LAPORAN REKAP KLAIM - RS NAHDLATUL ULAMA BANYUWANGI

Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Nov 2017 s/d 30 Nov 2017
Filter: Metode Pembayaran = Semua / / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D SWASTA
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. SEP INACBG Top Up Total Tarif Tarif RS Jenis
1 30 Okt 2017 2 Nov 2017 37444 RATNA UDAYANTI 0190R0021017V000099 A-4-14-II 3.139.400 2.143.072 RI
2 30 Okt 2017 2 Nov 2017 22708 BIAS KURNIAWAN WIJAKSONO 0190R0021017V000132 G-4-22-III 4.426.900 3.214.298 RI
3 29 Okt 2017 2 Nov 2017 34942 BUNAYA HARIYANTO 0190R0021017V000061 A-4-14-I 2.586.400 2.683.483 RI
4 31 Okt 2017 3 Nov 2017 17185 MILA MULTAKMIMAH 0190R0021017V000137 A-4-13-I 1.294.200 2.829.800 RI
5 31 Okt 2017 4 Nov 2017 37481 ERIKA YURIANA 0190R0021017V000131 W-4-16-I 2.348.200 1.789.508 RI
6 2 Nov 2017 4 Nov 2017 37536 FERI NANDASARI 0190R0021117V000068 O-6-10-I 5.306.800 5.719.792 RI
7 2 Nov 2017 5 Nov 2017 37489 GADING DAMAR 0190R002111V000036 N-4-12-I 2.397.600 2.219.951 RI
8 7 Nov 2017 10 Nov 2017 37617 ENI AGUSTINA 0190R0021117V000148 B-4-14-I 3.362.900 2.227.038 RI
9 6 Nov 2017 11 Nov 2017 37591 MULYADI 0190R0021117V000100 A-4-12-I 2.946.700 2.556.765 RI
10 10 Nov 2017 12 Nov 2017 27005 ATIKA AZAHRA 0190R0021117V000232 J-4-21-I 3.124.500 3.216.357 RI
11 10 Nov 2017 12 Nov 2017 36136 EVI ESTARINA 0190R0021117V000237 O-6-10-I 5.306.800 13.500.000 RI
12 12 Nov 2017 13 Nov 2017 37745 DELA DWI ROMADINI 0190R0021117V000255 O-6-13-II 2.147.000 2.774.900 RI
13 10 Nov 2017 15 Nov 2017 37702 WARSITI 0190R0021117V000235 I-4-12-I 2.777.300 2.574.782 RI
14 12 Nov 2017 15 Nov 2017 37742 IMELDA JANUARTA 0190R0021117V000257 A-4-14-I 2.586.400 1.717.216 RI
15 13 Nov 2017 16 Nov 2017 37764 ASHIKA AZNI 0190R0021117V000274 J-4-21-I 3.124.500 4.126.122 RI
16 10 Nov 2017 16 Nov 2017 37706 H. MOH. SUKANDAR 0190R0021117V000253 K-4-18-II 1.904.100 7.305.354 RI
17 15 Nov 2017 17 Nov 2017 37812 HERI PRASETYO 0190R0021117V000335 A-4-14-I 2.586.400 2.105.774 RI
18 16 Nov 2017 18 Nov 2017 37831 SRIWAHYUNINGSIH 0190R0021117V000392 A-4-14-I 2.586.400 1.762.075 RI
19 16 Nov 2017 18 Nov 2017 33529 ARJUNA 0190R0021117V000393 K-4-17-I 1.334.400 3.842.463 RI
20 15 Nov 2017 19 Nov 2017 37802 BTARI AQIFA 0190R0021117V000345 J-4-21-I 3.124.500 2.899.950 RI
21 14 Nov 2017 19 Nov 2017 37790 ERIZUKA 0190R0021117V000338 J-4-21-I 3.124.500 3.087.830 RI
22 11 Nov 2017 19 Nov 2017 37731 MURDIYANTO 0190R0021117V000249 N-4-10-I 2.653.400 4.887.499 RI
23 20 Nov 2017 22 Nov 2017 37858 DINA MAHARANI 0190R0021117V000489 M-1-60-I 6.395.500 10.092.329 RI
24 18 Nov 2017 22 Nov 2017 37866 H. KASTURI 0190R0021117V000394 S-4-12-II 2.125.800 4.186.422 RI
25 15 Nov 2017 22 Nov 2017 37815 HERI RUSWATI 0190R0021117V000348 I-4-19-II 4.893.400 6.212.535 RI
26 20 Nov 2017 23 Nov 2017 36293 MUH SHOLEH 0190R0021117V000431 M-4-18-I 2.231.900 3.967.506 RI
27 22 Nov 2017 23 Nov 2017 19995 NOVAYANA 0190R0021117V000474 W-4-14-I 1.330.900 1.375.829 RI
28 21 Nov 2017 24 Nov 2017 37941 A. ROSUL 0190R0021117V000463 K-4-17-I 1.334.400 2.722.346 RI
29 24 Nov 2017 25 Nov 2017 26605 JACHRIS 0190R0021117V000539 N-4-12-I 2.397.600 1.704.840 RI
30 21 Nov 2017 26 Nov 2017 37945 HERI SUCIADI 0190R0021117V000466 N-4-12-I 2.397.600 2.539.087 RI
31 25 Nov 2017 27 Nov 2017 37972 SITI AULIA 0190R0021117V000551 W-1-11-I 1.786.900 2.255.223 RI
32 26 Nov 2017 28 Nov 2017 38043 HILDA NOVITASARI 0190R0021117V000553 A-4-14-I 2.586.400 1.693.892 RI
33 28 Nov 2017 30 Nov 2017 23933 ANDITA YULIANTO 0190R0021117V000626 A-4-14-I 2.586.400 1.799.153 RI
Total 94.256.100 117.733.191

Kode RS: 3510102 Halaman 1/1