RAWAT INAPDAFTAR KLAIM RAWAT INAP PASIEN JAMKESDA RSUD TANAH BUMBUPROPINSI : KALIMANTAN SELATANBULAN : OktoberKABUPATEN : TANAH BUMBUTAHUN : 2013NONAMA PASIENNO.REKOMENDASI JAMKESDAUmur (Thn)TANGGALLOSDIAGNOSAPelayanan Kesehatan Dan Besaran Tarif sesuai PERDA (Rp)Pemakaian OksigenUSGPemeriksaan Darah Untuk Tranfusi dan KantongLaboratoriumObat, alat suntik, alat infus dan cairan infus selama dirawat dan atau operasiPoloklinik (Bedah)Tindakan Rehabilitasi MedikTindakan Rehabilitasi Medik (Latihan Wicara)Tindakan Rehabilitasi Medik (Latihan Fisik Lokal)Voucher Tindakan Rehabilitasi Medik (Elekrostimulasi)Voucher Tindakan Rehabilitasi Medik (Exc)Tindakan MedisJUMLAHAkomodasiJasa MedisJasa MedisJasa KeperawatanJasa ApotekerKonsultasiBerkas RMTindakan di UGDTindakan Persalinan & KebidananTindakan Operasi BedahAnastesiRontgenEKGLepas InfusMemasangInjeksi IVInjeksi IMPasang InfusObservasiPasang/Pemberian OGTTindakan Penyakit DalamTTVNebulisasiNebulizerInkubatorJahit lukaAngkat jahitanRawat Luka OPSuctionTindakan Poli BedahPsikologiHeactingKonselingPenyimpanan JenazahUPFBiaya Tindakan Poli UmumTAGIHANLPMasukKeluarSpesialisUmumTindakan KecilTindakan SedangTindakan IntensifGiziSederhanaSederhana Poli UmumKecilSedangBesarTndakan Penyakit DalamTindakan Rehabilitasi MedikPersalinan NormalPersalinan SulitResusitasi Bayi Baru LahirRJPOKuretasi + AnastesiKuretasi Sulit + AnastesiManual Plasenta + AnastesiSederhanaKecilSedangBesarKhususSederhanaKecilSedangBesarKhususSeprai1An. Ahmad fauzi63100409101100011.419 February 201323 February 20134 (Hari)Rp200,000Rp150,000Rp20,000Rp100,000Rp10,000Rp1,750,000Rp600,000Rp20,000Rp169,000Rp5,000Rp25,000Bedah&AnakRp3,049,00007.15.012An. Syahril63100216070000071205 March 201306 March 20131 (Hari)Intoksikasi organofosfatRp50,000Rp30,000Rp60,000Rp90,000Rp10,000Rp125,000Rp200,000Rp236,000Rp5,000Rp20,000Rp100,000AnakRp926,00007.24.683An. Akbar63100111100200021002 April 201305 April 20133 (Hari)Hepatitis ARp150,000Rp90,000Rp60,000Rp10,000Rp100,000Rp200,000Rp199,000Rp5,000Rp20,000AnakRp834,00007.36.074Tn. Ketut Sweden63100315124000017329 May 201331 May 20132 (Hari)ArtritisRp100,000Rp30,000Rp20,000Rp80,000Rp10,000Rp100,000Rp95,000Rp11,000Rp80,000Rp25,000InternaRp551,00007.58.585Tn. Asikianor63100901075400405931 July 201307 August 20137 (Hari)AnemiaRp350,000Rp140,000Rp270,000Rp10,000Rp100,000Rp45,000Rp770,000Rp60,000Rp268,000Rp614,000Rp160,000Rp100,000Rp130,000Rp160,000Rp60,000InternaRp3,237,00007.88.336An. Hendrawan63100202080100051331 July 201303 August 20133 (Hari)MalariaRp150,000Rp90,000Rp80,000Rp10,000Rp200,000Rp115,000Rp268,000Rp5,000Rp20,000AnakRp938,00007.88.277An. Ahmad Alkhaidir6310091007090006228 July 201303 August 20136 (Hari)Rp300,000Rp120,000Rp20,000Rp140,000Rp10,000Rp200,000Rp4,000,000Rp1,400,000Rp60,000Rp45,000Rp933,900Rp5,000Rp50,000Rp350,000Rp150,000BedahRp7,783,90007.86.868Ny. Wadari63100260056000024720 July 201306 August 201317 (Hari)Rp850,000Rp330,000Rp80,000Rp880,000Rp30,000Rp180,000Rp10,000Rp100,000Rp875,000Rp315,000Rp1,040,000Rp5,000Rp125,000InternaRp4,820,00007.62.319Tn. Elly Fransyorgen63100624087500013830 July 201303 August 20134 (Hari)FebrisRp200,000Rp120,000Rp160,000Rp10,000Rp100,000Rp253,000Rp223,000Rp150,000InternaRp1,216,00007.88.1710Ny. Kasmirah63100941073200158128 July 201302 August 20135 (Hari)Susp SNHRp250,000Rp150,000Rp20,000Rp240,000Rp30,000Rp180,000Rp10,000Rp100,000Rp400,000Rp229,500Rp921,000Rp5,000Rp50,000NerologiRp2,585,50007.86.8311Tn. Mustakim63100331126300415004 August 201306 August 20132 (Hari)Diare AkutRp100,000Rp40,000Rp120,000Rp90,000Rp10,000Rp200,000Rp95,000Rp355,000Rp5,000Rp50,000InternaRp1,065,00008.90.2412Ny. Poniyem63100741075600165706 August 201306 August 2013SHRp50,000Rp40,000Rp80,000Rp90,000Rp10,000Rp200,000Rp55,000Rp100,000Rp207,000Rp5,000InternaRp837,00007.90.6513Tn. Syamsuri63100107036200015006 August 201307 August 20131 (Hari)SHRp50,000Rp30,000Rp40,000Rp45,000Rp10,000Rp200,000Rp45,000Rp105,000Rp95,000Rp934,000Rp10,000Rp20,000Rp20,000Rp250,000Rp20,000InternaRp1,874,00007.90.7514Ny. Sitiyah/Sutiyah63100753104500026101 August 201305 August 20134 (Hari)SNNTRp200,000Rp30,000Rp40,000Rp160,000Rp10,000Rp100,000Rp148,000Rp189,500Rp5,000InternaRp882,50015Ny. Maulidiah63100241078803142504 August 201307 August 20133 (Hari)Susp Spinal injury susp fr turokalisRp150,000Rp20,000Rp100,000Rp10,000Rp97,000Rp5,000Rp80,000Rp200,000InternaRp662,00007.90.3016Ny. Ramlah63100241015700046006 August 201307 August 20131 (Hari)CKSRp50,000Rp20,000Rp20,000Rp50,000Rp10,000Rp200,000Rp45,000Rp183,500BedahRp578,50007.92.0617Ny. Suyatin63100841077100344229 August 201311 September 201313 (Hari)DM tipe IIRp650,000Rp270,000Rp40,000Rp480,000Rp60,000Rp10,000Rp125,000Rp60,000Rp575,000Rp1,815,000Rp20,000Rp150,000Rp4,255,00008.04.2718Tn. Sardiansyah63100405077100064230 August 201321 September 201322 (Hari)AnemiaRp1,100,000Rp660,000Rp180,000Rp1,000,000Rp600,000Rp5,000Rp10,000Rp100,000Rp60,000Rp2,080,000Rp418,000Rp3,130,000Rp250,000InternaRp9,593,00008.04.4719Tn. Yusriadi63100919125900025531 August 201308 September 20138 (Hari)DyspneuRp400,000Rp150,000Rp40,000Rp440,000Rp30,000Rp90,000Rp10,000Rp200,000Rp250,000Rp130,000Rp440,000InternaRp2,180,00008.04.6420An. Anton63100822020000021324 September 201326 September 20132 (Hari)Post eksisi tumorRp100,000Rp90,000Rp20,000Rp60,000Rp5,000Rp10,000Rp100,000Rp1,750,000Rp600,000Rp45,000Rp60,500Rp5,000Rp100,000Rp75,000BedahRp3,020,50008.18.6321Tn. Basran yusuf631000507084800026623 September 201327 September 20134 (Hari)Open Fr. Tibia fibulaRp200,000Rp150,000Rp100,000Rp5,000Rp10,000Rp1,750,000Rp4,000,000Rp1,400,000Rp130,000Rp60,000Rp165,500Rp923,000Rp10,000Rp50,000Rp250,000Rp75,000BedahRp9,278,50008.17.5122Ny. Hj. Sadina63100271125200046024 September 201326 September 20132 (Hari)Susp GanglinRp100,000Rp90,000Rp80,000Rp5,000Rp10,000Rp100,000Rp5,250,000Rp1,800,000Rp60,000Rp137,500Rp136,000Rp5,000Rp25,000Rp200,000BedahRp7,998,50008.18.2323Tn. Atim63100926037500023823 September 201325 September 20132 (Hari)Rp100,000Rp120,000Rp60,000Rp5,000Rp10,000Rp100,000Rp4,000,000Rp1,400,000Rp95,000Rp235,500Rp5,000Rp25,000Rp100,000Rp75,000BedahRp6,330,50008.12.8524Tn. Mufid63100726089500011825 September 201328 September 20133 (Hari)Rp150,000Rp150,000Rp80,000Rp5,000Rp10,000Rp5,000,000Rp1,750,000Rp451,000Rp10,000Rp100,000Rp150,000BedahRp7,856,00008.18.0925Tn. Surono / Suroto63100501075400355823 September 201326 September 20133 (Hari)Rp150,000Rp180,000Rp60,000Rp5,000Rp10,000Rp4,000,000Rp1,400,000Rp60,000Rp60,000Rp165,500Rp537,000Rp5,000Rp25,000Rp150,000Rp75,000BedahRp6,882,50008.17.2726Ny. Tuyem63101041074700348024 September 201328 September 20134 (Hari)Tumor kulitRp200,000Rp210,000Rp100,000Rp10,000Rp250,000Rp90,000Rp60,000Rp282,500Rp454,000Rp5,000Rp5,000Rp25,000Rp200,000Rp75,000BedahRp1,966,50008.17.9827Tn. Gimun63100527076100015024 September 201327 September 20133 (Hari)Post eksisi tumorRp150,000Rp120,000Rp80,000Rp5,000Rp10,000Rp200,000Rp1,750,000Rp600,000Rp60,000Rp120,000Rp211,000Rp605,500Rp10,000Rp150,000Rp75,000BedahRp4,146,50007.55.6928Tn. Edi Sobarna63100914059100022117 September 201320 September 20133 (Hari)Post op abdominal painRp150,000Rp120,000Rp80,000Rp5,000Rp10,000Rp5,250,000Rp1,800,000Rp135,000Rp695,000Rp5,000Rp25,000Rp200,000Rp50,000Rp75,000BedahRp8,600,00007.98.9629An. Aldo6310060106040003616 September 201319 September 20133 (Hari)Post op polipectomyRp150,000Rp90,000Rp80,000Rp5,000Rp10,000Rp50,000Rp4,000,000Rp1,400,000Rp141,500Rp286,000Rp5,000Rp25,000Rp50,000Rp75,000BedahRp6,367,50008.13.1830Tn. Harianto63100506028500012811 September 201320 September 20139 (Hari)Rp450,000Rp270,000Rp220,000Rp30,000Rp5,000Rp10,000Rp200,000Rp1,750,000Rp6,562,500Rp600,000Rp2,250,000Rp280,000Rp180,000Rp2,023,000Rp10,000Rp25,000Rp250,000Rp50,000Rp600,000BedahRp15,765,50008.08.5931Tn. Rahman63100914088500012814 September 201320 September 20136 (Hari)Nekrosis ManusRp300,000Rp180,000Rp140,000Rp5,000Rp10,000Rp4,000,000Rp1,400,000Rp45,000Rp715,000Rp5,000Rp250,000Rp50,000Rp450,000BedahRp7,550,00008.08.5232An. M. Khoiri63100812051300014 (Bulan)16 September 201330 September 201314 (Hari)Obs. febrisRp700,000Rp420,000Rp160,000Rp20,000Rp420,000Rp630,000Rp5,000Rp10,000Rp200,000Rp13,125,000Rp4,500,000Rp1,000,000Rp260,000Rp330,500Rp2,577,500Rp25,000Rp140,000Rp100,000Rp750,000AnakRp25,373,00008.12.5033An. Cahaya Ramadani6310036408090001424 September 201326 September 20132 (Hari)Kista AtheromaRp100,000Rp60,000Rp20,000Rp40,000Rp5,000Rp10,000Rp100,000Rp1,750,000Rp600,000Rp45,000Rp353,500Rp5,000Rp100,000Rp75,000BedahRp3,263,50007.85.6934Ny. Rusniah63100152097600013602 September 201305 September 20133 (Hari)Rp150,000Rp90,000Rp80,000Rp10,000Rp1,750,000Rp600,000Rp115,000Rp618,500Rp5,000Rp25,000Rp150,000Rp75,000BedahRp3,668,50008.07.9935Ny. Yumariah63100355087400023910 September 201317 September 20137 (Hari)Kolik abdomenRp350,000Rp210,000Rp20,000Rp160,000Rp30,000Rp10,000Rp125,000Rp5,000,000Rp1,750,000Rp60,000Rp100,000Rp112,000Rp1,139,000Rp10,000Rp400,000Rp225,000BedahRp9,701,00008.08.5136Nn. Nine Lahiriah S63100944029300011717 September 201319 September 20132 (Hari)Tumor MamaeRp100,000Rp120,000Rp20,000Rp60,000Rp10,000Rp100,000Rp1,750,000Rp600,000Rp132,500Rp1,238,000Rp5,000Rp100,000Rp75,000BedahRp4,310,50008.14.3437Tn. Edi Hermawan63100706039500031818 September 201320 September 20132 (Hari)Rp100,000Rp120,000Rp60,000Rp5,000Rp10,000Rp50,000Rp1,750,000Rp600,000Rp95,000Rp747,000Rp5,000Rp25,000Rp150,000Rp75,000BedahRp3,792,00008.12.3938Ny. Tuniati63100245055600025727 September 201330 September 20133 (Hari)CHFRp150,000Rp60,000Rp20,000Rp160,000Rp5,000Rp10,000Rp200,000Rp100,000Rp153,000Rp458,500Rp5,000Rp50,000InternaRp1,371,50007.71.1239An. M. Salman63100213051300014 (Bulan)26 September 201328 September 20132 (Hari)Rp100,000Rp90,000Rp60,000Rp20,000Rp30,000Rp90,000Rp5,000Rp10,000Rp125,000Rp30,000Rp77,000Rp250,000Rp5,000Rp10,000Rp100,000AnakRp1,002,00008.19.5640An. Rahmat Hidayat6310021605080001523 September 201325 September 20132 (Hari)GastritisRp100,000Rp60,000Rp40,000Rp45,000Rp5,000Rp10,000Rp100,000Rp182,000Rp123,000Rp5,000Rp20,000Rp50,000AnakRp740,00008.18.1341Tn. Agus sitohang63100904089200066628 September 201328 September 2013Cedera kepala ringanRp50,000Rp60,000Rp20,000Rp5,000Rp10,000Rp200,000Rp439,500Rp5,000Rp50,000Rp75,000BedahRp914,50008.20.5642An. Noval Nur. R6310095311050005924 September 201326 September 20132 (Hari)Obs febris susp ISKRp100,000Rp60,000Rp60,000Rp5,000Rp10,000Rp100,000Rp97,000Rp48,000Rp5,000Rp10,000AnakRp495,00008.18.7543Tn. Ery Yulianto63100515078300013023 September 201325 September 20132 (Hari)ISKRp100,000Rp60,000Rp5,000Rp10,000Rp100,000Rp120,000Rp160,000Rp620,000Rp5,000Rp150,000BedahRp1,330,00007.88.7444Tn. Afuda63101013118000013223 September 201327 September 20134 (Hari)Rp200,000Rp60,000Rp40,000Rp5,000Rp10,000Rp200,000Rp120,000Rp219,500Rp142,500InternaRp997,00008.18.3145Tn. Iman Yuli63101024079400011724 September 201326 September 20132 (Hari)Rp100,000Rp90,000Rp40,000Rp120,000Rp90,000Rp5,000Rp10,000Rp200,000Rp200,000Rp120,000Rp272,000Rp513,500Rp20,000Rp25,000InternaRp1,805,50008.18.3246An. M. Rafli63100606021300018 (Bulan)26 September 201328 September 20132 (Hari)DCARp100,000Rp90,000Rp40,000Rp20,000Rp90,000Rp5,000Rp10,000Rp125,000Rp77,000Rp61,000Rp5,000Rp100,000AnakRp723,00008.19.4047An. Ahmad Aqila. A63100124011300018 (Bulan)29 September 201330 September 20131 (Hari)GEARp50,000Rp30,000Rp20,000Rp30,000Rp90,000Rp5,000Rp10,000Rp100,000Rp150,500Rp5,000Rp20,000Rp150,000AnakRp660,50008.21.1048An. Nadia Agustina63100652081300011,5 (Bulan)28 September 201330 September 20132 (Hari)Diare cair akutRp100,000Rp60,000Rp20,000Rp40,000Rp30,000Rp5,000Rp10,000Rp100,000Rp182,000Rp5,000Rp25,000Rp50,000AnakRp627,00008.20.5949An. Khairun Niah631006541112000310 (Bulan)27 September 201330 September 20133 (Hari)Diare cair akutRp150,000Rp60,000Rp60,000Rp90,000Rp90,000Rp5,000Rp10,000Rp100,000Rp55,000Rp76,000Rp5,000Rp25,000Rp150,000Rp40,000AnakRp916,00008.19.9850Ny. Kartasiah63100542045500015829 September 201330 September 20131 (Hari)Angina pectorisRp50,000Rp30,000Rp40,000Rp160,000Rp135,000Rp5,000Rp10,000Rp100,000Rp50,000Rp60,000Rp288,000Rp507,500Rp5,000Rp25,000InternaRp1,465,50008.21.4651Tn. Ateng/Heri Priyono63100909075300032520 September 201323 September 20133 (Hari)Susp Fr mandibulaRp150,000Rp90,000Rp80,000Rp5,000Rp10,000Rp200,000Rp90,000Rp947,000Rp5,000Rp100,000Rp225,000BedahRp1,902,00008.16.4152Tn. Rahmatullah63100108115300016024 September 201327 September 20133 (Hari)GastroeteritisRp150,000Rp90,000Rp20,000Rp240,000Rp180,000Rp5,000Rp10,000Rp100,000Rp60,000Rp130,000Rp147,500Rp20,000Rp100,000InternaRp1,252,50008.18.3853Tn. Aliansyah63100901079201682523 September 201327 September 20134 (Hari)Obs. Vomitus susp hepatitis ARp200,000Rp120,000Rp20,000Rp280,000Rp90,000Rp5,000Rp10,000Rp100,000Rp147,000Rp266,000Rp20,000Rp100,000InternaRp1,358,00008.18.1054Ny. Maseinah63100241076002545024 September 201324 September 2013Susp stroke hemoragik, hipertensi emergencyRp50,000Rp60,000Rp80,000Rp5,000Rp10,000Rp100,000Rp95,000Rp180,000Rp15,000Rp25,000Rp100,000SarafRp720,00008.18.1655Ny. Jumaini63100263026800014523 September 201326 September 20133 (Hari)GEARp150,000Rp90,000Rp20,000Rp200,000Rp5,000Rp10,000Rp100,000Rp60,000Rp60,000Rp217,500Rp15,000Rp75,000InternaRp1,002,50008.17.7256Ny. Yamanah63200241075201166122 September 201324 September 20132 (Hari)Rp100,000Rp60,000Rp40,000Rp120,000Rp5,000Rp10,000Rp100,000Rp50,000Rp60,000Rp274,500Rp3,509,000Rp5,000Rp25,000InternaRp4,358,50008.16.9857Tn. Zulkipli Halil63100920044500037022 September 201324 September 20132 (Hari)Susp Ileus ParalitikRp100,000Rp90,000Rp80,000Rp160,000Rp225,000Rp5,000Rp10,000Rp125,000Rp50,000Rp120,000Rp213,000Rp496,500Rp15,000Rp25,000InternaRp1,714,50008.16.9558An. Zaki zain6310011709040003923 September 201326 September 20133 (Hari)Demam thypoidRp150,000Rp90,000Rp40,000Rp30,000Rp45,000Rp5,000Rp10,000Rp100,000Rp122,000Rp184,000Rp5,000Rp10,000Rp5,000AnakRp796,00008.17.2159Ny. Ainun63100942036700054523 September 201326 September 20133 (Hari)Rp150,000Rp60,000Rp200,000Rp5,000Rp10,000Rp100,000Rp60,000Rp313,000Rp10,000Rp50,000InternaRp958,00008.18.0660Ny. Darmawati63100961028400032819 September 201324 September 20135 (Hari)Obs FebrisRp250,000Rp150,000Rp20,000Rp320,000Rp5,000Rp10,000Rp100,000Rp60,000Rp438,000Rp289,500Rp15,000Rp75,000InternaRp1,732,50008.15.6061Tn. Misran63100407087400023920 September 201324 September 20134 (Hari)Obs febris+cepusiRp200,000Rp120,000Rp40,000Rp280,000Rp5,000Rp10,000Rp100,000Rp200,000Rp60,000Rp135,000Rp767,000Rp40,000Rp100,000Rp200,000InternaRp2,257,00008.16.4062Ny. Hj. Hermina63100947095300036025 September 201327 September 20132 (Hari)Psikosomatis, disorder, dispepsiRp100,000Rp60,000Rp200,000Rp90,000Rp5,000Rp10,000Rp100,000Rp120,000Rp234,500Rp15,000Rp75,000InternaRp1,009,50008.19.3463Tn. Nasrullah63101001079100592222 September 201325 September 20133 (Hari)EpilepsiRp150,000Rp90,000Rp240,000Rp5,000Rp10,000Rp200,000Rp200,000Rp130,000Rp222,500Rp40,000Rp100,000Rp150,000HemoRp1,537,50008.17.0564Tn. Mustaming63100205076200035112 September 201327 September 201315 (Hari)Obs. Intake sulitRp750,000Rp240,000Rp140,000Rp760,000Rp450,000Rp5,000Rp10,000Rp100,000Rp200,000Rp60,000Rp130,000Rp1,245,000Rp75,000Rp250,000InternaRp4,415,00065Ny. Salmiah63100265027000024311 September 201323 September 201312 (Hari)DMRp600,000Rp210,000Rp80,000Rp600,000Rp45,000Rp5,000Rp10,000Rp125,000Rp60,000Rp205,000Rp786,500Rp35,000Rp175,000Rp250,000InternaRp3,186,50007.73.6466Tn. Kastalani63100525039600031727 September 201328 September 20131 (Hari)cidera kepala ringanRp50,000Rp60,000Rp40,000Rp5,000Rp10,000Rp200,000Rp45,000Rp161,500Rp5,000Rp100,000BedahRp676,50008.20.4167Tn. Sugianto63100101046700034627 September 201330 September 20133 (Hari)Obs dispepsiRp150,000Rp90,000Rp20,000Rp280,000Rp5,000Rp10,000Rp100,000Rp100,000Rp60,000Rp112,000Rp359,000Rp20,000Rp50,000Rp75,000InternaRp1,431,00008.19.9468Ny. Jumiati63100153047500023826 September 201329 September 20133 (Hari)Sindrom dyspepsiRp150,000Rp60,000Rp20,000Rp80,000Rp45,000Rp5,000Rp10,000Rp100,000Rp60,000Rp80,000Rp163,500Rp5,000Rp50,000InternaRp828,50008.19.8669Tn. Sukamso63100801074500206822 September 201325 September 20133 (Hari)Sindrom dispepsiaRp150,000Rp30,000Rp60,000Rp140,000Rp5,000Rp10,000Rp125,000Rp20,000Rp60,000Rp60,000Rp349,000Rp236,500Rp5,000Rp25,000InternaRp1,275,50005.06.3770Ny. Hj. Rawiyah63100241075702075022 September 201326 September 20134 (Hari)OARp200,000Rp120,000Rp20,000Rp320,000Rp135,000Rp5,000Rp10,000Rp100,000Rp150,000Rp60,000Rp255,000Rp380,500Rp35,000Rp75,000InternaRp1,865,50008.17.0071Ny. Nor Aini63100249015500015717 September 201321 September 20134 (Hari)Susp SNHRp200,000Rp210,000Rp160,000Rp5,000Rp10,000Rp60,000Rp234,500Rp572,000Rp5,000Rp25,000SarafRp1,481,50008.14.9572Tn. H. Fahmi63100929107800013520 September 201327 September 20137 (Hari)Rp350,000Rp180,000Rp400,000Rp135,000Rp5,000Rp10,000Rp100,000Rp60,000Rp120,000Rp156,000Rp833,500Rp30,000Rp150,000InternaRp2,529,50008.16.4673Ny. Kursiah63100958046000025020 September 201328 September 20138 (Hari)Susp DispepsiaRp400,000Rp210,000Rp20,000Rp440,000Rp180,000Rp5,000Rp10,000Rp100,000Rp100,000Rp60,000Rp120,000Rp138,000Rp1,216,000Rp45,000Rp150,000InternaRp3,194,00008.16.4474Nn. Lisa Indria63100141069100042220 September 201323 September 20133 (Hari)Obs. FebrisRp150,000Rp60,000Rp240,000Rp5,000Rp10,000Rp100,000Rp100,000Rp240,000Rp393,000Rp25,000Rp125,000InternaRp1,448,00008.15.7575Tn. Jumardin6310022006003744020 September 201324 September 20134 (Hari)Rp200,000Rp90,000Rp240,000Rp5,000Rp10,000Rp100,000Rp117,000Rp625,000Rp10,000Rp50,000InternaRp1,447,00008.16.3076Ny. Mahrita63100955087000084320 September 201324 September 20134 (Hari)DM tipe IIRp200,000Rp90,000Rp240,000Rp5,000Rp10,000Rp100,000Rp60,000Rp304,500Rp337,500Rp10,000Rp50,000InternaRp1,407,00008.16.4877Tn. M. Riswan63100909129800011520 September 201322 September 20132 (Hari)Obs FebrisRp100,000Rp30,000Rp20,000Rp160,000Rp5,000Rp10,000Rp210,000Rp140,000Rp5,000Rp25,000InternaRp705,00008.16.2578Ny. Hartini63100371129100042220 September 201326 September 20136 (Hari)ISKRp300,000Rp150,000Rp20,000Rp140,000Rp5,000Rp10,000Rp100,000Rp100,000Rp299,000Rp1,950,000Rp5,000Rp25,000Rp300,000BedahRp3,404,00008.15.6579Ny. Arbayah63100950047800053519 September 201320 September 20131 (Hari)Obs. febrisRp50,000Rp30,000Rp80,000Rp5,000Rp10,000Rp100,000Rp200,000Rp60,000Rp165,000Rp446,000Rp5,000Rp25,000Rp100,000InternaRp1,276,00008.15.6180Tn. Basuki63101005057800053522 September 201325 September 20133 (Hari)CHF+hepatitis BRp150,000Rp90,000Rp240,000Rp5,000Rp10,000Rp125,000Rp400,000Rp120,000Rp120,000Rp235,000Rp321,500Rp30,000Rp50,000InternaRp1,896,50006.53.1181Ny. Saniah63100950013900017420 September 201323 September 20133 (Hari)CADRp150,000Rp90,000Rp200,000Rp5,000Rp10,000Rp100,000Rp100,000Rp60,000Rp95,000Rp431,000Rp5,000Rp25,000InternaRp1,271,00008.15.6782Tn. Asmudu631001150641000017118 September 201323 September 20135 (Hari)Sirosis hepatisRp250,000Rp150,000Rp340,000Rp5,000Rp10,000Rp125,000Rp50,000Rp180,000Rp60,000Rp324,000Rp373,500Rp15,000Rp75,000InternaRp1,957,50008.14.7183Tn. Muhammad Sabani63100908029300042021 September 201323 September 20132 (Hari)Obs vomitusRp100,000Rp60,000Rp200,000Rp5,000Rp10,000Rp100,000Rp145,000Rp257,000Rp5,000Rp25,000InternaRp907,00008.16.5484Tn. Husni63100915038400055219 September 201325 September 20136 (Hari)Retansio UrineRp300,000Rp150,000Rp380,000Rp45,000Rp5,000Rp10,000Rp60,000Rp316,000Rp468,500Rp20,000Rp100,000InternaRp1,854,50008.15.9185Ny. Hj. Zainah63100945107200074116 September 201319 September 20133 (Hari)Gastritis obs vomitusRp150,000Rp60,000Rp20,000Rp240,000Rp5,000Rp10,000Rp100,000Rp60,000Rp130,000Rp224,000Rp5,000Rp75,000InternaRp1,079,00008.14.5686Tn. Abbas63100201076501684806 September 201325 September 201319 (Hari)Rp950,000Rp390,000Rp80,000Rp600,000Rp45,000Rp5,000Rp10,000Rp160,000Rp60,000Rp587,500Rp1,627,500Rp10,000Rp250,000Rp500,000InternaRp5,275,00008.07.6487Ny. Jumriani63100267067100044217 September 201324 September 20137 (Hari)Obs abdominal painRp350,000Rp150,000Rp60,000Rp400,000Rp120,000Rp5,000Rp10,000Rp60,000Rp1,515,000Rp573,000Rp20,000Rp100,000InternaRp3,363,00008.14.6388An. Surya6310012502120002117 September 201320 September 20133 (Hari)KDKRp150,000Rp150,000Rp120,000Rp180,000Rp5,000Rp10,000Rp125,000Rp20,000Rp170,000Rp290,000Rp10,000Rp30,000Rp25,000Rp200,000AnakRp1,485,00008.14.6289Ny. Sampurna63100942044600015917 September 201320 September 20133 (Hari)StrokeRp150,000Rp180,000Rp200,000Rp5,000Rp10,000Rp100,000Rp50,000Rp60,000Rp135,000Rp83,000Rp10,000Rp100,000InternaRp1,083,00007.57.8590Tn. Jito paiman63100317074800016517 September 201320 September 20133 (Hari)Rp150,000Rp60,000Rp20,000Rp100,000Rp10,000Rp100,000Rp200,000Rp60,000Rp60,000Rp241,500Rp10,000Rp100,000InternaRp1,111,50008.14.6191Tn. Mansur63100711067200024116 September 201323 September 20137 (Hari)Susp TB paru relapsRp350,000Rp120,000Rp20,000Rp400,000Rp5,000Rp10,000Rp100,000Rp60,000Rp60,000Rp508,500Rp20,000Rp100,000Rp225,000InternaRp1,978,50008.12.6592Tn. Harun AR63100129116400024916 September 201321 September 20135 (Hari)Rp250,000Rp120,000Rp40,000Rp240,000Rp5,000Rp10,000Rp125,000Rp45,000Rp200,000Rp60,000Rp230,000Rp1,528,500Rp20,000Rp75,000InternaRp2,948,50008.12.6393Tn. Taha63100905055900015516 September 201321 September 20135 (Hari)Susp SNHRp250,000Rp240,000Rp20,000Rp320,000Rp5,000Rp10,000Rp200,000Rp100,000Rp220,000Rp1,061,000Rp15,000Rp75,000Rp225,000InternaRp2,741,00008.12.6794Tn. Samidi63100801073700047613 September 201324 September 201311 (Hari)Susp MalariaRp550,000Rp150,000Rp120,000Rp560,000Rp5,000Rp10,000Rp100,000Rp60,000Rp220,000Rp918,000Rp30,000Rp150,000InternaRp2,873,00008.10.9095Tn. Wiji63100715074800016515 September 201323 September 20138 (Hari)Retensio uri e.c erethrolithiesisRp400,000Rp240,000Rp160,000Rp5,000Rp10,000Rp200,000Rp220,000Rp60,000Rp152,000Rp976,000Rp5,000Rp400,000BedahRp2,828,00007.82.5696Tn. Sutisna63100901076801834514 September 201319 September 20135 (Hari)Gastritis KronisRp250,000Rp60,000Rp100,000Rp320,000Rp5,000Rp10,000Rp100,000Rp60,000Rp130,000Rp72,000Rp5,000Rp75,000InternaRp1,187,00008.12.0197Ny. Sumijah63100857084600016015 September 201326 September 201311 (Hari)obs. Dispnoe, susp CHFRp550,000Rp240,000Rp60,000Rp600,000Rp675,000Rp5,000Rp10,000Rp200,000Rp1,100,000Rp120,000Rp120,000Rp334,500Rp635,000Rp125,000Rp250,000InternaRp5,024,50008.12.1098An. Wildan Riadi63101022061300013 (Bulan)15 September 201319 September 20134 (Hari)KDKRp200,000Rp120,000Rp100,000Rp180,000Rp5,000Rp10,000Rp125,000Rp148,000Rp112,500Rp5,000Rp40,000Rp250,000AnakRp1,295,50008.12.5199Ny. Kade63100241073700927523 September 201328 September 20135 (Hari)Asma bronchialisRp250,000Rp90,000Rp40,000Rp360,000Rp135,000Rp5,000Rp10,000Rp200,000Rp200,000Rp60,000Rp60,000Rp60,000Rp418,000Rp45,000Rp100,000InternaRp2,033,00008.17.20100Ny. Sitti63100907025000028009 September 201310 September 20131 (Hari)Susp stroke hemoragikRp50,000Rp30,000Rp20,000Rp40,000Rp10,000Rp200,000Rp200,000Rp100,000Rp373,500Rp10,000Rp25,000Rp50,000Rp1,108,50008.08.25101Tn.Umar Dani63100511088600012728 September 201330 September 20132 (Hari)ISK dd BSKRp100,000Rp30,000Rp40,000Rp200,000Rp5,000Rp10,000Rp100,000Rp117,000Rp160,500Rp5,000Rp50,000InternaRp817,50008.20.94102Tn.Noorjani63100104066400014924 September 201330 September 20136 (hari)Hepber XLRp300,000Rp150,000Rp40,000Rp400,000Rp5,000Rp10,000Rp100,000Rp100,000Rp345,000Rp640,000Rp5,000Rp125,000InternaRp2,220,00008.18.18103Tn.Ratmo Tinoyo63100801014000018212 September 201325 September 201313 (hari)Obs FebrisRp650,000Rp210,000Rp120,000Rp680,000Rp5,000Rp10,000Rp200,000Rp200,000Rp380,000Rp180,000Rp503,000Rp1,861,000Rp75,000Rp250,000Rp300,000InternaRp5,624,00008.08.90104Ny.Rasunah63100244054800026521 September 201330 September 20139 (hari)Sups APP PertontaRp450,000Rp300,000Rp200,000Rp5,000Rp10,000Rp200,000Rp220,000Rp100,000Rp60,000Rp174,000Rp691,500Rp500,000BedahRp2,910,50008.16.59105Ny.Tuniati63100245055600025712 September 201325 September 201313 (hari)CHFRp650,000Rp210,000Rp100,000Rp680,000Rp5,000Rp10,000Rp125,000Rp350,000Rp120,000Rp180,000Rp694,500Rp1,012,500Rp55,000Rp475,000InternaRp4,667,00007.71.12106Ny.Norsiah63100957097400013925 September 201326 September 20131 (hari)u.laceratum os Frontalis + CKRRp50,000Rp30,000Rp40,000Rp5,000Rp10,000Rp200,000Rp50,000Rp90,000Rp613,000Rp5,000Rp50,000BedahRp1,143,00008.18.80107Tn.Sam Sam6310020504500035911 September 201325 September 201314 (hari)Destroyd Lukj AkliktasiRp700,000Rp600,000Rp140,000Rp720,000Rp5,000Rp10,000Rp200,000Rp154,000Rp150,000Rp60,000Rp235,000Rp3,673,500Rp45,000Rp200,000Rp850,000InternaRp7,742,50005.93.36108Tn.Acis63100201077300904002 September 201324 September 201324 (hari)Hemopros e/c TB ParuRp1,200,000Rp540,000Rp180,000Rp1,160,000Rp1,125,000Rp5,000Rp10,000Rp100,000Rp15,000,000Rp180,000Rp60,000Rp362,500Rp5,054,000Rp245,000Rp500,000InternaRp25,721,50007.98.05109Tn.Astam63101001075500646016 September 201325 September 20139 (hari)infeksi Post HerniatomyRp450,000Rp180,000Rp200,000Rp5,000Rp10,000Rp224,000Rp25,000Rp150,000Rp1,350,000BedahRp2,594,00005.41.44110Tn.Atmo63100508000018906025 September 201330 September 20135 (hari)Dispepsia + HT Grade IIRp250,000Rp120,000Rp20,000Rp320,000Rp90,000Rp5,000Rp10,000Rp100,000Rp100,000Rp120,000Rp520,000Rp153,000Rp411,000Rp5,000Rp100,000InternaRp2,324,00008.18.90111Tn. M. Saini63100201074701085321 September 201325 September 20134 (Hari)DM tipe IIRp200,000Rp120,000Rp20,000Rp280,000Rp90,000Rp5,000Rp10,000Rp100,000Rp60,000Rp120,000Rp197,500Rp279,500Rp20,000Rp100,000InternaRp1,602,00008.16.80112An.Hery Rahmadani6310092810060003706 September 201320 September 201314 (hari)Enselopaly thyposaRp700,000Rp510,000Rp60,000Rp450,000Rp630,000Rp5,000Rp10,000Rp125,000Rp450,000Rp778,000Rp1,044,000Rp15,000Rp140,000Rp800,000Rp260,000Rp40,000AnakRp6,017,00008.06.62113Tn.Syahrudin63100601077000364305 September 201310 September 20135 (Hari)tumor sinistraRp250,000Rp120,000Rp20,000Rp120,000Rp60,000Rp10,000Rp100,000Rp60,000Rp60,000Rp110,000Rp568,500Rp10,000Rp1,488,50008.06.51114An.Amiratus Sholihah6310084810110001228 September 201302 Oktober 20134 (hari)Sups.Rektum TendenRp200,000Rp90,000Rp20,000Rp80,000Rp5,000Rp10,000Rp200,000Rp5,250,000Rp1,800,000Rp170,000Rp1,069,500Rp5,000Rp200,000BedahRp9,099,50008.21.02115Tn.Suherman63100930097100053229 September 201303 Oktober 20134 (Hari)Close Fraktum Os amiluk 1/3 medan DeksralRp200,000Rp180,000Rp100,000Rp30,000Rp5,000Rp10,000Rp200,000Rp5,250,000Rp1,800,000Rp290,000Rp170,500Rp4,236,000Rp5,000Rp300,000Rp150,000OrthopediRp12,926,50008.21.06116Tn.m.Fauzan63100425059700021628 September 201303 Oktober 20135 (hari)Close Fraktum Os amiluk 1/3 medan DeksralRp250,000Rp180,000Rp20,000Rp120,000Rp5,000Rp100,000Rp10,500,000Rp1,800,000Rp120,000Rp170,500Rp6,740,500Rp5,000Rp250,000Rp225,000BedahRp20,486,00008.20.97117Tn.Abdul Halim63100708089800021529 September 201304 Oktober 20135 (hari)V Sercum at Armodigm II-III-IV pokstvaRp250,000Rp210,000Rp40,000Rp120,000Rp5,000Rp10,000Rp200,000Rp5,250,000Rp1,800,000Rp50,000Rp170,500Rp1,123,500Rp5,000Rp300,000BedahRp9,534,00008.21.40118Tn. Suro Iman/Imron63100801073900147024 September 201303 October 20139 (Hari)HeniaRp450,000Rp300,000Rp200,000Rp45,000Rp5,000Rp10,000Rp100,000Rp4,000,000Rp1,400,000Rp60,000Rp60,000Rp260,000Rp333,000Rp541,500Rp25,000Rp450,000Rp75,000BedahRp8,314,50008.16.17119Tn.Mugiran63101009074400016729 September 201303 Oktober 20134 (Hari)ObsDispreRp200,000Rp150,000Rp80,000Rp160,000Rp5,000Rp10,000Rp100,000Rp550,000Rp60,000Rp60,000Rp309,500Rp521,500Rp10,000Rp50,000InternaRp2,266,00008.21.22120Ny.Mundari63100970054000017028 September 201304 Oktober 20136 (hari)Sups GEARp300,000Rp330,000Rp20,000Rp240,000Rp5,000Rp10,000Rp200,000Rp400,000Rp371,000Rp718,000Rp29,000Rp48,000Rp20,000Rp25,000Rp75,000InternaRp2,791,00008.20.64121Ny.Aspiyah63100947046400094930 September 201301 Oktober 20131 (hari)liastreonteriksRp50,000Rp60,000Rp20,000Rp40,000Rp5,000Rp10,000Rp200,000Rp139,500Rp591,500Rp5,000Rp25,000Rp50,000InternaRp1,196,00008.21.44122Tn.Urian63100701076100065230 September 201302 Oktober 20132 (Hari)Sups.SNHRp100,000Rp150,000Rp20,000Rp240,000Rp5,000Rp10,000Rp100,000Rp50,000Rp60,000Rp224,500Rp746,000Rp5,000Rp25,000InternaRp1,735,50008.22.46123Tn.Suriyadi63100909066500024830 September 201304 Oktober 20134 (Hari)obs.vomims,DM sups dispepsiaRp200,000Rp120,000Rp200,000Rp5,000Rp10,000Rp100,000Rp60,000Rp140,000Rp255,000Rp10,000Rp50,000InternaRp1,150,00008.22.54124Ny.Jennah63100350037600053730 September 201303 Oktober 20133 (hari)Hemorid tube IIRp150,000Rp90,000Rp80,000Rp5,000Rp10,000Rp100,000Rp223,000Rp5,000Rp200,000BedahRp863,00008.21.67125Tn.Nur Kholis63100511129700021628 September 201301 Oktober 20133 (hari)Rp150,000Rp90,000Rp80,000Rp5,000Rp10,000Rp200,000Rp90,000Rp288,000Rp5,000Rp150,000BedahRp1,068,00008.21.09126Tn.M.Amin63100208046600014730 September 201302 Oktober 20132 (Hari)CHFRp100,000Rp60,000Rp20,000Rp120,000Rp5,000Rp10,000Rp60,000Rp80,000Rp5,000Rp25,000InternaRp485,00008.22.25127Ny.Hanawiyah6310065002500016330 September 201303 Oktober 20133 (hari)LBP + VertigoRp150,000Rp150,000Rp20,000Rp240,000Rp5,000Rp10,000Rp550,000Rp557,000Rp100,000Rp5,000Rp75,000NeurologiRp1,862,00008.20.35128An.Mkhusnul Wafa63100528091300011 Bulan29 September 201305 Oktober 20136 (hari)Rp300,000Rp210,000Rp60,000Rp20,000Rp150,000Rp270,000Rp5,000Rp10,000Rp200,000Rp50,000Rp60,000Rp120,000Rp306,000Rp10,000Rp60,000Rp25,000Rp300,000Rp20,000Rp20,000AnakRp2,196,00008.21.31129Tn.Siram63100801074500356830 September 201301 Oktober 20131 (hari)HipertensiRp50,000Rp30,000Rp20,000Rp40,000Rp5,000Rp10,000Rp100,000Rp108,000Rp63,500Rp5,000Rp25,000InternaRp456,50008.21.58130Tn.Fendi63100413058400032928 September 201302 Oktober 20134 (Hari)MalariaRp200,000Rp120,000Rp60,000Rp260,000Rp5,000Rp10,000Rp100,000Rp208,000Rp304,000Rp5,000Rp75,000InternaRp1,347,00008.20.54131Ny.Karniah63100243076600014830 September 201303 Oktober 20133 (hari)Sups SNHRp150,000Rp150,000Rp40,000Rp120,000Rp5,000Rp10,000Rp60,000Rp199,500Rp174,000Rp29,000Rp27,000Rp5,000Rp25,000NeurologiRp994,50008.22.43132Tn.Abas63100201076501684830 September 201303 Oktober 20133 (hari)Penurunan KesadaraanRp150,000Rp150,000Rp20,000Rp120,000Rp135,000Rp5,000Rp10,000Rp200,000Rp100,000Rp60,000Rp125,000Rp1,061,000Rp15,000Rp25,000InternaRp2,176,00008.07.64133Ny.Lusmiati63100441076001295330 September 201303 Oktober 20133 (hari)Obs abdomen + asstsRp150,000Rp150,000Rp80,000Rp5,000Rp10,000Rp100,000Rp100,000Rp100,000Rp116,500Rp163,500Rp5,000Rp150,000BedahRp1,130,00008.21.56134Ny. Marliah63100970097000024327 September 201301 October 20134 (Hari)Syndrom DyspepsiaRp200,000Rp120,000Rp40,000Rp200,000Rp5,000Rp10,000Rp125,000Rp198,000Rp152,500Rp5,000Rp50,000InternaRp1,105,50008.20.48135Tn. Sutiman63100806025700013030 September 201309 October 20139 (Hari)Retensio UrineRp450,000Rp240,000Rp20,000Rp200,000Rp5,000Rp10,000Rp200,000Rp160,000Rp117,000Rp1,870,500Rp10,000Rp25,000Rp500,000BedahRp3,807,50005.12.35136Ny. Sumirah63101041075700215030 September 201305 October 20135 (Hari)Rp250,000Rp150,000Rp20,000Rp120,000Rp90,000Rp5,000Rp10,000Rp60,000Rp603,000Rp10,000Rp75,000InternaRp1,393,00008.22.13137Tn. Saleh63100506047500033824 September 201304 October 201310 (Hari)TB ParuRp500,000Rp330,000Rp60,000Rp520,000Rp5,000Rp10,000Rp60,000Rp215,000Rp1,038,000Rp15,000Rp150,000InternaRp2,903,00008.18.67138Tn. H. Maharani63100425095300036030 September 201311 October 201311 (Hari)Obs AnemiaRp550,000Rp480,000Rp20,000Rp600,000Rp120,000Rp225,000Rp5,000Rp10,000Rp100,000Rp200,000Rp1,040,000Rp158,000Rp1,973,500Rp50,000Rp250,000Interna&SarafRp5,781,50008.22.47139Tn. Sunarsi63100605063800017430 September 201309 October 20139 (Hari)AnemiaRp450,000Rp240,000Rp40,000Rp520,000Rp120,000Rp270,000Rp5,000Rp10,000Rp300,000Rp60,000Rp60,000Rp780,000Rp417,000Rp384,000Rp35,000Rp175,000InternaRp3,866,00007.51.32140Ny. Janiyah63100241076001655327 September 201303 October 20136 (hari)Obs. DyspneuRp300,000Rp240,000Rp40,000Rp280,000Rp315,000Rp5,000Rp10,000Rp200,000Rp900,000Rp60,000Rp240,000Rp289,000Rp471,500Rp40,000Rp25,000InternaRp3,415,50008.20.42141Ny. Sumiatun63101044057400013909 October 201311 October 20132 (Hari)Keloid Articula SinistraRp100,000Rp120,000Rp60,000Rp5,000Rp10,000Rp50,000Rp1,750,000Rp600,000Rp443,000Rp5,000Rp25,000Rp150,000Rp75,000BedahRp3,393,00007.25.19142Ny. Dewi Wulandari63100949056600014709 October 201312 October 20133 (Hari)Close Fraktus 2/3 Tengah (s)Rp150,000Rp180,000Rp80,000Rp5,000Rp10,000Rp5,250,000Rp1,800,000Rp60,000Rp152,000Rp1,123,000Rp5,000Rp25,000Rp200,000Rp75,000OrthopediRp9,115,00008.28.33143Ny. Siti Alfiah63100356087200034108 October 201311 October 20133 (Hari)Tumor Mammae BilateralRp150,000Rp150,000Rp80,000Rp5,000Rp10,000Rp50,000Rp1,750,000Rp600,000Rp120,000Rp471,000Rp5,000Rp25,000Rp150,000Rp75,000BedahRp3,641,00008.26.14144Tn. Ilyas63101001075400275909 October 201312 October 20133 (Hari)HilRp150,000Rp150,000Rp80,000Rp5,000Rp10,000Rp4,000,000Rp1,400,000Rp60,000Rp152,500Rp1,027,500Rp10,000Rp25,000Rp200,000Rp75,000BedahRp7,345,00008.26.73145An. M. Rizki Anwar6310091002080005501 October 201304 October 20133 (Hari)HerniaRp150,000Rp150,000Rp80,000Rp5,000Rp10,000Rp50,000Rp4,000,000Rp1,400,000Rp45,000Rp1,288,500Rp5,000Rp25,000Rp200,000Rp75,000BedahRp7,483,50008.21.85146Ny. Saiyah63100241074000977301 October 201304 October 20133 (Hari)LipomaRp150,000Rp150,000Rp80,000Rp5,000Rp10,000Rp1,750,000Rp600,000Rp60,000Rp60,000Rp372,000Rp5,000Rp25,000Rp200,000Rp75,000BedahRp3,542,00008.21.84147An. Syaifuddin6310092006080001601 October 201305 October 20134 (Hari)Susp CLRp200,000Rp210,000Rp100,000Rp5,000Rp10,000Rp200,000Rp5,250,000Rp1,800,000Rp140,000Rp417,000Rp5,000Rp100,000Rp75,000Bedah OrthopediRp8,512,00008.22..61148Nn. Arum Widia. A63100348039700041508 October 201311 October 20133 (Hari)Susp FamRp150,000Rp120,000Rp80,000Rp5,000Rp10,000Rp50,000Rp1,750,000Rp600,000Rp60,000Rp120,000Rp878,000Rp50,000Rp5,000Rp150,000Rp75,000BedahRp4,103,00008.26.96149Tn. Kaderi63100501074200067110 October 201314 October 20134 (Hari)HILRp200,000Rp150,000Rp120,000Rp5,000Rp10,000Rp4,000,000Rp1,400,000Rp60,000Rp60,000Rp170,500Rp790,500Rp15,000Rp75,000Rp250,000BedahRp7,306,00008.29.03150Tn. HM Daud63100901084000027308 October 201314 October 20136 (Hari)Post HerniatumRp300,000Rp150,000Rp20,000Rp140,000Rp5,000Rp10,000Rp125,000Rp4,000,000Rp1,400,000Rp60,000Rp60,000Rp287,500Rp1,050,000Rp350,000BedahRp7,957,50008.27.71151An. Aulia Ramah6310094306040005916 October 201322 October 20136 (Hari)Fr. CrurisRp300,000Rp270,000Rp20,000Rp140,000Rp5,000Rp10,000Rp200,000Rp5,250,000Rp1,800,000Rp70,000Rp129,500Rp2,809,500Rp350,000Rp75,000Bedah OrthopediRp11,429,00008.30.93152Tn. Yadi63100812069700021608 October 201319 October 201311 (Hari)Post OrifRp550,000Rp390,000Rp240,000Rp5,000Rp10,000Rp4,000,000Rp5,250,000Rp1,400,000Rp1,800,000Rp70,000Rp170,500Rp2,926,000Rp10,000Rp150,000Rp600,000Rp150,000Rp40,000OrthopediRp17,761,50005.47.21153Tn. Mastur63100907098300042702 October 201308 October 20136 (Hari)Rp300,000Rp210,000Rp140,000Rp30,000Rp5,000Rp10,000Rp100,000Rp5,000,000Rp1,750,000Rp152,000Rp4,022,500Rp10,000Rp350,000Rp300,000BedahRp12,379,50008.24.04154Ny. Maimuna63100547038000013306 October 201312 October 20136 (Hari)Vulnus laceratumRp300,000Rp210,000Rp180,000Rp60,000Rp5,000Rp10,000Rp200,000Rp5,250,000Rp1,800,000Rp70,000Rp287,500Rp500,500Rp5,000Rp450,000BedahRp9,328,00008.25.29155Tn. Fahrullah63100919105900065403 October 201307 October 20134 (Hari)Rp200,000Rp120,000Rp20,000Rp80,000Rp5,000Rp10,000Rp1,750,000Rp600,000Rp60,000Rp60,000Rp153,000Rp857,000Rp15,000Rp5,000Rp25,000Rp200,000Rp150,000BedahRp4,310,00008.22.11156An. Sahaja63100126019900011402 October 201310 October 20138 (Hari)Rp400,000Rp300,000Rp220,000Rp5,000Rp10,000Rp100,000Rp5,000,000Rp1,750,000Rp93,000Rp2,281,000Rp20,000Rp500,000Rp600,000BedahRp11,279,00008.23.42157Tn.I Nyoman Pagu6310001963451887502 Oktober 201304 Oktober 20132 (Hari)CHF + PPOKRp100,000Rp60,000Rp20,000Rp80,000Rp5,000Rp10,000Rp125,000Rp60,000Rp60,000Rp100,000Rp328,500Rp5,000Rp25,000Rp50,000InternaRp1,028,50008.23.38158Ny.Warni63100444027500064002 Oktober 201304 Oktober 20132 (Hari)Hemoptoe e.c.SupsTBRp100,000Rp60,000Rp20,000Rp80,000Rp5,000Rp10,000Rp100,000Rp60,000Rp60,000Rp210,000Rp5,000Rp25,000InternaRp735,00008.23.57159Ny.Hj.Sitiharah63100260016500034801 Oktober 201303 Oktober 20132 (Hari)nomitus & sups MHRp100,000Rp30,000Rp20,000Rp80,000Rp5,000Rp10,000Rp100,000Rp290,000Rp125,000Rp5,000Rp25,000InternaRp790,00008.22.66160Tn.Widiyanto63100601074500056802 Oktober 201305 Oktober 20133 (hari)obs drspneu, ppok,ht grade IIRp150,000Rp90,000Rp240,000Rp5,000Rp10,000Rp100,000Rp70,000Rp60,000Rp100,000Rp287,500Rp30,000Rp75,000InternaRp1,217,50008.06.90161Tn.Darwis63100915068500092801 Oktober 201304 Oktober 20133 (hari)Obs FebrisRp150,000Rp120,000Rp140,000Rp5,000Rp10,000Rp100,000Rp150,000Rp444,000Rp5,000Rp25,000InternaRp1,149,00008.23.28162An. Zulfa imaroh6310086809120001101 October 201304 October 20133 (hari)Kejang demam kompleksRp150,000Rp90,000Rp90,000Rp135,000Rp5,000Rp10,000Rp100,000Rp50,000Rp45,000Rp186,000Rp5,000Rp30,000Rp150,000AnakRp1,046,00008.23.31163An. Mita normayanti6310085606050004906 October 201308 October 20132 (Hari)Rp100,000Rp60,000Rp20,000Rp90,000Rp135,000Rp5,000Rp10,000Rp100,000Rp20,000Rp131,000Rp158,500Rp30,000Rp150,000Rp75,000AnakRp1,084,50008.25.87164Tn. Ruslan63100112077000024305 October 201309 October 20134 (Hari)Rp200,000Rp120,000Rp20,000Rp240,000Rp45,000Rp5,000Rp10,000Rp60,000Rp60,000Rp180,000Rp498,000Rp10,000Rp25,000InternaRp1,473,00008.25.32165An. Aldi6310021805120001106 October 201308 October 20132 (Hari)DiareRp100,000Rp60,000Rp20,000Rp40,000Rp90,000Rp5,000Rp10,000Rp100,000Rp75,500Rp5,000Rp100,000AnakRp605,50008.25.48166Ny. Lisnawati63100162118800022506 October 201308 October 20132 (Hari)Rp100,000Rp60,000Rp60,000Rp5,000Rp10,000Rp100,000Rp147,000Rp377,000Rp5,000Rp150,000BedahRp1,014,00008.25.89167Tn. Agus tri syafa'at63101031089200022108 October 201311 October 20133 (hari)Rp150,000Rp90,000Rp20,000Rp280,000Rp180,000Rp5,000Rp10,000Rp100,000Rp220,000Rp166,500Rp25,000Rp125,000InternaRp1,371,50008.27.66168An. Sinta6310015004120001104 October 201305 October 20131 (Hari)Diare AkutRp50,000Rp60,000Rp20,000Rp20,000Rp45,000Rp5,000Rp10,000Rp100,000Rp55,000Rp5,000Rp50,000AnakRp420,00008.24.85169An. A. Mujiburrahman63100602081300022 (Bulan)03 October 201305 October 20132 (Hari)Diare Dehidrasi RinganRp100,000Rp60,000Rp20,000Rp20,000Rp90,000Rp5,000Rp10,000Rp100,000Rp40,000Rp64,500Rp10,000Rp100,000AnakRp619,50008.24.66170Tn. Amiruddin63100211019700071603 October 201305 October 20132 (Hari)CKRRp100,000Rp60,000Rp60,000Rp5,000Rp10,000Rp200,000Rp90,000Rp143,000Rp5,000Rp200,000BedahRp873,00005.24.09171Tn. Jamaludin63100401075500605804 October 201305 October 20131 (Hari)Obs. Penurunan Kesadaran + Susp SHRp50,000Rp90,000Rp40,000Rp90,000Rp5,000Rp10,000Rp125,000Rp100,000Rp60,000Rp441,500Rp15,000InternaRp1,026,50008.24.71172An. Nadia Agustina63100922078700022 (Bulan)03 October 201305 October 20132 (Hari)DCA Tanpa DehidrasiRp100,000Rp60,000Rp60,000Rp90,000Rp5,000Rp10,000Rp45,000Rp81,500Rp5,000Rp100,000AnakRp556,50008.20.59173An. M. Febriansyah63100819120500021005 October 201305 October 2013(Hari)CKRRp50,000Rp60,000Rp20,000Rp10,000Rp200,000Rp200,000Rp290,000Rp63,000Rp421,000Rp5,000Rp100,000AnakRp1,419,00008.25.18174Tn. Anang Hermawan63101012109800011404 October 201307 October 20133 (Hari)CKRRp150,000Rp60,000Rp80,000Rp5,000Rp10,000Rp200,000Rp90,000Rp427,500Rp5,000Rp250,000BedahRp1,277,50008.25.13175Ny. Ngapiah63101052046500014801 October 201303 October 20132 (Hari)Obs. Febris + Thypoid FeverRp100,000Rp60,000Rp20,000Rp80,000Rp5,000Rp10,000Rp100,000Rp100,000Rp60,000Rp170,000Rp221,500Rp5,000Rp25,000InternaRp956,50008.23.23176An. Mahlisa63100352120300011002 October 201304 October 20132 (Hari)Obs. FebrisRp100,000Rp60,000Rp20,000Rp60,000Rp45,000Rp5,000Rp10,000Rp100,000Rp222,000Rp147,000Rp30,000Rp50,000AnakRp849,00008.23.56177Ny. Raminih63100968128800032501 October 201302 October 20131 (Hari)Rp50,000Rp30,000Rp20,000Rp40,000Rp5,000Rp10,000Rp50,000Rp100,000Rp60,000Rp133,500Rp5,000Rp50,000BedahRp553,50008.22.62178Tn. H. Odin63100309024500016707 October 201312 October 20135 (Hari)Susp SNARp250,000Rp150,000Rp20,000Rp360,000Rp225,000Rp5,000Rp10,000Rp200,000Rp200,000Rp284,500Rp669,000Rp50,000Rp125,000InternaRp2,548,50008.26.42179Tn. Amit63100302108300023009 October 201311 October 20132 (Hari)Susp GGKRp100,000Rp60,000Rp20,000Rp200,000Rp90,000Rp5,000Rp10,000Rp100,000Rp60,000Rp100,000Rp198,000Rp401,000Rp15,000Rp75,000InternaRp1,434,00008.27.78180Tn. Safrajudin63100901073900137407 October 201309 October 20132 (Hari)Rp100,000Rp120,000Rp20,000Rp160,000Rp200,000Rp5,000Rp10,000Rp50,000Rp60,000Rp60,000Rp180,000Rp492,000Rp5,000Rp25,000InternaRp1,487,00008.26.05181An. Putri Aulia63100861051300025 (Bulan)03 October 201308 October 20135 (Hari)Pneumonia+DCA Tanpa DehidrasiRp250,000Rp150,000Rp20,000Rp150,000Rp225,000Rp5,000Rp10,000Rp100,000Rp100,000Rp60,000Rp257,000Rp5,000Rp50,000Rp200,000Rp80,000AnakRp1,662,00008.00.55182Tn. Juki63100819067900033404 October 201306 October 20132 (Hari)CKSRp100,000Rp30,000Rp20,000Rp60,000Rp5,000Rp10,000Rp200,000Rp680,500Rp5,000Rp150,000Rp150,000BedahRp1,410,50008.25.11183Tn. Sulkifli63100703077300024009 October 201310 October 20131 (Hari)DispepsiaRp50,000Rp30,000Rp20,000Rp120,000Rp135,000Rp5,000Rp10,000Rp199,000Rp10,000Rp50,000InternaRp629,00008.28.38184Ny. Mantang63100257086000034708 October 201312 October 20134 (Hari)SNHRp150,000Rp180,000Rp20,000Rp280,000Rp180,000Rp5,000Rp10,000Rp100,000Rp200,000Rp60,000Rp129,500Rp830,000Rp40,000Rp100,000InternaRp2,284,50008.27.69185An. M. Alwi Firmansyah63100220100300051009 October 201311 October 20132 (Hari)Asma BronkhialeRp100,000Rp60,000Rp20,000Rp60,000Rp90,000Rp5,000Rp10,000Rp125,000Rp300,000Rp60,000Rp162,000Rp5,000Rp10,000Rp50,000Rp20,000AnakRp1,077,00008.27.77186Tn. Zulkifli63100217059800031505 October 201307 October 20132 (Hari)Obs FebrisRp100,000Rp30,000Rp60,000Rp200,000Rp5,000Rp10,000Rp100,000Rp290,000Rp119,500Rp10,000Rp50,000InternaRp974,50008.25.70187Nn. Siti Norjannah63100955089500021805 October 201309 October 20134 (Hari)Susp Tukak peptikRp200,000Rp60,000Rp40,000Rp240,000Rp5,000Rp10,000Rp100,000Rp65,000Rp394,000Rp10,000Rp50,000InternaRp1,174,00008.22.51188Tn. Samijan63101001074500096805 October 201309 October 20134 (Hari)Obs Abdominal PainRp200,000Rp60,000Rp20,000Rp240,000Rp5,000Rp10,000Rp100,000Rp60,000Rp60,000Rp433,000Rp662,000Rp10,000Rp50,000InternaRp1,910,00008.25.19189An. Said Abdul Rahman6310061910120002109 October 201311 October 20132 (Hari)Obs. DispneaRp100,000Rp90,000Rp20,000Rp20,000Rp30,000Rp90,000Rp5,000Rp10,000Rp200,000Rp68,000Rp256,000Rp5,000Rp20,000Rp100,000Rp60,000AnakRp1,074,00008.27.74190Tn. Mashari63100918056900054407 October 201309 October 20132 (Hari)Sind DispepsiaRp100,000Rp30,000Rp60,000Rp80,000Rp5,000Rp10,000Rp100,000Rp200,000Rp321,000Rp5,000Rp25,000InternaRp936,00008.26.38191Ny.Dahliani63100166067400013921 Oktober 201324 Oktober 20133 (hari)Stroke Neu HemoragikRp150,000Rp120,000Rp160,000Rp5,000Rp10,000Rp100,000Rp60,000Rp339,000Rp859,500Rp15,000Rp25,000InternaRp1,843,50008.34.48192Tn.Hairan63100409015000015314 Oktober 201324 Oktober 201310 (hari)obsfebris + AsutesRp500,000Rp240,000Rp80,000Rp840,000Rp5,000Rp10,000Rp200,000Rp200,000Rp170,000Rp120,000Rp169,500Rp1,054,500Rp5,000Rp225,000InternaRp3,819,00008.30.32193Tn.Faher63100222116900014419 Oktober 201323 Oktober 20134 (Hari)Stomefis MeligungRp200,000Rp90,000Rp40,000Rp320,000Rp135,000Rp5,000Rp10,000Rp100,000Rp302,000Rp496,500Rp25,000Rp125,000InternaRp1,848,50008.33.29194Tn.Mursalin63100227125700035622 Oktober 201324 Oktober 20132 (Hari)Gostceenteritis akutRp100,000Rp60,000Rp20,000Rp120,000Rp5,000Rp10,000Rp200,000Rp50,000Rp60,000Rp77,000Rp131,000Rp5,000InternaRp838,00008.35.92195Ny.Sidah63100141077900273419 Oktober 201323 Oktober 20134 (Hari)Kista OvariumRp200,000Rp120,000Rp60,000Rp280,000Rp135,000Rp5,000Rp10,000Rp17,000Rp435,500Rp25,000Rp125,000InternaRp1,412,50008.04.04196An.Anto6310091009010006721 Oktober 201323 Oktober 20132 (Hari)Febris demam TifoidRp100,000Rp60,000Rp20,000Rp60,000Rp90,000Rp5,000Rp10,000Rp200,000Rp207,000Rp139,500Rp5,000Rp20,000Rp100,000AnakRp1,016,50008.35.25197Ny.Sugiyem63100571126300014921 Oktober 201323 Oktober 20132 (Hari)CHF + PPOKRp100,000Rp60,000Rp60,000Rp200,000Rp135,000Rp5,000Rp10,000Rp100,000Rp250,000Rp120,000Rp140,000Rp269,000Rp30,000Rp75,000InternaRp1,554,00008.34.62198An.Rifki Maulana6310091101120004116 Oktober 201318 Oktoer 20132 (Hari)GEA Dehidrasi ringan sedangRp100,000Rp60,000Rp20,000Rp90,000Rp45,000Rp5,000Rp10,000Rp100,000Rp158,500Rp5,000Rp10,000Rp50,000AnakRp653,50008.31.54199Tn.Syaifullah63100110118400012916 Oktober 201319 Oktober 20133 (hari)Febris sups malariaRp150,000Rp60,000Rp40,000Rp240,000Rp90,000Rp5,000Rp10,000Rp200,000Rp235,000Rp703,500Rp20,000Rp100,000InternaRp1,853,50008.31.40200Tn.Badawi63100106118700012617 Oktober 201324 Oktober 20137 (hari)Rp350,000Rp180,000Rp100,000Rp320,000Rp5,000Rp10,000Rp200,000Rp195,000Rp1,345,500Rp20,000Rp50,000InternaRp2,775,50008.28.00201Ny.Vivin Indriani63100370039600011718 Oktober 201323 Oktober 20135 (Hari)VertigoRp250,000Rp120,000Rp40,000Rp320,000Rp90,000Rp5,000Rp10,000Rp200,000Rp95,000Rp667,000Rp20,000Rp100,000InternaRp1,917,00008.33.71202Tn.Sumardi63101001077900653418 Oktober 201319 Oktober 20131 (Hari)Tumor Colon kiriRp50,000Rp60,000Rp40,000Rp30,000Rp5,000Rp10,000Rp100,000Rp282,500Rp168,500Rp10,000Rp25,000Rp100,000BedahRp881,00001.07.79203Tn.Mulyadi63100902038600022718 Oktober 201319 Oktober 20131 (Hari)Febris H2 malariaRp50,000Rp60,000Rp120,000Rp45,000Rp5,000Rp10,000Rp100,000Rp60,000Rp460,500Rp10,000Rp50,000InternaRp970,50008.33.30204Tn.Watiro63100218056100015217 Oktober 201319 Oktober 20132 (Hari)Dispepsia AkutRp100,000Rp60,000Rp20,000Rp200,000Rp135,000Rp5,000Rp10,000Rp60,000Rp218,000Rp15,000Rp75,000InternaRp898,00008.09.20205Tn.Kusnan Effendi63100201025700055617 Oktober 201318 October 20131 (Hari)Abodimal PainRp50,000Rp40,000Rp120,000Rp45,000Rp5,000Rp10,000Rp100,000Rp60,000Rp135,000Rp102,500Rp10,000Rp50,000Rp50,000InternaRp777,50008.31.63206Ny.Norsiah63100268109000036517 Oktober 201319 Oktober 20132 (Hari)Stroke Neu HemoragikRp100,000Rp60,000Rp20,000Rp80,000Rp90,000Rp5,000Rp10,000Rp200,000Rp100,000Rp130,000Rp404,500Rp10,000GinekologiRp1,209,50008.31.68207Tn.Sutisna63100901076801834516 Oktober 201323 Oktober 20137 (hari)Gastrrtu erond ddRp350,000Rp120,000Rp80,000Rp440,000Rp225,000Rp5,000Rp10,000Rp100,000Rp60,000Rp95,000Rp833,000Rp35,000Rp175,000InternaRp2,528,00008.31.55208Tn.Efendi63100320019100012115 Oktober 201317 Oktober 20132 (Hari)Kolik AbdomenRp100,000Rp60,000Rp20,000Rp200,000Rp90,000Rp5,000Rp10,000Rp100,000Rp60,000Rp120,000Rp130,000Rp341,500Rp15,000Rp75,000InternaRp1,326,50008.30.67209Tn.Yohanis Tanggilar63100813058600012713 Oktober 201317 Oktober 20134 (Hari)Febris sups malariaRp200,000Rp90,000Rp40,000Rp320,000Rp90,000Rp5,000Rp10,000Rp100,000Rp305,000Rp875,500Rp20,000Rp100,000InternaRp2,155,50007.54.80210Tn.Waluyo63100707098600022715 Oktober 201323 Oktober 20138 (Hari)TB ParuRp400,000Rp210,000Rp40,000Rp480,000Rp225,000Rp5,000Rp10,000Rp125,000Rp205,000Rp1,119,000Rp45,000Rp225,000InternaRp3,089,00008.30.770.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.0T O T A L K L A I MRp663,394,400Sepunggur , November 2013MengetahuiDirektur RSUD Tanah BumbuBendahara Jamkesmasdr.H.Daru Dewa, M.KesM. Adhi Sulaiman, SKMNIP.19680710 199803 1 011NIP.19840415 200908 1 001

PERSALINANDAFTAR KLAIM RAWAT INAP PASIEN KEBIDANAN JAMKESDA RSUD TANAH BUMBUPROPINSI : KALIMANTAN SELATANBULAN : OktoberKABUPATEN : TANAH BUMBUTAHUN : 2013NONAMA PASIENNO.REKOMENDASI JAMKESDAUmur (Thn)TANGGALLOSDIAGNOSAPelayanan Kesehatan Dan Besaran Tarif sesuai PERDA (Rp)Pemakaian OksigenUSGBiaya Pemeriksaan PoliklinikPemeriksaan Darah Untuk Tranfusi dan KantongLaboratoriumObat, alat suntik, alat infus dan cairan infus selama dirawat dan atau operasiTindakan MedisJUMLAHAkomodasiJasa MedisJasa MedisJasa KeperawatanKonsultasiJasaBerkas RMTindakan di UGDTindakan di VKTindakan Persalinan & KebidananTindakan Operasi BedahAnastesiRontgenEKGLepas InfusInjeksi IVInjeksi IMPasang InfusObservasiPasang OGTTindakan Penyakit DalamNebulizerFoto TerapiInkubatorTTVMandikan BayiPolioRawat Tali PusatJahit lukaAngkat jahitanRawat Luka OPSuctionCPAPHeactingPerawatan JenazahKonselingUPFBiaya Tindakan Poli UmumTAGIHANLPMasukKeluarSpesialisUmumTindakan KecilTindakan SedangTindakan IntensifMedis GigiApotekerSederhanaKecilSedangBesarTindakan Penyakit DalamSederhanaKecilSedangBesarPersalinan NormalPersalinan SulitResusitasi Bayi Baru LahirRJPOKuretasi + AnastesiKuretasi Sulit + AnastesiManual Plasenta + AnastesiSederhanaKecilSedangBesarKhususSederhanaKecilSedangBesarKhusus1Ny. Sulastri63100450048100053125 February 201328 February 20133 (Hari)G3p2a0 32-33 mg, JTHIU preskep kala 1 fase laten dg susp CPD+PPRp150,000Rp60,000Rp40,000Rp30,000Rp10,000Rp200,000Rp5,000,000Rp1,750,000Rp520,000Rp248,000Rp1,253,500Rp5,000Rp110,000Rp50,000ObstetriRp9,426,50007.20.852By. Ny. Sulastri63100450048100050 (Hari)25 February 201328 February 20133 (Hari)Bayi baru lahirRp75,000Rp120,000Rp20,000Rp60,000Rp10,000Rp125,000Rp69,000Rp5,000Rp50,000Rp50,000PerinatalogiRp584,00007.20.843Ny. Isnaini63100947037000063801 May 201304 May 20133 (Hari)G6p4a1 hamil 36 minggu+inpartu kala 1Rp150,000Rp150,000Rp40,000Rp240,000Rp10,000Rp100,000Rp1,200,000Rp1,625,000Rp100,000Rp255,000Rp324,500Rp5,000Rp30,000Rp5,000Rp150,000KebidananRp4,384,50007.46.624Ny. Nor Sam63100947066900054431 July 201303 August 20133 (Hari)G10p8a1 posterm dgn kala 1 fase aktifRp150,000Rp120,000Rp100,000Rp30,000Rp45,000Rp10,000Rp125,000Rp1,200,000Rp193,000Rp194,500Rp5,000Rp10,000Rp5,000Rp150,000ObstetriRp2,337,50007.95.145Ny. Mariana63100246058300013029 July 201304 August 20136 (Hari)G3p2a0 dgn plasenta previaRp300,000Rp300,000Rp150,000Rp180,000Rp45,000Rp10,000Rp125,000Rp5,000,000Rp1,750,000Rp100,000Rp1,040,000Rp188,000Rp753,000Rp5,000Rp250,000Rp200,000Rp75,000ObstetriRp10,471,00007.86.886Ny. Herlinda63100149038600022701 August 201301 August 2013G1p0a0 uk 37-38 minggu dg JTHIURp50,000Rp30,000Rp45,000Rp10,000Rp125,000Rp193,000Rp50,000ObstetriRp503,00007.81.787Ny. Yatini63100341018300023104 August 201304 August 2013SyncopeRp50,000Rp20,000Rp30,000Rp45,000Rp10,000Rp200,000Rp20,000Rp193,000Rp236,500Rp20,000Rp50,000Rp100,000ObstetriRp974,50007.90.238Ny. Jumriana63100257038300042501 August 201304 August 20133 (Hari)Rp150,000Rp210,000Rp220,000Rp90,000Rp10,000Rp200,000Rp5,000,000Rp1,750,000Rp380,000Rp623,500Rp50,000Rp190,000Rp250,000Rp75,000ObsgynRp9,198,50007.88.539By. Ny. Jumriana63100257038300040 (Hari)01 August 201305 August 20134 (Hari)Bayi Baru LahirRp100,000Rp120,000Rp10,000Rp125,000Rp10,000Rp50,000Rp50,000Rp100,000Rp80,000Rp20,000Rp150,000Rp10,000PerinatalogiRp825,00007.88.5510Ny. Syarifah63100752079200022105 August 201307 August 20132 (Hari)G1p0a0 hamil 38-39 minggu, kala 1 fase laten dengan PERRp100,000Rp60,000Rp40,000Rp30,000Rp45,000Rp10,000Rp125,000Rp1,200,000Rp210,000Rp232,000Rp5,000Rp10,000Rp20,000Rp100,000Rp50,000ObstetriRp2,237,00007.90.5011By. Ny. Syarifah63100752079200020 (Hari)06 August 201307 August 20131 (Hari)Bayi Baru LahirRp25,000Rp30,000Rp20,000Rp10,000Rp125,000Rp10,000Rp50,000Rp20,000Rp50,000Rp40,000Rp40,000Rp60,000Rp10,000PerinatalogiRp490,00012Ny. Halimatus Sa'diah63100241078203273122 August 201326 August 20134 (Hari)G1p0a0 H. Aterm susp plasenta previaRp200,000Rp150,000Rp240,000Rp10,000Rp125,000Rp100,000Rp210,000Rp189,000Rp5,000Rp40,000Rp100,000ObstetriRp1,369,00007.98.6813By.Halimatus/Firji Ananda63100230081300010 (Hari)30 Agustus 201314 September 201315 (hari)HIERp375,000Rp360,000Rp100,000Rp920,000Rp540,000Rp10,000Rp200,000Rp1,400,000Rp653,500Rp10,000Rp850,000Rp250,000Rp10,000PerinatalogiRp5,678,50008.04.3614Ny. Kasmawati63100241078004142718 September 201313 September 20135 (Hari)G6p0a5 uk 28 mingguRp250,000Rp180,000Rp220,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp100,000Rp193,000Rp281,000Rp5,000Rp20,000Rp5,000Rp25,000Rp150,000ObstetriRp2,844,00008.14.6915By. Ny. Kasmawati63100241078004140 (Hari)20 September 201322 September 20132 (Hari)Bayi Baru LahirRp100,000Rp30,000Rp60,000Rp120,000Rp90,000Rp135,000Rp5,000Rp10,000Rp125,000Rp200,000Rp600,000Rp172,000Rp60,000Rp5,000Rp25,000Rp150,000Rp150,000Rp10,000PerinatalogiRp2,047,00008.16.4716Ny. Rusdiah63101041078500872821 September 201323 September 20132 (Hari)G5p4a0 dg inpartu kala 1 fase aktif&presbokRp100,000Rp90,000Rp40,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp210,000Rp33,500Rp5,000Rp10,000Rp5,000Rp150,000ObstetriRp2,058,50008.16.8717By. Ny. Rusdiah63101041078500870 (Hari)21 September 201324 September 20133 (Hari)Bayi Baru LahirRp150,000Rp60,000Rp40,000Rp140,000Rp120,000Rp10,000Rp125,000Rp24,500Rp5,000Rp200,000Rp50,000Rp10,000PerinatalogiRp934,50008.16.9418Ny. Fitriah. L63100946097900023421 September 201324 September 20133 (Hari)G4p3a0 H. 36 mgg dgn blm inpartuRp150,000Rp120,000Rp80,000Rp90,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp201,500Rp557,500Rp5,000Rp20,000Rp5,000Rp150,000ObstetriRp2,764,00008.16.6219By. Ny. Fitriah. L63100946097900020 (Hari)22 September 201324 September 20132 (Hari)Bayi Baru LahirRp100,000Rp60,000Rp20,000Rp100,000Rp90,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp620,00008.17.0620Ny. Rafifah63100246129200012228 September 201330 September 20132 (Hari)Rp100,000Rp90,000Rp60,000Rp30,000Rp45,000Rp5,000Rp10,000Rp200,000Rp1,200,000Rp210,000Rp197,000Rp5,000Rp10,000Rp5,000Rp150,000Rp300,000ObstetriRp2,617,00008.21.0121By. Ny. Rafifah63100246129200010 (Hari)28 September 201329 September 20131 (Hari)Bayi Baru LahirRp25,000Rp30,000Rp20,000Rp60,000Rp60,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp445,00008.21.2922Ny. Rina63100650109500021724 September 201325 September 20131 (Hari)G1p0a0 H. aterm inpartu kala 1 fase latenRp50,000Rp60,000Rp100,000Rp30,000Rp90,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp193,000Rp237,000Rp5,000Rp5,000Rp250,000Rp200,000ObstetriRp2,560,00008.18.1423By. Ny. Rina63100650109500020 (Hari)24 September 201325 September 20131 (Hari)Bayi Baru LahirRp50,000Rp30,000Rp20,000Rp40,000Rp30,000Rp10,000Rp125,000Rp19,500Rp5,000Rp50,000Rp10,000PerinatalogiRp389,50008.18.3524Ny. Rusnah63100941028200033225 September 201327 September 20132 (Hari)G3p2a0 Hamil post termRp100,000Rp90,000Rp40,000Rp60,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp158,000Rp310,500Rp5,000Rp20,000Rp10,000Rp150,000Rp300,000ObstetriRp2,628,50008.10.5125By. Ny. Rusnah63100941028200030 (Hari)26 September 201327 September 20131 (Hari)Bayi Baru LahirRp50,000Rp30,000Rp20,000Rp60,000Rp60,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp470,00008.19.4126Ny. Vivi vebriana63100842029500011823 September 201327 September 20134 (Hari)G2p0a1 hamil post dateRp200,000Rp90,000Rp140,000Rp30,000Rp180,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp520,000Rp288,000Rp393,500Rp5,000Rp20,000Rp5,000Rp250,000Rp200,000ObstetriRp3,661,50008.17.4127By. Ny. Vivi63100842029500010 (Hari)24 September 201327 September 20133 (Hari)Bayi Baru LahirRp150,000Rp90,000Rp20,000Rp120,000Rp90,000Rp10,000Rp125,000Rp5,000Rp100,000Rp100,000Rp10,000PerinatalogiRp820,00008.18.3728Ny. Yuli Susanti63100467077300044021 September 201323 September 20132 (Hari)G4p3a0 dgn KPD digohidramionRp100,000Rp90,000Rp60,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp210,000Rp665,000Rp5,000Rp10,000Rp5,000Rp25,000Rp350,000ObstetriRp2,905,00008.16.5729By. Ny. Yuli63100467077300040 (Hari)21 September 201323 September 20132 (Hari)Bayi Baru LahirRp100,000Rp30,000Rp80,000Rp90,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp550,00008.16.8230Ny. Ayu Wandana63100249029100022225 September 201327 September 20132 (Hari)G1p0a0 H. aterm inpartu kala IIRp100,000Rp120,000Rp20,000Rp40,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp302,500Rp266,000Rp5,000Rp40,000Rp5,000Rp150,000Rp300,000ObstetriRp2,763,50008.18.8631By. Ny. Ayu63100249029100020 (Hari)25 September 201327 September 20132 (Hari)Bayi Baru LahirRp100,000Rp60,000Rp100,000Rp90,000Rp10,000Rp125,000Rp10,000Rp100,000Rp50,000Rp10,000PerinatalogiRp655,00008.19.2932Ny. Dety wulandari63100245058000093323 September 201327 September 20134 (Hari)G2p2a0 hamil aterm riwayat Sc 14 th dgn let-lintang+MOWRp200,000Rp180,000Rp160,000Rp120,000Rp5,000Rp10,000Rp125,000Rp1,750,000Rp5,250,000Rp1,800,000Rp203,000Rp1,627,500Rp5,000Rp60,000Rp100,000Rp75,000ObstetriRp11,670,50008.56.5533Ny. Sudiyah63100464047300014019 September 201324 September 20135 (Hari)G4p3a0 hamil aterm susp PEBRp250,000Rp240,000Rp160,000Rp150,000Rp45,000Rp5,000Rp10,000Rp200,000Rp1,750,000Rp5,000,000Rp1,750,000Rp100,000Rp276,000Rp1,218,000Rp5,000Rp160,000Rp20,000Rp200,000Rp75,000ObstetriRp11,614,00008.15.6334By. Ny. Sudiyah63100464047300010 (Hari)20 September 201324 September 20134 (Hari)Bayi Baru LahirRp200,000Rp150,000Rp180,000Rp150,000Rp10,000Rp200,000Rp182,500Rp10,000Rp50,000Rp50,000Rp10,000PerinatalogiRp1,192,50008.15.7135Ny. Sriyatun63100669118600012720 September 201324 September 20134 (Hari)G3p1a1 H 42 minggu post termRp200,000Rp240,000Rp160,000Rp120,000Rp5,000Rp10,000Rp5,000,000Rp1,750,000Rp225,500Rp1,920,000Rp5,000Rp210,000Rp100,000Rp75,000ObstetriRp10,020,50008.16.3936By. Ny. Sriyatun63100669118600010 (Hari)20 September 201324 September 20134 (Hari)Bayi Baru LahirRp200,000Rp120,000Rp20,000Rp180,000Rp150,000Rp10,000Rp200,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp995,00008.16.4937Ny. Ella63101067098400012920 September 201324 September 20134 (Hari)G3p1a1 hamil 40 minggu dengan letak lintangRp200,000Rp240,000Rp180,000Rp150,000Rp45,000Rp5,000Rp10,000Rp200,000Rp5,000,000Rp1,750,000Rp100,000Rp255,000Rp1,068,500Rp5,000Rp190,000Rp20,000Rp200,000Rp75,000ObstetriRp9,693,50008.15.6638By. Ny. Ella63101067098400010 (Hari)20 September 201324 September 20134 (Hari)Bayi Baru LahirRp200,000Rp120,000Rp180,000Rp150,000Rp10,000Rp200,000Rp169,500Rp10,000Rp50,000Rp50,000Rp10,000PerinatalogiRp1,149,50008.15.7339Ny. Yuliani63100466068700092622 September 201325 September 20133 (Hari)G1p0a0 hamil aterm kala 1 fase aktif dg KPDRp150,000Rp120,000Rp200,000Rp120,000Rp45,000Rp5,000Rp10,000Rp200,000Rp5,000,000Rp1,750,000Rp230,000Rp1,060,000Rp5,000Rp150,000Rp150,000Rp75,000ObstetriRp9,270,00008.17.0140By. Ny. Yuliani63100466068700090 (Hari)23 September 201325 September 20132 (Hari)Bayi Baru LahirRp100,000Rp90,000Rp40,000Rp100,000Rp90,000Rp10,000Rp200,000Rp60,000Rp10,000Rp100,000Rp50,000Rp10,000PerinatalogiRp860,00008.17.1741Ny. Aswatun Hasanah63100471129200052120 September 201324 September 20134 (Hari)G1p0a0 hamil aterm inpartu kala 1 fase latenRp200,000Rp210,000Rp140,000Rp120,000Rp45,000Rp5,000Rp10,000Rp125,000Rp5,000,000Rp1,750,000Rp473,000Rp1,192,000Rp5,000Rp240,000Rp10,000Rp200,000Rp75,000ObstetriRp9,800,00008.16.5042By. Ny. Aswatun63100471129200050 (Hari)21 September 201324 September 20133 (Hari)Bayi Baru LahirRp150,000Rp120,000Rp180,000Rp150,000Rp10,000Rp200,000Rp10,000Rp100,000Rp100,000Rp10,000PerinatalogiRp1,030,00008.16.7843Ny. Hj. Mardiana63100241078303234019 September 201324 September 20135 (Hari)G7p6a0 hamil aterm dg letak lintangRp250,000Rp240,000Rp160,000Rp150,000Rp45,000Rp5,000Rp10,000Rp200,000Rp5,000,000Rp1,750,000Rp266,000Rp1,467,500Rp5,000Rp80,000Rp20,000Rp200,000Rp75,000ObstetriRp9,923,50008.13.4744By. Ny. Hj. Mardiana63100241078303230 (Hari)20 September 201324 September 20134 (Hari)Bayi Baru LahirRp200,000Rp150,000Rp180,000Rp150,000Rp10,000Rp200,000Rp10,000Rp50,000Rp50,000Rp10,000PerinatalogiRp1,010,00008.15.6945Ny. Santi Martha63100951128200082323 September 201325 September 20132 (Hari)G5p2a2 atermRp100,000Rp180,000Rp120,000Rp90,000Rp5,000Rp10,000Rp200,000Rp1,750,000Rp5,000,000Rp1,750,000Rp220,000Rp977,000Rp5,000Rp140,000Rp50,000Rp75,000ObstetriRp10,672,00008.05.6846By. Ny. Santi Martha63100951128200080 (Hari)23 September 201325 September 20132 (Hari)Bayi Baru LahirRp50,000Rp60,000Rp100,000Rp90,000Rp10,000Rp200,000Rp60,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp685,00008.18.0247Ny. Jumiati63100461038000013323 September 201326 September 20133 (Hari)G3p1a1 dgn inpartu kala 1 fase aktif KPD+posttermRp150,000Rp210,000Rp180,000Rp180,000Rp45,000Rp5,000Rp10,000Rp125,000Rp5,000,000Rp1,750,000Rp225,000Rp961,000Rp5,000Rp170,000Rp150,000Rp75,000ObstetriRp9,241,00008.17.7448By. Ny. Jumiati63100461038000010 (Hari)23 September 201326 September 20133 (Hari)Bayi Baru LahirRp150,000Rp120,000Rp140,000Rp120,000Rp90,000Rp10,000Rp200,000Rp78,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp1,023,00008.18.0949Ny. Khairunnisa. U63100662099300022024 September 201327 September 20133 (Hari)Rp150,000Rp240,000Rp140,000Rp90,000Rp5,000Rp10,000Rp125,000Rp5,000,000Rp1,750,000Rp347,000Rp1,519,500Rp5,000Rp200,000Rp100,000Rp75,000ObstetriRp9,756,50008.18.1550By. Ny. Khairunnisa. U63100662099300020 (Hari)24 September 201327 September 20133 (Hari)Bayi Baru LahirRp150,000Rp120,000Rp140,000Rp120,000Rp10,000Rp200,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp855,00008.18.3651Ny. Endang63100242047900053418 September 201320 September 20132 (Hari)G4p3a0 dgn abortus inkomplitRp100,000Rp90,000Rp120,000Rp90,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,750,000Rp191,000Rp5,000Rp30,000Rp150,000GinekologiRp2,711,00008.15.2852Ny. Endang M63100370078800042528 September 201330 September 20132 (Hari)G2p1a0Rp100,000Rp60,000Rp220,000Rp5,000Rp10,000Rp255,500Rp278,500Rp5,000Rp50,000ObstetriRp984,00008.09.3653Ny. Siti Nur hasanah63100652069400012022 September 201326 September 20134 (Hari)Rp200,000Rp180,000Rp180,000Rp60,000Rp5,000Rp10,000Rp300,000Rp262,500Rp180,000Rp5,000Rp50,000GinekologiRp1,432,50008.16.0954Ny. Mamong63100241076502446816 September 201320 September 20134 (Hari)mioma uteriRp200,000Rp150,000Rp80,000Rp60,000Rp5,000Rp10,000Rp100,000Rp125,000Rp60,000Rp100,000Rp170,000Rp242,500Rp5,000Rp110,000Rp100,000GinekologiRp1,517,50008.12.7155Ny. Tamsiyah63101041077300854023 September 201328 September 20135 (Hari)P2a0 perdarahan pervaginaRp250,000Rp210,000Rp40,000Rp300,000Rp30,000Rp135,000Rp5,000Rp10,000Rp60,000Rp100,000Rp780,000Rp180,500Rp673,000Rp10,000Rp160,000Rp25,000Rp400,000GinekologiRp3,368,50008.18.0456Ny. Saniah/sennia63100941106800014012 September 201324 September 201312 (Hari)Susp Ca uteriRp600,000Rp330,000Rp440,000Rp180,000Rp5,000Rp10,000Rp200,000Rp1,560,000Rp55,000Rp504,000Rp20,000Rp220,000Rp100,000GinekologiRp4,224,00007.44.8557By. Ny. Salmiah /Muhammad63100118091300010 (Hari)18 September 201330 September 201312 (Hari)Asfiksia neonatorum, BBLR, KB, SMK, SpontanRp300,000Rp360,000Rp100,000Rp760,000Rp390,000Rp360,000Rp10,000Rp125,000Rp2,200,000Rp204,000Rp297,500Rp610,000Rp5,000Rp25,000Rp650,000Rp20,000Rp550,000Rp10,000PerinatalogiRp6,976,50008.14.6858By. Ny. Lina/M. farhansyah63100427091300010 (Hari)29 September 201330 September 20131 (Hari)BBLR, KMK, kelainan urogenitalRp25,000Rp30,000Rp20,000Rp20,000Rp30,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp375,00008.21.3059By. Ny. St. Maryam63100441027700020 (Hari)25 September 200928 September 20093 (Hari)Bayi Baru LahirRp75,000Rp120,000Rp140,000Rp120,000Rp10,000Rp200,000Rp5,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp785,00008.18.7960Ny. Watirah63100746077700023529 September 201301 October 20132 (Hari)35 tahun perdarahan pervagina+anemisRp100,000Rp120,000Rp100,000Rp90,000Rp5,000Rp10,000Rp125,000Rp1,750,000Rp600,000Rp520,000Rp167,500Rp184,000Rp5,000Rp10,000Rp50,000Rp3,836,50008.21.3461Ny. Pasri rahayu63101047039000012328 September 201302 October 20134 (Hari)Rp200,000Rp150,000Rp260,000Rp120,000Rp90,000Rp5,000Rp10,000Rp5,000,000Rp1,750,000Rp220,000Rp1,607,500Rp5,000Rp180,000Rp100,000Rp75,000ObstetriRp9,772,50008.21.0462By. Ny. Pasri rahayu63101047039000010 (Hari)28 September 201302 October 20134 (Hari)Bayi Baru LahirRp100,000Rp120,000Rp20,000Rp180,000Rp150,000Rp10,000Rp200,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp895,00008.21.2663Ny. Syarifah63100144028500022830 September 201301 October 20131 (Hari)G3p2a0 dgn abortus incomplitusRp50,000Rp90,000Rp40,000Rp5,000Rp10,000Rp200,000Rp1,750,000Rp600,000Rp193,000Rp14,000Rp5,000Rp50,000ObstetriRp3,007,00008.21.5364Ny. Setya puji L63101066069400021924 September 201301 October 20137 (Hari)G1p0a0 hamil postermRp350,000Rp240,000Rp300,000Rp90,000Rp45,000Rp5,000Rp10,000Rp200,000Rp5,000,000Rp1,750,000Rp178,000Rp1,825,000Rp5,000Rp130,000Rp200,000Rp75,000ObstetriRp10,403,00008.18.5565By. Ny. Setya puji L63101066069400020 (Hari)25 September 201301 October 20136 (Hari)Bayi Baru LahirRp150,000Rp150,000Rp40,000Rp260,000Rp210,000Rp10,000Rp200,000Rp236,500Rp120,000Rp10,000Rp350,000Rp100,000Rp20,000PerinatalogiRp1,856,50008.18.8966Ny. Windi Andewiasih63100641019300032028 September 201302 October 20134 (Hari)G1p0a0 hamil aterm kala II lamaRp200,000Rp180,000Rp320,000Rp150,000Rp135,000Rp5,000Rp10,000Rp125,000Rp5,000,000Rp1,750,000Rp243,000Rp1,503,000Rp5,000Rp240,000Rp200,000Rp75,000ObstetriRp10,141,00008.20.6067By. Ny. Windi63100641019300030 (Hari)28 September 201302 October 20134 (Hari)Bayi Baru LahirRp100,000Rp120,000Rp180,000Rp150,000Rp10,000Rp200,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp875,00008.20.6168Ny. Nor hayati63100241078601532729 September 201301 October 20132 (Hari)G1p0a0Rp100,000Rp120,000Rp120,000Rp30,000Rp90,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp1,750,000Rp600,000Rp100,000Rp208,000Rp244,000Rp5,000Rp10,000Rp5,000Rp150,000GinekologiRp4,872,00008.19.4969By. Ny. Nor hayati63100241078601530 (Hari)29 September 201304 October 20135 (Hari)Bayi Baru LahirRp125,000Rp150,000Rp60,000Rp300,000Rp180,000Rp10,000Rp125,000Rp200,000Rp1,000,000Rp311,000Rp5,000Rp5,000Rp25,000Rp300,000Rp300,000Rp10,000PerinatalogiRp3,106,00008.21.4370Ny. Kafiah63100268068900012326 September 201301 October 20135 (Hari)G2p1a0 vk 42 minggu dgn postdateRp250,000Rp120,000Rp40,000Rp420,000Rp60,000Rp135,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp260,000Rp168,000Rp172,000Rp5,000Rp20,000Rp5,000Rp50,000Rp300,000Rp300,000ObstetriRp3,645,00007.43.7871By. Ny. Kafiah63100268068900010 (Hari)28 September 201301 October 20133 (Hari)Bayi Baru LahirRp75,000Rp60,000Rp20,000Rp140,000Rp120,000Rp10,000Rp125,000Rp200,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp865,00008.21.2772Ny. Jumrahaini63100645059000022328 September 201301 October 20133 (Hari)Rp150,000Rp90,000Rp160,000Rp30,000Rp90,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp260,000Rp238,000Rp197,000Rp5,000Rp20,000Rp5,000Rp150,000ObstetriRp2,735,00008.20.9873By. Ny. Jumrahaini63100645059000020 (Hari)28 September 201301 October 20133 (Hari)Bayi Baru LahirRp75,000Rp60,000Rp180,000Rp150,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp715,00008.21.2874Ny. Mirna63100950119300071930 September 201301 October 20131 (Hari)G1p0a0 dgn kala II lamaRp50,000Rp60,000Rp60,000Rp30,000Rp45,000Rp5,000Rp10,000Rp200,000Rp1,200,000Rp198,000Rp190,000Rp5,000Rp10,000Rp5,000Rp50,000Rp150,000Rp300,000ObstetriRp2,568,00008.21.6575By. Ny. Mirna63100950119300070 (Hari)30 September 201301 October 20131 (Hari)Bayi Baru LahirRp25,000Rp30,000Rp60,000Rp60,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp425,00008.21.7076Ny. Rina susanti63100956038900022403 October 201308 October 20135 (Hari)G3p2a0 hamil posttermRp250,000Rp210,000Rp260,000Rp90,000Rp5,000Rp10,000Rp125,000Rp5,000,000Rp1,750,000Rp10,000Rp1,300,500Rp5,000Rp80,000Rp50,000ObstetriRp9,145,50007.77.9477By. Ny. Rina susanti63100956038900020 (Hari)04 October 201308 October 20134 (Hari)Bayi Baru LahirRp100,000Rp120,000Rp180,000Rp150,000Rp10,000Rp200,000Rp200,000Rp75,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp1,150,00008.25.0278Ny. Musdalifah63100241037700023601 October 201303 October 20132 (Hari)G6P4a1 dengan B.ORp100,000Rp90,000Rp80,000Rp5,000Rp10,000Rp125,000Rp1,750,000Rp600,000Rp100,000Rp220,000Rp274,000Rp5,000Rp150,000GinekologiRp3,509,00008.22.3879Ny. Haslinda63100148069300012006 October 200908 October 20092 (Hari)G2p1a0 dengan susp abortusRp100,000Rp120,000Rp80,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,750,000Rp600,000Rp247,500Rp393,000Rp5,000Rp200,000GinekologiRp3,680,50008.25.9280Ny. Emilda63100850108000032913 October 200917 October 20094 (Hari)G1p0a0 hamil aterm inpartu kala 1 fase aktifRp200,000Rp180,000Rp260,000Rp120,000Rp90,000Rp5,000Rp10,000Rp125,000Rp5,000,000Rp1,750,000Rp208,000Rp1,473,000Rp5,000Rp120,000Rp100,000Rp75,000ObstetriRp9,721,00008.30.1081By. Ny. Emilda63100850108000030 (Hari)13 October 200917 October 20094 (Hari)Bayi Baru LahirRp100,000Rp30,000Rp40,000Rp180,000Rp150,000Rp10,000Rp200,000Rp5,000Rp50,000Rp10,000PerinatalogiRp775,00008.26.3082Ny. Siti Aisah63100342129600011712 October 200915 October 20093 (Hari)G1p0a0 hamil aterm inpartu kala 1 fase aktif KPDRp150,000Rp120,000Rp180,000Rp90,000Rp90,000Rp5,000Rp10,000Rp125,000Rp5,000,000Rp1,750,000Rp185,000Rp974,500Rp5,000Rp100,000Rp100,000Rp75,000ObstetriRp8,959,50008.29.5683By. Ny. Siti Aisah63100342129600010 (Hari)12 October 200915 October 20093 (Hari)Bayi Baru LahirRp75,000Rp40,000Rp140,000Rp120,000Rp10,000Rp200,000Rp60,000Rp5,000Rp50,000Rp10,000PerinatalogiRp710,00008.30.0284Ny. Salasiah63100461058700032621 October 200923 October 20092 (Hari)G2p1a0 dgn abortu incompletusRp100,000Rp60,000Rp140,000Rp60,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,750,000Rp600,000Rp260,000Rp232,000Rp212,000Rp5,000Rp200,000ObstetriRp3,804,00008.35.3985Ny. Ni Wayan Dapet63100371127900013402 October 200907 October 20095 (Hari)Rp250,000Rp270,000Rp220,000Rp120,000Rp45,000Rp5,000Rp10,000Rp125,000Rp5,000,000Rp1,750,000Rp185,000Rp1,560,000Rp5,000Rp180,000Rp5,000Rp300,000Rp75,000ObstetriRp10,105,00008.02.7686By. Ny. Ni wayan dapet631003711279000103 October 200907 October 20094 (Hari)Bayi Baru LahirRp100,000Rp120,000Rp180,000Rp150,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp800,00008.24.7087Ny. Fitriani63100949029200022108 October 201311 October 20133 (Hari)G1p0a0 kala 1 fase latenRp150,000Rp90,000Rp140,000Rp30,000Rp45,000Rp5,000Rp10,000Rp1,200,000Rp203,000Rp375,500Rp5,000Rp10,000Rp5,000Rp200,000Rp250,000ObstetriRp2,718,50007.53.1788By. Ny. Fitriani63100949029200020 (Hari)09 October 201311 October 20132 (Hari)Bayi Baru LahirRp50,000Rp30,000Rp100,000Rp90,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp520,00008.27.7689Ny. Hanah63100948129400051904 October 201306 October 20132 (Hari)G1p0a0 hamil aterm dengan kala 1 fase aktifRp100,000Rp60,000Rp100,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp87,000Rp198,000Rp5,000Rp10,000Rp50,000Rp300,000ObstetriRp2,325,00008.25.1090By. Ny. Hanah63100948129400050 (Hari)04 October 201306 October 20132 (Hari)Bayi Baru LahirRp50,000Rp60,000Rp20,000Rp120,000Rp90,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp590,00008.25.3691Ny. Madinah63100160059200012103 October 201305 October 20132 (Hari)Rp100,000Rp90,000Rp40,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp210,500Rp415,000Rp5,000Rp5,000Rp100,000ObstetriRp2,380,50007.53.6192By. Ny. Madinah63100160059200010 (Hari)03 October 201305 October 20132 (Hari)Bayi Baru LahirRp50,000Rp60,000Rp20,000Rp100,000Rp90,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp570,00008.24.6493Ny. Hasriana. G63100268089500021902 October 201303 October 20131 (Hari)P1a0 dg post partumRp50,000Rp60,000Rp40,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp143,000Rp31,000Rp5,000Rp10,000Rp5,000Rp150,000Rp200,000ObstetriRp2,109,00008.24.0594By. Ny. Hasriana. G63100268089500020 (Hari)02 October 201304 October 20132 (Hari)Bayi Baru LahirRp50,000Rp60,000Rp20,000Rp100,000Rp90,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp570,00008.24.0695Ny. Herliani63100549088500022903 October 201305 October 20132 (Hari)G2p1a0 H.aterm inpartu kala&fase aktif dg kala 1 memanjangRp100,000Rp90,000Rp60,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp215,500Rp165,000Rp5,000Rp10,000Rp5,000Rp200,000Rp200,000ObstetriRp2,465,50001.24.1096By. Ny. Herliani63100549088500020 (Hari)03 October 201305 October 20132 (Hari)Bayi Baru LahirRp50,000Rp60,000Rp20,000Rp200,000Rp150,000Rp10,000Rp125,000Rp60,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp790,00008.24.1297Ny. Janatul Aliah63100546069100032201 October 201303 October 20132 (Hari)G1p0a0 vk 28 minggu dg PEBRp100,000Rp120,000Rp20,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp100,000Rp100,000Rp244,500Rp124,000Rp5,000Rp150,000Rp15,000Rp25,000Rp200,000ObstetriRp2,618,50008.23.3498By. Ny. Janatul Aliah63100546069100030 (Hari)03 October 201303 October 2013Bayi Baru LahirRp25,000Rp20,000Rp10,000Rp400,000PerinatalogiRp455,00008.24.6599Ny. Raodah63100241078001413105 October 201307 October 20132 (Hari)G4p3a0 H. aterm dg inpartuRp100,000Rp90,000Rp140,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp108,000Rp157,000Rp5,000Rp10,000Rp5,000Rp150,000ObstetriRp2,180,00008.25.27100By. Ny. Raodah63100241078001410 (Hari)05 October 201307 October 20132 (Hari)Bayi Baru LahirRp50,000Rp30,000Rp20,000Rp100,000Rp90,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp540,00008.25.64101Ny. Iyati63100341077200602006 October 201307 October 20131 (Hari)G1p0a0 H 38 mg inpartu kala 1 F. laten+KPDRp50,000Rp60,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp198,000Rp188,500Rp5,000Rp10,000Rp5,000Rp150,000ObstetriRp2,081,50008.25.783102By. Ny. Iyati63100341077200600 (Hari)06 October 201308 October 20132 (Hari)Bayi Baru LahirRp50,000Rp60,000Rp20,000Rp100,000Rp90,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp570,00008.25.91103Ny. Nur baya63100242038200023104 October 201307 October 20133 (Hari)G2p1a0 hamil atermRp150,000Rp150,000Rp140,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp200,000Rp2,400,000Rp2,050,000Rp100,000Rp230,000Rp321,000Rp5,000Rp70,000Rp10,000Rp400,000ObstetriRp6,441,00008.25.01104By. Ny. Nur baya I63100242038200020 (Hari)04 October 201307 October 20133 (Hari)Bayi Baru LahirRp75,000Rp90,000Rp20,000Rp140,000Rp120,000Rp10,000Rp125,000Rp63,000Rp5,000Rp100,000Rp100,000Rp20,000PerinatalogiRp868,00008.25.60105By. Ny. Nur baya II63100242038200020 (Hari)04 October 201307 October 20133 (Hari)Bayi Baru LahirRp75,000Rp90,000Rp20,000Rp140,000Rp120,000Rp10,000Rp125,000Rp63,000Rp5,000Rp100,000Rp50,000Rp10,000PerinatalogiRp808,00008.25.61106Ny. Murtiasih63101047077800063504 October 200907 October 20093 (Hari)Rp150,000Rp90,000Rp120,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp220,000Rp789,000Rp10,000Rp50,000Rp10,000Rp25,000Rp250,000Rp300,000ObstetriRp3,429,00007.87.81107By. Ny. Murtiasih63101047077800068 (Hari)04 October 200912 October 20098 (Hari)Bayi Baru LahirRp200,000Rp180,000Rp20,000Rp440,000Rp240,000Rp10,000Rp125,000Rp600,000Rp305,000Rp30,000Rp5,000Rp25,000Rp350,000Rp20,000Rp400,000Rp10,000PerinatalogiRp2,960,00008.25.67108Ny. Awaliyah63100147028900032407 October 200908 October 20091 (Hari)G2p1a0 dgn kala 1 fase aktif+riwayat epilepsiRp50,000Rp90,000Rp40,000Rp30,000Rp45,000Rp5,000Rp10,000Rp200,000Rp1,200,000Rp193,000Rp171,000Rp5,000Rp10,000Rp5,000Rp150,000ObstetriRp2,204,00008.26.45109By. Ny. Awaliyah63100147028900030 (Hari)07 October 200908 October 20091 (Hari)Bayi Baru LahirRp25,000Rp30,000Rp20,000Rp60,000Rp60,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp445,00008.27.04110Ny. Rosita Agustin63100153089500011810 October 200910 October 2009G1p0a0 H. Aterm inpartu kala 1 fase aktifRp50,000Rp60,000Rp80,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp193,000Rp156,000Rp5,000Rp10,000Rp5,000Rp150,000ObstetriRp2,124,00007.79.33111By. Ny. Rosita Agustin63100153089500010 (Hari)09 October 200910 October 20091 (Hari)Bayi Baru LahirRp25,000Rp60,000Rp60,000Rp60,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000PerinatalogiRp445,00008.27.75112Ny. Ida Rusliana6310046479000011707 October 200909 October 20092 (Hari)G1p0a0 dgn tali pusat menembung+presentasi kaki HUFDRp100,000Rp60,000Rp120,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp25,000Rp228,000Rp10,000Rp5,000Rp20,000Rp5,000Rp150,000ObstetriRp2,138,00008.26.46113By. Ny. Ida Rusliana6310046479000010 (Hari)07 October 200908 October 20091 (Hari)Bayi Baru LahirRp25,000Rp20,000Rp10,000PerinatalogiRp55,00008.26.48114Ny. Rustanti63100342029200101807 October 200909 October 20092 (Hari)G1p0a0 hamil aterm inpartu kala 1 fase laten+KPDRp100,000Rp60,000Rp40,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp195,000Rp228,000Rp5,000Rp10,000Rp5,000Rp150,000Rp300,000ObstetriRp2,508,00008.26.08115By. Ny. Rustanti63100342029200100 (Hari)08 October 200909 October 20091 (Hari)Bayi Baru LahirRp25,000Rp60,000Rp80,000Rp60,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp475,00008.27.08116Ny. Wahyuni63100961117900063406 October 200908 October 20092 (Hari)G6p5a0 H.aterm inpartu kala 1 fase aktifRp100,000Rp60,000Rp100,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp203,000Rp194,000Rp5,000Rp10,000Rp5,000Rp150,000ObstetriRp2,242,00008.25.73117By. Ny. Wahyuni63100961117900060 (Hari)06 October 200908 October 20092 (Hari)Bayi Baru LahirRp50,000Rp90,000Rp20,000Rp60,000Rp60,000Rp10,000Rp125,000Rp400,000Rp56,500Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp986,50008.25.76118Ny. Nurhayati63100567109500021805 October 200907 October 20092 (Hari)G2p0a1 H. 42 mg dg asma bronkaleRp100,000Rp90,000Rp100,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp100,000Rp215,000Rp153,000Rp5,000Rp10,000Rp5,000Rp150,000Rp300,000ObstetriRp2,643,00008.25.23119By. Ny. Nurhayati63100567109500020 (Hari)06 October 200907 October 20091 (Hari)Bayi Baru LahirRp25,000Rp30,000Rp20,000Rp60,000Rp60,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp445,00008.25.75120Ny. Ni Komang Ariani63100349109000032019 October 200921 October 20092 (Hari)G2p1a0 hamil aterm inpartu kala 1 fase latenRp100,000Rp90,000Rp60,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp210,000Rp154,500Rp5,000Rp10,000Rp5,000Rp150,000ObstetriRp2,199,50008.33.78121By. Ny. Ni Komang A63100349109000030 (Hari)20 October 200921 October 20091 (Hari)Bayi Baru LahirRp25,000Rp30,000Rp60,000Rp60,000Rp10,000Rp125,000Rp5,000Rp50,000Rp10,000PerinatalogiRp375,00008.34.28122Ny. Rahmaniah63100261068600012717 October 200917 October 2009G2p1a0 hamil aterm dgn kala II+pres-bokRp50,000Rp60,000Rp60,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp158,000Rp192,000Rp5,000Rp5,000Rp150,000Rp200,000ObstetriRp2,295,00008.14.91123By. Ny. Rahmaniah63100261068600010 (Hari)17 October 200917 October 2009Bayi Baru LahirRp25,000Rp40,000Rp30,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp345,00008.31.61124Ny. Elvira Rosiana63100258098800022912 October 200914 October 20092 (Hari)G1p0a0 H. Aterm dgn inpartuRp100,000Rp90,000Rp180,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp187,000Rp5,000Rp10,000Rp5,000Rp150,000Rp300,000ObstetriRp2,442,00007.93.89125By. Ny. Elvira R63100258098800020 (Hari)12 October 200914 October 20092 (Hari)Bayi Baru LahirRp50,000Rp20,000Rp120,000Rp90,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp530,00008.29.98126Ny. Rida Januari63100241018800132520 October 200921 October 20091 (Hari)Rp50,000Rp60,000Rp20,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp232,500Rp205,000Rp5,000Rp5,000Rp150,000Rp100,000ObstetriRp2,242,50008.33.99127By. Ny. Rida Januari63100241018800130 (Hari)20 October 200921 October 20091 (Hari)Bayi Baru LahirRp25,000Rp30,000Rp20,000Rp60,000Rp60,000Rp10,000Rp125,000Rp5,000Rp50,000Rp50,000Rp10,000PerinatalogiRp445,00008.34.32128Ny. Lisda Liana63100264028900012422 October 200924 October 20092 (Hari)G1p0a0Rp100,000Rp90,000Rp80,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,200,000Rp198,000Rp191,000Rp5,000Rp10,000Rp5,000Rp150,000Rp300,000ObstetriRp2,544,00008.35.88129By. Ny. Lisda Liana63100264028900010 (Hari)22 October 200924 October 20092 (Hari)Bayi Baru LahirRp50,000Rp60,000Rp20,000Rp100,000Rp90,000Rp10,000Rp125,000Rp10,000Rp50,000Rp50,000Rp10,000PerinatalogiRp575,00008.35.90130Ny. Ina Sitifatonah63101046099400032905 October 200908 October 20093 (Hari)G1p0a0 dg ab. IncompleteRp150,000Rp150,000Rp20,000Rp30,000Rp90,000Rp5,000Rp10,000Rp125,000Rp2,050,000Rp200,000Rp140,000Rp360,500Rp20,000Rp25,000Rp250,000GinekologiRp3,625,50008.25.24131Ny. Ni Ketut S63100864048400022912 October 200914 October 20092 (Hari)G3p1a1 dg molahidatidosaRp100,000Rp60,000Rp200,000Rp120,000Rp45,000Rp5,000Rp10,000Rp125,000Rp2,050,000Rp100,000Rp175,000Rp348,500Rp5,000Rp40,000Rp5,000Rp150,000InternaRp3,538,50008.29.69132Ny. Lisnawati63100248117700013621 October 200923 October 20092 (Hari)BORp100,000Rp120,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,750,000Rp100,000Rp200,000Rp30,000Rp5,000Rp100,000GinekologiRp2,620,00008.33.48133Ny. Rusdiana63100954068100023219 October 200921 October 20092 (Hari)G3p1a1 dgn Ab. InkompletRp100,000Rp150,000Rp20,000Rp30,000Rp45,000Rp5,000Rp10,000Rp125,000Rp1,750,000Rp108,000Rp421,000Rp10,000Rp5,000Rp100,000ObstetriRp2,879,00008.27.03134Ny. Paryati63100946119300012021 October 200923 October 20092 (Hari)G3p1a0 Uk 32-33 mg dgn KPDRp100,000Rp90,000Rp100,000Rp60,000Rp5,000Rp10,000Rp125,000Rp100,000Rp215,000Rp123,000Rp5,000Rp250,000ObstetriRp1,183,00007.73.77135Ny. Haniati63100841017900043405 October 200908 October 20093 (Hari)Perdarahan Uterus DisfungsionalRp150,000Rp120,000Rp160,000Rp45,000Rp5,000Rp10,000Rp125,000Rp203,000Rp168,000Rp5,000Rp100,000GinekologiRp1,091,00008.25.650.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.00.0T O T A L K L A I MRp408,754,500MengetahuiSepunggur, November 2013Direktur RSUD Tanah BumbuBendahara Jamkesmasdr.H.Daru Dewa, M.KesNIP.19680710 199803 1 011M.Adhi SulaimanNIP.19840415 200908 1 001

OBATDAFTAR TAGIHAN OBAT KLAIM RAWAT INAP PASIEN JAMKESDA RSUD TANAH BUMBUPROPINSI : KALIMANTAN SELATANBULAN :DesemberKABUPATEN : TANAH BUMBUTAHUN :2012NONAMA PASIENNO.REKOMENDASI JAMKESDAUmur (Thn)TANGGALDIAGNOSAObatJUMLAHTAGIHANLPMasukKeluar1Anita338113029 November 201205 December 2012G4P3A0Rp73,625Rp73,6252Warsiki337804025 November 201211 December 2012Colic AbdomonalRp208,500Rp208,5003By Marti338070 (Hr)28 November 201217 December 2012Sepsis Cleonatarum + BBLSRRp892,500Rp892,5004Tamsiyah338033929 November 201203 December 2012Obs Febris Susp Malaria dd thypoidRp22,800Rp22,8005Safarina Anggraini338082203 December 201205 December 2012FAMRp559,750Rp559,7506Siti Fiteriani337982527 November 201204 December 2012Susp DHF + MalariaRp15,000Rp15,0007Jum'riah314844504 December 201208 December 2012Retensi Urine Susp Mioma UteriRp1,517,456Rp1,517,4568M. Ilyas338281605 December 201208 December 2012Hepatitis ARp55,000Rp55,0009Iva Isnaini338262504 December 201208 December 2012Hepatitis VirusRp32,800Rp32,80010Nur'aidah338404808 December 201212 December 2012Susp SNHRp317,300Rp317,30011Abdul Aziz338392509 December 201216 December 2012Efusi PleuraRp115,000Rp115,00012Muna132904014 December 201221 December 2012Obs Stoke HemoragikRp935,500Rp935,50013Rusmatika338752417 December 201221 December 2012AnemiaRp144,760Rp144,76014Juhanah338943720 December 201226 December 2012G7P4A2Rp326,000Rp326,00015Tn Johardin3391925Wednesday, December 26, 2012Wednesday, December 26, 2012Obs Dyspepsia + GastritisRp63,100Rp63,100160.0170.0180.0190.0200.0JUMLAH TOTALRp5,279,091Sepunggur, 15 Januari 2013MengetahuiDirektur RSUD Tanah BumbuBendahara Jamkesmasdr. H. Daru Dewa, M.KesM. Adhi SulaimanNIP. 19680710 199803 1 011NIP. 19840415 200908 1 001

Sheet4DAFTAR TAGIHAN KALIM RAWAT JALAN PASIEN JAMKESDA RSUD TANAH BUMBUPROPINSI : KALIMANTAN SELATANBULAN : SeptembnerTAHUN :2012KABUPATEN : TANAH BUMBUNONAMA PASIENNO.REKOMENDASI JAMKESDAUmur (Thn)TANGGALDIAGNOSAPelayanan Kes.Dan Besaran Tarif sesuai PERDA (Rp)Pemeriksaan PenunjangTindakan MedisObatJUMLAHAkomodasiJasa MedisJasa MedisJasa KeperawatanBerkas RMTindakan di UGDTindakan Persalinan & KebidananTindakan Operasi BedahAnastesiTAGIHANLPMasukKeluarSpesialisUmumTindakan KecilTindakan SedangTindakan IntensifSederhanaKecilSedangBesarPersalinan NormalPersalinan SulitResusitasi Bayi Baru LahirKuretasi + AnastesiKuretasi Sulit + AnastesiManual Plasenta + AnastesiSederhanaKecilSedangBesarKhususSederhanaKecilSedangBesarKhusus1Rusian Wahyudi334073303 August 201203 September 2012Penetrating Thoraxo AbdomialRp1,550,000Rp780,000Rp100,000Rp620,000Rp210,000Rp1,350,000Rp10,000Rp1,000,000Rp1,750,000Rp5,000,000Rp360,000Rp600,000Rp1,750,000Rp6,091,000Rp1,779,417Rp22,950,4172Nor Ainah331022121 August 201208 September 2012Suspect Tumor AbdomenRp850,000Rp330,000Rp140,000Rp360,000Rp120,000Rp180,000Rp10,000Rp1,586,000Rp20,000Rp553,075Rp4,149,0753M. Sipe99136728 August 201201 September 2012Decomp Cordis cc AsmdRp200,000Rp60,000Rp40,000Rp80,000Rp30,000Rp10,000Rp1,194,000Rp1,614,0004Gunawan333105628 August 201212 September 2012Decomp Cordis cc AsmdRp750,000Rp360,000Rp60,000Rp320,000Rp160,000Rp10,000Rp100,000Rp774,000Rp197,768Rp2,731,7685Hayat Syamsudin334725229 August 201205 September 2012Syndrom DispepsiaRp350,000Rp180,000Rp20,000Rp140,000Rp30,000Rp10,000Rp372,000Rp43,406Rp1,145,4066Lippu334744231 August 201210 September 2012Smoke IslienikRp550,000Rp300,000Rp20,000Rp200,000Rp30,000Rp10,000Rp125,000Rp774,000Rp183,639Rp2,192,6397Suryaningsih334962431 August 201204 September 2012G1PoA, kala II Loma gawat JaninRp200,000Rp120,000Rp80,000Rp90,000Rp10,000Rp125,000Rp4,000,000Rp1,400,000Rp412,000Rp6,437,0008Sumarmi334715001 September 201201 September 2012Ca. MamaeRp50,000Rp30,000Rp20,000Rp20,000Rp10,000Rp50,000Rp161,000Rp55,000Rp396,0009Andre Hernuan / M Ramadhan334791001 September 201202 September 2012Suspect Hepatitis + Ensepalopati FibrosaRp100,000Rp30,000Rp20,000Rp60,000Rp90,000Rp10,000Rp125,000Rp801,500Rp1,236,50010Arpiah334836002 September 201210 September 2012Musa Abdomen, Mioma UteriRp400,000Rp240,000Rp180,000Rp60,000Rp90,000Rp10,000Rp100,000Rp4,000,000Rp1,400,000Rp937,500Rp9,029,378Rp16,446,87811Adi Setiawan / Wahyu Saputra33487403 September 201205 September 2012Abshes ColliRp150,000Rp60,000Rp20,000Rp20,000Rp90,000Rp10,000Rp50,000Rp1,750,000Rp600,000Rp170,000Rp2,920,00012Jawahir335007003 September 201206 September 2012AnemiaRp200,000Rp90,000Rp20,000Rp80,000Rp30,000Rp10,000Rp338,000Rp56,211Rp824,21113Rohmiati335582504 September 201209 September 2012Ketuban MudighaeRp300,000Rp180,000Rp40,000Rp180,000Rp10,000Rp125,000Rp3,500,000Rp85,000Rp217,309Rp4,637,30914By Syafi'atul Uzma334892 (Bln)13 September 201216 September 2012Diare Cair AkutRp150,000Rp60,000Rp20,000Rp80,000Rp10,000Rp100,000Rp120,500Rp314,145Rp854,64515Jenah153213204 September 201207 September 2012AbortusRp200,000Rp120,000Rp135,000Rp10,000Rp100,000Rp167,000Rp55,810Rp787,81016Juarti334934605 September 201208 September 2012GastritisRp200,000Rp60,000Rp40,000Rp60,000Rp30,000Rp10,000Rp100,000Rp983,500Rp119,991Rp1,603,49117Bahrun334904005 September 201208 September 2012Obs Hipoestesia Perianal Post Trauma + Retensio UrineRp200,000Rp90,000Rp20,000Rp80,000Rp10,000Rp125,000Rp434,500Rp80,022Rp1,039,52218Suparmi201524706 September 201207 September 2012Mioma UteriRp100,000Rp60,000Rp20,000Rp10,000Rp215,500Rp405,50019Marisa Dewi335152406 September 201212 September 2012IspaRp300,000Rp120,000Rp40,000Rp140,000Rp90,000Rp10,000Rp1,475,000Rp268,373Rp2,443,37320Ulfah Nurul335013206 September 201215 September 2012Partus Abnorm dgn SCRp500,000Rp150,000Rp100,000Rp40,000Rp135,000Rp10,000Rp125,000Rp4,000,000Rp1,400,000Rp1,222,000Rp50,000Rp32,000Rp7,764,00021Yahmarudin335123507 September 201208 September 2012Multiple Laceratum Wound + Fractur Phalange P RoximalRp50,000Rp30,000Rp20,000Rp60,000Rp10,000Rp200,000Rp27,500Rp75,000Rp472,50022Mahrita335043407 September 201210 September 2012Retensio PlasentaRp200,000Rp120,000Rp60,000Rp45,000Rp10,000Rp1,625,000Rp638,000Rp125,625Rp2,823,62523By Mina335083 (Hr)07 September 201211 September 2012HiperbilirubinemiaRp200,000Rp120,000Rp60,000Rp80,000Rp90,000Rp10,000Rp208,000Rp768,00024Supiani295365007 September 201208 September 2012Koma HipoglikemiaRp50,000Rp30,000Rp20,000Rp40,000Rp160,000Rp10,000Rp125,000Rp185,500Rp458,675Rp1,079,17525Mustaming335215007 September 201215 September 2012Asma AttackRp450,000Rp210,000Rp40,000Rp180,000Rp60,000Rp10,000Rp100,000Rp443,000Rp71,040Rp1,564,04026Siti Nafisah334963907 September 201210 September 2012G1 Hamil Aterm dgn gawat janinRp200,000Rp120,000Rp80,000Rp90,000Rp10,000Rp50,000Rp125,000Rp5,000,000Rp1,750,000Rp582,500Rp355,645Rp8,363,14527Masumi325064308 September 201210 September 2012Obs Cholic AbdomenRp150,000Rp60,000Rp60,000Rp10,000Rp100,000Rp178,000Rp558,00028By Vera Yulita335201 ( Hr)08 September 201224 September 2012Asfiksia Berat +BBLCRp850,000Rp480,000Rp20,000Rp20,000Rp450,000Rp10,000Rp878,000Rp50,000Rp299,802Rp3,057,80229Suginem335096008 September 201215 September 2012Hipertensi EmergencyRp400,000Rp210,000Rp20,000Rp140,000Rp150,000Rp315,000Rp10,000Rp125,000Rp1,009,500Rp50,000Rp15,902Rp2,445,40230Cunde335076508 September 201220 September 2012MalariaRp600,000Rp270,000Rp60,000Rp240,000Rp90,000Rp10,000Rp100,000Rp2,529,500Rp85,955Rp3,985,45531M. Rayhan33527109 September 201212 September 2012Diare Cair AkutRp150,000Rp90,000Rp80,000Rp30,000Rp10,000Rp50,000Rp141,000Rp551,00032Nanda Saputra/an M. Rauf33509909 September 201213 September 2012Malaria dgn KomplikasiRp200,000Rp120,000Rp100,000Rp90,000Rp10,000Rp100,000Rp948,000Rp1,568,00033Dian Ariyama334914706 September 201213 September 2012Gangren DiabetsRp400,000Rp240,000Rp160,000Rp360,000Rp10,000Rp100,000Rp1,750,000Rp600,000Rp2,139,000Rp1,143,182Rp6,902,18234Hardiana335134410 September 201212 September 2012Syndrom DispepsiaRp150,000Rp60,000Rp20,000Rp60,000Rp10,000Rp100,000Rp316,500Rp40,938Rp757,43835Vera Yulita335192408 September 201224 September 2012Kala II Inpartus dgn SCRp850,000Rp480,000Rp20,000Rp20,000Rp405,000Rp10,000Rp125,000Rp1,750,000Rp5,000,000Rp600,000Rp1,750,000Rp1,491,500Rp150,000Rp617,198Rp13,268,69836Tunia Wati335432910 September 201217 September 2012G3P2A0 Hamil 34 minggu dgn InpartusRp150,000Rp60,000Rp20,000Rp40,000Rp90,000Rp10,000Rp100,000Rp800,000Rp212,500Rp47,494Rp1,529,99437Yanto335255010 September 201213 September 2012Asma AttackRp150,000Rp60,000Rp20,000Rp60,000Rp60,000Rp10,000Rp510,500Rp870,50038Daimah323563611 September 201214 September 2012Ulcus PepticumRp200,000Rp90,000Rp20,000Rp80,000Rp30,000Rp10,000Rp100,000Rp372,000Rp50,082Rp952,08239Muhyati335163011 September 201213 September 2012Retensio PlasentaRp150,000Rp90,000Rp60,000Rp90,000Rp10,000Rp1,625,000Rp333,000Rp210,815Rp2,568,81540Sutrisno335187012 September