Rincian Biaya Opname 2016

YAYASAN SITI CHOTIMAH
RUMAH SAKIT BHAKTI WALUYO

Jl. Dr. Soetomo No. 32 Pekalongan
Telp. (0285) 423623
Nama : Ny. Minarni Kelas Perawatan : III F

No.RM : 00.71.23
RINCIAN BIAYA RAWAT INAP
1 Opname tanggal 28-12-2015 s/d 03-01-2016 = Rp 1,050,000 1

2 Pemeriksaan Poliklinik = Rp 100,000 2
Visite dr. Rosik Budioro, Sp.PD.FIN = Rp 305,000
Via phone dr. Rosik Budioro, Sp.PD.FIN = Rp 20,000
Visite dr. Fitri = Rp 85,000
Visite dr. Dian AR = Rp 85,000
3 Aquabedistilata = Rp 40,000 3
Antrain = Rp 420,000
Ondancentron = Rp 30,000
Ranitidine = Rp 15,000
Spuite 1cc = Rp 112,500
Spuite 5cc = Rp 28,000 4
4 NACL = Rp 350,000
Infus set = Rp 40,000
Abocath No.22 = Rp 40,000
Prasat infus = Rp 50,000 5
5 Laborat tgl 29-12-2015 = Rp 365,000 6
6 EKG + baca tgl 28-12-2015 = Rp 150,000 7
EKG + baca tgl 29-12-2015 = Rp 150,000
7 R/ tgl 28-12-2015 = Rp 28,000
R/ tgl 30-12-2015 = Rp 170,000
R/ tgl 31-12-2015 (33.000 + 6.000) = Rp 39,000 8
R/ tgl 02-01-2016 = Rp 38,000 9
8 Asuhan Keperawatan = Rp 105,000 10
9 Kapas, plester, alkohol = Rp 50,000 11
10 Administrasi = Rp 40,000
11 Pajak, dll = Rp 112,000
Rp 4,017,500
YAYASAN SITI CHOTIMAH Naik Kelas II - Utama

Telp. (0285) 423623
Nama : An. Alvindi Jadda Kelas Perawatan : II

No.RM : 00.47.88
1 Opname tanggal 02-01-2016 s/d 05-01-2016 = Rp 800,000 1

Visite dr. H. Moch. Kudori, Sp.A = Rp 455,000
3 Aquabedistilata = Rp 40,000
Ceftriaxone = Rp 280,000 3
4 D5% = Rp 175,000
Abocath No.24 = Rp 40,000 4
Verband = Rp 6,000
Prasat infus = Rp 50,000
Laborat tgl 02-01-2016 = Rp 285,000
5 Fhoto Ro + baca tgl 02-01-2016 = Rp 170,000 5
6 R/ tgl 02-01-2016 = Rp 8,000 6
R/ tgl 04-01-2016 (8.000 + 21.000) = Rp 29,000 7
R/ tgl 05-01-2016 = Rp 15,000
7 Asuhan Keperawatan = Rp 800,000
9 Administrasi = Rp 40,000 9
10 Pajak, dll = Rp 90,500 10
Rp 3,670,500 11
12

Telp. (0285) 423623
Nama : An. Dinar Puspa Kelas Perawatan : III B

No.RM : 00.71.35

1
2 Pemeriksaan Poliklinik = Rp 100,000
Visite dr. Riza Kurniawan, Sp.A,M.Kes = Rp 65,000
Ceftriaxone = Rp 70,000
Paracetamol = Rp 130,000
Vellutin = Rp 90,000
Berotec = Rp 96,000
4 Asering = Rp 40,000
Verband = Rp 6,000
5 Nebulizer 6x = Rp 360,000
6 Laborat tgl 08-01-2016 = Rp 242,000 6
Fhoto Ro + baca tgl 08-01-2016 = Rp 150,000 7
7 R/ tgl 08-01-2016 = Rp 38,000
R/ tgl 09-01-2016 = Rp 56,000
11 Pajak, dll = Rp 64,000 11
Rp 2,187,000

Telp. (0285) 423623
Nama : Tn. Ngatmin Kelas Perawatan : III

No.RM : 00.71.58

1
Via phone dr. Rosik Budioro, Sp.PD.FIN = Rp 20,000 3
Cefotaxime = Rp 120,000
Dexamethasone = Rp 90,000
4 RL = Rp 100,000
5 Laborat tgl 11-01-2016 = Rp 180,000 6
6 R/ tgl 11-01-2016 = Rp 138,000
R/ tgl 13-01-2016 = Rp 196,000 7
10 Pajak, dll = Rp 75,000
Rp 2,570,500

Telp. (0285) 423623
Nama : Ny. Wasriah Kelas Perawatan : III

No.RM : 00.71.63

1
2 Pemeriksaan Poliklinik (dr. Fitri) = Rp 100,000
Ceftazidime = Rp 360,000 3
Berotec = Rp 96,000
Bisolvon = Rp 27,500
4 RL = Rp 125,000
NACL = Rp 25,000
5 O₂ 1 tab besar + Selang O₂ = Rp 130,000
6 Nebulizer 9x = Rp 360,000
7 Laborat tgl 12-01-2016 = Rp 148,000
8 Fhoto Ro + baca tgl 13-01-2016 = Rp 160,000
9 Fisiotherapie tgl 13-01-2016 = Rp 40,000
10 R/ tgl 12-01-2016 = Rp 39,000
R/ tgl 14-01-2016 = Rp 51,000
Rp 3,349,000
8
9
10
11
Telp. (0285) 423623
Nama : Ny. Daryati Kelas Perawatan : III

No.RM : 00.71.71

1
1 Opname tanggal 14-01-2016 s/d 16-01-2016 = Rp 450,000
Ketorolac = Rp 360,000
Ranitidine = Rp 135,000 3
4 NACL = Rp 125,000
5 USG + baca tgl 14-01-2016 = Rp 150,000
6 Laborat tgl 14-01-2016 = Rp 27,000
7 R/ tgl 14-01-2016 (30.000 + 45.000) = Rp 75,000
R/ tgl 15-01-2016 = Rp 56,000 4
9 Kapas, plester, alkohol = Rp 50,000
11 Pajak, dll = Rp 69,000 5
Rp 2,355,500
6
7
8
9
10
11
12
13
14
15
YAYASAN SITI CHOTIMAH Naik Kelas II - Utama

Telp. (0285) 423623
Nama : An. Akmal Sabiq Kelas Perawatan : II

No.RM : 00.71.70
1
Sibital = Rp 21,000 4
Meropenem = Rp 600,000
4 D5 ¼ NS = Rp 210,000 5
Infus set = Rp 40,000 6
Verband = Rp 10,000 8
5 Laborat tgl 14-01-2016 = Rp 107,000 10
Laborat tgl 15-01-2016 = Rp 82,000
Laborat tgl 16-01-2016 = Rp 280,000
6 R/ tgl 18-01-2016 = Rp 130,000
11 Pajak, dll = Rp 139,000
Rp 4,707,500

Telp. (0285) 423623
Nama : Ny. Paryati Kelas Perawatan : III

No.RM : 00.71.68

1
Visite dr. Rosik Budioro, Sp.PD.FIN = Rp 425,000 3
Visite dr. Deborah = Rp 85,000
Visite dr. Septian = Rp 45,000
Furosemide = Rp 70,000
Antrain = Rp 360,000 4
Pantoprazole = Rp 575,000
4 RL = Rp 275,000 5
Asering = Rp 30,000 6
Abocath No.22 = Rp 160,000 7
Folley catheter = Rp 50,000 9
Urine bag = Rp 25,000 10
Prasat catheter = Rp 65,000
Jarum insulin = Rp 6,000
6 Laborat tgl 13-01-2016 = Rp 337,000
Laborat tgl 14-01-2016 = Rp 57,000
Laborat tgl 15-01-2016 = Rp 27,000
Laborat tgl 16-01-2016 = Rp 27,000
Laborat tgl 18-01-2016 = Rp 27,000
8 USG + baca tgl 14-01-2016 = Rp 150,000
9 EKG + baca tgl 14-01-2016 = Rp 150,000
10 R/ tgl 13-01-2016 = Rp 99,000
R/ tgl 14-01-2016 = Rp 138,000
R/ tgl 18-01-2016 = Rp 39,000
11 Handscoon 3 pasang = Rp 30,000
15 Pajak, dll = Rp 193,500
Rp 6,628,500

Telp. (0285) 423623
Nama : An. Dimas Aditya F Kelas Perawatan : II C

No.RM : 00.71.86

1
2 Pemeriksaan Poliklinik (dr. Deborah) = Rp 100,000
Visite dr. Najmi = Rp 50,000 3
Antrain = Rp 40,000
4 RL = Rp 75,000
NACL = Rp 125,000
Verband = Rp 6,000
Laborat tgl 19-01-2016 = Rp 478,000
6 R/ tgl 19-01-2016 = Rp 87,000
R/ tgl 20-01-2016 = Rp 14,000 5
Rp 3,320,000 7
8
9
10
11
12
Telp. (0285) 423623
Nama : An. Irsyadul Ibad Kelas Perawatan : III B

No.RM : 00.71.94
RINCIAN BIAYA RAWAT INAP 1

2
2 Pemeriksaan Poliklinik (dr. Fitri) = Rp 100,000 3
4 RL = Rp 25,000
D5% Rp 100,000
5 R/ tgl 19-01-2016 = Rp 23,000 7
R/ tgl 20-01-2016 = Rp 21,000 8
Rp 1,591,500

Telp. (0285) 423623
Nama : an. Farzan ahza argani Kelas Perawatan : III

No.RM : 00.71.43

2
Via phone dr. H. Moch. Kudori, Sp.A = Rp 425,000
Visite dr. H. Moch. Kudori, Sp.A = Rp 20,000 3
4 D5 ¼ NS = Rp 120,000 4
D5% = Rp 100,000
6 fhoto ro + baca tgl 19-01-2016 = Rp 150,000
Laborat tgl 18-01-2016 = Rp 180,000 7
7 R/ tgl 19-01-2016 = Rp 18,000 8
Rp 2,825,500

Telp. (0285) 423623
Nama : an. M. Aditya pratama Kelas Perawatan : III

No.RM : 00.72.00
1

Visite dr. H. Moch. Kudori, sp.a = Rp 485,000
ceftriaxone = Rp 175,000
antrain = Rp 100,000
sibital = Rp 21,000
4 d5% = Rp 150,000
verband = Rp 6,000 5
5 fhoto ro + baca tgl 19-01-2016 = Rp 150,000 7
6 laborat tgl 19-01-2016 = Rp 100,000
7 R/ tgl 20-01-2016 = Rp 7,000 8
R/ tgl 22-01-2016 = Rp 16,000 9
Rp 2,643,000

Telp. (0285) 423623
Nama : ny. Rantiyah Kelas Perawatan : III

No.RM : 00.72.06

2
Visite dr. Rosik budioro, sp.pd.fin = Rp 305,000
via phone dr. Rosik budioro, sp.pd.fin = Rp 20,000
visite dr. Qory amanda = Rp 45,000 3
visite dr. Fitri = Rp 45,000
ceftazidime = Rp 840,000
dexamethasone = Rp 180,000
vellutin = Rp 270,000
4 RL = Rp 250,000
NACL = Rp 25,000 4
5 folley catheter no.14 = Rp 50,000
urine bag = Rp 30,000 5
prasat catheter = Rp 85,000 6
6 O₂ 2 tab besar + Selang O₂ = Rp 245,000 7
7 nebulizer 18x = Rp 720,000 8
8 laborat tgl 21-01-2016 = Rp 391,000 9
10 fisiotherapie tgl 21-01-2016 = Rp 40,000 11
fisiotherapie tgl 23-01-2016 = Rp 40,000 12
11 ekg + baca tgl 24-01-2016 = Rp 150,000
12 R/ tgl 20-01-2016 = Rp 6,000
R/ tgl 21-01-2016 = Rp 85,000
R/ tgl 23-01-2016 = Rp 94,000
R/ tgl 25-01-2016 = Rp 144,000
13 handscoon 4 pasang = Rp 40,000
14 masker 10 = Rp 50,000
15 prasat jenazah = Rp 50,000
16 pengawasan = Rp 180,000
20 Pajak, dll = Rp 204,500
Rp 7,015,000
YAYASAN SITI CHOTIMAH naik kelas II - Utama

Telp. (0285) 423623
Nama : an. Atta al ghifar Kelas Perawatan : II

No.RM : 00.72.17

2
2 Pemeriksaan Poliklinik (dr. Qory amanda) = Rp 30,000
visite dr. Qory amanda = Rp 65,000
visite dr. H. Moch. Kudori, sp.a = Rp 455,000 3
via phone dr. H. Moch. Kudori sp.a = Rp 20,000
cefotaxim = Rp 40,000
ondancentron = Rp 30,000
gentacimin = Rp 20,000
ceftriaxone = Rp 140,000 4
novaldo = Rp 60,000
sibital = Rp 21,000
4 RL = Rp 75,000
d5% = Rp 75,000
Laborat tgl 25-01-2016 = Rp 98,000
6 R/ tgl 25-01-2016 = Rp 29,000 9
Rp 2,787,500

Telp. (0285) 423623
Nama : ny. Kaenah Kelas Perawatan : III

No.RM : 00.72.11
1

visite dr. Fitri = Rp 45,000 3
visite dr. Rosik budioro, sp.pd.fin = Rp 125,000
cefotaxime = Rp 140,000
ranitidine = Rp 150,000
4 RL = Rp 125,000
Infus set = Rp 80,000 4
5 laborat tgl 23-01-2016 = Rp 195,000
6 R/ tgl 23-01-2016 = Rp 200,000 5
R/ tgl 25-01-2016 = Rp 166,000 6
10 Pajak, dll = Rp 77,500 8
Rp 2,660,500 9
10
11
12

Telp. (0285) 423623
Nama : an. M. Zidan al faruq Kelas Perawatan : II C

No.RM : 00.72.22
1

visite dr. H. Moch. Kudori, sp.a = Rp 355,000
antrain = Rp 80,000
sibital = Rp 21,000
4 d5% = Rp 100,000
6 R/ tgl 25-01-2016 = Rp 7,000
R/ tgl 27-01-2016 = Rp 23,000
10 Pajak, dll = Rp 62,000 10
Rp 2,118,000

Telp. (0285) 423623
Nama : tn. Rampli Kelas Perawatan : III

No.RM : 00.72.27 1
2

2 Pemeriksaan Poliklinik (dr. Fitri) = Rp 30,000 3
bisolvon = Rp 29,000 4
4 RL = Rp 50,000
NACL = Rp 25,000
5 O₂ 1 tab besar + Selang O₂ = Rp 130,000 6
6 nebulizer 6x = Rp 240,000
8 fisiotherapie tgl 27-01-2016 = Rp 40,000 7
9 R/ tgl 27-01-2016 (6.000 + 56.000) = Rp 62,000 8
10 masker 3 pasang = Rp 15,000
11 handscoon 1 pasang = Rp 10,000 9
12 amulance ke rsud kraton = Rp 75,000 10
Rp 1,847,500

Telp. (0285) 423623
Nama : an. Kayla ayunindiya Kelas Perawatan : Ia

No.RM : 00.72.30
1

2 Pemeriksaan Poliklinik (dr. septian) = Rp 30,000
visite dr. Septian = Rp 55,000
visite d. H. Moch. Kudori, sp.a = Rp 85,000
visite dr. Tri kusumawardani, sp.a,m.kes = Rp 165,000
novaldo = Rp 40,000 4
4 RL = Rp 75,000
Infus set ped = Rp 45,000
6 R/ tgl 28-01-2016 = Rp 47,000 8
R/ tgl 29-01-2016 = Rp 38,000 9
10 Pajak, dll = Rp 61,000 13
Rp 2,090,500 14
15
16

Telp. (0285) 423623
Nama : an. Naelul kartin Kelas Perawatan : III

No.RM : 00.72.29

2
2 Pemeriksaan Poliklinik (dr. fitri) = Rp 30,000
visite dr. Tri kusumawardani, sp.a,m.kes = Rp 365,000 3
sibital = Rp 21,000
4 RL = Rp 50,000 4
d5% = Rp 175,000
infus set = Rp 40,000
abocath no.24 = Rp 40,000
ganti verband 2x = Rp 30,000
5 laborat tgl 79-01-2016 = Rp 483,000
laborat tgl 29-01-2016 = Rp 72,000
laborat tgl 30-01-2016 = Rp 72,000 6
6 R/ tgl 27-01-2016 = Rp 23,000
R/ tgl 30-01-2016 = Rp 8,000 7
Rp 2,959,500
Telp. (0285) 423623
Nama : Ny. Sariyah Kelas Perawatan : III F

No.RM : 00.71.25
Opname tanggal 28-12-2015 s/d 03-01-2016 = Rp 1,050,000

Pemeriksaan Poliklinik = Rp 100,000
Aquabedistilata = Rp 50,000
Asam Tranexamat = Rp 60,000
NACL = Rp 350,000
Laborat tgl 29-12-2015 = Rp 214,000
Fhoto Ro + baca tgl 29-12-2015 = Rp 160,000
R/ tgl 28-12-2015 = Rp 18,000
R/ tgl 30-12-2015 = Rp 75,000
R/ tgl 31-12-2015 = Rp 26,000
R/ tgl 02-01-2016 = Rp 80,000
Asuhan Keperawatan = Rp 105,000
Kapas, plester, alkohol = Rp 50,000
Administrasi = Rp 40,000
Pajak, dll = Rp 107,500
Rp 3,678,000

Telp. (0285) 423623
Nama : Ny. Intatik Kelas Perawatan : III

No.RM : 00.71.36
Opname tanggal 04-01-2016 s/d 07-01-2016 = Rp 600,000

Asam tranexamat = Rp 260,000
Berotec = Rp 96,000
NACL = Rp 175,000
Nebulizer 12x = Rp 480,000
R/ tgl 04-01-2016 (18.000 + n14.000) = Rp 32,000
R/ tgl 05-01-2016 = Rp 96,000
R/ tgl 07-01-2016 = Rp 71,000
Masker 3 = Rp 15,000
Rp 3,044,500

Telp. (0285) 423623
Nama : An. Adelia Tri Anjani Kelas Perawatan : III B

No.RM : 00.71.43

Pemeriksaan Poliklinik (dr. Septian) = Rp 100,000
Ceftazidime = Rp 480,000
Sibital = Rp 21,000
RL = Rp 150,000
Verband = Rp 6,000
Feeding Tube NGT = Rp 30,000
Prasat NGT = Rp 50,000
R/ tgl 08-01-2016 = Rp 8,000
R/ tgl 09-01-2016 = Rp 19,000
R/ tgl 11-01-2016 = Rp 23,000
Rp 2,754,500

Telp. (0285) 423623
Nama : An. Najwa Salma Kelas Perawatan : III B

No.RM : 00.71.52

Pemeriksaan Poliklinik (dr. Ilham) = Rp 100,000
Visite dr. Ilham = Rp 45,000
RL = Rp 150,000
Verband = Rp 6,000
R/ tgl 11-01-2016 (5.000 + 7.000) = Rp 12,000
R/ tgl 13-01-2016 = Rp 10,000
Rp 2,566,000

Telp. (0285) 423623
Nama : An. Refi Riski R Kelas Perawatan : II C

No.RM : 00.71.64

Pemeriksaan Poliklinik (dr. Fitri) = Rp 100,000
Visite dr. Riza Kurniawan, Sp.A, M.Kes = Rp 355,000
Via phone dr. Riza Kurniawan, Sp.A, M.Kes = Rp 60,000
"Co" THT dr. Rony Dwi Eko H, Sp.THT-KL = Rp 125,000
Tindakan ekstras serum & Parasintesa ADS = Rp 200,000
Chloramex = Rp 60,000
Metronidazole = Rp 60,000
Antrain = Rp 40,000
Stesolid = Rp 45,000
RL = Rp 25,000
Asering = Rp 90,000
D5 ¼ NS = Rp 30,000
Verband = Rp 14,000
Ganti verband = Rp 15,000
Laborat tgl 12-01-2016 = Rp 267,000
R/ tgl 12-01-2016 (6.000 + 55.000) = Rp 61,000
R/ tgl 13-01-2016 = Rp 7,000
R/ tgl 15-01-2016 = Rp 31,000
Rp 3,898,000

Telp. (0285) 423623
Nama : Tn. Dulnaim Kelas Perawatan : III

No.RM : 00.71.56
Opname tanggal 11-01-2016 s/d 12-01-2016 (III) = Rp 300,000

Opname tanggal 13-01-2016 s/d 16-01-2016 (IGD) = Rp 1,000,000
Berotec = Rp 96,000
Dolbutamol = Rp 75,000
NACL = Rp 200,000
Folley catheter no.20 = Rp 50,000
Handscoon 2 pasang = Rp 20,000
Urine bag = Rp 25,000
Prasat catheter = Rp 50,000
O₂ 5 tab besar + Selang O₂ = Rp 590,000
Nebulizer 15x = Rp 600,000
Fisiotherapie tgl 13-01-2016 = Rp 40,000
EKG baca tgl 13-01-2016 = Rp 150,000
R/ tgl 11-01-2016 = Rp 80,000
R/ tgl 13-01-2016 = Rp 52,000
R/ tgl 15-01-2016 = Rp 8,000
Pengawasan = Rp 200,000
Rp 6,446,000

Telp. (0285) 423623
Nama : An. Tandia Anggraini Kelas Perawatan : III B

No.RM : 00.71.92

Pemeriksaan Poliklinik (dr. Najmi) = Rp 100,000
Visite dr. Najmi = Rp 45,000
D5% = Rp 25,000
Verband = Rp 6,000
Rp 989,000

Telp. (0285) 423623
Nama : Nn. Rosita Riskiana Kelas Perawatan : III B

No.RM : 00.71.85

Pemeriksaan Poliklinik (dr. Deborah) = Rp 100,000
Piracetam = Rp 150,000
Citicolin = Rp 300,000
RL = Rp 250,000
Abocath No.22 =
Rp 120,000
Abocath No.24 =
Laborat tgl 18-01-2016 = Rp 154,000
R/ tgl 19-01-2016 = Rp 35,000
R/ tgl 20-01-2016 = Rp 233,000
Rp 3,375,500
Telp. (0285) 423623
Nama : Tn. Pataroh Kelas Perawatan : III i

No.RM : 00.71.83

Pemeriksaan Poliklinik (dr. Deborah) = Rp 100,000
Asam tranexamat = Rp 480,000
Delladryl = Rp 20,000
RL = Rp 125,000
NACL = Rp 100,000
Abocath No.22 =
Rp 120,000
Abocath No.24 =
Tranfusi set = Rp 160,000
Prasat tranfusi = Rp 200,000
Tranfusi darah 4 kolf = Rp 1,440,000
Laborat tgl 18-01-2016 (317.000 + 20.000) = Rp 337,000
Laborat tgl 19-01-2016 = Rp 27,000
R/ tgl 18-01-2016 = Rp 95,000
Handscoon 2 pasang = Rp 20,000
Rp 5,999,500

Telp. (0285) 423623
Nama : An. Adelia Tri Anjani Kelas Perawatan : III A

No.RM : 00.71.43

Antrain = Rp 80,000
D5% = Rp 125,000
Verband = Rp 6,000
fhoto ro + baca tgl 18-01-2016 = Rp 150,000
R/ tgl 19-01-2016 = Rp 8,000
R/ tgl 20-01-2016 = Rp 21,000
Rp 1,872,000

Telp. (0285) 423623
Nama : tn. Turidin Kelas Perawatan : III

No.RM : 00.71.96

Visite dr. Rosik budioro, sp.pd.fin = Rp 305,000
Via phone dr. Rosik budioro, sp.pd.fin = Rp 20,000
RL = Rp 300,000
laborat tgl 19-01-2016 = Rp 205,000
R/ tgl 18-01-2016 (15.000 + 28.000) = Rp 43,000
R/ tgl 19-01-2016 (9.000 + 237.000) = Rp 246,000
R/ tgl 20-01-2016 (84.000 + 103.000) = Rp 187,000
Rp 3,333,000

Telp. (0285) 423623
Nama : an. Aslam nasir asfa Kelas Perawatan : III

No.RM : 00.71.93

Visite dr. H. Moch. Kudori, sp.a = Rp 605,000
d5 ¼ ns = Rp 210,000
verband = Rp 10,000
laborat tgl 18-01-2016 = Rp 127,000
R/ tgl 18-01-2016 = Rp 25,000
R/ tgl 21-01-2016 = Rp 67,000
Rp 3,334,500
YAYASAN SITI CHOTIMAH naik kelas II - Utama

Telp. (0285) 423623
Nama : an. Farel gibran Kelas Perawatan : II

No.RM : 00.72.10

visite dr. Riza kurniawan, sp.a,m.kes = Rp 275,000
via phone dr. Riza kurniawan, sp.a,m.kes = Rp 20,000
paracetamol = Rp 130,000
cefxon = Rp 60,000
antrain = Rp 20,000
vellutin = Rp 90,000
pulmicort = Rp 150,000
d5 ¼ ns = Rp 150,000
verband = Rp 6,000
nebulizer = Rp 440,000
R/ tgl 26-01-2016 = Rp 48,000
Rp 3,932,000

Telp. (0285) 423623
Nama : ny. Warsiti Kelas Perawatan : III

No.RM : 00.72.09

NACL = Rp 250,000
laborat tgl 21-01-2016 = Rp 253,000
laborat tgl 22-01-2016 = Rp 67,000
laborat tgl 23-01-2016 = Rp 27,000
laborat tgl 25-01-2016 = Rp 27,000
usg + baca tgl 21-01-2016 = Rp 150,000
R/ tgl 21-01-2016 (51.000 + 102.000) = Rp 153,000
R/ tgl 23-01-2016 (26.000 + 138.000) = Rp 164,000
R/ tgl 25-01-2016 (136.000 + 143.000) = Rp 279,000
Rp 4,580,500

Telp. (0285) 423623
Nama : tn. Rusdi Kelas Perawatan : III

No.RM : 00.72.15

ketorolac = Rp 240,000
asam tranexamat = Rp 360,000
RL = Rp 250,000
laborat tgl 23-01-2016 = Rp 180,000
ekg + baca tgl 24-01-2016 = Rp 150,000
R/ tgl 23-01-2016 = Rp 205,000
R/ tgl 26-01-2016 = Rp 69,000
R/ tgl 27-01-2016 = Rp 117,000
pengawasan = Rp 100,000
Rp 5,100,000

Telp. (0285) 423623
Nama : tn. Abdul rozak Kelas Perawatan : III

No.RM : 00.72.20

rd5% = Rp 210,000
laborat tgl 25-01-2015 = Rp 180,000
R/ tgl 25-01-2016 = Rp 31,000
R/ tgl 26-01-2016 = Rp 36,000
R/ tgl 27-01-2016 = Rp 64,000
R/ tgl 28-01-2016 = Rp 25,000
Rp 3,171,000

Telp. (0285) 423623
Nama : an. Risky aditya putra Kelas Perawatan : Iic

No.RM : 00.72.25

visite d. H. Moch. Kudori, sp.a = Rp 285,000
visite dr. Tri kusumawardani, sp.a,m.kes = Rp 215,000
RL = Rp 50,000
d5% = Rp 125,000
verband = Rp 24,000
ganti verband 1x = Rp 15,000
laborat tgl 27-01-2016 = Rp 105,000
laborat tgl 27-01-2016 = Rp 190,000
laborat tgl 29-01-2016 = Rp 72,000
R/ tgl 26-01-2016 = Rp 5,000
R/ tgl 29-01-2016 = Rp 22,000
Rp 3,638,000

Telp. (0285) 423623
Nama : ny. Tukimah Kelas Perawatan : III
No.RM : 00.72.42

Pemeriksaan Poliklinik (dr. fitri) = Rp 30,000
bisolvon = Rp 29,000
RL = Rp 25,000
NACL = Rp 25,000
infus set = Rp 40,000
abocath no.24 = Rp 40,000
verband = Rp 6,000
O₂ tab besar + Selang O₂ = Rp 130,000
nebulizer 3x = Rp 120,000
laborat tgl 30-01-2016 = Rp 97,000
prasat jenazah = Rp 75,000
handscoon 1 pasang = Rp 10,000
masker 2 = Rp 10,000
ambulance = Rp 500,000
Rp 1,989,500

Telp. (0285) 423623
Nama : Sdr. Lufni Kelas Perawatan : III

No.RM : 00.72.26

NACL = Rp 375,000
Laborat tgl 26-01-2016 = Rp 180,000
Laborat tgl 27-01-2016 = Rp 285,000
Laborat tgl 28-01-2016 = Rp 72,000
Laborat tgl 29-01-2016 = Rp 72,000
Laborat tgl 30-01-2016 = Rp 72,000
R/ tgl 26-01-2016 = Rp 11,000
R/ tgl 31-01-2016 = Rp 30,000
Rp 5,570,000
Telp. (0285) 423623
Nama : An. M. Rezar Kelas Perawatan : I

via phone dr. Reza,Sp.A = Rp 91,000
visite dr. A'an,Sp.A = Rp 364,000
Ceftriaxon = Rp 105,000
Dexamethason = Rp 50,000
Ranitidin = Rp 30,000
Antrain = Rp 60,000
Asering = Rp 120,000
Verban = Rp 6,000
Laborat = Rp 631,000
Obat Oral = Rp 273,000
Rp 3,314,000

Telp. (0285) 423623
Nama : An. Jifan Prabu Kelas Perawatan : III

visite dr. Reza,Sp.A = Rp 91,000
Antrain = Rp 80,000
Vellutin Rp 45,000
Pulmicot Rp 75,000
Dexamethason Rp 60,000
Asering = Rp 90,000
Verban = Rp 10,000
Nebulizer Rp 240,000
Pengawasan Rp 100,000
Rp 3,471,500

Telp. (0285) 423623
Nama : An. Adelia Tri A Kelas Perawatan : III

visite dr. Reza,Sp.A = Rp 65,000
Konsul THT dr. Rony,Sp.THT-KL = Rp 125,000
Gentamicin = Rp 60,000
Ranitin = Rp 15,000
Omprazole Rp 345,000
Furosemid Rp 10,000
Keterolac Rp 40,000
Spuite 10 CC Rp 78,000
RL = Rp 175,000
NACL Rp 50,000
Verban = Rp 6,000
Transfusi set Rp 50,000
Prasat Transfusi Rp 50,000
Transfusi darah 1 kolf Rp 360,000
Rp 5,870,500

Telp. (0285) 423623
Nama : Tn. Saroni Kelas Perawatan : III

via phone dr. Rosik,Sp.PD = Rp 40,000
visite dr. Rosik,Sp.PD = Rp 185,000
Visite dr.Najmi = Rp 45,000
RL = Rp 250,000
Infus Set = Rp 80,000
Rp 4,182,500

Telp. (0285) 423623
Nama : An.Reva Aprili Kelas Perawatan : III

visite dr. Septian = Rp 45,000
Visite dr.Riza,Sp.A = Rp 91,000
Novaldo = Rp 120,000
Pulmicot = Rp 75,000
RL = Rp 75,000
Verband = Rp 6,000
Nebulizer = Rp 240,000
Rp 2,608,500

Telp. (0285) 423623
Nama : Ny. Kartiyah Kelas Perawatan : III
Opname tanggal1-2-2016 s/d 5-2-2016 = Rp 750,000

via phone dr. Rosik,Sp.PD = Rp 40,000
visite dr. Rosik,Sp.PD = Rp 245,000
Ondancentro = Rp 225,000
RL = Rp 175,000
Rp 3,183,000

Telp. (0285) 423623
Nama : An. Shla Mia Kelas Perawatan : III

visite dr. A'an, Sp.A = Rp 725,000
konsul THT dr.Rony,Sp.THT-KL = Rp 125,000
Antrain = Rp 20,000
Spuite = Rp 370,000
RL = Rp 250,000
Verban Rp 10,000
Rp 5,093,500

Telp. (0285) 423623
Nama : An. Abdus Sami Kelas Perawatan : II

visite dr. A'an, Sp.A = Rp 585,000
Via Phone = Rp 40,000
Spuite = Rp 377,000
Verban = Rp 10,000
Ganti verband = Rp 15,000
Foto Rontgen = Rp 150,000
Rp 4,685,500

Telp. (0285) 423623
Nama : An. Mundia Kelas Perawatan : III

Visite dr.Fitri = Rp 45,000
visite dr. Riza, Sp.A = Rp 120,000
Visite dr.A'an,Sp.A = Rp 305,000
Spuite = Rp 277,000
Asering = Rp 90,000
RL = Rp 100,000
Verban = Rp 6,000
Rp 3,257,000

Telp. (0285) 423623
Nama : An. Faris Edi Kelas Perawatan : II

visite dr. Riza, Sp.A = Rp 495,000
Konsul dr.Rony, Sp.THT-KL = Rp 125,000
Biaya Tindakan THT = Rp 200,000
Sibital = Rp 63,000
Schloramex = Rp 80,000
Antrain = Rp 20,000
Spuite = Rp 577,500
RL = Rp 25,000
NACL = Rp 25,000
Verban = Rp 10,000
Nebulozer = Rp 480,000
Rfoto Rontgen = Rp 150,000
Rp 5,728,500

Telp. (0285) 423623
Nama : An. Kaela Naza Kelas Perawatan : III

Visite dr.Dhita = Rp 50,000
Visite dr.Kudori,Sp.A = Rp 145,000
Antrain = Rp 40,000
Spuite = Rp 31,500
RL = Rp 50,000
Verban = Rp 10,000
O2 = Rp 130,000
Prasat Jenazah = Rp 75,000
Rp 1,315,000

Telp. (0285) 423623
Nama : An. Syakira Hanam Kelas Perawatan : III

Visite dr.A'an, Sp.A = Rp 485,000
Visite dr.Riza, Sp.A = Rp 65,000
Konsul THT = Rp 125,000
Biaya Tindakan THT = Rp 200,000
Antrain = Rp 80,000
Sibital = Rp 42,000
Metronidazol = Rp 60,000
Spuite = Rp 324,000
D5 1/4 NS = Rp 210,000
Infus Set Ped = Rp 90,000
Verban = Rp 10,000
Rp 4,119,000

Telp. (0285) 423623
Nama : Tn. Kuryo Kelas Perawatan : III

Visite. Dr.Rosik, Sp.PD = Rp 245,000
Visite dr. Dhita = Rp 85,000
Via phone dr.Rosik, Sp.PD = Rp 20,000
Asam Traneksamat = Rp 180,000
Spuite = Rp 181,000
NACL = Rp 75,000
O2 = Rp 130,000
Rp 3,383,000

Telp. (0285) 423623
Nama : An. Fatimah Azzahra Kelas Perawatan : III

Visite dr.Kudori, Sp.A = Rp 545,000
Konsul dr.Rony,Sp.THT-KL = Rp 250,000
Spuite = Rp 318,500
RL Rp 150,000
NACL = Rp 50,000
Verband Rp 10,000
Rp 4,431,000

Telp. (0285) 423623
Nama : An. Wulan Manisa Kelas Perawatan : III

Spuite = Rp 193,000
RL Rp 75,000
D5 1/4 NS = Rp 180,000
Rp 2,795,500
Telp. (0285) 423623
Nama : An. Marvelia Chantika Kelas Perawatan : III

Via Phone dr.Riza,Sp.A = Rp 40,000
Visite dr.Rony, Sp.THT-KL = Rp 125,000
Tindakan THT = Rp 100,000
Antrain = Rp 20,000
Spuite = Rp 199,000
RL = Rp 25,000
Asering = Rp 9,000
Verban = Rp 6,000
Rp 2,645,500

Telp. (0285) 423623
Nama : An. M. Fika Naful Kelas Perawatan : III

Antrain = Rp 20,000
Spuite = Rp 132,000
RL = Rp 75,000
NACL = Rp 150,000
Verban = Rp 10,000
O2 Rp 130,000
Laborat = Rp 72,000
Rp 2,608,000

Telp. (0285) 423623
Nama : Tn.Cahyono Kelas Perawatan : II

Visite dr.Rosik,Sp.PD = Rp 215,000
Spuite = Rp 249,000
RL = Rp 150,000
Rp 3,695,000

Telp. (0285) 423623
Nama : An. Didit Setiawan Kelas Perawatan : III

Spuite = Rp 142,000
RL = Rp 25,000
NACL = Rp 25,000
D5% = Rp 100,000
Verband = Rp 10,000
Laborat = Rp 72,000
Rp 2,768,000
Telp. (0285) 423623
Nama : An. Nur Indayati Kelas Perawatan : III

Aminophylin = Rp 30,000
Ventolin = Rp 15,000
Salbutamol = Rp 25,000
Spuite = Rp 219,000
D5% = Rp 25,000
NACL = Rp 25,000
O2 = Rp 245,000
Fisioteraphy = Rp 40,000
Rp 2,474,000

Telp. (0285) 423623
Nama : An. Dika Saputra Kelas Perawatan : III

Visite dr. Kudori,Sp.A = Rp 365,000
Extrace = Rp 60,000
Asam traneksamat = Rp 100,000
Spuite = Rp 138,500
RL = Rp 125,000
Laborat = Rp 72,000
Rp 2,291,500

Telp. (0285) 423623
Nama : An. M.Takhfif Kelas Perawatan : I

Spuite = Rp 107,500
RL = Rp 75,000
D5% = Rp 50,000
Rp 2,028,000

Telp. (0285) 423623
Nama : An. Abdul Rohman Kelas Perawatan : III

Spuite = Rp 300,000
RL = Rp 225,000
NACL = Rp 50,000
Transfusi Set = Rp 50,000
Prasat transfusi = Rp 50,000
Transfusi darah 2 kolf = Rp 720,000
Laborat = Rp 27,000
Rp 4,574,000

Telp. (0285) 423623
Nama : Tn.Carim Kelas Perawatan : III

Ondancentron Rp 150,000
Spuite = Rp 332,000
RL = Rp 225,000
NACL = Rp 25,000
Rp 3,794,000

Telp. (0285) 423623
Nama : Sdr. Faris Hamawn Kelas Perawatan : I

Antrain Rp 300,000
Spuite = Rp 458,000
RL = Rp 200,000
NACL = Rp 50,000
Rp 5,219,000

Telp. (0285) 423623
Nama : An. Rifki Tri Febrian Kelas Perawatan : III

Antrain Rp 20,000
Spuite = Rp 107,500
RL = Rp 75,000
Asering = Rp 30,000
Rp 1,568,500

Telp. (0285) 423623
Nama : An. Marsya Riski M Kelas Perawatan : III

Ceftazidim = Rp 60,000
Novalgin = Rp 40,000
Ceftriaxon Rp 140,000
Spuite = Rp 137,000
RL = Rp 125,000
Verban Rp 10,000
Rp 2,375,500

Telp. (0285) 423623
Nama : Tn. Kasdiyan Kelas Perawatan : III

Visite dr.Najmi Rp 45,000
Konsul THT Rp 125,000
Antrain Rp 360,000
Piracetam Rp 300,000
Spuite = Rp 506,000
RL = Rp 225,000
Verban Rp 4,000
O2 Rp 360,000
Laborat Rp 425,000
Foto Rontgen Rp 160,000
Feeding tube n0.3 = Rp 40,000
Rp 5,691,000

Telp. (0285) 423623
Nama : An. Istahal Nakhlan Kelas Perawatan : II

Antrain Rp 100,000
Sibital Rp 21,000
Spuite = Rp 198,500
D5% = Rp 150,000
Verban Rp 6,000
Laborat Rp 72,000
Rp 2,624,000

Telp. (0285) 423623
Nama : Ny. Ra'ati Kelas Perawatan : III

Visite dr. Rosik,Sp.PD = Rp 485,000
Furosemid = Rp 100,000
Cefotaxim = Rp 200,000
Spuite = Rp 117,000
NACL = Rp 225,000
Folly Catheter = Rp 50,000
Urin Bag = Rp 40,000
Prasat Catheter = Rp 75,000
O2 3 tab = Rp 360,000
Ekg + baca = Rp 150,000
Rivanol = Rp 6,000
Kompres Rivano; = Rp 180,000
Handscoon = Rp 60,000
Rp 4,771,000

Telp. (0285) 423623
Nama : An. Winda Kelas Perawatan : III

Visite dr.Deborah = Rp 45,000
Spuite = Rp 127,000
Asering = Rp 30,000
RL Rp 75,000
Verband = Rp 6,000
Rp 2,150,000

Telp. (0285) 423623
Nama : Sdr. Abdul Majid Kelas Perawatan : III

Visite dr.Kudor,Sp.A = Rp 45,000
Visite dr.Fitri,Sp.A = Rp 305,000
Antrain Rp 20,000
Spuite = Rp 408,000
RL = Rp 150,000
Rp 2,245,500

Telp. (0285) 423623
Nama : Tn. Ahmad Nurul Huda Kelas Perawatan : II

Via Phone dr.Rosik,Sp.PD = Rp 20,000
Spuite = Rp 348,000
RL = Rp 200,000
NACL = Rp 200,000
Rp 5,540,500

Telp. (0285) 423623
Nama : An. Tiara Anggun Kelas Perawatan : III

Spuite = Rp 124,000
Verband = Rp 6,000
Rp 2,554,500

Telp. (0285) 423623
Nama : An. M.Wafa Albanan Kelas Perawatan : III

Sibital = Rp 21,000
Spuite = Rp 49,500
RD5% = Rp 150,000
Verband = Rp 6,000
Rp 1,641,500

Telp. (0285) 423623
Nama : Ny. Kunariyah Kelas Perawatan : III

Visite dr.Septian = Rp 45,000
Visite dr.Rosik,SP.PD Rp 165,000
Keterolac = Rp 40,000
Spuite = Rp 97,500
RL = Rp 75,000
O2 Rp 245,000
EKG + baca Rp 150,000
Rp 2,205,000

Telp. (0285) 423623
Nama : Tn. M.Sujarno Kelas Perawatan : III

Visite dr.Kudori,Sp.A Rp 65,000
Spuite = Rp 25,000
RL = Rp 25,000
Verban = Rp 6,000
Rp 887,500

Telp. (0285) 423623
Nama : Tn. Sabar Kelas Perawatan : III

Cificolin = Rp 50,000
Spuite = Rp 27,000
RL = Rp 50,000
Laborat = Rp 27,000
Rp 977,500
Telp. (0285) 423623
Nama : Ny. Rumanah Kelas Perawatan : III

Spuite = Rp 202,000
RL = Rp 25,000
Asering = Rp 90,000
Rp 2,953,000

Telp. (0285) 423623
Nama : Nn. Riski Pramudita Kelas Perawatan : II

Spuite = Rp 235,000
RL = Rp 100,000
Asering = Rp 30,000
Rp 3,722,500

Telp. (0285) 423623
Nama : Tn. Wahyuri Kelas Perawatan : III

Spuite = Rp 141,000
RL = Rp 25,000
Asering = Rp 90,000
Rp 2,461,000

Telp. (0285) 423623
Nama : Tn. Cahyono Kelas Perawatan : III

Visite dr.Dhta = Rp 50,000
Spuite = Rp 334,000
RL = Rp 100,000
NACL = Rp 175,000
Rp 4,847,500

Telp. (0285) 423623
Nama : Tn. Khuza'i Kelas Perawatan : III

Visite dr.Dhta = Rp 45,000
Antrain = Rp 48,000
Spuite = Rp 466,000
RL = Rp 225,000
Asering = Rp 90,000
Rp 6,456,000

Telp. (0285) 423623
Nama : Tn. Kuryo Kelas Perawatan : III

Spuite = Rp 132,000
Asering = Rp 90,000
Rp 1,739,500

Telp. (0285) 423623
Nama : Tn. Dasim Kelas Perawatan : III

Visite dr.Septia = Rp 85,000
Visite dr. Deboro = Rp 45,000
Spuite = Rp 289,500
RL = Rp 25,000
NACL = Rp 75,000
D% 1/4 NS = Rp 30,000
Feeding Tube = Rp 40,000
O2 = Rp 130,000
USG = Rp 200,000
Rp 3,807,500

Telp. (0285) 423623
Nama : Ny. Mistini Kelas Perawatan : III

Spuite = Rp 624,500
RL = Rp 225,000
Rp 4,996,500

Telp. (0285) 423623
Nama : Tn. Frans Tri Yuli Kelas Perawatan : III

Aquabidestilata = Rp 30,000
Spuite = Rp 20,000
RL = Rp 25,000
NACL = Rp 75,000
O2 = Rp 130,000
Rp 2,488,500

Telp. (0285) 423623
Nama : Tn. Sadari Kelas Perawatan : III

Methocloramid = Rp 135,000
Alinamin =
Spuite = Rp 242,500
O2 = Rp 130,000
Rp 2,776,500

Telp. (0285) 423623
Nama : Ny. Sutinah Kelas Perawatan : III

Spuite = Rp 123,000
RL = Rp 125,000
Rp 2,405,000

Telp. (0285) 423623
Nama : An. Isani N Kelas Perawatan : III

Rinitidin = Rp 15,000
Spuite = Rp 93,500
RL = Rp 125,000
Verband = Rp 6,000
Laborat = Rp 72,000
Rp 1,850,500

Telp. (0285) 423623
Nama : An. Anggita P Kelas Perawatan : II

Novaldo = Rp 80,000
Sibital = Rp 21,000
Spuite = Rp 133,000
RL = Rp 75,000
D5% Rp 75,000
Verband = Rp 6,000
Laborat = Rp 72,000
Rp 1,545,000

Telp. (0285) 423623
Nama : An. Galang Atala Mahardika Kelas Perawatan : I

Visite dr. Riza,Sp.A = Rp 305,000
Visite dr.Debora = Rp 75,000
Sanmol = Rp 83,000
Cortidex = Rp 40,000
Spuite = Rp 234,000
Pulmicort = Rp 125,000
D5 1/4 NS = Rp 30,000
NACL = Rp 25,000
Verband = Rp 6,000
Fisuoterapi = Rp 120,000
Rp 3,690,000

Telp. (0285) 423623
Nama : Tn. Kandari Kelas Perawatan : III

Furosem = Rp 65,000
Birotec = Rp 20,000
Spuite = Rp 234,000
NACL = Rp 30,000
O2 = Rp 170,000
FotoRontgen = Rp 120,000
EKG
Nebulizer
Rp 3,211,000

Telp. (0285) 423623
Nama : Ny.Neneng Wijayanti Kelas Perawatan : III

Artain = Rp 480,000
Ondonentron = Rp 435,000
RL 2 = Rp 50,000
NACL = Rp 200,000
Laborat tgl 13-2-2016 = Rp 327,000
tgl 16-2-2016 = Rp 72,000
tgl 17-2-2016 = Rp 72,000
tgl 18-2-2016 = Rp 72,000
tgl 19-2-2016 = Rp 72,000
tgl 20-2-2016 = Rp 72,000
Fot0 RO + bao Tgl 18-2-2016 = Rp 160,000
R/ tgl 16-2-2016 = Rp 10,000
tgl 18-2-2016 = Rp 8,000
tgl 19-2-2016 = Rp 11,000
tgl 20-2-2016 = Rp 31,000
Rp 6,248,000

Telp. (0285) 423623
Nama : Tn.F.TAMSURI Kelas Perawatan : III

6 Cetotexime = Rp 240,000
9 Ranitidine = Rp 135,000
9 Ketosolec = Rp 360,000
NACL = Rp 50,000
R/ tgl 18-2-2016 = Rp 6,000
tgl 19-2-2016 = Rp 39,000
Rp 2,094,000
Ambulance ke RS.ARO = Rp 75,000
Rp 2,169,000

Telp. (0285) 423623
Nama : Ny.DURIYAH Kelas Perawatan : Il

Pemeriksaan Poliklinik (dr.Najmi) = Rp 30,000
Visite dr.Rosik, Sp.PD = Rp 285,000
Visite dr.Eva = Rp 50,000
NACL = Rp 75,000
Laborat tgl 18-2-2016 = Rp 170,000
EKG + baca tgl 17-2-2016 = Rp 150,000
R/ tgl 18-2-2016 = Rp 117,000
tgl 20-2-2016 = Rp 98,000
tgl 21-2-2016 = Rp 9,000
Rp 2,653,500

Telp. (0285) 423623
Nama : Ny.WARSITI Kelas Perawatan : lll

Pemeriksaan Poliklinik (dr.Eva) = Rp 30,000
Visite dr. Eva = Rp 85,000
Ketosolec = Rp 1,080,000
RL = Rp 50,000
NACL = Rp 200,000
Laborat tgl 15-2-2016 = Rp 285,000
tgl 16-2-2016 = Rp 72,000
tgl 17-2-2016 = Rp 72,000
tgl 18-2-2016 = Rp 72,000
tgl 19-2-2016 = Rp 72,000
tgl 20-2-2016 = Rp 72,000
tgl 22-2-2016 = Rp 72,000
EKG + baca tgl 14-2-2016 = Rp 150,000
USG + baca tgl 19-2-2016 = Rp 200,000
R/ tgl 16-2-2016 = Rp 57,000
19-2-2016 = Rp 94,000
22-2-2016 = Rp 85,000
Rp 6,146,500

Telp. (0285) 423623
Nama : TN. ABDUL MUHID Kelas Perawatan : lll

Visite dr.Rosik Budioro, Sp.PD = Rp 245,000
Spuite = Rp 200,500
RL = Rp 175,000
Abocate no.22 = Rp 40,000
Rp 2,697,500

Telp. (0285) 423623
Nama : NY.WAHYUNI Kelas Perawatan : lll

Visite dr.Rosik Budioro, Sp.PD = Rp 185,000
Benadon = Rp 46,000
Recodiyl = Rp 10,000
Spuite = Rp 179,000
NACL = Rp 150,000
Laborat tgl 25-2-2016 = Rp 143,000
Obat oral = Rp 193,000
Asuhan keperawatan = Rp 45,000
Rp 2,303,500
Telp. (0285) 423623
Nama : AN.RINJANI Kelas Perawatan : ll

Visite dr.Riza Kurniawan, Sp.A.M.Kes = Rp 215,000
Via phone dr.Riza Kurniawan, Sp.A.M.Kes = Rp 20,000
Spuite = Rp 171,500
Verband = Rp 6,000
Laborat tgl 25-2-2016 = Rp 107,000
Rp 2,073,000

Telp. (0285) 423623
Nama : AN.NOVI KHORNIA Kelas Perawatan : lll

Pemeriksaan Poliklinik (dr.H.M.Kudori Sp.A) = Rp 100,000
Visite dr.H.M.Kudori Sp.A = Rp 185,000
Sibital = Rp 21,000
Spuite = Rp 4,500
D5% = Rp 50,000
Verband = Rp 6,000
Laborat tgl 26-2-2016 = Rp 92,000
Foto RO + baca tgl 26-2-2016 = Rp 150,000
Rp 1,278,000

Telp. (0285) 423623
Nama : AN.NUCKYNRACHMAN Kelas Perawatan : lll

Visite dr.Riza Kurniawan Sp.A.M.Kes = Rp 185,000
Via phone dr.Riza Kurniawan Sp.A.M.Kes = Rp 20,000
Ceftilaxon = Rp 360,000
Antrain = Rp 60,000
Spuite = Rp 114,500
Asering = Rp 18,000
Verband = Rp 6,000
Laborat tgl 26 s/d 27-2-2016 = Rp 242,000
Obat oral tgl 27-2-2016 = Rp 58,000
Rp 2,244,000

Telp. (0285) 423623
Nama : AN. HISYAM IBRAHIM Kelas Perawatan : UTAMA

Visite dr.Riza Kurniawan Sp.A.M.Kes = Rp 185,000
Via phone dr.Riza Kurniawan Sp.A.M.Kes = Rp 20,000
Silitue = Rp 42,000
Farmadol = Rp 74,000
Spuite = Rp 153,500
Verband = Rp 10,000
Laborat tgl 25-2-2016 = Rp 125,000
Fisioterapi tgl 25-2-2016 = Rp 40,000
Obat oral tgl 25 s/d 26-2-2016 = Rp 219,000
Rp 2,754,000

Telp. (0285) 423623
Nama : AN. EMANUEL Kelas Perawatan : UTAMA

Pemeriksaan IGD (dr.Najmi) = Rp 30,000
Spuite = Rp 201,500
NACL = Rp 250,000
Laborat tgl 26 s/d 27-2-2016 = Rp 270,000
Rp 4,076,500

Telp. (0285) 423623
Nama : AN. M.DARIS SALAM Kelas Perawatan : UTAMA

Pemeriksaan Poliklinik (dr.Septian) = Rp 30,000
Sibite = Rp 42,000
Spuite = Rp 256,000
RL = Rp 200,000
Verband = Rp 16,000
Laborat = Rp 92,000
Rp 3,785,000

Telp. (0285) 423623
Nama : TN.SALAHUDIN Kelas Perawatan : lll

Ondencentron = Rp 210,000
Spuite = Rp 237,500
NACL = Rp 350,000
Laborat tgl 24-2-2016 = Rp 94,000
Rp 3,802,500

Telp. (0285) 423623
Nama : NY.SARWITI Kelas Perawatan : lll

Dexamethesone = Rp 180,000
Spuite = Rp 360,000
NACL = Rp 325,000
= Rp 6,000
Laborat tgl 24-2-2016 = Rp 94,000
Obat oral tgl 29-2-2016 = Rp 55,000
Kompres NACL = Rp 360,000
Rp 4,187,000

Telp. (0285) 423623
Nama : TN.ABDUL KOPIR Kelas Perawatan : lll

Spuite = Rp 388,000
RL = Rp 225,000
Abocath no.22 = Rp 40,000
Laborat tgl 26-2-2016 = Rp 202,000
Rp 3,802,000

Telp. (0285) 423623
Nama : Sdr.RETNA HENDRIK S Kelas Perawatan : lll

Spuite = Rp 390,500
RL = Rp 325,000
Laborat tgl 25 s/d 29-2-2016 = Rp 378,000
Obat oral tgl 26 & 29-2-2016 = Rp 57,000
Rp 3,976,500

Telp. (0285) 423623
Nama : NY.MARSITA Kelas Perawatan : lll

Spuite = Rp 175,000
RL = Rp 200,000
O2 tab besar + selang O2 Dewasa = Rp 130,000
Laborat tgl 26-2-2016 = Rp 170,000
EKG + baca = Rp 150,000
Rp 2,815,000

Telp. (0285) 423623
Nama : NY.SUWARNI Kelas Perawatan : lll

Cefatoxime = Rp 320,000
Spuite = Rp 234,500
NACL = Rp 200,000
Laborat tgl 26-2-2016 = Rp 94,000
Obat oral tgl 27 & 29-2-2016 = Rp 85,000
Rp 2,512,000

Telp. (0285) 423623
Nama : AN.VIREIAWAN DAMAR L Kelas Perawatan : lll

Visite dr.Riza Kurniawan, Sp.A = Rp 545,000
Via phone dr.Aan, Sp.A = Rp 125,000
Cefatoxime = Rp 270,000
Spuite = Rp 317,500
RL = Rp 25,000
Verband = Rp 6,000
Rp 4,124,000

Telp. (0285) 423623
Nama : AN. M.ADYA SURYA Kelas Perawatan : lll

Pemeriksaan Poliklinik (dr.Fitri) = Rp 30,000
Spuite = Rp 236,000
RL = Rp 125,000
Verband = Rp 6,000
Laborat = Rp 92,000
Rp 2,465,500

Telp. (0285) 423623
Nama : AN.ZIDNI ILMAN N Kelas Perawatan : lll

Via phone dr.Riza Kurniawan, Sp.A = Rp 20,000
Sanmol = Rp 85,000
Spuite = Rp 68,000
Asering = Rp 90,000
Verband = Rp 6,000
Laborat tgl 20-2-2016 = Rp 137,000
Obat oral tgl 22-2-2016 = Rp 107,000
Rp 1,908,500

Telp. (0285) 423623
Nama : AN.SHELLY NAMILA J Kelas Perawatan : l

Pulmicoh = Rp 100,000
Spuite = Rp 188,000
Verband = Rp 6,000
O2 tab besar + selang O2 bayi = Rp 130,000
Laborat tgl 20-2-2016 = Rp 339,000
Fisioterapi tgl 22-2-2016 = Rp 40,000
Obat oral tgl 20 & 22-2-2016 = Rp 216,000
Rp 3,667,500

Telp. (0285) 423623
Nama : AN.FASKIA NURSA B Kelas Perawatan : ll

Vitamin C = Rp 45,000
Spuite = Rp 179,000
RL = Rp 75,000
Verband = Rp 6,000
Obat oral tgl 22-2-2016 = Rp 21,000
Laborat = Rp 92,000
Rp 1,954,000

Telp. (0285) 423623
Nama : NY.USWATUN Kelas Perawatan : lll

Ketosolec = Rp 40,000
Spuite = Rp 97,000
RL = Rp 75,000
Laborat tgl 20 & 22-2-2016 = Rp 124,000
Obat oral tg 20 &l 22-2-2016 = Rp 333,000
Rp 2,084,500

Telp. (0285) 423623
Nama : AN.ZAKIAN MILADIA Kelas Perawatan : lll

Via phone dr.Kudori, Sp.A = Rp 20,000
Spuite = Rp 138,300
RL = Rp 100,000
Verband = Rp 6,000
Laborat = Rp 92,000
Obat oral tg 20 &l 22-2-2016 = Rp 45,000
Rp 1,692,800

Telp. (0285) 423623
Nama : AN.M.AYYAASY WIDYADHANA Kelas Perawatan : Utama

Visite dr.Riza Kurniawan,Sp.A = Rp 185,000
Taxigram = Rp 740,000
Sanmol = Rp 166,000
Vometron = Rp 132,000
Spuite = Rp 200,000
Asering = Rp 90,000
Verband = Rp 6,000
Obat oral tg = Rp 195,000
Rp 3,310,000

Telp. (0285) 423623
Nama : AN.M.FAIZIN Kelas Perawatan : lll

Via phone dr.Riza Kurniawan,Sp.A = Rp 20,000
Sanmol = Rp 249,000
Spuite = Rp 291,500
Verband = Rp 6,000
Rp 3,271,000

Telp. (0285) 423623
Nama : AN.HANI SINTA W Kelas Perawatan : lll

Via phone dr.A'an,Sp.A = Rp 20,000
Spuite = Rp 370,500
NACL = Rp 150,000
RL = Rp 150,000
Verband = Rp 6,000
Tranfusi 3 kolf = Rp 1,080,000
Transfusi set = Rp 50,000
Laborat tgl 20 s/d 23-2-2016 = Rp 258,000
Rp 4,947,000

Telp. (0285) 423623
Nama : NY.SELVI DIANA Kelas Perawatan : lll

Via phone dr.Rosik,Sp.PD = Rp 20,000
Spuite = Rp 244,500
NACL = Rp 175,000
Rp 3,294,500

Telp. (0285) 423623
Nama : AN.ULFIAH ZAHRO Kelas Perawatan : lll

Spuite = Rp 194,000
RL = Rp 125,000
Verband = Rp 6,000
Laborat = Rp 92,000
O2 tab besar + selang O2 = Rp 130,000
Obat oral tgl 22-2-2016 = Rp 28,000
Rp 2,438,500

Telp. (0285) 423623
Nama : AN.M.TAUFIQ KURAHMAN Kelas Perawatan : lll

Pemeriksaan Poliklinik (dr.Eva = Rp 30,000
Visite dr.A'an,`Sp.A = Rp 125,000
Spuite = Rp 76,500
RL = Rp 100,000
Verband = Rp 6,000
Rp 1,781,500

Telp. (0285) 423623
Nama : AN.LADAINA AZMIA Kelas Perawatan : lll

Visite drKudori,Sp.A = Rp 245,000
Novaldo = Rp 80,000
Spuite = Rp 155,000
RL = Rp 25,000
D5% = Rp 150,000
Verband = Rp 6,000
Laborat = Rp 72,000
Rp 2,064,500

Telp. (0285) 423623
Nama : AN.M.DIYYA AUFAH Kelas Perawatan : lll

Visite drKudori,Sp.A = Rp 305,000
Sibital = Rp 21,000
Spuite = Rp 199,500
RL = Rp 200,000
Verband = Rp 6,000
Foto RO + baca = Rp 150,000
Rp 3,326,500

Telp. (0285) 423623
Nama : AN.M.FADIL AKBAR BUDI Kelas Perawatan : Utama

Visite dr.Rosik, Sp.Pd = Rp 95,000
Terfaccet = Rp 1,375,000
Sanmol = Rp 249,000
Vometron = Rp 198,000
Spuite = Rp 291,000
Verband = Rp 6,000
USG = Rp 200,000
Rp 5,603,500

Telp. (0285) 423623
Nama : TN.KANAPI Kelas Perawatan : lll

Spuite = Rp 189,000
NACL = Rp 200,000
O2 tab besar + 1 selang O2 Dewasa = Rp 130,000
EKG _+ baca = Rp 150,000
Rp 3,933,000

Telp. (0285) 423623
Nama : TN.TARMUJI Kelas Perawatan : lll

Ceftaxim = Rp 480,000
Spuite = Rp 323,000
NACL = Rp 275,000
Rp 3,979,000

Telp. (0285) 423623
Nama : AN.ISANI MUTIARA H Kelas Perawatan : lll

Pemeriksaan Poliklinik (dr.Kudori,Sp.A) = Rp 100,000
Spuite = Rp 44,000
D5% = Rp 150,000
Laborat = Rp 92,000
Rp 1,964,000

Telp. (0285) 423623
Nama : AN.KHALISTA RINDU F Kelas Perawatan : l

Antrain = Rp 20,000
Sanmol = Rp 83,000
Spuite = Rp 190,500
Verband = Rp 6,000
Rp 2,477,000
Telp. (0285) 423623
Nama : AN.PUTRI NABILA Kelas Perawatan : Utama

Via phone dr.Kudori, Sp.A = Rp 20,000
Novaldo = Rp 40,000
Cefrtiaxone = Rp 105,000
Spuite = Rp 160,000
RL = Rp 25,000
Verband = Rp 6,000
Laborat = Rp 92,000
Rp 3,167,000

Telp. (0285) 423623
Nama : AN.VANIA ANDARI J Kelas Perawatan : Utama

Via phone dr.Riza Kurniawan,Sp.A = Rp 40,000
"CO" dr.Rony, SP.THT-KL = Rp 250,000
Spuite = Rp 382,000
Verband = Rp 6,000
Rp 4,867,000

Telp. (0285) 423623
Nama : Ny. Sauti Kelas Perawatan : III

Konsul dr.Rosik, Sp.PD = Rp 90,000
Spuite Rp 42,500
RL = Rp 25,000
Verband = Rp 8,000
O2 = Rp 130,000
Rp 1,171,000
91000
91.25
Telp. (0285) 423623
Nama : Nn. Afina Afiati Kelas Perawatan : II

Visite dr. Rosik,Sp.Pd = Rp 285,000
Spuite = Rp 245,000
D5% = Rp 75,000
Laborat = Rp 55,000
= Rp 3,936,500

Telp. (0285) 423623
Nama : Tn.Yuslasri Kelas Perawatan : III

Visite dr. Rosik,Sp.Pd = Rp 185,000
Antarin = Rp 240,000
Spuite = Rp 165,500
Nacl% = Rp 225,000
= Rp 2,989,000

Telp. (0285) 423623
Nama An.Naura Fatimatus Kelas Perawatan : I

Visite dr. Aan,Sp.A = Rp 270,000
Via phone dr. Aan,Sp.A = Rp 20,000
Dexamathason = Rp 20,000
Spuit = Rp 293,000
Nacl = Rp 25,000
Asering = Rp 90,000
Infuset = Rp 40,000
Verband = Rp 6,000
Prasat Infus = Rp 50,000
O2 1 Tab + Selang 02 = Rp 130,000
Foto Ronsen + Baca = Rp 160,000
Fisioterapi = Rp 40,000
Kpas Plester Alkohol = Rp 50,000
Pajak,dll = Rp 105,000
= Rp 3,610,500

Telp. (0285) 423623
Nama An.M. Hugo Majid Kelas Perawatan : I

Visite dr.Dian AR = Rp 65,000
Spuit = Rp 217,000
RL = Rp 200,000
Infuset = Rp 40,000
Verband = Rp 10,000
Kapas Plester Alkohol = Rp 50,000
= Rp 3,641,500

Telp. (0285) 423623
Nama An.Intan Soria R Kelas Perawatan : III

Visit dr.Aan,Sp.A = Rp 125,000
Antrain = Rp 80,000
Spuit = Rp 310,500
Nacl = Rp 25,000
Infuset = Rp 40,000
= Rp 3,041,500
Telp. (0285) 423623
Nama An.Alva Avicenna L Kelas Perawatan : I

Clatax = Rp 1,717,500
Spuit = Rp 175,500
Infuset = Rp 40,000
Laborat = Rp 40,000
= Rp 4,874,000

Telp. (0285) 423623
Nama An.Naura Fadya Kelas Perawatan : I

Novaldo = Rp 20,000
Spuit = Rp 150,000
Infuset = Rp 40,000
Verband = Rp 6,000
Foto Ronsen+baca = Rp 160,000
= Rp 2,662,000

Telp. (0285) 423623
Nama An.HABIBAH Kelas Perawatan : II

Spuit = Rp 250,000
RL = Rp 175,000
Infuset = Rp 40,000
Verband = Rp 6,000
= Rp 2,796,500

Telp. (0285) 423623
Nama An.Nazdira Iqnati Kelas Perawatan : II

Novaldo = Rp 80,000
Spuit = Rp 158,000
D5% = Rp 100,000
Infuset = Rp 40,000
Verband = Rp 60,000
= Rp 2,078,000

Telp. (0285) 423623
Nama Tn.Sarofi Kelas Perawatan : III

Visite dr.Caesar = Rp 45,000
Spuit = Rp 44,000
RL = Rp 50,000
D10% = Rp 30,000
Nacl = Rp 25,000
Infuset = Rp 40,000
Verband = Rp 10,000
02 1 Tabung besar+Selang 02 dewasa = Rp 130,000
Laborat = Rp 52,000
Medikasi = Rp 150,000
Ambulance = Rp 350,000
= Rp 2,319,000

Telp. (0285) 423623
Nama An.Nafisatul Aulia Kelas Perawatan : III

Visite dr.Kudori.Sp.A = Rp 425,000
"co" dr.Rony Sp.THT-KL = Rp 125,000
Novaldo = Rp 80,000
Spuit = Rp 158,500
RD5 % = Rp 210,000
Infuset = Rp 40,000
Verband = Rp 6,000
Foto Ronsen+Baca = Rp 150,000
= Rp 2,947,500

Telp. (0285) 423623
Nama An.Ummu Najeebah Zen Kelas Perawatan : II

Visite dr. Kudori, Sp.A = Rp 495,000
Spuit = Rp 280,000
RL = Rp 200,000
Infuset Ped = Rp 45,000
Verband = Rp 6,000
= Rp 3,213,500

Telp. (0285) 423623
Nama Tn. Kantong Kelas Perawatan : III

Via Phone dr. Rosik Sp.PD = Rp 80,000
Visit dr. Rosik, Sp.PD = Rp 245,000
Spuit = Rp 183,000
RL = Rp 175,000
Infuset = Rp 40,000
Urine Bag = Rp 30,000
Volly Chateter = Rp 50,000
Prasat Chateter = Rp 100,000
EKG+Baca = Rp 150,000
Handscond = Rp 15,000
= Rp 2,826,500

Telp. (0285) 423623
Nama An. Silvia Kelas Perawatan : III

Spuit = Rp 44,000
RL = Rp 100,000
Infuset = Rp 40,000
Laborat = Rp 52,000
= Rp 1,640,000
Telp. (0285) 423623
Nama An. Maulana Ariq Kelas Perawatan : II

Spuit = Rp 8,000
RL = Rp 25,000
Infuset = Rp 40,000
= Rp 899,500

Telp. (0285) 423623
Nama An. Moh Khaeron Kelas Perawatan : I

Spuit = Rp 178,000
RL = Rp 150,000
Infuset = Rp 40,000
= Rp 2,945,000

Telp. (0285) 423623
Nama Tn.Tojib Kelas Perawatan : III

Visit dr. Caesar = Rp 45,000
Visik dr.Rosik.Sp.PD = Rp 305,000
Via Phone dr. Rosik,Sp.PD = Rp 20,000
Berote = Rp 96,000
Spuit = Rp 153,000
Nacl = Rp 250,000
Infuset = Rp 40,000
o2 1 Tabung Besar+ Selang 02 dewasa = Rp 130,000
EKG+baca = Rp 150,000
= Rp 3,747,500

Telp. (0285) 423623
Nama Tn.Darmo Kelas Perawatan : III

Visit dr. Rosik,Sp,PD = Rp 245,000
Via dr.Rosik.Sp.PD = Rp 20,000
Asam Transenamat = Rp 240,000
Berotec = Rp 96,000
Spuit = Rp 325,000
RL = Rp 200,000
Nacl = Rp 25,000
Infuset = Rp 40,000
= Rp 4,189,500

Telp. (0285) 423623
Nama Tn.Sutrisno Kelas Perawatan : I

Visit dr. Rosik,Sp,PD = Rp 275,000
Spuit = Rp 24,000
D5% = Rp 175,000
Infuset = Rp 40,000
Laborat = Rp 87,000
= Rp 2,980,000
Telp. (0285) 423623
Nama An.Dimas Aditya Kelas Perawatan : III

Visite dr.deborah = Rp 45,000
Visit dr.Riza,Sp.A = Rp 305,000
"CO" dr.Rony,Sp.THT-KL = Rp 125,000
Spuit = Rp 190,500
Asering = Rp 30,000
RL = Rp 175,000
Verband = Rp 10,000
= Rp 2,995,000

Telp. (0285) 423623
Nama Ny.Sartami Kelas Perawatan : III

Visit dr.Rosik.Sp.PD = Rp 185,000
Berotec = Rp 96,000
Spuit = Rp 139,000
RL = Rp 125,000
Nacl = Rp 25,000
Infuset = Rp 40,000
Prasat Infis = Rp 50,000
Nebulezer = Rp 360,000
O2 Tabung Besar+ Selang O2 Dewasa = Rp 130,000
Foto Ronse+ Baca = Rp 160,000
= Rp 2,788,500

Telp. (0285) 423623
Nama An.Bilqis Alza Mahendra Kelas Perawatan : II

Visit dr.Riza Kurniawan, Sp.A = Rp 145,000
Visit dr.Eva = Rp 50,000
Via Phone dr. Riza.Sp.A = Rp 20,000
Metronodazol = Rp 30,000
Spuit = Rp 199,000
Verband = Rp 6,000
= Rp 2,287,000

Telp. (0285) 423623
Nama An.Bilqis Alza Mahendra Kelas Perawatan : II

Visit dr.Riza Kurniawan, Sp.A = Rp 145,000
Visit dr.Eva = Rp 50,000
Via Phone dr. Riza.Sp.A = Rp 20,000
Metronodazol = Rp 30,000
Spuit = Rp 199,000
Verband = Rp 6,000
Asuhan Keperawatan Rp 75,000
Kapas Plester Alkohol Rp 50,000
Administrasi Rp 40,000
Pajak,dll Rp 67,000
Rp 2,287,000

Telp. (0285) 423623
Nama An.Septia Rahma Aini Kelas Perawatan : III

Visit dr.Aan, Sp.A = Rp 185,000
Visit dr. Riza Sp.A = Rp 65,000
Spuit = Rp 378,500
RL = Rp 225,000
Infuset = Rp 40,000
Verband = Rp 6,000
= Rp 3,081,500

Telp. (0285) 423623
Nama An.Talita Qotron Kelas Perawatan : III

Visit dr.Deborah = Rp 45,000
Visit dr. Riza Sp.A = Rp 65,000
Cetriaxone = Rp 135,000
Spuit = Rp 106,500
RL = Rp 125,000
Infuset = Rp 40,000
Verband = Rp 6,000
Obat Oral Rp 55,000
Asuhan Keperawatan Rp 45,000
Kapas Plester Alkohol Rp 50,000
Pajak,dll Rp 1,637,500

Telp. (0285) 423623
Nama An.Isma Hidayatul Maula Kelas Perawatan : III F

Visit dr. Kudori Sp.A = Rp 365,000
Spuit = Rp 56,000
RL = Rp 300,000
Infuset = Rp 40,000
Rp 2,563,000

Telp. (0285) 423623
Nama An. M. IQBAL AL RAYYAN Kelas Perawatan : II

Visite dr. Riza. Sp.A = Rp 285,000
Farmadol Rp 170,000
Spuite = Rp 183,500
RL = Rp 25,000
Asering Rp 150,000
Infuset = Rp 40,000
Verband Rp 6,000
Kapas, Plester, Alkohol = Rp 50,000
= Rp 2,958,500

Telp. (0285) 423623
Nama An. CLARA V MAHARANI Kelas Perawatan : II

Paracetamol Rp 65,000
Spuite = Rp 68,000
RL = Rp 75,000
Infuset = Rp 40,000
Verband Rp 6,000
= Rp 1,401,000
Telp. (0285) 423623
Nama An. AHMAD YASHID RAMADHANI Kelas Perawatan : III

Pemeriksaan IGD = Rp 30,000
Novaldo = Rp 20,000
Spuite = Rp 102,000
RL = Rp 50,000
Infuset = Rp 40,000
Verband = Rp 6,000
Laborat = Rp 60,000
= Rp 1,367,000

Telp. (0285) 423623
Nama Ny. JINAH Kelas Perawatan : III

Visite dr. Rosik. Sp. PD = Rp 185,000
Visite dr. Septian Rp 45,000
Dexamethosan Rp 120,000
Spuite = Rp 154,000
RL = Rp 250,000
Infuset = Rp 40,000
O2 Tabung Besar 1+ selang O2 dewasa Rp 130,000
= Rp 2,975,000

Telp. (0285) 423623
Nama Tn. SUROSO Kelas Perawatan : III

Visite dr. Viyan = Rp 45,000
Visite dr. Eva Rp 45,000
Visite Deborah Rp 45,000
Antrain Rp 480,000
Ranitidine Rp 360,000
Spuite = Rp 612,000
RL = Rp 400,000
Infuset = Rp 120,000
Laborat = Rp 88,000
= Rp 5,887,500

Telp. (0285) 423623
Nama Tn. Safii Kelas Perawatan : III

Spuite = Rp 67,500
D5% = Rp 225,000
Infuset = Rp 40,000
Fisioterapi Rp 40,000
EKG+baca Rp 150,000
= Rp 2,625,000

Telp. (0285) 423623
Nama An. Wiwit Diargi Kelas Perawatan : III

Visite dr. Riza, Sp.A = Rp 245,000
Cortidex Rp 40,000
Spuite = Rp 149,000
RL = Rp 175,000
Infuset = Rp 40,000
= Rp 2,552,500
nmzz

Telp. (0285) 423623
Nama Tn. Rahmat Kelas Perawatan : II

Spuite = Rp 283,000
RL = Rp 25,000
Nacl = Rp 350,000
Infuset = Rp 40,000
Urine bag = Rp 40,000
Folley Catheter = Rp 50,000
Prasat Cateter = Rp 100,000
O2 Tabung Besar 1+ selang O2 dewasa = Rp 130,000
= Rp 5,947,500

Telp. (0285) 423623
Nama Ny. Chuzaemah Kelas Perawatan : III

Visite Dr. Septian = Rp 45,000
Spuite = Rp 568,000
Nacl = Rp 200,000
D5% = Rp 175,000
Infuset = Rp 80,000
Fisiotherapi = Rp 80,000
= Rp 5,540,500

Telp. (0285) 423623
Nama Tn. Slamet Kelas Perawatan : III

Visite dr. Rosik. Sp.PD Rp 245,000
"CO" THT dr. Rony, Sp.THT-KL Rp 125,000
Visite Dr. Septian Rp 45,000
Via Phone dr. Rosik Budioro, Sp.PD Rp 20,000
Vit C Rp 135,000
Norages Rp 360,000
Spuite = Rp 434,500
RL = Rp 125,000
Nacl Rp 250,000
Infuset = Rp 80,000
Laborat Rp 212,000
USG+baca Rp 296,000
= Rp 4,444,000

Telp. (0285) 423623
Nama Nn. Zulfa Khamidah Kelas Perawatan : III

Norages Rp 200,000
Ketorolac Rp 40,000
Spuite = Rp 387,500
RL = Rp 300,000
Infuset = Rp 40,000
Laborat Rp 315,000
= Rp 4,179,500

Telp. (0285) 423623
Nama Tn. Amsorudin Kelas Perawatan : III

Visite dr. Conita = Rp 45,000
Spuite = Rp 32,000
RL = Rp 125,000
Infuset = Rp 40,000
Foto Ronsen + Baca Rp 160,000
= Rp 1,493,500

Telp. (0285) 423623
Nama An. M. Sidqi Nafi Pratama Kelas Perawatan : III

Via Phone dr. Riza. Sp. A Rp 20,000
"CO" THT dr. Rony, Sp.THT-KL Rp 125,000
Visite dr. Riza. Sp.A Rp 165,000
Ceftriaxaone = Rp 90,000
Cortidex Rp 30,000
Sibital Rp 63,000
Spuite = Rp 159,000
RL = Rp 150,000
Infuset = Rp 40,000
Verband Rp 6,000
Laborat Rp 107,000
= Rp 2,376,500

Telp. (0285) 423623
Nama An. Dinda Ratna Sari Kelas Perawatan : III

Via Phone dr.Aan, Sp.A = Rp 45,000
Visite dr. Aan, Sp.A Rp 185,000
Norages Rp 60,000
Dexamethasone Rp 20,000
Vellutin Rp 30,000
Pulmicort Rp 50,000
Spuite = Rp 215,000
RL = Rp 175,000
Infuset = Rp 40,000
Verband Rp 6,000
Nebulizer Rp 160,000
Laborat Rp 87,000
Foto Ronsen + Baca Rp 150,000
Obat Oral Rp 52,000
= Rp 2,364,000

Telp. (0285) 423623
Nama Ny. Rastuki Kelas Perawatan : III

Via phone dr. Rosik. Sp. PD = Rp 20,000
Visite dr. Rosik, Sp.PD = Rp 185,000
Spuite = Rp 44,000
RL = Rp 175,000
Infuset = Rp 40,000
Laborat = Rp 60,000
Medikasi = Rp 150,000
= Rp 2,447,500
Telp. (0285) 423623
Nama An. Elyzabeth Alysyahbana Kelas Perawatan : III

Visite dr. Riza Sp.A = Rp 185,000
Cortidex Rp 20,000
Ceftrixone Rp 90,000
Spuite = Rp 127,500
RL = Rp 100,000
Verband Rp 6,000
= Rp 1,858,000

Telp. (0285) 423623
Nama An. M.Rizal Darul Q Kelas Perawatan : III

Visite dr. Kudori. Sp.A = Rp 245,000
Ceftrixone = Rp 100,000
Novaldo Rp 120,000
Spuite = Rp 181,000
RL = Rp 25,000
D5% Rp 100,000
Infuset = Rp 40,000
Verband Rp 6,000
Laborat = Rp 55,000
Foto Ronsen+baca Rp 150,000
= Rp 2,175,500

Telp. (0285) 423623
Nama An. M.AFNAN ALFIANSYAH Kelas Perawatan : II

Via Phone dr. A'an Sp.A = Rp 20,000
Visite dr. Deborah Rp 50,000
Visite dr. Riza Sp.A Rp 145,000
Novaldo Rp 60,000
Ceftriaxone Rp 90,000
Spuite = Rp 185,000
RL = Rp 150,000
Infuset = Rp 40,000
Verband Rp 6,000
Laborat = Rp 60,000
= Rp 2,059,000

Telp. (0285) 423623
Nama An. M.Fikri Syafran Kelas Perawatan : III

Via Phone dr. A'an Sp.A = Rp 20,000
"co" THT. Dr. Rony, Sp.THT-KL Rp 250,000
Antrain Rp 60,000
Ceftriaxone Rp 135,000
Spuite = Rp 341,000
RL = Rp 100,000
D5% Rp 150,000
Infuset = Rp 40,000
Verband Rp 6,000
= Rp 3,179,000

Telp. (0285) 423623
Nama An. Griselda Lituhayu Kelas Perawatan : I

Antrain Rp 100,000
Spuite = Rp 184,000
RL = Rp 175,000
Infuset = Rp 40,000
Verband = Rp 6,000
Foto Ronsen+ Baca = Rp 160,000
= Rp 4,142,000

Telp. (0285) 423623
Nama An. Vela Sari Kelas Perawatan : II

Spuite = Rp 24,000
RL = Rp 25,000
D5% = Rp 100,000
Infuset = Rp 40,000
Verband = Rp 6,000
= Rp 1,960,500

Telp. (0285) 423623
Nama An. M. Abrisam Al Fatih Kelas Perawatan : II

Novaldo = Rp 20,000
Sibital = Rp 21,000
Spuite = Rp 48,000
D5 1/4 NS = Rp 30,000
Verband = Rp 6,000
= Rp 1,287,500

Telp. (0285) 423623
Nama An. Devita Sari Kelas Perawatan : II

Spuite = Rp 60,000
RL = Rp 25,000
D5% = Rp 75,000
Infuset = Rp 40,000
Verband = Rp 10,000
= Rp 1,869,500

Telp. (0285) 423623
Nama Khansa Putri Ainul Y Kelas Perawatan : II

Visite dr. Debora = Rp 65,000
Visite dr. A'an. Sp.A = Rp 95,000
Via Phone dr. Riza. Sp.A = Rp 40,000
Norages = Rp 100,000
Spuite = Rp 108,000
RL = Rp 175,000
Infuset = Rp 40,000
Verband = Rp 6,000
Laborat Rp 165,000
Obat Oral Rp 80,000
= Rp 3,487,000

Telp. (0285) 423623
Nama M. Fino Kafabihi Kelas Perawatan : II

Sibital Rp 21,000
Spuite = Rp 136,500
Asering = Rp 30,000
D5% Rp 125,000
Infuset = Rp 40,000
Verband = Rp 6,000
O2 tabung besar 1+ Selang 02 Rp 100,000
Laborat Rp 62,000
Obat Oral Rp 8,000
= Rp 3,217,500

Telp. (0285) 423623
Nama An. Dzakira Aftani Kelas Perawatan : II

"CO" THT dr. Rony Sp.THT-KL = Rp 125,000
Sibital = Rp 63,000
Terfacef = Rp 825,000
Novaldo = Rp 20,000
Spuite = Rp 277,500
Verband = Rp 6,000
O2 tabung besar 1+ Selang 02 = Rp 130,000
= Rp 5,030,500

Telp. (0285) 423623
Nama An. Ani Fatmawati Kelas Perawatan : III

Visite dr.Rosik. Sp.PD = Rp 185,000
Spuite = Rp 320,500
RL = Rp 225,000
Infuset = Rp 40,000
= Rp 3,049,500

Telp. (0285) 423623
Nama An. Nesha Arwenda w Kelas Perawatan : II

Visite dr.Riza. Sp.A = Rp 285,000
Via Phone dr. Riza Sp.A = Rp 20,000
"CO" drg. Ahmad Musfikar = Rp 75,000
Antrain = Rp 20,000
Spuite = Rp 212,500
D5 1/4 NS = Rp 210,000
Infuset = Rp 40,000
= Rp 2,877,500

Telp. (0285) 423623
Nama Ny. Novita Sari Kelas Perawatan : II

Visite dr.Rosik. Sp.PD = Rp 145,000
"CO" THT dr Rony Sp.THT = Rp 125,000
Spuit = Rp 265,000
RL 3 = Rp 100,000
Abocate No 22 = Rp 40,000
Kapas , Plester, Alkohol = Rp 50,000
= Rp 2,904,000

Telp. (0285) 423623
Nama An Hilal Al Ashil Kelas Perawatan : I

Novaldo = Rp 30,000
Sibital = Rp 21,000
Spuit = Rp 205,500
D5 % = Rp 125,000
Verband = Rp 6,000
Laborat = Rp 62,000
= Rp 4,157,000

Telp. (0285) 423623
Nama An. Hanif Prahardian Kelas Perawatan : I
Opname tanggal 05-03-2016 s/d 05-03-2016 (I) = Rp 300,000

06-03-2016 s/d 08-03-2016 (Ut) = Rp 1,050,000
Visite dr.Kudori Sp.A = Rp 355,000
Vit.C = Rp 60,000
Sibital = Rp 21,000
Spuit = Rp 234,000
RL = Rp 175,000
Verband = Rp 6,000
= Rp 3,300,500

Telp. (0285) 423623
Nama Ny. Nuryati Kelas Perawatan : I

Opname tanggal 26-03-2016 s/d 26-03-2016 (I) = Rp 1,400,000
Spuit = Rp 211,500
RL = Rp 225,000
= Rp 4,159,000

Telp. (0285) 423623
Nama Ny. Khusnul Khotimah Kelas : III

"Co" drg. Ahmad Musfikar
Via Phone dr. Riza Sp.A
"CO" THT, dr. Rony. Sp. THT-KL
Anbacim = Rp 240,000
Sanmol = Rp 100,000
Spuit = Rp 250,000
RL = Rp 175,000
Asering
Infuset = Rp 40,000
Verband = Rp 6,000
O2 Tabung Besar 1+ Selang O2 = Rp 150,000
Laborat
= Rp 2,796,500

Telp. (0285) 423623
Nama An. Aninda Nur Aisha Kelas : II

"CO" drg. Ahmad Musfikar Rp 75,000
Via Phone dr. Riza Sp.A Rp 40,000
"CO" THT dr. Roni. Sp.THT-KL Rp 125,000
Sanmol = Rp 166,000
Spuit = Rp 208,500
RL Rp 25,000
Infuset = Rp 40,000
Verband = Rp 6,000
O2 tabung Besar 1 + Selang O2 Rp 130,000
= Rp 3,414,000

Telp. (0285) 423623
Nama An. Sodikur Rifqi Kelas Perawatan : III

Visite dr.Riza. Sp.A = Rp 185,000
"CO" drg. Ahmad Musfikar = Rp 75,000
Sanmol = Rp 415,000
Novaldo = Rp 20,000
Spuite = Rp 247,000
Infuset = Rp 40,000
Verband Rp 6,000
= Rp 3,434,500
Telp. (0285) 423623
Nama Ny. Rekhaniyah Kelas Perawatan : III

Visite dr.Rosik. Sp. PD = Rp 185,000
Spuite = Rp 279,000
RL = Rp 150,000
Nacl = Rp 75,000
Infuset = Rp 80,000
= Rp 3,128,500

Telp. (0285) 423623
Nama An. Bisma Fabian Arga Kelas Perawatan : II

Visite dr. Kudori = Rp 285,000
Novaldo = Rp 80,000
Spuite = Rp 146,000
D5% = Rp 125,000
Infuset = Rp 40,000
Verband Rp 6,000
= Rp 2,124,000

Telp. (0285) 423623
Nama An. Bisma Fabian Arga Kelas Perawatan : II

Novaldo = Rp 80,000
Spuite = Rp 146,000
D5% = Rp 125,000
Infuset = Rp 40,000
Verband Rp 6,000
= Rp 2,124,000
Telp. (0285) 423623
Nama An. Nirmala Angelica Kelas Perawatan : I

Spuite = Rp 210,000
RL = Rp 25,000.00
D5% = Rp 200,000
Infuset = Rp 40,000
= Rp 4,040,000

Telp. (0285) 423623
Nama An. Elizza Hilmi Kelas Perawatan : I

Via Phone dr. A'an, Sp.A
"CO" drg. Ahmad Musfikar
Ce = Rp 450,000
Spuite = Rp 210,000
RL = Rp 25,000.00
D5% = Rp 200,000
Infuset = Rp 40,000
= Rp 4,040,000

Telp. (0285) 423623
Nama An. M.DEVY RIZKIANA Kelas Perawatan : III

Via Phone dr. Riza Kurniawan Sp.A.M.Kes = Rp 245,000
"Co" dr. Rony Sp. THT- KL = Rp 125,000
Spuite = Rp 264,500
Infuset = Rp 40,000
Verband = Rp 6,000
Jumlah = Rp 3,162,000

Telp. (0285) 423623
Nama An. M.IRFAN Kelas Perawatan : III

Via Phone dr. Riza Kurniawan Sp.A.M.Kes = Rp 245,000
"Co" dr. Rony Sp. THT- KL = Rp 250,000
Tindakan = Rp 100,000
Asam tranekamat = Rp 60,000
Spuit = Rp 136,000
Abocate No. 24 = Rp 80,000
Verband = Rp 6,000
Kapas,Plaster,Alkohol = Rp 50,000
Jumlah = Rp 2,747,500
Telp. (0285) 423623
Nama Sdr.AHMAD HUDA Kelas Perawatan : III

Visite dr. Kudori Sp.A = Rp 245,000
Aquabidestilata Rp 30,000
Cefotaxim Rp 80,000
Antrain Rp 120,000
Ranitidin Rp 60,000
Spuit Rp 153,000
Infus RL Rp 25,000
Infus D5,%-3 Rp 75,000
Obat Oral Rp 15,000
Jumlah = Rp 2,001,500

Telp. (0285) 423623
Nama Tn. PRAPTO Kelas Perawatan : III

Visite dr. Rosik Sp.PD = Rp 365,000
Visite dr. Dany = Rp 45,000
Spuit = Rp 669,500
Infus RL = Rp 450,000
O2 3 Tabung Besar+1 Selang O2 Dewasa = Rp 360,000
Kapas, Plaster, Alkohol = Rp 75,000
Jumlah = Rp 6,132,500

Telp. (0285) 423623
Nama Nn. SISKA IRMAYANI Kelas Perawatan : IIIA

Antrain = Rp 40,000
Spuit = Rp 76,500
Infu set = Rp 40,000
Jumlah = Rp 1,669,500

Telp. (0285) 423623
Nama Tn. SUSFREDI DARMAWAN Kelas Perawatan : IIE

Norges/Novaldo = Rp 180,000
Spuit = Rp 189,000
Kapas,plaster,Alkohol = Rp 50,000
Jumlah = Rp 2,518,500

Telp. (0285) 423623
Nama Sdr. M. NABA ROMADHONI Kelas Perawatan : IIB

Ondancetron = Rp 180,000
Spuit = Rp 401,500
Jumlah = Rp 3,097,000

Telp. (0285) 423623
Nama Tn. MAKMUR Kelas Perawatan : III

Ondancetron = Rp 225,000
Omeprazol = Rp 230,000
Spuit = Rp 161,600
Jumlah = Rp 3,916,500

Telp. (0285) 423623
Nama Tn. COMO Kelas Perawatan : IIIB

Antrain = Rp 20,000
Berotec = Rp 96,000
Spuit = Rp 107,000
RL 22 = Rp 125,000
Na CL = Rp 25,000
O2 2 Tabung besar + selang 02 = Rp 245,000
Fisiotherapi = Rp 40,000
Jumlah Rp 2,529,000

Telp. (0285) 423623
Nama Tn. SOADI Kelas Perawatan : IIIB

Berotec = Rp 96,000
Spuit = Rp 386,000
Na Cl = Rp 325,000
O2 2 tabung besar+selang O2 = Rp 245,000
Photo Ro+baca = Rp 160,000
Fisiotherapy = Rp 40,000
Jumlah = Rp 4,835,000

Telp. (0285) 423623
Nama Tn. SOCOITO Kelas Perawatan : IIIB

Visite dr. Conita = Rp 45,000
Berotec = Rp 96,000
Spuit = Rp 228,000
Na Cl = Rp 25,000
O2 2 tabung besar+selang O2 = Rp 245,000
Photo Ro+baca = Rp 160,000
Jumlah = Rp 4,222,000

Telp. (0285) 423623
Nama Tn. YUDI ALVI SAHRIN Kelas Perawatan : II

Spuit = Rp 338,000
Abocate No22 = Rp 40,000
Jumlah = Rp 4,460,000

Telp. (0285) 423623
Nama Ny. SUPARTI Kelas Perawatan : IIIB

Antrain Rp 120,000
Spuit Rp 152,000
Na Cl Rp 150,000
Infus Set Rp 40,000
Abocate No22 Rp 40,000
Fisiotrapi = Rp 80,000
Obat Oral Rp 162,000
= Rp 3,288,000

Telp. (0285) 423623
Nama An. YUSUF ARFANDA Kelas Perawatan : II

Via phone dr. Aan Sp.A Rp 40,000
"Co"THT dr. Rony Sp. THT Rp 125,000
Cefriaxon Rp 450,000
Cetridex Rp 80,000
Novaldo Rp 40,000
Ondancetron Rp 15,000
Spuit = Rp 236,000
Abocate No. 24 Rp 40,000
Foto Ro+baca = Rp 160,000
Kapas, Plaster, Alkohol Rp 50,000
Pajak,dll Rp 119,000
Jumlah Rp 4,080,000
Telp. (0285) 423623
Nama An. Arva Bayu Saputra Kelas Perawatan : II

Taxegram = Rp 185,000
Novaldo = Rp 40,000
Sanmol = Rp 83,000
Metronidazol = Rp 120,000
Spuit = Rp 167,500
Asering = Rp 90,000
Abocate No.24 = Rp 80,000
Verband = Rp 6,000
= Rp 2,027,000

Telp. (0285) 423623
Nama Ny. Nita Hardyaningrum Kelas Perawatan : II

Visite dr. Rosik. Sp.PD = Rp 21,500
Spuit = Rp 135,500
RL = Rp 200,000
= Rp 2,524,500

Telp. (0285) 423623
Nama Ny. Winarti Kelas Perawatan : III

Via Phone dr. Rosik Sp. PD = Rp 20,000
Spuit = Rp 308,000
RL = Rp 225,000
= Rp 3,695,000

Telp. (0285) 423623
Nama An. AZZAHRA EKA PRAMUDYA Kelas Perawatan : II

Visite dr. Riza Sp. A = Rp 245,000
Novaldo = Rp 20,000
Spuit = Rp 181,500
Ds 1/4 NS = Rp 120,000
Verband = Rp 6,000
Foto Ro+ baca = Rp 160,000
Jumlah Rp 3,157,500

Telp. (0285) 423623
Nama An. ARFIF MAHES PRATAMA Kelas Perawatan : II

Via Phone dr, Kudori Sp.A = Rp 20,000
Sibitel = Rp 21,000
Spuit = Rp 196,500
DS% = Rp 150,000
Verband = Rp 6,000
Foto Ro+ baca = Rp 150,000
Jumlah = Rp 2,578,000

Telp. (0285) 423623
Nama An.Muhammad Iqbal al Rayyan Kelas Perawatan : II

Visite dr, Riza Sp.A = Rp 285,000
Spuit = Rp 129,500
RL = Rp 25,000
Verband = Rp 6,000
= Rp 2,904,500

Telp. (0285) 423623
Nama An. Dinda Ratnasari Kelas Perawatan : IIIC

Via Phone dr. Aan Sp.A = Rp 45,000
Visite dr. Aan Sp.A = Rp 185,000
Norages = Rp 60,000
Spuit = Rp 215,000
RL = Rp 175,000
Verban = Rp 6,000
Laborat = Rp 87,000
Foto RO + Baca = Rp 150,000
Jumlah Rp 2,364,000

Telp. (0285) 423623
Nama An. UTI DEWI Kelas Perawatan : III A

Visite dr Rosik, Sp. PD = Rp 245,000
Spuit = Rp 245,000
RL = Rp 175,000
Jumlah = Rp 3,025,500

Telp. (0285) 423623
Nama An. AlifahAzzahra Kelas Perawatan : I

Visite Riza Kurniawan Sp.A = Rp 165,000
"co" THT dr. Rony Sp. THT-KL = Rp 125,000
Sanmol = Rp 83,000
Spuit = Rp 40,000
Asering = Rp 90,000
Verband = Rp 6,000
Jumlah = Rp 1,914,000

Telp. (0285) 423623
Nama Tn. Amin Kelas Perawatan : IIIB

Visite Rosik Sp.PD = Rp 245,000
Birotex = Rp 96,000
Spuit = Rp 197,000
Na Cl = Rp 250,000
O2 1 Tabung Besar + 1 selang O2 = Rp 130,000
Foto RO" + Baca = Rp 160,000
Jumlah = Rp 3,059,500

Telp. (0285) 423623
Nama An. Siti Maesaroh Kelas Perawatan : Iii C

Visite dr. Devy = Rp 45,000
Visite dr, Kudori Sp.A = Rp 125,000
Novaldo = Rp 60,000
Spuit = Rp 104,000
DS% = Rp 50,000
Jumlah = Rp 1,285,500

Telp. (0285) 423623
Nama An. Thalita Ardine Nov Kelas Perawatan : I

Via Phone dr. Riza, Sp.A Rp 20,000
Taxigram = Rp 925,000
Cortidex Rp 40,000
Novaldo Rp 20,000
Farmadol Rp 255,000
Spuite = Rp 314,500
RL = Rp 150,000.00
Infuset = Rp 40,000
Verband Rp 6,000
= Rp 4,594,500

Telp. (0285) 423623
Nama An. Zulfa Azalia Kelas Perawatan : III

Spuite = Rp 112,000
RL = Rp 225,000.00
Infuset = Rp 40,000
Verband = Rp 6,000
= Rp 2,518,500

Telp. (0285) 423623
Nama An. M. Adrikul Hikam Kelas Perawatan : I

Via Phone dr. Aan. Sp.A = Rp 20,000
Novaldo = Rp 40,000
Dceftriaxone = Rp 90,000
Spuite = Rp 294,500
RL = Rp 150,000.00
Infuset = Rp 80,000
Verband = Rp 10,000
O2 Tabung besar 2+1 selang O2 = Rp 245,000
foto Ronsen+ Baca = Rp 160,000
= Rp 3,548,000

Telp. (0285) 423623
Nama An. M. Ibrahim Arrasyid Kelas Perawatan : II

Novaldo = Rp 60,000
Spuite = Rp 126,500
Asering = Rp 180,000.00
Verband = Rp 6,000
= Rp 2,955,000

Telp. (0285) 423623
Nama Tn. Casmadi Kelas Perawatan : III

Dobutamin = Rp 275,000
Spuit = Rp 82,500
D5% = Rp 75,000.00
Nacl Rp 100,000.00
Infuset = Rp 40,000
EKG+Baca Rp 150,000
= Rp 2,085,500

Telp. (0285) 423623
Nama An. Muhammad Abrisan Al Fatih Kelas Perawatan : II

Dobutamin = Rp 275,000
Spuit = Rp 82,500
D5% = Rp 75,000.00
Nacl Rp 100,000.00
Infuset = Rp 40,000
EKG+Baca Rp 150,000
= Rp 2,085,500

Telp. (0285) 423623
Nama Tn. Maghfurin Kelas Perawatan : II

Via Phone dr. Rosik. Sp.PD = Rp 60,000
Asaam Transenamat = Rp 240,000
Calci Gluconas = Rp 20,000
Spuit = Rp 175,000
Nacl = Rp 250,000.00
Infuset = Rp 40,000
Transfusi PRC = Rp 1,440,000
Prasat Transfusi = Rp 200,000
= Rp 5,114,000

Telp. (0285) 423623
Nama Ny. Tuminah Sari Kelas Perawatan : III

Spuit = Rp 278,000
Nacl = Rp 400,000
Infuset = Rp 80,000
= Rp 3,724,500

Telp. (0285) 423623
Nama An. Akira Arya Prima Kelas Perawatan : II

Visite dr. Aan. Sp.A = Rp 275,000
Spuit = Rp 208,500
D5% = Rp 125,000
Infuset = Rp 40,000
Verband = Rp 6,000
Laborat = Rp 60,000
= Rp 2,926,000

Telp. (0285) 423623
Nama Ny. Tariin Kelas Perawatan : III

Spuit = Rp 229,500
Nacl = Rp 225,000
Infuset = Rp 80,000
= Rp 3,243,000

Telp. (0285) 423623
Nama Ny. Afifah Kelas Perawatan : III

Via Phone dr. Rosik Budioro, Sp. PD = Rp 20,000
Dexamtehasone = Rp 150,000
Asem Transenamat = Rp 300,000
Spuit = Rp 1,690,000
D5% = Rp 250,000
Infuset = Rp 40,000
= Rp 3,340,500

Telp. (0285) 423623
Nama Tn. Sutarno Kelas Perawatan : III

Spuit = Rp 334,000
RL = Rp 325,000
Infuset = Rp 40,000
= Rp 4,114,000

Telp. (0285) 423623
Nama Ny. Nurul Hidayah Kelas Perawatan : III

Spuit = Rp 213,000
D5% = Rp 150,000
Nacl = Rp 250,000
Infuset = Rp 40,000
O2 tabung Besar 2 + selang O2 = Rp 245,000
Tranfusi Darah = Rp 720,000
Tranfusi Set = Rp 100,000
Foto Ronsen = Rp 160,000
USG+ baca = Rp 200,000
= Rp 5,643,500

Telp. (0285) 423623
Nama An. M. Rizal Darul Q Kelas Perawatan : III

Spuit = Rp 181,000
RL = Rp 25,000
D5% = Rp 100,000
Infuset = Rp 40,000
Verband = Rp 6,000
Laborat = Rp 55,000
= Rp 2,175,500

Telp. (0285) 423623
Nama An. Velia Sari Kelas Perawatan : II

Spuit = Rp 24,000
RL = Rp 25,000
D5% = Rp 100,000
Infuset = Rp 40,000
Verband = Rp 6,000
= Rp 1,960,500

Telp. (0285) 423623
Nama An.Chintya Ayu Ramadhani Kelas Perawatan : III

"CO" THT dr. Rony THT-KL = Rp 125,000
Novaldo Rp 160,000
Mikajek Rp 390,000
Imipenem Rp 286,000
Spuit = Rp 559,500
D5% = Rp 300,000
Verband = Rp 6,000
= Rp 4,471,000

Telp. (0285) 423623
Nama An. Devita Santi Kelas Perawatan : II

Spuit = Rp 60,000
RL = Rp 25,000
D5% Rp 75,000
Infuset = Rp 40,000
Verband Rp 10,000
= Rp 1,869,500

Telp. (0285) 423623
Nama Ny. Rayem Kelas Perawatan : III

Berotec = Rp 96,000
Spuit = Rp 213,500
Nacl = Rp 225,000
Infuset = Rp 40,000
02 Tabung Besar + Selang 02 = Rp 130,000
= Rp 3,323,000

Telp. (0285) 423623
Nama An. Ahmad Dian Bahari Kelas Perawatan : I

Visite dr. Ilham Rp 60,000
Via Phone dr. Kudori. Sp.A Rp 20,000
Spuit = Rp 244,500
RL = Rp 25,000
D5% = Rp 225,000
Asering = Rp 30,000
Infuset = Rp 80,000
= Rp 4,142,500

Telp. (0285) 423623
Nama Nn. Ana Latifah Kelas Perawatan : III

Visite dr. Najmi Rp 45,000
Dexamethasone Rp 120,000
Spuit = Rp 288,000
RL = Rp 250,000
Infuset = Rp 40,000
= Rp 3,064,500

Telp. (0285) 423623
Nama Tn. ROCHAN Kelas Perawatan : IIIB

Visite dr. Rosik Sp. PD = Rp 365,000
Via Photo dr. Rosik Sp. PD = Rp 20,000
Piracefam = Rp 420,000
Spuit = Rp 489,000
Nacl = Rp 325,000
Infuset = Rp 40,000
O2 2 Tab + 1 Selang 02 = Rp 245,000
Jasa Monitor = Rp 350,000
Kpas Plester Alkohol = Rp 75,000
Rp 5,374,000

Telp. (0285) 423623
Nama Nn. Rinastri Dwi Nur F Kelas Perawatan : Ut H

Visite dr. Rosik Sp, PD = Rp 365,000
Spuit = Rp 407,500
Nacl = Rp 325,000
Rp 4,649,000

Telp. (0285) 423623
Nama Tn. Susfredi Darmawan Kelas Perawatan : IIE

Norages/Novaldo = Rp 180,000
Spuit = Rp 189,000
RL = Rp 125,000
Rp 2,518,500

Telp. (0285) 423623
Nama M. Naba Romadhoni Kelas Perawatan : IIIB

Spuit = Rp 401,500
RL = Rp 200,000
Rp 3,097,000

Telp. (0285) 423623
Nama Tn. SOADI Kelas Perawatan : IIIB

Berotec = Rp 96,000
Spuit = Rp 386,000
Nacl = Rp 325,000
O2 2 Tabung + Selang O2 = Rp 245,000
Photo RO + Baca = Rp 160,000
Rp 4,835,000

Telp. (0285) 423623
Nama Sdr. Abelza Kelas Perawatan : Ut

Novaldo Rp 300,000
Spuit = Rp 537,000
RL = Rp 325,000
Rp 6,135,000

Telp. (0285) 423623
Nama Nn. Ani Fatmawati Kelas Perawatan : IIIA

Antrain Rp 260,000
Spuit = Rp 320,500
RL = Rp 225,000
Rp 3,049,500

Telp. (0285) 423623
Nama Tn. Samsudin Kelas Perawatan : IIIB

Berotec = Rp 96,000
Spuit = Rp 160,500
Nacl = Rp 250,000
O2 2 Tabung Besar + 1 Selang O2 = Rp 245,000
Rp 2,947,500
Telp. (0285) 423623
Nama Tn. Samsudin Kelas Perawatan : IIIB

Berotec = Rp 96,000
Spuit = Rp 160,500
Nacl = Rp 250,000
O2 2 Tabung Besar + 1 Selang O2 = Rp 245,000
Rp 2,947,500

Telp. (0285) 423623
Nama Tn. SUKIRNO Kelas Perawatan : IIIB

Spuit = Rp 149,000
RL = Rp 268,000
Rp 2,324,000

Telp. (0285) 423623
Nama Tn. ISMADI Kelas Perawatan : III

Visite dr. NAJMI = Rp 85,000
Berotec = Rp 96,000
Spuit = Rp 103,500
Nacl = Rp 200,000
O2 Tabung besar 1+ Selang OQ = Rp 130,000
Rp 2,642,500
Telp. (0285) 423623
Nama Ny. Wartini Kelas Perawatan : III

Visite dr. NAJMI = Rp 45,000
Spuit = Rp 342,500
Nacl = Rp 300,000
= Rp 3,390,500

Telp. (0285) 423623
Nama Ny. Retnowati Kelas Perawatan : II

Ceftiaxone = Rp 630,000
Spuit = Rp 509,000
RL = Rp 375,000
EKG+ baca = Rp 150,000
= Rp 5,598,500

Telp. (0285) 423623
Nama Tn. Rafii Kelas Perawatan : III

Spuit = Rp 576,000
RL = Rp 325,000
O2 Tabung Besar 1 + Selang 02 = Rp 130,000
= Rp 5,180,000

Telp. (0285) 423623
Nama Ny. Wartutik Kelas Perawatan : III

Aquabidestilata =
Spuit = Rp 85,000
RL = Rp 275,000
O2 Tabung Besar 1 + Selang 02 = Rp 130,000
= Rp 2,401,000

Telp. (0285) 423623
Nama Ny. Misriyah Kelas Perawatan : III

Visite dr. Deborah Rp 45,000
Spuit = Rp 368,000
Nacl = Rp 325,000
Laborat = 114000
= Rp 4,640,500

Telp. (0285) 423623
Nama An. Silma Wafirriya Kelas Perawatan : II

"Co" drg. Ahmad Musfikar = Rp 75,000
Spuit = Rp 202,000
Nacl = Rp 180,000
Verband = Rp 6,000
= Rp 3,027,500

Telp. (0285) 423623
Nama An. Adzkiya Naifa Setiani Kelas Perawatan : III

Sanmol = Rp 249,000
Sibital = Rp 42,000
Pantoprazol = Rp 230,000
Novaldo = Rp 20,000
Spuit = Rp 214,500
Nacl = Rp 25,000
Verband = Rp 6,000
= Rp 4,313,500

Telp. (0285) 423623
Nama Tn. Edhy Budhyartho Kelas Perawatan : I

Visite Rosik. Sp.PD = Rp 405,000
Via Phone dr. Rosik. Sp.PD = Rp 20,000
Vit K = Rp 90,000
Asam Transemanat = Rp 240,000
Spuit = Rp 271,000
Nacl = Rp 100,000
Darah = Rp 720,000
Ambulance ke semarang = Rp 1,200,000
= Rp 7,138,000

Telp. (0285) 423623
Nama An. Azzam Dzulfiqar Kelas Perawatan : II

Visite dr. Dian = Rp 75,000
Via Phone dr. Riza = Rp 20,000
Vit K = Rp 90,000
Asam Transemanat = Rp 240,000
Spuit = Rp 271,000
Nacl = Rp 100,000
Darah = Rp 720,000
= Rp 7,138,000

Telp. (0285) 423623
Nama Tn. Edi Pujiono Kelas Perawatan : II

Visite dr. Rosik Sp. PD = Rp 365,000
Spuit = Rp 143,000
RL = Rp 225,000
= Rp 3,466,000

Telp. (0285) 423623
Nama An. Abu Bakr Badjrie Kelas Perawatan : I
Opname tanggal 18-03-2016 s/d 18-03-2016 (I) = Rp 300,000

19-03-2016 s/d 21-03-2016 (Ut) Rp 1,050,000
Visite dr. Kudori Sp. A = Rp 95,000
Sanmol = Rp 166,000
Novaldo = Rp 20,000
Spuit = Rp 252,000
Verband = Rp 10,000
= Rp 4,273,500

Telp. (0285) 423623
Nama An. Aviera Najwa Faradisa Kelas Perawatan : IIIC

Sibital Rp 21,000
Spuit = Rp 181,000
D5% = Rp 175,000
Verband Rp 6,000
Laborat = Rp 55,000
Foto Ronsen+baca Rp 150,000
= Rp 2,349,500

Telp. (0285) 423623
Nama An. ABBAD NAILUN NABHAN Kelas Perawatan : IIIC

Vellutin Rp 15,000
Spuit Rp 230,000
Nabulizer Rp 40,000
RL Rp 25,000
D5% = Rp 125,000
Nacl Rp 25,000
Verband Rp 6,000
= Rp 2,214,500

Telp. (0285) 423623
Nama An. Azzam Dzulfikar K Kelas Perawatan : III

Visite dr. Dian = Rp 75,000
Antrain = Rp 40,000
Spuit = Rp 343,500
Verband = Rp 6,000
= Rp 4,793,500

Telp. (0285) 423623
Nama An. Etandra F Kelas Perawatan : II

Ondanctron = Rp 15,000
Spuit = Rp 156,000
RL = Rp 25,000
D5% = Rp 125,000
= Rp 2,890,500
Telp. (0285) 423623
Nama An. Hana Syaifa Azzaahra Kelas Perawatan : III

Sanmol = Rp 332,000
Spuit = Rp 151,500
= Rp 4,192,000

Telp. (0285) 423623
Nama An. M. Haydar Dzulkarnaen Kelas Perawatan : II

Visite dr. Kudori. Sp. A = Rp 485,000
Visite dr.Ilham = Rp 55,000
Spuit = Rp 192,000
RL = Rp 50,000
D5% Rp 75,000
Verband Rp 10,000
Pengaawasan Rp 100,000
= Rp 3,650,500

Telp. (0285) 423623
Nama An. Lailatul Ula Kelas Perawatan : III

Via Phone dr. Kudori. Sp. A = Rp 60,000
Spuit = Rp 248,500
RL = Rp 125,000
D5% = Rp 25,000
Verband = Rp 10,000
= Rp 3,471,000

Telp. (0285) 423623
Nama An. Akmal Sabiq Kelas Perawatan : II

Sibital = Rp 21,000
Meropenen = Rp 600,000
Spuit = Rp 268,500
D5 1/4 NS = Rp 210,000
Verband = Rp 10,000
Foto Ro+ Baca = Rp 160,000
= Rp 4,707,500

Telp. (0285) 423623
Nama An. Dimas Aditya Fiemansyah Kelas Perawatan : II

Antrain = Rp 40,000
Spuit = Rp 87,000
RL = Rp 75,000
Nacl = Rp 125,000
Verband = Rp 6,000
= Rp 3,320,000

Telp. (0285) 423623
Nama An. Kayla Ayunindiya Kelas Perawatan : I

Visite dr. Tri Kusuma Wardani. Sp.A = Rp 165,000
Novaldo = Rp 40,000
Spuit = Rp 119,500
RL = Rp 75,000
Verband = Rp 10,000
= Rp 2,090,500

Telp. (0285) 423623
Nama Tn. Slamet Syahroni Kelas Perawatan : III

Antarin = Rp 260,000
Paracetamom = Rp 390,000
Spuit = Rp 269,500
Nacl = Rp 300,000
= Rp 3,660,500
Telp. (0285) 423623
Nama Tn. Suhartono Kelas Perawatan : III

Calnex = Rp 210,000
Spuit = Rp 511,000
RL = Rp 17,500
D5% = Rp 168,000
= Rp 5,498,000

Telp. (0285) 423623
Nama An. M. Zidan Al Faruq Kelas Perawatan : II

Antrain = Rp 80,000
Sibital = Rp 21,000
Spuit = Rp 140,000
D5% = Rp 100,000
Verband Rp 10,000
Foto" Ro"+ Baca Rp 150,000
= Rp 2,118,000

Telp. (0285) 423623
Nama An. Alfito Karel M Kelas Perawatan : III

"CO"THT dr. Rony, Sp. THT-KL = Rp 125,000
Meropenem = Rp 800,000
Extrase = Rp 45,000
Spuit = Rp 503,500
RL = Rp 250,000
Verband = Rp 6,000
= Rp 5,990,000

Telp. (0285) 423623
Nama An. Kistian Milo Pratama Kelas Perawatan : III

Visitev dr. Aan. Sp.A = Rp 75,000
Spuit = Rp 167,500
RL = Rp 125,000
D5% = Rp 50,000
Verband = Rp 10,000
Foto "RO" + baca Rp 160,000
= Rp 3,354,500
Telp. (0285) 423623
Nama An. Abid Aqila Saputra Kelas Perawatan : II

Spuit = Rp 215,000
RL = Rp 200,000
Verband = Rp 10,000
= Rp 3,496,000

Telp. (0285) 423623
Nama An. Fadlila Rasyid Kelas Perawatan : I

Pemeriksaan Poliklinik
Aquabidestilata
Spuit = Rp 12,000
Asering = Rp 30,000
Verband = Rp 6,000
= Rp 1,397,500

Telp. (0285) 423623
Nama An. Fatimah Azzahra Kelas Perawatan : III

Pemeriksaan Poliklinik Rp 30,000
Visite dr. Riza. Sp.A Rp 185,000
Via Phone dr.Riza. Sp.A Rp 20,000
Ambacim = Rp 200,000
Sanmol = Rp 83,000
Novaldo Rp 20,000
Spuit = Rp 210,000
Asering = Rp 90,000
Verband = Rp 6,000
= Rp 2,874,000

Telp. (0285) 423623
Nama Tn. Sanawi Kelas Perawatan : III

Spuit = Rp 247,000
Nacl = Rp 200,000
= Rp 3,275,500

Telp. (0285) 423623
Nama An. M. Hisyam Syamsuri Sunarno P Kelas Perawatan : I

Via Phone dr. Aan. Sp.A = Rp 20,000
Novaldo = Rp 40,000
Spuit = Rp 294,500
RL = Rp 150,000
Verband = Rp 10,000
02 Tabung Besar 2+Selang 02 = Rp 245,000
= Rp 3,548,000

Telp. (0285) 423623
Nama An. M. Affanj Maulana. Z Kelas Perawatan : I

Visite dr Kudori. Sp.A = Rp 85,000
Visite dr, Riza Sp.A = Rp 405,000
Via phone dr Aan. Sp.A = Rp 20,000
"co" THT dr. Rony. Sp.THT-KL = Rp 125,000
"co" drg Ahmad Musfikar = Rp 75,000
Novaldo = Rp 48,000
Sanmol = Rp 790,000
Spuit = Rp 295,000
RL = Rp 17,500
aSering = Rp 120,000
Nacl = Rp 15,000
Infuset = Rp 40,000
Verband = Rp 10,000
= Rp 6,981,000
Telp. (0285) 423623
Nama An. Shilla Fitriana Kelas Perawatan : III

Via Phone dr. Riza,Sp.A = Rp 20,000
Visite dr. Aan, Sp.A = Rp 65,000
Spuite = Rp 126,000
Asering = Rp 60,000
Sanmol = Rp 158,000
Verband = Rp 6,000
= Rp 1,902,500

Telp. (0285) 423623
Nama An. Feri Muraizam Kelas Perawatan : III

Visite dr.Aan,Sp.A = Rp 365,000
Via Phone dr. Aan, Sp.A = Rp 60,000
Novaldo = Rp 48,000
Spuite = Rp 299,000
RL = Rp 157,500
Infuset = Rp 40,000
Verband = Rp 10,000
= Rp 3,001,000

Telp. (0285) 423623
Nama An. Fitriyani Kelas Perawatan : III

Via Phone dr. Riza, Sp.A = Rp 20,000
Spuit = Rp 83,000
Asering = Rp 45,000
Infuset = Rp 20,000
= Rp 1,276,500

Telp. (0285) 423623
Nama An. Wikan Aditya S Kelas Perawatan : III

Via Phone dr. Riza, Sp.A = Rp 40,000
Visite dr.Aan,Sp.A = Rp 65,000
Birotek = Rp 96,000
Vallutin = Rp 120,000
Spuit = Rp 225,000
D51/4 NS = Rp 160,000
Infuset = Rp 40,000
Verband = Rp 10,000
Fisoterapi = Rp 80,000
= Rp 3,627,000

Telp. (0285) 423623
Nama Ny.Karyem Kelas Perawatan : III

Spuit = Rp 5,000
Nacl = Rp 15,000
RL = Rp 52,500
Infuset = Rp 20,000
= Rp 1,106,000

Telp. (0285) 423623
Nama An.Almira Syanala Kelas Perawatan : III

"Co" THT dr,Rony,Sp.THT-KL = Rp 125,000
Novaldo = Rp 16,000
Spuit = Rp 131,000
D5 1/4 NS = Rp 60,000
Sanmol = Rp 158,000
Asering = Rp 75,000
Infuset = Rp 40,000
Verband = Rp 10,000
Ambulance Ke RSUD Batang = Rp 75,000
= Rp 2,394,000

Telp. (0285) 423623
Nama An. Hasan Bisri Kelas Perawatan : III

Visite dr.Maria = Rp 45,000
Visite dr.Dany = Rp 85,000
Vit K = Rp 40,000
Ondancentrone = Rp 176,000
Deladril = Rp 20,000
Gluconas Calcium = Rp 20,000
Spuit = Rp 393,000
Nacl = Rp 120,000
Infuset = Rp 20,000
Transfusi darah = Rp 1,440,000
USG+Baca = Rp 200,000
= Rp 5,543,500

Telp. (0285) 423623
Nama An. Nur Hayati Kelas Perawatan : III

Visite dr. Maria = Rp 125,000
Via Phone dr. Aan,Sp.A = Rp 100,000
Novaldo = Rp 48,000
Spuit = Rp 253,000
RL = Rp 105,000
Asering = Rp 15,000
Infuset = Rp 20,000
Verband = Rp 6,000
= Rp 2,342,500
Telp. (0285) 423623
Nama Ny.Siti Fatonah Kelas Perawatan : III

Visite dr.Dany = Rp 45,000
Antrain = Rp 96,000
Spuit = Rp 94,000
Nacl = Rp 45,000
Infuset = Rp 20,000
= Rp 1,293,000

Telp. (0285) 423623
Nama An. Fariz Lutfi Naufal Kelas Perawatan : II

Novaldo = Rp 80,000
Sibital = Rp 16,000
Spuit = Rp 160,000
D5 % = Rp 60,000
D5 1/4 NS = Rp 60,000
Verband = Rp 10,000
Foto RO+ Baca = Rp 150,000
= Rp 2,845,000

Telp. (0285) 423623
Nama An. Muhammad Mirtazam Kelas Perawatan : III

Via Phone dr. Riza,Sp.A = Rp 60,000
"CO" THT dr.Rony,Sp.THT-KL = Rp 125,000
Visite dr.Aan, Sp.A = Rp 65,000
Novaldo = Rp 16,000
Spuit = Rp 278,000
RL = Rp 17,500
Infuset = Rp 20,000
Verband = Rp 6,000
= Rp 3,187,500

Telp. (0285) 423623
Nama Ny.Surni Kelas Perawatan : III

Visite dr.Debora = Rp 45,000
Nacl = Rp 60,000
Infuset = Rp 20,000
O2 1 Tabung+Selang O2 Dewasa = Rp 130,000
= Rp 1,180,500
Telp. (0285) 423623
Nama An. Rava Dwi Al Habsi Kelas Perawatan : III

Spuit 5 cc = Rp 55,000
D5% = Rp 75,000
Infuset = Rp 20,000
Verband = Rp 6,000
= Rp 1,989,000

Telp. (0285) 423623
Nama Tn. Yopi Alamsyah Kelas Perawatan : III

Visite dr. Naufal = Rp 45,000
Via phone dr. Rosik,Sp.PD = Rp 40,000
Dexametason = Rp 117,000
Vit K = Rp 60,000
Spuit 5 cc = Rp 100,000
Spuit 1 cc = Rp 208,000
RL = Rp 70,000
Na Cl = Rp 75,000
Infuset = Rp 20,000
Kantong Darah = Rp 720,000
= Rp 4,204,500

Telp. (0285) 423623
Nama An. Sindi Anastasya Kelas Perawatan : III

Via phone dr. Riza,Sp.A = Rp 80,000
Spuit 10 cc = Rp 27,000
RL = Rp 70,000
Na Cl = Rp 15,000
Verband = Rp 6,000
= Rp 2,556,500

Telp. (0285) 423623
Nama An. Faris Edi Febrizio Kelas Perawatan : II

Visite dr. A'an, Sp.A = Rp 215,000
Via phone dr. A'an,Sp.A = Rp 20,000
Novaldo = Rp 48,000
Sibital = Rp 80,000
Spuit 1 cc = Rp 128,000
Spuit 10 cc = Rp 27,000
D5% = Rp 60,000
Infuset = Rp 20,000
Verband = Rp 10,000
O2 / Tab + selang O2 = Rp 130,000
= Rp 2,533,000

Telp. (0285) 423623
Nama Ny. Siti Romlah Kelas Perawatan : III

Visite dr. Kudor, Sp.A = Rp 305,000
Via photo dr. Kudori, Sp.A = Rp 20,000
Benodon = Rp 47,000
Velutin = Rp 75,000
RL = Rp 35,000
RD 5% = Rp 60,000
Infuset = Rp 20,000
= Rp 2,855,500

Telp. (0285) 423623
Nama An. M. Khudaifa Saputra Kelas Perawatan : III

Santagesik = Rp 64,000
D5 % = Rp 15,000
RD 5% = Rp 60,000
Infuset = Rp 20,000
Verban = Rp 6,000
= Rp 1,771,500

Telp. (0285) 423623
Nama An. Faradisa Akmalia Kelas Perawatan : III

Via Phone dr. Kudori, Sp.A = Rp 20,000
Extrace = Rp 60,000
RD 5% = Rp 120,000
Infuset = Rp 20,000
Verban = Rp 6,000
Laborat = Rp 65,000
= Rp 2,108,000

Telp. (0285) 423623
Nama Ny. Nur Baiti Kelas Perawatan : III

Na Cl = Rp 45,000
Infuset = Rp 20,000
EKG = Rp 150,000
O2 / Tab + Selang O2 = Rp 130,000
Urine Bag = Rp 30,000
Folley Catheter No.18 = Rp 50,000
Prasat Folley Catheter = Rp 100,000
= Rp 2,234,500

Telp. (0285) 423623
Nama Tn. Kastolani Kelas Perawatan : III

Novaldo = Rp 96,000
Na Cl = Rp 75,000
Infuset = Rp 20,000
EKG = Rp 150,000
= Rp 1,739,000

Telp. (0285) 423623
Nama Ny. Suratmi Kelas Perawatan : III

Birotex = Rp 98,000
Na Cl = Rp 75,000
Infuset = Rp 20,000
O2 Tab + Selang O2 = Rp 245,000
= Rp 2,707,000

Telp. (0285) 423623
Nama Sdr. M. Gelar Setiawan Kelas Perawatan : III

Visite dr. Adhyaksa = Rp 45,000
Via Phone dr, Rosik = Rp 20,000
Dexametasone = Rp 117,000
Spuit 1 cc = Rp 140,000
Spuit 5 cc = Rp 105,000
Ring As = Rp 210,000
Infuset = Rp 20,000
= Rp 3,123,000

Telp. (0285) 423623
Nama Tn. Udiyono Kelas Perawatan : III

RL = Rp 17,500
Nacl = Rp 75,000
Infuset = Rp 20,000
= Rp 1,998,000

Telp. (0285) 423623
Nama An. Alfaro Rifqi Kelas Perawatan : III

Jasa Lampu BL = Rp 100,000
= Rp 1,089,000

Telp. (0285) 423623
Nama Ny. Ramini Kelas Perawatan : III

Novoldo = Rp 160,000
Spuit 1 cc = Rp 104,000
Spuit 5 cc = Rp 100,000
RL = Rp 17,500
Na Cl = Rp 60,000
Infuset = Rp 20,000
O2 / Tab + Selang O2 = Rp 130,000
= Rp 2,945,500

Telp. (0285) 423623
Nama Tn. Rasdi Kelas Perawatan : III

Spuit 1 cc = Rp 176,000
Spuit 5 cc = Rp 120,000
Spuit 10 cc = Rp 108,000
Ring As = Rp 30,000
RL = Rp 17,500
Na Cl = Rp 180,000
Infuset = Rp 20,000
= Rp 3,885,000

Telp. (0285) 423623
Nama Tn. Suwarno Kelas Perawatan : III

Spuit 1 cc = Rp 112,000
Na Cl = Rp 90,000
Infuset = Rp 20,000
USG = Rp 200,000
= Rp 2,900,500

Telp. (0285) 423623
Nama ; Nadira Azka Thafana Kelas Perawatan : III

Co' USG dr Rosik Sp.PD = Rp 245,000
Co "THT dr Rony, Sp.THT = Rp 125,000
A = Rp 40,000
Novaldo = Rp 80,000
Spuit 1 cc = Rp 204,000
Spuit 5 cc = Rp 135,000
Spuit 10 cc = Rp 99,000
Na Cl = Rp 17,500
Infuset = Rp 40,000
Verband = Rp 10,000
= Rp 4,314,500
Telp. (0285) 423623
Nama Ny. Nur Hayati Kelas Perawatan : III

Novaldo = Rp 48,000
Spuit 10 cc = Rp 27,000
RD 5% = Rp 20,000
Infuset = Rp 20,000
= Rp 962,500

Telp. (0285) 423623
Nama An. M. Fabian Alfaro Kelas Perawatan : II

Visite dr.Christian = Rp 50,000
Anbacim = Rp 16,000
Spuit 10 cc = Rp 54,000
Sanmol = Rp 158,000
Infuset = Rp 20,000
Verband = Rp 6,000
= Rp 3,233,500

Telp. (0285) 423623
Nama An. Widagdha Buyapathybrana Kelas Perawatan : III

Via photo dr. Kudori, Sp.A = Rp 20,000
Santagesik = Rp 64,000
Sibital = Rp 16,000
D5 % = Rp 60,000
Infuset = Rp 20,000
Verband = Rp 6,000
= Rp 1,897,500

Telp. (0285) 423623
Nama Ny. Farid Hidayah Kelas Perawatan : III

Birotec = Rp 98,000
Na Cl = Rp 120,000
Infuset = Rp 20,000
O2 2 Tab + selang O2 = Rp 245,000
Nebullizer = Rp 40,000
EKG = Rp 150,000
= Rp 3,296,000

Telp. (0285) 423623
Nama Tn. Kaprawi Kelas Perawatan : III

Birotec = Rp 98,000
Na Cl = Rp 120,000
Infuset = Rp 20,000
O2 2 Tab + selang O2 = Rp 245,000
EKG = Rp 150,000
= Rp 3,296,000
Telp. (0285) 423623
Nama An. Andifa musica azzahra Kelas Perawatan :Ut
Opname tanggal26-07-2016 s/d 2807-2016 = Rp 1,050,000

Visite dr. zuldi = Rp 65,000
Visite dr.Kudori Sp.A = Rp 455,000
Via phone dr. Kudori Sp.A = Rp 20,000
ceftriaxan = Rp 153,000
novaldo = Rp 64,000
sibital = Rp 16,000
RL = Rp 69,000
Verban = Rp 9,000
Foto ro+baca tgl 26-07-2016 = Rp 160,000
= Rp 3,328,000

Telp. (0285) 423623
Nama Tn. Sajidin Kelas Perawatan : II

Birotec = Rp 98,000
Novaldo = Rp 16,000
Pulmicoird = Rp 25,000
Spuit 1 cc = Rp 132,000
Spuit 5 cc = Rp 145,000
Spuit 10 cc = Rp 45,000
Na Cl = Rp 105,000
Infuset = Rp 20,000
O2 2 Tab + selang O2 = Rp 160,000
Foto Ro" + Baca = Rp 160,000
Fisioterapy = Rp 40,000
= Rp 3,888,500

Telp. (0285) 423623
Nama Tn. Daryoso Kelas Perawatan : III

Birotec = Rp 98,000
Novaldo = Rp 16,000
Pulmicoird = Rp 25,000
Spuit 1 cc = Rp 132,000
Spuit 5 cc = Rp 145,000
Spuit 10 cc = Rp 45,000
Na Cl = Rp 105,000
Infuset = Rp 20,000
O2 2 Tab + selang O2 = Rp 160,000
Fisioterapy = Rp 40,000
= Rp 3,888,500

Telp. (0285) 423623
Nama An. M. Ardiyanto Mirza Kelas Perawatan : II

Sibital = Rp 16,000
RL = Rp 52,500
Infuset = Rp 30,000
Verband = Rp 6,000
= Rp 1,220,500

Telp. (0285) 423623
Nama Ny. Asiyah Kelas Perawatan : II

Visite dr. Zuldi = Rp 85,000
Visite dr. Sarah = Rp 45,000
Ranitin = Rp 30,000
Debutamin = Rp 55,000
Spuit 10 cc = Rp 144,000
RL = Rp 70,000
Na Cl = Rp 15,000
Infuset = Rp 20,000
Verband = Rp 6,000
Urin Bag = Rp 25,000
Folley Catheter = Rp 60,000
Prasat Folly Catheter = Rp 100,000
O2 Tab + selang O2 = Rp 130,000
= Rp 2,907,000

Telp. (0285) 423623
Nama naufal zhafran al bahri Kelas Perawatan : III
opname tgl 29-07-2016 s/d 30-07-2016 = Rp 600,000

visite dr maria = Rp 55,000
visite dr kudori Sp.A = Rp 245,000
santagesic = Rp 48,000
Spuit1cc = Rp 72,000
ring as = Rp 120,000
Infuset = Rp 20,000
Verband = Rp 6,000
lab tgl 29-07-2016 = Rp 120,000
= Rp 1,995,500

Telp. (0285) 423623
Nama Ny. Lia Rianti Kelas Perawatan : III

Visite dr. Sarah = Rp 45,000
Aminophyllin = Rp 10,000
Birotec = Rp 98,000
Spuit 10 cc = Rp 27,000
RL = Rp 25,000
Na Cl = Rp 25,000
Infuset = Rp 20,000
Tranfusi Set = Rp 50,000
Prasat Tranfusi = Rp 50,000
O2 Tab + selang O2 = Rp 130,000
= Rp 1,898,500

Telp. (0285) 423623
Nama An. Azzahra Eka Pramudya Kelas Perawatan : II - Ut

Via Phone dr. Aan,Sp.A = Rp 60,000
CO" THT dr Rony,Sp.THT = Rp 125,000
Novaldo = Rp 32,000
Spuit 1 cc = Rp 132,000
Spuit 10 cc = Rp 135,000
Infuset Pad = Rp 60,000
Verband = Rp 10,000
= Rp 4,077,000

Telp. (0285) 423623
Nama An. Muhammad Rayhan F Kelas Perawatan : I - Ut

Via Phone dr. Kudori,Sp.A = Rp 20,000
Novaldo = Rp 64,000
RL = Rp 125,000
Infuset = Rp 20,000
Verband = Rp 6,000
= Rp 3,466,000

Telp. (0285) 423623
Nama An. M. Aski Kelas Perawatan : I - Ut

Via Phone dr. Kudori,Sp.A = Rp 20,000
Mikajec = Rp 582,000
Methyl Prednisolon = Rp 70,000
Spuit 1 cc = Rp 140,000
RL = Rp 125,000
D5% = Rp 60,000
NaCl = Rp 50,000
Infuset = Rp 40,000
Verband = Rp 14,000
= Rp 6,055,500

Telp. (0285) 423623
Nama An. Nadine Elysia P Kelas Perawatan : II

Visite dr. Aan, Sp.A = Rp 325,000
CO" THT dr. Rony, Sp.THT = Rp 125,000
Novaldo = Rp 64,000
Ondacentron = Rp 110,000
Spuit 1 cc = Rp 200,000
Spuit 10 cc = Rp 126,000
Verband = Rp 10,000
= Rp 3,441,500

Rincian Biaya Opname 2016

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Rincian Biaya Opname 2016

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YAYASAN SITI CHOTIMAH

RUMAH SAKIT BHAKTI WALUYO

Nama : Ny. Minarni Kelas Perawatan : III F

RINCIAN BIAYA RAWAT INAP

1 Opname tanggal 28-12-2015 s/d 03-01-2016 = Rp 1,050,000 1

YAYASAN SITI CHOTIMAH Naik Kelas II - Utama

Nama : An. Alvindi Jadda Kelas Perawatan : II

RINCIAN BIAYA RAWAT INAP

1 Opname tanggal 02-01-2016 s/d 05-01-2016 = Rp 800,000 1

YAYASAN SITI CHOTIMAH

Nama : An. Dinar Puspa Kelas Perawatan : III B

RINCIAN BIAYA RAWAT INAP

YAYASAN SITI CHOTIMAH

Nama : Tn. Ngatmin Kelas Perawatan : III

RINCIAN BIAYA RAWAT INAP

YAYASAN SITI CHOTIMAH

Nama : Ny. Wasriah Kelas Perawatan : III

RINCIAN BIAYA RAWAT INAP

Nama : Ny. Daryati Kelas Perawatan : III

RINCIAN BIAYA RAWAT INAP

YAYASAN SITI CHOTIMAH Naik Kelas II - Utama

Nama : An. Akmal Sabiq Kelas Perawatan : II

YAYASAN SITI CHOTIMAH

Nama : Ny. Paryati Kelas Perawatan : III

RINCIAN BIAYA RAWAT INAP

YAYASAN SITI CHOTIMAH

Nama : An. Dimas Aditya F Kelas Perawatan : II C

RINCIAN BIAYA RAWAT INAP

Nama : An. Irsyadul Ibad Kelas Perawatan : III B

RINCIAN BIAYA RAWAT INAP 1

YAYASAN SITI CHOTIMAH

Nama : an. Farzan ahza argani Kelas Perawatan : III

RINCIAN BIAYA RAWAT INAP 1

YAYASAN SITI CHOTIMAH

Nama : an. M. Aditya pratama Kelas Perawatan : III

1 Opname tanggal 18-01-2016 s/d 22-01-2016 = Rp 750,000

YAYASAN SITI CHOTIMAH

Nama : ny. Rantiyah Kelas Perawatan : III

RINCIAN BIAYA RAWAT INAP 1

YAYASAN SITI CHOTIMAH naik kelas II - Utama

Nama : an. Atta al ghifar Kelas Perawatan : II

RINCIAN BIAYA RAWAT INAP 1

YAYASAN SITI CHOTIMAH

Nama : ny. Kaenah Kelas Perawatan : III

1 Opname tanggal 23-01-2016 s/d 25-01-2016 = Rp 450,000

YAYASAN SITI CHOTIMAH

Nama : an. M. Zidan al faruq Kelas Perawatan : II C

1 Opname tanggal 25-01-2016 s/d 27-01-2016 = Rp 600,000

YAYASAN SITI CHOTIMAH

Nama : tn. Rampli Kelas Perawatan : III

1 Opname tanggal 27-01-2016 s/d 28-01-2016 = Rp 300,000

YAYASAN SITI CHOTIMAH

Nama : an. Kayla ayunindiya Kelas Perawatan : Ia

1 Opname tanggal 27-01-2016 s/d 29-01-2016 = Rp 750,000 3

YAYASAN SITI CHOTIMAH

Nama : an. Naelul kartin Kelas Perawatan : III

RINCIAN BIAYA RAWAT INAP 1

Nama : Ny. Sariyah Kelas Perawatan : III F

RINCIAN BIAYA RAWAT INAP

Opname tanggal 28-12-2015 s/d 03-01-2016 = Rp 1,050,000

YAYASAN SITI CHOTIMAH

Nama : Ny. Intatik Kelas Perawatan : III

RINCIAN BIAYA RAWAT INAP