KARTU REKENING PASIEN

Nama Pasien .............................................

klas Rawatan ............................................

IGD / Poliklinik T
No Uraian Biaya
1 : ...............................
RM Baru / RM Lama
: ...............................
2 Prosedure Non Bedah : ...............................
Tenaga Ahli : ...............................
Nutrisionist
: ...............................
Dokter Obgyn
: ...............................
3
Dokter Anastesi : ...............................
Perawat Anastesi : ...............................

Perawat Ok : ...............................
4 USG : ...............................
5 OBAT : ...............................
Sewa Alat (Alat Medis) : ...............................
6
(nebulizer, Ventilator, dll) : ...............................
Prosedure Bedah : ...............................
7
(Mayor,Medium,Minor) : ...............................
Keperawatan : ...............................
Aff Heating : ...............................

8
 Pasang Infus : ...............................
8
Pasang Aff Kateter Urine : ...............................
Visite : ...............................
JM perugas Dinas : ...............................
9 Laboratorium : ...............................
10 Akomodasi Kamar : ...............................
Penunjang : ...............................
11
(EEG, EKG) : ...............................
12 Pelayanan Darah : ...............................
BMHP
: ...............................
13
(oksigen, Alkohol, Gel, dll)
: ...............................
TOTAL
 No. RM ...............................

Tanggal (Rp)
Simpang Empat ..............................
Admin Ruang Rawat Inap

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