Kdrs

Klsrs Norm
Klsrawat
Jnsrawat
Tglmsk Tglklr Los
Tgllhr UmurThn UmurHari
JK
CaraPlg Berat Dutama D1
Recid
Inacbg Deskripsi
Tarif TariffRS
TotalTarif
NamaPasien
DPJP
SEP
1703045 D
9238
1
1
28/09/2015
01/10/2015
4
12/06/1971
44
16179 2
1
R101
77
K-4-17-I
NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
2497600.
00
3883000 2497600 ELLI NENGSIH
dr.D.N Prastowo, Sp.PD 0096R00409150000
838^0001849855296
1703045 D
DPK798 1
1
28/09/2015
02/10/2015
5
20/07/1967
48
17602 1
1
M1301 J459
72
M-4-18-I
PENYAKIT TULANG DAN SENDI LAIN-LAIN RINGAN
1907500.00
4243000 1907500 SAIRAH dr.D.N Prastowo, Sp.PD 0096R00409150000844^000003091805
8
1703045 D
DPK806 1
1
29/09/2015
01/10/2015
3
03/11/1957
57
21149 1
1
G442
R101
78
G-4-23-I
MIGREN DAN SAKIT KEPALA LAIN (RINGAN) 2008200.00
2863000
2008200 PAIAN SIMANUNGKALIT
dr.D.N Prastowo, Sp.PD 0096R00409150000890^0000
030974196
1703045 D
48441 1
1
29/09/2015
02/10/2015
4
22/03/2000
15
5669
2
1
R42
K297
75
U-4-11-I
DYSEQUILIBRIUM RINGAN 1832700.00
2301000 1832700 CHINTYA
MARDIANTI
dr.D.N Prastowo, Sp.PD 0096R00409150000897^0000034179322
1703045 D
48445 1
1
30/09/2015
02/10/2015
3
26/12/2012
2
1008
1
2
R104
71
K-4-17-I
NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
2497600.
00
2874000 2497600 ACUZYO ALFAREZEL DALVARO
dr.Bustoni
0096R004
09150000898^0001080361484
1703045 D
48444 1
1
30/09/2015
03/10/2015
4
28/11/1980
34
12724 2
1
A91
N399
69
A-4-13-I
INFEKSI NON BAKTERI RINGAN
1767000.00
3879000 1767000
NOPA ELYANTI
dr.D.N Prastowo, Sp.PD 0096R00409150000905^0000030967198
1703045 D
DPK805 1
1
30/09/2015
02/10/2015
3
03/03/1974
41
15186 2
1
K297
F419
76
K-4-11-I
GASTRITIS & ULKUS PEPTIKUM RINGAN
1836300.00
1297000
1836300 SUMIARSIH
dr.D.N Prastowo, Sp.PD 0096R00409150000908^000110807181
9
1703045 D
DPK807 1
1
30/09/2015
02/10/2015
3
11/12/1971
43
15999 1
1
G442
M549
74
G-4-23-I
MIGREN DAN SAKIT KEPALA LAIN (RINGAN) 2008200.00
3453000
2008200 ITUSMAN dr.D.N Prastowo, Sp.PD 0096R00409150000909^0000031053521
1703045 D
DPK809 1
1
01/10/2015
03/10/2015
3
17/08/1958
57
20864 2
1
H813
E119
70
U-4-11-I
DYSEQUILIBRIUM RINGAN 1832700.00
1924000 1832700 ELMIYATI
dr.D.N Prastowo, Sp.PD 0096R00410150000015^0000031048255
1703045 D
385
1
1
01/10/2015
02/10/2015
2
23/05/1973
42
15471 2
1
H813
73
U-4-11-I
DYSEQUILIBRIUM RINGAN 1832700.00
1634000 1832700 TIURMA S
IJABAT dr.D.N Prastowo, Sp.PD 0096R00410150000053^0000030971136
1703045 D
45701 1
1
02/10/2015
05/10/2015
4
19/06/1958
57
20924 1
1
N390
67
N-4-12-I
INFEKSI GINJAL DAN SALURAN URIN RINGAN 2025900.00
2255000
2025900 MIRIN dr.D.N Prastowo, Sp.PD 0096R00410150000055^0001817768992
1703045 D
DPK812 1
1
03/10/2015
04/10/2015
2
03/04/1971
44
16254 2
1
K297
A09
68
K-4-11-I
GASTRITIS & ULKUS PEPTIKUM RINGAN
1836300.00
2497600
1836300 LILI SARYANI
dr.D.N Prastowo, Sp.PD 0096R00410150000059^000003104588
2
1703045 D
48403 1
1
03/10/2015
05/10/2015
3
27/04/2009
6
2350
2
1
A91
66

A-4-13-I
INFEKSI NON BAKTERI RINGAN
1767000.00
1916000 1767000
FELLYCIA AULIA SAPUTRI dr.Bustoni
0096R00410150000077^0000209054946
1703045 D
DPK805 1
1
04/10/2015
08/10/2015
5
03/03/1974
41
15190 2
1
K760
K219
62
B-4-13-I
GANGGUAN HATI SELAIN TUMOR, SIROSIS ATAU HEPATITIS ALKOHOLIK R
INGAN 2746100.00
3452000 2746100 SUMIARSIH
dr.D.N Prastowo, Sp.PD
0096R00410150000096^0001108071819
1703045 D
48224 1
1
03/10/2015
07/10/2015
5
02/11/1980
34
12753 2
1
O210
65
W-4-16-I
GANGGUAN ANTEPARTUM RINGAN
2677700.00
2920000 2677700
ADE MISNAINI
dr. Taufik
0096R00410150000106^0000030959166
1703045 D
38821 1
1
04/10/2015
07/10/2015
4
19/02/2013
2
957
1
1
A010
J029
63
A-4-14-I
PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN RINGAN 3562600.
00
3852000 3562600 ARJUNA ZAID FEBRIAN
dr julianto
0096R00410150000
107^0001839586296
1703045 D
19917 1
1
04/10/2015
07/10/2015
4
15/11/1987
27
10185 2
1
A09
N399
64
K-4-17-I
NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
2497600.
00
2442000 2497600 NOVI PURNAMA SARI
dr.D.N Prastowo, Sp.PD 0096R004
10150000112^0001883456256
1703045 D
DPK810 1
1
06/10/2015
09/10/2015
4
04/07/1965
50
18356 1
1
J180
61
J-4-16-I
SIMPLE PNEUMONIA & WHOOPING COUGH RINGAN
4462600.00
3052000 4462600 SAIBUL ARIFIN dr.D.N Prastowo, Sp.PD 0096R00410150000215^0000
031068505
1703045 D
40906 1
1
07/10/2015
09/10/2015
3
14/12/1974
40
14907 2
1
G442
I10
59
G-4-23-I
MIGREN DAN SAKIT KEPALA LAIN (RINGAN) 2008200.00
2088000
2008200 SITI ZUBAIDAH dr julianto
0096R00410150000216^0000031075119
1703045 D
DPK815 1
1
08/10/2015
09/10/2015
2
18/04/1959
56
20627 1
1
A09
E119
60
K-4-17-I
NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
2497600.
00
2259000 2497600 TUGIMIN dr julianto
0096R00410150000221^000003108241
1
1703045 D
7266
1
1
08/10/2015
09/10/2015
2
25/08/1950
65
23785 2
1
K921
58
K-4-18-I
DIAGNOSIS SISTEM PENCERNAAN LAIN-LAIN (RINGAN) 3569200.00
1791000 3569200 SUGIARTI
dr julianto
0096R00410150000222^000178733011
4
1703045 D
16685 1
1
08/10/2015
10/10/2015
3
25/12/1990
24
9053
2
1
O600
57
O-6-13-I
PERSALINAN VAGINAL RINGAN
2585900.00
1307000 2585900
POPI DESNIARTI dr. Taufik
0096R00410150000223^0001880516013
1703045 D
dpk800 1
1
09/10/2015
11/10/2015
3
17/11/1961
53
19684 2
1
A09
E119
54
K-4-17-I
NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
2497600.
00
2497600 2497600 NELIWATI
dr julianto
0096R00410150000228^0000
031131033
1703045 D
1441
1
1
09/10/2015
11/10/2015
3
03/04/1952
63
23199 1
1
A09
B349
56
K-4-17-I
NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
2497600.
00
2497600 2497600 MUHAMMAD MUKHIT dr julianto
0096R00410150000230^0000
030999407
1703045 D
20551 1
1
10/10/2015
11/10/2015
2
15/04/1998
17
6387
1
1
A09
K297
53
K-4-17-I
NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
2497600.
00
2441000 2497600 MUHAMMAD REZA FALEVI
dr julianto
0096R00410150000
232^0000031101513
1703045 D
26374 1
1
09/10/2015
12/10/2015
4

15/04/1962
53
19535 1
1
A09
E86
51
K-4-17-I
NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
2497600.
00
2997000 2497600 USMAN dr.D.N Prastowo, Sp.PD 0096R00410150000233^0000
031131426
1703045 D
12897 1
1
10/10/2015
11/10/2015
2
06/05/1979
36
13306 2
1
A09
K297
55
K-4-17-I
NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
2497600.
00
1393000 2497600 SASWANI dr julianto
0096R00410150000245^000003094639
7
1703045 D
DPK333 1
1
09/10/2015
12/10/2015
4
12/04/1936
79
29034 2
1
H811
G442
52
U-4-11-I
DYSEQUILIBRIUM RINGAN 1832700.00
2648000 1832700 JARIAH
dr.D.N Prastowo, Sp.PD 0096R00410150000265^0001314664097
1703045 D
7933
1
1
11/10/2015
15/10/2015
5
22/09/1966
49
17916 1
1
J180
45
J-4-16-I
SIMPLE PNEUMONIA & WHOOPING COUGH RINGAN
4462600.00
3246000 4462600 SUCIPTO dr.D.N Prastowo, Sp.PD 0096R00410150000277^000107845927
7
1703045 D
48785 1
1
12/10/2015
14/10/2015
3
10/04/1956
59
21734 2
1
R104
47
K-4-17-I
NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
2497600.
00
2109000 2497600 RUSNI dr.D.N Prastowo, Sp.PD 0096R00410150000284^0000
031057716
1703045 D
8560
1
1
10/10/2015
14/10/2015
5
26/01/1946
69
25459 2
1
I679
E784
48
G-4-26-I
GANGUAN-PENYAKIT SISTEM PERSARAFAN LAIN-LAIN (RINGAN) 3193600.
00
3569200 3193600 REGIANUS GULTOM dr julianto
0096R00410150000286^0000
031002107
1703045 D
3336
1
1
11/10/2015
14/10/2015
4
28/06/1973
42
15445 2
1
I959
R42
46
I-4-24-I
DIAGNOSIS SISTEM PEMBULUH DARAH LAIN-LAIN (RINGAN)
2099600.
00
3781400 2099600 CHRISTINA PONIARTI
dr.D.N Prastowo, Sp.PD 0096R004
10150000287^0000976264121
1703045 D
21974 1
1
12/10/2015
13/10/2015
2
11/10/1958
57
20820 1
1
H250
50
H-1-30-I
PROSEDUR LENSA DAN INTRA OKULER RINGAN 7795500.00
5430000
7795500 ABDUL MUNIR
DR. REYNO
0096R00410150000289^0000031251655
1703045 D
DPK797 1
1
13/10/2015
15/10/2015
3
05/04/1978
37
13705 1
1
K297
44
K-4-11-I
GASTRITIS & ULKUS PEPTIKUM RINGAN
1836300.00
2109000
1836300 FERY SETIAWAN dr.D.N Prastowo, Sp.PD 0096R00410150000358^000162464215
4
1703045 D
48771 1
1
12/10/2015
15/10/2015
4
12/03/1984
31
11536 2
1
A150
42
J-4-15-I
PERADANGAN DAN INFEKSI PERNAFASAN RINGAN
5355400.00
3426000 5355400 ILMI PURWATI
dr.D.N Prastowo, Sp.PD 0096R00410150000360^0000
030964241
1703045 D
48592 1
1
13/10/2015
16/10/2015
4
18/11/1987
27
10191 2
1
A91
40
A-4-13-I
INFEKSI NON BAKTERI RINGAN
1767000.00
2547000 1767000
DINA MARDIANI dr.D.N Prastowo, Sp.PD 0096R00410150000383^0001313808873
1703045 D
DPK190 1
1
14/10/2015
17/10/2015
4
27/05/1988
27
10001 2
1
A010
A09
38
A-4-14-I
PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN RINGAN 3562600.
00
3397000 3562600 MEMI SUSANTI H, A.MD
dr.D.N Prastowo, Sp.PD 0096R004
10150000387^0001085988148
1703045 D
8913
1
1
13/10/2015
15/10/2015
3
24/05/1969
46
16943 2
1
H811
43
U-4-11-I
DYSEQUILIBRIUM RINGAN 1832700.00
1832700 1832700 ROSDA
dr.D.N Prastowo, Sp.PD 0096R00410150000395^0000205160398

1703045 D
12916 1
1
13/10/2015
14/10/2015
2
27/01/1971
44
16330 1
2
I64
R51
49
G-4-15-I
KECEDERAAN PEMBULUH DARAH OTAK NON SPESIFIK & PENYUMBATAN PRE
-CEREBRAL TANPA INFARK RINGAN 2746700.00
2045000 2746700 FERRY BASTIAN
dr.D.N Prastowo, Sp.PD 0096R00410150000397^0000031095843
1703045 D
18420 1
1
14/10/2015
17/10/2015
4
06/11/1966
48
17874 1
1
G442
E781
35
G-4-23-I
MIGREN DAN SAKIT KEPALA LAIN (RINGAN) 2008200.00
2008200
2008200 RUSLAN dr.D.N Prastowo, Sp.PD 0096R00410150000402^0000031067875
1703045 D
48631 1
1
15/10/2015
17/10/2015
3
01/04/1988
27
10058 1
1
B349
R101
39
A-4-13-I
INFEKSI NON BAKTERI RINGAN
1767000.00
1778000 1767000
SUKIYADI
dr.D.N Prastowo, Sp.PD 0096R00410150000422^0001633096809
1703045 D
48370 1
1
14/10/2015
17/10/2015
4
02/08/1952
63
23083 2
1
M4792 I10
36
M-4-17-I
MASALAH BAGIAN PUNGGUNG/PINGGANG BELAKANG RINGAN
2336100.
00
2032000 2336100 INAYAH dr.D.N Prastowo, Sp.PD 0096R00410150000450^0001
270759623
1703045 D
44243 1
1
17/10/2015
19/10/2015
3
06/06/1963
52
19126 2
1
H811
A09
33
U-4-11-I
DYSEQUILIBRIUM RINGAN 1832700.00
2497600 1832700 PURWANIN
GSIH
dr.D.N Prastowo, Sp.PD 0096R00410150000462^0000031089824
1703045 D
30752 1
1
17/10/2015
19/10/2015
3
03/07/1952
63
23116 1
1
K297
I10
31
K-4-11-I
GASTRITIS & ULKUS PEPTIKUM RINGAN
1836300.00
2088000
1836300 SUGIJONO
dr.D.N Prastowo, Sp.PD 0096R00410150000478^000003107318
5
1703045 D
48550 1
1
16/10/2015
18/10/2015
3
09/09/2012
3
1132
1
1
B349
J069
34
A-4-13-I
INFEKSI NON BAKTERI RINGAN
1767000.00
1908000 1767000
MUHAMMAD IKBAR AL-FARIQ dr julianto
0096R00410150000484^0001370900204
1703045 D
3717
1
1
17/10/2015
19/10/2015
3
21/05/1972
43
15854 2
1
A09
R42
32
K-4-17-I
NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
2497600.
00
2183000 2497600 LYZA HORINA
dr.D.N Prastowo, Sp.PD 0096R00410150000
487^0000030939399
1703045 D
6472
1
1
18/10/2015
21/10/2015
4
01/05/1967
48
17702 1
1
J180
25
J-4-16-I
SIMPLE PNEUMONIA & WHOOPING COUGH RINGAN
4462600.00
3422000 4462600 HANURA MEIRI
dr.D.N Prastowo, Sp.PD 0096R00410150000489^0000
030956376
1703045 D
14943 1
1
17/10/2015
19/10/2015
3
21/10/1979
36
13145 2
1
A010
K219
30
A-4-14-I
PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN RINGAN 3562600.
00
2982000 3562600 HATMAWATI
dr.D.N Prastowo, Sp.PD 0096R00410150000
490^0000030963609
1703045 D
48691 1
1
19/10/2015
21/10/2015
3
16/02/1972
43
15951 2
1
J459
E119
27
J-4-18-I
ASTHMA & BRONKIOLITIS RINGAN 1418400.00
2688000 1418400
LILI SURYANI
dr.D.N Prastowo, Sp.PD 0096R00410150000537^0000030951448
1703045 D
48674 1
1
20/10/2015
22/10/2015
3
28/01/1989
26
9761
2
1
R509
24
A-4-12-I
DEMAM RINGAN 1834600.00
3962000 1834600 ATUN KARITI
dr.D.N Prastowo, Sp.PD 0096R00410150000538^0001380935259
1703045 D
3808
1
1
21/10/2015
23/10/2015
3
04/11/1964
50
18613 2
1
K297
K590
20
K-4-11-I
GASTRITIS & ULKUS PEPTIKUM RINGAN
1836300.00
1498000
1836300 TRI SUNARNI
dr.D.N Prastowo, Sp.PD 0096R00410150000546^000138502716
6
1703045 D
48685 1
1
21/10/2015
23/10/2015
3

03/04/1962
53
19559 1
1
A09
E86
17
K-4-17-I
NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
2497600.
00
2334000 2497600 AMINUL HADI
dr.D.N Prastowo, Sp.PD 0096R00410150000
547^0000031137491
1703045 D
48769 1
1
20/10/2015
23/10/2015
4
24/09/1962
53
19384 1
1
B349
E119
18
A-4-13-I
INFEKSI NON BAKTERI RINGAN
1767000.00
2405000 1767000
EDY SUWITO
dr.D.N Prastowo, Sp.PD 0096R00410150000548^0000031134227
1703045 D
48448 1
1
21/10/2015
22/10/2015
2
13/08/2014
1
434
2
1
J069
22
U-4-13-I
PERADANGAN EPIGLOTIS, TELINGA TENGAH, ISPA DAN LARINGOTRAKEITIS
RINGAN 1416600.00
1416600 1416600 WIDYA WIRA AUGYA PUTRI dr.Bustoni
0096r00410150000563^0001896752193
1703045 D
23903 1
1
21/10/2015
23/10/2015
3
30/09/1974
41
14996 2
1
G442
19
G-4-23-I
MIGREN DAN SAKIT KEPALA LAIN (RINGAN) 2008200.00
3087000
2008200 NURMUNA.LB
dr.D.N Prastowo, Sp.PD 0096R00410150000564^000020006024
5
1703045 D
44044 1
1
20/10/2015
22/10/2015
3
01/09/1989
26
9545
2
1
M549
21
M-4-17-I
MASALAH BAGIAN PUNGGUNG/PINGGANG BELAKANG RINGAN
2336100.
00
2228000 2336100 SEPTY HENI PURWANI S
dr.D.N Prastowo, Sp.PD 0096R004
10150000568^0001078230431
1703045 D
48891 1
1
22/10/2015
26/10/2015
5
12/09/1979
36
13189 1
1
A91
G442
15
A-4-13-I
INFEKSI NON BAKTERI RINGAN
1767000.00
4135000 1767000
PARBO NALDI
dr.D.N Prastowo, Sp.PD 0096R00410150000569^0000030967773
1703045 D
43385 1
1
18/10/2015
21/10/2015
4
01/01/1946
69
25492 2
1
I64
I10
26
G-4-15-I
KECEDERAAN PEMBULUH DARAH OTAK NON SPESIFIK & PENYUMBATAN PRE
-CEREBRAL TANPA INFARK RINGAN 2746700.00
2445000 2746700 JAWIRIAH
dr.D.N Prastowo, Sp.PD 0096R00410150000589^0000030997956
1703045 D
48690 1
1
21/10/2015
27/10/2015
7
28/11/1979
35
13111 2
1
A91
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13
A-4-13-I
INFEKSI NON BAKTERI RINGAN
1767000.00
6035000 1767000
LIANINGSIH
dr.D.N Prastowo, Sp.PD 0096R00410150000591^0001380932109
1703045 D
48890 1
1
22/10/2015
25/10/2015
4
06/04/2015
0
199
2
1
J180
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16
J-4-16-I
SIMPLE PNEUMONIA & WHOOPING COUGH RINGAN
4462600.00
4008000 4462600 RAISYA ARUSHI SYAKIRA SUKANDI dr julianto
0096R00410150000
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1703045 D
4182
1
1
19/10/2015
22/10/2015
4
10/01/1947
68
25119 1
1
N179
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N-4-10-I
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2510300.
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dr.D.N Prastowo, Sp.PD 0096R00410150000
622^0000030979271
1703045 D
16740 1
1
24/10/2015
27/10/2015
4
02/05/1955
60
22090 2
2
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12
A-4-10-I
SEPTIKEMIA RINGAN
2087400.00
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YAH
dr.D.N Prastowo, Sp.PD 0096R00410150000629^0001430740776
1703045 D
48855 1
1
24/10/2015
27/10/2015
4
19/02/2009
6
2438
2
1
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14
A-4-14-I
PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN RINGAN 3562600.
00
3562600 3562600 AULIA KHAIRUNISA
dr.Bustoni
0096R00410150000
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1703045 D
48903 1
1
25/10/2015
29/10/2015
5
24/12/1965
49
18202 2
1
R509
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A-4-12-I
DEMAM RINGAN 1834600.00
3348000 1834600 SRI RUDATIN
dr.D.N Prastowo, Sp.PD 0096R00410150000672^0000031072094
1703045 D
41000 1
1
25/10/2015
28/10/2015
4

04/03/1974
41
15210 2
1
J180
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10
J-4-16-I
SIMPLE PNEUMONIA & WHOOPING COUGH RINGAN
4462600.00
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dr.D.N Prastowo, Sp.PD 0096R00410150000674^0000
030914019
1703045 D
32172 1
1
14/10/2015
16/10/2015
3
21/02/2011
4
1696
2
1
A010
41
A-4-14-I
PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN RINGAN 3562600.
00
2978000 3562600 ZAAFIRAH MAISAAN SEPTIADI
dr.Bustoni
0096R004
10150000675^0001870362538
1703045 D
48403 1
1
24/10/2015
27/10/2015
4
27/04/2009
6
2371
2
1
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11
A-4-12-I
DEMAM RINGAN 1834600.00
1800000 1834600 FELLYCIA AULIA S
APUTRI dr.Bustoni
0096R00410150000677^0000209054946
1703045 D
48799 1
1
27/10/2015
29/10/2015
3
22/05/1994
21
7828
2
1
A010
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6
A-4-14-I
PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN RINGAN 3562600.
00
2884000 3562600 MEINARIYANTI BUBDI SATRIANI SB dr.D.N Prastowo, Sp.PD
0096R00410150000801^0001889421726
1703045 D
7485
1
1
27/10/2015
30/10/2015
4
13/05/1959
56
20621 2
1
H811
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U-4-11-I
DYSEQUILIBRIUM RINGAN 1832700.00
2370000 1832700 HERMAIWA
TI
dr.D.N Prastowo, Sp.PD 0096R00410150000806^0000031111841
1703045 D
48590 1
1
27/10/2015
29/10/2015
3
13/09/1959
56
20498 1
1
A010
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9
A-4-14-I
PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN RINGAN 3562600.
00
2914000 3562600 MANDIMAN
dr.D.N Prastowo, Sp.PD 0096R00410150000
810^0000031097698
1703045 D
48796 1
1
27/10/2015
30/10/2015
4
25/12/1994
20
7611
2
1
A010
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4
A-4-14-I
PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN RINGAN 3562600.
00
3360000 3562600 PUPUT DESI
dr.D.N Prastowo, Sp.PD 0096R00410150000
821^0001460538033
1703045 D
43413 1
1
27/10/2015
30/10/2015
4
01/04/2012
3
1304
2
1
J180
5
J-4-16-I
SIMPLE PNEUMONIA & WHOOPING COUGH RINGAN
4462600.00
3614000 4462600 FAIRA AZMI KHALILA
dr julianto
0096R00410150000823^0001
422003903
1703045 D
21830 1
1
28/10/2015
29/10/2015
2
17/10/1964
51
18638 1
1
J449
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8
J-4-17-I
PENYAKIT PARU OBSTRUKTIF KRONIS RINGAN
2526900.00
2519900 2526900 SUBAGYO dr.D.N Prastowo, Sp.PD 0096R00410150000829^000109563406
7
1703045 D
DPK655 1
1
28/10/2015
31/10/2015
4
11/11/1962
52
19344 2
1
H811
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U-4-11-I
DYSEQUILIBRIUM RINGAN 1832700.00
2125000 1832700 NOVIA SU
SIANI dr.D.N Prastowo, Sp.PD 0096R00410150000848^0000031062699
1703045 D
13278 1
1
29/10/2015
31/10/2015
3
08/12/1949
65
24066 2
1
A010
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2
A-4-14-I
PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN RINGAN 3562600.
00
2668000 3562600 SUMINAH dr.D.N Prastowo, Sp.PD 0096R00410150000867^0000
031076201
1703045 D
48728 1
1
18/10/2015
19/10/2015
2
14/04/1977
38
14066 2
1
K297
29
K-4-11-I
GASTRITIS & ULKUS PEPTIKUM RINGAN
1836300.00
2075000
1836300 FOLINDA KUSUMA SARI
dr.D.N Prastowo, Sp.PD 0096R00410150000912^0000
031132945
1703045 D
48615 1
1
16/10/2015
20/10/2015
5
19/10/1945
70
25564 1
1
E86
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28
E-4-11-I
HIPOVOLEMIA & GANGGUAN ELEKROLIT RINGAN
2186300.00
4962000 2186300 MUSTAJAB DS
dr.D.N Prastowo, Sp.PD 0096R00410150000913^0000

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1703045 D
48360 1
1
15/10/2015
17/10/2015
3
11/02/1981
34
12664 1
1
K297
R630
37
K-4-11-I
GASTRITIS & ULKUS PEPTIKUM RINGAN
1836300.00
1551000
1836300 SUDIRMAN
dr.D.N Prastowo, Sp.PD 0096R00410150000914^000020955347
8