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LAPORAN REKAP
Pasien KLAIM
Rawat - RSUD
Inap BALUNG
dan Rawat Jalan, Periode Tanggal Pulang: 1 Jan 2017 s/d 31 Jan 2017
Filter: Metode Pembayaran = Semua / / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D PE

No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien


1 27 Des 2016 1 Jan 2017 209421 SABARI
2 1 Jan 2017 3 Jan 2017 205350 WIKE ANDRI DUSTIRA
3 1 Jan 2017 4 Jan 2017 209709 JOHAN ARISANDI
4 2 Jan 2017 4 Jan 2017 209728 ISNAINIAH
5 30 Des 2016 4 Jan 2017 209674 RIFQY WHILDANA FIRDAUSY
6 3 Jan 2017 5 Jan 2017 127302 AMMARA AQILA ZAHIDAH
7 4 Jan 2017 6 Jan 2017 201735 SLAMET
8 4 Jan 2017 6 Jan 2017 210116 SUPINAH
9 3 Jan 2017 6 Jan 2017 179290 KRISNA EKO IMANUEL
10 4 Jan 2017 7 Jan 2017 121308 ASHFA ZAMITA NURIL AISY
11 2 Jan 2017 7 Jan 2017 189453 KAMAR
12 5 Jan 2017 8 Jan 2017 200245 RICHI ULIN NUHA
13 8 Jan 2017 10 Jan 2017 210209 DENI KURNIAWAN
14 10 Jan 2017 11 Jan 2017 210154 MOH. NURHAFIDZ
15 3 Jan 2017 12 Jan 2017 210002 IMROATUL AZIZAH
16 12 Jan 2017 15 Jan 2017 081328 DJALI
17 10 Jan 2017 15 Jan 2017 210328 AZZAM FACHRIEL PUTRA HASYMI
18 12 Jan 2017 15 Jan 2017 208740 DANIAL FAHMI WIBOWO
19 10 Jan 2017 16 Jan 2017 210291 SYAHIDAH
20 13 Jan 2017 18 Jan 2017 195844 BENU
21 17 Jan 2017 20 Jan 2017 128780 ACHADUN
22 14 Jan 2017 20 Jan 2017 210527 YUENI
23 21 Jan 2017 23 Jan 2017 210694 NABILAH SEPTIYAH DININGRUM
24 21 Jan 2017 23 Jan 2017 210516 KHOIMATUL IMA
25 23 Jan 2017 24 Jan 2017 210264 ANINDITA KEYSHA ZAHIRA
26 24 Jan 2017 25 Jan 2017 210784 YOSSY ARI WARDANI
27 24 Jan 2017 26 Jan 2017 128377 NINING LESTARI
28 26 Jan 2017 27 Jan 2017 210898 MIFTAHUL JANNAH
29 26 Jan 2017 28 Jan 2017 202024 ACHMAD LUTFI AZIS
30 27 Jan 2017 29 Jan 2017 210931 SETIYOWATI
31 23 Jan 2017 30 Jan 2017 209704 SUGITO
32 26 Jan 2017 30 Jan 2017 210900 MIFTAHUL JANNAH, BY
33 22 Jan 2017 30 Jan 2017 210705 SITI AISYAH, HJ
Total
Kode RS: 3509134

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arif = TARIF RS KELAS D PEMERINTAH

No. SEP INACBG Top Up Total Tarif Tarif RS Jenis


1329R00212160000707 I-4-16-I 1,635,400 1,859,768 RI
1329R00201170000062 A-4-14-I 2,511,000 1,763,954 RI
1329R00201170000122 L-4-13-I 2,584,000 2,578,234 RI
1329R00201170000007 K-4-18-I 1,300,900 1,028,977 RI
1329R00212160000920 B-4-13-I 3,268,400 2,016,785 RI
1329R00201170000056 A-4-12-I 2,860,900 1,016,805 RI
1329R00201170000110 I-4-16-I 1,635,400 2,099,430 RI
1329R00201170000149 A-4-14-I 2,511,000 1,667,274 RI
1329R00201170000091 K-4-17-I 1,295,500 1,095,659 RI
1329R00201170000185 K-4-17-I 1,295,500 1,602,944 RI
1329R00201170000120 I-4-16-I 1,635,400 3,682,704 RI
1329R00201170000205 K-1-13-II 3,213,800 7,320,558 RI
1329R00201170000275 K-4-17-I 1,295,500 1,761,712 RI
1329R00201170000310 L-1-40-I 3,870,300 3,442,175 RI
1329R00201170000027 A-4-14-I 2,511,000 7,125,588 RI
1329R00201170000370 M-1-40-I 3,355,000 6,809,356 RI
1329R00201170000397 K-4-17-II 1,942,600 2,110,686 RI
1329R00201170000419 G-4-22-I 2,878,900 1,488,887 RI
1329R00201170000306 I-4-12-I 2,696,400 4,360,874 RI
1329R00201170000437 K-4-17-I 1,295,500 3,232,515 RI
1329R00201170000553 K-1-14-I 4,741,200 7,252,111 RI
1329R00201170000563 A-4-13-I 1,256,500 2,424,186 RI
1329R00201170000692 K-4-17-I 1,295,500 1,444,915 RI
1329R00201170000714 W-1-10-I 1,659,800 3,632,516 RI
1329R00201170000751 K-4-17-I 1,295,500 714,437 RI
1329R00201170000796 W-4-16-II 3,048,700 2,396,179 RI
1329R00201170000845 K-4-17-I 1,295,500 1,760,564 RI
1329R00201170000912 O-6-13-II 2,084,400 2,295,960 RI
1329R00201170000899 A-4-15-II 5,148,200 1,088,384 RI
1329R00201170000966 U-4-11-I 1,373,200 877,427 RI
1329R00201170000721 D-4-13-III 4,203,500 4,563,356 RI
1329R00201170000938 P-8-17-I 3,628,800 1,428,086 RI
1329R00201170000749 D-4-13-II 3,286,500 17,375,836 RI
79,909,700 105,318,842

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