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  • Detail Rincian Biaya Perawatan: Periode Perawatan: 04-April-2018 S/D 07-April-2018

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    The document is a detailed bill of a patient's treatment from April 4th to April 7th 2018. It provides information on the patient such as their name, date of birth, doctor, and room. It then lists the various medical services received each day such as doctor visits, medical procedures, diagnostic tests, medications, and their associated costs which were covered by the patient's insurance. The total bill for the treatment was over 5 million rupiah.

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    The document is a detailed bill of a patient's treatment from April 4th to April 7th 2018. It provides information on the patient such as their name, date of birth, doctor, and room. It then lists the various medical services received each day such as doctor visits, medical procedures, diagnostic tests, medications, and their associated costs which were covered by the patient's insurance. The total bill for the treatment was over 5 million rupiah.

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    16 views3 pages

    Detail Rincian Biaya Perawatan: Periode Perawatan: 04-April-2018 S/D 07-April-2018

    Uploaded by

    Wahyu
    The document is a detailed bill of a patient's treatment from April 4th to April 7th 2018. It provides information on the patient such as their name, date of birth, doctor, and room. It then lists the various medical services received each day such as doctor visits, medical procedures, diagnostic tests, medications, and their associated costs which were covered by the patient's insurance. The total bill for the treatment was over 5 million rupiah.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    RSIA BUNDA SEJAHTERA, Tangerang

    DETAIL RINCIAN BIAYA PERAWATAN


    Periode Perawatan : 04-April-2018 s/d 07-April-2018

    No.Reg / No.RM : RI20180404-0022 / 00-01-89-13 Ruang Perawatan : MAWAR


    Nama Pasien : SUHAEBAH TULASLAMIAH Kelas / No.Tempat : III / 313
    Tanggal Lahir : 15-May-1995 Penjamin Bayar : INSTANSI
    Doktor Utama : dr. ANDRI, Sp.OG Instansi : BPJS
    Tanggal Masuk : 04-Apr-2018 22:14 Tanggal Keluar : 07-Apr-2018 16:44

    Tanggal Ruang Satuan Qty Total Instansi Total Pasien

    1 - Jasa Dokter
    dr. ANDRI, Sp.OG
    Visit ranap dokter spesialis 06-04-2018 MAWAR/III 40,000.00 1 40,000.00 0.00
    Visit ranap dokter spesialis 07-04-2018 MAWAR/III 40,000.00 1 40,000.00 0.00
    Total Jasa Dokter 80,000.00 0.00
    2 - Pelayanan Medis Poliklinik OBSGYN
    dr. ANDRI, Sp.OG
    Ganti Verban Spesialis 07-04-2018 MAWAR/III 75,000.00 1 75,000.00 0.00
    Total Pelayanan Medis Poliklinik OBSGYN 75,000.00 0.00
    3 - Sewa Kamar Perawatan
    dr. ANDRI, Sp.OG
    Sewa Kamar 06-04-2018 MAWAR/III 130,000.00 1 130,000.00 0.00
    Sewa Kamar 07-04-2018 MAWAR/III 130,000.00 1 130,000.00 0.00
    Total Sewa Kamar Perawatan 260,000.00 0.00
    4 - Pelayanan Lainnya
    dr. Umum
    Transaksi Rawat Darurat 06-04-2018 MAWAR/III 25,000.00 1 25,000.00 0.00
    Total Pelayanan Lainnya 25,000.00 0.00
    5 - Jasa Dokter
    dr. ANDRI, Sp.OG
    konsultasi spesialis via telpon 07-04-2018 IGD/III 100,000.00 1 100,000.00 0.00
    Total Jasa Dokter 100,000.00 0.00
    6 - Pelayanan Medis Diagnostik
    Perawat
    Pemakaian Oksigen 2-4 liter/mnt < 2 05-04-2018 KAMAR OPERASI/III 40,000.00 1 40,000.00 0.00
    jam
    Monitor Vital Sign < 3 jam 05-04-2018 KAMAR OPERASI/III 50,000.00 1 50,000.00 0.00
    Bidan
    CTG 07-04-2018 VK/III 50,000.00 1 50,000.00 0.00
    Pasang Infus Dewasa 07-04-2018 IGD/III 30,000.00 1 30,000.00 0.00
    EKG Rawat Inap (spesialis) 07-04-2018 VK/III 90,000.00 1 90,000.00 0.00
    Total Pelayanan Medis Diagnostik 260,000.00 0.00
    7 - Sewa Kamar Perawatan
    Perawat
    Sewa Kamar Pemulihan 05-04-2018 KAMAR OPERASI/III 75,000.00 1 75,000.00 0.00
    Total Sewa Kamar Perawatan 75,000.00 0.00
    8 - Tindakan Medis Operatif
    dr. ANDRI, Sp.OG
    Sewa OK Operasi Sedang 05-04-2018 KAMAR OPERASI/III 850,000.00 1 850,000.00 0.00
    Dokter Operator Operasi Sedang 05-04-2018 KAMAR OPERASI/III 990,000.00 1 990,000.00 0.00
    dr. KARYADI, Sp.An
    Dokter Anestesi Operasi Sedang 05-04-2018 KAMAR OPERASI/III 323,388.00 1 323,388.00 0.00
    Perawat
    Hon perawat/bidan asisten Operator 05-04-2018 KAMAR OPERASI/III 150,000.00 1 150,000.00 0.00
    Hon perawat/bidan asisten Instrumen 05-04-2018 KAMAR OPERASI/III 100,000.00 1 100,000.00 0.00

    Hon perawat asisten Anestesi 05-04-2018 KAMAR OPERASI/III 150,000.00 1 150,000.00 0.00

    Rincian Biaya Perawatan Gabungan - Detail | 004 | Page 1 of 3


    Medinfras. Print Date: 4/7/2018, Print Time: 3:17:51PM
    RSIA BUNDA SEJAHTERA, Tangerang

    DETAIL RINCIAN BIAYA PERAWATAN


    Periode Perawatan : 04-April-2018 s/d 07-April-2018

    No.Reg / No.RM : RI20180404-0022 / 00-01-89-13 Ruang Perawatan : MAWAR


    Nama Pasien : SUHAEBAH TULASLAMIAH Kelas / No.Tempat : III / 313
    Tanggal Lahir : 15-May-1995 Penjamin Bayar : INSTANSI
    Doktor Utama : dr. ANDRI, Sp.OG Instansi : BPJS
    Tanggal Masuk : 04-Apr-2018 22:14 Tanggal Keluar : 07-Apr-2018 16:44

    Tanggal Ruang Satuan Qty Total Instansi Total Pasien

    Hon perawat Sirculer 05-04-2018 KAMAR OPERASI/III 50,000.00 1 50,000.00 0.00


    Total Tindakan Medis Operatif 2,613,388.00 0.00
    9 - Pelayanan Penunjang Medis
    dr. ANDRI, Sp.OG
    Resep Farmasi 05-04-2018 FARMASI/III 127,383.00 1 127,383.00 0.00
    Resep Farmasi 06-04-2018 FARMASI/III 774,755.00 1 774,755.00 0.00
    Resep Farmasi 06-04-2018 FARMASI/III 23,810.00 1 23,810.00 0.00
    Pemeriksaan Laboratorium 06-04-2018 LABORATORIUM/III 85,000.00 1 85,000.00 0.00
    Resep Farmasi 07-04-2018 FARMASI/III 56,773.00 1 56,773.00 0.00
    Pemeriksaan Laboratorium 07-04-2018 LABORATORIUM/III 165,000.00 1 165,000.00 0.00
    Total Pelayanan Penunjang Medis 1,232,721.00 0.00
    10 - Obat-obatan dan Alkes

    AQUABIDEST 25 ML - VK 07-04-2018 /III 7,975.00 1 7,975.00 0.00


    CEFTRIAXONE INJ PHARPOS - VK 07-04-2018 /III 26,562.00 1 26,562.00 0.00
    FOLEY CATETER 16 ONE MED - VK 07-04-2018 /III 11,000.00 1 11,000.00 0.00
    KASA GASINDO - VK 07-04-2018 /III 173,250.00 0 5,198.00 0.00
    METOCLOPRAMIDE 10 MG INJEKSI - 07-04-2018 /III 5,500.00 1 5,500.00 0.00
    VK
    PENENG KUNING - VK 07-04-2018 /III 1,361.00 1 1,361.00 0.00
    PENENG PINK DEWASA - VK 07-04-2018 /III 1,675.00 1 1,675.00 0.00
    POVIDONE IODINE ONEMED - VK 07-04-2018 /III 100.00 100 10,000.00 0.00
    RANITIDIN INJEKSI DEXA - VK 07-04-2018 /III 3,213.00 1 3,213.00 0.00
    RL 500ML B-BRAUN - VK 07-04-2018 /III 10,313.00 1 10,313.00 0.00
    SENSIGLOVES MAS (SIZE M) - VK 07-04-2018 /III 536.00 6 3,216.00 0.00
    SPUIT 10CC ONEMED - VK 07-04-2018 /III 1,588.00 2 3,176.00 0.00
    SPUIT 1CC ONEMED - VK 07-04-2018 /III 1,040.00 1 1,040.00 0.00
    SPUIT 3CC ONEMED - VK 07-04-2018 /III 1,044.00 1 1,044.00 0.00
    UMBILICAL CORD CLASS OM - VK 07-04-2018 /III 2,200.00 1 2,200.00 0.00
    URIN BAG "T" TYPE - VK 07-04-2018 /III 5,001.00 1 5,001.00 0.00
    VASOFIX 18 B-BRAUN - VK 07-04-2018 /III 12,375.00 1 12,375.00 0.00
    Total Obat-obatan dan Alkes 110,849.00 0.00
    Total 4,831,958.00 0.00

    Rincian Biaya Perawatan Gabungan - Detail | | Page 2 of 3


    Medinfras. Print Date: 4/7/2018, Print Time: 3:17:51PM
    RSIA BUNDA SEJAHTERA, Tangerang

    DETAIL RINCIAN BIAYA PERAWATAN


    Periode Perawatan : 04-April-2018 s/d 07-April-2018

    No.Reg / No.RM : RI20180404-0022 / 00-01-89-13 Ruang Perawatan : MAWAR


    Nama Pasien : SUHAEBAH TULASLAMIAH Kelas / No.Tempat : III / 313
    Tanggal Lahir : 15-May-1995 Penjamin Bayar : INSTANSI
    Doktor Utama : dr. ANDRI, Sp.OG Instansi : BPJS
    Tanggal Masuk : 04-Apr-2018 22:14 Tanggal Keluar : 07-Apr-2018 16:44

    Tanggal Ruang Satuan Qty Total Instansi Total Pasien

    Instansi Pasien

    Jumlah Tagihan : 4,831,958.00 Jumlah Tagihan : 0.00


    Administrasi : 241,600.00 (+) Administrasi : 0.00 (+)
    Meterai : 0.00 Meterai : 0.00
    Service : 0.00 (+) Service : 0.00 (+)

    5,073,558.00 0.00
    Coverage Limit : 5,073,558.00 Sel Cover Limit : 0.00 (+)

    Tagihan Akhir : 5,073,558.00 Tagihan Akhir : 0.00

    Uang Muka : 0.00 (-) Uang Muka : 0.00 (-)


    Piutang : 5,073,558.00 (-) Piutang : 0.00 (-)
    Pelunasan : 0.00 (-) Pelunasan : 0.00 (-)
    Lain-Lain : 0.00 (-)

    Sisa Tagihan : 0.00 Sisa Tagihan : 0.00

    Terbilang : LIMA JUTA TUJUH PULUH TIGA RIBU LIMA RATUS LIMA PULUH DELAPAN RUPIAH

    Tangerang, 7-Apr-2018 3:18:54PM


    Pasien, Petugas Kasir, Petugas Admin,

    (..........................................) (..........................................) ( RINI )

    Rincian Biaya Perawatan Gabungan - Detail | | Page 3 of 3


    Medinfras. Print Date: 4/7/2018, Print Time: 3:18:54PM

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