DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN DESEMBER 2017 RUMAH BERSALIN & KLINIK

HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 7/Dec/17 NY.JUNAENA IM GDS 20,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
2 7/Dec/17 NY.HJ.HADIJA IM GDS 20,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
3 7/Dec/17 NY.SANARIA IM GDS 20,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000

4 7/Dec/17 NY.AMA IM GDS 20,000 5,800

L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000

TOTAL 132,000 132,000 4,000 48,000 23,200

-
Rincian Rawat Jalan 132,000 132,000 -
Jasa Laboran 10,224 Rawat Inap - -
Total Bruto 132,000 132,000 -

dr. Nur Rahmi, Sp. P 10,224.00

Reagensia 23,200.00
Jasa Klinik 31,240.00
BHP 48,000.00
L 4,000
79,240.00
2017 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

KD Dokter
TOTAL JASA PEMB. LAB AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K

14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K

56,800 31,240 25,560 - 10,224 10,224 5,112

- -
10,366.00
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN JANUARI 2018 RUMAH BERSALIN & KLINIK S
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 28/Dec/17 NY.HUSNIA AB GDS 20,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
2 28/Dec/17 TN.TABSIR IM GDS 20,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
3 2/Jan/18 NY.NURLIA IM GDS 40,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
4 2/Jan/18 TN.ABD.LATIF IM GDS 40,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
5 2/Jan/18 NY.NURHALIMA IM GDS 40,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
6 11/Jan/18 NY.ARWAN MATASA IM GDS 40,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
7 11/Jan/18 NY.MULIA IM GDS 40,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
10 11/Jan/18 TN.SALIL IM GDS 40,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
11 16/Jan/18 TN.SYAMRIL IM GDS 40,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
12 16/Jan/18 TN.PATTOLA IM GDS 40,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
13 16/Jan/18 TN.H.HARUNA IM GDS 40,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
14 18/Jan/18 NY.A.MUSTIKA NUR IM GDS 40,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
TOTAL 596,000 596,000 11,000 132,000 106,600
 -
Rincian Rawat Jalan 596,000 596,000 -
Jasa Laboran 60,012 Rawat Inap - -
Total Bruto 596,000 596,000 -

dr. Nur Rahmi, Sp. P 60,012.00

Reagensia 106,600.00
Jasa Klinik 183,370.00
BHP 132,000.00
L 11,000
315,370.00
2018 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

KD Dokter
TOTAL JASA PEMB. LAB AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
333,400 183,370 150,030 - 60,012 60,012 30,006
- -
10,366.00
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN FEBRUARI 2018 RUMAH BERSALIN & KLINIK S
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 1/Feb/18 TN.SAPARUDDIN FD GDS 40,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
2 6/Feb/18 TN.LALISI IM GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
3 15/Feb/18 TN.ALIMUDDIN IM GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
4 15/Feb/18 TN.H.MUKHTAR IM GDS 40,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
5 22/Feb/18 NY.HJ.ROSI IM GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
6 22/Feb/18 TN.H.BADMAN EI GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
7 22/Feb/18 NY.ROSDIA IM GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
8 22/Feb/18 TN.NASIR IM GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
TOTAL 316,000 316,000 8,000 96,000 53,800

-
Rincian Rawat Jalan 316,000 316,000 -
Jasa Laboran 28,476 Rawat Inap - -
Total Bruto 316,000 316,000 -

dr. Nur Rahmi, Sp. P 28,476.00

Reagensia 53,800.00
Jasa Klinik 87,010.00
BHP 96,000.00
L 8,000
183,010.00
2018 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

KD Dokter
TOTAL JASA PEMB. LAB AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00 NR

K
K
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR

K
K
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR

K
K
30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00 NR

K
K
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR

K
K
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR

K
K
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR

K
K
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR

K
K
158,200 87,010 71,190 - 28,476 28,476 14,238

- -
22,265.00
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN MARET 2018 RUMAH BERSALIN & KLINIK SP
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 27/Feb/18 NY.HJ.RUSMI IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
2 27/Feb/18 NY.HJ.FATIMA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
3 27/Feb/18 NY.SRI IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
4 6/Mar/18 NY.JUMA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
5 6/Mar/18 NY.KASMA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
6 20/Mar/18 NY.HJ.NURJAMA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
7 22/Mar/18 NY.HARAMI IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
TOTAL 322,000 322,000 7,000 84,000 140,000

-
Rincian Rawat Jalan 322,000 322,000 -
Jasa Laboran 16,380 Rawat Inap - -
Total Bruto 322,000 322,000 -

dr. Nur Rahmi, Sp. P 16,380.00

Reagensia 140,000.00
Jasa Klinik 50,050.00
BHP 84,000.00
L 7,000
134,050.00
018 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

KD Dokter
TOTAL JASA PEMB. LAB AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR 9,490.00

NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
91,000 50,050 40,950 - 16,380 16,380 8,190

- -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN MARET 2018 RUMAH BERSALIN & KLINIK SP
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 27/Mar/18 NY.ITHIA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
2 27/Mar/18 NY.ST.AMINAH IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
3 5/Apr/18 TN.H.PARENRENGI IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
4 10/Apr/18 TN.M.MUNIR IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
5 12/Apr/18 TN.TUKIYEM IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
6 17/Apr/18 TN.KUDDING IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
7 17/Apr/18 NY.HJ.DARMA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
8 24/Apr/18 NY.HJ.NAKE IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
9 24/Apr/18 TN.SUDIRMAN IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000

TOTAL 414,000 414,000 9,000 108,000 180,000

-
Rincian Rawat Jalan 414,000 414,000 -
Jasa Laboran 21,060 Rawat Inap - -
Total Bruto 414,000 414,000 -

dr. Nur Rahmi, Sp. P 21,060.00

Reagensia 180,000.00
Jasa Klinik 64,350.00
BHP 108,000.00
L 9,000
172,350.00
018 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

KD Dokter
TOTAL JASA PEMB. LAB AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR 9,490.00

NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
SR
117,000 64,350 52,650 - 21,060 21,060 10,530

- -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN MEI 2018 RUMAH BERSALIN & KLINIK SPE
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 3/May/18 NY.HJ.KATTE IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
2 3/May/18 TN.ASRIANTO IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
3 15/May/18 NY.HJ.HALAMIA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
TOTAL 138,000 138,000 3,000 36,000 60,000

-
Rincian Rawat Jalan 138,000 138,000 -
Jasa Laboran 7,020 Rawat Inap - -
Total Bruto 138,000 138,000 -

dr. Nur Rahmi, Sp. P 7,020.00

Reagensia 60,000.00
Jasa Klinik 21,450.00
BHP 36,000.00
L 3,000
57,450.00
18 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

KD Dokter
TOTAL JASA PEMB. LAB AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR 9,490.00

NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
39,000 21,450 17,550 - 7,020 7,020 3,510

- -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN MEI 2018 RUMAH BERSALIN & KLINIK SPE
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 3/Jul/18 NY.JAISA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
2 3/Jul/18 TN.H.HARUNA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
3 3/Jul/18 TN.H.RASA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
4 3/Jul/18 NY.SAIBONANG IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
5 17/Jul/18 NY.NURHAYATI EI GDS 33,000 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 37,000 -
6 19/Jul/18 TN.STEVANUS IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
TOTAL 267,000 267,000 7,000 62,000 120,000

-
Rincian Rawat Jalan 267,000 - 267,000
Jasa Laboran 14,040 Rawat Inap - -
Total Bruto 267,000 - 267,000

dr. Nur Rahmi, Sp. P 14,040.00

Reagensia 120,000.00
Jasa Klinik 42,900.00
BHP 62,000.00
L 7,000
104,900.00
18 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

KD Dokter
TOTAL JASA PEMB. LAB AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR 9,490.00

NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
78,000 42,900 35,100 - 14,040 14,040 7,020

- -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN AGUSTUS 2018 RUMAH BERSALIN & KLINIK S
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 26/Jun/18 NY.ICCI IM GDS 33,000 20,000
L -
BHP -
Spoit + Tempat Darah 10,000 43,000 10,000
2 31/Jul/18 TN.HALIM IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
3 2/Aug/18 NY.MUJIANI EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
4 14/Aug/18 NY.HJ.KOTONG IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000

TOTAL 181,000 181,000 3,000 46,000 80,000

-
Rincian Rawat Jalan 181,000 181,000 -
Jasa Laboran 9,360 Rawat Inap - -
Total Bruto 181,000 181,000 -

dr. Nur Rahmi, Sp. P 9,360.00

Reagensia 80,000.00
Jasa Klinik 28,600.00
BHP 46,000.00
L 3,000
74,600.00
2018 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

KD Dokter
TOTAL JASA PEMB. LAB AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR 9,490.00

SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR

52,000 28,600 23,400 - 9,360 9,360 4,680

- -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN SEPTEMBER 2018 RUMAH BERSALIN & KLINIK
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 4/Sep/18 NY.SEMI EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
2 13/Sep/18 TN.KORNELIS IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
3 20/Sep/18 TN.AHMADIAH IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000

TOTAL 138,000 138,000 3,000 36,000 60,000

-
Rincian Rawat Jalan 138,000 138,000 -
Jasa Laboran 7,020 Rawat Inap - -
Total Bruto 138,000 138,000 -

dr. Nur Rahmi, Sp. P 7,020.00

Reagensia 60,000.00
Jasa Klinik 21,450.00
BHP 36,000.00
L 3,000
57,450.00
R 2018 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

KD Dokter
TOTAL JASA PEMB. LAB AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR 9,490.00

K
K
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR

K
K
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR

K
K

39,000 21,450 17,550 - 7,020 7,020 3,510

- -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN OKTOBER 2018 RUMAH BERSALIN & KLIN
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 27/Sep/18 TN.IBRAHIM IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
2 9/Oct/18 TN.ZAINUDDIN EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
3 11/Oct/18 TN.MIU KAMIL IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
4 11/Oct/18 TN.NURHANUDDIN IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
5 16/Oct/18 TN.M.KAMIL EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
6 16/Oct/18 NY.HJ.NURMI IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000

7 18/Oct/18 NY.MUNAWAARAH AB Kolesterol 36,000 10,200

GDS 22,000 5,800
SGOT 33,000 7,500
SGPT 33,000 7,500
Asam Urat 33,000 9,500
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 12,000 12,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 247,000 10,000
8 18/Oct/18 TN.BAKRI IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
9 23/Oct/18 NY.MISKI EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
10 23/Oct/18 TN.H.BATMAN EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
11 23/Oct/18 NY.HJ.NAWIRA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
12 23/Oct/18 NY.ST.NUR IM GDS 33,000 20,000
L 1,000 1,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000

13 23/Oct/18 TN.ABD.RAUF IM GDS 33,000 20,000

L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
14 23/Oct/18 TN.HASAN IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
15 25/Oct/18 TN.SUDIRMAN IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
TOTAL 891,000 891,000 26,000 180,000 344,000

-
Rincian Rawat Jalan 891,000 - 891,000
Jasa Laboran 61,380 Rawat Inap - -
Total Bruto 891,000 - 891,000

dr. Nur Rahmi, Sp. P 61,380.00

Reagensia 344,000.00
Jasa Klinik 187,550.00
BHP 180,000.00
L 26,000
367,550.00
2018 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

KD Dokter
TOTAL JASA PEMB. LAB AN PJ LABORAN Pengirim
KLINIK 55% 45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR

NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
- - - - - SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
 K NR
K NR
NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K NR
K NR
341,000 187,550 153,450 - 61,380 61,380 30,690

- -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN NOVEMBER 2018 RUMAH BERSALIN & KLINIK
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 22/Nov/18 NY.ZAENAB EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
2 22/Nov/18 NY.MAEMUNA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
TOTAL 92,000 92,000 1,000 24,000 40,000

-
Rincian Rawat Jalan 92,000 - 92,000
Jasa Laboran 4,680 Rawat Inap - -
Total Bruto 92,000 - 92,000

dr. Nur Rahmi, Sp. P 4,680.00

Reagensia 40,000.00
Jasa Klinik 14,300.00
BHP 24,000.00
L 1,000
38,300.00
2018 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

KD Dokter
TOTAL JASA PEMB. LAB AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR

SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
26,000 14,300 11,700 - 4,680 4,680 2,340

- -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN JUNI 2019 RUMAH BERSALIN & KL
HARGA

NO TGL NAMA dr URAIAN TARIF TOTAL

PASIEN L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 28/May/19 NY. HJ. SUMI IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
2 11/Jun/19 TN. ARWIN IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
TOTAL 92,000 92,000 1,000 24,000 40,000

-
Rincian Rawat Jalan 92,000 92,000
Jasa Laboran 4,680 Rawat Inap - -
Total Bruto 92,000 92,000

dr. Nur Rahmi, Sp. PK 4,680.00

Reagensia 40,000.00
Jasa Klinik 14,300.00
BHP 24,000.00
L 1,000
38,300.00
I 2019 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

Dokter
TOTAL JASA PEMB. LAB KD AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR

SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K
26,000 14,300 11,700 - 4,680 4,680 2,340

- -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN JUNI 2019 RUMAH BERSALIN & KL
HARGA

NO TGL NAMA dr URAIAN TARIF TOTAL

PASIEN L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 4/Jul/19 TN. FACHRI IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
2 16/Jul/19 NY. ZAENAB IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
2 23/Jul/19 NY.SARI IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000

TOTAL 138,000 138,000 1,000 24,000 40,000

-
Rincian Rawat Jalan 138,000 138,000
Jasa Laboran 4,680 Rawat Inap - -
Total Bruto 138,000 138,000

dr. Nur Rahmi, Sp. PK 4,680.00

Reagensia 40,000.00
Jasa Klinik 14,300.00
BHP 24,000.00
L 1,000
38,300.00
I 2019 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

Dokter
TOTAL JASA PEMB. LAB KD AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR

SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K

26,000 14,300 11,700 - 4,680 4,680 2,340

- -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN AGUSTUS 2019 RUMAH BERSALIN &
HARGA

NO TGL NAMA dr URAIAN TARIF TOTAL

PASIEN L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 29/Aug/19 NY. HASNA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
2 3/Sep/19 NY.HJ.HALMI IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
3 3/Sep/19 SYARIFUDDIN IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
4 11/Jan/00 NY. DALA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
5 19/Sep/19 NY.HJ.SITTI IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
6 24/Sep/19 HJ. NAJAMIA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
7 24/Sep/19 NY. WINALDA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
8 24/Sep/19 Tn. Tappa IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000

TOTAL 368,000 368,000 1,000 24,000 40,000

-
Rincian Rawat Jalan 368,000 368,000
Jasa Laboran 4,680 Rawat Inap - -
Total Bruto 368,000 368,000

dr. Nur Rahmi, Sp. PK 4,680.00

Reagensia 40,000.00
Jasa Klinik 14,300.00
BHP 24,000.00
L 1,000
38,300.00
US 2019 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

Dokter
TOTAL JASA PEMB. LAB KD AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR

SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K

26,000 14,300 11,700 - 4,680 4,680 2,340

- -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN FEBRUARI 2020 RUMAH BERSALIN &
HARGA

NO TGL NAMA dr URAIAN TARIF TOTAL

PASIEN L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 28/Jan/20 NY. SARINEM IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
2 6/Feb/20 TN. KAMBUL IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
3 13/Feb/20 TN. ABD. RA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
4 20/Feb/20 AN RAYYAN AK Darah Rutin 64,000 32,000
IgG/IgM 140,000 100,000
Widal 28,000 3,500
L 10,000 -
BHP 9,000 -
Spoit + Tempat 15,000 266,000 -
5 20/Feb/20 NY. ASIA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
6 25/Feb/20 NY. NURHlisa IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000

TOTAL 496,000 496,000 1,000 24,000 40,000

-
Rincian Rawat Jalan 496,000 496,000
Jasa Laboran 4,680 Rawat Inap - -
Total Bruto 496,000 496,000

dr. Nur Rahmi, Sp. PK 4,680.00

Reagensia 40,000.00
Jasa Klinik 14,300.00
BHP 24,000.00
L 1,000
38,300.00
ARI 2020 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

Dokter
TOTAL JASA PEMB. LAB KD AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR

SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
40,000.00 22,000.00 18,000.00 L 7,200.00 7,200.00 3,600.00
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
- - - - -
K
K
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K

26,000 14,300 11,700 - 4,680 4,680 2,340

- -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA WONOMULYO BULAN APRIL 2020 RUMAH BERSALIN & KL
HARGA

NO TGL NAMA dr URAIAN TARIF TOTAL

PASIEN L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT JALAN
1 31/Mar/20 MUKINA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
2 7/Apr/20 TN. TASHIL IM GDS 33,000 20,000
L 1,000 1,000
BHP 7,000 7,000
Spoit + Tempat 10,000 51,000 10,000
3 14/Apr/20 TN. SAHABA IM GDS 33,000 20,000
L 1,000 1,000
BHP 7,000 7,000
Spoit + Tempat 10,000 51,000 10,000

TOTAL 148,000 148,000 1,000 29,000 40,000

-
Rincian Rawat Jalan 148,000 148,000
Jasa Laboran 4,680 Rawat Inap - -
Total Bruto 148,000 148,000

dr. Nur Rahmi, Sp. PK 4,680.00

Reagensia 40,000.00
Jasa Klinik 14,300.00
BHP 29,000.00
L 1,000
43,300.00
L 2020 RUMAH BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

Dokter
TOTAL JASA PEMB. LAB KD AN PJ LABORAN Pengirim
KLINIK 55%
45% 40% 40 % 20 %

11 12 13 14 15 16 17

13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR

SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
K SR

26,000 14,300 11,700 - 4,680 4,680 2,340

- -