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  • Formulir Pengajuan Jamkesda Rawat Jalan Puskesman Raas Ponkesdes Desa Brakas Dusun Talango Air Bulan Januari 2018

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    1. This document is a form listing outpatient treatments provided at Puskesmas Raas health clinic in Desa Brakas, Dusun Talango Air for the month of January 2018. 2. It includes details of 19 patients such as their name, age, address, diagnosis, treatment provided, ticket/admin costs and total costs. 3. All patients received injections and oral medications for conditions like rheumatoid arthritis, hypertension, ISPA (upper respiratory infection) and were charged 7,500 rupiah for the ticket and 1,000 rupiah for costs, totaling 8,500 rupiah.

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    1. This document is a form listing outpatient treatments provided at Puskesmas Raas health clinic in Desa Brakas, Dusun Talango Air for the month of January 2018. 2. It includes details of 19 patients such as their name, age, address, diagnosis, treatment provided, ticket/admin costs and total costs. 3. All patients received injections and oral medications for conditions like rheumatoid arthritis, hypertension, ISPA (upper respiratory infection) and were charged 7,500 rupiah for the ticket and 1,000 rupiah for costs, totaling 8,500 rupiah.

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    8 views1 page

    Formulir Pengajuan Jamkesda Rawat Jalan Puskesman Raas Ponkesdes Desa Brakas Dusun Talango Air Bulan Januari 2018

    Uploaded by

    Ibnu Jacks
    1. This document is a form listing outpatient treatments provided at Puskesmas Raas health clinic in Desa Brakas, Dusun Talango Air for the month of January 2018. 2. It includes details of 19 patients such as their name, age, address, diagnosis, treatment provided, ticket/admin costs and total costs. 3. All patients received injections and oral medications for conditions like rheumatoid arthritis, hypertension, ISPA (upper respiratory infection) and were charged 7,500 rupiah for the ticket and 1,000 rupiah for costs, totaling 8,500 rupiah.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    of 1

    FORMULIR PENGAJUAN JAMKESDA RAWAT JALAN

    PUSKESMAN RAAS
    PONKESDES DESA BRAKAS DUSUN TALANGO AIR
    BULAN JANUARI 2018
    NO TANGGAL No.KTP/KK/SPM NAMA PEMDERITA L/P UMUR ALAMAT DIAGNOSA CODE ICD X TINDAKAN KARCIS BIAYA TOTAL

    1 02/01/2018 3529220107700082 RASUL L 41 T.air RHEUMATOID M06.0 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    2 03/01/2018 3529224107670141 NURHAYATI P 50 T.air HT I109 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    3 04/01/2018 3529224107710095 MAWIYAH P 46 T.air RHEUMATOID M06.0 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    4 05/01/2018 3529226507680001 SUMARIYA P 49 T.air RHEUMATOID M06.0 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    5 06/01/2018 3529225012730003 SARIYANI P 44 T.air ISPA J069 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    6 08/01/2018 3529225402880003 PUSATON P 29 T.air DERMATITIS L20 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    7 10/01/2018 3529224107720063 WARSILI P 45 T.air GASTRITIS K297 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    8 12/01/2018 3529224023880003 HASANA P 29 T.air BATUK R05 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    9 13/01/2018 3529224107790084 SULAIHA P 38 T.air VERTIGO A88.1 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    10 15/01/2018 3529224107620035 SULIYANI P 55 T.air HT I109 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    11 17/01/2018 3529224107800052 SUPAINA P 37 T.air GE A09 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    12 18/01/2018 3529220308870001 MARSA'I L 30 T.air MYALGIA M792 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    13 19/01/2018 3529220107630133 MATSALEH L 48 T.air VOMITING R11 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    14 20/01/2018 3529220107790026 SAINULLAH L 38 T.air ALERGI L23.8 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    15 20/01/2018 3529224801900001 MISNATI P 27 T.air GE A09 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    16 22/01/2018 3529224107830116 NUR HASANA P 34 T.air VERTIGO A88.1 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    17 23/01/2018 3529224107650051 JAMAIYA P 52 T.air RHEUMATOID M06.0 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    18 24/01/2018 3529225301800002 AHYANI P 37 T.air ISPA J06 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500
    19 25/01/2018 3529224107610080 SAHWANI P 56 T.air RHEUMATOID M06.0 injeksi, obat oral Rp. 7500 Rp. 1000 Rp. 8500

    Raas, 25 JANUARI 2018


    Mengetahui
    Kepala Puskesmas Raas Penanggung Jawab Pustu/Polindes

    H. HERMANTO, S.Kep SAIFUL BAHRI ,Amd.Kep


    NIP 19690717 1990003 1 007 NITK -35290415025

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