verifikasi maret 2012 free

TARIFPEMBAYARAN KLAIM KLINIK PPK TK I

PROGRAM KAPITASI RS. BHAKTI HUSADA CIKARANG

NO PPK TK I JUMLAH

1 KLINIK GEMPOL Rp 30,000

PT. Gunung Steel Group

PT. Daelim Indonesia

PT. Sapta Buana

2 KLINIK YAKESTI GROUP Rp 30,000


3 KLINIK HARAPAN MULIA Rp 30,000


PT. Sapta Buana

4 KLINIK GRAHA PRIMA Rp 35,000


PT. Buana Samudra Lestari

5 KLINIK BAYU HUSADA Rp 30,000



6 KLINIK RYDHOKA Rp 30,000



7 KLINIK AL - IKHLAS Rp 35,000


8 KLINIK GRAHA MEDIKA Rp 35,000



PT. Banshu

9 KLINIK ANNISA Rp 35,000



10 KLINIK SUKARAYA MEDIKA Rp 30,000



PT. Sapta Buana


11 KLINIK MADANIYAH Rp 30,000


12 KLINIK YADI MEDIKA Rp 30,000


RS. BHAKTI HUSADA CIKARANG

Jl. R. E. Martadinata (By Pass) Cikarang - Bekasi

REKAPITULASI KLAIM RAWAT JALAN

PESERTA PROGRAM KAPITASI RS. BHAKTI HUSADA CIKARANG

PERIODE MARET 2012

PROVIDER KLINIK GEMPOL (PT. Daelim)

NO TGL NAMA KARYAWAN NAMA PASIEN DIAGNOSA PERUSAHAAN DIAJUKAN DIBAYAR SELISIH KETERANGAN

1 2 OMAN SOMANTRI AN. KARINA DWI PERTIWI FOLLIKULITIS PT. DAELIM Rp 30,000 Rp 30,000

2 2 JAENUDIN TN. JAENUDIN GASTRITIS PT. DAELIM Rp 30,000 Rp 30,000

3 3 DADANG SUHENDAR TN. DADANG SUHENDAR OBS. FEBRIS PT. DAELIM Rp 30,000 Rp 30,000

4 3 SUKARDI NY. IMAS MUTIAH ISPA PT. DAELIM Rp 30,000 Rp 30,000

5 4 MAICSHAL ALFARIZI NY. RIRIS FERAWAT DERMATITIS PT. DAELIM Rp 30,000 Rp 30,000

6 6 AMRIN AN. AENI ZAHRO ISPA PT. DAELIM Rp 30,000 Rp 30,000

7 7 SUPRIYATNA TN. SUPRIYATNA FARINGITIS PT. DAELIM Rp 30,000 Rp 30,000

8 8 UJANG MULYANA TN. UJANG MULYANA CEPHALGIA PT. DAELIM Rp 30,000 Rp 30,000

9 9 OMAN SOMANTRI AN. FIRDA ANISA ISPA PT. DAELIM Rp 30,000 Rp 30,000

10 9 OMAN SOMANTRI TN. OMAN SOMANTRI ISK PT. DAELIM Rp 30,000 Rp 30,000

11 10 MAMAN KUSMANA NY. BADRIAH RFA PT. DAELIM Rp 30,000 Rp 30,000

12 11 HERMAWAN H. AN. ANEU LUTHFIANA ISPA PT. DAELIM Rp 30,000 Rp 30,000

13 13 DADAN GETI TN. DADAN GETI CC PT. DAELIM Rp 30,000 Rp 30,000

14 13 DADAN GETI NY. WACIH SUNDARI GEA PT. DAELIM Rp 30,000 Rp 30,000

15 13 YOSA SUTRISNA NY. SITI KHODIZAH DYSPEPSIA PT. DAELIM Rp 30,000 Rp 30,000

16 14 SUHENDI AN. FAIZ ILMAN ZUHRI FARINGITIS PT. DAELIM Rp 30,000 Rp 30,000

17 16 ASEP SAEPUL NAWAS AN. ARYA FADIHILAH R. GEA PT. DAELIM Rp 30,000 Rp 30,000

18 16 IKWAN JUMALIANTAKA TN. IKWAN JUMALIANTAKA GEA PT. DAELIM Rp 30,000 Rp 30,000

19 17 KANAL NY. ANIH CLAVUS PT. DAELIM Rp 30,000 Rp 30,000

20 17 SAEPUDIN TN. SAEPUDIN KONJUNGTIVITIS PT. DAELIM Rp 30,000 Rp 30,000

21 17 SAENO NY. SITI SOLEAH SINUSITIS PT. DAELIM Rp 30,000 Rp 30,000

22 18 AHMAD SOPYAN TN. AHMAD SOPYAN FEBRIS PT. DAELIM Rp 30,000 Rp 30,000

23 18 NANANG WAHYU AN. SILVI AULIA P. ISPA PT. DAELIM Rp 30,000 Rp 30,000

24 21 ASEP SAEPUL NAWAS NY. FATIMAH GEA PT. DAELIM Rp 30,000 Rp 30,000

25 23 MAMAN KUSMANA AN. RIZKI ILHAM P. DYSPEPSIA PT. DAELIM Rp 30,000 Rp 30,000

26 25 HERMAWAN H. AN. RIFI ANSORI ISPA PT. DAELIM Rp 30,000 Rp 30,000

27 30 SUKARDI AN. DAFFA S. ARDITIA ISPA PT. DAELIM Rp 30,000 Rp 30,000

28 30 OMAN SOMANTRI TN. OMAN SOMANTRI CC PT. DAELIM Rp 30,000 Rp 30,000

29 30 SUKARDI TN. SUKARDI CARIES DENTIS PT. DAELIM Rp 30,000 Rp 30,000

GRAND TOTAL

( (021) 8900530 - 31, Fax. (021) 8900570

Cikarang, April 2012

Mengetahui

Wadir. Yanmed & Keperawatan Wadir. Keuangan Verifikator

Dr. Firyanti Firman, MARS M. Iqbal, SE. Msi N. Frida M





PERIODE MARET 2012

PROVIDER KLINIK GEMPOL (PT. Gunung Steel Group)


1 1 CARSOMA NY. ASIH FOLIKULITIS PT. GG Rp 30,000 Rp 30,000

2 1 IGIS PARIDI TN. IGIS PARIDI GEA PT. GG Rp 30,000 Rp 30,000

3 1 MULYANA YAZRI TN. MULYANA YAZRI ISPA PT. GG Rp 30,000 Rp 30,000

4 2 KARYADI TN. KARYADI RFA PT. GG Rp 30,000 Rp 30,000

5 2 MAMAT DIMYATI NY. YANTI HIPERTENSI PT. GG Rp 30,000 Rp 30,000

6 3 KARYADI NY. NURLELA G1P0A0 H 20 MINGGU PT. GG Rp 30,000 Rp 30,000

7 4 DENI ROSBANDI AN. WIDIA DWI S. ISPA PT. GG Rp 30,000 Rp 30,000

8 4 DENI ROSBANDI NY. SRI KUSNIATI KB SUNTIK PT. GG Rp 30,000 Rp 30,000

9 4 SUHERMAN AN. M. RIZKI KURNIAWAN ISPA PT. GG Rp 30,000 Rp 30,000

10 4 KARTO NY. ADE KOMARIAH SUNTIK KB PT. GG Rp 30,000 Rp 30,000

11 5 CARSOMA TN. CARSOMA HAEMOROID PT. GG Rp 30,000 Rp 30,000

12 6 KUNTORO BIN WARSO NY. RATNA URTIKARIA PT. GG Rp 30,000 Rp 30,000

13 6 KUNTORO BIN WARSO AN. RIZKY R. FIRNANDA VE PT. GG Rp 30,000 Rp 30,000

14 8 DANIL MAUKAR TN. DANIL MAUKAR CHEST PAIN PT. GG Rp 30,000 Rp 30,000

15 8 KARTO AN. HENDRAWANTO CC PT. GG Rp 30,000 Rp 30,000

16 10 MUDA SUPRIYADI TN. MUDA SUPRIYADI ISPA, LBP PT. GG Rp 30,000 Rp 30,000

17 10 SAMSURI AN. SITI HALIMATUSSYIFA ISPA PT. GG Rp 30,000 Rp 30,000

18 10 BAHRUDIN TN. BAHRUDIN LBP PT. GG Rp 30,000 Rp 30,000

19 12 MIRYADI NY. SATINAH ISPA PT. GG Rp 30,000 Rp 30,000

20 12 EMPUD MAHPUDIN AN. RIZKY NUR YASIN ISPA PT. GG Rp 30,000 Rp 30,000

21 12 MIRYADI AN. BAMBANG HARIANSYAH ISPA PT. GG Rp 30,000 Rp 30,000

( (021) 8900530 - 31, Fax. (021) 8900570

22 12 JOHAN NY. TETI FATMAWATI OF HARI II PT. GG Rp 30,000 Rp 30,000

23 15 ASWANI NY. ARINA ISPA PT. GG Rp 30,000 Rp 30,000

24 15 YAYAT SUPRIYATNA NY. SITI OMASIH ISPA PT. GG Rp 30,000 Rp 30,000

25 15 ASEP SOPIYAN TN. ASEP SOPIYAN ISPA PT. GG Rp 30,000 Rp 30,000

26 15 KARDANA TN. KARDANA CC PT. GG Rp 30,000 Rp 30,000

27 16 ASEP SOPIYAN TN. ASEP SOPIYAN SUSP. TYPHOID PT. GG Rp 30,000 Rp 30,000

28 16 KARDANA NY. YUYUN SUMIYATI G3P1A1 H 6 MINGGU PT. GG Rp 30,000 Rp 30,000

29 16 MUDA SUPRIYADI NY. TASMINAH ISPA PT. GG Rp 30,000 Rp 30,000

30 16 RIPAL NOPIAN TN. RIPAL NOPIAN FARINGITIS AKUT PT. GG Rp 30,000 Rp 30,000

31 16 AHMAD RUHAN AN. M. FAHRUROZI ISPA, IMPETIGO PT. GG Rp 30,000 Rp 30,000

32 19 JOHAN TN. JOHAN DYSPEPSIA PT. GG Rp 30,000 Rp 30,000

33 20 KUNTORO BIN WARSO AN. RIZKY R. FIRNANDA ISPA PT. GG Rp 30,000 Rp 30,000

34 20 KUNTORO BIN WARSO NY. RATNA CARIES DENTIS PT. GG Rp 30,000 Rp 30,000

35 20 CARSOMA TN. CARSOMA SUSP. TYPHOID PT. GG Rp 30,000 Rp 30,000

36 21 MUDA SUPRIYADI NY. TASMINAH ISPA PT. GG Rp 30,000 Rp 30,000

37 21 WAWAN SUKMA R. AN. IRWAN MAULANA SUSP. TYPHOID PT. GG Rp 30,000 Rp 30,000

38 21 AHMAD RUHAN AN. SUFI ISNA HIKMATIAR OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000

39 21 WAWAN SUKMA R. NY. TUTI INDRIYANTI DERMATITIS INFECTED PT. GG Rp 30,000 Rp 30,000

40 22 MIRYADI NY. SATINAH ISPA PT. GG Rp 30,000 Rp 30,000

41 22 MADINAH AN. RAKA ABDILLAH VARICELLA PT. GG tidak dilampirkan foto pasien

42 22 SUHERMAN AN. M. RIZKI KURNIAWAN ISPA PT. GG Rp 30,000 Rp 30,000

43 23 MUDA SUPRIYADI NY. TASMINAH ASMA BRONCHIALE PT. GG Rp 30,000 Rp 30,000

44 24 HERMANSYAH P. AN. NASIR ANANDA PUTRA RFA PT. GG Rp 30,000 Rp 30,000

45 25 YAYAT SUPRIYATNA AN. WULAN FEBRIANTI RFA PT. GG Rp 30,000 Rp 30,000

46 26 ROSIM EFENDI AN. HAIKAL EFENDI ISPA PT. GG Rp 30,000 Rp 30,000

47 26 YAYAT SUPRIYATNA AN. WULAN FEBRIANTI ISPA PT. GG Rp 30,000 Rp 30,000

48 27 KARTO NY. ADE KOMARIAH ATHRITIS PT. GG Rp 30,000 Rp 30,000

49 28 MUDA SUPRIYADI TN. MUDA SUPRIYADI GOUT PT. GG Rp 30,000 Rp 30,000

50 28 ASEP SOPIYAN TN. ASEP SOPIYAN GASTRITIS PT. GG Rp 30,000 Rp 30,000

51 30 ISNANTO AN. M. NUR RIZKI GEA PT. GG Rp 30,000 Rp 30,000

52 30 M. CAYA BIN TAYIM TN. M. CAYA BIN TAYIM FARINGITIS PT. GG Rp 30,000 Rp 30,000

53 30 HERDIANSYAH AN. ARRUM SARI ISPA, HORDELEUM PT. GG Rp 30,000 Rp 30,000

54 31 ISNANTO NY. NENI SUMARNI GEA PT. GG Rp 30,000 Rp 30,000

55 31 RAHMAT HIDAYAT AN. ABDUL MALIK RFA, DYSPEPSIA PT. GG Rp 30,000 Rp 30,000

GRAND TOTAL


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK GEMPOL (PT. Sapta Buana)


1 7 ENCENG AN. WIDAN AL HASBI PTODERMA PT. SAPTA BUANA Rp 30,000 Rp 30,000

2 20 SRI MARYATI NY. SRI MARYATI GASTRITIS PT. SAPTA BUANA Rp 30,000 Rp 30,000

3 20 ENCENG NY. SHOLIHAT AKSEPTOR KB SUNTIK PT. SAPTA BUANA Rp 30,000 Rp 30,000

GRAND TOTAL


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK GEMPOL (PT. Banshu)


21 SUJADI AN. ANANDA ADILA F. OBS. FEBRIS PT. Banshu Rp 30,000 Rp 30,000

27 SUJADI NY. CUCUM SUMIYATI DYSPEPSIA PT. Banshu Rp 30,000 Rp 30,000

( (021) 8900530 - 31, Fax. (021) 8900570

( (021) 8900530 - 31, Fax. (021) 8900570

27 SUJADI TN. SUJADI ISPA PT. Banshu Rp 30,000 Rp 30,000

27 SUJADI AN. AULIA NABILA CC PT. Banshu Rp 30,000 Rp 30,000

GRAND TOTAL


Mengetahui



PEMBAYARAN KLAIM RAWAT JALAN


PERIODE MARET 2012

PROVIDER KLINIK GEMPOL (PT. Daelim)

NO KETERANGAN KASUS JUMLAH

1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK GEMPOL (PT. Gunung Steel Group)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK GEMPOL (PT. Sapta Buana)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK GEMPOL (PT. Banshu)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK YAKESTI GROUP (PT. Daelim Indonesia)


1 1 SRI WIDODO AN. M. SAEP AGUS S. ISPA PT. DAELIM Rp 30,000 Rp 30,000

2 1 SRI WIDODO NY. UMI SOLIKHAN URTUKARIA PT. DAELIM Rp 30,000 Rp 30,000

3 1 SRI WIDODO AN. ENJELIA UMU ISPA PT. DAELIM Rp 30,000 Rp 30,000

4 4 SRI WIDODO AN. ENJELIA UMU ISPA PT. DAELIM Rp 30,000 Rp 30,000

5 6 SUNARDI NY. FITRIA HADI GASTRITIS PT. DAELIM Rp 30,000 Rp 30,000

6 9 AMIRUDIN AN. ZIDNI AL MUSYADDID CHEPALGIA PT. DAELIM Rp 30,000 Rp 30,000

7 9 ABDUL MUSANIP TN. ABDUL MUSANIP ISPA PT. DAELIM Rp 30,000 Rp 30,000

8 13 HASBIALLAH TN. HASBIALLAH ISPA PT. DAELIM Rp 30,000 Rp 30,000

9 14 ADAM IRIANA TN. ADAM IRIANA CONJUNGTIVITIS PT. DAELIM Rp 30,000 Rp 30,000

10 17 BAEDOWI NY. UDAH MUZALIDAH ISPA PT. DAELIM Rp 30,000 Rp 30,000 tanggal legalisasi di kartu kapitasi sudah kadaluarsa

11 18 ABDUL MUSANIP NY. RAHMA YANTI FARINGITIS PT. DAELIM Rp 30,000 Rp 30,000

12 18 JASMAN TN. JASMAN ISPA PT. DAELIM Rp 30,000 Rp 30,000

13 30 ANAN AFANDI NY. MINAH ARTHRITIS PT. DAELIM Rp 30,000 Rp 30,000

14 31 ANAN AFANDI TN. ANAN AFANDI CHEPALGIA PT. DAELIM Rp 30,000 Rp 30,000

GRAND TOTAL


Mengetahui





( (021) 8900530 - 31, Fax. (021) 8900570

( (021) 8900530 - 31, Fax. (021) 8900570



PERIODE MARET 2012

PROVIDER KLINIK YAKESTI GROUP (PT. Gunung Steel Group)


1 1 SAMSI AN. DWI SUHANTORO VARICCELA PT. GG Rp 30,000 Rp 30,000 Rp -

2 2 SAMSI AN. NOVATUL ISTIQOMAH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

3 2 SAMSI NY. DIAH RISMAYATI ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

4 3 SUSSIANTO TN. SUSSIANTO SUSP. ISK PT. GG Rp 30,000 Rp 30,000 Rp -

5 3 GRADUS NGARE TN. GRADUS NGARE ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

6 3 YURI SUSETYO TN. YURI SUSETYO DIARE PT. GG Rp 30,000 Rp 30,000 Rp -

7 4 MARUWIH AN. FAHMI F. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

8 7 GRADUS NGARE TN. GRADUS NGARE ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

9 8 ADE ANGGRIAWAN TN. ADE ANGGRIAWAN DYSPEPSIA PT. GG Rp 30,000 Rp 30,000 Rp -

10 8 DEDI SAPUTRA TN. DEDI SAPUTRA DERMATITIS PT. GG Rp 30,000 Rp 30,000 Rp -

11 10 DUDUNG SUDARMAJI TN. DUDUNG SUDARMAJI LBP PT. GG Rp 30,000 Rp 30,000 Rp -

12 10 SOBARI TN. SOBARI ISPA, HIPERTENSI PT. GG Rp 30,000 Rp 30,000 Rp -

13 11 NANA IRFANA TN. NANA IRFANA FARINGITIS PT. GG Rp 30,000 Rp 30,000 Rp -

14 11 NANA IRFANA AN. DIMAS ADIWIANSH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

15 12 MEMED TARMEDI TN. MEMED TARMEDI CC PT. GG Rp 30,000 Rp 30,000 Rp -

16 13 SAMSI AN. DWI SUHANTORO VARICCELA PT. GG Rp 30,000 Rp 30,000 Rp -

17 13 DUDUNG SUDARMAJI AN. YUNI NURAINI ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

18 13 KISTANTO AN. AINUR RIZQI OBS. FEBRIS, ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

19 13 MUSTOPA AN. IBNU ZASKI MUSHOFA ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

20 14 SUSSIANTO TN. SUSSIANTO CC PT. GG Rp 30,000 Rp 30,000 Rp - Kartu kapitasi tidak dilampirkan foto pasien

21 14 SAMSI NY. DIAH RISMAYATI PIL KB PT. GG Rp 30,000 Rp 30,000 Rp -

22 15 SUHARTO TN. SUHARTO ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

23 16 SUSSIANTO TN. SUSSIANTO GEA PT. GG Rp 30,000 Rp 30,000 Rp - Kartu kapitasi tidak dilampirkan foto pasien

24 16 MUSTOPA NY. FATMAWATI CC PT. GG Rp 30,000 Rp 30,000 Rp -

25 17 MUSTOPA NY. FATMAWATI GASTRITIS PT. GG Rp 30,000 Rp 30,000 Rp -

26 18 SUNGKONO AN. FAROL IBRAHIM MUFIKISPA PT. GG Rp 30,000 Rp 30,000 Rp -

27 18 SUNGKONO TN. SUNGKONO OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

28 19 MUSTOPA AN. IBNU ZASKI MUSHOFA PT. GG Rp 30,000 Rp 30,000 Rp - Tidak tercantum Diagnosa pasien di tanda bukti berobat

29 20 EFSON SIHOMBING AN. NANCY GISELA S. DYSPEPSIA PT. GG Rp 30,000 Rp 30,000 Rp -

30 22 WIDI SETYA W. TN. WIDI SETYA W. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

31 23 EFSON SIHOMBING AN. NANCY GISELA S. VULNUS LACERATUM PT. GG Rp 30,000 Rp 30,000 Rp -

32 23 SUSSIANTO NY. PARSI LBP PT. GG Rp 30,000 Rp 30,000 Rp -

33 23 TRI YULIYANTO AN. SINTA AMELIA OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

34 23 VERNANDO TN. VERNANDO DIARE AKUT PT. GG Rp 30,000 Rp 30,000 Rp -

35 24 M. ZAINUDIN TN. M. ZAINUDIN ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

36 25 NIUS MAKASAR NY. CHRISTINE ARIFIN CEPHALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

37 26 HENDI WIJAYA TN. HENDI WIJAYA ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

38 26 MARUWIH AN. FAHMI F. DYSPEPSIA PT. GG Rp 30,000 Rp 30,000 Rp -

39 28 EFSON SIHOMBING AN. NANCY GISELA S. VL PT. GG Rp 30,000 Rp 30,000 Rp -

40 30 SUHARTO TN. SUHARTO ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

41 30 DAVID SANJAYA TN. DAVID SANJAYA COMBUSTIO PT. GG Rp 30,000 Rp 30,000 Rp -

42 31 EFSON SIHOMBING AN. NANCY GISELA S. CC PT. GG Rp 30,000 Rp 30,000 Rp -

GRAND TOTAL


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK YAKESTI GROUP (PT. Buana Samudra Lestari)


1 17 ANIM SETIAWAN NY. NUR SAMSIAH ISPA PT. BSL Rp 30,000 Rp 30,000

2 14 ANIM SETIAWAN AN. M. RAFIF SETIAWAN ISPA PT. BSL Rp 30,000 Rp 30,000

GRAND TOTAL


Mengetahui


( (021) 8900530 - 31, Fax. (021) 8900570






PERIODE MARET 2012

PROVIDER KLINIK YAKESTI GROUP (PT. Banshu)


1 20 AHMAD DARIS AN. ARINI BAROKAH ISPA PT. BANSHU Rp 30,000 Rp 30,000

2 20 AHMAD DARIS AN. AT ILMAN NAFI ISPA PT. BANSHU Rp 30,000 Rp 30,000

3 20 AHMAD DARIS NY. UMI RUSLIYATI ISPA PT. BANSHU Rp 30,000 Rp 30,000

GRAND TOTAL


Mengetahui





PERIODE MARET 2012

PROVIDER KLINIK YAKESTI GROUP (PT. Daelim Indonesia)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

( (021) 8900530 - 31, Fax. (021) 8900570

PROVIDER KLINIK YAKESTI GROUP (PT. Gunung Steel Group)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK YAKESTI GROUP (PT. Buana Samudra Lestari)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK YAKESTI GROUP (PT. Banshu)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH


Mengetahui







PERIODE MARET 2012

PROVIDER RS. HARAPAN MULIA (PT. Daelim)

NO TGL NAMA KARYAWAN NAMA PASIEN DIAGNOSA PERUSAHAAN DIAJUKAN DIBAYAR SELISIH KETERANGAN1 1 HARTOYO TN. HARTOYO ISPA PT. DAELIM Rp 30,000 Rp30,000 Rp - 2 2 UCU SUGIANTO TN. UCU SUGIANTO ISPA PT. DAELIM Rp 30,000 Rp30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

3 3 ABDUL HARIS NY. SUPIAH KONTRASEPSI PT. DAELIM Rp 30,000 Rp30,000 Rp - 4 4 WAHIDIN AN. NAYFA AQILAH WAHID ISPA PT. DAELIM Rp 30,000 Rp30,000 Rp - 5 4 WAHIDIN AN. NABIL NUR WAHID EPISTAKSIS PT. DAELIM Rp 30,000 Rp30,000 Rp - 6 4 SAPUAN AN. ALVIN RAMADHAN S. ISPA PT. DAELIM Rp 30,000 Rp30,000 Rp - 7 4 NURCAHYO NN. RENY AFIYANI DYSMENORHAE PT. DAELIM Rp 30,000 Rp30,000 Rp - 8 4 NURCAHYO NY. KASMIYATI DYSPEPSIA PT. DAELIM Rp 30,000 Rp30,000 Rp - 9 6 IRWAN HERMAWAN NY. ELY SETIA WATI CC, ASMA PT. DAELIM Rp 30,000 Rp30,000 Rp - 10 8 JAYADI TN. JAYADI ISPA PT. DAELIM Rp 30,000 Rp30,000 Rp - 11 9 ABDUL HARIS AN. IKA NUR FADILAH ISPA PT. DAELIM Rp 30,000 Rp30,000 Rp - 12 11 ABDUL HARIS TN. IMAM ZARKASY ISPA PT. DAELIM Rp 30,000 Rp30,000 Rp - 13 12 IRWAN HERMAWAN NY. ELY SETIA WATI KONTRASEPSI PT. DAELIM Rp 30,000 Rp30,000 Rp - 14 14 ENCEP SAEPUDIN AN. FATIH RIZIK ISPA PT. DAELIM Rp 30,000 Rp30,000 Rp - 15 15 RIDWAN AN. SATRIA DWI ARDI FEBRIS PT. DAELIM Rp 30,000 Rp30,000 Rp - 16 17 MUHAEMIN AN. ABDUR RAMDANI OBS. FEBRIS PT. DAELIM Rp 30,000 Rp30,000 Rp - 17 21 AGUS TN. AGUS HEMATOM DIGIT III PT. DAELIM Rp 30,000 Rp30,000 Rp - 18 22 RIDWAN IBRAHIM NY. SITI MARFUAH OBS. FEBRIS PT. DAELIM Rp 30,000 Rp30,000 Rp - 19 22 RIDWAN IBRAHIM TN. RIDWAN IBRAHIM OBS. TYPHOID PT. DAELIM Rp 30,000 Rp30,000 Rp - 20 24 NURCAHYO TN. NURCAHYO BRONCHOPMONI PT. DAELIM Rp 30,000 Rp30,000 Rp - 21 25 NURCAHYO NN. ANIS MUFIDAH TFA PT. DAELIM Rp 30,000 Rp30,000 Rp -

22 28 NURKHOLIS TN. NURKHOLIS COLIC RENAL SINISTR PT. DAELIM Rp 30,000 Rp30,000 Rp -

23 29 NURCAHYO TN. NURCAHYO ISKA PT. DAELIM Rp 30,000 Rp30,000 Rp -

GRAND TOTAL


Mengetahui


( (021) 8900530 - 31, Fax. (021) 8900570




REKAPITULASI KLAIM RAWAT JALANPESERTA PROGRAM KAPITASI RS. BHAKTI HUSADA CIKARANG

PERIODE MARET 2012

PROVIDER RS. HARAPAN MULIA (PT. Sapta Buana)


23 RARA SANTO AN. RANU ALFIANTO ISPA PT. GG Rp 30,000 Rp30,000 Rp -

23 RARA SANTO AN. FAJAR ARGA A. ISPA PT. GG Rp 30,000 Rp30,000 Rp -

17 SUTRISNO TN. SUTRISNO DYSPEPSIA PT. GG Rp 30,000 Rp30,000 Rp -

17 SUTRISNO AN. RISNIA SYAH ISPA PT. GG Rp 30,000 Rp30,000 Rp -

29 MIFTAKHUDIN TN. MIFTAKHUDIN DYSPEPSIA PT. GG Rp 30,000 Rp30,000 Rp -

GRAND TOTAL


Mengetahui





PERIODE MARET 2012

PROVIDER RS. HARAPAN MULIA (PT. Daelim)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

( (021) 8900530 - 31, Fax. (021) 8900570

PROVIDER RS. HARAPAN MULIA (PT. Sapta Buana)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH


Mengetahui



tanggal legalisasi di kartu kapitasi sudah kadaluarsa





PERIODE MARET 2012

PROVIDER KLINIK GRAHA PRIMA (PT. Buana Samudra Lestari)


1 1 NUNUNG SUKAPTI NY. NUNUNG SUKAPTI CHEPALGIA PT. BSL Rp 35,000 Rp 35,000 Rp -

2 2 MANIH NY. ,MANIH SUNTIK KB PT. BSL Rp 35,000 Rp 35,000 Rp -

3 3 ANA WIDURI TN. DANA KRISTIADI ABSES PT. BSL Rp 35,000 Rp 35,000 Rp -

4 5 ATIH AN. FATIMAH AZZAHRA ISPA PT. BSL Rp 35,000 Rp 35,000 Rp -

5 6 ATIH AN. AISYAH NURALIAH ISPA PT. BSL Rp 35,000 Rp 35,000 Rp -

6 9 ATIH TN. ENTONG ROSIDI OBS. FEBRIS PT. BSL Rp 35,000 Rp 35,000 Rp -

7 9 YUYUN NY. YUYUN HYPOTENSI PT. BSL Rp 35,000 Rp 35,000 Rp -

8 10 SRI MARNELA TN. SARLAN DYSPEPSIA PT. BSL Rp 35,000 Rp 35,000 Rp -

9 11 NAROH AN. NAYLA APRILIA P. ISPA PT. BSL Rp 35,000 Rp 35,000 Rp -

10 12 SAINIH NY. SAINIH MYALGIA PT. BSL Rp 35,000 Rp 35,000 Rp -

11 12 MANIH AN. RIDHO PITRA R. CC PT. BSL Rp 35,000 Rp 35,000 Rp -

12 13 MISRA SARI TN. ZAINAL RHEMATIK PT. BSL Rp 35,000 Rp 35,000 Rp -

13 18 ATIH AN. FATIMAH AZZAHRA OBS. FEBRIS PT. BSL Rp 35,000 Rp 35,000 Rp -

14 19 JANIH JANAH NY. JANIH JANAH SUSP. THYPOID PT. BSL Rp 35,000 Rp 35,000 Rp -

15 19 JANIH JANAH AN. MUTIARA SANI ISPA PT. BSL Rp 35,000 Rp 35,000 Rp -

16 20 ATIH NY. ATIH ALLERGI PT. BSL Rp 35,000 Rp 35,000 Rp -

17 22 WAHYUNI ASIH AN. AFIFAH KHOIRINISA ISPA PT. BSL Rp 35,000 Rp 35,000 Rp -

18 22 WAHYUNI ASIH TN. SUYITNO ISPA PT. BSL Rp 35,000 Rp 35,000 Rp -

19 22 SUHARNI NY. SUHARNI ISPA PT. BSL Rp 35,000 Rp 35,000 Rp -

20 23 ATIH TN. ENTONG ROSIDI CHEPALGIA PT. BSL Rp 35,000 Rp 35,000 Rp -

21 24 MISRA SARI NY. MISRA SARI MYALGIA PT. BSL Rp 35,000 Rp 35,000 Rp -

22 25 IMAH TN. NEDIH CARIES DENTIS PT. BSL Rp 35,000 Rp 35,000 Rp -

23 26 ATIH NY. ATIH GEA PT. BSL Rp 35,000 Rp 35,000 Rp -

24 27 YUYUN TN. NESIN CC PT. BSL Rp 35,000 Rp 35,000 Rp -

25 28 ATIH AN. FATIMAH AZZAHRA ISPA PT. BSL Rp 35,000 Rp 35,000 Rp -

26 28 ATIH AN. AHMAD HABIBI CARIES DENTIS PT. BSL Rp 35,000 Rp 35,000 Rp -

27 28 IMAH NY. IMAH ISPA PT. BSL Rp 35,000 Rp 35,000 Rp -

( (021) 8900530 - 31, Fax. (021) 8900570

28 29 MUINAH ANDRIANI TN. ACEP SUPRIADI ASMA BRONCHIALE PT. BSL Rp 35,000 Rp 35,000 Rp -

29 31 WAHYUNI ASIH AN. AQIL RIDHWAN H. ISPA PT. BSL Rp 35,000 Rp 35,000 Rp -

GRAND TOTAL


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK GRAHA PRIMA (PT. Daelim)


5 DENI PUTRA MAHARTA TN. DENI PUTRA MAHARTA ISPA PT. DAELIM Rp 35,000 Rp 35,000 Rp -

20 WARYONO TN. WARYONO CC PT. DAELIM Rp 35,000 Rp 35,000 Rp -

21 DEDI MULYADI TN. DEDI MULYADI CARIES DENTIS PT. DAELIM Rp 35,000 Rp 35,000 Rp -

24 ABDUROHIM AN. SYAMSUL ALDIANSYAH CC PT. DAELIM Rp 35,000 Rp 35,000 Rp -

28 DENI PUTRA MAHARTA TN. DENI PUTRA MAHARTA ISPA PT. DAELIM Rp 35,000 Rp 35,000 Rp -

GRAND TOTAL


Mengetahui





( (021) 8900530 - 31, Fax. (021) 8900570




PERIODE MARET 2012

PROVIDER KLINIK GRAHA PRIMA (PT. Sapta Buana)


3 FITRIYANTO P AN. AHMAD BILAL P. ISPA PT. Sapta Buana Rp 35,000 Rp 35,000 Rp -

15 HENDRI HARTOKO TN. HENDRI HARTOKO CHEPALGIA PT. Sapta Buana Rp 35,000 Rp 35,000 Rp -

GRAND TOTAL


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK GRAHA PRIMA (PT. Gunung Steel Group)


1 2 HENDRIK AN. RINJANI LESTARI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

2 2 ARTO SUNARTO AN. DEA ARTA NISA FARINGITIS AKUT PT. GG Rp 35,000 Rp 35,000 Rp -

3 3 NASTIRI NY. SARIPAH CHEPALGIA PT. GG Rp 35,000 Rp 35,000 Rp -

4 4 IDI SETIADI TN. IDI SETIADI VERTIGO PT. GG Rp 35,000 Rp 35,000 Rp -

5 5 IDI SETIADI NY. YANTI RIANI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

6 6 TRI TEGUH RIYANTO NY. SUKARNI CARIES DENTIS PT. GG Rp 35,000 Rp 35,000 Rp -

( (021) 8900530 - 31, Fax. (021) 8900570

( (021) 8900530 - 31, Fax. (021) 8900570


7 6 M. EFENDI AN. SYIFA ZAHIRA EFENDI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

8 7 MARWAN TN. MARWAN GASTRITIS PT. GG Rp 35,000 Rp 35,000 Rp -

9 7 AHMAD NAHROWI TN. AHMAD NAHROWI CC PT. GG Rp 35,000 Rp 35,000 Rp -

10 7 ARTO SUNARTO AN. DEA ARTA NISA ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

11 9 BAMBANG FREDIANTO TN. BAMBANG FREDIANTO GOUT PT. GG Rp 35,000 Rp 35,000 Rp -

12 10 ABDUL ROHIM NY. ROSINI CC PT. GG Rp 35,000 Rp 35,000 Rp -

13 10 ABDUL ROHIM AN. MUHAMAD REHAN ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

14 10 RUDY JULIANDI TN. RUDY JULIANDI MYALGIA PT. GG Rp 35,000 Rp 35,000 Rp -

15 11 MOKHAMAD HIDAYAT AN. NATASYA AURA ISPA PT. GG Rp 35,000 Rp 35,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

16 12 NIPIN SARIPUDIN AN. ALDIANSYAH OBS. FEBRIS PT. GG Rp 35,000 Rp 35,000 Rp -

17 12 NIPIN SARIPUDIN TN. NIPIN SARIPUDIN ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

18 13 SARBINIH AN. ZULFIKAR ALI MUKHTI DYSPEPSIA PT. GG Rp 35,000 Rp 35,000 Rp -

19 14 AGUS PRASETIO NY. NURHAYATI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

20 14 ARTO SUNARTO NY. NENENG S. CHEPALGIA PT. GG Rp 35,000 Rp 35,000 Rp -

21 15 AGUS SUWINDRO NY. LILIK SUSILOWATI VERTIGO PT. GG Rp 35,000 Rp 35,000 Rp -

22 15 SUNGKONO AN. DIAN NIKO PRATAMA ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

23 16 WASYATIN AN. PRATIWI INDRIYANI CARIES DENTIS PT. GG Rp 35,000 Rp 35,000 Rp -

24 17 BAMBANG LASMONO NY. LAELA LATIFAH GASTRITIS PT. GG Rp 35,000 Rp 35,000 Rp -

25 18 MARWAN NY. ATI SUHATI ALLERGIA PT. GG Rp 35,000 Rp 35,000 Rp -

26 18 MINAR RESLINA PR. AN. CLESYA CRISTINE ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

27 18 TRI TEGUH RIYANTO AN. SASKIA EKA P. GEA PT. GG Rp 35,000 Rp 35,000 Rp -

28 18 ARTO SUNARTO AN. DEA ARTA NISA GEA PT. GG Rp 35,000 Rp 35,000 Rp -

29 19 ARTO SUNARTO TN. ARTO SUNARTO CC PT. GG Rp 35,000 Rp 35,000 Rp -

30 19 NUR HADI PRAYITNO AN. ABDUL MANAN P. ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

31 19 SINTORO AN. M. FAHRI AL FAZRI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

32 19 MANGASI BATUBARA NY. ROSMERI BB. MYALGIA PT. GG Rp 35,000 Rp 35,000 Rp -

33 19 SUWARTONO TN. SUWARTONO SUSP. THYPOID PT. GG Rp 35,000 Rp 35,000 Rp -

34 20 SARBINIH AN. RULLYA NURJANAH VARICELLA PT. GG Rp 35,000 Rp 35,000 Rp -

35 21 SUNGKONO AN. FAROL IBRAHIM MUFIK OBS. FEBRIS PT. GG Rp 35,000 Rp 35,000 Rp -

36 21 M. EFENDI NY. DEWI SETIANINGSIH CHEPALGIA PT. GG Rp 35,000 Rp 35,000 Rp -

37 22 SARIF HIDAYAT NY. MARYAM CARIES DENTIS PT. GG Rp 35,000 Rp 35,000 Rp -

38 22 WASYATIN AN. PRATIWI INDRIYANI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

39 23 AGUS LESTARI NY. YUNI S. CC PT. GG Rp 35,000 Rp 35,000 Rp -

40 23 NUR HADI PRAYITNO AN. ABDUL MANAN P. GEA PT. GG Rp 35,000 Rp 35,000 Rp -

41 24 HERY PRAYITNO NY. RAMIDA Br. PINEM CHEPALGIA, HIPERTENSI PT. GG Rp 35,000 Rp 35,000 Rp -

42 24 M. EFENDI AN. SYIFA ZAHIRA EFENDI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

43 26 SUNGKONO NY. ANEKE WASYANTI CARIES DENTIS PT. GG Rp 35,000 Rp 35,000 Rp -

44 27 RUDY JULIANDI AN. ROUF F. VOMITUS PT. GG Rp 35,000 Rp 35,000 Rp -


45 28 TRISNO SUSANTORO NY. LILIS NURCAHYANI GASTRITIS PT. GG Rp 35,000 Rp 35,000 Rp -

46 28 RICHAD PURBA NY. LISBED R. A SIDABUTAR FEBRIS PT. GG Rp 35,000 Rp 35,000 Rp -

47 29 ABDUL ROHIM TN. ABDUL ROHIM ALLERGIA PT. GG Rp 35,000 Rp 35,000 Rp -

48 30 RICHAD PURBA HARUMI M.D PURBA SUSP. THYPOID PT. GG Rp 35,000 Rp 35,000 Rp -

49 30 HENDRIK AN. RINJANI LESTARI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

50 31 DARWIS NY. WARSIAH ISPA PT. GG Rp 35,000 Rp 35,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

51 31 ABDUL ROHIM AN. MUHAMAD REHAN GEA PT. GG Rp 35,000 Rp 35,000 Rp -

52 31 MARWAN TN. MARWAN CC PT. GG Rp 35,000 Rp 35,000 Rp -

GRAND TOTAL


Mengetahui





PERIODE MARET 2012

PROVIDER KLINIK GRAHA PRIMA (PT. Buana Samudra Lestari)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK GRAHA PRIMA (PT. Daelim)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK GRAHA PRIMA (PT. Sapta Buana)



1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK GRAHA PRIMA (PT. Gunung Steel Group)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK BAYU HUSADA (PT. Buana Samudra Lestari)


PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

GRAND TOTAL


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK BAYU HUSADA (PT. Daelim Indonesia)


PT. DAELIM Rp 30,000 Rp 30,000 Rp -





( (021) 8900530 - 31, Fax. (021) 8900570

( (021) 8900530 - 31, Fax. (021) 8900570

GRAND TOTAL


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK BAYU HUSADA (PT. Gunung Steel Group)


PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

( (021) 8900530 - 31, Fax. (021) 8900570


PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -


PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -


PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -


PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 15,000 Rp 15,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -


PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -


PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp - Rp 30,000

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -


PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

PT. GG Rp 30,000 Rp 30,000 Rp -

GRAND TOTAL


Mengetahui





PERIODE MARET 2012

PROVIDER KLINIK BAYU HUSADA (PT. Buana Samudra Lestari)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK BAYU HUSADA (PT. Daelim Indonesia)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK BAYU HUSADA (PT. Gunung Steel Group)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH



Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK RYDHOKA (PT. Gunung Steel Group)


1 1 SUTAR TN. SUTAR VL ec KLL PT. GG Rp 30,000 Rp 30,000 Rp - KLL hanya di jamin 50 %

2 1 HERU SUMARNO TN. HERU SUMARNO ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

3 1 FEBRIANTO NURVENDA TN. FEBRIANTO NURVENDA ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

4 2 RICKY HERLIANSYAH TN. RICKY HERLIANSYAH CHEPALGIA ec HT PT. GG Rp 30,000 Rp 30,000 Rp -

5 2 WAHIM AN. EMMA ANGGRAINI H. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

6 3 ABDULLAH AN. FATHAN ALMAYZAN ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

7 3 HERRY SYACHRONI TN. HERRY SYACHRONI OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

8 3 HERRY SYACHRONI NY. NIA AGUSTIN SUSANTI ANC G2P1A0 PT. GG Rp 30,000 Rp 30,000 Rp -

9 4 SRI WAHYUDI AN. PUTRI UMI PRATIWI ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

10 5 JUNI AN. AGUSTI SETIAWAN STOMATITIS PT. GG Rp 30,000 Rp 30,000 Rp -

11 5 SUNARDI NY. SUKAMTI CARRIES DENTIS PT. GG Rp 30,000 Rp 30,000 Rp -

12 5 SUNARDI AN. SITI FATIMAH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

13 6 PARWOTO TN. PARWOTO ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

14 7 DEDE SETIAWAN TN. DEDE SETIAWAN ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

15 7 ARIS SUTORO AN. MUTIARA RIZKI F. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

16 8 FIRMAN YUDIAR S. TN. FIRMAN YUDIAR S. CHEPALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

17 8 SUPARYO NY. LASIYAH RA PT. GG Rp 30,000 Rp 30,000 Rp -

18 8 DESTARIS TARIGAN AN. NIKO E. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

19 8 SURIP SULISTIYONO AN. WAYAN SAPUTRA HERPES PT. GG Rp 30,000 Rp 30,000 Rp -

20 10 MARSUD WARYANTO TN. MARSUD WARYANTO ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

21 10 WARIDI NY. RUKMINI KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

22 10 WARIDI NY. RUKMINI ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

23 10 ENDANG PUJI LESTARI AN. BAYU ADITYO A. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

24 10 NURYANTO TN. NURYANTO SSP DISLOKASI PT. GG Rp 30,000 Rp 30,000 Rp -

25 10 NURYANTO AN. SHAFA AULIA A. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

26 11 RICKY HERLIANSYAH AN. LAURA RIKA NATASIA GEA PT. GG Rp 30,000 Rp 30,000 Rp -

27 11 AHMAD ROKHALI TN. AHMAD ROKHALI ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

28 11 RIDI RAIMAN S. AN. DIRLI RAIMA ISPA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

29 11 DONALD SIMANUNGKALITAN. LUKAS PEDRO ISPA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

( (021) 8900530 - 31, Fax. (021) 8900570





PERIODE MARET 2012

PROVIDER KLINIK AL - IKHLAS (PT. Gunung Steel Group)


1 3 HAMDAN ABDULLAH AN. SYAHRINI ISPA PT. GG tanggal legalisasi di kartu kapitasi sudah kadaluarsa

2 3 OMAN AN. SATYA RAMADAN ISPA PT. GG tidak tercantum tanggal legalisasi di kartu kapitasi

3 4 ROHMAT AN. RIZKA K. ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

4 4 NAJIM SUJANA NY. YANTI G2P1A0 H 32 MINGGU PT. GG Rp 35,000 Rp 35,000 Rp -

5 5 UKAR BIN NEIN TN. UKAR BIN NEIN CAMPAK PT. GG Rp 35,000 Rp 35,000 Rp -

6 5 ARYE PURNOMO TN. ARYE PURNOMO DISPEPSIA, URTIKARIA PT. GG Rp 35,000 Rp 35,000 Rp -

7 5 SUBUR SYAHRUDIN TN. SUBUR SYAHRUDIN ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

8 6 ANDO SUPRIATNA TN. ANDO SUPRIATNA ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

9 6 NEMIN SETIAWAN TN. NEMIN SETIAWAN ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

10 6 MASJIDI TN. MASJIDI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

11 6 NESIN SAPUTRA AN. ANNUR RAHMALIA R DIARE PT. GG tidak terdapat legalisasi pasien di kartu kapitasi

12 7 MOCHAMAD RUSNADI TN. MOCHAMAD RUSNADI GEA PT. GG Rp 35,000 Rp 35,000 Rp -

13 7 MULYANTO TN. MULYANTO ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

14 8 ALWIZAR NY. NAIMAN ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

15 9 TARIYANTO AN. BETARI AYUNDA ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

16 9 IRHAM SUSENO NY. ASIAH IRTAYANI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

17 9 IRHAM SUSENO AN. SATYA AL FAJRI FEBRIS, DERMATITIS PT. GG Rp 35,000 Rp 35,000 Rp -

18 10 TONO AN. OKTAVIA RAHMAWATI DISPEPSIA PT. GG Rp 35,000 Rp 35,000 Rp -

19 10 MIJA JAELANI NY. BADRIAH GASTRITIS PT. GG Rp 35,000 Rp 35,000 Rp -

20 11 NESIN SAPUTRA NY. SITI ERMAH F. ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

21 12 SYAIFULLAH TN. SYAIFULLAH OBS. FEBRIS PT. GG Rp 35,000 Rp 35,000 Rp -

22 12 SANAN AN. ANISA R P FARINGITIS AKUT PT. GG Rp 35,000 Rp 35,000 Rp -

23 12 TONO AN. OKTAVIA RAHMAWATI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

24 12 DEDI SUTIKNO AN. KEVIN FARRAS A. OBS. FEBRIS PT. GG Rp 35,000 Rp 35,000 Rp -

25 13 UKAR BIN NEIN AN. NAJARUDIN OBS. FEBRIS PT. GG Rp 35,000 Rp 35,000 Rp -

26 13 NUR JANAH NY. NUR JANAH NEURALGIA PT. GG Rp 35,000 Rp 35,000 Rp -

27 14 AMAN GUMILAR TN. AMAN GUMILAR CEPHALGIA PT. GG Rp 35,000 Rp 35,000 Rp -

( (021) 8900530 - 31, Fax. (021) 8900570


28 15 IRWANTO AN. MAHESA H ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

29 15 IRWANTO NY. TINA TINEA ERURIS, MYALGIA PT. GG Rp 35,000 Rp 35,000 Rp -

30 15 AHMAD YANI AN. EZRA ADRIYAN OBS. FEBRIS PT. GG Rp 35,000 Rp 35,000 Rp -

31 16 AHMAD YANI AN. EZRA ADRIYAN PRURITIS ALERGI PT. GG Rp 35,000 Rp 35,000 Rp -

32 16 IRHAM SUSENO TN. IRHAM SUSENO ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

33 16 MASJIDI AN. AGUNG PRASETYO ISPA PT. GG tanggal legalisasi di kartu kapitasi sudah kadaluarsa

34 17 TN. SUYOKO HARYONO AN. SIPTA RIMADHANI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

35 17 ISMAIL SALEH AN. M. ASRIL SALEH ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

36 18 USNI SAPUTRA AN. EFRIDA HAMIDAH ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

37 18 JOHAN ARIFIN NY. MARKONAH G2P1A0 H 34 MINGGU PT. GG Rp 35,000 Rp 35,000 Rp -

38 18 AGUS SUSANTO AN. ANDRE MARZAGI ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

39 19 PANDI BASKARA TN. PANDI BASKARA GASTROENTERITIS PT. GG Rp 35,000 Rp 35,000 Rp -

40 19 HENDRI ABDUL FATAH NY. NIA MARYANTI G1P0A0 H 9 MINGGU PT. GG Rp 35,000 Rp 35,000 Rp -

41 19 JULIANTO MANURUNG NY. ASNA SITORUS ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

42 19 MASYUDIN AN. ARWA SYAHLA AQILA ISPA PT. GG tanggal legalisasi di kartu kapitasi sudah kadaluarsa

43 20 MUHTAR BIN SUHENDI TN. MUHTAR BIN SUHENDIGASTRITIS PT. GG Rp 35,000 Rp 35,000 Rp -

44 21 PANDI BASKARA NY. PUTRI WULANDARI VERTIGO PT. GG Rp 35,000 Rp 35,000 Rp -

45 24 JAMRUDIN TN. JAMRUDIN LBP, HIPERTENSI PT. GG Rp 35,000 Rp 35,000 Rp -

46 24 KOMARUDIN TN. KOMARUDIN FARINGITIS PT. GG Rp 35,000 Rp 35,000 Rp -

47 26 YANTO SUSANTO TN. YANTO SUSANTO OEDEMA ANKLE PT. GG Rp 35,000 Rp 35,000 Rp -

48 27 TARIYANTO AN. BETARI AYUNDA STOMATITIS PT. GG Rp 35,000 Rp 35,000 Rp -

49 27 MIJA JAELANI AN. SARAH ANNAJWA VARICELLA, ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

50 28 UUS AN. SALSABILAH ADZARA ISPA, IMPETIGO PT. GG Rp 35,000 Rp 35,000 Rp -

51 28 SANIN AN. M. HAFIZ FADHIL ISPA, KONJUNGTIVITIS PT. GG Rp 35,000 Rp 35,000 Rp -

52 29 JOHAN ARIFIN TN. JOHAR ARIFIN THYPHOID PT. GG Rp 35,000 Rp 35,000 Rp -

53 31 OMAN AN. SATYA RAMADAN ISPA PT. GG tidak tercantum tanggal legalisasi di kartu kapitasi

54 31 MASJIDI AN. AGUNG PRASETYO CARIES DENTIS PT. GG tanggal legalisasi di kartu kapitasi sudah kadaluarsa

GRAND TOTAL


Mengetahui






PERIODE MARET 2012

PROVIDER KLINIK AL - IKHLAS (PT. Gunung Steel Group)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH


Mengetahui




tidak tercantum tanggal legalisasi di kartu kapitasi





PERIODE MARET 2012

PROVIDER KLINIK GRAHA MEDIKA (PT. Daelim )

NO TGL NAMA KARYAWAN NAMA PASIEN DIAGNOSA PERUSAHAAN DIAJUKAN DIBAYAR SELISIH KETERANGAN1 1 ERCE LIANA SARI NY. ERCE LIANA SARI ALLERGI PT. DAELIM Rp 35,000 Rp 35,000 2 1 SULISTIAWAN TN. SULISTIAWAN FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 3 1 FRANALA ARIFIN AN. ANNISA HANIF L. OBS. FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 4 1 FRANALA ARIFIN NY. SITI MAHMUDAH KONJUNGTIVITIS PT. DAELIM Rp 35,000 Rp 35,000 5 1 SUPRAPTO TN. SUPRAPTO GE PT. DAELIM Rp 35,000 Rp 35,000 6 1 DENI KUSNADI NY. NURWIDIA H. FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 7 2 CARLES SIMBOLON TN. CARLES SIMBOLON FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 8 2 MAMAD AN. DANI FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 9 2 ISTIQOMAWATI TN. TEGUH SUMARTONO GASTRITIS PT. DAELIM Rp 35,000 Rp 35,000 10 3 JANSEH SINAGA AN. JOY APRILIA ISPA PT. DAELIM Rp 35,000 Rp 35,000 11 3 JANSEH SINAGA NY. ENNY PANJAITAN GASTROENTERITIS PT. DAELIM Rp 35,000 Rp 35,000 12 3 DENI KUSNADI TN. DEDI KUSNADI CC PT. DAELIM Rp 35,000 Rp 35,000 13 3 DENI KUSNADI NY. NURWIDIA H. GE, DYSENTRI PT. DAELIM Rp 35,000 Rp 35,000 14 3 SUPONO NY. KARTINI ISPA PT. DAELIM Rp 35,000 Rp 35,000 15 3 SUPONO TN. SUPONO GASTRITIS PT. DAELIM Rp 35,000 Rp 35,000 16 6 ENGKOS KOSWARA TN. ENGKOS KOSWARA ARTRHITIS REUMATOID PT. DAELIM Rp 35,000 Rp 35,000 17 8 SUHARTO SUSYANTI GOUT PIRAI PT. DAELIM Rp 35,000 Rp 35,000 18 8 ANDA TN. ANDA FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 19 8 ANDA AN. IRVAN DODI S. VOMIT PT. DAELIM Rp 35,000 Rp 35,000 20 10 CARLES SIMBOLON NY. TIURLAN PASARIBU ISPA PT. DAELIM Rp 35,000 Rp 35,000 21 10 MAMAD NY. HERLINA CC PT. DAELIM Rp 35,000 Rp 35,000 22 10 SUHARTO AN. MOH. CALVIN RHINITIS ALLERGI PT. DAELIM Rp 35,000 Rp 35,000 23 10 ISTIQOMAWATI NY. ISTIQOMAWATI GASTRITIS PT. DAELIM Rp 35,000 Rp 35,000 24 10 ISTIQOMAWATI TN. TEGUH SUMARTONO OBS. FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 25 12 AGUS BINAFSIHI TN. AGUS BINAFSIHI FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 26 12 ENGKOS KOSWARA TN. ENGKOS KOSWARA CC PT. DAELIM Rp 35,000 Rp 35,000 27 12 SUHARTO AN. MOH. CALVIN ISPA PT. DAELIM Rp 35,000 Rp 35,000 28 12 ROSITA HERA SUSIANI NY. ROSITA HERA SUSIANNEURALGIA PT. DAELIM Rp 35,000 Rp 35,000 29 13 AGUS BINAFSIHI TN. AGUS BINAFSIHI PT. DAELIM Rp 35,000 Rp 35,000 30 14 BADAWI TN. BADAWI GE PT. DAELIM Rp 35,000 Rp 35,000 31 14 DASRIL TN. DASRIL CC PT. DAELIM Rp 35,000 Rp 35,000 32 14 NACEP TN. NACEP ISPA PT. DAELIM Rp 35,000 Rp 35,000 33 14 NACEP NY. SARMAH GASTRITIS AKUT PT. DAELIM Rp 35,000 Rp 35,000 34 14 NUR ABDUL FITRI TN. NUR ABDUL FITRI ABSES PT. DAELIM Rp 35,000 Rp 35,000

( (021) 8900530 - 31, Fax. (021) 8900570

35 16 SUHARTO AN. MOH. CALVIN ISPA PT. DAELIM Rp 35,000 Rp 35,000 36 16 ROHATI NY. ROHATI ASMA BRONCHITIS PT. DAELIM Rp 35,000 Rp 35,000 37 16 ROHATI AN. SITI RABIAH VL PT. DAELIM Rp 35,000 Rp 35,000 38 17 DASRIL AN. BELA ALIF FEBRIS PT. DAELIM Kartu kapitasi tidak dilampirkan foto pasien 39 17 DASRIL NY. RINI DANIRA ISPA PT. DAELIM Rp 35,000 Rp 35,000 40 17 MARDANI TN. MARDANI FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 41 17 SELAMAT RIADI AN. ANNISA NUR FITRI ISPA PT. DAELIM Rp 35,000 Rp 35,000 42 17 MUHAMAD SYAHRONI NY. MUSTIKA FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 43 17 MUHAMAD SYAHRONI AN. FARHANSYAH ISPA PT. DAELIM Rp 35,000 Rp 35,000 44 17 PANUT AN. DHEO SANDI P. ABSES PT. DAELIM Kartu kapitasi tidak dilampirkan foto pasien 45 17 ANDA AN. IRVAN DODI S. ISPA PT. DAELIM Rp 35,000 Rp 35,000 46 17 ELMI NASUTION NY. ELMI NASUTION GASTRITIS PT. DAELIM Rp 35,000 Rp 35,000 47 17 ELMI NASUTION TN. HARIS MUDA DS. DERMATTIS PT. DAELIM Rp 35,000 Rp 35,000 48 17 PANUT NY. SRI RISMIYATI DYSPEPSIA PT. DAELIM Rp 35,000 Rp 35,000 49 18 NACEP NY. SARMAH OBS. FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 50 18 NUR ABDUL FITRI TN. NUR ABDUL FITRI DYSENTRI PT. DAELIM Rp 35,000 Rp 35,000 51 18 SUPONO AN. ADITYA SAPUTRA ISPA PT. DAELIM Rp 35,000 Rp 35,000 52 18 SUPONO AN. M. NUR SYAFII OMA PT. DAELIM Rp 35,000 Rp 35,000 53 18 YUDA YORDANAL NY. MENA ASTUTI ISPA PT. DAELIM Rp 35,000 Rp 35,000 54 19 SAHRONI TN. SAHRONI CC PT. DAELIM Rp 35,000 Rp 35,000 55 19 MOHAMMAD SYAHID TN. MOHAMMAD SYAHID SUSP. ARTRHITIS PT. DAELIM Rp 35,000 Rp 35,000 56 19 SUPRIYADI NY. EKA MURDIKA ISPA PT. DAELIM Rp 35,000 Rp 35,000 57 20 SAHRONI NY. SARONIS KONJUNGTIVITIS PT. DAELIM Rp 35,000 Rp 35,000 58 20 RIDWAN IBRAHIM TN. RIDWAN IBRAHIM GEA PT. DAELIM Rp 35,000 Rp 35,000 59 20 ROHATI NY. ROHATI ASMA BRONCHITIS PT. DAELIM Rp 35,000 Rp 35,000 60 20 SAHRONI NY. SARONIS NEURALGIA PT. DAELIM Rp 35,000 Rp 35,000 61 20 ADE SOLIHAT TN. ADE SOLIHAT GASTROENTERITIS PT. DAELIM Rp 35,000 Rp 35,000 62 20 ADE SOLIHAT NY. EUIS LISNAWATI FARINGITIS PT. DAELIM Rp 35,000 Rp 35,000 63 20 FRANALA ARIFIN TN. FRANALA ARIFIN NEURALGIA PT. DAELIM Rp 35,000 Rp 35,000 64 21 RIDWAN IBRAHIM SITI MARFUAH FARINGITIS PT. DAELIM Rp 35,000 Rp 35,000 65 21 CARLES SIMBOLON TN. CARLES SIMBOLON FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 66 21 ANDA TN. ANDA OBS. FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 67 21 MUHAMMAD AFIF TN. MUHAMMAD AFIF GASTRITIS, HYPOTENSI PT. DAELIM Rp 35,000 Rp 35,000 68 21 ELMI NASUTION NY. ELMI NASUTION FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 69 23 MUGHNI GUNAWAN AN. ARDHAN JOHAR G. ISPA PT. DAELIM Rp 35,000 Rp 35,000 70 24 LAMHOT L. TN. LAMHOT L FARINGITIS PT. DAELIM Rp 35,000 Rp 35,000 71 24 MUGHNI GUNAWAN NY. RAUDHATUL JANAH CC PT. DAELIM Rp 35,000 Rp 35,000 72 25 JANSEH SINAGA AN. JASON PILIPPUS OBS. FEBRIS PT. DAELIM Kartu kapitasi tidak dilampirkan foto pasien 73 25 SAHRONI NY. SARONIS SUSP. THYPHOID PT. DAELIM Rp 35,000 Rp 35,000 74 25 JANSEH SINAGA NY. ENNY PANJAITAN ISPA PT. DAELIM Rp 35,000 Rp 35,000

75 26 WARJONO TN. WARJONO FEBRIS PT. DAELIM Rp 35,000 Rp 35,000

76 26 SUPONO NY. KARTINI DYSPEPSIA PT. DAELIM Rp 35,000 Rp 35,000

77 26 ELMI NASUTION AN. M. ICKHSAN ALI. DS CC PT. DAELIM Rp 35,000 Rp 35,000

78 26 GIANTO AN. NOVITA NUR H. ISPA PT. DAELIM Rp 35,000 Rp 35,000

79 26 SAHRONI SARONIS GASTRITIS PT. DAELIM Rp 35,000 Rp 35,000

80 27 SELAMAT RIADI TN. SELAMAT RIADI ISPA PT. DAELIM Rp 35,000 Rp 35,000

81 27 SELAMAT RIADI AN. ILHAM ANNAS FEBRIS PT. DAELIM Rp 35,000 Rp 35,000

82 27 ROBERT SIALLAGAN AN. YOHANA SIALLAGAN FARINGITIS PT. DAELIM Rp 35,000 Rp 35,000

83 27 MUGHNI GUNAWAN TN. MUGHNI GUNAWAN GEA PT. DAELIM Rp 35,000 Rp 35,000

84 28 SULISTIAWAN TN. SULISTIAWAN GASTRITIS PT. DAELIM Rp 35,000 Rp 35,000

85 29 DEDI KUSNADI TN. DEDI KUSNADI ISPA, HIPERTENSI PT. DAELIM Rp 35,000 Rp 35,000

86 29 SUHARTO TN. SUHARTO ISPA PT. DAELIM Rp 35,000 Rp 35,000

GRAND TOTAL


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK GRAHA MEDIKA (PT. Gunung Steel Group)


1 1 EKA RUBIYANTO TN. EKA RUBIYANTO ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

2 1 FAJAR TN. FAJAR FEBRIS PT. GG Kartu kapitasi tidak dilampirkan foto pasien

3 1 NURIDIN TN. NURIDIN ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

4 1 SARWA TN. SARWA ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

5 3 AGUS RICHAMAN AN. FADIA A. ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

6 3 AGUS RICHAMAN AN. FATIH SAKHA Z. ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

7 5 NURKHALIPAH DINY NY. NURKHALIPAH DINY GE PT. GG Rp 35,000 Rp 35,000 Rp -

8 10 KHAERUL UMAM TN. KHAERUL UMAM ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

9 15 AGUS RICHAMAN AN. FADIA A. ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

10 15 M. ABDUL CHARIS AN. DALTAFIKA CHARIS ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

11 15 IKSAN ARIYANTO TN. IKSAN ARIYANTO FEBRIS PT. GG Rp 35,000 Rp 35,000 Rp -

12 17 SARWA TN. SARWA OBS. LOW BACK PAIN PT. GG Rp 35,000 Rp 35,000 Rp -

( (021) 8900530 - 31, Fax. (021) 8900570

13 21 IMAM TOHARI NY. DWI SAYATI CC PT. GG Rp 35,000 Rp 35,000 Rp -

14 23 JOKO SUSILO AN. SANDY MUH. ILHAM ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

15 23 JOKO SUSILO AN. M. RIZKI RAMADHAN ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

16 24 DOHAR NOVIANTY NY. DOHAR NOVIANTY ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

17 24 AGUS RICHAMAN TN. AGUS RICHAMAN FEBRIS PT. GG Rp 35,000 Rp 35,000 Rp -

GRAND TOTAL Rp -


Mengetahui





PERIODE MARET 2012

PROVIDER KLINIK GRAHA MEDIKA (PT. Daelim )


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK GRAHA MEDIKA (PT. Gunung Steel Group)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK ANNISA (PT. Daelim)


1 4 CACAN TN. CACAN BRONKHITIS AKUT PT. DAELIM Rp 35,000 Rp 35,000 Rp -

2 5 HENDRIK SETIAWAN TN. HENDRIK SETIAWAN GE PT. DAELIM Rp 35,000 Rp 35,000 Rp -

3 6 JUNAEDI AN. M. DWIKI SEPTIANTO ISPA PT. DAELIM Rp 35,000 Rp 35,000 Rp -

4 10 AMRIN AN. GILANG PRATAMA OBS. BRONKHITIS AKUT PT. DAELIM Rp 35,000 Rp 35,000 Rp -

5 11 MAMAN NY. HODIJAH SUSP. TF PT. DAELIM Rp 35,000 Rp 35,000 Rp -

6 12 SUDARMAN TN. SUDARMAN COLIC ABDOMEN PT. DAELIM Rp 35,000 Rp 35,000 Rp -

7 13 YOGI ISKANDAR TN. YOGI ISKANDAR FEBRIS PT. DAELIM Rp 35,000 Rp 35,000 Rp -

8 13 ROHMAN TN. ROHMAN ISPA PT. DAELIM Rp 35,000 Rp 35,000 Rp -

9 13 SAWITRI NY. SAWITRI KLL PT. DAELIM KLL hanya di jamin 50 %

10 15 WASITO TN. WASITO SUSP. KOLERA PT. DAELIM Rp 35,000 Rp 35,000 Rp -

11 15 MAICSHAL ALFARIZI AN. M. DANAR ALFARIZI RFA PT. DAELIM Rp 35,000 Rp 35,000 Rp -

12 16 SUDARSONO NY. SULASTRI GEA PT. DAELIM Rp 35,000 Rp 35,000 Rp -

13 23 SAWITRI AN. ARIS RISMAWAN FARINGITIS PT. DAELIM Rp 35,000 Rp 35,000 Rp -

14 24 ZAENAL ARIFIN TN. ZAENAL ARIFIN HIPERTENSI, GOUT PT. DAELIM Rp 35,000 Rp 35,000 Rp -

15 28 SULAEMAN TN. SULAEMAN ABSES PT. DAELIM Rp 35,000 Rp 35,000 Rp -

16 30 HENDA SUHENDA TN. HENDA SUHENDA DERMATITIS PT. DAELIM Rp 35,000 Rp 35,000 Rp -

17 30 SUHADI NY. SUMIATI CARIES DENTIS PT. DAELIM Rp 35,000 Rp 35,000 Rp -

GRAND TOTAL


Mengetahui





( (021) 8900530 - 31, Fax. (021) 8900570



PERIODE MARET 2012

PROVIDER KLINIK ANNISA (PT. Gunung Steel Group)


1 1 M. NASIM NY. SARIYAH DYSPEPSIA PT. GG Rp 35,000 Rp 35,000 Rp -

2 5 CUCUN ADIARSO NY. IDAH ANGGRAENI SUSP. GOUT PT. GG Rp 35,000 Rp 35,000 Rp -

3 7 DEDE FATONI G. TN. DEDE FATONI G. RFA PT. GG Rp 35,000 Rp 35,000 Rp -

4 8 DEDE PERMANA NY. ERNI GASTRITIS PT. GG Rp 35,000 Rp 35,000 Rp -

5 9 ANAS SASMITA TN. ANAS SASMITA SUSP. TIPHOID FEVER PT. GG Rp 35,000 Rp 35,000 Rp -

6 9 ADE PUTRA TN. ADE PUTRA RHEMATOID ARTHRITIS PT. GG Rp 35,000 Rp 35,000 Rp -

7 9 FAJAR RUDIN TN. FAJAR RUDIN NAUSEA, DYSPEPSIA PT. GG Rp 35,000 Rp 35,000 Rp -

8 10 MISRAN AN. ROBI SAPUTRA EKSIM PT. GG Rp 35,000 Rp 35,000 Rp -

9 10 ROJALI TN. ROJALI SUSP. TIPHOID FEVER PT. GG Rp 35,000 Rp 35,000 Rp -

10 10 RIPAL NOPIAN NY. EKA KARWATI URTIKARIA PT. GG Rp 35,000 Rp 35,000 Rp -

11 10 SURAHMAN AN. FHIZRIL RACHMAN SUSP. TIPHOID FEVER PT. GG Rp 35,000 Rp 35,000 Rp -

12 13 AGUS KUSDIANA RIZKI PUTRI SUSP. KP PT. GG Rp 35,000 Rp 35,000 Rp -

13 14 AGUS KUSDIANA AN. RIZKI PUTRI PT. GG tidak tercantum diagnosa pasien

14 15 ELI SUHARDI AN. RIZKY JULIANSYAH FA, STOMATITIS PT. GG tanggal legalisasi di kartu kapitasi sudah kadaluarsa

15 16 MISRAN AN. CARTIM WIJAYA STOMATITIS, ISPA PT. GG Rp 35,000 Rp 35,000 Rp -

16 16 DERI RISWANTO AN. GILANG ANGGA RFA PT. GG kartu kapitasi sudah kadaluarsa

17 17 ANO ADRIAN NY. ERNA KORIAH SUSP. LIMFADENOPATI PT. GG Rp 35,000 Rp 35,000 Rp -

18 17 SAHIDIN ALI AN. RADITYA HAIKAL A. RFA PT. GG Rp 35,000 Rp 35,000 Rp -

19 20 KOSTAMANATUN NY. IROH GASTRITIS PT. GG Rp 35,000 Rp 35,000 Rp -

20 20 ABDUL RAHMAN TN. ABDUL RAHMAN GEA PT. GG Rp 35,000 Rp 35,000 Rp -

21 21 DEDE PERMANA TN. DEDE PERMANA GEA PT. GG Rp 35,000 Rp 35,000 Rp -

22 21 IWAN SUTISNA TN. IWAN SUTISNA OMA PT. GG Rp 35,000 Rp 35,000 Rp -

23 23 KOSTAMANATUN NY. IROH ISK PT. GG Rp 35,000 Rp 35,000 Rp -

24 23 RIPAL NOPIAN NY. EKA KARWATI MIGRAIN PT. GG Rp 35,000 Rp 35,000 Rp -

25 25 KOSTAMANATUN NY. IROH OF PT. GG Rp 35,000 Rp 35,000 Rp -

26 25 JONI PRANYONO AN. DIMAS GALIH P. TONSILITIS, FARINGITIS PT. GG Rp 35,000 Rp 35,000 Rp -

27 26 ATANG TN. ATANG GE PT. GG Rp 35,000 Rp 35,000 Rp -

28 28 FAJAR RUDIN TN. FAJAR RUDIN OFIHRECSUSPDF PT. GG Rp 35,000 Rp 35,000 Rp -

GRAND TOTAL

( (021) 8900530 - 31, Fax. (021) 8900570


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK ANNISA (PT. Sapta Buana)


19 DEDEN GINANJAR NY. NURLELA OBS. FEBRIS PT. SAPTA BUANA Rp 35,000 Rp 35,000 Rp -

GRAND TOTAL


Mengetahui





PERIODE MARET 2012

PROVIDER KLINIK ANNISA (PT. Daelim)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

( (021) 8900530 - 31, Fax. (021) 8900570

PROVIDER KLINIK ANNISA (PT. Gunung Steel Group)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK ANNISA (PT. Sapta Buana)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK SUKARAYA MEDIKA (PT. Gunung Steel Group)


1 1 ABDI SETIAWAN AN. NAYA ARSAL ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

2 1 CIIN DARMAJI TN. CIIN DARMAJI CC PT. GG Rp 30,000 Rp 30,000 Rp -

3 1 ABDUL KHOLIK TN. ABDUL KHOLIK TRAUMA PT. GG Rp 30,000 Rp 30,000 Rp -

4 1 SAHMAD TN. SAHMAD VULNUS EXCERATUM PT. GG Rp 30,000 Rp 30,000 Rp -

5 1 MEMET BIN TARSIN TN. MEMET BIN TARSIN CONJUNGTIVITIS PT. GG Rp 30,000 Rp 30,000 Rp -

6 1 ANYAN BIN ENDIS AN. ANISA SUSP. TYPHOID PT. GG Rp 30,000 Rp 30,000 Rp -

7 1 SUWARNO TN. SUWARNO DERMATITIS PT. GG Rp 30,000 Rp 30,000 Rp -

8 1 MEMET BIN TARSIN AN. SINANJUNG SUSP. TYPHOID PT. GG Rp 30,000 Rp 30,000 Rp -

9 1 SUWARNO NY. MUSLIMATIN GASTROENTERITIS PT. GG Rp 30,000 Rp 30,000 Rp -

10 2 AMRIL AN. ZAHRA RAHMA D. COUGH PT. GG Rp 30,000 Rp 30,000 Rp -

11 2 SURANTO NY. EPI NOVIAN ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

12 2 MUKTARUDDIN H. NY. UMUL AMINAH KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

13 2 HASANUDIN AN. FATAHILLA H. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

14 2 YAYAN DAHLAN NY. DEDEN RODIYAH KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

15 3 WADIMAN NY. LAURA SIREGAR OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

16 3 WADIMAN AN. RICKSON S. CONJUNGTIVITIS PT. GG Rp 30,000 Rp 30,000 Rp -

17 3 RAGIL SUBARDI AN. MAHIRAH NUR LATIFAH COUGH PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

18 3 BAHRUL ULUM NY. RAHMADANI ERAVIDARUM PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

19 3 ERWIN SETIADI NY. TRI FAJAR DIABETES PT. GG Rp 30,000 Rp 30,000 Rp -

20 3 SOMAD AN. IKBAL RAMADHAN ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

21 3 IDING WARDIANA AN. FANISA AZZAHRA COUGH PT. GG Rp 30,000 Rp 30,000 Rp -

22 4 TRI WINARNO AN. MITZY HERWIN N CC PT. GG Rp 30,000 Rp 30,000 Rp -

23 4 MADDIN SIHOMBING AN. STEVEND GANDA S. VARICELLA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

24 4 YUDI SULISTYO NY. KASITEM KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

25 4 SUPRIATO NY. RUSTIASIH KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

( (021) 8900530 - 31, Fax. (021) 8900570

26 5 IWAN GUNAWAN AN. RAIHAN ADITAMA TONSILITIS PT. GG Rp 30,000 Rp 30,000 Rp -

27 5 YUDI SULISTYO TN. YUDI SULISTYO ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

28 5 SOMAD AN. BAGAS HERDIANSYAH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

29 5 MUKTARUDDIN H. AN. NADIAH ZHAFIRAH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

30 5 SENDRA GUMILAR NY. WATI HERAWATI CHEPALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

31 6 MUNADI TN. MUNADI OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

32 6 HASANUDIN TN. HASANUDIN GEA PT. GG Rp 30,000 Rp 30,000 Rp -

33 6 SOPYAN ISKANDAR AN. SALSABILA PUTRI. ISPA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

34 6 MADDIN SIHOMBING AN. STEVEND GANDA S. CC PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

35 6 SAMSURI TN. SAMSURI SUSP. TYPHOID PT. GG Rp 30,000 Rp 30,000 Rp -

36 6 NAJIH TN. NAJIH GASTROENTERITIS PT. GG Rp 30,000 Rp 30,000 Rp -

37 6 SUKARDI NY. ZUMIATI KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

38 7 HASANUDIN AN. FATAHILLA H. CC PT. GG Rp 30,000 Rp 30,000 Rp -

39 7 EMAN SUKIRMAN NY. UNIH SUNTIK KB PT. GG Rp 30,000 Rp 30,000 Rp -

40 7 SOPYAN ISKANDAR NY. MIA SUMIATI EMESIS GRAVIDARUM PT. GG Rp 30,000 Rp 30,000 Rp -

41 7 NAJIH NY. WUJIATI EMESIS GRAVIDARUM PT. GG Rp 30,000 Rp 30,000 Rp -

42 7 DAMAN AN. MONICA DAMAYANTI ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

43 7 SAMSURI TN. SAMSURI SUSP. TYPHOID PT. GG Rp 30,000 Rp 30,000 Rp -

44 8 M. MARZUKI HARAHAP AN. FARIZ ZAKY H. OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

45 8 MUKTARUDDIN H. AN. SILVIA ZHAFIRAH GASTROENTERITIS PT. GG Rp 30,000 Rp 30,000 Rp -

46 8 DEDI IRAWAN TN. DEDI IRAWAN ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

47 8 AMRIL AN. SAHRUL RAMADHANI ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

48 8 WAWAN TARWAN NY. IRMAWANTI KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

49 8 SAMSURI AN. RIZKI AMALIA M. GEA PT. GG Rp 30,000 Rp 30,000 Rp -

50 8 NARTO NY. DWI ASIH SUNARNI GASTROENTERITIS PT. GG Rp 30,000 Rp 30,000 Rp -

51 8 DARUSMAN A.S MANURUN TN. DARUSMAN A.S M. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

52 8 DARYONO TN. DARYONO MYALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

53 8 DARYONO NY. FATMAWATI DERMATITIS PT. GG Rp 30,000 Rp 30,000 Rp -

54 8 WAHIDIN TN. WAHIDIN ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

55 8 IWAN GUNAWAN TN. IWAN GUNAWAN ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

56 8 MAULANA YUSUP TN. MAULANA YUSUP DYSPEPSIA PT. GG Rp 30,000 Rp 30,000 Rp -

57 8 BADARUDIN NY. ROHAYATI CHEPALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

58 9 AZIZ ARYANTO NY. DUMARIA PANJAITAN MYALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

59 10 CECEP N. AN. DEVI NURDIYANA ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

60 10 EMAN SUKIRMAN AN. JIDAN KHAIRUL V. VURUNKEL PT. GG Rp 30,000 Rp 30,000 Rp -

61 10 DJASMAN AN. DJUSTIN FATHIR R. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

62 10 KOMARUDIN AN. SYAQILA ZAHRA Q. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

63 10 DJASMAN NY. TITI SUMARNI ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

64 10 CAHYA SUMIRAT TN. CAHYA SUMIRAT CC PT. GG Rp 30,000 Rp 30,000 Rp -

65 11 FAJAR SAEFUDDIN TN. FAJAR SAEFUDDIN DYSPEPSIA PT. GG Rp 30,000 Rp 30,000 Rp -

66 11 SUDIGDYO AN. FRISKA RAHMA SARI ISPA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

67 11 AMRIL NY. YULIANTI SUNTIK KB PT. GG Rp 30,000 Rp 30,000 Rp -

68 11 HUSNU IHARA TN. HUSNU IHARA ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

69 11 MUHAMAD SUDARMAN AN. MUHAMMAD JULI CC PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

70 12 WARSONO AN. CINTA JULIANINGSIH VOMITUS PT. GG Rp 30,000 Rp 30,000 Rp -

71 12 KOMARUDIN AN. FADHILAH CC PT. GG Rp 30,000 Rp 30,000 Rp -

72 12 IMAM SUBARI AN. EKA FITRIANI CC PT. GG Rp 30,000 Rp 30,000 Rp -

73 12 IMAM SUBARI TN. IMAM SUBARI MYALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

74 13 SOLAHUDIN NY. NURYANI MYALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

75 13 HASANUDIN NY. EVI FITRIAH A.R GASTROENTERITIS PT. GG Rp 30,000 Rp 30,000 Rp -

76 13 SUWARNO TN. SUWARNO DERMATITIS PT. GG Rp 30,000 Rp 30,000 Rp -

77 13 AHMAD JUNAEDI AN. VIQI PRATAMA ISPA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

78 13 AHMAD JUNAEDI TN. AHMAD JUNAEDI CC PT. GG Rp 30,000 Rp 30,000 Rp -

79 13 MUSLIM JAUHARI AN. RYAN ARDIANSYAH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

80 13 MADDIN SIHOMBING TN. MADDIN SIHOMBING CC PT. GG Rp 30,000 Rp 30,000 Rp -

81 13 MISWANTO NY. MURNI SUMARNINGSIH KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

82 13 SUWARNO NY. SITI FATIMAH KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

83 13 SARMIN TOTO H. AN. RISKA DWI RAHAYU CONJUNGTIVITIS PT. GG Rp 30,000 Rp 30,000 Rp -

84 13 YAYAN SOFIAN HADI ASMA AN. YULIA ARTIKA C. DERMATTIS PT. GG Rp 30,000 Rp 30,000 Rp -

85 14 ONIM PRIATNA AN. EUGENESYAH ADITYA P. VURUNKEL PT. GG Rp 30,000 Rp 30,000 Rp -

86 14 MISWANTO AN. M. LINTANG S. CC PT. GG Rp 30,000 Rp 30,000 Rp -

87 14 EDI PURNOMO AN. KHALIFAH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

88 14 OKA BUDIN AN. JULIANSYAH B. OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

89 14 RAIHANA H. AN. RAIHANA H. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

90 14 RIDWAN NY. UMRIYAH COUGH PT. GG Rp 30,000 Rp 30,000 Rp -

91 14 BADRUN AN. JENNY NURKHEN ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

92 14 TRI SUWANDI TN. TRI SUWANDI GEA PT. GG Rp 30,000 Rp 30,000 Rp -

93 15 NURYADI TN. NURYADI ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

94 15 DIMAS BAYU SAMUDRA TN. DIMAS BAYU S. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

95 15 WARSONO AN. CINTA JULIANINGSIH ABDOMEN DC PT. GG Rp 30,000 Rp 30,000 Rp -

96 15 WARSONO NY. TUTI RETNONINGSIH KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

97 15 SENDRA GUMILAR TN. SENDRA GUMILAR ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

98 16 DARYONO AN. M. RIFALDO ISPA, GEA PT. GG Rp 30,000 Rp 30,000 Rp -

99 16 DARYONO NY. FATMAWATI KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

100 16 BADARUDIN TN. BADARUDIN CONJUNGTIVITIS PT. GG Rp 30,000 Rp 30,000 Rp -

101 16 HUSNU IHARA AN. RAIHAN KHOIRUL A. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

102 16 ZULKARNAIN TN. ZULKARNAIN CARRIES PT. GG Rp 30,000 Rp 30,000 Rp -

103 16 HERI MULYONO TN. HERI MULYONO CARRIES PT. GG Rp 30,000 Rp 30,000 Rp -

104 16 MADDIN SIHOMBING NY. DESIMA NATALIA COUGH PT. GG Rp 30,000 Rp 30,000 Rp -

105 16 NARTO AN. ABBASY RAYHAN CC PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

106 16 SARMIN TOTO H. NY. NUNUNG KONTARSEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

107 16 ABDI SETIAWAN AN. NAZWA SEPTIA ADISSA CARRIES PT. GG Rp 30,000 Rp 30,000 Rp -

108 16 SOPYAN ISKANDAR TN. SOPYAN ISKANDAR GEA PT. GG Rp 30,000 Rp 30,000 Rp -

109 16 SAHMAD AN. RYAN OKTAVIANTO GEA PT. GG Rp 30,000 Rp 30,000 Rp -

110 16 SAHMAD NY. TUGIRAH MYALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

111 17 SOMAD AN. BAGAS HERDIANSYAH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

112 17 ZULKARNAIN NY. HERWANI SUSP. NEPRHOLITIS PT. GG Rp 30,000 Rp 30,000 Rp -

113 17 AZIZ ARYANTO AN. BRILLY SAQINA ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

114 18 ABDI SETIAWAN AN. NAYA ARSAL VOMITUS PT. GG Rp 30,000 Rp 30,000 Rp -

115 18 SONI HARSONO NY. DWI SARI RAHMAWATI OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

116 18 HASANUDIN AN. FATAHILLA H. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

117 18 SANO SUSANTO TN. SANO SUSANTO ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

118 18 NARTO AN. ABBASY RAYHAN ISPA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

119 18 RUDI HARTONO TN. RUDI HARTONO HERPES PT. GG Rp 30,000 Rp 30,000 Rp -

120 18 ABDUL KHOLIK AN. WAFA ARDIANSYAH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

121 18 ABDUL KHOLIK TN. ABDUL KHOLIK MYALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

122 19 SAHMAD AN. PRASETYO WIBOWO CONJUNGTIVITIS PT. GG Rp 30,000 Rp 30,000 Rp -

123 19 EMAN SUKIRMAN AN. DENIS AULIA FARINGITIS PT. GG Rp 30,000 Rp 30,000 Rp -

124 19 DARUSMAN A.S MANURUN NY. INGGRIT EVELINA S. CC PT. GG Rp 30,000 Rp 30,000 Rp -

125 19 DARUSMAN A.S MANURUN TN. DARUSMAN A.S M. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

126 19 SOLAHUDIN TN. SOLAHUDIN CONJUNGTIVITIS PT. GG Rp 30,000 Rp 30,000 Rp -

127 19 SOLAHUDIN AN. KANIA MARSELIA HERVES PT. GG Rp 30,000 Rp 30,000 Rp -

128 19 DADAN DAHLAN NY.DEDEN RODIYAH OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

129 19 MEMET BIN TARSIN TN. MEMET BIN TARSIN CONJUNGTIVITIS PT. GG Rp 30,000 Rp 30,000 Rp -

130 19 WAHIDIN TN. WAHIDIN GEA PT. GG Rp 30,000 Rp 30,000 Rp -

131 19 WAWAN TARWAN AN. MAYANG RAISYA A. OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

132 20 ASEP MUDOPAR TN. ASEP MUDOPAR CONJUNGTIVITIS PT. GG Rp 30,000 Rp 30,000 Rp -

133 20 ASEP MUDOPAR NY. ANISAH FARINGITIS PT. GG Rp 30,000 Rp 30,000 Rp -

134 20 KOMARUDIN AN. FITRI AULIA ADZKIA OTITIS PT. GG Rp 30,000 Rp 30,000 Rp -

135 20 MUKTARUDDIN H. NY. UMUL AMINAH GASTROENTERITIS PT. GG Rp 30,000 Rp 30,000 Rp -

136 20 HASANUDIN NY. EVI FITRIAH A.R CC PT. GG Rp 30,000 Rp 30,000 Rp -

137 20 SANDI KAMARU JAMAN AN. INDAH KURNIAN. ISPA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

138 20 AZIZ ARYANTO NY. DUMARIA PANJAITAN MYALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

139 20 MISWANTO AN. M. ALFIAN P. FARINGITIS PT. GG Rp 30,000 Rp 30,000 Rp -

140 20 SOLAHUDIN NY. NURYANI OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

141 20 SOPYAN ISKANDAR AN. SALSABILA PUTRI. ISPA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

142 20 MUNADI AN. PASYA NADILA ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

143 20 IMAM SUBARI AN. DIKA PRATAMA GASTROENTERITIS PT. GG Rp 30,000 Rp 30,000 Rp -

144 21 SOMAD TN SOMAD CONJUNGTIVITIS PT. GG Rp 30,000 Rp 30,000 Rp -

145 21 WARSONO NY. RISWATI KONTARSEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

146 21 WARSONO AN. NOVIAN ANAS P. SUSP. TYPHOID PT. GG Rp 30,000 Rp 30,000 Rp -

147 21 ARIS TN. ARIS ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

148 21 HASANUDIN NY. EVI FITRIAH A.R AKBK PT. GG Rp 30,000 Rp 30,000 Rp -

149 21 ARIS NY. SITI MARYAM OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

150 21 ABDUL KHOLIK AN. AI FARIDAH AMALYAH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

151 22 WAWAN TARWAN TN. WAWAN TARWAN FARINGITIS PT. GG Rp 30,000 Rp 30,000 Rp -

152 22 ABDUROKHMAN AN. RAGIL FATHUR R. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

153 22 AHMAD JUNAEDI AN. VIQI PRATAMA ISPA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

154 22 AHMAD JUNAEDI NY. NUR SAADAH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

155 22 DWI HARTANTO YN. DWI HARTANTO GASTROENTERITIS PT. GG Rp 30,000 Rp 30,000 Rp -

156 23 PARLUHUTAN SIHOMBING AN. RAHEL YOHANA S. SUSP. TYPHOID PT. GG Rp 30,000 Rp 30,000 Rp -

157 23 DADANG EKA SAPUTRA NY. NELLY SEKAR SARI FARINGITIS PT. GG Rp 30,000 Rp 30,000 Rp -

158 23 EDIN NY. ALIYAH KONTARSEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

159 23 EDIN TN. EDIN CARRIES PT. GG Rp 30,000 Rp 30,000 Rp -

160 23 MISWANTO AN. M. LINTANG S. ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

161 23 RAGIL SUBARDI AN. MAHIRAH NUR LATIFAH OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

162 23 DARMANTO NY. SITI ROWIYAH CHEPALGIA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

163 24 ZULKARNAIN AN. EKO PRATAMA Z. OBS. UROLITIS PT. GG Rp 30,000 Rp 30,000 Rp -

164 24 WADIMAN TN. WADIMAN OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

165 24 MISWANTO TN. MISWANTO DERMATITIS PT. GG Rp 30,000 Rp 30,000 Rp -

166 25 YUDI SULISTYO AN. MOHAMADA DHANI R. DERMATITIS PT. GG Rp 30,000 Rp 30,000 Rp -

167 25 MISWANTO AN. M ALFIAN P. CC PT. GG Rp 30,000 Rp 30,000 Rp -

168 25 LUTFI EFENDI AN. NAYLA RIZKA R. CC PT. GG Rp 30,000 Rp 30,000 Rp -

169 25 AZIZ ARYANTO NY. DUMARIA PANJAITAN ARTRITIS PT. GG Rp 30,000 Rp 30,000 Rp -

170 25 AZIZ ARYANTO AN. BRILLY SAQINA OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

171 25 SANO SUSANTO AN. NUR AKBAR CONJUNGTIVITIS PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

172 25 TRI ANTORO AN. ZALSA ELENORA ALIN ISPA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

173 25 JIMAN KUSWORO AN. LINTANG ABDILLAH CC PT. GG Rp 30,000 Rp 30,000 Rp -

174 25 BUDI MARGONO AN. YOSHE ADRIAN F. GEA PT. GG Rp 30,000 Rp 30,000 Rp -

175 25 WAWAN HERMAWAN NY. NUNUNG CC PT. GG Rp 30,000 Rp 30,000 Rp -

176 26 TRI IMAM AN. M. AFIF NASRULLAH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

177 26 ASEP AHMAD AN. NURHALISAH CC PT. GG Rp 30,000 Rp 30,000 Rp -

178 26 ASEP AHMAD NY. EUIS NURHIDAYAH KONTARSEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

179 26 ARIS NY. SITI MARYAM KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

180 26 HUSNU IHARA AN. RAIHAN KHOIRUL A. COUGH PT. GG Rp 30,000 Rp 30,000 Rp -

181 26 FAJAR MANALU NY. ASI ROHANA CHEPALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

182 26 FAJAR MANALU AN. ELSHA GLORY MANALU MORBILI PT. GG Rp 30,000 Rp 30,000 Rp -

183 27 ABDUROKHMAN NY. ANTINAH KONTRASEPSI PT. GG Rp 30,000 Rp 30,000 Rp -

184 27 ABDUROKHMAN TN. ABDUROKHMAN OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

185 27 ZULKARNAIN TN. ZULKARNAIN OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

186 27 BADRUN TN. BADRUN CC PT. GG Rp 30,000 Rp 30,000 Rp -

187 27 MAULANA YUSUP TN. MAULANA YUSUP OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

188 27 FERRY EDI PRANOTO TN. FERRY EDI PRANOTO CHEPALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

189 27 IWAN GUNAWAN AN. RAIHAN ADITAMA ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

190 27 IWAN GUNAWAN TN. IWAN GUNAWAN ISPA, HAEMOROID PT. GG Rp 30,000 Rp 30,000 Rp -

191 27 WAHIDIN AN. MUHAMMAD H. COUGH PT. GG Rp 30,000 Rp 30,000 Rp -

192 27 RIDWAN NY. UMRIYAH AKBK PT. GG Rp 30,000 Rp 30,000 Rp -

193 27 AHMAD HAMBALI AN. SITI NUR H. VARICELLA PT. GG Rp 30,000 Rp 30,000 Rp -

194 27 WARSONO AN. KUKUH PRASETYO GASTROENTERITIS PT. GG Rp 30,000 Rp 30,000 Rp -

195 27 AZIZ ARYANTO AN. DITA AULIA DERMATITIS PT. GG Rp 30,000 Rp 30,000 Rp -

196 27 ABDUL KHOLIK AN. WAFA ARDIANSYAH ISPA PT. GG Rp 30,000 Rp 30,000 Rp -

197 27 ABDUL KHOLIK TN. ABDUL KHOLIK DISPEPSIA PT. GG Rp 30,000 Rp 30,000 Rp -

198 27 IMAM SUBARI NY. SUMIARNI AKBK PT. GG Rp 30,000 Rp 30,000 Rp -

199 28 CECEP N. TN. CECEP N. ISK PT. GG Rp 30,000 Rp 30,000 Rp -

200 28 DULHALIM TN. DULHALIM MYALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

201 29 MUKTARUDIN H. AN. NADIAH ZHAFIRAH COUGH PT. GG Rp 30,000 Rp 30,000 Rp -

202 29 YAYAN DAHYAN NY. DEDEN RODIYAH CHEPALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

203 29 SUWANTA AN. FADHIL ALFINO DERMATITIS PT. GG Rp 30,000 Rp 30,000 Rp -

204 29 CAHYA SUMIRAT NY. RENI ANDRIANI FARINGITIS PT. GG Rp 30,000 Rp 30,000 Rp -

205 29 WARSONO TN. WARSONO NEURORITIS PT. GG Rp 30,000 Rp 30,000 Rp -

206 29 SUGIYANTO AN. VANESYA ANGGRAENI ISPA PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

207 29 ABDUROKHMAN TN. ABDUROKHMAN POST TRAUMA PT. GG Rp 30,000 Rp 30,000 Rp -

208 30 SENDRA GUMILAR TN. SENDRA GUMILAR MYALGIA PT. GG Rp 30,000 Rp 30,000 Rp -

209 30 ABDUROKHMAN AN. GILANG RAMADHAN FARINGITIS PT. GG Rp 30,000 Rp 30,000 Rp -

210 30 E. KUSNADI NY. MANDRI KURNIATI AKBK PT. GG Rp 30,000 Rp 30,000 Rp - tanggal legalisasi di kartu kapitasi sudah kadaluarsa

211 30 BADRUN TN. BADRUN OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

212 30 DAMAN TN. DAMAN OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

213 31 YAYAN DAHYAN NY. DEDEH RODIYAH OBS. FEBRIS PT. GG Rp 30,000 Rp 30,000 Rp -

GRAND TOTAL


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK SUKARAYA MEDIKA (PT. Sapta Buana)


1 1 MELISA APRIANI NY. MELISA APRIANI CHEPALGIA PT. SAPTA BUANA Rp 30,000 Rp 30,000 Rp -

2 2 AINUL BASRI AN. FARREL DECHA ISPA PT. SAPTA BUANA Rp 30,000 Rp 30,000 Rp -

3 10 AINUL BASRI AN. FARREL DECHA PAROTITIS PT. SAPTA BUANA Rp 30,000 Rp 30,000 Rp -

4 21 AINUL BASRI NY. SUDARYANTI CHEPALGIA PT. SAPTA BUANA Rp 30,000 Rp 30,000 Rp -

5 23 AINUL BASRI AN. FARREL DECHA ISPA PT. SAPTA BUANA Rp 30,000 Rp 30,000 Rp -

6 23 AINUL BASRI NY. SUDARYANTI KONTRASEPSI PT. SAPTA BUANA Rp 30,000 Rp 30,000 Rp -

7 23 AINUL BASRI NY. SUDARYANTI FARINGITIS PT. SAPTA BUANA Rp 30,000 Rp 30,000 Rp -

8 24 SUGIARTO TN. SUGIARTO ISPA PT. SAPTA BUANA Rp 30,000 Rp 30,000 Rp -

9 24 AINUL BASRI NY. SUDARYANTI DERMATITIS PT. SAPTA BUANA Rp 30,000 Rp 30,000 Rp -

( (021) 8900530 - 31, Fax. (021) 8900570

10 26 AJAT SUDRAJAT TN. AJAT SUDRAJAT ISPA PT. SAPTA BUANA Rp 30,000 Rp 30,000 Rp -

11 31 AINUL BASRI AN. FARREL DECHA OBS. FEBRIS PT. SAPTA BUANA Rp 30,000 Rp 30,000 Rp -

GRAND TOTAL


Mengetahui






PESERTA PROGRAM KAPITASI RS. BHAKTI HUSADA CIKARANGPERIODE MARET 2012

PROVIDER KLINIK SUKARAYA MEDIKA (PT. Daelim)


1 1 AGUNG INDRA P. TN. AGUNG INDRA P. ABDOMEN DC PT. DAELIM Rp 30,000 Rp 30,000 Rp -

2 15 BAET BIN MUSTARI TN. BAET BIN MUSTARI MYALGIA PT. DAELIM Rp 30,000 Rp 30,000 Rp -

3 15 SAMSUDIN AN. SATRIA KALIMUSYADA GEA PT. DAELIM Rp 30,000 Rp 30,000 Rp -

4 16 EDI PRIYADI TN. EDI PRIYADI VERTIGO PT. DAELIM Rp 30,000 Rp 30,000 Rp -

5 21 ROHIMUDIN TN. ROHIMUDIN SUSP. TYPHOID PT. DAELIM Rp 30,000 Rp 30,000 Rp -

6 22 DIDI PRIADI TN. DIDI PRIADI GASTROENTERITIS PT. DAELIM Rp 30,000 Rp 30,000 Rp -

7 23 BAET BIN MUSTARI AN. GILANG RAMADHAN ISPA PT. DAELIM Rp 30,000 Rp 30,000 Rp -

8 25 SAMSUDIN NY. FITRI HANDAYANI SUSP. TYPHOID PT. DAELIM Rp 30,000 Rp 30,000 Rp -

9 27 SAMSUDIN AN. SATRIA KALIMUSYADA OBS. FEBRIS PT. DAELIM Rp 30,000 Rp 30,000 Rp -

10 27 ROHIMUDIN TN. ROHIMUDIN DISPEPSIA PT. DAELIM Rp 30,000 Rp 30,000 Rp -

11 28 SUSTER RAYA S. AN. KEYSIA GLOFIA TOMBA VARICELLA PT. DAELIM Rp 30,000 Rp 30,000 Rp -

GRAND TOTAL


( (021) 8900530 - 31, Fax. (021) 8900570

Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK SUKARAYA MEDIKA (PT. Buana Samudra Lestari)


1 10 ROSDIANA MANGUNSONG TN. HERMANTO S. MYALGIA PT. BSL Rp 30,000 Rp 30,000 Rp -

2 10 ROSDIANA MANGUNSONG AN. YOSHUA RICHARDO OBS. FEBRIS PT. BSL Rp 30,000 Rp 30,000 Rp -

GRAND TOTAL


Mengetahui





PERIODE MARET 2012

PROVIDER KLINIK SUKARAYA MEDIKA (PT. Gunung Steel Group)


1 TAGIHAN

( (021) 8900530 - 31, Fax. (021) 8900570

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK SUKARAYA MEDIKA (PT. Sapta Buana)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK SUKARAYA MEDIKA (PT. Daelim)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER KLINIK SUKARAYA MEDIKA (PT. Buana Samudra Lestari)


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK MADANIYAH ( PT. Buana Samudra Lestari )


PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

( (021) 8900530 - 31, Fax. (021) 8900570


PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp - Rp30,000

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -


PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp - Rp30,000

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp - Rp30,000

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -


PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

GRAND TOTAL



Mengetahui





PERIODE MARET 2012

PROVIDER KLINIK MADANIYAH ( PT. Buana Samudra Lestari )


1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH


Mengetahui







PERIODE MARET 2012

PROVIDER KLINIK YADI MEDIKA ( PT. Buana Samudra Lestari )


1 MARLINA AN. MUTIARA ANGGRAENI. ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

31 MISIH AN. KIKI DAMAYANTI ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

30 DAROS AN. AGUNG EKA CANDRA ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

23 TITI KOMALASARI AN. AZIS JAYUSMAN ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

24 DINA ANDRIANI NY. DINA ANDRIANI ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

24 DINA ANDRIANI AN. AHMAD RIDHO S. ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

22 ROHANI AN. SUGINA ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

18 ATIH PURMASARI AN. APRILIA NURFADILAH VARICELLA PT. BSL Rp 30,000 Rp 30,000 Rp -

18 SITI MAESAROH NY. SITI MAESAROH ISPA, DYSPEPSIA PT. BSL Rp 30,000 Rp 30,000 Rp -

18 MARIAH NY. MARIAH ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

19 PITRI ANDAYANI NY. PITRI ANDAYANI ABSES PT. BSL Rp 30,000 Rp 30,000 Rp -

16 NARSIH NY. NARSIH ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

17 KANIH NY. KANIH MYALGIA PT. BSL Rp 30,000 Rp 30,000 Rp -

16 NARSIH TN. ONYIN MARPUDIN ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

17 KANIH AN. KAHFI MUBAROK ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

16 SAMSUDIN NY. SITI LATIFAH GEA, DYSPEPSIA PT. BSL Rp 30,000 Rp 30,000 Rp -

16 SUMARNI AN. KHAIRUL MULKI FEBRIS PT. BSL Rp 30,000 Rp 30,000 Rp -

12 SANIH ASTUTI NY. SANIH ASTUTI HIPERMENORE PT. BSL Rp 30,000 Rp 30,000 Rp -

12 NAYAH AN. RIRIN DWI ARIYANTI ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

12 SALIM TN. SALIM FARINGITIS PT. BSL Rp 30,000 Rp 30,000 Rp -

11 MARIAH AN. M. RIFAI RAMAD ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

10 DAROS AN. DWI NUR AINI VARICELLA PT. BSL Rp 30,000 Rp 30,000 Rp -

10 DAROS NY. DAROS ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

10 NINGSIH AN. ALYA SAYNAFSIAH ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

9 KANIH AN. DIAN ROSIH ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

( (021) 8900530 - 31, Fax. (021) 8900570


10 MIAH AN. ADELIA AMALIA DYSPEPSIA PT. BSL Rp 30,000 Rp 30,000 Rp -

8 YANAH AN. INI INDRIANI ISPA, DYSPEPSIA PT. BSL Rp 30,000 Rp 30,000 Rp -

8 SITI MAESAROH NY. SITI MAESAROH DYSPEPSIA PT. BSL Rp 30,000 Rp 30,000 Rp -

21 CICIH TN. NAHRUDIN ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

21 CICIH AN. RIZKY SAPUTRA ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

21 SITI ROMLAH AN. SABRINA RAMADANI FEBRIS PT. BSL Rp 30,000 Rp 30,000 Rp -

21 KURNIATI TN. KUKUH SOSIAWAN VARICELLA PT. BSL Rp 30,000 Rp 30,000 Rp -

26 SITI ROMLAH AN. SABRINA RAMADANI ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

25 DWI JAYANTI TN. OMAN FEBRIS PT. BSL Rp 30,000 Rp 30,000 Rp -

26 MISIH NY. MISIH ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

25 KURNIATI TN. KUKUH SOSIAWAN VARICELLA PT. BSL Rp 30,000 Rp 30,000 Rp -

30 RATNA RIZKI AN. DANAR RIZKI GEA, FEBRIS PT. BSL Rp 30,000 Rp 30,000 Rp -

27 ATIH PURMASARI NY. ATIH PURMASARI ISPA, OBS. TYPHOID PT. BSL Rp 30,000 Rp 30,000 Rp -

4 NUNUNG WAHYUNI AN. VINKA ELISSA ISPA PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

PT. BSL Rp 30,000 Rp 30,000 Rp -

GRAND TOTAL


Mengetahui





PERIODE MARET 2012

PROVIDER KLINIK YADI MEDIKA ( PT. Buana Samudra Lestari )



1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH


Mengetahui







PERIODE MARET 2012

PROVIDER : KLINIK MANDIRI (PT. Daelim)

NO TGL NAMA KARYAWAN NAMA PASIEN

1 3 MULYADI TN. MULYADI

GRAND TOTAL

Mengetahui

Wadir. Yanmed & Keperawatan Wadir. Keuangan

Dr. Firyanti Firman, MARS M. Iqbal, SE. Msi





PERIODE MARET 2012

PROVIDER : KLINIK MANDIRI (PT. Gunung Steel Group)

NO TGL NAMA KARYAWAN NAMA PASIEN

1 20 NASRUL KADIR NY. LISNAWATI

2 20 NASRUL KADIR AN. RANGGA RAFIF R.

3 22 AGUS SUMBODO NY. INDRIYANI

4 29 IKHSAN LUBIS TN. IKHSAN LUBIS

GRAND TOTAL

Mengetahui

( (021) 8900530 - 31, Fax. (021) 8900570

( (021) 8900530 - 31, Fax. (021) 8900570







PERIODE MARET 2012

PROVIDER : KLINIK MANDIRI (PT. Daelim)

NO KETERANGAN KASUS

1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

PROVIDER : KLINIK MANDIRI (PT. Gunung Steel Group)

NO KETERANGAN KASUS

1 TAGIHAN

2 PEMBAYARAN

3 KOREKSI / SELISIH

Mengetahui



( (021) 8900530 - 31, Fax. (021) 8900570



PERIODE MARET 2012

DIAGNOSA PERUSAHAAN DIAJUKAN DIBAYAR

SUSP. TYPHOID PT. Daelim Rp 30,000 Rp 30,000

GRAND TOTAL


Verifikator

N. Frida M



PERIODE MARET 2012

DIAGNOSA PERUSAHAAN DIAJUKAN DIBAYAR

ASAM URAT PT. GSG Rp 30,000 Rp 30,000

ISPA PT. GSG Rp 30,000 Rp 30,000

ISPA PT. GSG Rp 30,000 Rp 30,000

CC, ISPA PT. GSG Rp 30,000 Rp 30,000

GRAND TOTAL


Verifikator

N. Frida M



PERIODE MARET 2012

JUMLAH

JUMLAH


Verifikator

N. Frida M



PERIODE MARET 2012

SELISIH KETERANGAN


Verifikator

N. Frida M



PERIODE MARET 2012

SELISIH KETERANGAN


Verifikator

N. Frida M

verifikasi maret 2012 free

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