Yarisga Kalianget

RSI Garam Kalianget

Ramah, Senyum, Ikhlas, Ghirah & Kekeluargaan

DAFTAR JASA PELAYANAN TINDAKAN

SPESIALIS RADIOLOGI
SESUAI JADWAL PRAKTEK
Jan-19
Tgl No. No. Reg Nama Pasien Umur Alamat
1/2/2019 1 47710 tn. Susyanto 35 saronggi
2 48432 tn. Yuda 37 kalianget
3 48356 ny. Ria sukmawati 37 pangarangan
4 48346 tn. Abd. Hamid 43 pasongsongan
5 48401 tn. H. ali makki 82 pragaan
6 37962 tn. Ach. Zeni 58 rubaru
7 48439 tn. Sudarsono 65 KT
8 26000 ny. Suriyah 63 marengan
9 48400 ny. Buhana 70 gapura
10 47189 tn. Saleman 63 batuan
11 48388 ny. Suryani 34 dasuk
1/3/2019 1 48461 ny. Wartik 65 KT
2 48461 ny. Wartik 65 KT
3 48358 ny. Sahma khairiyah 86 talango
4 37962 tn. Ach. Zeni 56 rubaru
5 48452 ny. Hairiyah 70 talango
6 48461 ny. Wartik 65 KT
7 48448 tn. Moh. Umar 63 pamolokan
8 26414 ny. Siti rasmina 75 KT
9 28859 tn. Abdul rasyid 41 KB
10 48465 tn. Edy sucipto 48 pasongsongan
11 48458 nn. Anik sukmawati 17 tanjung
12 48462 tn. Aswatun 57 saronggi
13 15196 ny. Suriyatun 36 kalimook
14 48455 tn. Sud 55 lenteng
15 48445 tn. Sunahwan 51 talango
1/7/2019 1 48494 tn. Sadik 64 lenteng
2 48579 tn. Buhasan 45 batu dinding
3 27260 ny. Ernawati 51 rubaru
4 48513 an. Wulandari 14 talango
5 48480 tn. Zauri 52 ambunten
6 48496 tn. Mattali 42 talango
7 44365 tn. Mas'udi 61 talango
 8 ny. Kismaniyah 43 kalianget
9 48526 tn. Lutfiyadi 22 talango
10 21453 tn. Moh. Syahrawi 63 kalianget
11 39159 tn. Atlawan 57 talango
12 48578 tn. Khairil anwar 22 kebunagung
13 26289 ny. Nariya 44 dungkek
14 48481 tn. As'adi 40 pakandangan barat
15 10678 ny. Sifa 45 talango
16 44708 ny. Isnandani 31 talango
17 44708 ny. isnandani 31 talango
18 48480 tn. zauri 52 ambunten
19 48330 tn. Ali wafa 58 talango
20 30166 tn. Matrawi 51 KB
21 39159 tn. Atlawan 57 talango
22 48489 sdr. Aden aldian 14 batang-batang
23 48468 ny. Juwina 68 talango
24 48488 tn. Mu'awi 50 gapura
25 48503 an. Nadin putri 7 karang panasan
1/8/2019 1 48601 ny. Isnawati 37 nambakor
2 48554 tn. Syaiful bahri 73 gapura
3 48539 tn. Muawi 60 ganding
4 23092 ny. Selvi 30 pajagalan
5 48549 tn. Ru'am 50 bluto
6 48494 tn. sadik 65 lenteng
7 48589 an. Ratna Qolilah 10 talango
8 8144 ny. Satriyah 56 ambunten
9 48539 tn. muawi 60 ganding
10 25635 tn. Abd. Rahman 58 KB
1/9/2019 1 27137 ny. Henny 31 marengan
2 44003 tn. Ahmad qusairi 70 marengan
3 17158 tn. Mustamin 70 talango
4 48523 tn. Muallam 47 lenteng
5 19030 ny. Minati 75 KT
6 48540 tn. Suwongso 65 leggung
1/10/2019 1 48599 an. Moh. Indra maulana 10 marengan daya
2 44708 ny. Isnandani 31 talango
3 48600 tn. Amin jakfar 43 guluk-guluk
4 48545 by. Nabilatus 6bln bluto
5 48580 tn. M. latip 61 pasongsongan
6 48559 sdr. Jeny martian 28 KT
1/14/2018 1 48663 tn. Sareyadi 46 dungkek
2 48682 tn. Saleh 42 marengan
3 48652 tn. Moh. Adnan 54 pangarangan
4 44843 ny. Bumawiyah 61 padike
 5 48666 tn. Muhlis 50 batu putih
6 48682 tn. saleh 42 marengan
7 48665 tn. Asmoni 50 manding
8 48625 tn. Jumali 42 lenteng
9 48662 tn. Abdur rahman 55 karanganyar
10 48682 tn. saleh 42 marengan
11 42435 tn. Durrahem 50 kalianget
12 48573 tn. Mohabi 68 gapura
13 48646 ny. Almatun 60 marengan
14 48683 ny. Siti aisyah 62 kebunagung
1/15/2019 1 23871 ny. Siti saliha 45 nambakor
2 48696 ny. Nur Velina 26 pamolokan
3 48711 ny. Asmani 70 talango
4 48714 tn. Bualwi 61 batang-batang
5 48610 tn. Moh. Kandar 64 KT
6 48692 nn. Faikatul 17 kolor
7 48634 tn. Murahman 73 talango
8 48705 ny. Maswiya 50 gapura
9 48713 ny. Astina 52 talango
10 ny. Dika lusia musrifah 31 karduluk
11 48592 sdr. Ilza mahendra 15 gili raje
12 48702 tn. Abdul muhni 26 lenteng
13 48232 by. Siti herliani 7 bln talango
14 48712 ny. Faridah 72 pajagalan
1/17/2019 1 48739 ny. Salama 36 kalimook
2 48787 tn. saleh 64 marengan
3 48734 tn. H. zainal 80 talango
4 48730 tn. Syaifuddin 40 kolor
5 48665 tn. asmoni 46 manding
6 48724 tn. Zainal 50 talango
7 48327 tn. Atro 62 gili genting
8 43518 tn. H. ahmad 66 dungkek
9 48611 ny. Arthina 70 talango
10 32944 tn. Sinaruddin 70 lenteng
11 48690 nn. Waqiatur R 14 dungkek
12 48737 tn. Abd. Rahman 54 talango
1/21/2019 1 48849 ny. Sutina 36 marengan laok
2 48836 sdr. Isfaza 15 karangduak
3 48844 tn. Sahun 79 talango
4 30838 ny. Mu'tiyah 51 talango
5 48818 tn. Moh. Amin 63 batuan
6 48776 tn. Bambang utoyo 63 KB
7 48739 ny. salama 35 kalimook
8 48744 ny. Herlina 56 kebunagung
 9 48844 tn. sahun 79 talango
10 30838 ny. Mu'tiyah 51 talango
11 48839 ny. Hasana 25 talango
1/22/2018 1 48887 ny. Mahriya 75 talango
2 48739 ny. salama 36 kalimook
3 48862 tn. Sama'adin 89 talango
4 48880 ny. Buriya 50 saronggi
5 47573 tn. Maddarus 51 dasuk
6 488844 tn. sahun 79 talango
7 48866 tn. Hosen 79 batang-batang
8 24870 tn. Jazuli 45 lenteng
9 22004 ny. Astariyah 69 kertasada
10 48867 tn. Mahsuna 70 kertasada
11 48106 tn. Murkam 60 saronggi
1/23/2019 1 5746 tn. Miftahol rahman 33 Kolor
2 48911 tn. Muriken 76 guluk-guluk
3 48862 tn. Samaadin 89 talango
4 48870 sdr. Nur miftah 15 bangselok
5 48883 ny. Haini 44 dasuk
1/28/2019 1 48973 ny. Jumiati 33 saronggi
2 48883 ny. haini 43 dasuk
3 40675 ny. Misnati 66 KT
4 48960 tn. Samman 60 gili yang
5 48886 tn. Saturiman 50 KT
6 48929 tn. Sudarso 57 Karduluk
7 48961 ny. Sirriyah 21 gili yang
8 48922 tn. Sanin 68 saronggi
9 48662 tn. Abdur rahman 70 saronggi
10 42561 ny. Patmiya 65 gapura
11 48588 tn. Hammad 55 dungkek
12 48527 ny. Harya/ ny. Hasiyah 55 prenduan
13 49003 tn. Dilan 60 saronggi
14 8004 ny. Halima 64 KT
15 49009 tn. Mohammad saleh 60 talango
16 49002 ny. Erfa 67 ellak laok
17 25740 tn. Suriyanto 50 KT
18 49037 ny. Arnami 50 talango
1/29/2019 1 42561 ny. Fatmiyah 64 gapura
2 49037 ny. arnami 51 talango
3 36298 ny. Mamnunah 50 lenteng
4 49060 tn. Halim 46 kangayan
5 49050 ny. Naila 70 saronggi
6 48971 tn. Hasan 40 legung
7 49045 tn. Marsuto 59 kalimook
 8 49065 ny. Masruroh 30 guluk-guluk
9 49040 ny. Nadiya 60 KT
10 44024 tn. Sahwi 45 marengan laok
11 49025 tn. Purboyo 53 talango
12 49057 tn. Juhana 66 kertasada
13 5746 tn. Miftahol rahman 33 kolor
14 45481 by. Fariz S. 6 bln gapura
1/30/2019 1 47450 tn. Suhartono 63 kepanjin
2 49069 ny. Nur jannah 38 KT
3 48994 by. Ny. Halimatus 3 hari kalianget
4 48939 tn. Mathari 73 arjasa
5 49090 tn. Moda 72 langsar
1/31/2019 1 49103 ny. Madiya 55 gayam
2 49125 tn. Muhammad 60 kertasada
3 49116 tn. Musawi 70 guluk-guluk
4 49082 tn. Sujana 70 kertasada
5 49115 tn. Suwandi 37 talango
 Jl. Raya Kalianget No. 1
Kalianget- Sumenep - 69471
TeIp. [0328] 664350 , 667433, 661713
Fax. [0328] 667433
E-mail : rsi_garam@yahoo.co.id

AKAN

Tindakan Status Tarif Ket tgl periksa

usg abdomen umum Rp 82,500 ri 2
usg urologi bpjs Rp 82,500 ri 2
usg abdomen umum Rp 82,500 rj 2
usg abdomen bpjs Rp 82,500 ri 2
thorax bpjs Rp 16,450 ri 2
baca thorax umum Rp 16,450 ri 2
thorax bpjs Rp 16,450 ri 2
thorax bpjs Rp 16,450 ri 2
thorax bpjs Rp 16,450 ri 2
thorax bpjs Rp 16,450 ri 2
thorax bpjs Rp 16,450 ri 31
usg abdomen bpjs Rp 82,500 rj 3
usg mammae bpjs Rp 82,500 rj 3
usg abdomen umum Rp 82,500 ri 3
usg urologi umum Rp 82,500 ri 3
thorax umum Rp 16,450 ri 3
thorax bpjs Rp 16,450 rj 3
thorax umum Rp 16,450 ri 3
thorax bpjs Rp 16,450 ri 3
thorax bpjs Rp 16,450 rj 3
thorax bpjs Rp 16,450 ri 3
thorax bpjs Rp 16,450 ri 3
thorax bpjs Rp 16,450 ri 3
thorax bpjs Rp 16,450 ri 3
thorax bpjs Rp 16,450 ri 3
thorax umum Rp 16,450 rj 3
usg urologi umum Rp 82,500 rj 7
usg abdomen umum Rp 82,500 ri 7
usg urologi bpjs Rp 82,500 rj 7
usg abdomen umum Rp 82,500 rj 7
usg urologi bpjs Rp 82,500 ri 7
usg testis umum Rp 82,500 ri 7
usg soft tissue umum Rp 82,500 ri 7
usg abdomen bpjs Rp 82,500 rj 7
usg soft tissue bpjs Rp 82,500 rj 7
usg urologi bpjs Rp 82,500 ri 7
usg abdomen umum Rp 82,500 ri 7
thorax umum Rp 16,450 rj 7
thorax umum Rp 16,450 ri 7
thorax umum Rp 16,450 rj 4
antebrachii umum Rp 20,250 rj 7
thorax umum Rp 16,450 ri 7
BOF umum Rp 16,875 ri
BOF bpjs Rp 16,875 ri 7
thorax umum Rp 16,450 rj 28-Dec
thorax bpjs Rp 16,450 ri 6
thorax umum Rp 16,450 ri
thorax umum Rp 16,450 ri 5
thorax umum Rp 16,450 ri 3
thorax umum Rp 16,450 ri 4
skull ap/lat umum Rp 20,250 ri 6
usg mammae bpjs Rp 82,500 rj 8
usg urologi umum Rp 82,500 ri 8
usg urologi bpjs Rp 82,500 ri 8
usg urologi bpjs Rp 82,500 rj 8
thorax bpjs Rp 16,450 ri 7
thorax umum Rp 16,450 ri 8
thorax umum Rp 16,450 8
pedis ap/ob bpjs Rp 20,250 rj 8
thorax bpjs Rp 16,450 ri 8
pedis ap/ob bpjs Rp 20,250 ri 8
usg obstetri bpjs Rp 82,500 ri 9
thorax bpjs Rp 16,450 ri 4
thorax bpjs Rp 16,450 ri 9
thorax bpjs Rp 16,450 ri 9
thorax bpjs Rp 16,450 ri 8
thorax bpjs Rp 16,450 ri 8
usg abdomen umum Rp 82,500 rj 10
usg abdomen bpjs Rp 82,500 ri 10
thorax bpjs Rp 16,450 ri 10
thorax umum Rp 16,450 ri 9
baca thorax umum Rp 16,450 ri 10
thorax umum Rp 16,450 rj 9
usg testis bpjs Rp 82,500 ri 14
usg testis bpjs Rp 82,500 rj 14
usg thyroid umum Rp 82,500 ri 14
usg abdomen umum Rp 82,500 rj 14
 usg urologi umum Rp 82,500 ri 14
BOF bpjs Rp 16,875 rj 14
BOF umum Rp 16,875 ri 13
colon in loop umum Rp 162,000 ri 14
thorax umum Rp 16,450 ri 13
thorax bpjs Rp 16,450 ri 14
thorax bpjs Rp 16,450 ri 14
thorax bpjs Rp 16,450 ri 9
thorax bpjs Rp 16,450 ri 12
thorax bpjs Rp 16,450 ri 14
usg urologi bpjs Rp 82,500 rj 15
usg abdomen umum Rp 82,500 ri 15
usg abdomen umum Rp 82,500 rj 15
thorax umum Rp 16,450 rj 15
genu ap/lat bpjs Rp 20,250 ri 15
thorax umum Rp 16,450 ri 15
thorax bpjs Rp 16,450 ri 15
thorax umum Rp 16,450 ri 15
thorax umum Rp 16,450 rj 15
thorax umum Rp 16,450 rj 15
thorax bpjs Rp 16,450 ri 15
thorax bpjs Rp 16,450 ri 15
thorax umum Rp 16,450 ri 15
thorax bpjs Rp 16,450 rj 15
usg ginekologi bpjs Rp 82,500 ri 17
usg urologi bpjs Rp 82,500 rj 17
usg urologi umum Rp 82,500 ri 17
usg abdomen bpjs Rp 82,500 ri 17
usg abdomen umum Rp 82,500 ri 17
thorax bpjs Rp 16,450 ri 16
thorax bpjs Rp 16,450 ri 4
thorax bpjs Rp 16,450 ri 17
thorax umum Rp 16,450 ri 16
thorax bpjs Rp 16,450 ri 17
thorax umum Rp 16,450 ri 17
thorax umum Rp 16,450 ri 17
usg obstetri bpjs Rp 82,500 ri 21
usg abdomen umum Rp 82,500 ri 21
usg soft tissue bpjs Rp 82,500 rj 21
usg abdomen bpjs Rp 82,500 rj 21
usg urologi bpjs Rp 82,500 ri 21
usg urologi bpjs Rp 82,500 rj 21
thorax bpjs Rp 16,450 ri 21
thorax umum Rp 16,450 ri 20
 manus ap/ob bpjs Rp 20,250 rj 21
thorax bpjs Rp 16,450 rj 21
thorax umum Rp 16,450 ri 20
usg abdomen umum Rp 82,500 rj 22
usg thorax bpjs Rp 82,500 ri 22
baca thorax bpjs Rp 16,450 ri 22
thorax bpjs Rp 16,450 ri 22
thorax bpjs Rp 16,450 ri 10
thorax bpjs Rp 16,450 ri 22
thorax bpjs Rp 16,450 ri 21
thorax umum Rp 16,450 ri 21
thorax bpjs Rp 16,450 ri 21
thorax bpjs Rp 16,450 ri 21
thorax umum Rp 16,450 rj 22
usg soft tissue bpjs Rp 82,500 rj 23
usg urologi bpjs Rp 82,500 rj 23
usg urologi bpjs Rp 82,500 ri 23
thorax bpjs Rp 16,450 ri 23
thorax bpjs Rp 16,450 ri 22
usg abdomen bpjs Rp 82,500 ri 28
usg abdomen bpjs Rp 82,500 ri 28
thorax bpjs Rp 16,450 ri 23
thorax bpjs Rp 16,450 ri 25
thorax bpjs Rp 16,450 ri 24
thorax umum Rp 16,450 ri 23
thorax umum Rp 16,450 ri 25
thorax bpjs Rp 16,450 ri 23
thorax umum Rp 16,450 ri 25
thorax umum Rp 16,450 ri 26
thorax bpjs Rp 16,450 ri 8
thorax bpjs Rp 16,450 ri 8
thorax umum Rp 16,450 ri 28
thorax bpjs Rp 16,450 ri 26
thorax bpjs Rp 16,450 ri 28
thorax umum Rp 16,450 ri 28
thorax bpjs Rp 16,450 ri 28
ls ap/lat umum Rp 20,250 ri 28
usg abdomen umum Rp 82,500 ri 29
usg abdomen umum Rp 82,500 ri 29
usg urologi bpjs Rp 82,500 ri 29
usg urologi umum Rp 82,500 ri 29
thorax umum Rp 16,450 ri 28
baca thorax bpjs Rp 16,450 ri 29
thorax bpjs Rp 16,450 ri 29
 thorax bpjs Rp 16,450 rj 29
thorax umum Rp 16,450 ri 28
thorax bpjs Rp 16,450 ri 29
thorax bpjs Rp 16,450 ri 29
thorax bpjs Rp 16,450 ri 29
thorax bpjs Rp 16,450 ri 29
thorax bpjs Rp 16,450 ri 28
thorax bpjs Rp 16,450 ri 30
thorax bpjs Rp 16,450 ri 30
thorax umum Rp 16,450 ri 29
genu ap/lat umum Rp 20,250 rj 30
thorax umum Rp 16,450 rj 30
usg abdomen umum Rp 82,500 ri 31
usg urologi umum Rp 82,500 rj 31
thorax bpjs Rp 16,450 ri 31
thorax bpjs Rp 16,450 ri 31
thorax bpjs Rp 16,450 ri 31
 J
Yarisga Kalianget Kalian
TeIp. [0328] 664
RSI Garam Kalianget E-mail : r
Ramah, Senyum, Ikhlas, Ghirah & Kekeluargaan

DAFTAR JASA PELAYANAN TINDAKAN

SPESIALIS RADIOLOGI
( CITO / On Call )
Dec-18

TGL NO REG NAMA PASIEN UMUR ALAMAT

1/12/2019 1 48580 tn. Moh. Latip 62 pasongsongan

2 31445 tn. Misraya 80 dasuk
3 46087 tn. Akh. Effendi 54 dasuk
4 48642 sdr. Hidayat rahman 20 karang anyar
5 48570 tn. Anwari 42 lenteng
6 48625 tn. Jumali 42 lenteng
7 48631 tn. Sunandar 45 nambakor
8 48533 an. Ainur fatimah 2hari talango
9 614 tn. Ismail 49 KB
10 48626 an. Moh. Zafran ali 3 dungkek
11 48565 an. Dzaki ibadur 15 bln lenteng
12 47752 ny. Buhami 56 gapura
13 48621 nn. Musdalifah 24 lenteng
14 48536 ny. Nurul aini 56 batu putih
15 48607 ny. Martiyani 62 gapura
16 48632 tn. Uwi 60 pajegungan
17 31445 tn. Misraye 80 dasuk
18 48625 tn. jumali 42 lenteng
1/19/2019 1 48802 ny. Asrima 46 gapura
2 48755 ny. Endang rustiyana 21 marengan laok
3 48768 tn. Sukran 55 dungkek
4 48822 an. Nur alam 7 KB
5 48796 ny. Nur sofiah 26 manding
6 48794 ny. Eka cahyaningrum 23 KT
7 48806 tn. Munamin 67 KB
8 48741 an. Aulian 28bln bluto
9 48818 tn. Moh. Amin effendi 63 batuan
10 38100 tn. Didik susanto 32 KB
11 32264 tn. Ahmad 60 KB
12 48798 ny. Surima 55 dasuk
13 40545 tn. Moh. Idris 64 pasongsongan
14 48662 tn. Abdur rahman 55 karang anyar
15 28705 ny. Siti nur 35 lenteng
16 48761 ny. Ruhani 58 KB
 Jl. Raya Kalianget No. 1
Kalianget- Sumenep - 69471
TeIp. [0328] 664350 , 667433, 661713
Fax. [0328] 667433
E-mail : rsi_garam@yahoo.co.id

N TINDAKAN
OGI
)

TINDAKAN STATUS TARIF KET tgl periksa

usg abdomen umum Rp 123,700 ri 12

usg abdomen bpjs Rp 123,700 ri 12
usg abdomen umum Rp 123,700 ri 12
usg soft tissue umum Rp 123,700 rj 12
usg abdomen bpjs Rp 123,700 ri 12
usg abdomen umum Rp 123,700 ri 12
usg urologi bpjs Rp 123,700 ri 12
BOF-LLD bpjs Rp 20,250 ri 11
thorax PT. Garam Rp 16,450 ri 12
thorax umum Rp 16,450 ri 11
thorax umum Rp 16,450 ri 11
thorax bpjs Rp 16,450 ri 11
thorax bpjs Rp 16,450 ri 11
thorax umum Rp 16,450 ri 11
thorax umum Rp 16,450 ri 11
thorax bpjs Rp 16,450 ri 11
thorax bpjs Rp 16,450 ri 11
BOF umum Rp 16,875 ri 11
usg obstetri bpjs Rp 123,700 ri 19
usg obstetri bpjs Rp 123,700 ri 19
usg marker hepar umum Rp 123,700 ri 19
usg abdomen bpjs Rp 123,700 rj 19
usg obstetri bpjs Rp 123,700 ri 19
usg obstetri umum Rp 123,700 ri 19
usg urologi bpjs Rp 123,700 ri 19
thorax umum Rp 16,450 ri 19
thorax bpjs Rp 16,450 ri 19
thorax bpjs Rp 16,450 ri 18
thorax bpjs Rp 16,450 ri 18
TL ap/lat bpjs Rp 20,250 ri 18
thorax umum Rp 16,450 ri 19
thorax umum Rp 16,450 ri 18
thorax bpjs Rp 16,450 ri 16
genu D, S ap/lat umum Rp 40,500 rj 17
 Jl.
Yarisga Kalianget Kaliange
TeIp. [0328] 6643
RSI Garam Kalianget E-mail : rsi
Ramah, Senyum, Ikhlas, Ghirah & Kekeluargaan

DAFTAR JASA PELAYANAN TINDAKAN

SPESIALIS RADIOLOGI
SESUAI JADWAL PRAKTEK
Feb-19
Tgl No. No. Reg Nama Pasien Umur Alamat Tindakan
2/4/2019 1 49219 tn. Santoso 45 bluto usg abdomen
2 49219 tn. Santoso 45 bluto BOF, LLD
3 40460 tn. Makki 63 talango thorax
4 48157 tn. Misnaya 62 KB thorax
5 49199 ny. Nursiyatun 57 rubaru thorax
6 47314 ny. Sri hartutik 58 saronggi thorax
7 49127 tn. Masrafik 50 saroka pedis ap/ob
8 895 nn. Devy verliantina 34 KT skull ap/lat
9 49151 tn. Nurul wardi 54 lalangon thorax
10 10116 ny. Sumariyani 61 KB thorax
11 49120 ny. Misnaya 65 dasuk thorax
12 49120 ny. misnaya 65 dasuk thorax
13 49148 tn. Ruhan 70 batu putih thorax
14 49180 tn. Santawi 60 talango thorax
15 49132 tn. Duge' 45 saronggi thorax
16 29549 tn. Surabi 55 talango thorax
2/6/2019 1 49258 ny. Suwarsik 50 talango usg thyroid
2 11498 ny. Siti aminah 50 KB usg urologi
3 49262 tn. Asit 65 talango TL ap/lat
4 49262 tn. asit 65 talango thorax
5 49264 tn. Bawi 60 bluto thorax
6 49127 tn. masrafik 50 saronggi thorax
7 49223 tn. Moh ali 58 talango thorax
8 49240 ny. Halima 66 bangselok thorax
9 49252 ny. Badriyah 49 sepudi thorax
10 49231 ny. Maimunah 60 kacongan thorax
11 49251 tn. Ahmad muhammad 46 KB thorax
2/7/2019 1 49261 tn. Ainur 36 gapura usg abdomen
2 49294 tn. Matlabi 76 kebunan usg colli
3 49199 ny. Nursiyatun 74 rubaru usg abdomen
4 48768 tn. Sukron 55 dungkek usg abdomen
5 49225 ny. Annawiyah 47 gili genting thorax
 6 49294 tn. Matlabi 76 kebunan thorax
7 49295 tn. Miskawan 50 KT thorax
8 34141 tn. Mat dahri 60 talango thorax
9 49078 ny. Nurhayati 55 bangselok thorax
10 49269 tn. Sumahmo 69 batang2 thorax
11 49277 tn. Roghibin 75 pasongsongan thorax
12 49290 tn. Nawari 60 talango thorax
13 49282 by. Ferdiansyah R 8 bln lenteng thorax
14 49266 tn. Masper 68 talango thorax
15 49237 ny. Su'udiyah 67 KB thorax
16 35322 tn. Tahiruddin 61 pabian thorax
17 35322 tn. Tahiruddin 61 pabian pedis ap/ob
2/11/2019 1 42086 tn. Abu yasid 62 saronggi usg abdomen
2 49388 tn. Abdul Rakhim 64 KB usg urologi
3 39142 an. Ainur taufiqurrahman 12 parsanga usg abdomen
4 49320 tn. Mad dahlan 51 talango usg abdomen
5 41657 tn. Miftahor rahman 31 KB usg soft tissue
6 49396 tn. Waris 38 lenteng thorax
7 49335 an. Izul 22 bln lenteng thorax
8 24923 ny. Rumina 60 marengan laok thorax
9 49320 tn. Mad dahlan 51 talango thorax
10 49305 tn. Zakariya 65 gapura thorax
11 13758 tn. Asmoni 61 legung timur thorax
12 49337 tn. Safrawi 65 dasuk thorax
13 49300 tn. Hoda'i 60 batuan thorax
14 32988 tn. Asbu 40 talango thorax
15 49390 tn. H. moh. Anwar 60 masalembu thorax
16 49321 ny. Nurhasanah 50 KT thorax
2/12/2019 1 40291 tn. Hendra irawan 29 pabian usg abdomen
2 48832 ny. Satriyani 49 parsanga usg abdomen
3 49367 sdr. Naufal 14 bekasi utara thorax
4 41657 tn. Miftahor rahman 31 KB thorax
5 49410 ny. Puzaimah 43 dungkek thorax
6 49415 an. Siti mufida 2 dasuk thorax
7 41963 tn. Aliman 40 gili genting thorax
8 49393 tn. Surain 75 guluk2 thorax
9 49418 sdr. Zainal faizin 20 ambunten thorax
10 49401 an. Mauludul 1 marengan thorax
11 49365 an. Aditya hidayah 1 marengan thorax
2/14/2019 1 49472 ny. Anni maftuhah 28 baban usg mammae
2 40934 tn. Hisbul wathoni 44 KT usg abdomen
 3 49161 tn. Moh. Syahrawi 70 sapeken usg urologi
4 49468 tn. Abd majid 59 kertasada thorax
5 44463 ny. Sahriyani 46 KT thorax
6 49482 tn. Sai 63 KT thorax
7 5809 ny. Helen 56 kalianget thorax
8 49434 tn. Hamsin 70 talango thorax
9 49430 tn. Jaelani 60 sepudi thorax
10 26150 tn. Mu'arom 70 talango thorax
11 49106 ny. Marpu'a 61 saronggi thorax
12 49467 tn. Morahna 65 batang2 thorax
13 49422 tn. Sahawi 63 gili raje thorax
14 49464 ny. Wahida 50 kalimook thorax
2/18/2018 1 46973 tn. Samin 52 nambakor usg abdomen
2 49560 tn. Jumahwi 55 talango usg urologi
3 49552 ny. Lutfiani 32 batuan usg abdomen
4 32885 ny. Tussiya 54 marengan laok usg urologi
5 49560 tn. Jumahwi 55 talango uretrografi
6 31933 ny. Aisyah dwiyani 40 kertasada BOF, LLD
7 49530 tn. M. syarif 27 karduluk skull ap/lat
8 49579 ny. Lilik endang 58 ambunten LS ap/lat
9 39680 ny. Ainul wardah 48 KT thorax
10 49466 by. Ny. Eka 1 hari kebunan thorax
12 46973 tn. samin 52 nambakor thorax
13 49535 tn. Syamsudin 54 lenteng timur thorax
14 10969 sdr. Andi sucipto 30 KB thorax
15 7159 tn. Bunasa 59 KT thorax
16 49516 ny. Sutiyem 77 ganding thorax
17 49460 ny. Kuntiya 63 gapura thorax
18 7722 ny. Farida 34 pabian thorax
19 49496 ny. Sanawiya 40 talango thorax
20 49580 tn. Alibuddin 70 talango thorax
2/19/2019 1 49600 tn. M. hasibun 64 batang2 usg abdomen
2 49504 tn. Rihwan 65 talango usg abdomen
3 49606 tn. Musyahnan 64 gayam usg soft tissue
4 49569 an. Adelia 1 KB thorax
5 44195 an. Nabila 9 bln KB thorax
6 35700 an. Ahmad alfin 7 talango thorax
7 49519 an. Athallah 1 saronggi thorax
8 49575 tn. Syafiuddin 49 kalimook thorax
9 49606 tn. musyahnan 62 gayam thorax
10 49612 tn. Mahwi 47 talango thorax
 11 49593 tn. Abd. Rakip 58 ganding thorax
12 25124 tn. Saleh achmad 75 kalimook thorax
13 49565 ny. Hatija 72 kalimook thorax
14 49600 tn. M. hasibun 64 batang2 thorax
15 49561 ny. Mulyati 65 kepanjin thorax
16 49552 ny. Lutfiani 32 patean thorax
17 49264 tn. bawi 61 bluto thorax
2/20/2019 1 49630 tn. Bura'i 58 padike usg abdomen
2 49646 ny. Siti aisyah 30 KB usg obstetri
3 16835 ny. Mufahiroh 38 KB usg urologi
4 49624 ny. Nur hasanah 36 marengan laok usg obstetri
5 49628 tn. Erfandi 45 kacongan thorax
6 43448 ny. Zaima 53 batu putih thorax
7 49619 by. Arreta ayu D 6 bln batang2 thorax
8 49604 tn. erfandi 60 pamolokan thorax
9 22997 tn. Ismail 54 karang anyar thorax
10 49601 tn. Sahru efendi 44 dasuk thorax
11 48777 tn. Moh. Zaini 25 talango thorax
12 49649 ny. Hairiyah 75 batu putih thorax
2/21/2019 1 21341 ny. Yuni 36 pandian usg abdomen
2 49680 ny. Nurdiana 19 talango usg obstetri
3 49683 tn. H. yusup 82 ambunten thorax
4 46477 ny. Afiyah 70 pabian thorax
5 49673 an. Ahmad zaqy 3 pandian thorax
6 49657 ny. Juma'ani 27 lenteng timur thorax
7 49630 tn. Bura'i 57 talango thorax
8 49521 tn. Muja'is 65 KT thorax
9 49639 ny. Masrima 59 pasongsongan thorax
10 49675 tn. M. hasib 53 dasuk thorax
2/26/2019 1 39456 ny. Siti aminah 38 poreh usg abdomen
2 49818 ny. Asriyani 43 KT usg mammae
3 34024 tn. Jahrawi 64 marengan usg urologi
4 49763 tn. Ali 33 raas usg abdomen
5 49793 tn. Wahet 45 gili raje thorax
6 49731 tn. Ahmad mudawi 47 lenteng thorax
7 49713 tn.misra 80 gapura thorax
8 49808 ny. Mahlamah 50 masalembu thorax
9 49783 nn. Dinda 14 sumenep BOF, LLD
10 49809 ny. Maskiye 70 saronggi thorax
11 49780 tn. Mohammad halil 47 ambunten thorax
12 49753 ny. Hastutik 60 sumenep thorax
 13 14937 tn. Isnin 50 KT thorax
2/27/2019 1 39258 ny. Mufidatun 24 marengan usg colli
2 27884 ny. Siti airiya 58 KT thorax
3 49817 tn. Agus maulidi 37 bangkal usg abdomen
4 49817 tn. Agus maulidi 37 bangkal baca thorax
5 49821 ny. Samiatun 45 KT usg abdomen
6 24242 tn. Ahmad nurul fatah 52 marengan thorax
2/28/2019 1 49884 ny. Hj. Mutmainnah 52 dasuk usg abdomen
2 22351 ny. Sukawati 60 KT usg abdomen
3 33642 tn. Marsuki 73 KB usg abdomen
4 49862 tn. Busamin 52 talango usg abdomen
5 49869 tn. Dulhadi 81 batuan usg abdomen
6 34024 tn. jahrawi 64 marengan daya thorax
7 49872 tn. Etto 67 talango thorax
8 19255 ny. Ulfa yuliana 28 KB thorax
9 49874 tn. Nali 56 dasuk thorax
10 49861 tn. Abd. Kawi 48 rubaru thorax
11 49884 ny. Hj. Mutmainnah 52 dasuk BOF
12 49882 ny. Dwi yani 63 kolor thorax
13 26970 ny. Ining 32 KT thorax
14 44708 ny. Isnandani 31 talango thorax
15 49854 ny. Siyam 49 ganding thorax
16 49844 ny. Muzayyanah 33 ambunten thorax
17 30596 tn. Hawiyanto 52 KB thorax
18 47880 tn. Moh. Hosen 54 KB thorax
19 33355 ny. Risnawati 32 kalianget thorax
20 49854 ny. siyam 49 ganding pedis ap/ob
21 49860 an. Revino 8 KB thorax
 Jl. Raya Kalianget No. 1
Kalianget- Sumenep - 69471
TeIp. [0328] 664350 , 667433, 661713
Fax. [0328] 667433
E-mail : rsi_garam@yahoo.co.id

Status Tarif Ket tgl periksa

bpjs Rp 82,500 ri 4
bpjs Rp 20,250 ri 4
bpjs Rp 16,450 ri 30
bpjs Rp 16,450 ri 2
bpjs Rp 16,450 ri 3
bpjs Rp 16,450 ri 2
bpjs Rp 20,250 ri 4
umum Rp 31,500 ri 2
bpjs Rp 16,450 ri 1
bpjs Rp 16,450 ri 3
umum Rp 16,450 ri 31
umum Rp 16,450 ri 1
umum Rp 16,450 ri 1
bpjs Rp 16,450 ri 2
bpjs Rp 16,450 ri 31
bpjs Rp 16,450 ri 4
bpjs Rp 82,500 rj 6
umum Rp 82,500 rj 6
umum Rp 20,250 ri 6
umum Rp 16,450 ri 6
umum Rp 16,450 ri 6
bpjs Rp 16,450 ri 6
bpjs Rp 16,450 ri 6
bpjs Rp 16,450 ri 6
umum Rp 16,450 ri 5
bpjs Rp 16,450 ri 4
bpjs Rp 16,450 ri 5
umum Rp 82,500 ri 7
bpjs Rp 82,500 rj 7
bpjs Rp 82,500 ri 7
umum Rp 82,500 rj 7
bpjs Rp 16,450 ri 4 marwah
bpjs Rp 16,450 rj 7
bpjs Rp 16,450 rj 7
umum Rp 16,450 ri 7
bpjs Rp 16,450 ri 6
bpjs Rp 16,450 ri 6
bpjs Rp 16,450 ri 6
bpjs Rp 16,450 ri 7
bpjs Rp 16,450 ri 7
umum Rp 16,450 ri 7
bpjs Rp 16,450 ri 7
bpjs Rp 16,450 ri 7
bpjs Rp 20,250 ri 7
bpjs Rp 82,500 ri 11
umum Rp 82,500 rj 11
bpjs Rp 82,500 ri 11
umum Rp 82,500 ri 11
bpjs Rp 82,500 rj 11
umum Rp 16,450 rj 11
umum Rp 16,450 ri 9
bpjs Rp 16,450 ri 8
umum Rp 16,450 ri 8
bpjs Rp 16,450 ri 7
kis Rp 16,450 ri 10
umum Rp 16,450 ri 9
bpjs Rp 16,450 ri 7
bpjs Rp 16,450 ri 7
umum Rp 16,450 ri 11
bpjs Rp 16,450 ri 8
bpjs Rp 82,500 ri 12
umum Rp 82,500 rj 12
bpjs Rp 16,450 ri 12
bpjs Rp 16,450 ri 12
bpjs Rp 16,450 ri 11
bpjs Rp 16,450 ri 12
bpjs Rp 16,450 ri 12
bpjs Rp 16,450 ri 12
bpjs Rp 16,450 ri 12
bpjs Rp 16,450 ri 12
bpjs Rp 16,450 ri 12
bpjs Rp 82,500 rj 14
umum Rp 82,500 rj 14
bpjs Rp 82,500 rj 14
bpjs Rp 16,450 rj 14
bpjs Rp 16,450 rj 14
bpjs Rp 16,450 rj 14
bpjs Rp 16,450 ri 12
umum Rp 16,450 ri 12
umum Rp 16,450 ri 12
bpjs Rp 16,450 ri 14
bpjs Rp 16,450 ri 1 marwah
bpjs Rp 16,450 ri 14
bpjs Rp 16,450 ri 12
umum Rp 16,450 ri 14
bpjs Rp 82,500 ri 18
bpjs Rp 82,500 ri 18
umum Rp 82,500 ri 18
bpjs Rp 82,500 ri 18
bpjs Rp 162,000 ri 18
bpjs Rp 20,250 ri 18
umum Rp 31,500 ri 16
bpjs Rp 20,250 rj 18
bpjs Rp 16,450 ri 16
bpjs Rp 16,450 ri 14
bpjs Rp 16,450 ri 18
bpjs Rp 16,450 ri 17
bpjs Rp 16,450 ri 15
bpjs Rp 16,450 ri 15
bpjs Rp 16,450 ri 15
umum Rp 16,450 ri 15
bpjs Rp 16,450 ri 17
umum Rp 16,450 ri 15
umum Rp 16,450 ri 18
bpjs Rp 82,500 ri 19
umum Rp 82,500 rj 19
bpjs Rp 82,500 ri 19
umum Rp 16,450 ri 19
bpjs Rp 16,450 ri 19
umum Rp 16,450 ri 19
bpjs Rp 16,450 ri 19
bpjs Rp 16,450 ri 19
bpjs Rp 16,450 ri 19
bpjs Rp 16,450 ri 19
bpjs Rp 16,450 ri 18
bpjs Rp 16,450 ri 18
umum Rp 16,450 ri 19
bpjs Rp 16,450 ri 19
bpjs Rp 16,450 ri 18
bpjs Rp 16,450 ri 19
bpjs Rp 16,450 ri 19
umum Rp 82,500 ri 20
umum Rp 82,500 ri 20
bpjs Rp 82,500 ri 20
bpjs Rp 82,500 ri 20
umum Rp 16,450 ri 19
umum Rp 16,450 ri 17 marwah
umum Rp 16,450 ri 18
umum Rp 16,450 ri 20
bpjs Rp 16,450 ri 20
bpjs Rp 16,450 ri 20
umum Rp 16,450 ri 20
umum Rp 16,450 ri 20
umum Rp 82,500 ri 21
umum Rp 82,500 ri 21
umum Rp 16,450 ri 21
umum Rp 16,450 ri 21
umum Rp 16,450 ri 21
bpjs Rp 16,450 ri 20
umum Rp 16,450 ri 21
bpjs Rp 16,450 ri 16 arofah
bpjs Rp 16,450 ri 21
bpjs Rp 16,450 ri 21
bpjs Rp 82,500 ri 26
bpjs Rp 82,500 rj 26
bpjs Rp 82,500 rj 26
umum Rp 82,500 ri 26
bpjs Rp 16,450 ri 25
bpjs Rp 16,450 ri 23
bpjs Rp 16,450 ri 26
bpjs Rp 16,450 ri 25
umum Rp 20,250 ri 24
umum Rp 16,450 ri 25
bpjs Rp 16,450 rj 24
bpjs Rp 16,450 ri 23
umum Rp 16,450 ri 24
umum Rp 82,500 rj 27
umum Rp 16,450 rj 15
bpjs Rp 82,500 ri 27
bpjs Rp 16,450 ri 27
bpjs Rp 82,500 rj 27
bpjs Rp 16,450 ri 26
bpjs Rp 82,500 ri 28
bpjs Rp 82,500 ri 28
bpjs Rp 82,500 rj 28
umum Rp 82,500 ri 28
umum Rp 82,500 ri 28
bpjs Rp 16,450 ri 28
umum Rp 16,450 ri 28
bpjs Rp 16,450 ri 24
bpjs Rp 16,450 ri 28
bpjs Rp 16,450 ri 27
bpjs Rp 16,875 ri 28
bpjs Rp 16,450 ri 28
bpjs Rp 16,450 ri 27
bpjs Rp 16,450 ri 28
bpjs Rp 16,450 ri 28
bpjs Rp 16,450 ri 28
bpjs Rp 16,450 rj 28
bpjs Rp 16,450 rj 28
bpjs Rp 16,450 ri 28
bpjs Rp 20,250 ri 28
bpjs Rp 16,450 ri 28
 J
Yarisga Kalianget Kalian
TeIp. [0328] 664
RSI Garam Kalianget E-mail : r
Ramah, Senyum, Ikhlas, Ghirah & Kekeluargaan

DAFTAR JASA PELAYANAN TINDAKAN

SPESIALIS RADIOLOGI
( CITO / On Call )
TGL NO REG NAMA PASIEN UMUR ALAMAT
2/23/2018 1 49685 ny. Mas'odah 57 ambunten timur
2 49740 tn. Ahmad sauki 26 gapura
3 19503 sdr. Moh. Heru sulung 19 KB
4 49666 tn. Omra 48 ganding
5 49740 tn. Ahmad sauki 26 gapura
6 49652 tn. Sutoyo 65 tanjung saronggi
7 40060 tn. Masdawi 64 manding
8 7035 nn. Puja 20 KT
9 36162 tn. Rahmo 60 saronggi
10 7304 tn. Sahrawi 66 KT
11 49729 tn. Jatim 65 pinggir papas
12 24107 ny. Mardiyani 57 KT
13 49655 tn. Jusup 67 batu putih
14 49706 ny. Moariya 53 gayam
15 49710 ny. Sunami 70 talango
16 49663 ny. Bunisa 65 gung-gung
17 49739 tn. Ahmad 70 ambunten
18 49702 tn. Ahmad salim 42 saronggi
19 49505 an. Alfin saukir 3 talango
 Jl. Raya Kalianget No. 1
Kalianget- Sumenep - 69471
TeIp. [0328] 664350 , 667433, 661713
Fax. [0328] 667433
E-mail : rsi_garam@yahoo.co.id

N TINDAKAN
LOGI
l)
TINDAKAN STATUS TARIF KET tgl periksa
usg abdomen bpjs Rp 123,700 ri 23
usg thorax umum Rp 123,700 ri 23
usg soft tissu umum Rp 123,700 rj 23
usg abdomen umum Rp 123,700 ri 23
baca thorax umum Rp 16,450 ri 23
usg abdomen bpjs Rp 123,700 ri 23
thorax bpjs Rp 16,450 ri 22
thorax umum Rp 16,450 ri 22
thorax umum Rp 16,450 ri 22
thorax bpjs Rp 16,450 ri 22
thorax bpjs Rp 16,450 ri 22
thorax bpjs Rp 16,450 ri 23
thorax bpjs Rp 16,450 ri 22
thorax umum Rp 16,450 ri 23
thorax umum Rp 16,450 ri 22
thorax umum Rp 16,450 ri 20 marwah
thorax bpjs Rp 16,450 ri 22
thorax umum Rp 16,450 ri 22
thorax umum Rp 16,450 ri 15 arofah anak
 Yarisga Kalianget Kalia
TeIp. [0328] 66
RSI Garam Kalianget E-mail :
Ramah, Senyum, Ikhlas, Ghirah & Kekeluargaan

DAFTAR JASA PELAYANAN TINDAKAN

SPESIALIS RADIOLOGI
SESUAI JADWAL PRAKTEK
Mar-19
Tgl No. No. Reg Nama Pasien Umur Alamat
2/4/2019 1 47131 tn. Sawi 55 dungkek
2 49978 tn. Imam sugianto 36 marengan daya
3 49968 ny. Hamidi 51 arjasa
4 49972 tn. Febrianto tio 20 KB
5 49916 ny. Hanifa 60 gili genting
6 49940 ny. Sariyama 68 KT
7 17354 ny. Dude liani J 27 karang panasan
8 49977 tn. Awin 47 gili genting
9 43032 an. Moh. Asyraf 1 gapura
10 49875 tn. Hayak 65 talango
11 49875 tn. Hayak 65 talango
12 49967 tn. Jirto 44 talango
13 49916 ny. hanifa 60 gili genting
14 49930 tn. Ismail 58 pasongsongan
15 48059 tn. H. marsuki 68 salopeng
16 48059 tn. Salamet 65 parsanga
17 49933 tn. Moh. Habib 57 kepanjin
18 5468 ny. Maskiya 72 KT
19 49931 tn. Maski 50 babbalan
20 49927 tn. Zainal 68 lenteng
21 20677 tn. Bunawi 55 KT
22 49926 nn. Masri'ah 14 karang nangka
23 16921 ny. Hidayati 46 KB
24 20997 ny. Fitriyah 32 parsanga
3/5/2019 1 49995 ny. Jannatin 45 bluto
2 49993 tn. Enno 42 talango
3 47768 ny. Masrifah 81 gapura
4 49711 ny. Kiki veronica 25 KT
5 49884 ny. Mutmainnah 56 dasuk
6 49990 tn. Nurul sahyudi 35 talango
7 49528 ny. Suwarni 71 pandian
8 33727 ny. Siti aisyah 57 kebunan
9 49987 by. Nafisyah 3 bln padike
10 48059 tn. Marsuki 68 ambunten
11 49972 tn. Febrianto 21 KB
 12 49876 tn. Matrawi 66 KB
13 49528 ny. Suwarni 71 pandian
14 47131 tn. sawi 55 dungkek
15 49968 ny. hamidi 51 kangean
16 16921 an. Ayatussyifa 9 KB
3/6/2019 1 50003 ny. Siti hasanah 49 sapeken
2 50020 ny. Iklil halilah 20 kangean
3 50015 an. Reihan 7 bln daramista
4 47148 ny. Mulyana 50 pajagalan
5 24220 tn. Samsuni 50 karanganyar
6 16921 ny. hidayati 47 KB
7 50019 ny. Ani warsih 44 KT
8 50006 tn. Sahnoki 70 talango
9 50001 ny. Hafia 75 pamolokan
3/11/2019 1 30062 ny. Karima 50 kalianget
2 50070 tn. Asitur rahman 28 talango
3 50030 tn. Achmad febriyanto 30 KT
4 50106 ny. Istik nurhayati 50 ambunten
5 50132 tn. Moh. Sjarif 84 bluto
6 50096 tn. Sundari 55 talango
3/13/2019 1 45469 tn. Kamaruddin 59 kalianget
2 50112 ny. Hesti 30 pajagalan
3 50186 tn. Herman wahyudi 32 sepudi
4 50186 tn. Herman wahyudi 32 sepudi
5 50149 tn. Ibrahim 64 karanganyar
6 50173 ny. Sunami 70 talango
7 43253 tn. Sa'i 65 talango
8 47471 tn. Sahirullah 70 talango
9 50144 an. Ahmad hazik 2 KT
10 17902 an. Widi apriliadi 9 KB
11 28445 tn. R.B. ahmad rafiuddin 75 KB
12 50147 tn. Abd. Hamid 72 batang2
13 50155 tn. Mohawi 75 talango
14 50138 tn. Hamaruddin 70 sepudi
3/14/2019 1 11556 ny. Wiwik suryawati 53 gapura
2 29817 ny. Masrifah 40 talango
3 50227 ny. Suhartini 33 gapurana
4 50215 tn. Sahrul ardiansyah 34 pabian
5 50142 ny. Raba'ah 71 guluk2
6 5764 ny. Saniya 71 rubaru
7 15263 tn. Samsul arifin 56 pabian
8 33839 nn. Gita 21 patean
9 50112 ny. Hesti agustina 29 pajagalan
10 50223 tn. Saduya 60 tamedung
 11 50227 ny. Suhartini 33 gapurana
12 50142 ny. Raba'ah 71 guluk2
3/19/2019 1 33010 ny. Badriyah 49 talango
2 21079 tn. Sumat 69 talango
3 50245 tn. Surakip 65 talango
4 49827 tn. Ibnu ibrahim 60 talango
5 50269 tn. H. fikri 63 dungkek
6 44263 tn. Musahwi 50 talango
7 28736 ny. Jumiati 47 kacongan
8 44339 ny. Jumaisa 49 KB
9 50268 an. Sri rahayu 6 kasengan
10 50317 ny. Nurhabiya 60 talango
11 44716 tn. Abd. Rafik 50 KT
12 50314 ny. Suparmi 69 talango
13 50311 tn. Ach. Sukandi 60 pinggirpapas
14 50252 an. Nailil farihah 6 bln pasongsongan
15 50274 an. Lina 8 talango
16 18924 ny. Kusriani 60 KB
17 50242 tn. Sukandar 34 kalimook
18 44746 ny. Sri wahyuni 54 pamolokan
19 50275 tn. Mas hendri 45 legung
20 50296 tn. Hamka 75 gili genting
21 26243 tn. Miskur 57 talango
22 32209 tn. Atmo 65 talango
23 25896 tn. Mustami 57 talango
24 50289 tn. Maskar 58 saronggi
25 50305 tn. Agus 21 KT
26 50069 sdr. Oki 23 KB
27 38182 an. Alif zaka ramadhani 23 bln lenteng
28 25896 tn. Mustami 57 talango
3/20/2019 1 50336 tn. Slamet riyadi 35 Jl. Pahlawan
2 45386 tn. Jatim 64 talango
3 50325 tn. Addus 70 batu putih
4 50334 ny. Asniyatun 25 padike
5 50302 tn. Asmoni 70 talango
6 32297 ny. Erlin H 50 KB
7 45508 tn. K. rapiuddin 74 dasuk
8 50276 ny. Sima 63 KB
9 50303 ny. Artiya 70 KT
10 44031 ny. Jumariyah 64 saronggi
3/21/2019 1 17438 nn. Hinnah humaizah 16 KB
2 9312 ny. Sahawi 61 KT
3 36455 tn. Fathor rahman 53 kalianget
4 50321 ny. Tammi 70 ambunten timur
 5 46571 tn. Sudiyono 42 nambakor
6 26451 tn. Tarnoji 57 ambunten
7 28986 tn. Abd. Razak 68 KT
8 50341 ny. Aliyah 74 batuan
9 50273 tn. Sunar 59 gayam
10 43483 tn. Mu'in 64 nambakor
11 50316 tn. Tahiruddin 50 KT
3/25/2019 1 518 tn. Moh. Arif 55 kertasda
2 31070 ny. Sumratun 49 batang2
3 50421 tn. Musahwi 50 patean-batuan
4 50380 tn. Misnadin 80 dasuk
5 27543 tn. Moh. Zain 76 pamolokan
6 50389 tn. Asmawi 48 batang2
7 50388 tn. Marban 69 talango
8 50403 ny. Hosni 68 talango
9 50410 tn. Hasan 60 KB
10 50401 tn pusiri 58 talango
11 48578 tn. Kharil anwar 23 kebunagung
12 50358 tn. Ridawi 50 grujugan
3/26/2019 1 50449 ny. Raudah 27 talango
2 50445 ny. Riski nur A. 23 karangduak
3 50096 tn. sundari 55 talango
4 44989 tn. Masruya 76 gapura
5 18101 an. Ahmat sufyan 7 talango
6 36455 tn. Fathor rahman 53 KB
7 15060 tn. Hadi bustomi 50 gili genting
8 22432 an. Annisa 7 kertasada
3/27/2019 1 50451 tn. Sutomo 57 pangarangan
2 50454 tn. Nurul anwar 31 bluto
3 10007 ny. Siti hamisah 31 kalianget
4 16369 ny. Maryani 45 kalianget
5 50394 ny. Galuh 26 kolor
6 50138 tn. hamaruddin 72 gayam
7 50435 ny. Nawi'ah 75 talango
8 50459 ny. Sawe 70 gapura
9 50432 tn. Sahom 100 talango
10 44061 nn. Nurul qomariyah 26 marengan daya
11 28815 ny. Ahmaniye 68 bluto
12 50455 an. Moh. Hozzen 2 bln batu putih
13 50408 ny. Minatun 60 gapura
14 28736 ny. Jumiyati 47 kacongan
 Jl. Raya Kalianget No. 1
Kalianget- Sumenep - 69471
TeIp. [0328] 664350 , 667433, 661713
Fax. [0328] 667433
E-mail : rsi_garam@yahoo.co.id

ANAN TINDAKAN
ADIOLOGI
L PRAKTEK

Tindakan Status Tarif Ket tgl periksa

usg urologi bpjs Rp 82,500 rj 4
usg abdomen umum Rp 82,500 rj 4
usg mammae bpjs Rp 82,500 rj 4
usg testis bpjs Rp 82,500 rj 4
usg abdomen umum Rp 82,500 ri 4
usg abdomen umum Rp 82,500 rj 4
usg obstetri bpjs Rp 82,500 ri 4
thorax bpjs Rp 16,450 ri 4
thorax bpjs Rp 16,450 ri 4
thorax bpjs Rp 16,450 ri 28
thorax bpjs Rp 16,450 ri 4
thorax umum Rp 16,450 ri 4
thorax umum Rp 16,450 ri 4
LS ap/lat bpjs Rp 20,250 ri 2
pedis ap/obl bpjs Rp 20,250 ri 28
thorax bpjs Rp 16,450 ri 1
thorax bpjs Rp 16,450 ri 4
thorax bpjs Rp 16,450 ri 1
thorax bpjs Rp 16,450 ri 4
thorax bpjs Rp 16,450 ri 4
thorax bpjs Rp 16,450 ri 3
thorax bpjs Rp 16,450 ri 2
BOF, LLD bpjs Rp 20,250 ri 4
thorax umum Rp 16,450 ri 4
usg abdomen umum Rp 82,500 ri 5
usg abdomen umum Rp 82,500 rj 5
usg abdomen umum Rp 82,500 ri 5
usg obstetri bpjs Rp 82,500 ri 5
usg guiding puntcie bpjs Rp 82,500 ri 5
usg abdomen umum Rp 82,500 ri 5
usg abdomen bpjs Rp 82,500 ri 5
usg abdomen bpjs Rp 82,500 ri 5
usg soft tissue umum Rp 82,500 ri 5
thorax bpjs Rp 16,450 ri 5
thorax bpjs Rp 16,450 ri 5
 thorax bpjs Rp 16,450 ri 5
thorax bpjs Rp 16,450 ri 5
thorax bpjs Rp 16,450 ri 5
thorax bpjs Rp 16,450 ri 5
thorax bpjs Rp 16,450 ri 28
usg urologi bpjs Rp 82,500 rj 6
usg abdomen umum Rp 82,500 ri 6
thorax umum Rp 16,450 ri 5
thorax bpjs Rp 16,450 ri 6
thorax umum Rp 16,450 ri 5
thorax bpjs Rp 16,450 ri 6
thorax umum Rp 16,450 ri 5
thorax bpjs Rp 16,450 ri 5
thorax bpjs Rp 16,450 ri 5
usg abdomen bpjs Rp 82,500 ri 11
thorax bpjs Rp 16,450 ri 8
thorax umum Rp 16,450 rj 11
thorax bpjs Rp 16,450 ri 11
thorax bpjs Rp 16,450 ri 11
thorax umum Rp 16,450 ri 9
usg abdomen bpjs Rp 82,500 rj 13
usg abdomen bpjs Rp 82,500 ri 13
usg abdomen umum Rp 82,500 ri 13
BOF, LLD umum Rp 20,250 ri 13
thorax umum Rp 16,450 ri 12
thorax umum Rp 16,450 ri 12
thorax umum Rp 16,450 ri 12
thorax bpjs Rp 16,450 ri 13
thorax bpjs Rp 16,450 ri 11
thorax bpjs Rp 16,450 ri 12
thorax bpjs Rp 16,450 ri 11
thorax umum Rp 16,450 ri 11
thorax umum Rp 16,450 ri 12
thorax bpjs Rp 16,450 ri 11
usg abdomen bpjs Rp 82,500 ri 14
usg soft tissue umum Rp 82,500 rj 14
usg abdomen umum Rp 82,500 rj 14
usg abdomen bpjs Rp 82,500 ri 14
usg abdomen bpjs Rp 82,500 ri 14
thorax bpjs Rp 16,450 rj 14
thorax bpjs Rp 16,450 ri 14
thorax bpjs Rp 16,450 ri 14
thorax bpjs Rp 16,450 ri 14
thorax umum Rp 16,450 rj 14
 thorax umum Rp 16,450 rj 14
thorax ap/lat bpjs Rp 20,250 ri 11
usg abdomen bpjs Rp 82,500 rj 19
usg urologi bpjs Rp 82,500 ri 19
usg urologi bpjs Rp 82,500 rj 19
usg urologi bpjs Rp 82,500 rj 19
usg abdomen umum Rp 82,500 ri 19
thorax umum Rp 16,450 ri 19
thorax bpjs Rp 16,450 ri 19
genu D, S ap/lat bpjs Rp 40,500 ri 19
thorax umum Rp 16,450 ri 16
thorax umum Rp 16,450 ri 19
thorax bpjs Rp 16,450 ri 19
thorax bpjs Rp 16,450 ri 19
thorax bpjs Rp 16,450 ri 19
thorax umum Rp 16,450 ri 15
thorax umum Rp 16,450 ri 19
thorax bpjs Rp 16,450 ri 15
thorax bpjs Rp 16,450 ri 15
thorax PLN Rp 16,450 ri 14
thorax umum Rp 16,450 ri 18
thorax umum Rp 16,450 ri 18
thorax bpjs Rp 16,450 ri 18
thorax umum Rp 16,450 ri 18
thorax bpjs Rp 16,450 ri 19
thorax umum Rp 16,450 ri 18
thorax bpjs Rp 16,450 ri 19
thorax bpjs Rp 16,450 ri 19
thorax umum Rp 16,450 ri 18
thorax bpjs Rp 16,450 ri 15
usg urologi bpjs Rp 82,500 rj 20
usg urologi umum Rp 82,500 ri 20
usg urologi umum Rp 82,500 ri 20
usg abdomen umum Rp 82,500 rj 20
usg abdomen umum Rp 82,500 ri 20
usg abdomen bpjs Rp 82,500 ri 20
colon in loop bpjs Rp 162,000 ri 20
thorax bpjs Rp 16,450 ri 19
thorax bpjs Rp 16,450 ri 18
thorax bpjs Rp 16,450 ri 20
usg mammae bpjs Rp 82,500 rj 21
usg urologi bpjs Rp 82,500 rj 21
usg testis bpjs Rp 82,500 rj 21
usg thyroid bpjs Rp 82,500 ri 21
 thorax bpjs Rp 16,450 rj 21
thorax bpjs Rp 16,450 ri 21
thorax umum Rp 16,450 ri 20
thorax bpjs Rp 16,450 ri 20
pedis ap/obl bpjs Rp 16,450 ri 21
thorax umum Rp 16,450 ri 21
thorax bpjs Rp 16,450 ri 21
usg urologi bpjs Rp 82,500 rj 25
usg abdomen umum Rp 82,500 ri 25
usg abdomen umum Rp 82,500 ri 25
thorax umum Rp 82,500 ri 25
thorax bpjs Rp 16,450 ri 24
thorax umum Rp 16,450 ri 23
thorax umum Rp 16,450 ri 23
thorax umum Rp 16,450 ri 24
thorax bpjs Rp 16,450 ri 25
thorax umum Rp 16,450 ri 24
thorax umum Rp 16,450 ri 25
thorax bpjs Rp 16,450 ri 22
usg obstetri umum Rp 82,500 ri 26
usg mammae bpjs Rp 82,500 rj 26
thorax umum Rp 16,450 ri 26
thorax bpjs Rp 16,450 ri 25
thorax bpjs Rp 16,450 ri 26
thorax bpjs Rp 16,450 ri 26
pedis ap/obl umum Rp 20,250 ri 26
thorax bpjs Rp 20,250 ri 26
usg urologi umum Rp 82,500 rj 27
usg abdomen bpjs Rp 82,500 ri 27
usg obstetri bpjs Rp 82,500 ri 27
usg gikenologi bpjs Rp 82,500 ri 27
thorax bpjs Rp 16,450 ri 27
thorax bpjs Rp 16,450 ri 27
thorax umum Rp 16,450 ri 26
thorax bpjs Rp 16,450 ri 26
thorax umum Rp 16,450 ri 25
thorax bpjs Rp 16,450 ri 25
thorax bpjs Rp 16,450 ri 26
thorax umum Rp 16,450 ri 27
thorax umum Rp 16,450 ri 27
thorax bpjs Rp 16,450 ri 19
 Yarisga Kalianget Kal
TeIp. [0328]
RSI Garam Kalianget E-mai
Ramah, Senyum, Ikhlas, Ghirah & Kekeluargaan

DAFTAR JASA PELAYANAN TINDAKAN

SPESIALIS RADIOLOGI
( CITO / On Call )
TGL NO REG NAMA PASIEN UMUR ALAMAT
3/9/2019 1 27770 ny. Nur aini 28 dungkek
2 50092 nn. Indri alifah 19 KT
3 50066 ny. Samaniyah 39 manding
4 5145 tn. Ismail 82 KT
5 50061 by. Ny. Susi nur 2 hari gapura
6 50021 an. Triadiza aulia H 4,5 th saronggi
7 50064 an. Shafa waradatin 2 talango
8 50029 an. Azka 3 paberasan
9 50072 by. Arvino N. R 2 bln batuan
10 50035 tn. Samsu 73 marengan laok
11 50071 tn. Madin 35 dasuk
12 30591 tn. Saleh 75 kalimook
13 50054 tn. Matsuri 59 ganding
14 5145 tn. ismail 83 KT
15 26346 sdr. Ananda 15 tambangan
16 44126 tn. Sunarto 53 parsanga
17 49913 ny. Busa'iyah 65 talango
18 50041 ny. Ahwa 60 talango
19 42197 tn. Mustawi 56 marengan daya
20 50026 an. Izzah nikmatin 1 gapura
21 27272 tn. Samsul 38 KT
22 50069 sdr. Okki anugrah 23 kalianget
23 22213 tn. Iswandi 49 KT
24 50048 tn. Moh. Sutomo 69 pamolokan
25 50032 ny. Saliha 80 sumenep
26 50019 ny. Anni warsih 44 KT
27 50063 ny. Sujina 63 KT
28 50078 ny. Siti rafiah 58 karangduak
3/23/2019 1 50353 ny. Maimunah 78 KB
2 47066 ny. Halima 74 talango
3 47066 ny. halima 74 talango
4 50375 tn. Dora 70 talango
5 48268 ny. Masriyani 46 dungkek
6 50339 ny. Mastu'a 84 pasongsongan
7 50302 tn. Asmoni 60 talango
8 50343 sdr. Mohammad syanum 13 sapeken
 9 50360 ny. Suwasna 70 saronggi
10 50355 an. Moh. Nadi 16 bln manding
11 50353 ny. maimunah 78 KB
12 50372 tn.iwan 21 KT
13 6604 ny. Hartini 56 KT
14 50322 tn. Nury akkub 42 dungkek
15 47127 tn. Satuman 66 talango
16 50361 tn. M.hasan 63 KT
17 50322 tn. Nury akkub 42 dungkek
3/30/2019 1 47806 tn. Mo'asan 36 dasuk laok
2 46272 tn. Sulaiman 56 KB
3 50460 ny. Salwiyah 65 gapura barat
4 47806 tn. Mo'asan 36 dasuk laok
5 50491 ny. Masna 60 talango
6 50515 an. Khaila 8 saronggi
7 47806 tn. Mo'asan 36 dasuk laok
8 50458 tn. Wahyu dony S 35 pangarangan
9 50505 hj. Aisyah 56 rubaru
10 18882 tn. Asmuni 60 talango
11 13758 tn. asmoni 52 legung
12 44459 tn. Niman 80 talango
13 50480 ny. Imaniyah 62 pabian
14 17578 ny. Sri wahyuningsih 60 KT
15 50522 ny. Eka jurupiyantari 45 surabaya
16 14845 tn. Wiyono 61 KT
17 50522 ny. Eka jurupiyantari 45 surabaya
 Jl. Raya Kalianget No. 1
Kalianget- Sumenep - 69471
TeIp. [0328] 664350 , 667433, 661713
Fax. [0328] 667433
E-mail : rsi_garam@yahoo.co.id

NDAKAN
I

TINDAKAN STATUS TARIF KET tgl periksa

usg abdomen bpjs Rp 123,700 ri 9
usg mammae umum Rp 123,700 rj 9
usg soft tissue bpjs Rp 123,700 rj 9
usg urologi bpjs Rp 123,700 ri 9
thorax bpjs Rp 16,450 ri 8
thorax bpjs Rp 16,450 ri 8
thorax umum Rp 16,450 ri 8
thorax umum Rp 16,450 ri 6
babygram bpjs Rp 16,450 ri 8
thorax bpjs Rp 16,450 ri 6
thorax bpjs Rp 16,450 ri 8
thorax bpjs Rp 16,450 ri 8
thorax bpjs Rp 16,450 ri 8
thorax bpjs Rp 16,450 ri 8
BOF, LLD bpjs Rp 20,250 ri 8
thorax bpjs Rp 16,450 ri 1
thorax umum Rp 16,450 ri 1
thorax bpjs Rp 16,450 ri 6
thorax bpjs Rp 16,450 ri 8
thorax umum Rp 16,450 ri 7
thorax bpjs Rp 16,450 ri 8
baca thorax bpjs Rp 16,450 ri 9
thorax bpjs Rp 16,450 ri 8
thorax bpjs Rp 16,450 ri 8
thorax bpjs Rp 16,450 ri 6
thorax umum Rp 16,450 ri 9
thorax bpjs Rp 16,450 ri 9
thorax bpjs Rp 16,450 ri 9
usg abdomen umum Rp 123,700 ri 23
usg soft tissue umum Rp 123,700 ri 23
thorax umum Rp 16,450 ri 21
thorax bpjs Rp 16,450 ri 23
thorax bpjs Rp 16,450 ri 22
thorax bpjs Rp 16,450 ri 20
thorax umum Rp 16,450 ri 20
thorax bpjs Rp 16,450 ri 20
 thorax bpjs Rp 16,450 ri 22
thorax umum Rp 16,450 ri 21
thorax umum Rp 16,450 ri 23
thorax umum Rp 16,450 ri 22
thorax umum Rp 16,450 ri 21
thorax umum Rp 16,450 ri 22
thorax bpjs Rp 16,450 ri 22
thorax umum Rp 16,450 ri 22
pedis ap/ob umum Rp 16,450 ri 22
usg abdomen bpjs Rp 123,700 ri 30
thorax bpjs Rp 16,450 ri 28
thorax umum Rp 16,450 ri 28
BOF bpjs Rp 16,875 ri 30
thorax bpjs Rp 16,450 ri 28
thorax umum Rp 16,450 ri 30
thorax bpjs Rp 16,450 ri 30
thorax umum Rp 16,450 ri 30
thorax umum Rp 16,450 ri 29
thorax bpjs Rp 16,450 ri 28
pedis ap/ob bpjs Rp 20,250 ri 28
thorax bpjs Rp 16,450 ri 28
thorax umum Rp 16,450 ri 29
thorax bpjs Rp 16,450 ri
skull ap/lat umum Rp 20,250 ri 29
thorax bpjs Rp 16,450 ri 30
genu ap/lat umum Rp 20,250 ri 29
 Jl
Yarisga Kalianget Kalian
TeIp. [0328] 664
RSI Garam Kalianget E-mail : r
Ramah, Senyum, Ikhlas, Ghirah & Kekeluargaan

DAFTAR JASA PELAYANAN TINDAKAN

SPESIALIS RADIOLOGI
SESUAI JADWAL PRAKTEK
Apr-19
Tgl No. No. Reg Nama Pasien Umur Alamat
4/1/2019 1 38546 an. Griselda 4 kepanjin
2 50530 ny. Nami 46 lenteng
3 50552 tn. Moh. Nasiruddin 49 ambunten
4 43806 tn. Marzuki 50 bluto
5 43806 tn. Marzuki 50 bluto
6 50567 ny. Patmina 65 bluto
7 50567 ny. patmina 65 bluto
8 50518 an. Ach. Rofiqul 2.5 rubaru
9 50533 an. Moh. Naufal 10 bln batu putih
10 50546 tn. Tayyib 72 giliyang
11 50448 tn. Atmawi 46 KT
12 50549 tn. Zaini 68 sepudi
13 50549 ny. Warniyati 57 marengan
4/4/2019 1 50586 tn. Mastuki 50 sapeken
2 50581 ny. Rustiya 53 talango
3 50611 ny. Sudiya 67 bluto
4 50632 tn. Agus rahmadiyanto 39 talango
5 32319 ny. Suhartini 34 kertasada
6 42937 ny. Herlina 37 talango
7 49994 ny. Suhartini 54 KB
8 50631 tn. Misnawi 50 manding
9 46739 by. Arfino 5 bln saronggi
10 50621 ny. Muatiya 65 talango
11 50581 ny. rustiya 53 talango
12 50573 an. Raden rara 1.5 KT
13 50588 tn. Holik 45 jember
14 30571 ny. Supini 70 gapura
15 50578 ny. Juwani 68 talango
16 26397 ny. Salama 77 talango
17 34068 tn. Sahrawi 70 batang2
18 50603 tn. Sapak 50 gili labak
19 50595 an. Wisa el hasima 3 talango
 20 5664 ny. Amya 62 KT
21 50622 ny. Mutia 65 lenteng
22 50518 an. Ach. Rofiqul 2.5 rubaru
23 50479 by. Ny. Nourma 6 hari marengan
24 50638 tn. Dul mannan 52 batu putih
25 50482 ny. Sani uzro 48 lenteng
26 50577 an. Nur maisah 13 KB
4/8/2019 1 9329 tn. Hermanto 48 KT
2 34068 tn. Sahrawi 63 batang2
3 14025 ny. R. R. suprapti 72 kepanjin
4 50694 ny. Markati 53 KT
5 50710 ny. Nurul fitri 26 pasongsongan
6 50712 ny. Nabiah 70 dungkek
7 50689 sdr. Hairul 20 marengan
8 50689 sdr. hairul 20 marengan
9 50708 tn. Mat alwi 70 manding
4/9/2019 1 50747 tn. Mat rasu 60 padike
2 50746 ny. Nur megawati 37 KB
3 50740 tn. Nitra' 47 saronggi
4 50745 tn. Arun 80 dasuk
5 50743 tn. KH. Ekhsan 68 pabian
6 50375 tn. Dora 70 talango
7 50744 tn. Kasiyat lojikantang
8 50721 tn. Moh. Halil 70 marengan
9 50721 tn. Moh. Halil 70 marengan
10 50718 ny. Siti nurbaya 58 bangselok
11 1032 an. Ayshila 1 ambunten
12 50738 tn. Jumaha 70 kalianget
13 50728 ny. H. hamza 50 talango
14 50727 ny. Sutikayatul 26 gili genting
15 32222 ny. Sahniya 50 talango
16 47977 ny. Hatini 52 gili genting
17 50722 ny. Isa 60 gapura
18 50709 tn. Misjan 71 belluk raje
19 50729 tn. Muasan 67 talango
4/10/2019 1 50756 tn. Arifin 39 kertasada
2 50711 ny. Anis 55 pandian
3 50768 by. Cemal 7 bln kertasada
4 50764 an. Muhammad izul 15 bln talango
5 50721 tn. Moh. Halil 78 marengan
6 30242 tn. Fuad 59 pangarangan
 7 11221 ny. Ainiyah 59 marengan
8 37389 tn. Mat rawan 78 KB
9 17411 ny. Dwi yulianti 35 bangselok
4/11/2019 1 50784 tn. Said 62 banyuates
2 32279 tn. Moh. Tayyib 46 kalianget
3 50777 ny. Sumina 63 bangkal
4 50756 tn. Arifin 39 kertasada
5 50779 ny. Yuli 37 KT
6 50780 tn. H. muksin 50 rubaru
7 50787 tn. Addur 70 talango
8 49798 tn. Wagiman 62 kolor
4/15/2019 1 50844 ny. Buriya 28 paberasan
2 44922 ny. Sundari 37 talango
3 50793 ny. Marwiyah 40 batang2
4 50877 tn. Asmudin 56 talango
5 41904 ny. Sri maria 35 kalianget
6 42055 ny. Nariya 47 giliyang
7 50872 ny. Hanipa 67 bluto
8 41279 ny. Pani 69 KT
9 50852 ny. Susi 36 bluto
10 50806 tn. Ibno 51 aeng tongtong
11 50836 ny. Hatiyah 54 batuan
13 50818 ny. Hamida 60 bluto
14 50794 by. Moh. Iqbal 1 bln dasuk
15 50844 ny. buriya 28 paberasan
16 50817 tn. Madriadi 60 kolor
17 50798 ny. Nur aini 37 bluto
4/16/2019 1 50854 sdr. Indra 19 KT
2 50841 ny. Sumratul 23 marengan laok
3 15811 sdr. Heru sigit yulianto 18 KT
4 46407 tn. Zainuddin 43 lenteng
5 50784 tn. said 67 kertasada
6 50892 ny. Sura'ena 50 saronggi
7 50888 ny. Saina/ ny. Zeina 45 talango
8 44922 ny. sundari 37 talango
4/18/2019 1 50935 tn. Ach. Hofil afrianto 36 KT
2 17121 nn. Rodiah 15 KT
3 50931 ny. Kusmiyah 49 talango
4 50914 sdr. Ach. Rohes 17 batu putih
5 50919 ny. Irda helmi 41 pamolokan
6 50921 tn. Ahmad busriadi 40 lenteng
 7 50922 ny. Siti suaiba 40 marengan
8 50877 tn. Asmodin 56 talango
9 48661 tn. Faris ismail 25 pandian
10 50913 ny. Sunadia 53 rubaru
4/23/2019 1 51035 ny. Suati 44 sapeken
2 51034 tn. Madrus 75 talango
3 50991 tn. Feri andriawan 36 ambunten
4 50922 ny. Siti suaibah 58 marengan daya
5 50949 tn. Alex novel 32 kertasada
6 50938 tn. Moh. Hasani 52 gapura
7 51015 ny. Hamina 42 manding
8 11589 ny. Ngasira 81 KB
9 50976 ny. Siti fadilah 57 bangselok
10 41349 tn. Sujakmo 61 KB
11 50985 tn. Ibnu hajar 50 talango
12 26842 tn. Moh. Tayyib 40 kalimook
13 50979 ny. Suningsih 54 kebunan
14 49658 tn. Hidayatur rahman 51 KB
15 32958 ny. Mahyatun 58 gung-gung
16 51017 ny. Saliha 62 gapura
17 51010 ny. Sri surya 55 kolor
18 51004 tn. Sumahri 54 andulang
19 50989 ny. Ernawati 26 manding
20 51019 tn. Safi'i 40 dasuk
21 51034 tn. Madrus 75 talango
22 50963 tn. Mathari 55 talango
23 51033 sdr. Ach. Ghufron 17 ambunten
4/24/2019 1 50996 tn. Salihuddin 63 talango
2 51027 ny. Ummul K 33 pangarangan
3 24254 ny. Arlina 40 kalianget
4 51037 tn. Hali 71 lenteng
5 51039 tn. Ahmadi 35 kacongan
6 51037 tn. hali 72 lenteng
7 51051 tn. Halil 68 gapura
8 51051 tn. Halil 68 gapura
9 51038 ny. Sajati 78 pasongsongan
10 16199 ny. Siti aisyah 69 KB
11 51056 tn. Sumarwi 48 pakandangan
12 50938 tn. Moh. hasani 53 gapura
4/25/2019 1 11589 ny. Ngasirah 81 KB
2 51087 tn. Hamidi 61 lenteng
 3 51065 tn. Moh. Alwan 77 batu putih
4 51076 by. Kholilah 26 hr ambunten
5 51082 ny. Layyinatin 26 lenteng
4/29/2019 1 51167 ny. Sahami 46 pasongsongan
2 16423 tn. Amse 65 kalianget
3 51146 ny. Triyuni 33 pabian
4 51166 ny. Atriani 31 KT
5 51107 tn. Busamma 65 kebunan
6 51128 ny. Muari 73 talango
7 51083 ny. Suhadiya 52 kalimook
8 51110 by. M. Wali Wafa 2 bln pasongsongan
9 51129 tn. Masna 65 talango
10 51147 ny. Busiya 54 dasuk
11 38805 ny. Sukina 79 KT
12 51105 ny. salama 65 talango
13 51157 tn. Mat sirat 79 dasuk
4/30/2019 1 51188 tn. Mat tarsak 50 guluk2
2 24548 ny. Tiana 32 talango
3 51176 tn. Faisol 27 talango
4 51174 ny. Maksumah 57 rubaru
5 10116 ny. Sumariyani 59 KB
6 51192 ny. Saniyah 55 pandian
7 16488 ny. Supatmi 78 KB
8 45653 an. Nur dwi 8bln KT
9 32004 ny. Suina 65 talango
10 51186 tn. Arsawan 46 saronggi
11 51183 tn. Atmora 79 paberasan
 Jl. Raya Kalianget No. 1
Kalianget- Sumenep - 69471
TeIp. [0328] 664350 , 667433, 661713
Fax. [0328] 667433
E-mail : rsi_garam@yahoo.co.id

ANAN TINDAKAN
DIOLOGI
L PRAKTEK

Tindakan Status Tarif Ket tgl periksa

usg colli umum Rp 82,500 rj 1
usg soft tissue bpjs Rp 82,500 ri 1
usg urologi umum Rp 82,500 ri 1
usg abdomen bpjs Rp 82,500 ri 1
BOF, LLD bpjs Rp 20,250 ri 31
LS ap/lat bpjs Rp 20,250 ri 1
thorax bpjs Rp 16,450 ri 1
thorax umum Rp 16,450 ri 1
thorax umum Rp 16,450 ri 31
thorax umum Rp 16,450 ri 31
thorax bpjs Rp 16,450 ri 1
thorax bpjs Rp 16,450 ri 31
genu D, S ap/lat bpjs Rp 40,500 ri 1
usg abdomen bpjs Rp 82,500 rj 4
usg soft tissue bpjs Rp 82,500 rj 4
usg urologi umum Rp 82,500 ri 4
usg urologi umum Rp 82,500 rj 4
usg obstetri bpjs Rp 82,500 ri 4
thorax umum Rp 16,450 4
pedis D, S ap/ob bpjs Rp 40,500 rj 4
thorax bpjs Rp 16,450 ri 4
thorax bpjs Rp 16,450 ri 4
thorax umum Rp 16,450 ri 4
thorax bpjs Rp 16,450 rj 4
thorax bpjs Rp 16,450 ri 2
BOF, LLD umum Rp 20,500 ri 2
thorax bpjs Rp 16,450 ri 2
BOF umum Rp 16,875 ri 2
thorax bpjs Rp 16,450 ri 4
thorax bpjs Rp 16,450 ri 2
thorax umum Rp 16,450 ri 2
thorax umum Rp 16,450 ri 2
 thorax umum Rp 16,450 rj 2
thorax umum Rp 16,450 ri 4
thorax umum Rp 16,450 ri 1
thorax bpjs Rp 16,450 ri 2
thorax bpjs Rp 16,450 ri 4
thorax umum Rp 16,450 rj 28
BOF umum Rp 16,875 ri 4
usg abdomen umum Rp 82,500 rj 8
usg urologi bpjs Rp 82,500 ri 8
usg urologi bpjs Rp 82,500 ri 8
thorax bpjs Rp 16,450 ri 8
thorax umum Rp 16,450 ri 8
thorax umum Rp 16,450 ri 8
thorax umum Rp 16,450 ri 7
cervical ap/lat umum Rp 20,250 ri 8
thorax bpjs Rp 16,450 ri 8
usg urologi bpjs Rp 82,500 rj 9
usg obstetri SPM Rp 82,500 ri 9
thorax bpjs Rp 16,450 ri 9
thorax umum Rp 16,450 ri 9
thorax umum Rp 16,450 rj 9
thorax bpjs Rp 16,450 rj 9
manus S ap/ob umum Rp 20,250 rj 9
thorax umum Rp 16,450 ri 8
pelvis umum Rp 16,450 ri 8
thorax bpjs Rp 16,450 ri 8
thorax bpjs Rp 16,450 ri 8
thorax bpjs Rp 16,450 ri 9
thorax umum Rp 16,450 ri 9
thorax umum Rp 16,450 ri 9
thorax bpjs Rp 16,450 ri 9
thorax umum Rp 16,450 ri 9
thorax umum Rp 16,450 ri 9
thorax bpjs Rp 16,450 ri 9
thorax bpjs Rp 16,450 ri 9
usg abdomen umum Rp 82,500 ri 10
usg urologi bpjs Rp 82,500 ri 10
thorax bpjs Rp 16,450 ri 10
thorax umum Rp 16,450 ri 10
LS ap/lat umum Rp 20,250 ri 10
thorax bpjs Rp 16,450 ri 10
 thorax umum Rp 16,450 ri 10
thorax umum Rp 16,450 ri 10
thorax bpjs Rp 16,450 ri 10
usg urologi umum Rp 82,500 rj 11
LS ap/lat umum Rp 20,250 ri 11
thorax bpjs Rp 16,450 ri 10
thorax umum Rp 16,450 ri 10
thorax bpjs Rp 16,450 ri 11
thorax bpjs Rp 16,450 ri 11
thorax bpjs Rp 16,450 ri 11
thorax bpjs Rp 16,450 rj 11
usg obstetri bpjs Rp 82,500 ri 15
usg obstetri bpjs Rp 82,500 ri 15
manus D ap/ob umum Rp 20,250 ri 13
thorax umum Rp 16,450 ri 15
thorax bpjs Rp 16,450 ri 13
thorax umum Rp 16,450 ri 15
thorax umum Rp 16,450 ri 15
thorax bpjs Rp 16,450 ri 15
thorax bpjs Rp 16,450 ri 15
thorax bpjs Rp 16,450 ri 12
thorax umum Rp 16,450 ri 13
thorax bpjs Rp 16,450 ri 12
thorax umum Rp 16,450 ri 12
thorax bpjs Rp 16,450 ri 14
thorax umum Rp 16,450 ri 12
thorax bpjs Rp 16,450 ri 14
usg soft tissue pt. garam Rp 82,500 ri 16
usg obstetri bpjs Rp 82,500 ri 16
usg soft tissue bpjs Rp 82,500 rj 16
BOF, LLD umum Rp 20,250 ri 16
thorax bpjs Rp 16,450 ri 16
thorax bpjs Rp 16,450 ri 16
thorax umum Rp 16,450 ri 16
thorax bpjs Rp 16,450 ri 16
usg abdomen umum Rp 82,500 ri 18
usg abdomen umum Rp 82,500 ri 18
usg colli umum Rp 82,500 rj 18
thorax umum Rp 16,450 ri 18
thorax bpjs Rp 16,450 ri 17
thorax umum Rp 16,450 ri 17
 thorax bpjs Rp 16,450 ri 17
BOF, LLD umum Rp 20,250 ri 17
thorax bpjs Rp 16,450 rj 18
thorax umum Rp 16,450 ri 18
usg abdomen umum Rp 82,500 rj 23
usg urologi bpjs Rp 82,500 ri 23
usg abdomen umum Rp 82,500 ri 23
usg abdomen bpjs Rp 82,500 ri 23
usg abdomen bpjs Rp 82,500 ri 23
usg soft tissue umum Rp 82,500 ri 23
usg abdomen bpjs Rp 82,500 ri 23
thorax bpjs Rp 16,450 ri 23
thorax bpjs Rp 16,450 ri 21
thorax umum Rp 16,450 ri 22
BOF, LLD umum Rp 20,250 ri 22
thorax umum Rp 16,450 ri 22
thorax umum Rp 16,450 ri 22
pedis S ap/ob bpjs Rp 20,250 rj 20
thorax bpjs Rp 16,450 ri 23
thorax bpjs Rp 16,450 ri 22
LS ap/lat umum Rp 20,250 rj 22
thorax umum Rp 16,450 rj 22
thorax bpjs Rp 16,450 ri 22
thorax bpjs Rp 16,450 ri 22
thorax bpjs Rp 16,450 ri 23
skull ap/lat umum Rp 31,500 ri 20
thorax bpjs Rp 16,450 ri 23
usg urologi umum Rp 82,500 rj 24
usg abdomen umum Rp 82,500 ri 24
usg mammae bpjs Rp 82,500 rj 24
usg urologi bpjs Rp 82,500 rj 24
fistulografi bpjs Rp 162,000 rj 24
thorax bpjs Rp 16,450 rj 24
thorax umum Rp 16,450 ri 23
BOF, LLD umum Rp 20,250 ri 23
thorax bpjs Rp 16,450 ri 23
pedis D ap/obl bpjs Rp 20,250 rj 22
baca thorax bpjs Rp 16,450 ri 24
thorax umum Rp 16,450 ri 23
usg abdomen bpjs Rp 82,500 ri 25
thorax bpjs Rp 16,450 ri 25
 thorax bpjs Rp 16,450 ri 25
BOF umum Rp 16,875 ri 25
thorax bpjs Rp 16,450 ri 25
usg ginekologi bpjs Rp 82,500 rj 29
usg urologi bpjs Rp 82,500 rj 29
usg urologi bpjs Rp 82,500 ri 29
usg obstetri bpjs Rp 82,500 ri 29
usg abdomen bpjs Rp 82,500 ri 29
manus D, S ap/ ob bpjs Rp 40,500 ri 29
thorax bpjs Rp 16,450 ri 26
thorax umum Rp 16,450 ri 26
thorax bpjs Rp 16,450 ri 27
thorax bpjs Rp 16,450 ri 29
thorax bpjs Rp 16,450 ri 29
thorax bpjs Rp 16,450 ri 26
thorax bpjs Rp 16,450 ri 29
usg colli bpjs Rp 82,500 rj 30
usg colli bpjs Rp 82,500 rj 30
usg abdomen bpjs Rp 82,500 ri 30
usg abdomen bpjs Rp 82,500 ri 30
thorax bpjs Rp 16,450 rj 30
thorax bpjs Rp 16,450 rj 30
thorax bpjs Rp 16,450 ri 30
thorax bpjs Rp 16,450 ri 30
thorax bpjs Rp 16,450 ri 30
thorax bpjs Rp 16,450 ri 30
thorax umum Rp 16,450 ri 30
 Jl
Yarisga Kalianget Kaliang
TeIp. [0328] 664
RSI Garam Kalianget E-mail : rs
Ramah, Senyum, Ikhlas, Ghirah & Kekeluargaan

DAFTAR JASA PELAYANAN TINDAKAN

SPESIALIS RADIOLOGI
( CITO / On Call )
TGL NO REG NAMA PASIEN UMUR ALAMAT

4/6/2019 1 45042 tn. Burawi 45 kertasada

2 50639 ny. Kusidatun 31 batang2
3 50638 tn. Dul mannan 53 batu putih
4 23702 tn. Budi utomo 23 pinggirpapas
5 50654 ny. Sumiyati 31 kertasada
6 50665 ny. Sundari 44 talango
7 50550 ny. Maryatun 53 saronggi
8 50650 ny. Enik 78 lenteng
 Jl. Raya Kalianget No. 1
Kalianget- Sumenep - 69471
TeIp. [0328] 664350 , 667433, 661713
Fax. [0328] 667433
E-mail : rsi_garam@yahoo.co.id
n

NAN TINDAKAN
OLOGI
all )
TINDAKAN STATUS TARIF KET tgl periksa

usg abdomen bpjs Rp 123,700 ri 6

usg abdomen bpjs Rp 123,700 ri 6
usg abdomen bpjs Rp 123,700 ri 6
usg abdomen umum Rp 123,700 ri 6
thorax bpjs Rp 16,450 ri 6
thorax bpjs Rp 16,450 ri 5
cruris ap/lat bpjs Rp 20,250 ri 5
thorax bpjs Rp 16,450 ri 6
 J
Yarisga Kalianget Kalian
TeIp. [0328] 664
RSI Garam Kalianget E-mail : r
Ramah, Senyum, Ikhlas, Ghirah & Kekeluargaan

DAFTAR JASA PELAYANAN TINDAKAN

SPESIALIS RADIOLOGI
SESUAI JADWAL PRAKTEK
May-19
Tgl No. No. Reg Nama Pasien Umur Alamat
5/2/2019 1 51183 tn. Atmura 79 paberasan
2 47399 ny. Ernawati 44 KB
3 51218 ny. Mahsunah 34 lenteng barat
4 9623 ny. Tutik agustin 47 KT
5 8806 ny. Rini yuli 39 pabian
6 51246 tn. Niwan 48 bluto
7 51156 tn. Sumarto 73 talango
8 28209 tn. Kustadi 54 kolor
9 42784 tn. Asip 68 bluto
10 51159 ny. Kasturia 65 kalimook
11 45081 ny. Mutia/ ny. Mufiah 68 legung
12 51217 tn. Zaini 50 manding
13 51241 ny. Farida 21 dasuk
14 51236 ny. Istiani 39 salopeng
15 51248 tn. Sasno 70 kacongan
16 8806 ny. Rini yuli 40 pabian
17 51182 an. Jazuli 7 talango
18 46862 tn. Moh. Mochtar 60 kepanjin
5/6/2019 1 51296 ny. Suhartin 45 talango
2 51310 tn. Moh. Ali 67 talango
3 51318 ny. Sahama 60 batu putih
4 40281 ny. Hawa 57 KT
5 40281 ny. hawa 57 KT
6 27534 ny. Suwarsih 50 KB
7 51308 tn. Jamal 68 baban
8 51309 ny. Nur faizah 50 lenteng
9 51275 tn. Moh. Tasip 53 lenteng
10 51196 ny. Suriyani 35 saronggi
5/8/2019 1 3448 ny. Juhara 52 pabian
2 51342 tn. Muasrin 80 talango
3 22747 tn. Rofi'ih 55 dungkek
4 33477 tn. Sarbini 68 talango
5 40675 ny. Misnati 65 kalianget
6 51343 ny. Suhartini 50 kalianget
 7 51340 tn. Ach. Zawawi 31 batang2
8 7874 ny. Nur yanti 68 perum satelit
5/9/2019 1 51365 tn. Aminuddin 70 kangean
2 27206 an. Nur muhammad 5 KB
3 51377 tn. Asmuni 42 KB
4 27710 sdr. Moh. Adi 22 KB
5 20035 an. Rista 6 KB
6 51363 ny. Sumiyati 51 parsanga
7 51363 ny. sumiyati 51 parsanga
8 51364 tn. Marhasan 73 arjasa
9 51364 tn. Marhasan 73 arjasa
10 51354 ny. Farida hartatik 64 kepanjin
11 51349 ny. Riksaniya 49 ambunten
5/13/2019 1 44159 sdr. Yoga 21 KT
2 51423 tn. Subairi 33 manding
3 51433 tn. R. moh. Maksum 60 kebunan
4 51432 an. R. dhafa F 12 kalimook
5 51388 an. Sela amalia 3 ganding
6 51414 sdr. Ahmad hidayat R 15 batang2
7 51438 ny. Sasmiyatun 26 pinggir papas
5/15/2019 1 50962 tn. Eko kusnadi 21 KT
2 51475 tn. Samsul arifin 38 karangduak
3 51434 tn. Rahwini 68 marengan laok
4 51476 tn. Moh tari 43 talango
5 51419 nn. Raudhatul I 19 sepudi
6 51459 tn. Mi'rad 48 gayam
7 40013 ny. Elfi 54 talango
8 51467 tn. Munir 50 manding
9 51463 ny. Suhadiyah 81 KB
10 39835 ny. Muiha 60 batu putih
11 51461 tn. Asmunri 48 batang2
5/16/2019 1 47956 tn. Budi S 55 KB
2 51495 tn. Dulhamit 78 saronggi
3 16921 nn. Hidayati 47 KB
4 39835 ny. muiha 60 batu putih
5 40094 sdr. Ach. Andi P 24 KT
6 14598 nn. Anis indah 22 pinggir papas
5/20/2019 1 51538 tn. Marsuki 61 ra'as
2 51476 tn. Moh. Tari 43 talango
3 51506 tn. Rahamdani 30 saronggi
4 12912 ny. Hendun 73 KT
5 30250 tn. H. misnawi 57 KT
6 30250 tn. H. misnawi 57 KT
7 51446 tn. Mupahran 66 arjasa
 8 51533 ny. Diyam 66 talango
9 51500 tn. Sunam 48 marengan laok
10 51492 ny. Kutmaya 26 marengan
11 8775 ny. Fitriyah 35 torbang
12 42583 an. Wais 14 bln kalimook
13 32553 tn. Sahmo 68 talango
14 35486 tn. Abd. Salam 46 gung2
15 8775 ny. Fitriyah 34 torbang
5/22/2019 1 44795 ny. Dwi ariyanti 30 KT
2 51562 ny. Kaprawiya 53 talango
3 48888 tn. Asan 53 talango
4 51569 ny. Liauw moy tjoen 87 sumenep
5/23/2019 1 51573 ny. Evi purnamasari 30 dungkek
2 51550 ny. Nafiah 64 lenteng
3 51362 ny. Hamidah 43 lenteng
4 51533 ny. Diyam 67 talango
5 51584 tn. Nihwan 40 dungkek
6 51584 tn. Nihwan 40 dungkek
7 6105 tn. Ibnu 65 bangselok
8 47657 tn. Imran 75 kertasada
9 51587 sdr. Habib 23 gapura
10 51550 ny. Nafiah 64 lenteng
5/27/2019 1 43838 ny. Asma 47 gapurana
2 51636 by. Ny. Atmawa 26 hr talango
3 51615 ny. Nabisah 45 batu mar mar
4 51615 ny. Nabisah 45 batu mar mar
5 7351 ny. Rachmaniyah 67 ambunten
6 26287 ny. Amriyatun 62 talango
7 51642 tn. Sanhaji 65 talango
5/29/2019 1 51718 tn. Reli fertawi D 31 pabian
2 7351 ny. Rachmaniyah 67 ambunten
3 51681 tn. Moh. Salam 52 manding
4 51704 tn. Ahmad fausi 56 kertasada
5 51704 tn. Ahmad fausi 56 kertasada
6 51708 ny. Musdalifah 40 talango
7 51706 tn. Fathor R 50 pamolokan
 Jl. Raya Kalianget No. 1
Kalianget- Sumenep - 69471
TeIp. [0328] 664350 , 667433, 661713
Fax. [0328] 667433
E-mail : rsi_garam@yahoo.co.id

N TINDAKAN
OGI
AKTEK

Tindakan Status Tarif Ket

usg thorax umum Rp 82,500 ri
usg abdomen umum Rp 82,500 rj
usg obstetri bpjs Rp 82,500 ri
usg abdomen bpjs Rp 82,500 ri
usg abdomen umum Rp 82,500 rj
usg abdomen bpjs Rp 82,500 ri
usg urologi umum Rp 82,500 rj
usg abdomen bpjs Rp 82,500 ri
thorax bpjs Rp 16,450 ri
thorax umum Rp 16,450 rj
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax umum Rp 16,450 rj
thorax umum Rp 16,450 ri
thorax bpjs Rp 16,450 rj
usg abdomen umum Rp 82,500 ri
usg abdomen umum Rp 82,500 rj
usg urologi bpjs Rp 82,500 ri
pedis D ap/ob bpjs Rp 20,250 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax umum Rp 16,450 ri
thorax bpjs Rp 16,450 ri
LS ap/lat bpjs Rp 20,250 ri
thorax bpjs Rp 16,450 rj
usg abdomen bpjs Rp 82,500 ri
usg urologi umum Rp 82,500 ri
thorax bpjs Rp 16,450 ri
thorax umum Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
 thorax umum Rp 16,450 ri
shoulder S exo, endo umum Rp 20,250 rj
usg urologi umum Rp 82,500 ri
skull ap/lat umum Rp 31,500 ri
skull ap/lat jasa rahaja Rp 31,500 ri
thorax bpjs Rp 16,450 ri
thorax umum Rp 16,450 ri
thorax bpjs Rp 16,450 ri
pedis D ap/ob bpjs Rp 20,250 ri
thorax umum Rp 16,450 ri
baca thorax umum Rp 16,450 ri
baca thorax bpjs Rp 16,450 ri
baca thorax bpjs Rp 16,450 ri
usg urologi bpjs Rp 82,500 ri
usg abdomen bpjs Rp 82,500 ri
thorax umum Rp 16,450 rj
clavicula D bpjs Rp 16,450 rj
thorax umum Rp 16,450 ri
thorax umum Rp 16,450 ri
thorax umum Rp 16,450 rj
usg abdomen bpjs Rp 82,500 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax umum Rp 16,450 ri
skull ap/lat umum Rp 31,500 ri
thorax umum Rp 16,450 ri
LS ap/lat umum Rp 20,250 rj
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
baca thorax bpjs Rp 16,450 ri
usg abdomen bpjs Rp 82,500 ri
LS ap/lat umum Rp 20,250 rj
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 rj
thorax umum Rp 16,450 rj
usg colli umum Rp 82,500 rj
usg abdomen umum Rp 82,500 ri
usg urologi umum Rp 82,500 ri
usg urologi bpjs Rp 82,500 rj
usg urologi umum Rp 82,500 rj
LS ap/lat umum Rp 20,250 rj
uretrografi umum Rp 162,000 ri
 thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax umum Rp 16,450 ri
thorax umum Rp 16,450 ri
thorax bpjs Rp 16,450 ri
pelvis ap/lat bpjs Rp 20,250 ri
thorax bpjs Rp 16,450 rj
thorax bpjs Rp 16,450 ri
thorax umum Rp 16,450 ri
pelvis umum Rp 16,450 rj
usg abdomen umum Rp 82,500 ri
usg abdomen bpjs Rp 82,500 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
manus D ap/ob bpjs Rp 20,250 rj
thorax bpjs Rp 16,450 rj
thorax umum Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
usg abdomen umum Rp 87,500 ri
thorax umum Rp 16,450 ri
thorax bpjs Rp 16,450 ri
pedis ap/ob bpjs Rp 20,250 ri
pedis ap/ob umum Rp 20,250 ri
thorax umum Rp 16,450 ri
LS ap/lat umum Rp 20,250 ri
usg urologi bpjs Rp 82,500 rj
usg doppler umum Rp 162,000 ri
thorax bpjs Rp 16,450 ri
thorax umum Rp 16,450 ri
pedis S ap/ob umum Rp 20,250 ri
thorax umum Rp 16,450 ri
thorax umum Rp 16,450 ri
 Jl
Yarisga Kalianget Kaliang
TeIp. [0328] 664
RSI Garam Kalianget E-mail : rs
Ramah, Senyum, Ikhlas, Ghirah & Kekeluargaan

DAFTAR JASA PELAYANAN TINDAKAN

SPESIALIS RADIOLOGI
( CITO / On Call )
TGL NO REG NAMA PASIEN UMUR ALAMAT

5/4/2019 1 51196 ny. Suriyani 36 nambakor

2 51283 tn. Moh. Amir hamzah 39 marengan laok
3 51272 tn. Suhari 80 talango
4 42784 tn. Asip 68 bluto
5 46148 ny. Sahriyem 60 talango
6 41602 ny. Nur Muhayyana 63 saronggi
7 51262 tn. Hasan 61 kangean
8 18728 ny. Juma'isah 65 kertasada
9 51262 tn. hasan 61 kangean
10 51268 an. Moh. Ibrahin 1 amparan kukup
11 51249 an. Moh. Bayu 1 dasuk
12 51206 ny. Sa'edah 50 dasuk
13 51229 tn. Mokari 65 parsanga
14 51231 by. Ny. Yesi 4 hari pinggir papas
5/11/2019 1 51405 nn. Andini ferawaty 17 KT
2 51392 ny. Monati 70 kertasada
3 51387 ny. Samseyati 48 gayam
4 51365 tn. Aminuddin 70 arjasa
5 51342 tn. Muasrin 75 talango
6 51376 ny. Sauni 75 saronggi
7 51365 tn. aminuddin 70 arjasa
8 51390 tn. Mat naji 63 bluto
9 51394 tn. Samsul 60 talango
10 51358 tn. Abu suud 61 ambunten
11 51408 nn. Misbahul hasanah 15 KB
12 51408 nn. Misbahul hasanah 15 KB
5/25/2019 1 51595 nn. Qory dhika 44 parsanga
2 6563 tn. A. durri 53 rubaru
3 51608 tn. Abd. Ghani 54 karangbudi
4 51573 ny. Evi purnamasari 30 dungkek
5 51609 ny. Moalma 76 sepudi
6 51602 tn. Moh. Zali 52 lenteng
7 51608 tn. Abdul ghani 54 gapura
8 25740 tn. Suriyanto 50 KT
9 50296 tn. Hamka 66 gili genting
10 36255 ny. Muria 51 gapura
11 51611 tn. Murtali 47 bluto
 Jl. Raya Kalianget No. 1
Kalianget- Sumenep - 69471
TeIp. [0328] 664350 , 667433, 661713
Fax. [0328] 667433
E-mail : rsi_garam@yahoo.co.id

TINDAKAN
OGI

TINDAKAN STATUS TARIF KET

usg tyroid bpjs Rp 123,700 rj

usg abdomen bpjs Rp 123,700 rj
usg urologi umum Rp 123,700 ri
pedis D ap/ob bpjs Rp 20,250 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
femus S ap/lat umum Rp 20,250 ri
LS ap/lat umum Rp 20,250 ri
coccyx ap/lat umum Rp 20,250 ri
thorax bpjs Rp 16,450 ri
thorax umum Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
BOF bpjs Rp 16,875 ri
usg mammae bpjs Rp 123,700 rj
usg abdomen bpjs Rp 123,700 ri
usg abdomen umum Rp 123,700 ri
urethrografi umum Rp 162,000 ri
thorax umum Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax umum Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax umum Rp 16,450 ri
thorax bpjs Rp 16,450 ri
skull Ap umum Rp 16,450 ri
thorax umum Rp 16,450 ri
usg abdomen umum Rp 123,700 ri
usg abdomen bpjs Rp 123,700 ri
usg abdomen bpjs Rp 123,700 ri
BOF, LLD umum Rp 20,250 ri
thorax umum Rp 16,450 ri
thorax umum Rp 16,450 ri
thorax bpjs Rp 16,450 ri
thorax bpjs Rp 16,450 ri
LS ap/lat umum Rp 20,250 ri
thorax umum Rp 16,450 ri
thorax umum Rp 16,450 ri