DATA PEMERIKSAAN RADIOLOGI LUAR (MRI)

TAHUN 2018

JANUARI FEBRUARI
NO TANGGAL NO.RM NAMA PASIEN TARIF NO
1 04-Jan-18 223078 MUHAMMAD SHOLIHIN TN 2,585,000 1
2 06-Jan-18 13683 NURUL HADIJAH NY/DJOKO S PLN/II 2,035,000 2
3 06-Jan-18 92098 JULIANTI NY 2,585,000 3
4 09-Jan-18 216841 KUWAT SANTOSO 2,035,000 4
5 09-Jan-18 32622 AFIFAH JANUARISKA NN/ TN SYAIFUL 2,035,000 5
6 12-Jan-18 225302 DWI OKTA PANGESTIKA NN 2,035,000 6
7 15-Jan-18 13643 VALENTINUS SRIYADI TN 2,035,000 7
8 17-Jan-18 40743 DEWI AYU HERIYATI NY 2,035,000 8
9 17-Jan-18 230728 ZAHIDA ZAHRO DWI A 2,035,000 9
10 18-Jan-18 209899 ARDI PUJOPRABOWO 2,035,000 10
11 18-Jan-18 232163 SUTRISNO 2,035,000 11
12 23-Jan-18 212144 ARIFAH RAHAYU HADI 2,035,000 12
13 23-Jan-18 202185 PARTONO TN 2,035,000 13
14 23-Jan-18 179381 VINA INDIARKO 2,035,000 14
15 24-Jan-18 204104 ROSSI JULIANAWATI 2,035,000 15
16 26-Jan-18 232931 GUFRON 2,585,000 16
17 30-Jan-18 2444 PURWANI P NY/00101867 RSP 2,035,000 17
18 30-Jan-18 231947 PANIYEM NY 2,035,000 18
19 02-Jan-18 231797 JOHANN DAVID LAMBERTUS 2,035,000 19
20 10-Jan-18 232297 DIDIK MULYADI TN 878,900 20
21 14-Jan-18 226341 ACHMAD WAHIB EFFENDI 2,585,000 21
22 24-Jan-18 233269 SRI MUTMAINAH 2,585,000 22
23 30-Jan-18 68811 BERTHY SOELEMAN TN 2,035,000 23
24 30-Jan-18 233362 SJAFRUDIN ALFATH KUSUMA YUDHA T 1,021,900
TOTAL 49,420,800

MARET APRIL
NO TANGGAL NO.RM NAMA PASIEN TARIF NO
1 02-Mar-18 216558 SITI FATIMAH 2,035,000 1
2 02-Mar-18 226043 NUNUNG TRIE RENANINGRUM 2,035,000 2
3 05-Mar-18 81593 INDRA KUNINGSIH NY TELK 2,035,000 3
4 05-Mar-18 4741 IMAM SUBAGYO 2,035,000 4
5 06-Mar-18 108893 SUHARTATI NY 2,035,000 5
6 07-Mar-18 234575 ENDANG LISTIANI NY 2,035,000 6
7 07-Mar-18 234473 PUDJI LESTARI 2,035,000 7
8 08-Mar-18 201980 SUYANI 2,035,000 8
 9 08-Mar-18 30313 BAGUS MINTOWARDI TN TELK/VC 2,035,000 9
10 09-Mar-18 232328 WIRJONO TN 2,035,000 10
11 10-Mar-18 80360 ANI SUMARNI NY BNI 2,035,000 11
12 12-Mar-18 205376 MUKTI HARI CAHYONO 2,035,000 12
13 12-Mar-18 130402 IMAM ROFII TN 2,035,000 13
14 16-Mar-18 15134 VINA WIDOWATI NY 2,035,000 14
15 16-Mar-18 90308 MUNAWAROH NY TELK 2,035,000 15
16 16-Mar-18 229412 LAY SIE JONG 2,035,000 16
17 19-Mar-18 103474 REGU PRIYONO TN 2,035,000 17
18 20-Mar-18 236890 MUH SUTRISNO 2,035,000 18
19 22-Mar-18 209636 ANDI RADIKA HADISAM NABABAN 2,585,000 19
20 23-Mar-18 232723 YUANITA WAHYUNI NY 2,035,000 20
21 23-Mar-18 174910 CAECILIA SRI WAHYUNI NY 2,035,000
22 24-Mar-18 221709 SUGIANTO TJAHYONO 2,035,000
23 28-Mar-18 231531 ARLIN SUSIATI NY 2,035,000
24 28-Mar-18 236091 SITI MUSYAYADAH 2,035,000
25 28-Mar-18 44265 SUGIK NURHAYATI NY/ANGGORO 2,035,000
26 29-Mar-18 136564 KHUTOBAH NY 2,035,000
27 29-Mar-18 150311 FREDDY ANDREANTO 2,035,000
28 29-Mar-18 238110 AHMAD MUTOHAR 2,035,000
29 01-Mar-18 236056 WIWIK INDRAYANI 2,035,000
30 01-Mar-18 235992 ROFI'AH NY 2,585,000
31 05-Mar-18 230704 SUYATI 2,585,000
32 10-Mar-18 153836 TAN MEECU 2,035,000
33 20-Mar-18 212345 RUDI HARTONO TN 1,021,900
34 24-Mar-18 25967 SUMARNO TN 2,035,000
35 26-Mar-18 25967 SUMARNO TN 2,035,000
36 27-Mar-18 67366 WIVIANO RIZKY TANTOWI AN SOS 1,127,500
TOTAL 72,989,400

MEI JUNI
NO TANGGAL NO.RM NAMA PASIEN TARIF NO
1 02-May-18 80869 SOFIA ARIEFIANA POERWANTO NY 2,035,000 1
2 04-May-18 239328 MOHAMAD ZULMI 2,035,000 2
3 07-May-18 239938 WAHYU FELIKS TANOTO 2,035,000 3
4 07-May-18 236292 SUMARIYONO 2,035,000 4
5 07-May-18 182430 SAMSUL BAHRI TN 2,035,000 5
6 07-May-18 222939 HERU S. P SAPUTRA 2,035,000 6
7 08-May-18 138378 AFFAN NUR MAJID AN 2,035,000 7
8 09-May-18 206843 EMI HARTATIK 2,035,000 8
9 14-May-18 209473 RAHMI NY / PT. POS 2,585,000 9
 10 16-May-18 239711 SHINTA MAYASARI 1,595,000 10
11 16-May-18 240978 BAGUS IKHWAN CRISTIAN TN / KAPOLR 1,595,000 11
12 18-May-18 209473 RAHMI NY / PT. POS 2,145,000 12
13 23-May-18 241084 TUKILAH NY 2,035,000 13
14 24-May-18 43 HAFID MUDLORI/00101807 2,035,000 14
15 26-May-18 240469 BUDI SANTOSO TN 2,035,000
16 28-May-18 240461 SLAMET RAHARDJO 2,035,000
17 28-May-18 234613 IMAM DARIYANTO 2,035,000
18 07-May-18 240097 RR SRI KAMIYATI 2,035,000
19 12-May-18 172662 SUDIRMAN TN 2,035,000
20 24-May-18 113273 SITI SHOLEHA HJ NY 2,035,000
21 28-May-18 176042 MELATI KUSUMA DEWI NY 2,520,100
TOTAL 43,000,100

JULI AGUSTUS
NO TANGGAL NO.RM NAMA PASIEN TARIF NO
1 05-Jul-18 135649 NYOMAN GEDE KHRISNABUDI TN 1,870,000 1
2 05-Jul-18 243283 JONI AHLIAWAN 1,870,000 2
3 05-Jul-18 176919 UMI KALSUM NY 1,870,000 3
4 07-Jul-18 223777 ESTI KRISDANINGRUM NY 1,870,000 4
5 09-Jul-18 212726 ROSNA WILIS 1,870,000 5
6 09-Jul-18 241460 SULANJI TN 1,870,000 6
7 09-Jul-18 121068 SUSANA ATIKASARI NN 1,870,000 7
8 11-Jul-18 224190 ARIEF ROCHMAN 1,870,000 8
9 16-Jul-18 240296 ERLIK HANDAYANI NY 1,870,000 9
10 16-Jul-18 243071 ANJAR SASMITO AJI TN 1,870,000 10
11 16-Jul-18 205090 WAHYU ORBANING PUTRI NY 1,870,000 11
12 17-Jul-18 21747 BURAWI SUGIANTO TN PENS 1,870,000 12
13 17-Jul-18 240923 HARTONO 1,870,000 13
14 18-Jul-18 241996 RIZAL PRASETYA 1,870,000 14
15 19-Jul-18 227060 ROHIM 1,870,000 15
16 20-Jul-18 1394 SUHARTINI ASRAH/51901024 RSP 1,870,000 16
17 23-Jul-18 205564 SITI MARIYAM 1,870,000 17
18 24-Jul-18 243730 YULI PRAYANA 1,870,000 18
19 25-Jul-18 230194 SUHARI 1,870,000 19
20 27-Jul-18 74777 SUSIANA NY 1,870,000 20
21 27-Jul-18 127744 AHMAD MUZAMMIL TN 1,870,000 21
22 31-Jul-18 202714 WIGNJO LIANTO TN 1,870,000 22
23 04-Jul-18 243673 SOERYADI TN 2,420,000 23
24 06-Jul-18 210902 WALIDATUL JANNAH NY 3,740,000 24
25 10-Jul-18 137741 EKO ENDANG ERNAWATI NY 1,760,000 25
26 10-Jul-18 243785 SUCI ARINI 2,520,100 26
 27 24-Jul-18 244983 HELENA KORO NY 1,127,500 27
28 25-Jul-18 245154 AHMAD IRFAN MAULANA HADI SDR 2,310,000 28
29 26-Jul-18 231325 WAHYU HERMININGTYAS 1,870,000 29
30 31-Jul-18 32097 LEO SURYO SANTOSO TN DJAR 1,760,000 30
TOTAL 58,647,600 31
32
33
34
35
36

SEPTEMBER OKTOBER
NO. TANGGAL NO. RM NAMA PASIEN TARIF NO.
1 01-Sep-18 179502 LELY WIDORINI NY 1,925,000 1
2 03-Sep-18 10482 TRI MUJI WILUJENG NY 1,925,000 3
3 04-Sep-18 47255 REYSMA HIDAYAH NN 1,870,000 4
4 04-Sep-18 32538 CUCK LEE TN 1,925,000 5
5 04-Sep-18 109774 UMI HANIK NY 2,475,000 6
6 05-Sep-18 243932 SITI FATIMAH NY 1,925,000 7
7 05-Sep-18 246193 RUDI YULIA FERDIANTO 1,925,000 8
8 06-Sep-18 244104 BUDIYONO 1,925,000 9
9 07-Sep-18 862 RUSNANIK/51901089 RSP 1,925,000 10
10 08-Sep-18 173403 SUHAYAH NY 1,925,000 13
11 10-Sep-18 4540 BRYAN ANDRIKA BAHARI SDR 1,925,000 14
12 10-Sep-18 184650 SRI SURYANI 1,925,000 15
13 10-Sep-18 171594 NOVA AFFENDI TN 1,925,000 16
14 12-Sep-18 112232 RINA APRILIA Y NY 1,925,000 17
15 12-Sep-18 248467 DULKHALIM TN 1,925,000 18
16 14-Sep-18 47699 TRI UTARI NY 1,925,000 19
17 15-Sep-18 248719 ACHMAD RUSDIANTO 1,925,000 21
18 17-Sep-18 28019 EDDY SURYONO TN 1,925,000 22
19 17-Sep-18 196516 ENDANG SULASTRI 1,925,000 24
20 18-Sep-18 243808 HAIRATUN 1,925,000 25
21 18-Sep-18 100668 HAMIDAH 1,925,000 26
22 18-Sep-18 178062 DJUERNA NY 2,475,000 27
23 22-Sep-18 193225 ANDHINI PRADIPTA W 2,475,000 28
24 22-Sep-18 248449 MUSTOFA 1,925,000 29
25 24-Sep-18 169050 FATHOR ROHMAN 1,925,000 31
26 24-Sep-18 209047 SUBAGIO 1,925,000 33
27 26-Sep-18 36190 SITI RUKAYAH NY 1,925,000 34
 28 26-Sep-18 214775 SUTRISNO BUDIARJO TN 2,475,000 35
29 26-Sep-18 49438 IRINE DEWI PATRIANINGSIH NY 1,925,000 36
30 26-Sep-18 249720 SITI SUHARNI NY 1,925,000 37
31 26-Sep-18 243058 NOVI SUSANA 1,925,000 39
32 27-Sep-18 244518 WIWIK SRI HARYUDIATI NY 1,925,000 40
33 27-Sep-18 246368 SUTRISNO 1,925,000 41
34 28-Sep-18 240458 KRISTYO PRABUDI TN 1,925,000 42
35 29-Sep-18 52746 YENIS PRATIWI INDAH S NY 1,925,000 43
36 12-Sep-18 248270 RIZKI FAJAR PRASETYO 2,475,000 44
37 20-Sep-18 242392 SRI WAHYUNINGSIH 1,925,000 45
38 22-Sep-18 249246 MOCH. QOMARUN TN 1,925,000 46
39 28-Sep-18 99611 TJANDRA GUNAWAN LIMANTO TN 1,925,000 47
TOTAL 77,770,000 48
49
50
52
53
54
55
56
57
58
59
60
61
62
63
64
65

NOVEMBER DESEMBER
NO. TANGGAL NO.RM NAMA PASIEN TARIF NO.
1 01-Nov-18 128015 RENATA REFANIA TAN WINARDI AN 1,925,000 1
2 02-Nov-18 213745 THALIA ANISYA DEWI 1,925,000 2
3 05-Nov-18 123939 HARIYONO H TN 1,925,000 3
4 05-Nov-18 101774 ARI WIDAYATI NY 1,925,000 4
5 05-Nov-18 250999 EDI WIDODO TN 1,925,000 5
6 05-Nov-18 252536 DEWI NUR MASITA 1,925,000 6
7 06-Nov-18 247369 TITI RAHAYU 1,925,000 7
8 06-Nov-18 251222 SITI SULIMAH 1,925,000 8
 9 06-Nov-18 219585 PAIMIN 1,925,000 9
10 07-Nov-18 5275 RIVAI TN/51401235 KRT 1,925,000 10
11 07-Nov-18 123164 RIANDINATA PS SDR 1,925,000 11
12 07-Nov-18 250478 SITI SUBAIDAH 1,925,000 12
13 08-Nov-18 73698 KRT SUTHEDJO ADINEGORO TN 1,925,000 13
14 08-Nov-18 92448 SITONO PAMUNGKAS 1,925,000 14
15 09-Nov-18 229339 SRI MULYANI 1,925,000 15
16 09-Nov-18 253392 MUAWANAH 1,925,000 16
17 12-Nov-18 168324 SUNI HERIYANTO 1,925,000 17
18 12-Nov-18 251722 ENDANG SOELASMI NY 1,925,000 18
19 12-Nov-18 253749 SLAMET RIYADI 1,925,000 19
20 12-Nov-18 149055 MUTMAINAH NY 1,925,000 20
21 13-Nov-18 251354 SUMINI 1,925,000 21
22 13-Nov-18 35281 RERI FITASARI NY RSP 2,475,000 22
23 13-Nov-18 193272 ERNI ANTIKA 1,925,000 23
24 14-Nov-18 247869 ZUMAROH NY 1,925,000 24
25 14-Nov-18 253242 SUNJOTO 1,925,000 25
26 16-Nov-18 142626 TILAH NY 1,925,000 26
27 16-Nov-18 250933 FARADIN ADYATAMA 1,925,000 27
28 16-Nov-18 201100 WIWIK HARTATIK 1,925,000 28
29 19-Nov-18 103473 ROBBY TN 1,925,000 29
30 21-Nov-18 50068 ERY FOLYA NY/SAMI TELKOM 1,925,000 30
31 21-Nov-18 249938 SRI HARTATIK 1,925,000 31
32 21-Nov-18 141334 DIAN NUGRAHINI NY 1,925,000 32
33 21-Nov-18 254667 SRI HARTATIK WULANDARI 1,925,000 33
34 22-Nov-18 249691 AGUSTIN PUJASWATI 1,925,000 34
35 22-Nov-18 250426 WIWIT WIJAYANTO TN 1,925,000 35
36 22-Nov-18 1929 SUTARTI WIDIYANTO NY PENS 1,925,000 36
37 23-Nov-18 159855 MUSIYAM 1,925,000 37
38 24-Nov-18 169277 MELATI NY 1,925,000 38
39 26-Nov-18 172105 LIANAWATI NY 1,925,000 39
40 26-Nov-18 206445 LUTFIAH NY 1,925,000 40
41 27-Nov-18 75367 QOMARIYAH NY 1,925,000 41
42 27-Nov-18 216558 SITI FATIMAH 1,925,000 42
43 28-Nov-18 177888 CHRISTINA SULISTYOWATI NY 1,925,000 43
44 28-Nov-18 73733 LUSI INDRAWATI NY 1,925,000 44
45 28-Nov-18 241460 SULANJI TN 1,925,000 45
46 28-Nov-18 178805 MAHFUT TN 1,925,000 46
47 29-Nov-18 232668 HALIMATUS SA'DIYAH 1,925,000 47
48 29-Nov-18 246749 SUNARTO 1,925,000 48
49 29-Nov-18 230786 UMAIDI RADI TN 1,925,000 49
50 29-Nov-18 255135 MINARTIK 2,200,000 50
51 30-Nov-18 178523 R.A. SRIWAHYOE 1,925,000 51
52 30-Nov-18 109077 ENDANG SUDARTIK NY 1,925,000 52
53 03-Nov-18 252865 DEBBY CHINTIA SUSILO 1,925,000 53
54 10-Nov-18 253830 SENETO 2,475,000 54
55 10-Nov-18 11954 RUSTAM TN TELKOMSEL 1,925,000
56 13-Nov-18 250840 TRENYUH SIH WINANCI 1,925,000
57 26-Nov-18 254893 JUNI RAHAYU 1,925,000
TOTAL 111,100,000
 ADIOLOGI LUAR (MRI)
N 2018

FEBRUARI
TANGGAL NO.RM NAMA PASIEN TARIF
01-Feb-18 106772 AHMAD SHOLIHIN TN 2,035,000
02-Feb-18 126026 ACHMAD MANSUR TN 2,035,000
03-Feb-18 80467 NOVAL FERDYANSAH MACHMUD TN 2,035,000
06-Feb-18 220956 ABD HADI TN 2,035,000
06-Feb-18 188360 HUSEN TN 2,035,000
08-Feb-18 234823 ARI SUWARSIH TN 2,585,000
10-Feb-18 234855 SANDY HIDAJANTO TN 2,035,000
12-Feb-18 33380 INTANIA EVANGELINE AN 2,585,000
13-Feb-18 60474 HUDZAIFAH UL MUFIDA NY 2,035,000
16-Feb-18 4386 HEPIYANI NY/WEWENG S KRT 2,035,000
19-Feb-18 230209 TRI KOESOEMA RATNAWATI NY 2,035,000
20-Feb-18 223193 ENDANG PUSPITOWATI 2,585,000
21-Feb-18 123142 ESTI SULISTYOWATI NY 2,035,000
26-Feb-18 230050 AGUS PRAWITO 2,035,000
26-Feb-18 45150 SUCI LESTARI NY BRI 2,035,000
26-Feb-18 117033 YAYUK MURYANINGSIH NY 2,035,000
27-Feb-18 133859 MELIANA FRANSISKA NY 2,035,000
03-Feb-18 111783 GUNAWAN GANDA WIJASA TN 2,035,000
05-Feb-18 66190 DYNASTHI DWI C NY 1,131,900
15-Feb-18 228894 MATSANI KARNO 1,576,300
21-Feb-18 29099 SUPRIYONO TN BCA 2,585,000
26-Feb-18 204488 KHOLID MAWARDI 2,035,000
26-Feb-18 235786 ASIH KRISMARTIWI NY 2,035,000
TOTAL 47,643,200

APRIL
TANGGAL NO.RM NAMA PASIEN TARIF
02-Apr-18 237834 ERFAN EFENDI TN 2,035,000
05-Apr-18 226169 SHOFWAN HAMID TN 2,035,000
05-Apr-18 2340 FATAH MUDRIYANTO TN 2,035,000
09-Apr-18 180004 MEISYA CHALINDA BERVI AN 2,585,000
09-Apr-18 225694 MARYOKO 2,035,000
09-Apr-18 237780 JAENAL ABIDIN AMINULLAH 2,035,000
11-Apr-18 100668 HAMIDAH 2,035,000
13-Apr-18 62407 FAHRUROJI TN 2,035,000
16-Apr-18 237645 SARMIATUN 2,035,000
17-Apr-18 5107 MISTRO TN/51401044 KRT/II 2,035,000
20-Apr-18 3439 RISQI ROSANDI TN 2,035,000
20-Apr-18 206000 M HABIBULLOH AL MAHBUBI AN 2,035,000
24-Apr-18 170778 AAT RUSMIATI NY 2,035,000
25-Apr-18 182573 ARISANDI BISMO SDR 2,035,000
27-Apr-18 228050 WAHYUNI 2,035,000
28-Apr-18 197612 KUSMINA 2,035,000
02-Apr-18 2444 PURWANI P NY/00101867 RSP 2,035,000
25-Apr-18 221957 HANNY QURROTUL AINI 1,127,500
27-Apr-18 224351 AGNETA FRANCISCA NY 2,035,000
28-Apr-18 40923 NURSALIM IR MT 2,035,000
TOTAL 40,342,500

TANGGAL NO.RM NAMA PASIEN TARIF

05-Jun-18 20809 EKO ROESBIYANTO TN 2,035,000
06-Jun-18 131194 HENDRA AGUNG KURNIAWAN SDR 2,035,000
06-Jun-18 62332 ISMHA PUNJUNG NY 2,035,000
06-Jun-18 16105 SUPRI WAHYUDI TN 2,035,000
06-Jun-18 227358 SRI WIGATI 2,035,000
06-Jun-18 242181 ROHANI SRI HANDAYANI NY 2,035,000
08-Jun-18 131134 MELISA LIEM 1,760,000
23-Jun-18 242772 TAN BOK LAN 2,035,000
25-Jun-18 207521 AISYAH GHAZALI 1,760,000
 26-Jun-18 168568 IVA LUTFIAH NY 1,760,000
26-Jun-18 135649 NYOMAN GEDE KHRISNABUDI TN 1,760,000
09-Jun-18 100197 ONG HWA ING NY 1,650,000
27-Jun-18 242988 ALIM MASHURIL CHAQQI 1,650,000
29-Jun-18 200374 YUVANI NY 1,650,000
TOTAL 26,235,000

AGUSTUS
TANGGAL NO.RM NAMA PASIEN TARIF
02-Aug-18 244214 SUWANDI TN 1,870,000
02-Aug-18 211001 JIMMY SJARKANI 1,925,000
02-Aug-18 241808 DYAH EKA RINI PRASETYA 1,925,000
02-Aug-18 172177 SUPARTI BUDI ASTUTI NY 1,925,000
02-Aug-18 118738 SRI KUSTINI NY 1,925,000
02-Aug-18 197701 ALFIN NUR AFNI 1,925,000
03-Aug-18 218193 MARIA THERESIA TRISILOWATI 1,870,000
04-Aug-18 245256 FILINA 1,870,000
04-Aug-18 3455 SUBANI/27009162 KRT 1,925,000
04-Aug-18 197713 AGUNG NILOGIRI 1,925,000
04-Aug-18 214845 YUYUL KRISNAWATI 1,925,000
06-Aug-18 118869 PUTUT PURWONODADI TN 1,925,000
06-Aug-18 245709 ABDUL KARIM 1,925,000
10-Aug-18 195683 elyzabeth santoso 1,925,000
10-Aug-18 246365 ACHMAD RIF'AT 1,925,000
11-Aug-18 96721 HENNY OCTAVIANI 1,925,000
11-Aug-18 243115 BUNGA KASIH 1,925,000
16-Aug-18 246687 HERI SETYONO 1,925,000
20-Aug-18 87000 TRI ENDANG UDAYANI NY 1,925,000
20-Aug-18 169039 LUKMAN HAKIM TN 1,925,000
23-Aug-18 1051 APRILIA HELMI NY RSP 1,925,000
24-Aug-18 14085 SAHID TN MT 1,925,000
27-Aug-18 215766 SIH INDAH PUDJIATI 1,925,000
27-Aug-18 165916 SITI WAQIAH 1,925,000
27-Aug-18 176857 CHOIRIL SDR 1,925,000
27-Aug-18 237799 NAFIK MUSTOFA TN 1,925,000
 29-Aug-18 226534 SUMARNI 1,925,000
30-Aug-18 6016 DODI WIDYOTOMO TN MT 1,925,000
30-Aug-18 21747 BURAWI SUGIANTO TN PENS 1,925,000
31-Aug-18 173077 RAHAYU SRI SAYEKTI NY 1,925,000
01-Aug-18 165612 MURWANI NY 1,870,000
03-Aug-18 245818 SULASTRI NY 2,475,000
13-Aug-18 246270 MOCH ROCHANI 1,925,000
15-Aug-18 4228 IMAM DJARKASIE TN 1,925,000
24-Aug-18 247107 SUSANTI 1,331,000
27-Aug-18 247293 SUYATNO 1,925,000
TOTAL 61,930,000

OKTOBER
TANGGAL NO.RM NAMA PASIEN TARIF
01-Oct-18 169782 JUMAIDAH NY 2,475,000
02-Oct-18 226239 WAHYU DIANASARI 1,925,000
02-Oct-18 247834 SUMARTINI 1,925,000
03-Oct-18 242079 HARYONO TN 1,925,000
03-Oct-18 250346 GUNTORO TN 1,925,000
03-Oct-18 98899 INDAH FARHATIN NY 1,925,000
04-Oct-18 235084 DEWI ISNIAWATI 1,925,000
05-Oct-18 247870 SUKANDAR NASUTION 1,925,000
05-Oct-18 242752 RATNAWATI 1,925,000
08-Oct-18 250715 SUKADI 1,925,000
10-Oct-18 228988 BAIDOWI ACHMAD 1,925,000
10-Oct-18 250122 SAMIYATI 1,925,000
10-Oct-18 123875 VANTI SANTILA NY 1,925,000
11-Oct-18 246677 SUMARWAN TN 1,925,000
11-Oct-18 3835 BIRIN RAHARDJO/92000002 PENS 1,925,000
11-Oct-18 240236 BAMBANG RUDIYANTO 1,925,000
11-Oct-18 251124 FITRIA CANDRA 1,925,000
12-Oct-18 249309 VIVIN TRI NOVIA KRISTIN 1,925,000
15-Oct-18 247519 DEWI LUQMANA SARI 1,925,000
16-Oct-18 240151 M JUNIAR RAHMATULLAH 1,925,000
17-Oct-18 145552 DJAMIL ABDULLAH TN 1,925,000
17-Oct-18 251591 KINTOKO AJI 1,925,000
18-Oct-18 95409 DYAH HANDAYANI NY 1,925,000
18-Oct-18 79337 SRI ASTUTIK NY/TN SOEWITO TELK/B 2,475,000
18-Oct-18 181701 UMI HAZIZAH NY 1,925,000
19-Oct-18 120922 ANNIE / ANNY NY 1,925,000
20-Oct-18 13756 ELFIN DEWI LESTARI NY SIMAS 1,925,000
 22-Oct-18 248430 RUMANITA SEMBIRING MELIALA 1,925,000
22-Oct-18 94665 EVI SURATI NY 1,925,000
22-Oct-18 250204 HILMY ATHA SITEPU 1,925,000
24-Oct-18 249567 SUMARNO 1,925,000
24-Oct-18 252237 AGUS HERY SULAKSONO 1,925,000
25-Oct-18 40984 A ANDRI RISKI NY 1,925,000
25-Oct-18 60351 GHURFATIN NY 1,925,000
25-Oct-18 252343 RUTJI ATININGSIH 1,925,000
25-Oct-18 235830 SITI KHOTIJAH NY 1,925,000
26-Oct-18 196554 RETNOWATI 1,925,000
26-Oct-18 249547 MUDJANNAH 1,925,000
29-Oct-18 252210 SENIMAN 1,925,000
29-Oct-18 221563 SOEKARNI NY 1,925,000
30-Oct-18 34221 ANI MUSRIFAH NY 1,925,000
30-Oct-18 252266 SLAMET SANTOSO 2,475,000
31-Oct-18 248309 SENTOT PIETONO 1,925,000
31-Oct-18 237643 ABBU HUROEROH TN 1,925,000
31-Oct-18 198348 DINA AYUSFI MANGGARSARI 1,925,000
31-Oct-18 252589 NUR MUZDALIFAH NY 1,925,000
01-Oct-18 249865 FATHUR RAHMAN 1,925,000
08-Oct-18 49061 SUNARDI TN 1,598,300
08-Oct-18 107798 LINDAWATI PRAKARSA NY 2,929,300
10-Oct-18 49061 SUNARDI TN 2,520,100
12-Oct-18 213354 MUSTIKA WATI 1,331,000
15-Oct-18 155758 MUHAMMAD FAUZI 2,475,000
24-Oct-18 230489 PONIDI HARIYADI TN 1,925,000
29-Oct-18 252481 NADIA FIMELIA 2,475,000
30-Oct-18 252489 SUKANI TN 2,998,600
30-Oct-18 225355 MARDOKO 1,925,000
TOTAL 112,302,300

DESEMBER
TANGGAL NO.RM NAMA PASIEN TARIF
01-Dec-18 168185 SISWANTO TN 1,925,000
03-Dec-18 79469 PUGUH AHMAD WIYONO TN 1,925,000
03-Dec-18 206342 MEIKZAL DWI SASETYO 1,925,000
04-Dec-18 37817 SUMINAH KARTOSOMO NY 1,925,000
04-Dec-18 233183 WAHYUNI BUDI HARTATIK NY 1,925,000
04-Dec-18 29526 SRI SUKINI 1,925,000
04-Dec-18 251377 SITI MARYAM 1,925,000
04-Dec-18 173566 MUZAYANAH SUPIAH NY 1,925,000
04-Dec-18 567 SRI RAHAYU NY/00101583 RSP 1,925,000
05-Dec-18 214440 DJUHARIYAH NY 1,925,000
05-Dec-18 4882 ENDANG SUNARTI NY/SUBANI 1,925,000
05-Dec-18 227487 DR NANANG HARI WIBOWO 1,925,000
07-Dec-18 253912 QOMARIYAH NY 1,925,000
07-Dec-18 141809 TJITRA WENI JANA PRASETYA NY 1,925,000
07-Dec-18 194948 SOLICHAH 1,925,000
08-Dec-18 95578 TITIK HARIYANTI NY 2,475,000
10-Dec-18 197784 SULONO, SE 1,925,000
11-Dec-18 214354 CIPTO KUSUMO HADI 1,925,000
13-Dec-18 253371 BROHIM SINAGA 1,925,000
13-Dec-18 191645 INDAH TRISNAWATI 1,925,000
13-Dec-18 167529 WIWIT SRIWAHYUNI NY 1,925,000
13-Dec-18 255717 M. SAID TN 1,925,000
13-Dec-18 197701 ALFIN NUR AFNI 1,925,000
14-Dec-18 153133 ENTIYANI ASTUTI NY 1,925,000
17-Dec-18 181836 NANI YULI HASTUTI NY 1,925,000
17-Dec-18 226527 SUGIATI 1,925,000
18-Dec-18 62452 NUGRAHADI TN 1,925,000
18-Dec-18 224274 SULIS MUZAMMIL 1,925,000
18-Dec-18 15950 ACH DEVANDA JAKFARI 1,925,000
20-Dec-18 68326 AGUS PAIMUN TN 1,925,000
21-Dec-18 254927 SUWOKO PONCO JATMIKO 2,475,000
21-Dec-18 178160 WIDYAWATI NY 1,925,000
22-Dec-18 116241 SRI ANINGSIH NY 1,925,000
24-Dec-18 130226 LILIS SRIWANING NY AVIVA 1,925,000
26-Dec-18 103209 IMAM SUPARDI SYAM TN 1,925,000
27-Dec-18 242015 SUSILOWATI NY 1,925,000
27-Dec-18 249656 SUHARTATIEK 1,925,000
27-Dec-18 18309 HOSNAN TN/51401111 KRT 1,925,000
28-Dec-18 250509 SOETJIPTO YADI 1,925,000
28-Dec-18 250204 HILMY ATHA SITEPU 1,925,000
28-Dec-18 90906 NUR HANIFAH NY 1,925,000
29-Dec-18 252223 MASRUR BAIHAQI 1,925,000
31-Dec-18 169677 ELI WALUYO TN 1,925,000
31-Dec-18 185614 EL INAYAH 1,925,000
31-Dec-18 255480 BIYARSIH 1,925,000
31-Dec-18 255153 FARIDA ARIANI NY 1,925,000
03-Dec-18 255362 SITI HAMIDAH 1,925,000
04-Dec-18 53003 HERIYATI NY 3,030,200
11-Dec-18 246167 MALIHATUL FIQHIYAH 2,475,000
17-Dec-18 10482 TRI MUJI WILUJENG NY 1,331,000
18-Dec-18 248756 MASRUL UMMAH NY 2,998,600
19-Dec-18 248756 MASRUL UMMAH NY 3,907,200
19-Dec-18 61859 SUPRIHATIN NY 3,797,200
20-Dec-18 46144 YUDI PRASOJO TN 2,475,000
TOTAL 111,589,200
 DATA PEMERIKSAAN RADIOLOGI LUAR (MRI)
TAHUN 2019

JANUARI FEBRUARI
NO. TANGGAL NO.RM NAMA PASIEN TARIF NO.
1 02-Jan-19 257673 NANIK INDRIYANI 1,925,000 1
2 02-Jan-19 62407 FAHRUROJI TN 1,925,000 2
3 03-Jan-19 257758 ABDUL GAFUR 2,475,000 3
4 04-Jan-19 1775 SURATINI DR/00101476 RSP 1,925,000 4
5 04-Jan-19 252092 HERIYANTO 1,925,000 5
6 05-Jan-19 200714 SUPARDI 1,925,000 6
7 07-Jan-19 79225 LILIK SUCIATI NY 1,925,000 7
8 08-Jan-19 256077 SRI WIDAYATI 1,925,000 8
9 08-Jan-19 206818 FAJRIN NURMAN ARIFIN 2,475,000 9
10 09-Jan-19 255445 SRI MUJI MULYANI 1,925,000 10
11 09-Jan-19 251725 RIKO KURNIAWAN 1,925,000 11
12 10-Jan-19 12654 DIAN ANGGRAENI RAHAYUNINGTYAS NY 1,925,000 12
13 10-Jan-19 255356 SUCIATININGSIH 1,925,000 13
14 10-Jan-19 17231 EKA RACHMAWATI S/GATOT S PLN 1,925,000 14
15 11-Jan-19 255207 MAIDEL BAZMUR 1,925,000 15
16 11-Jan-19 251386 ROBERT HARIONO 1,925,000 16
17 11-Jan-19 257077 SUPARMAN 1,925,000 17
18 12-Jan-19 256670 KARTONO 1,925,000 18
19 12-Jan-19 256037 WARSO TN 1,925,000 19
20 14-Jan-19 157611 CHOIRIYAH NY 1,925,000 20
21 14-Jan-19 256331 SIDEH 1,925,000 21
22 15-Jan-19 203644 M NOER SALIM 1,925,000 22
23 15-Jan-19 254246 MISYANINGSIH 1,925,000 23
24 16-Jan-19 255670 TUKI SUHERMAN TN 1,925,000 24
25 17-Jan-19 157087 EVA NURFADILAH NY 1,925,000 25
26 17-Jan-19 240998 M SLAMET ARYO SUBANDI 1,925,000 26
27 17-Jan-19 34859 ELY YULI ASTUTIK NY 1,925,000 27
28 18-Jan-19 232440 IIN INDAHYANI 1,925,000 28
29 19-Jan-19 255830 TOTOK MARDIANTO 1,925,000 29
30 21-Jan-19 254010 DANIEL EKO PRASETYO 2,475,000 30
31 21-Jan-19 257414 AMSITI 1,925,000 31
32 21-Jan-19 183247 SOEPARMI 1,925,000 32
33 22-Jan-19 198118 EVA TRIANDAYANI 1,925,000 33
34 22-Jan-19 8096 TEJASARI NY 1,925,000 34
35 22-Jan-19 74057 ANNE NUR AISYA NN 2,475,000 35
36 22-Jan-19 241533 IKA HARIANI NY 1,925,000 36
37 23-Jan-19 256902 HENDRIYONO 1,925,000 37
38 24-Jan-19 37015 ENDANG SRI DJATMIKOWATI NY 1,925,000 38
39 25-Jan-19 257347 SUTOPO SAJIT S, IR TN 1,925,000 39
40 28-Jan-19 221165 FARIDAH UMAR 1,925,000 40
41 28-Jan-19 247310 HERY KRISTIYANI 1,925,000 41
42 29-Jan-19 98507 ERLINA HADI DR NY 1,925,000 42
43 29-Jan-19 222593 SRIJATI 1,925,000 43
44 30-Jan-19 258201 SUTIYAH 1,925,000 44
45 30-Jan-19 257757 SRI SUPRIYATININGSIH 1,925,000 45
46 30-Jan-19 184576 HENNY RACHMAWATI NY 1,925,000 46
47 30-Jan-19 231990 MUHAMMAD SOFWAN 1,925,000 47
48 31-Jan-19 81989 ENDANG SITOPANINGSIH NY 1,925,000 48
49 04-Jan-19 257558 ATIM 2,475,000 49
50 08-Jan-19 249389 MATTASAN H 1,925,000 50
51 09-Jan-19 256928 KISWATI 2,475,000 51
TOTAL 101,475,000
FEBRUARI
TANGGAL NO.RM NAMA PASIEN TARIF
01-Feb-19 111461 RAHADIAN PRIBADI TN 2,475,000
02-Feb-19 167196 SRIATI MULYANINGSIH NY 1,925,000
04-Feb-19 181416 LINARSIH 1,925,000
04-Feb-19 225302 DWI OKTA PANGESTIKA NN 1,925,000
06-Feb-19 87096 SUPARMI NY 1,925,000
07-Feb-19 92232 LIDIA MELANIA NY 1,925,000
07-Feb-19 258762 KUTIYAH 1,925,000
07-Feb-19 1266 IDI WISAKSONO TN MT/I 1,925,000
07-Feb-19 253119 DIAN ASTARINI 1,925,000
07-Feb-19 33817 JAMILA 1,925,000
07-Feb-19 241334 SITI ROCHANI NY 1,925,000
08-Feb-19 254687 LULUK SISWATI 1,925,000
08-Feb-19 252237 AGUS HERY SULAKSONO 1,925,000
08-Feb-19 59598 LUH PUTU EKA NY 1,925,000
09-Feb-19 255790 SUDARMI 1,925,000
09-Feb-19 93778 KHOLISHOH LISTIANA 1,925,000
11-Feb-19 258540 SUUDI 1,925,000
11-Feb-19 243680 JUNUS 1,925,000
11-Feb-19 218164 HAMDI TN 1,925,000
11-Feb-19 144395 SUHAENI NY 1,925,000
12-Feb-19 254132 NI NJOMAN NANA S NY 1,925,000
13-Feb-19 258552 GINI 1,925,000
13-Feb-19 178108 LUCY ANDRIANY NY 1,925,000
13-Feb-19 161001 KOMSIAH NY 1,925,000
15-Feb-19 172837 ANNA SRI BUDI LESTARI NY 1,925,000
15-Feb-19 260699 SUWADJI TN 1,925,000
16-Feb-19 53883 HIDAYATI SUMANINGSIH NY P.BI 1,925,000
16-Feb-19 233206 FIBRI KUSTANTINI NY 1,925,000
18-Feb-19 73355 INTAN WAHYU PURBASARI NN 1,925,000
19-Feb-19 259420 SITI RUQOYYAH 1,925,000
19-Feb-19 180504 YULIA ZULKARNAEN NY 1,925,000
19-Feb-19 260317 TOSAN 2,475,000
20-Feb-19 201421 ADETHIA GEMA MAHARDHEKA 1,925,000
20-Feb-19 258195 HERY BAMBANG CAHYON 1,925,000
21-Feb-19 249680 UMMI KULTSUM 1,925,000
21-Feb-19 191323 INDRAWATI NY 1,925,000
21-Feb-19 207842 NENENG SRIWONO ENDANG NY 2,475,000
21-Feb-19 257152 EDI SUGIARTO TN 1,925,000
21-Feb-19 261326 MUKHLASIN 1,925,000
22-Feb-19 260094 KETOK RAHAYU 1,925,000
23-Feb-19 93657 SARTONO TN 1,925,000
26-Feb-19 150074 SITI HALIMAH NY 1,925,000
26-Feb-19 248446 YOYOK WALUYO 1,925,000
27-Feb-19 257240 SOFIYANTI 1,925,000
27-Feb-19 29473 BAMBANG ISNARNO TN 2,130,700
28-Feb-19 259386 ABDUL KOHAR 1,925,000
28-Feb-19 105697 DWI SUHARTATIK NY /IDHA TUPEN 1,925,000
01-Feb-19 60389 EVIE PRASETYO LESTARI NY 2,475,000
13-Feb-19 246681 RAHMA PUTRI WARDANI 3,577,200
26-Feb-19 97421 MOCHAMMAD ADIL 1,331,000
28-Feb-19 20964 ERRY DAMAYANTI NY/CHAYUDI MT 1,925,000
TOTAL 101,638,900