Cholelytiasis 2013 2015

INSTALASI REKAM MEDIS
RSUP Dr. HASAN SADIKIN

BANDUNG
MORBIDITAS PASIEN RAWAT INAP

PERIODE :
Kode ICD :
SMF
No No Ipd
K80
s/d
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
J. Kelamin :
Ruang
Kelas
1 13015423 0001335400 TITIN, NY
38
FRESIA 2
III A
2 13020027 0001245600 ROSWATI, NY
53
RBA
II
3 13028288 0001328500 POPON MINTARSIH 54
ANTURIU
M
IB
4 14027095 0000076600 TITI SUPRAPTI, NY
75
5 13009214 0001297700 OLAS NY
40
Tgl Masuk Tgl Keluar LOS
ICD
Nm Diagnosa
Disposisi C_Bay Jamin
29-DEC-13 03-JAN-14
K80.2
Calculus of gallbladder Perbaikan TIDAK

without without
MAMP
cholecystitis
U
02-JAN-13
09-JAN-13
K80.2
Calculus of gallbladder Perbaikan UMUM

without without
cholecystitis
04-DEC-13 16-DEC-13
12
K80.2
Calculus of gallbladder Perbaikan ASKES

without without
cholecystitis
PV.PARA RKUTM-C
HYANGA
N2
24-OCT-14 03-NOV-14
10
K80.2
Calculus of gallbladder Perbaikan KONTR

without without
AKTOR
cholecystitis
FRESIA 1
24-JUL-13
K80.3
Calculus of bile duct

with cholangitis
13-OCT-14 18-OCT-14
K80.1

with other cholecystitis
AKTOR
III A
30-JUL-13
BPJS
ASKES
Sembuh TIDAK
MAMP
U
6 14026764 0001393700 EDWIN SUHARDANI 33
7 13023735 0001283000 HABIB ALI
60
RBA
II
27-MAY-13 05-JUN-13
K80.5

without cholangitis or
cholecystitis
(choledolithiasis)
Perbaikan UMUM
8 15025627 0001470200 DIDI
70
KANA
III A
08-AUG-15 14-AUG-15
K80.4

with cholecystitis
Tidak UMUM
Sembuh
9 14022748 0001359400 QODIR KURDINAT
62
ANTURIU
M
IB
25-APR-14 02-MAY-14
K80.1

AKTOR
BPJS
UMUM
10 15021871 0001431800 SAHAT MANGARA
62
ANTURIU
M
11-MAR-15 25-MAR-15
14
K80.2
Calculus of gallbladder
Tidak KONTR
without without
Sembuh AKTOR
cholecystitis
BPJS
UMUM
11 14027820 0001403901 IRAWATI ,NY
35
PV.PARA RKUTM-C
HYANGA
N4
22-NOV-14 28-NOV-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
12 14020877 0001344501 KHODIJAH, HJ
71
PV.PARA RKUTM-A
HYANGA
N3
07-FEB-14
16-FEB-14
K80.2

without without
cholecystitis
13 14002504 0000038902 MOCH. GUN GUN
17
FRESIA 2
III A
07-MAR-14 08-MAR-14
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
14 15022723 0001444202 SENDY YOLA, NY.
37
KEMUNIN
G III(A)
III A
13-APR-15 29-APR-15
16
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
15 15022080 0001430302 MAMAH, NY
73
KEMUNIN
G III(A)
III A
19-MAR-15 01-APR-15
13
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
16 14028661 0001329502 TUTI , NY.
33
KEMUNIN
G III(A)
III A
25-DEC-14 07-JAN-15
13
K80.5

cholecystitis
(choledolithiasis)
BPJS
UMUM
TANJUNG
PV.PARA RKUTM-C
HYANGA
N2
Perbaikan KONTR
AKTOR
BPJS
ASKES
17 13027750 0001258302 SUHERMANTO, TN. 52
PV.PARA RKUTM-C
HYANGA
N2
13-NOV-13 19-NOV-13
K80.2

without without
cholecystitis
18 13025939 0001299402 SUMIATI, NY
56
ANTURIU
M
IB
28-AUG-13 02-SEP-13
K80.2

without without
cholecystitis
19 14023355 0001339602 NINING TARMINI
38
KEMUNIN
G III(B)
III A
22-MAY-14 05-JUN-14
14
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
20 14025575 0001384803 YETTY SUMIYATI
45
PV.PARA RKUTM-C
HYANGA
N3
24-AUG-14 02-SEP-14
K80.1

AKTOR
BPJS
UMUM
21 15000724 0001425403 AEP
68
PV.PARA RKUTM-B
HYANGA
N3
20-JAN-15
22
K80.5

cholecystitis
(choledolithiasis)
BPJS
UMUM
K80.1
ZAMAKHSYARI,
KH
22 15021934 0001437103 KARSIH , NY.
53
IHC
NOKLAS
11-FEB-15
11-MAR-15 17-MAR-15
Perbaikan KONTR
AKTOR
Calculus of gallbladder Perbaikan KONTR BPJS PBI

AKTOR
Hal 1/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
23 13027107 0001245103 DADE SAMBAS
48
KEMUNIN
G IV(B)
III A
24 13008778 0001295303 RUDI RUSANDI
54
MIC
II
25 13028641 0000509003 DYAH DWI P. HJ.
47
26 13026705 0001301303 SANTI TRIANTI, NY
32
27 14013262 0001034903 ETTY
ICD
Nm Diagnosa
15
K80.2
Calculus of gallbladder Sembuh TIDAK

without without
MAMP
cholecystitis
U
18-JUL-13
K80.3

with cholangitis
PV.PARA RKUTM-B
HYANGA
N3
18-DEC-13 24-DEC-13
K80.2

without without
cholecystitis
PV.PARA RKUTM-C
HYANGA
N3
30-SEP-13 04-OCT-13
K80
56
PV.PARA RKUTM-C
HYANGA
N4
21-DEC-14 10-JAN-15
20
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
28 14027100 0001398603 IDA KOMARIDAH
49
AGLONEM
A
II
25-OCT-14 03-NOV-14
K80.1

AKTOR
BPJS
UMUM
29 15022923 0001411504 LILIS NURYANI
37
KEMUNIN
G III(A)
III A
21-APR-15 08-MAY-15
17
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
30 14024091 0001374904 JAERAH
58
KEMUNIN
G III(A)
III A
21-JUN-14
24-JUL-14
33
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
31 15024665 0001444404 MEGA SARI, NY
39
KEMUNIN
G III(A)
III A
29-JUN-15
05-JUL-15
K80.4

with cholecystitis
Meninggal KONTR
> 48 Jam AKTOR
BPJS
UMUM
32 13025170 0001297504 WARSO
49
KEMUNIN
G IV
III A
23-JUL-13 19-AUG-13
27
K80.5

cholecystitis
(choledolithiasis)
Perbaikan TIDAK
GURMANTIKA, NY.
17-OCT-13 01-NOV-13
14-JUL-13
CHOLELITHIASIS
Meninggal UMUM
> 48 Jam
Sembuh UMUM
MAMP
U
33 13027408 0001320704 LATIFAH HANUM
71
PV.PARA RKUTM-C
HYANGA
N4
29-OCT-13 04-NOV-13
K80.2

without without
cholecystitis
34 14022723 0001339004 SITI ROHMAYANI,
33
KEMUNIN
G III(A)
24-APR-14 09-MAY-14
15
K80.2

without without
AKTOR
cholecystitis
39
PV.PARA RKUTM-B
HYANGA
N3
12-MAY-15 16-MAY-15
K80.4

with cholecystitis
NY
35 15023444 0001450604 LIA CAMELIA
RITA,NY
III A
Perbaikan KONTR
AKTOR
BPJS
ASKES
36 15024670 0001462104 DUHITAWANTI ,SE
50
PV.PARA RKUTM-C
HYANGA
N2
29-JUN-15
05-JUL-15
K80.1

AKTOR
BPJS
ASKES
37 14027631 0001409804 ELAN SUHERLAN,
52
PV.PARA RKUTM-C
HYANGA
N2
14-NOV-14 22-NOV-14
K80.1

AKTOR
BPJS
ASKES
46
DRK
RKUTM-C
LANTAI 4
18-JAN-13
25-JAN-13
K80.2

without without
cholecystitis
39 13011595 0001100204 A. SUKAESIH, NY
74
FRESIA 3
23-SEP-13 27-SEP-13
K80.2

without without
cholecystitis
40 14026936 0001403404 UJANG SYAHRIL
52
PV.PARA RKUTM-C
HYANGA
N2
19-OCT-14 28-OCT-14
K80.2
Calculus of gallbladder Perbaikan KONTR BPJS TNI

without without
AKTOR
cholecystitis
41 13027283 0001319604 EMUS
65
HCU
NOKLAS
KEMUNIN
G
24-OCT-13 16-NOV-13
23
K80.2
Calculus of gallbladder Meninggal TIDAK

without without
> 48 Jam MAMP
cholecystitis
U
42 14027448 0001407804 YANA
45
KEMUNIN
G III(A)
III A
07-NOV-14 25-NOV-14
18
K80.5

cholecystitis
(choledolithiasis)
S.PD
38 13000897 0001251104 MARI MARIA SARI
SPD ,NY
WIHARYANA, NY
IA
Perbaikan KONTR
AKTOR
BPJS
UMUM
43 14006552 0001354604 DEDEN WAHYU
46
FRESIA 3
IA
25-JUN-14
22-JUL-14
27
K80.1

AKTOR
BPJS
UMUM
44 14025706 0001364904 NUNUH
63
ANTURIU
M
IB
28-AUG-14 04-SEP-14
K80.1

AKTOR
BPJS
UMUM
Hal 2/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
45 14020314 0001339405 MINTARSIH
75
46 13025109 0001297205 OJO SUNARJO, TN
71
47 13020575 0001251905 DEDE DAHYO
50
DRK
RKUTM-B
LANTAI 3
23-JAN-13
48 14022775 0001362505 ETI SULASTRI
43
KEMUNIN
G III(B)
49 15024703 0001462105 ROSITA
49
PV.PARA RKUTM-C
HYANGA
N3
GBICU
II
III A
KEMUNIN
G III(A)
III A
%
ICD
Nm Diagnosa
20-JAN-14
K80.1

AKTOR
22-JUL-13 09-AUG-13
18
K80.2
Calculus of gallbladder Meninggal ASKES

without without
> 48 Jam
cholecystitis
27-JAN-13
K80.1

28-APR-14 06-MAY-14
K80.3

with cholangitis
Perbaikan KONTR BPJS PBI
17
K80.5

cholecystitis
(choledolithiasis)
15-JAN-14
29-JUN-15
16-JUL-15
AKTOR
AKTOR
60
KEMUNIN
G IV(A)
III A
05-SEP-14 26-SEP-14
21
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
51 14025668 0001389905 MUSLIMAH
35
KEMUNIN
G III(A)
III A
26-AUG-14 11-SEP-14
16
K80.2
Calculus of gallbladder Sembuh KONTR

without without
AKTOR
cholecystitis
BPJS
UMUM
52 14022929 0001355005 OOM
53
KANA
III A
03-MAY-14 27-MAY-14
24
K80.1

AKTOR
BPJS
UMUM
53 14023450 0001368905 NANDANG
37
ANTURIU
M
IB
26-MAY-14 07-JUN-14
12
K80.1

AKTOR
BPJS
UMUM
51
PV.PARA RKUTM-B
HYANGA
N3
04-MAY-15 10-MAY-15
K80.0

with acute cholecystitis
AKTOR
BPJS
ASKES
44
PV.PARA RKUTM-C
HYANGA
N2
25-SEP-14 08-OCT-14
13
K80.3

with cholangitis
AKTOR
BPJS
ASKES
50 14025896 0001390305 LILI BIN NASIHIN,
TN
SUPRIATNA
54 15023226 0001448805 KOMARIAHWATI,
NY
55 14026392 0001398505 OKTRIANA P.
SARY, NY
Perbaikan KONTR
56 14025701 0000410705 UNDANG SUDJANA 60
PV.PARA RKUTM-C
HYANGA
N2
28-AUG-14 02-SEP-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
57 15021512 0000247805 RATNA
59
ANTURIU
M
25-FEB-15 07-MAR-15
10
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
58 14024527 0001360405 UDIN SAMSUDIN
51
ANTURIU
M
IA
08-JUL-14
19-JUL-14
11
K80.1

AKTOR
BPJS
ASKES
59 14026172 0001395006 OYOK NY
53
AGLONEM
A
II
12-SEP-14 07-OCT-14
25
K80.3

with cholangitis
BPJS
UMUM
60 13021276 0001194206 HETI TRISNAWATI
67
DRK
RKUTM-C
LANTAI 3
18-FEB-13
23-FEB-13
K80.2

without without
cholecystitis
28
KEMUNIN
G III(A)
III A
07-FEB-14
19-FEB-14
12
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
62 14027231 0001281806 AGUS SAPTONO
49
KEMUNIN
G IV(A)
III A
30-OCT-14 17-NOV-14
18
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
63 14004250 0001362306 SUGANDA TN
41
FRESIA 2
III A
26-APR-14 01-MAY-14
K80.5

cholecystitis
(choledolithiasis)
21
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
KOMALASARI
,NY
61 14020871 0001326706 HETTY MELANY A
N, NY
64 15020693 0001426706 MEMED,TN
74
PV.PARA RKUTM-C
HYANGA
N2
26-JAN-15
16-FEB-15
Meninggal KONTR
> 48 Jam AKTOR
AKTOR
AKTOR
BPJS
ASKES
BPJS
ASKES
65 14026079 0001388506 DIDA HODIJAH, NY
57
AGLONEM
A
II
12-SEP-14 18-SEP-14
K80.2

without without
AKTOR
cholecystitis
66 13027090 0001212406 ENDANG
59
AZALIA
II
16-OCT-13 22-OCT-13
K80.3

with cholangitis
49
KEMUNIN
G IV(B)
III A
26-MAY-15 07-JUN-15
12
K80.2
Calculus of gallbladder Sembuh KONTR BPJS PBI

without without
AKTOR
cholecystitis
MARYANA
67 15023806 0001441507 DADANG
SUHERLAN
Perbaikan ASKES
Hal 3/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
68 14027892 0001412807 ENDANG RUSITO
54
PV.PARA RKUTM-B
HYANGA
N3
25-NOV-14 01-DEC-14
K80.1

AKTOR
BPJS
ASKES
69 14022357 0001206907 WEDYASIH .HJ
66
ANTURIU
M
IB
08-APR-14 17-APR-14
K80.1

AKTOR
BPJS
ASKES
70 13022345 0001268507 TRI WIYANTI
36
ANTURIU
M
IB
01-APR-13 11-APR-13
10
K80.2

without without
cholecystitis
71 14020968 0001329707 DEDI JUNAEDI
44
KEMUNIN
G IV(A)
III A
11-FEB-14
21-FEB-14
10
K80.1

AKTOR
72 14027237 0001406307 RIAN IRPAN
15
KEMUNIN
G II(A)
III A
29-OCT-14 03-DEC-14
35
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
KEMUNIN
G II(A)
III A
17
K80.5

cholecystitis
(choledolithiasis)
Sembuh KONTR
AKTOR
BPJS
UMUM
Meninggal KONTR
> 48 Jam AKTOR
BPJS
UMUM
OKTAPIAN
73 15020067 0001406307 RIAN IRPAN
15
OKTAPIAN
74 14022932 0001363808 YAYAH
05-JAN-15
22-JAN-15
AKTOR
BPJS
UMUM
64
HCU
NOKLAS
KEMUNIN
G
03-MAY-14 10-MAY-14
K80.3

with cholangitis
23
AGLONEM
A
II
11-JUL-13
18-JUL-13
K80.2

without without
cholecystitis
76 13020933 0001253208 CASMINI
33
KEMUNIN
G III
III A
04-FEB-13
19-FEB-13
15
K80.2

without without
MAMP
cholecystitis
U
77 13020399 0001250008 SYIFA
57
RBB
IA
15-JAN-13
24-JAN-13
K80.2

without without
cholecystitis
78 15024034 0001430408 TATAN
59
KEMUNIN
GV
II
03-JUN-15
16-JUN-15
13
K80.5

cholecystitis
(choledolithiasis)
Sembuh KONTR
KEMUNIN
GV
II
13
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
KEMUNIN
GV
II
K80.2

BPJS
without without
AKTOR JAMSOST
cholecystitis
III A
13-NOV-14 01-DEC-14
18
K80.4

with cholecystitis
MARYAMAH NY
75 13024863 0001292508 WIWIN NIRMALA,
NY
79 15021116 0001418008 NUNUNG KUSMIATI, 53
NY
80 15021127 0001367409 SUDRAJAT
53
11-FEB-15
11-FEB-15
24-FEB-15
16-FEB-15
AKTOR
AKTOR
BPJS
POLRI
BPJS
ASKES
EK
81 14027595 0001408909 IING ISMAIL
52
KEMUNIN
G IV(B)
82 13025670 0001301009 YUHAEMI, NY
81
AGLONEM
A
II
19-AUG-13 30-AUG-13
11
K80.2

without without
cholecystitis
83 12028795 0001245809 TATI HANDAYANI
34
KEMUNIN
G III
III A
28-DEC-12 13-JAN-13
16
K80.5

cholecystitis
(choledolithiasis)
12
K80.1

AKTOR
NY
Perbaikan KONTR
AKTOR
Perbaikan TIDAK
MAMP
U
84 15023723 0001440309 MASRANI
47
ANTURIU
M
85 13020781 0001195109 DIAH DURIYATI
58
RBB
IA
29-JAN-13
05-FEB-13
K80.1
Calculus of gallbladder Sembuh ASKES

86 14020962 0001338709 YAYAH, NY
49
KEMUNIN
G III(A)
III A
11-FEB-14
26-FEB-14
15
K80.5

cholecystitis
(choledolithiasis)
22-MAY-15 03-JUN-15
BPJS
ASKES
BPJS
UMUM
Perbaikan TIDAK BPJS PBI

MAMP
U
87 14020844 0000953609 AISAH APONG, NY
67
KEMUNIN
G III(A)
III A
06-FEB-14
21-FEB-14
15
K80.2

without without
AKTOR
cholecystitis
88 14024122 0000914509 SITI MAEMUNAH,
49
AGLONEM
A
II
23-JUN-14
30-JUN-14
K80.1

AKTOR
42
KEMUNIN
G III
III A
15-JUN-13
27-JUN-13
12
K80.3

with cholangitis
S.PD, NY
89 13024187 0001287510 OJA
BPJS
ASKES
Perbaikan TIDAK
MAMP
U
Hal 4/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
90 13023820 0001274510 NANI NY
Umur Sex
67
Ruang
J. Kelamin :
Kelas
KEMUNIN
G III
III A

30-MAY-13 31-MAY-13
ICD
K80.8
Nm Diagnosa
Other cholelithiasis

Perbaikan TIDAK
MAMP
U
91 14023464 0001369310 YENI ANGGRAENI
27
KANA
III A
27-MAY-14 01-JUN-14
K80.1

92 13027064 0001287510 OJA
42
KEMUNIN
G III(A)
III A
16-OCT-13 11-NOV-13
26
K80.5

cholecystitis
(choledolithiasis)
93 13021958 0001262810 AGUNG BUDI
KEMUNIN
G IV
III A
14-MAR-13 27-MAR-13
13
K80.2

without without
MAMP
cholecystitis
U
29
ANTURIU
M
IB
08-MAY-14 21-MAY-14
13
K80.4

with cholecystitis
Perbaikan KONTR
KEMUNIN
G IV(B)
III A
19
K80.5

cholecystitis
(choledolithiasis)
K80.2

without without
cholecystitis
SIMORANGKIR
95 14028284 0001403410 UKAR
96 13021518 0000538010 RUSLAN
MAMP
U
25
SANTOSA
94 14023068 0001364710 ELLYSABETH
Perbaikan TIDAK
41
10-DEC-14 29-DEC-14
AKTOR
AKTOR
63
ANTURIU
M
IA
26-FEB-13 05-MAR-13
97 13020733 0001246111 SUHERTI, NY
50
KEMUNIN
G III
III A
28-JAN-13
08-FEB-13
11
K80.2

without without
MAMP
cholecystitis
U
98 13003444 0001264011 RUDI MULYA TN
42
KEMUNIN
G IV
III A
12-MAR-13 10-APR-13
29
K80.3

with cholangitis
HUTAJULU
99 13014101 0000043311 MARYAM
PV.PARA RKUTM-B
HYANGA
N2
25-NOV-13 04-DEC-13
K80.2

without without
cholecystitis
56
PV.PARA RKUTM-B
HYANGA
N3
14-AUG-15 26-AUG-15
12
K80.1

AKTOR
BPJS
ASKES
39
ANTURIU
M
08-DEC-14 15-DEC-14
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
53
PV.PARA RKUTM-A
HYANGA
N4
04-APR-15 21-APR-15
17
K80.3

with cholangitis
Perbaikan KONTR
AKTOR
BPJS
ASKES
Meninggal KONTR
> 48 Jam AKTOR
BPJS
UMUM
SUDIAWAN
102 15022480 0001440012 TATANG WAHYUDI
MAMP
U
DASMINAR, SE
101 14028206 0001414911 WAWAN
Sembuh TIDAK
77
DANUWIRIA
100 15007284 0000345911 EEM KRISNA
BPJS
ASKES
103 15024339 0001430612 MIAN SUMARNA
51
KEMUNIN
G IV(B)
III A
16-JUN-15
26-JUN-15
10
K80.5

cholecystitis
(choledolithiasis)
104 13021304 0001251512 BUYUNG MAYA,
30
KEMUNIN
G III
III A
18-FEB-13
25-FEB-13
K80.2

without without
MAMP
cholecystitis
U
73
PV.PARA RKUTM-B
HYANGA
N3
26-JAN-15
03-FEB-15
K80.1

AKTOR
BPJS
ASKES
106 15020915 0001428412 TEDJA NINGSIH, NY 57
KEMUNIN
G III(A)
III A
02-FEB-15
25-FEB-15
23
K80.3

with cholangitis
BPJS
UMUM
11
K80.2

without without
cholecystitis
NY
105 15020645 0001426312 EMI ROHAEMI, NY
Perbaikan KONTR
AKTOR
107 13023725 0001282712 NURSASIH, NY
65
AGLONEM
A
II
27-MAY-13 07-JUN-13
108 13020962 0001254812 MOMIH KARMAH
49
AGLONEM
A
II
05-FEB-13
12-FEB-13
K80.2

without without
cholecystitis
24
AGLONEM
A
II
06-JUL-13
19-JUL-13
13
K80.5

cholecystitis
(choledolithiasis)
110 15026026 0001473912 N SUAEBAH AMA
58
PV.PARA RKUTM-B
HYANGA
N3
25-AUG-15 02-SEP-15
K80.2

without without
AKTOR
cholecystitis
111 13006218 0001280213 KOMARIAH
39
FRESIA 3
15-MAY-13 20-MAY-13
K80.1

NURAENI
109 13024733 0001293212 LALU MARIAWAN
AL - FARIZI
IB
Perbaikan ASKES
BPJS
ASKES
Hal 5/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
112 13028902 0000967513 ELLY MULYANTI
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
44
ANTURIU
M
IB
30-DEC-13 05-JAN-14
K80.2

without without
cholecystitis
113 14025894 0001386813 WARSA
53
KEMUNIN
G IV(B)
III A
05-SEP-14 15-SEP-14
10
K80.2

without without
AKTOR
cholecystitis
114 13025241 0001298213 CASNI, NY
47
KEMUNIN
G III
III A
28-JUL-13 17-AUG-13
20
K80.2

without without
MAMP
cholecystitis
U
115 14022695 0001349513 DIMYATI
54
ANTURIU
M
IB
23-APR-14 02-MAY-14
K80.2

without without
AKTOR
cholecystitis
116 13003814 0000032013 SITI DJUARIAH
79
FRESIA 1
II
22-MAR-13 27-MAR-13
K80.2

without without
cholecystitis
117 13023842 0001280213 KOMARIAH, NY
39
ANTURIU
M
IA
31-MAY-13 09-JUN-13
K80.1

118 13028387 0001330413 IMAS NY
54
KEMUNIN
G III(A)
III A
07-DEC-13 03-JAN-14
27
K80.3

with cholangitis
ABDULAH
119 13021361 0001258913 ASIH RATNASIH,
120 14020346 0001179014 SUHANDA
121 14024711 0001378614 NINING
Perbaikan TIDAK
MAMP
U
51
KANA
III A
20-FEB-13
28-FEB-13
K80.2

without without
cholecystitis
41
KANA
III A
16-JAN-14
30-JAN-14
14
K80.4

with cholecystitis
Sembuh TIDAK
11
K80.3

with cholangitis
Perbaikan KONTR
NY
39
WIDANINGSIH
AGLONEM
A
II
16-JUL-14
27-JUL-14
BPJS
ASKES
MAMP
U
AKTOR
BPJS
UMUM
BPJS
UMUM
122 15022513 0001440514 JALI SETIA, TN
30
KEMUNIN
G IV(A)
III A
06-APR-15 25-APR-15
19
K80.2

without without
AKTOR
cholecystitis
123 13007688 0001288214 SITI HODIJAH
62
FRESIA 2
III A
18-JUN-13
01-JUL-13
13
K80.2

without without
MAMP
cholecystitis
U
124 13021050 0001253014 E. NURUL HAQ
58
AGLONEM
A
II
08-FEB-13
17-FEB-13
K80.2

without without
cholecystitis
125 14023983 0001365914 RD. ROSNAENI, NY
61
AGLONEM
A
II
17-JUN-14
26-JUN-14
K80.1

AKTOR
126 13026116 0001305214 NT ALAWIYAH NY
54
ANTURIU
M
IA
05-SEP-13 12-SEP-13
K80.2

without without
cholecystitis
127 13021571 0001253614 DJOKO
64
ANTURIU
M
IB
28-FEB-13 07-MAR-13
K80.2

without without
cholecystitis
83
DRK
RKUTM-C
LANTAI 4
04-JUN-13
09-JUN-13
K80.2

without without
cholecystitis
46
KEMUNIN
G III(A)
24-JAN-14
21-FEB-14
28
K80.4

with cholecystitis
11
K80.3

with cholangitis
Perbaikan KONTR
SPD. H
POERWONO
128 13023933 0000553514 HJ SYAMSIAR
NURDIN
129 14020556 0001341414 CICIH NY
130 14012815 0001415515 HERNI WILASTRI
131 14022206 0001343415 BEDAH SITI
32
FRESIA 2
III A
III A
07-DEC-14 18-DEC-14
AKTOR
AKTOR
BPJS
UMUM
BPJS
UMUM
33
KANA
III A
02-APR-14 17-APR-14
15
K80.1

AKTOR
132 13002886 0001204915 IMON
33
FRESIA 2
III A
28-FEB-13 09-MAR-13
K80.2

without without
MAMP
cholecystitis
U
133 13025675 0001302515 WARSINAH, NY
63
ANTURIU
M
IA
19-AUG-13 25-AUG-13
K80.2

without without
cholecystitis
134 13022243 0001204915 IMON
33
KEMUNIN
G IV
III A
26-MAR-13 19-APR-13
24
K80.5

cholecystitis
(choledolithiasis)
K80.2
SAODAH, NY
135 15022931 0001221316 YUYUN
YUTIKA,HJ.NY
59
PV.PARA RKUTM-B
HYANGA
N3
21-APR-15 26-APR-15
Perbaikan TIDAK
MAMP
U

without without
cholecystitis
Hal 6/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
136 14024245 0001375116 HENI YOSEPHIANE 32
ANTURIU
M
IA
26-JUN-14
03-JUL-14
K80.1

AKTOR
137 13022363 0001242716 RUSDIATI RUMIAH,
44
ANTURIU
M
IB
01-APR-13 09-APR-13
K80.0

138 14006886 0001378016 SUNGADINI, NY
78
FRESIA 3
IA
04-JUL-14
10-JUL-14
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
139 14023360 0001363216 ATIH
36
ANTURIU
M
IA
22-MAY-14 29-MAY-14
K80.1

AKTOR
BPJS
ASKES
52
KEMUNIN
GV
II
02-APR-15 10-APR-15
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
141 13022385 0001269016 R.D WIEN WINARTI 75
DRK
RKUTM-B
LANTAI 2
02-APR-13 08-APR-13
K80.1

142 13005971 0001279016 NENENG MULYATI
63
DRK
RKUTM-C
LANTAI 2
10-MAY-13 16-MAY-13
K80.2

without without
cholecystitis
143 14021140 0000572616 NANDANG H, DRS.
72
ANTURIU
M
IB
18-FEB-14
24-FEB-14
K80.1

AKTOR
BPJS
ASKES
144 14027224 0001393216 TITI MARIYANI, NY
45
KEMUNIN
G III(A)
III A
30-OCT-14 18-NOV-14
19
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
145 15023634 0001424017 SITI ROHAMAH, NY
75
KEMUNIN
GV
II
19-MAY-15 31-MAY-15
12
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
146 15022811 0001414017 YANI SURYANI
51
KEMUNIN
GV
II
16-APR-15 04-MAY-15
18
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
BPJS
UMUM
KEMUNIN
G III(A)
III A
K80.3

with cholangitis
Perbaikan KONTR
KANA
III A
14
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
IR
KARDININGSIH, NY
140 15022459 0000776516 ATIS SUMIATI
147 15020238 0001100917 YANI CAHYANI .NY

148 15024423 0001450217 JAENUDIN, TN
34
56
P
L
09-FEB-15
19-JUN-15
14-FEB-15
03-JUL-15
AKTOR
AKTOR
BPJS
ASKES
BPJS
UMUM
AKTOR
BPJS
UMUM
24
KANA
III A
14-AUG-14 01-SEP-14
18
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
150 14023352 0001349617 IRA APRILIA FAJAR 30
KANA
III A
22-MAY-14 07-JUN-14
16
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
151 14025292 0000228317 EUIS HASMAYATI
64
ANTURIU
M
IA
13-AUG-14 17-AUG-14
K80.1

AKTOR
BPJS
ASKES
152 13024529 0001290717 YUYU
69
KEMUNIN
G III
III A
26-JUN-13
12-JUL-13
16
K80.1

MAMP
U
153 13022054 0001265517 NENI TRIHANDANI
46
KEMUNIN
G III
III A
19-MAR-13 26-APR-13
38
K80.2

without without
MAMP
cholecystitis
U
154 13020317 0001249518 RASID
48
IRD
12-JAN-13
28-JAN-13
16
K80.2

without without
MAMP
cholecystitis
U
155 14026099 0001395018 NENAH JAENAH,
50
KEMUNIN
G III(A)
III A
12-SEP-14 18-OCT-14
36
K80.2

without without
MAMP
cholecystitis
U
38
ANTURIU
M
IB
28-APR-14 20-MAY-14
22
K80.3

with cholangitis
149 14025346 0001385017 ANDRI MUHAMAD
SIDIK
NY
156 14004321 0001011618 R ENGKUS
KUSDIANA
Perbaikan KONTR
AKTOR
BPJS
ASKES
157 14024404 0001377218 E. KARTIKA
77
PV.PARA RKUTM-C
HYANGA
N2
03-JUL-14
07-JUL-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
158 14013237 0001355818 TIKA ERMAWATI
34
PV.PARA RKUTM-B
HYANGA
N3
19-DEC-14 25-DEC-14
K80.5

cholecystitis
(choledolithiasis)
BPJS
ASKES
,DR
Perbaikan KONTR
AKTOR
Hal 7/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
159 15023926 0000511618 KOMARIAH, NY
69
160 14001974 0001347718 IMAS MOLIYAH NY
40
Ruang
J. Kelamin :
Kelas
PV.PARA RKUTM-C
HYANGA
N3
AGLONEM
A
II
III A
ICD
Nm Diagnosa
31-MAY-15 05-JUN-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
21-FEB-14 19-MAR-14
26
K80.4

with cholecystitis
AKTOR
BPJS
UMUM
02-JUL-14
22
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
BPJS
UMUM
Sembuh KONTR
161 14023795 0001294018 UTANG SURYANA
57
KEMUNIN
G IV(B)
162 15025465 0001331218 SHINTA, NY
45
PV.PARA RKUTM-C
HYANGA
N4
03-AUG-15 08-AUG-15
K80.2

without without
AKTOR
cholecystitis
163 14025038 0001383818 ANING NY
37
KEMUNIN
G III(A)
III A
04-AUG-14 27-AUG-14
23
K80.3

with cholangitis
III A
24-DEC-14 02-JAN-15
K80.5

cholecystitis
(choledolithiasis)

AKTOR
10-JUN-14
AKTOR
164 14028655 0001356518 TATA SUTISNA TN
53
KEMUNIN
G IV(A)
165 14022503 0000747718 DARYA
59
KEMUNIN
G IV(B)
III A
14-APR-14 29-APR-14
15
K80.2

without without
AKTOR
cholecystitis
166 13023552 0001281318 SOPIA LUTPIAH
17
AGLONEM
A
II
20-MAY-13 28-MAY-13
K80.2

without without
cholecystitis
167 13021201 0000261118 SUNARYO, TN
56
ANTURIU
M
IB
13-FEB-13
25-FEB-13
12
K80.2

without without
cholecystitis
168 13005520 0000261118 SUNARYO
56
FRESIA 3
IB
30-APR-13 08-MAY-13
K80.2

without without
cholecystitis
169 14027447 0001408419 DIANA
49
ANTURIU
M
07-NOV-14 17-NOV-14
10
K80.2

without without
AKTOR
cholecystitis
170 13021178 0001257119 EMPONG JULAEHA 44
KEMUNIN
G III
III A
13-FEB-13
26-FEB-13
13
K80.2

without without
MAMP
cholecystitis
U
171 15025659 0001463919 EUGENY UTAMI
53
ANTURIU
M
10-AUG-15 22-AUG-15
12
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
172 15020863 0000023119 ARTATI
59
ANTURIU
M
02-FEB-15
13-FEB-15
11
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
173 15021125 0001428119 ACENG
56
KEMUNIN
G IV(B)
III A
11-FEB-15
13-FEB-15
K80.2
Tidak KONTR
without without
Sembuh AKTOR
cholecystitis
BPJS
ASKES
174 15025436 0001468619 ETI ROHAYATI
55
KEMUNIN
GV
II
01-AUG-15 23-AUG-15
22
K80.1

AKTOR
BPJS
ASKES
175 14020156 0000915719 SITI SOPIAWATI
48
ANTURIU
M
IB
13-JAN-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
176 14028497 0000479919 ATIH KARTINI, NY
65
PV.PARA RKUTM-B
HYANGA
N3
18-DEC-14 23-DEC-14
K80.1

AKTOR
BPJS
ASKES
177 14020302 0001329419 ENAH SUHAENAH,
78
ANTURIU
M
IB
15-JAN-14
20-JAN-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
41
ANTURIU
M
IB
06-JAN-14
12-JAN-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
179 13023603 0001274519 IIS HERNANINGSIH, 50
ANTURIU
M
IA
22-MAY-13 27-MAY-13
K80.2

without without
cholecystitis
180 13011204 0000645219 DJUWITA SRI IMAMI 67
DRK
RKUTM-C
LANTAI 3
11-SEP-13 19-SEP-13
K80.4

with cholecystitis
181 15022982 0001411119 ELIN HERLINA, NY.
PV.PARA RKUTM-A
HYANGA
N4
23-APR-15 01-MAY-15
K80.2

without without
AKTOR
cholecystitis
SUDARMAN
SIDABUTAR, NY
KARYANAGARI,
NY
RUSTAMAN
NY
178 14020084 0000794119 DINARTINA, NY
NY
65
08-JAN-14
BPJS
ASKES
Perbaikan ASKES
BPJS
ASKES
Hal 8/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
182 13027241 0001296019 SOPIAH, NY
Umur Sex
36
Ruang
J. Kelamin :
Kelas
KEMUNIN
G III(A)
III A

23-OCT-13 18-NOV-13
ICD
Nm Diagnosa
26
K80.5

cholecystitis
(choledolithiasis)

Perbaikan TIDAK
MAMP
U
183 14024541 0001379219 SUSI JUBAEDAH
59
ANTURIU
M
IB
09-JUL-14
22-JUL-14
13
K80.2
Tidak KONTR
without without
Sembuh AKTOR
cholecystitis
184 13025139 0001297320 WAWAN RAHMAN
48
KANA
III A
23-JUL-13 01-AUG-13
K80.2

without without
cholecystitis
185 13023436 0001278420 T. RUNAESIH, NY
55
15-MAY-13 21-MAY-13
K80.2

without without
cholecystitis
186 14026129 0001386820 JULLES DALLAS L
46
AGLONEM
A
II
15-SEP-14 22-SEP-14
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
187 14021688 0001352120 IKEU ROSTIKA
49
AGLONEM
A
II
12-MAR-14 28-MAR-14
16
K80.1

AKTOR
BPJS
UMUM
188 14026584 0001397720 CUNCUN MANSUR
44
PV.PARA RKUTM-C
HYANGA
N3
04-OCT-14 10-OCT-14
K80.1

AKTOR
BPJS
ASKES
189 15022674 0001443820 NENAH R. ANGGI,
41
KEMUNIN
G III(A)
III A
11-APR-15 20-APR-15
K80.3

with cholangitis
Tidak UMUM
Sembuh
77
FRESIA 1
II
17-MAY-14 28-MAY-14
11
K80.3

with cholangitis
Tidak KONTR
Sembuh AKTOR
BPJS
ASKES
191 14020926 0001344720 TITIN SUHARTINAH 71
ANTURIU
M
IA
10-FEB-14
16-FEB-14
K80.1

AKTOR
BPJS
ASKES
192 14024237 0001367820 SITI SUNDARI, NY
AGLONEM
A
II
26-JUN-14
03-JUL-14
K80.2

BPJS
without without
AKTOR JAMSOST
cholecystitis
NY
190 14005052 0001233320 OYAH ROKAYAH
31
DRK
RKUTM-C
LANTAI 2
BPJS
UMUM
EK
193 13023114 0001255720 AJUM
53
KEMUNIN
G IV
III A
02-MAY-13 17-MAY-13
15
K80.1

MAMP
U
194 15023084 0000920720 SRI RAHAYU
20
KEMUNIN
GV
II
28-APR-15 09-MAY-15
11
K80.5

cholecystitis
(choledolithiasis)
195 13023123 0001276721 SUSI SUPYATIN,
Perbaikan KONTR
AKTOR
51
ANTURIU
M
IB
02-MAY-13 10-MAY-13
K80.0

53
ANTURIU
M
IB
05-APR-13 15-APR-13
10
K80.2

without without
cholecystitis
197 13020453 0001250821 CUCU HERAWATI
39
RBB
IB
17-JAN-13
31-JAN-13
14
K80.0

198 14023593 0001370621 WANGSIH
65
KANA
III A
02-JUN-14
08-JUN-14
K80.5

cholecystitis
(choledolithiasis)
NY
196 13022458 0001269921 DINDIN NURDIN
AHMAD
Perbaikan KONTR
BPJS
ASKES
AKTOR
BPJS
UMUM
BPJS
ASKES
199 14023865 0001373121 UDEK SUWANDI TN 53
KANA
III A
12-JUN-14
23-JUN-14
11
K80.2
Tidak KONTR
without without
Sembuh AKTOR
cholecystitis
200 15022712 0001430621 ANIH, R
59
KEMUNIN
G III(A)
III A
13-APR-15 22-APR-15
K80.2

without without
AKTOR
cholecystitis
201 13022462 0001270122 WETY WIATINI
48
DRK
RKUTM-B
LANTAI 2
05-APR-13 08-APR-13
K80.2

without without
cholecystitis
202 15023091 0001445622 NANI YUHANI
44
KEMUNIN
G III(A)
28-APR-15 12-MAY-15
14
K80.2

without without
AKTOR
cholecystitis
203 15020589 0001360322 AGUS
37
PV.PARA RKUTM-B
HYANGA
N2
22-JAN-15
27-JAN-15
K80.1

AKTOR
BPJS
UMUM
51
PV.PARA RKUTM-C
HYANGA
N3
04-MAR-15 08-MAR-15
K80.3

with cholangitis
BPJS
ASKES
AWIBI
WIGANTARA,TN
204 15021657 0001435322 NANI SUHAENI
III A
Perbaikan KONTR
AKTOR
Hal 9/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
205 15022101 0001430022 AI TITA ROSITA
Umur Sex
31
206 14026622 0001394822 SITI NURAENI
49
207 14009236 0001392622 ABDUL ROSYID
59
Ruang
IHC
J. Kelamin :
Kelas
NOKLAS
PV.PARA RKUTM-A
HYANGA
N4
IRD
II
ICD
Nm Diagnosa
12
K80.3

with cholangitis
06-OCT-14 12-OCT-14
05-SEP-14 08-SEP-14
20-MAR-15 01-APR-15

Perbaikan KONTR
AKTOR
BPJS
UMUM
K80.1

AKTOR
BPJS
ASKES
K80.3

with cholangitis
BPJS
UMUM
Perbaikan KONTR
AKTOR
208 13020476 0001179023 INDAH
21
DRK
RKUTM-A
LANTAI 4
21-JAN-13
01-FEB-13
11
K80.2

without without
cholecystitis
209 13023716 0001282723 EEN SUHANAH,
48
DRK
RKUTM-B
LANTAI 2
27-MAY-13 30-MAY-13
K80.2

without without
cholecystitis
210 13021683 0001257723 REZA YUNIFITRIANI 26
AGLONEM
A
II
05-MAR-13 11-MAR-13
K80.2

without without
AKTOR
cholecystitis
57
FRESIA 3
IA
25-JUL-14 06-AUG-14
12
K80.1

AKTOR
BPJS
ASKES
39
KEMUNIN
G III(A)
III A
28-JAN-15
26
K80.3

with cholangitis
Perbaikan KONTR
BPJS
UMUM
KEMUNIN
G III(A)
III A
29
K80.3

with cholangitis
Perbaikan KONTR
AGLONEM
A
II
24
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
NY.
W
211 14007671 0000256823 TETY SUGIARTI
NY
212 15020771 0001424123 NENENG HENI
213 14021329 0001348523 WIWIN ROHAENI
214 14026117 0001395223 AI CUKMIATI, NY
33
41
P
P
23-FEB-15
25-FEB-14 26-MAR-14
14-SEP-14 08-OCT-14
AKTOR
AKTOR
BPJS
UMUM
AKTOR
BPJS
UMUM
BPJS
UMUM
66
PV.PARA RKUTM-A
HYANGA
N4
24-AUG-15 30-AUG-15
K80.2

without without
AKTOR
cholecystitis
216 13023385 0001279724 NELI JUMYANA ,NY 30
DRK
RKUTM-A
LANTAI 2
14-MAY-13 18-MAY-13
K80.2

without without
AKTOR
cholecystitis
217 13027728 0001322924 TUBAGUS ANDRI
34
ANTURIU
M
IB
12-NOV-13 17-NOV-13
K80.2

without without
cholecystitis
218 13026991 0001316524 MUSHAF SHIROTUL 16
AGLONEM
A
II
11-OCT-13 18-OCT-13
K80.2

without without
cholecystitis
61
ANTURIU
M
18-NOV-14 24-NOV-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
51
KEMUNIN
G IV(B)
III A
08-DEC-14 22-DEC-14
14
K80.5

cholecystitis
(choledolithiasis)
AKTOR
BPJS
UMUM
215 15025997 0001473623 NANI, NY
IRAWAN
UMMAH
219 14027714 0001368924 DADANG
SUDRADJAT
220 14028214 0001414024 YAYAN
ERYANDHI, TN
Perbaikan KONTR
221 14022913 0001340324 IMAS KARTINI
43
KEMUNIN
G III(A)
III A
02-MAY-14 12-MAY-14
10
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
222 15023825 0001450224 ADE MAESAROH,
61
ANTURIU
M
26-MAY-15 01-JUN-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
223 14028797 0001385024 IDA NURHAYATI
44
KEMUNIN
GV
II
31-DEC-14 10-JAN-15
10
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
224 13020689 0001252825 ENDANG HERDI
59
DRK
RKUTM-B
LANTAI 3
26-JAN-13
05-FEB-13
10
K80.1

225 13022978 0001274625 OOM KOMARIAH,
61
AGLONEM
A
II
26-APR-13 04-MAY-13
K80.2

without without
cholecystitis
23
KEMUNIN
GV
II
06-AUG-15 12-AUG-15
K80.0

AKTOR
BPJS
UMUM
55
PV.PARA RKUTM-B
HYANGA
N3
21-OCT-14 23-OCT-14
K80.1

AKTOR
BPJS
ASKES
70
KEMUNIN
GV
22-DEC-14 31-DEC-14
K80.4

with cholecystitis
BPJS
UMUM
NY
NY
226 15025552 0001469425 DIDAH PARIDAH,
NN
227 14027002 0001404125 SRI KUSNI BARUS,
NY
228 14028589 0001414225 SUWARSIH, NY
II
Sembuh KONTR
AKTOR
Hal 10/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
229 14026932 0001403625 NANDANG, TN
Umur Sex
45
Ruang
KEMUNIN
G IV(B)
J. Kelamin :
Kelas
III A

18-OCT-14 17-NOV-14
ICD
Nm Diagnosa
30
K80.5

cholecystitis
(choledolithiasis)

Perbaikan KONTR
AKTOR
BPJS
UMUM
230 14028236 0000996625 HANDARUN
72
PV.PARA RKUTM-B
HYANGA
N3
09-DEC-14 17-DEC-14
K80.1

AKTOR
BPJS
ASKES
231 15022057 0001438025 BENI SURYADI
23
KEMUNIN
GV
II
17-MAR-15 08-APR-15
22
K80.3

with cholangitis
BPJS
UMUM
Perbaikan KONTR
AKTOR
232 13023850 0001274326 NANI HAYANI, NY
47
KEMUNIN
G III
III A
31-MAY-13 10-JUN-13
10
K80.2

without without
MAMP
cholecystitis
U
233 13009635 0001299326 NENENG
55
FRESIA 1
II
05-AUG-13 19-AUG-13
14
K80.0

234 13020562 0001251826 ERYULIATI NINGSIH 46
DRK
RKUTM-A
LANTAI 4
21-JAN-13
26-JAN-13
K80.2

without without
cholecystitis
NURHAYATI
,HJ
235 14021343 0001348626 MIMIN SETIASIH
48
ANTURIU
M
IA
26-FEB-14 03-MAR-14
K80.2

without without
cholecystitis
236 13024421 0001288326 HATIMAH
57
ANTURIU
M
IB
24-JUN-13
01-JUL-13
K80.2

without without
cholecystitis
237 13023802 0001283726 SITI ATIKAH, NY
67
ANTURIU
M
IA
30-MAY-13 07-JUN-13
K80.4

with cholecystitis
Perbaikan ASKES
238 13025300 0001298926 HASBULAH
49
KEMUNIN
G IV
III A
30-JUL-13 05-AUG-13
K80.3

with cholangitis
Tidak TIDAK
Sembuh MAMP
239 15026415 0001475526 ASIH SUMIASIH
44
KEMUNIN
GV
II
08-SEP-15 17-SEP-15
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
240 14024402 0001377726 ETI ROHAETI NY
56
AGLONEM
A
II
02-JUL-14
19-JUL-14
17
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
241 14021717 0000095626 SRI SUTINI
42
AGLONEM
A
II
12-MAR-14 25-APR-14
44
K80.5

cholecystitis
(choledolithiasis)
AKTOR
BPJS
UMUM
242 14025934 0001382226 RAMADHAN
66
PV.PARA RKUTM-C
HYANGA
N2
08-SEP-14 14-SEP-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
54
PV.PARA RKUTM-C
HYANGA
N2
30-APR-14 07-MAY-14
K80.1

AKTOR
BPJS
ASKES
34
KEMUNIN
GV
II
16-JAN-15
22-JAN-15
K80.1

AKTOR
BPJS
POLRI
44
KEMUNIN
G III(A)
III A
21-APR-14 13-MAY-14
22
K80.3

with cholangitis
RAMLIE
243 14022726 0001361326 KARLAN
KOMANDOKO
244 15020439 0001419126 DAVID F. G.
MUNTHE
245 14022680 0001358226 WASNI
Perbaikan KONTR

AKTOR
246 13027746 0001320927 OOM RPMLAH, NY
48
ANTURIU
M
IB
13-NOV-13 18-NOV-13
K80.2

without without
AKTOR
cholecystitis
247 13022666 0001272027 JOSEPH OSCAN
60
ANTURIU
M
IB
13-APR-13 28-APR-13
15
K80.5

cholecystitis
(choledolithiasis)
59
AGLONEM
A
II
13-SEP-13 20-SEP-13
K80.2

without without
cholecystitis
249 14020707 0001343027 RINA NURAPRIANI
33
PV.PARA RKUTM-C
HYANGA
N2
01-FEB-14
06-FEB-14
K80.0

250 15023334 0001449727 RIANI
54
PV.PARA RKUTM-A
HYANGA
N2
07-MAY-15 15-MAY-15
K80.5

cholecystitis
(choledolithiasis)
PANGAU,TN
248 13026318 0001305327 AAN ARIPIN
SUMARSANA
TJAKRADIPURA
Perbaikan UMUM
Perbaikan KONTR
AKTOR
BPJS
UMUM
Hal 11/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
Nama Pasien
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
251 15023161 0001445027 ASEP MULYANA,
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
54
ANTURIU
M
30-APR-15 06-MAY-15
K80.3

with cholangitis
Meninggal KONTR
> 48 Jam AKTOR
BPJS
UMUM
64
ANTURIU
M
IA
09-OCT-14 18-OCT-14
K80.1

AKTOR
BPJS
ASKES
49
AGLONEM
A
II
17-MAY-13 24-MAY-13
K80.2

without without
cholecystitis
254 13024243 0001279328 OVI ROVIKAH
33
KEMUNIN
G III
III A
17-JUN-13
25-JUN-13
K80.2

without without
MAMP
cholecystitis
U
255 13027957 0001326228 WETI
44
KANA
III A
21-NOV-13 10-DEC-13
19
K80.4

with cholecystitis
256 13026780 0001016728 YATI DARYATI
62
ANTURIU
M
IA
02-OCT-13 10-OCT-13
K80.2

without without
cholecystitis
257 13025890 0001303028 U YAYAH ROHAETI
68
ANTURIU
M
IB
26-AUG-13 02-SEP-13
K80.2

without without
cholecystitis
258 13023800 0001283728 LINA HERLINA, NY
38
AGLONEM
A
II
30-MAY-13 07-JUN-13
K80.2

without without
cholecystitis
259 14023301 0001342228 EPON
44
KEMUNIN
G III(A)
III A
20-MAY-14 05-JUN-14
16
K80.2

without without
AKTOR
cholecystitis
260 15020721 0001422728 ENNY ROCHAENI,
66
KEMUNIN
GV
II
27-JAN-15
09-FEB-15
13
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
49
KEMUNIN
G IV(B)
III A
31-JUL-14 12-AUG-14
12
K80.3

with cholangitis
Perbaikan KONTR
AKTOR
BPJS
UMUM
05-APR-15 25-MAY-15
50
K80.3

with cholangitis
Tidak KONTR
Sembuh AKTOR
BPJS
UMUM
TN
252 14026703 0001236327 SAMUDJIANTO, S.
IP
253 13023469 0001280527 NONO RESPATI
SIHONO
HJ
261 14024946 0001383228 EMAN TN
Perbaikan UMUM
262 15022487 0001442228 TINI RUSTINI , NY.
36
KEMUNIN
G III(A)
III A
263 14020505 0001341028 IMING SURYATI
67
IHC
NOKLAS
22-JAN-14
06-FEB-14
15
K80.5

cholecystitis
(choledolithiasis)
Tidak KONTR
Sembuh AKTOR
BPJS
ASKES
264 14024412 0001375128 NANI SUMARSIH
66
ANTURIU
M
IA
03-JUL-14
12-JUL-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
265 15023090 0001429229 NUR NGALIYAH,
43
KEMUNIN
G III(A)
III A
28-APR-15 18-MAY-15
20
K80.2

without without
AKTOR
cholecystitis
28
KEMUNIN
G IV(B)
III A
23-APR-15 18-MAY-15
25
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
51
KEMUNIN
G IV(B)
III A
30-MAR-15 20-APR-15
21
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
BPJS
UMUM
KEMUNIN
G III(A)
III A
K80.5

cholecystitis
(choledolithiasis)
Sembuh KONTR
AKTOR
BPJS
UMUM
Meninggal KONTR
> 48 Jam AKTOR
BPJS
UMUM
NY
266 15022977 0001437329 DIMAS BAYU
DEWAJI
267 15022362 0001426829 ASEP JAYA
BRATA
268 14028729 0001396129 NEULIS JULIANTI
27
29-DEC-14 05-JAN-15
AKTOR
269 14024423 0001303829 ROMLAH
43
HCU
NOKLAS
KEMUNIN
G
03-JUL-14
08-JUL-14
K80.3

with cholangitis
270 13023206 0001257729 SAWIN
56
KEMUNIN
G IV
06-MAY-13 25-MAY-13
19
K80.2

without without
MAMP
cholecystitis
U
271 15020453 0001421429 EUIS ROHAETI,
51
PV.PARA RKUTM-B
HYANGA
N3
17-JAN-15
11
K80.3

with cholangitis
Perbaikan KONTR
PV.PARA RKUTM-C
HYANGA
N3
01-JUL-14
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
PV.PARA RKUTM-C
HYANGA
24-JUN-14
K80.5

cholecystitis
Perbaikan KONTR
S.PD
272 14024352 0001375629 YOEHAENI DJALIL,
79
NY.
273 14024159 0001375629 YOEHAENI DJALIL,
79
III A
28-JAN-15
05-JUL-14
27-JUN-14
AKTOR
AKTOR
AKTOR
BPJS
ASKES
BPJS
ASKES
BPJS
ASKES
Hal 12/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
(choledolithiasis)
N3
274 14022997 0001356729 SUPARNI
Nm Diagnosa
06-MAY-14 12-MAY-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
18-MAR-15 24-MAR-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
II
24-OCT-13 31-OCT-13
K80.2

without without
cholecystitis
II
25-SEP-13 05-OCT-13
10
K80.2

without without
cholecystitis
PV.PARA RKUTM-C
HYANGA
N2
23-OCT-13 29-OCT-13
K80.1

KEMUNIN
G III(A)
III A
30-DEC-14 31-DEC-14
K80.2
Calculus of gallbladder Meninggal KONTR

without without
< 48 Jam AKTOR
cholecystitis
BPJS
UMUM
49
KEMUNIN
G III(A)
III A
12-JUL-14
03-SEP-14
53
K80.1

AKTOR
BPJS
UMUM
49
KEMUNIN
G III(A)
III A
13-AUG-15 31-AUG-15
18
K80.3

with cholangitis
Perbaikan KONTR
BPJS
UMUM
06-MAY-13 14-MAY-13
K80.5

cholecystitis
(choledolithiasis)
Perbaikan UMUM
AGLONEM
A
70
275 15022046 0001437829 EUIS SAODAH
50
276 13027263 0000770830 DION PRATAMA
30
AGLONEM
A
277 13026601 0001310230 TIRAH
51
AGLONEM
A
278 13027238 0001319330 ENTIS SUTISNA
46
279 14028770 0001419530 KARTIKA , NY.
60
280 14024621 0001380030 SARINAH NY

281 15025781 0000912630 ODAH NY
SUSILAWATI, NY
,SAB
II
PV.PARA RKUTM-C
HYANGA
N4
AKTOR
282 13023198 0001277831 MU`MINAH, NY
47
AGLONEM
A
II
283 14021045 0001345931 NANIH SURYANI
61
ANTURIU
M
IA
14-FEB-14
22-FEB-14
K80.1

AKTOR
284 13023644 0001281931 EKUSYATI
61
KEMUNIN
G III
III A
22-MAY-13 18-JUN-13
27
K80.5

cholecystitis
(choledolithiasis)
30-MAY-14 02-JUN-14
K80.2

without without
cholecystitis
BPJS
ASKES
Perbaikan TIDAK
MAMP
U
285 14023515 0001365331 IDA HAMIDAH
71
286 13020976 0001254831 AI RISNAWATI
40
RBB
IA
05-FEB-13
12-FEB-13
K80.2

without without
cholecystitis
287 15020223 0001419932 NURHALIMAH
46
KEMUNIN
G III(A)
III A
09-JAN-15
09-FEB-15
31
K80.5

cholecystitis
(choledolithiasis)
IA
12-JAN-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
BPJS
UMUM
288 14020091 0000479932 TINI ROSILAWATI,
PV.PARA RKUTM-C
HYANGA
N3
AKTOR
66
ANTURIU
M
289 15026040 0001473932 ENDI SUBANDI, TN
56
PV.PARA RKUTM-C
HYANGA
N4
25-AUG-15 04-SEP-15
10
K80.1

AKTOR
290 15025119 0001464133 NUR AISAH
37
KEMUNIN
G III(A)
III A
22-JUL-15 02-AUG-15
11
K80.1

AKTOR
291 13009514 0001299333 RIRIN MARTIATIN
47
FRESIA 2
III A
01-AUG-13 10-AUG-13
K80.1

MAMP
U
292 15023418 0000454133 YANTI
41
KEMUNIN
GV
II
11-MAY-15 22-MAY-15
11
K80.5

cholecystitis
(choledolithiasis)
NY
AGUSTIYANTI
06-JAN-14
Perbaikan KONTR
AKTOR
BPJS
ASKES
BPJS
UMUM
293 14006803 0000028833 GAOS
18
ANGSANA
III A
01-JUL-14
10-JUL-14
K80.0

AKTOR
294 13025296 0001298834 DJUBAEDAH, NY
58
ANTURIU
M
IB
30-JUL-13 05-AUG-13
K80.2

without without
cholecystitis
295 13024932 0001294034 MISRIAH
58
ANTURIU
M
IB
15-JUL-13
K80.2

without without
cholecystitis
KARTADIMAJA, NY
22-JUL-13
Hal 13/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
296 14027608 0001396034 MOMOH SALIMAH,
Umur Sex
Ruang
J. Kelamin :
Kelas
01-JUL-13
10
K80.5

cholecystitis
(choledolithiasis)
23-FEB-15
K80.1

AKTOR
BPJS
UMUM
19-AUG-15 02-SEP-15
14
K80.5

cholecystitis
(choledolithiasis)
BPJS
UMUM
25-AUG-14 28-AUG-14
K80.1

05-MAR-14 24-MAR-14
19
K80.5

cholecystitis
(choledolithiasis)
II
14-NOV-14 21-NOV-14
30
AGLONEM
A
II
21-JUN-13
298 15021239 0001431634 FIFIH ROFIKOH, NY 34
PV.PARA RKUTM-C
HYANGA
N4
16-FEB-15
299 15025899 0001428334 FIRMAN SINAGA,
KEMUNIN
G IV(B)
27
TN
300 14025618 0000407534 DEDEH
83
42
HASBULLOH, NY.
301 14021508 0001343634 ENA KARTIKA
III A
PV.PARA RKUTM-A
HYANGA
N4
KANA
III A

AGLONEM
A
RUFAIDA, NY
Nm Diagnosa
K80.1
297 13024340 0001288334 RIFAYANTI
ICD
41
NY
Perbaikan UMUM
Perbaikan KONTR
AKTOR
Perbaikan KONTR
AKTOR
BPJS
UMUM
302 15021009 0001323234 H.D SURATNO ,SH
66
PV.PARA RKUTM-B
HYANGA
N3
08-FEB-15
14-FEB-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
303 14021257 0001347934 ARIYADI BASUKI,
40
PV.PARA RKUTM-C
HYANGA
N2
24-FEB-14
27-FEB-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
304 14012695 0001415134 EENG,HJ
74
HCU
NOKLAS
PARAHYA
NGAN
04-DEC-14 12-JAN-15
39
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
305 14026680 0001400534 NINAH ADINAH,
57
ANTURIU
M
IA
08-OCT-14 16-OCT-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
306 14023547 0001370234 HENDRIYANI
36
KEMUNIN
G III(A)
III A
01-JUN-14
06-JUN-14
K80.3

with cholangitis
Tidak KONTR
Sembuh AKTOR
BPJS
UMUM
307 13028060 0001327335 GUNAWAN
59
ANTURIU
M
IB
25-NOV-13 20-DEC-13
25
K80.5

cholecystitis
(choledolithiasis)
Perbaikan ASKES
308 13026875 0001313935 FEBRINA
39
ANTURIU
M
IB
07-OCT-13 09-OCT-13
K80.0

309 13023057 0001217135 AYI MUNAJAT
45
AGLONEM
A
II
30-APR-13 06-MAY-13
K80.2

without without
AKTOR
cholecystitis
310 15022954 0000575235 NUR ABADI ARIEF
60
KEMUNIN
G IV(B)
III A
22-APR-15 13-MAY-15
21
K80.2

without without
AKTOR
cholecystitis
311 13012495 0001313935 FEBRINA
39
FRESIA 3
IA
16-OCT-13 25-OCT-13
K80.2

without without
cholecystitis
27
KEMUNIN
GV
II
26-JAN-15
09-FEB-15
14
K80.2

BPJS
without without
AKTOR JAMSOST
cholecystitis
313 13001631 0000702235 EPON SUWARNI NY 72
MAWAR
IB
02-FEB-13
15-FEB-13
13
K80.3

with cholangitis
Perbaikan ASKES
314 15020464 0001424635 AAN , NY.
KEMUNIN
G III(A)
III A
17-JAN-15
18-FEB-15
32
K80.5

cholecystitis
(choledolithiasis)
Sembuh TIDAK
KANA
III A
25
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
12
K80.2
ST.MT.
S.PD
SINURAYA, DRG
SINURAYA, DRG
312 15020683 0001387735 SUJIATI, NY
BPJS
UMUM
EK
315 15022621 0001424635 AAN , NY.
316 13023660 0000298836 LUKMAN HAKIM,
DRS
57
57
53
ANTURIU
M
IB
09-APR-15 04-MAY-15
24-MAY-13 05-JUN-13
MAMP
U
AKTOR
BPJS
UMUM

without without
cholecystitis
Hal 14/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
317 15024766 0001453636 YANI PRIJATNI, NY
49
KEMUNIN
G III(A)
III A
02-JUL-15
10-JUL-15
K80.2

without without
AKTOR
cholecystitis
318 15021050 0001101036 JUSUP SUMARNA
76
KEMUNIN
GV
II
09-FEB-15
17-FEB-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
319 14000950 0000007236 LILI RUKANTI
53
FRESIA 1
II
26-JAN-14
31-JAN-14
K80.0

AKTOR
BPJS
ASKES
320 13027467 0001321336 EPON
46
KANA
III A
01-NOV-13 02-NOV-13
K80.1
321 14020799 0001343736 NENG WARSIH
40
AGLONEM
A
II
04-FEB-14
13-FEB-14
K80.1

AKTOR
322 13027045 0001315836 SUSI GOLVI, NY.
46
16-OCT-13 20-OCT-13
K80.2

without without
cholecystitis
323 14020247 0001338636 RULI TN
38
KANA
III A
12-JAN-14
25-JAN-14
13
K80.3

with cholangitis
324 14026638 0001399036 SUMIOTO OETJI, TN 78
ANTURIU
M
IB
06-OCT-14 13-OCT-14
K80.1

AKTOR
BPJS
ASKES
325 14022977 0001364237 TUTI SUGIARATI
66
IHC
NOKLAS
05-MAY-14 07-MAY-14
K80.3

with cholangitis
Meninggal KONTR
> 48 Jam AKTOR
BPJS
UMUM
326 15023526 0001442537 NIRWAN
56
ANTURIU
M
15-MAY-15 29-MAY-15
14
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
327 15022570 0000426537 ROSTARUM DRA
59
PV.PARA RKUTM-C
HYANGA
N3
08-APR-15 13-APR-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
328 15023410 0001450137 YOYOH , NY.
52
PV.PARA RKUTM-B
HYANGA
N3
11-MAY-15 15-MAY-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
329 14027733 0000420637 MUSTIKA DINARIA
30
AGLONEM
A
II
18-NOV-14 28-NOV-14
10
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
330 13028223 0001327838 ROJAK
69
AGLONEM
A
II
02-DEC-13 13-DEC-13
11
K80.5

cholecystitis
(choledolithiasis)
Perbaikan UMUM
331 14013446 0001419538 YANTI , NY.
41
KEMUNIN
G III(A)
III A
24-DEC-15 14-JAN-15
***
K80.5

cholecystitis
(choledolithiasis)
KEMUNIN
GV
II
22
K80.4

with cholecystitis
Perbaikan KONTR
KANA
III A
17
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
AKTOR
BPJS
UMUM
Tidak KONTR
Sembuh AKTOR
BPJS
UMUM
.TN
DARLIANI
HUSSAINY
332 15021980 0001437238 YULIANUS ZEBUA

333 14026663 0001401138 KAM'AT, BP.
33
54
L
L
PV.PARA RKUTM-B
HYANGA
N3
16-MAR-15 07-APR-15
07-OCT-14 24-OCT-14
Tidak UMUM
Sembuh
Perbaikan UMUM
AKTOR
AKTOR
38
KANA
III A
18-MAY-14 08-JUN-14
21
K80.5

cholecystitis
(choledolithiasis)
335 13011609 0001128038 UDIN SAPRUDIN HS 67
FRESIA 3
IA
23-SEP-13 07-OCT-13
14
K80.2

without without
cholecystitis
336 06024862 0000541238 ENUNG
39
R. 2
(DUA)
II
25-SEP-06 25-SEP-14
***
K80.1

45
28-JAN-15
K80.1

338 13021881 0001263538 ANE FITRIANI
35
KANA
III A
12-MAR-13 28-MAR-13
16
K80.2

without without
cholecystitis
339 14004370 0001363138 MISRATI NY
70
IHC
NOKLAS
30-APR-14 05-MAY-14
K80.3

with cholangitis
334 14023260 0001367038 ADE SUMARNA TN
NURHAYATI
337 15020603 0000636438 VETIANA HALIM,
NY
PV.PARA RKUTM-C
HYANGA
N3
23-JAN-15
BPJS
POLRI
BPJS
UMUM
Meninggal KONTR
> 48 Jam AKTOR
Hal 15/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
340 15023222 0000279738 KENI, NY
50
KEMUNIN
GV
341 13023880 0001060039 SOFIANI AL
72
DRK
RKUTM-C
LANTAI 4
03-JUN-13
61
ANTURIU
M
23
SURYANA
342 13028775 0001327839 RD E SETIAYATI,
NY
343 13026930 0001314839 NANI MULYANI
344 14023945 0001352239 EDDY SURYADI TN
345 14021716 0001352239 EDDY SURYADI TN

346 14020055 0001336839 NURSAADAH
347 14023012 0001364539 NOVA NOVIANTI
50
50
50
29
L
P
P
%
ICD
50
K80.2

without without
AKTOR
cholecystitis
06-JUN-13
K80.2

without without
cholecystitis
IA
23-DEC-13 14-JAN-14
22
K80.5

cholecystitis
(choledolithiasis)
Perbaikan ASKES
AGLONEM
A
II
08-OCT-13 21-OCT-13
13
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
KEMUNIN
G IV(B)
III A
13
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
KANA
III A
19
K80.3

with cholangitis
Perbaikan KONTR
18
K80.4

with cholecystitis
Perbaikan KONTR
18
K80.3

with cholangitis
Perbaikan KONTR
K80.3

with cholangitis
Perbaikan KONTR
KANA
IRD
III A
II
04-MAY-15 14-MAY-15
16-JUN-14
29-JUN-14
13-MAR-14 01-APR-14
04-JAN-14
22-JAN-14
06-MAY-14 24-MAY-14
ANGSANA
III A
22-MAY-14 27-MAY-14
349 14027003 0001389639 SITI NURLAELAH
21
AGLONEM
A
II
21-OCT-14 28-OCT-14
350 15023963 0001455339 YUSEP
44
KEMUNIN
GV
II
01-JUN-15
SAEFULUYUN
10
II
NY
348 14023359 0001352239 EDDY SURYADI TN
Nm Diagnosa
22-JUN-15
BPJS
ASKES
AKTOR
AKTOR
AKTOR
AKTOR
AKTOR
BPJS
UMUM
BPJS
UMUM
BPJS
UMUM
BPJS
UMUM
AKTOR
BPJS
UMUM
K80.1

AKTOR
BPJS
UMUM
21
K80.4

with cholecystitis
AKTOR
BPJS
ASKES
BPJS
ASKES
Sembuh KONTR
66
ANTURIU
M
03-NOV-14 08-NOV-14
K80.1

AKTOR
352 13025112 0001297239 NAWANG WULAN
22
RBA
II
23-JUL-13 04-AUG-13
12
K80.2

without without
AKTOR
cholecystitis
353 13025418 0001089539 ANANG
59
KEMUNIN
G IV
III A
09-AUG-13 21-AUG-13
12
K80.3

with cholangitis
354 13014694 0001330839 ENJU JUNADA
55
FRESIA 1
II
10-DEC-13 16-DEC-13
K80.1

355 14020605 0001334240 EULIS ASIAH, NY
47
ANTURIU
M
IB
27-JAN-14
02-FEB-14
K80.2

without without
AKTOR
cholecystitis
356 14020379 0001340040 ROKAYAH
55
KEMUNIN
G III(A)
III A
17-JAN-14
11-FEB-14
25
K80.1

AKTOR
357 13020810 0000224740 SUMARSIH
66
AGLONEM
A
II
30-JAN-13
05-FEB-13
K80.2

without without
cholecystitis
358 15020371 0000321540 HIDAYAT
61
ANTURIU
M
14-JAN-15
25-JAN-15
11
K80.2

without without
AKTOR
cholecystitis
359 13024483 0001290440 SAEPUDIN
63
ANTURIU
M
IA
26-JUN-13
02-JUL-13
K80.2

without without
cholecystitis
360 15003909 0001446840 RISA ERLINDA ,NY
53
PV.PARA RKUTM-C
HYANGA
N4
26-APR-15 28-APR-15
K80.4

with cholecystitis
351 14027319 0001362639 CLARA RUDJIATI,
NY
Meninggal TIDAK
> 48 Jam MAMP
U
LISTIANINGSIH NY
SUKANDA,DRS
361 14027544 0001409241 NITA NURYATIN,
S.PD
AKTOR
BPJS
ASKES
PV.PARA RKUTM-C
HYANGA
N4
12-NOV-14 16-NOV-14
K80.1

AKTOR
BPJS
ASKES
35
KEMUNIN
GV
II
10-AUG-15 15-AUG-15
K80.1

AKTOR
BPJS
ASKES
44
ANTURIU
M
16-MAR-15 23-MAR-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
NY
363 15021960 0001431041 IDAH ROSMIATI,
BPJS
ASKES
63
HJ.
362 15025678 0001468741 VERA ABRIYANTI,
Perbaikan KONTR
BPJS
ASKES
Hal 16/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
Nama Pasien
No RM
01-JAN-13
364 14022028 0001334841 TINTIN SUMARNI
Umur Sex
58
Ruang
J. Kelamin :
Kelas
KEMUNIN
G III(A)
III A

26-MAR-14 08-APR-14
ICD
Nm Diagnosa
13
K80.5

cholecystitis
(choledolithiasis)
Sembuh KONTR
Perbaikan ASKES
AKTOR
BPJS
UMUM
365 12028716 0000384641 ETI SUHAETI
40
RBA
II
24-DEC-12 22-JAN-13
29
K80.5

cholecystitis
(choledolithiasis)
366 13028412 0001104941 RATIH
45
AGLONEM
A
II
09-DEC-13 14-DEC-13
K80.2

without without
AKTOR
cholecystitis
367 14021689 0001351741 E. SUKAENAH
68
ANTURIU
M
IA
12-MAR-14 19-MAR-14
K80.1

AKTOR
368 15025172 0001445742 NANI SUMARNI
43
KEMUNIN
G III(A)
III A
23-JUL-15 09-AUG-15
17
K80.2

without without
AKTOR
cholecystitis
369 13023041 0000714942 POPON
55
AGLONEM
A
II
29-APR-13 08-MAY-13
K80.2

without without
cholecystitis
53
ANTURIU
M
IA
26-AUG-13 07-SEP-13
12
K80.2

without without
cholecystitis
371 13020046 0001241842 LINA KARLINA. NY
48
RBB
IB
02-JAN-13
08-JAN-13
K80.2

without without
cholecystitis
372 14022048 0001355542 NANI YUKNAENI
47
ANTURIU
M
IA
27-MAR-14 05-APR-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
373 14021260 0001343842 MUMU
54
PV.PARA RKUTM-C
HYANGA
N2
24-FEB-14
K80.5

cholecystitis
(choledolithiasis)
AKTOR
BPJS
ASKES
RATMIKASARI
HASMANAH
370 13025856 0001302042 BAMBANG
MULYANTO
ABDURAHMAN H
26-FEB-14
Perbaikan KONTR
BPJS
ASKES
54
PV.PARA RKUTM-C
HYANGA
N3
03-MAR-14 11-MAR-14
K80.1

AKTOR
BPJS
ASKES
60
PV.PARA RKUTM-B
HYANGA
N3
07-APR-15 13-APR-15
K80.1

AKTOR
BPJS
ASKES
58
PV.PARA RKUTM-C
HYANGA
N4
01-SEP-14 05-SEP-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
377 13003441 0000228943 NINA MULYANI
19
FRESIA 2
III A
13-MAR-13 16-MAR-13
K80.1

MAMP
U
378 15021912 0001437343 ANTONIUS
47
KEMUNIN
G IV(A)
III A
12-MAR-15 26-MAR-15
14
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
K80.3

with cholangitis
Perbaikan KONTR
10
K80.3

with cholangitis
Perbaikan TIDAK
23
K80.3

with cholangitis
Perbaikan KONTR
374 14021430 0001343842 MUMU
ABDURAHMAN H
375 15022545 0001441942 YAYAT SURYATI,
HJ., S.AG
376 14025771 0001388542 N. ELI MARLIANA,
S.PD
ARIYANTO
379 15021231 0001431543 NURHASANAH, NY
380 13006674 0001283043 NANDANG BIN
42
53
PV.PARA RKUTM-C
HYANGA
N3
MIC
NOKLAS
16-FEB-15
25-FEB-15
27-MAY-13 06-JUN-13
MAHRUP
381 14026860 0001402643 IDA ROSWIDA, NY
51
AGLONEM
A
II
14-OCT-14 06-NOV-14
AKTOR
AKTOR
AKTOR
KEMUNIN
G IV
III A
02-SEP-13 08-SEP-13
K80.2

without without
MAMP
cholecystitis
U
383 13022072 0001265544 ENTIK SUSILAWATI 54
AGLONEM
A
II
19-MAR-13 06-APR-13
18
K80.5

cholecystitis
(choledolithiasis)
BPJS
ASKES
MAMP
U
43
382 13026013 0001291943 ANTON
BPJS
ASKES
BPJS
UMUM
Perbaikan ASKES
384 13027441 0001321144 SARIAH
65
ANTURIU
M
IA
31-OCT-13 08-NOV-13
K80.2

without without
cholecystitis
385 14022886 0001363444 JUMIATI
31
ANTURIU
M
IA
30-APR-14 24-MAY-14
24
K80.3

with cholangitis
Perbaikan KONTR
AKTOR
BPJS
UMUM
Hal 17/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
386 13022539 0001270744 WAHIDIN
51
KANA
III A
387 14021179 0001346944 MOH. AMIN
59
AGLONEM
A
II
388 14025135 0001384644 SITI RIKMA
34
ARYANI, SPD
ICD
Nm Diagnosa
09-APR-13 21-APR-13
12
K80.2

without without
MAMP
cholecystitis
U
18-FEB-14
10
K80.5

cholecystitis
(choledolithiasis)
Sembuh KONTR
K80.4

with cholecystitis
Perbaikan KONTR
28-FEB-14
PV.PARA RKUTM-B
HYANGA
N3
07-AUG-14 15-AUG-14
AKTOR
BPJS
UMUM
AKTOR
389 13013495 0000643044 IDAH SAIDAH, NY
45
FRESIA 1
II
09-NOV-13 18-NOV-13
K80.0

390 15024087 0000414445 ANDI HERMAWAN
73
ANTURIU
M
05-JUN-15
11-JUN-15
K80.1

AKTOR
391 13022202 0001265245 EJE JENAB
70
AGLONEM
A
II
25-MAR-13 05-APR-13
11
K80.5

cholecystitis
(choledolithiasis)
392 15025895 0001447245 CUCU SOBARIAH
48
ANTURIU
M
19-AUG-15 28-AUG-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
393 14006463 0000394145 RUKMAN
59
HCU
NOKLAS
PARAHYA
NGAN
23-JUN-14
23-JUN-14
K80.3

with cholangitis
Meninggal KONTR
< 48 Jam AKTOR
BPJS
ASKES
394 14022236 0001357145 KENI KURNIASIH
37
ANTURIU
M
IA
03-APR-14 11-APR-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
395 14070594 0001359145 ROMLAH
60
FRESIA 2
III A
15-APR-14 24-APR-14
K80.2

without without
AKTOR
cholecystitis
396 14027592 0001409645 ANAH, NY
51
KEMUNIN
G III(A)
III A
12-NOV-14 02-DEC-14
20
K80.3

with cholangitis
NY
BPJS
ASKES
Sembuh UMUM

AKTOR
397 14021918 0001353346 RUSTINI
42
AGLONEM
A
II
21-MAR-14 01-APR-14
11
K80.1

AKTOR
BPJS
ASKES
398 14026277 0001397046 SUTARDJO
67
KANA
III A
20-SEP-14 03-OCT-14
13
K80.8
Meninggal KONTR
> 48 Jam AKTOR
BPJS
ASKES
399 14025016 0001371046 DEDEH FARIDAH
31
AGLONEM
A
II
04-AUG-14 11-AUG-14
K80.1

AKTOR
BPJS
UMUM
400 13023006 0000887246 ENING MARYATI
71
DRK
RKUTM-B
LANTAI 3
29-APR-13 06-MAY-13
K80.2

without without
cholecystitis
401 15024748 0001458646 ELLY HERLINA, NY
54
PV.PARA RKUTM-B
HYANGA
N3
02-JUL-15
07-JUL-15
K80.2

without without
AKTOR
cholecystitis
402 15022585 0001396047 NIRAH, NY
69
KEMUNIN
GV
II
08-APR-15 17-APR-15
K80.2

without without
AKTOR
cholecystitis
403 14027005 0001398147 AJAT INDRA
30
KEMUNIN
G IV(A)
III A
21-OCT-14 27-OCT-14
K80.2
Tidak KONTR
without without
Sembuh AKTOR
cholecystitis
404 14022375 0001358347 RUSMIATI
44
KEMUNIN
G III(B)
III A
08-APR-14 29-APR-14
21
K80.2

without without
AKTOR
cholecystitis
405 14028479 0001413347 SAANAH, NY
50
ANTURIU
M
17-DEC-14 22-DEC-14
K80.1

AKTOR
406 14021575 0001350947 DJUNAENGSIH NY
56
KEMUNIN
G III(A)
III A
07-MAR-14 02-APR-14
26
K80.2

without without
MAMP
cholecystitis
U
407 14023026 0001340447 ANIH, NY
55
KEMUNIN
G III(A)
III A
07-MAY-14 14-MAY-14
K80.2

without without
AKTOR
cholecystitis
408 13026229 0001308247 EDI HERNAWAN
52
PV.PARA RKUTM-B
HYANGA
N2
19-SEP-13 26-SEP-13
K80.2

without without
cholecystitis
CAKRADINATA
BPJS
ASKES
BPJS
UMUM
BPJS
ASKES
Hal 18/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
409 13026611 0001311947 SOPIAH NY
Umur Sex
36
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
K80.3

with cholangitis
21-JUL-14
K80.1

AKTOR
BPJS
UMUM
13
K80.3

with cholangitis
Perbaikan KONTR
BPJS
UMUM
K80.8
Perbaikan KONTR
HCU
NOKLAS
KEMUNIN
G
25-SEP-13 27-SEP-13
14-JUL-14
47
ANTURIU
M
411 14026862 0001401748 DEDEN HAMDANI
29
PV.PARA RKUTM-C
HYANGA
N4
16-OCT-14 29-OCT-14
KEMUNIN
GV
II
07-SEP-15 14-SEP-15
412 15026397 0001473548 RISNA YANTI
29

Meninggal TIDAK
< 48 Jam MAMP
U
410 14024642 0001377447 LELLY HAERANI
IB
AKTOR
AKTOR
BPJS
UMUM
413 14027562 0001409448 DEDI MULYANA
41
KEMUNIN
G IV(A)
III A
11-NOV-14 21-DEC-14
40
K80.2
Tidak KONTR
without without
Sembuh AKTOR
cholecystitis
BPJS
UMUM
414 14027334 0001393848 MOMOH
46
AGLONEM
A
II
03-NOV-14 10-NOV-14
K80.1

BPJS
UMUM
415 14025950 0001389948 NELIS
28
AGLONEM
A
II
08-SEP-14 12-SEP-14
K80.1

AKTOR
BPJS
UMUM
416 15024141 0001453948 N. NURJANAH
48
KEMUNIN
GV
II
08-JUN-15
19-JUN-15
11
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
417 14000880 0000251548 YATI ANISAH NY
58
FRESIA 3
IA
23-JAN-14
07-FEB-14
15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
418 13023863 0001284248 RUDI CANDRA
59
KANA
III A
01-JUN-13
13-JUN-13
12
K80.5

cholecystitis
(choledolithiasis)
Perbaikan TIDAK
MAMP
U
419 13009292 0001297748 TETI SYARIAH
48
FRESIA 2
III A
27-JUL-13
31-JUL-13
K80.1
Calculus of gallbladder Sembuh UMUM

420 13005699 0001277548 AROH
53
FRESIA 2
III A
03-MAY-13 14-MAY-13
11
K80.3

with cholangitis
12-MAY-13 24-MAY-13
12
K80.1

28-OCT-13 05-NOV-13
K80.4

with cholecystitis
16-JUN-14
13
K80.2

without without
AKTOR
cholecystitis
27-MAR-14 05-APR-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
BPJS
ASKES
Sembuh TIDAK
MAMP
U
421 13023326 0001279148 MAMAT, SPD.
57
422 13027367 0001319248 AZIS
33
AGLONEM
A
II
423 14023618 0001127449 NANI DJUHAENI
63
KEMUNIN
G III(A)
III A
424 14003244 0001355449 R INNA SURYANI
46
FRESIA 1
II
425 14024025 0001354749 MULYANAH, NY
49
ANTURIU
M
IB
18-JUN-14
26-JUN-14
K80.2

without without
AKTOR
cholecystitis
426 13024706 0001278049 ENDANG HIDAYAT
55
KEMUNIN
G IV
III A
05-JUL-13
18-JUL-13
13
K80.5

cholecystitis
(choledolithiasis)
Perbaikan TIDAK
KEMUNIN
G III(A)
III A
22
K80.3

with cholangitis
Perbaikan TIDAK
427 13027105 0001317449 SITI ROHYATI
428 13028242 0001324349 SANTI NURCAHYA
52
DRK
RKUTM-B
LANTAI 3
03-JUN-14
17-OCT-13 08-NOV-13
Perbaikan UMUM
MAMP
U
MAMP
U
30
KANA
III A
02-DEC-13 05-DEC-13
K80.1

429 13021849 0001263549 LILIS SUMIARSIH
56
AGLONEM
A
II
11-MAR-13 21-MAR-13
10
K80.5

cholecystitis
(choledolithiasis)
Perbaikan UMUM
430 13012139 0001315549 USEP KOMARA
55
FRESIA 1
II
07-OCT-13 11-OCT-13
K80.3

with cholangitis
Perbaikan UMUM
431 13021275 0001253549 WIEN
53
DRK
RKUTM-B
LANTAI 3
18-FEB-13
K80.2

without without
cholecystitis
NY
WIDIYANINGRUM
,NY
23-FEB-13
Hal 19/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
432 15024746 0000266649 WISNU
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
10-JUL-15
K80.1
IB
12-NOV-13 17-NOV-13
K80.2

without without
AKTOR
cholecystitis
AGLONEM
A
II
21-NOV-13 27-NOV-13
K80.2

without without
cholecystitis
FRESIA 2
III A
06-MAY-13 17-MAY-13
11
K80.2

without without
MAMP
cholecystitis
U
PV.PARA RKUTM-C
HYANGA
N3
06-MAY-15 31-MAY-15
25
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
AKTOR
BPJS
ASKES
Tidak KONTR
Sembuh AKTOR
BPJS
UMUM
35
ANTURIU
M
433 13027714 0001320249 AI SITI KULSUM, HJ 53
ANTURIU
M
434 13027969 0001324349 SANTI NURCAHYA
30
435 13005796 0001278049 ENDANG HIDAYAT
55
436 15023313 0001442350 ANDI, H
76
WARDHANA
NY
437 15023180 0001448150 IAM SURYATI NY
02-JUL-15
Tidak UMUM
Sembuh
57
KEMUNIN
G III(A)
III A
30-APR-15 11-MAY-15
11
K80.3

with cholangitis
438 12016882 0001243050 R. MOCH. BUCHARI 57
KEMUNIN
G IV
III A
17-DEC-12 14-JAN-13
28
K80.2

without without
MAMP
cholecystitis
U
439 13026893 0001142850 MASRIFAH
40
KEMUNIN
G III(A)
III A
07-OCT-13 28-OCT-13
21
K80.2

without without
MAMP
cholecystitis
U
440 15024096 0001456050 WAHYUDIN, H
57
ANTURIU
M
05-JUN-15
15-JUN-15
10
K80.2

without without
AKTOR
cholecystitis
441 13021522 0001260550 KUSNIADI. S,PD
51
ANTURIU
M
IB
26-FEB-13 06-MAR-13
K80.2

without without
cholecystitis
442 15004640 0001451751 ROHAYATI. NY
50
KEMUNIN
G III(A)
III A
19-MAY-15 23-JUN-15
35
K80.3

with cholangitis
Perbaikan KONTR
AKTOR
BPJS
UMUM
BPJS
UMUM
443 13027163 0001316051 NOVIARDI, DRS
50
PV.PARA RKUTM-C
HYANGA
N4
21-OCT-13 25-OCT-13
K80.1

AKTOR
444 14008711 0001389151 OCIN MAHPUDIN
73
FRESIA 2
III A
24-AUG-14 06-SEP-14
13
K80.1

AKTOR
445 14024330 0001368151 ZULKARNAEN
42
KANA
III A
30-JUN-14
13-JUL-14
13
K80.2

without without
AKTOR
cholecystitis
446 13020201 0001247551 RENNY SOFIRAENI
55
RKUTM-B
DRK
LANTAI 2
08-JAN-13
12-JAN-13
K80.2

without without
cholecystitis
447 14021197 0001331051 ANANG
51
KEMUNIN
G IV(A)
III A
20-FEB-14 07-MAR-14
15
K80.2

without without
MAMP
cholecystitis
U
448 13027326 0001320052 OTONG
76
AGLONEM
A
II
27-OCT-13 06-NOV-13
10
K80.5

cholecystitis
(choledolithiasis)
449 13027125 0001312152 KHANINAH, NY
53
ANTURIU
M
IA
18-OCT-13 24-OCT-13
K80.2

without without
cholecystitis
450 13021257 0001257952 NENGSIH
58
KANA
III A
16-FEB-13 02-MAR-13
14
K80.3

with cholangitis
Perbaikan ASKES
31
KEMUNIN
G III(A)
III A
09-OCT-13 19-OCT-13
10
K80.3

with cholangitis
Perbaikan TIDAK
NY
SONIANGSIH S PD
451 13026952 0001294152 LINA
452 14027156 0001402552 YAYA YULIAWATI,
NY
MAMP
U
ANTURIU
M
27-OCT-14 01-NOV-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
53
KEMUNIN
GV
II
03-JUN-15
11-JUN-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
52
ANTURIU
M
IB
30-SEP-13 07-OCT-13
K80.2

without without
cholecystitis
S.PD
454 13026729 0001310653 TITIN TRESNASIH,
Tidak ASKES
Sembuh
56
S.PD
453 15024028 0001431552 IMAS PURKAH,
BPJS
UMUM
Hal 20/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
K80
s/d
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
455 15025783 0001463853 MELANI RAHAYU
19
ANTURIU
M
14-AUG-15 23-AUG-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
456 14022575 0001353953 SITI SUHAENI
37
AGLONEM
A
II
17-APR-14 09-JUN-14
53
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
457 15023812 0001372053 ALFIANSYAH
23
KANA
III A
26-MAY-15 28-JUN-15
33
K80.5

cholecystitis
(choledolithiasis)
BPJS
UMUM
19-JUN-13
K80.2

without without
cholecystitis
458 13024233 0001197653 JUBAEDAH
AKTOR
38
AGLONEM
A
II
459 14027749 0001406553 RENI NURAENI, NN. 17
KEMUNIN
G III(A)
III A
19-NOV-14 27-NOV-14
K80.2

without without
AKTOR
cholecystitis
460 14011285 0001405653 USEP PARILLIANI
36
KEMUNIN
GI
III A
27-OCT-14 17-NOV-14
21
K80.2

without without
AKTOR
cholecystitis
30
KEMUNIN
GV
II
20-JAN-15
06-FEB-15
17
K80.2

without without
AKTOR
cholecystitis
462 13020228 0001247053 NEWI NY
54
RKUTM-C
DRK
LANTAI 3
09-JAN-13
18-JAN-13
K80.2

without without
cholecystitis
463 14027934 0001411353 YAYAH
66
AGLONEM
A
II
26-NOV-14 04-DEC-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
464 14027236 0001372053 ALFIANSYAH
22
AGLONEM
A
II
30-OCT-14 10-NOV-14
11
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
465 14025412 0001386654 YEYE
57
PV.PARA RKUTM-B
HYANGA
N3
17-AUG-14 21-AUG-14
K80.1

AKTOR
BPJS
ASKES
466 13022524 0001261754 IIS ROSMINI, NY
49
KEMUNIN
G III
III A
08-APR-13 26-APR-13
18
K80.2

without without
MAMP
cholecystitis
U
467 13022121 0001265854 KIAH
62
ANTURIU
M
IA
21-MAR-13 01-APR-13
11
K80.4

with cholecystitis
Perbaikan ASKES
468 14028595 0001416254 YANDRI CAPRIADI
28
PV.PARA RKUTM-C
HYANGA
N4
22-DEC-14 01-JAN-15
10
K80.3

with cholangitis
Perbaikan KONTR
KEMUNIN
G III(A)
III A
27-JUN-15
16
K80.3

with cholangitis
Perbaikan TIDAK
KEMUNIN
G IV
III A
21
K80.5

cholecystitis
(choledolithiasis)
Perbaikan TIDAK
KOSASIH, TN.
461 15020529 0001421153 LIBERTI MIMBAR
ROMANTIKA
ROKAYAH, NY
NITASUSIANTO,
IR.H
469 15024626 0001461654 NENG KARTIKA ,
24
NY.
470 12017007 0001243754 RIYANTO
50
17-JUN-13
Perbaikan KONTR
13-JUL-15
18-DEC-12 08-JAN-13
AKTOR
BPJS
UMUM
BPJS
ASKES
MAMP
U
MAMP
U
471 14005299 0001368554 DEDEH RUHIATI S.
81
ANTURIU
M
IA
23-MAY-14 21-JUN-14
29
K80.2

without without
AKTOR
cholecystitis
472 13023287 0001278755 WIWIN
43
ANTURIU
M
IB
10-MAY-13 15-MAY-13
K80.2

without without
cholecystitis
473 13024934 0001293655 TOTO WIHARTO
44
AGLONEM
A
II
15-JUL-13
20-JUL-13
K80.2

without without
cholecystitis
474 13023346 0001279255 KURIAH, NY
56
AGLONEM
A
II
13-MAY-13 23-MAY-13
10
K80.2

without without
cholecystitis
475 14021748 0001352655 KURSINI NY
58
KEMUNIN
G III(A)
III A
14-MAR-14 14-APR-14
31
K80.1

AKTOR
476 14023887 0001373355 UNING NY
54
KEMUNIN
G III(A)
III A
14-JUN-14
29-JUN-14
15
K80.5

cholecystitis
(choledolithiasis)
Tidak KONTR
Sembuh AKTOR
477 14021875 0001352955 NURMALASARI, NY
30
KEMUNIN
G III(A)
III A
19-MAR-14 15-APR-14
27
K80.4

with cholecystitis
Sembuh TIDAK
WINANINGSIH, NY
BPJS
UMUM
BPJS
UMUM
MAMP
Hal 21/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa

U
478 13023105 0001276855 AWIS SUKAESIH
35
KEMUNIN
G III
III A
01-MAY-13 17-MAY-13
16
K80.2

without without
MAMP
cholecystitis
U
479 13027048 0000533655 SUSANTI
60
ANTURIU
M
IA
16-OCT-13 22-OCT-13
K80.2

without without
cholecystitis
480 13028758 0000648356 R.KURAESIN
69
PV.PARA RKUTM-C
HYANGA
N3
23-DEC-13 28-DEC-13
K80.1

52
ANTURIU
M
02-JUN-14
10-JUN-14
K80.1

AKTOR
BPJS
ASKES
50
PV.PARA RKUTM-A
HYANGA
N3
11-SEP-14 19-SEP-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
483 14024684 0001364756 TONO ROHMAN
36
KANA
III A
30-JUL-14
15
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
484 14025350 0001385557 CICIH
30
AGLONEM
A
II
14-AUG-14 21-AUG-14
K80.1

485 13006603 0001193357 WIWIN SAPTIAH
34
FRESIA 1
II
25-MAY-13 05-JUN-13
11
K80.4

with cholecystitis
SUMARNI ,HJ
481 14023590 0001370656 KEKEN SUHAENI
NY
482 14026053 0001394756 EMMA SITI FATIMA
,NY
IB
15-JUL-14
Perbaikan KONTR
AKTOR
486 13002728 0001260257 AYI MASRIPAH
52
FRESIA 2
III A
25-FEB-13 01-MAR-13
K80.1

MAMP
U
487 13023556 0001281157 RUNAH, NY
54
KANA
III A
20-MAY-13 24-MAY-13
K80.2

without without
cholecystitis
488 15022881 0001418557 DEDEH ROKOYAH
53
ANTURIU
M
20-APR-15 30-APR-15
10
K80.1

AKTOR
BPJS
ASKES
489 15023719 0001452157 RATMAH
65
KEMUNIN
GV
II
22-MAY-15 10-JUN-15
19
K80.4

with cholecystitis
Perbaikan KONTR
BPJS
UMUM
ANTURIU
M
IA
11
K80.3

with cholangitis
Perbaikan KONTR
490 14024955 0001383358 RITAWATI, NY
35
02-AUG-14 13-AUG-14
AKTOR
AKTOR
BPJS
UMUM
491 14020826 0001320458 IPIT SARIPUDIN
44
KEMUNIN
G IV(A)
III A
05-FEB-14
17-FEB-14
12
K80.2

without without
AKTOR
cholecystitis
492 14020429 0001286458 JUSUF SUHARDI
64
ANTURIU
M
IB
20-JAN-14
30-JAN-14
10
K80.0

AKTOR
BPJS
ASKES
493 14024831 0001323558 ITA ROSITA, NY
51
KANA
III A
22-JUL-14 14-AUG-14
23
K80.4

with cholecystitis
Tidak KONTR
Sembuh AKTOR
BPJS
ASKES
494 15020570 0001425658 SUHERNI, NY
46
KEMUNIN
GV
II
21-JAN-15
14-FEB-15
24
K80.0

AKTOR
BPJS
ASKES
495 14020901 0001343358 LINA YULIA, NY
36
PV.PARA RKUTM-B
HYANGA
N3
10-FEB-14
14-FEB-14
K80.1

AKTOR
BPJS
ASKES
496 14028732 0001420158 ENDANG SUKANDI
67
KEMUNIN
G IV(B)
29-DEC-14 14-JAN-15
16
K80.5

cholecystitis
(choledolithiasis)
III A
Sembuh KONTR BPJS PBI

AKTOR
497 14020816 0001343958 ABDUL HAMID
59
PV.PARA RKUTM-C
HYANGA
N2
05-FEB-14
14-FEB-14
K80.1

AKTOR
498 13028708 0001295759 NURI HALIMAH, NY
40
ANTURIU
M
IA
19-DEC-13 28-DEC-13
K80.1

499 13008976 0001296659 IDA WIDAWATI
47
FRESIA 2
III A
19-JUL-13
K80.3

with cholangitis
K80.2
500 13022210 0001264559 HIKAYANTI, NY
54
ANTURIU
M
IB
26-JUL-13
25-MAR-13 01-APR-13
BPJS
UMUM
Perbaikan TIDAK
MAMP
U

without without
cholecystitis
Hal 22/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
K80
s/d
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
501 13006932 0001284359 APANDI
58
FRESIA 1
II
02-JUN-13
10-JUN-13
K80.2

without without
cholecystitis
502 14000200 0001337059 DIDI MUNADI ARDI,
60
FRESIA 3
IA
06-JAN-14
13-JAN-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
503 15025124 0000293959 NY. TUTI GANTINI
52
ANTURIU
M
22-JUL-15
26-JUL-15
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
504 15026301 0001428459 WIWIT WIARSIH
32
KEMUNIN
GV
II
03-SEP-15 14-SEP-15
11
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
505 14004257 0001362059 RUHIYAT
60
GICU
II
26-APR-14 14-MAY-14
18
K80.2
Calculus of gallbladder Meninggal KONTR

without without
< 48 Jam AKTOR
cholecystitis
BPJS
UMUM
506 12028693 0001244659 SITI ASIYAH
38
KANA
III A
21-DEC-12 04-JAN-13
14
K80.5

cholecystitis
(choledolithiasis)
Perbaikan UMUM
507 13013147 0001321159 HILLERIA BR.
55
FRESIA 1
II
31-OCT-13 20-NOV-13
20
K80.5

cholecystitis
(choledolithiasis)
Perbaikan UMUM
15
KEMUNIN
G IV(A)
III A
14-APR-14 02-MAY-14
18
K80.2
Tidak KONTR
without without
Sembuh AKTOR
cholecystitis
BPJS
UMUM
509 14021118 0001184260 CHURZANI
70
PV.PARA RKUTM-A
HYANGA
N4
18-FEB-14
19-FEB-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
510 14002283 0001184260 CHURZANI S,MM,
70
PV.PARA RKUTM-A
HYANGA
N4
02-MAR-14 10-MAR-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
47
25-JUN-14
30-JUN-14
K80.1

AKTOR
BPJS
ASKES
512 13022579 0001271160 DADAN BARDIANA
37
DRK
RKUTM-A
LANTAI 4
10-APR-13 15-APR-13
K80.2

without without
cholecystitis
513 14020934 0001344760 SITI SUMANDARI,
54
ANTURIU
M
10-FEB-14
15-FEB-14
K80.1

AKTOR
81
PV.PARA RKUTM-A
HYANGA
N3
29-SEP-13 01-OCT-13
K80.2

without without
cholecystitis
58
01-APR-13 14-MAY-13
43
K80.5

cholecystitis
(choledolithiasis)
DRS
SAGALA, NY.
508 14022526 0001359559 REGI TIBIAN
FIRDAUS
MBA
511 14024212 0001373660 SUZIE DECIANA
RACHMAWATI,
DRG
DRA
514 13026688 0001313460 R SOEKESIH
ATMANEGARA, HJ
515 13022377 0001268860 WAHYU
AGLONEM
A
GBICU
II
IB
II
BPJS
ASKES
Meninggal TIDAK
> 48 Jam MAMP
U
516 15021586 0001423461 NUR HAYANI
32
KEMUNIN
G III(A)
III A
28-FEB-15 12-MAR-15
12
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
517 14021162 0001343861 MOH SUJA'I
57
AGLONEM
A
II
19-FEB-14 08-MAR-14
17
K80.5

cholecystitis
(choledolithiasis)
AKTOR
BPJS
ASKES
AGLONEM
A
II
07-OCT-14 15-OCT-14
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
Perbaikan KONTR
518 14026661 0001393861 AI KOMALA
61
519 14023554 0001370261 ANDINI PUTRI
38
PV.PARA RKUTM-C
HYANGA
N3
01-JUN-14
05-JUN-14
K80.1

AKTOR
BPJS
UMUM
520 14026817 0001376462 CUCU SUTARA,
47
PV.PARA RKUTM-B
HYANGA
N3
14-OCT-14 16-OCT-14
K80.1

AKTOR
BPJS
UMUM
521 14020271 0000901562 ARNENGSIH, NY
45
AGLONEM
A
II
13-JAN-14
20-JAN-14
K80.1

AKTOR
BPJS
ASKES
522 13020260 0001248362 TITI KARSITI NY
72
RBB
IB
10-JAN-13
17-JAN-13
K80.2

without without
cholecystitis
DRS. H
Hal 23/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
Ruang
523 13028010 0001322962 SYLVIA YUNITA
28
524 13022605 0001271362 CECEP TAOPIK
34
AGLONEM
A
525 13022412 0000600462 AAH ROHANAH
54
526 13021878 0001263862 ADE SADIAH
64
HIDAYAT
J. Kelamin :
Kelas
ICD
Nm Diagnosa
23-NOV-13 03-DEC-13
10
K80.2

without without
cholecystitis
II
10-APR-13 19-APR-13
K80.0

AKTOR
KEMUNIN
G III
III A
03-APR-13 24-APR-13
21
K80.2

without without
MAMP
cholecystitis
U
KEMUNIN
G III
III A
11-MAR-13 01-APR-13
21
K80.3

with cholangitis
PV.PARA RKUTM-A
HYANGA
N4
Perbaikan TIDAK
MAMP
U
527 13023455 0001234862 SITI SOLIHAT
68
AGLONEM
A
II
16-MAY-13 12-JUN-13
27
K80.2

without without
cholecystitis
528 14022123 0001356162 HENI MARWATI NY
36
ANGSANA
III A
31-MAR-14 02-APR-14
K80.5

cholecystitis
(choledolithiasis)
Perbaikan UMUM
529 14025367 0001378862 SUDAR
30
KEMUNIN
G IV(B)
III A
15-AUG-14 01-SEP-14
17
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
AKTOR
BPJS
UMUM
III A
26-SEP-14 04-OCT-14
K80.5

cholecystitis
(choledolithiasis)
Tidak KONTR
Sembuh AKTOR
BPJS
UMUM
20-FEB-14 05-MAR-14
13
K80.0

AKTOR
BPJS
UMUM
530 14026407 0001378862 SUDAR
30
KEMUNIN
G IV(B)
531 14021189 0001347263 SITI HODIDJAH
56
PV.PARA RKUTM-C
HYANGA
N2
532 13022140 0001265863 ROHAENI, NY
57
ANTURIU
M
IA
22-MAR-13 01-APR-13
10
K80.2

without without
cholecystitis
533 13023774 0001283463 AISYAH, NY
72
ANTURIU
M
IB
29-MAY-13 07-JUN-13
K80.2

without without
cholecystitis
534 15024684 0001460863 YADI SUPRIADI
37
KANA
III A
30-JUN-15
10-JUL-15
10
K80.5

cholecystitis
(choledolithiasis)
535 13023893 0001033363 ANIE KURNIASIH,
61
KEMUNIN
G III
III A
03-JUN-13
17-JUN-13
14
K80.2

without without
MAMP
cholecystitis
U
65
ANTURIU
M
06-MAY-15 21-MAY-15
15
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
AKTOR
BPJS
UMUM
10-JUN-14
K80.5

cholecystitis
(choledolithiasis)
Tidak KONTR
Sembuh AKTOR
BPJS
UMUM
K80.3

with cholangitis
Meninggal TIDAK
> 48 Jam MAMP

cholecystitis
(choledolithiasis)
Perbaikan KONTR
AKTOR
NY
536 15023305 0001447263 EUIS KARTINI, NY
537 14023715 0001371863 EYE TN
60
IHC
NOKLAS
538 13021497 0001260264 RASTEM NY
68
KEMUNIN
G III
III A
25-FEB-13 04-MAR-13
III A
06-AUG-14 26-AUG-14
20
K80.5
07-JUN-14
Sembuh UMUM
539 14025104 0001372464 NENI MARYANI, NY
33
KEMUNIN
G III(A)
540 13023183 0001277764 YANTI KARISNA,
34
AGLONEM
A
II
06-MAY-13 14-MAY-13
K80.2

without without
cholecystitis
541 14028577 0001407064 KUSNADI
66
KEMUNIN
G IV(A)
III A
22-DEC-14 05-JAN-15
14
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
542 15022333 0001435264 ANA YULIANTI
40
PV.PARA RKUTM-B
HYANGA
N3
30-MAR-15 02-APR-15
K80.1

AKTOR
BPJS
ASKES
543 14021974 0001354564 IKEU KOMALA
51
PV.PARA RKUTM-A
HYANGA
N4
24-MAR-14 29-MAR-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
NY
SUNDARI, S.PD
BPJS
UMUM
Hal 24/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
544 15020125 0001420164 SITI JUBAEDAH, NY 56
545 15024764 0001455664 RIKA
31
Ruang
J. Kelamin :
Kelas
KEMUNIN
GV
II
KEMUNIN
G III(A)
III A

06-JAN-15
02-JUL-15
26-JAN-15
19-JUL-15
ICD
Nm Diagnosa
20
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
17
K80.5

cholecystitis
(choledolithiasis)
Sembuh TIDAK
AKTOR
BPJS
UMUM
MAMP
U
546 15020271 0001415264 MIMAD S GOLIB
61
KEMUNIN
G IV(B)
III A
12-JAN-15
20-JAN-15
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
547 14020613 0001261765 MUTIAH, HJ
60
ANTURIU
M
IA
27-JAN-14
30-JAN-14
K80.1

AKTOR
BPJS
ASKES
548 14020742 0001261765 MUTIAH, HJ
60
ANTURIU
M
IB
03-FEB-14
09-FEB-14
K80.1

AKTOR
BPJS
ASKES
549 14022168 0001354165 IRWAN MULYADI
42
PV.PARA RKUTM-C
HYANGA
N3
01-APR-14 07-APR-14
K80.0

AKTOR
BPJS
ASKES
550 14020325 0001330465 NOVIANISAR
45
AGLONEM
A
II
27-JAN-14
12
K80.1

AKTOR
BPJS
UMUM
551 14025400 0001387265 MARYAMAH NY
54
ANGSANA
III A
16-AUG-14 19-AUG-14
K80.1
Tidak KONTR
Sembuh AKTOR
BPJS
UMUM
552 15026404 0001452765 CICIH, NY
65
KEMUNIN
G III(A)
III A
07-SEP-15 18-SEP-15
11
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
553 13007711 0001289065 ENTIN SUTARSIH
54
FRESIA 3
IA
20-JUN-13
02-JUL-13
12
K80.2

without without
cholecystitis
554 13022963 0001275465 YULIARSIH
34
KEMUNIN
G III
III A
25-APR-13 14-MAY-13
19
K80.5

cholecystitis
(choledolithiasis)
Meninggal TIDAK
> 48 Jam MAMP
U
14-MAR-13 25-MAR-13
11
K80.2

without without
MAMP
cholecystitis
U
24-OCT-13 08-NOV-13
15
K80.1

II
18-MAR-13 23-MAR-13
K80.2

without without
AKTOR
cholecystitis
AGLONEM
A
II
17-MAY-13 24-MAY-13
K80.2

without without
cholecystitis
KEMUNIN
G III(A)
III A
17-FEB-14 04-MAR-14
15
K80.2

without without
AKTOR
cholecystitis
KEMUNIN
G III(A)
III A
15-DEC-14 22-DEC-14
K80.3

with cholangitis
555 13021946 0001256565 TATANG
34
KEMUNIN
G IV
556 13012897 0001319665 HASANAH
78
PV.PARA RKUTM-B
HYANGA
N3
557 13022047 0001194766 ADE SYARIFUDIN
51
AGLONEM
A
558 13023463 0001278766 YUNAH, NY
42
559 14021090 0001342366 TITIN SUPRIATIN,
55
63
NY
560 14028384 0001416966 IMAS
15-JAN-14
III A

AKTOR
561 13020532 0001251566 IMAS SUMARNI NY
59
AGLONEM
A
II
21-JAN-13
26-JAN-13
K80.0

562 13023910 0001284766 DIAH PUDJIASTUTI
27
AGLONEM
A
II
04-JUN-13
10-JUN-13
K80.2

without without
AKTOR
cholecystitis
563 13022359 0001259966 EROS ROSMAYATI, 22
KEMUNIN
G III
III A
01-APR-13 04-APR-13
K80.2

without without
MAMP
cholecystitis
U
NY
564 14025744 0001332266 SITI FUADAH, NY
46
AGLONEM
A
II
29-AUG-14 06-SEP-14
K80.2

without without
AKTOR
cholecystitis
565 13010485 0000272266 JAMIL
54
FRESIA 3
IB
25-AUG-13 03-SEP-13
K80.1

566 13021114 0001215367 KELLY CORNELIS,
51
RBB
IB
11-FEB-13
16
K80.5

cholecystitis
(choledolithiasis)
IR
27-FEB-13
BPJS
ASKES
Perbaikan UMUM
Hal 25/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
567 15024015 0001445067 IWAN SUHARNA,
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
42
KEMUNIN
G IV(B)
III A
03-JUN-15
23-JUN-15
20
K80.2

without without
AKTOR
cholecystitis
568 15022518 0001433167 SITI SUPIAH
47
KEMUNIN
G III(A)
III A
06-APR-15 21-APR-15
15
K80.2

without without
AKTOR
cholecystitis
569 15020852 0001428067 FERENOSI
25
KEMUNIN
GV
II
02-FEB-15
12-FEB-15
10
K80.2

without without
AKTOR
cholecystitis
570 13024293 0001288267 RAHMAN SUYADI
44
ANTURIU
M
IB
18-JUN-13
29-JUN-13
11
K80.1

571 14025137 0001384667 HASAN SOBANDI
45
PV.PARA RKUTM-C
HYANGA
N2
07-AUG-14 11-AUG-14
K80.1

AKTOR
BPJS
UMUM
572 14021541 0001350367 ESTER
57
05-MAR-14 01-APR-14
27
K80.5

cholecystitis
(choledolithiasis)
BPJS
UMUM
K80.2

without without
cholecystitis
24-JUL-13
23
K80.5

cholecystitis
(choledolithiasis)
TN
KARTIKA C M,
AMD.KEB
NAPITUPULU
573 13027288 0001318068 WILMAR SINAGA,
AGLONEM
A
II
Perbaikan KONTR
AKTOR
53
ANTURIU
M
IB
25-OCT-13 01-NOV-13
574 13024564 0000699468 SUDIRMAN
48
ANTURIU
M
IB
01-JUL-13
575 15022231 0000906068 CUCU AMALIA, NY
47
ANTURIU
M
25-MAR-15 02-APR-15
K80.1

AKTOR
576 12028491 0001237168 ANI ERYANTI, NY
30
RBA
II
13-DEC-12 05-JAN-13
23
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
Perbaikan ASKES
SH
577 13023189 0001276369 CICIH SUKAESIH
578 13027354 0001315969 RENI MARTINA

579 14020349 0001339469 ROSMIATI NY
ANTURIU
M
IB
06-MAY-13 24-MAY-13
18
K80.5

cholecystitis
(choledolithiasis)
40
AGLONEM
A
II
28-OCT-13 06-NOV-13
K80.1

AKTOR
48
KEMUNIN
G V(A)
III A
10
K80.3

with cholangitis
17-JAN-14
27-JAN-14
BPJS
ASKES
AKTOR
ENDO
BPJS
UMUM
Perbaikan ASKES
58
NY
BPJS
UMUM

AKTOR
580 15021896 0001092169 YAYAH, NY
60
KEMUNIN
GV
II
10-MAR-15 14-MAR-15
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
581 15021570 0001092169 YAYAH, NY
60
KEMUNIN
GV
II
27-FEB-15 09-MAR-15
10
K80.2

without without
cholecystitis
BPJS
UMUM
582 13028085 0001087069 IMAS MAEMUNAH
40
ANTURIU
M
IA
26-NOV-13 02-DEC-13
K80.2

without without
cholecystitis
63
ANTURIU
M
11
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
ANTURIU
M
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
KEMUNIN
G IV
III A
11
K80.5

cholecystitis
(choledolithiasis)
Tidak TIDAK
Sembuh MAMP
S.AG
583 15024299 0001452469 SUTARSIH, NY
584 15023865 0001452469 SUTARSIH, NY
585 13025499 0001300869 RUDIANTO
63
35
15-JUN-15
26-JUN-15
28-MAY-15 05-JUN-15
12-AUG-13 23-AUG-13
AKTOR
AKTOR
45
KEMUNIN
G III(A)
III A
16-DEC-13 06-JAN-14
21
K80.2
Tidak TIDAK
without without
Sembuh MAMP
cholecystitis
U
587 15022771 0001436969 H SITI NURJANAH
50
KEMUNIN
G III(A)
III A
15-APR-15 26-APR-15
11
K80.2

without without
AKTOR
cholecystitis
49
ANTURIU
M
IB
30-SEP-13 09-OCT-13
K80.2

without without
cholecystitis
588 13026728 0000086670 HARTI
BPJS
ASKES
586 13028586 0001306169 APONG
BT D
BPJS
ASKES
BPJS
UMUM
Hal 26/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
589 13023290 0000313070 YAYAH ROKAYAH
71
590 12028818 0001246170 NEMI, NY
32
RBB
IA
591 14020332 0001337670 LIA AMALIA R
30
AGLONEM
A
II
592 14025249 0001385970 DR PIUS P
67
593 15020718 0001409370 SUTARMI, NY
56
594 15021844 0001404770 SOPHIAH, NY
595 14024135 0001359370 RINI RESMINI
ICD
Nm Diagnosa
10-MAY-13 15-MAY-13
K80.2

without without
cholecystitis
29-DEC-12 10-JAN-13
12
K80.5

cholecystitis
(choledolithiasis)
24-JAN-14
K80.1

AKTOR
BPJS
ASKES
PV.PARA RKUTM-B
HYANGA
N3
12-AUG-14 15-AUG-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
KEMUNIN
GV
II
27-JAN-15
11-FEB-15
15
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
53
KEMUNIN
GV
II
10-MAR-15 24-MAR-15
14
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
44
KEMUNIN
G V(A)
III A
K80.3

with cholangitis
Perbaikan KONTR
BPJS
UMUM
KEMUNIN
G III(A)
III A
K80.5

cholecystitis
(choledolithiasis)
17-FEB-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
09-MAY-14 14-MAY-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
KETAREN,TN
596 15020320 0001418070 EUIS SUHAEBAH,
36
NY
DRK
RKUTM-B
LANTAI 3
16-JAN-14
23-JUN-14
13-JAN-15
29-JUN-14
20-JAN-15
Perbaikan ASKES
AKTOR
AKTOR
597 14020886 0001344571 JAJA
68
598 14023077 0001365171 ENDANG NY
41
AGLONEM
A
II
599 13024137 0000293871 WINARTI, NY
55
ANTURIU
M
IA
13-JUN-13
24-JUN-13
11
K80.1

600 13024235 0001287671 RIDWAN EFFENDI
55
ANTURIU
M
IA
17-JUN-13
24-JUN-13
K80.2

without without
cholecystitis
601 13021640 0001252671 KARTINI
42
KEMUNIN
G III
III A
04-MAR-13 10-MAR-13
K80.0

MAMP
U
602 13023257 0001278171 ILAH, NY
48
ANTURIU
M
IB
08-MAY-13 16-MAY-13
K80.2

without without
cholecystitis
603 13025278 0001298671 R.TIEN
69
KEMUNIN
G III
III A
29-JUL-13 05-AUG-13
K80.5

cholecystitis
(choledolithiasis)
DIANTINA,BA.
604 14022350 0001354571 UUS SUDRAJAT
38
605 13023174 0001275571 TETE TEJANINGSIH, 47
P
L
HJ
606 15022003 0001432272 SASMITA
607 13026997 0001309372 ANI MULYANI
71
41
PV.PARA RKUTM-C
HYANGA
N2
08-FEB-14
Meninggal TIDAK
> 48 Jam MAMP
U
08-APR-14 14-APR-14
K80.2

without without
AKTOR
cholecystitis
DRK
RKUTM-B
LANTAI 3
06-MAY-13 10-MAY-13
K80.2

without without
cholecystitis
PV.PARA RKUTM-B
HYANGA
N2
16-MAR-15 25-MAR-15
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
ANTURIU
M
IB
11-OCT-13 28-OCT-13
17
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
AGLONEM
A
II
AKTOR
BPJS
ASKES
BPJS
UMUM
AKTOR
608 15022166 0001425472 SUWARNI
62
KEMUNIN
G III(A)
III A
23-MAR-15 27-MAR-15
K80.2

without without
AKTOR
cholecystitis
609 14024139 0001325372 JUATI, NY
48
KEMUNIN
G V(A)
III A
23-JUN-14
K80.5

cholecystitis
(choledolithiasis)
ANTURIU
M
IB
12
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
610 14026719 0001401372 ELIN MARLINA, NY
47
02-JUL-14
08-OCT-14 20-OCT-14
AKTOR
AKTOR
BPJS
ASKES
Hal 27/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
K80
s/d
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
611 15020987 0001428972 IJUM/ UUM, NY
Umur Sex
50
Ruang
J. Kelamin :
Kelas
ANTURIU
M

06-FEB-15
13-FEB-15
ICD
Nm Diagnosa
K80.3

with cholangitis

Perbaikan KONTR
AKTOR
BPJS
ASKES
612 15025894 0000754572 YANI RUCHIANI NY
62
ANTURIU
M
19-AUG-15 27-AUG-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
613 14021848 0001353472 NURHAYATI NY
35
KANA
III A
18-MAR-14 27-MAR-14
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
BPJS
UMUM
17
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
K80.3

with cholangitis
Sembuh KONTR
614 15023093 0001445973 ULPAH
615 15021590 0001426373 DEWI YULIANI NY
25
28
KEMUNIN
G III(A)
III A
KEMUNIN
GV
II
28-APR-15 15-MAY-15
01-MAR-15 09-MAR-15
AKTOR
AKTOR
AKTOR
BPJS
UMUM
BPJS
UMUM
42
KEMUNIN
G III(A)
III A
25-MAY-15 09-JUN-15
15
K80.2

without without
AKTOR
cholecystitis
617 13013008 0001320074 IYE MUSTOPA
59
FRESIA 2
III A
28-OCT-13 04-NOV-13
K80.0

MAMP
U
618 14025910 0001386374 WAWANG, NY
50
KANA
III A
04-SEP-14 02-OCT-14
28
K80.2

without without
AKTOR
cholecystitis
619 13021425 0001252674 IPIT
43
KEMUNIN
G III
III A
22-FEB-13 02-MAR-13
K80.2

without without
MAMP
cholecystitis
U
620 12028529 0001242874 SITI DJUARIAH
55
RBA
II
15-DEC-12 08-JAN-13
24
K80.5

cholecystitis
(choledolithiasis)
621 13021695 0001248474 ADE EDAH
39
AGLONEM
A
II
05-MAR-13 11-MAR-13
K80.2

without without
cholecystitis
622 13021212 0001250974 KARTESIH, NY
61
ANTURIU
M
IA
14-FEB-13 11-MAR-13
25
K80.2

without without
cholecystitis
623 14027709 0001389474 ROSMAYATI, NY
27
KEMUNIN
G III(A)
III A
16-NOV-14 01-DEC-14
15
K80.3

with cholangitis
616 15023775 0001440073 YAYAH
ROKAYAH, NY
BPJS
UMUM
Perbaikan ASKES
Perbaikan KONTR
AKTOR
BPJS
UMUM
624 14020085 0001332175 SHITIE MURNI M, NY 24
AGLONEM
A
II
06-JAN-14
09-JAN-14
K80.0

625 14021298 0000182575 NINING
49
AGLONEM
A
II
25-FEB-14 01-MAR-14
K80.2

without without
AKTOR
cholecystitis
626 13026165 0001306375 IL YUSTINIAASIH
54
DRK
RKUTM-C
LANTAI 4
07-SEP-13 13-SEP-13
K80.1

627 14027233 0001404375 PUSPA W A
15
ANTURIU
M
30-OCT-14 05-NOV-14
K80.1

AKTOR
628 13021122 0001256575 JUJU JUNIATI
43
RBB
IA
11-FEB-13
18-FEB-13
K80.2

without without
cholecystitis
629 15026299 0001476376 WATI
54
PV.PARA RKUTM-C
HYANGA
N3
03-SEP-15 11-SEP-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
630 15026522 0000394276 DIANA S
55
PV.PARA RKUTM-C
HYANGA
N3
11-SEP-15 19-SEP-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
631 14025385 0001386976 EMAH
39
KEMUNIN
G III(A)
15-AUG-14 03-SEP-14
19
K80.5

cholecystitis
(choledolithiasis)
MULYANINGSIH
III A
AKTOR
59
PV.PARA RKUTM-B
HYANGA
N2
25-JUL-15 05-AUG-15
11
K80.2

without without
AKTOR
cholecystitis
633 13020425 0001250477 IBRAHIM HABIEBIE
58
ANYELIR
16-JAN-13
19
K80.2

without without
cholecystitis
04-FEB-13
BPJS
ASKES
632 15025227 0001466876 MATHEUS TOMO
II
BPJS
ASKES
BPJS
POLRI
Hal 28/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
634 14026226 0001391277 MUSLIM
Umur Sex
Ruang
J. Kelamin :
Kelas
57
KEMUNIN
G IV(B)
III A
18-SEP-14 26-SEP-14
635 15021078 0001421977 ITA JUNIANINGSIH, 38
KEMUNIN
G III(A)
III A
09-FEB-15
NY
23-FEB-15
ICD
Nm Diagnosa
K80.1

AKTOR
14
K80.5

cholecystitis
(choledolithiasis)

AKTOR
636 14023542 0001369777 IHAT SOLIHAT
33
KEMUNIN
G III(A)
III A
29-MAY-14 18-JUN-14
20
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
637 14028171 0001311877 IDAR ROSIDA , NY
54
KANA
III A
05-DEC-14 12-DEC-14
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
638 14023694 0001202777 IIN SUGIRI MASKURI 63
ANTURIU
M
IA
06-JUN-14
21-JUN-14
15
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
639 14020855 0001342477 NINGRUM HERMA
45
AGLONEM
A
II
06-FEB-14
13-FEB-14
K80.1

AKTOR
BPJS
UMUM
58
08-DEC-14 10-DEC-14
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
BPJS
ASKES
18
K80.5

cholecystitis
(choledolithiasis)
Sembuh KONTR
PUSPA, NY
640 14012776 0000354577 TETET WASRIAH,
HJ
641 14027988 0001413577 PURWANTI, NY
47
PV.PARA RKUTM-B
HYANGA
N3
ANTURIU
M
27-NOV-14 15-DEC-14
AKTOR
AKTOR
BPJS
ASKES
BPJS
POLRI
642 14024623 0001380077 KUSMIADI TN
52
PV.PARA RKUTM-C
HYANGA
N2
13-JUL-14
18-JUL-14
K80.0

AKTOR
643 13013449 0001323177 HENI ROSITA ,NY
41
PV.PARA RKUTM-A
HYANGA
N4
08-NOV-13 15-NOV-13
K80.2

without without
cholecystitis
644 13011613 0001311877 IDAR
52
KEMUNIN
GI
III A
23-SEP-13 28-SEP-13
K80.1

MAMP
U
645 13022085 0001253477 UKA, NY
63
KANA
III A
20-MAR-13 04-APR-13
15
K80.2

without without
AKTOR
cholecystitis
646 13000020 0001246578 E SALAMAH
71
ANYELIR
II
01-JAN-13
10-JAN-13
K80.2

without without
cholecystitis
647 14025691 0001296578 IIS HERLINA
36
AGLONEM
A
II
28-AUG-14 08-SEP-14
11
K80.1

AKTOR
648 13002571 0001259478 ETI ROHAYATI
48
FRESIA 2
III A
21-FEB-13
27-FEB-13
K80.1

MAMP
U
649 13021420 0001252878 YANI
32
KEMUNIN
G III
III A
22-FEB-13 01-MAR-13
K80.2

without without
MAMP
cholecystitis
U
650 15001482 0001430478 EMON SOIMAN
44
FRESIA 1
II
10-FEB-15
15-FEB-15
K80.5

cholecystitis
(choledolithiasis)
651 14026181 0001373278 P. SIMANJUNTAK
60
ANTURIU
M
IB
17-SEP-14 22-SEP-14
K80.1

AKTOR
BPJS
UMUM
652 14025928 0001392778 YANI ROSYANI NY
53
ANTURIU
M
IA
07-SEP-14 23-SEP-14
16
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
BPJS
UMUM
KEMUNIN
G IV(B)
III A
***
K80.5

cholecystitis
(choledolithiasis)
Sembuh KONTR
KEMUNIN
G IV(B)
III A
10
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
13
K80.2
YULIANENGSIH
653 14028764 0001389378 SAEPUDIN
654 14028223 0001389378 SAEPUDIN
655 13002879 0001261179 ODAS,NY
38
38
45
RKUTM-B
DRK
LANTAI 2
30-DEC-14 14-JAN-14
08-DEC-14 18-DEC-14
28-FEB-13 13-MAR-13
BPJS
UMUM
Meninggal KONTR BPJS TNI

> 48 Jam AKTOR
AKTOR
AKTOR
AKTOR
BPJS
UMUM
BPJS
UMUM

without without
cholecystitis
Hal 29/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
656 14023261 0001367079 AI KURNIASIH
54
ANTURIU
M
IA
18-MAY-14 05-JUN-14
18
K80.1

AKTOR
657 13026681 0001310879 OMAN ROHMAN
72
KEMUNIN
G IV(B)
III A
27-SEP-13 24-OCT-13
27
K80.5

cholecystitis
(choledolithiasis)
Perbaikan TIDAK
BPJS
UMUM
MAMP
U
658 13014588 0001330079 SAMSU
58
MIC
II
06-DEC-13 09-DEC-13
K80.4

with cholecystitis
Perbaikan UMUM
659 14012960 0001416579 ANDI SUDIRMAN
28
IHC
NOKLAS
12-DEC-14 13-DEC-14
K80.3

with cholangitis
Meninggal KONTR
< 48 Jam AKTOR
660 13027535 0001301079 YATI RUSMAYANTI
21
KEMUNIN
G III(A)
III A
04-NOV-13 21-NOV-13
17
K80.2

without without
MAMP
cholecystitis
U
661 15020720 0001394979 IDA DANINGSIH
74
KEMUNIN
GV
II
27-JAN-15
12-FEB-15
16
K80.2

without without
AKTOR
cholecystitis
662 13028180 0000004579 SITI AMINAH
65
AGLONEM
A
II
29-NOV-13 11-DEC-13
12
K80.2

without without
cholecystitis
663 14025700 0001001380 ATIM SULISTYO SE 67
ANTURIU
M
IB
27-AUG-14 11-SEP-14
15
K80.4

with cholecystitis
Perbaikan KONTR
AGLONEM
A
II
10
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
II
12-JAN-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
28-JUL-15 03-AUG-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
13-JUL-15
21-JUL-15
K80.3

with cholangitis
Tidak KONTR
Sembuh AKTOR
BPJS
UMUM
24-FEB-15 18-MAR-15
22
K80.3

with cholangitis
Perbaikan KONTR
BPJS
UMUM
MBA
664 13025066 0001296780 OMAH SANIA
42
665 15020091 0001414180 HALIMAH YUNUS
34
KEMUNIN
GV
666 15025313 0001467580 TAUFIK
49
PV.PARA RKUTM-B
HYANGA
N3
50
IHC
NOKLAS
668 15021517 0001428680 ETTY ROHAETI, NY 43
KEMUNIN
G III(A)
III A
HIDAYAT,DR.SP.A
N
667 15025000 0001186380 EUIS KOMARIAH,
20-JUL-13
05-JAN-15
30-JUL-13
NY.
669 13026696 0001310980 MIMIN
AKTOR
BPJS
UMUM
BPJS
ASKES
AKTOR
AKTOR
58
KEMUNIN
G III(A)
III A
29-SEP-13 11-OCT-13
12
K80.2

without without
MAMP
cholecystitis
U
670 13022293 0001263681 DASWA
26
ANTURIU
M
IB
28-MAR-13 11-APR-13
14
K80.5

cholecystitis
(choledolithiasis)
671 13023917 0001284781 TETI MERDIWATI,
59
ANTURIU
M
IA
04-JUN-13
11-JUN-13
K80.2

without without
cholecystitis
672 13006365 0001281281 MUHAMMAD RIDAN 45
FRESIA 3
IA
20-MAY-13 23-MAY-13
K80.3

with cholangitis
28-NOV-13 30-NOV-13
K80.0

AKTOR
09-JUN-14
15-JUN-14
K80.1

AKTOR
BPJS
ASKES
17-DEC-14 22-DEC-14
K80.1

AKTOR
BPJS
ASKES
04-SEP-15 13-SEP-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
AMINAH/BATALL
NY
ARIF
Perbaikan UMUM
Perbaikan ASKES
673 13028148 0001327381 MIRA OKTAVIA
21
RGB
II
674 14023760 0001372081 YETI HERNAWATI
45
ANTURIU
M
IB
675 14028461 0000193881 YANTI BT H LOKA
36
KEMUNIN
GV
II
676 15026350 0001474581 IWIN PERMANA, NY 54
PV.PARA RKUTM-B
HYANGA
N3
677 15023023 0001437381 SUHARNO
58
KANA
III A
27-APR-15 18-MAY-15
21
K80.1

AKTOR
BPJS
UMUM
678 14021516 0001350081 RINI RESMINI NY
44
KEMUNIN
G III(A)
III A
04-MAR-14 01-APR-14
28
K80.4

with cholecystitis
BPJS
UMUM
AGLONEM
A
II
K80.2
679 13020808 0001251081 TATI SURNATI NY
50
30-JAN-13
04-FEB-13
Sembuh KONTR
AKTOR

without without
cholecystitis
Hal 30/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
K80
s/d
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
680 13025439 0001298682 DEDE, NY
Umur Sex
57
Ruang
KEMUNIN
G III
J. Kelamin :
Kelas
III A

11-AUG-13 20-AUG-13
ICD
Nm Diagnosa
K80.4

with cholecystitis
Perbaikan TIDAK
MAMP
U
681 13009745 0001076282 TUTI AMIRHOED.NY 75
DRK
RKUTM-B
LANTAI 3
09-AUG-13 15-AUG-13
K80.3

with cholangitis
Perbaikan ASKES
682 14023524 0001367182 HUSNI LOKAWATI
43
KEMUNIN
G III(A)
III A
29-MAY-14 20-JUN-14
22
K80.3

with cholangitis
Tidak KONTR
Sembuh AKTOR
683 14025268 0001337382 SRI FITRIANI, NY
28
KEMUNIN
G III(A)
III A
12-AUG-14 01-SEP-14
20
K80.2

without without
AKTOR
cholecystitis
684 13027154 0001318282 AMAD
79
PV.PARA RKUTM-C
HYANGA
N2
20-OCT-13 09-NOV-13
20
K80.5

cholecystitis
(choledolithiasis)
685 14026287 0001390282 RESTU RAHAYU
25
PV.PARA RKUTM-C
HYANGA
N3
22-SEP-14 26-SEP-14
K80.1

AKTOR
BPJS
ASKES
686 14025796 0000631182 TETI SUGIARTI NY 57
AGLONEM
A
II
01-SEP-14 08-SEP-14
K80.5

cholecystitis
(choledolithiasis)
BPJS
ASKES
687 13015083 0001333282 ETTY ROSMANAH
61
FRESIA 3
IA
19-DEC-13 20-DEC-13
K80.2

without without
cholecystitis
49
AGLONEM
A
II
03-APR-13 16-APR-13
13
K80.0

689 15022349 0000605882 RIDA ROSIDA, NY
43
KEMUNIN
G III(A)
III A
30-MAR-15 21-APR-15
22
K80.2

without without
AKTOR
cholecystitis
690 14027403 0001363682 DIAH RODIAH, NY
49
AGLONEM
A
II
06-NOV-14 16-NOV-14
10
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
691 14023609 0001370882 MAEMUNAH, NY
69
08-JUN-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
692 14022996 0000631182 TETI SUGIARTI NY 57
AGLONEM
A
II
06-MAY-14 13-MAY-14
K80.1

AKTOR
BPJS
ASKES
693 14003230 0000605882 RIDA ROSIDA, NY
FRESIA 2
III A
27-MAR-14 01-APR-14
K80.5

cholecystitis
(choledolithiasis)
11
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
09-DEC-13 18-DEC-13
K80.1

12-JUN-14
16-JUN-14
K80.2

without without
AKTOR
cholecystitis
26-NOV-13 02-DEC-13
K80.2

without without
cholecystitis
18-DEC-14 19-DEC-14
K80.1

BPJS
AKTOR JAMSOST

without without
cholecystitis
BRATADIREJA
SUGIARTI HJ
688 13022411 0001257882 AISAH DEWI
SUHARTINI SE
694 15021432 0000365783 AISAH NINGSIH ,
42
70
NY.
PV.PARA RKUTM-A
HYANGA
N4
KEMUNIN
GV
II
AGLONEM
A
II
06-JUN-14
23-FEB-15 06-MAR-15
Perbaikan ASKES
Meninggal KONTR
> 48 Jam AKTOR
AKTOR
AKTOR
695 13028422 0001327883 UJIANTI SATTU
40
696 14006018 0001372883 ASEP SLAMET
35
PV.PARA RKUTM-A
HYANGA
N4
67
ANTURIU
M
698 14028492 0001417983 DUDDIE SUPRIADI
55
PV.PARA RKUTM-C
HYANGA
N4
699 13027780 0001318383 WAWAN
67
ANTURIU
M
IA
14-NOV-13 22-NOV-13
K80.2
700 15022889 0001445583 TETI HARYATI, NY
41
KEMUNIN
GV
II
20-APR-15 28-APR-15
K80.2

without without
AKTOR
cholecystitis
701 13027753 0001322583 ATE SITI SOLIHAH
48
AGLONEM
A
II
13-NOV-13 24-NOV-13
11
K80.2

without without
cholecystitis
DERAJAT
697 13028075 0001318383 WAWAN
SUWARNA
SUWARNA
IA
BPJS
UMUM
BPJS
ASKES
EK
BPJS
ASKES
Hal 31/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
702 13023102 0000244683 NUNUNG
Umur Sex
Ruang
J. Kelamin :
Kelas
47
ANTURIU
M
IA
30
KEMUNIN
GV
II
58
705 15025546 0001419084 SRI AGUSTINI
52
706 14027107 0001405184 ASMA, TN.
62
NURMANINGSIH
703 15024074 0001453984 RATNANENGSIH,

01-MAY-13 11-MAY-13
ICD
Nm Diagnosa
10
K80.2

without without
cholecystitis
without without
AKTOR
cholecystitis
04-JUN-15
13-JUN-15
K80.2
DRK
RKUTM-A
LANTAI 3
13-JUN-13
18-JUN-13
K80
ANTURIU
M
05-AUG-15 18-AUG-15
13
K80.2

without without
AKTOR
cholecystitis
KEMUNIN
G IV(A)
III A
25-OCT-14 24-NOV-14
30
K80.5

cholecystitis
(choledolithiasis)
24
K80.1

AKTOR
BPJS
ASKES
BPJS
UMUM
AM.KEB
704 13024127 0001285484 YAYAT RUCHIYAT,
TN
CHOLELITHIASIS
BPJS
ASKES
Perbaikan ASKES
BPJS
UMUM

AKTOR
707 14009371 0001393784 IDA KUSMINAH
47
FRESIA 3
IA
708 15025169 0001466384 IIN RUSTINI, NY
54
KEMUNIN
GV
II
23-JUL-15
31-JUL-15
K80.2

without without
AKTOR
cholecystitis
709 13023190 0001277084 SARIPAH
45
AGLONEM
A
II
06-MAY-13 14-MAY-13
K80.5

cholecystitis
(choledolithiasis)
710 15021780 0001436184 RINA
30
PV.PARA RKUTM-B
HYANGA
N3
08-MAR-15 15-MAR-15
K80.1

AKTOR
62
ANTURIU
M
25-FEB-15 05-MAR-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
712 15022125 0001439184 BUDIMAN. TN
39
KEMUNIN
G IV(B)
III A
20-MAR-15 30-MAR-15
10
K80.1

AKTOR
BPJS
UMUM
713 13010450 0001044185 ASNAT
44
KEMUNIN
GI
III A
24-AUG-13 24-SEP-13
31
K80.2
Calculus of gallbladder Meninggal TIDAK

without without
> 48 Jam MAMP
cholecystitis
U
714 14027133 0001385785 ENOK ENDAH, NY
32
KEMUNIN
G III(A)
III A
27-OCT-14 21-NOV-14
25
K80.2

without without
AKTOR
cholecystitis
715 14007443 0001381585 SUTOWO TN
41
MIC
II
20-JUL-14
27-JUL-14
K80.0
716 15024282 0001458385 ADE WARMAN
52
KANA
III A
13-JUN-15
20-JUN-15
K80.4

with cholecystitis
717 14025334 0001386785 ROCHADI TAWAF
61
PV.PARA RKUTM-A
HYANGA
N4
14-AUG-14 17-AUG-14
718 14024274 0001375885 N. JUHARIAH
59
PV.PARA RKUTM-B
HYANGA
N3
28-JUN-14
06-JUL-14
719 15023052 0001445885 NENDEN
43
27-APR-15 18-MAY-15
MARLIANA,NY
711 15021494 0001425184 ELIAKIM
PANJAITAN
NOBATONIS, NY
KANA
III A
08-SEP-14 02-OCT-14
Perbaikan ASKES
Tidak KONTR
Sembuh AKTOR
BPJS
UMUM
Meninggal KONTR
> 48 Jam AKTOR
BPJS
UMUM
K80.1

AKTOR
BPJS
ASKES
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
21
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
BPJS
ASKES
SULISTIAWATI
AKTOR
720 13028602 0001332085 RINA SEPTIANI
14
RGB
II
15-DEC-13 19-DEC-13
K80.5

cholecystitis
(choledolithiasis)
Perbaikan UMUM
721 13026064 0001306586 ENAH TOENAH
23
KANA
III A
03-SEP-13 13-SEP-13
10
K80.3

with cholangitis
Meninggal TIDAK
< 48 Jam MAMP

722 13027104 0001317586 NURMAN
PV.PARA RKUTM-C
HYANGA
N2
17-OCT-13 28-OCT-13
11
K80.1
43
723 14023400 0001368786 AGUS HERMANA S
50
ANTURIU
M
IA
24-MAY-14 09-JUN-14
16
K80.1

AKTOR
BPJS
ASKES
64
KEMUNIN
G IV(B)
III A
23-AUG-15 01-SEP-15
K80.2

without without
AKTOR
BPJS
UMUM
PD
724 15025979 0001473486 DEDI SUYUDI
Hal 32/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
cholecystitis
725 14000428 0001338586 SUHERMAN

726 14026983 0001387586 ENIH ROHAENIH,
48
FRESIA 2
III A
11-JAN-14
14-JAN-14
K80.3
28
K80.2

without without
AKTOR
cholecystitis

with cholangitis

AKTOR
34
KEMUNIN
G III(A)
III A
727 13020605 0001252086 IAT SOLIHAT NY
68
AGLONEM
A
II
22-JAN-13
31-JAN-13
K80.2

without without
cholecystitis
728 13021564 0001257486 DIDAH, NY
31
AGLONEM
A
II
28-FEB-13 08-MAR-13
K80.2

without without
AKTOR
cholecystitis
729 13011105 0001308086 EUIS MARIAH
56
ANTURIU
M
IB
09-SEP-13 19-SEP-13
10
K80.2

without without
cholecystitis
730 14023540 0001370087 ODI TN
75
ANTURIU
M
IA
30-MAY-14 13-JUN-14
14
K80.1

AKTOR
731 13020466 0001245387 NASRUDIN
54
KEMUNIN
G IV
III A
17-JAN-13
01-FEB-13
15
K80.2

without without
MAMP
cholecystitis
U
732 14011270 0000848587 AAN ZUHANA H.
72
PV.PARA RKUTM-C
HYANGA
N2
29-OCT-14 03-NOV-14
K80.4

with cholecystitis
Perbaikan KONTR
ANTURIU
M
30-JUN-15
K80.4

with cholecystitis
Perbaikan KONTR
28-JAN-15
23
NY
TN
733 15024697 0001461087 YUYUS YUSTINI
43
S.PD, SD
734 15020102 0001421687 HENRY WENSON
ANTURIU
M
72
PV.PARA RKUTM-C
HYANGA
N2
09-NOV-14 21-NOV-14
TN
736 15023960 0000934387 TJATJA MULYONO,
06-JUL-15
46
KODUNG
735 14011692 0000848587 AAN ZUHANA H.
20-OCT-14 17-NOV-14
05-JAN-15
AKTOR
BPJS
ASKES
BPJS
ASKES
AKTOR
BPJS
ASKES
K80.1

AKTOR
BPJS
ASKES
12
K80.5

cholecystitis
(choledolithiasis)
AKTOR
BPJS
ASKES
Perbaikan KONTR
60
PV.PARA RKUTM-B
HYANGA
N3
01-JUN-15
05-JUN-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
31
PV.PARA RKUTM-C
HYANGA
N4
29-JUL-15 02-AUG-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
738 15025117 0001462287 SRIWARTIN, NY
50
KANA
III A
22-JUL-15 07-AUG-15
16
K80.1

AKTOR
BPJS
UMUM
739 13026474 0001311087 EUIS ATUN
53
KANA
III A
19-SEP-13 29-SEP-13
10
K80.2

without without
cholecystitis
740 13025070 0001296787 EUIS KURAESIH
46
RBA
II
20-JUL-13
24-JUL-13
K80.2
Calculus of gallbladder Meninggal UMUM

without without
< 48 Jam
cholecystitis
741 15023451 0001445887 TISNA SUTISNA, H
65
KEMUNIN
GV
II
12-MAY-15 21-MAY-15
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
742 14023720 0001371887 DUMA ULI
28
KEMUNIN
G III(A)
III A
07-JUN-14
29-JUN-14
22
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
743 14024375 0001377388 NURTITAWATI
45
AGLONEM
A
II
02-JUL-14
07-JUL-14
K80.1

AKTOR
BPJS
ASKES
744 13022694 0001272388 NUNUN
44
ANTURIU
M
IB
15-APR-13 20-APR-13
K80.2

without without
AKTOR
cholecystitis
745 14000511 0001338888 SINTA WATI, NY
68
KEMUNIN
G III(A)
III A
13-JAN-14
17-FEB-14
35
K80.1

AKTOR
746 13024237 0001285988 AJAT DAROJAT M
44
ANTURIU
M
IA
17-JUN-13
24-JUN-13
K80.2

without without
cholecystitis
747 13026361 0000780989 MUTIA I. BADUDU
46
ANTURIU
M
IA
16-SEP-13 19-SEP-13
K80.2

without without
cholecystitis
TN
737 15025341 0001466687 RENY
SASTIANENGSIH,
HJ
SITUMEANG
NURKEMALA
BPJS
UMUM
Hal 33/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
%
No RM
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
748 13026411 0001310489 SRI HASTUTI
48
AGLONEM
A
II
17-SEP-13 25-SEP-13
K80.2

without without
cholecystitis
749 14008694 0001389089 AGUS SUSANTO
47
RGB
II
24-AUG-14 16-SEP-14
23
K80.3

with cholangitis
Perbaikan KONTR
K80.5

cholecystitis
(choledolithiasis)
TN/BATAL
750 15020520 0001382689 OLIH SOLIHIN TN
46
KEMUNIN
G IV(B)
III A
20-JAN-15
28-JAN-15
AKTOR
BPJS
UMUM
AKTOR
751 14020578 0001340389 INING WARTINI, SH 68
PV.PARA RKUTM-B
HYANGA
N3
29-JAN-14
03-FEB-14
K80.1

AKTOR
752 15021429 0001423390 PARDIMAN
44
KEMUNIN
G IV(B)
III A
23-FEB-15 09-MAR-15
14
K80.2

without without
AKTOR
cholecystitis
753 15021750 0001427490 R.M. DJUCHRI
79
KANA
III A
06-MAR-15 20-MAR-15
14
K80.5

cholecystitis
(choledolithiasis)
754 13021775 0001263090 AMMI SUSTIAWATI
69
DRK
RKUTM-B
LANTAI 3
08-MAR-13 16-MAR-13
K80.2

without without
cholecystitis
755 15025626 0001470190 TEDY KRISNA. H
50
KEMUNIN
G IV(B)
III A
08-AUG-15 11-AUG-15
K80.3

with cholangitis
756 14025424 0001379390 SRI SUGIYARNI
43
ANTURIU
M
IA
18-AUG-14 24-AUG-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
757 14004050 0001360690 MAYA SOPIANTI
39
KANA
III A
21-APR-14 07-MAY-14
16
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
758 15001201 0001419291 ANE SUSANTI, NY
28
FRESIA 2
III A
02-FEB-15
05-FEB-15
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
759 14027258 0001406791 JAHJA WAHJUDI,
70
KEMUNIN
GV
II
31-OCT-14 16-DEC-14
46
K80.3

with cholangitis
BPJS
UMUM
TN.
760 13026053 0001304891 LILIS KOMARIAH
BPJS
ASKES
Perbaikan UMUM
Perbaikan KONTR
AKTOR
40
KANA
III A
03-SEP-13 10-SEP-13
K80.2

without without
cholecystitis
KENANGA
1
III A
26-SEP-13 06-OCT-13
10
K80.5

cholecystitis
(choledolithiasis)
Perbaikan TIDAK
Perbaikan UMUM
NY
761 13034632 0001312991 SARIFA FAUJIAH
Meninggal KONTR
> 48 Jam AKTOR
BPJS
ASKES
MAMP
U
762 14024731 0001381191 INDRAYANTI
60
PV.PARA RKUTM-B
HYANGA
N2
17-JUL-14
21-JUL-14
K80.5

cholecystitis
(choledolithiasis)
763 14021652 0001027391 ENGKUS
60
PV.PARA RKUTM-C
HYANGA
N3
11-MAR-14 17-MAR-14
K80.2

without without
cholecystitis
764 13023038 0000649991 TETI MARIANI, NY
51
ANTURIU
M
29-APR-13 06-MAY-13
K80.2

without without
cholecystitis
765 14023449 0001368091 AGUS SLAMET
47
PV.PARA RKUTM-B
HYANGA
N2
26-MAY-14 01-JUN-14
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
766 14001016 0001341991 AMIN UNTARA
48
PV.PARA RKUTM-C
HYANGA
N4
27-JAN-14
21-FEB-14
25
K80.1

AKTOR
BPJS
ASKES
767 13023369 0001264892 AJAT SUDRAJAT
45
KEMUNIN
G IV
III A
13-MAY-13 27-MAY-13
14
K80.2

without without
MAMP
cholecystitis
U
768 13022067 0001254492 IRAH, NY
46
KEMUNIN
G III
III A
19-MAR-13 30-MAR-13
11
K80.2

without without
MAMP
cholecystitis
U
769 14022362 0000666492 ADE ROHAYATI,
55
KEMUNIN
G III(A)
III A
08-APR-14 21-APR-14
13
K80.2

without without
AKTOR
cholecystitis
FIRDAUS
NY
IA
Hal 34/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
770 15024189 0001451892 ENI ROSMIATI, NY
771 15021974 0001434992 IDAS, NY

772 14022072 0001355692 IIN NASIHIN
Umur Sex
27
62
36
P
L
Ruang
J. Kelamin :
Kelas
KEMUNIN
G III(A)
III A
KEMUNIN
G III(A)
III A
AGLONEM
A
II

10-JUN-15
19-JUN-15
16-MAR-15 07-APR-15
27-MAR-14 14-APR-14
ICD
Nm Diagnosa
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
22
K80.3

with cholangitis
Perbaikan KONTR
18
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
AKTOR
AKTOR
AKTOR
BPJS
UMUM
BPJS
UMUM
BPJS
UMUM
773 15024401 0001453592 RUMSIH
73
KEMUNIN
G III(A)
III A
18-JUN-15
26-JUN-15
K80.2

without without
AKTOR
cholecystitis
774 13025495 0001300792 AYI LINDA
40
KEMUNIN
G III
III A
12-AUG-13 19-AUG-13
K80.2

without without
MAMP
cholecystitis
U
775 13021602 0001261493 SAINU
48
ANTURIU
M
IB
02-MAR-13 08-APR-13
37
K80.0

776 15023765 0000334893 GANAWATI
43
ANTURIU
M
25-MAY-15 06-JUN-15
12
K80.2

without without
AKTOR
cholecystitis
BPJS
UMUM
777 14021058 0001346093 IKEU ROSITA NY
49
AGLONEM
A
II
14-FEB-14
21-FEB-14
K80.1
Tidak KONTR
Sembuh AKTOR
BPJS
UMUM
778 14021002 0001345593 IAR YUMIARSIH,NY
46
PV.PARA RKUTM-C
HYANGA
N4
12-FEB-14
17-FEB-14
K80.1

AKTOR
BPJS
ASKES
779 15020440 0001424093 HENI SUHAENI, NY
48
ANTURIU
M
16-JAN-15
07-FEB-15
22
K80.5

cholecystitis
(choledolithiasis)
BPJS
ASKES
SUTRIYANI
780 14023130 0000970293 HILMA EAKARINI,
Perbaikan KONTR
AKTOR
46
PV.PARA RKUTM-C
HYANGA
N3
12-MAY-14 17-MAY-14
K80.2

without without
AKTOR
cholecystitis
40
FRESIA 3
IB
23-AUG-13 03-SEP-13
11
K80.2

without without
cholecystitis
48
ANTURIU
M
IA
04-DEC-13 12-DEC-13
K80.1

783 13024499 0001289693 LUCKY ARIANSA
32
ANTURIU
M
IA
26-JUN-13
28-JUN-13
K80.2

without without
cholecystitis
784 14028005 0001411894 EUIS NURJANAH
55
PV.PARA RKUTM-C
HYANGA
N4
01-DEC-14 05-DEC-14
K80.2

without without
AKTOR
cholecystitis
785 13007394 0001077894 ROSMAYANTI
26
FRESIA 2
13-JUN-13
K80.3

with cholangitis
28-FEB-13 05-MAR-13
K80.2

without without
cholecystitis
23-AUG-13 13-SEP-13
21
K80.2

without without
cholecystitis
NY
781 13010417 0001303793 SUSY PUSPASARI
S KEP NERS
782 13028277 0001329493 ADANG
SUHERMAN TN
786 13021556 0001260994 ACHKMAN
III A
DRK
RKUTM-C
LANTAI 3
19-JUN-13
Sembuh TIDAK
MAMP
U
54
39
788 14027663 0001105895 RADIAN AZHAR G
23
PV.PARA RKUTM-A
HYANGA
N3
17-NOV-14 21-NOV-14
K80.2

without without
AKTOR
cholecystitis
789 13027077 0001317395 SRI RAHAYU S. PD
55
ANTURIU
M
IB
16-OCT-13 26-OCT-13
10
K80.2

without without
cholecystitis
790 13024578 0001287295 YAYAH, HJ. NY
62
AGLONEM
A
II
01-JUL-13
15-JUL-13
14
K80.2

without without
cholecystitis
791 13020971 0001248095 RATIMAH NY
53
KEMUNIN
G III
III A
05-FEB-13
18-FEB-13
13
K80.2

without without
MAMP
cholecystitis
U
792 13024167 0001287295 YAYAH, HJ. NY
62
AGLONEM
A
II
14-JUN-13
18-JUN-13
K80.2

without without
SYARUMAN
787 13025828 0001303995 NI NENGAH MARNI
PS
AGLONEM
A
II
BPJS
ASKES
BPJS
ASKES
Hal 35/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
No No Ipd
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
cholecystitis
793 14020094 0001304996 ENI ROHAENI, NY
33
KEMUNIN
G III(A)
III A
06-JAN-14
22-JAN-14
16
K80.2

without without
MAMP
cholecystitis
U
794 13020856 0001254196 AGUNG GUNAWAN 22
KEMUNIN
G IV
III A
31-JAN-13
22-FEB-13
22
K80.1

MAMP
U
795 14027080 0001397496 YATY MULYATI
43
AGLONEM
A
II
24-OCT-14 31-OCT-14
K80.1

AKTOR
796 13023298 0000810296 RIA C. THERIK, NY
34
AGLONEM
A
II
10-MAY-13 17-MAY-13
K80.2

without without
cholecystitis
797 13023595 0001276696 TRI SETIAWATI, NY 33
ANTURIU
M
IB
22-MAY-13 27-MAY-13
K80.2

without without
cholecystitis
798 15024144 0001457096 ADJUM
KEMUNIN
G IV(B)
III A
08-JUN-15
K80.5

cholecystitis
(choledolithiasis)
KANA
III A
24-JUN-13
14
K80.2

without without
cholecystitis
18-NOV-13 24-NOV-13
K80.1

70
MARTAGUSTAMAN
15-JUN-15
Perbaikan KONTR
AKTOR
799 13024053 0001286196 SOBAR PRIATNA
63
800 13027858 0001325496 NANA SUTISNA,SE
42
PV.PARA RKUTM-C
HYANGA
N4
801 13022519 0001261296 TATI SURYATI, NY
40
KEMUNIN
G III
III A
08-APR-13 25-APR-13
17
K80.2

without without
MAMP
cholecystitis
U
802 14026787 0001378597 AI ROHIYAH
33
KANA
III A
13-OCT-14 03-NOV-14
21
K80.8
K80.1
09-JUL-13
19
K80.2

without without
MAMP
cholecystitis
U
10-JUN-13
Perbaikan KONTR
BPJS
UMUM
Tidak KONTR
Sembuh AKTOR
BPJS
UMUM
24
ANGSANA
III A
01-SEP-14 04-SEP-14
804 13024349 0001026497 ELIYAWATI, NY
42
KEMUNIN
G III
III A
20-JUN-13
805 13025942 0001305097 ZIRMALENA
57
DRK
RKUTM-B
LANTAI 3
30-AUG-13 02-SEP-13
K80.2

without without
cholecystitis
806 13021802 0001262797 EE HAYATI, NY
41
ANTURIU
M
IA
08-MAR-13 17-MAR-13
K80.2

without without
cholecystitis
807 14027717 0001355897 TITIN SURTIATIN,
58
AGLONEM
A
II
18-NOV-14 27-NOV-14
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
KEMUNIN
G III(A)
III A
28
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
18
K80.2

without without
MAMP
cholecystitis
U
808 15022832 0001436797 ONYAS RUKIAH
56
17-APR-15 15-MAY-15
BPJS
ASKES
AKTOR
803 14025822 0000431997 ENENG
NY
BPJS
UMUM
AKTOR
AKTOR
BPJS
UMUM
BPJS
UMUM
809 13027610 0001313098 SUARSA
41
KEMUNIN
G IV(A)
III A
07-NOV-13 25-NOV-13
810 14021135 0001343998 DIYAH
58
KEMUNIN
G III(A)
III A
18-FEB-14
27-FEB-14
K80.2

without without
AKTOR
cholecystitis
811 13025922 0001263599 WINARDI KAHDAR
50
ANTURIU
M
IA
27-AUG-13 29-AUG-13
K80.2

without without
cholecystitis
812 13022475 0001269599 MUMUN
47
KEMUNIN
G IV
III A
03-APR-13 17-MAY-13
44
K80.5

cholecystitis
(choledolithiasis)
813 13027296 0001263599 WINARDI KAHDAR
TN.
MAMP
U
50
PV.PARA RKUTM-C
HYANGA
N2
25-OCT-13 29-OCT-13
K80.1

50
PV.PARA RKUTM-C
HYANGA
04-NOV-13 10-NOV-13
K80.2

without without
,DR
814 13027515 0001263599 WINARDI KAHDAR,
Sembuh TIDAK
Hal 36/ 37

BANDUNG

PERIODE :
Kode ICD :
SMF
s/d
K80
No RM
s/d
30-SEP-15
%
%
%
%
K80.8
KELOMPOK UMUR :
No No Ipd
01-JAN-13
Nama Pasien
Umur Sex
Ruang
J. Kelamin :
Kelas
ICD
Nm Diagnosa
cholecystitis
N3
815 13022490 0000995199 JUMALI
57
RGB
II
07-APR-13 13-APR-13
K80.2

without without
cholecystitis
816 14021832 0001352299 EUIS DANILAH
39
AGLONEM
A
II
18-MAR-14 29-MAR-14
11
K80.3

with cholangitis
Perbaikan KONTR
AKTOR
BPJS
ASKES
817 15021680 0001417999 KUSNADI
45
ANTURIU
M
04-MAR-15 09-MAR-15
K80.2

without without
AKTOR
cholecystitis
BPJS
ASKES
818 14011573 0001407999 ODEH, NY.
64
FRESIA 2
III A
05-NOV-14 12-NOV-14
K80.4

with cholecystitis
Sembuh KONTR
BPJS
UMUM
11
K80.5

cholecystitis
(choledolithiasis)
Perbaikan KONTR
819 14023671 0001371599 ANTON
28
KANA
III A
05-JUN-14
16-JUN-14
ISRAENDRA
820 14027174 0001394699 AAH HERAWATI,
KEMUNIN
G III(A)
III A
28-OCT-14 18-NOV-14
21
K80.2

without without
AKTOR
cholecystitis
51
AGLONEM
A
II
13-AUG-13 30-AUG-13
17
K80.5

cholecystitis
(choledolithiasis)
61
ANGSANA
III A
05-AUG-14 15-AUG-14
10
K80.1

AKTOR
TOTAL
RATA-RATA LAMA RAWAT
BPJS
UMUM
SOETIYAWAN
822 14025040 0001383899 SITI TJINTARSIH
AKTOR
62
NY
821 13025540 0001293899 TOMMY
AKTOR
11497
Perbaikan ASKES
BPJS
ASKES
822
13.99
KET:
LOS : Leng Of Stay (Lama Rawat)
Hal 37/ 37

Cholelytiasis 2013 2015

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Cholelytiasis 2013 2015

Uploaded by

Copyright:

Available Formats

INSTALASI REKAM MEDIS

RSUP Dr. HASAN SADIKIN

MORBIDITAS PASIEN RAWAT INAP

1 13015423 0001335400 TITIN, NY

2 13020027 0001245600 ROSWATI, NY

3 13028288 0001328500 POPON MINTARSIH 54

4 14027095 0000076600 TITI SUPRAPTI, NY

5 13009214 0001297700 OLAS NY

Tgl Masuk Tgl Keluar LOS

Disposisi C_Bay Jamin

Calculus of gallbladder Perbaikan TIDAK

Calculus of gallbladder Perbaikan UMUM

Calculus of gallbladder Perbaikan ASKES

Calculus of gallbladder Perbaikan KONTR

Calculus of bile duct

Calculus of gallbladder Perbaikan KONTR

6 14026764 0001393700 EDWIN SUHARDANI 33

7 13023735 0001283000 HABIB ALI

Calculus of bile duct

8 15025627 0001470200 DIDI

Calculus of bile duct

9 14022748 0001359400 QODIR KURDINAT

Calculus of gallbladder Perbaikan KONTR

10 15021871 0001431800 SAHAT MANGARA

11 14027820 0001403901 IRAWATI ,NY

Calculus of gallbladder Perbaikan KONTR

12 14020877 0001344501 KHODIJAH, HJ

Calculus of gallbladder Perbaikan UMUM

13 14002504 0000038902 MOCH. GUN GUN

Calculus of gallbladder Perbaikan KONTR

14 15022723 0001444202 SENDY YOLA, NY.

Calculus of gallbladder Perbaikan KONTR

15 15022080 0001430302 MAMAH, NY

Calculus of gallbladder Perbaikan KONTR

16 14028661 0001329502 TUTI , NY.

Calculus of bile duct

17 13027750 0001258302 SUHERMANTO, TN. 52

Calculus of gallbladder Perbaikan ASKES

18 13025939 0001299402 SUMIATI, NY

Calculus of gallbladder Perbaikan ASKES

19 14023355 0001339602 NINING TARMINI

Calculus of gallbladder Perbaikan KONTR

20 14025575 0001384803 YETTY SUMIYATI

Calculus of gallbladder Perbaikan KONTR

21 15000724 0001425403 AEP

Calculus of bile duct

Calculus of gallbladder Perbaikan KONTR BPJS PBI

INSTALASI REKAM MEDIS

MORBIDITAS PASIEN RAWAT INAP

23 13027107 0001245103 DADE SAMBAS

24 13008778 0001295303 RUDI RUSANDI

25 13028641 0000509003 DYAH DWI P. HJ.

26 13026705 0001301303 SANTI TRIANTI, NY

27 14013262 0001034903 ETTY

Tgl Masuk Tgl Keluar LOS

Disposisi C_Bay Jamin

Calculus of gallbladder Sembuh TIDAK

Calculus of bile duct

Calculus of gallbladder Perbaikan ASKES

Calculus of gallbladder Perbaikan KONTR

28 14027100 0001398603 IDA KOMARIDAH

Calculus of gallbladder Perbaikan KONTR

29 15022923 0001411504 LILIS NURYANI