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LAPORAN PASIEN RONTGEN BP.

MARDI NUGROHO WELAHAN


BULAN : SEPTEMBER 2013
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/9/2013 1632/13 AN.NABIL FAHMI 3TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
2 2/9/2013 605/08 NY.SITI SUPARTI 50TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
3 2/9/2013 1560/00 NY.BALIMAH 53TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
4 2/9/2013 4080/13 TN.SUGIYONO 45TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
5 2/9/2013 4081/13 NY.MASIRAH 73TH THORAX PA dr.ANE RUJUK 58000 5000 63000
6 3/9/2013 852/13 TN. MUHLISIN 42TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
7 3/9/2013 1241/13 AN. JIHAN NAJWA 2TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
8 3/9/2013 4003/13 TN. ABDUL GHOFUR 43TH THORAX PA dr.ANE RUJUK 58000 5000 63000
9 3/9/2013 2123/13 NN. LISTIANINGSIH 20TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
10 3/9/2013 4114/13 NY. ANA PUJIYANTI 33TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
11 4/9/2013 1225/13 AN. M. ABDA YUSRO 2,6TH THORAX AP dr.ANE dr.MICHEL 52000 18000 7000
12 4/9/2013 3571/13 TN MASRUN 57TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
13 4/9/2013 304/12 NY.DEWI 26TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
14 4/9/2013 2018/13 TN ABDUL ROHIM 63TH LUMBAL AP/LAT dr.FENNY dr.LISA 120000 20000 140000
15 4/9/2013 4137/13 TN SUTARNO 55TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
16 4/9/2013 4179/13 SDR MUKSON 25TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
17 5/9/2013 5017/12 TN. MUNADI 52TH THORAX PA dr.SHOLKHIN dr.LISA 58000 18000 76000
18 5/9/2013 4143/13 AN.ABDUL ROHMAN 1,6TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
19 5/9/2013 2117/11 TN AHMAD 75TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
20 5/9/2013 4152/13 NY. SRININGSIH 30TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
21 5/9/2013 4153/13 AN.ASKA ALFADILAH 1,2TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
22 6/9/2013 4158/13 TN. MASUDI 52TH LUMBAL AP/LAT dr.ANE dr.LINA 120000 20000 140000
23 6/9/2013 4172/13 NY. SITI MUSTOFIAH 31TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
24 6/9/2013 1295/13 NY.MASKANAH 50TH THORAX PA dr.ANE dr.LINA 58000 18000 76000
25 7/9/2013 1861/07 TN.URIP UTOMO 66TH CLAVICULA AP dr.ANE dr.LINA 65000 18000 83000
26 7/9/2013 3975/05 NY.ISMAIYAH 24TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
27 9/9/2013 3647/10 NY.RUKANAH 67TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
28 9/9/2013 4183/13 SDR.AHMAD MUSAFAK 20TH THORAX PA dr.ANE DR.LISA 58000 18000 76000
29 9/9/2013 4164/08 TN.KAHONO 31TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
30 9/9/2013 1025/11 AN.FAIZ ARYAGUNA 3,6TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
31 9/9/2013 4196/13 TN.ARIF MUNTAHA 38TH THORAX PA dr.ANE DR.LISA 58000 18000 76000
32 9/9/2013 3712/13 NY.SUMARNI 55TH CERVICAL AP/LAT dr.ANE dr.MICHEL 65000 20000 85000
33 9/9/2013 1608/13 AN.MOH.AULIA UMAR 2,6TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
34 10/9/2013 1548/13 TN.SUNARTO 48TH THORAX AP dr.ANE dr.MICHEL 58000 18000 76000
35 10/9/2013 3989/13 TN.MASHUR 56TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
36 11/9/2013 4229/13 TN.SULHAN 65TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
37 11/9/2013 3672/12 TN.KARSONO 60TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
38 11/9/2013 4230/13 NY FATIMAH 80TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
39 11/9/2013 5070/12 NY MUNAYAH 46TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
40 11/9/2013 2783/08 NY.SUPARTI 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
41 11/9/2013 4237/13 TN.MUNDAKIR 28TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
42 12/9/2013 4249/13 TN.MASLURI 35TH ABDOMEN dr.ANE dr.MICHEL 0 18000 76000
43 12/9/2013 4256/13 NY.SITI RUKAYAH 39TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
44 12/9/2013 4261/13 NY.FATIMAH 55TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
45 13/9/2013 4265/13 AN.MOH.SYAFI' AHDANI 11BLN THORAX AP dr.ANE dr.LISA 52000 18000 70000
46 13/9/2013 3246/12 TN.JAMARI 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
47 13/9/2013 4273/13 NY.JASMI 70TH THORAX PA dr.ANE DR.LISA 58000 18000 76000
48 13/9/2013 4283/13 NY.SUMIRAH 44TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
49 13/9/2013 3165/11 TN.ALI 60TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
50 14/9/2013 163/11 NY.SUKIRAH 52TH THORAX PA dr.ANE DR.MICHEL 58000 18000 76000
51 14/9/2013 4441/09 AN.DIKA NUR ALAMSYAH 4TH THORAX PA dr.ANE dr.LISA 52000 18000 70000
52 14/9/2013 3362/03 NY.NGASIRAH 65TH THORAX PA dr.ANE RUJUK 58000 5000 63000
53 16/9/2013 5167/02 NY.NUR HIKMAH 60TH LUMBAL AP/LAT dr.ANE DR.MICHEL 120000 20000 140000
54 16/9/2013 4307/13 AN.OLIVIA ARINA CINTYA 15BLN THORAX AP dr.ANE dr.LISA 52000 18000 70000
55 16/9/2013 4241/13 SDR.BAGAS 16TH THORAX PA dr.ANE DR.MICHEL 58000 18000 76000
56 16/9/2013 1603/08 NY.SITI MASKANAH 58TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
57 16/9/2013 4313/13 TN.MOH.SHOLIKIN 29TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
58 17/9/2013 3844/13 TN.MASUDI 60TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
59 17/9/2013 3562/09 AN.MOH.WAHIM ZAKARIA 5TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
60 17/9/2013 4332/13 TN.JUARI 38TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
61 17/9/2013 824/13 AN.ANDISTA 5TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
62 17/9/2013 2497/12 NY.MAHMUDAH 51TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
63 17/9/2013 3018/09 NY.ENI HADI 34TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
64 18/9/2013 300/13 AN.AHMAD FANZA.M 2,6TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
65 18/9/2013 4365/13 TN.SUPARMAN 36TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
66 19/9/2013 522/13 NY.TUGIRAH 40TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
67 19/9/2013 4372/13 SDR.NOR REFA 19TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
68 19/9/2013 4186/13 AN.NAUFAL ARSYAD 19BLN THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
69 19/9/2013 1614/13 NY.SUDARSO 66TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
70 20/9/2013 4384/13 TN.RUSDI 62TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
71 20/9/2013 4394/13 TN.MASRUHAN 54TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
72 20/9/2013 4091/13 NY.HJ.HALIMAH 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
73 20/9/2013 3162/10 NY.UMIYATI 40TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
74 21/09/2013 4411/13 SDR.SAMI'AN 29TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
75 21/09/2013 4412/13 NY.WARSINI 53TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
76 21/09/2013 4413/13 TN.SUTOMO 68TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
77 21/09/2013 4416/13 TN.SLAMET PURNOMO 49TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
78 21/09/2013 4247/13 TN.KUNDORI 50TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
79 21/09/2013 4420/13 AN.MOH.YAVAR ALI.M 12TH ANKLE JOINT AP/LAT dr.ANE RUJUK 80000 5000 85000
80 23/09/2013 2720/13 TN.AHADI 40TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
81 23/09/2013 4425/13 NY.MUZAENAH 70TH PELVIS AP dr.ANE dr.LISA 58000 18000 76000
82 23/09/2013 456/10 NY.SUKARTI 64TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
83 23/09/2013 4426/13 SDR.ARIF ANDRIAWAN 17TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
84 23/09/2013 4311/12 AN.AHMAD REZA AFIKI 18BLN THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
85 23/09/2013 4434/13 NY.DARSIH 60TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
86 23/09/2013 2356/13 TN.AHMAD MUNODO 46TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
87 23/09/2013 4443/13 TN.SUPADI 75TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
88 24/09/2013 4436/13 TN.SUTARNO 62TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
89 24/09/2013 4453/13 TN.MAKMUR 46TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
90 24/09/2013 4346/13 TN.NUR KHOLIK 53TH WATER'S SPN dr.ANE dr.MICHEL 52000 18000 70000
91 24/09/2013 4458/13 TN.KASNADI 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
92 24/09/2013 4459/13 TN.KASWADI 60TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
93 24/09/2013 4471/13 NN.FITRI 25TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
94 24/09/2013 4469/13 TN.MUSNAN 34TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
95 24/09/2013 4477/13 NN.SAMATUL FITRIYANI 15TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
96 25/09/2013 4481/13 TN.HANDONO 42TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
97 25/09/2013 1725/13 AN.ZAHRA KALULA MAULIDA 2TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
98 25/09/2013 4485/13 TN.SOEKARNO 57TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 80000 18000 98000
99 26/09/2013 420/12 AN.LAILI MAHFUDAH 2TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
100 26/09/2013 1264/12 AN.NASHA SAFATUL 3TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
101 26/09/2013 4508/13 TN.AHMAD MUZIL 31TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
102 27/09/2013 4512/13 NY.SUTIKAH 44TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
103 27/09/2013 5003/12 AN.NISRINA AMELIA 2TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
104 27/09/2013 1690/13 AN.HABIBULLAH 1TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
105 27/09/2013 4526/13 NY.SHOLIHATUN 35TH SHOULDER JOINT AP/LAT dr.ANE dr.LISA 80000 18000 98000
106 28/09/2013 1675/13 TN.SUNARYO 53TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
107 28/09/2013 3180/11 NY.HARTINI 57TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
108 28/09/2013 1342/13 TN.KASNADI 60TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
109 28/09/2013 4538/13 SDR.ROSID 23TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
110 30/09/2013 4542/13 NY.H.SUKOTUN 56TH GENUE AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
111 30/09/2013 880/13 NY.NGATMIRAH 55TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
112 30/09/2013 4343/13 TN.SAFAAT ZARKORI 44TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
113 30/09/2013 3937/06 NY.SITI 54TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
114 30/09/2013 4548/13 TN.SLAMET 37TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
115 30/09/2013 3407/04 TN.BARDI 58TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
116 30/09/2013 1774/13 TN.URIP FADHOLI 45TH CRANIUM 2PSS+ELBOW dr.ANE dr.LISA 180000 38000 218000
117 30/09/2013 4190/08 AN.SINTA ROKHATULHAYA 5TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
118 30/09/2013 2658/13 AN.MOH.BIAN RISWANTO 2TH THORAX PA dr.ANE dr.LISA 58000 18000 76000

Mengetahui Welahan,30 September 2013

Kepala BP.Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN BP. MARDI NUGROHO WELAHAN
BULAN : OKTOBER 2013
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/10/2013 3006/12 TN.SUDARDI 34TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
2 1/10/2013 4208/13 NY.MARIATI 40TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
3 1/10/2013 3633/13 TN.SUNARTO 45TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
4 1/10/2013 2567/13 TN.KUSMANTO 49TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
5 1/10/2013 4566/13 TN.ZAZERI 59TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
6 1/10/2013 52/08 TN.SOLIKHIN 34TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
7 2/10/2013 4577/13 SDR.MOH.ABDUL AZIZ 19TH THORAX PA dr.LULUK dr.MICHEL 58000 18000 76000
8 2/10/2013 881/13 NY.WIJAYANTI 30TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
9 2/10/2013 4584/13 TN.SUHARI 62TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
10 2/10/2013 4585/13 TN.BUSRI 67TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
11 2/10/2013 4528/13 NY.CICIK HIDAYATI 27TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
12 3/10/2013 4601/13 NN.RINI ASTUTI 13TH SPN WATER'S dr.ANE dr.LISA 52000 18000 70000
13 4/10/2013 4611/13 TN.MIFTAHUL HUDA 33TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
14 4/10/2013 4605/13 SDR.ROKIHMAT PUJIONO 23TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
15 4/10/2013 4612/13 AN.AGUNG PRASETYAN 10TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
16 4/10/2013 4614/13 TN.WIRYO 53TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
17 4/10/2013 2374/07 TN.NUR KHAFIT 37TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
18 4/10/2013 4120/12 AN.KHARISMA MASIATI 19BLN THORAX AP dr.ANE dr.LISA 52000 18000 70000
19 4/10/2013 4090/09 SDR.FIRDAUS FURKAN 18TH CERVIKAL AP/LAT dr.ANE dr.MICHEL 65000 20000 85000
20 4/10/2013 4226/06 AN.NUR ABIDIN 10TH THORAX PA dr.ANE dr.LISA 52000 18000 70000
21 5/10/2013 1017/13 TN.MUNDAKIR 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
22 5/10/2013 1930/12 TN.SUNJANI 61TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
23 5/10/2013 4148/12 AN.ANISA MAULIDA 2,6TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
24 5/10/2013 762/11 TN.RONDI 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
25 5/10/2013 309/07 NY.MASTUFAH 28TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
26 7/10/2013 1825/13 SDR.AHMAD HAMDAN 20TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
27 7/10/2013 4430/13 SDR.AHMAD YAZID 22TH GENUE AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
28 7/10/2013 4655/13 TN.MUSTAFIRIN 27TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
29 7/10/2013 4656/13 TN.ZULI KURNIAWAN 20TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
30 7/10/2013 4560/13 NY.ANIK SAFAATUR ROHMAH 24TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
31 7/10/2013 3514/06 NY.MUSTAKIMAH 57TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
32 8/10/2013 4675/13 NY.HJ.SITINAH 75TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
33 8/10/2013 4681/13 NN.HIDAYATUL KHOIROH 19TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
34 8/10/2013 2182/02 NY.SOFIATUN 38TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
35 8/10/2013 4685/13 TN.RAGIL UNTUNG PRABOWO 26TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
36 8/10/2013 4687/13 NY.ZAENAH 75TH THORAX AP dr.ANE dr.LISA 58000 18000 76000
37 8/10/2013 4408/13 SDR.SUKAMTO 29TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
38 8/10/2013 4693/13 TN.KLIWON 55TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
39 9/10/2013 4513/13 NY.SUPARNI 60TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
40 9/10/2013 4704/13 NY.SARMI 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
41 9/10/2013 2816/98 TN.H.IRSAT 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
42 10/10/2013 790/06 AN.GINA DEA 8TH THORAX PA dr.ANE dr.LISA 52000 18000 70000
43 10/10/2013 2802/12 TN.SUANDI 65TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
44 10/10/2013 4722/13 TN.ARIFIN 51TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
45 10/10/2013 4650/13 TN.SUTRISNO 48TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
46 10/10/2013 2388/12 TN.AHMAD YASIR 43TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
47 11/10/2013 4603/13 MUNTONO 72TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
48 11/10/2013 4729/13 TN.NASERI 57TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
49 12/10/2013 2475/04 TN.SARMAN 75TH THORAX PA dr.ANE RUJUK 58000 5000 63000
50 12/10/2013 3925/11 NY.HJ.UMI FATIMAH 68TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
51 12/10/2013 2586/13 AN.ZAHWA KHOIRUNISA 2TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
52 12/10/2013 3690/05 TN.DARSONO 45TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
53 14/10/2013 4756/13 TN.BUSONO 38TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
54 16/10/2013 4758/13 AN.MOH.FAID DUDIN 11TH GENUE AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
55 16/10/2013 4336/13 AN.NUR LAILATUL FADILAH 4TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
56 16/10/2013 4784/13 AN.EVA ASRI RAHMAWATI 11TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
57 17/10/2013 5078/12 AN.FAZA ALAMSAH 14BLN THORAX AP dr.ANE dr.LISA 52000 18000 70000
58 17/10/2013 3948/10 NY.HJ.ASRIYAH 60TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
59 17/10/2013 1082/11 NY.ZENI 33TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
60 17/10/2013 121/12 AN.MOH.HAIDAR ALI 2TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
61 17/10/2013 3617/09 TN.SUPONO 50TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
62 17/10/2013 3829/12 NY.SUKOWATI 28TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
63 18/10/2013 4817/13 NY.MASTIAH 55TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
64 18/10/2013 3650/11 NY.MUSYAWANAH 42TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
65 18/10/2013 4833/13 NY.KAROMI 65TH THORAX PA dr.ANE dr.LISA 56000 18000 76000
66 18/10/2013 4836/13 NY.ANA FARIDA 27TH THORAX PA dr.ANE dr.MICHEL 56000 18000 76000
67 19/10/2013 2607/02 NY.SUMINAH 51TH ANKLE JOINT AP/LAT dr.ANE dr.LISA 80000 18000 98000
68 19/10/2013 4840/13 TN.SUTAHAN 62TH THORAX PA dr.ANE dr.MICHEL 56000 18000 76000
69 21/10/2013 2143/13 TN.SUHADI 48TH THORAX PA dr.ANE dr.LISA 56000 18000 76000
70 21/10/2013 4848/13 TN.MASHADI 31TH ABDOMEN dr.ANE dr.MICHEL 56000 18000 76000
71 21/10/2013 2323/11 AN.RIFKIATUN 14TH PEDIS AP/OBLIQUE dr.ANE dr.LISA 80000 18000 98000
72 21/10/2013 4852/13 TN.SISWOYO 42TH LUMBAL AP/LAT dr.ANE RUJUK 120000 5000 125000
73 21/10/2013 4857/13 NY.SULAEMAH 53TH GENUE AP/LAT dr.ANE RUJUK 80000 5000 85000
74 21/10/2013 4073/11 NY.HARTI 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
75 22/10/2013 4870/13 SDR.SETIO WAHYUDI 20TH THORAX PA dr.ANE dr.LISA 56000 18000 76000
76 22/10/2013 327/11 NY.NUR KALIMAH 21TH THORAX PA dr.ANE dr.MICHEL 56000 18000 76000
77 22/10/2013 4878/13 TN.ANDI UHARJONO 55TH CRANIUM AP/LAT dr.ANE RUJUK 100000 5000 105000
78 23/10/2013 4884/13 NY.SUJINAH 70TH LUMBAL AP/LAT dr.ANE dr.LISA 56000 18000 76000
79 23/10/2013 2230/13 AN.ULUL AUFA 2,6TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
80 24/10/2013 4899/13 NY.MURSIDAH 42TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
81 24/10/2013 4895/13 TN.SYARIF ASY'ARI 42TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
82 24/10/2013 4910/13 NY.SULIKAH 45TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
83 25/10/2013 2908/11 TN.MASIAN 56TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
84 25/10/2013 2226/13 TN.DAMJI 60TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
85 25/10/2013 2386/13 AN.ARMAN MAULANA 7TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
86 25/10/2013 4917/13 SDR.AHMAD SYIFA 16TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
87 25/10/2013 4916/13 AN.MOH.ARDIRA RAMADON 5TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
88 25/10/2013 4924/13 NY.KARWATI 38TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
89 25/10/2013 2257/13 AN.SABRINA HAIFA 3TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
90 25/10/2013 4922/13 AN.WAHYU EKO BUDI 5TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
91 25/10/2013 1822/12 NY.MUNARSIH 34TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
92 26/10/2013 3844/12 TN.BASRI 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
93 26/10/2013 2218/13 AN.DAVIAN 3TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
94 26/10/2013 4942/13 NY.SITI ROFIAH 30TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
95 28/10/2013 4948/13 NY.ASTUTI 34TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
96 28/10/2013 1352/03 AN.AZIS NOR FAHMI 15TH PEDIS AP/OBLIQUE dr.ANE dr.LISA 80000 18000 98000
97 28/10/2013 4947/13 TN.SUNTONO 54TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
98 28/10/2013 3902/13 SDR.ZAINAL 23TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
99 28/10/2013 4952/13 TN.SUKADAR 65TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
100 28/10/2013 3630/07 NY.SUNARTI 55TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
101 28/10/2013 4220/11 NY.SUKARTI 28TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
102 29/10/2013 4974/13 TN.WAGIMIN 70TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
103 29/10/2013 714/07 AN.BIMA SETIAWAN 7TH CRANIUM AP/LAT dr.ANE dr.MICHEL 100000 20000 120000
104 29/10/2013 3936/09 AN.VAVIAN SURYA PRATAMA 4TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
105 29/10/2013 4864/13 NY.ENI RAHMAWATI 36TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
106 29/10/2013 3608/12 NY.NUR HIDAYAH 43TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
107 29/10/2013 4979/13 NY.KASIN 60TH THORAX PA dr.BAMBANG dr.MICHEL 58000 18000 76000
108 29/10/2013 4981/13 NY.ARTINAH 60TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
109 29/10/2013 4076/11 NY.SUDIYAH 37TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
110 29/10/2013 1888/13 TN.BAMBANG SUGIYANTO 44TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
111 29/10/2013 4183/12 NY.SUTRIMIN 52TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
112 30/10/2013 2365/11 NY.HJ.RUKIYAH 54TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
113 30/10/2013 4999/13 TN.M.TOHA 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
114 30/10/2013 4997/13 NY.NOR MASLIKAH 30TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
115 30/10/2013 5004/13 NY.RUBIAH 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
116 30/10/2013 5008/13 TN.NUR IRSAD 35TH SHOULDER JOINT 2 POSISI dr.ANE dr.MICHEL 80000 18000 98000
117 30/10/2013 2313/10 NY.SULASAH 54TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
118 30/10/2013 4931/13 NY.ZULIANTI 28TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
119 31/10/2013 4963/13 TN.JUNAIDI 50TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
120 31/10/2013 5015/13 AN.MOH.AL AKHLA 5TH THORAX PA dr.ANE dr.LISA 52000 18000 70000
121 31/10/2013 3547/13 TN.TRIONO SUBAGIO 45TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
122 31/10/2013 5017/13 NY.SURAYAH 50TH PELVIS AP dr.ANE RUJUK 58000 5000 63000
123 31/10/2013 2656/07 SDR.ABDUL WAHID 22TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000

Welahan,1 November 2013

Kepala BP.Mardi Nugroho Yang Membuat Laporan


(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)
LAPORAN PASIEN RONTGEN BP. MARDI NUGROHO WELAHAN
BULAN : NOVEMBER 2013
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/11/2013 5034/13 NY.ALIATI 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
2 1/11/2013 5027/13 TN.MANAN 47TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
3 1/11/2013 4007/13 NY.TRI MARWATI 29TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
4 1/11/2013 5032/13 TN.SUYOTO 53TH WATER'S SPN dr.ANE dr.LISA 52000 18000 70000
5 1/11/2013 1783/12 AN.REZA ARDIANSYAH 1,6TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
6 2/11/2013 1550/11 NY.SUPARTI 67TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
7 2/11/2013 910/11 NY.NASRO 58TH LUMBAL AP/LAT BUDIYONO dr.MICHEL 120000 20000 140000
8 2/11/2013 5050/13 AN.KHUFZAN KHAFIF 6TH THORAX PA dr.ANE dr.LISA 52000 18000 70000
9 4/11/2013 5054/13 NY.MURTI 50TH ABDOMEN dr.ANE dr.LINA 58000 18000 76000
10 6/11/2013 2249/13 NY.RINI SETYOWATI 22TH THORAX PA dr.ANE RUJUK 58000 5000 63000
11 6/11/2013 3678/12 AN.VIRA AULIA 18BLN THORAX AP dr.ANE dr.LINA 52000 18000 70000
12 6/11/2013 5083/13 NY.ASRIYAH 40TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
13 6/11/2013 2517/13 NY.MAGFIROTUN 50TH LUMBAL AP/LAT dr.ANE dr.LINA 120000 20000 140000
14 6/11/2013 5084/13 NY.SILVIS ANTIKA 24TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
15 6/11/2013 5096/13 TN.MOH.SOLEH 33TH THORAX PA dr.ANE dr.LINA 58000 18000 76000
16 7/11/2013 5100/13 TN.ZAINAL ABIDIN 45TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
17 7/11/2013 5102/13 NY.MUZAIDAH 67TH WRIST JOINT AP/LAT dr.ANE RUJUK 80000 5000 85000
18 7/11/2013 5103/13 AN.AZAHRA LAURA 10BLN THORAX AP dr.ANE dr.MICHEL 52000 18000 76000
19 7/11/2013 4303/13 NY.SEKAH 51TH LUMBAL AP/LAT dr.ANE dr.LINA 120000 20000 140000
20 7/11/2013 3878/13 AN.AHMAD IMAM 5TH THORAX AP dr.ANE dr.MICHEL 52000 18000 76000
21 7/11/2013 2517/09 TN.HERU WARSONO 51TH THORAX PA dr.ANE dr.LINA 58000 18000 76000
22 8/11/2013 3934/13 NY.MUSDALIFAH 40TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
23 8/11/2013 5117/13 NY.SUFIATI 59TH THORAX PA dr.ANE dr.LINA 58000 18000 76000
24 8/11/2013 2232/13 NY.MASRUAH 63TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
25 8/11/2013 5121/13 TN.KASBONO 41TH THORAX PA dr.ANE dr.LINA 58000 18000 76000
26 8/11/2013 1938/13 TN.JASIRAN 60TH THORAX AP dr.ANE dr.MICHEL 58000 18000 76000
27 8/11/2013 30/02 NY.ZUMAROH 45TH THORAX PA dr.ANE dr.LINA 58000 18000 76000
28 9/11/2013 5131/13 NY.NUR AMIROH 30TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
29 11/11/2013 5136/13 NY.JASEMI 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
30 11/11/2013 2906/10 NY.MURAPAH 43TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
31 11/11/2013 5139/13 TN.H.ZAWAWI 75TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
32 11/11/2013 3769/08 NY.HJ.KHUSNAH 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
33 11/11/2013 4790/12 TN.SUMONO 70TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
34 11/11/2013 4452/08 TN.SAMSUDIN 57TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
35 11/11/2013 792/11 AN.SAKIL IZUDIN 4TH THORAX PA dr.ANE dr.LISA 52000 18000 70000
36 11/11/2013 3764/13 TN.JASRI 60TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
37 11/11/2013 5145/13 NN.NURUL BASIROH 22TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
38 11/11/2013 3865/13 NY.LARASATI 40TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
39 12/11/2013 5158/13 NY.SUTIRAH 75TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
40 12/11/2013 5157/13 NY.KASTIAH 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
41 12/11/2013 5082/13 NY.MUSIROH 51TH WATER'S SPN dr.ANE dr.LISA 52000 18000 70000
42 12/11/2013 5162/13 TN.SUKARMAN 45TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 80000 18000 98000
43 13/11/2013 2539/13 NY.NGATONAH 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
44 13/11/2013 1293/11 NY.SUTIYEM 36TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
45 13/11/2013 1702/13 TN.MASKURIN 48TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
46 13/11/2013 2513/12 NY.SITI UDARSI 58TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
47 14/11/2013 5126/13 TN.WAHIB 28th THORAX PA dr.ANE dr.LISA 58000 18000 76000
48 15/11/2013 3693/06 NY.SUKINAH 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
49 15/11/2013 5199/13 NY.SUDARSIH 51TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
50 15/11/2013 1084/12 NY.ROSINI 51TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
51 15/11/2013 2163/09 NN.KUROTU AINI 23TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
52 15/11/2013 5209/13 AN.MESSI ANDIKA PRATAMA 3TH CLAVICULA AP dr.ANE dr.LISA 65000 18000 83000
53 15/11/2013 5211/13 TN.ALI MUSTAIN 29TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
54 15/11/2013 262/11 NY.RUBIATUN 31TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
55 15/11/2013 5003/13 AN.ELSA ADELIA 6TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
56 16/11/2013 967/10 NY.MASROCHAH 65TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
57 16/11/2013 5229/13 NY.SITI NURJANAH 25TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
58 18/11/2013 5240/13 TN.MURANI 60TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
59 18/11/2013 1965/12 TN.JASMAN 85TH WRIST JOINT AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
60 18/11/2013 1271/13 TN.KHUSDI 58TH GENUE AP/LAT dr.ANE dr.LISA 80000 18000 98000
61 18/11/2013 4992/13 NY.SUPARTI 40TH WATER'S SPN dr.ANE dr.MICHEL 52000 18000 70000
62 18/11/2013 1345/13 TN.SUHDI 55TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
63 19/11/2013 1195/13 NY.ZULIATI 41TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
64 19/11/2013 1451/06 TN.RUMANI 66TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
65 19/11/2013 4039/12 NY.ASRIPAH 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
66 19/11/2013 3399/13 NY.JAYATI 45TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
67 20/11/2013 774/12 AN.NURIS SORAYA 8TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
68 20/11/2013 5273/13 TN.SUUDI 44TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
69 20/11/2013 2615/13 NY.HJ.RUKMI 49TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
70 20/11/2013 2082/04 NY.MASROPAH 60TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
71 20/11/2013 5270/13 NY.TITIK YULIANTI 36TH THORAX PA+LUMBAL AP/LAT dr.ANE dr.MICHEL 178000 38000 216000
72 20/11/2013 5277/13 TN.SUPARNI 62TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
73 20/11/2013 2097/12 NY.SUMIATI 61TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
74 20/11/2013 4548/13 TN.SLAMET 37TH THORAX PA dr.ANE dr.LISA 58000 180000 76000
75 20/11/2013 1771/11 NY.BADRIYAH 28TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
76 21/11/2013 5291/13 TN.MUHALI 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
77 21/11/2013 5292/13 NY.SUMIATUN 38TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
78 21/11/2013 5296/13 AN.RAFID RAMADHANI 6TH THORAX PA dr.ANE dr.LISA 52000 18000 70000
79 22/11/2013 5315/13 NY.UMAMI 49TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
80 22/11/2013 1253/10 NY.ROMIJAH 36TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
81 23/11/2013 3265/13 NY.SUWARTI 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
82 23/11/2013 3498/03 SDR.TRI HIDAYANTO 13TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
83 23/11/2013 1405/12 NY.TUMIAH 55TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
84 23/11/2013 5345/13 AN.MOH.IKBAL 9TH ANTEBRACHI AP/LAT dr.ANE RUJUK 80000 5000 85000
85 25/11/2013 3338/13 TN.MAHMUDI 53TH THORAX PA dr.ANE dr.LINA 58000 18000 76000
86 25/11/2013 5351/13 TN.TASKAN 69TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
87 25/11/2013 2346/13 AN.DIAN AYU SEPTIANA 2,6TH THORAX AP dr.ANE dr.LINA 52000 18000 70000
88 25/11/2013 1929/13 TN.MASHURI 55TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
89 25/11/2013 2308/02 NY.SRI MUGI 41TH THORAX PA dr.ANE dr.LINA 58000 18000 76000
90 26/11/2013 5369/13 TN.SUTRISNO 49TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
91 26/11/2013 2467/02 TN.EDI SUPRAPTO 72TH THORAX PA dr.ANE dr.LINA 58000 18000 76000
92 26/11/2013 4023/10 NY.ETIK SUSIANTI 29TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
93 26/11/2013 2676/07 TN.TAUFIK 38TH WATER'S SPN dr.ANE dr.LINA 52000 18000 70000
94 26/11/2013 5270/13 NN.WADIYAH 18TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
95 28/11/2013 5374/13 NY.SUKAENAH 75TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
96 28/11/2013 876/13 TN.ASRORI 60TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
97 28/11/2013 5383/13 NY.NUR AFTINA 29TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
98 28/11/2013 5388/13 SDR.RITA IN'AMUL 15TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
99 28/11/2013 838/08 NY.KORI'ATUN 48TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
100 28/11/2013 5389/13 TN.YATIN 50TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
101 29/11/2013 5399/13 TN.ZAINI 31TH LUMBAL AP/LAT dr.FENNY dr.MICHEL 120000 20000 140000
102 29/11/2013 2764/13 AN.HILDA RIZKI 1TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
103 29/11/2013 5406/13 NY.ENDANG 28TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
104 29/11/2013 5408/13 SDR.ZAINAL ARIFIN 19TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
105 30/11/2013 5338/13 TN.SUHARJO 45TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000

Mengetahui Welahan,30 November 2013

Kepala BP.Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN BP. MARDI NUGROHO WELAHAN
BULAN : DESEMBER 2013
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/12/2013 5422/13 TN.SUDARMAN 43TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
2 2/12/2013 5426/13 NY.SUHARTI 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
3 2/12/2013 5348/13 TN.AHMADI 55TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
4 2/12/2013 5238/13 TN.H.SUPARNO 70TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
5 2/12/2013 3910/06 NY.SUMBER 50TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
6 2/12/2013 5424/13 SDR.M.ISLAKHUDDIN 17TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
7 2/12/2013 5429/13 NY.MARYUNI 58TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
8 2/12/2013 5431/13 NY.SITI ROHMATUN 34TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
9 2/12/2013 537/13 NY.HARTATIK 31TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
10 2/12/2013 2227/06 NY.SITI RAFATUN 51TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
11 3/12/2013 4682/13 TN.H.SAMSUDIN 63TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
12 3/12/2013 882/12 NY.LAKSMINI 48TH CRANIUM AP dr.ANE dr.MICHEL 52000 18000 70000
13 3/12/2013 5200/13 TN.SUPARDI 40TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
14 4/12/2013 5396/13 NY.SUPIYAH 50TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
15 4/12/2013 157/01 NY.MUKINI 47TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
16 4/12/2013 985/06 TN.BAJURI 53TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
17 4/12/2013 5456/13 NY.SARNI 42TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
18 4/12/2013 5457/13 TN.MUHAJIRIN 35TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
19 4/12/2013 139/08 NY.HJ.PARTINI 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
20 5/12/2013 3648/13 TN.MASHUDI 32TH THORAX PA+CLAVICULA AP dr.ANE dr.LISA 123000 36000 159000
21 5/12/2013 5481/13 TN.SUWARTO 42TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
22 6/12/2013 5485/13 NY.SULASTIN 50TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
23 6/12/2013 5379/13 SDR.M.ROZI 26TH THORAX PA+ABDOMEN dr.ANE dr.MICHEL 116000 36000 152000
24 6/12/2013 5255/13 TN.MASMIKAN 42TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
25 6/12/2013 5409/13 TN.AGUS SUSANTO 33TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
26 7/12/2013 3172/12 NY.SITI FATIMAH 64TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
27 7/12/2013 2028/06 NY.ZURIAH 56TH PELVIS AP dr.ANE RUJUK 58000 5000 63000
28 7/12/2013 5472/13 TN.MISHAKHUL MUNIR 46TH ABDOMEN 2 POSISI dr.ANE RUJUK 120000 5000 125000
29 9/12/2013 5513/13 TN.SUTRISNO 39TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
30 9/12/2013 4522/13 NY.MARYATUN 36TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
31 9/12/2013 5530/13 TN.ABDUL AZIZ 50TH GENUE AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
32 10/12/2013 933/12 AN.ZAROTUS SITA 4,6TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
33 10/12/2013 1519/04 NY.RASIMAH 67TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
34 10/12/2013 5536/13 NY.MASNI 55TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
35 10/12/2013 5540/13 TN.MOH.AZIZ 44TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
36 10/12/2013 803/13 TN.MUHLAS 45TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
37 11/12/2013 5547/13 NY.SULIMAH 60TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
38 11/12/2013 4996/12 AN.MOH.GIBRAN 1,6TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
39 11/12/2013 4033/13 NY.SULASIH 57TH ELBOW JOINT AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
40 11/12/2013 4037/05 NY.SRI SUGIARTI 52TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
41 11/12/2013 5559/13 AN.YUSNAR FAHMI 10TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
42 11/12/2013 3206/03 NY.KASMANAH 30TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
43 12/12/2013 5576/13 SDR.MOH.MU'ARIF 14TH CRURIS AP/LAT dr.ANE dr.LISA 80000 18000 98000
44 12/12/2013 5583/13 TN.RIFA'I 45TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
45 13/13/2013 5588/13 TN.ASLAM MALIKI 31TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
46 13/13/2013 3375/09 AN.ALFIN JOHAN 4,6TH THORAX AP dr.ANE dr.LISA 52000 18000 76000
47 13/13/2013 5394/13 NY.RETIMAH 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
48 13/13/2013 3702/13 SDR.MOH.FARIH AULIA 13TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
49 13/13/2013 5598/13 TN.AKROM HALIMI 45TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
50 13/13/2013 5528/13 NY.SUDARNI 35TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
51 14/12/2013 5605/13 NY.IZZATUN NISA 35TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
52 14/12/2013 5607/13 TN.SUHAILAN 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
53 16/12/2013 5613/13 NY.SITI RUKANAH 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
54 16/12/2013 38/09 TN.MURNI 60TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
55 16/12/2013 5616/13 TN.SUPRIYONO 49TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
56 16/12/2013 1614/06 NN.NUR KALIMAH 21TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
57 16/12/2013 5217/12 TN.SOLIKIN 38TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
58 17/12/2013 5645/13 TN.KASRI 52TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
59 18/12/2013 3297/12 NY.RUSMINAH 42TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
60 18/12/2013 3045/13 AN.MOH.SAFA'AT 21BLN THORAX AP dr.GUNARDI dr.LISA 52000 18000 70000
61 18/12/2013 180/06 TN.NGADONO ALIAS N.SALIM 70TH LUMBAL AP/LAT BUDIYONO dr.MICHEL 120000 20000 140000
62 18/12/2013 2994/13 AN.TAKIYUDIN NAFIS 4TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
63 18/12/2013 5658/13 AN.AHMAD NUR REZA 10TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
64 19/12/2013 5668/13 TN.SUWARTO 28TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
65 19/12/2013 3365/13 TN.SUNARYO 65TH WATER'S SPN dr.ANE dr.MICHEL 52000 18000 70000
66 19/12/2013 5564/13 TN.SUYIKNO 47TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
67 19/12/2013 1007/13 TN.ABDUL JAMAL 60TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
68 19/12/2013 5676/13 TN.ABDUL ROZAK 35TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
69 19/12/2013 1650/11 TN.RUDI PURNOMO 32TH HUMERUS AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
70 19/12/2013 711/05 SDR.EDI KURNIAWAN 24TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
71 20/12/2013 3170/13 TN.R.WAGINO 58TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
72 20/12/2013 2714/13 NY.KISMATUN 58TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
73 20/12/2013 3342/13 TN.SULIYANTO 52TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
74 20/12/2013 5691/13 TN.MASNO 68TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
75 20/12/2013 3061/13 NY.RODLOTUL BADIA 33TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
76 20/12/2013 4381/12 TN.SUHARYANTO 42TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
77 20/12/2013 5539/13 NY.UMI WAHYUNI 65TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
78 20/12/2013 1874/13 TN.MASLAN 45TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
79 20/12/2013 5702/13 NY.UMI HANIK 35TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
80 20/12/2013 3064/13 NY.SOFIATUN 43TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
81 21/12/2013 4318/08 AN.YULI NELA WATI 6TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
82 21/12/2013 4378/12 AN.VITA RAHMA 1,6TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
83 21/12/2013 1593/11 AN.AYATUL MAULA 7TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
84 23/12/2013 5730/13 AN.INTAN PUSPITASARI 2,6TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
85 23/12/2013 5723/13 NY.KASMARI 56TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
86 23/12/2013 5468/13 NY.KARSINAH 55TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
87 23/12/2013 4277/13 NY.MUNZAENAH 58TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
88 23/12/2013 5731/13 NY.MUFARIHAH 35TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
89 23/12/2013 5736/13 TN.ABDUL ROHIF 60TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
90 23/12/2013 5739/13 TN.USMAN 30TH WATER'S SPN dr.ANE dr.LISA 52000 18000 70000
91 23/12/2013 5741/13 NY.PARINAH 63TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
92 24/12/2013 4642/09 NY.KASBONAH 67TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
93 24/12/2013 5614/13 NY.RATENI 80TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
94 24/12/2013 5756/13 TN.SUHUD 31TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
95 24/12/2013 3250/11 AN.SABRINA DIAH 9TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
96 24/12/2013 5757/13 TN.RISWANDI 57TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
97 27/12/2013 5761/13 NY.GIYEM 70TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
98 27/12/2013 5765/13 TN.KASTAMI 34TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
99 27/12/2013 4126/11 NY.SITI KHOTIJAH 34TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
100 27/12/2013 5583/13 TN.RIFA'I 45TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
101 28/12/2013 5793/13 AN.FERLINA SUKMAWATI 7TH THORAX PA dr.ALIYA dr.LISA 52000 18000 70000
102 28/12/2013 5787/13 NY.MARYATUN 77TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
103 28/12/2013 3739/12 TN.MUSAFAK 59TH LUMBAL AP/LAT BUDIYONO dr.LISA 120000 20000 140000
104 28/12/2013 5788/13 NY.SUMARLIN 45TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
105 28/12/2013 1914/06 NY.SOIMAH 50TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
106 28/12/2013 2971/13 AN.SAFATUL MUKASAROH 2.6TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
107 30/12/2013 5754/13 TN.SANIMAN 70TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
108 30/12/2013 5797/13 TN.AHMAD TAWI 42TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
109 30/12/2013 5800/13 NY.SUWAEDAH 45TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
110 30/12/2013 5802/13 NY.BARDAH 50TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
111 30/12/2013 5814/13 NN.RIRIN SETIYANINGRUM 21TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
112 30/12/2013 2164/03 TN.ROIKHAN 60TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000

Mengetahui Welahan,31 Desember 2013

Kepala BP.Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN BP. MARDI NUGROHO WELAHAN
BULAN : JANUARI 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/1/2014 02//14 TN.MASDUKI 41TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
2 2/1/2014 17/14 TN.MASWAH 35TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
3 3/1/2014 29/14 NY.HJ.MUKAROMAH 70TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
4 3/1/2014 31/14 NY.DAIMAH 45TH LUMBAL AP/LAT dr.ANE RUJUK 120000 5000 125000
5 3/1/2014 30/14 NY.MARTINAH 42TH WATER'S SPN dr.DJOKO dr.LISA 52000 18000 70000
6 3/1/2014 40/14 NY.DATI 60TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
7 3/1/2014 3852/13 NY.RIPAH 50TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
8 3/1/2014 49/14 NY.SUMBER 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
9 3/1/2014 55/14 NY.SITI ZULIKAH 32TH WRIST JOINT AP/LAT dr.ANE dr.LISA 80000 18000 98000
10 3/1/2014 5317/13 NN.LAILATUL MUNAWAROH 18TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
11 4/1/2014 63/14 NY.SUWARTI 70TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
12 4/1/2014 62/14 NY.PARINI 60TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
13 4/1/2014 70/14 AN.NADIM RIQ'ZA 2,6TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
14 6/1/2014 1901/04 NY.KARTINAH 41TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
15 6/1/2014 74/14 NY.ALFIAH 45TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
16 6/1/2014 5271/13 TN.KUSRIN 65TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
17 6/1/2014 81/14 TN.RAWI 63TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
18 6/1/2014 71/14 SDR.SUMANTO 28TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
19 6/1/2014 1549/13 NY.SOLEHATUN ULFA 18TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
20 6/1/2014 80/14 NY.ISNIATUN 45TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
21 6/1/2014 5806/13 TN.NGADERI 56TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
22 6/1/2014 3283/13 AN.ANDIKA AHMAD 5TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
23 6/1/2014 87/14 TN.SUNARYO 42TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
24 6/1/2014 1102/05 SDR.AINUR ROZAK 18TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
25 6/1/2014 562/13 NY.SITI RIYANTI 29TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
26 7/1/2014 88/14 TN.SUMANI 65TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
27 7/1/2014 1720/11 TN.SULISTIANTO 40TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
28 7/1/2014 4543/13 TN.SUWARDI 58TH GENUE AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
29 7/1/2014 2805/09 NY.HJ.ASTOPAH 60TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
30 7/1/2014 115/14 NY.MA'RIFAH 58TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
31 7/1/2014 3306/13 AN.ABI ADITYA YAHYA 6TH THORAX PA dr.ANE dr.LISA 52000 18000 70000
32 7/1/2014 3290/13 AN.ANDIKA YUDA 3TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
33 8/1/2014 3648/13 SDR.MASHUDI 33TH CLAVICULA AP DR.JEFFREY dr.LISA 65000 18000 83000
34 8/1/2014 1428/02 TN.KUSAIRI 60TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
35 8/1/2014 116/11 TN.RUSDI 48TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
36 8/1/2014 4322/12 NY.SUWARTI 55TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
37 8/1/2014 5263/13 TN.SOEB 64TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
38 8/1/2014 102/14 TN.NGATONO 37TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
39 9/1/2014 1101/07 NY.ROUDHATUL JANAH 40TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
40 9/1/2014 151/14 TN.MOH.KHANAFI 33TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
41 9/1/2014 3393/13 AN.SYIFA LUKMANSYAH 4TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
42 9/1/2014 3783/11 NY.MULYATI 31TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
43 9/1/2014 5124/12 TN.SUPANGAT 59TH THORAX PA + ABDOMEN dr.ANE dr.LISA 116000 36000 152000
44 9/1/2014 2631/07 TN.SUNARYO 54TH CRANIUM AP/LAT dr.ANE RUJUK 100000 5000 105000
45 10/1/2014 170/14 NY.KIMYATI 60TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
46 10/1/2014 177/14 TN.KASDI 42TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
47 10/1/2014 175/14 TN.SUNARJO 54TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
48 10/1/2014 174/14 AN.KHAFIDATUL HANA 9BLN THORAX AP dr.ANE dr.LISA 52000 18000 70000
49 11/1/2014 5784/13 NY.LISA ATIKAWATI 20TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
50 11/1/2014 178/14 TN.MUJI SLAMET 32TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
51 11/1/2014 200/14 TN.HAFID SURYUTI 30TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
52 11/1/2014 955/11 NY.BADRIYAH 59TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
53 13/1/2014 315/13 TN.YUDIONO SLAMET 46TH ANKLE JOINT AP/LAT dr.ANE RUJUK 80000 50000 85000
54 13/1/2014 216/14 NY.SUGIRAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
55 13/1/2014 221/14 TN.SUGINO 35TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
56 13/1/2014 223/14 TN.SUWITO 53TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
57 15/1/2014 237/14 TN.MULYONO 36TH FEMUR AP/LAT dr.DINA dr.MICHEL 80000 18000 98000
58 15/1/2014 246/14 NY.SAFAAH 53TH THORAX PA dr.DINA dr.LISA 58000 18000 76000
59 17/1/2014 265/14 AN.MIFITA ARUMSARI 3TH THORAX PA dr.SONY dr.LISA 52000 18000 70000
60 17/1/2014 1582/12 TN.SAWIN 65TH THORAX PA dr.SONY dr.MICHEL 58000 18000 76000
61 18/1/2014 2072/12 NY.SANAH 70TH FEMUR AP/LAT dr.WORRO RUJUK 80000 5000 85000
62 20/1/2014 3166/04 NY.MASRONAH 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
63 20/1/2014 291/14 NY.ULFAH 41TH LUMBAL AP/LAT BUDIYONO dr.MICHEL 120000 20000 140000
64 20/1/2014 254/14 NY.SURIPAH 45TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
65 20/1/2014 4357/10 NY.NURIYAH 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000

Mengetahui Welahan,30 JANUARI 2014

Kepala BP.Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : FEBRUARI 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 5/2/2014 2986/11 NY.RASMINI 69TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
2 5/2/2014 374/14 TN.SADIMAN 64TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
3 5/2/2014 4730/13 NY.RASMINI 59TH THORAX PA+ABDOMEN dr.ANE dr.LISA 116000 36000 152000
4 5/2/2014 379/14 NY.SARTONAH 72TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
5 5/2/2014 956/05 NY.MUNARIYAH 50TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
6 5/2/2014 383/14 TN.KUMAIDI 45TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
7 5/2/2014 387/14 NY.SAONAH 60TH THORAX PA dr.ANE RUJUK 58000 5000 63000
8 5/2/2014 3615/13 AN.FAIQ'OH MAZAYA 6,6TH THORAX PA dr.ANE dr.MICHEL 52000 18000 76000
9 6/2/2014 397/14 TN.KHAMDAN 40TH LUMBAL AP/LAT BUDIYONO dr.LISA 120000 20000 140000
10 6/2/2014 3017/14 NY.BADIAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
11 6/2/2014 339/14 TN.MUNTHOLIB 55TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
12 6/2/2014 773/11 TN.JAMIL 64TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
13 6/2/2014 403/14 NY.SUGIYAH 55TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
14 6/2/2014 3716/13 NY.MUSLIKAH 31TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
15 7/2/2014 415/14 NY.HJ.MUSFIR 70TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
16 7/2/2014 4056/ NY.SRI HARTINI 40TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
17 7/2/2014 1822/12 NY.HARYATUN 40TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
18 7/2/2014 247/13 AN.ASFAN NAURA 23BLN THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
19 7/2/2014 932/12 AN.NAROTAMA DWI MALIK 8TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
20 8/2/2014 445/14 TN.WAGIMAN 65TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
21 8/2/2014 2283/11 TN.RAMIJAN 54TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
22 8/2/2014 3664/13 TN.BIBIT SAPUTRA 45TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
23 8/2/2014 315/14 TN.SAERONI 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
24 10/2/2014 317/13 NY.MUSA'ADAH 70TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
25 10/2/2014 453/14 NY.KASIMAH 55TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
26 10/2/2014 454/14 TN.MOH.KHOIRI 35TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
27 10/2/2014 450/14 NY.ISTIMA'AH 55TH THORAX PA dr.ANE RUJUK 58000 5000 63000
28 10/2/2014 456/14 TN.GATOT 35TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
29 10/2/2014 3078/13 NY.SURATI 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
30 10/2/2014 448/14 AN.VIKI MAHESA 12TH THORAX PA dr.ANE dr.LISA 52000 18000 70000
31 10/2/2014 524/07 AN.FATHAKHUR KOIRUL 16TH PEDIS AP/OBLIQUE dr.ANE RUJUK 80000 5000 85000
32 10/2/2014 464/14 NY.SULISTIYO ASIH 36TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
33 10/2/2014 466/14 AN.SULTAN ARIF SAPUTRA 6TH THORAX PA dr.ANE dr.LISA 52000 18000 76000
34 10/2/2014 471/14 NN.FARIDA 26TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
35 11/2/2014 495/14 NY.NGATMIRAH 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
36 11/2/2014 160/14 NY.SHOLIKHATUN 32TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
37 11/2/2014 564/13 NY.SRI HAYAH 62TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
38 11/2/2014 1464/12 TN.PAIMIN 52TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
39 11/2/2014 500/14 NY.SUMINI 56TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
40 11/2/2014 492/14 TN.SODIK 46TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
41 11/2/2014 501/14 SDR.MOH ARIS 17TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
42 11/2/2014 507/14 NY.SARMIAH 60TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
43 11/2/2014 478/14 NY.RUMISIH 50TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
44 11/2/2014 509/14 TN.SUPRAPTO 45TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
45 11/2/2014 2547/13 NY.NURYATI 35TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
46 11/2/2014 513/14 TN.SUKAMDI 39TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
47 12/2/2014 522/14 NY.USWATI 43TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
48 12/2/2014 524/14 NY.SURYAM 40TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
49 12/2/2014 532/14 NY.ZULIATI 34TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
50 12/2/2014 1808/13 TN.KASIRANTO 60TH PEDIS AP/OBLIQUE dr.ANE RUJUK 80000 5000 85000
51 12/2/2014 530/14 NY.ISTIANAH 32TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
52 13/2/2014 542/14 TN.SUHARTONO 50TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
53 13/2/2014 546/14 NY.MUNJAROH 56TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
54 13/2/2014 3823/13 NY.ZUMROTUN 43TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
55 13/2/2014 4090/09 SDR.FIRDAUS FURKON 19TH MANUS AP/OBLIQUE dr.ANE dr.MICHEL 80000 18000 98000
56 13/2/2014 2884/12 NY.SWANI 63TH GENUE AP/LAT dr.ANE dr.LISA 80000 18000 98000
57 14/2/2014 3449/05 NY.MARSINAH 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
58 14/2/2015 3667/13 TN.MUBARIZI 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
59 14/2/2016 563/14 NY.MASRIKAH 80TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
60 14/2/2017 564/13 TN.ABDUL ROZAD 35TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
61 14/2/2018 1971/11 AN.DICKY FIRMANSYAH 4,6TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
62 15/2/2014 5216/12 NY.ADABIYAH 40TH WATER'S SPN dr.ANE dr.MICHEL 52000 18000 70000
63 15/2/2014 588/14 NY.IMROTUN 55TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
64 15/2/2014 4038/04 NY.MUSA'ADAH 66TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
65 19/2/2014 2392/04 TN.BARNAWI 56TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
66 19/2/2014 3108/98 NY.MUATIN 47TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
67 19/2/2014 601/14 TN.SURONO 39TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
68 20/2/2014 671/14 TN.SLAMET SUTIONO 35TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
69 20/2/2014 677/14 TN.NGATMANI 69TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
70 20/2/2014 680/14 NY.SETIAWATI 26TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
71 22/2/2014 2038/10 AN.NAIMATUL NIHLA 4TH THORAX AP dr.ANE dr.LISA 58000 18000 76000
72 22/2/2014 688/14 TN.MOH.SAHID 65TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
73 22/2/2014 724/14 AN.ANJUN HAFIA 6,6TH HUMERUS AP/LAT dr.ANE dr.LISA 80000 18000 98000
74 22/2/2014 713/14 TN.MOH ALIM 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
75 22/2/2014 726/14 TN.MASKAN 60TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
76 22/2/2014 617/14 NY.NDARSIH 82TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
77 24/2/2014 741/14 AN.NITA WAHYUNI 30TH HUMERUS AP/LAT dr.ANE RUJUK 80000 5000 85000
78 24/2/2014 745/14 TN.ATMOJO 56TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
79 24/2/2014 711/14 SDRI.DZINWATUL HIKMAH 17TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
80 24/2/2014 1027/13 AN.KEVIN MAHDI 15BLN THORAX AP dr.ANE dr.LISA 52000 18000 70000
81 26/2/2014 490/14 NY.SUKESI 66TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
82 26/2/2014 1478/05 NY.WAGINAH 60TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
83 26/2/2014 592/12 AN.MAULANA 4TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
84 27/2/2014 810/14 TN.AHMAD BAEDHAWI 31TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
85 27/2/2014 812/14 TN.KAIRONI 35TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
86 28/2/2014 3113/11 NY.EKA FITRIYANI 24TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
87 28/2/2014 836/14 SDR.YUSUF BAGUS ALAMSYAH 19TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
88 28/2/2014 837/14 TN.BAJURI 60TH THORAX PA dr.ANE dr.LISA 58000 18000 76000

Mengetahui Welahan,28 FEBRUARI 2014

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan


(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)
LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : MARET 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/3/2014 249/09 NY.AFIFAH 27TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
2 1/3/2014 858/14 TN.WAGISAN 40TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
3 3/3/2014 862/14 TN.MATERAN 65TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
4 3/3/2014 207/14 NY.ZUMROTUN 41TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
5 3/3/2014 704/14 TN.SAHLAN 80TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
6 3/3/2014 777/14 TN.SUMARTO 60TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
7 3/3/2014 4215/13 NN.FINA LAILATUL SARIFAH 14TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
8 3/3/2014 894/14 TN.SUMAKRI 50TH PELVIS AP dr.ANE dr.MICHEL 58000 18000 76000
9 4/3/2014 4640/13 TN.SAMIDI 40TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
10 4/3/2014 897/14 TN.H.MOHAJI 45TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
11 4/3/2014 898/14 NY.ROSIKA 42TH GENUE AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
12 4/3/2014 1573/10 NY.RASENI 64TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
13 4/3/2014 3916/13 NY.NGATINI 45TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
14 4/3/2014 906/14 AN.BILLY RIDWAN 8TH THORAX PA/LAT dr.ANE RUJUK 90000 5000 95000
15 4/3/2014 903/14 TN.KASDI 38TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
16 5/3/2014 1801/07 NY.RUSMIYAH 30TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
17 5/3/2014 924/14 AN.MUZIZATUN SULISTYANI 5TH ANKLE AP/LAT dr.ANE dr.LISA 80000 18000 98000
18 6/3/2014 185/11 NY.SYARIFAH 15TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
19 6/3/2014 3476/13 NY.MUASIAH 46TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
20 6/3/2014 792/14 NY.ASROPAH 65TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
21 6/3/2014 4172/13 NY.SITI MUSTOFIAH 32TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
22 7/3/2014 949/14 TN.MUHSAN 54TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
23 7/3/2014 850/14 NY.RUBAMAH 50TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
24 7/3/2014 868/13 TN.KASDURI 55TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
25 7/3/2014 954/14 NY.SUTRIPAH 58TH ANKLE AP/LAT dr.ANE dr.LISA 80000 18000 98000
26 7/3/2014 4280/13 NY.ENDANG SULASTRI 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
27 7/3/2014 955/14 NY.HJ.ZUMAROH 60TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
28 7/3/2014 959/14 NY.DURATUL MILAH 38TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
29 7/3/2014 2123/07 TN.HARYONO 53TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
30 7/3/2014 957/14 NY.SARAH 58TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
31 8/3/2014 973/14 TN.SUDRAJAT 43TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
32 8/3/2014 1258/09 TN.SUMARDI 40TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
33 8/3/2014 3959/04 TN.SULKAN 70TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
34 10/3/2014 2278/08 NY.AMINAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
35 10/3/2014 986/14 TN.PAIMAN 58TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
36 10/3/2014 991/14 NY.MURSIH 53TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
37 10/3/2014 1002/14 TN.SARDONO 60TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
38 10/3/2014 965/14 NY.NOOR ASIH 25TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
39 11/3/2014 1023/14 TN.JUREMI 55TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
40 11/3/2014 4441/09 AN.DIKA NUR ALAMSYAH 5TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
41 11/3/2014 1018/14 NY.MUSAFA'AH 60TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
42 11/3/2014 4806/12 AN.SATRIA MIFTAKHUL 1,6TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
43 11/3/2014 1026/14 NY.IMROH 50TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
44 11/3/2014 1030/14 NY.TRESMI 75TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
45 12/3/2014 2730/13 TN.H.MUSTAIN 51TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
46 12/3/2014 894/01 TN.SARI'AN 65TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
47 13/3/2014 1063/14 NN. SRI SAFAATUN 17TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
48 13/3/2014 3585/09 NY.MUNJAROAH 40TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
49 13/3/2014 3722/12 NY.SIUPI 50TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
50 13/3/2014 1067/14 TN.SETIAWAN 26TH CRANIUM AP/LAT dr.ANE dr.MICHEL 100000 20000 120000
51 13/3/2014 1071/14 TN.KAMTO 34TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
52 14/3/2014 1079/14 NY.LUTFIATUN 31TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
53 14/3/2014 871/14 NY.KASWATI 46TH THORAX PA+ANKLE AP/LAT dr.ANE dr.MICHEL 174000 36000 200000
54 14/3/2014 1087/14 NY.PONIJAH 63TH WRIST JOINT AP/LAT dr.ANE dr.LISA 58000 18000 76000
55 14/3/2014 172/14 NY.KOSRIYATUN 31TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
56 14/3/2014 1090/14 TN.SABAR 66TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
57 15/3/2014 913/14 NY.SUMARMUAH 65TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
58 15/3/2014 4186/13 AN.NAUFAL ARSYAD 2TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
59 15/3/2014 1103/14 NN.SILVIA ANDRIANI 17TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
60 17/3/2014 382/11 NY.DJUMIATI 53TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
61 17/3/2014 1110/14 TN.MASROKIM 35TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
62 17/3/2014 4307/13 AN.OLIVIA ARINA CINTYA 20BLN THORAX AP dr.ANE dr.LISA 52000 18000 70000
63 17/3/2014 3299/05 TN.ALI FAUSAN 55TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
64 17/3/2014 3587/09 TN.MUSLIKAN 70TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
65 17/3/2014 2856/07 NY.SITI AMINAH 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
66 17/3/2014 2229/04 TN.SAPUAN 56TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
67 18/3/2014 1137/14 TN.SUNARDI 50TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
68 18/3/2014 3726/13 NY.SULASTRI 53TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
69 18/3/2014 3998/08 NN.MENIK MELIANA 21TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
70 18/3/2014 4383/13 NY.SUKARSIH 35TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
71 19/3/2014 365/06 TN.NASIKUN 73TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
72 19/3/2014 1173/14 AN.WAFA AL AULIASABIL 3,6TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
73 20/3/2014 2749/12 TN.SLAMET 60TH MANUS AP/OBLIQUE dr.ANE dr.MICHEL 80000 18000 98000
74 20/3/2014 1180/14 NY.RUKMINI 33TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
75 20/3/2014 2377/05 NY.ASNUAH 54TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
76 21/3/2014 128/14 NY.SUKINAH 40TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
77 21/3/2014 1195/14 SDR.FADRUR ROHMAH 27TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
78 21/3/2014 300/13 AN.AHMAD FANZA 3TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
79 21/3/2014 1198/14 TN.SUBANDI 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
80 21/3/2014 243/04 SDR.HERI RUSLI 15TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
81 21/3/2014 1155/14 TN.SUWANDI 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
82 22/3/2014 1222/14 TN.ASROBI 27TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
83 24/3/2014 2084/13 NY.ISMAWATI 20TH WATER'S dr.ANE dr.MICHEL 52000 18000 70000
84 24/3/2014 999/14 AN.PUTRI DEWI ANJAIRI 3TH SHOULDER JOINT AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
85 25/3/2014 1253/14 SDR.MASNO 21TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
86 25/3/2014 752/14 NY.MAHMUDAH 37TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
87 25/3/2014 1263/14 NY.NGATIRAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
88 26/3/2014 1268/14 TN.SARPIN 43TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
89 26/3/2014 1157/14 TN.SANAWI 80TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
90 26/3/2014 1163/14 TN.MASHADI 70TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
91 26/3/2014 2372/05 TN.NGADONO 49TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
92 27/3/2014 1297/14 NY.SHOLEHAH 55TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
93 27/3/2014 4005/08 AN.NAELAL MUFA WAZAH 5,6TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
94 27/3/2014 923/14 TN.ABDUL HADI 50TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
95 27/3/2014 1301/14 TN.MUKOROBIN 30TH ANKLE AP/LAT dr.ANE dr.MICHEL 80000 18000 98000
96 27/3/2014 1298/14 TN.JAMALUDDIN 29TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
97 27/3/2014 2787/13 TN.PURWO SUWITO 43TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
98 28/3/2014 4164/08 TN.KAHONO 38TH ABDOMEN dr.LIA dr.LISA 58000 18000 76000
99 28/3/2014 1314/14 NY.SUALIM 46TH THORAX PA dr.LIA dr.MICHEL 58000 18000 76000
100 29/3/2014 1320/14 AN.REZA RAJNI PRADILA 7TH THORAX PA dr.ANE dr.LISA 52000 18000 70000

Mengetahui Welahan,29 MARET 2014

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : APRIL 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/4/2014 1512/12 TN.SUKARJONO 64TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
2 1/4/2014 4047/06 NY.TOHA'AH 54TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
3 1/4/2014 1332/14 SDR.IBNU SALAM 22TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
4 1/4/2014 4564/13 AN.MOH YASAN 1TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
5 1/4/2014 1335/14 NY.FARIDATULLIFA 18TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
6 2/4/2014 1367/14 NY.MUAYANAH 58TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
7 2/4/2014 1312/14 NY.RUSMINI 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
8 2/4/2014 4729/13 TN.NASERI 58TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
9 2/4/2014 4439/12 AN.MOH.RIZKY 18BLN THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
10 2/4/2014 1375/14 SDR.IRHAM 32TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
11 2/4/2014 3462/12 TN.TO'AT 54TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
12 2/4/2014 4675/02 TN.CAHYONO 38TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
13 2/4/2014 1376/14 SDR.JOHAN PRASETYO 22TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
14 2/4/2014 5541/13 AN.HARUMI NAWASITA 2TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
15 2/4/2014 657/13 NY.SRI FITRIYANINGSIH 25TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
16 3/4/2014 4738/12 NY.FA'ATIN 62TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
17 3/4/2014 1392/14 TN.KOMARUDIN 38TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
18 3/4/2014 1413/11 TN.SASLANI 63TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
19 3/4/2014 1396/14 NY.RIKA AMANAH 19TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
20 3/4/2014 918/09 TN.KHOIRUN 42TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
21 3/4/2014 1404/14 NY.SUHARTINI 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
22 4/4/2014 4866/13 NN.NITA SURYANI 26TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
23 4/4/2014 1425/14 TN.WIDI ERI 53TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
24 4/4/2014 1433/14 TN.NUR YATIN 55TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
25 4/4/2014 2977/13 NY.TUTIK ADITAMA 27TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
26 4/4/2014 1435/14 NY.MUFAKHOTI 55TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
27 5/4/2014 1440/14 TN.M.SOFA MARWANI 38TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
28 5/4/2014 1449/14 AN.RIAN ARI 11TH WRIST JOINT AP/LAT dr.ANE dr.LISA 80000 18000 98000
29 7/4/2014 1457/14 NN.RATNAWATI 20TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
30 7/4/2014 1458/14 TN.H.WIYONO 57TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
31 7/4/2014 4226/06 AN.NUR ABIDIN 11TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
32 7/4/2014 1460/14 TN.AHMAD SUROSO 37TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
33 7/4/2014 1381/14 NY.MUNAZIROH 35TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
34 7/4/2014 1475/14 TN.RUKADI 32TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
35 8/4/2014 1477/14 NY.NGASIPAH 63TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
36 8/4/2014 1485/14 NY.JULIATI 33TH ANKLE JOINT AP/LAT dr.ANE RUJUK 80000 5000 85000
37 8/4/2014 1825/13 TN.MAKHALI 40TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
38 8/4/2014 1481/14 AN.MELANI NUR 5,3TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
39 8/4/2014 1038/14 NY.TRI ASIH 44TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
40 8/4/2014 2662/06 TN.MUNAJAT 25TH CRANIUM AP/LAT dr.ANE dr.LISA 100000 20000 120000
41 8/4/2014 4312/12 NY.ISTIKOMAH 30TH PEDIS AP/OBLIQUE dr.ANE RUJUK 80000 5000 85000
42 8/4/2014 1496/14 NY.ISTIROKHAH 37TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
43 10/4/2014 1501/14 AN.AYU ROSALINA 11TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
44 10/4/2014 1499/14 NY.SUMINAH 42TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
45 10/4/2014 364/14 SDR.KODRAD RAHARJO 24TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
46 10/4/2014 1506/14 TN.BAMBANG SUNGAIDI 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
47 10/4/2014 1293/14 NY.SITI UMI NASIKHAH 30TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
48 10/4/2014 1518/14 NY.ASRIPAH 45TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
49 10/4/2014 356/13 NY.SRI WAHYUNI 29TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
50 11/4/2014 1524/14 TN.ABDUR RAHMAN 69TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
51 11/4/2014 1527/14 AN.NABIL FATRUR ROHMAN 2,6TH THORAX AP dr.ANE dr.MICHEL 52000 18000 70000
52 11/4/2014 1528/14 NN.NURUL A'YUM 14TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
53 12/4/2014 1547/14 TN.H.MUANAM 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
54 12/4/2014 4217/02 NY.ATMIRAH 70TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
55 14/4/2014 1553/14 NN.AYU RIFAATI 17TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
56 14/4/2014 1554/14 NY.UMI SALAMAH 48TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
57 14/4/2014 5100/13 TN.ZAINAL ABIDIN 45TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
58 14/4/2014 1560/14 NY.MASRIATI 45TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
59 14/4/2014 3129/13 TN.SOFAN 61TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
60 14/4/2014 1519/14 NY.RASIMAH 55TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
61 14/4/2014 2783/09 YN.SUNYOTO 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
62 14/4/2014 3948/10 NY.HJ.ASRIYAH 60TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
63 14/4/2014 1574/14 SDR.SURAHMAN 27TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
64 15/4/2014 3222/05 TN.SUHARDI 47TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
65 15/4/2014 785/14 NN.LULUK DWI WIJAYANTI 15TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
66 15/4/2014 4465/08 TN.SIAGA ADI PURWANTO 34TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
67 16/4/2014 1327/14 TN.ANDI 30TH THORAX PA dr.AMANDA dr.MICHEL 58000 18000 76000
68 16/4/2014 1613/14 NN.FUJI SUSANTI 29TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
69 16/4/2014 1615/14 TN.KASNO 42TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
70 16/4/2014 1683/11 NY.SUNARTI 30TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
71 16/4/2014 2932/12 TN.RAFI'UDDIN 27TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
72 17/4/2014 1626/14 NY.KHOTIJAH 55TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
73 17/4/2014 1417/03 TN.AMRULLAH 35TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
74 19/4/2014 1640/14 NY.KUSNI 55TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
75 19/4/2014 2129/13 TN.WAGIMIN 39TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
76 21/4/2014 322/14 TN.KASRUN 55TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
77 21/4/2014 4916/13 AN.MOH.ARDIVA RAMADHAN 6TH THORAX AP dr.ANE dr.LISA 52000 18000 70000
78 21/4/2014 4922/13 AN.WAHYU EKO BUDI UTOMO 6TH THORAX PA dr.ANE dr.MICHEL 52000 18000 70000
79 21/4/2014 1656/14 SDR.MOH.ATOILAH HABIBI 13TH ANTEBRACHII AP/LAT dr.ANE RUJUK 80000 5000 85000
80 21/4/2014 795/07 TN.MARNO 50TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
81 21/4/2014 1659/14 TN.KASBULLAH 38TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
82 21/4/2014 5071/12 TN.MUNADI 52TH ABDOMEN 2 POSISI dr.ANE dr.MICHEL 120000 20000 140000
83 22/4/2014 1525/14 NY.SUMARNI 45TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
84 22/4/2014 1682/14 NY.JATEMI 65TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
85 22/4/2014 1679/14 NY.DJI REATNA 56TH THORAX PA dr.ANE RUJUK 58000 5000 63000
86 22/4/2014 1689/14 NY.ASIYAH 78TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
87 23/4/2014 1158/14 NY.SUMINI 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 120000 20000 140000
88 23/4/2014 781/00 NY.HJ.MASRIATUN 55TH LUMBAL AP/LAT dr.ANE dr.LISA 120000 20000 140000
89 23/4/2014 1713/14 NY.KHOEROBI 30TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
90 24/4/2014 1722/14 TN.SONI PRABOWO 30TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
91 24/4/2014 1733/14 AN.RUSILA ZIKRA 19BLN ANTEBRACHII AP/LAT dr.ANE RUJUK 80000 5000 85000
92 25/4/2014 3491/13 TN.AFANDI 63TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
93 25/4/2014 4981/13 NY.ARTINAH 55TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
94 25/4/2014 1750/14 NN.UMI ATIKA 25TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
95 25/4/2014 1754/14 TN.SANGKEK 73TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
96 25/4/2014 382/09 NY.MASMIATIN 27TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
97 25/4/2014 1765/14 NN.AYU BAHAGYASTUTI 18TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
98 26/4/2014 1774/14 TN.SAHLAN 55TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
99 28/4/2014 1663/14 SDR.DANIL SETIOKO 21TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
100 28/4/2014 1699/14 TN.MUJIANTO 50TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
101 28/4/2014 168/09 TN.H.NASIRUN 70TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
102 28/4/2014 1647/14 SDR.ASMUNI 29TH ABDOMEN dr.ANE dr.LISA 58000 18000 76000
103 28/4/2014 1800/14 NY.SUTAMI 50TH THORAX PA dr.ANE dr.MICHEL 58000 18000 76000
104 28/4/2014 1218/14 AN.MOH.ALBARIZI 2TH THORAX AP dr.H.SOLIKHIN dr.LISA 52000 18000 70000
105 29/4/2014 1814/14 TN.KANANDI 50TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
106 29/4/2014 20/00 NY.BUNASIH 74TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
107 29/4/2014 111/13 AN.NAILA FIHRIS SA'ADAH 5TH CRANIUM AP/LAT dr.ANE dr.MICHEL 100000 20000 120000
108 30/4/2014 1462/10 AN.JIHAN ZAHIRA 5TH THORAX PA dr.ANE dr.LISA 58000 18000 76000
109 30/4/2014 1845/14 TN.SULAIMAN 40TH ABDOMEN dr.ANE dr.MICHEL 58000 18000 76000
110 30/4/2014 1984/10 NN.PUTRI APRILIA 18TH THORACO LUMBAL AP/LAT + dr.ARIS JATI dr.MICHEL 240000 40000 280000
LUMBAL AP/LAT

Mengetahui Welahan,30 April 2014

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : MEI 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/5/2014 462/14 AN.ALDI RIYANTO 5,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
2 2/5/2014 1852/14 NN.INDANISIH 12TH CRANIUM AP/LAT dr.ANE dr.MICHEL 115000 23000 138000
3 2/5/2014 4241/08 NY.MARYATI 72TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
4 2/5/2014 1869/14 TN.MULYADI 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
5 2/5/2014 5050/13 AN.KHUFSAN KHAFIF 6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
6 2/5/2014 4835/13 NN.ZAHROTUL MARDIYAH 15TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
7 3/5/2014 3091/11 NN.NURUL AFIAH 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 3/5/2014 1878/14 TN.SODIKIN 42TH ANKLE AP/LAT+CRURIS AP/LAT dr.ANE RUJUK 185000 7500 192500
9 5/5/2014 1885/14 TN.SLAMET 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
10 5/5/2014 1884/14 NY.HJ.MASTIKAH 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
11 5/5/2014 1890/14 NY.SUTINAH 79TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
12 5/5/2014 3678/12 AN.VIRA AULIA 2TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
13 6/5/2014 1907/14 SDR.MOH.SAIFUL AZIZ 13TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
14 7/5/2014 1934/14 SDR.M.ISWANDI 30TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
15 7/5/2014 1684/14 TN.KASRI 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
16 7/5/2014 1932/14 TN.WAGIRAN 52TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
17 7/5/2014 503/08 TN.NGADIPAN 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
18 8/5/2014 3862/13 NN.SITI MOKHLISOTIN NISAK 22TH THORAX PA + CRANIUM AP/LAT dr.ANE dr.LISA 182500 43000 225500
19 8/5/2014 702/04 TN.DAKOH 68TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
20 8/5/2014 1947/14 TN.NASERIP 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
21 8/5/2014 1951/14 TN.MOH.KUSUNA 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
22 9/5/2014 792/11 AN.SYAKIL IZUDIN 5TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
23 9/5/2014 1874/14 NY.ROHIMANAH 48TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
24 9/5/2014 3878/11 AN.AHMAD IMAM KOMARUDIN 5,6TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
25 9/5/2014 1978/14 NY.SRI MASLIKHATUN 43TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
26 12/5/2014 2000/14 NY.KUSMIATUN 50TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
27 12/5/2014 2003/14 TN.ARIYANTO 34TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
28 12/5/2014 1995/14 NN.SA'IDAH 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 12/5/2014 4086/10 AN.MAULANA BURHANUDIN 5TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
30 12/5/2014 2014/14 AN.MOH.ROBIKHAN 7TH ANTEBRACHII AP/LAT dr.ANE RUJUK 92500 7500 100000
31 12/5/2014 2245/03 AN.MUSAROAH 70TH ANTEBRACHII AP/LAT dr.ANE dr.LISA 92500 20000 112500
32 12/5/2014 2017/14 NY.SUKARMI 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
33 12/5/2014 2018/14 NY.RISTIANA 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
34 13/5/2014 2067/12 NY.ISTIKHAROH 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
35 13/5/2014 3547/07 NY.SUYANAH 45TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
36 13/5/2014 2026/14 NN.NURUL KHOLIFAH 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
37 13/5/2014 2030/14 TN.AFIFUDIN 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
38 16/5/2014 503/09 NY.UMIYATI 39TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
39 16/5/2014 774/12 AN.NURIS SORAYA 9,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
40 16/5/2014 1280/07 NY.MUSLIKAH 34TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
41 17/5/2014 2092/14 AN.MOH.HAZIM 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
42 17/5/2014 3436/08 NY.MUKASANAH 75TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
43 19/5/2014 1887/14 TN.KISMANTO 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 19/5/2014 2102/14 TN.SABIKIN 50TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
45 19/5/2014 3531/13 NN.LIA INDAH SARI 14TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
46 19/5/2014 2106/14 NY.MASTUTIK 43TH ELBOW JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
47 19/5/2014 1489/14 NY.SUMINAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
48 19/5/2014 985/06 TN.BAJURI 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
49 19/5/2014 2112/14 NY.SUHARTI 34TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
50 19/5/2014 935/14 NY.SUMIATI 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
51 19/5/2014 2057/14 NY.SITI MAHMUDAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
52 20/5/2014 1785/12 AN.ALFIN BAGUS PRATAMA 3,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
53 20/5/2014 1430/05 NY.PAINEM 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
54 20/5/2014 2042/14 NY.MUSLIMAH 50TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
55 20/5/2014 4366/13 TN.SUWITONO 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
56 21/5/2014 2146/14 NY.KISWATI 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
57 21/5/2014 2148/14 NY.NUR LAELA 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 21/5/2014 2150/14 SDR.SLAMET MARIYANTO 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
59 21/5/2014 2155/14 TN.EDY MUSTOFA 31TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
60 21/5/2014 2157/14 TN.SUTIYONO 49TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
61 22/5/2014 2162/14 AN.MOH.ROSYID ANAFI 4,6TH SHOUDER 2PSS + CLAVICULA AP dr.ANE RUJUK 135000 7500 142500
62 22/5/2014 2165/14 TN.SUTRIMO 57TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
63 22/5/2014 583/14 NN.HARNI ROSIDAH 16TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
64 23/5/2014 248/14 TN.MARKUAT 44TH THORAX PA dr.ANE RUJUK 67500 7500 75000
65 23/5/2014 2190/14 AN.SYIFA REYUANO AL AKBAR 2,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
66 23/5/2014 2203/14 NY.RUSMI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
67 24/5/2014 4659/01 TN.KASRIN 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
68 26/5/2014 5730/13 AN.INTAN PUSPITASARI 3TH THORAX AP dr.WORRO dr.MICHEL 60000 20000 80000
69 28/5/2014 3335/12 TN.SUMARTO 51TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
70 30/5/2014 2276/14 AN.NUR NABILA 2,6TH THORAX AP dr.GUNARDI SP.A dr.MICHEL 60000 20000 80000
71 30/5/2014 5583/13 TN.RIFA'I 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
72 30/5/2014 2269/14 AN.BAGUS ADI PRASETYO 4TH CRANIUM AP/LAT dr.ANE RUJUK 115000 7500 122500
73 30/5/2014 2272/14 AN.ISTIQOMAH 17BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
74 30/5/2014 2274/14 NY.NGATEMI 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
75 30/5/2014 2282/14 NN.ATIKATUL AFIFAH 15TH ABDOMEN 2 POSISI dr.ANE RUJUK 137000 7500 144500
76 31/5/2014 2292/14 NN.DANIK MEGA 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
77 31/5/2014 1113/13 TN.SUKANI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
78 31/5/2014 1230/14 TN.MAHMUDI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
79 31/5/2014 4568/13 TN.WAHYUDI 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
80 31/5/2014 2297/14 TN.KASTEMAN 61TH THORAX PA dr.ANE dr.LISA 67500 20000 87500

Mengetahui Welahan,31 MEI 2014

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : JUNI 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/6/2014 2308/14 NY.WASIAH 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 2/6/2014 1742/14 TN.BUSARI 58TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
3 2/6/2014 4224/13 AN.AHMAD MAULANA YUSUF 3TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
4 2/6/2014 1630/06 TN.KORIP 58TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
5 2/6/2014 2326/14 TN.FANDHOLI 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 2/6/2014 2207/14 NY.YATIN 60TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
7 3/6/2014 2332/14 NY.MUJIATI 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 3/6/2014 2328/13 AN.NADIA AULIA FITRIANI 19BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
9 3/6/2014 2336/14 AN.YUSRON AINUR ROFIQ 9,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
10 3/6/2014 4528/13 NY.CICIK HIDAYATI 28TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
11 4/6/2014 2304/14 NY.LISMIATI 33TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
12 4/6/2014 2221/13 NY.DARWANTI 29TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500
13 5/6/2014 5761/13 NY.GIYEM 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 5/6/2014 2374/14 TN.SAKURUL ALIM 27TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
15 5/6/2014 2372/14 TN.SUPARMAN 75TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
16 6/6/2014 2395/14 TN.ZAINAL ARIFIN 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
17 6/6/2014 1398/11 TN.NAIMAM FAUZI 35TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
18 6/6/2014 4612/13 AN.AGUNG PRASETYAN 12TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
19 6/6/2014 1388/14 NY.HJ.SUPARTI 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
20 6/6/2014 933/12 AN.ZAROTUS SITA 5TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
21 6/6/2014 2399/14 TN.EDI PRANOTO 39TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
22 7/6/2014 4192/11 TN.ISMUN BIN MASRAN 75TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
23 9/6/2014 3077/13 NY.SRI SUHARTINI 38TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
24 9/6/2014 2428/14 NY.RINDUAH 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
25 9/6/2014 2416/14 NY.HJ.NASIKHAH 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
26 9/6/2014 778/14 NY.SUMIJAH 45TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
27 9/6/2014 4029/13 AN.AZAFA KHOIRUN NISA 20BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
28 9/6/2014 2433/14 SDR.ADITYA ANGGA 17TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
29 10/6/2014 2394/14 NY.MAELANAWATI 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
30 10/6/2014 2120/11 TN.SUBADI 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
31 10/6/2014 1818/14 TN.RUKIM 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 10/6/2014 414/14 NY.SUNARMI 47TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
33 10/6/2014 2245/14 NY.AMINAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
34 10/6/2014 1730/14 NN.UMI FARIDATUL 24TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
35 11/6/2014 2216/14 TN.SUKIR 59TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
36 11/6/2014 2462/14 NN.LAILA ROHMAH 16TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
37 11/6/2014 2828/12 TN.PURWANTO 54TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
38 11/6/2014 5605/13 NY.IZZATUN NISA 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
39 11/6/2014 2473/14 TN.MOH SAHLI 80TH ABDOMEN dr.ANE RUJUK 67500 7500 75000
40 12/6/2014 2468/03 TN.NARDI 60TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
41 12/6/2014 2480/14 TN.MAKHALI 32TH MANUS AP/OBLIQUE dr.ANE RUJUK 92500 7500 100000
42 12/6/2014 2489/14 NY.YULI AFIFA 28TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
43 13/6/2014 3585/09 NY.MUNJAROAH 50TH ANKLE JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
44 13/6/2014 2513/14 AN.NAFIQ ULIN NUHA 11TH ELBOW JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
45 13/6/2014 2517/14 NY.MULYATI 36TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
46 16/6/2014 2479/14 TN.AFRONZI 33TH CRANIUM AP dr.ANE dr.LISA 60000 20000 80000
47 16/6/2014 3634/08 NY.MUNJAENAH 55TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500
48 16/6/2014 772/14 NY.SRI WAHYUNI 30TH PEDIS AP/OBLIQUE dr.ANE dr.LISA 92500 20000 112500
49 16/6/2014 2550/14 SDR.AHMAD SARFUWAH 19TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
50 16/6/2014 2551/14 NY.KHOLIFAH 36TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
51 17/6/2014 2556/14 TN.MAKSUM 52TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
52 17/6/2014 1908/02 TN.SUMARDI 62TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
53 17/6/2014 1617/09 NY.SUPIATI 48TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
54 17/6/2014 2563/14 TN.MOH.TAUFIK 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
55 17/6/2014 322/14 TN.KASRUN 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
56 18/6/2014 2575/14 SDR.NUR ROHMAN 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
57 18/6/2014 2577/14 TN.WAHYUDI 31TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500
58 18/6/2014 2579/14 TN.DARSAN 64TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
59 18/6/2014 2581/14 NY.MASMOAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
60 19/6/2014 4178/13 TN.MATOHAR 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
61 20/6/2014 2600/14 TN.MASIKAN 59TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
62 20/6/2014 5809/13 AN.MOH.ZULFAN ARYA 1,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
63 23/6/2014 5765/13 TN.KASTAMI 34TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
64 23/6/2014 2062/13 TN.SADRI 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
65 23/6/2014 2627/14 NY.ARIS SUSANTI 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
66 23/6/2014 1933/14 TN.SAMI'AN 56TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
67 23/6/2014 70/14 AN.NADIM RIQ'ZA MUKTAFA 3TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
68 23/6/2014 2413/14 NY.ZULAIKAH 50TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
69 23/6/2014 2633/14 TN.SUPARMO 41TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
70 23/6/2014 2571/14 SDR.WIDODO 29TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
71 23/6/2014 2637/14 AN.AYUDIA AYUTUL. H 3,6TH CRANIUM AP/LAT dr.ANE dr.MICHEL 115000 23000 138000
72 24/6/2014 2651/14 TN.ABDUL KHALIM 47TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
73 24/6/2014 2662/14 AN.ELSA PARAMITA 8,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
74 25/6/2014 5787/13 NY.MARYATUN 77TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
75 25/6/2014 600/14 TN.SUWANTO 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
76 25/6/2014 5803/13 TN.FARIDIN 60TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
77 26/6/2014 2289/12 TN.AHMADUN 56TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
78 26/6/2014 2691/14 TN.RUSONO 53TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
79 26/6/2014 1264/13 NY.SITI ZULIYATI 36TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
80 27/6/2014 5658/13 AN.AHMAD NUR REZA 10TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
81 27/6/2014 1614/11 AN.MURADUN FASIH 4TH CRURIS AP/LAT dr.ANE RUJUK 75000 7500 82500
82 28/6/2014 5060/12 NY.YULIANA 26TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
83 28/6/2014 2727/14 TN.RAKIM 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
84 28/6/2014 3592/07 NN.SURYA NURUL 21TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
85 30/6/2014 2742/14 NY.SUMIRAH 59TH PELVIS AP dr.ANE dr.MICHEL 67500 20000 87500
86 30/6/2014 2376/13 NY.ZAINATUN AFIYAH 30TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
87 30/6/2014 2604/14 NY.PAIMAH 54TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500

Mengetahui Welahan,30 JUNI 2014

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan


(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)
LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : JULI 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/7/2014 1330/06 TN.JAYUS 53TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
2 1/7/2014 2829/04 TN.ASMADI 39TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
3 1/7/2014 2755/14 TN.SASMITO 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 2/7/2014 2768/14 NY.HJ.LIPUR KHAYATI 71TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
5 2/7/2014 640/14 NN.ANA ASTUTIK 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 2/7/2014 2771/14 NY.SOFIAH 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
7 2/7/2014 2761/14 TN.SOLIKIN 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 2/7/2014 2772/14 NY.SUMIATI 43TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
9 2/7/2014 1009/07 NY.AFIFAH 25TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
10 2/7/2014 2778/14 TN.PURWADI 39TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
11 3/7/2014 459/14 AN.KAMELIA NOVITASARI 2,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
12 3/7/2014 4781/12 NY.MUAROFAH 52TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
13 3/7/2014 1000/14 TN.ZARKONI 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 4/7/2014 2792/14 NY.MUKIJAH 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
15 4/7/2014 2793/14 NY.MUSLIKAH 69TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
16 5/7/2014 4412/13 NY.WARSINI 54TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
17 5/7/2014 3469/09 AN.SIVA ALYSHIA 5TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
18 7/7/2014 3450/10 AN.KEVIN SATRIA WIBAWA 6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
19 7/7/2014 1505/05 TN.BUDI SETYAWAN 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 8/7/2014 2836/14 TN.NUR SALIM 59TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
21 8/7/2014 2848/14 NY.SUMAIDAH 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
22 10/7/2014 2538/14 TN.MULYONO 61TH CRURIS AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
23 10/7/2014 3523/09 TN.MAHSUN 59TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
24 10/7/2014 2867/14 TN.KUSNAN 66TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
25 10/7/2014 2936/13 TN.TAS'AN 61TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
26 11/7/2014 477/10 NY.KASRINI 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
27 11/7/2014 512/05 TN.SUKANDAR 52TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
28 11/7/2014 2875/14 NY.SUYATI 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
29 11/7/2014 4632/13 NY.SITI ARIFAH 20TH CRURIS AP/LAT dr.ANE dr.LISA 92500 20000 112500
30 11/7/2014 4572/13 SDR.BUNARDI 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
31 12/7/2014 2301/14 NN.INTAN PERMATASARI 16TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 14/7/2014 2906/14 TN.SUPARJO 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
33 14/7/2014 2910/14 NY.MIATI 66TH THORAX AP dr.ANE dr.LISA 67500 20000 87500
34 14/7/2014 2912/14 NY.SRI PARIYAH 67TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
35 15/7/2014 2696/14 NY.SRI ASROFAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
36 15/7/2014 3734/03 SDR.MOH.KHUSNUL RONJIKUN 13TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
37 15/7/2014 1302/13 NY.SUKITA 43TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
38 16/7/2014 2946/14 NY.HJ.KHOISAH 48TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
39 17/7/2014 2951/14 NY.SUHARNI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
40 17/7/2014 2949/14 TN.KASNURI 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
41 17/7/2014 4217/02 NY.AFMIRAH 72TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 18/7/2014 2963/14 NY.MASLIKAH 52TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
43 18/7/2014 2965/14 TN.SUPONO 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 18/7/2014 247/12 NY.NURUL AINI 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
45 18/7/2014 2969/14 AN.TIARA PUSPITASARI 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
46 18/7/2014 2730/14 SDR.SLAMET FAHRUDIN 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
47 19/7/2014 2971/14 TN.NUR HADI 75TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
48 19/7/2014 3104/07 NY.RUKINI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
49 19/7/2014 627/06 TN.TEGO 84TH PELVIS AP dr.ANE dr.LISA 67500 20000 87500
50 19/7/2014 2673/11 TN.MUNASIR 52TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
51 21/7/2014 2986/14 TN.KUSNIN 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
52 21/7/2014 2980/14 AN.DEWI PUTRI ANJANAH 5TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
53 21/7/2014 2982/14 AN.ILZAM SHOFI 10TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
54 21/7/2014 2954/14 NY.HJ.ZULIFAH 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
55 21/7/2014 2178/04 NY.SATIRAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
56 22/7/2014 3008/14 TN.LEGIRAN 54TH THORAX PA dr.MEILINA dr.MICHEL 67500 20000 87500
57 22/7/2014 3013/14 AN.NAILA MUNA 8TH THORAX AP dr.MEILINA dr.LISA 60000 20000 80000
58 22/7/2014 22/14 AN.HAWA NORMAN 6TH THORAX AP dr.MEILINA dr.MICHEL 60000 20000 80000
59 23/7/2014 3204/14 TN.NGASRI 68TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
60 23/7/2014 2943/14 AN.KHILYATU LAINIYAH 11TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
61 23/7/2014 3018/14 TN.NASUKHA 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
62 23/7/2014 265/14 AN.MIFITA ARUMSARI 4TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
63 23/7/2014 3025/14 NY.SRI MURNI 51TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
64 23/7/2014 3037/14 AN.IRFAN ARIF SAPUTRA 5TH ANTEBRACHII AP/LAT dr.ANE dr.MICHEL 75000 20000 95000
65 24/7/2014 61/99 NY.RUKAYATUN 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
66 24/7/2014 3057/14 TN.AHWAN 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
67 30/7/2014 3983/14 NY.KAYATI 65TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
68 30/7/2014 2518/14 SDR.AHMAD ZAINAL AFIF 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
69 30/7/2014 2669/14 TN.SUJONO 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
70 30/7/2014 3088/14 NY.MULYATI 26TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
71 30/7/2014 1926/05 TN.KARDONO 46TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
72 30/7/2014 3099/14 TN.ROHMAN 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
73 31/7/2014 3106/14 TN.SABAR 34TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
74 31/7/2014 3107/14 NY.MASKHUNAH 65TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
75 31/7/2014 3097/14 SDR.ABDUL GOFUR 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
76 31/7/2014 3109/14 NN.WIWIK ZULAKHAH 18TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
77 31/7/2014 3108/14 TN.MUH.SULAIMAN 55TH THORAX PA + ABDOMEN dr.ANE dr.LINA 135000 40000 175000
78 31/7/2014 4313/13 TN.MOH.SHOLIKIN 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
79 31/7/2014 1572/14 TN.AHMAD ZAMRONI 34TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
80 31/7/2014 3132/14 TN.H.KHAMDAN 65TH THORAX PA dr.ANE RUJUK 67500 7500 75000
81 31/7/2014 3139/14 TN.SAMUJI 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500

TOTAL 6523000 1662000 7500 8192500

Mengetahui Welahan,31 JULI 2014

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : AGUSTUS 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/8/2014 3142/14 TN.KASBI 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 1/8/2014 2042/13 AN.IZA AZABI 1,6TH THORAX AP dr.ANE dr.LINA 60000 20000 80000
3 1/8/2014 3154/14 NY.NIKMATUL ULFA 25TH THORAX PA + ABDOMEN dr.ANE dr.LISA 135000 40000 175000
4 1/8/2014 3163/14 NY.HENI LUSIANA 57TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
5 1/8/2014 3166/14 TN.ALI BUSROH 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 2/8/2014 3160/14 TN.JUMADI 32TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
7 2/8/2014 3172/14 SDR.AHSANUDDIN 17TH ANKLE AP/LAT dr.ANE dr.LISA 92500 20000 112500
8 2/8/2014 2295/14 NY.SRI KHUMAIYAH 33TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
9 4/8/2014 3178/14 TN.RAWAN 60TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
10 4/8/2014 3183/14 NY.AMBAR TATIK 30TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
11 4/8/2014 329/14 NY.RUSMILAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
12 5/8/2014 3208/14 AN.DITAH 5TH THORAX AP dr.ANE dr.LINA 60000 20000 80000
13 5/8/2014 922/09 TN.WAGIMAN 67TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 5/8/2014 3210/14 TN.SEMO 70TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
15 5/8/2014 4056/12 NY.SRI HARTINI 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
16 6/8/2014 346/14 NY.SOFIATUN 50TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
17 6/8/2014 4344/13 NY.MURDIYANI 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
18 6/8/2014 3243/14 NY.SITI RUSMINI 40TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
19 7/8/2014 3254/14 NY.AMANAH 60TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
20 7/8/2014 682/14 TN.RUSCHAN 45TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
21 8/8/2014 33/07 TN.SUNOTO 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
22 8/8/2014 3272/14 TN.SUPRIYADI 38TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
23 8/8/2014 466/14 AN.SULTAN ARIF SAPUTRA 6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
24 8/8/2014 3274/14 TN.SOBIRIN 62TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
25 8/8/2014 5497/13 NY.RUSTAMAH 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
26 8/8/2014 3281/14 TN.MOH.KLISIN 40TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
27 9/8/2014 580/09 NY.MUPA'AH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
28 9/8/2014 3295/14 TN.KARTONO 58TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
29 11/8/2014 826/10 AN.AULIANA ZAHIRA 5TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
30 11/8/2014 3319/14 NY.JIMAH 60TH LUMBAL AP/LAT BUDIYONO dr.LINA 137000 23000 160000
31 11/8/2014 3312/14 SDR.MOH.MOKHID 28TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 11/8/2014 3320/14 NY.TUMIRAH 60TH GENUE AP/LAT dr.ANE RUJUK 92500 7500 100000
33 11/8/2014 3326/14 NY.KASMINAH 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
34 11/8/2014 1015/12 TN.ROHADI 41TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
35 11/8/2014 218/13 NY.SULASTRI 56TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
36 12/8/2014 3342/14 TN.ABDUL MANAN 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
37 12/8/2014 3832/01 NY.KASTI 67TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
38 12/8/2014 3218/14 SDR.AHMAD ANAS 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
39 12/8/2014 3346/14 NY.SUTINI 70TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
40 13/8/2014 3356/14 SDR.MAKRUF 28TH GENUE AP/LAT dr.ANE dr.LINA 92500 20000 112500
41 14/8/2014 3362/14 NY.BUDI SUSILOWATI 30TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
42 14/8/2014 5315/13 NY.UMAMI 50TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
43 15/8/2014 4164/08 TN.KAHONO 38TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
44 15/8/2014 3384/14 NY.JUMANAH 60TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
45 15/8/2014 3389/14 NN.NILA 18TH CRURIS AP/LAT dr.ANE dr.LISA 92500 20000 112500
46 16/8/2014 2372/14 TN.SUPARMAN 75TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
47 16/8/2014 3407/14 NN.IRTIFA'AH 12TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
48 18/8/2014 3421/14 SDR.MOH.IKHSAN 19TH THORACAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
49 18/8/2014 4649/13 NY.RUSMINAH 53TH WATER'S dr.ANE dr.LINA 60000 20000 80000
50 18/8/2014 2994/14 NN.SYAM YULIANI 34TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
51 18/8/2014 611/00 NY.ISTIKOMAH 55TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
52 18/8/2014 3443/14 AN.IRVAN SAID 11TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
53 18/8/2014 3446/14 TN.SUYADI 52TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
54 18/8/2014 3448/14 TN.YATIN ROSIDI 34TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
55 19/8/2014 636/02 NY.SAMINAH 58TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
56 19/8/2014 3459/14 NN.KHUMAIDAH 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
57 19/8/2014 3082/14 TN.RIFAI 37TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
58 20/8/2014 3343/12 AN.MOH.REHAN 2,6TH THORAX AP dr.JOSEF dr.LISA 60000 20000 80000
59 20/8/2014 3470/14 NN.KHUSWATUN KHASNAH 15TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
60 20/8/2014 3465/14 NY.RUKAYATI 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
61 20/8/2014 3407/14 TN.SUDARSONO 25TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
62 20/8/2014 3468/14 NY.SULASTRI 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
63 21/8/2014 3477/14 NY.SURIPAH 60TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
64 21/8/2014 3799/13 AN.AHMAD ALFARIZI 12TH CRANIUM AP/LAT dr.ANE dr.LINA 115000 23000 138000
65 21/8/2014 3480/14 AN.ROIS 12TH FEMUR AP/LAT dr.ANE dr.LINA 75000 20000 95000
66 21/8/2014 3451/14 NY.KHOIRIYAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
67 21/8/2014 3488/14 NY.NUR KHALIMAH 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
68 22/8/2014 2092/12 NY.ASPIYAH 60TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
69 22/8/2014 3114/09 NY.MANIKAH 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
70 22/8/2014 3474/14 TN.RONDI 65TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
71 22/8/2014 3492/14 SDR.AHMAD ANDI ARYANTO 17TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
72 22/8/2014 2005/06 TN.MOKSIN 70TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
73 22/8/2014 3455/14 TN.AGUS ALFARO 33TH WATER'S dr.ANE dr.LINA 60000 20000 80000
74 22/8/2014 3503/14 TN.SUTRISNO 37TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
75 22/8/2014 3508/14 NY.RINA KISWATI 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
76 23/8/2014 3512/14 NY.UMAROH 25TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
77 23/8/2014 3521/14 TN.SUNTONO 60TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
78 23/8/2014 3187/05 NY.SITI KHALIMAH 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
79 25/8/2014 284/13 TN.A.AFANDI 71TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
80 25/8/2014 341/14 NY.SULASTRI 55TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
81 25/8/2014 3530/14 NY.SUDARYATI 46TH THORAX PA dr.ANE RUJUK 67500 7500 75000
82 25/8/2014 3471/14 NY.EMAWATI 35TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
83 25/8/2014 3445/14 TN.MUALIM ZAID 39TH CLAVICULA AP dr.ANE dr.LINA 60000 20000 80000
84 25/8/2014 3153/14 TN.KHOIRUL ZAMAN 24TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
85 25/8/2014 2181/04 TN.SUTOMO 65TH THORAX PA dr.ANE dr.LINA 67500 7500 75000
86 25/8/2014 1666/14 AN.MOH.ULIN NUHA 11TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
87 25/8/2014 1822/12 NY.MUNARSIH 35TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
88 26/8/2014 124/14 NY.NURUL KHASANAH 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
89 26/8/2014 3453/12 TN.NDARU PRANOTO 52TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
90 26/8/2014 3556/14 NY.UKHROWIYAH 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
91 26/8/2014 3560/14 TN.ABDUL KHONJIN 34TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
92 26/8/2014 2437/14 NN.RAHMA NUR 14TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
93 27/8/2014 3916/13 NY.NGATINI 49TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
94 27/8/2014 3567/14 TN.SUMARDI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
95 27/8/2014 4263/09 AN.HANIF RAMADANI 8TH THORAX PA dr.ANE dr.LINA 60000 20000 80000
96 27/8/2014 3572/14 SDR.NAZIKUL HUDA 18TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
97 27/8/2014 3575/14 NY.JUARIYAH 43TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
98 28/8/2014 3587/14 TN.KASNUBI 80TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
99 28/8/2014 2512/12 NY.LISDARWATI 40TH CERVICAL AP/LAT dr.ANE dr.LINA 77000 23000 100000
100 28/8/2014 3592/14 SDR.MISBAKHUL MUNIR 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
101 28/8/2014 3600/14 AN.NAYA VIVIANA 3TH THORAX AP dr.ANE dr.LINA 60000 20000 80000
102 29/8/2014 3490/14 NY.PATEMI 76TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
103 29/8/2014 3612/14 NY.MASLUROH 36TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
104 29/8/2014 1844/11 TN.SUANDI 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
105 29/8/2014 1872/14 NY.SITI RUKAYAH 44TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
106 29/8/2014 636/02 NY.SAMINAH 62TH THORAX PA dr.ANE dr.LISA 67500 20000 87500

TOTAL 8826000 2152000 22500 11000500

Mengetahui Welahan,31 AGUSTUS 2014

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : SEPTEMBER 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/9/2014 3628/14 TN.MASRUKIN 34TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
2 1/9/2014 3629/14 TN.MASRODHI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
3 1/9/2014 3870/09 NY.MASRI 60TH THORAX PA+LUMBAL AP/LAT dr.ANE dr.LINA 204500 43000 247500
4 1/9/2014 1112/06 NY.IMROATUN 32TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
5 1/9/2014 2403/13 SDR.AZIZ FIKRI 17TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
6 1/9/2014 3631/14 NN.DIAN LESTARI 17TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
7 1/9/2014 3637/14 TN.HIRMANTO 49TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
8 1/9/2014 3638/14 TN.H.DARSO 60TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
9 1/9/2014 3639/14 NY.SRI KHATUN 52TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
10 1/9/2014 3649/14 AN.MOH.FAJAR ARYADI 7TH ANKLE AP/LAT dr.ANE RUJUK 75000 7500 82500
11 1/9/2014 3647/14 TN.RAHARJO 33TH MANUS AP/OBLIQUE dr.ANE dr.LINA 92500 20000 112500
12 1/9/2014 3655/14 TN.SUYADI 53TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
13 1/9/2014 2124/13 SDR.MOH.NUR KHOLIK 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 2/9/2014 3665/14 TN.EDI SISWANTO 32TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
15 2/9/2014 3669/14 TN.MULYADI 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
16 2/9/2014 4642/07 NY.SUKAMAH 60TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
17 2/9/2014 3671/14 NY.KARSITI 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
18 2/9/2014 3674/14 AN.DESI KHOIRUN NISA 21TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
19 2/9/2014 3231/14 NY.SUGIYEM 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 2/9/2014 3680/14 AN.MOH.NIZAR ABDULLAH 6TH THORAX PA dr.ANE dr.LINA 60000 20000 80000
21 3/9/2014 3685/14 SDR.MOH.FARIHIN 28TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
22 3/9/2014 3691/14 NY.SITI MURTI 29TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
23 3/9/2014 2320/14 TN.SUPARJO 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
24 3/9/2014 3692/14 TN.SUHARSONO 55TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
25 3/9/2014 544/07 NY.SUDARSIH 43TH MANUS AP/OBLIQUE dr.ANE dr.LISA 92500 20000 112500
26 3/9/2014 2369/07 NY.NGADINI 49TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
27 4/9/2014 3669/01 TN.SUYADI 61TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
28 4/9/2014 3716/14 SDR.ABDUL MUIN 31TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
29 5/9/2014 40/14 NY.DATI 60TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
30 5/9/2014 2079/14 NY.LUTFIATUN 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
31 5/9/2014 3256/13 NY.NIKMATUN 41TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
32 5/9/2014 1173/14 AN.WAFA AL AULIASABIL 4TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
33 8/9/2014 3744/14 TN.PANDIL 59TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
34 8/9/2014 1097/04 TN.SLAMET 45TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
35 8/9/2014 3586/13 AN.BIRNA NAJMA SAKIB 3TH THORAX AP dr.ANE dr.LINA 60000 20000 80000
36 8/9/2014 1037/07 TN.KASWONO 40TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
37 8/9/2014 3758/14 SDR.AGUS MUSTAKIM 20TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
38 8/9/2014 3644/14 NY.SARNI 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
39 8/9/2014 4583/09 NN.MILATUS ZAIROH 21TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
40 8/9/2014 3703/14 TN.SUWARDI 61TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 9/9/2014 2229/04 TN.SAPUAN 53TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
42 9/9/2014 3771/14 NY.FITRIYANA 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
43 9/9/2014 3768/14 SDR.AJI SETIAWAN 14TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
44 9/9/2014 2534/06 NY.SAFA'ATIN 52TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
45 9/9/2014 2232/11 NY.PARYUNI 38TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
46 10/9/2014 3578/14 NY.ASTRI SETIA 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
47 10/9/2014 3793/14 NN.ALVIN AZIZA 15TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
48 10/9/2014 3799/14 TN.MARGONO 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
49 11/9/2014 3098/12 NY.WARTINI 62TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
50 11/9/2014 4605/09 NY.NGASMIRAH 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
51 11/9/2014 3806/14 NN.ANA ANITA RAHMAWATI 26TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
52 11/9/2014 3807/14 NY.WAGINAH 65TH THORAX AP dr.ANE dr.LISA 67500 20000 87500
53 11/9/2014 3483/14 SDR.ALI ROSIDHI 30TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
54 11/9/2014 5090/14 SDR.BAYU PUTRA WINATA 15TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
55 12/9/2014 3839/14 SDR.SUGIRI 20TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
56 12/9/2014 3842/14 AN.SITI ANISAH 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
57 13/9/2014 3846/14 NY.SAIDAH 33TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
58 13/9/2014 399/07 TN.SARAH 77TH PELVIS AP dr.ANE dr.LISA 67500 20000 87500
59 15/9/2014 3867/14 NY.WIWIK 33TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
60 15/9/2014 3874/14 TN.SUTRIMAN 30TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
61 15/9/2014 3115/14 TN.ABDUL HAMID 32TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
62 15/9/2014 3876/14 NY.KHURIYATI 47TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
63 15/9/2014 3747/14 AN.FENDI ANDIKA 5TH THORAX AP dr.ANE dr.LINA 60000 20000 80000
64 15/9/2014 3869/14 NN.AISAH 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
65 15/9/2014 3879/14 TN.RAHMAT SASWONO 46TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
66 15/9/2014 3882/14 TN.SLAMET 62TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
67 16/9/2014 3889/14 NY.SUKARMI 75TH LUMBAL AP/LAT+THORAX AP dr.ANE dr.LINA 204000 43000 247000
68 16/9/2015 3894/14 TN.SUMARSONO 32TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
69 16/9/2016 3895/14 NY.USRIYAH 42TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
70 16/9/2017 4005/08 AN. NAELAL MUFAWAZAH 6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
71 16/9/2018 3898/14 NY.MIAH 55TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
72 16/9/2019 3902/14 TN.NUR ALIM ZEN 30TH THORAX AP/LAT dr.ANE dr.LISA 137000 23000 160000
73 16/9/2020 3904/14 TN.KHOIRUL ANAM 28TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
74 16/9/2021 3905/14 TN.ABDUL KALIM 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
75 16/9/2022 500/10 TN. SUDIRNO 47TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
76 17/09/2014 3912/14 NY.RUKMI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
77 17/09/2015 2337/07 TN.KOSIM 49TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
78 17/09/2016 3914/14 TN.MATROFIN 45TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
79 17/09/2017 3915/14 NN.ELIS DIAH 13TH CRURIS AP/LAT dr.ANE dr.LINA 92500 20000 112500
80 18/9/2014 3932/14 TN.KUMAIDI 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
81 18/9/2014 1178/14 AN.AINI NUR LAILIKA 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
82 18/9/2014 3945/14 TN.H.SUROSO 64TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
83 19/9/2014 3949/14 NN.INAYATUL 13TH THORAX PA dr.ANE RUJUK 67500 7500 75000
84 19/9/2014 3956/14 TN.UNDANG ISKANDAR 66TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
85 19/9/2014 3579/14 NY.SUMARNI 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
86 20/9/2014 3966/14 TN.WASPAN 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
87 20/9/2014 3974/14 TN.SUWARTO 70TH THORAX PA dr.ANE RUJUK 67500 7500 75000
88 20/9/2014 1772/02 SDR.ANANG 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
89 22/9/2014 3927/14 TN.IJEH 54TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
90 22/9/2014 1252/06 NY.SANIPAH 60TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
91 22/9/2014 3318/12 SDR.SAIFUL HUDA 23TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
92 22/9/2014 3983/14 NY.SUPRIYANTI 29TH MANUS AP/OBLIQUE dr.ANE dr.LINA 92500 20000 112500
93 22/9/2014 3984/14 TN.BUDIYONO 51TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
94 22/9/2014 3346/07 NY.MUKAROMAH 50TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
95 22/9/2014 3994/14 NY.SUMIYATI 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
96 22/9/2014 4149/13 AN.MOH.KHOIRUL ANWAR 12TH THORAX PA dr.ANE dr.LINA 60000 20000 80000
97 23/9/2014 3997/14 TN.KARNO 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
98 23/9/2014 1571/14 TN.H.NASIR 70TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
99 23/9/2014 3337/14 TN.SUWOTO 48TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
100 23/9/2014 4009/14 NY.SITI MUNAWAROH 28TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
101 24/9/2014 1629/14 NY.SUKARNI 65TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
102 24/9/2014 3913/14 NY.SUSILOWATI 47TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
103 24/9/2014 4020/14 NY.NUNUNG NUR KHAYATI 47TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
104 24/9/2014 3738/14 NY.MUJIWATI 52TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
105 25/9/2014 4024/14 NY.ROUDLOTUL 20TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
106 25/9/2014 4028/14 NY.NIHAYAH 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
107 25/9/2014 2223/13 AN.RENDI SAPUTRA 6TH THORAX PA dr.ANE dr.LINA 60000 20000 80000
108 26/9/2014 4044/14 TN.IMAM KHOERONI 25TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
109 26/9/2014 2431/14 NY.SUKANAH 70TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
110 26/9/2014 2681/11 NY.KARYATUN 39TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
111 26/9/2014 4059/14 TN.MAFTUCHIN 57TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
112 27/9/2014 3843/14 NY.WAGIRAH 50TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
113 29/9/2014 5541/13 AN.HARUMINA WASITA 2TH THORAX PA dr.ANE dr.LINA 60000 20000 80000
114 29/9/2014 1010/14 TN.SUPARNO 80TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
115 29/9/2014 3438/05 NY.KATIPAH 62TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
116 29/9/2014 501/02 NN.BAROKATI MILA SAFITRI 18TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
117 29/9/2014 4077/14 NY.LILIK MUAYANAH 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
118 29/9/2014 3026/09 TN.PURWONO 34TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
119 29/9/2014 4955/09 NY.MASIDAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
120 29/9/2014 4001/14 TN.SUNTANI 62TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
121 29/9/2014 518/12 TN.KURMUNDI 54TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
122 29/9/2014 1919/14 TN.H.FAUZAN 76TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
123 29/9/2014 4094/14 TN.KAMUS WORO 49TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
124 30/9/2014 4112/14 TN.ASPARI 51TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
125 30/9/2014 4116/14 TN.SADI 60TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
TOTAL 9741500 2528000 22500 12292000
Mengetahui Welahan,30 September 2014

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : OKTOBER 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/10/2014 4125/14 AN.RAUBAL AHMAD 1,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
2 1/10/2014 1367/06 TN.SUNTONO 59TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
3 1/10/2014 3967/14 TN.RIF'AN 65TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
4 2/10/2014 4148/14 NY.RUMIKAH 60TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
5 2/10/2014 4150/14 NY.MASFUAH 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 2/10/2014 1466/14 AN.MOH.RIZKI 8TH THORAX PA dr.ANE dr.LINA 60000 20000 80000
7 3/10/2014 546/05 TN.SOLKAN 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 3/10/2014 4177/14 SDR.MASHUR 30TH WATER'S SPN dr.ANE dr.LINA 60000 20000 80000
9 4/10/2014 1078/10 TN.SUHARI 46TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
10 6/10/2014 4201/14 NY.DURROTUL MISKIYAH 47TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
11 6/10/2014 4202/14 TN.SUTAMI 60TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
12 6/10/2014 1320/14 AN.REZA RAJNI PRADILI 7TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
13 6/10/2014 4204/14 AN.ABBY MAHDUROH 2TH THORAX AP dr.ANE dr.LINA 60000 20000 80000
14 6/10/2014 2801/11 NY.SUMA'ONAH 54TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
15 6/10/2014 1527/14 AN.NABIL FATUR 2,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
16 6/10/2014 781/00 NY.HJ.MASRIATUN 58TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
17 6/10/2014 3733/14 NY.SUPIRAH 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
18 7/10/2014 4169/14 NY.DARWATI 55TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
19 7/10/2014 3986/14 NY.SAPUTRI 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 7/10/2014 4067/08 AN.DAVIDIO YOGA 6TH THORAX PA dr.ANE dr.LINA 60000 20000 80000
21 8/10/2014 4258/14 SDR.MOH.YUSUF 22TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
22 8/10/2014 657/13 NY.SRI FITRIYANINGSIH 27TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
23 9/10/2014 4265/14 NN.ANI FARADILA 12TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
24 9/10/2014 4276/14 SDR.MUSTAGHFIRIN 23TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
25 9/10/2014 4230/14 NY.SRI YATUN 60TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
26 10/10/2014 374/12 TN.SUGIRAN 72TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
27 10/10/2014 3594/14 NN.FERI PUJI ASTUTI 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
28 10/10/2014 3512/12 TN.ABDUL KHOLIK 52TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
29 10/10/2014 4296/14 TN.SAKUWAN 59TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
30 10/10/2014 258/02 TN.WIDODO 35TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
31 10/10/2014 718/14 TN.SAKDUWAH 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 10/10/2014 4295/14 NY.TATIK 29TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
33 10/10/2014 4307/14 TN.MOH.SUBAGIO 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
34 11/10/2014 4313/14 TN.WAGIMAN 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
35 11/10/2014 4717/14 TN.SUHARTO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
36 13/10/2014 4321/14 TN.IKSAN 65TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
37 13/10/2014 4315/14 TN.RIFA'I 68TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
38 13/10/2014 4316/14 AN.GILANG RADITYA 7TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
39 13/10/2014 3060/14 NY.NUR SAIDAH 37TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
40 13/10/2014 4331/14 TN.MOH.ARIF 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 14/10/2014 4349/14 SDR.HERU 21TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
42 15/10/2014 4363/14 NY.HJ.SITI MASTUFAH 55TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
43 15/10/2014 1613/14 NY.SUSANTI 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 15/10/2014 4370/14 TN.PURNOMO 26TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
45 15/10/2014 3451/14 KHOIRIYAH 45TH WATER'S SPN dr.ANE dr.LISA 60000 20000 80000
46 16/10/2014 2142/08 AN.MOH.NOVAL 7TH ANKLE JOINT AP/LAT dr.ANE dr.LINA 75000 20000 95000
47 17/10/2014 4408/14 NN.YUYUN WIDIANTI 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
48 17/10/2014 4416/13 TN.SLAMET PURNOMO 50TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
49 17/10/2014 4409/14 TN.MUNASIR 50TH ANKLE JOINT AP/LAT dr.ANE dr.LINA 92500 20000 112500
50 17/10/2014 3804/07 TN.YADI 60TH PEDIS AP/OBLIQUE dr.ANE dr.LISA 92500 20000 112500
51 17/10/2014 4919/09 AN.MANAZIL RIZKI 5TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
52 17/10/2014 4404/14 TN.RIYANTO 65TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
53 18/10/2014 4999/13 TN.M.TOHA 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
54 20/10/2014 3745/09 NY.LEGISAH 55TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
55 20/10/2014 4440/14 TN.AHMAD KHOLIS 46TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
56 20/10/2014 4452/14 NY.KARTINI 34TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
57 20/10/2014 528/04 NY.SARINAH 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 21/10/2014 3813/09 NN.SRI ROHMA 31TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
59 21/10/2014 4468/14 NN.MAZRO'ATUL MUAKHIROH 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
60 21/10/2014 4464/14 TN.AHMAD SAIFUDDIN 34TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
61 21/10/2014 4476/14 NY.UMROH 56TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
62 21/10/2014 4478/14 TN.KARSANI 33TH THORAX PA + ABDOMEN dr.ANE dr.LINA 135000 40000 175000
63 22/10/2014 2792/13 TN.SAYUTI 61TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
64 23/10/2014 4018/13 NY.KOMARIAH 59TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
65 23/10/2014 973/14 TN.SUDRAJAT 43TH ANKLE JOINT AP/LAT dr.ANE dr.LINA 92500 20000 112500
66 23/10/2014 1800/14 NY.SUTAMI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
67 23/10/2014 4504/14 TN.SUMADI 43TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
68 24/10/2014 4510/14 TN.MUKANDAR 46TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
69 24/10/2014 4511/14 AN.FARA KOTRUN NADA 1TH THORAX AP dr.ANE dr.LINA 60000 20000 80000
70 24/10/2014 3946/13 AN.FARZA NUR LAELA 2,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
71 27/10/2014 4528/14 TN.MOEKARIM 75TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
72 27/10/2014 4540/14 SDR.WASONO DWI ANGGORO 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
73 27/10/2014 4200/14 NY.ANIK SULISTYOWATI 25TH THORAX PA + ABDOMEN dr.ANE dr.LINA 135000 40000 175000
74 27/10/2014 1774/14 TN.SAHLAN 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
75 27/10/2014 1024/12 NY.SUMIYATI 30TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
76 28/10/2014 4563/14 NY.HILMI NADIFA 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
77 28/10/2014 97/13 NY.RUKMIWATI 44TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
78 29/10/2014 2101/06 TN.SUKONO 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
79 29/10/2014 4582/14 NY.MURSIYAH 49TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
80 30/10/2014 4589/14 TN.SAIFUL ANAM 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
81 30/10/2015 4591/14 TN.MASROH 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
82 30/10/2015 1919/06 SDR.KOIRIL ANWAR 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
83 31/10/2014 4609/14 NN.NABILA ISTIANATUL 12TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
84 31/10/2014 4602/14 NN.LINDA AYU NUZULUL 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : OKTOBER 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/10/2014 4125/14 AN.RAUBAL AHMAD 1,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
2 1/10/2014 1367/06 TN.SUNTONO 59TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
3 1/10/2014 3967/14 TN.RIF'AN 65TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
4 2/10/2014 4148/14 NY.RUMIKAH 60TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
5 2/10/2014 4150/14 NY.MASFUAH 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 2/10/2014 1466/14 AN.MOH.RIZKI 8TH THORAX PA dr.ANE dr.LINA 60000 20000 80000
7 3/10/2014 546/05 TN.SOLKAN 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 3/10/2014 4177/14 SDR.MASHUR 30TH WATER'S SPN dr.ANE dr.LINA 60000 20000 80000
9 4/10/2014 1078/10 TN.SUHARI 46TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
10 6/10/2014 4201/14 NY.DURROTUL MISKIYAH 47TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
11 6/10/2014 4202/14 TN.SUTAMI 60TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
12 6/10/2014 1320/14 AN.REZA RAJNI PRADILI 7TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
13 6/10/2014 4204/14 AN.ABBY MAHDUROH 2TH THORAX AP dr.ANE dr.LINA 60000 20000 80000
14 6/10/2014 2801/11 NY.SUMA'ONAH 54TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
15 6/10/2014 1527/14 AN.NABIL FATUR 2,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
16 6/10/2014 781/00 NY.HJ.MASRIATUN 58TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
17 6/10/2014 3733/14 NY.SUPIRAH 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
18 7/10/2014 4169/14 NY.DARWATI 55TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
19 7/10/2014 3986/14 NY.SAPUTRI 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 7/10/2014 4067/08 AN.DAVIDIO YOGA 6TH THORAX PA dr.ANE dr.LINA 60000 20000 80000
21 8/10/2014 4258/14 SDR.MOH.YUSUF 22TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
22 8/10/2014 657/13 NY.SRI FITRIYANINGSIH 27TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
23 9/10/2014 4265/14 NN.ANI FARADILA 12TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
24 9/10/2014 4276/14 SDR.MUSTAGHFIRIN 23TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
25 9/10/2014 4230/14 NY.SRI YATUN 60TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
26 10/10/2014 374/12 TN.SUGIRAN 72TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
27 10/10/2014 3594/14 NN.FERI PUJI ASTUTI 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
28 10/10/2014 3512/12 TN.ABDUL KHOLIK 52TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
29 10/10/2014 4296/14 TN.SAKUWAN 59TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
30 10/10/2014 258/02 TN.WIDODO 35TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
31 10/10/2014 718/14 TN.SAKDUWAH 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 10/10/2014 4295/14 NY.TATIK 29TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
33 10/10/2014 4307/14 TN.MOH.SUBAGIO 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
34 11/10/2014 4313/14 TN.WAGIMAN 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
35 11/10/2014 4717/14 TN.SUHARTO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
36 13/10/2014 4321/14 TN.IKSAN 65TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
37 13/10/2014 4315/14 TN.RIFA'I 68TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
38 13/10/2014 4316/14 AN.GILANG RADITYA 7TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
39 13/10/2014 3060/14 NY.NUR SAIDAH 37TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
40 13/10/2014 4331/14 TN.MOH.ARIF 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 14/10/2014 4349/14 SDR.HERU 21TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
42 15/10/2014 4363/14 NY.HJ.SITI MASTUFAH 55TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
43 15/10/2014 1613/14 NY.SUSANTI 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 15/10/2014 4370/14 TN.PURNOMO 26TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
45 15/10/2014 3451/14 KHOIRIYAH 45TH WATER'S SPN dr.ANE dr.LISA 60000 20000 80000
46 16/10/2014 2142/08 AN.MOH.NOVAL 7TH ANKLE JOINT AP/LAT dr.ANE dr.LINA 75000 20000 95000
47 17/10/2014 4408/14 NN.YUYUN WIDIANTI 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
48 17/10/2014 4416/13 TN.SLAMET PURNOMO 50TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
49 17/10/2014 4409/14 TN.MUNASIR 50TH ANKLE JOINT AP/LAT dr.ANE dr.LINA 92500 20000 112500
50 17/10/2014 3804/07 TN.YADI 60TH PEDIS AP/OBLIQUE dr.ANE dr.LISA 92500 20000 112500
51 17/10/2014 4919/09 AN.MANAZIL RIZKI 5TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
52 17/10/2014 4404/14 TN.RIYANTO 65TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
53 18/10/2014 4999/13 TN.M.TOHA 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
54 20/10/2014 3745/09 NY.LEGISAH 55TH ABDOMEN dr.ANE dr.LINA 67500 20000 87500
55 20/10/2014 4440/14 TN.AHMAD KHOLIS 46TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
56 20/10/2014 4452/14 NY.KARTINI 34TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
57 20/10/2014 528/04 NY.SARINAH 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 21/10/2014 3813/09 NN.SRI ROHMA 31TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
59 21/10/2014 4468/14 NN.MAZRO'ATUL MUAKHIROH 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
60 21/10/2014 4464/14 TN.AHMAD SAIFUDDIN 34TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
61 21/10/2014 4476/14 NY.UMROH 56TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
62 21/10/2014 4478/14 TN.KARSANI 33TH THORAX PA + ABDOMEN dr.ANE dr.LINA 135000 40000 175000
63 22/10/2014 2792/13 TN.SAYUTI 61TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
64 23/10/2014 4018/13 NY.KOMARIAH 59TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
65 23/10/2014 973/14 TN.SUDRAJAT 43TH ANKLE JOINT AP/LAT dr.ANE dr.LINA 92500 20000 112500
66 23/10/2014 1800/14 NY.SUTAMI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
67 23/10/2014 4504/14 TN.SUMADI 43TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
68 24/10/2014 4510/14 TN.MUKANDAR 46TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
69 24/10/2014 4511/14 AN.FARA KOTRUN NADA 1TH THORAX AP dr.ANE dr.LINA 60000 20000 80000
70 24/10/2014 3946/13 AN.FARZA NUR LAELA 2,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
71 27/10/2014 4528/14 TN.MOEKARIM 75TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
72 27/10/2014 4540/14 SDR.WASONO DWI ANGGORO 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
73 27/10/2014 4200/14 NY.ANIK SULISTYOWATI 25TH THORAX PA + ABDOMEN dr.ANE dr.LINA 135000 40000 175000
74 27/10/2014 1774/14 TN.SAHLAN 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
75 27/10/2014 1024/12 NY.SUMIYATI 30TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
76 28/10/2014 4563/14 NY.HILMI NADIFA 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
77 28/10/2014 97/13 NY.RUKMIWATI 44TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
78 29/10/2014 2101/06 TN.SUKONO 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
79 29/10/2014 4582/14 NY.MURSIYAH 49TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
80 30/10/2014 4589/14 TN.SAIFUL ANAM 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
81 30/10/2015 4591/14 TN.MASROH 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
82 30/10/2015 1919/06 SDR.KOIRIL ANWAR 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
83 31/10/2014 4609/14 NN.NABILA ISTIANATUL 12TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
84 31/10/2014 4602/14 NN.LINDA AYU NUZULUL 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500

Mengetahui Welahan,31 Oktober 2014

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : NOVEMBER 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/11/2014 4436/13 TN.SUTARNO 62TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 3/11/2014 4622/14 TN.SUKARDI 70TH THORAX PA dr.FRANCISKA dr.MICHEL 67500 20000 87500
3 3/11/2014 4628/14 SDR.ARIS PRIYO 20TH THORAX PA dr.FRANCISKA dr.LISA 67500 20000 87500
4 3/11/2014 3061/14 NY.MUSTOFIROH 33TH THORAX PA dr.FRANCISKA dr.MICHEL 67500 20000 87500
5 3/11/2014 4624/14 TN.SUJONO 51TH THORAX PA dr.FRANCISKA dr.LISA 67500 20000 87500
6 4/11/2014 2092/14 AN.MOH HAZIM 3TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
7 5/11/2014 4604/14 NY.ISROFAH 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 5/12/2014 492/04 TN.H.ALI ROHMIN 56TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
9 6/11/2014 1694/13 AN.YUSUF MA'ARIF 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
10 6/12/2014 2714/08 TN.SUPARTO 52TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
11 6/13/2014 4074/14 TN.NUR ZAHIT 67TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
12 6/14/2014 4612/14 NY.ROISMAH 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
13 7/11/2014 4086/14 AN.MAULANA BURHANUDIN 5TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 7/12/2014 4694/14 NY.NGATINI 45TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
15 7/13/2014 3804/14 NY.TRESNI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
16 7/14/2014 4701/14 NY.KARMI 55TH CRANIUM AP/LAT dr.ANE dr.MICHEL 115000 23000 138000
17 8/112014 4717/14 NY.KARIATI 40TH LUMBAL AP/LAT DR.DINA dr.MICHEL 137000 23000 160000
18 8/11/2014 4727/14 AN.REFAN FERNANDA 2TH THORAX PA DR.DINA dr.LISA 60000 20000 80000
19 10/11/2014 4735/14 TN.BUNADI 73TH THORAX PA dr.FRANCISKA dr.MICHEL 67500 20000 87500
20 10/12/2014 4749/14 NN.NURIYAH 18TH THORAX PA dr.FRANCISKA dr.LISA 67500 20000 87500
21 12/11/2014 4790/14 SDR.SAIFUL MUNIF 25TH THORAX PA DR.PATRICIA dr.MICHEL 67500 20000 87500
22 13/11/2014 3151/14 NY.KUDATI 63TH THORAX PA DR.SUDJATMOKO dr.LISA 67500 20000 87500
23 13/11/2015 1082/14 NY.ZENI 33TH GENUE AP/LAT DR.SUDJATMOKO dr.MICHEL 92500 20000 112500
24 14/11/2014 4813/14 AN.ASYILLA RAHMA 2TH THORAX AP dr.VENSI dr.LISA 60000 20000 80000
25 15/11/2014 4700/14 TN.H.MASIKIN 75TH THORAX PA dr.JOHAN dr.LISA 67500 20000 87500
26 15/11/2014 4830/14 NY.SITI MURAIDAH 25TH LUMBAL AP/LAT dr.JOHAN dr.MICHEL 137000 23000 160000
27 17/11/2014 4844/14 NN.SUDATI 24TH THORAX PA dr.ALBERT dr.MICHEL 67500 20000 87500
28 17/11/2014 4485/14 NY.JUWARIYAH 36TH LUMBAL AP/LAT dr.ALBERT dr.LISA 137000 23000 160000
29 18/11/2014 4851/14 AN.ELINA NURIL FARISYA 1TH THORAX AP DR.SUDJATMOKO dr.MICHEL 60000 20000 80000
30 19/11/2014 3111/11 AN.SITI SOLIMAH 3,6TH THORAX AP dr.JOHAN dr.LISA 60000 20000 80000
31 19/11/2014 3293/12 AN.ADELIO DANA 3TH CRURIS AP/LAT dr.JOHAN RUJUK 75000 7500 82500
32 19/11/2014 3443/14 AN.IRVAN SAID 4TH THORAX PA dr.JOHAN RUJUK 60000 7500 67500
33 20/11/2014 4876/14 NN.FERA NORMA 22TH THORAX PA dr.VENSI dr.MICHEL 67500 20000 87500
34 20/11/2014 4881/14 NN.RIA RIANTI 18TH THORAX PA dr.VENSI dr.LISA 67500 20000 87500
35 24/11/2014 4923/14 NY.NUR INDRAWATI 24TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
36 24/11/2014 1739/11 AN.ALMIRA JULIA PUTRI 4TH WRIST JOINT AP/LAT dr.FRANCISKA RUJUK 75000 7500 82500
37 24/11/2014 4928/14 NY.SUMIK'ATI 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
38 24/11/2014 4921/14 NY.ASMIRAH 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
39 24/11/2014 4938/14 TN.SUTIYONO 33TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
40 25/11/2014 1280/07 NY.MUSLIKAH 34TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 25/11/2014 4945/14 NY.SUWARTI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 25/11/2014 4926/14 NY.NUR CAHAYA 42TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
43 25/11/2014 4954/14 NY.ELVIANA 33TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500
44 25/11/2014 4956/14 TN.SUNJADI 45TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
45 26/11/2014 4905/14 NY.SETYO BEKTI 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
46 26/11/2014 4853/14 TN.SUGIRAN 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
47 27/11/2014 4980/14 NY.SUMILAH 51TH LUMBAL AP/LAT BUDIYONO dr.LISA 137000 23000 160000
48 27/11/2014 4029/13 AN.AZAFA KHOIRUNNISA 1,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
49 29/11/2014 5000/14 TN.SUTRISNO 44TH THORAX PA dr.H.SOLIKHIN dr.LISA 67500 20000 87500
50 29/11/2014 3136/13 AN.AULIA AZAHRA 5,6TH LUMBAL AP/LAT dr.ANE dr.MICHEL 115000 23000 138000
51 29/11/2014 663/10 NY.PAINAH 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
TOTAL 4046500 987000 22500 5056000

Mengetahui Welahan,29 NOVEMBER 2014

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : DESEMBER 2014
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/12/2014 319/99 NY.KARMISIH 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 1/12/2014 5018/14 SDR.FAUZAN 14TH THORAX PA dr.ALBERT dr.MICHEL 67500 20000 87500
3 2/12/2014 5029/14 TN.RUSTAM 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 2/12/2014 5032/14 NY.MUINAH 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
5 3/12/2014 5052/14 TN.SUPATNO 80TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 3/12/2014 5051/14 TN.NGATONO 38TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
7 5/12/2014 3891/12 NY.SRI WANUN 47TH LUMBAL AP/LAT dr.SUJADMOKO dr.MICHEL 137000 23000 160000
8 6/12/2014 4178/13 TN.MATOHAR 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
9 6/12/2014 5090/14 NY.SUKARNI 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
10 6/12/2014 5091/14 TN.ALI ASRON 24TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
11 8/12/2014 5106/14 TN.AHMAD MUNASIR 45TH THORAX PA dr.WORO dr.MICHEL 67500 20000 87500
12 8/12/2014 5112/14 TN.KASNO 46TH LUMBAL AP/LAT BUDIYONO dr.LISA 137000 23000 160000
13 8/12/2014 5036/14 TN.NUR SALIM 45TH LUMBAL AP/LAT dr.WORO dr.MICHEL 137000 23000 160000
14 8/12/2014 5809/13 AN.MOH.ZULFAN ARYA 20BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
15 8/12/2014 1795/14 NY.SOLKAH 66TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
16 9/12/2014 5136/14 TN.MASUDI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
17 9/12/2014 1630/05 NY.EVI 40TH THORAX PA+CERVICAL 4PSS dr.WIRAWAN Sp.S.K dr.MICHEL 234500 43000 277500
18 10/12/2014 3613/12 NY.TASRINAH 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
19 12/12/2014 5182/14 TN.ROIKIN 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
20 12/12/2014 1038/14 NY.TRI ASIH 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
21 13/12/2014 5205/14 NY.PURWANINGSIH 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
22 13/12/2014 5202/14 NY.TARYUMI 64TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
23 13/12/2014 5203/14 AN.FADIA JIHAN NAILA ALIFA 6,6TH CLAVICULA AP dr.ANE RUJUK 75000 7500 82500
24 13/12/2014 5209/14 NY.HJ.SUTIMAH 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
25 13/12/2014 5211/14 AN.NAYSILLA ROHMAH 2TH THORAX AP/LAT dr.ANE dr.MICHEL 103500 23000 126500
26 15/12/2014 5214/14 TN.JAURI 80TH THORAX PA dr.NIKO dr.MICHEL 67500 20000 87500
27 15/12/2014 5221/14 TN.AHMAD WAHID 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
28 15/12/2014 598/12 TN.H. UMAR 85TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
29 15/12/2014 4427/12 TN.ALI MAHMUDI 50TH ANKLE AP/LAT dr.ANE RUJUK 92500 7500 100000
30 16/12/2014 5250/14 NY.KHOSIATUN 46TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
31 16/12/2014 3480/12 NY.JUMRONAH 75TH LUMBAL AP/LAT BUDIYONO dr.LISA 137000 23000 160000
32 16/12/2014 5251/14 TN.SUBEKHAN 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
33 16/12/2014 5259/14 SDR.YUSUF UMAR 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
34 16/12/2014 5271/14 NY.HIDAYAH 24TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
35 16/12/2014 2002/06 NY.HARTATIK 81TH CLAVICULA AP dr.ANE dr.LISA 60000 20000 80000
36 17/12/2014 4335/02 TN.SUBANDI 54TH THORAX PA DR.ANE dr.MICHEL 67500 20000 87500
37 17/12/2014 5280/14 TN.SOLIKIN 65TH THORAX PA DR.ANE dr.MICHEL 67500 20000 87500
38 17/12/2014 5287/14 NN.HANIK ZAHROTUL AINI 21TH THORAX PA DR.ANE dr.LISA 67500 20000 87500
39 17/12/2014 2447/13 TN.SUBAKIR 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
40 18/12/2014 3564/09 NY.SEMI 65TH THORAX PA dr.H.SOLIKHIN dr.MICHEL 67500 20000 87500
41 18/12/2014 5294/14 NY.KHOLIFAH 68TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 18/12/2014 5299/14 SDR.AHMAD HAMDUN 29TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
43 18/12/2014 4751/13 NY.MUNAFSIAH 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 19/12/2014 2662/14 AN.ELSA PARAMITA 9TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
45 19/12/2014 4119/05 NY.SRI LESTARI 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
46 19/12/2014 3293/12 AN.ADELIO DANA DIAKSA 3TH CRURIS AP/LAT dr.ANE dr.MICHEL 75000 20000 95000
47 19/12/2014 4251/14 TN.RAMBAT 75TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
48 19/12/2014 973/14 NN.SILVIA NURUL HIKMAH 16TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
49 19/12/2014 445/12 NY.SULIKAH 42TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
50 20/12/2014 5328/14 NY.HJ.SUMARYATI 67TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
51 20/12/2014 5332/14 NY.SRI SHOLEHATI 40TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
52 20/12/2014 5327/14 NN.LILIS SUMI DAYANI 16TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
53 20/12/2014 5329/14 TN.MAMAT 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
54 22/12/2014 5337/14 TN.SUHARTO 39TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
55 22/12/2014 3708/14 AN.TRUBUS PERDANA TEGAR 5TH THORAX AP dr.MEILINA dr.MICHEL 60000 20000 80000
56 22/12/2014 5347/14 TN.HARYANTO SUWONDO 61TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
57 22/12/2014 2936/13 TN.TAS'AN 61TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 22/12/2014 3829/12 NY.SUKOWATI 29TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
59 22/12/2014 517/07 AN.INDRI SULISTYOWATI 12TH CRURIS AP/LAT dr.ANE dr.LISA 75000 20000 95000
60 23/12/2014 5363/14 TN.MUSLIHIN 35TH LUMBAL AP/LAT dr.H.MUZAKKIR,SpPD dr.MICHEL 137000 23000 160000
61 23/12/2014 1139/09 TN.SUYOTO 43TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
62 24/12/2014 5381/14 NY.SUNARTI 28TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
63 27/12/2014 2012/09 AN.MOH.NAJWA 7TH THORAX PA dr.LIA dr.LISA 60000 20000 80000
64 27/12/2014 842/14 AN.ZAKIATUN NADA 1TH THORAX AP dr.LIA dr.MICHEL 60000 20000 80000
65 27/12/2014 4409/12 TN.JAKINI 78TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
66 27/12/2014 5352/14 NY.SITI RONDIYAH 34TH LUMBAL AP/LAT dr.LIA dr.MICHEL 137000 23000 160000
67 29/12/2014 5308/14 NY.KUSWATI 50TH CLAVICULA AP dr.ANE dr.MICHEL 75000 20000 95000
68 29/12/2014 5403/14 AN.NAURA ANIDA 8BLN THORAX AP dr.CLEMANTINE dr.LISA 60000 20000 80000
69 29/12/2014 5401/14 NY.SUHARTI 59TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
70 29/12/2014 5419/14 TN.AHMAD SODIQIN 43TH LUMBAL AP/LAT BUDIYONO dr.LISA 137000 23000 160000
71 29/12/2014 4856/14 NY.AMINAH 39TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
72 29/12/2014 5404/14 NN.MARYANAH 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
73 29/12/2014 4030/14 TN.ASNAWI 55TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
74 29/12/2014 5414/14 SDR.SAHRUL UMAM 17TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
75 29/12/2014 4350/12 NY.JAMILAH 38TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
76 29/12/2014 5424/14 TN.KHOLIYONO 28TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
77 30/12/2014 3469/09 AN.SIVA ALYSHIA PERMATA 5,6TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
78 30/12/2014 858/11 NN.FATIYA ZULFAIDA 22TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500
79 30/12/2014 1749/14 TN.NURUL HUDA 27TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
80 30/12/2014 5448/14 AN.MIFTAKHUL MUSTAKIM 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
81 31/12/2014 5450/14 SDR.NUAD FIRIN 27TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
82 31/12/2014 1656/11 TN.H.SUPARNO 65TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
TOTAL 6818000 1671000 15000 8504000

Mengetahui Welahan,31 Desember 2014

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : JANUARI 2015
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/1/2015 3856/14 NY.SUMIJAH 45TH THORAX PA dr.NIKO dr.LISA 67500 20000 87500
2 2/1/2015 1684/14 TN.KASRI 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
3 2/1/2015 1564/07 TN.JASRI 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 2/1/2015 1335/14 NY.FARIDATUL ULFA 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
5 5/1/2015 41/15 TN.RATEMUN 40TH WRIST JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
6 5/1/2015 46/15 NY.KUSWATI 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
7 6/1/2015 1408/14 NY.SOBIKHAH 42TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
8 6/1/2015 1440/04 NY.YANTI 71TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
9 6/1/2015 942/05 NY.KUMANAH 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
10 6/1/2015 74/15 TN.ALI MAKHFUDHI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
11 6/1/2015 77/15 TN.USKUT AHMADI 38TH LUMBAL AP/LAT BUDIYONO dr.MICHEL 137000 23000 160000
12 7/1/2015 83/15 AN.MOH.ZAKI 6TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
13 7/1/2015 84/15 NY.RUSTI 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 7/1/2015 91/15 NY.SUNDARI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
15 7/1/2015 2330/07 NY.HJ.MAHMUDAH 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
16 7/1/2015 97/15 NY.NAHARI 60TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
17 8/1/2015 106/15 TN.DAHRO 60TH LUMBAL AP/LAT BUDIYONO dr.LISA 137000 23000 160000
18 8/1/2015 1522/00 NY.ALFIATUN 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
19 8/1/2015 107/15 NN.AMINATUS ZUHRIYYAH 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 8/1/2015 109/15 TN.SUWARNO 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
21 8/1/2015 2889/14 TN.SUPANGAT 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
22 8/1/2015 118/15 TN.MAMAT 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
23 9/1/2015 3411/14 AN.GAMALA PUTRA 1TH THORAX AP dr.SUJADMOKO dr.MICHEL 60000 20000 80000
24 9/1/2015 126/15 TN.ASKAN 31TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
25 9/1/2015 4789/09 TN.ABU NAIM 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
26 10/1/2015 4192/11 TN.ISMUN BIN NASRAH 76TH ABDOMEN dr.LIA FRISKASARI RUJUK 67500 7500 75000
27 10/1/2015 3450/10 AN.KEVIN SATRIA 6,6TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
28 12/1/2015 176/15 TN.KASPURI 51TH LUMBAL AP/LAT BUDIYONO dr.LISA 137000 23000 160000
29 12/1/2015 179/15 TN.ZAINAL ARIFIN 27TH CRANIUM AP dr.ANE dr.MICHEL 60000 20000 80000
30 12/1/2015 182/15 TN.BISRI 35TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
31 12/1/2015 3871/10 AN.DESI 7TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
32 12/1/2015 2512/14 NY.SULASIH 49TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
33 13/1/2015 19/15 TN.KASMURI 81TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
34 13/1/2015 202/15 TN.SUWAR 35TH PEDIS 2PSS+ANKLE 2PSS dr.ANE dr.MICHEL 185000 40000 225000
35 13/1/2015 1727/05 NY.ISTIHARYATI 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
36 14/1/2015 4073/11 NY.HARTI 46TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
37 14/1/2015 2565/13 TN.MOHAMMAD 98TH THORAX AP dr.ANE dr.LISA 67500 20000 87500
38 14/1/2015 22/14 AN.HAWA NORMAN 6TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
39 15/01/2015 229/15 TN.ABDUL JALIL 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
40 15/01/2015 142/15 TN.NAKROWI 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 15/01/2015 227/15 NY.SURTINI 35TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
42 15/01/2015 175/15 NY.SOFIATUN 23TH ABDOMEN DR.WARRA dr.MICHEL 67500 20000 87500
43 15/01/2015 231/15 NY.SUKATMI 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 15/01/2015 233/15 SDR.INDRA ADIK PERMADI 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
45 15/01/2015 245/15 NY.LEGIRAH 60TH WRIST JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
46 16/1/2015 252/15 NY.NGATENI 73TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
47 16/1/2015 256/15 TN.ABDULLAH SAID 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
48 16/1/2015 254/15 NY.SRIMPI 56TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
49 16/1/2015 258/15 NY.KARTINEM 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
50 16/1/2015 2641/06 NY.MASKANAH 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
51 16/1/2015 265/15 SDR.KHOIRUL UMAR 16TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
52 16/1/2015 512/00 NY.HJ.ZAINAP 85TH THORAX AP dr.ANE dr.LISA 67500 20000 87500
53 17/1/2015 5226/14 TN.SUPARMAN 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
54 19/1/2015 1898/14 AN.FAZA ASKHA 2,6TH THORAX AP dr.RUTH RATNA dr.LISA 60000 20000 80000
55 19/1/2015 289/15 TN.H.MOH.RIF'AN 65TH THORAX PA dr.RUTH RATNA dr.MICHEL 67500 20000 87500
56 19/1/2015 301/15 NY.SITI AMINAH 55TH THORAX PA dr.RUTH RATNA dr.LISA 67500 20000 87500
57 19/1/2015 312/15 AN.FAWAZA FAIZ 4TH ELBOW JOINT AP/LAT dr.ANE RUJUK 75000 7500 82500
58 20/1/2015 317/15 AN.MOH.KHUSAIN NAJA 3TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 75000 20000 95000
59 20/1/2015 5289/13 NY.KARSINAH 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
60 20/1/2015 319/15 TN.MAFTUKHIN 40TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
61 20/1/2015 72/15 TN.ZAWARUL ABIDIN 37TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
62 21/1/2015 4350/12 NY.JAMILAH 38TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500
63 22/1/2015 1908/14 TN.ABDUL KAHFI 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
64 22/1/2016 362/15 NY.INDAH SUBEKTI 38TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
65 22/1/2017 3013/14 AN.NAILA MUNA 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
66 23/1/2015 72/14 NY.LEGIYEM 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
67 23/1/2016 388/15 TN.KASBOLAH 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
68 23/1/2017 391/15 AN.ERLANG SATRIA 1,5TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
69 26/1/2015 843/08 NN.MITA LERAWANTI 15T THORAX PA dr.ANE dr.LISA 67500 20000 87500
70 27/1/2015 405/15 NY.MURTINI 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
71 27/1/2016 443/15 TN.SUMARNO 51TH THORAX PA dr.EDI M.Sp.PA dr.LISA 67500 20000 87500
72 27/1/2017 444/15 NY.MAFUDAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
73 27/1/2018 2958/14 NY.SUMIRAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
74 28/1/2015 468/15 TN.SUHARI 67TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
75 28/1/2015 473/15 TN.MOH SOFWAN 37TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
76 29/1/2015 490/15 NN.RISA UMAMI 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
77 29/1/2015 1451/12 NY.SUMBER 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
78 29/1/2015 496/15 NY LENZY ACTINA 35TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
79 30/1/2015 518/15 NY.MUKIDAH 61TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
80 30/1/2015 522/15 NY.SUMIRAH 63TH LUTUT + ANKLE DX dr.ANE dr.LISA 185000 40000 225000
81 30/1/2015 504/5 NY.YUNI WIDAYANTI 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
TOTAL 6698000 1662000 15000 8375000

Mengetahui Welahan,31 Januari 2015

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : FEBRUARI 2015
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/2/2015 4282/13 TN.BUSRI 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 2/2/2015 2181/10 TN.SAHRI 62TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
3 3/2/2015 1820/14 AN.ASKA ALFARIZI 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
4 3/2/2015 302/15 NY.MUBARISIH 60TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
5 3/2/2015 2719/02 TN.MOH.ALI 57TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 3/2/2015 377/15 TN.H.MURHADI 50TH THORAX PA dr.AMRIH dr.MICHEL 67500 20000 87500
7 3/2/2015 3288/14 AN.DIFAH 5TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
8 3/2/2015 310/15 NY.FARNISIH 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
9 4/2/2015 292/15 NY.NUR YASAROH 48TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
10 4/2/2015 287/15 AN.RIFAL PRATAMA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
11 4/2/2015 399/15 NN.NIA LUTFITASARI 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
12 4/2/2015 3218/14 SDR.AHMAD ANAS 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
13 4/2/2015 2348/09 NY.SRI NINGSIH 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 5/2/2015 415/15 NY.MUNIROH 46TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
15 5/2/2015 3274/14 TN.SOBIRIN 62TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
16 5/2/2015 2923/12 TN.BAHRUDIN 35TH CERVICAL AP/LAT dr.ANE dr.MICHEL 77000 23000 100000
17 5/2/2015 425/15 NY.SASMISIH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
18 5/2/2015 430/15 NY.SRIATUN 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
19 6/2/2015 3308/03 TN.MASKURI 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 6/2/2015 439/15 NY.ROHMATUL UMAH 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
21 6/2/2015 426/14 TN.WARDI 63TH WRIST JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
22 6/2/2015 434/15 NN.FITRI PUSPITASARI 16TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
23 6/2/2015 3740/14 NY.SUPRAPTI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
24 6/2/2015 2092/11 NY.JASIMAH 34TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
25 9/2/2015 482/15 TN.SADI 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
26 9/2/2015 3802/14 SDR.AHMAD SYA'RONI 18TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
27 9/2/2015 481/15 NY.EVI LUVIA NINGRUM 23TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
28 9/2/2015 2705/05 NN.EFI SEPTIANA 22TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
29 9/2/2015 496/15 NY.ROUDLOTUL JANAH 23TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
30 9/2/2015 1988/12 NY.ERLI ERNAWATI 29TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
31 10/2/2015 4765/14 AN.AHMAD AHSAN SAFDAN.M 10BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
32 10/2/2015 2714/08 TN.SUPARTO 54TH LUMBAL AP/LAT dr.EDY M,Sp.PD dr.LISA 137000 23000 160000
33 10/2/2015 519/15 NY.SHOLHAH 40TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
34 10/2/2015 3541/07 NY.KARMINAH 60TH THORAX PA dr.ANE RUJUK 67500 7500 75000
35 11/2/2015 528/15 NY.TURIPAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
36 11/2/2015 2528/13 NY.IZATUL ULFAH 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
37 11/2/2015 541/15 NY.SRI MUFROTUN 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
38 11/2/2015 544/15 SDR.UMAM AFIF UDIN 17TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
39 12/2/2015 547/15 NY.MUSLIMAH 43TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
40 12/2/2015 488/15 NY.SAROH 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
41 12/2/2015 447/12 NY.SUKIJAH 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 13/2/2015 578/15 NY.KASNI 60TH THORAX PA dr.NIKO dr.MICHEL 67500 20000 87500
43 14/2/2015 4193/12 NY.KUSTINAH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 14/2/2015 64/12 NY.MUNJAYADAH 62TH LUMBAL AP/LAT dr.LIA dr.MICHEL 137000 23000 160000
45 16/2/2015 592/15 TN.ANWAR 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
46 16/2/2015 599/15 TN.ZAINURI 50TH THORAX PA dr.FRANCISKA dr.MICHEL 67500 20000 87500
47 16/2/2015 244/10 NY.NINING HERLINA 35TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
48 16/2/2015 598/15 NY.SOFI'AH 33TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
49 16/2/2015 312/15 AN.FAWAZA FAIZ 4,6TH ELBOW JOINT AP/LAT dr.FRANCISKA dr.MICHEL 75000 20000 95000
50 16/2/2015 549/15 NN.MUSFIROH 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
51 17/2/2015 624/15 NN.SONIATUL HASANAH 14TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
52 17/2/2015 627/15 NY.HESTI NUR YUHA 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
53 17/2/2015 2693/09 NY.ZUBAEDAH 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
54 17/2/2015 318/12 NY.AZIZAH 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
55 18/2/2015 637/15 TN.H.ABDUL HALIM 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
56 18/2/2015 642/15 AN.NIKO SILAEN 12TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
57 18/2/2015 645/15 SDR.AHMAD SUTOMI 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
58 18/2/2015 1440/13 TN.MUSMAN 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
59 18/2/2015 167/06 TN.TURIMAN 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
60 18/2/2015 887/08 NY.SRI HARTATI 74TH THORAX AP dr.ANE dr.LISA 67500 20000 87500
61 18/2/2015 3600/14 AN.NAYA VIVIANA 3TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
62 20/2/2015 662/15 TN.SOLIKUL 46TH THORAX PA dr.FRANCISKA dr.LISA 67500 20000 87500
63 20/2/2015 3618/12 AN.MOH.ARIEL RIZKY 6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
64 20/2/2015 671/15 NY.SITI RUSIYAH 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
65 20/2/2015 3925/14 NY.KASMIRAH 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
66 21/2/2015 687/15 AN.IRSYAD MAULANA 2TH THORAX AP dr.AFRIDATUL dr.MICHEL 60000 20000 80000
67 21/2/2015 690/15 NY.ATIK RAHMAWATI 24TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
68 21/2/2015 552/15 TN.ROSHADI 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
69 21/2/2015 1425/00 SDR.MOHLISUL HIKAM 26TH MANUS AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
70 21/2/2015 688/15 NY.SURATI 69TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
71 21/2/2015 692/15 NY.KHUMAIDAH 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
72 23/2/2015 711/15 TN.ZAENUDI 52TH CLAVICULA AP dr.ANE dr.MICHEL 92500 20000 112500
73 23/2/2015 1030/10 NY.MASLIKAH 75TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
74 23/2/2015 1893/12 NY.SUBIATUN 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
75 24/2/2015 741/15 NY.SRI HARTATI 46TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
76 24/2/2015 740/15 TN.DURMUJI 50TH LUMBAL AP/LAT+THORAX PA dr.ANE dr.MICHEL 204500 43000 247500
77 24/2/2015 746/15 NY.KURYATI 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
78 24/2/2015 742/15 TN.SUKAMDI 34TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
79 24/2/2015 749/15 NY.MASRIATUN 48TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
80 24/2/2015 752/15 NY.TURAH 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
81 25/2/2015 764/15 NY.SARMINAH 65TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
82 25/2/2015 763/15 NY.MASTIAH 49TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
83 25/2/2015 742/15 NY.TURIPAH 60TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
84 25/2/2015 772/15 TN.SOLIKUL 29TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
85 25/2/2015 3903/02 NY.RUKANAH 48TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
86 25/2/2015 783/15 TN.AHMADI 48TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
87 25/2/2015 781/15 TN.SUDIRMAN 18TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
88 26/2/2015 788/15 TN.JUNI ERWANDI 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
89 26/2/2015 790/15 NY.SRI MAHESWORO 56TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
90 26/2/2015 792/15 SDR.ZAINUR ROHMAN 14TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
91 26/2/2015 797/15 TN.SAIFUDIN 37TH GENUE AP/LAT dr.ANE dr.LINA 92500 20000 112500
92 26/2/2015 3592/14 SDR.MISBAKHUL MUNIR 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
93 26/2/2015 2278/03 NY.NASITEM 70TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
94 27/2/2015 4048/14 NY.ZURIYAH 22TH THORAX PA dr.JOHAN dr.LISA 67500 20000 87500
95 27/2/2015 819/15 NY.MASRUPI 61TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
96 27/2/2015 2472/12 TN.MOHARI 76TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
97 27/2/2015 821/15 NY.KHORIYAH 29TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
98 27/2/2015 3459/14 NN.KHUMAIDAH 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
99 27/2/2015 827/15 TN.SAIFUDIN 42TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
100 28/2/2015 3631/14 NN.DIAN LESTARI 17TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
101 28/2/2016 834/15 AN.SINTIA SEKAR AYU 5TH THORAX AP dr.ANE dr.LINA 60000 20000 80000
TOTAL 8260500 2077000 7500 10345000

Mengetahui Welahan,28 FEBRUARI 2015

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : MARET 2015
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/3/2015 836/15 NN.ISMATUS SHOLIHAH 12TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
2 2/3/2015 1557/11 AN.AFIFATUL ULIA 9TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
3 2/3/2015 402/15 TN.DARMADI 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 2/3/2015 858/15 TN.PALAL 78TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
5 4/3/2015 905/15 SDR.AGUNG ARIS 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 4/3/2015 3600/06 NY.KASTRI 66TH CERVICAL AP/LAT dr.ANE dr.MICHEL 77000 23000 100000
7 4/3/2015 913/15 TN.MULYADI 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 4/3/2015 4787/14 TN.KASINU 71TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
9 4/3/2015 914/15 TN.KASMIN 53TH PEDIS AP/OBLIQUE dr.ANE dr.LISA 92500 20000 112500
10 4/3/2015 2240/08 TN.MASNAN 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
11 4/3/2015 1178/14 AN.AINI NUR LAILIKA 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
12 5/3/2015 925/15 NY.HARTIAH 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
13 5/3/2015 933/15 AN.MOH.ILHAM 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
14 5/3/2015 1569/08 SDR.ALI MUSTOFA 27TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
15 6/3/2015 4787/13 NY.MASRIYAM 72TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
16 6/3/2015 964/15 AN.ADIVA MAURANIZAD 14BLN THORAX AP dr.DINA dr.LISA 60000 20000 80000
17 7/3/2015 980/15 NY.AINUR ROHMAH 46TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
18 7/3/2015 993/15 NN.IKA INDRIYANI 15TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
19 9/3/2015 1022/15 TN.KISWO 32TH THORAX PA dr.FRANCISKA dr.MICHEL 67500 20000 87500
20 10/3/2015 789/15 TN.MOH.YUSMAN 24TH CERVICAL AP/LAT DR.ANE dr.MICHEL 77000 23000 100000
21 10/3/2015 1045/15 TN.SAJAK 52TH LUMBAL AP/LAT DR.ANE dr.LISA 137000 23000 160000
22 10/3/2015 3163/13 NY.SRI MARIYATI 38TH LUMBAL AP/LAT DR.ANE dr.MICHEL 137000 23000 160000
23 11/3/2015 1073/15 TN.SUKATRIYONO 55TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
24 11/3/2015 2067/14 AN.HABIBUL AUFA 18BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
25 11/3/2015 2510/14 TN.MASHUDI 46TH THORAX PA dr.ANE dr.LISA 67000 20000 87500
26 11/3/2015 1081/15 NY.KARSITI 50TH CRANIUM AP dr.ANE dr.MICHEL 60000 20000 80000
27 11/3/2015 1083/15 NY.KASWATI 49TH THORAX PA dr.ANE dr.LISA 67000 20000 87500
28 11/3/2015 3526/05 TN.MOH KUSDI 37TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
29 11/3/2015 1088/15 NN.WINDA SAFITRI 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
30 12/3/2015 1098/15 TN.ARIF RIYANTO 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
31 12/3/2015 445/15 NY.HJ.AMINAH 57TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
32 12/3/2015 1106/15 NY.NUR MUJIADAH 31TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
33 13/3/2015 4695/12 NY.MUPIAH 55TH GENUE AP/LAT dr.TUNJUNG dr.MICHEL 92500 20000 112500
34 13/3/2015 1135/15 NY.NOVITA SARI 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
35 13/3/2015 320/15 NY.SUMIYATI 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
36 13/3/2015 2414/12 NN.DEWI NOVIANTI 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
37 14/3/2015 4267/14 TN.KASIRAN 73TH ABDOMEN 2 POSISI dr.ANE dr.LISA 137000 23000 160000
38 16/3/2015 1159/15 TN.MUHLISIN 43TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
39 16/3/2015 1172/15 TN.TONO 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
40 17/3/2015 724/09 NY.KARTINI 60TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
41 17/3/2015 574/15 NY.ISTIQOMAH 34TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
42 18/3/2015 1220/15 TN.ALIM MUNAIM 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
43 18/3/2015 720/15 TN.SUPARMAN 57TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 18/3/2015 2369/14 NY.RUKMINI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
45 19/3/2015 1019/10 AN.NOVA AURILIA 6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
46 19/3/2015 1253/15 NY.MUNASIKAH 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
47 19/3/2015 1078/15 TN.ARIFIN 41TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
48 19/3/2015 1260/15 SDR.ARIS MUNANDAR 19TH FEMUR AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
49 20/3/2015 1273/15 NY.ROFIAH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
50 20/3/2015 1269/15 NY.KARTISAH 65TH THORAX PA dr.SUDJATMOKO dr.MICHEL 67500 20000 87500
51 20/3/2015 1274/15 NY.TAFRIKAH 68TH ABDOMEN dr.SUDJATMOKO dr.LISA 67500 20000 87500
52 20/3/2015 3001/14 TN.NUR WAHID 32TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
53 23/3/2015 1837/14 AN.DEWI ANISA PUTRI 22BLN THORAX AP dr.DINA dr.LISA 60000 20000 80000
54 23/3/2015 3376/05 NY.NGADINI 65TH LUMBAL AP/LAT dr.DINA dr.MICHEL 137000 23000 160000
55 23/3/2015 1309/15 AN.SARIF ZUMZUMI 1TH THORAX AP dr.DINA dr.LISA 60000 20000 80000
56 23/3/2015 3365/12 NY.NGATINI 48TH CRANIUM AP/LAT dr.ANE dr.MICHEL 115000 23000 138000
57 23/3/2015 1315/15 NY.SUMARNI 57TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 23/3/2015 1323/15 TN.MUHAMAD ROZI 28TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
59 23/3/2015 1177/15 TN.AHMAD AZIZ 58TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
60 23/3/2015 4262/14 NY.DARWATI 50TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
61 23/3/2015 4196/09 AN.RATNA TRIA 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
62 24/3/2015 23/15 TN.MULYONO 47TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
63 24/3/2015 1336/15 AN.ZAHWA KHOIRUNNISA 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
64 24/3/2015 1354/15 NY.ROFIAH 46TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
65 24/3/2015 1352/15 NY.ARHAMAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
66 24/3/2015 1351/15 TN.RIF'AN 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
67 24/3/2015 1353/15 NY.WANTIKAH 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
68 25/3/2015 4357/08 TN.MASUDI 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
69 25/3/2016 3594/14 NN.FERI PUJI ASTUTI 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
70 25/3/2017 1359/15 TN.NORMAL 41TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
71 25/3/2018 3637/14 TN.HIRMANTO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
72 25/3/2019 1383/15 NY.RAKISAH 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
73 25/3/2020 1386/15 NY.MASRUROH 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
74 26/3/2015 1251/12 TN.SULAWI 80TH THORAX AP dr.ANE dr.MICHEL 67500 20000 87500
75 26/3/2015 1390/15 NY.PARJIN 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
76 26/3/2015 1399/15 NY.MUSTOFAH 42TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
77 26/3/2015 4870/14 NY.MUSLIMAH 28TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
78 27/3/2015 2822/13 NY.PARTINI 55TH THORAX PA dr.HERDARU dr.MICHEL 67500 20000 87500
79 27/3/2015 1407/15 AN.NAHID NABILA 6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
80 27/3/2015 4125/14 AN.RAUBAL AHMAD 20BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
81 27/3/2015 3008/14 TN.LEGIRAH 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
82 27/3/2015 4806/14 TN.SUBKHAN 44TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
83 27/3/2015 1428/15 NN.ZULFA RAHMA 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
84 28/3/2015 1448/15 TN.AGUS RIYANTO 34TH LUMBAL AP/LAT BUDIYONO dr.MICHEL 137000 23000 160000
85 28/3/2015 2006/04 NY.ISMINAH 46TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
86 30/3/2015 1461/15 SDR.SUHADAK 26TH THORAX PA dr.HERDARU dr.MICHEL 67500 20000 87500
87 30/3/2015 1475/15 NN.ANIDA HUSNA 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
88 30/3/2015 4152/05 NY.KOIRIYATI 52TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
89 30/3/2015 363/15 NY.NGATINAH 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
90 30/3/2015 1481/15 TN.AHMAD ARWANI 41TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
91 30/3/2015 1484/15 TN.TEGUH 39TH CLAVICULA AP dr.ANE dr.MICHEL 60000 20000 80000
92 30/3/2015 1486/15 NY.SOFIATUN 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
93 31/3/2015 1501/15 AN.AFIKAILAH FAJRIA 8BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
94 31/3/2015 1506/15 NN.ZUMAROH 26TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
TOTAL 7276500 1928000 9204500

Mengetahui Welahan,31 MARET 2015

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : APRIL 2015
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/4/2015 1522/15 NY.ASROPAH 41TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 1/4/2015 1519/15 TN.SUPRIYANTO 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
3 1/4/2015 3104/07 NY.RUKINI 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 2/4/2015 648/11 NY.MIANA 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
5 2/4/2015 1539/15 TN.SUGIYANTO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 2/4/2015 2249/13 NN.RINI SETYOWATI 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
7 2/4/2015 1543/15 SDR.AGUS MUSTAKIN 26TH THORAX PA dr.YUSROTUN dr.MICHEL 67500 20000 87500
8 2/4/2015 1551/15 TN.SANI 57TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
9 4/4/2015 4432/13 TN.AKIH 55TH THORAX PA DR.ANE dr.LISA 67500 20000 87500
10 4/4/2015 1376/15 AN.AHMAD RANGGA 2TH THORAX AP DR.ANE dr.MICHEL 60000 20000 80000
11 4/4/2015 1552/15 NY.UMI NAFIAH 31TH ABDOMEN DR.ANE dr.LISA 67500 20000 87500
12 6/4/2015 1561/15 NY.SUTARSIH 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
13 6/4/2015 1574/15 NY.MARFUATI 36TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
14 6/4/2015 2813/13 NY.KHOMSATUN 35TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
15 7/4/2015 1055/15 NY.KOIDAH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
16 7/4/2015 1612/15 AN.DYLAN VEDA 5TH ANTEBRACHII AP/LAT dr.ANE dr.LISA 92500 20000 112500
17 8/4/2015 4316/14 AN.GILANG RADITYA 7,6TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
18 8/4/2015 1631/15 NY.INTAN CANDRA DEWI 21TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
19 8/4/2015 1629/15 TN.KASMAN 61TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
20 8/4/2015 1632/15 NY.TUKIJAH 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
21 8/4/2015 1639/15 NY.ISTIKAH 34TH CLAVICULA AP dr.ANE dr.LISA 60000 20000 80000
22 8/4/2015 1239/15 TN.SURIYOTO 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
23 9/4/2015 1653/15 NN.IHWATUL IZATI 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
24 9/4/2015 1648/15 TN.RIFA'I 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
25 9/4/2015 2517/13 NY.MAGFIROTUN 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
26 9/4/2015 1657/15 NY.MARIANAH 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
27 9/4/2015 1671/15 TN.SATRIYANTO 50TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
28 9/4/2015 1550/15 NY.MUJIATI 40TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
29 10/4/2015 1689/15 TN.MATSARI 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
30 10/4/2015 4512/14 AN.MOH.NIZAR 15BLN THORAX AP dr.SUKARDJO dr.MICHEL 60000 20000 80000
31 10/4/2015 4919/09 AN.MANAZIL RIZKI 5,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
32 10/4/2015 1571/15 NY.MURTASIYAH 32TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
33 11/4/2015 1718/15 TN.SUWITO 35TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
34 11/4/2015 1720/15 TN.MUSAFIR 33TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
35 11/4/2015 1722/15 NN.SIBGHOTUN HANIAN 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
36 11/4/2015 4469/14 AN.BAGAS HAMID ASIDIK 3,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
37 11/4/2015 1723/15 TN.NGASIRAN 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
38 13/4/2015 1730/15 NN.LULUK FITRIA 19TH THORAX PA dr.LIA dr.MICHEL 67500 20000 87500
39 13/4/2015 1734/15 TN.SUPAAT 34TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
40 13/4/2015 3844/14 AN.ALIF DAFA PRATAMA 1TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
41 14/4/2015 1769/15 NY.SITI SUNDARI 67TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 14/4/2015 1213/14 AN.KHALILA ELBARIZA 14BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
43 14/4/2015 163/06 NY.MASTOPAH 47TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
44 14/4/2015 1785/15 NY.MUSTA'ANAH 48TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
45 15/4/2015 878/11 NN.NELA LARASATI 16TH MANUS AP/LAT dr.ANE RUJUK 92500 7500 100000
46 15/4/2015 4511/14 AN.FARA KOTRUN NADA 2,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
47 16/4/2015 1826/15 NY.SULAEDAH 56TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
48 16/4/2015 682/07 TN.RUKIN 56TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
49 16/4/2015 4997/14 TN.SANTOSO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
50 16/4/2015 1590/15 NY.SOFIAH 65TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
51 16/4/2015 1832/15 NN.APRILIANA 16TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
52 16/4/2015 4312/07 TN.KHOZIN 55TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
53 16/4/2015 2124/11 NY.SUMI'AH 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
54 17/4/2015 1852/15 NY.SRI PURWATI 42TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
55 17/4/2015 1834/15 NY.KURTI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
56 17/4/2015 1053/11 TN.MOH.LATIF 45TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
57 17/4/2015 3946/13 AN.FARZA NUR LAILA 3TH THORAX AP dr.LIA dr.LISA 60000 20000 80000
58 17/4/2015 4067/08 AN.DAVIDIO YOGA 6,6TH THORAX PA dr.LIA dr.LINA 60000 20000 80000
59 17/4/2015 1863/15 TN.SUPARDI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
60 17/4/2015 4478/14 TN.KARSANI 33TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
61 18/4/2015 5697/13 TN.TOLIB 65TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
62 18/4/2015 75/11 AN.AGUSTINA NUR 6TH THORAX PA dr.ANE dr.LINA 60000 20000 80000
63 20/4/2015 1892/15 TN.MUNTAHAL 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
64 20/4/2015 5184/14 AN.ALFIAN MAULANA 11TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
65 20/4/2015 1900/15 TN.MASTUR 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
66 20/4/2015 1893/15 AN.NIHAYATUN 2,6TH CRANIUM AP/LAT dr.ANE dr.MICHEL 115000 23000 138000
67 20/4/2015 1896/15 TN.CHAMID 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
68 21/4/2015 1063/15 TN.MUHROM 52TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
69 21/4/2015 1928/13 TN.ROCHIM MAHMUDI 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
70 21/4/2015 4023/14 NY.HJ.SUKARTI 80TH WATER'S dr.ANE dr.MICHEL 60000 20000 80000
71 21/4/2015 1276/15 NY.DWI NUR INSA 39TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
72 21/4/2015 3062/14 TN.SUWARDI 55TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
73 21/4/2015 1943/15 NY.ISTI'AROH 49TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
74 22/4/2015 4071/06 NY.ATIK 42TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
75 22/4/2015 1950/15 NY.ZULIFAH 41TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
76 22/4/2015 1955/15 NY.TURIPAH 47TH WATER'S dr.ANE dr.MICHEL 60000 20000 80000
77 23/4/2015 1971/15 AN.MOH.FEBRI 9TH ELBOW JOINT AP/LAT dr.ANE RUJUK 92500 7500 100000
78 23/4/2015 3149/10 NY.KUSNAH 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
79 23/4/2015 1974/15 TN.MOH.RAHMAT 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
80 23/4/2015 1978/15 TN.MUSTAIN 30TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
81 23/4/2015 3830/12 TN.JAENUDIN 35TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
82 24/4/2015 3894/14 TN.SUMARSONO 32TH ABDOMEN DR.ANE dr.LISA 67500 20000 87500
83 24/4/2015 3693/14 NY.SITI SOFIANA 39TH CRANIUM AP/LAT DR.ANE dr.MICHEL 115000 23000 138000
84 24/4/2015 2921/09 NY.HANA SAFURNA 25TH THORAX PA DR.ANE dr.LISA 67500 20000 87500
85 25/4/2015 2018/15 NY.PARSANI 67TH ABDOMEN DR.ANE dr.MICHEL 67500 20000 87500
86 25/4/2015 558/15 TN.WARSENO 55TH LUMBAL AP/LAT DR.ANE dr.LISA 137000 23000 160000
87 25/4/2015 2024/15 TN.MASROKIN 53TH THORAX PA DR.ANE dr.MICHEL 67500 20000 87500
88 25/4/2015 2025/15 TN.JUREMI 60TH THORAX PA DR.ANE dr.LISA 67500 20000 87500
89 25/4/2015 2342/07 TN.SADELI 45TH THORAX PA DR.ANE dr.LISA 67500 20000 87500
90 25/4/2015 1671/08 NY.ROFIFAH 55TH LUMBAL AP/LAT DR.ANE dr.MICHEL 137000 23000 160000
91 27/4/2015 2039/15 NY.SUWATI 40TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
92 27/4/2015 2031/15 TN.BASHORI 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
93 27/4/2015 2036/15 NY.SUNEKI 51TH LUMBAL AP/LAT dr.DINA dr.MICHEL 137000 23000 160000
94 27/4/2015 2032/15 TN.NAHROZI 63TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500
95 27/4/2015 2042/15 TN.SARBIN 56TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
96 27/4/2015 2045/15 TN.ASNAWI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
97 28/4/2015 3031/14 NY.KHOIRIYAH 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
98 28/4/2015 2063/15 NY.FUANAH 57TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
99 28/4/2015 2072/15 AN.RIZQY SYAIFUDIN 10TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
100 28/4/2015 3855/14 TN.SONDANG MARUDUT 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
101 28/4/2015 1735/15 TN.ABDUL MUIS 52TH THORAX PA + WATER'S dr.ANE dr.MICHEL 127500 40000 167500
102 29/4/2015 2098/15 TN.SUNADI 42TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
103 29/4/2015 1902/15 TN.MASTAWI 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
104 29/4/2015 2102/15 NY.SITI MARDIYAH 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
105 29/4/2015 2605/11 NY.SITI ASFIAH 64TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
106 30/4/2015 1258/09 TN.SUMARDI 41TH LUMBAL AP/LAT DR.ANE dr.LISA 137000 23000 160000
107 30/4/2015 1978/15 TN.KAMADI 54TH LUMBAL AP/LAT DR.ANE dr.MICHEL 137000 23000 160000
108 30/4/2015 2021/15 NY.ZURIAH 38TH THORAX PA DR.ANE dr.MICHEL 67500 20000 87500
109 30/4/2015 2023/15 TN.SUTIKNO 60TH THORAX PA DR.ANE dr.LISA 67500 20000 87500
110 30/4/2015 2031/15 NY.SRI HARYATI 48TH THORAX PA DR.ANE dr.MICHEL 67500 20000 87500
TOTAL 8766500 2237000 15000 11018500

Mengetahui Welahan,30 APRIL 2015

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : MEI 2015
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/5/2015 211/15 AN.AHMAD NUR RIZKI 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
2 2/5/2015 1278/13 TN.KUSNIN 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
3 2/5/2015 112/06 NY.SUBUR 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 2/5/2015 2116/15 AN.MOH.DIMAS 6TH LUMBAL AP/LAT dr.ANE dr.MICHEL 115000 23000 138000
5 2/5/2015 2119/15 SDR.SANDY PRAYOGO 16TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 553000
6 4/5/2015 2122/15 NY.MUZARO'AH 46TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
7 4/5/2015 2131/15 NY.WASILAH 39TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 4/5/2015 4727/14 AN.RIFAN FERNANDA 2,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
9 4/5/2015 2146/15 NY.SRI RIWAYANTI 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
10 4/5/2015 903/05 TN.ALI MAKSUN 49TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
11 4/5/2015 2147/15 NN.NUR ASIYAH 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
12 4/5/2015 4749/14 NN.NURIYAH 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
13 4/5/2015 5196/14 SDR.RIHWAN MUNIF 14TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 757500
14 5/5/2015 1037/15 TN.MARMINI 70TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
15 5/5/2015 2161/15 TN.SUNGATNO 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
16 5/5/2015 1171/07 NY.MANISAH 58TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
17 5/5/2015 2165/15 NN.SITI ELIYA 17TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
18 5/5/2015 5157/14 AN.AULIA NISWATUN 3,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
19 5/5/2015 2171/15 NY.SARMINAH 43TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
20 5/5/2015 4687/07 NN.NITA 24TH ANKLE JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500 775000
21 6/5/2015 2185/15 NY.BAITUL ISTIQOMAH 31TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
22 6/5/2015 2194/15 NY.MASNUAH 60TH ABDOMEN dr.ANE RUJUK 67500 7500 75000
23 6/5/2015 1694/13 AN.YUSUF MA'ARIF 9TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
24 6/5/2015 009/13 TN.NGADINI 52TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 330000
25 7/5/2015 2850/13 NY.SURYATI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
26 7/5/2015 2213/15 TN.NUR HASYIM 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
27 7/5/2015 2220/15 TN.HARYONO 62TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
28 7/5/2015 2218/15 TN.SUPRIYANTO 37TH CLAVICULA AP dr.ANE dr.MICHEL 75000 20000 95000
29 7/5/2015 2219/15 NN.WINDA INDAH WIJAYANTI 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
30 7/5/2015 2223/15 TN.ARIFIN 43TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 532500
31 8/5/2015 2243/15 TN.NGARDI 55TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
32 8/5/2015 2252/15 NY.RIFANA 36TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
33 8/5/2015 2256/15 NY.ASTURIAH 31TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
34 9/5/2015 2260/15 NY.SOFIATUN 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
35 9/5/2015 4073/08 NY.SUNDARI 65TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500 272500
36 11/5/2015 2282/15 TN.MOH.KUSIM 26TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
37 11/5/2015 2286/15 AN.ASNA FIKRI AMELIA 5TH GENUE AP/LAT dr.ANE dr.MICHEL 75000 20000 95000
38 11/5/2015 2294/15 NY.SRI MULYANI 40TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
39 11/5/2015 2288/15 AN.HIMMA NILAM 5TH CRURIS AP/LAT dr.ANE dr.MICHEL 75000 20000 95000
40 11/5/2015 2296/15 TN.AHMAD ROFEK 46TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 11/5/2015 1519/14 NY.NARTIK 27TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 685000
42 12/5/2015 2323/15 NY.AMINAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
43 12/5/2015 4801/12 NN.SIWI DWI HASTUTI 15TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
44 12/5/2015 2328/15 NY.JUWARIYAH 30TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 327500
45 13/5/2015 4813/14 AN.ASYILLA RAHMA 3TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
46 13/5/2015 2351/15 AN.MOH.NAUWAL 5,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
47 13/5/2015 2350/15 NN.RIZKI DWI SETIANI 20TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000 240000
48 15/5/2015 2367/15 AN.SAFA AYU AZAHRA 5TH THORAX AP dr.DINA dr.LISA 60000 20000 80000
49 15/5/2015 2278/15 SDR.ANTON SAPUTRO 16TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
50 15/5/2015 2652/14 AN.MOH.BILLY NIZAR 1TH THORAX AP dr.DINA dr.LISA 60000 20000 80000 247500
51 18/5/2015 2383/15 NY.SILAH 80TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
52 18/5/2015 2386/15 NY.MASTIAH 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
53 18/5/2015 2385/15 SDR.MUTHOHAR 15TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
54 18/5/2015 2389/15 NY.LEGINAH 31TH THORAX PA dr.JOHAN dr.LISA 67500 20000 87500
55 18/5/2015 2883/15 AN.HAIDAR ALI 2,6TH THORAX AP dr.JOHAN dr.MICHEL 60000 20000 80000
56 18/5/2015 1718/15 TN.SUWITO 35TH ABDOMEN dr.JOHAN dr.LISA 67500 20000 87500
57 18/5/2015 2245/15 SDR.MOH.ASFI 17TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 605000
58 19/5/2015 3538/10 NY.MUNJILAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
59 19/5/2015 2416/15 NY.YAYUK 32TH WATER'S+CERVICAL 2PSS dr.ANE dr.MICHEL 137000 43000 180000
60 19/5/2015 4346/14 NY.SUDIPAH 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
61 19/5/2015 2407/15 TN.SUYOTO 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
62 19/5/2015 497/08 NY.ZULIKAH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
63 19/5/2015 3158/12 NY.SITI ASIYAH 58TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
64 19/5/2015 2423/15 TN.AHMAD BASIR 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
65 19/5/2015 2424/15 TN.RASELI 90TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
66 19/5/2015 2427/15 NY.KOMSIATUN 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 1025000
67 20/5/2015 2372/15 NY.SUMIRAH 61TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
68 20/5/2015 4483/13 AN.RAIHAN WIJAYA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
69 20/5/2015 2448/15 TN.JAMAL 47TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
70 20/5/2015 2446/15 TN.KARJANI 67TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 415000
71 21/5/2015 2466/15 SDR.FAIZAL 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
72 21/5/2015 2471/15 TN.CHAERUDIN 34TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
73 22/5/2015 2483/15 SDR.WAHYU UTOMO 12TH ABDOMEN dr.LIA dr.LISA 67500 20000 87500
74 22/5/2015 2475/15 SDR.AGUS SETIAWAN 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
75 22/5/2015 4307/14 TN.MOH.SUBAGIO 37TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
76 23/5/2015 2508/15 TN.ZAENURI 78TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
77 23/5/2015 2480/15 NY.SHOFIAH 52TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 247500
78 25/5/2015 3418/14 TN.SUJOTO 63TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
79 25/5/2015 2516/15 NY.SITI ZULAIKAH 33TH ABDOMEN dr.DINA dr.LISA 67500 20000 87500
80 25/5/2015 2522/15 SDR.ADITYA YUKAL 12TH ANTEBRACHII AP/LAT dr.DINA dr.MICHEL 92500 20000 112500
81 25/5/2015 2523/15 NY.MAHMUDAH 40TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
82 25/5/2015 3380/13 AN.MAMDUH ABDILAH 2TH THORAX AP dr.DINA dr.LISA 60000 20000 80000
83 25/5/2015 2530/15 NY.NURSIH 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 615000
84 26/5/2015 4266/14 TN.ALI RIDHO 33TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
85 26/5/2015 2540/15 TN.NGARDI 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
86 26/5/2015 2543/15 NY.SHOFIAH 33TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
87 26/5/2015 1332/11 AN.ELZA FETRA HAMZA 4TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
88 26/5/2015 2546/15 TN.AHMAD NUR ALAM 34TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
89 26/5/2015 2376/15 NY.SUPALAL 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
90 26/5/2015 2549/15 NY.NOR ROSIDAH 36TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 677500
91 27/5/2015 2552/15 NY.SURIATUN 80TH THORAX AP dr.ANE dr.LISA 67500 20000 87500
92 27/5/2015 2562/15 TN.FADELI 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
93 27/5/2015 2561/15 TN.ABDUL GHOFUR 45TH MANUS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500 360000
94 28/5/2015 2575/15 TN.AHMAD ANAS 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
95 28/5/2015 2584/15 AN.INDAHNA SANIATUZ 10TH ANTEBRACHII AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
96 28/5/2015 2579/15 TN.KHUMAIDI 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
97 28/5/2015 43/13 DRG.ALBERT SUSILO 29TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 520000
98 29/5/2015 4499/14 TN.NANDIRIN 30TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
99 29/5/2015 2403/15 NY.TARMI 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
100 29/5/2015 2597/15 TN.MATORI 60TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
101 29/5/2015 1309/11 NY.LIA LIANA 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
102 29/5/2015 2620/15 TN.KUSMANTO 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 510000
103 30/5/2015 2707/13 NY.HJ.RUMI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
104 30/5/2015 1097/12 NY.KARTINAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
105 30/5/2015 1370/07 AN.ARIFATUL ULFA 16TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
106 30/5/2015 2629/15 NY.SRI YATUN 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 350000
TOTAL 8558000 2180000 7500 10745500

Mengetahui Welahan,30 MEI 2015

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : JUNI 2015
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/6/2015 2641/15 AN.YUSUF BAGUS 5TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
2 1/6/2015 2649/15 NY.PATEMI 58TH THORAX PA dr.LIA dr.MICHEL 67500 20000 87500 167500
3 3/6/2015 1405/06 TN.SAHLAN 50TH THORAX PA dr.SOLIKHIN RUJUK 67500 7500 75000
4 3/6/2015 2666/15 NY.SUMIATI 63TH PEDIS AP/OBLIQUE dr.ANE dr.LISA 92500 20000 112500
5 3/6/2015 2663/15 NN.CHILLIATUN NAFISAH 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
6 3/6/2015 381/13 NY.SUNARTI 48TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
7 3/6/2015 3722/13 NY.SUMARNI 57TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
8 3/6/2015 3551/04 TN.SUNTONO 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 610000
9 4/6/2015 2682/15 AN.MOH.SIHAB 3,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
10 4/6/2015 2680/15 TN.NOR AHMAD 31TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
11 4/6/2015 3629/08 NY.RUSTINAH 52TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
12 4/6/2015 1090/15 TN.SUTIKNO 69TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500 415000
13 5/6/2015 435/08 SDR.AHMAD RINOTO 23TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500 87500
14 6/6/2015 2708/15 TN.RUBIKAN 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
15 6/6/2015 2718/15 NY.DEFI FATMAWATI 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
16 8/6/2015 2721/15 TN.SAIFULLAH 44TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
17 8/6/2015 2722/15 NY.KARSILAH 60TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
18 8/6/2015 2735/15 NY.SUKATI 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
19 8/6/2015 3198/05 TN.SUPARTO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 8/6/2015 1750/15 NN.WIDYA APRILYANI 22TH HUMERUS AP/LAT dr.ANE RUJUK 92500 7500 100000 522500
21 9/6/2015 2753/15 TN.SURAWI 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
22 9/6/2015 2757/15 TN.NUR WAHID 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
23 9/6/2015 868/14 AN.KAYFIA ZUHAIROTUL 1,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
24 9/6/2015 2766/15 NY.SUPIAH 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 342500
25 10/6/2015 2325/15 TN.PARSUDI 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
26 10/6/2015 721/13 AN.NUR FADILAH 2,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
27 10/6/2015 2774/15 NY.NUR FASIKHAH 35TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
28 10/6/2015 4018/13 NY.KOMARIAH 61TH THORAX PA dr.ZULFAH dr.LISA 67500 20000 87500
29 10/6/2015 2778/15 NY.SUWATI 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 430000
30 11/6/2015 2790/15 NY.EMA MUDIATI 33TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
31 11/6/2015 2786/15 AN.EVA LUSIANA 9TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
32 11/6/2015 3708/14 AN.TRUBUS PERDANA TEGAR 6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 247500
33 12/6/2015 2814/15 SDR.EDI SAYOGO 27TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
34 12/6/2015 2821/15 NY.SUPIYAH 60TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
35 12/6/2015 2610/15 NY.SAIDAH 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
36 12/6/2015 2825/15 TN.SUKRIYANTO 42TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
37 12/6/2015 2830/15 NY.SITI KHOIRIYAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 510000
38 13/6/2015 2841/15 AN.NAWWAF 3TH THORAX AP dr.CLEMENTINE dr.LISA 60000 20000 80000
39 13/6/2015 3582/07 TN.SUKARJO 68TH THORACAL AP/LAT dr.CLEMENTINE dr.MICHEL 137000 23000 160000
40 13/6/2015 2597/15 TN.MATORI 60TH ABDOMEN dr.CLEMENTINE RUJUK 67500 7500 75000
41 13/6/2015 2850/15 TN.MOH.KUNDORI 80TH THORAX PA dr.CLEMENTINE dr.MICHEL 67500 20000 87500 402500
42 15/6/2015 2785/15 NY.SUMARTI 40TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
43 15/6/2015 1704/10 NY.KASMIJAH 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
44 15/6/2015 2870/15 TN.AHMAD SURURI 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
45 15/6/2015 4259/13 NY.SITI ROHMAH 72TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
46 15/6/2015 2075/13 TN.NGADIONO 49TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 510000
47 16/6/2015 2963/08 NY.SITI SUWARTI 70TH LUMBAL AP/LAT dr.DINA dr.MICHEL 137000 23000 160000
48 16/6/2015 2875/15 SDR.MOH.DURROHMAN 26TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
49 16/6/2015 2883/15 AN.NAILA CITRA 9BLN THORAX AP dr.DINA dr.MICHEL 60000 20000 80000
50 16/6/2015 831/10 NY.SURIPAH 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
51 16/6/2015 2889/15 TN.ZAINAL MUQTADI 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
52 16/6/2015 2890/15 TN.NOOR KHAMID 49TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
53 16/6/2015 1402/14 NY.SITI MAHMUDAH 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 677500
54 17/6/2015 2900/15 NY.MASTOZIROH 41TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
55 17/6/2015 2901/15 SDR.HANIF NAUFAL 13TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
56 17/6/2015 2904/15 SDR.AHMAD ZAKARIYA 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
57 17/6/2015 4927/14 TN.JUMIAN 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 487500
58 18/6/2015 2912/15 TN.SOLIKHIN 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
59 18/6/2015 2914/15 TN.SUDARMAN 36TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
60 18/6/2015 2918/15 TN.ASMUNI 46TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
61 18/6/2015 2918/15 TN.SUDARNO 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 422500
62 19/6/2015 3935/14 AN.ANISA MAULIDA 1,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
63 19/6/2015 2931/15 TN.MISBAHUL ANAM 33TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
64 19/6/2015 2934/15 NY.NIKMATUL HASANAH 29TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 400000
65 20/6/2015 2942/15 AN.LYNA ZAHRATUN 3TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 80000
66 22/6/2015 5204/14 NY.PURWANINGSIH 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
67 22/6/2015 3852/02 NY.KASDARI 80TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
68 22/6/2015 2955/15 TN.SUNARDI 51TH ABDOMEN dr.DINA dr.MICHEL 67500 20000 87500
69 22/6/2015 225/13 TN.MUNDOFAR 46TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 495000
70 23/6/2015 2983/15 TN.IKHSAN 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
71 23/6/2015 2984/15 NY.HIDAYAH 35TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
72 23/6/2015 3484/01 TN.SUJONO 63TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
73 23/6/2015 537/13 NY.HARTATIK 33TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 495000
74 24/6/2015 2997/15 SDR.NUR KARIM 12TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
75 24/6/2015 3006/15 TN.SUTIKNO 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 247500
76 25/6/2015 2628/15 NY.KISMIATUN 59TH ABDOMEN dr.ANE dr.MICHEL 67500 20000 87500
77 25/6/2015 5403/14 AN.NAURA ANIDA 1TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
78 25/6/2015 410/05 NY.SUNTARI 73TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 255000
79 26/6/2015 3017/15 NN.AMINATUR RIZA 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
80 26/6/2015 3022/15 NY.KASTAMAH 56TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
81 26/6/2015 3030/15 NY.RUKAYAH 50TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
82 26/6/2015 2018/15 NY.AZIZAH 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
83 26/6/2015 3038/15 NY.EKO LADY 28TH THORAX PA dr.LIA dr.LISA 67500 20000 87500 510000
84 27/6/2015 3024/15 TN.NOOR YADI TAMBUH 67TH ABDOMEN dr.ANE RUJUK 67500 7500 75000
85 27/6/2015 606/15 TN.SUGIMAN 59TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500 162500
86 29/6/2015 287/15 AN.RIFAL PRATAMA 3TH THORAX AP dr.LIA dr.MICHEL 60000 20000 80000
87 29/6/2015 474/12 TN.SODIK 60TH ABDOMEN dr.ANE dr.LISA 67500 20000 87500
88 29/6/2015 4084/13 NY.MAR'ATIN 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
89 29/6/2015 3072/15 TN.ALI ROSIKIN 28TH LUMBAL AP/LAT dr.LIA dr.LISA 137000 23000 160000
90 29/6/2015 1888/14 NY.KUSNI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
91 29/6/2015 1371/08 TN.ROZAK 35TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
92 29/6/2015 2969/15 NY.LIAN 83TH THORAX AP dr.ANE dr.LISA 67500 20000 87500 750000
93 30/6/2015 83/15 AN.MOH.ZAKI 6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
94 30/6/2015 2113/15 NY.MARDIYAH 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
95 30/6/2015 1305/11 NY.KUSMINAH 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 255000
TOTAL 7747500 1880000 30000 9657500

Mengetahui Welahan,30 JUNI 2015

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : JULI 2015
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/7/2015 2889/11 TN.SUPANGAT 59TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 1/7/2015 3101/15 TN.ULIL ALBAB 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
3 2/7/2015 3122/15 NY.NGATINAH 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 2/7/2015 1211/07 MY.MUSPIR 65TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
5 2/7/2015 154/15 AN.IRFAN ADI KURNIAWAN 6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
6 2/7/2015 4086/13 TN.MAS'UD 55TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
7 2/7/2015 3128/15 TN.NUR SOLEH 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 2/7/2015 2218/13 NY.SURATI 57TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
9 2/7/2015 2260/11 TN.AMDAD 43TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 677500
10 3/7/2015 3138/15 TN.SUKARDI 50TH LUMBAL AP/LAT dr.LIA F dr.LISA 137000 23000 160000
11 3/7/2015 5433/14 NY.KAMIJAH 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 247500
12 4/7/2015 2203/08 TN.SUWARNO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
13 4/7/2015 3674/14 NN.DESI KHOIRUN NISA 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
14 6/7/2015 3158/15 TN.JUMAIDI 38TH THORAX PA dr.LIA F dr.MICHEL 67500 20000 87500
15 6/7/2015 300/15 AN.ANGGI ANDRIYANI 2TH THORAX AP dr.LIA F dr.MICHEL 60000 20000 80000
16 6/7/2015 3716/14 SDR.ABDUL MUIN 32TH THORAX PA dr.VENSI dr.LISA 67500 20000 87500 255000
17 7/7/2015 326/15 TN.MASHURI 52TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
18 7/7/2015 3411/14 AN.GAMALA PUTRA ARIFIN 15BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
19 7/7/2015 3182/15 AN.DITA LESTARI 7TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 247500
20 8/7/2015 3190/15 TN.SUHADI 57TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
21 8/7/2015 5129/12 SDR.EKO ZULYANTO 25TH WATER'S SPN dr.ANE dr.LISA 60000 20000 80000 167500
22 9/7/2015 3201/15 NN.ZULFITA FALIANA 13TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
23 9/7/2015 3205/15 NY.DOFI FATMALASARI 20TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
24 9/7/2015 3208/15 NN.WULAN 20TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
25 9/7/2015 3209/15 NY.MASRUNI 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
26 9/7/2015 2761/13 TN.BUKAN SUDARSONO 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 437500
27 10/7/2015 951/12 AN.NALA ADISTI 12TH THORAX PA dr.M.NAUFAL dr.LISA 67500 20000 87500
28 10/7/2015 3221/15 TN.SUHUD 55TH LUMBAL AP/LAT dr.DINA dr.MICHEL 137000 23000 160000
29 10/7/2015 5356/14 AN.WINDA NAFISA 13BLN THORAX AP dr.DINA dr.LISA 60000 20000 80000
30 10/7/2015 3231/15 TN.SUTOMO 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
31 10/7/2015 3235/15 NY.SITI RUKAYAH 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 575000
32 11/7/2015 4155/05 NY.SUYATEMI 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
33 11/7/2015 3211/15 NY.SINTA 57TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 247500
34 13/7/2015 3252/15 TN.SUWADI 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
35 13/7/2015 3256/15 TN.MASHADI 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
36 13/7/2015 3260/15 TN.DARNO 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
37 13/7/2015 2061/10 AN.ALFIATUS ZAHRO 6TH THORAX AP dr.DINA dr.MICHEL 60000 20000 80000
38 13/7/2015 3270/15 AN.NAWAL IRBI SAHILA 13BLN THORAX AP dr.DINA dr.LISA 60000 20000 80000
39 13/7/2015 2583/13 AN.MINATI 10TH THORAX PA dr.DINA dr.MICHEL 60000 20000 80000
40 13/7/2015 3274/15 TN.DWI MAWARDI 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 590000
41 14/7/2015 4407/10 NY.ATMIRAH 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
42 14/7/2015 3289/15 TN.ZAINAL ARIFIN 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
43 14/7/2015 3195/15 NY.SUMBER 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
44 14/7/2015 1942/15 TN.DARWANTO 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 567500
45 15/7/2015 750/11 NY.SULIYEM 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
46 15/7/2015 3226/15 NY.SUPARTI 61TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
47 15/7/2015 1928/05 NY.ASKURIYAH 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
48 15/7/2015 3307/15 NY.ZULATIM 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
49 15/7/2015 3871/10 AN.DESI 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
50 15/7/2015 3315/15 NY.SRI SUGIYANTI 20TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 542500
51 16/7/2015 3327/15 NY.RUKATI 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
52 16/7/2015 3329/15 NY.SOLKHATUN 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
53 16/7/2015 3251/15 TN.NUR CHAMID 64TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 335000
54 20/7/2015 3346/15 TN.MUFA'ALIM 57TH THORAX PA dr.SUDJATMOKO dr.LISA 67500 20000 87500
55 20/7/2015 3353/15 TN.ABDUL JALIL 53TH THORAX PA dr.SUDJATMOKO dr.LISA 67500 20000 87500
56 20/7/2015 1709/15 NY.AGUNG FITRIYAH 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
57 20/7/2015 3357/15 NY.FITRIYAH 35TH CRURIS AP/LAT dr.ANE RUJUK 92500 7500 100000 362500
58 21/7/2015 4342/14 NY.ISTIKAH 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
59 21/7/2015 3843/14 NY.WAGIRAH 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
60 21/7/2015 5389/13 TN.YATIN 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
61 21/7/2015 3358/15 NN.DINA AMALIA 17TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
62 21/7/2015 3087/12 NY.SRIYATI 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 535000
63 22/7/2015 3402/15 SDR.MOH.SAMSUL 15TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
64 22/7/2015 3405/15 SDR.AGUS DWI 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
65 22/7/2015 257/13 NY.UMROTUN 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
66 22/7/2015 3406/15 TN.NASIKIN 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
67 22/7/2015 3410/15 SDR.KUSMANTO 19TH CRANIUM AP/LAT dr.ANE dr.MICHEL 115000 23000 138000
68 22/7/2015 43/15 NY.MASTIWI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
69 22/7/2015 2012/09 AN.MOH.NAJWA SIDQI 8TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000 655500
70 23/7/2015 3425/13 TN.MUNTOLIP 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
71 23/7/2015 4504/10 NY.SRI SUKISWATI 29TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
72 23/7/2015 3433/15 SDR.UJI UTOMO 29TH ANTEBRACHII AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
73 23/7/2015 3059/14 TN.GUNAWAN 30TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 447500
74 24/7/2015 3439/15 TN.CHOIRI 44TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
75 24/7/2015 3364/15 SDR.KRISTANTO 17TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
76 27/7/2015 2618/15 NY.NAIROTUN 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
77 27/7/2015 3464/15 NY.MARSIH 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
78 27/7/2015 3465/15 TN.SUPARTO 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
79 27/7/2015 1459/06 NY.ISIH 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
80 27/7/2015 3478/15 NY.KASEMI 75TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
81 27/7/2015 3479/15 NN.FINA SAFA'ATUL 18TH ELBOW JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
82 27/7/2015 2825/15 TN.SUKRIYANTO 42TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 782500
83 28/7/2015 3504/15 TN.MULYADI 65TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
84 28/7/2015 3511/15 NY.SITI ASIYAH 58TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 320000
85 29/7/2015 2895/15 NY.JASMI 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
86 29/7/2015 5089/14 NY.MASEMI 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
87 29/7/2015 173/11 NN.MARSUS MIATI 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
88 29/7/2015 2368/15 NY.SRI HIDAYAH 36TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
89 29/7/2015 3522/15 TN.ABDUL MANAH 45TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
90 29/7/2015 3514/15 NY.SUMIATI 51TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 670000
91 30/7/2015 3530/15 NN.KUNTARI 38TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
92 30/7/2015 3536/15 NY.WAGISAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
93 30/7/2015 3533/15 AN.ROFI MAULIDINI 5TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
94 30/7/2015 3543/15 NY.JAMILATUN 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
95 30/7/2015 3547/15 NY.OKTIAH 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 430000
96 31/7/2015 3204/15 TN.SUWITO 63TH THORAX PA dr.ANE dr.LISA 137000 23000 160000
97 31/7/2015 3556/15 AN.MOH.DAFA 18BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
98 31/7/2015 3256/13 NY.SUWARTI 67TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
99 31/7/2015 3572/15 NY.ISTIFAH 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 487500
TOTAL 8078000 2020000 7500 10105500

Mengetahui Welahan,31 JULI 2015

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : AGUSTUS 2015
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/8/2015 385/15 AN.NAILA NUR SAFITRI 17BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
2 1/8/2015 1828/14 AN.ASKA ALFARIZI 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
3 1/8/2015 3412/15 NY.KIPTIYAH 42TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 320000
4 3/8/2015 2779/07 NY.SUNDARI 70TH GENUE+CRURIS BUDIYONO dr.MICHEL 185000 40000 225000
5 3/8/2015 1148/11 TN.SUNARYO 36TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
6 3/8/2015 3501/15 NY.MUASIH 48TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
7 3/8/2015 2268/15 AN.MOH.RIZKI MUSTOFA 8TH THORAX PA dr.LIA dr.LISA 60000 20000 80000
8 3/8/2015 3437/15 TN.MUSTAKIM 40TH THORAX PA+BNO AP dr.ANE dr.MICHEL 135000 40000 175000
9 3/8/2015 3606/15 NY.SUMAENAH 51TH GENUE AP/LAT BUDIYONO dr.LISA 92500 20000 112500 840000
10 4/8/2015 3620/15 NN.KHAFSARI NAYATI 13TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
11 4/8/2015 3626/15 NN.EVA USSLIFATUL UAIDAH 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
12 4/8/2015 3630/15 NY.PURWATI 36TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
13 4/8/2015 1353/15 NY.WANTIKAH 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 350000
14 5/8/2015 4065/14 NY.KASRUMI 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
15 5/8/2015 3642/15 TN.MOHTAR 50TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 175000
16 6/8/2015 5727/13 NN.YUNI NUGRAHANI 25TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
17 6/8/2015 3666/15 AN.AHMAD ROBBY 17BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000 240000
18 7/8/2015 3788/10 NY.KAYATUN 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
19 7/8/2015 3677/15 NN.VIRA AMANDA 13TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
20 7/8/2015 3679/15 N Y.HJ.SUTIATI 50TH LUMBAL AP dr.ANE dr.MICHEL 67500 20000 87500
21 7/8/2015 3460/15 NY.ASRIYAH 60TH THORAX PA dr.FRANCISKA dr.LISA 67500 20000 87500 422500
22 8/8/2015 5061/14 NY.ZUMIATUN 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
23 8/8/2015 3692/15 NY.SRI PUJI KAYATI 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
24 10/8/2015 3697/15 TN.PARDI 52TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
25 10/8/2015 3712/15 TN.AHMADUN 52TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
26 10/8/2015 3714/15 NY.ENDANG SISWATI 42TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
27 10/8/2015 4081/06 NY.ISTIKOMAH 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 422500
28 11/8/2015 3721/15 NY.SRI WATI 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
29 11/8/2015 3722/15 TN.H.SUJITO 60TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
30 11/8/2015 3726/15 TN.SUPADI 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
31 11/8/2015 3733/15 NY.SUPRIYATI 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 11/8/2015 3732/15 SDR.MARGONO 25TH ANKLE JOINT AP/LAT dr.ANE RUJUK 92500 7500 100000
33 11/8/2015 2507/15 NY.MUNASIH 34TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
34 11/8/2015 4196/14 TN.SOBIRIN 34TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 697500
35 12/8/2015 3736/15 TN.MOHDI 55TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
36 12/8/2015 3738/15 TN.YULIANTO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
37 12/8/2015 3740/15 NY.FINA HIKMATUN 20TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
38 12/8/2015 3743/15 NY.SAMINAH 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
39 12/8/2015 801/14 NY.SRI NINGSIH 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 430000
40 13/8/2015 3751/15 AN.DWI HERAWATI 7TH PELVIS AP dr.ANE dr.LISA 60000 20000 80000
41 13/8/2015 3752/15 NY.MARSINAH 80TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
42 13/8/2015 3753/15 NY.SUMINTRAH 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
43 13/8/2015 3246/13 SDR.ABDUL WAHID 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 415000
44 14/8/2015 3767/15 TN.JOYO RIYANTO 42TH THORAX PA dr.FRANCISKA dr.LISA 67500 20000 87500
45 14/8/2015 3769/15 TN.MASRUDI 22TH THORAX PA dr.FRANCISKA dr.MICHEL 67500 20000 87500
46 14/8/2015 3776/15 NY.JUJUK 51TH THORAX PA dr.FRANCISKA RUJUK 67500 7500 75000
47 14/8/2015 3779/15 NY.SARIYAH 52TH THORAX PA dr.FRANCISKA dr.MICHEL 67500 20000 87500
48 14/8/2015 3786/15 NY.KASEH 60TH THORAX PA dr.FRANCISKA dr.LISA 67500 20000 87500 425000
49 15/8/2015 3683/15 NN.NURUL HIKMAH 17TH THORAX PA dr.LIA dr.MICHEL 67500 20000 87500 87500
50 18/8/2015 2882/14 TN.KASNARI 60TH FEMUR AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
51 18/8/2015 3807/15 TN.KASDULAH 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
52 18/8/2015 3805/15 AN.BUDI WALUYO 14BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
53 18/8/2015 4510/14 TN.MUKANDAR 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
54 18/8/2015 2653/13 TN.DIDIK AWAN 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
55 18/8/2015 3823/15 TN.ROHIM 32TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 542500
56 19/8/2015 3832/15 NY.SUHARTI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
57 19/8/2015 2395/00 NY.SUPARMI 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 19/8/2015 1476/15 TN.SUPENO 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
59 19/8/2015 3839/15 TN.SUMBER 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 350000
60 20/8/2015 3849/15 TN.PURWADI 52TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
61 20/8/2015 3819/15 MY.ASMIRAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
62 20/8/2015 3759/15 TN.JOYO PURNOMO 42TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 335000
63 21/8/2015 3884/13 NY.KUNTIAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
64 21/8/2015 3868/15 AN.MOH.HIZAM 2BLN ABDOMEN AP dr.JOHAN dr.MICHEL 60000 20000 80000
65 21/8/2015 3660/15 NY.SUDARMI 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
66 21/8/2015 3872/15 AN.MOH.FAHRI 2,6TH THORAX AP dr.JOHAN RUJUK 60000 7500 67500
67 21/8/2015 3874/15 TN.KOMARI 75TH ABDOMEN AP dr.JOHAN dr.LISA 67500 20000 87500
68 21/8/2015 3884/15 TN.AHMAD GHOFUR 35TH GENUE AP/LAT dr.JOHAN dr.MICHEL 92500 20000 112500
69 21/8/2015 3875/15 TN.SARPANI 69TH ABDOMEN AP dr.JOHAN dr.LISA 67500 20000 87500 610000
70 22/8/2015 3895/15 NY.SUKANAH 31TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
71 24/8/2015 14-Mar NY.MASRINAH 70TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
72 24/8/2015 3890/15 SDR.MOH. FAIZ 18TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
73 24/8/2015 5441/14 AN.AZA SALSABILA 10BLN THORAX AP DR.DINA dr.LISA 60000 20000 80000
74 24/8/2015 3914/15 AN.MOH.FAREL 9TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000 407500
75 25/8/2015 3771/15 TN.KARJONO 77TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
76 25/8/2015 219/10 NY.SURATEMI 50TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
77 25/8/2015 3924/15 TN.MUZAEKAN 37TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
78 25/8/2015 3934/15 AN.SHIFA 1,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
79 25/8/2015 3282/11 NY.UMAIDAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 430000
80 26/8/2015 3926/15 AN.PANJI MAULANA 2,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
81 26/8/2015 933/15 AN.MOH.ILHAM AL.M 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 160000
82 27/8/2015 2311/15 TN.BASUKI 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
83 27/8/2015 4360/12 TN.RIBHAN 38TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
84 27/8/2015 3963/15 SDR.OKI MUFTI 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
85 27/8/2015 2714/05 NY.SAMINAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
86 27/8/2015 3965/15 TN.AKHMADI 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
87 27/8/2015 3130/99 NY.SIE HONG HWA 80TH WRIST JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
88 27/8/2015 2279/07 NY.SARTIYAH 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
89 27/8/2015 644/09 TN.KUSMIAN 50TH LUMBAL AP dr.ANE dr.LISA 67500 20000 87500 797500
90 28/8/2015 3169/15 TN.JOKO LELONO 48TH THORAX PA dr.ANE RUJUK 67500 7500 75000
91 28/8/2015 3975/15 AN.MOH.MUFTI 6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
92 28/8/2015 3987/15 SDR.KHUSNUL LUTFI 14TH CRANIUM AP/LAT dr.ANE dr.MICHEL 115000 23000 138000 293000
93 29/8/2015 1557/11 AN.AFIFATUL 9TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
94 29/8/2015 3533/155 AN.ROFI MAULIDINI 5TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
95 29/8/2015 3994/15 SDR.FATHUL MUJIB 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
96 29/8/2015 3995/15 SDR.NASIRUL HASAN 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
97 29/8/2015 3996/15 TN.ANDIM 53TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 495000
98 31/8/2015 4000/15 TN.MOH.ASIKIN 35TH ABDOMEN AP dr.LIA dr.LISA 67500 20000 87500
99 31/8/2015 3954/15 TN.SUKAMAT 54TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
100 31/8/2015 4004/15 TN.MALAKIN 48TH ABDOMEN AP dr.LIA dr.LISA 67500 20000 87500
101 31/8/2015 40006/15 SDR.ULIL AMRI 30TH THORAX PA dr.LIA dr.MICHEL 67500 1996000 7500 75000 330000
TOTAL 7804500 1996000 37500 9838000

Mengetahui Welahan,31 AGUSTUS 2015

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : SEPTEMBER 2015
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/9/2015 749/08 TN.MOH.SATORI 58TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
2 1/9/2015 3988 TN.MANSUR 36TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
3 1/9/2015 4032/15 NY.SUHARTI 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
4 1/9/2015 2495/15 TN.NGARDI 54TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 567500
5 2/9/2015 3835/15 TN.ROSIDI 52TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
6 2/9/2015 4046/15 TN.KHOIRUL ANAM 30TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
7 2/9/2015 4047/15 NN.MEI JULIYANTI 20TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
8 2/9/2015 2647/08 NY.RUSMIYATI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
9 2/9/2015 74/12 NY.SOFIAH 53TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
10 2/9/2015 4058/15 NY.USRIAH 37TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
11 2/9/2015 892/12 TN.MURKAN 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
12 2/9/2015 4048/15 NY.ZURIYAH 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 990000
13 3/9/2015 4073/15 NY.MUSLIMAH 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
14 3/9/2015 3831/06 NY.MASMIMAH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
15 3/9/2015 703/05 TN.MOH.JAYADI 80TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
16 3/9/2015 2144/14 NY.IKA IEMAWATI 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
17 3/9/2015 2510/14 TN.MASHUDI 46TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 437500
18 4/9/2015 4090/15 AN.DINA KAMALIA 10TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
19 4/9/2015 4096/15 TN.ASHADI 69TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 4/9/2015 4093/15 AN.ZAZKIA AJENG 7TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
21 4/9/2015 4103/15 TN.SONG DJOEN 80TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 335000
22 5/9/2015 1098/15 TN.ARIF RIYANTO 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
23 5/9/2015 2089/10 NN.ZAHROH 31TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
24 5/9/2015 4112/15 NY.JASMIRAH 64TH PELVIS AP dr.ANE dr.LISA 67500 20000 87500 335000
25 7/9/2015 4124/15 SDR.DIVANI ADITYA 16TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
26 7/9/2015 854/15 TN.DHARIFURI ROHMAN 38TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
27 7/9/2015 3389/15 TN.SUMANTRI 47TH LUMBAL AP/LAT dr.FENNY dr.MICHEL 137000 23000 160000
28 7/9/2015 2828/13 NY.INAROH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 7/9/2015 3585/00 NY.SUGINAH 65TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 535000
30 8/9/2015 4145/15 NY.SUKARNI 57TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
31 8/9/2015 4150/15 TN.SUBHAN 40TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
32 8/9/2015 4810/13 NY.HJ.KOMARIAH 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
33 9/9/2015 4162/15 NY.NAFIAH 55TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
34 9/9/2015 4164/15 NY.MUNTAMAH 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
35 9/9/2015 4168/15 NY.IDA HAMIDA 43TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
36 9/9/2015 964/15 AN.ADIVA 18BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000 335000
37 10/9/2015 4185/15 NY.SRI NURYATI 44TH LUMBAL AP/LAT BUDIYONO dr.MICHEL 137000 23000 160000
38 10/9/2015 3944/15 AN.RENA MAULINA 6,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
39 10/9/2015 4190/15 SDR.SETYO WAHYU PRATAMA 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
40 10/9/2015 517/15 AN.SYAFA AQILA 15BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
41 10/9/2015 1598/06 NY.SUNARTRI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 495000
42 11/9/2015 4200/15 SDR.NUR AHMAD ALAWIDDIN 17TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
43 11/9/2015 4205/15 NN.LAKSMI RAMANING AMALIA 17TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 11/9/2015 4204/15 TN.RUKAIDI 36TH PEDIS AP/OBLIQUE dr.SUDJATMOKO dr.LINA 92500 20000 112500
45 11/9/2015 4333/07 NY.TASEMI 55TH CERVICAL AP/LAT dr.ANE dr.LINA 77000 23000 100000
46 11/9/2015 1501/15 AN.AFIKAILAH FAJRIA ADIA ARISTI 1TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 540000
47 12/9/2015 4217/15 NY.HASANAH 36TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
48 12/9/2015 883/09 TN.NUR SALIM 37TH THORAX PA dr.ANE DR.LISA 67500 20000 87500
49 12/9/2015 3598/09 TN.MUJI AMIN 36TH WATER'S SPN dr.ANE dr.LINA 60000 20000 80000
50 12/9/2015 1034/06 TN.SOLIKHAN 57TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 415000
51 14/9/2015 2714/08 TN.SUPARTO 60TH THORAX PA dr.ANE RUJUK 67500 7500 75000
52 14/9/2015 2807/10 TN.MANUT 75TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
53 14/9/2015 4232/15 AN.ALVITO 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
54 14/9/2015 4234/15 NN.ALVI IZATI 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
55 14/9/2015 4240/15 TN.BARKAH 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
56 14/9/2015 3606/13 TN.PUJIARTO 60TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 577500
57 15/9/2015 1837/14 AN.DEVI ANISA PUTRI 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
58 15/9/2015 3011/04 TN.MAKMUR 55TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
59 15/9/2015 4252/15 TN.BAMBANG WIDODO 36TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
60 15/9/2015 4256/15 NY.JUWOK 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
61 15/9/2015 3245/06 TN.MOHTAR 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 430000
62 16/9/2015 344/14 NY.RUKINI 65TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
63 16/9/2015 4266/15 TN.ALI 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
64 16/9/2015 1935/15 NY.SRI MURNI 39TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
65 17/9/2015 4280/15 NY.PASIRAH 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
66 17/9/2015 2344/15 NY.SUMIATUN 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
67 17/9/2015 4281/15 NY.LULUK IRVANA 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
68 17/9/2015 2378/15 NY.SUPALAL 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
69 17/9/2015 1603/05 TN.KAMBALI 70TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
70 17/9/2015 545/05 TN.ANDI SUHARJONO 57TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
71 17/9/2015 2894/15 NY.JUMIRAH 40TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 757500
72 18/9/2015 1652/15 AN.RINA ANGGRAYANI 16BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
73 18/9/2015 1853/15 NY.MAHMUDAH 46TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
74 18/9/2015 4195/15 NY.SUKARMI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
75 18/9/2015 4305/15 TN.KUSRIN 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
76 18/9/2015 4298/15 TN.SUPARDI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
77 18/9/2015 1450/15 NY.SOFIATUN 47TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
78 18/9/2015 2341/14 TN.SUTIKO 41TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
79 18/9/2015 4309/15 NN.AULIA KHAIRUN NABILA 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
80 18/9/2015 4310/15 TN.MUSRIAN 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 852500
81 19/9/2015 4315/15 NY.ASTIPAH 46TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
82 19/9/2015 4316/15 TN.ABDUL JALIL 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
83 21/9/2015 4326/15 NY.SUTINAH 65TH THORAX PA dr.VENSI dr.MICHEL 67500 20000 87500
84 21/9/2015 1407/15 AN.NAHID NABILA 6,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
85 21/9/2015 3851/15 TN.H.IRSAT 70TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
86 21/9/2015 3745/15 NY.RASMI 64TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
87 21/9/2015 4339/15 TN.NGATENO 33TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 575000
88 22/9/2015 2497/10 TN.KAHONO 60TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
89 22/9/2015 1892/15 TN.MUNTAHAL 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
90 22/9/2015 4359/15 SDR.MOH.MUJI 16TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
91 22/9/2015 697/15 TN.MASRIKHAN 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
92 22/9/2015 4370/15 TN.H.KARSONO 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
93 22/9/2015 4368/15 NY.TUMINAH 57TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 597500
94 25/9/2015 4395/15 NY.SUKATI 64TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
95 25/9/2015 4398/15 NY.SRI WANGINUN 47TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
96 25/9/2015 4401/15 AN.SYAKIRA NIKMATUS 1TH THORAX AP dr.DINA dr.LISA 60000 20000 80000
97 25/9/2015 4410/15 NY.MASADAH 65TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
98 25/9/2015 4413/15 TN.SUMULYONO 47TH LUMBAL AP/LAT dr.NIKO dr.MICHEL 137000 23000 160000 502500
99 26/9/2015 4416/15 NN.AFIATUR RONDIYAH 21TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
100 26/9/2015 4434/15 NY.TUMIAH 57TH LUMBAL AP/LAT dr.LIA dr.MICHEL 137000 23000 160000 247500
101 28/9/2015 4457/15 NY.SITI KHOMSATUN 27TH THORAX PA dr.NIKO dr.LISA 67500 20000 87500
102 28/9/2015 4462/15 NY.MASRIPAH 65TH THORAX PA dr.NIKO dr.MICHEL 67500 20000 87500 175000
103 29/9/2015 4469/15 TN.SONARI 53TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
104 29/9/2015 4470/15 NY.TUTIK 32TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
105 29/9/2015 4467/15 TN.KASMAN 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
106 29/9/2015 1067/09 NY.ISTIAROH 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
107 29/9/2015 4471/15 NY.SITI MASROATUL KHOIRIYAH 42TH WRIST JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500 527500
108 30/9/2015 3866/10 TN.AHMAD 63TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
TOTAL 8798500 2209000 7500 11015000

Mengetahui Welahan,30 SEPTEMBER 2015

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : OKTOBER 2015
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/10/2015 4508/15 NY.SUYATI 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
2 2/10/2015 2354/05 TN.ALI SODIKIN 47TH CLAVICULA AP dr.ANE dr.MICHEL 60000 20000 80000
3 2/10/2015 1345/13 TN.AHMAD TARZUQON 63TH THORAX PA dr.H.SOLIKHIN dr.LISA 67500 20000 87500
4 2/10/2015 4512/14 AN.MOH.NIZAR 21BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
5 2/10/2015 4522/15 TN.LUTFAN 33TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 407500
6 3/10/2015 4531/15 NN.NUR AIDA ARIFIYANI 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
7 3/10/2015 4532/15 TN.MUKHLISIN 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 3/10/2015 1309/15 AN.SARIF ZAMZANI 1,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
9 3/10/2015 1376/15 AN.AHMAD RANGGA ADINATA 4TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 335000
10 5/10/2015 2031/15 TN.BASHORI 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
11 5/10/2015 4545/15 NY.SOFIATUN 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
12 5/10/2015 4549/15 NY.SUMEH 56TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
13 5/10/2015 1811/13 NY.SRI SUNDARI 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 5/10/2015 189/13 NN.ERINA 16TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
15 5/10/2015 2534/06 NY.SAFAATIN 53TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
16 5/10/2015 4556/15 TN.ALI MASHUDI 37TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
17 5/10/2015 3250/15 TN.MARSUDI 38TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
18 5/10/2015 4558/15 TN.PERET 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 997500
19 6/10/2015 4568/15 TN.MUHAMAD 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
20 6/10/2015 4484/15 TN.SUKARDI 60TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
21 6/10/2015 4576/15 NN.WAHYU FATLIKA 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
22 6/10/2015 4584/15 NY.MUTHOHAROH 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
23 6/10/2015 4587/15 TN.PRAWITO HARJONO 73TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
24 6/10/2015 223/09 AN.MOH.RAFKI 7TH CLAVICULA AP dr.ANE dr.MICHEL 60000 20000 80000 517500
25 7/10/2015 4597/15 AN.AHMAD SHOLIKUL 3TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
26 7/10/2015 4595/15 TN.SUHARDI 39TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
27 7/10/2015 3844/14 AN.ALIF DAFA PRATAMA 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
28 7/10/2015 4604/15 SDR.MOH.HIDAYAT 27TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 335000
29 8/10/2015 1106/13 TN.ASMUI 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
30 9/10/2015 4937/01 TN.SANTOSO 50TH THORAX PA dr.FRANCISKA dr.MICHEL 67500 20000 87500
31 9/10/2015 4655/15 NY.KASMINAH 42TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 175000
32 10/10/2015 4663/15 NN.TUTIK ZULIANTI 16TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
33 10/10/2015 3892/15 TN.BAMBANG HADI 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
34 10/10/2015 4110/06 NY.MINTEN 44TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
35 12/10/2015 4675/15 TN.SUWARDI 28TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
36 12/10/2015 2309/06 TN.KASTONO 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
37 12/10/2015 4512/15 NN.ZULAIKAH 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
38 12/10/2015 4689/15 NY.MULYA NINGSIH 54TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
39 12/10/2015 4692/15 SDR.ARI RAHMAN 23TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
40 12/10/2015 4695/15 SDR.EDWIN SUGIYANTO 25TH ANTEBRACHII AP/LAT dr.ANE RUJUK 92500 7500 100000 610000
41 13/10/2015 4729/15 NY.HJ.SUMAIROH 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 13/10/2015 2856/07 NY.SITI AMIROH 62TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
43 13/10/2015 1153/14 AN.MOH.AKHIL SANI 20BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
44 13/10/2015 1820/14 NY.SUKERMI 49TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500 440000
45 15/10/2015 1561/15 NY.SUTARSIH 51TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
46 15/10/2015 749/15 NY.MASRIATUN 48TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
47 15/10/2015 2837/11 NY.NAPSIYAH 74TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
48 15/10/2015 4730/15 TN.SISWANTO 27TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 495000
49 16/10/2015 2188/14 NY.SRI KAYAH 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
50 16/10/2015 4752/15 NY.MA'RUFAH 53TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
51 16/10/2015 4750/15 SDR.SUPARJA RISMAN 20TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
52 16/10/2015 4590/15 SDR.MOH.ISMAIL 18TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
53 16/10/2015 2601/14 AN.PUTRI DEWI SINTA 10TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
54 16/10/2015 3021/05 NY.MARTA ISMAIL 78TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000 655000
55 17/10/2015 4766/15 NY.ANIK MUSRIFAH 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
56 17/10/2015 4762/15 NY.RANI LOVIANA 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
57 17/10/2015 4530/15 TN.MASHADI 51TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 17/10/2015 3731/15 TN.NGATMAN 46TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
59 17/10/2015 4765/15 TN.ALI SUBHAN 34TH CLAVICULA AP dr.ANE dr.MICHEL 60000 20000 80000 430000
60 19/10/2015 4773/15 AN.ZAHWA ANGGITA 15BLN THORAX AP dr.VENSI dr.LISA 60000 20000 80000
61 19/10/2015 3911/15 NY.MASTIYAH 35TH WATER'S SPN dr.VENSI dr.MICHEL 60000 20000 80000
62 19/10/2015 4790/15 NY.MASFUFAH 45TH CRURIS AP/LAT dr.VENSI dr.LISA 92500 20000 112500
63 19/10/2015 4793/15 NY.PUNJIYAH 61TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 360000
64 20/10/2015 4799/15 TN.AHMAD MUJAB 61TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
65 20/10/2015 2854/15 TN.HARNO 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
66 20/10/2015 4801/15 NY.DARYATI 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
67 20/10/2015 75/11 AN.AGUSTINA NUR SETIAWAN 6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 342500
68 21/10/2015 4486/14 TN.SANUSI 65TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
69 21/10/2015 1315/08 NY.TRI SETYO UMI 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
70 21/10/2015 3651/15 NY.MUTMAINAH 26TH PEDIS AP/OBLIQUE dr.ANE dr.LISA 92500 20000 112500 312500
71 22/10/2015 4839/15 TN.SUMADI 57TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
72 22/10/2015 4008/15 NY.PAINAH 66TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
73 22/10/2015 2840/12 NY.NAMISIH 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
74 22/10/2015 515/15 TN.AHMADI 40TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
75 22/10/2015 5173/14 AN.MOH.LUTFI HAKIM 1,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 430000
76 23/10/2015 803/13 TN.MUHLAS 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
77 23/10/2015 4853/15 TN.MUHAZIN 45TH THORAX PA dr.FRANCISKA dr.MICHEL 67500 20000 87500
78 23/10/2015 2476/15 TN.MUHADI 68TH THORAX PA dr.FRANCISKA dr.LISA 67500 20000 87500
79 23/10/2015 3450/12 NY.JEMI 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
80 23/10/2015 3742/12 NY.SITI KHOLIFAH 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 437500
81 24/10/2015 4203/15 NY.SANIATUN 50TH LUMBAL AP dr.ANE dr.MICHEL 67500 20000 87500
82 24/10/2015 4878/15 NY.SITI UMROH 46TH ANKLE JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
83 24/10/2015 5057/14 AN.AULIA NISWATUN 4TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
84 24/10/2015 4880/15 NY.RUMINI 57TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 440000
85 26/10/2015 4896/15 SDR.MOH.HASAN 20TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
86 26/10/2015 4901/15 AN.ULFI ROHMANIYAH 1TH THORAX AP dr.DINA dr.MICHEL 60000 20000 80000
87 26/10/2015 4904/15 NY.MUGIYATI 48TH LUMBAL AP/LAT dr.DINA dr.LISA 137000 23000 160000
88 26/10/2015 4910/15 NN.ANIS SETYONINGSIH 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
89 26/10/2015 4659/15 NY.RIKANAH 55TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 527500
90 27/10/2015 4835/15 NY.SUDARMIJAH 57TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
91 27/10/2015 4918/15 NY.KHOTIJAH 35TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
92 27/10/2015 4931/15 NY.KHUMAYIZAH 51TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
93 28/10/2015 4936/15 NY.SITI ATMINAH 46TH WRIST JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
94 28/10/2015 4742/15 TN.MASTUR 42TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
95 28/10/2015 4940/15 NY.SITI KHOTIJAH 45TH CLAVICULA AP dr.ANE RUJUK 60000 7500 67500
96 28/10/2015 4749/07 NY.SUDINAH 62TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 500000
97 29/10/2015 4947/15 SDR.ROZIKIN 23TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
98 29/10/2015 4789/13 NY.LUTFI 30TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
99 29/10/2015 4183/15 TN.AHMAD FAUZI 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
100 29/10/2015 4953/15 TN.SUPENO BIN SULAIMAN 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 422500
101 30/10/2015 4129/15 TN.MAHPUT 80TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
102 30/10/2015 4975/15 AN.MOH.AFNAN NUR 20BLN THORAX AP dr.JOHAN dr.MICHEL 60000 20000 80000
103 30/10/2015 4979/15 TN.SUWARNO 38TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 255000
104 31/10/2015 4403/15 SDR.MUSTOLIK 17TH WATER'S SPN dr.ANE dr.LISA 60000 20000 80000
105 31/10/2015 4816/15 NY.KASTINI 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
106 31/10/2015 4083/15 TN.ROHIM 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
107 31/10/2015 22/12 TN.SUGIANTO 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 415000
TOTAL 8377000 2148000 15000 10540000

Mengetahui Welahan,31 OKTOBER 2015

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : NOVEMBER 2015
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/11/2015 2460/14 NY.RADIMAH 80TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
2 2/11/2015 5006/15 NY.ASROFAH 33TH LUMBAL AP/LAT BUDIYONO dr.MICHEL 137000 23000 160000
3 2/11/2015 5007/15 NY.KARSIH 43TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
4 2/11/2015 5016/15 TN.TAUFIK RINDHO 31TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
5 2/11/2015 5023/15 TN.KONDORI 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 582500
6 3/11/2015 5033/15 TN.JAKOHAR 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
7 3/11/2015 5037/15 NY.JASWATI 48TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
8 3/11/2015 3590/15 AN.MOH.HAIKAL 16BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
9 3/11/2015 5046/15 NY.INSIYAH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 415000
10 4/11/2015 5052/15 TN.MUZAKI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
11 4/11/2015 4913/15 TN.KUSNAN 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
12 4/11/2015 3139/15 NY.NUR BADIAH 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
13 4/11/2015 4948/15 NY.SITI CHUZAIMAH 57TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
14 4/11/2015 5058/15 AN.SYANAZ FATKIYATUL 1,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
15 4/11/2015 5060/15 NY.MASMIRAH 35TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
16 4/11/2015 5404/14 NN.MARYANAH 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
17 4/11/2015 2883/13 AN.HAIDAR ALI 3TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
18 4/11/2015 4970/15 TN.HAMDAN 32TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
19 4/11/2015 4315/15 NY.ASTIPAH 46TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
20 4/11/2015 5068/15 TN.MUSTAGFIRIN 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
21 4/11/2015 5069/15 NY.HJ.AROFAH 56TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 1180000
22 5/11/2015 5073/15 AN.FELITA AZALIA 20BLN THORAX AP dr.IKO dr.MICHEL 60000 20000 80000
23 5/11/2015 4609/15 TN.PAIMAN 31TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
24 5/11/2015 4483/13 AN.RAIHAN WIJAYA 2,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 320000
25 6/11/2015 5097/15 TN.SURYADI 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
26 7/11/2015 2351/15 AN.MOH.NAWWAL ARINAL 6TH THORAX AP dr.FRANCISKA dr.MICHEL 60000 20000 80000 80000
27 9/11/2015 5118/15 TN.PARINDI 45TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
28 9/11/2015 1731/11 AN.NOVAL PUTRA 5TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
29 9/11/2015 4757/15 TN.SUMAJI 55TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
30 9/11/2015 4344/15 NN.NIKMATUR ROHMAH 20TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 342500
31 10/11/2015 566/06 TN.KHAMID 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 10/11/2015 5140/15 TN.IRFAIN 30TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
33 10/11/2015 5139/15 NY.SURIKAH 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 335000
34 11/11/2015 5156/15 TN.YATIN 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
35 11/11/2015 5164/15 NY.IMROATUN 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
36 11/11/2015 5160/15 NY.TUMINAH 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
37 11/11/2015 4396/15 NY.SUMI'AH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
38 11/11/2015 5161/15 NY.KASEMI 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
39 11/11/2015 2367/15 AN.SAFA AYU 5,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
40 11/11/2015 5166/15 TN.MAHMUDI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
41 11/11/2015 3858/09 TN.SUDARMAN 65TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 910000
42 12/11/2015 334/06 TN.MULYADI 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
43 12/11/2015 5173/15 NY.WAKIDAH 37TH THORAX PA dr.EDI dr.LISA 67500 20000 87500
44 12/11/2015 5132/15 NY.ENDANG SUYANA 36TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500 287500
45 13/11/2015 5182/15 NY.RUKAMAH 59TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
46 13/11/2015 5184/15 TN.SUKENI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
47 13/11/2015 4862/15 NN.DEWI SOLEKHATUN 15TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
48 13/11/2015 286/15 NY.SRI NURHAYATI 24TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
49 13/11/2015 5109/15 TN.MADURI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
50 13/11/2015 5197/15 TN.ASHARI 57TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 597500
51 14/11/2015 5202/15 TN.SUKARI 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
52 16/11/2015 5215/15 NY.MASLIKHAH 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
53 16/11/2015 3171/14 NY.KHAMDANAH 34TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
54 16/11/2015 5237/15 TN.GUMONO 55TH LUMBAL AP/LAT BUDIYONO dr.LISA 137000 23000 160000 407500
55 17/11/2015 5241/15 TN.RAWAN 61TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
56 17/11/2015 3990/10 NY.SOPIYAH 47TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
57 17/11/2015 5248/15 TN.ABDUL MUKHID 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 17/11/2015 5250/15 NY.SUTARTI 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
59 17/11/2015 2471/15 TN.CHAERUDIN 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
60 17/11/2015 5256/15 NY.ZURIYAH 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
61 17/11/2015 5420/14 NY.KASTONAH 53TH CERVICAL AP/LAT dr.ANE dr.LISA 77000 23000 100000 770000
62 18/11/2015 3557/15 AN.MOH.FAHMI 3TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
63 18/11/2015 5262/15 NY.KHOFIFAH 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
64 18/11/2015 3294/12 NY.SULASTRI 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
65 18/11/2015 1888/13 TN.BAMBANG SUGIYANTO 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
66 18/11/2015 5265/15 NY.MURWANI 51TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
67 18/11/2015 1332/11 AN.ELZA FETRA HAMZA 5TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 582500
68 19/11/2015 5282/15 NN.NAILI HIDAYAH 15TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
69 19/11/2015 7152/12 AN.DIMAS MAULANA 4TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 167500
70 20/11/2015 1754/13 AN.NILNA TASKIATUL 7TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
71 20/11/2015 5308/15 TN.NGATEMAN 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 167500
72 21/11/2015 452/14 NY.MAHMUDAH 61TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 87500
73 23/11/2015 5325/15 NY.RUKINI 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
74 23/11/2015 4802/15 NY.SUKIYAH 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
75 23/11/2015 64/15 TN.AS'AD 72TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
76 23/11/2015 5332/15 TN.SUPARNO 45TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
77 23/11/2015 4545/12 AN.NAZRIL IRHAM 5,5TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
78 23/11/2015 2682/15 AN.MOH.SIHAB 4TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 582500
79 24/11/2015 2207/09 NY.SRI SUSYATI 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
80 24/11/2015 5346/15 NY.HJ.MA'RUFAH 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
81 24/11/2015 2915/14 TN.WAKHIT AFANDI 34TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
82 24/11/2015 5359/15 SDR.ABDUL GOFUR 15TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
83 24/11/2015 5361/15 TN.SUPARJO 69TH LUMBAL AP/LAT BUDIYONO dr.MICHEL 137000 23000 160000
84 24/11/2015 3917/15 NN.KHOIROTUN NISA 28TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 742500
85 25/11/2015 1756/12 NY.KAYATUN 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
86 25/11/2015 2779/13 NY.MIATUN 50TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
87 25/11/2015 5357/15 TN.KASTUR 39TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
88 25/11/2015 5376/15 SDR.DENY SETIAWAN 15TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
89 25/11/2015 5384/15 NY.SITI ZUYINAH 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 510000
90 26/11/2015 5394/15 NY.SRI NINGSIH 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
91 26/11/2015 5395/15 SDR.MOH.RIF'AN 30TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
92 26/11/2015 2641/15 AN.YUSUF BAGUS 5TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 255000
93 27/11/2015 2212/12 TN.SLAMET 53TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
94 27/11/2015 5396/15 NY.PONISIH 40TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
95 27/11/2015 5411/15 NN.WIWIK ZULIANA 21TH THORAX PA dr.FRANCISKA dr.MICHEL 67500 20000 87500
96 27/11/2015 5413/15 NN.SITI NUR AFRIKAH 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
97 27/11/2015 4445/13 NY.SUYJINAH 44TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 437500
98 28/11/2015 2295/11 NY.MUNTIAH 60TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
99 28/11/2015 2676/04 TN.HANDOYO 38TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
100 28/11/2015 5429/15 TN.SUMARDI 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
101 28/11/2015 1370/07 NN.ARIFATUL ULIA 16TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
102 28/11/2015 5430/15 NY.DASILAH 57TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 510000
103 30/11/2015 5444/15 AN.ALVINA PUTRI 3TH THORAX AP dr.DINA dr.MICHEL 60000 20000 80000
104 30/11/2015 5447/15 TN.H.MUZAZIN 55TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
105 30/11/2015 5446/15 SDR.ABDUL GOFUR 15TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
106 30/11/2015 5452/15 NY.DURROTUN NIKMAH 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
107 30/11/2015 5355/15 NY.SUGINAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
108 30/11/2015 512/05 TN.SUKANDAR 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
109 30/11/2015 5455/15 NY.NOOR INAYAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 750000
TOTAL 8940000 2255000 11195000

Mengetahui Welahan,30 NOVEMBER 2015

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : DESEMBER 2015
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/12/2015 2721/15 TN.SAIFULLAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 1/12/2015 5076/14 NY.JUMIATUN 36TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
3 1/12/2015 5243/14 NY.ISTIROKHAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 1/12/2015 2683/13 NY.YATINI 42TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 422500
5 2/12/2015 5508/15 AN.ADITYA MAULANA 17BLN THORAX AP dr.H.SOLIKHIN dr.LISA 60000 20000 80000
6 2/12/2015 5433/15 SDR.MASHUR 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
7 2/12/2015 5519/15 TN.MARJO 62TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 255000
8 3/12/2015 2045/15 TN.ASNAWI 60TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
9 3/12/2015 5526/15 SDR.BURHANUDIN 13TH CRANIUM AP/LAT dr.ANE dr.LISA 115000 23000 138000
10 3/12/2015 721/13 AN.NUR FADILAH 3TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
11 3/12/2015 5530/15 NY.ULFAH KHASANAH 14TH LUMBAL AP/LAT BUDIYONO dr.LISA 137000 23000 160000
12 3/12/2015 5529/15 TN.SUWONDO 55TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
13 3/12/2015 2786/15 AN.EVA LUSIANA 9,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
14 3/12/2015 4306/12 TN.JALIL 67TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
15 3/12/2015 1087/07 NY.SUYATEMI 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
16 3/12/2015 986/13 TN.ABDUL MAJID 38TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 1040500
17 4/12/2015 2138/11 NY.SRI MURNI 32TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
18 4/13/2015 5549/15 TN.RAMIJAN 70TH PELVIS AP+ABDOMEN AP dr.ANE dr.LISA 135000 40000 175000
19 4/14/2015 4001/08 TN.NUR ALI 51TH THORAX PA dr.YOHARI dr.LISA 67500 20000 87500 422500
20 5/12/2015 5566/15 TN.HENDRA 32TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 160000
21 7/15/2015 4066/12 NY.KARMANAH 52TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
22 7/15/2015 2938/06 TN.SUPARDI 59TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
23 7/15/2015 2876/06 NY.SUNDARI 40TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
24 7/15/2015 5575/15 NY.KUSNI HARYATI 37TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
25 7/15/2015 5576/15 TN.WAGISAN 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
26 7/15/2015 2055/12 TN.ZARKONI 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 597500
27 8/12/2015 5541/15 TN.TARMUJI 51TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
28 8/12/2015 5596/15 TN.SUKARMAN 62TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 8/12/2015 1164/15 NY.SAADAH 30TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
30 8/12/2015 2543/13 NY.AINI MARIZKI 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
31 8/12/2015 5599/15 SDR.MUNDHO 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 502500
32 10/12/2015 5613/15 TN.NOR ARIP 35TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
33 10/12/2015 5616/15 NY.HESTI AYIN 34TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
34 10/12/2015 1005/13 NY.SUMIYATUN 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
35 12/12/2015 5646/15 TN.RIFAI 40TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
36 12/12/2015 5651/15 TN.MOHAMAD SANTOSO 30TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
37 12/12/2015 2942/15 AN.LYNA ZAHRATUN NISA 4TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 327500
38 14/12/2015 5659/15 TN.MOH.ALI ROSID 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
39 14/12/2015 1496/15 TN.KUNTONO 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
40 14/12/2015 5661/15 TN.JAIS 71TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
41 14/12/2015 5664/15 NY.SURIYAH 78TH FEMUR 2PSS+PELVIS AP dr.DINA RUJUK 160000 7500 167500
42 14/12/2015 5663/15 TN.SUROTO 49TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
43 14/12/2015 5670/15 NY.SARMIAH 50TH LUMBAL AP/LAT dr.DINA dr.LISA 137000 23000 160000
44 14/12/2015 4669/14 TN.H.ROSKAN 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 910000
45 15/12/2015 5682/15 NY.SUKATI 65TH THORAX AP dr.ANE dr.LISA 67500 20000 87500
46 15/12/2015 2883/15 AN.NAILA CITRA IMROATUS 15BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
47 15/12/2015 4179/11 NY.KAMILAH 61TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 327500
48 16/12/2015 1969/10 TN.SUKAHAR 55TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
49 16/12/2015 5699/15 TN.SUMIJAN 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
50 16/12/2015 5700/15 NY.FATONAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
51 16/12/2015 5704/15 NY.MASTURIHAH 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
52 16/12/2015 5307/15 TN.SUNGKONO 72TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 582500
53 17/12/2015 5718/15 TN.ZAINUDDIN 58TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
54 17/12/2015 4626/15 TN.ALI SAIDI 50TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 175000
55 18/12/2015 2626/15 NY.SHOFIYATUN 35TH THORAX PA dr.SUDJATMOKO dr.LISA 67500 20000 87500
56 18/12/2015 234/15 NY.KASMIJAH 57TH LUMBAL AP/LAT dr.SUDJATMOKO dr.LISA 137000 23000 160000
57 18/12/2015 1986/15 TN.JASMAN 84TH THORAX PA dr.SUDJATMOKO dr.LISA 67500 20000 87500 335000
58 19/12/2015 5741/15 TN.ALI FATONI 41TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
59 19/12/2015 5744/15 NY.HJ.FATIMAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 247500
60 21/12/2015 5743/15 TN.MOH.SADERI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
61 21/12/2015 5755/15 NN.JAMIATUL 19TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
62 21/12/2015 2850/15 TN.MOH.KUNDORI 81TH THORAX PA dr.FRANCISKA dr.MICHEL 67500 20000 87500 262500
63 22/12/2015 5771/15 NY.ISTIKOMAH 27TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
64 22/12/2015 5721/15 TN.NUR IKSAN 40TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
65 22/12/2015 2018/15 NY.AZIZAH 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
66 22/12/2015 5763/15 NY.SUMARIYAH 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 342500
67 23/12/2015 319/99 NY.KARMISIH 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
68 23/12/2015 5797/15 NY.MASMI 35TH CRURIS AP/LAT dr.ANE dr.LISA 92500 20000 112500
69 23/12/2015 5798/15 NY.MUTIAH 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 360000
70 28/12/2015 5602/15 TN.KARTIN 51TH ABDOMEN AP dr.LIA dr.MICHEL 67500 20000 87500
71 28/12/2015 3894/15 AN.MOH.HAIKAL 11BLN THORAX AP dr.LIA dr.LISA 60000 20000 80000
72 28/12/2015 1290/06 NY.MEGA SETYAWATI 30TH THORAX PA dr.LIA dr.MICHEL 67500 20000 87500
73 28/12/2015 5819/15 TN.WAGISAN 60TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
74 28/12/2015 5833/15 NY.MASRUROH 39TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
75 28/12/2015 5826/15 NY.ULIYAH 26TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
76 28/12/2015 5832/15 NY.SUGIANTI 41TH THORAX PA dr.LIA dr.MICHEL 67500 20000 87500
77 28/12/2015 5356/14 AN.WINDA NAFISA 18BLN THORAX AP dr.LIA dr.LISA 60000 20000 80000
78 28/12/2015 4516/07 TN.NOOR HAMZAH 38TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
79 28/12/2015 5814/15 TN.MASUDI 65TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 1005000
80 29/12/2015 5864/15 NY.UMI LATIFAH 29TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
81 29/12/2015 5858/15 NY.SRI SUPRIHATI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
82 29/12/2015 3835/13 TN.JUWADI 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
83 29/12/2015 5870/15 AN.SUKMA ADITYA PRANATA 1,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
84 29/12/2015 2270/10 TN.ABDUL WAKHID 57TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
85 29/12/2015 5877/15 TN.SONY ISKANDAR 38TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 517500
86 30/12/2015 5890/15 SDR.MOH.NADIF 16TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
87 30/12/2015 5884/15 TN.H.IRFAN 53TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
88 30/12/2015 5886/15 AN.WINDA NAILATUL 1,6TH THORAX AP dr.H.SOLIKHIN dr.LISA 60000 20000 80000
89 30/12/2015 5728/15 TN.KUSUMO BAMBANG 67TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
90 30/12/2015 5897/15 NY.SUSANTI 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
91 30/12/2015 5888/15 TN.SUHADAK 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 517500
92 31/12/2015 988/15 AN.MOH.ARFA 1TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
93 31/12/2015 5919/15 AN.ATAYA PUTRI 13BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
94 31/12/2015 5923/15 TN.DUL LATIF 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 247500
TOTAL 7870000 1943000 7500 9820500

Mengetahui Welahan,31 DESEMBER 2015

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : JANUARI 2016
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/1/2016 001/16 TN.MUHARI 76TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 2/1/2016 008/16 TN.ABDUL MUNIK 37TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
3 2/1/2016 007/16 NY.SUKARTI 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 2/1/2016 2568/09 NN.NURUL 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
5 2/1/2016 010/16 TN.SUBADI 60TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 510000
6 4/1/2016 3986/12 TN.GAMPANG 75TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
7 4/1/2016 23/16 NY.HARYANTI 48TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
8 4/1/2016 26/16 NY.SUDARNI 65TH LUMBAL AP/LAT dr.DINA dr.MICHEL 137000 23000 160000
9 4/1/2016 434/13 AN.FALIH ROHMAN 3TH ANKLE AP/LAT dr.ANE dr.MICHEL 75000 20000 95000
10 4/1/2016 3102/13 NY.MURIPAH 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
11 4/1/2016 38/16 TN.BUDI UTOMO 47TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
12 4/1/2016 39/16 NN.TRIA RISMAWATI 11TH LUMBAL AP/LAT dr.DINA dr.LISA 137000 23000 160000
13 4/1/2016 4542/13 NY.HJ.SUKOTUN 56TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
14 4/1/2016 1801/15 NY.TURIPAH 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
15 4/1/2016 4456/13 TN.SULAIMAN 60TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
16 4/1/2016 117/10 TN.MULYADI 44TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 1405000
17 5/1/2016 139/08 NY.PARTINI 50TH MANUS AP/OBLIQUE dr.ANE dr.LISA 92500 20000 112500 112500
18 6/1/2016 4066/10 TN.AHMAD SARIF 48TH ABDOMEN 2 POSISI dr.ANE dr.MICHEL 137000 23000 160000
19 6/1/2016 78/16 NY.PURGIYANTI 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 6/1/2016 80/16 TN.ATOK MAJIBUR 33TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
21 6/1/2016 91/16 TN.MUTADI 45TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
22 6/1/2016 50/16 NY.NAPSIYAH 56TH THORAX PA dr.ANE 67500 20000 87500 510000
23 7/1/2016 4342/14 NY.ISTIKAH 41TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
24 7/1/2016 95/16 NY.SUMIYATI 62TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
25 7/1/2016 97/16 SDR.ABDULLAH YUSUF 20TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 407500
26 8/1/2016 5422/15 NY.RASENI 42TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
27 8/1/2016 134/16 AN.NAJWA AINI 5,5TH THORAX PA dr.H.SHOLIKIN dr.LISA 60000 20000 80000 167500
28 9/1/2016 156/16 AN.MOH.SAPUTRA 7TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 9/1/2016 5603/15 NY.ULFATUN NAFIAH 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
30 9/1/2016 4575/14 SDR.WIDI NUGROHO 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
31 9/1/2016 591/07 TN.KATIONO 42TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500 375000
32 11/1/2016 5287/15 TN.HIDAYAT 70TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
33 11/1/2016 161/16 NY.MIAH 65TH LUMBAL AP/LAT dr.DINA dr.MICHEL 137000 23000 160000
34 11/1/2016 163/16 TN.NUR KHAMED 35TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
35 11/1/2016 2090/10 TN.RASEMAN 65TH HUMERUS AP/LAT dr.DINA dr.MICHEL 92500 20000 112500
36 11/1/2016 2061/10 AN.ALFIATUS 6TH THORAX AP dr.DINA dr.LISA 60000 20000 80000
37 11/1/2016 1919/15 NY.TAKRIFAH 41TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 760000
38 12/1/2016 199/16 NY.WARSINI 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
39 12/1/2016 194/16 NY.CHOLIFAH 57TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
40 12/1/2016 201/16 TN.JASMIRAN 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 12/1/2016 3738/15 SDR.DWIKA SAHRUL 15TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 375000
42 13/1/2016 4589/15 NY.SUMIYATI 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
43 13/1/2016 1229/07 TN.KHANDIR 46TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
44 13/1/2016 226/16 TN.NUR HUDA 38TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
45 13/1/2016 91/07 NY.SUNIATI 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 350000
46 14/1/2016 235/16 NY.MAHSUNAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
47 14/1/2016 236/169 TN.ABU YAZID 33TH WRIST JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
48 14/1/2016 237/16 NY.ZUMROH 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
49 14/1/2016 46/16 NY.NUR LAILA 25TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
50 14/1/2016 246/16 NY.SUTAMAH 55TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
51 14/1/2016 248/16 NN.RINA ELYANA 16TH LUMBAL AP/LAT+THORACAL AP dr.ANE dr.MICHEL 204500 43000 247500 782500
52 15/1/2016 255/16 NY.SURATI 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
53 15/1/2016 265/16 TN.MIFTAH FAHRUDIN 29TH ABDOMEN AP dr.YOHARI dr.MICHEL 67500 20000 87500
54 15/1/2016 261/16 TN.SUWARNO 54TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
55 15/1/2016 272/16 NY.KHOTIJAH 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 422500
56 16/1/2016 342/15 AN.USTIN EPIYANI 14BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000 80000
57 18/1/2016 288/15 SDR.SAHRUL KHAKIM 13TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 18/1/2016 3093/15 TN.SARAH 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
59 18/1/2016 3556/15 AN.MOH.DAFA 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
60 18/1/2016 304/16 TN.JAMARI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
61 18/1/2016 3330/15 NY.MASUNAH 50TH WATER'S SPN dr.ANE dr.LISA 60000 20000 80000 422500
62 19/1/2016 322/16 NN.RODOTUL JANAH 16TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
63 19/1/2016 4017/15 AN.NAILA NAJWA 1,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
64 19/1/2016 1141/06 NY.SITI AISAH 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
65 19/1/2016 327/16 TN.AHMAD ROZI 54TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
66 19/1/2016 333/16 NY.RIKA SETIYOWATI 31TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 430000
67 20/1/2016 206/16 TN.PARDI 76TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
68 20/1/2016 623/05 TN.SUHARTO 67TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
69 20/1/2016 1122/11 TN.SAWILAN 66TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
70 20/1/2016 4600/14 TN.SUKANTO 44TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
71 20/1/2016 351/16 NY.FATIMAH 28TH GENUE AP/LAT dr.ANE RUJUK 92500 7500 100000
72 20/1/2016 356/16 NY.MUSRIAH 37TH PEDIS AP/OBLIQUE dr.ANE dr.LINA 92500 20000 112500 635000
73 21/1/2016 364/16 NY.SUKARNI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
74 21/1/2016 3294/12 NY.SULASTRI 55TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000 247500
75 22/1/2016 455/14 TN.SUPAR 63TH LUMBAL AP/LAT dr.ANE dr.LINA 137000 23000 160000
76 22/1/2016 401/16 NY.SRI MASLIKAH 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 247500
77 23/1/2016 5205/14 NY.PURWANINGSIH 55TH GENUE AP/LAT dr.ANE dr.LINA 92500 20000 112500 112500
78 25/1/2016 2201/13 AN.FRANDIAH SEPTIANI 3TH THORAX AP dr.LIA dr.LISA 60000 20000 80000
79 25/1/2016 428/16 NY.BAENAH 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 167500
80 26/1/2016 451/16 NY.ZULIYAH 40TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
81 26/1/2016 453/16 NY.SUKIYEM 54TH THORAX PA dr.ANE RUJUK 67500 7500 75000
82 26/1/2016 455/16 NY.SITI ROSIDAH 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
83 26/1/2016 385/15 AN.NAILA NUR 17BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 330000
84 27/1/2016 3501/13 NY.MURSITI 58TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
85 27/1/2016 4112/15 NY.JASMIRAH 64TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
86 27/1/2016 3208/15 NN.WULAN 21TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
87 27/1/2016 481/16 TN.KARIMUN 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 495000
88 28/1/2016 2131/12 TN.SUTARJO 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
89 28/1/2016 496/16 AN.AMIRUL SAFIATUL 10TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 167500
90 29/1/2016 510/16 TN.ROHIM 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
91 29/1/2016 512/16 SDR.NOR ABIB 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
92 29/1/2016 508/16 TN.H.SUDARSO 70TH ABDOMEN AP dr.JOHAN RUJUK 67500 7500 75000
93 29/1/2016 2268/15 AN.MOH.RIZKI 9TH THORAX PA dr.JOHAN dr.LISA 67500 20000 87500
94 29/1/2016 524/16 NN.DANIA AFRIANTI 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
95 29/1/2016 2131/12 TN.SUTARJO 35TH THORAX TOP LORDOTIK dr.ANE dr.MICHEL 67500 20000 87500
96 29/1/2016 3882/06 TN.MIZBAH 36TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
97 29/1/2016 3666/15 AN.AHMAD ROBBY 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 680000
98 30/1/2016 497/16 TN.SANTOSO 46TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
99 30/1/2016 543/16 NY.NGATMINAH 57TH ELBOW JOINT AP/LAT dr.ANE dr.MICHEL 92500 7500 100000 187500
TOTAL 8367000 1983000 30000 10380000

Mengetahui Welahan,30 JANUARI 2016

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : FEBRUARI 2016
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/2/2016 554/16 NY.SUNDARI 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
2 1/2/2016 560/16 NN.MURNIWATI 17TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
3 1/2/2016 571/16 TN.BRURI 50TH THORAX PA dr.JOHAN dr.LISA 67500 20000 87500
4 1/2/2016 185/11 NN.SYARIFAH 20TH PEDIS AP/OBLIQUE dr.JOHAN dr.MICHEL 92500 20000 112500
5 1/2/2016 382/13 TN.SUPARDI 57TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
6 1/2/2016 572/16 AN.SAYYIDIL ANAM 9TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
7 1/2/2016 556/16 NY.MAS'UDAH 60TH ANTEBRACHII AP/LAT dr.JOHAN RUJUK 92500 7500 100000 715000
8 2/2/2016 3899/09 TN.NUR TURAIKHAN 41TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 160000
9 3/2/2016 606/16 SDR.DEDI HERMAWAN 27TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
10 3/2/2016 5410/15 TN.SUYATMIN 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
11 3/2/2016 623/16 TN.KARMIN 74TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
12 3/2/2016 622/16 SDR.AFRIZAL ANANDA 22TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
13 3/2/2016 1241/12 NY.SULAMAH 43TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
14 3/2/2016 1485/15 NY.NGATEMI 46TH ANKLE JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500 767500
15 4/2/2016 641/16 TN.MOH.SOLIKIN 27TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
16 4/2/2016 635/16 SDR.AGUNG PRASETYO 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
17 4/2/2016 642/16 SDR.JAUHAR FANANI 13TH THORAX AP dr.ANE dr.MICHEL 67500 20000 87500 262500
18 6/2/2016 4154/08 TN.SUMARJO 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 160000
19 9/2/2016 3805/15 AN.BUDI WALUYO 2TH THORAX AP dr.JOHAN dr.MICHEL 60000 20000 80000
20 9/2/2016 704/16 SDR.FARHANUDIN AHMAD 23TH THORAX PA dr.PUSKESMAS dr.LISA 67500 20000 87500
21 9/2/2016 3839/15 TN.SUMBER 43TH THORAX PA dr.JOHAN dr.MICHEL 67500 20000 87500 255000
22 10/2/2016 686/16 SDR.MOH.TEGUH PRATAMA 13TH THORAX PA dr.YOHARI dr.LISA 67500 20000 87500
23 10/2/2016 665/16 NY.SITI ZAENAH 47TH THORAX PA dr.YOHARI dr.MICHEL 67500 20000 87500 175000
24 11/2/2016 736/16 NN.JERMIA RAHMA 25TH CRURIS AP/LAT dr.DINA dr.LISA 92500 20000 112500
25 11/2/2016 740/16 TN.KASMITO 51TH ABDOMEN AP dr.DINA RUJUK 67500 7500 75000 187500
26 12/2/2016 3405/13 AN.MOH.ABDUWAH 4TH THORAX AP dr.LIA dr.MICHEL 60000 20000 80000 80000
27 13/2/2016 769/16 AN.VANIA KOTRUN NADA 4TH THORAX AP dr.YOHARI dr.LISA 60000 20000 80000
28 13/2/2016 775/16 TN.ZAENURI 41TH THORAX PA dr.YOHARI dr.MICHEL 67500 20000 87500
29 13/2/2016 776/16 TN.SUTRIMO 56TH THORAX PA dr.YOHARI dr.LISA 67500 20000 87500 255000
30 15/2/2016 792/16 NY.SITI WELAS 49TH THORAX PA dr.IRWAN dr.MICHEL 67500 20000 87500
31 15/2/2016 789/16 TN.SUNARWI 40TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
32 15/2/2016 793/16 NY.KHUZAEMAH 51TH THORAX PA dr.LIA dr.MICHEL 67500 20000 87500
33 15/2/2016 795/16 TN.WIRKAN 57TH LUMBAL AP/LAT dr.LIA dr.LISA 137000 23000 160000
34 15/2/2016 799/16 TN.MUHTAROM 53TH ANTEBRACHII AP/LAT dr.YOHARI dr.MICHEL 92500 20000 112500 535000
35 16/2/2016 4620/15 TN.MAHFURI 65TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
36 16/2/2016 808/16 TN.JUREMI 59TH THORAX PA dr.H.SOLIKHIN dr.MICHEL 67500 20000 87500 247500
37 17/2/2016 839/16 AN.AISFATUN NISLA NUR 7TH THORAX PA dr.H.SOLIKHIN dr.LISA 60000 20000 80000
38 17/2/2016 2565/13 NN.EFITO 27TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
39 17/2/2016 834/14 TN.ABDULLAH SYAFI'I 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 255000
40 18/2/2016 855/16 TN.NGADIMIN 65TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
41 18/2/2016 3460/10 TN.MUSTAJIB 42TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
42 18/2/2016 197/16 NY.SUJIYAH 37TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
43 18/2/2016 3926/15 AN.PANJI MAULANA ISHAK 3TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
44 18/2/2016 599/15 TN.ZAINURI 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
45 18/2/2016 860/16 NY.LIA KURNIA 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
46 18/2/2016 862/16 TN.SUWONDO 57TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
47 18/2/2016 870/16 TN.MASKUN 50TH ANKLE JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500 862500
48 19/2/2016 875/16 TN.SURAJIMAN 30TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
49 19/2/2016 877/16 TN.SUTOMO 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
50 19/2/2016 873/16 TN.ALI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
51 19/2/2016 887/16 TN.SUKILAN 64TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
52 19/2/2016 755/16 NN.SITI ZULAIKAH 27TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
53 19/2/2016 517/15 AN.SYAFA AQILA 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 662500
54 20/2/2016 913/16 AN.MOH.FAZA 16BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
55 20/2/2016 910/16 NY.MUZAKIAH 48TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
56 20/2/2016 909/16 TN.HARYANTO 58TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 352500
57 25/2/2016 3149/07 NY.SUPRIYANTI 38TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
58 25/2/2016 3101/15 TN.ULIL ALBAB 38TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 247500
59 26/2/2016 1018/16 NN.DITA SETYAUTAMI 16TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
60 26/2/2016 3914/15 AN.MOH.FAREL 9TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
61 26/2/2016 4521/10 TN.FAUZAN 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 327500
62 27/2/2016 1038/16 NY.SUNTARI 80TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
63 27/2/2016 941/16 AN.SEPTIANA VIVID 6TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000 167500
64 29/2/2016 1053/16 AN.REVALINA AZKIA 17BLN THORAX AP dr.DINA dr.MICHEL 60000 20000 80000
65 29/2/2016 1370/07 NN.ARIFATUL ULIA 17TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
TOTAL 5522500 1305000 15000 6842500

Mengetahui Welahan,29 FEBRUARI 2016

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN :MARET 2016
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/3/2016 1074/16 NY.LASTRI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
2 1/3/2016 16/14 TN.M.ABDUL ROHMAN 44TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
3 1/3/2016 1083/16 TN.SULISTIYONO 35TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 335000
4 2/3/2016 1094/16 NY.KARTINI 68TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
5 2/3/2016 1090/16 TN.AHMADI 57TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 2/3/2016 3605/10 NY.ROHMATUL MAULIDA 24TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
7 2/3/2016 4093/15 AN.ZAZKIA AJENG 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
8 2/3/2016 1097/16 NY.MUNAWAROH 59TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
9 2/3/2016 1101/16 TN.SUTAMAR 53TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 517500
10 3/3/2016 1111/16 NY.MUNAWAROH 52TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
11 3/3/2016 1114/16 NT.NGATMIAH 46TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
12 3/3/2016 1125/16 TN.SAERONI 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
13 3/3/2016 3998/15 NY.RUSTINAH 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
14 3/3/2016 4215/14 TN.PARYONO 66TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
15 3/3/2016 1130/16 NY.SUPARTI 63TH CRANIUM AP dr.ANE dr.LISA 60000 20000 80000 735000
16 4/3/2016 1081/16 TN.MAS'UD 49TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
17 4/3/2016 1136/16 TN.SUTARJO 74TH THORAX PA dr.LIA dr.MICHEL 67500 20000 87500
18 4/3/2016 1142/16 TN.NUR ALI 54TH LUMBAL AP/LAT dr.LIA dr.LISA 137000 23000 160000
19 4/3/2016 1146/16 TN.SUTARSI 54TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
20 4/3/2016 1145/16 NY.ASMANAH 47TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
21 4/3/2016 1147/16 TN.SUYUTI 50TH THORAX PA dr.LIA dr.MICHEL 67500 20000 87500 742500
22 5/3/2016 1157/16 AN.DIANA OKTAVERA 11TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 80000
23 7/3/2016 1173/16 NN.YENI WULANDARI 21TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
24 7/3/2016 1046/16 NY.DIANA PUTRI NINGSIH 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
25 7/3/2016 3648/15 NY.ROKIYAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 335000
26 8/3/2016 2045/15 TN.ASNAWI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
27 8/3/2016 1198/16 SDR.ROSIQ FUADI 25TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
28 8/3/2016 1202/16 TN.MAS'AN 25TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
29 8/3/2016 1197/16 TN.ROCHMAT 58TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
30 8/3/2016 1199/16 TN.ABDUL ROSID 38TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
31 8/3/2016 1204/16 SDR.BUDIYANTO 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
32 8/3/2016 3291/05 NY.ZUBAIDATUN NIKMAH 29TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
33 8/3/2016 1219/16 NY.SANIPAH 88TH THORAX AP dr.ANE dr.MICHEL 67500 20000 87500 772500
34 10/3/2016 1231/16 AN.NAILA ADHILA PUTRI 9TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
35 10/3/2016 1240/16 NN.SETIYANINGSIH 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 167500
36 11/3/2016 1259/16 NY.RULLIYAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
37 11/3/2016 406/16 AN.MOH.RAFA 21BLN THORAX AP dr.DINA dr.MICHEL 60000 20000 80000
38 11/3/2016 3415/12 NY.SUPARTI 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
39 11/3/2016 1278/16 SDR.FARID ULIN 15TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
40 11/3/2016 1274/16 TN.ABDUL HARIS 53TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
41 11/3/2016 1277/16 TN.SUMINGAN 60TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
42 11/3/2016 1282/16 SDR.ASRUL MA'ARIF 15TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
43 11/3/2016 584/16 AN.DITA PERMATASARI 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 830000
44 12/3/2016 1294/16 NN.ROFIQ LINDAYANTI 13TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
45 14/3/2016 1302/16 TN.ABDUL JALAL 51TH THORAX PA dr.EDY,Sp.PD dr.LISA 67500 20000 87500
46 14/3/2016 2136/15 NY.SRIPAH 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
47 14/3/2016 1296/16 TN.AHMAD MAHMUDI 33TH GENUE AP/LAT dr.DINA dr.LISA 92500 20000 112500
48 14/3/2016 1299/16 TN.DJAIDUN 58TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
49 14/3/2016 1305/16 TN.ABDUL WAHAB 45TH PEDIS 2 PSS+PELVIS AP dr.DINA dr.LISA 160000 40000 200000
50 14/3/2016 1319/16 AN.MAHARDIKA SATRIA 18BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
51 14/3/2016 4127/09 TN.SUKARDI 65TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
52 14/3/2016 1318/16 TN.NANDHO 46TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
53 14/3/2016 692/16 AN.ADAM BAYU 1,6TH THORAX AP dr.DINA dr.LISA 60000 20000 80000
54 14/3/2016 1311/16 NN.SITI MAIMUNAH 29TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
55 14/3/2016 1315/16 SDR.SETIA AJI 21TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
56 14/3/2016 1316/16 NY.MASRUIN 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 1390000
57 15/3/2016 1349/16 NY.LINDA LUTFITASARI 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 15/3/2016 1350/16 TN.ABDUL BASIT 32TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
59 15/3/2016 1352/16 TN.RASIMIN 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
60 15/3/2016 1353/16 NY.SUMIATI 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
61 15/3/2016 2507/12 NY.MUNASIH 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 437500
62 16/3/2016 2974/5 TN.SAIDI 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
63 16/3/2016 3252/15 TN.SUWARDI 64TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
64 16/3/2016 1402/14 NY.SITI MAHMUDAH 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
65 16/3/2016 3526/15 NY.MASRIAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
66 16/3/2016 1386/16 TN.KASNOMO 33TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 510000
67 17/3/2016 374/14 TN.SADIMAN 66TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
68 17/3/2016 1398/16 NY.SUKARTI 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
69 17/3/2016 1400/16 NY.MASRUMI 57TH THORAX PA dr.ANE dr.LISA 67500 7500 75000
70 17/3/2016 1401/16 NY.FITROTUN 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
71 17/3/2016 1410/16 NY.ANIS SIYANAH 46TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 425000
72 18/3/2016 1425/16 NY.SHOLIHATUN 75TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
73 18/3/2016 71/12 TN.TASKAN 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
74 21/3/2016 1247/16 NY.SOPIYATUN 58TH THORAX PA dr.LIA dr.MICHEL 67500 20000 87500 87500
75 22/3/2016 1521/16 NY.KUTSIYAH 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
76 22/3/2016 1741/14 TN.SUHARDI 59TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 175000
77 23/3/2016 1531/16 NY.RINI AMELIA 33TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
78 23/3/2016 4612/12 TN.NUR ROHMAN 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
79 23/3/2016 1546/16 NY.RITA 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
80 23/3/2016 1547/16 NN.NAIM MAISITA 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
81 23/3/2016 1552/16 NY.MARIYAH 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
82 23/3/2016 517/13 TN.SADURI 83TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 597500
83 24/3/2016 3680/07 NY.SUPANI 62TH PEDIS AP/OBLIQUE dr.ANE RUJUK 92500 7500 100000
84 24/3/2016 3065/98 TN.HASAN ANWAR 62TH ABDOMEN AP dr.ANE DR.LINA 67500 20000 87500
85 24/3/2016 5709/15 TN.KASMIN 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
86 24/3/2016 430/14 TN.KUSDI 72TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 362500
87 26/3/2016 1588/16 TN.SARDIMAN 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
88 28/3/2016 1598/16 AN.AHMAD ABDUL ROZAK 9BLN THORAX AP dr.DINA dr.LISA 60000 20000 80000
89 28/3/2016 807/16 NY.WARNI 60TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
90 28/3/2016 1046/15 AN.MOH.ALVIN 2TH THORAX AP dr.DINA dr.LISA 60000 20000 80000
91 28/3/2016 1605/16 AN.MOH.BAGUS ULIN 2,6TH THORAX AP dr.DINA dr.MICHEL 60000 20000 80000
92 28/3/2016 1051/16 AN.HASLA KHULUN 3,6TH THORAX AP dr.DINA dr.LISA 60000 20000 80000
93 28/3/2016 1612/16 TN.EKO PUTRO PANUT 36TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
94 28/3/2016 1613/16 NY.SUNARSIH 66TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
95 28/3/2016 4169/14 NY.DARWATI 50TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
96 28/3/2016 1625/16 TN.SARLAN 47TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
97 28/3/2016 236/15 NY.ASMAH 47TH ABDOMEN AP dr.DINA dr.MICHEL 67500 20000 87500
98 28/3/2016 934/16 NY.SUMIATI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
99 28/3/2016 4612/14 NY.ROISMAH 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 1092500
100 29/3/2016 1653/16 AN.ATIKA YASMIN 2,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
101 29/3/2016 1654/16 TN.SAHLI 59TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
102 29/3/2016 1661/16 NY.SRI KATUN 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
103 29/3/2016 1340/16 TN.MAHFUD 37TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 415000
104 30/3/2016 1677/16 NY.RUKEMI 50TH THORAX PA dr.ANE DR.LISA 67500 20000 87500
105 30/3/2016 5105/15 NY.NUR YATI 34TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
106 30/3/2016 1688/16 AN.REIHAN AL CHAYA'I 2,6TH MANUS AP/OBLIQUE dr.ANE dr.MICHEL 75000 20000 95000
107 30/3/2016 1690/16 NY.RUMIYATI 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
108 30/3/2016 1553/14 NN.AYU RIFAATI 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 445000
109 31/3/2016 445/09 TN.SUYANTO 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
110 31/3/2016 4174/15 NN.IMAMATUL HUSNI 14TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
TOTAL 8728500 2234000 7500 10990000

Mengetahui Welahan, 31 MARET 2016

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : APRIL 2016
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/4/2016 1613/16 SDR.MOH.YUSRIL 13TH CLAVICULA AP dr.LIA RUJUK 60000 7500 67500
2 1/4/2016 28/14 NY.SOFI'AT 35TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
3 1/4/2016 4588/15 NY.AMAROH 56TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
4 1/4/2016 1631/16 NY.MASKHOIRIYAH 43TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 402500
5 2/4/2016 1636/16 NY.MUSNAH 62TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
6 2/4/2016 780/14 TN.IBNU MUSHOFA 34TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
7 2/4/2016 1639/16 TN.KHUMAIDI 64TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 335000
8 4/4/2016 3164/15 NY.SUNARTI 56TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
9 4/4/2016 1652/16 NY.HJ.ZAROH 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
10 4/4/2016 4006/13 NY.SUMINI 62TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
11 4/4/2016 1661/16 NN.SUCI AMALIA 25TH THORAX PA dr.MUNARTO dr.MICHEL 67500 20000 87500
12 4/4/2016 1663/16 TN.SUGIRAN 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
13 4/4/2016 441/16 NN.MUNDHOIFAH 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
14 4/4/2016 1670/16 TN.IKSAN 75TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
15 4/4/2016 1671/16 TN,KHOIRUL UMAM 33TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 917500
16 5/4/2016 1395/13 TN.AHMAD TARZUQON 64TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
17 5/4/2016 1689/16 TN.SAROZI 39TH ANTEBRACHII PA/LAT dr.ANE RUJUK 92500 7500 100000
18 5/4/2016 1693/16 TN.ROFIKIN 35TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
19 5/4/2016 1702/16 NY.UMIYATUN 34TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 435000
20 6/4/2016 3892/15 TN.BAMBANG HADI 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
21 6/4/2016 1731/16 NN.ISNAINI NURJANAH 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
22 6/4/2016 4199/05 TN.TUKIRIN 48TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
23 6/4/2016 1734/16 NY.MASRINAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 422500
24 7/4/2016 1739/16 AN.AHMAD MAULANA 16BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
25 7/4/2016 433/16 TN.KARNADI 83TH THORAX PA dr.M.NAUFAL dr.MICHEL 67500 20000 87500
26 7/4/2016 1755/16 NY.SUKRIAH 59TH THORAX PA dr.H.SOLIKHIN dr.LISA 67500 20000 87500
27 7/4/2016 1750/16 NY.AROFAH 46TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
28 7/4/2016 1553/08 TN.LEGIMIN 45TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 430000
29 8/4/2016 4597/15 AN.AHMAD SHOLIKUL 3,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
30 8/4/2016 1416/16 NY.SULASI 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
31 8/4/2016 1611/16 NY.SUKIRAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 8/4/2016 1774/16 NY.HJ.KHALIMAH 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
33 8/4/2016 1781/16 AN.AHMAD EMIR 6TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
34 8/4/2016 4497/08 NN.PUTRI AYU 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
35 8/4/2016 4001/09 TN.SUGITO 46TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
36 8/4/2016 2601/14 AN.PUTRI DEWI SINTA 10,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 757500
37 11/4/2016 1813/16 TN.SUMARI 68TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
38 11/4/2016 1812/16 NY.TUNINGSIH 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
39 11/4/2016 1254/14 AN.LUTFIA ZAHRA 3TH THORAX AP dr.DINA dr.MICHEL 60000 20000 80000
40 11/4/2016 1814/16 TN.MUDHOFAR 62TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
41 11/4/2016 4999/15 TN.AHMAD SYAHIL 36TH ABDOMEN AP dr.DINA dr.MICHEL 67500 20000 87500
42 11/4/2016 1766/16 NY.TSAMROTUL HIDAYAH 30TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
43 11/4/2016 1817/16 NY.BUDRIYAH 47TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
44 11/4/2016 2195/15 NY.DARWATI 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
45 11/4/2016 5175/14 AN.MOH.LUTFI HAKIM 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
46 11/4/2016 1153/14 AN.MOH.AKHIL SANI 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
47 11/4/2016 1823/16 AN.RATNA QUINZHA 4,6TH ELBOW JOINT AP/LAT dr.ANE dr.MICHEL 75000 20000 95000 1020000
48 12/4/2016 1850/16 NY.FILLYANA FITRIANASARI 34TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
49 12/4/2016 294/05 NY.SRI ATUN 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 247500
50 13/4/2016 4104/14 NY.ISTIKOMAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
51 14/4/2016 1879/16 NN.ENI PUJI ASTUTI 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
52 14/4/2016 1885/16 TN.SADIK 30TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 175000
53 15/4/2016 1894/16 TN.ALI MAHDUM 43TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
54 15/4/2016 1899/16 NY.LISTIYORINI 34TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
55 15/4/2016 817/16 AN.ARFA SURYA DINATA 10BLN THORAX AP dr.DINA dr.MICHEL 60000 20000 80000
56 15/4/2016 1907/16 NN.SITI ZULAIKAH 21TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
57 15/4/2016 1908/16 NY.NGATRIYAN 31TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
58 15/4/2016 1915/16 NY.MARKONAH 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
59 15/4/2016 1919/16 NY.SUWATI 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 605000
60 16/4/2016 2645/07 TN.HARTO 37TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
61 16/4/2016 4773/15 AN.ZAHRA ANGGITA 20BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 167500
62 18/4/2016 2309/06 TN.KASTONO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
63 18/4/2016 1940/16 TN.HANAFI 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
64 18/4/2016 3926/08 TN.KASMADI 80TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
65 18/4/2016 1942/16 NY.NYAMIATI 36TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
66 18/4/2016 1947/16 NY.ENY RAHMAWATI 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
67 18/4/2016 1958/16 SDR.MASYUDI 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 597500
68 19/4/2016 1967/16 NY.KASEMI 65TH PELVIS AP dr.ANE dr.LISA 67500 20000 87500
69 19/4/2016 1970/16 TN.NOR HADI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
70 19/4/2016 1976/16 NN.HIDAYATUL MUNIROH 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
71 19/4/2016 1978/16 NY.NOR AFIFAH 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
72 19/4/2016 1983/16 TN.MOH.ABDUL JALIL 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
73 19/4/2016 1829/15 NY.JUMINAH 68TH ANTEBRACHII PA/LAT dr.ANE dr.MICHEL 92500 20000 112500
74 19/4/2016 1994/16 TN.DEDDY SISWANTO 28TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 637500
75 20/4/2016 1995/16 TN.SUKARJO 40TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
76 20/4/2016 1998/16 NY.SITI ALKOMAH 58TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 175000
77 21/4/2016 2017/16 TN.MUNARI 85TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
78 21/4/2016 2023/16 TN.SUHAILI 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
79 21/4/2016 2024/16 TN.SUTARNO 59TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
80 21/4/2016 2028/16 TN.IMAM SAFI'I 35TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
81 21/4/2016 2032/16 TN.RASPANI 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
82 21/4/2016 5363/15 SDR.AHMAD HILMI 15TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 525000
83 22/4/2016 2047/16 NY.KHARIZAH 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
84 22/4/2016 2054/16 NY.SUNYAR 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
85 22/4/2016 2056/16 SDR.NIAMUL AJIB 15TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 262500
86 25/4/2016 2092/16 NY.PASINI 58TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
87 25/4/2016 2095/16 SDR.ANAM RIO WIDODO 16TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
88 25/4/2016 3679/14 TN.SUKIMAN 40TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
89 25/4/2016 2111/16 TN.SISWANTO 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 350000
90 26/4/2016 1174/13 NY.KUSNAH 63TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
91 26/4/2016 4451/15 TN.ISMANTO 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
92 26/4/2016 797/16 SDR.SAIFUL AHMAD 21TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
93 26/4/2016 2131/16 SDR.MOHAMAD ARIF 13TH SOFTTISSUE NASAL dr.ANE dr.MICHEL 60000 20000 80000 342500
94 27/4/2016 2143/16 TN.ACHMAD SHOLEH 28TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
95 27/4/2016 2147/16 TN.ABDUL HADI 39TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
96 27/4/2016 2148/16 NY.SRI RUKINI 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
97 27/4/2016 2152/16 NN.DWI APRILIA LESTARI 22TH ANKLE AP/LAT dr.ANE dr.LISA 92500 20000 112500
98 27/4/2016 2156/16 AN.RADITYA FADILA 5,6TH WRIST JOINT AP/LAT dr.ANE dr.MICHEL 75000 20000 95000 470000
99 28/4/2016 837/15 TN.MOH.BUDI SANTOSO 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
100 28/4/2016 2176/16 NN.SAFA'ATIN KHOIRIYAH 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
101 29/4/2016 2207/16 AN.NATASYA RIZQI 1TH THORAX AP dr.MARIA dr.LISA 60000 20000 80000
102 29/4/2016 2651/15 AN.MOH.NABIL MAULANA 1TH THORAX AP dr.MARIA dr.MICHEL 60000 20000 80000
103 29/4/2016 2063/16 TN.AHSAN 36TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
104 29/4/2016 2211/16 AN.MOH.ZAKI FARQON 7TH PEDIS AP/OBLIQUE dr.MARIA dr.MICHEL 75000 20000 95000
105 29/4/2016 2210/16 TN.JOHARI 55TH THORAX PA dr.MARIA dr.LISA 67500 20000 87500
106 29/4/2016 2209/16 NY.NUR SAEKAH 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
107 29/4/2016 2213/16 TN.NGASMIN 85TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
108 29/4/2016 2215/16 TN.H.AHMAD HASYIM 73TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 692500
109 30/4/2016 2224/16 TN.KANDEG 55TH THORAX PA dr.H.SOLIKHIN dr.LISA 67500 20000 87500
110 30/4/2016 3567/06 TN.SUWARGI 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
TOTAL 8197000 2193000 15000 10405000

Mengetahui Welahan, 30 APRIL 2016

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : MEI 2016
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/5/2016 2239/16 NY.SULASAH 60TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
2 2/5/2016 1055/14 TN.RUSMIN 50TH THORAX PA dr.LIA dr.MICHEL 67500 20000 87500
3 2/5/2016 377/16 NY.AHRUFI 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 2/5/2016 925/14 NY.SOFIYANTI 33TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500
5 2/5/2016 2263/16 NY.SUTINAH 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 462500
6 3/5/2016 2264/16 SDR.MOH.KHOIRUN NIAM 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
7 3/5/2016 2270/16 NY.ROSA 37TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
8 3/5/2016 3416/14 NN.ISMATUL MUNA 15TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
9 3/5/2016 4157/11 NY.SITI ZULAICHAH 27TH WRIST JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
10 3/5/2016 4901/15 AN.ULFI ROHMANIYAH 18BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 455000
11 4/5/2016 2296/16 NY.SUMARNI 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
12 7/5/2016 2243/16 AN.RIFA FEBRIANA 9TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
13 7/5/2016 2319/16 NY.SHOFIYATI 65TH THORAX AP dr.ANE dr.LISA 67500 20000 87500 167500
14 9/5/2016 1833/16 TN.BURDI 65TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
15 9/5/2016 2751/06 NY.SOLIKHAH 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
16 9/5/2016 2348/16 TN.MAHMUDI 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
17 9/5/2016 1750/12 AN.DIMAS MAULANA 4,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
18 9/5/2016 4227/07 NY.ROBIYAH 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 455000
19 10/5/2016 247/14 NY.HJ.SITI SUMIATUN 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
20 11/5/2016 2947/10 SDR.FRISCO ADI 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
21 11/5/2016 2520/15 SDR.ABU BAKAR 23TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
22 11/5/2016 2384/16 TN.SULAINI 51TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
23 11/5/2016 3233/12 NY.LEGIMAH 60TH GENUE AP/LAT dr.ANE dr.LINA 92500 20000 112500
24 11/5/2016 2387/16 NY.MASROPAH 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
25 11/5/2016 1737/11 AN.NOVAL PUTRA 5,6TH THORAX AP dr.ANE dr.LINA 60000 20000 80000 542500
26 12/5/2016 3557/15 AN.MOH.FAHMI FEBRIAN 3,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
27 12/5/2016 2410/16 NY.SUMIATUN 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
28 12/5/2016 2409/16 TN.AHMAD RIDHO 39TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 12/5/2016 3652/14 TN.H.HANAFI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 342500
30 13/5/2016 2436/16 SDR.AGUS HADI UTOMO 18TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
31 13/5/2016 2275/12 NN.UMI KHOLIDAH 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
32 14/5/2016 2451/16 AN.ELVA RIYANI 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
33 14/5/2016 832/14 NY.SUJINAH 42TH CERVICAL AP/LAT dr.ANE dr.MICHEL 77000 23000 100000 180000
34 16/5/2016 3579/15 TN.SUPRIHATIN 70TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
35 16/5/2016 2464/16 TN.SIDO MULYO 47TH ABDOMEN AP dr.LIA dr.MICHEL 67500 20000 87500 175000
36 17/5/2016 2404/16 TN.MOH.SYAIFUDIN ARIF 40TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
37 17/5/2016 2507/16 AN.REHANA ANANDA SYAKILA 11BLN THORAX AP dr.AMRIH dr.MICHEL 60000 20000 80000
38 17/5/2016 2510/16 AN.ALMAFIRA KEISYA PUTRI 18BLN THORAX AP dr.H.SOLIKHIN dr.MICHEL 60000 20000 80000
39 17/5/2016 2505/16 AN.SIHAB ADI SAPUTRA 9TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
40 17/5/2016 3296/12 TN.MANDEG 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
41 17/5/2016 2519/16 NY.SITI FATIROH 33TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
42 17/5/2016 2521/16 TN.SUWARLAN 60TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
43 17/5/2016 1440/14 TN.M.SOFA MARWANI 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 750000
44 18/5/2016 2530/16 TN.SUNAWI 83TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
45 18/5/2016 2533/16 NY.TRI MURTINI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
46 18/5/2016 2540/16 SDR.ULIL ABSOR 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
47 18/5/2016 1118/16 NY.ROSIKAH 59TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 422500
48 19/5/2016 2297/16 AN.CLARA ZAIN TAJLEE 15BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
49 19/5/2016 2559/16 TN.SUHARJO 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
50 19/5/2016 2556/16 NY.SUMBER 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 255000
51 20/5/2016 2571/16 AN.PUTRI AYU NINGSIH 7TH THORAX PA dr.AMRIH dr.MICHEL 60000 20000 80000
52 20/5/2016 2455/16 AN.AINI 2TH THORAX AP dr.JOHAN dr.MICHEL 60000 20000 80000
53 20/5/2016 5411/15 NN.WIWIK ZULIANA 22TH THORAX PA dr.JOHAN dr.MICHEL 67500 20000 87500
54 20/5/2016 2578/16 AN.EDI SAPUTRA 10TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
55 20/5/2016 2583/16 TN.RIDWAN 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
56 20/5/2016 1484/15 TN.TEGUH 39TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
57 20/5/2016 2596/16 TN.SUPARMAN 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
58 20/5/2016 2599/16 NY.MASRIAH 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 750000
59 21/5/2016 2607/16 TN.ADI WASONO 31TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 87500
60 24/5/2016 2654/16 NY.SRIATUN 47TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
61 24/5/2016 4545/12 AN.NAZRIL IRHAM 6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
62 24/5/2016 2632/16 TN.SULKHAN 53TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
63 24/5/2016 2657/16 NY.MANDEK FITROTUN 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
64 24/5/2016 5207/12 NY.ENDANG 41TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
65 24/5/2016 2666/16 TN.MOH.ALI MANSHUR 44TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 590000
66 25/5/2016 1867/15 TN.MASRUKIN 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
67 25/5/2016 3071/15 SDR.LUKMAN HAKIM 13TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
68 25/5/2016 2679/16 NY.PARWATI 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
69 27/5/2016 2712/16 NY.TUMISIH 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
70 28/5/2016 2723/16 TN.ADI SUSILO 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
71 30/5/2016 2303/15 AN.ARSAKHA JONEA 21BLN THORAX AP dr.DINA dr.MICHEL 60000 20000 80000
72 30/5/2016 2737/16 SDR.JAMALUDDIN NASIR 25TH MANUS AP/OBLIQUE dr.DINA RUJUK 92500 7500 100000
73 30/5/2016 2744/16 NY.DAHLIA 43TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
74 30/5/2016 2745/16 SDR.NIAM 21TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
75 30/5/2016 2743/16 TN.KARDONO 58TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
76 30/5/2016 3964/15 TN.YOYOK 46TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
77 30/5/2016 2678/04 TN.SUTOYO 55TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
78 30/5/2016 3917/06 NY.YATENI 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
79 30/5/2016 2745/16 NY.SITI AMINAH 50TH CLAVICULA AP dr.ANE dr.MICHEL 60000 20000 80000 922500
80 31/5/2016 2761/16 NY.MARSINAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
81 31/5/2016 3834/12 TN.ALI BAIDI 67TH MANUS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500
82 31/5/2016 2767/16 NY.MARTINI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
83 31/5/2016 2769/16 NY.WINDA PRAWESTI 20TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 375000
TOTAL 6051500 1661000 7500 7720000

Mengetahui Welahan, 31 MEI 2016

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : JUNI 2016
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/6/2016 2454/16 NY.ASMIROH 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 1/6/2016 2774/16 NY.KHOIRUL ISMAH 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
3 1/6/2016 4743/14 NY.MASKANAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 1/6/2016 2777/16 NY.HJ.SUHARTI 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
5 1/6/2016 2778/16 AN.DAFA ARAFIF 11BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
6 1/6/2016 2779/16 TN.MULUS 47TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
7 1/6/2016 2781/16 TN.ABDUL ROKIB 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 677500
8 2/6/2016 4115/12 NY.ROFIATUN 37TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
9 2/6/2016 1191/16 TN.HERU 54TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
10 2/6/2016 2794/16 TN.ADITIA NURMAWAN 26TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
11 2/6/2016 2803/16 NY.JUATI 46TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
12 2/6/2016 2715/16 NY.SUTIPAH 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 680000
13 3/6/2016 3629/15 NY.ROKAYAH 42TH ELBOW JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
14 3/6/2016 2827/16 AN.ALFIRA MAULIDA 6TH THORAX PA dr.AMRIH dr.MICHEL 60000 20000 80000
15 3/6/2016 2833/16 TN.MASKURI 46TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 352500
16 4/6/2016 2839/16 SDR.NUR AFIFUDIN 25TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
17 4/6/2016 2845/16 SDR.IFAN KURNIAWAN 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 200000
18 6/6/2016 2088/08 TN.MUJI HARJO 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
19 6/6/2016 1325/07 NY.TEMURIPAH 70TH THORAX AP dr.ANE dr.LISA 67500 20000 87500
20 6/6/2016 5179/15 TN.SUKAMTO 39TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
21 7/6/2016 2565/16 SDR.NOR ARIFIN 28TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
22 7/6/2016 3894/15 AN.MOH.HAIKAL 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 167500
23 8/6/2016 2909/16 NY.RUGINAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
24 10/6/2016 5052/15 TN.MUZAKI 55TH THORAX PA dr.JOHAN dr.MICHEL 67500 20000 87500
25 10/6/2016 2940/16 NY.MUJIATI 62TH THORAX PA dr.JOHAN dr.LISA 67500 20000 87500
26 10/6/2016 2947/16 NY.KOIMATUN 45TH THORAX PA dr.JOHAN RUJUK 67500 7500 75000 250000
27 11/6/2016 2958/16 TN.SUPRIHADI 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
28 11/6/2016 2961/16 TN.MASDUKIN 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 11/6/2016 2964/16 NN.RIANA CITYA AGISTI 17TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
30 13/6/2016 4034/14 TN.ASNAWI 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
31 13/6/2016 2986/16 SDR.IRHAMUL ROIS 26TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
32 14/6/2016 456/10 NY.SUKARTI 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
33 14/6/2016 2995/16 TN.NGATENO 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
34 14/6/2016 1834/14 TN.MUNAWIR 71TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
35 15/6/2016 155/16 TN.FAUZAN 58TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 160000
36 16/6/2016 3026/16 NY.NAMIRAH 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
37 16/6/2016 2760/16 TN.YATIN 61TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 247500
38 17/6/2016 3041/16 TN.KUSNADI 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
39 17/6/2016 1320/15 NY.HJ.SUPIAH 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
40 17/6/2016 3041/16 TN.ABDUL HAMID 50TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 262500
41 18/6/2016 3053/16 AN.MOH.RAFI 4TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
42 18/6/2016 3048/16 TN.KUMAIDI 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
43 18/6/2016 988/15 AN.M.ARFA ALTAF 1,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 255000
44 20/6/2016 2190/12 TN.KOMARI 58TH LUMBAL AP/LAT dr.LIA dr.LISA 137000 23000 160000
45 20/6/2016 3066/16 NN.MALIKHATUN NISA 22TH THORAX PA dr.LIA dr.MICHEL 67500 20000 87500
46 20/6/2016 3077/16 SDR.M.KOIRUL EFENDI 18TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
47 20/6/2016 3557/15 AN.MOH.FAHMI FEBRIAN 3TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 75000 20000 95000 430000
48 21/6/2016 3092/16 NY.MASTINAH 61TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
49 21/6/2016 5870/15 AN.SUKMA ADITYA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 167500
50 23/6/2016 3124/16 NY.NGATISAH 70TH CRURIS AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 112500
51 24/6/2016 1290/06 NY.MEGA SETYAWATI 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
52 24/6/2016 871/16 SDR.AHMAD ABIDORI 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
53 25/6/2016 3142/16 TN.ABDUL WAHAB 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
54 27/6/2016 3154/16 NY.KARMI 58TH ABDOMEN AP dr.LIA dr.MICHEL 67500 20000 87500
55 27/6/2016 3155/16 TN.SUNARTO 42TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
56 27/6/2016 3165/16 SDR.MOH.ABDOLI 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
57 28/6/2016 3168/16 TN.MUHARI 76TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
58 28/6/2016 001/16 SDR.RIZAL BAIHAQI 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
59 29/6/2016 3184/16 NY.SRI DAIKAH 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
60 29/6/2016 007/16 NY.SUKARTI 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
61 29/6/2016 2680/16 NN.INTAN FATMAWATI 17TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
62 29/6/2016 3941/13 NY.MARDIYAH 43TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
63 29/6/2016 3192/16 NY.MASLAMAH 46TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
64 29/6/2016 3193/16 SDR.JOHARI 16TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 525000
65 30/6/2016 3148/14 TN.MADEKAN 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
TOTAL 5013500 1304000 7500 6325000

Mengetahui Welahan, 30 JUNI 2016

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : JULI 2016
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/7/2016 3222/16 SDR.LUKMAN HAKIM 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 1/7/2016 5676/15 NN.SHELLA DWI 16TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
3 2/7/2016 3235/16 NY.TURIPAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
4 4/7/2016 407/14 NY.SAUDAH 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
5 4/7/2016 5444/15 AN.ALVINA PUTRI ARUM 3,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
6 4/7/2016 3246/16 TN.AFIF RAHMAN 29TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 327500
7 5/7/2016 3271/16 SDR.MOH.ABDUS SALAM 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
8 5/7/2016 2692/16 TN.SULKAN 53TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
9 5/7/2016 3280/16 SDR.SAHLUT THORIQ 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
10 8/7/2016 3289/16 NY.SUMIRAH 50TH CRANIUM AP/LAT dr.ANE dr.LISA 115000 23000 138000
11 8/7/2016 3293/16 NY.SUMIYATI 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
12 8/7/2016 199/16 NY.WARSINI 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 313000
13 9/7/2016 2989/05 NY.DEWI SETYOWATI 46TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 9/7/2016 2129/16 TN.DAHLAN 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
15 11/7/2016 342/15 AN.USTIN EPIYANI 19BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
16 11/7/2016 3354/16 NY.MASROROTUN 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
17 11/7/2016 3359/16 NY.MUSRIKAH 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 255000
18 12/7/2016 2198/06 TN.AMAD 75TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
19 12/7/2016 3372/16 TN.H.SUYATIN 46TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
20 12/7/2016 3379/16 TN.SUPARMAN 66TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
21 12/7/2016 3381/16 TN.ALI MAHFUD 63TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 350000
22 13/7/2016 3390/16 NY.MUNZAROAH 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
23 13/7/2016 3401/16 TN.MASDI 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
24 13/7/2016 5382/14 TN.ABDUL AZIZ 34TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000 255000
25 14/7/2016 3413/16 TN.SHOHIBUN 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
26 14/7/2016 3414/16 TN.JUMBADI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
27 14/7/2016 4194/13 AN.HADRIYANSYAH 3TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
28 14/7/2016 3417/16 TN.SLAMET ARIFIN 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 14/7/2016 3427/16 TN.YUSMANTO 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 430000
30 15/7/2016 156/16 AN.MOH.SAPUTRA 7,6TH THORAX PA dr.JOHAN dr.LISA 60000 20000 80000
31 15/7/2016 3440/16 AN.ANNI TAHWIROTUL 12TH THORAX PA dr.JOHAN dr.LISA 67500 20000 87500
32 15/7/2016 3443/16 TN.SUPROTO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
33 15/7/2016 3445/16 TN.MUHAMAD 62TH WATER'S SPN dr.ANE dr.LISA 60000 20000 80000
34 15/7/2016 3450/16 SDR.MOH.SADULLAH 25TH ANKLE JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
35 15/7/2016 3452/16 NY.MARINEM 44TH MANUS AP/OBLIQUE dr.ANE dr.LISA 92500 7500 100000
36 15/7/2016 1271/16 NY.SATIR ROHMAH 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 635000
37 16/7/2016 3456/16 NY.SRI MURTINI 36TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
38 16/7/2016 3461/16 TN.MU'TASIM 28TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
39 16/7/2016 2693/11 TN.ADI SAPUTRA 34TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
40 16/7/2016 3465/16 TN.MISWADI 49TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 16/7/2016 294/16 SDR.SAMSUL MA'ARUF 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 16/7/2016 3387/13 NY.MARDIYAH 52TH HUMERUS AP/LAT dr.ANE dr.LISA 92500 20000 112500 550000
43 18/7/2016 4414/12 TN.YOHANES 48TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
44 18/7/2016 3387/16 NY.SITI HARTINI 56TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
45 18/7/2016 1663/16 TN.SUGIRAH 55TH ABDOMEN AP dr.JOHAN dr.MICHEL 67500 20000 87500
46 18/7/2016 1345/15 NY.EVA WIDIYANA 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
47 18/7/2016 3474/16 NY.RUMINAH 55TH THORAX PA dr.JOHAN dr.LISA 67500 20000 87500
48 18/7/2016 2681/11 NY.KARYATUN 41TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
49 18/7/2016 4041/15 AN.HABIBI LUTFI 1TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
50 18/7/2016 1031/12 SDR.MUSTOLIH FAIK 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 765000
51 19/7/2016 3498/16 AN.JUAN BAGUS 6BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
52 19/7/2016 3496/16 TN.MUSRANI 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
53 19/7/2016 3499/16 NY.JASMI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
54 19/7/2016 2295/16 NY.SUMASTRI 55TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000 335000
55 20/7/2016 3529/16 NY.ASMAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
56 20/7/2016 2884/12 NY.SWANI 66TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
57 20/7/2016 3528/16 TN.SUMARDI 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
58 20/7/2016 3392/16 NY.SUTRINI 39TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000 440000
59 21/7/2016 3546/16 NN.DUROTUN NASIKHAH 16TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
60 22/7/2016 3574/16 NY.MASTIANAH 43TH CRANIUM AP/LAT dr.ANE dr.MICHEL 115000 23000 138000
61 22/7/2016 4103/10 SDR.EDI SUTEJO 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 225500
62 23/7/2016 3586/16 SDR.CANDRA ADI PRASETYO 16TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
63 23/7/2016 711/09 NN.YUYUN NOVIANTI 26TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
64 23/7/2016 792/16 NY.SITI WELAS 49TH THORAX PA dr.IRWAN dr.MICHEL 67500 20000 87500
65 23/7/2016 3590/16 NY.SUPARTI 40TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
66 23/7/2016 2749/16 TN.SAJIDI 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 510000
67 25/7/2016 1689/14 NY.ASIYAH 80TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
68 25/7/2016 3607/16 NY.FATONAH 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
69 25/7/2016 1028/06 TN.MAHMUDI 55TH ABDOMEN AP dr.LIA dr.MICHEL 67500 20000 87500
70 25/7/2016 3603/16 YN.MOH.MUSA 29TH CRANIUM AP/LAT dr.ANE dr.LISA 115000 23000 138000
71 25/7/2016 3946/13 AN.FARZA NUR LAELA 4,6TH THORAX AP dr.LIA dr.LISA 60000 20000 80000
72 25/7/2016 3610/16 TN.SUMIJAN 47TH PELVIS AP dr.ANE dr.MICHEL 67500 20000 87500
73 25/7/2016 3488/16 TN.SUHARTO 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
74 25/7/2016 3553/16 TN.AMIR MAHMUD 32TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 888000
75 26/7/2016 3624/16 TN.SLAMET 61TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
76 27/7/2016 3639/16 NY.SHOLIHAH 51TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
77 27/7/2016 1450/16 NY.EFI RISTIANI 27TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
78 27/7/2016 3247/16 TN.BUKHARI 48TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
79 27/7/2016 4303/15 NY.SRI ZULANAH 52TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 375000
80 30/7/2016 2706/16 TN.PURSAID 32TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
81 30/7/2016 3567/06 TN.SUWARGI 50TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
82 30/7/2016 1876/06 NY.MUSRIPAH 75TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
83 30/7/2016 2709/16 NN.NUR WIDAYATI 16TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
84 30/7/2016 635/16 SDR.AGUS PRAYETNO 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
85 30/7/2016 3704/16 NY.SUMIYATI 62TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 550000
TOTAL 6364500 1707000 7500 8079000

Mengetahui Welahan, 30 JULI 2016

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan


(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)
LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : AGUSTUS 2016
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/8/2016 3707/16 TN.SAGE GUNAWAN 37TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
2 1/8/2016 3714/16 TN.SUNARTO 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
3 1/8/2016 3713/16 TN.MUHAIMIN 33TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
4 1/8/2016 3711/16 NY.SITI FATIMAH 70TH CLAVICULA AP dr.ANE dr.MICHEL 60000 20000 80000
5 1/8/2016 572/16 AN.SAYYIDIL ANAM 10TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000 495000
6 2/8/2016 3735/16 NY.MAIZAH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
7 2/8/2016 512/16 SDR.NUR AKIB 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
8 3/8/2016 3701/16 TN.MURTANDO 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
9 4/8/2016 3762/16 SDR.BAYU CANDRA 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
10 4/8/2016 3770/16 NY.RUKANI 80TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
11 5/8/2016 4426/09 TN.LEGIYO 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
12 6/8/2016 2586/15 TN.NAHROWI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
13 6/8/2016 1632/16 SDR.REKNO HANDAYANI 17TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 247500
14 8/8/2016 917/16 TN.MASKUN 62TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
15 8/8/2016 3813/16 TN.SUKAMTO 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
16 8/8/2016 3815/16 NY.MASRONAH 41TH THORAX PA dr.JOHAN dr.MICHEL 67500 20000 87500
17 8/8/2016 3822/16 TN.SUNARTO 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
18 8/8/2016 3828/16 NY.JUNNATUL WAFIROH 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
19 8/8/2016 1499/10 NN.ONANINGTYAS 11TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 525000
20 9/8/2016 1584/13 SDR.AGUNG ARIS 22TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
21 9/8/2016 1634/15 AN.KEYSA AULIA 8TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
22 9/8/2016 3836/16 TN.KARNO 62TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
23 9/8/2016 3844/16 TN.SOLIKIN 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
24 9/8/2016 3851/16 SDR.SYAIFUL MUADHOM 28TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 430000
25 10/8/2016 3855/16 NY.SUKINAH 48TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
26 10/8/2016 834/16 TN.ABDULLAH SYAFI'I 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
27 10/8/2016 3872/16 TN.SUWANTO 36TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
28 11/8/2016 3874/16 SDR.ENDRA SULISTYA 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 11/8/2016 4013/08 NY.SUKATI 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
30 11/8/2016 3891/16 NY.SITI SUSANTI 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
31 12/8/2016 3600/13 TN.ASRONI 49TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
32 13/8/2016 3916/16 TN.UTOMO 44TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 160000
33 15/8/2016 3720/16 NY.MASENI 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
34 15/8/2016 4183/14 TN.DJAMZURI 57TH ABDOMEN AP dr.JOHAN dr.LISA 67500 20000 87500
35 15/8/2016 441/07 TN.MUSTAKIM 60TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 335000
36 16/8/2016 3956/16 SDR.ROHMAT ABDUWAH 20TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
37 16/8/2016 3967/16 NY.SUKAMAH 77TH PELVIS AP dr.ANE dr.LISA 67500 20000 87500 247500
38 19/8/2016 1053/16 AN.REVALINA AZKIA 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
39 19/8/2016 3975/16 SDR.LAMIUN NAJI 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 167500
40 20/8/2016 4011/16 NY.JAMI'YATUL 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
41 22/8/2016 4019/16 NY.KAPSAH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 22/8/2016 4027/16 NY.ISTONAH 65TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
43 22/8/2016 4026/16 TN.RUDI HARTONO 42TH SHOULDER JOINT AP/LAT dr.KRISTIA dr.MICHEL 92500 20000 112500
44 22/8/2016 4025/16 TN.AHMAD KHALIMI 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
45 22/8/2016 1085/06 SDR.KHASAN MALIK 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
46 22/8/2016 4028/15 NY.ZAITUN 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
47 22/8/2016 4037/16 TN.ALI MASYHAR 40TH THORAX PA dr.ALI dr.MICHEL 67500 20000 87500
48 22/8/2016 2201/07 TN.SAYOGO 60TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 725000
49 23/8/2016 4042/16 AN.SA'DATUL MUYASAROH 12TH HUMERUS AP/LAT dr.ANE RUJUK 92500 7500 100000
50 23/8/2016 390/16 NY.ISTIAROH 42TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
51 23/8/2016 4028/16 AN.NOVA CALLISTA 12TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
52 23/8/2016 4010/14 AN.YULQI RISDA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
53 23/8/2016 318/13 NY.ILKHOMAH 51TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
54 23/8/2016 941/16 AN.SEPTIANA VIVID FITRIANI 7TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000 547500
55 24/8/2016 4057/16 TN.AHMAD AZKA 41TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 87500
56 25/8/2016 891/11 NY.SUMIATI 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
57 26/8/2016 2392/11 TN.BARNAWI 61TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 26/8/2016 3738/16 SDR.BUDI SANTOSO 26TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 200000
59 27/8/2016 4097/16 TN.ARIFIN 42TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
60 27/8/2016 4102/16 NY.MARMINAH 60TH LUMBAL AP/LAT BUDIYONO DR.LINA 137000 23000 160000
61 27/8/2016 4107/16 SDR.ASFAN 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 407500
62 31/8/2016 1173/16 NN.YENI WULANDARI 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
63 31/8/2016 406/16 AN.M.RAFA AKBAR 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
64 31/8/2016 4160/16 NN.SUSI 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
65 31/8/2016 4162/16 NY.JAMIATUN 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
66 31/8/2016 110/16 AN.TALITA NOR NABILA 1TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
67 31/8/2016 4167/16 TN.FATKHUL FATAH 35TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 510000
TOTAL 5049000 1341000 7500 6397500

Mengetahui Welahan, 31 AGUSTUS 2016

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : SEPTEMBER 2016
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/9/2016 3523/13 NY.I'IN NICO WIJAYANTI 28TH CRANIUM AP/LAT dr.ANE dr.MICHEL 115000 23000 138000
2 1/9/2016 3613/12 NY.TASRINAH 46TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
3 1/9/2016 3200/11 TN.SUWANTO 33TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
4 1/9/2016 3699/16 TN.SUBAKRI 32TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
5 1/9/2016 4174/16 NY.SRI UMAIYAH 43TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
6 1/9/2016 3222/04 NY.ATI 61TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 793000
7 2/9/2016 4083/16 NN.MUARIFAH 16TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
8 2/9/2016 4119/16 NY.NGATMI 53TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
9 2/9/2016 4196/16 SDR.ALI MUNDOFAR 27TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500
10 2/9/2016 3049/16 AN.MOH.NUR ROHMAN 6,6TH THORAX PA dr.ALI.M dr.LISA 60000 20000 80000 512500
11 3/9/2016 4211/16 NY.ARTINI 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
12 5/9/2016 4157/16 TN.MOH.MUNADI 34TH LUMBAL AP/LAT dr.JOHAN dr.LISA 137000 23000 160000
13 5/9/2016 1319/16 AN.MAHARDIKA SATRIA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
14 5/9/2016 4222/16 NY.PARISAH 70TH ABDOMEN AP dr.JOHAN dr.LISA 67500 20000 87500
15 5/9/2016 2445/13 SDR.KASEP MOH. IKSAN 14TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
16 5/9/2016 4039/16 TN.MOH.NUR FAIZ 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 502500
17 8/9/2016 368/15 TN.BUKARI 65TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 87500
18 9/9/2016 2048/07 NY.MUSLIMAH 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
19 9/9/2016 4270/16 TN.SUTRIMO 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
20 9/9/2016 692/16 AN.ADAM BAYU 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
21 9/9/2016 1311/16 NN.SITI MAIMUNAH 29TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
22 9/9/2016 4758/07 TN.SISWANTO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
23 9/9/2016 4334/16 NN.SITI ROVIANA 18TH MANUS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500 542500
24 10/9/2016 4862/16 AN.SASA MAESA 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 80000
25 15/9/2016 1739/16 AN.AHMAD MAULANA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
26 15/9/2016 4395/16 SDR.PRIYAH KOSRIYANTO 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
27 15/9/2016 1672/15 TN.SUDARSO 61TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
28 15/9/2016 4371/16 TN.MAULUDIN 34TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 15/9/2016 4379/16 NY.RITA RISTIANA 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
30 15/9/2016 4126/16 NY.ROHIMAH 38TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
31 15/9/2016 4398/16 SDR.FAHRI TIRTA AJI 18TH WRIST JOINT AP/LAT (2X) dr.ANE RUJUK 185000 7500 192500
32 15/9/2016 4403/16 TN.SUDIGJO 47TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
33 15/9/2016 4203/16 NY.MASLIKAH 66TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
34 15/9/2016 1231/16 AN.NAILA ADHILLA PUTRI 9,6TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
35 15/9/2016 4417/16 TN.SURYANTO 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 1342500
36 16/9/2016 3356/16 TN.KUSNAN 44TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
37 16/9/2016 3920/08 NY.SUKINAH 53TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
38 16/9/2016 4789/15 AN.AQILA KHUSNI ARSADA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
39 16/9/2016 4436/16 SDR.MOH.KHOIRONI 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 415000
40 17/9/2016 4444/16 TN.SUHARDI 45TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
41 17/9/2016 4446/16 AN.KAMILA HALWA FITRIANI 4TH THORAX AP dr.ANE dr.LINA 60000 20000 80000
42 17/9/2016 4455/16 TN.MUKHLISIN 40TH THORAX PA dr.ANE dr.LINA 67500 20000 87500 255000
43 19/9/2016 1670/16 TN.IKSAN 75TH THORAX PA dr.PATRICIA dr.MICHEL 67500 20000 87500
44 19/9/2017 4376/16 NY.HJ.ROKIMAH 61TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
45 19/9/2018 4338/16 TN.YUSUF EFENDI 36TH THORAX PA dr.PATRICIA dr.MICHEL 67500 20000 87500
46 19/9/2019 4260/16 NY.SANIRAH 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
47 19/9/2016 1653/16 AN.ATIKA YASMIN 3TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 575000
48 20/9/2016 3248/07 NN.LILIS HEPI PAMUNGKAS 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
49 20/9/2016 4491/16 NY.NGAIPAH 55TH THORAX PA dr.NAUFAL dr.MICHEL 67500 20000 87500
50 20/9/2016 4485/16 TN.KADIRNO 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
51 20/9/2016 4493/16 AN.ASMAUL HUSNA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
52 20/9/2016 3405/13 AN.MOH.ABDUWAH 4,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 422500
53 21/9/2016 4502/16 NY.MUNAZIROH 37TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
54 21/9/2016 2220/15 TN.HARYONO 63TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 247500
55 22/9/2016 4804/14 TN.HARNO 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
56 22/9/2016 4531/16 TN.ABDUL WAHIB 66TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
57 23/9/2016 809/13 TN.DARNO 59TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
58 23/9/2016 4545/16 NY.HJ.MUTMAINAH 56TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
59 23/9/2016 1451/06 TN.RUMANI 69TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
60 23/9/2016 4551/16 NY.SUTAMI 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
61 23/9/2016 4548/16 TN.SUWANDI 35TH ABDOMEN AP dr.JOHAN RUJUK 67500 7500 75000
62 23/9/2016 5105/15 NY.NUR YATI 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
63 23/9/2016 1598/16 AN.AHMAD ABDUL ROZAK 15BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
64 23/9/2016 4556/16 TN.MOHTAR 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 777500
65 24/9/2016 1046/15 AN.MOH.ALVIN 3TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 80000
66 26/9/2016 4578/16 TN.NOOR SALIM 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
67 26/9/2016 4580/16 NY.SOPIYAH 42TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
68 26/9/2016 4581/16 TN.JANURI 56TH THORAX PA dr.MARIA dr.LISA 67500 20000 87500
69 26/9/2016 2633/15 AN.PANCA 20BLN THORAX AP dr.MARIA dr.MICHEL 60000 20000 80000 415000
70 27/9/2016 4603/16 TN.MASHURI 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
71 28/9/2016 1056/16 AN.HASLA KHULUN 4TH THORAX AP dr.ANE dr.MICHEL 67500 20000 87500
72 28/9/2016 4490/16 TN.H.HUMAIDI 63TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
73 28/9/2016 4624/16 TN.SUKARSO 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
74 28/9/2016 1808/15 SDR.AKBAR PURWANTO 12TH WRIST JOINT AP/LAT dr.ANE RUJUK 92500 7500 100000 435000
75 29/9/2016 4207/08 TN.SULYONO 44TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
76 29/9/2016 4268/16 NY.RUKAYAH 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
77 29/9/2016 1724/15 NY.SUMIATI 62TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
78 29/9/2016 4420/10 SDR.FIRMAN PRAYOGO 12TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 495000
79 30/9/2016 4644/16 AN.AHMAD SUHARTO 8TH THORAX PA dr.LIA dr.MICHEL 60000 20000 80000
80 30/9/2016 4547/16 TN.TUMANI 51TH ABDOMEN AP dr.LIA dr.LISA 67500 20000 87500
81 30/9/2016 3591/16 NY.SITI NURUL HIDAYAH 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
82 30/9/2016 4654/16 AN.IFA RASIDAH 4TH THORAX AP dr.LIA dr.MICHEL 60000 20000 80000 335000
TOTAL 7000500 1640000 22500 8663000

Mengetahui Welahan, 30 SEPTEMBER 2016

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : OKTOBER 2016
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/10/2016 4662/16 SDR.SAIFUL NASIR 16TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
2 3/10/2016 2023/15 TN.SUTIKNO 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
3 3/10/2016 4668/16 TN.ZAINURI 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
4 3/10/2016 4464/16 TN.SUPARNO 65TH LUMBAL AP/LAT dr.LIA dr.MICHEL 137000 23000 160000
5 3/10/2016 4692/16 NN.DIAN SAFIRA 14TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 422500
6 4/10/2016 3918/14 NY.SITI HIDATUN 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
7 4/10/2016 3923/06 NY.SUHARSIH 46TH LUMBAL AP/LAT dr.ANE dr.LISA 67500 20000 87500
8 4/10/2016 1087/06 TN.ARIFIN 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 335000
9 5/10/2016 1864/11 NY.NURUL HIDAYAH 33TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
10 5/10/2016 4717/16 AN.MOH.BALYA AL AJAMY 5TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
11 5/10/2016 4143/16 NN.DWI SEPTIYANI PUTRI 21TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
12 5/10/2016 4722/16 TN.HARDOYO SUMBER 37TH THORAX PA dr.JAYA dr.LISA 67500 20000 87500
13 5/10/2016 3655/14 TN.SUYADI 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
14 5/10/2016 4723/16 TN.NUR HAMIM 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
15 5/10/2016 1858/14 TN.KARJUNI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
16 5/10/2016 1254/14 AN.LUTFIA ZAHRA 3,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 685000
17 7/10/2016 4751/16 TN.MASHADI 47TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
18 7/10/2016 4748/16 NY.SRI YATI 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
19 7/10/2016 817/16 AN.ARFA SURYA DINATA 15BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
20 7/10/2016 4704/16 TN.M.HARSONO 40TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
21 7/10/2016 4765/16 NN.KATUN 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 502500
22 10/10/2016 4784/16 SDR.MUNIF SIDIQ SETIAWAN 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
23 10/10/2016 4694/16 NY.SITI MUTOHAROH 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
24 11/10/2016 4813/16 TN.ASMUDI 53TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
25 11/10/2016 4697/16 NY.NGATIRAH 43TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 272500
26 12/10/2016 4821/16 TN.MIFTAHUL HUDA 40TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
27 12/10/2016 4829/16 SDR.FATKHUL AMIN 14TH PEDIS AP/OBLIQUE dr.ANE RUJUK 92500 7500 100000
28 12/10/2016 4830/16 NN.NUR ADLIMAH 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 12/10/2016 4836/16 TN.ALI KASMUDI 46TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 362500
30 13/10/2016 4858/16 AN.AHMAD ANIF MUZAKI 7TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
31 13/10/2016 4860/16 NY.WARTINI 57TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 167500
32 14/10/2016 1915/16 NY.MARKONAH 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
33 14/10/2016 1384/15 AN.MOH.KHOIRUL AZAM 4TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
34 14/10/2016 1456/09 TN.NGADERI 44TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 255000
35 15/10/2016 4888/16 TN.AMBAR RAHARJO 34TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
36 15/10/2016 4893/16 NY.ENDANG SISWATI 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
37 17/10/2016 4896/16 TN.SAWON 78TH THORAX PA dr.BILLIE dr.MICHEL 67500 20000 87500
38 17/10/2016 3946/16 AN.SATRIA RAFLI ALBANI 10TH THORAX PA dr.BILLIE dr.LISA 60000 20000 80000
39 17/10/2016 59/07 NY.MASRIPAH 51TH CRANIUM AP/LAT dr.BILLIE dr.MICHEL 115000 23000 138000 305500
40 18/10/2016 424/11 TN.SURATNO 49TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
41 20/10/2016 4952/16 SDR.ZAENAL ABIDIN 19TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
42 20/10/2016 4948/16 AN.AYU NINGRUM 16BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
43 20/10/2016 1117/12 NY.JUMINAH 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
44 20/10/2016 4497/08 NN.PUTRI AYU 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 415000
45 21/10/2016 4982/16 NY.SUMBER ISTIQOMAH 30TH THORAX PA dr.BILLIE dr.MICHEL 67500 20000 87500 87500
46 24/10/2016 4999/16 NY.KASRIPAH 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
47 24/10/2016 4504/16 SDR.MOH.AFWAN NOR 26TH GENUE AP dr.YOHARI dr.MICHEL 92500 20000 112500
48 24/10/2016 5381/13 NY.SAROH 52TH ANTEBRACHII AP/LAT dr.YOHARI RUJUK 92500 7500 100000
49 24/10/2016 4512/16 NY.SITI SULASMI 25TH THORAX PA dr.BILLIE dr.LISA 67500 20000 87500 460000
50 25/10/2016 4528/16 AN.AHSANA JAFAS ALHAKIM 7BLN THORAX AP dr.BILLIE dr.MICHEL 60000 20000 80000 80000
51 26/10/2016 5005/16 AN.SYIFA NAYLA 6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
52 26/10/2016 5006/16 NY.RUNTIYANI 44TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
53 26/10/2016 5094/13 NN.NOVI FITRIATUN 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
54 26/10/2016 4929/16 NY.MASNIAH 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
55 26/10/2016 5012/16 TN.JASERAN 58TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 502500
56 27/10/2016 5029/16 NY.MUTMAINNAH 49TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
57 28/10/2016 5039/16 TN.ANWARUDDIN 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 28/10/2016 5047/16 TN.KASNARI 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
59 28/10/2016 1781/16 AN.AHMAD EMIR 6,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
60 28/10/2016 607/08 NY.SUCI LESTARI 30TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
61 28/10/2016 1550/07 AN.AGUNG WIRAYANTO 10TH ABDOMEN AP dr.ANE dr.LISA 60000 20000 80000
62 28/10/2016 2972/15 NY.SUPA'AH 40TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 632500
63 29/10/2016 5060/16 TN.SAEFUDIN ASHAR 26TH CRANIUM AP/LAT dr.ANE dr.LINA 115000 23000 138000
64 29/10/2016 2153/16 TN.ASNAWI 60TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 298000
65 31/10/2016 5083/16 SDR.TABAH 25TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
66 31/10/2016 3449/05 NY.MARSINAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
67 31/10/2016 5086/16 NY.SUMINAH 90TH THORAX AP dr.ANE dr.MICHEL 67500 20000 87500
68 31/10/2016 4503/16 TN.MUSLIMAN 44TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
69 31/10/2016 4480/16 NY.MASEMI 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
70 31/10/2016 5097/16 AN.AURA DWI FEBRIANTI 6TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 75000 20000 95000
71 31/10/2016 2578/16 AN.EDI SAPUTRO 10,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 685000
TOTAL 5650000 1416000 15000 7081000

Mengetahui Welahan, 31 OKTOBER 2016

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : NOVEMBER 2016
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/11/2016 4894/16 SDR.HERU CAHYO UTOMO 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 1/11/2016 2393/16 TN.KARMAIN 62TH WATERS SPN dr.ANE dr.MICHEL 60000 20000 80000
3 1/11/2016 3198/16 TN.SUPARDI 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 255000
4 2/11/2016 5280/14 TN.SOLIKIN 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
5 2/11/2016 5037/16 TN.SUMARTO 62TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
6 2/11/2016 4931/16 NY.RUBIAH 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
7 2/11/2016 4764/15 TN.KASPAN 66TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 2/11/2016 691/15 NY.DARSIH 61TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 582500
9 5/11/2016 5168/16 SDR.AZIM MAULANA 13TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
10 5/11/2016 1820/14 NY.SUKARMI 50TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
11 5/11/2016 4946/16 TN.MAHMUDI 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 407500
12 7/11/2016 5183/16 YN.ROSYHADI 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
13 7/11/2016 3636/04 NY.EFI 58TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 247500
14 8/11/2016 5210/16 SDR.AHMAD QORIB 25TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 160000
15 9/11/2016 5221/16 TN.SUPRAPTO 49TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
16 9/11/2016 3159/16 NY.KUSRIYAH 49TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
17 9/11/2016 5230/16 NY.ZULIKAH 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
18 9/11/2016 3773/15 NN.RAHMA AZIZATUL 11TH THORAX PA dr.ABDUL dr.LISA 67500 20000 87500
19 9/11/2016 1440/14 TN.M.SOFA MARWANI 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
20 9/11/2016 5233/16 TN.SHOLIKUL HADI 38TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 525000
21 10/11/2016 4943/16 NY.HJ.SITI FATIMAH 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
22 10/11/2016 2455/16 AN.AINI 3TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
23 10/11/2016 5238/16 NY.FAIZAH 62TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
24 10/11/2016 2505/16 AN.SIHAB ADI SAPUTRO 9,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
25 10/11/2016 1970/05 NY.ISMIYATI FATIMAH 38TH LUMBAL AP/LAT BUDIYONO dr.MICHEL 137000 23000 160000
26 10/11/2016 5242/16 NY.ISMIATUL KIBTIYAH 28TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 655000
27 11/11/2016 5258/16 NY.SUHARTINI 54TH THORAX PA dr.JOHAN dr.MICHEL 67500 20000 87500
28 11/11/2016 5253/16 TN.MUKHORI 53TH GENUE AP/LAT dr.JOHAN dr.MICHEL 92500 20000 112500
29 11/11/2016 1228/16 AN.AHMAD FARIS 6,6TH THORAX PA dr.JOHAN dr.LISA 60000 20000 80000 280000
30 14/11/2016 5268/16 AN.HAMZAH WIDIANTORO 7BLN THORAX AP dr.DINA dr.MICHEL 60000 20000 80000
31 14/11/2016 5284/16 AN.NAURA ZAFARANI 10BLN THORAX AP dr.DINA dr.LISA 60000 20000 80000
32 14/11/2016 5289/16 AN.DINTA FIDI INDRIYANI 9BLN THORAX AP dr.DINA dr.MICHEL 60000 20000 80000
33 14/11/2016 5775/13 TN.RUKHANI 45TH GENUE AP/LAT dr.DINA dr.LISA 92500 20000 112500
34 14/11/2016 5291/16 TN.KASPAN 66TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
35 14/11/2016 4589/16 AN.NATASYA AULIA PUTRI 1TH THORAX AP dr.DINA dr.LISA 60000 20000 80000
36 14/11/2016 5225/16 SDR.ANDI BACHTIAR 23TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
37 14/11/2016 3309/15 NY.ASRIYAH 34TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
38 14/11/2016 5297/16 NY.IDA ROKHAYATI 32TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
39 14/11/2016 5303/16 AN.ULUMUL KHASAN 10TH THORAX PA dr.JOHAN dr.LISA 60000 20000 80000
40 14/11/2016 4089/12 NN.I'IN DAMAYANTI 17TH ABDOMEN AP dr.JOHAN dr.MICHEL 67500 20000 87500 950000
41 15/11/2016 189/13 NN.ERINA 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 15/11/2016 5311/16 NN.WINDA WIDIYASTUTI 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
43 15/11/2016 1711/06 NY.RUKAYAH 60TH THORAX PA dr.ANE RUJUK 67500 7500 75000
44 15/11/2016 5314/16 NY.SOFIAH 41TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 362500
45 16/11/2016 5316/16 SDR.ALI YUSUF ISMAIL 13TH ANTEBRACHII AP/LAT dr.ANE RUJUK 92500 7500 100000
46 16/11/2016 3860/14 NY.SUMIATI 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
47 16/11/2016 4423/08 NY.SUHARTI 49TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
48 16/11/2016 2876/16 NY.KARMINI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
49 16/11/2016 1580/14 TN.SUMARDI 62TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
50 16/11/2016 4097/12 TN.KARNO 70TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 537500
51 18/11/2016 5352/16 NY.MARSANAH 55TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
52 18/11/2016 2571/16 AN.PUTRI AYU NINGSIH 7,6TH THORAX PA dr.LIA dr.LISA 60000 20000 80000
53 18/11/2016 5346/16 TN.ALI BUSONO 24TH GENUE AP/LAT dr.LIA dr.LINA 92500 20000 112500
54 18/11/2016 5351/16 NY.KASMURAH 40TH THORAX PA dr.LIA dr.LISA 67500 20000 87500
55 18/11/2016 5262/14 NY.RATMI'AH 40TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
56 18/11/2016 1590/12 TN.SUKADI 61TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 615000
57 19/11/2016 3031/14 NY.KHOIRIYAH 72TH THORAX PA dr.ANE dr.LINA 67500 20000 87500
58 19/11/2016 5368/16 AN.MOH.ARDAN PRASETYO 1TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 167500
59 21/11/2016 4510/14 TN.MUKANDAR 48TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
60 21/11/2016 1656/11 TN.H.SUPARNO 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
61 21/11/2016 5398/16 TN.YAKUB 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
62 21/11/2016 5387/16 TN.H.SURIP 58TH LUMBAL AP/LAT dr.BILLIE dr.MICHEL 137000 23000 160000
63 21/11/2016 5402/16 TN.SUGIRI 36TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 510000
64 22/11/2016 5412/16 TN.KHOIRUL UMAM 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
65 22/11/2016 5415/16 NY.KAMISAH 60TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
66 22/11/2016 2657/16 NY.MANDEK FITROTUN 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
67 22/11/2016 967/10 NY.MUSROCHAH 62TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
68 22/11/2016 2203/08 TN.SUWARNO 58TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 510000
69 23/11/2016 4610/14 NY.SUTIANAH 62TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
70 23/11/2016 5426/16 TN.NGARDI 72TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
71 23/11/2016 2303/15 AN.ARSAKHA JONEA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
72 23/11/2016 5435/16 NY.NGATMIYANTO 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
73 23/11/2016 4177/15 TN.BAHRAN 81TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
74 23/11/2016 2124/13 SDR.MOH.NUR KHOLIK 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 662500
75 24/11/2016 4411/16 AN.RENDI HAFIS IRAWAN 7BLN THORAX AP dr.ABDUL dr.MICHEL 60000 20000 80000
76 24/11/2016 1666/10 NY.WAHYUNI 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
77 24/11/2016 5461/16 AN.MOH.FAHRI ILYAS RAHREZA 5TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 320000
78 25/11/2016 5338/16 NY.MUKIJAH 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
79 25/11/2016 5469/16 NN.SITI DEWI LAILATUL 19TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
80 25/11/2016 3934/16 TN.MANSUR 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
81 25/11/2016 2603/16 AN.AKHMAD FAHMI 19BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 487500
82 28/11/2016 5486/16 NY.NANING FITRIA RINI 23TH CRURIS AP/LAT dr.DINA dr.MICHEL 92500 20000 112500
83 28/11/2016 5490/16 NY.MARIYATUL HASANAH 24TH LUMBAL AP/LAT dr.DINA dr.LISA 137000 23000 160000
84 28/11/2016 5256/16 NY.SUDARNI 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
85 28/11/2016 3079/16 TN.HARNO 68TH THORAX PA dr.DINA dr.MICHEL 67500 20000 87500
86 28/11/2016 811/16 AN.SANDI AZKA 15BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
87 28/11/2016 5500/16 AN.HAURA NAZHIFA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
88 28/11/2016 5505/16 NY.BUNISIH 70TH PELVIS AP dr.ANE dr.LISA 67500 20000 87500 695000
89 29/11/2016 1876/15 AN.AMIRATUL HUSNA 5TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
90 29/11/2016 5514/16 AN.MOH.ZIKRI SAPUTRO 6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 160000
91 30/11/2016 5532/16 TN.SUPRAPTO 35TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 87500
TOTAL 7331500 1831000 15000 9177500
Mengetahui Welahan, 30 NOVEMBER 2016

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : DESEMBER 2016
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/12/2016 2778/16 AN.DAFA ARAFIF 17BLN dr.PSTRICIA dr.MICHEL 60000 20000 80000
2 2/12/2016 3291/05 NY.ZUBAIDATUN 34TH GENUE AP/LAT dr.PSTRICIA dr.MICHEL 92500 20000 112500
3 2/12/2016 5563/16 TN.IRSYAD 45TH GENUE AP/LAT BUDIYONO dr.LISA 92500 20000 112500
4 2/12/2016 5567/16 SDR.ZAMHURI MAKNAWI 13TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
5 2/12/2016 3770/16 NY.RUKANI 80TH HUMERUS AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 505000
6 5/12/2016 5572/16 TN.KUWADI 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
7 5/12/2016 1759/15 NN.AMALIA SOFIANA 20TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
8 5/12/2016 574/12 NY.MASKIN 58TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
9 5/12/2016 5591/16 NY.SRI KANAH 48TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 495000
10 6/12/2016 2344/16 AN.MOH.NOVAL ALBAR 17BLN dr.ANE dr.LISA 60000 20000 80000
11 6/12/2016 3142/14 TN.KASBI 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
12 6/12/2016 5606/16 SDR.TAUFIK ISMAIL 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 255000
13 8/12/2016 4213/16 NY.MARKHAMAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 8/12/2016 2526/16 AN.ADZKIYA HANINDIRA 5TH PELVIS AP dr.ANE dr.MICHEL 60000 20000 80000
15 8/12/2016 5635/16 NN.ROFIQOH 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 255000
16 9/12/2016 5641/16 SDR.IMAM MAHFUD 22TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
17 9/12/2016 5640/16 NY.MUSTA'ADAH 30TH ELBOW JOINT AP/LAT dr.DIAN.N RUJUK 92500 7500 100000
18 9/12/2016 5644/16 TN.ABDUL ROUF 44TH MANUS AP/OBLIQUE dr.DIAN.N dr.LISA 92500 20000 112500
19 9/12/2016 3564/15 NY.KUSNAH 66TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 9/12/2016 866/07 TN.SUPARDI SUDARMAN 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
21 9/12/2016 1414/11 TN.AHMAD 66TH ABDOMEN AP dr.DIAN.N dr.LISA 67500 20000 87500
22 9/12/2016 5648/16 TN.SUKARI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
23 9/12/2016 5646/16 TN.TARMUJI 55TH ABDOMEN AP dr.DIAN.N dr.LISA 67500 20000 87500
24 9/12/2016 5649/16 TN.RUSYANTO 52TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
25 9/12/2016 5655/16 NY.ZARODAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
26 9/12/2016 5657/16 AN.FRISKA NABILA 5TH ELBOW JOINT AP/LAT dr.ANE RUJUK 92500 7500 100000 1085000
27 10/12/2016 3121/15 TN.ASHADI 76TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 160000
28 14/12/2016 5541/16 NY.SULASTRI 47TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
29 14/12/2016 5692/16 NY.SITI ZUMAIKAH 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
30 14/12/2016 3142/16 TN.ABDUL WAHAB 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
31 14/12/2016 5693/16 NY.VIKTORIA SAIFIR RIZKI 31TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
32 14/12/2016 5682/16 NY.FIKA HULIYATU DURRI 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
33 14/12/2016 4368/16 NY.SUDARTI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
34 14/12/2016 5705/16 TN.ABDUL GOFUR 32TH ANTEBRACHII AP/LAT dr.ANE RUJUK 92500 7500 100000
35 14/12/2016 1238/13 NY.TITIK MASITAH 58TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
36 14/12/2016 5713/16 TN.SAYONO 45TH THORAX PA dr.HARIYONO RUJUK 67500 7500 75000 932500
37 15/12/2016 5720/16 TN.MASHUR 41TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
38 15/12/2016 5722/16 NY.MASTOPAH 41TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
39 15/12/2016 5715/16 TN.NUR SALIM 65TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
40 15/12/2016 5481/16 TN.SISWANTO 42TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
41 15/12/2016 3821/12 AN.AHMAD ARYA FRANANDA 7,6TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
42 15/12/2016 5732/16 NN.SYARIFATUL FITRIYAH 17TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 662500
43 16/12/2016 1215/10 TN.SLAMET 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
44 16/12/2016 2945/16 NY.SUNIPAH 37TH THORAX PA dr.JOHAN dr.LISA 67500 20000 87500
45 16/12/2016 5749/16 NY.YASINTA 44TH THORAX PA dr.ANE RUJUK 67500 7500 75000
46 16/12/2016 734/06 NY.FANI 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
47 16/12/2016 5753/16 NY.SUPARSIH 55TH ANTEBRACHII AP/LAT dr.ANE RUJUK 92500 7500 100000
48 16/12/2016 5754/16 NY.BASIROH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 525000
49 21/12/2016 4508/16 TN.TUMIJAN 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
50 21/12/2016 5822/16 TN.SUCHAIMI 59TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
51 21/12/2016 5620/16 TN.RIYANTO 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
52 21/12/2016 3026/16 NY.NAMIRAH 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 350000
53 22/12/2016 2924/16 TN.SUNADI 77TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
54 22/12/2016 5577/16 NY.SUPIYAT 70TH PELVIS AP dr.ANE dr.MICHEL 67500 20000 87500
55 22/12/2016 5844/16 TN.MUJI 57TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
56 22/12/2016 5845/16 SDR.SYAHWAL FAJAR 20TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500 375000
57 23/12/2016 5873/16 TN.SOLEH 42TH PEDIS AP/OBLIQUE dr.HERDARU RUJUK 92500 7500 100000
58 23/12/2016 5889/16 TN.ASMUDI 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 187500
59 28/12/2016 5919/16 NY.KUSTINI 62TH THORAX PA dr.JOHAN dr.LISA 67500 20000 87500
60 28/12/2016 3820/15 NY.ISWATUN HASANAH 30TH THORAX PA dr.JOHAN dr.MICHEL 67500 20000 87500
61 28/12/2016 5891/16 AN.ALIF RIZKI AULIA 5TH ANTEBRACHII AP/LAT dr.JOHAN dr.MICHEL 75000 20000 95000 270000
62 29/12/2016 5935/16 TN.SUTRISNO 32TH THORAX PA dr.JOHAN dr.MICHEL 67500 20000 87500
63 29/12/2016 5831/16 NY.PERET 43TH LUMBAL AP/LAT dr.JOHAN dr.LISA 137000 23000 160000 247500
64 31/12/2016 1186/15 TN.SURONO 61TH ABDOMEN AP dr.HERDARU dr.MICHEL 67500 20000 87500
65 31/12/2016 2714/14 NY.KHORIYAH 32TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
66 31/12/2016 5964/16 NY.MUNIJAH 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 335000
TOTAL 5377500 1210000 52500 6640000

Mengetahui Welahan, 30 DESEMBER 2016

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : JANUARI 2017
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/1/2017 003/17 NY.SOLIANAH 39TH THORAX PA dr.ANE RUJUK 67500 7500 75000
2 2/1/2017 5929/16 TN.JUMAILI 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
3 2/1/2017 006/17 AN.NAYARA ASYIFA 4TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
4 2/1/2017 4424/10 NY.SITI WAFIROH 51TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 330000
5 3/1/2017 22/17 NY.SUPARTI 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
6 3/1/2017 4194/13 AN.HADRIYANSYAH PRATAMA 3,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
7 3/1/2017 30/17 SDR.ABDUL ROZAK 17TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
8 3/1/2017 2709/05 NY.YUSRINA 47TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 480000
9 4/1/2017 54/17 TN.ABDUL GHOFUR 31TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
10 4/1/2017 4056/07 SDR.EKO YULIANTO 23TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
11 4/1/2017 1323/15 SDR.MUHAMAD ROZI 29TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
12 4/1/2017 60/17 TN.ABDUL ROSYID 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 350000
13 5/1/2017 3327/16 TN.AHMAD MUKLIS 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
14 5/1/2017 1252/10 AN.RIFA DWI FANTRI 7TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 167500
15 6/1/2017 5846/16 NY.MASIYATI 52TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
16 6/1/2017 83/17 SDR.PURNOMO 26TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
17 6/1/2017 881/14 NY.ISTIANAH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
18 6/1/2017 85/17 NY.WAGINI 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
19 6/1/2017 4041/15 AN.HABIBI LUTFI 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 527500
20 7/1/2017 3417/16 TN.SLAMET ARIFIN 31TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
21 9/1/2017 103/17 TN.SURATNO 67TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
22 9/1/2017 182/15 TN.BISRI 36TH MANUS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500
23 9/1/2017 128/17 SDR.KHAMIM NUR 14TH ANTEBRACHII AP/LAT dr.ANE RUJUK 75000 7500 82500 282500
24 10/1/2017 541/08 TN.SARLAN 75TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
25 10/1/2017 139/17 TN.SONI IKHWAN 28TH ANKLE JOINT AP/LAT dr.ANE RUJUK 92500 7500 100000
26 10/1/2017 143/17 TN.JUMARLAN 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 275000
27 11/1/2017 148/17 TN.SUMIJO 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
28 11/1/2017 147/17 NY.RASMINAH 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 11/1/2017 149/17 AN.MOH.ZAKY AZZAHWA 8TH PELVIS AP dr.ANE dr.MICHEL 60000 20000 80000
30 11/1/2017 4872/13 TN.ABDUL KHALIM 42TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
31 11/1/2017 2160/15 NY.SUGIARTI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 430000
32 12/1/2017 165/17 NN.DESI DEVIANA SARI 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
33 12/1/2017 169/17 SDR.AHMAD ZAMAH SYARI 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
34 13/1/2017 195/17 NY.KOMSIAH 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
35 14/1/2017 145/17 TN.AHMAD SEGER 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
36 14/1/2017 193/17 TN.BUNTANI 68TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
37 16/1/2017 476/16 AN.SYAFA'ATIN NISA 2TH THORAX AP dr.CH KARTIKA dr.LISA 60000 20000 80000 80000
38 17/1/2017 1177/13 AN.GAFRILA SAMANA AHMAD 12TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
39 17/1/2017 263/17 SDR.AHMAD NAIM 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 167500
40 18/1/2017 276/17 NN.DEWI FAJRIATUN NIA 17TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
41 18/1/2017 275/17 SDR.MIFTAKHUL ULUM 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 18/1/2017 1880/06 NY.RUBIANAH 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
43 19/1/2017 1073/09 NY.NURUL KOMARIYAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 19/1/2017 294/17 TN.SARONI 30TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
45 19/1/2017 1508/08 NY.SUMI'AH 75TH CRURIS AP/KLAT dr.ANE RUJUK 92500 7500 100000 267500
46 20/1/2017 4883/09 NY.MASLIKAH 51TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
47 20/1/2017 309/17 SDR.ILHAM FATUR ALVIAN 15TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
48 20/1/2017 312/17 TN.USWANTO 38TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
49 20/1/2017 2354/05 TN.ALI SADIKIN 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 350000
50 21/1/2017 1450/16 NY.EFI RISTIANA 28TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
51 23/1/2017 340/17 AN.KOIRUL WAFA 3TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
52 23/1/2017 338/17 SDR.MAULANA IKBAL 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 167500
53 25/1/2017 372/17 NY.MUKANAH 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
54 25/1/2017 377/17 TN.SUDARTO 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
55 25/1/2017 3714/16 TN.SUNARTO 59TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
56 25/1/2017 389/17 TN.AHMADI 64TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
57 25/1/2017 2780/16 TN.SAIFUL AMRI 29TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
58 25/1/2017 393/17 TN.AWAL NIZAM 40TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
59 25/1/2017 396/17 SDR.AHMAD SAFIK 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 685000
60 26/1/2017 314/17 TN.MULAZIM 53TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
61 26/1/2017 5339/16 TN.SUMARDI 52TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
62 26/1/2017 4662/16 SDR.SAIFUL NASIR 16TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
63 26/1/2017 411/17 NN.YUICE KUMALASARI 14TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
64 26/1/2017 431/17 TN.ROHMADI 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 510000
65 27/1/2017 1455/14 SDR.FATEKHUR ROHMAN 15TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
66 27/1/2017 433/17 NY.SRI MULYATI 65TH ELBOW JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 200000
67 30/1/2017 434/17 TN.HARTIKAN 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
68 30/1/2017 445/17 NY.SINAH 53TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
69 30/1/2017 449/17 NY.NASIPAH 54TH THORAX PA dr.LIA dr.MICHEL 67500 20000 87500
70 30/1/2017 452/17 TN.KHANDIK 31TH THORAX PA dr.LIA dr.LISA 67500 20000 87500 422500
71 31/1/2017 482/17 TN.ZARKONI 34TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
TOTAL 5267000 1358000 30000 6655000

Mengetahui Welahan, 31 JANUARI 2017

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : FEBRUARI 2017
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/2/2017 1657/07 NY.MASFUFAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
2 2/2/2017 510/17 NY.SITI LEGINAH 48TH CRANIUM AP/LAT dr.ANE dr.MICHEL 115000 23000 138000 138000
3 3/2/2017 5864/15 NY.UMI LATIFAH 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 3/2/2017 532/17 NN.ANIS FITRIYANI 14TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
5 3/2/2017 3874/16 SDR.ENDRA SULISTIYA 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 3/2/2017 529/17 TN.SADERI 64TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
7 3/2/2017 2596/15 NY.SUNTIATI 43TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 535000
8 6/2/2017 2624/15 AN.IFSYA YADINA PUTRI 5,6TH THORAX AP dr.DINA dr.LISA 60000 20000 80000
9 6/2/2017 568/17 SDR.SALAM TAUFIQ 19TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
10 6/2/2017 571/17 TN.LEGIMAN 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
11 6/2/2017 472/17 NY.SUWARTI 54TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
12 6/2/2017 493/15 NY.MASMIATUN 28TH THORAX PA dr.DINA dr.LISA 67500 20000 87500
13 6/2/2017 3482/15 NY.SUWARTI 46TH SHOULDER JOINT AP/LAT dr.DINA dr.MICHEL 92500 20000 112500
14 6/2/2017 3661/16 AN.M.RASYA 10BLN THORAX AP dr.DINA dr.LISA 60000 20000 80000
15 6/2/2017 4088/03 SDR.DINO 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 775000
16 16/2/2017 726/17 TN.SALWAN 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
17 16/2/2017 2424/16 NY.ELLA FERIYANI 21TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
18 16/2/2017 743/17 NY.RUBIAH 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
19 17/2/2017 745/17 NY.PUJI LESTARI 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 17/2/2017 748/17 TN.MUHLIS 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
21 17/2/2017 4010/14 AN.YULQI RISDA 3TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
22 17/2/2017 769/17 TN.SUKIMAN 62TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
23 17/2/2017 771/17 TN.ADI MOH.FAIZIN 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
24 17/2/2017 4216/15 TN.SUKANDAR 51TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 590000
25 18/2/2017 774/17 NN.MUSTAZIUN 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
26 18/2/2017 352/17 TN.DARMO 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
27 18/2/2017 5396/16 TN.MASKANAN 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
28 18/2/2017 705/17 TN.MASDURI 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 350000
29 20/2/2017 793/17 TN.MASYHUDI 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
30 20/2/2017 795/17 NY.SUPIATI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
31 20/2/2017 1292/14 NY.NGATMINAH 60TH THORAX AP dr.ANE dr.MICHEL 67500 20000 87500
32 20/2/2017 809/17 TN.MUNAWAR 57TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 350000
33 22/2/2017 4295/16 NY.KHAMIDAH 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
34 23/2/2017 1840/15 NY.KASTIPAH 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
35 23/2/2017 4107/16 TN.ASFAN 27TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
36 23/2/2017 4293/15 TN.AGUS PAWOKO 45TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
37 23/2/2017 1117/12 NY.JUMINAH 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 375000
38 24/2/2017 871/17 TN.JASMAN 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
39 24/2/2017 874/17 TN.AGUS SANTOSO 34TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 175000
40 25/2/2017 881/17 NY.SAJIAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 25/2/2017 762/17 TN.MOH.FATKHURROZIN 30TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 247500
42 27/2/2017 890/17 TN.SAGIMAN 60TH THORAX PA dr.HERDARU dr.LISA 67500 20000 87500
43 27/2/2017 457/17 NY.ASMIAH 71TH THORAX PA dr.HERDARU dr.MICHEL 67500 20000 87500 175000
44 28/2/2017 916/17 NY.KASTIPAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
45 28/2/2017 2152/05 NY.SATI 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
46 28/2/2017 2109/15 AN.MAULANA ABDAN 5,6TH THORAX AP dr.MUNARTO dr.MICHEL 60000 20000 80000 255000
TOTAL 3468000 935000 4403000

Mengetahui Welahan, 28 FEBRUARI 2017

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : MARET 2017
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/3/2017 923/17 TN.NUR HADI 49TH ABDOMEN 2 POSISI dr.ANE dr.MICHEL 137000 23000 160000
2 1/3/2017 943/14 SDR.MOH.JEVI FELANI 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 247500
3 2/3/2017 4152/11 TN.TUKUL 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
4 2/3/2017 947/17 TN.NARMAN 80TH THORAX AP dr.ANE dr.LISA 67500 20000 87500
5 2/3/2017 951/17 NY.NANIK YUMIATUN 27TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
6 2/3/2017 3671/16 TN.SUMARI 51TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
7 2/3/2017 1019/10 AN.NOVA AURILIA 8TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
8 2/3/2017 955/17 TN.ABDUL SYUKUR 33TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 517500
9 3/3/2017 960/17 TN.SUTOMO 61TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
10 3/3/2017 963/17 TN.TEMON 42TH THORAX PA dr.PATRICIA dr.LISA 67500 20000 87500
11 3/3/2017 4346/16 NY.SUPARTINI 44TH CRURIS AP/LAT dr.PATRICIA dr.MICHEL 92500 20000 112500
12 3/3/2017 973/17 NY.DEWI JUMAIYAH 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
13 3/3/2017 2365/11 NY.HJ.RUKIYAH 57TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
14 3/3/2017 978/17 NY.SUKARTI 85TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 622500
15 4/3/2017 5299/15 NN.NOOR FITRIANA 18TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
16 4/3/2017 981/17 NY.SITI HABSAH 34TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
17 4/3/2017 984/17 NN.NARIA ULFAH 20TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 335000
18 6/3/2017 1636/15 NY.MASITAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
19 6/3/2017 1532/14 AN.ILYAS MAULANA ZIKRI 10TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000 167500
20 7/3/2017 1016/17 TN.MUKHOROBIN 32TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
21 7/3/2017 991/17 TN.SAHIR 59TH THORAX PA dr.HERDARU dr.MICHEL 67500 20000 87500
22 7/3/2017 5132/13 NY.SAWET 59TH THORAX PA dr.HERDARU dr.LISA 67500 20000 87500
23 7/3/2017 767/12 NY.SUWARTI 50TH MANUS AP/OBLIQUE dr.WIEDA RUJUK 92500 7500 100000 362500
24 8/3/2017 3843/12 TN.AMENAN IBROHIM 59TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
25 8/3/2017 1038/17 NY.SITI MAHMUDAH 48TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
26 8/3/2017 1042/17 TN.ASMIAN 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 335000
27 9/3/2017 900/17 NN.ZUNIATUN 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
28 9/3/2017 175/17 TN.BAKURI 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 9/3/2017 1051/17 AN.MOH.RAFADHAN ATALAH 1TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
30 9/3/2017 1064/17 NY.SUNARKIM 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
31 9/3/2017 4379/16 NY.RITA RISTIANA 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 430000
32 10/3/2017 989/17 NY.MUSTAADAH 53TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 160000
33 13/3/2017 92/17 TN.ANWAR 47TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
34 13/3/2017 4787/14 TN.KASINU 75TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
35 13/3/2017 4493/16 AN.ASMAUL HUSNA NOVI 2,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 255000
36 14/3/2017 1709/12 SDR.ABDUL MUNTOLIB 21TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
37 14/3/2017 961/17 NY.NGASTRI 51TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
38 14/3/2017 1126/17 AN.MOH.ZIDAN ALFARIZI 14BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
39 14/3/2017 1132/17 TN.SLAMET RIYONO 47TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
40 14/3/2017 1133/17 NN.NATASYA FATIMATUZ 17TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 14/3/2017 111/17 NY.IPTIKOYAH 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 582500
42 16/3/2017 1153/17 NY.SUYATMI 49TH THORAX PA dr.WIEDA dr.LISA 67500 20000 87500
43 16/3/2017 1825/16 NY.SULIPAH 43TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 247500
44 17/3/2017 1152/17 AN.MOH.RIZKI PRATAMA 5TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
45 17/3/2017 767/17 TN.SULARNO 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
46 17/3/2017 1187/17 TN.SAIKUL MUNIB 32TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
47 17/3/2017 1152/08 NY.SITI MAHMUDAH 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
48 17/3/2017 1906/06 AN.DELA SUKESI 11TH ELBOW JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
49 17/3/2017 1195/17 NY.MUNTIANI 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 615000
50 18/3/2017 1209/17 TN.MURDIANTO 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
51 20/3/2017 1220/17 SDR.MUSLIKIN 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
52 20/3/2017 2438/06 NY.ROIKHATUN 31TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
53 20/3/2017 1233/17 NN.IMEL 14TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500 360000
54 21/3/2017 1243/17 TN.H.NUR SAMAD 75TH SHOULDER JOINT 2PSS dr.ANE dr.MICHEL 92500 20000 112500 112500
55 22/3/2017 891/11 NY.SUMIATI 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
56 22/3/2017 1726/16 NN.ERMATIS SA'DIYAH 17TH ELBOW JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 272500
57 23/3/2017 1277/17 AN.PUTRI NISWATUL LUTFIAH 20BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
58 23/3/2017 1279/17 NY.QURROTU AYNI 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
59 23/3/2017 1163/17 SDR.MOH.AYUB PUTRA 22TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 255000
60 23/3/2017 1294/17 TN.HARIYANTO 55TH THORAX PA dr.VICKY dr.LISA 67500 20000 87500
61 23/3/2017 4654/16 AN.IFA RASIDAH 5TH THORAX AP dr.VICKY dr.MICHEL 60000 20000 80000
62 23/3/2017 1296/17 AN.ULAM ANAFIS 11TH THORAX PA dr.VICKY dr.LISA 60000 20000 80000
63 23/3/2017 1297/17 AN.YUMMA FITRI 9BLN THORAX AP dr.VICKY dr.MICHEL 60000 20000 80000
64 23/3/2017 3446/09 NY.SUTARMI 64TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
65 23/3/2017 4758/07 TN.SISWANTO 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 502500
66 30/3/2017 1381/17 NY.KASTIRAH 76TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
67 30/3/2017 1385/17 NY.SUKARMI 48TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
68 30/3/2017 1807/11 TN.SULAIMAN 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
69 30/3/2017 1355/17 NY.SOFIATUN 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
70 30/3/2017 169/17 SDR.AHMAD ZAMAH SYARI 23TH THORAX PA dr.TRI,Sp.P,M.KES dr.LISA 92500 20000 112500
71 30/3/2017 1386/17 NY.KHORIYATUN 50TH GENUE AP/LAT dr.ANE dr.MICHEL 67500 20000 87500
72 30/3/2017 1316/17 TN.SUPIRMAN 67TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
73 30/3/2017 4717/16 AN.MOH.BALYA 6TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
74 30/3/2017 4578/16 TN.NOOR SALIM 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
75 30/3/2017 4692/16 NN.DIAN SAFIRA 15TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 965000
76 31/3/2017 1411/17 TN.SUPARJO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
77 31/3/2017 1415/17 TN.ABDUL MALIK 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
78 31/3/2017 1414/17 NY.SINTA 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
79 31/3/2017 4958/16 TN.SOBIRIN 59TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 350000
TOTAL 6182000 1593000 7500 7782500

Mengetahui Welahan, 31 MARET 2017

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : APRIL 2017
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/4/2017 1329/17 TN.MULYADI 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 1/4/2017 1431/17 NY.MIFTAHUL JANNAH 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
3 1/4/2017 1432/17 NY.LATRI 69TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
4 1/4/2017 1439/17 SDR.AHMAD JUMRON 21TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
5 1/4/2017 1444/17 AN.DESINTA 3,6TH THORAX AP dr.ANE RUJUK 75000 7500 82500 432500
6 3/4/2017 1449/17 SDR.ILHAM WAHYU WIBOWO 17TH THORAX PA dr.HERDARU dr.MICHEL 67500 20000 87500
7 3/4/2017 3060/15 TN.KURDI 55TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
8 3/4/2017 1371/17 NN.DEVI PUTRI HERLIYANA 21TH THORAX PA dr.HERDARU dr.LISA 67500 20000 87500
9 3/4/2017 1452/17 NY.NASIYAH 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
10 3/4/2017 4098/11 NN.SINTA FEBRIANTI 16TH ANKLE JOINT AP/LAT dr.HERDARU dr.LISA 92500 20000 112500
11 3/4/2017 1461/17 NY.SOFIYAH 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
12 3/4/2017 1463/17 NY.MASINI 80TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 637500
13 4/4/2017 1384/15 AN.MOH.KHOIRUL AZAM 5TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 80000
14 5/4/2017 1482/17 TN.SUDIBYO 41TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
15 5/4/2017 4886/16 AN.ABADI FIRMANSYAH 1,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
16 5/4/2017 1483/17 TN.MAHMUDI 35TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
17 5/4/2017 1486/17 TN.SUKARDI 45TH WRIST JOINT AP/LAT dr.WIEDA dr.MICHEL 92500 20000 112500
18 5/4/2017 3498/16 AN.JUAN BAGUS 14BLN THORAX AP dr.AMRIH dr.MICHEL 60000 20000 80000
19 5/4/2017 3488/15 NY.SARMI 57TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 5/4/2017 3279/07 NY.LILIK LUTFIATUN 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 767500
21 6/4/2017 1497/17 TN.MASYUM 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
22 6/4/2017 1148/15 TN.SUPAAT 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
23 6/4/2017 3016/14 TN.KUADI 58TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
24 6/4/2017 4927/14 TN.JAMIAN 56TH PEDIS 2PSS+ANKLE 2PSS dr.ANE RUJUK 185000 7500 192500
25 6/4/2017 4694/16 NY.SITI MUTOHAROH 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
26 6/4/2017 1116/17 NY.MULYATI 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
27 6/4/2017 1510/17 NY.EMI SUSILOWATI 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 790000
28 7/4/2017 1528/17 TN.MOH.HERI 35TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
29 7/4/2017 5094/13 NN.NOVI FITRIATUN NISA 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
30 10/4/2017 1542/17 SDR.ALFAN LUTFI 18TH THORAX PA dr.DEO dr.MICHEL 67500 20000 87500
31 10/4/2017 1544/17 TN.FALAKHUL MUTAKIM 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 10/4/2017 1552/17 NY.SUKESI 56TH GENUE AP/LAT dr.DEO dr.LISA 92500 20000 112500
33 10/4/2017 1550/17 AN.ASILA FATIMAHTUL 19BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
34 10/4/2017 2121/14 TN.SUKARMO 67TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
35 10/4/2017 1525/17 NY.SUKESI 61TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
36 10/4/2017 1569/17 NY.MUNZAROH 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 702500
37 11/4/2017 1333/15 NY.SUKISIH 42TH THORAX PA dr.ANE RUJUK 67500 7500 75000
38 11/4/2017 1587/17 NY.SUTARSIH 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
39 11/4/2017 5382/15 TN.SUKANDAR 50TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
40 11/4/2017 4860/16 NY.WARTINI 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 337500
41 12/4/2017 1596/17 TN.AHMAD ALAWI 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 12/4/2017 1598/17 SDR.MARYANTO 17TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
43 12/4/2017 1606/17 AN.FIZAL AFRIYANTO 12TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 255000
44 13/4/2017 4371/16 TN.MAULUDIN 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
45 15/4/2017 1535/17 NN.HIDAYATUS SALMA 14TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
46 15/4/2017 231/06 NY.NINGSIH 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
47 15/4/2017 1527/17 NY.TRIMA 65TH GENUE AP/LAT dr.ANE RUJUK 92500 7500 100000 275000
48 17/4/2017 1652/17 AN.NURUL AIDA ADHA 9TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 80000
49 18/4/2017 2245/16 AN.RAMA APRILIO PUTRA 1TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
50 18/4/2017 1668/17 NN.NUR ELISA 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
51 18/4/2017 1669/17 NY.SITI ZULAIKAH 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
52 18/4/2017 1685/17 TN.MOHTADI 80TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 342500
53 19/4/2017 1697/17 AN.ASILA KARTIKA PUTRI 3,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
54 19/4/2017 2228/16 NY.ZUMROTUL FUQOHA 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 167500
55 20/4/2017 3282/15 TN.FAUZAN 68TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
56 20/4/2017 729/07 NY.HABIBAH 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
57 20/4/2017 1724/17 TN.SUMARNO 58TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
58 20/4/2017 988/16 NY.SRINI 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 487500
59 21/4/2017 5813/16 NY.NINIK SETYOWATI 29TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
60 21/4/2017 4107/14 AN.RINA EKAWATI 4TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 240000
61 25/4/2017 1775/17 NY.SUMI 42TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
62 25/4/2017 1782/17 AN.DWI RAHARDIAN 6TH ELBOW JOINT AP/LAT dr.ANE RUJUK 75000 7500 82500
63 25/4/2017 5575/15 NY.KUSNI HARYATI 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
64 25/4/2017 1524/17 NN.RISTIYANA 21TH THORACAL AP dr.ANE dr.MICHEL 67500 20000 87500 417500
65 26/4/2017 1284/15 TN.SASMO 54TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
66 26/4/2017 1796/17 TN.RIDWAN 48TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
67 26/4/2017 1798/17 TN.ABDUL LATIF 27TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
68 26/4/2017 2564/05 TN.MOH.ROSID 80TH WRIST JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
69 26/4/2017 1802/17 TN.JUNAIDI 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
70 26/4/2017 1636/17 TN.AWAB ABDILAH 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
71 26/4/2017 1806/17 TN.ABDULLOH 67TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
72 26/4/2017 1812/17 TN.MUHAMMAD ZAINI 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 797500
73 27/4/2017 1827/17 TN.NUKIN 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
74 27/4/2017 1741/17 TN.NUR AHMAD ARIF 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
75 27/4/2017 2637/15 NY.SUMIAH 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
76 27/4/2017 1837/17 NY.SUYATMI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
77 27/4/2017 1839/17 NY.AINUN NI'MAH 27TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000 430000
78 28/4/2017 1849/17 AN.NABILA AZAHRA 9TH ELBOW JOINT AP/LAT dr.ANE dr.LISA 75000 20000 95000
79 28/4/2017 1853/17 NY.SUDARSIH 48TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
80 28/4/2017 5029/16 NY.MUTMAINAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
81 28/4/2017 5544/13 TN.NURYADI 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
82 28/4/2017 1857/17 TN.SLAMET SUHARJO 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
83 28/4/2017 3148/14 TN.MADEKAN 56TH SHOULDER JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 775000
84 29/4/2017 1872/17 TN.MASKURI 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
TOTAL 6711500 1616000 37500 8365000

Mengetahui Welahan, 29 APRIL 2017

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : MEI 2017
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/5/2017 4807/16 TN.TRENGGONO 79TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
2 2/5/2017 1882/17 TN.SLAMET HERIYANTO 34TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
3 2/5/2017 2321/13 TN.PARTOYO 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 335000
4 3/5/2017 921/17 TN.SUBADI 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
5 3/5/2017 1814/17 NY.SULIKAH 54TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
6 3/5/2017 388/15 NY.ISLAMIATUN 30TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 407500
7 4/5/2017 1925/17 NN.LISDIANA ULFA 21TH MANUS 2PSS+WRIST 2PSS dr.ANE RUJUK 185000 7500 192500
8 4/5/2017 2886/11 TN.KAHADI 68TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 280000
9 5/5/2017 1762/16 AN.AMANDA PUTRI IKMALA 9TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
10 5/5/2017 1948/17 NY.SUHARIYANTI 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
11 5/5/2017 1952/17 NY.ISTIANAH 33TH WATER'S SPN dr.ANE dr.LISA 60000 20000 80000
12 5/5/2017 1780/05 NY.ZUMARIAH 44TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 415000
13 6/5/2017 1646/17 NY.TURIPAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
14 8/5/2017 1621/11 NY.TURIPAH 76TH ABDOMEN AP dr.MARIA dr.MICHEL 67500 20000 87500
15 8/5/2017 4218/14 TN.RONDI 39TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
16 8/5/2017 1522/14 TN.DASUKI 68TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 335000
17 9/5/2017 4128/16 AN.AZMIL AUFAR RIZKI 5TH ANTEBRACHII AP/LAT dr.ANE RUJUK 75000 7500 82500 82500
18 10/5/2017 1992/17 TN.SUTRISNO 52TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
19 10/5/2017 1993/17 NY.ATIYAH 72TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
20 10/5/2017 5303/16 AN.ULUMUL KHASAN 11TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000 280000
21 12/5/2017 1522/17 TN.ASDI 63TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
22 12/5/2017 4589/16 AN.NATASYA AULIA PUTRI 19BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
23 12/5/2017 5289/16 AN.DINTA FIDI INDRIYANI 14BLN THORAX AP dr.SOPHIE dr.LISA 60000 20000 80000
24 12/5/2017 5284/16 AN.NAURA ZAFARONI 15BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
25 12/5/2017 3675/14 NY.INDRA WAHYUNI 28TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 487500
26 15/5/2017 2033/17 TN.MASDUKI 33TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
27 15/5/2017 2047/17 NY.SUMIYATI 56TH THORAX PA dr.DEO dr.LISA 67500 20000 87500
28 15/5/2017 2052/17 TN.ISMANTO 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
29 15/5/2017 136/16 TN.ABDUL NUGHIS 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
30 15/5/2017 2058/17 TN.M.WARSITO 45TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500 462500
31 16/5/2017 2064/17 NY.SUMARNI 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
32 16/5/2017 2076/17 NY.SITI NUR HALIMAH 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 247500
33 17/5/2017 2421/07 TN.RIZAL 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
34 17/5/2017 2090/17 TN.AHMAD DURRI 45TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
35 17/5/2017 2093/17 SDR.EKO APRIYANTO 20TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
36 20/5/2017 2139/17 NY.JAMILATUN 54TH THORAX PA dr.WIEDA dr.LISA 67500 20000 87500
37 20/5/2017 5761/16 AN.KHOLILUR ROHMAN 1,6 TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 167500
38 22/5/2017 5500/16 AN.HAURA NAZHIFA 2,6TH THORAX AP dr.NADIA dr.LISA 60000 20000 80000 80000
39 23/5/2017 2164/17 NY.RANISA 43TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
40 23/5/2017 2170/17 TN.GAMPANG 54TH THORAX PA dr.ANE RUJUK 67500 7500 75000
41 23/5/2017 5831/16 NY.PERET 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 250000
42 24/5/2017 3159/16 NY.KUSRIYAH 49TH THORAX PA dr.NADIA dr.MICHEL 67500 20000 87500
43 24/5/2017 3772/15 AN.MOH.UBAIDILLAH 2TH THORAX AP dr.SONNY dr.LISA 60000 20000 80000
44 24/5/2017 2182/17 NY.SUWARTI 57TH GENUE AP/LAT dr.SONNY dr.MICHEL 92500 20000 112500
45 24/5/2017 1107/15 SDR.ALI MARTAHUDI 26TH THORAX PA dr.SONNY dr.LISA 67500 20000 87500 367500
46 26/5/2017 1443/15 TN.KOSMANTO 37TH THORAX PA dr.NADIA dr.MICHEL 67500 20000 87500
47 26/5/2017 3860/14 NY.SUMIATI 70TH THORAX PA dr.NADIA dr.LISA 67500 20000 87500
48 26/5/2017 1876/15 AN.AMIRATUL HUSNA 5TH THORAX AP dr.NADIA dr.MICHEL 60000 20000 80000
49 26/5/2017 1292/16 NY.NGATMINAH 60TH THORAX PA dr.NADIA dr.LISA 67500 20000 87500
50 26/5/2017 2206/17 NY.SUMASTRI 30TH THORAX PA dr.NADIA dr.MICHEL 67500 20000 87500
51 26/5/2017 5461/16 AN.MOH.FAHRI ILYAS 6TH THORAX AP dr.NADIA dr.LISA 60000 20000 80000 510000
52 27/5/2017 192/17 TN.SUPARNO 50TH LUMBAL AP/LAT dr.YOHARI dr.MICHEL 137000 23000 160000
53 27/5/2017 5230/16 NY.ZULIKAH 43TH THORAX PA dr.YOHARI dr.LISA 67500 20000 87500
54 27/5/2017 1258/07 TN.SOLIKHIN 54TH GENUE AP/LAT dr.YOHARI dr.MICHEL 92500 20000 112500 360000
55 29/5/2017 5754/16 NY.BASIROH 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
56 29/5/2017 2244/17 NY.KRISTIANI 32TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
57 29/5/2017 4512/16 NY.SITI SULASMI 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 287500
58 30/5/2017 2247/17 NY.TURAH 39TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
59 30/5/2017 2248/17 NG.NGASEMI 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
60 30/5/2017 1624/17 NN.FITRI HANIFAH 13TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
61 30/5/2017 2252/17 NY.NOR KHALIMAH 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
62 30/5/2017 2255/17 TN.SUWANDI 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 437500
63 31/5/2017 5831/15 TN.ABDULLAH HAFIDZ 37TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
64 31/5/2017 2173/17 NY.SULASIH 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
65 31/5/2017 1258/07 TN.SOLIKHIN 54TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
66 31/5/2017 2263/17 TN.MIFTAKUL ZAIRI 27TH ANKLE JOINT AP/LAT dr.ANE RUJUK 92500 7500 100000
67 31/5/2017 2265/17 SDR.FENDI 23TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
68 31/5/2017 2344/16 AN.MOH.NOVAL ALBAR 2,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 602500
total 5408000 1307000 30000 6745000

Mengetahui Welahan, 31 MEI2017

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


0
LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : JUNI 2017
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/6/2017 2100/17 AN.NAZRIL FAZA 9TH THORAX PA dr.YONATHAN dr.MICHEL 60000 20000 80000
2 2/6/2017 2276/17 NN.RIKA FATMAWATI 22TH THORAX PA dr.YONATHAN dr.LISA 67500 20000 87500
3 2/6/2017 2289/17 NN.NOR ASIATUL 19TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
4 2/6/2017 2290/17 NY.ZULIYATI 32TH THORAX PA dr.YONATHAN dr.LISA 67500 20000 87500
5 2/6/2017 4435/15 AN.MOH.NUR DAFA PRATAMA 3TH THORAX AP dr.YONATHAN dr.MICHEL 60000 20000 80000
6 2/6/2017 2296/17 NY.MASINAH 33TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 582500
7 3/6/2017 2300/17 NN.FATMAWATI 41TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
8 3/6/2017 2360/16 AN.NASHA DEVIANI 6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
9 3/6/2017 3142/14 TN.KASBI 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 255000
10 6/6/2017 4955/09 NY.MASIDAH 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
11 6/6/2017 2335/17 NY.MASANAH 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
12 7/6/2017 2342/17 NY.MUJIAH 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
13 7/6/2017 2345/17 NN.RONA JANA MAWAR 17TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
14 8/6/2017 5522/16 NY.MIYARTI 58TH THORAX PA dr.SONNY dr.LISA 67500 20000 87500
15 8/6/2017 2362/17 AN.IRWAN SETIAWAN 7BLN THORAX AP dr.SONNY dr.MICHEL 60000 20000 80000
16 8/6/2017 2363/17 SDR.TRI MILINIUM SAKTI 17TH THORAX PA dr.SONNY dr.LISA 67500 20000 87500 255000
17 10/6/2017 4452/13 NY.SUTAMI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
18 10/6/2017 4695/14 TN.ABDUL GHONI 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
19 10/6/2017 2391/17 AN.AINA ASFA ASQIYA 14BLN THORAX AP dr.ISFANDIYAR dr.MICHEL 60000 20000 80000 255000
20 12/6/2017 5911/15 AN.MOH.HARUN WIJONARKO 18BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
21 12/6/2017 2407/17 TN.AHMAD ZAKARIYA 26TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 167500
22 13/6/2017 995/11 TN.KOLIL 57TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
23 13/6/2017 2419/17 TN.JANI 52TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 175000
24 14/6/2017 167/11 NY.SUNARTI 37TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 160000
25 15/6/2017 2447/17 NY.MUNIROH 75TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
26 15/6/2017 2014/17 TN.H.KASAN 81TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
27 15/6/2017 2442/17 TN.MISRAN 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
28 15/6/2017 893/17 NY.SEMI 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 350000
29 16/6/2017 2465/17 NY.SITI MUNAWAROH 39TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
30 16/6/2017 4791/09 NY.MASRAH 62TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
31 16/6/2017 2471/17 TN.RUHAELI 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 16/6/2017 953/13 AN.SATRIO MUKTI WIBOWO 8TH LUMBAL AP/LAT dr.ANE dr.MICHEL 115000 23000 138000
33 16/6/2017 2474/17 NY.RUKAMAH 85TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 488000
34 19/6/2017 2494/17 SDR.HAIDAR MUSTHOFA 14TH THORAX PA dr.MARIA dr.MICHEL 67500 20000 87500
35 19/6/2017 3399/16 AN.HIYOGI ITO 1TH THORAX AP dr.MARIA dr.MICHEL 60000 20000 80000
36 19/6/2017 2498/17 TN.MADRUM 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
37 19/6/2017 4628/12 AN.AZMIL AUFAR RIZKI 5TH ANTEBRACHII AP/LAT dr.ANE dr.LISA 75000 20000 95000 350000
38 20/6/2017 5105/16 NY.SOLEKATUN 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
39 21/6/2017 614/17 NY.JUMIRAH 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
40 22/6/2017 5965/16 NY.ULUM MUSTOFIYAH 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 22/6/2017 2535/17 SDR.MASYANTO 28TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
42 22/6/2017 2545/17 NN.MURNI RAHMAWATI 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
43 22/6/2017 2231/17 NY.MASNI 50TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 350000
44 23/6/2017 2556/17 TN.MISDI 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
45 23/6/2017 2560/17 TN.AHMAD FARIKIN 46TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
46 23/6/2017 2565/17 NN.ZULFATUN NAIM 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
47 23/6/2017 2245/17 TN.SUDARYOSO 47TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
48 23/6/2017 2776/08 NN.VERA MARTIASARI 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 437500
49 24/6/2017 2591/17 NN.UMU LATIFAH 21TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
50 28/6/2017 006/17 AN.NAYARA ASYIFA 5TH THORAX AP dr.YONATHAN dr.MICHEL 60000 20000 80000
51 28/6/2017 2632/17 TN.KANDANG 58TH THORAX PA dr.YONATHAN dr.LISA 67500 20000 87500 167500
52 29/6/2017 2658/17 TN.HAFIDIN 35TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
53 29/6/2017 2124/15 NY.UJI ZATUN NIDOM 38TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
54 29/6/2017 3022/15 NY.KASTAMAH 58TH CRURIS AP/LAT dr.ANE RUJUK 92500 7500 100000
55 29/6/2017 969/13 NY.SULASTRI 57TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
56 29/6/2017 2670/17 TN.KASRUN 66TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 572500
57 30/6/2017 1252/10 AN.RIFA DWI FANTRI 7,6TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
58 30/6/2017 1165/16 NY.PASIRAH 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
59 30/6/2017 2943/14 NN.KHILYATU LAINIYAH 14TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 255000
TOTAL 4253500 1172000 7500 5433000
Mengetahui Welahan, 30 JUNI 2017

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN :JULI 2017
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/7/2017 2694/17 NY.NUR ASIFAH 25TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
2 1/7/2017 2696/17 TN.HARDIANSYAH 62TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
3 1/7/2017 2704/17 TN.SUPARMAN 50TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
4 1/7/2017 2698/17 TN.BUKARI 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 422500
5 3/7/2017 2729/17 TN.KARMENI 60TH THORAX PA dr.JOHAN dr.MICHEL 67500 20000 87500
6 3/7/2017 2730/17 NY.KUSMIYATI 34TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
7 3/7/2017 2731/17 NY.SULIKAH 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
8 3/7/2017 2728/17 TN.KARMUJI 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
9 3/7/2017 2502/17 NY.ZUMAROH 32TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 510000
10 4/7/2017 2977/16 NY.LATIFAH 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
11 4/7/2017 2588/17 TN.SUTARJO 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
12 4/7/2017 2674/17 NY.RUMISIH 71TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
13 4/7/2017 2757/17 NY.ASMIRADAH 63TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
14 4/7/2017 2754/17 TN.MASLIKANTO 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
15 4/7/2017 2761/17 AN.FAJRI IKHSAN RAMADHAN 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
16 4/7/2017 5612/16 AN.MOH.HELMI 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 670000
17 5/7/2017 2769/17 TN.MOH.KHOERI 31TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
18 5/7/2017 2777/17 TN.SUBAKIR 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
19 5/7/2017 2778/17 TN.MASUDI 75TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
20 5/7/2017 436/09 AN.MOH.ANDRIAN SAPUTRA 9TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 342500
21 6/7/2017 4424/16 TN.KUSRIN 80TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
22 6/7/2017 989/14 TN.ABDUL ROHMAN 38TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
23 6/7/2017 5683/15 TN.MASMUDI 71TH PELVIS AP dr.ANE dr.MICHEL 67500 20000 87500
24 6/7/2017 3911/15 NY.MASTIYAH 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 422500
25 7/7/2017 2807/17 NY.HJ.SUYATI 60TH SHOULDER JOINT AP/LAT dr.NADIA dr.MICHEL 92500 20000 112500
26 7/7/2017 2816/17 NN.AGESTI ANDRIYANI 15TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
27 7/7/2017 2819/17 TN.MUARIF 31TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
28 7/7/2017 2455/09 NY.KASRUMI 75TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 447500
29 8/7/2017 2841/17 NY.IMROATUN 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
30 8/7/2017 3545/16 NY.WIJATMI 69TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 247500
31 10/7/2017 416/04 NY.NAFSIAH 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 10/7/2017 2850/17 NY.WINARTI 31TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
33 10/7/2017 736/17 SDR.PUTR SYAFI'UL UMUM 21TH THORAX PA dr.HERDARU dr.MICHEL 67500 20000 87500
34 10/7/2017 2853/17 NY.RATINI 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
35 10/7/2017 2361/17 AN.ABID FADHIL ARIKIN 1TH THORAX AP dr.HERDARU dr.MICHEL 60000 20000 80000
36 10/7/2017 1625/15 NY.NGATIRAH 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
37 10/7/2017 2862/17 NY.SITI CHURRIYAH 67TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 605000
38 11/7/2017 2871/17 NY.ALFI SURYANI 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
39 11/7/2017 2886/17 NY.LASTRI 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
40 12/7/2017 001/15 NY.TAFRIHAH 52TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
41 12/7/2017 4883/09 NY.MASLIKAH 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 12/7/2017 2896/17 TN.NUR KHAMID 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
43 12/7/2017 2893/17 TN.DHORI KUMAIDI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
44 12/7/2017 2718/17 NY.SUTIATI 47TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
45 12/7/2017 2894/17 NY.TOLIATUL KHIRIYAH 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
46 12/7/2017 919/15 NY.SUNARSIH 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 757500
47 13/7/2017 2907/17 NY.KUSMINI 41TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
48 13/7/2017 2270/10 TN.ABDUL WAKHID 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
49 13/7/2017 2923/17 NY.KARLIN 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 335000
50 14/7/2017 2927/17 NY.ROHMAH 34TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
51 14/7/2017 2938/17 NY.ARIS SETYOWATI 26TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
52 17/7/2017 2955/17 TN.MASKUN 83TH THORAX PA dr.MARIA dr.LISA 67500 20000 87500
53 17/7/2017 2964/17 SDR.MUALIMIN 29TH THORAX PA DR.ANE dr.MICHEL 67500 20000 87500
54 17/7/2017 2970/17 NY.RUMIJAH 71TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
55 18/7/2017 5415/13 TN.NGARJO 55TH ABDOMEN 2PSS dr.ANE RUJUK 137000 7500 144500
56 18/7/2017 1078/15 TN.ARIFIN 43TH THORAX PA dr.ANE RUJUK 67500 7500 75000
57 18/7/2017 2980/17 NN.NAILIS SAADAH 23TH CLAVICULA AP dr.ANE RUJUK 60000 7500 67500 287000
58 19/7/2017 879/16 TN.KHAMIDI 43TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
59 19/7/2017 5659/15 TN.MOH.ALI.ROSID 48TH THORAX PA dr.ERNAWATI dr.LISA 67500 20000 87500
60 19/7/2017 1654/17 NY.JUMIATUN 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
61 19/7/2017 2997/17 NY.RUKAYAH 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 422500
62 20/7/2017 3000/17 TN.KHAMZAWI 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
63 20/7/2017 3001/17 NY.ZIROH 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
64 20/7/2017 2903/17 TN.SUHARI 51TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
65 20/7/2017 340/17 AN.KOIRUL WAFA 3,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 415000
66 21/7/2017 4424/10 NY.SITI WAFIROH 52TH THORAX PA dr.PATRICIA dr.LISA 67500 20000 87500
67 21/7/2017 3014/17 TN.SUPANGAT 60TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
68 21/7/2017 2908/17 TN.SUMARDI 52TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
69 21/7/2017 372/17 NY.MUKANAH 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 422500
70 22/7/2017 1290/16 NY.MARYATI 61TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
71 22/7/2017 3022/17 NY.SARTINAH 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
72 22/7/2017 2845/17 TN.KASMARI 41TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
73 22/7/2017 2430/17 NY.HINDUN 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 422500
74 25/7/2017 4088/08 TN.MOHARI 69TH THORAX PA dr.TRI RH BUDI dr.MICHEL 67500 20000 87500
75 25/7/2017 61/16 NY.SRI MURNI 54TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
76 25/7/2017 4720/15 TN.ROHMAD 34TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 335000
77 27/7/2017 3077/17 NY.YATIMAH 71TH THORAX PA dr.WIEDA dr.LISA 67500 20000 87500
78 27/7/2017 66/17 NY.NGATINAH 46TH THORAX PA dr.WIEDA dr.MICHEL 67500 20000 87500 175000
79 29/7/2017 2102/15 NY.SITI MARDIYAH 44TH THORAX PA dr.JOHAN dr.MICHEL 67500 20000 87500 87500
80 31/7/2017 640/14 NN.ANA ASTUTIK 23TH ABDOMEN AP dr.MARIA dr.MICHEL 67500 20000 87500
81 31/7/2017 3131/17 TN.MASKURI 52TH SHOULDER JOINT AP/LAT dr.MARIA dr.LISA 92500 20000 112500
82 31/7/2017 3133/17 AN.LINA NUR 5TH THORAX AP dr.MARIA dr.MICHEL 60000 20000 80000
83 31/7/2017 2526/17 AN.ISNA 7TH ANTEBRACHII AP/LAT dr.ANE dr.LISA 60000 20000 95000 375000
TOTAL 6635000 1642000 22500 8314500

Mengetahui Welahan, 31 JULI 2017

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : AGUSTUS 2017
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/8/2017 643/17 TN.BANI 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 1/8/2017 3147/17 TN.MULYADI 53TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
3 1/8/2017 203/17 TN.NASLAN 80TH THORAX AP dr.ANE dr.LISA 67500 20000 87500 262500
4 3/8/2017 4293/10 AN.NUR IDA FITRIANA 7TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 80000
5 4/8/2017 2656/17 NY.NASLIKHATUN 42TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 4/8/2017 382/17 AN.ADIFA ASHALIRA 1TH dr.ANE dr.MICHEL 60000 20000 80000
7 4/8/2017 3172/17 SDR.NUR KHOLIL 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 4/8/2017 4527/16 NY.YATEMI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
9 4/8/2017 3180/17 NN.AYU KUSUMA DWI 18TH LUMBAL+CLAVICULA AP dr.ANE RUJUK 197000 7500 204500 547000
10 8/8/2017 3228/17 SDR.USEP SHOLIHIN 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
11 8/8/2017 1218/17 TN.KASPUR 62TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
12 8/8/2017 3360/15 NY.SUBIATUN 65TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
13 8/8/2017 3232/17 TN.SUMARLAN 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 422500
14 10/8/2017 4950/13 SDR.NOOR FUAT 32TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
15 10/8/2017 3257/17 NY.ISTIKOMAH 38TH THORAX PA dr.WIEDA dr.MICHEL 67500 20000 87500 247500
16 11/8/2017 3239/17 TN.ACHMAD 66TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
17 11/8/2017 3277/17 TN.AKMAD BURHANUDDIN 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
18 11/8/2017 3112/17 TN.AHMADI 50TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 335000
19 12/8/2017 3284/17 NY.DWI PUJI LESTARI 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
20 12/8/2017 3285/17 SDR.HERU WIBOWO 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
21 12/8/2017 3225/09 NY.NGAPINI 68TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 335000
22 14/8/2017 5399/09 TN.SUNOTO 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
23 14/8/2017 830/17 AN.DAVID HARDIANSYAH 15BLN THORAX AP dr.CLEMENTINE dr.LISA 60000 20000 80000 167500
24 15/8/2017 3306/17 TN.ABDUL QODIR 40TH ANKLE JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
25 15/8/2017 3310/17 TN.MA'RUF 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
26 15/8/2017 3313/17 NY.SULASTRI 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
27 15/8/2017 3316/17 AN.AFILIANI 13TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 375000
28 16/8/2017 3330/17 NY.SUMINI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
29 16/8/2017 5236/16 NY.HENI NOVIANA 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
30 16/8/2017 951/17 NY.NANIK JUMIATUN 28TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
31 16/8/2017 3264/17 TN.MASDUKI 40TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 422500
32 21/8/2017 3389/17 NY.FAIZAH 26TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 160000
33 22/8/2017 1324/17 TN.H ABDULLAH 75TH THORAX PA dr.LUKMAN dr.MICHEL 67500 20000 87500
34 22/8/2017 3402/17 SDR.NUR M ALI MUKSAR 17TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
35 23/8/2017 3418/17 NY.PUTRI BUNGA NIRWANA 24TH CLAVICULA AP dr.ANE RUJUK 60000 7500 67500
36 23/8/2017 1737/14 AN.BURHANUDIN ABBAS 13TH LUMBAL AP/LAT dr.ANE dr.MICHEL 115000 23000 138000 205500
37 24/8/2017 3425/17 NY.SADIPAH 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
38 24/8/2017 3429/17 TN.SUKARNO 37TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
39 24/8/2017 3434/17 TN.KASTURI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
40 25/8/2017 3442/17 NY.UMAYAH 43TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 160000
41 26/8/2017 3463/17 AN.ZAINAL FAIZ 12TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
42 26/8/2017 895/17 NY.SUMARI 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 247500
43 28/8/2017 2201/07 TN.SAYOGO 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 28/8/2017 3435/17 NY.SRI WAHYU NINGSIH 47TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 247500
45 29/8/2017 3496/17 TN.BUDI SULISTIYONO 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
46 30/8/2017 3369/17 NY.RUSMINAH 52TH THORAX PA dr.ANE RUJUK 67500 7500 75000
47 30/8/2017 3512/17 SDR.AHMAD ZAMRONI 15TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
48 30/8/2017 3516/17 TN.KACUNG IRAWAN 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
49 30/8/2017 3517/17 TN.MUSAFAK 39TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 337500
50 31/8/2017 5430/17 SDR.MARTIN 24TH THORAX PA dr.WIEDA dr.LISA 67500 20000 87500
51 31/8/2017 1019/10 AN.NOVA AURILIA 8TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
52 31/8/2017 639/17 AN.MOH.HAFIS ALI 8TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
53 31/8/2017 4505/15 TN.AHMAD MUNDAKIR 33TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 407500
TOTAL 4429500 1033000 22500 5485000

Mengetahui Welahan, 31 AGUSTUS 2017

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan


(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)
LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : SEPTEMBER 2017
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/9/2017 3114/15 NN.USWATUN HASANAH 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 2/9/2017 3544/17 SDR.RAMADHAN DWI ADITAMA 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
3 2/9/2017 4416/12 AN.BIRGITTA LIDWINA 6TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000 255000
4 4/9/2017 2464/14 AN.MUTIARA AISYAH 4TH THORAX AP dr.AMRIH dr.LISA 60000 20000 80000
5 4/9/2017 1325/12 NY.KUSRIYAH 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
6 4/9/2017 400/07 TN.MUSLIM 57TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
7 4/9/2017 3563/17 SDR.RIJAL MUKHAROR 22TH MANUS AP/OBLIQUE dr.ANE RUJUK 92500 7500 100000
8 4/9/2017 1597/16 TN.MARDUKI 57TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
9 4/9/2017 4137/14 AN.ALDIFA ABABIL 3,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 595000
10 5/9/2017 1704/10 NY.KASMIJAH 73TH WRIST JOIN AP/LAT dr.ANE RUJUK 92500 7500 100000 100000
11 6/9/2017 4143/09 TN.MASROKAN 67TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
12 6/9/2017 3598/17 SDR.EDI SUSANTO 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
13 6/9/2017 33/08 NY.SUGIYARTI 52TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
14 6/9/2017 1606/15 NY.UMI KULSUM 58TH GENUE AP/LAT dr.ANE RUJUK 92500 7500 100000
15 6/9/2017 1126/17 AN.MOH.ZIDAN ALFARIZI 21BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 442500
16 7/9/2017 981/17 NY.SITI HABSAH 34TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
17 7/9/2017 3621/17 TN.AHMAD KHOIRONI 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
18 7/9/2017 943/17 SDR.MOH.JEVI FELANI 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
19 7/9/2017 3626/17 TN.MULYADI 61TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 350000
20 9/9/2017 1152/17 AN.MOH.RIZKI PRATAMA 5TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
21 9/9/2017 3562/17 TN.AHMAD RIYADI 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
22 9/9/2017 1122/11 TN.SAWILAN 67TH THORAX PA dr.H.SOLIKHIN dr.MICHEL 67500 20000 87500
23 9/9/2017 3654/17 NY.SITI ISMIATI 26TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
24 9/9/2017 4147/16 SDR.AGUNG PRASETYO 26TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 430000
25 11/9/2017 3143/17 SDR.MOH.NASTAIN 25TH THORAX PA dr.YONATHAN dr.LISA 67500 20000 87500
26 11/9/2017 3661/17 AN.SAFINATUL NAJA 4,6TH THORAX AP dr.YONATHAN dr.MICHEL 60000 20000 80000
27 11/9/2017 310/06 TN.MISBAH 51TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
28 11/9/2017 3185/15 NY.MARIAH 63TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000 335000
29 12/9/2017 1405/06 TN.SAHLI 51TH GENUE 2PSS+FEMUR 2PSS dr.ANE RUJUK 185000 7500 192500
30 12/9/2017 710/13 NY.SRI SUMARTI 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
31 12/9/2017 1051/17 AN.MOH RAFADHAN 19BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
32 12/9/2017 4034/15 AN.ALYA NAZAYA 5TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
33 12/9/2017 3642/17 TN.SUGITO 41TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 527500
34 13/9/2017 3698/17 NY.HARTINI 50TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
35 13/9/2017 3701/17 AN.AIDA ULFA FAZILA 16BLN THORAX AP dr.YUNITA dr.MICHEL 60000 20000 80000
36 13/9/2017 2018/15 NY.PASRINI 69TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
37 13/9/2017 3709/17 AN.SISKA ARIYANTI 12TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
38 13/9/2017 3104/07 NY.RUKINI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
39 13/9/2017 3713/17 NY.MASFA'AH 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 590000
40 14/9/2017 3660/17 NY.KHOLIMATUL KHUMAIDAH 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 14/9/2017 2105/13 NY.SAPA'ATIN 49TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
42 14/9/2017 3718/17 TN.SUNARYO 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
43 14/9/2017 3121/17 NY.SURINI 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
44 14/9/2017 3729/17 AN.NAJWA KHOIRUN NISA 7TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 575000
45 15/9/2017 3733/17 TN.FAUZUL AMIN 37TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
46 15/9/2017 1195/17 NY.MUNTIANI 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 (87500x2)
47 18/9/2017 3756/17 NY.SITI KOMARIYAH 38TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
48 18/9/2017 3761/17 TN.AHMAD MUNAWIR 26TH THORAX PA dr.YUNITA dr.LISA 67500 20000 87500
49 18/9/2017 3762/17 TN.MASYKURI 34TH LUMBAL AP/LAT dr.YUNITA dr.MICHEL 137000 23000 160000
50 18/9/2017 3774/17 NY.NOR SIDAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
51 18/9/2017 76/14 NY.YATIMAH 73TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
52 18/9/2017 1297/17 AN.YUMMA FITRI FARINGGI 15BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
53 18/9/2017 2416/16 AN.VIALIN SALSABILA 18BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 670000
54 19/9/2017 3780/17 AN.NADIA PUTRI AULIA 8TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
55 19/9/2017 2131/12 TN.SUTARJO 40TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
56 19/9/2017 3785/17 NY.FATIHATIN NASIHA 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
57 19/9/2017 3787/17 NY.LISDIANA 35TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000 335000
58 20/9/2017 4371/10 TN.TEFSANI 55TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
59 20/9/2017 3801/17 NY.NUR IKA ALIKA 24TH WATER'S SPN dr.ANE dr.LISA 60000 20000 80000
60 20/9/2017 3979/05 TN.FAIZIN 48TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
61 20/9/2017 3806/17 NY.PARMI 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
62 20/9/2017 1689/16 TN.SAROZI 40TH WRIST JOIN AP/LAT dr.ANE dr.LISA 92500 20000 112500 505000
63 22/9/2017 3489/17 NY.MARYONAH 72TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
64 22/9/2017 3826/17 NY.SUNARSIH 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
65 22/9/2017 3754/17 NY.SUKINI 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 480000
66 23/9/2017 3832/17 SDR.SOLIKUL HADI 15TH CLAVICULA AP dr.ANE RUJUK 60000 7500 67500 67500
67 26/9/2017 3859/17 TN.VIRGIAWAN YUMARDIKA 27TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
68 26/9/2017 2491/14 NY.RIF'ATIN 47TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
69 26/9/2017 3880/17 TN.SAKDULLAH 47TH CLAVICULA AP dr.ANE dr.MICHEL 60000 20000 80000
70 26/9/2017 852/12 NY.EMI ZULIANI 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
71 26/9/2017 2884/12 NY.SWANI 67TH ANKLE JOINT AP/LAT dr.ANE RUJUK 92500 7500 100000 540000
72 27/9/2017 3895/17 TN.MOH.SUHADI 31TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
73 27/9/2017 286/13 NY.SUPRATUN 64TH THORAX AP dr.ANE dr.MICHEL 67500 20000 87500
74 27/9/2017 4337/15 NY.ALFIYAH 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 335000
75 28/9/2017 2696/14 NY.SRI ASROFAH 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
76 28/9/2017 241/17 SDR.AHMAD ANIQ AISAR 14TH WRIST JOIN AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 200000
77 29/9/2017 4199/14 NY.SAFA'ATUN 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
78 29/9/2017 1432/17 NY.LATRI 69TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
79 29/9/2017 3926/17 AN.RAYAN FIRDAUS 1,6TH THORAX AP PUSKESMAS M2 dr.MICHEL 60000 20000 80000 255000
80 30/9/2017 3936/17 NY.SITI ASIYAH 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
81 30/9/2017 639/17 AN.MOH.NAFIS ALI 9TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
82 30/9/2017 3831/17 SDR.NUR ARIS 17TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 255000
TOTAL 6422500 1550000 45000 8017500

Mengetahui Welahan, 30 SEPTEMBER 2017

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : OKTOBER 2017
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/10/2017 5446/15 TN.SUUDI 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 2/10/2017 3953/17 TN.MAT SURIP 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
3 2/10/2017 3969/17 SDR.ABDUL AZIS 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
4 2/10/2017 1417/15 NY.IMROATUL SOLIHAH 41TH THORAX PA dr.MARIA dr.MICHEL 67500 20000 87500
5 2/10/2017 3961/17 SDR.PRASETYO 22TH THORAX PA dr.MARIA dr.LISA 67500 20000 87500 437500
6 3/10/2017 1785/13 NN.SAFIRA NURULITA 17TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
7 3/10/2017 3982/17 TN.WAGIMIN 74TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
8 3/10/2017 3981/17 SDR.MOH.HANDOKO 20TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 255000
9 4/10/2017 1574/17 AN.PACO YUMA KANZA 9BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
10 4/10/2017 2474/12 TN.SUTINGGAL 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
11 4/10/2017 1697/17 AN.ASILA KARTIKA PUTRI 4TH THORAX AP dr.ANE dr.LISA 60000 20000 80000 247500
12 5/10/2017 4011/17 AN.KAILA QINARA RISKY 1,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
13 5/10/2017 1012/17 NY.SUKOMAH 25TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 240000
14 6/10/2017 1599/17 NY.MITA LISTIANI 28TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
15 6/10/2017 1606/17 AN.FIZAL AFRIYANTO 12TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
16 6/10/2017 3946/17 TN.SUSANTO 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
17 6/10/2017 658/17 NY.ZARIAH 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 342500
18 7/10/2017 4717/12 TN.SUHARTO 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
19 7/10/2017 3744/17 TN.AHSANUDDIN 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
20 7/10/2017 4045/17 NY.NONA AMBAR MULATSIH 59TH PEDIS AP/OBLIQUE dr.ANE RUJUK 92500 7500 100000
21 7/10/2017 4047/17 TN.SUPARMO 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 507500
22 9/10/2017 4055/17 AN.PASYA ADITYA AINUN 11TH ELBOW JOINT AP/LAT dr.NADIA RUJUK 75000 7500 82500
23 9/10/2017 47/15 TN.KASMANI 71TH THORAX PA dr.NADIA dr.LISA 67500 20000 87500
24 9/10/2017 4065/17 TN.MADUKI 54TH THORAX PA dr.ANE RUJUK 67500 7500 75000
25 9/10/2017 4068/17 NY.KOKOM 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 332500
26 10/10/2017 4081/17 NY.RUSTAMAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
27 10/10/2017 3972/14 NY.MAS'UDAH 63TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
28 10/10/2017 5631/15 NY.YATMI 55TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
29 10/10/2017 4088/17 NY.ROSA 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
30 10/10/2017 318/12 NY.AZIZAH 55TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500 535000
31 11/10/2017 4091/17 SDR.ZAULKHAQ 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 11/10/2017 3250/17 TN.SUKRISNO 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
33 12/10/2017 3894/17 NY.SUMIATI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
34 14/10/2017 4141/17 TN.JUMIYANTO 57TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 87500
35 16/10/2017 1652/17 AN.NURUL AIDA ADHA 9TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
36 16/10/2017 3866/17 TN.SUPRIYANTO 38TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
37 16/10/2017 4149/17 NY.SRI AMINAH 61TH GENUE AP/LAT dr.PATRICIA dr.LISA 92500 20000 112500
38 16/10/2017 4778/14 TN.SURONO 41TH THORAX PA dr.PATRICIA dr.LISA 67500 20000 87500
39 16/10/2017 4159/17 NY.MUNAIFAH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 480000
40 17/10/2017 1783/16 AN.ANNISA ZAHRA 4TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
41 17/10/2017 4179/17 AN.LATIFATUL ILMIAH 13TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
42 17/10/2017 303/16 NY.SITI RUMIYATUN 45TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 320000
43 18/10/2017 4188/17 NY.AWALIN NAJAH 51TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 18/10/2017 4194/17 NY.FINA YULIA MITA 29TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000 167500
45 19/10/2017 3418/17 NY.PUTRI BUNGA NIRMALA 24TH CLAVICULA AP dr.ZUHAD,Sp.OT dr.MICHEL 60000 20000 80000
46 19/10/2017 4209/17 TN.ZAINAL ARIFIN 34TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 167500
47 20/10/2017 4216/17 TN.MULYADI 53TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
48 20/10/2017 3483/15 TN.SUBARJO 42TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
49 20/10/2017 4222/17 NY.SUDARI 65TH THORAX PA dr.WIEDA dr.LISA 67500 20000 87500 255000
50 21/10/2017 4236/17 NY.SA'ATUN 66TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
51 21/10/2017 4329/17 NY.SITI MULYASIH 36TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 320000
52 23/10/2017 1915/05 NY.RUKIYAH 46TH THORAX PA dr.MARIA dr.LISA 67500 20000 87500
53 23/10/2017 4248/17 AN.NABILA AZAHRA 15BLN THORAX AP dr.H.SOLIKHIN dr.MICHEL 60000 20000 80000
54 23/10/2017 224/17 NY.KUMARIAH 50TH LUMBAL AP/LAT dr.MARIA dr.LISA 137000 23000 160000
55 23/10/2017 4258/17 NY.MUSTOLIFAH 57TH THORAX PA dr.MARIA dr.MICHEL 67500 20000 87500
56 23/10/2017 4259/17 NY.LAILA BADRIYAH 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
57 23/10/2017 2684/03 TN.SUKARI 67TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
58 23/10/2017 4266/17 NN.MUALIMATUR ROFIK 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 677500
59 24/10/2017 4272/17 SDR.AZIMUDIN ASFIYAQ 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
60 24/10/2017 4170/17 NY.YUNI TRI HANDAYANI 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
61 24/10/2017 4414/12 TN.YOHANES 47TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 262500
62 25/10/2017 5246/17 NY.MAMI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
63 25/10/2017 4295/17 NY.IKHA 33TH ANKLE JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 200000
64 26/10/2017 4297/17 NY.ANISATUL QOMARIYAH 22TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
65 26/10/2017 4300/17 TN.H.NURI 65TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
66 26/10/2017 4299/17 NY.PURYATUN 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
67 26/10/2017 4311/17 SDR.LUKMAN HALIM 26TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
68 26/10/2017 4318/17 TN.KIROM 40TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 510000
69 27/10/2017 4328/17 NN.EMA RISTI 16TH CRURIS AP/LAT dr.ANE dr.LISA 92500 20000 112500
70 27/10/2017 3643/17 NY.BANISIH 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
71 27/10/2017 635/13 NY.TITIK INDRAWATI 39TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 287500
72 30/10/2017 4352/17 TN.HENRI KURNIAWAN 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
73 30/10/2017 4354/17 NY.MUHLISAH 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
74 30/10/2017 4355/17 NY.SUATI 65TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
75 30/10/2017 4351/17 TN.AGUS PUJI HARYONO 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
76 30/10/2017 843/08 NN.MITA LERAWANTI 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
77 30/10/2017 3548/17 NN.SUMIYATI 15TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
78 30/10/2017 4364/17 AN.MOH.ALFIN 8TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000 677500
79 31/10/2017 4375/17 AN.SATRIA RISYA KENZI 3TH ELBOW JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500 112500
TOTAL 6112500 1550000 22500 7685000

Mengetahui Welahan, 31 OKTOBER 2017

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : NOVEMBER 2017
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/11/2017 2720/06 NY.SHOLIKAH 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 1/11/2017 4387/17 AN.AHMAD NADZIL WILDAN 13BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 167500
3 2/11/2017 4404/17 NY.SUKIRAH 40TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
4 2/11/2017 4399/17 AN.DWI AHMAD ZAKIA FAHRI 11TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
5 2/11/2017 3688/14 NY.MUKHOROMAH 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
6 2/11/2017 1551/07 AN.MOH.SAFRIL HALIM 12TH ANTEBRACHII AP/LAT dr.ANE RUJUK 92500 7500 100000
7 2/11/2017 3764/15 TN.MUHRI 58TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 595000
8 3/11/2017 4415/17 NY.NUTHI' HILMIYATI 38TH ABDOMEN AP dr.MARIA dr.MICHEL 67500 20000 87500
9 3/11/2017 4414/17 NY.SURIYAH 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
10 3/11/2017 2689/08 TN.ABDUL AFIF 46TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
11 3/11/2017 4427/17 SDR.AHMAD SYAFI'I 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
12 3/11/2017 4420/17 AN.ULYATUS SANIA 7BLN THORAX AP dr.MARIA dr.MICHEL 60000 20000 80000
13 3/11/2017 4433/17 NY.ERAWATI 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 3/11/2017 4432/17 TN.SUPARJI 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 605000
15 4/11/2017 4298/17 NY.TURIPAH 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 160000
16 6/11/2017 4449/17 TN.MOH.ALI ARFAN 27TH THORAX PA dr.PATRICIA dr.MICHEL 67500 20000 87500
17 6/11/2017 313/13 NY.RISA PURNAMASARI 25TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
18 7/11/2017 4462/17 NN.WINDI MIRWATI 14TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
19 7/11/2017 4461/17 TN.SUYADI 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
20 7/11/2017 4122/17 TN.ALI WAHYUDI 37TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
21 7/11/2017 5774/13 NY.RUBIATUN 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
22 7/11/2017 4474/17 TN.MUFRODI 72TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 510000
23 8/11/2017 4481/17 NY.SRI WUNARTI 48TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
24 8/11/2017 4490/17 AN.DARMA SAPUTRA 2TH ELBOW JOINT AP/LAT dr.ANE RUJUK 92500 7500 100000
25 8/11/2017 4489/17 AN.MOH.RIZKI FADILAH 6TH CRANIUM AP dr.ANE dr.LISA 60000 20000 80000
26 8/11/2017 4135/17 SDR.FAISHOL AMIN 20TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 427500
27 9/11/2017 4260/17 TN.SULKHAN 37TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
28 9/11/2017 4498/17 NY.MURTI 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
29 9/11/2017 4448/17 AN.DEWI TARA 1,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
30 9/11/2017 2860/09 NN.ARTA MARIATUN 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
31 9/11/2017 4500/17 NY.SRI SUMARNI 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 430000
32 11/11/2017 136/16 TN.ABDUL MUGHIS 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
33 11/11/2017 5571/16 TN.NUR KAFID 40TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 175000
34 24/11/2017 4656/17 NY.ELI FERIYANTI 30TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
35 24/11/2017 3405/02 TN.MASHADI 63TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
36 24/11/2017 4674/17 NY.MUYAZANAH 50TH PELVIS AP dr.SELLY dr.MICHEL 67500 20000 87500
37 24/11/2017 502/15 NY.MASTOPAH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
38 24/11/2017 4435/15 AN.MOH.NUR DAFA PRATAMA 3,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 502500
39 25/11/2017 54/17 TN.ABDUL GHOFUR 32TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
40 27/11/2017 4695/17 TN.SUKARMAN 70TH THORAX PA dr.SELLY dr.LISA 67500 20000 87500
41 27/11/2017 1624/17 AN.FITRI HANIFAH 13,6TH THORAX PA dr.SELLY dr.LISA 67500 20000 87500
42 27/11/2017 4707/17 TN.BAMBANG 37TH CLAVICULA AP dr.SELLY dr.MICHEL 75000 20000 95000
43 27/11/2017 3669/17 SDR.AGUNG SETIYO PURNOMO 18TH THORAX PA dr.SELLY dr.MICHEL 67500 20000 87500
44 27/11/2017 4639/17 SDR.AHMAD TAUFIK 16TH THORAX PA dr.SELLY dr.LISA 67500 20000 87500 445000
45 28/11/2017 4726/17 AN.MOH.ASIF SAIFUL FAJRI 13TH THORAX PA dr.SELLY dr.MICHEL 67500 20000 87500 87500
46 29/11/2017 1801/15 NY.TURIPAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
47 29/11/2017 4630/17 TN.MUHTADI 74TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
48 29/11/2017 2360/16 AN.NASHA DEVIANI 7TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
49 29/11/2017 2680/10 TN.SUPRAT 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
50 29/11/2017 4740/17 AN.MOH.TAUFIQUR ROHMAN 10,6TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 495000
51 30/11/2017 4750/17 SDR.KRIS MUHAMINUL AJID 20TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
52 30/11/2017 2290/17 NY.ZULIYATI 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
53 30/11/2017 4752/17 TN.ABU MANSUR 39TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
TOTAL 4069000 1041000 15000 5125000

Mengetahui Welahan, 30 NOVEMBER 2017

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan


(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)
LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : DESEMBER 2017
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/12/2017 926/16 AN.GHAISA MIRZA 3,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
2 2/12/2017 4779/17 NY.MUNTAMAH 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 167500
3 4/12/2017 4792/17 SDR.KHOIRUL ANAM 26TH THORAX PA dr.DEO dr.LISA 67500 20000 87500
4 4/12/2017 2362/17 AN.IRWAN SETIAWAN 1TH THORAX AP dr.DEO dr.MICHEL 60000 20000 80000 167500
5 5/12/2017 4097/16 TN.ARIFIN 43TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
6 6/12/2017 4075/17 AN.FATAN AL MAISAN 1TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
7 6/12/2017 3048/14 TN.SUPRIYANTO 38TH THORACAL1PSS+LUMBAL 2 PSS dr.ANE dr.MICHEL 204500 43000 247500
8 6/12/2017 4037/17 NY.HJ.MASLIKAH 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
9 6/12/2017 4812/17 NY.MUNZA 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 502500
10 7/12/2017 4381/17 NY.MUNAFIAH 67TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
11 7/12/2017 1945/12 NY.SITI AMINAH 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
12 8/12/2017 3381/17 AN.RAFA RIZKY AULIL 8TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 80000
13 9/12/2017 4879/17 NY.SUTIMAH 79TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 9/12/2017 3817/14 NY.RUKANAH 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
15 9/12/2017 4883/17 TN.ARIS SURYADI 34TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
16 11/12/2017 763/08 NY.MUNAZIROTUN 44TH PELVIS AP dr.BAMBANG dr.MICHEL 67500 20000 87500
17 11/12/2017 4071/06 NY.ATIK ROFIKAH 45TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
18 11/12/2017 2428/13 NN.ASMA'AH 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
19 11/12/2017 4910/17 TN.MUSNAN 38TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
20 11/12/2017 4801/17 SDR.ZAINAL MUTTAQIM 33TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 462500
21 12/12/2017 4922/17 TN.NGATEMO 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
22 12/12/2017 1538/07 TN.SUMARNO 62TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
23 12/12/2017 4926/17 TN.ROBIKAN 30TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
24 12/12/2017 3399/16 AN.HIYOGI ITO 1,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
25 12/12/2017 2961/13 NY.AMINAH 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 502500
26 13/12/2017 4643/17 TN.JUMARDI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
27 13/12/2017 3032/17 NN.BAROROTUL FUADAH 23TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
28 13/12/2017 1713/15 TN.CAHYONO 48TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 335000
29 14/12/2017 4873/17 TN.SUGIMAN 90TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
30 14/12/2017 4954/17 NY.YAZIDAH 52TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
31 14/12/2017 5601/16 TN.MUGIHARJO 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 287500
32 15/12/2017 4981/17 NY.ETIK ISTIANINGSIH 30TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
33 15/12/2017 3820/08 TN.NGADIONO 58TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 175000
34 16/12/2017 1817/13 TN.SUDONO 36TH CLAVICULA AP dr.ANE dr.MICHEL 75000 20000 95000
35 16/12/2017 756/09 NY.SUKAENAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 182500
36 18/12/2017 5911/15 AN.MOH.HARUN WIJONARKO 2TH THORAX AP dr.SOPHIE dr.MICHEL 60000 20000 80000
37 18/12/2017 4997/17 NY.KUNARIYAH 41TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
38 18/12/2017 5000/17 TN.SARWAN 69TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
39 18/12/2017 4504/08 NY.SUPRAPTI 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 342500
40 19/12/2017 2391/17 AN.AINA ASWA ASQIYA 20BLN THORAX AP dr.INFANDIYAR dr.MICHEL 60000 20000 80000
41 19/12/2017 5032/17 TN.SINWAN 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 19/12/2017 3324/15 NY.SUGIRAH 52TH CRANIUM AP dr.ANE dr.MICHEL 60000 20000 80000 247500
43 20/12/2017 404/06 TN.RAMIJAN 70TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
44 20/12/2017 5036/17 TN.SUZAINI 61TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
45 20/12/2017 5037/17 NY.AMSAINAH 52TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
46 20/12/2017 3611/17 NY.SRI WAHYUNI 47TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
47 20/12/2017 3306/17 TN.ABDUL QODIR 40TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
48 20/12/2017 5042/17 NN.ANISATUN 19TH GENUE AP/LAT dr.ANE RUJUK 92500 7500 100000 707500
49 26/12/2017 2751/12 TN.ASRORI 59TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
50 26/12/2017 5090/17 NY.SITI RUBIAH 48TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
51 26/12/2017 5091/17 TN.SUPRIYADI 38TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
52 26/12/2017 2361/17 AN.ABID FADHIL 18BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
53 26/12/2017 5088/17 TN.MAHRUS 35TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
54 26/12/2017 2509/17 TN.MOH.ROMZAN 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
55 26/12/2017 5096/17 SDR.MOH.KHAFIDIN 28TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
56 26/12/2017 5097/17 TN.MOH.NOCHID 52TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 765000
57 27/12/2017 5107/17 SDR.DONY PUTRA IMANUEL 17TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 27/12/2017 4030/12 TN.SABARI 74TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
59 27/12/2017 5112/17 TN.NADIRIN 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
60 27/12/2017 4749/07 NY.SUDINAH 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
61 27/12/2017 5119/17 NY.SRI NORYATI 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 437500
62 28/12/2017 1026/05 NY.SRI WAHYUNI 57TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
63 28/12/2017 4166/14 TN.SARMANI 68TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 175000
64 29/12/2017 840/16 NY.MASROKAH 61TH THORAX PA dr.MARIA dr.MICHEL 67500 20000 87500
65 29/12/2017 5160/17 TN.DAHROMI 45TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 175000
66 30/12/2017 1274/14 AN.MOH.FARDAN 10TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
67 30/12/2017 2100/17 AN.NAZRIL FAZA 10TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
68 30/12/2017 5178/17 NN.DINDA LAILAFI PUTRI 17TH FEMUR AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 272500
TOTAL 5124500 1378000 7500 6510000

Mengetahui Welahan, 30 DESEMBER 2017

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : JANUARI 2018
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/1/2018 001/18 NT.SULIKAH 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 2/1/2018 002/18 NY.SUPATMI 54TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
3 2/1/2018 3177/13 NY.SUTRINI 65TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
4 3/1/2018 28/18 TN.MUJIYANTO 24TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
5 3/1/2018 5105/17 NY.TASIKHAH 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 3/1/2018 5118/17 NN.UMMI IMAROH 21TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
7 3/1/2018 436/09 AN.MOH.ANDRIAN SAPUTRA 9TH THORAX PA dr.ANE dr.LISA 60000 20000 80000 342500
8 4/1/2018 53/18 SDR.NUR SAFI'I 20TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
9 4/1/2018 58/18 TN.SUWITO 41TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
10 4/1/2018 3852/17 NY.MUNZAROH 52TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
11 4/1/2018 1558/05 TN.WASIS 60TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 350000
12 18/1/2018 179/18 NY.SUPENI 70TH PELVIS AP dr.ANE dr.MICHEL 67500 20000 87500
13 18/1/2018 272/18 NN.NUR ROHMAH 19TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
14 18/1/2018 278/18 TN.AHMAD MULYADI 34TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
15 19/1/2018 284/18 TN.SUYITNO 66TH THORAX PA dr.PATRICIA dr.LISA 67500 20000 87500
16 19/1/2018 282/18 NY.SUYATI 49TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
17 19/1/2018 288/18 SDR.EKO ADI PRASETYO 30TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
18 19/1/2018 3891/12 NY.SRI WANUN 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
19 19/1/2018 292/18 TN.DIRLAN 60TH THORAX PA dr.PATRICIA dr.LISA 67500 20000 87500 437500
20 20/1/2018 305/18 NY.DWI RAHMAWATI SOLEKAH 22TH CLAVICULA AP dr.ANE dr.MICHEL 75000 20000 95000
21 20/1/2018 310/18 NY.MASTIAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
22 20/1/2018 2263/13 NY.RASINI 52TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 342500
23 22/1/2018 1793/17 NY.TUMINI 59TH THORAX PA dr.DEO dr.LISA 67500 20000 87500
24 22/1/2018 1137/16 AN.YUSNIA KHOIRUN NISA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
25 22/1/2018 3108/17 NN.NUR ANDINI RAHMA 15TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
26 22/1/2018 3249/17 NY.ASMI 34TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
27 22/1/2018 330/18 AN.TESSA FEBRIANA 11TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 502500
28 23/1/2018 333/18 TN.KASMIJAN 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
29 23/1/2018 270/18 TN.SAERONZI 63TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
30 23/1/2018 3997/17 NY.SULAMI 34TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 407500
31 24/1/2018 356/18 TN.KONDERIN 62TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 24/1/2018 364/18 NY.HARTINI 48TH THORAX PA dr.IKO UMIATI dr.MICHEL 67500 20000 87500
33 24/1/2018 367/18 NY.SITI TUMI 54TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 335000
34 25/1/2018 95/18 TN.SOLEH 67TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
35 25/1/2018 4035/12 NY.AMIN 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
36 25/1/2018 370/18 NY.NGARSINAH 75TH THORAX AP dr.ANE dr.MICHEL 67500 20000 87500
37 25/1/2018 734/06 NY.FENI 38TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
38 25/1/2018 309/18 NY.SITI ZULAIHAH 43TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
39 25/1/2018 3133/17 AN.LINA NUR HIKMAH 5,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
40 25/1/2018 375/18 NY.NANIK 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
41 25/1/2018 1815/17 TN.WAHYU DWI JAYA 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 790000
42 26/1/2018 379/18 AN.AZA ALYA 10TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
43 26/1/2018 392/18 TN.RIYANTO 44TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
44 26/1/2018 394/18 SDR.SADAM EMIRUDIN 17TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 255000
45 27/1/2018 630/14 TN.MUJIONO 42TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
46 27/1/2018 403/18 NY.NILNA MAHMUDAH 22TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 247500
47 29/1/2018 5171/17 TN.SUPARTO 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
48 29/1/2018 3705/12 TN.SAWILAN 70TH THORAX PA dr.PATRICIA RUJUK 67500 7500 75000
49 29/1/2018 64/18 NY.KUSTIYO RINI 26TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
50 29/1/2018 5333/15 NY.KAMIDAH 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
51 29/1/2018 424/18 SDR.MIFTAKHUL HUDA 21TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 425000
52 30/1/2018 4878/07 NY.DWI HAYATI 54TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500 112500
53 31/1/2018 447/18 NN.SITI ULFA NASIKHA 17TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500
54 31/1/2018 455/18 NY.KARTI 72TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
55 31/1/2018 3284/17 NY.DWI PUJI LESTARI 31TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 360000
TOTAL 4321000 1104000 7500 5432500

Mengetahui Welahan, 31 JANUARI 2018

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan


(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)
LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : FEBRUARI 2018
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/2/2018 480/18 NY.UMI LATIFAH 22TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
2 2/2/2018 43/18 NY.SUTARMI 46TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
3 2/2/2018 489/18 SDR.ALI MUSTOFA 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 335000
4 5/2/2018 494/18 NY.DESSY ARIANTI 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
5 5/2/2018 497/18 NY.USWATUN HASANAH 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
6 5/2/2018 499/18 NY.SOFIANA 27TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
7 5/2/2018 1129/16 NY.MUANIFAH 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 350000
8 6/2/2018 431/18 TN.KARTONO 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
9 6/2/2018 519/18 TN.SURANI 67TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
10 6/2/2018 1636/15 NY.MASITAH 50TH WRIST JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
11 6/2/2018 526/18 TN.NASRIN 62TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
12 6/2/2018 224/18 NY.SALMA MURNI 39TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
13 6/2/2018 3813/16 TN.SUKAMTO 33TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 622500
14 7/2/2018 3568/12 NN.MISFAH KHOIRINAH 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
15 7/2/2018 536/18 TN.SUGENG WAHYUDI 37TH GENUE AP/LAT dr.IKO dr.MICHEL 92500 20000 112500
16 7/2/2018 830/17 AN.DAVID HARDIANSYAH 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
17 7/2/2018 540/18 NN. IMI DIYAH LESTARI 18TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 367500
18 8/2/2018 428/18 TN.KUSMADI 48TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
19 8/2/2018 548/18 TN.KARSAN 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
20 8/2/2018 1116/11 NY.NUR ALIMAH 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
21 8/2/2018 875/17 SDR.BURHANUDIN ABAS 12TH THORACAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 422500
22 9/2/2018 4858/13 NY.DARWATI 55TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
23 9/2/2018 4782/17 AN.NABIL ILMAN 16BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
24 9/2/2018 2761/17 AN.FAJRI IKHSAN 2,6TH THORAX AP dr.PATRICIA dr.LISA 60000 20000 80000
25 9/2/2018 2752/16 TN.ABDUL JALAL 50TH ABDOMEN AP dr.PATRICIA dr.MICHEL 67500 20000 87500 360000
26 10/2/2018 583/18 NN.AMSIATI 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
27 10/2/2018 1378/06 NY.SITI ASIYAH 53TH WATER'S SPN dr.ANE dr.MICHEL 60000 20000 80000
28 10/2/2018 4582/13 AN.HASNA WIDIANTI 7TH ELBOW JOINT AP/LAT dr.ANE dr.MICHEL 75000 20000 95000
29 10/2/2018 586/18 NY.KUSTRINI 57TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 350000
30 12/2/2018 596/18 TN.MUHAMMAD ABIDIN 31TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
31 12/2/2018 1323/15 SDR.MUHAMAD ROZI 30TH ABDOMEN AP dr.MARIA dr.LISA 67500 20000 87500
32 12/2/2018 603/18 NY.SUGIHARTI 64TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 287500
33 13/2/2018 3567/14 TN.SUMARDI 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
34 14/2/2018 3434/17 TN.KASTURI 61TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
35 14/2/2018 94/05 TN.KOIRONI 60TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
36 14/2/2018 624/08 TN.HERI 32TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
37 14/2/2018 507/18 TN.SUHARTO 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
38 14/2/2018 3356/17 TN.SULARNO 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 510000
39 15/2/2018 634/18 NY.YUMAIROH 25TH PELVIS AP+LUMBAL AP dr.ANE dr.MICHEL 135000 40000 175000
40 15/2/2018 1576/07 SDR.AINUR ROFIK 18TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
41 15/2/2018 643/18 TN.ABDUL HARIS 38TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
42 15/2/2018 644/18 SDR.ASEP ARIANTO 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 582500
43 17/2/2018 2365/14 SDR.RANGGA SATRIA 14TH THORAX PA dr.DEO dr.MICHEL 67500 20000 87500
44 17/2/2018 648/18 SDR.NUR HASAN 15TH ANTEBRACHII AP/LAT dr.DEO dr.LISA 92500 20000 112500 200000
45 19/2/2018 658/18 SDR.MOH.SHOFIUDIN 25TH CLAVICULA AP dr.PATRICIA dr.MICHEL 75000 20000 95000
46 19/2/2018 2179/17 NN.MILKHATUL FITRIYAH 15TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
47 19/2/2018 1971/15 AN.MOH.FEBRI ARDIANSYAH 10TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000 262500
48 20/2/2018 689/18 SDR.IRFAN SUSANTO 16TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
49 20/2/2018 695/18 TN.NUR RAHMAD 58TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
50 21/2/2018 706/18 SDR.IRFAN BAIHAQI 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
51 21/2/2018 710/18 NY.JAMIRAH 39TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
52 21/2/2018 716/18 NY.DEFI AYU PERMATA SARI 21TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
53 21/2/2018 3494/17 TN.SUMARI 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 350000
54 22/2/2018 722/18 NY.SALIMAH 45TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
55 22/2/2018 397/18 TN.PAERAN 80TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
56 22/2/2018 3873/17 AN.SABRINA ZHAFIRA 13BLN THORAX AP dr.ANE dr.LISA 60000 20000 80000
57 22/2/2018 737/18 NY.SUADAH 53TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 415000
58 23/2/2018 742/18 NY.SURYATI 52TH ABDOMEN AP dr.JOHAN dr.MICHEL 67500 20000 87500
59 23/2/2018 750/18 NY.NUR KHAYATI 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
60 23/2/2018 681/18 TN.NGATRIMAN 36TH ABDOMEN AP dr.JOHAN dr.MICHEL 67500 20000 87500
61 23/2/2018 754/18 TN.SOLIKHUL 30TH CERVICAL AP/LAT dr.ANE dr.MICHEL 77000 23000 100000
62 23/2/2018 758/18 NY.SITI ALMARIYA ULFA 31TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
63 23/2/2018 437/15 TN.MUNTONO 46TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
64 23/2/2018 1580/14 TN.SUMARDI 64TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 625000
65 24/2/2018 4484/10 NN.KIKI KUMALASARI 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
66 24/2/2018 2402/07 NY.SUMIYAH 58TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 200000
67 26/2/2018 888/17 TN.SUKARTO 49TH THORAX PA dr.YUNITA dr.LISA 67500 20000 87500
68 26/2/2018 783/18 TN.AFANDI 60TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
69 26/2/2018 782/18 TN.PAIJO 58TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
70 27/2/2018 803/18 TN.SUTRISNO 60TH THORAX PA dr.ANE RUJUK 67500 7500 75000
71 27/2/2018 3935/07 TN.RUSLI 52TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
72 27/2/2018 809/18 TN.SUNARTO 45TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
73 27/2/2018 3028/09 AN.AHMAD ADIB WILDAN 9TH ABDOMEN AP dr.ANE dr.MICHEL 60000 20000 80000
74 27/2/2018 729/18 NN.LINDA SAFITRI 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
75 27/2/2018 5140/14 NY.BAIDAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
76 27/2/2018 294/10 NN.ANITA WIDYANINGRUM 26TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 665000
77 28/2/2018 3104/07 NY.RUKINI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
78 28/2/2018 835/18 TN.DAHRONI 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
79 28/2/2018 3991/17 SDR.FATKHULLOH HIL MAYAN 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
80 28/2/2018 842/18 NY.PUNIPAH 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 350000
TOTAL 6145500 1627000 7500 7780000

Mengetahui Welahan, 28 FEBRUARI 2018

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : MARET 2018
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 1/3/2018 672/18 NY.SRIATI 39TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
2 2/3/2018 2781/13 AN.AQILA TADKIA 5TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
3 2/3/2018 879/18 NY.SITI MUNIAH 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
4 2/3/2018 872/18 AN.AMANDA ELVINA PUTRI 1TH THORAX AP dr.PATRICIA dr.LISA 60000 20000 80000 247500
5 3/3/2018 891/18 NY.ARUM INDAH 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
6 3/3/2018 895/18 TN.KASMURI 70TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
7 3/3/2018 898/18 TN.SUPRAYITNO 37TH ANKLE JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500
8 3/3/2018 3228/07 SDR.USEP SHOLIHIN 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
9 3/3/2018 3715/17 NY.ANA MUSTAGHFIROH 36TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
10 3/3/2018 4760/17 NY.SRI MUJIATI 52TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 622500
11 5/3/2018 906/18 TN.SUPENO 54TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
12 5/3/2018 4767/15 NY.RUKAYAH 58TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
13 5/3/2018 2416/16 AN.VIALIN SALSABILA 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
14 5/3/2018 917/18 TN.MURTADLO 44TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 415000
15 6/3/2018 2408/15 TN.MASRUP 52TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
16 6/3/2018 866/18 TN.BENI ARYANTO 26TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
17 7/3/2018 4351/16 AN.RAIHAN RAMADAN 2,6TH dr.ANE dr.LISA 60000 20000 80000
18 7/3/2018 1568/16 TN.SUTEJI 49TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 167500
19 8/3/2018 3679/16 TN.ABDUL LATIF 36TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
20 8/3/2018 962/18 TN.SUKARNO 84TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
21 8/3/2018 966/18 NY.TASRIPAH 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
22 8/3/2018 967/18 AN.ZAHRA AMELIA 6,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
23 8/3/2018 3598/13 AN.AHMAD ADI SAPUTRO 6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
24 8/3/2018 2018/17 TN.SUPRIYONO 54TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
25 8/3/2018 2395/00 NY.SUPARMI 67TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
26 8/3/2018 4513/17 NY.FASIHATUN NASIKAH 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 855000
27 12/3/2018 1014/18 AN.KHASBULLAH MUKHID 5,6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
28 12/3/2018 1019/18 TN. NOR KHALIMI 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
29 12/3/2018 4523/16 NY.KASRUMIATI 38TH WATER'S SPN dr.ANE dr.LISA 60000 20000 80000
30 12/3/2018 4034/15 AN.ALYA MAZAYA 5,6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 327500
31 13/3/2018 1045/18 NN.ISMA YULIANA 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
32 13/3/2018 108/18 TN.BASARI 50TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
33 13/3/2018 3008/13 NY.FARIDA ROHMATUN 46TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
34 14/3/2018 1056/18 TN.AHMAD KHARIRI 36TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
35 14/3/2018 1057/18 NY.KATRIYAH 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
36 14/3/2018 1028/17 TN.MARKUM 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
37 14/3/2018 797/11 NY.USRIYAH 65TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
38 14/3/2018 5886/16 AN.NAFLA SAKHIRA 19BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
39 14/3/2018 920/18 TN.NUHIN 74TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
40 14/3/2018 2005/05 NY.KASMIRAH 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 677500
41 15/3/2018 767/18 NY.ZURIYAH 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
42 15/3/2018 3357/12 NY.NGATIRAH 75TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 247500
43 16/3/2018 374/14 TN.SADIMAN 68TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
44 16/3/2018 3780/17 AN.NADIA PUTRI AULIA 8TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000
45 16/3/2018 5039/16 TN.ANWARUDDIN 30TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
46 16/3/2018 5306/15 NY.KASIYATI 70TH THORAX PA dr.DEDIK dr.MICHEL 67500 20000 87500
47 16/3/2018 3701/17 AN.AIDA ULFA FAZILA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
48 16/3/2018 1096/18 TN.AHMAD MAKSUM 35TH THORAX PA dr.DEDIK dr.MICHEL 67500 20000 87500
49 16/3/2018 3774/17 NY.NOR SIDAH 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
50 16/3/2018 1101/18 NY.SIYUN 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
51 16/3/2018 1105/18 NY.SITI AISYAH 50TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
52 16/3/2018 1103/18 TN.SUJUD 80TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 1077500
53 19/3/2018 2136/15 NY.SRIPAHAN 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
54 19/3/2018 1924/17 AN.AHMAD DZAKI 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
55 19/3/2018 1064/18 AN.HILMALIA SYAFITRI 13TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 255000
56 20/3/2018 2647/17 TN.SUNARTO 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
57 20/3/2018 1136/18 TN.SUNDOYO 47TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
58 20/3/2018 1140/18 TN.WARSONO 37TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
59 20/3/2018 131/17 AN.AZKA NUR RAMDHANI 2TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
60 20/3/2018 797/14 NY.MASKANAH 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
61 20/3/2018 1070/18 NY.MATNI 77TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
62 20/3/2018 4572/17 TN.DWI PRASTYO 29TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 677500
63 21/3/2018 5196/13 TN.SUNGKONO 75TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
64 21/3/2018 4730/13 NY.RASMINI 63TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
65 21/3/2018 3527/16 NY.SUTARMI 69TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
66 21/3/2018 3954/17 AN.GIBRAN FAWWAS 13BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
67 21/3/2018 1157/18 SDR.SUTRISNO 20TH THORAX PA dr.H.SOLIKHIN dr.LISA 67500 20000 87500 502500
68 22/3/2018 1159/18 NY.KHUMROTUN 70TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
69 22/3/2018 479/08 TN.SAHLI 70TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
70 22/3/2018 4854/17 AN.MOH.AZKA PRATAMA 1TH THORAX AP dr.ABDUL,Sp.A dr.LISA 60000 20000 80000
71 22/3/2018 5142/12 TN.WARISAN 73TH THORAX PA dr.IKO UMIATI dr.LISA 67500 20000 87500
72 22/3/2018 3018/15 NY.YANTI 70TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 502500
73 23/3/2018 1176/18 NN.TAHTIROTUL MAFTUKHAH 25TH THORAX PA dr.CLEMENTINE dr.LISA 67500 20000 87500
74 23/3/2018 3926/17 AN.RAYAN FIRDAUS 2TH THORAX AP dr.INDAH dr.LISA 60000 20000 80000
75 23/3/2018 1179/18 NN.SRI ASTUTIK 38TH THORAX PA dr.CLEMENTINE dr.LISA 67500 20000 87500 255000
76 26/3/2018 1209/18 NY.RUBIAH 71TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
77 26/3/2018 1161/18 TN.NGARSANI 67TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 175000
78 27/3/2018 1227/18 SDR.AHMAD ALVIN 15TH ANKLE JOINT AP/LAT dr.ANE RUJUK 92500 7500 100000
79 27/3/2018 898/18 TN.SUPRAYITNO 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
80 27/3/2018 675/18 NY.SURIYAH 58TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
81 27/3/2018 194/11 NY.MAMIK 55TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 460000
82 28/3/2018 652/18 NN.NIA OKTAMISARI 22TH ANKLE JOINT AP/LAT dr.ANE RUJUK 92500 7500 100000
83 28/3/2018 1242/18 NY.WARSILAH 75TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
84 28/3/2018 1245/18 SDR.MUJAZIN 35TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
85 28/3/2018 1574/17 AN.PACO YUMA KANZA 14BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
86 28/3/2018 4480/09 NY.SUPARTI 60TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
87 28/3/2018 1252/18 TN.MOH.UNTUNG SLAMET 29TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 602500
88 29/3/2018 1253/18 NY.AEMANAH 56TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
89 29/3/2018 2370/16 NY.FAIZAH 47TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
90 29/3/2018 1142/12 NY.SRIYATUN 36TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
91 29/3/2018 1838/14 NY.SITI KAWINAH 63TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
92 29/3/2018 1260/18 TN.GIMAN 72TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
93 29/3/2018 1072/16 NY.NANIK PUJIATININGSIH 52TH GENUE AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 550000
94 31/3/2018 3489/09 TN.INDARTO 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
95 31/3/2018 1273/18 TN.MAT SOLEH 48TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
TOTAL 7400500 1902000 15000 9317500

Mengetahui Welahan, 31 MARET 2018

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : APRIL 2018
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/4/2018 1282/18 TN.SURATNO 75TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
2 2/4/2018 4030/14 NY.PARTI 54TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500
3 2/4/2018 1809/17 NY.NUR HAYATI 39TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
4 2/4/2018 1293/18 NY.SURIYAH 53TH THORAX PA dr.JOHAN dr.MICHEL 67500 20000 87500
5 2/4/2018 1257/18 TN.SAHAL ABIDIN 28TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
6 2/4/2018 1300/18 NY.SITI SOFIATUN 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
7 2/4/2018 3872/16 NY.SRI KATI 50TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
8 2/4/2018 1301/18 NN.JIHAN SYARIATIN 29TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
9 2/4/2018 4874/17 TN.NUR WAHIB 51TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 982500
10 3/4/2018 904/18 TN.ADENAN 72TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
11 3/4/2018 1311/18 TN.TOYIB 78TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
12 3/4/2018 1600/06 NY.SUPATMI 54TH PEDIS AP/OBLIQUE dr.ANE dr.MICHEL 92500 20000 112500 360000
13 4/4/2018 1324/18 TN.SUYOTO 57TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 160000
14 5/4/2018 1346/18 AN.MOH.FARHAN ABDILAH 6TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
15 5/4/2018 334/18 AN.MOH.RAFLI 2,5TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
16 5/4/2018 1808/17 NY.SURIP 66TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 320000
17 6/4/2018 1368/18 NN.FINA AIDATUS SILMI 20TH THORAX PA dr.DEDIK dr.MICHEL 67500 20000 87500
18 6/4/2018 4389/15 NY.YALATIF 82TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
19 6/4/2018 1372/18 SDR.ANZAM SAIFUL 22TH LUMBAL AP/LAT dr.DEDIK dr.MICHEL 137000 23000 160000 335000
20 7/4/2018 1139/18 TN.MASHUR 42TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
21 7/4/2018 185/11 NN.SYARIFAH 20TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 247500
22 9/4/2018 1410/18 TN.MUSTAGHFIRIN 42TH THORAX PA dr.YUNITA RUJUK 67500 7500 75000
23 9/4/2018 4855/16 TN.ROHADI 45TH LUMBAL AP/LAT dr.YUNITA dr.MICHEL 137000 23000 160000
24 9/4/2018 1970/16 TN.NOR HADI 62TH THORAX PA dr.YUNITA dr.LISA 67500 20000 87500
25 9/4/2018 4733/15 NN.ISNAINI 18TH WRIST JOINT AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 435000
26 10/4/2018 1420/18 AN.MOH.HISYAM 6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
27 10/4/2018 1427/18 TN.SUROSO 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
28 10/4/2018 4935/15 TN.SARMIDI 54TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
29 10/4/2018 4297/17 NY.ANISATUL QOMARIYAH 23TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
30 10/4/2018 4034/15 AN.ALYA NATASYA 6TH THORAX AP dr.ANE dr.LISA 60000 20000 80000
31 10/4/2018 4157/17 AN.NAZILATUR RAHMA 20BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 527500
32 11/4/2018 1447/18 TN.NOOR CHOLID 53TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
33 11/4/2018 2896/17 TN.NUR KHAMID 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 175000
34 12/4/2018 1463/18 TN.ALI MASDUKI 42TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 87500
35 13/4/2018 1472/18 AN.DIMAS SAPUTRA 5TH THORAX AP dr.NISIA dr.MICHEL 60000 20000 80000 80000
36 16/4/2018 1491/18 NY.NOR HAYATI 43TH THORAX PA dr.DEO dr.LISA 67500 20000 87500
37 16/4/2018 194/16 NY.CHOLIFAH 59TH HUMERUS AP/LAT dr.ANE dr.MICHEL 92500 20000 112500 200000
38 17/4/2018 1508/18 NY.PATONAH 72TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
39 17/4/2018 2638/14 AN.PUTRA ADI WIBOWO 4TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
40 17/4/2018 1515/18 TN.DARYOTO 43TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500 327500
41 18/4/2018 1525/18 NY.SUKATI 61TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
42 18/4/2018 1535/18 TN.SAID 80TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 247500
43 19/4/2018 1547/18 NY.CHOIRIYAH 53TH THORAX PA dr.WIEDA NS dr.MICHEL 67500 20000 87500
44 19/4/2018 1552/18 NY.KASMILAH 55TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000 247500
45 20/4/2018 1006/16 TN.SAMUDI 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
46 20/4/2018 1567/18 TN.KUSNIN 62TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
47 20/4/2018 1311/17 NY.HJ.MAONAH 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
48 20/4/2018 1576/18 SDR.HENDRI LUKMAN 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 350000
49 23/4/2018 133/18 NY.JUWANTI 48TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
50 23/4/2018 4349/17 NY.UMAYAH 35TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
51 23/4/2018 1601/18 NY.SITI NAFIAH 30TH THORAX PA dr.DEO dr.MICHEL 67500 20000 87500
52 23/4/2018 1518/18 TN.SOLEKAN 55TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
53 23/4/2018 4364/17 AN.MOH.ALFIN 8,5TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000 502500
54 24/4/2018 1612/18 TN.MOERDI 79TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
55 25/4/2018 4387/17 AN.NADZIL 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
56 25/4/2018 1393/17 TN.SYAIFUDIN 40TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
57 25/4/2018 1608/16 SDR.ZIDAN 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 255000
58 26/4/2018 1640/18 NY.SOPIAH 45TH CRANIUM AP dr.ANE dr.LISA 60000 20000 80000
59 26/4/2018 1646/18 NN.JANNATUL WASIK 24TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
60 26/4/2018 1658/18 TN.MARSAM 49TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 255000
61 27/4/2018 3643/17 NY.BANISIH 56TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
62 28/4/2018 1683/18 TN.ABDULLAH 35TH THORAX PA dr.ALBERT dr.LISA 67500 20000 87500
63 28/4/2018 1684/18 SDR.MUTA ALIMIN 17TH THORAX PA dr.ALBERT dr.MICHEL 67500 20000 87500
64 28/4/2018 3093/15 TN.SARAH 67TH THORAX PA dr.ALBERT dr.LISA 67500 20000 87500
65 28/4/2018 4420/17 AN.ULYATUS SANIA 1TH THORAX AP dr.ALBERT dr.MICHEL 60000 20000 80000 342500
66 30/4/2018 5229/15 TN.SALIM 62TH THORAX PA dr.YUNITA dr.LISA 67500 20000 87500
67 30/4/2018 1274/15 NY.TAPRIKAH 68TH WRIST JOINT AP/LAT dr.YUNITA dr.MICHEL 92500 20000 112500
68 30/4/2018 1733/17 TN.TAHLISUL ABID 34TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
69 30/4/2018 1397/18 AN.JAMIATUL KHASANAH 9TH THORAX PA dr.ANE dr.MICHEL 60000 20000 80000 367500
TOTAL 5576500 1396000 7500 6980000

Mengetahui Welahan, 30 APRIL 2018

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)


LAPORAN PASIEN RONTGEN KLINIK PRATAMA MARDI NUGROHO WELAHAN
BULAN : MEI 2018
NO TANGGAL NO. RM NAMA PASIEN UMUR JENIS DOKTER DOKTER BIAYA SARANA TOTAL
PEMERIKSAAN PENGIRIM RADIOLOGI RS JS.DOKTER
1 2/5/2018 1710/18 TN.TRI BUWONO 36TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
2 2/5/2018 1724/18 SDR.MOH.FAKHRUN NUHA 17TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 175000
3 3/5/2018 1734/18 AN.MOH.ARWANI 8TH CRANIUM AP/LAT dr.ANE dr.MICHEL 115000 23000 138000
4 3/5/2018 648/11 NY.MIANA 33TH CERVICAL AP dr.ANE dr.LISA 60000 20000 80000
5 3/5/2018 1746/18 TN.ANDI HERMAWAN 32TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 378000
6 4/5/2018 1764/18 AN.MUHAMMAD RISKY 3TH THORAX AP dr.HERDARU dr.LISA 60000 20000 80000
7 4/5/2018 1769/18 TN.BAMBANG SUPARTO 44TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
8 4/5/2018 1770/18 AN.DIMAS SETIA BUDI 12TH THORAX PA dr.ANE dr.LISA 60000 20000 80000
9 4/5/2018 1772/18 NY.MASRIF 40TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000 407500
10 7/5/2018 62/14 TN.MASDUKI 45TH THORAX PA dr.PATRICIA dr.LISA 67500 20000 87500
11 7/5/2018 1796/18 SDR.GUNAWAN 24TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500
12 7/5/2018 1799/18 SDR.NGATREKAN 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
13 7/5/2018 843/08 NN.MITA LREAWANTI 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
14 7/5/2018 1800/18 AN.RAIHAN ABDUL WIGUNA 7TH CLAVICULA AP dr.PATRICIA RUJUK 75000 7500 82500
15 7/5/2018 4448/17 AN.DEWI TARA 2TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
16 7/5/2018 533/11 NY.SUYATI 50TH ANKLE JOINT AP/LAT dr.ANE dr.LISA 92500 20000 112500 625000
17 8/5/2018 1814/18 TN.BONADI 35TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
18 8/5/2018 2084/17 TN.KASMIRAN 62TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
19 8/5/2018 1816/18 TN.NGADI 60TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 262500
20 9/5/2018 1831/18 TN.MUSLIKHAN 33TH ABDOMEN AP dr.ANE dr.LISA 67500 20000 87500
21 9/5/2018 4243/08 TN.WAGIRAN 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
22 9/5/2018 5798/15 NY.MUNTIAH 75TH THORAX PA dr.MUNDAKIR dr.LISA 67500 20000 87500
23 9/5/2018 3254/10 TN.KUSNAN 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
24 9/5/2018 1839/18 SDR.AWANG BUDI 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
25 9/5/2018 4539/17 TN.ISNANTO 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 525000
26 11/5/2018 1971/10 TN.SUKARI 68TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
27 11/5/2018 1851/18 SDR.MIFTAKHUL FALAKH 18TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
28 11/5/2018 1744/18 NY.MASNI 60TH WATER'S SPN dr.YOAS dr.LISA 60000 20000 80000
29 11/5/2018 1864/18 NY.MARNI 65TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 342500
30 12/5/2018 650/18 NY.SUGIYATI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
31 12/5/2018 1703/12 AN.NURIS AZWAS 12TH THORAX PA dr.TRI RH dr.MICHEL 60000 20000 80000 167500
32 14/5/2018 1887/18 NY.CHOTIMAH 45TH ANTEBRACHII AP/LAT dr.MARIA dr.LISA 92500 20000 112500
33 14/5/2018 1892/18 TN.JUMBARI 67TH THORAX PA dr.MARIA dr.MICHEL 67500 20000 87500
34 14/5/2018 3798/14 NY.UNFIYAH 31TH THORAX PA dr.MARIA dr.LISA 67500 20000 87500 287500
35 17/5/2018 1945/18 NY.WARKATI 45TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
36 17/5/2018 3370/17 TN.SUALI 70TH LUMBAL AP/LAT dr.ANE dr.LISA 137000 23000 160000
37 17/5/2018 1948/18 TN.DIDIK ISMAWAN 37TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
38 17/5/2018 5226/15 NN.KHOMARIAH 24TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 422500
39 18/5/2018 1956/18 TN.SUHARDI 68TH THORAX PA dr.ANE RUJUK 67500 7500 75000
40 18/5/2018 1957/18 SDR.SIGIT SETIAWAN 20TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
41 18/5/2018 2788/15 TN.BAKRUN 57TH LUMBAL AP/LAT dr.ANE dr.MICHEL 137000 23000 160000
42 18/5/2018 1971/18 SDR.OKI BAGUS SAPUTRA 23TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 410000
43 19/5/2018 1723/18 NY.HJ.SITI ROHMAH 55TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 87500
44 21/5/2018 3115/05 TN.TOHRIN 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
45 21/5/2018 533/18 NY.KUNTINAH 51TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
46 21/5/2018 2006/18 SDR.ROFIUL HUDA 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
47 22/5/2018 2023/18 NN.SITI FITRIYANI 33TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
48 22/5/2018 2026/18 SDR.AHMAD ZIDAM ILMANA 15TH CRURIS AP/LAT dr.ANE dr.LISA 92500 20000 112500 200000
49 23/5/2018 1962/18 NN.KHANIFATUL MAULA 15TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
50 23/5/2018 2028/18 TN.BUSARI 45TH SHOULDER JOINT dr.ANE dr.MICHEL 92500 20000 112500 200000
51 24/5/2018 335/17 TN.MUHIDIN 29TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
52 24/5/2018 4178/13 TN.MATOHAR 64TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
53 24/5/2018 2035/18 NY.SEPTI NUR HAYATI 28TH ANKLE JOINT AP/LAT dr.ANE RUJUK 92500 7500 100000 275000
54 25/5/2018 2040/18 NY.RUKIMAH 50TH ANKLE JOINT AP/LAT dr.SELLY dr.LISA 92500 20000 112500
55 25/5/2018 3184/12 NY.AMELIA 25TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
56 25/5/2018 4814/17 NN.NOVALIA RISTANTI 18TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
57 25/5/2018 2054/18 TN.JUMADI 32TH ABDOMEN AP dr.ANE dr.MICHEL 67500 20000 87500 375000
58 26/5/2048 2055/18 NY.USRIYAH 45TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 87500
59 28/5/2018 2064/18 TN.MOHAMADI 42TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
60 28/5/2018 2238/17 TN.MOH.RIDWAN 35TH LUMBAL AP/LAT dr.JOHAN dr.LISA 137000 23000 160000
61 28/5/2018 4752/17 TN.ABU MANSUR 40TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
62 28/5/2018 2066/18 NY.SUKARMI 50TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
63 28/5/2018 2277/04 NY.SUTIMAH 54TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500 510000
64 30/5/2018 2039/18 TN.SUWARDI 60TH THORAX PA dr.ANE dr.LISA 67500 20000 87500
65 30/5/2018 2075/18 NY.SRI WIDAYAT 36TH THORAX PA dr.ANE dr.MICHEL 67500 20000 87500
66 30/5/2018 4981/17 NY.ETIK ESTIANINGSIH 33TH THORAX PA dr.ANE dr.LISA 67500 20000 87500 262500
67 31/5/2018 3267/13 AN.AQILA RISMA RISTIANTO 5TH THORAX AP dr.ANE dr.MICHEL 60000 20000 80000
68 31/5/2018 1741/18 TN.MUHAMMAD SAKIR 45TH GENUE AP/LAT dr.ANE dr.LISA 92500 20000 112500
69 31/5/2018 4075/17 AN.FATAN AL MAISAN 16BLN THORAX AP dr.ANE dr.MICHEL 60000 20000 80000 272500
TOTAL 5175000 1338000 22500 6535500

Mengetahui Welahan, 31 MEI 2018

Kepala Klinik Pratama Mardi Nugroho Yang Membuat Laporan

(dr.Ane Roviana,M.Kes) (Benny Irawan,AMR)

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