LAPORAN REKAP KLAIM - RSUD TALISAYAN

Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Agu 2022 s/d 31 Agu 2022
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D PEMERINTAH
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. Klaim / SEP INACBG Top Up Total Tarif Tarif RS Jenis
1 1 Agu 2022 2 Agu 2022 019104 HARYANI 0296R0020822V000017 W-4-16-I 1.951.100 662.000 RI
2 31 Jul 2022 2 Agu 2022 017291 NURMA KEWA 0296R0020722V000160 K-4-17-I 1.330.500 797.500 RI
3 1 Agu 2022 2 Agu 2022 019087 AYU HINRIANI 0296R0020822V000001 O-6-13-I 1.507.200 2.766.500 RI
4 31 Jul 2022 4 Agu 2022 016634 DEMIANUS 0296R0020722V000157 I-4-10-I 2.609.200 2.899.000 RI
5 4 Agu 2022 5 Agu 2022 019122 HARMIATI 0296R0020822V000029 O-6-13-I 1.507.200 425.000 RI
6 4 Agu 2022 5 Agu 2022 019135 IRA HAIRANI 0296R0020822V000031 O-6-13-I 1.507.200 1.075.000 RI
7 4 Agu 2022 5 Agu 2022 019133 ASQA MELATI 0296R0020822V000030 O-6-13-I 1.507.200 1.176.500 RI
8 4 Agu 2022 6 Agu 2022 019143 AFRINDA OLANG 0296R0020822V000035 W-4-16-I 1.951.100 694.500 RI
9 4 Agu 2022 8 Agu 2022 019148 AHMAD JOHAN 0296R0020822V000036 K-4-15-I 1.668.200 914.000 RI
10 8 Agu 2022 9 Agu 2022 017680 NURLINA KUMALASARI 0296R0020822V000049 O-6-13-I 1.507.200 1.356.000 RI
11 8 Agu 2022 11 Agu 2022 018058 AMATUS ALOWISIUS 0296R0020822V000060 K-4-15-II 2.487.000 1.145.500 RI
12 10 Agu 2022 11 Agu 2022 018022 ELISABET 0296R0020822V000073 O-6-13-I 1.507.200 1.326.000 RI
13 10 Agu 2022 13 Agu 2022 001942 REVAN 0296R0020822V000078 A-4-14-I 2.149.000 722.500 RI
14 9 Agu 2022 15 Agu 2022 019187 MARIA NINES 0296R0020822V000070 I-4-16-I 1.399.600 4.586.500 RI
15 12 Agu 2022 15 Agu 2022 013118 AFIFA KANZA AZZAHRA 0296R0020822V000087 J-4-16-I 3.251.400 757.500 RI
16 15 Agu 2022 16 Agu 2022 018531 MIFTAHUL KHOIRIYA 0296R0020822V000098 O-6-13-I 1.507.200 1.055.000 RI
17 16 Agu 2022 17 Agu 2022 013371 MARINA AGUSTIANI 0296R0020822V000108 O-6-13-I 1.507.200 1.075.000 RI
18 17 Agu 2022 18 Agu 2022 007267 FITRAH 0296R0020822V000114 O-6-13-I 1.507.200 1.118.000 RI
19 17 Agu 2022 19 Agu 2022 019287 MUJAHID ADABY 0296R0020822V000112 K-4-17-I 1.108.700 525.000 RI
20 16 Agu 2022 19 Agu 2022 018198 WILHELM TELADAN MANURUNG 0296R0020822V000110 J-4-16-I 3.251.400 729.500 RI
21 18 Agu 2022 19 Agu 2022 019293 NURAIJIN 0296R0020822V000116 U-4-11-I 1.410.300 799.000 RI
22 15 Agu 2022 21 Agu 2022 001436 YATINI 0296R0020822V000097 E-4-11-III 4.061.500 1.295.500 RI
23 19 Agu 2022 21 Agu 2022 017858 DESITA 0296R0020822V000124 K-4-17-I 1.330.500 720.500 RI
24 19 Agu 2022 22 Agu 2022 002645 MARKUS MOAD 0296R0020822V000122 A-4-14-I 2.149.000 808.500 RI
25 21 Agu 2022 23 Agu 2022 002191 ASIH 0296R0020822V000136 W-4-17-II 2.599.500 1.250.600 RI
26 20 Agu 2022 24 Agu 2022 019314 MUHAMMAD ABIL AL GHAZZAL 0296R0020822V000126 A-4-12-I 2.448.500 888.000 RI
27 16 Agu 2022 24 Agu 2022 017223 SUPRIYADI 0296R0020822V000111 I-4-12-I 2.307.600 7.949.500 RI
28 24 Agu 2022 25 Agu 2022 003312 KAILA HAIRA PASIRA 0296R0020822V000152 J-4-21-I 3.115.400 934.500 RI
29 23 Agu 2022 26 Agu 2022 012233 SYAMSU ALAM 0296R0020822V000144 K-4-18-I 1.336.000 826.500 RI
30 23 Agu 2022 26 Agu 2022 003230 FITRI HANDAYANI 0296R0020822V000162 K-4-18-II 1.898.500 767.500 RI
31 21 Agu 2022 27 Agu 2022 014791 PUTRI AZURAYQA AROVI 0296R0020822V000137 K-4-17-I 1.552.200 1.329.500 RI
32 25 Agu 2022 27 Agu 2022 003861 ELISABETH KELYZANIA ARZHELLA 0296R0020822V000159 K-4-17-I 1.108.700 641.500 RI
NGGERI
33 27 Agu 2022 28 Agu 2022 017583 ELFIANA YUVENTA 0296R0020822V000169 K-4-18-II 1.582.100 521.000 RI

Kode RS: 6405012 Halaman 1/2

 LAPORAN REKAP KLAIM - RSUD TALISAYAN
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Agu 2022 s/d 31 Agu 2022
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D PEMERINTAH
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. Klaim / SEP INACBG Top Up Total Tarif Tarif RS Jenis
34 27 Agu 2022 28 Agu 2022 019379 DARWITA 0296R0020822V000171 J-4-21-I 2.596.200 1.814.500 RI
35 26 Agu 2022 29 Agu 2022 003312 KAILA HAIRA PASIRA 0296R0020822V000168 J-4-21-I 3.115.400 2.071.500 RI
36 29 Agu 2022 31 Agu 2022 019398 MARUSA' 0296R0020822V000181 K-4-15-I 1.668.200 688.000 RI
37 29 Agu 2022 31 Agu 2022 006639 AZZAM NABHAN PRATAMA 0296R0020822V000186 G-4-22-II 3.148.000 531.000 RI
Total 74.149.600 49.643.600

Kode RS: 6405012 Halaman 2/2