Nama RS : RS ISLAM GORONTALO LAPORAN HASIL VERIFIKASI SECARA ADMINISTRASI

Tingkat Pelayanan : RITL

Tgl.Pelayanan : 01-08-2015 s/d 31-08-2015
Status : Layak

No No SEP Tgl Msk Tgl Plg No.Kartu Nm Pst LP Kd CBGs Nm Cbgs CMG Tarif Gruper Tarif Biaya Klaim Tarip
(59) (Grp+CMG) (59+CMG)
1 0354R00507150000114 28-07-2015 07-08-2015 0001833538217 ASMA LATIF P N-4-12-II RENAL & URINARY TRACT SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,458,500 2,458,500 2,458,500 2,458,500
INFECTIONS Rp.0,SD: Rp.0
2 0354R00507150000126 28-07-2015 01-08-2015 0000139722456 ARIFIN PADIDO L A-4-13-I VIRAL AND OTHER NON SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,772,100 1,772,100 1,772,100 1,772,100
BACTERIAL INFECTIONS Rp.0,SD: Rp.0
3 0354R00507150000129 29-07-2015 02-08-2015 0001237834798 SUAIBA BAGU P G-4-15-II NON SPECIFICIED CVA SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,396,600 2,396,600 2,396,600 2,396,600
WITHOUT INFARCT Rp.0,SD: Rp.0
4 0354R00507150000136 30-07-2015 04-08-2015 0000139451229 DJUHURA ABDULGANI P I-4-15-I PERIPHERAL & OTHER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,685,800 3,685,800 3,685,800 3,685,800
VASCULAR DISEASEAS Rp.0,SD: Rp.0
5 0354R00507150000137 28-07-2015 01-08-2015 0001093762416 HASANUDDIN L I-4-12-I HEART FAILURE SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,379,700 3,379,700 3,379,700 3,379,700
KIAYMODJO Rp.0,SD: Rp.0
6 0354R00507150000138 30-07-2015 04-08-2015 0001793886963 AMINA TANIYO P N-4-12-I RENAL & URINARY TRACT SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,451,300 1,451,300 1,451,300 1,451,300
INFECTIONS Rp.0,SD: Rp.0
7 0354R00507150000139 31-07-2015 05-08-2015 0000139942282 ZULFAKARAIN YUNUS L J-4-16-I SIMPLE PNEUMONIA & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 4,475,600 4,475,600 4,475,600 4,475,600
PERTUSIS Rp.0,SD: Rp.0
8 0354R00507150000140 31-07-2015 09-08-2015 0000139724853 MONICA DESI FIONA P L-4-11-I NEOPLASMS OF BREAST SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,959,000 2,959,000 2,959,000 2,959,000
TATUIL Rp.0,SD: Rp.0
9 0354R00507150000141 30-07-2015 01-08-2015 0001871228935 SITI MAULANI P A-4-14-I OTHER BACTERIAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,552,300 2,552,300 2,552,300 2,552,300
PARASITIC INFECTIONS Rp.0,SD: Rp.0
10 0354R00507150000149 31-07-2015 05-08-2015 0000139690686 FITRI SUKIDJO P L-4-11-I NEOPLASMS OF BREAST SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,959,000 2,959,000 2,959,000 2,959,000
Rp.0,SD: Rp.0
11 0354R00507150000150 31-07-2015 11-08-2015 0000139958886 HARNAN MANOPO L N-4-13-I URINARY CALCULI SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,517,300 2,517,300 2,517,300 2,517,300
Rp.0,SD: Rp.0
12 0354R00507150000151 31-07-2015 04-08-2015 0000139616717 SALMIAH NOOR P U-4-13-I EPIGLOTTITISUPPER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,420,700 1,420,700 1,420,700 1,420,700
SIMATUPANG RESPIRATORY TRACT Rp.0,SD: Rp.0
INFECTION
LARYNGOTRACHEITIS &
OTITIS MEDIA
13 0354R00507150000154 31-07-2015 04-08-2015 0000139363154 HARTATI HUMAGI P K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,579,500 3,579,500 3,579,500 3,579,500
DISORDERS Rp.0,SD: Rp.0
14 0354R00507150000156 25-07-2015 04-08-2015 0001235264927 TONI MOINTI L G-4-15-II NON SPECIFICIED CVA SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,396,600 2,396,600 2,396,600 2,396,600
WITHOUT INFARCT Rp.0,SD: Rp.0
15 0354R00507150000157 28-07-2015 04-08-2015 0000960279557 TUTE SANGOLE L K-4-11-II GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,139,800 2,139,800 2,139,800 2,139,800
Rp.0,SD: Rp.0
16 0354R00507150000163 26-07-2015 08-08-2015 0001819108798 MITRAWATY DJ. M. P K-4-11-II GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,995,700 2,995,700 2,995,700 2,995,700
AKHIR Rp.0,SD: Rp.0
Nama RS : RS ISLAM GORONTALO LAPORAN HASIL VERIFIKASI SECARA ADMINISTRASI
Tingkat Pelayanan : RITL
Tgl.Pelayanan : 01-08-2015 s/d 31-08-2015
Status : Layak
17 0354R00508150000001 01-08-2015 03-08-2015 0001236227679 FATMA R BAGUE P O-6-13-I VAGINAL DELIVERY SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,852,200 1,852,200 1,852,200 1,852,200
Rp.0,SD: Rp.0
18 0354R00508150000002 01-08-2015 03-08-2015 0000127638009 ABDULLAH ATTAMIMI L K-4-17-I GASTROENTERITIS & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,504,900 2,504,900 2,504,900 2,504,900
ABDOMINAL PAIN Rp.0,SD: Rp.0
19 0354R00508150000003 01-08-2015 03-08-2015 0001237372288 LIAN DUMBI P W-4-16-I PREPARTUM DISEASES SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,918,200 1,918,200 1,918,200 1,918,200
Rp.0,SD: Rp.0
20 0354R00508150000004 02-08-2015 05-08-2015 0000959674184 MERISKA DAKO P G-4-21-II NON TRAUMATIC STUPOR & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,992,600 1,992,600 1,992,600 1,992,600
COMA Rp.0,SD: Rp.0
21 0354R00508150000005 01-08-2015 05-08-2015 0001237056287 ANTON DJALILU L Z-4-12-II OTHER FACTORS SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,858,600 1,858,600 1,858,600 1,858,600
INFLUENCING HEALTH STATUS Rp.0,SD: Rp.0
22 0354R00508150000006 02-08-2015 05-08-2015 0001786221101 ADEN Z SALILAMA L K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,579,500 3,579,500 3,579,500 3,579,500
DISORDERS Rp.0,SD: Rp.0
23 0354R00508150000009 03-08-2015 05-08-2015 0001096110156 RAHMAT AKBAR L K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,068,400 3,068,400 3,068,400 3,068,400
DISORDERS Rp.0,SD: Rp.0
24 0354R00508150000011 03-08-2015 11-08-2015 0000139792724 MARJAM BIAHIMO P M-4-17-I MEDICAL BACK DISORDERS SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,342,900 2,342,900 2,342,900 2,342,900
Rp.0,SD: Rp.0
25 0354R00508150000012 03-08-2015 15-08-2015 0000139372345 SAMIN RAHMAN L E-4-12-II INBORN ERRORS OF SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 4,144,800 4,144,800 4,144,800 4,144,800
METABOLISM Rp.0,SD: Rp.0
26 0354R00508150000013 03-08-2015 06-08-2015 0001299943113 RAFIKA A NUR P W-4-14-I THREATENED ABORTION SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 983,600 983,600 983,600 983,600
Rp.0,SD: Rp.0
27 0354R00508150000015 04-08-2015 07-08-2015 0001235911757 FITRIYANTI ISMET P K-4-11-I GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,315,300 1,315,300 1,315,300 1,315,300
Rp.0,SD: Rp.0
28 0354R00508150000016 04-08-2015 10-08-2015 0001811267144 marie P K-4-11-II GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,568,000 2,568,000 2,568,000 2,568,000
Rp.0,SD: Rp.0
29 0354R00508150000017 03-08-2015 05-08-2015 0000139642424 MOHAMAD RIVAI L U-4-11-I DYSEQUILIBRIUM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,838,000 1,838,000 1,838,000 1,838,000
BUKUSU Rp.0,SD: Rp.0
30 0354R00508150000018 04-08-2015 09-08-2015 0000139991973 RUSTAM ANWAR L J-4-18-I ASTHMA & BRONCHIOLITIS SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,422,500 1,422,500 1,422,500 1,422,500
Rp.0,SD: Rp.0
31 0354R00508150000020 04-08-2015 07-08-2015 0001446365799 DARSON OGA L K-4-11-II GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,139,800 2,139,800 2,139,800 2,139,800
Rp.0,SD: Rp.0
32 0354R00508150000021 05-08-2015 07-08-2015 0000959314421 AKBAR PUTRA ALI L A-4-13-I VIRAL AND OTHER NON SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,265,900 1,265,900 1,265,900 1,265,900
BACTERIAL INFECTIONS Rp.0,SD: Rp.0
33 0354R00508150000023 05-08-2015 07-08-2015 0001379707064 SARIPUDIN THAIB L L-4-13-I TRAUMA TO THE SKIN SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,909,200 1,909,200 1,909,200 1,909,200
SUBCUTANEOUS TISSUE & Rp.0,SD: Rp.0
BREAST
34 0354R00508150000024 06-08-2015 10-08-2015 0000960951734 YUSDA OHIHIYA P O-6-10-I CESAREAN SECTON SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,699,700 3,699,700 3,699,700 3,699,700
Rp.0,SD: Rp.0
Nama RS : RS ISLAM GORONTALO LAPORAN HASIL VERIFIKASI SECARA ADMINISTRASI
Tingkat Pelayanan : RITL
Tgl.Pelayanan : 01-08-2015 s/d 31-08-2015
Status : Layak
35 0354R00508150000026 06-08-2015 10-08-2015 0000139665701 ISRA SULEMAN L K-4-17-I GASTROENTERITIS & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,504,900 2,504,900 2,504,900 2,504,900
ABDOMINAL PAIN Rp.0,SD: Rp.0
36 0354R00508150000028 06-08-2015 10-08-2015 0000139447956 AMIN TULI L J-4-16-I SIMPLE PNEUMONIA & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 4,475,600 4,475,600 4,475,600 4,475,600
PERTUSIS Rp.0,SD: Rp.0
37 0354R00508150000030 07-08-2015 11-08-2015 0001236848725 KONO AMBO P K-4-11-II GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,139,800 2,139,800 2,139,800 2,139,800
Rp.0,SD: Rp.0
38 0354R00508150000031 05-08-2015 12-08-2015 0000139804694 SULEMAN HUNOWU L I-4-12-I HEART FAILURE SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,896,600 2,896,600 2,896,600 2,896,600
Rp.0,SD: Rp.0
39 0354R00508150000032 07-08-2015 08-08-2015 0000910101172 GAIRAM ABAS P E-4-13-I OTHER DISEASES OF SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,073,800 2,073,800 2,073,800 2,073,800
ENDOCRINE SYSTEM Rp.0,SD: Rp.0
40 0354R00508150000033 08-08-2015 10-08-2015 0000139397422 LUSYANA JUSUF P K-4-17-I GASTROENTERITIS & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,504,900 2,504,900 2,504,900 2,504,900
ABDOMINAL PAIN Rp.0,SD: Rp.0
41 0354R00508150000034 06-08-2015 10-08-2015 0001250204883 MINTJE HASAN P K-4-11-I GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,315,300 1,315,300 1,315,300 1,315,300
Rp.0,SD: Rp.0
42 0354R00508150000035 07-08-2015 10-08-2015 0000961656355 RIFALDO OHIHIYA L A-4-14-I OTHER BACTERIAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,552,300 2,552,300 2,552,300 2,552,300
PARASITIC INFECTIONS Rp.0,SD: Rp.0
43 0354R00508150000036 08-08-2015 15-08-2015 0000962148284 ABDULLAH MALO L J-4-15-I RESPIRATORY INFECTIONS & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,836,800 3,836,800 3,836,800 3,836,800
INFLAMMATIONS Rp.0,SD: Rp.0
44 0354R00508150000038 09-08-2015 12-08-2015 0001809279494 AGUSTINA LIHAWA P A-4-14-I OTHER BACTERIAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,552,300 2,552,300 2,552,300 2,552,300
PARASITIC INFECTIONS Rp.0,SD: Rp.0
45 0354R00508150000039 08-08-2015 13-08-2015 0001249793785 RAHAYU HARUN P K-4-11-II GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,139,800 2,139,800 2,139,800 2,139,800
Rp.0,SD: Rp.0
46 0354R00508150000040 10-08-2015 13-08-2015 0000139672258 SITRIA SALEH P U-4-11-I DYSEQUILIBRIUM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,838,000 1,838,000 1,838,000 1,838,000
Rp.0,SD: Rp.0
47 0354R00508150000041 08-08-2015 11-08-2015 0001875890891 adinda khumaira P K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,579,500 3,579,500 3,579,500 3,579,500
tomayahu DISORDERS Rp.0,SD: Rp.0
48 0354R00508150000043 10-08-2015 13-08-2015 0001075702937 RISAN MADI L J-4-21-I RESPIRATORY SYSTEM SIGNS SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,409,000 1,409,000 1,409,000 1,409,000
SYMPTOMS & OTHER Rp.0,SD: Rp.0
DISORDERS
49 0354R00508150000044 10-08-2015 15-08-2015 0001075744787 RAHIM SUNATI L G-4-14-I CEREBROVASCULAR SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,575,900 2,575,900 2,575,900 2,575,900
ACCIDENT WITH INFARCTION Rp.0,SD: Rp.0
50 0354R00508150000047 10-08-2015 13-08-2015 0001237836341 JUWAIRIYYAH MUSA P K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,557,000 2,557,000 2,557,000 2,557,000
DISORDERS Rp.0,SD: Rp.0
51 0354R00508150000049 11-08-2015 15-08-2015 0001095971084 ANDRIKISWADI L A-4-13-I VIRAL AND OTHER NON SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,519,100 1,519,100 1,519,100 1,519,100
BACTERIAL INFECTIONS Rp.0,SD: Rp.0
52 0354R00508150000050 12-08-2015 15-08-2015 0001096183574 DEYSKEL AWINFIET L K-1-13-I APPENDIX OPERATION SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,665,500 2,665,500 2,665,500 2,665,500
Rp.0,SD: Rp.0
Nama RS : RS ISLAM GORONTALO LAPORAN HASIL VERIFIKASI SECARA ADMINISTRASI
Tingkat Pelayanan : RITL
Tgl.Pelayanan : 01-08-2015 s/d 31-08-2015
Status : Layak
53 0354R00508150000051 12-08-2015 17-08-2015 0000139836328 SIA S. TANANGO P K-4-11-I GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,841,600 1,841,600 1,841,600 1,841,600
Rp.0,SD: Rp.0
54 0354R00508150000052 12-08-2015 15-08-2015 0001819108798 MITRAWATY DJ. M. P K-4-11-I GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,841,600 1,841,600 1,841,600 1,841,600
AKHIR Rp.0,SD: Rp.0
55 0354R00508150000054 12-08-2015 16-08-2015 0000139339067 RONALD DODA, SH L B-4-14-I OTHER BILIARY TRACT SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,160,000 3,160,000 3,160,000 3,160,000
DISEASES Rp.0,SD: Rp.0
56 0354R00508150000055 12-08-2015 16-08-2015 0000139820387 SYARIF ALI, A.MD L K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,579,500 3,579,500 3,579,500 3,579,500
DISORDERS Rp.0,SD: Rp.0
57 0354R00508150000056 09-08-2015 13-08-2015 0001235511641 KARSUM PATAMANI P A-4-14-III OTHER BACTERIAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,761,100 3,761,100 3,761,100 3,761,100
PARASITIC INFECTIONS Rp.0,SD: Rp.0
58 0354R00508150000058 13-08-2015 14-08-2015 0000196214422 SRIWIDYASTUTI P J-4-18-I ASTHMA & BRONCHIOLITIS SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,422,500 1,422,500 1,422,500 1,422,500
Rp.0,SD: Rp.0
59 0354R00508150000059 13-08-2015 15-08-2015 0000210514691 ANDI ANUGRAH BAKTI L A-4-14-I OTHER BACTERIAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,062,500 3,062,500 3,062,500 3,062,500
PARASITIC INFECTIONS Rp.0,SD: Rp.0
60 0354R00508150000060 11-08-2015 14-08-2015 0001075999342 ZUBAIDA WALANGADI P U-4-11-I DYSEQUILIBRIUM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,312,900 1,312,900 1,312,900 1,312,900
Rp.0,SD: Rp.0
61 0354R00508150000062 12-08-2015 16-08-2015 0000040144263 RUSDA PODUNGE P K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,579,500 3,579,500 3,579,500 3,579,500
DISORDERS Rp.0,SD: Rp.0
62 0354R00508150000063 14-08-2015 22-08-2015 0001075739523 NURMA ANETA P J-4-16-I SIMPLE PNEUMONIA & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,196,800 3,196,800 3,196,800 3,196,800
PERTUSIS Rp.0,SD: Rp.0
63 0354R00508150000064 15-08-2015 18-08-2015 0000139447956 AMIN TULI L J-4-17-I CHRONIC OBSTRUCTIVE SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,534,200 2,534,200 2,534,200 2,534,200
PULMONARY DISEASE Rp.0,SD: Rp.0
64 0354R00508150000065 15-08-2015 21-08-2015 0000139768997 UKO ABDJUL P K-4-11-II GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,568,000 2,568,000 2,568,000 2,568,000
Rp.0,SD: Rp.0
65 0354R00508150000066 15-08-2015 15-08-2015 0001237765094 REGINA TOMAILI P O-6-13-I VAGINAL DELIVERY SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,593,400 2,593,400 2,593,400 2,593,400
Rp.0,SD: Rp.0
66 0354R00508150000067 15-08-2015 18-08-2015 0001249432446 SEHA MASEKE P J-4-17-I CHRONIC OBSTRUCTIVE SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,810,200 1,810,200 1,810,200 1,810,200
PULMONARY DISEASE Rp.0,SD: Rp.0
67 0354R00508150000068 15-08-2015 22-08-2015 0001873813419 HAMNA RADJIKU P N-4-13-II URINARY CALCULI SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,388,800 2,388,800 2,388,800 2,388,800
Rp.0,SD: Rp.0
68 0354R00508150000069 17-08-2015 20-08-2015 0001237849615 MIN MUSTAFA P K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,557,000 2,557,000 2,557,000 2,557,000
DISORDERS Rp.0,SD: Rp.0
69 0354R00508150000070 16-08-2015 20-08-2015 0001867917521 SERLI LATIF P O-6-10-I CESAREAN SECTON SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 4,439,700 4,439,700 4,439,700 4,439,700
Rp.0,SD: Rp.0
70 0354R00508150000071 17-08-2015 22-08-2015 0001871593637 SUTRIANITA Y. P U-4-11-I DYSEQUILIBRIUM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,838,000 1,838,000 1,838,000 1,838,000
PULUHULAWA Rp.0,SD: Rp.0
71 0354R00508150000072 17-08-2015 25-08-2015 0000010686993 SRITO A. MUSA, S.PD P A-4-13-II VIRAL AND OTHER NON SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,133,300 2,133,300 2,133,300 2,133,300
Nama RS : RS ISLAM GORONTALO LAPORAN HASIL VERIFIKASI SECARA ADMINISTRASI
Tingkat Pelayanan : RITL
Tgl.Pelayanan : 01-08-2015 s/d 31-08-2015
Status : Layak
BACTERIAL INFECTIONS Rp.0,SD: Rp.0
72 0354R00508150000073 12-08-2015 19-08-2015 0001843955278 ARSY LESTARI P K-1-13-I APPENDIX OPERATION SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,109,800 3,109,800 3,109,800 3,109,800
DARMARI Rp.0,SD: Rp.0
73 0354R00508150000074 17-08-2015 21-08-2015 0001236393415 DONO DEFRIYANTO L U-4-13-I EPIGLOTTITISUPPER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,014,700 1,014,700 1,014,700 1,014,700
WANTOGIA RESPIRATORY TRACT Rp.0,SD: Rp.0
INFECTION
LARYNGOTRACHEITIS &
OTITIS MEDIA
74 0354R00508150000075 17-08-2015 19-08-2015 0001237003839 RUSNI KUDAY P K-4-11-I GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,315,300 1,315,300 1,315,300 1,315,300
Rp.0,SD: Rp.0
75 0354R00508150000076 17-08-2015 20-08-2015 0000961606001 RAPIKA IBRAHIM P K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,557,000 2,557,000 2,557,000 2,557,000
DISORDERS Rp.0,SD: Rp.0
76 0354R00508150000077 17-08-2015 21-08-2015 0000960617957 MARYAM NGABITO P O-6-10-I CESAREAN SECTON SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,699,700 3,699,700 3,699,700 3,699,700
Rp.0,SD: Rp.0
77 0354R00508150000078 03-08-2015 07-08-2015 0001234540473 SALEHA PULUKADANG P G-4-15-II NON SPECIFICIED CVA SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,396,600 2,396,600 2,396,600 2,396,600
WITHOUT INFARCT Rp.0,SD: Rp.0
78 0354R00508150000079 17-08-2015 19-08-2015 0000139858705 SOFYA DODA P I-4-17-II HYPERTENSION SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 5,558,500 5,558,500 5,558,500 5,558,500
Rp.0,SD: Rp.0
79 0354R00508150000080 15-08-2015 17-08-2015 0001235184096 NIRMALA S. MASIE P A-4-14-I OTHER BACTERIAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,552,300 2,552,300 2,552,300 2,552,300
PARASITIC INFECTIONS Rp.0,SD: Rp.0
80 0354R00508150000081 17-08-2015 20-08-2015 0001481769549 SARTONO LATIF L I-4-17-III HYPERTENSION SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 6,746,200 6,746,200 6,746,200 6,746,200
Rp.0,SD: Rp.0
81 0354R00508150000084 17-08-2015 21-08-2015 0001275324333 SUHURI I. CONO P E-4-10-II DIABETES AND NUTRITIONAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,917,300 3,917,300 3,917,300 3,917,300
OTHER METABOLIC DISEASES Rp.0,SD: Rp.0
82 0354R00508150000085 18-08-2015 22-08-2015 0001442599953 MUH. EL-SIRAJ TUMULO L A-4-14-II OTHER BACTERIAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 4,596,100 4,596,100 4,596,100 4,596,100
PARASITIC INFECTIONS Rp.0,SD: Rp.0
83 0354R00508150000086 18-08-2015 25-08-2015 0000139891746 ZULAECHA NGIU P W-1-20-II UTERUS & ADNEXA SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 8,041,800 8,041,800 8,041,800 8,041,800
OPERATION Rp.0,SD: Rp.0
84 0354R00508150000087 18-08-2015 20-08-2015 0000021813783 SINTIA SALWA P A-4-14-I OTHER BACTERIAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,572,900 3,572,900 3,572,900 3,572,900
KOJONGKAM PARASITIC INFECTIONS Rp.0,SD: Rp.0
85 0354R00508150000088 17-08-2015 20-08-2015 0000139686974 ZAKIYA MOHAMMAD P J-4-18-I ASTHMA & BRONCHIOLITIS SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,422,500 1,422,500 1,422,500 1,422,500
BASEREWAN Rp.0,SD: Rp.0
86 0354R00508150000089 18-08-2015 19-08-2015 0001874138128 asna ismail P O-6-13-I VAGINAL DELIVERY SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,852,200 1,852,200 1,852,200 1,852,200
Rp.0,SD: Rp.0
87 0354R00508150000090 19-08-2015 24-08-2015 0000139718542 IYAM AKUBA P A-4-14-II OTHER BACTERIAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 4,596,100 4,596,100 4,596,100 4,596,100
PARASITIC INFECTIONS Rp.0,SD: Rp.0
88 0354R00508150000091 15-08-2015 20-08-2015 0001237834798 SUAIBA BAGU P G-4-15-II NON SPECIFICIED CVA SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,396,600 2,396,600 2,396,600 2,396,600
Nama RS : RS ISLAM GORONTALO LAPORAN HASIL VERIFIKASI SECARA ADMINISTRASI
Tingkat Pelayanan : RITL
Tgl.Pelayanan : 01-08-2015 s/d 31-08-2015
Status : Layak
WITHOUT INFARCT Rp.0,SD: Rp.0
89 0354R00508150000093 20-08-2015 25-08-2015 0001250130115 SARCE LIHAWA P K-4-11-II GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,139,800 2,139,800 2,139,800 2,139,800
Rp.0,SD: Rp.0
90 0354R00508150000094 20-08-2015 22-08-2015 0000961304771 MOH PUTRA MOODUTO L A-4-14-I OTHER BACTERIAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,552,300 2,552,300 2,552,300 2,552,300
PARASITIC INFECTIONS Rp.0,SD: Rp.0
91 0354R00508150000095 20-08-2015 21-08-2015 0001235607276 OLIS DAUD P O-6-13-I VAGINAL DELIVERY SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,852,200 1,852,200 1,852,200 1,852,200
Rp.0,SD: Rp.0
92 0354R00508150000097 21-08-2015 23-08-2015 0000148632039 KHARDIYAWAN A. Y. L A-4-13-I VIRAL AND OTHER NON SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,772,100 1,772,100 1,772,100 1,772,100
PARWENI, S.PD BACTERIAL INFECTIONS Rp.0,SD: Rp.0
93 0354R00508150000098 21-08-2015 25-08-2015 0001237056467 ATJE MILE P I-4-17-I HYPERTENSION SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,928,500 2,928,500 2,928,500 2,928,500
Rp.0,SD: Rp.0
94 0354R00508150000099 21-08-2015 27-08-2015 0001234244531 HASANAH SANGOLE P J-4-15-I RESPIRATORY INFECTIONS & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,836,800 3,836,800 3,836,800 3,836,800
INFLAMMATIONS Rp.0,SD: Rp.0
95 0354R00508150000100 20-08-2015 22-08-2015 0001370408365 KARTINI BUMULO P K-4-11-I GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,841,600 1,841,600 1,841,600 1,841,600
Rp.0,SD: Rp.0
96 0354R00508150000101 18-08-2015 22-08-2015 0000958291907 NONA PANIGORO P N-4-12-I RENAL & URINARY TRACT SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,451,300 1,451,300 1,451,300 1,451,300
INFECTIONS Rp.0,SD: Rp.0
97 0354R00508150000103 23-08-2015 30-08-2015 0000207708816 RENI LABOLO P J-4-15-I RESPIRATORY INFECTIONS & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 4,604,100 4,604,100 4,604,100 4,604,100
INFLAMMATIONS Rp.0,SD: Rp.0
98 0354R00508150000104 22-08-2015 25-08-2015 0001075734178 AGUSRIA NUSI P K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,557,000 2,557,000 2,557,000 2,557,000
DISORDERS Rp.0,SD: Rp.0
99 0354R00508150000107 24-08-2015 25-08-2015 0000139678694 ANDRICA SUGIARTI P N-4-12-I RENAL & URINARY TRACT SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,031,800 2,031,800 2,031,800 2,031,800
ijham INFECTIONS Rp.0,SD: Rp.0
100 0354R00508150000109 24-08-2015 27-08-2015 0000139648138 HENI D NAKI P A-4-14-I OTHER BACTERIAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,572,900 3,572,900 3,572,900 3,572,900
PARASITIC INFECTIONS Rp.0,SD: Rp.0
101 0354R00508150000111 24-08-2015 30-08-2015 0001390001984 SUKARTIN NAIU P I-4-17-I HYPERTENSION SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,928,500 2,928,500 2,928,500 2,928,500
Rp.0,SD: Rp.0
102 0354R00508150000112 23-08-2015 27-08-2015 0001236823356 RUSNI TILAHUNGA P K-4-11-II GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,139,800 2,139,800 2,139,800 2,139,800
Rp.0,SD: Rp.0
103 0354R00508150000113 25-08-2015 29-08-2015 0001389643536 FADEL ISMUNANDAR L A-4-14-I OTHER BACTERIAL & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,572,900 3,572,900 3,572,900 3,572,900
PARASITIC INFECTIONS Rp.0,SD: Rp.0
104 0354R00508150000114 24-08-2015 27-08-2015 0000139836835 ARWIN ALI YUSUF L N-4-13-I URINARY CALCULI SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,517,300 2,517,300 2,517,300 2,517,300
Rp.0,SD: Rp.0
105 0354R00508150000115 27-08-2015 28-08-2015 0001830026845 DEISI OLII P K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,557,000 2,557,000 2,557,000 2,557,000
DISORDERS Rp.0,SD: Rp.0
106 0354R00508150000118 27-08-2015 31-08-2015 0000139538171 SOFYAN GASIM P U-4-11-I DYSEQUILIBRIUM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,838,000 1,838,000 1,838,000 1,838,000
Rp.0,SD: Rp.0
Nama RS : RS ISLAM GORONTALO LAPORAN HASIL VERIFIKASI SECARA ADMINISTRASI
Tingkat Pelayanan : RITL
Tgl.Pelayanan : 01-08-2015 s/d 31-08-2015
Status : Layak
107 0354R00508150000119 28-08-2015 29-08-2015 0001306883081 ROLLY DJ HUSAIN L K-4-17-I GASTROENTERITIS & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,504,900 2,504,900 2,504,900 2,504,900
ABDOMINAL PAIN Rp.0,SD: Rp.0
108 0354R00508150000120 24-08-2015 26-08-2015 0001236934023 UMAR BUTA L K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,557,000 2,557,000 2,557,000 2,557,000
DISORDERS Rp.0,SD: Rp.0
109 0354R00508150000124 28-08-2015 31-08-2015 0000959739827 MIRA KUNA P I-4-17-I HYPERTENSION SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,928,500 2,928,500 2,928,500 2,928,500
Rp.0,SD: Rp.0
110 0354R00508150000128 29-08-2015 31-08-2015 0000194824416 MOH.AGIL ALMUNAWAR L J-4-18-I ASTHMA & BRONCHIOLITIS SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,422,500 1,422,500 1,422,500 1,422,500
ZEES Rp.0,SD: Rp.0
111 0354R00508150000130 30-08-2015 30-08-2015 0001101857771 muh. nasir potewasi L K-4-18-I OTHER DIGESTIVE SYSTEM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,068,400 3,068,400 3,068,400 3,068,400
DISORDERS Rp.0,SD: Rp.0
112 0354R00508150000131 29-08-2015 31-08-2015 0000961231004 YUSNA POLUMULO P O-6-13-I VAGINAL DELIVERY SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,852,200 1,852,200 1,852,200 1,852,200
Rp.0,SD: Rp.0
113 0354R00508150000133 23-08-2015 30-08-2015 0000960295048 DJAFAR SUNGE L J-4-15-II RESPIRATORY INFECTIONS & SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 4,583,400 4,583,400 4,583,400 4,583,400
INFLAMMATIONS Rp.0,SD: Rp.0
114 0354R00508150000136 27-08-2015 31-08-2015 0001237553684 KARTIN GOBEL P G-4-14-II CEREBROVASCULAR SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,979,500 3,979,500 3,979,500 3,979,500
ACCIDENT WITH INFARCTION Rp.0,SD: Rp.0
115 0354R00508150000137 27-08-2015 31-08-2015 0000959401787 AISARI MAHAJU P M-1-50-I OPERATION OF SOFT TISSUES SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 4,480,800 4,480,800 4,480,800 4,480,800
Rp.0,SD: Rp.0
116 0354R00508150000138 19-08-2015 27-08-2015 0001249432446 SEHA MASEKE P J-4-17-II CHRONIC OBSTRUCTIVE SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,457,500 2,457,500 2,457,500 2,457,500
PULMONARY DISEASE Rp.0,SD: Rp.0
117 0354R00508150000140 29-08-2015 29-08-2015 0001842995733 SULISTIYAWATI P O-6-13-I VAGINAL DELIVERY SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,852,200 1,852,200 1,852,200 1,852,200
Rp.0,SD: Rp.0
118 0354R00508150000141 27-08-2015 28-08-2015 0000139836824 RAHMAWATY P K-4-11-I GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,841,600 1,841,600 1,841,600 1,841,600
POLONTALO Rp.0,SD: Rp.0
119 0354R00508150000142 28-08-2015 31-08-2015 0001428272796 NIZMA SULEMAN P K-4-11-I GASTRITIS & PEPTIC ULCER SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,841,600 1,841,600 1,841,600 1,841,600
Rp.0,SD: Rp.0
120 0354R00508150000146 25-08-2015 28-08-2015 0000139616741 SRI ASRA DEWI B P U-4-11-I DYSEQUILIBRIUM SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 1,838,000 1,838,000 1,838,000 1,838,000
UTIARAHMAN Rp.0,SD: Rp.0
TOTAL 321,547,900 321,547,900 321547900 321547900

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