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LAPORAN REKAP KLAIM - RS HAPSAH


Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Sep 2017 s/d 30 Sep 2017
Filter: Metode Pembayaran = Semua / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien
1 30 Agu 2017 1 Sep 2017 004916 SUMRAH
2 25 Agu 2017 1 Sep 2017 003878 HASMUDDIN
3 31 Agu 2017 1 Sep 2017 005486 MADJDAH MULIA ASMIN
4 31 Agu 2017 2 Sep 2017 009180 BY. NOOR HASLINDA
5 30 Agu 2017 3 Sep 2017 009176 AMIR
6 31 Agu 2017 3 Sep 2017 009185 HUSNAINI
7 2 Sep 2017 5 Sep 2017 006045 A. TENRI OLA PERTIWI
8 29 Agu 2017 5 Sep 2017 009133 SUJONO
9 3 Sep 2017 7 Sep 2017 009226 DWI ASTUTI
10 3 Sep 2017 7 Sep 2017 009229 MUHAMMAD TANG
11 6 Sep 2017 7 Sep 2017 009287 SAHRIANA HA
12 5 Sep 2017 7 Sep 2017 009261 NURALAM
13 4 Sep 2017 7 Sep 2017 009258 ANDI SUGIANTI
14 7 Sep 2017 8 Sep 2017 008309 DARMI
15 6 Sep 2017 8 Sep 2017 009306 MOH. ALGIFARI
16 4 Sep 2017 8 Sep 2017 009239 MAHLIL
17 7 Sep 2017 8 Sep 2017 003730 RAMAYANA DG SITURU
18 7 Sep 2017 9 Sep 2017 009356 KARTINI
19 7 Sep 2017 10 Sep 2017 009329 A. RIZKI DAMAYANTI
20 9 Sep 2017 11 Sep 2017 009395 ARIFAI
21 8 Sep 2017 11 Sep 2017 009365 HJ. ROSMINI
22 7 Sep 2017 11 Sep 2017 000443 H. AMBO ASSE
23 7 Sep 2017 11 Sep 2017 006018 AINI MAESURI
24 5 Sep 2017 11 Sep 2017 005517 AMINUDDIN. S
25 8 Sep 2017 12 Sep 2017 006916 HASLINA
26 10 Sep 2017 12 Sep 2017 009406 ROSNAWATI
27 11 Sep 2017 12 Sep 2017 009428 NURFAISAH ASWAL
28 10 Sep 2017 13 Sep 2017 009419 A. KAMARUDDIN
29 10 Sep 2017 13 Sep 2017 003719 NURHAYATI
30 12 Sep 2017 14 Sep 2017 008215 SUKNILAWATI
31 10 Sep 2017 14 Sep 2017 009409 SEMA
32 15 Sep 2017 16 Sep 2017 009594 ASNI ELIYANTY, SE
33 13 Sep 2017 16 Sep 2017 000872 KHAIRANI
34 12 Sep 2017 16 Sep 2017 009511 LATANG
35 14 Sep 2017 16 Sep 2017 006015 SUKMAWATI RASYID
36 15 Sep 2017 16 Sep 2017 009601 BY NY SUKMAWATI
37 15 Sep 2017 17 Sep 2017 005361 AULIA RAHMA
38 16 Sep 2017 18 Sep 2017 009607 DARMAWATI ABU MAS
39 13 Sep 2017 18 Sep 2017 006907 AMIRUDDIN
40 11 Sep 2017 18 Sep 2017 004213 H. MUH ARAS DG PATAPPU
41 13 Sep 2017 18 Sep 2017 009522 SUBAEDAH
42 14 Sep 2017 18 Sep 2017 009565 AHMAD REIGAN SADIL
43 15 Sep 2017 18 Sep 2017 009589 WIRDA NINGSIH
44 14 Sep 2017 18 Sep 2017 002002 SURIATI
45 16 Sep 2017 19 Sep 2017 009609 DARMAN
46 12 Sep 2017 19 Sep 2017 009487 ANDI NILAWATI
47 17 Sep 2017 19 Sep 2017 009614 SAMSIR DAUD
48 17 Sep 2017 20 Sep 2017 009620 TIJA

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49 18 Sep 2017 20 Sep 2017 009626 HASNIATI HASYIM


50 12 Sep 2017 20 Sep 2017 009488 JOJJO
51 18 Sep 2017 20 Sep 2017 009651 A. AHMAD YUSUF
52 8 Sep 2017 21 Sep 2017 009373 ITA
53 19 Sep 2017 21 Sep 2017 005918 HERMAN
54 20 Sep 2017 21 Sep 2017 009659 MARWANAH
55 18 Sep 2017 21 Sep 2017 009625 SUBAEDAH
56 15 Sep 2017 22 Sep 2017 009596 KAYA
57 15 Sep 2017 22 Sep 2017 006992 ABDU RAHIM
58 18 Sep 2017 22 Sep 2017 009652 BONGAWALI P.
59 20 Sep 2017 23 Sep 2017 005950 YUSRIANI
60 20 Sep 2017 23 Sep 2017 009730 SARIFUDDIN
61 21 Sep 2017 23 Sep 2017 009750 A. NABIGHAH AZZAHRA
62 22 Sep 2017 23 Sep 2017 009758 SAHRIENI
63 23 Sep 2017 24 Sep 2017 009791 RAMANG
64 23 Sep 2017 24 Sep 2017 007781 SITI FITRAH SARI
65 22 Sep 2017 24 Sep 2017 009771 ANDI RAMALIA
66 18 Sep 2017 24 Sep 2017 009648 AYU PURNAMA RAHMAN
67 22 Sep 2017 24 Sep 2017 007214 ANDI INDRIA SMITA
68 18 Sep 2017 26 Sep 2017 009645 SYAHYAWI ERPAN
69 24 Sep 2017 26 Sep 2017 009806 FAJAR
70 22 Sep 2017 26 Sep 2017 009774 A. NENNE
71 27 Sep 2017 27 Sep 2017 009895 BY NY HAMIDA
72 23 Sep 2017 27 Sep 2017 009794 RATNAWATI
73 18 Sep 2017 27 Sep 2017 009633 MUH FIRMAN
74 20 Sep 2017 27 Sep 2017 009723 HERLINDA
75 23 Sep 2017 27 Sep 2017 009780 HARDIANA
76 25 Sep 2017 27 Sep 2017 009829 KIKI FATMALASARI
77 25 Sep 2017 28 Sep 2017 009818 MUH HAIKAL
78 25 Sep 2017 28 Sep 2017 009855 NIRWAN
79 27 Sep 2017 29 Sep 2017 009935 VERA
80 26 Sep 2017 29 Sep 2017 009368 NURUL AWALYAH RUSTAN, S. PI
81 25 Sep 2017 29 Sep 2017 009809 MUHAMMAD YUNUS
82 26 Sep 2017 29 Sep 2017 009882 HJ. ST. HARMONI, S. PD
83 27 Sep 2017 30 Sep 2017 009911 ASMAWATI
84 23 Sep 2017 30 Sep 2017 009157 ANDI ULFASARI
85 26 Sep 2017 30 Sep 2017 009862 BY NY ANDI ULPASARI
86 17 Sep 2017 21 Sep 2017 008909 FIRDAUS
87 12 Sep 2017 16 Sep 2017 009492 NURDIANA
88 28 Sep 2017 29 Sep 2017 009968 IKA MERDEKAWATI M
89 26 Sep 2017 28 Sep 2017 009878 MUH. FIKRI
90 17 Sep 2017 18 Sep 2017 009616 MARDIANA
Total
Kode RS: 7308058

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mua / Jenis Tarif = TARIF RS KELAS C SWASTA


No. SEP INACBG Top Up Total Tarif Tarif RS Jenis
0330R00108170001273 K-4-17-I 1,465,800 1,260,348 RI
0330R00108170001006 I-4-12-II 3,111,900 4,937,770 RI
0330R00108170001282 O-6-13-I 2,254,400 3,163,723 RI
0330R00108170001272 K-4-17-I 1,465,800 1,242,545 RI
0330R00108170001258 N-4-16-I 4,005,100 4,085,200 RI
0330R00108170001274 O-6-13-I 1,932,400 2,640,460 RI
0330R00109170000055 O-6-10-I 6,041,800 13,510,581 RI
0330R00108170001187 G-4-26-I 3,085,200 5,182,000 RI
0330R00109170000031 A-4-14-II 3,177,100 5,344,010 RI
0330R00109170000056 G-4-10-I 3,278,800 1,845,700 RI
0330R00109170000127 O-6-13-I 1,610,300 4,337,445 RI
0330R00109170000243 K-4-17-I 2,052,100 2,848,800 RI
0330R00109170000068 O-6-13-I 1,932,400 3,373,945 RI
0330R00109170000201 O-6-13-I 1,610,300 3,270,000 RI
0330R00109170000194 K-4-17-I 1,759,000 2,256,200 RI
0330R00109170000063 G-4-23-I 2,871,800 4,904,900 RI
0330R00109170000204 O-6-13-I 1,932,400 4,312,460 RI
0330R00109170000265 O-6-13-I 1,932,400 3,263,405 RI
0330R00109170000202 K-1-13-I 3,490,800 6,966,719 RI
0330R00109170000325 K-4-17-I 1,465,800 1,367,730 RI
0330R00109170000262 E-4-12-I 3,153,500 3,771,635 RI
0330R00109170000218 K-4-17-I 1,465,800 6,135,000 RI
0330R00109170000257 A-4-12-I 2,615,900 1,947,200 RI
0330R00109170000116 I-4-12-II 4,356,700 7,451,115 RI
0330R00109170000270 O-6-13-I 1,610,300 3,556,018 RI
0330R00109170000298 O-6-13-II 1,905,900 2,611,100 RI
0330R00109170000342 O-6-13-I 2,254,400 3,536,710 RI
0330R00109170000403 G-4-24-II 2,854,600 2,892,540 RI
0330R00109170000307 N-4-12-I 2,246,700 1,968,600 RI
0330R00109170000486 O-6-13-II 2,287,100 4,370,023 RI
0330R00109170000299 K-4-18-II 1,840,600 4,869,575 RI
0330R00109170000570 O-6-13-I 2,254,400 2,995,405 RI
0330R00109170000423 K-1-13-I 4,072,600 7,975,380 RI
0330R00109170000539 G-4-26-I 3,085,200 2,173,000 RI
0330R00109170000547 O-6-13-I 1,610,300 2,535,355 RI
0330R00109170000618 P-8-17-I 3,467,300 855,000 RI
0330R00109170000563 K-4-17-I 2,052,100 2,378,460 RI
0330R00109170000575 K-4-17-I 1,465,800 1,525,600 RI
0330R00109170000480 I-4-17-I 2,566,300 4,923,120 RI
0330R00109170000368 G-1-13-I 1,382,800 11,923,800 RI
0330R00109170000484 E-4-10-I 4,860,300 4,220,000 RI
0330R00109170000534 A-4-12-I 3,139,100 4,254,185 RI
0330R00109170000558 O-6-13-I 1,932,400 3,450,155 RI
0330R00109170000494 E-4-10-I 4,860,300 6,273,300 RI
0330R00109170000578 S-4-10-I 2,100,000 1,930,500 RI
0330R00109170000393 Z-4-12-II 2,982,100 4,554,763 RI
0330R00109170000581 N-4-13-I 4,064,800 2,818,000 RI
0330R00109170000631 U-4-13-III 2,684,300 2,813,143 RI

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0330R00109170000615 L-1-40-I 3,853,500 5,670,000 RI


0330R00109170000392 L-4-12-I 1,842,300 15,489,306 RI
0330R00109170000671 A-4-12-I 3,662,200 2,808,600 RI
0330R00109170000271 E-4-10-I 3,471,700 16,154,360 RI
0330R00109170000767 K-4-17-I 1,759,000 2,518,100 RI
0330R00109170000772 W-1-11-I 2,072,800 6,079,583 RI
0330R00109170000625 Z-4-12-II 4,174,900 4,820,585 RI
0330R00109170000577 E-4-10-III 8,429,600 5,428,525 RI
0330R00109170000557 J-4-21-I 3,328,400 7,582,365 RI
0330R00109170000745 E-4-10-I 4,860,300 5,314,900 RI
0330R00109170000763 O-6-10-I 6,041,800 10,970,800 RI
0330R00109170000749 A-4-12-I 3,139,100 3,799,960 RI
0330R00109170000796 A-4-12-I 3,662,200 2,274,200 RI
0330R00109170000791 O-6-13-I 2,254,400 3,835,510 RI
0330R00109170000820 I-4-17-I 1,833,100 828,100 RI
0330R00109170000810 O-6-13-II 2,287,100 4,213,158 RI
0330R00109170000815 I-4-17-I 2,566,300 1,492,204 RI
0330R00109170000667 A-4-13-I 2,202,300 5,834,720 RI
0330R00109170000794 O-6-13-I 2,254,400 3,204,518 RI
0330R00109170000639 J-4-15-I 4,169,100 3,849,379 RI
0330R00109170000923 J-4-16-I 3,473,800 1,750,500 RI
0330R00109170000904 O-6-10-II 7,445,400 11,455,790 RI
0330R00109170000985 P-8-12-I 6,054,800 3,055,500 RI
0330R00109170000823 A-4-13-III 2,843,800 3,055,175 RI
0330R00109170000620 J-4-15-II 4,980,900 9,437,335 RI
0330R00109170000764 J-4-15-II 4,980,900 8,960,650 RI
0330R00109170000861 O-6-10-I 7,048,800 12,535,850 RI
0330R00109170000871 O-6-13-I 1,932,400 3,616,700 RI
0330R00109170000877 A-4-14-I 2,181,200 1,854,000 RI
0330R00109170000912 I-4-12-I 3,758,600 4,322,434 RI
0330R00109170001057 G-4-24-II 2,854,600 1,438,830 RI
0330R00109170000915 O-6-13-I 1,932,400 2,992,560 RI
0330R00109170000869 M-4-17-I 3,996,300 4,124,500 RI
0330R00109170000997 A-4-14-II 3,706,600 4,187,000 RI
0330R00109170001000 W-4-12-II 5,352,000 4,274,710 RI
0330R00109170000824 O-6-10-I 6,041,800 13,721,300 RI
0330R00109170000909 P-8-17-I 4,160,800 2,457,500 RI
0330R00109170000582 G-4-26-I 3,702,300 4,284,200 RI
0330R00109170000411 O-6-10-I 6,041,800 11,828,470 RI
0330R00109170001047 W-1-11-I 2,418,300 9,984,210 RI
0330R00109170001035 A-4-12-I 2,615,900 1,381,600 RI
0330R00109170000614 O-6-13-II 1,905,900 2,710,660 RI
281,035,100 423,710,310

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