PELAYANAN LABORAT PRB DM KLINIK IIS MEDIKA

JL. SLAMET RIYADI No 156 KARTASURA, HP 087876760101

BULAN :DESEMBER 2022 KODE FASKES : 0151B113

NO NO BPJS NAMA ALAMAT DX GDP TGL PELY LAB TARIF (Rp)
1 0001294600241 B Agus Dwi Noegraha Tegal Mulyo 2/8 DM 249 03/09/2022 KIM Rp 20,000
2 0001526196093 Agus Purnomo Windan 01/09 DM 288 03/09/2022 KIM Rp 20,000
3 0000088860317 CH Endang Widiyati Purbayan 04/01 DM 123 05/09/2022 KIM Rp 20,000
4 0002259774268 Budi Eko Saputro Gempol 01/04 DM 125 06/09/2022 KIM Rp 20,000
5 0001276959701 Sarwo Sri Hastuti Sedahromo Kidul 1/9 DM 125 08/09/2022 KIM Rp 20,000
6 0002430194174 Sumiati Ngadijayan 3/4 DM 197 09/09/2022 KIM Rp 20,000
7 0000200980236 Sumiyati Tegalbrojol 1/1 DM 219 11/09/2022 KIM Rp 20,000
8 0000088848371 Sri Rahayu Sedahromo Kidul 1/9 DM 122 12/09/2022 KIM Rp 20,000
9 0000088858337 Theresia Mursiti Kampung Masjid 2/11 DM 123 13/09/2022 KIM Rp 20,000
10 0001273705749 Siti Halimah Kampung Masjid 2/11 DM 125 13/09/2022 KIM Rp 20,000
11 0000166320461 Ernawati Kopen 1/7 DM 83 13/09/2022 KIM Rp 20,000
12 0000088859799 Ummi Chulsum Gunung Kunci 4/9 DM 106 13/09/2022 KIM Rp 20,000
13 0001105923115 Sumarni Pucangan Baru 2 DM 93 13/09/2022 KIM Rp 20,000
14 0000091002813 Imam Madi Purbayan 6/1 DM 88 13/09/2022 KIM Rp 20,000
15 0000168076001 Haryati Purbayan 6/1 DM 85 13/09/2022 KIM Rp 20,000
16 0000194785907 Walinem Temon Gowongan 3/2 DM 123 13/09/2022 KIM Rp 20,000
17 0000088860249 Warti Perum PBS no 6 4/1 DM 118 13/09/2022 KIM Rp 20,000
18 0000088860238 Wuryanto Perum PBS no 6 4/1 DM 118 13/09/2022 KIM Rp 20,000
19 0001300435266 Y Minto Raharjo Brontowiryan DM 123 13/09/2022 KIM Rp 20,000
20 0000211174312 Sutarsih Kopen 1/7 DM 87 13/09/2022 KIM Rp 20,000
21 0001531889335 Suranta Sanggrahan DM 112 13/09/2022 KIM Rp 20,000
22 0002769137425 Sriyatun Manang 1/3 DM 362 13/09/2022 KIM Rp 20,000
23 0000091450427 Sri Rahayu DRA JL.Slamet Riyadi 189 DM 104 13/09/2022 KIM Rp 20,000
24 0001824138595 Sri Mulyaningsih Banaran DM 206 13/09/2022 KIM Rp 20,000
25 0000088960318 Sri Sujiyati Kemasan 2/9 DM 106 13/09/2022 KIM Rp 20,000
26 0000088973256 Johanes Harjono Blumbangrejo 2/6 DM 230 13/09/2022 KIM Rp 20,000
27 0000088973245 Nanik Suparni SPD Blumbangrejo 2/6 DM 98 13/09/2022 KIM Rp 20,000
28 0000088958889 Kardiyanto Soditan Ngadirejo DM 109 13/09/2022 KIM Rp 20,000
29 0002290393574 Nanik Winarni Mayang 3/3 DM 125 13/09/2022 KIM Rp 20,000
30 0000089060938 Sri Permata R Perum PBS 4/1 DM 228 13/09/2022 KIM Rp 20,000
31 0001906327269 Sri Sudjini Kebon Baru 4/9 DM 125 13/09/2022 KIM Rp 20,000
32 0000088860453 Siti Rochani Sedahromo Kidul 1/9 DM 122 13/09/2022 KIM Rp 20,000
33 0001312884718 Wiyanto Hadi Kopen 4/7 DM 83 13/09/2022 KIM Rp 20,000
34 0000076340362 Alif Noor Anna Gang Siwalan 14 DM 114 14/09/2022 KIM Rp 20,000
35 0001893316296 Samuel Samidi Pucangan 1/13 DM 120 14/09/2022 KIM Rp 20,000
36 0000088958799 Sumiyati Keputren 3/8 DM 82 14/09/2022 KIM Rp 20,000
35 0000088710401 Sihadi Dawukan 1/2 DM 81 14/09/2022 KIM Rp 20,000
38 0002053245554 Sajiyo Hutomo Pucangan 3/13 DM 104 14/09/2022 KIM Rp 20,000
39 0000088958452 Musri Hartini Perum Pucangan DM 86 14/09/2022 KIM Rp 20,000
40 0000088850676 Mahmudi Sedahromo Lor 1/7 DM 123 14/09/2022 KIM Rp 20,000
41 0001310540714 Titik Ismiyati Pucangan DM 257 14/09/2022 KIM Rp 20,000
42 0000204595648 Sri Rahayu Keputren 3/8 DM 81 14/09/2022 KIM Rp 20,000
43 0000091502774 Bambang Kristanto Krapyak, Pucangan DM 81 14/09/2022 KIM Rp 20,000
44 0002091963947 Suparni Pucangan 2/13 DM 87 14/09/2022 KIM Rp 20,000
45 0002091963565 Samino Padmorejo Pucangan 2/13 DM 120 14/09/2022 KIM Rp 20,000
46 0000086880058 R. Parwoto Perengsari 02/05 DM 92 14/09/2022 KIM Rp 20,000
47 0002080091878 Riana Sulistyowati Pelembatok 1/8 DM 120 14/09/2022 KIM Rp 20,000
48 0001161998188 Basuki Nugroho Jaganharjo 1/9 DM 82 14/09/2022 KIM Rp 20,000
49 0000088853433 Hartiningsih Perum PBS No.16 DM 95 14/09/2022 KIM Rp 20,000
50 0000088853422 Saksono Hadi Perum PBS No.16 DM 84 14/09/2022 KIM Rp 20,000
51 0000088853668 Saptarochni Kopen 1/1 DM 108 14/09/2022 KIM Rp 20,000
0001863616342 Yulia Permata Sari Candibaru DM 125 14/09/2022 KIM Rp 20,000
53 0001524822085 Sri Mulyani Rojoniten DM 122 14/09/2022 KIM Rp 20,000
54 0001525257832 Margareta Rumini Perengrejo DM 121 14/09/2022 KIM Rp 20,000
55 0000075925866 Sarwoko Sanggrahan 3/1 DM 117 14/09/2022 KIM Rp 20,000
56 0001797761766 Sri Soejiyanti Tegal Kembang DM 113 14/09/2022 KIM Rp 20,000
57 0001793819182 Eriwati Mangkuyudan DM 86 14/09/2022 KIM Rp 20,000
58 0000089962402 Totok Sartobeno Mangkuyudan DM 82 14/09/2022 KIM Rp 20,000
59 0000086665162 Binti Marwati Jl.Slamet Riyadi No.21 DM 121 14/09/2022 KIM Rp 20,000
60 0001427263086 Sukarmi Sedahromo Lor 1/7 DM 121 14/09/2022 KIM Rp 20,000
61 0000088958169 Mursiti Keputren DM 101 15/09/2022 KIM Rp 20,000
62 0001143313143 Danang Winardi Ngabeyan 3/2 DM 120 15/09/2022 KIM Rp 20,000
63 0001620171393 Ari Haryanto Tegalan DM 120 15/09/2022 KIM Rp 20,000
64 0001316845293 Nur Widjayanti Blumbangrejo DM 88 15/09/2022 KIM Rp 20,000
65 0000067459814 IR.Murtadi Darmo Perum PBS 4/1 DM 122 16/09/2022 KIM Rp 20,000
66 0002200432274 Sulastri Tisanan 1/5 DM 80 16/09/2022 KIM Rp 20,000
67 0002036042605 Sri Hartini Kopen 4/7 DM 200 16/09/2022 KIM Rp 20,000
68 0001821487937 Suparso Singopuran 1/2 DM 105 16/09/2022 KIM Rp 20,000
69 0000089061614 Yoenita Farida Pucangan Baru DM 122 16/09/2022 KIM Rp 20,000
70 0000088851183 Shaumi Kebon Baru DM 330 16/09/2022 KIM Rp 20,000
71 0000088853409 Sajoeti Madijo Notosuman 4/5 DM 123 17/09/2022 KIM Rp 20,000
72 0001528320126 Siti Kasanah Blagungan 17/3 DM 98 19/09/2022 KIM Rp 20,000
73 0001907954673 Sri Wartini Jiwan 2/6 DM 122 19/09/2022 KIM Rp 20,000
74 0002305756923 Giyarsi Grogolan 2/5 DM 90 23/09/2022 KIM Rp 20,000
75 0001273347753 Tumiyati Ngebeyan 02/13 DM 125 23/09/2022 KIM Rp 20,000
76 0001524762606 Ratih Wijayanti Ngemplak 01/04 DM 124 24/09/2022 KIM Rp 20,000
77 0001275299109 Sudarmi Windan 7/1 DM 125 24/09/2022 KIM Rp 20,000
78 0001388153992 Prapto Yuwono Pandean 3/1 DM 123 24/09/2022 KIM Rp 20,000
79 0001794896267 Suwarti Gang Siwalan 3/7 DM 124 24/09/2022 KIM Rp 20,000
80 Rp.1,580,000

Mengetahui
Direktur Klinik Iis Medika

dr.Tri Isponingsih
NO NO BPJS NAMA TANGGAL LAHIR
1 0001294600241 B Agus Dwi Noegraha 8/17/1954
2 0001877024665 Sri Miarsih 1/6/1960
3 0002259774268 Budi Eko Saputra 6/30/1945
4 0001526196093 Agus Purnomo 10/08/1975
5 0000088860317 CH Endang Widiyati 7/22/1950
6 0000103966683 Sugiyanto 1/1/1958
7 0000076340362 Alif Noor Anna 3/7/1963
8 0000086880058 R Parwoto 12/25/1954
9 0000088848371 Sri Rahayu 8/18/1956
10 0000200980236 Sumiyati 9/12/1953
11 0002430194174 Sumiati 5/27/1966
12 0000166320461 Ernawati 2/17/1962
13 0000088860453 Siti Rochani 10/3/1950
14 0000088710401 Sihadi 3/27/1943
15 0001310540714 Titik Ismiyati 6/8/1970
16 0001276959701 Sarwo Sri Hastuti 1/29/1972
17 0001273705749 Siti Halimah 6/26/1964
18 0000088858337 Theresia Mursiti 12/22/1955
19 0001105923115 Sumarni 10/11/1963
20 0000088958889 Kardiyanto Sukardi 4/3/1950
21 0001312884718 Wiyanto Hadi 10/15/1960
22 0000088934218 Rubinah 7/15/1965
23 0000088958799 Sumiyati 6/25/1953
24 0000088846751 Agnes Sujatmi 1/21/1947
25 0000088853668 Saptarochni 11/11/1949
26 0001863616342 Yulia Permatasari 7/10/1978
27 0000088960318 Sri Sujiyati 8/21/1950
28 0001300435266 Y Minto Raharjo 12/31/1944
29 0002080091878 Riana Sulistyowati 11/21/1973
30 0001531889335 Suranta 1/10/1963
31 0001824138595 Sri Mulyaningsih 8/18/1968
32 0001524822085 Sri Mulyani 7/10/1970
33 0000204595648 Sri Rahayu 5/5/1963
34 0002769137425 Sriyatun 3/1/1962
35 0001427263086 Sukarmi 7/22/1955
36 0000089060938 Sri Permata R 6/4/1953
35 0000067459814 Murtadi Darmo Prawiro 5/21/1948
38 0000091450427 Sri Rahayu 7/6/1955
39 0002290393574 Nanik Winarni 11/8/1969
40 0000088853433 Hartiningsih 12/23/1954
41 0000088853422 Saksono Hadi 5/12/1946
42 0002053245554 Sajiyo Hutomo 7/6/1958
43 0001893316296 Samuel Samidi 12/8/1966
44 0000088850676 Mahmudi 3/31/1950
45 0000088860249 Warti 2/12/1954
46 0000088860238 Wuryanto 6/15/1946
47 0001906327269 Sri Sudjini 12/31/1954
48 0001906326281 Sudarno Pono 5/28/1956
49 0001273347753 Tumiyati 12/31/1950
50 0000086665162 Binti Mawarti 1/18/1965
51 0001525257832 Margareta Rumini 4/12/1966
52 0000075925866 Sarwoko 7/29/1961
53 0001316845293 Nur Widjayanti 1/18/1971
54 0001793819182 Eriwati 2/15/1967
55 0000089962402 Totok Sartobeno 12/30/1958
56 0000088973256 Johanes Harjono 4/20/1949
57 0000088973245 Nanik Suparni 2/21/1951
58 0001620171393 Ari Haryanto 2/6/1976
59 0000088958169 Mursiti 1/1/1956
60 0002327974536 Juwantiyah 12/31/1972
61 0000211174312 Sutarsih 5/4/1959
62 0000085257584 Paidjo Edy Purwito 2/8/2023
63 0001794128962 Budi Irwanto 3/4/1952
64 0001104186587 Budi Sugiyatno 11/16/1960
65 0000088855997 Sri Setiyati 8/12/1944
66 0001325258526 Aniek Kastiyaningsih 8/13/1958
67 0001863612562 Rachmat Pratomo 1/30/1950
68 0002305756923 Giyarsi 9/2/1957
69 0000168076001 Haryati 5/10/1957
70 0000091002813 Imam Madi 8/28/1951
71 0002497660301 Yatini 8/10/1971
72 0001143313143 Danang Winardi 12/28/1978
73 0000565115411 Rajiyem 6/10/1962
74 0001161998188 Basuki Nugroho 7/6/1970
75 0000088075214 Rajinem 3/15/1965
76 0000090992395 Joko Subagyo 3/21/1959
77 0000077185844 Rina Ashar 5/3/1960
78 0000075881575 Saida Achmad 2/10/1989
79 0001427280355 Mulat Sri Lestari 11/4/1960
80 0001524836845 Muklis Al Ariyanto 7/26/1968
81 0000208484796 Siti Zubaidah 12/15/1964
82 0000088958452 Musri Hartini 7/13/1959
83 0000089070941 Nina Setya Silawati 10/1/1969
84 0002246677571 Jito Purwanto 2/5/1959
85 0001899089436 Djumadi 11/15/1960
86 0001524822873 Madinem 6/11/1973
87
88
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91
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ALAMAT GDP GD2PP CHOL TG AU UR CR
Tegalmulyo 2/8 125
Jambon 1/5 236
Gempol 1/4 236
Windan 1/9 245
Purbayan 4/1 125
Perum Gumpang 108
Gang Siwalan 14 124
Palembatok 110
Sedahromo Kidul 123
Tegal Brojol 216
Ngadijayan 288
Kopen 80
Sedahromo Kidul 182
Dawukan 83
Pucangan 237
Sedahromo Kidul 125
Kampung Masjid 125
Kampung Masjid 120
Pucangan Baru 2 87
Soditan 104
Kopen 85
Singopuran 92
Keputren 112
Pucangan 97
Kopen 182
Candi Baru 185
Kemasan 94
Brontowiryan 94
Palembatok 119
Sanggrahan 94
Banaran 123
Rojonitan 208
Keputren 83
Manang 270
Sedahromo Lor 125
Perum PBS 125
Perum PBS 123
Jl. Slamet riyadi 189 88
Mayang 228
Perum PBS No.16 76 206
Perum PBS No.16 76 206 6.3 1.1
Pucangan 3/13 190
Pucangan 1/13 191
Sedahromo Lor 123
Perum PBS No.6 125
Perum PBS No.6 102
Kebon Baru 4/9 252
Kebon Baru 4/9 123
Pucangan 122
Jl.Slamet Riyadi 21 223
Perengrejo 1/2 97
Sanggrahan 3/1 111
Blumbangrewjo 80
Mangkuyudan 95
Wikarta 96
Blumbangrejo 2/6 121
Blumbangrejo 2/6 107
Tegalan 3/5 122
Keputren 4/8 121
Ngabeyan 3/2 123
Kopen 01/07 113
Komplek SMA Th 102
Jahidan 3/2 101 151
Pucangan Baru 2 82
Jahidan 3/2 89
Brontowiryan 7/1 124
Candi Baru 2/11 125
Grogolan 2/5 81
Purbayan 6/1 86
Purbayan 6/1 182
Prayan 2/1 106
Ngabeyan 3/2 124
Brontowiryan 254
Jaganharjo 1/ 123
Gumpang 122
Sedahromo Kidul 1/9 109
Sedahromo Kidul 1/9 118
Kepuh Pelem 120
Perengsari 122
Manggisan 3/9 102
Blumbang Rejo 124
Perum Pucangan Baru 88 153 5.7
Sidorejo 18/6 185
Ledok 1/6 124
Kebon Baru 2/10 120
Singopuran 3/2 125
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2/8/2023 TIDAK DITAGIHKAN =
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80
0000088853433 Hartiningsih Perum PBS No.16
0000088853422 Saksono Hadi Perum PBS No.16
0002053245554 Sajiyo Hutomo Pucangan 3/13
0001893316296 Samuel Samidi Pucangan 1/13
0000088850676 Mahmudi Sedahromo Lor
0000088860249 Warti Perum PBS No.6
0000088860238 Wuryanto Perum PBS No.6
0001906327269 Sri Sudjini Kebon Baru 4/9
0001906326281 Sudarno Pono Kebon Baru 4/9
0001273347753 Tumiyati Pucangan
0000086665162 Binti Mawarti Jl.Slamet Riyadi 21
0001525257832 Margareta Rumini Perengrejo 1/2
0000075925886 Sarwoko Sanggrahan 3/1
0001316845293 Nur Widjayanti Blumbangrewjo
0001793819182 Eriwati Mangkuyudan
0000089962401 Totok Sartobeno Wikarta
0000088973256 Johanes Harjono Blumbangrejo 2/6
0000088973245 Nanik Suparni Blumbangrejo 2/6
0001620171393 Ari Haryanto Tegalan 3/5
0000088958169 Mursiti Keputren 4/8