Vous êtes sur la page 1sur 2

sheet1 1

LAPORAN REKAP KLAIM - RSUD BALUNG


Pasien Rawat Inap 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 PEMERINT
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien
1 29 Des 2016 3 Jan 2017 209646 SOERIYAH
2 1 Jan 2017 4 Jan 2017 209696 YULI NOVELIA ARLIYANTI
3 3 Jan 2017 4 Jan 2017 210040 WIWIK KUSMIATI
4 5 Jan 2017 5 Jan 2017 031335 SUTRISNO
5 2 Jan 2017 5 Jan 2017 209726 AGHA AVEROES
6 2 Jan 2017 7 Jan 2017 208271 SUKANDAR
7 5 Jan 2017 10 Jan 2017 205682 HARSONO
8 7 Jan 2017 11 Jan 2017 182826 SRI WELAS
9 5 Jan 2017 11 Jan 2017 204087 SUNIK
10 12 Jan 2017 14 Jan 2017 147377 SUGENG RIYADI
11 15 Jan 2017 16 Jan 2017 210452 SUGENG HARYONO
12 11 Jan 2017 16 Jan 2017 210354 SITI ILAFI
13 15 Jan 2017 17 Jan 2017 187079 RAISYA ADZKIA SAUFA RAMADHANI
14 17 Jan 2017 18 Jan 2017 070087 SOLEKHAN
15 16 Jan 2017 18 Jan 2017 113831 LILIEK SUHARTI
16 17 Jan 2017 19 Jan 2017 208629 YOYOK WIDIYOKO
17 16 Jan 2017 19 Jan 2017 210524 IIN TRIANI
18 14 Jan 2017 20 Jan 2017 210444 ABDUL BASID H
19 20 Jan 2017 21 Jan 2017 138176 ANIK HASNIWATI, S.PD
20 17 Jan 2017 21 Jan 2017 183585 ABDUL SALAM
21 24 Jan 2017 27 Jan 2017 109484 INDAHYAATUN
22 23 Jan 2017 30 Jan 2017 210733 AMINDARI
23 25 Jan 2017 30 Jan 2017 210863 RIBUT
Total
Kode RS: 3509134

Page 1
sheet1 1

IF RS KELAS D PEMERINTAH
No. SEP INACBG Top Up Total Tarif Tarif RS Jenis
1329R00212160000918 D-4-14-I 2,905,600 5,063,607 RI
1329R00201170000034 L-4-10-III 2,088,900 2,173,475 RI
1329R00201170000064 I-4-16-I 1,907,900 1,846,487 RI
1329R00201170000137 H-1-20-I 2,581,500 3,081,705 RI
1329R00201170000003 U-4-13-I 2,429,000 1,150,483 RI
1329R00201170000005 B-4-13-I 3,813,200 1,836,022 RI
1329R00201170000184 I-4-15-I 5,668,500 2,402,379 RI
1329R00201170000217 E-4-10-I 4,429,700 6,670,686 RI
1329R00201170000213 I-4-17-I 2,338,900 3,158,384 RI
1329R00201170000391 E-1-20-I 6,817,100 7,201,239 RI
1329R00201170000558 I-4-12-I 3,145,800 1,216,080 RI
1329R00201170000382 W-4-16-II 3,556,800 2,781,978 RI
1329R00201170000507 N-4-12-I 2,715,800 1,744,369 RI
1329R00201170000560 I-4-16-II 3,063,700 2,216,292 RI
1329R00201170000559 K-4-17-II 2,266,400 1,759,947 RI
1329R00201170000562 M-1-40-I 3,914,100 8,334,401 RI
1329R00201170000532 I-4-17-I 2,338,900 1,268,758 RI
1329R00201170000564 I-4-12-II 3,646,300 6,668,760 RI
1329R00201170000662 K-4-17-I 1,511,400 1,066,581 RI
1329R00201170000599 K-4-18-I 1,517,700 5,377,722 RI
1329R00201170000852 W-4-11-I 2,867,200 3,547,232 RI
1329R00201170000745 I-4-17-II 2,723,000 3,075,657 RI
1329R00201170000898 I-4-17-III 3,267,600 1,483,081 RI
71,515,000 75,125,325

Page 2