sheet1 -1

No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien

2 1 Jan 2021 3 Jan 2021 452815 LILIS OKTA VIANASARI
14 6 Jan 2021 9 Jan 2021 494015 SONIA ANAS TASYA
20 7 Jan 2021 11 Jan 2021 004115 BY NY FERA NURUL AZIZAH
21 10 Jan 2021 15 Jan 2021 724115 JONI SISWOYO.TN
26 14 Jan 2021 20 Jan 2021 244315 KATMARI .TN
30 19 Jan 2021 20 Jan 2021 484415 EKA ARIMA DEVI
36 21 Jan 2021 23 Jan 2021 129014 UMI SAUDAH
37 24 Jan 2021 26 Jan 2021 433815 HANDARU.NY
40 25 Jan 2021 26 Jan 2021 464615 NAZWA AULIA SARI
46 8 Feb 2021 9 Feb 2021 770810 BAYU SETIAWAN TN
48 13 Feb 2021 14 Feb 2021 615215 WINDA MARGANINGRUM .NY
50 15 Feb 2021 19 Feb 2021 775215 WAHYU SETIAWAN
54 21 Feb 2021 24 Feb 2021 436502 CANDRA DWI PERMANATN
55 21 Feb 2021 22 Feb 2021 591411 ONNY CHRISTINA NY
56 22 Feb 2021 24 Feb 2021 323915 SITI ROHMATUS SAUDAH
57 23 Feb 2021 26 Feb 2021 362114 MITUN
61 26 Feb 2021 28 Feb 2021 994915 WAKIJAN TN
62 25 Feb 2021 28 Feb 2021 119404 YOLANDA FAJAR NURCAHYANTI NN
63 4 Feb 2021 8 Feb 2021 701314 NINING WIDYASARI
64 25 Des 2020 1 Jan 2021 973515 LASINI
65 26 Des 2020 1 Jan 2021 009813 PARTININGSIH
66 27 Des 2020 1 Jan 2021 633615 KETUT SUHARDI.TN
67 28 Des 2020 1 Jan 2021 883615 FIRMAN DAMAR SETIONO
68 28 Des 2020 2 Jan 2021 903615 NADIA ZAHRA SASABILA
69 28 Des 2020 4 Jan 2021 913615 MAWAN SUPRIYANTO
70 28 Des 2020 4 Jan 2021 807103 IWAN PRASETYO. TN
71 28 Des 2020 2 Jan 2021 108409 UJIANTO TN
72 28 Des 2020 2 Jan 2021 083715 NUR ABDUL ROZIQ SETIADI ,AN
73 28 Des 2020 2 Jan 2021 113715 ANITA ANUGRAWATI.NY
74 29 Des 2020 3 Jan 2021 203715 ENY RINAWATI.NY
75 29 Des 2020 2 Jan 2021 543407 FARID ARI PURNAWAN,TN
80 30 Des 2020 1 Jan 2021 863715 DIAH TRI WAHYUNI
86 30 Des 2020 2 Jan 2021 910904 GATI PERTIWI,NY
87 30 Des 2020 4 Jan 2021 378404 ZAENAL ARIFIN,TN
89 31 Des 2020 4 Jan 2021 363815 JAJANG HAJAR NUR ULTRANTO
96 1 Jan 2021 6 Jan 2021 563815 DELKIANO VIDIANTO ,AN
98 2 Jan 2021 4 Jan 2021 583815 ANISA WAHDATI ,NY
100 2 Jan 2021 6 Jan 2021 763815 ONNY ALBERTO
101 2 Jan 2021 9 Jan 2021 151400 AGUS FIRDO WIRASAPUTRA AN
103 2 Jan 2021 9 Jan 2021 151813 RINI UTAMI
114 3 Jan 2021 4 Jan 2021 093915 AURELIA YUNA AISYAH
115 4 Jan 2021 7 Jan 2021 623915 MARSINI

Page 1
 sheet1 -1

118 5 Jan 2021 18 Jan 2021 873915 SUMARNI.TN

119 5 Jan 2021 6 Jan 2021 795602 QUEENENSYA SHERYLIA IRAWANAN
120 5 Jan 2021 6 Jan 2021 378912 YASIM TN
123 5 Jan 2021 9 Jan 2021 284015 FERA NURUL AZIZAH NY
124 6 Jan 2021 8 Jan 2021 663715 SUMARNI TN
129 7 Jan 2021 8 Jan 2021 823215 VITA VITRIANA WULANDARI
130 7 Jan 2021 15 Jan 2021 024115 SUNARNO,TN
143 11 Jan 2021 13 Jan 2021 523915 MEGA LUTFI NUGRAHENI
144 9 Jan 2021 15 Jan 2021 890608 KAMIT TN
148 12 Jan 2021 15 Jan 2021 194215 AHMAD HAIDAR ,BY
150 12 Jan 2021 18 Jan 2021 861101 SRINGATUN NY
154 12 Jan 2021 13 Jan 2021 286213 MUDJITO
155 12 Jan 2021 14 Jan 2021 514215 CHUSNUL KHOTIMAH
156 13 Jan 2021 14 Jan 2021 883915 BUDIANTA ,TN
160 14 Jan 2021 20 Jan 2021 954215 BAMBANG WIDARSONO
162 14 Jan 2021 15 Jan 2021 894309 MALISA NIMATUL ADINIYAH
170 15 Jan 2021 19 Jan 2021 915811 AHMAD RAFINDRAAN
178 17 Jan 2021 19 Jan 2021 944807 KHAIRUL FAHMI TN
179 17 Jan 2021 19 Jan 2021 397413 OETIK MIRAWATI NY
183 16 Jan 2021 19 Jan 2021 123614 SHAFIRA PUTRI NURAINI AN
188 18 Jan 2021 20 Jan 2021 424415 MISTINI ANDAYANI ,BYNY
193 19 Jan 2021 21 Jan 2021 714415 ALVIN ARDANA ABIPUTRA
199 20 Jan 2021 22 Jan 2021 319407 BAMBANG SENI TN
207 20 Jan 2021 29 Jan 2021 023209 TOTOK SUDARTO TN
211 21 Jan 2021 29 Jan 2021 399901 LAMBANG WAHYU DIANATA
212 21 Jan 2021 25 Jan 2021 027808 ANDRI UTOMOTN
227 24 Jan 2021 28 Jan 2021 108508 RELAWATI NY
228 24 Jan 2021 26 Jan 2021 130615 RUDI PRASETYO
229 24 Jan 2021 28 Jan 2021 084615 JUMAADI ST
236 25 Jan 2021 27 Jan 2021 514015 MUJIONO
251 27 Jan 2021 29 Jan 2021 324315 MUJONO.TN
259 28 Jan 2021 1 Feb 2021 342911 EKO PURWANTO TN
260 28 Jan 2021 2 Feb 2021 375901 WAHONO TN
262 29 Jan 2021 30 Jan 2021 063714 MARMI
267 29 Jan 2021 30 Jan 2021 275007 JESIKA ERFIRANDA AN
269 30 Jan 2021 2 Feb 2021 574103 DAFA ILHAM SUDRAJATAN
275 31 Jan 2021 3 Feb 2021 454815 MUJITO TN
278 29 Jan 2021 1 Feb 2021 144815 BY NY RISKA APRILIA FANANI
291 1 Feb 2021 4 Feb 2021 834815 BY NY. PUTRI EKA BUDI HANDARI
297 3 Feb 2021 5 Feb 2021 264015 SUBIYAN
298 3 Feb 2021 5 Feb 2021 108409 UJIANTO TN
299 3 Feb 2021 5 Feb 2021 634915 FAIZAL LEO ADIYASA.SDR
300 3 Feb 2021 4 Feb 2021 534406 PIPIT EVA ADI PUTRA TN

Page 2
 sheet1 -1

301 3 Feb 2021 9 Feb 2021 514611 MURSIYAHNY

302 3 Feb 2021 5 Feb 2021 704815 AHMAD AFRIADI .AN
303 4 Feb 2021 6 Feb 2021 627306 SUKARTI NY
304 4 Feb 2021 10 Feb 2021 035015 LAMINAH
305 3 Feb 2021 6 Feb 2021 654915 BY NY TRI WAHYUNI
306 4 Feb 2021 7 Feb 2021 078001 PAVITA AMANDA DIANTY PUTRI
307 4 Feb 2021 9 Feb 2021 125015 MUSIRAH
308 4 Feb 2021 9 Feb 2021 145015 UMAR SAID
309 5 Feb 2021 6 Feb 2021 175015 MINI ,NY
310 5 Feb 2021 10 Feb 2021 235015 SUMARIN
311 5 Feb 2021 9 Feb 2021 880100 RITA SAHARA NY
312 5 Feb 2021 9 Feb 2021 185015 YOGI FAHRUDIN ,SDR
313 4 Feb 2021 10 Feb 2021 834915 LILIK AGUSTINA ,NY
314 5 Feb 2021 7 Feb 2021 583615 HABIBAH RIQKI NOVIANI
315 5 Feb 2021 10 Feb 2021 224114 ALMEERA MEIDA RAMADHANI
316 5 Feb 2021 9 Feb 2021 455015 JURIYAH .NY
317 5 Feb 2021 9 Feb 2021 465015 SASDA FEBYAN ANGGITA SARI.AN
318 5 Feb 2021 6 Feb 2021 485015 SUMARTI NY
319 6 Feb 2021 8 Feb 2021 505015 INDRI TRI PINTARTI
320 6 Feb 2021 9 Feb 2021 185112 NILA WIRDATUL M
321 6 Feb 2021 9 Feb 2021 783703 BUDITN
322 7 Feb 2021 7 Feb 2021 725015 SAIDAH
323 7 Feb 2021 11 Feb 2021 080609 SASONGKO EDI TN
324 7 Feb 2021 9 Feb 2021 004915 SETIONO
325 7 Feb 2021 10 Feb 2021 671403 WINARTINY
326 7 Feb 2021 10 Feb 2021 825015 UGIK WURYATI ,NY
327 7 Feb 2021 10 Feb 2021 259609 CELIA DEVA AN
328 7 Feb 2021 11 Feb 2021 865015 AMIARSIH ,NY
329 7 Feb 2021 10 Feb 2021 325106 RIO FAREL FAHRIANSYAH AN
330 8 Feb 2021 10 Feb 2021 171715 TITIK AMINAH
331 8 Feb 2021 13 Feb 2021 135115 TUMIDJAN
332 6 Feb 2021 10 Feb 2021 565015 BY NY INDRI TRI PINTARTI
333 5 Feb 2021 19 Feb 2021 015610 SUPARMO,TN
334 8 Feb 2021 10 Feb 2021 111000 WAHYU EDI PURNOMO TN
335 8 Feb 2021 13 Feb 2021 596409 SITI ALIPAHNY
336 8 Feb 2021 10 Feb 2021 664815 OCTAVIA RAHMAWATI
337 8 Feb 2021 10 Feb 2021 115115 BY NY UGIK WURYANI
338 7 Feb 2021 9 Feb 2021 615015 KHANZA AIESHA ABBASY
339 8 Feb 2021 10 Feb 2021 425115 SISWONDO .TN
340 9 Feb 2021 10 Feb 2021 002914 EVANO ASHAR ADZAKI
341 9 Feb 2021 11 Feb 2021 124915 DEVA FEBRIANTI .NY
342 9 Feb 2021 11 Feb 2021 524915 SITI ASIYAH
343 9 Feb 2021 11 Feb 2021 740912 KEN ALFINA ZUHRI

Page 3
 sheet1 -1

344 9 Feb 2021 12 Feb 2021 209213 SAFIA NAFEEZA FATHARANI AN

345 8 Feb 2021 11 Feb 2021 205115 BY NY TITIK AMINAH
346 9 Feb 2021 12 Feb 2021 793709 LOUIS ANDRIANTO TJANG AN
347 9 Feb 2021 11 Feb 2021 915811 AHMAD RAFINDRAAN
348 9 Feb 2021 12 Feb 2021 645115 JAMILATUN MUCHOBAH
349 9 Feb 2021 13 Feb 2021 934814 HENI PUSPITASARIAN
350 9 Feb 2021 15 Feb 2021 134013 H SOPINGI TN
351 10 Feb 2021 13 Feb 2021 138106 RUDI PURWANTOTN
352 10 Feb 2021 12 Feb 2021 865115 SULISTIANAH
353 10 Feb 2021 13 Feb 2021 725115 BY NY JAMILATUN MUCHOBAH
354 10 Feb 2021 13 Feb 2021 995115 BIMA SATRIA UTAMA.AN
355 10 Feb 2021 14 Feb 2021 055215 ABIDAH SEKAR GENDHIS
356 10 Feb 2021 15 Feb 2021 283013 SURIP NY
357 10 Feb 2021 13 Feb 2021 035215 SARIYATI .NY
358 10 Feb 2021 12 Feb 2021 853405 ELENSYA INTAN PERMADI.NY
359 11 Feb 2021 13 Feb 2021 245215 KASIRAH ,NY
360 11 Feb 2021 13 Feb 2021 795602 QUEENENSYA SHERYLIA IRAWANAN
361 10 Feb 2021 14 Feb 2021 005215 BY NY SULISTIANAH
362 11 Feb 2021 12 Feb 2021 037014 SUYADI TN
363 11 Feb 2021 16 Feb 2021 315215 AMIRA PUTRI
364 11 Feb 2021 16 Feb 2021 385215 ERIK DWI PURWANTO
365 12 Feb 2021 13 Feb 2021 479905 PASHA DWI OKTAVIAAN
366 12 Feb 2021 17 Feb 2021 157208 ENDRO PRAYITNOTN
367 12 Feb 2021 17 Feb 2021 545215 AGUNG SISWANTO
368 13 Feb 2021 18 Feb 2021 509611 LINGGAR AURA DAMAYANTI
369 12 Feb 2021 14 Feb 2021 717812 MASRONI TN
370 13 Feb 2021 17 Feb 2021 655215 CANDRA FEBRIANTO
371 13 Feb 2021 17 Feb 2021 461803 ALIYA JASMINAN
372 13 Feb 2021 17 Feb 2021 665215 ASSIFA MARWAH TAQIYYA SEJATI ,AN
373 13 Feb 2021 16 Feb 2021 467708 FERNANDO BAGUS PRASETYA AN
374 14 Feb 2021 16 Feb 2021 368111 ISAURA ERY IRSYADYAH AN
375 14 Feb 2021 16 Feb 2021 123107 ASFA TRISTAN NABIHAAN
376 14 Feb 2021 19 Feb 2021 745215 DEWI NURBAIYAH
377 14 Feb 2021 16 Feb 2021 595215 PIPIT NOVITASARI .NY
378 15 Feb 2021 18 Feb 2021 841607 DIKA AZAM HARIS HADISSINANUDIN AN
379 15 Feb 2021 18 Feb 2021 795215 ABDUL WAHIB WIDODO ,TN
380 15 Feb 2021 17 Feb 2021 925015 UMI NASIROH ,NY
381 11 Feb 2021 15 Feb 2021 885911 ATABIKATSANI IQBAL FARADI AN
382 15 Feb 2021 19 Feb 2021 025315 ANGGAR YUDIARTA
383 15 Feb 2021 17 Feb 2021 854413 ADIMAS CAHYANING TRIANGGARANI
384 15 Feb 2021 17 Feb 2021 985215 BY NY DESIANA BANU SAPUYRI
385 15 Feb 2021 18 Feb 2021 166614 SISKA RAHAYU
386 15 Feb 2021 21 Feb 2021 466111 ARYA LINTANG SATRIASDR

Page 4
 sheet1 -1

387 16 Feb 2021 22 Feb 2021 175315 K.MARGO UTOMO

388 16 Feb 2021 18 Feb 2021 614915 ABDUL MUNIR
389 16 Feb 2021 22 Feb 2021 098512 ACHMAD DAMAR WILIS
390 16 Feb 2021 18 Feb 2021 383311 SUHARTINY
391 16 Feb 2021 23 Feb 2021 405315 ABU ZEIN GHOFUR
392 15 Feb 2021 20 Feb 2021 155315 BAYI NY SISKA
393 16 Feb 2021 18 Feb 2021 845115 TUKANI .TN
394 16 Feb 2021 18 Feb 2021 104915 MUSRINGAH.NY
395 16 Feb 2021 19 Feb 2021 219110 ZUROIDATUL ASMAHNY
396 17 Feb 2021 18 Feb 2021 488907 RIRIS PUJI RAHAYUNN
397 17 Feb 2021 18 Feb 2021 964215 SETYO BUDI
398 17 Feb 2021 19 Feb 2021 754714 MULYATIN
399 15 Feb 2021 18 Feb 2021 822315 KENZIEO PUTRA KARILANO.AN
400 16 Feb 2021 19 Feb 2021 505315 AGUS DJALU PRAHORO,TN
401 16 Feb 2021 18 Feb 2021 165315 ZAKARIA NARENDRA PUTRA WIJAYANTO
402 17 Feb 2021 24 Feb 2021 870915 SAMSURI
403 17 Feb 2021 20 Feb 2021 645215 MUNASIH NY
404 17 Feb 2021 20 Feb 2021 601809 REZRA KURNIAWAN HUDAYAAN
405 18 Feb 2021 19 Feb 2021 213313 SUSMIATI NY
406 18 Feb 2021 24 Feb 2021 652815 EVA PURMINASARI
407 18 Feb 2021 21 Feb 2021 785206 MATNURTN
408 18 Feb 2021 24 Feb 2021 585415 ERWINA YAWANTI.NY
409 19 Feb 2021 23 Feb 2021 980900 SUKENI NY
410 15 Feb 2021 20 Feb 2021 815215 SITI IMROATUS SAKDIYAH .NY
411 19 Feb 2021 21 Feb 2021 455001 TRISTAN HELGA BELVA WIJAYAAN
412 19 Feb 2021 22 Feb 2021 347605 YOSSIE DARA AGUSTINA NY
413 19 Feb 2021 23 Feb 2021 098312 AL HAFIZ ZIAN RAMDANI
414 20 Feb 2021 22 Feb 2021 162709 AISHA AYU ROSELLA AN
415 20 Feb 2021 22 Feb 2021 085710 EVANO AKBAR ALMAHYRAAN
416 20 Feb 2021 23 Feb 2021 105515 APRILIA PINGKY ANINDITA
417 20 Feb 2021 22 Feb 2021 592803 WINDARTININGSIH NY
418 19 Feb 2021 24 Feb 2021 815415 EKO SANTOSO
419 21 Feb 2021 21 Feb 2021 355515 M GALIH TRI ASMORO
420 21 Feb 2021 22 Feb 2021 065515 RUMINI
421 21 Feb 2021 23 Feb 2021 935600 AGUSTINA RIZQI AN
422 21 Feb 2021 23 Feb 2021 691205 ZAHRA APRILIA PUTRI SIANTY
423 22 Feb 2021 24 Feb 2021 223714 JASMINE ARIANIAN
424 22 Feb 2021 28 Feb 2021 171801 LUSI HARIYANI NY
425 22 Feb 2021 23 Feb 2021 635200 SUMADI TN
426 22 Feb 2021 24 Feb 2021 052615 HANANIA JIHAN AZZAHRA AN
427 22 Feb 2021 25 Feb 2021 205615 AQILA AINAYA SANTIKA RAMADHANI
428 21 Feb 2021 25 Feb 2021 405515 BY NY ONNY CRISTINA RIANTI PUTRI
429 22 Feb 2021 26 Feb 2021 972907 NOVI ATIKA SARINY

Page 5
 sheet1 -1

430 21 Feb 2021 24 Feb 2021 395515 ULFATUL HANIAH .NY

431 22 Feb 2021 24 Feb 2021 225315 NURUL CHASANAH
432 22 Feb 2021 24 Feb 2021 255315 AMIN NURUL ALIYAH.NY
433 20 Feb 2021 25 Feb 2021 165515 BY NY EVA PURMINASARI
434 22 Feb 2021 25 Feb 2021 928110 RHARAS DHAYU WIDIHANGGITA AN
435 23 Feb 2021 26 Feb 2021 085715 UNTUNG AKHIR .TN
436 23 Feb 2021 26 Feb 2021 697413 SRI INDARTI
437 23 Feb 2021 24 Feb 2021 385715 ENY WIDHI HASTUTI
438 23 Feb 2021 24 Feb 2021 415715 GIAN PARTINI
439 23 Feb 2021 26 Feb 2021 063415 KATENI
440 23 Feb 2021 24 Feb 2021 555515 SUNYOTO
441 23 Feb 2021 27 Feb 2021 455715 M AZZAM AL FARUQ
442 23 Feb 2021 25 Feb 2021 465715 BY NY GIAN PARTINI
443 24 Feb 2021 26 Feb 2021 765715 SUPRIANTO MAMUN NASIR
444 23 Feb 2021 25 Feb 2021 077413 ANA YULIARSIH NY
445 24 Feb 2021 25 Feb 2021 325615 DEWI NURAINI.NY
446 24 Feb 2021 26 Feb 2021 135815 RAYYA IQLIMA RABBANI
447 24 Feb 2021 27 Feb 2021 185815 DWI HANDAYANI
448 24 Feb 2021 27 Feb 2021 481613 TARJA RUZAIN ,AN
449 25 Feb 2021 26 Feb 2021 915115 ACHMAD ZAINUDIN
450 25 Feb 2021 28 Feb 2021 164815 BALQIS FARAHDIBA
451 26 Feb 2021 28 Feb 2021 524815 MISNO ARIFIN
452 26 Feb 2021 28 Feb 2021 134612 ZEFANO EDGAR REIGA AN
453 27 Feb 2021 28 Feb 2021 055915 AYU FATHIKA VALBIE
454 26 Feb 2021 28 Feb 2021 895815 BY NY YOLANDA FAJAR NUR CAHYANTI
455 26 Feb 2021 28 Feb 2021 855815 BY NY BALQIS FARAHDIBA SYAHPUTRI ISWA
456 31 Des 2020 5 Jan 2021 337812 MUCHTAR RAFFA SYAHPUTRA AN

Page 6
 sheet1 -1

No. Klaim / SEP INACBG Top Up Total Tarif Tarif RS

0184R0040121V000013 0184R0040121V000042 2,194,200 2,772,300
0184R0040121V000514 0184R0040121V000051 2,586,500 2,634,900
0184R0040121V000851 0184R0040121V000169 4,989,600 4,450,200
0184R0040121V000871 0184R0040121V000172 3,048,000 3,831,300
0184R0040121V001409 0184R0040121V000688 2,661,000 2,594,600
0184R0040121V001731 0184R0040121V000395 1,853,900 2,125,900
0184R0040121V002183 0184R0040121V000340 1,828,500 2,763,500
0184R0040121V002326 0184R0040121V000341 5,376,500 4,906,300
0184R0040121V002480 0184R0040121V000424 2,671,300 2,272,900
0184R0040221V000784 0184R0040121V000548 5,792,000 11,884,275
0184R0040221V001429 0184R0040121V000566 5,134,500 2,741,600
0184R0040221V001443 0184R0040121V000568 2,728,200 2,717,900
0184R0040221V002316 0184R0040121V000707 7,495,800 14,127,775
0184R0040221V002319 0184R0040121V000689 1,544,900 2,283,400
0184R0040221V002415 0184R0040121V000690 4,853,300 6,634,300
0184R0040221V002592 0184R0040121V000691 3,017,500 5,351,600
0184R0040221V002989 0184R0040121V000582 6,562,900 8,452,800
0184R0040221V003169 0184R0040121V000583 4,830,200 6,843,200
0184R0040221V003189 0184R0040121V000584 2,744,300 2,052,104
0184R0041220V002931 0184R0040121V000585 5,776,400 4,039,000
0184R0041220V002946 0184R0040121V000586 3,048,000 3,161,000
0184R0041220V002962 0184R0040121V000587 3,556,000 3,484,000
0184R0041220V003120 0184R0040121V000588 3,999,100 2,590,000
0184R0041220V003121 0184R0040121V000589 3,819,500 4,202,000
0184R0041220V003124 0184R0040121V000590 5,972,300 4,860,000
0184R0041220V003145 0184R0040121V000591 3,048,000 4,840,000
0184R0041220V003147 0184R0040121V000592 3,048,000 4,053,000
0184R0041220V003148 0184R0040121V000593 2,511,000 2,579,000
0184R0041220V003149 0184R0040121V000594 3,017,500 5,118,000
0184R0041220V003166 0184R0040121V000595 3,529,600 5,915,000
0184R0041220V003251 0184R0040121V000596 2,586,500 3,350,000
0184R0041220V003450 0184R0040121V000842 2,661,700 2,980,000
0184R0041220V003516 0184R0040121V000867 7,495,800 9,147,250
0184R0041220V003518 0184R0040121V000868 3,999,100 3,315,000
0184R0041220V003540 0184R0040121V000870 4,467,200 3,024,000
0184r0040121v000018 0184R0040121V000974 1,968,700 1,562,700
0184r0040121v000032 0184R0040121V000985 4,830,200 6,254,500
0184r0040121v000039 0184R0040121V000990 2,540,000 2,898,500
0184r0040121v000041 0184R0040121V000991 3,014,300 5,799,800
0184r0040121v000045 0184R0040121V003065 4,818,400 3,981,300
0184r0040121v000195 0184R0040121V001138 2,626,400 971,000
0184r0040121v000197 0184R0040121V001139 3,017,500 1,926,200

Page 7
 sheet1 -1

0184r0040121v000314 0184R0040121V001284 4,683,100 6,769,200

0184r0040121v000326 0184R0040121V001285 2,661,700 2,068,100
0184r0040121v000352 0184R0040121V001287 2,218,100 2,398,600
0184r0040121v000401 0184R0040121V001291 5,102,000 7,219,100
0184r0040121v000409 0184R0040121V001401 6,562,900 7,859,100
0184r0040121v000701 0184R0040121V001407 1,902,500 20,000
0184r0040121v000702 0184R0040121V001408 3,332,600 5,469,300
0184r0040121v000959 0184R0040121V001557 4,853,300 6,034,400
0184r0040121v000980 0184R0040121V001558 5,776,400 5,199,000
0184r0040121v001004 0184R0040121V001565 1,687,500 1,785,300
0184r0040121v001073 0184R0040121V001687 5,966,900 9,302,900
0184r0040121v001093 0184R0040121V001567 4,227,800 4,418,100
0184r0040121v001137 0184R0040121V001568 1,544,900 2,514,000
0184r0040121v001140 0184R0040121V001569 5,376,500 4,515,200
0184r0040121v001303 0184R0040121V001573 4,665,600 4,164,900
0184r0040121v001400 0184R0040121V001576 1,853,900 2,157,700
0184r0040121v001539 0184R0040121V001730 1,509,200 1,859,300
0184r0040121v001571 0184R0040121V001860 5,434,700 6,445,700
0184r0040121v001572 0184R0040121V001868 6,697,900 6,628,200
0184r0040121v001668 0184R0040121V001910 1,509,200 1,352,200
0184r0040121v001812 0184R0040121V001926 3,326,400 1,812,900
0184r0040121v001842 0184R0040121V002014 2,525,300 1,191,000
0184r0040121v001921 0184R0040121V002084 6,562,900 8,660,600
0184r0040121v002056 0184R0040121V002181 4,512,500 9,713,501
0184r0040121v002170 0184R0040121V002419 3,273,800 5,435,500
0184r0040121v002172 0184R0040121V002286 3,231,200 4,946,100
0184r0040121v002321 0184R0040121V002315 3,330,600 2,964,400
0184r0040121v002322 0184R0040121V002318 4,421,500 5,029,200
0184r0040121v002323 0184R0040121V002319 3,602,600 4,647,900
0184r0040121v002484 0184R0040121V002328 6,820,100 8,424,300
0184r0040121v002698 0184R0040121V002561 3,840,300 3,169,800
0184r0040121v002923 0184R0040121V002647 4,662,800 3,476,200
0184r0040121v002924 0184R0040121V002648 6,811,600 8,185,202
0184r0040121v002990 0184R0040121V002650 2,860,900 1,780,100
0184r0040121v003028 0184R0040121V002726 1,406,200 1,086,200
0184r0040121v003038 0184R0040121V002892 3,011,500 1,321,300
0184r0040121v003055 0184R0040121V003066 3,722,700 2,807,900
0184r0040121v003060 0184R0040121V002966 3,326,400 2,341,400
0184r0040221v000281 0184R0040121V003050 3,326,400 2,339,300
0184r0040221v000331 5,792,000 7,743,838
0184r0040221v000332 6,950,400 9,519,603
0184r0040221v000398 4,259,200 6,657,900
0184r0040221v000399 2,217,300 1,518,200

Page 8
 sheet1 -1

0184r0040221v000407 1,967,900 2,168,200

0184r0040221v000473 2,188,700 3,605,900
0184r0040221v000593 5,918,900 9,251,600
0184r0040221v000595 3,332,600 3,358,900
0184r0040221v000601 3,326,400 2,457,900
0184r0040221v000610 1,811,000 1,972,509
0184r0040221v000614 3,332,600 3,256,000
0184r0040221v000617 3,332,600 3,054,803
0184r0040221v000620 1,657,100 2,845,600
0184r0040221v000660 2,155,400 2,304,500
0184r0040221v000690 3,767,200 3,853,000
0184r0040221v000694 1,509,200 1,732,104
0184r0040221v000707 3,996,700 3,797,003
0184r0040221v000727 1,509,200 1,152,900
0184r0040221v000742 2,738,800 2,797,000
0184r0040221v000743 5,776,400 2,824,305
0184r0040221v000744 1,509,200 1,709,803
0184r0040221v000746 3,330,600 2,273,700
0184r0040221v000760 4,830,200 7,300,900
0184r0040221v000769 3,209,200 1,758,900
0184r0040221v000770 2,361,500 1,477,100
0184r0040221v000773 1,406,200 818,400
0184r0040221v000775 2,511,000 2,440,700
0184r0040221v000776 4,421,500 6,378,400
0184r0040221v000777 1,968,700 3,396,500
0184r0040221v000778 6,762,300 7,046,300
0184r0040221v000780 7,117,300 9,995,600
0184r0040221v000781 4,665,600 4,011,638
0184r0040221v000783 1,509,200 1,984,500
0184r0040221v000802 5,102,000 7,591,576
0184r0040221v000879 2,540,000 3,105,976
0184r0040221v000884 5,451,100 4,350,500
0184r0040221v000885 8,087,000 17,073,914
0184r0040221v000886 5,376,500 9,010,000
0184r0040221v000905 3,556,000 5,989,200
0184r0040221v000909 4,608,400 4,584,400
0184r0040221v000910 3,326,400 1,736,000
0184r0040221v000912 1,687,500 1,224,900
0184r0040221v000915 4,665,600 1,930,376
0184r0040221v000916 2,525,300 999,400
0184r0040221v001018 5,824,000 5,990,000
0184r0040221v001028 3,840,300 4,380,900
0184r0040221v001031 3,840,300 4,183,400

Page 9
 sheet1 -1

0184r0040221v001046 2,525,300 1,581,100

0184r0040221v001057 3,841,500 3,063,100
0184r0040221v001081 2,191,600 1,841,300
0184r0040221v001082 2,525,300 1,517,100
0184r0040221v001083 5,796,300 7,333,800
0184r0040221v001084 3,332,600 2,185,600
0184r0040221v001085 2,462,000 3,708,502
0184r0040221v001143 3,017,500 4,873,902
0184r0040221v001240 5,102,000 6,842,176
0184r0040221v001242 3,326,400 2,130,300
0184r0040221v001243 1,509,200 1,611,900
0184r0040221v001246 2,929,500 2,719,600
0184r0040221v001247 4,683,100 3,195,600
0184r0040221v001249 1,749,500 5,134,700
0184r0040221v001313 1,585,400 3,678,100
0184r0040221v001378 3,667,500 3,269,800
0184r0040221v001389 2,661,700 2,127,100
0184r0040221v001391 3,841,500 3,994,800
0184r0040221v001392 3,105,300 2,524,200
0184r0040221v001393 2,790,800 7,648,500
0184r0040221v001395 3,011,500 2,846,300
0184r0040221v001404 2,218,100 2,155,200
0184r0040221v001410 2,273,500 2,613,702
0184r0040221v001411 2,112,800 3,744,900
0184r0040221v001417 2,728,200 2,703,800
0184r0040221v001420 1,967,900 1,180,800
0184r0040221v001432 1,509,200 2,080,600
0184r0040221v001434 2,112,800 1,773,600
0184r0040221v001435 2,112,800 3,460,200
0184r0040221v001436 1,811,000 1,859,300
0184r0040221v001438 1,811,000 1,447,200
0184r0040221v001439 1,811,000 1,281,400
0184r0040221v001440 6,967,700 6,506,000
0184r0040221v001442 1,585,400 3,007,800
0184r0040221v001446 2,191,600 2,058,000
0184r0040221v001447 3,017,500 2,535,000
0184r0040221v001550 4,853,300 6,140,900
0184r0040221v001565 2,112,800 2,792,300
0184r0040221v001582 2,092,500 2,132,000
0184r0040221v001591 7,699,300 6,055,900
0184r0040221v001593 3,326,400 2,153,700
0184r0040221v001594 4,830,200 7,173,600
0184r0040221v001595 3,048,000 4,534,800

Page 10
 sheet1 -1

0184r0040221v001598 3,556,000 5,525,976

0184r0040221v001686 4,528,900 6,234,000
0184r0040221v001714 3,048,000 4,967,776
0184r0040221v001730 6,295,600 6,536,900
0184r0040221v001738 3,332,600 4,645,300
0184r0040221v001740 3,841,500 5,359,800
0184r0040221v001775 6,246,500 6,223,200
0184r0040221v001796 3,464,300 5,678,800
0184r0040221v001797 2,155,400 2,366,990
0184r0040221v001800 2,586,500 1,983,076
0184r0040221v001867 4,227,800 4,161,100
0184r0040221v001890 2,661,700 2,915,100
0184r0040221v001947 1,242,600 1,742,700
0184r0040221v001949 3,330,600 3,243,076
0184r0040221v001950 1,811,000 1,721,200
0184r0040221v001952 3,826,700 3,864,400
0184r0040221v002003 3,722,700 2,655,800
0184r0040221v002019 1,406,200 1,269,500
0184r0040221v002141 4,653,900 2,867,400
0184r0040221v002143 6,136,900 10,239,900
0184r0040221v002144 4,683,400 5,246,900
0184r0040221v002145 4,813,800 5,003,938
0184r0040221v002168 5,584,700 3,418,500
0184r0040221v002242 3,722,700 3,546,400
0184r0040221v002244 2,191,600 1,827,600
0184r0040221v002287 2,399,800 2,072,300
0184r0040221v002288 1,826,300 1,687,700
0184r0040221v002289 3,030,400 1,504,400
0184r0040221v002290 1,509,200 1,370,400
0184r0040221v002291 1,406,200 1,527,000
0184r0040221v002301 3,137,900 3,034,300
0184r0040221v002313 3,273,800 4,679,900
0184r0040221v002314 1,406,200 1,243,200
0184r0040221v002318 1,657,100 3,196,800
0184r0040221v002321 1,811,000 1,327,400
0184r0040221v002322 1,509,200 1,486,400
0184r0040221v002324 1,509,200 1,361,700
0184r0040221v002325 3,996,700 5,797,400
0184r0040221v002394 7,719,600 5,265,500
0184r0040221v002438 3,845,600 6,443,600
0184r0040221v002446 1,509,200 1,744,800
0184r0040221v002454 3,326,400 3,813,000
0184r0040221v002456 2,511,000 3,321,300

Page 11
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0184r0040221v002472 2,586,500 2,600,314

0184r0040221v002488 3,840,300 3,207,500
0184r0040221v002490 4,853,300 6,574,900
0184r0040221v002491 10,624,500 5,022,100
0184r0040221v002493 1,811,000 1,558,600
0184r0040221v002581 1,311,700 1,435,200
0184r0040221v002594 5,796,300 6,635,976
0184r0040221v002634 1,585,400 3,003,900
0184r0040221v002635 1,544,900 2,506,700
0184r0040221v002637 2,155,400 2,027,190
0184r0040221v002638 4,227,800 4,583,600
0184r0040221v002639 1,509,200 1,915,506
0184r0040221v002750 3,326,400 1,219,138
0184r0040221v002771 4,528,900 6,072,600
0184r0040221v002815 1,902,500 3,491,500
0184r0040221v002820 1,828,500 2,300,500
0184r0040221v002821 2,525,300 1,365,300
0184r0040221v002824 3,999,300 2,897,700
0184r0040221v002827 3,030,400 1,269,200
0184r0040221v002831 3,204,700 4,783,400
0184r0040221v002983 4,830,200 7,027,900
0184r0040221v002990 9,188,000 8,628,700
0184r0040221v003143 1,968,700 1,650,900
0184r0040221v003144 1,853,900 2,889,400
0184r0040221v003167 3,326,400 1,866,200
0184r0040221v003185 3,326,400 2,026,200
0184r0041220v003546 2,525,300 2,217,000

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Jenis
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0184R0040121V000042 covid
0184R0040121V000051 covid
0184R0040121V000169 covid
0184R0040121V000172 covid
0184R0040121V000340 covid
0184R0040121V000341 covid
0184R0040121V000395 covid
0184R0040121V000424 covid
0184R0040121V000548 covid
0184R0040121V000566 covid
0184R0040121V000568 covid
0184R0040121V000582 dobel SEP
0184R0040121V000583 dobel SEP
0184R0040121V000584 dobel SEP
0184R0040121V000585 dobel SEP
0184R0040121V000586 dobel SEP
0184R0040121V000587 dobel SEP
0184R0040121V000588 dobel SEP
0184R0040121V000589 dobel SEP
0184R0040121V000590 dobel SEP
0184R0040121V000591 dobel SEP
0184R0040121V000592 dobel SEP
0184R0040121V000593 dobel SEP
0184R0040121V000594 dobel SEP
0184R0040121V000595 dobel SEP
0184R0040121V000596 dobel SEP
0184R0040121V000688 covid
0184R0040121V000689 covid
0184R0040121V000690 covid
0184R0040121V000691 covid
0184R0040121V000707 covid
0184R0040121V000842 covid
0184R0040121V000867 covid
0184R0040121V000868 covid
0184R0040121V000870 TIDAK JADI
0184R0040121V000974 covid
0184R0040121V000985 covid
0184R0040121V000990 covid
0184R0040121V000991 covid
0184R0040121V001138 covid
0184R0040121V001139 TIDAK JADI
0184R0040121V001284 covid
0184R0040121V001285 covid
0184R0040121V001287 TIDAK JADI
0184R0040121V001291 covid
0184R0040121V001401 dobel SEP
0184R0040121V001407 TIDAK JADI
0184R0040121V001408 covid
0184R0040121V001557 covid
0184R0040121V001558 covid
0184R0040121V001565 SATU KLAIM
0184R0040121V001567 covid
0184R0040121V001568 dobel SEP
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0184R0040121V001573 TIDAK JADI
0184R0040121V001576 covid
0184R0040121V001687 SATU KLAIM
0184R0040121V001730 covid
0184R0040121V001860 covid
0184R0040121V001868 covid
0184R0040121V001910 covid
0184R0040121V001926 covid
0184R0040121V002014 covid
0184R0040121V002084 covid
0184R0040121V002181 TIDAK JADI
0184R0040121V002286 covid
0184R0040121V002315 TIDAK JADI
0184R0040121V002318 covid
0184R0040121V002319 covid
0184R0040121V002328 TIDAK JADI
0184R0040121V002419 covid
0184R0040121V002561 dobel SEP
0184R0040121V002647 TIDAK JADI
0184R0040121V002648 TIDAK JADI
0184R0040121V002650 TIDAK JADI
0184R0040121V002726 covid
0184R0040121V002892 TIDAK JADI
0184R0040121V002966 covid
0184R0040121V003050 covid
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