Professional Documents
Culture Documents
SENTRA MEDIKA
Jl.Raya Bogor KM.33 Cisalak Depok
(021) 8743790 (Hunting)
BPJS
No
Nama Pasien
Tanggal
Register
Kelas
Rawat
No
Biaya
SPT
R Rawat
Jumlah
BPJS
1
00707958
KRIS PRATOMO, TN
29/10/2014
ICU
3,560,000
24,541,401
00707704
DIAN, BY, NY
27/10/2014
PERINATOLOGI
4,710,000
14,092,689
00708317
ZAENURIDAH ARSYAD, NY
31/10/2014
KLS I
430,000
2,441,009
00708403
MOCHTAR. TN
31/10/2014
KLS II
310,000
4,094,667
00708464
ENI KURNIAWATI. NN
01/11/2014
KLS II
310,000
6,707,417
00708314
31/10/2014
KLS II
930,000
1,888,759
00707854
TARSIM , TN
28/10/2014
KLS II
1,860,000
7,938,821
00708379
AGUS HARIMULYO. TN
31/10/2014
KLS II
930,000
6,085,191
00708094
29/10/2014
KLS II
1,550,000
5,916,243
10
00708250
YEKTI SURAHMI, NY
30/10/2014
KLS II
1,240,000
2,875,697
11
00708412
31/10/2014
KLS I
1,290,000
7,907,088
12
00708862
MULAT, TN
03/11/2014
KLS I
430,000
2,368,040
13
00709008
NYAI, NY
04/11/2014
KLS II
310,000
2,699,690
14
00708909
HARDJONO, TN
03/11/2014
KLS I
1,720,000
4,908,852
15
00708708
MARJAM, NY
02/11/2014
KLS I
1,290,000
8,296,438
16
00708304
31/10/2014
KLS I
1,290,000
2,662,955
17
00708421
31/10/2014
KLS II
620,000
1,765,975
18
00708170
30/10/2014
KLS II
930,000
5,976,137
19
00708338
FITRIA SAVITRI, NY
31/10/2014
KLS II
1,240,000
10,905,009
20
00708553
01/11/2014
KLS II
620,000
1,451,598
21
00708427
YOYOH MAESAROH, NY
31/10/2014
KLS II
1,240,000
12,664,504
22
00708713
03/11/2014
KLS II
930,000
2,230,056
23
00708710
R YULY ASTUTY, NY
03/11/2014
KLS II
930,000
10,494,110
24
00709053
RAFFI AL SURYA, AN
04/11/2014
KLS II
25
00708822
03/11/2014
KLS I
930,000
2,536,800
1,290,000
3,223,031
26
00709188
MUHAMMAD IQBAL, AN
04/11/2014
KLS II
930,000
2,358,313
27
00709261
ASFUL SYAIBILLILLAH, TN
05/11/2014
KLS II
1,240,000
2,521,411
28
00709294
RONI JAYADI, TN
29
00709446
FAJAR MAULANA, TN
05/11/2014
KLS II
1,240,000
3,503,194
06/11/2014
KLS II
930,000
7,511,703
30
00709124
YESSY WIDARTA. TN
04/11/2014
KLS II
1,550,000
12,061,179
31
00709405
HAMIRULLAH.TN
06/11/2014
KLS II
1,240,000
7,408,919
32
00707874
28/10/2014
KLS II
3,720,000
9,746,074
33
00710073
JAMAL RIZQI, TN
10/11/2014
KLS I
430,000
2,226,000
34
00709667
DUDUN, TN
07/11/2014
KLS II
930,000
3,029,880
35
00709958
10/11/2014
KLS II
310,000
2,183,378
36
00709718
AGUS SUHERMAN , TN
08/11/2014
KLS II
1,240,000
5,066,629
37
00709295
NAQIYYAH. AN
05/11/2014
KLS II
930,000
2,796,076
38
00709711
07/11/2014
KLS II
620,000
2,311,141
39
00709555
WIWIT AGUSTINA, NY
06/11/2014
KLS II
930,000
2,121,813
40
00709157
04/11/2014
KLS II
1,550,000
3,129,834
41
00709631
07/11/2014
KLS II
620,000
1,965,715
42
00709201
05/11/2014
KLS II
1,550,000
3,627,603
43
00709716
M . RIFKI ALFARIZKY , AN
07/11/2014
KLS II
930,000
2,774,332
44
00709708
07/11/2014
KLS II
930,000
3,742,096
45
00709399
06/11/2014
KLS II
1,570,000
6,163,546
46
00709780
08/11/2014
KLS ISOLASI
930,000
1,865,158
47
00709651
07/11/2014
KLS II
1,240,000
3,120,566
48
00709611
07/11/2014
KLS II
1,280,000
7,095,829
49
00709806
M. RESTIAN NURHADI, AN
04/11/2014
KLS II
2,480,000
17,019,855
50
00710593
JAMAL RIZQI, TN
13/11/2014
ICU
660,000
9,659,635
51
00710507
MAULIDA MARZANI P. U, NN
13/11/2014
KLS I
1,290,000
3,730,407
52
00710158
11/11/2014
KLS II
620,000
3,016,890
53
00710519
EKKY ANGGIARIZKY, NY
13/11/2014
KLS III
130,000
1,999,711
54
00709728
SAMSANI,NY
08/11/2014
KLS I
2,580,000
13,381,928
55
00710311
MILA HERMALIA, NY
11/11/2014
KLS II
930,000
2,891,025
56
00710244
WAGIYAH, NY
11/11/2014
KLS II
930,000
3,978,678
57
11/11/2014
11/11/2014 00:00:00
58
00710149
10/11/2014
KLS II
1,550,000
2,210,466
6,500,987
59
00710281
ETI , NY
11/11/2014
KLS II
1,240,000
3,862,590
60
00710670
MARJAM, NY
14/11/2014
KLS I
430,000
2,347,446
61
00710500
12/11/2014
KLS II
930,000
5,987,163
62
00710469
H .M . ASLAH , TN
12/11/2014
KLS I
1,720,000
6,547,020
63
00710264
AGUS HARIYANTO , TN
11/11/2014
KLS II
1,550,000
12,756,736
64
00710603
SAMSI B JUSWANDI, TN
13/11/2014
KLS II
930,000
2,884,923
65
00710664
MACHNO, TN
14/11/2014
KLS I
1,290,000
3,203,022
66
00710793
NEFRI DEWANI. NY
14/11/2014
KLS II
620,000
2,210,845
67
00710817
MUHAMAD ZEIN. TN
14/11/2014
KLS II
620,000
8,335,334
68
00710844
CHORIDA MALIK, NY
14/11/2014
KLS I
860,000
2,355,035
69
00710853
15/11/2014
KLS II
310,000
4,397,798
70
00710225
11/11/2014
KLS II
620,000
2,838,983
71
00709938
10/11/2014
KLS II
1,550,000
3,542,135
72
00711006
SRI WURIYANI.NY
15/11/2014
KLS II
620,000
1,674,090
73
00710623
UNARSIH,NY
13/11/2014
KLS II
1,240,000
5,446,225
74
00710567
RIYANTO, TN
13/11/2014
KLS II
1,550,000
4,521,008
75
00710956
NIDYA ASCARYA, NY
15/11/2014
KLS II
930,000
7,433,657
76
00711243
17/11/2014
KLS II
310,000
3,959,249
77
00711306
RAJINEM, NY
18/11/2014
KLS I
430,000
2,239,377
78
00711283
17/11/2014
KLS II
620,000
9,073,161
79
00711352
INE KUSUMAWATI, NY
18/11/2014
KLS II
930,000
7,294,415
80
00711013
SITI AISYAH, NY
15/11/2014
KLS I
2,150,000
5,453,751
81
00711607
MUHAMAD DJUMIN . TN
19/11/2014
KLS II
310,000
1,495,466
82
00710504
IDA IMELDA,NY
12/11/2014
KLS II
1,410,000
15,903,368
83
00710665
NURUL BADRIAH, NY
14/11/2014
KLS II
1,240,000
10,438,444
84
00711258
17/11/2014
KLS II
930,000
2,166,084
85
00711163
KARTINI, NY
17/11/2014
KLS I
1,290,000
12,667,576
86
00710798
VILDA MALINI, NY
14/11/2014
KLS II
2,170,000
12,494,765
87
00711404
SITI MARYAM, NY
18/11/2014
KLS II
1,240,000
13,581,090
88
00711295
17/11/2014
KLS I
1,720,000
12,277,647
89
00711613
19/11/2014
KLS II
620,000
2,111,031
90
00711787
20/11/2014
KLS II - BAYI
750,000
1,085,000
91
00711161
MILA HERMALIA, NY
17/11/2014
KLS I
2,580,000
8,686,236
92
00711608
B.MANURUNG,TN
19/11/2014
KLS I
1,720,000
6,109,876
93
00711710
HARYANTI OKTAVIA, NY
20/11/2014
KLS II
930,000
10,353,856
94
00711589
NASYITHA NOURA A, AN
19/11/2014
KLS II
1,240,000
2,731,073
95
00711741
M ABDULLAH MUBARAK, AN
20/11/2014
KLS II
930,000
1,846,001
96
00711418
DANIEL CORNELIAS R, TN
18/11/2014
KLS II
1,240,000
16,496,014
97
00707427
TARUNI , NY
25/10/2014
KLS II
2,910,000
19,438,835
98
00711056
HOEDIE IRIANTO, TN
17/11/2014
Kls VIP
5,390,000
14,289,687
99
00708672
JANTJE B O, TN
02/11/2014
Kls VIP
14,610,000
61,295,474
100
00711826
20/11/2014
KLS II - BAYI
750,000
1,230,780
101
00711821
20/11/2014
KLS II
930,000
2,128,098
102
00711672
SITI AMINAH. NY
19/11/2014
KLS II
1,240,000
12,104,793
103
00711838
20/11/2014
KLS II
930,000
2,419,411
104
00711205
RAFIF GHAUSANI G F, AN
17/11/2014
KLS II
1,860,000
4,179,573
105
00711443
18/11/2014
KLS II
1,550,000
3,228,899
106
00711300
OMAN HERMAWAN. TN
18/11/2014
KLS I
3,010,000
11,450,271
107
00711246
ROYANI . TN
17/11/2014
KLS ISOLASI
2,170,000
7,641,194
108
00712308
ALUN GUNAWAN , TN
23/11/2014
KLS II
310,000
1,396,204
109
00711637
MARTALENA , NY
19/11/2014
KLS I
2,150,000
5,307,000
110
00712437
RISNAWATI, NY
24/11/2014
KLS II
310,000
2,075,529
111
00711940
21/11/2014
KLS II
1,240,000
2,937,024
112
00712145
BENTUR TAPA A, NY
22/11/2014
KLS II
930,000
13,693,286
113
00712216
MULAT, TN
22/11/2014
KLS I
1,290,000
3,663,400
114
00711763
RISTI IMALIA, NN
20/11/2014
KLS II
1,550,000
6,461,585
115
00712263
IKHWAN ALAMSYAH . TN
23/11/2014
KLS II
930,000
4,325,779
116
00712024
MUYASSAR PRAMUDYA, AN
21/11/2014
KLS ISOLASI
1,240,000
2,806,634
117
00711970
M.RASYA IRFANDY,AN
21/11/2014
KLS II
1,550,000
3,995,315
118
00712546
PURWANTO, TN
25/11/2014
KLS II
620,000
6,300,629
119
00712519
MEVIENA YUDHA P. NY
24/11/2014
KLS I
860,000
2,578,469
120
00712259
ARIANI, NY
22/11/2014
KLS II
1,240,000
3,740,759
121
00711862
PRESTIANI NURIAH, NN
21/11/2014
KLS II
1,860,000
4,890,704
122
00712270
23/11/2014
KLS ISOLASI
930,000
2,560,326
123
00712359
24/11/2014
KLS II
620,000
2,062,311
124
00712533
25/11/2014
KLS II
620,000
6,442,217
125
00712208
NOVARA THAMRIN, TN
22/11/2014
KLS II
1,550,000
4,817,510
126
00711570
SITI HOLISOH . NY
19/11/2014
KLS II
2,480,000
9,745,952
127
00712670
SUYITNO . TN
25/11/2014
KLS I
860,000
3,124,071
128
00711686
20/11/2014
KLS II
2,230,000
14,055,410
129
00712314
IRFAN . B . PRASETIA . AN
24/11/2014
KLS II
1,240,000
3,058,248
130
00711033
16/11/2014
NICU
5,400,000
23,078,257
131
00712894
26/11/2014
KLS II - BAYI
500,000
835,000
132
00712930
EKKY ANGGIARIZKY, NY
27/11/2014
KLS III
130,000
1,947,059
133
00712303
24/11/2014
KLS II
1,670,000
5,864,257
134
00712609
MUHAMMAD FAEYZA R, AN
25/11/2014
KLS II
930,000
2,206,312
135
00712916
27/11/2014
KLS II
620,000
6,429,511
136
00712780
VALERIA AISTA M, NY
26/11/2014
KLS II
930,000
10,400,248
137
00712203
VILDA MALINI, NY
22/11/2014
KLS II
2,170,000
10,453,424
138
00712898
26/11/2014
KLS II
880,000
3,706,438
139
00712823
26/11/2014
KLS I
1,720,000
3,348,291
140
00712844
JATMIKO, TN
26/11/2014
KLS II
1,240,000
4,517,957
141
00712826
DUDUN, TN
26/11/2014
KLS II
1,240,000
4,043,548
142
00711943
21/11/2014
KLS I
3,870,000
17,134,020
193,930,000
901,609,337
TOTAL
Tarif
BPJS (B)
GRUPING
Nominal
Selisih
Jumlah
Jaminan
Tagihan
6,720,000
17,821,401
34,022,400
14,092,689
12,902,400
2,441,009
5,663,500
4,094,667
2,669,500
573,744
6,133,673
2,761,800
1,888,759
7,938,821
1,028,877
5,056,314
4,165,900
5,916,243
5,697,000
2,589,700
6,215,897
6,268,700
2,875,697
2,589,700
1,500,000
6,407,088
9,908,400
2,368,040
5,663,500
2,699,690
4,854,400
4,908,852
5,307,600
7,158,376
1,138,062
5,663,500
2,662,955
3,126,900
1,765,975
3,662,300
5,976,137
2,658,000
10,905,009
5,309,200
1,451,598
3,662,300
12,664,504
8,819,900
2,230,056
3,663,700
10,494,110
5,309,200
2,536,800
3,663,700
3,223,031
7,673,600
2,358,313
2,680,000
2,521,411
2,759,200
3,503,194
2,646,800
7,511,703
4,474,800
12,061,179
8,310,700
7,408,919
4,474,800
1,458,000
8,288,074
5,503,500
2,226,000
5,663,500
3,029,880
2,748,300
2,183,378
4,854,400
101,393
4,965,236
5,099,000
2,796,076
2,680,000
2,311,141
4,587,100
2,121,813
2,752,600
3,129,834
3,662,300
1,965,715
3,663,700
3,627,603
3,663,700
2,774,332
3,663,700
3,742,096
4,587,100
6,163,546
5,397,300
1,865,158
2,589,700
3,120,566
3,663,700
1,670,597
5,425,232
3,843,500
17,019,855
10,679,400
9,659,635
9,908,400
760,000
2,970,407
4,280,600
3,016,890
4,854,400
1,999,711
4,045,400
13,381,928
11,665,300
2,891,025
2,748,300
3,978,678
7,996,300
2,210,466
6,505,300
6,500,987
5,082,200
3,862,590
5,697,000
2,347,446
5,663,500
5,987,163
6,461,100
659,318
5,887,702
5,263,200
1,533,960
11,222,776
10,335,700
2,884,923
5,082,200
3,203,022
2,432,084
4,280,600
2,210,845
1,472,661
5,134,600
8,335,334
2,355,035
1,919,481
4,274,500
4,397,798
4,039,836
4,854,400
2,838,983
2,082,567
3,368,100
3,542,135
2,163,817
4,710,600
1,674,090
2,752,600
5,446,225
4,854,400
4,521,008
3,426,100
7,433,657
4,474,800
3,959,249
3,602,000
2,239,377
4,045,400
9,073,161
6,461,200
7,294,415
4,474,800
5,453,751
7,433,700
1,495,466
3,669,100
7,902,319
9,504,562
5,309,200
10,438,444
5,309,200
2,166,084
3,663,700
12,667,576
6,194,100
12,494,765
11,597,200
13,581,090
13,454,100
2,849,769
9,427,878
3,729,000
2,111,031
3,663,700
6,219,500
1,085,000
2,195,400
6,522,236
2,164,000
2,851,900
1,076,754
5,033,122
7,313,500
10,353,856
5,309,200
2,731,073
5,397,300
1,846,001
2,680,000
16,496,014
14,982,400
19,438,835
9,998,800
5,243,587
9,046,100
9,329,000
27,273,074
34,022,400
34,022,400
1,230,780
2,195,400
2,128,098
3,074,500
12,104,793
6,144,900
2,419,411
3,669,100
4,179,573
3,663,700
3,228,899
3,663,700
1,925,271
9,525,000
9,525,000
7,641,194
12,779,100
1,396,204
2,680,000
5,307,000
5,929,300
2,075,529
4,854,400
2,937,024
6,446,100
13,693,286
14,200,400
3,663,400
4,202,400
282,991
6,178,594
4,710,600
4,325,779
3,426,100
2,806,634
5,505,300
3,995,315
6,446,100
6,300,629
4,793,200
458,800
2,119,669
2,752,600
3,740,759
3,957,400
4,890,704
3,527,100
2,560,326
2,589,700
2,062,311
2,680,000
6,442,217
5,853,300
4,817,510
5,397,300
9,745,952
7,996,300
473,600
2,650,471
2,841,500
1,054,946
13,000,464
10,669,000
3,058,248
3,663,700
23,078,257
24,301,700
835,000
2,195,400
1,947,059
4,045,400
1,625,000
4,239,257
4,854,400
2,206,312
2,680,000
6,429,511
5,744,500
10,400,248
5,309,200
3,242,782
7,210,642
5,021,000
230,000
3,476,438
2,929,400
3,348,291
4,274,500
4,517,957
4,615,200
4,043,548
4,587,100
17,134,020
11,665,300
83,325,394
819,787,456
20,326,343
825,611,300