daftar klaim

66
PROPINSI : KALIMANTAN SELATAN KABUPATEN : TANAH BUMBU L P Masuk Keluar 1 An. Ahmad fauzi 6310040910110001 1.4 19 Februari 2013 23 Februari 2013 4 (Hari) 200,0 Rp 2 An. Syahril 6310021607000007 12 05 Maret 2013 06 Maret 2013 1 (Hari) Intoksikasi organofosfat 50,0 Rp 3 An. Akbar 6310011110020002 10 02 April 2013 05 April 2013 3 (Hari) Hepatitis A 150,0 Rp 4 Tn. Ketut Sweden 6310031512400001 73 29 Mei 2013 31 Mei 2013 2 (Hari) Artritis 100,0 Rp 5 Tn. Asikianor 6310090107540040 59 31 Juli 2013 07 Agustus 2013 7 (Hari) Anemia 350,0 Rp 6 An. Hendrawan 6310020208010005 13 31 Juli 2013 03 Agustus 2013 3 (Hari) Malaria 150,0 Rp 7 An. Ahmad Alkhaidir 6310091007090006 2 28 Juli 2013 03 Agustus 2013 6 (Hari) 300,0 Rp 8 Ny. Wadari 6310026005600002 47 20 Juli 2013 06 Agustus 2013 17 (Hari) 850,0 Rp 9 Tn. Elly Fransyorgen 6310062408750001 38 30 Juli 2013 03 Agustus 2013 4 (Hari) Febris 200,0 Rp 10 Ny. Kasmirah 6310094107320015 81 28 Juli 2013 02 Agustus 2013 5 (Hari) Susp SNH 250,0 Rp 11 Tn. Mustakim 6310033112630041 50 04 Agustus 2013 06 Agustus 2013 2 (Hari) Diare Akut 100,0 Rp 12 Ny. Poniyem 6310074107560016 57 06 Agustus 2013 06 Agustus 2013 SH 50,0 Rp 13 Tn. Syamsuri 6310010703620001 50 06 Agustus 2013 07 Agustus 2013 1 (Hari) SH 50,0 Rp 14 Ny. Sitiyah/Sutiyah 6310075310450002 61 01 Agustus 2013 05 Agustus 2013 4 (Hari) SNNT 200,0 Rp 15 Ny. Maulidiah 6310024107880314 25 04 Agustus 2013 07 Agustus 2013 3 (Hari) Susp Spinal injury susp fr turokalis 150,0 Rp 16 Ny. Ramlah 6310024101570004 60 06 Agustus 2013 07 Agustus 2013 1 (Hari) CKS 50,0 Rp 17 Ny. Suyatin 6310084107710034 42 29 Agustus 2013 11 September 2013 13 (Hari) DM tipe II 650,0 Rp 18 Tn. Sardiansyah 6310040507710006 42 30 Agustus 2013 21 September 2013 22 (Hari) Anemia 1,100,0 Rp 19 Tn. Yusriadi 6310091912590002 55 31 Agustus 2013 08 September 2013 8 (Hari) Dyspneu 400,0 Rp 20 An. Anton 6310082202000002 13 24 September 2013 26 September 2013 2 (Hari) Post eksisi tumor 100,0 Rp 21 Tn. Basran yusuf 63100050708480002 66 23 September 2013 27 September 2013 4 (Hari) Open Fr. Tibia fibula 200,0 Rp 22 Ny. Hj. Sadina 6310027112520004 60 24 September 2013 26 September 2013 2 (Hari) Susp Ganglin 100,0 Rp 23 Tn. Atim 6310092603750002 38 23 September 2013 25 September 2013 2 (Hari) 100,0 Rp 24 Tn. Mufid 6310072608950001 18 25 September 2013 28 September 2013 3 (Hari) 150,0 Rp 25 Tn. Surono / Suroto 6310050107540035 58 23 September 2013 26 September 2013 3 (Hari) 150,0 Rp 26 Ny. Tuyem 6310104107470034 80 24 September 2013 28 September 2013 4 (Hari) Tumor kulit 200,0 Rp 27 Tn. Gimun 6310052707610001 50 24 September 2013 27 September 2013 3 (Hari) Post eksisi tumor 150,0 Rp 28 Tn. Edi Sobarna 6310091405910002 21 17 September 2013 20 September 2013 3 (Hari) Post op abdominal pain 150,0 Rp 29 An. Aldo 6310060106040003 6 16 September 2013 19 September 2013 3 (Hari) Post op polipectomy 150,0 Rp 30 Tn. Harianto 6310050602850001 28 11 September 2013 20 September 2013 9 (Hari) 450,0 Rp 31 Tn. Rahman 6310091408850001 28 14 September 2013 20 September 2013 6 (Hari) Nekrosis Manus 300,0 Rp 32 An. M. Khoiri 6310081205130001 4 (Bulan) 16 September 2013 30 September 2013 14 (Hari) Obs. febris 700,0 Rp 33 An. Cahaya Ramadani 6310036408090001 4 24 September 2013 26 September 2013 2 (Hari) Kista Atheroma 100,00 Rp 34 Ny. Rusniah 6310015209760001 36 02 September 2013 05 September 2013 3 (Hari) 150,0 Rp 35 Ny. Yumariah 6310035508740002 39 10 September 2013 17 September 2013 7 (Hari) Kolik abdomen 350,0 Rp 36 Nn. Nine Lahiriah S 6310094402930001 17 17 September 2013 19 September 2013 2 (Hari) Tumor Mamae 100,00 Rp 37 Tn. Edi Hermawan 6310070603950003 18 18 September 2013 20 September 2013 2 (Hari) 100,0 Rp 38 Ny. Tuniati 6310024505560002 57 27 September 2013 30 September 2013 3 (Hari) CHF 150,0 Rp 39 An. M. Salman 6310021305130001 4 (Bulan) 26 September 2013 28 September 2013 2 (Hari) 100,0 Rp 40 An. Rahmat Hidayat 6310021605080001 5 23 September 2013 25 September 2013 2 (Hari) Gastritis 100,0 Rp 41 Tn. Agus sitohang 6310090408920006 66 28 September 2013 28 September 2013 Cedera kepala ringan 50,0 Rp 42 An. Noval Nur. R 6310095311050005 9 24 September 2013 26 September 2013 2 (Hari) Obs febris susp ISK 100,0 Rp 43 Tn. Ery Yulianto 6310051507830001 30 23 September 2013 25 September 2013 2 (Hari) ISK 100,0 Rp 44 Tn. Afuda 6310101311800001 32 23 September 2013 27 September 2013 4 (Hari) 200,0 Rp 45 Tn. Iman Yuli 6310102407940001 17 24 September 2013 26 September 2013 2 (Hari) 100,0 Rp 46 An. M. Rafli 6310060602130001 8 (Bulan) 26 September 2013 28 September 2013 2 (Hari) DCA 100,0 Rp 47 An. Ahmad Aqila. A 6310012401130001 8 (Bulan) 29 September 2013 30 September 2013 1 (Hari) GEA 50,0 Rp 48 An. Nadia Agustina 6310065208130001 1,5 (Bulan) 28 September 2013 30 September 2013 2 (Hari) Diare cair akut 100,0 Rp 49 An. Khairun Niah 6310065411120003 10 (Bulan) 27 September 2013 30 September 2013 3 (Hari) Diare cair akut 150,0 Rp LOS  DAFTAR KLAIM RAWAT INAP PASIEN JAMKESDA RSUD TANAH BUMBU NO NAMA PASIEN NO.REKOMENDASI JAMKESDA Umur (Thn) TANGGAL DIAGNOSA Akomoda

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7/27/2019 DAFTAR KLAIM

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PROPINSI : KALIMANTAN SELATAN

KABUPATEN : TANAH BUMBU

L P Masuk K1 An. Ahmad fauzi 6310040910110001 1.4 19 Februari 2013 23 Feb

2 An. Syahril 6310021607000007 12 05 Maret 2013 06 M

3 An. Akbar 6310011110020002 10 02 April 2013 05 A

4 Tn. Ketut Sweden 6310031512400001 73 29 Mei 2013 31 M

5 Tn. Asikianor 6310090107540040 59 31 Juli 2013 07 Agu

6 An. Hendrawan 6310020208010005 13 31 Juli 2013 03 Agu

7 An. Ahmad Alkhaidir 6310091007090006 2 28 Juli 2013 03 Agu

8 Ny. Wadari 6310026005600002 47 20 Juli 2013 06 Agu

9 Tn. Elly Fransyorgen 6310062408750001 38 30 Juli 2013 03 Agu

10 Ny. Kasmirah 6310094107320015 81 28 Juli 2013 02 Agu

11 Tn. Mustakim 6310033112630041 50 04 Agustus 2013 06 Agu

12 Ny. Poniyem 6310074107560016 57 06 Agustus 2013 06 Agu

13 Tn. Syamsuri 6310010703620001 50 06 Agustus 2013 07 Agu

14 Ny. Sitiyah/Sutiyah 6310075310450002 61 01 Agustus 2013 05 Agu

15 Ny. Maulidiah 6310024107880314 25 04 Agustus 2013 07 Agu16 Ny. Ramlah 6310024101570004 60 06 Agustus 2013 07 Agu

17 Ny. Suyatin 6310084107710034 42 29 Agustus 2013 11 Sept

18 Tn. Sardiansyah 6310040507710006 42 30 Agustus 2013 21 Sept

19 Tn. Yusriadi 6310091912590002 55 31 Agustus 2013 08 Sept

20 An. Anton 6310082202000002 13 24 September 2013 26 Sept

21 Tn. Basran yusuf 63100050708480002 66 23 September 2013 27 Sept

22 Ny. Hj. Sadina 6310027112520004 60 24 September 2013 26 Sept

23 Tn. Atim 6310092603750002 38 23 September 2013 25 Sept

24 Tn. Mufid 6310072608950001 18 25 September 2013 28 Sept

25 Tn. Surono / Suroto 6310050107540035 58 23 September 2013 26 Sept

26 Ny. Tuyem 6310104107470034 80 24 September 2013 28 Sept

27 Tn. Gimun 6310052707610001 50 24 September 2013 27 Sept

28 Tn. Edi Sobarna 6310091405910002 21 17 September 2013 20 Sept

29 An. Aldo 6310060106040003 6 16 September 2013 19 Sept

30 Tn. Harianto 6310050602850001 28 11 September 2013 20 Sept31 Tn. Rahman 6310091408850001 28 14 September 2013 20 Sept

32 An. M. Khoiri 6310081205130001 4 (Bulan) 16 September 2013 30 Sept

33 An. Cahaya Ramadani 6310036408090001 4 24 September 2013 26 Sept

34 Ny. Rusniah 6310015209760001 36 02 September 2013 05 Sept

35 Ny. Yumariah 6310035508740002 39 10 September 2013 17 Sept

36 Nn. Nine Lahiriah S 6310094402930001 17 17 September 2013 19 Sept

37 Tn. Edi Hermawan 6310070603950003 18 18 September 2013 20 Sept

38 Ny. Tuniati 6310024505560002 57 27 September 2013 30 Sept

39 An. M. Salman 6310021305130001 4 (Bulan) 26 September 2013 28 Sept

40 An. Rahmat Hidayat 6310021605080001 5 23 September 2013 25 Sept

41 Tn. Agus sitohang 6310090408920006 66 28 September 2013 28 Sept

42 An. Noval Nur. R 6310095311050005 9 24 September 2013 26 Sept

43 Tn. Ery Yulianto 6310051507830001 30 23 September 2013 25 Sept

44 Tn. Afuda 6310101311800001 32 23 September 2013 27 Sept

45 Tn. Iman Yuli 6310102407940001 17 24 September 2013 26 Sept

46 An. M. Rafli 6310060602130001 8 (Bulan) 26 September 2013 28 Sept

47 An. Ahmad Aqila. A 6310012401130001 8 (Bulan) 29 September 2013 30 Sept

48 An. Nadia Agustina 6310065208130001 1,5 (Bulan) 28 September 2013 30 Sept

49 An. Khairun Niah 6310065411120003 10 (Bulan) 27 September 2013 30 Sept

 DAFTAR KLAIM RAWAT IN

NO NAMA PASIEN NO.REKOMENDASI JAMKESDA

Umur (Thn) TANGGAL

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50 Ny. Kartasiah 6310054204550001 58 29 September 2013 30 Sept

51 Tn. Ateng/Heri Priyono 6310090907530003 25 20 September 2013 23 Sept

52 Tn. Rahmatullah 6310010811530001 60 24 September 2013 27 Sept

53 Tn. Aliansyah 6310090107920168 25 23 September 2013 27 Sept

54 Ny. Maseinah 6310024107600254 50 24 September 2013 24 Sept

55 Ny. Jumaini 6310026302680001 45 23 September 2013 26 Sept

56 Ny. Yamanah 6320024107520116 61 22 September 2013 24 Sept

57 Tn. Zulkipli Halil 6310092004450003 70 22 September 2013 24 Sept

58 An. Zaki zain 6310011709040003 9 23 September 2013 26 Sept59 Ny. Ainun 6310094203670005 45 23 September 2013 26 Sept

60 Ny. Darmawati 6310096102840003 28 19 September 2013 24 Sept

61 Tn. Misran 6310040708740002 39 20 September 2013 24 Sept

62 Ny. Hj. Hermina 6310094709530003 60 25 September 2013 27 Sept

63 Tn. Nasrullah 6310100107910059 22 22 September 2013 25 Sept

64 Tn. Mustaming 6310020507620003 51 12 September 2013 27 Sept

65 Ny. Salmiah 6310026502700002 43 11 September 2013 23 Sept

66 Tn. Kastalani 6310052503960003 17 27 September 2013 28 Sept

67 Tn. Sugianto 6310010104670003 46 27 September 2013 30 Sept

68 Ny. Jumiati 6310015304750002 38 26 September 2013 29 Sept

69 Tn. Sukamso 6310080107450020 68 22 September 2013 25 Sept

70 Ny. Hj. Rawiyah 6310024107570207 50 22 September 2013 26 Sept

71 Ny. Nor Aini 6310024901550001 57 17 September 2013 21 Sept

72 Tn. H. Fahmi 6310092910780001 35 20 September 2013 27 Sept

73 Ny. Kursiah 6310095804600002 50 20 September 2013 28 Sept74 Nn. Lisa Indria 6310014106910004 22 20 September 2013 23 Sept

75 Tn. Jumardin 631002200600374 40 20 September 2013 24 Sept

76 Ny. Mahrita 6310095508700008 43 20 September 2013 24 Sept

77 Tn. M. Riswan 6310090912980001 15 20 September 2013 22 Sept

78 Ny. Hartini 6310037112910004 22 20 September 2013 26 Sept

79 Ny. Arbayah 6310095004780005 35 19 September 2013 20 Sept

80 Tn. Basuki 6310100505780005 35 22 September 2013 25 Sept

81 Ny. Saniah 6310095001390001 74 20 September 2013 23 Sept

82 Tn. Asmudu 63100115064100001 71 18 September 2013 23 Sept

83 Tn. Muhammad Sabani 6310090802930004 20 21 September 2013 23 Sept

84 Tn. Husni 6310091503840005 52 19 September 2013 25 Sept

85 Ny. Hj. Zainah 6310094510720007 41 16 September 2013 19 Sept

86 Tn. Abbas 6310020107650168 48 06 September 2013 25 Sept

87 Ny. Jumriani 6310026706710004 42 17 September 2013 24 Sept

88 An. Surya 6310012502120002 1 17 September 2013 20 Sept89 Ny. Sampurna 6310094204460001 59 17 September 2013 20 Sept

90 Tn. Jito paiman 6310031707480001 65 17 September 2013 20 Sept

91 Tn. Mansur 6310071106720002 41 16 September 2013 23 Sept

92 Tn. Harun AR 6310012911640002 49 16 September 2013 21 Sept

93 Tn. Taha 6310090505590001 55 16 September 2013 21 Sept

94 Tn. Samidi 6310080107370004 76 13 September 2013 24 Sept

95 Tn. Wiji 6310071507480001 65 15 September 2013 23 Sept

96 Tn. Sutisna 6310090107680183 45 14 September 2013 19 Sept

97 Ny. Sumijah 6310085708460001 60 15 September 2013 26 Sept

98 An. Wildan Riadi 6310102206130001 3 (Bulan) 15 September 2013 19 Sept

99 Ny. Kade 6310024107370092 75 23 September 2013 28 Sept

100 Ny. Sitti 6310090702500002 80 09 September 2013 10 Sept

101 Tn.Umar Dani 6310051108860001 27 28 September 2013 30 Sept

102 Tn.Noorjani 6310010406640001 49 24 September 2013 30 Sept

103 Tn.Ratmo Tinoyo 6310080101400001 82 12 September 2013 25 Sept104 Ny.Rasunah 6310024405480002 65 21 September 2013 30 Sept

105 Ny.Tuniati 6310024505560002 57 12 September 2013 25 Sept

106 Ny.Norsiah 6310095709740001 39 25 September 2013 26 Sept

107 Tn.Sam Sam 631002050450003 59 11 September 2013 25 Sept

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108 Tn.Acis 6310020107730090 40 02 September 2013 24 Sept

109 Tn.Astam 6310100107550064 60 16 September 2013 25 Sept

110 Tn.Atmo 6310050800001890 60 25 September 2013 30 Sept

111 Tn. M. Saini 6310020107470108 53 21 September 2013 25 Sept

112 An.Hery Rahmadani 6310092810060003 7 06 September 2013 20 Sept

113 Tn.Syahrudin 6310060107700036 43 05 September 2013 10 Sept

114 An.Amiratus Sholihah 6310084810110001 2 28 September 2013 02 Okt

115 Tn.Suherman 6310093009710005 32 29 September 2013 03 Okt

116 Tn.m.Fauzan 6310042505970002 16 28 September 2013 03 Okt

117 Tn.Abdul Halim 6310070808980002 15 29 September 2013 04 Okt118 Tn. Suro Iman/Imron 6310080107390014 70 24 September 2013 03 Okt

119 Tn.Mugiran 6310100907440001 67 29 September 2013 03 Okt

120 Ny.Mundari 6310097005400001 70 28 September 2013 04 Okt

121 Ny.Aspiyah 6310094704640009 49 30 September 2013 01 Okt

122 Tn.Urian 6310070107610006 52 30 September 2013 02 Okt

123 Tn.Suriyadi 6310090906650002 48 30 September 2013 04 Okt

124 Ny.Jennah 6310035003760005 37 30 September 2013 03 Okt

125 Tn.Nur Kholis 6310051112970002 16 28 September 2013 01 Okt

126 Tn.M.Amin 6310020804660001 47 30 September 2013 02 Okt

127 Ny.Hanawiyah 631006500250001 63 30 September 2013 03 Okt

128 An.Mkhusnul Wafa 6310052809130001 1 Bulan 29 September 2013 05 Okt

129 Tn.Siram 6310080107450035 68 30 September 2013 01 Okt

130 Tn.Fendi 6310041305840003 29 28 September 2013 02 Okt

131 Ny.Karniah 6310024307660001 48 30 September 2013 03 Okt

132 Tn.Abas 6310020107650168 48 30 September 2013 03 Okt133 Ny.Lusmiati 6310044107600129 53 30 September 2013 03 Okt

134 Ny. Marliah 6310097009700002 43 27 September 2013 01 Okt

135 Tn. Sutiman 6310080602570001 30 30 September 2013 09 Okt

136 Ny. Sumirah 6310104107570021 50 30 September 2013 05 Okt

137 Tn. Saleh 6310050604750003 38 24 September 2013 04 Okt

138 Tn. H. Maharani 6310042509530003 60 30 September 2013 11 Okt

139 Tn. Sunarsi 6310060506380001 74 30 September 2013 09 Okt

140 Ny. Janiyah 6310024107600165 53 27 September 2013 03 Okt

141 Ny. Sumiatun 6310104405740001 39 09 Oktober 2013 11 Okt

142 Ny. Dewi Wulandari 6310094905660001 47 09 Oktober 2013 12 Okt

143 Ny. Siti Alfiah 6310035608720003 41 08 Oktober 2013 11 Okt

144 Tn. Ilyas 6310100107540027 59 09 Oktober 2013 12 Okt

145 An. M. Rizki Anwar 6310091002080005 5 01 Oktober 2013 04 Okt

146 Ny. Saiyah 6310024107400097 73 01 Oktober 2013 04 Okt

147 An. Syaifuddin 6310092006080001 6 01 Oktober 2013 05 Okt148 Nn. Arum Widia. A 6310034803970004 15 08 Oktober 2013 11 Okt

149 Tn. Kaderi 6310050107420006 71 10 Oktober 2013 14 Okt

150 Tn. HM Daud 6310090108400002 73 08 Oktober 2013 14 Okt

151 An. Aulia Ramah 6310094306040005 9 16 Oktober 2013 22 Okt

152 Tn. Yadi 6310081206970002 16 08 Oktober 2013 19 Okt

153 Tn. Mastur 6310090709830004 27 02 Oktober 2013 08 Okt

154 Ny. Maimuna 6310054703800001 33 06 Oktober 2013 12 Okt

155 Tn. Fahrullah 6310091910590006 54 03 Oktober 2013 07 Okt

156 An. Sahaja 6310012601990001 14 02 Oktober 2013 10 Okt

157 Tn.I Nyoman Pagu 631000196345188 75 02 Oktober 2013 04 Okt

158 Ny.Warni 6310044402750006 40 02 Oktober 2013 04 Okt

159 Ny.Hj.Sitiharah 6310026001650003 48 01 Oktober 2013 03 Okt

160 Tn.Widiyanto 6310060107450005 68 02 Oktober 2013 05 Okt

161 Tn.Darwis 6310091506850009 28 01 Oktober 2013 04 Okt

162 An. Zulfa imaroh 6310086809120001 1 01 Oktober 2013 04 Okt163 An. Mita normayanti 6310085606050004 9 06 Oktober 2013 08 Okt

164 Tn. Ruslan 6310011207700002 43 05 Oktober 2013 09 Okt

165 An. Aldi 6310021805120001 1 06 Oktober 2013 08 Okt

166 Ny. Lisnawati 6310016211880002 25 06 Oktober 2013 08 Okt

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167 Tn. Agus tri syafa'at 6310103108920002 21 08 Oktober 2013 11 Okt

168 An. Sinta 6310015004120001 1 04 Oktober 2013 05 Okt

169 An. A. Mujiburrahman 6310060208130002 2 (Bulan) 03 Oktober 2013 05 Okt

170 Tn. Amiruddin 6310021101970007 16 03 Oktober 2013 05 Okt

171 Tn. Jamaludin 6310040107550060 58 04 Oktober 2013 05 Okt

172 An. Nadia Agustina 6310092207870002 2 (Bulan) 03 Oktober 2013 05 Okt

173 An. M. Febriansyah 6310081912050002 10 05 Oktober 2013 05 Okt

174 Tn. Anang Hermawan 6310101210980001 14 04 Oktober 2013 07 Okt

175 Ny. Ngapiah 6310105204650001 48 01 Oktober 2013 03 Okt

176 An. Mahlisa 6310035212030001 10 02 Oktober 2013 04 Okt177 Ny. Raminih 6310096812880003 25 01 Oktober 2013 02 Okt

178 Tn. H. Odin 6310030902450001 67 07 Oktober 2013 12 Okt

179 Tn. Amit 6310030210830002 30 09 Oktober 2013 11 Okt

180 Tn. Safrajudin 6310090107390013 74 07 Oktober 2013 09 Okt

181 An. Putri Aulia 6310086105130002 5 (Bulan) 03 Oktober 2013 08 Okt

182 Tn. Juki 6310081906790003 34 04 Oktober 2013 06 Okt

183 Tn. Sulkifli 6310070307730002 40 09 Oktober 2013 10 Okt

184 Ny. Mantang 6310025708600003 47 08 Oktober 2013 12 Okt

185 An. M. Alwi Firmansyah 6310022010030005 10 09 Oktober 2013 11 Okt

186 Tn. Zulkifli 6310021705980003 15 05 Oktober 2013 07 Okt

187 Nn. Siti Norjannah 6310095508950002 18 05 Oktober 2013 09 Okt

188 Tn. Samijan 6310100107450009 68 05 Oktober 2013 09 Okt

189 An. Said Abdul Rahman 6310061910120002 1 09 Oktober 2013 11 Okt

190 Tn. Mashari 6310091805690005 44 07 Oktober 2013 09 Okt

191 Ny.Dahliani 6310016606740001 39 21 Oktober 2013 24 Okt192 Tn.Hairan 6310040901500001 53 14 Oktober 2013 24 Okt

193 Tn.Faher 6310022211690001 44 19 Oktober 2013 23 Okt

194 Tn.Mursalin 6310022712570003 56 22 Oktober 2013 24 Okt

195 Ny.Sidah 6310014107790027 34 19 Oktober 2013 23 Okt

196 An.Anto 6310091009010006 7 21 Oktober 2013 23 Okt

197 Ny.Sugiyem 6310057112630001 49 21 Oktober 2013 23 Okt

198 An.Rifki Maulana 6310091101120004 1 16 Oktober 2013 18 Ok

199 Tn.Syaifullah 6310011011840001 29 16 Oktober 2013 19 Okt

200 Tn.Badawi 6310010611870001 26 17 Oktober 2013 24 Okt

201 Ny.Vivin Indriani 6310037003960001 17 18 Oktober 2013 23 Okt

202 Tn.Sumardi 6310100107790065 34 18 Oktober 2013 19 Okt

203 Tn.Mulyadi 6310090203860002 27 18 Oktober 2013 19 Okt

204 Tn.Watiro 6310021805610001 52 17 Oktober 2013 19 Okt

205 Tn.Kusnan Effendi 6310020102570005 56 17 Oktober 2013 18 Okt

206 Ny.Norsiah 6310026810900003 65 17 Oktober 2013 19 Okt207 Tn.Sutisna 6310090107680183 45 16 Oktober 2013 23 Okt

208 Tn.Efendi 6310032001910001 21 15 Oktober 2013 17 Okt

209 Tn.Yohanis Tanggilar 6310081305860001 27 13 Oktober 2013 17 Okt

210 Tn.Waluyo 6310070709860002 27 15 Oktober 2013 23 Okt

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Jasa MedisKonsultasi

Umum

Tindakan Kecil

Tindakan

Sedang

Tindakan

Intensif Gizi

Sederhana

Sederhana Pol

Umum20,000Rp 100,000Rp 10,000Rp

60,000Rp 90,000Rp 10,000Rp

60,000Rp 10,000Rp

20,000Rp 80,000Rp 10,000Rp

140,000Rp 270,000Rp 10,000Rp

80,000Rp 10,000Rp

20,000Rp 140,000Rp 10,000Rp

80,000Rp 880,000Rp 30,000Rp 180,000Rp 10,000Rp

160,000Rp 10,000Rp

20,000Rp 240,000Rp 30,000Rp 180,000Rp 10,000Rp

40,000Rp 120,000Rp 90,000Rp 10,000Rp

40,000Rp 80,000Rp 90,000Rp 10,000Rp

40,000Rp 45,000Rp 10,000Rp

40,000Rp 160,000Rp 10,000Rp

20,000Rp 100,000Rp 10,000Rp20,000Rp 20,000Rp 50,000Rp 10,000Rp

40,000Rp 480,000Rp 60,000Rp 10,000Rp

180,000Rp 1,000,000Rp 600,000Rp 5,000Rp 10,000Rp

40,000Rp 440,000Rp 30,000Rp 90,000Rp 10,000Rp

20,000Rp 60,000Rp 5,000Rp 10,000Rp

100,000Rp 5,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp

60,000Rp 5,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp

60,000Rp 5,000Rp 10,000Rp

100,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp 50,000Rp

220,000Rp 30,000Rp 5,000Rp 10,000Rp 140,000Rp 5,000Rp 10,000Rp

160,000Rp 20,000Rp 420,000Rp 630,000Rp 5,000Rp 10,000Rp

20,000Rp 40,000Rp 5,000Rp 10,000Rp

80,000Rp 10,000Rp

20,000Rp 160,000Rp 30,000Rp 10,000Rp

20,000Rp 60,000Rp 10,000Rp

60,000Rp 5,000Rp 10,000Rp 50,000Rp

20,000Rp 160,000Rp 5,000Rp 10,000Rp

60,000Rp 20,000Rp 30,000Rp 90,000Rp 5,000Rp 10,000Rp

40,000Rp 45,000Rp 5,000Rp 10,000Rp

20,000Rp 5,000Rp 10,000Rp

60,000Rp 5,000Rp 10,000Rp

60,000Rp 5,000Rp 10,000Rp

40,000Rp 5,000Rp 10,000Rp

40,000Rp 120,000Rp 90,000Rp 5,000Rp 10,000Rp

40,000Rp 20,000Rp 90,000Rp 5,000Rp 10,000Rp

20,000Rp 30,000Rp 90,000Rp 5,000Rp 10,000Rp

20,000Rp 40,000Rp 30,000Rp 5,000Rp 10,000Rp

60,000Rp 90,000Rp 90,000Rp 5,000Rp 10,000Rp

Berkas RM

Jasa Keperawatan

Jasa Apoteker

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40,000Rp 160,000Rp 135,000Rp 5,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp

20,000Rp 240,000Rp 180,000Rp 5,000Rp 10,000Rp

20,000Rp 280,000Rp 90,000Rp 5,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp

20,000Rp 200,000Rp 5,000Rp 10,000Rp

40,000Rp 120,000Rp 5,000Rp 10,000Rp

80,000Rp 160,000Rp 225,000Rp 5,000Rp 10,000Rp

40,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 200,000Rp 5,000Rp 10,000Rp

20,000Rp 320,000Rp 5,000Rp 10,000Rp

40,000Rp 280,000Rp 5,000Rp 10,000Rp

200,000Rp 90,000Rp 5,000Rp 10,000Rp

240,000Rp 5,000Rp 10,000Rp

140,000Rp 760,000Rp 450,000Rp 5,000Rp 10,000Rp

80,000Rp 600,000Rp 45,000Rp 5,000Rp 10,000Rp

40,000Rp 5,000Rp 10,000Rp

20,000Rp 280,000Rp 5,000Rp 10,000Rp

20,000Rp 80,000Rp 45,000Rp 5,000Rp 10,000Rp

60,000Rp 140,000Rp 5,000Rp 10,000Rp

20,000Rp 320,000Rp 135,000Rp 5,000Rp 10,000Rp

160,000Rp 5,000Rp 10,000Rp

400,000Rp 135,000Rp 5,000Rp 10,000Rp

20,000Rp 440,000Rp 180,000Rp 5,000Rp 10,000Rp 240,000Rp 5,000Rp 10,000Rp

240,000Rp 5,000Rp 10,000Rp

240,000Rp 5,000Rp 10,000Rp

20,000Rp 160,000Rp 5,000Rp 10,000Rp

20,000Rp 140,000Rp 5,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp

240,000Rp 5,000Rp 10,000Rp

200,000Rp 5,000Rp 10,000Rp

340,000Rp 5,000Rp 10,000Rp

200,000Rp 5,000Rp 10,000Rp

380,000Rp 45,000Rp 5,000Rp 10,000Rp

20,000Rp 240,000Rp 5,000Rp 10,000Rp

80,000Rp 600,000Rp 45,000Rp 5,000Rp 10,000Rp

60,000Rp 400,000Rp 120,000Rp 5,000Rp 10,000Rp

120,000Rp 180,000Rp 5,000Rp 10,000Rp 200,000Rp 5,000Rp 10,000Rp

20,000Rp 100,000Rp 10,000Rp

20,000Rp 400,000Rp 5,000Rp 10,000Rp

40,000Rp 240,000Rp 5,000Rp 10,000Rp

20,000Rp 320,000Rp 5,000Rp 10,000Rp

120,000Rp 560,000Rp 5,000Rp 10,000Rp

160,000Rp 5,000Rp 10,000Rp

100,000Rp 320,000Rp 5,000Rp 10,000Rp

60,000Rp 600,000Rp 675,000Rp 5,000Rp 10,000Rp

100,000Rp 180,000Rp 5,000Rp 10,000Rp

40,000Rp 360,000Rp 135,000Rp 5,000Rp 10,000Rp

20,000Rp 40,000Rp 10,000Rp

40,000Rp 200,000Rp 5,000Rp 10,000Rp

40,000Rp 400,000Rp 5,000Rp 10,000Rp

120,000Rp 680,000Rp 5,000Rp 10,000Rp 200,000Rp 5,000Rp 10,000Rp

100,000Rp 680,000Rp 5,000Rp 10,000Rp

40,000Rp 5,000Rp 10,000Rp

140,000Rp 720,000Rp 5,000Rp 10,000Rp

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180,000Rp 1,160,000Rp 1,125,000Rp 5,000Rp 10,000Rp

200,000Rp 5,000Rp 10,000Rp

20,000Rp 320,000Rp 90,000Rp 5,000Rp 10,000Rp

20,000Rp 280,000Rp 90,000Rp 5,000Rp 10,000Rp

60,000Rp 450,000Rp 630,000Rp 5,000Rp 10,000Rp

20,000Rp 120,000Rp 60,000Rp 10,000Rp

20,000Rp 80,000Rp 5,000Rp 10,000Rp

100,000Rp 30,000Rp 5,000Rp 10,000Rp

20,000Rp 120,000Rp 5,000Rp

40,000Rp 120,000Rp 5,000Rp 10,000Rp 200,000Rp 45,000Rp 5,000Rp 10,000Rp

80,000Rp 160,000Rp 5,000Rp 10,000Rp

20,000Rp 240,000Rp 5,000Rp 10,000Rp

20,000Rp 40,000Rp 5,000Rp 10,000Rp

20,000Rp 240,000Rp 5,000Rp 10,000Rp

200,000Rp 5,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp

20,000Rp 120,000Rp 5,000Rp 10,000Rp

20,000Rp 240,000Rp 5,000Rp 10,000Rp

60,000Rp 20,000Rp 150,000Rp 270,000Rp 5,000Rp 10,000Rp

20,000Rp 40,000Rp 5,000Rp 10,000Rp

60,000Rp 260,000Rp 5,000Rp 10,000Rp

40,000Rp 120,000Rp 5,000Rp 10,000Rp

20,000Rp 120,000Rp 135,000Rp 5,000Rp 10,000Rp 80,000Rp 5,000Rp 10,000Rp

40,000Rp 200,000Rp 5,000Rp 10,000Rp

20,000Rp 200,000Rp 5,000Rp 10,000Rp

20,000Rp 120,000Rp 90,000Rp 5,000Rp 10,000Rp

60,000Rp 520,000Rp 5,000Rp 10,000Rp

20,000Rp 600,000Rp 120,000Rp 225,000Rp 5,000Rp 10,000Rp

40,000Rp 520,000Rp 120,000Rp 270,000Rp 5,000Rp 10,000Rp

40,000Rp 280,000Rp 315,000Rp 5,000Rp 10,000Rp

60,000Rp 5,000Rp 10,000Rp 50,000Rp

80,000Rp 5,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp 50,000Rp

80,000Rp 5,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp 50,000Rp

80,000Rp 5,000Rp 10,000Rp

100,000Rp 5,000Rp 10,000Rp 80,000Rp 5,000Rp 10,000Rp 50,000Rp

120,000Rp 5,000Rp 10,000Rp

20,000Rp 140,000Rp 5,000Rp 10,000Rp

20,000Rp 140,000Rp 5,000Rp 10,000Rp

240,000Rp 5,000Rp 10,000Rp

140,000Rp 30,000Rp 5,000Rp 10,000Rp

180,000Rp 60,000Rp 5,000Rp 10,000Rp

20,000Rp 80,000Rp 5,000Rp 10,000Rp

220,000Rp 5,000Rp 10,000Rp

20,000Rp 80,000Rp 5,000Rp 10,000Rp

20,000Rp 80,000Rp 5,000Rp 10,000Rp

20,000Rp 80,000Rp 5,000Rp 10,000Rp

240,000Rp 5,000Rp 10,000Rp

140,000Rp 5,000Rp 10,000Rp

90,000Rp 135,000Rp 5,000Rp 10,000Rp 20,000Rp 90,000Rp 135,000Rp 5,000Rp 10,000Rp

20,000Rp 240,000Rp 45,000Rp 5,000Rp 10,000Rp

20,000Rp 40,000Rp 90,000Rp 5,000Rp 10,000Rp

60,000Rp 5,000Rp 10,000Rp

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20,000Rp 280,000Rp 180,000Rp 5,000Rp 10,000Rp

20,000Rp 20,000Rp 45,000Rp 5,000Rp 10,000Rp

20,000Rp 20,000Rp 90,000Rp 5,000Rp 10,000Rp

60,000Rp 5,000Rp 10,000Rp

40,000Rp 90,000Rp 5,000Rp 10,000Rp

60,000Rp 90,000Rp 5,000Rp 10,000Rp

20,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp

20,000Rp 80,000Rp 5,000Rp 10,000Rp

20,000Rp 60,000Rp 45,000Rp 5,000Rp 10,000Rp 20,000Rp 40,000Rp 5,000Rp 10,000Rp 50,000Rp

20,000Rp 360,000Rp 225,000Rp 5,000Rp 10,000Rp

20,000Rp 200,000Rp 90,000Rp 5,000Rp 10,000Rp

20,000Rp 160,000Rp 200,000Rp 5,000Rp 10,000Rp

20,000Rp 150,000Rp 225,000Rp 5,000Rp 10,000Rp

20,000Rp 60,000Rp 5,000Rp 10,000Rp

20,000Rp 120,000Rp 135,000Rp 5,000Rp 10,000Rp

20,000Rp 280,000Rp 180,000Rp 5,000Rp 10,000Rp

20,000Rp 60,000Rp 90,000Rp 5,000Rp 10,000Rp

60,000Rp 200,000Rp 5,000Rp 10,000Rp

40,000Rp 240,000Rp 5,000Rp 10,000Rp

20,000Rp 240,000Rp 5,000Rp 10,000Rp

20,000Rp 20,000Rp 30,000Rp 90,000Rp 5,000Rp 10,000Rp

60,000Rp 80,000Rp 5,000Rp 10,000Rp

160,000Rp 5,000Rp 10,000Rp80,000Rp 840,000Rp 5,000Rp 10,000Rp

40,000Rp 320,000Rp 135,000Rp 5,000Rp 10,000Rp

20,000Rp 120,000Rp 5,000Rp 10,000Rp

60,000Rp 280,000Rp 135,000Rp 5,000Rp 10,000Rp

20,000Rp 60,000Rp 90,000Rp 5,000Rp 10,000Rp

60,000Rp 200,000Rp 135,000Rp 5,000Rp 10,000Rp

20,000Rp 90,000Rp 45,000Rp 5,000Rp 10,000Rp

40,000Rp 240,000Rp 90,000Rp 5,000Rp 10,000Rp

100,000Rp 320,000Rp 5,000Rp 10,000Rp

40,000Rp 320,000Rp 90,000Rp 5,000Rp 10,000Rp

40,000Rp 30,000Rp 5,000Rp 10,000Rp

120,000Rp 45,000Rp 5,000Rp 10,000Rp

20,000Rp 200,000Rp 135,000Rp 5,000Rp 10,000Rp

40,000Rp 120,000Rp 45,000Rp 5,000Rp 10,000Rp

20,000Rp 80,000Rp 90,000Rp 5,000Rp 10,000Rp80,000Rp 440,000Rp 225,000Rp 5,000Rp 10,000Rp

20,000Rp 200,000Rp 90,000Rp 5,000Rp 10,000Rp

40,000Rp 320,000Rp 90,000Rp 5,000Rp 10,000Rp

40,000Rp 480,000Rp 225,000Rp 5,000Rp 10,000Rp

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Persalinan Sulit

Resusitasi Bayi

Baru Lahir RJPO Kuretasi + Anastesi

Kuretasi Sulit +

Anastesi

Manual

Plasenta + SederhanaKecil Sedang

1,750,000Rp

45,000Rp

45,000Rp

1,750,000Rp

1,750,000Rp

250,000Rp

1,750,000Rp

1,750,000Rp

1,750,000Rp

1,750,000Rp

1,750,000Rp

1,750,000Rp

Tindakan Persalinan & Kebidanan Tindakan Operasi B

  i PERDA (Rp)

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45,000Rp

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1,750,000Rp

1,750,000Rp

1,750,000Rp

1,750,000Rp

1,750,000Rp

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Rontgen EKG

20,000Rp 169,000Rp

200,000Rp 236,000Rp

200,000Rp 199,000Rp

95,000Rp 11,000Rp

770,000Rp 60,000Rp 268,000Rp 614,000Rp

115,000Rp 268,000Rp

60,000Rp 45,000Rp 933,900Rp

875,000Rp 315,000Rp 1,040,000Rp

253,000Rp 223,000Rp

400,000Rp 229,500Rp 921,000Rp

95,000Rp 355,000Rp

55,000Rp 100,000Rp 207,000Rp

105,000Rp 95,000Rp 934,000Rp

148,000Rp 189,500Rp

97,000Rp 45,000Rp 183,500Rp

60,000Rp 575,000Rp 1,815,000Rp

60,000Rp 2,080,000Rp 418,000Rp 3,130,000Rp

250,000Rp 130,000Rp 440,000Rp

45,000Rp 60,500Rp

130,000Rp 60,000Rp 165,500Rp 923,000Rp

60,000Rp 137,500Rp 136,000Rp

95,000Rp 235,500Rp

451,000Rp

60,000Rp 60,000Rp 165,500Rp 537,000Rp

60,000Rp 282,500Rp 454,000Rp

60,000Rp 120,000Rp 211,000Rp 605,500Rp

135,000Rp 695,000Rp

141,500Rp 286,000Rp

280,000Rp 180,000Rp 2,023,000Rp 45,000Rp 715,000Rp

1,000,000Rp 260,000Rp 330,500Rp 2,577,500Rp

45,000Rp 353,500Rp

115,000Rp 618,500Rp

60,000Rp 100,000Rp 112,000Rp 1,139,000Rp

132,500Rp 1,238,000Rp

95,000Rp 747,000Rp

100,000Rp 153,000Rp 458,500Rp

30,000Rp 77,000Rp 250,000Rp

182,000Rp 123,000Rp

439,500Rp

97,000Rp 48,000Rp

120,000Rp 160,000Rp 620,000Rp

120,000Rp 219,500Rp 142,500Rp

200,000Rp 120,000Rp 272,000Rp 513,500Rp

77,000Rp 61,000Rp

150,500Rp

182,000Rp

55,000Rp 76,000Rp

USG

Pemeriksaan Darah

Untuk Tranfusi dan

Kantong

Pemakaian

OksigenPoloklinik (BeLaboratorium

Obat, alat suntik,

alat infus dan

cairan infus selama

dirawat dan atau

operasi

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50,000Rp 60,000Rp 288,000Rp 507,500Rp

90,000Rp 947,000Rp

60,000Rp 130,000Rp 147,500Rp

147,000Rp 266,000Rp

100,000Rp 95,000Rp 180,000Rp

60,000Rp 60,000Rp 217,500Rp

50,000Rp 60,000Rp 274,500Rp 3,509,000Rp

50,000Rp 120,000Rp 213,000Rp 496,500Rp

122,000Rp 184,000Rp 60,000Rp 313,000Rp

60,000Rp 438,000Rp 289,500Rp

200,000Rp 60,000Rp 135,000Rp 767,000Rp

120,000Rp 234,500Rp

200,000Rp 130,000Rp 222,500Rp

200,000Rp 60,000Rp 130,000Rp 1,245,000Rp

60,000Rp 205,000Rp 786,500Rp

45,000Rp 161,500Rp

100,000Rp 60,000Rp 112,000Rp 359,000Rp

60,000Rp 80,000Rp 163,500Rp

20,000Rp 60,000Rp 60,000Rp 349,000Rp 236,500Rp

150,000Rp 60,000Rp 255,000Rp 380,500Rp

60,000Rp 234,500Rp 572,000Rp

60,000Rp 120,000Rp 156,000Rp 833,500Rp

100,000Rp 60,000Rp 120,000Rp 138,000Rp 1,216,000Rp 100,000Rp 240,000Rp 393,000Rp

117,000Rp 625,000Rp

60,000Rp 304,500Rp 337,500Rp

210,000Rp 140,000Rp

100,000Rp 299,000Rp 1,950,000Rp

200,000Rp 60,000Rp 165,000Rp 446,000Rp

400,000Rp 120,000Rp 120,000Rp 235,000Rp 321,500Rp

100,000Rp 60,000Rp 95,000Rp 431,000Rp

50,000Rp 180,000Rp 60,000Rp 324,000Rp 373,500Rp

145,000Rp 257,000Rp

60,000Rp 316,000Rp 468,500Rp

60,000Rp 130,000Rp 224,000Rp

160,000Rp 60,000Rp 587,500Rp 1,627,500Rp

60,000Rp 1,515,000Rp 573,000Rp

20,000Rp 170,000Rp 290,000Rp 50,000Rp 60,000Rp 135,000Rp 83,000Rp

200,000Rp 60,000Rp 60,000Rp 241,500Rp

60,000Rp 60,000Rp 508,500Rp

200,000Rp 60,000Rp 230,000Rp 1,528,500Rp

100,000Rp 220,000Rp 1,061,000Rp

60,000Rp 220,000Rp 918,000Rp

220,000Rp 60,000Rp 152,000Rp 976,000Rp

60,000Rp 130,000Rp 72,000Rp

1,100,000Rp 120,000Rp 120,000Rp 334,500Rp 635,000Rp

148,000Rp 112,500Rp

200,000Rp 60,000Rp 60,000Rp 60,000Rp 418,000Rp

200,000Rp 100,000Rp 373,500Rp

117,000Rp 160,500Rp

100,000Rp 345,000Rp 640,000Rp

200,000Rp 380,000Rp 180,000Rp 503,000Rp 1,861,000Rp 220,000Rp 100,000Rp 60,000Rp 174,000Rp 691,500Rp

350,000Rp 120,000Rp 180,000Rp 694,500Rp 1,012,500Rp

50,000Rp 90,000Rp 613,000Rp

154,000Rp 150,000Rp 60,000Rp 235,000Rp 3,673,500Rp

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15,000,000Rp 180,000Rp 60,000Rp 362,500Rp 5,054,000Rp

224,000Rp

100,000Rp 120,000Rp 520,000Rp 153,000Rp 411,000Rp

60,000Rp 120,000Rp 197,500Rp 279,500Rp

450,000Rp 778,000Rp 1,044,000Rp

60,000Rp 60,000Rp 110,000Rp 568,500Rp

170,000Rp 1,069,500Rp

290,000Rp 170,500Rp 4,236,000Rp

120,000Rp 170,500Rp 6,740,500Rp

50,000Rp 170,500Rp 1,123,500Rp 60,000Rp 60,000Rp 260,000Rp 333,000Rp 541,500Rp

550,000Rp 60,000Rp 60,000Rp 309,500Rp 521,500Rp

400,000Rp 371,000Rp 718,000Rp

139,500Rp 591,500Rp

50,000Rp 60,000Rp 224,500Rp 746,000Rp

60,000Rp 140,000Rp 255,000Rp

223,000Rp

90,000Rp 288,000Rp

60,000Rp 80,000Rp

550,000Rp 557,000Rp 100,000Rp

50,000Rp 60,000Rp 120,000Rp 306,000Rp

108,000Rp 63,500Rp

208,000Rp 304,000Rp

60,000Rp 199,500Rp 174,000Rp

100,000Rp 60,000Rp 125,000Rp 1,061,000Rp 100,000Rp 100,000Rp 116,500Rp 163,500Rp

198,000Rp 152,500Rp

160,000Rp 117,000Rp 1,870,500Rp

60,000Rp 603,000Rp

60,000Rp 215,000Rp 1,038,000Rp

200,000Rp 1,040,000Rp 158,000Rp 1,973,500Rp

300,000Rp 60,000Rp 60,000Rp 780,000Rp 417,000Rp 384,000Rp

900,000Rp 60,000Rp 240,000Rp 289,000Rp 471,500Rp

443,000Rp

60,000Rp 152,000Rp 1,123,000Rp

120,000Rp 471,000Rp

60,000Rp 152,500Rp 1,027,500Rp

45,000Rp 1,288,500Rp

60,000Rp 60,000Rp 372,000Rp

140,000Rp 417,000Rp 60,000Rp 120,000Rp 878,000Rp 5Rp

60,000Rp 60,000Rp 170,500Rp 790,500Rp

60,000Rp 60,000Rp 287,500Rp 1,050,000Rp

70,000Rp 129,500Rp 2,809,500Rp

70,000Rp 170,500Rp 2,926,000Rp

152,000Rp 4,022,500Rp

70,000Rp 287,500Rp 500,500Rp

60,000Rp 60,000Rp 153,000Rp 857,000Rp

93,000Rp 2,281,000Rp

60,000Rp 60,000Rp 100,000Rp 328,500Rp

60,000Rp 60,000Rp 210,000Rp

290,000Rp 125,000Rp

70,000Rp 60,000Rp 100,000Rp 287,500Rp

150,000Rp 444,000Rp

50,000Rp 45,000Rp 186,000Rp 20,000Rp 131,000Rp 158,500Rp

60,000Rp 60,000Rp 180,000Rp 498,000Rp

75,500Rp 5,000Rp

147,000Rp 377,000Rp

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220,000Rp 166,500Rp

55,000Rp

40,000Rp 64,500Rp

90,000Rp 143,000Rp

100,000Rp 60,000Rp 441,500Rp

45,000Rp 81,500Rp

200,000Rp 290,000Rp 63,000Rp 421,000Rp

90,000Rp 427,500Rp

100,000Rp 60,000Rp 170,000Rp 221,500Rp

222,000Rp 147,000Rp100,000Rp 60,000Rp 133,500Rp

200,000Rp 284,500Rp 669,000Rp

60,000Rp 100,000Rp 198,000Rp 401,000Rp

50,000Rp 60,000Rp 60,000Rp 180,000Rp 492,000Rp

100,000Rp 60,000Rp 257,000Rp

680,500Rp

199,000Rp

200,000Rp 60,000Rp 129,500Rp 830,000Rp

300,000Rp 60,000Rp 162,000Rp

290,000Rp 119,500Rp

65,000Rp 394,000Rp

60,000Rp 60,000Rp 433,000Rp 662,000Rp

68,000Rp 256,000Rp

200,000Rp 321,000Rp

60,000Rp 339,000Rp 859,500Rp 200,000Rp 170,000Rp 120,000Rp 169,500Rp 1,054,500Rp

302,000Rp 496,500Rp

50,000Rp 60,000Rp 77,000Rp 131,000Rp

17,000Rp 435,500Rp

207,000Rp 139,500Rp

250,000Rp 120,000Rp 140,000Rp 269,000Rp

158,500Rp

235,000Rp 703,500Rp

195,000Rp 1,345,500Rp

95,000Rp 667,000Rp

100,000Rp 282,500Rp 168,500Rp

60,000Rp 460,500Rp

60,000Rp 218,000Rp

60,000Rp 135,000Rp 102,500Rp

100,000Rp 130,000Rp 404,500Rp 60,000Rp 95,000Rp 833,000Rp

60,000Rp 120,000Rp 130,000Rp 341,500Rp

305,000Rp 875,500Rp

205,000Rp 1,119,000Rp

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Memasang

Seprai

25,000Rp

20,000Rp 100,000Rp

20,000Rp

80,000Rp 25,000Rp

160,000Rp 100,000Rp 130,000Rp 160,000Rp

20,000Rp

50,000Rp 350,000Rp

125,000Rp

150,000Rp

50,000Rp

50,000Rp

20,000Rp 20,000Rp 250,000Rp 20,000Rp

80,000Rp 200,000Rp

150,000Rp

250,000Rp

100,000Rp

50,000Rp 250,000Rp

25,000Rp 200,000Rp

25,000Rp 100,000Rp

100,000Rp

25,000Rp 150,000Rp

5,000Rp 25,000Rp 200,000Rp

150,000Rp

25,000Rp 200,000Rp

25,000Rp 50,000Rp

25,000Rp 250,000Rp 250,000Rp

140,000Rp 100,000Rp 750,000Rp

100,000Rp

25,000Rp 150,000Rp

400,000Rp

100,000Rp

25,000Rp 150,000Rp

50,000Rp

10,000Rp 100,000Rp

20,000Rp 50,000Rp

50,000Rp

10,000Rp

150,000Rp

25,000Rp

100,000Rp

20,000Rp 150,000Rp

25,000Rp 50,000Rp

25,000Rp 150,000Rp 40,000Rp

Pasang/Pemberian OGT

Tindakan

Penyakit

Dalam

Observasi NebInjeksi IV Injeksi IM Pasang Infus TTV

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25,000Rp

100,000Rp

100,000Rp

100,000Rp

25,000Rp 100,000Rp

75,000Rp

25,000Rp

25,000Rp

10,000Rp 5,000Rp50,000Rp

75,000Rp

100,000Rp 200,000Rp

75,000Rp

100,000Rp 150,000Rp

250,000Rp

175,000Rp 250,000Rp

100,000Rp

50,000Rp 75,000Rp

50,000Rp

25,000Rp

75,000Rp

25,000Rp

150,000Rp

150,000Rp125,000Rp

50,000Rp

50,000Rp

25,000Rp

25,000Rp 300,000Rp

25,000Rp 100,000Rp

50,000Rp

25,000Rp

75,000Rp

25,000Rp

100,000Rp

75,000Rp

250,000Rp 500,000Rp

100,000Rp

30,000Rp 25,000Rp 200,000Rp100,000Rp

100,000Rp

100,000Rp

75,000Rp

75,000Rp

150,000Rp

400,000Rp

75,000Rp

250,000Rp

40,000Rp 250,000Rp

100,000Rp

25,000Rp 50,000Rp

50,000Rp

125,000Rp

250,000Rp 300,000Rp500,000Rp

475,000Rp

50,000Rp

200,000Rp 850,000Rp

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500,000Rp

25,000Rp 150,000Rp

100,000Rp

100,000Rp

140,000Rp 800,000Rp 260,000Rp

200,000Rp

300,000Rp

250,000Rp

300,000Rp25,000Rp 450,000Rp

50,000Rp

75,000Rp

25,000Rp 50,000Rp

25,000Rp

50,000Rp

200,000Rp

150,000Rp

25,000Rp

75,000Rp

60,000Rp 25,000Rp 300,000Rp 20,000Rp

25,000Rp

75,000Rp

25,000Rp

25,000Rp150,000Rp

50,000Rp

25,000Rp 500,000Rp

75,000Rp

150,000Rp

250,000Rp

175,000Rp

25,000Rp

25,000Rp 150,000Rp

25,000Rp 200,000Rp

25,000Rp 150,000Rp

25,000Rp 200,000Rp

25,000Rp 200,000Rp

25,000Rp 200,000Rp

100,000Rp 150,000Rp

75,000Rp 250,000Rp

350,000Rp

350,000Rp

150,000Rp 600,000Rp

350,000Rp

450,000Rp

5,000Rp 25,000Rp 200,000Rp

500,000Rp

25,000Rp

25,000Rp

25,000Rp

75,000Rp

25,000Rp

30,000Rp 150,000Rp30,000Rp 150,000Rp

25,000Rp

100,000Rp

150,000Rp

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125,000Rp

50,000Rp

100,000Rp

200,000Rp

100,000Rp

100,000Rp

250,000Rp

25,000Rp

30,000Rp 50,000Rp50,000Rp

125,000Rp

75,000Rp

25,000Rp

50,000Rp 200,000Rp

150,000Rp

50,000Rp

100,000Rp

10,000Rp 50,000Rp

50,000Rp

50,000Rp

50,000Rp

20,000Rp 100,000Rp

25,000Rp

25,000Rp225,000Rp

125,000Rp

5,000Rp

125,000Rp

20,000Rp 100,000Rp

75,000Rp

10,000Rp 50,000Rp

100,000Rp

50,000Rp

100,000Rp

25,000Rp 100,000Rp

50,000Rp

75,000Rp

50,000Rp 50,000Rp

175,000Rp

75,000Rp

100,000Rp

225,000Rp

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Konseling

Bedah&Anak

Anak

Anak

Interna

Interna

Anak

Bedah

Interna

Interna

Nerologi

Interna

Interna

Interna

Interna

InternaBedah

Interna

Interna

Bedah

Bedah

Bedah

Bedah

Bedah

Bedah

Bedah

Bedah

Bedah

Bedah

BedahBedah

Anak

Bedah

Bedah

Bedah

Bedah

Bedah

Interna

Anak

Anak

Bedah

Anak

Bedah

Interna

Interna

Anak

Anak

Anak

Anak

UPFHeacting Penyimpanan JenazahBiaya Tindakan Po

UmumPsikologiTindakan Poli Bedah

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Interna

Bedah

Interna

Interna

Saraf

Interna

Interna

Interna

AnakInterna

Interna

Interna

Interna

Hemo

Interna

Interna

Bedah

Interna

Interna

Interna

Interna

Saraf

Interna

InternaInterna

Interna

Interna

Interna

Bedah

Interna

Interna

Interna

Interna

Interna

Interna

Interna

Interna

Interna

AnakInterna

Interna

Interna

Interna

Interna

Interna

Bedah

Interna

Interna

Anak

Interna

Interna

Interna

InternaBedah

Interna

Bedah

Interna

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Interna

Bedah

Interna

Interna

Anak

Bedah

Orthopedi

Bedah

BedahBedah

Interna

Interna

Interna

Interna

Interna

Bedah

Bedah

Interna

Neurologi

Anak

Interna

Interna

Neurologi

InternaBedah

Interna

Bedah

Interna

Interna

Interna&Saraf

Interna

Interna

Bedah

Orthopedi

Bedah

Bedah

Bedah

Bedah

Bedah OrthopediBedah

Bedah

Bedah

Bedah Orthopedi

40,000Rp Orthopedi

Bedah

Bedah

Bedah

Bedah

Interna

Interna

Interna

Interna

Interna

AnakAnak

Interna

Anak

Bedah

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Interna

Anak

Anak

Bedah

Interna

Anak

Anak

Bedah

Interna

AnakBedah

Interna

Interna

Interna

Anak

Bedah

Interna

Interna

Anak

Interna

Interna

Interna

Anak

Interna

InternaInterna

Interna

Interna

Interna

Anak

Interna

Anak

Interna

Interna

Interna

Bedah

Interna

Interna

Interna

GinekologiInterna

Interna

Interna

Interna

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Sepunggur , November 2013

Bendahara Jamkesmas

M. Adhi Sulaiman, SKM

NIP.19840415 200908 1 001

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PROPINSI : KALIMANTAN SELATAN

KABUPATEN : TANAH BUMBU

L P Masuk Keluar

1 Ny. Sulastri 6310045004810005 31 25 Februari 2013 28 Februari 2013 3

2 By. Ny. Sulastri 6310045004810005 0 (Hari) 25 Februari 2013 28 Februari 2013 3

3 Ny. Isnaini 6310094703700006 38 01 Mei 2013 04 Mei 2013 3

4 Ny. Nor Sam 6310094706690005 44 31 Juli 2013 03 Agustus 2013 3

5 Ny. Mariana 6310024605830001 30 29 Juli 2013 04 Agustus 2013 6

6 Ny. Herlinda 6310014903860002 27 01 Agustus 2013 01 Agustus 2013

7 Ny. Yatini 6310034101830002 31 04 Agustus 2013 04 Agustus 2013

8 Ny. Jumriana 6310025703830004 25 01 Agustus 2013 04 Agustus 2013 3

9 By. Ny. Jumriana 6310025703830004 0 (Hari) 01 Agustus 2013 05 Agustus 2013 4

10 Ny. Syarifah 6310075207920002 21 05 Agustus 2013 07 Agustus 2013 2

11 By. Ny. Syarifah 6310075207920002 0 (Hari) 06 Agustus 2013 07 Agustus 2013 1

12 Ny. Halimatus Sa'diah 6310024107820327 31 22 Agustus 2013 26 Agustus 2013 4

13 By.Halimatus/Firji Ananda 6310023008130001 0 (Hari) 30 Agustus 2013 14 September 2013 1514 Ny. Kasmawati 6310024107800414 27 18 September 2013 13 September 2013 5

15 By. Ny. Kasmawati 6310024107800414 0 (Hari) 20 September 2013 22 September 2013 2

16 Ny. Rusdiah 6310104107850087 28 21 September 2013 23 September 2013 2

17 By. Ny. Rusdiah 6310104107850087 0 (Hari) 21 September 2013 24 September 2013 3

18 Ny. Fitriah. L 6310094609790002 34 21 September 2013 24 September 2013 3

19 By. Ny. Fitriah. L 6310094609790002 0 (Hari) 22 September 2013 24 September 2013 2

20 Ny. Rafifah 6310024612920001 22 28 September 2013 30 September 2013 2

21 By. Ny. Rafifah 6310024612920001 0 (Hari) 28 September 2013 29 September 2013 1

22 Ny. Rina 6310065010950002 17 24 September 2013 25 September 2013 1

23 By. Ny. Rina 6310065010950002 0 (Hari) 24 September 2013 25 September 2013 1

24 Ny. Rusnah 6310094102820003 32 25 September 2013 27 September 2013 2

25 By. Ny. Rusnah 6310094102820003 0 (Hari) 26 September 2013 27 September 2013 1

26 Ny. Vivi vebriana 6310084202950001 18 23 September 2013 27 September 2013 4

27 By. Ny. Vivi 6310084202950001 0 (Hari) 24 September 2013 27 September 2013 3

28 Ny. Yuli Susanti 6310046707730004 40 21 September 2013 23 September 2013 229 By. Ny. Yuli 6310046707730004 0 (Hari) 21 September 2013 23 September 2013 2

30 Ny. Ayu Wandana 6310024902910002 22 25 September 2013 27 September 2013 2

31 By. Ny. Ayu 6310024902910002 0 (Hari) 25 September 2013 27 September 2013 2

32 Ny. Dety wulandari 6310024505800009 33 23 September 2013 27 September 2013 4

33 Ny. Sudiyah 6310046404730001 40 19 September 2013 24 September 2013 5

34 By. Ny. Sudiyah 6310046404730001 0 (Hari) 20 September 2013 24 September 2013 4

35 Ny. Sriyatun 6310066911860001 27 20 September 2013 24 September 2013 4

36 By. Ny. Sriyatun 6310066911860001 0 (Hari) 20 September 2013 24 September 2013 4

37 Ny. Ella 6310106709840001 29 20 September 2013 24 September 2013 4

38 By. Ny. Ella 6310106709840001 0 (Hari) 20 September 2013 24 September 2013 4

39 Ny. Yuliani 6310046606870009 26 22 September 2013 25 September 2013 3

40 By. Ny. Yuliani 6310046606870009 0 (Hari) 23 September 2013 25 September 2013 2

41 Ny. Aswatun Hasanah 6310047112920005 21 20 September 2013 24 September 2013 4

42 By. Ny. Aswatun 6310047112920005 0 (Hari) 21 September 2013 24 September 2013 343 Ny. Hj. Mardiana 6310024107830323 40 19 September 2013 24 September 2013 5

44 By. Ny. Hj. Mardiana 6310024107830323 0 (Hari) 20 September 2013 24 September 2013 4

45 Ny. Santi Martha 6310095112820008 23 23 September 2013 25 September 2013 2

DAFTAR KLAIM RAWAT INAP PASIEN KEBIDA

NO NAMA PASIEN

Umur (Thn)

NO.REKOMENDASI JAMKESDA

TANGGAL

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46 By. Ny. Santi Martha 6310095112820008 0 (Hari) 23 September 2013 25 September 2013 2

47 Ny. Jumiati 6310046103800001 33 23 September 2013 26 September 2013 3

48 By. Ny. Jumiati 6310046103800001 0 (Hari) 23 September 2013 26 September 2013 3

49 Ny. Khairunnisa. U 6310066209930002 20 24 September 2013 27 September 2013 3

50 By. Ny. Khairunnisa. U 6310066209930002 0 (Hari) 24 September 2013 27 September 2013 3

51 Ny. Endang 6310024204790005 34 18 September 2013 20 September 2013 2

52 Ny. Endang M 6310037007880004 25 28 September 2013 30 September 2013 2

53 Ny. Siti Nur hasanah 6310065206940001 20 22 September 2013 26 September 2013 4

54 Ny. Mamong 6310024107650244 68 16 September 2013 20 September 2013 4

55 Ny. Tamsiyah 6310104107730085 40 23 September 2013 28 September 2013 556 Ny. Saniah/sennia 6310094110680001 40 12 September 2013 24 September 2013 12

57 By. Ny. Salmiah /Muhammad 6310011809130001 0 (Hari) 18 September 2013 30 September 2013 12

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58 By. Ny. Lina/M. farhansyah 6310042709130001 0 (Hari) 29 September 2013 30 September 2013 1

59 By. Ny. St. Maryam 6310044102770002 0 (Hari) 25 September 2009 28 September 2009 3

60 Ny. Watirah 6310074607770002 35 29 September 2013 01 Oktober 2013 2

61 Ny. Pasri rahayu 6310104703900001 23 28 September 2013 02 Oktober 2013 4

62 By. Ny. Pasri rahayu 6310104703900001 0 (Hari) 28 September 2013 02 Oktober 2013 4

63 Ny. Syarifah 6310014402850002 28 30 September 2013 01 Oktober 2013 1

64 Ny. Setya puji L 6310106606940002 19 24 September 2013 01 Oktober 2013 7

65 By. Ny. Setya puji L 6310106606940002 0 (Hari) 25 September 2013 01 Oktober 2013 6

66 Ny. Windi Andewiasih 6310064101930003 20 28 September 2013 02 Oktober 2013 4

67 By. Ny. Windi 6310064101930003 0 (Hari) 28 September 2013 02 Oktober 2013 468 Ny. Nor hayati 6310024107860153 27 29 September 2013 01 Oktober 2013 2

69 By. Ny. Nor hayati 6310024107860153 0 (Hari) 29 September 2013 04 Oktober 2013 5

70 Ny. Kafiah 6310026806890001 23 26 September 2013 01 Oktober 2013 5

71 By. Ny. Kafiah 6310026806890001 0 (Hari) 28 September 2013 01 Oktober 2013 3

72 Ny. Jumrahaini 6310064505900002 23 28 September 2013 01 Oktober 2013 3

73 By. Ny. Jumrahaini 6310064505900002 0 (Hari) 28 September 2013 01 Oktober 2013 3

74 Ny. Mirna 6310095011930007 19 30 September 2013 01 Oktober 2013 1

75 By. Ny. Mirna 6310095011930007 0 (Hari) 30 September 2013 01 Oktober 2013 1

76 Ny. Rina susanti 6310095603890002 24 03 Oktober 2013 08 Oktober 2013 5

77 By. Ny. Rina susanti 6310095603890002 0 (Hari) 04 Oktober 2013 08 Oktober 2013 4

78 Ny. Musdalifah 6310024103770002 36 01 Oktober 2013 03 Oktober 2013 2

79 Ny. Haslinda 6310014806930001 20 06 Oktober 2009 08 Oktober 2009 2

80 Ny. Emilda 6310085010800003 29 13 Oktober 2009 17 Oktober 2009 4

81 By. Ny. Emilda 6310085010800003 0 (Hari) 13 Oktober 2009 17 Oktober 2009 4

82 Ny. Siti Aisah 6310034212960001 17 12 Oktober 2009 15 Oktober 2009 383 By. Ny. Siti Aisah 6310034212960001 0 (Hari) 12 Oktober 2009 15 Oktober 2009 3

84 Ny. Salasiah 6310046105870003 26 21 Oktober 2009 23 Oktober 2009 2

85 Ny. Ni Wayan Dapet 6310037112790001 34 02 Oktober 2009 07 Oktober 2009 5

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86 By. Ny. Ni wayan dapet 6310037112790001 03 Oktober 2009 07 Oktober 2009 4

87 Ny. Fitriani 6310094902920002 21 08 Oktober 2013 11 Oktober 2013 3

88 By. Ny. Fitriani 6310094902920002 0 (Hari) 09 Oktober 2013 11 Oktober 2013 2

89 Ny. Hanah 6310094812940005 19 04 Oktober 2013 06 Oktober 2013 2

90 By. Ny. Hanah 6310094812940005 0 (Hari) 04 Oktober 2013 06 Oktober 2013 2

91 Ny. Madinah 6310016005920001 21 03 Oktober 2013 05 Oktober 2013 2

92 By. Ny. Madinah 6310016005920001 0 (Hari) 03 Oktober 2013 05 Oktober 2013 2

93 Ny. Hasriana. G 6310026808950002 19 02 Oktober 2013 03 Oktober 2013 1

94 By. Ny. Hasriana. G 6310026808950002 0 (Hari) 02 Oktober 2013 04 Oktober 2013 2

95 Ny. Herliani 6310054908850002 29 03 Oktober 2013 05 Oktober 2013 2

96 By. Ny. Herliani 6310054908850002 0 (Hari) 03 Oktober 2013 05 Oktober 2013 2

97 Ny. Janatul Aliah 6310054606910003 22 01 Oktober 2013 03 Oktober 2013 2

98 By. Ny. Janatul Aliah 6310054606910003 0 (Hari) 03 Oktober 2013 03 Oktober 2013

99 Ny. Raodah 6310024107800141 31 05 Oktober 2013 07 Oktober 2013 2

100 By. Ny. Raodah 6310024107800141 0 (Hari) 05 Oktober 2013 07 Oktober 2013 2

101 Ny. Iyati 6310034107720060 20 06 Oktober 2013 07 Oktober 2013 1

102 By. Ny. Iyati 6310034107720060 0 (Hari) 06 Oktober 2013 08 Oktober 2013 2

103 Ny. Nur baya 6310024203820002 31 04 Oktober 2013 07 Oktober 2013 3

104 By. Ny. Nur baya I 6310024203820002 0 (Hari) 04 Oktober 2013 07 Oktober 2013 3

105 By. Ny. Nur baya II 6310024203820002 0 (Hari) 04 Oktober 2013 07 Oktober 2013 3

106 Ny. Murtiasih 6310104707780006 35 04 Oktober 2009 07 Oktober 2009 3

107 By. Ny. Murtiasih 6310104707780006 8 (Hari) 04 Oktober 2009 12 Oktober 2009 8

108 Ny. Awaliyah 6310014702890003 24 07 Oktober 2009 08 Oktober 2009 1

109 By. Ny. Awaliyah 6310014702890003 0 (Hari) 07 Oktober 2009 08 Oktober 2009 1110 Ny. Rosita Agustin 6310015308950001 18 10 Oktober 2009 10 Oktober 2009

111 By. Ny. Rosita Agustin 6310015308950001 0 (Hari) 09 Oktober 2009 10 Oktober 2009 1

112 Ny. Ida Rusliana 631004647900001 17 07 Oktober 2009 09 Oktober 2009 2

113 By. Ny. Ida Rusliana 631004647900001 0 (Hari) 07 Oktober 2009 08 Oktober 2009 1

114 Ny. Rustanti 6310034202920010 18 07 Oktober 2009 09 Oktober 2009 2

115 By. Ny. Rustanti 6310034202920010 0 (Hari) 08 Oktober 2009 09 Oktober 2009 1

116 Ny. Wahyuni 6310096111790006 34 06 Oktober 2009 08 Oktober 2009 2

117 By. Ny. Wahyuni 6310096111790006 0 (Hari) 06 Oktober 2009 08 Oktober 2009 2

118 Ny. Nurhayati 6310056710950002 18 05 Oktober 2009 07 Oktober 2009 2

119 By. Ny. Nurhayati 6310056710950002 0 (Hari) 06 Oktober 2009 07 Oktober 2009 1

120 Ny. Ni Komang Ariani 6310034910900003 20 19 Oktober 2009 21 Oktober 2009 2

121 By. Ny. Ni Komang A 6310034910900003 0 (Hari) 20 Oktober 2009 21 Oktober 2009 1

122 Ny. Rahmaniah 6310026106860001 27 17 Oktober 2009 17 Oktober 2009

123 By. Ny. Rahmaniah 6310026106860001 0 (Hari) 17 Oktober 2009 17 Oktober 2009124 Ny. Elvira Rosiana 6310025809880002 29 12 Oktober 2009 14 Oktober 2009 2

125 By. Ny. Elvira R 6310025809880002 0 (Hari) 12 Oktober 2009 14 Oktober 2009 2

126 Ny. Rida Januari 6310024101880013 25 20 Oktober 2009 21 Oktober 2009 1

127 By. Ny. Rida Januari 6310024101880013 0 (Hari) 20 Oktober 2009 21 Oktober 2009 1

128 Ny. Lisda Liana 6310026402890001 24 22 Oktober 2009 24 Oktober 2009 2

129 By. Ny. Lisda Liana 6310026402890001 0 (Hari) 22 Oktober 2009 24 Oktober 2009 2

130 Ny. Ina Sitifatonah 6310104609940003 29 05 Oktober 2009 08 Oktober 2009 3

131 Ny. Ni Ketut S 6310086404840002 29 12 Oktober 2009 14 Oktober 2009 2

132 Ny. Lisnawati 6310024811770001 36 21 Oktober 2009 23 Oktober 2009 2

133 Ny. Rusdiana 6310095406810002 32 19 Oktober 2009 21 Oktober 2009 2

134 Ny. Paryati 6310094611930001 20 21 Oktober 2009 23 Oktober 2009 2

135 Ny. Haniati 6310084101790004 34 05 Oktober 2009 08 Oktober 2009 3

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T O T A L K L A I M

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Konsultasi Jasa

Tindakan KecilTindakan

Sedang

Tindakan

Intensif Medis Gigi Apoteker Sederhana Kecil Sedang B

40,000Rp 30,000Rp 10,000Rp Rp

60,000Rp 10,000Rp

240,000Rp 10,000Rp

100,000Rp 30,000Rp 45,000Rp 10,000Rp

150,000Rp 180,000Rp 45,000Rp 10,000Rp 125,000Rp

30,000Rp 45,000Rp 10,000Rp 125,000Rp

30,000Rp 45,000Rp 10,000Rp Rp

220,000Rp 90,000Rp 10,000Rp

10,000Rp

40,000Rp 30,000Rp 45,000Rp 10,000Rp 125,000Rp

10,000Rp

240,000Rp 10,000Rp 125,000Rp

920,000Rp 540,000Rp 10,000Rp220,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

120,000Rp 90,000Rp 135,000Rp 5,000Rp 10,000Rp

40,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

140,000Rp 120,000Rp 10,000Rp

90,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

100,000Rp 90,000Rp 10,000Rp

60,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp Rp

60,000Rp 60,000Rp 10,000Rp

100,000Rp 30,000Rp 90,000Rp 5,000Rp 10,000Rp 125,000Rp

40,000Rp 30,000Rp 10,000Rp

40,000Rp 60,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

60,000Rp 60,000Rp 10,000Rp

140,000Rp 30,000Rp 180,000Rp 5,000Rp 10,000Rp 125,000Rp

120,000Rp 90,000Rp 10,000Rp

60,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp 80,000Rp 90,000Rp 10,000Rp

40,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

100,000Rp 90,000Rp 10,000Rp

160,000Rp 120,000Rp 5,000Rp 10,000Rp 125,000Rp

160,000Rp 150,000Rp 45,000Rp 5,000Rp 10,000Rp Rp

180,000Rp 150,000Rp 10,000Rp

160,000Rp 120,000Rp 5,000Rp 10,000Rp

180,000Rp 150,000Rp 10,000Rp

180,000Rp 150,000Rp 45,000Rp 5,000Rp 10,000Rp Rp

180,000Rp 150,000Rp 10,000Rp

200,000Rp 120,000Rp 45,000Rp 5,000Rp 10,000Rp Rp

100,000Rp 90,000Rp 10,000Rp

140,000Rp 120,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

180,000Rp 150,000Rp 10,000Rp160,000Rp 150,000Rp 45,000Rp 5,000Rp 10,000Rp Rp

180,000Rp 150,000Rp 10,000Rp

120,000Rp 90,000Rp 5,000Rp 10,000Rp Rp

Berkas RM

Jasa Keperawatan Tindakan di UGD

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100,000Rp 90,000Rp 10,000Rp

180,000Rp 180,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

140,000Rp 120,000Rp 90,000Rp 10,000Rp

140,000Rp 90,000Rp 5,000Rp 10,000Rp 125,000Rp

140,000Rp 120,000Rp 10,000Rp

120,000Rp 90,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

220,000Rp 5,000Rp 10,000Rp

180,000Rp 60,000Rp 5,000Rp 10,000Rp

80,000Rp 60,000Rp 5,000Rp 10,000Rp 100,000Rp 125,000Rp

300,000Rp 30,000Rp 135,000Rp 5,000Rp 10,000Rp440,000Rp 180,000Rp 5,000Rp 10,000Rp Rp

760,000Rp 390,000Rp 360,000Rp 10,000Rp 125,000Rp

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20,000Rp 30,000Rp 10,000Rp

140,000Rp 120,000Rp 10,000Rp

100,000Rp 90,000Rp 5,000Rp 10,000Rp 125,000Rp

260,000Rp 120,000Rp 90,000Rp 5,000Rp 10,000Rp

180,000Rp 150,000Rp 10,000Rp

40,000Rp 5,000Rp 10,000Rp Rp

300,000Rp 90,000Rp 45,000Rp 5,000Rp 10,000Rp Rp

260,000Rp 210,000Rp 10,000Rp

320,000Rp 150,000Rp 135,000Rp 5,000Rp 10,000Rp 125,000Rp

180,000Rp 150,000Rp 10,000Rp120,000Rp 30,000Rp 90,000Rp 5,000Rp 10,000Rp 125,000Rp

300,000Rp 180,000Rp 10,000Rp

420,000Rp 60,000Rp 135,000Rp 5,000Rp 10,000Rp 125,000Rp

140,000Rp 120,000Rp 10,000Rp

160,000Rp 30,000Rp 90,000Rp 5,000Rp 10,000Rp 125,000Rp

180,000Rp 150,000Rp 10,000Rp

60,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp Rp

60,000Rp 60,000Rp 10,000Rp

260,000Rp 90,000Rp 5,000Rp 10,000Rp 125,000Rp

180,000Rp 150,000Rp 10,000Rp

80,000Rp 5,000Rp 10,000Rp 125,000Rp

80,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

260,000Rp 120,000Rp 90,000Rp 5,000Rp 10,000Rp 125,000Rp

180,000Rp 150,000Rp 10,000Rp

180,000Rp 90,000Rp 90,000Rp 5,000Rp 10,000Rp 125,000Rp140,000Rp 120,000Rp 10,000Rp

140,000Rp 60,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

220,000Rp 120,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

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180,000Rp 150,000Rp 10,000Rp

140,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp

100,000Rp 90,000Rp 10,000Rp

100,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

120,000Rp 90,000Rp 10,000Rp

40,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

100,000Rp 90,000Rp 10,000Rp

40,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

100,000Rp 90,000Rp 10,000Rp

30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

200,000Rp 150,000Rp 10,000Rp

20,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

10,000Rp

140,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

100,000Rp 90,000Rp 10,000Rp

30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

100,000Rp 90,000Rp 10,000Rp

140,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp Rp

140,000Rp 120,000Rp 10,000Rp

140,000Rp 120,000Rp 10,000Rp

120,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

440,000Rp 240,000Rp 10,000Rp

40,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp Rp

60,000Rp 60,000Rp 10,000Rp80,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

60,000Rp 60,000Rp 10,000Rp

120,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

20,000Rp 10,000Rp

40,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

80,000Rp 60,000Rp 10,000Rp

100,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

60,000Rp 60,000Rp 10,000Rp

100,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

60,000Rp 60,000Rp 10,000Rp 125,000Rp

60,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

60,000Rp 60,000Rp 10,000Rp

60,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

40,000Rp 30,000Rp 10,000Rp180,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

120,000Rp 90,000Rp 10,000Rp

20,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

60,000Rp 60,000Rp 10,000Rp

80,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

100,000Rp 90,000Rp 10,000Rp

20,000Rp 30,000Rp 90,000Rp 5,000Rp 10,000Rp 125,000Rp

200,000Rp 120,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

20,000Rp 30,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

100,000Rp 60,000Rp 5,000Rp 10,000Rp 125,000Rp

160,000Rp 45,000Rp 5,000Rp 10,000Rp 125,000Rp

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Resusitasi Bayi

Baru LahirRJPO Kuretasi + Anastesi Kuretasi Sulit + Anastesi

Manual

Plasenta +Sederhana Kecil Sedang

125,000Rp

1,625,000Rp

125,000Rp

125,000Rp

200,000Rp

125,000Rp 200,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

1,750,000Rp

1,750,000Rp 5,000,000Rp

200,000Rp

200,000Rp

200,000Rp

200,000Rp

200,000Rp

200,000Rp

1,750,000Rp

Tindakan Operasi Bed

)

Tindakan Persalinan & Kebidanan

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200,000Rp

200,000Rp

200,000Rp

1,750,000Rp

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125,000Rp

200,000Rp

1,750,000Rp

200,000Rp

1,750,000Rp

200,000Rp

200,000Rp1,750,000Rp

125,000Rp 200,000Rp

125,000Rp

125,000Rp

125,000Rp

200,000Rp

1,750,000Rp

1,750,000Rp

200,000Rp

200,000Rp

1,750,000Rp

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125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

2,050,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

2,050,000Rp

2,050,000Rp

1,750,000Rp

1,750,000Rp

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Rontgen EKG

520,000Rp 248,000Rp 1,253,500Rp Rp

69,000Rp

100,000Rp 255,000Rp 324,500Rp Rp

193,000Rp 194,500Rp Rp

100,000Rp 1,040,000Rp 188,000Rp 753,000Rp Rp

193,000Rp

20,000Rp 193,000Rp 236,500Rp

380,000Rp 623,500Rp 5Rp

210,000Rp 232,000Rp Rp

100,000Rp 210,000Rp 189,000Rp Rp

1,400,000Rp 653,500Rp 100,000Rp 193,000Rp 281,000Rp Rp

600,000Rp 172,000Rp 6Rp

210,000Rp 33,500Rp Rp

24,500Rp

201,500Rp 557,500Rp Rp

210,000Rp 197,000Rp Rp

193,000Rp 237,000Rp Rp

19,500Rp

158,000Rp 310,500Rp Rp

520,000Rp 288,000Rp 393,500Rp Rp

210,000Rp 665,000Rp Rp

302,500Rp 266,000Rp Rp

203,000Rp 1,627,500Rp Rp

100,000Rp 276,000Rp 1,218,000Rp Rp

182,500Rp

225,500Rp 1,920,000Rp Rp

100,000Rp 255,000Rp 1,068,500Rp Rp

169,500Rp

230,000Rp 1,060,000Rp Rp

60,000Rp

473,000Rp 1,192,000Rp Rp

266,000Rp 1,467,500Rp Rp

220,000Rp 977,000Rp Rp

Pemakaian

OksigenUSG

Pemeriksaan Darah

Untuk Tranfusi dan

Kantong Lepas

Obat, alat

suntik, alat

infus dan

cairan infus

selama

dirawat dan

Laboratorium

Biaya

Pemeriksaan

Poliklinik

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60,000Rp Rp

225,000Rp 961,000Rp Rp

78,000Rp

347,000Rp 1,519,500Rp Rp

191,000Rp Rp

255,500Rp 278,500Rp Rp

300,000Rp 262,500Rp 180,000Rp Rp

60,000Rp 100,000Rp 170,000Rp 242,500Rp Rp

60,000Rp 100,000Rp 780,000Rp 180,500Rp 673,000Rp 1Rp 1,560,000Rp 55,000Rp 504,000Rp 2Rp

2,200,000Rp 204,000Rp 297,500Rp

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Rp

520,000Rp 167,500Rp 184,000Rp Rp

220,000Rp 1,607,500Rp Rp

193,000Rp 14,000Rp Rp

178,000Rp 1,825,000Rp Rp

236,500Rp 120,000Rp

243,000Rp 1,503,000Rp Rp

100,000Rp 208,000Rp 244,000Rp Rp

1,000,000Rp 311,000Rp Rp

260,000Rp 168,000Rp 172,000Rp Rp

200,000Rp

260,000Rp 238,000Rp 197,000Rp Rp

198,000Rp 190,000Rp Rp

10,000Rp 1,300,500Rp Rp

200,000Rp 75,000Rp

100,000Rp 220,000Rp 274,000Rp Rp

247,500Rp 393,000Rp Rp

208,000Rp 1,473,000Rp Rp

185,000Rp 974,500Rp Rp 60,000Rp

260,000Rp 232,000Rp 212,000Rp Rp

185,000Rp 1,560,000Rp Rp

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203,000Rp 375,500Rp Rp

87,000Rp 198,000Rp Rp

210,500Rp 415,000Rp Rp

143,000Rp 31,000Rp Rp

215,500Rp 165,000Rp Rp

60,000Rp

100,000Rp 100,000Rp 244,500Rp 124,000Rp Rp

108,000Rp 157,000Rp Rp

198,000Rp 188,500Rp Rp

100,000Rp 230,000Rp 321,000Rp Rp

63,000Rp

63,000Rp

220,000Rp 789,000Rp 1Rp

600,000Rp 305,000Rp

193,000Rp 171,000Rp Rp

193,000Rp 156,000Rp Rp

25,000Rp 228,000Rp 10,000Rp Rp

195,000Rp 228,000Rp Rp

203,000Rp 194,000Rp Rp

400,000Rp 56,500Rp

100,000Rp 215,000Rp 153,000Rp Rp

210,000Rp 154,500Rp Rp

158,000Rp 192,000Rp Rp

187,000Rp Rp

232,500Rp 205,000Rp Rp

198,000Rp 191,000Rp Rp

200,000Rp 140,000Rp 360,500Rp

100,000Rp 175,000Rp 348,500Rp Rp

100,000Rp 200,000Rp

108,000Rp 421,000Rp

100,000Rp 215,000Rp 123,000Rp Rp

203,000Rp 168,000Rp Rp

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50,000Rp

75,000Rp

75,000Rp

50,000Rp 100,000Rp 80,000Rp 20,000Rp 150,000Rp 10Rp

50,000Rp

50,000Rp 40,000Rp 40,000Rp 60,000Rp 10Rp

250,000Rp 10Rp

150,000Rp 10Rp

50,000Rp 10Rp

50,000Rp 10Rp

300,000Rp

50,000Rp 10Rp

200,000Rp

10Rp

300,000Rp

50,000Rp 10Rp

200,000Rp

100,000Rp 10Rp

50,000Rp 10Rp

300,000Rp

50,000Rp 10Rp

75,000Rp

75,000Rp

50,000Rp 10Rp

75,000Rp

50,000Rp 10Rp

75,000Rp

50,000Rp 10Rp

75,000Rp

50,000Rp 10Rp

75,000Rp

100,000Rp 10Rp 75,000Rp

50,000Rp 10Rp

75,000Rp

Tindakan Medis

Jahit luka SuctInkubator Angkat jahitanRawat Luka

OPFoto Terapi TTV Mandikan Bayi Polio

Rawat Tali

Pusat

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50,000Rp 10Rp

75,000Rp

50,000Rp 10Rp

75,000Rp

50,000Rp 10Rp

550,000Rp 10Rp

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50,000Rp 10Rp

50,000Rp 10Rp

75,000Rp

50,000Rp 10Rp

75,000Rp

100,000Rp 20Rp

75,000Rp

50,000Rp 10Rp

300,000Rp 10Rp

300,000Rp

50,000Rp 10Rp

50,000Rp 10Rp

300,000Rp

50,000Rp 10Rp

50,000Rp 10Rp

75,000Rp

10Rp

75,000Rp 10Rp

75,000Rp

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50,000Rp 10Rp

250,000Rp

50,000Rp 10Rp

300,000Rp

50,000Rp 10Rp

50,000Rp 10Rp

200,000Rp

50,000Rp 10Rp

200,000Rp

50,000Rp 10Rp

50,000Rp 10Rp

50,000Rp 10Rp

100,000Rp 20Rp

50,000Rp 10Rp

300,000Rp

400,000Rp 10Rp

50,000Rp 10Rp

50,000Rp

300,000Rp

50,000Rp 10Rp

50,000Rp 10Rp

300,000Rp

50,000Rp 10Rp

10Rp

200,000Rp

50,000Rp 10Rp 300,000Rp

50,000Rp 10Rp

100,000Rp

50,000Rp 10Rp

300,000Rp

50,000Rp 10Rp

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07.20.85

07.20.84

07.46.62

07.95.14

07.86.88

07.81.78

07.90.23

07.88.53

07.88.55

07.90.50

07.98.68

08.04.3608.14.69

08.16.47

08.16.87

08.16.94

08.16.62

08.17.06

08.21.01

08.21.29

08.18.14

08.18.35

08.10.51

08.19.41

08.17.41

08.18.37

08.16.5708.16.82

08.18.86

08.19.29

08.56.55

08.15.63

08.15.71

08.16.39

08.16.49

08.15.66

08.15.73

08.17.01

08.17.17

08.16.50

08.16.7808.13.47

08.15.69

08.05.68

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08.18.02

08.17.74

08.18.09

08.18.15

08.18.36

08.15.28

08.09.36

08.16.09

08.12.71

08.18.0407.44.85

08.14.68

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08.21.30

08.18.79

08.21.34

08.21.04

08.21.26

08.21.53

08.18.55

08.18.89

08.20.60

08.20.6108.19.49

08.21.43

07.43.78

08.21.27

08.20.98

08.21.28

08.21.65

08.21.70

07.77.94

08.25.02

08.22.38

08.25.92

08.30.10

08.26.30

08.29.5608.30.02

08.35.39

08.02.76

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08.24.70

07.53.17

08.27.76

08.25.10

08.25.36

07.53.61

08.24.64

08.24.05

08.24.06

01.24.10

08.24.12

08.23.34

08.24.65

08.25.27

08.25.64

08.25.783

08.25.91

08.25.01

08.25.60

08.25.61

07.87.81

08.25.67

08.26.45

08.27.0407.79.33

08.27.75

08.26.46

08.26.48

08.26.08

08.27.08

08.25.73

08.25.76

08.25.23

08.25.75

08.33.78

08.34.28

08.14.91

08.31.6107.93.89

08.29.98

08.33.99

08.34.32

08.35.88

08.35.90

08.25.24

08.29.69

08.33.48

08.27.03

07.73.77

08.25.65

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3

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PROPINSI : KALIMANTAN SELATAN

KABUPATEN : TANAH BUMBU

L P Masuk Keluar1 Anita 33811 30 29 Nopember 2012 05 Desember 2012 G

2 Warsiki 33780 40 25 Nopember 2012 11 Desember 2012 Colic

3 By Marti 33807 0 (Hr) 28 Nopember 2012 17 Desember 2012 Sepsis Cleo

4 Tamsiyah 33803 39 29 Nopember 2012 03 Desember 2012 Obs Febris Sus

5 Safarina Anggraini 33808 22 03 Desember 2012 05 Desember 2012

6 Siti Fiteriani 33798 25 27 Nopember 2012 04 Desember 2012 Susp D

7 Jum'riah 31484 45 04 Desember 2012 08 Desember 2012 Retensi Urine

8 M. Ilyas 33828 16 05 Desember 2012 08 Desember 2012 He

9 Iva Isnaini 33826 25 04 Desember 2012 08 Desember 2012 Hep

10 Nur'aidah 33840 48 08 Desember 2012 12 Desember 2012 Su

11 Abdul Aziz 33839 25 09 Desember 2012 16 Desember 2012 Efu

12 Muna 13290 40 14 Desember 2012 21 Desember 2012 Obs Sto13 Rusmatika 33875 24 17 Desember 2012 21 Desember 2012 A

14 Juhanah 33894 37 20 Desember 2012 26 Desember 2012 G

15 Tn Johardin 33919 25 ###################### ##################### Obs Dysp

16

17

18

19

20

Mengetahui

Direktur RSUD Tanah Bumbu

dr. H. Daru Dewa, M.Kes

JUMLAH TOTAL

DAFTAR TAGIHAN OBAT KLAIM RAWAT INAP PASIEN JAMKESDA RSUD TANAH BUMBU

NO NAMA PASIENNO.REKOMENDASI

JAMKESDA

Umur (Thn) TANGGAL

DI

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NIP. 19680710 199803 1 011

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Desember

2012

JUMLAH

TAGIHAN

73,625Rp

208,500Rp

892,500Rp

22,800Rp

559,750Rp

15,000Rp

1,517,456Rp

55,000Rp

32,800Rp

317,300Rp

115,000Rp

935,500Rp144,760Rp

326,000Rp

63,100Rp

-Rp

-Rp

-Rp

-Rp

-Rp

5,279,091Rp

ara Jamkesmas

  hi Sulaiman

, 15 Januari 2013

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  415 200908 1 001

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PROPINSI : KALIMANTAN SELATAN

KABUPATEN : TANAH BUMBU

L P Masuk

1 Rusian Wahyudi 33407 33 03 Agustus 2012

2 Nor Ainah 33102 21 21 Agustus 2012

3 M. Sipe 9913 67 28 Agustus 2012

4 Gunawan 33310 56 28 Agustus 2012

5 Hayat Syamsudin 33472 52 29 Agustus 2012

6 Lippu 33474 42 31 Agustus 2012

7 Suryaningsih 33496 24 31 Agustus 2012

8 Sumarmi 33471 50 01 September 2012

9 Andre Hernuan / M Ramadhan 33479 10 01 September 2012

10 Arpiah 33483 60 02 September 2012

11 Adi Setiawan / Wahyu Saputra 33487 4 03 September 2012

12 Jawahir 33500 70 03 September 2012

13 Rohmiati 33558 25 04 September 2012

14 By Syafi'atul Uzma 33489 2 (Bln) 13 September 2012

15 Jenah 15321 32 04 September 2012

16 Juarti 33493 46 05 September 2012

17 Bahrun 33490 40 05 September 2012

18 Suparmi 20152 47 06 September 2012

19 Marisa Dewi 33515 24 06 September 2012

20 Ulfah Nurul 33501 32 06 September 2012

21 Yahmarudin 33512 35 07 September 2012

22 Mahrita 33504 34 07 September 2012

23 By Mina 33508 3 (Hr) 07 September 2012

24 Supiani 29536 50 07 September 2012

25 Mustaming 33521 50 07 September 2012

26 Siti Nafisah 33496 39 07 September 2012

27 Masumi 32506 43 08 September 2012

28 By Vera Yulita 33520 1 ( Hr) 08 September 2012

29 Suginem 33509 60 08 September 2012

30 Cunde 33507 65 08 September 2012

31 M. Rayhan 33527 1 09 September 2012

32 Nanda Saputra/an M. Rauf 33509 9 09 September 2012

NO NAMA PASIENNO.REKOMENDASI

JAMKESDA

Umur (Thn) TAN

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33 Dian Ariyama 33491 47 06 September 2012

34 Hardiana 33513 44 10 September 2012

35 Vera Yulita 33519 24 08 September 2012

36 Tunia Wati 33543 29 10 September 2012

37 Yanto 33525 50 10 September 2012

38 Daimah 32356 36 11 September 201239 Muhyati 33516 30 11 September 2012

40 Sutrisno 33518 70 12 September 2012

41 Linda Sriyanti 33528 23 12 September 2012

42 Mahirap 33551 41 12 September 2012

43 Sri Juwariah 33531 40 12 September 2012

44 By Saiful Uzma 33495 2 (Bln) 13 September 2012

45 Mila Amalia 33532 20 14 September 2012

46 Ali Azhar 33540 3 (Bln) 15 September 2012

47 Lippu 33474 42 16 September 2012

48 Tukijem 33545 44 16 September 2012

49 Indo Upe 33526 44 17 September 2012

50 Kahar 33549 40 17 September 2012

51 Nonong 33544 30 17 September 2012

52 Murni 33542 50 17 September 2012

53 Mahjur 33533 60 17 September 2012

54 Riduan 33560 55 18 September 2012

55 M. Zainur Ramadani 33541 1 (Bln) 18 September 2012

56 Menceng 33556 52 18 September 2012

57 Hanisa 33547 36 18 September 2012

58 Maryam 33552 30 19 September 2012

59 Rukmiati 33546 32 19 September 201260 Ainun 33557 20 19 September 2012

61 Dika 33555 18 19 September 2012

62 M. Nor Efendi 33566 23 20 September 2012

63 Hamzah 33559 12 21 September 2012

64 Iriani 33535 30 21 September 2012

65 Basse Hikmawati 33564 25 23 September 2012

66 By Syafi'atul Uzma 33489 3 (Bln) 23 September 2012

67 Suwardiyono 33567 13 23 September 2012

68 Abd. Hafid 33561 60 23 September 2012

69 Madiana 33562 23 23 September 2012

70 Renawati 33569 35 24 September 2012

71 Marhana 33463 50 26 September 2012

72 Rusmin 33524 55 26 September 2012

73 Nurlaina 33578 40 27 September 2012

74 M. Amirullah 33065 53 27 Agustus 2012

75 Sudirman 33495 40 05 September 2012

76 By Ulfah Nurul 33505 0 (Hr) 06 September 2012

77

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BULAN : Septem

Pelayanan Kes.Dan Besaran Tarif sesuai PERDA (R

Jasa Medis Jasa Medis

Keluar

Spesialis Umum

03 September 2012 Penetrating Thoraxo Abdomial 1,550,000Rp 780,000Rp 100,000Rp

08 September 2012 Suspect Tumor Abdomen 850,000Rp 330,000Rp 140,000Rp

01 September 2012 Decomp Cordis cc Asmd 200,000Rp 60,000Rp 40,000Rp

12 September 2012 Decomp Cordis cc Asmd 750,000Rp 360,000Rp 60,000Rp

05 September 2012 Syndrom Dispepsia 350,000Rp 180,000Rp 20,000Rp

10 September 2012 Smoke Islienik 550,000Rp 300,000Rp 20,000Rp

04 September 2012 G1PoA, kala II Loma gawat Janin 200,000Rp 120,000Rp

01 September 2012 Ca. Mamae 50,000Rp 30,000Rp 20,000Rp

02 September 2012Suspect Hepatitis + Ensepalopati

Fibrosa100,000Rp 30,000Rp 20,000Rp

10 September 2012 Musa Abdomen, Mioma Uteri 400,000Rp 240,000Rp

05 September 2012 Abshes Colli 150,000Rp 60,000Rp 20,000Rp

06 September 2012 Anemia 200,000Rp 90,000Rp 20,000Rp

09 September 2012 Ketuban Mudighae 300,000Rp 180,000Rp

16 September 2012 Diare Cair Akut 150,000Rp 60,000Rp 20,000Rp

07 September 2012 Abortus 200,000Rp 120,000Rp

08 September 2012 Gastritis 200,000Rp 60,000Rp 40,000Rp

08 September 2012Obs Hipoestesia Perianal Post

Trauma + Retensio Urine200,000Rp 90,000Rp 20,000Rp

07 September 2012 Mioma Uteri 100,000Rp 60,000Rp

12 September 2012 Ispa 300,000Rp 120,000Rp 40,000Rp

15 September 2012 Partus Abnorm dgn SC 500,000Rp 150,000Rp 100,000Rp

08 September 2012Multiple Laceratum Wound +

Fractur Phalange P Roximal50,000Rp 30,000Rp

10 September 2012 Retensio Plasenta 200,000Rp 120,000Rp

11 September 2012 Hiperbilirubinemia 200,000Rp 120,000Rp

08 September 2012 Koma Hipoglikemia 50,000Rp 30,000Rp 20,000Rp

15 September 2012 Asma Attack 450,000Rp 210,000Rp 40,000Rp

10 September 2012 G1 Hamil Aterm dgn gawat janin 200,000Rp 120,000Rp

10 September 2012 Obs Cholic Abdomen 150,000Rp 60,000Rp

24 September 2012 Asfiksia Berat +BBLC 850,000Rp 480,000Rp 20,000Rp

15 September 2012 Hipertensi Emergency 400,000Rp 210,000Rp 20,000Rp

20 September 2012 Malaria 600,000Rp 270,000Rp 60,000Rp

12 September 2012 Diare Cair Akut 150,000Rp 90,000Rp

13 September 2012 Malaria dgn Komplikasi 200,000Rp 120,000Rp

Akomodasi

GALDIAGNOSA

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13 September 2012 Gangren Diabets 400,000Rp 240,000Rp

12 September 2012 Syndrom Dispepsia 150,000Rp 60,000Rp 20,000Rp

24 September 2012 Kala II Inpartus dgn SC 850,000Rp 480,000Rp 20,000Rp

17 September 2012G3P2A0 Hamil 34 minggu dgn

Inpartus150,000Rp 60,000Rp 20,000Rp

13 September 2012 Asma Attack 150,000Rp 60,000Rp 20,000Rp

14 September 2012 Ulcus Pepticum 200,000Rp 90,000Rp 20,000Rp13 September 2012 Retensio Plasenta 150,000Rp 90,000Rp

14 September 2012 Calic Abdomen 150,000Rp 60,000Rp 20,000Rp

14 September 2012 Tuba Ovarium Abses 150,000Rp 60,000Rp 20,000Rp

15 September 2012 Hil 150,000Rp 90,000Rp

17 September 2012 Mioma Uteri 150,000Rp 90,000Rp

16 September 2012 Diare Cair Akut 150,000Rp 60,000Rp 20,000Rp

21 September 2012 Dyspepsia 400,000Rp 120,000Rp 80,000Rp

20 September 2012 Mertigoensetalitis 300,000Rp 120,000Rp 40,000Rp

22 September 2012 Stroke Iskemik 350,000Rp 150,000Rp 40,000Rp

26 September 2012 Stroke Iskemik 550,000Rp 240,000Rp 60,000Rp

21 September 2012 P0A0 dgn cista Ovarium 250,000Rp 150,000Rp

21 September 2012 Kiral Inspection 250,000Rp 60,000Rp 60,000Rp

21 September 2012 G3P2A0 PEW 200,000Rp 120,000Rp

24 September 2012 Syndrom Dispepsia 400,000Rp 60,000Rp 120,000Rp

19 September 2012 Syndrom Dispepsia 150,000Rp 60,000Rp 20,000Rp

29 September 2012 PPOK 600,000Rp 180,000Rp 120,000Rp

21 September 2012 Imetigo Krustosub 200,000Rp 120,000Rp

21 September 2012 HIL 200,000Rp 120,000Rp 20,000Rp

24 September 2012 Asma Bronkeal 350,000Rp 30,000Rp 120,000Rp

21 September 2012 Placenta Previa 150,000Rp 90,000Rp

23 September 2012 G4P3A0 450,000Rp 240,000Rp 20,000Rp21 September 2012 G1P0A0 Kala II lama 150,000Rp 90,000Rp

21 September 2012 Malaria 150,000Rp 60,000Rp

28 September 2012 Open Fractur Talus 400,000Rp 180,000Rp 40,000Rp

22 September 2012 CKE 100,000Rp 30,000Rp 20,000Rp

25 September 2012 Soft Tissue Tumor 250,000Rp 120,000Rp 20,000Rp

24 September 2012 Retensio Plasenta 50,000Rp 30,000Rp 20,000Rp

25 September 2012 Diare Cair Akut 150,000Rp 60,000Rp 20,000Rp

25 September 2012 Heald Injury GCS 15 150,000Rp 60,000Rp 20,000Rp

27 September 2012 ISPA 250,000Rp 90,000Rp 40,000Rp

26 September 2012 Malaria Tropik 200,000Rp 60,000Rp 40,000Rp

25 September 2012 G3P2A0 dgn PEB 200,000Rp 90,000Rp 20,000Rp

28 September 2012 Stroke Intrakranial 150,000Rp 90,000Rp

29 September 2012 HIL 200,000Rp 90,000Rp 20,000Rp

28 September 2012 100,000Rp 60,000Rp

03 September 2012 DM Type II 400,000Rp 150,000Rp 60,000Rp

13 September 2012 Cirosis Hapatis 400,000Rp 180,000Rp 40,000Rp

15 September 2012Abfirasi Meconium Hipoxic

Ischemic250,000Rp 300,000Rp

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bner

p)

Tindakan KecilTindakan

Sedang

Tindakan

Intensif Sederhana Kecil

620,000Rp 210,000Rp 1,350,000Rp 10,000Rp

360,000Rp 120,000Rp 180,000Rp 10,000Rp

80,000Rp 30,000Rp 10,000Rp

320,000Rp 160,000Rp 10,000Rp 100,000Rp

140,000Rp 30,000Rp 10,000Rp

200,000Rp 30,000Rp 10,000Rp

80,000Rp 90,000Rp 10,000Rp

20,000Rp 10,000Rp 50,000Rp

60,000Rp 90,000Rp 10,000Rp

180,000Rp 60,000Rp 90,000Rp 10,000Rp 100,000Rp

20,000Rp 90,000Rp 10,000Rp 50,000Rp

80,000Rp 30,000Rp 10,000Rp

40,000Rp 180,000Rp 10,000Rp

80,000Rp 10,000Rp 100,000Rp

135,000Rp 10,000Rp 100,000Rp

60,000Rp 30,000Rp 10,000Rp 100,000Rp

80,000Rp 10,000Rp

20,000Rp 10,000Rp

140,000Rp 90,000Rp 10,000Rp

40,000Rp 135,000Rp 10,000Rp

20,000Rp 60,000Rp 10,000Rp

60,000Rp 45,000Rp 10,000Rp

60,000Rp 80,000Rp 90,000Rp 10,000Rp

40,000Rp 160,000Rp 10,000Rp

180,000Rp 60,000Rp 10,000Rp 100,000Rp

80,000Rp 90,000Rp 10,000Rp 50,000Rp

60,000Rp 10,000Rp 100,000Rp

20,000Rp 450,000Rp 10,000Rp

140,000Rp 150,000Rp 315,000Rp 10,000Rp

240,000Rp 90,000Rp 10,000Rp 100,000Rp

80,000Rp 30,000Rp 10,000Rp 50,000Rp

100,000Rp 90,000Rp 10,000Rp 100,000Rp

Jasa Keperawatan

Berkas RM

Tindaka

DAFTAR TA

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160,000Rp 360,000Rp 10,000Rp 100,000Rp

60,000Rp 10,000Rp 100,000Rp

20,000Rp 405,000Rp 10,000Rp

40,000Rp 90,000Rp 10,000Rp 100,000Rp

60,000Rp 60,000Rp 10,000Rp

80,000Rp 30,000Rp 10,000Rp 100,000Rp60,000Rp 90,000Rp 10,000Rp

60,000Rp 10,000Rp

60,000Rp 10,000Rp

80,000Rp 90,000Rp 45,000Rp 10,000Rp 100,000Rp

30,000Rp 45,000Rp 10,000Rp

80,000Rp 10,000Rp 100,000Rp

160,000Rp 30,000Rp 10,000Rp 100,000Rp

120,000Rp 90,000Rp 270,000Rp 10,000Rp

140,000Rp 60,000Rp 10,000Rp

220,000Rp 90,000Rp 360,000Rp 10,000Rp

40,000Rp 135,000Rp 10,000Rp 100,000Rp

100,000Rp 30,000Rp 10,000Rp 100,000Rp

20,000Rp 60,000Rp 180,000Rp 10,000Rp

140,000Rp 30,000Rp 10,000Rp 100,000Rp

60,000Rp 60,000Rp 10,000Rp 100,000Rp

220,000Rp 60,000Rp 10,000Rp

20,000Rp 60,000Rp 90,000Rp 10,000Rp

80,000Rp 90,000Rp 10,000Rp

120,000Rp 30,000Rp 10,000Rp 100,000Rp

20,000Rp 135,000Rp 10,000Rp 100,000Rp

80,000Rp 120,000Rp 90,000Rp 20,000Rp60,000Rp 90,000Rp 10,000Rp

60,000Rp 10,000Rp

60,000Rp 240,000Rp 270,000Rp 10,000Rp

20,000Rp 30,000Rp 10,000Rp 100,000Rp

100,000Rp 120,000Rp 45,000Rp 10,000Rp 100,000Rp

40,000Rp 90,000Rp 10,000Rp

60,000Rp 60,000Rp 10,000Rp 100,000Rp

60,000Rp 60,000Rp 10,000Rp 100,000Rp

80,000Rp 90,000Rp 10,000Rp 100,000Rp

60,000Rp 30,000Rp 10,000Rp 100,000Rp

60,000Rp 135,000Rp 20,000Rp

60,000Rp 10,000Rp

20,000Rp 90,000Rp 135,000Rp 10,000Rp 100,000Rp

45,000Rp 10,000Rp

160,000Rp 120,000Rp 10,000Rp

160,000Rp 30,000Rp 10,000Rp 100,000Rp

20,000Rp 360,000Rp 10,000Rp

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Mengetahui

Direktur RSUD Tanah B

dr. H. Daru Dewa, M.

NIP. 19680710 199803

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Sedang BesarPersalinan

NormalPersalinan Sulit

Resusitasi Bayi

Baru Lahir

Kuretasi +

Anastesi

125,000Rp

125,000Rp

125,000Rp

125,000Rp 3,500,000Rp

125,000Rp

125,000Rp

200,000Rp

125,000Rp

125,000Rp

125,000Rp

di UGD Tindakan Persalinan & Kebidan

  GIHAN KALIM RAWAT JALAN PASIEN JAMKESDA RSUD TANAH BUMBU

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125,000Rp

800,000Rp

125,000Rp

800,000Rp

125,000Rp

125,000Rp

125,000Rp

125,000Rp

1,200,000Rp

125,000Rp

125,000Rp125,000Rp

125,000Rp

1,200,000Rp

200,000Rp

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umbu

.Kes

1 011

JUMLAH TOTAL

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Kuretasi Sulit +

Anastesi

Manual Plasenta +

AnastesiSederhana Kecil Sedang Besar

1,000,000Rp 1,750,000Rp 5,000,000Rp

4,000,000Rp

4,000,000Rp

1,750,000Rp

4,000,000Rp

1,625,000Rp

5,000,000Rp

an Tindakan Operasi Bedah

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1,750,000Rp

1,750,000Rp 5,000,000Rp

1,625,000Rp

1,750,000Rp

4,000,000Rp

4,000,000Rp

4,000,000Rp

5,000,000Rp

4,000,000Rp5,000,000Rp

1,750,000Rp

1,750,000Rp

1,625,000Rp

4,000,000Rp

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Sepunggur, November 2012

Bendahara Jamkesmas

M. Adhi Sulaiman

NIP. 19840415 200908 1 001

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Khusus Sederhana Kecil Sedang Besar Khusus

360,000Rp 600,000Rp 1,750,000Rp

1,400,000Rp

1,400,000Rp

600,000Rp

1,400,000Rp

1,750,000Rp

Anastesi

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600,000Rp

600,000Rp 1,750,000Rp

600,000Rp

1,400,000Rp

1,400,000Rp

1,400,000Rp

1,750,000Rp

5,250,000Rp 1,400,000Rp 1,800,000Rp1,750,000Rp

600,000Rp

600,000Rp

1,400,000Rp

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TAHUN : 2012

JUMLAH

TAGIHAN

6,091,000Rp 1,779,417Rp 22,950,417Rp

1,586,000Rp 20,000Rp 553,075Rp 4,149,075Rp

1,194,000Rp 1,614,000Rp

774,000Rp 197,768Rp 2,731,768Rp

372,000Rp 43,406Rp 1,145,406Rp

774,000Rp 183,639Rp 2,192,639Rp

412,000Rp 6,437,000Rp

161,000Rp 55,000Rp 396,000Rp

801,500Rp 1,236,500Rp

937,500Rp 9,029,378Rp 16,446,878Rp

170,000Rp 2,920,000Rp

338,000Rp 56,211Rp 824,211Rp

85,000Rp 217,309Rp 4,637,309Rp

120,500Rp 314,145Rp 854,645Rp

167,000Rp 55,810Rp 787,810Rp

983,500Rp 119,991Rp 1,603,491Rp

434,500Rp 80,022Rp 1,039,522Rp

215,500Rp 405,500Rp

1,475,000Rp 268,373Rp 2,443,373Rp

1,222,000Rp 50,000Rp 32,000Rp 7,764,000Rp

27,500Rp 75,000Rp 472,500Rp

638,000Rp 125,625Rp 2,823,625Rp

208,000Rp 768,000Rp

185,500Rp 458,675Rp 1,079,175Rp

443,000Rp 71,040Rp 1,564,040Rp

582,500Rp 355,645Rp 8,363,145Rp

178,000Rp 558,000Rp

878,000Rp 50,000Rp 299,802Rp 3,057,802Rp

1,009,500Rp 50,000Rp 15,902Rp 2,445,402Rp

2,529,500Rp 85,955Rp 3,985,455Rp

141,000Rp 551,000Rp

948,000Rp 1,568,000Rp

Pemeriksaan

Penunjang

Tindakan

MedisObat

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2,139,000Rp 1,143,182Rp 6,902,182Rp

316,500Rp 40,938Rp 757,438Rp

1,491,500Rp 150,000Rp 617,198Rp 13,268,698Rp

212,500Rp 47,494Rp 1,529,994Rp

510,500Rp 870,500Rp

372,000Rp 50,082Rp 952,082Rp333,000Rp 210,815Rp 2,568,815Rp

109,500Rp 42,374Rp 451,874Rp

425,000Rp

648,500Rp 84,609Rp 3,648,109Rp

525,000Rp 318,149Rp 7,368,149Rp

120,500Rp 540,500Rp

492,500Rp 117,070Rp 1,509,570Rp

460,000Rp 1,535,000Rp

412,000Rp 1,287,000Rp

1,039,500Rp 145,401Rp 2,839,901Rp

550,000Rp 100,000Rp 640,917Rp 7,500,917Rp

197,000Rp 127,104Rp 934,104Rp

336,000Rp 2,126,000Rp

519,000Rp 1,379,000Rp

356,500Rp 62,868Rp 879,368Rp

429,000Rp 1,619,000Rp

226,000Rp 50,000Rp 776,000Rp

582,500Rp 53,507Rp 6,556,007Rp

221,000Rp 6,634Rp 987,634Rp

398,000Rp 50,000Rp 75,523Rp 7,903,523Rp

939,000Rp 50,000Rp 14,584,000Rp666,000Rp 101,768Rp 8,042,768Rp

244,000Rp 9,500Rp 533,500Rp

927,000Rp 649,653Rp 5,251,653Rp

665,000Rp 975,000Rp

499,000Rp 62,544Rp 3,676,544Rp

1,214,000Rp 30,000Rp 3,109,000Rp

43,500Rp 503,500Rp

412,000Rp 84,800Rp 956,800Rp

431,000Rp 40,000Rp 65,175Rp 1,196,175Rp

507,500Rp 6,634Rp 1,014,134Rp

368,000Rp 100,000Rp 2,193,000Rp

325,500Rp 2,634Rp 638,134Rp

818,000Rp 19,739Rp 6,902,739Rp

273,000Rp 50,000Rp 106,018Rp 644,018Rp

565,500Rp 1,465,500Rp

707,000Rp 78,420Rp 1,705,420Rp

808,500Rp 100,000Rp 280,126Rp 2,328,626Rp

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242,652,564Rp