7/1/2020 Cek CRP Bayi Tiga Rp 230,000 1 Rp 230,000
30 7/1/2020 NACL 500 ML Tiga Rp 20,000 2 Rp 40,000
31 7/1/2020 NALD NO 23 Tiga Rp 15,000 1 Rp 15,000
35 7/1/2020 RL 500 ML Tiga Rp 11,880 6 Rp 71,280
44 7/1/2020 STIK HB Tiga Rp 1,650 1 Rp 1,650
50 7/1/2020 T-VIO 3-0 Tiga Rp 103,500 1 Rp 103,500
59 7/1/2020 LEVICA Tiga Rp 70,000 1 Rp 70,000
60 7/1/2020 Vagina Thoucher Tiga Rp 50,000 1 Rp 50,000
69 7/1/2020 Tindakan Infus Tiga Rp 275,000 1 Rp 275,000
75 7/1/2020 Jasa Dokter Kebidanan Visite Ke Ruang Tiga Rp 110,000 1 Rp 110,000
83 7/1/2020 Perawatan Anak Tiga Rp 165,000 1 Rp 165,000
Terbilang : Sebelas juta dua ratus lima belas ribu Total Seluruh : Rp 11,215,130
seratus tiga puluh rupiah Diskon :
Tagihan :

RSIA BUNDA NONI
No. Reg : 005711

Nama Pasien : Hartati Total Seluruh :
Tgl. Lahir : 13 november 1989 Diskon :
Alamat : Jl. Irigasi Palembang Tagihan :

10 7/18/2020 Oksigen Dua Rp 300,000 1
11 7/18/2020 ABOCATH NO 20 Dua Rp 17,500 1
16 7/18/2020 BLOOD SET Dua Rp 29,000 1
17 7/18/2020 CATETER NO 16 Dua Rp 40,500 1
20 7/18/2020 D5% 500 ML Dua Rp 17,500 2
23 7/18/2020 GELANG IBU Dua Rp 4,620 1
31 7/18/2020 NACL 500 ML Dua Rp 20,000 2
32 7/18/2020 NALD NO 23 Dua Rp 1,500 2
35 7/18/2020 RL 500 ML Dua Rp 11,880 5
38 7/18/2020 SPUIT 1 ML Dua Rp 1,800 1
39 7/18/2020 SPUIT 10 ML Dua Rp 4,500 2
40 7/18/2020 SPUIT 3 ML Dua Rp 3,000 3
41 7/18/2020 SPUIT 5 ML Dua Rp 3,500 2
42 7/18/2020 STIK BSS Dua Rp 37,000 1
43 7/18/2020 STIK HB Dua Rp 36,000 2
48 7/18/2020 T-VIO 3-0 Dua Rp 103,500 1
49 7/18/2020 UNDERPAD Dua Rp 29,000 1
50 7/18/2020 URINE BAG Dua Rp 11,500 1
52 7/18/2020 T-VIO 1 PGA 100 Dua Rp 130,000 2
55 7/18/2020 LEVICA Dua Rp 70,000 1
57 7/18/2020 Doppler Dua Rp 25,000 1
59 7/18/2020 BSS Manual Dua Rp 31,000 1
65 7/18/2020 Injeksi Dua Rp 20,000 1
66 7/19/2020 Injeksi Dua Rp 20,000 1
Terbilang : Sebelas juta tujuh ratus dua puluh tujuh ribu Total Seluruh :
lima ratus empat puluh rupiah Diskon :
Tagihan :
Rini Aprilianti
Rp 11,727,540
BRUTO
Rp 1,888,000
Rp 650,000
Rp 420,000
Rp 250,000
Rp 180,000
Rp 150,000
Rp 2,520,000
Rp 300,000
Rp 17,500
Rp 1,500
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 38,808
Rp 9,000
Rp 35,000
Rp 36,000
Rp 57,500
Rp 4,620
Rp 1,000
Rp 60,000
Rp 80,000
Rp 34,000
Rp 9,000
Rp 200,100
Rp 25,400
Rp 40,000
Rp 3,000
Rp 23,000
Rp 78,012
Rp 59,400
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 9,000
Rp 7,000
Rp 37,000
Rp 72,000
Rp 17,500
Rp 73,000
Rp 77,500
Rp 29,400
Rp 103,500
Rp 29,000
Rp 11,500
Rp 8,500
Rp 260,000
Rp 52,500
Rp 52,000
Rp 70,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 57,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 120,000
Rp 132,000
Rp 132,000
Rp 132,000
Rp 210,000
Rp 210,000
Rp 210,000
Rp 500,000
BRUTO
Rp 11,727,540
RSIA BUNDA NONI
No. Reg : 007660

Nama Pasien : Putri Aditia Total Seluruh :
Tgl. Lahir : 30 agustus 1996 Diskon :
Alamat : Jl. Sultan M.Mansyur Tagihan :
Kelas Kemalian :

1 4/1/2020 Konsultasi Penyakit Dalam Tiga Rp 150,000 1
2 3/31/2020 ABOCATH 20 Tiga Rp 17,500 1
3 3/31/2020 BLOOD SET Tiga Rp 29,000 1
4 3/31/2020 D5% 500 ML Tiga Rp 17,500 2
5 3/31/2020 DEXAMETHASONE AMP Tiga Rp 4,500 2
6 3/31/2020 Aquades Tiga Rp 5,000 1
8 3/31/2020 NIFEDIPIN Tiga Rp 1,000 10
9 3/31/2020 ULTRAGESTON Tiga Rp 18,000 1
10 3/31/2020 RL 500 ML Tiga Rp 18,000 6
11 3/31/2020 SPUIT 3 ML Tiga Rp 3,000 3
12 3/31/2020 STIK BSS Tiga Rp 37,000 1
13 3/31/2020 STIK HB Tiga Rp 36,000 1
16 3/31/2020 Doppler Tiga Rp 25,000 1
17 4/1/2020 Doppler Tiga Rp 25,000 1
18 4/2/2020 Doppler Tiga Rp 25,000 1
22 3/31/2020 Print USG 3D tanpa foto Tiga Rp 75,000 1
28 3/31/2020 Injeksi Tiga Rp 20,000 1
29 4/1/2020 Injeksi Tiga Rp 20,000 1
30 4/2/2020 Injeksi Tiga Rp 20,000 1
Terbilang : Dua juta lima ratus sembilan puluh lima ribu Total Seluruh :
Lima ratus rupiah Diskon :
Tagihan :
Palembang,

Rp 2,595,500
BRUTO
Rp 150,000
Rp 17,500
Rp 29,000
Rp 35,000
Rp 9,000
Rp 5,000
Rp 7,000
Rp 10,000
Rp 18,000
Rp 108,000
Rp 9,000
Rp 37,000
Rp 36,000
Rp 25,000
Rp 25,000
Rp 25,000
Rp 100,000
Rp 75,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 40,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 25,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 150,000
Rp 150,000
Rp 150,000
BRUTO
Rp 2,595,500
RSIA BUNDA NONI
No. Reg : 007915

Nama Pasien : Kismeri Total Seluruh :
Tgl. Lahir : 01 April 1996 Diskon :
Alamat : Jl. Waringin Laut Tagihan :

8 6/20/2020 Oksigen Tiga Rp 200,000 1
14 6/20/2020 BLOOD SET Tiga Rp 29,000 1
18 6/20/2020 D5% 500 ML Tiga Rp 17,500 10
29 6/20/2020 MYOTONIC INJ 1 ML Tiga Rp 12,700 2
30 6/20/2020 NACL 500 ML Tiga Rp 20,000 2
31 6/20/2020 NALD NO 23 Tiga Rp 15,000 1
35 6/20/2020 RL 500 ML Tiga Rp 18,000 6
38 6/20/2020 SPUIT 1 ML Tiga Rp 1,800 1
39 6/20/2020 SPUIT 10 ML Tiga Rp 4,500 2
40 6/20/2020 Antasida Tab Tiga Rp 1,000 9
41 6/20/2020 SPUIT 3 ML Tiga Rp 3,000 6
42 6/20/2020 SPUIT 5 ML Tiga Rp 3,500 2
43 6/20/2020 STIK BSS Tiga Rp 37,000 1
44 6/20/2020 STIK HB Tiga Rp 36,000 1
50 6/20/2020 T-VIO 3-0 Tiga Rp 103,500 1
52 6/20/2020 UNDERPAD Tiga Rp 29,000 1
53 6/20/2020 URINE BAG Tiga Rp 11,500 1
55 6/20/2020 T-VIO 1 PGA 100 Tiga Rp 130,000 1
59 6/20/2020 LEVICA Tiga Rp 70,000 1
60 6/20/2020 Vagina Thouvher Tiga Rp 50,000 1
62 6/20/2020 Doppler Tiga Rp 25,000 1
69 6/20/2020 Washen Tiga Rp 20,000 1
71 6/20/2020 Injeksi Tiga Rp 20,000 1
72 6/21/2020 Injeksi Tiga Rp 20,000 1
75 6/20/2020 Cukur Tiga Rp 30,000 1
79 6/20/2020 Ganti Balut Tiga Rp 30,000 1
88 6/20/2020 Perawatan HCU Tiga Rp 500,000 1
90 6/20/2020 Suction Tiga Rp 40,000 1
Terbilang : Sepuluh juta tujuh ribu lima ratus rupiah Total Seluruh :
Diskon :
Tagihan :
Palembang, 21 Juni 2020
Rini Aprilianti
Rp 10,007,500
BRUTO
Rp 1,400,000
Rp 600,000
Rp 300,000
Rp 250,000
Rp 150,000
Rp 150,000
Rp 2,000,000
Rp 200,000
Rp 17,500
Rp 3,000
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 42,000
Rp 9,000
Rp 175,000
Rp 9,000
Rp 57,500
Rp 7,000
Rp 6,900
Rp 1,000
Rp 80,000
Rp 51,000
Rp 9,000
Rp 200,100
Rp 25,400
Rp 40,000
Rp 15,000
Rp 46,000
Rp 97,500
Rp 6,900
Rp 108,000
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 9,000
Rp 18,000
Rp 7,000
Rp 37,000
Rp 36,000
Rp 14,000
Rp 17,500
Rp 73,000
Rp 77,500
Rp 29,400
Rp 103,500
Rp 6,000
Rp 29,000
Rp 11,500
Rp 8,500
Rp 130,000
Rp 52,500
Rp 13,000
Rp 39,000
Rp 70,000
Rp 50,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 20,000
Rp 40,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 25,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 500,000
Rp 70,000
Rp 40,000
BRUTO
Rp 10,007,500
RSIA BUNDA NONI
No. Reg : 007698

Nama Pasien : Torisah Total Seluruh :
Tgl. Lahir : 01 mei 1978 Diskon :
Alamat : Jl. Rambutan dalam Tagihan :

8 4/9/2020 Oksigen Tiga Rp 200,000 1
14 4/9/2020 BLOOD SET Tiga Rp 29,000 1
18 4/9/2020 D5% 500 ML Tiga Rp 17,500 1
30 4/9/2020 NACL 500 ML Tiga Rp 20,000 1
31 4/9/2020 NALD NO 23 Tiga Rp 15,000 1
35 4/9/2020 RL 500 ML Tiga Rp 18,000 6
38 4/9/2020 SPUIT 1 ML Tiga Rp 1,800 1
39 4/9/2020 SPUIT 10 ML Tiga Rp 4,500 2
40 4/9/2020 SPUIT 3 ML Tiga Rp 3,000 1
41 4/9/2020 SPUIT 3 ML Tiga Rp 3,000 5
42 4/9/2020 SPUIT 5 ML Tiga Rp 3,500 2
43 4/9/2020 STIK BSS Tiga Rp 37,000 1
44 4/9/2020 STIK HB Tiga Rp 36,000 1
50 4/9/2020 T-VIO 3-0 Tiga Rp 103,500 1
52 4/9/2020 UNDERPAD Tiga Rp 29,000 1
53 4/9/2020 URINE BAG Tiga Rp 11,500 1
55 4/9/2020 T-VIO 1 PGA 100 Tiga Rp 130,000 1
59 4/9/2020 LEVICA Tiga Rp 70,000 1
62 4/9/2020 Doppler Tiga Rp 25,000 1
69 4/9/2020 Washen Tiga Rp 20,000 1
71 4/9/2020 Injeksi Tiga Rp 20,000 1
72 4/9/2020 Injeksi Tiga Rp 20,000 1
75 4/9/2020 Cukur Tiga Rp 30,000 1
89 4/9/2020 Suction Tiga Rp 40,000 1
Terbilang : Sembilan juta tujuh ratus sembilan puluh satu ribu Total Seluruh :
Tagihan :
Palembang,

Rp 9,791,300
BRUTO
Rp 1,400,000
Rp 600,000
Rp 300,000
Rp 250,000
Rp 150,000
Rp 150,000
Rp 2,000,000
Rp 200,000
Rp 17,500
Rp 3,000
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 42,000
Rp 15,000
Rp 17,500
Rp 9,000
Rp 57,500
Rp 7,000
Rp 6,900
Rp 1,000
Rp 80,000
Rp 51,000
Rp 9,000
Rp 200,100
Rp 12,700
Rp 20,000
Rp 15,000
Rp 23,000
Rp 97,500
Rp 6,900
Rp 108,000
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 3,000
Rp 15,000
Rp 7,000
Rp 37,000
Rp 36,000
Rp 14,000
Rp 17,500
Rp 73,000
Rp 77,500
Rp 29,400
Rp 103,500
Rp 6,000
Rp 29,000
Rp 11,500
Rp 8,500
Rp 130,000
Rp 52,500
Rp 13,000
Rp 39,000
Rp 70,000
Rp 50,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 20,000
Rp 40,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 25,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 500,000
Rp 70,000
Rp 40,000
BRUTO
Rp 9,791,300
RSIA BUNDA NONI
No. Reg : 000814

Nama Pasien : Riri Widyasari Total Seluruh :
Alamat : Jl. Sult.M. Mansyur Palembang Tagihan :

1 6/5/2020 Jasa dr OP SC Satu Rp 1,800,000 1
2 6/5/2020 Jasa dr Ant SC Satu Rp 700,000 1
3 6/5/2020 Penata Ant SC Satu Rp 400,000 1
4 6/5/2020 Asisten dr OP Satu Rp 250,000 1
5 6/5/2020 Intrumen dr Satu Rp 150,000 1
6 6/5/2020 Konsultasi dr Penyakit Dalam Satu Rp 150,000 1
7 6/5/2020 Kamar Operasi Satu Rp 2,200,000 1
8 6/5/2020 Oksigen Satu Rp 200,000 1
10 6/5/2020 ALKOHOL SWAB Satu Rp 1,500 1
11 6/5/2020 AQUA PRO INJ (OTSUKA) Satu Rp 11,500 4
12 6/5/2020 ASAM MEFENAMAT CAP Satu Rp 1,000 9
13 6/5/2020 ASAM TRANEKSAMAT 100 MG/ML Satu Rp 9,500 2
14 6/5/2020 BLOOD SET Satu Rp 29,000 1
15 6/5/2020 CATETER NO 16 Satu Rp 40,500 1
16 6/5/2020 CEFOTAXIM VIAL Satu Rp 21,000 2
17 6/5/2020 CIPROFLOXACIN 500 MG Satu Rp 1,500 10
18 6/5/2020 D5% 500 ML Satu Rp 17,500 2
19 6/5/2020 DEXAMETHASONE AMP Satu Rp 4,500 8
20 6/5/2020 EPEDRIN HCL AMP Satu Rp 57,500 1
22 6/5/2020 HANDSPLAST BIASA Satu Rp 1,000 1
25 6/5/2020 KASSA STERIL 16X16MH Satu Rp 17,000 2
26 6/5/2020 METRONIDAZOLE 500MG TAB Satu Rp 1,000 9
27 6/5/2020 METRONIDAZOLE INFUS 100ML Satu Rp 66,700 3
28 6/5/2020 MYOTONIC INJ 1 ML Satu Rp 12,700 1
29 6/5/2020 NACL 500 ML Satu Rp 20,000 2
30 6/5/2020 NALD NO 23 Satu Rp 1,500 1
31 6/5/2020 ONDANSENTRON 4 ML AMP Satu Rp 11,500 2
33 6/5/2020 RL 500 ML Satu Rp 18,000 6
34 6/5/2020 SOFRATULLE Satu Rp 32,500 1
35 6/5/2020 SPINOCAN NO 27 Satu Rp 63,500 1
36 6/5/2020 SPUIT 1 ML Satu Rp 1,800 1
37 6/5/2020 SPUIT 10 ML Satu Rp 4,500 2
38 6/5/2020 SPUIT 3 ML Satu Rp 3,000 3
39 6/5/2020 SPUIT 5 ML Satu Rp 3,500 2
40 6/5/2020 STIK BSS Satu Rp 37,000 1
41 6/5/2020 STIK HB Satu Rp 36,000 2
42 6/5/2020 SURGICAL BLADS NO 21 Satu Rp 17,500 1
43 6/5/2020 T-PLAIN CATGUT 0 Satu Rp 73,000 1
44 6/5/2020 T-PLAIN CATGUT 2-0 Satu Rp 77,500 1
45 6/5/2020 TRAMADOL INJ 100MG/2ML Satu Rp 9,800 1
46 6/5/2020 T-VIO 3-0 Satu Rp 103,500 1
47 6/5/2020 UNDERPAD Satu Rp 29,000 1
48 6/5/2020 URINE BAG Satu Rp 11,500 1
49 6/5/2020 HANDSAPLAS ROLL Satu Rp 8,500 1
50 6/5/2020 T-VIO 1 PGA 100 Satu Rp 130,000 1
51 6/5/2020 SUPRAFENID SUPP Satu Rp 17,500 3
53 6/5/2020 LEVICA Satu Rp 70,000 1
54 6/5/2020 Vagina Thouvher Satu Rp 50,000 2
55 6/5/2020 Electro Kardiographi (EKG) Satu Rp 80,000 1
56 6/5/2020 Doppler Satu Rp 25,000 1
59 6/5/2020 Hemoglobin Manual Satu Rp 28,000 1
60 6/5/2020 Protein urine Satu Rp 57,000 1
64 6/5/2020 Washen Satu Rp 30,000 1
66 6/5/2020 Injeksi Satu Rp 30,000 1
67 6/6/2020 Injeksi Satu Rp 30,000 1
69 6/5/2020 Cukur Satu Rp 30,000 1
70 6/5/2020 Skin Test Satu Rp 30,000 1
71 6/5/2020 Supositoria Satu Rp 30,000 1
73 6/5/2020 Ganti Balut Satu Rp 30,000 1
84 6/5/2020 Perawatan HCU Satu Rp 500,000 1
Terbilang : Dua belas juta dua ratus tiga ribu Total Seluruh :
empat ratus rupiah Diskon :
Tagihan :
Palembang,
Rini Aprilianti
Rp 12,203,400
BRUTO
Rp 1,800,000
Rp 700,000
Rp 400,000
Rp 250,000
Rp 150,000
Rp 150,000
Rp 2,200,000
Rp 200,000
Rp 35,000
Rp 1,500
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 42,000
Rp 15,000
Rp 35,000
Rp 36,000
Rp 57,500
Rp 7,000
Rp 1,000
Rp 80,000
Rp 60,000
Rp 34,000
Rp 9,000
Rp 200,100
Rp 12,700
Rp 40,000
Rp 1,500
Rp 23,000
Rp 117,000
Rp 108,000
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 9,000
Rp 7,000
Rp 37,000
Rp 72,000
Rp 17,500
Rp 73,000
Rp 77,500
Rp 9,800
Rp 103,500
Rp 29,000
Rp 11,500
Rp 8,500
Rp 130,000
Rp 52,500
Rp 39,000
Rp 70,000
Rp 100,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 57,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 30,000
Rp 45,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 25,000
Rp 100,000
Rp 120,000
Rp 120,000
Rp 120,000
Rp 120,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 500,000
BRUTO
Rp 12,203,400
RSIA BUNDA NONI
No. Reg : 007402

Nama Pasien : Tri Indah Kriswanti Total Seluruh :
Alamat : Jl. Kemuning No. 705 Palembang Tagihan :

10 6/8/2020 Oksigen Dua Rp 200,000 1
11 6/8/2020 ABOCATH NO 20 Dua Rp 17,500 1
16 6/8/2020 BLOOD SET Dua Rp 29,000 1
17 6/8/2020 CATETER NO 16 Dua Rp 40,500 1
20 6/8/2020 D5% 500 ML Dua Rp 17,500 2
23 6/8/2020 GELANG IBU Dua Rp 7,000 1
30 6/8/2020 NIFEDIPINE 10 MG Dua Rp 1,000 10
31 6/8/2020 NACL 500 ML Dua Rp 20,000 2
32 6/8/2020 NALD NO 23 Dua Rp 1,500 2
35 6/8/2020 RL 500 ML Dua Rp 18,000 5
38 6/8/2020 SPUIT 1 ML Dua Rp 1,800 1
39 6/8/2020 SPUIT 10 ML Dua Rp 4,500 2
40 6/8/2020 SPUIT 3 ML Dua Rp 3,000 3
41 6/8/2020 SPUIT 5 ML Dua Rp 3,500 2
42 6/8/2020 STIK BSS Dua Rp 37,000 1
43 6/8/2020 STIK HB Dua Rp 36,000 2
48 6/8/2020 T-VIO 3-0 Dua Rp 103,500 1
49 6/8/2020 UNDERPAD Dua Rp 29,000 1
50 6/8/2020 URINE BAG Dua Rp 11,500 1
52 6/8/2020 T-VIO 1 PGA 100 Dua Rp 130,000 2
55 6/8/2020 LEVICA Dua Rp 70,000 1
56 6/8/2020 Vagina Thouvher Dua Rp 50,000 1
58 6/8/2020 Doppler Dua Rp 25,000 1
60 6/8/2020 BSS Manual Dua Rp 31,000 1
67 6/8/2020 Washen Dua Rp 30,000 1
69 6/8/2020 Injeksi Dua Rp 20,000 1
70 6/8/2020 Injeksi Dua Rp 20,000 1
71 6/8/2020 Vulva Hygiene Dua Rp 20,000 1
72 6/8/2020 Cukur Dua Rp 20,000 1
73 6/8/2020 Skin Test Dua Rp 20,000 1
76 6/8/2020 Ganti Balut Dua Rp 30,000 1
77 6/8/2020 Up Chateter/Infus Dua Rp 20,000 1
87 6/8/2020 Suction Dua Rp 40,000 1
88 6/8/2020 Pasang Chateter Dua Rp 70,000 1
Terbilang : sebelas juta empat ratus tiga puluh sembilan ribu Total Seluruh :
enam ratus rupiah Diskon :
Tagihan :
Rini Aprilianti
Rp 11,439,600
BRUTO
Rp 1,600,000
Rp 650,000
Rp 350,000
Rp 250,000
Rp 150,000
Rp 150,000
Rp 2,100,000
Rp 200,000
Rp 17,500
Rp 1,500
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 42,000
Rp 9,000
Rp 35,000
Rp 18,000
Rp 57,500
Rp 7,000
Rp 1,000
Rp 60,000
Rp 40,000
Rp 34,000
Rp 9,000
Rp 200,100
Rp 10,000
Rp 40,000
Rp 3,000
Rp 46,000
Rp 97,500
Rp 90,000
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 9,000
Rp 7,000
Rp 37,000
Rp 72,000
Rp 17,500
Rp 146,000
Rp 77,500
Rp 39,200
Rp 103,500
Rp 29,000
Rp 11,500
Rp 8,500
Rp 260,000
Rp 52,500
Rp 52,000
Rp 70,000
Rp 50,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 30,000
Rp 45,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 20,000
Rp 100,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 500,000
Rp 40,000
Rp 70,000
BRUTO
Rp 11,439,600
11 Juni 2020
RSIA BUNDA NONI
No. Reg : 007836

Nama Pasien : Sulistiana Total Seluruh :
Alamat : Jl. Srijaya negara lrg. Karyawan Tagihan :

10 5/27/2020 Oksigen Dua Rp 200,000 1
11 5/27/2020 ABOCATH NO 20 Dua Rp 17,500 1
16 5/27/2020 BLOOD SET Dua Rp 29,000 1
17 5/27/2020 CATETER NO 16 Dua Rp 40,500 1
20 5/27/2020 D5% 500 ML Dua Rp 17,500 2
23 5/27/2020 GELANG IBU Dua Rp 7,000 1
31 5/27/2020 NACL 500 ML Dua Rp 20,000 2
32 5/27/2020 NALD NO 23 Dua Rp 1,500 2
35 5/27/2020 RL 500 ML Dua Rp 18,000 5
38 5/27/2020 SPUIT 1 ML Dua Rp 1,800 1
39 5/27/2020 SPUIT 10 ML Dua Rp 4,500 2
40 5/27/2020 SPUIT 3 ML Dua Rp 3,000 3
41 5/27/2020 SPUIT 5 ML Dua Rp 3,500 2
42 5/27/2020 STIK BSS Dua Rp 37,000 1
43 5/27/2020 STIK HB Dua Rp 36,000 2
48 5/27/2020 T-VIO 3-0 Dua Rp 103,500 1
49 5/27/2020 UNDERPAD Dua Rp 29,000 1
50 5/27/2020 URINE BAG Dua Rp 11,500 1
52 5/27/2020 T-VIO 1 PGA 100 Dua Rp 130,000 2
55 5/27/2020 LEVICA Dua Rp 70,000 1
58 5/27/2020 Doppler Dua Rp 25,000 1
60 5/27/2020 BSS Manual Dua Rp 31,000 1
68 5/27/2020 Washen Dua Rp 30,000 1
70 5/27/2020 Injeksi Dua Rp 20,000 1
71 5/27/2020 Injeksi Dua Rp 20,000 1
74 5/27/2020 Cukur Dua Rp 20,000 1
75 5/27/2020 Skin Test Dua Rp 20,000 1
81 5/27/2020 Jasa Dokter Kebidanan Visite Ke Ruanga Dua Rp 110,000 1
69 5/28/2020 lepas Infus Dua Rp 45,000 1
90 5/27/2020 Suction Dua Rp 40,000 1
91 5/27/2020 Pasang Chateter Dua Rp 70,000 1
Terbilang : sepuluh juta delapan ratus enam puluh ribu rupiah Total Seluruh :
Diskon :
Tagihan :
Palembang,
Rini Aprilianti
Rp 10,860,000
BRUTO
Rp 1,600,000
Rp 650,000
Rp 350,000
Rp 250,000
Rp 150,000
Rp 150,000
Rp 2,100,000
Rp 200,000
Rp 17,500
Rp 1,500
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 42,000
Rp 9,000
Rp 35,000
Rp 18,000
Rp 57,500
Rp 7,000
Rp 1,000
Rp 60,000
Rp 40,000
Rp 34,000
Rp 9,000
Rp 200,100
Rp 25,400
Rp 40,000
Rp 3,000
Rp 46,000
Rp 97,500
Rp 90,000
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 9,000
Rp 7,000
Rp 37,000
Rp 72,000
Rp 17,500
Rp 146,000
Rp 77,500
Rp 39,200
Rp 103,500
Rp 29,000
Rp 11,500
Rp 8,500
Rp 260,000
Rp 52,500
Rp 52,000
Rp 70,000
Rp 50,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 30,000
Rp 45,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 20,000
Rp 100,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 45,000
Rp 500,000
Rp 40,000
Rp 70,000
BRUTO
Rp 10,860,000
RSIA BUNDA NONI
No. Reg : 007379

Nama Pasien : Dwi Pahlawanti Total Seluruh :
Tgl. Lahir : 10 Nov 1991 Diskon :
Alamat : Jl. Asrama TNI AD Blok E Kalidoni Tagihan :

1 6/29/2020 Jasa dr Kuret Bius Umum Dua Rp 1,200,000 1
2 6/29/2020 Jasa dr Ant Kuret Dua Rp 216,000 1
3 6/29/2020 Penata Ant Kuret Dua Rp 144,000 1
4 6/29/2020 Oksigen Dua Rp 250,000 1
5 6/29/2020 Asisten dr Dua Rp 200,000 1
6 6/29/2020 RUANG KURET Dua Rp 700,000 1
7 6/29/2020 ABOCATH NO 20 Dua Rp 17,500 1
10 6/29/2020 BLOOD SET Dua Rp 29,000 1
13 6/29/2020 D5% 500 ML Dua Rp 17,500 1
14 6/29/2020 FENTANYL AMP Dua Rp 57,500 2
15 6/29/2020 GELANG IBU Dua Rp 7,000 1
18 6/29/2020 ULTRAGESTON Dua Rp 18,000 2
19 6/29/2020 METRONIDAZOLE 500 MG TAB Dua Rp 1,000 9
21 6/29/2020 RECOFOL N Dua Rp 118,000 1
22 6/29/2020 RL 500 ML Dua Rp 18,000 3
23 6/29/2020 USG 3D tanpa foto Dua Rp 75,000 1
24 6/29/2020 SPUIT 1 ML Dua Rp 1,800 1
25 6/29/2020 SPUIT 10 ML Dua Rp 4,500 1
26 6/29/2020 SPUIT 3 ML Dua Rp 3,000 1
27 6/29/2020 SPUIT 5 ML Dua Rp 3,500 1
28 6/29/2020 STIK BSS Dua Rp 37,000 1
29 6/29/2020 STIK HB Dua Rp 36,000 1
30 6/29/2020 UNDERPAD Dua Rp 29,000 1
32 6/29/2020 UTROGESTAN 100 MG Dua Rp 18,000 2
34 6/29/2020 BSS Manual Dua Rp 31,000 1
39 6/29/2020 Washen Dua Rp 30,000 1
41 6/29/2020 Injeksi Dua Rp 30,000 1
42 6/29/2020 Injeksi Dua Rp 30,000 1
44 6/29/2020 Skin Test Dua Rp 30,000 1
Terbilang : Lima juta dua ratus tujuh ribu tiga ratus rupiah Total Seluruh :
Diskon :
Tagihan :
Rini Aprilianti
Rp 5,207,300
BRUTO
Rp 1,200,000
Rp 216,000
Rp 144,000
Rp 250,000
Rp 200,000
Rp 700,000
Rp 17,500
Rp 11,500
Rp 9,000
Rp 29,000
Rp 21,000
Rp 9,000
Rp 17,500
Rp 115,000
Rp 7,000
Rp 40,000
Rp 20,000
Rp 36,000
Rp 9,000
Rp 23,000
Rp 118,000
Rp 54,000
Rp 75,000
Rp 1,800
Rp 4,500
Rp 3,000
Rp 3,500
Rp 37,000
Rp 36,000
Rp 29,000
Rp 26,000
Rp 36,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 375,000
Rp 375,000
Rp 30,000
Rp 45,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 40,000
Rp 35,000
Rp 100,000
Rp 200,000
Rp 200,000
BRUTO
Rp 5,207,300
30 juni 2020
No. RM : 007671
Nama Pasien : Tatik Marini Total Seluruh :
Tgl. Lahir : 01 januari 1991 Diskon :
Alamat : Jl. Padang Selasa Tagihan :

1 4/3/2020 Jasa dr Kuret Bius Umum Tiga Rp 1,000,000 1
2 4/3/2020 Jasa dr Ant Kuret Tiga Rp 180,000 1
3 4/3/2020 Penata Ant Kuret Tiga Rp 120,000 1
4 4/3/2020 Oksigen Tiga Rp 200,000 1
6 4/3/2020 RUANG KURET Tiga Rp 700,000 1
10 4/3/2020 BLOOD SET Tiga Rp 29,000 1
12 4/3/2020 D5% 500 ML Tiga Rp 17,500 1
13 4/3/2020 FENTANYL AMP Tiga Rp 57,500 1
15 4/3/2020 KONSUL DOKTER PENYAKIT DALAM Tiga Rp 150,000 1
17 4/3/2020 RECOFOL N Tiga Rp 118,000 1
18 4/3/2020 RL 500 ML Tiga Rp 18,000 1
19 4/3/2020 RL 500 ML Tiga Rp 18,000 2
20 4/3/2020 SPUIT 1 ML Tiga Rp 1,800 1
21 4/3/2020 SPUIT 10 ML Tiga Rp 4,500 1
22 4/3/2020 SPUIT 10 ML Tiga Rp 4,500 1
23 4/3/2020 SPUIT 3 ML Tiga Rp 3,000 1
24 4/3/2020 SPUIT 5 ML Tiga Rp 3,500 1
25 4/3/2020 SPUIT 5 ML Tiga Rp 3,500 1
26 4/3/2020 STIK BSS Tiga Rp 37,000 1
27 4/3/2020 STIK HB Tiga Rp 36,000 1
38 4/3/2020 Injeksi Tiga Rp 20,000 1
39 4/4/2020 Injeksi Tiga Rp 20,000 1
40 4/5/2020 Injeksi Tiga Rp 20,000 1
Terbilang : Empat juta sembilan ratus delapan puluh sembilan ribu Total Seluruh :
delapan ratus rupiah Diskon :
Tagihan :
Palembang,
Rini Aprilianti, Amd.k

Rp 4,989,800
BRUTO
Rp 1,000,000
Rp 180,000
Rp 120,000
Rp 200,000
Rp 200,000
Rp 700,000
Rp 17,500
Rp 11,500
Rp 11,500
Rp 29,000
Rp 21,000
Rp 17,500
Rp 57,500
Rp 7,000
Rp 150,000
Rp 11,500
Rp 118,000
Rp 18,000
Rp 36,000
Rp 1,800
Rp 4,500
Rp 4,500
Rp 3,000
Rp 3,500
Rp 3,500
Rp 37,000
Rp 36,000
Rp 17,500
Rp 17,500
Rp 13,000
Rp 36,000
Rp 100,000
Rp 31,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 40,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 25,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 150,000
Rp 150,000
Rp 150,000
BRUTO
Rp 4,989,800
RSIA BUNDA NONI
No. Reg : 007907

Nama Pasien : Bayi Nyonya Nurhidayati Islamiah Total Seluruh : Rp 5,042,300
Tgl. Lahir : 15/06/ 2020 Diskon :
Alamat : Jl. Anggrek 1 Tagihan :
Kelas : SATU Kemalian :

1 6/15/2020 ALKOHOL SWABS Satu Rp 1,500 16 Rp 24,000
3 6/15/2020 GELANG BAYI LAKI LAKI Satu Rp 6,900 1 Rp 6,900
6 6/15/2020 PHYTOMENADION Satu Rp 6,900 1 Rp 6,900
9 6/15/2020 SUCTION CATHETER NO 8 Satu Rp 14,000 1 Rp 14,000
10 6/15/2020 UMBILLICAL Satu Rp 6,000 1 Rp 6,000
11 6/15/2020 CEFTAZIDIME VIAL 1G Satu Rp 120,000 2 Rp 240,000
12 6/15/2020 Vaksin Hepatitis B Satu Rp 1,500 1 Rp 1,500
14 6/15/2020 CRP Kuantitatif (P) Satu Rp 230,000 1 Rp 230,000
29 6/16/2020 Jasa Dokter Anak Visite Ke Ruangan Satu Rp 120,000 2 Rp 240,000
34 6/15/2020 Perawatan Anak/Bayi Satu Rp 200,000 1 Rp 200,000
Terbilang : Lima juta empat puluh dua ribu Total Seluruh: Rp 5,042,300
Tagihan :
Rini Aprilianti
RSIA BUNDA NONI
No. Reg : 007878

Nama Pasien : Khoirunnisa Total Seluruh :
Alamat : Jl. Simanjuntak Palembang Tagihan :

9 6/25/2020 Asisten dr anak Dua Rp 250,000 1
10 6/25/2020 Oksigen Dua Rp 200,000 1
11 6/25/2020 ABOCATH NO 20 Dua Rp 17,500 1
16 6/25/2020 BLOOD SET Dua Rp 29,000 1
17 6/25/2020 CATETER NO 16 Dua Rp 40,500 1
20 6/25/2020 D5% 500 ML Dua Rp 17,500 2
23 6/25/2020 GELANG IBU Dua Rp 7,000 1
31 6/25/2020 NACL 500 ML Dua Rp 20,000 2
32 6/25/2020 NALD NO 23 Dua Rp 1,500 2
35 6/25/2020 RL 500 ML Dua Rp 18,000 5
38 6/25/2020 SPUIT 1 ML Dua Rp 1,800 1
39 6/25/2020 SPUIT 10 ML Dua Rp 4,500 2
40 6/25/2020 SPUIT 3 ML Dua Rp 3,000 3
41 6/25/2020 SPUIT 5 ML Dua Rp 3,500 2
42 6/25/2020 STIK BSS Dua Rp 37,000 1
43 6/25/2020 STIK HB Dua Rp 36,000 2
48 6/25/2020 T-VIO 3-0 Dua Rp 103,500 1
49 6/25/2020 UNDERPAD Dua Rp 29,000 1
50 6/25/2020 URINE BAG Dua Rp 11,500 1
52 6/25/2020 T-VIO 1 PGA 100 Dua Rp 130,000 2
55 6/25/2020 LEVICA Dua Rp 70,000 1
58 6/25/2020 Doppler Dua Rp 25,000 1
60 6/25/2020 BSS Manual Dua Rp 31,000 1
66 6/25/2020 Washen Dua Rp 30,000 1
68 6/25/2020 Injeksi Dua Rp 20,000 1
69 6/25/2020 Injeksi Dua Rp 20,000 1
72 6/25/2020 Cukur Dua Rp 20,000 1
73 6/25/2020 Skin Test Dua Rp 20,000 1
85 6/25/2020 Perawatan anak Dua Rp 175,000 1
88 6/25/2020 lepas Infus Dua Rp 45,000 1
90 6/25/2020 Suction Dua Rp 40,000 1
Terbilang : Dua belas juta seratus tujuh puluh lima ribu rupiah Total Seluruh :
Diskon :
Tagihan :
Palembang, 21 Mei 2020
Rini Aprilianti
Rp 12,175,000
BRUTO
Rp 1,600,000
Rp 650,000
Rp 350,000
Rp 250,000
Rp 150,000
Rp 150,000
Rp 2,100,000
Rp 500,000
Rp 250,000
Rp 200,000
Rp 17,500
Rp 1,500
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 42,000
Rp 9,000
Rp 35,000
Rp 18,000
Rp 57,500
Rp 7,000
Rp 1,000
Rp 60,000
Rp 40,000
Rp 34,000
Rp 9,000
Rp 200,100
Rp 25,400
Rp 40,000
Rp 3,000
Rp 46,000
Rp 97,500
Rp 90,000
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 9,000
Rp 7,000
Rp 37,000
Rp 72,000
Rp 17,500
Rp 146,000
Rp 77,500
Rp 39,200
Rp 103,500
Rp 29,000
Rp 11,500
Rp 8,500
Rp 260,000
Rp 52,500
Rp 52,000
Rp 70,000
Rp 50,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 110,000
Rp 30,000
Rp 45,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 20,000
Rp 100,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 45,000
Rp 500,000
Rp 40,000
BRUTO
Rp 12,175,000
21 Mei 2020
RSIA BUNDA NONI
No. Reg : 007870

Nama Pasien : Bayi Ny.Septia Wulandari Total Seluruh :
Alamat : Jl. Bandung Indah palembang Tagihan :

3 6/6/2020 GELANG BAYI LAKI LAKI Satu Rp 6,900 1
7 6/6/2020 SPUIT 1 ML Satu Rp 1,800 16
8 6/6/2020 SPUIT 1 ML Satu Rp 1,800 2
11 6/6/2020 CEFTAZIDIME VIAL 1G Satu Rp 120,000 2
14 6/6/2020 CRP Kuantitatif (P) Satu Rp 230,000 1
21 6/6/2020 Injeksi Satu Rp 30,000 2
22 6/7/2020 Injeksi Satu Rp 30,000 1
23 6/8/2020 Injeksi Satu Rp 30,000 1
24 6/9/2020 Injeksi Satu Rp 30,000 1
25 6/10/2020 Injeksi Satu Rp 30,000 1
37 6/6/2020 Suction Satu Rp 50,000 1
Terbilang : Lima juta empat ratus delapan puluh tujuh ribu Total Seluruh :
dua ratus rupiah Diskon :
Tagihan :
Rini Aprilianti
Rp 5,487,200
BRUTO
Rp 22,500
Rp 23,000
Rp 6,900
Rp 40,000
Rp 34,000
Rp 6,900
Rp 28,800
Rp 3,600
Rp 14,000
Rp 6,000
Rp 240,000
Rp 1,500
Rp 100,000
Rp 230,000
Rp 230,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 60,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 100,000
Rp 240,000
Rp 120,000
Rp 120,000
Rp 120,000
Rp 120,000
Rp 200,000
Rp 400,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 50,000
BRUTO
Rp 5,487,200
RSIA BUNDA NONI
No. RM : 007742
Nama Pasien : Hidayah Arfiatunisa Total Seluruh : Rp 4,417,300
Tgl. Lahir : 16 Maret 1977 Diskon :
Alamat : Yaktapena I Palembang Tagihan :

1 4/22/2020 Jasa dr Kuret Bius Umum Tiga Rp 1,000,000 1 Rp 1,000,000
2 4/22/2020 Jasa dr Ant Kuret Tiga Rp 180,000 1 Rp 180,000
3 4/22/2020 Penata Ant Kuret Tiga Rp 120,000 1 Rp 120,000
5 4/22/2020 Asisten dr Tiga Rp 200,000 1 Rp 200,000
6 4/22/2020 RUANG KURET Tiga Rp 700,000 1 Rp 700,000
12 4/22/2020 D5% 500 ML Tiga Rp 17,500 1 Rp 17,500
13 4/22/2020 FENTANYL AMP Tiga Rp 57,500 1 Rp 57,500
15 4/22/2020 MERSIBION AMP Tiga Rp 7,500 1 Rp 7,500
17 4/22/2020 RECOFOL N Tiga Rp 118,000 1 Rp 118,000
18 4/22/2020 RL 500 ML Tiga Rp 18,000 1 Rp 18,000
19 4/22/2020 RL 500 ML Tiga Rp 18,000 2 Rp 36,000
27 4/22/2020 STIK HB Tiga Rp 36,000 1 Rp 36,000
31 4/22/2020 UTROGESTAN 100 MG Tiga Rp 18,000 2 Rp 36,000
43 4/22/2020 Jasa Dokter Kebidanan Visite Ke Ru Tiga Rp 100,000 1 Rp 100,000
44 4/23/2020 Jasa Dokter Kebidanan Visite Ke Ru Tiga Rp 100,000 1 Rp 100,000
Terbilang : Empat juta empat ratus tujuh belas ribu Total Seluruh : Rp 4,417,300
Tagihan :
Palembang, 23 April 2020
Rini Aprilianti, Amd.

RSIA BUNDA NONI
No. Reg : 007746

Nama Pasien : Bayi Nyonya Atika Total Seluruh : Rp 4,578,800

3 4/24/2020 CEFOTAXIM VIAL Dua Rp 21,000 2 Rp 42,000
4 4/24/2020 GELANG BAYI Dua Rp 6,900 1 Rp 6,900
6 4/24/2020 NALD NO 23 Dua Rp 15,000 15 Rp 225,000
7 4/24/2020 PHYTOMENADION Dua Rp 6,900 1 Rp 6,900
8 4/24/2020 SPUIT 1 ML Dua Rp 1,800 3 Rp 5,400
9 4/24/2020 SPUIT 1 ML Dua Rp 1,800 2 Rp 3,600
10 4/24/2020 SPUIT 10 ML Dua Rp 4,500 1 Rp 4,500
11 4/24/2020 SPUIT 3 ML Dua Rp 3,000 1 Rp 3,000
23 4/25/2020 Washen Dua Rp 30,000 1 Rp 30,000
24 4/26/2020 Washen Dua Rp 30,000 1 Rp 30,000
25 4/27/2020 Washen Dua Rp 30,000 1 Rp 30,000
26 4/28/2020 Washen Dua Rp 30,000 1 Rp 30,000
28 4/24/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
29 4/25/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
30 4/26/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
31 4/27/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
32 4/28/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
45 4/24/2020 Suction Dua Rp 40,000 1 Rp 40,000
Terbilang : Empat juta lima ratus tujuh puluh delapan ribu Total Seluruh: Rp 4,578,800
Tagihan :
Rini Aprilianti
RSIA BUNDA NONI
No. Reg : 007734

Nama Pasien : Bayi Ny. Meilinda Total Seluruh :
Alamat : Jl. Indralaya Selatan Tagihan :

3 4/19/2020 GELANG BAYI LAKI LAKI Satu Rp 6,900 1
7 4/19/2020 SPUIT 1 ML Satu Rp 1,800 18
8 4/19/2020 SPUIT 1 ML Satu Rp 1,800 2
11 4/19/2020 CEFTAZIDIME VIAL 1G Satu Rp 120,000 2
21 4/19/2020 Injeksi Satu Rp 30,000 2
22 4/20/2020 Injeksi Satu Rp 30,000 1
23 4/21/2020 Injeksi Satu Rp 30,000 1
24 4/22/2020 Injeksi Satu Rp 30,000 1
25 4/23/2020 Injeksi Satu Rp 30,000 1
37 4/19/2020 Suction Satu Rp 50,000 1
Terbilang : Lima juta empat ratus delapan puluh sembilan ribu Total Seluruh :
Tagihan :
Rini Aprilianti
Rp 5,489,300
BRUTO
Rp 21,000
Rp 23,000
Rp 6,900
Rp 40,000
Rp 34,000
Rp 6,900
Rp 32,400
Rp 3,600
Rp 14,000
Rp 6,000
Rp 240,000
Rp 1,500
Rp 100,000
Rp 230,000
Rp 230,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 60,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 100,000
Rp 240,000
Rp 120,000
Rp 120,000
Rp 120,000
Rp 120,000
Rp 200,000
Rp 400,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 50,000
BRUTO
Rp 5,489,300
23 April 2020
RSIA BUNDA NONI
No. Reg : 007860

Nama Pasien : Bayi Ny. Andriyana Total Seluruh:
Alamat : Jl. Sungai Tenang Gandus PalembangTagihan :

4 6/4/2020 GELANG BAYI Dua Rp 6,900 1
6 6/4/2020 NALD NO 23 Dua Rp 15,000 15
7 6/4/2020 PHYTOMENADION Dua Rp 6,900 1
8 6/4/2020 SPUIT 1 ML Dua Rp 1,800 3
9 6/4/2020 SPUIT 1 ML Dua Rp 1,800 2
10 6/4/2020 SPUIT 10 ML Dua Rp 4,500 1
11 6/4/2020 SPUIT 3 ML Dua Rp 3,000 1
12 6/4/2020 SUCTION CATHETER NO 8 Dua Rp 14,000 1
13 6/4/2020 UMBILLICAL Dua Rp 6,000 1
15 6/4/2020 CRP Kuantitatif (P) Dua Rp 230,000 1
23 6/5/2020 Washen Dua Rp 30,000 1
24 6/6/2020 Washen Dua Rp 30,000 1
25 6/7/2020 Washen Dua Rp 30,000 1
26 6/8/2020 Washen Dua Rp 30,000 1
26 6/9/2020 Washen Dua Rp 30,000 1
26 6/10/2020 Washen Dua Rp 30,000 1
28 6/5/2020 Injeksi Dua Rp 20,000 1
29 6/6/2020 Injeksi Dua Rp 20,000 1
30 6/7/2020 Injeksi Dua Rp 20,000 1
31 6/8/2020 Injeksi Dua Rp 20,000 1
31 6/9/2020 Injeksi Dua Rp 20,000 1
32 6/10/2020 Injeksi Dua Rp 20,000 1
40 6/5/2020 Perawatan Anak/Bayi Dua Rp 175,000 1
46 6/4/2020 Suction Dua Rp 40,000 1
Terbilang : Lima juta lima ratus delapan puluh tiga ribu Total Seluruh:
Tagihan :
Rini Aprilianti
Rp 5,583,800
BRUTO
Rp 1,500
Rp 23,000
Rp 42,000
Rp 6,900
Rp 17,000
Rp 225,000
Rp 6,900
Rp 5,400
Rp 3,600
Rp 4,500
Rp 3,000
Rp 14,000
Rp 6,000
Rp 100,000
Rp 230,000
Rp 230,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 100,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 40,000
BRUTO
Rp 5,583,800
ng, 10 Juni 2020

RSIA BUNDA NONI
No. RM : 007620
Nama Pasien : Pebrina Rizki Pratama Total Seluruh : Rp 5,834,800
Tgl. Lahir : 22 Februari 1992 Diskon :
Alamat :Jl. Alamsyah RPN Tagihan :

1 5/5/2020 Jasa dr Partus EV Satu Rp 1,500,000 1 Rp 1,500,000
2 5/5/2020 Jasa dr Anak Partus Satu Rp 120,000 1 Rp 120,000
3 5/5/2020 Kamar Bersalin Satu Rp 550,000 1 Rp 550,000
4 5/5/2020 Asisten dr Anak Satu Rp 270,000 1 Rp 270,000
5 5/5/2020 Hecting Perinium Satu Rp 200,000 1 Rp 200,000
9 5/5/2020 CUTGUT CROMIC 3/0 Satu Rp 16,500 2 Rp 33,000
10 5/5/2020 GELANG BAYI Satu Rp 6,900 1 Rp 6,900
11 5/5/2020 GELANG IBU Satu Rp 7,000 1 Rp 7,000
14 5/5/2020 KASSA STERIK 16X16MH Satu Rp 17,000 1 Rp 17,000
15 5/5/2020 LIDOCAIN 2% AMP Satu Rp 4,000 1 Rp 4,000
18 5/5/2020 RL 500 ML Satu Rp 18,000 2 Rp 36,000
19 5/5/2020 Nifedipine 10 MG Satu Rp 1,000 10 Rp 10,000
20 5/5/2020 CEFOTAXIM VIAL satu Rp 21,000 2 Rp 42,000
24 5/5/2020 STIK HB Satu Rp 36,000 1 Rp 36,000
30 5/5/2020 Vaginal Thoucher Satu Rp 50,000 1 Rp 50,000
38 5/5/2020 Pasang Infus Satu Rp 45,000 1 Rp 45,000
40 5/5/2020 Vulva Hygiene Satu Rp 30,000 1 Rp 30,000
41 5/5/2020 Up Chateter/Infus Satu Rp 35,000 1 Rp 35,000
Terbilang : Lima juta delapan ratus tiga puluh empat ribu Total Seluruh : Rp 5,834,800
Tagihan :
Palembang,
Rini Aprilianti
RSIA BUNDA NONI
No. Reg : 007905

Nama Pasien : Novita Sari Total Seluruh :
Tgl. Lahir : 29 November 1996 Diskon :
Alamat :Jl. Insp Marzuki Lr. Bhakti Tagihan :

8 6/25/2020 Oksigen Tiga Rp 200,000 1
14 6/25/2020 BLOOD SET Tiga Rp 29,000 1
18 6/25/2020 D5% 500 ML Tiga Rp 17,500 1
30 6/25/2020 NACL 500 ML Tiga Rp 20,000 1
31 6/25/2020 NALD NO 23 Tiga Rp 15,000 1
35 6/25/2020 RL 500 ML Tiga Rp 18,000 6
38 6/25/2020 SPUIT 1 ML Tiga Rp 1,800 1
39 6/25/2020 SPUIT 10 ML Tiga Rp 4,500 2
41 6/25/2020 SPUIT 3 ML Tiga Rp 3,000 5
42 6/25/2020 SPUIT 5 ML Tiga Rp 3,500 2
43 6/25/2020 STIK BSS Tiga Rp 37,000 1
44 6/25/2020 STIK HB Tiga Rp 36,000 1
50 6/25/2020 T-VIO 3-0 Tiga Rp 103,500 1
52 6/25/2020 UNDERPAD Tiga Rp 29,000 1
53 6/25/2020 URINE BAG Tiga Rp 11,500 1
55 6/25/2020 T-VIO 1 PGA 100 Tiga Rp 130,000 1
59 6/25/2020 LEVICA Tiga Rp 70,000 1
60 6/25/2020 USG 3D TANPA FOTO Tiga Rp 75,000 1
62 6/25/2020 Doppler Tiga Rp 25,000 1
69 6/26/2020 Washen Tiga Rp 20,000 1
71 6/25/2020 Injeksi Tiga Rp 20,000 1
72 6/26/2020 Injeksi Tiga Rp 20,000 1
75 6/25/2020 Cukur Tiga Rp 30,000 1
80 6/25/2020 Pasang Chateter/Infus Tiga Rp 25,000 1
93 6/25/2020 Lepas infus/ Chateter Tiga Rp 30,000 1
94 6/25/2020 Suction Tiga Rp 40,000 1
Terbilang : Sembilan juta tujuh ratus sembilan puluh dua ribu dua ratus rupiah Total Seluruh :
Diskon :
Tagihan :

Rp 9,792,200
BRUTO
Rp 1,400,000
Rp 600,000
Rp 300,000
Rp 250,000
Rp 150,000
Rp 150,000
Rp 2,000,000
Rp 200,000
Rp 17,500
Rp 6,000
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 42,000
Rp 15,000
Rp 17,500
Rp 9,000
Rp 57,500
Rp 7,000
Rp 13,800
Rp 1,000
Rp 80,000
Rp 51,000
Rp 9,000
Rp 200,100
Rp 12,700
Rp 20,000
Rp 15,000
Rp 23,000
Rp 97,500
Rp 6,900
Rp 108,000
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 9,000
Rp 15,000
Rp 7,000
Rp 37,000
Rp 36,000
Rp 14,000
Rp 17,500
Rp 73,000
Rp 77,500
Rp 29,400
Rp 103,500
Rp 6,000
Rp 29,000
Rp 11,500
Rp 8,500
Rp 130,000
Rp 52,500
Rp 13,000
Rp 39,000
Rp 70,000
Rp 75,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 20,000
Rp 40,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 25,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 500,000
Rp 30,000
Rp 40,000
BRUTO
Rp 9,792,200
27 Juni 2020
RSIA BUNDA NONI
No. Reg : 007748

Nama Pasien : BY. NY. MASTNIYAH Total Seluruh: Rp 6,172,300

3 4/24/2020 GELANG BAYI LAKI LAKI Satu Rp 6,900 1 Rp 6,900
11 4/24/2020 CEFTAZIDIME VIAL 1G Satu Rp 120,000 2 Rp 240,000
Terbilang : Enam juta seratus tujuh puluh dua ribu Total Seluruh: Rp 6,172,300
Tagihan :
Rini Aprilianti
RSIA BUNDA NONI
No. RM : 000270
Nama Pasien : Tri Ariesta Belianti Total Seluruh:
Tgl. Lahir : 12/04/1986 Diskon :
Alamat : jl. Hulubalang II Tagihan :
Kelas : Dua Dibayar :
Perawatan : Rawat Inap Kemalian :

1 5/18/2020 Handscoen gamex Dua Rp 20,000 1
2 5/18/2020 ABOCATH 20 Dua Rp 17,500 1
3 5/18/2020 BLOOD SET Dua Rp 29,000 1
4 5/18/2020 D5% 500 ML Dua Rp 17,500 2
6 5/18/2020 GELANG IBU Dua Rp 7,000 1
7 5/18/2020 RL 500 ML Dua Rp 18,000 4
8 5/18/2020 SPUIT 5 ML Dua Rp 3,000 2
9 5/18/2020 STIK HB Dua Rp 36,000 1
11 5/18/2020 Print USG 3D @1 Dua Rp 75,000 1
17 5/18/2020 Ultrageston Dua Rp 18,000 6
18 5/18/2020 RL 500 ML Dua Rp 18,000 4
19 5/18/2020 Print USG 3D @1 Dua Rp 75,000 1
21 5/18/2020 Injeksi Dua Rp 30,000 1
22 5/19/2020 Injeksi Dua Rp 30,000 1
Terbilang : Dua juta delapan ratus tujuh puluh enam ribu Total Seluruh:
lima ratus rupiah Diskon :
Tagihan :
Palembang,
Rini Aprilianti
Rp 2,876,500
BRUTO
Rp 20,000
Rp 17,500
Rp 29,000
Rp 35,000
Rp 9,000
Rp 7,000
Rp 72,000
Rp 6,000
Rp 36,000
Rp 100,000
Rp 75,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 108,000
Rp 72,000
Rp 75,000
Rp 40,000
Rp 30,000
Rp 30,000
Rp 10,000
Rp 25,000
Rp 100,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 175,000
Rp 175,000
Rp 175,000
BRUTO
Rp 2,876,500
RSIA BUNDA NONI
No. Reg : 007952

Nama Pasien : Horezki Juwita Total Seluruh:
Alamat : Jl. Macan lindungan lr. Tunggal Tagihan :
Perawatan : Satu Dibayar :
Kelas Kemalian :

1 7/6/2020 ABOCATH 20 Satu Rp 17,500 1
2 7/6/2020 BLOOD SET Satu Rp 29,000 1
3 7/6/2020 D5% 500 ML Satu Rp 17,500 2
4 7/6/2020 Ondansentron 4 ML Amp Satu Rp 11,500 6
5 7/6/2020 Aquades Satu Rp 5,000 1
7 7/6/2020 RL 500 ML Satu Rp 18,000 8
8 7/6/2020 SPUIT 3 ML Satu Rp 3,000 3
9 7/6/2020 STIK BSS Satu Rp 37,000 1
10 7/6/2020 Mediamer B6 Satu Rp 1,200 9
11 7/6/2020 Print USG 3D tanpa foto Satu Rp 75,000 1
13 7/8/2020 Print USG 3D tanpa foto Satu Rp 75,000 1
18 7/6/2020 Injeksi Satu Rp 20,000 1
19 7/7/2020 Injeksi Satu Rp 20,000 1
20 7/8/2020 Injeksi Satu Rp 20,000 1
21 7/6/2020 Tindakan Infus Satu Rp 295,000 1
Terbilang : Empat juta empat ratus sembilan puluh ribu Total Seluruh:
Empat ratus dua puluh rupiah Diskon :
Tagihan :

Rp 4,490,420
BRUTO
Rp 17,500
Rp 29,000
Rp 35,000
Rp 69,000
Rp 5,000
Rp 4,620
Rp 144,000
Rp 9,000
Rp 37,000
Rp 10,800
Rp 75,000
Rp 100,000
Rp 75,000
Rp 575,000
Rp 575,000
Rp 575,000
Rp 40,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 295,000
Rp 127,500
Rp 204,000
Rp 204,000
Rp 204,000
Rp 340,000
Rp 340,000
Rp 340,000
BRUTO
Rp 4,490,420
ng, 17 juni 2020

RSIA BUNDA NONI
No. RM : 001285
Nama Pasien : Lia Anggraini Total Seluruh:
Alamat : Jl.Talang Jambe Tagihan :
Kelas : Dua Dibayar :
Perawatan Kemalian :

1 6/24/2020 Dopler Dua Rp 25,000 1
2 6/24/2020 ABOCATH 20 Dua Rp 17,500 1
3 6/24/2020 BLOOD SET Dua Rp 29,000 1
4 6/24/2020 D5% 500 ML Dua Rp 17,500 2
6 6/24/2020 GELANG IBU Dua Rp 7,000 1
7 6/24/2020 RL 500 ML Dua Rp 18,000 2
8 6/24/2020 SPUIT 3 ML Dua Rp 3,000 2
9 6/24/2020 STIK HB Dua Rp 36,000 1
11 6/24/2020 Print USG 3D @1 Dua Rp 75,000 1
16 6/24/2020 Ultrageston 100 Mg Dua Rp 18,000 6
17 6/24/2020 Cefotaxime Vial Dua Rp 21,000 4
18 6/27/2020 Print USG 3D @1 Dua Rp 75,000 1
20 6/24/2020 Injeksi Dua Rp 30,000 1
21 6/25/2020 Injeksi Dua Rp 30,000 1
24 6/25/2020 Dopler Dua Rp 25,000 1
25 6/26/2020 Dopler Dua Rp 25,000 1
Terbilang : Tiga juta lima ratus tujuh puluh enam ribu lima ratus rupiah Total Seluruh:
Diskon :
Tagihan :
Rini Aprilianti
Rp 3,576,500
BRUTO
Rp 25,000
Rp 17,500
Rp 29,000
Rp 35,000
Rp 18,000
Rp 7,000
Rp 36,000
Rp 6,000
Rp 36,000
Rp 100,000
Rp 75,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 108,000
Rp 84,000
Rp 75,000
Rp 40,000
Rp 30,000
Rp 30,000
Rp 10,000
Rp 25,000
Rp 25,000
Rp 25,000
Rp 100,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 175,000
BRUTO
Rp 3,576,500
g, 27 juni 2020
RSIA BUNDA NONI
No. Reg : 007772

Nama Pasien : Deyan Dini Sari Total Seluruh:
Tgl. Lahir : 26 Desember 1994 Diskon :
Alamat : Jl. Ahmad Yani Lrg. Kelakar Tagihan :
Kelas Kemalian :

1 5/15/2020 Konsultasi Penyakit Dalam Tiga Rp 150,000 1
2 5/15/2020 ABOCATH 20 Tiga Rp 17,500 1
3 5/15/2020 BLOOD SET Tiga Rp 29,000 1
4 5/15/2020 D5% 500 ML Tiga Rp 17,500 2
6 5/15/2020 Aquades Tiga Rp 5,000 1
8 5/15/2020 NIFEDIPIN Tiga Rp 1,000 10
9 5/15/2020 ULTRAGESTON Tiga Rp 18,000 1
10 5/15/2020 RL 500 ML Tiga Rp 18,000 6
11 5/15/2020 SPUIT 3 ML Tiga Rp 3,000 3
12 5/15/2020 STIK BSS Tiga Rp 37,000 1
13 5/15/2020 Ciprofloxacin 500 Mg Tiga Rp 1,500 10
16 5/15/2020 Doppler Tiga Rp 25,000 1
17 5/16/2020 Doppler Tiga Rp 25,000 1
18 5/17/2020 Doppler Tiga Rp 25,000 1
22 5/15/2020 Print USG 3D tanpa foto Tiga Rp 75,000 1
28 5/15/2020 Injeksi Tiga Rp 20,000 1
29 5/16/2020 Injeksi Tiga Rp 20,000 1
30 5/17/2020 Injeksi Tiga Rp 20,000 1
Terbilang : Dua juta lima ratus tujuh puluh empat ribu lima ratus rupiah Total Seluruh:
Diskon :
Tagihan :
Palembang,

Rp 2,574,500
BRUTO
Rp 150,000
Rp 17,500
Rp 29,000
Rp 35,000
Rp 9,000
Rp 5,000
Rp 7,000
Rp 10,000
Rp 18,000
Rp 108,000
Rp 9,000
Rp 37,000
Rp 15,000
Rp 25,000
Rp 25,000
Rp 25,000
Rp 100,000
Rp 75,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 40,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 25,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 150,000
Rp 150,000
Rp 150,000
BRUTO
Rp 2,574,500
RSIA BUNDA NONI
No. Reg : 007868

Nama Pasien : Rika Anggraini Pratiwi Total Seluruh :
Alamat : Jl. Kemang manis Tagihan :

8 6/6/2020 Oksigen Tiga Rp 200,000 1
14 6/6/2020 BLOOD SET Tiga Rp 29,000 1
18 6/6/2020 D5% 500 ML Tiga Rp 17,500 1
30 6/6/2020 NACL 500 ML Tiga Rp 20,000 1
31 6/6/2020 NALD NO 23 Tiga Rp 15,000 1
35 6/6/2020 RL 500 ML Tiga Rp 18,000 6
38 6/6/2020 SPUIT 1 ML Tiga Rp 1,800 1
39 6/6/2020 SPUIT 10 ML Tiga Rp 4,500 2
40 6/6/2020 SPUIT 3 ML Tiga Rp 3,000 1
41 6/6/2020 SPUIT 3 ML Tiga Rp 3,000 5
42 6/6/2020 SPUIT 5 ML Tiga Rp 3,500 2
43 6/6/2020 STIK BSS Tiga Rp 37,000 1
44 6/6/2020 STIK HB Tiga Rp 36,000 1
50 6/6/2020 T-VIO 3-0 Tiga Rp 103,500 1
52 6/6/2020 UNDERPAD Tiga Rp 29,000 1
53 6/6/2020 URINE BAG Tiga Rp 11,500 1
55 6/6/2020 T-VIO 1 PGA 100 Tiga Rp 130,000 1
59 6/6/2020 LEVICA Tiga Rp 70,000 1
62 6/6/2020 Doppler Tiga Rp 25,000 1
69 6/6/2020 Washen Tiga Rp 20,000 1
71 6/6/2020 Injeksi Tiga Rp 20,000 1
72 6/7/2020 Injeksi Tiga Rp 20,000 1
75 6/6/2020 Cukur Tiga Rp 30,000 1
94 6/6/2020 Suction Tiga Rp 40,000 1
Terbilang : Sembilan juta tujuh ratus lima puluh delapan ribu dua ratus rupiah Total Seluruh :
Diskon :
Tagihan :

Rp 9,758,200
BRUTO
Rp 1,400,000
Rp 600,000
Rp 300,000
Rp 250,000
Rp 150,000
Rp 150,000
Rp 2,000,000
Rp 200,000
Rp 17,500
Rp 3,000
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 42,000
Rp 15,000
Rp 17,500
Rp 9,000
Rp 57,500
Rp 7,000
Rp 13,800
Rp 1,000
Rp 80,000
Rp 51,000
Rp 9,000
Rp 200,100
Rp 12,700
Rp 20,000
Rp 15,000
Rp 23,000
Rp 97,500
Rp 6,900
Rp 108,000
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 3,000
Rp 15,000
Rp 7,000
Rp 37,000
Rp 36,000
Rp 14,000
Rp 17,500
Rp 73,000
Rp 77,500
Rp 29,400
Rp 103,500
Rp 6,000
Rp 29,000
Rp 11,500
Rp 8,500
Rp 130,000
Rp 52,500
Rp 13,000
Rp 39,000
Rp 70,000
Rp 50,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 20,000
Rp 40,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 25,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 500,000
Rp 30,000
Rp 40,000
BRUTO
Rp 9,758,200
08 Juni 2020
RSIA BUNDA NONI
No. Reg : 007954

Nama Pasien : Agustina lestari Total Seluruh :
Alamat : Jl. Bukit Baru No.59 Palembang Tagihan :

1 7/7/2020 ABOCATH 20 Tiga Rp 14,700 1
6 7/7/2020 D5% 500 ML Tiga Rp 17,500 2
9 7/7/2020 SPUIT 3 ML Tiga Rp 2,503 2
10 7/7/2020 RL Tiga Rp 18,000 6
11 7/7/2020 SPUIT 5 ML Tiga Rp 3,500 6
12 7/7/2020 STIK BSS Tiga Rp 37,000 1
13 7/7/2020 ASAM MEFENAMAT 500 MG Tiga Rp 1,000 9
14 7/7/2020 ASAM TRANEKSAMAT 100 MG Tiga Rp 9,500 4
15 7/7/2020 DARAH RUTIN Tiga Rp 100,000 1
21 7/7/2020 Injeksi Tiga Rp 30,000 1
22 7/7/2020 Injeksi Tiga Rp 30,000 1
23 7/7/2020 Injeksi Tiga Rp 30,000 1
24 7/7/2020 Skin Test Tiga Rp 30,000 1
Terbilang : Tiga juta sembilan puluh delapan ribu seratus rupiah Total Seluruh :
Diskon :
Tagihan :
Palembang,03 Juni 2020
Rini Aprilianti
Rp 2,613,242
BRUTO
Rp 17,500
Rp 11,500
Rp 21,000
Rp 77,616
Rp 9,000
Rp 35,000
Rp 4,620
Rp 15,000
Rp 5,006
Rp 108,000
Rp 21,000
Rp 37,000
Rp 2,000
Rp 38,000
Rp 100,000
Rp 31,000
Rp 330,000
Rp 330,000
Rp 330,000
Rp 45,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 55,000
Rp 180,000
Rp 180,000
Rp 180,000
Rp 110,000
Rp 110,000
Rp 110,000
BRUTO
Rp 2,613,242
3 Juni 2020
RSIA BUNDA NONI
No. Reg : 007937

Nama Pasien : Mastuti Total Seluruh :
Alamat : Jl. Kadir TKR Tagihan :

8 6/27/2020 Oksigen Tiga Rp 200,000 1
14 6/27/2020 BLOOD SET Tiga Rp 29,000 1
18 6/27/2020 D5% 500 ML Tiga Rp 17,500 1
30 6/27/2020 NACL 500 ML Tiga Rp 20,000 1
31 6/27/2020 NALD NO 23 Tiga Rp 15,000 1
35 6/27/2020 RL 500 ML Tiga Rp 18,000 6
38 6/27/2020 SPUIT 1 ML Tiga Rp 1,800 1
39 6/27/2020 SPUIT 10 ML Tiga Rp 4,500 2
40 6/27/2020 SPUIT 3 ML Tiga Rp 3,000 1
41 6/27/2020 SPUIT 3 ML Tiga Rp 3,000 5
42 6/27/2020 SPUIT 5 ML Tiga Rp 3,500 2
43 6/27/2020 STIK BSS Tiga Rp 37,000 1
44 6/27/2020 STIK HB Tiga Rp 36,000 1
50 6/27/2020 T-VIO 3-0 Tiga Rp 103,500 1
52 6/27/2020 UNDERPAD Tiga Rp 29,000 1
53 6/27/2020 URINE BAG Tiga Rp 11,500 1
55 6/27/2020 T-VIO 1 PGA 100 Tiga Rp 130,000 1
59 6/27/2020 LEVICA Tiga Rp 70,000 1
62 6/27/2020 Doppler Tiga Rp 25,000 1
69 6/27/2020 Washen Tiga Rp 20,000 1
71 6/27/2020 Injeksi Tiga Rp 20,000 1
72 6/27/2020 Injeksi Tiga Rp 20,000 1
75 6/27/2020 Cukur Tiga Rp 30,000 1
94 6/27/2020 Suction Tiga Rp 40,000 1
Terbilang : Sembilan juta tujuh ratus lima puluh delapan ribu dua ratus rup Total Seluruh :
Diskon :
Tagihan :

Rp 9,758,200
BRUTO
Rp 1,400,000
Rp 600,000
Rp 300,000
Rp 250,000
Rp 150,000
Rp 150,000
Rp 2,000,000
Rp 200,000
Rp 17,500
Rp 3,000
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 42,000
Rp 15,000
Rp 17,500
Rp 9,000
Rp 57,500
Rp 7,000
Rp 13,800
Rp 1,000
Rp 80,000
Rp 51,000
Rp 9,000
Rp 200,100
Rp 12,700
Rp 20,000
Rp 15,000
Rp 23,000
Rp 97,500
Rp 6,900
Rp 108,000
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 3,000
Rp 15,000
Rp 7,000
Rp 37,000
Rp 36,000
Rp 14,000
Rp 17,500
Rp 73,000
Rp 77,500
Rp 29,400
Rp 103,500
Rp 6,000
Rp 29,000
Rp 11,500
Rp 8,500
Rp 130,000
Rp 52,500
Rp 13,000
Rp 39,000
Rp 70,000
Rp 50,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 20,000
Rp 40,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 20,000
Rp 20,000
Rp 30,000
Rp 25,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 500,000
Rp 30,000
Rp 40,000
BRUTO
Rp 9,758,200
08 Juni 2020
RSIA BUNDA NONI
No. Reg : 007866

Nama Pasien : Nurhidayati Islamiah Total Seluruh :
Alamat : Jl. Anggrek No 140 Palembang Tagihan :

1 6/15/2020 Jasa dr OP SC Satu Rp 1,800,000 1
2 6/15/2020 Jasa dr Ant SC Satu Rp 700,000 1
3 6/15/2020 Penata Ant SC Satu Rp 400,000 1
4 6/15/2020 Asisten dr OP Satu Rp 250,000 1
5 6/15/2020 Intrumen dr Satu Rp 150,000 1
6 6/15/2020 Konsultasi dr Penyakit Dalam Satu Rp 150,000 1
7 6/15/2020 Kamar Operasi Satu Rp 2,200,000 1
8 6/15/2020 Oksigen Satu Rp 200,000 1
10 6/15/2020 ALKOHOL SWAB Satu Rp 1,500 1
12 6/15/2020 ASAM MEFENAMAT CAP Satu Rp 1,000 9
13 6/15/2020 ASAM TRANEKSAMAT 100 MG/ML Satu Rp 9,500 2
14 6/15/2020 BLOOD SET Satu Rp 29,000 1
15 6/15/2020 CATETER NO 16 Satu Rp 40,500 1
16 6/15/2020 CEFOTAXIM VIAL Satu Rp 21,000 2
17 6/15/2020 CIPROFLOXACIN 500 MG Satu Rp 1,500 10
18 6/15/2020 D5% 500 ML Satu Rp 17,500 2
19 6/15/2020 DEXAMETHASONE AMP Satu Rp 4,500 8
20 6/15/2020 EPEDRIN HCL AMP Satu Rp 57,500 1
22 6/15/2020 HANDSPLAST BIASA Satu Rp 1,000 1
26 6/15/2020 METRONIDAZOLE 500MG TAB Satu Rp 1,000 9
27 6/15/2020 METRONIDAZOLE INFUS 100ML Satu Rp 66,700 4
28 6/15/2020 MYOTONIC INJ 1 ML Satu Rp 12,700 1
29 6/15/2020 NACL 500 ML Satu Rp 20,000 2
30 6/15/2020 NALD NO 23 Satu Rp 1,500 1
31 6/15/2020 ONDANSENTRON 4 ML AMP Satu Rp 11,500 4
33 6/15/2020 RL 500 ML Satu Rp 18,000 6
34 6/15/2020 SOFRATULLE Satu Rp 32,500 1
35 6/15/2020 SPINOCAN NO 27 Satu Rp 63,500 1
36 6/15/2020 SPUIT 1 ML Satu Rp 1,800 1
37 6/15/2020 SPUIT 10 ML Satu Rp 4,500 2
38 6/15/2020 SPUIT 3 ML Satu Rp 3,000 3
39 6/15/2020 SPUIT 5 ML Satu Rp 3,500 2
40 6/15/2020 STIK BSS Satu Rp 37,000 1
41 6/15/2020 STIK HB Satu Rp 36,000 2
42 6/15/2020 SURGICAL BLADS NO 21 Satu Rp 17,500 1
43 6/15/2020 T-PLAIN CATGUT 0 Satu Rp 73,000 1
44 6/15/2020 T-PLAIN CATGUT 2-0 Satu Rp 77,500 1
45 6/15/2020 TRAMADOL INJ 100MG/2ML Satu Rp 9,800 1
46 6/15/2020 T-VIO 3-0 Satu Rp 103,500 1
47 6/15/2020 UNDERPAD Satu Rp 29,000 1
48 6/15/2020 URINE BAG Satu Rp 11,500 1
49 6/15/2020 HANDSAPLAS ROLL Satu Rp 8,500 1
50 6/15/2020 T-VIO 1 PGA 100 Satu Rp 130,000 1
51 6/15/2020 SUPRAFENID SUPP Satu Rp 17,500 3
53 6/15/2020 LEVICA Satu Rp 70,000 1
54 6/15/2020 Vagina Thouvher Satu Rp 50,000 2
55 6/15/2020 Electro Kardiographi (EKG) Satu Rp 80,000 1
56 6/15/2020 Doppler Satu Rp 25,000 1
59 6/15/2020 Hemoglobin Manual Satu Rp 28,000 1
60 6/15/2020 Protein urine Satu Rp 57,000 1
64 6/15/2020 Washen Satu Rp 30,000 1
66 6/15/2020 Injeksi Satu Rp 30,000 1
67 6/15/2020 Injeksi Satu Rp 30,000 1
69 6/15/2020 Cukur Satu Rp 30,000 1
70 6/15/2020 Skin Test Satu Rp 30,000 1
73 6/15/2020 Ganti Balut Satu Rp 30,000 1
82 6/15/2020 Perawatan HCU Satu Rp 500,000 1
Terbilang : Sebelas juta lima ratus dua puluh tiga ribu seratus rupiah Total Seluruh :
Diskon :
Tagihan :
Rini Aprilianti
Rp 11,523,100
BRUTO
Rp 1,800,000
Rp 700,000
Rp 400,000
Rp 250,000
Rp 150,000
Rp 150,000
Rp 2,200,000
Rp 200,000
Rp 35,000
Rp 1,500
Rp 46,000
Rp 9,000
Rp 19,000
Rp 29,000
Rp 40,500
Rp 42,000
Rp 15,000
Rp 35,000
Rp 36,000
Rp 57,500
Rp 7,000
Rp 1,000
Rp 80,000
Rp 60,000
Rp 34,000
Rp 9,000
Rp 266,800
Rp 12,700
Rp 40,000
Rp 1,500
Rp 46,000
Rp 117,000
Rp 108,000
Rp 32,500
Rp 63,500
Rp 1,800
Rp 9,000
Rp 9,000
Rp 7,000
Rp 37,000
Rp 72,000
Rp 17,500
Rp 73,000
Rp 77,500
Rp 9,800
Rp 103,500
Rp 29,000
Rp 11,500
Rp 8,500
Rp 130,000
Rp 52,500
Rp 39,000
Rp 70,000
Rp 100,000
Rp 80,000
Rp 25,000
Rp 100,000
Rp 31,000
Rp 28,000
Rp 57,000
Rp 450,000
Rp 450,000
Rp 450,000
Rp 30,000
Rp 45,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 25,000
Rp 100,000
Rp 120,000
Rp 120,000
Rp 120,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 500,000
BRUTO
Rp 11,523,100
17 juni 2020
RSIA BUNDA NONI
No. RM : 007905
Nama Pasien : Novita Sari Total Seluruh :
Tgl. Lahir : 29 Nov 1996 Diskon :
Alamat : Jl. Insp marzuki Palembang Tagihan :

1 6/15/2020 ABOCATH 20 Tiga Rp 17,500 1
4 6/15/2020 RL 500 ML Tiga Rp 6,900 3
6 6/15/2020 D5% 500 ML Tiga Rp 17,500 2
9 6/15/2020 SPUIT 3 ML Tiga Rp 1,800 2
10 6/15/2020 SPUIT 5 ML Tiga Rp 4,500 1
11 6/15/2020 SPUIT 5 ML Tiga Rp 3,500 1
14 6/15/2020 Print USG 3D TANPA FOTO Tiga Rp 75,000 1
20 6/15/2020 Lepas Infus Tiga Rp 45,000 1
21 6/15/2020 Injeksi Tiga Rp 30,000 1
22 6/16/2020 Injeksi Tiga Rp 30,000 1
Terbilang : Dua juta tiga ratus tiga puluh ribu tiga ratus rupiah Total Seluruh :
Diskon :
Tagihan :

Rp 2,330,300
BRUTO
Rp 17,500
Rp 11,500
Rp 10,000
Rp 20,700
Rp 30,000
Rp 35,000
Rp 7,000
Rp 15,000
Rp 3,600
Rp 4,500
Rp 3,500
Rp 100,000
Rp 36,000
Rp 75,000
Rp 31,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 45,000
Rp 30,000
Rp 30,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 175,000
Rp 175,000
Rp 175,000
BRUTO
Rp 2,330,300
RSIA BUNDA NONI
No. Reg : 007850

Nama Pasien : Bayi Ny. Anita Total Seluruh :
Tgl. Lahir : 30 mei 2020 Diskon :
Alamat : Jl. Serengam I Tagihan :

3 5/30/2020 CEFTAZIDINE VIAL Tiga Rp 120,000 2
4 5/30/2020 GELANG BAYI LAKI-LAKI Tiga Rp 6,900 1
6 5/30/2020 NALD NO 23 Tiga Rp 15,000 15
8 5/30/2020 SPUIT 1 ML Tiga Rp 1,800 3
9 5/30/2020 SPUIT 1 ML Tiga Rp 1,800 2
10 5/30/2020 SPUIT 10 ML Tiga Rp 4,500 2
11 5/30/2020 SPUIT 3 ML Tiga Rp 3,000 1
15 5/30/2020 CRP Kuantitatif (P) Tiga Rp 230,000 1
16 5/30/2020 CRP Kuantitatif (P) Tiga Rp 230,000 1
23 5/30/2020 Washen Tiga Rp 20,000 1
24 5/31/2020 Washen Tiga Rp 20,000 1
25 6/1/2020 Washen Tiga Rp 20,000 1
26 6/2/2020 Washen Tiga Rp 20,000 1
27 6/3/2020 Washen Tiga Rp 20,000 1
28 5/30/2020 Injeksi Tiga Rp 20,000 1
29 5/31/2020 Injeksi Tiga Rp 20,000 1
30 6/1/2020 Injeksi Tiga Rp 20,000 1
31 6/2/2020 Injeksi Tiga Rp 20,000 1
32 6/3/2020 Injeksi Tiga Rp 20,000 1
46 5/30/2020 Suction Tiga Rp 40,000 1
Terbilang : Empat juta dua ratus sebelas ribu Total Seluruh :
Tagihan :
Rini Aprilianti
Rp 4,211,300
BRUTO
Rp 1,500
Rp 23,000
Rp 240,000
Rp 6,900
Rp 17,000
Rp 225,000
Rp 6,900
Rp 5,400
Rp 3,600
Rp 9,000
Rp 3,000
Rp 14,000
Rp 6,000
Rp 100,000
Rp 230,000
Rp 230,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 300,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 150,000
Rp 40,000
BRUTO
Rp 4,211,300
RSIA BUNDA NONI
No. Reg : 007881

Nama Pasien : Bayi Ny. Tri Indah Kriswanti Total Seluruh :
Alamat : Jl. Kemuning Palembang Tagihan :

3 6/8/2020 CEFTAZIDINIE VIAL Dua Rp 120,000 2
4 6/8/2020 GELANG BAYI Dua Rp 6,900 1
6 6/8/2020 NALD NO 23 Dua Rp 15,000 15
7 6/8/2020 PHYTOMENADION Dua Rp 6,900 1
8 6/8/2020 SPUIT 1 ML Dua Rp 1,800 3
9 6/8/2020 SPUIT 1 ML Dua Rp 1,800 2
10 6/8/2020 SPUIT 10 ML Dua Rp 4,500 1
11 6/8/2020 SPUIT 3 ML Dua Rp 3,000 1
12 6/8/2020 SUCTION CATHETER NO 8 Dua Rp 14,000 1
13 6/8/2020 UMBILLICAL Dua Rp 6,000 1
24 6/8/2020 Washen Dua Rp 30,000 1
25 6/9/2020 Washen Dua Rp 30,000 1
26 6/10/2020 Washen Dua Rp 30,000 1
27 6/11/2020 Washen Dua Rp 30,000 1
28 6/12/2020 Washen Dua Rp 30,000 1
29 6/13/2020 Washen Dua Rp 30,000 1
30 6/14/2020 Washen Dua Rp 30,000 1
31 6/8/2020 Injeksi Dua Rp 20,000 1
32 6/9/2020 Injeksi Dua Rp 20,000 1
33 6/10/2020 Injeksi Dua Rp 20,000 1
34 6/11/2020 Injeksi Dua Rp 20,000 1
35 6/12/2020 Injeksi Dua Rp 20,000 1
36 6/13/2020 Injeksi Dua Rp 20,000 1
37 6/14/2020 Injeksi Dua Rp 20,000 1
53 6/8/2020 Suction Dua Rp 40,000 1
Terbilang : Enam juta dua ratus enam puluh dua ribu Total Seluruh :
Tagihan :
Rini Aprilianti
Rp 6,226,800
BRUTO
Rp 1,500
Rp 23,000
Rp 240,000
Rp 6,900
Rp 17,000
Rp 225,000
Rp 6,900
Rp 5,400
Rp 3,600
Rp 4,500
Rp 3,000
Rp 14,000
Rp 6,000
Rp 100,000
Rp 230,000
Rp 230,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 375,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 30,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 20,000
Rp 100,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 110,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 175,000
Rp 40,000
BRUTO
Rp 6,226,800
14 Juni 2020
RSIA BUNDA NONI
No. Reg : 00
Nama Pasien : Bayi Ny. Vera Yanti Total Seluruh: Rp 1,965,100
Tgl. Lahir : 10 juni 2020 Diskon :

3 6/10/2020 CEFTAZIDINE Dua Rp 120,000 1 Rp 120,000
4 6/10/2020 GELANG BAYI Dua Rp 6,900 1 Rp 6,900
6 6/10/2020 NALD NO 23 Dua Rp 15,000 15 Rp 225,000
7 6/10/2020 PHYTOMENADION Dua Rp 6,900 1 Rp 6,900
8 6/10/2020 SPUIT 1 ML Dua Rp 1,800 1 Rp 1,800
9 6/10/2020 SPUIT 3 ML Dua Rp 3,000 1 Rp 3,000
14 6/10/2020 Kamar perinatologi Dua Rp 375,000 1 Rp 375,000
15 6/10/2020 Injeksi Dua Rp 20,000 1 Rp 20,000
17 6/10/2020 Jasa Dokter Anak Visite Ke Ruan Dua Rp 110,000 1 Rp 110,000
19 6/10/2020 Resusitasi Dua Rp 200,000 1 Rp 200,000
20 6/10/2020 Oksigen Dua Rp 200,000 1 Rp 200,000
21 6/10/2020 Suction Dua Rp 40,000 1 Rp 40,000
Terbilang : Satu juta sembilan ratus enam puluh lima ribu Total Seluruh: Rp 1,965,100
Seratus rupiah Diskon :
Tagihan :

Rini Aprilianti

5 6102750933903474983

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RSIA BUNDA NONI

No. Reg : 007889

No TANGGAL URAIAN KELAS TARIF QTY BRUTO

No. Reg : 007980

No TANGGAL URAIAN KELAS TARIF QTY BRUTO

No. Reg : 007253

No TANGGAL URAIAN KELAS TARIF QTY BRUTO

Palembang, 14 juni 2020

Rini Aprilianti, Amd.keb

No TANGGAL URAIAN KELAS TARIF QTY BRUTO

Palembang, 12 juni 2020

Rini Aprilianti, Amd

No. Reg : 007865

No TANGGAL URAIAN KELAS TARIF QTY

No URAIAN KELAS TARIF QTY BRUTO

Rini Aprilianti, Amd.keb

No. Reg : 007837

No TANGGAL URAIAN KELAS TARIF QTY BRUTO

No. Reg : 007888

No TANGGAL URAIAN KELAS TARIF QTY BRUTO

Palembang,19 Juli 2020

No. Reg : 007343

No TANGGAL URAIAN KELAS TARIF QTY BRUTO

No TANGGAL URAIAN KELAS TARIF QTY BRUTO

Palembang,06 juli 2020

No. Reg : 007875

No TANGGAL URAIAN KELAS TARIF QTY BRUTO

Palembang, 09 Juli 2020

No TANGGAL URAIAN KELAS TARIF QTY

Palembang, 24 Mei 2020

No. Reg : 004543

No TANGGAL URAIAN KELAS TARIF QTY

Palembang,06 Juli 2020

g,06 Juli 2020

No. Reg : 007873

No TANGGAL URAIAN KELAS TARIF QTY

Palembang,09 Juli 2020

No. Reg : 007341

No TANGGAL URAIAN KELAS TARIF QTY

Palembang, 08 Juli 2020

Rini Aprilianti, Amd.

No. Reg : 007255

No TANGGAL URAIAN KELAS TARIF QTY

Palembang, 07 Juli 2020

Rini Aprilianti, Amd.ke

No TANGGAL URAIAN KELAS TARIF QTY

Rini Aprilianti, Amd.keb

No. Reg : 007252

No TANGGAL URAIAN KELAS TARIF QTY BRUTO

Palembang, 06 Juli 2020

No. Reg : 007941

No TANGGAL URAIAN KELAS TARIF

Palembang, 03 Juli 2020

Rini Aprilianti, Amd.keb

mbang, 03 Juli 2020

No. Reg : 006342

No TANGGAL URAIAN KELAS TARIF QTY BRUTO

Palembang, 03 Juli 2020

Rini Aprilianti, Amd

No. Reg : 005711

No TANGGAL URAIAN KELAS TARIF QTY

Palembang,20 Juli 2020

No. Reg : 007660