Sheet134,780274,282283,3941123200APPENDICITIS AKUT(kelas 3)SECTIO CAESARIA (kelas 2)SECTIO CAESARIA (kelas 1)

Aktifitas PelayananHari rawat 1Hari rawat 2Hari rawat 3Hari rawat 4Aktifitas PelayananHari rawat 1Hari rawat 2Hari rawat 3Hari rawat 4103,594Aktifitas PelayananHari rawat 1Hari rawat 2Hari rawat 3Hari rawat 4Ruangan48,750Ruangan81,250Ruangan243,750Perawatan19,500975,000Perawatan26,0001,170,000Perawatan32,500Pemeriksaan klinisVisite dokter umumVisite dokter umumVisite dokter828,750Pemeriksaan klinisVisite dokter umumVisite dokterVisite dokter994,500Pemeriksaan klinisVisite dokter umumVisite dokterVisite dokterTanda vitalKonsultasi (telp) dr.Sp.OG0.00.020,719 Tanda vitalKonsultasi (telp) dr.Sp.OG0.00.024,863Tanda vitalKonsultasi (telp) dr.Sp.OG0.00.0Status cairanKonsultasi (telp) dr.Sp.An (PinRu)20,719Status cairanKonsultasi (telp) dr.Sp.An (PinRu)24,863Status cairanKonsultasi (telp) dr.Sp.An (PinRu)VisiteVisite dokter spesialisVisite dokter spesialis787,313VisiteVisite dokter spesialisVisite dokter spesialis944,775VisiteVisite dokter spesialisVisite dokter spesialisPemeriksaan penunjangDL, 38,500-Pemeriksaan penunjangDL, 42,700-Pemeriksaan penunjangDL, 46,200-DL, CT/BT406,000DL, CT/BT487,500DL, CT/BTDL, CT/BT, GDA345,100DL, CT/BT, GDA414,375DL, CT/BT, GDADL, CT/BT, GDA, EKG8,628DL, CT/BT, GDA, EKG10,359DL, CT/BT, GDA, EKGDL, CT/BT, GDA, EKG, Thorax,8,628DL, CT/BT, GDA, EKG, Thorax,10,359DL, CT/BT, GDA, EKG, Thorax,DL, CT/BT, GDA, EKG, Thorax, BUN327,845DL, CT/BT, GDA, EKG, Thorax, BUN393,656DL, CT/BT, GDA, EKG, Thorax, BUNDL, CT/BT, GDA, EKG, Thorax, BUN, CreatinumDL, CT/BT, GDA, EKG, Thorax, BUN, CreatinumDL, CT/BT, GDA, EKG, Thorax, BUN, CreatinumTindakanSectio Caesaria (SC)TindakanSectio Caesaria (SC)TindakanSectio Caesaria (SC) Dokter975,000800,000 Dokter1,170,000950,000 Dokter1,404,000Anasthesi406,000350,000Anasthesi487,500400,000Anasthesi585,000Ass. Anasthesi102,00085,000Ass. Anasthesi121,875100,000Ass. Anasthesi146,250Ass. Operator I102,000Ass. Operator I121,875Ass. Operator I146,250Ass. Operator II102,000Ass. Operator II121,875Ass. Operator II146,250Kamar Operasi366,000Kamar Operasi438,750Kamar Operasi526,500Kamar RR65,000Kamar RR65,000Kamar RR65,000Observasi RR/12 Jam49,000Observasi RR/12 Jam48,750Observasi RR/12 Jam48,750Tindakan RR49,000Tindakan RR48,750Tindakan RR48,750Obat2an Kamar OperasiObat2an Kamar OperasiObat2an Kamar Operasi

Infus13,000Infus14,300Infus15,600ANC Bidan9,750ANC Bidan9,750ANC Bidan9,750Vaginal Toucher (VT)6,500Vaginal Toucher (VT)7,150Vaginal Toucher (VT)7,800NST39,000NST42,900NST46,800Sceeren13,000Sceeren14,300Sceeren15,600Inj Per Infus VK3,900Inj Per Infus VK4,290Inj Per Infus VK4,680Observasi Urine19,500Observasi Urine19,500Observasi Urine21,450Observasi Urine21,450Observasi Urine23,400Observasi Urine23,400Pasang Cateter19,5000.0Pasang Cateter21,4500.0Pasang Cateter23,4000.0

resusitasi bayi16,250resusitasi bayi16,250resusitasi bayi16,250

lepas kateter13,000lepas kateter14,300lepas kateter15,600Aff Infus6,500Aff Infus7,150Aff Infus7,800

NutrisiPuasaDiet TKTPDiet TKTPNutrisiPuasaDiet TKTPDiet TKTPNutrisiPuasaDiet TKTPDiet TKTPObat-obatanceftriaxone 2 x 1 (2)24,200ceftriaxone 2 x 1 (1)12,100Obat-obatanceftriaxone 2 x 1 (2)24,200ceftriaxone 2 x 1 (1)12,100Obat-obatanceftriaxone 2 x 1 (2)24,200ceftriaxone 2 x 1 (1)12,100gentamycin amp (3)gentamycin amp (3)gentamycin amp (3)Antrain 3x1 (3)34,200Antrain 3x1 (3)34,200Antrain 3x1 (3)34,200ondansetron (1)37,900ondansetron (1)37,900ondansetron (1)37,900Ranitidin Inj (1)3,000Ranitidin Inj (1)3,000Ranitidin Inj (1)3,000Methergin Inj (1)Methergin Inj (1)Methergin Inj (1)Pitogin Inj (2)16,000Pitogin Inj (1)8,000Pitogin Inj (2)16,000Pitogin Inj (1)8,000Pitogin Inj (2)16,000Pitogin Inj (1)8,000

Lidodex/Bunascan Inj (1)66,900 Lidodex/Bunascan Inj (1)66,900 Lidodex/Bunascan Inj (1)66,900 Adrenalin Inj (1)3,300Adrenalin Inj (1)3,300Adrenalin Inj (1)3,300Ephedrin Inj (1)71,500Ephedrin Inj (1)71,500Ephedrin Inj (1)71,500Sulfat Atropin Inj (3)7,800Sulfat Atropin Inj (3)7,800Sulfat Atropin Inj (3)7,800Miloz (1)28,600Miloz (1)28,600Miloz (1)28,600WFI (4)14,400WFI (4)14,400WFI (4)14,400

Abocath (1)Abocath (1)Abocath (1)Blood set pack (1)28,500Blood set pack (1)28,500Blood set pack (1)28,500cairan Infus (3 RL)20,400cairan Infus (2 RL)13,600cairan Infus (3 RL)20,400cairan Infus (2 RL)13,600cairan Infus (3 RL)20,400cairan Infus (2 RL)13,600cairan Infus (1 D5)cairan Infus (1 D5)6,800cairan Infus (1 D5)cairan Infus (1 D5)6,800cairan Infus (1 D5)cairan Infus (1 D5)6,800Inf PZ (1)6,100Inf PZ (1)6,100Inf PZ (1)6,100Cateter No.16 (1)18,900Cateter No.16 (1)18,900Cateter No.16 (1)18,900Urine Bag (1)8,700Urine Bag (1)8,700Urine Bag (1)8,700Sarung Tangan Obgyn (4)61,600Sarung Tangan Obgyn (4)61,600Sarung Tangan Obgyn (4)61,600Leukomed T Plus B (1)Leukomed T Plus B (1)0.0Leukomed T Plus B (1)Leukomed T Plus B (1)0.0Leukomed T Plus B (1)Leukomed T Plus B (1)0.0Spinocain (1)48,600Spinocain (1)48,600Spinocain (1)48,600

Underpad On (2)7,800Underpad On (2)7,800Underpad On (2)7,800Underpad Steril (1)7,900Underpad Steril (1)7,900Underpad Steril (1)7,900Gelang Ibu (1)900Gelang Ibu (1)900Gelang Ibu (1)900

Kassa Bendel OK (2)7,800Kassa Bendel OK (2)7,800Kassa Bendel OK (2)7,800Chromalux (3)38,100Chromalux (3)38,100Chromalux (3)38,100Benang 245,300Benang OP245,300Benang OP245,300

Mess No. 10 (1)2,700Mess No. 10 (1)2,700Mess No. 10 (1)2,700Spuit 3 cc (7)7,700Spuit 3 cc (7)7,700Spuit 3 cc (7)7,700Spuit 5 cc (3)4,200Spuit 5 cc (3)4,200Spuit 5 cc (3)4,200Spuit 10 cc (4)7,200Spuit 10 cc (4)7,200Spuit 10 cc (4)7,200Spuit 1 cc (1)2,000Spuit 1 cc (1)2,000Spuit 1 cc (1)2,000Betadine 240cc15,150Betadine 240cc15,150Betadine 240cc15,150Alkohol 95% 120cc 7,150Alkohol 95% 120cc 7,150Alkohol 95% 120cc 7,150Oksigen 30,000Oksigen 30,000Oksigen 30,000

Tx Oral : Tx Oral : Tx Oral : cefadroxil 3 x 1 (15)13,500cefadroxil 3 x 1 (15)13,500cefadroxil 3 x 1 (15)13,500Ponsamic 3 x 1 (15)24,000Ponsamic 3 x 1 (15)24,000Ponsamic 3 x 1 (15)24,000Metherinal 3 x 1 (5)3,000Metherinal 3 x 1 (5)3,000Metherinal 3 x 1 (5)3,000

MobilisasiTirah Baring Duduk, Jalan MobilisasiTirah Baring Duduk, Jalan MobilisasiTirah BaringDuduk, jalanKonsultasiDr. Sp. Anastesi-KonsultasiDr. Sp. Anastesi-KonsultasiDr. Sp. Anastesi-Anastesi dg SABAnastesi dg SABAnastesi dg SAB

Edukasi/rencana pulangInformed consentEdukasi/rencana pulangInformed consentEdukasi/rencana pulangInformed consentOutcome (hasil)Boleh Pulang Outcome (hasil)Boleh Pulang Outcome (hasil)Boleh Pulang KesadaranKesadaranKesadaranDemamDemamDemamBiaya Administrasi22,750Biaya Administrasi32,500Biaya Administrasi48,750BHPBHPBHPJumlah3,279,400211,0000.00.0Jumlah3,703,415263,6500.00.0Jumlah4,210,730452,8000.00.03,490,4003,967,0654,663,530FK174,520FK198,353FK233,1773,664,9204,165,4184,896,707Nama PerawatLilik Agustin, Amd.KebLilik Agustin, Amd.KebLilik Agustin, Amd.KebNama PerawatLilik Agustin, Amd.KebLilik Agustin, Amd.KebLilik Agustin, Amd.KebNama PerawatLilik Agustin, Amd.KebLilik Agustin, Amd.KebLilik Agustin, Amd.KebNama Dokterdr . Hud Suhargono, Sp.OGdr . Hud Suhargono, Sp.OGdr . Hud Suhargono, Sp.OG Nama Dokterdr . Hud Suhargono, Sp.OGdr . Hud Suhargono, Sp.OGdr . Hud Suhargono, Sp.OG Nama Dokterdr . Hud Suhargono, Sp.OGdr . Hud Suhargono, Sp.OGdr . Hud Suhargono, Sp.OG INA-CBG3,699,700 INA-CBG4,439,700 INA-CBG5,180,100

selisih34,780selisih274,282selisih283,394

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