Program Kerja Igd

SENSUS HARIAN INSTALASI GAWAT DARURAT
RSUD SURADADI KABUPATEN TEGAL
TANGGAL/BULAN : 1 Januari 2018
JAM ASAL PASIEN CARA BAYAR CARA KELUAR

NO. NO. RM NAMA PASIEN TGL LAHIR ALAMAT DIAGNOSA DOKTER
MASUK dr. Layali
DS R DOA DP U PBI N PBI JR L RI RJ MD RJK
1 02.18 19247 ABDUL KARIM.SDR 11/13/1997 PURWAHAMBA 28/11 VL DYAH 1 1 1 -
2 00.55 52912 MARNI.NY 1/1/1958 KRAMAT 8/3 COLIC RENAL DYAH 1 1 1 -
3 03.35 52915 MIFTAKHUL AZIZ.TN 5/22/1965 BOJONGSANA 9/3 RFA DYAH 1 1 1 -
4 03.46 45633 AHMAD NAWAWI.TN 7/3/1960 BALAMOA 3/1 CHF DYAH 1 1 1 -
5 05.46 52916 WILDAN ARI M.AN 1/23/2010 JATIBOGOR 1/4 DYAH 1 1 1 -
6 07.10 52917 FADLAN KHALEF,AN 5/19/2007 PLUMBUNGAN 3/1 GEA + VOMITUS FREQUENT FARADITA 1 1 1
7 07.20 52918 ISWANTO,TN 3/25/1985 DEMANGHARJO 5/1 GEA + VOMITUS FREQUENT FARADITA 1 1 1
8 08.55 46887 MELDA SHERLY,AN 3/23/2016 KARANGMULYA 4/7 FEBRIS + GEA EDI 1 1 1
9 09.00 52708 NANI KUMALA DEWI,NY 2/5/1988 KRAMAT 5/1 DYSPEPSIA EDI 1 1 1
10 10.00 O09414 SUJAIL,TN 9/28/1958 SURADADI 2/14 MIALGIA EDI 1 1 1
11 10.10 52920 PATMAH,NY 10/10/1955 SURADADI 1/15 DHF EDI 1 1 1
12 10.10 52841 TASJAN,TN 12/31/1957 KARANGMULYA 1/8 POST OP EDI 1 1 1
13 11.20 41626 SITI MAHFIROH,NY 6/19/1989 KRAMAT 1/2 DYSPEPSIA EDI 1 1 1
14 11.30 52922 TARJONO,TN 10/11/1958 SIDAMULYA 1/2 IKTERIK EC SUSP HEPATOMA EDI 1 1 1
15 14.21 52925 WINARNI,NY 7/30/1989 KERTASARI 8/7 HAMIL DENGAN RIWAYAT SC DYAH 1 1 1
16 17.16 52928 WAKHIDI,TN 1/1/1947 TANJUNGHARJA 3/4 GASTRITIS DYAH 1 1 1
18 17.55 52929 ALIF TAUFAN SYAIFULLAH,SDR 3/23/1993 DEPOK COMMEN COLD DYAH 1 1 1
19 15.30 42501 BINTANG PUTRA PRATAMA,AN 7/9/2012 PLUMBUNGAN 4/7 OBS FEBRIS DYAH 1 1 1
20 15.30 42501 BINTANG PUTRA PRATAMA,AN 7/9/2012 PLUMBUNGAN 4/7 RFA DYAH 1 1 1
21 20.12 42948 KARNITI,NY 12/30/1953 KERTASARI 1/2 VERTIGO DYAH 1 1 1
22 20.12 52930 MIFTAKHUL JANAH,NY 2/6/1971 DEMANGHARJO 5/2 VOMITUS DYAH 1 1 1 -
23 20.12 23298 SINGGIH HARTOYO,TN 3/27/1973 BONGKOK 1/1 DISPEPSIA DYAH 1 1 1 -
24 21.45 52932 SANALI.TN 4/1/1962 TANJUNGHARJA 1/3 FADEL 1 1 1
JUMLAH 22 1 0 0 14 5 4 0 0 11 11 0 0 - -
DS : Datang Sendiri, R : Rujukan, DP : Diantar Petugas, U : Umum, N PBI : Non PBI, JR : Jasa Raharja, L : Lainnya, RI : Rawat Inap, RJ : Rawat Jalan, MD : Meninggal <8 Jam, RJK : Rujuk
Kepala Ruang IGD
SENSUS HARIAN KECELAKAAN LALU LINTAS INSTALASI GAWAT DARURAT


MASUK dr. Layali
1 02.00 52914 AGUNG IMAM A.SDR 8/10/1991 SURADADI 2/8 CKR DYAH 1 1 1 -
2 07.35 52919 REZA FAKHLEVI,TN 1/12/1991 LEBETENG 6/1 VL + VE FARADITA 1 1 1 -
3 01.48 52921 KARNADI,TN 1/1/1948 KRAMAT 1/1 VL + VE EDI S 1 1 1 -
4 13.55 52924 ULFA ASMAWATI,NN 7/29/1997 PLUMBUNGAN 3/2 DYAH 1 1 1 -
5 13.55 52923 DEKA IZAZAN SAPUTRA,AN 12/12/2003 PLUMBUNGAN 3/2 DYAH 1 1 1 -
6 14.30 52926 KHARISMA AZZAH,AN 12/9/2001 PLUMBUNGAN 3/2 DYAH 1 1 1
8 16.00 52927 SAMSURI,TN 12/30/1963 PURWAHAMAB 3/2 MIYALGIA DYAH 1 1 1
JUMLAH 6 0 0 0 3 0 0 2 0 2 4 0 0 - -
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) SAMPEL OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. EDI dr. Faradita Sederhana Kecil Sedang Berat DARAH dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- - 1 28,000 - - - - 1 35,000 - - - - - - - - - - -
- 1 28,000 - - - - - - - - - - -
- 1 28,000 - - - - - - - - - - -
- 1 28,000 - - - 2 70,000 2 108,000 - - 10,800 - - -
- 1 28,000 - - - 1 35,000 1 54,000 - - - - - 1 23,000
1 28,000 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
1 28,000 1 35,000 1 54,000 - - 15,000 - - - -
1 28,000 - - - - - 15,000 - - - -
1 28,000 - - - - - - - - -
1 28,000 - - - - - - - - -
1 28,000 - 2 70,000 2 108,000 - - 115,000 - - - -
1 28,000 - - 1 54,000 - - - - - -
1 28,000 - 1 35,000 1 54,000 - - 15,000 - - - -
1 28,000 - 1 35,000 2 108,000 - - 15,000 - - - -
1 28,000 1 54,000 15,000 -
1 28,000
1 28,000 1 35,000
1 28,000 - -
1 28,000 1 35,000 1 54,000 15,000 1 23,000
1 28,000 - - - - - - - - - -
- 1 28,000 - - - 2 70,000 2 108,000 - - 15,000 - - - -
- 1 28,000 - - - - - - - - - - -
- - 13 364,000 - - 7 196,000 2 56,000 14 490,000 15 810,000 - - - - 235,000 10,800 - - - - 3 69,000

PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 )
OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. EDI dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- - 1 28,000 - - - - 1 35,000 1 54,000 - - 1 80,000 - 14,400 - - 1 23,000 -

- - - - 1 28,000 - - 1 80,000 - - - - -
- - - 1 28,000 - - 1 54,000 - - - - - -
- 1 28,000 - - - 1 35,000 1 35,000 - - 15,000 - 1 23,000 -
- 1 28,000 - - - - - - - - - - -
1 28,000 1
1 28,000
- - 4 112,000 - - 1 28,000 1 28,000 2 70,000 3 143,000 - - 2 160,000 - 29,400 - - 2 46,000 - -
KONSUL DOKTER SPESIALIS PENDAPATAN BERDASAR CARA BAYAR
AMBULANCE VISUM JUMLAH
dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr.Fira Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - - - 63,000 63,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 216,800 - - 216,800 -
- - - - - - 140,000 140,000 - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
1 23,000
-
- - - - - -
- - - - - - 206,000 - 206,000 - -
- - - - - - 28,000 28,000 - - -
- - - - 1 23,000 - - - - - - - - 709,800 287,000 206,000 216,800 -

709,800
709,800
dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - - - 234,400 234,400 - - -
- - - - - - 108,000 108,000 - - -
- - - - - - 82,000 82,000 - - -
- - - - - - 136,000 - - - 136,000
- - - - - - 28,000 - - - 28,000
- - - - - - - - - - - - - - 588,400 424,400 - - 164,000

588,400

MASUK dr. Edi dr. FaD
1 00.30 52933 TARSINAH.NY 10/20/1971 KRAMAT 2/1 HT FADEL 1 1 1 1
2 01.10 52934 KUEWATINY 5/7/1969 BEKASI DISPEPSYA FADEL 1 1 1 1
3 02.00 52935 MOH NOVAL.AN 8/1/2016 SIDAHARJA 8/5 KDS FADEL 1 1 1 1
4 04.00 52936 AYU WULANSARI.AN 10/11/2004 SURADADI 2/1 FEBRIS FARADITA 1 1 1 1
5 07.00 52937 SURIPTO,TN 1/1/1990 BOJONGSANA 4/2 VL FARADITA 1 1 1 -
6 07.50 47809 KHAERUL IRFANSYAH,SDR 5/5/1997 SURADADI 1/6 GEA FARADITA 1 1 1 -
7 08.05 45666 SAYIDI,TN 7/1/1953 GEMBONGDADI 5/3 PPOK FARADITA 1 1 1 -
8 08.15 41527 AHMAD QOTRUL,AN 9/16/2008 PURWAHAMBA 7/3 RFA FARADITA 1 1 1 -
9 08.45 52943 M.SUPRIYANTO,SDR 2/15/1999 SEMEDO 6/2 VL FARADITA 1 1 1 -
10 08.50 52946 IKA NURRAHMA,AN 3/14/2005 BONGKOK 1/5 DKA + INFEKSI SEKUNDER FARADITA 1 1 1 -
11 09.45 52949 SANDY AULIA,AN 1/25/2008 PURWAHAMBA 20/8 VOMITUS FREQUENT FARADITA 1 1 1 -
12 09.45 38618 MARKUMI,NY 7/1/1957 JATIBOGOR 1/11 GASTRITIS AKUT FARADITA 1 1 1 -
13 10.10 52951 FARKHATUN ANGGI,NN 4/19/1999 TANJUNGHARJA 4/3 TYPOID FEVER FARADITA 1 1 1 -
14 10.45 41861 KHAMISAH,NY 4/2/1952 TANJUNGHARJA 2/2 CEPALGIA BERAT FARADITA 1 1 1 -
17 12.25 52960 TUMI,NY 7/20/1982 RANGGIMULYA 3/1 P2A1 H35 MGG DGN SUSP MOLA FARADITA 1 1 1 -
18 10.10 52953 AYU MEGAWATI,NY 6/2/1996 SIDAHARJA 1/1 G1P0A0 H40MGG DGM HDK FARADITA 1 1 1 -
19 14.54 9367 DARYADI,TN 10/10/1948 RANGIMULYA 4/2 DIPSNEU EDI 1 28,000
20 13.05 19366 PARTI,NY 12/31/1967 JATIBOGOR 3/5 CLOSE FRACTURE HUMERUS FARADITA 1 1 1 -
22 15.27 52963 SUGIYANTO,AN 2/11/2002 KEDUNGKELOR 5/2 VL EDI 1 1 1 1 28,000
23 16.41 52964 KHALIMATUL AZIZAH,NY 5/4/1992 BANJARTURI 1/2 FEBRIS + RFA EDI 1 1 1 1 28,000
24 16.57 35192 ADNAN AZRORI,AN 6/22/2013 SUKAREJA 3/9 FEBRIS + TFA EDI 1 1 1 1 28,000
25 17.58 52966 EKA MURNINGSIH,NY 10/19/1993 GROGOL 10/4,DUKUHTURI HAMIL DENGAN KPD EDI 1 1 1 1 28,000
26 18.58 52967 RABID,TN 5/17/1960 SUKAREJA 3/9 VERTIGO EDI 1 1 1 1 28,000
20 19.00 3585 TARIYAH.NY 9/12/1941 SURADADI 1/3 DIPSNEU EDI 1 1 1 1 28,000
21 19.15 8040 TASRIPAH,NY 2/8/1950 JATIMULYA 3/6 GEA EDI 1 1 1 1 28,000
22 20.50 52968 YULLI SUSMIYATI,NY 7/7/1979 KERTASARI 1/3 AB IMINEN EDI 1 1 1
23 20.55 52969 M.WAHYU S,AN 12/20/2004 KARANGWULUH 4/1 FEBRIS EDI 1 1 1
24 21.05 48314 CAHYONO.TN 1/1/1947 JATIBOGOR 2/6 SINKOP DYAH 1 1 1
25. 22.00 52970 FARAH AZHAR.AN 1/1/2015 TANJUNG PRIOK JKT KDK DYAH 1 1 1
JUMLAH 22 2 0 0 13 8 3 0 0 19 7 0 0 8 224,000 4
Kepala Ruang IGD

TANGGAL/BULAN : 2 0

MASUK dr. Layali dr. Fai
1 11.15 52957 DURROTUN NASKHIN,SDR 5/28/1999 NGELING 3/1 JEPARA FRCTURE 1/3 DISTAL OS RADIUS FARADITA 1 1 1 -
2 11.15 52958 DAKIYAH,NY 7/12/1974 DEMANGHARJO 8/1 CKR GCS IS + HEMATOM FARADITA 1 1 1 -
3 13.50 52961 NOVI NUR FAUZIAH,NN 11/17/1998 KERTASARI 5/4 FRAKTUR HUMERUS EDI 1 1 -
4 15.02 52962 DAMIR,TN 1/21/1970 JAGALEMPENI 1/5.WANASARI EDI 1 1 -
5 11.10 40914 NUR IKHLAS TADIANA,AN 1/4/2002 BOJONGSANA 7/3 CKR + FRACTURE NASSAL FARADITA 1 1 1 -
6 11.40 52959 ALFIYAH DAMAYANTI,NN 6/14/1999 PLUMBUNGAN 2/1 SPRAIMN SOLDER FARADITA 1 1 1 -
7 23.00 52971 SAHRONI.TN 12/1/1963 MARIBAYA 1/3 DYAH 1 1 1
JUMLAH 4 0 0 0 2 0 1 1 0 0 2 0 0 - - -
OKSIGEN
dr. FaDEL dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
1 35,000 2 108,000 - - 15,000 - - - -

- - - - - - - -
1 35,000 1 54,000 - - 15,000 - - - 1 23,000
1 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - - - 1 28,000 1 35,000 1 54,000 - 1 80,000 15,000 - - 1 23,000 -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 2 70,000 2 108,000 1 65,000 - 15,000 - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 - - - 1 80,000 - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - - -
- - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - - - -
1 28,000 15,000
1 28,000 - 2 108,000 - - 15,000 - - - -
- - - - - - - -
1 28,000 2 70,000 2 70,000 15,000
- 1 54,000 - -
- - - -
1 35,000 1 54,000 15,000 1
1 35,000 2 108,000 15,000
2 70,000 2 108,000 15,000
2 70,000 2 108,000 - - 15,000 - - - -
2 70,000 2 108,000 - - 15,000 - - - -
1
1 1 1 15,000 1
- - - - - - - 14 364,000 22 770,000 27 1,420,000 1 65,000 2 160,000 255,000 - - - 1 23,000 4 69,000

OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. EDI dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- - - - 1 28,000 - 1 54,000 - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - 1 28,000 - 1 35,000 1 54,000 1 65,000 - 15,000 - - - -
- - - - - - - - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - - 1 28,000 2 56,000 1 35,000 2 108,000 1 65,000 - - 15,000 - - - - - - -

dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. NADIA Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - 143,000
- - - - - - -
- - - - - - 112,000
- - - - - - 112,000
- - - - - - 220,000
- - - - - - 28,000
1 23,000 - - - - - 294,000
- - - - - - 28,000
- - - - - - 108,000
- - - - - - 28,000
- - - - - - 140,000
- - - - - - 206,000
- - - - - - 117,000
- - - - - - 206,000
1 23,000
- - 1 23,000 - - - 159,000
- - - - - - 28,000
1 23,000
- - - - - - 206,000
- - - - - - 206,000
1 23,000 1 23,000 2 46,000 - - - - - - - - 2,341,000 - - - -
2,341,000

- - - - - - 82,000
- - - - - - 28,000
- 1 23,000 - - - - 205,000
- - - - - - -
- - - - - - 28,000
- - - - - - 28,000
- - 1 23,000 - - - - - - - - - - 315,000 - - - -
315,000

MASUK dr. Layali dr. Faila
1 01.30 12063 WARSITI.NY 4/2/1965 RANGIMULYA 1/4 DISPEPSYA DYAH 1 1 1 - -
2 04.00 52973 TANIJAH.NY 5/13/1980 KERTASARI 4/8 KPD DYAH 1 1 1 -
3 05.00 52974 WIDIYAWATI.NY 9/10/1989 JATOBOGOR 1/1 DYAH 1 1 1 -
4 08.00 52982 TITI YULIANTI.NY 6/23/1993 SUKAREJA 2/9 APENDICITIS FARADITA 1 1 1 -
5 10.00 52979 AJI SETIAWAN.SDR 3/12/1998 JATIBOGOR 1/4 CEK GOLDA FARADITA 1 1 1 -
8 13.45 52997 SUCHAENAH.NY 12/2/1977 RAWAMANGUN 4/1/4.PGADUNG TB PARU FARADITA 1 1 1 -
11 12.08 52993 RINA SUSANTI.NY 3/14/1991 BANJARSARI 3/4 H DG IUFD FARADITA 1 1 1 -
12 13.05 52995 ALVON NUR A.AN 3/19/2001 KERTASARI 1/2 HEMATOME FARADITA 1 1 1 -
13 14.40 32826 NAJWA HAFIZAH,AN 6/17/2015 KEMUNING 4/4 VL ROSNELINA 1 1 1 -
14 14.44 50597 SUHEMI,NY 12/31/1950 JATIBOGOR 1/4 VERTIGO + HT ROSNELINA 1 1 1 -
15 16.20 18609 SALAMAH,NY 5/2/1943 PLUMBUNGAN 3/2 CHF + DM ROSNELINA 1 1 1 -
16 16.30 52928 WAKHIDI,TN 8/6/1946 TANJUNGHARJA 3/4 CHEPALGIA ROSNELINA 1 1 1 -
17 17.35 38377 KHOTIJAH,NY 1/1/1946 JATIMULYA 2/6 HT BERAT+ VERTIGO ROSNELINA 1 1 1 -
18 18.00 52999 RIFKI AJI MAULANA,AN 7/4/2006 KEDUNGKELOR 5/1 SUSP BRPN ROSNELINA 1 1 1 -
19 20.45 53001 ARIPIN,TN 10/10/1962 KARANGMULYA 3/3 CHEST PAIN + HT ROSNELINA 1 1 1 -
20 23.15 52002 DHARMO EKA,TN 7/23/1943 AFDIWERNA ASMA BRONCHIALE EDI.S 1 1 1

TANGGAL/BULAN : 3 KRAMAT 1/1

7 10.05 52989 SUKARDI.TN 12/26/1941 SIDAMULYA 4/2 CKR FARADITA 1 1 1 -
9 11.40 52992 TESTIA AMANDA.AN 6/5/2002 SIDAHARJA 1/1 VE FARADITA 1 1 1 - -
6 10.05 52988 TAKHMID.TN 1/1/1943 KERTASARI 3/2 VULNUS LACERATUM FARADITA 1 1 1 -
10 11.40 52991 FEBRISARI MULYATI.AN 2/2/2003 TANJUNGHARJA 2/4 VE FARADITA 1 1 1 - -
5 11.40 52994 CINDI AULIA SYIFA,AN 3/27/2004 TANJUNGHARJA 2/4 CKR FARADITA 1 1 1 -
OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini
- 1 28,000 - - - 1 35,000 2 108,000 - - - 15,000 - 1 23,000 - -

- 1 28,000 - - - 1 35,000 1 54,000 - - 15,000 - - - -
- 1 28,000 - - - 1 35,000 1 54,000 - - 15,000 - - - -
- - - - 1 28,000 1 35,000 1 54,000 - 15,000 - - 1 23,000 -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 2 70,000 1 54,000 - - 15,000 - - - - 1
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - - -
- - - - 1 28,000 - - - - - - - -
- - 1 28,000 - - - 1 54,000 - - - - - -
- - 1 28,000 - - 1 35,000 - - - - - - -
- - 1 28,000 - - 2 70,000 3 162,000 - - 15,000 - - - -
- - 1 28,000 - - 2 70,000 2 108,000 - - - - - -
- - 1 28,000 - - 2 70,000 2 108,000 - - 15,000 - - - -
- - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - 1 28,000 - - 2 70,000 2 108,000 - - 15,000 - - - -

OKSIGEN
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 2 70,000 2 108,000 1 65,000 - 15,000 10,800 - 1 23,000 -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - 1 23,000 -
dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. YESSI Sp.PD UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - - - 194,000 - 194,000 - -
- - - 1 23,000 - - 140,000 - 140,000 - -
- - - - - - 117,000 117,000 - - -
- - - - - - 140,000 - 140,000 - -
- - - - - 28,000 28,000 - - -
23,000 - - - - - 175,000 - 175,000 - -
- - - 1 23,000 - - 140,000 - - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 82,000
- - - - - - 63,000
- - - - 1 23,000 - 283,000
- - - - - - 206,000
- - - - - - 206,000
- - - - - - 140,000
- - - - - - 206,000
2,148,000

- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 - - - 28,000
- - - - - - 304,800 304,800 - - -
- - - - - - 28,000 - - - 28,000
- - - - - 140,000 - - - 140,000
528,800

MASUK
1 00.35 53003 DWI AJI SUSILO,SDR 5/30/1995 SIDAHARJA 6/4 DISPEPSIA EDI.S 1 1 1
2 00.35 53004 ANGGA SAPUTRA 10/1/1994 LAMPUNG SELATAN GASTRITIS AKUT EDI.S 1 1 1
3 02.15 53005 RISA SHERLYANI,NY 5/11/1978 VOMITUS FREQUEN DISPEPSIA EDI.S 1 1 1
4 07.40 53007 SRIYATI.NY 10/19/1958 KREMAN 6/2 VERTIGO DYAH 1 1 1
5 09.00 53014 ASENG RUKMAN.TN 1/1/1973 PURWOKERTO LOR 2/2 HIPERLIPEDEMIA DYAH 1 1 1
6 09.00 53018 MARLI.NY 7/5/1945 SIDAMULYA 2/2 KONJUNGTIVITIS DYAH 1 1 1
7 09.50 53017 SODIKIN.TN 10/27/1984 KESEMEN 2/8.SKRJA PNEMUTHORAK DYAH 1 1 1
8 10.10 44845 SUMARTO.TN 12/31/1955 SEMEDO 3/1 PPOK + TB PARU DYAH 1 1 1
9 12.52 53022 TAHRIRUDIN.TN 12/30/1961 KERTASARI 6/2 DEMAM DENGUE + VOMITUS DYAH 1 1 1
10 12.00 53021 SISKA LEKISA O.NN 10/15/1996 DS CIGUGUR 14/4/.SUBANG GASTRITIS AKUT DYAH 1 1 1
11 15.01 31647 DEWI AMANAH,NY 6-Jun-89 TANJUNGHARJA 6/3 RETENSIO URINE LAYALI 1 1 1
12 2938 292938 RAMADHANI S,AN 7/19/2003 BOJONGSANA 10/4 CORPOL ARRIATA DEXTRA LAYALI 1 1 1
13 19.00 52968 YULLI S,NY 1/1/1978 KERTASARI 6/2 AB INCOMPLIT LAYALI 1 1 1
14 19.27 53024 DARMINI,NY 1/1/1977 PURWAHAMBA 28/11 VL PUNCTUM DGN ANALSIVE CORPUS LAYALI 1 1 1
15 19.40 53025 MUHAMAD SYARIFUL ARIFIN,SDR 1/1/1996 KERTAYASA 1/4 INTOKSIKASI LAKOHOL LAYALI 1 1 1
16 19.42 53026 LILY COLFOORT 8/9/1947 SERPONG UTARA FEBRIS 1 HARI LAYALI 1 1 1
17 20.40 53027 MURNI ASIH DESI,NN 12/5/1999 SEMEDO 3/1 G1P0A0 H5MGG DGN HEG LAYALI 1 1 1
18 21.10 O5073 WATEM,NY 12/6/1950 SEMEDO 2/1 ANEMIA + GASTRITIS ROSNELINA 1 1 1
19 21.17 47541 SAROTUN,,NY 12/11/1979 JATIMULYA 6/4 TYPOID FEVER ROSNELINA 1 1 1
20 21.40 42746 PASTA ALFARIZKI PUTRA,AN 1/4/2017 PLUMBUNGAN 4/2 TYPOID FEVER ROSNELINA 1 1 1
JUMLAH 20 0 0 0 9 7 4 0 0 9 11 0 0

TANGGAL/BULAN : 3 0

MASUK
1 13.00 27884 IZATUL UMA.AN 9/28/2012 SIDAHARJA 12/6 HEMATOMA TEMPORAL DYAH 1 1 1
SEMPEL DARAH OKSIGEN
dr. Layali dr.Edi dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD
- 1 28,000 - - - - - 1 35,000 1 54,000 - - - 15,000 - - -

- 1 28,000 - - - - - - - - - - -
- 1 28,000 - - - - - - - - - -
- - 1 28,000 - - - 2 70,000 2 108,000 - - 15,000 - -
- - 1 28,000 - - - - - - - - -
- - 1 28,000 - - - - - - - - -
- - 1 28,000 - - - 1 35,000 2 108,000 - - 15,000 10,800 -
- - - 1 28,000 - - - 2 70,000 2 108,000 - - 15,000 10,800 -
- - - 1 28,000 - - - 2 70,000 2 108,000 - - 15,000 - -
- - 1 28,000 - - - - - - - - -
- - - - - - - - - - -
1 28,000 - - - - - - - - - -
1 28,000 - - - - - - - - - -
1 28,000 - - - - - - - - - -
1 28,000 - - - - - - - - - -
1 28,000 - - - - - - - - - 15,000 -
1 28,000 - - - - - 1 35,000 1 54,000 - - 15,000
1 28,000 2 70,000 2 108,000 15,000
1 28,000 1 35,000 1 54,000
1 28,000 - -
6 168,000 3 84,000 7 196,000 3 84,000 - - - - 12 420,000 13 702,000 - - - - 45,000 21,600 - -

OKSIGEN
dr. Layali dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B
- - 1 28,000 - - - - - - - - -
KONSUL DOKTER SPESIALIS PENDAPATAN BERDASAR CARA
dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An UMUM BPJS PBI
- - - - - - - - - - 117,000 - -
- - - - - - - - 28,000 28,000 -
- - - - - - - - 28,000 28,000 -
- - - - - - - - 206,000 - -
- - - - - - - - 28,000 28,000 -
- - - - - 1 23,000 - - 51,000 51,000 -
- - 1 23,000 - - - - - 204,800 - 204,800
- - 1 23,000 - - - - - 239,800 - 239,800
- 1 23,000 - - - - - - 229,000 - -
- - - - - - - - 28,000 28,000 -
- - - - - - - - - - -
- - - - - 1 ### - - - 51,000 -
- - - - - - - - - 28,000 28,000
- - - - - - - - - 28,000 28,000
- - - - - - - - - 28,000 28,000
- - - - - - - - - 28,000 28,000
- - 1 23,000 2 46,000 - - - 1 ### 23,000 - - - - - - 1,159,600 163,000 556,600

1,159,600

Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An UMUM BPJS PBI BPJS NON PBI
- - - - - - - - 28,000 28,000 - -
28,000
ATAN BERDASAR CARA BAYAR
BPJS NON PBI JASA RAHARJA

117,000 -
- -
- -
206,000 -
- -
- -
- -
- -
229,000 -
- -
- - -
- 51,000 -
- - -
- - -
- - -
- - -
552,000 51,000
ARA BAYAR
JASA RAHARJA
-

MASUK dr.Ilham
1 01.50 53028 DAKRUN,TN 12/24/1978 PLUMBUNGAN 1/2 ACS STEMI ROSNELINA 1 1 1
2 02.25 53029 ADE AAM MARGANI,TN 2/12/1973 MARIBAYA 4/1 COLIC ABDOMEN ROSNELINA 1 1 1
3 02.50 53030 FILZA AZZAYIN,AN 5/2/2016 DEMANGHARJO 6/1 RFA ROSNELINA 1 1 1
4 02.50 53031 MOHAMMAD FAHRIL ,AN 8/12/2017 SIDAHARJA 7/4 RFA + FEBRIS ROSNELINA 1 1 1
5 06.05 53032 AGUS MAKSUM,TN 12/12/1980 KERTAYASA 6/2 VL ROSNELINA 1 1 1
6 06.15 53034 NURSIAM AZIZAH,NY 4/15/1990 SURADADI 3/10 G1P0A0 H37MGG DGN KPD ROSNELINA 1 1 1
7 08.00 53040 SALFA PUTRA.AN 5/8/2008 KARANGMULYA DHF FARADITA 1 1 1
8 08.30 530402 MASRIAH.NY 12/17/1957 KARANGWULUH 3/2 HEMIPARESIS FARADITA 1 1 1
9 09.10 53047 YAHYA.TN 6/10/1986 SURADADI 1/9 SKD FARADITA 1 1 1
10 10.00 53036 SAINAH.NY 7/1/1967 BADAK BELIK HML DG LETAK LINTANG FARADITA 1 1 1
13.15 10.06 53048 BUDI SANTOSO 9/20/1994 PAGONGAN,TEGAL VL FARADITA 1 1 1
12 10.30 33056 SRI EKA.NY 1/1/1993 MARIBAYA4/3 KPD FARADITA 1 1 1
13 11.30 1998 SITI SUTINAH.NY 4/14/1981 SIDAHARJA 7/4 GASTRISTIS FARADITA 1 1 1
14 11.00 53046 DARYATI.NY 1/1/1979 PURWAHAMBA 6/2 HDK FARADITA 1 1 1
15 13.00 53052 umi khasanah.ny 7/20/2003 bongkok 3/3 vl FARADITA 1 1 1
16 13.20 53053 WAISAH.NY 8/18/1971 SIDAMULYA 2/8 DISPEPSYA FARADITA 1 1 1
17 13.30 53045 PRASETIOWATI.NY 1/1/1981 SIDAMULYA FARADITA 1 1 1
18 11.30 44783 AMELIA WULANDARI 1/1/2003 KERTASARI SINCOP FARADITA 1 1 1
19 14.00 53054 RAFKA AL FARIZI.AN 3/28/2017 TANJUNGHARJA 8/3 RFA ILHAM 1 1 1 1
20 14.35 34196 ROPIAH.NY 12/31/1963 PURWAHAMBA 11/5 HT + DM DYAH 1 1 1
21 15.03 52943 MOH SUPRIYAN.SDR 2/15/1999 SEMEDO 6/2 KONTROL LUKA JAHIT DYAH 1 1 1
22 15.00 53055 SATIO.TN 5/29/1961 DS SUBAH 3/6.BATANG RETENTIO URINE DYAH 1 1 1
23 15.49 53057 ASTI.NY 7/13/1943 JATIMULYA 3/1 BRPN DYAH 1 1 1
24 16.00 50828 TURINAH.NY 5/2/1960 SUKAREJA 4/8 OA GENEU DEXTRA DYAH 1 1 1
25 15.31 53056 NURJANAH TRI F.NY 2/25/1992 KERTAHARJA 1/3 H DG KALA 1 LAMA DYAH 1 1 1
26 18.55 53058 ROMI CANDRA.SDR 11/11/1994 JAYA SETIA 22/1. KEC PASAR MUARA BUNGO. GONORHE DYAH 1 1 1
27 20.00 53059 LENI MULKHAYATI.NY 8/25/1985 PLUMUNGAN 4/2 HAMIL DG HEG DYAH 1 1 1
28 20.00 53060 SUTARI.NY 4/30/1958 RANGIMULYA 4/4 TYPOID FEVER DYAH 1 1 1
29 20.45 53061 SAPRAH.TN 1/1/1938 SIGENTONG 2/2 DYAH 1 1 1
JUMLAH 25 4 0 0 17 8 4 0 0 15 14 0 0 1

TANGGAL/BULAN : 5 0
NO. MASUK NO. RM NAMA PASIEN TGL LAHIR ALAMAT DIAGNOSA DOKTER
DS R DOA DP U PBI N PBI JR L RI RJ MD RJK dr. Layali
1 12.45 53050 MUSTOFA,SDR 4/16/1994 DEMANGHARJA 6/3 VL FARADITA 1 1 1
JUMLAH 1 0 0 0 1 0 0 0 0 0 1 0 0 -
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) SAMPEL
OKSIGEN
dr.Ilham dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat DARAH dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana,
- - - 1 28,000 - - 2 70,000 3 162,000 - - 15,000 108,000 - -

- - - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - -
- - - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - - 1
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - - - 1 54,000 - - - - -
- - - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - -
- - - - - 1 28,000 - - - - 15,000 - - -
- - - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - - -
- - - - - 1 28,000 - - - - - - -
- - - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - -
- - - - - 1 28,000 - 1 54,000 - - - - -
- - - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - -
- - - - - 1 28,000 - - - - - - -
- - - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - -
- - - - - 1 28,000 - - - - - - -
- - - - - 1 28,000 - - - - - - -
- - - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - -
- - - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - -
28,000 - - - - - - - - - - - -
- - 1 28,000 - - - 1 35,000 - - - - - -
- - 1 28,000 - - - 1 35,000 - - - - - -
- - 1 28,000 - - - 1 35,000 1 54,000 - - - - -
- - 1 28,000 - - - 2 70,000 2 108,000 1 65,000 - 15,000 28,800 - -
- - 1 28,000 - - - - - - - - - -
- 1 28,000 - - - - 2 108,000 - - - - -
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 - - - 2 70,000 1 54,000 - - 15,000 - - -
- - 1 28,000 - - - 2 70,000 2 108,000 - - 15,000 - - -
- - 1 28,000 - - - 2 70,000 2 108,000 - - 15,000 - - -
28,000 - - 10 280,000 6 168,000 - - 12 336,000 23 805,000 25 1,350,000 1 65,000 - - 225,000 136,800 - - - - 1

OKSIGEN
dr. Layali dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana,
- - - - - 1 28,000 - - - - - - -
- - - - - - - - - 1 28,000 - - - - - - - - - - - - - - -
dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. YESSI Sp.PD UMUM BPJS PBI BPJS NON PBI
- - - - - 1 23,000 - 391,000 391,000 - -
- - - - - - - 117,000 - - 117,000
23,000 - - - - - - 140,000 140,000 - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 82,000 82,000 - -
- - - - 1 23,000 - - 140,000 - - 140,000
- - - - - - - 28,000 28,000 - -
- - - - - - - 206,000 - - 206,000
- - - - - - - 28,000 28,000 - -
- - - - - - - 117,000 - 117,000 -
- - - - - - - 82,000 82,000 - -
- - - - - - - 117,000 - 117,000 -
- - - - - - - 28,000 28,000 - -
- - - - - - - 117,000 - 117,000 -
- - - - - - - 28,000 - - 28,000
- - - - - - - 28,000 28,000 - -
- - - - - - - 117,000 - 117,000 -
- - - - - - - 117,000 - 117,000 -
- - - - - - - 28,000 28,000 - -
- - - - - - - 63,000 63,000 - -
- - - - - - - 63,000 63,000 - -
- - - - - - - 117,000 117,000 - -
- 1 23,000 - - - - - 322,800 322,800 - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 136,000 - 136,000 -
- - - - - - - 28,000 28,000 - -
- - - - - - - 152,000 152,000 - -
- - - - - - - 206,000 - 206,000 -
- - - - - - - 206,000 - 206,000 -
23,000 1 23,000 - - - - 1 23,000 1 23,000 - - - - 3,260,800 1,636,800 1,133,000 491,000
11 3,260,800

dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An UMUM BPJS PBI BPJS NON PBI
- - - - - - - 28,000 28,000 - -
- - - - - - - - - - - - - - - 28,000 28,000 - -
RA BAYAR
JASA RAHARJA
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
RA BAYAR
JASA RAHARJA
-
-

MASUK dr. Layali dr. Fadel
1 01.40 53063 DASERI,TN 1/1/1953 PURWAHAMBA 28/11 RETENSIO URINE ROSNELINA 1 1 1 -
3 08.00 53064 RIQKI DEWI ARYANI.AN 9/4/2009 SURADADI 2/9 FR FIBULA RIA 1 1 1 -
2 08.00 53063 MISBAKHUL IZJAH. 5/1/2003 JATIMULYA 2/6 FR ULNA RIA 1 1 1 -
4 09.00 52 RAHMAN MAULANA 1/1/2016 SURADADI EPILEPSI RIA 1 1 1 -
5 09.30 53069 MUSLIKHATUN.NY 6/2/1989 JATIBOGOR 1/3 KPD RIA 1 1 1 -
6 11.00 47554 RIDAH.NY 10/8/1941 BUMIJAWA CHF RIA 1 1 1 -
7 11.30 53075 WASRIAH.NY 7/19/1965 BANDASARI.DUKUH TURI VL RIA 1 1 1 -
8 12.00 53076 AZZAHRA.AN 10/15/2013 TAMBUN BEKASI ATSMA RIA 1 1 1 -
9 12.37 53077 JUMROTUN.NY 1/15/1968 KERTRASARI VL RIA 1 1 1 -
10 14.20 52685 KASANUDIN.TN 5/1/1985 KERTASARI 6/3 PNEMUTHORAX LAYALI 1 1 1 1 28,000
11 14.05 53080 WAHYU SAPUTRA.AN 3/24/2001 KERTASARI 5/2 AMPUTATUM DIGITI 4.5 LAYALI 1 1 1 1 28,000
12 15.00 53079 NUNIK ZUL A.NY 4/24/1996 KERTAYASA 5/2 PENDARAHAM POST PATUS LAYALI 1 1 1 1 28,000
13 17.52 19941 SUTORO.TN 12/12/1945 SIDAHARJA 14/7 VOMITUS LAYALI 1 1 1 1 28,000
14 17.17 53082 WAGE.TN 2/24/1964 SEMEDO 3/1 ACS LAYALI 1 1 1 1 28,000
15 16.28 53081 WASMU.TN 12/31/1940 HARJASARI 3/2 TF LAYALI 1 1 1 1 28,000
16 16.25 9432 MUSTAJIB.TN 12/20/1975 SURADADI 1/16 FR RADIUS 1/3 DISTAL LAYALI 1 1 1 1 28,000
17 22.45 46173 WILDA SOFIANA,AN 8/12/2001 JATIMULYA 1/3 DEMAM + CEPALGIA FADEL 1 1 1 - 1
18 22.50 13828 DJOKO EKO PRATOMO,TN 11/19/1965 SURADADI 2/11 GASTRITIS AKUT FADEL 1 1 1 - 1
19 22.55 53084 HISAM MAULANA,AN 7/4/5017 SIDAHARJA 24/9 DADRS FADEL 1 1 1 - 1
JUMLAH 18 1 0 0 8 4 7 0 0 12 7 0 0 7 196,000 3

TANGGAL/BULAN : 5 0
DS R DOA DP U PBI N PBI JR L RI RJ MD RJK dr. Layali dr. Faila
1 10.00 53073 DWI WASKITO.SDR 3/19/1993 SINDANGMULYA,BKS VL RIA 1 1 1 -
JUMLAH 1 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0
OKSIGEN
dr. Fadel dr. Dyah dr. Rosnel dr. RIA dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- - 1 28,000 - - 2 70,000 3 162,000 - - 15,000 - - - -

- - - 1 28,000 - 1 35,000 1 54,000 - - - - - -
- - - 1 28,000 - 1 35,000 1 54,000 - - - - - -
- - - 1 28,000 - 1 35,000 2 108,000 - - - - - 1 23,000
- - - 1 28,000 - 1 35,000 1 54,000 - - - - - -
- - - 1 28,000 - 1 35,000 2 108,000 - - 15,000 - - - -
- - - 1 28,000 - - 1 54,000 - - - - - -
- - - 1 28,000 - - - 1 65,000 - - - - -
- - - 1 28,000 - - 1 54,000 - - - - - -
- - - - - 1 35,000 - - - - - - -
- - - - - - - 1 65,000 - - - - -
- - - - - 2 70,000 2 108,000 1 65,000 2 160,000 15,000 10,800 - - -
- - - - - 2 70,000 2 108,000 - - 15,000 - - - -
- - - - - 2 70,000 2 108,000 - - 15,000 - - - -
- - - - - 2 70,000 2 108,000 - - 15,000 - - - -
- - - - - - 1 54,000 - - - - - -
28,000 - - - - - - - - 15,000 - - - -
28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - - -
28,000 - - - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
84,000 - - 1 28,000 8 224,000 - - 19 665,000 24 1,296,000 3 195,000 2 160,000 135,000 10,800 - - - - 2 46,000

OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. RIA dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- - - 1 28,000 - - 1 54,000 - - - - - -
0 0 0 0 0 1 28000 0 0 0 0 1 54000 0 0 0 0 0 0 0 0 0 0 0 0
- - - - - - 260,000 260,000 - - -
- 1 23,000 - - - - 140,000 - 140,000 - -
- 1 23,000 - - - - 140,000 - - 140,000 -
- - - - - - 194,000 - - 194,000 -
- - - - - - 117,000 - - 117,000 -
- - - - - - 171,000 - - 171,000 -
- - - - - - 82,000 - - 82,000 -
- - - - - - 93,000 93,000 - - -
- - - - - - 82,000 82,000 - - -
- - - - - - 63,000 63,000 - - -
- - - - - - 93,000 93,000 - - -
- - - - - - 441,800 - 441,800 - -
- - - - - - 206,000 - - 206,000 -
- - - - - - 206,000 - 206,000 - -
- - - - - - 206,000 - 206,000 - -
- - - - - - 82,000 82,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 206,000 - - 206,000 -
- - - - - - 140,000 140,000 - - -
- - 2 46,000 - - - - - - - - - - 2,950,800 841,000 993,800 1,116,000 -
2,950,800

- - - - - - 82,000 82,000 - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 82000 1,173,000 1,405,800 1,322,000 -

MASUK dr. Layali dr. Fade
1 01.50 O1998 SITI SUTINAH,NY 4/14/1981 SIDAHARJA 7/4 dyspepsia FADEL 1 1 1 - 1
2 03.10 14550 ROMLI,TN 11/17/1957 MARIBAYA 6/3 FEBRIS + DYSPEPSIA FADEL 1 1 1 - 1
3 03.55 38379 SURURI IDRIS,TN 7/1/1957 BOJONGSANA 10/4 DM2 + VOMITUS + GASTRITIS AKUT FADEL 1 1 1 - 1
4 06.40 53085 TIA ULFA,NN 11/28/1992 SURADADI 4/1 DISPAGIA FADEL 1 1 1 - 1
5 07.14 53086 SODIKIN,TN 2/22/1965 KERTASARI 6/1 EPITAKSIS FADEL 1 1 1 -
6 09.05 45153 SUKARSO,TN 12/31/1933 SURADADI 4/16 RETENSIO URINE ROSNELINA 1 1 1 -
7 10.59 53087 GENDIS TRI AULIA,AN 4/2/2017 KALIJAMBE 3/1 OBS.FEBRIS ROSNELINA 1 1 1 -
8 11.29 42308 DIO ALIF RAMADHAN,AN 5/6/2006 PURWAHAMBA 20/8 ASMA ROSNELINA 1 1 1 -
9 11.51 53090 YOGI BUDIHARTO,AN 12/18/2002 PLUMBUNGAN 4/2 SKD ROSNELINA 1 1 1 -
10 15.00 53091 NAJMIATUL.AN 12/31/2003 DEMANGHARJA 7/1 DADRS LAYALI 1 1 1 1 28,000
11 18.30 53092 devis kurniawan.an 6/18/2013 KARANGMULYA 2/4 FEBRIS LAYALI 1 1 1 1 28,000
12 19.00 53093 AHMAD ARMIA.AN 6/28/2017 GAMBUHAN 7/3 KDS LAYALI 1 1 1 1 28,000
13 19.10 53094 JUINAH.NY 1/1/1952 KARANGMULYA2/5 LAYALI 1 1 1 1 28,000
14 19.20 53095 NUR ISTIQOMAH.NN 11/1/1997 SURADADI 2/6 VERTIGO LAYALI 1 1 1 1 28,000
15 19.40 53096 MASTURO UTAMI.NY 1/20/1982 BANGUNGALIH 3/2 HEG LAYALI 1 1 1 1 28,000
16 20.20 53040 SALFA PUTRA.AN 5/8/2008 KARANGMULYA 4/7 TF LAYALI 1 1 1 1 28,000
17 21.15 42238 TARYATUN.NY 4/4/1936 KEDUNGKELOR 3/1 FEBRIS FADEL 1 1 1 - 1
18 22.41 53097 DATEM.NY 6/10/1958 JATIMULYA 3/8 FEBRIS AKUT, DISENTRI, ACS FADEL 1 1 1 - 1
JUMLAH 18 0 0 0 10 4 4 0 0 12 6 0 0 7 196,000 6

TANGGAL/BULAN : 5 0
1 11.00 53088 EVI RATNA DEWI,NN 9/25/1995 KETANGGUNGAN,BREBES FRAKTUR FEMUR ROSNELINA 1 1 1 -
2 11.00 53089 MEISI DWI PUTRI,AN 5/1/2003 KETANGGUNGAN,BREBES VE ROSNELINA 1 1 1 -
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) K
OKSIGEN
dr. Fadel dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, S
28,000 - - - - - - - - - - - -
28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - - -
28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - - -
28,000 - - - - - - - - - - - -
- - - - - - - - - - - - -
- - 1 28,000 - - 2 70,000 3 162,000 - - 15,000 - - - -
- 1 28,000 - - - - - - - - - -
- - 1 28,000 - - - - 1 65,000 - - - - -
- - 1 28,000 - - - - - - - - - -
- - - - - 1 35,000 1 54,000 - - 15,000 - - - -
- - - - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - - - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - - - - 2 70,000 2 108,000 - - 15,000 - - - -
- - - - - 1 35,000 1 54,000 - - 15,000 - - - -
- - - - - 1 35,000 1 54,000 - - 15,000 - - - -
- - - - - 1 35,000 1 54,000 - - 15,000 - - - 2 46,000
28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - - -
28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - - -
168,000 - - 4 112,000 - - - - 18 630,000 19 1,026,000 1 65,000 - - 180,000 - - - - - 4 92,000 -
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) K

OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, S
- - 1 28,000 - - 1 35,000 3 162,000 1 65,000 1 80,000 15,000 18,000 - - -
- - 1 28,000 - - - - - - - - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 206,000 - - 206,000 -
- - - - - - 206,000 - - 206,000 -
- - - - - - 28,000 28,000 - - -
- - - - - - - - - - -
- - - - - - 260,000 - 260,000 - -
- - - - - - 28,000 28,000 - - -
- - - - - - 93,000 93,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 117,000 - - 117,000 -
- - - - - - 140,000 140,000 - - -
- - - - - - 140,000 140,000 - - -
- - - - - - 206,000 206,000 - - -
- - - - - - 117,000 117,000 - - -
- - - - - - 117,000 - - 117,000 -
- - - - - - 163,000 - 163,000 - -
- - - - - - 206,000 - 206,000 - -
- - - - - - 206,000 - 206,000 - -
- - - - - - - - - - - - - 2,289,000 808,000 835,000 646,000 -
2,289,000

- 1 23,000 - - - - 411,000 411,000 - - -
- - - - - - 28,000 28,000 - - -
JAM ASAL PASIEN CARA BAYAR CARA KELUAR PEM

MASUK dr.Fadel dr. Dyah
1 02.30 53098 SUKRI.TN 11/18/1998 BANGUNGALIH 2/1 COLIC ABDOMEN FADEL 1 1 1 1 28,000 -
2 03.03 53099 EKO ARDI S.SDR 4/5/1994 PURWAHAMBA 12/5 EPILEPSI FADEL 1 1 1 1 28,000
3 07.51 53050 MUSTOFA.SDR 4/16/1994 DEMANGHARJO KONTROL LUKA DYAH 1 1 1 - 1
4 08.30 53106 SITI ATIQOH,NY 4/3/1971 TANJUNGHARJA 8/3 GEA DYAH 1 1 1 - 1
5 08.42 53109 WATRI,NY 12/31/1936 JATIBOGOR 3/9 HT DYAH 1 1 1 - 1
6 08.54 50063 UMI HANI B,NN 5/5/1996 SURADADI 1/5 FEBRIS DYAH 1 1 1 - 1
7 09.17 53048 BUDI SANTOSO,SDR 9/20/1994 PAGONGAN 3/5,DUKUHTURI KONTROL LUKA DYAH 1 1 1 - 1
8 09.40 5881 NURROHMAN,TN 1/1/1983 KERTAYASA 2/3 KONTROL LUKA DYAH 1 1 1 - 1
9 10.15 53100 SITI MARYAM,NY 1/12/1987 JATIBOGOR 2/14 AB INCOMPLIT DYAH 1 1 1 - - 1
10 10.20 53114 YAHYA RIZQI R,SDR 2/14/1996 TANJUNGHARJA 1/2 GASTRITIS DYAH 1 1 1 - - 1
11 11.00 53118 ROKHIMI,NY 6/1/1979 DEMANGHARJO 8/1 FRAKTUR RADIUS 1/3 DISTAL DYAH 1 1 1 - 1
12 12.00 53119 ZAENUL MUTAQIN 8/15/1999 JATIMULYA 8/1 GEA DYAH 1 1 1 - 1
13 13.45 51319 RONAH,NY 6/14/1983 PURWAHMBA 27/11 HMAIL DENGAN DYAH 1 1 1 - 1
14 15.00 53121 RAMINAH.NY 9/5/1965 KARANGWULUH 1/3 CKD EDI 1 1 1 -
15 15.30 53122 AGUNG DWI.TN 11/2/1982 TEGALSARI ANIMAL BITCH EDI 1 1 1 -
16 17.00 39007 SITI NASRIAH.NY 12/9/1985 BONGKOK 3/2 GINGGIVITI EDI 1 1 1 -
17 17.40 53123 KHUSAERI.TN 11/1/1972 SIDAHARJA 6/4 DISPEPSYA EDI 1 1 1 -
18 18.10 53124 DARYUTI.NY 8/10/1981 WARUREJA 5/3 HML DG FEBRIS EDI 1 1 1 -
19 18.45 53125 ELFIN.SDR 7/14/1996 WONOSOBO INSOMIA EDI 1 1 1 -
20 19.30 53126 AZZAHRA NAYA.AN 6/16/2013 KERTASARI 6/1 ASTMA EDI 1 1 1 -
21 20.30 53127 SHAQILLA ZAHZY.AN 4/14/2014 JL SALAK TEGAL DADRS EDI 1 1 1 -
22 20.30 2151 TASRIPAH.NY 5/5/1958 SIDAHARJA 26/1 DOA EDI 1 1 1 -
23 21.03 53128 RIKI FEBRI P.AN 2/17/2003 RANGIMULYA 4/2 FEBRIS EDI 1 1 1 -
24 22.23 53129 DARI.NY 7/1/1955 KEMUNING 1/3.KRAMAT HEMATEMESIS,MELENA.HEMAPTOE LAYALI 1 1 1 -
25 23.30 14636 HERLINA.NY 6/27/1982 KEDUNGKELOR 3/2 chest pain LAYALI 1 1 1 -
26 -
27 -
28 -
29 -
30 -
JUMLAH 25 0 0 0 16 7 2 0 0 13 11 1 0 2 56,000 11

TANGGAL/BULAN : 5 0
JAM ASAL PASIEN CARA BAYAR CARA KELUAR PEM
DS R DOA DP U PBI N PBI JR L RI RJ MD RJK dr. Layali dr. Dyah
1 07.29 53103 ZIAN FITROTUNNISA,NN 1/20/2002 JATIBOGOR 3/13 VL DYAH 1 1 1 - 1
2 13.45 53120 JENAR WISESA,AN 6/26/2011 DEMANGHARJO 2/2 VL DYAH -
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) KONSUL DO
OKSIGEN
dr. Dyah dr.layla dr. EDI dr. Faradita Sederhana Kecil Sedang Berat LAB dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P
- - - - - - - - - - - - - - - - -
- - - - - - - - - - - - -
28,000 - - - - - - - - - - -
28,000 - - - - - - - - - - -
28,000 - - - 2 70,000 2 108,000 - - 15,000 - - - -
28,000 - - - 1 35,000 1 54,000 - - 15,000 - - - -
28,000 - - - - - - - - - - -
28,000 - - - - - - - - - - -
28,000 - - - 1 35,000 1 54,000 - - 15,000 - - - -
28,000 - - - 1 35,000 1 54,000 - - 15,000 - - -
28,000 - - - - - 1 65,000 - - - -
28,000 - - - - - - - - - -
28,000 - - - 1 35,000 1 54,000 - - 15,000 - - - -
- - 1 28,000 - 2 3 162,000 - - 15,000 - - - -
- - 1 28,000 - - - - - - - - -
- - 1 28,000 - - - - - - - - -
- - 1 28,000 - - - - - - - - -
- - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - - -
- - 1 28,000 - - - - - - - - 1
- - 1 28,000 - - - 1 65,000 - - - - -
- - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - - - 1
- - 1 28,000 - - 1 54,000 - - - - - -
- - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- 1 28,000 - - 2 70,000 2 108,000 - - 15,000 28,800 - - -
- 1 28,000 - - 1 35,000 2 108,000 - - 15,000 - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
308,000 2 56,000 10 280,000 - - 14 420,000 17 918,000 2 130,000 - - - 28,800 - - - - 1 23,000 2
OKSIGEN
dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P
28,000 - - - - 1 54,000 - - - - - -
- - - - - - - - - - - -
dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An dr.yesi.sp.pd UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - - - #REF! - - #REF! -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - 1 23,000 - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! - #REF! - -
- - - - - - #REF! - #REF! - -
- - - - - - #REF! - #REF! - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! - #REF! - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! - #REF! - -
23,000 - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
23,000 - - - - - #REF! - - #REF! -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! - #REF! - -
- - 1 23,000 - - - #REF! - #REF! - -
- - - - - 1 23,000 #REF! #REF! - - -
- - - - - - #REF! - - - -
- - - - - - #REF! - - - -
- - - - - - #REF! - - - -
- - - - - - #REF! - - - -
- - - - - - #REF! - - - -
46,000 - - 1 23,000 1 23,000 - - 1 23,000 - - #REF! #REF! #REF! #REF! -
#REF!

- - - - - - #REF! #REF! - - -
- - - - - - #REF! - - - -

MASUK dr. Layali dr. Fai
1 02.49 53044 KISMAROH.NY 12/31/1967 SURADADI 4/1 POST TRAUMA LAYALI 1 1 1 1 28,000 -
2 08.00 53134 SUNARTO,TN 1/1/1961 KERTASARI 3/4 VL FARADITA 1 1 1 -
3 08.25 53137 WARTO,TN 11/23/1966 SEMEDO 2/1 VL + HT FARADITA 1 1 1 -
4 08.50 53131 WARYUNAH,NY 6/15/1982 PURWAHAMBA 20/8 G3P2A0 H35MGG DGN PPI + KPD FARADITA 1 1 1 -
5 08.50 53138 KARSO,TN 1/1/1962 WANAGOPA 3/5 SNAKE BITE FARADITA 1 1 1 -
6 09.30 18530 APTI WIWINDIATI,NY 7/10/1991 KRAMAT 5/2 G4P2A1 H8MGG DGN SUSP KET FARADITA 1 1 1 -
7 0+9.45 10495 SUAEMI,NY 6/4/1950 BOJONGSANA 11/14 HT+DYSPEPSIA FARADITA 1 1 1 -
8 09.50 53141 NASIRIN,TN 1/7/1985 SIDAHARJA 24/9 VL FARADITA 1 1 1 -
9 09.50 53142 TARSUMI,NY 10/19/1943 SURADADI 2/7 TB PARU +EFUSI FARADITA 1 1 1 - -
10 09.50 83143 SURIYAH,NY 8/25/1993 SIDAMULYA 7/2 ISK DD URETNOLITHIASIS FARADITA 1 1 1 - -
11 10.15 53144 ULFA AULIA RAHMA,AN 2/7/2012 KARANGMULYA 1/7 LIMFADENOPATI COLLI FARADITA 1 1 1 -
12 10.30 53056 NURJANAH,NY 2/25/1992 KERTAHARJA 1/3 G1P0A0 H38MGG DGN KPD FARADITA 1 1 1 -
13 13.00 40049 ANINDYA NAUVALIA ,AN 9/25/2016 KARANGMULYA 4/1 GEA FARADITA 1 1 1 -
14 13.45 30440 DARKONAH,NY 1/1/1952 SURADADI 4/1 GASTRITIS AKUT FARADITA 1 1 1 -
15 15.06 53147 MUHAMAD UMAR ALFARUK 3/23/2013 KEMUNING 1/5 DADRS ROSNELINA 1 1 1 -
16 16.45 53148 SITI KHOLIPAH,NY 7/22/1991 KERTASARI 5/5 DHF ROSNELINA 1 1 1 -
17 17.14 38500 DARTI,NY 7/1/1952 SURADADI 1/2 GEA ROSNELINA 1 1 1 -
18 18.08 39060 ASBUDI,TN 4/3/1947 SURADADI 1/12 COLIK ABDOMEN ROSNELINA 1 1 1 -
19 18.08 53149 PONIRIN,TN 3/16/1987 KEBUMEN GASTRITIS AKUT ROSNELINA 1 1 1 -
20 18.30 53152 KARDILAH,NY 3/11/1975 BANJARTURI 2/6 SNH ROSNELINA 1 1 1 -
21 18.58 53153 MARCELINO SEPRIYANTO,AN 12/29/2012 SURADADI 02/15 ALERGI MAKANAN ROSNELINA 1 1 1 -
22 19.50 23057 AHMAD ZIAM ASSODIQ,AN 1/9/2015 SURADADI 3/15 OBS FEBRIS ROSNELINA 1 1 1 -
23 20.09 53153 NURWITO,TN 6/8/1963 SURADADI 1/10 THYPOID FEVER ROSNELINA 1 1 1 -
24 22.20 53155 TINO KARNO.TN 2/28/1987 KEMUNING 2/1 COLIC RENAL LAYALI 1 1 1 1 28,000
25 23.00 53156 KOYAH.NY 1/1/1966 KRAMAT 7/3 DIARE LAYALI 1 1 1 1 28,000
JUMLAH 22 3 0 0 13 8 4 0 0 13 12 0 0 3 84,000 -
TANGGAL/BULAN : 5 0
DS R DOA DP U PBI N PBI JR L RI RJ MD RJK dr. Layali dr. Fai
1
2 -
3 -
4 -
5 -
6 -
OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. YESSI, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini
- - - - - - - 1 35,000 - - - - - - - -
- - - - 1 28,000 - 1 54,000 - - - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - - - -
- - - - 1 28,000 - 1 54,000 - - 15,000 - - -
- - - - 1 28,000 2 70,000 3 162,000 - - 15,000 10,800 - 1 23,000 -
- - - - 1 28,000 1 35,000 2 108,000 - - 15,000 - - - -
- - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - - - 1 23,000
- - - - 1 28,000 - - - 1 80,000 - - - -
- - - - 1 28,000 2 70,000 2 108,000 - - 15,000 10,800 - - - 1
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - - - -
- - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - - -
- - 1 28,000 - - 2 70,000 3 162,000 - - 15,000 - - - -
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 - - 2 70,000 2 108,000 - - 15,000 - 1 23,000 - -
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - 1 28,000 - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - 1 35,000 2 108,000 - - 15,000 - - - -
- - - 9 252,000 - - 13 364,000 20 700,000 25 1,350,000 - - 1 80,000 195,000 21,600 1 23,000 1 23,000 3 69,000 1
OKSIGEN
- - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. AXEL Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An dr. Hary Sp.S UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - - - 63,000 63,000 - - -
- - - - - - 82,000 82,000 - - -
- - - - - - 117,000 - 117,000 - -
- - 1 23,000 - - - 105,000 105,000 - - -
- - - - - - 293,800 - 293,800 - -
- - 1 23,000 - - - 194,000 - 194,000 - -
- - - - - - 229,000 - - 229,000 -
- - - - - - 108,000 108,000 - - -
23,000 - - - - - 239,800 - 239,800 - -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - 1 23,000 - - - 140,000 - 140,000 - -
- - - - - - 28,000 28,000 - - -
- - - - - - 206,000 - - 206,000 -
- - - - - - 140,000 140,000 - - -
- - - - - - 117,000 - 117,000 - -
- - - - - - 260,000 - - 260,000 -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 229,000 - 229,000 - -
- - - - - - 28,000 28,000 - - -
- - - - - - 140,000 - - 140,000 -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 - 28,000 - -
- - - - - - 171,000 171,000 - - -
23,000 - - 3 69,000 - - - - - - - - 3,058,600 865,000 1,358,600 835,000 -
3,058,600
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -

MASUK dr. Layali dr. FADEL
1 01.00 53157 RISKIANTI EKO.NY 5/14/1988 SURADADI 1/5 COLIC RENAL LAYALI 1 1 1 1 28,000 -
2 03.00 25539 tuti heriwati.ny 7/16/1951 suradadi 2/12 ASTMA LAYALI 1 1 1 1 28,000
3 04.00 53158 SUMARTI.NY 1/1/1962 MARIBAYA 2/2 GEA LAYALI 1 1 1 1 28,000
4 05.30 26588 AHMAD LUTFUL. 1/1/2014 MARIBAYA 3/1 KDS LAYALI 1 1 1 1 28,000
5 07.10 24294 CARMAD,TN 12/31/1950 SIDAHARJA 1/1 COLIC ABDOMEN + HT FADEL 1 1 1 - 1
6 08.15 53167 SAEFUL AMIN,TN 4/11/1985 MARIBAYA 5/1 PPOK + TB PARU FADEL 1 1 1 - 1
7 08.35 53168 VIRNA MAHARANI,NN 5/25/1997 SURADADI 1/17 OTALGIA FADEL 1 1 1 - 1
8 11.05 31647 DEWI AMANAH,NY 6/6/1989 TANJUNGHARJA 6/3 RETENSIO URINE FADEL 1 1 1 - 1
9 11.10 53178 MAHAR MASHURI,SDR 5/3/1985 BOJONGSANA 6/2 BIKIN SKD FADEL 1 1 1 - - 1
10 12.55 53180 SITI RUMJANAH,NY 1/29/1965 SURADADI 4/16 DM + HT FADEL 1 1 1 - - 1
11 14.53 19712 ISNAWATI,NY 6/15/1994 JATIMULYA 2/2 VOMITUS DYAH 1 1 1 -
12 16.16 42825 WAMIL,NY 7/15/1977 BONGKOK 3/5 DM + HT DYAH 1 1 1 -
13 17.10 34818 KIRANA AGUSTIN,AN 8/30/2015 MARIBAYA 3/3 RFA DYAH 1 1 1 -
14 20.24 15367 SAKIR,TN 10/10/1953 JATIMULYA 5/3 PPOK DYAH 1 1 1 -
15 23.00 53182 EKA NUR DEWI.NY 7/6/1999 HARJASARI 2/6 KALA 1 LAMA ROSNELINA 1 1 1 -
16 23.30 53183 DIAN HIDAYAH.NY 10/2/1986 JATIBOGOR 2/6 ROSNELINA 1 1 1 -
17 07.05 53186 MOH SIDIK.TN 12/7/1978 SURADADI 2/14 MYALGIA + DROWNING FARADITA 1 1 1 -
18 08.00 53187 UNTUNG SURADI.TN 5/12/1987 JATIMULYA 1/1 VL EC PATIL IKAN FARADITA 1 1 1 -
19 08.00 53189 SURATMI.NY 12/31/1964 JATIMULYA 1/7 VE REGIO PUNGGUNG KANAN FARADITA 1 1 1 -
20 08.20 53192 RUSLAN.TN 2/10/1969 SURADADI 2/14 DROWNING FARADITA 1 1 1 -
21 08.15 53191 SODAH.NY 3/14/1981 TANJUNGHARJA 1/3 H DG KALA 1 LAMA FARADITA 1 1 1 -
JUMLAH 21 0 0 0 7 6 7 0 1 15 6 0 0 4 112,000 6

TANGGAL/BULAN : 0
JAM
MASUK DS R DOA DP U PBI N PBI JR L RI RJ MD RJK dr. Layali dr. Faila
1 -
2 -
3 -
OKSIGEN
dr. FADEL dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- - - - - - - 1 35,000 1 54,000 - - - - - - - - -
- - - - - 1 35,000 2 108,000 1 65,000 - - - - - -
- - - - - 1 35,000 2 108,000 - - - - - -
- - - - - 1 35,000 1 54,000 - - - - - 1 23,000
28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - -
28,000 - - - - 1 35,000 1 54,000 1 65,000 - 15,000 14,400 - - -
28,000 - - - - - - - - - - - -
28,000 - - - - - 1 54,000 - - - - - -
28,000 - - - - - - - - - - - -
28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - - -
- 1 28,000 - - - 1 35,000 2 108,000 - - 15,000 - - - -
- 1 28,000 - - - 2 70,000 2 108,000 - - 15,000 - - - -
- 1 28,000 - - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- 1 28,000 - - - 2 70,000 2 108,000 - - 15,000 10,800 - - -
- - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - - -
- - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - - -
- - - - 1 28,000 - - - - - - -
- - - - 1 28,000 1 35,000 - - - - - -
- - - - 1 28,000 1 35,000 - - - - - -
- - - - 1 28,000 2 70,000 1 54,000 - - 15,000 - 1 23,000 -
- - - - 1 28,000 - 1 54,000 - - 15,000 - - -
168,000 4 112,000 2 56,000 - - 5 140,000 21 735,000 23 1,242,000 2 130,000 - - 165,000 25,200 - - 1 23,000 2 46,000

OKSIGEN
OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- - - - 1 28,000 - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. AXEL Sp.OG dr. Riyani, Sp.OG dr. NADIA Sp.OG DR.YESSI.SP.PD UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - 1 23,000 - - - - 140,000 - - 140,000 -
1 23,000 - - - - - 259,000 - - 259,000 -
- - - - - - 171,000 171,000 - - -
- - - 1 23,000 - - 163,000 - - 163,000 -
- - - - - - 206,000 - - 206,000 -
1 23,000 - - - - - 219,400 - - 219,400 -
- - - - - - 28,000 28,000 - - -
- - - - - - 82,000 - 82,000 - -
- - - - - - 28,000 28,000 - - -
- - - - - - 206,000 - - 206,000 -
- - - - - - 171,000 - 171,000 - -
- - - - - - 206,000 - - 206,000 -
- - - - - - 140,000 140,000 - - -
1 23,000 - - - - - 239,800 - 239,800 - -
- - - 1 23,000 - - 140,000 - 140,000 - -
- - - - - - 117,000 - - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 63,000 63,000 - - -
- - - - - - 63,000 63,000 - - -
- - - - - - 175,000 - 175,000 - -
- - - 1 23,000 - - 105,000 - 105,000 - -
3 69,000 - - - - 4 92,000 - - - - - - 2,950,200 521,000 912,800 1,399,400 -
2,950,200

- - - - - - 28,000 - - - -
- - - - - - - - - - -
- - - - - - - - - - -

MASUK dr. Layali
1 08.00 53187 UNTUNG SURADI.TN 5/12/1987 JATIMULYA 1/1 VL EC PATIL IKAN FARADITA 1 1 1
2 08.00 53189 SURATMI.NY 12/31/1964 JATIMULYA 1/7 VE REGIO PUNGGUNG KANAN FARADITA 1 1 1
3 08.20 53192 RUSLAN.TN 2/10/1969 SURADADI 2/14 DROWNING FARADITA 1 1 1
4 08.15 53191 SODAH.NY 3/14/1981 TANJUNGHARJA 1/3 H DG KALA 1 LAMA FARADITA 1 1 1
5 10.00 53197 SUGIONO.TN 3/1/1952 BOJONGSANA 2/1 POST DROWNING FARADITA 1 1 1
6 10.00 53196 AGIL MAULANA.SDR 2/25/1998 BOJONGSANA 4/2 VL DIGITI 2 PEDIS FARADITA 1 1 1
7 10.00 53199 SUMARI.SDR 4/3/1998 BOJONGSANA 2/1 DOWNING FARADITA 1 1 1
8 07.05 53186 MOH SIDIK.TN 12/7/1978 SURADADI 2/14 MYALGIA + DOWNING FARADITA 1 1 1
9 10.00 35042 ALFIAN RISKI.AN 8/21/2015 JATIBOGOR 04/09 ISPA FARADITA 1 1 1
10 10.00 53198 BAGUS SUGIARTO.TN 10/28/1992 BOJONGSANA 2/1 DROWNING FARADITA 1 1 1
11 10.00 53202 TATI HARYATI.NY 6/4/1986 SEMEDO 6/2 H DG POST SC FARADITA 1 1 1
12 13.50 53131 WARYUNAH.NY 6/15/1982 PURWAHAMBA 20/8 RETENTIO URINE FARADITA 1 1 1
13 14.50 53206 SITI AISYAH,NY 5/25/1990 KERTASARI 4/8 G2P1A0 H38MGG DGN POLIHIRAMYIOM FADEL 1 1 1
14 17.05 42934 AJENG MUSTAMAROH,NN 8/1/2001 MARIBAYA 1/2 CHEPALGIA BERAT FADEL 1 1 1
15 20.12 29124 KORI'AH,NY 5/7/1975 SEMEDO 1/.1 FEBRIS AKUT + GASTRITIS AKUT FADEL 1 1 1
16 21.35 53208 DEWI WULAN SARI,NY 12/16/1991 TAMAN,PEMALANG THYPOID FEVER DYAH 1 1 1
17 22.39 30282 KAPIDIN,TN 5/23/1964 KERTASARI 7/1 COLIK ABDOMEN DYAH 1 1 1
JUMLAH 16 1 0 0 10 6 0 0 1 9 8 0 0 -

TANGGAL/BULAN : 11 0
1 10.55 53200 NAYLA NAFI'AH.AN 8/5/2011 SIDAHARJA 8/5 MULTIPLE VE FARADITA 1 1 1
2 10.55 53201 MOH HASIM.TN 3/23/1980 JATIBOGOR 1/1 MULTIPLE VE FARADITA 1 1 1
3 14.15 45927 SUMARTI,NY 12/31/1962 SURADADI 3/15 CKR + VE FADEL 1 1 1
4 14.15 53205 IBRA CITRA WULANDARI,AN 8/12/2004 SURADADI 3/15 CKR + VE FADEL 1 1 1
OKSIGEN
dr. Layali dr. FADEL dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana
- - - - - 1 28,000 - - - - - -
- - - - - 1 28,000 - - - - - -
- - - - - 1 28,000 - - - - - -
- - - - - 1 28,000 - - - - - -
- - - - - 1 28,000 - - - - - -
- - - - - 1 28,000 - 1 54,000 - - - -
- - - - - 1 28,000 - - - - - -
- - - - - 1 28,000 - - - - - -
1 28,000
1 28,000 1 35,000 1 54,000 10,800 1 23,000
1 28,000 1 54,000 15,000
1 28,000 1 35,000 1 54,000 -
1 28,000 1 35,000 1 54,000 - - 15,000 -
1 28,000 1 35,000 1 54,000 - - 15,000 - 1
1 28,000 2 70,000 2 108,000 - - 15,000 -
- 1 28,000 1 35,000 1 54,000 - - -
- 1 28,000 2 70,000 2 108,000 - - -
- 3 84,000 2 56,000 - - - - 12 336,000 9 315,000 11 594,000 - - - - 45,000 25,800 - - 1 23,000 1

OKSIGEN
dr. Layali dr. FADEL dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana
- - - - - 1 28,000 1 35,000 - - - - - -
- - - - - 1 28,000 1 35,000 - - - - - -
- 1 28,000 - - - - 1 35,000 2 108,000 - - 15,000 10,800 - 1 23,000
- 1 28,000 - - - - - 1 54,000 - - - - -
dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. AXEL Sp.OG dr. Riyani, Sp.OG dr. YESSI Sp.PD UMUM BPJS PBI BPJS NON PBI
- - - - - - - 28,000 28,000 - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 28,000 - 28,000 -
- - - - - - - 28,000 - 28,000 -
- - - - - - - 28,000 28,000 - -
- - - - - - - 82,000 82,000 - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 28,000 28,000 - -
1 23,000
- - - - - - -
- - - - 1 23,000 - -
23,000 - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
23,000 - - - - - - 2 46,000 - - - - - - 278,000 222,000 56,000 -
278,000

- - - - - - - 63,000 63,000 - -
- - - - - - - 63,000 63,000 - -
- - - - - - - 204,800 - - 204,800
- - - - - - - 82,000 82,000 - -
RA BAYAR
JASA RAHARJA
-
-
-
-
-
-
-
-
RA BAYAR
JASA RAHARJA
-
-
-
-

MASUK dr. Layali
1 01.29 53210 NUR KHASANAH,NY 4/1/1986 KEMUNING 2/5 G2P1A1 HAMIL DENGAN SUSP.GEMELI DYAH 1 1 1
2 01.52 53211 NUR KHASANAH,BY,NY 1/12/2018 KEMUNING 2/5 BAYI BARU LAHIR DYAH 1 1 1
3 09.00 28002 UMIYASIH.NY 12/31/1965 SURADADI 1/5 VL FARADITA 1 1 1
4 10.05 53215 SAKLAN.TN 12/30/1961 KEPUNDUHAN 1/1 CHEPALGIA.ISK.FEBRIS FARADITA 1 1 1
5 10.30 53218 TARUNI.NY 8/12/1979 KEDUNGKELOR 3/1 DEPRESI BERAT FARADITA 1 1 1
6 11.30 53219 EKA HIDAYAT.SDR 1/2/1998 DS ARGATAWAN 8/2 VL FARADITA 1 1 1
7 09.40 53072 SUDOMO.TN 7/12/1984 SIDAHARJA 22/09 SKD FARADITA 1 1 1
8 14.50 53220 AHMAD SUPRIYANTO,TN 1/19/1967 KARANGMULYA 2/1 VL EDI S 1 1 1
9 15.02 53221 SARYO,TN 12/16/1954 DSEMEDO 8/3 CHEPALFGIA EDI S 1 1 1 -
10 15.55 53222 MALIKHTUN,NY 9/25/1971 KREMAN 7/1 VERTIGO DGN VOMITUS EDI S 1 1 1 -
11 17.50 53223 AHMAD SOFIUDIN,TN 6/12/1986 MARIBAYA 3/3 VL EDI S 1 1 1
12 18.40 53224 PRADIPTA SETIANINGTYAS,NN 7/31/1991 SURADADI 4/12 VL EDI S 1 1 1
13 19.10 53225 RISKA FITRIYANI,AN 11/28/2005 TANJUNGHARJA 3/3 VL EDI S 1 1 1
14 20.05 53226 SUPARI,TN 7/1/1943 HARJASARI 2/3 DYSPEP[SIA + SUSP CHF EDI S 1 1 1
15 20.08 34291 TINA NUR,NN 10/29/1997 SEMEDO 4/2 GASTRITIS AKUT DGN KU LEMAH EDI S 1 1 1
16 20.55 13551 ARPAH,NY 5/12/1955 MARIBAYA 3/3 OBS FEBRIS + VOMITUS + DM EDI S 1 1 1
17 21.24 53227 SUTINO,SDR 5/27/1989 JATIMULYA 3/7 THYPOID FEVER FADEL 1 1 1
18 21.47 27051 ABDUL GHOFUR,SDR 9/3/1995 PLUMBUNGAN 4/2 RECTAL BLEEDING FADEL 1 1 1
19 22.00 53228 NUR AENI,NY 9/25/1987 BANGUNGALIH 3/2 CEPALGIA FADEL 1 1 1
20 22.45 53229 PURNOMO,TN 8/18/1953 GROBOGAN VERRTIGO FADEL 1 1 1
JUMLAH 19 1 0 0 10 5 3 0 2 9 11 0 0 -

TANGGAL/BULAN : 5 0
1 00.23 53209 MUHAMAD ILHAM AFFAN,AN 5/18/2005 KEPUNDUHAN 5/2 CKR DYAH
OKSIGEN
dr. Layali dr. Fadel dr. Dyah dr. Rosnel dr. EDI dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, S
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 - - - - - - - - - - -
- - - - - 1 28,000 - - 1 65,000 - - - -
- - - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - -
- - - - - 1 28,000 2 70,000 2 108,000 - - - - -
- - - - - 1 28,000 - 1 54,000 - - - - -
- - - - 1 28,000 - - - - - - -
- - - 1 28,000 - - 1 54,000 - - - - -
- - - 1 28,000 - - - - - 15,000 - - -
- - - 1 28,000 - 1 35,000 2 108,000 - - 15,000 - - -
- - - 1 28,000 - - - 1 65,000 - - - -
- - - 1 28,000 - 2 70,000 - - - - - -
- - - 1 28,000 - - 1 54,000 - - - - -
- - - 1 28,000 - 2 70,000 3 162,000 - - 15,000 10,800 - -
- - - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - -
- - - 1 28,000 - 2 70,000 2 108,000 - - 15,000 - - -
1 28,000 - - - - - - - - - - -
1 28,000 - - - - 1 35,000 1 54,000 - - 15,000 - - 1 23,000
1 28,000 - - - - - - - - - - -
1 28,000 - - - - - - - - - - -
- 4 112,000 2 56,000 - - 9 252,000 5 140,000 13 455,000 16 864,000 2 130,000 - - 90,000 25,800 - - 1 23,000 -

OKSIGEN
dr. Layali dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, S
- - - - - 1 28,000 - - - - - - -
- - - - 1 23,000 - - 51,000 - - -
- - - - - - - 28,000 - - -
- - - - - - - 93,000 93,000 - -
- - - - - - - 221,000 - - 221,000
- - - - - - - 206,000 - 206,000 -
- - - - - - - 82,000 82,000 - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 82,000 82,000 - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 171,000 - 171,000 -
- - - - - - - 93,000 93,000 - -
- - - - - - - 98,000 - - 98,000
- - - - - - - 82,000 82,000 - -
- - - - - - - 270,800 - 270,800 -
- - - - - - - 117,000 - 117,000 -
- - - - - - - 206,000 - - 206,000
- - - - - - - 28,000 28,000 - -
- - - - - - - 140,000 - 140,000 -
- - - - - - - 28,000 28,000 - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 1 23,000 - - - - - - 2,080,800 572,000 904,800 525,000
2,080,800

- - - - - - - 28,000 - - -
RA BAYAR
JASA RAHARJA
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
RA BAYAR
JASA RAHARJA
-
JAM ASAL PASIEN CARA BAYAR CARA KELUAR PEMERIKSA

MASUK dr. EDI dr. FADEL
1 06.32 53230 SANURI,TN 12/10/1956 JATIBOGOR 1/11 SUSP APENDIC FADEL 1 1 1 - 1
2 06.51 53231 RASMANI,TN 9/1/1948 DEMANGHARJO 8/1 CHF FADEL 1 1 1 - 1
3 08.00 53232 SALFA AULIA.AN 1/6/2010 BOJONGSANA 6/2 RFA EDI 1 1 1 1 28,000
4 08.30 53235 MOH ABDUL AZIZ 1/13/2014 JATIBOGOR 4/9 KEMASUKAN BENDA ASING EDI 1 1 1 1 28,000
5 08.30 53234 SAMPURDI.TN 9/4/1965 LUMAJANG EDI 1 1 1 1 28,000
6 09.30 53236 YUMNA HAWIN.AN 1/17/2014 DEMANGHARJO 8/1 VL EDI 1 1 1 1 28,000
7 10.00 35114 SURATNA.NY 1/16/1986 SURADADI 2/2 ASTMA EDI 1 1 1 1 28,000
8 13.30 28908 DASRI.NY 12/31/1955 SURADADI 3/10 VERTIGO EDI 1 1 1 1 28,000
9 16.55 53241 MOH ISWANDI.SDR 6/6/1991 JATIBOGOR DENGUE FEVER LAYALI 1 1 1 -
10 17.20 53242 FIRMANSYAH.AN 7/24/2000 TANJUNGHARJA 6/3 DENGUE FEVER LAYALI 1 1 1 -
11 17.35 53243 WIWIT SETIAWAN.TN 2/21/1982 GEMBONGDADI 10/01 DENGUE FEVER LAYALI 1 1 1 -
12 20.30 53244 DARI.NY 12/5/1951 SEMEDO 9/3 anemia,febris LAYALI 1 1 1 -
13 21.10 51720 CARTI,NY 11/26/1947 KEDUNGKELOR 2/1 TB PARU FADEL 1 1 1 - 1
14 23.51 21390 TASUKRI,TN 5/1/1940 KERTASARI 7/7 CHF FADEL 1 1 1 - 1
JUMLAH 14 0 0 0 9 3 2 0 0 8 6 0 0 6 168,000 4

TANGGAL/BULAN : 5 0
JAM ASAL PASIEN CARA BAYAR CARA KELUAR PEMERIKSA
1 1 1 1 -
2 -
3 -
4 -
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) KONSUL DOKTER SPESIALIS
OKSIGEN
dr. FADEL dr.Layali dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT
28,000 - - - - - - 2 70,000 2 108,000 - - - - - - - - -

28,000 - - - - 2 70,000 2 108,000 1 65,000 - - 10,800 - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - 1 54,000 - - - - - - - -
- - - - - 1 65,000 - - - - - - -
- - - 2 70,000 2 108,000 - - - - - - - -
- 1 28,000 - - - - - - - - - - -
- 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - 1 23,000 - -
- 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - - - -
- 1 28,000 - 2 70,000 2 108,000 - - 15,000 - - - - -
28,000 - - 2 70,000 3 162,000 - - 15,000 10,800 - - - 1 23,000 -
28,000 - - 2 70,000 3 162,000 1 65,000 - 15,000 108,000 - - - - -
112,000 4 112,000 - - 10 350,000 13 702,000 6 270,000 4 216,000 30,001 228,800 - - - 10,800 1 23,000 1 23,000 - -
OKSIGEN
dr. Dyah dr. Rosnel dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
ER SPESIALIS PENDAPATAN BERDASAR CARA BAYAR
dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - - - 206,000 206,000 - -
- - - - - - 281,800 - 281,800 -
- - - - #REF! #REF! - - -
- - - - #REF! #REF! - - -
- - - - #REF! #REF! - - -
- - - - #REF! #REF! - - -
- - - - #REF! #REF! - - -
- - - - #REF! - - #REF! -
- - - - #REF! #REF! - - -
- - - - #REF! #REF! - - -
- - - - #REF! - #REF! - -
- - - - #REF! - #REF! - -
- - - - #REF! #REF! - - -
- - - - #REF! - - #REF! -
- - - - - - - - - - #REF! #REF! #REF! #REF! -
#REF!

- - - - #REF! #REF! - - -
- - - - #REF! - - - -
- - - - #REF! - - - -
- - - - #REF! - - - -
-
-

MASUK dr. EDI dr. Fadel
1 05.50 50851 WASRUN,TN 12/21/1962 HARJASARI GASTRITIS + BRONCHITIS FADEL 1 1 1 - 1
2 07.05 16152 ROLAH.NY 12/31/1960 SIDAHARJA 20/7 FEBRIS EDI 1 1 1 1 28,000
3 08.30 35254 SARKUM.TN 10/12/1960 SIDAHARJA 19/8 GEA EDI 1 1 1 1 28,000
4 11.00 53246 KASMURI.TN 1/1/1978 DEMANGHARJA 1/2 VL EDI 1 1 1 1 28,000
5 13.00 16100 FATONAH.NY 11/19/1955 HARJASARI 6/6 GEA EDI 1 1 1 1 28,000
6 14.15 48630 TARWADI.TN 9/16/1959 JATIMULYA 2/1 GEA ILHAM 1 1 1 -
7 15.50 53247 DAIMAH.NY 1/1/1979 JATIMULYA 4/6 ASMA LAYALI 1 1 1 -
8 16.10 3718 NUR KOSIM.TN 7/1/1958 DEMANGHARJO 1/2 VERTIGO LAYALI 1 1 1 -
9 17.29 44795 DEWI RATNASARI.NY 4/20/1998 PURWAHAMBA 07/03 H DG DIPSNEU LAYALI 1 1 1 -
10 19.24 22779 JABIDI.TN 1/1/1948 KERTASARI 2/1 VL LAYALI 1 1 1 -
11 19.28 48140 IMAM SYAFII.TN 2/2/1986 MARIBAYA 3/3 ASMA BRONCIALE LAYALI 1 1 1 -
12 19.00 53248 UMI KHAERUNISA.NY 2/21/1997 JATIBOGOR 2/3 H DG HBSAG + LAYALI 1 1 1 -
13 20.30 48441 TIKNO.TN 3/2/1983 HARJASARI 7/7 MALIGANT ROUND CELL TUMOR LAYALI 1 1 1 -
14 21.35 53249 SUGITO,TN 2/22/1979 DEMANGHARJO 3/1 DYSPEPSIA + SIROSIS HEPATIS DYAH 1 1 1 -
JUMLAH 13 1 0 0 7 6 0 0 1 9 5 0 0 4 112,000 1

TANGGAL/BULAN : 5 0
1 06.40 18798 AMALIA PUJI ARUM,NN 6/14/2000 KERTASARI 1/7 VE FADEL 1 1 1 - 1
2 06.40 41499 SHINTA SETIASIH,NN 10/4/2000 HARJASARI 4/5 VE + CKR FADEL 1 1 1 - 1
OKSIGEN
dr. Fadel dr. Dyah dr. Rosnel dr. Gesa dr.Layali Sederhana Kecil Sedang Berat DARAH dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - - -

- - - - - 1 35,000 2 108,000 - - 15,000 - - - -
- - - - - - - - - - - - -
- - - - - - 1 54,000 - - - - - -
- - - - - 2 70,000 2 108,000 - - 15,000 - - - -
- 1 28,000 - - - 1 35,000 2 108,000 - - 15,000 - - - -
- - - - 1 28,000 2 70,000 2 108,000 1 65,000 - 15,000 - - - -
- - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - -
- - - 1 28,000 - - - - - - -
- - - - 1 28,000 2 70,000 - - - - - - -
- - - - 1 28,000 - - 1 65,000 - - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - 1 23,000 -
- 1 28,000 - - 2 56,000 2 70,000 - - - 15,000 - - - -
28,000 2 56,000 - - - - 9 252,000 16 560,000 15 810,000 2 130,000 - - 135,000 - - - 1 23,000 - -
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) SAMPEL OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat DARAH dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
28,000 - - - 1 35,000 - - - - - - -
28,000 - - - 1 35,000 3 162,000 ### - 15,000 - 1 23,000 ###
- - - - - -
- - - - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 82,000 82,000 - - -
- - - - - - 206,000 206,000 - - -
- - - - - - 171,000 - 171,000 - -
1 23,000 - - - - - 294,000 294,000 - - -
- - - - - - 206,000 - 206,000 - -
- - - - - - 28,000 28,000 - - -
- - - - - - 98,000 98,000 - - -
- - - - - - 93,000 93,000 - - -
- - - - - - 117,000 - - - -
- - - - - - 140,000 - 140,000 - -
- - - - - - 154,000 - 154,000 - -
1 23,000 - - - - - - - - - - - - 1,617,000 829,000 671,000 - -
1,617,000

- - - - - - #REF!
- - - - - - ###
JAM ASAL PASIEN CARA BAYAR CARA KELUAR PEMERIKSAAN

MASUK dr. FADEL dr. Dyah
1 00.58 53250 KASTURI,TN 12/31/1959 SURADADI 1/1 GEA + HT GRADE II DYAH 1 1 1 - 1
2 04.40 52323 WARSO,TN 3/5/1979 SURADADI 4/2 PPOK EKSASERBASI DYAH 1 1 1 - 1
3 05.25 45535 SUNARTI,NY 12/30/1967 KERTAYASA 7/1 ASMA BRONCIALE DYAH 1 1 1 - 1
4 05.50 53251 ARFINSYA AULIA,AN 10/21/2012 KERTAYASA 7/1 FEBRIS DYAH 1 1 1 - 1
5 06.40 30304 SUIROTUN,NY 7/1/1968 KERTASARI 5/2 ARITMIA DYAH 1 1 1 - 1
6 07.27 52820 WATRI,NY 9/1/1946 JATIBOGOR 3/11 COLIK ABDOMEN FARADITA 1 1 1 -
7 08.10 1791 SITI KARI SUGIARTI,NY 3/18/1974 PURWAHAMBA 2/1 VL FARADITA 1 1 1 -
8 10.10 53271 ROMLAH,NY 8/19/1974 KEDUNGJATI 2/3 CKR FARADITA 1 1 1 -
9 10.35 53275 SOLEMAN,TN 5/3/1940 MARIBAYA 3/1 GEA FARADITA 1 1 1 - -
10 10.57 53278 TARLIM,TN 1/1/1961 SURADADI 1/14 VL FARADITA 1 1 1 - -
11 12.02 53281 DAKRONI,TN 1/1/1958 PEGIRIKAN 26/7,TALANG VL FARADITA 1 1 1 -
12 12.27 26833 ABINAKA HAZZA,AN 10/14/2005 SIDAHARJA 1/1 THYPOID FEVER FARADITA 1 1 1 -
13 14.41 39237 M.KHAERIZAL,SDR 3/22/1995 DEMANGHARJO 3/3 SKD FARADITA 1 1 1 -
14 13.56 53223 AHMAD SOFIUDIN,TN 6/12/1986 MARIBAYA 3/3 KONTROL LUKA FARADITA 1 1 1 -
15 16.00 53283 KENZI ADI RAJASA.AN 4/19/2014 DEMANGHARJA 4/1 INTOKSIKASI BAYCLIN FADEL 1 1 1 1 28,000
16 17.00 53284 DIKA ARYA.AN 5/7/2008 KRAMAT 6/1 VL FADEL 1 1 1 1 28,000
17 22.00 53285 KASUM.TN 4/17/1958 HARJASARI 1/3 CML, NEFROLITHIATS LAYALI 1 1 1 -
JUMLAH 17 0 0 0 9 7 1 0 0 7 10 0 0 2 56,000 5

TANGGAL/BULAN : 5 0
1 08.02 53256 TAHRONI,TN 7/10/1985 PURWAHAMBA 4/10 VL + AMPUTATUM FARADITA 1 1 1 -
2 07.40 41216 SIFA SALSABILA,AN 12/29/2000 PURWAHAMBA 15/6 VE FARADITA 1 1 1 -
3 11.03 53276 ISYNA SARIFATUN N,AN 7/7/2012 MARIBAYA 2/1 VE FARADITA 1 1 1 -
4 11.03 53277 RAKA OKTAVIANDI,SDR 10/10/1996 PADURAKSA 3/1,PEMALANG VE FARADITA 1 1 1 -
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) SAMPEL KONSUL DOKTER SPESIALIS
OKSIGEN
dr. Dyah dr.Layali dr. Faradita Sederhana Kecil Sedang Berat DARAH dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT
28,000 - - 2 70,000 2 108,000 - - 15,000 - - - - - -

28,000 - - - - 1 65,000 - - - - - - -
28,000 - - - - 1 65,000 - - - - - - -
28,000 - - 1 35,000 1 54,000 1 65,000 - 15,000 - - - 1 23,000 - -
28,000 - - 2 70,000 3 162,000 - - 15,000 10,800 - - - - -
- - 1 28,000 2 70,000 2 108,000 - - 15,000 - - - - - -
- - 1 28,000 2 70,000 - - - - - - - - -
- - 1 28,000 1 35,000 2 108,000 - - 15,000 - - - -
- - 1 28,000 2 70,000 2 108,000 - - - - - - - -
- - 1 28,000 - - 1 65,000 - - - - - - -
- - 1 28,000 - 1 54,000 - - - - - - - -
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 1 35,000 - - - - - - - - -
- - - - - - - - - - - - -
- - - - 1 54,000 - - - - - - - -
- 1 28,000 - - 2 108,000 2 130,000 - 15,000 - 1 23,000 - - - -
140,000 1 28,000 9 252,000 13 455,000 16 864,000 6 390,000 - - 90,000 10,800 1 23,000 - - 1 23,000 - - - -
OKSIGEN
- - 1 28,000 1 35,000 2 108,000 - - 15,000 - - 1 23,000 - - -
- - 1 28,000 1 35,000 - - - - - - - - -
- - 1 28,000 1 35,000 - - - - - - - - -
- - 1 28,000 - - - - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - #REF! - #REF! - -
- - - - #REF! #REF! - - -
- - - - #REF! - #REF! - -
- - - - #REF! - #REF! - -
- - - - #REF! #REF! - - -
- - - - #REF! - #REF! - -
- - - - #REF! #REF! - - -
- - - - #REF! - #REF! - -
- - - - #REF! #REF! - - -
- - - - #REF! - - #REF! -
- - - - #REF! #REF! - - -
- - - - #REF! #REF! - - -
- - - - #REF! #REF! - - -
- - - - #REF! #REF! - - -
- - - - #REF! - #REF! - -
- - - - - - - - - - #REF! #REF! #REF! #REF! -
#REF!

- - - - - - - -
- - - - - - - -
- - - - #REF! #REF! - - -
- - - - #REF! #REF! - - -

MASUK dr. Layali dr. Fadel
1 00.56 53286 AIDA SU'UDAH C.NY 6/23/1992 JATIBOGOR 4/7 H DG SEROTINUS LAYALI 1 1 1 1 28,000
2 07.32 52323 WARSO,TN 3/5/1979 SURADADI 4/2 PPOK FADEL 1 1 1 - 1
3 07.57 53291 SUMARNO,TN 10/22/1985 SIDAHARJA 23/9 DISPEPSIA FADEL 1 1 1 - 1
4 07.58 14772 SITI CHORIYAH,NY 9/6/1981 DEMANGHARJO 5/3 HAMIL DENGAN HBSA + FADEL 1 1 1 - 1
5 08.14 53290 KARWI,NY 4/13/1983 SUKAREJA MIALGIA FADEL 1 1 1 - 1
6 09.33 53254 NURUL AMRIH,NY 8/28/1992 KERTASARI AB INSIPIENS FADEL 1 1 1 - 1
7 09.42 32552 SODIKIN,TN 1/1/1952 MARIBAYA 3/1 ASITES FADEL 1 1 1 - 1
8 10.10 45685 AHNAN MAFTUH R,AN 3/27/2017 BANJARHARJO 4/9 BRONCHITIS FADEL 1 1 1 - - 1
9 10.37 28516 MARYAM,NY 6/26/1940 PURWAHAMBA 3/2 COLIK ABDOMEN E.C DISLOKASI IUD FADEL 1 1 1 - - 1
10 13.29 42802 NUR AENI,NY 10/5/1984 KERTASARI 5/3 HAMIL DENGAN ANEMIA FARADITA 1 1 1 -
11 13.39 51337 SANITI,NY 4/25/1945 GEMBONGDADI 4/4 TB PARU FARADITA 1 1 1 -
12 14.30 17092 SUHARJO.TN 2/10/1947 JATIBOGOR 1/16 HT ROSNELINA 1 1 1 -
13 14.50 53306 KASTURI.TN 2/23/1961 SIDAHARJA 29/2 RETIO URINE ROSNELINA 1 1 1 -
14 16.10 19274 NURKHOTIMAH.NY 6/13/1993 PLUMBUNGAN 4/2 TINEA CORPOSIS ROSNELINA 1 1 1 -
15 18.20 53308 MUNIROH.NY 3/7/1983 JATIMULYA 1/6 TF ROSNELINA 1 1 -
17 19.30 24726 WAGE.TN 1/1/1960 BOJONGSANA 7/3 CKR.VL ROSNELINA 1 1 1 -
18 19.00 53309 NAYA NUR AWLIA 10/22/2013 KERTAYASA 7/1 ROSNELINA 1 1 -
19 20.00 53310 FANISA AHMAD.AN 8/27/2015 BOJONGSANA 13/5 KDS ROSNELINA 1 1 1 -
20 22.30 53312 KHASANAH.NY 1/1/1957 BOJONGSANA 9/3 GASTRITIS AKUT DYAH 1 1 1 -
JUMLAH 18 1 0 0 10 1 7 1 0 10 7 0 0 1 28,000 8

TANGGAL/BULAN : 5 0
1 09.42 53310 M.HASAN SUKUR,SDR 5/5/1994 KEBONDALM 1/4 VE FADEL -
2 20.00 53310 WASNARI.TN 1/1/1962 TANJUNGHARJA 6/3 VL ROSNELINA 1 -
SEMPEL DARAH OKSIGEN
dr. Fadel dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- - - - - - - - - 18,000 - -
28,000 - - - - 2 70,000 2 108,000 1 65,000 - 15,000 - - -
28,000 - - - - - - - - - - -
28,000 - - - - 1 35,000 1 54,000 - - 15,000 - - -
28,000 - - - - - - - - - - -
28,000 - - - - 1 35,000 1 54,000 - - 15,000 - - -
28,000 - - - - 2 70,000 2 108,000 - - 15,000 - 1 23,000 -
28,000 - - - - - - - - - -
28,000 - - - - 1 35,000 2 108,000 - - 15,000 - - -
- - - - 1 28,000 1 35,000 2 108,000 - - 15,000 - - -
- - - - 1 28,000 2 70,000 2 108,000 - - 15,000 10,800 - -
- - 1 28,000 - 1 28,000 - - - - - - -
- - 1 28,000 - - - 1 54,000 - - - - -
- - 1 28,000 - - - - - - - - -
- - 1 28,000 - - - - - - - - -
- - 1 28,000 - - 2 70,000 2 108,000 - 1 80,000 25,000 - - 1 23,000
- - 1 28,000 - - - - - - - - -
- - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - -
- 1 28,000 - - - - - - - - - -
224,000 1 28,000 7 196,000 - - 3 84,000 13 455,000 16 864,000 1 65,000 1 80,000 - 28,800 1 23,000 1 23,000 -

OKSIGEN
- - - - - - - - - - - -
- - - - - - - - - - - -
dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Safira, Sp.OG dr. Arif Sp.An UMUM BPJS PBI BPJS NON PBI
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 117,000 - - 117,000
- - - - - - - 28,000 28,000 - -
- - - - 1 23,000 - - 140,000 - 140,000 -
- - - - - - - 229,000 - - 229,000
- - - - - - - 28,000 28,000 - -
- - - - 1 23,000 - - 194,000 - - 194,000
- - - - 1 23,000 - - 194,000 - - 194,000
- 1 23,000 - - - - - 239,800 - - 239,800
- - - - - - - 56,000 56,000 - -
- - - - - - - 82,000 82,000 - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 309,000 - - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 117,000 117,000 - -
- - - - - - - 28,000 28,000 - -
- 1 23,000 - - - - 3 69,000 - - - - - - 1,873,800 451,000 140,000 973,800
1,873,800

- - - - - - - - - -
- - - - - - - - - -
RA BAYAR
JASA RAHARJA
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
309,000
-
-
-
309,000
RA BAYAR
JASA RAHARJA
-
-

1 00.30 53313 WARMAH.NY 6/15/1982 JATIMULYA 4/4 H DG PRETERM DYAH 1 1 1 -
2 00.36 53314 WARMAH.BY.NY 1/17/2018 JATIMULYA 4/4 BAYI BARU LAHIR DYAH 1 1 1 -
3 02.23 53315 BUDI PRATAMA Y.SDR 6/22/1994 SURADADI 2/3 VL DYAH 1 1 1 -
4 07.30 21781 TARBIN,TN 12/31/1962 KARANGMULYA 1/4 GEA DGN COLIC FARADIYTA 1 1 1 -
5 08.29 12532 TASRIPIN,TN 3/15/1974 SIDAHARJA 26/1 FISIOTERAPY FARADIYTA 1 1 1 -
6 08.30 53324 SUKARDI,TN 1/20/1950 SIDAMULYA 7/2 DM + MYALGIA FARADIYTA 1 1 1 -
7 09.20 53328 ELI NURRAHMI.NY 1/4/1976 SIDAHARJA 26/1 CEK GOLDA FARADIYTA 1 1 1 - -
8 09.52 53329 AHMAD KUMAEDI,TN 6/6/1980 KALIMATI 19/2 ADIWERNA VL FARADIYTA 1 1 1 - -
9 10.30 53331 DUMI,NY 1/1/1960 KERTAYASA 7/1 MYALGIA FARADIYTA 1 1 1 -
10 11.35 53333 WALBI,TN 5/10/1977 KARANGMULYA 1/2 ISK FARADIYTA 1 1 1 -
11 11.45 50892 KOMARIYAH,NY 12/15/1943 SURADADI 2/6 VOMITUS FREQUENT FARADIYTA 1 1 1 -
12 12.55 31305 KASMINAH,NY 3/14/1953 SIDAMULYA 8/2 DYSPEPSIA + GEA ILHAM 1 1 1 -
13 13.44 14471 DARSINAH,NY 8/31/1979 SIDAHARJA 5/3 DYSPEPSIA FARADITA 1 1 1 -
14 14.23 53335 RIZKA MULIANA,NN 3/20/1994 MARIBAYA 3/3 MIGRAIN DYAH 1 1 1 -
15 14.29 43336 SOFIYAH BUNGA,AN 7/11/2000 JATIBOGOR 2/16 DISPEPSIA DYAH 1 1 1 -
16 19.30 10732 RUSTAM.TN 1/28/1958 KERTAYASA 3/4 HT DYAH 1 1 1 -
17 19.25 50293 ROSILAH,NY 1/1/1958 JATIMULYA 1/3 VERTIGO DYAH 1 1 1 -
18 20.08 46023 KASMU'I,TN 6/4/1953 SIDAHARJA 19/8 ATRIAN FIBRIASIS DYAH 1 1 1 -
22 21.15 51343 SUMITRO.TN 1/15/1950 BOJONGSANA 13/5 CHF LAYALI 1 1 1 1 28,000
JUMLAH 17 2 0 0 12 4 3 0 0 7 12 0 0 -

TANGGAL/BULAN : 5 0
1 10.55 53332 NELLA MALIDA,NN 3/7/1996 KANDANG 23/4 COMAL,PML VE FARADIYTA 1 1 1 -
2 05.05 53316 SAUMAN.TN 5/5/1972 KRAJAN 2/5.SURUH.SMG OPEN FR TIBIA DEXTRA + SUSP FR DYAH 1 1 1 -
3 05.05 53317 SUGIANTO.TN 5/4/1979 MBETON 4/4, KARANGANYAR MULTIPLE VL DYAH 1 1 1 -
OKSIGEN
- 1 28,000 - - - 2 70,000 1 54,000 - - 15,000 - - -

- 1 28,000 - - - - - - - - - - 1 23,000
- 1 28,000 - - - - - 1 65,000 - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 1 35,000 1 - - - -
- - - - 1 28,000 - - - 15,000 - - - -
- - - - 1 28,000 - 1 54,000 - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 2 70,000 1 54,000 - - - - - -
- 1 28,000 - - - - - - - - - - -
- 1 28,000 - - 1 28,000 1 35,000 - - - 15,000 - - - -
- 1 28,000 - - 2 56,000 2 70,000 - - - 15,000 - - - -
- 1 28,000 - - - 1 35,000 - - - - - - -
- 1 28,000 - - 2 56,000 2 70,000 - - - - - - -
- - - - - 1 35,000 2 108,000 - - 15,000 - - - -
- - - - - - - - - - - - -

OKSIGEN
- - - - 1 28,000 1 35,000 - - - - - - -
- 1 28,000 - - - - - - - - - - -
- 1 28,000 - - - - - 1 65,000 - - - - -
- - - - - - - - 167,000 - - 167,000 -
- - - - - - 51,000 - - 51,000 -
- - - - - - 93,000 93,000 - - -
- - - - - - 28,000 - 28,000 - -
- - - - - - 28,000 28,000 - - -
- - - - - - 63,001 63,001 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 82,000 82,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 206,000 - - 206,000 -
- - - - - - 28,000 28,000 - - -
- - - - - - 152,000 152,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 91,000 - 91,000 - -
- - - - - - 154,000 154,000 - - -
- - - - - - 63,000 63,000 - - -
- - - - - - 154,000 - 154,000 - -
- - - - - - 171,000 - 171,000 - -
- - - - - - - - 1,643,001 775,001 444,000 424,000 -
1,643,001

- - - - - - 63,000 63,000 - - -
- - - - - - 28,000 - - - 28,000
- - - - - - 93,000 - - - 93,000

1 00.08 40104 TONI.TN 10/20/1976 PURWAHAMBA 17/7 COLIC LAYALI 1 1 1 1 28,000
2 06.00 53337 DARMIN.TN 1/1/1945 SIDAHARJA 2/3 DADRS.HT LAYALI 1 1 1 1 28,000
3 06.00 53338 TARWADI.TN 4/4/1985 MUNJUNGAGUNG 1/1 DM LAYALI 1 1 1 1 28,000
4 08.15 53343 KASRIYAH,NY 7/8/1950 JATIBOGOR 1/8 ASMA BRONCIALE EDI 1 1 1 -
5 08.15 O2020 KOTIAH,NY 4/18/1963 SEMEDO 7/3 COMBUSSIO GRADE II EDI 1 1 1 -
6 09.25 53001 ARIPIN,TN 10/10/1962 KARANGMULYA 3/3 KOLIK ABDOMEN + TB PARU EDI 1 1 1 -
7 09.25 53345 MASRUN,TN 12/21/1964 SURADADI 1/14 VL EDI 1 1 1 -
8 09.40 53351 NURTATI,NY 12/11/1989 SIGENTONG 3/3 G3P2A0 H19MGG DGN ASMA EDI 1 1 1 -
9 10.15 15273 TANITI,NY 10/3/1963 JATIMULYA 4/3 OBS FEBRIS + LBP EDI 1 1 1 - -
10 11.05 53354 WARIDAH,NY 9/2/1940 TANJUNGHARJA 1/5 CLOSE FR OS RADIUS 1/3 DISTAL EDI 1 1 1 - -
11 1335 53355 SUWANDI,TN 12/11/1983 KERTASARI 5/8 MYALGIA EDI 1 1 1 -
12 13.45 50814 HANS WIBAWA S,AN 3/7/2016 SIDAHARJA 7/16 KDK EDI 1 1 1 -
13 14.15 17092 KASTURI,TN 2/23/1961 SIDAHARJA 12/5 POST RETENSIO URINE EDI 1 1 1 -
14 15.08 53356 BACHTIAR,TN 5/8/1956 SURADADI 1/17 GASTRITIS LAYALI 1 1 1 1 28,000
15 16.35 53080 WAHYU SAPUTRA,AN 3/24/2001 KERTASARI 5/2 KONTROL LUKA LAYALI 1 1 1 1 28,000
16 15.30 53357 DAROJAT,TN 12/1/1960 SURADADI 3/2 VL LAYALI 1 1 1 1 28,000
17 16.50 53358 M.SETIAWAN ,AN 9/24/2014 DEMANGHARJO 1/3 VL LAYALI 1 1 1 1 28,000
18 17.34 53361 SUNI,NY 10/26/1956 KERTAYASA 7/3 DISENTRI LAYALI 1 1 1 1 28,000
19 17.41 40462 M.AKMAL FIRDUS,AN 3/28/2014 PURWAHAMBA 2/29 FEBRIS LAYALI 1 1 1 1 28,000
20 18.49 53361 WINDA FATMAWATI,NY 2/5/1995 MARIBAYA 3/2 HAMIL DENGAN KPD + PER LAYALI 1 1 1 1 28,000
21 19.15 53364 HARDONI,TN 7/9/1978 SURADADI 2/2 GASTRITIS LAYALI 1 1 1 1 28,000
22 20.52 27542 KASTURI,TN 11/17/1948 JATIMULYA 1/1 CHF ROSNELINA 1 1 1 -
23 21.15 53365 IQRO AMIRULLAH.SDR 8/20/1990 SURADADI 2/7 FR MANUS ROSNELINA 1 1 1 -
24 23.00 28803 KELVIN ALDIANO 10/19/2014 PLUMBUNGAN 7/3 ROSNELINA 1 1 1 -
JUMLAH 22 2 0 0 15 4 4 0 1 11 13 0 0 11 308,000 -

TANGGAL/BULAN : 5 0
1 16.50 53360 WISKA DESPIANI,AN 1/1/2003 HARJASARI DOA LAYALI 1 1 1 1 28,000
2 16.50 53359 ASIH HIDAYATUN,AN 3/4/2004 HARJASARI VE LAYALI 1 1 1 1 28,000
3 19.10 53363 AGUS ZAKARIYA,TN 3/3/1988 SLEROK 3/4 MULTIPLE VE LAYALI 1 1 1 1 28,000
4 -
5 -
OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. Edi dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- - - - - 1 35,000 1 54,000 - - - - - -
- - - - - 2 70,000 2 108,000 - - - - - -
- - - - - 2 70,000 2 108,000 - - - - - -
- - - 1 28,000 - - - 1 65,000 - - - - -
- - - 1 28,000 - 1 35,000 2 108,000 - 1 80,000 15,000 - - 1 23,000 -
- - - 1 28,000 - 1 35,000 2 108,000 - - 15,000 - - - -
- - - 1 28,000 - 2 70,000 - - - - - - -
- - - 1 28,000 - - - 1 65,000 - 10,800 - -
- - - 1 28,000 - 2 70,000 2 108,000 - - 15,000 - - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - - - - - 15,000 - - - -
- - - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - - 1 28,000 - 1 35,000 - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - 1 35,000 2 108,000 - - 15,000 - - - -
- - - - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - - - - 1 35,000 1 54,000 - - 15,000 - - - -
- - - - - - - - - - - - -
- - 1 28,000 - - 2 70,000 2 108,000 - - 15,000 - - - -
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 - - - - - - - - - -
- - - 3 84,000 10 280,000 - - 18 630,000 18 972,000 2 130,000 1 80,000 135,000 10,800 - - 1 23,000 2 46,000
OKSIGEN
- - - - - - - - - - - - -
- - - - - 1 35,000 1 54,000 - - 15,000 - - 1 23,000 -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - 117,000 117,000 - - -
- - - - - - 206,000 206,000 - - -
- - - - - - 206,000 - - 206,000 -
- - - - - - 93,000 - - 93,000 -
- - - - - - 274,000 - 274,000 - -
- - - - - - 171,000 - 171,000 - -
- - - - - - 98,000 - 98,000 - -
- - - - - - 103,800 - - - -
- - - - - - 206,000 206,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 140,000 140,000 - - -
- - - - - - 63,000 63,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 - - 28,000 -
- - - - - - 28,000 28,000 - - -
- - - - - - 171,000 171,000 - - -
- - - - - - 140,000 140,000 - - -
- - - - - - 117,000 - 117,000 - -
- - - - - - 28,000 28,000 - - -
- - - - - - 206,000 - - 206,000 -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - - - - - - - - - 2,563,800 1,267,000 660,000 533,000 -
2,563,800
- - - - - - 28,000 28,000 - - -
- - - - - - 140,000 140,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - - - - - -
- - - - - - - - - - -

MASUK dr. Layali dr. EDI
1 00.15 42948 KARNITI.NY 12/30/1953 KERTASARI HIPOGLEKEMIA ROSNELINA 1 1 1 -
2 03.30 53102 SITI JAETUN.NY 8/23/1990 JATIBOGOR 1/4 KALA 1 LAMA ROSNELINA 1 1 1 -
3 03.30 53367 TRI AMALIA.AN 7/17/2008 KEDUNGKELOR 1/3 ROSNELINA 1 1 1 -
4 08.29 53373 SAIMAH.NY 5/5/1938 KEMUNING 3/4 VOMITUS, GASTRITIS FARADITA 1 1 1 -
5 09.11 49237 SRI WINDA ETIKA.NY 10/31/1985 JATIBOGOR 3/8 H DG PPI POST SC FARADITA 1 1 1 -
6 10.30 53333 WALBI.TN 5/10/1977 KARANGMULYA 1/2 COLIC RENAL FARADITA 1 1 1 -
7 11.15 53384 DEWI WINANGSIH.AN 12/17/2002 DEMANGHARJO 6/3 SPRAIN FARADITA 1 1 1 -
8 11.15 53383 AYU LESTARI.AN 4/30/2003 DEMANGHARJO 6/3 SPRAIN FARADITA 1 1 1 -
9 13.00 53281 DAKRONI.TN 1/1/1958 PEGIRIKAN 26/7 FOLLOW UP HECTING VL FARADITA 1 1 1 -
10 13.30 41626 SITI MAHFIROH.NY 6/19/1989 KRAMAT 1/2 GASTRITIS AKUT FARADITA 1 1 1 -
11 13.30 53386 KASDANI.TN 12/30/1963 KARANGMULYA 1/4 TF FARADITA 1 1 1 -
12 14.45 53387 IQBAL ALAMSYAH,SDR 5/1/1998 MANGUNSAREN 5/2 VL EDI 1 1 1 - 1
13 14.45 53271 ROMLAH,NY 8/19/1974 KEDUNGJATI 2/3 GEA EDI 1 1 1 - 1
14 14.50 53054 RAFKA ALFARIZI,AN 3/28/2017 TANJUNGHARJA 8/3 OBS FEBRIS + VOMITUS FREQUENT EDI 1 1 1 - 1
15 15.45 53388 ABDUL SALAM,AN 9/21/2016 KERTASARI 1/5 DADRS EDI 1 1 1 - 1
16 17.12 53389 SULTAN MUHAMMAD,AN 6/23/2017 MARIBAYA 4/1 OBS. FEBRIS H 10 + RFA EDI 1 1 1 - 1
17 18.05 51823 ZULFA NI'MATUL ,AN 11/20/2017 JATIMULYA 1/6 ABDOMINAL DISTENSI EDI 1 1 1 - 1
18 21.43 53390 ROPIAH,NY 11/18/1974 JATIMULYA 1/6 GASTRITIS AKUT LAYALI 1 1 1 1 28,000
Kepala Ruang IGD

TANGGAL/BULAN : 5 0
1 06.00 53368 SITI NUR AROFAH.NN 3/17/1991 PACUL 1/1 FR CLAVICULA ROSNELINA 1 1 1 -
2 -
OKSIGEN
dr. EDI dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat DARAH dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- - 1 28,000 - - 2 70,000 2 108,000 - - - - - - - - -

- - 1 28,000 - - 1 35,000 1 54,000 - - - - - - -
- - 1 28,000 - - 1 35,000 1 54,000 - - - - - 1 23,000
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - -
- - - - 1 28,000 1 35,000 2 108,000 - - - - 15,000 - - - -
- - - 1 28,000 1 35,000 1 54,000 - - - 15,000 - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 1 35,000 - - - - - - - - - -
- - - - 1 28,000 2 70,000 1 54,000 - - - 15,000 - - -
- - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - - -
28,000 - - - - - - - - - - - -
28,000 - - - - 1 35,000 2 108,000 - - - 15,000 - - - - -
28,000 - - - - - - - - - - - - -
28,000 - - - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
28,000 - - - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
28,000 - - - - 1 35,000 1 54,000 - - - 15,000 - - - - 1 23,000
- - - - - - 1 54,000 - - - - - - -

OKSIGEN
- - 1 28,000 - 1 28,000 1 35,000 2 108,000 - 1 80,000 - - - -
- - - - - - - - - - - - -
- - - - - - - - 206,000 - - 206,000 -
- - - 1 23,000 - - 140,000 - 140,000 - -
- - - - - - 140,000 140,000 - - -
- - - - - - 132,000 132,000 - - -
- - - - - - - - 186,000 - 186,000 - -
- - - - - - 132,000 132,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - - - 63,000 63,000 - - -
- - - - - - 167,000 - 167,000 - -
- - - - - - 221,000 - 221,000 - -
- - - - - - 28,000 28,000 - - -
- - - - - - - - 171,000 - 171,000 - -
- - - - - - 28,000 28,000 - - -
- - - - - - 140,000 140,000 - - -
- - - - - - 140,000 - - 140,000 -
- - - - - - - - 140,000 - 140,000 - -
- - - - - - 82,000 82,000 - - -
2,172,000

- 1 23,000 - - - - 302,000 - - - 302,000
- - - - - - - - - - -

MASUK dr. Layali
1 01.08 53391 SITI MARYAM,NY 6/5/1983 PURWAHAMBA 18/8 HAMIL DENGAN KPD LAYALI 1 1 1 1
2 01.18 19572 NUR ISNAINI,NY 11/4/1991 PURWAHAMBA 2/1 HAMIL DENGAN KALA I LAMA LAYALI 1 1 1 1
3 01.43 53392 SAILAH,NY 1/1/1961 KEMUNING 3/2 VL LAYALI 1 1 1 1
4 05.47 53393 SOFIYAH,NY 7/1/1946 JATIBOGOR 1/5 HT LAYALI 1 1 1 1
5 06.41 2418 ABDUL WAHID,TN 1/6/1953 SURADADI 3/11 HEMATEMESIS LAYALI 1 1 1 1
6 07.30 53395 AYU.NY 9/25/1992 MARIBAYA 4/1 VE FARADITA 1 1 1
7 08.00 44856 ARSYFA SYAUQINA S.AN 7/5/2016 SIDAHARJA 01/01 TYPOID FEVER,RFA FARADITA 1 1 1
8 09.00 53398 SITI ZAHRO.NY 12/9/1952 CISALAK PASAR 2/5, CIMANGGIS GEA FARADITA 1 1 1
9 08.50 13659 WATEM.NY 6/3/1958 HARJASARI 5/4 GASTRITIS FARADITA 1 1 1 -
10 08.00 53397 SITI DAROJATUN.NY 4/24/1981 SURADADI 1/15 SKD, SURAT BEBAS NARKOBA FARADITA 1 1 1 -
11 09.30 53399 KRISTINAH.AN 12/2/2001 HARJASARI 6/5 CEPHALGIA FARADITA 1 1 1
12 09.51 53400 SEVTIANI MUZIZAH.NY 9/1/1998 KETILENG 2/1 H DG KALA 1 LAMA FARADITA 1 1 1
13 12.30 53407 ELY SUSYANTI.NN 8/3/1993 KERTAYASA 2/3 DISPEPSIA FARADITA 1 1 1
14 12.30 53406 DASIYONO.SDR 12/18/1996 BANJARAGUNG 6/1 SNAKE BITE FARADITA 1 1 1
15 10.59 53405 FEBBY RAHMANIA S.AN 8/27/2015 KEDUNGSAMBI 4/3 BRPN, FEBRIS AKUT FARADITA 1 1 1
16 15.30 53408 SAILAH,NY 1/1/1966 PUYWAHAMBA 2/1 TRAUMA COCYGEUS ROSNELINA 1 1 1
17 17.10 53291 SUMARNO,TN 10/22/1985 SIDAHARJA 23/9 GASTRITIS + IMSOMIA ROSNELINA 1 1 1
18 17.30 O1358 DIMAS BAYU,AN 8/4/2009 KERTAYASA 1/7 FEBRIS ROSNELINA 1 1 1
19 17.45 19941 SUTORO,TN 12/12/1945 SIDAHARJA 14/7 VOMITUS DGN DEHIDRASI ROSNELINA 1 1 1
20 17.45 53410 NISBAH,NY 1/1/1948 SIDAMULYA 2/2 CHEPALGIA + DM GRADE 2 ROSNELINA 1 1 1
21 18.00 53409 DAROH,NY 3/10/1979 WOTGALIH 2/1 G4P3A0 H25MGG DGN IMPENDING EMKLAMSI ROSNELINA 1 1 1
22 18.50 49923 SRI REJEKI,NY 6/5/1997 MARIBAYA 3/2 CORPUS ALINIUM DI TELINGA ROSNELINA 1 1 1
23 19.15 O9808 SULASMI,NY 12/22/1947 DEMANGHARJO 3/3 HT + VERTIGO ROSNELINA 1 1 1
24 20.00 53411 ERIZA IMPRONI,SDR 8/16/1996 SIDAHARJA 17/7 BIKIN SKD ROSNELINA 1 1 1
25 20.30 53413 REYHAN RIZQI,AN 10/10/2011 SURADADI 3/11 VOMITUS ROSNELINA 1 1 1
26 22.48 42937 MUTIYAH,NY 12/6/1974 KREMAN 6/2 GASTRITIS EDI.S 1 1 1
JUMLAH 22 4 0 0 18 6 2 0 0 17 9 0 0 5
Kepala Ruang IGD
Agus Riyanto, AMK
Layali M, dr
Rosnelina, dr
Faila S, dr
Dyah Novi, dr
Gesa Tidar, dr
Faradita, dr

TANGGAL/BULAN : 5 0
1 09.56 53404 SUMAMI.NY 7/12/1990 KERTASARI 5/8 MULTIPLE VE FARADITA 1 1 1
2 09.56 53402 ANDRI SYAEFUL.TN 10/25/1989 KERTASARI 5/6 MULTIPLE VE FARADITA 1 1 1
3 09.56 53401 RATI.NY 7/1/1967 KERTASARI 8/7 CKR, FR WRIST JOINT FARADITA 1 1 1
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) SEMPEL
OKSIGEN
dr. Layali dr. Edi dr. Dyah dr. Rosnel dr. Faradita Sederhana Kecil Sedang Berat DARAH dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - - -

28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - - -
28,000 - - - - - - 1 65,000 - - - - -
28,000 - - - - 2 70,000 2 108,000 1 65,000 - 15,000 10,800 - - -
28,000 - - - - 2 70,000 2 108,000 - - 15,000 10,800 - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - - -
- - - - 1 28,000 - - - - - -
- - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - - -
- - - - 1 28,000 - - - - - - -
- - - - 1 28,000 2 70,000 1 54,000 - - 15,000 15,000 - 1 23,000 -
- - - - 1 28,000 1 35,000 1 54,000 1 65,000 - 15,000 - - - 1 23,000
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - - -
- - - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - - 1 28,000 - 2 70,000 1 54,000 - - 15,000 - - - -
- - - 1 28,000 - 2 70,000 1 54,000 - - 15,000 - - - -
- - - 1 28,000 - 1 35,000 2 108,000 - - 15,000 108,000 - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - 2 70,000 1 54,000 - - - - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- 1 28,000 - - - 2 70,000 2 108,000 - - 15,000 - - - -
140,000 1 28,000 - - 10 280,000 10 280,000 27 945,000 24 1,296,000 3 195,000 - - - 144,600 - - 1 23,000 3 69,000
OKSIGEN
dr. Layali dr. Faila dr. Dyah dr. Rosnel dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - 1 23,000 -
dr. Fullarini, Sp.P dr. Yuli, Sp.OTdr. NADIA SAFIRA Sp.OG
dr. Riyani, Sp.OG dr. Arif Sp.An dr,nadia s UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - - - #REF! #REF! - - -
- - - - - - #REF! - #REF! - -
- - - - - - #REF! #REF! - - -
1 23,000 - - - - - #REF! - #REF! - -
- - - - - - #REF! - #REF! - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! - #REF! - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - 1 23,000 #REF! - - #REF! -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! - - #REF! -
- - - - - - #REF! #REF! - - -
- - 1 23,000 - - - #REF! - #REF! - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! - #REF! - -
1 23,000 - - 1 23,000 - - - - 1 23,000 - - #REF! #REF! #REF! #REF! -
#REF!
KONSUL DOKTER SPESIALIS
dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An
- - - - - -
- - - - - -
- - - - - - #REF!

MASUK dr. FADEL
1 00.27 19 SLAMET,TN 1/20/1943 SURADADI 3/5 ASMA EDI.S 1 1 1
2 03.00 53414 RANOTO,TN 11/16/1961 KAMPUNG BARU,JAKARTA PUSAT CHF EDI.S 1 1 1
3 06.30 50544 SATRIYAH,NY 7/15/1942 PURWAHAMBA 27/11 STROKE HEMORAGIC EDI.S 1 1 1
4 08.30 3766 SOPIAH.NY 1/1/1954 SIDAHARJA 14/7 ASTMA FADEL 1 1 1
5 08.30 53182 EKA NUR DEWI.NY 1/6/1999 HARJASARI 2/6 RETIO URINE FADEL 1 1 1 1
6 840 53377 DANI IRAWAN.AN 1/1/2014 DEMANGHARJA FEBRIS FADEL 1 1 1 1
7 11.00 53415 MULYANI.NY 7/18/1973 KETILENG 5/1 COLIC ABD FADEL 1 1 1 1
8 11.20 53416 WASTAF.TN 1/1/1952 KERTASARI 4/8 INTOKSIKASI PESTISIDA FADEL 1 1 1 1
9 13.00 52400 SUWIGNYO.TN 1/1/1956 JATIBOGOR 5/6 HT BERAT FADEL 1 1 1 1
10 15.08 53417 MANIS ASLIYAH.NY 8/12/1985 KERTASARI 4/5 H DG KALA 1 LAMA DYAH 1 1 1
11 15.15 53418 SUR'ID.TN 12/12/1974 KALIJAMBE 3/3.TARUB VL DYAH 1 1 1
12 16.12 53419 HERLIN AYU W.NY 1/11/1993 MINTARAGEN 5/10,TEGAL TIMUR H DG AB IMINEN DYAH 1 1 1
13 18.57 53420 FADLI PUTRA D.AN 2/12/2015 SURADADI 3/11 DHF DYAH 1 1 1
14 20.30 53423 DINA ISTIKOMAH,NN 6/12/1998 JATIBOGOR 1/16 TRAUMA MUSCULOSCELETAL EDI.S 1 1 1
15 20.30 53424 JULEKHA,NN 3/1/1997 SURADADI 3/3 DHF EDI.S 1 1 1
16 21.55 53425 TOHIR,TN 1/1/1936 TANJUNGHARJA 4/1 DOA EDI.S 1 1 1
JUMLAH 15 1 0 0 8 3 5 0 0 9 6 1 0 5

TANGGAL/BULAN : 5 0
1 20.09 53422 DEDY PURWANTO.TN 11/21/1967 PROCOT 4/2.SLAWI MULTIPLE VE DYAH 1 1 1
2 23.55 53426 TOHIRIN,SDR 8/21/1985 SURADADI 1/6 CLOSE FR1/3 DISTRAL OS RADIUS EDI.S 1 1 1
3
OKSIGEN
dr. FADEL dr. Edi.S dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- 1 28,000 - - - - - - 1 65,000 - - - - - -
- 1 28,000 - - - - 1 35,000 2 108,000 - - - 36,600 1 23,000 -
- 1 28,000 - - - - 2 70,000 3 162,000 - 1 80,000 10,800 1 23,000 -
- 1 28,000 - - - - 1 35,000 2 108,000 1 65,000 - - - -
28,000 - - - - - - - 1 65,000 - - - - - -
28,000 - - - - - 1 35,000 1 54,000 - - - - - - 1
28,000 - - - - - - - - - - - -
28,000 - - - - - 1 35,000 2 108,000 - - - - - - - -
28,000 - - - - - 2 70,000 2 108,000 - - 1 10,000 - -
- - 1 28,000 - - - 2 70,000 3 162,000 - - 15.000 + 14400 - -
- - 1 28,000 - - - - 1 54,000 - - - - -
- - 1 28,000 - - - - 2 108,000 - - - - 15,000 - - -
- - 1 28,000 - - - 1 35,000 1 54,000 - - - 18,000 - - 1
- 1 28,000 - - - - 1 35,000 - - - - - -
- 1 28,000 - - - - 1 35,000 1 54,000 - - - - 15,000 - - -
- 1 28,000 - - - - - 1 54,000 - - - - - -
140,000 7 196,000 4 112,000 - - - - - - 13 455,000 21 1,134,000 3 195,000 1 80,000 1 105,400 2 46,000 - - 2

OKSIGEN
dr. Layali dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- - 1 28,000 - - - 1 35,000 - - - - - -
- 1 28,000 - - - - 1 35,000 3 162,000 - - 15,000 - -
- - - - - - - - - - - - -
dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An dr.NADIA S UMUM BPJS PBI BPJS NON PBI
- - - - - - - - - 93,000 - - 93,000
- - - - - - - 230,600 230,600 - -
- - - - - - - 373,800 - - 373,800
- - - - - - - 236,000 - 236,000 -
- - - - - - - - - 93,000 - 93,000 -
23,000 - - - - - - 140,000 140,000 - -
- - - - - - - 28,000 - 28,000 -
- - - - - - - - - 171,000 171,000 - -
- - - - - - - 216,000 - - 216,000
- - - - - - 1 23,000 #VALUE! #VALUE! - -
- - - - - - - 82,000 82,000 - -
- - - - - - 1 23,000 - - 174,000 - - 174,000
23,000 - - - - - - 158,000 158,000 - -
- - - - - - - 63,000 - - 63,000
- - - - - - - - - 132,000 132,000 - -
- - - - - - - 185,000 267,000 267,000 - -
46,000 - - - - - - - - - - 2 46,000 185,000 - #VALUE! #VALUE! 357,000 919,800
#VALUE!

dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An
- - - - - - -
- - 1 23,000 - - - - 263,000
- - - - - - - -
RA BAYAR
JASA RAHARJA
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

MASUK dr. EDI dr. Faila
1 01.25 53427 SUSWATI,NY 8/20/1992 PURWAHAMBA 25/10 G3P2A0 H38MGG DGN KPD EDI S 1 1 1 1 28,000
2 01.35 53428 SUSWATI,BY,NY 1/22/2018 PURWAHAMBA 25/10 BCB SMK SPT EDI S 1 1 1 1 28,000
3 02.50 27158 SUKLI,TN 5/15/1954 JATIBOGOR 3/6 KOLIK ABDOMEN EDI S 1 1 1 1 28,000
4 03.50 27036 SUKIRMAN,TN 7/1/1967 SEMEDO 11/4 ASMA BRONKIALE EDI S 1 1 1 1 28,000
04.20 47869 DEVI FARIDA ,NY 1/5/1992 KEDUNGJATI 1/5 GASTRITIS AKUT EDI S 1 1 1 1 28,000
6 08.00 53436 TRI MULYAWAN.TN 1/1/1981 JATIMULYA SKD FARADITA 1 1 1 -
7 08.30 43434 NASIRUDIN.TN 7/2/1959 MARIBAYA 1/1 COLI ABD FARADITA 1 1 1 -
8 08.30 53213 WAITAH.NY 5/12/1958 BONGKOK 1/1 KONTROL LUKA FARADITA 1 1 1 -
9 09.00 10026 SAMITUN.TN 1/4/1943 KARANGMULYA 3/2 ASMA FARADITA 1 1 1 -
10 09.10 18277 MOH TOSIM 7/1/1977 SURADADI 2/1 ASMA FARADITA 1 1 1 -
11 09.30 53440 AHMAD ROJAI.TN 10/16/1943 KARANGMULYA 9/2 VERTIGO FARADITA 1 1 1 -
12 11.30 53443 SUPARDI.TN 7/1/1963 MANGUNSAREN 2/6 DEPRESI BERART FARADITA 1 1 1 -
13 13.30 53445 SITI NUR RIZKI.NY 3/13/1989 WARUREJA COLI ABD FARADITA 1 1 1 -
14 17.40 44599 KASNAWI.TN 1/1/1957 SURADADI 2/3 BRPN,SUSP TB PARU ROSNELINA 1 1 1 -
15 17.00 53452 ISMIYANTI.NY 9/8/1986 DEMANGHARJO 4/2 H DG KALA 1 LAMAA ROSNELINA 1 1 1 -
16 15.45 53451 SITI FATIMAH.NY 12/25/1990 KEDUNGKELOR 6/1 H DG PEB ROSNELINA 1 1 1 -
17 14.38 53447 MURIASIH.BY.NY 1/22/2018 TANJUNGHARJA 7/3 BAYI BARU LAHIR ROSNELINA 1 1 1 -
18 14.09 53446 MURIASIH.NY 4/27/1992 TANJUNGHARJA 7/3 H DG KALA 2 LAMA ROSNELINA 1 1 1 -
19 14.37 53448 DAUMI.NY 1/1/1977 SIDAHARJA 11/6 ASMA BRONKIALE ROSNELINA 1 1 1 -
20 15.30 53450 SUDEWI.NY 1/5/1955 KARANGMULYA 1/5 HT BERAT ROSNELINA 1 1 1 -
21 15.06 53449 MIKHAILA SALWA.AN 10/17/2017 PURWAHAMBA 1/1 GASTROENTERITIS ROSNELINA 1 1 1 -
22 19.00 53454 KEVIN ARSENIO K.AN 9/2/2015 SIDAHARJA 26/10 TRAUMA ROSNELINA 1 1 1 -
23 19.05 53455 IRIN WAHYUDI.SDR 10/10/1992 BONGKOK 2/5 GASTRITIS AKUT ROSNELINA 1 1 1 -
24 20.30 25219 ISTILAENI.NY 10/24/1989 KERTASARI 06/01 G5P2A0 H38MGG DGN KALA 1 ROSNELINA 1 1 1 -
25 20.50 53457 ASOYIDAH,NY 1/1/1967 SIDAHARJA 17/7 GEA ROSNELINA 1 1 1 -
26 21.45 53458 SAOTUN,NY 7/13/1978 KERTAYASA 4/7 GASTRITIS AKUT DYAH 1 1 1 -
27 23.25 53461 NURLAELA,NY 8/28/1982 SURADADI 3/15 GEA + VOMITUS DYAH 1 1 1 -
JUMLAH 23 4 0 0 13 9 4 0 1 18 9 0 0 5 140,000 -
TANGGAL/BULAN : 5 0
1 17.05 53453 AGUS WIDODO.TN 6/18/1998 JATIBOGOR 2/2 VL,VE ROSNELINA 1 1 1 -
2 17.05 52590 ADAWIYAH.NY 4/1/1998 PEREAN 1/2,MEKAKAU ILIR VE ROSNELINA 1 1 1 -
3 19.30 53456 SILVI SULISTIAWATI.AN 12/4/2005 SURADADI 02/12 VL, VE ROSNELINA 1 1 1 -
4 -
OKSIGEN
- - - - - 1 35,000 1 54,000 - - - 15,000 - - - - -

- - - - - 1 35,000 - - - - - - - 1 23,000
- - - - - 1 35,000 2 108,000 - - 15,000 - - - -
- - - - - - - 1 65,000 - - - - -
- - - - - - - - - - - - - - - -
- - - - 1 28,000 - - - - - - - - -
- - - - 1 28,000 1 35,000 2 108,000 - - - - - -
- - - - 1 28,000 1 35,000 - - - - - - - - - -
- - - - 1 28,000 1 35,000 1 54,000 1 65,000 - - - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - - - - - - - -
- - - - 1 28,000 1 35,000 - - - - - - - -
- - 1 28,000 - - 2 70,000 1 54,000 - - 15,000 10,800 - - -
- - 1 28,000 - - - 1 54,000 - - - 15,000 - - - - -
- - 1 28,000 - - 1 35,000 - 2 130,000 - 15,000 - - - -
- - 1 28,000 - - - - - - - - - 1 23,000
- - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - - -
- - 1 28,000 - - 2 70,000 1 54,000 - - - 15,000 - - - - -
- - 1 28,000 - - - - - - - - - - -
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 - - - - - - - - - - - - -
- - 1 28,000 - - - - - - - - - - -
- - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - - -
- - 1 28,000 - - - - - - - - - -
- 1 28,000 - - - 1 35,000 1 54,000 - - - 15,000 - - - - -
- 1 28,000 - - - 1 35,000 1 54,000 - - 15,000 - - - -
- 2 56,000 12 336,000 - - 8 224,000 19 665,000 16 864,000 4 260,000 - - 150,000 10,800 - - - - 2 46,000
OKSIGEN
- - 1 28,000 - - - 1 54,000 - - - - - -
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 - - - 1 54,000 - - - - - -
- - - - - - - - - - - - -
dr. Fullarini, Sp.P dr. Yuli, Sp.OTdr. NADIA SAFIRA Sp.OG
dr. Riyani, Sp.OG dr. Arif Sp.An dr.exel.s.og UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - 1 23,000 - - - - - 140,000 - 140,000 - -
- - - - - - 86,000 - 86,000 - -
- - - - - - 171,000 - 171,000 - -
- - - - - - 93,000 - 93,000 - -
- - - - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 171,000 171,000 - - -
- - - - - - - - 63,000 63,000 - - -
- - - - - - 182,000 182,000 - - -
- - - - - - 117,000 - 117,000 - -
- - - - - - 117,000 - - 117,000 -
- - - - - - - - 117,000 - 117,000 - -
- - - - - - 63,000 63,000 - - -
1 23,000 - - - - - 185,800 185,800 - - -
- - - - - 1 23,000 - - 105,000 - - 105,000 -
- - - - - 1 23,000 216,000 - - - -
- - - - - - 51,000 - 51,000 - -
- - - - - - 117,000 - 117,000 - -
1 23,000 - - - - - - - 175,000 175,000 - - -
- - - - - - 28,000 - - 28,000 -
- - - - - - 28,000 28,000 - - -
- - - - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - 1 23,000 140,000 - 140,000 - -
- - - - - - 28,000 28,000 - - -
- - - - - - - - 117,000 117,000 - - -
- - - - - - 117,000 - - 117,000 -
2 46,000 - - 1 23,000 - - - - 3 69,000 - - 2,739,800 1,124,800 1,032,000 367,000 -
2,739,800
- - - - - -
- - - - - -
- - - - - - 82,000
- - - - - - -

MASUK dr. Layali
1 01.50 53462 SAIRAH,NY 7/1/1965 KEMUNING 2/3 GEA + GASTRITIS AKUT DYAH 1 1 1 -
2 04.21 15855 KHUMAENI,NY 11/27/1983 PURWAHAMBA 26/10 RETENSIO URINE DYAH 1 1 1 -
3 07.46 53464 SITI NUR ANISAH,AN 11/14/2003 SIDAMULYA 4/2 VL FADEL 1 1 1 -
07.51 805 RUBAN,TN 6/12/1958 KARANGWULUH 4/1 VL FADEL 1 1 1 -
5 08.00 30632 MUSRIPAH,NY 12/30/1963 SIDAHARJA 26/1 VERTIGO FADEL 1 1 1 -
6 08.35 15975 WI'AH,NY 5/13/1989 JATIMULYA 3/3 KONSTIPASI FADEL 1 1 1 -
7 08.35 53441 MUHAMAD YULIANTO,AN 7/13/2011 KERTASARI PROLONGED FEVER FADEL 1 1 1 -
8 08.55 53467 TIRMAN,TN 12/31/1943 JATIBOGOR 2/3 ACS FADEL 1 1 1 -
9 08.55 53392 SAILAH,NY 1/1/1963 KEMUNING 2/3 KONTROL LUKA FADEL 1 1 1 - -
10 09.36 53464 KASRIYAH,NY 7/8/1950 JATIBOGOR 1/8 ASMA FADEL 1 1 1 - -
11 10.24 22200 SERENA,AN 5/16/2013 SURADADI 3/15 POST TRAUMA FADEL 1 1 1 -
12 12.05 53470 SAYAN,TN 12/31/1941 BANGUNGALIH 8/1 GASTRITIS FADEL 1 1 1 -
13 12.27 53471 RASTONO,TN 2/12/1968 BREKAT 10/1 SYOCK HIPOVOLEMIK FADEL 1 1 1 -
14 16.00 53474 LULU IL MAKNUN 11/19/2010 DEMANGHARJA 2/2 VL PD BIBIR ROSNELINA 1 1 1 -
15 17.00 47194 DODI IRAWAN.TN 6/8/1993 SIDAHARJA 1/1 VL ROSNELINA 1 1 1 -
16 19.30 53475 SANTI NURHIDAYAH.NN 8/26/1994 KARANGWULUH 3/2 TF ROSNELINA 1 1 1 -
17 20.00 53476 ASHALINAH YUMNA 1/25/2017 KARANGMULYA 1/3 KDS ROSNELINA 1 1 1 -
18 20.30 53477 SAKHURI.TN 10/1/1972 BANJARTURI 1/6 MOBILI ROSNELINA 1 1 1 -
19 21.28 53478 GLADISTIA ELLSA H.AN 1/24/2014 SURADADI 2/14 KDK LAYALI 1 1 1 1 28,000
20 22.30 53479 SHUMAYSI.NY 3/8/1981 SURADADI 2/17 KOLIK ABDOMEN LAYALI 1 1 1 1 28,000
JUMLAH 18 2 0 0 10 7 3 0 0 12 8 0 0 2 56,000

TANGGAL/BULAN : 5 0

MASUK
JAM
MASUK dr. Layali
1 -
2 -
3 -
OKSIGEN
dr. Fadel dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat DARAH dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A
- 1 28,000 - - - 1 35,000 1 54,000 - - 15,000 - - -

- 1 28,000 - - - - 1 54,000 - - - - -
1 28,000 - - - - - 1 54,000 - - - - -
1 28,000 - - - - 1 54,000 - - - - -
1 28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - -
1 28,000 - - - - 2 70,000 1 54,000 - - 15,000 - - -
1 28,000 - - - - 1 35,000 1 54,000 - - 15,000 - - -
1 28,000 - - - - 2 70,000 3 162,000 - - 15,000 10,800 1 -
1 28,000 - - - - 1 35,000 - - - - - -
1 28,000 - - - - - - 1 65,000 - - - -
1 28,000 - - - - - - - - - - -
1 28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - -
1 28,000 - - - - 2 70,000 2 108,000 - - 15,000 10,800 - -
- - 1 28,000 - - - 1 54,000 - - - - -
- - 1 28,000 - - - 1 54,000 - - - - -
- - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - -
- - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - - 2
- - 1 28,000 - - 1 35,000 2 108,000 - - 15,000 - - -
- - - - - 1 35,000 1 54,000 - - 15,000 - - - 1
- - - - - 1 35,000 1 54,000 - - 18,000 - - -
11 308,000 2 56,000 5 140,000 - - - - 18 630,000 23 1,242,000 1 65,000 - - 183,000 21,600 1 - - - 3

OKSIGEN
OKSIGEN
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - 117,000 - 117,000 -
- - - - - - - 82,000 82,000 - -
- - - - - - - 82,000 82,000 - -
- - - - - - - 82,000 - 82,000 -
- - - - - - - 206,000 - - 206,000
- - - - - - - 152,000 152,000 - -
- - - - - - - 117,000 - 117,000 -
- - - - - - - 270,800 - - 270,800
- - - - - - - 63,000 63,000 - -
- - - - - - - 93,000 - - 93,000
- - - - - - - 28,000 28,000 - -
- - - - - - - 206,000 - 206,000 -
- - - - - - - 216,800 - 216,800 -
- - - - - - - 82,000 82,000 - -
- - - - - - - 82,000 82,000 - -
- - - - - - - 117,000 - 117,000 -
46,000 - - - - - - 163,000 163,000 - -
- - - - - - - 171,000 - 171,000 -
23,000 - - - - - - 140,000 140,000 - -
- - - - - - - 117,000 117,000 - -
69,000 - - - - - - - - - - - - - - 2,587,600 991,000 1,026,800 569,800
2,587,600

- - - - - - -
- - - - - - -
- - - - - - - -
RA BAYAR
JASA RAHARJA
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

MASUK dr. Layali dr. EDI
1 00.40 53480 BAEDAH.NY 7/1/1951 KEMUNING 4/2 HT,GASTRITIS, LAYALI 1 1 1 1 28,000
2 02.35 53481 M ROFIF NABIL.AN 8/17/2009 MARIBAYA 6/3 DADRS LAYALI 1 1 1 1 28,000
3 02.47 53482 MAKTUBI.TN 7/6/1945 GEMBONGDADI 8/2 HEMAPTOE LAYALI 1 1 1 1 28,000
4 04.39 53483 ROHMAN.TN 1/1/1952 KEMUNING 2/4 HT LAYALI 1 1 1 1 28,000
5 07.03 53484 RUIDAH.NY 12/31/1959 JATIMULYA 4/5 CHF FARADITA 1 1 1 -
6 07.57 53488 TASIRIN,TN 10/15/1969 PURWAHAMBA 10/4 POST TRAUMA FADEL 1 1 1 -
7 08.29 53490 EKA NURFARIDAH,NY 8/16/1982 SURADADI 1/14 HAMIL DENGAN KPD FADEL 1 1 1 -
8 09.37 53496 WARJA,TN 10/14/1930 SIGENTONG 1/4 DISPEPSIA FARADITA 1 1 1 -
9 10.00 53080 WAHYU,AN 3/24/2001 KERTASARI 5/2 KONTROL LUKA FARADITA 1 1 1 - -
10 10.00 53329 AHAMAD KHUMAEDI,TN 6/6/1980 KALIMATI 19/2 KONTROL LUKA FARADITA 1 1 1 - -
11 11.15 48852 RIZKI SAPUTRA,AN 1/21/2008 JATIMULYA 4/5 ASMA FARADITA 1 1 1 -
12 12.24 53503 AFRY ADIT PRATAMA,AN 11/18/2001 TANJUNGHARJA 1/3 DISPEPSIA FARADITA 1 1 1 -
13 12.35 53504 MISBAHUL HUDA,AN 9/21/2001 DEMANGHARJO 8/1 BRPN FARADITA 1 1 1 -
14 12.45 51330 SODIKIN,SDR 5/6/1989 SURADADI 1/5 KOLIK ABDOMEN FARADITA 1 1 1 -
15 14.00 53506 NIDAAN KHOFIYA,AN 4/5/2016 MARIBAYA 3/1 FEBRIS FARADITA 1 1 1 - 1
16 14.00 53507 MASRIYAH.NY 1/1/1958 PURWAHAMBA22/9 GASTRISTIS EDI 1 1 1 - 1
17 14.30 45207 RATINAH.NY 2/12/1959 JATIBOGOR 2/10 CHF EDI 1 1 1 - 1
18 16.00 53509 DAMIRI.TN 1/1/1985 SIDAHARJA 29/8 VL EDI 1 1 1 - 1
19 17.00 53324 SUKARDI.TN 1/1/1950 SIDAMULYA 7/2 HIPOGLIKEMI EDI 1 1 1 - 1
20 17.15 8592 SUTIKNO.TN 1/1/1969 KERTAYASA 1/4 VERTIGO EDI 1 1 1 1
21 17.18 24069 ICIH SURATMI.NY 1/1/1964 SURADADI 2/4 DISPEPSYA EDI 1 1 1 - 1
22 18.00 53510 WARSO.TN 1/1/1947 JATIMULYA 1/6 VL EDI 1 1 -
23 20.00 53511 RAHADATUL AISY.AN 7/12/2013 KEDUNGKEKOR 4/3 CLOSE FR 1/3 DX EDI 1 1 -
24 20.30 53512 SUMINTO.SDR 7/24/1997 SURADADI 2/7 FEBRIS EDI 1 1 -
JUMLAH 22 2 0 0 10 8 6 0 0 15 6 0 0 4 112,000 7

TANGGAL/BULAN : 5 0
1 10.40 52286 M,FAUZAN,SDR 11/22/1986 KEMUNING 2/5 CKB FARADITA 1 1 1 -
2 -
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) KONSU
OKSIGEN
dr. EDI dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P
- - - - - 2 70,000 2 108,000 - - 15,000 - - -

- - - - - 1 35,000 1 54,000 - - 15,000 - - 1 23,000
- - - - - 2 70,000 1 54,000 - - 15,000 - - - 1
- - - - - 2 70,000 1 54,000 - - 15,000 - - -
- - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - -
- - - - 1 28,000 - - - - - -
- - - 1 28,000 2 70,000 2 108,000 - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 - - 1 65,000 - - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - - - - 1 23,000
- - - - 1 28,000 1 35,000 1 54,000 1 65,000 - 15,000 - - 1 23,000
- - - - 1 28,000 - - - - - - - -
28,000 - - - - 1 35,000 - - - 15,000 - - -
28,000 - - - - 1 35,000 2 108,000 - - 15,000 - - -
28,000 - - - - 1 35,000 2 108,000 - - 15,000 - - -
28,000 - - - - 1 35,000 - - - - - - -
28,000 - - - - 1 35,000 2 108,000 - - - - - -
28,000 - - - - 1 35,000 2 108,000 - - - - - -
28,000 - - - - 1 35,000 2 108,000 - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
196,000 - - - - - - 10 280,000 21 735,000 22 1,188,000 2 130,000 - - - 150,000 - - - - 3 69,000 1
OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P
- - - - 1 28,000 2 70,000 2 108,000 - 1 80,000 - - 1 23,000 -
- - - - - - - - - - - - -
- - - - - - - - 221,000 - 221,000 - -
- - - - - - 155,000 - - 155,000 -
23,000 - - - - - 190,000 - 190,000 - -
- - - - - - 167,000 167,000 - - -
- - - - - - 221,000 - 221,000 - -
- - - - - - 28,000 28,000 - - -
- - - 1 23,000 - - 155,000 - - 155,000 -
- - - - - - 28,000 - 28,000 - -
- - - - - - 206,000 206,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 93,000 93,000 - - -
- - - - - - 140,000 - 140,000 - -
- - - - - - 220,000 - 220,000 - -
- - - - - - 28,000 - 28,000 - -
- - - - - - 78,000 78,000 - - -
- - - - - - 186,000 186,000 - - -
- - - - - - 186,000 - - 186,000 -
- - - - - - 63,000 - - 63,000 -
- - - - - - 171,000 - 171,000 - -
- - - - - - 171,000 - - 171,000 -
- - - - - - 171,000 - - 171,000 -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
23,000 - - - - 1 23,000 - - - - - - 2,906,000 786,000 1,219,000 901,000 -
2,906,000
- - - - - -
- - - - - -

MASUK dr.EDI
1 01.10 53513 URIPAH.NY 12/16/1987 GEMBONGDADI 10/4 H DG KALA 1 LAMA ROSNELINA 1 1 1
2 01.40 40662 PAWESTRI SEKAR A.AN 2/3/2016 KRAMAT 2/1 DADRS ROSNELINA 1 1 1
3 04.35 53514 LIFA ALFATIHA I.AN 1/8/2016 SURADADI 3/11 VOMITUS ROSNELINA 1 1 1
4 05.00 53516 MUPASIHA.NY 10/4/1986 SIDAHARJA 11/6 H DG PRESBO ROSNELINA 1 1 1
5 05.10 53517 MUPASIHA.BY.NY 1/25/2018 SIDAHARJA 11/6 BAYI BARU LAHIR EDI 1 1 1
6 07.00 8420 DAMIN.TN 9/12/1969 MARIBAYA 4/3 GEA DG VOMITUS EDI 1 1 1 1
7 07.25 53526 WAHIDIN,TN 4/17/1967 MARIBAYA 5/3 GEA DG VOMITUS + FEBRIS EDI 1 1 1 1
8 08.45 28084 KHOMISATUN,NY 8/18/1989 SURADADI 1/8 G3P0A2 H ATERM DGN RIW.OBS JELEK EDI 1 1 1 1
9 08.00 53522 TORIPIN,TN 10/24/1962 KENDAWA 5/2 BREBES GERD EDI 1 1 1
10 10.30 51605 MUSOFANI,TN 4/16/1990 JATIMULYA 1/6 TB PARU DGN HIV + EDI 1 1 1 1
11 10.45 53220 AHMAD SUPRIYANTO,TN 1/19/1967 KARANGMULYA 2/1 VL GENUE DEXTRA EDI 1 1 1 1
12 10.55 53528 ALDI EKO SETIAWAN,AN 12/28/2001 KREMAN 6/2 FEBRIS H KE 3 EDI 1 1 1 1
13 12.10 53530 EKO AJI SAPUTRA,TN 12/9/1987 SURADADI 1/7 DROWNING EDI 1 1 1 1
14 10.10 53529 HAMBALI,TN 8/19/1982 HARJASARI 6/5 RETENSIO URINE EDI 1 1 1 1
15 12.55 12.55 MUKSIN,TN 7/17/1979 SURADADI 2/3 GEA DGN VOMITUS + FEBRIS EDI 1 1 1 1
16 13.50 53464 SITI NUR ANISAH,AN 11/14/2003 SIDAMULYA 4/2 VL EDI 1 1 1 1
17 14.23 43064 SUNARDI,TN 12/31/1962 SURADADI 1/1 COMBUSTIO DYAH 1 1 1
18 14.23 11550 KARMI,NY 9/4/1938 KERTASARI 5/8 PNEUMONIA DYAH 1 1 1
19 15.31 53343 KASRIYAH,NY 7/8/1950 JATIBOGOR 1/8 ASMA DYAH 1 1 1
20 19.20 53532 EKA ROSITA,NN 12/2/1998 KARANGMULYA 4/3 THYPOID FEVER DYAH 1 1 1
21 19.36 53533 INDRA SUPRIYADI,TN 2/27/1991 JATILAWANG 1/3 VL DYAH 1 1 1
22 22.30 45082 RIKHANAHWATI.NY 1/1/1983 BOJONGSANA 3/1 KPD ROSNELINA 1 1 1
23 22.45 53534 SITI DEWI.NY 8/13/1994 SIDAMULYA 5/1 HML DG HDK ROSNELINA 1 1 1
24 23.00 47575 AHMAD KENZI.PAN 12/12/2010 KERTASARI ASTMA ROSNELINA 1 1 1
JUMLAH 20 4 0 0 9 5 7 0 2 16 8 0 0 11

TANGGAL/BULAN : 5 0
1 07.20 53524 ATIPAH,NY 4/6/1961 JATIMULYA 5/7 COMBUSTIO GRADE 2 EDI 1 1 1
2
OKSIGEN
dr.EDI dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana,
- - - 1 28,000 - - 1 35,000 2 108,000 - - 15,000 - -

- - - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - 1
- - - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - 1
- - - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - -
- - - 1 28,000 - - - - - - - - - 1
28,000 - - - - - 1 35,000 1 54,000 - - 15,000 - -
28,000 - - - - - 2 70,000 2 108,000 - - 15,000 - - -
28,000 - - - - - 1 35,000 1 54,000 - - 15,000 -
28,000 - - - - - - - - - - -
28,000 - - - - - 1 35,000 1 54,000 - - 15,000 - - -
28,000 - - - - - 1 35,000 - - - - - -
28,000 - - - - - - - - - 15,000 - - -
28,000 - - - - - 1 35,000 1 54,000 - - 15,000 10,800 1 23,000 -
28,000 - - - - - - - - - - - -
28,000 - - - - - 1 35,000 1 54,000 - - 15,000 - - -
28,000 - - - - - 1 35,000 - - - - - -
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 - - - 2 70,000 1 54,000 - - 15,000 10,800 - -
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 - - - 1 35,000 1 54,000 - - 15,000 - - -
- - 1 28,000 - - - - - - - - - -
- - - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - -
- - - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - -
- - - 1 28,000 - - 1 35,000 1 54,000 1 65,000 - 15,000 - - - 1
308,000 - - 5 140,000 8 224,000 - - - - 19 665,000 17 918,000 1 65,000 - - 165,000 96,600 1 23,000 - - 4
OKSIGEN
dr. Layali dr. EDI dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana,
- 1 28,000 - - - - 1 35,000 3 162,000 - 1 80,000 15,000 - - 1 23,000
- - - - - - - - - - - - -
KONSUL DOKTER SPESIALIS PENDAPATAN BERDASAR CARA BAYA
dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. MONICA Sp.An DR HARY.SP.S DR.YESSI.SP.PD UMUM BPJS PBI
- - - 1 23,000 - - - - - 209,000 - -
23,000 - - - - - - - 155,000 - -
23,000 - - - - - - - 155,000 155,000 -
- - - - - - - - 132,000 - 132,000
23,000 - - - - - - - 51,000 - 51,000
- - - - - - - - 132,000 - -
- - - - - - - - 206,000 - -
- - - - 1 23,000 1 23,000 1 23,000 1 23,000 186,000 - -
- - - - - - - - 28,000 - -
- 1 23,000 - - - - - - 140,000 - -
- - - - - - - 63,000 63,000 -
- - - - - - - 28,000 28,000 -
- - - - - - - 150,800 150,800 -
- - - - - - - 28,000 28,000 -
- - - - - - - 117,000 117,000 -
- - - - - - - 63,000 63,000 -
- - - - - - - 28,000 - 28,000
- 1 23,000 - - - - - 185,800 - 185,800
- - - - - - - 28,000 - -
- - - - - - - 117,000 - 117,000
- - - - - - - 28,000 28,000 -
- - - - 1 23,000 - - 140,000 - -
- - - - 1 23,000 - - 140,000 - -
23,000 - - - - - - 205,000 205,000 -
92,000 2 46,000 - - - - 4 92,000 1 23,000 1 23,000 - - 2,715,600 837,800 513,800
2,715,600
- - - - - - -
- - - - - - -

- -
155,000 -
- -
- -
- -
132,000 -
206,000 -
186,000 -
- -
140,000 -
- -
- -
- -
- -
- -
- -
- -
- -
28,000 -
- -
- -
140,000 -
- -
- -
987,000 -

MASUK dr. EDI
1 00.05 24124 KASIATI.NY 1/7/1944 DEMANGHARJA 2/4 PPOK ROSNELINA 1 1 1
2 00.30 53535 SLAMET NURMANDI.TN 1/1/1982 PURWAHAMBA 1/1 VOMITUS ROSNELINA 1 1 1
3 03.30 53537 KARTINI.NY 12/7/1997 JATIMULYA 6/7 KALA 1 LAMA ROSNELINA 1 1 1
4 07.15 45222 SHINTA PUTRI SUYANTO,AN 3/9/2017 SURADADI 3/15 DADRS FARADITA 1 1 1
5 07.40 53543 MULYATI,NY 11/9/1988 KERTASARI 3/5 G2P1A0 H40MGG DGN KPD FARADITA 1 1 1
6 07.40 13276 MIFTAHUDIN,TN 1/21/1969 JATIMULYA 3/4 SUSP FR COTSTA II SINISTRA FARADITA 1 1 1
7 08.00 53544 DIDIK SUSWANTO,SDR 7/26/1992 KEMANTRAN 2/1 BIKIN SKD + TEST NARKOBA FARADITA 1 1 1
8 08.35 53547 PANGGIH CAHYO IMAMI,TN 5/28/1989 NGLARIS 2/3 PURWOREJO BIKIN SKD + TEST NARKOBA FARADITA 1 1 1
9 08.35 53549 MUHAMMAD YUSUF,AN 7/14/2004 TANJUNGHARJA 2/5 FR RADIUS 1/3 PROXIMAL FARADITA 1 1 1 -
10 08.35 53392 SAILAH,NY 1/1/1963 KEMUNING 3/2 VL FARADITA 1 1 1 -
11 09.45 53550 TAJIR,TN 5/1/1949 SIDAHARJA 16/7 VL FARADITA 1 1 1
12 10.20 53557 MUINAH,NY 12/31/1948 KARANGMULYA 4/6 GASTRITIS AKUT FARADITA 1 1 1
13 10.55 53558 PAHRUR ROZI,TN 2/4/1986 JATINEGARA 3/2 BIKIN SKD + TEST NARKOBA FARADITA 1 1 1
14 11.23 53559 DARMAN,TN 12/31/1963 PURWAHAMBA 2/1 COLIC ABDOMEN FARADITA 1 1 1
15 12.00 O1856 ELSA NOVITA SARI,AN 11/21/2002 JATIBOGOR 2/13 POST SYNKOP FARADITA 1 1 1
16 13.35 53560 ISMI HABIBAH,NY 8/16/1979 BANJAR AGUNG 4/1 P3A3 H DGN ANEMIA FARADITA 1 1 1
17 13.50 53561 TACHARI,TN 5/31/1961 BOJONGSANA 8/3 GASTRITIS FARADITA 1 1 1
18 14.05 53562 DWIKY ALDYANTO,SDR 6/29/1999 SURADADI 1/12 DISLOC DYAH 1 1 1
19 17.50 53565 MOHAMAD AMIN,SDR 8/5/1999 KENDAYAKAN 6/2 FURANGKLE DYAH 1 1 1
20 18.22 53566 TURWI,NY 1/1/1927 KRAMAT 1/1 FRAKTUR FEMUR DYAH 1 1 1
21 19.05 44599 KASNAWI,TN 1/1/1957 SURADADI 2/3 DOA DYAH 1 1 1
JUMLAH 19 2 0 0 13 4 4 0 0 8 12 1 0 -

TANGGAL/BULAN : 5 0
1 14.20 25148 SUPARNO,TN 1/1/1944 GEMASARI 1/4 CKB DYAH 1 1 1
2 15.13 53564 FITROH NUR KOMARIYAH,NN 2/20/2004 JATIBOGOR 1/12 VL DYAH 1 1 1
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) SKD SAMPEL OKSIGEN
dr. EDI dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat DARAH dr. Luqman, Sp.PD dr. Anidyo, Sp.B
- - - 1 28,000 - - 1 35,000 2 108,000 - - - -

- - - 1 28,000 - - 2 70,000 2 108,000 - - - -
- - - 1 28,000 - - 1 35,000 1 54,000 - - - -
- - - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - -
- - - - - 1 28,000 1 35,000 2 108,000 - - 15,000 - -
- - - - - 1 28,000 - - - - - -
- - - - - 1 28,000 - - - - 20,000 - -
- - - - - 1 28,000 - - - - 20,000
- - - - - 1 28,000 1 54,000 - - - -
- - - - - 1 28,000 1 35,000 - - - - -
- - - - - 1 28,000 - 1 54,000 - - - -
- - - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - -
- - - - - 1 28,000 - - - - 20,000 - -
- - - - - 1 28,000 2 70,000 2 108,000 - - 15,000 - -
- - - - - 1 28,000 - - - - - -
- - - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - -
- - - - - 1 28,000 - - - - - -
- - 1 28,000 - - - - - - - - -
- - 1 28,000 - - - - - - - - -
- - 1 28,000 - - - 1 35,000 2 108,000 - - 15,000 - -
- - 1 28,000 - - - - 1 54,000 - - - -
- - - 4 112,000 3 84,000 - - 14 392,000 13 455,000 18 972,000 - - - - 90,000 - - - -

OKSIGEN
- - 1 28,000 - - - 2 70,000 2 108,000 - 1 80,000 15,000 28,800 - 1
- - 1 28,000 - - - - 1 54,000 - - - -
KONSUL DOKTER SPESIALIS PENDAPATAN BERDASAR CARA BAYA
dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. AXELSp.OG dr. Riyani, Sp.OG dr. Arif Sp.An UMUM BPJS PBI
- - - - - - - - - - 171,000 - 171,000
- - - - - - - - 206,000 206,000 -
- - - - - 1 23,000 #VALUE! - #VALUE! - -
- 1 23,000 - - - - - - 140,000 - -
- - - - 1 23,000 - - - 194,000 - -
- - - - - - - - 28,000 28,000 -
- - - - - - - - 28,000 28,000 -
- - - - - - - - 28,000 28,000 -
- - - - - - - - 82,000 82,000 -
- - - - - - - - 63,000 63,000 -
- - - - - - - - 82,000 82,000 -
- - - - - - - - 206,000 - -
- - - - - - - - 28,000 28,000 -
- - - - - - - - 206,000 - 206,000
- - - - - - - - 28,000 - 28,000
- - - - 1 23,000 - - - 140,000 - 140,000
- - - - - - - - 28,000 28,000 -
- - - - - - - - 28,000 28,000 -
- - - - - - - - 28,000 28,000 -
- - - 1 23,000 - - - - 194,000 194,000 -
- - - - - - - - 82,000 82,000 -
- 1 23,000 - - 1 23,000 2 46,000 1 23,000 - #VALUE! - - - - #VALUE! 905,000 545,000
#VALUE!

dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An
23,000 - - - - - - -
- - - - - - - -

- -
- -
#VALUE! -
140,000 -
194,000 -
- -
- -
- -
- -
- -
- -
206,000 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
#VALUE! -

MASUK dr. Layali
1 02.00 53567 KASMUI.TN 3/3/1944 HARJASARI 2/6 CHF FADEL 1 1 1
2 03.00 53568 RIANAH.NY 8/30/1982 PURWAHAMBA 26/10 COLIC RENAL FADEL 1 1 1
3 06.30 43206 RAMINAH.NY 1/1/1971 PURWAHAMBA 25/10 COLIC RENAL FADEL 1 1 1
4 07.00 53569 MUSAROPAH.NY 1/1/1973 JATIMULYA 6/6 VERTIGO FADEL 1 1 1
5 08.00 53213 WAITAH.NY 3/22/1958 BONGKOK 1/1 KONTROL LUKA FARADITA 1 1 1
6 09.22 53574 MUDIROH.NY 7/5/1985 DEMANGHARJO 6/2 CHEPALGIA FARADITA 1 1 1
7 09.25 53576 SEFRINA LUTFIANI.AN 9/14/2004 BANJARTURI 1/7 FARINGITIS AKUT + ISPA FARADITA 1 1 1
8 09.00 53352 DITA ZUHRA U.AN 7/20/1987 SURADADI 1/9 H DG AB IMINENS FARADITA 1 1 1
9 10.00 53577 MADKURI.TN 12/31/1960 PURWAHAMBA 5/2 CHF FARADITA 1 1 1 -
10 10.00 16343 NURDIYANAH.NY 4/19/1993 JATIBOGOR 3/1 H DG HEG+ DEPRESI FARADITA 1 1 1 -
11 12.00 15999 M.NURSIDIK.TN 6/7/1963 DEMANGHARJO 5/2 GEA FARADITA 1 1 1
12 13.50 53578 ANDIKA PUTRA P.AN 6/21/2016 PONCOL 5/3/PKL TIMUR KDS FARADITA 1 1 1
13 14.30 49048 ALFINA SHAFIYA,AN 9/6/2016 KARANGMULYA 1/6 KDS EDI 1 1 1
14 14.40 53580 DULGANI,TN 1/15/1954 BLIMBING WULUH 1/1 VE + EPISTAKSIS EDI 1 1 1
15 17.40 53581 WILDAN JAYA PRATAMA,AN 3/19/2006 JATIMULYA 1/6 DENGUE FEVER EDI 1 1 1
16 18.15 53582 FADILAH NURUL KHOTIMAH,AN 3/13/2001 KERTAYASA 4/3 CLOSE FR DIGITI IV MANUS DEXTRA EDI 1 1 1
17 18.15 53584 HAIKAL AL HAFIZ,AN 5/9/2010 SURADADI 2/14 MYALGIA EDI 1 1 1
18 18.15 53583 EKI NUR KHOLIFATUN,NY 12/14/1987 KERTAYASA 1/1 VERTIGO DGN VOMITUS + FEBRIS EDI 1 1 1
19 19.50 53585 TOCHID,SDR 12/31/1984 SURADADI 4/3 GASTRITIS EDI 1 1 1
20 20.35 53586 ADINDA YUNITA SARASWATI,NY 6/17/1996 PURWAHAMBA 12/6 G3P0A2 H42MGG DGN SEROTINUS EDI 1 1 1
21 21.25 53587 JULIO PRANATA,SDR 7/23/1997 JAMBI ABSES FADEL 1 1 1
22 23.45 5912 WAHIDUN,TN 3/22/1940 MARIBAYA 4/1 VERTIGO FADEL 1 1 1
23 23.45 12063 WARSITI,NY 4/27/1965 RANGIMULYA 1/4 SVT FADEL 1 1 1
JUMLAH 20 3 0 0 11 7 5 0 0 13 10 0 0 -

TANGGAL/BULAN : 5 0
1
2
3
OKSIGEN
dr. Layali dr. FaDEL dr. Dyah dr. Rosnel dr. EdI dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B
- 1 28,000 - - - - 1 35,000 2 108,000 - - - 1 23,000 -

- 1 28,000 - - - - - - - - - - -
- 1 28,000 - - - - - - - - - - -
- 1 28,000 - - - - 1 35,000 2 108,000 - - - 1 23,000 -
- - - - - 1 28,000 1 35,000 - - - - - -
- - - - - 1 28,000 - - - - - - -
- - - - - 1 28,000 - - - - - - -
- - - - - 1 28,000 1 35,000 1 54,000 - - 15,000 -
- - - - - 1 28,000 2 70,000 3 162,000 - - 15000+36000 1 23,000 -
- - - - - 1 28,000 1 35,000 1 54,000 - - 15000+10800 - -
- - - - - 1 28,000 - - - - - - -
- - - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - -
- - - - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - -
- - - - 1 28,000 - 1 35,000 - - - - - -
- - - - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - -
- - - - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - - -
- - - - - - - - - - - - -
- 1 28,000 - - - - 1 35,000 - - - - - -
- 1 28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - -
- 1 28,000 - - - - 2 70,000 2 108,000 - - 15,000 - - -
- 7 196,000 - - - - 7 196,000 8 224,000 18 630,000 18 972,000 - - - - 90,000 30,000 3 69,000 - -
OKSIGEN
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An dr.axel.sp,og UMUM BPJS PBI BPJS NON PBI
- - - - - - - - - 194,000 - 194,000 -
- - - - - - - 28,000 - 28,000 -
- - - - - - - 28,000 - 28,000 -
- - - - - - - 194,000 194,000 - -
- - - - - - - 63,000 63,000 - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 28,000 28,000 - -
- - - - - - 1 23,000 155,000 - - 155,000
- - - - - - - #VALUE! - #VALUE! -
- - - - - - 1 23,000 #VALUE! - #VALUE! -
- - - - - - - 28,000 28,000 - -
1 23,000 - - - - - - 155,000 155,000 - -
1 23,000 - - - - - - 140,000 - - 140,000
- - - - - - - 63,000 63,000 - -
1 23,000 - - - - - - 140,000 - - 140,000
- - - - - - - 28,000 28,000 - -
- - - - - - - 28,000 28,000 - -
- - - - - - - 117,000 - - 117,000
- - - - - - - 117,000 117,000 - -
- - - - - - - - - - -
- - - - - - - 63,000 63,000 - -
- - - - - - - 206,000 - 206,000 -
- - - - - - - 206,000 - 206,000 -
3 69,000 - - - - - - - - - - 2 46,000 - - #VALUE! 795,000 #VALUE! 552,000
#VALUE!
- - - - - - -
- - - - - - -
- - - - - - - -
RA BAYAR
JASA RAHARJA
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

MASUK dr. EDI dr. Fad
1 01.45 42117 DAMIRAH,NY 12/30/1983 JATIBOGOR 1/1 HAMIL DENGAN SEROTINUS FADEL 1 1 1 - 1
2 02.01 53588 ANU SAFITRI,NY 4/12/1994 KEDUNGKELOR 5/1 HEG FADEL 1 1 1 - 1
3 02.54 53250 KASTURI,TN 12/31/1959 SURADADI 1/1 COLIK ABDOMEN FADEL 1 1 1 - 1
4 03.11 53589 BY,NY,DAMIRAH 1/28/2018 SJATIBOGOR 1/1 BAYI BARU LAHIR FADEL 1 1 1 - 1
5 03.12 53590 DARYONO,TN 7/12/1980 JATIBOGOR 4/7 COLIK ABDOMEN FADEL 1 1 1 - 1
6 05.45 24294 CARMAD,TN 12/31/1950 SUIDAHARJA 1/1 CHF FADEL 1 1 1 - 1
7 05.45 53093 AHMAD ARMIA,AN 6/28/2017 GAMBUHAN 7/3 DADRS FADEL 1 1 1 - 1
8 07.16 51693 SITI SADIYAH.NY 5/22/1980 KERTAYASA 4/2 H DG HYPATYROID ROSNELINA 1 1 1 -
9 08.09 48140 IMAM SYAFII.TN 2/2/1986 MARIBAYA 03/03 ASMA BRONCIALE ROSNELINA 1 1 1 - -
10 09.17 53450 SUDEWI.NY 1/5/1955 KARANGMULYA 01/05 HIPERTENSI BERTA + AFESIA ROSNELINA 1 1 1 - -
11 10.00 53592 ISTANTI.NY 1/14/1997 MARIBAYA2/3 H DG BRAXTON HIS ROSNELINA 1 1 1 -
12 12.50 32517 khamim.tn 2/20/1946 JATIMULYA 4/6 GEA ROSNELINA 1 1 1 -
13 14.45 53593 SAEFUL ABDUL BASRI,SDR 11/8/1987 BOJONGSANA 14/5 HT URGENT + VOMITUS EDI 1 1 1 1 28,000
14 15.10 33061 RUSLANI,TN 12/17/1955 KERTASARI 1/3 PERDARAHAN TUMOR LIDAH EDI 1 1 1 1 28,000
15 15.30 33561 MUNDRIYATUN,NY 12/31/1949 DEMANGHARJO 4/2 GEA DGN VOMITUS EDI 1 1 1 1 28,000
16 15.40 52622 RAINAANUN SAIDA,AN 8/19/2017 SIDAHARJA 1/1 OBS FEBRIS DGN VOMITUS EDI 1 1 1 1 28,000
17 16.00 43805 UMROH,NN 8/16/1996 JATIBOGOR 4/14 PARONIKIA EDI 1 1 1 1 28,000
18 17.50 51958 TASROH,TN 12/31/1953 JATIMULYA 1/2 DYSPEPSIA + GERD EDI 1 1 1 1 28,000
19 17.50 53594 KARNIAH,NY 5/10/1970 KEDUNGJATI 3/1 VL EDI 1 1 1 1 28,000
20 18.00 38731 SUBODRO,TN 11/19/1960 MARIBAYA 1/2 COLIC ABDOMEN DD GASTRITIS EDI 1 1 1 1 28,000
21 18.00 53595 IHTIZAZ HAWA ANDRIYAN,NY 9/12/1997 KERTASARI 2/1 KISTA GATOLINITIS EDI 1 1 1 1 28,000
22 19.20 53597 SUGITO,TN 11/30/1977 SURADADI 4/3 GASTRITIS KRONIS + HT EDI 1 1 1 1 28,000
23 20.35 53598 YOSI NUR AFIANI,NN 11/20/1998 KERTAYASA 4/4 DERMATITIS ATROPI EDI 1 1 1 1 28,000
24 21.20 53599 MUKHITUM,NY 9/17/1943 KERTAYASA 7/2 CHF DYAH 1 1 1 -
25 22.44 53600 RIZQON AHMAD FAQIH,SDR 11/19/1990 PEGIRIKAN 15/4,TALANG DISPEPSIA DYAH 1 1 1 -
26 23.48 41439 KALIMAH,NY 1/1/1950 MARIBAYA 2/3 VERTIGO DYAH 1 1 1 -
JUMLAH 25 1 0 0 12 7 7 0 0 15 11 0 0 11 308,000 7
Kepala Ruang IGD
Agus Riyanto, AMK
Layali M, dr
Rosnelina, dr
Faila S, dr
Dyah Novi, dr
Gesa Tidar, dr
Faradita, dr

TANGGAL/BULAN : 5 0
DS R DOA DP U PBI N PBI JR L RI RJ MD RJK dr. Layali dr. Fai
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 - -
10 - -
13.15 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
22 -
23 -
24 -
25 -
26 -
27 -
28 -
29 -
30 -
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) SEMPEL KONSUL DO
OKSIGEN
dr. Fadel dr. Dyah dr. Rosnel dr. Faradita Sederhana Kecil Sedang Berat DARAH dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P
28,000 - - - 1 35,000 1 54,000 - - 15,000 - - - -

28,000 - - - 1 35,000 1 54,000 - - 15,000 - - - -
28,000 - - - 2 70,000 2 108,000 - - 15,000 - - - -
28,000 - - - 1 35,000 - - - - - - 1 23,000
28,000 - - - - - - - - - - -
28,000 - - - 2 70,000 2 108,000 - - 15,000 - - - -
28,000 - - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - 1 28,000 - 1 35,000 1 54,000 - - 15,000 - -
- - 1 28,000 - - 1 65,000 - - - - -
- - 1 28,000 - - - - - - - - -
- - 1 28,000 - - 1 54,000 - - - - - -
- - 1 28,000 - 1 35,000 - - - - - - -
- - - - 1 35,000 1 54,000 - - 15,000 - - - -
- - - - - - - - - - - -
- - - - 2 70,000 2 108,000 - - 15,000 - - - -
- - - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - - - - 1 54,000 - - - - - -
- - - - - - - - - - - -
- - - - - 1 54,000 - - - - - -
- - - - - 1 54,000 2 130,000 - 15,000 - - - -
- - - - - - - - - - - - - - -
- - - - - 1 54,000 2 130,000 - 15,000 - - - - -
- - - - - - - - - - - -
- 1 28,000 - - 2 70,000 3 162,000 1 65,000 15,000 - 1 23,000 - -
- 1 28,000 - - 1 35,000 1 54,000 - - - 15,000 - - - - - -
- 1 28,000 - - 2 70,000 2 108,000 - - - - - - -
196,000 3 84,000 5 140,000 - - 19 665,000 23 1,242,000 6 390,000 - - - - 1 23,000 - - 3 69,000 -
OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
dr. Fullarini, Sp.P dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An dr.nadia shafira UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - - - - -
- - - - - - - - - -
- - - - - - #REF! - #REF! - -
- - - - - - #REF! - #REF! - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! - - #REF! -
- - - - - - #REF! #REF! - - -
- - - - - 1 23,000 #REF! - #REF! - -
- - - - - - #REF! - - #REF! -
- - - - - - #REF! - - #REF! -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! - - #REF! -
- - - - - - #REF! - #REF! - -
- - - - - - #REF! - #REF! - -
- - - - - - #REF! - - #REF! -
- - - - - - #REF! - - #REF! -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! - #REF! - -
- - - - - - #REF! #REF! - - -
- - - - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - #REF! - - #REF! -
- - - - - - - - #REF! #REF! - - -
- - - - - - #REF! #REF! - - -
- - - - - - - - - 1 23,000 - - #REF! #REF! #REF! #REF! -
#REF!
- - - - - -
- - - - - -
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!
- - - - - - #REF!

MASUK dr. RIA dr. EDI
1 00.38 53590 DARYONO,TN 7/12/1980 JATIBOGOR 4/7 COLIK ABDOMEN DYAH 1 1 1 - 1
2 06.43 53104 DWI ARI W,NY 1/26/1992 SURADADI 2/2 HMIL DENGNA CPD DYAH 1 1 1 - 1
3 06.55 53601 MELI ADE 1/19/2000 SIDAHARJA 19/8 POST SINCOP DYAH 1 1 1 - 1
4 07.00 53603 SITI HARWATI.NN 5/14/1989 KERTASARI 3/5 SKD RIA 1 1 1 1 28,000
5 07.30 53464 SITI NUR ANISAH 11/14/2003 SIDANULYA 4/2 KONTROL LUKA RIA 1 1 1 1 28,000
6 08.15 53608 LAELATUS SADIYAH.NN 6/26/2000 GEMASRI 3/4 FEBRIS RIA 1 1 1 1 28,000
7 09.00 51278 MAD YASIR.TN 1/1/1952 SIDAMULYA 8/1 DISPEPSYA RIA 1 1 1 1 28,000
8 09.30 53617 SLAMET SUGENG.TN 2/24/1979 GEMBONGDADI 10/1 VL AMPUTATUM RIA 1 1 1 1 28,000
9 09.30 53622 DAMU.TN 1/1/1953 KARANGMULYA VERTIGO RIA 1 1 1 1 28,000
10 10.00 53623 RATONO.TN 1/1/1975 PEANARUKAN.ADIWERNA FEBRIS RIA 1 1 1 1 28,000
11 10.10 53329 A HMAD KHUMADI. 1/1/1980 ADIWERNA KONTROL LUKA RIA 1 1 1 1 28,000
12 10.30 53624 AHMAD MUZAKI 3/31/1989 DUKUH TURI VL RIA 1 1 1 1 28,000
13 13.00 53627 FADLI SALMAN.AN 11/16/2016 MARIBAYA 5/1 FARINGITIS AKUT RIA 1 1 1 1 28,000
16 14.27 53630 MUNASIR.TN 7/24/1967 DEMANGHARJO 1/3 COLIC ABDOMEN LAYALI 1 1 1 -
17 14.40 53631 SONI AKMAL F.AN 5/24/2015 KERTASARI 5/2 KDK LAYALI 1 1 1 -
18 15.35 53632 ALVA ALVIYANO.AN 3/21/2014 KREMAN 3/1 PHIMOSIS LAYALI 1 1 1 -
19 15.19 2649 SUTRISNO.TN 6/18/1958 KERTASARI 1/3 CHF LAYALI 1 1 1 -
20 17.20 53633 BUNGA AULIA I.AN 3/7/2015 HARJASARI 1/4 CORPAL HIDUNG LAYALI 1 1 1 -
21 18.00 53634 KASNIAH.NY 7/7/1973 JATIMULYA 4/7 VERTIGO BERAT LAYALI 1 1 1 -
22 19.46 53635 MIFTAKHUL YASIR.TN 9/22/1971 JATIBOGOR 2/9 FRAKTUR COSTA 2+ VE LAYALI 1 1 1 -
23 21.15 53636 SITI WIJAYANTI,NY 3/23/1995 BANJARTURI 2/5 DYSPEPSIA EDI 1 1 1 1
24 22.40 53637 HASAN ARIF ,AN 11/14/2015 HARJASARI 7/4 DADRS DGN VOMITUS FREQUENT EDI 1 1 1 1
25 23.15 53638 HAEKAL HIBATUL AZIZ,AN 7/3/2011 KARANGMULYA 2/7 RFA EDI 1 1 1 - 1
26 23.33 53639 KUSNOTO,TN 11/2/1977 KREMAN 6/2 COLIC RENAL + LBP EDI 1 1 1 - 1
JUMLAH 23 1 0 0 12 7 5 0 0 16 8 0 0 10 280,000 7

TANGGAL/BULAN : 5 0
1 13.20 53628 DARMANTO.TN 8/29/1984 PAKETIBAN 8/2 VL RIA 1 1 1 1 28,000
2 13.50 53629 MIFTAHUL AZIZ 7/13/2001 SIDAHARJA 17/7 VE RIA 1 1 -
3 -
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) SEMPEL KONSUL DOKTER SPESIALIS
OKSIGEN
dr. EDI dr. Rosnel dr.layali Sederhana Kecil Sedang Berat DARAH dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.OT
28,000 - - 2 70,000 2 108,000 - - 15,000 - - - - -

28,000 - - 1 35,000 1 54,000 - - 15,000 - - - - -
28,000 - - - - - - - - - - -
- - - - - - - - - - - -
- - - 1 35,000 - - - - - - - -
- - - 1 35,000 1 54,000 - - 15,000 - - - - -
- - - 1 35,000 2 108,000 - - - - - - -
- - - 1 35,000 2 108,000 - 1 80,000 15,000 1 23,000 - -
- - - 1 35,000 2 108,000 - - 15,000 - - - - -
- - - 1 35,000 2 108,000 - - 15,000 - - - - -
- - - - - - - - - - - -
- - - - - 1 65,000 - - - - - -
- - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000 -
- - 1 28,000 1 35,000 2 108,000 - - 15,000 - - - - -
- - 1 28,000 1 35,000 1 54,000 - - 15,000 - - - 1 23,000 -
- - 1 28,000 1 35,000 1 54,000 - - 15,000 - - - - -
- - 1 28,000 2 70,000 2 108,000 - - 18,000 10,800 - - - -
- - 1 28,000 - 1 54,000 - - - - - - -
- - 1 28,000 2 70,000 2 108,000 - - 15,000 - - - - -
- - 1 28,000 1 35,000 - - - - - - - -
28,000 2 70,000 1 54,000 - - 15,000
28,000 1 35,000 1 54,000 - - 15,000 1 23,000
28,000 - - - - - - 15,000 - - - - -
28,000 - - 1 35,000 2 108,000 - - 15,000 - - - - -
196,000 - - 7 196,000 22 770,000 26 1,404,000 1 65,000 1 80,000 - 10,800 - - 1 23,000 3 69,000 - - -
OKSIGEN
- - - 1 35,000 1 54,000 1 65,000 - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Fira, Sp.OG dr. Arif Sp.An UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - - - -
- - 1 23,000 - - - - - -
- - - - - #REF! #REF! - - -
- - - - - #REF! #REF! - - -
- - - - - #REF! #REF! - - -
- - - - - #REF! #REF! - - -
- - - - - #REF! #REF! - - -
- - - - - #REF! - #REF! - -
- - - - - #REF! - #REF! - -
- - - - - #REF! #REF! - - -
- - - - - #REF! #REF! - - -
- - - - - #REF! #REF! - - -
- - - - - #REF! - - #REF! -
- - - - - #REF! #REF! - - -
- - - - - #REF! - #REF! - -
- - - - - #REF! - - #REF! -
- - - - - #REF! - - #REF! -
- - - - - #REF! #REF! - - -
- - - - - #REF! - #REF! - -
- - - - - #REF! - - #REF! -
- - - - - #REF! #REF! - - -
- - - - - #REF! - #REF! - -
- - - 1 23,000 - - - - - - #REF! #REF! #REF! #REF! -
#REF!
dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An
- - - - - #REF! #REF! - - -
- - - - - #REF! #REF! - - -
- - - - - #REF!

MASUK dr. EDI
1 00.30 53640 SUROSO,SDR 2/28/1980 SURADADI 2/11 LOW BACK PAIN EDI S 1 1 1 1 28,000
2 00.35 52804 WASKINAH,NY 11/8/1969 KERTASARI 2/6 CHF + HHD + CKD + HT EDI S 1 1 1 1 28,000
3 00.35 46502 AINUN NAJIKHA,NY 2/5/1997 KETILENG 4/1 GASTRITIS AKUT EDI S 1 1 1 1 28,000
4 02.30 53641 DURMIN,TN 9/19/1963 JATIMULYA 4/4 RETENSIO URINE EDI S 1 1 1 1 28,000
5 05.50 53642 CASUNI,NY 7/1/1969 DEMANGHARJO 6/1 VERTIGO DGN VOMITUS EDI S 1 1 1 1 28,000
6 06.40 53643 SRI AGUSTINA,NY 8/17/1979 BOJONGSANA 4/2 G1P0A0 H39MGG DGN PEB EDI S 1 1 1 1 28,000
7 06.50 18006 SITI PATIKHA,NY 7/28/1988 HARJASARI 7/4 G2P1A0 H41MGG DGN SEROTINUS EDI S 1 1 1 1 28,000
8 07.40 53644 NELI KANTIANA.NY 5/3/1987 SURADADI 2/17 PENDARAHAN PERVAGINA FARADITA 1 1 1 -
9 08.30 53645 TAMINAH.NY 1/1/1967 JATIMULYA 1/2 GEA FARADITA 1 1 1 - -
10 10.30 52628 KUSERI.TN 12/30/1955 BOJONGSANA 14/5 DISPEPSYA FARADITA 1 1 1 - -
11 11.40 53653 WIDYA WINARTI.NN 4/29/2000 MARIBAYA 1/1 SKD FARADITA 1 1 1 -
12 12.00 49628 DEMAH.NY 5/20/1940 HARJASARI 5/7 TB PARU FARADITA 1 1 1 -
13 13.00 53654 RASELA ARTANIA,AN 6/1/2017 SIDAHARJA 13/6 FEBRIS FARADITA 1 1 1 -
14 13.40 53655 MOH SAHID EKO. 10/18/1997 MARIBAYA 3/2 VOMITUS FARADITA 1 1 1 -
15 13.45 53348 ROBIAH.NY 10/19/1981 KARANGMULYA 4/4 PEB FARADITA 1 1 1 -
16 14.26 19091 UMALIYAH.NY 6/2/1939 SURADADI 3/12 GASTRITIS,MYALGIA ROSNELINA 1 1 1 -
17 15.28 53419 HERLIN AYU W.NY 1/11/1992 MINTARAGEN 5/10. TGL TIMUR H DG AB INCOMPLETE ROSNELINA 1 1 1 -
18 18.34 16436 SIPON.TN 12/31/1955 JATIMULYA 1/2 VERTIGO,HT,DM ROSNELINA 1 1 1 -
19 19.00 11993 TARUNAH.NY 11/10/1925 RANGIMULYA 4/2 GEA+ DEHIDrasi sedang ROSNELINA 1 1 1 -
20 21.50 51588 SITI NURKHAYATUN,NY 12/9/1996 KEMUNING 1/5 G1P0A0 H40MGG DGN PRESKEP + KPD ROSNELINA 1 1 1 -
21 22.25 53656 LISKA ARIDIANA,NY 7/20/1997 JATIBOGOR 2/4 G1P0A0 H329MGG DGN BRAXTON ROSNELINA 1 1 1 -
22 23.50 53655 MOH SAHID EKO,SDR 10/18/1997 MARIBAYA 3/2 VOMITUS ROSNELINA 1 1 1 -
JUMLAH 18 4 0 1 9 7 3 0 2 17 5 0 0 7 196,000
Kepala Ruang IGD
Agus Riyanto, AMK

Layali M, dr
Rosnelina, dr
Faila S, dr
Dyah Novi, dr
Gesa Tidar, dr
Faradita, dr

TANGGAL/BULAN : 5 PLUMBUNGAN 2/1

1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 - -
10 - -
13.15 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
22 -
23 -
24 -
25 -
26 -
27 -
28 -
29 -
30 -
OKSIGEN
- - - - - - - - - - - - -
- - - - - 1 35,000 2 108,000 - - 15,000 36,000 - - -
- - - - - 1 35,000 1 54,000 - - 15,000 - - - -
- - - - - - 1 54,000 - - - - - -
- - - - - 2 70,000 2 108,000 - - 15,000 - - - -
- - - - - 1 35,000 1 54,000 - - 15,000 - - - -
- - - - - 1 35,000 1 54,000 - - 15,000 - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - -
- - - - 1 28,000 1 35,000 2 108,000 - - 15,000 - - - -
- - - - 1 28,000 1 35,000 2 108,000 - - 15,000 - - - -
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 2 70,000 3 162,000 - - 15,000 - - - -
- - - - 1 28,000 1 35,000 1 54,000 - - 15,000 - - - 1 23,000
- - - - 1 28,000 - - - - - - - -
- - - - 1 28,000 1 35,000 2 108,000 - - 15,000 - - - -
- - 1 28,000 - - - - - - - - - -
- - 1 28,000 - - 1 35,000 - - - 15,000 - - - -
- - 1 28,000 - - 2 70,000 2 108,000 - - 15,000 - - - -
- - 1 28,000 - - 2 70,000 2 108,000 - - 15,000 - - - -
- - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - - -
- - 1 28,000 - - 1 35,000 2 108,000 - - 15,000 - - - -
- - 1 28,000 - - 1 35,000 1 54,000 - - 15,000 - - - -
- - - - 7 196,000 - - 8 224,000 21 735,000 27 1,458,000 - - - - 255,000 36,000 - - - - 1 23,000
OKSIGEN
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
dr. Fullarini, Sp.P dr. Yuli, Sp.OTdr. NAFIA SAFIRA Sp.OG
dr. Riyani, Sp.OG dr. Arif Sp.An UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 117,000 - 117,000 - -
- - - - - - 82,000 82,000 - - -
- - - - - - 206,000 - 206,000 - -
- - 1 23,000 - - - 140,000 - - 140,000 -
- - 1 23,000 - - - 140,000 - - - -
- - - - - - 117,000 - - - -
- - - - - - 171,000 171,000 - - -
- - - - - - 171,000 171,000 - - -
- - - - - - 28,000 28,000 - - -
1 23,000 - - - - - 283,000 - 283,000 - -
- - - - - - 140,000 140,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 171,000 - 171,000 - -
- - - - - - 28,000 28,000 - - -
- - 1 23,000 - - - 86,000 - - 86,000 -
- - - - - - 206,000 - - 206,000 -
- - - - - - 206,000 - 206,000 - -
- - 1 23,000 - - - 140,000 - - - -
- - 1 23,000 - - - 194,000 - 194,000 - -
- - - - - - 117,000 117,000 - - -
1 23,000 - - 5 115,000 - - - - - - - - 2,771,000 765,000 1,177,000 432,000 -
2,771,000
- - - - - -
- - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
JAM ASAL PASIEN CARA BAYAR CARA KELUAR P

MASUK dr. Layali dr. Fad
1 00.50 53657 IRPANUDIN,SDR 3/3/1994 SIDAMULYA 1/2 DENGUE FEVER ROSNELINA 1 1 1 - -
2 08.21 53661 SOLEH,SDR 7/4/1986 KARANGMULYA 3/3 VL FADEL 1 1 1 - 1
3 09.50 53668 ASIBUN SISPRAYETNO,AN 12/2/2003 SIDAMULYA 6/2 DISPEPSIA FADEL 1 1 1 - 1
4 10.41 47426 MUSLICH,TN 6/12/1958 KARANGWULUH 4/1 DIGIGIT BINATANG FADEL 1 1 1 - 1
5 12.05 53670 SUKIRNO,TN 1/1/1981 PLUMBUNGAN 1/1 POST TRAUMA FADEL 1 1 1 - 1
6 14.30 35114 SURATNA.NY 1/15/1986 SURADADI 2/3 ASTMA DYAH 1 1 1 -
7 15.30 53674 PAING.TN 1/1/1951 KERTAYASA 4/1 dispepsya DYAH 1 1 1 -
8 16.00 42485 DAUMI.NY 1/1/1958 SIDAHARJA 20/9 CHF DYAH 1 1 1 -
9 16.30 53343 KASRIYAH.NY 7/8/1950 JATIBOGOR 1/8 GASTRISTIS DYAH 1 1 1 -
10 17.00 53676 MAFTUKHA.NY 11/4/1982 BANGUNGALIH 4/1 ab iminem DYAh 1 1 1 -
11 17.15 53675 SURATMAH.NY 1/1/1964 KARANGWULUH3/1 GEA DYAH 1 1 1 -
12 17.30 32751 SUTORO.TN 6/11/1950 JATIMULYA 1/7 FEBRIS DYAH 1 1 1 -
13 20.00 53677 WARYUTI.NY 1/1/1942 MARIBAYA 4/1 HT BERAT DYAH 1 1 1 -
14 20.15 53678 SRI NURKHOTIMAH.NY 8/1/1990 KRAMAT 1/1 ab iminem DYAH 1 1 1 -
15 20.30 53679 SITI KAMSAH.NY 1/8/1977 DEMANGHARJA 2/1 tramuma muskulo DYAH 1 1 1 -
16 21.18 17107 slamet.tn 1/28/1957 DEMANGHARJA 1/3 ACS STEMI LAYALI 1 1 1 1 28,000 -
17 21.29 47745 INDRI PRASTI N.AN 5/8/2017 MARIBAYA 4/1 VOMITUS FREQUENT LAYALI 1 1 1 1 28,000 -
18 - -
19 - - -
20 - - -
JUMLAH 16 1 0 0 7 6 4 0 0 8 9 0 0 2 56,000 4
Kepala Ruang IGD
Agus Riyanto, AMK

SENSUS HARIAN KLL INSTALASI GAWAT DARURAT
TANGGAL/BULAN : 31 0
JAM ASAL PASIEN CARA BAYAR CARA KELUAR P

MASUK dr. Layali dr. Fail
1 15.30 53673 MAURIF.SDR 5/9/1993 PURWAHAMBA 20/8 VE DYAH 1 1 1 - -
2 -
3 -
4 -
5 -
JUMLAH 1 0 0 0 1 0 0 0 0 0 1 0 0 - - -
Kepala Ruang IGD
Agus Riyanto, AMK

PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) SAMPEL KONSUL DOKTER SP
OKSIGEN
dr. Fadel dr. Dyah dr. Rosnel dr. Faradita Sederhana Kecil Sedang Berat DARAH dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.
- - - 1 28,000 - 1 35,000 2 108,000 - - - 15,000 18,000 - - - - -

28,000 - - - - 2 108,000 - - - - - - - -
28,000 - - - - - - - - - - - -
28,000 - - 1 28,000 - - - - - - - - -
28,000 - - 2 56,000 - - - - 10,800 - - - -
1 1 35,000 1 54,000 1 15,000
1 1 35,000 2 108,000 15,000
1 1 35,000 3 162,000 15,000
1 - -
1 1 35,000 1 54,000 15,000
1 1 35,000 2 108,000 15,000
1 1 35,000 2 108,000 15,000
1 2 70,000 3 162,000 15,000 21,600
1 - -
1 - -
- - - - 1 35,000 1 54,000 - - - - - -
- - - - 1 35,000 1 54,000 - - 15,000 - - - 1 23,000 -
- - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
112,000 10 - 1 28,000 3 84,000 11 385,000 20 1,080,000 1 - - - 135,000 50,400 - - - - 1 23,000 - - -
PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) KONSUL DOKTER SP
OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P dr. Yuli, Sp.
- 1 28,000 - - 1 35,000 - - - - - - - - - - - -
- - - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- - - - - - - - - - - - -
- 1 28,000 - - - - 1 35,000 - - - - - - - - - - - - - - - - -
dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - - #REF! - #REF! - -
- - - - - #REF! #REF! - - -
- - - - - #REF! #REF! - - -
- - - - - #REF! - - #REF! -
- - - - - #REF! #REF! - - -
- - - - - #REF! #REF! - - -
- - - - - #REF! - - #REF! -
- - - - - #REF! - - - -
- - - - - #REF! - - - -
- - - - - #REF! - - - -
- - - - - - - - - - - #REF! #REF! #REF! #REF! -
#REF!
dr. Yuli, Sp.OT dr. Budi Sp.OG dr. Riyani, Sp.OG dr. Arif Sp.An UMUM BPJS PBI BPJS NON PBI JASA RAHARJA
- - - - - - - #REF! #REF! - - -
- - - - - #REF! - - - -
- - - - - #REF! - - - -
- - - - - #REF! - - - -
- - - - - #REF! - - - -
- - - - - - - - - - - #REF! #REF! - - -
#REF!

1 00.10 42648 H.MUALIF YUSUF 3/12/1983 WARUREJA 3/4 VE FARADITA 1 1 1 - -
2 05.50 42649 SURILAH,NY 12/31/1957 JATIBOGOR 1/4 FEBRIS FARADITA 1 1 1 -
3 07.10 42650 ANGGER ANJAR 12/7/1974 SUKAMAJU,CILEDOG,DEPOK FEBRIS GESA 1 1 1 -
4 07.52 42652 MARINAH 7/14/1957 SIDOHARJO 08/05 DM TYPE II + VERTIGO GESA 1 1 1 -
5 08.07 15232 TAMJID, TN 4/29/1944 BANGUN GALIH 07/01 ASMA GESA 1 1 1 -
6 08.20 42611 SOLEKHA, NY 7/28/1990 KARANGWULUH 3/2 GASTRITIS AKUT GESA 1 1 1 -
7 08.15 22451 MATRILAH, NY 6/23/1970 JATIMULYA 4/4 GASTRITIS EROSIVA GESA 1 1 1 -
8 09.10 42653 ENDANG SUSPURWANTI 6/7/1986 KARANG MALANG 15/07 EPITAXIS POST TRAUMA TUMPUL GESA 1 1 1 -
9 09.15 42654 TRI PUJI M, NY 1/17/1987 SURADADI 01/12 VE GESA 1 1 1 - -
10 09.45 22917 RASMI, NY 1/1/1943 SIDAMULYA 04/01 PPOK GESA 1 1 1 - -
11 10.53 42655 TARSUMI 11/23/1965 MARGAPADANG 12/2 COLIC ABDOMEN GESA 1 1 1 -
12 11.18 42656 KIKI NURFAUZAN 7/22/2007 SURADADI 01/17 DHF GESA 1 1 1 -
13 12.30 42658 TAN JIN TAN 6/28/1966 REGOL 03/01 PUNGKUR SUSP.CHF GESA 1 1 1 -
14 13.25 42663 M.FAREL MUH ANANDA,AN 8/10/2008 BARANANG SIANG 7/5,BOGOR MOSLEN SICKNUS GESA 1 1 1 -
15 13.45 42662 SEPTO ARIS,SDR 9/20/1996 BANJARTURI 1/7 VE GESA 1 1 1 -
16 13.45 42659 ERLITA SOFIYA,AN 6/11/2016 SURADADI 2/2 DEMAM GESA 1 1 1 -
17 13.35 42661 IRWANSYAH,TN 7/7/1983 BANJARAGUNG 1/7 VE GESA 1 1 1 -
18 13.49 42660 DESI AYUNINGTIYAS,NN 9/20/1996 KALI SAPU 4/1,SLAWI DYSPEPSI GESA 1 1 1 -
19 13.30 9903 AENUN SAFITRI,AN 12/20/2005 JATIMULYA 4/7 RFA GESA 1 1 1 -
20 13.03 1694 TIWAN,TN 6/12/1969 SEMEDO 7/3 DM TYPE II GESA 1 1 1 -
21 17.10 18785 SUHADI,TN 5/5/1969 GEMBONGDADI 5/3 VERTIGO,BPPV DYAH 1 1 1 -
22 17.27 42664 ERNA SUKMA,NY 6/2/1990 KERTASARI 1/5 ABORTUS INSIPEN DYAH 1 1 1 -
23 19.00 42665 TUWI,NY 1/1/1966 SIDOHARJO 5/3 MUSCLEPAIN DYAH 1 1 1 -
24 19.26 42666 HAFIZH RA'IF F,AN 9/3/2004 SURADADI 1/15 VIRAL INFEKSI DYAH 1 1 1 -
25 21.00 42456 REFI ADITIA,AN 11/6/2014 KARANGMULYA 1/3 GEA FAILA 1 1 1 - 1
1 07.50 42667 RADI.TN 3/14/1950 KESADIKAN 17/2 GEA GESA 1 1 1 - -
2 8.20 42668 KHOLISOH.NY 9/17/1978 SIDOHARJO 16/7 GEA GESA 1 1 1 -
3 8.25 42669 PUTRI HANDAYANI.AN 1/26/2005 WANAGOPA 5/4 ASMA SERANGAN SEDANG GESA 1 1 1 -
4 8.30 19236 SUTARNO.TN 4/1/1979 SIDOHARJO 2/2 DM GESA 1 1 1 -
5 8.40 42670 PENTI SUSILOWATI.NY 11/21/1984 PURWAHAMBA 10/4 DEMAM THYPOID GESA 1 1 1 -
6 9.30 42672 WARLIKHA.NY 3/14/1975 KARANGMULYA 1/6 CEPALGIA GESA 1 1 1 -
7 10.15 42674 NGATIMIN.TN 11/2/1983 BANYU BIRU 1/11 SMG VULNUS PUNTCHUM PEDIS SINISTRA GESA 1 1 1 -
8 9.30 42671 AFIKAH KHOLIPATUN 5/12/2012 KALIGANGSA 4/3 VE GESA 1 1 1 -
9 9.00 42119 SITI ANISAH.NY 5/11/1957 BANGUNGALIH 9/1 VL GESA 1 1 1 - -
10 11.05 42676 RICO FEBI ANDRIANSYAH 2/20/2002 SURADADI 3/1 VE GESA 1 1 1 - -
11 9.40 42671 FIKRI AULIA RAHAMAN.AN HARJASARI 6/6 RFA GESA 1 1 1 -
12 10.30 42298 TITIN KRISMIASIH.NY 10/12/1969 BABAKAN 4/2 TB PARU GESA 1 1 1 -
13 12.05 42677 SIFA OKTAVIANI 10/18/2010 SURADADI 3/1 RFA GESA 1 1 1 -
14 9.00 42675 SARIAH.NY 7/5/1950 PURWAHAMBA 12/5 ACS GESA 1 1 1 -
15 13.30 42678 SYARA SAVONIAS R.NN 1/9/1996 PROCOT 3/2 VE GESA 1 1 1 -
16 14:00 42679 FARDAN TONISAH B.AN 10/21/2012 SIDAMULYA 04/07 FEBRIS FAILA 1 1 1 - 1
17 14.30 42680 FANI DAMAYANTI,AN 4/12/2009 DEMANGHARJO 1/3 FEBRIS FAILA 1 1 1 - 1
18 15.00 42682 SUGIARTO,SDR 12/31/1996 KERTASARI 5/6 CKR,VL,VE FAILA 1 1 1 - 1
19 15.00 42682 ROWI,TN 10/6/1990 KERTASARI 4/6 CKR,VL,VE FAILA 1 1 1 - 1
20 17.59 42683 MOKHAMAD SAHROJI,TN 7/2/1979 KERTASARI 3/3 VL PUNCTUM FAILA 1 1 1 - 1
21 19.30 23307 GILANG ARIP,SDR 10/7/1997 SIDOHARJO 25/10 DYSPEPSIA FAILA 1 1 1 - 1
22 19.54 42684 M.IQBAL,TN 6/24/1982 JATIBOGOR 1/9 ULKUS DEGUBITUS FAILA 1 1 1 - 1
23 21.55 42685 SAMIAN,TN 1/1/1966 KERTASARI 2/5 HIPERTENSI GRID 2 ROSNELIA 1 1 1 -
1 00.45 34799 ERI HERMAWAN,TN 1/16/1988 BOJONGSANA 7/3 ABDOMINAL PAIN ROSNELINA 1 1 1 - -
2 02.50 41012 TRIPOSA SUPADMI,NN 2/7/1998 SIDOHARJO 25/10 TRAMA FASIALIS ROSNELINA 1 1 1 -
3 03.45 42686 SURATMI,NY 3/7/1971 SURADADI 2/6 EMERGENCY DG VERTIGO BRT ROSNELINA 1 1 1 -
4 7.45 42691 RODLIJAH.NY 1/1/1938 KARANGMULYA 2/1 HT EMERGENCY DYAH 1 1 1 -
5 9.50 42700 TAMEN.NY 11/18/1981 KRAMAT 5/2 RETIO PLACENTA DYAH 1 1 1 -
6 10.30 42704 UKFI NAISILA, AN 2/1/2009 SIDAMULYA 8/1 DHF DYAH 1 1 1 -
7 10.20 42703 ITALIANA FILANI 9/21/1990 WAREUREJA 5/6 IMPARTU DG HBSAG , FASE LATEN KAL DYAH 1 1 1 -
8 11.25 42308 DIO ALIF RAMADAN 5/6/2006 PURWAHAMBA 20/08 ASMA ATTACK DYAH 1 1 1 -
9 11.30 42707 OEZIL ZAFRAN TAFTAZANI, A 4/22/2014 KERTASARI 7/1 HIPERPIREKSIDG DEHIDRASI DYAH 1 1 1 - -
10 12.15 42710 AQHIFA NAYLA.AN 12/12/2014 TANJUNGHARJA 2/1 KDS DYAH 1 1 1 1 - -
11 12.30 42712 ERU DINI, SDR 11/29/1991 JATIBOGOR VE DYAH 1 1 1 -
12 14:55 42713 SAHSON.TN 12/13/1955 HARJOSARI 7/4 VL,MULTIPLE VE LAYALI 1 1 1 1 28,000
13 15:37 42714 FAISAL ARDIANI.AN 4/11/2002 BANGUNGALIH07/01 COMBUSTIO DRAJAT II LAYALI 1 1 1 1 28,000
14 17:00 42715 NUNUNG INDRIYATI.NY 11/28/1962 SURADADI 02/12 FEBRIS,HT LAYALI 1 1 1 1 28,000
15 22.40 42717 MOH.SOLIKHUN 8/15/1967 MARIBAYA 3/3 DYSPEPSI + KONSTIPASI ROSNELINA 1 1 1 -
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JUMLAH 60 3 0 0 44 12 8 0 0 33 30 0 0 3 84,000 8
Kepala Ruang IGD
Agus Riyanto, AMK
Layali M, dr
Rosnelina, dr
Faila S, dr
Dyah Novi, dr
Gesa Tidar, dr
Faradita, dr
OKSIGEN
dr. Faila dr. Dyah dr. Rosnel dr. Gesa dr. Faradita Sederhana Kecil Sedang Berat dr. Luqman, Sp.PD dr. Anidyo, Sp.B dr. Septiana, Sp.A dr. Fullarini, Sp.P
- - - - - - 1 28,000 1 35,000 - - - - - - - - - - -
- - - - 1 28,000 - - - - - - - -
- - - 1 28,000 - 1 35,000 1 54,000 - - - - - -
- - - 1 28,000 - - - - - - -
- - - 1 28,000 - 2 70,000 2 108,000 - - - - - -
- - - 1 28,000 - 1 65,000 - - - - -
- - - 1 28,000 - 1 35,000 2 108,000 - - - - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - - 1 54,000 - - - - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - 1 35,000 2 108,000 - - - - - -
- - - 1 28,000 - - 1 54,000 - - - - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - 1 35,000 - - - - - - -
- - - 1 28,000 - 1 35,000 1 54,000 - - - - - 1 23,000
- - - 1 28,000 - 1 35,000 - - - - - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - 2 70,000 2 108,000 - - - - - -
- 1 28,000 - - - 1 35,000 - - - - - - -
- 1 28,000 - - - - 1 54,000 - - - - - 1 23,000
- 1 28,000 - - - - 1 54,000 - - - - - -
- 1 28,000 - - - - - - - - - - -
28,000 - - - - 1 35,000 1 54,000 - - - - - 1 23,000
- - - - - 1 28,000 - 1 35,000 2 108,000 - - - - - - - - -
- - - 1 28,000 - 1 35,000 1 54,000 - - - - - - -
- - - 1 28,000 - - - 1 65,000 - - - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - 1 35,000 - - - - - - -
- - - 1 28,000 - 1 35,000 - - - - - - -
- - - 1 28,000 - - 1 54,000 - - - - - -
- - - 1 28,000 - - - - - - - - -
- - - 1 28,000 - 1 35,000 1 54,000 - - - - - 1 23,000
- - - 1 28,000 - 1 35,000 1 54,000 - - 1 10,000 - - - 1
- - - 1 28,000 - 1 35,000 1 54,000 - - - - - 1 23,000
- - - 1 28,000 - 2 70,000 3 162,000 - - 1 1 - - -
- - - 1 28,000 - 1 35,000 14 756,000 - - - - - -
28,000 - - - - 1 35,000 1 54,000 - - - - - 1 23,000
28,000 - - - - 1 35,000 1 54,000 - - - - - 1 23,000
28,000 - - - - 2 70,000 2 108,000 - - - - - -
28,000 - - - - 1 35,000 2 108,000 - - - - 1 23,000 -
28,000 - - - - 2 70,000 - - - - - - -
28,000 - - - - - - - - - - - -
28,000 - - - - 1 35,000 1 54,000 - - - - 1 23,000 -
- - 1 28,000 - - 2 70,000 2 108,000 - - 1 10,000 1 23,000 - -
- - - 1 28,000 - - 1 35,000 1 54,000 - - - 3 10,800 - - - -
- - 1 28,000 - - - - - - - - - - -
- - 1 28,000 - - 2 70,000 2 108,000 - - 1 10,000 1 23,000 - -
- 1 28,000 - - - 1 35,000 3 162,000 - - 2 20,800 - - -
- 1 28,000 - - - 1 35,000 1 54,000 - - 1 10,000 - - -
- 1 28,000 - - - 1 35,000 1 54,000 - - - - - 1 23,000
- 1 28,000 - - - - - - - - - - -
- 1 28,000 - - - - - 1 65,000 - - - - -
- 1 28,000 - - - 1 35,000 1 54,000 - - - - - 1 23,000
- 1 28,000 - - - 1 35,000 1 54,000 - - - - - 1 23,000
- 1 28,000 - - - 1 35,000 - - - - - - -
- - - - - - 1 54,000 1 65,000 - - - - -
- - - - - 1 35,000 - - - - - 1 23,000 -
- - - - - - - - - - - - -
- - 1 28,000 - - - - - - - - - -
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- -
- - - - - - - - - - - - -
224,000 12 336,000 5 140,000 33 924,000 2 56,000 43 1,505,000 59 3,186,000 4 260,000 - - 10 71,601 2 46,000 3 69,000 10 230,000 1
- - - - - - - - 63,000 63,000 - - -
- - - - - - 28,000 - 28,000 - -
- - - - - - 117,000 117,000 - - -
- - - - - - 28,000 - - 28,000 -
- - - - - - 206,000 - - 206,000 -
- - - - - - 93,000 - 93,000 - -
- - - - - - 171,000 - - 171,000 -
- - - - - - 28,000 28,000 - - -
- - - - - - 82,000 82,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 171,000 171,000 - - -
- - - - - - 82,000 82,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 63,000 63,000 - - -
- - - - - - 140,000 140,000 - - -
- - - - - - 63,000 63,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 206,000 - 206,000 - -
- - - - - - 63,000 63,000 - - -
- - - - - - 105,000 - 105,000 - -
- - - - - - 82,000 82,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 140,000 140,000 - - -
- - - - - - - - 171,000 - - 171,000 -
- - - - - - 117,000 117,000 - - -
- - - - - - 93,000 93,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 63,000 63,000 - - -
- - - - - - 63,000 63,000 - - -
- - - - - - 82,000 82,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 140,000 - 140,000 - -
23,000 - - - - - 150,000 - - 150,000 -
- - - - - - 140,000 140,000 - - -
- - - - - - 260,001 260,001 - - -
- - - - - - 819,000 819,000 - - -
- - - - - - 140,000 140,000 - - -
- - - - - - 140,000 140,000 - - -
- - - - - - 206,000 206,000 - - -
- - - - - - 194,000 194,000 - - -
- - - - - - 98,000 98,000 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 140,000 - 140,000 - -
- - - - - - 239,000 - 239,000 - -
- - - - - - - - 127,800 127,800 - - -
- - - - - - 28,000 28,000 - - -
- - - - - - 239,000 - 239,000 - -
- - - - - - 245,800 - - 245,800 -
- - - 1 - - 127,000 - 127,000 - -
- - - - - - 140,000 - 140,000 - -
- - 1 23,000 - - - 51,000 - 51,000 - -
- - - - - - 93,000 93,000 - - -
- - - - - - 140,000 - - 140,000 -
- - - - - - 140,000 140,000 - 140,000 -
- - - - - - 63,000 63,000 - - -
- - - - - - 147,000 147,000 - - -
- - - - - - 86,000 86,000 - - -
- - - - - - 28,000 - 28,000 - -
- - - - - - 28,000 28,000 - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
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- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
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- - - - -
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- - - - -
- - - - -
- - - - - - - - - - -
23,000 - - 1 23,000 1 - - - - - - - 7,177,601 4,529,801 1,536,000 1,251,800 -
7,177,601
7,317,601

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SENSUS HARIAN INSTALASI GAWAT DARURAT

RSUD SURADADI KABUPATEN TEGAL

TANGGAL/BULAN : 1 Januari 2018

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

Kepala Ruang IGD

SENSUS HARIAN KECELAKAAN LALU LINTAS INSTALASI GAWAT DARURAT

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

- - 13 364,000 - - 7 196,000 2 56,000 14 490,000 15 810,000 - - - - 235,000 10,800 - - - - 3 69,000

- - 1 28,000 - - - - 1 35,000 1 54,000 - - 1 80,000 - 14,400 - - 1 23,000 -

- - - - 1 23,000 - - - - - - - - 709,800 287,000 206,000 216,800 -

- - - - - - - - - - - - - - 588,400 424,400 - - 164,000

TANGGAL/BULAN : 2 Januari 2018

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

Kepala Ruang IGD

SENSUS HARIAN KECELAKAAN LALU LINTAS INSTALASI GAWAT DARURAT

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

1 35,000 2 108,000 - - 15,000 - - - -

PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 )

- - - - - 1 28,000 2 56,000 1 35,000 2 108,000 1 65,000 - - 15,000 - - - - - - -

KONSUL DOKTER SPESIALIS PENDAPATAN BERDASAR CARA BAYAR

TANGGAL/BULAN : 3 Januari 2018

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

SENSUS HARIAN KECELAKAAN LALU LINTAS INSTALASI GAWAT DARURAT

TANGGAL/BULAN : 3 KRAMAT 1/1

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

- 1 28,000 - - - 1 35,000 2 108,000 - - - 15,000 - 1 23,000 - -

PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 )

KONSUL DOKTER SPESIALIS PENDAPATAN BERDASAR CARA BAYAR

TANGGAL/BULAN : 4 Januari 2018

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

SENSUS HARIAN KECELAKAAN LALU LINTAS INSTALASI GAWAT DARURAT

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

- 1 28,000 - - - - - 1 35,000 1 54,000 - - - 15,000 - - -

PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 )

- - 1 23,000 2 46,000 - - - 1 ### 23,000 - - - - - - 1,159,600 163,000 556,600

KONSUL DOKTER SPESIALIS PENDAPATAN BERDASAR CARA BAYAR

BPJS NON PBI JASA RAHARJA

TANGGAL/BULAN : 5 Januari 2018

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

SENSUS HARIAN KECELAKAAN LALU LINTAS INSTALASI GAWAT DARURAT

- - - 1 28,000 - - 2 70,000 3 162,000 - - 15,000 108,000 - -

PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 )

KONSUL DOKTER SPESIALIS PENDAPATAN BERDASAR CARA BAYAR

TANGGAL/BULAN : 6 Januari 2018

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

SENSUS HARIAN KECELAKAAN LALU LINTAS INSTALASI GAWAT DARURAT

- - 1 28,000 - - 2 70,000 3 162,000 - - 15,000 - - - -

PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 )

KONSUL DOKTER SPESIALIS PENDAPATAN BERDASAR CARA BAYAR

TANGGAL/BULAN : 7 Januari 2018

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

SENSUS HARIAN KECELAKAAN LALU LINTAS INSTALASI GAWAT DARURAT

PEMERIKSAAN IGD ( Rp. 28.000,- ) TMNO ( 35.000, 54.000, 65.000, 80.000 ) K

KONSUL DOKTER SPESIALIS PENDAPATAN BERDASAR CARA BAYAR

TANGGAL/BULAN : 8 Januari 2018

JAM ASAL PASIEN CARA BAYAR CARA KELUAR PEM

SENSUS HARIAN KECELAKAAN LALU LINTAS INSTALASI GAWAT DARURAT

KONSUL DOKTER SPESIALIS PENDAPATAN BERDASAR CARA BAYAR

TANGGAL/BULAN : 9 Januari 2018

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

TANGGAL/BULAN : 10 Januari 2018

JAM ASAL PASIEN CARA BAYAR CARA KELUAR

SENSUS HARIAN KECELAKAAN LALU LINTAS INSTALASI GAWAT DARURAT