REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP PIHAK KETIGA (PIII)

RUANG TULIP BULAN JANUARI 2016

KELAS VIP
NO. NAMA TANGGAL MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
PASIEN MASUK KELUAR PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI
1 Djasp A Hiong 9 11 2 30,000 1 8,000 1 21,000 1 8,000 1 21,000 6 88,000
2 Dwi Satrio 6 8 2 30,000 2 16,000 2 42,000 1 8,000 1 21,000 8 117,000
3 Men Djang 3 5 2 30,000 3 24,000 3 63,000 2 16,000 2 42,000 12 175,000
4 Nyimas Elfira 31 1 1 15,000 1 8,000 1 21,000 1 8,000 1 21,000 5 73,000
5 Rudianto Liu 13 15 2 30,000 2 16,000 2 42,000 1 8,000 1 21,000 8 117,000
TOTAL 9 135,000 9 72,000 9 189,000 6 48,000 6 126,000 39 570,000

AHLI GIZI

MAYASARI

REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP PIHAK KETIGA (P III)

RUANG TULIP BULAN JANUARI 2016

KELAS 1
NO. NAMA TANGGAL MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
PASIEN MASUK KELUAR PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI
1 Deli Natalis 13 14 1 14,000 1 7,500 1 17,000 1 7,500 1 17,000 5 63,000
2 Resi 16 18 2 28,000 2 15,000 3 51,000 3 22,500 2 34,000 12 150,500
3 Yap Sui Khin 14 19 5 70,000 5 37,500 5 85,000 4 30,000 4 68,000 23 290,500
4 Aca Suganda 3 6 3 42,000 3 22,500 3 51,000 2 15,000 2 34,000 13 164,500
5 Samuel Didik 3 6 3 42,000 3 22,500 3 51,000 3 22,500 3 51,000 15 189,000
6 Herry Novyana 6 9 3 42,000 3 22,500 3 51,000 3 22,500 3 51,000 15 189,000
7 Okberto 11 13 2 28,000 2 15,000 2 34,000 2 15,000 2 34,000 10 126,000
8 Hairudin 13 14 1 14,000 1 7,500 1 17,000 1 7,500 1 17,000 5 63,000
9 Syamsiar Bochri 30 9 10 140,000 11 82,500 11 187,000 10 75,000 10 170,000 52 654,500
10 Hasyim 9 10 1 14,000 1 7,500 1 17,000 1 7,500 1 17,000 5 63,000
11 Bun Kin Kon 30 3 4 56,000 4 30,000 3 51,000 3 22,500 3 51,000 17 210,500
12 Felita 11 12 1 14,000 0 0 1 17,000 1 7,500 1 17,000 4 55,500
13 Umar Ali 10 12 2 28,000 2 15,000 1 17,000 1 7,500 1 17,000 7 84,500
14 Bandy B Bakri 31 3 3 42,000 3 22,500 2 34,000 2 15,000 2 34,000 12 147,500
TOTAL 41 574,000 41 307,500 40 680,000 37 277,500 36 612,000 195 2,451,000

AHLI GIZI

MAYASARI
 REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP BPJS
RUANG TULIP BULAN JANUARI 2016

KELAS VIP
NAMA TANGGAL MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
NO.
PASIEN MASUK KELUAR PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI
1 Mariati 29 1 4 60,000 4 32,000 4 84,000 4 32,000 3 63,000 19 271,000
2 Kaswan Maesari 2 3 2 30,000 2 16,000 1 21,000 1 8,000 1 21,000 7 96,000
3 Ahmad Fatoni 31 2 2 30,000 2 16,000 1 21,000 1 8,000 1 21,000 7 96,000
4 Trora Aprista 3 5 2 30,000 2 16,000 1 21,000 1 8,000 1 21,000 7 96,000
5 Meyzira 4 5 1 15,000 1 8,000 1 21,000 1 8,000 1 21,000 5 73,000
6 Suharsih 5 8 4 60,000 4 32,000 3 63,000 3 24,000 3 63,000 17 242,000
7 Meri 7 9 2 30,000 2 16,000 2 42,000 1 8,000 1 21,000 8 117,000
8 Hasanusi Doing 9 12 3 45,000 3 24,000 2 42,000 2 16,000 2 42,000 12 169,000
9 Mie-Mie 9 16 7 105,000 7 56,000 7 147,000 7 56,000 7 147,000 35 511,000
10 Syamsidar 12 15 3 45,000 3 24,000 2 42,000 2 16,000 2 42,000 12 169,000
11 Thamrin B Lunyu 9 17 8 120,000 8 64,000 8 168,000 8 64,000 8 168,000 40 584,000
12 dr. Dameria 21 22 1 15,000 1 8,000 1 21,000 1 8,000 1 21,000 5 73,000
13 Andu Rusli 19 20 1 15,000 1 8,000 1 21,000 1 8,000 1 21,000 5 73,000
14 Wartiyem 14 20 5 75,000 5 40,000 5 105,000 5 40,000 5 105,000 25 365,000
TOTAL 45 675,000 45 360,000 39 819,000 38 304,000 37 777,000 204 2,935,000

AHLI GIZI

MAYASARI
 REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP BPJS
RUANG ASOKA BULAN DESEMBER 2015

KELAS III
NO. NAMA TANGGAL MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
PASIEN MASUK KELUAR PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI
1 RAFIQAH 3 5 2 18,000 2 5,000 1 12,000 1 2,500 1 12,000 7 49,500
2 WENDI JUNIANTO 31 4 4 36,000 4 10,000 4 48,000 4 10,000 4 48,000 20 152,000
3 SINDRI 26 2 6 54,000 6 15,000 6 72,000 6 15,000 6 72,000 30 228,000
4 CHERRY AMANDA 7 8 1 9,000 1 2,500 1 12,000 1 2,500 1 12,000 5 38,000
5 FLORENSIA 7 8 1 9,000 1 2,500 1 12,000 1 2,500 1 12,000 5 38,000
6 AISYA 6 9 3 27,000 3 7,500 3 36,000 3 7,500 3 36,000 15 114,000
7 GHESYA FITRI 4 9 5 45,000 5 12,500 4 48,000 4 10,000 4 48,000 22 163,500
8 AUFAR 7 9 2 18,000 2 5,000 1 12,000 1 2,500 1 12,000 7 49,500
9 HENORK 15 17 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
10 VIORENTIUS 15 17 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
11 LAURIN TABITA 14 17 3 27,000 3 7,500 3 36,000 3 7,500 3 36,000 15 114,000
12 FIKA SAPUTRI 17 19 3 27,000 3 7,500 3 36,000 2 5,000 2 24,000 13 99,500
13 RAFIQAH 17 19 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
14 M. AGBI 18 19 1 9,000 1 2,500 1 12,000 0 0 0 0 3 23,500
15 M. IQBAL 18 21 4 36,000 4 10,000 4 48,000 3 7,500 3 36,000 18 137,500
16 YOEL APRILIO 21 23 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
TOTAL 43 387,000 43 107,500 40 480,000 37 92,500 37 444,000 200 1,511,000

AHLI GIZI

MAYASARI

REKAPITULASI BIAYA MAKAN PASIEN RAWAT BPJS

RUANG ASOKA BULAN JANUARI 2016

KELAS VIP
NO. NAMA TANGGAL MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
PASIEN MASUK KELUAR PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI
1 GISELLA 30 2 2 30,000 2 16,000 2 42,000 1 8,000 1 21,000 8 117,000
2 ABI NUGRAHA 6 8 3 45,000 3 24,000 3 63,000 2 16,000 2 42,000 13 190,000
3 ZIAN 6 8 2 30,000 2 16,000 1 21,000 1 8,000 1 21,000 7 96,000
4 GERALDO 9 10 1 15,000 2 16,000 2 42,000 2 16,000 2 42,000 9 131,000
5 PETRA DEAVE 15 20 5 75,000 5 40,000 5 105,000 5 40,000 5 105,000 25 365,000
TOTAL 13 195,000 14 112,000 13 273,000 11 88,000 11 231,000 62 899,000

AHLI GIZI

MAYASARI
 REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP PIHAK KETIGA (P3)
RUANG ASOKA BULAN JANUARI 2016

KELAS II
NO. NAMA TANGGAL MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
URUT PASIEN Masuk Keluar PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI
1 DESI NATALIA 6 9 3 33,000 3 19,500 3 45,000 3 19,500 3 45,000 15 162,000
2 DALVINO 5 8 3 33,000 3 19,500 2 30,000 2 13,000 2 30,000 12 125,500
TOTAL 6 66,000 6 39,000 5 75,000 5 32,500 5 75,000 27 287,500

AHLI GIZI

MAYASARI
REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP PIHAK KETIGA (P3)
RUANG ASOKA BULAN JANUARI 2016

KELAS III
NO. NAMA TANGGAL MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
URUT PASIEN Masuk Keluar PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI
1 SYAIFULLAH 15 16 1 9,000 2 5,000 2 24,000 2 5,000 1 12,000 8 55,000
2 HAURA 22 23 1 9,000 2 5,000 2 24,000 1 2,500 1 12,000 7 52,500
TOTAL 2 18,000 4 10,000 4 48,000 3 7,500 2 24,000 15 107,500

AHLI GIZI

MAYASARI
 REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP PIHAK KETIGA (P3)
RUANG MAWAR BULAN JANUARI 2016

KELAS II
NO. NAMA TANGGAL MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
URUT PASIEN Masuk Keluar PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI
1 NOVIE 9 10 1 11,000 1 6,500 1 15,000 0 0 0 0 3 32,500
2 VINCE 7 12 5 55,000 5 32,500 5 75,000 5 32,500 5 75,000 25 270,000
3 LILIS 11 15 5 55,000 5 32,500 5 75,000 4 26,000 4 60,000 23 248,500
TOTAL 11 121,000 11 71,500 11 165,000 9 58,500 9 135,000 51 551,000

AHLI GIZI

MAYASARI

REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP PIHAK KETIGA (PIII)

RUANG MAWAR BULAN JANUARI 2016

KELAS VIP
NO. NAMA TANGGAL MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
URUT PASIEN Masuk Keluar PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI
1 WIDYA ANGGREANI 23 25 3 45,000 3 24,000 3 63,000 2 16,000 2 42,000 13 190,000
TOTAL 3 45,000 3 24,000 3 63,000 2 16,000 2 42,000 13 190,000

AHLI GIZI

MAYASARI
 REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP BPJS
RUANG FLAMBOYAN BULAN JANUARI 2016

KELAS II
NO. NAMA TANGGAL MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
URUT PASIEN MASUK KELUAR PORSI NILAI (Rp) PORSI NILAI (Rp) PORSI NILAI (Rp) PORSI NILAI (Rp) PORSI NILAI (Rp) PORSI NILAI (Rp)
1 Demi Agrecia 30 1 2 22,000 2 13,000 2 30,000 1 6,500 1 15,000 8 86,500
2 Supripto Karno 30 1 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
3 Andri Iskandar P 1 2 1 11,000 2 13,000 2 30,000 1 6,500 1 15,000 7 75,500
4 Rohani 1 3 2 22,000 2 13,000 2 30,000 1 6,500 1 15,000 8 86,500
5 M. Ali Hanafiah 26 3 8 88,000 8 52,000 8 120,000 7 45,500 7 105,000 38 410,500
6 Muin Muslihi 1 4 3 33,000 3 19,500 3 45,000 2 13,000 2 30,000 13 140,500
7 Lusi Bt Djuliar 2 4 2 22,000 2 13,000 2 30,000 1 6,500 1 15,000 8 86,500
8 Zuharla 2 4 2 22,000 2 13,000 1 15,000 1 6,500 1 15,000 7 71,500
9 Eli Daud Ora 2 4 2 22,000 2 13,000 2 30,000 1 6,500 1 15,000 8 86,500
10 Romidjah 29 1 3 33,000 2 13,000 2 30,000 2 13,000 2 30,000 11 119,000
11 Tumijan 1 4 4 44,000 4 26,000 4 60,000 3 19,500 3 45,000 18 194,500
12 Muriani 30 4 5 55,000 5 32,500 5 75,000 4 26,000 4 60,000 23 248,500
13 Friyanto 28 4 7 77,000 7 45,500 7 105,000 7 45,500 7 105,000 35 378,000
14 Lontas Silaban 4 5 1 11,000 1 6,500 1 15,000 1 6,500 1 15,000 5 54,000
15 Hasanusi Doing 1 5 4 44,000 4 26,000 4 60,000 3 19,500 3 45,000 18 194,500
16 Sumiyati 2 5 3 33,000 3 19,500 3 45,000 2 13,000 2 30,000 13 140,500
17 Untung Jiun 3 5 2 22,000 2 13,000 2 30,000 1 6,500 1 15,000 8 86,500
18 Suminem 2 5 3 33,000 3 19,500 3 45,000 3 19,500 3 45,000 15 162,000
19 Sioe Fa 4 6 3 33,000 3 19,500 3 45,000 2 13,000 2 30,000 13 140,500
20 Frihartini 3 6 3 33,000 3 19,500 3 45,000 2 13,000 2 30,000 13 140,500
21 Zakaria B Ridwan 3 6 3 33,000 3 19,500 3 45,000 3 19,500 3 45,000 15 162,000
22 K. Husin 3 7 4 44,000 4 26,000 3 45,000 3 19,500 3 45,000 17 179,500
23 Martino 6 7 2 22,000 2 13,000 2 30,000 1 6,500 1 15,000 8 86,500
24 Herawati 5 8 3 33,000 3 19,500 3 45,000 2 13,000 2 30,000 13 140,500
25 Nasibah 8 9 1 11,000 1 6,500 1 15,000 1 6,500 1 15,000 5 54,000
26 Redowansyah 3 9 6 66,000 6 39,000 6 90,000 5 32,500 5 75,000 28 302,500
27 Rohimin Romli 3 9 6 66,000 6 39,000 6 90,000 6 39,000 6 90,000 30 324,000
28 Muhayar Ismail 7 9 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
29 Minarsih 8 10 2 22,000 3 19,500 3 45,000 2 13,000 2 30,000 12 129,500
30 Djakaria B Salim 6 11 5 55,000 5 32,500 5 75,000 5 32,500 5 75,000 25 270,000
31 Hj. Kawit 8 11 3 33,000 3 19,500 3 45,000 2 13,000 2 30,000 13 140,500
32 Wahyu Andari 9 11 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
33 Tju Nyuk Bui 9 9 0 0 0 0 0 0 0 0 0 0 0 0
34 Maya Fajar Sari 9 11 3 33,000 3 19,500 3 45,000 2 13,000 2 30,000 13 140,500
35 Marsinta 11 12 1 11,000 2 13,000 2 30,000 1 6,500 1 15,000 7 75,500
36 Ana 9 12 3 33,000 3 19,500 3 45,000 2 13,000 2 30,000 13 140,500
37 Selvia Desy 9 12 3 33,000 3 19,500 3 45,000 3 19,500 3 45,000 15 162,000
38 Yamini 8 12 4 44,000 4 26,000 4 60,000 4 26,000 4 60,000 20 216,000
39 Latifah 8 12 4 44,000 4 26,000 4 60,000 3 19,500 3 45,000 18 194,500
40 Kusnaidi 11 13 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
41 Ernawati 11 13 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
42 Suwina 11 13 2 22,000 1 6,500 1 15,000 1 6,500 1 15,000 6 65,000
43 Mastika 11 13 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
44 Ahmad Syamsudin 5 8 3 33,000 3 19,500 3 45,000 3 19,500 3 45,000 15 162,000
45 Harli Basri 11 14 3 33,000 3 19,500 3 45,000 3 19,500 3 45,000 15 162,000
46 Sutarmi Bt Hambali 11 14 3 33,000 3 19,500 3 45,000 3 19,500 3 45,000 15 162,000
47 Lim Mie Jin 13 14 1 11,000 1 6,500 1 15,000 1 6,500 1 15,000 5 54,000
48 Jusak Tjimko 12 15 3 33,000 3 19,500 3 45,000 3 19,500 3 45,000 15 162,000
49 Leviani Yasmaniar 14 16 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
50 Then Jung Khian 14 16 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
51 Tati Fariati 15 17 3 33,000 3 19,500 2 30,000 2 13,000 2 30,000 12 125,500
52 Sri Arniza 15 17 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
53 Samsidi 15 17 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
54 Kasri 15 17 2 22,000 3 19,500 3 45,000 2 13,000 2 30,000 12 129,500
55 Mochtar Ramli 15 18 3 33,000 3 19,500 2 30,000 2 13,000 2 30,000 12 125,500
56 Safitri 16 18 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
57 Mamat 1 1 1 11,000 1 6,500 1 15,000 0 0 0 0 3 32,500
58 Lho Kai Tjhan 29 2 4 44,000 3 19,500 3 45,000 3 19,500 3 45,000 16 173,000
59 M. A. Zainal 18 19 1 11,000 1 6,500 0 0 1 6,500 1 15,000 4 39,000
60 Linda Sufianto 18 19 1 11,000 1 6,500 1 15,000 1 6,500 1 15,000 5 54,000
61 Sumaini 15 19 4 44,000 4 26,000 4 60,000 4 26,000 4 60,000 20 216,000
62 Rosmalah 17 19 2 22,000 2 13,000 1 15,000 1 6,500 1 15,000 7 71,500
63 Darna 16 19 3 33,000 2 13,000 2 30,000 2 13,000 2 30,000 11 119,000
64 Hermawan 16 19 3 33,000 2 13,000 2 30,000 2 13,000 2 30,000 11 119,000
65 Ardiansyah 17 19 2 22,000 2 13,000 2 30,000 1 6,500 1 15,000 8 86,500
66 Michael 17 20 3 33,000 4 26,000 4 60,000 3 19,500 3 45,000 17 183,500
67 Zahera 18 20 2 22,000 2 13,000 1 15,000 1 6,500 1 15,000 7 71,500
68 Lu Lie Hiong 12 20 8 88,000 8 52,000 8 120,000 8 52,000 8 120,000 40 432,000
69 Ramali 18 20 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
70 M. Muzanto 18 22 4 44,000 5 32,500 5 75,000 4 26,000 4 60,000 22 237,500
 71 Sumiyati Mataris 18 22 4 44,000 4 26,000 4 60,000 3 19,500 3 45,000 18 194,500
72 Mahyanto 18 22 4 44,000 5 32,500 5 75,000 5 32,500 4 60,000 23 244,000
73 Yohana 19 22 3 33,000 3 19,500 3 45,000 3 19,500 3 45,000 15 162,000
74 Rohani 19 22 3 33,000 4 26,000 4 60,000 3 19,500 3 45,000 17 183,500
75 Zuriati 18 22 4 44,000 5 32,500 5 75,000 4 26,000 4 60,000 22 237,500
76 Firanti Natasha 19 22 3 33,000 3 19,500 3 45,000 3 19,500 3 45,000 15 162,000
77 Effendi B Ishak 21 23 2 22,000 2 13,000 2 30,000 2 13,000 2 30,000 10 108,000
78 Djamaah B Talaha 22 23 1 11,000 1 6,500 1 15,000 1 6,500 1 15,000 5 54,000
79 Hermano B Asri 22 23 1 11,000 2 13,000 2 30,000 1 6,500 1 15,000 7 75,500
80 Tjen A Djin 23 24 1 11,000 1 6,500 1 15,000 1 6,500 1 15,000 5 54,000
81 Safari 19 24 5 55,000 5 32,500 5 75,000 5 32,500 5 75,000 25 270,000
82 Asnuryati 22 25 3 33,000 3 19,500 3 45,000 3 19,500 3 45,000 15 162,000
TOTAL 232 2,552,000 237 1,540,500 230 3,450,000 199 1,293,500 198 2,970,000 1,096 11,806,000

AHLI GIZI

MAYASARI

REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP BPJS

RUANG FLAMBOYAN BULAN JANUARI 2016

KELAS III
NO. NAMA TANGGAL MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
URUT PASIEN Masuk Keluar PORSI NILAI (Rp) PORSI NILAI (Rp) PORSI NILAI (Rp) PORSI NILAI (Rp) PORSI NILAI (Rp) PORSI NILAI (Rp)
1 Nazarudin 28 1 4 36,000 4 10,000 4 48,000 4 10,000 4 48,000 20 152,000
2 Ardi B Samid 31 2 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
3 Hayuni 30 3 4 36,000 4 10,000 4 48,000 3 7,500 3 36,000 18 137,500
4 Husna Bt Lorong 29 1 3 27,000 2 5,000 2 24,000 2 5,000 2 24,000 11 85,000
5 Ninik Purwasih 4 6 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
6 Tjhiung Sen 4 6 2 18,000 1 2,500 2 24,000 2 5,000 2 24,000 9 73,500
7 Nguie Mie Lie 5 7 2 18,000 3 7,500 3 36,000 2 5,000 2 24,000 12 90,500
8 Vivi Aprilia 4 7 3 27,000 3 7,500 3 36,000 2 5,000 2 24,000 13 99,500
9 Amir B Pagak 4 7 3 27,000 3 7,500 3 36,000 3 7,500 3 36,000 15 114,000
10 Geo Dwi P 6 8 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
11 Edi Suprianto 6 8 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
12 Izam Ramadhan 6 8 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
13 Mie Sian 3 8 6 54,000 6 15,000 6 72,000 5 12,500 5 60,000 28 213,500
14 Hurmadaini 3 8 5 45,000 5 12,500 5 60,000 4 10,000 4 48,000 23 175,500
15 Bambang Irawan 7 9 2 18,000 2 5,000 1 12,000 1 2,500 1 12,000 7 49,500
16 Herwan 9 10 1 9,000 1 2,500 1 12,000 1 2,500 1 12,000 5 38,000
17 A. Gopar 8 11 3 27,000 3 7,500 3 36,000 2 5,000 2 24,000 13 99,500
18 Salbiyah 10 11 1 9,000 1 2,500 1 12,000 1 2,500 1 12,000 5 38,000
19 Rusana 9 12 4 36,000 4 10,000 4 48,000 3 7,500 3 36,000 18 137,500
20 Djamuk Mini 11 13 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
21 Ahyar 12 14 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
22 Kasma 13 15 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
23 Hendri 13 15 2 18,000 2 5,000 1 12,000 1 2,500 2 24,000 8 61,500
24 Susanni 14 16 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
25 Fira 15 17 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
26 Nopianti 17 18 1 9,000 1 2,500 1 12,000 1 2,500 1 12,000 5 38,000
27 Phang Mie Sin 8 9 1 9,000 1 2,500 1 12,000 1 2,500 1 12,000 5 38,000
28 Miarno 10 10 1 9,000 1 2,500 1 12,000 1 2,500 1 12,000 5 38,000
29 Ardi 9 10 1 9,000 1 2,500 1 12,000 1 2,500 1 12,000 5 38,000
30 Nurlaeli 12 13 1 9,000 1 2,500 1 12,000 0 0 0 0 3 23,500
31 Nilawati 16 19 3 27,000 3 7,500 2 24,000 2 5,000 2 24,000 12 87,500
32 Febi Andrianto 17 19 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
33 Sitam Bt H. Said 13 21 8 72,000 8 20,000 8 96,000 8 20,000 8 96,000 40 304,000
34 Sunia Saputri 19 22 3 27,000 3 7,500 3 36,000 2 5,000 2 24,000 13 99,500
35 Slamet Widodo 21 23 3 27,000 3 7,500 3 36,000 2 5,000 2 24,000 13 99,500
36 Daeng Taena 18 23 5 45,000 5 12,500 5 60,000 4 10,000 4 48,000 23 175,500
37 A. Gopar 21 23 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
38 Amir B Pagak 21 23 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
39 Ardi B Samid 22 24 3 27,000 3 7,500 3 36,000 2 5,000 2 24,000 13 99,500
40 Fu Aco 20 23 3 27,000 3 7,500 3 36,000 3 7,500 3 36,000 15 114,000
41 Kasma 21 23 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
42 Padli B Lanju 22 25 3 27,000 3 7,500 3 36,000 3 7,500 3 36,000 15 114,000
43 Zulhazar B Almah 22 25 4 36,000 4 10,000 3 36,000 3 7,500 3 36,000 17 125,500
44 Sui Sen 15 25 10 90,000 10 25,000 10 120,000 10 25,000 10 120,000 50 380,000
45 Halimah Tusadiyah 20 22 2 18,000 2 5,000 2 24,000 2 5,000 2 24,000 10 76,000
TOTAL 125 1,125,000 124 310,000 121 1,452,000 109 272,500 110 1,320,000 589 4,479,500

AHLI GIZI

MAYASARI
 REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP BPJS
RUANG ICU BULAN JANUARI 2016

KELAS I
NO. NAMA TANGGAL JAM JAM MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
URUT PASIEN MASUK KELUAR MASUK KELUAR PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI
1 Tn. Karim 5 8 22.3 16.31 3 42,000 3 22,500 3 51,000 3 22,500 3 51,000 15 189,000
2 Tn. Galih Arzeni 6 7 23.45 06,40 1 14,000 0 0 0 0 0 0 0 0 23.45 14,000
3 Tn. Yusman 7 8 21.15 1451 1 14,000 1 7,500 1 17,000 1 7,500 0 0 24.15 46,000
4 Tn. M Muzanto 18 19 10.2 11.45 1 14,000 1 7,500 1 17,000 1 7,500 1 17,000 14.2 63,000
TOTAL 6 84,000 5 37,500 5 85,000 5 37,500 4 68,000 77 312,000

AHLI GIZI

MAYASARI

REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP PIHAK KETIGA (PIII)

RUANG ICU BULAN JANUARI 2016
KELAS 1
NO. NAMA TANGGAL TANGGAL JAM JAM MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
URUT PASIEN MASUK KELUAR MASUK KELUAR PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI PORSI NILAI
1 Ny.Ponikem 3 6 11.45 10.22 3 42,000 3 22,500 3 51,000 3 22,500 3 51,000 15 189,000
TOTAL 3 42,000 3 22,500 3 51,000 3 22,500 3 51,000 15 189,000

AHLI GIZI

MAYASARI
 REKAPITULASI BIAYA MAKAN PASIEN RAWAT INAP PIHAK KETIGA (P III)
RUANG FLAMBOYAN BULAN JANUARI 2016

KELAS II
NO. NAMA TANGGAL MAKAN PAGI SNACK PAGI MAKAN SIANG SNACK SORE MAKAN SORE JUMLAH
URUT PASIEN MASUK KELUAR PORSI NILAI (Rp) PORSI NILAI (Rp) PORSI NILAI (Rp) PORSI NILAI (Rp) PORSI NILAI (Rp) PORSI NILAI (Rp)
1 Suri 1 3 2 22,000 2 13,000 2 30,000 1 6,500 1 15,000 8 86,500
2 Siti Rohil 4 5 1 11,000 1 6,500 1 15,000 1 6,500 0 0 4 39,000
3 Melta 4 5 1 11,000 1 6,500 1 15,000 0 0 0 0 3 32,500
4 Desi Susanti 3 6 3 33,000 4 26,000 4 60,000 4 26,000 3 45,000 18 190,000
5 Rianti 6 9 3 33,000 3 19,500 3 45,000 2 13,000 2 30,000 13 140,500
6 Fifi 8 10 2 22,000 3 19,500 3 45,000 2 13,000 2 30,000 12 129,500
7 Yeni Oktavia 12 14 2 22,000 2 13,000 1 15,000 1 6,500 1 15,000 7 71,500
8 Selvia Desy 14 15 1 11,000 1 6,500 1 15,000 1 6,500 1 15,000 5 54,000
9 Barry Dela N 16 17 2 22,000 2 13,000 2 30,000 1 6,500 1 15,000 8 86,500
10 Abdul Thalib 22 23 1 11,000 1 6,500 1 15,000 0 0 0 0 3 32,500
11 Sutanto 21 23 1 11,000 1 6,500 1 15,000 0 0 0 0 3 32,500
12 Alfin Sanjaya 21 23 2 22,000 2 13,000 2 30,000 1 6,500 1 15,000 8 86,500
13 Kasih Wibowo 22 24 2 22,000 2 13,000 2 30,000 1 6,500 1 15,000 8 86,500
14 Suhanda 21 25 4 44,000 4 26,000 4 60,000 3 19,500 3 45,000 18 194,500
TOTAL 27 297,000 29 188,500 28 420,000 18 117,000 16 240,000 118 1,262,500

AHLI GIZI

MAYASARI
 REKAPITULASI TAGIHAN MAKAN PASIEN RSMS BULAN JANUARI 2016

P III BPJS JUMLAH

KETERANGAN KELAS
PORSI NILAI PORSI NILAI PORSI NILAI
II 118 1,262,500 1,096 11,806,000 1,214 13,068,500
R. FLAMBOYAN
III - - 589 4,479,500 589 4,479,500
JUMLAH 118 1,262,500 1,685 16,285,500 1,803 17,548,000
VIP 39 570,000 204 2,935,000 243 3,505,000
R. TULIP
I 195 2,451,000 810 10,182,000 1,005 12,633,000
JUMLAH 234 3,021,000 1,014 13,117,000 1,248 16,138,000
VIP 13 190,000 - - 13 190,000
I - - 77 963,000 77 963,000
R. MAWAR
II 51 551,000 132 1,419,500 183 1,970,500
III - - 161 1,225,500 161 1,225,500
JUMLAH 64 741,000 370 3,608,000 434 4,349,000
VIP 33 475,000 62 899,000 95 1,374,000
I 28 353,500 237 2,964,000 265 3,317,500
R. ASOKA
II 27 287,500 126 1,365,500 153 1,653,000
III 15 107,500 200 1,511,000 215 1,618,500
JUMLAH 103 1,223,500 625 6,739,500 728 7,963,000
R. HEMODIALISA II - - 62 403,000 62 403,000
R. ICU I 15 189,000 77 312,000 92 501,000
JUMLAH 15 189,000 139 715,000 154 904,000
TOTAL 534 6,437,000 3,833 40,465,000 4,367 46,902,000

TERBILANG : EMPAT PULUH ENAM JUTA SEMBILAN RATUS DUA RIBU RUPIAH

Sungailiat, 25 Januari 2016

Unit Gizi
Mayasari