RSIA PURI BUNDA

Jl. Simpang Sulfat Utara No. 60A, Malang, Jawa Timur

(0341) 480047, E-mail : puribunda.malang@yahoo.com

BILLING
No.Nota : 2021/01/RI/000001
Bangsal/Kamar : A15, Amarta 4B
Tgl.Perawatan : 12 December 2020 09:04:36 s.d. 7 January 2021 08:56:37 ( 30 Hari )
No.R.M. : 106605
Nama Pasien : Eka Oktariani, Ny (31Th)
Alamat Pasien : JL. DANAU RANAU X/14, SAWOJAJAR, KEDUNGKANDANG, MALANG KOTA
Ruang :
                   A15, Amarta 4B : 250.000 27.0 0 6.750.000
                   IGD5, KS IGD 5 : 300.000 1.0 0 300.000
                   K0000214, KS RR 5 : 300.000 1.0 0 300.000
                   A12, Amarta 2 : 250.000 1.0 0 250.000
Total Kamar Inap : 7.600.000
Rincian Biaya :
1. Pemeriksaan Lab :
                   Darah Lengkap : 70.000 1.0 0 70.000
Total Periksa Lab : 70.000
2. Obat & BHP :
Alkes Habis Pakai :
Hansaplast Elastis Standar (Alkes) (ALKES HABIS
                   : 314 1.0 0 314
PAKAI)
                   Hansaplast Jumbo (Alkes) (ALKES HABIS PAKAI) : 700 1.0 0 700
                   Spuit 5 cc OM (Alkes) (ALKES HABIS PAKAI) : 840 4.0 0 3.360
                   Needle No. 26 Terumo (Alkes) (ALKES HABIS PAKAI) : 896 2.0 0 1.792
                   Needle No. 27 Terumo (Alkes) (ALKES HABIS PAKAI) : 896 1.0 0 896
                   Spuit 3 cc Terumo (Alkes) (ALKES HABIS PAKAI) : 1.275 2.0 0 2.550
                   Spuit 5 cc Terumo (Alkes) (ALKES HABIS PAKAI) : 1.792 1.0 0 1.792
                   Spuit 10 cc Terumo (Alkes) (ALKES HABIS PAKAI) : 2.094 4.0 0 8.376
                   Umbilical Cord Klem OM (Alkes) (ALKES HABIS PAKAI) : 2.240 2.0 0 4.480
                   Mess Aesculap No 10 (Alkes) (ALKES HABIS PAKAI) : 4.480 1.0 0 4.480
                   Nasal Cannul Dewasa (Alkes) (ALKES HABIS PAKAI) : 6.191 1.0 0 6.191
                   Opsite IV Dewasa (Alkes) (ALKES HABIS PAKAI) : 6.438 1.0 0 6.438
                   Urine Bag Onemed (Alkes) (ALKES HABIS PAKAI) : 6.720 1.0 0 6.720
                   Handscoen Maxter No. 7 (BMHP) (ALKES HABIS PAKAI) : 6.899 2.0 0 13.798
Handscoen Maxter No. 6,5 (BMHP) (ALKES HABIS
                   : 6.899 2.0 0 13.798
PAKAI)
Handscoen Maxter No. 7,5 (BMHP) (ALKES HABIS
                   : 6.899 3.0 0 20.697
PAKAI)
                   Underpad Steril (Alkes) (ALKES HABIS PAKAI) : 9.246 1.0 0 9.246
                   Blood Set Cosmo (Alkes) (ALKES HABIS PAKAI) : 9.520 1.0 0 9.520
                   IV Canulla HEUER No 20 (ALKES HABIS PAKAI) : 12.197 1.0 0 12.197
                   Polyflex No. 18 (Alkes) (ALKES HABIS PAKAI) : 13.552 1.0 0 13.552
                   Dermafix (ALKES HABIS PAKAI) : 16.240 1.0 0 16.240
                   Folley Chateter 16 Gold (Alkes) (ALKES HABIS PAKAI) : 21.280 1.0 0 21.280
                   Zlym Zuiger JMS (Alkes) (ALKES HABIS PAKAI) : 38.080 2.0 0 76.160
                   Spinocain No. 27 (Alkes) (ALKES HABIS PAKAI) : 48.160 1.0 0 48.160
                   T Plain 0 P88 (Alkes) (ALKES HABIS PAKAI) : 60.480 1.0 0 60.480
                   T Dio BP9 (Alkes) (ALKES HABIS PAKAI) : 137.446 1.0 0 137.446
                   Nova T (Alkes) (ALKES HABIS PAKAI) : 320.499 1.0 0 320.499
Total Alkes Habis Pakai : 821.162
Bahan Medis Habis Pakai
:
                   Aquabidest 25 ml (BMHP) (BAHAN MEDIS HABIS PAKAI): 3.203 -3.0 0 -9.609
Obat (Oral & Non Oral) :
                   Samconal Kaplet (Obat) (OBAT ORAL) : 347 15.0 0 5.205
                   Costan Kaplet (Obat) (OBAT ORAL) : 470 15.0 0 7.050
                   Bundavin Kaplet (Obat) (OBAT ORAL) : 661 15.0 0 9.915
                   Gencef Kaplet (OBAT ORAL) : 896 15.0 0 13.440
                   Ketorolac  Ampul 30 mg (Obat) (OBAT NON ORAL) : 1.220 4.0 0 4.880
                   Ranitidine Ampul (Obat) (OBAT NON ORAL) : 1.331 1.0 0 1.331
                   Oxytocin Ampul (Obat) (OBAT NON ORAL) : 1.343 11.0 0 14.773
                   Ephineprine Ampul (Ethica) (Obat) (OBAT NON ORAL) : 1.577 0.0 0 0
                   Atropine Sulfas Ampul (Obat) (OBAT NON ORAL) : 1.836 1.0 0 1.836
                   Ondansentron Ampul 4 mg (Obat) (OBAT NON ORAL) : 4.004 1.0 0 4.004
Ceftriaxone Vial 1000 mg (Obat) Berno (OBAT NON
                   : 4.999 2.0 0 9.998
ORAL)
                   Betadine Solution 5 ml (Obat) (OBAT NON ORAL) : 5.482 2.0 0 10.964
Dulcolax Suppositoria Dewasa (Obat) (OBAT NON
                   : 6.608 1.0 0 6.608
ORAL)
Tramadol Ampul 100 mg/2 ml (Obat) (OBAT NON
                   : 7.170 1.0 0 7.170
ORAL)
                   Cortidex Ampul (Obat) (OBAT NON ORAL) : 7.309 2.0 0 14.618
                   WIDA NS 500 ML (Obat) (OBAT NON ORAL) : 7.661 2.0 0 15.322
                   Plasminex Ampul (Obat) (OBAT NON ORAL) : 7.773 2.0 0 15.546
                   D5 500 ml Wida (OBAT NON ORAL) : 8.247 1.0 0 8.247
                   RL Sanbe (Obat) (OBAT NON ORAL) : 8.544 5.0 0 42.720
                   Bledstop Ampul (Obat) (OBAT NON ORAL) : 8.841 1.0 0 8.841
                   Diazole Infus 100 ml (Obat) (OBAT NON ORAL) : 8.870 1.0 0 8.870
                   Ephedrin Injeksi (OBAT NON ORAL) : 9.597 1.0 0 9.597
                   Piralen Ampul (Obat) (OBAT NON ORAL) : 9.856 1.0 0 9.856
                   Noprostol Tab (Obat) (OBAT ORAL) : 11.552 2.0 0 23.104
                   Cefazolin 1 gr Injeksi (OBAT NON ORAL) : 16.016 0.0 0 0
                   Pethidin Ampul (Obat) (OBAT NON ORAL) : 21.819 1.0 0 21.819
                   Lidodex Ampul (Obat) (OBAT NON ORAL) : 67.760 1.0 0 67.760
                   Regivel Ampul (Obat) (OBAT NON ORAL) : 86.240 1.0 0 86.240
Total Obat (Oral & Non Oral) : 429.714
Total Obat & BHP : 1.241.267
Retur Obat :
Retur Alkes Habis Pakai :
                   Spuit 3 cc Terumo (Alkes) (ALKES HABIS PAKAI) : 1.275 -1.0 0 -1.275
                   Spuit 5 cc Terumo (Alkes) (ALKES HABIS PAKAI) : 1.792 -1.0 0 -1.792
                   Handscoen Maxter No. 7 (BMHP) (ALKES HABIS PAKAI) : 6.899 -1.0 0 -6.899
Total Retur Alkes Habis Pakai : -9.966
Retur Bahan Medis Habis
Pakai :
                   Aquabidest 25 ml (BMHP) (BAHAN MEDIS HABIS PAKAI): 3.203 -2.0 0 -6.406
Total Retur Bahan Medis Habis Pakai : -6.406
Retur Obat (Oral & Non
Oral) :
                   Ephineprine Ampul (Ethica) (Obat) (OBAT NON ORAL) : 1.577 -1.0 0 -1.577
                   Cefazolin 1 gr Injeksi (OBAT NON ORAL) : 16.016 -1.0 0 -16.016
Total Retur Obat (Oral & Non Oral) : -17.593
Total Retur Semua : -33.965
Total Obat Bersih : 1.207.302
TOTAL TAGIHAN : 8.877.302
PPN : 0
TAGIHAN+PPN : 8.877.302
DEPOSIT : 0
BAYAR : 0
KEMBALI : -8.877.302
     
Mengetahui,
  Malang, 10-01-2021 12:02:28
a/n Direktur
Kabid Umum & Keuangan   Kasir
   
   
( ............................. )   ( .............................. )
 
NB : Mohon maaf apabila ada tagihan yang belum tertagihkan dalam perincian ini akan ditagihkan kemudian, dan apabila berlebih akan
dikembalikan.