TAGIHAN ' BPJS '

TGL TGL NAMA NOMOR NOMOR NOMOR

NO KLS
MRS KRS PASIEN RM KARTU SEP

1 5/28/2019 5/31/2019 Nur Dia Susanti, Ny, Ny 02.60.57 0002744783054 0204R0150519V000645 II

2 5/26/2019 5/29/2019 Sistiawan, Tn 04.07.42 0002158737017 204R0150519V000606 III
3 5/27/2019 5/29/2019 Dewi Lutfiyati Ningrum, Ny 04.06.34 0000759752368 0204R0150519V000639 III
4 5/28/2019 5/30/2019 Nur Aini, Ny 03.18.85 0000760187935 0204R0150519V000646 III
5 5/28/2019 5/29/2019 Nur Afifah, Ny 04.07.90 0000760669255 0204R0150519V000647 III
6 5/29/2019 5/29/2019 Umrotus Shofiyah, Ny 00.02.90 0001047392188 0204R0150519V000671 III
7 5/23/2019 5/29/2019 Syifausy Syauqiyah, An 02.97.84 0002421437185 0204R0150519V000534 III
8 5/24/2019 5/28/2019 Ayla Varisya, An 04.07.10 0002202249982 0204R0150519V000546 III
9 5/27/2019 5/29/2019 Rita Sofiana. Ny, Ny 00.86.09 0002758500044 0204R0150519V000617 III
10 5/27/2019 5/29/2019 Naufa Aqila Aulia, An 04.07.34 0002260080922 0204R0150519V000640 III
11 5/27/2019 5/28/2019 Kusmantoyo, Tn 03.73.14 0002414017967 0204R0150519V000641 III
12 5/28/2019 5/29/2019 Dewi Suci Ati, Ny 03.75.13 0001535958213 0204R0150519V000642 III
13 5/22/2019 5/29/2019 Ainiya Faida Nur Azmi, An 03.80.35 0002595933865 0204R0150519V000513
14 5/23/2019 5/29/2019 Silvia Antasari, Ny 00.16.91 0001742426627 0204R0150519V000530
15 5/25/2019 5/29/2019 Illiyyun, Nn 04.07.28 0000760121728 0204R0150519V000601
16 5/25/2019 5/31/2019 Sri Fajar Subkhiati, Ny 03.80.20 0001535866975 0204R0150519V000602
17 5/25/2019 5/28/2019 Leni Risdiana, Ny 03.17.89 0002271845079 0204R0150519V000637
18 5/26/2019 5/29/2019 By. Ny Novitarul Aini , Ny 04.07.44 0002767009127 0204R0150519V000629
19 5/26/2019 5/28/2019 Vinasti Akhlakul Karima, Nn 04.07.47 0000760636001 0204R0150519V000608
20 5/27/2019 5/30/2019 Samiaseh, Ny, Ny 04.07.52 0001047415217 0204R0150519V000638
21 5/27/2019 5/28/2019 Ma'rifatus Sholihah, Ny 04.01.11 0000760847951 0204R0150519V000611
22 5/27/2019 5/30/2019 Lailiyah, Ny 04.07.56 0002377944044 0204R0150519V000614
23 5/27/2019 5/28/2019 Cinta Nur Amelia Agustin, An 03.75.82 0000759467643 0204R0150519V000619
24 5/27/2019 5/29/2019 Anis Eka Islamy. Ny, Ny 00.55.23 0002757999363 0204R0150519V000621
25 5/27/2019 5/29/2019 Suripno, Sdr 04.07.65 0001535865794 0204R0150519V000622
26 5/27/2019 5/29/2019 M. Alfian Khoruddin, An 04.07.67 0001047388498 0204R0150519V000633
27 5/27/2019 5/29/2019 Ana Lailatul Fitria , Ny 04.06.15 0002624999488 0204R0150519V000636
28 5/28/2019 5/31/2019 By. Ny. Nur Aini, By 04.07.94 0002768116792 0204R0150519V000684
29 5/28/2019 5/30/2019 Jumiati, Ny 04.01.58 0000218563929 0204R0150519V000648
30 5/29/2019 5/31/2019 Puja Aditia, Ny 04.07.63 0002204705709 0204R0150519V000675
31 5/29/2019 5/31/2019 Ummu Kulsum Aziz , Ny 04.01.90 0001846631395 0204R0150519V000669
32 5/30/2019 5/31/2019 Umi Faizah. Ny 01.17.06 0000103914718 0204R0150519V000672
33 5/30/2019 5/31/2019 Martahid, Tn 01.78.57 0000760103796 0204R0150519V000673
TAGIHAN ' BPJS ' Tanggal Keluar 28-05-2019 sd 31-05-2019 (RAWAT INAP)
RJTL DIAGNOSE
DOKTER TAGIHAN RS INA-CBG REALISASI SELISIH RS SELISIH INA
RITL UTAMA

RITL Akhmad Khof A 2,625,442 - Rp - Rp (2,625,442) Rp -

RITL Fajar Admayan 1,683,336 - Rp - Rp (1,683,336) Rp -
RITL Akhmad Khof A 2,012,881 - Rp - Rp (2,012,881) Rp -
RITL Akhmad Khof A 2,039,499 - Rp - Rp (2,039,499) Rp -
RITL Akhmad Khof A 1,616,484 - Rp - Rp (1,616,484) Rp -
RITL Utami Luwih A 732,825 - Rp - Rp (732,825) Rp -
RITL Taufiqurrahman 3,318,485 - Rp - Rp (3,318,485) Rp -
RITL Taufiqurrahma 2,678,929 - Rp - Rp (2,678,929) Rp -
RITL Akhmad Khof A 4,062,458 - Rp - Rp (4,062,458) Rp -
RITL Maulida izzati 1,949,327 - Rp - Rp (1,949,327) Rp -
RITL Fajar Admayan 1,334,174 - Rp - Rp (1,334,174) Rp -
RITL Akhmad Khof A 2,273,303 - Rp - Rp (2,273,303) Rp -
RITL Taufiqurrahma 3,515,012 - Rp - Rp (3,515,012) Rp -
RITL O757 Akhmad Khof A 7,757,743 - Rp - Rp (7,757,743) Rp -
RITL Fajar Admayan 2,933,231 - Rp - Rp (2,933,231) Rp -
RITL Fajar Admayan 8,141,448 - Rp - Rp (8,141,448) Rp -
RITL Utami Luwih A 4,521,292 - Rp - Rp (4,521,292) Rp -
RITL Taufiqurrahma 1,086,068 - Rp - Rp (1,086,068) Rp -
RITL Ganis Tjahjono 1,466,275 - Rp - Rp (1,466,275) Rp -
RITL L02.3 Fajar Admayan 1,866,704 - Rp - Rp (1,866,704) Rp -
RITL Akhmad Khof A 1,602,543 - Rp - Rp (1,602,543) Rp -
RITL Fajar Admayan 2,106,790 - Rp - Rp (2,106,790) Rp -
RITL Muhammad Fai 1,033,364 - Rp - Rp (1,033,364) Rp -
RITL Akhmad Khof A 5,240,118 - Rp - Rp (5,240,118) Rp -
RITL Fajar Admayan 1,843,551 - Rp - Rp (1,843,551) Rp -
RITL Fajar Admayan 1,483,258 - Rp - Rp (1,483,258) Rp -
RITL Akhmad Khof A 4,329,148 - Rp - Rp (4,329,148) Rp -
RITL Taufiqurrahma 1,137,621 - Rp - Rp (1,137,621) Rp -
RITL Akhmad Khof A 1,971,269 - Rp - Rp (1,971,269) Rp -
RITL Utami Luwih A 4,263,100 - Rp - Rp (4,263,100) Rp -
RITL Utami Luwih A 4,212,374 - Rp - Rp (4,212,374) Rp -
RITL Akhmad Khof A 2,072,602 - Rp - Rp (2,072,602) Rp -
RITL Fajar Admayan 1,073,486 - Rp - Rp (1,073,486) Rp -
Rp 89,984,140 Rp - Rp - Rp (89,984,140) Rp -
 RUJUKAN / PUSKESMAS PELUNASAN

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