LAMPIRAN : DAFTAR REKAPITULASI TAGIHAN RAWAT INAP

PESERTA BPJS KESEHATAN

PUSKESMAS : BABAHROT
TAHUN : 2023

JENIS RAWAT INAP

TANGGAL TANGGAL LAMA JUMLAH SELURUH
NO NAMA NOMOR IDENTITAS ALAMAT DAN No.Telp STATUS
MASUK KELUAR RAWATAN umum piv TAGIHAN

1 ZIA ULHAQ 0001118758645 Pante Rakyat 1/29/2023 2/1/2023 3 HARI √ Rp 900.000

2 AJA NAILIS 0000225578687 Blang Dalam 1/29/2023 2/1/2023 3 HARI √ Rp 900.000
3 MULADI 0000225917829 alue dawah 1/30/2023 2/1/2023 2 HARI √ Rp 600.000
4 RAHMI NUR 0002475177952 Gunung Samarinda 1/30/2023 2/2/2023 3 HARI √ Rp 900.000
5 SITI HALIMAH 0000224846188 PANTE CERMIN 1/30/2023 2/2/2023 3 HARI √ Rp 900.000
6 M .RACIP 0000224534013 ie mirah 31/02/2023 2/1/2023 1 HARI √ Rp 300.000
7 IMA ASSIDA 0001118762493 Simpang Gadeng 12/31/2022 2/2/2023 2 HARI √ Rp 600.000
8 T. RUSTAM 0001304639357 Blang Dalam 12/31/2022 2/4/2023 4 HARI √ Rp 1200.000
9 DASNIAR 0000981316462 Blang raja 12/31/2022 2/3/2023 3 HARI √ Rp 900.000
10 SAYUTI 0002449648528 Simpang Gadeng 2/1/2023 2/4/2023 3 HARI √ Rp 855.000
11 MULYADI 0000224098064 Blang Dalam 2/1/2023 2/4/2023 3 HARI √ Rp 855.000
12 IDAWATI 0002297372949 Gunung Samarinda 2/2/2023 2/4/2023 2 HARI √ Rp 570.000
13 CUT DIN 0002905605549 Gunung Samarinda 2/3/2023 2/6/2023 3 HARI √ Rp 855.000
14 DEWI 0002440210397 Gunung Samarinda 2/3/2023 2/4/2023 1 HARI √ Rp 285.000
15 NURHAFSAH 0000981330682 Alue Peunawa 2/4/2023 2/6/2023 2 HARI √ Rp 570.000
16 ASMAUL HUSNA 0002045398151 Pantee Cermin 2/4/2023 2/6/2023 2 HARI √ Rp 570.000
17 PATIMAHNI 0002457190269 Lhok Gayo 2/4/2023 2/6/2023 2 HARI √ Rp 570.000
18 FATIMA WATI 0000213765131 Lhok Gayo 2/4/2023 2/5/2023 1 HARI √ Rp 285.000
19 SYAHRIL 0002524909307 IE MIRAH 2/5/2023 2/6/2023 1 HARI √ Rp 285.000
20 PARMAN 0000225918538 ie mirah 2/5/2023 2/6/2023 1 HARI √ Rp 285.000
21 DAHLAN 0000223312184 Cot Seumantok 2/5/2023 2/7/2023 2 HARI √ Rp 570.000
22 LATIFAH 0001896428621 BABAHROT 2/5/2023 2/7/2023 2 HARI √ Rp 570.000
23 RINAWATI 0000224818233 Pante Rakyat 2/5/2023 2/7/2023 2 HARI √ Rp 570.000
24 HUSNA 0001837251268 Cot Seumantok 2/5/2023 2/7/2023 2 HARI √ Rp 570.000
25 ARISKA 0000224288515 COT SEUMANTOK 2/6/2023 2/9/2023 3 HARI √ Rp 855.000
26 FENDI 0000225439007 MATA IE 2/6/2023 2/8/2023 2 HARI √ Rp 570.000
27 SARIYAH 0001118672842 Pante Rakyat 2/6/2023 2/8/2023 2 HARI √ Rp 570.000
28 MAISA ALIFIANA 0002741773364 Cot Seumantok 2/6/2023 2/8/2023 2 HARI √ Rp 570.000
29 MAULIDIN 0000981332368 blang raja 2/6/2023 2/7/2023 1 HARI √ Rp 300.000
30 SYARIFAH 0000224179582 Gunung Samarinda 2/7/2023 2/8/2023 1 HARI √ Rp 285.000
31 AGUSSALIM 0000225002902 Teladan Jaya 2/7/2023 2/9/2023 2 HARI √ Rp 570.000
32 SAID MUKTAR 0002380461074 ie mirah 2/7/2023 2/11/2023 4 HARI √ Rp 1140.000
33 AFRIZAL 0000224331467 Teladan Jaya 2/7/2023 2/10/2023 3 HARI √ Rp 855.000
34 EVI MISNAWATI 0000224088221 BLANG DALAM 2/8/2023 2/9/2023 1 HARI √ Rp 285.000
35 MAHFUD JASADI JP 0002282715718 Simpang Gadeng 2/8/2023 2/10/2023 2 HARI √ Rp 570.000
36 RUSNAWATI. MY 0000224890053 Blang raja 2/9/2023 2/11/2023 2 HARI √ Rp 570.000
37 ERMALINDA 0000225227889 Blang Dalam 2/9/2023 2/11/2023 2 HARI √ Rp 570.000
38 SALAMAH 0000225042221 blang raja 2/9/2023 2/11/2023 2 HARI √ Rp 570.000
39 DESI RATNA 0000214666514 Cot Seumantok 2/9/2023 2/10/2023 1 HARI √ Rp 285.000
40 JANNATi 0000225306099 ie mirah 2/10/2023 2/12/2023 2 HARI √ Rp 570.000
41 YAZIF ASH SHADIQ AL BARIQ 0000038416959 MUKA BLANG 2/10/2023 2/12/2023 2 HARI √ Rp 570.000
42 JEMI 0002213632045 LHOK GAYO 2/11/2023 2/14/2023 3 HARI √ Rp 855.000
43 KHUMAIRAH AZ- ZAHRA 0002303621166 IE MIRAH 2/11/2023 2/12/2023 1 HARI √ Rp 285.000
44 M. EDIL 0002090903343 ALUE JAMBE 2/11/2023 2/13/2023 2 HARI √ Rp 570.000
45 HUMAIRAH 0002380607662 ie mirah 2/11/2023 2/15/2023 4 HARI √ Rp 1140.000
46 TGK. IBRAHIM 0000226462061 KRUNG SEUMAYAM 2/12/2023 2/14/2023 2 HARI √ Rp 570.000
47 ZUL MASRI 0000224295941 Alue Jeureujak 2/12/2023 2/14/2023 2 HARI √ Rp 570.000
48 SITI RAKABAH 0001797486895 Alue Jeureujak 2/12/2023 2/14/2023 2 HARI √ Rp 570.000
49 CUT MUZALIFAH 0002611806333 ie mirah 2/12/2023 2/16/2023 4 HARI √ Rp 1140.000
50 NURMALINATIL ADIYANI 0002494753029 Pante Rakyat 2/12/2023 2/13/2023 1 HARI √ Rp 570.000
51 LISNAWATI 0000004199027 Blang raja 2/13/2023 2/16/2023 3 HARI √ Rp 570.000
52 NADELI SAFIRA 0002443884197 Simpang Gadeng 2/13/2023 2/14/2023 1 HARI √ Rp 285.000
53 SITI ANI 0001480013133 ie mirah 2/13/2023 2/15/2023 2 HARI √ Rp 570.000
54 SAKDIAH 0000224852848 Pante Rakyat 2/14/2023 2/16/2023 2 HARI √ Rp 570.000
55 LAISA 0000225853828 Alue Beliyong 2/14/2023 2/16/2023 2 HARI √ Rp 570.000
56 hilma fazila 0003112646275 ALUE PINEUNG 2/14/2023 2/17/2023 3 HARI √ Rp 855.000
57 RAMANIAR. S 0000225445847 PANTE CERMIN 2/14/2023 2/16/2023 2 HARI √ Rp 570.000
58 M. BAKRI 0000225248128 ie mirah 2/14/2023 2/16/2023 2 HARI √ Rp 570.000
59 HAMZAH 0001118759681 Pante Rakyat 2/14/2023 2/16/2023 2 HARI √ Rp 570.000
60 MARZUKI 0000226159176 PANTE CERMIN 2/14/2023 2/15/2023 1 HARI √ Rp 285.000
61 MAULIZA 0002076165303 Simpang Gadeng 2/15/2023 2/17/2023 2 HARI √ Rp 570.000
62 NURMANI 0000224868249 Blang raja 2/15/2023 2/18/2023 3 HARI √ Rp 855.000
63 ASSYIFATUN MUNAUWARAH 0002084160508 Alue Peunawa 2/15/2023 2/16/2023 1 HARI √ Rp 285.000
64 ASLIDAN 0000212555755 simeuleu 2/15/2023 2/16/2023 1 HARI √ Rp 285.000
65 RUSNIAR 0000226348367 Pante Rakyat 2/16/2023 2/19/2023 3 HARI √ Rp 855.000
66 YULIDAR 0000225169525 Alue Jeureujak 2/16/2023 2/18/2023 2 HARI √ Rp 570.000
67 NAHDATUL ULA 0002074375754 Blang raja 2/16/2023 2/18/2023 2 HARI √ Rp 570.000
68 LINDA WATI 0000225064078 Alue Peunawa 2/16/2023 2/18/2023 2 HARI √ Rp 570.000
69 DESYA NOVITA 0001118759027 Pantee Rakyat 2/16/2023 2/18/2023 2 HARI √ Rp 570.000
70 M. NASIR 0001276219574 Blang Dalam 2/17/2023 2/18/2023 1 HARI √ Rp 285.000
71 SAKDAH 0001123120686 Alue Jeureujak 2/17/2023 2/18/2023 1 HARI √ Rp 285.000
72 AJA HAYATI 0002213453564 ie mirah 2/17/2023 2/19/2023 2 HARI √ Rp 570.000
73 RUSNAWATI. K 0000224746209 ie mirah 2/17/2023 2/19/2023 2 HARI √ Rp 570.000
74 ROZAH SAFITRI 0000224966709 Simpang Gadeng 2/18/2023 2/20/2023 2 HARI √ Rp 570.000
75 SAMSINI 0000225950815 ie mirah 2/18/2023 2/20/2023 2 HARI √ Rp 570.000
76 NURMA 0000225142176 Alue Jeureujak 2/18/2023 2/20/2023 2 HARI √ Rp 570.000
77 RAHMA LISA 0000225945461 ie mirah 2/18/2023 2/20/2023 2 HARI √ Rp 570.000
78 ERLINA YANTI 0000224932386 Blang Dalam 2/18/2023 2/20/2023 2 HARI √ Rp 570.000
79 RIKI MURSALIN 0002380461129 ie mirah 2/19/2023 2/21/2023 2 HARI √ Rp 570.000
80 SYARIFAH FATIMAH 0000225746706 pante cermin 2/20/2023 2/21/2023 1 HARI √ Rp 285.000
81 REZAMI 0000981327824 Cot Seumantok 2/20/2023 2/22/2023 2 HARI √ Rp 570.000
82 YENNI ZULFITRI 0002065228029 lhok meukek 2/20/2023 2/22/2023 2 HARI √ Rp 570.000
83 ASNIDAR 0000981328138 alue beuliyong 2/21/2023 2/23/2023 2 HARI √ Rp 570.000
84 MISWANDI 0001894831277 Cot Seumantok 2/21/2023 2/23/2023 2 HARI √ Rp 570.000
85 BALQIS SYAKIRA 0002447643576 Cot Seumantok 2/21/2023 2/24/2023 3 HARI √ Rp 855.000
86 DARNI MAWAR 0000225846606 Teladan jaya 2/21/2023 2/24/2023 3 HARI √ Rp 855.000
87 MUHAMMAD MISDAR 0000981325721 Ie Mirah 2/22/2023 2/25/2023 3 HARI √ Rp 855.000
88 SARLINA WATI 0001291880158 Pantee Rakyat 2/22/2023 2/24/2023 2 HARI √ Rp 570.000
89 KHALIDI 0002449513607 Alue beuliyong 2/22/2023 2/23/2023 1 HARI √ Rp 285.000
90 YULIANDRIA 0002037306306 IE MIRAH 2/23/2023 2/26/2023 3 HARI √ Rp 855.000
91 T. RUSTAM 0001304639357 Alue Peunawa 2/23/2023 2/26/2023 3 HARI √ Rp 855.000
92 SYAHRIL 0002524909307 ie mirah 2/23/2023 2/24/2023 1 HARI √ Rp 285.000
93 RUSLI. B 0000225304648 Pante Rakyat 2/23/2023 2/25/2023 2 HARI √ Rp 570.000
94 RAFIZAH 0000981332908 Blang raja 2/23/2023 2/25/2023 2 HARI √ Rp 570.000
95 MILLA RASYIDA 0003263688819 Alue Jeureujak 2/23/2023 2/25/2023 2 HARI √ Rp 570.000
96 RUSNA DEWI 0000224964562 Blang raja 2/23/2023 2/27/2023 4 HARI √ Rp 1140.000
97 TUTI PASRANI 0000224589677 Ie Mirah 2/24/2023 2/25/2023 1 HARI √ Rp 285.000
98 HASANUDDIN 0002045969414 Alue Peunawa 2/24/2023 2/27/2023 3 HARI √ Rp 855.000
99 MUSTAFA. S 0002058822213 Pante Rakyat 2/24/2023 2/27/2023 4 HARI √ Rp 1140.000
100 RIZKI ULIL AZMI 0001110816145 Simpang Gadeng 2/24/2023 2/26/2023 2 HARI √ Rp 570.000
101 EDI RAHMAN 0001118672436 Simpang Gadeng 2/24/2023 2/25/2023 1 HARI √ Rp 285.000
102 RAHIMI. B 0002246277701 alue mentri 2/24/2023 2/27/2023 3 HARI √ Rp 855.000
103 SULAIMAN. B 0000224800839 Pante Rakyat 2/25/2023 2/27/2023 2 HARI √ Rp 570.000
104 CUT DIN 0000981322514 ie mirah 2/25/2023 2/28/2023 3 HARI √ Rp 855.000
105 DESI MAHZALENA 0001815744069 Cot Seumantok 2/25/2023 2/28/2023 3 HARI √ Rp 855.000
106 AINON MARDHIAH 0000224713405 PANTE RAKYAT 2/25/2023 2/26/2023 1 HARI √ Rp 285.000
107 WIWIK SUTRIANINGSIH 0000224494863 gunung samarinda 2/26/2023 2/28/2023 2 HARI √ Rp 570.000
108 CUT AINUR HARIRA 0002476723408 GEUNANG JAYA 2/27/2023 2/28/2023 1 HARI √ Rp 285.000
109 MARNILA DEWI 0001118715063 Alue Jeureujak 2/27/2023 2/28/2023 1 HARI √ Rp 285.000
JUMLAH Rp 65,640.000

Mengetahui Babahrot, 06 Maret 2023

Kepala Puskesmas Babahrot Bendahara JKN

MASRITAWATI, Amd.Keb IRNAIDA, A.Md.Keb

NIP. 19760304 200312 2 003 NIP. 19930726 202203 2 002