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LAPORAN REKAP KLAIM - KLINIK UTAMA SEHAT SEJAHTERA


Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Des 2018 s/d 31 Des 2018
Filter: Metode Pembayaran = JKN / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KE
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien
1 24 Nov 2018 1 Des 2018 025423 HANNAH ZHAFIRA PUTRI
2 30 Nov 2018 1 Des 2018 000244 AMRAN
3 27 Nov 2018 1 Des 2018 025503 SAKINAH
4 29 Nov 2018 1 Des 2018 025556 AZZIKRI
5 28 Nov 2018 1 Des 2018 012660 ALIMIN
6 27 Nov 2018 1 Des 2018 021748 VIDIA YUNITA
7 19 Nov 2018 1 Des 2018 008104 MARYAM
8 17 Nov 2018 1 Des 2018 025263 HERLINA
9 19 Nov 2018 1 Des 2018 017496 INSUN
10 30 Nov 2018 2 Des 2018 025593 RUGISWATI
11 29 Nov 2018 2 Des 2018 019958 ISKANDAR
12 27 Nov 2018 2 Des 2018 025505 ZAHRA ATIKA
13 27 Nov 2018 3 Des 2018 025465 M. TOHIR
14 1 Des 2018 3 Des 2018 025637 SANIATI
15 29 Nov 2018 3 Des 2018 020046 E. KOM KOMSALI
16 27 Nov 2018 3 Des 2018 024827 NUR ASNA
17 27 Nov 2018 3 Des 2018 025508 SOBRI
18 26 Nov 2018 4 Des 2018 022412 BURHANUDIN
19 25 Nov 2018 4 Des 2018 024791 WULAN MAYANG SARI
20 26 Nov 2018 4 Des 2018 010271 SURIATI
21 1 Des 2018 4 Des 2018 023422 FAJAR BUDIMAN
22 30 Nov 2018 5 Des 2018 025600 BAYU ARIFANDI
23 1 Des 2018 5 Des 2018 025545 MUHAMMAD HABIBI ALFARIZI
24 2 Des 2018 5 Des 2018 025639 RHEEZKY NIDAL BANI ALTHAF
25 24 Nov 2018 5 Des 2018 018871 SUMARNI
26 4 Des 2018 5 Des 2018 025396 HOLIDAH
27 29 Nov 2018 5 Des 2018 023182 M. TEGUH
28 3 Des 2018 5 Des 2018 025643 HARIYANTI
29 4 Des 2018 5 Des 2018 025673 MUHAMAD DIGO ADRIAN PRADIPTO
30 25 Nov 2018 5 Des 2018 023216 NETI AIKA
31 6 Des 2018 6 Des 2018 023564 IZUDDIN
32 6 Des 2018 7 Des 2018 025693 HABIB ARSYID SANJAYA
33 6 Des 2018 7 Des 2018 025742 MUHAMMAD FEHRAN FIRDAUS
34 2 Des 2018 7 Des 2018 025642 FATIMA
35 30 Nov 2018 7 Des 2018 025551 RATNA
36 1 Des 2018 7 Des 2018 019657 BUSTOMI
37 4 Des 2018 8 Des 2018 025200 NINDYA REZKY ARINDA
38 7 Des 2018 8 Des 2018 000244 AMRAN
39 7 Des 2018 8 Des 2018 025806 DEPI APRILIYANI
40 29 Nov 2018 8 Des 2018 024217 M. ZUBER BAIJURI
41 2 Des 2018 8 Des 2018 015003 MUQODDAS
42 7 Des 2018 8 Des 2018 025803 MERIYATI
43 4 Des 2018 8 Des 2018 018196 RUSMI
44 3 Des 2018 8 Des 2018 025574 BAIDILLAH
45 4 Des 2018 8 Des 2018 025707 ZAHRIAH
46 5 Des 2018 8 Des 2018 025730 RAHMI
47 28 Nov 2018 8 Des 2018 025533 ASNUN
48 4 Des 2018 9 Des 2018 025669 IZHAR

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49 5 Des 2018 9 Des 2018 025713 MASRI


50 5 Des 2018 9 Des 2018 025729 ANISA
51 4 Des 2018 9 Des 2018 025685 CIK ISAH
52 7 Des 2018 9 Des 2018 025816 SITI
53 8 Des 2018 9 Des 2018 025824 NURMAYUNITA
54 6 Des 2018 10 Des 2018 025738 PONINO
55 5 Des 2018 12 Des 2018 025712 ANDINI DWI RAMADHAN
56 11 Des 2018 12 Des 2018 025906 ROSDIANA PASARIBU
57 10 Des 2018 12 Des 2018 000065 CIKMAN ABDUL KADIR
58 10 Des 2018 12 Des 2018 025776 EFKA FIRSTA
59 10 Des 2018 13 Des 2018 025868 MUHAMMAD HAYKAL AL AFGHANI
60 12 Des 2018 14 Des 2018 025967 HELENA ENTONG
61 8 Des 2018 14 Des 2018 024280 HAMDI
62 11 Des 2018 14 Des 2018 020972 HUMAIDA
63 8 Des 2018 14 Des 2018 025826 M. ARYA PRADANA
64 10 Des 2018 14 Des 2018 025792 KOYA
65 7 Des 2018 14 Des 2018 025758 RUSMIYATI
66 11 Des 2018 14 Des 2018 020469 HATTA BIN PUTIH HAMBALI
67 28 Nov 2018 14 Des 2018 025526 SYUKRON
68 11 Des 2018 14 Des 2018 020094 HERMAN
69 9 Des 2018 14 Des 2018 025854 ZAINAP AINI
70 10 Des 2018 15 Des 2018 025870 SYAPARUDDIN
71 10 Des 2018 15 Des 2018 025876 NIRWANA. A. RONI
72 10 Des 2018 15 Des 2018 025630 ISTIKOMA
73 10 Des 2018 15 Des 2018 025847 LENA RS
74 13 Des 2018 15 Des 2018 000009 LISNAYATI
75 14 Des 2018 15 Des 2018 008780 PENDI HASAN
76 11 Des 2018 15 Des 2018 024726 SHAFA ADINDA
77 11 Des 2018 16 Des 2018 025896 NOVE AFIANIS GULO
78 14 Des 2018 16 Des 2018 020251 NURDIN BIN AGANI
79 13 Des 2018 17 Des 2018 025866 MUHAMMAD FAUZAN
80 12 Des 2018 18 Des 2018 025911 DASRIL
81 14 Des 2018 18 Des 2018 025936 LAMIJA
82 13 Des 2018 18 Des 2018 017514 JAUHARI
83 15 Des 2018 18 Des 2018 026027 SULIYAH
84 12 Des 2018 18 Des 2018 025955 LESTA FIRDA AVIANI
85 15 Des 2018 18 Des 2018 016135 TINA WATI
86 9 Des 2018 19 Des 2018 025850 ROLETA
87 16 Des 2018 19 Des 2018 025079 PASRIANTI
88 15 Des 2018 19 Des 2018 020516 SARONA
89 17 Des 2018 19 Des 2018 025395 PENDI
90 17 Des 2018 19 Des 2018 026028 SAHIL AL KASTURI
91 19 Des 2018 19 Des 2018 026156 POHDI
92 17 Des 2018 20 Des 2018 025858 KHODIJAH
93 19 Des 2018 20 Des 2018 000244 AMRAN
94 14 Des 2018 20 Des 2018 026020 AQILA KHAIRA
95 19 Des 2018 20 Des 2018 001468 SHANTI MELANI
96 17 Des 2018 20 Des 2018 025868 MUHAMMAD HAYKAL AL AFGHANI
97 18 Des 2018 20 Des 2018 019176 FAUZI
98 17 Des 2018 20 Des 2018 018268 SULIAH SOMAD
99 14 Des 2018 21 Des 2018 025999 SOPIDI
100 18 Des 2018 21 Des 2018 026035 IRWANSYAH

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101 18 Des 2018 22 Des 2018 021742 RISPA RIZKIA


102 20 Des 2018 23 Des 2018 025832 HASAN
103 19 Des 2018 24 Des 2018 026045 NABILLAH ASRORRIYAH SASMITA
104 19 Des 2018 24 Des 2018 019964 JAMALUDDIN
105 21 Des 2018 24 Des 2018 026170 ISMAIL
106 21 Des 2018 25 Des 2018 026230 RAHAYU
107 21 Des 2018 25 Des 2018 026235 A. KARIM
108 23 Des 2018 26 Des 2018 026116 KARTIKAH
109 22 Des 2018 26 Des 2018 026251 ABDUL ROZAK
110 22 Des 2018 27 Des 2018 026238 INDRAWATI
111 24 Des 2018 27 Des 2018 026262 RESINTA
112 21 Des 2018 27 Des 2018 026219 YULYANI
113 15 Des 2018 28 Des 2018 026022 SAERAH
114 25 Des 2018 28 Des 2018 026391 NURUL JANNAH
115 17 Des 2018 28 Des 2018 026040 ZURIAH
116 26 Des 2018 28 Des 2018 010070 H M SYAHIR
117 26 Des 2018 28 Des 2018 026292 H. M. ALI SAANI
118 21 Des 2018 28 Des 2018 022056 MURTI ASIH
119 19 Des 2018 28 Des 2018 025707 ZAHRIAH
120 27 Des 2018 29 Des 2018 026122 BAIRUNA
121 24 Des 2018 29 Des 2018 026272 M. YUNUS
122 27 Des 2018 29 Des 2018 004830 SAPUAN
123 28 Des 2018 29 Des 2018 000244 AMRAN
124 27 Des 2018 31 Des 2018 026294 KHALISTA NABILAH ZAHIRA
Total
Kode RS: K1610001

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a / Jenis Tarif = TARIF RS KELAS D SWASTA


No. SEP INACBG Top Up Total Tarif Tarif RS Jenis
0429S0011118V000991 A-4-13-II 2,049,100 5,265,900 RI
0429S0011118V001307 B-4-13-I 2,830,600 628,850 RI
0429S0011118V001086 U-4-11-I 1,427,100 2,339,900 RI
0429S0011118V001276 K-4-17-I 1,122,000 953,350 RI
0429S0011118V001207 I-4-17-II 2,829,900 2,161,700 RI
0429S0011118V001270 K-4-18-I 1,126,600 1,747,570 RI
0429S0011118V000773 I-4-12-I 3,269,300 6,552,700 RI
0429S0011118V000734 F-4-15-I 2,626,300 7,476,700 RI
0429S0011118V000817 A-4-14-II 3,695,600 7,509,130 RI
0429S0011118V001293 K-4-18-I 1,126,600 1,177,530 RI
0429S0011118V001227 A-4-14-I 3,044,600 2,489,500 RI
0429S0011118V001154 K-4-18-I 1,351,900 2,474,100 RI
0429S0011118V001108 K-4-18-I 1,126,600 2,042,900 RI
0429S0011218V000044 I-4-12-I 2,335,200 1,494,660 RI
0429S0011118V001267 J-4-17-I 3,477,000 3,049,750 RI
0429S0011118V001247 A-4-13-II 1,756,400 4,211,900 RI
0429S0011118V001100 K-4-18-II 1,601,000 2,929,300 RI
0429S0011118V001127 K-4-12-I 1,989,400 3,571,900 RI
0429S0011118V001011 K-4-17-I 1,346,400 4,775,850 RI
0429S0011118V001037 I-4-16-II 2,274,300 4,016,300 RI
0429S0011218V000870 K-4-18-I 1,577,300 2,024,860 RI
0429S0011118V001317 A-4-14-I 3,044,600 3,430,900 RI
0429S0011218V000026 A-4-13-I 1,305,900 2,689,700 RI
0429S0011218V000045 A-4-13-I 1,523,500 2,102,300 RI
0429S0011118V000992 I-4-17-II 2,021,400 4,404,600 RI
0429S0011218V000126 K-4-18-I 1,126,600 1,049,050 RI
0429S0011118V001292 J-4-18-I 2,027,000 2,032,450 RI
0429S0011218V000113 K-4-18-I 1,351,900 1,554,500 RI
0429S0011218V000176 K-4-17-I 1,122,000 745,250 RI
0429S0011118V001048 I-4-15-I 4,208,000 5,232,900 RI
0429S0011218V000233 G-4-26-II 4,370,600 976,450 RI
0429S0011218V000215 A-4-13-I 1,305,900 1,442,300 RI
0429S0011218V000252 A-4-13-I 1,088,200 935,200 RI
0429S0011218V000100 I-4-16-I 1,982,800 3,898,710 RI
0429S0011118V001315 K-4-15-I 2,025,700 4,504,700 RI
0429S0011218V000032 J-4-17-I 2,483,600 2,722,500 RI
0429S0011218V000183 W-4-16-I 2,369,400 2,103,950 RI
0429S0011218V000311 B-4-13-I 2,830,600 565,600 RI
0429S0011218V000276 M-4-20-I 1,974,200 526,990 RI
0429S0011118V001243 N-4-15-I 2,845,000 5,630,000 RI
0429S0011218V000035 I-4-12-I 3,269,300 4,148,850 RI
0429S0011218V000273 J-4-18-I 2,027,000 1,589,150 RI
0429S0011218V000150 K-4-17-I 1,570,800 3,272,500 RI
0429S0011218V000097 M-4-17-II 4,861,700 4,774,200 RI
0429S0011218V000158 E-4-10-I 3,946,000 1,796,500 RI
0429S0011218V000234 I-4-12-I 2,802,300 2,348,500 RI
0429S0011118V001184 I-4-20-I 2,744,600 3,686,300 RI
0429S0011218V000145 K-4-18-I 1,126,600 2,458,700 RI

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0429S0011218V000186 A-4-14-II 2,639,700 2,106,700 RI


0429S0011218V000251 A-4-14-I 2,174,700 1,458,800 RI
0429S0011218V000146 L-4-12-I 1,144,600 1,990,100 RI
0429S0011218V000318 E-4-10-I 3,288,300 1,098,900 RI
0429S0011218V000348 A-4-13-I 1,088,200 1,464,850 RI
0429S0011218V000232 G-4-16-I 2,273,500 1,939,300 RI
0429S0011218V000182 A-4-13-I 1,523,500 4,664,860 RI
0429S0011218V000514 G-4-21-I 1,812,500 1,215,150 RI
0429S0011218V000437 I-4-17-II 2,021,400 2,768,460 RI
0429S0011218V000527 A-4-14-I 3,044,600 2,012,650 RI
0429S0011218V000428 A-4-14-I 3,044,600 2,448,800 RI
0429S0011218V000550 A-4-14-I 2,174,700 1,253,100 RI
0429S0011218V000353 A-4-14-I 2,174,700 2,869,000 RI
0429S0011218V000494 I-4-16-I 1,416,300 1,663,950 RI
0429S0011218V000466 A-4-13-I 1,523,500 3,808,950 RI
0429S0011218V000517 I-4-17-I 1,736,300 2,020,900 RI
0429S0011218V000277 K-4-18-II 1,601,000 3,134,320 RI
0429S0011218V000499 I-4-10-I 3,696,500 2,980,320 RI
0429S0011118V001206 J-4-15-I 4,738,700 8,631,350 RI
0429S0011218V000501 B-4-13-II 3,297,600 2,426,360 RI
0429S0011218V000465 G-4-15-I 3,309,400 5,392,950 RI
0429S0011218V000516 N-4-10-II 2,698,600 3,484,450 RI
0429S0011218V000436 N-4-12-I 2,822,400 3,877,700 RI
0429S0011218V000434 I-4-17-II 2,829,900 3,380,500 RI
0429S0011218V000468 A-4-13-I 1,305,900 3,759,780 RI
0429S0011218V000651 I-4-17-I 2,430,800 1,543,500 RI
0429S0011218V000652 J-4-18-I 2,027,000 856,110 RI
0429S0011218V000515 A-4-14-I 2,174,700 1,832,600 RI
0429S0011218V000519 A-4-13-I 1,523,500 3,640,100 RI
0429S0011218V000642 I-4-20-I 3,842,400 1,732,610 RI
0429S0011218V000578 A-4-13-I 1,088,200 2,031,900 RI
0429S0011218V000536 K-4-18-II 2,241,400 4,263,690 RI
0429S0011218V000611 G-4-26-I 2,683,600 4,541,000 RI
0429S0011218V000608 K-4-18-I 1,126,600 2,401,500 RI
0429S0011218V000696 K-4-18-I 1,577,300 2,317,350 RI
0429S0011218V000531 A-4-13-I 1,523,500 4,878,700 RI
0429S0011218V000691 I-4-16-II 2,274,300 1,079,300 RI
0429S0011218V000358 L-4-10-II 1,335,900 4,246,200 RI
0429S0011218V000701 M-4-18-I 1,876,700 1,329,550 RI
0429S0011218V000700 J-4-21-I 2,627,200 2,210,100 RI
0429S0011218V000756 K-4-15-I 1,688,100 1,296,000 RI
0429S0011218V000721 J-4-16-II 6,473,200 1,797,600 RI
0429S0011218V000897 K-4-17-I 1,570,800 600,250 RI
0429S0011218V000778 A-4-14-I 3,044,600 2,516,450 RI
0429S0011218V000893 B-4-13-I 2,830,600 476,610 RI
0429S0011218V000679 A-4-13-I 1,523,500 4,321,000 RI
0429S0011218V000895 K-4-17-I 1,346,400 1,003,400 RI
0429S0011218V000755 U-4-13-I 2,524,400 2,512,600 RI
0429S0011218V000811 K-4-12-II 3,748,000 2,242,550 RI
0429S0011218V000773 I-4-17-I 2,083,500 1,507,000 RI
0429S0011218V000735 L-4-10-I 1,381,100 3,910,700 RI
0429S0011218V000825 E-4-10-I 3,946,000 1,931,800 RI

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0429S0011218V000836 A-4-13-I 1,523,500 3,480,600 RI


0429S0011218V000931 K-4-18-I 1,126,600 2,218,900 RI
0429S0011218V000902 A-4-13-I 1,305,900 2,107,800 RI
0429S0011218V000988 I-4-10-I 2,640,400 2,100,650 RI
0429S0011218V000996 A-4-14-I 2,174,700 1,510,500 RI
0429S0011218V001005 I-4-24-II 4,671,700 1,752,050 RI
0429S0011218V001007 J-4-17-I 2,483,600 2,068,200 RI
0429S0011218V001038 K-4-18-I 1,126,600 1,740,400 RI
0429S0011218V001037 V-4-11-II 3,336,000 1,722,250 RI
0429S0011218V001009 J-4-18-I 2,027,000 2,700,920 RI
0429S0011218V001071 A-4-14-I 2,174,700 2,132,000 RI
0429S0011218V000975 A-4-13-I 1,088,200 2,725,890 RI
0429S0011218V000754 K-4-18-II 2,241,400 11,700,145 RI
0429S0011218V001088 A-4-13-I 1,088,200 1,736,000 RI
0429S0011218V000776 I-4-15-I 4,208,000 4,683,450 RI
0429S0011218V001185 I-4-10-I 3,696,500 1,960,950 RI
0429S0011218V001096 K-4-18-II 1,601,000 1,303,150 RI
0429S0011218V001118 J-4-18-I 2,027,000 2,771,250 RI
0429S0011218V000842 E-4-10-I 3,946,000 4,013,000 RI
0429S0011218V001240 K-4-18-I 1,126,600 1,159,490 RI
0429S0011218V001084 E-4-10-II 5,513,800 2,728,200 RI
0429S0011218V001219 I-4-10-I 3,168,500 1,904,630 RI
0429S0011218V001312 B-4-13-I 2,830,600 510,820 RI
0429S0011218V001203 A-4-14-I 2,174,700 1,995,600 RI
288,534,000 337,116,315

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