MARET 2021

BULAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1-May-19 S S R K J S M S S R K J S M S S R K J S M S S R K J S M S S R

DIDIK P P P P P C L P P P L P P L P P P P P P L P P P P P P L P P P

CANDRA L L C S S S M M L S S M M L P P S S M M L L P L S L M M L S S 178 8

AGUS M L P P P L P P M M L L C C S M M L L S P S M M L L S S M L P 178 8

HERU L S S L M L S S P P M M L L C S P M M L S L P P M M L P P M L 178 8
S
IBNU L P P S M M L L S L S S P M M L S P P L M M L L S S P P M M L 178 8
S
RIZKI M M L L S P M L S M M L P S S M L L S P L M L S S S M L S S S 178 8

IWAN S S M M L P P M L P P S M M L S L S S P L S S S L L M M L L M 178 8
P
SUGENG P P; M M L L C S M L P P S S S L M M L L S P M M L P P L S M L 178 8

CHRISTIN S S C C C M M L L S M M L P M L L P P M L L S S P P M M L P L 178 8

MARSITI M L L P P S S M L L P P S P M M L S S M M L L P M M L C L S S 178 8

TRIYANTO M L S S M M L L P S S S S M L S P M L S P P L L M M L L P P M 178 8

DANING P L S M L P P S S M M L L C P M M L L S M M L L P P S S S L M 178 8
C P
ARI S S M M L S S S P M L L M L P P P S L M M L S S M L S S L M L P 178 8

PAGI 3 3 3 3 3 3 3 3 3 3 3 3 3 2 3 3 3 3 3 3 2 3 3 3 3 4 3 2 3 3 3
SIANG 3 3 3 3 3 3 3 3 3 3 3 3 3 2 3 3 3 3 3 3 2 3 3 3 3 3 3 2 3 3 3
MALAM 3 2 3 3 3 3 2 3 3 3 3 3 2 3 3 3 3 3 3 3 3 2 2 3 3 3 3 2 3 3 3
RUMAH SAKIT CAKRA HUSADA
Data Jasa Tindakan Dokter
Periode April 2019
dr. VM Prasanita Wiyati
RAWAT JALAN
Pemeriksaa Tindak
No Tanggal No Rm Nama Jaminan
n an Total

1 26-Mar-19 19-32-72 TEMU JKN 16800 44160 60,960.00

2 19-32-75 TASRIFAH JKN 16800 0 16,800.00

QANITA
3 18-97-50 PUTRI JKN 16800 0 16,800.00
AIZA
SUKIRMA
4 15-85-43
N
Umum 30000 17400 47,400.00

5 16-00-74 SURIP JKN 16800 7680 24,480.00

6 19-32-85 SUMARDI Umum 30000 30,000.00

YULIAWA
7 18-71-87
N
JKN 16800 0 16,800.00
NASWA
8 17-82-08 ZANUBA Umum 30000 30,000.00
APRILIAN

9 05-13-65 HARJONO Umum 30000 30,000.00

DUWI
10 19-32-79
PRIHANTO
Umum 30000 10800 40,800.00
ATTALLA
11 15-78-70 H BAHY JKN 16800 16,800.00
GHAZALI
SRI
12 12-99-75
MARYANI
JKN 16800 0 16,800.00
Sub Total : 347,640.00

WAGINEM
13 27-Mar-19 18-32-97 MARTO JKN 16800 32640 49,440.00
SUWITO
AZKADIN
A KIREI
14 19-34-40
PUTRI
Umum 30000 47400 77,400.00
ANDUNA
AGUS
15 19-34-43
RIYANTO
Umum 0 0.00

16 19-34-42 IRIYANTI JKN 16800 24000 40,800.00

EKA ARDI
17 13-52-12
NUGRAHA
JKN 16800 16,800.00
DANENDR
A
18 13-81-36
ANANDA
Asuransi 21000 47400 68,400.00
WIBOWO
AFFAN
19 08-94-63 ROZAQI JKN 16800 16,800.00
ARROSID
AMELYA
20 19-34-00 ASNA TRI JKN 17280 17,280.00
HAPSARI
 TIMOTIUS
21 19-34-45 RADITYA JKN 16800 24000 40,800.00
PRATAMA
TUKINAH
22 19-34-39 HADI Umum 30000 0 30,000.00
SUMITRO
WARTENB
23 19-29-32
ERG
Umum 30000 0 30,000.00

24 19-34-41 SEHONO Umum 30000 0 30,000.00

ESTI IKE
25 13-16-69 WULAND JKN 16800 24000 40,800.00
ARI
MUHAMM
AD RIZKY
26 17-85-19
GUNTUR
JKN 16800 16,800.00
SAPUTRO

ADEILA
RATU
27 12-28-31
MAYANG
JKN 16800 16,800.00
SARI
CITRA
28 19-34-44
ROSIANA
JKN 16800 16,800.00
KENANGA
29 6/7/2020
MAY
Umum 30000 0 30,000.00
FEBI EKA
30 19-34-46 SETYAWA JKN 16800 16,800.00
N
EQI
31 08-60-46
MUFIDAH
JKN 16800 16,800.00

32 19-34-49 SUMIYATI JKN 16800 24000 40,800.00

MUHAMM
AD
33 19-31-91 ARYSYAI Umum 4200 4,200.00
KH AL
HAFIDZ
Sub Total : 617,520.00

SAGUNG
34 28-Mar-19 02-16-91
RAI ADI
JKN 16800 16,800.00
EUSTACHI
US
35 15-60-29 HARYO JKN 16800 16,800.00
HABIRON
O
Sub Total : 33,600.00

36 29-Mar-19 19-35-70 WARTI JKN 16800 24000 40,800.00

AMBARW
ATI
37 19-35-39
WIDYANI
Umum 30000 0 30,000.00
NGSIH
SARDION
38 19-35-78
O
JKN 16800 16,800.00
ANANG
39 19-35-44
NUGROHO
Umum 30000 0 30,000.00
REGINA
40 11-72-20 ANGGI Umum 30000 30,000.00
ASTUTI
 SAKINA
41 12-37-04 PUTRI Asuransi 21000 0 21,000.00
AISYAH
NOVA
42 19-34-76 ASRIYANT Umum 30000 30000 60,000.00
I
APRILIA
NUR
43 19-35-58
AVITASAR
Umum 30000 0 30,000.00
I
EDWARD
44 15-20-24 WIJANAR JKN 16800 19200 36,000.00
KO
CH
45 16-18-53
SUTILAH
Umum 30000 6600 36,600.00
SRI
46 19-34-34
SURATMI
JKN 16800 7680 24,480.00
FREDELL
47 ### A AVI JKN 16800 24000 40,800.00
ADRISTI
SUKARMI
48 ###
N
JKN 16800 7680 24,480.00
ISMARTA
49 19-35-81
NI
Umum 30000 30000 60,000.00
RAMPAK
50 19-35-43 ALHAFIZ Umum 30000 30000 60,000.00
BAYU AJI
ENDAH
51 ###
ARYANTI
JKN 16800 16,800.00
NOVI
52 19-35-46 WIDYAW JKN 16800 24000 40,800.00
ATI
DARYANT
53 19-35-52
O
JKN 16800 0 16,800.00
YESSI
54 19-32-45 NOVITA JKN 16800 0 16,800.00
SARI
MUHAMM
55 19-35-66 AD HAFIZ Umum 30000 30,000.00
AL AUFA
FARIDA
56 15-80-91 PUSPITA Asuransi 21000 21,000.00
HARTI
Sub Total : 683,160.00

LEONARD
O
57 31-Mar-19 10-59-44 GALANG JKN 16800 16,800.00
ADRIANO
PUTRA
NUR
58 ### ALLISA JKN 16800 24000 40,800.00
VIO D
PUJININGS
59 19-36-49
IH
JKN 16800 16,800.00
NAVY
GLENDA
60 19-36-50
TARISKOF
JKN 16800 24000 40,800.00
A
NITA
61 12-24-22
EFIANA
JKN 16800 0 16,800.00
ANIK
62 19-36-51
ANIFAH
JKN 16800 0 16,800.00
 YOGA
63 12-96-13 HAQIM Umum 30000 30000 60,000.00
WIGUNA
CATUR
64 18-27-76 BEKTI JKN 16800 0 16,800.00
UTAMI
AYEM
65 19-36-54
TENTREM
Umum 30000 6600 36,600.00
MIT DWI
66 05-24-52 KARYANT JKN 16800 0 16,800.00
O
NAYYARA
67 ### QURRATU Umum 21000 30000 51,000.00
AIN
SRI
68 13-83-96
LESTARI
Umum 30000 0 30,000.00
Sub Total : 360,000.00

69 1-Apr-19 14-82-65 TUGINO JKN 16800 33600 50,400.00

ENDANG
70 19-37-55 DWI JKN 16800 24000 40,800.00
LESTARI
SURTIYAN
71 19-36-55
A
Umum 30000 0 30,000.00
SYAQILLA
72 ### NEISYA JKN 16800 16,800.00
ANINDYA
KANAYA
73 19-23-45
ARFARIA
JKN 16800 16,800.00
VARESA
RIO
74 19-36-43
PRASETY
JKN 16800 24000 40,800.00
AN

75 15-38-08 KASIAMI JKN 16800 24000 40,800.00

76 14-23-01 SUTIKNO JKN 16800 24000 40,800.00

TRI
77 15-88-97
RIYANTI
JKN 16800 0 16,800.00
PERMADI
TA
78 13-81-42
RAFLESIA
Umum 30000 0 30,000.00
NA
SUGIYAN
79 09-53-26 A DIHANA Umum 30000 0 30,000.00
BP
LATIF
80 19-37-56
KURNIATI
JKN 16800 0 16,800.00

81 11-83-72 ENJANG JKN 16800 16,800.00

TOTOK
ENDAR
82 15-24-41
SURYANT
JKN 16800 0 16,800.00
O
ARIYANT
83 19-37-58
O
Umum 30000 30,000.00
UMI
84 19-36-58 MUTMAIN Umum 30000 30000 60,000.00
AH
 RIFKY
ARISTO
85 17-24-61
NAYOTA
Umum 30000 30,000.00
MA
GABRIEL
86 18-40-00 RICI ARTA JKN 16800 24000 40,800.00
ANGGARA

87 19-13-05 SUTARTI JKN 16800 31680 48,480.00

Sub Total : 613,680.00

88 2-Apr-19 19-16-73 SUKARMI JKN 16800 24000 40,800.00

ANIK
89 14-64-02 MARWIYA JKN 16800 24000 40,800.00
H
SRI
90 16-82-68
LESTARI
JKN 16800 24000 40,800.00
NGADIYE
91 19-27-90
M
JKN 16800 58560 75,360.00
SRI
92 17-47-22 SUGIYAT JKN 16800 0 16,800.00
MI
SRI
93 19-37-61
WAHYUNI
JKN 16800 24000 40,800.00
AQILLA
94 15-90-71 BELVANI JKN 16800 16,800.00
A MAEDA
EMY
95 15-72-94
IDAWATI
JKN 16800 0 16,800.00
MARMO
96 19-37-68
WIYONO
JKN 16800 31680 48,480.00
JONATHA
N KEVIN
97 19-37-60
EMRALDE
Umum 30000 30,000.00
US
Sub Total : 367,440.00

FATCHUR
98 3-Apr-19 16-24-26
OJI
JKN 16800 8640 25,440.00

99 05-28-51 MIRANTO JKN 16800 58560 75,360.00

UNTUNG
100 19-38-81
WIYONO
JKN 16800 13440 30,240.00
AYUMITA
SETYA
101 14-34-33
CANDRA
JKN 16800 16,800.00
DEWI
AMEYLYA
102 19-38-76
QURROTA
JKN 16800 24000 40,800.00
FRISKA
103 14-24-77 SABRINA JKN 16800 24000 40,800.00
PUTRI
MARYON
104 19-38-77
O
JKN 16800 24000 40,800.00
PURWANT
105 19-34-53
O
JKN 16800 31680 48,480.00

106 17-30-40 WINARNO JKN 16800 0 16,800.00

 MUHAMM
107 19-38-86 AD ARDI Asuransi 30000 0 30,000.00
ANGGARA
WARTINI
108 19-38-78 PUJO JKN 16800 24000 40,800.00
HARJONO
AL
109 19-38-79 GIBRAN Umum 30000 21600 51,600.00
IBRAHIM
NI
110 05-92-85 NENGAH JKN 16800 16,800.00
RUSTINI
SUSILOW
111 11-95-88
ATI
JKN 16800 16,800.00

112 19-38-82 SETIYONO Umum 30000 0 30,000.00

NASYITA
SYAHWA
113 17-13-55
LATIFATU
JKN 16800 6720 23,520.00
NNISA

114 17-68-35 SUYATMI JKN 16800 7680 24,480.00

MUHAMM
AD
115 19-38-80
FAISHAL
Umum 30000 30000 60,000.00
ASYRAF
NUR
116 19-24-78
SEPTIANI
JKN 16800 0 16,800.00
IBNU
117 09-74-89 SUBIANTO JKN 16800 13920 30,720.00
RO
ERWIN
JANUART
118 19-37-25 A JKN 16800 0 16,800.00
RAMADH
AN
MARWADI
119 19-38-83
MARGANI
JKN 16800 24000 40,800.00
M IKHSAN
120 19-37-28 FAKHRUD JKN 16800 0 16,800.00
IN
Sub Total : 751,440.00

NARENDR
121 5-Apr-19 19-40-22 A PUTRA JKN 16800 37920 54,720.00
ANINDITO

122 17-94-10 RONI Umum 30000 0 30,000.00

123 18-47-88 ZULIATIN JKN 16800 0 16,800.00

SRI
124 19-40-26 PURWANI JKN 16800 0 16,800.00
NGSIH

125 13-14-47 ASHADI JKN 16800 16,800.00

RAHMAT
126 19-39-76 ABDUL JKN 16800 24000 40,800.00
MALIK
NANIK
127 06-76-90
SUHADI
JKN 16800 46560 63,360.00
SRI
128 19-40-28
MAHERI
JKN 16800 24000 40,800.00
 SUKARMA
129 19-40-21
N
Umum 30000 25800 55,800.00
RETNA
130 05-51-11 WULAND JKN 16800 7680 24,480.00
ARI
PASCAL
131 11-37-99 PRASETY JKN 16800 24000 40,800.00
A
132 16-40-18 TUKINEM JKN 16800 0 16,800.00

133 19-40-25 SUHARTI JKN 16800 58560 75,360.00

SIDIQ
134 12-74-45 RUWANT JKN 16800 24000 40,800.00
O
ANNA
135 19-39-96 LITA JKN 16800 54240 71,040.00
BARAT
SYAFAAT
136 19-39-57
UN
Umum 30000 30000 60,000.00
Sub Total : 665,160.00

EKO
137 7-Apr-19 19-41-05 WIDIYAST Umum 30000 0 30,000.00
OPO
SAELANG
GA
138 19-40-99 ALNAN Asuransi 30000 30,000.00
JUAN
FARISKY
139 19-41-04 SARTINI JKN 16800 37440 54,240.00

140 11-28-38 TRIMO JKN 16800 24000 40,800.00

SISWO
141 19-38-68 DIHARJO JKN 16800 24000 40,800.00
DIMAN
DINAR
NOVELIA
142 19-40-46 NA Umum 30000 30,000.00
ANGGRAI
NI
143 19-41-02 SUNASRI Umum 21000 39600 60,600.00
Y
144 ### KUSMIYA Asuransi 30000 30,000.00
NTO
YULINA
EKA
145 19-41-01
ANGGRAI
JKN 16800 0 16,800.00
NI
SHOYITU
146 17-67-10
N
JKN 16800 72000 88,800.00
GALIH
FAJAR
147 19-41-03 PUTRA JKN 16800 24000 40,800.00
SYAHBAN
A
WIJI
148 13-15-04 COKRO Umum 30000 0 30,000.00
MIARJO
ERLANGG
A
149 17-66-02 ADHINAT JKN 16800 16,800.00
A
NUGROHO
SUGIANT
150 19-41-00
O
Umum 30000 0 30,000.00
 YUSTINUS
151 9/2/2027
SUWARDI
JKN 16800 72000 88,800.00

152 16-18-10 SUMIYEM JKN 16800 7680 24,480.00

EVA
PADMAW
153 11-80-02 ATI Asuransi 30000 30000 60,000.00
FADILLAH
SE
IRA
154 17-40-44
MEIRIANA
Umum 30000 30,000.00
JOKO
PAMBUDI
155 15-84-22
PRIHASTO
JKN 16800 5280 22,080.00
MO
SAGUNG
156 01-73-88 PUTRA JKN 16800 0 16,800.00
ARDANI
TRI
157 16-56-27
PUJIANTO
JKN 16800 24000 40,800.00
PATMIAT
158 16-26-73
UN
JKN 16800 0 16,800.00
Sub Total : 839,400.00

AQILA
159 8-Apr-19 18-37-93 ARNETTA JKN 16800 16,800.00
PUTRI
160 ### MARINEM Umum 30000 18000 48,000.00
161 ### MARJO Umum 30000 42000 72,000.00
SUSILO
162 07-20-70 DARMON Umum 30000 42000 72,000.00
O
ILHAM
163 19-42-18 ABID Umum 30000 30,000.00
ARIFUDIN
JUWARIA
164 ###
H
JKN 16800 31680 48,480.00
MUHAMM
165 19-42-24 AD JAZIM JKN 16800 16,800.00
AHNAF

166 17-91-61 SARYATI JKN 16800 0 16,800.00

Sub Total : 320,880.00

167 9-Apr-19 19-42-61 PONIDAH JKN 16800 0 16,800.00

MUHAMM
AD
168 16-96-05 HAMAS JKN 16800 16,800.00
AL
HAFIDZ
SUGIYON
169 19-43-07
O
JKN 16800 41280 58,080.00
MG
170 ###
SARJIKEM
JKN 16800 7680 24,480.00

171 19-43-03 RAHAYU JKN 16800 0 16,800.00

HARTINE
172 14-52-31 M HARTO Umum 30000 0 30,000.00
SUWITO
SURATNO
173 11-58-47 RATNOGI JKN 16800 0 16,800.00
HARJO
 MUH
174 ###
MUNIR
JKN 16800 58560 75,360.00
SHINTA
175 19-42-31 CAHYA JKN 16800 16,800.00
KAMILA
REZA
176 12-00-51 YOGA JKN 16800 0 16,800.00
SAPUTRA
SHAQUEE
177 16-55-32 NA ZOYA JKN 16800 16,800.00
ARETHA
IHYA
178 16-97-48 ULUMIDDI JKN 16800 37920 54,720.00
N ZUHDI
EMY
179 15-72-94
IDAWATI
JKN 16800 16,800.00
JOKO
180 ###
SUSENO
JKN 16800 0 16,800.00
SUPRIANT
181 12-45-65
O
JKN 16800 32640 49,440.00
SANTI
182 16-48-13 WULAND JKN 16800 0 16,800.00
ARI
FITRI
183 19-25-77 ANDRIYA JKN 16800 44640 61,440.00
NTI
SITI
184 ###
LATIFAH
JKN 16800 16,800.00
APRIYANT
185 19-42-97
O
Umum 30000 30,000.00
KAMIDI
186 19-42-01 ADI JKN 16800 44640 61,440.00
WIYONO
REYNAND
187 19-31-60 ADYA JKN 16800 16,800.00
NANDANA
KIRANA
NASSYA
188 14-42-41
ANNORA
JKN 16800 16,800.00
UTOMO
RAFID
189 19-43-06
HANAN
JKN 16800 24000 40,800.00
REYNAND
190 19-31-60 ADYA JKN 16800 24000 40,800.00
NANDANA

191 12-59-70 NURIYAH JKN 16800 58560 75,360.00

JUMINAH
192 19-42-28 SETYO Umum 30000 45600 75,600.00
SUMARTO
AGNES
193 17-15-28
TABITA
JKN 16800 16,800.00
NOVIARSI
H
194 11-47-79
RAHMAW
JKN 16800 16,800.00
ATI
GUNAWA
195 14-15-98 N JKN 16800 16,800.00
WIBISONO
196 17-94-41 LASMIATI JKN 16800 31680 48,480.00
 AGUNG
197 19-43-04
NUGRAHA
Umum 30000 0 30,000.00
SAMIYEM
198 19-42-29 PRAPTO JKN 16800 31680 48,480.00
HADI
RAFANDA
199 19-43-08
NOFALYN
JKN 16800 16,800.00

200 19-31-56 RAMINI Umum 30000 0 30,000.00

SRI
201 19-42-36
WAHYUNI
JKN 0 0.00
ILHAM
202 19-42-18 ABID Umum 30000 30000 60,000.00
ARIFUDIN
203 17-52-85 INDARTI Umum 30000 0 30,000.00
Sub Total : 1,210,080.00

204 10-Apr-19 19-43-91 DARYANI JKN 16800 7680 24,480.00

LISNAWA
205 19-43-89
TI
Umum 30000 30,000.00
MUHAMM
AD
206 16-96-05 HAMAS JKN 0 0.00
AL
HAFIDZ
YULI TRI
207 13-33-10
MARYANI
Umum 30000 30000 60,000.00
VALERIA
N
EVANGELI
208 19-43-88
NO
Umum 30000 10800 40,800.00
ABHINAY
A
VITTAMU
DA
209 19-43-67
DHARMA
JKN 16800 0 16,800.00
WATI
210 ### PARTINI JKN 16800 32640 49,440.00
YULI
211 19-43-90
ASTUTI
Umum 30000 30,000.00
IKA
212 19-16-70 SUPRIHAT Asuransi 30000 0 30,000.00
IN
DIAN
213 19-40-41 OCTAVIA JKN 16800 24000 40,800.00
NI
214 19-43-92 MARTOYO JKN 16800 58560 75,360.00
KIRANA
NASSYA
215 14-42-41
ANNORA
JKN 0 0.00
UTOMO

FAHTURO
HMAN
216 19-43-66
BINTORO
JKN 16800 0 16,800.00
PUTRO

MIKHAILA
AZZAHRA
217 15-98-60 PUTRI JKN 16800 16,800.00
IRMANSY
AH

IDA
218 19-43-87 SETYANIN Umum 21000 21,000.00
GSIH
 VICTORIA
NOVITA
219 19-27-87 ANIS JKN 16800 24000 40,800.00
PRASETY
ANI

220 19-41-82 SUPATMI JKN 16800 0 16,800.00

Sub Total : 509,880.00

MUHAMM
221 11-Apr-19 14-62-06 AD NUUR JKN 16800 0 16,800.00
ADDIN
YUSUB
222 19-43-95 FEBRI JKN 16800 31200 48,000.00
SUSANTO
ENI
223 19-43-94 KRISTANT Umum 30000 0 30,000.00
I
DWI
224 19-43-98 FEBRIANT Umum 30000 30000 60,000.00
O
ASKADIN
O
225 19-43-78
SYAKIRA
JKN 16800 37920 54,720.00
PURNAMA
ZASKISA
PUTRI
226 18-98-34
MAHARA
JKN 16800 24000 40,800.00
NI
FARIDA
227 18-32-75
HANUM
JKN 16800 0 16,800.00
MEI
SAROH
228 19-43-93
DWI
JKN 16800 16,800.00
ASTUTI
RAIHAN
MAHENDR
229 18-77-09
A JATI
Umum 30000 30,000.00
ROSYADI

230 17-23-85 SUMAROH JKN 16800 0 16,800.00

FARRAH
ASWAND
231 17-48-06 A JKN 16800 24000 40,800.00
ALTHAFU
NNISA
RAYAN
232 16-83-10 DWI JKN 16800 16,800.00
ISNAINUN
ANISA
233 ### MAKWA JKN 16800 16,800.00
AZIZA
Sub Total : 405,120.00

NILAM
234 12-Apr-19 19-45-03
SARI
Umum 30000 6600 36,600.00
SUPARMA
235 13-88-75
N
JKN 16800 32640 49,440.00

236 19-45-02 JUMIYEM JKN 16800 24000 40,800.00

DIANA
237 18-51-30 PUSPITAS JKN 16800 0 16,800.00
ARI
 ZAIDAN
238 19-44-98
ILHAM
Umum 30000 8400 38,400.00
HERI
239 16-54-74 PRASETY Umum 30000 0 30,000.00
O
NGATIYE
240 13-14-94
M
JKN 16800 0 16,800.00
TH INTAN
CHRISTIY
241 10-36-86
ANINGTY
Asuransi 30000 30,000.00
AS
DANIK
242 ###
NUGRAHA
Umum 30000 9600 39,600.00
ADLA
243 19-38-73 AMZAR JKN 16800 24000 40,800.00
HAMIZAN
STELLA
244 18-43-17 INTAN Umum 30000 17400 47,400.00
SURYATI
YUANITA
245 06-21-98 KUSUMAR JKN 16800 0 16,800.00
DANI
VALERIA
N
EVANGELI
246 19-43-88
NO
Umum 30000 10800 40,800.00
ABHINAY
A
PUTHUT
247 17-36-76 PURUHITO Asuransi 30000 30,000.00
SUBEKTI
WIJANG
248 19-44-99 PUTRA Umum 30000 30,000.00
SASMITA
LISTYARI
NI RATNA
249 13-31-94
WULAND
JKN 16800 0 16,800.00
ARI
MF
250 07-90-32 SRIRAWA Asuransi 30000 30,000.00
TI
251 19-45-01 SUTINEM Umum 30000 0 30,000.00
ALFAREZ
ELSETYA
252 17-19-39
KAVINDR
Asuransi 30000 30,000.00
A
Sub Total : 611,040.00

253 14-Apr-19 19-45-64 PAINEM JKN 16800 24000 40,800.00

AGUS
254 19-45-66 TRIYANT JKN 16800 75840 92,640.00
O
TRI
255 14-30-39 WININGSI JKN 16800 0 16,800.00
H HJ
SRI
256 08-64-07
NETTY
JKN 6720 6,720.00
AUDRIA
AFIA
257 13-42-18
PURBANI
JKN 16800 16,800.00
NGRUM
S NOVITA
258 19-45-48 TRI Umum 30000 30,000.00
JAYANTI
 DWI
259 19-45-60
NIKEN
JKN 16800 24000 40,800.00

260 19-45-57 LASIYEM JKN 16800 24000 40,800.00

UNTUNG
261 19-45-67
TRIYONO
Umum 30000 30,000.00
UMI
262 11-86-98 LESTARI JKN 16800 58560 75,360.00
HJ
AZZAM
QORIE
263 12-43-60
UMAR
JKN 16800 16,800.00
HAMZAH
ARVITA
264 18-43-76 PUTRI JKN 16800 16,800.00
HASTUTI

265 18-25-34 SUWARNI JKN 16800 32640 49,440.00

266 07-73-18 MARSITI JKN 16800 16,800.00

ENY
267 03-60-95 SULISTIA JKN 16800 0 16,800.00
NINGSIH
ANTONIU
S
268 7/7/1982
PRASETY
JKN 16800 41280 58,080.00
O JATI
269 19-45-55 KASTOYO JKN 16800 30720 47,520.00
JESSICA
270 19-45-65 CAESYA JKN 33600 24000 57,600.00
AGUSTIN
DOLY
ENY
271 11-71-23
KHALIFA
Umum 30000 30,000.00
H
GITO
272 15-79-37 SUHARJO Umum 30000 40800 70,800.00
SUGITO
PURWANT
273 12-95-05
I
JKN 16800 24000 40,800.00
FITRI
274 19-45-59
LESTARI
JKN 16800 16,800.00
DESI
275 13-30-67 WULAND JKN 16800 16,800.00
ARI
JOSHE
276 15-46-72 SASTRA Umum 30000 30,000.00
WINATA
PC
277 17-32-21 PURWANT JKN 16800 0 16,800.00
O
MUHAMM
AD
278 16-96-05 HAMAS JKN 16800 16,800.00
AL
HAFIDZ
WITRO
279 19-45-62
SUKARTO
JKN 16800 31680 48,480.00
LAURENTI
NA
280 14-55-74
SUPARTIN
Umum 30000 30,000.00
I
LOLITA
281 19-45-63
ELENSARI
Umum 30000 0 30,000.00
Sub Total : 1,017,840.00

NOVIA
282 15-Apr-19 19-41-30 RAMASAR JKN 16800 0 16,800.00
I
NOVANDA
DEA
283 17-22-85
SYAVALE
Umum 30000 30,000.00
NSY
FINA
284 19-46-63
SHOFIYA
Umum 30000 28200 58,200.00
NARENDR
A ARYA
285 19-46-62
KASYAFA
JKN 16800 24000 40,800.00
NI
286 07-20-95 GIYEM Umum 30000 0 30,000.00
YABES
287 09-87-21 ABDI Umum 30000 6600 36,600.00
ZEBAOTH
INDRI
288 17-58-63
HASTUTI
JKN 16800 0 16,800.00
SOFIYANA
289 17-46-76
YUBAIDA
JKN 16800 16,800.00
YUNI
290 19-46-58 SETYOWA Umum 30000 30,000.00
TI
ALOYSIUS
PRAMASE
291 17-86-09
TYA
Umum 30000 30,000.00
YUNIAR
WIDLIA
292 13-53-94 DWI JKN 16800 0 16,800.00
LEONA
AYU
NOVITA
293 19-46-64
NUGRAHE
Umum 30000 30,000.00
NI
RAHARJA
294 19-46-65
NTI
JKN 16800 13920 30,720.00
GILANG
295 16-87-23 AKBAR JKN 16800 24000 40,800.00
RIYADI
ADLI
296 19-46-29 AMZAR JKN 16800 16,800.00
HAMIZAN
ADZKIA
OLIVIA
297 19-46-57
PUTRI
Umum 30000 21600 51,600.00
ROHIB
WULAN
298 19-46-50
ISTIFARA
JKN 16800 24000 40,800.00
Sub Total : 533,520.00

AGUSTIN
299 16-Apr-19 ### RATNA JKN 16800 24000 40,800.00
RAHAYU

300 19-46-97 YATI JKN 16800 0 16,800.00

SRI
301 19-47-29
MULYANI
Umum 30000 38400 68,400.00
 MELANI
302 19-47-05 PUTRIA Umum 30000 17400 47,400.00
DEWI
ADIBA
303 18-50-42 FATHUNN JKN 16800 37920 54,720.00
ISA
RASYA
MUHAMM
304 17-96-54
AD
JKN 16800 24000 40,800.00
ARSAKHA
DEVAN
RAVINDR
305 16-72-85 A Asuransi 30000 21600 51,600.00
AKHTAR
MOUZA
FAZA
306 19-43-13 AZIZ Umum 30000 15000 45,000.00
ISMAIL
MELVIN
307 11-51-03 ADI JKN 16800 16,800.00
BINTARA
308 13-41-97 PAINU Umum 30000 0 30,000.00

309 18-95-01 HERPIYAH JKN 16800 0 16,800.00

AMELIA
310 19-47-20 RISTA Umum 30000 17400 47,400.00
PRATIWI
311 ### SUGIARTO JKN 16800 7680 24,480.00
312 19-47-24 SUYADI JKN 16800 31680 48,480.00
YUNI
313 19-46-58 SETYOWA Umum 30000 30,000.00
TI
SUKADI
314 18-65-25 SASTRO JKN 16800 16,800.00
ATMOJO
MARYON
315 15-73-70
O
Umum 30000 30000 60,000.00
ZELVANO
DIMAS
316 18-62-75
SYAPUTR
JKN 16800 16,800.00
A
317 19-47-04 DARNO JKN 16800 0 16,800.00
MUHAMM
AD
318 19-47-02 RAEHAN JKN 16800 24000 40,800.00
DWI
SAPUTRA
MURYANT
319 19-47-12
I
Umum 0 0 0.00
SAVIERA
FIDELA
320 15-68-50
ARAWIND
Umum 30000 30,000.00
A
SUKO
321 19-46-88
RAHARJO
Umum 30000 6600 36,600.00
QINJI
322 19-28-71 INDAH JKN 16800 0 16,800.00
CAHYANI

323 18-69-74 SUYANTI JKN 16800 24000 40,800.00

HIQMATU
324 19-47-27
L WAHDA
JKN 16800 24000 40,800.00
 MUHAMA
325 ### D ADIB Umum 30000 9600 39,600.00
EFENDI
Sub Total : 935,280.00

326 17-Apr-19 18-49-24 SUMARNI Asuransi 30000 0 30,000.00

SHAKENA
327 ### KHANZA Umum 30000 0 30,000.00
HUMAIRA
MEILATIA
328 19-47-71 DIVA JKN 16800 16,800.00
WAHYUDI
EKO
329 19-43-52 HARYANT JKN 16800 0 16,800.00
O
SUTARMA
330 19-35-15
N
JKN 16800 24000 40,800.00
Sub Total : 134,400.00

NURJANN
331 18-Apr-19 12-58-83 AH ARY JKN 16800 0 16,800.00
SUMARNO

332 19-47-84 TUMIRAH JKN 16800 31680 48,480.00

ROHMAT
333 19-47-77
SOLIKIN
JKN 16800 0 16,800.00
TRI
334 09-68-95
UTAMI
JKN 16800 0 16,800.00

335 15-16-92 HARJONO JKN 16800 63840 80,640.00

MULYON
336 19-47-85
O
Umum 30000 45000 75,000.00
SUKARJA
TI
337 12-55-31
PURWANI
JKN 16800 24000 40,800.00
NGSIH
338 ### HARTINI JKN 16800 13920 30,720.00
GO SIOE
339 10-74-38
HAY
JKN 16800 0 16,800.00
Sub Total : 342,840.00

CLODIO
YOGA
340 21-Apr-19 18-37-24
SYAHPUT
Umum 30000 30,000.00
RA
SEMI
341 19-49-61 HADI JKN 16800 0 16,800.00
SUGONDO
ZARIFA
AFANDA
342 19-49-58
RASYAFA
Umum 30000 30,000.00
NI
YULIANI
343 19-49-59
SAJIMAN
JKN 16800 16,800.00
Sub Total : 93,600.00

ANITA
344 22-Apr-19 19-43-81
IKAWATIE
Umum 30000 24000 54,000.00
ISTIANAH
345 19-50-04
MINATIN
Umum 30000 30,000.00
 ANGGER
346 09-73-56 SATYATA JKN 16800 16,800.00
MA
ENDRI
347 09-38-19 ROSITA JKN 16800 24000 40,800.00
DEWI

348 19-50-28 MARIYEM JKN 16800 0 16,800.00

JOKO
349 19-38-62
SUGORO
JKN 16800 16,800.00
ARMI
350 10-53-12 SURAHMA Umum 30000 0 30,000.00
DI
AISAH
SINTA
351 19-50-17
ARROYAN
JKN 16800 0 16,800.00
I
POSPER
352 19-49-64 KANANG JKN 16800 0 16,800.00
KUSALA
ANDI
353 19-50-13
RIYANTA
JKN 16800 0 16,800.00
ATIK
354 18-26-54 ROKHAYA Umum 0 0.00
NI
355 ### WAGIMAN JKN 16800 31680 48,480.00
HANIF
356 10-77-35
HUDA I
JKN 16800 0 16,800.00
SISWANT
357 15-36-00
O
JKN 16800 0 16,800.00
ML
358 16-58-76
KIRYEM
JKN 16800 0 16,800.00
NURUL
KURNIAW
359 14-56-43 ATI JKN 16800 16,800.00
SUDRAJA
T
LATIFAH
360 19-49-69 NURHAYA Asuransi 30000 30,000.00
TI
SITI
361 19-49-62
WARDANI
JKN 16800 32640 49,440.00
AZKA
362 17-77-36 MAULAN JKN 16800 16,800.00
A FADHIL
BOWO
363 17-54-91 SUPRIYAN JKN 16800 24000 40,800.00
TO
ARIE ADI
364 06-25-69
WALUYO
Umum 30000 9600 39,600.00

365 19-50-05 ESTI JKN 16800 24000 40,800.00

DWI
366 ### YULIANT Umum 30000 0 30,000.00
O
NOVITA
367 19-50-09
IKAWATI
Umum 30000 25800 55,800.00
KIRNIYAT
368 19-50-26
I
Umum 30000 73200 103,200.00

369 05-13-65 HARJONO Umum 30000 30,000.00

 YUNUS
370 19-50-27 TRIYANT JKN 16800 58560 75,360.00
O
FEBRI
371 19-49-63 TRIYANT Umum 30000 30,000.00
O
AQIL
RAZIQ
372 17-84-33
JARIS
JKN 16800 24000 40,800.00
SASIA
AGUS TRI
373 19-50-30
WAHYUDI
JKN 16800 0 16,800.00
DESY
TRISNA
374 14-58-09
AYUNING
JKN 16800 0 16,800.00
TYAS
375 ### JUMIKEM JKN 16800 16,800.00
ARDI
376 12-66-29 INDRAWA Asuransi 30000 30000 60,000.00
N
MIKHAYL
A AYUDIA
377 19-29-02
KASYAFA
JKN 16800 16,800.00
NI
378 19-50-23 SARYONO Umum 30000 30,000.00
AMRI
379 19-50-29
LATIFAH
JKN 24000 13920 37,920.00
RIRIN
KHUSWAT
380 19-38-12 UN JKN 16800 0 16,800.00
KHASANA
H
RAFA ADI
381 09-41-54 WICAKSA Umum 30000 30000 60,000.00
NA
ADHISTA
382 14-98-91 WIDHIAS JKN 16800 16,800.00
WARI
CHRITOH
383 11-96-22 ORUS EDY Umum 30000 30,000.00
MARTONO

384 19-50-24 SUMIRAH Umum 30000 0 30,000.00

NUR
385 11-78-71 ISTIQOMA JKN 16800 0 16,800.00
H
Sub Total : 1,319,400.00

ULYA
386 23-Apr-19 19-50-94 AWALIN Umum 30000 30000 60,000.00
NISSA
SEMI
387 19-49-61 HADI JKN 16800 24000 40,800.00
SUGONDO
388 19-51-01 SUYANTO JKN 16800 0 16,800.00
CANGGIH
389 19-50-66 CAHYO Umum 30000 0 30,000.00
UTOMO

390 19-49-74 SAENI JKN 16800 24000 40,800.00

RIS
391 06-94-13
HARJONO
JKN 16800 24000 40,800.00
 OKTORIA
392 19-50-77 N ANTON JKN 16800 24000 40,800.00
SUSILO
MAYLINA
393 19-50-87 KHANSA Umum 30000 30,000.00
DAMARA

394 19-30-01 FATIMAH JKN 16800 0 16,800.00

RAMIYAN
395 ###
TO
Umum 31800 31,800.00
GUSTIN
396 19-50-96 DYAH Umum 30000 6600 36,600.00
PRAMESTI
SURATINA
397 15-00-34
H
Umum 30000 0 30,000.00
ANDRIE
398 12-75-49 WIDIATM Umum 30000 30,000.00
OKO
TRIYANT
399 ###
O
Asuransi 30000 0 30,000.00
TINA
400 17-70-18 ANDRIA JKN 33600 24000 57,600.00
SARI
AA
401 17-67-06 GANESH Umum 30000 30000 60,000.00
WIDHI
SURATNO
402 11-58-47 RATNOGI JKN 16800 24000 40,800.00
HARJO
YUNITA
403 3/6/1973 SARASWA JKN 16800 16,800.00
TI
MARDI
404 14-54-30 WIDODO JKN 16800 58560 75,360.00
WAKIDIN
MUSTAK
WIN
405 11-72-36
FATKUL
JKN 16800 0 16,800.00
DJANAH
406 19-50-86 MARYANI JKN 16800 20640 37,440.00

407 19-50-92 MINAH JKN 16800 31680 48,480.00

PARTO
408 10-47-28
SUKIRNO
JKN 24000 45600 69,600.00

409 12-32-12 AMINAH Asuransi 30000 30,000.00

SONTO
410 07-14-80
INANGUN
JKN 16800 24000 40,800.00
Sub Total : 968,880.00

TYAS
CHICHI
411 24-Apr-19 14-26-11
ANGGRAI
JKN 0 0.00
NI
412 14-38-00 DALIMIN JKN 16800 0 16,800.00
MURWANI
413 19-51-73
NGSIH
JKN 16800 24000 40,800.00
414 ### PONIYEM Umum 30000 0 30,000.00
 IKA
415 14-58-31 ERNAWAT JKN 16800 0 16,800.00
I
ORDIN
416 19-51-71 YULIANT Umum 30000 30000 60,000.00
O
IKA BUDI
417 19-33-71
PURWANI
JKN 16800 0 16,800.00
KUS
418 19-51-72 HENDRAT Umum 30000 73200 103,200.00
MO
NURUL
419 19-18-50
AISIYAH
Umum 30000 30,000.00
Sub Total : 314,400.00

420 25-Apr-19 3/9/1999 MULYATI Umum 30000 30,000.00

SAUQI
421 18-72-34 DAFFIQ JKN 16800 24000 40,800.00
ASSEGAF
MUSLIKA
422 08-18-23
TUN HJ
JKN 16800 0 16,800.00
IKA
423 14-58-31 ERNAWAT JKN 16800 0 16,800.00
I
424 18-61-06 TRINEM JKN 16800 24000 40,800.00
DANU TRI
425 14-19-11 KURNIAW JKN 16800 29280 46,080.00
AN

426 14-38-00 DALIMIN JKN 16800 24000 40,800.00

ERNAWAT
427 18-88-50
I
Asuransi 30000 0 30,000.00
EDY
428 5/4/1987
YUWONO
JKN 16800 0 16,800.00
AIRA
429 16-31-53 FATIATUR JKN 16800 16,800.00
AHMAH

430 14-97-39 SUTIYEM JKN 16800 0 16,800.00

JONI
431 06-84-79
SANTOSO
JKN 16800 7680 24,480.00

432 19-52-21 SUKARTI JKN 16800 37920 54,720.00

ERNA
433 19-16-41 SUPRIHAT JKN 16800 0 16,800.00
IN
BAGUS
434 17-76-44 HERWINA JKN 16800 16,800.00
NTA
ISTIAWAT
I
435 05-40-75
PANCANI
JKN 16800 0 16,800.00
NG DYAH
ANINDITA
436 19-52-14 KEISHA JKN 16800 16,800.00
ZAHRA
ALIKA
437 19-39-86 NAILA JKN 16800 16,800.00
PUTRI
SRI
438 19-52-16
HARIYANI
Umum 30000 30000 60,000.00
 TIGOR
PARLINDU
439 19-52-18 NGAN Umum 30000 30,000.00
NAINGGO
LAN
JOKO
440 19-52-25
SANTOSO
Asuransi 30000 0 30,000.00
UMI
441 19-52-20
HABIBAH
JKN 16800 24000 40,800.00
SRI
442 19-34-68
MARTINI
JKN 16800 24000 40,800.00
ENDY
443 9/9/1983 PERMANA JKN 16800 0 16,800.00
ADI
ENDRI
444 09-38-19 ROSITA JKN 16800 24000 40,800.00
DEWI
Sub Total : 734,880.00
14,731,080.0
Jumlah
0

RAWAT INAP
Kirima
No Tanggal No Rm Nama Jaminan Visite
n Total

SAJI
1 19-Mar-19 18-96-27 MIARJO JKN 15,750.00 0.00 15,750.00
SAJIMAN
SUNGKON
2 28-Mar-19 10-74-11
O
JKN 13,608.00 0.00 13,608.00
SLAMET
3 29-Mar-19 ###
WIDODO
Umum 15,120.00 0.00 15,120.00

4 29-Mar-19 11-28-41 SUDARTA JKN 16,632.00 0.00 16,632.00

HADI
5 2-Apr-19 19-38-45
MIARJO
Umum 10,584.00 0.00 10,584.00
6 4-Apr-19 ### SAMIRAH JKN
IKA
10,584.00 0.00 10,584.00
MARHENI
7 4-Apr-19 15-75-26 K Asuransi 16,632.00 0.00 16,632.00
ANGGELL
A
AGUSTIN
8 4-Apr-19 14-28-65 A DWI JKN 10,584.00 0.00 10,584.00
RAHAYU
YUSTINUS
9 7-Apr-19 9/2/2027
SUWARDI
JKN 13,608.00 0.00 13,608.00
SUTIKNO
10 8-Apr-19 01-57-64 DIBYO JKN 13,608.00 0.00 13,608.00
SUTIKNO

11 12-Apr-19 19-31-27 SAMINAH JKN 9,525.60 0.00 9,525.60

CATHARI
NA
12 14-Apr-19 17-69-91
TRIWIJI
JKN 0.00 0.00 0.00
ASTUTI
SURAHMI
13 15-Apr-19 08-75-55
N
JKN 9,525.60 0.00 9,525.60
 DWI
14 16-Apr-19 19-47-38 HARYANT JKN 13,608.00 0.00 13,608.00
O
SUMIYON
15 16-Apr-19 ###
O
JKN 9,525.60 0.00 9,525.60
16 17-Apr-19 14-19-26 SUHARNI JKN 9,525.60 0.00 9,525.60
Jumlah 188,420.40

Tambahan Lain-lain
No Item
1X-
1 Pot BPJS = -75000
75000
Total -75000

Tambahan Lain-lain Potong PPH

No Item
Insentif 184 X
1 = 276,000.00
ranap 1500
Jadwal 9X
2 = 630,000.00
ICU 70000
Jadwal 8X
3 = 280,000.00
IGD 35000
Uang 8X
4 = 67,760.00
Hadir 8470
1,253,760.0
Total
0
Rekap Transaksi
Rekap
Rekap Rekap
Rekap Pendding
Item Keselur Dibayarka
Pendding Terbayar
uhan n
Bulan lalu
Rawat 14,731,0 14,731,080.
0.00 0.00
Jalan 80.00 00
Rawat
Jalan
0.00 0.00 0.00 0.00
Pemeriksaa
n IGD
Rawat Inap
Tindakan 0.00 0.00 0.00 0.00
IGD
Rawat Inap
188,420.
Tanpa 0.00 0.00 188,420.00
00
Kiriman
Rawat Inap
0.00 0.00 0.00 0.00
Kiriman
Jasa
0.00 0.00 0.00 0.00
Kiriman
Tambahan
1,253,76
Lain -lain 0 0 -75,000.00
0.00
potong pph
16,173,2 14,844,500.
Sub Total 0.00 0.00
60.00 00
-
Potongan
404,332. 0.00 0.00 -404,332.00
PPh 5 %
00
Potongan
Rawat Inap
Tanpa 0.00 0.00 0.00 0.00
Kiriman
20%

Potongan
Rawat Inap
0.00 0.00 0.00 0.00
Kiriman
15%
Potongan -
Perawat 745,975. 0.00 0.00 -745,975.00
IGD 5% 00
Bahan 0.00 0.00 0.00 0.00
Residen 0.00 0.00 0.00 0.00
Lain-lain 0.00 0.00 0.00 0.00
Gaji
Komite 0.00 0 0 0.00
Medik
Potongan
Telp Air 0.00 0 0 0.00
Litrik
- -
Potongan
2,523,54 0 0 2,523,549.0
Koperasi
9.00 0
Potongan
0.00 0 0 0.00
Piknik
-
Tambahan
75,000.0 0 0 -75,000.00
Lain-lain
0
12,424,4 12,424,404.
Total 0.00 0.00
04.00 00
 JADWAL AG
BULAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1-May-19 S M S S R K J S M S S R K J S M S S

DIDIK P L P P P P P P L P P P P P P L L P

CANDRA P P S S L L M M L L P P S M M L L P

AGUS S S P P M M L L S S P P M L C C C P
i i s
HERU L S S M M L L P P L M M L P P P S S
S L
IBNU M M L L P P S S C P P L M L S S P M
i i m
RIZKI C C M L S S P P M L L S S S M L L P
S S
IWAN L C M M L L S S M L S S P P P M L S
m L m
SUGENG S P M L P S S S L M M L L S S P P M
S
CHRISTIN P P L M L P P P S S M L P P M L M M
i i p
TRIYANTO M L P P P M L L P P
M L S L S S L C
m m
DANING L M L S S S M M L S S S P M L L S S
m
ARI S S L S S S P P L M M L L S S P M M L

MARSITI P P P S S L P P P L S S

PAGI 3 2 2 3 3 3 3 3 2 2 3 3 3 3 3 2 2 4
SIANG 3 2 3 3 3 3 2 3 2 2 3 3 3 3 3 2 2 3
MALAM 2 2 2 2 3 2 2 2 2 2 2 2 2 2 2 2 2 3

PERUBHAN JADWAL

JAGA PAGI

JAGA SIANG
WAL AGUSTUS 2020
19 20 21 22 23 24 25 26 27 28 29 30 31
R K J S M S S R K J S M S M

P L P P L P P P P P P L P

P P M L P P S S S L M M L 175 7

M M L L S S S P L M L L S 179 6

L P P M M L L C S S P L M 175 7

L L P P P S L M M L P P S 179 6

S S S S M L S S S L M M L 179 6

S S L P P M M L L P S S S 179 6
L
M L S S S S P M L L P L P 179 6
L
L L P S P P M L P P M L L 179 7

P M M L P L P S M M L P P 179 7
L
S P L M M L P P P S S S L 179 6
L
L S S C S M M L L S S L M 175

3 3 4 3 2 4 4 3 3 3 3 2 3
3 3 3 3 2 3 3 3 3 3 3 2 3
2 2 2 2 2 3 2 2 2 2 2 2 2