7/19/23, 3:33 PM riwayat.

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No. Tanggal Masuk Tanggal Keluar Lama Inap Kamar Status Biaya

1 2023-07-17 2023-07-18 2 COLB004, COLATERAL Pindah 900,000

16:12:31 16:40:34 Kamar

2 2023-07-18 2023-07-18 1 MANYO012, MANYOURI Pindah 450,000

16:40:34 16:42:20 Kamar

3 2023-07-18 2023-07-18 1 MANYO013, MANYOURI Pindah 450,000

16:42:20 16:42:56 Kamar

4 2023-07-18 2023-07-18 1 MANYO020, MANYOURI Pindah 450,000

16:42:56 16:43:13 Kamar

5 2023-07-18 null 00:00:00 1 MANYO013, MANYOURI - 450,000

16:43:13

Pemeriksaan Radiologi :

No. Tanggal Kode Nama Pemeriksaan Dokter PJ Petugas Biaya

1 2023-07-18 RD00008 Photo torax biasa dr. Muhammad Fadjar Sumardi 0

13:38:26 Nur,Sp.Rad

2 2023-07-18 RD00025 USG Abdomen dr. Muhammad Fadjar Sumardi 275,000

13:45:46 Nur,Sp.Rad

Bacaan/Hasil Radiologi

No. Tanggal Hasil Pemeriksaan

1 2023-07-18 foto thorax

13:38:26
1. pulmo :
- infiltrat + kavitas terutama di pulmo kanan
- limfadenopati parahilus kanan
________ tb aktif

2. cor/aorta/trakea/sinus/diafragma : normal

2 2023-07-18 usg abdomen

13:45:46
1. hepar : hepatomegaly ringan

2. gaster : dilatasi, gastric content meningkat ___ gastritis

3. mcburney : obs app akut

4. k empedu/lien/pakreas/ginjal/ k kemih/ uterus/ adnexa : normal

5. tidak tampak : massa/bsk/hidronefrosis/nefritis/kista ov/pid

Pemeriksaan Laboratorium PK & MB :

No. Tanggal Kode Nama Pemeriksaan Dokter PJ Petugas Biaya

1 2023-07-17 J000067 HEMATOLOGI dr. Iras BP Zeth Fred Tju,A.md.AK 0

13:32:54 Rumbiak,Sp.PK

Detail Pemeriksaan Hasil Nilai Rujukan

HemoGlobin (Hb) 8,5 gr/dl 0

Eritrosit (RBC) 4,0 juta/mm3 0

Hematokrit (HCT) 30 % 0

Leukosit 6.600 /mm3 0

Hitung Jenis Lekosit Basofil 0% 0

Hitung Jenis Lekosit Eosinophil 5% 0

Hitung Jenis Lekosit Staf/Batang 0% 0

Hitung Jenis Lekosit Segmen 66 % 0

Hitung Jenis Lekosit Limfosit 17 % 0

Hitung Jenis Lekosit Monosit 12 % 0

Trombosit (AT) 470 10/mm3 0

2 2023-07-19 J000066 IMUNOLOGI/SEROLOGI dr. Iras BP Herdi Samperura 0

13:44:39 Rumbiak,Sp.PK

Detail Pemeriksaan Hasil Nilai Rujukan

HIV REAKTIF (+), REAGEN 110,000

I,II,III

J000068 KIMIA KLINIK/KIMIA DARAH dr. Iras BP Herdi Samperura 0

Rumbiak,Sp.PK

Detail Pemeriksaan Hasil Nilai Rujukan

Gula Darah Sewaktu (GDS) 87 Mg/dl 0

Cholestrol Total 92 Mg/dl 0

HDL- Cholestrol 19 Mg/dl 0

LDL - Cholestrol 48 Mg/dl 0

Tryglicerida 125 Mg/dl 60,000

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7/19/23, 3:33 PM riwayat.html

Kreatinin Darah 0,4 Mg/dl 62,000

Asam urat 2,0 Mg/dl 5,000

SGOT 21 U/L 0

SGPT 11 U/L 0

Pemberian Obat/BHP/Alkes :

No. Tanggal Kode Nama Obat/BHP/Alkes Jumlah Aturan Pakai Biaya

1 2023-07-17 B000000531 Ranitidine amp 25mg/ml (2 ml) 1.0 AMP per 24 jam 5,000
12:22:08

2 2023-07-17 B000006309 Abbocath 22 1.0 PCS per 24 jam 25,000

12:22:08

3 2023-07-17 B000006345 Disposible 3 cc 2.0 PCS per 12 jam 10,000

12:22:08

4 2023-07-17 B000006347 Disposible 5 cc 2.0 PCS per 24 jam 10,000

12:22:08

5 2023-07-17 B000006496 Infus set Dewasa 1.0 PCS per 24 jam 25,000
12:22:08

6 2023-07-17 B000006595 Ondansetron amp 4mg/2ml 2.0 AMP per 8 jam 100,000
12:22:08

7 2023-07-17 B000006708 Cairan Ringer Laktat (500 ml) 1.0 INF per 24 jam 10,000
12:22:08

8 2023-07-18 B000000247 Sucralfate sirup 100 ml 1.0 BTL 3x2 cth/oral 0

09:54:59

9 2023-07-18 B000000251 Test kehamilan (Onemed) 1.0 PCS imm 8,000

09:54:59

10 2023-07-18 B000000531 Ranitidine amp 25mg/ml (2 ml) 2.0 AMP 1 amp/12 jam/iv 10,000
09:54:59

11 2023-07-18 B000006345 Disposible 3 cc 4.0 PCS imm 20,000

09:54:59

12 2023-07-18 B000006595 Ondansetron amp 4mg/2ml 2.0 AMP 4 mg/12 jam/iv 100,000
09:54:59

13 2023-07-18 B000006708 Cairan Ringer Laktat (500 ml) 3.0 INF 500 ml/ 8 jam 30,000
09:54:59

Total Biaya : 5,530,000

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