Tabel 1.

Pendapatan Rawat Inap Bulan Januari 2017

NO Tanggal Nama Pasien

ADM
INFUS INJEK
1 31 Desember 2016 Tn.Maskam 20,000 15,000
2 01 Januari 2017 Caswati. Ny 20,000 15,000 10,000
3 01 Januari 2017 Dedi.S .Tn.H 20,000 15,000
4 01 Januari 2017 Suud.Tn 20,000 15,000
5 02 Januari 2017 Nengsih.NY 20,000 15,000
6 03 Januari 2017 Tn. Uju 20,000 15,000
7 04 Januari 2017 Tn. Andi 20,000 15,000 10,000
8 04 Januari 2017 Tn. Bohim 20,000 15,000
9 06 Januari 2017 Ny. Anesih 20,000 15,000
10 06 Januari 2017 Ny. Eti Rohaeti 20,000 15,000
11 06 Januari 2017 Tn. Ahmad Yudi 20,000 15,000 10,000
12 13 Januari 2017 Tn. Sapan 20,000 15,000
13 10 Januari 2017 An. Azka 20,000 15,000
14 11 Januari 2017 Ny. Imun 20,000 15,000
15 11 Januari 2017 Tn. Juhen 20,000 15,000
16 12 Januari 2017 Ny. Dati 20,000 15,000 10,000
17 12 Januari 2017 Enjong.NY 20,000 15,000
18 14 Januari 2017 Ecin.Ny 20,000 15,000 10,000
19 28 Januari 2017 Kholik.An 20,000 15,000
18 19 Januari 2017 Ahmad.Tn 20,000 15,000
19 21 Januari 2017 Upi.Ny 20,000 15,000
20 22 Januari 2017 Rika Sari.Ny 20,000 15,000
21 23 Januari 2017 Edah.Ny 20,000 15,000
22 23 Januari 2017 Kasti.Ny 20,000 15,000
23 23 Januari 2017 Suparti.Ny 20,000 15,000
24 24 Januari 2017 Sadi.Tn 20,000 15,000
25 25 Januari 2017 Hendi Junaedi.Tn 20,000 15,000 10,000
26 25 Januari 2017 Nunung.Ny 20,000 15,000
27 26 Januari 2017 Ruki.Ny 20,000 15,000
28 26 Januari 2017 Lukman Hakim.Tn 20,000 15,000
29 27 Januari 2017 Wanto.Tn 20,000 15,000
30 28 Januari 2017 Salsi Hj.Ny 20,000 15,000 10,000
31 28 Januari 2017 Kaswati.Ny 20,000 15,000 10,000
32 29 Januari 2017 Sugiarto.Tn 20,000 15,000
33 29 Januari 2017 Utari.Tn 20,000 15,000 10,000
JUMLAH 700,000.00 525,000.00 90,000.00
JASA YANG DITERIMA

CATATAN : KALO ADA PENAMBAHAN KOLOM ATO BARIS LAPOR....!!!!

Tambahan Kolom : dr.Meri,dr.Eha,dr.Sigit SpPD
 3172900

ADMINISTRASI, TINDAKAN DAN PENUNJANG MEDIS DI IGD

TINDAKAN IGD
/ Hecting/ EKG Monitor Tin.Suction/Rectal TubeCuci Luka NEBU/spalk Catheter NGT/Incici

30,000 30,000

40,000 40,000

40,000

- 30,000.00 - 30,000.00 80,000.00 40,000.00

r.Sigit SpPD
 =1700*2

RUANGAN
PENUNJANG MEDIS JASMED
GDS O2 Observasi EKG ADRU KAS
10,000 17,000 15,000 209,000 40,000
10,000 15,000 503,000 70,000
10,000 15,000 55,000 226,000 60,000
15,000 160,000 27,000
15,000 107,000 40,000
15,000 270,000 70,000
15,000 272,000 70,000
15,000 55,000 139,000 30,000
10,000 15,000 138,000 30,000
55,000 81,000 30,000
15,000 55,000 86,000 30,000
15,000 141,000 40,000
15,000 145,000 40,000
15,000 264,000 60,000
10,000 15,000 55,000 187,000 30,000
15,000 142,000 30,000
15,000 55,000 412,000 59,500 10,500.00
10,000 17,000 15,000 55,000 335,100 50,000
15,000 115,000 30,000
15,000 441,000 18,000 12,000.00
15,000 211,000 50,000
15,000 164,000 30,000
10,000 15,000 55,000 349,000 50,000
10,000 15,000 55,000 201,000 40,000
15,000 130,000 40,000
10,000 17,000 15,000 55,000 132,000 40,000
10,000 17,000 15,000 116,000 30,000
15,000 167,000 30,000
17,000 15,000 317,000 40,000
15,000 513,000 90,000
15,000 141,000 30,000
10,000 15,000 100,000 60,000
15,000 55,000 127,000 28,000
10,000 15,000 55,000 175,000 40,000
17,000 15,000 55,000 238,000 60,000
120,000.00 102,000.00 565,000.00 660,000.00 7,454,100.00 1,512,500.00 22,500.00

12.00
 4.80
67,200.00
RUANGAN JPRS
OBAT
RPU OK JPRS KAS OBAT TUSLAG
280,000 107,500 9,500 738,000
332,000 157,500 9,500 1,829,000 40,000
285,000 135,500 9,500 1,231,000 30,000
405,000 103,500 10,500 884,000
280,000 90,500 9,500 761,000 15,000
332,000 157,500 9,500 2,062,000 30,000
490,000 157,500 9,500 1,998,000 20,000
35,000 85,500 9,500 383,000 15,000
210,000 85,500 9,500 391,000 15,000
150,000 101,500 10,500 57,000
47,000 75,500 9,500 304,000 12,000
210,000 102,500 9,500 1,096,000 25,000
195,000 85,500 9,500 1,172,000 30,000
900,000 189,500 10,500 1,421,000 25,000
450,000 116,500 10,500 385,000 15,000
210,000 85,500 9,500 936,000 15,000
770,000 500,000 225,000 3,395,000 40,000
1,125,000 167,000 10,500 1,607,900 20,000
140,000 98,000 9,500 346,000
560,000 350,000 300,000 2,434,000 48,000
750,000 166,500 10,500 686,000 20,000
675,000 117,000 10,500 399,000 16,000
550,000 200,500 9,500 1,853,000 41,000
760,000 142,500 9,500 1,162,000 18,000
184,000 75,500 9,500 1,045,000 20,000
142,000 102,500 9,500 779,000 15,000
450,000 116,500 10,500 657,000 25,000
570,000 117,000 10,500 950,000 50,000
190,000 107,500 9,500 1,535,000 35,000
1,045,000 185,500 9,500 2,372,000 80,000
142,000 85,500 9,500 856,000 15,000
354,000 150,500 9,500 698,000
270,000 79,500 10,500 544,000 20,000
280,000 107,500 9,500 1,369,000 21,000
390,000 135,500 9,500 1,765,000 25,000
14,158,000.00 850,000.00 4,516,500.00 323,500.00 40,100,900.00 796,000.00
 796,000.00

486,200
486,200
22,800

811000
 TINDAKAN PENUNJANG MEDIS RUANGAN
Prodia
LAB GDS EKG EKG MONITOR RO

1,063,000 55,000.00 80,000

764,000 160,000 55,000 330,000 80,000
385,000 100,000
274,000
438,000 80,000
360,000 593,000
360,000 713,000 80,000
288,000 80,000
222,000 60,000 80,000
115,000
211,000 55,000 80,000
132,000 160,000
95,000
342,000
175,000 120,000 80,000
138,000 80,000
403,000 160,000 55,000
1,344,000 180,000 440,000 80,000
127,500
1,035,000 20,000 55,000 80,000
399,000
287,000
1,113,000 920,000
575,000 80,000
189,000 150,000
442,000 60,000
192,000 280,000 80,000
414,000
371,000 20,000
874,000 1,649,000 80,000
168,000 80,000
212,500 100,000
119,000
442,000 60,000
325,000 80,000
1,783,000.00 15,716,000.00 2,140,000.00 275,000.00 870,000.00 1,440,000.00

27,119,500.00 5.00
Rp19 Rp0
 Rp266,000

15,716,000.00
RUANGAN
TINDAKAN R
GIZI
USG URM O2
GIZI Konsul Gizi KAS NEBU /GV
225,000 20,000 6,000
405,500 20,000 10,500 200,000.00
333,000 35,000 9,000 160,000
249,500 30,000 4,500
228,000 20,000 3,000
405,500 20,000 10,500
125,000 389,500 20,000 10,500
185,000 169,500 20,000 4,500
35,000.00 164,500 25,000 4,500
93,500 30,000 1,500
57,500 20,000 1,500
185,000 35,000.00 164,500 25,000 4,500
153,500 20,000 4,500 200,000
564,000 30,000 9,000
281,500 30,000 4,500
164,500 25,000 4,500
658,500 30,000 9,500
185,000 470,000 30,000 7,500 200,000
116,000 20,000 3,000
982,500 25,000 9,500
65,000 399,500 30,000 7,500
285,000 30,000 1,500
125,000 469,500 30,000 7,500
376,000 30,000 6,000
185,000 172,000 20,000 6,000
153,500 20,000 4,500 238,000
281,500 30,000 4,500 350,000
282,000 30,000 4,500
232,000 20,000 6,000
494,500 25,000 13,500
153,500 20,000 4,500
164,000 35,000 1,500 110,000
65,000 131,000 30,000 3,000
215,000 25,000 6,000
365,000 348,000 20,000 9,000 200,000
1,485,000.00 70,000.00 10,433,000.00 890,000.00 208,000.00 1,658,000.00 -

2.33

Rp160,000
 dr. Emma

TINDAKAN RUANGAN
TRANSPORT dr.Elly,SpPD
Infuspum Lampusorot IGD Tanggal Visite VISIT
320,000.00 29.30.31 175,000.00
149,000 27.28.29.30.31.1 367,000
485,000 28.29.30.31.1 261,000
31,1 160,000
31.1.2 193,000.00
28.29.30.31.1.2.3 362,000
29.30.31.1.2.3.4 400,000
3.4 125,000
4.5.6 175,000
6 85,000
214,000
12.13 175,000

7.8.9.10.11 340,000
9.10.11 205,000
10.11.12 175,000
100,000.00 7.8.10.11.12 400,000
10.11.12.13 390,000

12.13.14.15.16 275,000
19.20.21 205,000
21.22 160,000
20.21.22.23 310,000
21.22.23,konsul 250,000
100,000.00 21.22.23 160,000
50,000
23.24.25 205,000
120,000 24 85,000
80,000 24.25.26 160,000
65,000 19.20.22.23.24.25 405,000
25.27 115,000
27 100,000
27,28 160,000
27,28 125,000
25.27.28 160,000
- - 1,483,000.00 200,000.00 - 6,863,000.00
160,000.00 5,490,400.00
5,490,400.00
- -
Rp160,000 Rp5,490,400
40,000.00 1,372,600.00
-
HD

dr. Rio.SpPD dr.Sigit.SpPD

TINDAKAN IGD Tanggal Visite VISIT

- - - - -
- - -
-
 anaknya dr.Herlina gak ditarif jasabnya

dr.shinta,SpA
TINDAKAN IGD Tanggal Visite VISIT TINDAKAN

- - - - -
- - - -
-
-
- - -
-
 dr.Irwan,SpB dr. Uun. SpP
IGD Tanggal Visite VISIT TINDAKAN IGD

29.00 70,000.00

10.12 205,000.00 1,650,000.00

16.19.15. 175,000.00 1,100,000.00

26.00 70,000.00

- 520,000.00 2,750,000.00 -
- 416,000.00 2,200,000.00 -
- 520,000.00 2,750,000.00 -
 PEMERIKSAAN, VISIT & TIN
dr. Uun. SpP dr.Nursyamsi,SpOG
Tanggal Visite VISIT TINDAKAN IGD Tanggal Visite

18.00

28.00

- - - -
- - -
- - -
 PEMERIKSAAN, VISIT & TINDAKAN DOKTER AHLI IGD
dr.Nursyamsi,SpOG dr.Yadi SpOG
VISIT TINDAKAN IGD Tanggal Visite VISIT

85,000.00

106,000.00

191,000.00 - - - -
152,800.00 - - -
191,000.00 - - -
 dr. Erni. SpM
TINDAKAN IGD Tanggal Visite VISIT TINDAKAN

- - - - -
- - - -
- - - -
 dr.shanti,Sp.Rad dr.Guntur,Sp.Rad
IGD VISIT TINDAKAN IGD VISIT

- - - - -
- - - - -
- - - - -
tur,Sp.Rad dr.Awaludin,SpS
TINDAKAN IGD Tanggal Visite VISIT TINDAKAN
30.0 70,000.00
30.00 84,000.00

12.00 70,000.00

20.00 85,000.00

25.00 85,000.00

- - 394,000.00 -
- - 315,200.00 -
- - 394,000.00 -
 drg.Intan
dr.Abu,SpKK dr.Luhur,SpKJ
tgl Visite IGD VISIT

- - - - -
- -

tolong diingatkan ke nia. Pas drg. Intan asa ada yg dikonsulkan

- - - -
 ektrasi 34 Asisten 2NY 2 orng
TINDAKAN KRU OK
g.Intan
dr.Rezka Dian,SpAn PENATA ASS 1 ASS2
TINDAKAN

660,000.00 240,000.00 240,000.00 120,000.00

565,000.00 240,000.00 240,000.00 120,000.00

- 1,225,000.00 480,000.00 480,000.00 240,000.00

980,000.00 400,000.00 400,000.00 144,000.00

as drg. Intan asa ada yg dikonsulkan 400,000.00

- 1,225,000.00 480,000.00 480,000.00 240,000.00
 VCT

dr.Herlina dr. Meriyanah

ON LOOP
IGD tgl Visite VISIT IGD
40,000.00 31 35,000.00
27 18,000.00
27 20,000.00

28.3 35,000.00
40,000.00 3 20,000
3 20,000

6 18,000.00

10 15,000
10 30,000
10 30,000
10 25,000
60,000.00 10 30,000
40,000.00

60,000.00 15,17 40,000

23 15,000
24 30,000
24 35,000
24,26 30,000
20.22.24.26 102,000
25.26 35,000

40,000.00

120,000.00 160,000.00 - 583,000.00 -

72,000.00 96,000.00 349,800.00 -
160,000.00
96,000.00 -
120,000.00 160,000.00 583,000.00 -
(387,050.00) -
Karyawan 16000
(403,050.00)

400000 1,023,000.00
 =

dr. Meriyanah dr.Guruh

tgl visite VISIT IGD tgl Visite VISIT

50,000 31 18,000
40,000 31 15,000
40,000 31 30,000
40,000 31 20,000
31 15,000
31 20,000
40,000

40,000

27,27 35,000

27.0 15,000
27.0 45,000
27.0 30,000
27.0 20,000
27.0 15,000
- - 250,000.00 278,000.00
- 150,000.00 166,800.00
-
- 250,000.00 278,000.00
-

166,800.00
 PEMERIKSAAN,VISIT & TINDAKAN DOKTER UMUM IGD
dr.Nurudin
TINDAKAN IGD tgl Visite VISIT TINDAKAN
28,29 35,000
28.29 36,000
28.29 30,000

28.29 30,000
29 25,000

40,000 11.12 45,000

40,000 12 20,000
40,000

25,26 60,000
26 15,000
18 48,000
26 15,000

26 25,000
40,000 26 30,000
- 160,000.00 - 414,000.00 -
- 96,000.00 248,400.00 -
160,000.00 414,000.00
 vct ferus
SIT & TINDAKAN DOKTER UMUM IGD
VCT dr. Sopi
IGD tgl Visite VISIT IGD VISIT

- - - - -
- - - -
-
- -
- -
 Anaknya dr. Herlina salma

dr.Wiwi dr.Eha
IGD TGL VISITE VISIT IGD Tgl Visite

26

1
1
1
1
2 31,000
6 20,000 4
5
40,000 5 24,000

9
7 30,000
40,000
11
6,7 65,000 11
13 36,000 11
40,000 28
12.13.17 65,000
18,20 60,000
40,000 20,21 65,000
40,000 20,21 60,000
40,000 21 30,000
20,21 35,000
50,000
40,000

25
40,000 20.21 48,000 18.21.25
25
27 50,000 40,000
27 35,000 40,000
19 25,000
29 18,000 25
290,000.00 - 697,000.00 160,000.00 -
174,000.00 418,200.00 96,000.00
-
96,000.00
290,000.00 697,000.00 160,000.00
 5000 Karyawan

r.Eha dr.Armi dr.Lodry

VISIT IGD Tgl Visite VISIT IGD

24,000.00

37,000.00
20,000.00
18,000.00 40,000
25,000.00

25,000.00
35,000.00

15,000.00 50,000

20,000 40,000.00
30,000
36,000
15,000

40,000.00
15,000 40,000.00
78,000
15,000

15,000
423,000.00 - - - 210,000.00
253,800.00 - - 126,000.00
494,000.00 126,000.00
-
423,000.00 - - 210,000.00
 TOTAL
dr.Lodry dr.Yati IGD
Tgl Visite VISIT IGD Tgl Visite VISIT
30 15,000 117,000
30 18,000 120,000
30 15,000 155,000
30 35,000.00 90,000
30 25,000 90,000
30.2 30,000 90,000
30.2 45,000.00 100,000
2 25,000 145,000
40,000 5 20,000.00 100,000
90,000
155,000
90,000
9.10 30,000 8 20,000.00 160,000
6.8.9 95,000 90,000
9 35,000 155,000
100,000
8,9 67,000 205,000
14 36,000 10 78,000.00 182,000
90,000
14.16.17 60,000 90,000
17,19 65,000.00 90,000
90,000
22 37,000 19 35,000.00 155,000
20.22.23 95,000 155,000
22 18,000 150,000
22,23 35,000 262,000
22,23 65,000 127,000
90,000
24 20,000 107,000
22.23 54,000 19 24,000.00 90,000
40,000.00 90,000
110,000
28 37,000 195,000
28 20,000 155,000
24 20,000.00 172,000
- 912,000.00 80,000.00 - 262,000.00 4,452,000.00
547,200.00 48,000.00 157,200.00
- 48,000.00 -
157,200.00
Rp547,200 Rp129,469,000
364,800.00 80,000.00 262,000.00
TOTAL K
RPU GRAN TOTAL KELAS
VVIP VIP Kls.1 Kls.2 Kls.3
3,483,000 3,600,000 - 4
5,680,000 5,800,000 7
3,895,000 4,050,000 - 6
2,410,000 2,500,000 3
2,330,000 2,420,000 4
4,810,000 4,900,000 7
5,250,000 5,350,000 7
1,645,000 1,790,000 - 3
1,710,000 1,810,000 3
790,000 880,000 1
1,245,000 1,400,000 1
2,550,000 2,640,000 3
2,230,000 2,390,000 3
4,310,000 4,400,000 6
2,155,000 2,310,000 3
2,130,000 2,230,000 3
10,495,000 10,700,000 7
6,828,000 7,010,000 5
1,055,000 1,145,000 2
9,330,000 9,420,000 8
3,210,000 3,300,000 5
2,240,000 2,330,000 3
6,245,000 6,400,000 5
3,775,000 3,930,000 4
2,439,000 2,589,000 4
2,238,000 2,500,000 3
2,923,000 3,050,000 3
3,010,000 3,100,000 3
3,273,000 3,380,000 4
8,255,000 8,345,000 9
1,900,000 1,990,000 3
2,190,000 2,300,000 1
1,795,000 1,990,000 2
2,965,000 3,120,000 4
4,228,000 4,400,000 6
### 129,469,000.00
0 1 45 47 52
-
129,469,000.00
Rp0
129,469,000
-

125,854,000 3,615,000

690000
259 563
 KETERANGAN
PERAWATAN
ICU PENYAKIT DALAM ANAK Kebidanan BEDAH Syaraf JIWA
3,600,000
5,800,000 -
4,050,000
2,500,000
2,420,000
4,900,000
5,350,000
1,790,000
1,810,000
880,000
1,400,000
2,640,000
2,390,000
4,400,000
2,310,000
2,230,000
10,700,000
7,010,000
1,145,000
9,420,000
3,300,000
2,330,000
6,400,000
3,930,000
2,589,000 -
2,500,000
3,050,000
3,100,000
3,380,000
8,345,000
1,990,000
2,300,000
1,990,000
3,120,000
4,400,000
105,814,000 3,535,000 - 20,120,000 - -
 2220

Unit Hemodialisa Retur obat Retur oksigen

SpP
106,800
142,400
340,400

131,600

29,200
61,600
96,800
-
73,600

145,200
1,180,000

808,800
56,000
56,000
310,000
52,000
126,400
30,160 162000
9,600
119,200

138,800

103,200 90000
82,400
106,400
203,200
- 1,180,000 2,695,760
128,289,000.00
-
 Tabel 1. Pendapatan Rawat Jalan Bulan Januari 2017

NO Tanggal Keterangan PRODIA

OBAT ADM APTK

1 Sunday, January 01, 2017 Rajal 354,000

2 Monday, January 02, 2017 Rajal 776,500 6,000
3 Tuesday, January 03, 2017 Rajal 1,166,450 5,000 660,000
4 Wednesday, January 04, 2017 Rajal 2,070,300 8,000
5 Thursday, January 05, 2017 Rajal 1,081,000 2,000 708,000
6 Friday, January 06, 2017 Rajal 1,629,500 3,000 182,000
7 Saturday, January 07, 2017 Rajal 1,202,300 2,000
8 Sunday, January 08, 2017 Rajal 503,000 1,000
9 Monday, January 09, 2017 Rajal 925,000 4,000
10 Tuesday, January 10, 2017 Rajal 719,500 2,000
11 Wednesday, January 11, 2017 Rajal 1,269,700 3,000
12 Thursday, January 12, 2017 Rajal 1,325,250 6,000 95,000
13 Friday, January 13, 2017 Rajal 1,449,000 3,000 182,000
14 Saturday, January 14, 2017 Rajal
15 Sunday, January 15, 2017 Rajal 1,689,200
16 Monday, January 16, 2017 Rajal 1,478,000 6,000
17 Tuesday, January 17, 2017 Rajal 2,311,000 3,000
18 Wednesday, January 18, 2017 Rajal 981,500 4,000
19 Thursday, January 19, 2017 Rajal 1,539,500 3,000
20 Friday, January 20, 2017 Rajal 978,000 1,000
21 Saturday, January 21, 2017 Rajal 518,000
22 Sunday, January 22, 2017 Rajal 423,000
23 Monday, January 23, 2017 Rajal 1,538,000 5,000
24 Tuesday, January 24, 2017 Rajal 1,434,750 1,000 340,000
25 Wednesday, January 25, 2017 Rajal 2,302,000 3,000
26 Thursday, January 26, 2017 Rajal 1,531,500 3,000
27 Friday, January 27, 2017 Rajal 1,519,500 3,000
28 Saturday, January 28, 2017 Rajal 1,044,600 1,000
29 Sunday, January 29, 2017 Rajal 472,800 2,000
30 Monday, January 30, 2017 Rajal 1,269,500 4,000 95,000
31 Tuesday, January 31, 2017 Rajal 2,480,000 1,000
Jumlah 37,464,350 85,000 2,780,000
Terima Jasa 85,000.00

Tambahan Kolom Dr.Guntur

69
 -Rp45,299
TINDAKAN PENUNJANG MEDIS
EKG
LAB GDS EKG MONITOR JPRS RO' USG

285,000
60,000 160,000
397,500 10,000 80,000
709,000 20,000 160,000 120,000
775,000
305,000 80,000
820,000 160,000

96,000
10,000
165,000
115,000 10,000 120,000
345,000 55,000 80,000

560,000
10,000 320,000
630,000 10,000
100,000 20,000
55,000 160,000
30,000

610,000 10,000 320,000

475,000 10,000 400,000
411,000
335,000 160,000
20,000 10,000 160,000
620,000 80,000
10,000
730,000 10,000
30,000 10,000
8,623,500 150,000 110,000 - - 2,440,000 120,000

2 31 2

2
4
 TINDAK
Pasang
FISIOTERAPY GIZI O2 TRANSPORT NEBU Spalk/Suction/Chatete
r/NGT
170,000

35,000 25,000 950,000

140,000 25,000 128,000
35,000 65,000
105,000 130,000
162,000

35,000 25,000 75,000

105,000 380,000
70,000 25,000
105,000 120,000
80,000

400,000
35,000 50,000
35,000 50,000
500,000
35,000
35,000
1,345,000

35,000 50,000
1,350,000
450,000
35,000 50,000
140,000 120,000

140,000 165,000
105,000 238,500
1,225,000 100,000 - 7,028,500 - -
-
35
4
40,000
 Insisi 250000
Extrasi Kuku 170000
TINDAKAN MEDIS POLI

OBSERVASI/ADM IGD/UP CUCI LUKA/ GANTI VERBAN TINDAKAN IGD

Hecting INJEK/ Infus
BEDAH MINOR

25,000 10,000

15,000

10,000

10,000 40,000 10,000 -

32,000.00 -

Tindakan Amputasi (dr. Nurudin, Fera) 8/6/2016

RS
Jasa Medis
dr.Nurudin
PerawatFera

TGL 13 jan 2016

RS
Jasa Medis
dr. Nurudin
Perawat Sule
 dr. Nurudin,Ida ,Yadi

JASA TINDAKAN
JASA RS Perawat (IGD) dr.Elly,SpPD dr.shinta,SpA
PERAWAT & RADIOLOGI

400,000
400,000
800,000
200,000
200,000

300,000
100,000
250,000
400,000
100,000

200,000

100,000

400,000

200,000

300,000

300,000
100,000
- - - 4,750,000 -
- - 3,800,000.00 -
0
mputasi (dr. Nurudin, Fera) 8/6/2016 85
100,000 34000
400,000 136000
280,000 95200 dr. Guruh
120,000 40800 Frenki

30,000
120,000
84,000
36,000
 Rp258,002 drg. Angsuran Leli ( ke drg.Intan s
PEMERIKSAAN MEDIS DOKTER AHLI
dr.Irwan,SpB
dr. Mahyudin.SPBdr.Nursyamsi,SpOG dr. Erni Sp M dr.Abu,SpKK
TINDAKAN POLI

100,000

100,000

- 200,000 - - - -
160,000.00 - - - -
Angsuran Leli ( ke drg.Intan sdh dibayar bln September)

dr.Herlina
dr.Luhur,SpKJ dr.Guntur Sp.Rad drg.Intan
TINDAKNA POLI Visum

75,000

35,000

- - - - 110,000 -
- - - 77,000 -
a
dr.Wiwi dr.MeriYana dr.G
KIR POLI Visum KIR POLI Visum KIR TINDAKNA

35,000

80,000 100,000

35,000
35,000

35,000

35,000

- 255,000 100,000 - - - - -
- 178,500.00 56,000.00 - - - - -
 PEMERIKSAAN MEDIS DOKTER

dr.Guruh dr. Army dr.Nurudin

POLI Visum KIR POLI Visum KIR TINDAKAN

35,000
35,000

35,000

105,000
70,000

110,000

35,000

425,000 - - - - - -
297,500.00 - - - - -
0

RS 350,000
Jasa Medis 280,000
dr. 196,000
Perawat 58,800
PEMERIKSAAN MEDIS DOKTER UMUM
dr.Eha
dr.Nurudin
POLI Visum KIR Tindakan POLI Visum KIR

128,000

35,000
70,000

105,000 20,000

75,000

35,000

35,000
35,000

110,000 - - - 408,000 - 20,000

77,000.00 - - - 285,600.00 - 12,000.00
 dr.Aji dr.loudry dr
POLI Visum KIR TINDAKAN POLI Visum KIR TINDAKAN

44,000

- - - - 44,000 - - -
- - - 30,800.00 - -
1.2571428571
 1065000

TOTAL
dr.Yati
POLI Visum KIR DLL
809,000
1,530,500
3,763,950
4,215,300
2,866,000
2,669,500
2,451,300
539,000
1,504,000 4,204,500
1,351,500 2,700,500
1,782,700 1782700
2,476,250
2,369,000
-
2,649,200
2,259,000
3,144,000
1,825,500
1,902,500
1,144,000
1,863,000
423,000
3,003,000 65,500
4,045,750
3,476,000
2,224,500
2,272,500 (321,700)
1,780,600 116,000
554,800
2,748,500 -
2,964,500
- - - - 66,608,350
- - - 5,091,400
0
116,000
 Tabel 1. Pendapatan Inap Kebidanan April 2016

ADMINISTRASI, TINDA
TINDAKAN IGD
NO Tanggal Nama Pasien
ADM
INFUS INJEK

1
2
3
4
5
6
7
JUMLAH - - -
JASA YANG DITERIMA
 ADMINISTRASI, TINDAKAN DAN PENUNJANG MEDIS DI IGD
TINDAKAN IGD PENUNJANG MEDIS
NEBU NGT/cather GDS O2 Observasi EKG

- - - - - -
 RUANGAN JPRS
JASMED
ADRU KAS RPU OK / VK JPRS

- - - - - -
 TINDAKAN PENUNJAN
JPRS
OBAT
LAB GDS EKG
KAS OBAT TUSLAG

- - - - - -

-
-
 TINDAKAN PENUNJANG MEDIS RUANGAN
GIZI
EKG MONITOR RO USG URM
GIZI Konsul Gizi

- - - - - -

20000
 TINDAKAN RUANGAN
GIZI
O2
KAS NEBU CUCI LUKA NGT B/P CHATETER B/P

- - - - - -
 dr.Elly,SpPD dr.shinta,SpA
TRANSPORT
IGD VISIT TINDAKAN IGD VISIT

- - - - - -
- - - - -
 PEMERIKSAAN, VISIT & TINDAKAN DO
hinta,SpA dr.Irwan,SpB dr.Asep,SpB
TINDAKAN IGD VISIT TINDAKAN IGD VISIT

- - - - - -
- - - - - -
ERIKSAAN, VISIT & TINDAKAN DOKTER AHLI
Asep,SpB dr.Nursyamsi,SpOG dr.Yadi SpOG
TINDAKAN IGD VISIT TINDAKAN IGD VISIT

- - - - - -
- - - - - -
152,800.00
2,112,000.00
.Yadi SpOG drg.Intan
dr.Abu,SpKK dr.Luhur,SpKJ
TINDAKAN IGD VISIT TINDAKAN

- - - - - -
- - -
 TINDAKAN KRU OK TINDAKAN
PARTUS
dr.Acep,SpAn PENATA ASS 1 ASS2 ON LOOP BIDAN
RS

- - - - - -
- - - - -
SC 200000 80000
Curet 200000
TINDAKAN PEMERIKSAAN,VISIT
PARTUS dr.Herlina dr. Eha
BIDAN IGD VISIT PARTUS IGD VISIT
BIDAN

- - - - - -
- - - -

karyawan
 PEMERIKSAAN,VISIT & TINDAKAN DOKTER UMUM IGD
dr. Eha dr. Army dr.Yati
PARTUS IGD VISIT PARTUS IGD VISIT

- - - - - -
- - - -
-
dr.Yati dr. Nurudin dr.Lodry
PARTUS IGD VISIT PARTUS IGD VISIT

- - - - - -
- - - -
 PERINATOLOGI
r.Lodry dr.Guruh
PARTUS IGD VISIT PARTUS ADM RUANGAN

- - - - - -
- - - -

166,800.00
NATOLOGI

JASMED dr. Guruh dr. Eha

RS PERI SpA dr. Guruh RS

- - - - - -
 RESUS TANPA SpA
dr. Eha dr. Yati
PERI SpA dr. Eha RS PERI SpA

- - - - - -
-
SpA
dr.lodry dr. Nurudin
dr.Yati RS PERI SpA dr.lodry RS

- - - - - -
 KELAS
GRAN TOTAL
dr. Nurudin
PERI SpA dr. Nurudin VVIP VIP Kls.1
-

-
-
-
-
- - - - - - -
-

129,469,000.00
KELAS
keterangan
Kls.2 Kls.3
3

\
3.00 - -
 PARTUS BIDAN

BIDAN 300,000
NO NAMA JENIS PARTUS
RS BIDAN SPOG
20% 36% 44%
60,000 108,000
1
2
3
4
TOTAL 0 0 0
- - -

132000
 jika VIP
RESUSITASI
S BIDAN
SPONTAN SC
750,000 TANPA SpA 150,000 TANPA SpA
DOKTER UMUM RS SpA DR.UMUM PERI RS SpA
44% 20% 30% 40% 10% 20% 30%
132,000 30,000 45,000 60,000 15,000 50,000 75,000

0 0 0 0 0 0 0
- - - - - - -
 SC
PA SpA 250,000 250,000
DR.UMUM PERI
40% 10%
100,000 25,000

0 0
- -
Tabel Pembagian Jasa Kebidanan Resus dan Tindakan Partus

NO Uraian Pembagian
I Resus Spontan RS 20%
Tindakan 80%
Dokter Umum 70%
Veri 30%

II Resus Sc (SpA tidak ada) 250,000 200,000

RS 20% 50,000
SPA dr.Shinta) 40% 80,000 80,000
Dr.Umum 50% 100,000 100,000
Veri (Kas) 10% 20,000 20,000

III Jasa Partus 250,000

RS 20% 20% 50,000
Bidan 45% (kas) 45% 90,000 200,000
dr.Umum 55% 55% 110,000

Iv Resus Spontan (SpA tidak ada) 150,000

RS 20% 30,000 120,000
SPA dr.Shinta) 40% 48,000
Dr.Umum 50% 60,000
Veri (Kas) 10% 12,000
dr.Elly Wijaya N,SpPD 4,750,000 540,000 200,000 6,863,000 - 12,353,000
dr.Irwan,SpB 200,000 3,270,000 - 3,470,000
dr.Nursyamsi,Sp.Og - 191,000 - 191,000
DR. Rezka.SpAN 1,225,000 - 1,225,000
dr.Awaludin,Sp.S 394,000 394,000
dr.Herlina 110,000 160,000 583,000 - - 853,000
dr,. Wiwi 355,000 290,000 697,000 - 1,342,000
dr.Yati - 80,000 262,000 - - 342,000
dr.Eha 428,000 160,000 423,000 - - 1,011,000
dr.Lodry 44,000 210,000 912,000 - - 1,166,000
dr.Guruh 425,000 165,000 250,000 278,000 - - 1,118,000
dr.Nurudin 110,000 165,000 160,000 414,000 - - 849,000
penata 480,000 - 480,000
asisten 1 480,000 - 480,000
asisten 2 240,000 - 240,000
on loop 120,000 - 120,000
dr.Elly Wijaya N,SpPD 4,750,000 540,000 200,000 6,863,000 - 12,353,000
dr.Irwan,SpB 200,000 3,270,000 - 3,470,000
dr.Nursyamsi,Sp.Og - 191,000 - 191,000
DR. Rezka.SpAN 1,225,000 - 1,225,000
dr.Awaludin,Sp.S 394,000 394,000
dr.Herlina 110,000 160,000 583,000 - - 853,000
dr,. Wiwi 355,000 290,000 697,000 - 1,342,000
dr.Yati - 80,000 262,000 - - 342,000
dr.Eha 428,000 160,000 423,000 - - 1,011,000
dr.Lodry 44,000 210,000 912,000 - - 1,166,000
dr.Guruh 425,000 165,000 250,000 278,000 - - 1,118,000
dr.Nurudin 110,000 165,000 160,000 414,000 - - 849,000
penata 480,000 - 480,000
asisten 1 480,000 - 480,000
asisten 2 240,000 - 240,000
on loop 120,000 - 120,000
LAMPIRAN 1. JASA MEDIS DOKTER UMUM,DOKTER AHLI & KRU OK BULA
RAJAL RANAP
NO NAMA DOKTER JASA POLI VISUM KIR IGD
Rp 56,000 12,000
1 dr.Elly Wijaya N,SpPD 3,800,000 160,000
2 dr.Shinta,SpA - -
3 dr.Irwan,SpB 160,000 -
4 dr. Mahyudin.SpB - -
5 dr.Yadi,SpOg - -
6 dr.Nursyamsi,Sp.Og - -
7 dr. Rezka.SpAN -
8 dr,Abu,SpKK -
9 dr. Sigit .SpPD -
10 dr. Yanti,SpRAD -
11 dr.Guntur,Sp.Rad - -
12 dr.Awaludin,Sp.S - -
13 dr.Luhur,Sp.KJ -
14 drg.Intan - - -
15 dr.Herlina 77,000 - - 96,000
16 dr. Wiwi 178,500 56,000 - 174,000
17 dr. Eha 285,600 - 12,000 96,000
18 dr.Yati - - - 48,000
19 dr.Meri - - - -
20 dr.Guruh 297,500 - - 150,000
21 VCT Fersus - - - -
22 dr.Nurudin 77,000 - - 96,000
24 dr,Army - - - -
25 dr.Lodry 30,800 - - 126,000
26 Penata
27 Asisten 1
28 Asisten 2
On Loop
Total 4,906,400 56,000 12,000 946,000
AHLI & KRU OK BULAN OKTOBER 2015
Rp (1,088,000) dr. Emma

VISIT TINDAKAN ( HD ) EKG USG RONTEGENT

RPU RKB Rp 14,000 Rp 20,000 Rp 18,000
5,490,400 540,000 - 266,000
- - -
416,000 2,200,000
- -
- - -
152,800 - - 42,000
980,000 -
-
- -
- - 1,239,000 651,000
- 504,000 2,670,000
315,200
-
- -
349,800 -
418,200 - -
253,800 -
157,200 -
- -
166,800 165,000 -
- -
248,400 165,000 -
- -
547,200 -
400,000 -
400,000 -
144,000 -
72,000 -
8,515,800 5,066,000 - 266,000 1,785,000 3,321,000
 486000

TOTAL

10,256,400
-
2,776,000
-
-
194,800
980,000
-
-
1,890,000
3,174,000
315,200
-
-
522,800
826,700
647,400
205,200
-
779,300
- Sudah Masuk ke JMT Karyawan
586,400
-
704,000
400,000
400,000
144,000
72,000
24,874,200
LAMPIRAN 1. JASA MEDIS DOKTER UMUM,DOKTER AHLI & KRU OK BULAN O
RAJAL
NO NAMA DOKTER KIR VISUM IGD VISIT
JASA POLI
Rp 12,000 56,000
1 dr.Elly Wijaya N,SpPD
2 dr.Shinta,SpA
3 dr.Irwan,SpB
4 dr.Asep,SpB
5 dr.Yadi,SpOg
6 dr.Nursyamsi,Sp.Og Rp -
7 dr.Acep,SpAn
8 dr,Abu,SpKK
9 dr.Santi,Sp.Rad
10 dr.Guntur,Sp.Rad
11 dr.Awaludin,Sp.S
12 dr.Luhur,Sp.KJ
13 drg.Intan
14 dr.Herlina
15 dr.Indah
16 dr.Taufan
17 dr.Yati
18 dr.Meri
19 dr.Ema
20 dr.Ade ria
21 dr.Resti
22 dr.Arini
23 dr.Aji
24 dr.Lodry
25 Ustori ( Penata)
26 H. Udin ( Penata)
27 Yayan ( Penata)
28 Asisten 1
29 Asisten 2
30 Dedi ( Assisten 2)
31 On Loop

Total
RU OK BULAN Oktober 2014
RANAP
TINDAKAN EKG USG RONTEGENT TOTAL
Rp 14,000 Rp 20,000 Rp 18,000

Rp 52,401,999
 TINDAKAN PENUNJANG MEDIS RUANGAN
RUANGAN
NO Tanggal Nama Pasien JASMED OBAT
LAB GDS EKG PMI RO
Snack OBAT TUSLAG
1 02 Januari 2017 Ny.Eti Rp 128,500 Rp 290,000 6,000 621,000
2 03 Januari 2017 Sri sopiyatun Rp 128,500 Rp 290,000 6,000 683,000
3 05 Januari 2017 Eti Rohaeti,Ny Rp 128,500 Rp 290,000 6,000 621,500
4 06 Januari 2017 Tn.Sarmini Rp 128,500 Rp 290,000 6,000 621,000
5 07 Januari 2017 Warni.Ny Rp 128,500 Rp 290,000 6,000 621,500
6 09 Januari 2017 Eti.Ny Rp 128,500 Rp 290,000 6,000 621,000
7 12 Januari 2017 Asep Rp 128,500 Rp 290,000 6,000 772,000 335,000
8 14 Januari 2017 Ecin.Ny Rp 128,500 Rp 290,000 6,000 653,000 30,000
9 15 Januari 2017 Umar Hamidi.Tn Rp 128,500 Rp 290,000 6,000 653,000
10 16 Januari 2017 Ecin.Ny Rp 128,500 Rp 290,000 6,000 653,000
11 19 Januari 2017 Entin.Ny Rp 128,500 Rp 290,000 6,000 621,500
12 25 Januari 2017 Dede Awan.Tn Rp 128,500 Rp 290,000 6,000 621,500

1,542,000 3,480,000 72,000 7,763,000 - 365,000 - - - -

45000
27500
Ny.Suminah Bayar di bln Februar 10000
Ny.Asimah Bayar di bln Februari
 dr.Elly,SpPD dr. Nurudin] dr. Guruh GRAN TOTAL
USG Oksigen
VISIT VISIT
45,000 27500 1,118,000
45,000 27,500 1,180,000 -
45,000 27,500 1,118,500
45,000 27,500 1,118,000
45,000 27500 1,118,500
45,000 27500 1,118,000
96,000.00 45,000 27,500.00 1,700,000 -
45,000 27,500 1,180,000
45,000 27,500 1,150,000
45,000 27,500 1,150,000 (157)
45,000 27500 1,118,500
45,000 27500 1,118,500

-
- 96,000 540,000 165,000 165,000 14,188,000
NO TANGGAL NAMA PASIEN KLS JENIS PELAYANAN

1 1-Jan-17 Ny. Eha Julaeha Askes

2 1-Jan-17 Ny. Juariyah I-VVIP Premi
3 7-Jan-17 Tn. Miska II-I Premi
4-Jan-17 Kanti II-I Premi
4 9-Jan-17 Ny. Siti Latifah II-I Premi
5 9-Jan-17 Ny. Hj. Asiah I-VIP Askes
6 9-Jan-17 Ny. Enting I II) Premi
7 9-Jan-17 Ny. Emah III-I Premi
8 10-Jan-17 Nn. Devvie putri I - VIP Askes
9 10-Jan-17 Ny. Suhartini I-VIP Askes
10 10-Jan-17 Tn. Nurhaer I-VIP Askes
11 10-Jan-17 Tn. Wirya I-VIP Askes
12 15-Jan-17 Ny. Atjih II-VIP Askes
13 17-Jan-17 Ny. Hj. Aan Amelia II-VIP Premi
14 18-Jan-17 Tn. Mahfud II-VIP Premi
15 20-Jan-17 Ny. Suhartini I-VIP Askes
16 26-Jan-17 Ny.Enih Munaroh II-I Askes
28-Jan-17 Tn.H.Didi I-VIP Askes
29-Jan-17 Ny.Rusminah III-I
BIAYA PENAMBAHAN Tarif RS taRIF inacbgS TOTAL PENDAPATAN Sia Piutang

2,380,000 380,000
2,720,000
491,000
240,000
564,000
1,130,000
942,000
490,000
810,000
413,600
612,000
1,105,200
818,000
3,780,000
700,000
612,000
865,000
1,646,000
1,050,000

21,368,800