LAPORAN REKAP KLAIM - RS MATA PADANG EYE CENTER

Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 20 Feb 2017 s/d 20 Feb 2017
Filter: Metode Pembayaran = Semua / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = Semua
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. SEP INACBG Top Up Total Tarif Tarif RS Jenis
1 20 Feb 2017 20 Feb 2017 06-44-33 JERRY FERNANDO PUTRA 0050R05402170002820 Q-5-44-0 192.100 130.000 RJ
2 20 Feb 2017 20 Feb 2017 06-44-95 ROSMINA 0050R05402170002920 H-2-36-0 YY-10-III,YY-10-III 7.342.000 7.333.500 RJ
3 20 Feb 2017 20 Feb 2017 06-44-55 SYIVA ASYSWARA 0050R05402170002851 Q-5-44-0 192.100 130.000 RJ
4 20 Feb 2017 20 Feb 2017 06-44-69 YOLARITA 0050R05402170002872 Q-5-44-0 192.100 130.000 RJ
5 20 Feb 2017 20 Feb 2017 06-44-79 ASRIL 0050R05402170002891 Q-5-44-0 192.100 130.000 RJ
6 20 Feb 2017 20 Feb 2017 05-05-97 ARMAEN MELAYU 0050R05402170002874 Q-5-44-0 192.100 170.200 RJ
7 20 Feb 2017 20 Feb 2017 06-44-80 TESHA AYU FEBIOLA 0050R05402170002892 Q-5-44-0 192.100 130.000 RJ
8 20 Feb 2017 20 Feb 2017 04-43-92 H ARDIZAL AMK 0050R05402170002900 H-3-12-0 223.800 300.500 RJ
9 20 Feb 2017 20 Feb 2017 04-99-38 NURHAYATI 0050R05402170002895 Q-5-44-0 192.100 193.000 RJ
10 20 Feb 2017 20 Feb 2017 06-33-81 MOSHADDEQ 0050R05402170002803 Q-5-44-0 192.100 193.100 RJ
11 20 Feb 2017 20 Feb 2017 04-40-70 CHANDRA DEWITA 0050R05402170002886 Q-5-44-0 192.100 144.200 RJ
12 20 Feb 2017 20 Feb 2017 05-23-26 ABDULLAH 0050R05402170002885 Q-5-44-0 192.100 320.500 RJ
13 20 Feb 2017 20 Feb 2017 06-44-77 SARAS PUTRI PRATIWI 0050R05402170002887 Q-5-44-0 192.100 130.000 RJ
14 20 Feb 2017 20 Feb 2017 06-44-88 RUKMINI 0050R05402170002908 Q-5-44-0 192.100 185.300 RJ
15 20 Feb 2017 20 Feb 2017 03-72-36 SURIATI KESUMA 0050R05402170002778 Q-5-44-0 192.100 166.000 RJ
16 20 Feb 2017 20 Feb 2017 06-44-87 SYARIFUDDIN SYARIF 0050R05402170002907 Q-5-44-0 192.100 125.000 RJ
17 20 Feb 2017 20 Feb 2017 06-44-18 ALMAINI 0050R05402170002827 H-2-36-0 3.671.000 2.272.600 RJ
18 20 Feb 2017 20 Feb 2017 06-44-89 AZUARDI 0050R05402170002910 Q-5-44-0 192.100 130.000 RJ
19 20 Feb 2017 20 Feb 2017 02-98-06 ODANG GUMANDA 0050R05402170002899 Q-5-44-0 192.100 141.000 RJ
20 20 Feb 2017 20 Feb 2017 06-35-91 TRI SYUKRI JONI 0050R05402170002846 Q-5-44-0 192.100 189.100 RJ
21 20 Feb 2017 20 Feb 2017 06-44-19 HARTATI 0050R05402170002795 Q-5-44-0 192.100 130.000 RJ
22 20 Feb 2017 20 Feb 2017 06-44-57 EVA SUSANTI 0050R05402170002853 Q-5-44-0 192.100 130.000 RJ
23 20 Feb 2017 20 Feb 2017 06-40-20 HAMIDAH 0050R05402170002759 Q-5-44-0 192.100 422.200 RJ
24 20 Feb 2017 20 Feb 2017 06-44-58 DESMITA 0050R05402170002854 Q-5-44-0 192.100 130.000 RJ
25 20 Feb 2017 20 Feb 2017 06-44-64 HARDI PRAWIRA 0050R05402170002869 Q-5-44-0 192.100 130.000 RJ
26 20 Feb 2017 20 Feb 2017 06-44-67 SARAH PUTRI PRAWIRA 0050R05402170002870 Q-5-44-0 192.100 115.000 RJ
27 20 Feb 2017 20 Feb 2017 06-44-91 LISSA DESYARINI 0050R05402170002914 Q-5-44-0 192.100 130.000 RJ
28 20 Feb 2017 20 Feb 2017 06-44-90 FAUZAN 0050R05402170002911 Q-5-44-0 192.100 130.000 RJ
29 20 Feb 2017 20 Feb 2017 06-44-65 BUNGA CHIRANI PRAWIRA 0050R05402170002867 Q-5-44-0 192.100 130.000 RJ
30 20 Feb 2017 20 Feb 2017 06-18-26 AMINAR 0050R05402170002859 Q-5-44-0 192.100 227.800 RJ
31 20 Feb 2017 20 Feb 2017 05-89-92 MARLINDA 0050R05402170002893 Q-5-44-0 192.100 153.100 RJ
32 20 Feb 2017 20 Feb 2017 06-44-59 SYAFRI DJ 0050R05402170002857 Q-5-44-0 192.100 130.000 RJ
33 20 Feb 2017 20 Feb 2017 06-44-93 FADIA HADISTI ZEN 0050R05402170002917 Q-5-44-0 192.100 176.900 RJ
34 20 Feb 2017 20 Feb 2017 06-44-92 SITI HARDIYANTI 0050R05402170002916 Q-5-42-0 193.500 168.100 RJ

Kode RS: 1371457 Halaman 1/5

 LAPORAN REKAP KLAIM - RS MATA PADANG EYE CENTER
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 20 Feb 2017 s/d 20 Feb 2017
Filter: Metode Pembayaran = Semua / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = Semua
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. SEP INACBG Top Up Total Tarif Tarif RS Jenis
35 20 Feb 2017 20 Feb 2017 06-36-69 HENDRI NURSIN 0050R05402170002912 Q-5-44-0 192.100 218.700 RJ
36 20 Feb 2017 20 Feb 2017 06-44-36 RAFDINAL R 0050R05402170002816 Q-5-44-0 192.100 204.900 RJ
37 20 Feb 2017 20 Feb 2017 06-44-03 RUCITRA 0050R05402170002793 Q-5-44-0 192.100 176.900 RJ
38 20 Feb 2017 20 Feb 2017 06-44-21 RAMDAYANI 0050R05402170002799 Q-5-44-0 192.100 225.900 RJ
39 20 Feb 2017 20 Feb 2017 06-44-22 DYANNITA PUTRI RAMDAYANI 0050R05402170002800 Q-5-44-0 192.100 199.500 RJ
40 20 Feb 2017 20 Feb 2017 06-11-44 AMRIL 0050R05402170002806 Q-5-44-0 192.100 153.900 RJ
41 20 Feb 2017 20 Feb 2017 06-44-83 ABDUL RAHMAN SIDDIQ 0050R05402170002897 Q-5-44-0 192.100 225.900 RJ
42 20 Feb 2017 20 Feb 2017 06-33-14 AZMI 0050R05402170002913 Q-5-44-0 192.100 168.900 RJ
43 20 Feb 2017 20 Feb 2017 06-31-38 ARAY PINANG 0050R05402170002896 Q-5-44-0 192.100 206.700 RJ
44 20 Feb 2017 20 Feb 2017 06-40-64 DINA YANTI 0050R05402170002865 Q-5-44-0 192.100 241.200 RJ
45 20 Feb 2017 20 Feb 2017 06-44-52 DARMAWANSYAH 0050R05402170002845 Q-5-44-0 192.100 225.900 RJ
46 20 Feb 2017 20 Feb 2017 06-44-62 YUSNANI 0050R05402170002861 Q-5-44-0 192.100 221.700 RJ
47 20 Feb 2017 20 Feb 2017 06-44-20 HARNELI 0050R05402170002796 Q-5-44-0 192.100 130.000 RJ
48 20 Feb 2017 20 Feb 2017 06-40-28 HARMON 0050R05402170002774 Q-5-44-0 192.100 138.900 RJ
49 20 Feb 2017 20 Feb 2017 06-44-41 PAIJEM 0050R05402170002828 Q-5-44-0 192.100 163.900 RJ
50 20 Feb 2017 20 Feb 2017 06-44-17 YASMANITA 0050R05402170002771 Q-5-44-0 192.100 164.700 RJ
51 20 Feb 2017 20 Feb 2017 06-26-04 A ERDIZAR 0050R05402170002797 Q-5-44-0 192.100 130.400 RJ
52 20 Feb 2017 20 Feb 2017 06-42-70 RINI MULSATI FEBRI 0050R05402170002787 Q-5-44-0 192.100 135.800 RJ
53 20 Feb 2017 20 Feb 2017 06-44-54 SRI MULYANI 0050R05402170002850 Q-5-44-0 192.100 115.000 RJ
54 20 Feb 2017 20 Feb 2017 06-19-06 DJALINUS 0050R05402170002882 Q-5-44-0 192.100 201.800 RJ
55 20 Feb 2017 20 Feb 2017 06-44-74 JUNAIDI 0050R05402170002880 Q-5-44-0 192.100 130.000 RJ
56 20 Feb 2017 20 Feb 2017 06-44-71 MUHAMMAD IRSYAD 0050R05402170002875 Q-5-44-0 192.100 130.000 RJ
57 20 Feb 2017 20 Feb 2017 06-44-66 MIA TAMILA 0050R05402170002868 Q-5-44-0 192.100 166.200 RJ
58 20 Feb 2017 20 Feb 2017 06-44-72 ASNA 0050R05402170002876 Q-5-44-0 192.100 130.000 RJ
59 20 Feb 2017 20 Feb 2017 04-71-70 ELFISON 0050R05402170002849 Q-5-42-0 193.500 240.100 RJ
60 20 Feb 2017 20 Feb 2017 06-18-10 KASMIDAR 0050R05402170002825 Q-5-44-0 192.100 100.000 RJ
61 20 Feb 2017 20 Feb 2017 05-90-97 MARTINI 0050R05402170002791 Q-5-44-0 192.100 208.900 RJ
62 20 Feb 2017 20 Feb 2017 06-32-71 NURBAITI 0050R05402170002783 Q-5-44-0 192.100 153.100 RJ
63 20 Feb 2017 20 Feb 2017 06-32-72 DAHLIA IDRUS 0050R05402170002768 Q-5-44-0 192.100 242.500 RJ
64 20 Feb 2017 20 Feb 2017 04-57-06 ASRIFIL AKMAL 0050R05402170002784 Q-5-44-0 192.100 100.000 RJ
65 20 Feb 2017 20 Feb 2017 06-36-94 FADLY SYAHRIAL 0050R05402170002873 Q-5-44-0 192.100 100.000 RJ
66 20 Feb 2017 20 Feb 2017 06-35-71 DEDDY RASYID 0050R05402170002884 Q-5-44-0 192.100 115.000 RJ
67 20 Feb 2017 20 Feb 2017 06-44-51 YURMANETI 0050R05402170002843 Q-5-44-0 192.100 100.000 RJ
68 20 Feb 2017 20 Feb 2017 06-25-21 YURNALIS 0050R05402170002862 Q-5-44-0 192.100 153.100 RJ

Kode RS: 1371457 Halaman 2/5

 LAPORAN REKAP KLAIM - RS MATA PADANG EYE CENTER
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 20 Feb 2017 s/d 20 Feb 2017
Filter: Metode Pembayaran = Semua / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = Semua
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. SEP INACBG Top Up Total Tarif Tarif RS Jenis
69 20 Feb 2017 20 Feb 2017 03-57-79 ZULKARNAIN CHAIDIR 0050R05402170002780 H-3-13-0 252.200 458.600 RJ
70 20 Feb 2017 20 Feb 2017 01-67-36 PATMAWATI 0050R05402170002841 Q-5-44-0 192.100 134.000 RJ
71 20 Feb 2017 20 Feb 2017 06-44-24 MASRIKO SAPUTRA 0050R05402170002814 Q-5-44-0 192.100 285.000 RJ
72 20 Feb 2017 20 Feb 2017 06-31-95 SYAMSIWAR 0050R05402170002801 Q-5-44-0 192.100 147.000 RJ
73 20 Feb 2017 20 Feb 2017 06-28-94 ALIZAR 0050R05402170002767 Q-5-44-0 192.100 100.000 RJ
74 20 Feb 2017 20 Feb 2017 06-02-26 ARIYETTI 0050R05402170002776 Q-5-44-0 192.100 237.500 RJ
75 20 Feb 2017 20 Feb 2017 05-99-79 GINZA WIDJAJA 0050R05402170002788 Q-5-44-0 192.100 203.900 RJ
76 20 Feb 2017 20 Feb 2017 06-30-07 USMAN 0050R05402170002792 Q-5-44-0 192.100 153.100 RJ
77 20 Feb 2017 20 Feb 2017 06-11-25 MISDAR 0050R05402170002798 Q-5-44-0 192.100 153.100 RJ
78 20 Feb 2017 20 Feb 2017 06-44-98 WAHYU KURNIAWAN 0050R05402170002928 Q-5-44-0 192.100 130.000 RJ
79 20 Feb 2017 20 Feb 2017 06-42-25 NELTI 0050R05402170002915 Q-5-44-0 192.100 172.000 RJ
80 20 Feb 2017 20 Feb 2017 05-61-16 ARIFIN 0050R05402170002840 Q-5-44-0 192.100 174.600 RJ
81 20 Feb 2017 20 Feb 2017 04-35-98 NISNAINI ZUBIR 0050R05402170002786 Q-5-44-0 192.100 196.000 RJ
82 20 Feb 2017 20 Feb 2017 04-41-51 ZULFAJRI 0050R05402170002764 Q-5-44-0 192.100 193.600 RJ
83 20 Feb 2017 20 Feb 2017 05-87-09 RIZKY TRI FADILLAH 0050R05402170002777 Q-5-44-0 192.100 174.000 RJ
84 20 Feb 2017 20 Feb 2017 06-40-68 ALIMAR 0050R05402170002889 Q-5-44-0 192.100 191.700 RJ
85 20 Feb 2017 20 Feb 2017 04-80-24 MUHAMAD RAJAB 0050R05402170002863 Q-5-44-0 192.100 195.000 RJ
86 20 Feb 2017 20 Feb 2017 05-86-38 MARWAN 0050R05402170002785 H-3-12-0 223.800 158.900 RJ
87 20 Feb 2017 20 Feb 2017 04-62-47 EDI JUNAIDI 0050R05402170002753 H-3-12-0 223.800 264.100 RJ
88 20 Feb 2017 20 Feb 2017 04-76-09 MARWIN K 0050R05402170002770 H-3-12-0 223.800 155.000 RJ
89 20 Feb 2017 20 Feb 2017 06-27-96 SURIANI 0050R05402170002856 H-3-12-0 223.800 153.600 RJ
90 20 Feb 2017 20 Feb 2017 06-38-56 YAHYA 0050R05402170002918 H-3-12-0 223.800 187.000 RJ
91 20 Feb 2017 20 Feb 2017 05-27-63 ELVI 0050R05402170002909 H-3-12-0 223.800 198.900 RJ
92 20 Feb 2017 20 Feb 2017 06-44-12 RIRIN TRIYANI 0050R05402170002755 H-3-12-0 223.800 155.000 RJ
93 20 Feb 2017 20 Feb 2017 06-44-63 FIRDA ILHAMI HUSNA 0050R05402170002866 Q-5-44-0 192.100 130.000 RJ
94 20 Feb 2017 20 Feb 2017 01-02-10 PONIATI 0050R05402170002902 H-3-12-0 223.800 263.000 RJ
95 20 Feb 2017 20 Feb 2017 05-91-74 ROSMANI 0050R05402170002925 Q-5-44-0 192.100 158.900 RJ
96 20 Feb 2017 20 Feb 2017 05-94-48 HURUDIN 0050R05402170002919 H-3-12-0 223.800 301.100 RJ
97 20 Feb 2017 20 Feb 2017 06-10-95 SYUHERMEIN RAHIM 0050R05402170002905 Q-5-44-0 192.100 155.900 RJ
98 20 Feb 2017 20 Feb 2017 04-15-15 FRANS MARWADY 0050R05402170002921 Q-5-44-0 192.100 100.000 RJ
99 20 Feb 2017 20 Feb 2017 06-44-56 KHAIRANI MUSLIHAH 0050R05402170002852 Q-5-44-0 192.100 160.000 RJ
100 20 Feb 2017 20 Feb 2017 04-92-93 ELVANI OCTAVIA 0050R05402170002790 Q-5-44-0 192.100 100.000 RJ
101 20 Feb 2017 20 Feb 2017 06-31-71 INDRA JAYA 0050R05402170002906 Q-5-44-0 192.100 153.600 RJ
102 20 Feb 2017 20 Feb 2017 06-44-50 YULINAR 0050R05402170002842 Q-5-44-0 192.100 115.000 RJ

Kode RS: 1371457 Halaman 3/5

 LAPORAN REKAP KLAIM - RS MATA PADANG EYE CENTER
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 20 Feb 2017 s/d 20 Feb 2017
Filter: Metode Pembayaran = Semua / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = Semua
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. SEP INACBG Top Up Total Tarif Tarif RS Jenis
103 20 Feb 2017 20 Feb 2017 06-44-39 YULIANA 0050R05402170002823 Q-5-44-0 192.100 130.000 RJ
104 20 Feb 2017 20 Feb 2017 06-44-45 SAHAT NAINGGOLAN 0050R05402170002833 Q-5-44-0 192.100 130.000 RJ
105 20 Feb 2017 20 Feb 2017 06-44-43 YULIZAR 0050R05402170002830 Q-5-44-0 192.100 130.000 RJ
106 20 Feb 2017 20 Feb 2017 06-44-37 ERNAWATI 0050R05402170002821 Q-5-44-0 192.100 130.000 RJ
107 20 Feb 2017 20 Feb 2017 06-44-16 RIDWAN ABJA 0050R05402170002766 Q-5-44-0 192.100 115.000 RJ
108 20 Feb 2017 20 Feb 2017 04-67-06 DEDI SISWANDI 0050R05402170002775 Q-5-44-0 192.100 129.600 RJ
109 20 Feb 2017 20 Feb 2017 06-44-32 RATNA DEWI SUHITA 0050R05402170002811 Q-5-44-0 192.100 151.800 RJ
110 20 Feb 2017 20 Feb 2017 06-44-34 BAYU SYAFHAL JAMIL 0050R05402170002812 Q-5-44-0 192.100 130.000 RJ
111 20 Feb 2017 20 Feb 2017 06-44-29 JAMAL 0050R05402170002815 Q-5-44-0 192.100 130.000 RJ
112 20 Feb 2017 20 Feb 2017 06-44-31 OLIF CLAUDIA PUTRI 0050R05402170002818 Q-5-44-0 192.100 130.000 RJ
113 20 Feb 2017 20 Feb 2017 06-44-30 MERI YANTI 0050R05402170002817 Q-5-44-0 192.100 130.000 RJ
114 20 Feb 2017 20 Feb 2017 02-11-85 NURMA 0050R05402170002809 Q-5-44-0 192.100 137.200 RJ
115 20 Feb 2017 20 Feb 2017 06-40-38 MARTINI ARLIN 0050R05402170002772 Q-5-44-0 192.100 115.400 RJ
116 20 Feb 2017 20 Feb 2017 06-44-46 FIRMAN HIDAYAT 0050R05402170002834 Q-5-44-0 192.100 145.400 RJ
117 20 Feb 2017 20 Feb 2017 01-95-17 DARLIS CHAN 0050R05402170002835 Q-5-44-0 192.100 134.200 RJ
118 20 Feb 2017 20 Feb 2017 06-42-28 MARIANA 0050R05402170002881 Q-5-44-0 192.100 155.000 RJ
119 20 Feb 2017 20 Feb 2017 06-40-60 MERI WARTI 0050R05402170002860 Q-5-44-0 192.100 123.900 RJ
120 20 Feb 2017 20 Feb 2017 06-44-26 YUNIZAR 0050R05402170002807 Q-5-44-0 192.100 115.800 RJ
121 20 Feb 2017 20 Feb 2017 04-87-43 JAMALUDIN 0050R05402170002838 Q-5-44-0 192.100 152.200 RJ
122 20 Feb 2017 20 Feb 2017 06-32-77 SUJATMOKO 0050R05402170002773 Q-5-44-0 192.100 122.000 RJ
123 20 Feb 2017 20 Feb 2017 04-77-14 BENTRI WIRSAL 0050R05402170002794 Q-5-42-0 193.500 188.700 RJ
124 20 Feb 2017 20 Feb 2017 05-87-14 FATHUR GHANI AL KARIM 0050R05402170002844 Q-5-44-0 192.100 145.000 RJ
125 20 Feb 2017 20 Feb 2017 05-91-45 MARNA 0050R05402170002822 Q-5-44-0 192.100 128.600 RJ
126 20 Feb 2017 20 Feb 2017 06-02-44 HADLI HAMZAH 0050R05402170002760 Q-5-44-0 192.100 166.000 RJ
127 20 Feb 2017 20 Feb 2017 04-14-59 NAZAR 0050R05402170002758 Q-5-44-0 192.100 194.600 RJ
128 20 Feb 2017 20 Feb 2017 05-97-82 SYAFRIANTI 0050R05402170002765 Q-5-44-0 192.100 341.700 RJ
129 20 Feb 2017 20 Feb 2017 05-22-92 USRI 0050R05402170002762 Q-5-44-0 192.100 125.000 RJ
130 20 Feb 2017 20 Feb 2017 04-63-34 ROMEOMAN 0050R05402170002789 Q-5-44-0 192.100 165.000 RJ
131 20 Feb 2017 20 Feb 2017 06-34-42 ENI ZULHAYATI 0050R05402170002877 Q-5-44-0 192.100 155.000 RJ
132 20 Feb 2017 20 Feb 2017 05-58-88 DJOKO DAULAT 0050R05402170002781 Q-5-44-0 192.100 292.600 RJ
133 20 Feb 2017 20 Feb 2017 05-72-09 HJ DESIWATI SSOS 0050R05402170002924 Q-5-44-0 192.100 184.400 RJ
134 20 Feb 2017 20 Feb 2017 02-85-05 ADITYA JOVI PRATAMA 0050R05402170002894 H-3-12-0 223.800 100.000 RJ
135 20 Feb 2017 20 Feb 2017 06-44-27 SYAHRIL 0050R05402170002808 Q-5-44-0 192.100 144.600 RJ
136 20 Feb 2017 20 Feb 2017 02-55-54 RUDY GUNAWAN LIAN 0050R05402170002855 Q-5-44-0 192.100 115.000 RJ

Kode RS: 1371457 Halaman 4/5

 LAPORAN REKAP KLAIM - RS MATA PADANG EYE CENTER
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 20 Feb 2017 s/d 20 Feb 2017
Filter: Metode Pembayaran = Semua / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = Semua
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. SEP INACBG Top Up Total Tarif Tarif RS Jenis
137 20 Feb 2017 20 Feb 2017 06-44-13 SAUDAH 0050R05402170002756 Q-5-44-0 192.100 170.000 RJ
138 20 Feb 2017 20 Feb 2017 05-77-99 FARIDA 0050R05402170002761 Q-5-44-0 192.100 138.900 RJ
139 20 Feb 2017 20 Feb 2017 06-44-73 GUSNIATI 0050R05402170002879 Q-5-44-0 192.100 115.000 RJ
140 20 Feb 2017 20 Feb 2017 04-85-45 SYAFRI SIDIK 0050R05402170002836 Q-5-44-0 192.100 115.000 RJ
Total 37.935.800 32.498.300

Kode RS: 1371457 Halaman 5/5