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RODIAH (P) 63

376

07 Juli 2014 11:26 18 Juli 2014 1204600

Rodiah

63

DM. HT, Ketosis dalam DM
DM Ketosis, CHF ec HHD, Hyponatremia
JKN (Jaminan Kesehatan Nasional)
Ruang Dahlia
Ruang 7302 - PD
Perempuan 7302 - 3
Islam Jl. Kemandoran VIII RT 08 RW 011
Grogol Utara / Kebayoran Lama / Jakarta Selatan / DKI Jakarta
Nurjanah / Andi Kurnia
Anak 02197625264 / 08129947600 IGD Dr.
Maria Sari / Dr. Dati Sagoro, Sp.PD
Sri Ruswati E11.1, I11.0, E87.1 88.76
9.489.985

[ 01204600 ] R
ODIAH
Hospital
Admission:

[ Pilih Pasien ]
7 Juli 2014 11:26 /
JKN - Jaminan
Kesehatan Nasional

Unit:

Ruang
Dahlia

Order ID

Waktu

No. Resep

Jaminan

15

18/07/2014 13:24

50000236075

Tindakan/Lay
anan
UPO 2014-0718 13:24:51

ID

Item

Unit Cost

Quantity

Subtotal

JKN Jaminan
Kesehata
n
Nasional
Pasien

DRx0000460

ASPILETS TABLET,
CHEWABLE 80 MG
RAMIPRIL 5MG
TABL(JKN)
SPIRONOLACTONE
100 MG
TABLET(JKN)
BISOPROLOL 5 MG
TABLET (JKN)
TABLET
FUROSEMID INF
TABLET
ISOSORBIDE
DINITRATE TABLET
(JKN)

685

10

TAB

6850

725

5

TAB

3625

1125

5

TAB

5625

806

5

TAB

4030

134

20

TAB

2680

110

10

TAB

1100

DRx0016600
DRx0016613

DRx0016484

DRx0010109
DRx0016538

Depo
Rawat
Inap

LIQUID. INJECTION 100 UNT/10 ML (JKN) BD MICRO-FINE TUSLAH NON RACIKAN TOTAL 98956 1 CTG 98956 102000 1 PKG 102000 1828 500 5 9 UNT UNT 9140 4500 13 17/07/2014 2:47 50000234081 UPO 2014-0717 02:47:41 Depo Rawat Jalan ID Item Unit Cost Quantity Subtotal JKN Jaminan Kesehata n Nasional Pasien MDVx000022 MDEVx00000014 9 PROCx00000724 2 IVENA IV CATH 22 TRANSFUSION SET JMS TUSLAH NON RACIKAN TOTAL 14988 18975 1 1 UNT UNT 14988 18975 500 2 UNT 1000 12 15/07/2014 10:45 50000232037 UPO 2014-0715 10:45:42 Depo Rawat Inap ID Item Unit Cost Quantity Subtotal JKN Jaminan Kesehata n Nasional Pasien MDEVx00000007 0 MDVx000022 INFUS SET JMS 8910 1 UNT 8910 IVENA IV CATH 22 14988 1 UNT 14988 DRx0016488 MDVx000039 PROCx00000724 2 238506 Petugas : Asih Saryanti [ No Tagihan : 0011000026306 9] 34963 Petugas : Retno Agus Pratiwi [ No Tagihan : 0011000026306 9] . CONCENTRATE.DRx0010540 APIDRA (JKN) 3 ML INJECTION LANTUS SOLUTION.

MDEVx00000006 7 MDEVx00000000 2 DRx0016538 HANDSCOON NON STERIL M (PCS) ALKOHOL SWAB 502 20 PKG 10040 356 5 UNT 1780 ISOSORBIDE DINITRATE TABLET (JKN) ASPILETS TABLET. CHEWABLE 80 MG KSR TABLET (JKN) RAMIPRIL 5MG TABL(JKN) SPIRONOLACTONE 25 MG TABLET CEFOPERAZONE SULBACTAM 1 GM INJECTION DISP WIN 10CC DISP ONEMED 5CC DISP WIN 3CC DISP SYRINGE 1 CC INSULIN NATRIUM KLORIDA (NACL) SANBE 100 ML INFUSION TUSLAH NON RACIKAN TOTAL 110 12 TAB 1320 685 4 TAB 2740 2000 725 12 2 TAB TAB 24000 1450 448 4 TAB 1792 112200 4 VIL 448800 1162 632 581 3025 3 10 5 5 PKG PKG PKG UNT 3486 6320 2905 15125 10117 5 BAG 50585 500 15 UNT 7500 11 15/07/2014 0:03 50000231622 UPO 2014-0715 00:03:19 Depo Rawat Jalan ID Item Unit Cost Quantity Subtotal JKN Jaminan Kesehata n Nasional Pasien MDVx000022 MDEVx00000014 9 MDEVx00000024 7 PROCx00000724 IVENA IV CATH 22 TRANSFUSION SET JMS THREE WAY STOPCOCK TUSLAH NON 14988 18975 1 1 UNT UNT 14988 18975 22137 1 UNT 22137 500 3 UNT 1500 DRx0000460 DRx0016604 DRx0016600 DRx0014599 DRx0010889 MDVx001068 MDVx001007 MDVx001066 MDEVx00000002 6 DRx0016371 PROCx00000724 2 601741 Petugas : Asih Saryanti [ No Tagihan : 0011000026306 9] .

2 RACIKAN TOTAL 57600 Petugas : ade paramitha [ No Tagihan : 0011000026306 9] 10 14/07/2014 19:27 50000231501 UPO 2014-0714 19:27:22 Depo Rawat Jalan ID Item Unit Cost Quantity Subtotal JKN Jaminan Kesehata n Nasional Pasien MDVx000022 MDEVx00000014 9 MDVx001066 PROCx00000724 2 IVENA IV CATH 22 TRANSFUSION SET JMS DISP WIN 3CC TUSLAH NON RACIKAN TOTAL 14988 18975 1 1 UNT UNT 14988 18975 581 500 2 3 PKG UNT 1162 1500 9 14/07/2014 12:33 50000231128 UPO 2014-0714 12:33:10 Depo Rawat Inap ID Item Unit Cost Quantity Subtotal JKN Jaminan Kesehata n Nasional Pasien DRx0016647 FUROSEMID INF INJECTION (JKN) ISOSORBIDE DINITRATE TABLET (JKN) TUSLAH NON RACIKAN TOTAL 2286 4 AMP 9144 110 2 TAB 220 500 2 UNT 1000 36625 Petugas : Friani [ No Tagihan : 0011000026306 9] DRx0016538 PROCx00000724 2 Petugas : Asih Saryanti [ No Tagihan : 0011000026306 9] 10364 .

8 12/07/2014 0:23 50000228795 UPO 2014-0712 00:23:42 Depo Rawat Jalan ID Item Unit Cost Quantity Subtotal JKN Jaminan Kesehata n Nasional Pasien DRx0016488 LANTUS SOLUTION. CONCENTRATE. LIQUID. INJECTION 100 UNT/10 ML (JKN) BD MICRO-FINE TUSLAH NON RACIKAN TOTAL 102000 1 PKG 102000 1828 500 1 2 UNT UNT 1828 1000 7 10/07/2014 22:12 50000227683 UPO 2014-0710 22:12:13 Depo Rawat Jalan ID Item Unit Cost Quantity Subtotal JKN Jaminan Kesehata n Nasional Pasien DRx0016604 PROCx00000724 2 KSR TABLET (JKN) TUSLAH NON RACIKAN TOTAL 2000 500 3 1 TAB UNT 6000 500 6 10/07/2014 13:14 50000227430 UPO 2014-0710 13:14:46 Depo Rawat Inap ID Item Unit Cost Quantity Subtotal JKN Jaminan Kesehata n Nasional Pasien MDVx000022 IVENA IV CATH 22 14988 1 UNT 14988 MDVx000039 PROCx00000724 2 104828 Petugas : Hafiz Surahman [ No Tagihan : 0011000026306 9] 6500 Petugas : inggil setia ningrum [ No Tagihan : 0011000026306 9] .

CHEWABLE 80 MG BIFOTIK POWDER.MDEVx00000007 0 MDEVx00000006 7 MDEVx00000000 2 DRx0016552 INFUS SET JMS 8910 1 UNT 8910 HANDSCOON NON STERIL M (PCS) ALKOHOL SWAB 502 20 PKG 10040 356 10 UNT 3560 NATRIUM CHLORIDA (NACL) WIDATRA 500 ML(JKN) ISOSORBIDE DINITRATE TABLET (JKN) ASPILETS TABLET. FOR INJECTION SUSPENSION DISP WIN 10CC DISP WIN 5CC DISP WIN 3CC DISP SYRINGE 1 CC INSULIN NATRIUM KLORIDA ( NACL ) OTSU 100 ML INFUSION IMIPENEM CILASTATIN 1 GR INJECTION TUSLAH NON RACIKAN TOTAL 5875 4 BOT 23500 110 12 TAB 1320 685 4 TAB 2740 169579 4 VIL 678316 1162 893 581 3025 10 5 5 5 PKG PKG PKG UNT 11620 4465 2905 15125 12012 5 BAG 60060 225600 8 VIL 1804800 500 14 UNT 7000 5 08/07/2014 10:19 50000225234 UPO 2014-0708 10:19:31 Depo Rawat Inap ID Item Unit Cost Quantity Subtotal JKN Jaminan Kesehata n Nasional Pasien MDEVx00000007 0 INFUS SET JMS 8910 1 UNT 8910 DRx0016538 DRx0000460 DRx0000762 MDVx001068 MDVx001067 MDVx001066 MDEVx00000002 6 DRx0010274 DRx0016366 PROCx00000724 2 2649349 Petugas : Neng Apriliani Pransiska [ No Tagihan : 0011000026306 9] .

MDVx000022 MDEVx00000006 7 MDEVx00000000 2 DRx0016551 IVENA IV CATH 22 HANDSCOON NON STERIL M (PCS) ALKOHOL SWAB 14988 502 1 20 UNT PKG 14988 10040 356 5 UNT 1780 RINGER LACTATE WIDATRA 500 ML (JKN) NATRIUM KLORIDA ( NACL ) OTSU 100 ML INFUSION TUSLAH NON RACIKAN TOTAL 6500 4 BOT 26000 12012 3 BAG 36036 500 6 UNT 3000 4 08/07/2014 0:38 50000224877 UPO 2014-0708 00:38:40 Depo Rawat Jalan ID Item Unit Cost Quantity Subtotal JKN Jaminan Kesehata n Nasional Pasien MDEVx00000014 9 MDVx000022 MDEVx00000003 5 MDEVx00000008 6 PROCx00000724 2 TRANSFUSION SET JMS IVENA IV CATH 22 EXTENSION TUBE ET 1 V:0.79ML(ANAK) MICROPORE 1/2 INC 18975 1 UNT 18975 14988 28875 1 1 UNT UNT 14988 28875 12573 1 UNT 12573 TUSLAH NON RACIKAN TOTAL 500 4 UNT 2000 07/07/2014 12:14 50000224446 DRx0010274 PROCx00000724 2 100754 Petugas : Asih Saryanti [ No Tagihan : 0011000026306 9] 77411 Petugas : Friani [ No Tagihan : 0011000026306 9] 2 UPO 2014-0707 12:14:44 Depo Rawat Jalan JKN Jaminan Kesehata n Nasional .

ID Item Unit Cost Quantity Subtotal Pasien DRx0016684 NOVORAPID FLEXPEN 3 ML SOLUTION. INJECTION (jkn) TUSLAH NON RACIKAN TOTAL 106681 1 PKG 106681 500 1 UNT 500 1 07/07/2014 12:04 50000224410 UPO 2014-0707 12:04:51 Trolley IGD ID Item Unit Cost Quantity Subtotal JKN Jaminan Kesehata n Nasional Pasien MDEVx00000019 5 MDEVx00000003 3 MDVx001068 DRx0015387 FOLLEY CATHETER 16 RUSCH DRAINAGE BAG STERIL DISP WIN 10CC AQUA FOR INJECT OTSUKA 25 ML INJECTION TUSLAH NON RACIKAN TOTAL 24750 1 UNT 24750 7418 1 UNT 7418 1162 3445 1 1 PKG BOT 1162 3445 500 4 UNT 2000 3 07/07/2014 10:52 50000224101 UPO 2014-0707 10:52:22 Trolley IGD ID Item Unit Cost Quantity Subtotal PROCx00000724 2 107181 Petugas : Anita Mila Puspita [ No Tagihan : 0011000026299 3] PROCx00000724 2 38775 Petugas : Nia Kusniawati [ No Tagihan : 0011000026306 9] JKN Jaminan Kesehata n Nasional Pasien .

MDEVx00000002 6 DRx0016551 MDEVx00000007 0 MDEVx00000007 4 MDEVx00000019 5 MDEVx00000003 3 DRx0016638 MDVx001066 MDVx000548 PROCx00000724 2 DISP SYRINGE 1 CC INSULIN RINGER LACTATE WIDATRA 500 ML (JKN) INFUS SET JMS 3025 1 UNT 3025 6500 1 BOT 6500 8910 1 UNT 8910 IVENA IV CATH 20 14988 1 UNT 14988 FOLLEY CATHETER 16 RUSCH DRAINAGE BAG STERIL XYLOCAINE 2% 10 GM JELLY(JKN) DISP WIN 3CC DERMAFIX-1V TUSLAH NON RACIKAN TOTAL 24750 1 UNT 24750 7418 1 UNT 7418 49996 1 TUB 49996 581 2970 500 1 1 9 PKG PKG UNT 581 2970 4500 123638 Petugas : Nia Kusniawati [ No Tagihan : 0011000026306 9] TOTAL 4188235 .