Rekapan Klaim JULI 2018

REKAPITULASI KLAIM RAWAT INAP PUSKESMAS KEDIRI
BULAN : MEI 2015

NAMA FASKES : PUSKESMAS KEDIRI
ALAMAT FASKES : JL. TGH. ABDUL KARIM.KEDIRI.LOMBOK BARAT
NO NAMA PENDERITA NOMOR KARTU ALAMAT DIAGNOSA TGL MASUK TGL KELUAR JUMLAH HR RAWAT JUMLAH TAGIHAN KET
Samukir Samah miring Astma bronchial 1
1 0001607213709 1/4/2015 Rp 100,000
Melisa Gelogor DHF gr II 7
2 0001576562635 23/03/2015 Rp 700,000
M.danil Montong are DHF gr II 4
3 0001785349282 1/4/2015 Rp 400,000
Rohanah Menemeng dyspepsia 5
4 0001837286403 31/3/2015 Rp 500,000
Seinah Penandah ISK 4
5 0001267638107 1/4/2015 Rp 400,000
Mahsun Pelowok Dysentri 3
6 0000829560014 5/6/2015 Rp 300,000
Hj.maslahah Gelogor myalgia 2
7 0000830283647 5/7/2015 Rp 200,000
Rakmah Bengkel ISK 1
8 0001426686759 5/8/2015 Rp 100,000
Hj.patimatuzzakrah Batu tumpeng Astma bronchial 1
9 0000829119789 5/9/2015 Rp 100,000
Neli ulyasari Sedayu TF 2
10 0000831922716 5/10/2015 Rp 200,000
Sa’rah Gelogor TF 2
11 0000830508941 5/11/2015 Rp 200,000
Ijtihad Pelowok GEA 1
12 0001576561792 5/12/2015 Rp 100,000
Fuatullah Sedayu Obs.febris ec.susp.TF 1
13 0001607212181 5/13/2015 Rp 100,000
Sudi irmayani Lelede Tormbositopenia+ 2
14 0000830253554 DHF gr II 5/14/2015 Rp 200,000
Dani ahmadi Krng.bucu TF+susp ISK 3
15 0000829253507 5/15/2015 Rp 300,000
Muhammad tahir Krng.bedil Post TIA 1
16 0000830284773 5/16/2015 Rp 100,000
Aeniah Ombe desa Anemia+ISK 4
17 0000829145621 5/17/2015 Rp 400,000
18 0001326925089 5/18/2015 Rp -
19 0000829372206 5/19/2015 Rp -
20 0001607213979 5/20/2015 Rp -
21 0001055598963 5/21/2015 Rp -
22 0001576402582 5/22/2015 Rp -
23 0001575489475 5/23/2015 Rp -
24 0000829556392 5/24/2015 Rp -
25 0001576561803 5/25/2015 Rp -
26 0000829535196 5/26/2015 Rp -
27 0001607214104 5/27/2015 Rp -
28 0001575330783 5/28/2015 Rp -
29 0001575331323 5/29/2015 Rp -
30 0000829783877 5/30/2015 Rp -
31 0001607211988 5/1/2015 Rp -
32 0001147292774 5/2/2015 Rp -
33 0001607214183 5/3/2015 Rp -
34 0000829929925 5/4/2015 Rp -
35 0000829862144 5/5/2015 Rp -
36 0001575331525 5/6/2015 Rp -
37 0000830473874 5/7/2015 Rp -
38 0001483303645 5/8/2015 Rp -
39 0000830437773 5/9/2015 Rp -
40 0000829806052 5/10/2015 Rp -
41 0000829684168 5/11/2015 Rp -
42 0001836309284 5/12/2015 Rp -
43 0000829810989 5/13/2015 Rp -
44 0000830472614 5/14/2015 Rp -
45 0001576402424 5/15/2015 Rp -
46 0001055629539 5/16/2015 Rp -
47 0000146166142 5/17/2015 Rp -
48 0001055647089 5/18/2015 Rp -
49 0000833805213 5/19/2015 Rp -
50 0001055587162 5/20/2015 Rp -
51 0000830977828 5/21/2015 Rp -
52 0000830412404 5/22/2015 Rp -
53 0001055642268 5/23/2015 Rp -
54 0001607214104 5/24/2015 Rp -
55 0000830466134 5/25/2015 Rp -
56 0000840009172 5/26/2015 Rp -
57 0001576402558 5/19/2015 Rp -
58 0001842579066 5/20/2015 Rp -
59 0000829861053 5/21/2015 Rp -
60 0001607214093 5/22/2015 Rp -
61 0000830751693 5/23/2015 Rp -
62 0000839194052 5/24/2015 Rp -
63 0000829525961 5/25/2015 Rp -
64 0000829734715 5/26/2015 Rp -
65 0001607214205 7/4/2015 Rp -
TOTAL DANA Rp 4,400,000
Kediri, 19 Mei 2015

Kepala Puskesmas Kediri
Rosmayadi,SKM.MPH
NIP: 19681212 199003 1 014
1/4/2015 2/4/2015
28-03-2015 4/4/2015
1/4/2015 5/4/2015
31-03-2015 5/4/2015
1/4/2015 5/4/2015
3/4/2015 6/4/2015
4/4/2015 6/4/2015
3/4/2015 4/4/2015
7/4/2015 8/4/2015
7/4/2015 9/4/2015
7/4/2015 9/4/2015
10/4/2015 11/4/2015
10/4/2015 11/4/2015
9/4/2015 11/4/2015
8/4/2015 11/4/2015
11/4/2015 12/4/2015
9/4/2015 13-04-2015
REKAPITULASI
RAWAT INAP TINGKAT PERTAMA (RITP) BAGI PESERTA BPJS KESEHATAN
BULAN JANUARI 2017
NO NAMA PENDERITA NOMOR KARTU ALAMAT NO.TELP./HP DIAGNOSA
1 LUJJ'AINI 0000830467416 PELOWOK SELATAN 081933125833 DHF GR II

2 ANANG YUDIA PURNAMA 0000829480274 PELOWOK BARAT 082340709776 TYFOID
3 RIZKI PANDU 0001055625862 OMBE REROT FEBRIS
4 SAKRAH 0000831517514 TB ELENG KURIPAN GEA + DEHIDARSI R/S
5 FEBI AYUNI 0000829931782 RUMAK BARAT OBS FEBRIS H5 + DHF GR I
6 SITI 0000829809325 BANYUMULEK BARAT FEBRIS H 5 + DHF GR I
7 HENDRI 0000829308969 GELOGOR SELATAN 081917223590 GEA + MELENA
8 IBRAHIM HOLIDI 0000830518018 OMBE DESE TF
9 FATA AL GHIFARY 0001889213646 TANGKEBAN 081757508 TYFOID
10 ROSITA 0000828976296 DASAN GERES TYFOID
11 NUZULIA 0000829102768 PELOWOK TIMUR OBS FEBRIS H 7 + S DHF
12 SURYADI 00008292922848 GELOGOR TYFOID
13 SAPDI 0000830197089 KEDIRI 080805585428 DISENTRI + ANEMIA
14 HAERIAH 0000830268797 SEDAYU TIMUR OBS FEBRIS e.c PNEUMONIA + ISK
15 IBRAL HARSADI 0000829957263 KRG KURIPAN BARAT TYFOID
16 JASMAN 0000830486463 MONTONG ARE 087765947892 TYFOID
17 ZAHARA RESKI S 0001476770038 KRG SEMBUNG DEHIDRASI RS ec DIARE AKUT
18 M ADAM IBRAHIM 0000830273444 OMBE DESA TYFOID
19 TAHIR 0001886160655 MONTONG ARE MELENA e.c S.ULCUS PEPTICUM+HIPOTENSI
20 FAHRI TARMIZI 0000829934504 TERATE HIPOTENSI + VERTIGO
21 NUR HOLIS MAJID 0001055601775 MONTONG ARE OBS FEBRIS dd DHF
22 UMARUMIYAH 0000829837686 MONTONG ARE GEA + VOMITING
23 NOSITA 0000828976296 DASAN GERES TYFOID
24 MUNERAH 000105685067 MONTONG ARE 083129922504 TYFOID
25 JAMINAH 0000830482468 ADENG DAYE 087765161155 GASTRITIS KRONIS
26 HANDIKA 0000829579116 BENGKEL TIMUR TYFOID
27 SAKRAH 0000831517514 KURIPAN GEA + DEHIDRASI RS
28 TUTIK ALAWIYAH 0001056361779 JONGGAT 0818907220733 HIPOTENSI + OBS FEBRIS
29 UTIA AZAHRA 000191994334 RUMAK BARAT DEHIDRASI RS dd TF
30 SUKRIAH 0000144457468 KEDIRI VULNUS LACERATUM ec POST STROKE
31 MISTARI 0000830228207 BANGLE DASAN BARU ANEMIA SEDANG
32 SIUCI 0000829937002 GELOGOR 081915996803 TYFOID
REKAPITULASI
NGKAT PERTAMA (RITP) BAGI PESERTA BPJS KESEHATAN
BULAN JANUARI 2017
JUMLAH HR
TINDAKAN YANG DIBERIKAN TGL MASUK TGL PULANG TARIF PAKET JUMLAH BIAYA
RAWAT
Memberikan Infus rl, memberikan obat inj rani, inj metoc, pct, antasida, b com, inj ampicilin 16/01/2017 21/01/2017 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, memberikan obat pamol supp, inj rani, pct, b com, inj ampi, antasida 18/01/2017 21/01/2017 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, memberikan obat pct, b com, vit A 27/01/2017 28/01/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat pct, loperamid,metoc, cotrimoxazole, antasida, b 6, inj
18/01/2017 24/01/2017 6 Rp 120,000 Rp 720,000
Memberikan Infus rl, memberikan obat pct, inj ampi, inj rani, b com, amoxicilin 18/01/2017 23/01/2017 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, memberikan obat pct, b com, 21/01/2017 23/01/2017 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, memberikan obat inj rani, ketorolac, antasida, metoc, b6, omeprazole, 17/01/2017 21/01/2017 4 Rp 120,000 Rp 480,000
Memberikan Infus rl, memberikan obat inj inj ampi, inj rani, pct, gg, ctm, b6, amox, 16/01/2017 21/01/2017 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, memberikan obat pct, chloramphenicol, b6 13/01/2017 14/01/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat pct, inj rani, inj metoc, inj ampi, antasida 7/1/2017 9/1/2017 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, memberikan obat pct, b com, ctm, antasida, inj ranitidine 22/01/2017 25/01/2017 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, memberikan obat pct, inj ampi, b com, antasida 19/01/2017 24/01/2017 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, memberikan obat inj ranitidine,loperamid, cotri, oralit, SF, antasida 28/01/2017 29/01/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat inj metoc, pct, antasida, b com, inj ampi, inj rani, 21/01/207 29/01/2017 8 Rp 120,000 Rp 960,000
Memberikan Infus RL, memberikan obat inj ampi, antasida, b com, pct 25/01/20174 29/01/2017 4 Rp 120,000 Rp 480,000
Memberikan Infus rl, memberikan obat inj rani, pct, thiamphenicol, b.com, 25/01/2017 30/01/2017 5 Rp 120,000 Rp 600,000
Memberikan Infus RL, memberiikan obat inj rani,loperamid, antasida, oralit, zinc 4/1/2017 5/1/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat chloramphenicol, pct, b com, ambroxol, 24/01/2017 28/01/2017 4 Rp 120,000 Rp 480,000
Memberikan Infus rl, memberikan obat pct, b com, inj rani, inj dyphen, betahistine 26/01/2017 27/01/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obatinj rani, inj dyphen, pct, b com, betahistine, 30/01/2017 31/01/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat inj rani, pct, b com, antasida 29/01/2017 31/01/2017 2 Rp 120,000 Rp 240,000
Memberikan Infus RL, memberikan obat inj metoc, oralit, loperamid, antasida, b com, inj ran 26/01/2017 31/01/2017 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, memberikan obat inj rani, inj ampi, inj metoc, pct, antasida 7/1/2017 9/1/2017 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, memberikan obat inj dyphen, pct, antasida, b com, inj rani, 28/01/2017 2/1/2017 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, memberikan obat antasida, metoc, inj rani, inj metoc, b6, pct, omepra 31/12/2016 1/1/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat inj ampi, pct, b com, 21/01/2017 25/01/2017 4 Rp 120,000 Rp 480,000
Memberikan Infus rl, memberikan obat inj rani,loperamid, pct, metoc, cotri, antasida, b6 18/01/2017 24/01/2017 6 Rp 120,000 Rp 720,000
Memberikan Infus rl, memberikan obat b com, pct, inj metoc, amoxicilin 20/01/2017 22/01/2017 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, memberikan obat oralit, pct, b.com 2/1/2017 3/1/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat amox, asmef, oksigen, 2/1/2017 3/1/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat inj rani, antasida, pct, b com, inj ampi, metoc, 30/12/2017 4/1/2017 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, memberikan obat inj rani, pct, b com, inj ampicilin 27/12/2017 6/1/2017 10 Rp 120,000 Rp 1,200,000
REKAPITULASI
BULAN FEBRUARI 2017
1 NURHAYANI 0000829628165 GELOGOR SELATAN 087865981890 DYSPEPSIA + GERD

2 HARMAN 0000829497014 NYIUR GADING 087864284027 TYFOID FEVER
3 LOMEH 0000829837451 KRG KURIPAN TIMUR ISK + DM TYP II
4 M MUSA 0000829263947 OMBE DESA HEMIPARISES E.C SUSP SNH + SUSP APP
5 AYU 0000829331245 GELOGOR SELATAN 087865813434 VOMITING + KONSTIPASI
6 RIZKI RAMADAN 0001919707209 SELAPARANG KEDIRI 081907517138 TYFOID FEVER
7 ISNENMAOLOAD 0000830163868 PELOWOK BARAT 082340709776 TYFOID FEVER
8 SAPENAH 0000829550891 SAMAH NGIRING VERTIGO + SUSP. HIPOKALEMIA
9 NINANTI ATMANEGARA 0000829977805 BANGKET DALEM TYFOID FEVER
10 RAKIMAH 0001920108835 GERSIK SELATAN HT EMERGENCY + DM TYP II
11 YANTI SUSILAWATI 0002207650623 SUKARAJA PRAYA ISK
12 NURUL AINI 0000146097483 TAPON 087865270121 DIARE AKUT DEHIDRASI RS
13 MAHRAENI 0001055600155 SAMAH JAYA 087865209920 SUSP. TBC
14 WASIAH 0000829462228 BENGKEL BARAT 087765056006 DIARE AKUT DDRS + DM TYP II + HT GR I
15 RISKI AGUS KURNIAWAN 0000829984893 BATU TUMPENG 087864486717
IMMUNOCOMPROMISIDE DD TYFOID + ANEMIA SEDANG
16 M SAUFI 0000830306766 GELOGOR UTARA OBS FEBRIS DD S TYFOID
17 NURAINI 0000829588476 RUMAK TIMUR SUSP. DYSENTRI AMOEBA
18 HALIMATUSSA'DIAH 0000830476001 BANYUMULEK 082339188955 DYSPEPSIA + HT GR I
19 MUR 0000830464942 TONGKEK GASTRITIS KRONIS + ISPA
20 RAMELAH 0001232873842 BENGKEL 085237745163 ASMA BRONCHILAE + GASTRITIS AKUT
21 SAHARUDIN 00001447302023 RANGGAGATA 083129829663 VERTIGO + DYSPEPSIA
22 HURIAH 0001898676584 GELOGOR FEBRIS + TF + DHF
23 NURILAH 0001055629743 BANGKET DALEM DIARE KRONIS TANPA DEHIDRASI
24 PEBRIANA SAPITRI 0001055610257 GELOGOR FEBRIS + TF
25 HASABAB 0000144318464 KEDIRI 087865566585 COLIC ABDOMEN + GEA
26 SAUPI 0000832575813 RANGGAGATA 081907613788 FEBRIS EC S TYFOID + DM TYP II + HT GR I
27 INTAN 0000830727167 KRG BEDIL TIMUR 085239116750 MYALGIA + GASTRITIS AKUT
28 MUHAMMAD RAFKI AL HAF 000187070612 KRG KURIPAN BARAT PNEUMONIA RINGAN
29 GALIH HARIADI 0000830236059 PLABU KURIPAN 081547278358 GEA + URTIKARIA
30 SAKMAH 0000830158481 KRG BEDIL SELATAN 082340880878 OSTEOATRITIS GENU + LBP
31 ALFIA SYAHIDA 0000829868163 KRG BEDIL SELATAN 081803754698 FEBRIS + S DHF
32 IHSAN 0000829225089 GELOGOR DYSPNEA EC PPOK
33 NURUL HUDA 0000831002545 KRG BUCU JAGARAGA DHF GR I
34 MUHAMMAD FAHRURROZI 0002208928375 OMBE DESA 081917541658 GASTRITIS AKUT
35 ARYANDA ALI 0000829410142 KRG KURIPAN BARAT 081917237019 TYFOID FEVER
36 DIANA SAPITRI 0000830130816 KARNG RUMAK TYFOID FEVER
37 HAERUDIN 0000829882462 GERSIK UTARA DYSPNEA EC PPOK
38
39
40
41
42
43
44
45
TOTAL DANA
REKAPITULASI
KAT PERTAMA (RITP) BAGI PESERTA BPJS KESEHATAN
BULAN FEBRUARI 2017
JUMLAH HR
RAWAT
Memberikan Infus rl, memberikan obat inj rani, inj metoc, inj scopamin, pct, antasida, b com 1/30/2017 2/1/2017 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, memberikan obat inj metoc, pct, antasida, b com, loperamid, inj ampic 1/29/2017 2/2/2017 4 Rp 120,000 Rp 480,000
Memberikan Infus rl, memberikan obat simpastatin,antasida, b com, glimepiride, ciprofloxac 1/31/2017 2/2/2017 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, memberikan obat pct, antasida, b com 2/1/2017 2/2/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat inj ondancentron, inj dyphen. Inj ketorolac, antasida, 1/31/2017 2/2/2017 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, memberikan obat inj rani, inj metoc, pct, antasida, b com, inj ampicilin, 1/29/2017 2/2/2017 4 Rp 120,000 Rp 480,000
Memberikan Infus rl, memberikan obat inj rani, inj metoc, pct, antasida, b com, inj ampicilin, 1/29/2017 2/2/2017 4 Rp 120,000 Rp 480,000
Memberikan Infus rl, memberikan obat inj rani, inj metoc, pct, antasida, b com, betahistine, 1/28/2017 2/3/2017 6 Rp 120,000 Rp 720,000
Memberikan Infus rl, memberikan obat inj rani, inj metoc, pct, antasida, b com, chloramphe 1/28/2017 2/5/2017 6 Rp 120,000 Rp 720,000
Memberikan Infus rl, memberikan obat amlodipine, domperidon, betahistine, captopril, glim 2/4/2017 2/10/2017 6 Rp 120,000 Rp 720,000
Memberikan Infus rl, memberikan obat pct, inj ampicilin, AMOXICILIN 2/4/2017 2/7/2017 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj rani, inj scopamin,loperamid pct,metoc, b com 2/8/2017 2/12/2017 4 Rp 120,000 Rp 480,000
Memberikan Infus rl, memberikan obat inj norages, pct,ambroxol, b com 2/5/2017 2/12/2017 7 Rp 120,000 Rp 840,000
Memberikan Infus rl, memberikan obat inj rani, inj ketorolac, loperamid, metoc, b com, amlo 2/10/2017 2/13/2017 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj rani, pct, antasida, vit c, nistatin, anti hemoroid, 2/11/2017 2/14/2017 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, memberikan obat pct, ctm, ambroxol, b com, amoxicilin syrup 2/10/2017 2/15/2017 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, memberikan obat inj scopamin, inj metoc, pct, loperamid, oralit, metron2/13/2017 2/15/2017 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, memberikan obat inj rani, metoc, captopril, antasida, inj metoc, b com 2/8/2017 2/15/2017 7 Rp 120,000 Rp 840,000
Memberikan Infus rl, memberikan obat inj rani, inj metoc, pct, antasida, obh syrup 2/13/2017 2/17/2017 4 Rp 120,000 Rp 480,000
Memberikan Infus rl, memberikan obat inj rani, inj ketoralac, salbutamol, antasida, b com, 2/16/2017 2/17/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat betahistine, ctm, antasida, omperazole, b com 2/15/2017 2/17/2017 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, memberikan obat inj rani, inj metoc, pct, antasida, b com, omeprazol 2/15/2017 2/17/2017 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, memberikan obat inj rani, inj metoc, antasida, b com, loperamid, orali 2/15/2017 2/17/2017 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, memberikan obat rani, metoc, pct, b com, ambroxol, inj ampi 2/13/2017 2/19/2017 6 Rp 120,000 Rp 720,000
Memberikan Infus rl, memberikan obat inj rani, inj ketorolac, ctm, antasida,omeprazole 2/19/2017 2/20/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat inj rani, inj ketorolac, pct, glimepiride, b com, inj amp 2/16/2017 2/21/2017 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, memberikan obat inj rani, inj metoc, pct, antasida, b com, 2/18/2017 2/21/2017 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, memberikan obat pct syrup, inj ampicilin, inj gentamicin, ambroxol syr 2/17/2017 2/21/2017 4 Rp 120,000 Rp 480,000
Memberikan Infus rl, memberikan obat inj rani, metoc, pct, ctm, b com, oralit, dexametaso 2/26/2017 2/27/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat inj rani, inj ket, ketorolac, natrium diklopenak, b co 2/26/2017 2/27/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat inj rani, metoc, pct, b com, inj ampicilin 2/25/2017 2/28/2017 3 Rp 120,000 Rp 360,000
Memberikan Infus D5%, memberikan obat salbutamol, dexa, ambroxol, inj ampicilin, 2/23/2017 2/27/2017 4 Rp 120,000 Rp 480,000
Memberikan Infus rl, memberikan obat inj rani, inj antrain, inj ondancentron, pct, antasida, 2/21/2017 2/26/2017 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, memberikan obat inj rani, inj metoc, pct, antasida, b com, omeprazole 2/22/2017 2/23/2017 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, memberikan obat pct, antasida, b com, inj ampicilin 2/20/2017 2/24/2017 4 Rp 120,000 Rp 480,000
Memberikan Infus rl, memberikan obat inj rani, inj antrain, pct, antasida, b com, chloramph 2/15/2017 2/23/2017 8 Rp 120,000 Rp 960,000
Memberikan Infus D5%, memberikan obat salbutamol, dexa, ambroxol, inj ampicilin, nebu 2/21/2017 2/23/2017 2 Rp 120,000 Rp 240,000
NA 128 Rp 4,440,000 Rp 15,600,000

Kediri, Januari 2016
Kepala Puskesmas Kediri
Rosmayadi,SKM.MPH
NIP: 19681212 199003 1 014
REKAPITULASI
BULAN MARET 2017
1 PANANI 0002225407577 OMBE BARU FEBRIS + SUSP TB PARU
2 AZZRIL RAMDAN 0002222962435 OMBE BARU FEBRIS EC PNEUMONIA SEDANG + DIARE

3 SAHABUDIN 0000830281105 JAGARAGA INDAH COLIC ABDOMEN EC GEA
4 SAPA NOVIANI 0001055631442 LELEDE DHF GRADE I
5 SATINAH 0000830091936 OMBE BARU 085738326638 COLIC ABDOMEN EC GASTROPATHY DM + ICTIOSIS
6 MUSLIMAH 0000829246522 DASAN TEBU DM TP II + GEA

7 HJ SITI HAWA 0000830320953 KRG BEDIL TIMUR 082339446475 COLIC ABDOMEN EC GASTRITIS AKUT DD SUSP ISK
8 ATIKA ZAHRA RATIFA 0002058373067 DASAN BARU FEBRIS EC S.TYFOID, DD BRONCHIOLITIS
9 NURUL AINI 0000829196504 GERSIK SELATAN FEBRIS EC ISK + SEPSIS
10 SABAI 0000829203928 GERSIK SELATAN MALARIA MIX

11 NIA WULAN DARI 0000829308655 GELOGOR SELATAN THYFOID DD DHF
12 ISTIADAH 0000829186323 PELOWOK BARAT 081917237019 OBS FEBRIS H 4 EC TYFOID FEVER
13 GIET 0001055653211 PESONGORAN 081997861447 LOW INTAKE + GERD
14 MANSUR 0000830739068 TAMBANG ELEH 081917332149 FEBRIS H7 + VOMITING

15 MUKMINAH 0000829332191 GELOGOR UTARA 083129545027 GASTRITIS AKUT DG ISPA + POST TB PARU
16 INAQ MARHAENI 0001056378598 TAPON BARAT 083129506066 DYSPEPSIA ec CHF dd S.TB PARU
17 KHOLIL 0000830464582 KRG BEDIL SELATAN OBS VOMITING
18 MUSTAKIM 0001055616063 BANYU MULEK FEBRIS EC DHF

19 DIAMAS PRAYOGA 0000830577003 BENGKEL SELATAN 081805272215 VOMITING + DIARE AKUT DG DEHIDRASI R/S
20 FAHRIAL AZHARI 0000144529424 KEDIRI 083111857000 DHF GR I
21 NADIVA ALIVIA 0000144771761 KRG KURIPAN TIMUR FEBRIS EC TF
22 KINARA AZILNA PUTRI 0001901662986 KEDIRI 081805251318 FEBRIS EC DHF GR I

23 SAMSUDIN 0000830196281 BAGEK POLAK KRG KEBON OBS FEBRIS EC DHF + VERTIGO PERIFER
24 MUHTAR 0000829386191 KEBON BARU KEDIRI CHEST PAIN
25 AMIN 0000835297446 TAPON S. TB
26 INAQ MARHAENI 0001056378598 TAPON BARAT 083129506066 SINDROM NEFROTIK + GAGAL GINJAL KRONIK
27 M.FARID ATTAULLAH 0002086323952 KRG BEDIL TIMUR KEJANG EC SUSP EPILEPSI KDS
28 ABDUL WARIS 0000830731318 SEDAYU TENGAH OBS DYSPNEA + ANEMIA GRAFIS
29 SAHDAN 0000831636909 PERENDEKAN OBS FEBRIS H 3 E.C DHF GR I
30 SITI HAWA 0000830030387 OMBE DESA DIARE AKUT

31 PAUZIAH 0000830441182 DASAN TEBU 082341827809 HIPOTENSI + ISK
32 SAOGI WIRAYUDI 0001055609212 GELOGOR FEBRIS E.C DHF GR I
33 SANIP 0000829089933 KRG MIDANG TB PARU PUTUS OBAT + LOW INTAKE
34 WIWIN HARIANTO 0000829332606 KRG BEDIL SELATAN 081907783050 VOMITING + DHF GRI + TYFOID
35 ADIAH 0000830242192 BATU TUMPENG 087864300944 FEBRIS E.C TYFOID
36 JOHANAH 0000830518198 TANGKEBAN 087865777346 ASMA BRONCHIALE
37 JAMUHUR 0000829503628 NYIUR GADING TYFOID FEVER
38 ROHAYANAH 0000830494506 DASAN TEBU ISK + S. TB + G4P2A1

39 FAIZAH ALWATI 0002086965639 TELABAH GERES HYPEREMESIS GRAVIDARUM
40 MAINAH 0000829676125 LABUAPI UTARA HYPEREMESIS GRAVIDARUM
41 MITAH MUL JATNAH 0000830484933 KR. KURIPAN HYPEREMESIS GRAVIDARUM
TOTAL DANA
REKAPITULASI
BULAN MARET 2017
TINDAKAN YANG DIBERIKAN TGL MASUK TGL PULANG JUMLAH HR RAWAT TARIF PAKET
Memberikan Infus rl, memberikan obat pct, ambroxol, b com 3/3/2017 3/4/2017 1 Rp 180,000
Memberikan Infus rl, memberikan obat pct syr, inj.ampi, nebu combivent, zink, oralit, ambroxol, ctm, b com, inj 3/1/2017 3/4/2017 3 Rp 180,000
Memberikan Infus rl, memberikan obat inj ketorolac, inj.raniridin, omeprazole, metoc, antasida 3/1/2017 3/3/2017 2 Rp 180,000
Memberikan Infus rl, memberikan obat pct, antasid, metoc, b com, 2/27/2017 3/2/2017 3 Rp 180,000
Memberikan Infus rl, memberikan obat inj dexa, inj rani, inj metoc, pct, glimepiride, ctm, b com 3/4/2017 3/6/2017 2 Rp 180,000
Memberikan Infus rl, memberikan obat inj rani, inj metoc, loeperamide, omeprazole, bcomp, antasida, 3/2/2017 3/5/2017 3 Rp 180,000
Memberikan Infus rl, memberikan obat inj diphen, inj rani, inj ketorolac, antasida, scopamin, b6, pct 3/6/2017 3/8/2017 2 Rp 180,000
Memberikan Infus rl, memberikan obat pct syrup, salbu, ctm, dexa, inj ampi, 3/2/2017 3/6/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat pct, b comp, inj.ampi, inj rani, inj ketorolac, cotrimoxazole 3/4/2017 3/7/2017 3 Rp 180,000
Memberikan Infus rl, memberikan obat amoxicilin, pct, b comp, antasida, inj metoc, inj rani 2/27/2017 3/3/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampi, pct, antasid, b comp 3/6/2017 3/10/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat pct, Inj.ampicillin, antasida, b com, inj rani, inj metoc, amoxicilin 3/10/2017 3/11/2017 1 Rp 180,000
Memberikan Infus rl, memberikan obat pct, inj rani, omeprazole, antasida, b com 3/12/2017 3/13/2017 1 Rp 180,000
Memberikan Infus rl, memberikan obat pct, metoc, antasida, b com, 3/8/2017 3/11/2017 3 Rp 180,000
Memberikan Infus rl, memberikan obat inj. Ampi, inj. rani, pct, bc, antasida, GG, nebu combivent + Nacl, OBH sy 3/10/2017 3/14/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat inj.ranitidin, inj etorolac, GG, ctm, B6, cotrimoxazole, prednison, furosem 3/6/2017 3/10/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat inj metoc, inj.ranitidin, pct syr, antasida, oralit, b6 3/15/2017 3/16/2017 1 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampi, inj rani, pct, antasida, vit b com 3/18/2017 3/20/2017 2 Rp 180,000
Memberikan Infus rl, memberikan obat inj rani, antasida, vit B6, oralit 3/19/2017 3/20/2017 1 Rp 180,000
Memberikan Infus rl, memberikan obat inj metoc, inj.ranitidin, pct, loperamid, b com 3/15/2017 3/18/2017 3 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampi, inj rani, pct, antasida, vit b com 3/13/2017 3/17/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat pct syr, ctm, b com, amoxicilin syr 3/13/2017 3/17/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat pct, antasida, betahistine, metoc, b com 3/14/2017 3/18/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat ISDN, antasida, O2, natrium diklopenak, B1 3/18/2017 3/20/2017 2 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampi, pct, ambroxol, ctm, bc, salbu, dexa 3/28/2017 3/30/2017 2 Rp 180,000
Memberikan Infus rl, memberikan obat pct, antasida, prednison, b com, furosemid, ambroxol, inj furosemid, kat 3/21/2017 3/26/2017 5 Rp 180,000
Memberikan Infus D10, memberikan obat pct, phenoparbital, oksigen, inj ampi, zinc, oralit 3/20/2017 3/21/2017 1 Rp 180,000
Memberikan Infus rl, memberikan oksigen 3/26/2017 3/27/2017 1 Rp 180,000
Memberikan Infus rl, memberikan obat pct, antasida, b com, omeprazole, inj rani, inj ampi 3/23/2017 3/27/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat loperamide, metoc, pct, b6, antasida 3/24/2017 3/25/2017 1 Rp 180,000
Memberikan Infus rl, memberikan obat inj rani, inj ampi, pct, b com, antasida, ctm, betahistine, 3/16/2017 3/20/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat pct, b com, cloramphenicol, itamol forte, hufadine, infatrin 3/17/2017 3/21/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat inj norages, inj metoc, inj rani, pct, antasida, b com 3/15/2017 3/19/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat inj rani, pct, b com, antasida, inj metoc 3/17/2017 3/23/2017 6 Rp 180,000
Memberikan Infus rl, memberikan obat pct, antasida, omeprazole, b com, dulcolak, inj ampi, inj rani. 3/15/2017 3/18/2017 3 Rp 180,000
Memberikan Infus rl, memberikan obat drip aminopilin, inj aminopilin, pct, ambroxol, nebu combivent, salbutam 3/24/2017 3/28/2017 4 Rp 180,000
Memberikan Infus rl, memberikan obat inj rani, inj antrain, chloramphenicol, pct, b6, antasida 3/20/2017 3/23/2017 3 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampi, pct, b6, metoc, nipedipin, b6 3/26/2017 3/29/2017 3 Rp 180,000
Memberikan Infus rl, memberikan obat inj metoc, pct tab 3/26/2017 3/27/2017 1 Rp 180,000
Memberikan Infus rl, memberikan obat inj metoc, inj.ranitidin 3/21/2017 3/22/2017 1 Rp 180,000
Memberikan Infus rl, memberikan obat inj metoc,inj. Ranitidin, b6, oralit, pct 3/28/2017 3/31/2017 3 Rp 180,000
TOTAL DANA 115 Rp 7,380,000
Kediri, Maret 2017
Pemimpin UPT BLUD Puskesmas Kediri
Rosmayadi,SKM.MPH
NIP: 19681212 199003 1 014
JUMLAH BIAYA
Rp 180,000
Rp 540,000
Rp 360,000
Rp 540,000
Rp 360,000
Rp 540,000
Rp 360,000
Rp 720,000
Rp 540,000
Rp 720,000
Rp 720,000
Rp 180,000
Rp 180,000
Rp 540,000
Rp 720,000
Rp 720,000
Rp 180,000
Rp 360,000
Rp 180,000
Rp 540,000
Rp 720,000
Rp 720,000
Rp 720,000
Rp 360,000
Rp 360,000
Rp 900,000
Rp 180,000
Rp 180,000
Rp 720,000
Rp 180,000
Rp 720,000
Rp 720,000
Rp 720,000
Rp 1,080,000
Rp 540,000
Rp 720,000
Rp 540,000
Rp 540,000
Rp 180,000
Rp 180,000
Rp 540,000
Rp 20,700,000
REKAPITULASI
BULAN MEI 2017
1 RIADAH 0000829960953 KRG BEDIL BUTARA RETENSIO URINE
2 SITI ADRIANI 0000829771503 MONTONG ARE 81907875351 GEA TANPA DEHIDRASI

3 HENDRAWAN 0001899079874 KURIPAN 81805705227 SUSP TYPOID FIVER, DHF GRATE 1
4 moh ipan maria 0000829817482 kuripan dhf grate II susp typoid
5 M syukri 0000829396181 DUSUN BAJUR INDUK THYPOID FEVER
6 HENI MURONI 0000828894936 DUSUN OMBE SUSP DEMAM TYFOID DD GERD

7 murni 0001266100121 kediri susp tb paru dd efusi pleura
8 delisha azzahra 0002204209811 pelowok KDS + Urtikaria
9 Saepul 0000829478035 dusun datar gea tanpa dehidrasi
10 lalu sapwan 0000829692401 gelogor dispepsia

11 ika febriani 0000834777606 pringarata tyfoid fiver
12 molingga elisa 0000829707175 kr kuripan gastritis

13 saimah 0000829811643 gelogor GEA tanpa degidrasi
14 titi indra dewi 000083330799999 ombe bae tyfoid fiver + dhf
15 abizar algifari 0000830519537 gelogor utara vomiting + dehidrasi
16 baharudin 0000830163789 dusun sedayu tyfoid
17 aditya 0000829997717 kuripan utara tyfoid
18 rusmillah 0000830155803 batu tumpeng susp tyfoid dd DHF

19 udi setiawadi 0000829043043 jagerage indah dhf grate II
20 ardi suryadi 0000830581648 banyumulek diare akut
21 parhan 0000829735569 pelowok barat diare +vomiting dd isk
22 m samsul hadi 0000830942739 perendekan selatan tyfoid
23 suzana rahman 0001575869602 bangket dalem 87863842689 gea dehidrasi
24 lazqia hafiza 0001055604756 kr kuripan tyfoid

25 anugerah aprilyadi 0001109837935 rangegate 87765281038 vomiting dengan dehidrasi
26 selemah 0001055588433 tangkeban 85338219935 gea tanpa dehidrasi
27 HJ NIKMAH 0001483417956 KEDIRI 87865143397 vomiting dengan dehidrasi
28 amelia putri 0000829748079 dusun beremi kuripan 81933178336 tyfoid fiver dd dhf grate I
29 noviana ulfa 0000829901968 gelogor 87864724632 obs febfis h4 ec susp DHF
30 sukri 0000829528334 terajon vertigo + vomiting

31 maya istianti 0000829302096 adeng daye obs febris + tyfoid
32 mursini 0000829631529 gelogor vomiting low intake + DM type II
33 mukamilah 0000829992576 dasan baru typoid
34 nursah 0000830638236 kuripan utara susp urolitiasis dd apendicitis
35 hj rakmah 0000830588444 gelogor timur sindrom geriatri dd susp tb
TOTAL DANA
REKAPITULASI
AT INAP TINGKAT PERTAMA (RITP) BAGI PESERTA BPJS KESEHATAN
BULAN MEI 2017
JUMLAH HR
RAWAT
Memberikan Infus rl, memberikan obat inj ranitidin, inj ketorolak, vit b6, kateter 25/05/2017 27/05/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat, inj.ampiculin, paracetamol, omeprazol,vit b complek, 23/05/2017 24/05/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj norages, inj ranitidin, paracetamol, ambroxol, b com, 21/05/2017 24/05/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj ketorolak, inj ranitidin, inj metokloramid, pct, amoxcilin, b com 30/4/2017 3/5/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj ranitidin,pct,metokloramid,clorampenicol, 26/05/2017 29/05/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj ranitidin,inj metokloramid, clorampenicole,pct 29/04/2017 2/5/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj ketorolak, inj ranitidin, ibuprofen, vit b com, omeprazol,inj dipen 25/5/2017 26/5/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat pct syr, dizepam suup 29/05/2017 29/05/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj metokloramid, ceftriaxon, inj ranitidin 6/5/2017 8/5/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj ketorolak, pct,ctm,scopamin,antasida, 21/05/2017 22/05/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampicilin, inj ranitidin, pct, b com, inj ranitidin,antasida 19/05/2017 23/05/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat antasida,pct,vit b com, 3/5/2017 4/5/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin, inj metok, scopamin,loperamid,pct 21/05/2017 24/05/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj ranitidin, inj metok, inj ampicilin, loperamid,pct, b com 18/05/2017 24/05/2017 6 Rp 180,000 Rp 1,080,000
Memberikan Infus rl, memberikan obat inj metok,inj ranitidin,inj ampicilin,pct,b com 22/05/2017 23/05/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat ciprolacin,pcr, vit b com 7/5/2017 9/5/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat metok,pct,amoxcilin, 8/5/2017 9/5/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj metok,inj ranitidinpct,vit bcom,inj ampicilin 1/5/2017 8/5/2017 7 Rp 180,000 Rp 1,260,000
Memberikan Infus rl, memberikan obat inj ranitidin,vit k,pcr,antasida,inj metok,metokloramid 6/5/2017 8/5/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj ranitidin, pct, vit b com,loperamid, oralit 4/5/2017 5/5/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat pct,antaida,loperamid,oralit,inj ampicilin,inj gentamicin, zink, 30/4/2017 5/5/2017 5 Rp 180,000 Rp 900,000
Memberikan Infus rl, memberikan obat ibuprofen, amoxcilin,vit b com, inj ranitidin 5/5/2017 8/5/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat loperamide,vit b6,oralit, mrtok, inj ampicilin, 7/5/2017 9/5/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus D10, memberikan obat inj ranitidin,innj metok,inj ampicilin,pct,zink,oralit,ambroxol,ctm 11/5/2017 14/05/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj metok,inj ranitidin,zink,oralit,pct syr 11/5/2017 14/05/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj ranitidin, inj metok,loperamid,vit b com,omeprazol,oralit 15/05/2017 18/05/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat domperidon,pct,inj dipen,inj ranitidin 17/05/2017 18/05/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,pct,inj ampicilin,vit b com,amoxcilin 14/5/2017 18/05/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat inj ampicilim,inj ranitidin,pcr,ambroxol,ctm 17/05/2017 19/05/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj dipenhidramid,domperidone,ibuprofen,b com 17/05/2017 18/05/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat ampicilin,gentian violet,pct,b com 18/05/2017 20/05/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj ranitidin,inj metok,omeprazol,pct 17/05/2017 20/05/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj metok,inj ampicilin,inj ranitidin,vit b com,pct 22/05/2017 26/05/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat sinj scopamin,inj ranitidin,inj ketorolak,ranitidin,scopamin,vit b com 22/05/2017 25/05/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj ampicilin,inj metok,inj ranitidin,dexametason,paracetamol,ambroxol, 24/05/2017 26/05/2017 2 Rp 180,000 Rp 360,000
ANA 89 Rp 6,300,000 Rp 16,020,000
Kediri, MEI 2017

Rosmayadi,SKM.MPH
NIP: 19681212 199003 1 014
REKAPITULASI
BULAN MEI 2017
1 dina pratani 0001575954662 gunung sari 83129506066 tyfoid fiver
2 muhammad raffa 0001969979286 bengkel selatan dyspepsia

3 saehul lael 0000829988346 sedayu utara TYPOID FIVER
4 munrah 0001056382042 sempoja GEA + vomiting
5 zohaeri 0000829416352 montong are susp tb paru
6 ruslan 0001055593721 merembu barat susp hepatitis

7 murni 0001266100121 kediri susp tb paru dd efusi pleura
8 samaqyah 0000829797941 gersik utara ht urgensi + vertigo
9 fendi 000105558983 datar hipotensi + isk
10 sarini 0000828954617 merembu barat hipotensi + gastritis

11 fitra rahmayanti 0001019912231 kr kuripan gizi buruk dd pnemonia ringan
12 indah hani 0000830039196 ombe baret tyfoid fiver

13 hj rakmah 0000830588444 gelogor 818547814 demam tyfoid + susp tb paru
14 nova olivia 0002199214269 gelogor pnemonia ringan
15 ida wyan rudi 0001055599424 jagerage indah hiperglikemi dd dm type II
16 fitriani 0000829940411 gelogor tengah dispepsia, susp isk
17 islahul umam 0000830267921 sedayu timur tyfoid
18 yulianti 0001577141965 rumak barat tyfoid

19 heni muroni 0000828894936 kediri obs febris H-3
20 herlina kamariah 000144491984 banyumulek ht urgensi + hematomisis
21 haddatin 0000830017956 ombe bebae anemia sedang menometragia
22 sumarni 0000144439874 kediri obs febris + vomitinf
23 sapri 0000829327364 gersik utara 87863842689 gea
24 siti jumaenah 001055629653 sedayu tengah GEA DEHIDRASI BERAT

25 dina mar'aini 0002207506241 mantang tifoid fiver
26 ahmad yani 0000829177626 jagerage indah 85338219935 dispesia
27 h saat 0000830552815 KEDIRI anafilaktik reaction
28 anul hafizi 0000830267684 gelogor tengah susp dhf dd tifoid
29 idaham kholid 0002221412387 gersik utara hiperhlikemi
30 rianti 0000830119533 ombe baru gastritis kronik

31 irdawati 000829848194 gelogor 81916050760 vomiting + gea dehidrasi sedang
TOTAL DANA
REKAPITULASI
NAP TINGKAT PERTAMA (RITP) BAGI PESERTA BPJS KESEHATAN
BULAN MEI 2017
JUMLAH HR
RAWAT
Memberikan Infus rl, memberikan obat metok,paracetamol,antasida,clorampenicole,inj ranitidin 5/6/2017 8/6/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat, inj ampicilin,inj ranitidin,pct syr,dexa,vit b6 26/06/2017 30/06/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat inj ampicilin,inj ranitidin,pct,vit bcom,antasida 26/06/2017 30/06/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat loperamide,vit b6,oralit, donperidone,antasida 27/06/2017 28/06/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampicilin, asamtraneksamat,ambroxol,b com,paracetamol,inj metok 23/06/2017 28/06/2017 5 Rp 180,000 Rp 900,000
Memberikan Infus rl, memberikan obat inj ampicilin, inj ranitidin,mertonidazol,vit b com 25/06/2017 28/06/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj ketorolak, inj ranitidin, ibuprofen, vit b com, omeprazol,inj dipen 25/5/2017 26/5/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,inj metok,inj dipenhidramid,captrofil,vit b com,antasida 25/06/2017 28/06/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj ampicilin,inj ketorolak,paracetamol,vit b com 26/06/2017 27/06/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,inj metok, vit b com 25/06/2017 27/06/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj ampicilin, inj gentamicin, ambroxol syr, pcr syr,salbutamol,vit c 19/06/2017 24/06/2017 5 Rp 180,000 Rp 900,000
Memberikan Infus rl, memberikan obat inj ampicilin, pct, antasida, b com, ranitidin 19/06/2017 23/06/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat inj ampicili,pct,ambroxol,salbutamol,ctm 20/06/2017 23/06/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj ampicilin,inj gentamicin,pcr syr, ambroxol,ctm salbuamol, 17/06/2017 19/06/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat metformin,glimepirid,vit b com 24/06/2017 27/6/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj ranitidin, 21/06/2017 22/06/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampicilin,pct,ranitidin,vit b com 19/06/2017 22/06/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj ampicilin,inj ranitin,inj metok,pct,dimenhidramid 14/06/2017 18/06/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat metok,vit bom,inj ranitin 15/06/2017 17/06/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj ranitidin,pct,captrofil, 16/06/2017 17/06/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat paracetamol,vit b com 16/06/2017 17/06/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,inj metok,pct,antasida,donperidonw 16/06/2017 17/06/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj metok,inj ranitidin, antasid,antapilgit,vit b com 15/06/2017 16/06/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus D10, memberikan obat inj ranitidin,inj metok,antasida, oralit, 16/06/2017 17/06/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampicilin,ranitidin,pct,antasida,vit b com 9/6/2017 11/6/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj metok,inj ranitidin,pct,vit b com, 7/6/2017 10/6/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj furosemid,inj dexametason,ctm, vit b com,dex,salbutamol 3/6/2017 4/6/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampicilin,inj ranitidin,pct,vit bcom,antasida 17/06/2017 18/06/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat glimepirid,metformin 7/6/2017 8/6/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,antasida,ibuprofen,vit b com, 1/6/2017 3/6/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj ranitidin,donperidone,vit b com,scopamin.inj ampicilin,pct,antapulgit 4/6/2017 8/6/2017 4 Rp 180,000 Rp 720,000
72 Rp 5,580,000 #REF!
#REF!
#REF!
#REF!
#REF!
Kediri, MEI 2017 #REF!
Pemimpin UPT BLUD Puskesmas Kediri #REF!
Rp 12,960,000
REKAPITULASI
BULAN JULI2017
NO NAMA PENDERITA NOMOR KARTU ALAMAT NO.TELP./HP DIAGNOSA TINDAKAN YANG DIBERIKAN
1 SUHADA 0000829317598 GELOGOR TIMUR TYFOID FIVER + HEMOROID EKXTERNAL

Memberikan Infus rl, memberikan obat inj tiamphenicole,paracetamol,antihemoroid
2 lukman hadi 0000829531866 sama jaya montong are abdominal pain Memberikan Infus rl, memberikan obat, inj ranitidin,,scopamin,vit b com,paracetam
3 imbuk 0000829731543 gelogor timur gea dengan dehidrasi ringan Memberikan Infus rl, memberikan obat inj metok,inj ranitidin,inj ketorolack,oralit,ca
4 asifa salsabila salim 0001865917359 karang kuripan vomiting dengan dehidrasi ringan sedang
Memberikan Infus rl, memberikan obat metok, inj metok,oralit
5 sofiana ardianti 0002121761351 banumulek barat tyfoid + isk Memberikan Infus rl, memberikan obat inj ranitidin,inj metok,inj ketorolack,inj ampi
6 ahmad habibi 0001435015934 bagek polak gea dengan dehidrasi ringan Memberikan Infus rl, memberikan obat inj ranitidin,inj metok,zick,pct syr,
7 amnah 0000830564572 gersik utara dm tipe II + ht graten II Memberikan Infus rl, memberikan obat amlodipin,metformin,ranitidin,
8 asmak 0000829830611 jagerage indah susp selulitis Memberikan Infus rl, memberikan obat inj ampicilin,gentamicin salep,parcetamol,c
9 arum nirmala 0002216483627 bengkel gea sengan dehidrasi ringan Memberikan Infus rl, memberikan obat zick,domperidone syr,oralit
10 haeriah 00008299914682 sedayu gea dengan dehidrasi ringan Memberikan Infus rl, memberikan obat inj ampicilin, inj metock,inj ketorolack,anta
11 safina 0000830556325 gersik utara susp chf Memberikan Infus rl, memberikan obat furosemid,captrofil
12 jumrah 0000830275863 montong are tyfoid fiver + ht grate II Memberikan Infus rl, memberikan obat inj ampicilin,inj ranitidin,paracetamol,captro
13 rohaniah 0000144451304 kediri isk Memberikan Infus rl, memberikan obat inj ranitidin,inj ampicilin,inj metok,inj nor
14 iswanti 0000830564932 gersik utara dhf dd tyfoid Memberikan Infus rl, memberikan obat inj ampicilin,paracetamol,vit b com,
15 zaenul 0000829346679 gelogor selatan tyfoid fiver + isk Memberikan Infus rl, memberikan obat inj ampicilin,inj ranitidin,paracetamol,vit b
16 saehan 0001055600886 nyiur gading gea Memberikan Infus rl, memberikan obat inj ranitidin,inj metok,antapulgit,antasida
17 nasrullah 0000829156948 gelogor tengah isk Memberikan Infus rl, memberikan obat inj metok,inj ranitidinpct,vit bcom,inj ampic
18 wiwin 0000830043843 dasan tebu tyfoid fiver Memberikan Infus rl, memberikan obat cifrolaxim,paracetamol,ranitidin,metock,inj
19 nasri 0000829900348 datar isk Memberikan Infus rl, memberikan obat inj ampicilin,inj ranitidin,inj ketorolac,met
20 nurhayati 0000829628166 gelogor selatan gea Memberikan Infus rl, memberikan obat oralit, vit b comloperamid,antasida
21 sumarni 0000144376209 sedayu selatan dispepsia Memberikan Infus rl, memberikan obat inj ranitidin,inj ketorolac,paracetamol,omep
22 viola chantika putri 000183710789 puyung tonsilitis akut Memberikan Infus rl, memberikan obat inj ampicilin,paracetamol,ctm,dexa
23 wan azhari 0000829944393 kuripan gea Memberikan Infus rl, memberikan obat inj ranitidin,loperamid,paracetamol,vit b c
24 nur najma 0001896623717 kediri tifoid fiver + tb kelenjar Memberikan Infus rl, memberikan obat ibuprofen,vit b com,inj metok,inj ranitidin,
25 ahmad sahirudin 0000829875611 kr bedil timur gea Memberikan Infus rl, memberikan obat ranitidin,oralit,paracetamol,vit b com,antas
26 nuraedah 0000830004941 gersik utara tyfoid fiver Memberikan Infus rl, memberikan obat inj ampicilin,inj ranitidin,paracetamol,vit
27 mari'ah 0000830294357 kuripan utara gea Memberikan Infus rl, memberikan obat antapulgit,paracetamol.vit b com,oralit
28 dewa ketut ariani 0000830104773 adeng daye tonsilitis krons Memberikan Infus rl, memberikan obat inj ampicilin,inj ketorolak,asam mefenamat,
29 khaeroni 0000830018518 dusun bebae tifoid fiver Memberikan Infus rl, memberikan obat inj ranitidin,paracetamol,vit b com,metokl
TOTAL DANA
JUMLAH HR
TGL MASUK TGL PULANG TARIF PAKET JUMLAH BIAYA
RAWAT
24/07/2017 27/06/2017 3 Rp 180,000 Rp 540,000
23/07/2017 25/07/2017 2 Rp 180,000 Rp 360,000
5/7/2017 7/7/2017 2 Rp 180,000 Rp 360,000
8/7/2017 9/7/2017 1 Rp 180,000 Rp 180,000
3/7/2017 9/7/2017 6 Rp 180,000 Rp 1,080,000
9/7/2017 11/7/2017 2 Rp 180,000 Rp 360,000
7/7/2017 8/7/2017 1 Rp 180,000 Rp 180,000

9/7/2017 11/7/2017 2 Rp 180,000 Rp 360,000
11/7/2017 13/07/2017 2 Rp 180,000 Rp 360,000
16/07/2017 19/07/2017 3 Rp 180,000 Rp 540,000
16/07/2017 17/07/2017 1 Rp 180,000 Rp 180,000
15/07/2017 19/07/2017 4 Rp 180,000 Rp 720,000
15/07/2017 18/07/2017 3 Rp 180,000 Rp 540,000
19/07/2017 21/07/2017 2 Rp 180,000 Rp 360,000
17/07/2017 21/07/2017 4 Rp 180,000 Rp 720,000
20/07/2017 21/07/2017 1 Rp 180,000 Rp 180,000
20/07/2017 21/07/2017 1 Rp 180,000 Rp 180,000
19/07/2017 21/07/2017 2 Rp 180,000 Rp 360,000
19/07/2017 22/07/2017 3 Rp 180,000 Rp 540,000
21/07/2017 22/07/2017 1 Rp 180,000 Rp 180,000
24/07/2017 27/07/2017 3 Rp 180,000 Rp 540,000
28/07/2017 29/07/2017 1 Rp 180,000 Rp 180,000
28/07/2017 30/07/2017 2 Rp 180,000 Rp 360,000
26/07/2017 29/07/2017 3 Rp 180,000 Rp 540,000

29/07/2017 31/07/2017 2 Rp 180,000 Rp 360,000
26/06/2017 1/7/2017 5 Rp 180,000 Rp 900,000
30/06/2017 1/7/2017 1 Rp 180,000 Rp 180,000
1/7/2017 3/7/2017 2 Rp 180,000 Rp 360,000
29/06/2017 1/7/2017 2 Rp 180,000 Rp 360,000
67 Rp 4,500,000 Rp 12,060,000
Kediri, JULI 2017
H.Sahruji, SE, SKM, MM
NIP: 196712311989 1 130

REKAPITULASI
BULAN JULI2017
1 afandi 0000829951075 sedayu vertigo + HT e=grate II
2 dapa intihan 0000829968063 rumak barat GEA dehidrasi ringan

3 HJ nur 0000830587059 gelogor selatan GEA dehidrasi ringan sedang
4 najamudin 0000829986647 sedayu utara PPOK + dyspepsia

5 nurlaela 0000828868061 karang bedil GEA dehidrasi ringan sedang
6 heriadi 0001656036347 kel kemangisan GEA dehidrasi ringan

7 hasan 000014405336 kediri hipoglikemi
8 hambali 0000830388238 montong are obs febris susp tyfoid
9 susandi 0000829729833 sedayu utara susp DBD
10 mursini 0000829631529 gersik utara DM tipe II + vomiting

11 akidudin 0000830472366 pelowok timur susp ilius partikel
12 mikael rizki 0002086454024 kr kuripan barat susp epilepsi dd kdk

13 inaq acem 0000829731475 kediri GEA dehrasi berat
14 nurman 0000829804915 gelogor tengah tyfoid fiver + anemia + hipertensi grate II

15 muhamad saat 0000829964676 bangket dalem dehidrasi berat
16 sumarni 0000829042097 batu tumpeng GEA dengan dehidrasi ringan sedang

17 jamhur 0001474911742 kediri asthma bronchial + PPOK
18 sahrun 0000829562905 montong are isk

19 muhidin 0000828953199 batu tumpeng susp CA colon + isk
20 inaq daiyah 0001868406917 kuripan vomiting + GEA dengan dehidrasi serang

21 aermah 0000829327555 gelogor selatan asthma serangan berat
22 nurhasanah 0000829761794 kebon orong GEA dehidrasi ringan sedang

23 mustiani 0000829374401 kediri low intake + dehidrasi ringan sedang
24 line 0000835654847 kediri hipoglikemi

25 jam'ah 0000830536975 ombe dese GEA dehidrasi
26 saidi 0000829441967 terajon tifoid fiver
27 bilal rabbani 0000830557089 adeng daye GEA dengan dehirasi ringan
28 ida wayan rai 00008293333629 kediri DM tipe II + vomiting

29 ahila aneria 0001887297592 kediri febris + dehidrasi ringan sedang
30 habiburahman 0000829984645 batu tumpeng tifoid fiver + DHF + malaria

31 kalsum 0000829188808 gelogor GEA + vomiting protus
32 nurilah 0001055629743 bangket dalem syok hipovolemik + GEA akut

33 rian fahrizal 0000829574188 karang sembung tyfoid
34 fita helidawati 0000830256074 gersik selatan syok hipovoleme

35 arum nazaha 0002204237632 ombe bae vomiting protus dengan dehidrasi berat
36 kunti kusumawati 0000829691234 pelowok timur kolik abdomen
37 nurminah 0000167743809 kuripan utara GEA + febris
38 rianah 0000829422911 pelowok syok hipovolemik dd GEA
39 markunah 0002210282739 kr kuripan barat dispepsia
40 rusnan 0000828961885 timur raya jagerage vulnus eksrosisi + dispepsia
41 salma humairo 0000829829338 pelowok selatan vomiting dengan dehidrasi ringan
42 nursah 0000830638236 pelulan isk + dispepsia
43 ahmad said 0000829740486 batu tumpeng dispepsia
44 ainatalita azzahra 0002040790904 dasan tebu GEA dehidrasi ringan sedang
45 ruslam 0000829736572 bt tumpeng hemoroid grate II/III
46 nuredah 0000830004941 gersik utara hiperpireksia ec susp tyfoid fivr
47 inaq suja 0000830407252 merembu tengah vomiting dengan dehidrasi ringan
48 nengah rentet 0000834730738 kr kubu susp epitaksis + low intake
49 muhamad tahir 0001270020824 kediri dispnea ec CHF dd PPOK + HT emergensi
50 nursah 0000830638236 plulan low intake + dipepsia
51 mulana ezza yahya 0001897308887 kr bedil GEA dehidrasi ringan sedang
52 talmiah 0000144827313 kediri vomiting profus
53 fariah 0001577386653 kr bucu isk
54 alda putra pengestu 0000211094493 kediri hipereksia + dyspepsia

55 m yusron 0000167814663 kediri demam tifoid
56 zainal 0000830017348 kuripan tyfoid fiver + leukositosis
57 ahmad fatah 0000830413809 kuripan pelulan
58 nur hayati 0000828940904 kediri GEA dehidrasi ringan sedang
59 nila aprilia 0000830077874 kuripan demam tifoid
60 lalu azman lutfi 0000829201353 kediri hipereksia
61 muzaki 0000144306461 kediri ht urgensi + dehidrasi

TOTAL DANA
REKAPITULASI
BULAN JULI2017
JUMLAH HR
RAWAT
Memberikan Infus rl, memberikan obat inj dimenhidramit,inj metok,paracetamol,betahistin,captrofi,dimenhidramit 10/8/2017 13/08/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat, clorampenicole,oralit,ambroxol,ampicilin,paracetaml syr, 6/8/2017 9/8/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat metronidazol,oralit,paracetamol,scopamin,inj ranitidin,vit b com, 9/8/2017 13/08/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat paracetamol,ambroxol,inj ranitidin,amoxcilin,inj dexametason,salbutamol, 11/8/2017 13/08/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj ranidin,scopamin,metok,antapulgit, 13/08/2017 14/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj randin,inj scopamin,antapulgit,vit b com,scopamin, 14/08/2017 16/08/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat donperidon,iansoprazole 13/08/2017 14/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,ambroxol,paracetamol,vit b com, 15/08/2017 17/08/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat paracetamol,vit b com,amox, 19/08/2017 20/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,metformin,glimepirid,vit b com,inj metok,antasida,scopamin, 19/08/2017 20/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,metokloramid,antasdia,omepazole, 18/08/2017 19/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat paracetamol,pamol supp, fenobarbital,diazepam 14/08/2017 15/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,loperamid,paracetamol,vit b com,scopamin,antapulgit,metronidazole 11/8/2017 15/08/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat paracetamol,ambroxol,ctm,sf,salbutamol,amlodipin, 8/9/2017 8/13/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat inj ketorolak,inj ranitidin,paracetamol,loperamid,scopamin, 8/11/2017 8/12/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ketorolak, inj ranitidin, inj metokloramid,metronidazol,loperamid,antasida,donperidone 8/7/2017 8/10/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat nebu combivent,inj dexametason,salbutamol, 8/7/2017 8/9/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj ampicilin,inj ketorolak,ranitidin,vit b com,paracetamol,scopamin, 8/19/2017 8/22/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj ranitidin,inj ketorolak,scopamin,vit b com,omeprazole, 8/19/2017 8/20/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj metok,inj ranitidin,captrofil,loperamid,scopamin,paracetamol, 8/18/2017 8/21/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj dexametason,nebu combivent 8/19/2017 8/20/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat loperamid,oralit,inj metok,inj scopamin,inj ranitidin 8/16/2017 8/19/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat captrofil,vit c, ranitidin,paracetamol, 8/12/2017 8/13/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat paracetamol,metformin,glimepirid,cifrolaksin,ambroxol 8/13/2017 8/16/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat loperamid,donperidone,vit b com,inj metokloramid, 8/4/2017 8/6/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj ranitidin,paracetamol,vit b com, inj ampicilin,antapulgit,klorampenicole, 8/10/2017 8/13/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat domperidone,amoxcilin,paracetamol, 8/15/2017 8/15/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,antasida,metformin,oralit 8/17/2017 8/18/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat donperidone syr,pamol supp.pct syr 12/8/2017 13/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,paracetamol,vit b com, inj ampicilin,ambroxol, 26/08/2017 30/08/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat inj ketorolak,inj ranitidin,loperamid,doneridine,paracetamol,vit b com 6/8/2017 7/8/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,antapulgit,donperidone,paracetamol,cotrimoxsazol 3/8/2017 6/8/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat paracetamol,vit b com,inj ampicilin,inj antrain,antapulgit 31/08/2017 05/08/20171 5 Rp 180,000 Rp 900,000
Memberikan Infus rl, memberikan obat donperidone,loading rl 1 klove 7/8/2017 8/8/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat metok syr,oralit 7/8/2017 8/8/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj metok, inj ranitidin,inj ketorolak,oralit,metok,ibuprofen 7/8/2017 8/8/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,cotrimox,paracetamol,antasida syr,loperamid,inj metok, 5/8/2017 9/8/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat inj ranitidin,cotrimox,paracetamol,antasida syr,loperamid,inj metok, 4/8/2017 5/8/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj metok, inj ranitidin,inj ketorolak,paracetamol,vit b com 4/8/2017 5/1/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj paracetamol,vit b com,amox 30/07/2017 1/8/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj metok,inj ranitidin,donperidone 6/8/2017 7/8/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampicilin,inj antrain,inj ranitidin,paracetamol,vit b com, antasida 28/7/2017 1/8/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat inj ranitidin,inj metok,antasida,ranitidin, 29/07/2017 1/8/2017 3 Rp 180,000 Rp 540,000
Memberikan Infus rl, memberikan obat inj oralit,zink 4/8/2017 5/1/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,cotrimox,scopamin,vit b com,antihemoroid 22/08/2017 27/08/2017 5 Rp 180,000 Rp 900,000
Memberikan Infus rl, memberikan obat inj ranitidin,inj norages,inj metok,paracetamol,vit b com 24/08/2017 29/08/2017 5 Rp 180,000 Rp 900,000
Memberikan Infus rl, memberikan obat donperidone,amoxilin,vit b com,ctm 28/08/2017 29/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj norages,inj ranitidin,vit b com,ambroxol,paracetamol,antasida, 27/08/2017 28/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat captrofil,ambroxol,slbutamol, 25/08/2017 26/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,inj metok,inj ketorolak,antasida 7/8/2017 11/8/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat zink,paracetamol,vit b com, 20/08/2017 21/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ranitidin,inj ketorolak,donperidone,metformin,vit b com 22/08/2017 23/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampicilin,paracetamol,amoxcilin, 24/08/2017 26/08/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat inj ranitidin,ambroxol,paracetamol,vit b com, 22/08/2017 26/08/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat paracetamol,ranitidin,donperidone,antasida,vit b com 21/08/2017 26/08/2017 5 Rp 180,000 Rp 900,000
Memberikan Infus rl, memberikan obat cloampenicole syr,metok syr, 16/08/2017 21/08/2017 5 Rp 180,000 Rp 900,000
Memberikan Infus rl, memberikan obat paracetamol,donperidone,vit b com, 26/08/2017 28/08/2017 2 Rp 180,000 Rp 360,000
Memberikan Infus rl, memberikan obat scopamin,antasida,antapulgit,oralit 14/08/2017 15/08/2017 1 Rp 180,000 Rp 180,000
Memberikan Infus rl, memberikan obat inj ampicilin,paracetamol,vit b com,donperidone, 21/08/2017 30/08/2017 9 Rp 180,000 Rp 1,620,000
Memberikan Infus rl, memberikan obat inj noregaes,paracetamol,vit b com,mbroxol, 27/08/2017 31/08/2017 4 Rp 180,000 Rp 720,000
Memberikan Infus rl, memberikan obat inj ranitidin,captrofi,paracetamol,vit b com 27/08/2017 29/08/2017 2 Rp 180,000 Rp 360,000
TOTAL DANA 168 Rp 4,500,000 Rp 30,240,000
REKAPI
RAWAT INAP TINGKAT PERTAMA (R
BULAN SEPT

1 CANDRA ADI 0000829530696 LABUAPI SUSP OPENFRAKTUR RADIUS ULNA
2 MUHIDIN 0000828953199 JAGERAGE INDAH STROK HIPOVOLEMIK + CHEFALGIA

3 H WILDAN 0000830299072 SEDYU TENGAH FEBRIS + ASTHMA BRONCIALIS
4 MAHYUDIN 0002249266915 BK DALEM DEHIDRASI RINGAN SEDANG LOW INTAKE + TB PARU

5 JIDAH 0001055650948 KURIPAN UTARA FEBRIS + DERMATITIS TERBROLIK
6 M HAELAL 0000830686961 PELOWOK SELATAN CKR

7 MARNE 0000834866346 PRINGGARATA DEMAM TIFOID
8 AZZAM KHALIF ISMI 0002220032079 SEBELEK HIPOGLIKEMIA GEA DEHIDRASI
9 HJ HUSNIAH 0002059545317 KR BEDIL SELATAN DIARE PROTUS ENGAN DEHIDRASI RINGAN SEDANG
10 SAKRAL JANUARI 0000830310052 SEDAYU DHF

11 NASRUDIN 0002213918976 GELOGOR UTARA MELENA ec SUSP ULKUS PEPTIKUM
12 AGUS SUPRIADI 0000827636725 RUMAK BARAT SYOK HIPOVOLEMIK+ GEA

13 KARTINI 0000829490523 SEDAYU TENAGH HIPERTENSI URGENSI
14 ASTUTI MARIANA 0001445549308 BENGKEL UTARA KOLIK ABDOMEN + DISPEPSIA

15 MUHIDIN 0000828953199 JAGERAGE KOLIK ABDOMEN
16 SUSILAWATI 0000829694812 GERSIK UTARA CKR + VULNUS LASERATUM

17 M AZWAR 0000829762334 LABUAPI FEBRIS + TYFOID FIVER
18 AMAQ AWINAH 0000830760129 KR RUMAK tyfoid fiver

19 HMAYATI FAJRI 0000829916109 SEDAYU TIMUR KOLIK RENAL SUSP IS
20 RODI EBRIAN 0000829825828 TERAJON SUSP DEMAM TIFOID

21 HUSNIAH 0000830015133 SEDAYU SUSP SNH
22 IDAHAM 0000829899281 GELOGOR SELATAN HIPOTENSI + DISPEPSIA
23 MARSAH 0000829378574 MT ARE VOMITING PROTUS + GEA
24 BAHARUDIN 0000829279629 GELOGOR HEMATOMISIS + GASTRITIS

25 MARZUKI 0001055586115 LABUAPI VERTIGO SENTRAL
26 IDAHAM 0000829950671 GELOGOR ANEMIA SEDANG

27 NURUJI 0000829794115 GELOGOR TIMUR COLIK ABDOMEN + DYSPEPSIA
28 WAHYU ADI SAPUTRA 0000829284153 LABUAPI ANEMIA BERAT + DHF

29 RAMNAH 000829516702 KEDIRI LOW INTAKE + MIALGIA
30 HAMDANI 0000829568676 BENGKEL SELATAN KOLIK ABDOMEN + DISPEPSIA

31 JANIRAH 0002239505054 KR BUCU DYSPEPSIA ec TB PARU
32 ABDUL FATAH 0001055629798 SEDAYU SELATAN SUSP STROK HEMORAGIK

33 NENGAH LEMBUNG 000082907365 JAGERAGE VOMITING
34 SAKMAH 0001055610472 gersik selatan DYSPEPSIA

35 ASTUTI MARIANA 0001445549308 LABUAPI GEA VOMITING PROTUS
36 SANEP 000083027753 KEDIRI ASTHMA BRONCHIAL

37 CAYAH INAQ 0001920071856 KURIPAN GEA KOLIK ABDOMEN
TOTAL DANA
REKAPITULASI
BULAN SEPTEMBER 2017
TINDAKAN YANG DIBERIKAN TGL MASUK TGL PULANG
Memberikan Infus rl, memberikan obat PARACETAMOL,AMOX,CTM, 1/9/2017 2/9/2017
Memberikan Infus rl, memberikan obat PARACETAMOL,VIT B COM 31/08/2017 1/9/2017
Memberikan Infus rl, memberikan obat PARACETAMOL,ANTASIDA,VIT B COM,SALBUTAMOL,AMBRXOL, 1/9/2017 2/9/2017
Memberikan Infus rl, memberikan obat INJ RANITIDIN,VIT B COM,INJ AMPICILIN, 2/9/2017 4/9/2017
Memberikan Infus rl, memberikan obat INJ RANITIDIN,PARACETAMOL,VIT BCOM,CETIRIZIN, 2/9/2017 5/9/2017
Memberikan Infus rl, memberikan obat paracetamol,donperidone,vit b com, 4/9/2017 5/9/2017
Memberikan Infus rl, memberikan obat PARACETAMOL,DONPERIDNE,ANTASIDA,VIT B COM,INJ KETOROLAK,INJ AMPICILIN, 1/9/2017 5/9/2017
Memberikan Infus rl, memberikan obat INJ METOK,PARACETAMOL,POMOL SUPP 31/08/2017 2/9/2017
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ KETOROLAK,PARACETAMOL,ORALIT 1/9/2017 2/9/2017
Memberikan Infus rl, memberikan obat PARACETAMOL,INJ AMPICILIN,DONNPERIDONE,VIT B COM, 30/08/2017 6/9/2017
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ KETOROLAK,VIT B COM 6/9/2017 8/9/2017
Memberikan Infus rl, memberikan obat INJ RANITIDIN,OMEPRAZOLE,ANTASIDA,PARACETAMOL, 16/09/2017 17/09/2017
Memberikan Infus rl, memberikan obat PARACETAMOL,VIT B COM,CAPTROFIL, 15/09/2017 17/09/2017
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ KETOROLAK,OMEPRAZOLE,ANTASIDA,DONPERIDON, 13/09/2017 17/09/2017
Memberikan Infus rl, memberikan obat INJ KETOROLAK,INJ RANITIDIN,INJ SCOPAMIN, 22/09/2017 23/09/2017
Memberikan Infus rl, memberikan obat INJ KETOROLAK,INJ RANITIDIN,AMOXCILIN, 17/09/2017 19/09/2017
Memberikan Infus rl, memberikan obat INJ RANITIDIN,KLORAMFENIKOL,PARACETAMOL 13/09/2017 19/09/2017
Memberikan Infus rl, memberikan obat INJ AMPICILIN,INJ RANITIDIN,,PARACETAMOL,VIT B COM,ANTAPULGIT 13/09/2017 19/09/2017
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ KETOROLAK,SCOPAMIN,CIPROLAXIM,IBUPROFEN,ANTASIDA 16/09/2017 19/09/2017
Memberikan Infus rl, memberikan obat PARACETAMOL,CLORAMPENICOLE,METOKLORAMID,VIT B COM,RANITIDIN, 18/09/2017 22/09/2017
Memberikan Infus rl, memberikan obat PARACETAMOL 11/9/2017 12/9/2017

Memberikan Infus rl, memberikan obat INJ RANITIDIN,VIT B 6, 6/9/2017 8/9/2017
Memberikan Infus rl, memberikan obat ANTAPULGIT,ANTASIDA,SCOPAMIN,ORALIT, 9/9/2017 10/9/2017
Memberikan Infus rl, memberikan obat DONPERIDONE,OMEPRAZOLE,ASTRANEKSAMAT 9/9/2017 11/9/2017
Memberikan Infus rl, memberikan obat PARACETAMOL,OMEPRAZOLE,ANTASIDA,DONPERIDONE,INJ KETOROLAK 9/9/2017 11/9/2017
Memberikan Infus rl, memberikan obat INJ METOK,INJ RANITIDIN,PARACETAMOL, 9/9/2017 11/9/2017
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ KETOROLAK,VIT B COM,OMEPRAZOLE, 12/9/2017 13/09/2017
Memberikan Infus rl, memberikan obat PARACETAMOL,INJ RANITIDIN,SF,VIT B COM 13/09/2017 15/09/2017
Memberikan Infus rl, memberikan obat INJ RANITIDIN,PARACETAMOL,AMBROXOL,INJ KETOROLAK,CTM 11/9/2017 14/09/2017
Memberikan Infus rl, memberikan obat INJ RANITIDIN,PARACETAMOL,VIT B COM 6/9/2017 7/9/2017
Memberikan Infus rl, memberikan obat INJ RANITIDIN,PARACETAMOL,OAT, 10/9/2017 12/9/2017
Memberikan Infus rl, memberikan obat CAPTROFIL,PARACETAMOL, 4/9/2017 6/9/2017
Memberikan Infus rl, memberikan obat INJ METOK,INJ RANITIDIN,LANSOPRAZOL, 13/09/2017 14/09/2017
Memberikan Infus rl, memberikan obat PARACETAMOL,OMEPRAZOLE,ANTASIDA 13/09/2017 14/09/2017
Memberikan Infus rl, memberikan obat IJ KETOROLAK,INJ RANITIDIN,SCOPAMIN,ANTAPULGIT 22/09/2017 26/09/2017
Memberikan Infus rl, memberikan obat DEXAMETASON,SALBUTAMOL,AMBROXOL, 28/09/2017 29/09/2017

Memberikan Infus rl, memberikan obat INJ KETOROLAK,INJ RANITIDIN,ANTAPULGIT,ORALIT,PARACETAMOL, 27/09/2017 29/09/2017
TOTAL DANA
JUMLAH
HR TARIF PAKET JUMLAH BIAYA
RAWAT
1 Rp 180,000 Rp 180,000
1 Rp 180,000 Rp 180,000
1 Rp 180,000 Rp 180,000
2 Rp 180,000 Rp 360,000
3 Rp 180,000 Rp 540,000
1 Rp 180,000 Rp 180,000
4 Rp 180,000 Rp 720,000
2 Rp 180,000 Rp 360,000
1 Rp 180,000 Rp 180,000
7 Rp 180,000 Rp 1,260,000
2 Rp 180,000 Rp 360,000
1 Rp 180,000 Rp 180,000
2 Rp 180,000 Rp 360,000
4 Rp 180,000 Rp 720,000
1 Rp 180,000 Rp 180,000
2 Rp 180,000 Rp 360,000
6 Rp 180,000 Rp 1,080,000
6 Rp 180,000 Rp 1,080,000
3 Rp 180,000 Rp 540,000
4 Rp 180,000 Rp 720,000
1 Rp 180,000 Rp 180,000
2 Rp 180,000 Rp 360,000
2 Rp 180,000 Rp 360,000
2 Rp 180,000 Rp 360,000
2 Rp 180,000 Rp 360,000
2 Rp 180,000 Rp 360,000
1 Rp 180,000 Rp 180,000
2 Rp 180,000 Rp 360,000
3 Rp 180,000 Rp 540,000
1 Rp 180,000 Rp 180,000
2 Rp 180,000 Rp 360,000
2 Rp 180,000 Rp 360,000
1 Rp 180,000 Rp 180,000
1 Rp 180,000 Rp 180,000
4 Rp 180,000 Rp 720,000
1 Rp 180,000 Rp 180,000
2 Rp 180,000 Rp 360,000
85 Rp 4,500,000 Rp 15,300,000
REKAPITULASI KLAIM RAWAT INAP PUSKESMAS KEDIRI
BULAN : AGUSTUS 2015
NO NAMA PENDERITA NOMOR KARTU ALAMAT NO.TELP./HP DIAGNOSA TINDAKAN YANG DIBERIKAN
1 INARA LAURA 0002259780219 KEDIRI TF + GEA Memberikan Infus rl, memberikan obat INJ AMPICILIN, ZINK,ORALIT,PARACETAM
2 AZUKA ATIVIANI 0000834656894 BAGU TF + DYSPEPSIA Memberikan Infus rl, memberikan obat INJ AMPICIIN,INJ RANITIDIN,INJ METO
3 SUKRI HAJI 0000830716121 OMBE BAE ISK Memberikan Infus rl, memberikan obat CIPRO,AMBROXOL,ANTASIDA,
4 SAHNI 0000144380035 KEDIRI GEA DENGAN DEHDRASI Memberikan Infus rl, memberikan obat ANTAPULGIT,ORALIT,ANTASIDA,PARACE
5 AHMAD MUZAMIL 0001887802683 KEDIRI GERD + ISPA Memberikan Infus rl, memberikan obat INJ RANITIDIN,AMBROXOL,CTM,PARAC
6 FATIH RIZKY EFRIYADI 0002073678423 KEDIRI KDR Memberikan Infus rl, memberikan obat PARACETAMOL,AMBROXOL SYR,PENOBAR
7 MARDIANTI 0000829090721 KEDIRI GEA Memberikan Infus rl, memberikan obat ANTASIDA,B COM,PARACETAMOL,
8 MASTIAH 0001055487958 GERUNG ANEMIASEDANG LOW INTAKE Memberikan Infus rl, memberikan obat PARACETAMOL,INJ RANITIDIN,B COM,
9 ROSMIATUN 0000830276998 BANYUULEK DYSPEPSIA + TF Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ METOK,PARACETAMO
10 KHAIFAH UMAR 000226646405 BK DALEM CAMPAK Memberikan Infus rl, memberikan obat ACYCLOVIR,PCR SYR,VIT A,GENTAMICIN,
11 I GEDE KRISYA 0002315121906 KEDIRI KDS Memberikan Infus rl, memberikan obat PCR SYR,AMBROXOL,VIT C,FENOBARBITA
12 HJ NIKMAH 0001483417956 KEDIRI FEBRIS + TYFOID FIVER Memberikan Infus rl, memberikan obat INJ AMPICILIN,INJ RANITIDIN,PARACETA
13 SINAREP 0000828961569 KEDIRI GEA Memberikan Infus rl, memberikan obat PARACETAMOL,ANTASIDA,B COM
14 IZZATUL ALVIA 0000835449309 LABUAPI TF Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ AMPICILIN,PARAC
15 ERNI KAMILA WATI 0001859456294 KEDIRI KEJANG DDEMAM Memberikan Infus rl, memberikan obat PARACETAMOL SYR,PENOBARBITAL,AM
16 MUHLIS 0001055607254 KEDIRI DEMM TF Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ AMPICILIN,PARACET
17 NIKMAH 0000829735773 KEDIRI ANGINA PEKTORIS + CHF Memberikan Infus rl, memberikan obat INJ RANITIDIN,PARACETAMOLVIT B CO
18 SAMAH 0000830191599 PELOWOK BARAT GEA DEHIDASI SEDANG Memberikan Infus rl, memberikan obat CAPTROFIL,NTAPULGIT
19 FARIDAH 0000144403997 KEDIRI HEMAPTOMA Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ KETOROLAK,PARA
20 SARWITI 0002286112252 KEDIRI DYSPEPSIA Memberikan Infus rl, memberikan obat INJ ANIITIDIN,ANTASIDA,OMEPRAZOL
21 ELIN 0000830886535 KEDIRI OBS FEBRIS Memberikan Infus rl, memberikan obat INJRANITIDIN,PARACETAMOL,AMBROXOL
22 DESIANA 0000829871199 KEDIRI TF Memberikan Infus rl, memberikan obat INJ METOKLORAMID,INJ RANITIDIN,
23 HARIANTO 0000830616219 KEDIRI TF Memberikan Infus rl, memberikan obat PARACETAMOL,AMBROXOL,INJ AMPICIL
24 YULIANI 0000830500492 KEDIRI TF Memberikan Infus rl, memberikan obat INJ AMPICILIN,AMBROXOL,CTM
25 SALMAN 0001055487947 GERUNG TF Memberikan Infus rl, memberikan obat CIPRO,PARACETAMOL,ANTASIDA,VIT B
26 MULYANI 0000829206268 GELOGOR TIMUR SUSP DEMAM TIFOID Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ METOK,PARACETAM
27 ULANDARI 0000829448237 KEDIRI TF FIVER Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ METOK,INJ AMICILI
28 RAYHAN 0002251711124 KEDIRI FEBRIS + TYFOID FIVER Memberikan Infus rl, memberikan obat PARACETAMOL SYR,AMBROXOL,ANTRAIN
29 HJ PATIMAH 0000830264049 KEDIRI DISTENSI ABDM Memberikan Infus rl, memberikan obat SCOPAMIN,INJ RANITIDIN,INJ METOK,VIT
30 H MUHID 0000829447907 KEDIRI OBS FEBRIS Memberikan Infus rl, memberikan obat AMBROXOL,PARACETAMOL,AMPICILIN,
31 DILLA ANDIRA 000014424545 KEDIRI INJ AMPICLIN,INJ RANITIDIN,PARACETAMOL,HIPERTENSIMemberikan Infus rl, memberikan obat INJ AMPICILIN,INJ RANITIDIN,PARACET
32 MARLINA 0001055927889 DAREK OBS FEBRIS Memberikan Infus rl, memberikan obat PARACETAMOL,VIT C
33 ASMUNI 0000829540653 KEDIRI PPOK Memberikan Infus rl, memberikan obat INJ AMPICILI,DEZA,SALBUTAMOL,
34 BY NI WYAN HARTINI 0002264765128 KURIPAN PNEMONIA RINGAN Memberikan Infus rl, memberikan obat INJ AMPICILIN,INJ GENTAMICIN,PARAC
35 HELMI 000082933053 BANYUULEK TF + ISK Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ METOK,PRACETAMOL
36 HAFIZ 0001055608402 KEDIRI PNEUMONIA Memberikan Infus rl, memberikan obat INJN KETOROLAK,INJ RANITIDIN,INJ AMPI
37 SUGIANTO 0000830530541 KEDIRI GEA DENGAN DEHIDRASI Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ SCOPAMIN,INJ ME
38 NAJAMUDIN 0000829986647 KEDIRI GEA TANPA DEHIDRASI Memberikan Infus rl, memberikan obat ANTAPULGIT,ORALIT,ANTASIDA,PARACE
39 MIFTAHULJANAH 000224289689 DASAN CERMEN KEJANG DEMAM Memberikan Infus rl, memberikan obat PAMOL SUPP,PCR SYR,PENOBARBITAL
40 JURIAH 0002062757406 MEREMBU DISENTRI Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ METOK,ANTAPULGIT,
41 SINARAH 0000829968996 BANYUMULEK DYSPEPSIA Memberikan Infus rl, memberikan obat INJ RANITIDIN,OMEPRAZOLE,PCT,DULXO
42 HAYATI 0000146261766 BENGKEL SELATAN ISK VWERIGO Memberikan Infus rl, memberikan obat PCT,AMBROXO,CTM,INJ AMPICILIN,INJ R
43 NOVERIKA 0002238617801 KEDIRI SUSP DEMAM TIFOID Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ KETOROLAK,PARACET
44 NURIYAH 0000830254149 KEDIRI GEA DEHIDRASI Memberikan Infus rl, memberikan obat INJ RANITIDIN,CAPTROFIL,ORALIT,PARA
45 SAKYAH 0000829168391 KEDIRI OBS FEBRIS Memberikan Infus rl, memberikan obat BETAHISTIN,PARACETAMOL,ANRASIDA,
46 LI NOVI 000083063332 KEDIRI ISK Memberikan Infus rl, memberikan obat INJ RANITIDIN,PARACETAMOL,CIPRO,CT
47 HENDON 000830308533 KEDIRI GEA Memberikan Infus rl, memberikan obat INJ RANITIDIN,PARACETAMOL,ANTAPU
TOTAL DANA
JUMLAH HR
TGL MASUK TGL PULANG TARIF PAKET JUMLAH BIAYA
RAWAT
27/12/2017 1/1/2018 4 Rp 180,000 Rp 720,000
25/11/2017 1/12/2017 6 Rp 180,000 Rp 1,080,000
30/11/2017 2/12/2017 2 Rp 180,000 Rp 360,000
30/11/2017 4/12/2017 4 Rp 180,000 Rp 720,000
2/12/2017 4/12/2017 2 Rp 180,000 Rp 360,000
2/12/2017 4/12/2017 2 Rp 180,000 Rp 360,000
4/12/2017 5/12/2017 1 Rp 180,000 Rp 180,000

3/12/2017 5/12/2017 2 Rp 180,000 Rp 360,000
5/12/2017 7/12/2017 2 Rp 180,000 Rp 360,000
4/12/2017 8/12/2017 4 Rp 180,000 Rp 720,000
7/12/2017 8/12/2017 1 Rp 180,000 Rp 180,000
7/12/2017 8/12/2017 1 Rp 180,000 Rp 180,000
7/12/2017 8/12/2017 1 Rp 180,000 Rp 180,000
6/12/2017 9/12/2017 3 Rp 180,000 Rp 540,000
7/12/2017 9/12/2017 2 Rp 180,000 Rp 360,000
6/12/2017 9/12/2017 3 Rp 180,000 Rp 540,000
5/12/2017 9/12/2017 4 Rp 180,000 Rp 720,000
9/12/2017 10/12/2017 1 Rp 180,000 Rp 180,000
7/12/2017 10/12/2017 3 Rp 180,000 Rp 540,000
18/12/2017 20/12/2017 2 Rp 180,000 Rp 360,000
13/12/2017 20/12/2017 7 Rp 180,000 Rp 1,260,000

12/12/2017 18/12/2017 6 Rp 180,000 Rp 1,080,000
14/12/2017 17/12/2017 3 Rp 180,000 Rp 540,000
11/12/2017 17/12/2017 6 Rp 180,000 Rp 1,080,000
12/12/2017 16/12/2017 4 Rp 180,000 Rp 720,000
9/12/2017 15/12/2017 6 Rp 180,000 Rp 1,080,000
11/12/2017 14/12/2017 3 Rp 180,000 Rp 540,000
7/12/2017 14/12/2017 6 Rp 180,000 Rp 1,080,000
6/12/2017 14/09/2017 7 Rp 180,000 Rp 1,260,000
11/12/2017 13/12/2017 2 Rp 180,000 Rp 360,000
9/12/2017 13/12/2017 4 Rp 180,000 Rp 720,000
9/12/2017 12/12/2017 3 Rp 180,000 Rp 540,000
10/12/2017 12/12/2017 2 Rp 180,000 Rp 360,000
8/12/2017 12/12/2017 4 Rp 180,000 Rp 720,000
08/12/21017 12/11/2017 3 Rp 180,000 Rp 540,000
12/22/2017 12/23/2017 1 Rp 180,000 Rp 180,000
12/20/2017 12/24/2017 4 Rp 180,000 Rp 720,000
12/29/2017 12/31/2017 2 Rp 180,000 Rp 360,000
12/27/2017 12/28/2017 2 Rp 180,000 Rp 360,000
12/25/2017 12/28/2017 3 Rp 180,000 Rp 540,000
12/21/2017 12/27/2017 7 Rp 180,000 Rp 1,260,000
12/19/2017 12/22/2017 3 Rp 180,000 Rp 540,000
12/20/2017 12/26/2017 6 Rp 180,000 Rp 1,080,000
12/24/2017 12/28/2017 4 Rp 180,000 Rp 720,000
12/27/2017 12/30/2017 3 Rp 180,000 Rp 540,000
12/27/2017 12/31/2017 4 Rp 180,000 Rp 720,000
12/25/2017 12/31/2017 7 Rp 180,000 Rp 1,260,000

162 Rp 4,500,000 Rp 29,160,000
Kediri, September 2017


NIP: 196712311989 1 130
REKAPITULASI KLAIM RAWAT INAP UPT BLUD PUSKESMAS KEDIRI
BULAN : MARET 2016
NAMA FASKES : UPT BLUD PUSKESMAS KEDIRI
1 MUSLEH HAJARUDIN 0000831250664 KR.KURIPAN 087864943553 OBS DYSPNEU + S.PPOK + S.TB PARU
2 MUNISAH 0000830521675 MEREMBU 087864775764 HT URGENCY + VERTIGO
3 HAMDINA 0001274669267 SEDAYU 087865315300 TONSILITIS KRONIS
4 SALWA AMELIA 0001968016476 KR.BEDIL 081991170809 PNEUMONIA + TF
5 AMAQ SAMSUDIN 0000830201117 BLUNSUK 081907266503 DHF GR I + TF
6 KT LEBAH 0000830221391 JAGARAGA INDAH S.TF + DHF
7 MAKMUR 0000829296617 GERSIK 081933005249 OBS.DYSPNEU + PENURUNAN KESADARAN + S.PPOK
8 M.RISKI AKBAR 0000830064396 BT TUMPENG VULNUS LACERATUM
9 PATIMAH 0000830142628 KR.KURIPAN 081805250561 GENERAL WEAKNESS + S.TBPARU
10 IWAN 0000829396315 KR.KURIPAN 081907169452 CKR + CEPAL HEMATOMA REGIO TEMPORSL DEXTRA
11 RODI ARDIANSYAH 0000829848824 BT TUMPENG 0878865843251 CKR
12 GUNAWAN 0000829255004 RUMAK TB PARU + GENERAL WEAKNESS
13 MULIANAH 0000829364512 DATAR 087765818466 S.TF
14 SITI JUERIAH 0001920109476 KR.BEDIL 081936797126 DM TIPE II + HT GR III + ISK
15 INAQ ARINAH 0000830783608 BANYUMULEK 081805727303 GASTRITIS AKUT + ISPA
16 DIAN MUNAWARAH 0000830377653 NYIUR GADING '087765150318 DEMAM DENGUE
17 H.WAJDI 0000829915007 RUMAK 081936702244 GEA
18 IDA A NYMN KIRTI 0000830131255 JAGARAGA INDAH 087865857840 GEA
19 ARBI HAEKAL 0000830219005 SEDAYU 087765576176 S.TF
20 IRNAWATI 0000829040319 BENGKEL 081803676935 DM TIPE II
21 MUKSIN SAIF 0000144250571 BANGKET DALEM 087865888489 GENERALWEAKNES + S.TF
22 AIDIL IHWAN 0000830119511 KR.KURIPAN 087765653782 TF + ISK
23 MAHYUNI 0000830461331 OMBE DESA GEA + ANEMIA RINGAN
24 RONI SETIAWAN 0000829508499 KR.KURIPAN TF
25 DINDA RAHMAYANTI 0000830242798 KR.MAKAM 081907857657 DHF GR I
26 HJ.AENUN NISWAH 0001055611675 GELOGOR 081933134447 GEA
27 AHMAD HABIB T. 00001435015934 JERNENG 081917372771 OBS.VOMITING
28 BQ SUCIATI 0000829979291 TERATE 081907498741 FEBRIS + ISK +S.HEPATITIS A + GASTRITIS AKUT + S.TB
29 YUDI HARTTADI 0001848305542 KURIPAN 081907625293 DHF GR I + ISPA
30 SAHNIM 0000830003185 TANGKEBAN 087865255149 GEA + HYPOTENSION
31 MURSIT 0000831189802 BEREMI 087864216564 GEA + ISPA + ISK
32 ADITYA RAHMAN 0000829653131 OMBAE 081907050500 ISK
33 RAMDAN 0000830256974 MTONTONG ARE 085237169732 TF + DHF + OBS.VOMITING
34 ISMAIL 0000829694979 PELOEOK 081917057700 S.TB PARU + KONSTIPASI
35 MALIKI 0001055624962 OMBE REROT 081936751348 S.GASTRITIS EROSIF + ANEMIA SEDANG
36 M. ADIS 0001055925358 RANGGAGATA 081907017149 TF
37 NURJANAH 0000829751152 RUNGKANG 087765526189 S.TB PARU + ISPA + OBS.FEBRIS
38 MARTINI 0000829010169 BT.TUMPENG HEMOROID GR I + DYSPEPSIA + OBS.FEBRIS
39 SAEHAN 0001055600886 NYIUR GADING 081907545898 GEA + OBS.VOMITTTING
40 NURUL HANDAYANI 0001577662018 PELOWOK UTARA G1P0A0H0, T/H/IU, K/U IBU BAIK & JANIN TAKIKARDI + FEBRIS
TOTAL DANA
RAWAT INAP UPT BLUD PUSKESMAS KEDIRI
BULAN : MARET 2016
JUMLAH
TINDAKAN YANG DIBERIKAN TGL MASUK TGL KELUAR HR RAWAT JUMLAH TAGIHAN KET
Memberikan Infus rl, inj.ceftriaxon,pct,sf,dexa,ambroxol 2/23/2016 3/1/2016 7 Rp 120,000 Rp 840,000
Memberikan Infus rl, inj. Ranitidin,inj.metoc,captopril 3/9/2016 3/10/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, inj.norages,pct,antasida,b6 3/1/2016 3/7/2016 6 Rp 120,000 Rp 720,000
Memberikan Infus rl drip ampicillin,in.genta,nebulisasi combiven, pct syr, ambroxol syr 2/27/2016 3/4/2016 6 Rp 120,000 Rp 720,000
Memberikan Infus rl,inj.ampicillin,pct,antasid,bc 3/2/2016 3/5/2016 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, inj. Ampicillin,pct,b6,antasid 3/6/2016 3/7/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, O2 3/8/2016 3/9/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl pct,amoxilin 3/18/2016 3/19/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, pct,vitc,gg,sf 2/29/2016 3/6/2016 6 Rp 120,000 Rp 720,000
Memberikan Infus rl, heating,rawat luka ,o2,pct,dexametason,amoxilin,bc, 3/6/2016 3/7/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus RL, O2,pct,amoxilin 3/7/2016 3/8/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl,inj.ranitidin,mtoc,pct,bc 3/7/2016 3/8/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, inj.ampicillin,pct,b6,antasid 3/5/2016 3/14/2016 9 Rp 120,000 Rp 1,080,000
Memberikan Infus D5%, D40%, 3/11/2016 3/14/2016 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, inj.norages,pct,antasida,omeperazol,bc,in.metoc 3/9/2016 3/15/2016 6 Rp 120,000 Rp 720,000
Memberikan Infus rl, inj.ranitiin,pct,bc,antasid, 3/12/2016 3/15/2016 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, inj.rani,inj.metoc,scopamin,pct 3/13/2016 3/15/2016 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, pularex,oralit, b6,scopamin 3/13/2016 3/15/2016 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, inj.rani, pcT, b6 3/11/2016 3/14/2016 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, isdn, antasida 2/19/2016 2/20/2016 1 Rp 120,000 Rp 120,000
memberikan infus rl, inj.rani, antasid, pct,bc 3/14/2016 3/15/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, inj.ampicillin,pct,antasid,bc 3/27/2016 3/6/2016 8 Rp 120,000 Rp 960,000
Memberikan Infus rl, sf,bc,pct 3/14/2016 3/17/2016 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, inj. Rani,antasida, pct,bc 3/11/2016 3/17/2016 6 Rp 120,000 Rp 720,000
Memberikan Infus rl, inj.metoc,,pct,antasid,b6 3/16/2016 3/19/2016 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, inj.rani,pct,loperamid,b6,scopamin,aludofina syr 3/16/2016 3/19/2016 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, inj.metoc,pct,b6 3/19/2016 3/20/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, inj.ceftri,inj.metoc, pct,antasid,bc 3/15/2016 3/21/2016 6 Rp 120,000 Rp 720,000
Memberikan Infus rl, inj.Metoc, inj.norages,inj.rani, pct,ambroxol,ctm 3/19/2016 24//3/2016 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, pct, pularex,ambroxol,oralit 5/25/2016 3/26/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, inj.rani,pct,loperamid,ciprofloksasin,nadik,b6 3/22/2016 3/26/2016 4 Rp 120,000 Rp 480,000
Memberikan Infus rl,pct,bc,inj.ceftri 3/23/2016 3/26/2016 3 Rp 120,000 Rp 360,000
Memberikan infus rl, inj.rani,pct,antasid,b6 3/23/2016 3/26/2016 3 Rp 120,000 Rp 360,000
memberikan infus rl, drip neurobion,pct,bc,amox 3/21/2016 3/28/2016 7 Rp 120,000 Rp 840,000
Memberikan infus RL, antasid,sf,vit.k, 3/27/2016 3/28/2016 1 Rp 120,000 Rp 120,000
Memberikan infus RL,inj.ceftri,pct,bc 3/24/2016 3/29/2016 5 Rp 120,000 Rp 600,000
Memberikan infus RL,pct,amboxol,ctm,antasida 3/22/2016 3/30/2016 8 Rp 120,000 Rp 960,000
Memberikan infus RL,inj. Metoc,pct,oralit,cotrymoksazol 3/26/2016 3/30/2016 4 Rp 120,000 Rp 480,000
Memberikan infus RL,loperamid,oralit,cotrymoksazol 3/28/2016 3/31/2016 3 Rp 120,000 Rp 360,000
Memberikan infus RL, ampicillin,O2 3/1/2016 3/2/2016 1 Rp 120,000 Rp 120,000
ANA 140 Rp 120,000 Rp 16,800,000
Kediri, April 2016

Rosmayadi,SKM.MPH
NIP: 19681212 199003 1 014
BULAN : FEBRUARI 2016
1 ROB'I HAKAMI 0001893837003 SEDAYU 087765787253 DF + ISK

2 HUMAROK 0000830181058 KR.BEDIL 081803646592 DYSPEPSIA
3 ZIADU LULUM 0000830209689 LELEDE S.TF
4 SAID MARZUKI 0001286678687 RUMAK ASTHMA EKSERBASI AKUT
5 MAZUKI 00010556111304 GERSIK S.ULKUS PEPTIKUM
6 RISMAWATI 0000829719797 GELOGOR SELATAN 081917966336 TF + DHF + VOMITING
7 NI KOMANG KIRTI 0000829571782 ADENG DAYE 087862733332 HT + DHF
8 HJ.INDRAWATI 0001969095734 SEDAYU 087782871344 EPYLEPSI
9 JIHAN ULWA 0001055611225 GELOGOR SELATAN DYSPEPSIA
10 M. ZAROQI RABBANI 0000173413078 GELOGOR 08175766086 SUSP. GASTRITIS EROSIF
11 ANAH 0000829224483 GELOGOR TIMUR 087865346968 HYPOGLIKEMIA
12 DSK PUTU M UTAMI 0007050829015 JAGARAGA 087765820797 TF + DHF
13 INAQ ICAH 0000830428413 OMBAE 081917253890 DYSPEPSIA + ANEMIA
14 HAERIAH 0000830261474 GELOGOR TIMUR 081805263332 HEMOPTOE + S. TB PARU
15 HAJI ZAENAL 0000830718909 PERENGGE LUAH 087864725852 ISK + BPH
16 MUHMMAD KAHAIRUL T 0001872451372 BENGKEL PNEMONIA
17 HJ.INDRAWATI 0001969095734 SEDAYU SELATAN 087782871344 DYSPEPSIA + FEBRIS
18 M. MUAMMAR 0001825392701 MEREMBU 85236987035 DYSPPEPIA
19 BULAN RAMDHIA S.P 0000162410736 PPNH 081917961635 TF
20 MISLAH 0000829298507 GERSIK SELATAN DM TIPE II
21 MIRZA UKAIL 0001966306217 OMBE REROT 081907274736 PNEUMONIA + BRONCHIOLITIS
22 SITI JUERIAH 0001920109476 KR.BEDIL 081936797126 HT GRADE II + DM TIPE II
23 SALIKIN 0000829153102 GELOGOR UTARA 087865806257 GEA
24 SALEH 0000829331504 GERSIK UTARA LOWBACK PAINT + GENERAL WEAKNESS
25 NURAINI 0001806999142 BAGEK POLAK 081907815307 GENERAL WEAKNESS + DYSPEPSIA + ISK
26 INDRA MAYADI 0000144801933 BANYUMULEK 08175771229 DHF GR I
27 SALMIN 0000828994296 SEDAYU 08175709984 DHF GR I
28 PATEMAH 0000828986657 BT TUMPENG GEA + VOMITING
29 SURIAH 0001969077644 BT TUMPENG 081907625293 OBS.VOMITING + ANEMIA
30 IMBUK 0000829803385 ITING LANGGEM 081907241954 DHF GR I
31 HENDRIAWAN 0000830085423 ITING LANGGEM DHF GR I + TONSILTIS
32 SABNI 0000830305427 MONTONG ARE S.CVA HEMORAGIC + GEA
33 ALPARUH 0000829405067 PELOWOK BARAT 081803671653 OBS.FEBRIS + ISPA
34 BUDI HARTINI 0000829214234 BT TUMPENG 087765759735 GEA
35 SAPUTRA JAYADI 0001284850585 BANGKET DALEM PNEUMONIA
36 NURHAYATI 0000830727674 KURIPAN UTARA 087865805154 HYPEREMESIS GRAVIDARUM
TOTAL DANA
AIM RAWAT INAP UPT BLUD PUSKESMAS KEDIRI
BULAN : FEBRUARI 2016
JUMLAH HR JUMLAH
TINDAKAN YANG DIBERIKAN TGL MASUK TGL KELUAR KET
RAWAT TAGIHAN
Memberikan Infus rl, pct,bc 1/28/2016 2/2/2016 5 Rp 120,000 Rp 600,000

Memberikan Infus rl, inj. Ranitidin,pct, antasid 2/5/2016 2/6/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, thiampenikol,pct,bc 2/5/2016 2/7/2016 2 Rp 120,000 Rp 240,000
Memberikan Infus rl drip aminophilin 1 A, inj.dexa + aminophilin, inj.epinephrine, nebulisasi combi 2/6/2016 2/7/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl,, inj. Ceftriaxone, inj. Ranitidin,pct, antasid 2/7/2016 2/10/2016 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, inj. Ceftriaxone, inj.metoc, pct, antasid 2/7/2016 2/10/2016 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, captopril,pct,bc 2/8/2016 2/10/2016 2 Rp 120,000 Rp 240,000
Memberikan Infus rl drip diazepan, O2,inj.diiazepam, ambroxol, amoxilin 2/10/2016 2/11/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, , inj.metoc, inj. Ranitidin, inj.keto, antasid, metoc 2/9/2016 2/11/2016 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, inj.asam traneksamat, inj. Ceftriaxone, inj.metoc, inj. Ranitidin 2/4/2016 2/11/2016 7 Rp 120,000 Rp 840,000
Memberikan Infus d5%, O2 2/11/2016 2/13/2016 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, IJK. Ampicilin.ijk, gentamicin.ambroxol sirup 2/7/2016 2/12/2016 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, inj.rani, antasid, sf, bc 2/10/2016 2/12/2016 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, vit k, ambroxol 2/15/2016 2/16/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, BC 2/9/2016 2/16/2016 7 Rp 120,000 Rp 840,000
Memberikan Infus rl, inj.gentamicin, inj.ampicilin, ambroxol syr 2/15/2016 2/16/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, inj.rani, antasid, bc, pct 2/15/2016 2/18/2016 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, inj. Rani, inj. Keto, antasida,omeperazol 2/16/2016 2/17/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, inj.rani, pct 2/16/2016 2/18/2016 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, isdn, antasida 2/19/2016 2/20/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, inj. Ceftriaxone,nebulisasinacl,pct drop,gg,salbutamol 2/15/2016 2/20/2016 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, captopril sl,inj.rani,in.ondancentron, antasida,metoc,glibenklamid,nifedipin 2/17/2016 2/20/2016 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, O2,in.ranitidin,nebu combiven,pct,oralit 2/19/2016 2/20/2016 1 Rp 120,000 Rp 120,000
Memberikan Infus rl, inj. Rani,antasida, pct,bc 2/20/2016 2/22/2016 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, inj.rani, antasid, rani, bc 2/14/2016 2/22/2016 8 Rp 120,000 Rp 960,000
Memberikan Infus rl, inj.rani,pct,bc 2/20/2016 2/23/2016 3 Rp 120,000 Rp 360,000
Memberikan Infus rl, inj.rani, pct, bc 2/20/2016 2/22/2016 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, inj.ampicillin, inj.metoc,pularex,antasid,bc 2/21/2016 2/23/2016 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, inj.Metoc, inj.keto,loperamid, antasid,bc, pct, oralit 2/22/2016 2/24/2016 2 Rp 120,000 Rp 240,000
Memberikan Infus rl, pct, antasid,bc, inj.rani 2/19/2016 2/24/2016 5 Rp 120,000 Rp 600,000
Memberikan Infus rl, inj.ceftriaxon,inj.rani,pct, antasid,bc 2/22/2016 2/26/2016 4 Rp 120,000 Rp 480,000
Memberikan Infus rl,pct, pularex, oralit, 2/28/2016 2/29/2016 1 Rp 120,000 Rp 120,000
Memberikan infus rl, coparcetin syr 2/26/2016 2/29/2016 3 Rp 120,000 Rp 360,000
memberikan infus rl, pularex,oralit, in.ondancentron, pct 2/13/2016 2/16/2016 3 Rp 120,000 Rp 360,000
Memberikan infus RL, inj.ampicillin, inj.genta,nebulisasinacl, o2 2/22/2016 2/23/2016 1 Rp 120,000 Rp 120,000
Memberikan infus RL,inj. Metoc,inj.rani 2/9/2016 2/10/2016 1 Rp 120,000 Rp 120,000
TAL DANA 98 Rp 120,000 Rp 11,760,000
Kediri, Maret 2016

Rosmayadi,SKM.MPH
NIP: 19681212 199003 1 014
BULAN : JANUARI 2016
1 KALSUM 0000829889954 SEDAYU SELATAN 087865110222 GEA + FEBRIS

2 BQ RIA SILVA 0000210273118 LELEDE 081918366477 GEA + VOMITUS PERBAIKAN
3 SAMINAH 0000830388082 MONTONG ARE 087865974000 GEA + VOMITING
4 KARTINI 0000830813578 PENANDAH 087765108876 GEA
5 H. SAFWAN 0000829703259 SEDAYU SELATAN 081805287462 GEA + OBS.FEBRIS
6 MUHUR 0000830569059 OMBE 081907122935 DM TIPE II
7 M. DIFAL ALGIFARI 0001858468612 JAKEM DIARE AKUT DENAN DEHIDRASI RINGAN
8 BUSTAN 0000829533892 MONTONG ARE SUSP. BSK + ISK
9 MARIYUNI 0000037610346 KR. SEMBUNG 08175790170 GASTRITIS
10 HUSNIWATI 0000829812611 BT.TUMPENG HEPATITIS A
11 RAUHUN 0000829927833 GERSIK UTARA DYSPEPSIA + S. ISK
12 SITI SAKDIYAH 0001263167987 SEDAYU 081933039968 S. TYPHOID FEVER
13 MUHIBIN 0000829154665 KR. BEDIL 080907850588 GASTRITIS
14 NURLAELY YUSHIDA F. 0001270234541 SEDAYU TENGAH 081917228968 DYSPEPSIA
15 JURRIATI 0000144329444 KEDIRI DHF GR I
16 SETIAWAN DJODI 0001078272022 KR. BEDIL 087864808747 DYSPEPSIA
17 ROHANI 0001055591807 MEREMBU 087864908130 S. TB KELENJAR + ISPA + GEA
18 ROHIMAH 0000830142977 OMBAE BRONCHITIS + S. TB PARU
19 CIPTA KARYATI 0001055582324 BENGKEL 081907872938 GEA
20 DESITA MILA 0001841520868 KERANGKENG 081907131570 BRONCHIOLOTIS
21 MUKMINAH 0000830273883 JAGARAGA GEA
22 NURIADI HABIBI 0000829277223 KEDIRI 087765589370 DYSPEPSIA
23 INSUN 0000833028107 RANGGAGATA 081917002327 DYSENTRY
24 FATIN MAULIDIA 00001962889479 OMBAE 081917476503 BRONCHIOLITIS
25 OMAQ URI 0000830297856 KURIPAN 087865814636 OBS. FEBRIS H II + TF
26 SAHUNI 0001055610437 GELOGOR 087765996996 GEA
27 HERMAYANTI 0000830297858 SUMBAWA ISK + TF
28 M. RIFKI ALIF AKBAR 0001908485291 JAGARAGA INDAH 081907900131 PNEUMONIA RINGAN
29 H. FAHRURROZI 0001882765012 PELOWOK 085937017855 GEA
30 IDA KT SUKAYASA 0001055597005 JAGARAGA DF + TF
31 IDA BAGUS WIRATMAJA 0001055597084 JAGARAGA 087864825889 SUSP. TF + S.
32 ZAKIAH DARAJAT 0000831207183 SEDAYU TENGAH 087865164664 GEA
33 UMMY GHAFIRA 0000202091894 BANGKET DALEM POST PARTUM HR KE 35 DGN FEBRIS
34 MULIA ANDINI 0000847592245 REMBIGA HYPEREMESIS GRAVIDARUM
35 NUNUNG FAWANI 0000830512383 OMBE ABORTUS COMPLETE
36 YANTI APRIANI 0000830615883 GERSIK SELATAN FEBRIS + JANIN TAKIKARDI
37 HAERI SAFITRIANA 0001846611246 BANGKET DALEM ISK
TOTAL DANA
IM RAWAT INAP UPT BLUD PUSKESMAS KEDIRI
BULAN : JANUARI 2016
TINDAKAN YANG DIBERIKAN TGL MASUK TGL KELUAR JUMLAH HR RAWAT JUMLAH TAGIHAN KET
Memberikan Infus rl, inj.metoc, inj.ceftri, inj.diphen, pularex, pct 28/12/2015 3/1/2016 6 Rp 720,000
Memberikan Infus rl, pularex, pct, oralit 13/01/2016 16/01/2016 3 Rp 360,000
Memberikan Infus rl, pularex, pct,vit b, ranitidin inj, oralitrsni tab,inj.scopamin 29/01/2015 2/1/2016 4 Rp 480,000
Memberikan Infus rl, pularex, pct, antasid, oralit, ranitidin 21/01/2016 23/01/2016 2 Rp 240,000
Memberikan Infus rl, pularex, pct, metoc, oralit 4/1/2016 6/1/2016 2 Rp 240,000
Memberikan Infus d10 %, d40%, d5%, vit bc. 5/1/2016 6/1/2016 1 Rp 120,000
Memberikan Infus rl, inj.metoc, inj.ceftri, inj.diphen, pularex, pct 5/1/2016 8/1/2016 3 Rp 360,000
Memberikan Infus rl, inj.keto, inj.rani, injcefti 5/1/2016 7/1/2016 2 Rp 240,000
Memberikan Infus rl, inj.rani, pularex 17/1/2016 19/1/2016 2 Rp 240,000
Memberikan Infus rl, inj.antrain, pct 14/1/2016 19/1/2016 5 Rp 600,000
Memberikan Infus rl, inj.ranitidin, inj.keto, scopma plus 17/1/2016 19/1/2016 2 Rp 240,000
Memberikan Infus rl, thiampenikol, pct, bc, rani 10/1/2016 12/1/2016 2 Rp 240,000
Memberikan Infus rl, inj.rani, antasid, ranitidin, bc 14/1/2016 16/1/2016 2 Rp 240,000
Memberikan Infus rl, b6, rani, antasid 11/1/2016 13/1/2016 2 Rp 240,000
Memberikan Infus rl, pct, antasid 11/1/2016 13/1/8/2016 2 Rp 240,000
Memberikan Infus rl, inj.ondancenntron, ranitidin 10/1/2016 11/1/2016 1 Rp 120,000
Memberikan Infus rl, ranitidin,inj.rani, pularex, ctm 6/1/2016 11/1/2016 5 Rp 600,000
Memberikan Infus rl, pct, ambroxol, ranitidin, bc 10/1/2016 11/1/2016 1 Rp 120,000
Memberikan Infus rl, inj.metoc, pularex, b6 9/1/2016 11/1/2016 2 Rp 240,000
Memberikan Infus rl, inj.ceftri, pct syr, ambroxol, ctm 20/1/2016 22/01/2016 2 Rp 240,000
Memberikan Infus rl, rani,, metoc, pularex, oralit 2/1/2016 3/1/2016 1 Rp 120,000
Memberikan Infus rl, rani,, metoc, pularex, oralit 19/1/2016 21/1/2016 2 Rp 240,000
Memberikan Infus rl, inj.scopamin, pularex, bc, ketoconazole 21/1/2016 26/1/2016 5 Rp 600,000
Memberikan Infus d5%, inj.aminophilin, inj.genta, nebulisasi combiven 23/1/2016 26/1/2016 3 Rp 360,000
Memberikan Infus rl, rani, antasid, pct, bc 23/1/2016 26/1/2016 3 Rp 360,000
Memberikan Infus rl, pularex, oralit, antasid, rani, loperamid 23/1/2016 27/1/2016 4 Rp 480,000
Memberikan Infus rl, inj.rani, inj.metoc, pct, bc 23/1/2016 27/1/2016 4 Rp 480,000
Memberikan Infus rl, inj.ampicillin, inj.genta, nebu combiven, o2 24/1/2016 28/1/216 4 Rp 480,000
Memberikan Infus rl, inj.Metocpularex, pct, oralit 26/1/2016 29/1/2016 3 Rp 360,000
Memberikan Infus rl, inj.rani, inj. Ceftri, pct, domperidon 26/1/2016 29/1/2016 3 Rp 360,000
Memberikan Infus rl, inj.Metoc, thiampenikol, pct, bc 28/1/2016 30/1/2016 2 Rp 240,000
Memberikan Infus rl, inj. Metoc, pct, pularex, oralit, loperamid 28/1/2016 31/1/2016 3 Rp 360,000
Memberikan infus RL,inj.ceftriaxone,inj.ranitidin, inj. Antrain 5/1/2016 7/1/2016 2 Rp 240,000
Memberikan Vit.B6, Ranitidin, Metoc 2/1/2016 3/1/2016 1 Rp 120,000
Memberikan infus RL, Drip Oxytocin 20 IU 22/01/2016 23/01/2016 1 Rp 120,000
Memberikan infus RL,inj. Ceftriaxone,paracetamol 7/1/2016 10/1/2016 3 Rp 360,000
Memberikan infus RL,antasid,paracetamol,amoxicilin 5/1/2016 6/1/2016 1 Rp 120,000
NA 96 Rp 11,400,000
Kediri, Februari 2016

Rosmayadi,SKM.MPH
NIP: 19681212 199003 1 014
REKAPITULASI KLAIM RAWAT
BULAN : AGU
ALAMAT FASKES
: JL. TGH. ABDUL KARIM.KEDIRI.LOMBOK BARAT
1 MAHISA DWI SAFITRI 0002034166522 KEDIRI GEA + VOMITING

2 MUNAKAT 0000830991846 KURIPAN GEA DEHIDRASI RINGAN SEDANG
3 FAHRURROZI 0000830040849 KURIPAN OBS FEBRIS + SUSP ISK
4 NURSAN 0000829708007 KURIPAN OBS FEBRIS SUSP TIFOID
5 NUR AZIZAH 0001577551061 KARANG PULE ASTHMA SERANGAN BERAT
6 M RAHULLOH 0000828995635 KEDIRI OBS FEBRIS EC SUSP TYFOID FIVER
7 MARISAH 0000830192062 KEDIRI GEA DENGAN DEHIDRASI SEDANG
8 NURUL HIDAYANI 0000830477597 KEDIRI DIARE AKUT + LOW INTAKE
9 LIMEK 0000830457818 LABUAPI GEA DEHIDRASI RINGAN SEDANG
10 RAHIL 0000829017426 BANYUMULEK ISK dd BSK + LOW INTAKE
11 AMAQ SAMSUDIN 0000830412347 KURIPAN GEA DEHIDRASI RINGAN SEDANG
12 M SUPARDI 0000829725827 KEDIRI OBS FEBRIS SUSP DEMAM TIFOID
13 JAMALUDIN 0000830513261 KEDIRI DYSPEPSIA + VOMITING
14 QONITA HAERUNISA 0002448578081 BANYUMULEK GEA DEHIDRASI
15 YOSHIE EL NINO 0002303401083 UBUNG DIARE AKUT + LOW INTAKE
16 ALMAH 0000830631453 KURIPAN VERTIGO + HT
17 ANISA SALSA SAIDA 0002108933875 KEDIRI GEA
18 MARIATU 0000829800325 KEDIRI DERMATITIS NUMULIASIS
19 RAPIAH 0000830534477 LABUAPI HT URGENCY
20 MISTAUDIN 0000830638775 KURIPAN GEA DEHIDRAI RINGAN SEDANG
21
22 DESIANA 0000829871199 KEDIRI TF
23 HARIANTO 0000830616219 KEDIRI TF
24 YULIANI 0000830500492 KEDIRI TF
25 SALMAN 0001055487947 GERUNG TF
26 MULYANI 0000829206268 GELOGOR TIMUR SUSP DEMAM TIFOID
27 ULANDARI 0000829448237 KEDIRI TF FIVER
28 RAYHAN 0002251711124 KEDIRI FEBRIS + TYFOID FIVER
29 HJ PATIMAH 0000830264049 KEDIRI DISTENSI ABDM
30 H MUHID 0000829447907 KEDIRI OBS FEBRIS
31 DILLA ANDIRA 000014424545 KEDIRI INJ AMPICLIN,INJ RANITIDIN,PARACETAMOL,HIPERTENSI
32 MARLINA 0001055927889 DAREK OBS FEBRIS
33 ASMUNI 0000829540653 KEDIRI PPOK
34 BY NI WYAN HARTINI 0002264765128 KURIPAN PNEMONIA RINGAN
35 HELMI 000082933053 BANYUULEK TF + ISK
36 HAFIZ 0001055608402 KEDIRI PNEUMONIA
37 SUGIANTO 0000830530541 KEDIRI GEA DENGAN DEHIDRASI
38 NAJAMUDIN 0000829986647 KEDIRI GEA TANPA DEHIDRASI
39 MIFTAHULJANAH 000224289689 DASAN CERMEN KEJANG DEMAM
40 JURIAH 0002062757406 MEREMBU DISENTRI
41 SINARAH 0000829968996 BANYUMULEK DYSPEPSIA
42 HAYATI 0000146261766 BENGKEL SELATAN ISK VWERIGO
43 NOVERIKA 0002238617801 KEDIRI SUSP DEMAM TIFOID
44 NURIYAH 0000830254149 KEDIRI GEA DEHIDRASI
45 SAKYAH 0000829168391 KEDIRI OBS FEBRIS
46 LI NOVI 000083063332 KEDIRI ISK
47 HENDON 000830308533 KEDIRI GEA
TOTAL D
APITULASI KLAIM RAWAT INAP PUSKESMAS KEDIRI
BULAN : AGUSTUS 2015
TINDAKAN YANG DIBERIKAN
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ SCOPAMIN,INJ METOK,LOPERAMID,PARACETAMOLANTASIDA,METOK

Memberikan Infus rl, memberikan obat INJ SCOPAMIN,INJ RANITIDIN,PARACETAMOL,METRONIDAZOL,MOLAGIT,VIT B COM
Memberikan Infus rl, memberikan obat PARACETAMOL,DEXAMETASON,INJ AMPICILIN,
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ KETOROLAK,PARACETAMOL,SALBUTAMOL,DEXA
Memberikan Infus rl, memberikan obat DRIP AMINOPILIN,INJ DEXAMETASON,NEBU COMBIVENT,
Memberikan Infus rl, memberikan obat INJ AMPICILIN,INJ RANITIDIN,MOLAGIT,AMBROXOL,
Memberikan Infus rl, memberikan obat INJ SCOPAMIN,PARACETAMOL,MOLAGIT,INJ AMPICILIN,
Memberikan Infus rl, memberikan obat INJ DIPENHIDRAMID,MOLAGIT,SCOPAMIN,PARACETAMOL,VIT B COM
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ SCOPAMIN,MOLAGIT,ORALIT,AMLODIPIN
Memberikan Infus rl, memberikan obat INJ AMPICILIN,INJ RANITIDIN,PARACETAMOL,ANTASIDA,VIT B COM
Memberikan Infus rl, memberikan obat INJ METOK,INJ RANITIDIN,PARACETAMOL,SCOPAMIN,MOLAGIT
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ METOK,PARACETAMOL,ANTASIDA,
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ METOK,ANTASIDA,VIT B COM,PARACETAMOL
Memberikan Infus rl, memberikan obat ZINK,ORALIT,PCT SYR,DONPERIDON SYR,
Memberikan Infus rl, memberikan obatINJ METOK,ORALIT,METOK SYR
Memberikan Infus rl, memberikan obat DIPENHIDRAMID,CAPTROFIL,BETAHISTIN,IBUPROFEN,DONPERIDON.
Memberikan Infus rl, memberikan obat IZINK,PCT SYR,ORALIT,DONPERIDON SYR
Memberikan Infus rl, memberikan obat PARACETAMOL,VIT B COM.DEXA,CTM
Memberikan Infus rl, memberikan obat CAPTROFIL,AMLODIPIN,IBUPROFEN,VIT COM
Memberikan Infus rl, memberikan obat INJ RANITIDN,INJ METOK,ANTAPULGIT,PARACETAMOL,METRONIDAZOL,
Memberikan Infus rl, memberikan obat INJRANITIDIN,PARACETAMOL,AMBROXOL,
Memberikan Infus rl, memberikan obat INJ METOKLORAMID,INJ RANITIDIN,PARACETAMOL,CIPROLAXIM,AMBROXOL,CTM
Memberikan Infus rl, memberikan obat PARACETAMOL,AMBROXOL,INJ AMPICILIN
Memberikan Infus rl, memberikan obat INJ AMPICILIN,AMBROXOL,CTM
Memberikan Infus rl, memberikan obat CIPRO,PARACETAMOL,ANTASIDA,VIT B COM
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ METOK,PARACETAMOL,AMBROXOL,INJ AMPICILIN
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ METOK,INJ AMICILIN PARACETAMOL,
Memberikan Infus rl, memberikan obat PARACETAMOL SYR,AMBROXOL,ANTRAIN,
Memberikan Infus rl, memberikan obat SCOPAMIN,INJ RANITIDIN,INJ METOK,VIT K,VIT B CM
Memberikan Infus rl, memberikan obat AMBROXOL,PARACETAMOL,AMPICILIN,
Memberikan Infus rl, memberikan obat INJ AMPICILIN,INJ RANITIDIN,PARACETAMOL,INJ METOK,
Memberikan Infus rl, memberikan obat PARACETAMOL,VIT C
Memberikan Infus rl, memberikan obat INJ AMPICILI,DEZA,SALBUTAMOL,
Memberikan Infus rl, memberikan obat INJ AMPICILIN,INJ GENTAMICIN,PARACETAMOL SUPP,PCR SYR
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ METOK,PRACETAMOL,VIT B COM,CIPRO
Memberikan Infus rl, memberikan obat INJN KETOROLAK,INJ RANITIDIN,INJ AMPICILIN,
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ SCOPAMIN,INJ METOK,PARACETAMOL,ANTAPULGIT
Memberikan Infus rl, memberikan obat ANTAPULGIT,ORALIT,ANTASIDA,PARACETAMOL,
Memberikan Infus rl, memberikan obat PAMOL SUPP,PCR SYR,PENOBARBITAL
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ METOK,ANTAPULGIT,KOTRIMOX,
Memberikan Infus rl, memberikan obat INJ RANITIDIN,OMEPRAZOLE,PCT,DULXOLAK,,
Memberikan Infus rl, memberikan obat PCT,AMBROXO,CTM,INJ AMPICILIN,INJ RANITIDIN,INJ KETOROLAK,
Memberikan Infus rl, memberikan obat INJ RANITIDIN,INJ KETOROLAK,PARACETAML,INJ AMPICILIN,
Memberikan Infus rl, memberikan obat INJ RANITIDIN,CAPTROFIL,ORALIT,PARACETAMOL,
Memberikan Infus rl, memberikan obat BETAHISTIN,PARACETAMOL,ANRASIDA,
Memberikan Infus rl, memberikan obat INJ RANITIDIN,PARACETAMOL,CIPRO,CTM
Memberikan Infus rl, memberikan obat INJ RANITIDIN,PARACETAMOL,ANTAPULGIT,KOTRIMOXAZOLE
TOTAL DANA
JUMLAH
TGL MASUK TGL PULANG HR TARIF PAKET JUMLAH BIAYA
RAWAT
7/15/2018 7/16/2018 1 Rp 180,000 Rp 180,000
7/3/2018 7/5/2018 2 Rp 180,000 Rp 360,000
7/1/2018 7/4/2018 3 Rp 180,000 Rp 540,000
6/28/2018 7/2/2018 5 Rp 180,000 Rp 900,000
6/30/2018 7/1/2018 2 Rp 180,000 Rp 360,000
7/5/2018 7/10/2018 5 Rp 180,000 Rp 900,000
7/8/2018 7/11/2018 3 Rp 180,000 Rp 540,000
7/11/2018 7/12/2018 1 Rp 180,000 Rp 180,000
7/12/2018 7/13/2018 1 Rp 180,000 Rp 180,000
7/16/2018 7/19/2018 3 Rp 180,000 Rp 540,000
7/18/2018 7/20/2018 3 Rp 180,000 Rp 540,000
7/13/2018 7/20/2018 7 Rp 180,000 Rp 1,260,000
7/17/2018 7/20/2018 3 Rp 180,000 Rp 540,000
7/21/2018 7/23/2018 2 Rp 180,000 Rp 360,000
7/24/2018 7/25/2018 1 Rp 180,000 Rp 180,000
7/22/2018 7/25/2018 3 Rp 180,000 Rp 540,000
7/27/2018 7/28/2018 1 Rp 180,000 Rp 180,000
7/6/2018 7/7/2018 1 Rp 180,000 Rp 180,000
7/9/2018 7/11/2018 2 Rp 180,000 Rp 360,000
7/21/2018 7/23/2018 2 Rp 180,000 Rp 360,000
Rp 180,000 Rp -
12/12/2017 18/12/2017 6 Rp 180,000 Rp 1,080,000
14/12/2017 17/12/2017 3 Rp 180,000 Rp 540,000
11/12/2017 17/12/2017 6 Rp 180,000 Rp 1,080,000
12/12/2017 16/12/2017 4 Rp 180,000 Rp 720,000
9/12/2017 15/12/2017 6 Rp 180,000 Rp 1,080,000
11/12/2017 14/12/2017 3 Rp 180,000 Rp 540,000
7/12/2017 14/12/2017 6 Rp 180,000 Rp 1,080,000
6/12/2017 14/09/2017 7 Rp 180,000 Rp 1,260,000
11/12/2017 13/12/2017 2 Rp 180,000 Rp 360,000
9/12/2017 13/12/2017 4 Rp 180,000 Rp 720,000
9/12/2017 12/12/2017 3 Rp 180,000 Rp 540,000
10/12/2017 12/12/2017 2 Rp 180,000 Rp 360,000
8/12/2017 12/12/2017 4 Rp 180,000 Rp 720,000
08/12/21017 12/11/2017 3 Rp 180,000 Rp 540,000
12/22/2017 12/23/2017 1 Rp 180,000 Rp 180,000
12/20/2017 12/24/2017 4 Rp 180,000 Rp 720,000
12/29/2017 12/31/2017 2 Rp 180,000 Rp 360,000
12/27/2017 12/28/2017 2 Rp 180,000 Rp 360,000
12/25/2017 12/28/2017 3 Rp 180,000 Rp 540,000
12/21/2017 12/27/2017 7 Rp 180,000 Rp 1,260,000
12/19/2017 12/22/2017 3 Rp 180,000 Rp 540,000
12/20/2017 12/26/2017 6 Rp 180,000 Rp 1,080,000
12/24/2017 12/28/2017 4 Rp 180,000 Rp 720,000
12/27/2017 12/30/2017 3 Rp 180,000 Rp 540,000
12/27/2017 12/31/2017 4 Rp 180,000 Rp 720,000
12/25/2017 12/31/2017 7 Rp 180,000 Rp 1,260,000
156 Rp 4,500,000 Rp 28,080,000
Kediri, September 2017


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REKAPITULASI KLAIM RAWAT INAP PUSKESMAS KEDIRI

BULAN : MEI 2015

TOTAL DANA Rp 4,400,000

Kediri, 19 Mei 2015

1 LUJJ'AINI 0000830467416 PELOWOK SELATAN 081933125833 DHF GR II

1 NURHAYANI 0000829628165 GELOGOR SELATAN 087865981890 DYSPEPSIA + GERD

NA 128 Rp 4,440,000 Rp 15,600,000

NO NAMA PENDERITA NOMOR KARTU ALAMAT NO.TELP./HP DIAGNOSA

1 PANANI 0002225407577 OMBE BARU FEBRIS + SUSP TB PARU

2 AZZRIL RAMDAN 0002222962435 OMBE BARU FEBRIS EC PNEUMONIA SEDANG + DIARE

6 MUSLIMAH 0000829246522 DASAN TEBU DM TP II + GEA

10 SABAI 0000829203928 GERSIK SELATAN MALARIA MIX

14 MANSUR 0000830739068 TAMBANG ELEH 081917332149 FEBRIS H7 + VOMITING

18 MUSTAKIM 0001055616063 BANYU MULEK FEBRIS EC DHF

22 KINARA AZILNA PUTRI 0001901662986 KEDIRI 081805251318 FEBRIS EC DHF GR I

30 SITI HAWA 0000830030387 OMBE DESA DIARE AKUT

38 ROHAYANAH 0000830494506 DASAN TEBU ISK + S. TB + G4P2A1

Memberikan Infus rl, memberikan oksigen 3/26/2017 3/27/2017 1 Rp 180,000

Kediri, Maret 2017

Pemimpin UPT BLUD Puskesmas Kediri

NO NAMA PENDERITA NOMOR KARTU ALAMAT NO.TELP./HP DIAGNOSA

1 RIADAH 0000829960953 KRG BEDIL BUTARA RETENSIO URINE

2 SITI ADRIANI 0000829771503 MONTONG ARE 81907875351 GEA TANPA DEHIDRASI

6 HENI MURONI 0000828894936 DUSUN OMBE SUSP DEMAM TYFOID DD GERD

10 lalu sapwan 0000829692401 gelogor dispepsia

12 molingga elisa 0000829707175 kr kuripan gastritis

18 rusmillah 0000830155803 batu tumpeng susp tyfoid dd DHF

24 lazqia hafiza 0001055604756 kr kuripan tyfoid

30 sukri 0000829528334 terajon vertigo + vomiting

Kediri, MEI 2017

NO NAMA PENDERITA NOMOR KARTU ALAMAT NO.TELP./HP DIAGNOSA

1 dina pratani 0001575954662 gunung sari 83129506066 tyfoid fiver

2 muhammad raffa 0001969979286 bengkel selatan dyspepsia

6 ruslan 0001055593721 merembu barat susp hepatitis

10 sarini 0000828954617 merembu barat hipotensi + gastritis

12 indah hani 0000830039196 ombe baret tyfoid fiver

18 yulianti 0001577141965 rumak barat tyfoid

24 siti jumaenah 001055629653 sedayu tengah GEA DEHIDRASI BERAT

30 rianti 0000830119533 ombe baru gastritis kronik

Kediri, MEI 2017 #REF!

Pemimpin UPT BLUD Puskesmas Kediri #REF!

1 SUHADA 0000829317598 GELOGOR TIMUR TYFOID FIVER + HEMOROID EKXTERNAL

24/07/2017 27/06/2017 3 Rp 180,000 Rp 540,000

23/07/2017 25/07/2017 2 Rp 180,000 Rp 360,000

5/7/2017 7/7/2017 2 Rp 180,000 Rp 360,000

8/7/2017 9/7/2017 1 Rp 180,000 Rp 180,000

3/7/2017 9/7/2017 6 Rp 180,000 Rp 1,080,000

9/7/2017 11/7/2017 2 Rp 180,000 Rp 360,000

7/7/2017 8/7/2017 1 Rp 180,000 Rp 180,000

11/7/2017 13/07/2017 2 Rp 180,000 Rp 360,000

16/07/2017 19/07/2017 3 Rp 180,000 Rp 540,000

16/07/2017 17/07/2017 1 Rp 180,000 Rp 180,000

15/07/2017 19/07/2017 4 Rp 180,000 Rp 720,000

15/07/2017 18/07/2017 3 Rp 180,000 Rp 540,000

19/07/2017 21/07/2017 2 Rp 180,000 Rp 360,000

17/07/2017 21/07/2017 4 Rp 180,000 Rp 720,000

20/07/2017 21/07/2017 1 Rp 180,000 Rp 180,000

20/07/2017 21/07/2017 1 Rp 180,000 Rp 180,000

19/07/2017 21/07/2017 2 Rp 180,000 Rp 360,000

19/07/2017 22/07/2017 3 Rp 180,000 Rp 540,000

21/07/2017 22/07/2017 1 Rp 180,000 Rp 180,000

24/07/2017 27/07/2017 3 Rp 180,000 Rp 540,000