LAPORAN REKAP KLAIM - RSUD TEBING TINGGI KAB.

EMPAT LAWANG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Nov 2018 s/d 30 Nov 2018
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D PEMERINTAH
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. SEP INACBG Top Up Total Tarif Tarif RS Jenis
1 24 Okt 2018 1 Nov 2018 05.15.95.A TIARA 0451R0001018V000404 P-8-13-I 4.576.800 2.484.250 RI
2 30 Okt 2018 1 Nov 2018 01.56.32 WAHIMAH 0451R0001018V000486 K-4-18-II 2.176.200 1.653.600 RI
3 29 Okt 2018 1 Nov 2018 04.85.77 WATIYA 0451R0001018V000459 D-4-13-I 1.952.500 2.326.800 RI
4 30 Okt 2018 1 Nov 2018 04.99.74 AMRAN 0451R0001018V000487 K-4-18-I 1.093.800 1.672.500 RI
5 1 Nov 2018 2 Nov 2018 05.03.73 YUNITA SULISTIA 0451R0001118V000012 O-6-13-II 1.752.700 1.016.500 RI
6 1 Nov 2018 3 Nov 2018 04.07.65 AQIFAH NAYLA PUTRI 0451R0001118V000014 D-4-13-I 2.343.000 671.000 RI
7 5 Nov 2018 6 Nov 2018 02.32.04 EKA WIDYA WATI 0451R0001118V000077 O-6-13-II 1.752.700 1.764.000 RI
8 3 Nov 2018 6 Nov 2018 05.18.53 DINA MARYANA 0451R0001118V000033 W-1-11-II 1.609.700 4.703.050 RI
9 3 Nov 2018 7 Nov 2018 05.18.54 ROCKI IDHAM AKBAR 0451R0001118V000057 L-4-13-II 2.553.500 7.191.800 RI
10 6 Nov 2018 7 Nov 2018 05.19.45 NOVI MARLISA 0451R0001118V000099 O-6-13-I 1.480.800 1.645.750 RI
11 6 Nov 2018 8 Nov 2018 05.16.28 SUMIATI 0451R0001118V000081 J-4-15-II 4.580.400 3.056.900 RI
12 8 Nov 2018 9 Nov 2018 05.10.37 MIRIL APENDI 0451R0001118V000128 Z-4-11-I 1.635.500 461.500 RI
13 7 Nov 2018 9 Nov 2018 05.19.37 RUKIMAN 0451R0001118V000085 L-1-40-I 3.905.100 3.823.950 RI
14 5 Nov 2018 9 Nov 2018 05.17.17 ROSDIANA 0451R0001118V000097 O-6-10-II 4.583.100 19.052.700 RI
15 8 Nov 2018 9 Nov 2018 05.19.66 MATCIK 0451R0001118V000132 J-1-20-I 6.729.100 2.243.600 RI
16 10 Nov 2018 12 Nov 2018 05.18.77 DODI HARVERI 0451R0001118V000138 S-4-12-I 1.303.800 919.600 RI
17 11 Nov 2018 14 Nov 2018 04.48.51 SARNA 0451R0001118V000140 J-1-20-III 12.301.600 5.841.100 RI
18 13 Nov 2018 15 Nov 2018 05.19.84 MUKMIN 0451R0001118V000182 I-4-12-III 3.153.500 7.007.750 RI
19 13 Nov 2018 16 Nov 2018 04.72.71 YUNI SARA 0451R0001118V000205 K-4-18-I 1.093.800 966.150 RI
20 14 Nov 2018 16 Nov 2018 05.20.37 IROYATI 0451R0001118V000201 L-1-40-I 4.555.900 3.762.000 RI
21 18 Nov 2018 19 Nov 2018 04.59.62 OKTA YANI 0451R0001118V000251 O-6-13-I 1.777.000 842.500 RI
22 14 Nov 2018 20 Nov 2018 05.20.20 YUSNI 0451R0001118V000203 I-4-10-II 4.577.400 12.546.000 RI
23 19 Nov 2018 20 Nov 2018 05.20.90 EKO 0451R0001118V000268 M-1-50-I 3.380.500 3.977.550 RI
24 19 Nov 2018 20 Nov 2018 05.20.64 DARUSMAN 0451R0001118V000286 M-1-50-I 3.380.500 3.152.500 RI
25 16 Nov 2018 21 Nov 2018 03.30.37 IIS SUMIATI 0451R0001118V000233 K-1-13-I 2.456.600 6.495.900 RI
26 19 Nov 2018 21 Nov 2018 01.94.21 MUHAMMAD QINTHAR ALMUZAKKI 0451R0001118V000272 J-4-16-I 4.472.200 1.744.750 RI
27 21 Nov 2018 22 Nov 2018 05.21.48 ULAN SARI 0451R0001118V000300 O-6-13-II 1.752.700 820.250 RI
28 20 Nov 2018 22 Nov 2018 04.10.20 AZIMAR 0451R0001118V000308 I-4-20-I 3.730.500 2.936.400 RI
29 19 Nov 2018 23 Nov 2018 01.00.81 HIDAYA 0451R0001118V000279 M-4-21-I 1.929.900 10.531.400 RI
30 22 Nov 2018 23 Nov 2018 05.17.17 ROSDIANA 0451R0001118V000325 N-4-10-I 2.166.100 667.400 RI
31 22 Nov 2018 24 Nov 2018 05.11.43 MUSTOPA 0451R0001118V000326 J-4-18-I 1.967.900 1.748.350 RI
32 21 Nov 2018 24 Nov 2018 04.92.10 SETIYO RINI 0451R0001118V000295 L-1-40-I 3.254.200 4.896.800 RI
33 21 Nov 2018 24 Nov 2018 05.21.83 SUSI ENDANG TASTINI 0451R0001118V000287 L-1-50-I 4.272.200 4.463.000 RI
34 22 Nov 2018 25 Nov 2018 05.21.73 INDRA BUANA 0451R0001118V000324 B-4-14-I 2.745.300 1.179.500 RI

Kode RS: 1611042 Halaman 1/2

 LAPORAN REKAP KLAIM - RSUD TEBING TINGGI KAB. EMPAT LAWANG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Nov 2018 s/d 30 Nov 2018
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D PEMERINTAH
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. SEP INACBG Top Up Total Tarif Tarif RS Jenis
35 26 Nov 2018 27 Nov 2018 05.27.77 RATNA YATI 0451R0001118V000380 I-4-17-I 1.685.700 1.199.500 RI
36 24 Nov 2018 27 Nov 2018 05.22.22 ROS ELFRIANA TAMBA 0451R0001118V000450 W-1-11-I 1.750.400 3.285.500 RI
37 25 Nov 2018 27 Nov 2018 05.21.70 YENI 0451R0001118V000359 N-4-12-I 2.740.200 2.120.750 RI
38 24 Nov 2018 28 Nov 2018 05.22.33 MARYAN 0451R0001118V000353 W-4-16-II 2.563.500 2.148.500 RI
39 27 Nov 2018 28 Nov 2018 05.18.50 ZONI CANDRA 0451R0001118V000397 B-4-13-I 2.748.200 1.929.500 RI
40 26 Nov 2018 28 Nov 2018 01.64.63 HASAN BASRI 0451R0001118V000382 I-4-12-I 3.174.100 1.475.950 RI
41 26 Nov 2018 29 Nov 2018 05.22.84 RINI YUSTUTI 0451R0001118V000403 O-6-10-I 4.332.200 6.611.000 RI
42 29 Nov 2018 30 Nov 2018 05.21.46 SAHARIAH 0451R0001118V000447 G-4-10-I 2.768.900 1.593.500 RI
43 28 Nov 2018 30 Nov 2018 04.99.74 AMRAN 0451R0001118V000446 K-4-17-I 1.089.300 1.460.550 RI
Total 129.849.000 150.091.550

Kode RS: 1611042 Halaman 2/2