LIST KELENGKAPAN ADMINISTRASI KLAIM COVID-19

FORM 4/KET.
MRS/KET. RUANG HASIL RADIOLOGI SURAT KET.
No Tgl. Masuk Tgl. Pulang NO.KLAIM NO RM Pasien KTP PENGGANTI HASIL SWAB RESUME MEDIS
PERAWATAN PERBAIKAN PUSKESMAS
BIAYA

1 3-Jul-21 3-Jul-21 8171123ICC2107002A 00.01.03.31 TN. YANDRI SOEYONO 1

ARYA PERDANA BUTTU

2 27-Jun-21 4-Jul-21 8171123ICC2107002D 00.00.85.87 1 1 1
LAYUK
3 2-Jul-21 4-Jul-21 8171123ICC21070016 10259 MELKIANUS TJANDUA 1 1
4 1-Jul-21 4-Jul-21 8171123ICC21070018 10249 AGUSTINA MAKATITA 1 1
5 26-Jun-21 5-Jul-21 8171123ICC210601A3 00.00.64.27 MEGA SINTIA SAHUSIWA 1 1 1 1
SILVIA NOVITA PULANG SWAB
6 20-Jun-21 5-Jul-21 8171123ICC210601A5 00.00.54.13 1 1 1 1
RAHAWARIN NEGATIVE

IYAN PAHLEVY
7 16-Jun-21 5-Jul-21 8171123ICC21070025 00.00.04.15 1 1 1
LESTALUHU, S.KEP, NERS
8 18-Jun-21 5-Jul-21 8171123ICC21070026 00.00.37.30 JAMAL HOLLE 1 1 1
9 19-Jun-21 5-Jul-21 8171123ICC2107002B 00.00.96.77 WILHELMINA TANATE 1 1 1 1
10 3-Jul-21 5-Jul-21 8171123ICC21070037 00.01.03.39 RIZAL SUHAILI 1 1
11 26-Jun-21 5-Jul-21 8171123ICC2107004C 00.00.95.94 YAMES ISTIA 1 1 1 1

12 26-Jun-21 6-Jul-21 8171123ICC2108003E 00.00.03.26 NURHEFI 1 1 1 1

PAULINA WATUGULY/
13 2-Jul-21 6-Jul-21 8171123ICC21070015 9582 1 1
NOTANUBUN
ROMARIO STENLY
14 27-Jun-21 6-Jul-21 8171123ICC210601BD 00.00.99.67 1
RIRINAMA
15 7-Jul-21 7-Jul-21 8171123ICC21070053 10500 ARDIANSYAH 1
MELIANUS HANNY
16 7-Jul-21 7-Jul-21 8171123ICC21070056 10506 1
KAKERISSA
APRILIA BATSEBA JACOBA
17 30-Jun-21 7-Jul-21 8171123ICC21070022 00.01.01.17 1 1 1
SAUNUNU
18 7-Jul-21 7-Jul-21 8171123ICC2107005B 10529 RIZKA ADELYA 1 1

19 7-Jul-21 7-Jul-21 8171123ICC2107005C 10530 JAMALUDIN BUGIS 1 1

ADELEDA ABETSINA
20 7-Jul-21 7-Jul-21 8171123ICC2107005E 10532 1
MESLOY
YUSTINA ROLANI
21 26-Jun-21 7-Jul-21 8171123ICC210601A9 9922 1 1 1
KEILAIKOU
MAYRILIN DORTEA
22 26-Jun-21 7-Jul-21 8171123ICC210601AA 9923 1 1 1 1
TUTURMUTU
SILVIA RIANITA
23 25-Jun-21 7-Jul-21 8171123ICC210601AB 9868 1 1 1 1
SINULINGGA
OCTOVIANUS ANTONIUS
24 26-Jun-21 7-Jul-21 8171123ICC210601AC 9925 1 1 1 1
TOREH
28 30-Jun-21 7-Jul-21 8171123ICC2107004E 00.00.37.43 BESTARIA BUTAR BUTAR 1 1 1 1 SWAB NEGATIVE 1

29 30-Jun-21 8-Jul-21 8171123ICC210601E8 10149 IGNACIUS DHANI SUKAR 1 1

30 8-Jul-21 8-Jul-21 8171123ICC21070061 7726 TAN BOEN KING 1 1 1 1
31 2-Jul-21 8-Jul-21 8171123ICC21070024 00.00.99.3 MANUMARA ANTJE 1
32 30-Jun-21 9-Jul-21 8171123ICC210601E3 10139 ERNA SANGADJI 1 1 1 1
33 8-Jul-21 9-Jul-21 8171123ICC21070066 10550 NASUHAN DJOHAR 1 1
34 26-Jun-21 9-Jul-21 8171123ICC2108003A 00.00.99.19 FIFI SAFIRA 1 1
IGNATIUS AARON
35 4-Jul-21 9-Jul-21 8171123ICC21070035 00.01.03.44 1 1
KHOESUMA
36 4-Jul-21 9-Jul-21 8171123ICC21070036 00.01.03.43 CHANDRA KHOESUMA 1 1
37 24-Jun-21 9-Jul-21 8171123ICC2106018B 00.00.97.34 ERWIN SIMAREMARE 1 1 1 1 1
38 10-Jul-21 10-Jul-21 8171123ICC2107006F 10666 NOVITA SARI RIFAI 1 1
39 9-Jul-21 10-Jul-21 8171123ICC21070070 10626 YONG ALAN DE YONG 1 1
40 10-Jul-21 10-Jul-21 8171123ICC21070071 10676 SUMIYATI 1 1
41 10-Jul-21 10-Jul-21 8171123ICC21070072 10675 YULIANA SAMADARA 1 1
42 26-Jun-21 10-Jul-21 8171123ICC2108003B 00.00.99.26 ADOLF LEONARD SILALILY 1 1 1
DR. ALFONS OCTAVIAN
43 10-Jul-21 10-Jul-21 8171123ICC21070074 10677 1 1
SABANDAR
44 10-Jul-21 10-Jul-21 8171123ICC21070075 10590 IBRAHIM ACHMAD 1 1
45 10-Jul-21 10-Jul-21 8171123ICC21070076 10680 JECKLIN KHO
46 11-Jul-21 11-Jul-21 8171123ICC21070077 10624 FRANGKY SOPACUA 1 1
47 30-Jun-21 11-Jul-21 8171123ICC210601ED 7139 EVAN TIMOTIUS SIMON 1 1 1 1
48 29-Jun-21 11-Jul-21 8171123ICC21070079 10038 WILLEM NGORANUBUN 1 1 1 1 1
49 29-Jun-21 11-Jul-21 8171123ICC2107007A 10104 RHEZA YOGA PRATAMA 1 1 1 1 1

50 29-Jun-21 11-Jul-21 8171123ICC2107007B 10028 MUHAMMAD NUR AZIIZ 1 1 1 1 1

51 11-Jul-21 11-Jul-21 8171123ICC2107007C 10111 FAHMI HANIF WINANTO 1 1 1

52 29-Jun-21 11-Jul-21 8171123ICC2107007D 10105 DANIEL MAYLANDO 1 1 1 1

53 29-Jun-21 11-Jul-21 8171123ICC2107007E 10109 BINSAR 1 1 1 1 1

54 11-Jul-21 11-Jul-21 8171123ICC2107007F 10256 DANI AYU RIATOSSENG 1
YOULANDA EMILIA MOERI,
55 11-Jul-21 11-Jul-21 8171123ICC21080040 00.01.07.19 1 1
DR
56 8-Jul-21 12-Jul-21 8171123ICC21070054 10505 ESTHER SRI LASMINI 1
57 30-Jun-21 12-Jul-21 8171123ICC210601EA 10152 IR. FRIEDSON, WNK 1 1 1 1 1 1
IR. NETRA AUGI PRAMITA
58 30-Jun-21 12-Jul-21 8171123ICC210601EB 10151 1 1 1 1 1 1
ADARJONO
59 2-Jul-21 12-Jul-21 8171123ICC21070019 10283 FIKARRUDDIN 1 1 1 1
60 12-Jul-21 12-Jul-21 8171123ICC21070085 00.00.98.79 NATALIA LATUHERU 1 1 1 1 1
AGNES FRANSISCA
61 27-Jun-21 13-Jul-21 8171123ICC21070023 00.00.99.33 1 1 1 1
KABORA
62 3-Jul-21 13-Jul-21 8171123ICC21070029 00.01.02.45 INDRAWANTI KUSADHIANI 1 1 1

63 27-Jun-21 13-Jul-21 8171123ICC2107002E 00.00.99.32 PAULINA S LENGGU M. 1 1

64 8-Jul-21 14-Jul-21 8171123ICC21070067 157 RIVAL DAKDAKUR 1 1 1
65 14-Jul-21 14-Jul-21 8171123ICC21070093 10832 SALAMA KAPLALE 1 1
EVANGELINE NORIMARNA /
66 12-Jul-21 14-Jul-21 8171123ICC2108003F 00.01.07.60 1
W
67 11-Jul-21 14-Jul-21 8171123ICC21080014 00.01.07.22 H A GANI MARASABESSY 1 1
QANTAS RIFKY
68 6-Jul-21 15-Jul-21 8171123ICC21070046 00.01.01.13 1 1 1 1
MUHAMMAD
69 15-Jul-21 15-Jul-21 8171123ICC2107009E 00.00.91.10 NADIA FIRDHA NALAHELLU 1 1
HIKA DERIYA FAJAR ASHIL
70 5-Jul-21 15-Jul-21 8171123ICC21070047 00.01.04.13 1 1 1 1
PUTRA
71 15-Jul-21 15-Jul-21 8171123ICC210700A0 00.00.15.83 WIDYA SOHILAIT
72 6-Jul-21 15-Jul-21 8171123ICC21070048 00.01.04.11 BRAMA KUNTORO 1 1 1 1
IR. PIETER MICHELMAN
73 15-Jul-21 15-Jul-21 8171123ICC210700A2 10865 1 1 1
MUSTAMU
74 15-Jun-21 16-Jul-21 8171123ICC210600FF 9309 YESTIATAMI TANASALE 1 1 1 1 1

75 17-Jul-21 17-Jul-21 8171123ICC210700B2 10887 RICO GINO OHELLO 1

LEENTJE MARIA
76 17-Jul-21 17-Jul-21 8171123ICC210700B3 10882 1
SAHUSILAWANE
77 17-Jul-21 17-Jul-21 8171123ICC210700B4 10890 SION TANNE 1

78 16-Jul-21 17-Jul-21 8171123ICC210700B5 10888 SARAH JUNITA PATTIAPON 1

79 16-Jul-21 17-Jul-21 8171123ICC210700B6 10886 MARTHINUS TAHAPARY 1 1

MARVELIN FREJEN
80 8-Jul-21 17-Jul-21 8171123ICC210700B7 1046 1
LUTURMAS
81 14-Jul-21 17-Jul-21 8171123ICC21070094 10806 AMI ROSIANA 1 1 1 1
82 27-Jun-21 17-Jul-21 8171123ICC2107002C 00.00.99.48 ANGELIQUE ENGEL 1 1 1 1
83 9-Jul-21 18-Jul-21 8171123ICC21070058 10511 FARIDA GENDA 1 1
84 11-Jul-21 18-Jul-21 8171123ICC2108003C 10636 JEFTA IMAPULY 1

85 14-Jul-21 19-Jul-21 8171123ICC21080011 4288 BITCARLIUS SITUMORANG 1 1 1 1 1

86 20-Jul-21 20-Jul-21 8171123ICC210700D0 10933 LILIS HARIJANI RETTOP 1

87 21-Jul-21 21-Jul-21 8171123ICC210700D1 10893 EMIE RETRAUBUN

88 21-Jul-21 21-Jul-21 8171123ICC210700D2 10881 EMMA NURMALA FENDIANI

89 21-Jul-21 21-Jul-21 8171123ICC210700D3 10934 FRANSINA TUANKOTTA

90 7-Jul-21 21-Jul-21 8171123ICC2108000C 00.01.03.52 DWI PUJI LAKSANA 1 1

91 4-Jul-21 21-Jul-21 8171123ICC21070028 00.01.02.22 OKTOVIANUS RAHAYAAN 1 1
HANNY MEIDO
92 10-Jul-21 22-Jul-21 8171123ICC2107005A 10528
SOPLANTILA
93 17-Jul-21 24-Jul-21 8171123ICC210700B0 10836 BETTY THIE 1

94 6-Jul-21 27-Jul-21 8171123ICC2107008B 00.01.04.18 YUNAIDI SETIAWAN 1 1 1

95 17-Jul-21 28-Jul-21 8171123ICC210700B1 10889 KIEM SITANIA / TJOA 1 1

96 11-Jul-21 28-Jul-21 8171123ICC21070073 10529 RIZKA ADELYA 1 1 1 1
97 9-Jul-21 31-Jul-21 8171123ICC21070057 10510 SVEN ROBERT LOUPATTY 1
98 7-Jul-21 31-Jul-21 8171123ICC21070044 00.01.04.29 LINDA NATAN 1 1 1

Yang memeriksa
1. Chandra Akasa
2. Dwi Joko
3. Yudha Irawan
4. Rahman
5. Cahya Lestaluhu
6. Leni
1. KURANG KTP ( 13 PASIEN)
No Tgl. Masuk Tgl. Pulang NO.KLAIM NO RM

14 27-Jun-21 6-Jul-21 8171123ICC210601BD 00.00.99.67

34 26-Jun-21 9-Jul-21 8171123ICC2108003A 00.00.99.19
42 26-Jun-21 10-Jul-21 8171123ICC2108003B 00.00.99.26
45 10-Jul-21 10-Jul-21 8171123ICC21070076 10680
52 29-Jun-21 11-Jul-21 8171123ICC2107007D 10105
61 27-Jun-21 13-Jul-21 8171123ICC21070023 00.00.99.33
66 12-Jul-21 14-Jul-21 8171123ICC2108003F 00.01.07.60
71 15-Jul-21 15-Jul-21 8171123ICC210700A0 00.00.15.83
84 11-Jul-21 18-Jul-21 8171123ICC2108003C 10636
87 21-Jul-21 21-Jul-21 8171123ICC210700D1 10893
88 21-Jul-21 21-Jul-21 8171123ICC210700D2 10881
89 21-Jul-21 21-Jul-21 8171123ICC210700D3 10934
92 10-Jul-21 22-Jul-21 8171123ICC2107005A 10528
 Pasien KTP

ROMARIO STENLY RIRINAMA

FIFI SAFIRA
ADOLF LEONARD SILALILY
JECKLIN KHO
DANIEL MAYLANDO
AGNES FRANSISCA KABORA
EVANGELINE NORIMARNA / W
WIDYA SOHILAIT
JEFTA IMAPULY
EMIE RETRAUBUN
EMMA NURMALA FENDIANI
FRANSINA TUANKOTTA
HANNY MEIDO SOPLANTILA
2. KURANG MRS ( 32 PASIEN)
No Tgl. Masuk Tgl. Pulang

1 3-Jul-21 3-Jul-21
2 27-Jun-21 4-Jul-21
3 2-Jul-21 4-Jul-21

13 2-Jul-21 6-Jul-21

14 27-Jun-21 6-Jul-21
16 7-Jul-21 7-Jul-21
19 7-Jul-21 7-Jul-21
20 7-Jul-21 7-Jul-21
33 8-Jul-21 9-Jul-21
39 9-Jul-21 10-Jul-21
40 10-Jul-21 10-Jul-21
41 10-Jul-21 10-Jul-21

43 10-Jul-21 10-Jul-21

45 10-Jul-21 10-Jul-21
46 11-Jul-21 11-Jul-21
54 11-Jul-21 11-Jul-21
56 8-Jul-21 12-Jul-21
63 27-Jun-21 13-Jul-21
64 8-Jul-21 14-Jul-21
66 12-Jul-21 14-Jul-21
71 15-Jul-21 15-Jul-21

73 15-Jul-21 15-Jul-21

77 17-Jul-21 17-Jul-21
78 16-Jul-21 17-Jul-21
79 16-Jul-21 17-Jul-21
86 20-Jul-21 20-Jul-21
87 21-Jul-21 21-Jul-21
88 21-Jul-21 21-Jul-21
90 7-Jul-21 21-Jul-21
93 17-Jul-21 24-Jul-21
97 9-Jul-21 31-Jul-21
98 7-Jul-21 31-Jul-21
 NO.KLAIM NO RM Pasien

8171123ICC2107002A 00.01.03.31 TN. YANDRI SOEYONO

8171123ICC2107002D 00.00.85.87 ARYA PERDANA BUTTU LAYUK
8171123ICC21070016 10259 MELKIANUS TJANDUA
PAULINA WATUGULY/
8171123ICC21070015 9582
NOTANUBUN
8171123ICC210601BD 00.00.99.67 ROMARIO STENLY RIRINAMA
8171123ICC21070056 10506 MELIANUS HANNY KAKERISSA
8171123ICC2107005C 10530 JAMALUDIN BUGIS
8171123ICC2107005E 10532 ADELEDA ABETSINA MESLOY
8171123ICC21070066 10550 NASUHAN DJOHAR
8171123ICC21070070 10626 YONG ALAN DE YONG
8171123ICC21070071 10676 SUMIYATI
8171123ICC21070072 10675 YULIANA SAMADARA
DR. ALFONS OCTAVIAN
8171123ICC21070074 10677
SABANDAR
8171123ICC21070076 10680 JECKLIN KHO
8171123ICC21070077 10624 FRANGKY SOPACUA
8171123ICC2107007F 10256 DANI AYU RIATOSSENG
8171123ICC21070054 10505 ESTHER SRI LASMINI
8171123ICC2107002E 00.00.99.32 PAULINA S LENGGU M.
8171123ICC21070067 157 RIVAL DAKDAKUR
8171123ICC2108003F 00.01.07.60 EVANGELINE NORIMARNA / W
8171123ICC210700A0 00.00.15.83 WIDYA SOHILAIT
IR. PIETER MICHELMAN
8171123ICC210700A2 10865
MUSTAMU
8171123ICC210700B4 10890 SION TANNE
8171123ICC210700B5 10888 SARAH JUNITA PATTIAPON
8171123ICC210700B6 10886 MARTHINUS TAHAPARY
8171123ICC210700D0 10933 LILIS HARIJANI RETTOP
8171123ICC210700D1 10893 EMIE RETRAUBUN
8171123ICC210700D2 10881 EMMA NURMALA FENDIANI
8171123ICC2108000C 00.01.03.52 DWI PUJI LAKSANA
8171123ICC210700B0 10836 BETTY THIE
8171123ICC21070057 10510 SVEN ROBERT LOUPATTY
8171123ICC21070044 00.01.04.29 LINDA NATAN
MRS/KET. RUANG PERAWATAN
2. KURANG FORM PENGGANTI BIAYA ( 38 PASIE
No Tgl. Masuk Tgl. Pulang NO.KLAIM NO RM

3 2-Jul-21 4-Jul-21 8171123ICC21070016 10259

8 18-Jun-21 5-Jul-21 8171123ICC21070026 00.00.37.30

10 3-Jul-21 5-Jul-21 8171123ICC21070037 00.01.03.39

13 2-Jul-21 6-Jul-21 8171123ICC21070015 9582

14 27-Jun-21 6-Jul-21 8171123ICC210601BD 00.00.99.67

15 7-Jul-21 7-Jul-21 8171123ICC21070053 10500

16 7-Jul-21 7-Jul-21 8171123ICC21070056 10506

20 7-Jul-21 7-Jul-21 8171123ICC2107005E 10532

21 26-Jun-21 7-Jul-21 8171123ICC210601A9 9922

29 30-Jun-21 8-Jul-21 8171123ICC210601E8 10149

33 8-Jul-21 9-Jul-21 8171123ICC21070066 10550

34 26-Jun-21 9-Jul-21 8171123ICC2108003A 00.00.99.19

44 10-Jul-21 10-Jul-21 8171123ICC21070075 10590

45 10-Jul-21 10-Jul-21 8171123ICC21070076 10680

46 11-Jul-21 11-Jul-21 8171123ICC21070077 10624

54 11-Jul-21 11-Jul-21 8171123ICC2107007F 10256

56 8-Jul-21 12-Jul-21 8171123ICC21070054 10505

63 27-Jun-21 13-Jul-21 8171123ICC2107002E 00.00.99.32

65 14-Jul-21 14-Jul-21 8171123ICC21070093 10832

66 12-Jul-21 14-Jul-21 8171123ICC2108003F 00.01.07.60

67 11-Jul-21 14-Jul-21 8171123ICC21080014 00.01.07.22

69 15-Jul-21 15-Jul-21 8171123ICC2107009E 00.00.91.10

71 15-Jul-21 15-Jul-21 8171123ICC210700A0 00.00.15.83

75 17-Jul-21 17-Jul-21 8171123ICC210700B2 10887

76 17-Jul-21 17-Jul-21 8171123ICC210700B3 10882

77 17-Jul-21 17-Jul-21 8171123ICC210700B4 10890

78 16-Jul-21 17-Jul-21 8171123ICC210700B5 10888

80 8-Jul-21 17-Jul-21 8171123ICC210700B7 1046

84 11-Jul-21 18-Jul-21 8171123ICC2108003C 10636

86 20-Jul-21 20-Jul-21 8171123ICC210700D0 10933

87 21-Jul-21 21-Jul-21 8171123ICC210700D1 10893

88 21-Jul-21 21-Jul-21 8171123ICC210700D2 10881

89 21-Jul-21 21-Jul-21 8171123ICC210700D3 10934

92 10-Jul-21 22-Jul-21 8171123ICC2107005A 10528

93 17-Jul-21 24-Jul-21 8171123ICC210700B0 10836

94 6-Jul-21 27-Jul-21 8171123ICC2107008B 00.01.04.18

95 17-Jul-21 28-Jul-21 8171123ICC210700B1 10889

97 9-Jul-21 31-Jul-21 8171123ICC21070057 10510

TI BIAYA ( 38 PASIEN)
Pasien FORM 4/KET. PENGGANTI BIAYA

MELKIANUS TJANDUA

JAMAL HOLLE

RIZAL SUHAILI

PAULINA WATUGULY/ NOTANUBUN

ROMARIO STENLY RIRINAMA

ARDIANSYAH

MELIANUS HANNY KAKERISSA

ADELEDA ABETSINA MESLOY

YUSTINA ROLANI KEILAIKOU

IGNACIUS DHANI SUKAR

NASUHAN DJOHAR

FIFI SAFIRA

IBRAHIM ACHMAD

JECKLIN KHO

FRANGKY SOPACUA

DANI AYU RIATOSSENG

ESTHER SRI LASMINI

PAULINA S LENGGU M.

SALAMA KAPLALE

EVANGELINE NORIMARNA / W

H A GANI MARASABESSY

NADIA FIRDHA NALAHELLU

WIDYA SOHILAIT
 RICO GINO OHELLO

LEENTJE MARIA SAHUSILAWANE

SION TANNE

SARAH JUNITA PATTIAPON

MARVELIN FREJEN LUTURMAS

JEFTA IMAPULY

LILIS HARIJANI RETTOP

EMIE RETRAUBUN

EMMA NURMALA FENDIANI

FRANSINA TUANKOTTA

HANNY MEIDO SOPLANTILA

BETTY THIE

YUNAIDI SETIAWAN

KIEM SITANIA / TJOA

SVEN ROBERT LOUPATTY

3. KURANG HASIL RADIOLOGI PERBAIKAN/SWA

No Tgl. MasukTgl. Pulang NO.KLAIM NO RM Pasien

1 3-Jul-21 3-Jul-21 8171123ICC2107002A 00.01.03.31 TN. YANDRI SOEYONO

2 27-Jun-21 4-Jul-21 8171123ICC2107002D 00.00.85.87 ARYA PERDANA BUTTU LAYUK

3 2-Jul-21 4-Jul-21 8171123ICC21070016 10259 MELKIANUS TJANDUA

4 1-Jul-21 4-Jul-21 8171123ICC21070018 10249 AGUSTINA MAKATITA
5 26-Jun-21 5-Jul-21 8171123ICC210601A3 00.00.64.27 MEGA SINTIA SAHUSIWA
IYAN PAHLEVY LESTALUHU,
7 16-Jun-21 5-Jul-21 8171123ICC21070025 00.00.04.15
S.KEP, NERS
8 18-Jun-21 5-Jul-21 8171123ICC21070026 00.00.37.30 JAMAL HOLLE
9 19-Jun-21 5-Jul-21 8171123ICC2107002B 00.00.96.77 WILHELMINA TANATE
10 3-Jul-21 5-Jul-21 8171123ICC21070037 00.01.03.39 RIZAL SUHAILI
11 26-Jun-21 5-Jul-21 8171123ICC2107004C 00.00.95.94 YAMES ISTIA
12 26-Jun-21 6-Jul-21 8171123ICC2108003E 00.00.03.26 NURHEFI
PAULINA WATUGULY/
13 2-Jul-21 6-Jul-21 8171123ICC21070015 9582
NOTANUBUN
14 27-Jun-21 6-Jul-21 8171123ICC210601BD 00.00.99.67 ROMARIO STENLY RIRINAMA
15 7-Jul-21 7-Jul-21 8171123ICC21070053 10500 ARDIANSYAH

16 7-Jul-21 7-Jul-21 8171123ICC21070056 10506 MELIANUS HANNY KAKERISSA

APRILIA BATSEBA JACOBA
17 30-Jun-21 7-Jul-21 8171123ICC21070022 00.01.01.17
SAUNUNU
18 7-Jul-21 7-Jul-21 8171123ICC2107005B 10529 RIZKA ADELYA
19 7-Jul-21 7-Jul-21 8171123ICC2107005C 10530 JAMALUDIN BUGIS
20 7-Jul-21 7-Jul-21 8171123ICC2107005E 10532 ADELEDA ABETSINA MESLOY
21 26-Jun-21 7-Jul-21 8171123ICC210601A9 9922 YUSTINA ROLANI KEILAIKOU

22 26-Jun-21 7-Jul-21 8171123ICC210601AA 9923 MAYRILIN DORTEA TUTURMUTU

23 25-Jun-21 7-Jul-21 8171123ICC210601AB 9868 SILVIA RIANITA SINULINGGA

24 26-Jun-21 7-Jul-21 8171123ICC210601AC 9925 OCTOVIANUS ANTONIUS TOREH

29 30-Jun-21 8-Jul-21 8171123ICC210601E8 10149 IGNACIUS DHANI SUKAR

30 8-Jul-21 8-Jul-21 8171123ICC21070061 7726 TAN BOEN KING
31 2-Jul-21 8-Jul-21 8171123ICC21070024 00.00.99.3 MANUMARA ANTJE
32 30-Jun-21 9-Jul-21 8171123ICC210601E3 10139 ERNA SANGADJI
33 8-Jul-21 9-Jul-21 8171123ICC21070066 10550 NASUHAN DJOHAR
34 26-Jun-21 9-Jul-21 8171123ICC2108003A 00.00.99.19 FIFI SAFIRA
35 4-Jul-21 9-Jul-21 8171123ICC21070035 00.01.03.44 IGNATIUS AARON KHOESUMA
36 4-Jul-21 9-Jul-21 8171123ICC21070036 00.01.03.43 CHANDRA KHOESUMA
37 24-Jun-21 9-Jul-21 8171123ICC2106018B 00.00.97.34 ERWIN SIMAREMARE
38 10-Jul-21 10-Jul-21 8171123ICC2107006F 10666 NOVITA SARI RIFAI
39 9-Jul-21 10-Jul-21 8171123ICC21070070 10626 YONG ALAN DE YONG
40 10-Jul-21 10-Jul-21 8171123ICC21070071 10676 SUMIYATI
41 10-Jul-21 10-Jul-21 8171123ICC21070072 10675 YULIANA SAMADARA
42 26-Jun-21 10-Jul-21 8171123ICC2108003B 00.00.99.26 ADOLF LEONARD SILALILY
DR. ALFONS OCTAVIAN
43 10-Jul-21 10-Jul-21 8171123ICC21070074 10677
SABANDAR
44 10-Jul-21 10-Jul-21 8171123ICC21070075 10590 IBRAHIM ACHMAD
45 10-Jul-21 10-Jul-21 8171123ICC21070076 10680 JECKLIN KHO
46 11-Jul-21 11-Jul-21 8171123ICC21070077 10624 FRANGKY SOPACUA
47 30-Jun-21 11-Jul-21 8171123ICC210601ED 7139 EVAN TIMOTIUS SIMON
48 29-Jun-21 11-Jul-21 8171123ICC21070079 10038 WILLEM NGORANUBUN
49 29-Jun-21 11-Jul-21 8171123ICC2107007A 10104 RHEZA YOGA PRATAMA
50 29-Jun-21 11-Jul-21 8171123ICC2107007B 10028 MUHAMMAD NUR AZIIZ
51 11-Jul-21 11-Jul-21 8171123ICC2107007C 10111 FAHMI HANIF WINANTO
52 29-Jun-21 11-Jul-21 8171123ICC2107007D 10105 DANIEL MAYLANDO
53 29-Jun-21 11-Jul-21 8171123ICC2107007E 10109 BINSAR
54 11-Jul-21 11-Jul-21 8171123ICC2107007F 10256 DANI AYU RIATOSSENG
55 11-Jul-21 11-Jul-21 8171123ICC21080040 00.01.07.19 YOULANDA EMILIA MOERI, DR
56 8-Jul-21 12-Jul-21 8171123ICC21070054 10505 ESTHER SRI LASMINI
57 30-Jun-21 12-Jul-21 8171123ICC210601EA 10152 IR. FRIEDSON, WNK
IR. NETRA AUGI PRAMITA
58 30-Jun-21 12-Jul-21 8171123ICC210601EB 10151
ADARJONO
59 2-Jul-21 12-Jul-21 8171123ICC21070019 10283 FIKARRUDDIN
60 12-Jul-21 12-Jul-21 8171123ICC21070085 00.00.98.79 NATALIA LATUHERU
61 27-Jun-21 13-Jul-21 8171123ICC21070023 00.00.99.33 AGNES FRANSISCA KABORA
62 3-Jul-21 13-Jul-21 8171123ICC21070029 00.01.02.45 INDRAWANTI KUSADHIANI
63 27-Jun-21 13-Jul-21 8171123ICC2107002E 00.00.99.32 PAULINA S LENGGU M.
64 8-Jul-21 14-Jul-21 8171123ICC21070067 157 RIVAL DAKDAKUR
65 14-Jul-21 14-Jul-21 8171123ICC21070093 10832 SALAMA KAPLALE
66 12-Jul-21 14-Jul-21 8171123ICC2108003F 00.01.07.60 EVANGELINE NORIMARNA / W
67 11-Jul-21 14-Jul-21 8171123ICC21080014 00.01.07.22 H A GANI MARASABESSY
68 6-Jul-21 15-Jul-21 8171123ICC21070046 00.01.01.13 QANTAS RIFKY MUHAMMAD
69 15-Jul-21 15-Jul-21 8171123ICC2107009E 00.00.91.10 NADIA FIRDHA NALAHELLU
HIKA DERIYA FAJAR ASHIL
70 5-Jul-21 15-Jul-21 8171123ICC21070047 00.01.04.13
PUTRA
71 15-Jul-21 15-Jul-21 8171123ICC210700A0 00.00.15.83 WIDYA SOHILAIT
72 6-Jul-21 15-Jul-21 8171123ICC21070048 00.01.04.11 BRAMA KUNTORO
IR. PIETER MICHELMAN
73 15-Jul-21 15-Jul-21 8171123ICC210700A2 10865
MUSTAMU
74 15-Jun-21 16-Jul-21 8171123ICC210600FF 9309 YESTIATAMI TANASALE
75 17-Jul-21 17-Jul-21 8171123ICC210700B2 10887 RICO GINO OHELLO
LEENTJE MARIA
76 17-Jul-21 17-Jul-21 8171123ICC210700B3 10882
SAHUSILAWANE
77 17-Jul-21 17-Jul-21 8171123ICC210700B4 10890 SION TANNE
78 16-Jul-21 17-Jul-21 8171123ICC210700B5 10888 SARAH JUNITA PATTIAPON
79 16-Jul-21 17-Jul-21 8171123ICC210700B6 10886 MARTHINUS TAHAPARY
80 8-Jul-21 17-Jul-21 8171123ICC210700B7 1046 MARVELIN FREJEN LUTURMAS

81 14-Jul-21 17-Jul-21 8171123ICC21070094 10806 AMI ROSIANA

82 27-Jun-21 17-Jul-21 8171123ICC2107002C 00.00.99.48 ANGELIQUE ENGEL
83 9-Jul-21 18-Jul-21 8171123ICC21070058 10511 FARIDA GENDA
84 11-Jul-21 18-Jul-21 8171123ICC2108003C 10636 JEFTA IMAPULY
85 14-Jul-21 19-Jul-21 8171123ICC21080011 4288 BITCARLIUS SITUMORANG
86 20-Jul-21 20-Jul-21 8171123ICC210700D0 10933 LILIS HARIJANI RETTOP
87 21-Jul-21 21-Jul-21 8171123ICC210700D1 10893 EMIE RETRAUBUN
88 21-Jul-21 21-Jul-21 8171123ICC210700D2 10881 EMMA NURMALA FENDIANI
89 21-Jul-21 21-Jul-21 8171123ICC210700D3 10934 FRANSINA TUANKOTTA
90 7-Jul-21 21-Jul-21 8171123ICC2108000C 00.01.03.52 DWI PUJI LAKSANA
91 4-Jul-21 21-Jul-21 8171123ICC21070028 00.01.02.22 OKTOVIANUS RAHAYAAN
92 10-Jul-21 22-Jul-21 8171123ICC2107005A 10528 HANNY MEIDO SOPLANTILA
93 17-Jul-21 24-Jul-21 8171123ICC210700B0 10836 BETTY THIE
94 6-Jul-21 27-Jul-21 8171123ICC2107008B 00.01.04.18 YUNAIDI SETIAWAN
95 17-Jul-21 28-Jul-21 8171123ICC210700B1 10889 KIEM SITANIA / TJOA
96 11-Jul-21 28-Jul-21 8171123ICC21070073 10529 RIZKA ADELYA
97 9-Jul-21 31-Jul-21 8171123ICC21070057 10510 SVEN ROBERT LOUPATTY
98 7-Jul-21 31-Jul-21 8171123ICC21070044 00.01.04.29 LINDA NATAN
AIKAN/SWAB NEGATIVE

HASIL RADIOLOGI PERBAIKAN

No Tgl. MasukTgl. Pulang NO.KLAIM NO RM
1 3-Jul-21 3-Jul-21 8171123ICC2107002A 00.01.03.31
2 27-Jun-21 4-Jul-21 8171123ICC2107002D 00.00.85.87
3 2-Jul-21 4-Jul-21 8171123ICC21070016 10259
4 1-Jul-21 4-Jul-21 8171123ICC21070018 10249
5 26-Jun-21 5-Jul-21 8171123ICC210601A3 00.00.64.27
6 20-Jun-21 5-Jul-21 8171123ICC210601A5 00.00.54.13

7 16-Jun-21 5-Jul-21 8171123ICC21070025 00.00.04.15

8 18-Jun-21 5-Jul-21 8171123ICC21070026 00.00.37.30

9 19-Jun-21 5-Jul-21 8171123ICC2107002B 00.00.96.77
10 3-Jul-21 5-Jul-21 8171123ICC21070037 00.01.03.39
11 26-Jun-21 5-Jul-21 8171123ICC2107004C 00.00.95.94
12 26-Jun-21 6-Jul-21 8171123ICC2108003E 00.00.03.26

13 2-Jul-21 6-Jul-21 8171123ICC21070015 9582

14 27-Jun-21 6-Jul-21 8171123ICC210601BD 00.00.99.67

15 7-Jul-21 7-Jul-21 8171123ICC21070053 10500
16 7-Jul-21 7-Jul-21 8171123ICC21070056 10506

17 30-Jun-21 7-Jul-21 8171123ICC21070022 00.01.01.17

18 7-Jul-21 7-Jul-21 8171123ICC2107005B 10529

19 7-Jul-21 7-Jul-21 8171123ICC2107005C 10530
20 7-Jul-21 7-Jul-21 8171123ICC2107005E 10532
21 26-Jun-21 7-Jul-21 8171123ICC210601A9 9922
22 26-Jun-21 7-Jul-21 8171123ICC210601AA 9923
23 25-Jun-21 7-Jul-21 8171123ICC210601AB 9868
24 26-Jun-21 7-Jul-21 8171123ICC210601AC 9925
29 30-Jun-21 8-Jul-21 8171123ICC210601E8 10149
30 8-Jul-21 8-Jul-21 8171123ICC21070061 7726
31 2-Jul-21 8-Jul-21 8171123ICC21070024 00.00.99.3
32 30-Jun-21 9-Jul-21 8171123ICC210601E3 10139
33 8-Jul-21 9-Jul-21 8171123ICC21070066 10550
34 26-Jun-21 9-Jul-21 8171123ICC2108003A 00.00.99.19
35 4-Jul-21 9-Jul-21 8171123ICC21070035 00.01.03.44
36 4-Jul-21 9-Jul-21 8171123ICC21070036 00.01.03.43
38 10-Jul-21 10-Jul-21 8171123ICC2107006F 10666
39 9-Jul-21 10-Jul-21 8171123ICC21070070 10626
40 10-Jul-21 10-Jul-21 8171123ICC21070071 10676
41 10-Jul-21 10-Jul-21 8171123ICC21070072 10675
42 26-Jun-21 10-Jul-21 8171123ICC2108003B 00.00.99.26

43 10-Jul-21 10-Jul-21 8171123ICC21070074 10677

44 10-Jul-21 10-Jul-21 8171123ICC21070075 10590

45 10-Jul-21 10-Jul-21 8171123ICC21070076 10680
46 11-Jul-21 11-Jul-21 8171123ICC21070077 10624
47 30-Jun-21 11-Jul-21 8171123ICC210601ED 7139
49 29-Jun-21 11-Jul-21 8171123ICC2107007A 10104
50 29-Jun-21 11-Jul-21 8171123ICC2107007B 10028
51 11-Jul-21 11-Jul-21 8171123ICC2107007C 10111
52 29-Jun-21 11-Jul-21 8171123ICC2107007D 10105
53 29-Jun-21 11-Jul-21 8171123ICC2107007E 10109
54 11-Jul-21 11-Jul-21 8171123ICC2107007F 10256
55 11-Jul-21 11-Jul-21 8171123ICC21080040 00.01.07.19
56 8-Jul-21 12-Jul-21 8171123ICC21070054 10505
59 2-Jul-21 12-Jul-21 8171123ICC21070019 10283
62 3-Jul-21 13-Jul-21 8171123ICC21070029 00.01.02.45
63 27-Jun-21 13-Jul-21 8171123ICC2107002E 00.00.99.32
64 8-Jul-21 14-Jul-21 8171123ICC21070067 157
65 14-Jul-21 14-Jul-21 8171123ICC21070093 10832
66 12-Jul-21 14-Jul-21 8171123ICC2108003F 00.01.07.60
67 11-Jul-21 14-Jul-21 8171123ICC21080014 00.01.07.22
68 6-Jul-21 15-Jul-21 8171123ICC21070046 00.01.01.13
69 15-Jul-21 15-Jul-21 8171123ICC2107009E 00.00.91.10

70 5-Jul-21 15-Jul-21 8171123ICC21070047 00.01.04.13

71 15-Jul-21 15-Jul-21 8171123ICC210700A0 00.00.15.83

72 6-Jul-21 15-Jul-21 8171123ICC21070048 00.01.04.11

73 15-Jul-21 15-Jul-21 8171123ICC210700A2 10865

75 17-Jul-21 17-Jul-21 8171123ICC210700B2 10887

76 17-Jul-21 17-Jul-21 8171123ICC210700B3 10882

77 17-Jul-21 17-Jul-21 8171123ICC210700B4 10890

78 16-Jul-21 17-Jul-21 8171123ICC210700B5 10888
79 16-Jul-21 17-Jul-21 8171123ICC210700B6 10886
80 8-Jul-21 17-Jul-21 8171123ICC210700B7 1046
82 27-Jun-21 17-Jul-21 8171123ICC2107002C 00.00.99.48
83 9-Jul-21 18-Jul-21 8171123ICC21070058 10511
84 11-Jul-21 18-Jul-21 8171123ICC2108003C 10636
86 20-Jul-21 20-Jul-21 8171123ICC210700D0 10933
87 21-Jul-21 21-Jul-21 8171123ICC210700D1 10893
88 21-Jul-21 21-Jul-21 8171123ICC210700D2 10881
89 21-Jul-21 21-Jul-21 8171123ICC210700D3 10934
90 7-Jul-21 21-Jul-21 8171123ICC2108000C 00.01.03.52
91 4-Jul-21 21-Jul-21 8171123ICC21070028 00.01.02.22
92 10-Jul-21 22-Jul-21 8171123ICC2107005A 10528
93 17-Jul-21 24-Jul-21 8171123ICC210700B0 10836
94 6-Jul-21 27-Jul-21 8171123ICC2107008B 00.01.04.18
95 17-Jul-21 28-Jul-21 8171123ICC210700B1 10889
96 11-Jul-21 28-Jul-21 8171123ICC21070073 10529
97 9-Jul-21 31-Jul-21 8171123ICC21070057 10510
98 7-Jul-21 31-Jul-21 8171123ICC21070044 00.01.04.29
 Pasien ALAMAT
TN. YANDRI SOEYONO FIDITAN INDAH - AMBON
ARYA PERDANA BUTTU LAYUK POKA - AMBON
MELKIANUS TJANDUA TAWIRI - AMBON
AGUSTINA MAKATITA LEIHITU BARAT - MALUKU TENGAH
MEGA SINTIA SAHUSIWA AMAHUSU - AMBON
SILVIA NOVITA RAHAWARIN OHOI AD NGURWUL - AMBON
IYAN PAHLEVY LESTALUHU,
TULEHU - MALUKU TENGAH
S.KEP, NERS
JAMAL HOLLE SIRIMAU - AMBON
WILHELMINA TANATE HATIVE BESAR - AMBON
RIZAL SUHAILI WAIHAONG - AMBON
YAMES ISTIA LAYENI - MALUKU TENGAH
NURHEFI RUMAH TIGA - AMBON
PAULINA WATUGULY/
RUMAH TIGA - AMBON
NOTANUBUN
ROMARIO STENLY RIRINAMA BATU MERAH - AMBON
ARDIANSYAH BATU MERAH - AMBON
MELIANUS HANNY KAKERISSA PASSO - AMBON
APRILIA BATSEBA JACOBA
NUSANIWE - AMBON
SAUNUNU
RIZKA ADELYA KEBUN CENGKEH - AMBON
JAMALUDIN BUGIS TANTUI - AMBON
ADELEDA ABETSINA MESLOY BENTENG ATAS A- AMBON
YUSTINA ROLANI KEILAIKOU LUHULELY - AMBON
MAYRILIN DORTEA TUTURMUTU LUHULELY - AMBON
SILVIA RIANITA SINULINGGA WAYAME - AMBON
OCTOVIANUS ANTONIUS TOREH RUMAH TIGA - AMBON
IGNACIUS DHANI SUKAR JL.PETRA - AMBON
TAN BOEN KING JL.NAAR SOPACUA - AMBON
MANUMARA ANTJE LATERI - AMBON
ERNA SANGADJI BTN MANUSELA - AMBON
NASUHAN DJOHAR BANDA - MALUKU TENGAH
FIFI SAFIRA WAYAME - AMBON
IGNATIUS AARON KHOESUMA RIJALI - AMBON
CHANDRA KHOESUMA RIJALI - AMBON
NOVITA SARI RIFAI RUMAH TIGA - AMBON
YONG ALAN DE YONG RUMAH TIGA - AMBON
SUMIYATI
YULIANA SAMADARA
ADOLF LEONARD SILALILY
DR. ALFONS OCTAVIAN
SABANDAR
IBRAHIM ACHMAD
JECKLIN KHO
 FRANGKY SOPACUA HALONG - AMBON
EVAN TIMOTIUS SIMON
RHEZA YOGA PRATAMA RUMAH TIGA - AMBON
MUHAMMAD NUR AZIIZ RUMAH TIGA - AMBON
FAHMI HANIF WINANTO RUMAH TIGA - AMBON
DANIEL MAYLANDO RUMAH TIGA - AMBON
BINSAR RUMAH TIGA - AMBON
DANI AYU RIATOSSENG RUMAH TIGA - AMBON
YOULANDA EMILIA MOERI, DR JL.GUDANG ARANG - AMBON
ESTHER SRI LASMINI
FIKARRUDDIN RUMAH TIGA - AMBON
INDRAWANTI KUSADHIANI BENTENG ATAS A- AMBON
PAULINA S LENGGU M. LATERI - AMBON
RIVAL DAKDAKUR RUMAH TIGA - AMBON
SALAMA KAPLALE KBN CENGKEH - AMBON
EVANGELINE NORIMARNA / W MAKASSAR
H A GANI MARASABESSY MAKASSAR
QANTAS RIFKY MUHAMMAD VILA NUSA INDAH - AMBON
NADIA FIRDHA NALAHELLU

HIKA DERIYA FAJAR ASHIL PUTRA

WIDYA SOHILAIT NUSANIWE - AMBON

BRAMA KUNTORO RUMAH TIGA - AMBON
IR. PIETER MICHELMAN
MUSTAMU
RICO GINO OHELLO URIMESSING

LEENTJE MARIA SAHUSILAWANE

SION TANNE IR PUTUHENA - AMBON

SARAH JUNITA PATTIAPON
MARTHINUS TAHAPARY
MARVELIN FREJEN LUTURMAS
ANGELIQUE ENGEL JL KESEHATAN - AMBON
FARIDA GENDA WAIHAONG - AMBON
JEFTA IMAPULY
LILIS HARIJANI RETTOP
EMIE RETRAUBUN
EMMA NURMALA FENDIANI
FRANSINA TUANKOTTA RIJALI - AMBON
DWI PUJI LAKSANA KEBUN CENGKEH - AMBON
OKTOVIANUS RAHAYAAN OHOIJANG - WATDEK
HANNY MEIDO SOPLANTILA
BETTY THIE HONIPOPU - AMBON
YUNAIDI SETIAWAN
KIEM SITANIA / TJOA BT MEJA - AMBON
RIZKA ADELYA RUMAH TIGA - AMBON
SVEN ROBERT LOUPATTY BTN WAYAME
LINDA NATAN KUDA MATI - AMBON