sheet1 1

No. Tgl. Masuk Tgl. Pulang No. RM

5 24 Jul 2018 1 Agu 2018 958111
2 27 Jul 2018 1 Agu 2018 066289
1 29 Jul 2018 1 Agu 2018 026885
4 28 Jul 2018 1 Agu 2018 014630
3 30 Jul 2018 1 Agu 2018 084121
6 31 Jul 2018 1 Agu 2018 084127
1 Agu 2018 Cou 6
29 8 Agu 2018 10 Agu 2018 075500
10 Agu 2018 Co 1
30 6 Agu 2018 11 Agu 2018 084214
11 Agu 2018 Co 1
32 7 Agu 2018 12 Agu 2018 084242
31 8 Agu 2018 12 Agu 2018 084259
33 9 Agu 2018 12 Agu 2018 084270
12 Agu 2018 Co 3
34 7 Agu 2018 13 Agu 2018 083650
13 Agu 2018 Co 1
36 11 Agu 2018 14 Agu 2018 084302
35 11 Agu 2018 14 Agu 2018 956408
14 Agu 2018 Co 2
39 12 Agu 2018 15 Agu 2018 085916
37 13 Agu 2018 15 Agu 2018 086014
38 13 Agu 2018 15 Agu 2018 084335
15 Agu 2018 Co 3
40 14 Agu 2018 18 Agu 2018 084565
18 Agu 2018 Co 1
41 15 Agu 2018 19 Agu 2018 039416
42 15 Agu 2018 19 Agu 2018 064471
19 Agu 2018 Co 2
10 30 Jul 2018 2 Agu 2018 072608
9 30 Jul 2018 2 Agu 2018 020618
8 31 Jul 2018 2 Agu 2018 068283
7 1 Agu 2018 2 Agu 2018 084139
2 Agu 2018 Cou 4
45 20 Agu 2018 23 Agu 2018 958631
43 19 Agu 2018 23 Agu 2018 957741
46 20 Agu 2018 23 Agu 2018 086085
44 22 Agu 2018 23 Agu 2018 079104
23 Agu 2018 Co 4
47 15 Agu 2018 24 Agu 2018 069314
24 Agu 2018 Co 1
48 23 Agu 2018 26 Agu 2018 084530
49 23 Agu 2018 26 Agu 2018 958179
50 25 Agu 2018 26 Agu 2018 960557
51 25 Agu 2018 26 Agu 2018 036754
26 Agu 2018 Co 4
52 24 Agu 2018 27 Agu 2018 084543
53 25 Agu 2018 27 Agu 2018 086331
27 Agu 2018 Co 2
55 21 Agu 2018 28 Agu 2018 956408
54 26 Agu 2018 28 Agu 2018 820009

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28 Agu 2018 Co 2
12 29 Jul 2018 3 Agu 2018 070559
15 30 Jul 2018 3 Agu 2018 958616
13 31 Jul 2018 3 Agu 2018 085734
14 2 Agu 2018 3 Agu 2018 066690
11 1 Agu 2018 3 Agu 2018 084135
3 Agu 2018 Cou 5
57 22 Agu 2018 30 Agu 2018 084594
56 27 Agu 2018 30 Agu 2018 075319
58 27 Agu 2018 30 Agu 2018 081864
30 Agu 2018 Co 3
61 29 Agu 2018 31 Agu 2018 058068
63 29 Agu 2018 31 Agu 2018 086368
59 29 Agu 2018 31 Agu 2018 957015
66 30 Agu 2018 31 Agu 2018 079855
64 30 Agu 2018 31 Agu 2018 086381
65 30 Agu 2018 31 Agu 2018 086382
62 30 Agu 2018 31 Agu 2018 073633
60 30 Agu 2018 31 Agu 2018 086387
31 Agu 2018 Co 8
17 2 Agu 2018 6 Agu 2018 066644
16 3 Agu 2018 6 Agu 2018 051466
6 Agu 2018 Cou 2
18 5 Agu 2018 7 Agu 2018 700008
7 Agu 2018 Cou 1
20 6 Agu 2018 8 Agu 2018 033368
21 4 Agu 2018 8 Agu 2018 084188
22 6 Agu 2018 8 Agu 2018 077011
19 7 Agu 2018 8 Agu 2018 084248
8 Agu 2018 Cou 4
23 6 Agu 2018 9 Agu 2018 067620
25 6 Agu 2018 9 Agu 2018 064284
27 5 Agu 2018 9 Agu 2018 084210
24 7 Agu 2018 9 Agu 2018 085007
28 7 Agu 2018 9 Agu 2018 040827
26 6 Agu 2018 9 Agu 2018 084226
9 Agu 2018 Cou 6
Total
Kode RS: 1801015

Grand Count 66

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Nama Pasien No. SEP INACBG Top Up

M RIFA'I 0805R0010718V001364 E-4-10-I
M SIROZI 0805R0010718V001482 D-4-13-II
A MUZAMIL DRS 0805R0010718V001507 I-4-12-I
ROSIDAH 0805R0010718V001551 B-4-14-I
P SARAGIH 0805R0010718V001600 J-4-15-I
PATIRSON 0805R0010718V001620 K-4-18-I

WINDA ASTUTI 0805R0010818V000448 W-4-16-I

SUWARTI 0805R0010818V000278 E-4-10-III

RAHMAN BUSTONI 0805R0010818V000343 G-4-15-II

MUHAMMAD RISKI CHASIYA 0805R0010818V000453 J-4-18-I
IRTINA 0805R0010818V000481 W-4-12-II

DENI KURNIAWAN 0805R0010818V000369 B-4-13-I

MUNHAMIR 0805R0010818V000571 E-4-10-I

LENI,S.SOS 0805R0010818V000648 K-4-18-II

FIRNANDA KURNIA PUTRA 0805R0010818V000553 U-1-15-I

AHMAD JULIAN IGRA BATARA 0805R0010818V000687 L-1-40-I
KARYADI 0805R0010818V000774 I-4-20-III

NURPUDA 0805R0010818V000837 I-4-17-II

DENTI AFRINA 0805R0010818V000807 K-4-17-I

CHINTYA NAURA BERLIANSYAH 0805R0010818V000841 J-4-18-II

HARZIM 0805R0010718V001602 D-4-13-I

ALI YURZA 0805R0010718V001629 K-1-14-I
CYNTHIA MELIANISA 0805R0010718V001651 U-1-15-I
SAHRO 0805R0010818V000062 G-4-16-I

NURHIDAYATI 0805R0010818V000983 I-4-17-II

ABDUROSIK 0805R0010818V000990 I-4-12-I
KHADIJAH 0805R0010818V001037 L-1-50-I
ALBIZAR 0805R0010818V001067 B-4-14-I

BAYI NY LINDAYANA 0805R0010818V000777 G-4-22-III

RAHMIYATI 0805R0010818V001126 G-4-26-I

SRI WAHYULIN 0805R0010818V001138 K-4-17-I
SITI MASNA 0805R0010818V001262 I-4-12-III
RAMAL RAICIA ALAM SH 0805R0010818V001267 G-4-22-I

MAT BUKTIN 0805R0010818V001202 I-4-12-I

SYAMSUDIN 0805R0010818V001225 K-4-17-I

LENI,S.SOS 0805R0010818V001119 B-4-14-II

AMRON 0805R0010818V001265 N-1-30-I

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 sheet1 1

ABIYU AL FATIH 0805R0010718V001542 D-4-13-I

ROSMANIAH 0805R0010718V001633 D-4-13-II
HERLIS ZAINANI 0805R0010718V001665 D-4-13-I
LESTARI CLEOPATRA 0805R0010818V000161 I-4-21-I
ZHAFRAN KOTARA 0805R0010818V000162 K-4-17-I

YUSNANI Z 0805R0010818V001046 K-1-40-II

LAHMUDDIN 0805R0010818V001290 N-4-13-I
JON KENEDI 0805R0010818V001367 K-4-18-II

SAKRUNA 0805R0010818V001401 I-4-12-I

NADIA FRISANTI 0805R0010818V001455 K-4-18-I
DZAKI ADNAN 0805R0010818V001457 K-4-17-I
NUR HASANAH,A.MD 0805R0010818V001483 O-6-13-I
FALISHA SHAMIM NIBRAS 0805R0010818V001494 K-4-17-I
AZLAN DILAWAR MURTAZA 0805R0010818V001495 K-4-17-I
ENI LISDIAWATI 0805R0010818V001496 K-4-17-I
BELINA EKA PUTRI 0805R0010818V001498 I-4-17-I

EVITA PRATIWI 0805R0010818V000170 K-4-18-II

ELI YATI 0805R0010818V000180 B-4-14-I

TJIK INUN 0805R0010818V000209 E-4-10-II

MASYULIA 0805R0010818V000252 L-1-50-I

NGATMAN 0805R0010818V000259 N-4-10-II
ARFAN ALPARO 0805R0010818V000283 A-4-13-II
NOPRIYANTO 0805R0010818V000355 I-4-17-I

M. ASKOP UMAR 0805R0010818V000250 G-4-15-III

ATIKA RATIFA NURWANDYA 0805R0010818V000270 J-4-16-I
SURANTA 0805R0010818V000288 A-4-13-I
BAYI NY ROSMIATI 0805R0010818V000332 P-8-08-I
MASNAWI HD 0805R0010818V000357 L-1-40-I
ROSMIATI 0805R0010818V000360 O-6-10-I

Page 4
 sheet1 1

Total Tarif Tarif RS Jenis

4,704,800 9,009,394 RI
4,434,600 4,541,940 RI
3,638,300 1,991,274 RI
4,405,500 2,353,957 RI
5,650,000 1,474,903 RI
1,755,300 1,162,352 RI

2,825,000 1,805,119 RI

8,159,800 4,518,800 RI

5,128,000 2,093,077 RI
2,900,100 1,680,925 RI
5,180,700 2,982,164 RI

4,410,200 3,421,127 RI

4,704,800 2,110,392 RI
2,494,400 1,902,000 RI

5,013,700 4,875,070 RI
5,222,300 3,542,630 RI
7,384,800 1,868,073 RI

2,892,100 2,063,348 RI

1,986,500 1,818,634 RI
3,988,800 3,349,826 RI

3,133,300 2,536,754 RI
6,397,500 3,734,179 RI
5,013,700 4,004,209 RI
3,542,100 1,137,731 RI

2,892,100 1,884,082 RI
3,638,300 2,566,585 RI
6,855,800 3,597,272 RI
4,405,500 1,105,452 RI

5,325,700 5,748,921 RI

4,181,100 2,665,184 RI
1,986,500 1,767,798 RI
5,060,800 3,071,094 RI
3,567,300 3,588,587 RI

3,638,300 1,896,566 RI
1,986,500 1,427,568 RI

5,139,600 4,003,486 RI
9,110,400 4,606,937 RI

Page 5
 sheet1 1

3,133,300 3,189,994 RI
4,434,600 4,406,900 RI
3,133,300 2,361,130 RI
3,199,800 666,434 RI
1,986,500 1,279,261 RI

9,012,200 7,905,814 RI
4,590,500 1,418,278 RI
2,494,400 1,563,446 RI

3,638,300 1,542,086 RI
1,755,300 1,228,873 RI
1,986,500 1,298,116 RI
2,182,300 1,908,689 RI
1,986,500 903,230 RI
1,986,500 890,590 RI
1,986,500 891,024 RI
2,484,200 1,178,881 RI

2,494,400 2,475,204 RI
4,405,500 1,741,324 RI

6,574,100 1,802,433 RI

6,855,800 3,268,500 RI
4,204,400 2,637,750 RI
3,211,600 1,080,543 RI
2,484,200 930,124 RI

7,237,700 1,665,614 RI
4,707,600 1,747,719 RI
2,131,900 3,516,642 RI
5,426,500 427,796 RI
5,222,300 3,441,284 RI
6,823,200 4,495,823 RI

274,524,100 169,770,912

Page 6
Tgl. Masuk Tgl. Pulang Nama Pasien No. SEP
24 Jul 2018 1 Agu 2018 M RIFA'I 0805R0010718V001364
27 Jul 2018 1 Agu 2018 M SIROZI 0805R0010718V001482
29 Jul 2018 1 Agu 2018 A MUZAMIL DRS 0805R0010718V001507
28 Jul 2018 1 Agu 2018 ROSIDAH 0805R0010718V001551
30 Jul 2018 1 Agu 2018 P SARAGIH 0805R0010718V001600
31 Jul 2018 1 Agu 2018 PATIRSON 0805R0010718V001620
6
8 Agu 2018 10 Agu 2018 WINDA ASTUTI 0805R0010818V000448
1
6 Agu 2018 11 Agu 2018 SUWARTI 0805R0010818V000278
1
7 Agu 2018 12 Agu 2018 RAHMAN BUSTONI 0805R0010818V000343
8 Agu 2018 12 Agu 2018 MUHAMMAD RISKI CHASIYA 0805R0010818V000453
9 Agu 2018 12 Agu 2018 IRTINA 0805R0010818V000481
3
7 Agu 2018 13 Agu 2018 DENI KURNIAWAN 0805R0010818V000369
1
11 Agu 2018 14 Agu 2018 MUNHAMIR 0805R0010818V000571
11 Agu 2018 14 Agu 2018 LENI,S.SOS 0805R0010818V000648
2
12 Agu 2018 15 Agu 2018 FIRNANDA KURNIA PUTRA 0805R0010818V000553
13 Agu 2018 15 Agu 2018 AHMAD JULIAN IGRA BATARA 0805R0010818V000687
13 Agu 2018 15 Agu 2018 KARYADI 0805R0010818V000774
3
14 Agu 2018 18 Agu 2018 NURPUDA 0805R0010818V000837
1
15 Agu 2018 19 Agu 2018 DENTI AFRINA 0805R0010818V000807
15 Agu 2018 19 Agu 2018 CHINTYA NAURA BERLIANSYAH 0805R0010818V000841
2
30 Jul 2018 2 Agu 2018 HARZIM 0805R0010718V001602
30 Jul 2018 2 Agu 2018 ALI YURZA 0805R0010718V001629
31 Jul 2018 2 Agu 2018 CYNTHIA MELIANISA 0805R0010718V001651
1 Agu 2018 2 Agu 2018 SAHRO 0805R0010818V000062
4
20 Agu 2018 23 Agu 2018 NURHIDAYATI 0805R0010818V000983
19 Agu 2018 23 Agu 2018 ABDUROSIK 0805R0010818V000990
20 Agu 2018 23 Agu 2018 KHADIJAH 0805R0010818V001037
22 Agu 2018 23 Agu 2018 ALBIZAR 0805R0010818V001067
4
15 Agu 2018 24 Agu 2018 BAYI NY LINDAYANA 0805R0010818V000777
1
23 Agu 2018 26 Agu 2018 RAHMIYATI 0805R0010818V001126
23 Agu 2018 26 Agu 2018 SRI WAHYULIN 0805R0010818V001138
25 Agu 2018 26 Agu 2018 SITI MASNA 0805R0010818V001262
25 Agu 2018 26 Agu 2018 RAMAL RAICIA ALAM SH 0805R0010818V001267
4
24 Agu 2018 27 Agu 2018 MAT BUKTIN 0805R0010818V001202
25 Agu 2018 27 Agu 2018 SYAMSUDIN 0805R0010818V001225
2
21 Agu 2018 28 Agu 2018 LENI,S.SOS 0805R0010818V001119
26 Agu 2018 28 Agu 2018 AMRON 0805R0010818V001265
2
29 Jul 2018 3 Agu 2018 ABIYU AL FATIH 0805R0010718V001542
30 Jul 2018 3 Agu 2018 ROSMANIAH 0805R0010718V001633
31 Jul 2018 3 Agu 2018 HERLIS ZAINANI 0805R0010718V001665
2 Agu 2018 3 Agu 2018 LESTARI CLEOPATRA 0805R0010818V000161
1 Agu 2018 3 Agu 2018 ZHAFRAN KOTARA 0805R0010818V000162
5
22 Agu 2018 30 Agu 2018 YUSNANI Z 0805R0010818V001046
27 Agu 2018 30 Agu 2018 LAHMUDDIN 0805R0010818V001290
27 Agu 2018 30 Agu 2018 JON KENEDI 0805R0010818V001367
3
29 Agu 2018 31 Agu 2018 SAKRUNA 0805R0010818V001401
29 Agu 2018 31 Agu 2018 NADIA FRISANTI 0805R0010818V001455
29 Agu 2018 31 Agu 2018 DZAKI ADNAN 0805R0010818V001457
30 Agu 2018 31 Agu 2018 NUR HASANAH,A.MD 0805R0010818V001483
30 Agu 2018 31 Agu 2018 FALISHA SHAMIM NIBRAS 0805R0010818V001494
30 Agu 2018 31 Agu 2018 AZLAN DILAWAR MURTAZA 0805R0010818V001495
30 Agu 2018 31 Agu 2018 ENI LISDIAWATI 0805R0010818V001496
30 Agu 2018 31 Agu 2018 BELINA EKA PUTRI 0805R0010818V001498
8
2 Agu 2018 6 Agu 2018 EVITA PRATIWI 0805R0010818V000170
3 Agu 2018 6 Agu 2018 ELI YATI 0805R0010818V000180
2
5 Agu 2018 7 Agu 2018 TJIK INUN 0805R0010818V000209
1
6 Agu 2018 8 Agu 2018 MASYULIA 0805R0010818V000252
4 Agu 2018 8 Agu 2018 NGATMAN 0805R0010818V000259
6 Agu 2018 8 Agu 2018 ARFAN ALPARO 0805R0010818V000283
7 Agu 2018 8 Agu 2018 NOPRIYANTO 0805R0010818V000355
4
6 Agu 2018 9 Agu 2018 M. ASKOP UMAR 0805R0010818V000250
6 Agu 2018 9 Agu 2018 ATIKA RATIFA NURWANDYA 0805R0010818V000270
5 Agu 2018 9 Agu 2018 SURANTA 0805R0010818V000288
7 Agu 2018 9 Agu 2018 BAYI NY ROSMIATI 0805R0010818V000332
7 Agu 2018 9 Agu 2018 MASNAWI HD 0805R0010818V000357
6 Agu 2018 9 Agu 2018 ROSMIATI 0805R0010818V000360
6

66