RWT JLN P. Bedah'14

PEMERINTAH KABU
RUMAH SAKIT
Jl. Sriwijaya Ridge I Tlp ( 0981 ) 21
FORM KLAIM PAS

Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
NO
:
:
:
:
:
:
:
NAMA
JANUARI 2014
RSUD BIAK
102 PASIEN
dr. IRAS B.P RUMBIAK, M Kes,SpPK
RAWAT JALAN TINGKAT LANJUT
No. MR
UMUR
THN
BLN
4
5
59
P/L
2
Tn. Fredik Wompere
3
1/194992/14
6
L
Ny. Epi Rumabar
1/191404/14
30
3
4
Ny. Yolanda Orisu

An. Hewel Sada
1/194853/14
2/140110/14
30
3
P
L
Tn. Arnold Rumkorem
1/185397/13
71
6
7
8
9
10
11
Tn.
Tn.
Tn.
Tn.
Ny.
Tn.
Petrus Ronsumbre
Dirk Wanma
Edy Krey
Aristoteles Rumbrawer
Anna Sada
Isak Krobo
2/165019/13
1/182914/13
2/178533/13
1/194959/14
1/194954/14
1/173388/13
53
55
33
31
56
29
L
L
L
L
P
L
12
13
14
15
16
Ny.
Ny.
Tn.
Tn.
Tn.
Yakomina Yapen
Yolanda Orisu
Fredik Maryen
Kusuma Rumbiak
Carei Rumbiak
2/106612/14
1/194853/14
1/192548/14
1/128446/11
1/194856/14
51
30
40
28
28
P
P
L
L
L
17
18
An. Yohan Wakris

Tn. Kusuma Rumbiak
1/159553/13
1/128446/11
11
28
L
L
19
An. Yohan Wakris
1/159553/13
11
20
An. Yehuda Korwa
1/194073/13
21
Ny. Ade Nussi
2/140887/12
29
22
Tn. Rudolf Rumaseuw
2/193305/14
29
23
24
25
Tn. Usman Manggombo

Tn. Alfeus Kafiar
An. Yehuda Korwa
1/182935/13
1/112958/11
1/194073/14
42
42
8
L
L
L
26
27
28
Tn. Alfeus Kafiar

Ny. Epi Rumabar
1/112958/11
1/191404/14
42
30
L
P
Tn. Rudolf Rumaseuw
2/193305/14
29
29
Tn. Rudolf Rumaseuw
2/193305/14
29
30
Tn. Denny Yewun
1/151167/12
29
31
Ny. Martha Wakum
1/106222/10
61
32
33
An. Yano Mirino

Tn. Paul Mara
1/193813/14
1/168374/13
3
34
L
L
34
35
36
37
38
39
40
Nn. Elisabeth Rumawak

An. Serli Wayoi
Nn. Ester Rumbiak
An. Maria Wakdomi
An. Samuel Yarangga
Ny. Kristina Mandosir
Tn. Paul Mara
2/128566/12
1/135950/12
1/193885/14
2/125700/12
1/193873/14
1/193841/14
1/168374/13
22
3
24
3
2
24
34
P
P
P
P
L
P
L
41
Ny. Elisabeth Rumawak
2/128566/11
22
42
An. Joshua Rawai
1/161323/13
43
Tn. Adelard Nahumury
1/193471/14
19
44
An. Falen Randongkir
1/193350/14
14
45
56
Tn. Fiktor Sambeka

An. Maria Wakdomi
1/193175/13
40
3
L
P
47
48
Ny. Lendra Samsandri

Tn. Arnold Rumkorem
1/193280/14
1/185397/13
62
71
P
L
49
Ny. Ade Marin
2/109679/10
32
2/125700/12
50
51
52
53
Tn. Fiktor Sambeka

Tn. Yeremias Bonggoibo
Ny. Louisa Rumbrawer
Tn. Robby Rumawak
1/193175/13
2/147893/13
1/193095/13
2/168765/13
40
32
27
43
L
L
P
L
54
55
56
57
Ny. Welmina Yafdas

Tn. Melky Sroyer
1/119630/11
1/193176/14
25
62
P
L
Ny. Emma Sabarofek

Tn. Yulius Wospakrik
1/192585/14
1/192540/14
28
44
P
L
58
An. Agnes Kmur
1/192564/14
59
60
61
62
63
Nn. Charisma Makuker

An. Aldo Rumaropen
Ny. Welmina Yafdas
Tn. Marvel Mirino
Tn. Dirk Wanma
1/117399/11
1/103521/10
1/119630/11
1/192516/14
1/182914/13
24
6
25
32
55
P
L
P
L
L
64
65
Tn. Apot Lokobal

Nn. Charisma Makuker
1/128444/12
1/117399/11
46
24
L
P
66
Nn. Ida Asyerem
2/155493/12
30
67
68
69
Tn. Rutherford Managasi

Tn. Isak Krobo
Tn. Dolfinus Ronsumbre
1/192366/14
1/173388/13
1/141150/12
38
29
33
L
L
L
70
71
Yan Korwa
An. Aldo Rumaropen
1/114597/13
1/103521/12
52
6
L
L
72
Tn. Mathias Amsyamsum
2/191240/13
53
73
74
75
76
77
An. Natalia Wanma

Tn. Efraim Inuri
Tn. Melkianus Sada
An. Aldo Rumaropen
Tn. Mathias Badi
1/191862/13
2/140203/12
1/139409/13
1/103352/13
1/189236/14
4
50
46
6
67
P
L
L
L
L
78
Tn. Alfeus Kafiar
1/112958/11
42
79
80
Ny. Debora Kmur

Tn. Alfeus Kafiar
1/194315/14
1/112958/11
28
42
P
L
81
82
Nn. Lisa Korwa

An. Lidya Mayor
1/151178/12
2/116027/13
19
9
P
P
83
Tn. Jeno Kafiar
2/119439/11
23
84
Tn. Fiktor Sambeka
1/193175/13
40
85
Ny. Corry Rumkorem
2/193115/14
59
86
Tn. Rudolf Rumaseuw
2/193305/14
29
87
Tn. Ny. Louisa Rumbrawer
1/193095/13
27
88
89
90
Nn. Ester Rumbiak

An. Serli Wayoi
Nn. Elisabeth Rumawak
1/193885/14
1/135950/12
2/128566/12
24
3
22
P
P
P
91
Ny. Martha Wakum
1/106222/10
61
92
Tn. Rudolf Rumaseuw
2/193305/14
29
93
94
Tn. Hendrikus Manggombo

Ny. Ade Nussy
1/193862/14
2/140887/12
28
29
L
P
95
96
97
An. Samuel Yarangga

Tn. Simin Wonngo
An. Yehuda Korwa
1/193873/14
1/193843/14
1/194073/14
2
36
7
L
L
L
98 Tn. Fredrik Maryen

99 Tn. Makarius Wabdaron
100 Tn. Rudolf Rumaseuw
1/192548/14
2/188667/13
2/193305/14
40
28
29
L
L
L
101 Ny Emma D Sabarofek
1/192585/14
68
102 Tn. Usman Manggombo
1/182935/13
TOTAL
PEMERINTAH KABUPATEN BIAK NUMFOR

RUMAH SAKIT UMUM DAERAH
ya Ridge I Tlp ( 0981 ) 21294 Fax ( 0981 ) 22747 BIAK PAPUA
FORM KLAIM PASIEN JAMKES PAPUA
DKTR
DIAGNOSA
ICD
7
Poli Bedah
8
Fraktur
Poli Bedah
TINDAKAN
ICD
10
11
Kontrol
RO
8908
ISK
Kontrol
Lab
8908
Poli Bedah
Poli Bedah
Tumor cruris (s)

Post op
Kontrol
Kontrol
GV
Lab
8908
8908
Poli Bedah
BPH
8908
GK
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Gow Atritis
Artritis post operatif
Trauma Infraorbita
Soft tissue sewelling susp
Trauma tumpul thorax
Nepritis
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
8908
8908
8908
8908
8908
GK
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
TB paru+HT
Septic atritis
Fr tibia pedis (D)
Fistel ani
Fr costa
Kontrol
Kontrol
Kontrol
Kontrol
8908
8908
8908
8908
RO
Poli Bedah
Poli Bedah
Closed fr radius
Fistel ani
Kontrol
Kontrol
8908
8908
Poli Bedah
Fr os radius
8908
Poli Bedah
Z 480
Kontrol
RO
Kontrol
8908
Poli Bedah
Z 480
Poli Bedah
Off hecting
Poli Bedah
Poli Bedah
Poli Bedah
Z 480
Sinositis
Z 480
Poli Bedah
Poli Bedah
Poli Bedah
Kista aterum temporalis

Nepritis
Poli Bedah
Z 480
Poli Bedah
Fr tibia terbuka
Poli Bedah
Z 480
Poli Bedah
Poli Bedah
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Post op
CKB
Nepritis
Fr radius ulnus
Z42
R51
Fr clavicula
App acute
Nepritis
Poli Bedah
Syandilitis
Poli Bedah
Fr line distal phalanx dg I
Poli Bedah
Efusi sendi
Poli Bedah
Tumor mediasis
Poli Bedah
Poli Bedah
Post orif
Fraktur challs
Poli Bedah
Poli Bedah
LBP+Lipoma
BPH
Poli Bedah
Post reposisi fraktur
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
GV
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
RO
Kontrol
RO
Kontrol
RO
Kontrol
RO
Kontrol
RO
RO
Kontrol
Kontrol
GK
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Poli Bedah
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Post orif femur (S)

ISK
Tumor tangan
Post fraktur reposisi
Colitiasis
Uretralis
Cepalgia
Post fraktur wajah
Impetigo bulosa
App acute
Septic atritis
Hemorrhoid interna gr IV
CKR
VL
Poli Bedah
Poli Bedah
Bronchitis
Susp App acute
Poli Bedah
Miyalgin
Poli Bedah
Poli Bedah
Poli Bedah
Post implant silicone

Nefrilesi
Ostelytis kronik tibula
Poli Bedah
Poli Bedah
Septic arthritis
Poli Bedah
VL
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Nepritis
Tumor mamae (D)

Fraktur tibia fibulla
Multiple VL
Susp fr patela
BPH
Poli Bedah
Tumor kepala
Poli Bedah
Poli Bedah
App acute
Cepalgia
Kontrol
Kontrol
Kontrol
Kontrol
RO
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
RO
Kontrol
RO
Kontrol
Kontrol
Kontrol
RO
Kontrol
Kontrol
RO
Kontrol
GV
8908
8908
8908
8908
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GK
Kontrol
RO
Kontrol
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
Poli Bedah
Poli Bedah
PID
Tendo
Poli Bedah
Post op
Poli Bedah
Post op
Poli Bedah
Tendo
Poli Bedah
Post op
Poli Bedah
Post op App
Poli Bedah
Poli Bedah
Poli Bedah
Cepalgia
Post op VL
Fr radius ulna
Poli Bedah
Post op App
Poli Bedah
Post op App
Poli Bedah
Poli Bedah
Laparatomi coli
Post op App
Poli Bedah
Poli Bedah
Poli Bedah
Anthebrahi spril genu (s)

App perforasi
Tendon
Poli Bedah
Poli Bedah
Poli Bedah
VL
Reposisi clavicula
Post opm fr terbuka
Poli Bedah
Post Kll
Poli Bedah
Post op fr tibia terbuka
Kontrol
Kontrol
Off htg
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Lab
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Ct Scan
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
TOTAL
Biak, 01 Februari 2014

Direktur RSUD Biak
dr. Iras B.P Rumbiak,M.Ke

NIP : 19681014 200012 2
BIAYA
12
27,500
25,500
27,500
18,000
27,500
27,500
20,000
18,000
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
25,500
JUMLAH
KETERANGAN
13
14
53,000
dr. Edo
45,500
27,500
dr. Edo
dr. Edo
65,500
dr. Dewi P
47,500
27,500
27,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
dr.
dr.
47,500
27,500
27,500
27,500
27,500
53,000
Dewi
Dewi
Dewi
Dewi
Dewi
Dewi
dr.
dr.
dr.
dr.
dr.
P
P
P
P
P
P
Edo
Edo
Edo
Edo
Edo
27,500
27,500
27,500
27,500
dr. Edo
dr. Edo
dr. I Gede
27,500
25,500
27,500
53,000
dr. I Gede
20,000
47,500
dr. Wayan W. SpB
27,500
20,000
47,500
dr. Wayan W. SpB
27,500
20,000
47,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
dr. Darien
dr. Darien
dr. Darien
47,500
dr. Wayan W. SpB
27,500
20,000
47,500
dr. Wayan W. SpB
27,500
20,000
47,500
dr. Wayan W. SpB
27,500
20,000
47,500
47,500
27,500
27,500
36,000
27,500
27,500
27,500
27,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
63,500
27,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
dr.
27,500
27,500
54,000
27,500
51,000
27,500
25,500
27,500
25,500
27,500
25,500
27,500
dr. Wayan W. SpB
81,500
dr. Wayan W. SpB
78,500
dr. Imelda
53,000
dr. Imelda
53,000
dr. Darien
53,000
dr. Wayan W. SpB
27,500
27,500
20,000
27,500
27,500
dr. Wayan W. SpB
47,500
27,500
dr. Wayan W. SpB

dr. Jonathan
27,500
20,000
47,500
27,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
Wayan
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
W.
SpB
SpB
SpB
SpB
SpB
27,500
27,500
27,500
27,500
51,000
27,500
27,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
78,500
27,500
27,500
27,500
27,500
20,000
27,500
20,000
27,500
27,500
27,500
dr.
dr.
dr.
dr.
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
106,000
27,500
dr. Michael
dr. Michael
133,500
dr. Michael
27,500
25,500
53,000
dr. Michael
dr. Michael
dr. Michael
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
SpB
SpB
SpB
SpB
47,500
dr. Edo
47,500
dr. Edo
dr. Edo
dr. Edo
dr. Imelda
dr. Wayan W. SpB
47,500
27,500
27,500
27,500
51,000
27,500
27,500
27,500
27,500
25,500
27,500
20,000
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
53,000
dr. Wayan W. SpB
47,500
dr. Oky
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
47,500
dr. Mike
78,500
27,500
638,000
665,500
27,500
27,500
27,500
27,500
Oky
Oky
Oky
Oky
dr. Mike
dr. Wayan W. SpB
dr. Wayan W. SpB
27,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB

dr. Jonathan
27,500
20,000
47,500
47,500
47,500
27,500
20,000
47,500
dr. Wayan W. SpB
27,500
20,000
47,500
27,500
27,500
dr. Imelda
dr. Wayan W. SpB
dr. Wayan W. SpB
63,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB

dr. Wayan W. SpB
27,500
27,500
20,000
27,500
20,000
27,500
20,000
27,500
27,500
27,500
36,000
27,500
20,000
27,500
20,000
dr. Jonathan
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Darien
27,500
27,500
27,500
20,000
27,500
638,000
27,500
27,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
665,500
27,500
5,286,000.00
dr. Wayan W. SpB
47,500
ak, 01 Februari 2014

Direktur RSUD Biak
B.P Rumbiak,M.Kes,SpPK
19681014 200012 2 002
PEMERINTAH KABUPA
RUMAH SAKIT U
FORM KLAIM PASIE

Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
NO
1
1
2
3
4
5
6
7
8
9
:
:
:
:
:
:
:
NAMA
FEBRUARI 2014
RSUD BIAK
78 PASIEN
No. MR
2
Tn. Marthinus Randongkir
Ny. Giri Rumaropen
Tn. Lambertus Rumaropen
Ny. Yubelina Rumpaidus
Ny. Marice Moibu
Tn. Denny Yewun
An. Maria Ronsumbre
Tn. Fredrik Maryen
Tn. Paulus Bonay
3
1/103248/10
1/195072/14
1/195961/14
1/152791/12
1/156079/12
1/151167/12
1/121188/11
1/192548/14
1/195522/14
10
An. Kores Sarewo
1/195571/14
11
Tn. Mesak Arsai
1/195515/14
12
13
14
Tn. Kusuma Rumbiak

Nn. Cicin Korwa
Tn. Simon Wenggo
15
16
17
UMUR
THN
BLN
4
5
64
26
36
24
23
29
3
40
45
P/L
6
L
P
L
P
P
L
P
L
L
10
1/128446/12
2/189322/14
2/194351/14
27
18
36
P
L
An. Yohan Wakris

Tn. Leonard Rumbarar
Tn. Noak Koibur
1/159553/13
1/104562/10
1/187796/13
6
49
26
L
L
L
18
Tn. Eliveret Mariani
1/195406/14
48
19
20
21
22
Tn. Aristoteles Rumbrawer

Ny. Giri Rumaropen
1/194959/14
1/195072/14
1/191404/14
31
26
L
P
30
84
P
P
23
24
Tn. Soleman Moriwari

Ny. Yanti Marsyom
28
26
L
P
Ny. Epi Rumabar

Ny. Geralda Mansnandifu
1/192905/14
2/194495/14
2/141436/12
25
26
27
Tn. Aristoteles Rumbrawer

Tn. Kusuma Rumbiak
Nn. Yanti Marsyam
1/194959/14
1/128446/12
2/141436/12
31
27
26
L
L
P
28
29
30
31
Charli Rumbiak
Nn. Karolina Rumayar
Tn. Fredek Maryen
Nn. Gili Rumaropen
1/194856/14
1/160830/13
1/192548/14
1/195072/14
28
33
40
34
L
P
L
P
32
Ny. Epi Rumabar
1/191404/14
30
33
34
An. Almendo Wambrauw

An. Yusmina Rumgrar
2/195112/14
1/193894/11
8
13
L
P
35
36
An. Denny Saali

Tn. Niko Mandibodibo
1/196534/14
2/195496/14
8
24
L
L
37
Tn. Fiktor Marandof
1/197100/14
40
38
An. Junior Yarangga
2/138808/12
39
40
41
42
43
44
Tn. Diyogi Korwa

Nn. Sara Rumere
Tn. Kusuma Rumbiak
Tn. Denny Yewun
Tn. Noak Koibur
An. Suryati Kafiar
2/180446/13
1/186904/14
1/128446/12
1/151167/12
1/187796/13
1/196279/14
24
24
27
26
26
6
L
P
L
L
L
P
45
46
Tn. Niko Mandibidibo

Nn. Yuliana Kmur
2/189496/14
1/196704/14
25
12
L
P
47
48
49
50
51
An. Gabriel Sanggenafa

Tn. Yan Korwa
An. Ambari Mansnandifu
Tn. Deky Rumbiak
An. Suriati Kafiar
1/196707/14
1/114597/13
1/162653/14
1/196666/14
1/196279/14
11
52
5
29
6
L
L
L
L
P
52
Tn. Niko Mandibidibo
2/189496/14
25
53
Tn. Salmon Orisu
1/127938/11
46
54
55
56
57
58
59
60
Ny. Lambertina Kaisepo

Nn. Agnes Wutoi
An. Denny Saali
An. Paul Mansnandifu
Tn. Denny Yewun
Tn.Festus Ronsumbre
Tn. Denny Yewun
1/196455/14
2/121824/13
1/196534/14
2/171389/13
1/151167/12
1/196371/14
1/151167/12
51
24
7
7
29
57
29
L
P
L
L
L
L
L
61
62
63
64
65
Nn. Ela Rumayauw

Tn. Kusuma Rumbiak
1/195439/14
1/128446/11
18
27
P
L
Tn. Saul Manam

Nn. Agnes Wutoi
An. Junior Yarangga
1/196372/14
2/121824/13
2/168808/14
39
24
4
L
P
L
66
67
An. Yohan Wakris

Niko Mandibodibo
1/159553/14
1/196244/13
6
25
L
L
68
An. Suriati Kafiar
1/196279/14
69
70
An. Paul Mansnandifu

Ny. Yosefina Sefkaur
2/171389/14
1/196192/14
7
33
L
P
71
An. Junior Yarangga
2/138808/14
72
73
74
An. Yohan Wakris

An. Meida Rumgeur
Tn. Matias Badi
1/159553/14
1/186435/14
1/189236/13
5
8
67
L
P
L
75
76
77
78
Noak Koibur
An. Paul
Saneraro Sanadi
Tn. Kusuma Rumbiak
1/187796/14
2/171389/13
1/196063/14
1/12844/11
26
7
26
27
L
L
L
L
TOTAL

a Ridge I Tlp ( 0981 ) 21294 Fax ( 0981 ) 22747 BIAK PAPUA
DKTR
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
7
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
DIAGNOSA
ICD
8
Kista backer
VL
Kontusio pasca trauma
PID+ISK
App acut
Fr tibia (D)
Gout schisan
VL
Cefalgia
Poli Bedah
Post op App
Poli Bedah
Post op App
Poli Bedah
Poli Bedah
Poli Bedah
Fistel ani
App acut
Post op laparatomi
Poli Bedah
Poli Bedah
Poli Bedah
Fr radius 1/3 (D)

Cefalgia
Poli Bedah
Frozen shoulder
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Poli Bedah
Poli Bedah
Gout atritis
Dislokasi phalanx (D)

Osteo artritis
Fionefrosis
Ulkus pedis+DM II
Reposisi fr tibia (D)
Muscle spasme
TINDAKAN
ICD
10
11
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
CT Scan
8908
8908
8908
8908
8908
8908
8908
8908
8908
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
RO
Kontrol
RO
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
Poli Bedah
Poli Bedah
Poli Bedah
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Dislokasi inter phalanx joint

Fistel ani
Subluxatio genu (D)
Trauma thorax
Fionefrosis
Fr tibia pedis (D)
Abses tibia
Poli Bedah
Fionefrosis
Poli Bedah
Poli Bedah
Fr femur (S)
Post op laparatomi
Poli Bedah
Poli Bedah
Tumor tangan
Poli Bedah
OA genu+Ruptur lingual
Poli Bedah
Post op tumor mandibula
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Poli Bedah
Poli Bedah
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Fr clavicula
Hidronefrosis
Hemoroid externa
Fistel perianel
Fr tibia (D)
Varicocole
Abses
Fr clavicula
LBP
Tumor scalp
Colelitiasis+B20
Phimosis+ISK
Fr clavicula
VL
Poli Bedah
Fraktur
Poli Bedah
Ulnus vasicarta
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Nefritis
App acut
Tumor tangan+Ganlion
Hernia urimbikalis (S)
Fraktur tibia
Cholesitis
VL
Kontrol
Kontrol
Kontrol
USG
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
USG
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
USG
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
RO
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Cholesitis
Post op fistel parineal
Dypepsia
Hidronefrosis
Post op tumor mandibula
Poli Bedah
Poli Bedah
Fraktur radius
Fr clavicula (S) 1/3 proximal
Poli Bedah
Fr mandibula
Poli Bedah
Poli Bedah
Hernia inguinalis (S)
Poli Bedah
Tumor pipi
Poli Bedah
Poli Bedah
Poli Bedah
Fr brachri (D)
Coxitas
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
VL
BPH
Varicocle (S)
Hernia inguinalis lateral (S)
Fr prox digit IV medius (D)
Post op tumor anal
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
GK
Kontrol
Kontrol
Kontrol
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
TOTAL
Biak, 01 Maret 2014
Direktur RSUD Biak
dr. Iras B.P Rumbiak,M.Kes,

NIP : 19681014 200012 2 0
BIAYA
12
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
638,000
27,500
20,000
27,500
20,000
27,500
27,500
27,500
20,000
27,500
27,500
27,500
25,500
27,500
25,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
JUMLAH
KETERANGAN
13
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
14
dr. Wayan W. SpB
dr. Darien
dr. Darien
dr. Imelda
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Edo
dr. Wayan W. SpB
665,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
47,500
27,500
27,500
dr. Wayan W. SpB

dr. Delly
dr. Delly
47,500
27,500
27,500
dr. Edo
dr. Edo
dr. Edo
53,000
dr. Edo
53,000
27,500
27,500
27,500
dr. Edo
dr. Edo
dr. Edo
dr. Wayan W. SpB
47,500
dr. Edo
dr. Delly
dr. Delly
27,500
27,500
27,500
27,500
27,500
53,000
27,500
27,500
27,500
27,500
20,000
27,500
53,000
27,500
27,500
dr. Delly
dr. Edo
80,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
47,500
dr. Edo
80,500
dr. Edo
dr. Edo
Edo
Edo
Edo
Edo
27,500
27,500
20,000
27,500
27,500
27,500
20,000
27,500
dr. Edo
dr. Mike
47,500
dr. Wayan W. SpB
53,000
dr. Wayan W. SpB
47,500
27,500
25,500
27,500
20,000
47,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
25,500
27,500
27,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
dr.
dr.
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
W.
W.
SpB
SpB
SpB
SpB
SpB
SpB
47,500
27,500
dr. Wayan W. SpB

dr. Darien
53,000
27,500
27,500
27,500
27,500
27,500
20,000
27,500
20,000
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
Wayan W. SpB
Wayan W. SpB
Wayan W. SpB
Wayan W. SpB
dr. Darien
47,500
dr. Darien
47,500
dr. Wayan W. SpB
47,500
27,500
27,500
27,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
dr.
dr.
dr.
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
W.
W.
W.
SpB
SpB
SpB
SpB
SpB
SpB
SpB
20,000
47,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
47,500
dr. Edo
47,500
27,500
dr. Edo
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB

dr. Edo
dr. Edo
47,500
27,500
20,000
27,500
27,500
20,000
27,500
20,000
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
dr.
47,500
27,500
27,500
27,500
27,500
3,371,000.00
Biak, 01 Maret 2014

Direktur RSUD Biak
B.P Rumbiak,M.Kes,SpPK
19681014 200012 2 002
dr.
dr.
dr.
dr.
Wayan
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
W.
dr. Mike
Wayan W.
Wayan W.
Wayan W.
Wayan W.
SpB
SpB
SpB
SpB
SpB
SpB
SpB
SpB
SpB
PEMERINTAH KABUP
RUMAH SAKIT U
FORM KLAIM PASI

Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
NO
:
:
:
:
:
:
:
NAMA
MARET 2014
RSUD BIAK
115 PASIEN
No. MR
1
1
2
An. Mei Manggaprouw
3
1/197399/14
2
3
4
By. Yenny Rumbiak

An. Anjelin Arwam
An. Denny Saah
1/197348/14
1/197373/14
1/196534/14
5
6
7
Ny. Penina Mamoribo

Tn. Usman Manggombo
Ny. Marthina Randongkir
8
9
10
11
12
13
14
15
UMUR
THN
BLN
4
5
2
P/L
6
P
14
8
P
P
L
2/138565/13
1/182935/13
1/152805/12
25
31
Ny. Dolly Sroyer

Ny. Delilian Yawan
Tn. Nicolas Yawan
Nn. Lowice Mnumumes
Tn. Niko Mandibindibo
An. Anjelin Arwam
Ny. Flora Pariaribo
Tn. Paulus Karubaba
1/197599/14
1/197604/14
1/197603/14
1/197592/14
2/195496/14
1/197373/14
1/197600/14
1/197671/14
52
44
5
16
25
14
35
35
P
P
L
P
L
P
P
L
16
An. Elan Rumbiak
1/197724/14
17
18
19
20
21
Ny. Dolly Sroyer

Ny. Flora Pariaribo
Tn. Elisa Koibur
Tn. Yohanes Swabra
50
42
49
45
P
P
L
L
1/197599/14
1/197600/14
2/126664/12
1/123349/14
1/152805/14
31
22
23
Tn. Yohanes Swabra

Ny. Mira Saba
2/123349/12
1/197271/14
44
41
L
P
24
25
26
27
28
29
Ny. Merry Wanimbo

Nn. Merlina Yarangga
Ny. Septina Awendu
Tn. Yohanes Swabra
Ny. Beatriks Diken
Tn. Enos Rumaropen
1/197375/14
1/197391/14
2/126397/11
1/123349/11
1/192544/14
1/140301/12
27
15
51
44
21
55
P
P
P
L
P
L
30
1/152805/12
31
31
32
33
34
Nn. Marsela Rumander

An. Nikolas Yawan
Ny. Deli Yawan
2/113714/11
1/197603/14
1/197604/14
1/152805/12
15
5
44
31
P
L
P
P
35
36
Nn. Anjelin Arwam

Tn. Yulius Baab
1/197373/14
1/128632/14
13
46
P
L
37
An. Yohan Womsiwor
1/102017/10
38
By. Frans Sada
2/195534/14
39
40
41
Tn. Obed Baab

An. Marsiki Baab
Ny. Margaretha Ohee
2/111973/11
1/197834/14
1/133831/12
52
3
17
L
L
P
42
43
44
45
An. Herman Mambyeuw

Tn. Kusuma Rumbiak
Ny. Nelli Abidondifu
An. Gloria Sroyer
1/197845/14
1/128446/11
1/138682/12
1/198044/14
12
28
46
4
L
L
P
P
46
47
48
49
50
Tn. Hais Msen

An. Erna Rumbiak
Nn. Yolanda Rumbrapuk
Tn. Elia Boseren
Ny. Purininda Warnares
2/181004/14
1/198484/14
1/197928/14
2/197852/14
2/198786/14
26
7
21
70
24
L
P
P
L
P
51
An. Keke Sombuk
1/156098/14
52
An. Matias Wambrauw
1/133906/12
53
Ny. Marthina Marandof
1/152805/12
31
54
Ny. Ros Ayorbaba
1/197934/14
45
55
56
57
Tn. Ferdinan Sada

Tn. Anas Rumsowek
1/121330/11
1/197993/14
1/152805/13
80
31
31
L
L
P
58
59
Tn. Yohanes Swabra

Ny. Arlen Mamoribo
1/123349/14
2/103271/10
45
27
L
P
60
Tn. Matias Badi
1/189236/14
65
61
62
Ny. Hais Msen

An. Mathias Wambrauw
2/181004/14
1/133906/14
25
2
P
L
63
1/152805/12
31
64
65
66
Tn. Buce Maryen

Tn. Kusuma Rumbiak
An. Nehemia Korwa
2/172586/13
1/128446/11
1/19855/14
25
28
4
L
L
L
67
Tn. Abia Rumbiak
2/194940/14
45
68
1/152805/12
31
69
By. Frans Sada
2/195534/14
70
71
72
73
Tn. Isak Inggilion

An. Angganety Korwa
Tn. Yohanes Swabra
2/198659/14
1/198579/14
1/123349/14
17
8
44
L
P
L
1/133906/14
74
75
Tn. Theo Rejauw

Nn. Anjelin Arwam
2/198397/14
1/197373/14
57
14
L
P
76
Nn. Marsela Rumander
2/113714/11
15
77
78
79
An. Daniel Mabel

Ny. Yuliance Sada
2/188133/14
1/198846/14
1/152805/12
5
30
31
L
P
P
80
81
82
83
84
85
86
87
88
89
Ny. Deasy Rawar

Ny. Bastiana Marsim
Tn. Kusuma Rumbiak
An. Arnold Rumbekwan
Ny. Yosefina Rumpaidus
An. Ayub Rumansara
Tn. Yohanes Swabra
Nn. Nursia Ronsumbre
Tn. Ferdinan Sada
2/118910/11
1/133906/14
1/198876/14
1/128446/11
2/145795/14
2/197865/14
1/199023/14
1/123349/14
2/125418/14
1/121330/11
36
2
49
28
26
38
15
55
13
80
P
L
P
L
L
P
L
L
P
L
90
91
92
93
94
95
Tn. Maikel Rumere

An.Gloria Sroyer
Tn. Yosua Rawar
Ny. Hanna Binur
An. Korina Krey
An. Frits Manfau
2/171214/13
1/198044/14
1/198825/14
2/131093/12
1/107566/14
1/199019/14
19
3
35
33
12
22
L
P
L
P
P
L
96
97
98
Ny. Sonya Mayor

Ny. Regina Mnsen
Ny. Naomi Wadibor
1/100964/10
1/199103/14
2/198400/14
51
35
35
P
P
P
An. Keke Sombuk

Ny. Deasy Rawar
Tn. Ferdinan Sada
An. Daniel Mabel
Ny. Yuliance Sada
Ny. Yustina Ronsumbre
Tn. Buce Maryen
Ny. Viay Korwa
Tn. Theo Rejauw
1/156098/14
2/118910/11
1/121330/11
2/188133/14
1/198846/14
1/179187/14
2/172586/13
1/199153/14
2/198377/14
4
37
80
5
30
22
25
32
58
P
P
L
L
P
P
L
P
L
An. Dariel Mabel
2/188133/14
109 An. Hermelino Mirino

110 An. Raine Rumbewas
111 An. Frans Sada
2/103113/10
1/145443/12
2/195534/14
14
3
1
L
P
L
112 Ny. Marthina Randongkir
1/152805/14
31
113 Tn. Yohanes Swabra

114 Tn. Leodrik Ronsumbre
115 Tn. Ferdinan Sada
1/123349/14
2/124459/11
1/121330/14
45
42
30
L
L
L
99
100
101
102
103
104
105
106
107
108
TOTAL

a Ridge I Tlp ( 0981 ) 21294 Fax ( 0981 ) 22747 BIAK PAPUA
DKTR
DIAGNOSA
ICD
7
Poli Bedah
8
Tumor punggung
Poli Bedah
Poli Bedah
Poli Bedah
CKR
App
Post op tumor
Poli Bedah
Poli Bedah
Poli Bedah
Tumor mamae
Nefritis
Post op
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Poli Bedah
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Poli Bedah
Poli Bedah
Trauma vetebral
Trauma vetebral
CKS
App
Fraktur
App
Trauma vetebral
Fraktur tibia fibula (D)
Tumor
Tumor pelvis
LBH
Post fraktur
Fraktur
VL
Fr tertutup antebrachy (S)
Susp App+Dyspepsia
TINDAKAN
ICD
10
11
Kontrol
RO
USG
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
RO
Kontrol
RO
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
RO
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Poli Bedah
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Mastitis
Combutio
Osteo arteri
Fraktur antebrachy (s)
Nefriatis
Ulnus pedis
VL digiti III
App
Fraktur
Trauma panggul
Post op
Poli Bedah
Poli Bedah
App acut
Asteo melitis
Poli Bedah
VL
Poli Bedah
Colostomy
Poli Bedah
Poli Bedah
Poli Bedah
Gout artritis
Tumor dada
VL
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Kontusio abdomen
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Orchitis
Fraktur patella (s) genu (s)
Abses gluten
App acut+Nefritis
Dislokasi
Nefritis+App acut
HT+Stroke
Nefritis
Poli Bedah
Fraktur 1/3 distal os tibia
Poli Bedah
Post op herniadectomi
Poli Bedah
VL
Poli Bedah
Tumor
Poli Bedah
Poli Bedah
Poli Bedah
Tumor pedis (s)

App acut
Post op tumor di jari
USG
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Lab
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
RO
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
USG
Kontrol
RO
Kontrol
GV
Kontrol
GV
Kontrol
USG
Kontrol
Kontrol
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
Poli Bedah
Poli Bedah
Fraktur radius ulna

Trauma tumpul thorax
Poli Bedah
BPH
Poli Bedah
Poli Bedah
Hernia scrotalis (D)
Poli Bedah
VL
Poli Bedah
Poli Bedah
Poli Bedah
Tumor kaki kiri

Fistel
Susp dislokasi siku kanan
Poli Bedah
Post amputasi
Poli Bedah
VL
Poli Bedah
Colostomy
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Post op hernia
LBP+HNP
Trauma capitis
Fraktur antebrachy (s)
Post op hernia
Poli Bedah
Poli Bedah
Post op App
Poli Bedah
Post op App
Poli Bedah
Poli Bedah
Poli Bedah
VL
App
Post op clavis
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
BPH
Post ORIF
Hernia Scratolis
VL
Fistel
BPH
Post op
Parotitis (D)+(S)
Post op
OA genu (D)
Tumor pedis (s)
GV
Kontrol
Kontrol
RO
Kontrol
GK
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
RO
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Tumor palans
Dislokasi
Fraktur costa VIII,IX
Fraktur/Off gibs
Fraktur scapulei
Post op
Poli Bedah
Poli Bedah
Poli Bedah
Tumor abdomen
App acut
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Fraktur tibia (S)

Osteo artritis
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Selulity
Poli Bedah
Poli Bedah
Poli Bedah
Post op App
Tumor pedis (S)

Post op fraktur
App acut
App acut
Tumor pedis (S)
Tumor
Post op
VL
VL
Colostomy
VL
Post op
Tumor thorax
Post op
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
RO
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
TOTAL
Biak, 01 April 2014

Direktur RSUD Biak
dr. Iras B.P Rumbiak,M.Kes,

NIP : 19681014 200012 2 0
BIAYA
JUMLAH
KETERANGAN
12
13
14
27,500
51,000
53,000
27,500
27,500
131,500
27,500
27,500
27,500
20,000
27,500
27,500
47,500
27,500
27,500
dr. Edo
dr. Wayan W. SpB
dr. Wayan W. SpB
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
47,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
53,000
dr. Wayan W. SpB
53,000
27,500
27,500
27,500
dr.
dr.
dr.
dr.
27,500
25,500
27,500
25,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
25,500
27,500
47,500
27,500
dr. Edo
dr. Edo
dr. Edo
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
W.
W.
W.
W.
SpB
SpB
SpB
SpB
SpB
SpB
SpB
SpB
Wayan W. SpB
Wayan W. SpB
Wayan W. SpB
Wayan W. SpB
dr. Jonathan
dr. Edo
dr. I Gede
53,000
106,000
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
dr. I Gede
dr. Edo
dr. Edo
dr. Edo
dr. Edo
dr. Edo
47,500
dr. Edo
47,500
27,500
dr. Edo
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
27,500
20,000
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
18,000
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
45,500
dr. Wayan W. SpB
27,500
20,000
47,500
dr. Edo
27,500
20,000
47,500
dr. Wayan W. SpB

dr. Edo
dr. Edo
47,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
25,500
27,500
27,500
27,500
27,500
27,500
53,000
27,500
27,500
27,500
dr. Edo
dr. Edo
dr. Edo
dr. Wayan W. SpB
53,000
27,500
27,500
27,500
27,500
dr. Imelda
Wayan W. SpB
Wayan W. SpB
Wayan W. SpB
Wayan W. SpB
47,500
dr.
dr.
dr.
dr.
80,500
dr. Jonathan
53,000
dr. Jonathan
47,500
dr. Jonathan
27,500
20,000
47,500
dr. Jonathan
27,500
53,000
80,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
27,500
25,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
20,000
47,500
27,500
27,500
25,500
27,500
20,000
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
53,000
dr. Imelda
47,500
27,500
27,500
20,000
27,500
dr. Imelda
dr. Imelda
47,500
dr. I Gede
27,500
20,000
47,500
27,500
27,500
27,500
27,500
dr. Wayan W. SpB

dr. Jonathan
dr. Jonathan
53,000
dr. Jonathan
47,500
dr. Wayan W. SpB
27,500
20,000
47,500
dr. Wayan W. SpB
27,500
20,000
47,500
dr.
dr.
dr.
dr.
27,500
25,500
27,500
20,000
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
SpB
SpB
SpB
SpB
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
20,000
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
27,500
27,500
27,500
20,000
27,500
27,500
dr. I Gede
dr. I Gede
47,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
dr. I Gede
dr. I Gede
dr. I Gede
dr. I Gede
dr. Wayan W. SpB
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
20,000
47,500
47,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
27,500
27,500
27,500
27,500
27,500
27,500
27,500
25,500
27,500
27,500
27,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
dr.
53,000
27,500
27,500
dr. Wayan W. SpB

dr. Jonathan
dr. Wayan W. SpB
47,500
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
27,500
20,000
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
W.
W.
W.
W.
W.
W.
W.
W.
W.
W.
W.
SpB
SpB
SpB
SpB
SpB
SpB
SpB
SpB
SpB
SpB
SpB
SpB
SpB
SpB
SpB
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
47,500
27,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
47,500
27,500
20,000
27,500
27,500
27,500
20,000
4,180,000.00
Biak, 01 April 2014

Direktur RSUD Biak
ras B.P Rumbiak,M.Kes,SpPK

NIP : 19681014 200012 2 002
PEMERINTAH KABUPATEN
RUMAH SAKIT UMUM
Jl. Sriwijaya Ridge I Tlp ( 0981 ) 21294 Fax
FORM KLAIM PASIEN JA

Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
:
:
:
:
:
:
:
APRIL 2014
RSUD BIAK
142 PASIEN
UMUR
THN
BLN
4
5
NO
NAMA
No. MR
1
1
2
Tn. Kusuma Rumbiak

Tn. Ferdinan Sada
1/128446/12
1/121330/11
27
80
L
L
1/152805/12
31
Ny. Naomi Wadobar
2/198400/14
34
5
6
7
8
Tn. Yulius Baab

An. Erna Rumbiak
An. Erna Rumbiak
Tn. Krits Manfau
1/128632/11
1/198484/14
1/198484/14
1/199019/14
45
5
5
23
L
P
P
L
9
10
11
Nn. Klarce Rumpaidus

Ny. Dorthea Amsamsyum
An. Matias Wambrauw
2/143105/12
1/115436/11
1/133906/11
22
47
2
P
P
L
12
13
14
15
Tn. Yohanes Swabra

Tn. Yosua Rawar
Tn. Ferdinan Saba
Ny. Dorthea Amsamsyum
1/123349/14
1/198825/14
1/121330/14
1/115436/11
45
35
83
47
L
L
L
P
16
17
18
19
20
21
Ny. Hanna Binur

Nn. Ivon Rumbiak
Ny. Yuliance Sada
An. Jemmy Rumaikeuw
Nn. Mona Korwa
Ny. Naomi Wadibor
2/131093/12
1/165477/13
2/198400/14
33
22
19
6
16
34
P
P
P
L
P
P
22
Ny. Yunita Wanma
1/111910/11
24
1/198846/14
2/200047/14
1/201432/14
P/L
6
23
Ny. Regina Mnsen
1/199103/14
35
24
25
26
An. Glen Bukorpioper

Tn. Yohanes Swabra
Ny. Yunita Wanma
1/199440/14
1/123349/12
1/111910/11
1
45
24
L
L
P
27
Nn. Yustina Ronsumbre
1/179187/13
22
28
Nn. Etta Sukan
1/200020/14
23
29
30
Tn. Uterk Kafiar

An. Frans Sada
1/168499/13
2/195534/14
68
1
L
L
31
32
33
34
Ny. Karolina Baab

Tn. Arnold Rumbekwan
Tn. Kusuma Rumbiak
Ny. Regina Msen
2/150736/13
2/145795/12
1/128446/12
1/199103/14
25
27
25
35
P
L
L
P
35
Tn. Elieser Bonsapia
2/199225/14
26
36
37

Tn. Yudha Mandosir
1/199440/14
2/114939/11
1
40
L
L
38
39

Nn. Yunita Wanma
2/145795/12
1/111910/11
26
24
L
P
40
An. Maria Kbarek
2/137305/13
41
42
An. Keke Sombuk

Tn. Theo Rejauw
1/156098/14
2/198397/14
4
58
P
L
43
44
45
Ny. Intan Farsan

An. Sisco Ddumapes
Ny. Yunita Wanma
2/148631/14
2/157939/13
1/111910/14
23
3
25
P
L
P
46
Tn. Yudha Mandosir
2/114939/14
41
47
48
Ny. Rebeka Rumpaidus

Tn. Ferdinan Mirino
1/133407/12
1/201216/14
57
19
P
L
49
50
Tn. Otto Wompere

Agus Rumbiak
1/201199/14
1/200594/14
29
16
L
L
51
52
53
An. Nataniel Rumbrawer

Tn. Felix Unani
Ny. Yunita Wanma
1/200589/14
2/143746/14
1/111910/11
5
27
24
L
L
P
54
Ny. Batseba Rumborias
1/152813/12
67
55
By. Frans Sada
2/195534/14
56
1/199440/14
57
58
Tn. Marthen Asyerem

An. Maria Kbarek
2/167665/14
2/137305/12
35
4
L
P
59
Ny. Yunita Wanma
1/111910/11
24
60
An. Patrick Wakum
1/200732/14
14
61
Ny. Dormina Fainserem
2/200627/14
44
62
Ny. Selina Rejauw
1/160167/13
41
63
By. Trio Pedai
1/200523/14
64
Nn. Mira Papare
1/200751/14
13
65
66
67
68
69
Tn. Jhon Rumansara

Tn. Jimmy Wakris
Tn. Daniel Mirino
An. Brian Yom
Tn. Frediks Kalem
2/193772/14
1/137852/14
1/138388/12
1/200538/14
2/164370/14
33
33
79
6
17
L
L
L
L
L
70
71
Tn. Yosep Yewun

Tn. Beren Kmur
1/200882/14
2/199221/14
33
32
L
L
72
Ny. Yunita Wanma
1/111910/11
24
73
74
75
An. Brian Yom

An. Yuliana Kespo
Tn. Frits Manufandu
1/200538/14
1/111185/11
1/199014/14
6
4
23
L
P
L
76
Ny. Intan Rumander
2/148631/12
21
77
78
79
80
81
82
Ny. Dorce Patiran

An. Keke Sombuk
Ny. Mergina Rumere
Ny. Maria Ondit
Tn. Decky Rumaropen
Tn. Yohanes Swabra
1/177131/14
1/156098/14
2/200363/14
1/200912/14
1/201021/14
1/123349/14
39
3
23
48
49
44
P
P
P
P
L
L
83
Ny. Yunita Wanma
1/111910/11
24
84
Ny. Anace Burdam
1/200370/14
56
85
Tn. Criston Womsiwor
1/200395/14
22
86
Ny. Naomi Wadibar
2/198400/14
35
87
88
89
90
Ny. Regina Mnsen

Tn. Hermanus Rumbrapuk
An. Keke Sombuk
Tn. Jhon Rumansara
1/199103/14
1/200472/14
1/156098/14
2/193772/14
35
22
3
36
P
L
P
L
91
92
93
94
95
96
97
Nn. Siska Korwa

An. Maria Kbarek
By. Trio Pedai
Tn. Marthen Asyerem
An. Briyan Yom
Tn. Leo Rejauw
Tn. Yudha Mandosir
2/139819/13
2/137305/13
1/200523/14
2/167665/13
1/200538/14
2/198397/14
2/114939/11
14
4
37
7
57
40
P
P
L
L
L
L
L
98
Ny. Yuliana Wakris
1/201364/14
30
99
100
Tn. Jhon Rumansara

Nn. Beatriks Randongkir
2/193772/14
1/201291/14
32
18
L
P
101
Tn. Gideon Lemauk
1/201272/14
33
102
An. Maxwell Manggombo
1/201243/14
12
103
104
Tn. Oktovianus Rumanyum

Tn. Frits Manufandu
1/132599/14
1/199014/14
50
23
L
L
105
Ny. Intan Rumander
2/148631/12
21
106
107
108
109
110
111
Ny. Dorce Patiran

An. Keke Sombuk
Ny. Mergina Rumere
Ny. Maria Ondit
Tn. Decky Rumaropen
Tn. Yohanes Swabra
1/177131/14
1/156098/14
2/200363/14
1/200912/14
1/201021/14
1/123349/14
39
3
23
48
49
44
P
P
P
P
L
L
112
Ny. Yunita Wanma
1/111910/11
24
113
Ny. Anace Burdam
1/200370/14
56
114
Tn. Criston Womsiwor
1/200395/14
22
115
Ny. Naomi Wadibar
2/198400/14
35
116
117
118
Ny. Regina Mnsen

Tn. Hermanus Rumbrapuk
An. Keke Sombuk
1/199103/14
1/200472/14
1/156098/14
35
22
3
P
L
P
119
Tn. Jhon Rumansara
2/193772/14
36
120
121
122
123
124
125
126
Nn. Siska Korwa

An. Maria Kbarek
By. Trio Pedai
Tn. Marthen Asyerem
An. Briyan Yom
Tn. Leo Rejauw
Tn. Yudha Mandosir
2/139819/13
2/137305/13
1/200523/14
2/167665/13
1/200538/14
2/198397/14
2/114939/11
14
4
37
7
57
40
P
P
L
L
L
L
L
127
Ny. Yuliana Wakris
1/201364/14
30
128
129
Tn. Jhon Rumansara

Nn. Beatriks Randongkir
2/193772/14
1/201291/14
32
18
L
P
130
Tn. Gideon Lemauk
1/201272/14
33
131
An. Maxwell Manggombo
1/201243/14
12
132
133
134
Tn. Oktovianus Rumanyum

Tn. Everd Kay
Ny. Intan Ramander
1/132599/14
2/153583/14
2/148631/12
50
35
21
L
L
P
135
136
137
138
139
140
An. Jimmy Rumaikeuw

Ny. Dorce Patirai
Nn. Wihelmina Rumaropen
Ny. Ice Kafiar
An. Suley Kayoi
Tn. Noak Rumbarar
2/200017/14
1/177131/14
2/125400/11
1/107102/10
2/201182/14
1/196074/14
6
40
14
45
10
69
L
P
P
P
L
L
141
142
Tn. Yakob Mansawan

Tn. Decky Rumaropen
1/201529/14
1/201021/14
48
49
L
L
TOTAL
MERINTAH KABUPATEN BIAK NUMFOR

idge I Tlp ( 0981 ) 21294 Fax ( 0981 ) 22747 BIAK PAPUA
DKTR
DIAGNOSA
ICD
TINDAKAN
ICD
BIAYA
7
Poli Bedah
Poli Bedah
8
Fraktur
10
11
12
Post tumor pedis
8908
8908
27,500
27,500
20,000
Poli Bedah
Tumor
8908
27,500
20,000
Poli Bedah
Post App
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
RO
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
RO
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
8908
27,500
20,000
8908
8908
27,500
27,500
20,000
27,500
25,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
25,500
27,500
27,500
27,500
27,500
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Poli Bedah
Poli Bedah
Poli Bedah
Post op
Tumor
Fraktur genu
HNP
Post op HIL
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Post op fr antebrachy
Fr costal VII&IX (s)
Post op tumor pedis (s)
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Fraktur antebrachy (S)

PID
PID+Post App
Fraktur radius ulna (s) 1/3
PID
Post op App
Poli Bedah
Post op tumor mamae (D)
Osteo arthristis
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
27,500
27,500
20,000
27,500
20,000
Poli Bedah
Post App
Poli Bedah
Poli Bedah
Poli Bedah
Kista dermoid+Ispa
Post fraktur radius ulna
Post op tumor mamae
Poli Bedah
Post op App
Poli Bedah
Post op App
Poli Bedah
Poli Bedah
Buker's cyst cruris (S)
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Post op colostomi
Tumor
Tumor penis
Fistula ani
Post op App
Poli Bedah
VL
Poli Bedah
Poli Bedah
Tumor telinga
Post op
Poli Bedah
Poli Bedah
Tumor penis
Post op
Poli Bedah
VL
Poli Bedah
Poli Bedah
Post op
BPH
Poli Bedah
Poli Bedah
Poli Bedah
App acut
Tumor
Post op tumor mamae
Poli Bedah
VL
Poli Bedah
Poli Bedah
Tumor
VL
Poli Bedah
Poli Bedah
Cholesistitin
Fraktur tibia
Poli Bedah
Poli Bedah
Poli Bedah
Post op mammae
Poli Bedah
Nefritis
Abses
Acute urchitris
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GK
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
RO
Kontrol
Kontrol
Kontrol
GV
Kontrol
8908
8908
8908
8908
27,500
20,000
27,500
27,500
27,500
20,000
8908
27,500
20,000
8908
27,500
20,000
27,500
8908
8908
27,500
20,000
8908
8908
8908
8908
27,500
27,500
27,500
27,500
20,000
8908
27,500
20,000
8908
8908
27,500
27,500
20,000
8908
8908
27,500
27,500
20,000
8908
27,500
20,000
8908
8908
27,500
27,500
20,000
8908
8908
8908
27,500
27,500
27,500
20,000
27,500
20,000
8908
8908
8908
8908
8908
8908
8908
8908
8908
27,500
27,500
20,000
27,500
27,500
25,500
27,500
27,500
27,500
20,000
27,500
Poli Bedah
Post op colestomy
Poli Bedah
Trauma artriculer
Poli Bedah
Poli Bedah
Nefrolitis
Poli Bedah
Post op mammae
Poli Bedah
VL
Poli Bedah
Fr radius ulna (s)
Poli Bedah
Post op App
Poli Bedah
Dislokasi bahu kiri
Poli Bedah
Fr terbuka digiti III (D)
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
VL
Post ORIF
Nefrolitis (D)
Post op App
Post fraktur
VL
Poli Bedah
Poli Bedah
Chepalgia
Trauma thorax
Poli Bedah
Post op mammae
Poli Bedah
Poli Bedah
Poli Bedah
Post fraktur
Fr distal ulna (s)
Abses punggung
Poli Bedah
Post op App
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Abses abdomen
Fr tungkai kiri
Post op App
Selulitis+Gout arthritis
Trauma tumpul
Fr radius ulna
Poli Bedah
Post op mammae
Poli Bedah
Osto arthritis
Poli Bedah
Abses
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
RO
Kontrol
GV
Kontrol
RO
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
RO
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
RO
Kontrol
GV
Kontrol
RO
Kontrol
8908
27,500
20,000
8908
27,500
20,000
27,500
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
27,500
20,000
27,500
20,000
27,500
20,000
27,500
25,500
27,500
20,000
27,500
25,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
25,500
27,500
20,000
27,500
27,500
27,500
20,000
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
25,500
27,500
20,000
27,500
25,500
27,500
Poli Bedah
Post op App
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Post op App
Orchitis
Fraktur tibia
Fr tibia S 1/3 distal
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Tonsilitis
Fraktur femur (D)
Dislokasi bahu (D)
Nefrolitis
Greeshick fraktur
BPH
VL
Poli Bedah
Pychofritis
Poli Bedah
Poli Bedah
Post ORIF
App
Poli Bedah
Sinusitis
Poli Bedah
Fraktur genu (D)
Poli Bedah
Poli Bedah
Fraktur ORIF
Abses punggung
Poli Bedah
Post op App
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Abses abdomen
Fr tungkai kiri
Post op App
Selulitis+Gout arthritis
Trauma tumpul
Fr radius ulna
Poli Bedah
Post op mammae
Poli Bedah
Osto arthritis
Poli Bedah
Abses
Poli Bedah
Post op App
Poli Bedah
Poli Bedah
Poli Bedah
Post op App
Orchitis
Fraktur tibia
RO
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
RO
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
USG
Kontrol
Kontrol
USG
Kontrol
CT Scan
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
RO
Kontrol
GV
Kontrol
RO
Kontrol
RO
Kontrol
GV
Kontrol
Kontrol
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
25,500
27,500
20,000
27,500
27,500
27,500
27,500
25,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
53,000
27,500
27,500
53,000
27,500
680,000
27,500
20,000
27,500
27,500
20,000
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
25,500
27,500
20,000
27,500
25,500
27,500
25,500
27,500
20,000
27,500
27,500
27,500
Poli Bedah
Fr tibia S 1/3 distal
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Tonsilitis
Fraktur femur (D)
Dislokasi bahu (D)
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Nefrolitis
Greeshick fraktur
BPH
VL
Poli Bedah
Pychofritis
Poli Bedah
Poli Bedah
Post ORIF
App
Poli Bedah
Sinusitis
Poli Bedah
Fraktur genu (D)
Poli Bedah
Poli Bedah
Poli Bedah
Fraktur ORIF
Ca rongga mulut
Post op App
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Poli Bedah
Poli Bedah
Post op fraktur tangan kiri

Post op App
Tumor mandibula
Gangren DM
Post reposisi
Tumor genu (D)
Cedera Kepala Sedang
Hematom traumalic
Kontrol
RO
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
USG
Kontrol
Kontrol
USG
Kontrol
CT Scan
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
27,500
25,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
53,000
27,500
27,500
53,000
27,500
680,000
27,500
20,000
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
TOTAL
Biak, 01 Mei 2014

Direktur RSUD Biak
dr. Iras B.P Rumbiak,M.Kes,SpPK

NIP : 19681014 200012 2 002
JUMLAH
KETERANGAN
13
27,500
14
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
47,500
dr. Edo
47,500
dr. Wayan W. SpB
27,500
27,500
47,500
dr. Wayan W. SpB
53,000
27,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
47,500
27,500
27,500
27,500
dr. Wayan W. SpB

dr. Michael
dr. Michael
dr. Wayan W. SpB
53,000
27,500
27,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
dr. Edo
Wayan W.
Wayan W.
Wayan W.
Wayan W.
dr. Edo
SpB
SpB
SpB
SpB
47,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
47,500
27,500
27,500
dr. Wayan W. SpB

dr. Delly
dr. Delly
47,500
dr. Delly
47,500
dr. Delly
47,500
27,500
dr. Delly
dr. Wayan W. SpB
47,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
47,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB

dr. Wayan W. SpB
27,500
47,500
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
SpB
SpB
SpB
SpB
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB

dr. Wayan W. SpB
27,500
47,500
27,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB

dr. Wayan W. SpB
47,500
27,500
dr. Edo
dr. Edo
53,000
27,500
27,500
dr. Darien
dr. Darien
dr. Darien
47,500
27,500
dr. Darien
dr. Edo
47,500
dr. Edo
47,500
27,500
dr. Edo
dr. Edo
47,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
53,000
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
53,000
dr. Wayan W. SpB
47,500
27,500
dr. Wayan W.
dr. Edo
dr. Wayan W.
dr. Wayan W.
dr. Wayan W.
27,500
27,500
27,500
47,500
SpB
SpB
SpB
SpB
27,500
dr. Wayan W. SpB

dr. Edo
53,000
dr. Edo
47,500
27,500
27,500
dr. Oki
dr. Wayan W. SpB
dr. Oki
47,500
dr. Dewi
47,500
27,500
27,500
27,500
27,500
27,500
dr. Dewi
dr. Wayan W. SpB
dr. Dewi
dr. Oki
dr. Wayan W. SpB
dr. Oki
53,000
dr. Darien
47,500
dr. Edo
53,000
dr. Edo
53,000
dr. Edo
47,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
Edo
Edo
Edo
Edo
53,000
27,500
27,500
27,500
27,500
27,500
27,500
dr. Edo
dr. Edo
dr. Edo
dr. Edo
dr. Wayan W. SpB
dr. Edo
dr. Wayan W. SpB
47,500
dr. Edo
80,500
27,500
dr. Edo
dr. Edo
80,500
dr. Edo
707,500
dr. Wayan W. SpB
47,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
47,500
dr. Dewi
47,500
27,500
27,500
27,500
27,500
27,500
dr. Dewi
dr. Wayan W. SpB
dr. Dewi
dr. Oki
dr. Wayan W. SpB
dr. Oki
53,000
dr. Darien
47,500
dr. Edo
53,000
dr. Edo
53,000
dr. Edo
47,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
Edo
Edo
Edo
Edo
53,000
27,500
27,500
27,500
27,500
27,500
27,500
dr. Edo
dr. Edo
dr. Edo
dr. Edo
dr. Wayan W. SpB
dr. Edo
dr. Wayan W. SpB
47,500
dr. Edo
80,500
27,500
dr. Edo
dr. Edo
80,500
dr. Edo
707,500
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
27,500
27,500
47,500
27,500
27,500
27,500
27,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
47,500
27,500
27,500
6,706,500.00
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
Mei 2014
SUD Biak
biak,M.Kes,SpPK
4 200012 2 002
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
PEMERINTAH KABUPATEN B
RUMAH SAKIT UMUM D
Jl. Sriwijaya Ridge I Tlp ( 0981 ) 21294 Fax (
FORM KLAIM PASIEN JAMK

Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
:MEI 2014
: RSUD BIAK
:
:
: 76 PASIEN
: dr. IRAS B.P RUMBIAK, M Kes,SpPK
: RAWAT JALAN TINGKAT LANJUT
NO
NAMA
No. MR
1
1
2
UMUR
THN
BLN
4
5
P/L
6
3
4
Ny Ariance Saflembolo
Nn Beatriks Randongkir
Tn Yansen Korano
Tn Edi Kafiar
An Fransiska F. Marandof
1/102598/14
1/201291/14
2/201235/14
2/145693/12
1/201984/14
50
18
41
19
11
P
P
L
L
P
Tn Jhon Rumansara
2/193772/14
33
Nn Mergina Rumere
2/200363/14
23
7
8
Tn Dedi Rumbarar
Tn Eddy Kafiar
1/201801/14
2/145693/12
44
21
L
L
9
10
11
Nn Anna R. Korwa
Ny Fransiska Wambrauw
Tn Theo Rejauw
2/165922/13
1/201990/14
2/198397/14
17
84
57
P
P
L
12
13
14
15
Tn Kusuma Rumbiak
An Paul Maran
Ny Blandina Mandowen
Tn evert Kay
1/128446/12
2/147218/14
1/110812/11
2/153583/14
28
3
31
37
L
L
P
L
16
17
An Paul Maran
An Indri Awom
1/147218/12
2/136180/14
2
6
l
P
18
An Maria Ronsumbre
1/121188/12
19
Ny Yebelina Farwas
1/202324/14
41
20
Tn Marthen Yawan
2/161463/14
45
21
Ny Martha sroyer
1/147231/12
40
22
An fajar Rumansara
1/161144/14
11
P
L
L
23
An Demianus Rumbiak
1/202284/14
24
An Maria Ronsumbre
1/121188/12
P
P
25
26
27
Tn evert Kay
NY Nela Korwa
An Elisabeth Mofu
2/153583/14
1/125739/12
1/202478/13
37
49
10
L
P
P
28
29
30
31
Tn Yunus warwer
Ny Levina Bokorsyom
NY Betseba Rumborias
Ny martha Ap
2/121449/11
2/202301/14
1/152813/14
1/202617/14
29
69
62
69
L
P
P
P
32
Ny Yebelina Farwas
1/202324/14
41
33
An Maria Ronsumbre
1/121188/12
34
35
An Demianus Rumbiak
1/202284/14
Tn Marthen Yawan
2/161463/14
45
36
Oridek Ronsumbre
1/163015/14
17
37
38
Tn Kusuma Rumbiak
An fajar Rumansara
1/128446/11
1/161144/14
28
11
L
L
39
40
Ny Agustina Maryen
By Frans Sada
1/201991/14
2/195534/14
29
41
Tn Yehezkiel Ap
1/202621/14
48
42
Ny Dessi Dimara
1/202582/14
25
43
Ny Marieta Mofu
1/202616/14
45
44
Oridek Ronsumbre
1/163015/14
16
45
Tn Marthen Yawan
2/161463/14
45
10
P
L
46
An Maria Ronsumbre
1/121188/12
47
Tn Jhon Rumansara
2/193772/14
33
48
Oridek Ronsumbre
1/163015/14
16
49
50
Ny Nella Korwa
48
An Maria Ronsumbre
1/125739/11
1/121188/12
51
Ny Agustina Maryen
1/201991/14
29
52
Ny Dessi Dimara
1/202582/14
25
53
54
55
56
57
Frits Manfau
Tn Isak Randongkir
Tn Kusuma Rumbiak
Ny Septina Awendu
Tn Titus Awantano
1/199019/14
1/155876/14
1/128446/11
2/12639/11
1/104383/10
23
51
28
50
44
L
L
L
P
L
58
59
An Paul Maran
Tn Jhon Rumansara
1/147218/12
2/193772/14
2
33
l
L
60
Tn Fredi Manufandu
2/202944/14
49
61
62
63
Ny Nella Korwa
1/125739/11
48
Tn Isak Randongkir
Tn Simon Mansawan
1/155876/14
2/193440/14
51
53
L
L
64
65
66
Ny Milka Kararbo
Tn Isak Randongkir
Tn Kusuma Rumbiak
1/203093/14
1/155876/14
1/128446/11
63
51
28
P
L
L
67
By Rian Rejauw
2/202959/14
68
By Frans Sada
2/195534/14
10
69
Tn Klaas Rumbewas
2/174161/13
31
70
71
An Eli Rumbrawer
Ny Agustina Maryen
2/203277/14
1/201991/14
13
29
L
P
72
73
Ny Theresia Tompo
Tn Israel Rumaropen
1/203228/14
2/179614/14
38
46
P
L
74
Ny Milka Kararbo
1/203093/14
63
75
76
Ny Nella Korwa
1/125739/11
48
Tn Efradus Faidiban
1/203087/14
22
TOTAL
INTAH KABUPATEN BIAK NUMFOR

UMAH SAKIT UMUM DAERAH
I Tlp ( 0981 ) 21294 Fax ( 0981 ) 22747 BIAK PAPUA
M KLAIM PASIEN JAMKES PAPUA
DKTR
Poli
Poli
Poli
Poli
Poli
7
Bedah
Bedah
Bedah
Bedah
Bedah
Poli Bedah
Poli Bedah
DIAGNOSA
ICD
TINDAKAN
ICD
BIAYA
8
Osteomilits
10
11
12
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Lab
GV
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
8908
8908
Kontrol
GV
PID
Malaria
Susp. App Akut
Tumor Oceh
Post Op Fraktur
Post op
Poli Bedah
Poli Bedah
Artritis
Apendicitis Akut
Poli Bedah
Poli Bedah
Poli Bedah
Hernia Latercelis
Tumor
AFF Cateter
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Abses Ani
Hernia
Susp App Akut
Tumor
Poli Bedah
Poli Bedah
Hernia
OMA
Poli Bedah
Post Op Bibir sumbing
8908
27,500
27,500
27,500
27,500
27,500
8908
20,000
27,500
8908
8908
20,000
27,500
8908
20,000
27,500
27,500
36,000
27,500
27,500
27,500
54,000
20,000
27,500
27,500
27,500
27,500
8908
8908
20,000
27,500
27,500
8908
27,500
8908
8908
8908
8908
8908
8908
8908
20,000
Poli Bedah
Post Op hernia
Poli Bedah
Post Op Tumor
Poli Bedah
Poli Bedah
Poli Bedah
Poli Bedah
Poli Bedah
Poli Bedah
Poli Bedah
Poli Bedah
Poli Bedah
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Poli Bedah
Post Op Tumor
Post Op hernia
Post Op hernia
Ca Rongga Mulut
Post Reposisi
AbsesPeranal
Post Op Cks
ISK + Dermatitis
Post Op Tumor
Post Op hernia
Poli Bedah
Poli Bedah
Poli Bedah
Post Op hernia
Post Op Tumor
Poli Bedah
Post Op tumor kepala
Poli Bedah
Poli Bedah
Abses Ani
Post Op hernia
Poli Bedah
Poli Bedah
Neroplamat
Colostomy
Poli Bedah
Post Op App
Poli Bedah
Post Op Exici Lipoma
Poli Bedah
Post Op App
Poli Bedah
Tumor Kepala
Poli Bedah
Post Op Tumor
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
8908
27,500
8908
20,000
27,500
8908
20,000
27,500
8908
20,000
27,500
8908
20,000
27,500
8908
20,000
27,500
8908
8908
8908
20,000
27,500
27,500
27,500
8908
8908
8908
8908
20,000
27,500
27,500
27,500
27,500
8908
20,000
27,500
8908
20,000
27,500
8908
8908
20,000
27,500
27,500
8908
20,000
27,500
8908
8908
20,000
27,500
27,500
Kontrol
GV
Kontrol
GV
Kontrol
GV
8908
8908
8908
8908
8908
8908
20,000
27,500
27,500
20,000
27,500
20,000
27,500
20,000
27,500
20,000
27,500
8908
20,000
27,500
20,000
Poli Bedah
Post Op Bibir Sumbing
Poli Bedah
Post Op Fraktur
Poli Bedah
Tumor Kepala
Poli Bedah
Poli Bedah
Post Reposisi
Poli Bedah
Poli Bedah
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah

Neroplamat
Post Op Exici Lipoma
Hill
OA
Abses Ani
Tumor Kaki
Post Op App
Poli Bedah
Poli Bedah
Hernia
Post Op Fraktur
Poli Bedah
Post Op App
Poli Bedah
Poli Bedah
Poli Bedah
Poli Bedah
Poli Bedah
Poli Bedah
Post Reposisi
OA
HNP
Coles Fraktur
OA
Abses Ani
Poli Bedah
Abses Mandibula
Poli Bedah
Kolestomi
Poli Bedah
Dislokasi Bahu
Poli Bedah
Poli Bedah
Trauma Oculi
Neroplamat
Poli Bedah
Poli Bedah
Cedera Vertebra
Dislokasi Bahu
Poli Bedah
Coles Fraktur
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Radiologi
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
8908
Kontrol
Radiologi
Kontrol
Kontrol
GV
Kontrol
Kontrol
RO
Kontrol
RO
8908
27,500
20,000
27,500
8908
8908
8908
20,000
27,500
20,000
27,500
27,500
20,000
27,500
8908
8908
8908
20,000
27,500
20,000
27,500
27,500
27,500
27,500
27,500
8908
8908
20,000
27,500
27,500
8908
8908
20,000
27,500
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
20,000
27,500
27,500
27,500
25,500
27,500
27,500
27,500
20,000
27,500
20,000
27,500
27,500
25,500
27,500
27,500
20,000
27,500
27,500
25,500
27,500
25,500
Poli Bedah
Poli Bedah
Post Reposisi
Orchitis
Kontrol
Kontrol
8908
8908
27,500
27,500
TOTAL
Biak, 01 Juni 2014

Direktur RSUD Biak

NIP : 19681014 200012 2 002
JUMLAH
KETERANGAN
13
14
dr. Wayan W. SpB
dr. Wayan W. SpB
dr Benyamin
dr Benyamin
dr I Wayan W.SpB
27,500
27,500
27,500
27,500
47,500
dr. Wayan W. SpB

47,500
dr. Wayan W. SpB
47,500
27,500
63,500
27,500
27,500
101,500
27,500
27,500
27,500
47,500
27,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr Darien
dr Darien
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB

47,500
dr. Wayan W. SpB

47,500
dr Darien
47,500
dr Darien
47,500
dr Darien
47,500
dr Darien
47,500
dr Darien
47,500
27,500
27,500
47,500
27,500
27,500
27,500
dr Imelda
dr Oki
dr Imelda
dr Oki
dr Dewi
dr Dewi
dr Darien
47,500
dr Dewi
47,500
dr. Wayan W. SpB
47,500
27,500
dr Michael
dr Michael
47,500
dr Michael
47,500
27,500
47,500
27,500
dr Darien
dr Michael
dr Darien
dr Darien
47,500
dr Darien
47,500
dr Michael
47,500
dr Dewi
47,500
dr oki
47,500
dr Oki
47,500
dr Oki
47,500
dr Dewi
47,500
dr Darien
47,500
27,500
dr Darien
dr Darien
47,500
dr. Wayan w.SpB
47,500
dr. Wayan w.SpB
47,500
27,500
27,500
27,500
27,500
47,500
27,500
dr.
dr.
dr.
dr.
dr.
Wayan w.SpB
Wayan w.SpB
Wayan w.SpB
Wayan w.SpB
Wayan w.SpB
dr. Wayan w.SpB

dr. Wayan w.SpB
47,500
dr. Wayan w.SpB
47,500
27,500
27,500
53,000
27,500
27,500
dr. Wayan w.SpB

dr. Wayan w.SpB
dr. Wayan w.SpB
dr Oki
dr Oki
dr Oki
47,500
dr Oki
47,500
27,500
dr. Wayan W. SpB
dr. Wayan W. SpB

53,000
27,500
47,500
27,500
dr Oki
dr. Oki
dr Oki
dr Oki
53,000
dr Oki
53,000
27,500
27,500
3,049,500.00
Juni 2014
RSUD Biak
biak,M.Kes,SpPK
4 200012 2 002
dr Oki
dr. Oki
PEMERINTAH KABUPATE
RUMAH SAKIT UMU
Jl. Sriwijaya Ridge I Tlp ( 0981 ) 21294 F
FORM KLAIM PASIEN J

Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
:
:
:
:
:
:
:
JUNI 2014
RSUD BIAK
61 PASIEN
UMUR
THN
BLN
4
5
NO
NAMA
No. MR
1
1
Ny Enderyeta Warnares
1/102612/11
52
2
3
Tn Fredi Manufandu
Frits Manfau
2/202944/14
1/199019/14
49
23
L
L
Ny Milka Kararbo
Tn Firman Rumsarwir
Tn Konor Mandosir
Tn Paulus Mirino
An Ferderika Koibur
Nurul Ascia Saba
Tn Mathias Badi
1/203093/14
2/144518/14
63
24
23
31
10
40
P
L
L
L
P
P
L
4
5
6
7
8
9
10
1/204272/14
1/204273/14
2/141739/14
1/204057/14
1/194444/14
P/L
6
11 Ny Mince Yarangga
1/152833/13
34
12 An Alfonsina Marsyom
1/192075/14
13 Tn Ayub Marsyom
2/204167/14
50
Ny Milka Kararbo
Tn Adolof Waramori
Ny Nella Korwa
1/203093/14
1/204470/14
1/125739/11
63
59
48
P
L
P
Tn Ayub Marsyom
2/204167/14
50
Tn meliaki manggaprow
An Yunita Mansawan
Ny Yunita Wanma
Tn Alfian Randongkir
2/203935/14
2/204421/14
1/111910/14
2/172609/14
17
6
25
23
P
P
P
L
1/204735/14
51
14
15
16
17
17
18
19
20
21 Ny fince Wambrauw
22 Ny Oktovina Dawan
1/144620/14
50
23
24
25
26
27
28
Nn Ester Wenda
Nn Kesya Krey
2/201098/14
1/204715/14
9
18
P
P
Ny Milka Kararbo
Frits Manfau
An adolof Rumbiak
Ny Ice Kafiar
1/203093/14
1/199019/14
2/110162/14
1/107102/14
63
23
7
P
L
L
P
29
30
31
32
33
34
35
36
37
38
Ny Nella Korwa
1/125739/11
48
Ny selvi Mambiuw
Ny Yubelina tanati
An Yunita Mansawan
Tn George Rumere
Ny Leni wakum
Tn adolof Wanma
Nn Fitri Randongkir
Tn Kusuma Rumbiak
Tn matius Ngutra
2/204314/14
1/204998/14
2/204421/14
65
45
6
40
37
46
21
28
21
P
P
P
L
P
L
P
L
L
39 Tn Roi R Rumbewas
40 Disyon kararbo
41 Tn Jhon Rumansara
1/202208/14
55
19
33
L
L
L
42 An Yunita Mansawan
43 Tn salomo sawor
2/204421/14
1/137034/12
6
68
P
L
44 Tn bernadus Rumere
45 Tn yulianus Burdam
46 Tn aleander kawer
1/188472/13
1/102798/10
2/204539/14
70
37
25
L
L
L
47 Ny Ribka S arwam
48 Ny Irene wakum
1/205471/14
2/205215/14
30
37
P
P
49 Nn Trivena Rumaropen
1/205511/14
15
50 An Aron Bonggoibo
1/205526/14
51 Ny Nelfince Koibur
2/185098/14
46
52
53
54
55
56
57
58
2/195534/14
1/164150/14
2/204314/14
2/142018/14
2/193772/14
2/163267/14
1
40
65
39
33
P
L
L
L
P
L
L
By Frans Sada
Tn Obaja Rumaseb
Ny selvi Mambieuw
Tn Laban Pahabol
Tn Jhon Rumansara
Tn Yan petrus rayar
Ny Titi Y Ngerjaratan
2/152634/12
1/205163/14
2/205087/14
1/204309/14
1/128446/11
2/121922/14
1/205292/14
2/193772/14
1/205654/14
45
25
L
P
L
59 Tn yulianus Burdam
60 Tn Kusuma Rumbiak
61 Tn Elias Baransano
1/102798/10
37
1/128446/11
1/202908/14
28
L
P
TOTAL

DKTR
DIAGNOSA
ICD
TINDAKAN
ICD
BIAYA
7
Poli Bedah
8
Tumor ooli
10
11
12
Poli Bedah
Poli Bedah
Post Op Orif
Bronchitis
Kontrol
Radiologi
Kontrol
Kontrol
Radiologi
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
USG
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Coles Fraktur
Tumor Genue
neorolis
Osteomilits
Uretrocitis
Tumor
BPH
Poli Bedah
Nefrotiasis
Poli Bedah
Vulnus Laceratum
Poli Bedah
Post Op Tumor
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Coles Fraktur
Post Stroke NHS
Post Reposisi
Post Op Tumor
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Dermatitis
Post orif
celulitis
Fraktur colles
Poli Bedah
APP acut +nefritis
27,500
25,500
27,500
27,500
25,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
53,000
27,500
20,000
27,500
20,000
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
20,000
27,500
Poli Bedah
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Trauma panggul
Cedera kepala
nefritis
Coles Fraktur
TB Tulang Pevis
Korpus Alineum
Ganggren DM
Post Reposisi
Fraktur Mandibula
LBP
Post orif
Cedera kepala
PID
Open Fraktur
Cepalgia
Abses Ani
Fraktur genue
Poli Bedah
Poli Bedah
Poli Bedah
Mialgia
Tumor Pelvis
Orchitis
Poli Bedah
Poli Bedah
Post orif
BPH
Poli Bedah
Poli Bedah
Poli Bedah
Trauma
Fraktur Tibia
Post tumor Thyroid
Poli Bedah
Poli Bedah
LBP
Post Op App
Poli Bedah
Susp APP akut
Poli Bedah
Vulnus laceratum
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Vulnus laceratum
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Kolestomi
osteomilits
Tumor mailla
Gaout Artritis
Orchitis
Hernia
Vulnus laceratum
Kontrol
Radiologi
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Radiologi
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
USG
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
USG
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
27,500
25,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
25,500
27,500
27,500
27,500
20,000
27,500
27,500
53,000
27,500
27,500
27,500
20,000
27,500
27,500
20,000
27,500
53,000
27,500
20,000
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
Poli Bedah
Poli Bedah
Poli Bedah
Fraktur Tibia
Abses Ani
Fraktur Radius Ulna
Kontrol
Kontrol
Kontrol
8908
8908
8908
27,500
27,500
27,500
TOTAL
Biak, 01 Juli 2014

Direktur RSUD Biak

NIP : 19681014 200012 2 002
JUMLAH
KETERANGAN
13
14
dr. Wayan W. SpB
53,000
27,500
dr. Wayan w.SpB

dr. Wayan w.SpB
53,000
27,500
27,500
27,500
27,500
27,500
27,500
dr.
dr.
dr.
dr.
dr.
dr.
dr.
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
W.
W.
W.
SpB
SpB
SpB
SpB
SpB
SpB
SpB
47,500
dr. Wayan W. SpB
80,500
dr Delly
47,500
dr Lato
47,500
27,500
27,500
27,500
47,500
27,500
27,500
27,500
47,500
27,500
dr Lato
dr Jonatan
dr Jonatan
dr Jonatan
dr Benny Ap
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB

53,000
27,500
27,500
27,500
27,500
27,500
47,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan w.SpB
dr. Wayan w.SpB
dr Michael
dr Delly
dr. Wayan w.SpB
dr. Wayan w.SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan w.SpB
dr Jonatan
53,000
27,500
27,500
47,500
27,500
80,500
27,500
27,500
47,500
27,500
dr Benny Ap
dr. Wayan w.SpB
dr. Wayan w.SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr Lato
dr Lato
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
47,500
dr Delly
80,500
dr Delly
47,500
dr. Wayan W. SpB
47,500
27,500
27,500
27,500
27,500
27,500
27,500
47,500
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
dr Jonatan
dr. Wayan w.SpB
dr. Wayan w.SpB
dr. Wayan w.SpB
27,500
27,500
27,500
2,206,000.00
uli 2014
SUD Biak
biak,M.Kes,SpPK
4 200012 2 002
dr Delly
dr Delly
dr Delly
PEMERINTAH KABUPATEN
RUMAH SAKIT UMUM
Jl. Sriwijaya Ridge I Tlp ( 0981 ) 21294 Fax
FORM KLAIM PASIEN JAM

Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
NO
:
:
:
:
:
:
:
NAMA
1
1
2
3
4
5
Tn Aleks koibur
Tn Kusuma Rumbiak
By Frans Sada
Tn yulianus Burdam
JULI 2014
RSUD BIAK
68 PASIEN
No. MR
3
UMUR
THN
BLN
4
5
P/L
6
57
28
1
37
L
L
L
L
An Martha Rumbarak
2/201861/14
1/128446/11
2/195534/14
1/102798/10
2/206265/14
14
Ny Paulina Duwiri
2/203798/14
55
An Lisa Wambrauw
2/205780/14
10
8
9
10
Ny Paulina Duwiri
Tn Jhon Rumansara
55
33
P
L
Ny Paulina Duwiri
2/203798/14
2/193772/14
2/203798/14
55
11
12
13
14
15
16
Tn yulianus Burdam
1/102798/10
37
Nn Feni wabes
Tn Jhon Rumansara
1/206438/14
2/193772/14
15
33
P
L
An Kornelia wayoi
Tn Yan Petrus rayar
Ny Paulina Duwiri
1/143110/14
2/163267/14
2/203798/14
3
50
55
P
L
P
17
18
19
20
Ny Musina wambrauw
2/146373/13
Tn Deki Rumbarar
Tn Kusuma Rumbiak
An Fitriani Rumbiak
1/201891/14
1/128446/11
2/202093/14
36
28
7
L
L
P
21
22
23
Tn Jhon Rumansara
2/193772/14
33
An Yoel Burdam
Ny Norce Swabra
1/207324/14
1/207326/14
1
29
L
P
24
25
Tn Yohanes Mirino
Tn Michael Aibekob
1/207313/14
1/207328/14
27
19
L
L
26
Ny Paulina Duwiri
2/203798/14
55
27
An Hengki Boseren
1/166369/13
28
29
30
31
32
33
34
35
36
An Paskalis Mangge
Ny Bertha Msiren
An Paskalis Mangge
An Hengki Boseren
An Irene Rumbarar
An Marice Mansawan
Tn Jhon Rumansara
1/161360/13
1/166369/13
1/155613/12
2/206987/14
2/193772/14
6
56
6
1
2
4
33
L
P
L
L
P
P
L
An Maresa Ronsumbre
Tn Mathias Badi
2/207042/14
1/104444/14
14
67
P
L
37
38
39
40
Tn Kusuma Rumbiak
Tn Michael Aibekob
An Ronaldo warwer
An Marice Mansawan
1/128446/11
1/207328/14
1/207612/14
2/206987/14
28
19
12
4
L
L
L
P
41
42
43
Tn Yotam Rumbiak
1/110818/12
31
Ny Estevina Simopiaref
Tn Samuel Kapong
1/207755/14
1/205909/14
57
25
P
L
44
45
46
47
Tn Nevel Wanindu
Ny Welhelmina Kurni
An Frnas wospakrik
Ny Ice kafiar
1/205921/14
1/205907/14
1/205887/14
1/107102/11
39
34
10
45
L
P
L
P
48
49
50
51
52
53
54
Tn Mathias Badi
Ny Nella Korwa
1/104444/14
1/125739/11
67
48
L
P
An anelis Rumsayor
Ny Maria Rumkabas
An Hewel Sada
Tn Isak Randongkir
Tn Yakob Lewa
1/163614/14
1/206105/14
2/140110/14
1/153876/14
1/206176/14
4
34
4
51
58
P
P
L
L
L
55
56
57
Ny Paulina Duwiri
Tn natalis Badi
Tn Yakob Lewa
2/203798/14
1/145110/14
1/206176/14
55
36
58
P
L
L
58
Tn Isak Randongkir
1/153876/14
51
59
Tn antonius Kbarek
2/205855/14
42
2/119440/11
1/161360/13
60
61
62
63
64
65
Tn Paulus yarangga
Tn Jhon Rumansara
35
33
L
L
7
45
P
P
Tn Isak Randongkir
Tn Yakob Lewa
1/120611/12
2/193772/14
1/206355/14
1/206497/14
1/153876/14
1/206176/14
51
58
L
L
66
67
68
Nn Feni Wabes
1/206438/14
15
Tn Heri Fonataba
An Albert Rumabar
2/206289/14
2/205828/14
43
1
L
L
An maryati P Mambobo
Ny Netty wenda
TOTAL

DKTR
Poli
Poli
Poli
Poli
Poli
7
Bedah
Bedah
Bedah
Bedah
Bedah
DIAGNOSA
ICD
8
HIL
Abses Ani
Kolestomi
Fraktur Tibia
HIL
Poli Bedah
Tumor Kepala
Poli Bedah
Combutsio
Poli Bedah
Poli Bedah
Poli Bedah
Tumor Kepala
Post Op Orif
Post OpTumor Kepala
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Fraktur Tibia
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
OA Bahu
Tumor kepala
Poli Bedah
Poli Bedah
Poli Bedah
Post Op Orif
Retensio Urine
Abses jari
Distruksi Lumbal
Post Op Orif
Fraktur Lumbal
Ileus paralistik
Post OpTumor Kepala
Abses Ani
Efusi Pleura
TINDAKAN
ICD
BIAYA
12
10
11
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
gv
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
27,500
27,500
27,500
27,500
27,500
20,000
27,500
20,000
27,500
20,000
Kontrol
Kontrol
Kontrol
8908
8908
8908
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
20,000
Poli Bedah
Poli Bedah
APP Akut
Post Op APP
Poli Bedah
Post OpTumor Kepala
Poli Bedah
Fraktur
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Poli Bedah
Poli Bedah
Poli Bedah
Post Gips
PID
Post Gips
Posr Reposisi Fraktur
Cedera Kepala Ringan
Vulnus Digitalis
Post Op Orif
Post OpReposisi
BPH
Abses Ani
Post Op APP
Cronik Bunr Kontraktur
Vulnus Digitalis
Lumbogo
Vulnus
Fraktur Nasal
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Vulnus laceratum
Ileus paralistik
Fraktur Tibia
Osteomilitis
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
BPH
Post Reposisi
Tumor tangan
Nefritis
Tumor
HNP
Tumor
Poli Bedah
Poli Bedah
Poli Bedah
Post OpTumor Kepala

Post orif
spondilosis Lumbalis
Poli Bedah
HNP
Poli Bedah
Post Op
gv
Kontrol
Kontrol
gv
Kontrol
GV
Kontrol
Radiologi
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kateter
Kontrol
Kontrol
Kontrol
Kontrol
gv
Kontrol
Kontrol
Kontrol
Radiologi
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
20,000
Kontrol
Kontrol
Kontrol
Radiologi
Kontrol
Radiologi
Kontrol
8908
8908
8908
8908
8908
8908
8908
27,500
27,500
27,500
25,500
27,500
25,500
27,500
27,500
27,500
20,000
27,500
20,000
27,500
25,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Poli Bedah
Poli Bedah
Poli Bedah
Orchitis
Post Op Orif
Otitis media akut
PID
HNP
spondilosis Lumbalis
LBP
Post Op
Post Op
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Radiologi
Kontrol
Kontrol
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
27,500
27,500
27,500
27,500
27,500
27,500
25,500
27,500
27,500
27,500
TOTAL
Biak, 01 Agustus 2014

Direktur RSUD Biak

NIP : 19681014 200012 2 002
JUMLAH
KETERANGAN
13
14
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan w.SpB
dr. Wayan w.SpB
27,500
27,500
27,500
27,500
47,500
dr. Wayan W. SpB

47,500
dr Benny Ap
47,500
27,500
27,500
47,500
27,500
27,500
27,500
27,500
27,500
47,500
27,500
27,500
27,500
dr Lato
dr. Wayan W. SpB
dr Jonatan
dr.
dr.
dr.
dr.
dr.
Wayan W.
Wayan W.
Wayan W.
Wayan W.
Wayan W.
dr Delly
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
dr Syukri
47,500
27,500
27,500
SpB
SpB
SpB
SpB
SpB
dr Syukri
dr Syukri
dr Syukri
47,500
27,500
dr Syukri
dr Syukri
47,500
dr Syukri
47,500
dr Syukri
53,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
dr Syukri
dr. Wayan w.SpB
dr. Wayan w.SpB
dr Lato
dr Lato
dr Lato
dr Lato
dr Lato
dr Lato
47,500
27,500
27,500
27,500
47,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
47,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
dr Lato
dr Lato
dr Lato
dr Michael
dr Michael
dr Michael
dr. Wayan W. SpB
dr.
dr.
dr.
dr.
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
SpB
SpB
SpB
SpB
dr.
dr.
dr.
dr.
dr.
dr.
dr.
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
W.
W.
W.
SpB
SpB
SpB
SpB
SpB
SpB
SpB
dr. Wayan W. SpB

dr. Wayan W. SpB
dr Lato
53,000
dr Lato
53,000
27,500
dr Lato
27,500
27,500
27,500
27,500
27,500
53,000
27,500
27,500
27,500
2,239,500.00
gustus 2014
RSUD Biak
mbiak,M.Kes,SpPK
14 200012 2 002
dr.
dr.
dr.
dr.
dr.
dr.
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
w.SpB
w.SpB
w.SpB
w.SpB
w.SpB
w.SpB
dr. Wayan w.SpB

dr. Wayan w.SpB
dr. Wayan w.SpB
PEMERINTAH KABUPATE
RUMAH SAKIT UMU
Jl. Sriwijaya Ridge I Tlp ( 0981 ) 21294 F
FORM KLAIM PASIEN J

Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
:
:
:
:
:
:
:
AGUSTUS 2014
RSUD BIAK
82 PASIEN
NO
NAMA
No. MR
1
1
2
3
4
5
6
P/L
6
38
26
2
50
L
P
P
P
Ny Theodora Rumabar
Ny Anike Warwer
1/210272/14
2/122873/14
2/208598/14
2/115297/14
1/209854/14
2/115297/14
51
50
P
P
An Evans Y. Runaweri
Nn Enji Randongkir
Ny Septina Boseren
1/107273/14
1/207960/14
2/122873/14
7
12
26
L
P
P
10
Tn Yan Rumere
1/207629/14
35
11
12
13
14
15
16
17
18
19
An Hengkye Boseren
Tn Kusuma Rumbiak
Tn Yusak Kbarek
Ny Nella Korwa
1/166369/13
1/128446/11
1/178374/14
1/125739/11
2
28
64
48
L
L
L
P
An Paskalis R. Mangge
Tn Wilem Ronsumbre
Ny Anike Wambrauw
Tn Wilem Ronsumbre
Ny Septina Boseren
1/161360/13
1/208540/14
2/115297/14
1/208540/14
2/122873/14
6
61
49
61
26
L
L
P
L
P
20
21
Tn Daud Sarewo
Ny Welmince K. Sawen
1/208642/14
1/208636/13
46
64
L
P
22
Ny Anike Warwer
2/115297/14
50
7
8
9
Tn Pauwentoyudo Mampioper
Ny Septina Boseren
An Advenia Sada
Ny Anike Warwer
UMUR
THN BLN
4
5
23
24
25
26
27
28
Ny Erna Prawar
Tn Jhon Rumansara
Tn Yan Rumere
1/108207/14
2/193772/14
1/207629/14
27
33
35
P
L
L
Ny Feni Wabes
Tn Festus Boseren
Tn Yakub Wambrauw
1/206438/14
1/140491/14
1/208855/14
15
32
55
P
L
L
29
An Majai Yawan
2/207255/14
13
30
Ny Feni Wabes
1/206438/14
15
31
32
33
34
35
An Niko Sarewo
An Israel Kayai
An Elisabeth Rumbekwan
Ny Erna Prawar
1/208978/14
2/154803/12
2/171354/14
1/108207/14
1
3
1
27
L
L
L
P
An Hengkye Boseren
1/166369/13
36
An Angel Randongkir
2/119701/12
12
37
Ny Septina Boseren
2/122873/14
26
38
39
40
41
Ny Martha Ayomi
Nn Agustina Womsiwor
Tn Arnold Rumbekwan
Tn Patrias Rumere
2/133770/12
1/209194/14
2/145795/12
1/141251/12
32
23
26
26
P
P
L
L
42
Tn Habel Rumbrapuk
2/143180/14
31
43
Ny Welmince K. Sawen
Tn Syoti Rumbekwan
1/208636/14
1/209191/14
63
44
P
L
44
Ny Septina Boseren
2/122873/14
26
45
An Majai Yawan
2/207255/14
13
46
Ny Insos K. Wanggober
2/208623/14
25
47
Ny Septina Boseren
2/122873/14
26
48
Ny Bertha Bonsapia
1/102753/10
47
49
2/208623/14
25
50
51
Tn Jefta Kadiwaru
An Majai Yawan
1/209289/14
2/207255/14
64
13
L
P
52
Tn Festus Boseren
1/140491/14
32
53
Tn George Rumere
2/152634/14
35
54
2/208623/14
25
55
An Majai Yawan
2/207255/14
13
56
Ny Ace Bonsapia
2/139774/14
32
57
58
An Niko Sarewo
Ny Naomi Woof
1/208778/14
1/115563/14
1
62
L
P
59
60
61
Ny Nuryati Ambran
Ny Margaretha Simbiak
Ny Agusta M.Rumainum
2/209133/14
2/208960/14
1/119120/14
21
35
28
P
P
P
62
An Renol Samuel Rumaropen
2/195232/14
63
Tn Akwila Rumanasem
1/114476/14
28
64
Tn Jhon Rumansara
2/193772/14
33
65
66
Ny Yolanda Mambrasar
34
An Majai Yawan
1/209683/14
2/207255/14
13
67
Ny Anike Warwer
2/115297/14
50
68
69
Ny Nelly Wakum
1/122347/11
48
Ny Septina Boseren
2/122873/14
26
70
An Elisabeth Rumbekwan
2/171354/14
71
72
Tn Daud Sarewo
An Salmon Awom
1/208642/14
1/165198/14
46
1
L
L
73
74
Ny Agusta M.Rumainum
Ny Feni M.Swabra
1/119120/14
1/209846/14
28
31
P
P
75
76
Ny Theodora Rumabar
Ny Luwuce Imbiri
1/209854/14
2/132872/12
51
51
P
P
77
Ny Anike Warwer
2/115297/14
50
78
Ny Septina Boseren
2/122873/14
26
79
80
81
82
An Niko Sarewo
Tn Jhon Mandibondibo
An Frans Sada
Tn Michael Makmaker
1/208778/14
1/1022932/10
2/195534/14
2/207741/14
1
45
1
40
L
L
L
L
TOTAL
EMERINTAH KABUPATEN BIAK NUMFOR

Ridge I Tlp ( 0981 ) 21294 Fax ( 0981 ) 22747 BIAK PAPUA
DKTR
Poli
Poli
Poli
Poli
Poli
Poli
7
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
DIAGNOSA
ICD
TINDAKAN
ICD
8
Tumor Penis
10
11
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
Kontrol
Lab
8908
8908
Post Op Orif
Fraktur
OA
CKR
OA
Poli Bedah
Poli Bedah
Poli Bedah
KGB
Susp Disloc Ankle
Poli Bedah
Post Op Orif
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Post Op Orif
Neuralgia
Abses Ani
BPL
Post Reposisi
Post Reposisi
DM Tipe II
DM Tipe II
ISK +Post Op Debridemant
Post Op Orif
Poli Bedah
Poli Bedah
Tumor
Tumor
Poli Bedah
OA
Poli
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Hematochesis
Post Op Orif
Post Op Orif
Sponchilitis Lumbal
LBP + Bronchitis
Gangren Diabeticum Pedis
Poli Bedah
Post Op App
Poli Bedah
Sponchilitis Lumbal
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
Atresia Ani
HIL
Tumor Palbe
Hematochesis
Post Op App
Poli Bedah
Fraktur Ankle
Poli Bedah
Post Op App
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Vulnus Digitalis
ISK + Pelvic
Tumor
Hematom Pd Hidung
Poli Bedah
Post Op App Akut
Poli Bedah
Poli Bedah
Tumor Kepala Kanan

Vulnus Pd Pipi Kanan
Poli Bedah
Post Op App
Poli Bedah
Post Op App
Poli Bedah
Selulitis Pedis extra
Poli Bedah
Post Op App
Poli Bedah
Nefrolitiasis
Poli Bedah
Poli Bedah
Poli Bedah
Selulitis Cruris
Post Op App
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Radiologi
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Radiologi
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Radiologi
Ct Scan
Kontrol
GV
Kontrol
Kontrol
Radiologi
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Radiologi
Kontrol
GV
Kontrol
Kontrol
GV
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
Poli Bedah
LBP + Bronchitis
Poli Bedah
Post Trauma Tumpul
Poli Bedah
Poli Bedah
Post Op App
Poli Bedah
Post Op App
Poli Bedah
Poli Bedah
Post Colostomi
Dislokasi Mandibula
Poli Bedah
Poli Bedah
Poli Bedah
Post Op App
Post Op App
Appendiks Akut
Poli Bedah
Vulnus Laceratum
Poli Bedah
Trauma Tumpul Thoraks
Poli Bedah
Post Op Orik
Poli Bedah
Poli Bedah
PID
Poli Bedah
Post Op App
OA
Poli Bedah
Poli Bedah
Post Op App
Poli Bedah
Tumor Palbe
Poli Bedah
Poli Bedah
Tumor
Vulnus Laceratum
Poli Bedah
Poli Bedah
Appendiks Akut
Kista Ovarium
Poli Bedah
Poli Bedah
Hipertensi + Cepalgia
Vulnus Laceratum
Poli Bedah
Poli Bedah
Kusta
OA
Post Op App
Kontrol
Radiologi
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Radiologi
Kontol
Kontrol
Kontrol
Lab
Radiologi
Kontrol
GV
Kontrol
Radiologi
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Lab
Kontrol
Kontrol
GV
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
Kontrol
Kontrol
GV
Kontrol
Kontrol
USG
Kontrol
Kontrol
GV
Kontrol
Lab
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Post Colostomi
Trauma Thorax
Abses Akut
Trauma Thorax
GV
Kontrol
Kontrol
Kontrol
Kontrol
8908
8908
8908
8908
8908
TOTAL
Biak, 01 September 2014

Direktur RSUD Biak
dr. Iras B.P Rumbiak,M.Kes,Sp

NIP : 19681014 200012 2 002
BIAYA
JUMLAH
KETERANGAN
12
13
14
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan w.SpB
dr. Wayan w.SpB
dr. Wayan w.SpB
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
20,000
47,500
47,500
dr. Wayan W. SpB
47,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
18,000
dr. Wayan W. SpB

dr Maichel
dr. Wayan W. SpB
dr.
dr.
dr.
dr.
dr.
Wayan W.
Wayan W.
Wayan W.
Wayan W.
Wayan W.
dr Lia
dr Lia
dr Lato
dr. Wayan W.
SpB
SpB
SpB
SpB
SpB
SpB
47,500
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan w.SpB
20,000
65,500
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
47,500
27,500
20,000
47,500
27,500
25,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
25,500
27,500
20,000
27,500
27,500
27,500
27,500
25,500
638,000
27,500
25,500
27,500
27,500
25,500
27,500
20,000
27,500
20,000
27,500
20,000
27,500
20,000
27,500
dr. Wayan W.SpB

dr Michael
dr Michael
dr Michael
dr Lato
dr Lato
dr. Wayan w.SpB
dr. Wayan w.SpB
53,000
27,500
27,500
27,500
27,500
dr. Wayan w.SpB

dr. Wayan w.SpB
dr. Wayan w.SpB
dr. Wayan W.SpB
dr. Wayan W. SpB
47,500
dr. Wayan W. SpB
53,000
dr. Wayan W. SpB
47,500
27,500
27,500
27,500
27,500
53,000
691,000
dr
dr
dr
dr
Jonatan
Jonatan
Jonatan
Jonatan
dr Jonatan
53,000
27,500
dr Jonatan
dr Jonatan
53,000
dr Jonatan
47,500
dr Jonatan
47,500
dr Lato
47,500
dr Lato
47,500
dr Lato
25,500
27,500
20,000
53,000
27,500
27,500
20,000
27,500
dr Lato
47,500
47,500
dr Lato
dr Lato
27,500
25,500
27,500
20,000
27,500
20,000
dr Syukri
53,000
dr Syukri
47,500
dr Syukri
47,500
dr Syukri
27,500
20,000
47,500
27,500
20,000
47,500
27,500
27,500
25,500
27,500
27,500
27,500
18,000
25,500
27,500
20,000
27,500
25,500
27,500
20,000
27,500
27,500
20,000
27,500
18,000
dr. Wayan w.SpB

27,500
53,000
27,500
27,500
dr. Wayan w.SpB

dr. Wayan w.SpB
dr. Wayan w.SpB
dr I Gede
dr I Gede
71,000
dr I Gede
47,500
dr I Gede
53,000
dr. Wayan W.SpB
47,500
27,500
dr. Wayan W.SpB

dr. Wayan W.SpB
47,500
dr. Wayan W.SpB
45,500
dr. Wayan W.SpB
dr. Wayan W.SpB
27,500
27,500
20,000
27,500
27,500
27,500
dr. Wayan w.SpB
27,500
27,500
20,000
27,500
dr. Wayan W. SpB
47,500
27,500
27,500
53,000
27,500
27,500
20,000
27,500
dr. Wayan W. SpB

dr Syukri
27,500
18,000
27,500
47,500
80,500
27,500
27,500
47,500
dr Syukri
dr Syukri
dr Syukri
dr. Wayan W.SpB
45,500
dr. Wayan W.SpB
20,000
47,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
3,956,000.00
Biak, 01 September 2014

Direktur RSUD Biak
as B.P Rumbiak,M.Kes,SpPK
P : 19681014 200012 2 002
dr.
dr.
dr.
dr.
Wayan
Wayan
Wayan
Wayan
w.SpB
w.SpB
w.SpB
w.SpB

Jl. Sriwijaya Ridge I Tlp ( 0981 ) 21294 Fax ( 0981 ) 22747 BIAK PAPUA
FORM KLAIM KARTU PAPUA SEHAT

Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
:
:
:
:
:
:
:
NO
NAMA
1
1
2
Ny. Lowice Imbir
SEPTEMBER 2014
RSUD BIAK
87 PASIEN
TANGGAL
No. MR
UMUR
BLN Hari
5
P/L
DKTR
DIAGNOSA
ICD
TINDAKAN
ICD
8
Abses
10
11
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
8908
THN
4
01 Sept 2014
2/132872/12
51
7
dr. Tjendono H
Ny. Ludia T
01 Sept 2014
1/161664/13
34
dr. Tjendono H
3
4
5
6
Tn. Kusuma Rumbiak

2014
2014
2014
2014
1/128446/12
2/145795/12
1/210433/14
28
26
Tn. Simson Rumbekwan

Ny. Anike Warwer
02
02
02
02
37
50
L
L
L
P
dr.
dr.
dr.
dr.
7
8
An. Salmon Awom

Jastrik A. Ap
02 Sept 2014
02 Sept 2014
1/165198/13
1/210427/14
1
18
L
L
dr. Wayan W. SpB

dr. Wayan W. SpB
Varicella
Ny. Helena Ayomi
03 Sept 2014
2/208613/14
44
dr. Tjendono H
Post Op App
04 Sept 2014
2/149744/12
60
dr. Wayan W. SpB
Cepalgia Post Trauma
10 Tn. Masri Saba
Sept
Sept
Sept
Sept
2/115297/13
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
SpB
SpB
SpB
SpB
LBP
DM
11 Jaka Satriadi
12 Nn. Feni Wabes
13 Agustinus Womsiwor
14 Ny. Anike Warwer
04
04
04
04
2014
2014
2014
2014
1/210575/14
2/115297/13
24
25
16
50
L
P
L
P
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
Tumor Tangan
LBP
Variacel
Ganggren DM
15 Ny. Agusta M. Rumainum
05 Sept 2014
1/119120/11
28
dr. Tjendono H
Post Op App
16 Ny. Anike Warwer
06 Sept 2014
2/115297/13
50
dr. Wayan W. SpB
DM
17 Ny. Yolanda Rumbrapuk
06 Sept 2014
1/209966/14
26
dr. Wayan W. SpB
Post Op App
18
19
20
21
06
06
08
08
2/187860/14
2/149744/12
1/112813/11
1/210751/14
19
60
35
56
P
L
L
P
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Tjendono H
dr. Tjendono H
HT
Trauma Tumpul
Fraktur Terbuka
dr. R Mayor
Ny.
Tn.
Tn.
Ny.
Martha Ronsumbre
Masri Saba
Yohanes Yantem
Yohana Mayor
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
1/206438/14
1/210571/14
RO
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
GV
RO
22 Tn. Yose Rizal P. Mayor
08 Sept 2014
1/210789/14
19
Kontrol
RO
23 Tn. Niko Rumkorem
24 Tn. Michael Rumbewas
09 Sept 2014
09 Sept 2014
2/210510/14
42
35
L
L
dr. Tjendono H
dr. Tjendono H
Fraktur Clavikula
Fraktur Tibia Vibula
2/208774/14
25 An. Febrian Yawan
09 Sept 2014
2/210328/14
dr. Tjendono H
Fraktur
26 Ny. Anike Warwer
09 Sept 2014
2/115297/13
51
dr. Tjendono H
DM
27 Tn. Roberth Blesia

28 Tn. Stevanus Korwa
09 Sept 2014
09 Sept 2014
2/107090/10
1/210825/14
61
61
L
L
dr. Tjendono H
dr. Tjendono H
Ulkus Digit I pedis
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
29 Tn. Hans Rumsarwir

30 Ny. Leunora Raprap
10 Sept 2014
10 Sept 2014
2/210869/14
1/210850/14
35
37
L
P
dr. Tjendono H
dr. Tjendono H
Tumor Digit II
Tumor Thyroid
31 Ny. Leunora Raprap

32 Tn. Karlos Rumaropen
11 Sept 2014
11 Sept 2014
1/210850/14
2/182348/14
37
39
P
L
dr. Wayan W. SpB

dr. Wayan W. SpB
Trauma Thorax
33 Nn. Dian S. Korwa
11 Sept 2014
2/210704/14
18
dr. Wayan W. SpB
CKF
34 Tn. Arnold Rumbekwan
11 Sept 2014
2/145795/12
26
dr. Wayan W. SpB
Post OP
35 Tn. Stevanus Korwa
11 Sept 2014
1/210825/14
61
dr. Wayan W. SpB
36 Tn. Kusuma Rumbiak

37 Tn. Michael Rumbewas
11 Sept 2014
11 Sept 2014
1/128446/12
2/208774/14
28
28
L
L
dr. Wayan W. SpB

dr. Wayan W. SpB
Fistel Pharianel
Post OP
38
39
40
41
11
13
13
13
2014
2014
2014
2014
2/137773/12
1/100919/10
2/182348/14
57
57
39
2/210704/14
18
L
P
L
P
dr.
dr.
dr.
dr.
OA Coxitis
Nefrolitiasis
Trauma Thorax
Post Op APP
42 By. Nikolas Simopiaref

43 Ny. Ernita Morin
44 Ny. Netty Wenda
13 Sept 2014
15 Sept 2014
15 Sept 2014
1/210897/14
1/146483/12
1/206497/14
40
45
L
P
P
dr. Wayan W. SpB

dr. Tjendono H
dr. Tjendono H
Herchspung Disiase
Gastritis Akut
Abdomen
45 Ny. Anike Warwer
15 Sept 2014
2/115297/13
50
dr. Tjendono H
Post OP+DM
46
47
48
49
16
16
16
16
2014
2014
2014
2014
1/211391/14
1/211349/14
2/195534/14
2/208774/14
30
2
1
28
L
L
L
L
dr.
dr.
dr.
dr.
16 Sept 2014
2/210704/14
18
dr. Wayan W. SpB
Tn. Micha Rumabar

Ny. Hamida Kafiar
Tn. Karlos Rumaropen
Nn. Dian S. Korwa
Tn. Aron Rumbrapuk

An. Almendo Wamafma
An. Frans Sada
Tn. Michael Rumbewas
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
14
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
W.
W.
W.
W.
SpB
SpB
SpB
SpB
SpB
SpB
SpB
SpB
Fractur
Herchspung Disiase
Post Op Fr Terbuka
VL
Kontrol
Kontrol
USG
Kontrol
Kontrol
RO
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
CT Scan
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
51 Tn. Ronsen Sroyer

L
P
dr. Tjendono H
dr. Wayan W. SpB
17 Sept 2014
18 Sept 2014
1/131777/12
2/210704/14
29
18
Trauma Dada Kanan

VL
53 Nn. Petronela Korwa

54 Tn. Alekx P. Erbo
18 Sept 2014
18 Sept 2014
2/183515/14
1/128574/12
14
32
P
L
dr. Wayan W. SpB

dr. Wayan W. SpB
Trauma Thorax
Nefritis Pedis
55 Tn. Hengki Kapisa

20 Sept 2014
20 Sept 2014
2/211678/14
2/183515/14
22
14
L
P
dr. Tjendono H
dr. Tjendono H
Vulnus Excorisie Multiple

Scolosis Thorax
57 Tn. Soleman Kaisiepo
20 Sept 2014
2/211212/14
21
dr. Tjendono H
Post App
58 Tn. Niko Rumkorem

59 An. Natalia Rumaropen
20 Sept 2014
20 Sept 2014
2/210510/14
2/211072/14
40
5
L
P
dr. Tjendono H
dr. Tjendono H
Reposisi Ransil Verban
60 Ny. Awil Wamu
22 Sept 2014
1/211723/14
24
dr. Tjendono H
Ulcus Manus
61 Jimmy Aronggear
22 Sept 2014
2/211484/14
15
dr. Tjendono H
Vulnus Laceratum
62 Tn. Yoseph Weyai

22 Sept 2014
23 Sept 2014
1/211781/14
1/128446/12
30
28
L
L
dr. Tjendono H
dr. Tjendono H
Righ S Paint
Fistel Anni
64 Ny. Grice F. Ayer
23 Sept 2014
2/211407/14
41
dr. Tjendono H
Post Op
65 Tn. Pauwentoyudo W
24 Sept 2014
1/211631/14
38
dr. Tjendono H
Post Op Tumor Penis
66 Ny. Ditcje Rumpaidus
24 Sept 2014
1/197917/14
55
dr. Tjendono H
DM+Ulcus
67 Ny. Dessy Morin

68 Tn. Yonas Arwam
69 An. Grasty Kurni
24 Sept 2014
24 Sept 2014
25 Sept 2014
2/130447/12
1/211899/14
2/211789/14
28
52
14
P
L
P
dr. Tjendono H
dr. Tjendono H
dr. Tjendono H
Struma
Multiple Tumor
Vulnus Laceratum
Vulnus Laceratum
Z48
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
Lab
Kontrol
Kontrol
RO
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol

71 Jimmy Aronggear
25 Sept 2014
26 Sept 2014
2/183515/14
2/211484/14
14
15
P
L
dr. Tjendono H
dr. Tjendono H
Malaria
Vulnus Laceratum
72 An. Almendo Wamafma

73 An. Grasty Kurni
27 Sept 2014
27 Sept 2014
1/211349/14
2/211789/14
2
14
L
P
dr Lato
dr Lato
Fraktur Frontalis
Post Op Ruptur Tendon
27 Sept 2014
1/211631/14
38
dr Lato
Post Op Tumor Penis
29 Sept 2014
1/211631/14
38
dr Lato
Post Op Tumor Penis
76 Tn. Lucas J. Marjen

77 Jimmy Aronggear
29 Sept 2014
29 Sept 2014
2/209347/14
2/211484/14
49
15
L
L
dr Lato
dr Lato
Musde Spraien
Selulitis Pedis Sinistra

79 Tn. Romario Sarewo
80 Nn. Sarlota Puari
30 Sept 2014
30 Sept 2014
30 Sept 2014
2/183515/14
2/212059/14
1/212148/14
14
23
16
P
L
P
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
App Acut
1/210850/14
37
1/211723/14
1/211349/14
24
2
L
P
L
P
P
L
P
dr.
dr.
dr.
dr.
dr.
dr.
dr.
81
82
83
84
85
86
87
Tn. Kilion Kawer

Ny. Leonora Raprap
An. Ridho Andarek
Nn. Felma Mandowen
Ny. Awel Wamu
An. Almendo Wamafma
Nn. Dessy Sada
30
30
30
30
30
30
30
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
2014
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
W.
W.
W.
SpB
SpB
SpB
SpB
SpB
SpB
SpB
App Kronik
Tumor Thyroid
CKR
Kista
Post Fraktur
App Acut
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
USG
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
TOTAL
Biak, 01 No
Direktur
dr. Iras B.P Rum

NIP : 196810
BIAYA
JUMLAH
KETERANGAN
12
13
14
Poli Bedah
27,500
20,000
27,500
20,000
27,500
###
###
###
20,000
27,500
###
20,000
27,500
20,000
27,500
47,500
47,500
27,500
27,500
27,500
47,500
27,500
47,500
47,500
25,500
27,500
###
###
###
20,000
53,000
27,500
27,500
27,500
47,500
27,500
20,000
47,500
27,500
20,000
47,500
27,500
20,000
27,500
###
###
###
20,000
25,500
27,500
25,500
27,500
###
20,000
27,500
20,000
27,500
20,000
27,500
###
20,000
47,500
27,500
27,500
27,500
73,000
53,000
27,500
47,500
47,500
47,500
27,500
47,500
27,500
###
53,000
27,500
27,500
25,500
27,500
20,000
27,500
20,000
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
638,000
27,500
20,000
27,500
27,500
27,500
27,500
20,000
27,500
27,500
80,500
27,500
53,000
47,500
47,500
47,500
27,500
27,500
27,500
27,500
27,500
47,500
27,500
27,500
665,500
47,500
27,500
27,500
27,500
47,500
20,000
27,500
27,500
20,000
27,500
27,500
18,000
27,500
###
25,500
27,500
20,000
27,500
27,500
20,000
27,500
20,000
27,500
20,000
27,500
27,500
27,500
20,000
27,500
20,000
27,500
20,000
27,500
27,500
27,500
47,500
27,500
47,500
27,500
45,500
27,500
53,000
47,500
27,500
47,500
47,500
47,500
27,500
27,500
47,500
47,500
47,500
27,500
27,500
20,000
27,500
###
20,000
27,500
###
20,000
27,500
20,000
27,500
20,000
27,500
###
20,000
27,500
###
###
53,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
47,500
27,500
47,500
27,500
47,500
47,500
47,500
27,500
47,500
27,500
27,500
80,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
3,982,000
Biak, 01 November 2014

Direktur RSUD Biak

NIP : 19681014 200012 2 002


Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
:
:
:
:
:
:
:
OKTOBER 2014
RSUD BIAK
93 PASIEN
TANGGAL
No. MR
UMUR
THN BLN
4
5
NO
NAMA
P/L
DKTR
DIAGNOSA
ICD
TINDAKAN
ICD
1
1
8
Celulitis Pedis
10
11
7
dr Lato
An. Jemmy Aronggear
01 Okt 2014
2/211484/14
15
L03.9
8908
38
dr Lato
Post Op Tumor Penis
1/211631/14
38
dr. Wayan W. SpB
Post Op Tumor Penis
02 Okt 2014
2/126406/12
15
dr. Wayan W. SpB
Trauma Tangan Manus S
Nn. Smirna Ansek

An. Jemmy Aronggear
02 Okt 2014
03 Okt 2014
2/211801/14
19
15
P
L
dr. Wayan W. SpB

dr Lato
Post Op Vullac Pedis
7
8
Tn. Yonas Ruatakurei

Tn. Dan Joni Yaroseray
04 Okt 2014
04 Okt 2014
1/212738/14
1/212740/14
19
21
L
L
dr. Wayan W. SpB

dr. Wayan W. SpB
Contusio Antebraci
Laserasi Infeksi Kepala
Tn. Melkianus Krey
04 Okt 2014
2/189065/14
53
dr. Wayan W. SpB
Post Op App
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Tn. Pauwentoyudo Wenehenubun
01 Okt 2014
1/211631/14
02 Okt 2014
Nn. Sandra Manbrasar
5
6
2/211484/14
10
dr. Wayan W. SpB
Tn. Yunus Yarangga
04 Okt 2014
2/132347/12
20
Cepalgia Post Trauma
11
12
Tn. Manasa Marandof

04 Okt 2014
04 Okt 2014
1/198636/14
52
38
L
L
dr. Wayan W. SpB

dr. Wayan W. SpB
GO
Post Op Tumor Penis
13
14
Ny. Rode Kafiar

Tn. Alberth Yafdas
07 Okt 2014
07 Okt 2014
1/124837/12
1/117406/11
66
64
P
L
dr. Wayan W. SpB

dr. Wayan W. SpB
Trauma Uretra
Post Op App
15
Tn. Jhon Calvin Rumaropen
07 Okt 2014
1/200918/14
20
dr. Wayan W. SpB
16
17
An. Putra S. Wayoi

An. Jemmy Aronggear
07 Okt 2014
07 Okt 2014
2/130544/12
2/211484/14
3
15
L
L
dr. Wayan W. SpB

dr. Wayan W. SpB
Vulnus Laceratum
Post Op
18
07 Okt 2014
1/211631/14
38
dr. Wayan W. SpB
Post Op Tumor Penis
19
20
21
Maxi H. Rumanasen
Ny. Fransiska Kawer
Tn. Pagale P. Jikwa
07 Okt 2014
08 Okt 2014
09 Okt 2014
1/212765/14
1/153382/12
2/212286/14
16
23
29
L
P
L
dr. Wayan W. SpB

dr. Tjendono H
dr Lato
Tumor Pedis
Limprodemitis Axila
Trauma Amputasi
22
09 Okt 2014
1/211631/14
38
dr Lato
Post Op Tumor Penis
23
24
Tn. Barnabas Womsiwor
1/212896/14
20
Tn. Daud Kafiar
09 Okt 2014
09 Okt 2014
2/173245/14
22
L
L
dr Lato
dr. Wayan W. SpB
ISK
Ruptur Tendon
25
Ny. Dessy A. Faknik
10 Okt 2014
2/143690/12
32
dr. Tjendono H
Abdomen
26
27
28
Tn. Simon Yawan

Ny. Syulaila Rumabar
An. Jemmy Aronggear
10 Okt 2014
10 Okt 2014
10 Okt 2014
2/113576/11
46
25
15
L
P
P
dr. Tjendono H
dr. Tjendono H
dr. Tjendono H
Fractur Clavicula
ISK
1/211631/14
2/198882/14
2/211484/14
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
USG
Kontrol
Kontrol
Kontrol
GV
29
11 Okt 2014
1/211631/14
38
dr. Wayan W. SpB
Post Op Tumor Penis
30
11 Okt 2014
11 Okt 2014
1/212806/14
1/212896/14
49
20
P
L
dr. Wayan W. SpB
LBP
31
Ny. Regina Asaribab

Tn. Barnabas Womsiwor
32
Ny. Maryana Yapen
13 Okt 2014
2/136036/12
52
dr. Tjendono H
33
13 Okt 2014
1/211631/14
38
dr. Tjendono H
Post Op Tumor Penis
34
An. Jemmy Aronggear
13 Okt 2014
2/211484/14
15
dr. Tjendono H
Vulnus Laceratum
35
Tn. Roberth Maran
14 Okt 2014
1/213091/14
39
dr. Wayan W. SpB
Dyspepsia
36
37
38
39
40
Tn. Falentino Joris Randongkir

An. Sefanya S. Manami
2014
2014
2014
2014
2014
1/213133/14
1/213121/14
22
1
Nn. Hanny Mampioper

Nn. Felina Mandowen
Tn. Alberth Yafdas
14
14
14
14
14
2/212867/14
2/212488/14
1/117406/11
16
19
48
L
P
P
P
dr.
dr.
dr.
dr.
dr.
41
Tn. Yunus Kararbo
15 Okt 2014
1/177828/14
65
dr. Tjendono H
42
Tn. Falentino Joris Randongkir
15 Okt 2014
1/213133/14
22
dr. Tjendono H
43
15 Okt 2014
1/211631/14
38
dr. Tjendono H
Post Op Tumor Penis
44
An. Susana Sada
16 Okt 2014
1/213217/14
dr. Wayan W. SpB
Post Op Laparatomi
45
46
An. Maya Andarek

Nn. Felina Mandowen
16 Okt 2014
16 Okt 2014
1/213181/14
2/212488/14
5
19
P
P
dr. Wayan W. SpB

dr. Wayan W. SpB
OMA
Okt
Okt
Okt
Okt
Okt
dr. Wayan W. SpB
Wayan
Wayan
Wayan
Wayan
Wayan
W.
W.
W.
W.
W.
SpB
SpB
SpB
SpB
SpB
Post Op App
Vulnus Laceratum
Post Op Laparatomi
Kontrol
GV
Kontrol
Kontrol
RO
USG
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
RO
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
47
48
2/180210/13
1/213240/14
49
Tn. Oktofianus Imbir

Ny. Emi Kafiar
Tn. Yosep A. Korwa
16 Okt 2014
17 Okt 2014
L
P
1/213301/14
57
39
38
dr. Wayan W. SpB

dr. Tjendono H
17 Okt 2014
50
51
Ny. Fransiska Kawer

dr. Tjendono H
17 Okt 2014
18 Okt 2014
1/153382/12
1/211631/14
23
38
dr. Tjendono H
dr. Wayan W. SpB
Post Op Tumor Penis
52
53
An. Susana Sada

Tn. Otis Kararbo
18 Okt 2014
18 Okt 2014
1/213217/14
2/175192/14
7
21
P
L
dr. Wayan W. SpB

dr. Wayan W. SpB
Post Op
Post Op App
54
Nn. Felina Mandowen
18 Okt 2014
2/212488/14
19
dr. Wayan W. SpB
Post Op
55
Tn. Daan Rumbarar
18 Okt 2014
1/101481/10
70
dr. Wayan W. SpB
56
57
58
59
An. Niko Sarewo

AN. Agnes Mofu
Ny. Potifina Koibur
Nn. Felina Mandowen
20
20
21
21
2014
2014
2014
2014
1/208978/14
1/213554/14
1/146361/14
2/212488/14
1
1
43
19
L
P
P
P
dr Jonatan
dr Jonatan
dr. Dewi P
dr Lato
Post Op Colostomy
Abses Pd Pantat
Trauma Tumpul Thorax
60
21 Okt 2014
1/211631/14
38
dr. Dewi P
Post Op Tumor Penis
61
Tn. Pagale P. Jikwa
21 Okt 2014
2/212286/14
29
dr Lato
Trauma Amputasi
62
63
64
Tn. Daud Kafiar

Tn. Amos Rumainum
21 Okt 2014
21 Okt 2014
23 Okt 2014
2/173245/14
2/196478/14
1/211631/14
22
72
38
L
L
L
dr. Dewi P
dr. Dewi P
dr Jonatan
Post Op
Tumor Lidah
Post Op Tumor Penis
65
An. Susana Sada
23 Okt 2014
1/213217/14
dr Jonatan
Post Op+App+ Laparatomi
Okt
Okt
Okt
Okt
Fraktur Ceplagia
Tumor
Post Op
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
66
Nn. Felina Mandowen
23 Okt 2014
2/212488/14
19
dr Jonatan
Post Op Laparatomi
67
Tn. Decky A. Rumbarar

Ny. Oktovina Runaweri
An. Rikson Mansoben
23 Okt 2014
23 Okt 2014
24 Okt 2014
1/201891/14
2/170383/14
2/213784/14
36
42
10
L
P
dr Jonatan
Orchitis
Hepatomegali
Post Op Combutio
70
71
72
Ny. Yuliana Simbiak

Tn. Yerri Bonggoibo
2/197645/14
1/115273/11
48
42
Ny. Yohana Sada
24 Okt 2014
24 Okt 2014
24 Okt 2014
1/116194/11
73
Nn. Marthina Baransano
24 Okt 2014
74
Tn. Maxi A. Rumanasen
75
68
69
dr Jonatan
dr Lato
33
L
P
dr Lato
dr Lato
dr Lato
1/213858/14
27
dr Lato
24 Okt 2014
1/212765/14
16
dr Lato
Post Op Crarus Plenter Pedis
Tn. ErisamOskar Krey
24 Okt 2014
1/213856/14
25
dr Lato
Myospasme
76
Nn. Orpa Mambrasar
27 Okt 2014
2/154088/13
14
dr. Tjendono H
Post Op Jari
77
Ny. Yuliana Simbiak
27 Okt 2014
2/197645/14
48
dr. Tjendono H
Post Op Fraktur Terbuka
78
An. Aprilia Marandof
27 Okt 2014
1/214060/14
dr. Tjendono H
Celulitis
79
Tn. Yerri Bonggoibo
27 Okt 2014
1/115273/11
42
dr. Tjendono H
Post Op Fraktur Terbuka
80
27 Okt 2014
1/211631/14
38
dr. Tjendono H
Post Op Tumor Penis
81
82
83
An. Nando A. Korwa

Tn. Kusuma Rumbiak
Nn. Felina Mandowen
27 Okt 2014
28 Okt 2014
28 Okt 2014
1/214052/14
1/128446/13
2/212488/14
10
28
19
L
L
P
dr. Tjendono H
dr Lato
dr Lato
Post Fraktur
Post Op Laparatomy
Post Op Laparatomy
Post Op Gips Antebrachili

Post Op Reposisi Cruris
Gastritis+Abdomen
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
USG
Kontrol
RO
USG
Kontrol
GV
Kontrol
RO
Kontrol
GV
Kontrol
GV
Kontrol
RO
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
84
85
Tn. Herry Erik Sawor

An. Rico Rumaropen
28 Okt 2014
29 Okt 2014
2/210969/14
2/168778/13
34
7
L
L
dr Lato
dr. Dewi P
Orchitis
Fraktur Ttp 1/3 Distal
86
An. Rikson Mansoben
29 Okt 2014
2/213784/14
dr. Dewi P
Combutio
87
30 Okt 2014
1/211631/14
38
dr Lato
Post Op Tumor Penis
88
89
90
91
An. Maryam Mamoribo

Tn. Lisyas Rumaseuw
Tn. Dan Arton Turunat
Nn. Dessi Miokbun
30
30
30
30
2014
2014
2014
2014
1/168540/13
1/158239/13
1/213652/14
1/213122/14
3
39
25
16
dr
dr
dr
dr
92
Nn. Hendrika Baab
31 Okt 2014
2/173081/14
18
dr. Tjendono H
93
An. Insiryomi Awak
31 Okt 2014
1/214442/14
dr. Tjendono H
Okt
Okt
Okt
Okt
L
L
P
Lato
Lato
Lato
Lato
Vul Combutio Frontalis

Corpal Penis
Tonsilitis
ISK
Post Op App Acut
Kontrol
Kontrol
RO
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
USG
Kontrol
GV
Kontrol
TOTAL
Biak, 01 No
Direktur
dr. Iras B.P Rum

NIP : 1968101
BIAYA
JUMLAH
KETERANGAN
12
13
14
Poli Bedah
27,500
20,000
47,500
27,500
20,000
47,500
27,500
20,000
47,500
27,500
20,000
27,500
###
20,000
27,500
###
20,000
27,500
47,500
27,500
47,500
27,500
47,500
20,000
27,500
20,000
27,500
###
20,000
27,500
###
20,000
27,500
20,000
27,500
###
20,000
27,500
20,000
27,500
###
###
20,000
27,500
20,000
27,500
###
20,000
27,500
53,000
27,500
###
###
20,000
47,500
47,500
27,500
47,500
27,500
47,500
47,500
27,500
47,500
47,500
27,500
27,500
47,500
47,500
27,500
47,500
80,500
27,500
27,500
47,500
27,500
20,000
27,500
###
25,500
53,000
27,500
20,000
27,500
20,000
27,500
###
###
###
###
###
20,000
27,500
20,000
27,500
25,500
27,500
20,000
27,500
20,000
27,500
###
47,500
27,500
106,000
47,500
47,500
27,500
27,500
27,500
27,500
27,500
47,500
47,500
53,000
47,500
47,500
27,500
20,000
27,500
###
###
20,000
27,500
###
20,000
27,500
###
20,000
27,500
20,000
27,500
20,000
27,500
###
###
###
20,000
27,500
20,000
27,500
20,000
27,500
###
###
20,000
27,500
20,000
47,500
27,500
27,500
47,500
27,500
47,500
27,500
47,500
47,500
47,500
27,500
27,500
27,500
47,500
47,500
47,500
27,500
27,500
47,500
47,500
27,500
20,000
27,500
###
###
20,000
27,500
###
###
53,000
27,500
25,500
53,000
27,500
20,000
27,500
25,500
27,500
20,000
27,500
20,000
27,500
25,500
27,500
20,000
27,500
20,000
27,500
###
###
47,500
27,500
27,500
47,500
27,500
27,500
80,500
106,000
47,500
53,000
47,500
47,500
53,000
47,500
47,500
27,500
27,500
27,500
27,500
###
25,500
27,500
20,000
27,500
20,000
27,500
###
###
###
53,000
27,500
20,000
27,500
27,500
53,000
47,500
47,500
27,500
27,500
27,500
80,500
47,500
27,500
3,848,000
Biak, 01 November 2014

Direktur RSUD Biak

NIP : 19681014 200012 2 002


Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
:
:
:
:
:
:
:
NOVEMBER 2014
RSUD BIAK
119 PASIEN
UMUR
THN BLN
5
6
NO
NAMA
TANGGAL
No. MR
1
1
Ny. Agnes L. Marandof
01 Nov 2014
1/129058/12
29
2
3
Nn. Felina Mandowen

Tn. Puwentoyudo W
01 Nov 2014
01 Nov 2014
2/212488/14
1/211631/14
Tn. Denny Yewun
01 Nov 2014
5
6
7
8
An. Max H. Rumanasen

Ny. Hagar Rumaropen
Ny.Agnes Marandof
Tn.Puwentoyudo W
01
01
03
03
9 Tn. Yohanes Swabra

10 Nn. Orpa Mambrasar
11 An. Rico Rumaropen
P/L
DKTR
DIAGNOSA
ICD
TINDAKAN
ICD
9
Post op
10
11
12
8
dr. Wayan W. SpB
8908
19
38
P
L
dr. Wayan W. SpB

dr. Wayan W. SpB
Post op
Post op
1/151167/12
29
dr. Wayan W. SpB
Refraktur post ORIF
2014
2014
2014
2014
1/212765/14
1/101854/10
1/129058/14
1/211631/14
15
65
29
38
L
P
P
L
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Tjendono H
Post op exesitee
Os coxigis
Ileces abstruksi
Posr op
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
RO
Kontrol
Kontrol
Kontrol
Kontrol
03 Nov 2014
03 Nov 2014
03 Nov 2014
1/123349/14
45
14
7
L
P
L
dr. Tjendono H
dr. Tjendono H
dr. Tjendono H
Fraktur clavicula
Necrosis distal digiti III
Fraktur scapula
Kontrol
Kontrol
Kontrol
Nov
Nov
Nov
Nov
2/154088/14
2/168778/14
12 Ny.Naema Sundoy
03 Nov 2014
1/157244/13
42
dr. Tjendono H
Nefrolitasi dextra
13 Tn. Anis Sarawan

14 An. Hans Yapen
04 Nov 2014
04 Nov 2014
2/129099/14
1/188737/14
32
5
L
L
dr. Wayan W. SpB

dr. Wayan W. SpB
Post op
Greenshic fraktur distal
15 An. Frans Sada
04 Nov 2014
2/195534/14
dr. Wayan W. SpB
Post colostomy
16 Nn. Hendrika Baab
04 Nov 2014
2/173081/14
18
dr. Wayan W. SpB
Post op
17 Tn. Anis Sarawan
05 Nov 2014
2/129099/14
32
dr. Wayan W. SpB
Dislokasi sendi bahu
18 An. Rico Rumaropen

19 Tn. Puwentoyudo. W
05 Nov 2014
06 Nov 2014
2/168778/14
1/211631/14
7
38
L
P
dr. Tjendono H
dr. Wayan W. SpB
Post op tumor penis
20 Nn. Hendrika Baab
08 Nov 2014
2/173081/14
18
dr. Wayan W. SpB
Post op App
21
22
23
24
25
26
27
Tn. Markus L. Rumbiak

Tn. Puwentoyudo. W
An. Hendra Rumsarwir
An Josua Rumbekwan
Ny. Dessy Morin
Tn. Viktor Msen
An. Everdina Wamafma
08
08
10
10
10
10
10
Nov
Nov
Nov
Nov
Nov
Nov
Nov
2014
2014
2014
2014
2014
2014
2014
1/124918/14
1/211631/14
2/134313/13
1/214955/14
2/130447/12
1/214958/14
2/188556/14
33
38
2
3
28
27
12
L
L
L
L
P
L
P
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Tjendono H
dr. Tjendono H
dr. Tjendono H
dr. Tjendono H
dr. Tjendono H
Tumor kaki dextra

Post op
Post op
Corpus alineum+nasoparings
Hyperfiroid
STT fontal
VL
28
29
30
31
32
33
34
35
An. Fiktor Rumbrapuk

Tn. Puwentoyudo. W
An. Petra Simbiak
Tn. Luki Sanggeuw
Tn. Efraim Inur
Ny. Agnes Marandof
Tn. Yulens Faidiban
Ny. Martha Marisan
10
11
11
11
11
11
11
11
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
2014
2014
2014
2014
2014
2014
2014
2014
2/122457/12
1/211631/14
1/108739/14
2/110248/14
1/215151/14
1/129058/14
1/179074/14
2/161420/14
16
38
4
39
46
29
26
48
L
L
L
L
L
P
L
P
dr. Tjendono H
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
VL
Post op tumor penis
Post op fraktur
Post op
Ca lidah+bibir
Goli abdomen
Tumor colli
Ca mamae (D)
Kontrol
RO
Kontrol
Kontrol
RO
Kontrol
Kontrol
GV
Kontrol
RO
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
RO
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
8908
8908
8908
8908

37 An. Hendra Rumsarwir
38 Ny. Naema Sundoy
dr. Wayan W. SpB

Vistel penianal
dr. Tjendono H
Fager tiyp lengan digiti IV manus (s)
dr. Tjendono H
ISK nefroliti dextra
38
39
L
L
P
L
L
dr. Wayan W. SpB

dr. Wayan W. SpB
Post op tumor penis

Negletidda
1/215385/14
1/215366/14
2/134313/14
47
10
25
17
31
2
P
L
P
P
P
L
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Tjendono H
dr. Tjendono H
dr. Tjendono H
Trauma vetebra
Post op reposisi fraktur
Pharingitis
Multiple abses seluruh tubuh
15 Nov 2014
1/215270/14
47
dr. Wayan W. SpB
Tumor Ginjal (D)
48 Ny. Yakomina Arwakon
15 Nov 2014
1/215518/14
40
dr. Wayan W. SpB
Nefrolitiasis acut
15 Nov 2014
1/211631/14
38
dr. Wayan W. SpB
Post op
50 Tn. Yulles Maniani

17 Nov 2014
17 Nov 2014
1/215638/14
2/134313/14
47
2
L
L
dr. Tjendono H
dr. Tjendono H
VL
Post op
52 Tn. Kristian Kafiar

53 Nyg.Viktor Rumbrapuk
17 Nov 2014
17 Nov 2014
1/215607/14
2/122457/14
47
17
L
L
dr. Tjendono H
dr. Tjendono H
Hernia scrotalis
VL
17 Nov 2014
1/211631/14
38
dr. Tjendono H
Tumor penis (STT)
55 Ny. Fredika. Arwakon

56 Ny. Yustina Ronsumbre
57 NY. Popy.J. Rumbiak
18 Nov 2014
18 Nov 2014
18 Nov 2014
1/215787/14
1/215730/14
1/153892/14
31
48
31
P
P
P
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
LBP
App
Abses bahu
Nov
Nov
Nov
Nov
Nov
2014
2014
2014
2014
2014
1/128446/14
2/134313/14
1/157244/14
28
2
42
40 Tn. Luki Sanggeuw
11
12
12
12
13
1/211631/14
2/110248/11
41
42
43
44
45
46
13
13
13
14
14
14
Nov
Nov
Nov
Nov
Nov
Nov
2014
2014
2014
2014
2014
2014
1/215270/14
1/214052/14
1/111910/14
47 Ny. Erna R.Y. Sulla
Ny. Erna R.Y. Sulla

An. Nando Andris Korwa
Ny. Yunita Wanma
Nn. Vinna Elembo
Ny. Dolfina Sanadi
An. Hendra Rumsarwir
App cronis
Post op VL di jari tangan
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
RO
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
USG
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Kontrol
8908
8908
8908
8908
8908
58 Tn Jhon Mandibondibo
59 Ny.Erna Y.Sulla
60 Nn. Natalia Sikbat
18 Nov 2014
18 Nov 2014
19 Nov 2014
1/102984/10
1/215270/14
2/215422/14
44
47
18
L
P
P
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Tjendono H
ISK
VL
Multiple VE wajah+VL
61
62
63
64
19
19
20
20
2014
2014
2014
2014
2/114929/14
38
47
14
22
dr. Tjendono H
dr. Tjendono H
dr. Wayan W. SpB
dr. Wayan W. SpB
Conmad coles
1/215270/14
1/216030/14
1/216020/14
L
P
P
65 Ny. Anetha Swabra

66 An. Yulianus Krisifu
67 An. Habel Mansoben
20 Nov 2014
20 Nov 2014
20 Nov 2014
1/111539/14
1/216016/14
2/214822/14
24
12
1
P
L
L
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
Fr radius ulnam1/3 distal (D)

Fr os radius ulna
Post op
20 Nov 2014
1/211631/14
38
dr. Wayan W. SpB
Post op tumor penis
21 Nov 2014
2/134313/12
dr. Tjendono H
Post op VL
70 An. Isak Fairnap

71 Ny. Everdina Fairyo
21 Nov 2014
21 Nov 2014
1/216073/14
1/131584/14
2
64
L
P
dr. Tjendono H
dr. Tjendono H
STT glusa sinistra

STT parieta
72 Ny. Martha Marisan
21 Nov 2014
2/161420/13
49
dr. Tjendono H
Tumor mamae dextra
73 Ny. Yunita Wanma

21 Nov 2014
22 Nov 2014
1/111910/14
2/215422/14
25
18
P
P
dr. Tjendono H
dr. Tjendono H
Hemaroid
VL kepala
22 Nov 2014
2/214822/14
dr. Tjendono H
Abses hepar
76 Ny. Yubelina Baransano
22 Nov 2014
2/105548/10
50
dr. Tjendono H
Post op
Tn. David Wakum

Ny. Erna R.Y. Sulla
Nn. Febriana M. Rumansara
Nn. Fani Rumbino
Nov
Nov
Nov
Nov
Henatura
App acut
Post App acut
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
GV
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
22 Nov 2014
1/211631/14
38
dr. Tjendono H
Post op tumor penis
78 Ny. Elisabeth Paif
24 Nov 2014
2/132411/14
68
dr. Tjendono H
Post op
79 Nn. Insoraki Adadikam

80 Tn. Alex P. Erbo
24 Nov 2014
24 Nov 2014
2/185023/14
1/128574/14
15
32
P
L
dr. Tjendono H
dr. Tjendono H
App acut
Hipercenican
81 An. Novadila Ch. Erbo
24 Nov 2014
1/105622/10
dr Michael
Malter
24 Nov 2014
1/211631/14
38
dr. Tjendono H
Post op tumor penis
83
84
85
86
87
88
89
90
91
92
93
94
24
24
25
25
25
25
25
25
25
25
2/110248/11
2/161420/14
1/216016/14
1/215151/14
1/195958/14
2/167386/14
1/216402/14
1/216433/14
26 Nov 2014
26 Nov 2014
2/212023/14
1/216416/14
1/211631/14
1/216402/14
48
12
46
26
39
29
45
38
69
19
38
45
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
95 Tn. Yonas Wakum
26 Nov 2014
2/212023/14
69
dr. Tjendono H
VL
96 Ny. Foni. Rumbino
26 Nov 2014
1/216020/14
22
dr. Tjendono H
Post App
97 Ny. Elisabeth Paif
26 Nov 2014
2/132411/14
68
dr. Tjendono H
Post op
98 Ny. Milka Yembise
26 Nov 2014
1/216486/14
22
dr. Tjendono H
App acut
Tn. Luki Sanggeuw

Ny. Martha Marisan
An. Yulianus Krisifu
Tn. Efraim Inur
Ny. Yanti Manggaprouw
Tn. Obaja Iyai
Ny. Ferderika Wondiwoi
Tn. Yakob Bukorsyom
Tn. Yonas Wakum
Tn. Enjel David Korwa
Tn. Puwentoyudo. W
Ny. Ferderika Wondiwoi
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
P
L
L
P
L
P
L
L
L
L
Tjendono
Tjendono
Tjendono
Tjendono
Tjendono
Tjendono
Tjendono
Tjendono
Tjendono
Tjendono
Tjendono
Tjendono
H
H
H
H
H
H
H
H
H
H
H
H
Post op tumor
Fraktur antebrachi dextra
VL
Post op
Paraplegia
LBP
SWNT
Open fr corpus (S) mandibula
Post op
Tonsilitis
Post op tumor penis
Post op
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
Lab
Kontrol
Lab
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
GV
Kontrol
GV
Kontrol
GV
8908
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
26 Nov 2014
2/215422/14
19
dr. Tjendono H
Multiple VE+VL
100 Tn. Kristian Kafiar
26 Nov 2014
1/215607/14
47
dr. Tjendono H
Post op hernia
101 Ny. Anetha Swabra

102 Ny. Dolfina Sanadi
26 Nov 2014
26 Nov 2014
1/111539/141
1/215366/14
24
32
P
P
dr. Tjendono H
dr. Tjendono H
Fr ulna (D) 1/3 tengah ttp

Post App
103 Tn. Ayub W. Rumabar

104 Ny. Margaretha Sasatubun
27 Nov 2014
27 Nov 2014
27 Nov 2014
1/126080/14
1/216524/14
2/214822/14
49
65
1
L
P
L
dr. Wayan W. SpB

dr. Wayan W. SpB
dr. Wayan W. SpB
Post SKB
Closed fr of radius (D)
Post op
106 Ny. Yustina Ronsumbre
27 Nov 2014
1/215730/14
46
dr. Wayan W. SpB
Post op
107 Tn. Yohan. Yarangga
27 Nov 2014
1/216557/14
56
dr. Wayan W. SpB
Close fr of ungkle just (D)
108 Nn. Yanti. Manggaprouw
27 Nov 2014
1/195958/14
25
dr. Wayan W. SpB
Spondilosis DM
109
110
111
112
Tn. Puwentoyudo. W
By. Indania A. Karubaba
Ny. Dolfina Sanadi
Ny.Elisabeth. Paif
28
28
28
28
Nov
Nov
Nov
Nov
2014
2014
2014
2014
1/211631/14
2/215180/14
1/215366/14
38
113
114
115
116
117
Tn. Yakob Bukorsyom
28
29
29
29
29
Nov
Nov
Nov
Nov
Nov
By. Indania A. Karubaba

Ny. Natalia. Sikbat
An. Katrin Marandof
Ny. Natalia Marisan
118 Tn. Yohan Wakum

2/132411/14
31
68
P
P
P
2014
2014
2014
2014
2014
1/216433/14
38
2/215180/14
2/215422/14
1/151081/12
2/161420/13
19
2
40
29 Nov 2014
29 Nov 2014
2/212023/14
2/214822/14
69
1
P
P
P
P
L
L
dr.
dr.
dr.
dr.
Tjendono
Tjendono
Tjendono
Tjendono
H
H
H
H
Post op tumor penis

Post op
Ulkus di tangan
dr. Tjendono H
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
dr. Wayan W. SpB
Fraktur mandibula sinistra
dr. Wayan W. SpB

dr. Wayan W. SpB
Post op ORIF
Abses hepar
Hematuri
VL kepala
COR
Post op mamae
Kontrol
GV
Kontrol
GV
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
GV
Kontrol
GV
Kontrol
RO
Kontrol
CT Scan
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
GV
Kontrol
Kontrol
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
8908
TOTAL
Biak, 01 Desem
Direktur RS
dr. Iras B.P Rumbi

NIP : 19681014
BIAYA
JUMLAH
KETERANGAN
13
14
15
27,500
20,000
27,500
27,500
20,000
27,500
25,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
47,500
27,500
Poli Bedah
Poli Bedah
47,500
Poli Bedah
53,000
27,500
27,500
27,500
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
47,500
27,500
27,500
27,500
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
27,500
53,000
27,500
27,500
25,500
80,500
27,500
Poli Bedah
Poli Bedah
27,500
53,000
27,500
Poli Bedah
Poli Bedah
27,500
20,000
47,500
Poli Bedah
45,500
27,500
Poli Bedah
Poli Bedah
47,500
Poli Bedah
47,500
27,500
27,500
27,500
27,500
27,500
27,500
Poli
Poli
Poli
Poli
Poli
Poli
Poli
53,000
Poli Bedah
47,500
27,500
27,500
27,500
27,500
27,500
27,500
Poli
Poli
Poli
Poli
Poli
Poli
Poli
27,500
25,500
27,500
27,500
20,000
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
25,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
27,500
27,500
27,500
27,500
Poli Bedah
Poli Bedah
Poli Bedah
27,500
27,500
27,500
27,500
27,500
27,500
78,500
27,500
27,500
27,500
27,500
27,500
27,500
Poli
Poli
Poli
Poli
Poli
Poli
Poli
27,500
90,000
117,500
Poli Bedah
27,500
53,000
80,500
Poli Bedah
73,000
27,500
Poli Bedah
Poli Bedah
47,500
27,500
Poli Bedah
Poli Bedah
47,500
Poli Bedah
47,500
27,500
27,500
27,500
Poli
Poli
Poli
Poli
27,500
27,500
27,500
27,500
27,500
51,000
27,500
20,000
27,500
27,500
20,000
27,500
27,500
20,000
27,500
20,000
27,500
27,500
27,500
Poli Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
27,500
27,500
Poli Bedah
Poli Bedah
47,500
27,500
27,500
27,500
Poli
Poli
Poli
Poli
47,500
27,500
27,500
Poli Bedah
Poli Bedah
Poli Bedah
47,500
Poli Bedah
47,500
Poli Bedah
47,500
27,500
Poli Bedah
Poli Bedah
47,500
Poli Bedah
47,500
27,500
Poli Bedah
Poli Bedah
47,500
Poli Bedah
27,500
20,000
47,500
Poli Bedah
27,500
20,000
47,500
Poli Bedah
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
20,000
27,500
20,000
27,500
20,000
27,500
27,500
20,000
27,500
20,000
27,500
27,500
20,000
Bedah
Bedah
Bedah
Bedah
27,500
20,000
40,000
Poli Bedah
40,000
27,500
Poli Bedah
Poli Bedah
63,500
Poli Bedah
45,000
Poli Bedah
47,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
Poli
45,500
Poli Bedah
27,500
20,000
47,500
Poli Bedah
27,500
20,000
47,500
Poli Bedah
27,500
20,000
47,500
Poli Bedah
27,500
27,500
Poli Bedah
27,500
20,000
27,500
27,500
36,000
27,500
18,000
27,500
20,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
18,000
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
Bedah
27,500
20,000
47,500
Poli Bedah
47,500
27,500
Poli Bedah
Poli Bedah
47,500
27,500
27,500
Poli Bedah
Poli Bedah
Poli Bedah
47,500
Poli Bedah
27,500
20,000
47,500
Poli Bedah
27,500
25,500
45,500
Poli Bedah
27,500
20,000
27,500
27,500
20,000
27,500
27,500
27,500
20,000
27,500
680,000
27,500
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
27,500
20,000
27,500
27,500
Biak, 01 Desember 2014

Direktur RSUD Biak
707,500
27,500
27,500
27,500
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
47,500
27,500
27,500
27,500
27,500
Poli
Poli
Poli
Poli
Poli
Bedah
Bedah
Bedah
Bedah
Bedah
47,500
27,500
27,500
5,046,500
Poli Bedah
Poli Bedah
Poli Bedah
Iras B.P Rumbiak,M.Kes,SpPK

NIP : 19681014 200012 2 002
Total Pasien Polik Bedah tahun 2014

Januari
Februari
Maret
April
Mei
Juni
Juli
Agustus
September
Oktober
November
Desember
Total >>>>>>>>>>>>>>>
:
:
:
:
:
:
:
:
:
:
:
:
102
78
115
142
76
61
68
82
87
93
904

RWT JLN P. Bedah'14

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PEMERINTAH KABU

Jl. Sriwijaya Ridge I Tlp ( 0981 ) 21

FORM KLAIM PAS

Ny. Epi Rumabar

Ny. Yolanda Orisu

Tn. Arnold Rumkorem

An. Yohan Wakris

An. Yohan Wakris

An. Yehuda Korwa

Ny. Ade Nussi

Tn. Rudolf Rumaseuw

Tn. Usman Manggombo

Tn. Alfeus Kafiar

Tn. Rudolf Rumaseuw

Tn. Rudolf Rumaseuw

Tn. Denny Yewun

Ny. Martha Wakum

An. Yano Mirino

Nn. Elisabeth Rumawak

Ny. Elisabeth Rumawak

An. Joshua Rawai

Tn. Adelard Nahumury

An. Falen Randongkir

Tn. Fiktor Sambeka

Ny. Lendra Samsandri

Ny. Ade Marin

Tn. Fiktor Sambeka

Ny. Welmina Yafdas

Ny. Emma Sabarofek

An. Agnes Kmur

Nn. Charisma Makuker

Tn. Apot Lokobal

Nn. Ida Asyerem

Tn. Rutherford Managasi

Tn. Mathias Amsyamsum

An. Natalia Wanma

Tn. Alfeus Kafiar

Ny. Debora Kmur

Nn. Lisa Korwa

Tn. Jeno Kafiar

Tn. Fiktor Sambeka

Ny. Corry Rumkorem

Tn. Rudolf Rumaseuw

Tn. Ny. Louisa Rumbrawer

Nn. Ester Rumbiak

Ny. Martha Wakum

Tn. Rudolf Rumaseuw

Tn. Hendrikus Manggombo

An. Samuel Yarangga

98 Tn. Fredrik Maryen

101 Ny Emma D Sabarofek

102 Tn. Usman Manggombo

PEMERINTAH KABUPATEN BIAK NUMFOR

ya Ridge I Tlp ( 0981 ) 21294 Fax ( 0981 ) 22747 BIAK PAPUA

FORM KLAIM PASIEN JAMKES PAPUA

Tumor cruris (s)

Kista aterum temporalis

Fr line distal phalanx dg I

Post reposisi fraktur

Post orif femur (S)

Post implant silicone

Tumor mamae (D)