BBA OK RSU AN NISAA'

: Operator
Jenis Operasi Sedang Kls.3
Nama / Umur : Kartini Ny Asisten Operator

Alamat : Bence 1/2 Garum Anesthesi

Ruang : Aziziyah 1 Asisten anesthesi

Diagnosa : Instrument
Tindakan : Debudement Onloop
Jenis Ans : SAB Resusitasi bayi
LAB PA : - Perawat
Tanggal : 13-Jan-20 PP
OK : OK 2 RR
Jenis Pasien : umum No. Bukti Pembayaran
No Nama barang Satuan
BAHAN & ALAT
1 B.Cromic no. 0 mtr
2 B.Cromic no. 1 / Orthopedic mtr
3 B.Cromic no. 2 mtr
4 B.Cromic no. 2/0
5 B.Cromic no. 3/0 mtr
6 B.Cromic no. 3 mtr
7 B.Plain no. 0 mtr
8 B.Plain no. 1 mtr
9 B.Plain no. 2/0 mtr
10 B.Plain no. 3/0 mtr
11 Dexon no 1/no 0/no 2/0 / no 3/0 / no 4/0 no 5/0 biji
12 Surgicryl / prolene/ iud/orthocast/T vio biji
gizi
13 B.Seide no. 0 mtr
14 B.Seide no. 1 mtr
15 B.Seide no. 2 mtr
16 B.Seide no. 2/0 mtr
17 B.Seide no. 3/0 mtr
18 Betadine cleanser cc
19 Betadine solution cc
20 Bloodmess no 20 / no 15/ no 11/10 biji
21 ECG Monitor
22 Elektroda 3 biji
23 Handscoen biji
24 Handsweet biji
25 Hypafix cm
26 Kassa mtr
27 Oksigen ….2. ltr/ jam
28 Plester/ Tensoplast cm
29 Spongostan pak
30 Spuit no 10 biji
31 Spuit no3/ nedle/terumo biji
32 Spuit no5 (terumo)/ insulin biji
33 Underpad/ nurse cup/transofix biji
34 bloodset/ngt/alkohol/infuset/slem swiker/canul O2 bayi
35 Venflon/cateter/wingneedle no.23/magslang/spuit 50 cc
36 Urobag/colostomy bag/Nasal Canul Bayi
37 ETT no 3/Tensocrep 10/treeway 22/cateter 3way/non rebritheng mask
38 Hibicef
39 Infuset pump/ xilocain ……..GA 1
40 BBA SAB 1

No OBAT & CAIRAN Satuan

1 Cairan Aquabidest biji
2 Cairan D % sanbe fls
3 Cairan PZ/NS 0,5ltr fls
4 Cairan PZ 1 lt/ Larutan irigasi 1lt fls
5 Cairan RL sanbe fls
6 Cairan RL wida/ otsu/ogb fls
7 OB. Miloz amp
8 OB. Ethran cc
9 OB. Halotan cc
10 OB. Ketalar/ KTM/ Diazepam cc
11 OB. Lidocain 2% / Asam Tranexamat amp
12 OB. Pehacain 2% amp
13 OB. Pentothal cc
14 OB. Petidine / Fentanil/Clopedin amp
15 OB.Sucsinil Cholin cc
16 OB.Sulfas Atropin(SA) / Isofluran amp
17 OB.Trachium=notrixum amp
18 Metergin/ dexamethason/ulsikur/ kalmet/oksitosin amp
19 Primperan/ Aminopilin/ondancetron amp
20 Syntocinon/prostigmin/ softband/cmbivent amp
21 Widahes / Haemecel / gelafusal / OPSITE
22 Epedrin/ Profenid supp/ tensocrep 7,5/NGT 16
23 Regivell/ Markain/Decain/spongostan/curaspon/ Selang Suction/cromic 2/0
24 Spinocan no.25 / 26 / 27/cendrantron
25 Remopain/teranol/ketorolac/ketopain/toramin
 26 Safol /Tensocrep 15
27 Cortidex / pehidrol 1lt/ tradosix/ adrenalin/Noprostol
28 lain lain ok
29 kalnex/lumatul/cutiself/poliban/poligyp/stokinet/spuit 50 cc
TOTAL
TOTAL OBAT & ALAT 620,000
Catatan: Ka Kamar Operasi
* Jam : :13.35-14.00

BBA OK RSU AN NISAA'

: Operator
Jenis Operasi SC Kls. 3
AN NISAA'

dr. Dwiyanto, Sp.B

Misnanto Tidak Dinas

dr. M. Yani Faudi, Sp.An

Sugeng Tidak Dinas

Asnawi Tidak Dinas Jl. Suparyono Timur No. 1 B
Nanang Tidak Dinas

Tidak Dinas
Tanggal :
Nama / Umur :
04 - 00175 Alamat :
Harga Jenis Pasien :

27,000 -
30,000 - No
99,000 - 1.
45,000 - 2.
20,000 - 3.
35,000 - 4.
75,000 - 5.
26,000 - 6.
90,000 - 7.
26,000 - 8.
150,000 - 9.
160,000 - 10
65,000 -
12,000 -
12,000 -
17,000 - 1.
15,000 - 2.
11,000 - TOTAL
200 30 6,000
200 200 40,000
5,000 1 5,000
125,000 1 125,000
5,000 1 5,000
25,000 -
 25,000 -
1,500 1 1,500
4,000 3 12,000
20,000 -
1,000 -
74,500 -
5,000 1 5,000
4,500 -
7,500 2 15,000
7,500 -
47,000 -
45,000 -
18,500 -
85,000 -
500 50 25,000
15,000 1 15,000
80,000 1 80,000
334,500

Harga Total
7,500 1 7,500
21,000 -
18,000 -
28,000 1 28,000
25,000 -
20,000 -
51,500 -
7,000 -
7,000 -
32,000 -
8,000 -
6,000 -
87,500 -
51,500 -
31,000 -
10,000 -
97,500 -
20,000 -
22,000 -
25,000 -
231,000 -
70,000 -
96,500 -
54,000 -
55,000 -
 123,000 -
25,000 -
250,000 1 250,000
35,000 -
285,500

Ka Kamar Operasi

AN NISAA'

dr. Puspita, Sp.OG

 RUMAH SAKIT UMUM AN NISAA'
Jl. Suparyono Timur No. 1 Bajang Talun Blitar Telp. 0342- 692999, Fax 693999

BUKTI PEMBAYARAN OPERASI

13-Jan-20 Ruang :
Kartini Ny Jenis Operasi:
Bence 1/2 Garum Tindakan :
umum No. Bukti :

Uraian
Administrasi
Pemakaian Alat & Kamar Operasi
Ruang Pemulihan (RR)
Jasa operator dr. Dwiyanto, Sp.B
Jasa anastesi dr. M. Yani Faudi, Sp.An
Jasa Tim
Asuhan Keperawatan OK
Resusitasi -
Perawatan
Lain-lain

Bahan & alat Kesehatan

Obat & Cairan

GRAND TOTAL : 5,120,000

Petugas
Kholifatul Rohmah

48,200

(800)

652,700
611,600
491,200
Aziziyah 1
Sedang Kls.3
Debudement
04 - 00175

Jumlah
125,000
700,000
250,000
1,500,000
750,000
550,000
100,000
500,000
25,000

4,500,000

334,500
285,500
620,000
14,424,500