Kasir 5

No.
Kwitansi Tanggal No RM
00621.A. 0001 00621.A.0001 ### 01.06.42

00621.A. 0002 00621.A.0002 ### 01.06.43
00621.A. 0003 00621.A.0003 ### 01.06.44
00621.A. 0004 00621.A.0004 ### 01.06.45
00621.A. 0005 00621.A.0005 ### 01.06.46
00621.A. 0006 00621.A.0006 ### 01.06.47
00621.A. 0007 00621.A.0007 ### 01.06.47
00621.A. 0008 00621.A.0008 ### 01.06.48
00621.A. 0009 00621.A.0009 ### 00.80.04
00621.A. 0010 00621.A.0010 ### 01.06.49
00621.A. 0011 00621.A.0011 ### 01.06.50
00621.A. 0012 00621.A.0012 ### 01.06.51
00621.A. 0013 00621.A.0013 ### 01.06.52
00621.A. 0014 00621.A.0014 ### 01.05.53
00621.A. 0015 00621.A.0015 ### 01.05.93
00621.A. 0016 00621.A.0016 ### 01.06.66
00621.A. 0017 00621.A.0017 ### 01.06.81
00621.A. 0018 00621.A.0018 ### 00.43.32
00621.A. 0019 00621.A.0019 ### 0.107.18
00621.A. 0020 00621.A.0020 ### 01.07.19
00621.A. 0021 00621.A.0021 ### 01.07.19
00621.A. 0022 00621.A.0022 ### 01.04.57
00621.A. 0023 00621.A.0023 ### 01.07.20
00621.A. 0024 00621.A.0024 ### 00.28.23
00621.A. 0025 00621.A.0025 ### 01.07.21
00621.A. 0026 00621.A.0026 ### 01.07.22
00621.A. 0027 00621.A.0027 ### 01.07.22
00621.A. 0028 00621.A.0028 ### 01.07.23
00621.A. 0029 00621.A.0029 ### 01.07.24
00621.A. 0030 00621.A.0030 ### 01.07.25
00621.A. 0031 00621.A.0031 ### 01.07.26
00621.A. 0032 00621.A.0032 ### 01.07.27
00621.A. 0033 00621.A.0033 ### 01.07.28
00621.A. 0034 00621.A.0034 ### 01.07.29
00621.A. 0035 00621.A.0035 ### 01.07.30
00621.A. 0036 00621.A.0036 ### 00.94.97
00621.A. 0037 00621.A.0037 ### 01.07.31
00621.A. 0038 00621.A.0038 ### 01.07.32
00621.A. 0039 00621.A.0039 ### 00.84.31
00621.A. 0040 00621.A.0040 ### 01.07.33
00621.A. 0041 00621.A.0041 ### 01.07.28
00621.A. 0042 00621.A.0042 ### 01.01.35
00621.A. 0043 00621.A.0043 ### 01.07.34
00621.A. 0044 00621.A.0044 ### 01.07.35
00621.A. 0045 00621.A.0045 ### 01.07.36
00621.A. 0046 00621.A.0046 ### 00.80.04
00621.A. 0047 00621.A.0047 ### 01.07.47
00621.A. 0048 00621.A.0048 ### 010763
00621.A. 0049 00621.A.0049 ### 010770
00621.A. 0050 00621.A.0050 ### 010764
00621.A. 0051 00621.A.0051 ### 01.07.89
00621.A. 0052 00621.A.0052 ### 01.08.15
00621.A. 0053 00621.A.0053 ### 01.08.16
00621.A. 0054 00621.A.0054 ### 01.06.65
00621.A. 0055 00621.A.0055 ### 01.08.89
00621.A. 0056 00621.A.0056 ### 01.08.92
00621.A. 0057 00621.A.0057 ### 01.08.91
00621.A. 0058 00621.A.0058 ### 01.08.91
00621.A. 0059 00621.A.0059 ### 01.08.87
00621.A. 0060 00621.A.0060 ### 01.06.46
00621.A. 0061 00621.A.0061 ### 01,08.93
00621.A. 0062 00621.A.0062 ### 010894
00621.A. 0063 00621.A.0063 ### 010895
00621.A. 0064 00621.A.0064 ### 010896
00621.A. 0065 00621.A.0065 ### 006151
00621.A. 0066 00621.A.0066 13 junu 2021 01.03.58
00621.A. 0067 00621.A.0067 ### 01.08.97
00621.A. 0068 00621.A.0068 ### 01.08.98
00621.A. 0069 00621.A.0069 ### 01.08.99
00621.A. 0070 00621.A.0070 ### 01.08,99
00621.A. 0071 00621.A.0071 ### 01.09.01
00621.A. 0072 00621.A.0072 ### 01.09.03
00621.A. 0073 00621.A.0073 ### 010937
00621.A. 0074 00621.A.0074 ### 01 09 38
00621.A. 0075 00621.A.0075 ### 01.09.39
00621.A. 0076 00621.A.0076 ### 01.07.81
00621.A. 0077 00621.A.0077 ### 01.09.40
00621.A. 0078 00621.A.0078 ### 01.09.69
00621.A. 0079 00621.A.0079 ### 01.09.92
00621.A. 0080 00621.A.0080 ### 01.09.93
00621.A. 0081 00621.A.0081 ### 01.05.13
00621.A. 0082 00621.A.0082 ### 01.10.56
00621.A. 0083 00621.A.0083 ### 01.10.55
00621.A. 0084 00621.A.0084 ### 01.10.57
00621.A. 0085 00621.A.0085 ### 01.10.58
00621.A. 0086 00621.A.0086 ### 01.03.66
00621.A. 0087 00621.A.0087 ### 01.10.60.
00621.A. 0088 00621.A.0088 ### 01.10.61
00621.A. 0089 00621.A.0089 ### 00.14.47
00621.A. 0090 00621.A.0090 ### 01.10.62
00621.A. 0091 00621.A.0091 ### 01.10.63
00621.A. 0092 00621.A.0092 ### 01.10.64
00621.A. 0093 00621.A.0093 ### 01.02.55
00621.A. 0094 00621.A.0094 ### 00.96.11
00621.A. 0095 00621.A.0095 ### 00.35,79
00621.A. 0096 00621.A.0096 ### 00.33.12
00621.A. 0097 00621.A.0097 ### 01.10.69
00621.A. 0098 00621.A.0098 ### 00.81.39
00621.A. 0099 00621.A.0099 ### 01.10.70
00621.A. 0100 00621.A.0100 ### 00.04.19
00621.A. 0101 00621.A.0101 ### 01.10.72
00621.A. 0102 00621.A.0102 ### 01.10.71
00621.A. 0103 00621.A.0103 ### 01.10.73
00621.A. 0104 00621.A.0104 ### 01.10.74
00621.A. 0105 00621.A.0105 ### 01.10.75
00621.A. 0106 00621.A.0106 ### 01.10.76
00621.A. 0107 00621.A.0107 ### 01.10.77
00621.A. 0108 00621.A.0108 ### 01.10.78
00621.A. 0109 00621.A.0109 ### 01.10.79
00621.A. 0110 00621.A.0110 ### 01.10.80
00621.A. 0111 00621.A.0111 ### 00.17.31
00621.A. 0112 00621.A.0112 ### 01.10.87
00621.A. 0113 00621.A.0113 ### 01.11.38
00621.A. 0114 00621.A.0114 ### 01.11.40
00621.A. 0115 00621.A.0115 ### 011242
00621.A. 0116 00621.A.0116 ### 000269
00621.A. 0117 00621.A.0117 ### 01.12.80
00621.A. 0118 00621.A.0118 ### 01.02.81
00621.A. 0119 00621.A.0119 ### 01.02.82
00621.A. 0120 00621.A.0120 ### 010986
00621.A. 0121 00621.A.0121 ### 01.12.84
00621.A. 0122 00621.A.0122 ### 01.02.81
00621.A. 0123 00621.A.0123 ### 01.12.85
00621.A. 0124 00621.A.0124 ### 01.12.83
00621.A. 0125 00621.A.0125 ### 01.12.87
00621.A. 0126 00621.A.0126 ### 01.12.86
00621.A. 0127 00621.A.0127 ### 01.12.88
00621.A. 0128 00621.A.0128 ### 01.12.89
00621.A. 0129 00621.A.0129 ### 01.12.90
00621.A. 0130 00621.A.0130 ### 01.12.91
00621.A. 0131 00621.A.0131 ### 01.12.93
00621.A. 0132 00621.A.0132 ### 01.12.92
00621.A. 0133 00621.A.0133 ### 01.12.94
00621.A. 0134 00621.A.0134 ### 01.12.95
00621.A. 0135 00621.A.0135 ### 01.12.96
00621.A. 0136 00621.A.0136 ### 01.12.97
00621.A. 0137 00621.A.0137 ### 011298
00621.A. 0138 00621.A.0138 ### 01.12.99
00621.A. 0139 00621.A.0139 ### 01.13.00
00621.A. 0140 00621.A.0140 ### 01.13.02
00621.A. 0141 00621.A.0141 ### 01.13.00
00621.A. 0142 00621.A.0142 ### 011301
00621.A. 0143 00621.A.0143 ### 01.13.01
00621.A. 0144 00621.A.0144 ### 01.13.03
00621.A. 0145 00621.A.0145 ### 01.12.42
00621.A. 0146 00621.A.0146 ### 01.13.04
00621.A. 0147 00621.A.0147 ### 00.02.69
00621.A. 0148 00621.A.0148 ### 00.02.69
00621.A. 0149 00621.A.0149 ### 00.32.25
00621.A. 0150 00621.A.0150 ### 01.09.67
00621.A. 0151 00621.A.0151 ### 01.13.05
00621.A. 0152 00621.A.0152 ### 01.13.06
00621.A. 0153 00621.A.0153 ### 01.13.07
00621.A. 0154 00621.A.0154 ### 01.13.49
00621.A. 0155 00621.A.0155 ### 01.13.38
00621.A. 0156 00621.A.0156 ### 01.13.71
00621.A. 0157 00621.A.0157 ### 01.13.72
00621.A. 0158 00621.A.0158 ### 01.13.73
00621.A. 0159 00621.A.0159 ### 01.13.74
00621.A. 0160 00621.A.0160 ### 01.13.75
00621.A. 0161 00621.A.0161 ### 01.13,76
00621.A. 0162 00621.A.0162 ### 01.13.77
00621.A. 0163 00621.A.0163 ### 01.13.78
00621.A. 0164 00621.A.0164 ### 01.14.17
00621.A. 0165 00621.A.0165 ### 01.14.18
00621.A. 0166 00621.A.0166 ### 01.14.19
00621.A. 0167 00621.A.0167 ### 01.14.20
00621.A. 0168 00621.A.0168 ### 01.14.21
00621.A. 0169 00621.A.0169 ### 01.14.22
00621.A. 0170 00621.A.0170 ### 01.14.23
00621.A. 0171 00621.A.0171 ### 01.14.24

00621.A. 0172 00621.A.0172 ### 01. 14. 25
00621.A. 0173 00621.A.0173 ### 01.14.62
00621.A. 0174 00621.A.0174 ### 01.14.63
00621.A. 0175 00621.A.0175 ### 01.15.99
00621.A. 0176 00621.A.0176 ### 01.15.00
00621.A. 0177 00621.A.0177 ### 01.15.34
00621.A. 0178 00621.A.0178 ### 01.15.35
00621.A. 0179 00621.A.0179 ### 01.15.36
00621.A. 0180 00621.A.0180 ### 01.15.37
00621.A. 0181 00621.A.0181 ### 01.15.38
00621.A. 0182 00621.A.0182 ### 01.15.39
00621.A. 0183 00621.A.0183 ### 01.15.40
00621.A. 0184 00621.A.0184 ### 01.15.41
00621.A. 0185 00621.A.0185 ### 01.15.48
00621.A. 0186 00621.A.0186 ### 01.15.57
00621.A. 0187 00621.A.0187 04 JLI 2021 01.15.58
00621.A. 0188 00621.A.0188 ### 01.15.59
00621.A. 0189 00621.A.0189 ### 01.15.60
00621.A. 0190 00621.A.0190 ### 01.15.61
00621.A. 0191 00621.A.0191 ### 01.15.62
00621.A. 0192 00621.A.0192 ### 01.15.65
00621.A. 0193 00621.A.0193 ### 01.15.64
00621.A. 0194 00621.A.0194 ### 01.15.69
00621.A. 0195 00621.A.0195 ### 01.15.70
00621.A. 0196 00621.A.0196 ### 01.15.71
00621.A. 0197 00621.A.0197 ### 01.15.72
00621.A. 0198 00621.A.0198 ### 01.15.73
00621.A. 0199 00621.A.0199 ### 01.15.63
00621.A. 0200 00621.A.0200 ### 01.15.66
00621.A. 0201 00621.A.0201 ### 01.06.86
00621.A. 0202 00621.A.0202 ### 0
00621.A. 0203 00621.A.0203 ### 0
00621.A. 0204 00621.A.0204 ### 0
00621.A. 0205 00621.A.0205 ### 0
00621.A. 0206 00621.A.0206 ### 0
00621.A. 0207 00621.A.0207 ### 0
00621.A. 0208 00621.A.0208 ### 0
00621.A. 0209 00621.A.0209 ### 0
00621.A. 0210 00621.A.0210 ### 0
00621.A. 0211 00621.A.0211 ### 0
00621.A. 0212 00621.A.0212 ### 0
00621.A. 0213 00621.A.0213 ### 0
00621.A. 0214 00621.A.0214 ### 0
00621.A. 0215 00621.A.0215 ### 0
00621.A. 0216 00621.A.0216 ### 0
00621.A. 0217 00621.A.0217 ### 0
00621.A. 0218 00621.A.0218 ### 0
00621.A. 0219 00621.A.0219 ### 0
00621.A. 0220 00621.A.0220 ### 0
00621.A. 0221 00621.A.0221 ### 0
00621.A. 0222 00621.A.0222 ### 0
00621.A. 0223 00621.A.0223 ### 0
00621.A. 0224 00621.A.0224 ### 0
00621.A. 0225 00621.A.0225 ###
00621.A. 0226 00621.A.0226 ###
00621.A. 0227 00621.A.0227 ###
00621.A. 0228 00621.A.0228 ###
00621.A. 0229 00621.A.0229 ###
00621.A. 0230 00621.A.0230 ###
00621.A. 0231 00621.A.0231 ###
00621.A. 0232 00621.A.0232 ###
00621.A. 0233 00621.A.0233 ###
00621.A. 0234 00621.A.0234 ###
00621.A. 0235 00621.A.0235 ###
00621.A. 0236 00621.A.0236 ###
00621.A. 0237 00621.A.0237 ###
00621.A. 0238 00621.A.0238 ###
00621.A. 0239 00621.A.0239 ###
00621.A. 0240 00621.A.0240 ###
00621.A. 0241 00621.A.0241 ###
00621.A. 0242 00621.A.0242 ###
00621.A. 0243 00621.A.0243 ###
00621.A. 0244 00621.A.0244 ###
00621.A. 0245 00621.A.0245 ###
00621.A. 0246 00621.A.0246 ###
00621.A. 0247 00621.A.0247 ###
00621.A. 0248 00621.A.0248 ###
00621.A. 0249 00621.A.0249 ###
00621.A. 0250 00621.A.0250 ###
00621.A. 0251 00621.A.0251 ###
00621.A. 0252 00621.A.0252 ###
00621.A. 0253 00621.A.0253 ###
00621.A. 0254 00621.A.0254 ###
00621.A. 0255 00621.A.0255 ###
00621.A. 0256 00621.A.0256 ###
00621.A. 0257 00621.A.0257 ###
00621.A. 0258 00621.A.0258 ###
00621.A. 0259 00621.A.0259 ###
00621.A. 0260 00621.A.0260 ###
00621.A. 0261 00621.A.0261 ###
00621.A. 0262 00621.A.0262 ###
00621.A. 0263 00621.A.0263 ###
00621.A. 0264 00621.A.0264 ###
00621.A. 0265 00621.A.0265 ###
00621.A. 0266 00621.A.0266 ###
00621.A. 0267 00621.A.0267 ###
00621.A. 0268 00621.A.0268 ###
00621.A. 0269 00621.A.0269 ###
00621.A. 0270 00621.A.0270 ###
00621.A. 0271 00621.A.0271 ###
00621.A. 0272 00621.A.0272 ###
00621.A. 0273 00621.A.0273 ###
00621.A. 0274 00621.A.0274 ###
00621.A. 0275 00621.A.0275 ###
00621.A. 0276 00621.A.0276 ###
00621.A. 0277 00621.A.0277 ###
00621.A. 0278 00621.A.0278 ###
00621.A. 0279 00621.A.0279 ###
00621.A. 0280 00621.A.0280 ###
00621.A. 0281 00621.A.0281 ###
00621.A. 0282 00621.A.0282 ###
00621.A. 0283 00621.A.0283 ###
00621.A. 0284 00621.A.0284 ###
00621.A. 0285 00621.A.0285 ###
00621.A. 0286 00621.A.0286 ###
00621.A. 0287 00621.A.0287 ###
00621.A. 0288 00621.A.0288 ###
00621.A. 0289 00621.A.0289 ###
00621.A. 0290 00621.A.0290 ###
00621.A. 0291 00621.A.0291 ###
00621.A. 0292 00621.A.0292 ###
00621.A. 0293 00621.A.0293 ###
00621.A. 0294 00621.A.0294 ###
00621.A. 0295 00621.A.0295 ###
00621.A. 0296 00621.A.0296 ###
00621.A. 0297 00621.A.0297 ###
00621.A. 0298 00621.A.0298 ###
00621.A. 0299 00621.A.0299 ###
00621.A. 0300 00621.A.0300 ###
00621.A. 0301 00621.A.0301 ###
00621.A. 0302 00621.A.0302 ###
00621.A. 0303 00621.A.0303 ###
00621.A. 0304 00621.A.0304 ###
00621.A. 0305 00621.A.0305 ###
00621.A. 0306 00621.A.0306 ###
00621.A. 0307 00621.A.0307 ###
00621.A. 0308 00621.A.0308 ###
00621.A. 0309 00621.A.0309 ###
00621.A. 0310 00621.A.0310 ###
00621.A. 0311 00621.A.0311 ###
00621.A. 0312 00621.A.0312 ###
00621.A. 0313 00621.A.0313 ###
00621.A. 0314 00621.A.0314 ###
00621.A. 0315 00621.A.0315 ###
00621.A. 0316 00621.A.0316 ###
00621.A. 0317 00621.A.0317 ###
00621.A. 0318 00621.A.0318 ###
00621.A. 0319 00621.A.0319 ###
00621.A. 0320 00621.A.0320 ###
00621.A. 0321 00621.A.0321 ###
00621.A. 0322 00621.A.0322 ###
00621.A. 0323 00621.A.0323 ###
00621.A. 0324 00621.A.0324 ###
00621.A. 0325 00621.A.0325 ###
00621.A. 0326 00621.A.0326 ###
00621.A. 0327 00621.A.0327 ###
00621.A. 0328 00621.A.0328 ###
00621.A. 0329 00621.A.0329 ###
00621.A. 0330 00621.A.0330 ###
00621.A. 0331 00621.A.0331 ###
00621.A. 0332 00621.A.0332 ###
00621.A. 0333 00621.A.0333 ###
00621.A. 0334 00621.A.0334 ###
00621.A. 0335 00621.A.0335 ###
00621.A. 0336 00621.A.0336 ###
00621.A. 0337 00621.A.0337 ###
00621.A. 0338 00621.A.0338 ###
00621.A. 0339 00621.A.0339 ###
00621.A. 0340 00621.A.0340 ###
00621.A. 0341 00621.A.0341 ###
00621.A. 0342 00621.A.0342 ###
00621.A. 0343 00621.A.0343 ###
00621.A. 0344 00621.A.0344 ###
00621.A. 0345 00621.A.0345 ###
00621.A. 0346 00621.A.0346 ###
00621.A. 0347 00621.A.0347 ###
00621.A. 0348 00621.A.0348 ###
00621.A. 0349 00621.A.0349 ###
00621.A. 0350 00621.A.0350 ###
00621.A. 0351 00621.A.0351 ###
00621.A. 0352 00621.A.0352 ###
00621.A. 0353 00621.A.0353 ###
00621.A. 0354 00621.A.0354 ###
00621.A. 0355 00621.A.0355 ###
00621.A. 0356 00621.A.0356 ###
00621.A. 0357 00621.A.0357 ###
00621.A. 0358 00621.A.0358 ###
00621.A. 0359 00621.A.0359 ###
00621.A. 0360 00621.A.0360 ###
00621.A. 0361 00621.A.0361 ###
00621.A. 0362 00621.A.0362 ###
00621.A. 0363 00621.A.0363 ###
00621.A. 0364 00621.A.0364 ###
00621.A. 0365 00621.A.0365 ###
00621.A. 0366 00621.A.0366 ###
00621.A. 0367 00621.A.0367 ###
00621.A. 0368 00621.A.0368 ###
00621.A. 0369 00621.A.0369 ###
00621.A. 0370 00621.A.0370 ###
00621.A. 0371 00621.A.0371 ###
00621.A. 0372 00621.A.0372 ###
00621.A. 0373 00621.A.0373 ###
00621.A. 0374 00621.A.0374 ###
00621.A. 0375 00621.A.0375 ###
00621.A. 0376 00621.A.0376 ###
00621.A. 0377 00621.A.0377 ###
00621.A. 0378 00621.A.0378 ###
00621.A. 0379 00621.A.0379 ###
00621.A. 0380 00621.A.0380 ###
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00621.A. 0810 00621.A.0810 ###
00621.A. 0811 00621.A.0811 ###
00621.A. 0812 00621.A.0812 ###
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00621.A. 0840 00621.A.0840 ###
00621.A. 0841 00621.A.0841 ###
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00621.A. 0844 00621.A.0844 ###
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00621.A. 0851 00621.A.0851 ###
00621.A. 0852 00621.A.0852 ###
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00621.A. 0854 00621.A.0854 ###
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00621.A. 0858 00621.A.0858 ###
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00621.A. 0860 00621.A.0860 ###
00621.A. 0861 00621.A.0861 ###
00621.A. 0862 00621.A.0862 ###
00621.A. 0863 00621.A.0863 ###
00621.A. 0864 00621.A.0864 ###
00621.A. 0865 00621.A.0865 ###
00621.A. 0866 00621.A.0866 ###
00621.A. 0867 00621.A.0867 ###
00621.A. 0868 00621.A.0868 ###
00621.A. 0869 00621.A.0869 ###
00621.A. 0870 00621.A.0870 ###
00621.A. 0871 00621.A.0871 ###
00621.A. 0872 00621.A.0872 ###
00621.A. 0873 00621.A.0873 ###
00621.A. 0874 00621.A.0874 ###
00621.A. 0875 00621.A.0875 ###
00621.A. 0876 00621.A.0876 ###
00621.A. 0877 00621.A.0877 ###
00621.A. 0878 00621.A.0878 ###
00621.A. 0879 00621.A.0879 ###
00621.A. 0880 00621.A.0880 ###
00621.A. 0881 00621.A.0881 ###
00621.A. 0882 00621.A.0882 ###
00621.A. 0883 00621.A.0883 ###
00621.A. 0884 00621.A.0884 ###
00621.A. 0885 00621.A.0885 ###
00621.A. 0886 00621.A.0886 ###
00621.A. 0887 00621.A.0887 ###
00621.A. 0888 00621.A.0888 ###
00621.A. 0889 00621.A.0889 ###
00621.A. 0890 00621.A.0890 ###
00621.A. 0891 00621.A.0891 ###
00621.A. 0892 00621.A.0892 ###
00621.A. 0893 00621.A.0893 ###
00621.A. 0894 00621.A.0894 ###
00621.A. 0895 00621.A.0895 ###
00621.A. 0896 00621.A.0896 ###
00621.A. 0897 00621.A.0897 ###
00621.A. 0898 00621.A.0898 ###
00621.A. 0899 00621.A.0899 ###
00621.A. 0900 00621.A.0900 ###
00621.A. 0901 00621.A.0901 ###
00621.A. 0902 00621.A.0902 ###
00621.A. 0903 00621.A.0903 ###
00621.A. 0904 00621.A.0904 ###
00621.A. 0905 00621.A.0905 ###
00621.A. 0906 00621.A.0906 ###
00621.A. 0907 00621.A.0907 ###
00621.A. 0908 00621.A.0908 ###
00621.A. 0909 00621.A.0909 ###
00621.A. 0910 00621.A.0910 ###
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00621.A. 0921 00621.A.0921 ###
00621.A. 0922 00621.A.0922 ###
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00621.A. 0925 00621.A.0925 ###
00621.A. 0926 00621.A.0926 ###
00621.A. 0927 00621.A.0927 ###
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00621.A. 0930 00621.A.0930 ###
00621.A. 0931 00621.A.0931 ###
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00621.A. 0951 00621.A.0951 ###
00621.A. 0952 00621.A.0952 ###
00621.A. 0953 00621.A.0953 ###
00621.A. 0954 00621.A.0954 ###
00621.A. 0955 00621.A.0955 ###
00621.A. 0956 00621.A.0956 ###
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00621.A. 0958 00621.A.0958 ###
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00621.A. 0962 00621.A.0962 ###
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00621.A. 0964 00621.A.0964 ###
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00621.A. 0970 00621.A.0970 ###
00621.A. 0971 00621.A.0971 ###
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00621.A. 0974 00621.A.0974 ###
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00621.A. 0978 00621.A.0978 ###
00621.A. 0979 00621.A.0979 ###
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00621.A. 0986 00621.A.0986 ###
00621.A. 0987 00621.A.0987 ###
00621.A. 0988 00621.A.0988 ###
00621.A. 0989 00621.A.0989 ###
00621.A. 0990 00621.A.0990 ###
00621.A. 0991 00621.A.0991 ###
00621.A. 0992 00621.A.0992 ###
00621.A. 0993 00621.A.0993 ###
00621.A. 0994 00621.A.0994 ###
00621.A. 0995 00621.A.0995 ###
00621.A. 0996 00621.A.0996 ###
00621.A. 0997 00621.A.0997 ###
00621.A. 0998 00621.A.0998 ###
00621.A. 0999 00621.A.0999 ###
00621.A. 1000 00621.A.1000 ###
00621.A. 1001 00621.A.1001 ###
00621.A. 1002 00621.A.1002 ###
00621.A. 1003 00621.A.1003 ###
00621.A. 1004 00621.A.1004 ###
00621.A. 1005 00621.A.1005 ###
00621.A. 1006 00621.A.1006 ###
00621.A. 1007 00621.A.1007 ###
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00621.A. 1010 00621.A.1010 ###
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00621.A. 1016 00621.A.1016 ###
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00621.A. 1038 00621.A.1038 ###
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00621.A. 1099 00621.A.1099 ###
00621.A. 1100 00621.A.1100 ###
00621.A. 1101 00621.A.1101 ###
00621.A. 1102 00621.A.1102 ###
00621.A. 1103 00621.A.1103 ###
00621.A. 1104 00621.A.1104 ###
00621.A. 1105 00621.A.1105 ###
00621.A. 1106 00621.A.1106 ###
00621.A. 1107 00621.A.1107 ###
00621.A. 1108 00621.A.1108 ###
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00621.A. 1110 00621.A.1110 ###
00621.A. 1111 00621.A.1111 ###
00621.A. 1112 00621.A.1112 ###
00621.A. 1113 00621.A.1113 ###
00621.A. 1114 00621.A.1114 ###
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00621.A. 1118 00621.A.1118 ###
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00621.A. 1120 00621.A.1120 ###
00621.A. 1121 00621.A.1121 ###
00621.A. 1122 00621.A.1122 ###
00621.A. 1123 00621.A.1123 ###
00621.A. 1124 00621.A.1124 ###
00621.A. 1125 00621.A.1125 ###
00621.A. 1126 00621.A.1126 ###
00621.A. 1127 00621.A.1127 ###
00621.A. 1128 00621.A.1128 ###
00621.A. 1129 00621.A.1129 ###
00621.A. 1130 00621.A.1130 ###
00621.A. 1131 00621.A.1131 ###
00621.A. 1132 00621.A.1132 ###
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00621.A. 1138 00621.A.1138 ###
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00621.A. 1161 00621.A.1161 ###
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00621.A. 1177 00621.A.1177 ###
00621.A. 1178 00621.A.1178 ###
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00621.A. 1180 00621.A.1180 ###
00621.A. 1181 00621.A.1181 ###
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00621.A. 1190 00621.A.1190 ###
00621.A. 1191 00621.A.1191 ###
00621.A. 1192 00621.A.1192 ###
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00621.A. 1196 00621.A.1196 ###
00621.A. 1197 00621.A.1197 ###
00621.A. 1198 00621.A.1198 ###
00621.A. 1199 00621.A.1199 ###
00621.A. 1200 00621.A.1200 ###
00621.A. 1201 00621.A.1201 ###
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00621.A. 1238 00621.A.1238 ###
00621.A. 1239 00621.A.1239 ###
00621.A. 1240
1241 00621.A.1240
00621.A.1241 ###
00621.A. 0153 00621.A.0153 ###
00621.A. 0153 00621.A.0153 ###
00621.A. 0153 00621.A.0153 ###
00621.A. 0153 00621.A.0153 ###
00621.A. 0153 00621.A.0153 ###
00621.A. 0154 00621.A.0154 ###
00621.A. 0155 00621.A.0155 ###
00621.A. 0156 00621.A.0156 ###
00621.A. 0157 00621.A.0157 ###
00621.A. 0158 00621.A.0158 ###
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Pasien Alamat Administrasi
MUSTACHSINAH SALSABILA SURAKARTA

LUSI WONOGIRI 35,000
IRMA WONOGIRI 35,000
TOMMY CAHYO PRAPTOMO SURAKARTA
NOVAN ANDRI DWI KURNIAWAN SURAKARTA 35,000
ARIE TRI KUNCAHYO YOGYAKARTA
ARIE TRI KUNCAHYO YOGYAKARTA
ADRIAN DAMHURI HARAHAP JAMBI
SARNI BOYOLALI 30,000
ARDO ANDRE LAKSANA SUKOHARJO 35,000
DANIEL DEVENDRA H.B SURAKARTA
BRAM JATTUPERKASA SURAKARTA
YUDANINGSIH TITIK M SURAKARTA 35,000
EMA YULI ASTUTI SURAKARTA 35,000
paramita raditya putri SURAKARTA 30,000
Kustartining Sulistyani Surakarta 35,000
eva lucyana surakarta
dewi oktarinasari pangkalpinang
SRIYANI KARANGANYAR 35,000
MUHAMMAD RIZKY PRASETYA KARANGANYAR 35,000
MUHAMMAD RIZKY PRASETYA KARANGANYAR
LATASYA PUAN NAGARI SURAKARTA
ASTARIO MARCESAR KOTA BANDUNG 35,000
EDHI MULYONO PURWOSARI
RINA KOESOEMA WARDANI KOTA SURAKARTA
DINAR HARUMACAHYA KARANGANYAR 35,000
DINAR HARUMACAHYA KARANGANYAR 35,000
AKBAR RIZKY PASCARAMADHANU KARANGANYAR 35,000
SAPRONI KOTA BANDAR LAMPUNG 35,000
YOEL ENA YALLA KOTA KUPANG
FIRSTA A. MENGGA KABUPATEN TIMOR TENGAH SELATAN
IMELDA MAUMABE KABUPATEN TIMOR TENGAH UTARA
NINIK HANDAYANI BOYOLALI 35,000
VICTORIUS WALI NIAS SELATAN 35,000
IYOP ROPIKA SUKOHARJO
RIFKA FAISA NURNAHDAH SUKOHARJO
ARIYO FAVIAN TAMIM SUKOHARJO
RIFAHIYO FARREL SHAFWAN SUKOHARJO
KUNTA AR SORAM KUDUS
SITI YUMAROH GROBOGAN
NINIK HANDAYANI BOYOLALI
MUHAMAD FADLI ARSYADA BOGOR
ANYK WIENARSIH SURAKARTA
TRI YULIANI SURAKARTA
HENDRI ISKANDARDINATA
SARNI PANDEYAN 30,000
Trini Kristanti SURAKARTA 35,000
novia anggraini ponorogo 35,000
MUHAMMAD ZAKI LOMBOK TENGAH
IR. BUDI UTOMO SURAKARTA
DIKA ARIFIANTI WINONG
BEATRICIA DARA SURAKARTA 35,000
ALWIYAH KAMILA SURAKARTA 35,000
PARTINI KARANGANYAR 30,000
Munawar Yogyakarta
THIO LIAN HOA JAKARTA UTARA
HENNY OCTORIA TANGERANG
BUNGA FERAWATI TANGERANG
Sartono Wonogiri 35,000
NOVAN ANDRI DWI KURNIAWAN KLATEN
suedi husain jawa barat
RISCA DWI JAYANTI MALANG
SAPTO PRAMUDYO SURAKARTA
CHATARINA SUMIYATI SURAKARTA
LUSIA RETNO WULANDARI SURAKARTA
M RIFFAI SUKOHARJO
NURUL AIFIYANTI PURWODADI
ikka wijayanti kendal
raden muhammad rafi Y surakarta
ahmad qiwamudin purwodadi
yuli kristanto surakarta
arif akbar budiman sukoharjo
AHMAD ARIYADI SAHRUL GROBOGAN
MAGDALENA KUTI SURAKARTA 35,000
MARANI BOYOLALI 35,000
GRANAYA THALITA SURAKARTA 30,000
SRI LESTARI SUKOHARJO
MUHAMMAD DA'I SURAKARTA
Dwi Daryani Surakarta
Franciscus xaverius murdiyanto SURAKARTA
Joni Arisanto Semarang
Rifi Rais Hidayatulloh Wonogiri
Umi Sukiyarti KARANGANYAR
Tygo Van Hasselt Bali
Rina Ayu Wahyuningtyas sragen 35,000
aditiya bayuwihascaryo SURAKARTA
ALVIOLITA WAHYUNINGTYAS Y S,NN KARANGANYAR 35,000
SUWARDJO, S.H.HUM SURAKARTA 35,000
MICHAEL DJAROT KARANGANYAR 30,000
VIRENDRA ARJUNA PM SRAGEN 35,000
WASMI WONOGIRI
TRI HARTONO SURAKARTA
NUR ROHMAN HIDAYATULLOH LAMPUNG UTARA
KISRINI SURAKARTA
NEZAR YAWANOV PUTRA SUKOHARJO
GRAVITO PUTRA H K SURAKARTA
MUHAMMAD ENRIQUE R SURAKARTA
ENI BUDIARTI, NY SURAKARTA
SRI SULAMI, NY SURAKARTA
HENIDA DWI PUSPITASARI SURAKARTA
JASMINE ARMANTYAS S B SURAKARTA
MUHAMMAD FIRMAN ARIF B SURAKARTA 35,000
ALIKA FIRDAUSYA SURAKARTA
LISA AJI SASMITA SURAKARTA
BAGUS SAMAHITA BUMI SURAKARTA
JULIAN HARDHIKA W SURAKARTA
MUHAMMAD NUR REZA PUTRA surakarta
RAICHEL RIANDIE RIAU
WILLY LESMANA PEKANBARU
R.A.ATINILAM TANGERANG
parahesti kusuma wardhani grobogan
ferina hanan tunjung ngawi 30,000
MUH. ALFIAN CANDRADITYA KLATEN 35,000
FEBRIANA KAWI NINGSIH SUKOHARJO 35,000
Muhamad Risqi Mei Brebes
AHMAD KHOIRUL BOYOLALI
YULI HARTANTO SURAKARTA 35,000
THASA ANIESA WAHYUDI MADIUN 35,000
RIANA WAHYU PERMATA SARI SURAKARTA
SURYA INDAH TUNJUNG AYU SUKOHARJO
ALDAIR CHRISTIAWAN,S.E sukoharjo
THASA ANIESA WAHYUDI MADIUN
HAFSAH HUMAIRA A SUKOHARJO
HILYA ARBA,S.E SUKOHARJO
MUH ARSHAQ FIRDAUS A DEMAK
EKA ISTI INDAH DEMAK
KURNIAWAN HARI P BANJARSARI
NURITA GUNUNG KIDUL
FELISIA FEMY K D SUKOHARJO
SADINAH SUKOHARJO
POPY KURNIANINGSIH KLATEN
IGNASIUS ISWADI KLATEN
ROSALIA ARIYANTI SEMARANG
FLORENCIA DANDY SUKOHARJO
VERENA KIMICO SUKOHARJO
PARAMITHA DESSI P SURAKARTA
SRI MAHANANI R KARANGANYAR
IPUNG SONIA F SURAKARTA
PITRA SRI HARTATI SURAKARTA
KRISTIYANI SURAKARTA
PITRA SRI HARTATI SURAKARTA 35,000
NUR ROHMAH AL FIYANI KARANGANYAR
NUR ROHMAH AL FIYANI KARANGANYAR 35,000
MUHAMAD ARIEF RAMADHANY SURAKARTA 35,000
MUHAMMAD RISQI MEI SONJAYA Brebes
VIA FEBRIANA MUSTIKA SARI SUKOHARJO
Dina Setiyani Sukoharjo
PRAWIDA GALIH SAPUTRO, S.ST SUKOHARJO
SRI SUPARNI, S.ST SUKOHARJO
DRG. SUPRIANTO SURAKARTA
MUHAMAMAD FAUZI SURAKARTA
Frisky Lutfia W Magetan
Hariyanto KARANGANYAR 30,000
KHIKY RIDHO AL IHSAN BOYOLALI 30,000
SRI HARYATMI BOYOLALI
MUHAMMAD RISQI ABIYYA BOYOLALI
HERLINA KUMALA SARI BOYOLALI
WISNU WARDHANA YURIS BOYOLALI
Shakilla putri wardhana boyolali
sri wuryani sukoharjo
Stephen salim surakarta
Agus Saputra Banjarnegara
Rita Retno Hastuti Wonogiri
Riska Yulia Surakarta
Kasdadi Sukoharjo
DR. Henda Ageng Rasena Sukoharjo
Dra. Tuty Saraswanti Sukoharjo
Inanda Damantia Sukoharjo
Dr. Ir. Ahmad Muh. Faudi Surakarta
Aliyah Himawati R. Surakarta
DWIJO PURNOMO SRAGEN
SRI NURGANTININGSIH SUKAHARJO
AHMAD YUSUF ALFIANSYAH PATI
SALSA ALIMA AZZAHRA YOGYAKARTA
Diana dwi kusuma kediri
Annisa Sekar Irsa surakarta
SUSANTO SURAKARTA
SRI NIATI IRIANI SURAKARTA
ASRA FAIZA KHOIRUNNISA SURAKARTA
Dita Hikmawaty Sukoharjo
Muhammad imam H Sukoharjo
Ida Fatmawati Boyolali
RIFFATHEA EVANIA YASINTA SRAGEN
AFRIZAL SURAKARTA 35,000
EKO SUPARYANTI SURAKARTA
Haryanti sukoharjo
Andri wahyudi samarinda
Tika paringga yogyakarta
Andri nitasari ngawi
Mar'atul dini Latif Sukoharjo
Muhammad Saleh Abdat Surakarta 35,000
ninuk roudlotul jannah boyolali
Hanif Makruf Nugroho Sragen
SOLEHAH LINTANG BUANA PUTRI SURAKARTA
ADI BASKORO SURAKARTA
BAGUS SAMAHITA BUMI SURAKARTA
muhammad fajri surakarta
Sucipto surakarta 35,000
IZZUDIN HANIF KLATEN
Nunung Sri Pujiatin Surakarta
KETUT DANANG ROHMADI SUKOHARJO
Amalia Kartika Syafri sukoharjo
Febriani Dara Ninggar Kudus
Ahmad Fitro
Agus Wahyono surakarta
Tri Handoko Sragen
Dwi Herry Widyatmoko Sleman
NOVRAN ARIF SUHADA surakarta
VIA FEBRIANA MUSTIKA SARI sukoharjo
NINDYA NOVITASARI sukoharjo
ENY TRI UTOMOWATI surakarta
MUHAMMAD FAISAL ARDI Surakarta
ANDIKASETIA PRAYOGO KLATEN
Drs. Ir SUTENG SUPRIYANTORO Surakarta
Bintang arifian ghanny surakarta
NURWAHYUDI BOGOR
TIFANNY GITA SESARIA PACE
AHMAD SYAEFULLOH, S.E Surakarta
DEWI DAMAYANTI PERTIWI, S.PSI Surakarta
ZAFRANO HAIDAR ATHAILLAH Surakarta
QUILLA AMAZEA ATHAILLAH Surakarta
rifky al thariq purwodadi
Dokter KODE Tindakan 1
0
drg. Windi Merinda A13 APD
0
0
0
0
drg. Astri Retno Wikandari A13 APD
0
0
A13 APD
drg. Ananda Nan Fitrah 0
drg. Windi Merinda 0
0
0
drg. Fahmi Fauzi A13 APD
drg. Grandis Ratnaning F APD
0
0
drg. Grandis Ratnaning F A13 APD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
drg. Astri Retno Wikandari a13 APD
0
0
0
drg.Hikmah Fajarorista Az Zahrah A13 APD
drg. Fahmi Fauzi 0
drg. Fahmi Fauzi 0
drg. Fahmi Fauzi 0
drg. Fahmi Fauzi 0
drg. Fahmi Fauzi a13 APD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
drg. Astri Retno Wikandari 0
0
0
0
0
0
0
0
0
0
drg. Ananda Nan Fitrah A13 APD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
drg. Astri Retno Wikandari a21 DOKTER GIGI UMUM
0
0
drg. Fahmi Fauzi A428 Pasang Infus
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
drg. Astri Retno Wikandari
drg. Grandis Ratnaning F a13 APD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
drg. Ananda Nan Fitrah a13 APD
0
0
0
0
0
0
drg. Ananda Nan Fitrah a13 APD
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
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0
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Nilai KODE Tindakan 2 Nilai KODE
0 0 0
20,000 A21 DOKTER GIGI UMUM 124,000
20,000 A316 DEVITALISASI/TREPANASI 234,000
0 0 0
20,000 A334 SCALLING SEDANG RA & RB 352,000
0 0 0
0 0 0
0 0 0
20,000 a327 DRESSING CAOH 159,000 A385
0 0 0
0 0 0
20,000 A320 OPEN ACCESS PSA/PULPEK & EKSTIRPASI 354,000
0 a21 DOKTER GIGI UMUM 124,000
a21 DOKTER GIGI UMUM 124,000 a428
0 0 0
0 0 0
20,000 A31 PEMERIKSAAN FISIK (incl spooling, grinding) 162,000
0 0 0
0 0 0
0 0 0
0 0 0
20,000 0 0
20,000 A334 SCALLING SEDANG RA & RB 352,000
0 0 0
0 0 0
0 0 0
20,000 A334 SCALLING SEDANG RA & RB 352,000 A316
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
20,000 a36 TUMPATAN RK SEDANG 417,000
20,000 A21
0 0 0
0 0 0
0 0 0
20,000 A388 EXO TANPA KOMPLIKASI 296,000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
20,000 A44 Debridemen Kecil 45,000
20,000 A336 DRESSING TI-ES 222,000
0 A21 DOKTER GIGI UMUM 124,000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
20,000 A335 SCALLING BERAT RA & RB 442,000 A316
20,000 A21 DOKTER GIGI UMUM 124,000 B21
20,000 A388 EXO TANPA KOMPLIKASI 296,000 A388
0 0 0
0 0 0
0 0 0
0 0 0
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20,000 a21 DOKTER GIGI UMUM 124,000 A428
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Tindakan 3 Nilai KODE Tindakan 4
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DOKTER GIGI UMUM 124,000 0
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0 0 A420 Medikasi Sedang
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DEVITALISASI/TREPANASI 234,000 A316 DEVITALISASI/TREPANASI
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EXO TANPA KOMPLIKASI 296,000 0
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DRESSING CAOH 159,000 0
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Debridemen Kecil 45,000 0
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DOKTER GIGI UMUM 124,000 0
DOKTER GIGI UMUM 124,000 a428 Pasang Infus
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0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Rontgen 2 Nilai Rontgen 3 Nilai Lab1 Nilai Lab2 Nilai
RAPID ANTIGEN 165,000

2X GDS 110,000
REPID ANTIGEN 165,000






RAPID ANTIGEN 6 P 990,000

rapid antigen 165,000

RAPID ANTIGEN -
RAPID ANTIGEN
RAPID ANTIGEN
REPID ANTIGEN 165,000






KEMBALIAN RAPID (25,000)
Repid Antigen 165,000
rapid antigen 165,000 gula darah 55,000

Rapid Antigen 140,000
Rapid Antigen 165,000


repid antigen 165,000
Lab3 Nilai Obat/BHP JUMLAH admin bank Diskon
165,000
179,000
171,700 460,700
165,000 3,053
407,000
165,000
115,100 5,100
165,000
232,500 516,500
360,000 776,000
165,000
165,000
140,000 549,000
179,000
154,000
417,500 859,500
165,000
130,000
217,000
255,500 434,500
240,000
165,000
117,000 296,000
165,000
165,000
295,000
283,500 572,500
407,000
38,000 327,000
165,000
165,000
165,000
70,000 711,000
179,000
65,000
140,000
140,000
140,000
130,000
165,000
240,000
165,000
165,000
165,000
165,000
50,000 224,000
472,000
179,000
140,000
990,000
140,000
217,000
79,000 430,000
232,000
165,000
165,000
165,000
165,000
227,000 571,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000 1,650
165,000
165,000
108,500 208,500
284,500 561,500
154,000
165,000
-
165,000
165,000
165,000
165,000
165,000
165,000
217,000
165,000
965,000 91,000
179,000
70,000 712,000
161,500 340,500
165,000
165,000
165,000
825,000
165,000 1,650
165,000 1,650
165,000 1,650
165,000
165,000
140,000
140,000
371,000 3,710
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
154,000
66,500 328,500
268,000 485,000
165,000
165,000
130,000 309,000
100,000 505,000
165,000
165,000
165,000
600,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
240,000
165,000
138,000 317,000
240,000
228,500 637,500
179,000
165,000
165,000
165,000
(25,000)
165,000
165,000
165,000
140,000
140,000
140,000
154,000
250,000 687,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
140,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
65,000 244,000
165,000
165,000
165,000
165,000
165,000
165,000
197,500 376,500
495,000
165,000
165,000
165,000
165,000
165,000
160,000 547,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
165,000
140,000
165,000
165,000 1,650
165,000 1,650
165,000 1,650
165,000 1,650
140,000
-
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-
-
Pembayaran
GRAND TOTAL Terbilang Bayar
TUNAI/DEBET
165,000 seratus enam puluh lima ribu Debet BNI

179,000 seratus tujuh puluh sembilan ribu Tunai
460,700 empat ratus enam puluh ribu tujuh ratus Tunai
168,053 seratus enam puluh delapan ribu lima puluh tig Debet BNI
407,000 empat ratus tujuh ribu Debet BNI
165,000 seratus enam puluh lima ribu Debet BNI
120,200 seratus dua puluh ribu dua ratus Debet BNI
165,000 seratus enam puluh lima ribu Tunai
516,500 lima ratus enambelas ribu lima ratus Tunai
776,000 tujuh ratus tujuh puluh enam ribu Tunai
549,000 lima ratus empat puluh sembilan ribu Tunai
154,000 seratus lima puluh empat ribu Tunai
859,500 delapan ratus lima puluh sembilan ribu lima ra Tunai
130,000 seratus tiga puluh ribu Tunai
217,000 dua ratus tujuhbelas ribu Tunai
434,500 empat ratus tiga puluh empat ribu lima ratus Tunai
240,000 dua ratus empat puluh ribu Tunai
296,000 dua ratus sembilan puluh enam ribu Tunai
295,000 dua ratus sembilan puluh lima ribu Tunai
572,500 lima ratus tujuh puluh dua ribu lima ratus Tunai
407,000 empat ratus tujuh ribu Tunai
327,000 tiga ratus dua puluh tujuh ribu Tunai
711,000 tujuh ratus sebelas ribu Tunai
65,000 enam puluh lima ribu Tunai
140,000 seratus empat puluh ribu Tunai
130,000 seratus tiga puluh ribu Tunai
224,000 dua ratus dua puluh empat ribu Tunai
472,000 empat ratus tujuh puluh dua ribu Tunai
990,000 sembilan ratus sembilan puluh ribu Tunai
430,000 empat ratus tiga puluh ribu Transfer
232,000 dua ratus tiga puluh dua ribu Tunai
571,000 lima ratus tujuh puluh satu ribu Tunai
165,000 seratus enam puluh lima ribu Transfer
166,650 seratus enam puluh enam ribu enam ratus lima Tunai
208,500 dua ratus delapan ribu lima ratus Tunai
561,500 lima ratus enam puluh satu ribu lima ratus Transfer
- nol
874,000 delapan ratus tujuh puluh empat ribu Debet BNI
712,000 tujuh ratus duabelas ribu Tunai
340,500 tiga ratus empat puluh ribu lima ratus Tunai
825,000 delapan ratus dua puluh lima ribu Debet BNI
166,650 seratus enam puluh enam ribu enam ratus lima Debet BNI
140,000 seratus empat puluh ribu Debet BNI
374,710 tiga ratus tujuh puluh empat ribu tujuh ratus s Debet Mandiri
328,500 tiga ratus dua puluh delapan ribu lima ratus Tunai
485,000 empat ratus delapan puluh lima ribu Tunai
309,000 tiga ratus sembilan ribu Tunai
505,000 lima ratus lima ribu
600,000 enam ratus ribu Tunai
317,000 tiga ratus tujuhbelas ribu Transfer
637,500 enam ratus tiga puluh tujuh ribu lima ratus Tunai
(25,000) minus dua puluh lima ribu Tunai
687,000 enam ratus delapan puluh tujuh ribu Tunai
244,000 dua ratus empat puluh empat ribu Tunai
376,500 tiga ratus tujuh puluh enam ribu lima ratus Tunai
495,000 empat ratus sembilan puluh lima ribu Transfer
547,000 lima ratus empat puluh tujuh ribu Tunai
166,650 seratus enam puluh enam ribu enam ratus lima Debet Mandiri
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
- nol Tunai
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- nol Tunai
Kembalian/ UMUM/
perawat Asesmen Kasir
Kekurangan KOASS
165,000 UMUM PUR NITA NITA

168,053 UMUM PUR NITA
407,000 UMUM PUR DAN NITA NITA PUR
165,000 UMUM PUR NITA PUR
120,200 UMUM PUR NITA PUR
165,000 UMUM PUR NITA
516,500 UMUM NITA PUR PUR
776,000 UMUM SUPARTI SUMI SUPARTI
165,000 UMUM SUMI SUMI
165,000 UMUM SUMI SPT
549,000 UMUM SUPARTI SUMI SPT
179,000 UMUM EKA ROHMAH ROHMAH RANAP
154,000 UMUM pur suparti SUPARTI ranap
859,500 UMUM NISA ANNA ANNA
165,000 UMUM pur pur pur
130,000 KOASS emi sigit
217,000 UMUM RENI EMI EMI
434,500 UMUM SUPARTI SRIYATI GALUH
240,000 UMUM SUPARTI SRIYATI SRIYATI
165,000 UMUM SUPARTI GALUH
165,000 UMUM SUPARTI GALUH
165,000 UMUM SRIYATI GALUH
295,000 UMUM
327,000 UMUM PUR SRIYATI GALUH
165,000 UMUM
165,000 UMUM
165,000 UMUM
711,000 UMUM pur rohmah pur
179,000 UMUM PUR ROHMAH GALUH
65,000 UMUM
140,000 UMUM PUR GALUH
130,000 UMUM ROHMAH GALUH
240,000 UMUM
224,000 UMUM PUR ROHMAH PUR
472,000 UMUM Eka ANNA ANNA
179,000 UMUM SUMI SPT SUMI
140,000 UMUM SUMI PUR PUR
990,000 UMUM SUMI PUR PUR 6 PASIEN
140,000 UMUM SRIYATI ROHMAH
217,000 UMUM SUPARTI YATI YATI
430,000 UMUM SUPARTI YATI YATI
232,000 UMUM IMAM SIGIT SIGIT
165,000 UMUM ANNA ANNA ANNA
165,000 UMUM ANNA ANNA SIGIT
571,000 RANAP ANNA ANNA sigit
165,000 UMUM SPT SPT
165,000 UMUM spt spt
165,000 UMUM EKA EKA RINA
165,000 UMUM SRIYATI SRIYATI ROHMAH
165,000 UMUM SRIYATI SRIYATI ROHMAH
165,000 UMUM rohmah yati yati
165,000 UMUM rohmah yati yati
165,000 UMUM ROHMAH yati yati
166,650 UMUM pur pur pur
165,000 UMUM pur rpur reni
208,500 UMUM SUMI ROHMAH ROHMAH
- UMUM eka rohmah BPH RSGM
165,000 UMUM yati yati yati
165,000 UMUM PUR SUMI
165,000 UMUM PUR SUMI
165,000 UMUM Imam sigit sigit
217,000 UMUM imam sigit sigit
165,000 UMUM ROHMAH ROHMAH
874,000 UMUM SULIS RENI YANTI
179,000 UMUM SULIS ROHMAH YANTI
712,000 UMUM SULIS ROHMAH YANTI
340,500 UMUM SULIS RENI YANTI
165,000 UMUM RENI YANTI
825,000 UMUM SUPARTI YANTI
140,000 UMUM SUPARTI SUPARTI
374,710 UMUM ANNA SUPARTI SUPARTI
165,000 UMUM SUPARTI ANNA
165,000 UMUM PUR SIGIT
165,000 UMUM rohmah pur pur
154,000 UMUM pur pur pur {pasien Ranap)
328,500 UMUM UDIN SUMI GALUH
485,000 UMUM ROHMAH SPT SPT
165,000 UMUM
165,000 UMUM
309,000 UMUM IMAM EMI EMI
505,000 UMUM imam emi emi PASIEN RANAP
165,000 UMUM ROHMAH DEWI
165,000 UMUM rohmah DEWI
240,000 UMUM NISA DEWI
317,000 UMUM ANISA ROHMAH DEWI
240,000 UMUM YATI DEWI
637,500 UMUM YATI ANNA DEWI
179,000 UMUM YATI ANNA ANNA
165,000 UMUM YATI ANNA ANNA
165,000 UMUM yati anna anna
165,000 UMUM yati anna anna
(25,000) UMUM YATI ANNA ANNA
165,000 UMUM Sumi sumi
165,000 UMUM SUMI SUPARTI
165,000 UMUM SUMI SUPARTI
140,000 UMUM SPT SUMI
154,000 UMUM spt SUMI IKUT RANAP
687,000 UMUM SRIYATI EMI EMI masuk ranap
165,000 UMUM EMI
165,000 UMUM EMI
165,000 UMUM EMI
165,000 UMUM EMI
165,000 UMUM emi
165,000 UMUM emi emi yati
165,000 UMUM emi emi yati
165,000 UMUM SIGIT anna
165,000 UMUM PUR ROHMAH
165,000 UMUM sigit eka
165,000 UMUM emi eka
165,000 UMUM emi eka
165,000 UMUM YATI YATI
244,000 UMUM sumi sumi
165,000 UMUM yati yati
376,500 UMUM sumi sriyati sumi
165,000 UMUM
165,000 UMUM
165,000 UMUM
547,000 RANAP SIGIT SUMI SIGIT ranap
165,000 UMUM SIGIT ANNA
165,000 UMUM
165,000 UMUM Lukman
165,000 UMUM Lukman
165,000 UMUM Lukman
165,000 UMUM Lukman
165,000 UMUM Lukman
165,000 UMUM Lukman
165,000 UMUM Lukman
165,000 UMUM Lukman
165,000 UMUM Lukman
165,000 UMUM Lukman
165,000 UMUM Lukman
165,000 UMUM eka
165,000 UMUM eka
165,000 UMUM eka
165,000 UMUM eka eka
140,000 UMUM eka
165,000 UMUM eka
166,650 UMUM eka
166,650 UMUM eka
166,650 UMUM eka
166,650 UMUM eka
140,000 UMUM eka eka
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00621.A.0224 Monday, July 05, 2021 0 rifky al thariq
JANGAN PASTE DI TEMPAT YANG LAIN, TETAP DI PASTE DI KOLOM 3 DENGAN P

purwodadi
TETAP DI PASTE DI KOLOM 3 DENGAN POSISI BLOK (SEMUA KOLOM 3)

0 0 0
0 0 0
0 0 0
0 rapid antig
140,000 140,000
140,000 seratus empat puluh ribu
us empat puluh ribu Tunai 140,000 UMUM
eka eka
UNIVERSITAS MUHAMMADIYAH SURAKARTA
RUMAH SAKIT GIGI DAN MULUT SOELASTRI
Jl. Brigjen Slamet Riyadi No. 366 Surakarta. Kodepos 57141
Telepon (0271) 7467796 Fax: (0271) 7467796
Email : rsgmsoelastri@ums.ac.id Website : http://rsgmsoelastri.ums.ac.id/
Kwitansi IGD
No RM : 0 00621.A.0224
Pasien : rifky al thariq UMUM
Alamat : purwodadi
Tanggal : 05 Juli 2021 0
KETERANGAN NILAI
Administrasi : -
Tindakan :
Rontgen : -
Lab :
Obat : 0
Jumlah 140,000
Adm Bank -
diskon -
Total Tagihan 140,000
Terbilang : seratus empat puluh ribu

Pembayaran : Tunai Bayarnya -
Kembalian (140,000)
Surakarta 05 Juli 2021
Kasir
. eka
08/01/2021 02:34:47
UNIVERSITAS MUHAMMADIYAH SURAKARTA
RUMAH SAKIT GIGI DAN MULUT SOELASTRI
Jl Brigjend Slamet Riyadi No 366 Surakarta Kodepos 57141
Telepon (0271) 7467796 Fax: (0271) 7467796
Email : rsgmsoelastri@umsacid Website : http://rsgmsoelastriumsacid/
Tindakan Medis Gigi dan Mulut

Instalasi Gawat Darurat
KODE PENDAFTARAN TARIF

A11 PASIEN BARU Rp 35,000
A12 PASIEN LAMA Rp 30,000
A13 APD Rp20,000
KODE PEMERIKSAAN TARIF FINAL

A21 DOKTER GIGI UMUM 124,000
A22 DOKTER GIGI SPESIALIS 145,000
A23 DOKTER SPESIALIS PENYAKIT DALAM 120,000
A24 DOKTER UMUM 100,000
KODE NAMA TINDAKAN TARIF FINAL

A31 PEMERIKSAAN FISIK (incl spooling, grinding) Rp 162,000
A32 TUMPATAN GIC KECIL Rp 252,000
A33 TUMPATAN GIC SEDANG Rp 285,000
A34 TUMPATAN GIC BESAR Rp 329,000
A35 TUMPATAN RK KECIL Rp 318,000
A36 TUMPATAN RK SEDANG Rp 417,000
A37 TUMPATAN RK BESAR Rp 516,000
A38 TUMPATAN RMGIC KECIL Rp 250,000
A39 TUMPATAN RMGIC SEDANG Rp 285,000
A310 TUMPATAN RMGIC BESAR Rp 329,000
A311 TUMPATAN SANDWICH Rp 349,000
A312 LINING ZINC PHOSPAT Rp 125,000
A313 LINING GIC Rp 136,000
A314 LINING CAOH Rp 127,000
A315 PULP CAPING Rp 248,000
A316 DEVITALISASI/TREPANASI Rp 234,000
A317 TUMPATAN SEMENTARA Rp 196,000
A318 REWALLING GIC Rp 252,000
A319 REWALLING RK Rp 317,000
A320 OPEN ACCESS PSA/PULPEK & EKSTIRPASI Rp 354,000
A321 PREPARASI PSA/PULPEK PER SALURAN Rp 263,000
A322 OBTURASI PSA/PULPEK PER SALURAN Rp 254,000
A323 PSA ONE VISIT ANTERIOR Rp 933,000
A324 PSA ONE VISIT PREMOLAR Rp 1,447,000
A325 PSA ONE VISIT MOLAR Rp 1,879,000
A326 PULPOTOMI Rp 387,000
A327 DRESSING CAOH Rp 159,000
A328 DRESSING CHKM Rp 158,000
A329 DRESSING CRESSOPHENE Rp 158,000
A330 DRESSING TKF Rp 158,000
A331 BONGKAR TAMBALAN Rp 157,000
A332 APEKSOGENESIS Rp 335,000
A333 SCALLING RINGAN RA & RB Rp 265,000
A334 SCALLING SEDANG RA & RB Rp 352,000
A335 SCALLING BERAT RA & RB Rp 442,000
A336 DRESSING TI-ES Rp 222,000
A337 KURETASE RINGAN Rp 340,000
A338 KURETASE SEDANG Rp 447,000
A339 KURETASE BERAT Rp 522,000
A340 SPLINTING WIRE KOMPOSIT 1-3 GIGI Rp 550,000
A341 SPLINTING FIBER KOMPOSIT 1-3 GIGI Rp 735,000
A342 SCALLING MANUAL Rp 248,000
A343 GINGIVEKTOMI RINGAN Rp 604,000
A344 GINGIVEKTOMI SEDANG Rp 693,000
A345 GINGIVEKTOMI BERAT Rp 758,000
A346 OCCLUSAL ADJUSTMENT Rp 273,000
A347 DESENSITASI Rp 619,000
A348 FRENEKTOMI Rp 1,630,000
A349 AVULSI (LIGATURE) Rp 1,505,000
A350 ALVEOLECTOMY Rp 1,724,000
A351 KONTROL (GINGIVEK/KURET/FRENEK/DLL) Rp 265,000
A352 LEPAS GTC Rp 315,000
A353 RELINING Rp 542,000
A354 REBASING Rp 609,000
A355 REPARASI Rp 452,000
A356 DRAINASE/ INSISI ABSES ANAK Rp 299,000
A357 FISSURE SEALANT GIC Rp 266,000
A358 FISSURE SEALANT RK FLOW Rp 272,000
A359 TUMPATAN GIC KECIL ANAK Rp 245,000
A360 TUMPATAN GIC SEDANG ANAK Rp 269,000
A361 TUMPATAN GIC BESAR ANAK Rp 320,000
A362 TUMPATAN RMGIC KECIL ANAK Rp 262,000
A363 TUMPATAN RMGIC SEDANG ANAK Rp 280,000
A364 TUMPATAN RMGIC BESAR ANAK Rp 338,000
A365 PULPOTOMI DESIDUI Rp 358,000
A366 PSA ONE VISIT DESIDUI Rp 684,000
A367 OPEN ACCESS & EKSTIRPASI ANAK (PSA/PULPEK) Rp 268,000
A368 PREPARASI PSA/PULPEK PER SALURAN ANAK Rp 273,000
A369 OBTURASI PER SALURAN ANAK Rp 179,000
A370 DRESSING CAOH ANAK Rp 134,000
A371 DRESSING CHKM ANAK Rp 132,000
A372 DRESSING CRESSOPHENE ANAK Rp 133,000
A373 DRESSING TKF ANAK Rp 133,000
A374 DEVITALISASI. TREPANASI ANAK Rp 197,000
A375 EXO CE. TOPIKAL ANAK Rp 194,000
A376 EXO INFIL ANAK Rp 268,000
A377 SCALLING ANAK PER RAHANG Rp 225,000
A378 PROFILAKSIS ANAK Rp 197,000
A379 EXO BLOK ANAK Rp 300,000
A380 ODONTEKTOMI RINGAN Rp 1,649,000
A381 EKSTIRPASI MOCOCELE RINGAN Rp 631,000
A382 FIKSASI WIRE 1 RAHANG Rp 981,000
A383 HECTING AFF 1-2 SIMPUL Rp 197,000
A384 HECTING AFF LEBIH 2 SIMPUL Rp 276,000
A385 SPOOLING/ IRIGASI Rp 202,000
A386 OPERCULECTOMY Rp 679,000
A387 INSISI/DRAINASE INTRAORAL Rp 487,000
A388 EXO TANPA KOMPLIKASI Rp 296,000
A389 EXO DENGAN KOMPLIKASI Rp 857,000
A390 EXO CE Rp 234,000
A391 PENATALAKSANAAN DRY SOCKET Rp 286,000
A392 GRINDING Rp 116,000
Kode Nama Tindakan TARIF FINAL

A41 Aff Jahitan Rp 35,000
A42 Aff Jahitan >10Jahitan Rp 8,000
A43 Cross Insisi Rp 83,000
A44 Debridemen Kecil Rp 45,000
A45 Debridemen Sedang Rp 80,000
A46 Debridemen Luas Rp 112,000
A47 EKG Rp 52,000
A48 Ekstirpasi Clavus/Veruka Rp 151,000
A49 Ekstraksi Kuku Rp 151,000
A410 Injeksi (diluar obat) per shift Rp 12,000
A411 Jahit Luka Kecil (1-5 Jahitan) Rp 63,000
A412 Jahit Luka Sedang (6-10 Jahitan) Rp 82,000
A413 Jahit Luka Luas (11-15 Jahitan) Rp 107,000
A414 Jahitan per simpul (Tambahan) Rp 8,000
A415 Lepas Infus Rp 8,000
A416 Lepas Kateter Rp 7,000
A417 Lepas NGT Rp 7,000
A418 Lepas Tampon Rp 7,000
A419 Medikasi Ringan Rp 40,000
A420 Medikasi Sedang Rp 58,000
A421 Medikasi Luas Rp 76,000
A422 Nebulasi (tidak termasuk obat) Rp 47,000
A425 Oksigen 3-4 lpm/jam Rp 9,000
A426 Oksigen 5-7 lpm/jam Rp 11,000
A427 Oksigen >7 lpm/jam Rp 15,000
A428 Pasang Infus Rp 43,000
A429 Pasang Kateter Rp 35,000
A430 Pasang NGT Rp 41,000
A431 Pasang Tampon Rp 30,000
A432 Resusitasi (RJP) Rp 150,000
A433 Suction Rp 35,000
A434 Pasang Bebat Rp 40,000
A435 Pasang Spalk Rp 50,000
A436 Pasang Collar Neck Rp 30,000
KODE Nama Tindakan Tarif

UB1 Darah Rutin Rp 125,000
UB2 HIV Rp 225,000
UB3 HbsAg Rp 150,000
UB4 Hemoglobin Rp 75,000
UB5 Gula Darah Sewaktu Rp 55,000
UB6 Cholesterol Rp 65,000
UB7 Asam Urat Rp 55,000
UB8 Natrium (NA) Rp 150,000
UB9 Kalium (K) Rp 150,000
UB10 Clorida (CL) Rp 150,000
UB11 Albumin Rp 100,000
UB12 Ureum Rp 70,000
UB13 Creatinin Rp 70,000
UB14 Golongan Darah Rp 50,000
UB15 SGOT Rp 75,000
UB16 SGPT Rp 75,000
UB17 PT Rp 225,000
UB18 APTT Rp 325,000
UB19 CT,BT Rp 50,000
UB20 NA,K,CL Rp 450,000
Tarif Pemeriksaan Radiologi 1. Penambahan Print kecil ( Periapikal, Bitewing, Sh
Pasien UMUM 2. Print Besar Rp. 25000
3. DvD / CD Rp. 25000
NO JENIS PEMERIKSAAN HARGA
1 PERIAPIKAL DEWASA PER GIGI 185,000
2 PERIPIKAL ANAK PER GIGI 195,000
3 BITE WING 195,000
4 OKLUSAL 195,000
5 SLOB 195,000
6 PANORAMIK 240,000
7 CHEPHALOMETRI 240,000
8 CARPAL/HAND WRIST 240,000
9 EKSTRA ORAL LAINNYA 240,000
10 CBCT 3D (KATEGORI 1) ENDO/PER GIGI 450,000
11 CBCT 3D (KATEGORI 2) TIDAK SAMPAI ORBIT 500,000
12 CBCT 3D (KATEGORI 3) FULL FACE 600,000
bahan Print kecil ( Periapikal, Bitewing, Shift sketch method ) Rp. 15000
Besar Rp. 25000
/ CD Rp. 25000
No NAMA lengkap pembayaran
1 drg. Grandis Ratnaning F Tunai
2 drg. Fahmi Fauzi Transfer
3 drg.Hikmah Fajarorista Az Zahrah Debet Mandiri
4 drg. Jalu Debet BNI
5 drg. Windi Merinda
6 drg. Astri Retno Wikandari
7 drg. Ananda Nan Fitrah
8 dr. Ari Prasetyo Nugroho,Sp.PD
Jenis Pasien
UMUM
KOASS
RANAP

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00621.A. 0001 00621.A.0001 ### 01.06.42

00621.A. 0165 00621.A.0165 ### 01.14.18

00621.A. 0166 00621.A.0166 ### 01.14.19

00621.A. 0167 00621.A.0167 ### 01.14.20

00621.A. 0168 00621.A.0168 ### 01.14.21

00621.A. 0169 00621.A.0169 ### 01.14.22

00621.A. 0170 00621.A.0170 ### 01.14.23

00621.A. 0171 00621.A.0171 ### 01.14.24

MUSTACHSINAH SALSABILA SURAKARTA

RAPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

REPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

RAPID ANTIGEN 65,000

RAPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

rapid antigen 165,000

RAPID ANTIGEN 165,000

RAPID ANTIGEN 165,000

rapid antigen 165,000 gula darah 55,000

rapid antigen 165,000

rapid antigen 495,000

165,000 seratus enam puluh lima ribu Debet BNI

165,000 UMUM PUR NITA NITA

JANGAN PASTE DI TEMPAT YANG LAIN, TETAP DI PASTE DI KOLOM 3 DENGAN P

TETAP DI PASTE DI KOLOM 3 DENGAN POSISI BLOK (SEMUA KOLOM 3)

Terbilang : seratus empat puluh ribu

Tindakan Medis Gigi dan Mulut

KODE PENDAFTARAN TARIF

KODE PEMERIKSAAN TARIF FINAL

KODE NAMA TINDAKAN TARIF FINAL

Kode Nama Tindakan TARIF FINAL

KODE Nama Tindakan Tarif

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