Rekapitulasi Kasir Harian 2022

RINCIAN RETRIBUSI PELAYANAN BULAN JANUARI TAHUN 2022
NO JENIS PELAYANAN TARIF
3 4
1 Pelayanan Pemeriksaan dan Obat Dasar 5000 22 110000 26
2 Pelayanan Pemeriksaan dan Pengobatan Kunjungan
Sore
10000 1 10000 1
3 Pelayanan Gawat Darurat di UGD 0
4 Perawatan Luka : 0
a. Rawat luka ringan 8000 0
b. Rawat luka berat 20000 0
c. Rawat luka Ganggren 0
5 Perawatan Luka Bakar : 0
a. Rawat luka bakar derajat I / regio ( kecil ) 0
b. Rawat luka bakar derajat II / regio ( sedang ) 0
6 Nebulizer 0
7 Circumsisi 0
8 Incisi Abses 0
9 Ekstraksi Kuku 25000 0
10 Stump plasty 0
11 Ekstirpasi Mata Ikan ( Excisi clavus ) 0
12 Heacting : 0
a. 1 - 3 per luka 20000 0
b. Lebih dari 4 per luka 0
c. Angkat / lepas jahitan 7000 0
13 Ekstirpasi Lipoma 0
14 Bulektomi 0
15 Pasang Naso Gastric Tube (NGT) 0
16 Jahit 1 Telinga dawir 0
17 Kateter : 0
a. Pasang kateter / Dower kateter 0
b. Lepas kateter 0
18 Pemasangan Infus 0
Ganti cairan infus 0
19 Injeksi Intra Vena 10000 0
20 Injeksi Intra Muscular / Sub Cutan / Intra Cutan 7500 0
21 Pemakaian Oksigen (per jam) dewasa / anak 0
22 Surat Keterangan : 0
a. Sehat 5000 8 40000 28
b. Kelahiran 0
c. Visum hidup 0
23 Observasi (per jam) 0
24 Pelayanan Kesehatan Mata 0
a. Pemeriksaan visus mata 0
b. Tindakan Irigasi mata ( Trauma Kimia ) 0
c. Pengambilan Corpus alienum (benda asing) 0
25 Pelayanan Kesehatan THT 0
a. Ekstraksi serumen 0
b. Ekstraksi benda asing THT 0
26 ECG 25000 0
27 Home Care 0
28 Pembersihan karang gigi /Scalling Per Regio 11000 0
29 Penanganan Dry Socket 0
30 Penanganan Trismus 0
31 Pencabutan Gigi Sulung Dengan Chlorethyl 7500 1 7500 1
32 Pencabutan Gigi Sulung Dengan Injeksi Lokal
anestesi
15000 0
33 Pencabutan Gigi Permanent 22000 0 1
34 Pencabutan Gigi Permanent Akar 3 0
35 Pencabutan Gigi Permanent M3 50000 0
36 Pencabutan Gigi Permanent M3 Miring 0
37 Tumpatan Sementara 0
38 Devitalisasi Pulpa Gigi Permanen (T.Sementara 1)
0
39 Insici Abses 0
40 Open Boor 12500 0
41 Pulp Capping (T. Sementara 2) 15000 0
42 Pulpotomi dengan Trimix (Tumpatan Sementara 3)
0
43 Sterilisasi Ruang Pulpa 1 (Tumpatan Sementara 4)
15000 0
44 Sterilisasi Ruang Pulpa 2 (Tumpatan Sementara 5)
0
45 Pulpotomi (T. Sementara 6 ) 0
46 Tumpatan Basis (T. Sementara 7) 0
47 Tumpatan Tetap Glass Ionomer Cement 15000 0
48 Tumpatan Tetap Composit 25000 0
49 Eugenol Cavit ( Tumpatan Sementara 8 ) 15000 0
50 Devitalisasi Pulpa Gigi Sulung (Tumpatan Sementara
9)
0
51 Tumpatan tetap amalgam 0
52 Tumpatan tetap Fissure sealent 0
53 Curettage PocketGingiva 25000 0
54 Operculectomy / Gingivectomy / Frenulectomi (per
regio)
0
55 Flap periodontal 0
56 Alveolectomy 0
57 Topical Aplikasi / per regio 0
1 Pelayanan Kesehatan Ibu : 0
a. Pap Smear 0
b. I V A : 0
- See (pemeriksaan) 0
- Treat Ringan 0
- Treat Cryo 0
c. Inspekulo / Pemeriksaan Dalam ( VT ) 0
2 Pelayanan Kesehatan Anak : 0
a. Tindik 5000 0
b. Deteksi Dini Tumbuh Kembang Anak 0
c. Fototerapi 0
3 Pelayanan KB 0
a. KB Suntik 3 bulan 0
b. KB Suntik 1 bulan 0
c. KB PIL 0
d. Implant : 0
- Pasang 0
- Cabut / Lepas 0
e. IUD : 0
- Pasang 0
- Cabut / Lepas 20000 0
f. Steril : 0
- MOP 0
1 Pelayanan Konsultasi Kesehatan Rawat Jalan
Spesialistik
0
2 Tindakan Spesialis Mata 0
a. Pemeriksaan penyakit degenaratif (katarak /
glukoma)
0
b. Tindakan Operasi Kecil : 0
- Incisi Hordeolum / chalazion 0
- Eksisi Pterigium ( selaput tipis tumbuh di
konjungtiva )
0
- eksisi kista/lipoma/atheroma/nevus
konjunctiva/palpebra
0
3 Tindakan Spesialis Penyakit Dalam / Paru / Jantung 0
a. Injeksi intra artikuler 0
b. Puncti pleura effusion 0
c. Puncti Ascites 0
4 Tindakan Spesialis Obgyn 0
- MOW 0
5 Tindakan Spesialis THT 0
a. Parasintesis 0
b. Penghentian Epistaksis 0
- ringan 0
- berat (dengan tampon) 0
c. Irigasi Sinus Maksillaris 0
1 USG 0
a. USG Kandungan 35000 0
b. USG Upper Abdomen 0
c. USG Lower Abdomen 0
1 Pemeriksaan Jenazah 27500 3 82500
2 Pemeriksaan Jenazah di Luar Jam Kerja 50000 0
3 Konsultasi 0
a. Psikologi 2500 0
b. Gizi ( Pojok Gizi ) 0
4 Pelayanan Pengobatan Tradisional (Battra) 0
a. Akupuntur 20000 0
b. Akupresur 0
c. Aromatherapi 0
d. Medik Herbal 0
e. Pijat Bayi : 0
- Umur 0 – 1 tahun 7500 0
- Umur > 1 tahun 10000 0
5 Konseling VCT 0
6 Pelayanan Program Terapi Rumatan Metadon 0
7 Terapi Infra Merah 0
1 Biaya Rawat Inap termasuk makan 0
a. Bayi 0
b. Anak / Dewasa 0
c. Bayi dengan inkubator 0
2 Visite : 0
a. Dokter Umum 0
b. Dokter Spesialis : 0
3 Konsultasi On Call : 0
a. Dokter Umum 0
b. Dokter Spesialis 0
1 Pertolongan Persalinan Normal 0
2 Pertolongan Persalinan Patologis 0
3 Pertolongan Persalinan Normal Oleh Obgyn 0
4 Pertolongan Persalinan Patologis Oleh Obgyn 0
5 Manual Placenta 0
6 HPP dgn Kompresi Bimanual Interna 0
7 HPP dgn Kondom Katheter 0
8 Vacum Ekstraksi 0
9 Forcep Ekstraksi 0
10 Curretage 0
11 Induksi Persalinan dengan OD 0
12 Hecting Portio 0
13 Hecting Ruptur Perineum Totalis 0
14 Resusitasi Asphyxia 0
15 Resusitasi BBL 0
16 Sectio Caesaria 0
1 Hematologi 0
a. Darah Rutin (Analizer) 25000 0
b. Darah Rutin (manual) 0
- Hemoglobin 4000 0 1
- Lekosit 0
- Trombosit 0
c. Laju Endap Darah (LED ) 0
d. Pemeriksaan Hematokrit / PCV (Mikro ) 0
e. Pemeriksaan Hitung Eritrosit (Manual) 0
f. Pemeriksaan Hitung Jenis Lekosit ( Manual ) 0
g. Pemeriksaan Golongan Darah 7000 0 2
2 Pemeriksaan Urine : 0
a. Urine analyzer 0
b. Urine lengkap 12500 0 1
c. Albumin 0
d. pH 0
e. Pemeriksaan Reduksi Urine 0
- Reduksi Urine (Strips ) 0
- Reduksi Urine (Benedict) 0
f. Pemeriksaan Bilirubin Urine (Foucet ) 0
g. Pemeriksaan Urobilin Urine (Schlessinger ) 0
h. Pemeriksaan Sedimen Urine 0
i. Trichomonas 0
3 Pemeriksaan Glukosa Darah : 0
a. Pemeriksaan gula darah stick 10000 0
b. Pemeriksaan gula darah fotometer 11000 0 3
4 Pemeriksaan Faal Hati : 0
a. Bilirubin Direct 0
b. Blirubin Total 0
c. SGOT / ASAT 12500 0
d. SGPT / ALAT 12500 0
e. Total Protein 0
f. Albumin 0
5 Mikrobiologi : 0
a. Malaria 0
b. BTA / TBC 0
c. BTA / Kusta 0
d. GO 0
e. VDRL 0
f. TPHA 0
g. Rectal Swab 0
h. Widal 15000 0
i. Pemeriksaan Jamur 0
6 Plano Test ( Tes Kehamilan Urine ) 15000 0
7 Pemeriksan Faal Ginjal : 0
a. Creatinin 0
b. Ureum (BUN) 0
c. Pemeriksaan Asam Urat : 0
- Asam Urat Stick 11000 0
- Asam Urat Fotometer 12000 0
8 Pemeriksaan Lemak : 0
a. Cholesterol Total 15000 0 1
b. Trigliserida 0
c. HDL-Cholesterol 0
d. LDL-Cholesterol 0
9 Pemeriksaan Feaces : 0
a. Faeces Rutin 0
b. Pemeriksaan Faeces (Makroskopis ) 0
c. Pemeriksaan Faeces (Mikroskopis ) 0
d. Telur Cacing 0
e. Amoeba 0
10 Pemeriksaan Lain-Lain 0
a. H I V 0
b. H I V konfirmasi 0
c. HBs Ab 0
d. HBs Ag 0
e. Narkoba 0
f. Cholinesterase 0
g. ............................ 0
h. ............................ 0
11 Pemeriksaan Darah 0
a. Ig G 0
b. Ig M 0
1 Pemeriksaaan Kesehatan Calon Jemaah Haji Tahap I
0
2 Pemeriksaan Kesehatan Calon Jemaah Haji Tahap II
0
1 Pemakaian Mobil Ambulance 0
a. Dalam Kota Surabaya 0
b. Keluar Kota Surabaya 0
250000
4 5 6 7 8 10 11
130000 3 15000 12 60000 10 50000 10 50000 16 80000 17
10000 0 0 0 1 10000 0 3
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140000 8 40000 15 75000 1 5000 5 25000 7 35000 7
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22000 0 0 0 0 0
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4000 2 8000 2 8000 1 4000 1 4000 0 1
0 0 0 0 0 0
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0 0 0 0 0 0
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14000 1 7000 2 14000 0 1 7000 0 1
0 0 0 0 0 0
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12500 2 25000 2 25000 0 1 12500 0 1
0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
0 1 10000 0 0 0 0
33000 1 11000 3 33000 2 22000 1 11000 2 22000 1
0 0 0 0 0 0
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388000 176000 222500 125000 134500 152000
TANGGAL
11 12 13 14 15 17 18
85000 17 85000 14 70000 13 65000 11 55000 22 110000 12
30000 0 2 20000 1 10000 1 10000 0 1

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35000 6 30000 10 50000 6 30000 5 25000 3 15000 4
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0 2 40000 0 0 1 20000 0
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7000 0 2 14000 1 7000 1 7000 0
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12500 1 12500 3 37500 1 12500 1 12500 0
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0 1 10000 2 20000 0 2 20000 0
11000 1 11000 2 22000 1 11000 0 0
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0 1 15000 1 15000 0 0 1 15000
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184500 207500 268000 159500 223500 162000
GAL
18 19 20 21 22 24
60000 14 70000 9 45000 9 45000 5 25000 16 80000
10000 1 10000 0 1 10000 0 0

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20000 6 30000 9 45000 5 25000 3 15000 6 30000
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5000 1 5000 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 4 80000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 8000 1 4000 1 4000 1 4000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 7000 1 7000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 25000 1 12500 1 12500 1 12500 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 10000 0 0 1 10000 0
0 0 2 22000 1 11000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 12000 0 0 0
0 0 0 0 0 0
0 0 1 15000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
151500 270500 155500 164500 73500 110000
25 26 27 28 29 31
12 60000 7 35000 13 65000 10 50000 10 50000 7 35000
1 10000 0 2 20000 2 20000 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1 20000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
5 25000 4 20000 6 30000 2 10000 4 20000 4 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2 15000 1 7500 0 2 15000 0 1 7500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 20000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
3 82500 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 3 60000 3 60000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1 4000 2 8000 1 4000 1 4000 0 1 4000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1 7000 2 14000 1 7000 1 7000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1 12500 2 25000 1 12500 1 12500 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2 22000 2 22000 2 22000 2 22000 0 1 11000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 15000 0 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 12000 0 1 12000
0 0 0 0 0 0
1 15000 0 0 0 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
273000 191500 235500 152500 90000 119500
TOTAL
317 1,585,000.00
18 180,000.00
0 -
0 -
0 -
2 40,000.00
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
2 14,000.00
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
167 835,000.00
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
2 22,000.00
0 -
0 -
17 127,500.00
0 -
3 66,000.00
0 -
0 -
0 -
0 -
0 -
0 -
2 25,000.00
0 -
0 -
1 15,000.00
0 -
0 -
0 -
0 -
1 25,000.00
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
2 10,000.00
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
1 20,000.00
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
8 220,000.00
0 -
0 -
0 -
0 -
0 -
16 320,000.00
0 -
0 -
0 -
0 -
1 7,500.00
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
25 100,000.00
0 -
0 -
0 -
0 -
0 -
0 -
18 126,000.00
0 -
0 -
23 287,500.00
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
8 80,000.00
29 319,000.00
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
1 15,000.00
0 -
2 30,000.00
0 -
0 -
0 -
0 -
0 -
3 36,000.00
0 -
9 135,000.00
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
4,640,500.00
RINCIAN RETRIBUSI PELAYANAN BULAN FEBRUARI TAHUN 2023

2 3
1 Pelayanan Pemeriksaan dan Obat Dasar 5000 11 55000 8
2 Pelayanan Pemeriksaan dan Pengobatan Kunjungan 10000 1 10000
Sore
3 Pelayanan Gawat Darurat di UGD 0
4 Perawatan Luka : 0
a. Rawat luka ringan 8000 0 1
b. Rawat luka berat 20000 1 20000
c. Rawat luka Ganggren 0
5 Perawatan Luka Bakar : 0
a. Rawat luka bakar derajat I / regio ( kecil ) 0
b. Rawat luka bakar derajat II / regio ( sedang ) 0
6 Nebulizer 0
7 Circumsisi 0
8 Incisi Abses 0
9 Ekstraksi Kuku 25000 0
10 Stump plasty 0
11 Ekstirpasi Mata Ikan ( Excisi clavus ) 0
12 Heacting : 0
a. 1 - 3 per luka 20000 0
b. Lebih dari 4 per luka 30000 0
c. Angkat / lepas jahitan 7000 0
13 Ekstirpasi Lipoma 0
14 Bulektomi 0
15 Pasang Naso Gastric Tube (NGT) 0
16 Jahit 1 Telinga dawir 0
17 Kateter : 0
a. Pasang kateter / Dower kateter 0
b. Lepas kateter 0
18 Pemasangan Infus 25000 0
Ganti cairan infus 0
19 Injeksi Intra Vena 10000 0
20 Injeksi Intra Muscular / Sub Cutan / Intra Cutan 7500 0
21 Pemakaian Oksigen (per jam) dewasa / anak 0
22 Surat Keterangan : 0
a. Sehat 5000 2 10000 6
b. Kelahiran 5000 0
c. Visum hidup 0
23 Observasi (per jam) 4000 0
24 Pelayanan Kesehatan Mata 0
a. Pemeriksaan visus mata 0
b. Tindakan Irigasi mata ( Trauma Kimia ) 0
c. Pengambilan Corpus alienum (benda asing) 0
25 Pelayanan Kesehatan THT 0
a. Ekstraksi serumen 0
b. Ekstraksi benda asing THT 0
26 ECG 25000 0
27 Home Care 0
28 Pembersihan karang gigi /Scalling Per Regio 11000 0
29 Penanganan Dry Socket 0
30 Penanganan Trismus 0
31 Pencabutan Gigi Sulung Dengan Chlorethyl 7500 0 1
32 Pencabutan Gigi Sulung Dengan Injeksi Lokal 15000 0
anestesi
33 Pencabutan Gigi Permanent 22000 0
34 Pencabutan Gigi Permanent Akar 3 0
35 Pencabutan Gigi Permanent M3 50000 0
36 Pencabutan Gigi Permanent M3 Miring 0
37 Tumpatan Sementara 0
38 Devitalisasi Pulpa Gigi Permanen (T.Sementara 1) 0
39 Insici Abses 0
40 Open Boor 12500 0
41 Pulp Capping (T. Sementara 2) 15000 0
42 Pulpotomi dengan Trimix (Tumpatan Sementara 3) 0
43 Sterilisasi Ruang Pulpa 1 (Tumpatan Sementara 4) 15000 0
44 Sterilisasi Ruang Pulpa 2 (Tumpatan Sementara 5) 15000 0
45 Pulpotomi (T. Sementara 6 ) 0
46 Tumpatan Basis (T. Sementara 7) 0
47 Tumpatan Tetap Glass Ionomer Cement 15000 0
48 Tumpatan Tetap Composit 25000 0
49 Eugenol Cavit ( Tumpatan Sementara 8 ) 15000 0
50 Devitalisasi Pulpa Gigi Sulung (Tumpatan Sementara 0
9)
51 Tumpatan tetap amalgam 0
52 Tumpatan tetap Fissure sealent 0
53 Curettage PocketGingiva 25000 0
54 Operculectomy / Gingivectomy / Frenulectomi (per 0
regio)
55 Flap periodontal 0
56 Alveolectomy 0
57 Topical Aplikasi / per regio 0
1 Pelayanan Kesehatan Ibu : 0
a. Pap Smear 0
b. I V A : 0
- See (pemeriksaan) 0
- Treat Ringan 0
- Treat Cryo 0
c. Inspekulo / Pemeriksaan Dalam ( VT ) 1500 0
2 Pelayanan Kesehatan Anak : 0
a. Tindik 5000 0
b. Deteksi Dini Tumbuh Kembang Anak 0
c. Fototerapi 0
3 Pelayanan KB 0
a. KB Suntik 3 bulan 0
b. KB Suntik 1 bulan 0
c. KB PIL 0
d. Implant : 0
- Pasang 0
- Cabut / Lepas 0
e. IUD : 0
- Pasang 0
- Cabut / Lepas 0
f. Steril : 0
- MOP 0
1 Pelayanan Konsultasi Kesehatan Rawat Jalan 0
Spesialistik
2 Tindakan Spesialis Mata 0
a. Pemeriksaan penyakit degenaratif (katarak / 0
glukoma)
b. Tindakan Operasi Kecil : 0
- Incisi Hordeolum / chalazion 0
- Eksisi Pterigium ( selaput tipis tumbuh di 0
konjungtiva )
- eksisi kista/lipoma/atheroma/nevus 0
konjunctiva/palpebra
3 Tindakan Spesialis Penyakit Dalam / Paru / Jantung 0
a. Injeksi intra artikuler 0
b. Puncti pleura effusion 0
c. Puncti Ascites 0
4 Tindakan Spesialis Obgyn 0
- MOW 0
5 Tindakan Spesialis THT 0
a. Parasintesis 0
b. Penghentian Epistaksis 0
- ringan 0
- berat (dengan tampon) 0
c. Irigasi Sinus Maksillaris 0
1 USG 0
a. USG Kandungan 35000 0
b. USG Upper Abdomen 0
c. USG Lower Abdomen 0
1 Pemeriksaan Jenazah 27500 0
2 Pemeriksaan Jenazah di Luar Jam Kerja 50000 0
3 Konsultasi 0
a. Psikologi 2500 0
b. Gizi ( Pojok Gizi ) 0
4 Pelayanan Pengobatan Tradisional (Battra) 0
a. Akupuntur 20000 3 60000 1
b. Akupresur 0
c. Aromatherapi 0
d. Medik Herbal 0
e. Pijat Bayi : 0
- Umur 0 – 1 tahun 7500 0
- Umur > 1 tahun 10000 0
5 Konseling VCT 0
6 Pelayanan Program Terapi Rumatan Metadon 0
7 Terapi Infra Merah 0
1 Biaya Rawat Inap termasuk makan 0
a. Bayi 15000 0
b. Anak / Dewasa 20000 0
c. Bayi dengan inkubator 0
2 Visite : 0
a. Dokter Umum 5000 0
b. Dokter Spesialis : 0
3 Konsultasi On Call : 0
a. Dokter Umum 2500 0
b. Dokter Spesialis 0
1 Pertolongan Persalinan Normal 250000 0
2 Pertolongan Persalinan Patologis 0
3 Pertolongan Persalinan Normal Oleh Obgyn 0
4 Pertolongan Persalinan Patologis Oleh Obgyn 0
5 Manual Placenta 0
6 HPP dgn Kompresi Bimanual Interna 0
7 HPP dgn Kondom Katheter 0
8 Vacum Ekstraksi 0
9 Forcep Ekstraksi 0
10 Curretage 0
11 Induksi Persalinan dengan OD 0
12 Hecting Portio 0
13 Hecting Ruptur Perineum Totalis 0
14 Resusitasi Asphyxia 0
15 Resusitasi BBL 0
16 Sectio Caesaria 0
1 Hematologi 0
a. Darah Rutin (Analizer) 25000 0
b. Darah Rutin (manual) 0
- Hemoglobin 4000 3 12000 4
- Lekosit 0
- Trombosit 0
c. Laju Endap Darah (LED ) 0
d. Pemeriksaan Hematokrit / PCV (Mikro ) 0
e. Pemeriksaan Hitung Eritrosit (Manual) 0
f. Pemeriksaan Hitung Jenis Lekosit ( Manual ) 0
g. Pemeriksaan Golongan Darah 7000 2 14000 3
2 Pemeriksaan Urine : 0
a. Urine analyzer 0
b. Urine lengkap 12500 2 25000 4
c. Albumin 0
d. pH 0
e. Pemeriksaan Reduksi Urine 0
- Reduksi Urine (Strips ) 0
- Reduksi Urine (Benedict) 0
f. Pemeriksaan Bilirubin Urine (Foucet ) 0
g. Pemeriksaan Urobilin Urine (Schlessinger ) 0
h. Pemeriksaan Sedimen Urine 0
i. Trichomonas 0
3 Pemeriksaan Glukosa Darah : 0
a. Pemeriksaan gula darah stick 10000 0
b. Pemeriksaan gula darah fotometer 11000 2 22000 3
4 Pemeriksaan Faal Hati : 0
a. Bilirubin Direct 0
b. Blirubin Total 0
c. SGOT / ASAT 12500 0
d. SGPT / ALAT 12500 0
e. Total Protein 0
f. Albumin 0
5 Mikrobiologi : 0
a. Malaria 0
b. BTA / TBC 0
c. BTA / Kusta 0
d. GO 0
e. VDRL 0
f. TPHA 0
g. Rectal Swab 0
h. Widal 15000 0
i. Pemeriksaan Jamur 0
6 Plano Test ( Tes Kehamilan Urine ) 15000 0
7 Pemeriksan Faal Ginjal : 0
a. Creatinin 0
b. Ureum (BUN) 0
c. Pemeriksaan Asam Urat : 0
- Asam Urat Stick 11000 0
- Asam Urat Fotometer 12000 0
8 Pemeriksaan Lemak : 0
a. Cholesterol Total 15000 0
b. Trigliserida 0
c. HDL-Cholesterol 0
d. LDL-Cholesterol 0
9 Pemeriksaan Feaces : 0
a. Faeces Rutin 0
b. Pemeriksaan Faeces (Makroskopis ) 0
c. Pemeriksaan Faeces (Mikroskopis ) 0
d. Telur Cacing 0
e. Amoeba 0
10 Pemeriksaan Lain-Lain 0
a. H I V 0
b. H I V konfirmasi 0
c. HBs Ab 0
d. HBs Ag 0
e. Narkoba 0
f. Cholinesterase 0
g. ............................ 0
h. ............................ 0
11 Pemeriksaan Darah 0
a. Ig G 0
b. Ig M 0
1 Pemeriksaaan Kesehatan Calon Jemaah Haji Tahap I 25000 0
2 Pemeriksaan Kesehatan Calon Jemaah Haji Tahap II 50000 0
1 Pemakaian Mobil Ambulance 0
a. Dalam Kota Surabaya 0
b. Keluar Kota Surabaya 0
228000
3 4 5 7 8 9 10
40000 5 25000 11 55000 20 100000 25 125000 10 50000 12
0 0 1 10000 0 4 40000 0
0 0 0 0 0 0
0 0 0 0 0 0
8000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
30000 7 35000 10 50000 7 35000 2 10000 2 10000 6
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7500 0 0 2 15000 1 7500 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 1500 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 27500 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
16000 2 8000 0 0 0 1 4000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
21000 2 14000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
50000 2 25000 0 0 0 1 12500 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 10000 0 0 0 1 10000
33000 2 22000 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 12000 0 2 24000 0 0
0 0 0 0 0 0
0 1 15000 0 2 30000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
225500 193500 115000 204000 184000 101500
TANGGAL
10 11 12 14 15 16
60000 8 40000 18 90000 25 125000 15 75000 11 55000
0 2 20000 1 10000 0 3 30000 1 10000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 30000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
30000 2 10000 7 35000 4 20000 6 30000 1 5000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7500 0 0 0 2 15000 1 7500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
4000 0 3 12000 1 4000 0 3 12000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 3 21000 1 7000 0 3 21000
0 0 0 0 0 0
0 0 0 0 0 0
25000 0 3 37500 1 12500 0 3 37500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 3 30000
11000 0 3 33000 1 11000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
137500 70000 268500 179500 150000 193000
17 18 19 21 22 23
11 55000 7 35000 4 20000 21 105000 13 65000 9
1 10000 1 10000 2 20000 0 0
0 0 0 0 0
0 0 0 0 0
0 0 1 8000 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
6 30000 0 4 20000 1 5000 3 15000 3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 7500 0 0 1 7500 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 1 5000 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 27500 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 8000 1 4000 1 4000 1 4000 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 7000 1 7000 1 7000 1 7000 0
0 0 0 0 0
0 0 0 0 0
3 37500 1 12500 1 12500 1 12500 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 10000 0 0 0 0
2 22000 1 11000 1 11000 1 11000 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 1 15000 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 15000 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
229500 79500 102500 172000 80000
TOTAL
23 24 25 26
45000 12 60000 14 70000 8 40000 278 1,390,000.00
0 0 1 10000 0 18 180,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 2 16,000.00
0 0 0 0 1 20,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 1 30,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 1 25000 1 25,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 1 7500 1 7500 2 15,000.00
0 0 0 0 0 -
0 0 0 0 0 -
15000 3 15000 6 30000 2 10000 90 450,000.00
0 0 1 5000 1 5000 2 10,000.00
0 0 0 0 0 -
0 0 24 96000 22 88000 46 184,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 1 7500 0 0 11 82,500.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 1 1500 1 1500 3 4,500.00
0 0 0 0 0 -
0 0 0 0 1 5,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 2 55,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 4 80,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 1 15000 1 15000 2 30,000.00
0 0 1 20000 1 20000 2 40,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 1 5000 1 5000 2 10,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 1 2500 0 1 2,500.00
0 0 0 0 0 -
0 0 1 250000 1 250000 2 500,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 2 8000 3 12000 1 4000 29 116,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 18 126,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 2 25000 1 12500 0 27 337,500.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 2 20000 0 0 8 80,000.00
0 0 0 0 17 187,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 1 15,000.00
0 0 0 0 0 -
0 0 0 0 2 30,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 3 36,000.00
0 0 0 0 0 -
0 0 0 0 4 60,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
60000 135500 537000 471000 4,117,000.00
RINCIAN RETRIBUSI PELAYANAN BULAN MARET TAHUN 2022

1 2
1 Pelayanan Pemeriksaan dan Obat Dasar
5000 12 60000 22 110000
2 Pelayanan Pemeriksaan dan Pengobatan
Kunjungan Sore 10000 0 0
3 Pelayanan Gawat Darurat di UGD
0 0
4 Perawatan Luka :
0 0
a. Rawat luka ringan
8000 0 0
b. Rawat luka berat
20000 0 0
c. Rawat luka Ganggren
0 0
5 Perawatan Luka Bakar :
0 0
a. Rawat luka bakar derajat I / regio ( kecil )
0 0
b. Rawat luka bakar derajat II / regio ( sedang )
0 0
6 Nebulizer
0 0
7 Circumsisi
0 0
8 Incisi Abses
0 0
9 Ekstraksi Kuku
25000 0 0
10 Stump plasty
0 0
11 Ekstirpasi Mata Ikan ( Excisi clavus )
0 0
12 Heacting :
0 0
a. 1 - 3 per luka
20000 0 0
b. Lebih dari 4 per luka
0 0
c. Angkat / lepas jahitan
7000 0 0
13 Ekstirpasi Lipoma
0 0
14 Bulektomi
0 0
15 Pasang Naso Gastric Tube (NGT)
0 0
16 Jahit 1 Telinga dawir
0 0
17 Kateter :
0 0
a. Pasang kateter / Dower kateter
0 0
b. Lepas kateter
0 0
18 Pemasangan Infus
0 0
Ganti cairan infus
0 0
19 Injeksi Intra Vena
10000 0 0
20 Injeksi Intra Muscular / Sub Cutan / Intra Cutan
7500 0 0
21 Pemakaian Oksigen (per jam) dewasa / anak
0 0
22 Surat Keterangan :
0 0
a. Sehat
5000 2 10000 5 25000
b. Kelahiran
0 0
c. Visum hidup
0 0
23 Observasi (per jam)
4000 0 0
24 Pelayanan Kesehatan Mata
0 0
a. Pemeriksaan visus mata
0 0
b. Tindakan Irigasi mata ( Trauma Kimia )
0 0
c. Pengambilan Corpus alienum (benda asing)
0 0
25 Pelayanan Kesehatan THT
0 0
a. Ekstraksi serumen
0 0
b. Ekstraksi benda asing THT
0 0
26 ECG
25000 0 0
27 Home Care
0 0
28 Pembersihan karang gigi /Scalling Per Regio
11000 0 0
29 Penanganan Dry Socket
0 0
30 Penanganan Trismus
0 0
31 Pencabutan Gigi Sulung Dengan Chlorethyl
7500 1 7500 2 15000
anestesi 15000 0 0
33 Pencabutan Gigi Permanent
22000 0 0
34 Pencabutan Gigi Permanent Akar 3
0 0
35 Pencabutan Gigi Permanent M3
50000 0 0
36 Pencabutan Gigi Permanent M3 Miring
0 0
37 Tumpatan Sementara
0 0
0 0
39 Insici Abses
0 0
40 Open Boor
12500 0 0
41 Pulp Capping (T. Sementara 2)
15000 0 0
42 Pulpotomi dengan Trimix (Tumpatan Sementara
3) 0 0
43 Sterilisasi Ruang Pulpa 1 (Tumpatan Sementara
4) 15000 0 0
5) 15000 0 0
45 Pulpotomi (T. Sementara 6 )
0 0
46 Tumpatan Basis (T. Sementara 7)
15000 0 0
47 Tumpatan Tetap Glass Ionomer Cement
15000 0 0
48 Tumpatan Tetap Composit
25000 0 0
49 Eugenol Cavit ( Tumpatan Sementara 8 )
15000 0 0
50 Devitalisasi Pulpa Gigi Sulung (Tumpatan
Sementara 9) 0 0
51 Tumpatan tetap amalgam
0 0
52 Tumpatan tetap Fissure sealent
0 0
53 Curettage PocketGingiva
25000 0 0
54 Operculectomy / Gingivectomy / Frenulectomi
(per regio) 0 0
55 Flap periodontal
0 0
56 Alveolectomy
0 0
57 Topical Aplikasi / per regio
0 0
1 Pelayanan Kesehatan Ibu :
0 0
a. Pap Smear
0 0
b. I V A :
0 0
- See (pemeriksaan)
0 0
- Treat Ringan
0 0
- Treat Cryo
0 0
c. Inspekulo / Pemeriksaan Dalam ( VT )
0 0
2 Pelayanan Kesehatan Anak :
0 0
a. Tindik
5000 0 1 5000
b. Deteksi Dini Tumbuh Kembang Anak
0 0
c. Fototerapi
0 0
3 Pelayanan KB
0 0
a. KB Suntik 3 bulan
0 0
b. KB Suntik 1 bulan
0 0
c. KB PIL
0 0
d. Implant :
0 0
- Pasang
0 0
- Cabut / Lepas
20000 0 0
e. IUD :
0 0
- Pasang
0 0
- Cabut / Lepas
0 0
f. Steril :
0 0
- MOP
0 0
Spesialistik 0 0
2 Tindakan Spesialis Mata
0 0
glukoma) 0 0
b. Tindakan Operasi Kecil :
0 0
- Incisi Hordeolum / chalazion
0 0
konjungtiva ) 0 0
konjunctiva/palpebra 0 0
3 Tindakan Spesialis Penyakit Dalam / Paru / Jantung
0 0
a. Injeksi intra artikuler
0 0
b. Puncti pleura effusion
0 0
c. Puncti Ascites
0 0
4 Tindakan Spesialis Obgyn
0 0
- MOW
0 0
5 Tindakan Spesialis THT
0 0
a. Parasintesis
0 0
b. Penghentian Epistaksis
0 0
- ringan
0 0
- berat (dengan tampon)
0 0
c. Irigasi Sinus Maksillaris
0 0
1 USG
0 0
a. USG Kandungan
35000 0 0
b. USG Upper Abdomen
0 0
c. USG Lower Abdomen
0 0
1 Pemeriksaan Jenazah 27500 0 1 27500
2 Pemeriksaan Jenazah di Luar Jam Kerja 50000 0 0
3 Konsultasi 0 0
a. Psikologi
2500 0 0
b. Gizi ( Pojok Gizi )
0 0
4 Pelayanan Pengobatan Tradisional (Battra)
0 0
a. Akupuntur
20000 0 2 40000
b. Akupresur
0 0
c. Aromatherapi
0 0
d. Medik Herbal
0 0
e. Pijat Bayi :
0 0
- Umur 0 – 1 tahun
7500 0 0
- Umur > 1 tahun
10000 0 0
5 Konseling VCT
0 0
6 Pelayanan Program Terapi Rumatan Metadon
0 0
7 Terapi Infra Merah
0 0
1 Biaya Rawat Inap termasuk makan
0 0
a. Bayi
0 0
b. Anak / Dewasa
0 0
c. Bayi dengan inkubator
0 0
2 Visite :
0 0
a. Dokter Umum
0 0
b. Dokter Spesialis :
0 0
3 Konsultasi On Call :
0 0
a. Dokter Umum
0 0
b. Dokter Spesialis
0 0
1 Pertolongan Persalinan Normal
0 0
2 Pertolongan Persalinan Patologis
0 0
3 Pertolongan Persalinan Normal Oleh Obgyn
0 0
4 Pertolongan Persalinan Patologis Oleh Obgyn
0 0
5 Manual Placenta
0 0
6 HPP dgn Kompresi Bimanual Interna
0 0
7 HPP dgn Kondom Katheter
0 0
8 Vacum Ekstraksi
0 0
9 Forcep Ekstraksi
0 0
10 Curretage
0 0
11 Induksi Persalinan dengan OD
0 0
12 Hecting Portio
0 0
13 Hecting Ruptur Perineum Totalis
0 0
14 Resusitasi Asphyxia
0 0
15 Resusitasi BBL
0 0
16 Sectio Caesaria
0 0
1 Hematologi
0 0
a. Darah Rutin (Analizer)
25000 0 0
b. Darah Rutin (manual)
0 0
- Hemoglobin
4000 1 4000 0
- Lekosit
0 0
- Trombosit
0 0
c. Laju Endap Darah (LED )
0 0
d. Pemeriksaan Hematokrit / PCV (Mikro )
0 0
e. Pemeriksaan Hitung Eritrosit (Manual)
0 0
f. Pemeriksaan Hitung Jenis Lekosit ( Manual )
0 0
g. Pemeriksaan Golongan Darah
7000 0 0
2 Pemeriksaan Urine :
0 0
a. Urine analyzer
0 0
b. Urine lengkap
12500 0 0
c. Albumin
0 0
d. pH
0 0
e. Pemeriksaan Reduksi Urine
0 0
- Reduksi Urine (Strips )
0 0
- Reduksi Urine (Benedict)
0 0
f. Pemeriksaan Bilirubin Urine (Foucet )
0 0
g. Pemeriksaan Urobilin Urine (Schlessinger )
0 0
h. Pemeriksaan Sedimen Urine
0 0
i. Trichomonas
0 0
3 Pemeriksaan Glukosa Darah :
0 0
a. Pemeriksaan gula darah stick
10000 0 0
b. Pemeriksaan gula darah fotometer
11000 0 1 11000
4 Pemeriksaan Faal Hati :
0 0
a. Bilirubin Direct
0 0
b. Blirubin Total
0 0
c. SGOT / ASAT
12500 0 0
d. SGPT / ALAT
12500 0 0
e. Total Protein
0 0
f. Albumin
0 0
5 Mikrobiologi :
0 0
a. Malaria
0 0
b. BTA / TBC
0 0
c. BTA / Kusta
0 0
d. GO
0 0
e. VDRL
0 0
f. TPHA
0 0
g. Rectal Swab
0 0
h. Widal
15000 0 0
i. Pemeriksaan Jamur
0 0
6 Plano Test ( Tes Kehamilan Urine )
15000 0 0
7 Pemeriksan Faal Ginjal :
0 0
a. Creatinin
0 0
b. Ureum (BUN)
0 0
c. Pemeriksaan Asam Urat :
0 0
- Asam Urat Stick
11000 0 0
- Asam Urat Fotometer
12000 0 1 12000
8 Pemeriksaan Lemak :
0 0
a. Cholesterol Total
15000 0 1 15000
b. Trigliserida
0 0
c. HDL-Cholesterol
0 0
d. LDL-Cholesterol
0 0
9 Pemeriksaan Feaces :
0 0
a. Faeces Rutin
0 0
b. Pemeriksaan Faeces (Makroskopis )
0 0
c. Pemeriksaan Faeces (Mikroskopis )
0 0
d. Telur Cacing
0 0
e. Amoeba
0 0
10 Pemeriksaan Lain-Lain 0 0
a. H I V
0 0
b. H I V konfirmasi
0 0
c. HBs Ab
0 0
d. HBs Ag
0 0
e. Narkoba
0 0
f. Cholinesterase
0 0
g. ............................
0 0
h. ............................
0 0
11 Pemeriksaan Darah
0 0
a. Ig G
0 0
b. Ig M
0 0
1 Pemeriksaaan Kesehatan Calon Jemaah Haji
Tahap I 25000 0 0
2 Pemeriksaan Kesehatan Calon Jemaah Haji Tahap
II 50000 0 0
1 Pemakaian Mobil Ambulance
0 0
a. Dalam Kota Surabaya
0 0
b. Keluar Kota Surabaya
0 0
81500 260500
4 5 7 8 9 10
11 55000 7 35000 19 95000 21 105000 3 15000 14 70000
0 0 0 1 10000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 25000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
5 25000 2 10000 1 5000 6 30000 3 15000 2 10000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 15000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 27500 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 2 40000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 10000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 4000 0 1 4000 4 16000 5 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 7000 2 14000 4 28000
0 0 0 0 0 0
0 0 0 0 0 0
1 12500 1 12500 1 12500 1 12500 4 50000 5 62500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 10000 0 0 3 30000 2 20000
0 0 0 2 22000 2 22000 3 33000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 15000 1 15000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
92500 96500 112500 233000 202000 283500
TANGGAL
11 12 14 15 16 17
13 65000 12 60000 19 95000 11 55000 12 60000 19 95000
2 20000 0 0 1 10000 2 20000 3 30000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 20000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
4 20000 5 25000 2 10000 2 10000 6 30000 8 40000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 6 66000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 7500 1 7500 2 15000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 25000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 4 80000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 25000 0
0 0 0 0 0 0
2 8000 0 0 0 6 24000 3 12000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2 14000 1 7000 0 0 6 42000 3 21000
0 0 0 0 0 0
0 0 0 0 0 0
2 25000 0 0 0 6 75000 3 37500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 2 20000
2 22000 1 11000 1 11000 2 22000 6 66000 2 22000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 15000 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 12000 0 2 24000 0 1 12000
0 0 0 0 0 0
0 1 15000 1 15000 2 30000 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
174000 162500 138500 232000 457000 304500
18 19 21 22 23 24
8 40000 3 15000 14 70000 9 45000 15 75000 5
0 2 20000 0 0 2 20000 1
0 0 0 0 0
0 0 0 0 0
0 0 0 1 8000 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 1 20000 0
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0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
4 20000 4 20000 5 25000 2 10000 2 10000 4
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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6 66000 0 0 0 0
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0 0 0 1 7500 0
0 0 0 0 0
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0 0 0 2 10000 0
0 0 0 0 0
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1 25000 0 0 0 0 1
0 0 0 0 0
0 0 0 0 6 24000 4
0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 1 7000 0 3 21000 4
0 0 0 0 0
0 0 0 0 0
1 12500 1 12500 0 0 6 75000 4
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 3 30000
2 22000 1 11000 0 0 3 33000 4
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 1
0 0 0 0 0
0 0 0 0 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 1 12000 0 0 0
0 0 0 0 0
1 15000 1 15000 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 2 100000 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
200500 105500 102000 200500 348000
24 25 26 28 29 30 31
25000 4 20000 9 45000 21 105000 10 50000 6 30000 6
10000 0 2 20000 0 1 10000 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 20000 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 7500 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20000 5 25000 2 10000 5 25000 10 50000 1 5000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
15000 1 15000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 20000 0 1 20000 0 2 40000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
25000 0 2 50000 1 25000 0 0
0 0 0 0 0 0
16000 3 12000 0 0 0 4 16000 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
28000 1 7000 0 0 0 0 2
0 0 0 0 0 0
0 0 0 0 0 0
50000 2 25000 2 25000 0 0 4 50000 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 4 40000 2
44000 1 11000 2 22000 2 22000 0 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15000 0 0 1 15000 0 0
0 0 0 0 0 0
15000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 2 30000 2 30000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 30 1500000 6
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
263000 150000 202000 269500 110000 1681000
TOTAL
31
30000 305 1,525,000.00
10000 18 180,000.00
0 0 -
0 0 -
0 1 8,000.00
20000 3 60,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
25000 2 50,000.00
0 0 -
0 0 -
0 0 -
0 1 20,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 1 7,500.00
0 0 -
0 0 -
10000 99 495,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 12 132,000.00
0 0 -
0 0 -
0 10 75,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
15000 2 30,000.00
0 0 -
0 1 25,000.00
0 2 30,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 3 15,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 2 55,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 15 300,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 1 10,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 6 150,000.00
0 0 -
16000 44 176,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
14000 30 210,000.00
0 0 -
0 0 -
50000 48 600,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
20000 17 170,000.00
22000 39 429,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 3 45,000.00
0 0 -
0 1 15,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 6 72,000.00
0 0 -
0 14 210,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
300000 38 1,900,000.00
0 0 -
0 0 -
0 0 -
532000 724 6,994,500.00
RINCIAN RETRIBUSI PELAYANAN BULAN APRIL TAHUN 2022

1 2 4
5000 8 40000 12 60000 9
Kunjungan Sore 10000 1 10000 0
0 0
4 Perawatan Luka :
0 0
8000 0 0
b. Rawat luka berat
20000 0 1 20000
0 0
0 0
0 0
0 0
6 Nebulizer
0 0
7 Circumsisi
0 0
8 Incisi Abses
0 0
9 Ekstraksi Kuku
25000 0 0
10 Stump plasty
0 0
0 0
12 Heacting :
0 0
a. 1 - 3 per luka
20000 0 0
0 0
7000 0 0
0 0
14 Bulektomi
0 0
0 0
0 0
17 Kateter :
0 0
0 0
b. Lepas kateter
0 0
18 Pemasangan Infus
0 0
Ganti cairan infus
0 0
10000 0 0
7500 0 0
0 0
0 0
a. Sehat
5000 4 20000 8 40000 2
b. Kelahiran
0 0
c. Visum hidup
0 0
4000 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
26 ECG
25000 0 0
27 Home Care
0 0
11000 0 0
0 0
0 0
7500 0 2 15000
anestesi 15000 0 0
22000 0 0
0 0
50000 0 0
0 0
0 0
15000 0 0
39 Insici Abses
0 0
40 Open Boor
12500 0 0
15000 0 0
3) 0 0
4) 15000 0 0
5) 15000 0 0
0 0
0 0
15000 0 0
25000 1 25000 2 50000
15000 1 15000 0
Sementara 9) 0 0
0 0
0 0
25000 0 0
(per regio) 0 0
55 Flap periodontal
0 0
56 Alveolectomy
0 0
0 0
0 0
a. Pap Smear
0 0
b. I V A :
0 0
- See (pemeriksaan)
0 0
- Treat Ringan
0 0
- Treat Cryo
0 0
0 0
0 0
a. Tindik
5000 0 0
0 0
c. Fototerapi
0 0
3 Pelayanan KB
0 0
0 0
0 0
c. KB PIL
0 0
d. Implant :
0 0
- Pasang
0 0
- Cabut / Lepas
20000 0 0
e. IUD :
0 0
- Pasang
0 0
- Cabut / Lepas
0 0
f. Steril :
0 0
- MOP
0 0
Spesialistik 0 0
0 0
glukoma) 0 0
0 0
0 0
konjungtiva ) 0 0
0 0
0 0
0 0
c. Puncti Ascites
0 0
0 0
- MOW
0 0
0 0
a. Parasintesis
0 0
0 0
- ringan
0 0
0 0
0 0
1 USG
0 0
a. USG Kandungan
35000 0 0
0 0
0 0
3 Konsultasi 0 0
a. Psikologi
2500 0 0
0 0
0 0
a. Akupuntur
20000 0 4 80000
b. Akupresur
0 0
c. Aromatherapi
0 0
d. Medik Herbal
0 0
e. Pijat Bayi :
0 0
7500 0 0
- Umur > 1 tahun
10000 0 0
5 Konseling VCT
0 0
0 0
0 0
0 0
a. Bayi
0 0
b. Anak / Dewasa
0 0
0 0
2 Visite :
0 0
a. Dokter Umum
0 0
0 0
0 0
a. Dokter Umum
0 0
b. Dokter Spesialis
0 0
0 0
0 0
0 0
0 0
5 Manual Placenta
0 0
0 0
0 0
8 Vacum Ekstraksi
0 0
9 Forcep Ekstraksi
0 0
10 Curretage
0 0
0 0
12 Hecting Portio
0 0
0 0
0 0
15 Resusitasi BBL
0 0
16 Sectio Caesaria
0 0
1 Hematologi
0 0
25000 0 0
0 0
- Hemoglobin
4000 2 8000 0
- Lekosit
0 0
- Trombosit
0 0
0 0
0 0
0 0
0 0
7000 1 7000 2 14000
0 0
a. Urine analyzer
0 0
b. Urine lengkap
12500 2 25000 0
c. Albumin
0 0
d. pH
0 0
0 0
0 0
0 0
0 0
0 0
0 0
i. Trichomonas
0 0
0 0
10000 0 0
11000 1 11000 0
0 0
a. Bilirubin Direct
0 0
b. Blirubin Total
0 0
c. SGOT / ASAT
12500 0 0
d. SGPT / ALAT
12500 0 0
e. Total Protein
0 0
f. Albumin
0 0
5 Mikrobiologi :
0 0
a. Malaria
0 0
b. BTA / TBC
0 0
c. BTA / Kusta
0 0
d. GO
0 0
e. VDRL
0 0
f. TPHA
0 0
g. Rectal Swab
0 0
h. Widal
15000 0 0
0 0
15000 0 0
0 0
a. Creatinin
0 0
b. Ureum (BUN)
0 0
0 0
- Asam Urat Stick
11000 0 0
12000 0 0
0 0
15000 0 0
b. Trigliserida
0 0
c. HDL-Cholesterol
0 0
d. LDL-Cholesterol
0 0
0 0
a. Faeces Rutin
0 0
0 0
0 0
d. Telur Cacing
0 0
e. Amoeba
0 0
a. H I V
0 0
b. H I V konfirmasi
0 0
c. HBs Ab
0 0
d. HBs Ag
0 0
e. Narkoba
0 0
f. Cholinesterase
0 0
g. ............................
0 0
h. ............................
0 0
0 0
a. Ig G
0 0
b. Ig M
0 0
Tahap I 25000 0 0
II 50000 0 0
0 0
0 0
0 0
161000 279000
4 5 6 7 8 9 11
45000 5 25000 1 5000 10 50000 5 25000 4 20000 9
0 3 30000 1 10000 2 20000 1 10000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 10 50000 7 35000 6 30000 4 20000 4 20000 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 7500 0 0
0 0 0 0 0 0
0 0 1 22000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 15000 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 5000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 4 80000 0 0 2 40000 4 80000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 25000 0 0
0 0 0 0 0 0
0 0 1 4000 4 16000 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 7000 4 28000 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 12500 4 50000 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 2 20000 0 0 0 1
0 2 22000 0 4 44000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 24000 0 0 0 0
0 0 0 0 0 0
0 3 45000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
55000 276000 120500 285500 95000 135000
TANGGAL
11 12 13 14 16 18 19
45000 12 60000 3 15000 12 60000 6 30000 20 100000 9
0 1 10000 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15000 3 15000 4 20000 1 5000 8 40000 5 25000 9
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 7500 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 25000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 5000 1 5000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 20000 0 0 2 40000 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 25000 0 0 1 25000 1 25000
0 0 0 0 0 0
4000 1 4000 1 4000 0 2 8000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7000 0 0 0 2 14000 0
0 0 0 0 0 0
0 0 0 0 0 0
12500 1 12500 1 12500 0 2 25000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 1 10000 1 10000 0 0 0
0 0 0 1 11000 2 22000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 15000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 15000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
93500 181500 61500 103500 224000 150000
19 20 21 22 23 25
45000 11 55000 10 50000 4 20000 10 50000 14 70000
10000 1 10000 0 0 1 10000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
45000 3 15000 2 10000 5 25000 7 35000 4 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 7500 1 7500 0 0 1 7500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
40000 1 20000 0 0 4 80000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 50000 1 25000 0 0 0
0 0 0 0 0 0
0 2 8000 2 8000 2 8000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 14000 2 14000 2 14000 1 7000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 25000 2 25000 2 25000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 3 33000 2 22000 2 22000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 30000 1 15000 0 0 0
0 0 0 0 0 0
0 0 1 15000 0 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 2 100000 1 50000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
140000 297500 291500 164000 182000 112500
TOTAL
26 27 28 29 30
12 60000 6 30000 6 30000 5 25000 4 20000 207
2 20000 1 10000 1 10000 0 0 16
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 20000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
8 40000 10 50000 3 15000 1 5000 2 10000 123
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 7
0 0 0 0 0 0
0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 4
0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
3 60000 0 0 0 0 27
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1 25000 2 50000 0 0 1 25000 11
0 0 0 0 0 0
0 0 2 8000 1 4000 0 21
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 2 14000 1 7000 0 21
0 0 0 0 0 0
0 0 0 0 0 0
0 0 2 25000 1 12500 0 21
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 10000 0 6
0 0 2 22000 0 0 19
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1 15000 2 30000 0 0 1 15000 8
0 0 0 0 0 0
0 0 0 0 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 2
0 0 0 0 0 0
0 0 0 0 0 5
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
220000 170000 124000 63500 90000 513
TOTAL
1,035,000.00
160,000.00
-
-
-
40,000.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
615,000.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
52,500.00
-
22,000.00
-
-
-
-
15,000.00
-
-
-
-
30,000.00
-
-
-
-
100,000.00
15,000.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
15,000.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
540,000.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
275,000.00
-
84,000.00
-
-
-
-
-
-
147,000.00
-
-
262,500.00
-
-
-
-
-
-
-
-
-
-
60,000.00
209,000.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
120,000.00
-
30,000.00
-
-
-
-
-
24,000.00
-
75,000.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
150,000.00
-
-
-
4,076,000.00
RINCIAN RETRIBUSI PELAYANAN BULAN MEI TAHUN 2022

3 4 5
5000 2 10000 2 10000 3
Kunjungan Sore 10000 0 0
0 0
4 Perawatan Luka :
0 0
8000 0 0
b. Rawat luka berat
20000 0 0
0 0
0 0
0 0
0 0
6 Nebulizer
0 0
7 Circumsisi
0 0
8 Incisi Abses
0 0
9 Ekstraksi Kuku
25000 0 0
10 Stump plasty
0 0
0 0
12 Heacting :
0 0
a. 1 - 3 per luka
20000 0 0
0 0
7000 0 0
0 0
14 Bulektomi
0 0
0 0
0 0
17 Kateter :
0 0
0 0
b. Lepas kateter
0 0
18 Pemasangan Infus
0 0
Ganti cairan infus
0 0
10000 0 0
7500 0 0
0 0
0 0
a. Sehat
5000 0 1 5000 1
b. Kelahiran
0 0
c. Visum hidup
0 0
4000 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
26 ECG
25000 0 0
27 Home Care
0 0
11000 0 0
0 0
0 0
7500 0 0
anestesi 15000 0 0
22000 0 0
0 0
50000 0 0
0 0
0 0
15000 0 0
39 Insici Abses
0 0
40 Open Boor
12500 0 0
15000 0 0
3) 0 0
4) 15000 0 0
5) 15000 0 0
0 0
0 0
15000 0 0
25000 0 0
15000 0 0
Sementara 9) 0 0
0 0
0 0
25000 0 0
(per regio) 0 0
55 Flap periodontal
0 0
56 Alveolectomy
0 0
0 0
0 0
a. Pap Smear
0 0
b. I V A :
0 0
- See (pemeriksaan)
0 0
- Treat Ringan
0 0
- Treat Cryo
0 0
0 0
0 0
a. Tindik
5000 0 0
0 0
c. Fototerapi
0 0
3 Pelayanan KB
0 0
0 0
0 0
c. KB PIL
0 0
d. Implant :
0 0
- Pasang
0 0
- Cabut / Lepas
20000 0 0
e. IUD :
0 0
- Pasang
0 0
- Cabut / Lepas
0 0
f. Steril :
0 0
- MOP
0 0
Spesialistik 0 0
0 0
glukoma) 0 0
0 0
0 0
konjungtiva ) 0 0
0 0
0 0
0 0
c. Puncti Ascites
0 0
0 0
- MOW
0 0
0 0
a. Parasintesis
0 0
0 0
- ringan
0 0
0 0
0 0
1 USG
0 0
a. USG Kandungan
35000 0 0
0 0
0 0
3 Konsultasi 0 0
a. Psikologi
2500 0 0
0 0
0 0
a. Akupuntur
20000 0 0
b. Akupresur
0 0
c. Aromatherapi
0 0
d. Medik Herbal
0 0
e. Pijat Bayi :
0 0
7500 0 0
- Umur > 1 tahun
10000 0 0
5 Konseling VCT
0 0
0 0
0 0
0 0
a. Bayi
0 0
b. Anak / Dewasa
0 0
0 0
2 Visite :
0 0
a. Dokter Umum
0 0
0 0
0 0
a. Dokter Umum
0 0
b. Dokter Spesialis
0 0
0 0
0 0
0 0
0 0
5 Manual Placenta
0 0
0 0
0 0
8 Vacum Ekstraksi
0 0
9 Forcep Ekstraksi
0 0
10 Curretage
0 0
0 0
12 Hecting Portio
0 0
0 0
0 0
15 Resusitasi BBL
0 0
16 Sectio Caesaria
0 0
1 Hematologi
0 0
25000 0 0
0 0
- Hemoglobin
4000 0 0
- Lekosit
0 0
- Trombosit
0 0
0 0
0 0
0 0
0 0
7000 0 0
0 0
a. Urine analyzer
0 0
b. Urine lengkap
12500 0 0
c. Albumin
0 0
d. pH
0 0
0 0
0 0
0 0
0 0
0 0
0 0
i. Trichomonas
0 0
0 0
10000 0 0
11000 0 0
0 0
a. Bilirubin Direct
0 0
b. Blirubin Total
0 0
c. SGOT / ASAT
12500 0 0
d. SGPT / ALAT
12500 0 0
e. Total Protein
0 0
f. Albumin
0 0
5 Mikrobiologi :
0 0
a. Malaria
0 0
b. BTA / TBC
0 0
c. BTA / Kusta
0 0
d. GO
0 0
e. VDRL
0 0
f. TPHA
0 0
g. Rectal Swab
0 0
h. Widal
15000 0 0
0 0
15000 0 0
0 0
a. Creatinin
0 0
b. Ureum (BUN)
0 0
0 0
- Asam Urat Stick
11000 0 0
12000 0 0
0 0
15000 0 0
b. Trigliserida
0 0
c. HDL-Cholesterol
0 0
d. LDL-Cholesterol
0 0
0 0
a. Faeces Rutin
0 0
0 0
0 0
d. Telur Cacing
0 0
e. Amoeba
0 0
a. H I V
0 0
b. H I V konfirmasi
0 0
c. HBs Ab
0 0
d. HBs Ag
0 0
e. Narkoba
0 0
f. Cholinesterase
0 0
g. ............................
0 0
h. ............................
0 0
0 0
a. Ig G
0 0
b. Ig M
0 0
Tahap I 25000 0 0
II 50000 0 0
0 0
0 0
0 0
10000 15000
5 6 7 9 10 11 12
15000 1 5000 2 10000 15 75000 0 0 7 35000 10
0 0 0 0 1 10000 1 10000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
5000 1 5000 3 15000 13 65000 8 40000 2 10000 6
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 7500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 4000 1 4000 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 7000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 12500 1 12500 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 2
0 0 0 0 0 1 11000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20000 10000 25000 140000 66500 117000
TANGGAL
12 13 14 17 18 19 20
50000 18 90000 6 30000 9 45000 21 105000 13 65000 7 35000
10000 0 0 0 0 1 10000 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
30000 3 15000 6 30000 2 10000 2 10000 7 35000 3 15000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 3 33000 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 2 15000 0 1 7500 1 7500 1 7500 1 7500
0 0 0 0 0 0 0
0 0 0 2 44000 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 2 50000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 1 5000 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 1 20000 0 1 20000 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 1 10000 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 2 50000 0 0 1 25000 2 50000 2 50000
0 0 0 0 0 0 0
12000 1 4000 0 0 3 12000 2 8000 2 8000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
14000 1 7000 0 0 3 21000 2 14000 1 7000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
37500 1 12500 0 0 3 37500 2 25000 2 25000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
20000 0 0 0 2 20000 0 1 10000
11000 1 11000 0 1 11000 1 11000 2 22000 1 11000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 15000 0 0 1 15000 2 30000 2 30000
0 0 0 0 0 0 0
0 0 0 1 15000 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
184500 219500 90000 170500 284000 266500 248500
21 23 24 25 27 28 30
13 65000 27 135000 12 60000 11 55000 13 65000 5 25000 27
0 0 0 1 10000 0 1 10000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
16 80000 1 5000 1 5000 3 15000 3 15000 9 45000 5
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 7500 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 15000 1 15000
0 0 0 0 0 0
0 0 0 0 1 12500 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 15000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 2 10000 1 5000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2 40000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2 50000 0 1 25000 0 0 0
0 0 0 0 0 0
0 0 1 4000 1 4000 7 28000 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 7000 1 7000 4 28000 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 12500 1 12500 7 87500 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 10000 6 60000 0
0 1 11000 1 11000 2 22000 1 11000 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1 15000 0 1 15000 0 0 0
0 0 0 0 0 0
0 1 15000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 12000 0 0
0 0 0 0 0 0
0 0 0 1 15000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
250000 173500 139500 162500 347000 100000
30 31 TOTAL
135000 9 45000 233 1,165,000.00
0 0 6 60,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
25000 6 30000 102 510,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 3 33,000.00
0 0 0 -
0 0 0 -
0 0 8 60,000.00
0 0 0 -
0 0 2 44,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 2 30,000.00
0 0 0 -
12500 0 2 25,000.00
0 0 0 -
0 0 0 -
0 0 1 15,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 1 25000 3 75,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 4 20,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 5 100,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 1 10,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 10 250,000.00
0 0 0 -
4000 3 12000 26 104,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
7000 3 21000 20 140,000.00
0 0 0 -
0 0 0 -
12500 3 37500 26 325,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 12 120,000.00
11000 3 33000 17 187,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 8 120,000.00
0 0 0 -
0 0 2 30,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 1 12,000.00
0 0 0 -
0 0 1 15,000.00
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
207000 203500 495 3,450,000.00
RINCIAN RETRIBUSI PELAYANAN BULAN JUNI TAHUN 2022

2 3 4
5000 11 55000 15 75000 8
0 0
4 Perawatan Luka :
0 0
8000 0 0
b. Rawat luka berat
20000 0 0 2
0 0
0 0
0 0
0 0
6 Nebulizer
0 0
7 Circumsisi
0 0
8 Incisi Abses
0 0
9 Ekstraksi Kuku
25000 0 0
10 Stump plasty
0 0
0 0
12 Heacting :
0 0
a. 1 - 3 per luka
20000 0 0
0 0
7000 0 0
0 0
14 Bulektomi
0 0
0 0
0 0
17 Kateter :
0 0
0 0
b. Lepas kateter
0 0
18 Pemasangan Infus
0 0
Ganti cairan infus
0 0
10000 0 0
7500 0 0
0 0
0 0
a. Sehat
5000 5 25000 11 55000 7
b. Kelahiran
5000 0 0
c. Visum hidup
0 0
4000 0 0
0 0
0 0
0 0
0 0
0 0
0 0
5000 0 0
26 ECG
25000 0 0
27 Home Care
0 0
11000 0 0
0 0
0 0
7500 2 15000 1 7500
anestesi 15000 0 0
22000 0 0
0 0
50000 0 0
0 0
0 0
0 0
39 Insici Abses
0 0
40 Open Boor
12500 0 0
15000 0 0
3) 0 0
4) 15000 0 0 1
5) 15000 0 1 15000
0 0
15000 0 0
15000 0 0
25000 0 0
15000 0 0
Sementara 9) 0 0
0 0
0 0
25000 0 0
(per regio) 0 0
55 Flap periodontal
0 0
56 Alveolectomy
0 0
0 0
0 0
a. Pap Smear
0 0
b. I V A :
0 0
- See (pemeriksaan)
0 0
- Treat Ringan
0 0
- Treat Cryo
0 0
1500 0 0
0 0
a. Tindik
5000 0 0
0 0
c. Fototerapi
0 0
3 Pelayanan KB
0 0
0 0
0 0
c. KB PIL
0 0
d. Implant :
0 0
- Pasang
0 0
- Cabut / Lepas
20000 0 0
e. IUD :
0 0
- Pasang
0 0
- Cabut / Lepas
0 0
f. Steril :
0 0
- MOP
0 0
Spesialistik 0 0
0 0
glukoma) 0 0
0 0
0 0
konjungtiva ) 0 0
0 0
0 0
0 0
c. Puncti Ascites
0 0
0 0
- MOW
0 0
0 0
a. Parasintesis
0 0
0 0
- ringan
0 0
0 0
0 0
1 USG
0 0
a. USG Kandungan
35000 0 0
0 0
0 0
3 Konsultasi 0 0
a. Psikologi
2500 0 0
0 0
0 0
a. Akupuntur
20000 0 0 1
b. Akupresur
15000 0 0
c. Aromatherapi
0 0
d. Medik Herbal
0 0
e. Pijat Bayi :
0 0
7500 0 0
- Umur > 1 tahun
10000 0 0
5 Konseling VCT
0 0
0 0
0 0
0 0
a. Bayi
15000 0 0
b. Anak / Dewasa
20000 0 0
0 0
2 Visite :
0 0
a. Dokter Umum
5000 0 0
0 0
0 0
a. Dokter Umum
0 0
b. Dokter Spesialis
0 0
250000 0 0
0 0
0 0
0 0
5 Manual Placenta
0 0
0 0
0 0
8 Vacum Ekstraksi
0 0
9 Forcep Ekstraksi
0 0
10 Curretage
0 0
0 0
12 Hecting Portio
0 0
0 0
0 0
15 Resusitasi BBL
0 0
16 Sectio Caesaria
0 0
1 Hematologi
0 0
25000 0 0
0 0
- Hemoglobin
4000 5 20000 5 20000 1
- Lekosit
0 0
- Trombosit
0 0
0 0
0 0
0 0
0 0
7000 4 28000 3 21000 1
0 0
a. Urine analyzer
0 0
b. Urine lengkap
12500 5 62500 5 62500
c. Albumin
0 0
d. pH
0 0
0 0
0 0
0 0
0 0
0 0
0 0
i. Trichomonas
0 0
0 0
10000 1 10000 4 40000 1
11000 5 55000 1 11000 1
0 0
a. Bilirubin Direct
0 0
b. Blirubin Total
0 0
c. SGOT / ASAT
12500 0 0
d. SGPT / ALAT
12500 0 0
e. Total Protein
0 0
f. Albumin
0 0
5 Mikrobiologi :
0 0
a. Malaria
0 0
b. BTA / TBC
0 0
c. BTA / Kusta
0 0
d. GO
0 0
e. VDRL
0 0
f. TPHA
0 0
g. Rectal Swab
0 0
h. Widal
15000 0 0
0 0
15000 0 0
0 0
a. Creatinin
0 0
b. Ureum (BUN)
0 0
0 0
- Asam Urat Stick
11000 0 0
12000 0 0 1
0 0
15000 1 15000 0 1
b. Trigliserida
0 0
c. HDL-Cholesterol
0 0
d. LDL-Cholesterol
0 0
0 0
a. Faeces Rutin
0 0
0 0
0 0
d. Telur Cacing
0 0
e. Amoeba
0 0
a. H I V
0 0
b. H I V konfirmasi
0 0
c. HBs Ab
0 0
d. HBs Ag
0 0
e. Narkoba
0 0
f. Cholinesterase
0 0
g. ............................
0 0
h. ............................
0 0
0 0
a. Ig G
0 0
b. Ig M
0 0
Tahap I 25000 0 0
II 50000 1 50000 0
0 0
0 0
0 0
335500 334500
4 6 7 8 9 10 11
40000 22 110000 6 30000 10 50000 11 55000 13 65000 14
10000 0 1 10000 1 10000 0 1 10000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 8000 0 0 2 16000
40000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
35000 3 15000 11 55000 12 60000 9 45000 9 45000 10
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 7500 0 0 1 7500 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15000 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 27500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20000 0 1 20000 1 20000 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 25000 2 50000 2 50000 1 25000 1 25000
0 0 0 0 0 0
4000 0 1 4000 1 4000 3 12000 1 4000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7000 0 1 7000 0 3 21000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 12500 1 12500 4 50000 1 12500 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 0 0 1 10000 3 30000 1 10000 1
11000 0 0 0 1 11000 1 11000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 1 15000 2 30000 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
12000 0 0 0 0 1 12000 1
0 0 0 0 0 0
15000 0 0 0 0 1 15000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
219000 165000 219000 246500 249000 275500
TANGGAL
11 13 14 15 16 17 18
70000 19 95000 6 30000 9 45000 8 40000 22 110000 3
0 0 1 10000 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 25000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 7500
0 0 0 0 0 0
0 0 0 0 0 0
50000 3 15000 5 25000 2 10000 1 5000 7 35000 5
0 0 0 0 0 1 5000
0 0 0 0 0 0
0 0 0 0 0 21 84000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 5000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7500 0 0 1 7500 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 1500
0 0 0 0 0 0
0 1 5000 0 1 5000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20000 0 0 0 0 0 1
0 0 0 0 0 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 15000
0 0 0 0 0 1 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 5000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 250000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 25000 1 25000 1 25000 1 25000 0
0 0 0 0 0 0
4000 0 1 4000 3 12000 1 4000 1 4000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 2 14000 1 7000 1 7000
0 0 0 0 0 0
0 0 0 0 0 0
25000 0 1 12500 3 37500 1 12500 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 0 0 1 10000 0 1 10000 1
11000 0 0 2 22000 1 11000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 1 15000 0 1 15000 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
12000 0 0 0 0 0
0 0 0 0 0 0
15000 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
239500 155000 121500 213000 124500 569000
18 20 21 22 23 24 25
15000 15 75000 33 165000 10 50000 19 95000 17 85000 11
10000 0 1 10000 1 10000 0 1 10000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 20000 0 0 0 1 20000
0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
25000 12 60000 27 135000 20 100000 13 65000 15 75000 24
0 0 0 0 0 0
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15000 0 0 0 0 0
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0 0 0 0 0 2 3000
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20000 0 0 2 40000 0 2 40000
30000 0 0 1 15000 0 0
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0 0 1 25000 1 25000 0 0 1
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0 0 2 8000 6 24000 7 28000 0
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10000 0 1 10000 2 20000 0 0
0 0 0 6 66000 9 99000 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
132500 155000 365500 506000 424000 260500
25 27 28 29 30 TOTAL
55000 29 145000 10 50000 12 60000 14 70000 347 1,735,000.00
0 0 0 2 20000 0 11 110,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 3 24,000.00
0 0 0 1 20000 0 5 100,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 1 25,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 1 7,500.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
120000 21 105000 24 120000 35 175000 16 80000 307 1,535,000.00
0 0 0 0 0 1 5,000.00
0 0 0 0 0 0 -
0 0 0 0 0 21 84,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 1 5,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 4 44000 0 0 4 44000 8 88,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 2 15000 0 11 82,500.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 1 15,000.00
0 0 0 0 0 2 30,000.00
0 0 0 0 0 0 -
0 0 0 0 0 1 15,000.00
0 0 0 0 0 0 -
25000 0 0 0 0 2 50,000.00
0 0 0 0 0 1 15,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 3 4,500.00
0 0 0 0 0 0 -
0 0 0 0 0 2 10,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 3 82,500.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 3 60000 1 20000 0 13 260,000.00
0 0 0 0 0 3 45,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 1 15,000.00
0 0 0 0 0 1 20,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 1 5,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 1 250,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
25000 1 25000 0 2 50000 2 50000 19 475,000.00
0 0 0 0 0 0 -
0 2 8000 0 6 24000 3 12000 50 200,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 1 7000 0 6 42000 4 28000 35 245,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 2 25000 0 6 75000 3 37500 49 612,500.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 1 10000 0 0 19 190,000.00
0 1 11000 0 6 66000 3 33000 38 418,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 1 15000 0 2 30000 1 15000 13 195,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 4 48,000.00
0 0 0 0 0 0 -
0 0 0 0 0 5 75,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 1 50,000.00
0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 0 0 0 0 0 -
225000 385000 240000 597000 369500 985 7,126,500.00
RINCIAN RETRIBUSI PELAYANAN BULAN JULI TAHUN 2022

1 2 4
5000 15 75000 16 80000 17
0 0
4 Perawatan Luka :
0 0
8000 0 1 8000
b. Rawat luka berat
20000 0 0
0 0
0 0
0 0
0 0
6 Nebulizer
0 0
7 Circumsisi
0 0
8 Incisi Abses
0 0
9 Ekstraksi Kuku
25000 0 0
10 Stump plasty
0 0
0 0
12 Heacting :
0 0
a. 1 - 3 per luka
20000 0 0
30000 0 0
7000 0 0
0 0
14 Bulektomi
0 0
0 0
0 0
17 Kateter :
0 0
0 0
b. Lepas kateter
0 0
18 Pemasangan Infus
0 0
Ganti cairan infus
0 0
10000 0 0
7500 0 0
0 0
0 0
a. Sehat
5000 15 75000 9 45000 5
b. Kelahiran
0 0
c. Visum hidup
0 0
4000 0 0
0 0
0 0
0 0
0 0
0 0
5000 0 0
0 0
26 ECG
25000 0 0
27 Home Care
0 0
11000 0 2 22000
0 0
0 0
7500 0 1 7500 1
anestesi 15000 0 0
22000 0 0
0 0
50000 0 0
0 0
0 0
0 0
39 Insici Abses
0 0
40 Open Boor
12500 0 0
15000 0 0
3) 0 0
4) 15000 0 0
5) 15000 0 0
0 0
0 0
15000 0 0
25000 0 0
15000 0 0
Sementara 9) 0 0
0 0
0 0
25000 0 0
(per regio) 0 0
55 Flap periodontal
0 0
56 Alveolectomy
0 0
0 0
0 0
a. Pap Smear
0 0
b. I V A :
0 0
- See (pemeriksaan)
0 0
- Treat Ringan
0 0
- Treat Cryo
0 0
0 0
0 0
a. Tindik
5000 0 0
0 0
c. Fototerapi
0 0
3 Pelayanan KB
0 0
0 0
0 0
c. KB PIL
0 0
d. Implant :
0 0
- Pasang
0 0
- Cabut / Lepas
20000 0 0
e. IUD :
0 0
- Pasang
0 0
- Cabut / Lepas
0 0
f. Steril :
0 0
- MOP
0 0
Spesialistik 0 0
0 0
glukoma) 0 0
0 0
0 0
konjungtiva ) 0 0
0 0
0 0
0 0
c. Puncti Ascites
0 0
0 0
- MOW
0 0
0 0
a. Parasintesis
0 0
0 0
- ringan
0 0
0 0
0 0
1 USG
0 0
a. USG Kandungan
35000 0 0
0 0
0 0
3 Konsultasi 0 0
a. Psikologi
2500 0 0
0 0
0 0
a. Akupuntur
20000 3 60000 0
b. Akupresur
15000 0 0
c. Aromatherapi
0 0
d. Medik Herbal
0 0
e. Pijat Bayi :
0 0
7500 0 0
- Umur > 1 tahun
10000 0 0
5 Konseling VCT
0 0
0 0
0 0
0 0
a. Bayi
0 0
b. Anak / Dewasa
0 0
0 0
2 Visite :
0 0
a. Dokter Umum
0 0
0 0
0 0
a. Dokter Umum
0 0
b. Dokter Spesialis
0 0
0 0
0 0
0 0
0 0
5 Manual Placenta
0 0
0 0
0 0
8 Vacum Ekstraksi
0 0
9 Forcep Ekstraksi
0 0
10 Curretage
0 0
0 0
12 Hecting Portio
0 0
0 0
0 0
15 Resusitasi BBL
0 0
16 Sectio Caesaria
0 0
1 Hematologi
0 0
25000 0 1 25000
0 0
- Hemoglobin
4000 2 8000 0
- Lekosit
0 0
- Trombosit
0 0
0 0
0 0
0 0
0 0
7000 2 14000 0
0 0
a. Urine analyzer
0 0
b. Urine lengkap
12500 2 25000 0
c. Albumin
0 0
d. pH
0 0
0 0
0 0
0 0
0 0
0 0
0 0
i. Trichomonas
0 0
0 0
10000 0 1 10000
11000 2 22000 0
0 0
a. Bilirubin Direct
0 0
b. Blirubin Total
0 0
c. SGOT / ASAT
12500 0 0
d. SGPT / ALAT
12500 0 0
e. Total Protein
0 0
f. Albumin
0 0
5 Mikrobiologi :
0 0
a. Malaria
0 0
b. BTA / TBC
0 0
c. BTA / Kusta
0 0
d. GO
0 0
e. VDRL
0 0
f. TPHA
0 0
g. Rectal Swab
0 0
h. Widal
15000 0 0
0 0
15000 0 0
0 0
a. Creatinin
0 0
b. Ureum (BUN)
0 0
0 0
- Asam Urat Stick
11000 0 0
12000 0 0
0 0
15000 0 0
b. Trigliserida
0 0
c. HDL-Cholesterol
0 0
d. LDL-Cholesterol
0 0
0 0
a. Faeces Rutin
0 0
0 0
0 0
d. Telur Cacing
0 0
e. Amoeba
0 0
a. H I V
0 0
b. H I V konfirmasi
0 0
c. HBs Ab
0 0
d. HBs Ag
0 0
e. Narkoba
0 0
f. Cholinesterase
0 0
g. ............................
0 0
h. ............................
0 0
0 0
a. Ig G
0 0
b. Ig M
0 0
Tahap I 25000 0 0
II 50000 0 0
0 0
0 0
0 0
289000 197500
4 5 6 7 8 9 11
85000 16 80000 3 15000 19 95000 25 125000 6 30000 27
0 1 10000 0 2 20000 1 10000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 30000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
25000 35 175000 16 80000 10 50000 26 130000 1 5000 14
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 4 44000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7500 0 4 30000 2 15000 1 7500 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 40000 0 1 20000 1 20000 0
0 0 0 1 15000 1 15000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 25000 0 2 50000 2
0 0 0 0 0 0
0 2 8000 3 12000 1 4000 2 8000 1 4000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 7000 3 21000 1 7000 2 14000 2 14000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 3 37500 3 37500 1 12500 2 25000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 4 40000 0 0
0 3 33000 4 44000 1 11000 2 22000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 2 30000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
117500 434500 239500 314500 376500 183000
TANGGAL
11 12 13 14 15 16 18
135000 8 40000 12 60000 8 40000 8 40000 8 40000 16 80000
0 0 0 0 2 20000 1 10000 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 1 8000 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
70000 10 50000 11 55000 3 15000 10 50000 14 70000 4 20000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 7500 0 1 7500 0 0 0
0 0 1 15000 0 0 0 0
0 0 0 1 22000 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 1 27500 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 20000 2 40000 0 1 20000 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
50000 0 0 0 0 2 50000 0
0 0 0 0 0 0 0
0 0 6 24000 1 4000 1 4000 2 8000 2 8000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
7000 0 6 42000 1 7000 0 2 14000 2 14000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 7 87500 1 12500 0 2 25000 2 25000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 1 10000 0 3 30000 3 30000
0 0 7 77000 1 11000 0 2 22000 2 22000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
15000 0 0 0 0 1 15000 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 2 30000 1 15000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
277000 117500 428000 137000 134000 314000 214000
19 20 21 22 23 25
17 85000 9 45000 10 50000 13 65000 8 40000 36 180000
1 10000 0 0 0 2 20000 0
0 0 0 0 0 0
0 0 0 0 0 0
1 8000 0 0 0 0 0
0 0 2 40000 1 20000 1 20000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7 35000 15 75000 5 25000 5 25000 4 20000 16 80000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 5000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 4 44000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 2 15000 3 22500 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 5000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 27500 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 40000 1 20000 0 2 40000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2 50000 2 50000 1 25000 1 25000 0 0
0 0 0 0 0 0
1 4000 3 12000 2 8000 2 8000 0 1 4000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1 7000 3 21000 2 14000 2 14000 0 1 7000
0 0 0 0 0 0
0 0 0 0 0 0
1 12500 3 37500 3 37500 2 25000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 10000 0 0 2 20000 0
1 11000 3 33000 1 11000 2 22000 0 1 11000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2 30000 2 30000 1 15000 1 15000 0 0
0 0 0 0 0 0
0 1 15000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
252500 396000 289500 234000 192500 282000
TOTAL
26 27 28 29
6 30000 7 35000 7 35000 16 80000 333 1,665,000.00
1 10000 0 1 10000 2 20000 15 150,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 3 24,000.00
0 0 0 0 5 100,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 1 30,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
8 40000 6 30000 3 15000 11 55000 263 1,315,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 1 5,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 4 44000 0 0 14 154,000.00
0 0 0 0 0 -
0 0 0 0 0 -
2 15000 0 0 0 18 135,000.00
1 15000 0 0 0 2 30,000.00
0 0 0 0 1 22,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
1 25000 0 0 0 1 25,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 1 5,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 2 55,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
3 60000 3 60000 0 3 60000 25 500,000.00
1 15000 1 15000 0 0 4 60,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 1 25000 1 25000 2 50000 18 450,000.00
0 0 0 0 0 -
3 12000 5 20000 3 12000 2 8000 45 180,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
2 14000 0 3 21000 0 37 259,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 2 25000 0 0 34 425,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
1 10000 4 40000 3 30000 2 20000 25 250,000.00
1 11000 1 11000 0 0 34 374,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
1 15000 1 15000 1 15000 2 30000 15 225,000.00
0 0 0 0 0 -
1 15000 0 0 1 15000 3 45,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 1 11000 0 1 11,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 3 45,000.00
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
0 0 0 0 0 -
287000 320000 174000 338000 904 6,539,000.00
RINCIAN RETRIBUSI PELAYANAN BULAN AGUSTUS TAHUN 2022

1 2 3
5000 23 115000 14 70000 16
0 0
4 Perawatan Luka :
0 0
8000 0 0
b. Rawat luka berat
20000 0 0
0 0
0 0
0 0
0 0
6 Nebulizer
0 0
7 Circumsisi
0 0
8 Incisi Abses
0 0
9 Ekstraksi Kuku
25000 0 0
10 Stump plasty
0 0
0 0
12 Heacting :
0 0
a. 1 - 3 per luka
20000 0 0
30000 0 0
7000 0 0
0 0
14 Bulektomi
0 0
0 0
0 0
17 Kateter :
0 0
0 0
b. Lepas kateter
0 0
18 Pemasangan Infus
0 0
Ganti cairan infus
0 0
10000 0 0
7500 0 0
0 0
0 0
a. Sehat
5000 0 6 30000 8
b. Kelahiran
0 0
c. Visum hidup
0 0
4000 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
26 ECG
25000 0 0
27 Home Care
0 0
11000 0 4 44000 6
0 0
0 0
7500 0 0
anestesi 15000 0 0
22000 0 0
0 0
50000 0 0
0 0
0 0
0 0
39 Insici Abses
0 0
40 Open Boor
12500 0 0
15000 0 0
3) 0 0
4) 15000 0 0
5) 15000 0 0
0 0
15000 0 0
15000 0 0
25000 0 0
15000 0 0
Sementara 9) 0 0
0 0
0 0
25000 0 0
(per regio) 0 0
55 Flap periodontal
0 0
56 Alveolectomy
0 0
0 0
0 0
a. Pap Smear
0 0
b. I V A :
0 0
- See (pemeriksaan)
0 0
- Treat Ringan
0 0
- Treat Cryo
0 0
0 0
0 0
a. Tindik
5000 0 0
0 0
c. Fototerapi
0 0
3 Pelayanan KB
0 0
0 0
0 0
c. KB PIL
0 0
d. Implant :
0 0
- Pasang
0 0
- Cabut / Lepas
20000 0 0
e. IUD :
0 0
- Pasang
0 0
- Cabut / Lepas
5000 0 0
f. Steril :
0 0
- MOP
0 0
Spesialistik 0 0
0 0
glukoma) 0 0
0 0
0 0
konjungtiva ) 0 0
0 0
0 0
0 0
c. Puncti Ascites
0 0
0 0
- MOW
0 0
0 0
a. Parasintesis
0 0
0 0
- ringan
0 0
0 0
0 0
1 USG
0 0
a. USG Kandungan
35000 0 0
0 0
0 0
3 Konsultasi 0 0
a. Psikologi
2500 0 0
0 0
0 0
a. Akupuntur
20000 1 20000 1 20000 3
b. Akupresur
15000 0 0
c. Aromatherapi
0 0
d. Medik Herbal
0 0
e. Pijat Bayi :
0 0
7500 0 0
- Umur > 1 tahun
10000 0 0
5 Konseling VCT
0 0
0 0
0 0
0 0
a. Bayi
0 0
b. Anak / Dewasa
0 0
0 0
2 Visite :
0 0
a. Dokter Umum
0 0
0 0
0 0
a. Dokter Umum
0 0
b. Dokter Spesialis
0 0
0 0
0 0
0 0
0 0
5 Manual Placenta
0 0
0 0
0 0
8 Vacum Ekstraksi
0 0
9 Forcep Ekstraksi
0 0
10 Curretage
0 0
0 0
12 Hecting Portio
0 0
0 0
0 0
15 Resusitasi BBL
0 0
16 Sectio Caesaria
0 0
1 Hematologi
0 0
25000 1 25000 1 25000 1
0 0
- Hemoglobin
4000 0 2 8000 7
- Lekosit
0 0
- Trombosit
0 0
0 0
0 0
0 0
0 0
7000 0 1 7000 5
0 0
a. Urine analyzer
0 0
b. Urine lengkap
12500 0 1 12500 7
c. Albumin
0 0
d. pH
0 0
0 0
0 0
0 0
0 0
0 0
0 0
i. Trichomonas
0 0
0 0
10000 0 0
11000 0 2 22000 6
0 0
a. Bilirubin Direct
0 0
b. Blirubin Total
0 0
c. SGOT / ASAT
12500 0 0
d. SGPT / ALAT
12500 0 0
e. Total Protein
0 0
f. Albumin
0 0
5 Mikrobiologi :
0 0
a. Malaria
0 0
b. BTA / TBC
0 0
c. BTA / Kusta
0 0
d. GO
0 0
e. VDRL
0 0
f. TPHA
0 0
g. Rectal Swab
0 0
h. Widal
15000 1 15000 1 15000
0 0
15000 0 0
0 0
a. Creatinin
0 0
b. Ureum (BUN)
0 0
0 0
- Asam Urat Stick
11000 0 0 1
12000 0 0
0 0
15000 0 0
b. Trigliserida
0 0
c. HDL-Cholesterol
0 0
d. LDL-Cholesterol
0 0
0 0
a. Faeces Rutin
0 0
0 0
0 0
d. Telur Cacing
0 0
e. Amoeba
0 0
a. H I V
0 0
b. H I V konfirmasi
0 0
c. HBs Ab
0 0
d. HBs Ag
0 0
e. Narkoba
0 0
f. Cholinesterase
0 0
g. ............................
0 0
h. ............................
0 0
0 0
a. Ig G
0 0
b. Ig M
0 0
Tahap I 25000 0 0
II 50000 0 0
0 0
0 0
0 0
195000 253500
3 4 5 6 8 9 10
80000 25 125000 13 65000 13 65000 24 120000 16 80000 21
0 1 10000 0 0 0 1 10000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 20000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
40000 12 60000 3 15000 2 10000 4 20000 3 15000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
66000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 22000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 20000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 5000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
60000 0 0 7 140000 0 3 60000 1
0 0 0 0 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
25000 0 0 0 0 1 25000
0 0 0 0 0 0
28000 2 8000 0 0 0 1 4000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
35000 0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
87500 2 25000 0 0 0 1 12500 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 20000 0 0 0 0 3
66000 0 0 0 0 1 11000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
11000 0 0 0 0 0 2
0 0 0 0 0 1 12000
0 0 0 0 0 0
0 0 0 0 0 1 15000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
498500 263000 120000 237000 140000 279500
TANGGAL
10 11 12 13 15 16 18
105000 17 85000 11 55000 18 90000 26 130000 27 135000 25
0 0 2 20000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 1
0 3 60000 0 1 20000 0 1 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 25000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 30000 0 0 0 0
0 0 0 0 0 1 7000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 15000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 5 25000 3 15000 5 25000 3 15000 11 55000 7
0 0 0 0 0 0
0 0 0 0 0 0
0 3 12000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 2 15000 0 0
0 0 0 0 2 30000 0
0 1 22000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 1 5000 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20000 0 1 20000 5 100000 0 4 80000 1
0 0 1 15000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 3 75000 2 50000 0 2 50000 1 25000 2
0 0 0 0 0 0
8000 1 4000 1 4000 1 4000 1 4000 0 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7000 2 14000 1 7000 1 7000 0 0 3
0 0 0 0 0 0
0 0 0 0 0 0
12500 1 12500 0 1 12500 1 12500 0 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
30000 2 20000 0 2 20000 1 10000 0 2
0 1 11000 2 22000 1 11000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 2 30000 0 0 1 15000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
22000 0 0 1 11000 0 0 1
0 0 2 24000 0 0 0
0 0 0 0 0 0
30000 0 1 15000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
254500 430500 277000 315500 251500 337000
18 19 20 22 23 24 25
125000 27 135000 15 75000 18 90000 4 20000 16 80000 33
0 0 0 0 1 10000 0 2
0 0 0 0 0 0
0 0 0 0 0 0
8000 0 0 2 16000 0 0
0 0 1 20000 0 0 1 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 7500 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
35000 8 40000 1 5000 3 15000 11 55000 16 80000 5
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 7500 0 1 7500 0 2
0 0 0 0 0 0
0 0 0 0 0 1 22000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 15000 0 0
25000 0 0 0 0 0
15000 1 15000 0 1 15000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
5000 1 5000 0 1 5000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 27500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20000 0 5 100000 0 3 60000 2 40000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
50000 1 25000 1 25000 1 25000 2 50000 0
0 0 0 0 0 0
12000 1 4000 0 0 1 4000 3 12000 7
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
21000 0 0 0 0 1 7000 3
0 0 0 0 0 0
0 0 0 0 0 0
37500 2 25000 0 0 1 12500 4 50000 7
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20000 1 10000 0 0 5 50000 3 30000 4
0 0 0 0 0 0 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15000 0 1 15000 1 15000 1 15000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
11000 0 0 0 1 11000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
406500 259000 255000 196000 295000 368500
TOTAL
25 26 27 29 30 31
165000 13 65000 4 20000 22 110000 13 65000 11 55000 465
20000 2 20000 2 20000 0 0 0 13
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 3
0 0 0 0 0 0 8
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 2
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 3
0 0 0 0 0 0 0
0 0 0 0 0 0 0
25000 13 65000 9 45000 3 15000 7 35000 7 35000 157
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 3
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 10
0 0 0 0 0 0 0
0 0 0 0 0 0 0
15000 0 0 0 0 0 6
0 0 0 0 0 0 2
0 0 0 2 44000 0 0 5
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 4
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 1 5000 0 0 0 7
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 6 120000 0 3 60000 2 40000 48
0 0 0 0 0 1 15000 3
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 25000 2 50000 3 75000 2 50000 3 75000 30
0 0 0 0 0 0 0
28000 1 4000 1 4000 0 0 0 35
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
21000 0 3 21000 1 7000 0 0 22
0 0 0 0 0 0 0
0 0 0 0 0 0 0
87500 1 12500 1 12500 0 0 0 34
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
40000 1 10000 0 2 20000 0 0 28
33000 0 1 11000 0 1 11000 0 18
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 1 15000 1 15000 1 15000 2 30000 15
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 2 22000 0 0 8
0 0 0 0 1 12000 0 4
0 0 0 0 0 0 0
0 0 0 0 1 15000 1 15000 6
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
434500 201500 323500 308000 263000 265000 947
TOTAL
2325000
130000
0
0
24000
160000
0
0
0
0
0
0
0
25000
0
0
0
0
30000
14000
0
0
0
0
0
0
0
0
0
0
22500
0
0
785000
0
0
12000
0
0
0
0
0
0
0
0
0
110000
0
0
45000
30000
110000
0
0
0
0
0
0
0
0
0
0
0
0
15000
15000
25000
60000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
35000
0
0
0
0
0
0
0
0
20000
0
0
5000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
27500
0
0
0
0
0
960000
45000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
750000
0
140000
0
0
0
0
0
0
154000
0
0
425000
0
0
0
0
0
0
0
0
0
0
280000
198000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
225000
0
0
0
0
0
0
88000
48000
0
90000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7428000
RINCIAN RETRIBUSI PELAYANAN BULAN SEPTEMBER TAHUN 2022

1 2 3
5000 17 85000 8 40000 13
0 0
4 Perawatan Luka :
0 0
8000 0 0
b. Rawat luka berat
20000 0 0
0 0
0 0
0 0
0 0
6 Nebulizer
0 0
7 Circumsisi
0 0
8 Incisi Abses
0 0
9 Ekstraksi Kuku
25000 0 0
10 Stump plasty
0 0
0 0
12 Heacting :
0 0
a. 1 - 3 per luka
20000 0 0
30000 0 0
7000 0 0
0 0
14 Bulektomi
0 0
0 0
0 0
17 Kateter :
0 0
0 0
b. Lepas kateter
0 0
18 Pemasangan Infus
0 0
Ganti cairan infus
0 0
10000 0 0
7500 0 0
0 0
0 0
a. Sehat
5000 5 25000 2 10000 9
b. Kelahiran
0 0
c. Visum hidup
0 0
4000 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
26 ECG
25000 0 0
27 Home Care
0 0
11000 0 0 4
0 0
0 0
7500 0 2 15000
anestesi 15000 0 0
22000 0 0
0 0
50000 0 0
0 0
0 0
15000 0 0
39 Insici Abses
0 0
40 Open Boor
12500 0 0
15000 0 0
3) 0 0
4) 15000 0 0
5) 15000 0 0
0 0
15000 0 0
15000 0 0
25000 0 0
15000 0 0
Sementara 9) 0 0
0 0
0 0
25000 0 0
(per regio) 0 0
55 Flap periodontal
0 0
56 Alveolectomy
0 0
0 0
0 0
a. Pap Smear
0 0
b. I V A :
0 0
- See (pemeriksaan)
0 0
- Treat Ringan
0 0
- Treat Cryo
0 0
0 0
0 0
a. Tindik
5000 0 0
0 0
c. Fototerapi
0 0
3 Pelayanan KB
0 0
0 0
0 0
c. KB PIL
0 0
d. Implant :
0 0
- Pasang
0 0
- Cabut / Lepas
20000 0 0
e. IUD :
0 0
- Pasang
0 0
- Cabut / Lepas
0 0
f. Steril :
0 0
- MOP
0 0
Spesialistik 0 0
0 0
glukoma) 0 0
0 0
0 0
konjungtiva ) 0 0
0 0
0 0
0 0
c. Puncti Ascites
0 0
0 0
- MOW
0 0
0 0
a. Parasintesis
0 0
0 0
- ringan
0 0
0 0
0 0
1 USG
0 0
a. USG Kandungan
35000 0 0
0 0
0 0
3 Konsultasi 0 0
a. Psikologi
2500 0 0
0 0
0 0
a. Akupuntur
20000 0 0 2
b. Akupresur
0 0
c. Aromatherapi
0 0
d. Medik Herbal
0 0
e. Pijat Bayi :
0 0
7500 0 0
- Umur > 1 tahun
10000 0 0
5 Konseling VCT
0 0
0 0
0 0
0 0
a. Bayi
0 0
b. Anak / Dewasa
0 0
0 0
2 Visite :
0 0
a. Dokter Umum
0 0
0 0
0 0
a. Dokter Umum
0 0
b. Dokter Spesialis
0 0
0 0
0 0
0 0
0 0
5 Manual Placenta
0 0
0 0
0 0
8 Vacum Ekstraksi
0 0
9 Forcep Ekstraksi
0 0
10 Curretage
0 0
0 0
12 Hecting Portio
0 0
0 0
0 0
15 Resusitasi BBL
0 0
16 Sectio Caesaria
0 0
1 Hematologi
0 0
25000 1 25000 2 50000
0 0
- Hemoglobin
4000 2 8000 0 2
- Lekosit
0 0
- Trombosit
0 0
0 0
0 0
0 0
0 0
7000 2 14000 0
0 0
a. Urine analyzer
0 0
b. Urine lengkap
12500 2 25000 0 2
c. Albumin
0 0
d. pH
0 0
0 0
0 0
0 0
0 0
0 0
0 0
i. Trichomonas
0 0
0 0
10000 2 20000 0 1
11000 3 33000 0
0 0
a. Bilirubin Direct
0 0
b. Blirubin Total
0 0
c. SGOT / ASAT
12500 0 0
d. SGPT / ALAT
12500 0 0
e. Total Protein
0 0
f. Albumin
0 0
5 Mikrobiologi :
0 0
a. Malaria
0 0
b. BTA / TBC
0 0
c. BTA / Kusta
0 0
d. GO
0 0
e. VDRL
0 0
f. TPHA
0 0
g. Rectal Swab
0 0
h. Widal
15000 1 15000 1 15000
0 0
15000 0 0
0 0
a. Creatinin
0 0
b. Ureum (BUN)
0 0
0 0
- Asam Urat Stick
11000 0 0
12000 1 12000 0
0 0
15000 0 0
b. Trigliserida
0 0
c. HDL-Cholesterol
0 0
d. LDL-Cholesterol
0 0
0 0
a. Faeces Rutin
0 0
0 0
0 0
d. Telur Cacing
0 0
e. Amoeba
0 0
a. H I V
0 0
b. H I V konfirmasi
0 0
c. HBs Ab
0 0
d. HBs Ag
0 0
e. Narkoba
0 0
f. Cholinesterase
0 0
g. ............................
0 0
h. ............................
0 0
0 0
a. Ig G
0 0
b. Ig M
0 0
Tahap I 25000 0 0
II 50000 0 0
0 0
0 0
0 0
282000 130000
3 5 6 7 8 9 10
65000 7 35000 10 50000 8 40000 23 115000 16 80000 8
0 0 1 10000 1 10000 0 0 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 8000 0 0 0
0 0 0 1 20000 0 1 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 20000 0 0
0 0 0 0 0 0
0 0 0 0 0 1 7000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
45000 2 10000 6 30000 10 50000 27 135000 6 30000 5
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
44000 0 0 2 22000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 7500 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 15000 0 0
0 0 0 0 0 0
0 0 0 0 0 1 12500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 5000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 27500 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
40000 0 3 60000 0 0 0 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 7500 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 50000 2 50000 2 50000 2 50000 0 4
0 0 0 0 0 0
8000 1 4000 7 28000 3 12000 2 8000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 7 49000 2 14000 1 7000 0
0 0 0 0 0 0
0 0 0 0 0 0
25000 1 12500 7 87500 2 25000 1 12500 1 12500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 1 10000 0 2 20000 0 0 1
0 0 7 77000 0 3 33000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 30000 2 30000 2 30000 2 30000 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 2 24000 0
0 0 0 0 0 0
0 0 0 0 2 30000 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
237000 151500 487000 335500 472000 182000
TANGGAL
10 12 13 14 15 16 17
40000 23 115000 14 70000 18 90000 24 120000 11 55000 8
40000 0 0 2 20000 1 10000 1 10000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 20000 0 1 20000 1 20000 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 30000 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 7500 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
25000 1 5000 12 60000 5 25000 1 5000 3 15000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 4000 0 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15000 0 0 0 1 15000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 12500 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 15000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
80000 0 1 20000 1 20000 0 0 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 7500 0 0 0
10000 0 0 1 10000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100000 1 25000 2 50000 0 0 1 25000 2
0 0 0 0 0 0
0 1 4000 1 4000 2 8000 4 16000 4 16000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 2 14000 0 2 14000 3 21000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 12500 2 25000 4 50000 5 62500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 0 0 4 40000 1 10000 1 10000
0 0 3 33000 0 2 22000 4 44000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
30000 1 15000 2 30000 0 0 1 15000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
11000 0 0 0 0 0
0 0 2 24000 0 1 12000 1 12000
0 0 0 0 0 0
15000 0 1 15000 0 1 15000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
376000 221500 340000 289500 309000 285500
17 19 20 21 22 23 24
40000 23 115000 15 75000 4 20000 12 60000 17 85000 22
10000 0 1 10000 2 20000 2 20000 6 60000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
40000 0 1 20000 0 0 1 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
30000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 1
7500 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 0 1 5000 14 70000 32 160000 22 110000 29
0 0 0 0 0 0
0 0 0 0 0 0
8000 0 0 0 0 1 4000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 0 0 0 0
0 0 1 22000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 27500 1 27500 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
60000 0 3 60000 1 20000 0 0 5
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 7500 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
50000 0 3 75000 3 75000 3 75000 4 100000 2
0 0 0 0 0 0
0 2 8000 2 8000 1 4000 2 8000 1 4000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 7000 0 1 7000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 25000 2 25000 1 12500 1 12500 1 12500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2 20000 1 10000 2 20000 1 10000 2 20000
0 0 1 11000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15000 0 3 45000 3 45000 0 4 60000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 11000 1 11000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 15000 1 15000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
270500 218000 400500 312500 378500 475500
24 26 27 28 29 30
110000 20 100000 14 70000 28 140000 10 50000 4 20000
20000 0 0 0 1 10000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 8000 0 0 1 8000
0 0 1 20000 1 20000 0 1 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 30000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 0 0 0 0 0
0 0 0 0 0 1 7500
0 0 0 0 0 0
0 0 0 0 0 0
145000 8 40000 53 265000 44 220000 27 135000 22 110000
0 0 0 0 0 0
0 0 0 0 0 0
4000 0 1 4000 1 4000 0 1 4000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 15000 2 30000 0
0 0 0 0 1 22000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 15000 0 0 0
0 0 0 0 0 0
0 0 1 25000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 25000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
27500 0 0 1 27500 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 7500 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
50000 1 25000 1 25000 2 50000 0 1 25000
0 0 0 0 0 0
0 0 0 1 4000 1 4000 1 4000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 7000 1 7000 1 7000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 12500 1 12500 1 12500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 10000 0 2 20000 1 10000 2 20000
0 0 0 0 1 11000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 15000 0 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 11000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
466500 182500 447000 520000 316500 294000
TOTAL
377 1885000
27 270000
0 0
0 0
3 24000
12 240000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 20000
3 90000
1 7000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 10000
3 22500
0 0
0 0
348 1740000
0 0
0 0
8 32000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
6 66000
0 0
0 0
3 22500
6 90000
2 44000
0 0
0 0
0 0
0 0
1 15000
0 0
2 25000
0 0
0 0
1 15000
0 0
0 0
1 15000
1 15000
1 25000
0 0
0 0
0 0
0 0
1 25000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 5000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 137500
0 0
0 0
0 0
0 0
0 0
23 460000
0 0
0 0
0 0
0 0
4 30000
2 20000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
41 1025000
0 0
40 160000
0 0
0 0
0 0
0 0
0 0
0 0
24 168000
0 0
0 0
38 475000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
27 270000
24 264000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
29 435000
0 0
0 0
0 0
0 0
0 0
0 0
4 44000
7 84000
0 0
7 105000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1085 8380500
RINCIAN RETRIBUSI PELAYANAN BULAN OKTOBER TAHUN 2022

1 3
5000 3 15000 13 65000
0 0
4 Perawatan Luka :
0 0
8000 0 0
b. Rawat luka berat
20000 1 20000 0
20000 0 0
0 0
0 0
0 0
6 Nebulizer
0 0
7 Circumsisi
0 0
8 Incisi Abses
0 0
9 Ekstraksi Kuku
25000 0 0
10 Stump plasty
0 0
0 0
12 Heacting :
0 0
a. 1 - 3 per luka
20000 0 0
30000 0 0
7000 0 0
0 0
14 Bulektomi
0 0
0 0
0 0
17 Kateter :
0 0
0 0
b. Lepas kateter
0 0
18 Pemasangan Infus
0 0
Ganti cairan infus
0 0
10000 0 0
7500 0 0
0 0
0 0
a. Sehat
5000 11 55000 4 20000
b. Kelahiran
0 0
c. Visum hidup
0 0
4000 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
26 ECG
25000 0 0
27 Home Care
0 0
11000 0 0
0 0
0 0
7500 0 0
anestesi 15000 0 0
22000 0 1 22000
0 0
50000 0 0
0 0
0 0
15000 0 0
39 Insici Abses
0 0
40 Open Boor
12500 0 0
15000 0 0
3) 0 0
4) 15000 0 0
5) 15000 0 0
0 0
0 0
15000 0 0
25000 0 0
15000 0 0
Sementara 9) 0 0
0 0
0 0
25000 0 1 25000
(per regio) 0 0
55 Flap periodontal
0 0
56 Alveolectomy
0 0
0 0
0 0
a. Pap Smear
0 0
b. I V A :
0 0
- See (pemeriksaan)
0 0
- Treat Ringan
0 0
- Treat Cryo
0 0
0 0
0 0
a. Tindik
5000 0 0
0 0
c. Fototerapi
0 0
3 Pelayanan KB
0 0
0 0
0 0
c. KB PIL
0 0
d. Implant :
0 0
- Pasang
0 0
- Cabut / Lepas
20000 0 0
e. IUD :
0 0
- Pasang
0 0
- Cabut / Lepas
0 0
f. Steril :
0 0
- MOP
0 0
Spesialistik 0 0
0 0
glukoma) 0 0
0 0
0 0
konjungtiva ) 0 0
0 0
0 0
0 0
c. Puncti Ascites
0 0
0 0
- MOW
0 0
0 0
a. Parasintesis
0 0
0 0
- ringan
0 0
0 0
0 0
1 USG
0 0
a. USG Kandungan
35000 0 0
0 0
0 0
3 Konsultasi 0 0
a. Psikologi
2500 0 0
0 0
0 0
a. Akupuntur
20000 5 100000 0
b. Akupresur
15000 0 0
c. Aromatherapi
0 0
d. Medik Herbal
0 0
e. Pijat Bayi :
0 0
7500 1 7500 0
- Umur > 1 tahun
10000 0 0
5 Konseling VCT
0 0
0 0
0 0
0 0
a. Bayi
0 0
b. Anak / Dewasa
0 0
0 0
2 Visite :
0 0
a. Dokter Umum
0 0
0 0
0 0
a. Dokter Umum
0 0
b. Dokter Spesialis
0 0
0 0
0 0
0 0
0 0
5 Manual Placenta
0 0
0 0
0 0
8 Vacum Ekstraksi
0 0
9 Forcep Ekstraksi
0 0
10 Curretage
0 0
0 0
12 Hecting Portio
0 0
0 0
0 0
15 Resusitasi BBL
0 0
16 Sectio Caesaria
0 0
1 Hematologi
0 0
25000 1 25000 0
0 0
- Hemoglobin
4000 2 8000 0
- Lekosit
0 0
- Trombosit
0 0
0 0
0 0
0 0
0 0
7000 1 7000 0
0 0
a. Urine analyzer
0 0
b. Urine lengkap
12500 1 12500 0
c. Albumin
7500 0 0
d. pH
0 0
0 0
5000 0 0
0 0
0 0
0 0
0 0
i. Trichomonas
0 0
0 0
10000 1 10000 0
11000 0 0
0 0
a. Bilirubin Direct
0 0
b. Blirubin Total
0 0
c. SGOT / ASAT
12500 0 0
d. SGPT / ALAT
12500 0 0
e. Total Protein
0 0
f. Albumin
0 0
5 Mikrobiologi :
0 0
a. Malaria
0 0
b. BTA / TBC
0 0
c. BTA / Kusta
0 0
d. GO
0 0
e. VDRL
0 0
f. TPHA
0 0
g. Rectal Swab
0 0
h. Widal
15000 0 0
0 0
15000 0 0
0 0
a. Creatinin
0 0
b. Ureum (BUN)
0 0
0 0
- Asam Urat Stick
11000 0 0
12000 0 0
0 0
15000 0 0
b. Trigliserida
0 0
c. HDL-Cholesterol
0 0
d. LDL-Cholesterol
0 0
0 0
a. Faeces Rutin
0 0
0 0
0 0
d. Telur Cacing
0 0
e. Amoeba
0 0
a. H I V
0 0
b. H I V konfirmasi
0 0
c. HBs Ab
0 0
d. HBs Ag
0 0
e. Narkoba
0 0
f. Cholinesterase
0 0
g. ............................
0 0
h. ............................
0 0
0 0
a. Ig G
0 0
b. Ig M
0 0
Tahap I 25000 0 0
II 50000 0 0
0 0
0 0
0 0
307500 132000
4 5 6 7 10 11 12
25 125000 10 50000 7 35000 6 30000 18 90000 11 55000 13
1 10000 1 10000 1 10000 2 20000 0 1 10000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 1 8000 0 0 0 2 16000
0 0 0 0 0 0
0 0 0 1 20000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 7000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1 5000 8 40000 13 65000 3 15000 6 30000 10 50000 12
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 6 66000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1 15000 0 0 0 3 45000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 2500 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2 40000 1 20000 0 0 0 4 80000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2 50000 0 1 25000 0 0 0 1
0 0 0 0 0 0
0 0 2 8000 2 8000 0 0 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 3 21000 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 12500 2 25000 0 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 10000 3 30000 0 0 1
0 0 1 11000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2 30000 0 1 15000 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 11000 0 0
0 0 1 12000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
275000 128000 269500 182500 165000 218000
TANGGAL
12 13 14 15 17 18 19
65000 13 65000 19 95000 28 140000 23 115000 16 80000 15
20000 0 1 10000 1 10000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 8000
0 1 20000 0 0 0 0
0 0 1 20000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
60000 13 65000 22 110000 8 40000 2 10000 12 60000 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0
0 12 132000 0 4 44000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 1 15000 0 1 15000 0
0 0 1 22000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 12500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 25000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 5000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 8 160000 0 1 20000
0 0 0 2 30000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
25000 0 2 50000 1 25000 1 25000 0 1
0 0 0 0 0 0
12000 2 8000 1 4000 11 44000 1 4000 1 4000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7000 2 14000 2 14000 9 63000 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
25000 3 37500 1 12500 9 112500 0 1 12500 2
0 0 0 2 15000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 5000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 1 10000 1 10000 13 130000 1 10000 2 20000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15000 0 1 15000 0 1 15000 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 11000 2 22000 2 22000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
239000 377500 424500 835500 199000 237000
19 20 21 22 24 25 26
75000 15 75000 8 40000 9 45000 18 90000 15 75000 21
0 0 1 10000 0 0 6 60000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 8000 0 1 8000
0 0 0 1 20000 0 1 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 25000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 30000 0 0
28000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 7500 1 7500 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20000 4 20000 4 20000 9 45000 3 15000 13 65000 7
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 4000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
25000 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 12 132000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 0 0 0 1 15000 1
0 0 0 1 22000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 25000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 4 80000 0 4 80000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
25000 0 0 2 50000 0 0 1
0 0 0 0 0 0
8000 4 16000 1 4000 3 12000 1 4000 1 4000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7000 0 1 7000 2 14000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
25000 4 50000 1 12500 2 25000 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20000 4 40000 1 10000 3 30000 0 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15000 1 15000 0 1 15000 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
248000 231000 140000 428500 241000 327000
TOTAL
26 27 28 29 31
105000 11 55000 26 130000 11 55000 19 95000 373 1865000
10000 1 10000 1 10000 1 10000 0 23 230000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 6 48000
0 0 0 2 40000 0 6 120000
0 0 0 0 0 2 40000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 1 25000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 1 30000
0 0 0 0 0 5 35000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 2 15000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
35000 1 5000 6 30000 4 20000 0 180 900000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 1 4000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 1 25000
0 0 0 0 0 0 0
0 0 0 0 0 34 374000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
15000 1 15000 0 1 15000 0 12 180000
0 0 1 22000 0 1 22000 5 110000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 1 15000 1 15000
0 0 0 0 0 0 0
0 1 12500 1 12500 0 1 12500 4 50000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 1 15000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 15000 0 0 0 1 15000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 1 25000 0 1 25000 5 125000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 1 5000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 1 27500
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 1 2500
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 20000 0 8 160000 0 38 760000
0 0 0 0 0 2 30000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 1 7500
10000 0 0 1 10000 0 2 20000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
25000 1 25000 3 75000 0 0 17 425000
0 0 0 0 0 0 0
4000 1 4000 2 8000 1 4000 0 42 168000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 6 42000 0 28 196000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
12500 1 12500 2 25000 1 12500 0 34 425000
0 0 0 0 0 2 15000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 1 5000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
20000 1 10000 2 20000 1 10000 1 10000 41 410000
0 0 0 0 0 1 11000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
15000 1 15000 3 45000 0 0 14 210000
0 0 0 0 0 0 0
0 0 0 0 1 15000 1 15000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
11000 0 0 0 0 7 77000
0 0 0 0 0 1 12000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
262500 199000 402500 378500 194500 899 7042500
RINCIAN RETRIBUSI PELAYANAN BULAN NOVEMBER TAHUN 2022

1 2
5000 18 90000 11 55000
Kunjungan Sore 10000 2 20000 2 20000
0 0
4 Perawatan Luka :
0 0
8000 0 0
b. Rawat luka berat
20000 1 20000 0
0 0
0 0
0 0
0 0
6 Nebulizer
0 0
7 Circumsisi
0 0
8 Incisi Abses
0 0
9 Ekstraksi Kuku
25000 0 0
10 Stump plasty
0 0
0 0
12 Heacting :
0 0
a. 1 - 3 per luka
20000 0 0
30000 0 1 30000
7000 0 0
0 0
14 Bulektomi
0 0
0 0
0 0
17 Kateter :
0 0
0 0
b. Lepas kateter
0 0
18 Pemasangan Infus
0 0
Ganti cairan infus
0 0
10000 0 0
7500 0 0
0 0
0 0
a. Sehat
5000 11 55000 7 35000
b. Kelahiran
0 0
c. Visum hidup
0 0
4000 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
26 ECG
25000 0 0
27 Home Care
0 0
11000 12 132000 0
0 0
0 0
7500 0 0
anestesi 15000 0 1 15000
22000 0 0
0 0
50000 0 0
0 0
0 0
0 0
39 Insici Abses
0 0
40 Open Boor
12500 0 0
15000 0 0
3) 0 0
4) 15000 0 0
5) 15000 0 0
0 0
0 0
15000 0 0
25000 0 0
15000 0 0
Sementara 9) 0 0
0 0
0 0
25000 0 0
(per regio) 0 0
55 Flap periodontal
0 0
56 Alveolectomy
0 0
0 0
0 0
a. Pap Smear
0 0
b. I V A :
5000 0 0
- See (pemeriksaan)
0 0
- Treat Ringan
0 0
- Treat Cryo
0 0
1500 0 0
0 0
a. Tindik
5000 1 5000 0
0 0
c. Fototerapi
0 0
3 Pelayanan KB
0 0
0 0
0 0
c. KB PIL
0 0
d. Implant :
0 0
- Pasang
0 0
- Cabut / Lepas
20000 0 0
e. IUD :
0 0
- Pasang
0 0
- Cabut / Lepas
0 0
f. Steril :
0 0
- MOP
0 0
Spesialistik 0 0
0 0
glukoma) 0 0
0 0
0 0
konjungtiva ) 0 0
0 0
0 0
0 0
c. Puncti Ascites
0 0
0 0
- MOW
0 0
0 0
a. Parasintesis
0 0
0 0
- ringan
0 0
0 0
0 0
1 USG
0 0
a. USG Kandungan
35000 0 0
0 0
0 0
3 Konsultasi 0 0
a. Psikologi
2500 0 0
0 0
0 0
a. Akupuntur
20000 1 20000 1 20000
b. Akupresur
15000 0 1 15000
c. Aromatherapi
0 0
d. Medik Herbal
0 0
e. Pijat Bayi :
0 0
7500 0 0
- Umur > 1 tahun
10000 0 0
5 Konseling VCT
0 0
0 0
0 0
0 0
a. Bayi
0 0
b. Anak / Dewasa
0 0
0 0
2 Visite :
0 0
a. Dokter Umum
0 0
0 0
0 0
a. Dokter Umum
0 0
b. Dokter Spesialis
0 0
0 0
0 0
0 0
0 0
5 Manual Placenta
0 0
0 0
0 0
8 Vacum Ekstraksi
0 0
9 Forcep Ekstraksi
0 0
10 Curretage
0 0
0 0
12 Hecting Portio
0 0
0 0
0 0
15 Resusitasi BBL
0 0
16 Sectio Caesaria
0 0
1 Hematologi
0 0
25000 0 0
0 0
- Hemoglobin
4000 1 4000 5 20000
- Lekosit
0 0
- Trombosit
0 0
0 0
0 0
0 0
0 0
7000 0 1 7000
0 0
a. Urine analyzer
0 0
b. Urine lengkap
12500 1 12500 5 62500
c. Albumin
0 0
d. pH
0 0
0 0
0 0
0 0
0 0
0 0
0 0
i. Trichomonas
0 0
0 0
10000 1 10000 6 60000
11000 0 0
0 0
a. Bilirubin Direct
0 0
b. Blirubin Total
0 0
c. SGOT / ASAT
12500 0 0
d. SGPT / ALAT
12500 0 0
e. Total Protein
0 0
f. Albumin
0 0
5 Mikrobiologi :
0 0
a. Malaria
0 0
b. BTA / TBC
0 0
c. BTA / Kusta
0 0
d. GO
0 0
e. VDRL
0 0
f. TPHA
0 0
g. Rectal Swab
0 0
h. Widal
15000 0 0
0 0
15000 0 0
0 0
a. Creatinin
0 0
b. Ureum (BUN)
0 0
0 0
- Asam Urat Stick
11000 0 1 11000
12000 0 0
0 0
15000 0 0
b. Trigliserida
0 0
c. HDL-Cholesterol
0 0
d. LDL-Cholesterol
0 0
0 0
a. Faeces Rutin
0 0
0 0
0 0
d. Telur Cacing
0 0
e. Amoeba
0 0
a. H I V
0 0
b. H I V konfirmasi
0 0
c. HBs Ab
0 0
d. HBs Ag
0 0
e. Narkoba
0 0
f. Cholinesterase
0 0
g. ............................
0 0
h. ............................
0 0
0 0
a. Ig G
0 0
b. Ig M
0 0
Tahap I 25000 0 0
II 50000 0 0
0 0
0 0
0 0
368500 350500
3 4 5 7 8 9 10
11 55000 16 80000 15 75000 18 90000 18 90000 18 90000 22
0 0 0 0 0 1 10000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 20000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
3 15000 4 20000 8 40000 5 25000 7 35000 16 80000 7
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 4000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 6 66000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 2 30000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 12500 1 12500 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 15000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 15000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 4 80000 0 4 80000 1 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 25000 0 0 1 25000 1 25000 1
0 0 0 0 0 0
4 16000 0 1 4000 0 0 3 12000 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
3 21000 0 1 7000 0 0 1 7000
0 0 0 0 0 0
0 0 0 0 0 0
4 50000 0 1 12500 0 0 3 37500 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
4 40000 0 2 20000 0 1 10000 4 40000 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 0 0 1 15000 1 15000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 11000 0 1 11000 1 11000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
197000 140000 301000 172500 332000 347500
TANGGAL
10 11 12 14 15 16 17
110000 21 105000 14 70000 33 165000 28 140000 18 90000 25
10000 1 10000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 8000 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 2 50000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 7000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
35000 12 60000 7 35000 3 15000 7 35000 18 90000 23
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 4000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 6 66000 0 0 0 6 66000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 7500 1 7500
0 0 0 1 15000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 12500 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 1500 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 27500 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 8 160000 0 3 60000 3 60000
0 0 1 15000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
25000 1 25000 1 25000 1 25000 0 0 2
0 0 0 0 0 0
12000 1 4000 0 0 1 4000 0 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 7000 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
37500 1 12500 0 0 0 0 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20000 1 10000 0 1 10000 0 0 5
0 0 0 1 11000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15000 1 15000 1 15000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 11000 0 1 11000
0 0 0 1 12000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
264500 314500 351500 265500 324000 324500
17 18 19 21 22 23 24
125000 11 55000 7 35000 16 80000 16 80000 16 80000 18
0 1 10000 2 20000 0 2 20000 0
0 0 0 0 0 0
0 0 0 0 0 0
8000 0 1 8000 0 3 24000 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
115000 20 100000 3 15000 4 20000 12 60000 2 10000 5
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 6 66000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 3 45000 4 60000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 12500 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 15000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
55000 0 1 27500 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 20000 0 0 3 60000 3 60000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 10000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
50000 1 25000 1 25000 1 25000 1 25000 2 50000 1
0 0 0 0 0 0
16000 4 16000 0 1 4000 0 2 8000 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7000 3 21000 0 0 0 1 7000 2
0 0 0 0 0 0
0 0 0 0 0 0
50000 4 50000 0 1 12500 0 2 25000 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
50000 4 40000 0 1 10000 0 3 30000 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 1 15000 1 15000 1 15000 2 30000 1
0 0 0 0 0 0
0 0 0 1 15000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 11000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
476000 418000 145500 209000 339000 371000
TOTAL
24 25 26 28 29 30
90000 15 75000 13 65000 18 90000 17 85000 17 85000 450
0 0 0 0 1 10000 0 13
0 0 0 0 0 0 0
0 0 0 0 0 0 0
8000 0 1 8000 0 0 0 8
0 0 0 1 20000 0 0 3
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 2
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
25000 6 30000 7 35000 6 30000 10 50000 22 110000 235
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 2
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 10 110000 0 0 0 46
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 7500 0 0 0 0 3
0 1 15000 1 15000 0 1 15000 0 14
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 4
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 1 15000 0 0 0 2
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 2
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 1 5000 0 0 0 2
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
27500 0 0 0 0 1 27500 6
0 0 0 0 0 1 50000 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 1 20000 0 1 20000 2 40000 36
0 0 0 0 1 15000 0 3
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 1 7500 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
25000 1 25000 0 0 0 1 25000 18
0 0 0 0 0 0 0
12000 0 2 8000 0 0 4 16000 39
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
14000 0 0 0 0 2 14000 16
0 0 0 0 0 0 0
0 0 0 0 0 0 0
37500 0 2 25000 0 0 4 50000 38
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
40000 1 10000 1 10000 0 1 10000 4 40000 46
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
15000 1 15000 0 0 0 1 15000 15
0 0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 11000 1 11000 0 1 11000 2 22000 12
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
294000 188500 334500 140000 216000 494500 1024
TOTAL
2250000
130000
0
0
64000
60000
0
0
0
0
0
0
0
50000
0
0
0
0
30000
7000
0
0
0
0
0
0
0
0
0
0
0
0
0
1175000
0
0
8000
0
0
0
0
0
0
0
0
0
506000
0
0
22500
210000
0
0
0
0
0
0
0
50000
0
0
30000
0
0
0
30000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1500
0
10000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
165000
50000
0
0
0
0
720000
45000
0
0
0
7500
10000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
450000
0
156000
0
0
0
0
0
0
112000
0
0
475000
0
0
0
0
0
0
0
0
0
0
460000
11000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
225000
0
15000
0
0
0
0
132000
12000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7679500
RINCIAN RETRIBUSI PELAYANAN BULAN DESEMBER TAHUN 2022

1 2 3
5000 22 110000 13 65000 10
Kunjungan Sore 10000 2 20000 5 50000 2
0 0
4 Perawatan Luka :
0 0
8000 0 1 8000
b. Rawat luka berat
20000 0 0
0 0
0 0
0 0
0 0
6 Nebulizer
20000 0 0
7 Circumsisi
0 0
8 Incisi Abses
0 0
9 Ekstraksi Kuku
25000 0 0
10 Stump plasty
0 0
0 0
12 Heacting :
0 0
a. 1 - 3 per luka
20000 0 0
0 0
7000 0 0
0 0
14 Bulektomi
0 0
0 0
0 0
17 Kateter :
0 0
0 0
b. Lepas kateter
0 0
18 Pemasangan Infus
0 0
Ganti cairan infus
0 0
10000 0 0
7500 0 0
0 0
0 0
a. Sehat
5000 15 75000 13 65000 6
b. Kelahiran
5000 0 0
c. Visum hidup
0 0
4000 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
26 ECG
25000 0 0
27 Home Care
0 0
11000 0 0
0 0
0 0
7500 0 0
anestesi 15000 0 0 1
22000 0 0
0 0
50000 0 0
0 0
0 0
15000 0 0
39 Insici Abses
0 0
40 Open Boor
12500 0 0
15000 0 0
3) 0 0
4) 15000 0 0
5) 15000 0 0
0 0
0 0
15000 0 0
25000 0 0
15000 0 0
Sementara 9) 0 0
0 0
0 0
25000 0 0
(per regio) 0 0
55 Flap periodontal
0 0
56 Alveolectomy
0 0
0 0
0 0
a. Pap Smear
0 0
b. I V A :
0 0
- See (pemeriksaan)
0 0
- Treat Ringan
0 0
- Treat Cryo
0 0
0 0
0 0
a. Tindik
5000 0 0
0 0
c. Fototerapi
0 0
3 Pelayanan KB
0 0
0 0
0 0
c. KB PIL
0 0
d. Implant :
0 0
- Pasang
0 0
- Cabut / Lepas
20000 0 0
e. IUD :
0 0
- Pasang
0 0
- Cabut / Lepas
0 0
f. Steril :
0 0
- MOP
0 0
Spesialistik 0 0
0 0
glukoma) 0 0
0 0
0 0
konjungtiva ) 0 0
0 0
0 0
0 0
c. Puncti Ascites
0 0
0 0
- MOW
0 0
0 0
a. Parasintesis
0 0
0 0
- ringan
0 0
0 0
0 0
1 USG
0 0
a. USG Kandungan
35000 0 0
0 0
0 0
3 Konsultasi 0 0
a. Psikologi
2500 0 0
0 0
0 0
a. Akupuntur
20000 0 0 5
b. Akupresur
15000 0 0
c. Aromatherapi
0 0
d. Medik Herbal
0 0
e. Pijat Bayi :
0 0
7500 0 0
- Umur > 1 tahun
10000 0 0
5 Konseling VCT
0 0
0 0
0 0
0 0
a. Bayi
15000 0 0
b. Anak / Dewasa
20000 0 0
0 0
2 Visite :
0 0
a. Dokter Umum
5000 0 0
0 0
0 0
a. Dokter Umum
0 0
b. Dokter Spesialis
0 0
250000 0 0
0 0
0 0
0 0
5 Manual Placenta
0 0
0 0
0 0
8 Vacum Ekstraksi
0 0
9 Forcep Ekstraksi
0 0
10 Curretage
0 0
0 0
12 Hecting Portio
0 0
0 0
0 0
15 Resusitasi BBL
0 0
16 Sectio Caesaria
0 0
1 Hematologi
0 0
25000 2 50000 1 25000
0 0
- Hemoglobin
4000 2 8000 0
- Lekosit
0 0
- Trombosit
0 0
0 0
0 0
0 0
0 0
7000 1 7000 0
0 0
a. Urine analyzer
0 0
b. Urine lengkap
12500 3 37500 0
c. Albumin
0 0
d. pH
0 0
0 0
0 0
0 0
0 0
0 0
0 0
i. Trichomonas
0 0
0 0
10000 1 10000 1 10000 2
11000 1 11000 0
0 0
a. Bilirubin Direct
0 0
b. Blirubin Total
0 0
c. SGOT / ASAT
12500 0 0
d. SGPT / ALAT
12500 0 0
e. Total Protein
0 0
f. Albumin
0 0
5 Mikrobiologi :
0 0
a. Malaria
0 0
b. BTA / TBC
0 0
c. BTA / Kusta
0 0
d. GO
0 0
e. VDRL
0 0
f. TPHA
0 0
g. Rectal Swab
0 0
h. Widal
15000 2 30000 0
0 0
15000 0 0
0 0
a. Creatinin
0 0
b. Ureum (BUN)
0 0
0 0
- Asam Urat Stick
11000 0 1 11000 2
12000 0 0
0 0
15000 0 0
b. Trigliserida
0 0
c. HDL-Cholesterol
0 0
d. LDL-Cholesterol
0 0
0 0
a. Faeces Rutin
0 0
0 0
0 0
d. Telur Cacing
0 0
e. Amoeba
0 0
a. H I V
0 0
b. H I V konfirmasi
0 0
c. HBs Ab
0 0
d. HBs Ag
0 0
e. Narkoba
0 0
f. Cholinesterase
0 0
g. ............................
0 0
h. ............................
0 0
0 0
a. Ig G
0 0
b. Ig M
0 0
Tahap I 25000 0 0
II 50000 0 0
0 0
0 0
0 0
358500 234000
3 5 6 7 8 9 10
50000 24 120000 12 60000 18 90000 6 30000 12 60000 9
20000 0 0 2 20000 2 20000 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 8000 0
0 1 20000 1 20000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
30000 10 50000 11 55000 11 55000 10 50000 11 55000 12
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15000 0 2 30000 0 0 0
0 0 1 22000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 12500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 25000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
27500 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100000 0 2 40000 3 60000 0 0 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 7500 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 25000 2 50000 0 2 50000 1
0 0 0 0 0 0
0 0 0 1 4000 3 12000 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 7000 3 21000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 12500 0 0 3 37500 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20000 0 1 10000 2 20000 3 30000 2 20000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 15000 2 30000 0 2 30000
0 0 0 0 0 0
0 0 0 0 1 15000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
22000 0 0 1 11000 0 1 11000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
284500 202500 309500 347000 223500 253500
TANGGAL
10 12 13 14 15 16 17
45000 16 80000 11 55000 11 55000 16 80000 11 55000 7
20000 0 1 10000 0 0 1 10000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 20000 1 20000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 25000 0 0 1 25000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
60000 8 40000 4 20000 20 100000 13 65000 8 40000 15
0 0 0 0 1 5000 0
0 0 0 0 0 0
0 0 0 0 20 80000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 15000 1 15000
0 1 22000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 12500 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 15000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 25000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
60000 1 20000 3 60000 2 40000 0 0 5
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 15000 0
0 0 0 0 1 20000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 5000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1 250000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
25000 0 1 25000 1 25000 0 1 25000 1
0 0 0 0 0 0
4000 0 0 1 4000 7 28000 1 4000 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 7000 2 14000 0
0 0 0 0 0 0
0 0 0 0 0 0
12500 0 0 1 12500 7 87500 1 12500 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 2 20000 0 2 20000 4 40000 3 30000 1
0 0 0 0 1 11000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1 15000 0 1 15000 1
0 0 0 0 0 0
0 0 1 15000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1 11000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 15000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
236500 232000 227500 278500 760500 237500
L
17 19 20 21 22 23 24
35000 24 120000 15 75000 15 75000 10 50000 9 45000 5
10000 0 1 10000 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 1 8000 0 0 0 0
0 0 1 20000 0 1 20000 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
75000 6 30000 4 20000 6 30000 7 35000 6 30000 5
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 2 30000 0 1 15000 1 15000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0
0 1 12500 0 1 12500 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 1 15000 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100000 0 1 20000 0 0 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
25000 0 1 25000 1 25000 1 25000 0 1
0 0 0 0 0 0
4000 2 8000 2 8000 4 16000 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 7000 2 14000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
12500 2 25000 2 25000 4 50000 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10000 3 30000 4 40000 4 40000 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15000 0 1 15000 0 1 15000 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 2 22000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
286500 248500 317000 262500 160000 90000
24 26 27 28 29 30 31
25000 13 65000 19 95000 17 85000 17 85000 9 45000 1 5000
10000 0 0 1 10000 1 10000 0 1 10000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 8000 1 8000 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 2 40000 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
25000 5 25000 8 40000 5 25000 1 5000 7 35000 6 30000
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 1 15000 0 0
0 1 22000 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
15000 0 0 0 0 0 0
0 0 0 0 0 0 0
12500 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 25000 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 1 27500
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
40000 0 3 60000 0 0 2 40000 5 100000
0 0 0 1 15000 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
7500 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
25000 1 25000 1 25000 2 50000 1 25000 0 0
0 0 0 0 0 0 0
4000 0 1 4000 3 12000 4 16000 1 4000 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 1 7000 2 14000 1 7000 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
12500 0 1 12500 4 50000 4 50000 1 12500 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
10000 1 10000 3 30000 3 30000 4 40000 1 10000 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
15000 1 15000 1 15000 1 15000 1 15000 0 0
0 0 0 0 0 0 0
0 0 0 1 15000 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 2 22000 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 1 15000 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
201500 195000 311500 329000 315000 153500 172500
TOTAL
352 1760000
23 230000
0 0
0 0
5 40000
6 120000
0 0
0 0
0 0
0 0
2 40000
0 0
0 0
2 50000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
233 1165000
1 5000
0 0
20 80000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
10 150000
3 66000
0 0
0 0
0 0
0 0
1 15000
0 0
5 62500
0 0
0 0
0 0
1 15000
0 0
0 0
0 0
0 0
2 30000
0 0
0 0
0 0
3 75000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 55000
0 0
0 0
0 0
0 0
0 0
37 740000
1 15000
0 0
0 0
0 0
2 15000
0 0
0 0
0 0
0 0
0 0
1 15000
1 20000
0 0
0 0
1 5000
0 0
0 0
0 0
0 0
1 250000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
22 550000
0 0
35 140000
0 0
0 0
0 0
0 0
0 0
0 0
15 105000
0 0
0 0
37 462500
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
49 490000
2 22000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
17 255000
0 0
3 45000
0 0
0 0
0 0
0 0
10 110000
0 0
0 0
2 30000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
907 7228000

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RINCIAN RETRIBUSI PELAYANAN BULAN JANUARI TAHUN 2022

NO JENIS PELAYANAN TARIF

30000 0 2 20000 1 10000 1 10000 0 1

10000 1 10000 0 1 10000 0 0

1 10000 0 2 20000 2 20000 0 0

NO JENIS PELAYANAN TARIF

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NO JENIS PELAYANAN TARIF

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