DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN DESEMBER 2017 RUMAH SAKIT BERSALIN &

HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 29/11/17 Tn. H. Saddong SW Darah Rutin 58,000
GDS 20,000
SGOT 30,000
SGPT 30,000
Ureum 30,000
Kreatinin 30,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 216,000 10,000
2 30/11/17 Tn. Irwansyah SP Urine Rutin 45,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 60,000 10,000
3 01/12/17 Ny. Hj. A. St. Djamro EI GDS 20,000
Kolesterol 32,000
SGOT 30,000
SGPT 30,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 128,000 10,000
4 01/12/17 An. Edwin Chandra RD Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
5 02/12/17 Ny. Salva Ramadhant AB Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
6 05/12/17 Ny. Anis Wahida AB Darah Rutin 58,000
Darah Rutin 58,000
Golongan Darah 15,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 158,000 20,000
7 05/12/17 Tn. Muh. Natsir RD Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
8 01/12/17 Ny. Hasna RD GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Darah Rutin 58,000
GDS 20,000
GDS 20,000
GDS 20,000
GDS 20,000
GDS 20,000
 L 9,000 9,000
BHP 12,000 12,000
Spoit + Tempat Darah 60,000 349,000 60,000
9 06/12/17 Ny. Marlina AB Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
10 10/12/17 Ny. Suarmi RT Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
11 09/12/17 Ny. Martadika RD GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Darah Rutin 58,000
Darah Rutin 58,000
Darah Rutin 58,000
Asam Urat 30,000
Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
Elektrolit 60,000 60,000
transport 17,000 17,000
GDS 20,000
L 15,000 15,000
BHP 17,000 17,000
Spoit + Tempat Darah 70,000 633,000 70,000
12 05/12/17 An. Andi M. Rafa KR Darah Rutin 58,000
Darah Rutin 58,000
Darah Rutin 58,000
SGOT 30,000
SGPT 30,000
GDS 20,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat Darah 30,000 292,000 30,000
13 11/12/17 Tn. Nurdin Moha RD Darah Rutin 58,000
Darah Rutin 58,000
SGOT 30,000
SGPT 30,000
Ureum 30,000
Kreatinin 30,000
HCV 67,000 67,000
Billdirek 25,000 25,000
Billtot 25,000 25,000
HbSAg 35,000
transport 16,000
GDS 20,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 454,000 20,000
14 17/12/17 Ny. Hj. Nurlia RD GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 10,000
SW GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
15 17/12/17 Tn. H. Daming KR GDS 20,000
Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
Albumin 20,000 20,000
transport 17,000 17,000
L 15,000 15,000
BHP 17,000 17,000
Spoit + Tempat Darah 20,000 20,000
SW GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 261,000 10,000
16 17/12/17 Ny. Risnawati RT Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
17 13/12/17 Ny. Mulianti AB Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
18 05/12/17 Ny. Nurhana KR Darah Rutin 58,000
Widal 25,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
19 11/12/17 Ny. Hj. Rahmawati EI Darah Rutin 58,000
SGOT 30,000
SGPT 30,000
GDS 20,000
GDS 20,000
Elektrolit 60,000 60,000
transport 17,000 17,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat Darah 25,000 270,000 25,000
20 13/12/17 Tn. Irwan IR GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Asam Urat 30,000
Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
Elektrolit 60,000 60,000
transport 9,000 9,000
L 9,000 9,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 350,000 10,000
21 14/12/17 Tn. Bakir EI Darah Rutin 58,000
 Ureum 30,000
Kreatinin 30,000
GDS 20,000
SGOT 30,000
SGPT 30,000
HbSAg 35,000
Urine Rutin 45,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 294,000 10,000
22 13/12/17 Ny. Hj. Lisa RD GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
Elektrolit 60,000 60,000
transport 9,000 9,000
L 9,000 9,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 20,000
EI Urine Rutin 45,000
GDS 20,000
GDS 20,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat Darah 30,000 454,000 30,000
23 20/12/17 Ny. Fatmawati SP Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Elektrolit 60,000 60,000
transport 17,000 17,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 10,000
EI Urine Rutin 45,000
GDS 20,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat Darah 30,000 339,000 30,000
24 21/12/17 Tn. Mahyadi Mahdi SW Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Urine Rutin 45,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 200,000 10,000
25 09/12/17 An. Nafila AK Elektrolit 60,000 60,000
Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Urine Rutin 45,000
L 3,000 3,000
 BHP 4,000 4,000
Spoit + Tempat Darah 10,000 260,000 10,000
26 22/12/17 An. Thyo IR Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
27 24/12/17 Ny. Hj. Juliana Ali RT Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
28 24/12/17 Ny. Satriawati AB Darah Rutin 58,000
Darah Rutin 58,000
Golongan Darah 15,000
Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
GDS 20,000
Urine Rutin 45,000
L 9,000 9,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 349,000 20,000
29 24/12/17 Tn. Ambun EI Darah Rutin 58,000
GDS 20,000
GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
Kreatinin 30,000
Ureum 30,000
SGOT 30,000
SGPT 30,000
GDS 20,000
L 10,000 10,000
BHP 6,000 6,000
Spoit + Tempat Darah 30,000 346,000 30,000
30 13/12/2017 An. Muh. Andryl isma RD Widal 25,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 38,000 10,000
RAWAT JALAN
1 01/12/17 TN.H.BAHRI LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
2 01/12/17 NN.ERNA SP Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
3 01/12/17 TN.HAMDANI LL Golongan Darah 15,000
GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 4,000 4,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 113,000 10,000
4 01/12/17 AN.MUH.ANWAR SP Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
5 02/11/17 TN.HASAMI RD Kolesterol 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 45,000 10,000
6 04/12/17 NY. RASMAWATI LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
7 04/12/17 NY. IKA SP GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
8 04/12/17 TN. BONGGA SP GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
9 04/12/17 NY. HARTATI SP Kolesterol 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 45,000 10,000
10 04/12/17 NY.HASNA IR GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
11 04/12/17 TN.ISKAK LL GDS 20,000
Kolesterol 32,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
12 05/12/17 TN.ANDA KR Malaria 70,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 142,000 10,000
13 05/12/17 NY. HASNA LL Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
14 06/12/17 NY.HJ.SANABI RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 97,000 10,000
15 06/12/17 TN. SUWITO EI Darah Rutin 58,000
Kolesterol 32,000
Asam Urat 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
L 10,000 10,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 237,000 15,000
16 07/12/17 AN.RESKY ADITYA RD Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
17 07/12/17 AN. A. FARZAN LL GDS 20,000
Darah Rutin 58,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 107,000 20,000
18 08/12/17 TN. H. SAIFUL LL GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
19 08/12/17 NY. HJ. MUNIRA LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
20 08/12/17 NY. HASNA IB GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
21 08/12/17 NN. NUR AZILA LL Darah Rutin 58,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 59,000 -
22 09/12/17 NY. HJ. NURWIAH RT Darah Rutin 58,000
L -
BHP -
Spoit + Tempat Darah 58,000 -
23 09/12/17 NY. HASMA SW Darah Rutin 58,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 125,000 10,000
24 09/12/17 NY. HJ. SALMA LL Asam Urat 30,000
Darah Rutin 58,000
GDS 20,000
Kolesterol 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 156,000 10,000
25 11/12/17 NY.HJ.ROHANI LL GDS 20,000
Kolesterol 32,000
 Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
26 11/12/17 TN.SAIPUL LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
27 11/12/17 TN.JUNAIT LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
28 11/12/17 TN. ZAMHARIL RD GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
29 11/12/17 NY. HJ. RADIAH IM GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
30 11/12/17 NY. AMA IM GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
31 11/12/17 TN. H. M. RUSLI EI HbSAg 35,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 79,000 20,000
32 11/12/17 NY. FAJRIAH EI Urine Rutin 45,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 58,000 10,000
33 11/12/17 NY. SRI JAMALIA EI Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
34 12/12/17 TN. ARIFIN IR GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
35 13/12/17 NY.NAIMA LL Darah Rutin 58,000
GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 156,000 10,000
36 13/12/17 NY.HJ.SURIANI RD GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 33,000 10,000
37 13/12/17 TN. H. RUSLY RD Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
38 13/12/17 NY. SATRIAWATI AB Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
39 13/12/17 NY. ILMA EI GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
40 13/12/17 TN. H. HERMAN RD Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
41 13/12/17 NY. HJ. RADIAH EI GDS 20,000
L -
BHP -
Spoit + Tempat Darah 10,000 30,000 10,000
42 13/12/17 NY. HJ. RAMLAH RD Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
43 14/12/17 TN. MANSUR EI Urine Rutin 45,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 58,000 10,000
44 14/12/17 TN. JIMMY KR Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
45 14/12/17 NY. SANAWIAH EI HbSAg 35,000
Darah Rutin 58,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 124,000 20,000
46 15/12/17 TN. IRWAN KR Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
47 15/12/17 TN. ABD. LATIEF KR Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
48 15/12/17 NY.HARMANI LL GDS 20,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 92,000 10,000
49 15/12/17 NY.ERNA KR Kolesterol 32,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
50 16/12/17 NY.HJ.HASNAH LL Trigliserida 25,000
GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 123,000 10,000
51 16/12/17 TN.RIKI REZKI KR Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
52 18/12/17 TN.RAMDAN LL Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
53 18/12/17 NY.RUKMINI LL GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
54 18/12/17 NY.A.YULIANI KR Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
55 18/12/17 AN. RAFASYA LL Malaria 70,000
Widal 25,000
Darah Rutin 58,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 168,000 10,000
56 18/12/17 NY.HJ. BAWANG SIN IR GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
57 18/12/17 TN. JALALUDDIN LL Kolesterol 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 45,000 10,000
58 18/12/17 NY. NARA IM GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
59 19/12/17 NY.HJ.NURMA RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
60 19/12/17 TN. H. M. ARIF RD Kolesterol 32,000
 Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
61 20/12/17 TN.H. HAMZAH RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
62 20/12/17 NY. HJ. LIJA EI GDS 20,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 92,000 10,000
63 22/12/17 TN.DADANG RD Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
64 22/12/17 TN.H.PATAJANGI RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
65 22/12/17 NY.DARMAWATI RT Urine Rutin 45,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 58,000 10,000
66 25/12/17 NN.AYU SP GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
67 25/12/17 TN.MASKAR SP HbSAg 35,000
SGOT 30,000
SGPT 30,000
GDS 20,000
Darah Rutin 58,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 190,000 10,000
68 25/12/17 NY.HJ.DALLE RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
69 25/12/17 NY.HJ.RAHMANIA RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
70 25/12/17 NY.LELA LL Asam Urat 30,000
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
71 25/12/17 NY. RAHMA LL Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
72 25/12/17 TN. MUH. ILYAS SP Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000

TOTAL 12,221,000 12,221,000 905,000 1,604,000

-

Rincian Rawat Inap 6,185,000 - 6,185,000

Jasa Laboran 1,130,652 Rawat Jalan 6,036,000 6,036,000 -
Total Bruto 12,221,000 6,036,000 6,185,000

dr. Nur Rahmi, Sp. 1,119,612.00

Reagensia 3,676,600.00
Jasa Klinik 3,426,020.00
BHP 1,604,000.00 1,580,000
L 905,000
5,030,020.00
SEMBER 2017 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
 K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00

25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
 K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
 9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K

30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00
 K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00

K
K

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
 K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
60,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
 K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
 9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
 K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
 K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
2,000 23,000.00 9,200.00 13,800.00 L 1,380.00 12,420.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
60,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
 9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
 K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K

3,676,600 6,235,400 3,426,020 2,809,380 - 1,119,612 1,130,652 553,437

1,734,385
1,691,635 -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN DESEMBER 2017 RUMAH SAKIT BERSALIN &
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 01/12/17 Ny. Hj. A. St. Djamro EI GDS 20,000
Kolesterol 32,000
SGOT 30,000
SGPT 30,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 128,000 10,000
2 01/12/17 An. Edwin Chandra RD Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
3 02/12/17 Ny. Salva Ramadhant AB Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
4 05/12/17 Ny. Anis Wahida AB Darah Rutin 58,000
Darah Rutin 58,000
Golongan Darah 15,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 158,000 20,000
5 05/12/17 Tn. Muh. Natsir RD Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
6 01/12/17 Ny. Hasna RD GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Darah Rutin 58,000
GDS 20,000
GDS 20,000
GDS 20,000
GDS 20,000
GDS 20,000
L 9,000 9,000
BHP 12,000 12,000
Spoit + Tempat Darah 60,000 349,000 60,000
7 06/12/17 Ny. Marlina AB Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
8 10/12/17 Ny. Suarmi RT Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
 9 09/12/17 Ny. Martadika RD GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Darah Rutin 58,000
Darah Rutin 58,000
Darah Rutin 58,000
Asam Urat 30,000
Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
Elektrolit 60,000 60,000
transport 17,000 17,000
GDS 20,000
L 10,000 10,000
BHP 17,000 17,000
Spoit + Tempat Darah 70,000 628,000 70,000
10 05/12/17 An. Andi M. Rafa KR Darah Rutin 58,000
Darah Rutin 58,000
Darah Rutin 58,000
SGOT 30,000
SGPT 30,000
GDS 20,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat Darah 30,000 292,000 30,000
11 11/12/17 Tn. Nurdin Moha RD Darah Rutin 58,000
Darah Rutin 58,000
SGOT 30,000
SGPT 30,000
Ureum 30,000
Kreatinin 30,000
HCV 67,000 67,000
Billdirek 25,000 25,000
Billtot 25,000 25,000
HbSAg 35,000
transport 16,000
GDS 20,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 454,000 20,000
12 17/12/17 Ny. Hj. Nurlia RD GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 10,000
SW GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
12 17/12/17 Tn. H. Daming KR GDS 20,000
Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
Albumin 20,000 20,000
transport 17,000 17,000
L 15,000 15,000
BHP 17,000 17,000
 Spoit + Tempat Darah 20,000 20,000
SW GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 261,000 10,000
14 17/12/17 Ny. Risnawati RT Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
15 13/12/17 Ny. Mulianti AB Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
16 05/12/17 Ny. Nurhana KR Darah Rutin 58,000
Widal 25,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
17 11/12/17 Ny. Hj. Rahmawati EI Darah Rutin 58,000
SGOT 30,000
SGPT 30,000
GDS 20,000
GDS 20,000
Elektrolit 60,000 60,000
transport 17,000 17,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat Darah 25,000 270,000 25,000
18 13/12/17 Tn. Irwan IR GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Asam Urat 30,000
Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
Elektrolit 60,000 60,000
transport 9,000 9,000
L 9,000 9,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 350,000 10,000
19 14/12/17 Tn. Bakir EI Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
SGOT 30,000
SGPT 30,000
HbSAg 35,000
Urine Rutin 45,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 294,000 10,000
20 13/12/17 Ny. Hj. Lisa RD GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
 Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
Elektrolit 60,000 60,000
transport 9,000 9,000
L 9,000 9,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 20,000
EI Urine Rutin 45,000
GDS 20,000
GDS 20,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat Darah 30,000 454,000 30,000
21 20/12/17 Ny. Fatmawati SP Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Elektrolit 60,000 60,000
transport 17,000 17,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 10,000
EI Urine Rutin 45,000
GDS 20,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat Darah 30,000 339,000 30,000
22 21/12/17 Tn. Mahyadi Mahdi SW Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Urine Rutin 45,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 200,000 10,000
23 09/12/17 An. Nafila AK Elektrolit 60,000 60,000
Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Urine Rutin 45,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 260,000 10,000
24 22/12/17 An. Thyo IR Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
25 24/12/17 Ny. Hj. Juliana Ali RT Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
26 24/12/17 Ny. Satriawati AB Darah Rutin 58,000
 Darah Rutin 58,000
Golongan Darah 15,000
Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
GDS 20,000
Urine Rutin 45,000
L 9,000 9,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 349,000 20,000
27 24/12/17 Tn. Ambun EI Darah Rutin 58,000
GDS 20,000
GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
Kreatinin 30,000
Ureum 30,000
SGOT 30,000
SGPT 30,000
GDS 20,000
L 10,000 10,000
BHP 6,000 6,000
Spoit + Tempat Darah 30,000 346,000 30,000
28 13/12/2017 An. Muh. Andryl isma RD Widal 25,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 38,000 10,000
RAWAT JALAN
1 01/12/17 TN.H.BAHRI LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
2 01/12/17 NN.ERNA SP Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
3 01/12/17 TN.HAMDANI LL Golongan Darah 15,000
GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 113,000 10,000
4 01/12/17 AN.MUH.ANWAR SP Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
5 02/11/17 TN.HASAMI RD Kolesterol 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 45,000 10,000
6 04/12/17 NY. RASMAWATI LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
7 04/12/17 NY. IKA SP GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
8 04/12/17 TN. BONGGA SP GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
9 04/12/17 NY. HARTATI SP Kolesterol 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 45,000 10,000
10 04/12/17 NY.HASNA IR GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
11 04/12/17 TN.ISKAK LL GDS 20,000
Kolesterol 32,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
12 05/12/17 TN.ANDA KR Malaria 70,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 142,000 10,000
13 05/12/17 NY. HASNA LL Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
14 06/12/17 NY.HJ.SANABI RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
15 06/12/17 TN. SUWITO EI Darah Rutin 58,000
Kolesterol 32,000
Asam Urat 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
L 10,000 10,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 237,000 15,000
16 07/12/17 AN.RESKY ADITYA RD Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
17 07/12/17 AN. A. FARZAN LL GDS 20,000
Darah Rutin 58,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 107,000 20,000
18 08/12/17 TN. H. SAIFUL LL GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
19 08/12/17 NY. HJ. MUNIRA LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
20 08/12/17 NY. HASNA IB GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
21 08/12/17 NN. NUR AZILA LL Darah Rutin 58,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 59,000 -
22 09/12/17 NY. HJ. NURWIAH RT Darah Rutin 58,000
L -
BHP -
Spoit + Tempat Darah 58,000 -
23 09/12/17 NY. HASMA SW Darah Rutin 58,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 125,000 10,000
24 09/12/17 NY. HJ. SALMA LL Asam Urat 30,000
Darah Rutin 58,000
GDS 20,000
Kolesterol 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 156,000 10,000
25 11/12/17 NY.HJ.ROHANI LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
26 11/12/17 TN.SAIPUL LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
27 11/12/17 TN.JUNAIT LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
28 11/12/17 TN. ZAMHARIL RD GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
29 11/12/17 NY. HJ. RADIAH IM GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
30 11/12/17 NY. AMA IM GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
31 11/12/17 TN. H. M. RUSLI EI HbSAg 35,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 79,000 20,000
32 11/12/17 NY. FAJRIAH EI Urine Rutin 45,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 58,000 10,000
33 11/12/17 NY. SRI JAMALIA EI Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
34 12/12/17 TN. ARIFIN IR GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
35 13/12/17 NY.NAIMA LL Darah Rutin 58,000
GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 156,000 10,000
36 13/12/17 NY.HJ.SURIANI RD GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
37 13/12/17 TN. H. RUSLY RD Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
38 13/12/17 NY. SATRIAWATI AB Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
39 13/12/17 NY. ILMA EI GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
40 13/12/17 TN. H. HERMAN RD Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
41 13/12/17 NY. HJ. RADIAH EI GDS 20,000
L -
BHP -
Spoit + Tempat Darah 10,000 30,000 10,000
42 13/12/17 NY. HJ. RAMLAH RD Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
43 14/12/17 TN. MANSUR EI Urine Rutin 45,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 58,000 10,000
44 14/12/17 TN. JIMMY KR Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
45 14/12/17 NY. SANAWIAH EI HbSAg 35,000
Darah Rutin 58,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 124,000 20,000
46 15/12/17 TN. IRWAN KR Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
47 15/12/17 TN. ABD. LATIEF KR Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
48 15/12/17 NY.HARMANI LL GDS 20,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 92,000 10,000
49 15/12/17 NY.ERNA KR Kolesterol 32,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
50 16/12/17 NY.HJ.HASNAH LL Trigliserida 25,000
GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 123,000 10,000
51 16/12/17 TN.RIKI REZKI KR Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
52 18/12/17 TN.RAMDAN LL Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
53 18/12/17 NY.RUKMINI LL GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
54 18/12/17 NY.A.YULIANI KR Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
55 18/12/17 AN. RAFASYA LL Malaria 70,000
Widal 25,000
Darah Rutin 58,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 168,000 10,000
56 18/12/17 NY.HJ. BAWANG SIN IR GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
57 18/12/17 TN. JALALUDDIN LL Kolesterol 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 45,000 10,000
58 18/12/17 NY. NARA IM GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
59 19/12/17 NY.HJ.NURMA RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
60 19/12/17 TN. H. M. ARIF RD Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
61 20/12/17 TN.H. HAMZAH RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
62 20/12/17 NY. HJ. LIJA EI GDS 20,000
Darah Rutin 58,000
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 92,000 10,000
63 22/12/17 TN.DADANG RD Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
64 22/12/17 TN.H.PATAJANGI RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
65 22/12/17 NY.DARMAWATI RT Urine Rutin 45,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 58,000 10,000
66 25/12/17 NN.AYU SP GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
67 25/12/17 TN.MASKAR SP HbSAg 35,000
SGOT 30,000
SGPT 30,000
GDS 20,000
Darah Rutin 58,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 190,000 10,000
68 25/12/17 NY.HJ.DALLE RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
69 25/12/17 NY.HJ.RAHMANIA RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
70 25/12/17 NY.LELA LL Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
71 25/12/17 NY. RAHMA LL Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
72 25/12/17 TN. MUH. ILYAS SP Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
 TOTAL 12,156,000 12,156,000 891,000 1,580,000
-

Rincian Rawat Inap 6,120,000 6,120,000 -

Jasa Laboran 1,100,070 Rawat Jalan 6,036,000 6,036,000 -
Total Bruto 12,156,000 12,156,000 -

dr. Nur Rahmi, Sp. 1,089,030.00

Reagensia 3,603,500.00
Jasa Klinik 3,332,575.00
BHP 1,580,000.00 1,580,000
L 891,000
4,912,575.00
SEMBER 2017 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
 5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00

25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00

K
 K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
 9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K

30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00

K
K

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
 K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
60,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
 K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
 K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
 K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
2,000 23,000.00 9,200.00 13,800.00 L 1,380.00 12,420.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
60,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
 K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
3,603,500 6,065,500 3,332,575 2,732,925 - 1,089,030 1,100,070 538,146
1,734,385
1,598,190 -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN DESEMBER 2017 RUMAH SAKIT BERSALIN &
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 01/12/17 Ny. Hj. A. St. Djamro EI GDS 20,000
Kolesterol 32,000
SGOT 30,000
SGPT 30,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 128,000 10,000
2 01/12/17 An. Edwin Chandra RD Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
3 02/12/17 Ny. Salva Ramadhant AB Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
4 05/12/17 Ny. Anis Wahida AB Darah Rutin 58,000
Darah Rutin 58,000
Golongan Darah 15,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 158,000 20,000
5 05/12/17 Tn. Muh. Natsir RD Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
6 01/12/17 Ny. Hasna RD GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Darah Rutin 58,000
GDS 20,000
GDS 20,000
GDS 20,000
GDS 20,000
GDS 20,000
L 9,000 9,000
BHP 12,000 12,000
Spoit + Tempat Darah 60,000 349,000 60,000
7 06/12/17 Ny. Marlina AB Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
8 10/12/17 Ny. Suarmi RT Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
 9 09/12/17 Ny. Martadika RD GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Darah Rutin 58,000
Darah Rutin 58,000
Darah Rutin 58,000
Asam Urat 30,000
Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
Elektrolit 60,000 60,000
transport 17,000 17,000
GDS 20,000
L 10,000 10,000
BHP 17,000 17,000
Spoit + Tempat Darah 70,000 628,000 70,000
10 05/12/17 An. Andi M. Rafa KR Darah Rutin 58,000
Darah Rutin 58,000
Darah Rutin 58,000
SGOT 30,000
SGPT 30,000
GDS 20,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat Darah 30,000 292,000 30,000
11 11/12/17 Tn. Nurdin Moha RD Darah Rutin 58,000
Darah Rutin 58,000
SGOT 30,000
SGPT 30,000
Ureum 30,000
Kreatinin 30,000
HCV 67,000 67,000
Billdirek 25,000 25,000
Billtot 25,000 25,000
HbSAg 35,000
transport 16,000
GDS 20,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 454,000 20,000
12 17/12/17 Ny. Hj. Nurlia RD GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 10,000
SW GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
12 17/12/17 Tn. H. Daming KR GDS 20,000
Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
Albumin 20,000 20,000
transport 17,000 17,000
L 15,000 15,000
BHP 17,000 17,000
 Spoit + Tempat Darah 20,000 20,000
SW GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 261,000 10,000
14 17/12/17 Ny. Risnawati RT Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
15 13/12/17 Ny. Mulianti AB Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
16 05/12/17 Ny. Nurhana KR Darah Rutin 58,000
Widal 25,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
17 11/12/17 Ny. Hj. Rahmawati EI Darah Rutin 58,000
SGOT 30,000
SGPT 30,000
GDS 20,000
GDS 20,000
Elektrolit 60,000 60,000
transport 17,000 17,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat Darah 25,000 270,000 25,000
18 13/12/17 Tn. Irwan IR GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Asam Urat 30,000
Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
Elektrolit 60,000 60,000
transport 9,000 9,000
L 9,000 9,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 350,000 10,000
19 14/12/17 Tn. Bakir EI Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
SGOT 30,000
SGPT 30,000
HbSAg 35,000
Urine Rutin 45,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 294,000 10,000
20 13/12/17 Ny. Hj. Lisa RD GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
 Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
Elektrolit 60,000 60,000
transport 9,000 9,000
L 9,000 9,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 20,000
EI Urine Rutin 45,000
GDS 20,000
GDS 20,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat Darah 30,000 454,000 30,000
21 20/12/17 Ny. Fatmawati SP Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Elektrolit 60,000 60,000
transport 17,000 17,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 10,000
EI Urine Rutin 45,000
GDS 20,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat Darah 30,000 339,000 30,000
22 21/12/17 Tn. Mahyadi Mahdi SW Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Urine Rutin 45,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 200,000 10,000
23 09/12/17 An. Nafila AK Elektrolit 60,000 60,000
Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Urine Rutin 45,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 260,000 10,000
24 22/12/17 An. Thyo IR Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
25 24/12/17 Ny. Hj. Juliana Ali RT Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
26 24/12/17 Ny. Satriawati AB Darah Rutin 58,000
 Darah Rutin 58,000
Golongan Darah 15,000
Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
GDS 20,000
Urine Rutin 45,000
L 9,000 9,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 349,000 20,000
27 24/12/17 Tn. Ambun EI Darah Rutin 58,000
GDS 20,000
GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
Kreatinin 30,000
Ureum 30,000
SGOT 30,000
SGPT 30,000
GDS 20,000
L 10,000 10,000
BHP 6,000 6,000
Spoit + Tempat Darah 30,000 346,000 30,000
28 13/12/2017 An. Muh. Andryl isma RD Widal 25,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 38,000 10,000
RAWAT JALAN
1 01/12/17 TN.H.BAHRI LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
2 01/12/17 NN.ERNA SP Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
3 01/12/17 TN.HAMDANI LL Golongan Darah 15,000
GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 113,000 10,000
4 01/12/17 AN.MUH.ANWAR SP Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
5 02/11/17 TN.HASAMI RD Kolesterol 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 45,000 10,000
6 04/12/17 NY. RASMAWATI LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
7 04/12/17 NY. IKA SP GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
8 04/12/17 TN. BONGGA SP GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
9 04/12/17 NY. HARTATI SP Kolesterol 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 45,000 10,000
10 04/12/17 NY.HASNA IR GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
11 04/12/17 TN.ISKAK LL GDS 20,000
Kolesterol 32,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
12 05/12/17 TN.ANDA KR Malaria 70,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 142,000 10,000
13 05/12/17 NY. HASNA LL Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
14 06/12/17 NY.HJ.SANABI RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
15 06/12/17 TN. SUWITO EI Darah Rutin 58,000
Kolesterol 32,000
Asam Urat 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
L 10,000 10,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 237,000 15,000
16 07/12/17 AN.RESKY ADITYA RD Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
17 07/12/17 AN. A. FARZAN LL GDS 20,000
Darah Rutin 58,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 107,000 20,000
18 08/12/17 TN. H. SAIFUL LL GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
19 08/12/17 NY. HJ. MUNIRA LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
20 08/12/17 NY. HASNA IB GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
21 08/12/17 NN. NUR AZILA LL Darah Rutin 58,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 59,000 -
22 09/12/17 NY. HJ. NURWIAH RT Darah Rutin 58,000
L -
BHP -
Spoit + Tempat Darah 58,000 -
23 09/12/17 NY. HASMA SW Darah Rutin 58,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 125,000 10,000
24 09/12/17 NY. HJ. SALMA LL Asam Urat 30,000
Darah Rutin 58,000
GDS 20,000
Kolesterol 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 156,000 10,000
25 11/12/17 NY.HJ.ROHANI LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
26 11/12/17 TN.SAIPUL LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
27 11/12/17 TN.JUNAIT LL GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
28 11/12/17 TN. ZAMHARIL RD GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
29 11/12/17 NY. HJ. RADIAH IM GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
30 11/12/17 NY. AMA IM GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
31 11/12/17 TN. H. M. RUSLI EI HbSAg 35,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 79,000 20,000
32 11/12/17 NY. FAJRIAH EI Urine Rutin 45,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 58,000 10,000
33 11/12/17 NY. SRI JAMALIA EI Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
34 12/12/17 TN. ARIFIN IR GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
35 13/12/17 NY.NAIMA LL Darah Rutin 58,000
GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 156,000 10,000
36 13/12/17 NY.HJ.SURIANI RD GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
37 13/12/17 TN. H. RUSLY RD Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
38 13/12/17 NY. SATRIAWATI AB Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
39 13/12/17 NY. ILMA EI GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
40 13/12/17 TN. H. HERMAN RD Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
41 13/12/17 NY. HJ. RADIAH EI GDS 20,000
L -
BHP -
Spoit + Tempat Darah 10,000 30,000 10,000
42 13/12/17 NY. HJ. RAMLAH RD Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
43 14/12/17 TN. MANSUR EI Urine Rutin 45,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 58,000 10,000
44 14/12/17 TN. JIMMY KR Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
45 14/12/17 NY. SANAWIAH EI HbSAg 35,000
Darah Rutin 58,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 124,000 20,000
46 15/12/17 TN. IRWAN KR Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
47 15/12/17 TN. ABD. LATIEF KR Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
48 15/12/17 NY.HARMANI LL GDS 20,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 92,000 10,000
49 15/12/17 NY.ERNA KR Kolesterol 32,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
50 16/12/17 NY.HJ.HASNAH LL Trigliserida 25,000
GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 123,000 10,000
51 16/12/17 TN.RIKI REZKI KR Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
52 18/12/17 TN.RAMDAN LL Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
53 18/12/17 NY.RUKMINI LL GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
54 18/12/17 NY.A.YULIANI KR Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
55 18/12/17 AN. RAFASYA LL Malaria 70,000
Widal 25,000
Darah Rutin 58,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 168,000 10,000
56 18/12/17 NY.HJ. BAWANG SIN IR GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
57 18/12/17 TN. JALALUDDIN LL Kolesterol 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 45,000 10,000
58 18/12/17 NY. NARA IM GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
59 19/12/17 NY.HJ.NURMA RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
60 19/12/17 TN. H. M. ARIF RD Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
61 20/12/17 TN.H. HAMZAH RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
62 20/12/17 NY. HJ. LIJA EI GDS 20,000
Darah Rutin 58,000
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 92,000 10,000
63 22/12/17 TN.DADANG RD Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
64 22/12/17 TN.H.PATAJANGI RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
65 22/12/17 NY.DARMAWATI RT Urine Rutin 45,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 58,000 10,000
66 25/12/17 NN.AYU SP GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
67 25/12/17 TN.MASKAR SP HbSAg 35,000
SGOT 30,000
SGPT 30,000
GDS 20,000
Darah Rutin 58,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 190,000 10,000
68 25/12/17 NY.HJ.DALLE RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
69 25/12/17 NY.HJ.RAHMANIA RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
70 25/12/17 NY.LELA LL Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
71 25/12/17 NY. RAHMA LL Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
72 25/12/17 TN. MUH. ILYAS SP Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
 TOTAL 12,156,000 12,156,000 891,000 1,580,000
-

Rincian Rawat Inap 6,120,000 6,120,000 -

Jasa Laboran 1,100,070 Rawat Jalan 6,036,000 6,036,000 -
Total Bruto 12,156,000 12,156,000 -

dr. Nur Rahmi, Sp. 1,089,030.00

Reagensia 3,603,500.00
Jasa Klinik 3,332,575.00
BHP 1,580,000.00 1,580,000
L 891,000
4,912,575.00
SEMBER 2017 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
 5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00

25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00

K
 K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
 9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K

30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00

K
K

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
 K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
60,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
 K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
 K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
 K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
2,000 23,000.00 9,200.00 13,800.00 L 1,380.00 12,420.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
60,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
 K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
25,000 10,000.00 5,500.00 4,500.00 1,800.00 1,800.00 900.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
3,603,500 6,065,500 3,332,575 2,732,925 - 1,089,030 1,100,070 541,980
1,734,385
1,598,190 -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN JANUARI 2018 RUMAH SAKIT BERSALIN &
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 26/12/17 Ny. Rahmawati rd GDS 20,000
Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 216,000 10,000
2 26/12/17 Ny. Hj. Katrina AB Darah Rutin 58,000
Darah Rutin 58,000
Golongan Darah 15,000
SGOT 30,000
SGPT 30,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 303,000 20,000
3 26/12/17 Ny. Nuraini RT Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
4 23/12/17 An. Muh. Abid RD Darah Rutin 58,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 92,000 10,000
5 26/12/17 Nn. Vita SP Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
6 26/12/17 Ny. Hj. Samsinar SP Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
7 29/12/17 Tn. H. Gazali SP Darah Rutin 58,000
GDS 20,000
GDS 20,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Elektrolit 260,000 260,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat Darah 30,000 479,000 30,000
8 28/12/17 Ny. Poniati RD GDS 22,000
 GDS 22,000
GDS 22,000
GDS 22,000
Darah Rutin 64,000
Kolesterol 32,000
Darah Rutin 64,000
Asam Urat 30,000
SGOT 33,000
SGPT 33,000
Ureum 33,000
Kreatinin 33,000
Urine Rutin 50,000
GDS 22,000
Golongan Darah 22,000
L 15,000 15,000
BHP 10,000 10,000
Spoit + Tempat Darah 50,000 579,000 50,000
9 06/01/18 Ny. Ludia Palembang sp GDS 20,000
GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Asam Urat 30,000
L 7,000 7,000
BHP 8,000 8,000
Spoit + Tempat Darah 30,000 30,000
SW GDS 20,000
GDS 20,000
GDS 20,000
L 4,000 4,000
BHP 8,000 8,000
Spoit + Tempat Darah 30,000 307,000 30,000
10 03/01/18 Tn. H. Usman ei GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Darah Rutin 58,000
Asam Urat 30,000
Ureum 30,000
Kreatinin 30,000
L 7,000 7,000
BHP 8,000 8,000
Spoit + Tempat Darah 20,000 293,000 20,000
11 04/01/18 Ny. Sarkiah AB Darah Rutin 58,000
GDS 20,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 117,000 20,000
12 03/01/18 Tn. H. Abd. Hakim RD Darah Rutin 64,000
GDS 20,000
GDS 20,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 20,000
EI SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
Ureum 33,000
 Kreatinin 33,000
Kolesterol 32,000
Asam Urat 30,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
Urine Rutin 50,000
L 10,000 10,000
BHP 6,000 6,000
Spoit + Tempat Darah 80,000 667,000 80,000
13 07/01/18 Tn. Hasanuddin EI Darah Rutin 58,000
GDS 20,000
GDS 20,000
GDS 20,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Elektrolit 260,000 260,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat Darah 45,000 518,000 45,000
14 06/01/18 An. Jesica KR GDS 20,000
GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
15 07/12/17 An. Fira Mifi KR Darah Rutin 58,000
GDS 20,000
GDS 20,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 123,000 20,000
16 07/12/17 Tn. Muh. Natsir KR Darah Rutin 58,000
Kolesterol 32,000
Ureum 30,000
Kreatinin 30,000
Kolesterol 32,000
L 5,000 5,000
BHP 6,000 6,000
Spoit + Tempat Darah 20,000 213,000 20,000
17 07/01/18 An. Afika KR Darah Rutin 64,000
GDS 22,000
GDS 22,000
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 123,000 10,000
18 09/01/18 Tn. H. Usman EI Darah Rutin 64,000
GDS 22,000
GDS 22,000
SGOT 33,000
SGPT 33,000
Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
 Asam Urat 33,000
GDS 22,000
GDS 22,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat Darah 15,000 383,000 15,000
19 10/01/18 Ny. Hj. St. Hajar RD GDS 22,000
Kolesterol 36,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat Darah 20,000 93,000 20,000
20 09/01/18 An. Ahmad Faqih IR Darah Rutin 64,000
L 1,000 1,000
BHP 3,000 3,000
Spoit + Tempat Darah 15,000 83,000 15,000
21 11/01/18 Ny. Hj. Diana SW Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Kolesterol 36,000
Kreatinin 33,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 208,000 10,000
22 11/01/18 An. Muh. Andryl Isma RD Widal 25,000
BHP 1,000 1,000
L 2,000 2,000
Spoit + Tempat Darah 10,000 38,000 10,000
23 12/01/18 AN. Meisya AK Darah Rutin 64,000
Widal 28,000
L 13,000 13,000
BHP 5,000 5,000
Spoit + Tempat Darah 10,000 120,000 10,000
24 11/01/18 Ny. Daeng Pandang SW Darah Rutin 64,000
GDS 22,000
GDS 22,000
SGOT 33,000
SGPT 33,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
GDS 22,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 303,000 10,000
25 12/01/18 Ny. Arniwati AB Darah Rutin 64,000
Golongan Darah 17,000
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 105,000 10,000
26 13/01/18 Ny. Zawiyah AB Darah Rutin 64,000
Golongan Darah 15,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 5,000 87,000 5,000
27 11/01/18 Ny. Nurlina SP Darah Rutin 64,000
L 5,000 5,000
BHP 4,000 4,000
 Spoit + Tempat Darah 10,000 83,000 10,000
28 16/01/18 Ny. Minarni AB Darah Rutin 64,000
Golongan Darah 17,000
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 105,000 10,000
29 16/01/18 By. Lyla SP Darah Rutin 64,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 83,000 10,000
30 19/01/18 An. Ahmad Khaerul IR GDS 22,000
Darah Rutin 64,000
L 10,000 10,000
BHP 7,000 7,000
Spoit + Tempat Darah 20,000 123,000 20,000
31 19/01/18 Tn. Rahman IR Darah Rutin 64,000
GDS 22,000
Widal 28,000
SGOT 33,000
SGPT 33,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
GDS 22,000
L 12,000 12,000
BHP 8,000 8,000
Spoit + Tempat Darah 20,000 330,000 20,000
32 19/01/18 Ny. Masna RD Darah Rutin 64,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
ADT 100,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
Elektrolit 260,000 260,000
L 20,000 20,000
BHP 15,000 15,000
Spoit + Tempat Darah 80,000 803,000 80,000
33 24/01/18 Ny. Agustina Dewi SV Darah Rutin 64,000
Golongan Darah 15,000
L 2,300 2,300
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 93,300 10,000
34 24/01/18 An. Farah IR Darah Rutin 64,000
Widal 28,000
L 4,800 4,800
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 109,800 10,000
35 25/01/18 Ny. Murniati SV Darah Rutin 64,000
Golongan Darah 15,000
L 2,300 2,300
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 93,300 10,000

RAWAT JALAN
1 26/12/17 TN. ANSAR LL/SP Darah Rutin 58,000
Widal 25,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 130,000 10,000
2 27/12/17 H. BAHRI LL GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
3 27/12/17 Hj. RAFA LL GDS 20,000
Kolesterol 32,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
4 27/12/17 NY. SUKMAWATI RD GDS 20,000
Asam Urat 30,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
5 27/12/17 NY. Hj. NURHAEDAH RD GDS 20,000
Asam Urat 30,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
6 27/12/17 NY. HJj. RISMA RD Asam Urat 30,000
Kolesterol 32,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
7 27/12/17 NY.YULIAN LL Asam Urat 30,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
8 27/12/17 NY. LUDIA SP Asam Urat 30,000
Kolesterol 32,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
9 27/12/17 Hj. ASLINA SP Asam Urat 30,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
10 27/12/17 Hj. ROHANIA EI Asam Urat 30,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
11 27/12/17 NY. FAHRISAH SP Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
12 28/12/17 TN.JAMALUDDIN SP Asam Urat 30,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 49,000 10,000
13 28/12/17 NY.HJ.AISYAH RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
Kreatinin 30,000
Ureum 30,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 159,000 10,000
14 30/12/17 TN. YACOB LL Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
15 30/12/17 TN.H.MANNAN RD GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
16 30/12/17 TN. TAUFIK LL Kolesterol 32,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
17 01/01/18 NY. INDAH IR Asam Urat 30,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
18 01/01/18 AN.FARIQ SP Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
19 01/01/18 NY.HERAWATI SP Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
20 01/01/18 AN.ANISA RD Widal 37,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 50,000 10,000
21 01/01/18 Hj. NISMA LL Darah Rutin 74,000
GDS 32,000
Kolesterol 40,000
Asam Urat 40,000
 L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 203,000 10,000
22 02/01/18 TN.NAJAMUDDIN LL Golongan Darah 17,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
23 03/01/18 TN.KRISTO KR Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
24 03/01/18 AN. NAUVAL LL Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
25 03/01/18 NY. Hj. RADIAH AA GDS 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 57,000 20,000
26 03/01/18 NY. DEBORA EI Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 264,000 20,000
27 03/01/18 NY. Hj. SIRANG AA Asam Urat 30,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
28 03/01/18 TN. ARIS KASA EI Darah Rutin 64,000
Widal 25,000
GDS 20,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 125,000 10,000
29 05/01/18 NY.HJ.YUSNIAR RD Darah Rutin 64,000
Widal 25,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 123,000 10,000
30 05/01/18 NY.HASNA SK Urine Rutin 45,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
31 05/01/18 AN.M.ILYAS AK Darah Rutin 70,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
32 06/01/18 TN. SYAHRIL SP GDS 39,000
Kolesterol 40,000
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 93,000 10,000
33 06/01/18 NY.HARTATI SV Urine Rutin 45,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
34 06/01/18 NY.NURHADIA LL Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
35 08/01/18 ERNAWATI IR Asam Urat 39,000
Kolesterol 40,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 93,000 10,000
36 08/01/18 NY.FATIMA KR Darah Rutin 58,000
Widal 25,000
GDS 20,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 120,000 10,000
37 08/01/18 NY.HJ.RADIAH AA GDS 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 53,000 15,000
38 09/01/18 NY.HJ.SARINA LL Kolesterol 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 53,000 15,000
39 09/01/18 TN. NOPRIANUS SW Urine Rutin 45,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
40 09/01/18 NY. SITTI JOSHA RD Darah Rutin 70,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
41 10/01/18 TN.ARIFIN KR Asam Urat 39,000
Kolesterol 40,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 93,000 10,000
42 10/01/18 NY.DALLE EI GDS 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 53,000 15,000
43 10/01/18 NY. HANI KR Darah Rutin 64,000
Widal 25,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 123,000 10,000
44 10/01/18 TN. KARMAN IM GDS 32,000
L 4,000 4,000
BHP 2,000 2,000
 Spoit + Tempat Darah 15,000 53,000 15,000
45 10/01/18 TN. SAIDIN IM GDS 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 53,000 15,000
46 11/01/18 NY.FARIDA LL Darah Rutin 70,000
GDS 32,000
Kolesterol 40,000
Asam Urat 40,000
Ureum 40,000
Kreatinin 40,000
SGOT 40,000
SGPT 40,000
L 12,000 12,000
BHP 6,000 6,000
Spoit + Tempat Darah 35,000 395,000 35,000
47 11/01/18 NY.HJ.NISMA LL Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
48 11/01/18 NY.BURU SW Urine Rutin 50,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 75,000 20,000
49 11/01/18 TN. SELLE SW Asam Urat 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 65,000 20,000
50 11/01/18 TN.YOSEP SW GDS 32,000
Kolesterol 40,000
Asam Urat 40,000
Kreatinin 40,000
L 12,000 12,000
BHP 6,000 6,000
Spoit + Tempat Darah 20,000 190,000 20,000
51 12/01/18 TN.HASNUR LL Kolesterol 40,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
52 12/01/18 NY.HJ.HAJAR LL Darah Rutin 70,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
53 12/01/18 FITRANINGSIH RD Kolesterol 40,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
54 12/01/18 TN.MUSANIP EI Darah Rutin 70,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
55 13/01/18 AN.RISTO RD Malaria 90,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 120,000 20,000
56 13/01/18 TN.SUPRIADI RD Malaria 90,000
L 10,000 10,000
BHP 3,000 3,000
Spoit + Tempat Darah 20,000 123,000 20,000
57 15/01/18 NY. MARJI SP Asam Urat 40,000
GDS 40,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 135,000 10,000
58 15/01/18 NY. HJ. SRI YUNIARTI LL GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
59 15/01/18 NY. ROSMAWATI LL Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
60 17/01/18 TN.HAERUDDIN IR Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
61 17/01/18 TN.ABD.KADIR RD Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
62 17/01/18 NY.MASDA RD Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
63 19/01/18 TN.SILFERIUS RD Kolesterol 40,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
64 19/01/18 NY.MEGAWATI AB Darah Rutin 70,000
Widal 28,000
Malaria 90,000
GDS 20,000
L 9,000 9,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 230,000 10,000
65 19/01/18 NY.INDAWATI EI Urine Rutin 45,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
66 19/01/18 NY.RAHMAWATI IR Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
67 20/01/18 TN.ROHANDI SW Kolesterol 40,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
68 22/01/18 TN.HENDRA RD Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
69 22/01/18 TN.BASTIAN IR Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 45,000 10,000
70 22/01/18 AN.MAMAS IR Golongan Darah 15,000
Widal 25,000
Darah Rutin 58,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 113,000 10,000
71 22/01/18 NY.HJ.NURLIA RD Kolesterol 32,000
GDS 20,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 67,000 10,000
72 22/01/18 TN.MAIL IR Asam Urat 40,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
73 22/01/18 TN.AULIA RAHMAN IR Widal 28,000
Darah Rutin 70,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 120,000 15,000
74 22/01/18 NY.NASBIAH EI Asam Urat 40,000
GDS 38,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 93,000 10,000
75 22/01/18 NY. IMLA RAHIM EI Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
76 23/01/18 HJ.HAPIDA IR Darah Rutin 70,000
Asam Urat 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 163,000 10,000
77 23/01/18 TN.ANSAR RD Darah Rutin 70,000
Widal 28,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 118,000 10,000
 78 23/01/18 NY.DIONESIS VERIA SW GDS 20,000
Urine Rutin 45,000
L 6,500 6,500
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 84,500 10,000
79 23/01/18 TN.HASAN SW Kolesterol 36,000
L 1,200 1,200
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 48,200 10,000
80 24/01/18 NY.RUFINA RD Kolesterol 36,000
L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 48,000 10,000
81 24/01/18 NY.HJ.FATIMAH RD Asam Urat 33,000
GDS 22,000
Kolesterol 36,000
L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 103,000 10,000
TOTAL 13,195,100 13,195,100 1,267,100 2,015,000
-

Rincian Rawat Inap 7,555,400 - 7,555,400

Jasa Laboran 1,438,452 Rawat Jalan 7,844,700 7,844,700 -
Total Bruto 15,400,100 7,844,700 7,555,400

dr. Nur Rahmi, Sp. 1,438,452.00

Reagensia 4,120,600.00
Jasa Klinik 4,395,270.00
BHP 2,015,000.00 1,550,000
L 1,267,100
6,410,270.00
ANUARI 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,000 17,000.00 9,350.00 7,650.00 L 3,060.00 3,060.00 1,530.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00

K
K
3,500 21,500.00 11,825.00 9,675.00 L 3,870.00 3,870.00 1,935.00
K

K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
25,000 75,000.00 41,250.00 33,750.00 L 13,500.00 13,500.00 6,750.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
L - - -

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00
 K
K

32,000 26,000.00 14,300.00 11,700.00 L 4,680.00 4,680.00 2,340.00

3,500 21,500.00 11,825.00 9,675.00 L 3,870.00 3,870.00 1,935.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00
 K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00

K
K
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
2,000 35,000.00 19,250.00 15,750.00 L 6,300.00 6,300.00 3,150.00

K
K
32,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00
10,000 30,000.00 16,500.00 13,500.00 L 5,400.00 5,400.00 2,700.00
 K
K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00

K
K
32,000 26,000.00 14,300.00 11,700.00 L 4,680.00 4,680.00 2,340.00

K
K
32,000 26,000.00 14,300.00 11,700.00 L 4,680.00 4,680.00 2,340.00

K
K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 21,500.00 11,825.00 9,675.00 L 3,870.00 3,870.00 1,935.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 21,500.00 11,825.00 9,675.00 L 3,870.00 3,870.00 1,935.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00

K
K
5,800 33,200.00 18,260.00 14,940.00 L 5,976.00 5,976.00 2,988.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00
 K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
9,500 29,500.00 16,225.00 13,275.00 L 5,310.00 5,310.00 2,655.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
32,000 26,000.00 14,300.00 11,700.00 L 4,680.00 4,680.00 2,340.00
3,500 21,500.00 11,825.00 9,675.00 L 3,870.00 3,870.00 1,935.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00

K
K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00

K
K
9,500 29,500.00 16,225.00 13,275.00 L 5,310.00 5,310.00 2,655.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 21,500.00 11,825.00 9,675.00 L 3,870.00 3,870.00 1,935.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00

K
 K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00
10,000 30,000.00 16,500.00 13,500.00 L 5,400.00 5,400.00 2,700.00
10,000 30,000.00 16,500.00 13,500.00 L 5,400.00 5,400.00 2,700.00
13,500 26,500.00 14,575.00 11,925.00 L 4,770.00 4,770.00 2,385.00
7,500 32,500.00 17,875.00 14,625.00 L 5,850.00 5,850.00 2,925.00
7,500 32,500.00 17,875.00 14,625.00 L 5,850.00 5,850.00 2,925.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00
10,000 30,000.00 16,500.00 13,500.00 L 5,400.00 5,400.00 2,700.00
13,500 26,500.00 14,575.00 11,925.00 L 4,770.00 4,770.00 2,385.00

K
K
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00

K
K
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00

K
K
65,000 25,000.00 13,750.00 11,250.00 L 4,500.00 4,500.00 2,250.00

K
K
65,000 25,000.00 13,750.00 11,250.00 L 4,500.00 4,500.00 2,250.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 34,200.00 18,810.00 15,390.00 L 6,156.00 6,156.00 3,078.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
65,000 25,000.00 13,750.00 11,250.00 L 4,500.00 4,500.00 2,250.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00
 K
K
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00
9,500 28,500.00 15,675.00 12,825.00 L 5,130.00 5,130.00 2,565.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
 5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
4,120,600 7,991,400 4,395,270 3,596,130 - 1,438,452 1,438,452 719,226
2,444,255
1,951,015 -
HARGA BARU

SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00 L

SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00 L
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L
Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L
Elektrolit 260,000 260,000
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L
Malaria 80,000 60,000 20,000.00 11,000.00 9,000.00 L
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L
ADT 100,000 10,000 90,000.00 30,000.00 60,000.00 L
 4,590.00 4,590.00 2,295.00
4,590.00 4,590.00 2,295.00
5,760.00 5,760.00 2,880.00
4,140.00 4,140.00 2,070.00
3,510.00 3,510.00 1,755.00
4,644.00 4,644.00 2,322.00
4,230.00 4,230.00 2,115.00
2,916.00 2,916.00 1,458.00
7,560.00 7,560.00 3,780.00

2,160.00 2,160.00 1,080.00

2,340.00 2,340.00 1,170.00 strip
3,600.00 3,600.00 1,800.00
4,410.00 4,410.00 2,205.00
24,000.00 24,000.00 12,000.00
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN JANUARI 2018 RUMAH SAKIT BERSALIN &
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 26/12/17 Ny. Rahmawati RD GDS 20,000
Darah Rutin 58,000
Ureum 30,000
Kreatinin 30,000
SGOT 30,000
SGPT 30,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 216,000 10,000
2 26/12/17 Ny. Hj. Katrina AB Darah Rutin 58,000
Darah Rutin 58,000
Golongan Darah 15,000
SGOT 30,000
SGPT 30,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 303,000 20,000
3 26/12/17 Ny. Nuraini RT Darah Rutin 58,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 87,000 10,000
4 23/12/17 An. Muh. Abid RD Darah Rutin 58,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 92,000 10,000
5 26/12/17 Nn. Vita SP Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
6 26/12/17 Ny. Hj. Samsinar SP Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
7 29/12/17 Tn. H. Gazali SP Darah Rutin 58,000
GDS 20,000
GDS 20,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Elektrolit 260,000 260,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat Darah 30,000 479,000 30,000
8 28/12/17 Ny. Poniati RD GDS 22,000
 GDS 22,000
GDS 22,000
GDS 22,000
Darah Rutin 64,000
Kolesterol 32,000
Darah Rutin 64,000
Asam Urat 30,000
SGOT 33,000
SGPT 33,000
Ureum 33,000
Kreatinin 33,000
Urine Rutin 50,000
GDS 22,000
Golongan Darah 22,000
L 15,000 15,000
BHP 10,000 10,000
Spoit + Tempat Darah 50,000 579,000 50,000
9 06/01/18 Ny. Ludia Palembang sp GDS 20,000
GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Asam Urat 30,000
L 7,000 7,000
BHP 8,000 8,000
Spoit + Tempat Darah 30,000 30,000
SW GDS 20,000
GDS 20,000
GDS 20,000
L 4,000 4,000
BHP 8,000 8,000
Spoit + Tempat Darah 30,000 307,000 30,000
10 03/01/18 Tn. H. Usman EI GDS 20,000
Kolesterol 32,000
Darah Rutin 58,000
Darah Rutin 58,000
Asam Urat 30,000
Ureum 30,000
Kreatinin 30,000
L 7,000 7,000
BHP 8,000 8,000
Spoit + Tempat Darah 20,000 293,000 20,000
11 04/01/18 Ny. Sarkiah AB Darah Rutin 58,000
GDS 20,000
Golongan Darah 15,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 117,000 20,000
12 03/01/18 Tn. H. Abd. Hakim RD Darah Rutin 64,000
GDS 20,000
GDS 20,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 20,000
EI SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
Ureum 33,000
 Kreatinin 33,000
Kolesterol 32,000
Asam Urat 30,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
Urine Rutin 50,000
L 10,000 10,000
BHP 6,000 6,000
Spoit + Tempat Darah 80,000 667,000 80,000
13 07/01/18 Tn. Hasanuddin EI Darah Rutin 58,000
GDS 20,000
GDS 20,000
GDS 20,000
Ureum 30,000
Kreatinin 30,000
GDS 20,000
Elektrolit 260,000 260,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat Darah 45,000 518,000 45,000
14 06/01/18 An. Jesica KR GDS 20,000
GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
15 07/12/17 An. Fira Mifi KR Darah Rutin 58,000
GDS 20,000
GDS 20,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 123,000 20,000
16 07/12/17 Tn. Muh. Natsir KR Darah Rutin 58,000
Kolesterol 32,000
Ureum 30,000
Kreatinin 30,000
Kolesterol 32,000
L 5,000 5,000
BHP 6,000 6,000
Spoit + Tempat Darah 20,000 213,000 20,000
17 07/01/18 An. Afika KR Darah Rutin 64,000
GDS 22,000
GDS 22,000
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 123,000 10,000
18 09/01/18 Tn. H. Usman EI Darah Rutin 64,000
GDS 22,000
GDS 22,000
SGOT 33,000
SGPT 33,000
Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
 Asam Urat 33,000
GDS 22,000
GDS 22,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat Darah 15,000 383,000 15,000
19 10/01/18 Ny. Hj. St. Hajar RD GDS 22,000
Kolesterol 36,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat Darah 20,000 93,000 20,000
20 09/01/18 An. Ahmad Faqih IR Darah Rutin 64,000
L 1,000 1,000
BHP 3,000 3,000
Spoit + Tempat Darah 15,000 83,000 15,000
21 11/01/18 Ny. Hj. Diana SW Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Kolesterol 36,000
Kreatinin 33,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 208,000 10,000
22 11/01/18 An. Muh. Andryl Isma RD Widal 25,000
BHP 1,000 1,000
L 2,000 2,000
Spoit + Tempat Darah 10,000 38,000 10,000
23 12/01/18 AN. Meisya AK Darah Rutin 64,000
Widal 28,000
L 13,000 13,000
BHP 5,000 5,000
Spoit + Tempat Darah 10,000 120,000 10,000
24 11/01/18 Ny. Daeng Pandang SW Darah Rutin 64,000
GDS 22,000
GDS 22,000
SGOT 33,000
SGPT 33,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
GDS 22,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 303,000 10,000
25 12/01/18 Ny. Arniwati AB Darah Rutin 64,000
Golongan Darah 17,000
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 105,000 10,000
26 13/01/18 Ny. Zawiyah AB Darah Rutin 64,000
Golongan Darah 15,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 5,000 87,000 5,000
27 11/01/18 Ny. Nurlina SP Darah Rutin 64,000
L 5,000 5,000
BHP 4,000 4,000
 Spoit + Tempat Darah 10,000 83,000 10,000
28 16/01/18 Ny. Minarni AB Darah Rutin 64,000
Golongan Darah 17,000
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 105,000 10,000
29 16/01/18 By. Lyla SP Darah Rutin 64,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 83,000 10,000
30 19/01/18 An. Ahmad Khaerul IR GDS 22,000
Darah Rutin 64,000
L 10,000 10,000
BHP 7,000 7,000
Spoit + Tempat Darah 20,000 123,000 20,000
31 19/01/18 Tn. Rahman IR Darah Rutin 64,000
GDS 22,000
Widal 28,000
SGOT 33,000
SGPT 33,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
GDS 22,000
L 12,000 12,000
BHP 8,000 8,000
Spoit + Tempat Darah 20,000 330,000 20,000
32 19/01/18 Ny. Masna RD Darah Rutin 64,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
ADT 100,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
Elektrolit 260,000 260,000
L 20,000 20,000
BHP 15,000 15,000
Spoit + Tempat Darah 80,000 803,000 80,000
33 24/01/18 Ny. Agustina Dewi SK Darah Rutin 64,000
Golongan Darah 15,000
L 2,300 2,300
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 93,300 10,000
34 24/01/18 An. Farah IR Darah Rutin 64,000
Widal 28,000
L 4,800 4,800
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 109,800 10,000
35 25/01/18 Ny. Murniati SK Darah Rutin 64,000
Golongan Darah 15,000
L 2,300 2,300
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 93,300 10,000
RAWAT JALAN
1 26/12/17 TN. ANSAR LL/SP Darah Rutin 58,000
Widal 25,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 130,000 10,000
2 27/12/17 H. BAHRI LL GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
3 27/12/17 Hj. RAFA LL GDS 20,000
Kolesterol 32,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
4 27/12/17 NY. SUKMAWATI RD GDS 20,000
Asam Urat 30,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
5 27/12/17 NY. Hj. NURHAEDAH RD GDS 20,000
Asam Urat 30,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
6 27/12/17 NY. HJj. RISMA RD Asam Urat 30,000
Kolesterol 32,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
7 27/12/17 NY.YULIAN LL Asam Urat 30,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
8 27/12/17 NY. LUDIA SP Asam Urat 30,000
Kolesterol 32,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
9 27/12/17 Hj. ASLINA SP Asam Urat 30,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
10 27/12/17 Hj. ROHANIA EI Asam Urat 30,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 97,000 10,000
11 27/12/17 NY. FAHRISAH SP Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
12 28/12/17 TN.JAMALUDDIN SP Asam Urat 30,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 49,000 10,000
13 28/12/17 NY.HJ.AISYAH RD GDS 20,000
Kolesterol 32,000
Asam Urat 30,000
Kreatinin 30,000
Ureum 30,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 159,000 10,000
14 30/12/17 TN. YACOB LL Kolesterol 32,000
Asam Urat 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
15 30/12/17 TN.H.MANNAN RD GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
16 30/12/17 TN. TAUFIK LL Kolesterol 32,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 66,000 10,000
17 01/01/18 NY. INDAH IR Asam Urat 30,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
18 01/01/18 AN.FARIQ SP Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
19 01/01/18 NY.HERAWATI SP Asam Urat 30,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 43,000 10,000
20 01/01/18 AN.ANISA RD Widal 37,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 50,000 10,000
21 01/01/18 Hj. NISMA LL Darah Rutin 74,000
GDS 32,000
Kolesterol 40,000
Asam Urat 40,000
L 5,000 5,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 203,000 10,000
22 02/01/18 TN.NAJAMUDDIN LL Golongan Darah 17,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
23 03/01/18 TN.KRISTO KR Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
24 03/01/18 AN. NAUVAL LL Darah Rutin 58,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
25 03/01/18 NY. Hj. RADIAH AA GDS 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 57,000 20,000
26 03/01/18 NY. DEBORA EI Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 264,000 20,000
27 03/01/18 NY. Hj. SIRANG AA Asam Urat 30,000
GDS 20,000
Kolesterol 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
28 03/01/18 TN. ARIS KASA EI Darah Rutin 64,000
Widal 25,000
GDS 20,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 125,000 10,000
29 05/01/18 NY.HJ.YUSNIAR RD Darah Rutin 64,000
Widal 25,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 123,000 10,000
30 05/01/18 NY.HASNA SK Urine Rutin 45,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
31 05/01/18 AN.M.ILYAS AK Darah Rutin 70,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
32 06/01/18 TN. SYAHRIL SP GDS 39,000
Kolesterol 40,000
L 2,000 2,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 93,000 10,000
33 06/01/18 NY.HARTATI SK Urine Rutin 45,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
34 06/01/18 NY.NURHADIA LL Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
35 08/01/18 ERNAWATI IR Asam Urat 39,000
Kolesterol 40,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 93,000 10,000
36 08/01/18 NY.FATIMA KR Darah Rutin 58,000
Widal 25,000
GDS 20,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 120,000 10,000
37 08/01/18 NY.HJ.RADIAH AA GDS 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 53,000 15,000
38 09/01/18 NY.HJ.SARINA LL Kolesterol 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 53,000 15,000
39 09/01/18 TN. NOPRIANUS SW Urine Rutin 45,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
40 09/01/18 NY. SITTI JOSHA RD Darah Rutin 70,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
41 10/01/18 TN.ARIFIN KR Asam Urat 39,000
Kolesterol 40,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 93,000 10,000
42 10/01/18 NY.DALLE EI GDS 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 53,000 15,000
43 10/01/18 NY. HANI KR Darah Rutin 64,000
Widal 25,000
GDS 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 123,000 10,000
44 10/01/18 TN. KARMAN IM GDS 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 53,000 15,000
45 10/01/18 TN. SAIDIN IM GDS 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 53,000 15,000
46 11/01/18 NY.FARIDA LL Darah Rutin 70,000
GDS 32,000
Kolesterol 40,000
Asam Urat 40,000
Ureum 40,000
Kreatinin 40,000
SGOT 40,000
SGPT 40,000
L 12,000 12,000
BHP 6,000 6,000
Spoit + Tempat Darah 35,000 395,000 35,000
47 11/01/18 NY.HJ.NISMA LL Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
48 11/01/18 NY.BURU SW Urine Rutin 50,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 75,000 20,000
49 11/01/18 TN. SELLE SW Asam Urat 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 65,000 20,000
50 11/01/18 TN.YOSEP SW GDS 32,000
Kolesterol 40,000
Asam Urat 40,000
Kreatinin 40,000
L 12,000 12,000
BHP 6,000 6,000
Spoit + Tempat Darah 20,000 190,000 20,000
51 12/01/18 TN.HASNUR LL Kolesterol 40,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
52 12/01/18 NY.HJ.HAJAR LL Darah Rutin 70,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
53 12/01/18 FITRANINGSIH RD Kolesterol 40,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
54 12/01/18 TN.MUSANIP EI Darah Rutin 70,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
55 13/01/18 AN.RISTO RD Malaria 90,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 120,000 20,000
56 13/01/18 TN.SUPRIADI RD Malaria 90,000
 L 10,000 10,000
BHP 3,000 3,000
Spoit + Tempat Darah 20,000 123,000 20,000
57 15/01/18 NY. MARJI SP Asam Urat 40,000
GDS 40,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 135,000 10,000
58 15/01/18 NY. HJ. SRI YUNIARTI LL GDS 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 33,000 10,000
59 15/01/18 NY. ROSMAWATI LL Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
60 17/01/18 TN.HAERUDDIN IR Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
61 17/01/18 TN.ABD.KADIR RD Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
62 17/01/18 NY.MASDA RD Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
63 19/01/18 TN.SILFERIUS RD Kolesterol 40,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
64 19/01/18 NY.MEGAWATI AB Darah Rutin 70,000
Widal 28,000
Malaria 90,000
GDS 20,000
L 9,000 9,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 230,000 10,000
65 19/01/18 NY.INDAWATI EI Urine Rutin 45,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
66 19/01/18 NY.RAHMAWATI IR Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 133,000 10,000
67 20/01/18 TN.ROHANDI SW Kolesterol 40,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
68 22/01/18 TN.HENDRA RD Widal 25,000
Darah Rutin 58,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
69 22/01/18 TN.BASTIAN IR Asam Urat 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 45,000 10,000
70 22/01/18 AN.MAMAS IR Golongan Darah 15,000
Widal 25,000
Darah Rutin 58,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 113,000 10,000
71 22/01/18 NY.HJ.NURLIA RD Kolesterol 32,000
GDS 20,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 67,000 10,000
72 22/01/18 TN.MAIL IR Asam Urat 40,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 53,000 10,000
73 22/01/18 TN.AULIA RAHMAN IR Widal 28,000
Darah Rutin 70,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 120,000 15,000
74 22/01/18 NY.NASBIAH EI Asam Urat 40,000
GDS 38,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 93,000 10,000
75 22/01/18 NY. IMLA RAHIM EI Asam Urat 40,000
GDS 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 133,000 10,000
76 23/01/18 HJ.HAPIDA IR Darah Rutin 70,000
Asam Urat 38,000
Kolesterol 40,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 163,000 10,000
77 23/01/18 TN.ANSAR RD Darah Rutin 70,000
Widal 28,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 118,000 10,000
78 23/01/18 NY.DIONESIS VERIA SW GDS 20,000
 Urine Rutin 45,000
L 6,500 6,500
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 84,500 10,000
79 23/01/18 TN.HASAN SW Kolesterol 36,000
L 1,200 1,200
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 48,200 10,000
80 24/01/18 NY.RUFINA RD Kolesterol 36,000
L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 48,000 10,000
81 24/01/18 NY.HJ.FATIMAH RD Asam Urat 33,000
GDS 22,000
Kolesterol 36,000
L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 103,000 10,000
TOTAL 13,195,100 13,195,100 1,267,100 2,015,000
-

Rincian Rawat Inap 7,555,400 - 7,555,400

Jasa Laboran 1,438,452 Rawat Jalan 7,844,700 7,844,700 -
Total Bruto 15,400,100 7,844,700 7,555,400

dr. Nur Rahmi, Sp. 1,438,452.00

Reagensia 4,120,600.00
Jasa Klinik 4,395,270.00
BHP 2,015,000.00 1,550,000
L 1,267,100
6,410,270.00
ANUARI 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
6,800 23,200.00 12,760.00 10,440.00 L 4,176.00 4,176.00 2,088.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,000 17,000.00 9,350.00 7,650.00 L 3,060.00 3,060.00 1,530.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00

K
K
3,500 21,500.00 11,825.00 9,675.00 L 3,870.00 3,870.00 1,935.00
K

K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
25,000 75,000.00 41,250.00 33,750.00 L 13,500.00 13,500.00 6,750.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
L - - -

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00
 K
K

32,000 26,000.00 14,300.00 11,700.00 L 4,680.00 4,680.00 2,340.00

3,500 21,500.00 11,825.00 9,675.00 L 3,870.00 3,870.00 1,935.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
 K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
13,500 16,500.00 9,075.00 7,425.00 L 2,970.00 2,970.00 1,485.00
9,000 21,000.00 11,550.00 9,450.00 L 3,780.00 3,780.00 1,890.00

K
K
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
2,000 35,000.00 19,250.00 15,750.00 L 6,300.00 6,300.00 3,150.00

K
K
32,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00
10,000 30,000.00 16,500.00 13,500.00 L 5,400.00 5,400.00 2,700.00
 K
K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00

K
K
32,000 26,000.00 14,300.00 11,700.00 L 4,680.00 4,680.00 2,340.00

K
K
32,000 26,000.00 14,300.00 11,700.00 L 4,680.00 4,680.00 2,340.00

K
K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
10,200 21,800.00 11,990.00 9,810.00 L 3,924.00 3,924.00 1,962.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 21,500.00 11,825.00 9,675.00 L 3,870.00 3,870.00 1,935.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 21,500.00 11,825.00 9,675.00 L 3,870.00 3,870.00 1,935.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00

K
K
5,800 33,200.00 18,260.00 14,940.00 L 5,976.00 5,976.00 2,988.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
 K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
9,500 29,500.00 16,225.00 13,275.00 L 5,310.00 5,310.00 2,655.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
32,000 26,000.00 14,300.00 11,700.00 L 4,680.00 4,680.00 2,340.00
3,500 21,500.00 11,825.00 9,675.00 L 3,870.00 3,870.00 1,935.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00

K
K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00

K
K
9,500 29,500.00 16,225.00 13,275.00 L 5,310.00 5,310.00 2,655.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 21,500.00 11,825.00 9,675.00 L 3,870.00 3,870.00 1,935.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00

K
K
 5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00
10,000 30,000.00 16,500.00 13,500.00 L 5,400.00 5,400.00 2,700.00
10,000 30,000.00 16,500.00 13,500.00 L 5,400.00 5,400.00 2,700.00
13,500 26,500.00 14,575.00 11,925.00 L 4,770.00 4,770.00 2,385.00
7,500 32,500.00 17,875.00 14,625.00 L 5,850.00 5,850.00 2,925.00
7,500 32,500.00 17,875.00 14,625.00 L 5,850.00 5,850.00 2,925.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
5,800 26,200.00 14,410.00 11,790.00 L 4,716.00 4,716.00 2,358.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00
10,000 30,000.00 16,500.00 13,500.00 L 5,400.00 5,400.00 2,700.00
13,500 26,500.00 14,575.00 11,925.00 L 4,770.00 4,770.00 2,385.00

K
K
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00

K
K
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00

K
K
65,000 25,000.00 13,750.00 11,250.00 L 4,500.00 4,500.00 2,250.00

K
K
65,000 25,000.00 13,750.00 11,250.00 L 4,500.00 4,500.00 2,250.00
 K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 34,200.00 18,810.00 15,390.00 L 6,156.00 6,156.00 3,078.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
65,000 25,000.00 13,750.00 11,250.00 L 4,500.00 4,500.00 2,250.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
 K
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 20,500.00 11,275.00 9,225.00 L 3,690.00 3,690.00 1,845.00

K
K
5,000 10,000.00 5,500.00 4,500.00 L 1,800.00 1,800.00 900.00
2,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
30,000 28,000.00 15,400.00 12,600.00 L 5,040.00 5,040.00 2,520.00

K
K
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00

K
K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00

K
K
9,500 30,500.00 16,775.00 13,725.00 L 5,490.00 5,490.00 2,745.00
5,800 32,200.00 17,710.00 14,490.00 L 5,796.00 5,796.00 2,898.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00
9,500 28,500.00 15,675.00 12,825.00 L 5,130.00 5,130.00 2,565.00
10,200 29,800.00 16,390.00 13,410.00 L 5,364.00 5,364.00 2,682.00

K
K
32,000 38,000.00 20,900.00 17,100.00 L 6,840.00 6,840.00 3,420.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 1,278.00
 1,200 43,800.00 24,090.00 19,710.00 L 7,884.00 7,884.00 3,942.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
4,120,600 7,991,400 4,395,270 3,596,130 - 1,438,452 1,438,452 719,226
2,444,255
1,951,015 -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN FEBRUARI 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL TOTAL JASA

BAYAR PEMB. LAB
L KLINIK REAGEN KLINIK 55%
45%

1 2 3 4 5 6 7 8 9 10 11 12 13
RAWAT INAP
1 27/01/18 Ny. Nurul Hidayah SK Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Golongan Darah 16,000 5,000 11,000.00 6,050.00 4,950.00
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 94,000 10,000
2 28/01/18 Ny. Hasmiah SK Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00
Golongan Darah 16,000 5,000 11,000.00 6,050.00 4,950.00
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 220,000 20,000
3 30/01/18 Tn. H. Syamsul EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00
SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00
Malaria 80,000 60,000 20,000.00 11,000.00 9,000.00
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 420,000 15,000
4 30/01/18 Ny. Ari Wahyuni Ami SK Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Golongan Darah 17,000 5,000 12,000.00 6,600.00 5,400.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
ADT 100,000 10,000 90,000.00 30,000.00 60,000.00
EI Elektrolit 260,000 260,000
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
 Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00
L 10,000 10,000
BHP 9,000 9,000
Spoit + Tempat Darah 45,000 827,000 45,000
5 30/01/18 Tn. Rahmat SP SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 143,000 10,000
6 31/01/18 An. Muh. Ibrahim IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
7 31/01/18 Ny. Hj. Astina AA/IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 168,000 10,000
8 31/01/18 Tn. H. Syamsul IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 132,000 10,000
9 01/02/18 Ny. Kistiawati IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
L 1,000 1,000
sw GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 157,000 10,000
10 03/02/18 Ny. Hj. St. Hajar SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 168,000 10,000
11 04/02/18 Ny. Dewi RT Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Golongan Darah 16,000 5,000 11,000.00 6,050.00 4,950.00
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 94,000 10,000
12 08/02/18 Ny. Evi AB Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Golongan Darah 16,000 5,000 11,000.00 6,050.00 4,950.00
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 94,000 10,000
13 10/02/18 Tn. A. Muslim Fatta SP Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 2,000 2,000
BHP 2,000 2,000
cyto 9,000 9,000
Spoit + Tempat Darah 10,000 125,000 10,000
14 10/02/18 Ny. Irwana Syamsul AB Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 141,000 10,000
15 12/02/18 Tn. Abd. Halim EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00
GDS 33,000 10,000 23,000.00 12,650.00 10,350.00
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat Darah 25,000 249,000 25,000
16 14/02/18 Ny. Musdalifah AB Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Golongan Darah 16,000 5,000 11,000.00 6,050.00 4,950.00
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 94,000 10,000
17 14/02/18 Ny. Ni Kadek Yulianti AB Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
GDS 33,000 10,000 23,000.00 12,650.00 10,350.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Golongan Darah 16,000 5,000 11,000.00 6,050.00 4,950.00
L 6,000 6,000
BHP 6,000 6,000
 Spoit + Tempat Darah 30,000 219,000 30,000
18 15/02/18 Tn. Sapri RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
19 16/02/18 An. Muh. Faris Fayya SP Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
20 14/02/17 An. Muh. Ahsan IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
GDS 33,000 10,000 23,000.00 12,650.00 10,350.00
Malaria 80,000 60,000 20,000.00 11,000.00 9,000.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 190,000 10,000
21 19/02/18 Ny. St. Hadria SP Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
GDS 33,000 10,000 23,000.00 12,650.00 10,350.00
cyto 8,000 8,000
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 156,000 10,000
22 21/02/18 An. Rifandi IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
23 22/02/18 Tn. Musa EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
HbSAg 50,000 25,000 25,000.00 13,750.00 11,250.00
Albumin 50,000 50,000
Elektrolit 260,000 260,000
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00
SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00
L 10,000 10,000
BHP 10,000 10,000
Spoit + Tempat Darah 30,000 758,000 30,000
24 20/02/18 Tn. Kalapadang SP GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
 LDL 110,000 110,000
L -
BHP -
Spoit + Tempat Darah 132,000 -
RAWAT JALAN
1 26/01/18 NY.NASBIAH EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L -
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 98,000 10,000
2 26/01/18 NY.SYAMSIAH LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L -
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 103,000 10,000
3 26/01/18 TN.IBRAHIM SP Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L -
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 103,000 10,000
4 27/01/18 TN. ADRIAN IR GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L -
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 33,000 10,000
5 27/01/18 TN. ADRIAN LL GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L -
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 33,000 10,000
6 27/01/18 NY.HJ.ROHANI LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L -
BHP 2,200 2,200
Spoit + Tempat Darah 10,000 103,200 10,000
7 27/01/18 NY.LILIA MULIANI RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
8 27/01/18 NY.SUNDARSANI RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
9 27/01/18 NY.HJ.JEMRIANI LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L -
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 103,000 10,000
10 29/01/18 TN.ADRIAN LL GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L -
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 33,000 10,000
11 29/01/18 TN.RIYAN LL GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L -
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 33,000 10,000
12 29/01/18 AN.MIKA IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
13 29/01/18 AN.IKKA MOLIDYA IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
14 29/01/18 NY.SARKIA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
15 29/01/18 NY.HJ.ROSMINI IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
16 29/01/18 SUNARTI RD HbSAg 50,000 25,000 25,000.00 13,750.00 11,250.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 127,000 10,000
17 29/01/18 NAKILAH RD HbSAg 50,000 25,000 25,000.00 13,750.00 11,250.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 127,000 10,000
18 29/01/18 NY.MANDALLE EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
19 29/01/18 NY.HJ.HADRA LL Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
20 30/01/18 NY.NASSA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
21 30/01/18 TN.H.NURDIN SP Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
22 30/01/18 HJ.NADIRA SP Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
23 30/01/18 TN.IBNU SP Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
24 30/01/18 TN.SYAHRIR LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 104,000 10,000
25 31/01/18 NY.SRIGANDI LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 82,000 10,000
26 01/02/18 H.NURDIN SP GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
27 02/02/18 NY.MURIATI LL Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 68,000 10,000
28 02/02/18 NY.LINA LL Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
29 02/02/18 NY.SALMA LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
30 02/02/18 NY.DAMI RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
31 02/02/18 TN.AMIR PATIROI EI Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
32 02/02/18 NY.HJ.HALIJAH FD GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
33 03/02/18 NY.HARTATI SW Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 63,000 10,000
34 05/02/18 NY.NAJMI IR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
35 05/02/18 NUY.HJ.ROSDIANA RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
36 05/02/18 TN.M.SAUQI IM GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
37 05/02/18 A. JAHYA AA Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
38 06/02/18 NY.HJ.NURSIANG LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 82,000 10,000
39 07/02/18 TN.A.SAHABUDDIN EI Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 137,000 10,000
40 08/02/18 NN.A.PUTRI RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 82,000 10,000
41 08/02/18 TN.HAMDANI LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
 GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
42 08/02/18 NY.ANDRIANI LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
43 09/02/18 TN.ABD.HARIS SP Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
44 09/02/18 NN.MELANI RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
45 09/02/18 TN.HASBI RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
46 09/02/18 NY.NURDIANA LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
47 10/02/18 NY.HJ.MAHANI RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
48 12/02/18 TN.BASRI KR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
49 12/02/18 AN.KARINA KR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
50 12/02/18 NY.SRI RAHAYU AB Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
51 12/02/18 TN.RUSLI KR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
52 13/02/18 TN. TAHIR ARIFIN SP GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
53 14/02/18 NY.HJ.SRI MULIANI RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
54 14/02/18 NY.A.SURIATI RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
55 14/02/18 NY.MERICE EI Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
56 14/02/18 NY.IDA WAHIDA IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
57 14/02/18 TN.KADEK IM GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
58 15/02/18 NY.HJ.MUNIRA IR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
59 15/02/18 NY.HJ.ROSIDA RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 82,000 10,000
60 15/02/18 NY.ELISABETH RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 82,000 10,000
61 17/02/18 NY.JUPITA RD Malaria 80,000 60,000 20,000.00 11,000.00 9,000.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 185,000 10,000
62 19/02/18 NY.HJ.SABANNA SP Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L -
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
63 19/02/18 TN.MUHAMMAD RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
64 19/02/18 NY.HERLINA SP Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
65 19/02/18 TN.NURSALAM SP Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
 Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
66 19/02/18 NY.FATMAWATI EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 179,000 10,000
67 20/02/18 NY.HJ.RAISYA RD GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
68 20/02/18 TN.REWA RD GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
69 20/02/18 NN.MELANI RD Widal 28,000 3,500 24,500.00 13,475.00 11,025.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 41,000 10,000
70 20/02/18 NY.AMANA IR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
71 21/02/18 NY.HAPSA IR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
72 21/02/18 TN.HAJIMAI EI Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00
L 10,000 10,000
 BHP 7,000 7,000
Spoit + Tempat Darah 20,000 250,000 20,000
73 22/02/18 NN.NILAWATI LL HbSAg 50,000 25,000 25,000.00 13,750.00 11,250.00
Plano test 25,000 25,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 88,000 10,000
74 22/02/18 NY.HASTIA LL HbSAg 50,000 25,000 25,000.00 13,750.00 11,250.00
Plano test 25,000 25,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 88,000 10,000
75 22/02/18 NY.HJ.SURIANI RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 179,000 10,000
76 23/02/18 NY.WAHYUNI LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
77 24/02/18 TN.H.RUSTAM RD GDS 33,000 20,000 13,000.00 7,150.00 5,850.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
78 24/02/18 TN.FIRMASYAH KR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
TOTAL 12,123,200 12,123,200 153,000 2,096,200 3,698,400 6,175,600 3,377,080 2,798,520
- 2,188,450
1,188,630 -
Rincian Rawat Inap 4,861,000 - 4,861,000
Jasa Laboran 1,119,408 Rawat Jalan 7,262,200 7,262,200 -
Total Bruto 12,123,200 7,262,200 4,861,000

dr. Nur Rahmi, Sp. 1,119,408.00

Reagensia 3,698,400.00
Jasa Klinik 3,377,080.00
BHP 2,096,200.00 997,200
L 153,000
5,473,280.00
MIFTA
JASA

KD Dokter
AN PJ LABORAN Pengirim
40% 40 % 20 %

14 15 16 17

L 5,760.00 5,760.00 2,880.00 dr,goldar

L 1,980.00 1,980.00 990.00

K
K
L 5,760.00 5,760.00 2,880.00 dr,goldar,protein,dr
L 5,760.00 5,760.00 2,880.00
L 7,560.00 7,560.00 3,780.00 220,000
L 1,980.00 1,980.00 990.00

K
K
L 5,760.00 5,760.00 2,880.00 dr,gds,kol,au,ur,cr,ot,pt,widal,ddr
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00 420,000
L 4,140.00 4,140.00 2,070.00
L 3,510.00 3,510.00 1,755.00
L 4,590.00 4,590.00 2,295.00
L 4,590.00 4,590.00 2,295.00
L 4,410.00 4,410.00 2,205.00
L 3,600.00 3,600.00 1,800.00

K
K
L 5,760.00 5,760.00 2,880.00
L 2,160.00 2,160.00 1,080.00
L 2,916.00 2,916.00 1,458.00
L 2,916.00 2,916.00 1,458.00
L 4,644.00 4,644.00 2,322.00
L 24,000.00 24,000.00 12,000.00

L 5,760.00 5,760.00 2,880.00

L 5,760.00 5,760.00 2,880.00 827,000
L 5,760.00 5,760.00 2,880.00
L 7,560.00 7,560.00 3,780.00

K
K
L 4,590.00 4,590.00 2,295.00 ot,pt
L 4,590.00 4,590.00 2,295.00 143
L 5,760.00 5,760.00 2,880.00

K
K
L 5,760.00 5,760.00 2,880.00 dr

K
K
L 5,760.00 5,760.00 2,880.00 dr,gds,kol,au
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00 168,000
L 2,916.00 2,916.00 1,458.00

K
K
L 5,760.00 5,760.00 2,880.00 dr,gds,ur,cr
L 2,916.00 2,916.00 1,458.00
L 3,510.00 3,510.00 1,755.00 132,000

K
K
L 5,760.00 5,760.00 2,880.00 dr,gds,kol(IR), / gdp(SW)
L 2,916.00 2,916.00 1,458.00
L 4,644.00 4,644.00 2,322.00
157,000
L 2,916.00 2,916.00 1,458.00
K
K
L 5,760.00 5,760.00 2,880.00 dr,gds,kol,au
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00
168,000
K
K
L 5,760.00 5,760.00 2,880.00 dr,goldar
L 1,980.00 1,980.00 990.00

K
K
L 5,760.00 5,760.00 2,880.00 dr,golda
L 1,980.00 1,980.00 990.00

K
K
L 4,644.00 4,644.00 2,322.00 gds,kol,au,cyto 15.000
L 4,230.00 4,230.00 2,115.00
L 2,340.00 2,340.00 1,170.00

K
L 5,760.00 5,760.00 2,880.00 dr,dr
L 5,760.00 5,760.00 2,880.00

K 141,000
K
L 5,760.00 5,760.00 2,880.00 dr,gds,ot,pt,widal,gdp
L 2,916.00 2,916.00 1,458.00
L 4,590.00 4,590.00 2,295.00 249,000
L 4,590.00 4,590.00 2,295.00
L 4,410.00 4,410.00 2,205.00
L 4,140.00 4,140.00 2,070.00

K
K
L 5,760.00 5,760.00 2,880.00 dr,goldar
L 1,980.00 1,980.00 990.00

K
K
L 5,760.00 5,760.00 2,880.00 dr,goldar,dr(AB), gds(AK)
L 4,140.00 4,140.00 2,070.00
L 5,760.00 5,760.00 2,880.00
L 1,980.00 1,980.00 990.00 219,000

K
K
L 4,644.00 4,644.00 2,322.00 kol

K
K
L 5,760.00 5,760.00 2,880.00 dr

K
K
L 5,760.00 5,760.00 2,880.00 dr,gds(IR)/malariah(AK)
L 4,140.00 4,140.00 2,070.00
L 3,600.00 3,600.00 1,800.00

K
K 190,000
L 4,644.00 4,644.00 2,322.00 dr,gds,kol,cyto
L 4,140.00 4,140.00 2,070.00

L 5,760.00 5,760.00 2,880.00

156,000
K
K
L 5,760.00 5,760.00 2,880.00 dr

K
K
L 5,760.00 5,760.00 2,880.00 ur,cr,ot,pt,elektrolit,albumin,dr,gds,ur,cr,hbsag,ot,pt,dr,ur,widal
L 5,760.00 5,760.00 2,880.00
L 4,140.00 4,140.00 2,070.00
L 3,510.00 3,510.00 1,755.00
L 2,916.00 2,916.00 1,458.00
4,500.00 4,500.00 2,250.00

758,000
L 4,140.00 4,140.00 2,070.00
L 3,510.00 3,510.00 1,755.00
L 4,590.00 4,590.00 2,295.00
L 4,590.00 4,590.00 2,295.00

K
K
L 2,916.00 2,916.00 1,458.00 gds,kol,ldl
 132,000
K
K

L 5,760.00 5,760.00 2,880.00

L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00 103,000
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 2,916.00 2,916.00 1,458.00

K
K
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00 103,200

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00
104,000
K
K
L 4,644.00 4,644.00 2,322.00
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00
103,000
K
K
L 2,916.00 2,916.00 1,458.00

K
K
L 2,916.00 2,916.00 1,458.00

K
K
L 5,760.00 5,760.00 2,880.00
L 4,410.00 4,410.00 2,205.00
105,000
K
K
L 5,760.00 5,760.00 2,880.00
L 4,410.00 4,410.00 2,205.00

K
K
L 5,760.00 5,760.00 2,880.00

K
K
L 5,760.00 5,760.00 2,880.00
L 4,410.00 4,410.00 2,205.00

K
K
4,500.00 4,500.00 2,250.00
L 5,760.00 5,760.00 2,880.00

K
K
4,500.00 4,500.00 2,250.00
L 5,760.00 5,760.00 2,880.00

K
K
L 5,760.00 5,760.00 2,880.00 KOL,GDS
L 4,410.00 4,410.00 2,205.00

K
K
L 7,560.00 7,560.00 3,780.00

K
K
L 5,760.00 5,760.00 2,880.00 DR

K
K
L 7,560.00 7,560.00 3,780.00
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00 GDS,KOL,AU
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 5,760.00 5,760.00 2,880.00
L 4,410.00 4,410.00 2,205.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00

K
K
L 2,916.00 2,916.00 1,458.00

K
K
L 4,230.00 4,230.00 2,115.00 DR,WIDAL
L 2,916.00 2,916.00 1,458.00

K
K
L 4,230.00 4,230.00 2,115.00

K
K
L 4,644.00 4,644.00 2,322.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 2,916.00 2,916.00 1,458.00

K
K
L 7,560.00 7,560.00 3,780.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00

K
K
L 4,140.00 4,140.00 2,070.00
L 3,510.00 3,510.00 1,755.00
L 4,644.00 4,644.00 2,322.00
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00 UR
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 5,760.00 5,760.00 2,880.00 DR,WIDAL
L 4,410.00 4,410.00 2,205.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 4,644.00 4,644.00 2,322.00
L 5,760.00 5,760.00 2,880.00
K
K
L 5,760.00 5,760.00 2,880.00

K
K
L 4,644.00 4,644.00 2,322.00 DR,TES MALARIA,WIDAL
L 4,590.00 4,590.00 2,295.00
L 4,590.00 4,590.00 2,295.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,916.00 2,916.00 1,458.00

K
K
L 2,340.00 2,340.00 1,170.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,340.00 2,340.00 1,170.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,340.00 2,340.00 1,170.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,340.00 2,340.00 1,170.00

K
K
L 5,760.00 5,760.00 2,880.00
L 4,410.00 4,410.00 2,205.00
K
K
L 2,340.00 2,340.00 1,170.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,340.00 2,340.00 1,170.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00

K
K
L 4,644.00 4,644.00 2,322.00 DR,GDS
L 4,230.00 4,230.00 2,115.00

K
K
L 3,600.00 3,600.00 1,800.00
L 5,760.00 5,760.00 2,880.00
L 4,410.00 4,410.00 2,205.00

K
K
L 5,760.00 5,760.00 2,880.00

K
K
L 4,644.00 4,644.00 2,322.00

K
K
L 5,760.00 5,760.00 2,880.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,340.00 2,340.00 1,170.00

K
K
L 5,760.00 5,760.00 2,880.00
L 4,644.00 4,644.00 2,322.00
L 4,590.00 4,590.00 2,295.00
L 4,590.00 4,590.00 2,295.00

K
K
L 2,340.00 2,340.00 1,170.00

K
K
L 2,340.00 2,340.00 1,170.00

K
K
L 4,410.00 4,410.00 2,205.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,340.00 2,340.00 1,170.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,340.00 2,340.00 1,170.00

K
K
L 4,140.00 4,140.00 2,070.00
L 3,510.00 3,510.00 1,755.00
L 5,760.00 5,760.00 2,880.00
L 4,230.00 4,230.00 2,115.00
L 7,560.00 7,560.00 3,780.00
K
K
4,500.00 4,500.00 2,250.00

K
K
4,500.00 4,500.00 2,250.00

K
K
L 5,760.00 5,760.00 2,880.00
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,340.00 2,340.00 1,170.00

K
K
L 4,644.00 4,644.00 2,322.00
L 4,230.00 4,230.00 2,115.00
L 2,340.00 2,340.00 1,170.00

K
K
L 2,340.00 2,340.00 1,170.00

K
K
L 5,760.00 5,760.00 2,880.00

K
K
- 1,119,408 1,119,408 559,704
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN FEBRUARI 2018 RUMAH SAKIT BERSAL
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 27/01/18 Ny. Nurul Hidayah SK Darah Rutin 64,000
Golongan Darah 16,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 94,000 10,000
2 28/01/18 Ny. Hasmiah SK Darah Rutin 64,000
Darah Rutin 64,000
Urine Rutin 50,000
Golongan Darah 16,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 220,000 20,000
3 30/01/18 Tn. H. Syamsul EI Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Widal 28,000
Malaria 80,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 420,000 15,000
4 30/01/18 Ny. Ari Wahyuni Ami SK Darah Rutin 64,000
Golongan Darah 17,000
GDS 22,000
GDS 22,000
Kolesterol 36,000
ADT 100,000
EI Elektrolit 260,000 260,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Urine Rutin 50,000
L 10,000 10,000
BHP 9,000 9,000
Spoit + Tempat Darah 45,000 827,000 45,000
5 30/01/18 Tn. Rahmat SP SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 143,000 10,000
6 31/01/18 An. Muh. Ibrahim IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
7 31/01/18 Ny. Hj. Astina AA/IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 168,000 10,000
8 31/01/18 Tn. H. Syamsul IR Darah Rutin 64,000
GDS 22,000
Kreatinin 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 132,000 10,000
9 01/02/18 Ny. Kistiawati IR Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
L 1,000 1,000
sw GDS 22,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 157,000 10,000
10 03/02/18 Ny. Hj. St. Hajar SW Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 168,000 10,000
11 04/02/18 Ny. Dewi RT Darah Rutin 64,000
Golongan Darah 16,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 94,000 10,000
12 08/02/18 Ny. Evi AB Darah Rutin 64,000
Golongan Darah 16,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 94,000 10,000
13 10/02/18 Tn. A. Muslim Fatta SP Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
cyto 9,000 9,000
Spoit + Tempat Darah 10,000 125,000 10,000
14 10/02/18 Ny. Irwana Syamsul AB Darah Rutin 64,000
Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 141,000 10,000
15 12/02/18 Tn. Abd. Halim EI Darah Rutin 64,000
GDS 22,000
SGOT 33,000
SGPT 33,000
Widal 28,000
GDS 33,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat Darah 25,000 249,000 25,000
16 14/02/18 Ny. Musdalifah AB Darah Rutin 64,000
Golongan Darah 16,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 94,000 10,000
17 14/02/18 Ny. Ni Kadek Yulianti AB Darah Rutin 64,000
GDS 33,000
 Darah Rutin 64,000
Golongan Darah 16,000
L 6,000 6,000
BHP 6,000 6,000
Spoit + Tempat Darah 30,000 219,000 30,000
18 15/02/18 Tn. Sapri RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
19 16/02/18 An. Muh. Faris Fayya SP Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
20 14/02/17 An. Muh. Ahsan IR Darah Rutin 64,000
GDS 33,000
Malaria 80,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 190,000 10,000
21 19/02/18 Ny. St. Hadria SP Kolesterol 36,000
GDS 33,000
cyto 8,000 8,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 156,000 10,000
22 21/02/18 An. Rifandi IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
23 22/02/18 Tn. Musa EI Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
HbSAg 50,000
Albumin 50,000 50,000
Elektrolit 260,000 260,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 10,000 10,000
BHP 10,000 10,000
Spoit + Tempat Darah 30,000 758,000 30,000
24 20/02/18 Tn. Kalapadang SP GDS 22,000
LDL 110,000 110,000
L -
BHP -
Spoit + Tempat Darah 132,000 -
RAWAT JALAN
1 26/01/18 NY.NASBIAH EI Darah Rutin 64,000
GDS 22,000
L -
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 98,000 10,000
2 26/01/18 NY.SYAMSIAH LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L -
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 103,000 10,000
3 26/01/18 TN.IBRAHIM SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L -
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 103,000 10,000
4 27/01/18 TN. ADRIAN IR GDS 22,000
L -
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 33,000 10,000
5 27/01/18 TN. ADRIAN LL GDS 22,000
L -
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 33,000 10,000
6 27/01/18 NY.HJ.ROHANI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L -
BHP 2,200 2,200
Spoit + Tempat Darah 10,000 103,200 10,000
7 27/01/18 NY.LILIA MULIANI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
8 27/01/18 NY.SUNDARSANI RD Kolesterol 36,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 71,000 10,000
9 27/01/18 NY.HJ.JEMRIANI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L -
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 103,000 10,000
10 29/01/18 TN.ADRIAN LL GDS 22,000
L -
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 33,000 10,000
11 29/01/18 TN.RIYAN LL GDS 22,000
L -
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 33,000 10,000
12 29/01/18 AN.MIKA IR Darah Rutin 64,000
Widal 28,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
13 29/01/18 AN.IKKA MOLIDYA IR Darah Rutin 64,000
Widal 28,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
14 29/01/18 NY.SARKIA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
15 29/01/18 NY.HJ.ROSMINI IR Darah Rutin 64,000
 Widal 28,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
16 29/01/18 SUNARTI RD HbSAg 50,000
Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 127,000 10,000
17 29/01/18 NAKILAH RD HbSAg 50,000
Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 127,000 10,000
18 29/01/18 NY.MANDALLE EI Darah Rutin 64,000
Widal 28,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
19 29/01/18 NY.HJ.HADRA LL Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
20 30/01/18 NY.NASSA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
21 30/01/18 TN.H.NURDIN SP Urine Rutin 50,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
22 30/01/18 HJ.NADIRA SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
23 30/01/18 TN.IBNU SP Darah Rutin 64,000
Widal 28,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
24 30/01/18 TN.SYAHRIR LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
25 31/01/18 NY.SRIGANDI LL Kolesterol 36,000
Asam Urat 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 82,000 10,000
26 01/02/18 H.NURDIN SP GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
27 02/02/18 NY.MURIATI LL Asam Urat 33,000
 GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 68,000 10,000
28 02/02/18 NY.LINA LL Asam Urat 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
29 02/02/18 NY.SALMA LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
30 02/02/18 NY.DAMI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
31 02/02/18 TN.AMIR PATIROI EI Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
32 02/02/18 NY.HJ.HALIJAH FD GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
33 03/02/18 NY.HARTATI SW Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
34 05/02/18 NY.NAJMI IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
35 05/02/18 NUY.HJ.ROSDIANA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
36 05/02/18 TN.M.SAUQI IM GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
37 05/02/18 A. JAHYA AA Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
38 06/02/18 NY.HJ.NURSIANG LL Kolesterol 36,000
Asam Urat 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 82,000 10,000
39 07/02/18 TN.A.SAHABUDDIN EI Ureum 33,000
Kreatinin 33,000
 Kolesterol 36,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 137,000 10,000
40 08/02/18 NN.A.PUTRI RD Kolesterol 36,000
Asam Urat 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 82,000 10,000
41 08/02/18 TN.HAMDANI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
42 08/02/18 NY.ANDRIANI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
43 09/02/18 TN.ABD.HARIS SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
44 09/02/18 NN.MELANI RD Darah Rutin 64,000
Widal 28,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
45 09/02/18 TN.HASBI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
46 09/02/18 NY.NURDIANA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
47 10/02/18 NY.HJ.MAHANI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
48 12/02/18 TN.BASRI KR Kolesterol 36,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
49 12/02/18 AN.KARINA KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
50 12/02/18 NY.SRI RAHAYU AB Kolesterol 36,000
 SGOT 33,000
SGPT 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
51 12/02/18 TN.RUSLI KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 104,000 10,000
52 13/02/18 TN. TAHIR ARIFIN SP GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
53 14/02/18 NY.HJ.SRI MULIANI RD Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
54 14/02/18 NY.A.SURIATI RD Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
55 14/02/18 NY.MERICE EI Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
56 14/02/18 NY.IDA WAHIDA IR Darah Rutin 64,000
Widal 28,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 105,000 10,000
57 14/02/18 TN.KADEK IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
58 15/02/18 NY.HJ.MUNIRA IR Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
59 15/02/18 NY.HJ.ROSIDA RD Kolesterol 36,000
Asam Urat 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 82,000 10,000
60 15/02/18 NY.ELISABETH RD Kolesterol 36,000
Asam Urat 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 82,000 10,000
61 17/02/18 NY.JUPITA RD Malaria 80,000
Darah Rutin 64,000
Widal 28,000
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 185,000 10,000
62 19/02/18 NY.HJ.SABANNA SP Darah Rutin 64,000
L -
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 76,000 10,000
63 19/02/18 TN.MUHAMMAD RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
64 19/02/18 NY.HERLINA SP Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
65 19/02/18 TN.NURSALAM SP Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
66 19/02/18 NY.FATMAWATI EI Darah Rutin 64,000
Kolesterol 36,000
SGOT 33,000
SGPT 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 179,000 10,000
67 20/02/18 NY.HJ.RAISYA RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
68 20/02/18 TN.REWA RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
69 20/02/18 NN.MELANI RD Widal 28,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 41,000 10,000
70 20/02/18 NY.AMANA IR Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
71 21/02/18 NY.HAPSA IR Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
72 21/02/18 TN.HAJIMAI EI Ureum 33,000
Kreatinin 33,000
Darah Rutin 64,000
Asam Urat 33,000
Urine Rutin 50,000
L 10,000 10,000
BHP 7,000 7,000
Spoit + Tempat Darah 20,000 250,000 20,000
73 22/02/18 NN.NILAWATI LL HbSAg 50,000
 Plano test 25,000 25,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 88,000 10,000
74 22/02/18 NY.HASTIA LL HbSAg 50,000
Plano test 25,000 25,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 88,000 10,000
75 22/02/18 NY.HJ.SURIANI RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 179,000 10,000
76 23/02/18 NY.WAHYUNI LL Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 115,000 10,000
77 24/02/18 TN.H.RUSTAM RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
78 24/02/18 TN.FIRMASYAH KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
TOTAL 12,123,200 12,123,200 153,000 2,096,200
-

Rincian Rawat Inap 4,861,000 - 4,861,000

Jasa Laboran 1,119,408 Rawat Jalan 7,262,200 7,262,200 -
Total Bruto 12,123,200 7,262,200 4,861,000

dr. Nur Rahmi, Sp. 1,119,408.00

Reagensia 3,698,400.00
Jasa Klinik 3,377,080.00
BHP 2,096,200.00 997,200
L 153,000
5,473,280.00 500,000
BRUARI 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR

5,000 11,000.00 6,050.00 4,950.00 L 1,980.00 1,980.00 990.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
5,000 11,000.00 6,050.00 4,950.00 L 1,980.00 1,980.00 990.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
10,000 90,000.00 30,000.00 60,000.00 L 24,000.00 24,000.00 12,000.00 SR
SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
 NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 11,000.00 6,050.00 4,950.00 L 1,980.00 1,980.00 990.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 11,000.00 6,050.00 4,950.00 L 1,980.00 1,980.00 990.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 11,000.00 6,050.00 4,950.00 L 1,980.00 1,980.00 990.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 11,000.00 6,050.00 4,950.00 L 1,980.00 1,980.00 990.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
SR
K SR
K SR
SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
 K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
 NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
20,000 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
20,000 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
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
20,000 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
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
 SR
SR
K SR
K SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
20,000 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
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
3,698,400 6,175,600 3,377,080 2,798,520 - 1,119,408 1,119,408 559,704
2,188,450
1,188,630 -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN MARET 2018 RUMAH SAKIT BERSALIN & K
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 22/02/18 An. Athar IR Darah Rutin 64,000
GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 110,000 10,000
2 23/02/18 An.Shakila SP Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
3 28/02/18 Ny.Hj.Lisna AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
4 25/02/18 Tn.Rukhyat IR Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 111,000 10,000
5 01/03/18 Ny. Ayu Wulandari AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
6 02/03/18 Ny.dr.Suhrawarni AB GR
7 28/02/18 An.Nur Azahra Hasda AK Darah Rutin 64,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000
8 01/03/18 Ahmad Haruna RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 10,000
EI Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Elektrolit 260,000 260,000
GDS 22,000
GDS 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 661,000 15,000
9 03/03/18 An.Ainun SP Darah Rutin 64,000
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
10 28/02/18 An. Muh. Zaki KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
11 05/03/18 Ny.Sri Rahayu SV Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
12 06/03/18 Ny.Ari Wahyuni AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
13 04/03/18 Tn.H.Palo IR Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
Asam Urat 33,000
Urine Rutin 50,000
L 6,000 6,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 10,000
EI Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
Asam Urat 33,000
Urine Rutin 50,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 484,000 10,000
14 07/03/18 Tn.Sukirman RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat Darah 15,000 15,000
EI GDS 22,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 246,000 10,000
15 07/03/18 Ny.Amriati IR Darah Rutin 64,000
Asam Urat 33,000
GDS 22,000
Urine Rutin 50,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 253,000 10,000
16 09/03/180 Ny.Husbaniah KR Darah Rutin 64,000
Kolesterol 36,000
 Widal 28,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 166,000 10,000
17 11/03/18 Tn.H.Syamsuddin SW Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 142,000 10,000
18 10/03/18 Nn. Harisa Raden SP Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
19 11/03/18 Nn.Yuni SP Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
Darah Rutin 64,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat Darah 30,000 260,000 30,000
20 11/03/18 An.Nadin SP Darah Rutin 64,000
Widal 28,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat Darah 20,000 212,000 20,000
21 11/03/18 An.Fahmi SP Widal 28,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
22 13/03/18 Ny.Reski Wahyuni AB Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
GDS 22,000
GDS 22,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat Darah 30,000 254,000 30,000
23 14/03/18 Ny.Sandra Dewi EI Darah Rutin 64,000
Urine Rutin 50,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 219,000 10,000
24 15/03/18 Ny.Sahara AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
 Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
GDS 22,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 30,000 363,000 30,000
25 16/03/18 Ny. Nini AB Darah Rutin 64,000
GDS 22,000
Kreatinin 33,000
SGOT 33,000
L 6,000 6,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 171,000 10,000
26 16/03/18 Tn.Masyhuni Syahid IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
27 16/03/18 Ny.Badariah AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 331,000 20,000
28 17/03/18 Ny.Nurbaniah AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 331,000 20,000
29 15/03/18 By. Afizah IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
30 15/03/18 Ny.Berlian IR GDS 22,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000
31 12/03/18 An.Uwais RD Darah Rutin 64,000
GDS 22,000
GDS 22,000
Widal 28,000
Elektrolit 260,000 260,000
Faces 35,000 35,000
GDS 33,000
 Lain2 9,000
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat Darah 30,000 517,000 30,000
32 18/03/18 Tn.Andi Ismail SP Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
33 17/03/18 Tn.H.Tassa RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
34 21/03/18 Ny. Yuliani IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000

RAWAT JALAN
1 26/02/18 NY.JUMRIANI IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 170,000 10,000
2 26/02/18 NY.BUDIATI LESTARI IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
3 26/02/18 TN.H.HERMAN RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
4 26/02/18 M.ABD.RAHMAN LL Golongan Darah 17,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 30,000 10,000
5 26/02/18 NY.HJ.WADARIA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
6 26/02/18 NY.MEKARSARI EI Kolesterol 36,000
GDS 22,000
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
7 27/02/18 NY.ZILVIA SW Darah Rutin 64,000
Widal 28,000
GDS 22,000
SGOT 33,000
SGPT 33,000
Urine Rutin 50,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 248,000 10,000
8 28/02/18 NY.NURJANNAH RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
9 28/02/18 NY.HJ.SURIANI LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
10 28/02/18 NY.ERVIN AB Darah Rutin 64,000
GDS 22,000
Urine Rutin 50,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 151,000 10,000
11 28/02/18 TN.HERLING IM GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
12 28/02/18 HJ.TARI AA GDS 22,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 69,000 10,000
13 28/02/18 TN.M.SAEDA IM GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
14 28/02/18 NN.ARINI EI Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
15 28/02/18 TN.AJIR IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
16 28/02/18 TN.ALADIN IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
17 28/02/18 NN.AMBARWATI IR Darah Rutin 64,000
 Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
18 28/02/18 HJ.SUKURA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
19 28/02/18 AN.AUFAR IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
20 01/03/18 TN.MUH.ARWAN IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat Darah 20,000 182,000 20,000
21 01/03/18 TN.ARDIANSYAH RD Widal 28,000
Kolesterol 36,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 101,000 10,000
22 02/03/18 TN.ABD.RASYID IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
23 02/03/18 TN.H.TASSA IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
24 02/03/18 NY.HASLINDA EI Ureum 33,000
Kreatinin 33,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 250,000 10,000
25 02/03/18 NY.RUKMINI SP Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 4,000 4,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 182,000 10,000
26 03/03/18 NN.FITRI SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
27 05/03/18 TN. MUH.ZUBIR RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
28 05/03/18 TN.ARIFIN RD Kolesterol 36,000
Asam Urat 33,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat Darah 15,000 94,000 15,000
29 05/03/18 TN.AMINUDDIN LL Urine Rutin 50,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 4,000 55,000 4,000
30 05/03/18 TN.SULTAN LL Urine Rutin 50,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 4,000 55,000 4,000
31 05/03/18 NY.HJ.ROSIDA LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
32 05/03/18 AN.FARIH IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
33 05/03/18 TN.MUIS RAHIM LL Ureum 33,000
Kreatinin 33,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 32,000
L - -
BHP 2,000 2,000
Spoit + Tempat Darah - 200,000 -
34 05/03/18 TN.BASRI IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
35 05/03/18 TN.RAHMAN IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
36 05/03/18 NY.HJ.HAWIAH RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
37 05/03/18 NY.BIAH EI GDS 22,000
L 1,000 1,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
38 06/03/18 TN.MUH.TAHIR RD GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
39 06/03/18 NY.NAOMI RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
40 06/03/18 TN.H.JAMID LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
41 06/03/18 NY.DORCE DATU SW Widal 28,000
Malaria 80,000
Darah Rutin 64,000
Kolesterol 36,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 224,000 10,000
42 07/03/18 NY.HJ.NASNA RD GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
43 08/03/18 TN.SAPRI IR Asam Urat 33,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 111,000 10,000
44 08/03/18 TN.GUNAWAN LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
45 09/03/18 NY.RISMAWATI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
46 09/03/18 TN.RAMLI PANGLOLI RD Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 168,000 10,000
47 09/03/18 NY.ASLI DAUD RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
48 09/03/18 TN.A.IDRIS LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
49 09/03/18 AN.AHMAD KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
50 10/03.34 TN.JALIL SW Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
51 10/03.36 NY.NURBIAH SP Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 148,000 10,000
52 10/03.37 NY.RAHMAWATI SP Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
53 10/03.38 NY.NURMIATI SP GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
54 12/03/18 TN.H.ABD.MUIS SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
55 12/03/18 NY.YASNI KR GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
56 13/03/18 TN.RUSMAN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
57 13/03/18 TN.H.MANDI KR GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
58 13/03/18 NY.LEONORA LL Ureum 33,000
Kreatinin 33,000
Darah Rutin 64,000
 Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 239,000 10,000
59 14/03/18 NY.SALMA EI Darah Rutin 64,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 134,000 10,000
60 14/03/18 NY.HJ.RIRIN AB Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
61 14/03/18 NY.SUNAPATI IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
62 14/03/18 TN.H.MUKHTAR IR Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
63 14/03/18 TN.H.SAGIMIN IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
64 14/03/18 TN.RAHMAN IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
65 14/03/18 NY.RAPIAH IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
66 15/03/18 NY.ADE IRMA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
67 15/03/18 AN.AINUN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
68 15/03/18 TN.ANWAR RD Kolesterol 36,000
Asam Urat 33,000
 GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
69 16/03/18 NY.HJ.SANIA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
70 16/03/18 NN.YUSRINA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
71 17/03/18 NY. SIMANSIAL LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 5,000 41,000 5,000
72 17/03/18 NY.HJ.SIRUA RD GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
73 17/03/18 NY.HJ.EDA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
74 19//3/19 TN.FERDI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
75 19//3/21 TN.SYAHRIL RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
76 19/03/18 NY.HJ.MULTI LL GDS 22,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 69,000 10,000
77 19/03/18 TN.ABIDIN IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
78 20/01/18 TN.AMIRULLAH FATTA IR GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
79 20/01/18 TN.DEDEN DENI LL Darah Rutin 64,000
 Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
80 20/01/18 NY.HJ.RASDIANA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
81 20/01/18 NY.UMMU KHUSNUL SW Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
82 20/01/18 AN.A.KAMILA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
83 21/03/18 NY.NIPEN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
84 21/03/18 NY.ST.HAJAR KR Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
85 21/03/18 NY.WAHIDA LL Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
86 21/03/18 TN.ABD.AZIZ RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
87 21/03/18 NY.HERLINA IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
88 21/03/18 NY.HJ.NURJANNAH IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
89 21/03/18 NY.HJ.RAHMAWATI IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 171,000 10,000
90 22/03/18 TN.H.TAHIR RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
91 22/03/18 AN.NUR AQIFAH RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
92 22/03/18 HJ.SHIMANUSIA LL Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat Darah 10,000 174,000 10,000
93 22/03/18 AN.MUH.SYAHRAWI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
94 22/03/18 AN.MUH.JAELANI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
95 23/03/18 TN.RUDI RD GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
96 23/03/18 HJ.HAMSINA LL GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
97 23/03/18 NY.HJ.LISNA RD Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
98 23/03/18 AN.EMILIA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
99 23/03/18 HJ.HAJAR LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
100 24/03/18 AN.MIRZA KR Darah Rutin 64,000
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
101 24/03/18 AN.NUR FAIKA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
102 24/03/18 TN.SAPRI LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
103 24/03/18 TN.H.MUSAID RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
104 24/03/18 TN.ABDULLAH RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000

TOTAL 17,018,000 17,018,000 386,000 2,366,000

-

Rincian Rawat Inap 6,492,000 - 6,492,000

Jasa Laboran 1,686,474 Rawat Jalan 10,526,000 - 10,526,000
Total Bruto 17,018,000 - 17,018,000

dr. Nur Rahmi, Sp. 1,686,474.00

Reagensia 5,147,700.00
Jasa Klinik 5,153,115.00
BHP 2,366,000.00 1,239,000
L 386,000
7,519,115.00
MARET 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR

20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
 NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
260,000.00 143,000.00 117,000.00 L 46,800.00 46,800.00 23,400.00 SR
SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
NR
NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
 K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
 K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 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
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
 K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
 SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
SR
5,147,700 9,369,300 5,153,115 4,216,185 - 1,686,474 1,686,474 843,237
3,256,385
1,896,730 -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN MARET 2018 RUMAH SAKIT BERSALIN
dr HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 24/03/18 Nn.A.Anggi H. RD Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 111,000 10,000
2 27/03/18 Ny.Sarah Intan KR Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 205,000 10,000
3 27/03/18 Tn.Musu SW Darah Rutin 64,000
Golongan Darah 17,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 257,000 10,000
4 28/03/18 Ny.hj.Madinah IR Darah Rutin 64,000
GDS 22,000
GDS 22,000
GDS 22,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat Darah 30,000 258,000 30,000
5 29/03/18 Tn.Hasanuddin SP Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
6 02/04/18 An.Muh. Aiman IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
7 29/03/18 Ny.Rosmiati SP Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
Elektrolit 260,000 260,000
GDS 33,000
L 8,000 8,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 535,000 10,000
8 03/04/18 An.St.Zahra KR Darah Rutin 64,000
 GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000
9 03/04/18 Tn.H.Fajar Abd.Rauf IR Darah Rutin 64,000
GDS 22,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 194,000 10,000
10 01/04/18 Ny.Hj.Saoda RD Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 137,000 10,000
11 05/04/18 Ny.Hasrianti AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
12 05/04/18 Ny.Kasimah KR Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
GDS 22,000
SGOT 33,000
SGPT 33,000
SGOT 33,000
SGPT 33,000
Elektrolit 260,000 260,000
albumin 50,000 50,000
L 8,000 8,000
BHP 6,000 6,000
Spoit + Tempat Darah 35,000 663,000 35,000
13 10/04/18 An.A.Yusuf RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
14 11/04/18 Ny.Nia Inrawati AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
15 11/04/18 Ny.Syarifah Aisyah AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
16 12/04/18 Tn.ibrahim KR Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
Urine Rutin 50,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat Darah 30,000 307,000 30,000
17 16/04/18 Nn.Nur Amalia SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
18 Ny.Maya Lestari AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
19 Ny.Desi AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
20 Ny.Reski Ekawati AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
21 18/04/18 An.Muh.Faisal SP Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 187,000 10,000
22 20/04/18 Tn.Afandi RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
23 20/04/18 Ny.Tenri SP Darah Rutin 64,000
Elektrolit 260,000 260,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 361,000 10,000
24 18/04/18 Ny.Agusni AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
GDS 33,000
L 8,000 8,000
BHP 6,000 6,000
Spoit + Tempat Darah 25,000 283,000 25,000
25 13/04/18 Ny.Wahida SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
26 14/04/10 Ny.Hj.Halmiah SW Darah Rutin 64,000
GDS 22,000
Kreatinin 33,000
Kolesterol 36,000
Urine Rutin 50,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 222,000 10,000
27 Ny.Tri Utami RT Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
 28 Ny.Rasna AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
29 07/04/18 Ny.Ruwaeda SW Darah Rutin 64,000
GDS 22,000
GDS 33,000
GDS 33,000
Kreatinin 33,000
Kolesterol 36,000
L 7,000 7,000
BHP 10,000 10,000
Spoit + Tempat Darah 30,000 268,000 30,000
RAWAT JALAN
1 26/03/18 NY.HJ.CAMBARU EI GDS 22,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 10,000 33,000 10,000
2 26/03/18 AN.MUH.ILHAM KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
3 26/03/18 NY.MASRAWATI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
4 27/03/18 NY.AYU RD Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
5 27/03/18 NY.ROSMINA RD Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
6 27/03/18 NY.INCI SARI RD Darah Rutin 64,000
Widal 28,000
Kolesterol 36,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat Darah 10,000 148,000 10,000
7 28/03/18 NY.RAMLAH RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 111,000 15,000
8 28/03/18 TN.ADI IR Darah Rutin 64,000
Widal 28,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 129,000 10,000
9 28/03/18 NY.SARMINA EI Darah Rutin 64,000
GDS 33,000
 L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 111,000 10,000
10 29/03/18 TN.H.ALI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
11 29/03/18 TN.RUSLI RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
12 29/03/18 TN.ABIDIN LL GDS 33,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 80,000 10,000
13 29/03/18 NY.HJ,YUSNIAR SP Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
14 29/03/18 NY.ERFINA SW Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 239,000 10,000
15 30/03/18 TN.RUDI RD GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
16 30/03/18 HJ.MADINA LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
17 30/03/18 TN.HASBI SP Darah Rutin 64,000
GDS 22,000
SGOT 33,000
SGPT 33,000
Urine Rutin 50,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 219,000 10,000
18 31/03/18 TN.HAERUDDIN LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
19 31/03/18 FATIMAH RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
20 31/03/18 NY.EMMA SW Darah Rutin 64,000
 Ureum 33,000
Kreatinin 33,000
GDS 22,000
Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 205,000 10,000
21 31/03/18 NY.NELDA RT Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
22 02/04/18 TN.H.AMRI IR GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
23 02/04/18 NN.ERNAWATI LL Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
24 02/04/18 NN.NURMANINGSIH LL Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
25 02/04/18 NY.JAMALIA LL Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
26 02/04/18 TN.SYAMSUL BAHAR RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
27 02/04/18 AN.ST.ZAHRA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
28 02/04/18 TN.SAKKA RD Darah Rutin 64,000
GDS 22,000
LED 30,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 131,000 10,000
29 02/04/18 TN.M.NATSIR IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
30 02/04/18 TN.DAMIR EI Darah Rutin 64,000
GDS 33,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 141,000 10,000
31 02/04/18 NY.RAHMAWATI LL Kolesterol 36,000
Asam Urat 33,000
 GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
32 02/04/18 NY.HJ.ST.NUR EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
33 03/04/18 TN.ALI LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
34 03/04/18 NY.AMELIA IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
35 04/04/18 TN.ABIDIN LL GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
36 04/04/18 NY.YASNI EI GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
37 04/04/18 NY.SUNU LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
38 04/04/18 TN.ABD.SYUKUR IM GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
39 05/04/18 NY.MUNIRA KR GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
40 05/04/18 NY.ERVINA SW Urine Rutin 50,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 51,000 -
41 06/04/18 TN.JUANDA LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
42 06/04/18 TN.SYAMSUL LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
43 06/04/18 NY.HERA RD GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 36,000 10,000
44 06/04/18 NY.SUPIMAH RD Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
45 06/04/18 TN.HUSAIN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
46 06/04/18 HJ.ROHANI IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
47 06/04/18 NY.IFFA KARTINI NS Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
48 07/04/18 TN.RUSTAM RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
49 07/04/18 NY.IDA SW Urine Rutin 50,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat Darah 10,000 68,000 10,000
50 09/04/18 NY.HJ.SANATI LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
LDL 50,000 50,000
HDL 50,000 50,000
TG 50,000 50,000
SGPT 33,000
transprt 30,000 30,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 402,000 20,000
51 09/04/18 AN.M.AZKA KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
52 09/04/18 TN.ZULKIFLI RD Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 151,000 10,000
53 09/04/18 NY.HJ.SURYANA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
54 09/04/18 NY.ABA RD GDS 22,000
 Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
55 09/04/18 NY.HJ. FARIDA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
56 09/04/18 NY.HJ.HALIMAH LL Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
57 09/04/18 TN.JUNAEDI AA Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
58 10/04/18 AN.WIDIA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
59 11/04/18 TN.ABIDIN RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
60 11/04/18 NY.HJ.MURNI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
61 11/04/18 AN.M.DERMAWAN KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
62 12/04/18 NY.HJ.INCI SARI RD Kolesterol 36,000
Widal 28,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 101,000 10,000
63 12/04/18 NY.RUWAEDA SW GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
64 12/04/18 TN.SAMSUL BAHAR SW GDS 33,000
Urine Rutin 50,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
65 12/04/18 NY.A.SANIA RD Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
66 12/04/18 TN.M.IQBAL KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
67 12/04/18 NY.MUNIRA LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
68 13/04/18 NY.HJ.MARAWIAH LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
69 13/04/18 NY.HAFSAH IR Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 111,000 10,000
70 13/04/18 TN. H.ADRIAN NS GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
71 13/04/18 NY.HJ.SYAMSIA SP Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
72 14/04/18 NY.HERNIA RD GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
73 16/04/18 TN.MIZWAR RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
74 16/04/18 NY.RUKMINI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
75 16/04/18 TN.RIAN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
76 16/04/18 NY.HERNA RD Kolesterol 36,000
GDS 33,000
L -
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 80,000 10,000
77 16/04/18 NY.HJ.CAMBARU EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat Darah 15,000 51,000 15,000
78 16/04/18 NY.HJ.MURNI IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 51,000 15,000
79 16/04/18 NN.KAMISA EI Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
80 16/04/18 TN.SAHARUDDIN EI Darah Rutin 64,000
HbSAg 50,000
GDS 22,000
Widal 28,000
SGOT 33,000
SGPT 33,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 248,000 10,000
81 16/04/18 TN.SYARIFUDDIN SP Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 182,000 10,000
82 16/04/18 NY.HJ.NISMA AB Golongan Darah 17,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 189,000 10,000
83 16/04/18 NN.ANGELA LL Golongan Darah 17,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 30,000 10,000
84 16/04/18 NY.NUR ASIA AB Golongan Darah 17,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 30,000 10,000
85 17/04/18 NY.RAHMA RD Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat Darah 20,000 169,000 20,000
86 17/04/18 NY.HJ.MASNAYA SP Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
87 17/04/18 NY.NURSAMI LL Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
88 18/04/18 NN. RUTH EI Kolesterol 36,000
 Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
89 19/04/18 NN.YANTI RD Darah Rutin 64,000
Kolesterol 36,000
L -
BHP -
Spoit + Tempat Darah 100,000 -
90 19/04/18 NN.SINAR WAHYU SP Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
91 20/04/18 TN.H.BASRUDDIN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
92 20/04/18 TN.MASDAR RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
93 20/04/18 NY.NURJANNAH SP Kolesterol 36,000
Asam Urat 33,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 148,000 10,000
94 21/04/18 NY.RAIYAH SP GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
95 21/04/18 HJ.NURMA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
96 21/04/18 TN.SSUKRIADI SP Golongan Darah 17,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 187,000 10,000
97 23/04/18 AN.MUTIA KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
98 23/04/18 AN.IFAN RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 46,000 10,000
99 23/04/18 NY.SUARNI RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
100 23/04/18 NY.RAHMAWATI RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
101 23/04/18 TN.H.JAMALUDDIN KR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
102 24/04/18 TN.ALI LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
103 24/04/18 AN.MIFTA AK Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
104 25/04/18 NY.HJ.YASSA LL Urine Rutin 50,000
L -
BHP -
Spoit + Tempat Darah 50,000 -
105 25/04/18 NY.EMY SUKMA IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
106 25/04/18 NY.HJ.CAMBARU EI GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
107 25/04/18 NY.CAWANG EI GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
108 25/04/18 NY.ST.AMINAH IM GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
109 25/04/18 TN.BUSTAM EI Kolesterol 36,000
GDS 22,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 137,000 10,000

TOTAL 16,117,000 16,117,000 360,000 2,994,000

-

Rincian Rawat Inap 5,301,000 5,301,000 -

Jasa Laboran 1,476,594 Rawat Jalan 10,816,000 10,816,000 -
Total Bruto 16,117,000 16,117,000 -
dr. Nur Rahmi, Sp. 1,476,594.00
Reagensia 4,819,700.00
Jasa Klinik 4,511,815.00
BHP 2,994,000.00 1,697,000
L 360,000
7,505,815.00
MARET 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR

20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
 SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 255,000.00 140,250.00 114,750.00 L 45,900.00 45,900.00 22,950.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR

5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR

SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 24,200.00 13,310.00 10,890.00 L 4,356.00 4,356.00 2,178.00 SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
 SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
NR
NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 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
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 NR
NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 NR
NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR

4,819,700 8,203,300 4,511,815 3,691,485 - 1,476,594 1,476,594 738,297

3,115,365
1,396,450 -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN MARET 2018 RUMAH SAKIT BERSALIN & K
dr HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
2 27/03/18 Ny.Sarah Intan KR Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 205,000 10,000
3 27/03/18 Tn.Musu SW Darah Rutin 64,000
Golongan Darah 17,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 257,000 10,000
5 29/03/18 Tn.Hasanuddin SP Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
7 29/03/18 Ny.Rosmiati SP Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
Elektrolit 260,000 260,000
GDS 33,000
L 8,000 8,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 535,000 10,000
8 03/04/18 An.St.Zahra KR Darah Rutin 64,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000
9 03/04/18 Tn.H.Fajar Abd.Rauf IR Darah Rutin 64,000
GDS 22,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 194,000 10,000
10 01/04/18 Ny.Hj.Saoda RD Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 137,000 10,000
11 05/04/18 Ny.Hasrianti AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
12 05/04/18 Ny.Kasimah KR Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
GDS 22,000
SGOT 33,000
SGPT 33,000
SGOT 33,000
SGPT 33,000
Elektrolit 260,000 260,000
albumin 50,000 50,000
L 8,000 8,000
BHP 6,000 6,000
Spoit + Tempat Darah 35,000 663,000 35,000
14 11/04/18 Ny.Nia Inrawati AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
15 11/04/18 Ny.Syarifah Aisyah AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
25 13/04/18 Ny.Wahida SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
29 07/04/18 Ny.Ruwaeda SW Darah Rutin 64,000
GDS 22,000
GDS 33,000
GDS 33,000
Kreatinin 33,000
Kolesterol 36,000
L 7,000 7,000
BHP 10,000 10,000
Spoit + Tempat Darah 30,000 268,000 30,000
4 27/03/18 NY.AYU RD Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
5 27/03/18 NY.ROSMINA RD Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
6 27/03/18 NY.INCI SARI RD Darah Rutin 64,000
Widal 28,000
Kolesterol 36,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat Darah 10,000 148,000 10,000
10 29/03/18 TN.H.ALI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
11 29/03/18 TN.RUSLI RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
12 29/03/18 TN.ABIDIN LL GDS 33,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 80,000 10,000
13 29/03/18 NY.HJ,YUSNIAR SP Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
14 29/03/18 NY.ERFINA SW Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 239,000 10,000
18 31/03/18 TN.HAERUDDIN LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
19 31/03/18 FATIMAH RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
20 31/03/18 NY.EMMA SW Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 205,000 10,000
33 03/04/18 TN.ALI LL GDS 33,000
L 1,000 1,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
34 03/04/18 NY.AMELIA IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
39 05/04/18 NY.MUNIRA KR GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
40 05/04/18 NY.ERVINA SW Urine Rutin 50,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 51,000 -
48 07/04/18 TN.RUSTAM RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
49 07/04/18 NY.IDA SW Urine Rutin 50,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat Darah 10,000 68,000 10,000
50 09/04/18 NY.HJ.SANATI LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
LDL 50,000 50,000
HDL 50,000 50,000
TG 50,000 50,000
SGPT 33,000
transprt 30,000 30,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 402,000 20,000
51 09/04/18 AN.M.AZKA KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
52 09/04/18 TN.ZULKIFLI RD Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 151,000 10,000
53 09/04/18 NY.HJ.SURYANA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
54 09/04/18 NY.ABA RD GDS 22,000
 Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
55 09/04/18 NY.HJ. FARIDA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
56 09/04/18 NY.HJ.HALIMAH LL Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
57 09/04/18 TN.JUNAEDI AA Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
59 11/04/18 TN.ABIDIN RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
60 11/04/18 NY.HJ.MURNI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
61 11/04/18 AN.M.DERMAWAN KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
68 13/04/18 NY.HJ.MARAWIAH LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
69 13/04/18 NY.HAFSAH IR Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 111,000 10,000
70 13/04/18 TN. H.ADRIAN NS GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
71 13/04/18 NY.HJ.SYAMSIA SP Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
85 17/04/18 NY.RAHMA RD Darah Rutin 64,000
HbSAg 50,000
 plano test 25000 25,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat Darah 20,000 169,000 20,000
86 17/04/18 NY.HJ.MASNAYA SP Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
87 17/04/18 NY.NURSAMI LL Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
89 19/04/18 NN.YANTI RD Darah Rutin 64,000
Kolesterol 36,000
L -
BHP -
Spoit + Tempat Darah 100,000 -
90 19/04/18 NN.SINAR WAHYU SP Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
94 21/04/18 NY.RAIYAH SP GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
95 21/04/18 HJ.NURMA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
96 21/04/18 TN.SSUKRIADI SP Golongan Darah 17,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 187,000 10,000
97 23/04/18 AN.MUTIA KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
98 23/04/18 AN.IFAN RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
99 23/04/18 NY.SUARNI RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
100 23/04/18 NY.RAHMAWATI RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
101 23/04/18 TN.H.JAMALUDDIN KR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
104 25/04/18 NY.HJ.YASSA LL Urine Rutin 50,000
L -
BHP -
Spoit + Tempat Darah 50,000 -
105 25/04/18 NY.EMY SUKMA IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
106 25/04/18 NY.HJ.CAMBARU EI GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
107 25/04/18 NY.CAWANG EI GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
108 25/04/18 NY.ST.AMINAH IM GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
109 25/04/18 TN.BUSTAM EI Kolesterol 36,000
GDS 22,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 137,000 10,000

TOTAL 16,117,000 16,117,000 360,000 2,994,000

-

Rincian Rawat Inap 5,301,000 - 5,301,000

Jasa Laboran 1,476,594 Rawat Jalan 10,816,000 10,816,000 -
Total Bruto 16,117,000 10,816,000 5,301,000

dr. Nur Rahmi, Sp. 1,476,594.00

Reagensia 4,819,700.00
Jasa Klinik 4,511,815.00
BHP 2,994,000.00 1,697,000
L 360,000
7,505,815.00
MARET 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR

10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
 NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 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
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
NR
NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 NR
 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 NR
NR
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
 K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR

4,819,700 8,203,300 4,511,815 3,691,485 - 1,476,594 1,476,594 738,297

3,115,365
1,396,450 -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN MARET 2018 RUMAH SAKIT BERSALIN & K
HARGA

NO TGL NAMA PASIEN dr URAIAN TARIF TOTAL

BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
2 23/02/18 An.Shakila SP Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
4 25/02/18 Tn.Rukhyat IR Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 111,000 10,000
5 01/03/18 Ny. Ayu Wulandari AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
8 01/03/18 Ahmad Haruna RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 10,000
EI Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Elektrolit 260,000 260,000
GDS 22,000
GDS 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 661,000 15,000
9 03/03/18 An.Ainun SP Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
11 05/03/18 Ny.Sri Rahayu SV Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
14 07/03/18 Tn.Sukirman RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat Darah 15,000 15,000
EI GDS 22,000
 GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 246,000 10,000
15 07/03/18 Ny.Amriati IR Darah Rutin 64,000
Asam Urat 33,000
GDS 22,000
Urine Rutin 50,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 253,000 10,000
16 09/03/180 Ny.Husbaniah KR Darah Rutin 64,000
Kolesterol 36,000
Widal 28,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 166,000 10,000
17 11/03/18 Tn.H.Syamsuddin SW Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 142,000 10,000
19 11/03/18 Nn.Yuni SP Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
Darah Rutin 64,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat Darah 30,000 260,000 30,000
20 11/03/18 An.Nadin SP Darah Rutin 64,000
Widal 28,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat Darah 20,000 212,000 20,000
21 11/03/18 An.Fahmi SP Widal 28,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
22 13/03/18 Ny.Reski Wahyuni AB Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
GDS 22,000
GDS 22,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat Darah 30,000 254,000 30,000
24 15/03/18 Ny.Sahara AB Darah Rutin 64,000
 Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
GDS 22,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 30,000 363,000 30,000
28 17/03/18 Ny.Nurbaniah AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 331,000 20,000
29 15/03/18 By. Afizah IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
30 15/03/18 Ny.Berlian IR GDS 22,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000
33 17/03/18 Tn.H.Tassa RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
34 21/03/18 Ny. Yuliani IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000

RAWAT JALAN
7 27/02/18 NY.ZILVIA SW Darah Rutin 64,000
Widal 28,000
GDS 22,000
SGOT 33,000
SGPT 33,000
Urine Rutin 50,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 248,000 10,000
20 01/03/18 TN.MUH.ARWAN IR Darah Rutin 64,000
 Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat Darah 20,000 182,000 20,000
21 01/03/18 TN.ARDIANSYAH RD Widal 28,000
Kolesterol 36,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 101,000 10,000
26 03/03/18 NN.FITRI SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
27 05/03/18 TN. MUH.ZUBIR RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
28 05/03/18 TN.ARIFIN RD Kolesterol 36,000
Asam Urat 33,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat Darah 15,000 94,000 15,000
29 05/03/18 TN.AMINUDDIN LL Urine Rutin 50,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 4,000 55,000 4,000
30 05/03/18 TN.SULTAN LL Urine Rutin 50,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 4,000 55,000 4,000
31 05/03/18 NY.HJ.ROSIDA LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
32 05/03/18 AN.FARIH IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
33 05/03/18 TN.MUIS RAHIM LL Ureum 33,000
Kreatinin 33,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 32,000
L - -
BHP 2,000 2,000
Spoit + Tempat Darah - 200,000 -
34 05/03/18 TN.BASRI IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 83,000 10,000
35 05/03/18 TN.RAHMAN IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
36 05/03/18 NY.HJ.HAWIAH RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
37 05/03/18 NY.BIAH EI GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
42 07/03/18 NY.HJ.NASNA RD GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
45 09/03/18 NY.RISMAWATI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
46 09/03/18 TN.RAMLI PANGLOLI RD Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 168,000 10,000
47 09/03/18 NY.ASLI DAUD RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
48 09/03/18 TN.A.IDRIS LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
49 09/03/18 AN.AHMAD KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
56 13/03/18 TN.RUSMAN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
57 13/03/18 TN.H.MANDI KR GDS 22,000
Kolesterol 36,000
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
58 13/03/18 NY.LEONORA LL Ureum 33,000
Kreatinin 33,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 239,000 10,000
66 15/03/18 NY.ADE IRMA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
67 15/03/18 AN.AINUN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
68 15/03/18 TN.ANWAR RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
71 17/03/18 NY. SIMANSIAL LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 5,000 41,000 5,000
72 17/03/18 NY.HJ.SIRUA RD GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
73 17/03/18 NY.HJ.EDA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
74 19//3/19 TN.FERDI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
75 19//3/21 TN.SYAHRIL RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
76 19/03/18 NY.HJ.MULTI LL GDS 22,000
 Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 69,000 10,000
77 19/03/18 TN.ABIDIN IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
83 21/03/18 NY.NIPEN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
84 21/03/18 NY.ST.HAJAR KR Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
85 21/03/18 NY.WAHIDA LL Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
86 21/03/18 TN.ABD.AZIZ RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
87 21/03/18 NY.HERLINA IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
88 21/03/18 NY.HJ.NURJANNAH IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
89 21/03/18 NY.HJ.RAHMAWATI IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
95 23/03/18 TN.RUDI RD GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
96 23/03/18 HJ.HAMSINA LL GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
97 23/03/18 NY.HJ.LISNA RD Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
98 23/03/18 AN.EMILIA RD Kolesterol 36,000
Asam Urat 33,000
 GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
99 23/03/18 HJ.HAJAR LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
Rincian Rawat Inap 6,492,000 - 6,492,000
Jasa Laboran 1,686,474 Rawat Jalan 10,526,000 - 10,526,000
Total Bruto 17,018,000 - 17,018,000

dr. Nur Rahmi, Sp. 1,686,474.00

Reagensia 5,147,700.00
Jasa Klinik 5,153,115.00
BHP 2,366,000.00 1,239,000
L 386,000
7,519,115.00
MARET 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR

NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
NR
NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 22,500.00 12,375.00 10,125.00 L 4,050.00 4,050.00 2,025.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
 K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
 K NR
K NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
20,000 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
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN MEI 2018 RUMAH SAKIT BERSALIN & KL
dr HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 20/06/18 Tn.H.Masgamal RD 421,000
2 13/06/18 Ny.Sri Marliani RT 95,000
3 13/06/18 An.Fathia KR 100,000
4 18/06/18 Tn.Rahman EI 302,000
5 18/06/18 Tn.Abdullah SW 77,000
6 17/06/18 Tn.Irfan KR 239,000
7 14/06/18 Ny.Mu'Minang IR 46,000
8 19/06/18 Tn.Adnan IR 229,000
9 20/06/18 An.Asraf SP 100,000
10 18/06/18 AN.Evelin IR 77,000
11 20/06/18 Tn.Ahmad Sadikin SP 360,000
12 10/06/18 Ny.Hj.Wagira RD 521,000
13 28/05/18 An.M.Hafis RD 77,000
14 04/06/18 Tn.Ihsan KR 592,000
15 08/06/18 Ny. Hj.Sarifa T.A IR 287,000
16 14/06/18 Tn.Mahesa EI 458,000
17 09/06/18 An.Azalea IR 77,000
18 19/06/18 Ny.Tarlia EI 230,000
19 01/06/18 Ny.Rahmawati SW 943,000
20 08/06/18 An.Farhan IR 687,000
21 18/06/18 Ny. Hj.Rita RT 77,000
22 28/05/18 Ny.Hj.Tenri a.w RD 557,000
23 07/06/18 Ny.Hj.Perawati IR 205,000
24 09/06/18 Ny.Rafika IR 77,000
25 02/06/18 Tn.Rahmat IR 535,000
26 12/06/18 Ny.Sadriyanti AB 95,000
27 19/06/18 Ny.Hasmira RT 95,000
28 30/05/18 ny.Hj.Ramadhan RT 77,000
29 12/06/18 Ny.Syamsiah AB 172,000
30 11/06/18 Ny.Ade Arini AB/RT 331,000
31 03/06/18 Ny.Alfiah AB 331,000
32 16/06/18 Ny.A.Kamelia RT 100,000
33 20/06/18 Ny.Eni Winarni AB 95,000
34 25/06/18 Ny.wirdaningsih AB 195,000
35 22/06/18 Tn. Ilman KR 280,000

RAWAT JALAN
1 26/05/18 NY.SARTIKA RD 49,000
2 28/05/18 NY.MARWAH ATIB KR 106,000
3 28/05/18 TN. TAUFIK KR 46,000
4 28/05/18 TN.SAHARUDDIN SP 121,000
5 28/05/18 TN.H.PATURUSI SP 109,000
6 28/05/18 NY.HADARAWI SP 83,000
7 28/05/18 NY. LENNY KWANG LL 83,000
8 28/05/18 NY.ENIFTJE RD 49,000
9 28/05/18 TN.H.PATRUSI EI 46,000
10 28/05/18 NY.JAMALIAH AA 106,000
11 29/05/18 TN.RAHMAT RD 35,000
12 29/05/18 NY.HJ.YOTUM RD 83,000
13 30/05/18 NY.ENDANG RD 49,000
14 31/05/18 TN.ABD.MAJID SP 63,000
15 31/05/18 TN. CHANDRA WIJAYA IR 49,000
16 31/05/18 NY.HJ.FARIDA IR 106,000
17 01/06/18 NY.HJ.ZAW LL 89,000
18 02/06/18 AN.FARHAN RD 106,000
19 02/06/18 NY.MARYAM RD 158,000
20 02/06/18 NY.KASMAWATI IR 77,000
21 02/06/18 NY.HJ.BUBA LL 46,000
22 02/06/18 NY.NULFIANI RD 106,000
23 02/06/18 AN.ERIK SW 77,000
24 02/06/18 TN.ASRI SAPUTRA IR 106,000
25 04/06/18 AN. TRI HARIMURTI LL 124,000
26 04/06/18 TN.M.TAHIR RD 69,000
27 04/06/18 TN.JUMAIR IM 35,000
28 04/06/18 HJ.HASNAWATI EI 106,000
29 05/06/18 TN.H.PATAJANGI RD 72,000
30 05/06/18 NY.BECCE SW 46,000
31 05/06/18 NY.HJ.YUSNIAR RD 49,000
32 06/06/18 TN.RAHMAN LL 49,000
33 06/06/18 TN.H.HAFID EI 106,000
34 06/06/18 TN.BASIR EI 229,000
35 07/06/18 TN.H.AMIN IR 109,000
36 09/06/18 TN.RAHMAT LL 35,000
37 09/06/18 TN.AZIS IR 83,000
38 09/06/18 TN.SYAHRUL IR 126,000
39 09/06/18 TN.CACO RD 163,000
40 09/06/18 NY.SUMA SW 100,000
41 11/06/18 NY.HJ.NURSIANG SW 122,000
42 11/06/18 TN.LATUP LL 72,000
43 11/06/18 NN.RADINA RD 187,000
44 11/06/18 TN.ALWI LL 72,000
45 11/06/18 TN.M.TAHIR RD 106,000
46 11/06/18 NY.HJ.MULTI LL 72,000
47 11/06/18 TN.RENDI JULIO SELAN RD 145,000
48 11/06/18 NY.JULIANA IM 35,000
49 12/06/18 NY.HJ.ROHANI SP 83,000
50 12/06/18 AN. ABDULLAH SP 77,000
51 13/06/18 NY.MUTIARA SP 146,000
52 16/06/18 NY.MULIANI SP 53,000
53 16/06/18 HJ.HANIA LL 49,000
54 18/06/18 TN.HAMDANI LL 106,000
55 18/06/18 NY.NURMAWATI EI 151,000
56 18/06/18 TN.HENDRIK EI 72,000
57 18/06/18 NY.YARDA LL 106,000
58 19/06/18 NY. HIKMA LL 40,000
59 19/06/18 NY. TRI SANTI LL 63,000
60 19/06/18 NY.HJ.NURSIA SW 86,000
61 20/06/18 NN.PUTRI SP 49,000
62 20/06/18 NY.HJ.MULI LL 106,000
63 20/06/18 NY.SYAMSIAR LL 171,000
64 20/06/18 NY.YUSNITA SP 49,000
65 21/06/18 NY.NURJANNAH SP 83,000
 66 21/06/18 TN.H.ANDASA SP 46,000
67 21/06/18 NY.YOTONG EI 148,000
68 21/06/18 TN.JUNAID LL 106,000
69 21/06/18 TN.RUSLI LL 106,000
70 22/06/18 AN.MUH.ZULGIFARI KR 77,000
71 22/06/18 TN.YUDHA RD 106,000
72 22/06/18 TN.USMAN IM 35,000
73 22/06/18 NY.HASMALIA EI 157,000
74 22/06/18 TN.H.LAUDIN IM 35,000
75 23/06/18 NY.HAJAMIAH SP 106,000
76 23/06/18 NY.HJ.NURHAEDAH LL 200,000
77 25/06/18 TN.AKHIRUDDIN LL 71,000
78 25/06/18 NN.RAFIKA RD 106,000
79 25/06/18 NY.HJ.PAIDAH LL 83,000
80 25/06/18 NY.JALAINTANG RD 49,000
81 25/06/18 AN.MIIZA RD 187,000
82 25/06/18 TN.ABDULLAH RD 69,000
83 25/06/18 TN. BAKTIAR LL 106,000
84 25/06/18 TN. KURNIADI LL 106,000
85 25/06/18 TN. MUDING RD 106,000
86 25/06/18 HJ.DEWI SP 38,000

TOTAL - 16,933,000 - -
16,933,000

Rincian Rawat Inap 9,140,000 9,140,000 -

Jasa Laboran - Rawat Jalan 7,793,000 - 7,793,000
Total Bruto 16,933,000 9,140,000 7,793,000

dr. Nur Rahmi, Sp. -

Reagensia -
Jasa Klinik -
BHP - -
L -
-
MEI 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

DR,GOLDA
DR,GDS
DR,GDS,KOL,UR,KR,WIDA
DR2X,GDS,KR,UR,WIDAL

GDS

dr,widal,gds,ot,pt,elektrolit

dr,ur,cr,ot,pt
dr,dr,dr,dr,gds(2),dr,gdp,dr,

DR

dr,gds,kol,ur,kr

dr,goldar
dr,goldar
dr
dr,dr,golda
dr,golda,gds,ur,cr,ot,pt
dr,golda,gds,ur,cr,ot,pt
dr,golda
dr,golda
dr,golda
dr,golda,gds
dr,widal

DR
GDS,KOL,AU

10.000 Masuk di klinik

inhealt

GDS,HbSAg

GDS,KOL,AU

DR,TES MALARIA,WIDAL

KOL,AU
GDS,KOL,AU
 DR,WIDAL

- - - - - - - -
-
- -
DR,GOLDA

DR,GDS,KOL,UR,KR,WIDAL,SGOT,SGPT
DR2X,GDS,KR,UR,WIDAL

dr,widal,gds,ot,pt,elektrolit

dr,ur,cr,ot,pt
dr,dr,dr,dr,gds(2),dr,gdp,dr,widal,gds,kol

dr,gds,kol,ur,kr

dr,dr,golda
dr,golda,gds,ur,cr,ot,pt
dr,golda,gds,ur,cr,ot,pt

dr,golda,gds
GDS,KOL,AU

10.000 Masuk di klinik

DR,TES MALARIA,WIDAL
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN JULI 2018 RUMAH SAKIT BERSALIN & K
dr HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 16/07/18 An.Evelyn Aurelia IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
2 11/06/18 Ny.Marwah IR Urine Rutin 50,000
GDS 33,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 162,000 10,000
3 05/07/18 An.Altaf RD Widal 28,000
Darah Rutin 64,000
L 2,000 2,000
Cyto 25,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 131,000 10,000
4 08/07/18 Tn.Hari AF Kolesterol 36,000
GDS 33,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 9,000 9,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 362,000 20,000
5 08/07/18 Ny.Hj.Kalobang AF Kolesterol 36,000
GDS 22,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
Darah Rutin 64,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 282,000 20,000
6 28/06/18 Ny.Hj.Kassa Kolesterol 36,000
GDS 33,000
Elektrolit 260,000 260,000
Asam Urat 33,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SW SGPT 33,000
L 8,000 8,000
BHP 3,000 3,000
 Spoit + Tempat Darah 20,000 717,000 20,000
7 10/07/18 Ny.A.Wero SW Kolesterol 36,000
Darah Rutin 64,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 116,000 10,000
8 27/06/18 Ny.Hj.Malotong RD Kolesterol 36,000
GDS 33,000
Asam Urat 33,000
Darah Rutin 64,000
Ureum 50,000 50,000
Kreatinin 50,000 50,000
SGOT 50,000 50,000
SGPT 50,000 50,000
Transport 10,000 10,000
L 8,000 8,000
BHP 3,000 3,000
Spoit + Tempat Darah 20,000 407,000 20,000
9 12/07/18 An.Heru RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
10 12/07/18 Ny.St.Salma AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
11 01/07/18 Ny.Hj.Fuji AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
12 16/07/18 Ny.Nmurhayati AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
13 02/07/18 Ny.Saskia SW GDS 33,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 111,000 10,000
14 04/07/18 Ny.Nur Alam AF SGOT 33,000
SGPT 33,000
GDS 22,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 166,000 10,000
15 14/07/17 Ny.Hj.Fuji SK Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
16 10/07/18 Ny.Sri Rahayu KR Kolesterol 36,000
GDS 22,000
 SGOT 33,000
SGPT 33,000
HbSAg 100,000 100,000
HCV 120,000 120,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 490,000 10,000
17 27/06/18 Ny.A.Erni AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat Darah 10,000 287,000 10,000
18 09/07/18 An.Ahnaf AF Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
19 29/06/18 Ny.Sriyantyi AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
20 28/06/18 An.Aisyah Syahrani KR GDS 22,000
Widal 28,000
Darah Rutin 64,000
Darah Rutin 64,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 206,000 20,000
21 01/07/18 An. Rasfanjani IR GDS 22,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000
22 23/06/18 An.Fathan RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
23 26/06/18 Ny.Hafni SP Darah Rutin 64,000
Darah Rutin 64,000
L 2,000 2,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 154,000 20,000
24 28/06/18 Ny.Asliana SP Kolesterol 36,000
GDS 22,000
Elektrolit 260,000 260,000
Asam Urat 33,000
Darah Rutin 64,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 432,000 10,000
25 29/06/18 Tn.Ambun EI Kolesterol 36,000
GDS 33,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat Darah 20,000 356,000 20,000
26 09/07/18 Nn.Iin Nurselin AF Darah Rutin 64,000
Darah Rutin 64,000
L 2,000 2,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 154,000 20,000
27 02/07/18 Tn.M.Tasrif IR Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
Darah Rutin 64,000
L -
BHP -
Spoit + Tempat Darah 155,000 -
28 27/06/18 An.Salsabila RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
29 29/16/18 Tn.H.Halide KR Ureum 33,000
GDS 22,000
Elektrolit 260,000 260,000
Kreatinin 33,000
Darah Rutin 64,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 429,000 10,000
30 04/07/18 Ny.hj.Siteng IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
31 19/07/18 Ny.Lisda RD Widal 28,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 41,000 10,000
32 22/07/18 Ny.Nila Santi RD Widal 28,000
SGOT 33,000
SGPT 33,000
Urine Rutin 50,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 3,000 3,000
 Spoit + Tempat Darah 10,000 293,000 10,000
33 23/07/18 An.Nuarqila AF Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
34 18/07/18 Ny.Mayang Sari AB Ureum 33,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 362,000 15,000
35 20/07/18 Tn.Abdullah EI Kolesterol 36,000
GDS 33,000
Elektrolit 250,000 250,000
Asam Urat 33,000
IgG 120,000 120,000
IgM 120,000 120,000
Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Widal 28,000
L 10,000 10,000
BHP 3,000 3,000
Spoit + Tempat Darah 20,000 913,000 20,000
36 21/07/18 Nn.Atika SK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
37 18/07/18 Ny. Maria Allo IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
38 13/07/18 An. Husni Safitri RD Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
IgG 120,000 120,000
IgM 120,000 120,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 11,000 11,000
BHP 12,000 12,000
Spoit + Tempat Darah 50,000 789,000 50,000
39 14/07/18 Tn. Ansar RD Darah Rutin 64,000
SGOT 33,000
SGPT 33,000
L 3,000 3,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 145,000 10,000
40 16/07/18 An. Evelyn Aurelia W IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
41 23/07/18 An. Nyr Aqila AF Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
42 17/07/18 Ny. Hj. Rukaya EI Golongan Darah 17,000
Kolesterol 36,000
GDS 33,000
GDS 33,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
Urine Rutin 50,000
L 12,000 12,000
BHP 11,000 11,000
Spoit + Tempat Darah 40,000 556,000 40,000
43 18/07/18 Tn. H. Muhammad KR GDS 33,000
Elektrolit 250,000 250,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 497,000 10,000
44 21/07/18 Ny.Santi SK Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
45 26/07/18 Ny. Rosdiana SK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
46 26/07/18 Ny. Aan Rosdiana SK Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000

RAWAT JALAN
1 26/06/18 TN. BUDIMAN RD GDS 22,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 69,000 10,000
2 26/06/18 AN.NUR AFNI SP Darah Rutin 64,000
 Urine Rutin 50,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 128,000 10,000
3 27/06/18 KAK TUTI LL Darah Rutin 64,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 65,000 -
4 27/06/18 NY.MARYAM RD Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
5 28/06/18 NY.HJ.HAJAR RD Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
6 28/06/18 TN.MUH.ASNUR LL Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
7 28/06/18 NY.HJ.TARI RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
8 28/06/18 NY.NONI RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
9 28/06/18 NY.BUAH RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
10 28/06/18 NY.ASMAR SW Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
11 28/06/18 TN.PAULUS IB Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
12 29/06/18 AN.M.NUR ILMAN LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
13 29/06/18 NY.SAHATI KR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
14 30/06/18 TN.PAULUS RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 5,000 41,000 5,000
15 30/06/18 NY.MARDINA LL HbSAg 50,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 157,000 10,000
16 30/06/18 NY.NURJANNAH RD Urine Rutin 50,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 157,000 10,000
17 02/07/18 AN.LINDA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
18 02/07/18 SYAMSUDDIN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
19 02/07/18 TN.FIRMAN RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
20 02/07/18 NY.WATI LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
21 02/07/18 NY.ENI ROLIATI LL HbSAg 50,000
plano test 25000 25,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 89,000 10,000
22 02/07/18 NY.JUSMITA LL Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
23 02/07/18 NN.NADIA LL Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
24 02/07/18 NN.LINDA LL Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
25 02/07/18 TN.PAULUS EI Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Darah Rutin 64,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
26 03/07/18 NY.SAPRIANA LL plano test 25000 25,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 38,000 10,000
27 03/07/18 NY.RANISA LL plano test 25000 25,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 38,000 10,000
28 03/07/18 NY.RASNAWATI RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
29 04/07/18 TN.M.TAHIR RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
30 04/07/18 NY.MEDIAWATI LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
31 04/07/18 TN.H.HARUNA LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
32 04/07/18 NY.YULIANA LOGA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
33 05/07/18 TN.H.LANAWI AF Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
34 05/07/18 TN.FIKRO LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 5,000 41,000 5,000
35 05/07/18 NY.HIJAYAH LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
36 05/07/18 NY.HJ.NURBAYA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 106,000 10,000
37 06/07/18 NY.KAMARIA EI Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
38 06/07/18 TN.BAHARUDDIN IB Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
39 06/07/18 AN.FATIAH EI Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
Widal 28,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 177,000 10,000
40 06/07/18 TN.ZULKIFLI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
41 07/07/18 TN.ADI RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
42 07/09/18 NY.NASIA LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
43 07/09/18 TN.SUPRIADI AF Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
44 07/09/18 NY.DARMA AF Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
45 07/10/18 TN.M.ASRIADI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
46 07/10/18 H.GAZALI EI Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 111,000 10,000
47 07/10/18 NY.HJ.RAHMA KR Asam Urat 33,000
Darah Rutin 64,000
Kolesterol 36,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 148,000 10,000
48 07/10/18 NN.NURMIATI AK Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
49 07/10/18 NY.RATNA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
50 07/10/18 NY.HJ.SUARNI KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
51 07/10/18 TN.LANDO IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
52 07/11/18 TN.PAULUS RD Kolesterol 36,000
Asam Urat 33,000
L -
BHP 1,000 1,000
Spoit + Tempat Darah 10,000 80,000 10,000
53 07/11/18 NY.A.ERNI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
54 07/11/18 TN.RIDWAN RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
55 07/12/18 TN.ENOS RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
56 07/12/18 TN.ISKANDAR RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
57 07/12/18 TN.HAMZAH RD Kolesterol 36,000
Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 103,000 -
58 07/12/18 NY.MASITA RD Darah Rutin 64,000
Kolesterol 36,000
 L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
59 07/12/18 NY.AMELIA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
60 07/12/18 NN.RAHAYU IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
61 07/12/18 TN.ANSAR LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
62 07/12/18 TN.JARI IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
63 16/7/2018 TN.DARWIS RD Kolesterol 36,000
GDS 22,000
L -
BHP -
Spoit + Tempat Darah 58,000 -
64 16/7/2018 NY.ARMIA RD Widal 28,000
Darah Rutin 64,000
L -
BHP -
Spoit + Tempat Darah 92,000 -
65 16/7/2018 TN.ZULKIFLI RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 5,000 41,000 5,000
66 16/7/2018 TN.HENDRA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
67 16/7/2018 NY.HJ.MANUSIA LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
68 16/7/2018 NY.ISMAWATI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
69 16/7/2018 TN.HARISULA EI Darah Rutin 64,000
Kreatinin 33,000
Ureum 33,000
SGPT 33,000
SGOT 33,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 307,000 10,000
70 16/7/2018 NY.FAUZIAH EI Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
71 17/7/2018 NY.FARIDA RD Darah Rutin 64,000
HbSAg 120,000 120,000
plano test 23000 23,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 222,000 10,000
72 19/7/2018 NY.LISDA KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
73 19/7/2018 NY.MARIA ALLO LL GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
74 19/7/2018 NY.HJ.MASNIA RD Urine Rutin 50,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
75 19/7/2018 TN.SYAHRIL SW Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
76 20/7/2018 AN.ASWAR LL LED 30,000 30,000
Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 217,000 10,000
77 20/7/2018 NY.ERNI RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
78 20/7/2018 NY.HJ.EMA USRI LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
79 20/7/2018 TN.ADNAN RD Kolesterol 36,000
 Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
80 20/7/2018 NY.HJ.HAPIDA IM Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
81 20/7/2018 TN.AHMAD NUR EI Darah Rutin 64,000
Kolesterol 36,000
Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 143,000 10,000
82 20/7/2018 NY.NURSELANG RD Darah Rutin 64,000
Kolesterol 36,000
Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 143,000 10,000
83 20/7/2018 NY.SUARNI RD Darah Rutin 64,000
HbSAg 120,000 120,000
plano test 25000 25,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 227,000 10,000
84 20/7/2018 NY.BANONA KEIYA RD Darah Rutin 64,000
HbSAg 120,000 120,000
plano test 25000 25,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 227,000 10,000
85 21/07/2018 NY.INA LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
86 21/07/2018 NY.BUDIATI SW Ureum 33,000
Kreatinin 33,000
Asam Urat 33,000
Kolesterol 36,000
GDS 33,000
L 8,000 8,000
BHP 6,000 6,000
Spoit + Tempat Darah 20,000 202,000 20,000
87 23/07/2018 NY.YUSDALENA LL Asam Urat 33,000
Kolesterol 36,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 148,000 10,000
88 23/07/2018 TN.ESAM NIU RD Kolesterol 36,000
L 1,000 1,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
89 23/07/2018 NN.BUNGA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
90 23/07/2018 NY.NUR HAEDAH RD Kolesterol 36,000
Asam Urat 33,000
L 10,000 10,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 92,000 10,000
91 23/07/2018 TN.SIMON LL Kolesterol 36,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
92 23/07/2018 NY.ERNA EI IgG 120,000 120,000
IgM 120,000 120,000
Widal 28,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 346,000 10,000
93 24/07/2018 TN.SYAHRIL SW GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
94 24/07/2018 NN.CLARA CRISTINA RD Darah Rutin 64,000
HbSAg 60,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 164,000 10,000
95 24/07/2024 NY.NURMA LL Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 187,000 10,000
96 25/07/2018 TN.SAPPE IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
97 25/07/2018 NY.HJ.IRMAYANTI SV Urine Rutin 50,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 69,000 10,000
98 25/07/2018 AN.CERI LL Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 187,000 10,000
 TOTAL 20,810,000 20,810,000 400,000 4,915,000
-

Rincian Rawat Inap 10,487,000 10,487,000 -

Jasa Laboran 1,716,372 Rawat Jalan 10,323,000 10,323,000 -
Total Bruto 20,810,000 20,810,000 -

dr. Nur Rahmi, Sp. PK 1,716,372.00

Reagensia 5,935,600.00
Jasa Klinik 5,244,470.00
BHP 4,915,000.00 2,007,000
L 400,000
10,159,470.00
JULI 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR

SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
L - - - SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
 K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
NR
NR
NR
NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
L - - - SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR kurang
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
L - - - NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
L - - - SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
 K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
L - - - SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR

SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 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
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
NR
NR
K NR
K NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
 K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
 NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
 NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
20,000 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
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
20,000 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
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
 K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
NR
NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 35,000.00 19,250.00 15,750.00 6,300.00 6,300.00 3,150.00 SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
NR
K NR
K NR
5,935,600 9,535,400 5,244,470 4,290,930 - 1,716,372 1,716,372 858,186
2,839,815
2,404,655 -
152696

152697

152698

204189

204190

217692

152703

128145
179546

204197

152710

152711
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN MEI 2018 RUMAH SAKIT BERSALIN & KL
dr HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 24/04/18 Ny.dr.Ratih,Sp.OG RD Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 303,000 20,000
2 27/04/18 An.Arinda IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
3 30/04/18 Ny.A.Norma AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 331,000 20,000
4 26/04/18 Ny.Hj.Yahya KR Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
GDS 22,000
GDS 22,000
Urine Rutin 50,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 275,000 20,000
5 01/05/18 Ny.St.Nurjannah RT Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
6 01/05/18 An.Andayani RD Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
SGOT 33,000
SGPT 33,000
L 7,000 7,000
BHP 4,000 4,000
 Spoit + Tempat Darah 15,000 325,000 15,000
7 02/05/18 Ny.Hj.Perawati SW Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 205,000 10,000
8 01/05/18 An.Nur Zairah AK Darah Rutin 64,000
Golongan Darah 17,000
GDS 22,000
Darah Rutin 64,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 5,000 198,000 5,000
9 30/04/18 Ny.Emma SP Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 33,000
GDS 22,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat Darah 30,000 377,000 30,000
10 30/04/18 An.Astika RD Urine Rutin 50,000
SGOT 33,000
SGPT 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 131,000 10,000
11 03/05/18 Ny.Hj.Nisma SK Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
12 05/03/18 Ny.Andi Anti AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat Darah 10,000 319,000 10,000
13 04/05/18 An.Afika KR Darah Rutin 64,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000
14 05/03/18 Ny.St.Maemuna AB Darah Rutin 64,000
 GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000
15 06/05/18 Ny.Yusrianti RD Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 33,000
GDS 22,000
L 10,000 10,000
BHP 7,000 7,000
Spoit + Tempat Darah 30,000 362,000 30,000
16 02/05/18 Ny.Hj.St.Mina IM GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
17 14/05/18 Ny.Hj.Sandae EI Darah Rutin 64,000
Darah Rutin 64,000
Asam Urat 33,000
GDS 22,000
GDS 22,000
SGOT 33,000
SGPT 33,000
SGOT 33,000
SGPT 33,000
Elektrolit 260,000 260,000
albumin 50,000 50,000
L 10,000 10,000
BHP 6,000 6,000
Spoit + Tempat Darah 35,000 698,000 35,000
18 11/05/18 Ny.hijarana RD Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 9,000 9,000
BHP 7,000 7,000
Spoit + Tempat Darah 20,000 254,000 20,000
19 09/05/18 Ny. Zahrawani AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 331,000 20,000
20 16/05/18 Ny.A.Afni AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 95,000 10,000
21 19/05/18 Tn.H.Sunusi SW Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
22 17/05/18 Ny.Rani SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
23 22/05/18 Ny.Maryam RD Darah Rutin 64,000
Darah Rutin 64,000
Urine Rutin 50,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
GDS 22,000
Widal 28,000
L 6,000 6,000
BHP 5,000 5,000
Spoit + Tempat Darah 15,000 345,000 15,000
24 22/05/18 An.Muh.Fathul Muin IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
25 22/05/18 Ny. Eka Handayani AB Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 187,000 10,000
26 05/05/18 An.Widia RD Darah Rutin 64,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000

RAWAT JALAN
1 26/04/18 AN,RESKI KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
2 26/04/18 TN.ANWAR KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
3 26/04/18 TN.ANWAR KR Darah Rutin 64,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000
4 28/04/18 TN.H.HAPIL LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
5 28/04/18 NY.WINDA SV Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
6 28/04/18 NY.HJ.HADANIA RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
7 30/04/18 NY.HJ.HAPIDA RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 182,000 10,000
8 30/04/18 TN.MUGI BUDIMAN SP Kolesterol 36,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 56,000 15,000
9 30/04/18 NY.RAMALANG LL Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
10 30/04/18 NY.HJ.HASMA SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
11 30/04/18 NY.ENDANG LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
12 30/04/18 TN.ACO A. RAHMAN LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
13 30/04/18 NY.BIAH EI Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 182,000 10,000
14 03/05/18 NY.ST.MAN RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
15 03/05/18 DYAH LL GDS 33,000
L 1,000 1,000
 BHP 1,000 1,000
Spoit + Tempat Darah 10,000 45,000 10,000
16 03/05/18 NY.HJ.MAMTAHA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
17 04/05/18 TN.ABDUL RAHMAN LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
18 05/05/18 NY.ST. SUHURIA LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
19 05/05/18 TN.DOLLA SW Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 239,000 10,000
20 07/05/18 AN. FAREX RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
21 07/05/18 TN. HENDRA RD Darah Rutin 64,000
Asam Urat 33,000
Kreatinin 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 155,000 20,000
22 07/05/18 NY.HJ.JOHORANG RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
23 07/05/18 NY.ASTI EI Darah Rutin 64,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000
24 07/05/18 TN.ALIMUDDIN EI Urine Rutin 50,000
SGOT 33,000
SGPT 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 131,000 10,000
25 07/05/18 TN.SUNARDI IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
26 08/05/18 NY.HJ.HADIJA LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
27 08/05/18 TN. H.SAIPUL LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
28 08/05/18 TN.NASARUDDIN LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
29 08/05/18 TN.ZULKARNAIN LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
30 08/05/18 NY.HJ.TARI SP Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
31 09/05/18 NY.HJ.ROHANI EI GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
32 09/05/18 TN.IRDAN IR Darah Rutin 64,000
HbSAg 50,000
SGPT 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 162,000 10,000
33 10/05/18 NY.HJ.RUSNI IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
34 10/05/18 NY.ELVIANA RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
35 10/05/18 .HJ.HAFIDA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
36 11/05/18 NY.MAHDIA EI Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
37 12/05/18 TRI SANTI SW Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
38 12/05/18 NY.SATIA SW GDS 33,000
Urine Rutin 50,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
39 14/05/18 TN.ALBERT LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
40 14/05/18 TN.SUKANDAR RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
41 14/05/18 NY.ST.AMINAH SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
42 14/05/18 TN.HAERUDDIN SP Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
43 14/05/18 TN.RIDWAN SP Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
44 14/05/18 AN.ELIS KR Widal 28,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 41,000 10,000
45 14/05/18 TN.RISMAN KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
46 14/05/18 NY.SURIANI KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
47 15/05/18 NN.LINA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
48 15/05/18 NY.HJ.HADRIA RD Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 95,000 20,000
49 15/05/18 NY.WIDI RD Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 95,000 20,000
50 15/05/18 NY.NI KADEK SW Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
51 16/05/18 NY.RAMIA LL Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
52 16/05/18 TN.ANIS AA Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 148,000 10,000
53 17/05/18 TN.M.ASAD RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
54 17/05/18 NY.REZKI SP Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
55 17/05/18 NY.HARTINI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
56 17/05/18 TN.ASMADI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
57 17/05/18 TN.A.IDRIS LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
58 18/05/18 NY.ULFAH RESIANI IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
59 18/05/18 NY.HJ.BUBA RD Kolesterol 36,000
 Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
60 18/05/18 TN.IO SATRIO LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
61 18/05/18 TN.LACO IM GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
62 18/05/18 NY.LILING IM GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
63 19/05/18 NY.ASLIA LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
64 19/05/18 TN.SOPIAN SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
65 19/05/18 NY.HJ.SITI SW Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
Urine Rutin 50,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 290,000 10,000
66 21/05/18 NY.HJ.SAHORA SP Darah Rutin 64,000
LED 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 108,000 10,000
67 21/05/18 NY.HJ.FATIMA RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 181,000 10,000
68 21/05/18 TN. H.JAMALUDDIN RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 181,000 10,000
69 23/05/18 TN.RAHMAT LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
70 23/05/18 TN.KARUN RD Darah Rutin 64,000
Asam Urat 33,000
L 10,000 10,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 129,000 20,000
71 23/05/18 AN.EGA RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
72 23/05/18 NY.HJ.NABA EI Darah Rutin 64,000
Kolesterol 36,000
Golongan Darah 17,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 155,000 10,000
73 24/05/18 NY.NUR MURSYAROFA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
74 24/05/18 NY.HJ.MUTI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
75 24/05/18 TN.BUR RAHMAN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
76 24/05/18 NY.HJ.HAFIDA IA Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
77 25/05/18 NY.HJ.JAMARU RD GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
78 25/05/18 TN.RAHMAN IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
79 25/05/18 TN.GARIBI IM GDS 33,000
L 1,000 1,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
80 25/05/18 NY.DR.SUMIATI EI Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
TOTAL 13,467,000 13,467,000 312,000 1,803,000
-

Rincian Rawat Inap 5,692,000 - 5,692,000

Jasa Laboran 1,311,372 Rawat Jalan 7,775,000 - 7,775,000
Total Bruto 13,467,000 - 13,467,000

dr. Nur Rahmi, Sp. 1,311,372.00

Reagensia 4,066,600.00
Jasa Klinik 4,006,970.00
BHP 1,803,000.00 1,029,000
L 312,000
5,809,970.00
MEI 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR 303,000

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR dr,golda,gds,ur,cr,ot,pt
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR 331,000
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR dr,golda
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR 275,000
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR DRGDS,KOL,AU,KR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
 K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR UR,DR,GDS(2X)
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR 377
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR dr,golda
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR dr,golda,gds,ur,cr,ot,pt,dr
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR 319,000
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR dr,golda,dr,gds (AK)
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR 362,000
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR DR,GDS,SGOT,SGPT
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR dr,golda,gds,ur,cr,ot,pt,dr
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR 254
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR DR,GDS,KOL,AU
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
 K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR DR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR DR,TES MALARIA,WIDAL
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR dr,gds
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
NR
NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR KOL
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR DR,GDS,
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR 10.000 Masuk di klinik
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR UANG KA' SARAH Rp.50.000 sudah di am
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR UR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR DR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR NEBO
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR GDP
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR KOL,AU
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR DR,WIDAL
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR DR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR KURANG 54.000
 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR Kolestrol, A. Urat
5,800 24,200.00 13,310.00 10,890.00 L 4,356.00 4,356.00 2,178.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
4,066,600 7,285,400 4,006,970 3,278,430 - 1,311,372 1,311,372 655,686
2,388,705
1,618,265 -
dr,golda,gds,ur,cr,ot,pt

DRGDS,KOL,AU,KR
UR,DR,GDS(2X)

dr,golda,gds,ur,cr,ot,pt,dr

dr,golda,dr,gds (AK)
DR,GDS,SGOT,SGPT

698,000

dr,golda,gds,ur,cr,ot,pt,dr

DR,GDS,KOL,AU
DR,TES MALARIA,WIDAL
10.000 Masuk di klinik

UANG KA' SARAH Rp.50.000 sudah di ambil

KURANG 54.000
Kolestrol, A. Urat
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN MEI 2018 RUMAH SAKIT BERSALIN & KL
dr HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
1 24/04/18 Ny.dr.Ratih,Sp.OG RD Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 20,000 303,000 20,000
3 30/04/18 Ny.A.Norma AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 331,000 20,000
4 26/04/18 Ny.Hj.Yahya KR Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
GDS 22,000
GDS 22,000
Urine Rutin 50,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 275,000 20,000
7 02/05/18 Ny.Hj.Perawati SW Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 205,000 10,000
9 30/04/18 Ny.Emma SP Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 33,000
GDS 22,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat Darah 30,000 377,000 30,000
10 30/04/18 An.Astika RD Urine Rutin 50,000
SGOT 33,000
SGPT 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 131,000 10,000
13 04/05/18 An.Afika KR Darah Rutin 64,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000
15 06/05/18 Ny.Yusrianti RD Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 33,000
GDS 22,000
L 10,000 10,000
BHP 7,000 7,000
Spoit + Tempat Darah 30,000 362,000 30,000
16 02/05/18 Ny.Hj.St.Mina IM GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
17 14/05/18 Ny.Hj.Sandae EI Darah Rutin 64,000
Darah Rutin 64,000
Asam Urat 33,000
GDS 22,000
GDS 22,000
SGOT 33,000
SGPT 33,000
SGOT 33,000
SGPT 33,000
Elektrolit 260,000 260,000
albumin 50,000 50,000
L 10,000 10,000
BHP 6,000 6,000
Spoit + Tempat Darah 35,000 698,000 35,000
20 16/05/18 Ny.A.Afni AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
23 22/05/18 Ny.Maryam RD Darah Rutin 64,000
Darah Rutin 64,000
Urine Rutin 50,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
GDS 22,000
Widal 28,000
L 6,000 6,000
BHP 5,000 5,000
Spoit + Tempat Darah 15,000 345,000 15,000
24 22/05/18 An.Muh.Fathul Muin IR Darah Rutin 64,000
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
25 22/05/18 Ny. Eka Handayani AB Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 187,000 10,000
1 26/04/18 AN,RESKI KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
2 26/04/18 TN.ANWAR KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
3 26/04/18 TN.ANWAR KR Darah Rutin 64,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 100,000 10,000
4 28/04/18 TN.H.HAPIL LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
5 28/04/18 NY.WINDA SV Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
6 28/04/18 NY.HJ.HADANIA RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
7 30/04/18 NY.HJ.HAPIDA RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 182,000 10,000
8 30/04/18 TN.MUGI BUDIMAN SP Kolesterol 36,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 56,000 15,000
9 30/04/18 NY.RAMALANG LL Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
10 30/04/18 NY.HJ.HASMA SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
11 30/04/18 NY.ENDANG LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
12 30/04/18 TN.ACO A. RAHMAN LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
13 30/04/18 NY.BIAH EI Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 182,000 10,000
17 04/05/18 TN.ABDUL RAHMAN LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
26 08/05/18 NY.HJ.HADIJA LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
27 08/05/18 TN. H.SAIPUL LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 72,000 10,000
28 08/05/18 TN.NASARUDDIN LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
29 08/05/18 TN.ZULKARNAIN LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
30 08/05/18 NY.HJ.TARI SP Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
33 10/05/18 NY.HJ.RUSNI IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
34 10/05/18 NY.ELVIANA RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 46,000 10,000
35 10/05/18 .HJ.HAFIDA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
37 12/05/18 TRI SANTI SW Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
38 12/05/18 NY.SATIA SW GDS 33,000
Urine Rutin 50,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 97,000 10,000
39 14/05/18 TN.ALBERT LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
40 14/05/18 TN.SUKANDAR RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
41 14/05/18 NY.ST.AMINAH SP Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
42 14/05/18 TN.HAERUDDIN SP Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
43 14/05/18 TN.RIDWAN SP Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
44 14/05/18 AN.ELIS KR Widal 28,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 41,000 10,000
45 14/05/18 TN.RISMAN KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
46 14/05/18 NY.SURIANI KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
51 16/05/18 NY.RAMIA LL Darah Rutin 64,000
 HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
52 16/05/18 TN.ANIS AA Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 148,000 10,000
58 18/05/18 NY.ULFAH RESIANI IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
59 18/05/18 NY.HJ.BUBA RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
60 18/05/18 TN.IO SATRIO LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
61 18/05/18 TN.LACO IM GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
62 18/05/18 NY.LILING IM GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 35,000 10,000
73 24/05/18 NY.NUR MURSYAROFA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
74 24/05/18 NY.HJ.MUTI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
75 24/05/18 TN.BUR RAHMAN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
76 24/05/18 NY.HJ.HAFIDA IA Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 106,000 10,000
Rincian Rawat Inap 5,692,000 - 5,692,000
Jasa Laboran 1,311,372 Rawat Jalan 7,775,000 - 7,775,000
Total Bruto 13,467,000 - 13,467,000

dr. Nur Rahmi, Sp. 1,311,372.00

Reagensia 4,066,600.00
Jasa Klinik 4,006,970.00
BHP 1,803,000.00 1,029,000
L 312,000
5,809,970.00
MEI 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR 303,000
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR 331,000
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR dr,golda
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR 275,000
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR UR,DR,GDS(2X)
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR 377
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR dr,golda
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR dr,golda,dr,gds (AK)
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR 362,000
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR DR,GDS,SGOT,SGPT
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR DR,GDS,KOL,AU
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR DR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR DR,TES MALARIA,WIDAL
 SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR dr,gds
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR KOL
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
 K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR UANG KA' SARAH Rp.50.000 sudah di am
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR NEBO
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR GDP
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR DR,WIDAL
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR DR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR KURANG 54.000
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
UR,DR,GDS(2X)
dr,golda,dr,gds (AK)

DR,GDS,SGOT,SGPT

698,000

DR,GDS,KOL,AU

DR,TES MALARIA,WIDAL
UANG KA' SARAH Rp.50.000 sudah di ambil
KURANG 54.000
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN JULI 2018 RUMAH SAKIT BERSALIN & K
dr HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
1 16/07/18 An.Evelyn Aurelia IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
4 08/07/18 Tn.Hari AF Kolesterol 36,000
GDS 33,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 9,000 9,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 362,000 20,000
5 08/07/18 Ny.Hj.Kalobang AF Kolesterol 36,000
GDS 22,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
Darah Rutin 64,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 282,000 20,000
6 28/06/18 Ny.Hj.Kassa Kolesterol 36,000
GDS 33,000
Elektrolit 260,000 260,000
Asam Urat 33,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SW SGPT 33,000
L 8,000 8,000
BHP 3,000 3,000
Spoit + Tempat Darah 20,000 717,000 20,000
7 10/07/18 Ny.A.Wero SW Kolesterol 36,000
Darah Rutin 64,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 116,000 10,000
9 12/07/18 An.Heru RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
10 12/07/18 Ny.St.Salma AB Darah Rutin 64,000
 Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
12 16/07/18 Ny.Nmurhayati AB Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
13 02/07/18 Ny.Saskia SW GDS 33,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 111,000 10,000
14 04/07/18 Ny.Nur Alam AF SGOT 33,000
SGPT 33,000
GDS 22,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 166,000 10,000
15 14/07/17 Ny.Hj.Fuji SK Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
16 10/07/18 Ny.Sri Rahayu KR Kolesterol 36,000
GDS 22,000
SGOT 33,000
SGPT 33,000
HbSAg 100,000 100,000
HCV 120,000 120,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 490,000 10,000
20 28/06/18 An.Aisyah Syahrani KR GDS 22,000
Widal 28,000
Darah Rutin 64,000
Darah Rutin 64,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 206,000 20,000
23 26/06/18 Ny.Hafni SP Darah Rutin 64,000
Darah Rutin 64,000
L 2,000 2,000
BHP 4,000 4,000
Spoit + Tempat Darah 20,000 154,000 20,000
24 28/06/18 Ny.Asliana SP Kolesterol 36,000
GDS 22,000
Elektrolit 260,000 260,000
Asam Urat 33,000
Darah Rutin 64,000
L 5,000 5,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 432,000 10,000
27 02/07/18 Tn.M.Tasrif IR Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
Darah Rutin 64,000
L -
BHP -
Spoit + Tempat Darah 155,000 -
30 04/07/18 Ny.hj.Siteng IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
32 22/07/18 Ny.Nila Santi RD Widal 28,000
SGOT 33,000
SGPT 33,000
Urine Rutin 50,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 293,000 10,000
34 18/07/18 Ny.Mayang Sari AB Ureum 33,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 15,000 362,000 15,000
35 20/07/18 Tn.Abdullah EI Kolesterol 36,000
GDS 33,000
Elektrolit 250,000 250,000
Asam Urat 33,000
IgG 120,000 120,000
IgM 120,000 120,000
Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Widal 28,000
L 10,000 10,000
BHP 3,000 3,000
Spoit + Tempat Darah 20,000 913,000 20,000
37 18/07/18 Ny. Maria Allo IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
39 14/07/18 Tn. Ansar RD Darah Rutin 64,000
 SGOT 33,000
SGPT 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 145,000 10,000
40 16/07/18 An. Evelyn Aurelia W IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
43 18/07/18 Tn. H. Muhammad KR GDS 33,000
Elektrolit 250,000 250,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 497,000 10,000
45 26/07/18 Ny. Rosdiana SK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
46 26/07/18 Ny. Aan Rosdiana SK Darah Rutin 64,000
Golongan Darah 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 95,000 10,000
RAWAT JALAN
1 26/06/18 TN. BUDIMAN RD GDS 22,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 69,000 10,000
2 26/06/18 AN.NUR AFNI SP Darah Rutin 64,000
Urine Rutin 50,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 128,000 10,000
5 28/06/18 NY.HJ.HAJAR RD Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
6 28/06/18 TN.MUH.ASNUR LL Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 114,000 10,000
7 28/06/18 NY.HJ.TARI RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
8 28/06/18 NY.NONI RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 49,000 10,000
9 28/06/18 NY.BUAH RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
10 28/06/18 NY.ASMAR SW Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
11 28/06/18 TN.PAULUS IB Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
14 30/06/18 TN.PAULUS RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 5,000 41,000 5,000
15 30/06/18 NY.MARDINA LL HbSAg 50,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 157,000 10,000
16 30/06/18 NY.NURJANNAH RD Urine Rutin 50,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 157,000 10,000
17 02/07/18 AN.LINDA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
18 02/07/18 SYAMSUDDIN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
19 02/07/18 TN.FIRMAN RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
20 02/07/18 NY.WATI LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
21 02/07/18 NY.ENI ROLIATI LL HbSAg 50,000
plano test 25000 25,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 89,000 10,000
22 02/07/18 NY.JUSMITA LL Darah Rutin 64,000
 HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
23 02/07/18 NN.NADIA LL Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
24 02/07/18 NN.LINDA LL Darah Rutin 64,000
HbSAg 50,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 154,000 10,000
25 02/07/18 TN.PAULUS EI Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Darah Rutin 64,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
29 04/07/18 TN.M.TAHIR RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
30 04/07/18 NY.MEDIAWATI LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
31 04/07/18 TN.H.HARUNA LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
32 04/07/18 NY.YULIANA LOGA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
37 06/07/18 NY.KAMARIA EI Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
38 06/07/18 TN.BAHARUDDIN IB Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 63,000 10,000
39 06/07/18 AN.FATIAH EI Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
Widal 28,000
L 4,000 4,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 177,000 10,000
40 06/07/18 TN.ZULKIFLI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
63 16/7/2018 TN.DARWIS RD Kolesterol 36,000
GDS 22,000
L -
BHP -
Spoit + Tempat Darah 58,000 -
64 16/7/2018 NY.ARMIA RD Widal 28,000
Darah Rutin 64,000
L -
BHP -
Spoit + Tempat Darah 92,000 -
65 16/7/2018 TN.ZULKIFLI RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 5,000 41,000 5,000
66 16/7/2018 TN.HENDRA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
67 16/7/2018 NY.HJ.MANUSIA LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
68 16/7/2018 NY.ISMAWATI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
69 16/7/2018 TN.HARISULA EI Darah Rutin 64,000
Kreatinin 33,000
Ureum 33,000
SGPT 33,000
SGOT 33,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 307,000 10,000
70 16/7/2018 NY.FAUZIAH EI Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 77,000 10,000
Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
 BHP 2,000 2,000
Spoit + Tempat Darah 10,000 217,000 10,000
77 20/7/2018 NY.ERNI RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 83,000 10,000
78 20/7/2018 NY.HJ.EMA USRI LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 49,000 10,000
79 20/7/2018 TN.ADNAN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 106,000 10,000
80 20/7/2018 NY.HJ.HAPIDA IM Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 171,000 10,000
81 20/7/2018 TN.AHMAD NUR EI Darah Rutin 64,000
Kolesterol 36,000
Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 143,000 10,000
82 20/7/2018 NY.NURSELANG RD Darah Rutin 64,000
Kolesterol 36,000
Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 143,000 10,000
83 20/7/2018 NY.SUARNI RD Darah Rutin 64,000
HbSAg 120,000 120,000
plano test 25000 25,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 227,000 10,000
84 20/7/2018 NY.BANONA KEIYA RD Darah Rutin 64,000
HbSAg 120,000 120,000
plano test 25000 25,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat Darah 10,000 227,000 10,000
93 24/07/2018 TN.SYAHRIL SW GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 46,000 10,000
94 24/07/2018 NN.CLARA CRISTINA RD Darah Rutin 64,000
HbSAg 60,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat Darah 10,000 164,000 10,000
95 24/07/2024 NY.NURMA LL Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat Darah 10,000 187,000 10,000
Rincian Rawat Inap 10,487,000 10,487,000 -
Jasa Laboran 1,716,372 Rawat Jalan 10,323,000 10,323,000 -
Total Bruto 20,810,000 20,810,000 -

dr. Nur Rahmi, Sp. PK 1,716,372.00

Reagensia 5,935,600.00
Jasa Klinik 5,244,470.00
BHP 4,915,000.00 2,007,000
L 400,000
10,159,470.00
JULI 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
L - - - SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
L - - - SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
 K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR kurang
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
L - - - SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
L - - - SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
 K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
20,000 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
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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
20,000 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
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
 K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
 K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000 35,000.00 19,250.00 15,750.00 6,300.00 6,300.00 3,150.00 SR
SR
SR
K SR
 K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
152696

152697
152698

204189

204190

128145

179546

204197

152710

152711
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN AGUSTUS 2018 RUMAH SAKIT BERSALIN & K
KODE HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

dr BAYAR L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT INAP
1 26/07/18 NY. ROSDIANA SK Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
2 26/07/18 NY. AAN ROSDIAN SK Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
3 25/07/2018 NY.HJ.RUSNI IR Darah Rutin 64,000 32,000
GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 99,000 10,000
4 21/07/2018 AN. M.AYDIN RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
5 25/07/2018 NN.SAENAB KR Widal 28,000 3,500
Darah Rutin 64,000 32,000
L -
BHP -
Spoit + Tempat Darah 92,000 -
6 23/07/2018 AN.PUTI ASYIFA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
7 13/8/2018 TN.A.IQBAL RD GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
SGOT 33,000 7,500
SGPT 33,000 7,500
Darah Rutin 64,000 32,000
Widal 28,000 3,500
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 10,000 10,000
BHP 10,000 10,000
Spoit + Tempat 35,000 378,000 35,000
8 14/8/2018 NN.NUR ILZA RD GDS 33,000 20,000
Golongan Dara 17,000 5,000
Darah Rutin 64,000 32,000
Widal 28,000 3,500
Ureum 33,000 10,000
Kreatinin 33,000 13,500
 L 10,000 10,000
BHP 10,000 10,000
Spoit + Tempat 35,000 263,000 35,000
9 14/8/2018 NN.KARYAWATI KR Darah Rutin 64,000 32,000
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 100,000 10,000
10 15/8/2018 NY.SRI AYU LESTAR WT Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
11 15/08/2018 NY.HERLINA RUSLI AB Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
12 08/03/18 AN.BANI IR Widal 28,000 3,500
GDS 33,000 20,000
Urine Rutin 50,000 8,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 25,000 226,000 25,000
13 08/09/18 AN.AZ-ZAHRA RD Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
14 08/09/18 NY.ST.MUNIRA RD Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
15 08/12/18 NY.NIKMAH WT Widal 28,000 3,500
Darah Rutin 64,000 32,000
Urine Rutin 50,000 8,000
Darah Rutin 64,000 32,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 15,000 231,000 15,000
16 08/12/18 NY.HADIJAH EI 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
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 10,000 307,000 10,000
17 08/01/18 NY.ATIRA RD Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
 Urine Rutin 50,000 8,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 6,000 254,000 6,000
18 08/05/18 NY.A.RASMA SATI RD Darah Rutin 64,000 32,000
Malaria 80,000 60,000
Widal 28,000 3,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
19 08/02/18 NY.HJ.MULIANA AF Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
20 30/7/18 NY.HJ.AMBONG KR Urine Rutin 50,000 8,000
Kolesterol 36,000 10,200
GDS 22,000 5,800
GDS 22,000 5,800
SGOT 33,000 7,500
SGPT 33,000 7,500
Asam Urat 33,000 9,500
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 20,000 389,000 20,000
21 25/7/18 NY.SYAMSIAR AF Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
22 17/8/2018 TN.FAHRI IR HIV 135,000 135,000
bHP 50,000 50,000
Kolesterol 36,000 10,200
Urine Rutin 50,000 8,000
GDS 33,000 20,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
Darah Rutin 64,000 32,000
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat 20,000 468,000 20,000
23 17/8/2018 NY.DINI DEWI E. NA Kolesterol 36,000 10,200
GDS 33,000 20,000
Urine Rutin 50,000 8,000
Asam Urat 33,000 9,500
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Widal 28,000 3,500
Golongan Dara 17,000 5,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 13,000 13,000
 BHP 4,000 4,000
Spoit + Tempat 20,000 558,000 20,000
24 22/8/2018 NY.HIJRANA WT Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
25 23/08/18 NN.KASMAWATI RD Darah Rutin 64,000 32,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 179,000 10,000
26 22/8/2018 AN.NURIN NAJWA AK Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
27 21/08/18 TN.ACO KURNIAW KR Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
IgG 120,000 120,000
IgM 120,000 120,000
L -
BHP -
Spoit + Tempat 8,000 440,000 8,000
28 23/08/18 AN.ANINDITA IR Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
29 23/08/18 NY.HJ.HAMIDIA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Kreatinin 33,000 13,500
Golongan Dara 17,000 5,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 12,000 12,000
BHP 2,000 2,000
Spoit + Tempat 10,000 467,000 10,000
30 20/08/18 NY.HJ.NURMATAN RD Kolesterol 36,000 10,200
GDS 33,000 20,000
Urine Rutin 50,000 8,000
Asam Urat 33,000 9,500
Darah Rutin 64,000 32,000
GDS 33,000 20,000
Darah Rutin 64,000 32,000
Widal 28,000 3,500
Elektrolit 250,000 250,000
Elektrolit 250,000 250,000
albumin 50,000 50,000
Golongan Dara 17,000 5,000
 Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 13,000 13,000
BHP 10,000 10,000
Spoit + Tempat 70,000 1,197,000 70,000
31 23/08/18 AN.RAFA RD Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
32 24/08/18 NY.NURJANNAH AB Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
RAWAT JALAN
1 26/07/2018 AN.BUNGA AF Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
2 26/07/2018 TN.TALLI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
3 26/07/2018 NY.HJ.NURYANTI IA GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
4 27/07/2018 NY.HJ.FARIDA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
5 27/07/2018 NY.HJ.AMBONG AF Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
6 27/07/2018 TN.SUYADI EI Kreatinin 33,000 13,500
SGPT 33,000 7,500
Urine Rutin 50,000 8,000
Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat 20,000 248,000 20,000
7 27/07/2018 NY.FITRAH RD GDS 22,000 5,800
Asam Urat 33,000 9,500
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 69,000 10,000
8 27/07/2018 NY.MARIA ALLO IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
9 27/07/2018 TN.H.HARUNA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
10 28/07/2027 TN.A.ANAS LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
11 28/07/2028 NAWAYYAD AF Kolesterol 36,000 10,200
Urine Rutin 50,000 8,000
Darah Rutin 64,000 32,000
SGPT 33,000 7,500
SGOT 33,000 7,500
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 290,000 10,000
12 28/07/2038 TN.ABD.HAFID SW Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
13 28/07/2041 NY.A.ANTI SW Urine Rutin 50,000 8,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
14 28/07/2047 AN.IBRAHIM LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
15 28/07/2048 NN.TAMI RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
16 30/07/2051 NY.HJ.LILI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L -
BHP -
Spoit + Tempat Darah 91,000 -
17 30/07/2052 NY.SANIA LL Darah Rutin 64,000 32,000
SGPT 33,000 7,500
SGOT 33,000 7,500
 Asam Urat 33,000 9,500
GDS 33,000 20,000
L 10,000 10,000
BHP 5,000 5,000
Spoit + Tempat 10,000 221,000 10,000
18 30/07/2053 TN.SAPPE EI GDS 22,000 5,800
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 8,000 8,000
BHP 3,000 3,000
Spoit + Tempat 10,000 112,000 10,000
19 30/07/2059 TN.ABDULLAH RD Asam Urat 33,000 9,500
L -
BHP -
Spoit + Tempat Darah 33,000 -
20 30/07/2072 AN.M.EMIRSA IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
21 30/07/2084 NY.SUPIANA EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
22 30/07/2092 NN.SALBIA LL Darah Rutin 64,000 32,000
HbSAg 60,000 25,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 164,000 10,000
23 30/07/2093 NN.URMILA DOFA LL Darah Rutin 64,000 32,000
HbSAg 60,000 25,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 164,000 10,000
24 30/07/2097 TN.ARDIANSYAH LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
25 31/07/2018 TN.RISMAN RD GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
26 31/07/2018 NY.RAMLAH LL Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
27 08/01/18 TN.ACO JALALUDDIN RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
28 08/01/18 TN.HASAN RD GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
29 08/01/18 AN.PUTRA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
30 08/01/18 TN.SOLIHIN RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
31 08/01/18 NY.HJ,MARHUMA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
32 08/01/18 NURWAHIDA AF Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
33 08/01/18 NY.HJ.NADI AF Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
34 08/03/18 TN.RUDI SUHARTO EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
35 08/03/18 TN.ARIEF EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
36 08/03/18 TN.AMIRUDDIN EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
37 08/03/18 TN.INYOMAN EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
38 08/03/18 TN.SIMON EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
39 08/03/18 TN.IKRAM EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
40 08/03/18 TN.HASBI EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
41 08/03/18 TN.TRI EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
42 08/03/18 TN.IFDAL EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
43 08/03/18 NY.HOUSNI EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
44 08/03/18 TN.MURIDAN EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
45 08/03/18 TRIYAS POPO UNTOR EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000

46 08/03/18 TN.MUH.ABIDIN EI Kolesterol 36,000 10,200

Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
47 08/03/18 TN.RAHMAT BAHARU EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
48 08/03/18 NY.SUSILAWATI EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
49 08/03/18 NY.JUMRIANI EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
50 08/03/18 NY.DEWI RATNASARI EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
51 08/03/18 NY.INRANTI BASRI EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
52 08/03/18 TN.ABD.WARIS EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
53 08/03/18 ANGGA PURNAMA EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
54 08/03/18 TN.MUH.RUSTAM EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
55 08/03/18 TN.MAHARDIKA EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
56 08/03/18 NY.HJ.NURHUDA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
57 08/03/18 NY.HJ.TANI RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
58 08/06/18 NY.HASBIA RD Darah Rutin 64,000 32,000
HbSAg 50,000 25,000
plano test 24000 24,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 153,000 10,000
59 08/06/18 NY.NURMAYANI RD Darah Rutin 64,000 32,000
HbSAg 50,000 25,000
plano test 24000 24,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 153,000 10,000
60 08/06/18 NY.HERNI RD Darah Rutin 64,000 32,000
HbSAg 50,000 25,000
plano test 24000 24,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 153,000 10,000
61 08/06/18 NY.HJ.MANNA RD Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
62 08/06/18 TN.ESAM NIN RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
63 08/06/18 NY.SANATI LL GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 36,000 10,000
64 08/06/18 NY.MUTMAINNAH KR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
65 08/06/18 NY.NIA KR Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
66 08/06/18 NY.HARDIYANTI ARIF RD GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 5,000 41,000 5,000
67 08/07/18 NY.SUHENI IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
68 08/08/18 TN.SYAHRIL RD Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Widal 28,000 3,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 143,000 10,000
69 08/08/18 AN.RATU SAKILA RD Widal 28,000 3,500
GDS 22,000 5,800
Darah Rutin 64,000 32,000
Urine Rutin 50,000 8,000
L 9,000 9,000
BHP 4,000 4,000
Spoit + Tempat 20,000 197,000 20,000
70 08/08/18 NY.ST.HAJAR LL Asam Urat 33,000 9,500
GDS 22,000 5,800
Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Widal 28,000 3,500
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 200,000 10,000
71 08/08/18 NY.HJ.MANNA EI Darah Rutin 64,000 32,000
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 100,000 10,000
72 09/08/18 AN.MUTMAINNAH RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
73 09/08/18 HJ.ASLINA LL Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
74 08/10/19 NY.HJ.AMBONG EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
75 08/10/19 TN.DEPPANINDING EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
76 08/10/19 TN.SUTEJO EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat 10,000 103,000 10,000
77 08/11/18 NY.MASDIANA KR Darah Rutin 64,000 32,000
L 1,000 1,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
78 08/11/18 AN.FIRDAH RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
79 08/11/18 NY.LEMBANG RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
80 08/11/18 TN.ANWAR RD Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
81 13/08/2018 TN.AHMAD LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L -
BHP -
Spoit + Tempat Darah 91,000 -
82 13/08/2018 TN.ARIFIN RD GDS 22,000 5,800
L -
BHP -
Spoit + Tempat Darah 22,000 -
83 13/08/2018 TN.FITRAH KR Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
84 14/08/2018 TN.SYAMSUL LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
85 14/08/2018 TN.HAMDANI RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
86 14/08/2018 HJ.RAMLAH RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
87 15/08/2018 NY.MUTMAINNAH RD GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 5,000 41,000 5,000
88 15/08/2018 TN.HATTAH RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
 L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
89 15/08/2018 NY.LIMBONG RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
90 18/8/2018 NY.ST HAJAR LL Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 114,000 10,000
91 18/8/2018 TN. NASIR LL Urine Rutin 50,000 8,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
92 20/8/2018 NY.HJ.AMBONG EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
93 20/8/2018 NY.MASIAH EI Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
94 21/08/2018 AN.MUHARRAM RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000

95 21/08/2018 NY.HUDAEDA LL Darah Rutin 64,000 32,000

Kolesterol 36,000 10,200
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 137,000 10,000
96 23/08/2018 NY.HIDAYAH IR Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
97 23/08/2018 NY.MASDALIA RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
98 24/08/2018 TN.DADANG RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
99 24/08/2018 TN.HENDRIK RD Kolesterol 36,000 10,200
GDS 22,000 5,800
L 6,000 6,000
 BHP 4,000 4,000
Spoit + Tempat 10,000 78,000 10,000
100 24/08/2018 AN.JOKOWI RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
101 24/08/2018 AN.MUH.TAMSIL RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
TOTAL 17,697,000 17,697,000 389,000 2,839,000 5,211,900
-

Rincian Rawat Inap 7,250,000 7,250,000 -

Jasa Laboran 1,666,278 Rawat Jalan 10,447,000 10,447,000 -
Total Bruto 17,697,000 17,697,000 -

dr. Nur Rahmi, Sp. PK 1,666,278.00

Reagensia 5,211,900.00
Jasa Klinik 5,091,405.00
BHP 2,839,000.00
L 389,000
7,930,405.00
2018 RUMAH SAKIT 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

32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR dr

SR
K SR
K SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR dr,golda
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 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
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 NR DR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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 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 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR DR(2X)
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR DR,GDS,KOL,KOL,AU,UR,KR,SG
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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 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 SR DR,WIDAL.DDR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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 SR
SR
K SR
K SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 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
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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
NR
NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
 K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
L - - - SR
L - - - SR
SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
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
- - - - - SR
K SR
K SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR

25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR GDS,KOL,AU

23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR GOLDA,GDS,KOL,AU
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 DR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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 GDS,KOL,AU
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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 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
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
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
35,000.00 19,250.00 15,750.00 6,300.00 6,300.00 3,150.00 SR
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 SR
35,000.00 19,250.00 15,750.00 6,300.00 6,300.00 3,150.00 SR
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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR DR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
 K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
 NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR DR,GDS,KOL,AU
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
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 SR
25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
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 SR
25,000.00 13,750.00 11,250.00 4,500.00 4,500.00 2,250.00 SR
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 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR GDS,KOL,AU
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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 GDS,KOL,AU
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR GDP
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
 NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 NR
NR
 K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR GDS,KOL,AU
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR KOL
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
 NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 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 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K 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
SR
 K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
9,257,100 5,091,405 4,165,695 - 1,666,278 1,666,278 833,139

5,091,405 -
KOL,KOL,AU,UR,KR,SGOT,SGPT
152696

152697
152698

204189
204190

128145

179546
204197
152710

152711
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN SEPTEMBER 2018 RUMAH SAKIT BERSALIN &
KODE HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

dr BAYAR L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT INAP
1 10/09/18 TN.FAISAL RD Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 33,000 20,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 10,000 186,000 10,000
2 25/09/18 NN.NURPANCAWA AF Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 33,000 20,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 183,000 10,000
3 27/08/18 AN.A.NABILA IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 105,000 10,000
4 31/08/18 NY.ISA EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
5 01/09/18 TN.RUSLI KR Kolesterol 36,000 10,200
GDS 33,000 20,000
SGPT 33,000 7,500
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 249,000 10,000
6 06/09/18 NY.NURFAHITA AB Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
7 27/08/18 NY.HJ.AZIZAH IR Kolesterol 36,000 10,200
GDS 22,000 5,800
GDS 33,000 20,000
Urine Rutin 50,000 8,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
 Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 14,000 14,000
BHP 8,000 8,000
Spoit + Tempat 35,000 539,000 35,000
8 02/09/18 NN.HASRIANTI AF Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
9 24/08/18 NY.HJ.NURLIA RD Kolesterol 36,000 10,200
GDS 33,000 20,000
GDS 22,000 5,800
Urine Rutin 50,000 8,000
GDS 22,000 5,800
GDS 22,000 5,800
Darah Rutin 64,000 32,000
Asam Urat 33,000 9,500
Darah Rutin 64,000 32,000
SGOT 33,000 7,500
SGPT 33,000 7,500
L 15,000 15,000
BHP 5,000 5,000
Spoit + Tempat 20,000 452,000 20,000
10 02/09/18 AN.MUH SYAKI AF Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
11 05/09/18 NY.LUSIANA SAID RD GDS 33,000 20,000
Urine Rutin 50,000 8,000
L 8,000 8,000
BHP 10,000 10,000
Spoit + Tempat 10,000 111,000 10,000
12 03/09/18 NY.JASMITA RD Urine Rutin 50,000 8,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
13 14/09/18 NN.PUPUT EI Darah Rutin 64,000 32,000
SGPT 33,000 7,500
SGOT 33,000 7,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 145,000 10,000
14 13/09/18 TN.KUBA IR GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
15 10/09/18 AN.FARID RD Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
16 09/09/18 TN.ANDRE IR Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 4,000 4,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 171,000 10,000
17 08/09/18 NY.NURHAINI AB Darah Rutin 64,000 32,000
IgG/IgM 150,000 100,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 228,000 10,000
18 16/09/18 NY.TENRI ABENG RD Darah Rutin 64,000 32,000
GDS 22,000 5,800
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 10,000 236,000 10,000
19 15/09/18 AN.NAUVAL RD Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L -
BHP -
Spoit + Tempat 6,000 87,000 6,000
20 18/09/18 NY.EDEL TRUDIS AB Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
21 18/09/18 NY.MISBAH AB Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
22 03/09/18 TN.BAHARUDDIN SW Darah Rutin 64,000 32,000
GDS 22,000 5,800
Ureum 33,000 10,000
Kreatinin 33,000 13,500
Kolesterol 36,000 10,200
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 205,000 10,000
23 04/09/18 TN.TULLAH GANI IR GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
24 06/09/18 NY,KANU IR Darah Rutin 64,000 32,000
GDS 22,000 5,800
Ureum 33,000 10,000
Kreatinin 33,000 13,500
Kolesterol 36,000 10,200
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 205,000 10,000
25 07/09/18 AN.M.AKSAN IR Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
26 06/09/18 NN.FADILA EI IgG/IgM 150,000 100,000
Darah Rutin 64,000 32,000
Widal 28,000 3,500
Darah Rutin 64,000 32,000
L 4,000 4,000
 BHP 3,000 3,000
Spoit + Tempat 20,000 333,000 20,000
27 07/09/18 AN.M.AKBAR IR Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
28 08/09/18 TNJ.ASWAN IR GDS 22,000 5,800
Elektrolit 250,000 250,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGPT 33,000 7,500
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat 10,000 457,000 10,000
29 20/09/18 TN.SUPARDI IR Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
GDS 22,000 5,800
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 168,000 10,000
30 18/09/18 NY.SUTINI AB GDS 22,000 5,800
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat 20,000 331,000 20,000
31 18/09/18 NY. HJ. FUJI AB GDS 22,000 5,800
GDS 33,000 20,000
GDS 33,000 20,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 8,000 8,000
BHP 5,000 5,000
Spoit + Tempat 30,000 408,000 30,000
32 04/09/18 NY. HJ. ST. NURM AB Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
33 09/09/18 NY.SANRIANI RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
34 18/09/18 NY.SARI INTANG RD Kolesterol 36,000 10,200
 Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
35 02/09/18 BY.ALFARIZI AF Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
36 21/09/18 AN.MAULANA IB Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
37 24/09/18 TN.H.PALATANGI IR GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
38 24/09/18 NY.HJ.JUMRA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
39 25/09/18 NY. HARDIANTI AB Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 137,000 -
40 25/09/18 NY.PUTRI AB Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000

RAWAT JALAN
1 27/08/2018 AN.SENDI RD Widal 28,000 3,500
Darah Rutin 64,000 32,000
L -
BHP -
Spoit + Tempat Darah 92,000 -
2 27/08/2018 NY.ASNI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
3 27/08/2018 TN.ABD.AZIZ IM GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 35,000 10,000
4 27/08/2018 NY.MULIATI EI Urine Rutin 50,000 8,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
5 27/08/2018 AN.REGITA LL Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
6 27/08/2018 HJ.HUSNIA LL Darah Rutin 64,000 32,000
 Kolesterol 36,000 10,200
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 137,000 10,000
7 28/08/2018 TN.MAHYUDDIN EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 10,000 307,000 10,000
8 28/08/2018 NY.SRI WAHYUNI EI Kolesterol 36,000 10,200
Golongan Dara 17,000 5,000
GDS 22,000 5,800
Darah Rutin 64,000 32,000
Widal 28,000 3,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 252,000 10,000
9 28/08/2018 NY.YULIANA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
10 28/08/2018 AN.MUH.FADEL RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
11 29/08/2018 NY.RUSNI RD Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
12 29/08/2018 TN.ISMAIL LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
13 29/08/2018 NY.ROSMIATI AB Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
14 30/08/2018 NY.NURJANNAH RD Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
 L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
15 30/08/2018 NY.NURSIA LL Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
16 30/08/2018 NY.ASIA SW Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
17 30/08/2018 NY.HJ.JURUMIAH IB Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
18 30/08/2018 NY.ST.HAJAR LL Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Widal 28,000 3,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 143,000 10,000
19 31/8/2018 NY.JIRAH RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
20 31/8/2018 TN.SUARDI SW Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 10,000 307,000 10,000
21 31/8/2018 NY.HJ.HATIJA IA Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
22 31/8/2018 NY.HJ.MANNA EI GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 35,000 10,000
23 31/8/2018 NY.BUDIATI EI GDS 22,000 5,800
Darah Rutin 64,000 32,000
Kreatinin 33,000 13,500
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 10,000 139,000 10,000
24 01/09/18 TN.RUSLI RD Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
25 01/09/18 NY.SURIANI LL Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
GDS 22,000 5,800
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 10,000 142,000 10,000
26 03/09/18 TN.AMINUDDIN LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
27 03/09/18 TN.ARSYAD EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
28 03/09/18 NY.HJ.ASIZAH EI GDS 33,000 20,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 50,000 10,000
29 04/09/18 TN.KARIM AF GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
30 04/09/18 TN.TALLA IR GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
31 05/09/18 TN.A.MUH.NUR IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
32 05/09/18 NY.DERAWAYA RD GDS 22,000 5,800
Darah Rutin 64,000 32,000
Kreatinin 33,000 13,500
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 138,000 10,000
33 05/09/18 NY.ARLINA LL Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
34 05/09/18 NY.FARIDA LATIF LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 106,000 10,000
35 05/09/18 TN.SYARIFUDDIN RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
36 05/09/18 AN.MUH.AMMAR LL Darah Rutin 64,000 32,000
Urine Rutin 50,000 8,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 128,000 10,000
37 09/06/18 NY.HJ.HANAFIAH IR GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 35,000 10,000
38 09/06/18 TN.MIO SATRI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
39 09/06/18 TN. YUSUF SW Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat 10,000 157,000 10,000
40 09/07/18 TN.RUSLI RD Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 69,000 10,000
41 09/07/18 AN.PUTRI IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
42 09/08/18 FAQIH IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
43 09/08/18 TN.H.M.SAID RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
44 09/08/18 TN.TAMSIR SW Darah Rutin 64,000 32,000
Urine Rutin 50,000 8,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 129,000 10,000
45 10/09/18 NY.HJ.RAHMA LL Kolesterol 36,000 10,200
 Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
46 10/05/18 NY.WATI LL Darah Rutin 64,000 32,000
HbSAg 60,000 25,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 164,000 10,000
47 10/04/18 NY.ERNAWATI LL Darah Rutin 64,000 32,000
HbSAg 60,000 25,000
BILIRUBIN 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 164,000 10,000
48 10/08/17 NY.HJ.NABA RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L -
BHP -
Spoit + Tempat 10,000 182,000 10,000
49 10/06/17 TN.MASDAR RD GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
50 10/05/17 NY.HJ.NORMA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
51 10/03/17 NY.HJ.SYUHADA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
52 10/02/17 NY.ST.AISYAH RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
53 10/01/17 TN.HERMAN RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
54 10/09/18 TN.WAHYUDDIN EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L -
BHP 1,000 1,000
Spoit + Tempat 10,000 80,000 10,000
55 10/09/18 NY.SURIANTI EI Darah Rutin 64,000 32,000
Widal 28,000 3,500
 L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 10,000 110,000 10,000
56 11/09/18 AN.ANINDITA IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
57 11/09/18 NY.HJ.ANI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
58 12/09/18 TN.RUDI RD GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
59 12/09/18 TNY.YUNI RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
60 12/09/18 NY.YULIANA IM Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
61 12/09/18 TN.HAMMALIK IM GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 35,000 10,000
62 12/09/18 NY.HJ.NARISA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
63 12/09/18 NY.SUKMAWATI LL Urine Rutin 50,000 8,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
64 13/09/18 AN.SAUKI LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
65 14/09/18 RUDI RD GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 35,000 10,000
66 14/09/18 NY.HJ.MARIFA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 106,000 10,000
67 14/09/18 TN,UDIN RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
68 15/09/18 TN.H.DEDIYANTO RD Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
69 15/09/18 NY.YULIANI LL Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGPT 33,000 7,500
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 10,000 208,000 10,000
70 15/09/18 TN.HASRUL LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
71 15/09/18 NY.NURLINA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
72 15/09/18 TN.AYYUB YUSUF LL Ureum 33,000 10,000
Kreatinin 33,000 13,500
Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 33,000 20,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 10,000 250,000 10,000
73 15/09/18 AN.AHSAN RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
74 17/09/18 TN.AJIWAN RD GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 35,000 10,000
75 17/09/18 TN.TALIP RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 106,000 10,000
76 17/09/18 NY.FARIMA RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
77 17/09/18 TN.YOHANES RD GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
78 17/09/18 NY.CEMPAKA EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
79 17/09/18 A.SYAMSIAH EI Urine Rutin 50,000 8,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
80 18/09/18 TN.AL IMRAN AF Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
81 18/09/18 NY.HARANI RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
82 18/09/18 NY.EMA USRI LL Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 148,000 10,000
83 19/09/18 TN.SAYYID FAHMI IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
84 19/09/18 TN.JABAL LL GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
85 19/09/18 NY.ST.NAISA EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
86 19/09/18 TN.DARWIS IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
87 21/09/18 AN.RADIT AF HBSAG 150,000 100,000
Darah Rutin 64,000 32,000
Malaria 80,000 60,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 309,000 10,000
88 21/09/18 TN.KODA AF Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
89 21/09/18 NY.SALMA LL Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 111,000 10,000
90 21/09/18 NY.HJ.LULU IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
91 21/09/18 NY.HAJIRAH IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
92 21/09/18 NY.JUMRAH EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
93 22/09/18 NY.SYAMSIAH LL Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
94 22/09/18 AN.MARSYUKA IR Kolesterol 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 70,000 10,000
95 24/09/18 NY.HJ.SALAMINA RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
96 24/09/18 NY.ARIANTI RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
97 24/09/18 NY.RINI LL/SW Urine Rutin 50,000 8,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
98 24/09/18 NY.HJ.ROHANI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
99 24/09/18 NY.USTIHARI AF Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
100 24/09/18 TN.LOLANG AA Kolesterol 36,000 10,200
 Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
101 24/09/18 TN.TADDU EI Elektrolit 250,000 250,000
GDS 33,000 20,000
L 2,000 2,000
BHP 2,000 2,000
Transport 10,000 10,000
Spoit + Tempat 10,000 307,000 10,000
102 24/09/18 TN.ASLIN LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
103 25/09/18 NY.HJ. A.HASNA LL Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
104 25/09/18 NY.HJ.SANATI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
105 25/09/18 NY.HJ.A.RUSNI RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
106 25/09/18 NY.HARDIANTI LL/AB Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 36,000 36,000
Spoit + Tempat 10,000 170,000 10,000

TOTAL 17,774,000 17,774,000 417,000 2,425,000 5,766,300

-

Rincian Rawat Inap 6,438,000 6,438,000 -

Jasa Laboran 1,649,826 Rawat Jalan 11,336,000 11,372,000 (36,000)
Total Bruto 17,774,000 17,810,000 (36,000)

dr. Nur Rahmi, Sp. PK 1,649,826.00

Reagensia 5,766,300.00
Jasa Klinik 5,041,135.00
BHP 2,425,000.00 #REF!
L 417,000
7,466,135.00
R 2018 RUMAH SAKIT 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

32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR

25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
- - - - - SR
K SR
K SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
 K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 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 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
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
- - - - - SR
K SR
K SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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 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 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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 NR
NR
K NR
K NR
50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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 SR
SR
K SR
K SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
L - - - NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
- - - - - SR
K SR
K SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
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
- - - - - SR
K SR
K SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
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
- - - - - SR
K SR
K SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
NR
NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
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
- - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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
- - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
 SR
K SR
K 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
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
 K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
35,000.00 19,250.00 15,750.00 6,300.00 6,300.00 3,150.00 SR
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 SR
35,000.00 19,250.00 15,750.00 6,300.00 6,300.00 3,150.00 SR
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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
 - - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 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 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
NR
K NR
K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
 K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
NR
K NR
K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
 K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
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
SR
K SR
K SR
(10,200.00) (5,610.00) (4,590.00) L (1,836.00) (1,836.00) (918.00) SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
L - - - SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
SR
K SR
SR
K SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 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 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
NR
9,165,700 5,041,135 4,124,565 - 1,649,826 1,649,826 824,913

5,041,135 -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN OKTOBER 2018 RUMAH SAKIT BERSALIN & K
KODE HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

dr BAYAR L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT INAP
1 14/10/18 NY.HJ.HAJINA RD Kolesterol 36,000 10,200
GDS 22,000 5,800
Asam Urat 33,000 9,500
Urine Rutin 50,000 8,000
Elektrolit 265,000 265,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
Lain - lain 10,000
L 15,000 15,000
BHP 9,000 9,000
Spoit + Tempat 20,000 590,000 20,000
2 16/10/18 NY.SURYANI RD GDS 22,000 5,800
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L -
BHP -
Spoit + Tempat 10,000 177,000 10,000
3 18/10/18 NY.FITRIANI AB Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 20,000 172,000 20,000
4 17/10/18 TN.KADE IM GDS 33,000 20,000
L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat 10,000 45,000 10,000
5 15/10/18 AN.NUR ALIA PUTR AK Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 20,000 183,000 20,000
6 15/10/18 AN.MUH, SYAHIM RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
7 10/12/18 NY.JUMIANTI AF Darah Rutin 64,000 32,000
Urine Rutin 50,000 8,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 6,000 6,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 267,000 10,000
8 20/10/18 NY.YESRI MARURU AB Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 160,000 10,000
9 29/09/18 NY.TABITA WT Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
10 19/10/18 NY.SYAMSIAR RD Kolesterol 36,000 10,200
GDS 33,000 20,000
SGOT 33,000 7,500
SGPT 33,000 7,500
Elektrolit 265,000 265,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
Lain - lain 10,000
L 9,000 9,000
BHP 9,000 9,000
Spoit + Tempat 20,000 578,000 20,000
11 01/10/18 NY.HERMIATI IB Kolesterol 36,000 10,200
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 22,000 5,800
SGOT 33,000 7,500
SGPT 33,000 7,500
Asam Urat 33,000 9,500
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 10,000 10,000
BHP 10,000 10,000
Spoit + Tempat 50,000 522,000 50,000
12 10/02/18 NY.RAHMATIA WT Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
13 10/04/18 NY.KHUMAIRAH EI Darah Rutin 64,000 32,000
Urine Rutin 50,000 8,000
GDS 33,000 20,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 162,000 10,000
14 18/10/18 NY.A.SUGIATI RD Kolesterol 36,000 10,200
GDS 33,000 20,000
Asam Urat 33,000 9,500
SGPT 33,000 7,500
Elektrolit 265,000 265,000
Darah Rutin 64,000 32,000
 Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 10,000 615,000 10,000
15 29/09/18 NY.HJ.SADIANA RD Kolesterol 36,000 10,200
GDS 22,000 5,800
GDS 33,000 20,000
GDS 33,000 20,000
Asam Urat 33,000 9,500
SGOT 33,000 7,500
SGPT 33,000 7,500
Elektrolit 265,000 265,000
Elektrolit 265,000 265,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 7,000 7,000
BHP 5,000 5,000
Spoit + Tempat 20,000 979,000 20,000
16 10/04/18 AN.AINUN AK Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 111,000 10,000
17 10/04/18 NY.SUKATMI RD Kolesterol 36,000 10,200
GDS 33,000 20,000
SGOT 33,000 7,500
SGPT 33,000 7,500
SGOT 50,000 50,000
SGPT 50,000 50,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
Darah Rutin 64,000 32,000
Ureum 50,000 50,000
Kreatinin 50,000 50,000
Lain - lain 6,000 6,000
L 11,000 11,000
BHP 6,000 6,000
Spoit + Tempat 25,000 513,000 25,000
18 5/10/2018 NY.HJ.JUMRA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
19 24/09/18 NY.HJ.JUMRA IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
20 10/07/18 AN.AIRA AF Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
21 10/07/18 TN.YUDIKA KR Widal 28,000 3,500
GDS 33,000 20,000
SGOT 33,000 7,500
 SGPT 33,000 7,500
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 11,000 11,000
BHP 9,000 9,000
Spoit + Tempat 25,000 558,000 25,000
22 09/10/18 NY.LELI SUGIARTI AB Kolesterol 36,000 10,200
GDS 33,000 20,000
Golongan Dara 17,000 5,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
L 8,000 8,000
BHP 6,000 6,000
Spoit + Tempat 15,000 437,000 15,000
23 10/12/18 TN.H.BATMAN RD Kolesterol 36,000 10,200
GDS 33,000 20,000
SGOT 33,000 7,500
SGPT 50,000 50,000
Ureum 33,000 10,000
Darah Rutin 64,000 32,000
Kreatinin 50,000 50,000
Widal 28,000 3,500
GDS 33,000 20,000
GDS 22,000 5,800
GDS 33,000 20,000
Lain - lain 10,000 10,000
GDS 33,000 20,000
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat 35,000 507,000 35,000
24 22/10/18 NY.JENY WT Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
25 10/09/18 NY.APRIANTY AB Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
Cyto 30,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 125,000 10,000
26 10/07/18 TN.H.TASSA KR GDS 22,000 5,800
Elektrolit 265,000 265,000
Elektrolit 265,000 265,000
Elektrolit 265,000 265,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
L 7,000 7,000
 BHP 7,000 7,000
Spoit + Tempat 20,000 948,000 20,000
27 11/10/18 NURHAYATI AB Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 20,000 172,000 20,000
28 19/10/18 NY.NURLIANA AB Kolesterol 36,000 10,200
GDS 22,000 5,800
Darah Rutin 64,000 32,000
Asam Urat 33,000 9,500
Golongan Dara 17,000 5,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 10,000 322,000 10,000
29 29/09/18 TN.H.BADDU IR Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 20,000 184,000 20,000
30 17/10/18 NY.HERLINA RD SGPT 33,000 7,500
GDS 22,000 5,800
Asam Urat 33,000 9,500
Urine Rutin 50,000 8,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 10,000 321,000 10,000
31 19/10/18 NN. ATIKAH AB Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 160,000 10,000
32 10/07/18 AN.M.BERKAH IR GDS 22,000 5,800
Urine Rutin 50,000 8,000
Darah Rutin 64,000 32,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 151,000 10,000
33 10/10/18 SALINA KR Kolesterol 36,000 10,200
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat Darah 170,000 -
34 21/10/18 NY.DESI HERAWAT KR Kolesterol 36,000 10,200
GDS 33,000 20,000
 GDS 22,000 5,800
SGPT 33,000 7,500
Elektrolit 265,000 265,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 15,000 543,000 15,000
35 22/10/18 NY.HJ.NURBAYA IR Kolesterol 36,000 10,200
GDS 33,000 20,000
SGPT 33,000 7,500
Elektrolit 250,000 250,000
Darah Rutin 64,000 32,000
SGOT 33,000 7,500
Kreatinin 33,000 13,500
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 14,000 505,000 14,000
36 25/10/2018 TN.SUYITNO AA Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 137,000 10,000
37 20/10/2018 Ny. FEBRINA AB Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 160,000 10,000

RAWAT JALAN
1 27/09/18 NY.DARMI AF Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
2 28/09/18 NY.JUSNA RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
3 28/09/18 NY.NURMA AF Darah Rutin 64,000 32,000
GDS 22,000 5,800
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 168,000 10,000
4 29/09/18 HJ.NURJANNAH IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
5 29/09/18 NY.NURSIA LL Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 114,000 10,000
6 29/09/18 TN.RUSTAM RD Kolesterol 36,000 10,200
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 5,000 49,000 5,000
7 10/01/18 NY.NURBIAH LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
8 10/01/18 NY.SIRUA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
9 10/01/18 AN.KAILAH ZAFIRA I RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
10 10/01/18 NY.NURLINDA LL/SW Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
11 10/01/18 AN.VANESA IB Darah Rutin 64,000 32,000
Widal 28,000 3,500
GDS 33,000 20,000
Kolesterol 36,000 10,200
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 179,000 10,000
12 10/01/18 TN.NASARUDDIN EI Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 111,000 10,000
13 10/02/18 TN.ABD.MANAF LL Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGPT 33,000 7,500
L 7,000 7,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 273,000 10,000
14 10/02/18 NY.HJ.BASSE AF Kolesterol 36,000 10,200
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 5,000 49,000 5,000
15 10/03/18 NY.FARIDA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
16 10/03/18 NY.HJ.ROHANI LL Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 5,000 72,000 5,000
17 10/04/18 AN.SALMAN IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
18 10/04/18 NY.NURWANA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
19 10/05/18 NY.AKKU SW GDS 33,000 20,000
Ureum 33,000 10,000
L 5,000 5,000
BHP 6,000 6,000
Spoit + Tempat 20,000 97,000 20,000
20 10/05/18 NY.LULI LL Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
21 10/05/18 TN.KADE IM GDS 33,000 20,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
22 10/06/18 AN.NUR AULIA IR Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
23 10/06/18 AN.ASTRID RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
24 10/06/18 TN.SYAIFUDDIN LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
25 10/06/18 NY.ST.HAJAR LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 72,000 -
26 10/08/18 TN.ABD.RAHMAN LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 72,000 -
27 10/08/18 NY.HJ.SUHURIA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 72,000 -
28 10/08/18 NY.SALMA LL GDS 33,000 20,000
L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat Darah 35,000 -
29 10/08/18 TN.ILHAM LL Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
30 10/08/18 TN.ILMAN LL Asam Urat 33,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
31 10/08/18 TN.SYAHRIL IR Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
32 10/08/18 NY.SUBAEDAH IR Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 135,000 10,000
33 10/08/18 NY.NELLI KR GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
34 10/08/18 NY.HALAMIAH AA Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
35 10/08/18 A.RIDHA EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
36 10/10/18 TN.SUDIRMAN LL Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
Urine Rutin 50,000 8,000
Kolesterol 36,000 10,200
L 7,000 7,000
BHP 5,000 5,000
Spoit + Tempat 20,000 248,000 20,000
37 10/10/18 NY.ST.HAJAR LL Darah Rutin 64,000 32,000
 Widal 28,000 3,500
GDS 22,000 5,800
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 200,000 10,000
38 10/10/18 TN.AMIRUDDIN RD Kolesterol 36,000 10,200
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 12,000 12,000
BHP 15,000 15,000
Spoit + Tempat 20,000 149,000 20,000
39 10/10/18 AN.ARIFA LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat 10,000 187,000 10,000
40 10/10/18 TN.MAHDIN LL Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kolesterol 36,000 10,200
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat 10,000 137,000 10,000
10/10/18 TN.JUNAEDI AA Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
42 10/11/18 NY.HJ.HAPIDA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
43 10/11/18 NY.HJ.NISMA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
44 10/11/18 TN.DARWIS RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
45 10/12/18 NY.ST.HAJAR RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
GDS 22,000 5,800
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 200,000 10,000
46 10/12/18 NY.WAHYUNI AF Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
47 13/10/18 H.ABD.JALIL RD Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
48 13/10/18 TN.BURHAN LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
49 13/10/18 NY.SUHEMI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
50 15/10/18 NY.HJ.ST.HAJAR LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
GDS 22,000 5,800
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 10,000 203,000 10,000
51 15/10/18 NY.NURMANENGSIH LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
52 15/10/18 TN.AMIRUDDIN EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
53 15/10/18 TN.SANDI LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 185,000 10,000
54 16/10/18 TN.ALADIN AF Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
55 16/10/18 TN.H.HERMAN RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
56 17/10/18 TN.MUHIDDIN KR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
 GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
57 17/10/18 TN.MUJITABA LL GDS 33,000 20,000
L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat Darah 35,000 -
58 18/10/18 NY.HJ.MURLIA EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat Darah 72,000 -
59 18/10/18 NY.HJ.RUSLI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
60 18/10/18 TN.MULIADI LL Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
61 18/10/18 AN.CICI LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat 10,000 187,000 10,000
62 18/10/18 TN.AZIZ LL Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 80,000 10,000
63 19/10/18 NY.ARUM PONE LL GDS 33,000 20,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 5,000 46,000 5,000
64 22/10/18 NY.HJ.PUANG MINDI RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
65 22/10/18 NY.YUSNIAR SW Darah Rutin 64,000 32,000
GDS 22,000 5,800
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 231,000 10,000
66 22/10/18 NY.ST.HAJAR LL Darah Rutin 64,000 32,000
GDS 22,000 5,800
Ureum 33,000 10,000
Kreatinin 33,000 13,500
 Kolesterol 36,000 10,200
L -
BHP 2,000 2,000
Spoit + Tempat 10,000 200,000 10,000
67 22/10/18 NY.RUSDA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
68 22/10/18 NY.HJ.JURANA IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
69 23/10/18 NY.HJ.SANIA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
70 23/10/18 TN.M.MAKKARANNU KR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
71 23/10/18 AN.RAFA LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat 10,000 187,000 10,000
72 23/10/18 NY.MUSRA LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat 10,000 187,000 10,000
73 24/10/18 NY.RAMLAH LL Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 6,000 6,000
BHP 3,000 3,000
Spoit + Tempat 10,000 174,000 10,000
74 23/10/2018 TN.EKO KR Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
75 24/10/2018 TN. H. MUCHTAR RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
76 25/10/2018 NY. ARIASTUTI LL Urine Rutin 50,000 8,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
77 25/10/2018 NY. FAIDA NS GDS 33,000 20,000
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
78 25/10/2018 NY. ADRIANI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000

TOTAL 19,785,000 19,785,000 392,000 4,554,000 5,705,800

-

Rincian Rawat Inap 11,034,000 10,737,000 297,000

Jasa Laboran 1,634,976 Rawat Jalan 3,033,000 - 3,033,000
Total Bruto 14,067,000 10,737,000 3,330,000

dr. Nur Rahmi, Sp. PK 1,634,976.00

Reagensia 5,705,800.00
Jasa Klinik 4,995,760.00
BHP 4,554,000.00
L 392,000
9,549,760.00
2018 RUMAH SAKIT 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

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
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
L - - - SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
- - - - - SR
K SR
K SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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
- - - - - SR
K SR
 K SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
L - - - NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
L - - - SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
L - - - NR
L - - - NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 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
L - - - SR
L - - - 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
L - - - SR
L - - - SR
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 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 SR
SR
K SR
K SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
L - - - SR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
L - - - SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
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 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
SR
K SR
K SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
L - - - SR
L - - - SR
L - - - SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 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 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
L - - - NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
L - - - SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR

25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR

23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
 K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
 SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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 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
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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 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
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 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 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
- - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
- - - - - SR
K SR
K 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 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
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
- - - - - SR
K SR
K SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
- - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR

9,083,200 4,995,760 4,087,440 - 1,634,976 1,634,976 817,488

4,995,760 -
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN NOVEMBER 2018 RUMAH SAKIT BERSALIN
KODE HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

dr BAYAR L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT INAP
1 23/10/2018 An.St. Khumaira AK Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 177,000 10,000
2 28/10/2018 Ny. Dian Permatasa WT Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
3 26/10/2018 Tn. Sukri EI Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Widal 28,000 3,500
SGOT 33,000 7,500
SGPT 33,000 7,500
IgG/IgM 150,000 100,000
L 10,000 10,000
BHP 8,000 8,000
Spoit + Tempat 15,000 405,000 15,000
4 27/10/2018 TN. Ancu SW Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 22,000 5,800
Urine Rutin 50,000 8,000
SGOT 33,000 7,500
SGPT 33,000 7,500
Kreatinin 33,000 13,500
Ureum 33,000 10,000
L 10,000 10,000
BHP 8,000 8,000
Spoit + Tempat 10,000 426,000 10,000
5 28/10/2018 Tn. M.Asdar AA Kolesterol 36,000 10,200
GDS 22,000 5,800
SGOT 33,000 7,500
SGPT 33,000 7,500
Kreatinin 33,000 13,500
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Asam Urat 33,000 9,500
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 10,000 307,000 10,000
6 29/10/2018 NY. Suryani AB Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
7 30/10/2018 Ny. Hamda Saman IR Darah Rutin 64,000 32,000
 Asam Urat 33,000 9,500
Kolesterol 36,000 10,200
GDS 33,000 20,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 182,000 10,000
8 29/10/2018 NY. Suryani IB Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
GDS 33,000 20,000
L 10,000 10,000
BHP 5,000 5,000
Spoit + Tempat 20,000 149,000 20,000
9 31/10/2018 Ny.Hj.Azisah EI Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kolesterol 36,000 10,200
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 273,000 10,000
10 11/01/18 An. Khanza AK Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 10,000 10,000
BHP 7,000 7,000
Spoit + Tempat 10,000 188,000 10,000
11 23/11/2018 Ny.hj.hadara FD GDS 33,000 20,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
12 11/02/18 Ny. Hj. Fatima IB Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
GDS 33,000 20,000
GDS 33,000 20,000
SGOT 33,000 7,500
SGPT 33,000 7,500
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 18,000 18,000
BHP 15,000 15,000
Spoit + Tempat 20,000 460,000 20,000
13 11/03/18 An. M. Raka AK Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
14 11/03/18 Ny. Rahmi WT Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
15 11/03/18 Tn. Dg.Lugu IB Golongan Dara 17,000 5,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
 L 10,000 10,000
BHP 8,000 8,000
Spoit + Tempat 15,000 180,000 15,000
16 11/05/18 An. Abd. Kahfi AK Darah Rutin 64,000 32,000
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 100,000 10,000
17 11/07/18 Ny. Anita WT Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 95,000 10,000
18 09/11/18 Tn. Undas EI Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
19 11/10/2018 NY. Hj. Ratna SW Darah Rutin 64,000 32,000
GDS 22,000 5,800
GDS 33,000 20,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 135,000 10,000
20 13/11/18 Ny. Sabannur SW Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 10,000 239,000 10,000
21 09/11/18 Ny.Hj. St. Aminah EI Darah Rutin 64,000 32,000
GDS 22,000 5,800
GDS 33,000 20,000
Asam Urat 33,000 9,500
Kolesterol 36,000 10,200
Ureum 33,000 10,000
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 8,000 8,000
BHP 3,000 3,000
Spoit + Tempat 10,000 341,000 10,000
22 14/11/18 An. Afrianti AK Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
23 16/11/18 Tn. Yusuf AB Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 8,000 8,000
BHP 6,000 6,000
Spoit + Tempat 15,000 126,000 15,000
24 16/11/18 Ny. Hj.Muliati AB Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
 Golongan Dara 17,000 5,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 22,000 5,800
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat 10,000 258,000 10,000
25 18/11/18 Ny. Iie. St. Sarinah EI Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 95,000 95,000
Urine Rutin 50,000 8,000
Kolesterol 36,000 10,200
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat 15,000 404,000 15,000
26 19/11/18 Tn . Aco Nasrul SW Darah Rutin 64,000 32,000
GDS 22,000 5,800
Asam Urat 33,000 9,500
Kolesterol 36,000 10,200
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
27 21/11/18 Ny. Nurafni AB Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
28 21/11/18 Tn. M. Amin IR Kolesterol 36,000 10,200
GDS 22,000 5,800
Darah Rutin 64,000 32,000
Asam Urat 33,000 9,500
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
29 18/11/2018 Ny. Rahmawati RD Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
GDS 33,000 20,000
GDS 33,000 20,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 18,000 18,000
BHP 12,000 12,000
Spoit + Tempat 30,000 387,000 30,000
30 11/07/18 Ny. Anita WT Darah Rutin 64,000 32,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
31 11/02/18 Nn.st.fadillah EI Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 177,000 10,000
RAWAT JALAN
1 26/10/18 NY.HJ.RAHMASIA IR Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 10,000 171,000 10,000
2 27/09/18 TN. HAIRIL IR Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
3 27/10/18 NY.ISA IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
4 27/10/18 TN.A.MUKHTAR LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
5 29/10/18 NY.FUJI RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
6 29/10/18 NY.ROSDIANA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
7 29/10/18 TN.SAKTIAWAN LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
8 29/10/18 NY.HASNAWATI FD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
9 29/10/18 TN. TAKKA FD Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 80,000 10,000
10 29/10/18 AN. AQIPANELA AF Darah Rutin 64,000 32,000
HbSAg 60,000 25,000
SGOT 33,000 7,500
Bilirubin 75,000 75,000
L 7,000 7,000
 BHP 4,000 4,000
Spoit + Tempat 20,000 263,000 20,000
11 30/10/2018 NY.ROSDIANA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
12 30/10/2018 NY.HJ.HADARA FD GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
13 30/10/2018 TN.ADAM RD Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kolesterol 36,000 10,200
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 137,000 10,000
14 31/10/2018 TN.EKO SETIAWAN LL GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
15 31/10/2018 TN. SUWAHYONO LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
16 31/10/2018 NY.HJ.A.HASNA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
17 31/10/2018 NY.HJ.DARIA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
18 31/10/2018 NY.HJ.MUNA EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
19 31/10/2018 NY.HJ.WAHIDA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
20 31/10/2018 NY.SRI WAHYUNI EI Darah Rutin 64,000 32,000
Widal 28,000 3,500
Kolesterol 36,000 10,200
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 143,000 10,000
21 31/10/2018 TN.AMINUDDIN RD Kolesterol 36,000 10,200
L 2,000 2,000
BHP 1,000 1,000
 Spoit + Tempat 10,000 49,000 10,000
22 31/10/2018 TN.H.DEDIANTO EI Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 10,000 171,000 10,000
23 11/01/18 NY.HJ.HADIJAH LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 1,000 1,000
BHP 3,000 3,000
Spoit + Tempat 10,000 83,000 10,000
24 11/01/18 NY.HASNAWATI RD GDS 22,000 5,800
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 69,000 10,000
25 11/01/18 TN.BURHAN EI GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
26 11/01/18 TN.KASMAN EI Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 1,000 1,000
BHP 3,000 3,000
Spoit + Tempat 10,000 83,000 10,000
27 11/02/18 TN.H.BAHARUDDIN RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
28 11/02/18 NY.HJ.SUCI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
29 11/02/18 NY.HJ.HAERANI EI Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat 10,000 137,000 10,000
30 11/03/18 TN.MARTEN LL GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 35,000 10,000
31 11/03/18 NN.NURHANDAYANI RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
32 11/03/18 TN.ZULKIFLI RD Widal 28,000 3,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 41,000 10,000
33 11/05/18 NN.A.PRICIA RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 106,000 10,000
34 11/05/18 NY.HJ.ROHANI LL Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
35 11/05/18 TN.MADA ALI RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
36 11/05/18 NY.HARMAH LL Darah Rutin 64,000 32,000
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 100,000 10,000
37 11/05/18 NY.ST.HAJAR LL Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 10,000 171,000 10,000
38 11/06/18 AN.LEA KR Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
39 11/06/18 NY.ASNI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
40 11/06/18 NY.SAKKE IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
41 11/06/18 NY.MUTMAINNA KR Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
42 11/07/18 NY.HJ.FATIMA IB GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
43 11/07/18 NY.SYAMSINAR EI Urine Rutin 50,000 8,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
44 11/08/18 TN.ALADIN RD Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
45 11/09/18 NY.HJ.NURJANNAH RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 1,000 1,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 82,000 10,000
46 11/09/18 NY.ARPRIANTI LL Urine Rutin 50,000 8,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
47 11/09/18 NY.HJ.SURYANI RD Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 111,000 10,000
48 11/09/18 NY.NURSIA WT GDS 22,000 5,800
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 35,000 10,000
49 11/10/18 NY.JARNI SW Darah Rutin 64,000 32,000
Urine Rutin 50,000 8,000
Kreatinin 33,000 13,500
Ureum 33,000 10,000
SGOT 33,000 7,500
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat 15,000 324,000 15,000
50 11/10/18 AN.DAFA LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
Malaria 80,000 60,000
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat 10,000 187,000 10,000
51 11/12/18 NY.HJ.NURJANNAH IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
52 11/12/18 TN.H.NAHAR RD Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
GDS 22,000 5,800
Asam Urat 33,000 9,500
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 10,000 171,000 10,000
53 11/12/18 TN.MUH.TAHER LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
54 11/12/18 TN.ZAINAL ABIDIN RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
55 13/11/2018 TN.USMAN LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
56 13/11/2018 NY.MATAMASSE RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
57 13/11/2018 NY.MAGDALENA RD Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
58 13/11/2018 NY.ASRUMI AF Kolesterol 36,000 10,200
GDS 22,000 5,800
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat 10,000 106,000 10,000
59 14/11/2018 NN.ST.FATMA HAYO KR Darah Rutin 64,000 32,000
HbSAg 60,000 25,000
plano test 25000 25,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 164,000 10,000
60 14/11/2018 NY.HARMANI LL Urine Rutin 50,000 8,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
61 14/11/2018 NY.HJ.NURMI IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
62 14/11/2018 NY.SENNA LALLE EI Darah Rutin 64,000 32,000
GDS 22,000 5,800
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat 10,000 134,000 10,000
63 14/11/2018 TN.SUDIRMAN RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
64 16/11/2018 TN.MUH.IDRIS RD Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
65 17/11/2018 NY.SAODA LL GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
66 17/11/2018 NY.NASRIA RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
67 17/11/2018 NY.ST.AMINAH RD GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 46,000 10,000
68 17/11/2018 NY.NADIRA RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
69 17/11/2018 NY.TITI NURWAHDA RD Kolesterol 36,000 10,200
trigliserida 75,000 75,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 124,000 10,000
70 19/11/2018 AN.ASMA ASIP RD Widal 28,000 3,500
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 41,000 10,000
71 19/11/2018 NY.HARTINI RD Kolesterol 36,000 10,200
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
72 19/11/2018 NY.HJ.CIMBONG AF Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
73 21/11/18 TM.MUSATRIO LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
74 21/11/18 Ny. Hj. Berlian LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
75 21/11/18 Tn. Hamid EI Darah Rutin 64,000 32,000
Kreatinin 33,000 13,500
Ureum 33,000 10,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 145,000 10,000
76 21/11/18 Tn. Aco Babo RD Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 137,000 10,000
77 22/11/18 Ny. Hj. Rosida LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
78 22/11/18 Tn. Sudirman LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 106,000 10,000
79 22/11/18 Ny. Nurdia IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 200,000 10,000
80 22/11/18 Tn. Syafai RD Malaria 80,000 60,000
Asam Urat 33,000 9,500
Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 221,000 10,000
82 23/11/18 Tn. Erwin IR Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
83 23/11/18 An. A. Syifa LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
84 24/11/18 Tn. Rusli RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
85 25/11/2018 TN.SABANG KR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
TOTAL 14,721,000 14,638,000 368,000 1,793,000 4,863,200
(83,000)

Rincian Rawat Inap 6,159,000 6,159,000 -

Jasa Laboran 1,378,764 Rawat Jalan 8,562,000 8,562,000 -
Total Bruto 14,721,000 14,721,000 -

dr. Nur Rahmi, Sp. PK 1,374,120.00

Reagensia 4,863,200.00
Jasa Klinik 4,225,815.00
BHP 1,793,000.00
L 368,000
6,018,815.00

26/10/18 TN.M.SUKRI RD 405,000

28/10/18 TN.M.ASDAR IR 307,000
27/10/18 TN.ANCU IR 426,000
29/10/18 NY.DIAN PERMATA WT 95,000
 31/10/18 NY.SURYANI IB 149,000
25/10/18 NY.SURYANI AB 77,000
30/10/18 NY.HAMDA SAMA IR 182,000
31/10/18 NY.HJ.AZIZAH IR 273,000
11/06/18 NY.RAHMI WT 77,000
11/03/18 AN.M.RUH. RAKA RD 77,000
11/01/18 AN.KHANZA KR 188,000
11/04/18 NY.HJ.FATIMAH IB 460,000
11/05/18 AN.ABD.KAHFI KR 100,000
13/11/18 NY.SABANNUR AF 239,000
14/11/18 AN.AFRIANTI AF 77,000
11/09/18 NY.HJ.AMINAH RD 341,000
11/10/18 NY.HJ.RATNA IR 135,000
11/10/18 NY.ANITA WT 77,000
11/09/18 TN.UDAS AF 187,000
11/03/18 TN.DG.LUGU RD 180,000
11/07/18 NY.ANITA WT 95,000
17/11/18 TN,YUSUF IB 126,000
18/11/18 NY.RAHMAWATI RD 387,000
23/11/18 AN.ST.KHUMAIRA AF 177,000
18/11/2018 NY.IIE ST.SARINAH AF 404,000
21/11/2018 NY.HJ.MULIAWATI AB 258,000
21/11/18 NY.NUR AFNI AB 95,000
20/11/2018 TN.ACO NASRULLA AF 171,000
23/11/18 NY.HJ.HADARA FD 46,000
22/11/18 TN.H.MUH.AMIN IR 171,000
02/11/18 NN. ST. FADILAH RD 177,000 6,159,000

catatan yang salah

11 11/02/18 Ny. Hj EI Darah Rutin 64,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
CT 20,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 12,000 12,000
BHP 10,000 10,000
Spoit + Tempat 50,000 517,000 50,000
14 11/03/18 Tn. Dg IB Golongan Darah 17,000
Darah Rutin 64,000
Darah Rutin 64,000
Urine Rutin 50,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 277,000 10,000
15 11/05/18 An. Ab AK Darah Rutin 64,000
 GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 111,000 10,000
16 11/05/18 Ny. An WT Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 20,000 170,000 20,000
18 11/10/2018 NY. Hj SW Darah Rutin 64,000
GDS 33,000
GDS 33,000
GDS 33,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 30,000 202,000 30,000
22 16/11/18 Tn. Yu AB Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 111,000 10,000
23 16/11/18 Ny. Hj AB Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Darah 17,000
GDS 33,000
GDS 33,000
GDS 33,000
L 7,000 7,000
BHP 6,000 6,000
Spoit + Tempat 30,000 351,000 30,000
24 18/11/18 Ny. Iie EI Darah Rutin 80,000 80,000
Darah Rutin 95,000 95,000
Darah Rutin 95,000 95,000
Urine Rutin 50,000
GDS 22,000
Asam Urat 33,000
Kolesterol 36,000
Ureum 33,000
Kreatinin 33,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat 30,000 522,000 30,000
26 20/11/18 By. Ny AK GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
ER 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
JASA JASA

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

11 12 13 14 15 16 17

32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR

32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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
50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 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 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
NR
K NR
K NR
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
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 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
23,000.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
 - - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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 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 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
 SR
SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
35,000.00 19,250.00 15,750.00 6,300.00 6,300.00 3,150.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
SR
SR
 K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
- - - - - NR
K NR
 K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 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 NR
NR
K NR
K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
 K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K 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 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
 K NR
K NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
- - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 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
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
 K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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 SR
35,000.00 19,250.00 15,750.00 6,300.00 6,300.00 3,150.00 SR
SR
SR
K SR
K SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 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 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
NR
K NR
K NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
 K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR

K
K
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

7,683,300 4,225,815 3,446,910 - 1,374,120 1,378,764 689,382

(10,575.00)
 2,880.00
1,170.00
1,170.00
1,170.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 1,170.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,278.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 2,295.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 2,295.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 2,880.00
5,800 14,200.00 7,810.00 6,390.00 L 2,556.00 2,556.00 2,070.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 -
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,080.00
- - - - 2,880.00
K 2,880.00
K 3,780.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 2,070.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 1,755.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 - NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 2,880.00 NR
- - - - 1,170.00 NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 2,880.00
2,880.00
K 1,080.00
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 2,880.00 NR
1,170.00 NR
K 1,170.00 NR
K 1,170.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 2,880.00 SR
1,170.00 SR
K - SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 2,880.00 SR
- - - - 2,880.00 SR
K 2,880.00 SR
K 1,080.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 1,170.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 1,170.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 1,170.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 -
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
- - - -
K
K 3,780.00
1,458.00 SR
2,115.00 SR
2,322.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 2,070.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,755.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,170.00 SR
- SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 SR
- - - - SR
K SR
K SR
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN NOVEMBER 2018 RUMAH SAKIT BERSALIN
KODE HARGA

NO TGL NAMA URAIAN TARIF TOTAL

PASIEN dr BAYAR L KLINIK REAGEN

1 2 3 4 5 6 7 8 9 10
RAWAT INAP
1 22/11/2018 BY.NURMALA IM Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 111,000 10,000
2 26/11/2018 NY.TIKA sw Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Elektrolit 265,000 265,000
Elektrolit 265,000 265,000
Elektrolit 265,000 265,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 940,000 10,000
3 26/11/2018 TN.BIMOKO EI Darah Rutin 64,000 32,000
Widal 28,000 3,500
GDS 33,000 20,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 140,000 10,000
4 28/11/2018 TN. M.ASHAD EI Darah Rutin 64,000 32,000
GDS 22,000 5,800
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 5,000 100,000 5,000
5 28/11/2018 NY. HASLINA AB Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 95,000 10,000
6 29/11/2018 TN.A.PUTRA SW Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
GDS 33,000 20,000
GDS 33,000 20,000
Widal 28,000 3,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 15,000 15,000
BHP 7,000 7,000
Spoit + Tempat 30,000 596,000 30,000
7 30/11/2018 NY. WINDA AB Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 3,000 3,000
 BHP 1,000 1,000
Spoit + Tempat 10,000 95,000 10,000
8 12/01/18 NY. SURYA SW Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kreatinin 33,000 13,500
Ureum 33,000 10,000
SGOT 33,000 7,500
SGPT 33,000 7,500
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 20,000 247,000 20,000
9 12/03/18 NY. MARYAM Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
Kolesterol 36,000 10,200
Ureum 33,000 10,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
Kreatinin 33,000 13,500
Elektrolit 265,000 265,000
Elektrolit 265,000 265,000
L 10,000 10,000
BHP 7,000 7,000
Spoit + Tempat 50,000 1,025,000 50,000
10 12/03/18 AN. NURAWA AK Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
11 12/05/18 AN.NURAQIL AK Darah Rutin 64,000 32,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
12 12/06/18 NY. HJ.SADIA SW Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
Elektrolit 265,000 265,000
Elektrolit 265,000 265,000
Albumin 65,000 65,000
Albumin 65,000 65,000
Albumin 65,000 65,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
 GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
L 17,000 17,000
BHP 14,000 14,000
Spoit + Tempat 40,000 1,712,000 40,000
13 11/07/18 TN. BATMAN EI Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
L 15,000 15,000
BHP 10,000 10,000
Spoit + Tempat 30,000 619,000 30,000
14 12/07/18 NY. RISKI WT Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
15 12/07/18 AN. NAILA IB Golongan Dara 17,000 5,000
Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 10,000 134,000 10,000
16 12/07/18 NY. JULIANA WT Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
17 12/10/18 NN. RESKI A WT Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
 L 9,000 9,000
BHP 7,000 7,000
Spoit + Tempat 20,000 183,000 20,000
18 12/10/18 NY. SYAMSIA EI Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
GDS 22,000 5,800
SGOT 33,000 7,500
SGPT 33,000 7,500
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 10,000 251,000 10,000
19 12/10/18 NY. JANANTI AB Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
20 16/12/2018 NY. HJ. ASMA SW Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
SGOT 33,000 7,500
SGPT 33,000 7,500
GDS 33,000 20,000
Elektrolit 265,000 265,000
L 12,000 12,000
BHP 9,000 9,000
Spoit + Tempat 20,000 560,000 20,000
21 16/12/2018 NY. IRMAWAT EI Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Widal 28,000 3,500
Golongan Dara 17,000 5,000
GDS 33,000 20,000
LED 45,000 45,000
TCM 35,000 35,000
L 15,000 15,000
BHP 9,000 9,000
Spoit + Tempat 30,000 340,000 30,000
22 16/12/2018 NY. MASTUR IA Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
L 8,000 8,000
BHP 3,000 3,000
Spoit + Tempat 10,000 275,000 10,000
23 17/12/2018 NY. HIKMAWA EI Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 111,000 10,000
24 18/12/2018 TN.M.RAFLI SW Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
SGOT 33,000 7,500
SGPT 33,000 7,500
L 25,000 25,000
BHP 18,000 18,000
Spoit + Tempat 90,000 920,000 90,000
25 18/12/2018 NY. ZAM-ZAM SW Darah Rutin 64,000 32,000
GDS 22,000 5,800
Asam Urat 33,000 9,500
Kolesterol 36,000 10,200
L 5,000 5,000
BHP 1,000 1,000
Spoit + Tempat 10,000 171,000 10,000
26 19/12/2018 NY. HJ. DEWI AB Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 100,000 10,000
27 19/12/2018 NY. HJ. LISNA AB Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 22,000 5,800
Kreatinin 33,000 13,500
Ureum 33,000 10,000
SGOT 33,000 7,500
SGPT 33,000 7,500
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 20,000 331,000 20,000
28 19/12/2018 TN. H.SAHAB EI Darah Rutin 64,000 32,000
GDS 22,000 5,800
SGOT 33,000 7,500
SGPT 33,000 7,500
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 10,000 173,000 10,000
29 20/12/2018 NY.ST.NURBA AA Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 4,000 4,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
30 21/12/2018 NY.LUSIANA WT GDS 33,000 20,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
31 12/10/18 NY. SURYA DARMA Darah Rutin 64,000 32,000
Golongan Dara 17,000 5,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 100,000 10,000
32 20/12/2018 TN. MASKUR EI Darah Rutin 64,000 32,000
GDS 22,000 5,800
Kolesterol 36,000 10,200
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 205,000 10,000
33 21/12/2018 NY.HJ.HADAR EI Darah Rutin 64,000 32,000
GDS 33,000 20,000
GDS 33,000 20,000
GDS 33,000 20,000
Ureum 33,000 10,000
Ureum 33,000 10,000
Kreatinin 33,000 13,500
Kreatinin 33,000 13,500
SGOT 33,000 7,500
SGPT 33,000 7,500
Elektrolit 265,000 265,000
Elektrolit 265,000 265,000
L 30,000 30,000
BHP 15,000 15,000
Spoit + Tempat 40,000 976,000 40,000

RAWAT JALAN
1 26/11/18 NY.HJ. FARIDA IR Asam Urat 33,000 9,500
Kolesterol 36,000 10,200
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
2 26/11/18 TN. UDIN IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
3 26/11/18 NY. A. RUSNI LL GDS 22,000 5,800
Asam Urat 33,000 9,500
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 69,000 10,000
4 26/11/18 TN. RUDI EI HbSAg 60,000 25,000
 SGOT 33,000 7,500
SGPT 33,000 7,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 141,000 10,000
5 26/11/18 NY. AMANAH RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
6 27/11/18 NY. SRIYANTI RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
7 27/11/18 NY.HJ.HASNA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
8 27/11/18 T. HARIS RD Kolesterol 36,000 10,200
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
9 27/11/18 NY. HJ.BAWAN RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
10 28/11/18 AN. ALFAREZA LL Darah Rutin 64,000 32,000
Malaria 80,000 60,000
Widal 28,000 3,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
11 28/11/18 TN. AHMAD AF Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
12 29/11/18 NY. ASIA AF Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
13 29/11/18 TN.SUKMA RD GDS 22,000 5,800
Kolesterol 36,000 10,200
L 2,000 2,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 72,000 10,000
14 29/11/18 NY.SISKA LL GDS 22,000 5,800
Kolesterol 36,000 10,200
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
15 29/11/18 NY.NANI TRI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
16 29/11/18 NY.SANDRA DE IR Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
17 29/11/18 TN.FAISAL LL Urine Rutin 50,000 8,000
L 8,000 8,000
BHP 5,000 63,000 5,000
18 29/11/18 TN.SYARIKUN IR Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 UR 9,500
GDS 22,000 5,800
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
19 30/11/18 AN.ZAHRA RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 15,000 113,000 15,000
20 30/11/18 TN.SUPARMAN IR Darah Rutin 64,000 32,000
Widal 28,000 3,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 129,000 10,000
21 12/01/18 TN.ABD.RASYI RD Kolesterol 36,000 10,200
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
22 12/01/18 NY.ST.AMINAH RD GDS 22,000 5,800
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 35,000 10,000
23 12/03/18 NY.MURNI DA RD Darah Rutin 64,000 32,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
24 12/03/18 TN.DARWIS RD Kolesterol 36,000 10,200
GDS 22,000 5,800
L 3,000 3,000
BHP 3,000 3,000
 Spoit + Tempat 15,000 79,000 15,000
25 12/03/18 NN.HASNADI IR Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
26 12/03/18 NY. NURHAYA AA Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 1,000 1,000
BHP 3,000 3,000
Spoit + Tempat 10,000 83,000 10,000
27 12/04/18 AN. ABDILLAH IR GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
28 12/04/18 HAMZI IZAM EI Darah Rutin 64,000 32,000
GDS 33,000 20,000
Malaria 80,000 60,000
Widal 28,000 3,500
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 10,000 221,000 10,000
29 12/04/18 NY.ARWAN IR Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Widal 28,000 3,500
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 20,000 155,000 20,000
30 12/04/18 TN.HIDAYAT RD Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Widal 28,000 3,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 143,000 10,000
31 12/05/18 TN.MUH.TAMR RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
32 12/05/18 NY. MARDEWI LL Darah Rutin 64,000 32,000
Malaria 80,000 60,000
Widal 28,000 3,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
33 12/06/18 NY. RESKI LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
34 12/06/18 TN. SAJID LL Kolesterol 36,000 10,200
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
35 12/07/18 SYAMSUDDIN RD Darah Rutin 64,000 32,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 10,000 171,000 10,000
36 12/08/18 NY.MEY SUKM RD Kolesterol 36,000 10,200
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
37 12/08/18 TN.HUSNI HAM LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
38 12/10/18 AN.MUH.ALI RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
39 12/10/18 TN.ALI RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
40 12/10/18 NN. HIKMA KR Darah Rutin 64,000 32,000
GDS 33,000 20,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 111,000 10,000
41 12/10/18 TN.BAYU IM GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
42 12/11/18 AN.ARIKA KR Darah Rutin 64,000 32,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
43 12/11/18 TN.MUH.RIZAL SW Darah Rutin 64,000 32,000
Widal 28,000 3,500
SGOT 33,000 7,500
SGPT 33,000 7,500
L 10,000 10,000
BHP 9,000 9,000
Spoit + Tempat 20,000 197,000 20,000
44 12/11/18 NY.AVILA AK L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat 10,000 12,000 10,000
45 12/11/18 NY.ST.AMINAH IB GDS 33,000 20,000
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 46,000 10,000
46 12/11/18 TN. HARISMAN RD Kolesterol 36,000 10,200
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
47 12/12/18 NY.SUSILAWAT LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
48 12/12/18 NY.HJ.HUSBIA LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
49 12/12/18 NY. PAINAH KR Kolesterol 36,000 10,200
GDS 22,000 5,800
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 15,000 83,000 15,000
50 12/12/18 NY.RASMAWAT LL Kolesterol 36,000 10,200
GDS 22,000 5,800
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 3,000 3,000
Spoit + Tempat 10,000 106,000 10,000
51 12/12/18 NY.HJ.MARHU RD GDS 22,000 5,800
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 69,000 10,000
52 12/12/18 NY.APUS RD Kolesterol 36,000 10,200
GDS 22,000 5,800
Asam Urat 33,000 9,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
53 12/12/18 TN.SAINAL LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 174,000 10,000
54 14/12/2018 NN.NURHALISA LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
55 14/12/2018 NY. NABIAH RD Kolesterol 36,000 10,200
L 2,000 2,000
 BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
56 14/12/2018 TN. ILHAM AF GDS 33,000 20,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
57 14/12/2018 TN.BATMAN EI GDS 33,000 20,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
58 14/12/2018 AN.FAHRUL LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
59 14/12/2018 NY.HADANA EI Darah Rutin 64,000 32,000
Urine Rutin 50,000 8,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
SGOT 33,000 7,500
SGPT 33,000 7,500
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 10,000 358,000 10,000
60 14/12/2018 TN.ISMAIL EI Darah Rutin 64,000 32,000
Urine Rutin 50,000 8,000
Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
SGOT 33,000 7,500
SGPT 33,000 7,500
Ureum 33,000 10,000
Kreatinin 33,000 13,500
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 10,000 358,000 10,000
61 14/12/2018 AN.HUMAIRA LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
62 15/12/2018 NY.SARINAH IR GDS 33,000 20,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
63 17/12/2018 TN.ALADIN LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 106,000 10,000
64 17/12/2018 AN.IBRAHIM LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
65 17/12/2018 TN.AFRIZAL IR Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
66 17/12/2018 TN.WAHYU EI Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
67 18/12/2018 AN.INDRA LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
68 18/12/2018 NY.RITA LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
69 18/12/2018 TN.ABD.RAHM LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
70 18/12/2018 NY.ARINI IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
71 19/12/2018 AN.FAUZAN IR Darah Rutin 64,000 32,000
Widal 28,000 3,500
IgG/IgM 150,000 100,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 256,000 10,000
72 19/12/2018 NY.NURMA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
73 19/12/2018 TN.PANJI RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 106,000 10,000
74 19/12/2018 AN.EDELWEIS LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
75 19/12/2018 TN.UKI RD Asam Urat 33,000 9,500
GDS 22,000 5,800
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 69,000 10,000
76 20/12/2018 NY.HJ.ROHANI LL Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
77 20/12/2018 TN.ADRIANUS RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
78 21/12/2018 NY.HALIJA LL Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
79 21/12/2018 NY.APSIANI EI Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
80 21/12/2018 TN.M.ALFIAN IR Darah Rutin 64,000 32,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
81 21/12/2018 TN.SAIDIMAN EI GDS 33,000 20,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
82 22/12/2018 NY.NURFAUZIA RD Darah Rutin 64,000 32,000
Widal 28,000 3,500
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
83 22/12/2018 NY.HJ.RASMA RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
84 22/12/2018 TN.MASKUR KR GDS 33,000 20,000
L 2,000 2,000
 BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
85 22/12/2018 TN.LAHAMUDD KR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
86 24/12/2018 NY.HJ.RISAL LL Kolesterol 36,000 10,200
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
87 24/12/2018 NY. HUNNIATI IR Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
Darah Rutin 64,000 32,000
Widal 28,000 3,500
IgG/IgM 150,000 100,000
L 7,000 7,000
BHP 5,000 5,000
Spoit + Tempat 10,000 333,000 10,000
88 24/12/2018 TN.H.ADMAN RD Kolesterol 36,000 10,200
Asam Urat 33,000 9,500
GDS 22,000 5,800
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
89 24/12/2018 NN.NURHIDAY IR Darah Rutin 64,000 32,000
Widal 28,000 3,500
IgG/IgM 150,000 100,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 257,000 10,000
90 25/12/2018 TN.BAHARUDD EI Kolesterol 36,000 10,200
GDS 22,000 5,800
Asam Urat 33,000 9,500
Darah Rutin 64,000 32,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
91 25/12/2018 NY.YUSI IR Darah Rutin 64,000 32,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
92 27/11/2018 TN. A. IKHSAN LL Golongan Dara 17,000 5,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 5,000 25,000 5,000
93 25/12/2018 TN. DARWIS RD Kolesterol 36,000 10,200
GDS 22,000 5,800
Asam Urat 33,000 9,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
94 25/12/2018 NY.HJ. ROHANI LL Kolesterol 36,000 10,200
GDS 22,000 5,800
Asam Urat 33,000 9,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
95 25/12/2018 NY. HALIMA LL Kolesterol 36,000 10,200
GDS 22,000 5,800
Asam Urat 33,000 9,500
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
TOTAL 21,375,000
018 RUMAH SAKIT 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
SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
L - - - SR
L - - - SR
L - - - 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
L - - - NR
L - - - NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
L - - - SR
L - - - SR
L - - - SR
L - - - SR
L - - - SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 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 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,458.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 - NR
NR
K NR
K NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 SR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 2,880.00 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 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 - 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
SR
K SR
K SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 2,880.00 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 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
L - - - 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 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
L - - - SR
L - - - 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 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 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 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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
- - - - - SR
K SR
K SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 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 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
- - - - - SR
K SR
K SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
L - - - NR
L - - - NR
NR
K NR
K NR

23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR

25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
35,000.00 19,250.00 15,750.00 6,300.00 6,300.00 3,150.00 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
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
- - - - - NR
K NR
 K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
 K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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 NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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 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 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K 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
SR
K SR
K 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
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K 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
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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
23,000.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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
23,000.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
 K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 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 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
 K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 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 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 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
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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
 SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
- - - - - SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
SR
SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 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 SR
24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
SR
SR
K SR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
NR
K NR
32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
NR
K NR
12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
NR
K NR
25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
NR
K NR
-
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN NOVEMBER 2018 RUMAH SAKIT BER
KODE HARGA

TOTAL
NO TGL NAMA PASIEN URAIAN TARIF BAYAR
dr L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP ,0
1 26/12/18 NY. FARIDA SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
L 12,000 12,000
BHP 8,000 8,000
Spoit + Tempat 50,000 390,000 50,000
2 27/12/18 NY.POINEM SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
Kolesterol 36,000
Asam Urat 33,000
Kreatinin 33,000
Ureum 33,000
Urine Rutin 50,000
L 10,000 10,000
BHP 7,000 7,000
Spoit + Tempat 30,000 573,000 30,000
3 27/12/18 NY.SILVANI FI Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
4 28/12/18 NY. MARYAM SW Darah Rutin 64,000
Kreatinin 33,000
Ureum 33,000
L 10,000 10,000
BHP 7,000 7,000
Spoit + Tempat 15,000 162,000 15,000
5 28/12/18 NY. PRIYATI SW Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 168,000 10,000
6 29/12/18 TN.ABD.KADIR SW Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Kreatinin 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 236,000 10,000
7 30/12/18 NY. SILVANI FI Darah Rutin 64,000
 L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
8 30/12/18 AN.A.OJA SW Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
9 31/12/18 NY. RUKMINI FI Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 95,000 10,000
10 01/01/19 NY.IRMAWATI FI Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 20,000 172,000 20,000
11 01/01/19 TN.DARMAWAN SW Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
Urine Rutin 50,000
Urine Rutin 50,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 20,000 293,000 20,000
12 02/01/19 NY.AMRIANI FI Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
13 03/01/19 TN.MUH.DAHLA SW Darah Rutin 64,000
Urine Rutin 50,000
Ureum 33,000
Kreatinin 33,000
GDS 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 230,000 10,000
14 04/01/19 NY. KHUSNUL K AB Golongan Dara 17,000
Darah Rutin 64,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 95,000 10,000
15 04/01/19 TN.FAISAL SW Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 20,000 172,000 20,000
16 04/01/19 TN.HASPAR SW Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
GDS 22,000
Kolesterol 36,000
Kolesterol 36,000
 Asam Urat 33,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
L 10,000 10,000
BHP 6,000 6,000
Spoit + Tempat 30,000 422,000 30,000
17 04/01/19 NN.ST.NUR RA EI Darah Rutin 64,000
Urine Rutin 50,000
GDS 33,000
SGOT 33,000
SGPT 33,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 20,000 242,000 20,000
18 05/01/19 NY.HJ.AZIZAH EI Darah Rutin 64,000
GDS 33,000
Elektrolit 265,000 265,000
L 9,000 9,000
BHP 5,000 5,000
Spoit + Tempat 10,000 386,000 10,000
19 06/01/19 NY.NURMADINA EI Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
20 07/01/19 AN.NUR ALFIAN EI Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
21 07/01/19 AN.MUH.ALFIKR AK Darah Rutin 64,000
GDS 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 111,000 10,000
22 08/01/19 NY. HARDINI AA Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
L 4,000 4,000
BHP 1,000 1,000
Spoit + Tempat 10,000 137,000 10,000
23 09/01/19 TN.SUAIB EI Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
SGOT 33,000
SGPT 33,000
L 8,000 8,000
BHP 3,000 3,000
Spoit + Tempat 20,000 253,000 20,000
24 09/01/19 NY. HJ.BECCE EI Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
 L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 10,000 236,000 10,000
25 09/01/19 NY. HJ. PUTTIRI EI Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Elektrolit 265,000 265,000
Albumin 65,000 65,000
Golongan Dara 17,000
L 25,000 25,000
BHP 15,000 15,000
Spoit + Tempat 70,000 1,146,000 70,000
26 11/01/19 NY. INDRAYANI AB Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 95,000 10,000
27 11/01/19 AN.WIDIA AK Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
28 12/01/19 NY.MARTA EI Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
29 12/01/19 TN.ZULKIFLI EI Darah Rutin 64,000
Widal 28,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
SGOT 33,000
SGPT 33,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 20,000 280,000 20,000
30 13/01/19 AN.NAILA AK Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
 Spoit + Tempat 10,000 77,000 10,000
31 13/01/19 TN.RUSTAN SW Darah Rutin 64,000
GDS 22,000
Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 129,000 10,000
32 15/01/19 AN.SATRIO AK Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
33 16/01/19 NY.MUNAWARA AB Darah Rutin 64,000
Cyto 54,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 131,000 10,000
34 16/01/19 AN.ANNASYA AB Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
35 16/01/19 NY.ENDAH AB Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 95,000 10,000
36 17/01/19 AN.MUTIA AK Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
L 12,000 12,000
BHP 6,000 6,000
Spoit + Tempat 20,000 183,000 20,000
37 17/01/19 NY.NURFADILAH IR Darah Rutin 64,000
GDS 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 111,000 10,000
38 18/01/09 TN.ABD.RAHMAN AA Darah Rutin 64,000
GDS 33,000
GDS 33,000
Kolesterol 36,000
Ureum 33,000
Kreatinin 33,000
SGPT 33,000
L 15,000 15,000
BHP 7,000 7,000
Spoit + Tempat 20,000 307,000 20,000
39 18/01/19 AN.SALSABILA AK Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
40 18/01/19 NY.FIKA SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 30,000 231,000 30,000
41 19/01/19 NY.HARA NAIM SW Darah Rutin 64,000
 Darah Rutin 64,000
Darah Rutin 64,000
Kolesterol 36,000
GDS 33,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 30,000 302,000 30,000
42 19/01/19 AN.ATIKA AK Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
L 8,000 8,000
BHP 3,000 3,000
Spoit + Tempat 30,000 283,000 30,000
43 19/01/19 AN.NAILA AZZA AK Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
44 20/01/19 TN.H.JAMALUDD EI Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 5,000 5,000
BHP 1,000 1,000
Spoit + Tempat 10,000 168,000 10,000
45 21/01/19 AN.NUR ALIA AK Darah Rutin 64,000
GDS 33,000
Widal 28,000
L 4,000 4,000
BHP 1,000 1,000
Spoit + Tempat 10,000 140,000 10,000
46 21/01/19 AN.MUH.GALI AK Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
Widal 28,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 20,000 212,000 20,000
47 24/01/19 NY.MARENDEN EI Darah Rutin 64,000
GDS 33,000
GDS 33,000
GDS 33,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 20,000 292,000 20,000
47 25/01/19 NY.HJ.MUSDALI SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Kolesterol 36,000
IgG/IgM 150,000
Widal 28,000
L 10,000 10,000
 BHP 5,000 5,000
Spoit + Tempat 40,000 525,000 40,000
48 25/01/19 NY. NURIANI EI Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
GDS 33,000
Elektrolit 265,000 265,000
L 6,000 6,000
BHP 3,000 3,000
Spoit + Tempat 20,000 479,000 20,000
49 25/01/19 NY. MAYA APRI RD Darah Rutin 64,000
Widal 28,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 129,000 10,000

RAWAT JALAN
1 26/01/18 NY.YAMASIA RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
2 26/01/18 NY. H.DAKKA RD Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
3 26/01/18 TN. ISHAK LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
4 27/01/18 TN. KARSI LL Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
5 27/01/18 TN. ZULKIFLI RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
6 27/12/18 TN.A.IWAN LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
7 27/12/18 NY.HJ.NARISA RD Kolesterol 36,000
 GDS 22,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 72,000 10,000
8 27/12/18 NY.MASRIANI SW Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
9 27/12/18 TN.RIFLI EI Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
10 28/12/18 NY.HJ.SIRUA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
11 28/12/18 AN.ASILA IR Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
12 28/12/18 NY.NURDIANA IR Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
13 28/12/18 NY.HJ.SANIA RD GDS 22,000
Asam Urat 33,000
Kolesterol 36,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
14 29/12/18 NY. FARIDA SW Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
15 29/12/18 NY. SUPIAH SW Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
16 29/12/18 TN.BANI BON LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
17 31/12/18 NY.HJ.TUTI LL Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
18 01/01/19 NY. HADASIA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 106,000 10,000
19 02/01/19 TN.H.LANAWI IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
20 02/01/19 TN.MUH. FAJRIN AA Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
21 03/01/19 NY.A.NURLIANTI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
22 03/01/19 TN. HADRI IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
23 03/01/19 TN.YAKOB IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Kreatinin 33,000
SGPT 33,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 10,000 239,000 10,000
24 03/01/19 NY.SEMSIATI RD Asam Urat 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
25 04/01/19 TN.ADAM LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
26 04/01/19 NY.DARMI RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
27 04/01/19 NY.HIJRA FZ GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
28 04/01/19 TN.WAHYU LL Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 1,000 1,000
 Spoit + Tempat 10,000 95,000 10,000
29 04/01/19 TN.H.HAFID LL Asam Urat 33,000
Kolesterol 36,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
30 04/01/19 NY.NURHAYATI FZ GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
31 04/01/19 NY. NURLIA FZ GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
32 05/01/19 NY. OVI FZ GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
33 05/01/19 TN. MUH.ZUBIR KR GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
34 05/01/19 NN.ADMAYANTI RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
35 05/01/19 AN.SUKMA RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
36 05/01/19 TN. BAHARUDDIN SW Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 216,000 10,000
37 06/01/19 TN. MUH.IDRIS RD GDS 33,000
Kolesterol 36,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
38 06/01/19 NY.NURNAJIBA LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
39 06/01/19 NY.HJ.ATIQA FZ GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
40 07/01/19 TN.YOGA IR GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
41 07/01/19 AN.ASMA KR Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
42 07/01/19 TN. HADRI KR Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
43 07/01/19 NY.HJ.HARIANTI KR GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
44 07/01/19 NY. IKA LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
45 07/01/19 NY.HJ.NURLINA RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
46 07/01/19 TN.GAMAL EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
47 07/01/19 TN.ALADIN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
48 07/01/19 NY.ERNI LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
49 07/01/19 NY.NURJANNAH EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 46,000 10,000
50 09/01/19 TN.SABRANI IM GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
51 09/01/19 NY.HJ.SYAMSIAH LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
52 10/01/19 TN.TANAWALI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
53 10/01/19 AN.ARLEN IR Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
54 11/01/19 TN. MUHTAR LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
55 11/01/19 TN.RIZAL LL Kolesterol 36,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
56 11/01/19 TN.SUBHAN LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
57 11/01/19 TN.ABD.SAMAD FZ Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
58 11/01/19 AN.SATRIO FZ Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
59 11/01/19 AN.MUTIA FZ Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
60 11/01/19 NY.FRANSISKA FZ Asam Urat 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
61 12/01/19 TN.SUBIR RD Asam Urat 33,000
L 2,000 2,000
BHP 1,000 1,000
 Spoit + Tempat 10,000 46,000 10,000
62 12/01/19 AN.ATIKA IR IgG/IgM 150,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 163,000 10,000
63 12/01/19 NY.ST.HAJAR LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
64 12/01/19 NY.MARYAM LL Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
67 12/01/19 TN.AHIRUDDIN LL Darah Rutin 64,000
Asam Urat 33,000
GDS 22,000
Kreatinin 33,000
Ureum 33,000
L 29,000 29,000
BHP 15,000 15,000
Spoit + Tempat 40,000 269,000 40,000
68 13/01/19 NY.LISWATI LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
69 14/01/19 NY.MUTMAINNA RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
70 14/01/19 AN.ATIKA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
71 14/01/19 NY.KIA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
72 14/01/19 NY.MUNAWARAH AB Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
SGOT 33,000
SGPT 33,000
Kreatinin 33,000
Ureum 33,000
L 20,000 20,000
BHP 10,000 10,000
Spoit + Tempat 15,000 332,000 15,000
73 14/01/19 TN.H.NURRAHMA IR Kolesterol 36,000 ,
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
74 15/01/19 TN.SYAMSUL LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
75 15/01/19 NY.YULIANA LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
76 15/01/19 NY.HJ.FARIDA LL Kolesterol 36,000
TG 65,000 65,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 148,000 10,000
77 15/01/19 NY.ARINI LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
78 15/01/19 TN.NUSI SW Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
79 15/01/19 AN.RAHMADANI AK Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
80 16/01/19 TN.PARMAN IR Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
81 16/01/19 TN.ARMAN IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
82 16/01/19 NY.NURSIA EI GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
83 17/01/19 NY.SABRIANI SW Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
84 18/01/19 NY.HJ.ASIA LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
85 18/01/19 NY.HJ.MANUSIA LL Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
86 18/01/19 NY.RAHMAWATI AB Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 95,000 10,000
87 18/01/19 TN.NATSIR RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
88 18/01/19 NY.FUJI LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
89 19/01/19 NY.HJ.MANUSIA LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
90 19/01/19 NY.MULHAMA RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
91 19/01/19 AN.MUH.GALIF RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
92 20/01/19 NY.NURSIA EI GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
93 20/01/19 TN.ALADIN LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
94 20/01/19 TN.BASRI RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
95 20/01/19 AN.MUH.GAZALI RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
96 20/01/19 TN.ZULFIKAR RD Darah Rutin 64,000
Widal 28,000
Kolesterol 36,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 142,000 10,000
97 21/01/19 NY. ULFI RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
98 21/01/19 NY. HJ.NARISA LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
99 21/01/19 TN.ARFAN RD Kolesterol 36,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
100 22/01/19 TN. HERMAN RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
101 22/01/19 NY.HJ..JAHORANG RD Kreatinin 33,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 140,000 10,000
102 23/01/19 NY. HJ. DALLE LL GDS 22,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 35,000 10,000
103 23/01/19 NY. ARMINA LL Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
104 23/01/19 NN. LINDA IR Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
105 23/01/19 NY. SAKABA IR Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
Kreatinin 33,000
Ureum 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 205,000 10,000
106 23/01/19 AN.AIDIL RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
 BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
107 24/01/19 TN.ABD.HAMID RD Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Kreatinin 33,000
Ureum 33,000
SGOT 33,000
SGPT 33,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 10,000 307,000 10,000
108 24/01/19 TN.M.ALI RD Asam Urat 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
109 24/01/19 AN.FADLY RD Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
110 25/01/19 NY. INDRIANI RD Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
111 25/01/19 TN. SUNUSI EI Kolesterol 36,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
112 25/01/19 NY. NURMALASAR LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
113 25/01/19 TN. ABDUL MAGFI LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
114 25/01/19 TN. NUR ANNAS LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
 TOTAL 22,103,000 22,103,000 602,000 3,111,000
-

Rincian Rawat Inap 10,829,000 10,829,000 -

Jasa Laboran 1,989,000 Rawat Jalan 11,274,000 11,274,000 -
Total Bruto 22,103,000 22,103,000 -

dr. Nur Rahmi, Sp. PK 1,989,000.00

Reagensia 7,175,000.00
Jasa Klinik 6,077,500.00
BHP 3,111,000.00
L 602,000
9,188,500.00
OVEMBER 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17
SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
 SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
20,000 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
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
L - - - NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
 NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
L - - - NR
L - - - NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
 K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 34,000.00 18,700.00 15,300.00 L 6,120.00 6,120.00 3,060.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 - NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 - SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
 K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 - NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
L - - - NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR

5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR

10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
 K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
20,000 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
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
 K SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
 NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 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
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
 K SR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
 SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
 K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
7,175,000 Err:522 6,077,500 4,972,500 - 1,989,000 1,989,000 983,700

Err:522
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN NOVEMBER 2018 RUMAH SAKIT BE
KODE HARGA

TOTAL
NO TGL NAMA PASIEN URAIAN TARIF BAYAR
dr L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 26/01/19 NY. DIAN ELENI AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
Kreatinin 33,000
SGPT 33,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 20,000 275,000 20,000
2 27/01/18 NY. EVITA IB Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Widal 28,000
DDR 65,000 65,000
L 10,000 10,000
BHP 5,000 5,000
Spoit + Tempat 20,000 347,000 20,000
3 29/01/19 TN. MASNUR AK Darah Rutin 64,000
Widal 28,000
Darah Rutin 95,000 95,000
Transport 10,000 10,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 20,000 224,000 20,000
4 29/01/19 AN. MUH FADIL KR GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
5 29/01/19 TN. SUMITRO SW Darah Rutin 64,000
Widal 28,000
GDS 33,000
GDS 22,000
Kolesterol 36,000
SGOT 65,000 65,000
SGPT 65,000 65,000
Transport 10,000 10,000
L 15,000 15,000
BHP 7,000 7,000
Spoit + Tempat 20,000 365,000 20,000
6 29/01/19 TN. MUH. RIDW SW Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
GDS 33,000
Bilirubin Total 50,000 50,000
Bilirubin Direk 50,000 50,000
Bilirubin Total 65,000 65,000
Bilirubin Direk 65,000 65,000
Transport 20,000 20,000
 SGOT 33,000
SGPT 33,000
SGOT 50,000 50,000
SGPT 50,000 50,000
Ureum 50,000 50,000
Kreatinin 50,000 50,000
GDS 22,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 27,000 27,000
BHP 10,000 10,000
Spoit + Tempat 50,000 910,000 50,000
7 31/01/19 AN. NADIN AK Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 20,000 183,000 20,000
8 01/02/19 NY. FATIMA SW Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 111,000 10,000
9 01/02/19 NY. DIANA AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat 20,000 334,000 20,000
10 02/02/19 NY. FITRA WAH AB Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat 20,000 334,000 20,000
11 02/02/19 NY. NURYAH AB Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 95,000 10,000
12 05/02/19 TN. LANCONG IR Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
Asam Urat 33,000
L 5,000 5,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 202,000 10,000
13 05/02/19 AN. ALYAURA KR Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 111,000 10,000
14 07/02/19 AN. KAMILA KR Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat 40,000 394,000 40,000
15 07/02/19 AN. AL- HAFSYI AK Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 20,000 183,000 20,000
16 07/02/19 AN. ALILA AK Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
17 06/02/19 NY. HARIANA SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 8,000 8,000
Spoit + Tempat 40,000 337,000 40,000
18 09/02/19 NY. UMMI KAL AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 7,000 7,000
BHP 5,000 5,000
Spoit + Tempat 20,000 331,000 20,000
19 10/02/19 Ny. Irma FI Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
20 10/02/19 NY. MARTHA EI Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Urine Rutin 50,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 5,000 5,000
Spoit + Tempat 45,000 317,000 45,000
21 10/02/19 NY. FITRA WAH EI Darah Rutin 64,000
Darah Rutin 64,000
Elektrolit 265,000 265,000
GDS 33,000
L 4,000 4,000
BHP 6,000 6,000
Spoit + Tempat 25,000 461,000 25,000
22 10/02/19 NY. NURAINI EI Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Urine Rutin 50,000
Ureum 33,000
Kreatinin 33,000
L 8,000 8,000
BHP 5,000 5,000
Spoit + Tempat 45,000 319,000 45,000
23 10/02/91 NY. IRMA YUNIT FN Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
24 11/02/19 NY. MELI AB Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Golongan Dara 17,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat 30,000 319,000 30,000
25 11/02/19 HJ. MURNIATI RD Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 6,000 6,000
Spoit + Tempat 20,000 351,000 20,000
26 11/02/19 AN. FARADILA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
27 11/02/19 TN. ASLAN AK Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 35,000 451,000 35,000
28 12/02/19 NY. FITRAH EI Darah Rutin 64,000
SGOT 33,000
SGPT 33,000
Bilirubin Total 65,000 65,000
 Bilirubin Direk 50,000 50,000
HbSAg 90,000
L 8,000 8,000
BHP 6,000 6,000
Spoit + Tempat 20,000 369,000 20,000
29 12/02/19 TN. SUNUSI EI Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 273,000 10,000
30 16/02/19 An. JALILAH AK Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 20,000 183,000 20,000
31 16/02/19 AN. ZAHARA AK Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
Widal 28,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 20,000 334,000 20,000
32 16/02/19 TN. YUSUF SW Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
Golongan Dara 17,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 25,000 246,000 25,000
33 16/02/19 NY. RAKIBA EI Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Urine Rutin 50,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat 30,000 324,000 30,000
34 17/02/19 NY. YULIANI AB Darah Rutin 64,000
Darah Rutin 64,000
Elektrolit 265,000 265,000
Ureum 33,000
Kreatinin 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
 GDS 33,000
GDS 33,000
GDS 33,000
L 67,000 67,000
BHP 25,000 25,000
Spoit + Tempat 60,000 2,789,000 60,000
35 16/02/19 NY. HERAWATI EI Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
36 17/02/19 TN. ABDILLAH EI Darah Rutin 64,000
Widal 28,000
SGOT 33,000
SGPT 33,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 20,000 186,000 20,000
37 17/02/19 NY.RILA AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
38 16/02/19 NY. ADIBA AB Darah Rutin 64,000
SGOT 33,000
Golongan Dara 17,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGPT 33,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 254,000 10,000
39 19/02/19 TN.SYARIFUDDI RD Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 186,000 10,000
40 19/02/19 NY. RESI EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 6,000 6,000
Spoit + Tempat 30,000 260,000 30,000
41 22/02/19 an. QAEREN IR Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 20,000 305,000 20,000
RAWAT JALAN
1 26/01/19 NY. YAMASIA RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
2 26/01/19 TN. H. JAKKA RD GDS 33,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
3 26/01/19 TN. ISHAK LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
4 27/01/19 NY. DIA EI Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Albumin 65,000 65,000
L 6,000 6,000
BHP 3,000 3,000
Spoit + Tempat 15,000 307,000 15,000
5 27/01/19 TN. KARSI LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
6 27/01/19 TN. ZULKIFLI RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
7 28/01/19 TN. JUNAID LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
8 28/01/19 NY. ARMITASARI LL Golongan Dara 17,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 30,000 10,000
9 28/01/19 TN. DARWIS IM GDS 33,000
L 1,000 1,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
10 28/01/18 NY. HADIJA EI GDS 22,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 69,000 10,000
11 29/01/19 TN. SAIFUL LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
12 30/01/19 NY.HASNAWATI RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
13 30/01/19 NN. NADINE RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
14 30/01/19 AN. AFIFAH LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
15 30/01/19 NY. PARIDA AA Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
16 31/01/19 TN. UMAR LL Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
17 31/01/19 NY. HJ. ST. MURNI IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
18 31/01/19 TN. BONANG RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 200,000 10,000
19 31/01/19 AN. KAMILA IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
20 31/01/19 NY. NURHASNI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 106,000 10,000
21 31/01/19 AN. M . AKMAL LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
22 01/02/19 AN. MAULANA KR Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
23 01/02/19 TN. SAID LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
24 01/02/19 NY. HASNA IM GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
25 03/02/19 TN.MUH. ASKUR RD Kolesterol 36,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
26 04/02/19 NY. DEDE RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
27 04/02/19 TN. NURDIN EI GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
28 04/02/19 TN. ZULKIFLI EI Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
29 05/02/19 TN. TEO RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
30 05/02/19 TN. RONALD LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
31 05/02/19 NY. PAINAH RD Darah Rutin 64,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 111,000 10,000
32 05/02/19 TN. HAYATULLAH IR Darah Rutin 64,000
Widal 28,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 140,000 10,000
33 05/02/19 NY. HJ. EMAUSRI LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
34 05/02/19 AN. ALMIRA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
35 05/02/19 AN. NASLATU IR Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
36 06/02/19 TN. RIJAL LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
37 06/02/19 NN. EKA RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
38 06/02/19 TN. HASAN RD GDS 33,000
Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 140,000 10,000
39 06/02/19 NN. UMMI KALSU AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
40 06/02/19 NY.RASLINA SARI AB Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 95,000 10,000
41 06/02/19 NY.ST.HAJAR RD Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 169,000 10,000
42 07/02/19 NY.NUMI LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
43 07/02/19 TN.H.SUAIB LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
44 07/02/19 NY. ROSMINI RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
45 07/02/19 TN. FAUZI RD Kolesterol 36,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
46 07/02/19 NY. RISKA LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
47 08/02/19 NY. RATNA LL Kolesterol 36,000
GDS 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
48 08/02/19 NY.HJ. MILING RD Asam Urat 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
49 08/02/19 NY. SURYANI RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
50 08/02/19 NY. ST. NUR IM Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 168,000 10,000
51 08/02/19 TN.ASLAN RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
52 09/02/19 AN. GEISYA RD Darah Rutin 64,000
Widal 28,000
Cyto 64,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 170,000 10,000
53 09/02/19 NY. RATNAWATI LL GDS 22,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 20,000 70,000 20,000
54 09/02/19 TN. SULEMAN SW Ureum 33,000
Kreatinin 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 80,000 10,000
55 09/02/19 AN. NAMIRA RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
56 09/02/19 TN. JAYA KUSUMA LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
57 10/02/19 TN. TAMANG FZ Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
58 11/02/19 TN. THOMAS KR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
59 11/02/19 TN YUSUF RD Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
60 11/02/19 NY. FATIMA KR Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
61 11/02/19 NY. ROSMAWATI IR Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
63 11/02/19 NY. MASKURIATI KR Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
64 11/02/19 NY. HJ. SUHURIA LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
67 11/02/19 TN. ABD. RAHMA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
68 11/02/19 NY. EVI ERIANTI EI Darah Rutin 64,000
Kreatinin 33,000
 Ureum 33,000
Urine Rutin 50,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 196,000 10,000
69 11/02/19 TN. NURDIN EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
70 11/02/19 NY. ERNI LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
71 11/02/19 TN. ALMUNAWIR LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
72 11/02/19 TN. H. M. YUSUF LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
73 11/02/19 TN. JAYA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
74 12/02/19 AN. MUH. GAYYU KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
75 12/02/19 NY. WIDIASTUTI LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
76 12/02/19 NY. KASMAWATI LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
77 12/02/19 NY. BADARIAH SW Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 137,000 10,000
78 13/02/19 AN. JALILAH IR Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
79 13/02/19 NY. MAYANTI IM GDS 33,000
L 1,000 1,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
80 13/02/19 TN. BEDENG EI Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
L 5,000 5,000
BHP 1,000 1,000
Spoit + Tempat 10,000 179,000 10,000
81 13/02/19 AN. MUHAJIR LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
82 13/02/19 NY. MAISA EI GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
83 13/02/19 NY.SURIANI EI Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
84 14/02/19 TN. DADANG FZ Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
85 14/02/19 AN. BASTIAN LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
86 14/02/19 AN. ACO IGI LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
87 15/02/19 NY. NUNIK IR Kolesterol 36,000
GDS 22,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 137,000 10,000
88 15/02/19 TN. H. LANAWI RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
89 15/02/19 AN. RAFIL RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
90 15/02/19 TN. H. SAIDA RD Kolesterol 36,000
GDS 22,000
 Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
91 15/02/19 AN. ANITA EI Darah Rutin 64,000
Kreatinin 33,000
Ureum 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 145,000 10,000
92 15/02/19 TN. AJAY LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
93 15/02/19 NY. HERAWATI AK Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
94 15/02/19 NY. HJ. AERBIA RD Kolesterol 36,000
Darah Rutin 64,000
Widal 28,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 166,000 10,000
95 17/02/19 TN. H. ZAINUDDIN RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
96 17/02/19 TN.H.PATURUSI RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
97 18/02/19 TN. MULIADI RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
98 18/02/19 HJ. NARISA LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
99 19/02/19 TN.H. MUKHTAR IR Kolesterol 36,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
100 19/02/19 NY. A. MURNI IR Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
101 20/02/19 TN. ABD. RAHIM LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
102 20/02/19 NY. MAYANTI IM GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
103 20/02/19 NY. SAKABA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
104 21/02/19 TN. SULAIMAN IM GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
105 21/02/19 NY. HERAWATI RD Kolesterol 36,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
106 22/02/19 AN. MUH. TANZIL LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP -
Spoit + Tempat Darah 94,000 -
107 22/02/19 NY. RISKA EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
108 22/02/19 TN. WIRA LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
109 23/02/19 TN. ACO RAHMAT LL Kolesterol 36,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
110 25/02/19 AN. AISYAH RD Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
110 25/02/19 ANY. SARI INTANG EI Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 5,000 5,000
BHP 1,000 1,000
Spoit + Tempat 10,000 171,000 10,000
111 25/02/19 TN. NIMRUT EI Darah Rutin 64,000
Urine Rutin 50,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
 Kreatinin 33,000
Ureum 33,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 290,000 10,000
112 25/02/19 TN. MANSUR EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
113 25/02/19 NY. NUR SAJRA A AB Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000

TOTAL 24,189,000 24,189,000 555,000 3,706,000

-

Rincian Rawat Inap 13,236,000 13,236,000 -

Jasa Laboran 2,054,826 Rawat Jalan 10,953,000 10,953,000 -
Total Bruto 24,189,000 24,189,000 -

dr. Nur Rahmi, Sp. PK 2,054,826.00

Reagensia 8,361,300.00
Jasa Klinik 6,278,635.00
BHP 3,706,000.00
L 555,000
9,984,635.00
OVEMBER 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17
SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
L - - - NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
NR
NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
L NR
L NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
NR
NR
NR
NR
 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
NR
L NR
L NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
 K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
L - - - SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
 SR
25,000 65,000.00 35,750.00 29,250.00 11,700.00 11,700.00 5,850.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
L - - - NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
L - - - NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
20,000 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
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
 K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
 K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 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
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000 44,000.00 24,200.00 19,800.00 L 7,920.00 7,920.00 3,960.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
- - - - - NR
K NR
K NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
20,000 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
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
 K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
20,000 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
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
- - - - - NR
K NR
K NR
20,000 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
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR

8,361,300 11,415,700 6,278,635 5,137,065 - 2,054,826 2,054,826 1,027,413

-
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN NOVEMBER 2018 RUMAH SAKIT BER
KODE HARGA

TOTAL
NO TGL NAMA PASIEN URAIAN TARIF BAYAR
dr L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 01/03/19 AN. ARSYILA AK Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
2 02/03/19 NY. SURIANI AB Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
3 05/03/19 AN. LUTFI AK Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
IgG & IgM 270,000 270,000
L 7,000 7,000
BHP 5,000 5,000
Spoit + Tempat 25,000 463,000 25,000
4 26/02/19 NY. ANDI ARIS FN Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
5 10/03/19 NY. ARINI WL Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
SGOT 33,000
SGPT 33,000
Ureum 33,000
Kreatinin 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 307,000 15,000
6 15/03/19 TN. SYUKUR EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 30,000 260,000 30,000
7 04/03/19 TN. HARIANDO EI Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
SGOT 33,000
SGPT 33,000
Ureum 33,000
Kreatinin 33,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 15,000 278,000 15,000
8 04/03/19 NY. AYU PUSPIT AB Darah Rutin 64,000
Golongan Dara 17,000
 L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
9 04/03/19 NN. JUWITA AM Darah Rutin 64,000
Darah Rutin 64,000
L 2,000 2,000
BHP 4,000 4,000
Spoit + Tempat 20,000 154,000 20,000
10 05/03/19 NY. HJ. FARIDA AB Darah Rutin 64,000
CYTO 30,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 125,000 10,000
11 28/02/19 H. M.YUSUF EI Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
SGOT 33,000
SGPT 33,000
Ureum 33,000
Kreatinin 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 307,000 15,000
12 26/02/19 TN. KAHARUDD RD Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
13 26/02/19 NY. AYUMI AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
15 03/03/19 AN. RAFI AK Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
17 02/03/19 TN.A.MAKKAR RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 15,000 176,000 15,000
18 07/03/19 TN.H.MANDA EI Darah Rutin 64,000
Darah Rutin 64,000
Elektrolit 265,000 265,000
Elektrolit 265,000 265,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
 Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 22,000 22,000
BHP 15,000 15,000
Spoit + Tempat 65,000 1,024,000 65,000
19 08/03/19 HJ.JERNI EI Darah Rutin 64,000
Elektrolit 265,000 265,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 20,000 527,000 20,000
20 10/03/19 TN. RAHMAN EI Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
21 12/03/19 TN.IMAM SYAHR EI Darah Rutin 64,000
SGOT 33,000
SGPT 33,000
GDS 22,000
Widal 28,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 20,000 209,000 20,000
22 12/03/19 NY.INSANI RA AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
23 12/03/19 MUH. RANDI RD Darah Rutin 64,000
Urine Rutin 50,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 133,000 15,000
24 13/03/19 NY.FIA LESTARI AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
25 14/03/19 TN. MAHYUDDI EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Elektrolit 265,000 265,000
Widal 28,000
GDS 33,000
Kolesterol 36,000
GDS 33,000
Urine Rutin 50,000
L 8,000 8,000
 BHP 9,000 9,000
Spoit + Tempat 50,000 704,000 50,000
26 15/03/19 TN.EDO/PETRO EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 40,000 334,000 40,000
27 14/03/19 NY.HELMI WT Darah Rutin 64,000
Golongan Dara 17,000
CT 20,000
BT 20,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 137,000 10,000
28 16/03/19 NY.HARMAWAT WT Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
29 18/03/19 TN. AHMAD JU RD Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Widal 28,000
Widal 28,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 224,000 10,000
30 18/03/19 HJ. MASATI EI Darah Rutin 64,000

Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 107,000 10,000
31 19/03/19 AN. ZAHARA SW Darah Rutin 64,000
GDS 33,000
SPUTUM 40,000 40,000
Widal 28,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat 20,000 197,000 20,000
32 19/03/19 TN.ZINAL BASRI AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
33 20/03/19 NY. HERMAWAT AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
34 21/03/19 NY.HJ.FATIMA AA Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
 L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
35 21/03/19 NY. LESTI EI Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
36 22/03/19 NY.SURYANI AB Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 10,000 225,000 10,000
37 22/03/19 NY. NURJANNA AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
38 24/03/19 NY.HAJARIAH AB Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 9,000 9,000
BHP 2,000 2,000
Spoit + Tempat 10,000 325,000 10,000
RAWAT JALAN
1 26/02/19 NN. MUSDALIFAH IR Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
2 26/02/19 NY. HJ. BECCE FZ GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
3 26/02/19 TN. ERWIN LL Darah Rutin 64,000
Widal 28,000
DDR 80,000 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
4 26/02/19 TN. ADIL LL Darah Rutin 64,000
Widal 28,000
DDR 80,000 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
5 26/02/19 NY. HILDA AB Darah Rutin 64,000
Widal 28,000
DDR 80,000 80,000
Golongan Dara 17,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 204,000 10,000
6 27/02/19 NY. NUR ALIAH IR HbSAg 90,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 103,000 10,000
7 27/02/19 NY. HJ. HADARIA AA Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
8 27/02/19 AN. ZAHRA LL Darah Rutin 64,000
Widal 28,000
DDR 80,000 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
9 27/02/19 TN. M. ASHARI IR Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
10 28/02/19 TN. IDHAR LL Darah Rutin 64,000
Widal 28,000
DDR 80,000 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
11 01/03/19 TN. BECO LL GDS 33,000
L 1,000 1,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
12 01/03/19 NY. MUNAWARA EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
13 01/03/19 TN. LUKMAN RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
14 01/03/19 TN. M. IMAN RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
15 01/03/19 NN. WINDI RD Kolesterol 36,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
16 01/03/19 TN. ASAR LL Darah Rutin 64,000
Widal 28,000
DDR 80,000 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
17 2/3/2019 NY. SURYANI AM Kolesterol 36,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 73,000 10,000
18 02/03/19 TN. ZAKI AM IgG/IgM 150,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 197,000 15,000
19 02/03/19 NN. FAJRIAH LL Darah Rutin 64,000
L 1,000 1,000
B 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
20 02/03/19 TN. A. MAKKARU RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 175,000 15,000
21 02/03/19 NY. BUDIATI LEST IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
22 02/03/19 HJ. HANAWIA RD Kolesterol 36,000
Asam Urat 33,000
 L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
23 02/03/19 AN. AHMAD RASY IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
24 02/03/19 TN. RAHMAN IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
25 03/03/19 TN. SUGIHARTO LL Kolesterol 36,000
GDS 22,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 72,000 10,000
26 05/03/19 NY. SUARNI KR GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
27 05/03/19 NY. HJ. KIKI KR Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
28 05/03/19 AN. ANANDA PUT LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
29 06/03/19 NY. ROSMAWATI LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
30 06/03/19 TN. M. KAMIL RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
31 06/03/19 NY. JUMANA FZ GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
32 TN. ALADIN LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
33 07/03/19 NY. SUSAN RD Darah Rutin 64,000
 Plano Test 25,000 25,000
HbSAg 90,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 194,000 10,000
34 08/03/19 NY. SANAWIAH RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
35 08/03/19 TN. MUH. ANWAR RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
36 08/03/19 TN. DARUL ADNA EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
37 09/03/19 TN. H. HAFID LL Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 84,000 10,000
38 09/03/19 NY. HJ. ARBIA RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
39 09/03/19 NY. DESRIANA WL Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
40 10/03/19 TN. ARDIANSYAH RD Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 15,000 113,000 15,000
41 11/03/19 NY. HJ. SANATI LL Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
42 11/03/19 TN. EKO RD Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
43 11/03/19 NN. RINI AM Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 15,000 111,000 15,000
44 12/03/19 AN. MUH. SATRIA RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
 Spoit + Tempat 15,000 111,000 15,000
45 12/03/19 NY. HAMSIA RD Asam Urat 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
46 12/03/19 AN. MARDA LL Darah Rutin 64,000
Widal 28,000
DDR 65,000 65,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 15,000 176,000 15,000
47 13/03/19 NY. HJ. SANATI LL Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 169,000 10,000
48 13/03/19 TN. H. UDIN AM GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
49 13/03/19 AN. M. AL FAHRI AM Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
50 13/03/19 NY. NURJANNAH WL Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
51 13/03/19 NY. FATMAWATI WL Darah Rutin 64,000
Plano Test 25,000 25,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 103,000 10,000
52 14/03/19 NY. TADIKA TOBI LL Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
53 15/03/19 NY. RATIALANG NS GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
54 15/03/19 NY. FARA KARTIK EI Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
L 8,000 8,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 307,000 10,000
55 15/03/19 NY. HJ. MASATI EI Darah Rutin 64,000
Widal 28,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 140,000 10,000
56 16/03/19 TN. AMIRUDDIN RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
57 16/03/19 NY. SAPPEAMI LL Widal 28,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 75,000 10,000
58 16/03/19 NY.HJ.LULI KR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
59 16/03/19 AN. NADIA LL Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 192,000 15,000
60 16/03/19 NY. INDAH SARI LL Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 192,000 15,000
61 17/03/19 TN. ZAINAL KR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
63 17/03/19 TN. AERY YEZKEL KR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
64 17/03/19 TN. YUSUF KR Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
67 17/03/19 NY. NONI RD GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
68 18/03/19 NY. KAUSAR RD Darah Rutin 64,000
Widal 28,000
 GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 145,000 15,000
69 18/03/19 AN. AGPIRA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
70 18/03/19 NY. MARYAM RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
80 03/03/19 NY. RAHMIA FZ Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
81 18/03/19 TN. PASINRINGI SW Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
82 18/03/19 AN. RAHMAT LL Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 192,000 15,000
83 18/03/19 AN. AKIL FIRDAUS LL Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 192,000 15,000
84 18/03/19 TN. M. SAID FZ Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
85 19/03/19 HJ. JOHARA AA GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
86 19/03/19 AN. SALMAH IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
87 20/03/19 HJ. SURIANI RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
88 20/03/19 HJ. NURMA FZ Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
89 20/03/19 TN. ASLIN AMEL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
90 20/03/19 AN. ANFIS LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
91 20/03/19 NY. HERAWATY RD Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 114,000 10,000
92 21/03/19 NY. YUNIAHTY LL Darah Rutin 64,000
GDS 22,000
Urine Rutin 50,000
HbSAg 90,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 242,000 10,000
93 21/03/19 NY.HJ.NISMA LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
94 22/03/19 NY.HJ.MING RD Asam Urat 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
95 22/03/19 NY.HJ.YOTONG RD Kolesterol 36,000
Darah Rutin 64,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 148,000 10,000
96 22/03/19 NY. HJ. DARMAW IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
97 22/03/19 TN. M. SAHABUD EI Darah Rutin 64,000
Widal 28,000
SGOT 33,000
SGPT 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 174,000 10,000
98 22/03/19 NN. FARANIKA IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
99 23/3/209 TN. OKA SAPUTR FZ Darah Rutin 64,000
 Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
100 24/03/19 NY.HJ.HASNA RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
101 24/03/19 HJ.JAMALIA RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
102 25/03/19 TN.A.MAKKARUN LL Darah Rutin 64,000
CT 20,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 132,000 10,000
103 25/03/19 TN.KIKI LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
 TOTAL 18,112,000 18,112,000 376,000 3,815,000
-

Rincian Rawat Inap 7,921,000 7,921,000 -

Jasa Laboran 1,504,962 Rawat Jalan 10,191,000 10,191,000 -
Total Bruto 18,112,000 18,112,000 -

dr. Nur Rahmi, Sp. PK 1,504,962.00

Reagensia 5,560,100.00
Jasa Klinik 4,598,495.00
BHP 3,815,000.00
L 376,000
8,413,495.00
OVEMBER 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17
-
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
 SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
30,000 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
L - - - NR
L - - - NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
L - - - SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
L - - - SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
 K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
5,000 15,000.00 8,250.00 6,750.00 L 2,700.00 2,700.00 1,350.00 SR
5,000 15,000.00 8,250.00 6,750.00 L 2,700.00 2,700.00 1,350.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
L - - - NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
 NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
SR
SR
SR
SR
SR
SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
L - - - SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
L - - - SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
L - - - SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
25,000 65,000.00 35,750.00 29,250.00 11,700.00 11,700.00 5,850.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
L - - - NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
L - - - SR
SR
K SR
K SR
20,000 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
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
L - - - NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
 SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
 L - - - NR
25,000 65,000.00 35,750.00 29,250.00 11,700.00 11,700.00 5,850.00 NR
- - - - - NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
20,000 2,000.00 1,100.00 900.00 L 360.00 360.00 180.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
 K SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
L - - - SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 2,000.00 1,100.00 900.00 L 360.00 360.00 180.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 2,000.00 1,100.00 900.00 L 360.00 360.00 180.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
L - - - NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 2,000.00 1,100.00 900.00 L 360.00 360.00 180.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
 K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
 K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 2,000.00 1,100.00 900.00 L 360.00 360.00 180.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
25,000 65,000.00 35,750.00 29,250.00 11,700.00 11,700.00 5,850.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 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
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 15,000.00 8,250.00 6,750.00 L 2,700.00 2,700.00 1,350.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
SR
SR
SR
SR
SR
SR
SR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
SR
SR
SR
SR
SR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
5,560,100 8,360,900 4,598,495 3,762,405 - 1,504,962 1,504,962 752,481

-
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN NOVEMBER 2018 RUMAH SAKIT BER
KODE HARGA

TOTAL
NO TGL NAMA PASIEN URAIAN TARIF BAYAR
dr L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 29/03/19 NY. YUNIATI AB Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 95,000 10,000
2 29/03/19 NY. HALMIAH SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
Kolesterol 36,000
Ureum 33,000
Ureum 33,000
Kreatinin 33,000
Kreatinin 33,000
L 10,000 10,000
BHP 6,000 6,000
Spoit + Tempat 30,000 445,000 30,000
3 30/03/19 TN. H. HASANU SW Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
4 30/03/19 NY. RADIA AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 7,000 7,000
BHP 5,000 5,000
Spoit + Tempat 20,000 331,000 20,000
5 30/03/19 NY. MULIATI AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 7,000 7,000
BHP 5,000 5,000
Spoit + Tempat 20,000 331,000 20,000
6 31/03/19 NY. FARIDA AB Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
 GDS 22,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 25,000 436,000 25,000
7 08/04/19 TN. RAMLIADI SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 35,000 265,000 35,000
8 04/03/19 NY. AYU PUSPIT AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
9 04/03/19 NN. JUWITA AM Darah Rutin 64,000
Darah Rutin 64,000
L 2,000 2,000
BHP 4,000 4,000
Spoit + Tempat 20,000 154,000 20,000
10 05/03/19 NY. HJ. FARIDA AB Darah Rutin 64,000
CYTO 30,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 125,000 10,000
11 28/02/19 H. M.YUSUF EI Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
SGOT 33,000
SGPT 33,000
Ureum 33,000
Kreatinin 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 307,000 15,000
12 26/02/19 TN. KAHARUDD RD Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
13 26/02/19 NY. AYUMI AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
15 03/03/19 AN. RAFI AK Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
17 02/03/19 TN.A.MAKKAR RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 15,000 176,000 15,000
18 07/03/19 TN.H.MANDA EI Darah Rutin 64,000
Darah Rutin 64,000
Elektrolit 265,000 265,000
Elektrolit 265,000 265,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 22,000 22,000
BHP 15,000 15,000
Spoit + Tempat 65,000 1,024,000 65,000
19 08/03/19 HJ.JERNI EI Darah Rutin 64,000
Elektrolit 265,000 265,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 20,000 527,000 20,000
20 10/03/19 TN. RAHMAN EI Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
21 12/03/19 TN.IMAM SYAHR EI Darah Rutin 64,000
SGOT 33,000
SGPT 33,000
GDS 22,000
Widal 28,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 20,000 209,000 20,000
22 12/03/19 NY.INSANI RA AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
23 12/03/19 MUH. RANDI RD Darah Rutin 64,000
Urine Rutin 50,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 133,000 15,000
24 13/03/19 NY.FIA LESTARI AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
25 14/03/19 TN. MAHYUDDI EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Elektrolit 265,000 265,000
Widal 28,000
GDS 33,000
Kolesterol 36,000
GDS 33,000
Urine Rutin 50,000
L 8,000 8,000
BHP 9,000 9,000
Spoit + Tempat 50,000 704,000 50,000
26 15/03/19 TN.EDO/PETRO EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 40,000 334,000 40,000
27 14/03/19 NY.HELMI WT Darah Rutin 64,000
Golongan Dara 17,000
CT 20,000
BT 20,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 137,000 10,000
28 16/03/19 NY.HARMAWAT WT Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
29 18/03/19 TN. AHMAD JU RD Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Widal 28,000
Widal 28,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 224,000 10,000
30 18/03/19 HJ. MASATI EI Darah Rutin 64,000

Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 107,000 10,000
31 19/03/19 AN. ZAHARA SW Darah Rutin 64,000
GDS 33,000
SPUTUM 40,000 40,000
Widal 28,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat 20,000 197,000 20,000
32 19/03/19 TN.ZINAL BASRI AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
33 20/03/19 NY. HERMAWAT AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
34 21/03/19 NY.HJ.FATIMA AA Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
35 21/03/19 NY. LESTI EI Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
36 22/03/19 NY.SURYANI AB Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 10,000 225,000 10,000
37 22/03/19 NY. NURJANNA AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
38 24/03/19 NY.HAJARIAH AB Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 9,000 9,000
BHP 2,000 2,000
Spoit + Tempat 10,000 325,000 10,000
RAWAT JALAN
1 26/03/19 NY. KIKI LL Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
2 26/03/19 NY. HJ. JAMALIA KR GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
3 26/03/19 TN. BONGA KR Asam Urat 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
4 26/03/19 TN. MUH. RIJAL KR Darah Rutin 64,000
Widal 28,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 15,000 117,000 15,000
5 26/03/19 NY. HJ. MARHUM RD GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
6 27/03/19 NY. HJ. SIRUA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
7 27/03/19 TN. ILMAN UKAS IR Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
8 27/03/19 NY. WAGINEM IM GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
9 27/03/19 NY. ROSMIATI IR Darah Rutin 64,000
Widal 28,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 15,000 118,000 15,000
10 28/03/19 TN. H. HERMAN RD Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
11 28/03/19 NY. MUSYAWARA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
12 28/03/19 TN. ABD. KARIM LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
13 29/03/19 NY. SUHEMI AM Kolesterol 36,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
14 29/03/19 NY. HJ. HARISA IM GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
15 30/03/19 NY. HJ. JAMALIA RD GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
16 31/03/19 NY. NURWASITA RD Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 42,000 10,000
17 31/03/19 TN. SYAMSUL RD Darah Rutin 64,000
Widal 28,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 15,000 118,000 15,000
18 31/03/19 TN. HERMAN RD Darah Rutin 64,000
Widal 28,000
GDS 33,000
Malaria 80,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 15,000 224,000 15,000
19 01/04/19 NY. EVA KR Darah Rutin 64,000
Widal 28,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 15,000 118,000 15,000
20 02/03/19 TN. A. MAKKARU RD Kolesterol 36,000
Asam Urat 33,000
 GDS 22,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 175,000 15,000
21 02/03/19 NY. BUDIATI LEST IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
22 02/03/19 HJ. HANAWIA RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
23 02/03/19 AN. AHMAD RASY IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
24 02/03/19 TN. RAHMAN IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
25 03/03/19 TN. SUGIHARTO LL Kolesterol 36,000
GDS 22,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 72,000 10,000
26 05/03/19 NY. SUARNI KR GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
27 05/03/19 NY. HJ. KIKI KR Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
28 05/03/19 AN. ANANDA PUT LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
29 06/03/19 NY. ROSMAWATI LL GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
30 06/03/19 TN. M. KAMIL RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
31 06/03/19 NY. JUMANA FZ GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
32 TN. ALADIN LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
33 07/03/19 NY. SUSAN RD Darah Rutin 64,000
Plano Test 25,000 25,000
HbSAg 90,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 194,000 10,000
34 08/03/19 NY. SANAWIAH RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
35 08/03/19 TN. MUH. ANWAR RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
36 08/03/19 TN. DARUL ADNA EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
37 09/03/19 TN. H. HAFID LL Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 84,000 10,000
38 09/03/19 NY. HJ. ARBIA RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
39 09/03/19 NY. DESRIANA WL Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
40 10/03/19 TN. ARDIANSYAH RD Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 15,000 113,000 15,000
41 11/03/19 NY. HJ. SANATI LL Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
42 11/03/19 TN. EKO RD Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 77,000 10,000
43 11/03/19 NN. RINI AM Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 15,000 111,000 15,000
44 12/03/19 AN. MUH. SATRIA RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 15,000 111,000 15,000
45 12/03/19 NY. HAMSIA RD Asam Urat 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
46 12/03/19 AN. MARDA LL Darah Rutin 64,000
Widal 28,000
DDR 65,000 65,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 15,000 176,000 15,000
47 13/03/19 NY. HJ. SANATI LL Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 169,000 10,000
48 13/03/19 TN. H. UDIN AM GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
49 13/03/19 AN. M. AL FAHRI AM Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
50 13/03/19 NY. NURJANNAH WL Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
51 13/03/19 NY. FATMAWATI WL Darah Rutin 64,000
Plano Test 25,000 25,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 103,000 10,000
52 14/03/19 NY. TADIKA TOBI LL Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
53 15/03/19 NY. RATIALANG NS GDS 33,000
 L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
54 15/03/19 NY. FARA KARTIK EI Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 10,000 307,000 10,000
55 15/03/19 NY. HJ. MASATI EI Darah Rutin 64,000
Widal 28,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 140,000 10,000
56 16/03/19 TN. AMIRUDDIN RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
57 16/03/19 NY. SAPPEAMI LL Widal 28,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 75,000 10,000
58 16/03/19 NY.HJ.LULI KR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
59 16/03/19 AN. NADIA LL Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 192,000 15,000
60 16/03/19 NY. INDAH SARI LL Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 192,000 15,000
61 17/03/19 TN. ZAINAL KR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
63 17/03/19 TN. AERY YEZKEL KR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
64 17/03/19 TN. YUSUF KR Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
67 17/03/19 NY. NONI RD GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
68 18/03/19 NY. KAUSAR RD Darah Rutin 64,000
Widal 28,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 145,000 15,000
69 18/03/19 AN. AGPIRA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
70 18/03/19 NY. MARYAM RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
80 03/03/19 NY. RAHMIA FZ Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
81 18/03/19 TN. PASINRINGI SW Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
82 18/03/19 AN. RAHMAT LL Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 192,000 15,000
83 18/03/19 AN. AKIL FIRDAUS LL Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 192,000 15,000
84 18/03/19 TN. M. SAID FZ Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
85 19/03/19 HJ. JOHARA AA GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 46,000 10,000
86 19/03/19 AN. SALMAH IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
87 20/03/19 HJ. SURIANI RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
88 20/03/19 HJ. NURMA FZ Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
89 20/03/19 TN. ASLIN AMEL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
90 20/03/19 AN. ANFIS LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
91 20/03/19 NY. HERAWATY RD Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 114,000 10,000
92 21/03/19 NY. YUNIAHTY LL Darah Rutin 64,000
GDS 22,000
Urine Rutin 50,000
HbSAg 90,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 242,000 10,000
93 21/03/19 NY.HJ.NISMA LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
94 22/03/19 NY.HJ.MING RD Asam Urat 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
95 22/03/19 NY.HJ.YOTONG RD Kolesterol 36,000
Darah Rutin 64,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 148,000 10,000
96 22/03/19 NY. HJ. DARMAW IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
97 22/03/19 TN. M. SAHABUD EI Darah Rutin 64,000
Widal 28,000
SGOT 33,000
SGPT 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 174,000 10,000
98 22/03/19 NN. FARANIKA IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
99 23/3/209 TN. OKA SAPUTR FZ Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
100 24/03/19 NY.HJ.HASNA RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
101 24/03/19 HJ.JAMALIA RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
102 25/03/19 TN.A.MAKKARUN LL Darah Rutin 64,000
CT 20,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 132,000 10,000
103 25/03/19 TN.KIKI LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
 TOTAL 17,896,000 17,896,000 410,000 3,129,000
-

Rincian Rawat Inap 8,438,000 8,438,000 -

Jasa Laboran 1,560,888 Rawat Jalan 9,458,000 9,458,000 -
Total Bruto 17,896,000 17,896,000 -

dr. Nur Rahmi, Sp. PK 1,560,888.00

Reagensia 5,685,400.00
Jasa Klinik 4,769,380.00
BHP 3,129,000.00
L 410,000
7,898,380.00
OVEMBER 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17
-
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
30,000 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
L - - - NR
L - - - NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
L - - - SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
L - - - SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
5,000 15,000.00 8,250.00 6,750.00 L 2,700.00 2,700.00 1,350.00 SR
5,000 15,000.00 8,250.00 6,750.00 L 2,700.00 2,700.00 1,350.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
L - - - NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
NR
NR
NR
NR
NR
 NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
SR
SR
SR
SR
SR
SR

8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR

SR
K SR
K SR
20,000 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
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
20,000 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
20,000 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
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
 K SR
K SR
20,000 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
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
L - - - NR
25,000 65,000.00 35,750.00 29,250.00 11,700.00 11,700.00 5,850.00 NR
- - - - - NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
20,000 2,000.00 1,100.00 900.00 L 360.00 360.00 180.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
L - - - SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 2,000.00 1,100.00 900.00 L 360.00 360.00 180.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 2,000.00 1,100.00 900.00 L 360.00 360.00 180.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
L - - - NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 2,000.00 1,100.00 900.00 L 360.00 360.00 180.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 2,000.00 1,100.00 900.00 L 360.00 360.00 180.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
25,000 65,000.00 35,750.00 29,250.00 11,700.00 11,700.00 5,850.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 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
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 15,000.00 8,250.00 6,750.00 L 2,700.00 2,700.00 1,350.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
SR
SR
SR
SR
SR
SR
SR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
SR
SR
SR
SR
SR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
 NR
NR
NR
NR
NR
NR
NR
NR

5,685,400 8,671,600 4,769,380 3,902,220 - 1,560,888 1,560,888 780,444

-
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN NOVEMBER 2018 RUMAH SAKIT BERSA
KODE HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

dr BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 24/04/19 NY.HJ. AMINAH EI GDS 50,000 50,000
Kolesterol 50,000 50,000
Asam Urat 50,000 50,000
Ureum 50,000 50,000
Kreatinin 50,000 50,000
konsul 75,000 75,000
Plebo 15,000 15,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 341,000 -
2 24/04/19 TN. ABD. LATIF EI Darah Rutin 80,000 80,000
GDS 50,000 50,000
Kolesterol 50,000 50,000
Asam Urat 50,000 50,000
Ureum 50,000 50,000
Kreatinin 50,000 50,000
konsul 120,000 120,000
Plebo 15,000 15,000
SGOT 50,000 50,000
SGPT 50,000 50,000
L 10,000 10,000
BHP 6,000 6,000
transport 10,000
Spoit + Tempat 15,000 606,000
3 27/04/19 AN. ZAHRA AK Darah Rutin 80,000 80,000
Widal 50,000 50,000
konsul 30,000 30,000
L - -
BHP -
Spoit + Tempat 10,000 170,000 10,000
4 28/04/19 BY. ARFAN AK Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 9,000 9,000
BHP 5,000 5,000
Spoit + Tempat 25,000 195,000 25,000
5 29/04/19 NY. FITRTAH WAH AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
6 29/04/19 NY. MARDIANA AB Darah Rutin 80,000 80,000
Golongan Dara 35,000 35,000
GDS 50,000 50,000
Ureum 50,000 50,000
Kreatinin 50,000 50,000
 SGOT 50,000 50,000
SGPT 50,000 50,000
KONSUL 105,000 105,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 10,000 490,000 10,000
7 29/04/19 TN.H. SAULANG EI Darah Rutin 80,000 80,000
Darah Rutin 80,000 80,000
Darah Rutin 80,000 80,000
Elektrolit 265,000 265,000
GDS 50,000 50,000
Kolesterol 50,000 50,000
DDR 120,000 120,000
Widal 50,000 50,000
KONSUL 75,000 75,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 30,000 890,000 30,000
8 02/05/19 NN. ST. FATIMA I EI Darah Rutin 80,000 80,000
Darah Rutin 80,000 80,000
Darah Rutin 80,000 80,000
Darah Rutin 80,000 80,000
Darah Rutin 80,000 80,000
Darah Rutin 80,000 80,000
GDS 50,000 50,000
DDR 120,000 120,000
Widal 50,000 50,000
KONSUL 125,000 125,000
L 13,000 13,000
BHP 8,000 8,000
Spoit + Tempat 30,000 876,000 30,000
9 03/05/19 TN. ALFIZAR SW Darah Rutin 80,000 80,000
GDS 50,000 50,000
SGPT 50,000 50,000
KONSUL 45,000
L -
BHP -
Spoit + Tempat 10,000 235,000 10,000
10 04/05/19 AHMAD ARFATAN AK Darah Rutin 80,000 80,000
KONSUL 15,000
L -
BHP -
Spoit + Tempat 10,000 105,000 10,000
11 05/05/19 NN. FADILLA RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
12 07/05/19 NY. MELIANI AB Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
 Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 9,000 9,000
BHP 2,000 2,000
Spoit + Tempat 10,000 325,000 10,000
13 07/05/19 NN. NURUL ANGG SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 80,000 80,000
GDS 50,000 50,000
GDS 50,000 50,000
DDR 120,000 120,000
Widal 50,000 50,000
KONSUL 90,000 90,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 25,000 664,000 25,000
15 09/05/19 NY. SUGAIYYAH AB Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGPT 33,000
GDS 22,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 10,000 220,000 10,000
17 09/05/19 TN. RUSTAM SW Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
HBSAG 90,000
GDS 22,000
Darah Rutin 97,000 97,000
Darah Rutin 97,000 97,000
Darah Rutin 97,000 97,000
Elektrolit 265,000 265,000
HCV 120,000 120,000
KONSUL 83,000 83,000
SGOT 50,000 50,000
SGPT 50,000 50,000
BILTOT 50,000 50,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
 GDS 33,000
L 10,000 10,000
BHP 9,000 9,000
Spoit + Tempat 20,000 1,622,000 20,000
18 12/05/19 HJ. SINA SW Darah Rutin 97,000 97,000
Darah Rutin 97,000 97,000
Darah Rutin 97,000 97,000
Elektrolit 265,000 265,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Kreatinin 50,000 50,000
Kreatinin 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
L 22,000 22,000
BHP 18,000 18,000
Spoit + Tempat 65,000 1,233,000 65,000
19 12/05/19 NY. JUMRIA AB Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 6,000 6,000
BHP 3,000 3,000
Spoit + Tempat 10,000 254,000 10,000
20 14/05/19 TN. BASIRU EI Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
21 14/05/19 TN. JUSNA AB Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 6,000 6,000
BHP 3,000 3,000
Spoit + Tempat 10,000 254,000 10,000
22 14/05/19 TN. TAMSIL AB Darah Rutin 64,000
 GDS 33,000
SGOT 33,000
SGPT 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 179,000 10,000
23 16/05/19 TN. RAHMAT R EI Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 116,000 15,000
24 20/05/19 NY. IIE ST SARINA EI Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 20,000 273,000 20,000
25 21/05/19 NY. A. WIRA EI Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 15,000 185,000 15,000
26 21/05/19 NY. HERWANA EI Darah Rutin 64,000
GDS 22,000
Widal 28,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 10,000 134,000 10,000
27 22/05/19 TN. H. SAULUNG EI Darah Rutin 64,000
Golongan Dara 17,000
CT 20,000
BT 20,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 10,000 139,000 10,000
28 22/05/19 NN. NURHIDAYAH EI Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
29 22/05/19 NY. SRI WULAN AB Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
L 9,000 9,000
 BHP 6,000 6,000
Spoit + Tempat 20,000 270,000 20,000
30 25/05/19 ny. Samsuarman EI Darah Rutin 64,000
GDS 22,000
Elektrolit 265,000 265,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 19,000 375,000 19,000

RAWAT JALAN
1 26/04/19 TN. NURDIN SW Kolesterol 36,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
2 26/04/19 TN. ISHAK RD Kolesterol 36,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 49,000 10,000
3 29/04/19 TN. ADMAN IR GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
4 30/04/19 AN. ERIK AF Darah Rutin 64,000
Widal 28,000
IgG/IgM 150,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 257,000 10,000
5 29/04/19 TN. ARDI LL GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 5,000 41,000 5,000
6 05/01/19 NY. HASNI EI Darah Rutin 64,000
GDS 22,000
L -
BHP 1,000 1,000
Spoit + Tempat 10,000 97,000 10,000
7 05/03/19 TN. H. PARAKASSI AM Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
8 05/03/19 HJ. SURYANI LL Darah Rutin 64,000
Widal 28,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 15,000 118,000 15,000
9 05/03/19 TN. BARMAN LL Darah Rutin 64,000
Malaria 80,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 5,000 152,000 5,000
10 06/05/19 TN. ABD. AMIN RD Darah Rutin 64,000
Widal 28,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 15,000 118,000 15,000
11 06/05/19 TN. ZULKARNAIN IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
12 08/05/19 AN. ST. MUTMAINN KR Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 15,000 116,000 15,000
13 08/05/19 AN. ZULFATRAH LL Widal 28,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 41,000 10,000
14 08/05/19 NY. MOLING IM Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
15 08/05/19 NY. JUMRIANI WT Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
16 08/05/19 NY. ST. AMINA RD Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
17 09/05/19 TN. ANDASA RD Darah Rutin 64,000
Kolesterol 36,000
Kolesterol 36,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat 15,000 163,000 15,000
18 10/05/19 NY. SUTYANI RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
19 10/05/19 NY. NATALIA RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
20 10/05/19 NY. ASLI DAUD LL GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 35,000 10,000
21 10/05/19 NY. SERLINA AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
22 10/05/19 TN. RAUF IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
23 10/05/19 TN. LOLONG AM Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
24 11/05/19 NY. EKA EI Darah Rutin 64,000
HbSAg 90,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 168,000 10,000
25 11/05/19 TN.H.IRSAN IR GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
26 11/05/19 NY. MARDA IR GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
27 13/05/19 NY. RUSMIATI IR Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
28 13/05/19 TN. BAHARUDDIN IR Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
29 13/05/19 NY. HJ. AMBONG EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
30 14/05/19 TN. PAULUS RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
31 14/05/19 TN. ARIFIN IR GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
32 15/05/19 TN.H.ABD. KADIR RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
33 15/05/19 NY. YULIANTI RD Darah Rutin 64,000
HbSAg 100,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 178,000 10,000
34 15/05/19 NY. NURBIA RD Darah Rutin 64,000
HbSAg 100,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 178,000 10,000
35 15/05/19 NY. FHAFIDA RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
36 16/05/19 TN. HAMZAH LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 15,000 198,000 15,000
37 16/05/19 TN. RIJAN RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 15,000 82,000 15,000
38 16/05/19 TN. FREDI LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
39 17/05/19 AN. MUH. ALI RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
40 17/05/19 TN. RUSDI EI Darah Rutin 64,000
Kolesterol 36,000
TG 50,000 50,000
LDL 100,000 100,000
HDL 75,000 75,000
KREAtinin 50,000 50,000
L 6,000 6,000
Lain - Lain 10,000
BHP 7,000 7,000
Spoit + Tempat 25,000 423,000 25,000
41 17/05/19 TN. SANDI LL Darah Rutin 64,000
Malaria 80,000
Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 187,000 10,000
42 20/05/19 AN. HIDAYAH IR Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 106,000 10,000
43 20/05/19 NY. HJ. FARIDA AM Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
44 20/05/19 NY. NAIFA EI GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 46,000 10,000
45 20/05/19 TN. SAFRUDDIN RD Darah Rutin 64,000
Malaria 80,000
DDR 45,000
L 4,000 4,000
BHP 1,000 1,000
Spoit + Tempat 10,000 204,000 10,000
46 21/05/19 NY. ASLIA RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
47 21/05/19 AN. SINTA RD Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 6,000 6,000
Spoit + Tempat 15,000 118,000 15,000
48 21/05/19 TN.M. SAMSUARMA SW GDS 22,000
Darah Rutin 64,000
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 100,000 10,000
49 21/05/19 NY. HJ. NARISA IR Kolesterol 36,000
GDS 33,000
Kreatinin 33,000
L 20,000 20,000
BHP 6,000 6,000
Spoit + Tempat 20,000 148,000 20,000
50 21/05/19 NY. IRMA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 192,000 15,000
51 22/05/19 TN. AHMAD JUNAED IR Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
52 22/05/19 NY. HIDAYAH LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
53 22/05/19 AN. NURAQIFA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
54 23/05/19 Tn. ABDILLAH RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
55 23/05/19 NY. MULIATI RD Darah Rutin 64,000
Widal 28,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 15,000 205,000 15,000
56 24/05/19 TN. ABD. RASYID RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 20,000 118,000 20,000
57 24/05/19 NY. HARMAWATI RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 20,000 118,000 20,000
 58 23/05/19 NY. HARMAWATI RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 20,000 118,000 20,000
59 24/05/19 NY. ASMIATI RD Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Urine Rutin 50,000
Asam Urat 33,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 10,000 316,000 10,000
60 25/05/19 HJ. DALLE RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
61 25/05/19 TN. ISMAIL IR Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 20,000 118,000 20,000

TOTAL 17,619,000 17,619,000 317,000 7,214,000

-

Rincian Rawat Inap 10,574,000 10,574,000 -

Jasa Laboran 1,042,092 Rawat Jalan 7,045,000 7,045,000 -
Total Bruto 17,619,000 17,619,000 -

dr. Nur Rahmi, Sp. PK 1,042,092.00

Reagensia 4,027,600.00
Jasa Klinik 3,184,170.00
BHP 7,214,000.00
L 317,000
10,398,170.00
VEMBER 2018 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17
-
SR
SR
SR
SR
SR
SR
SR
- - - - - SR
K SR
K SR
SR
SR
SR
SR
SR
SR
SR
SR
L - - - SR
L - - - SR
- - - - - SR
K SR
SR
K SR
L - - - NR
L - - - NR
L - - - NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
- - L - - - NR
- - L - - - NR
- - L - - - NR
- - L - - - NR
- - L - - - NR
 - - L - - - NR
- - L - - - NR
NR
NR
K NR
K NR
- - L - - - NR
NR
NR
NR
- - L - - - NR
- - L - - - NR
- - L - - - NR
NR
NR
NR
K NR
K NR
- - L - - - SR
SR
SR
SR
SR
- - L SR
- - L SR
- - L SR
SR
SR
SR
K - - - SR
K SR
- - L - - - NR
- - L - - - NR
- - L - - - NR
NR
- - - - - NR
K NR
K NR
- - L - - - SR
SR
- - - - - SR
K SR
K SR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
NR
NR
NR
NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 80,500.00 44,275.00 36,225.00 L 14,490.00 14,490.00 7,245.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
NR
K NR
K NR
NR
NR
NR
NR
NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 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
- - L - - - SR
- - L - - - SR
SR
L - - - SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - L - - - SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
5,000 15,000.00 8,250.00 6,750.00 L 2,700.00 2,700.00 1,350.00 NR
5,000 15,000.00 8,250.00 6,750.00 L 2,700.00 2,700.00 1,350.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
 K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
NR
K NR
K NR

10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR

5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,000 65,000.00 35,750.00 29,250.00 11,700.00 11,700.00 5,850.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,000 75,000.00 41,250.00 33,750.00 13,500.00 13,500.00 6,750.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
25,000 75,000.00 41,250.00 33,750.00 13,500.00 13,500.00 6,750.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
20,000 2,000.00 1,100.00 900.00 L 360.00 360.00 180.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
SR
SR
SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
3,500 41,500.00 22,825.00 18,675.00 L 7,470.00 7,470.00 3,735.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
20,000 2,000.00 1,100.00 900.00 L 360.00 360.00 180.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
 K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR

4,027,600 5,789,400 3,184,170 2,605,230 - 1,042,092 1,042,092 521,046

-
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN JUNI 2019 RUMAH SAKIT BERSAL
KODE HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

dr BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 24/05/19 ny. Hasmiati AB Darah Rutin 64,000
Darah Rutin 64,000
Asam Urat 33,000
Golongan Dara 17,000
GDS 22,000
Kolesterol 36,000
Ureum 33,000
Ureum 33,000
Kreatinin 33,000
Kreatinin 33,000
L 10,000 10,000
BHP 28,000 28,000
Spoit + Tempat 25,000 431,000 25,000
2 25/06/19 NY.HJ. A. MURTIN SW Darah Rutin 64,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
Elektrolit 265,000 265,000
Ureum 33,000
Elektrolit 265,000 265,000
Kreatinin 33,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 811,000 10,000
3 27/05/19 TN. CAMPAWALI EI Darah Rutin 64,000
SGPT 33,000
Darah Rutin 64,000
Widal 28,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
L 5,000 5,000
SGPT 33,000
BHP 8,000 8,000
Spoit + Tempat 15,000 333,000 15,000
4 27/05/19 TN. RISMAN EI Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
5 25/05/19 NY.HH.RATNA AB Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
 SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Golongan Dara 17,000
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat 20,000 402,000 20,000
6 28/05/19 HJ. ST. NURUNG AA Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
DDR 120,000 120,000
Widal 28,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 15,000 15,000
BHP 27,000 27,000
Spoit + Tempat 20,000 623,000 20,000
7 26/05/19 TN.ALFIZAR SW Darah Rutin 64,000
Darah Rutin 64,000
Kreatinin 33,000
Elektrolit 265,000 265,000
GDS 22,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 20,000 476,000 20,000
8 27/05/19 TN.H.AGUS EI Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
GDS 22,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 20,000 206,000 20,000
9 26/05/19 NY.SARA AB Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 9,000 9,000
BHP 4,000 4,000
Spoit + Tempat 20,000 384,000 20,000
10 30/05/19 AN. FATIMAH AK Darah Rutin 64,000
Darah Rutin 64,000
L 2,000 2,000
BHP 4,000 4,000
 Spoit + Tempat 20,000 154,000 20,000
11 02/03/19 AN. MUH. ARAB S AK GDS 22,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 100,000 10,000
12 04/06/19 NY. SRI HANATI IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
13 02/06/19 NY. JUNIANTI SW Darah Rutin 64,000
Kreatinin 33,000
GDS 33,000
Urine Rutin 50,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 20,000 208,000 20,000
15 02/06/19 TN. MUH.ASLAM SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
L 9,000 9,000
BHP 10,000 10,000
Spoit + Tempat 60,000 613,000 60,000
17 05/06/19 NY. HJ. MIRA EI Darah Rutin 64,000
Urine Rutin 50,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Widal 28,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 15,000 256,000 15,000
18 05/06/19 AN.ISMAIL SW Darah Rutin 87,000 87,000
Ureum 33,000
Kreatinin 50,000 50,000
ADT 125,000 125,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 310,000 10,000
19 08/06/19 AN. NAFLA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
20 09/06/19 TN. ANSAR EI Darah Rutin 64,000
Widal 28,000
IgG/IgM 150,000
L 3,000 3,000
 BHP 9,000 9,000
Spoit + Tempat 20,000 274,000 20,000
21 09/06/19 AN. ADIBA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
22 09/06/19 NY. IRMA AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 15,000 82,000 15,000
23 11/06/19 NY. MASTURA AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
24 11/06/19 TN. FACHRI SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
GDS 33,000
Golongan Dara 17,000
L 8,000 8,000
BHP 10,000 10,000
Spoit + Tempat 60,000 540,000 60,000
25 11/06/19 TN. FENDI IB Darah Rutin 64,000
GDS 22,000
Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 129,000 10,000
26 11/06/19 NY. NURBAYA EI Darah Rutin 80,000 80,000
GDS 33,000
L -
BHP -
Spoit + Tempat 8,000 121,000 8,000
27 11/06/19 NY.HJ. NUREDI EI Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kolesterol 36,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 215,000 10,000
28 06/10/19 tn. Firman hidaya ei Darah Rutin 95,000 95,000
Darah Rutin 80,000 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 20,000 200,000 20,000
29 06/10/19 TN. BASSAL EI Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
 SGPT 33,000
Asam Urat 33,000
GDS 33,000
GDS 33,000
Urine Rutin 50,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat 20,000 344,000 20,000
30 09/06/19 NY.HJ. MARITA AA Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
31 09/06/19 TN. MAHESA SW Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
32 13/06/19 NY. FITRIANI AB Darah Rutin 64,000
Darah Rutin 80,000 80,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 20,000 172,000 20,000
33 13/06/19 AN. SIGIT AK LED 50,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 128,000 10,000
34 14/06/19 AN. ADRYL AK Darah Rutin 80,000 80,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
LED 50,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 30,000 359,000 30,000
35 15/06/19 NY. RUSNI SW Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 114,000 10,000
36 14/06/19 NY. HERAWATI FN Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 4,000 4,000
Spoit + Tempat 10,000 97,000 10,000
37 15/06/19 NY.HJ.HAFSA SW Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 6,000 6,000
 Spoit + Tempat 20,000 187,000 20,000
38 17/06/19 NY. NURHAYATI AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 4,000 4,000
Spoit + Tempat 10,000 97,000 10,000
39 18/06/19 NY.WAHDIA SW GDS 22,000
Kolesterol 36,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 95,000 95,000
L 7,000 7,000
BHP 6,000 6,000
Spoit + Tempat 10,000 368,000 10,000
40 19/06/19 SUCI AK Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
41 19/06/19 A. TENRI EI Kolesterol 36,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Asam Urat 33,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 20,000 483,000 20,000
42 20/06/19 Maryam SW Darah Rutin 64,000
Kolesterol 36,000
Kolesterol 36,000
GDS 33,000
L 16,000 16,000
BHP 8,000 8,000
Spoit + Tempat 20,000 213,000 20,000
43 20/06/19 NY. ZAENAB EI Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 4,000 4,000
Spoit + Tempat 10,000 113,000 10,000
44 20/06/19 an. AQILA AK Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 4,000 4,000
Spoit + Tempat 10,000 113,000 10,000
45 20/06/19 TN. MUNAJIB EI Darah Rutin 64,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 20,000 95,000 20,000
46 20/06/19 AN. ZAHRA AK Darah Rutin 64,000
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
47 21/06/19 An.RESKI NURUL AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
48 21/06/19 NY. SITTI HAJAR EI Darah Rutin 64,000
IgG/IgM 150,000
Kolesterol 36,000
Darah Rutin 85,000 85,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 350,000 10,000
49 21/06/19 NY. FITRIANI AB Darah Rutin 64,000
L 1,000 1,000
BHP 6,000 6,000
Spoit + Tempat 10,000 81,000 10,000
50 21/06/19 An. suCI AK Darah Rutin 64,000
L 1,000 1,000
BHP 6,000 6,000
Spoit + Tempat 10,000 81,000 10,000
51 21/06/19 NY. AISYAH SW GDS 33,000
GDS 33,000
GDS 33,000
Darah Rutin 64,000
Widal 28,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat 35,000 241,000 35,000
52 22/06/19 Bapak ANCA EI GDS 33,000
Darah Rutin 64,000
Elektrolit 265,000 265,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 375,000 10,000
53 22/06/19 HASRIANI EI Kolesterol 36,000
GDS 22,000
Darah Rutin 64,000
Widal 28,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat 10,000 175,000 10,000
54 25/06/19 Ny. Nur afifa ab Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
L 10,000 10,000
BHP 5,000 5,000
Spoit + Tempat 20,000 180,000 20,000
55 25/06/19 NY. NURSAMASA EI Urine Rutin 50,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
 GDS 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 20,000 242,000 20,000

RAWAT JALAN
1 27/5/2019 NY.HJ. BARDIA RD Kolesterol 36,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
2 27/5/2019 NY.HJ.ST. FATIMAH LL GDS 22,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 35,000 10,000
3 27/5/2019 AN. NURUL RD Darah Rutin 64,000
Widal 28,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 15,000 118,000 15,000
4 27/5/2019 TN. MUNAWIR AM Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
5 27/5/2019 NY.HJ.FATIMAH AM Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
6 27/5/2019 NY. ULFI AM Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
7 28/5/2019 NY.JAMALIA AF Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
8 Spoit + Tempat 10,000 171,000 10,000
9 28/5/2019 NY.HJ.AMBONG EI Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
L 6,000 6,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 300,000 10,000
10 28/5/2019 NY.OTAVINA RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
11 29/5/2019 NY. KAUSAR AF Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 20,000 262,000 20,000
12 29/5/2019 NY. NURIA HUSEIN AF Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
13 29/5/2019 TN.ARIFIN LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
14 29/5/2019 TN. YAISN LL Urine Rutin 50,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 64,000 10,000
15 29/5/2019 TN. EDY EDOGAWA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
16 29/5/2019 NY. DAMIRA EI Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
17 30/5/2019 NY. IDA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
18 30/5/2019 TN.M.FADLI EI Kolesterol 36,000
GDS 33,000
Kreatinin 33,000
L 12,000 12,000
BHP 6,000 6,000
Spoit + Tempat 20,000 140,000 20,000
19 30/5/2019 TN. MULIATI EI GDS 22,000
 L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 35,000 10,000
20 01/06/19 TN. YUSUF EI Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Widal 28,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 20,000 214,000 20,000
21 01/06/19 NY. SUHARTINI AB Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
22 06/01/19 TN. EDY LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
23 01/06/19 NY. NURAINI KR GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
24 03/06/19 AN. A. NURADIFA EI Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
25 03/06/19 TN. NUR RAHMAT RD Darah Rutin 64,000
Widal 28,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 15,000 118,000 15,000
26 03/06/19 AN. AISYAH KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
27 04/06/19 NY. ST. HARA IR Kolesterol 36,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
28 04/06/19 TN. LOLANG EI Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
29 13/05/19 TN. HERIANTO EI Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
30 04/06/19 TN. NIZAM IR Darah Rutin 64,000
Widal 28,000
 L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
31 06/06/19 AN. AGNIA AL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
32 06/06/19 TN. AKHIRUDDIN LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
33 06/06/19 TN. AMRI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
34 06/06/19 NY. SAKINAH RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
35 07/06/19 TN IHWAL IR GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
36 07/06/19 NY. ANDRIANI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
37 07/06/19 TN.M.AKBAR IR Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
38 07/06/19 NY. SARIFAH IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
39 07/06/19 SARIFUDDIN IR Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
40 07/06/19 NY. HERMIYANTI LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
41 10/06/19 NY.HJ. MARDUWIA RD Kolesterol 36,000
GDS 22,000
 L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
42 10/06/19 AN. M. ZAFRAN SK Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 20,000 118,000 20,000
43 10/06/19 TN. IRFAN RAIF SK Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
44 10/06/19 NY. SARIPA SK Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 84,000 10,000
45 10/06/19 NY. EKA SK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
46 10/06/19 NY. BERNADEL RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 20,000 118,000 20,000
47 10/06/19 HJ. PUANG NGINRI SK Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
48 10/06/19 TN. DAHMAR SW Darah Rutin 64,000
Kolesterol 36,000
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat 20,000 134,000 20,000
49 10/06/19 TN. HUSAINI IB Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 151,000 10,000
50 10/06/19 NY. HJ. HALIJA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
51 11/06/19 TN. ARFANDI IR Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
52 11/06/19 NY. HASMAWATI AF Kolesterol 36,000
 GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
53 11/06/19 NY.HJ.A. MURTINI SW Urine Rutin 50,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 63,000 10,000
54 11/06/19 TN.KALVIN SW Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
55 12/06/19 NY.HJ.HASMAWATI LL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
56 12/06/19 TN.H.HERMAN RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
57 12/06/19 NY. SARTIKA RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
58 12/06/19 NN. NAIMA LL Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
59 12/06/19 NY. SRI. MULIANI RD Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Urine Rutin 50,000
Asam Urat 33,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 10,000 316,000 10,000
60 13/06/19 HJ. RAHMANIA RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
61 13/06/19 NY. FARIDA LL Darah Rutin 64,000
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
62 14/06/19 TN.H. MUHAIMIN RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
63 14/06/19 NY.HJ.SUMIATI IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
64 14/06/19 AN. ALNI FEBRIANTI LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 20,000 118,000 20,000
65 15/06/19 AN. MELINDA SYAHR RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 20,000 118,000 20,000
66 15/06/19 TN. BUYUNG RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
67 15/06/19 NY. NURSAMASA KR Golongan Dara 17,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 15,000 224,000 15,000
68 15/06/19 HJ. MADINA LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
69 17/06/19 TN. TAKDIR KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
70 17/06/19 TN.ALFIAN RD Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
71 17/06/19 AN. BILLY RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
72 17/06/19 AN. AHMAD RD Widal 28,000
 L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 42,000 10,000
73 17/06/19 TN. ABRAR LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 20,000 118,000 20,000
74 17/06/19 NY. RAHMAWATI RD Kolesterol 36,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
75 17/06/19 TN. HASLAM RD Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 20,000 118,000 20,000
76 17/06/19 NY. NAJAMIA AB Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Urine Rutin 50,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 15,000 288,000 15,000
77 17/06/19 NY. ALWIAH IM GDS 22,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 35,000 10,000
78 17/06/19 ABD. KADIR EI Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 20,000 118,000 20,000
79 17/06/19 NY. MAISA EI Darah Rutin 64,000
GDS 33,000
L 10,000 10,000
BHP 7,000 7,000
Spoit + Tempat 20,000 134,000 20,000
80 17/06/19 HJ. SANA RD Kolesterol 36,000
Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 143,000 10,000
81 17/06/19 NY. MUSDALIFA LL Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 20,000 118,000 20,000
82 17/06/19 NY. MARAITANG RD Ureum 33,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 103,000 10,000
83 18/06/19 AN. M. DERMAWAN RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
84 18/06/19 TN. ALADIN RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
85 18/6/2019 TN. WANDI RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
86 18/6/2019 NY.HJ. NANI RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
87 18/6/2019 TN. RUDI RD Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 15,000 58,000 15,000
88 18/6/2019 NY. NURLELA RD GDS 22,000
L 1,000 1,000
BHP -
Spoit + Tempat 10,000 33,000 10,000
89 19/6/2019 NY.HJ.SADALI RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
90 19/6/2019 NY. SUMIATI AM GDS 33,000
GDS 33,000
L 2,000 2,000
BHP 4,000 4,000
Spoit + Tempat 20,000 92,000 20,000
91 19/6/2019 AN ALIKA AK IgG/IgM 150,000
Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 6,000 6,000
Spoit + Tempat 15,000 267,000 15,000
92 19/6/2019 TN. BUDI IM
93 19/6/2019 TN. AHMAD AMI AK IgG/IgM 150,000
Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 6,000 6,000
Spoit + Tempat 15,000 267,000 15,000
94 19/6/2019 NY. MARWAH RD Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
95 19/6/2019 TN. ANIS RD Darah Rutin 64,000
Kreatinin 33,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 205,000 10,000
96 19/6/2019 TN. ARIS SW Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 20,000 181,000 20,000
97 19/6/2019 TN. TOLAYU EI Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 15,000 176,000 15,000
98 20/6/2019 NY. ST. HASAM SW Darah Rutin 64,000
Widal 28,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 15,000 205,000 15,000
99 21/6/2019 NY. BERNAND EI Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
100 21/6/2019 HJ.RESNI SW Darah Rutin 64,000
Kolesterol 36,000
GDS 33,000
 L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 147,000 10,000
101 21/6/2019 TN.A.UNTA IR GDS 22,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 69,000 10,000
102 21/6/2019 TN. SIMON IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
103 22/06/19 NY.HJ.A. TENRI RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
104 21/06/19 NY. HANA RD Urine Rutin 50,000
Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 128,000 10,000
105 21/06/19 TN. UDIN IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
106 22/06/19 NY. MURBAYANI RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
107 22/06/19 TN. SAIFUL SW Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
108 22/06/19 TN. DELGIA EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
109 22/06/19 NY. INDAH ASTUTI EI Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 15,000 115,000 15,000
110 24/06/19 TN. ALIMUDDIN AM Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
111 24/06/19 NY. NURLINA AM Kolesterol 36,000
 GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
112 24/06/19 NY. HJ. HABA EI Kolesterol 36,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
113 24/06/19 AN. NAURAH RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
114 24/06/19 NY. MONIKA FZ Darah Rutin 64,000
Widal 28,000
L 10,000 10,000
BHP 5,000 5,000
Spoit + Tempat 20,000 127,000 20,000
115 24/06/19 AN. SABBE FZ Darah Rutin 64,000
Widal 28,000
L 20,000 20,000
BHP 48,000 48,000
Spoit + Tempat 20,000 180,000 20,000
116 25/06/19 NY. IRAWATI IR Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 15,000 176,000 15,000
117 25/06/19 MY. AMIRA IR Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
118 25/06/19 TN. IRWAN LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
119 25/06/19 TN. TAUFIK IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000

TOTAL 24,972,000 24,972,000 398,000 3,882,000

-
 Rincian Rawat Inap 12,170,000 12,170,000 -
Jasa Laboran 2,094,840 Rawat Jalan 12,535,000 12,535,000 -
Total Bruto 24,705,000 24,705,000 -

dr. Nur Rahmi, Sp. PK 2,094,840.00

Reagensia 7,815,000.00
Jasa Klinik 6,400,900.00
BHP 3,882,000.00
L 398,000
10,282,900.00
N JUNI 2019 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17
-
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
- - NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
- - L - - - NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - L - - - NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
 K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
- - L - - - SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
- - L - - - SR
SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
- - - - - NR
 K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
- - L - - - NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
- - L - - - SR
- - L - - - SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - L - - - NR
NR
K NR
K NR
20,000 30,000.00 16,500.00 13,500.00 L 5,400.00 5,400.00 2,700.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
- - L - - - NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 30,000.00 16,500.00 13,500.00 L 5,400.00 5,400.00 2,700.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
 K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - L - - - SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
 SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
- - L - - - NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
20,000 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

10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR

5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
 K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
13,500 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
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
 SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
20,000 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
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
 SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
 SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
 NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
 - - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
 K
K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00

K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
- - - - -
K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
- - - - -
K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K

7,815,000 11,638,000 6,400,900 5,237,100 - 2,094,840 2,094,840 1,047,420

-
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN JUNI 2019 RUMAH SAKIT BE
KODE HARGA

TOTAL
NO TGL NAMA PASIEN URAIAN TARIF BAYAR
dr L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 23/06/19 NN. A. RISKA EI Widal 28,000
Golongan Dara 17,000
L 24,000 24,000
BHP 2,000 2,000
Spoit + Tempat 10,000 81,000 10,000
2 25/06/19 NY. ASTRID AB Darah Rutin 64,000
Golongan Dara 17,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 15,000 99,000 15,000
3 27/06/19 AN. HAFIDSA AK Darah Rutin 95,000 95,000
Elektrolit 265,000 265,000
ADT 125,000 125,000
Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
Darah Rutin 64,000
Golongan Dara 17,000
Urine Rutin 50,000
L 15,000 15,000
BHP 11,000 11,000
Spoit + Tempat 35,000 838,000 35,000
4 28/06/19 NN. WIDYANINGS SW Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
Widal 28,000
L -
BHP -
Spoit + Tempat 5,000 183,000 5,000
5 28/06/19 NY. NURHAYATI SW Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
GDS 33,000
Elektrolit 265,000 265,000
L 6,000 6,000
BHP 3,000 3,000
Spoit + Tempat 15,000 483,000 15,000
6 28/06/19 AN. REFLIANDI IB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
7 29/06/19 NY. WKA ZULASM AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
8 30/06/19 NY. HJ. BADRIAH SW Darah Rutin 64,000
Kreatinin 33,000
GDS 33,000
 Elektrolit 265,000 265,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 412,000 10,000
9 01/07/19 NY. NURFADILLAH AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
10 01/07/19 NY. FATMUSARI SW Darah Rutin 64,000
Widal 28,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 200,000 10,000
11 03/07/19 AN. SALMAN AK Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 20,000 183,000 20,000
12 04/07/19 AN. DWIKI SW Darah Rutin 64,000
Ureum 33,000
Kolesterol 36,000
Kreatinin 33,000
GDS 22,000
L 5,000 5,000
BHP 6,000 6,000
Spoit + Tempat 10,000 209,000 10,000
13 04/07/19 NY. DWIKI EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
IgG/IgM 150,000
GDS 33,000
L 20,000 20,000
BHP 10,000 10,000
Spoit + Tempat 45,000 600,000 45,000
15 04/07/19 NN. A.RISKI EI Darah Rutin 64,000
Kolesterol 36,000
Widal 28,000
GDS 22,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat Darah 157,000 -
17 04/07/19 NY. NURJANNAH FN Darah Rutin 64,000
Widal 28,000
L -
BHP -
Spoit + Tempat 3,000 95,000 3,000
18 05/07/19 TN. SUPRIANSYAH SW Darah Rutin 64,000
Widal 28,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
 L 9,000 9,000
BHP 5,000 5,000
Spoit + Tempat 40,000 371,000 40,000
19 05/07/19 NY. NAIMA AB Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Golongan Dara 17,000
GDS 33,000
BHP 2,000 2,000
Spoit + Tempat 10,000 258,000 10,000
20 06/07/19 TN. H. SAULUNG EI Darah Rutin 64,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 100,000 10,000
21 06/07/19 TN. ABD. RAHMA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
22 09/06/19 NY. IRMA AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 15,000 82,000 15,000
23 07/07/19 NY.HJ.SANAPI EI Elektrolit 265,000 265,000
GDS 33,000
Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 7,000 372,000 7,000
24 05/07/19 AN. MUH.ASYAM AK Darah Rutin 64,000
SGOT 50,000 50,000
SGPT 50,000 50,000
BILTOT 50,000 50,000
BILDEK 50,000 50,000
L 15,000 15,000
BHP 10,000 10,000
Spoit + Tempat 50,000 339,000 50,000
25 06/07/19 AN. AGNES AK Urine Rutin 50,000
PLANO TEST 25,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 154,000 10,000
26 08/07/19 NY. ST. SANI EI Widal 28,000
GDS 33,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 145,000 15,000
27 10/07/19 NY. GUNA AA Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
 Spoit + Tempat 14,000 175,000 14,000
28 11/07/19 TN.H.ZAINUDDIN SW Ureum 33,000
Kreatinin 33,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 10,000 239,000 10,000
29 11/07/19 NY. HASNA SW Kolesterol 36,000
GDS 33,000
Asam Urat 33,000
L 15,000 15,000
BHP 5,000 5,000
Spoit + Tempat 15,000 137,000 15,000
30 12/07/19 NY. MATTARUNG IM GDS 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
31 12/07/19 NY. SUBAEDAH IM GDS 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
32 11/07/19 NY. RESKI KUSUM EI Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
33 10/07/19 NY. MARDAWIYA AB Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Golongan Dara 17,000
GDS 22,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 14,000 387,000 14,000
34 13/07/19 NY. TITIN AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
35 14/07/19 NY. AN.TENRI AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
36 14/07/19 NY.HJ.FAJRIANI SW Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
Widal 28,000
IgG/IgM 150,000
GDS 33,000
Kolesterol 36,000
 GDS 33,000
Elektrolit 265,000 265,000
L 18,000 18,000
BHP 8,000 8,000
Spoit + Tempat 40,000 805,000 40,000
37 15/07/19 NY. MIRNA A AB Darah Rutin 64,000
Golongan Dara 17,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 99,000 10,000
38 16/07/19 NY.HJ.MIRA SW Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
GDS 33,000
Elektrolit 265,000 265,000
L 6,000 6,000
BHP 7,000 7,000
Spoit + Tempat 30,000 507,000 30,000
39 19/07/19 HJ.HANA EI GDS 33,000
GDS 33,000
Darah Rutin 95,000 95,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 20,000 191,000 20,000
40 18/07/19 AN.ZESHA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 15,000 82,000 15,000
41 18/07/19 T. PAULUS SW Widal 28,000
Darah Rutin 95,000 95,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
GDS 22,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 24,000 334,000 24,000
42 19/07/19 NY.IRMELI AB Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Golongan Dara 17,000
GDS 33,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 15,000 335,000 15,000
43 19/07/19 TN.KAHFI SW Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
IgG/IgM 150,000
GDS 33,000
L 5,000 5,000
BHP 2,000 2,000
 Spoit + Tempat 15,000 361,000 15,000
44 19/07/19 AN. FATIN AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
45 19/07/19 AN. JESSIKA RD Darah Rutin 64,000
SGOT 33,000
SGPT 33,000
GDS 33,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 10,000 183,000 10,000
46 21/07/19 NY.SADIANA RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
47 22/07/19 NY.NURFADILLA AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
48 22/07/19 TN.HENDRA EI Darah Rutin 64,000
SGOT 33,000
SGPT 33,000
GDS 33,000
Elektrolit 265,000 265,000
HIV 135,000 135,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 10,000 583,000 10,000
49 22/07/19 NY.IRMA LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP -
Spoit + Tempat Darah 95,000 -
50 25/07/19 AN.NURMALA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000

RAWAT JALAN
1 27/06/19 TN. INRI RD Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 20,000 118,000 20,000
2 27/06/19 NY. WAHYU LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
3 27/06/19 NY. SRI DAMAYANTI RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
4 27/5/2019 TN. DAHLAN RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
5 27/06/19 NY. NURMIN RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
6 28/06/19 HJ. JARA AM GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
7 28/06/19 NY. HJ. MANUSIA AF Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
8 Spoit + Tempat 10,000 83,000 10,000
9 28/06/19 AN. ABDULLAH EI Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
10 28/06/19 TN. RUSTAM RD GDS 22,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
Widal 28,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 15,000 206,000 15,000
11 28/06/19 TN. SYAMSUL AF GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
12 29/06/19 TN. BORAHIMA RD Urine Rutin 50,000
GDS 22,000
Darah Rutin 64,000
 Ureum 33,000
Kreatinin 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 219,000 10,000
13 29/06/19 NY. INTAN LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
14 29/06/19 NY. RAHMAWATI RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
15 29/06/19 NY. HJ. MASLIHAT RD GDS 22,000
Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
16 29/07/19 AN. MUH. ARDAN RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
17 30/06/19 TN. ARI AM Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 15,000 116,000 15,000
18 01/07/19 NY. BAHARIA EI GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
19 01/07/19 AN. LATIFA AK Darah Rutin 64,000
Widal 28,000
IgG/IgM 150,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 20,000 266,000 20,000
21 01/07/19 NY. YUNI LL Darah Rutin 64,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
HBSAG 90,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 10,000 274,000 10,000
22 01/07/19 NY. MADINA AB Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 22,000
 Golongan Dara 17,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 254,000 10,000
23 01/07/19 TN. SAIPUL KR Kolesterol 36,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 182,000 10,000
24 01/07/19 NY. NADIRA RD Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 18,000 118,000 18,000
25 01/07/19 NY. ASMIRA AM Kolesterol 36,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
26 01/07/19 TN. H. TASAD AM Kolesterol 36,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
27 02/07/19 NY. ASHINI LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
29 02/07/19 TN. SYAHRIL LL Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 109,000 10,000
30 02/07/19 TN. SULAIMAN LL Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 109,000 10,000
31 02/07/19 TN. AHMAD RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
32 02/07/19 TN.MUH.NASIR RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
33 02/07/19 TN.MUH. TAMSIL LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
34 03/07/19 NY. BARLINA AM Kolesterol 36,000
 Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
35 03/07/19 NY. NUSIA AM Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
36 03/07/19 NY. MATTURUNGA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
37 03/07/19 TN. ASWAR LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
38 03/07/19 HJ. A. TENRI KR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
39 03/07/19 HJ. MAISURI LL Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 87,000 10,000
40 03/07/19 HJ. BUHANI RD Kolesterol 36,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 72,000 10,000
41 04/07/19 AN. AISYAH AM Darah Rutin 64,000
Widal 28,000
IgG/IgM 150,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 257,000 10,000
42 04/07/19 HJ. NISMA SK Urine Rutin 50,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 157,000 10,000
43 06/07/19 TN. RAUPU EI HBSAG 90,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 107,000 10,000
44 06/07/19 HJ. AMIRAH SK Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 20,000 122,000 20,000
45 06/07/19 TN. HIDAYAT RD GDS 22,000
L 1,000 1,000
 BHP 1,000 1,000
Spoit + Tempat 15,000 39,000 15,000
46 06/07/19 TN. AMRIN RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 15,000 54,000 15,000
47 06/07/19 NN. MONICA RD Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 20,000 122,000 20,000
48 06/07/19 HJ. HADIJA SW Urine Rutin 50,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 67,000 10,000
49 26/06/19 HJ. HADINAN LL Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 153,000 15,000
50 26/06/19 NY.RASMI AB Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
51 26/06/19 TN. AMBO ENRE IR Kolesterol 36,000
Urine Rutin 50,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 165,000 10,000
52 26/06/19 NY. HASMAWATI LL Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 5,000 5,000
Spoit + Tempat 15,000 118,000 15,000
53 08/07/19 TN. DEDI RD IgG/IgM 150,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 163,000 10,000
54 08/07/19 TN. RIDWAN EI Urine Rutin 50,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 67,000 10,000
55 08/07/19 NY. ROSMIATI EI Kolesterol 36,000
Darah Rutin 64,000
GDS 22,000
Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 170,000 15,000
56 08/07/19 NY. ASNAWI EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
57 09/07/19 TN. A. MUCHTAR LL Kolesterol 36,000
Asam Urat 33,000
 GDS 22,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 15,000 110,000 15,000
58 09/07/19 AN. HABIBI LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP -
Spoit + Tempat Darah 94,000 -
59 09/07/19 AN. AZALEA KR Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
60 09/07/19 NY. HASMIA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
61 09/07/19 TN. ABD. RAHMAN LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
62 09/07/19 TN. HERMAN SW Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
63 09/07/19 NN. FANI RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
64 09/07/19 NY.HJ.WARNIDA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
65 10/07/19 NY. HASNA EI Asam Urat 33,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 84,000 14,000
66 10/07/19 NY. FARIDA EI Urine Rutin 50,000
Darah Rutin 64,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 166,000 14,000
67 10/07/19 AN. M. SYAHRIL KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
68 10/07/19 AN. AZZALEA KR Widal 28,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 45,000 14,000
69 10/07/19 NY. SUKMAWATI RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
70 11/07/19 NY. ELLY RD Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 20,000 122,000 20,000
71 11/07/19 NY. AMELIA RD Asam Urat 33,000
Darah Rutin 64,000
Kolesterol 36,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 20,000 191,000 20,000
72 11/07/19 AN. REYNALDY LL Darah Rutin 64,000
L 1,000 1,000
BHP -
Spoit + Tempat Darah 65,000 -
73 11/07/19 TN. ALADIN RD Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 117,000 10,000
74 12/07/19 TN. JOHN RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
75 12/07/19 AN. KHADIJA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
76 13/07/19 NY. MEGAWATI LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
77 15/07/19 NY. NURMIATI AM Kolesterol 36,000
Asam Urat 33,000
Darah Rutin 64,000
Widal 28,000
IgG/IgM 150,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 325,000 10,000
78 15/07/19 NY. HATIJA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
79 15/07/19 TN. ALFIAN RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
 Spoit + Tempat 14,000 87,000 14,000
80 15/07/19 AN/. ALIF RESKI LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
81 15/07/19 NY. MANDINA LL Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 117,000 10,000
82 15/07/19 NY.HJ.TIJA KR Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 10,000 83,000 10,000
83 15/07/19 NY. NYUMA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
84 15/07/19 TN. ASWADI EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
85 16/07/19 TN. HIDAYAT RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
86 16/07/19 M. YUSUF LL Darah Rutin 64,000
Widal 28,000
L 15,000 15,000
BHP 3,000 3,000
Spoit + Tempat 20,000 130,000 20,000
87 16/07/19 NY. FARIDA RD Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 15,000 115,000 15,000
88 17/07/19 TN. HAMKA LL Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 67,000 14,000
89 17/07/19 TN. A. MUCHTAR LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
90 17/07/19 NY. SAYARU LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
91 17/07/19 NY. DAHNIA LL Kolesterol 36,000
Asam Urat 33,000
 GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
92 17/07/19 TN. MUSLIM RD Darah Rutin 64,000
Widal 28,000
L 8,000 8,000
BHP 4,000 4,000
Spoit + Tempat 15,000 119,000 15,000
93 17/07/19 TN. AHMAD RD Darah Rutin 64,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 14,000 85,000 14,000
94 17/07/19 TN. CANDRAWARD EI Asam Urat 33,000
Darah Rutin 64,000
GDS 22,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 15,000 142,000 15,000
95 18/07/19 TN. IRFAN RD Golongan Dara 17,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 14,000 132,000 14,000
96 18/07/19 NY.HJ.MUMTAHA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
97 18/07/19 TN. BANGGUILUNG SW Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 67,000 14,000
98 18/07/19 NY. SURATIN IR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
99 15/07/19 TN. A. ANIL AM Darah Rutin 64,000
IgG/IgM 150,000
Widal 28,000
L 8,000 8,000
BHP 2,500 2,500
Spoit + Tempat 15,000 267,500 15,000
100 17/07/19 DR. WARNI LL Kolesterol 36,000
Darah Rutin 64,000
GDS 22,000
Widal 28,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 15,000 175,000 15,000
101 19/07/19 NY. SURYANI AF Kolesterol 36,000
Darah Rutin 64,000
GDS 33,000
Asam Urat 33,000
 L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 14,000 186,000 14,000
102 20/07/19 TN.M.TAHIR RD Kolesterol 36,000
GDS 33,000
Asam Urat 33,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 121,000 10,000
103 20/07/19 NY.SUHERA SW Kolesterol 36,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 76,000 14,000
104 20/07/19 NY. TUO RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
105 20/07/19 NY.SURATEN IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
106 22/07/19 TN. BAHARUDDIN LL Asam Urat 33,000
GDS 22,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 68,000 10,000
107 22/07/19 NY.HILDA NUR EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
108 22/07/19 NY.RUKAYYAH im GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
109 22/07/19 NY.WAHIDAH LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
110 23/07/19 NY.HJ.ASMA LL Kolesterol 36,000
Darah Rutin 64,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 14,000 175,000 14,000
111 24/07/19 HJ.ASMA AF Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
112 24/07/19 NY.HILDA NUR EI GDS 33,000
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
113 24/07/19 NY. NAIMA IM GDS 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
114 24/07/19 NY.HALIMA IM GDS 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
115 24/07/19 NY.PERTILIA IM GDS 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
116 24/07/19 TN.JAYA IM GDS 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
117 24/07/19 NY. NELLY EI GDS 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
118 25/07/19 TN.MUNIR LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
119 25/07/19 AN.DAFA LL Darah Rutin 64,000
Malaria 80,000
Widal 28,000
L 7,000 7,000
BHP 2,000 2,000
Spoit + Tempat 10,000 191,000 10,000
120 25/07/19 AN.GIA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000

TOTAL 23,623,500 23,623,500 400,000 4,199,000

-

Rincian Rawat Inap 10,905,000 10,905,000 -

Jasa Laboran 1,893,114 Rawat Jalan 12,718,500 12,718,500 -
Total Bruto 23,623,500 23,623,500 -

dr. Nur Rahmi, Sp. PK 1,893,114.00

Reagensia 7,328,700.00
Jasa Klinik 5,784,515.00
BHP 4,199,000.00
L 400,000
9,983,515.00
N JUNI 2019 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17
-
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
NR
NR

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- NR
NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - - -
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
 SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR

20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00
20,000 5,000.00 2,750.00 2,250.00 L 900.00 900.00 450.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - - -
K
 K
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - - -
K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
- - - - -
K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
- - - - - NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
9,500 80,500.00 44,275.00 36,225.00 L 14,490.00 14,490.00 7,245.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR

K
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
- - - - - NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
SR
K SR
K SR
9,500 80,500.00 44,275.00 36,225.00 L 14,490.00 14,490.00 7,245.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
 K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
- - - - - NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
20,000 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
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
 K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
SR
K SR
K SR
20,000 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
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
- - - - -
K
K
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00
- - - -
K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - - -
K
K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00
- - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
- - - - -
K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
 - - - - -
K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
- - - - -
K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - - -
K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
 K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K

7,328,700 10,517,300 5,784,515 4,732,785 - 1,893,114 1,893,114 940,797

-
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN JUNI 2019 RUMAH SAKIT BERSAL
KODE HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

dr BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 25/07/19 NY. HJ. HARIFA AB Darah Rutin 64,000
Golongan Dara 17,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 15,000 99,000 15,000
2 26/07/19 NY.RASNI AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
GDS 33,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 15,000 335,000 15,000
3 27/07/19 AN. RAFI INDRA IR Darah Rutin 64,000
L 1,000 1,000
BHP 6,000 6,000
Spoit + Tempat 10,000 81,000 10,000
4 27/07/19 NY. JUMRIAH SW Darah Rutin 64,000
Golongan Dara 17,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 15,000 99,000 15,000
5 26/07/19 TN. NURDIN AA Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 14,000 243,000 14,000
6 28/07/19 NY.HJ. NUR UMAI FN Darah Rutin 64,000
Golongan Dara 17,000
L 8,000 8,000
BHP 6,000 6,000
Spoit + Tempat 30,000 125,000 30,000
7 27/09/19 AN. MUH. HAIRUL AK Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 115,000 10,000
8 27/07/19 AN. MUH. ALISRA AK Darah Rutin 64,000
L 2,000 2,000
 BHP 5,000 5,000
Spoit + Tempat 10,000 81,000 10,000
9 30/07/19 NY.BUDIATI BEST SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
GDS 33,000
L 10,000 10,000
BHP 5,000 5,000
Spoit + Tempat 30,000 303,000 30,000
10 22/07/19 NY.HJ.SANIA AA Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 10,000 10,000
BHP 5,000 5,000
Spoit + Tempat 20,000 322,000 20,000
11 02/08/19 NY.INTAN INDAH AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 7,000 7,000
Spoit + Tempat 10,000 100,000 10,000
12 05/08/19 AN.MUH. GALIB AK Darah Rutin 64,000
Golongan Dara 17,000
L 8,000 8,000
BHP 6,000 6,000
Spoit + Tempat 15,000 110,000 15,000
13 08/08/19 AN. AYLIN AK Darah Rutin 64,000
L 1,000 1,000
BHP -
Spoit + Tempat 3,000 68,000 3,000
15 07/08/19 NN. HAWA EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
IgG/IgM 150,000
L 10,000 10,000
BHP 8,000 8,000
Spoit + Tempat 40,000 428,000 40,000
17 07/08/19 TN. RUSLAN EI Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
GDS 22,000
GDS 33,000
Golongan Dara 17,000
L 11,000 11,000
BHP 6,000 6,000
Spoit + Tempat 30,000 280,000 30,000
18 08/08/19 NY.HASNAENI AB Darah Rutin 64,000
 Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
SGOT 33,000
SGPT 33,000
GDS 33,000
L 10,000 10,000
BHP 8,000 8,000
Spoit + Tempat 30,000 394,000 30,000
19 13/08/19 NY. TALAHA AB Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 111,000 10,000
20 11/08/19 NY. SRI ENDANG AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 99,000 14,000
21 10/08/19 AN. ANUGRAH AK Darah Rutin 64,000
GDS 22,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 104,000 14,000
22 12/08/19 NN. LINDA EI Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Widal 28,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 20,000 180,000 20,000
23 12/08/19 AN. RESKI INDah AK Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 15,000 115,000 15,000
24 13/08/19 NY. RISMAYANTI SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
SGOT 33,000
SGPT 33,000
L 20,000 20,000
BHP 10,000 10,000
Spoit + Tempat 55,000 429,000 55,000
25 15/08/19 TN. KRISMAS SW GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 53,000 15,000
26 14/08/19 BY. ARSILA AK Darah Rutin 64,000
 L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 81,000 10,000
27 13/08/19 NY. NURBAETI AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
SGOT 33,000
SGPT 33,000
GDS 33,000
L 10,000 10,000
BHP 8,000 8,000
Spoit + Tempat 30,000 394,000 30,000
28 14/08/19 AN. KHANZA AK Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 110,000 10,000
29 14/08/19 NY. METTI EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
Widal 28,000
Golongan Dara 17,000
GDS 22,000
Kolesterol 36,000
GDS 22,000
IgG/IgM 150,000
L 18,000 18,000
BHP 10,000 10,000
Spoit + Tempat 60,000 749,000 60,000
30 16/08/19 NY. ALVIRA EI Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
Urine Rutin 50,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 19,000 228,000 19,000
31 19/08/19 TN.H.MUSTANGIN EI Darah Rutin 64,000
Kolesterol 36,000
Widal 28,000
GDS 22,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 15,000 175,000 15,000
32 17/08/19 NY. FITRIA SW Darah Rutin 64,000
Kolesterol 36,000
 GDS 33,000
Asam Urat 33,000
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat 25,000 205,000 25,000
33 17/08/19 TN. SYAFARUDDI AA Darah Rutin 64,000
Widal 28,000
Malaria 80,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 14,000 196,000 14,000
34 20/08/19 NY. INDRAYANI SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
L 10,000 10,000
BHP 6,000 6,000
Spoit + Tempat 35,000 243,000 35,000
35 22/08/19 NY. FIRDA AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 99,000 14,000
36 23/08/19 AN. MIKAILA AK Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 115,000 14,000
37 23/08/19 AN. AKHWA AK Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 115,000 14,000
39 23/08/19 NY. MAHDANIA FN Spoit + Tempat 5,000 5,000 5,000
40 24/08/19 AN. ANDI YUSUF AK Darah Rutin 64,000
Widal 28,000
GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 138,000 10,000
41 24/08/19 TN. H. M. DAHLA SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 11,000 11,000
BHP 6,000 6,000
Spoit + Tempat 30,000 462,000 30,000
RAWAT JALAN
1 26/07/19 NY. NUR,ILA RD Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 14,000 175,000 14,000
2 26/07/19 TN. ABD. KADIR EI Kolesterol 36,000
GDS 22,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 10,000 76,000 10,000
3 26/07/19 NY. HAPSAH IR GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Darah Rutin 64,000
L 5,000 5,000
BHP 6,000 6,000
Spoit + Tempat 14,000 180,000 14,000
4 27/07/19 TN. MUHTAR IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 87,000 10,000
5 27/07/19 NY. NURSANTI SW GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
6 29/07/19 TN. A. SYARIF RD Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
7 29/07/19 TN. HARIS RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
9 29/07/19 NY. HILDA LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
10 29/07/19 NY. HJ. HASNA RD GDS 22,000
 Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 110,000 10,000
11 29/07/19 NY. HASRIANI AF GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 110,000 10,000
12 29/07/19 TN. RAHMAT IR Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 15,000 115,000 15,000
13 29/07/19 AN. M. FAITH AF Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
14 29/07/19 TN. HARDIANSYAH RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
15 29/07/19 NY. SALMIA AM Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
16 29/07/19 AN. QILA AF Urine Rutin 50,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 13,000 67,000 13,000
17 29/07/19 NY. HUSNIA AM GDS 22,000
Kolesterol 36,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 76,000 10,000
18 30/07/19 NY. HAFSAH IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
19 30/07/19 AN. ADI AKSA IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
21 31/07/19 NY. FITRIANI EI Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
22 08/01/19 TN. SUDIRMAN RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
23 08/01/19 NY. JAMASIA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
24 08/02/19 TN. MAHMUD RD Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
25 02/08/19 NY. ALFRIDA LL GDS 33,000
GDS 33,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 20,000 96,000 20,000
26 02/08/19 NY. ASLIA LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 87,000 10,000
27 02/08/19 NY. HJ. MURNI IM GDS 33,000
L 2,000 2,000
BHP 5,000 5,000
Spoit + Tempat 10,000 50,000 10,000
29 02/08/19 TN. H. PATURUSI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat 10,000 110,000 10,000
30 02/08/19 NY. RIA LL Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 15,000 15,000
BHP 6,000 6,000
Spoit + Tempat 20,000 196,000 20,000
31 03/08/19 TN. DARUL ADAM LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat 10,000 110,000 10,000
32 03/08/19 NY. MARDIANA LL GDS 33,000
L 3,000 3,000
BHP 4,000 4,000
 Spoit + Tempat 10,000 50,000 10,000
33 03/08/19 TN. YAKUB LL Asam Urat 33,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 50,000 10,000
34 05/08/19 TN. MUH. AL AKSAR RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
35 05/08/19 NY. SURIANI AM Widal 28,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 41,000 10,000
36 05/08/19 NY. HJ. MARYAM IM GDS 33,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 50,000 10,000
37 05/08/19 NY. METTI EI Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 115,000 14,000
38 07/08/19 TN. IAN RD Darah Rutin 64,000
SGOT 33,000
SGPT 33,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 15,000 154,000 15,000
39 07/08/19 HJ. DEWI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat 10,000 110,000 10,000
40 09/08/19 TN. BASRI RD Kolesterol 36,000
GDS 22,000
L 8,000 8,000
BHP 8,000 8,000
Spoit + Tempat 13,000 87,000 13,000
41 07/08/19 NY. MARIATUN RD Darah Rutin 64,000
SGOT 33,000
SGPT 33,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 13,000 152,000 13,000
42 08/08/19 TN. RUSLAN EI Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 115,000 14,000
43 08/08/19 TN. A. PUTRA EI Kolesterol 36,000
Asam Urat 33,000
 L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat 10,000 81,000 10,000
44 09/08/19 TN. JUNAEDI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat 10,000 110,000 10,000
45 09/08/19 NY. NURSIA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat 10,000 110,000 10,000
46 10/08/19 BY. AUFA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
47 12/08/19 NY. SURIANI RD Darah Rutin 64,000
Kolesterol 36,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 113,000 10,000
48 12/08/19 TN. HAMMA ADI IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
49 13/08/19 NY. HJ. HATIJA LL GDS 33,000
L 1,000 1,000
BHP -
Spoit + Tempat 5,000 39,000 5,000
50 13/08/19 NN. MARSUKA RD Darah Rutin 64,000
Widal 28,000
L 10,000 10,000
BHP 3,000 3,000
Spoit + Tempat 15,000 120,000 15,000
51 13/08/19 NY. HJ. TARI AM Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
52 14/08/19 NY. BURAHIMA EI Kolesterol 36,000
Asam Urat 33,000
Kreatinin 33,000
SGPT 33,000
L 4,000 4,000
BHP -
Spoit + Tempat 5,000 144,000 5,000
53 14/08/19 NY. MAISA EI GDS 33,000
 L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 50,000 10,000
54 15/08/19 TN. MARTONI RD Kolesterol 36,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 53,000 10,000
55 15/08/19 TN. MUCKLIS LL Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 13,000 87,000 13,000
56 15/08/19 HJ. NURSANG FD GDS 22,000
Asam Urat 33,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 73,000 10,000
57 16/08/19 TN. GUSTI IR Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 15,000 115,000 15,000
58 17/08/19 TN. H. OKI RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
59 17/08/19 AN. FAHMI R LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
60 19/08/19 TN. H. GASALI KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
61 19/08/19 HJ. HADARIA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
62 19/08/19 NY. SENDARANI KR PLANOTEST 25,000 25,000
L -
BHP -
Spoit + Tempat Darah 25,000 -
63 19/08/19 NY. ST. NURBAYA AA Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 106,000 10,000
64 20/08/19 NN. RIMBA IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
65 21/08/19 NY. JURMIAH AF Kolesterol 36,000
GDS 22,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 76,000 10,000
66 21/08/19 TN. M YUSUF AM Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 5,000 5,000
Spoit + Tempat 14,000 180,000 14,000
67 21/08/19 NY. HJ. NURMI IM GDS 33,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 50,000 10,000
68 21/08/19 TN. AHMAD MUHA EI Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
69 21/08/19 TN. AHMAD AA Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 5,000 5,000
Spoit + Tempat 14,000 180,000 14,000
70 22/08/19 NY. IRMAYANI LL Darah Rutin 64,000
Kolesterol 36,000
GDS 33,000
Malaria 80,000
HBSAG 90,000
L 6,000 6,000
BHP 5,000 5,000
Spoit + Tempat 10,000 324,000 10,000
71 22/08/19 YN. ILHAM RD GDS 33,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 50,000 10,000
72 22/08/19 NY. RADIANI RD Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 73,000 10,000
73 22/08/19 NY. ANI RD Kolesterol 36,000
 Asam Urat 33,000
GDS 22,000
Darah Rutin 64,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 12,000 175,000 12,000
74 22/08/19 AN. RISWADI KR Golongan Dara 17,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 34,000 10,000
75 22/08/19 NY. SUMAINA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
76 22/08/19 NY. SICUMMI LL Urine Rutin 50,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 13,000 67,000 13,000
77 22/08/19 TN. BAHARUDDIN LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000

TOTAL 15,094,000 15,094,000 394,000 1,664,000

-

Rincian Rawat Inap 7,589,000 7,589,000 -

Jasa Laboran 1,344,726 Rawat Jalan 7,505,000 7,505,000 -
Total Bruto 15,094,000 15,094,000 -

dr. Nur Rahmi, Sp. PK 1,344,726.00

Reagensia 5,107,300.00
Jasa Klinik 4,108,885.00
BHP 1,664,000.00
L 394,000
5,772,885.00
N JUNI 2019 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17
-
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- NR
NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
 K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
 SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
20,000 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
20,000 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
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
 K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
20,000 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
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
 SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
 K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
- - - - NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
- - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
9,500 80,500.00 44,275.00 36,225.00 L 14,490.00 14,490.00 7,245.00 SR
- - - - - SR
K SR
K SR
20,000 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
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR

5,107,300 7,470,700 4,108,885 3,361,815 - 1,344,726 1,344,726 672,363

-
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN JUNI 2019 RUMAH SAKIT BE
KODE HARGA

TOTAL
NO TGL NAMA PASIEN URAIAN TARIF BAYAR
dr L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 29/08/19 NY.HJ.NURLIA AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
2 29/08/19 NY. SUKMAWATI SW Darah Rutin 64,000
Kreatinin 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 134,000 10,000
3 29/08/19 NY. WAHYUNI SW Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 115,000 10,000
4 29/08/19 HJ. EDDAH AA Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 11,000 11,000
BHP 4,000 4,000
Spoit + Tempat 15,000 350,000 15,000
5 02/09/19 HJ. MULIANI EI Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
Urine Rutin 50,000
L 6,000 6,000
BHP 6,000 6,000
Spoit + Tempat 14,000 242,000 14,000
6 02/09/19 NY. FADLIA AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 99,000 10,000
7 28/08/19 AN. SIGIT AK Darah Rutin 64,000
GDS 33,000
Urine Rutin 50,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 166,000 10,000
8 26/08/19 NY.LEONORA SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
 Ureum 33,000
Kreatinin 33,000
GDS 33,000
SGPT 33,000
GDS 33,000
Golongan Dara 17,000
L 11,000 11,000
BHP 10,000 10,000
Spoit + Tempat 40,000 499,000 40,000
9 05/09/19 HJ. HAYATI EI Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 141,000 10,000
10 07/09/19 NY. RAODA AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
11 07/09/19 NY.HJ.HAJIBA SW Darah Rutin 64,000
GDS 33,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 10,000 115,000 10,000
12 05/09/19 TN. SYAFARUDDI IM GDS 22,000
GDS 33,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGPT 33,000
Darah Rutin 64,000
SGPT 33,000
Kreatinin 33,000
L 14,000 14,000
BHP 6,000 6,000
Spoit + Tempat 25,000 393,000 25,000
13 09/09/19 NY. INDRAYANI EI Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
15 08/09/19 AN. AFIFAH AK Darah Rutin 64,000
GDS 33,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 115,000 10,000
17 06/09/19 TN. MUH. DAALI EI Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 10,000 172,000 10,000
18 06/09/19 NY. NILA SANTI AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
 Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 10,000 10,000
BHP 9,000 9,000
Spoit + Tempat 20,000 316,000 20,000
19 09/09/19 AN. AZZALEA AK Darah Rutin 64,000
GDS 33,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 115,000 10,000
20 10/09/19 NY. MARYAM AA Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 141,000 14,000
21 09/09/19 NY. INDRAYANI EI Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
22 11/09/19 TN. A. M. ASHAR EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 95,000 95,000
Darah Rutin 95,000 95,000
Darah Rutin 95,000 95,000
IgG/IgM 150,000
Golongan Dara 17,000
Widal 28,000
L 15,000 15,000
BHP 6,000 6,000
Spoit + Tempat 50,000 807,000 50,000
23 13/09/19 AN. KHOFIFAH AK Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 110,000 10,000
24 08/09/19 AN. KHOFIFAH AK Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 115,000 14,000
25 16/09/19 NY.EKA SURYANIN AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 99,000 10,000
26 17/09/19 NN.RATNA AA Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
 SGOT 33,000
SGPT 33,000
L 10,000 10,000
BHP 9,000 9,000
Spoit + Tempat 30,000 381,000 30,000
27 19/09/19 NY. SAMIA AA Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 10,000 175,000 10,000
28 19/09/19 DR. WARNI FN Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
29 19/09/19 NY. SRI HARTATI EI Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
30 21/09/19 NN. PUTRI SW Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
31 23/09/19 NY. WAHIDA AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 99,000 14,000
32 22/09/19 NY. MASNUR AB Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 133,000 10,000
33 24/09/19 NY. ASLIANA SW Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 14,000 180,000 14,000
RAWAT JALAN
1 26/07/19 NY. RUSDIA RD Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Widal 28,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 14,000 207,000 14,000
2 26/08/19 NY. IRMA AM Kolesterol 36,000
L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat 10,000 48,000 10,000
3 26/08/19 TN. IDRIS LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
4 26/08/19 NY. SARI IM GDS 33,000
L 1,000 1,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
5 26/08/19 NY. DARAMIA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
6 26/08/19 NY. RAHMAWATI AM Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
7 26/08/19 TN. JASMADIO IM Darah Rutin 64,000
CT 20,000
Golongan Dara 17,000
GDS 22,000
BT 20,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 9,000 9,000
BHP 1,000 1,000
Spoit + Tempat 15,000 300,000 15,000
9 26/08/19 NN. RENI EI Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
10 27/08/19 AN. MUH. GIBRAN AM Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
11 27/08/19 NY. KARMILA IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
12 27/08/19 NY. TITIK NURWAH IR Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
13 28/08/19 TN. RUSLAN EI Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 14,000 152,000 14,000
14 29/08/19 NY. RESKIANTI AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
15 29/08/19 NY. SYERLINA KR Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 53,000 10,000
16 29/08/19 NY. NURHALISA KR Darah Rutin 64,000
 Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
17 29/08/19 AN. ZASKIA KR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
18 29/08/19 NY.HJ. HAMSIAH KR Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 13,000 50,000 13,000
19 29/08/19 NY. RAHMAWATI FD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
21 30/08/19 TN. HERMAWAN KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
22 30/08/19 NY. JURMIATI RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
23 31/08/19 NY. ARMIA LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
24 31/08/19 TN. YUSRIFA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat 10,000 110,000 10,000
25 31/08/19 TN . MUSTAFA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat 10,000 110,000 10,000
26 09/02/19 NY. SILVANI AF Kolesterol 36,000
Asam Urat 33,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 148,000 10,000
27 09/02/19 NY. MASLIANI AF Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
29 09/02/19 TN. EDYL AF GDS 33,000
L 5,000 5,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 50,000 10,000
30 09/02/19 NY. HAFIDA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
31 09/02/19 NY. HASDIARAH EI Darah Rutin 64,000
GDS 33,000
Widal 28,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat 15,000 149,000 15,000
32 02/09/19 NY. BADARIAH IM GDS 33,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 50,000 10,000
33 03/09/19 TN. EDDY LOGOWO SW GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
34 03/09/19 NY. A. TENRI LL Darah Rutin 64,000
Urine Rutin 50,000
GDS 22,000
L 10,000 10,000
BHP 5,000 5,000
Spoit + Tempat 15,000 166,000 15,000
35 03/09/19 NY. EMI LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 1,000 1,000
Spoit + Tempat 15,000 191,000 15,000
36 05/09/19 TN. KAHARUDDIN LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
37 05/09/19 NY. HASLIANA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
38 05/09/19 TN. ALADIN LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
39 06/09/19 TN. ILHAM RD Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 14,000 76,000 14,000
40 06/09/19 NY. HAJIBA LL PLANOTEST 15,000 15,000
GDS 22,000
Urine Rutin 50,000
 L 8,000 8,000
BHP 8,000 8,000
Spoit + Tempat 13,000 116,000 13,000
41 06/09/19 TN. SARIF IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
42 06/09/19 TN. H. BATMAN EI GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
43 06/09/19 NY. HASMIATI EI Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
44 06/09/19 AN. EVELIN KR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
45 09/09/19 NY. NANI LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 192,000 15,000
46 09/09/19 NY. NURBAYA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP -
Spoit + Tempat 10,000 104,000 10,000
47 09/09/19 BY. AISYAH KR Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 82,000 14,000
48 09/09/19 NY. NURRAHMA KR Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 10,000 110,000 10,000
49 09/09/19 NY. EVA LL Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 10,000 151,000 10,000
50 09/09/19 NY. BERLIAN RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
51 09/09/19 TN. HAIKAL RD Golongan Dara 17,000
Darah Rutin 64,000
SGOT 33,000
SGPT 33,000
L 6,000 6,000
 BHP 4,000 4,000
Spoit + Tempat 10,000 167,000 10,000
52 09/09/19 ST. RAODA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
53 09/09/19 TN.H.M.SAID AF Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
54 09/09/19 NY. HERMIATI LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
55 10/09/19 TN. M. KAMIL AF Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
56 10/09/19 TN. ALIMUDDIN RD GDS 22,000
Darah Rutin 64,000
Widal 28,000
L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat 10,000 126,000 10,000
57 10/09/19 NY. JURMIAH RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Urine Rutin 50,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 220,000 10,000
58 11/09/19 TN. SOFYAN KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
59 11/09/19 TN. MANSUR EI HBSAG 90,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 13,000 107,000 13,000
60 11/09/19 NY. SRI MINARTI LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
61 11/09/19 NY. NURHIDAYAH AB Darah Rutin 64,000
GDS 33,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 115,000 10,000
62 11/09/19 TN. HASANUDDIN IM GDS 33,000
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
63 11/09/19 NY. PAITA AA Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 1,000 1,000
Spoit + Tempat 15,000 243,000 15,000
64 12/09/19 NY.ST. HAJAR LL Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 10,000 175,000 10,000
65 12/09/19 NN. MADIA AM Asam Urat 33,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 50,000 10,000
66 12/09/19 NN. MITA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 191,000 14,000
67 12/09/19 NY.HJ. MUNAR LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 14,000 196,000 14,000
68 12/09/19 NY. FITRIANI AM Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
69 13/09/19 NY.HJ.HAYATI RD Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 53,000 10,000
70 13/09/19 AN.M.ALI IR Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 3,000 3,000
Spoit + Tempat 14,000 115,000 14,000
71 13/09/19 NY. NURFADILLA EI Widal 28,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 45,000 10,000
72 14/09/19 TN. AMINUDDIN RD Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 53,000 10,000
73 14/09/19 NY. AISYAH RD Kolesterol 36,000
 L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
74 14/09/19 NY. HJ. MARHUMA RD Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
75 14/09/19 TN. ABD. RAHMAN LL Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 8,000 8,000
BHP 3,000 3,000
Spoit + Tempat 14,000 177,000 14,000
76 16/09/19 NY. SUHRA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
77 16/09/19 NY. RAJANA IR Kolesterol 36,000
Darah Rutin 64,000
Widal 28,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 13,000 205,000 13,000
78 16/09/19 TN. JAMALUDDIN RD GDS 33,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 144,000 10,000
79 16/09/19 TN. DEDIANTO EI Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 14,000 81,000 14,000
80 17/09/19 TN. MASA EI GDS 33,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 50,000 10,000
81 17/09/19 TN. A. PUTRA LL Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
82 17/09/19 NY. FERAWATI LL Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
83 18/09/19 TN. TAMSIR EI Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
84 18/09/19 NY. MURNI IB CT 20,000
Darah Rutin 64,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 10,000 102,000 10,000
85 22/09/19 AN. NUR FAUZIAH LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
86 22/09/19 TN. RIZAL ADI LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 191,000 14,000
87 24/09/19 NY. HASLIA LL Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 53,000 10,000
88 24/09/19 NY.HJ. MANUSIA RD Asam Urat 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 14,000 141,000 14,000
89 24/09/19 TN. ANWAR AM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
90 24/09/19 AN. RAIKA AK Widal 28,000
Darah Rutin 64,000
IgG/IgM 150,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 14,000 266,000 14,000
91 24/09/19 NY. SUKRIA AM Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000

TOTAL 14,786,000 14,786,000 299,000 1,577,000

-

Rincian Rawat Inap 5,817,000 5,817,000 -

Jasa Laboran 1,342,278 Rawat Jalan 9,330,000 9,330,000 -
Total Bruto 15,147,000 15,147,000 -
dr. Nur Rahmi, Sp. PK 1,342,278.00
Reagensia 5,168,900.00
Jasa Klinik 4,021,490.00
BHP 1,577,000.00
L 299,000
5,598,490.00
N JUNI 2019 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17
-
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
- NR
NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 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
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR

5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
- - - - - NR
K NR
K SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
NR
NR
NR
NR
NR
 NR
NR
NR
NR
NR
NR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR

5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 15,000.00 8,250.00 6,750.00 L 2,700.00 2,700.00 1,350.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
5,000 15,000.00 8,250.00 6,750.00 L 2,700.00 2,700.00 1,350.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
- - - - -
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
20,000 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
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
L - - - NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00
 NR
K NR
K NR
20,000 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
20,000 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
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
- - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
 K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - - - NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
9,500 80,500.00 44,275.00 36,225.00 L 14,490.00 14,490.00 7,245.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - - SR
K SR
K SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00
- - - - -
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
 SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
- - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K
 5,000 15,000.00 8,250.00 6,750.00 L 2,700.00 2,700.00 1,350.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00
- - - - -
K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
- - - -
K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00
- - - - -
K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K

5,168,900 7,311,800 4,021,490 3,290,310 - 1,342,278 1,342,278 671,139

-
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN OKTOBER 2019 RUMAH SAKIT BERS
KODE HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

dr BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 29/08/19 NY. ARMIAH AB Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
Golongan Dara 17,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
L 16,000 16,000
BHP 6,000 6,000
Spoit + Tempat 20,000 410,000 20,000
2 29/08/19 NN. RIHADATU AK Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 95,000 95,000
Darah Rutin 95,000 95,000
ADT + DR 250,000 250,000
IgG/IgM 150,000
Plano Test 25,000 25,000
Widal 28,000
SGOT 33,000
SGPT 33,000
L 20,000 20,000
BHP 11,000 11,000
Spoit + Tempat 55,000 923,000 55,000
3 29/08/19 NY. NURJANNAH AB Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
L 14,000 14,000
BHP 6,000 6,000
Spoit + Tempat 20,000 339,000 20,000
4 29/08/19 TN. A. M. NAUFAL AK Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 14,000 186,000 14,000
5 02/09/19 NY. MARYAM AA Darah Rutin 64,000
Kolesterol 36,000
 Asam Urat 33,000
GDS 22,000
L 8,000 8,000
BHP 2,000 2,000
Spoit + Tempat 15,000 180,000 15,000
6 02/09/19 NY. ST. AMINA FN Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 99,000 10,000
7 28/08/19 AN. A. ASSA AK Darah Rutin 64,000
GDS 33,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 10,000 115,000 10,000
8 26/08/19 NY. HJ. NURDIAH AB Darah Rutin 64,000
GDS 33,000
GDS 33,000
GDS 22,000
GDS 33,000
SGOT 33,000
SGPT 33,000
L 7,000 7,000
BHP 10,000 10,000
Spoit + Tempat 15,000 283,000 15,000
9 05/09/19 AN. ERIK IRMAW AK Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 25,000 191,000 25,000
10 07/09/19 NY. ZULFA RAMA AB Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
L 13,000 13,000
BHP 6,000 6,000
Spoit + Tempat 20,000 316,000 20,000
11 07/09/19 NY. HARTATI IB Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
L 10,000 10,000
BHP 6,000 6,000
Spoit + Tempat 35,000 243,000 35,000
12 05/09/19 NY. FAHRIANI AB Darah Rutin 64,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 81,000 10,000
13 09/09/19 NY. RESKI WAHYT AB Darah Rutin 64,000
Golongan Dara 17,000
 GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
L 14,000 14,000
BHP 6,000 6,000
Spoit + Tempat 20,000 339,000 20,000
15 08/09/19 NY. BADRIAH AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
17 06/09/19 TN. BUDIMAN EI Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
18 06/09/19 TN. MUH. RAMLI EI Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
HbA1C 240,000 240,000
L 10,000 10,000
BHP 9,000 9,000
Spoit + Tempat 20,000 440,000 20,000
19 09/09/19 NY.HJ.SITTIANI IR Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 10,000 10,000
BHP 4,000 4,000
Spoit + Tempat 10,000 311,000 10,000
20 10/09/19 NY. MARDIANA AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
21 09/09/19 BY.A.FATIN AK Darah Rutin 64,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 12,000 104,000 12,000
22 11/09/19 TN. RYAN PURWA EI Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
GDS 33,000
GDS 33,000
GDS 33,000
SGOT 33,000
SGPT 33,000
 SGOT 33,000
SGPT 33,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 35,000 431,000 35,000
23 13/09/19 AN. A. AIMAN AK Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 18,000 18,000
BHP 13,000 13,000
Spoit + Tempat 60,000 439,000 60,000
24 08/09/19 TN. ALDI PAEIADI IB Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 110,000 10,000
25 16/09/19 AN. M. AL FIQIH AK Elektrolit 252,000 252,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 265,000 10,000
26 17/09/19 TN. HASANUDDIN IM GDS 33,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 50,000 10,000
27 19/09/19 TN. MUSA AA Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 14,000 14,000
BHP 6,000 6,000
Spoit + Tempat 13,000 251,000 13,000
28 19/09/19 AN. RIFANDI AK Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 9,000 9,000
BHP 6,000 6,000
Spoit + Tempat 20,000 191,000 20,000
29 19/09/19 TN. RUDI EI Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 14,000 175,000 14,000
30 21/09/19 AN. RIFANDI AK Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 9,000 9,000
 BHP 6,000 6,000
Spoit + Tempat 20,000 191,000 20,000
31 23/09/19 NY. HJ. ST. HAJIN SW Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 14,000 183,000 14,000
32 22/09/19 AN. ARSYILA BUL AK Darah Rutin 64,000
Darah Rutin 64,000
L 2,000 2,000
BHP 4,000 4,000
Spoit + Tempat 20,000 154,000 20,000
33 24/09/19 NY. HJ. HAJINA SW Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 14,000 183,000 14,000
34 23/10/19 NY. GLADIS SW Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 13,000 114,000 13,000
35 23/10/19 AN. RANI AK Widal 28,000
Darah Rutin 64,000
GDS 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 13,000 144,000 13,000
36 23/10/19 AN. YAFIQ AK Widal 28,000
Darah Rutin 64,000
GDS 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 13,000 144,000 13,000
37 23/10/19 AN. PRADIPTA AK Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 13,000 81,000 13,000
38 24/10/19 NY. HERLINA FN Darah Rutin 64,000
Golongan Dara 17,000
Darah Rutin 64,000
L 8,000 8,000
BHP 7,000 7,000
Spoit + Tempat 20,000 180,000 20,000
RAWAT JALAN
1 26/08/19 BY. AISYAH LL Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 13,000 81,000 13,000
26/08/19 H. ABD. SAMAD LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
2 BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
26/08/19 NY. DR. JAMAL LL Darah Rutin 64,000
Widal 28,000
3 L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
4 26/08/19 NY. NURJANNAH EI GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
4 Spoit + Tempat 13,000 50,000 13,000
5 26/08/19 NY. LIMBONG RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
6 26/08/19 TN. SYAMSUDDIN RD Kolesterol 36,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 119,000 14,000
7 26/08/19 TN.H.JANA RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 106,000 10,000
9 26/08/19 TN. H. LUNANG LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
10 27/08/19 TN.H. M. SAID RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
11 27/08/19 NY. ST. NURBIAH IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 82,000 10,000
12 27/08/19 TN. SUDIRMAN IR GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
13 28/08/19 AN. M. SAID AM Darah Rutin 64,000
Widal 28,000
IgG/IgM 150,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 14,000 266,000 14,000
14 29/08/19 TN. LA TOLA IM GDS 33,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 14,000 55,000 14,000
15 29/08/19 TN. JABAL NUR IM GDS 33,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 14,000 55,000 14,000
16 29/08/19 NY. NURJANNNA EI Kolesterol 36,000
Asam Urat 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 11,000 87,000 11,000
17 29/08/19 TN. HARIS HARAHA KR Darah Rutin 64,000
L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat 10,000 76,000 10,000
18 29/08/19 NY. NURHAYATI RD GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 110,000 14,000
19 29/08/19 NY. SAHARIA RD Kolesterol 36,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 53,000 10,000
21 30/08/19 AN. A. BANGSAWAN KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 14,000 81,000 14,000
22 30/08/19 AN. WILMA CAHYA LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
23 31/08/19 NY. HASNIATI IR GDS 22,000
Darah Rutin 64,000
Widal 28,000
Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 13,000 170,000 13,000
24 31/08/19 TN.H. MAJI LL Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 10,000 87,000 10,000
25 31/08/19 NY.HJ.JATIN AM Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat 10,000 110,000 10,000
26 09/02/19 TN. GAMAN AM GDS 33,000
Darah Rutin 64,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 13,000 115,000 13,000
27 09/02/19 NY. ST. ANI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat 10,000 110,000 10,000
29 09/02/19 TN.H.HANAWI RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 10,000 175,000 10,000
30 09/02/19 NY. YEIS RD Kolesterol 36,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 53,000 10,000
31 09/02/19 NY. LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 7,000 103,000 7,000
32 02/09/19 NY. MUSDALIFA LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
33 03/09/19 TN. IRMAN LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
34 03/09/19 NY.HJ. MADINAH LL Darah Rutin 64,000
Urine Rutin 50,000
GDS 22,000
L 10,000 10,000
BHP 5,000 5,000
Spoit + Tempat 15,000 166,000 15,000
35 03/09/19 TN. H. SUDIRMAN LL GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat 10,000 110,000 10,000
36 05/09/19 NY. MARYAM LL GDS 22,000
Golongan Dara 17,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 10,000 52,000 10,000
37 05/09/19 HJ. RIRIN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP -
Spoit + Tempat 10,000 104,000 10,000
38 05/09/19 TN. ISMAIL RD GDS 33,000
L -
BHP -
Spoit + Tempat 3,000 36,000 3,000
39 06/09/19 AN. WIDYA RD Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
40 06/09/19 NY. JUHANA IM GDS 33,000
L 2,000 2,000
BHP 2,000 2,000
 Spoit + Tempat 13,000 50,000 13,000
41 06/09/19 TN. HASANUDDIN IM Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
42 06/09/19 AN. M. HALIM IR Darah Rutin 64,000
Widal 28,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
43 06/09/19 NY. HASMIATI EI Urine Rutin 50,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 63,000 10,000
44 06/09/19 AN. EVELIN KR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
45 09/09/19 NY. NANI LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 15,000 192,000 15,000
46 09/09/19 NY. NURBAYA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP -
Spoit + Tempat 10,000 104,000 10,000
47 09/09/19 BY. AISYAH KR Darah Rutin 64,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 14,000 82,000 14,000
48 09/09/19 NY. NURRAHMA KR Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 2,000 2,000
Spoit + Tempat 10,000 110,000 10,000
49 09/09/19 NY. EVA LL Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 10,000 151,000 10,000
50 09/09/19 NY. BERLIAN RD Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
51 09/09/19 TN. HAIKAL RD Golongan Dara 17,000
 Darah Rutin 64,000
SGOT 33,000
SGPT 33,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 10,000 167,000 10,000
52 09/09/19 ST. RAODA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
53 09/09/19 TN.H.M.SAID AF Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
54 09/09/19 NY. HERMIATI LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
55 10/09/19 TN. M. KAMIL AF Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
56 10/09/19 TN. ALIMUDDIN RD GDS 22,000
Darah Rutin 64,000
Widal 28,000
L 1,000 1,000
BHP 1,000 1,000
Spoit + Tempat 10,000 126,000 10,000
57 10/09/19 NY. JURMIAH RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Urine Rutin 50,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 220,000 10,000
58 11/09/19 TN. SOFYAN KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
59 11/09/19 TN. MANSUR EI HBSAG 90,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 13,000 107,000 13,000
60 11/09/19 NY. SRI MINARTI LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
 BHP 2,000 2,000
Spoit + Tempat 10,000 83,000 10,000
61 11/09/19 NY. NURHIDAYAH AB Darah Rutin 64,000
GDS 33,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 115,000 10,000
62 11/09/19 TN. HASANUDDIN IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
63 11/09/19 NY. PAITA AA Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 1,000 1,000
Spoit + Tempat 15,000 243,000 15,000
64 12/09/19 NY.ST. HAJAR LL Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 4,000 4,000
Spoit + Tempat 10,000 175,000 10,000
65 12/09/19 NN. MADIA AM Asam Urat 33,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 50,000 10,000
66 12/09/19 NN. MITA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 191,000 14,000
67 12/09/19 NY.HJ. MUNAR LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 14,000 196,000 14,000
68 12/09/19 NY. FITRIANI AM Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
69 13/09/19 NY.HJ.HAYATI RD Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 53,000 10,000
70 13/09/19 AN.M.ALI IR Darah Rutin 64,000
Widal 28,000
 L 6,000 6,000
BHP 3,000 3,000
Spoit + Tempat 14,000 115,000 14,000
71 13/09/19 NY. NURFADILLA EI Widal 28,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 45,000 10,000
72 14/09/19 TN. AMINUDDIN RD Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 53,000 10,000
73 14/09/19 NY. AISYAH RD Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
74 14/09/19 NY. HJ. MARHUMA RD Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
75 14/09/19 TN. ABD. RAHMAN LL Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 8,000 8,000
BHP 3,000 3,000
Spoit + Tempat 14,000 177,000 14,000
76 16/09/19 NY. SUHRA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
77 16/09/19 NY. RAJANA IR Kolesterol 36,000
Darah Rutin 64,000
Widal 28,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 13,000 205,000 13,000
78 16/09/19 TN. JAMALUDDIN RD GDS 33,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 144,000 10,000
79 16/09/19 TN. DEDIANTO EI Darah Rutin 64,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 14,000 81,000 14,000
80 17/09/19 TN. MASA EI GDS 33,000
L 3,000 3,000
BHP 4,000 4,000
 Spoit + Tempat 10,000 50,000 10,000
81 17/09/19 TN. A. PUTRA LL Kolesterol 36,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
82 17/09/19 NY. FERAWATI LL Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 10,000 171,000 10,000
83 18/09/19 TN. TAMSIR EI Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
84 18/09/19 NY. MURNI IB CT 20,000
Darah Rutin 64,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 10,000 102,000 10,000
85 22/09/19 AN. NUR FAUZIAH LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
86 22/09/19 TN. RIZAL ADI LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 191,000 14,000
87 24/09/19 NY. HASLIA LL Kolesterol 36,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 53,000 10,000
88 24/09/19 NY.HJ. MANUSIA RD Asam Urat 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 14,000 141,000 14,000
89 24/09/19 TN. ANWAR AM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
90 24/09/19 AN. RAIKA AK Widal 28,000
Darah Rutin 64,000
IgG/IgM 150,000
L 7,000 7,000
BHP 3,000 3,000
Spoit + Tempat 14,000 266,000 14,000
91 24/09/19 NY. SUKRIA AM Kolesterol 36,000
 L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000

TOTAL 17,179,000 17,179,000 413,000 2,439,000

-

Rincian Rawat Inap 8,095,000 8,095,000 -

Jasa Laboran 1,497,726 Rawat Jalan 9,445,000 9,445,000 -
Total Bruto 17,540,000 17,540,000 -

dr. Nur Rahmi, Sp. PK 1,497,726.00

Reagensia 5,722,300.00
Jasa Klinik 4,496,470.00
BHP 2,439,000.00
L 413,000
6,935,470.00
OKTOBER 2019 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17
-
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00

100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00

3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
- - L - - - SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
- - L - - - NR
NR
K NR
K NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
 K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 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
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
SR
K SR
K SR
SR
SR
SR
SR
SR
 SR
SR
SR
SR
SR

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR

K
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
- - - - SR
K SR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00

K
 K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00
NR
K NR
K NR
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
NR
K
 K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
- - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - - - NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
9,500 80,500.00 44,275.00 36,225.00 L 14,490.00 14,490.00 7,245.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
 K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - - SR
K SR
K SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00
- - - - -
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
 SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
- - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
- - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K
5,000 15,000.00 8,250.00 6,750.00 L 2,700.00 2,700.00 1,350.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
- - - - -
K
K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00
- - - - -
K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00

K
K
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00
- - - -
K
K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00

K
K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00
- - - - -
K
K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00
 K
K

5,722,300 8,175,400 4,496,470 3,678,930 - 1,497,726 1,497,726 748,863

-
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN novembe
KODE HARGA

TOTAL
NO TGL NAMA PASIEN URAIAN TARIF BAYAR
dr L

1 2 3 4 5 6 7 8
RAWAT INAP
1 25/10/2019 NN.PUTRI AKILA EI Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
Widal 28,000
L 8,000 8,000
BHP 8,000
Spoit + Tempat 20,000 342,000
2 24/10/2019 AN.NAIFA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
3 26/10/2019 NY.RIRIN TRIANA AB Darah Rutin 64,000
Golongan Dara 17,000
L 4,000 4,000

BHP 4,000
Spoit + Tempat 10,000 99,000
4 26/10/2019 NY.AULIA AB Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 9,000 9,000
BHP 4,000
Spoit + Tempat 10,000 258,000
5 23/10/2019 AN.MUH.SAPPEWALI AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
6 27/10/2019 BY.ALIKA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
7 23/10/2019 NN.NABILA EI Darah Rutin 64,000
Darah Rutin 64,000
Urine Rutin 50,000
Urine Rutin 50,000
Widal 28,000
L 9,000 9,000
BHP 8,000
Spoit + Tempat 20,000 293,000
8 10/27/2019 Ny. Nabila EI Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
 SGPT 33,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 316,000
8 28/10/2019 AN.MAULANA AK Darah Rutin 64,000
Darah Rutin 64,000
L 6,000 6,000
BHP 8,000
Spoit + Tempat 20,000 162,000
9 28/10/2019 AN.NUR ZAM ZAM AK Darah Rutin 64,000
Darah Rutin 64,000
L 6,000 6,000
BHP 8,000
Spoit + Tempat 20,000 162,000
10 28/10/2019 AN.MUH.KAUSAR AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
11 29/10/2019 NY.HJ.JAMALIA SW Darah Rutin 64,000
GDS 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
Asam Urat 33,000
L 9,000 9,000
BHP 4,000
Spoit + Tempat 15,000 282,000
12 27/10/2019 NY.IMA SYAHRIANI AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000

L 9,000 9,000

BHP 6,000
Spoit + Tempat 25,000 350,000
13 10/31/2019 HJ. NURMA AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000

L 16,000 16,000

BHP 6,000
Spoit + Tempat 25,000 454,000
14 11/1/2019 NY. ARMINA AB Darah Rutin 64,000
 L 1,000 1,000

BHP 2,000
Spoit + Tempat 10,000 77,000
13 1/11/2019 NY.A.ASARAFA FI Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 95,000
14 31/10/2019 AN.RESKY AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
15 30/10/2019 AN.AFIKA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
16 1/11/2019 AN. NUR JAWHARA AK Darah Rutin 64,000
Widal 28,000

L 6,000 6,000

BHP 2,000
Spoit + Tempat 10,000 110,000
17 3/11/2019 NY.RAHMATIA EI Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
Elektrolit 252,000
Elektrolit 252,000
L 21,000 21,000
BHP 11,000
Spoit + Tempat 35,000 1,049,000
18 2/11/2019 NY.BIBIT LESTARI SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
GDS 33,000
Widal 28,000
L 7,000 7,000
BHP 5,000
Spoit + Tempat 20,000 318,000
19 4/11/2019 BY.MUH.ABIDZAR AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
20 3/11/2019 BY.SOFI AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
21 5/11/2019 BY.M.ILMAN FAUZI AK Darah Rutin 64,000
L 1,000 1,000

BHP 2,000
Spoit + Tempat 10,000 77,000
22 4/11/2019 NY.ANDI FATIMAH EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
IgG/IgM 150,000
Malaria 80,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
Widal 28,000
Urine Rutin 50,000
L 15,000 15,000
BHP 6,000
Spoit + Tempat 30,000 785,000
23 5/11/2019 TN.MUH.ARSY EI Darah Rutin 64,000
GDS 33,000
Widal 28,000

L 7,000 7,000

BHP 8,000
Spoit + Tempat 20,000 160,000
24 8/11/2019 TN.AKBAR EI Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
IgG/IgM 150,000
Widal 28,000
L 9,000 9,000
BHP 8,000
Spoit + Tempat 20,000 376,000
25 8/11/2019 NY.DIAH EI Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
IgG/IgM 150,000
Widal 28,000
L 9,000 9,000
BHP 8,000
Spoit + Tempat 20,000 376,000
26 8/11/2019 NY.ISA EI Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 9,000 9,000
BHP 8,000
Spoit + Tempat 25,000 172,000
27 7/11/2019 AN.AKILA AK Darah Rutin 64,000
GDS 22,000
Urine Rutin 50,000
Widal 28,000
L 3,000 3,000
BHP 2,000
 Spoit + Tempat 13,000 182,000
28 8/11/2019 NY.NUNI EI Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
IgG/IgM 150,000
Widal 28,000
Widal 28,000
L 8,000 8,000
BHP 2,000
Spoit + Tempat 10,000 376,000
29 11/11/2019 BY. BAYYED AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
29 10/11/2019 AN.ASRAF KR Darah Rutin 64,000
GDS 22,000
L 5,000 5,000
BHP 3,000
Spoit + Tempat 10,000 104,000
30 10/11/2019 AN.MIRZA AK Darah Rutin 64,000
GDS 33,000
Widal 28,000
L 7,000 7,000
BHP 4,000
Spoit + Tempat 10,000 146,000
31 9/11/2019 AN.ADIBA AK Darah Rutin 64,000
GDS 22,000
L 5,000 5,000
BHP 3,000
Spoit + Tempat 10,000 104,000
32 10/11/2019 NY.FARIDA ANDRIANI EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
IgG/IgM 150,000
IgG/IgM 150,000
Kolesterol 36,000
Widal 28,000
L 8,000 8,000
BHP 5,000
Spoit + Tempat 20,000 622,000
33 11/14/2019 hj. NANI AF Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
IgG/IgM 150,000
Malaria 80,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
Widal 28,000
L 28,000 28,000
BHP 7,000
Spoit + Tempat 35,000 754,000
33 14/11/2019
AN.RIKSAN PUTRA SABARA AK Darah Rutin 64,000
L 1,000 1,000

BHP 2,000
Spoit + Tempat 10,000 77,000
34 11/16/2019 TN.H.M.YUSUF EI Darah Rutin 64,000
GDS 33,000
SGOT 33,000
SGPT 33,000
Widal 28,000

L 3,000 3,000

BHP 2,000
Spoit + Tempat 10,000 206,000
34 18/11/2019 NY.EVI KASMAWATI AB Darah Rutin 64,000
Golongan Dara 17,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 99,000
35 11/18/2019 NY. FEBRINA AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 14,000 14,000
BHP 6,000
Spoit + Tempat 20,000 350,000
35 19/11/2019 NY.NURFIAH AB Darah Rutin 64,000
Golongan Dara 17,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 99,000
36 20/11/2019 AN.QUMAIRAH AK Widal 28,000
Darah Rutin 64,000
L 4,000 4,000
BHP 2,000
Spoit + Tempat 13,000 111,000
37 19/11/2019 TN.MISBAHUDDIN EI Darah Rutin 64,000
GDS 33,000
SGOT 33,000
SGPT 33,000
TCM 40,000
Widal 28,000
L 6,000 6,000
BHP 5,000
Spoit + Tempat 20,000 262,000
38 20/11/2019 NY.A.TENRI ABENG EI Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000
Spoit + Tempat 14,000 175,000
39 11/22/2019 NY. SUBAEDAH AM Darah Rutin 64,000
 Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
IgG/IgM 150,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
Elektrolit 252,000
L 27,000 27,000
BHP 11,000
Spoit + Tempat 35,000 953,000
39 23/12/2019 MY.HJ,ROHANI AF Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000
Spoit + Tempat 10,000 171,000
40 11/23/2019 TN. YUSUF SW Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 4,000
Spoit + Tempat 10,000 175,000
40 22/11/2019 NY.NINING AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
41 24/11/2019 NY.ST.MUSLINAH WT Darah Rutin 64,000
Golongan Dara 17,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 99,000
51 11/16/2019 TN. AHMAD TOLAI AM Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 233,000
52 11/15/2019 NY.IIE AM Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
Kreatinin 33,000
 SGOT 33,000
SGPT 33,000
L 10,000 10,000
BHP 6,000
Spoit + Tempat 25,000 448,000
53 16/11/19 NY. MSKURATI AM Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
54 14/11/19 TN> ABD RASYID A AM Darah Rutin 64,000
Kolesterol 36,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 9,000 9,000
BHP 4,000
Spoit + Tempat 20,000 298,000

RAWAT JALAN
1 26/10/2019 SUHERNA EI Darah Rutin 64,000
GDS 22,000
SGOT 33,000
SGPT 33,000
Asam Urat 33,000
L 8,000 8,000
BHP 3,000
Spoit + Tempat 15,000 211,000
2 26/10/2019 TN.MUHAMMAD LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 196,000
3 26/10/2019 NY.WAHYUNI AM Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
4 28/10/2019 TN.ZAMIR FAHMI LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 14,000 191,000
5 28/10/2019 NN.ANDI RISKA RD Darah Rutin 64,000
Kolesterol 36,000
Widal 28,000
GDS 22,000
L 8,000 8,000
BHP 2,000
Spoit + Tempat 15,000 175,000
6 28/10/2019 NY.HARDIANTI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
7 28/10/2019 NY.HJ,FADILAH LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 5,000 103,000
8 28/10/2019 NY.HJ.HASNA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
9 29/10/2019 NY.FATIMAH KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
10 29/10/2019 NY.HJ.NURSIANG LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
11 30/10/2019 AN.FATIR LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 187,000
12 30/10/2019 NY.HASMA RD Darah Rutin 64,000
HBSAG 90,000
Plano Test 25,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 198,000
13 30/10/2019 NY.HARTATI AA Darah Rutin 64,000
Kolesterol 36,000
Widal 28,000
GDS 22,000
L 8,000 8,000
BHP 2,000
Spoit + Tempat 15,000 175,000
14 31/10/2019 TN.BURHAN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
15 31/10/2019 TN.ABD.SALAM RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
 L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
16 31/10/2019 NY.JUARYA KR Kolesterol 36,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 49,000
17 31/10/2019 TN.SURYANI LL GDS 33,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 46,000
18 11/01/19 HJ.RAMASIA KR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
19 11/01/19 NY.NABILA EI Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
20 11/01/19 TN.YOHANNES EI Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
21 11/01/19 TN.H.HASAN EI Asam Urat 33,000
Urine Rutin 50,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 14,000 101,000
22 11/01/19 AN.ATIFA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
23 11/01/19 AN. NURFAQIHAH LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 196,000
24 11/01/19 AN.M.ALIF AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
25 11/01/19 NN.WARDA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 8,000 8,000
BHP 4,000
Spoit + Tempat 20,000 204,000
26 11/01/19 AN.NAILA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
27 11/02/19 NY.METTI IR Widal 28,000
Darah Rutin 64,000
Kolesterol 36,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 15,000 148,000
28 11/04/19 AN.HUSNA RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
29 11/04/19 TN.YUDI RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
30 11/04/19 AN.DESTA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
31 11/04/19 NN.TRIMILDANI AA Darah Rutin 64,000
Asam Urat 33,000
GDS 33,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 14,000 149,000
32 11/04/19 TN.M.RIFAI LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
33 11/04/19 TN.HAMRULLAH LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
34 11/04/19 TN.HERI LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
35 11/04/19 TN.ADAM HIDAYAT LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
36 11/04/19 TN.ALLI LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
37 11/04/19 TN.ISKANDAR LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
38 11/04/19 TN.GANDI LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
39 11/04/19 TN.M.NARLAN LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
 Spoit + Tempat 10,000 34,000
40 11/04/19 TN.HUSEN LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
41 11/04/19 TN.ANSAR LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
42 11/05/19 NY.HJ.NURHUDA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
43 11/05/19 AN.ALFAR RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
44 11/05/19 NY.HERLINA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
45 11/05/19 TN.HAERUL SW Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
46 11/06/19 TN.ZABIR IM Kolesterol 36,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 50,000
47 11/06/19 NY.HJ.HASNA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
48 12/07/19 TN.BURHAN LL Kolesterol 36,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 53,000
49 12/07/19 NY.RISKA RD Widal 28,000
Darah Rutin 64,000
IgG/IgM 150,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 266,000
51 12/07/19 TN.HUSAIN RD Darah Rutin 64,000
SGOT 33,000
SGPT 33,000
L 5,000 5,000
BHP 3,000
Spoit + Tempat 11,000 149,000
52 12/07/19 PARADIBA LL Widal 28,000
Darah Rutin 64,000
 Malaria 80,000
L 6,000 6,000
BHP 4,000
Spoit + Tempat 10,000 192,000
53 11/08/19 TN.ASRADI KR Kolesterol 36,000
GDS 22,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 76,000
54 11/09/19 NY.WARNI RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 49,000
55 11/09/19 NY.SAKINAH RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
56 11/09/19 NY.HJ,NISMA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 106,000
57 11/09/19 AN.KHAIRUNNISA IR Darah Rutin 64,000
IgG/IgM 150,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 232,000
58 11/09/19 TN.ROHANDI IR Widal 28,000
Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 15,000 170,000
59 11/11/19 NY.HJ.MULIANI KR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 83,000
60 11/11/19 NY.LISWATI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
61 11/11/19 TN.ABD.SOMAD LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
62 11/11/19 AN.ARIF MAULANA KR Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
63 11/11/19 TN.H.BASRI EI Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
64 11/11/19 TN.HASBI KR Kolesterol 36,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 15,000 58,000
65 11/12/19 NN.ARMA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 190,000
66 11/12/19 NY.SELFI KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
67 13/11/2019 TN.PATU RAHMAN LL Kolesterol 36,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 4,000 44,000
68 13/11/2019 TN.TORO EI Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 10,000 149,000
69 14/11/2019 TN.ALDI FEBRIANSY LL Darah Rutin 64,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 81,000
70 14/11/2019 TN.NUR KEONG IM GDS 33,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 50,000
71 14/11/19 NY.WANA LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 83,000
72 15/11/19 NY/FERAWATI AM Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 10,000 118,000
73 15/11/19 TN.H.AHMAD.TOLAI EI Ureum 33,000
Kreatinin 33,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 15,000 254,000
74 15/11/19 AN.A.CELLA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
75 16/11/19 NY.HJ.ST.HAJAR LL Darah Rutin 64,000
Kolesterol 36,000
GDS 33,000
L 6,000 6,000
BHP 7,000
Spoit + Tempat 15,000 161,000
76 16/11/19 TN.MASRULLAH LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 49,000
77 18/11/19 TN.TAMRIN RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
78 18/11/19 AN.MIKAEL LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
79 18/11/2019 TN.NAJAMUDIN LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
80 18/11/2019 NY.SANTI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 14,000 204,000
81 18/11/2019 NY.MUSLIATI EI Kolesterol 36,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 50,000
82 18/11/2019 NY.HARISA IM Kolesterol 36,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 50,000
83 18/11/2019 NY.P.INDRI EI GDS 33,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 5,000
Spoit + Tempat 14,000 149,000
84 18/11/2019 TN.AHMAD RD Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
85 19/11/2019 NY.ASIZAH RD Darah Rutin 64,000
 Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
86 19/11/2019 NY.YULIANA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
87 20/11/2019 DERA LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 5,000
Spoit + Tempat 5,000 104,000
88 20/11/2019 NY.IIE EI Darah Rutin 64,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 81,000
89 20/11/2019 TN.IR.MUSTAJI AN AA GDS 33,000
L 1,000 1,000
BHP 1,000
Spoit + Tempat 5,000 40,000
90 20/11/2019 TN.AHMAD EI GDS 22,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 8,000 33,000
91 21/11/2019 TN.MUSLIM AM Kolesterol 36,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 50,000
92 21/11/2019 AN.M.AGUNG PRAT LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 196,000
93 21/11/2019 AN.RARA PERMANA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 196,000
94 22/11/2019 NY.LENI IFANI LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 3,000
Spoit + Tempat 14,000 111,000
95 22/11/2019 TN.AHMAD LL Kolesterol 36,000
GDS 33,000
L 6,000 6,000
BHP 5,000
Spoit + Tempat 20,000 100,000
96 22/11/2019 TN.BAHARUDDIN LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
 Spoit + Tempat 14,000 110,000
97 23/11/2019 NY.HJ.YULI AF Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 87,000
98 25/11/2019 TN.AHMAD LL Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
Asam Urat 33,000
L 10,000 10,000
BHP 5,000
Spoit + Tempat 20,000 273,000
99 25/11/2019 DEWI AF Darah Rutin 64,000
IgG/IgM 150,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 228,000
100 25/11/2019 NY.FESTI AF Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 106,000
101 25/11/2019 TN.GAZALI AF Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 106,000
102 25/11/2019 TN.AHMAD EI Kolesterol 36,000
L 6,000 6,000
BHP 2,000
Spoit + Tempat 10,000 54,000

TOTAL 24,272,000 24,272,000 743,000

-

Rincian Rawat Inap 13,204,000 13,204,000

Jasa Laboran 2,071,620 Rawat Jalan 11,068,000 11,068,000
Total Bruto 24,272,000 24,272,000

dr. Nur Rahmi, Sp. PK 2,071,620.00

Reagensia 8,719,000.00
Jasa Klinik 6,329,950.00
BHP 3,301,000.00
L 743,000
9,630,950.00
A POLEWALI BULAN november 2019 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

TOTAL JASA KD AN PJ
KLINIK REAGEN KLINIK 55% PEMB. LAB 45%
40%

9 10 11 12 13 14 15

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
8,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
8,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
8,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
8,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
6,000 K
25,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
6,000 K
25,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
 - - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
252,000 - - L -
252,000 - - L -
- - -
11,000 K
35,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
5,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
- - -
6,000 K
30,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
8,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
8,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
8,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
- - -
8,000 K
25,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
2,000 K
13,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
5,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
7,000 K
35,000 K
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
6,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
4,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00

2,000 K
13,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
40,000 - - L -
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
5,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
252,000 - - L -
- - -
11,000 K
35,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
6,000 K
25,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
4,000 K
20,000 K

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00

5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
3,000 K
15,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
2,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
15,000 K
 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
5,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
9,500 80,500.00 44,275.00 36,225.00 L 14,490.00
25,000
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
 4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
10,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00

2,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
2,000 K
14,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
- - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
3,000 K
11,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
 60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
- - -
4,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
15,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
4,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
- - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00

2,000 K
10,000 K
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
- - -
3,000 K
10,000 K
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
2,000 K
15,000 K
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
7,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
10,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

5,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

5,000 K
5,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00

1,000 K
5,000 K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
8,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
15,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
5,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
 14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
5,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
10,000 K

3,301,000 8,719,000 11,509,000 6,329,950 5,179,050 - 2,071,620

-
-
-
JASA

Dokter
LABORAN Pengirim
40 % 20 %

16 17
-
5,760.00 2,880.00 NR
5,760.00 2,880.00
9,000.00 4,500.00
4,410.00 2,205.00
- - NR
NR
NR
5,760.00 2,880.00 SR
- - SR
SR
SR
5,760.00 2,880.00 DR,GOLDA
2,160.00 1,080.00
- -

5,760.00 2,880.00 DR,GOLDA,GDS,URE,CREA,SGOT,SGPT

2,160.00 1,080.00
2,916.00 1,458.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR (2X),WIDAL,UR(2X),

5,760.00 2,880.00
7,560.00 3,780.00
7,560.00 3,780.00
4,410.00 2,205.00
- -

5,760.00 2,880.00
5,760.00 2,880.00
2,160.00 1,080.00
2,916.00 1,458.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00 DR (2X),WIDAL,UR(2X),

5,760.00 2,880.00
- -

5,760.00 2,880.00 DR2X

5,760.00 2,880.00
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR,GDS,KOL,AU,GDP,UREUM,CREA

2,340.00 1,170.00 10/8/1900 282
2,916.00 1,458.00
4,140.00 2,070.00
3,510.00 1,755.00
4,644.00 2,322.00
4,230.00 2,115.00
- -

5,760.00 2,880.00 DR,GOLDA,GDS ,UREUM,CREA,SGOT,SGPT

5,760.00 2,880.00
2,160.00 1,080.00
2,340.00 1,170.00 350
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00
5,760.00 2,880.00
2,160.00 1,080.00
5,760.00 2,880.00
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00
 - -

5,760.00 2,880.00 DR,GOLDA

2,160.00 1,080.00
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR
4,410.00 2,205.00
- -

5,760.00 2,880.00 GOLDA (2X),DR,GDS(2),KOL,AU,URE (2X),CREA(2X),SGOT,SGPT ,ELECTOLIT(2X) RSUD

5,760.00 2,880.00
2,160.00 1,080.00 1,049,000
2,340.00 1,170.00
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
4,644.00 2,322.00
4,230.00 2,115.00
- -
- -
- -

5,760.00 2,880.00 DR (3X),GDS(2X),WIDAL,

5,760.00 2,880.00
5,760.00 2,880.00
2,340.00 1,170.00 318,000
2,340.00 1,170.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR
- -
5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR (4X) TES MALARIA, IGGGM ,URIN,WIDAL,GDS,KOL,AU,UR.CREA,SGOT,SGPT

5,760.00 2,880.00
5,760.00 2,880.00 785
2,340.00 1,170.00
9,000.00 4,500.00
3,600.00 1,800.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
4,644.00 2,322.00
4,230.00 2,115.00
4,410.00 2,205.00
7,560.00 3,780.00
- -

5,760.00 2,880.00 DR,GDS STRIP,WIDAL

2,340.00 1,170.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR (2X),GDS STRIP,WIDAL,IGGGM

5,760.00 2,880.00
2,340.00 1,170.00
9,000.00 4,500.00 376,000
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR (2X),GDS STRIP,WIDAL,IGGGM

5,760.00 2,880.00
2,340.00 1,170.00
9,000.00 4,500.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR,UR,CERA

4,140.00 2,070.00
3,510.00 1,755.00
- -

5,760.00 2,880.00 DR,WIDAL,UR

2,916.00 1,458.00
7,560.00 3,780.00 182,000
4,410.00 2,205.00
- -
5,760.00 2,880.00 DR (2X),GDS STRIP,WIDAL (2X),IGGGM
5,760.00 2,880.00
2,916.00 1,458.00 376
9,000.00 4,500.00
4,410.00 2,205.00
4,410.00 2,205.00
- -

5,760.00 2,880.00
- -

5,760.00 2,880.00 DR,GDS

2,916.00 1,458.00
- -

5,760.00 2,880.00 DR(2X)

2,340.00 1,170.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR,GDS

2,916.00 1,458.00
- -

5,760.00 2,880.00 DR,WIDAL,IGGGM,KOL

5,760.00 2,880.00
5,760.00 2,880.00
2,340.00 1,170.00
9,000.00 4,500.00 622
9,000.00 4,500.00
4,644.00 2,322.00
4,410.00 2,205.00
- -

5,760.00 2,880.00
5,760.00 2,880.00
5,760.00 2,880.00
2,340.00 1,170.00
9,000.00 4,500.00
3,600.00 1,800.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
4,644.00 2,322.00
4,230.00 2,115.00
4,410.00 2,205.00
- -
5,760.00 2,880.00 DR
- -

5,760.00 2,880.00
2,340.00 1,170.00
4,590.00 2,295.00
4,590.00 2,295.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR,GOLDA

2,160.00 1,080.00
- -

5,760.00 2,880.00
5,760.00 2,880.00
2,160.00 1,080.00
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00 DR,GOLDA

2,160.00 1,080.00
- -

4,410.00 2,205.00 DR,WIDAL

5,760.00 2,880.00

5,760.00 2,880.00 DR,GDS,WIDAL,OT,PT,TCM

2,340.00 1,170.00
4,590.00 2,295.00 262,000
4,590.00 2,295.00
- -
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR,GDS,KOL,AU

4,644.00 2,322.00
4,230.00 2,115.00
2,916.00 1,458.00 176,000
- -

5,760.00 2,880.00
5,760.00 2,880.00
2,160.00 1,080.00
2,340.00 1,170.00
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
9,000.00 4,500.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
4,644.00 2,322.00
4,230.00 2,115.00
- -
- -

5,760.00 2,880.00 DR,GDS,KOL,AU

4,644.00 2,322.00
4,230.00 2,115.00
2,916.00 1,458.00
- -

5,760.00 2,880.00
4,644.00 2,322.00
4,230.00 2,115.00
2,916.00 1,458.00
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR,GOLDA

2,160.00 1,080.00
- -

5,760.00 2,880.00
2,916.00 1,458.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00
5,760.00 2,880.00
2,160.00 1,080.00
5,760.00 2,880.00
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00
- -

5,760.00 2,880.00
4,644.00 2,322.00
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00 DR,GDS,AU,OT,PT

2,916.00 1,458.00
4,590.00 2,295.00
4,590.00 2,295.00
4,230.00 2,115.00
- -

4,410.00 2,205.00 DR,WIDAL.DDR

5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00 DR
- -

4,410.00 2,205.00 DR,TES MALARIA ,WIDAL

5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00 DR,GDS,KOL,WIDAL

4,644.00 2,322.00 175,000
4,410.00 2,205.00
2,916.00 1,458.00
- -
 4,644.00 2,322.00 GDS ,KOL,AU
4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

5,760.00 2,880.00
4,410.00 2,205.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,410.00 2,205.00
5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00 DR,PLANO TEST , HBS AG

14,490.00 7,245.00

- -

5,760.00 2,880.00 DR,GDS,KOL,AU

4,644.00 2,322.00
4,410.00 2,205.00
2,916.00 1,458.00
- -

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00
4,644.00 2,322.00 KOL

2,340.00 1,170.00 GDS STRIP

5,760.00 2,880.00 GDS,KOL,AU

4,410.00 2,205.00

4,644.00 2,322.00 DR,WIDAL

4,230.00 2,115.00
2,916.00 1,458.00

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

4,230.00 2,115.00 UR,AU

7,560.00 3,780.00

5,760.00 2,880.00 DR
- -

4,410.00 2,205.00 DR,TES MALARIA,WIDAL

5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00 DR
- -

4,410.00 2,205.00 DR,WIDAL,DDR

5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00
4,410.00 2,205.00 DR,KOL,WIDAL
5,760.00 2,880.00
4,644.00 2,322.00
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

5,760.00 2,880.00 DR,GDS ,AU

4,230.00 2,115.00
2,340.00 1,170.00
- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -
2,160.00 1,080.00 GOLDA
- -

2,160.00 1,080.00 GOLDA

- -

5,760.00 2,880.00 GDS,KOL,AU

- -

5,760.00 2,880.00 DR
- -

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 DR,WIDAL K'RAHMA300.000

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS STRIP

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 KOL

4,410.00 2,205.00 DR,WIDAL,IGGGM

5,760.00 2,880.00
9,000.00 4,500.00
- -

5,760.00 2,880.00 DR,OT,PT

4,590.00 2,295.00
4,590.00 2,295.00
- -

4,410.00 2,205.00 DR,WIDAL/TES MALARIA

5,760.00 2,880.00
3,600.00 1,800.00
- -

4,644.00 2,322.00 GDS,KOL

2,916.00 1,458.00

4,644.00 2,322.00 KOL

5,760.00 2,880.00 DR
- -

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

5,760.00 2,880.00 DR,IGGGM

9,000.00 4,500.00
- -

4,410.00 2,205.00 DR,GDS,KOL,WIDAL

5,760.00 2,880.00
4,644.00 2,322.00
2,916.00 1,458.00
- -

4,644.00 2,322.00 KOL,AU

4,230.00 2,115.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00
5,760.00 2,880.00 DR,WIDAL
4,410.00 2,205.00

4,644.00 2,322.00 KOL

4,410.00 2,205.00 DR,WIDAL,DDR

5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00
- -

4,644.00 2,322.00 KOL

5,760.00 2,880.00 DR,UR,CERA

4,140.00 2,070.00
3,510.00 1,755.00
- -

5,760.00 2,880.00 DR
- -

2,340.00 1,170.00 GDS STRIP

4,644.00 2,322.00 KOL,AU

4,230.00 2,115.00

4,230.00 2,115.00 AU,URE,CREA

4,140.00 2,070.00
3,510.00 1,755.00
- -

4,140.00 2,070.00 DR,GDS STRIP,KOL,AU,UR,CREA DR.EMMY 150000

3,510.00 1,755.00
5,760.00 2,880.00
4,644.00 2,322.00
4,230.00 2,115.00
2,340.00 1,170.00
- -
5,760.00 2,880.00 DR,WIDAL
4,410.00 2,205.00

5,760.00 2,880.00 DR,KOL,GDS

4,644.00 2,322.00
2,340.00 1,170.00
- -

4,644.00 2,322.00 KOL

- -

5,760.00 2,880.00
4,410.00 2,205.00

5,760.00 2,880.00
4,410.00 2,205.00

2,160.00 1,080.00 GOLDA

- -

4,644.00 2,322.00 DR,GDS,KOL,AU,WIDAL

4,230.00 2,115.00
2,916.00 1,458.00
5,760.00 2,880.00
4,410.00 2,205.00

4,644.00 2,322.00 GDS STRIP

- -

4,644.00 2,322.00 GDS STRIP

- -

2,340.00 1,170.00 DR,GDS STRIP,WIDAL

5,760.00 2,880.00
4,410.00 2,205.00

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

5,760.00 2,880.00 DR
- -

2,340.00 1,170.00 GDS STRIP

2,916.00 1,458.00 GDS

4,644.00 2,322.00 GDS STRIP

- -

4,410.00 2,205.00 DR,WIDAL,DDR

5,760.00 2,880.00
3,600.00 1,800.00
- -

4,410.00 2,205.00 DR,WIDAL,DDR

5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

4,644.00 2,322.00 GDS STRIP2X

2,340.00 1,170.00
- -

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00
 4,644.00 2,322.00 KOL,AU
4,230.00 2,115.00

5,760.00 2,880.00 DR,GOLDA,GDS,KOL,AU,UR,CREA

2,160.00 1,080.00
2,916.00 1,458.00
4,140.00 2,070.00 273
3,510.00 1,755.00
4,644.00 2,322.00
4,230.00 2,115.00
- -

5,760.00 2,880.00 DR,IGG IGM

9,000.00 4,500.00
- -

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS STRIP

- -

2,071,620 1,035,810
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN Desember 201
KODE HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

dr BAYAR L

1 2 3 4 5 6 7 8
RAWAT INAP
1 26/11/2019 NY.HANAWIAH RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000

GDS 22,000
L 6,000 6,000
BHP 4,000
Spoit + Tempat 20,000 212,000
26/11/2019 NY.NASRAH AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 95,000
24/11/2019 BY.ADLIN FAUZAN AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000

4 25/11/2019 NY.ST.DARASIA EI Darah Rutin 64,000

GDS 33,000
Ureum 33,000
Kreatinin 33,000

L 8,000 8,000

BHP 8,000
Spoit + Tempat 20,000 199,000
5 25/11/2019 TN.TANDA EI GDS 33,000
Elektrolit 250,000
L 7,000 7,000
BHP 6,000
Spoit + Tempat 15,000 311,000
6 28/11/2019 NY.SRI WAHYUNI AB Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 95,000
7 26/11/2019 AN.DEWI QUMAIRA AK Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 20,000 185,000
8 28/11/2019 NY.ASMIAH AB Darah Rutin 64,000
L 1,000 1,000

BHP 2,000
Spoit + Tempat 10,000 77,000
9 27/11/2019 NY.HJ.DARMA Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Urine Rutin 50,000

L 10,000 10,000

BHP 3,000
Spoit + Tempat 10,000 355,000
 29/11/2019 NY.NIA INDRAWATI AB Darah Rutin 64,000
Golongan Dara 17,000
L 4,000 4,000

BHP 4,000
Spoit + Tempat 10,000 99,000
1/12/2019 NY.ST.NURHAYATI SW Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000

L 4,000 4,000

BHP 4,000
Spoit + Tempat 12,000 172,000
2/12/2019 NY. ANDI KUSTIA EI Urine Rutin 50,000

L 1,000 1,000

BHP 2,000
Spoit + Tempat 10,000 63,000
3/12/2019 NY.RAHMATIA SW Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
Asam Urat 33,000
L 7,000 7,000
BHP 2,000
Spoit + Tempat 13,000 243,000
2/12/2019 TN.AGUS PRANOTO EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
Widal 28,000

GDS 22,000
L 15,000 15,000

BHP 9,000
Spoit + Tempat 40,000 520,000
2/12/2019 NY.NINING AB Darah Rutin 64,000
L 4,000 4,000

BHP 3,000
Spoit + Tempat 10,000 81,000
3/12/2019 NN. FAHIRA ULFA SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
GDS 22,000
L 10,000 10,000
BHP 15,000
Spoit + Tempat 40,000 493,000
4/12/2019 AN. JAUHARA RD Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Widal 28,000
L 10,000 10,000
BHP 9,000
Spoit + Tempat 22,000 214,000
5 7/12/2019 NY,NURSAMASA AA Darah Rutin 64,000
GDS 22,000
Elektrolit 250,000
Kolesterol 36,000
Asam Urat 33,000
L 10,000 10,000
BHP 5,000
Spoit + Tempat 25,000 445,000
 9/12/2019 NY.CITRA AA Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 5,000 5,000
BHP 5,000
Spoit + Tempat 10,000 175,000
11/12/2019 TN.NURDIN RD/AA Darah Rutin 64,000
GDS 33,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 115,000
10/12/2019 AN.MUH.FANNES IR Darah Rutin 64,000
LED 45,000
L 4,000 4,000

BHP 4,000
Spoit + Tempat 15,000 132,000
11/12/2019 NY.HJ.RIA AA Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 5,000 5,000
BHP 5,000
Spoit + Tempat 15,000 180,000
12/12/2019 AN.MUDAFFAR HAFI AK Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 3,000
Spoit + Tempat 15,000 115,000
14/12/2019 AN.AHMAD YASANI AK Darah Rutin 64,000
L 4,000 4,000
BHP 3,000
Spoit + Tempat 15,000 86,000
15/12/2019 AN.ZAFRAN AK Widal 261,000
15/12/2019 AN.AIDIL AK L 191,000 191,000
18/!2/2019 NY.NURASIA IM BHP
TN.H.ABD.LATIF IM Spoit + Tempat Darah 653,000
8 NY.SRI MARYATI IM Darah Rutin
17/12/2019 AN.MUH.RAYYAN AK Darah Rutin 162,000
16/12/2019 NN. NABILA EI Golongan Dara 387,000
18/12/2019 TN.MUSTAKIN EI GDS 1,110,000
20/12/2019 NY.MUINEM IM Ureum
18/12/2019 AN.A.RARAS AK Kreatinin 77,000
19/12/2019 NY.SUNARIYAH AB SGOT 261,000
19/12/2019 AN.IPAH CHANDRA IB SGPT 95,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 2,109,000
8 28/10/2019 AN.MAULANA AK Darah Rutin 64,000
Darah Rutin 64,000
L 6,000 6,000
BHP 8,000
Spoit + Tempat 20,000 162,000
9 28/10/2019 AN.NUR ZAM ZAM AK Darah Rutin 64,000
Darah Rutin 64,000
L 6,000 6,000
BHP 8,000
Spoit + Tempat 20,000 162,000
10 28/10/2019 AN.MUH.KAUSAR AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
11 29/10/2019 NY.HJ.JAMALIA SW Darah Rutin 64,000
GDS 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
Asam Urat 33,000
 L 9,000 9,000
BHP 4,000
Spoit + Tempat 15,000 282,000
12 27/10/2019 NY.IMA SYAHRIANI AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000

L 9,000 9,000

BHP 6,000
Spoit + Tempat 25,000 350,000
13 10/31/2019 HJ. NURMA AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000

L 16,000 16,000

BHP 6,000
Spoit + Tempat 25,000 454,000
14 11/1/2019 NY. ARMINA AB Darah Rutin 64,000
L 1,000 1,000

BHP 2,000
Spoit + Tempat 10,000 77,000
13 1/11/2019 NY.A.ASARAFA FI Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 95,000
14 31/10/2019 AN.RESKY AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
15 30/10/2019 AN.AFIKA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
16 1/11/2019 AN. NUR JAWHARA AK Darah Rutin 64,000
Widal 28,000

L 6,000 6,000

BHP 2,000
Spoit + Tempat 10,000 110,000
17 3/11/2019 NY.RAHMATIA EI Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
Elektrolit 252,000
Elektrolit 252,000
 L 21,000 21,000
BHP 11,000
Spoit + Tempat 35,000 1,049,000
18 2/11/2019 NY.BIBIT LESTARI SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
GDS 33,000
Widal 28,000
L 7,000 7,000
BHP 5,000
Spoit + Tempat 20,000 318,000
19 4/11/2019 BY.MUH.ABIDZAR AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
20 3/11/2019 BY.SOFI AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
21 5/11/2019 BY.M.ILMAN FAUZI AK Darah Rutin 64,000
L 1,000 1,000

BHP 2,000
Spoit + Tempat 10,000 77,000
22 4/11/2019 NY.ANDI FATIMAH EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
IgG/IgM 150,000
Malaria 80,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
Widal 28,000
Urine Rutin 50,000
L 15,000 15,000
BHP 6,000
Spoit + Tempat 30,000 785,000
23 5/11/2019 TN.MUH.ARSY EI Darah Rutin 64,000
GDS 33,000
Widal 28,000

L 7,000 7,000

BHP 8,000
Spoit + Tempat 20,000 160,000
24 8/11/2019 TN.AKBAR EI Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
IgG/IgM 150,000
Widal 28,000
L 9,000 9,000
BHP 8,000
Spoit + Tempat 20,000 376,000
25 8/11/2019 NY.DIAH EI Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
IgG/IgM 150,000
Widal 28,000
L 9,000 9,000
BHP 8,000
Spoit + Tempat 20,000 376,000
26 8/11/2019 NY.ISA EI Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 9,000 9,000
BHP 8,000
 Spoit + Tempat 25,000 172,000
27 7/11/2019 AN.AKILA AK Darah Rutin 64,000
GDS 22,000
Urine Rutin 50,000
Widal 28,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 13,000 182,000
28 8/11/2019 NY.NUNI EI Darah Rutin 64,000
Darah Rutin 64,000
GDS 22,000
IgG/IgM 150,000
Widal 28,000
Widal 28,000
L 8,000 8,000
BHP 2,000
Spoit + Tempat 10,000 376,000
29 11/11/2019 BY. BAYYED AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
29 10/11/2019 AN.ASRAF KR Darah Rutin 64,000
GDS 22,000
L 5,000 5,000
BHP 3,000
Spoit + Tempat 10,000 104,000
30 10/11/2019 AN.MIRZA AK Darah Rutin 64,000
GDS 33,000
Widal 28,000
L 7,000 7,000
BHP 4,000
Spoit + Tempat 10,000 146,000
31 9/11/2019 AN.ADIBA AK Darah Rutin 64,000
GDS 22,000
L 5,000 5,000
BHP 3,000
Spoit + Tempat 10,000 104,000
32 10/11/2019 NY.FARIDA ANDRIANI EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
IgG/IgM 150,000
IgG/IgM 150,000
Kolesterol 36,000
Widal 28,000
L 8,000 8,000
BHP 5,000
Spoit + Tempat 20,000 622,000
33 11/14/2019 hj. NANI AF Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
GDS 33,000
IgG/IgM 150,000
Malaria 80,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
Widal 28,000
L 28,000 28,000
BHP 7,000
Spoit + Tempat 35,000 754,000
33 14/11/2019
AN.RIKSAN PUTRA SABARA AK Darah Rutin 64,000
L 1,000 1,000

BHP 2,000
Spoit + Tempat 10,000 77,000
34 11/16/2019 TN.H.M.YUSUF EI Darah Rutin 64,000
 GDS 33,000
SGOT 33,000
SGPT 33,000
Widal 28,000

L 3,000 3,000

BHP 2,000
Spoit + Tempat 10,000 206,000
34 18/11/2019 NY.EVI KASMAWATI AB Darah Rutin 64,000
Golongan Dara 17,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 99,000
35 11/18/2019 NY. FEBRINA AB Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 14,000 14,000
BHP 6,000
Spoit + Tempat 20,000 350,000
35 19/11/2019 NY.NURFIAH AB Darah Rutin 64,000
Golongan Dara 17,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 99,000
36 20/11/2019 AN.QUMAIRAH AK Widal 28,000
Darah Rutin 64,000
L 4,000 4,000
BHP 2,000
Spoit + Tempat 13,000 111,000
37 19/11/2019 TN.MISBAHUDDIN EI Darah Rutin 64,000
GDS 33,000
SGOT 33,000
SGPT 33,000
TCM 40,000
Widal 28,000
L 6,000 6,000
BHP 5,000
Spoit + Tempat 20,000 262,000
38 20/11/2019 NY.A.TENRI ABENG EI Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000
Spoit + Tempat 14,000 175,000
39 11/22/2019 NY. SUBAEDAH AM Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
IgG/IgM 150,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
Elektrolit 252,000
L 27,000 27,000
BHP 11,000
Spoit + Tempat 35,000 953,000
39 23/12/2019 MY.HJ,ROHANI AF Darah Rutin 64,000
Kolesterol 36,000
 Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 2,000
Spoit + Tempat 10,000 171,000
40 11/23/2019 TN. YUSUF SW Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 4,000
Spoit + Tempat 10,000 175,000
40 22/11/2019 NY.NINING AB Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
41 24/11/2019 NY.ST.MUSLINAH WT Darah Rutin 64,000
Golongan Dara 17,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 99,000
51 11/16/2019 TN. AHMAD TOLAI AM Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 233,000
52 11/15/2019 NY.IIE AM Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 10,000 10,000
BHP 6,000
Spoit + Tempat 25,000 448,000
53 16/11/19 NY. MSKURATI AM Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
54 14/11/19 TN> ABD RASYID A AM Darah Rutin 64,000
Kolesterol 36,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
L 9,000 9,000
BHP 4,000
Spoit + Tempat 20,000 298,000

RAWAT JALAN
1 26/10/2019 SUHERNA EI Darah Rutin 64,000
GDS 22,000
SGOT 33,000
SGPT 33,000
Asam Urat 33,000
L 8,000 8,000
 BHP 3,000
Spoit + Tempat 15,000 211,000
2 26/10/2019 TN.MUHAMMAD LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 196,000
3 26/10/2019 NY.WAHYUNI AM Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
4 28/10/2019 TN.ZAMIR FAHMI LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 14,000 191,000
5 28/10/2019 NN.ANDI RISKA RD Darah Rutin 64,000
Kolesterol 36,000
Widal 28,000
GDS 22,000
L 8,000 8,000
BHP 2,000
Spoit + Tempat 15,000 175,000
6 28/10/2019 NY.HARDIANTI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
7 28/10/2019 NY.HJ,FADILAH LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 5,000 103,000
8 28/10/2019 NY.HJ.HASNA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
9 29/10/2019 NY.FATIMAH KR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
10 29/10/2019 NY.HJ.NURSIANG LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
11 30/10/2019 AN.FATIR LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 187,000
12 30/10/2019 NY.HASMA RD Darah Rutin 64,000
HBSAG 90,000
Plano Test 25,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 198,000
13 30/10/2019 NY.HARTATI AA Darah Rutin 64,000
Kolesterol 36,000
Widal 28,000
GDS 22,000
 L 8,000 8,000
BHP 2,000
Spoit + Tempat 15,000 175,000
14 31/10/2019 TN.BURHAN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
15 31/10/2019 TN.ABD.SALAM RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
16 31/10/2019 NY.JUARYA KR Kolesterol 36,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 49,000
17 31/10/2019 TN.SURYANI LL GDS 33,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 46,000
18 11/01/19 HJ.RAMASIA KR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
19 11/01/19 NY.NABILA EI Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
20 11/01/19 TN.YOHANNES EI Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
21 11/01/19 TN.H.HASAN EI Asam Urat 33,000
Urine Rutin 50,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 14,000 101,000
22 11/01/19 AN.ATIFA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
23 11/01/19 AN. NURFAQIHAH LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 196,000
24 11/01/19 AN.M.ALIF AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
25 11/01/19 NN.WARDA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 8,000 8,000
BHP 4,000
Spoit + Tempat 20,000 204,000
26 11/01/19 AN.NAILA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
27 11/02/19 NY.METTI IR Widal 28,000
 Darah Rutin 64,000
Kolesterol 36,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 15,000 148,000
28 11/04/19 AN.HUSNA RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
29 11/04/19 TN.YUDI RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
30 11/04/19 AN.DESTA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
31 11/04/19 NN.TRIMILDANI AA Darah Rutin 64,000
Asam Urat 33,000
GDS 33,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 14,000 149,000
32 11/04/19 TN.M.RIFAI LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
33 11/04/19 TN.HAMRULLAH LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
34 11/04/19 TN.HERI LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
35 11/04/19 TN.ADAM HIDAYAT LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
36 11/04/19 TN.ALLI LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
37 11/04/19 TN.ISKANDAR LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
38 11/04/19 TN.GANDI LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
39 11/04/19 TN.M.NARLAN LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
40 11/04/19 TN.HUSEN LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
41 11/04/19 TN.ANSAR LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
42 11/05/19 NY.HJ.NURHUDA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
43 11/05/19 AN.ALFAR RD Darah Rutin 64,000
 L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
44 11/05/19 NY.HERLINA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
45 11/05/19 TN.HAERUL SW Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
46 11/06/19 TN.ZABIR IM Kolesterol 36,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 50,000
47 11/06/19 NY.HJ.HASNA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
48 12/07/19 TN.BURHAN LL Kolesterol 36,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 53,000
49 12/07/19 NY.RISKA RD Widal 28,000
Darah Rutin 64,000
IgG/IgM 150,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 266,000
51 12/07/19 TN.HUSAIN RD Darah Rutin 64,000
SGOT 33,000
SGPT 33,000
L 5,000 5,000
BHP 3,000
Spoit + Tempat 11,000 149,000
52 12/07/19 PARADIBA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 6,000 6,000
BHP 4,000
Spoit + Tempat 10,000 192,000
53 11/08/19 TN.ASRADI KR Kolesterol 36,000
GDS 22,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 76,000
54 11/09/19 NY.WARNI RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 49,000
55 11/09/19 NY.SAKINAH RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
56 11/09/19 NY.HJ,NISMA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 106,000
57 11/09/19 AN.KHAIRUNNISA IR Darah Rutin 64,000
IgG/IgM 150,000
L 4,000 4,000
BHP 4,000
 Spoit + Tempat 10,000 232,000
58 11/09/19 TN.ROHANDI IR Widal 28,000
Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 15,000 170,000
59 11/11/19 NY.HJ.MULIANI KR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 83,000
60 11/11/19 NY.LISWATI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
61 11/11/19 TN.ABD.SOMAD LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
62 11/11/19 AN.ARIF MAULANA KR Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
63 11/11/19 TN.H.BASRI EI Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
64 11/11/19 TN.HASBI KR Kolesterol 36,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 15,000 58,000
65 11/12/19 NN.ARMA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 190,000
66 11/12/19 NY.SELFI KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
67 13/11/2019 TN.PATU RAHMAN LL Kolesterol 36,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 4,000 44,000
68 13/11/2019 TN.TORO EI Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 10,000 149,000
69 14/11/2019 TN.ALDI FEBRIANSY LL Darah Rutin 64,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 81,000
70 14/11/2019 TN.NUR KEONG IM GDS 33,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 50,000
71 14/11/19 NY.WANA LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
 BHP 2,000
Spoit + Tempat 10,000 83,000
72 15/11/19 NY/FERAWATI AM Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 10,000 118,000
73 15/11/19 TN.H.AHMAD.TOLAI EI Ureum 33,000
Kreatinin 33,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 15,000 254,000
74 15/11/19 AN.A.CELLA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
75 16/11/19 NY.HJ.ST.HAJAR LL Darah Rutin 64,000
Kolesterol 36,000
GDS 33,000
L 6,000 6,000
BHP 7,000
Spoit + Tempat 15,000 161,000
76 16/11/19 TN.MASRULLAH LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 49,000
77 18/11/19 TN.TAMRIN RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
78 18/11/19 AN.MIKAEL LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
79 18/11/2019 TN.NAJAMUDIN LL Golongan Dara 17,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 34,000
80 18/11/2019 NY.SANTI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 14,000 204,000
81 18/11/2019 NY.MUSLIATI EI Kolesterol 36,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 50,000
82 18/11/2019 NY.HARISA IM Kolesterol 36,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 50,000
83 18/11/2019 NY.P.INDRI EI GDS 33,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 5,000
Spoit + Tempat 14,000 149,000
84 18/11/2019 TN.AHMAD RD Darah Rutin 64,000
Widal 28,000
 L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
85 19/11/2019 NY.ASIZAH RD Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
86 19/11/2019 NY.YULIANA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
87 20/11/2019 DERA LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 5,000
Spoit + Tempat 5,000 104,000
88 20/11/2019 NY.IIE EI Darah Rutin 64,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 81,000
89 20/11/2019 TN.IR.MUSTAJI AN AA GDS 33,000
L 1,000 1,000
BHP 1,000
Spoit + Tempat 5,000 40,000
90 20/11/2019 TN.AHMAD EI GDS 22,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 8,000 33,000
91 21/11/2019 TN.MUSLIM AM Kolesterol 36,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 50,000
92 21/11/2019 AN.M.AGUNG PRAT LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 196,000
93 21/11/2019 AN.RARA PERMANA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 196,000
94 22/11/2019 NY.LENI IFANI LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 3,000
Spoit + Tempat 14,000 111,000
95 22/11/2019 TN.AHMAD LL Kolesterol 36,000
GDS 33,000
L 6,000 6,000
BHP 5,000
Spoit + Tempat 20,000 100,000
96 22/11/2019 TN.BAHARUDDIN LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 14,000 110,000
97 23/11/2019 NY.HJ.YULI AF Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 87,000
98 25/11/2019 TN.AHMAD LL Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
 Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
Asam Urat 33,000
L 10,000 10,000
BHP 5,000
Spoit + Tempat 20,000 273,000
99 25/11/2019 DEWI AF Darah Rutin 64,000
IgG/IgM 150,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 228,000
100 25/11/2019 NY.FESTI AF Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 106,000
101 25/11/2019 TN.GAZALI AF Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 106,000
102 25/11/2019 TN.AHMAD EI Kolesterol 36,000
L 6,000 6,000
BHP 2,000
Spoit + Tempat 10,000 54,000

TOTAL 30,033,000 30,234,000 1,036,000

201,000

Rincian Rawat Inap 18,965,000 13,204,000

Jasa Laboran 2,697,768 Rawat Jalan 11,068,000 11,068,000
Total Bruto 30,033,000 24,272,000

dr. Nur Rahmi, Sp. PK 2,697,768.00

Reagensia 9,832,400.00
Jasa Klinik 8,243,180.00
BHP 4,141,000.00
L 1,036,000
12,384,180.00
A POLEWALI BULAN Desember 2019 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

TOTAL JASA KD AN PJ
KLINIK REAGEN KLINIK 55% PEMB. LAB 45% 40%

9 10 11 12 13 14 15

10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00

20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
- - -
8,000 K
20,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
250,000 - - L -
- - -
6,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
3,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
- - -
3,000 K
10,000 K
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
- - -
4,000 K
12,000 K
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
2,000 K
13,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
9,000 K
40,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
15,000 K
40,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
9,000 K
22,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
250,000 - - L -
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
5,000 K
25,000 K
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
5,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 25,000.00 13,750.00 11,250.00 L 4,500.00
- - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
5,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
3,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
3,000 K
15,000 K
3,500 257,500.00 141,625.00 115,875.00 L 46,350.00
- - -
- K
- K
32,000 (32,000.00) (17,600.00) (14,400.00) L (5,760.00)
32,000 130,000.00 71,500.00 58,500.00 L 23,400.00
5,000 382,000.00 210,100.00 171,900.00 L 68,760.00
5,800 1,104,200.00 607,310.00 496,890.00 L 198,756.00
10,000 (10,000.00) (5,500.00) (4,500.00) L (1,800.00)
13,500 63,500.00 34,925.00 28,575.00 L 11,430.00
7,500 253,500.00 139,425.00 114,075.00 L 45,630.00
7,500 87,500.00 48,125.00 39,375.00 L 15,750.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
8,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
8,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
 - - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
6,000 K
25,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
6,000 K
25,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
252,000 - - L -
252,000 - - L -
 - - -
11,000 K
35,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
5,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
- - -
6,000 K
30,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
8,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
8,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
8,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
- - -
8,000 K
25,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
2,000 K
13,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
5,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
7,000 K
35,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
6,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
4,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00

2,000 K
13,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
40,000 - - L -
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
5,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
252,000 - - L -
- - -
11,000 K
35,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
6,000 K
25,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
4,000 K
20,000 K

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00

5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
 3,000 K
15,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
2,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
5,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
9,500 80,500.00 44,275.00 36,225.00 L 14,490.00
25,000
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
 - - -
2,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
10,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00

2,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
2,000 K
14,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
 - - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
- - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
3,000 K
11,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
- - -
4,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
15,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
4,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
- - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
 2,000 K
10,000 K
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
- - -
3,000 K
10,000 K
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
7,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
10,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

5,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
 3,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

5,000 K
5,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00

1,000 K
5,000 K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
8,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
15,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
5,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
5,000 K
20,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
10,000 K

4,141,000 9,832,400 14,987,600 8,243,180 6,744,420 - 2,697,768

5,761,000
-
5,761,000
JASA

Dokter
LABORAN Pengirim
40 % 20 %

16 17
-
4,644.00 2,322.00 212,000 GDS,KOL,AU 2X
4,230.00 2,115.00 DR,GOLDA
2,916.00 1,458.00 DR
4,644.00 2,322.00
4,230.00 2,115.00
2,916.00 1,458.00

DR,GDS STRIP,URE,CREA
5,760.00 2,880.00 95,000
2,160.00 1,080.00
- -

5,760.00 2,880.00 77,000 DR2,WIDAL

- -

DR
DR,UR,KOL,AU,URE,CREA,OT,PT
5,760.00 2,880.00 199,000 DR,GOLDA
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
- -

2,340.00 1,170.00 311,000 DR,GDS,URE,CREA

- -
- -

5,760.00 2,880.00 -
2,160.00 1,080.00
- -

5,760.00 2,880.00 185,000 DR,GDS,KOL,AU,URE,CREA

5,760.00 2,880.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 77,000 WIDAL,DR (4X),IGGGM,

- -

5,760.00 2,880.00 355,000 DR

5,760.00 2,880.00
2,916.00 1,458.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
7,560.00 3,780.00
- -
5,760.00 2,880.00 99,000
2,160.00 1,080.00
- -

5,760.00 2,880.00 172,000 DR4,IGG IGM.GOLDA

2,916.00 1,458.00
4,140.00 2,070.00
3,510.00 1,755.00
- -

7,560.00 3,780.00 63,000 DR,GDS,KOL,AU

- -

5,760.00 2,880.00 243,000

2,916.00 1,458.00
4,140.00 2,070.00
3,510.00 1,755.00
4,644.00 2,322.00
4,230.00 2,115.00
- -

5,760.00 2,880.00 520,000

5,760.00 2,880.00
5,760.00 2,880.00
5,760.00 2,880.00
9,000.00 4,500.00
4,410.00 2,205.00
2,916.00 1,458.00
- -

5,760.00 2,880.00 81,000 DR,GDS STRIP

- -

5,760.00 2,880.00 493,000 DR,GDS,KOL,AU

5,760.00 2,880.00
5,760.00 2,880.00
5,760.00 2,880.00
9,000.00 4,500.00
2,916.00 1,458.00
- -

5,760.00 2,880.00 214,000

5,760.00 2,880.00
2,160.00 1,080.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 445,000

2,916.00 1,458.00
- -
4,644.00 2,322.00
4,230.00 2,115.00
- -
 5,760.00 2,880.00 175,000 DR,WIDAL
2,916.00 1,458.00
4,644.00 2,322.00
4,230.00 2,115.00
- -

5,760.00 2,880.00 115,000

2,340.00 1,170.00
- -

5,760.00 2,880.00 132,000

4,500.00 2,250.00
- -

5,760.00 2,880.00 180,000

2,916.00 1,458.00
4,644.00 2,322.00
4,230.00 2,115.00
- -

5,760.00 2,880.00 115,000 DR2,UR,DR4,KOL,AU,UR,CREA,OT,PT,IGG IGM

4,410.00 2,205.00
- -

5,760.00 2,880.00 86,000

- -

46,350.00 23,175.00 261,000 DR

- - 191,000 DR(2X),GOLDA
DR,GOLDA

(5,760.00) (2,880.00)
23,400.00 11,700.00 162,000
68,760.00 34,380.00 387,000
198,756.00 99,378.00 1,110,000
(1,800.00) (900.00)
11,430.00 5,715.00 77,000
45,630.00 22,815.00 261,000
15,750.00 7,875.00 95,000
- -

5,760.00 2,880.00 DR (2X),WIDAL,UR(2X),

5,760.00 2,880.00
- -

5,760.00 2,880.00 DR2X

5,760.00 2,880.00
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR,GDS,KOL,AU,GDP,UREUM,CREA

2,340.00 1,170.00 10/8/1900 282
2,916.00 1,458.00
4,140.00 2,070.00
3,510.00 1,755.00
4,644.00 2,322.00
4,230.00 2,115.00
 - -

5,760.00 2,880.00 DR,GOLDA,GDS ,UREUM,CREA,SGOT,SGPT

5,760.00 2,880.00
2,160.00 1,080.00
2,340.00 1,170.00 350
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00
5,760.00 2,880.00
2,160.00 1,080.00
5,760.00 2,880.00
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00
- -

5,760.00 2,880.00 DR,GOLDA

2,160.00 1,080.00
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR
4,410.00 2,205.00
- -

5,760.00 2,880.00 GOLDA (2X),DR,GDS(2),KOL,AU,URE (2X),CREA(2X),SGOT,SGPT ,ELECTOLIT(2X) RSUD

5,760.00 2,880.00
2,160.00 1,080.00 1,049,000
2,340.00 1,170.00
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
4,644.00 2,322.00
4,230.00 2,115.00
- -
- -
 - -

5,760.00 2,880.00 DR (3X),GDS(2X),WIDAL,

5,760.00 2,880.00
5,760.00 2,880.00
2,340.00 1,170.00 318,000
2,340.00 1,170.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR (4X) TES MALARIA, IGGGM ,URIN,WIDAL,GDS,KOL,AU,UR.CREA,SGOT,SGPT

5,760.00 2,880.00
5,760.00 2,880.00 785
2,340.00 1,170.00
9,000.00 4,500.00
3,600.00 1,800.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
4,644.00 2,322.00
4,230.00 2,115.00
4,410.00 2,205.00
7,560.00 3,780.00
- -

5,760.00 2,880.00 DR,GDS STRIP,WIDAL

2,340.00 1,170.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR (2X),GDS STRIP,WIDAL,IGGGM

5,760.00 2,880.00
2,340.00 1,170.00
9,000.00 4,500.00 376,000
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR (2X),GDS STRIP,WIDAL,IGGGM

5,760.00 2,880.00
2,340.00 1,170.00
9,000.00 4,500.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR,UR,CERA

4,140.00 2,070.00
3,510.00 1,755.00
- -
5,760.00 2,880.00 DR,WIDAL,UR
2,916.00 1,458.00
7,560.00 3,780.00 182,000
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR (2X),GDS STRIP,WIDAL (2X),IGGGM

5,760.00 2,880.00
2,916.00 1,458.00 376
9,000.00 4,500.00
4,410.00 2,205.00
4,410.00 2,205.00
- -

5,760.00 2,880.00
- -

5,760.00 2,880.00 DR,GDS

2,916.00 1,458.00
- -

5,760.00 2,880.00 DR(2X)

2,340.00 1,170.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR,GDS

2,916.00 1,458.00
- -

5,760.00 2,880.00 DR,WIDAL,IGGGM,KOL

5,760.00 2,880.00
5,760.00 2,880.00
2,340.00 1,170.00
9,000.00 4,500.00 622
9,000.00 4,500.00
4,644.00 2,322.00
4,410.00 2,205.00
- -

5,760.00 2,880.00
5,760.00 2,880.00
5,760.00 2,880.00
2,340.00 1,170.00
9,000.00 4,500.00
3,600.00 1,800.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
4,644.00 2,322.00
4,230.00 2,115.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00
2,340.00 1,170.00
4,590.00 2,295.00
4,590.00 2,295.00
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR,GOLDA

2,160.00 1,080.00
- -

5,760.00 2,880.00
5,760.00 2,880.00
2,160.00 1,080.00
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00 DR,GOLDA

2,160.00 1,080.00
- -

4,410.00 2,205.00 DR,WIDAL

5,760.00 2,880.00

5,760.00 2,880.00 DR,GDS,WIDAL,OT,PT,TCM

2,340.00 1,170.00
4,590.00 2,295.00 262,000
4,590.00 2,295.00
- -
4,410.00 2,205.00
- -

5,760.00 2,880.00 DR,GDS,KOL,AU

4,644.00 2,322.00
4,230.00 2,115.00
2,916.00 1,458.00 176,000
- -

5,760.00 2,880.00
5,760.00 2,880.00
2,160.00 1,080.00
2,340.00 1,170.00
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
9,000.00 4,500.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
4,644.00 2,322.00
4,230.00 2,115.00
- -
- -

5,760.00 2,880.00 DR,GDS,KOL,AU

4,644.00 2,322.00
4,230.00 2,115.00
2,916.00 1,458.00
- -

5,760.00 2,880.00
4,644.00 2,322.00
4,230.00 2,115.00
2,916.00 1,458.00
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR,GOLDA

2,160.00 1,080.00
- -

5,760.00 2,880.00
2,916.00 1,458.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00
5,760.00 2,880.00
2,160.00 1,080.00
5,760.00 2,880.00
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00
- -

5,760.00 2,880.00
4,644.00 2,322.00
2,340.00 1,170.00
4,140.00 2,070.00
3,510.00 1,755.00
4,590.00 2,295.00
4,590.00 2,295.00
- -

5,760.00 2,880.00 DR,GDS,AU,OT,PT

2,916.00 1,458.00
4,590.00 2,295.00
4,590.00 2,295.00
4,230.00 2,115.00
- -
 4,410.00 2,205.00 DR,WIDAL.DDR
5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00 DR
- -

4,410.00 2,205.00 DR,TES MALARIA ,WIDAL

5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00 DR,GDS,KOL,WIDAL

4,644.00 2,322.00 175,000
4,410.00 2,205.00
2,916.00 1,458.00
- -

4,644.00 2,322.00 GDS ,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

5,760.00 2,880.00
4,410.00 2,205.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,410.00 2,205.00
5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00 DR,PLANO TEST , HBS AG

14,490.00 7,245.00

- -

5,760.00 2,880.00 DR,GDS,KOL,AU

4,644.00 2,322.00
4,410.00 2,205.00
2,916.00 1,458.00
 - -

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 KOL

2,340.00 1,170.00 GDS STRIP

5,760.00 2,880.00 GDS,KOL,AU

4,410.00 2,205.00

4,644.00 2,322.00 DR,WIDAL

4,230.00 2,115.00
2,916.00 1,458.00

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

4,230.00 2,115.00 UR,AU

7,560.00 3,780.00

5,760.00 2,880.00 DR
- -

4,410.00 2,205.00 DR,TES MALARIA,WIDAL

5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00 DR
- -

4,410.00 2,205.00 DR,WIDAL,DDR

5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

4,410.00 2,205.00 DR,KOL,WIDAL

5,760.00 2,880.00
4,644.00 2,322.00
- -

5,760.00 2,880.00 DR
- -

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

5,760.00 2,880.00 DR,GDS ,AU

4,230.00 2,115.00
2,340.00 1,170.00
- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

2,160.00 1,080.00 GOLDA

- -

5,760.00 2,880.00 GDS,KOL,AU

- -

5,760.00 2,880.00 DR
 - -

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 DR,WIDAL K'RAHMA300.000

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS STRIP

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 KOL

4,410.00 2,205.00 DR,WIDAL,IGGGM

5,760.00 2,880.00
9,000.00 4,500.00
- -

5,760.00 2,880.00 DR,OT,PT

4,590.00 2,295.00
4,590.00 2,295.00
- -

4,410.00 2,205.00 DR,WIDAL/TES MALARIA

5,760.00 2,880.00
3,600.00 1,800.00
- -

4,644.00 2,322.00 GDS,KOL

2,916.00 1,458.00

4,644.00 2,322.00 KOL

5,760.00 2,880.00 DR
- -

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

5,760.00 2,880.00 DR,IGGGM

9,000.00 4,500.00
- -
4,410.00 2,205.00 DR,GDS,KOL,WIDAL
5,760.00 2,880.00
4,644.00 2,322.00
2,916.00 1,458.00
- -

4,644.00 2,322.00 KOL,AU

4,230.00 2,115.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

4,644.00 2,322.00 KOL

4,410.00 2,205.00 DR,WIDAL,DDR

5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00
- -

4,644.00 2,322.00 KOL

5,760.00 2,880.00 DR,UR,CERA

4,140.00 2,070.00
3,510.00 1,755.00
- -

5,760.00 2,880.00 DR
- -

2,340.00 1,170.00 GDS STRIP

4,644.00 2,322.00 KOL,AU

4,230.00 2,115.00
4,230.00 2,115.00 AU,URE,CREA
4,140.00 2,070.00
3,510.00 1,755.00
- -

4,140.00 2,070.00 DR,GDS STRIP,KOL,AU,UR,CREA DR.EMMY 150000

3,510.00 1,755.00
5,760.00 2,880.00
4,644.00 2,322.00
4,230.00 2,115.00
2,340.00 1,170.00
- -

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

5,760.00 2,880.00 DR,KOL,GDS

4,644.00 2,322.00
2,340.00 1,170.00
- -

4,644.00 2,322.00 KOL

- -

5,760.00 2,880.00
4,410.00 2,205.00

5,760.00 2,880.00
4,410.00 2,205.00

2,160.00 1,080.00 GOLDA

- -

4,644.00 2,322.00 DR,GDS,KOL,AU,WIDAL

4,230.00 2,115.00
2,916.00 1,458.00
5,760.00 2,880.00
4,410.00 2,205.00

4,644.00 2,322.00 GDS STRIP

- -

4,644.00 2,322.00 GDS STRIP

- -

2,340.00 1,170.00 DR,GDS STRIP,WIDAL

5,760.00 2,880.00
4,410.00 2,205.00

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00
5,760.00 2,880.00 DR,WIDAL
4,410.00 2,205.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

5,760.00 2,880.00 DR
- -

2,340.00 1,170.00 GDS STRIP

2,916.00 1,458.00 GDS

4,644.00 2,322.00 GDS STRIP

- -

4,410.00 2,205.00 DR,WIDAL,DDR

5,760.00 2,880.00
3,600.00 1,800.00
- -

4,410.00 2,205.00 DR,WIDAL,DDR

5,760.00 2,880.00
3,600.00 1,800.00
- -

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

4,644.00 2,322.00 GDS STRIP2X

2,340.00 1,170.00
- -

5,760.00 2,880.00 DR,WIDAL

4,410.00 2,205.00

4,644.00 2,322.00 KOL,AU

4,230.00 2,115.00

5,760.00 2,880.00 DR,GOLDA,GDS,KOL,AU,UR,CREA

2,160.00 1,080.00
2,916.00 1,458.00
 4,140.00 2,070.00 273
3,510.00 1,755.00
4,644.00 2,322.00
4,230.00 2,115.00
- -

5,760.00 2,880.00 DR,IGG IGM

9,000.00 4,500.00
- -

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS,KOL,AU

4,230.00 2,115.00
2,916.00 1,458.00

4,644.00 2,322.00 GDS STRIP

- -

2,697,768 1,348,884
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN Januari
KODE HARGA

TOTAL
NO TGL NAMA PASIEN URAIAN TARIF BAYAR
dr L

1 2 3 4 5 6 7 8
RAWAT INAP
1 23/12/2019 NY.ST.HUMRONIA AA Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000

Kolesterol 36,000
Asam Urat 33,000

L 22,000 22,000

BHP 8,000
Spoit + Tempat 15,000 343,000
2 24/12/2019 TN.KAREBA AA Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
L 10,000 10,000
BHP 4,000
Spoit + Tempat 10,000 311,000
3 23/12/2019 NY.HJ.SARNAB EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Ureum 33,000
Kreatinin 33,000
SGOT 33,000
SGPT 33,000
Urine Rutin 50,000
GDS 33,000
IgG/IgM 150,000
Golongan Dara 17,000
Widal 28,000
L 17,000 17,000
BHP 15,000
Spoit + Tempat 30,000 728,000
4 25/12/2019 TN.H.ABD. GANI SW Darah Rutin 64,000
GDS 22,000
Kreatinin 33,000
Kolesterol 36,000
Asam Urat 33,000
L 5,000 5,000
BHP 6,000
Spoit + Tempat 10,000 209,000
5 26/12/2019 TN.JAELANI SW Darah Rutin 64,000
Darah Rutin 64,000
 Darah Rutin 95,000
L 15,000 15,000
BHP 11,000
Spoit + Tempat 18,000 267,000
6 29/12/2019 AN.MUH.KHAIRUL AK Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 7,000
Spoit + Tempat 10,000 115,000
7 30/1/2019 TN.GEORGE EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Urine Rutin 50,000
GDS 33,000
IgG/IgM 150,000
Widal 28,000
L 19,000 19,000
BHP 15,000
Spoit + Tempat 35,000 650,000
8 3/1/2020 NN.NUR AINUN EI Darah Rutin 64,000
Urine Rutin 50,000
GDS 33,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 165,000
9 1/1/2020 NN.NUR INDAH IKA EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Asam Urat 33,000
L 19,000 19,000
BHP 17,000
Spoit + Tempat 50,000 439,000
10 3/1/2020 NN.NUR FAIZA EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 95,000
Darah Rutin 95,000
GDS 33,000
IgG/IgM 150,000
Widal 28,000
L 11,000 11,000
BHP 10,000
Spoit + Tempat 45,000 723,000
11 5/1/2020 AN.MOZA AK Darah Rutin 64,000
GDS 22,000
Widal 28,000
L 3,000 3,000
BHP 6,000
Spoit + Tempat 15,000 138,000
12 8/1/2020 TN.MUHAMMAD EI Darah Rutin 64,000
L 2,000 2,000
BHP 5,000
 Spoit + Tempat 10,000 81,000
13 7/1/2020 NY.AFNI SW Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 7,000
Spoit + Tempat 10,000 115,000
14 6/1/2020 TN.CECEP BAYU EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
Widal 28,000
L 11,000 11,000
BHP 10,000
Spoit + Tempat 55,000 574,000
15 9/1/2020 TN.SYAHRIL AA Darah Rutin 64,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
Kolesterol 36,000
Asam Urat 33,000
L 7,000 7,000
BHP 2,000
Spoit + Tempat 13,000 243,000
16 6/1/2020 AN.NAYLA AK Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 3,000
Spoit + Tempat 25,000 187,000
17 AN.KARINA AK Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 35,000 264,000
18 8/1/2020 NY.ARINI SW Darah Rutin 64,000
GDS 33,000
GDS 33,000
GDS 33,000
Kolesterol 36,000
Asam Urat 33,000
L 7,000 7,000
BHP 9,000
Spoit + Tempat 30,000 278,000
19 9/1/2020 NY.RUWAEDAH SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
L 9,000 9,000
BHP 7,000
Spoit + Tempat 40,000 312,000
20 12/1/2020 NY.ISMAYANI FN Darah Rutin 64,000
L 2,000 2,000
BHP 5,000
 Spoit + Tempat 10,000 81,000
21 15/1/2020 dr.IRNA TRISTANTI EI Darah Rutin 64,000
GDS 22,000
L 2,000 2,000
BHP 6,000
Spoit + Tempat 10,000 104,000
22 15/1/2020 AN.ANDI FAUZUL EI Darah Rutin 64,000
GDS 33,000
IgG/IgM 150,000
Widal 28,000
L 4,000 4,000
BHP 2,000
Spoit + Tempat 15,000 296,000
23 18/1/2020 NY.HJ.SURAEDA SW Darah Rutin 64,000
GDS 33,000
Kreatinin 33,000
L 3,000 3,000
BHP 6,000
Spoit + Tempat 10,000 149,000
24 18/1/2020 TN.YUNUS YUSUF SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 95,000
IgG/IgM 150,000
Widal 28,000
Malaria 80,000
L 13,000 13,000
BHP 11,000
Spoit + Tempat 45,000 614,000
25 17/1/2020 NY.DEWI ANITA EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Urine Rutin 50,000
GDS 33,000
IgG/IgM 150,000
Widal 28,000
L 7,000 7,000
BHP 9,000
Spoit + Tempat 35,000 504,000
26 20/1/2020 TN.SYAMSUL AA Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 2,000
Spoit + Tempat 13,000 152,000
27 20/1/2020 NY.JAYANTI FN Darah Rutin 64,000
Golongan Dara 17,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 99,000
28 21/1/2020 NY. HJ SINAR AA Ureum 33,000
Kreatinin 33,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
 BHP 5,000
Spoit + Tempat 13,000 245,000
29 21/1/2020 NY.ST,.FATIMAH AA Ureum 33,000
Kreatinin 33,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
SGOT 33,000
SGPT 33,000
L 15,000 15,000
BHP 8,000
Spoit + Tempat 30,000 468,000
30 21/1/2020 NY.MURNI IA Darah Rutin 64,000
L 2,000 2,000
BHP 5,000
Spoit + Tempat 10,000 81,000
31 22/1/2020 AN. HUSNA AK Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
32 22/1/2020 NY.SINTA EI Darah Rutin 64,000
Urine Rutin 50,000
L 10,000 10,000
BHP 8,000
Spoit + Tempat 12,000 144,000
33 1/24/2020 An. ALIFA KIAN AK Darah Rutin 64,000
Golongan Dara 17,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 99,000
34 1/24/2020 TN. ABD. HALIM RD GDS 33,000
L 3,000 3,000
BHP 4,000
Spoit + Tempat 10,000 50,000
35 1/24/2020 NY. A. NUR ANNI SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Golongan Dara 17,000
Widal 28,000
L 7,000 7,000
BHP 6,000
Spoit + Tempat 35,000 376,000

RAWAT JALAN Widal 28,000

1 24/12/2019 AN. MUH. HAERUL IR Darah Rutin 64,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 107,000
 Kolesterol 36,000
2 24/12/2019 NY.HJ.SUHAENI LL L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 49,000
Darah Rutin 64,000
3 24/12/2019 AN.ARJUN AL Malaria 80,000
L 2,000 2,000
BHP 6,000
Spoit + Tempat 10,000 162,000
GDS 33,000
4 24/12/2019 NY.HASLIANA SW L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 46,000
Darah Rutin 64,000
5 25/12/2019 AN.RAINA LL L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
Darah Rutin 64,000
6 25/12/2019 AN.UWAIRA LL L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
Darah Rutin 64,000
7 25/12/2019 TN.TAMRIN KR L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
Darah Rutin 64,000
8 25/12/2019 AN.MUH.ARI LL L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
Darah Rutin 64,000
9 25/12/2019 AN.OKTAVIANI LL L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
Widal 28,000
10 25/12/2019 AN.BILQIS LL Darah Rutin 64,000
L 6,000 6,000
BHP 6,000
Spoit + Tempat 15,000 119,000
Kolesterol 36,000
11 26/12/2019 NY.HAMSIA KR Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 106,000
GDS 33,000
12 26/12/2019 NY.NURALANG IB L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 46,000
Darah Rutin 64,000
13 27/12/2019 NY.YELSI LL Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
Kolesterol 36,000
14 28/12/2019 TN.H.RUSLI LL Asam Urat 33,000
L 1,000 1,000
BHP 1,000
 Spoit + Tempat 10,000 81,000
Darah Rutin 64,000
15 28/12/2019 TN.PALLESERI KR Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
Kolesterol 36,000
16 28/12/2019 NY.MULIANA KR Asam Urat 33,000
L 1,000 1,000
BHP 1,000
Spoit + Tempat 10,000 81,000
Darah Rutin 64,000
17 30/12/2019 AN.GAVIN KR L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 81,000
Kolesterol 36,000
18 30/12/2019 TN.SIKTIO MAMAH AL Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Darah Rutin 64,000
19 31/12/2019 NY.NURSANG KR GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 5,000 5,000
BHP 5,000
Spoit + Tempat 15,000 180,000
Darah Rutin 64,000
20 31/12/2019 TN.ARWAN KR Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
Darah Rutin 64,000
21 31/12/2019 TN.ABD.RAHMAN SW IgG/IgM 150,000
Widal 28,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 257,000
Darah Rutin 64,000
22 01/01/20 NY.ST.HALIJA LL Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
Darah Rutin 64,000
23 01/01/20 AN.M.YAMIL AL L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
Widal 28,000
24 02/01/20 NY.INDAH IKA LL IgG/IgM 150,000
Darah Rutin 64,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 266,000
Kolesterol 36,000
25 02/01/20 TN.ANGGONG KR Asam Urat 33,000
GDS 22,000
 L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Kolesterol 36,000
26 02/01/20 NY.KACA KR Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Darah Rutin 64,000
27 02/01/20 AN.GISEL KR L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 81,000
Urine Rutin 50,000
28 02/01/20 ADIT LL L 2,000 2,000
BHP 3,000
Spoit + Tempat 10,000 65,000
Kolesterol 36,000
29 02/01/20 NY.RASDIANA LL Asam Urat 33,000
L 1,000 1,000
BHP 1,000
Spoit + Tempat 10,000 81,000
Darah Rutin 64,000
30 01/03/20 AN. RUSMITA KR Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
Urine Rutin 50,000
31 01/03/20 AN.KHALID KR L 1,000 1,000
BHP 1,000
Spoit + Tempat 10,000 62,000
Kolesterol 36,000
32 01/04/20 TN.ADI AL L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 53,000
Kolesterol 36,000
33 01/04/20 AN.MUH.AZKA IR Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Darah Rutin 64,000
34 01/04/20 TN.ADAM SYAHRUL IR Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
Kolesterol 36,000
35 01/06/20 AN.AFIFAH IR Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Darah Rutin 64,000
36 01/06/20 TN.DANDI KR Widal 28,000
L 6,000 6,000
BHP 4,000
Spoit + Tempat 14,000 116,000
 Darah Rutin 64,000
37 01/06/20 NY.HJ.NURSANG KR L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
Darah Rutin 64,000
38 01/06/20 TN.M.HALIK KR Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
Kolesterol 36,000
39 01/06/20 TN.ROHANDI KR GDS 22,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 72,000
Kolesterol 36,000
40 01/06/20 TN.TAUFIQ IR Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Kolesterol 36,000
41 01/06/20 AN.M.ATAYA KR Asam Urat 33,000
L 1,000 1,000
BHP 1,000
Spoit + Tempat 10,000 81,000
Kolesterol 36,000
42 01/06/20 NY.SAWIAH KR L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 50,000
Darah Rutin 64,000
43 01/06/20 AN.GLORIA KR L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 81,000
Darah Rutin 64,000
44 01/06/20 TN.GEORGE VETER EI L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 81,000
GDS 22,000
45 01/06/20 TN.BISON DL L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 39,000
Kolesterol 36,000
46 01/06/20 TN.MUH.ASNUR LL Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Kolesterol 36,000
47 01/06/20 NY.HJ.HAJAR LL Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Kolesterol 36,000
48 01/07/20 NY.SUSIYATI LL Asam Urat 33,000
GDS 22,000
L 5,000 5,000
 BHP 4,000
Spoit + Tempat 10,000 110,000
Widal 28,000
49 01/07/20 NY.FATMAWATI LL Darah Rutin 64,000
Malaria 80,000
L -
BHP
Spoit + Tempat 3,000 175,000
Kolesterol 36,000
50 01/07/20 TN.H.TAHSYAD IR GDS 22,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 73,000
Darah Rutin 64,000
51 01/07/20 NY.HJ.NURLINA SW Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
Darah Rutin 64,000
52 01/07/20 TN.CANDRA SW L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
Kolesterol 36,000
53 01/08/20 AN.M.RIFAI RD Asam Urat 33,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 84,000
Kolesterol 36,000
54 01/09/20 NY.HJ.HALIJA LL Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Darah Rutin 64,000
55 01/09/20 AN.A.ALFARABI AL L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 81,000
GDS 22,000
56 01/09/20 NY.PATMINI IR Kolesterol 36,000
Asam Urat 33,000
L 10,000 10,000
BHP 5,000
Spoit + Tempat 15,000 121,000
Golongan Dara 17,000
57 01/09/20 NY.ETIK LL L 1,000 1,000
BHP 1,000
Spoit + Tempat 5,000 24,000
Darah Rutin 64,000
58 01/09/20 NY.AYU IR Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
Darah Rutin 64,000
59 01/09/20 TN. HAERUL LL L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
Darah Rutin 64,000
60 01/09/20 NY.FATMINI RD L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 81,000
Darah Rutin 64,000
61 01/09/20 AN.A.AHMAD LL L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 81,000
GDS 22,000
62 01/09/20 TN.FREDI AL Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
L -
BHP
Spoit + Tempat 10,000 123,000
GDS 33,000
63 01/09/20 TN.FAARDIAN LL L 1,000 1,000
BHP 1,000
Spoit + Tempat 10,000 45,000
Kolesterol 36,000
64 01/11/20 TN.MARTEN SW L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 50,000
Widal 28,000
65 01/11/20 TN.ASKID ID Darah Rutin 64,000
Malaria 80,000
Kolesterol 36,000
Asam Urat 33,000
SGOT 33,000
L 10,000 10,000
BHP 3,000
Spoit + Tempat 14,000 301,000
Darah Rutin 64,000
66 13/1/2020 AN.KENNENT ID Malaria 80,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 15,000 167,000
Widal 28,000
67 13/1/2020 AN.ALISYA ID Darah Rutin 64,000
Malaria 80,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 196,000
Kolesterol 36,000
68 13/1/2020 NY.HJ.NANNA RD Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Darah Rutin 64,000
69 13/1/2020 TN.A.ABD.WAHID RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
Widal 28,000
L 11,000 11,000
BHP 6,000
Spoit + Tempat 20,000 220,000
Kolesterol 36,000
70 13/1/2020 NY.NURJANNAH IN L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 53,000
Kolesterol 36,000
71 13/1/2020 TN.JASMAN SW L 1,000 1,000
BHP 3,000
Spoit + Tempat 10,000 50,000
Widal 28,000
72 13/1/2020 AN.WILMAN IN Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 14,000 191,000
Widal 28,000
73 13/1/2020 TN.TAHHIR EI Darah Rutin 64,000
Kolesterol 36,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 14,000 147,000
Kolesterol 36,000
74 13/1/2020 NY.MINANG EI L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 53,000
Darah Rutin 64,000
75 14/1/2020 NY.HUSNAENI LL L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 81,000
Ureum 33,000
76 14/1/2020 NY.SRI MULIANA RD Kreatinin 33,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 10,000 240,000
Darah Rutin 64,000
77 14/1/2020 TN.ANDI IDRIS LL Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 10,000 106,000
Darah Rutin 64,000
78 14/1/2020 TN.IBRAHIM SW L 1,000 1,000
BHP 1,000
Spoit + Tempat 10,000 76,000
Widal 28,000
79 14/1/2020 AN.RASTI LL Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 14,000 191,000
Darah Rutin 64,000
80 14/1/2020 TN.YAKUB IR Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
Kolesterol 36,000
81 14/1/2020 TN.ARIS RD L 1,000 1,000
BHP 3,000
Spoit + Tempat 10,000 50,000
Darah Rutin 64,000
82 14/1/2020 TN.LABAE SW Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
Darah Rutin 64,000
83 14/1/2020 TN.SUARDI SW L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
Darah Rutin 64,000
84 14/1/2020 NY.HJ.NURSANA EI Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
Darah Rutin 64,000
85 15/1/2020 BY.AQSAM RD L 6,000 6,000
BHP 2,000
Spoit + Tempat 15,000 87,000
Darah Rutin 64,000
86 15/1/2020 NY.HJ.DEWI KR L 6,000 6,000
BHP 2,000
Spoit + Tempat 15,000 87,000
Kolesterol 36,000
87 15/1/2020 TN.ABD.RAHMAN LL Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Darah Rutin 64,000
88 15/1/2020 TN,HUSAIN LL L 6,000 6,000
BHP 2,000
Spoit + Tempat 15,000 87,000
Widal 28,000
89 15/1/2020 AN.RAHMAN LL Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 14,000 191,000
Kolesterol 36,000
90 16/1/2020 NY.SUHEMI KR Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Darah Rutin 64,000
91 16/1/2020 TN.YUSUF ll L 6,000 6,000
BHP 2,000
Spoit + Tempat 15,000 87,000
Widal 28,000
92 16/1/2020 TN.SYARIFUDDIN KR Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
L 6,000 6,000
BHP 4,000
 Spoit + Tempat 15,000 175,000
Darah Rutin 64,000
93 16/1/2020 TN.NAJAMUDIN KR L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 81,000
Kolesterol 36,000
94 16/1/2020 AN.ARYA LL Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Kolesterol 36,000
95 16/1/2020 NY.HJ.BADARIA EI Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Kolesterol 36,000
96 17/1/2020 NY.NENNI AL L 1,000 1,000
BHP 3,000
Spoit + Tempat 10,000 50,000
Kolesterol 36,000
97 17/1/2020 TN.RISKI MUNANDA EI Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Widal 28,000
98 18/1/2020 NY.HJ.KASIFA IN Darah Rutin 64,000
Malaria 80,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 15,000 196,000
Darah Rutin 64,000
99 18/1/2020 TN.BADULU SW Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
Ureum 33,000
100 18/1/2020 TN.LABAE SW Kreatinin 33,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 14,000 242,000
Kolesterol 36,000
101 18/1/2020 AN.MUCHLIS ABDU RD Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
GDS 22,000
102 20/1/2020 SASKIA RD Kolesterol 36,000
GDS 22,000
Asam Urat 33,000
 L 4,000 4,000
BHP 1,000
Spoit + Tempat 10,000 128,000
Darah Rutin 64,000
103 20/1/2020 NY.NURBAYA EI Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
Darah Rutin 64,000
104 20/1/2020 TN.IRWANDI LL Kolesterol 36,000
GDS 33,000
L 6,000 6,000
BHP 7,000
Spoit + Tempat 15,000 161,000
Darah Rutin 64,000
105 21/1/2020 NY.HJ.NURSIAH AM L 6,000 6,000
BHP 2,000
Spoit + Tempat 15,000 87,000
Darah Rutin 64,000
106 21/1/2020 NY.HJ.TURA SW L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
Widal 28,000
107 21/1/2020 NN.NURPIANI LL Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 14,000 191,000
Darah Rutin 64,000
108 22/1/2020 AN.BAYU RESKI LL Widal 28,000
L 2,000 2,000
BHP 2,000
Spoit + Tempat 15,000 111,000
Kolesterol 36,000
109 22/1/2020 NY.HJ. NASIRA LL GDS 22,000
L 3,000 3,000
BHP 2,000
Spoit + Tempat 10,000 73,000
Darah Rutin 64,000
110 23/1/2020 AN.FAIKA LL Kolesterol 36,000
GDS 33,000
L 3,000 3,000
BHP 5,000
Spoit + Tempat 15,000 156,000
Kolesterol 36,000
111 23/1/2020 NY.KASMAWATI LL Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Darah Rutin 64,000
112 23/1/2020 NN. HARUNNISA LL L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 81,000
Widal 28,000
113 23/1/2020 AN.FAIZUL AM Darah Rutin 64,000
IgG/IgM 150,000
 GDS 22,000
L 4,000 4,000
BHP 6,000
Spoit + Tempat 10,000 284,000
Widal 28,000
114 23/1/2020 AN.M.FATIR LL Darah Rutin 64,000
Malaria 80,000
GDS 22,000
L 4,000 4,000
BHP 6,000
Spoit + Tempat 10,000 214,000
115 23/1/2020 H.ANDASA AM Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
Kolesterol 36,000
116 23/1/2020 NY.HJ.KARTININ AM L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 53,000
Darah Rutin 64,000
117 24/1/2020 AN.AHMAD AM IgG/IgM 150,000
L 6,000 6,000
BHP 6,000
Spoit + Tempat 10,000 236,000
Kolesterol 36,000
118 24/1/2020 NY.SUARTINI LL Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000
Spoit + Tempat 10,000 110,000
Kolesterol 36,000
119 24/1/2020 NY.SUARNI KR GDS 22,000
L 4,000 4,000
BHP 4,000
Spoit + Tempat 10,000 76,000
Darah Rutin 64,000
120 24/1/2020 AN.AISYAH KR GDS 22,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 99,000
121 24/1/2020 AN.AIDIL LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
122 24/1/2020 NN.ERNI PULO LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
123 24/1/2020 NY.ST.AISYAH EI Darah Rutin 64,000
Widal 28,000
L 6,000 6,000
BHP 3,000
Spoit + Tempat 14,000 115,000
124 25/1/2020 TN.BAYU SW Darah Rutin 64,000
L 4,000 4,000
BHP 3,000
Spoit + Tempat 10,000 81,000
125 25/1/2020 AN.AIDIL LL Darah Rutin 64,000
 L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
126 25/1/2020 AN.ADELIA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 77,000
127 25/1/2020 NY.ARWAN LL Darah Rutin 64,000
Widal 28,000
L 5,000 5,000
BHP 3,000
Spoit + Tempat 10,000 110,000
128 25/1/2020 TN.HERMAN RD GDS 22,000
L 5,000 5,000
BHP 2,000
Spoit + Tempat 10,000 39,000
129 25/1/2020 AN. ADRIAN LL Golongan Dara 17,000
Darah Rutin 64,000
Widal 28,000
L 1,000 1,000
BHP 1,000
Spoit + Tempat 5,000 116,000
130 25/1/2020 AN. DWI AISYAH KR Darah Rutin 64,000
GDS 22,000
L 1,000 1,000
BHP 2,000
Spoit + Tempat 10,000 99,000

23,854,000 23,854,000 713,000

TOTAL

Rawat Inap 9,156,000 9,156,000

Rawat Jalan 14,173,000 14,173,000
Rincian Total Bruto 23,329,000 23,329,000
Jasa Laboran 2,025,108

dr. Nur Rahmi, Sp. PK 2,025,108.00

Reagensia 8,706,400.00
Jasa Klinik 6,187,830.00
BHP 2,895,000.00
L 713,000
9,082,830.00
A POLEWALI BULAN Januari 2020 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

TOTAL JASA KD AN PJ
KLINIK REAGEN KLINIK 55% PEMB. LAB 45%
40%

9 10 11 12 13 14 15

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00

20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
8,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
15,000 K
30,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
6,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
95,000 - - L -
- - -
11,000 K
18,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
7,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
15,000 K
35,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
17,000 K
50,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
95,000 - - L -
95,000 - - L -
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
10,000 K
45,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
6,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
5,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
7,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
10,000 K
55,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
2,000 K
13,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
3,000 K
25,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
4,000 K
35,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
9,000 K
30,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
7,000 K
40,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
5,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
6,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
- - -
6,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
95,000 - - L -
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
11,000 K
45,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
9,000 K
35,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
2,000 K
13,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
4,000 K
10,000 K
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
 5,000 K
13,000 K
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
8,000 K
30,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
5,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
- - -
8,000 K
12,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
- - -
4,000 K
10,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
6,000 K
35,000 K

3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
6,000 K
10,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
6,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
10,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00

1,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00

1,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
3,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
- - -
5,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
4,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
 4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
3,000 K
10,000 K
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
- - -
3,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00

1,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00
- - -
1,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
3,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

4,000 K
14,000 K
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00

1,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
3,000 K
10,000 K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
 4,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
- K
3,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00

2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
3,000 K
10,000 K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00

5,000 K
15,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00

1,000 K
5,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
 - - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
3,000 K
10,000 K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00

- K
10,000 K
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00

1,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00
- - -
3,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
15,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

6,000 K
20,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
 - - -
3,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
3,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
2,000 K
14,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
2,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
3,000 K
10,000 K
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
1,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
2,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
 - - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00

2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00

2,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00

2,000 K
15,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
2,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00

2,000 K
15,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
3,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
3,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
4,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
14,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
 1,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
7,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00

2,000 K
15,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
- - -
2,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

2,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00
- - -
5,000 K
15,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
3,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
6,000 K
10,000 K
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
6,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
- - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00
- - -
6,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00

4,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
14,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
3,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
 - - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
- - -
2,000 K
10,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

3,000 K
10,000 K
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
10,000 K
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00

1,000 K
5,000 K
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00
- - -
2,000 K
10,000 K

2,895,000 8,706,400 11,250,600 6,187,830 5,062,770 - 2,025,108

-

-
-
-
JASA

Dokter
LABORAN Pengirim
40 % 20 %

16 17

5,760.00 2,880.00 NR
2,340.00 1,170.00 NR
4,140.00 2,070.00 NR
3,510.00 1,755.00 NR
4,590.00 2,295.00 NR
4,590.00 2,295.00 NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
- - NR
NR
NR
5,760.00 2,880.00 SR
2,916.00 1,458.00 SR
4,140.00 2,070.00 SR
3,510.00 1,755.00 SR
4,590.00 2,295.00 SR
4,590.00 2,295.00 SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
- - SR
SR
SR
5,760.00 2,880.00 NR
5,760.00 2,880.00
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
4,140.00 2,070.00 NR
3,510.00 1,755.00 NR
4,590.00 2,295.00 NR
4,590.00 2,295.00 NR
7,560.00 3,780.00 NR
2,340.00 1,170.00 NR
9,000.00 4,500.00 NR
2,160.00 1,080.00 NR
4,410.00 2,205.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
2,916.00 1,458.00 NR
3,510.00 1,755.00 NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
- - NR
NR
NR
5,760.00 2,880.00 SR
5,760.00 2,880.00 SR
 - - SR
- - SR
SR
SR
5,760.00 2,880.00 NR
4,410.00 2,205.00 NR
- - NR
NR
NR
5,760.00 2,880.00 SR
5,760.00 2,880.00 SR
5,760.00 2,880.00 SR
5,760.00 2,880.00 SR
5,760.00 2,880.00 SR
7,560.00 3,780.00 SR
2,340.00 1,170.00 SR
9,000.00 4,500.00 SR
4,410.00 2,205.00 SR
- - SR
SR
SR
5,760.00 2,880.00 NR
7,560.00 3,780.00 NR
2,340.00 1,170.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
4,230.00 2,115.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
- - NR
- - NR
2,340.00 1,170.00 NR
9,000.00 4,500.00 NR
4,410.00 2,205.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
2,916.00 1,458.00 NR
4,410.00 2,205.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
 NR
5,760.00 2,880.00 NR
4,410.00 2,205.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
9,000.00 4,500.00 NR
4,410.00 2,205.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
2,916.00 1,458.00 NR
4,140.00 2,070.00 NR
3,510.00 1,755.00 NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
4,410.00 2,205.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
4,410.00 2,205.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
2,340.00 1,170.00 NR
2,340.00 1,170.00 NR
2,340.00 1,170.00 NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
 NR
5,760.00 2,880.00 NR
2,916.00 1,458.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
2,340.00 1,170.00 NR
9,000.00 4,500.00 NR
4,410.00 2,205.00 NR
- - NR
NR
NR
5,760.00 2,880.00 SR
2,340.00 1,170.00 SR
3,510.00 1,755.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
5,760.00 2,880.00 SR
5,760.00 2,880.00 SR
- - SR
9,000.00 4,500.00 SR
4,410.00 2,205.00 SR
3,600.00 1,800.00 SR
- - SR
SR
SR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
7,560.00 3,780.00 NR
2,340.00 1,170.00 NR
9,000.00 4,500.00 NR
4,410.00 2,205.00 NR
- - NR
NR
NR
5,760.00 2,880.00 SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
2,160.00 1,080.00 SR
- - SR
SR
SR
4,140.00 2,070.00 NR
3,510.00 1,755.00 NR
5,760.00 2,880.00 NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
2,916.00 1,458.00 NR
- - NR
 NR
NR
4,140.00 2,070.00 NR
3,510.00 1,755.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
5,760.00 2,880.00 NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
2,916.00 1,458.00 NR
4,590.00 2,295.00 NR
4,590.00 2,295.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
5,760.00 2,880.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
7,560.00 3,780.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
2,160.00 1,080.00 SR
- - SR
SR
SR
2,340.00 1,170.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
5,760.00 2,880.00 SR
5,760.00 2,880.00 SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
2,160.00 1,080.00 SR
4,410.00 2,205.00 SR
- - SR
SR

4,410.00 2,205.00
5,760.00 2,880.00 SR
- - SR
SR
SR
4,644.00 2,322.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
3,600.00 1,800.00 SR
- - SR
SR
SR
2,340.00 1,170.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
- - NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
4,410.00 2,205.00 NR
5,760.00 2,880.00 NR
- - NR
NR
NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
2,340.00 1,170.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 NR
NR
NR
NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 SR
SR
SR
 SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
- - SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
2,916.00 1,458.00 NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
4,410.00 2,205.00 NR
NR
NR
NR
5,760.00 2,880.00 NR
9,000.00 4,500.00 NR
4,410.00 2,205.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
4,410.00 2,205.00 NR
NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
4,410.00 2,205.00 NR
9,000.00 4,500.00 SR
5,760.00 2,880.00 SR
- - SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
 SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
- - SR
SR
SR
7,560.00 3,780.00 SR
- - SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 NR
NR
NR
NR
7,560.00 3,780.00 NR
- - NR
NR
NR
4,644.00 2,322.00 NR
- - SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
- - SR
SR
SR
2,916.00 1,458.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 NR
2,916.00 1,458.00 NR
NR
 NR
NR
4,410.00 2,205.00 NR
5,760.00 2,880.00 NR
3,600.00 1,800.00 NR
- - NR
NR
NR
4,644.00 2,322.00 NR
2,916.00 1,458.00 NR
NR
NR
NR
5,760.00 2,880.00 NR
4,410.00 2,205.00 NR
NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 NR
2,916.00 1,458.00 NR
NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
2,916.00 1,458.00 NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
NR
NR
NR
2,160.00 1,080.00 NR
NR
NR
NR
5,760.00 2,880.00 NR
4,410.00 2,205.00 NR
NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
 - - NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
2,916.00 1,458.00 NR
4,644.00 2,322.00 NR
2,916.00 1,458.00 NR
4,230.00 2,115.00 NR
NR
NR
NR
2,340.00 1,170.00 NR
NR
NR
NR
4,644.00 2,322.00 NR
- - NR
NR
NR
4,410.00 2,205.00 NR
5,760.00 2,880.00 NR
3,600.00 1,800.00 NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
4,590.00 2,295.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
3,600.00 1,800.00 NR
- - NR
NR
NR
4,410.00 2,205.00 NR
5,760.00 2,880.00 NR
3,600.00 1,800.00 NR
- - NR
NR
NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
2,916.00 1,458.00 NR
NR
NR
NR
5,760.00 2,880.00 NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
2,916.00 1,458.00 NR
4,410.00 2,205.00 NR
NR
NR
NR
4,644.00 2,322.00 NR
 - - NR
NR
NR
4,644.00 2,322.00 NR
- - NR
NR
NR
4,410.00 2,205.00 NR
5,760.00 2,880.00 NR
3,600.00 1,800.00 NR
- - NR
NR
NR
4,410.00 2,205.00 NR
5,760.00 2,880.00 NR
4,644.00 2,322.00 NR
- - NR
NR
NR
4,644.00 2,322.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
- - SR
SR
SR
4,140.00 2,070.00 SR
3,510.00 1,755.00 SR
5,760.00 2,880.00 SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
- - SR
SR
SR
4,410.00 2,205.00 SR
5,760.00 2,880.00 SR
3,600.00 1,800.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
 - - SR
SR
SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 NR
2,916.00 1,458.00 NR
NR
NR
NR
5,760.00 2,880.00 NR
NR
NR
NR
4,410.00 2,205.00 NR
5,760.00 2,880.00 NR
3,600.00 1,800.00 NR
- - NR
NR
NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
SR
SR
SR
4,410.00 2,205.00 SR
5,760.00 2,880.00 SR
4,644.00 2,322.00 SR
2,916.00 1,458.00 SR
- - SR
SR
 SR
5,760.00 2,880.00 SR
- - SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
- - NR
NR
NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
2,916.00 1,458.00 NR
NR
NR
NR
4,410.00 2,205.00 NR
5,760.00 2,880.00 SR
3,600.00 1,800.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 SR
SR
SR
SR
4,140.00 2,070.00 SR
3,510.00 1,755.00 SR
5,760.00 2,880.00 SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
- - SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
2,916.00 1,458.00 SR
4,644.00 2,322.00 SR
2,916.00 1,458.00 SR
4,230.00 2,115.00 SR
 SR
SR
SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
4,644.00 2,322.00 SR
2,340.00 1,170.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
4,410.00 2,205.00 NR
5,760.00 2,880.00 NR
3,600.00 1,800.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
4,410.00 2,205.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
4,644.00 2,322.00 NR
2,340.00 1,170.00 NR
- - NR
NR
NR
4,644.00 2,322.00 NR
4,230.00 2,115.00 NR
2,916.00 1,458.00 NR
NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
4,410.00 2,205.00 NR
5,760.00 2,880.00 NR
9,000.00 4,500.00 NR
2,916.00 1,458.00 NR
- - NR
NR
NR
4,410.00 2,205.00 NR
5,760.00 2,880.00 NR
3,600.00 1,800.00 NR
2,916.00 1,458.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
4,644.00 2,322.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
9,000.00 4,500.00 SR
- - SR
SR
SR
4,644.00 2,322.00 SR
4,230.00 2,115.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
4,644.00 2,322.00 SR
2,916.00 1,458.00 SR
SR
SR
SR
5,760.00 2,880.00 SR
2,916.00 1,458.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
- - SR
SR
SR
5,760.00 2,880.00 SR
4,410.00 2,205.00 SR
SR
SR
SR
5,760.00 2,880.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
 - - NR
NR
NR
5,760.00 2,880.00 NR
- - NR
NR
NR
5,760.00 2,880.00 NR
4,410.00 2,205.00 NR
NR
NR
NR
2,916.00 1,458.00 NR
- - NR
NR
NR
2,160.00 1,080.00 NR
5,760.00 2,880.00 NR
4,410.00 2,205.00 NR
NR
NR
NR
5,760.00 2,880.00 NR
2,916.00 1,458.00 NR
- - NR
NR
NR

2,025,108 1,012,554
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN februari 2020 RUMAH SAKIT BER
KODE HARGA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL

dr BAYAR L KLINIK

1 2 3 4 5 6 7 8 9
RAWAT INAP
1 23/1/2020 AN.ANDI NABILA AK Darah Rutin 64,000
Urine Rutin 50,000
Golongan Dara 17,000
L 10,000 10,000
BHP 5,000 5,000
Spoit + Tempat 20,000 166,000 20,000
2 25/1/2020 NY.HJ.RUKMIATI EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
Widal 28,000
GDS 22,000
Kolesterol 36,000
L 9,000 9,000
BHP 8,000 8,000
Spoit + Tempat 30,000 539,000 30,000
3 25/1/2020 TN. FADLIANTO EI Golongan Dara 17,000
GDS 33,000
GDS 33,000
GDS 33,000
Darah Rutin 64,000
Darah Rutin 64,000
Kolesterol 36,000
Kolesterol 36,000
Elektrolit 252,000 252,000
Asam Urat 33,000

GDS 22,000
GDS 22,000
GDS 22,000
L 15,000 15,000

BHP 9,000 9,000

Spoit + Tempat 30,000 721,000 30,000
4 26/1/2020 TN.SAMUEL BATO EI Darah Rutin 64,000
GDS 33,000
Ureum 33,000
Kreatinin 33,000
Urine Rutin 50,000

GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
 L 12,000 12,000

BHP 9,000 9,000

Spoit + Tempat 15,000 340,000 15,000
5 25/1/2020 AN.GLADIS AK Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Widal 28,000
L 4,000 4,000
BHP 8,000 8,000
Spoit + Tempat 20,000 205,000 20,000
6 28/1/2020 TN.SUPARDI SW Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
L 4,000 4,000
BHP 5,000 5,000
Spoit + Tempat 10,000 133,000 10,000
7 27/1/2020 TN.HUSAIN EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
IgG/IgM 150,000
Golongan Dara 17,000
GDS 33,000
GDS 22,000
Ureum 33,000
Kreatinin 33,000
L 17,000 17,000
BHP 15,000 15,000
Spoit + Tempat 60,000 786,000 60,000
8 28/1/2020 BY.AYUNINDYA AK Darah Rutin 64,000
L 3,000 3,000
BHP 4,000 4,000
Spoit + Tempat 10,000 81,000 10,000
9 26/1/2020 NY.NURLINA BURAERAT KR Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 10,000 99,000 10,000
10 29/1/2020 TN.ERWIN SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Widal 28,000
Dahak 45,000 45,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 15,000 15,000
BHP 10,000 10,000
Spoit + Tempat 30,000 428,000 30,000
11 1/2/2020 NY.SH.ST.AMINAH SW Darah Rutin 64,000
Golongan Dara 17,000
 Ureum 33,000
Kreatinin 33,000
GDS 33,000
L 4,000 4,000
BHP 7,000 7,000
Spoit + Tempat 10,000 201,000 10,000
12 31/1/12020 NY.HASNA EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Widal 28,000
Urine Rutin 50,000
L 13,000 13,000
BHP 10,000 10,000
Spoit + Tempat 35,000 409,000 35,000
13 1/2/2020 NN. ADE SILVIA SW Darah Rutin 95,000 95,000
Darah Rutin 95,000 95,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Widal 28,000
GDS 33,000
SGOT 33,000
SGPT 33,000
L 10,000 10,000
BHP 10,000 10,000
Spoit + Tempat 30,000 640,000 30,000
14 3/2/2020 TN.BAGUS Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 297,000 14,000
15 NY.NAIMA EI Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Widal 28,000
3/2/2020 4,000 4,000
L
BHP 8,000 8,000
Spoit + Tempat 20,000 205,000 20,000
16 TN.ABD.SOMAD EI Asam Urat 33,000
Darah Rutin 64,000
Golongan Dara 17,000
Ureum 33,000
Kreatinin 33,000
GDS 22,000
L 5,000 5,000
BHP 7,000 7,000
Spoit + Tempat 10,000 224,000 10,000
17 6/2/2020 TN.SIMON RD Darah Rutin 64,000
 GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 4,000 4,000
BHP 6,000 6,000
Spoit + Tempat 10,000 175,000 10,000
18 2/2/2020 AN. ADYAN WILDAN AK Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Widal 28,000
L 4,000 4,000
BHP 8,000 8,000
Spoit + Tempat 20,000 205,000 20,000
19 3/2/2020 AN. FADLI AK Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 110,000 10,000
20 5/2/2020 RN.ASNUR EI Kolesterol 36,000
Asam Urat 33,000
Golongan Dara 17,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
IgG/IgM 150,000
L 12,000 12,000
BHP 10,000 10,000
Spoit + Tempat 25,000 475,000 25,000
21 6/2/2020 TN.RIDWANSYAH AA GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Golongan Dara 17,000
Darah Rutin 64,000
Elektrolit 252,000 252,000
L 13,000 13,000
BHP 12,000 12,000
Spoit + Tempat 20,000 469,000 20,000
22 5/2/2020 AN. KHANSA AK Golongan Dara 17,000
Darah Rutin 64,000
GDS 33,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 133,000 10,000
23 6/2/2020 NY.HJ.ST.NUR EI Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
Urine Rutin 50,000
Urine Rutin 50,000
Kolesterol 36,000
 Asam Urat 33,000
Elektrolit 252,000 252,000
L 20,000 20,000
BHP 17,000 17,000
Spoit + Tempat 45,000 780,000 45,000
24 5/2/2020 TN. RAHMAT HIDAYAT EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
Widal 28,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
L 20,000 20,000
BHP 17,000 17,000
Spoit + Tempat 45,000 604,000 45,000
25 6/2/2020 NY. NUR QADRIANTI FN Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 10,000 99,000 10,000
26 9/2/2020 NY.LIMBONG AA Golongan Dara 17,000
GDS 22,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
L 7,000 7,000
BHP 6,000 6,000
Spoit + Tempat 10,000 261,000 10,000
27 10/2/2020 NY.JASMITA EI Golongan Dara 17,000
GDS 22,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
L 7,000 7,000
BHP 9,000 9,000
Spoit + Tempat 10,000 264,000 10,000
28 9/2/2020 NY. DEWI ANDRIANI FN Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 10,000 99,000 10,000
29 7/2/2020 TN.FACHRUDDIN EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
 Darah Rutin 64,000
Golongan Dara 17,000
IgG/IgM 150,000
Widal 28,000
Darah Rutin 64,000
Darah Rutin 64,000
L 15,000 15,000
BHP 13,000 13,000
Spoit + Tempat 60,000 667,000 60,000
30 10/2/2020 NY. DIAN MAYASARI FN Darah Rutin 64,000
Golongan Dara 17,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 95,000 10,000
31 10/2/2020 NY.WANTI FN Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 10,000 99,000 10,000
32 8/2/2020 NY.JUDDAH SW GDS 22,000
Kreatinin 33,000
Darah Rutin 64,000
Golongan Dara 17,000
L 4,000 4,000
BHP 6,000 6,000
Spoit + Tempat 10,000 156,000 10,000
33 11/2/2020 NY.WARDIA PUTRI FN Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 10,000 99,000 10,000
34 11/2/2020 TN.AMIRUDDIN SW GDS 22,000
Darah Rutin 64,000
Kolesterol 36,000
L 3,000 3,000

BHP 6,000 6,000

Spoit + Tempat 10,000 141,000 10,000
35 12/2/2020 AN.HADIBA RD GDS 33,000
Darah Rutin 64,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 115,000 10,000
36 11/2/2020 AN.SYAHNUM AK Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 110,000 10,000
37 13/2/2020 NY.SUTRIA IR Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 10,000 99,000 10,000
38 13/2/2020 NY.SABRIANI SW GDS 33,000
Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 133,000 10,000
39 13/2/2020 TN.MUH.ALI USMAN EI Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
L 12,000 12,000
BHP 10,000 10,000
Spoit + Tempat 40,000 474,000 40,000
40 10/2/2020TN.ADI HERMANSYAH EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
IgG/IgM 150,000
Widal 28,000
Darah Rutin 95,000 95,000
Darah Rutin 95,000 95,000
SGOT 65,000 65,000
SGPT 65,000 65,000
L 17,000 17,000
BHP 15,000 15,000
Spoit + Tempat 60,000 927,000 60,000
41 11/2/2020 AN.SAFIKA AZ ZAHRA AK Darah Rutin 64,000
IgG/IgM 140,000
Widal 28,000
L -
BHP -
Spoit + Tempat Darah 232,000 -
42 11/2/2020 NN.LUSI EI Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
IgG/IgM 150,000
Widal 28,000
L 5,000 5,000
BHP 6,000 6,000
Spoit + Tempat 35,000 433,000 35,000
43 12/2/2020 BY.MUH.FADLI AK Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
 BHP 5,000 5,000
Spoit + Tempat 10,000 99,000 10,000
44 13/2/2020 AN. ADIBA AK GDS 22,000
Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 122,000 10,000
45 14/2/2020 NY.HJ.MURNIATI EI Darah Rutin 64,000
Golongan Dara 17,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
GDS 33,000
Widal 28,000
Urine Rutin 50,000
Malaria 80,000
Ureum 33,000
Kreatinin 33,000
Albumin 50,000 50,000
HbA1c 300,000 300,000
SGOT 65,000 65,000
SGPT 65,000 65,000
L 14,000 14,000
BHP 10,000 10,000
Spoit + Tempat 40,000 1,212,000 40,000
46 18/2/2020 AN. AMIRAH IB Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000

BHP 5,000 5,000

Spoit + Tempat 10,000 99,000 10,000
47 17/2/2020 TN.ANCHU SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
IgG/IgM 150,000
Malaria 80,000
Urine Rutin 50,000
L 8,000 8,000
BHP 7,000 7,000
Spoit + Tempat 35,000 667,000 35,000
48 19/2/2020 TN.H.RUSTAM AA Darah Rutin 64,000
Golongan Dara 17,000
 GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 6,000 6,000
BHP 5,000 5,000
Spoit + Tempat 10,000 193,000 10,000
49 19/2/2020 NY.RAMLAH AA Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
Ureum 33,000
Kreatinin 33,000
GDS 33,000
GDS 33,000
L 6,000 6,000
BHP 5,000 5,000
Spoit + Tempat 15,000 330,000 15,000
50 20/2/2020NN. INDRAYANI YUNDING SW Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000

BHP 5,000 5,000

Spoit + Tempat 10,000 99,000 10,000
51 19/2/2020 AN. AYLIN AK Darah Rutin 64,000
Darah Rutin 64,000
Golongan Dara 17,000
L 5,000 5,000
BHP 10,000 10,000
Spoit + Tempat 20,000 180,000 20,000
52 20/2/2020 NY.HJ.NURAENI AA Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 10,000 175,000 10,000
53 18/2/2020 TN.ARIFUDDIN SW Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 64,000
Darah Rutin 95,000 95,000
Golongan Dara 17,000
IgG/IgM 150,000
Widal 28,000
L 5,000 5,000
BHP 6,000 6,000
Spoit + Tempat 40,000 533,000 40,000
54 21/2/2020 NY.ASKARIA FN Darah Rutin 64,000
Golongan Dara 17,000
GDS 22,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 122,000 10,000
 55 19/2/2020 NY.NURFADILAH EI SGOT 33,000
SGPT 33,000
Darah Rutin 64,000
GDS 22,000
Kolesterol 36,000
Asam Urat 33,000
L 8,000 8,000
BHP 15,000 15,000
Spoit + Tempat 17,000 261,000 17,000
56 22/2/2020 NY.FIKA FITRIANI FN Darah Rutin 64,000
Golongan Dara 17,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 10,000 99,000 10,000

RAWAT JALAN
1 26/1/2020 TN. BAYU LL Darah Rutin 64,000
L 2,000 2,000
BHP 5,000 5,000
Spoit + Tempat 10,000 81,000 10,000
2 26/1/2020 AN. SAHWA LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP -
Spoit + Tempat Darah 94,000 -
3 26/1/2020 AN.SAIRIL LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP -
Spoit + Tempat Darah 94,000 -
4 26/1/2020 AN. PUTRA LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP -
Spoit + Tempat Darah 94,000 -
5 26/1/2020 TN.H.DEDIANTO EI SGOT 65,000
SGPT 33,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 11,000 11,000
BHP 8,000 8,000
Spoit + Tempat 15,000 223,000 15,000
6 26/1/2020 AN.ARSYAM KR Darah Rutin 64,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 10,000 82,000 10,000
7 26/1/2020 NY.HJ.SAKURA RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
 Spoit + Tempat 10,000 106,000 10,000
8 26/1/2020 AN.IIN RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 15,000 111,000 15,000
9 26/1/2020 NY.NONI RD Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
10 26/1/2020 NY,HJ,NURLINA LL Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 87,000 10,000
11 27/1/2020 BETA AF Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
12 27/1/2020 AL.FREAD LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
13 27/1/2020 NY.NISMA IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 87,000 10,000
14 27/1/2020 NY.AMINAH LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 4,000 4,000
BHP 6,000 6,000
Spoit + Tempat 14,000 196,000 14,000
15 27/1/2020 MUH.RAFLI LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
16 27/1/2020 NY.ST.RASIA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 4,000 4,000
BHP 2,000 2,000
Spoit + Tempat 14,000 192,000 14,000
17 28/1/2020 TN.MUH.HALIM IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 15,000 115,000 15,000
18 28/1/2020 ALFRED LL Darah Rutin 64,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 81,000 10,000
19 28/1/2020 TN.ARIO RAMADHA LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 15,000 115,000 15,000
20 28/1/2020 AN.ANDI TENRI LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
21 28/1/2020 NYM.HASNA AM Golongan Dara 17,000
Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 15,000 133,000 15,000
22 28/1/2020 TN.TUKA SW Golongan Dara 17,000
Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 128,000 14,000
23 28/1/2020 NY.NURLIA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
24 29/1/2020 NN LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
25 29/1/2020 NN. FANI AF Darah Rutin 64,000
IgG/IgM 150,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 8,000 8,000
BHP 8,000 8,000
Spoit + Tempat 10,000 331,000 10,000
26 29/1/2020 AN.M.ABDULLAH AF Darah Rutin 64,000
IgG/IgM 150,000
Widal 28,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 261,000 10,000
27 29/1/2020 TN.ADI SW Urine Rutin 50,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 67,000 10,000
28 29/1/2020 TN.ABD.JALIL RD GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
29 29/1/2020 NY.MUTMAINNAH RD Darah Rutin 64,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 81,000 10,000
30 29/1/2020 AN.NURSAM LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
31 20/1/2024 NY.DESI MUSA LL SGOT 65,000
SGPT 33,000
L 9,000 9,000
BHP 8,000 8,000
Spoit + Tempat 15,000 130,000 15,000
32 30/1/2025 NN.RARA LL Urine Rutin 50,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 64,000 10,000
33 30/1/2027 TN.ASWAR IR Darah Rutin 64,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 81,000 10,000
34 30/1/2027 TN.ARDI IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
35 30/1/2027 NY.NANTANG SW Darah Rutin 64,000
Kolesterol 36,000
Widal 28,000
GDS 22,000
L 5,000 5,000
BHP 5,000 5,000
Spoit + Tempat 10,000 170,000 10,000
36 30/1/2027 K'FIKA LL/FR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
37 31/1/2020 NY.MARLIA LL Elektrolit 252,000 252,000
GDS 33,000
L 5,000 5,000
BHP 4,000 4,000
 Spoit + Tempat 10,000 304,000 10,000
38 31/1/2020 TN.SYUKUR DL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
39 31/1/2020 NY.MASITA IR Kolesterol 36,000
Darah Rutin 64,000
Widal 28,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 143,000 10,000
40 31/1/2020 NY.WATI IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
41 02/01/20 TN. NISWAR AM Darah Rutin 64,000
IgG/IgM 150,000
Widal 28,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 261,000 10,000
42 02/03/20 AN. AHMAD SIRAT LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 15,000 115,000 15,000
43 02/03/20 TN. MUHAJIRIN RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 5,000 5,000
Spoit + Tempat 15,000 114,000 15,000
44 02/03/20 NY.HJ.HANISA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
45 02/03/20 TN.SUKIRMAN LL Kolesterol 36,000
Ureum 33,000
Kreatinin 33,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 121,000 10,000
46 02/03/20 NY.MARNI IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
47 02/03/20 TN.SATTU LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
 BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
48 02/04/20 M.SATRIA KR Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
49 02/04/20 NN. ANGRENI WAR Darah Rutin 64,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 81,000 10,000
50 02/04/20 AN. MUH RIZKI AK Darah Rutin 64,000
SGOT 65,000
SGPT 65,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 211,000 10,000
51 02/05/20 NY. MEGAWATI LL Darah Rutin 64,000
Widal 28,000
L -
BHP -
Spoit + Tempat Darah 92,000 -
52 02/05/20 TN.RUKMAN AM Kolesterol 36,000
Asam Urat 33,000
L -
BHP -
Spoit + Tempat Darah 69,000 -
53 02/05/20 TN.A.ALIS SW GDS 33,000
L -
BHP -
Spoit + Tempat Darah 33,000 -
54 02/05/20 AN.MUH.KAHFI AF Darah Rutin 64,000
IgG/IgM 150,000
Widal 28,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 15,000 266,000 15,000
55 02/05/20 NY.HJ.MINA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
56 02/05/20 NY.NAIMA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
57 02/05/20 NY.FITRANI LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 4,000 4,000
BHP 6,000 6,000
Spoit + Tempat 14,000 196,000 14,000
58 02/05/20 NN.HASRIANTI AM Darah Rutin 64,000
IgG/IgM 150,000
Widal 28,000
 L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 15,000 266,000 15,000
59 02/06/20 TN.SYARIFUDDIN LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
60 02/06/20 NN.LAURA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
61 02/06/20 TN.TAHIR RD Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 8,000 8,000
BHP 7,000 7,000
Spoit + Tempat 10,000 180,000 10,000
62 02/06/20 TN.MUNASSIR IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
63 02/07/20 TN.,ISRAN RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
64 02/07/20 NY.ERNI RD Kolesterol 36,000
L 3,000 3,000
BHP 5,000 5,000
Spoit + Tempat 10,000 54,000 10,000
65 02/07/20 TN.H.KAMANG IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
66 02/07/20 NY.JUNARTI IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
67 02/07/20 NY.SARIFA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
68 02/07/20 TN.FAIZAL EI Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
 L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
69 02/08/20 AN. FAHRI LL Darah Rutin 64,000
L -
BHP -
Spoit + Tempat 5,000 69,000 5,000
70 02/08/20 AN. M.SARIAHNAF LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 1,000 1,000
Spoit + Tempat 1,000 96,000 1,000
71 02/08/20 TN.FATAHUNDAR KR Darah Rutin 64,000
GDS 33,000
L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 10,000 112,000 10,000
72 02/08/20 NY.DEWI AYU SW Darah Rutin 64,000
Kolesterol 36,000
L 5,000 5,000
BHP 3,000 3,000
Spoit + Tempat 10,000 118,000 10,000
73 02/10/20 NY.RIA RIANI AF Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
74 02/10/20 AN.AMIRUL LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
75 02/10/20 NY.HJ.SURIANI KR Darah Rutin 64,000
GDS 33,000
L 2,000 2,000
BHP -
Spoit + Tempat 5,000 104,000 5,000
76 02/10/20 AN.AHMAD LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
77 02/10/20 TN.BACO AA Kolesterol 36,000
Asam Urat 33,000
GDS 33,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 121,000 10,000
78 02/10/20 NN.KARMILA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
 L 3,000 3,000
BHP 2,000 2,000
Spoit + Tempat 14,000 191,000 14,000
79 02/11/20 NY.WARLIA IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 15,000 115,000 15,000
80 02/11/20 NY.HJ.HAFIDA SW Darah Rutin 64,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 4,000 4,000
BHP 6,000 6,000
Spoit + Tempat 10,000 175,000 10,000
81 02/11/20 NY.SUHENI LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
82 02/12/20 TN.H.RAMLI IR GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
83 02/12/20 TN.SAING LAWI LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 15,000 115,000 15,000
84 02/12/20 NY.ITA LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 2,000
Spoit + Tempat 10,000 106,000 10,000
85 02/12/20 NY.WARLIA LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
86 02/12/20 AN.ABD.RAHMAN LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP -
Spoit + Tempat 9,000 103,000 9,000
87 02/12/20 AN. NILUH MADE LL Darah Rutin 64,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 81,000 10,000
88 02/12/20 TN.H.MANSYUR RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 15,000 115,000 15,000
89 02/12/20 NY.HJ.RAHMA RD Kolesterol 36,000
L 4,000 4,000
 BHP 3,000 3,000
Spoit + Tempat 10,000 53,000 10,000
90 13/2/2020 NY.HJ.MINA IM GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
91 13/2/2020 NY.NURLIA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 3,000
BHP 3,000 3,000
Spoit + Tempat 10,000 107,000 10,000
92 13/2/2020 NY.RUSNI IR Darah Rutin 64,000
Widal 28,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 7,000 7,000
BHP 4,000 4,000
Spoit + Tempat 10,000 204,000 10,000
93 13/2/2020 NY,FATMAWATI SW GDS 33,000
L 5,000 5,000
BHP 2,000 2,000
Spoit + Tempat 10,000 50,000 10,000
94 13/2/2020 NY.HJ.NURSIA IR Ureum 33,000
Darah Rutin 64,000
Kreatinin 33,000
Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 7,000 7,000
BHP 5,000 5,000
Spoit + Tempat 10,000 243,000 10,000
95 13/2/2020 AN.SYAHRIR IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
96 13/2/2020 HJ. BUHANI IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
97 14/2/2020 TN.UMAR SW Kolesterol 36,000
GDS 22,000
L 4,000 4,000
BHP 4,000 4,000
Spoit + Tempat 10,000 76,000 10,000
98 14/2/2020 TN.BADULU EI Darah Rutin 64,000
L 4,000 4,000
BHP 3,000 3,000
 Spoit + Tempat 10,000 81,000 10,000
99 14/2/2020 AN.SAHIR LL Darah Rutin 64,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 81,000 10,000
100 14/2/2020 NY.BUDIMAN LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 191,000 10,000
101 15/2/2020 NY.HATIJA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
102 15/2/2020 AN.MUH.RIFAT LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 15,000 115,000 15,000
103 15/2/2020 AN.MASITA LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 15,000 115,000 15,000
104 15/2/2020 TN.ABD.SOMAD IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
105 15/2/2020 TN.USMAN LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 191,000 10,000
106 15/2/2020 NY.HJ.SAE DL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 15,000 115,000 15,000
107 15/2/2020 TN.ABD.AZIS DL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
108 17/2/2020 AN.YADELA LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 6,000 6,000
 Spoit + Tempat 10,000 191,000 10,000
109 17/2/2020 AN.ABDULLAH IR Darah Rutin 64,000
L 4,000 4,000
BHP 3,000 3,000
Spoit + Tempat 10,000 81,000 10,000
110 17/2/2020 NY. HJ.RUSIDA LL Kolesterol 36,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 49,000 10,000
111 17/2/2020 NY.FATIMAH AM Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 191,000 10,000
112 17/2/2020 NY.NURLINA LL Darah Rutin 50,000
L 4,000
BHP 3,000
Spoit + Tempat Darah 50,000 10,000
113 17/2/2020 TN.INO LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
114 17/2/2020 NY.A.NASRAL FN Golongan Dara 17,000
Darah Rutin 64,000
L 2,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 99,000 15,000
115 17/2/2020 AN.DUTRA LL Darah Rutin 64,000
Widal 28,000
L 3,000 2,000
BHP 6,000 6,000
Spoit + Tempat 10,000 111,000 15,000
116 18/2/2020 NY.HASNA RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
117 18/2/2020 NY. EMI RD Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
118 18/2/2020 TN.H.M.RIDWAN LL Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
119 18/2/2020 AN. ALIYAH LL Widal 28,000
Darah Rutin 64,000
Malaria 80,000
L 4,000 4,000
 BHP 6,000 6,000
Spoit + Tempat 14,000 196,000 14,000
120 19/2/2020 NY.FADILLAH AM Darah Rutin 64,000
IgG/IgM 150,000
Widal 28,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 15,000 266,000 15,000
121 19/2/2020 NY.RAHMA IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
122 19/2/2020 TN.JAMALUDDIN IR Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
123 20/2/2020 AN.MUH.ALFARIZI IR Widal 28,000
Golongan Dara 17,000
Darah Rutin 64,000
L 3,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 128,000 15,000
124 20/2/2020 NY.HJ.NORMA IR Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 6,000 6,000
Spoit + Tempat 15,000 115,000 15,000
125 20/2/2020 HJ.EDDA AM Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 5,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 110,000 10,000
126 20/2/2020 TN.ABD LATIF SW Widal 28,000
Golongan Dara 17,000
Darah Rutin 64,000
L 3,000 3,000
BHP 5,000 6,000
Spoit + Tempat 15,000 132,000 15,000
127 21/2/2020 AN.M.HANIF LL Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 2,000 6,000
Spoit + Tempat 2,000 98,000 15,000
128 21/2/2020 SANITA IR Kolesterol 36,000
Asam Urat 33,000
L 2,000 5,000
BHP 2,000 4,000
Spoit + Tempat 10,000 83,000 10,000
129 21/2/2020 TN.H.AHMAD IB Urine Rutin 50,000
L 1,000 2,000
BHP 1,000 2,000
Spoit + Tempat 4,000 56,000 10,000
130 21/2/2020 NY. SAMAATI EI Kolesterol 36,000
Darah Rutin 64,000
L 2,000 5,000
BHP 2,000 4,000
Spoit + Tempat 10,000 114,000 10,000
131 22/2/2020 NY.HANIRA AF Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 5,000
BHP 2,000 4,000
Spoit + Tempat 10,000 106,000 10,000
132 22/2/2020 NN. HASNA SW Urine Rutin 50,000
L 1,000 2,000
BHP 2,000
Spoit + Tempat 4,000 55,000 10,000
133 22/2/2020 MIRZA RD Darah Rutin 64,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 77,000 10,000
134 22/2/2020 TN.INO LL GDS 33,000
L 1,000 1,000
BHP 2,000 2,000
Spoit + Tempat 10,000 46,000 10,000
135 22/2/2020 HJ.RASDIANA LL Kolesterol 36,000
Asam Urat 33,000
GDS 22,000
L 3,000 5,000
BHP 2,000 4,000
Spoit + Tempat 10,000 106,000 10,000
136 22/2/2020 TN..AMIRUDDIN RD Kolesterol 36,000
GDS 22,000
L 3,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 75,000 10,000
137 22/2/2020 TN.RUSDI RD Kolesterol 36,000
Malaria 80,000
L 4,000 5,000
BHP 4,000 4,000
Spoit + Tempat 10,000 134,000 10,000
138 22/2/2020 TN.IKSAN RD Darah Rutin 64,000
Widal 28,000
L 2,000 2,000
BHP 1,000 6,000
Spoit + Tempat Darah 95,000 15,000
139 22/2/2020 TN.SAING LABI LL Darah Rutin 64,000
Kolesterol 36,000
GDS 22,000
L 3,000 5,000
BHP 2,000 4,000
 Spoit + Tempat 14,000 141,000 10,000
140 22/2/2020 NY.DIEN HARDIANTI LL/FN Golongan Dara 17,000
Darah Rutin 64,000
L 2,000 3,000
BHP 6,000 6,000
Spoit + Tempat 10,000 99,000 15,000
141 25/2/2020 JASWATI IB Asam Urat 33,000
L 1,000 5,000
BHP 2,000 4,000
Spoit + Tempat 10,000 46,000 10,000

33,042,000 33,042,000 1,323,000 3,210,000

TOTAL

Rawat Inap 17,119,000 17,119,000 -

Rawat Jalan 15,923,000 15,923,000 -
Rincian Total Bruto 33,042,000 33,042,000 -
Jasa Laboran 2,544,300

dr. Nur Rahmi, Sp. PK 2,544,300.00

Reagensia 10,702,000.00
Jasa Klinik 7,774,250.00
BHP 3,210,000.00
L 1,323,000
10,984,250.00
bruari 2020 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
HARGA JASA JASA

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

10 11 12 13 14 15 16 17

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR

8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
- - - - - NR
K NR
K NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
- - L - - - NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
 - - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - L - - - NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
- - L - - - SR
- - L - - - SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
- - - - - SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - L - - - SR
- - - - - SR
K SR
K SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - L - - - SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
- - - - - NR
K NR
K NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - L - - - SR
- - L - - - SR
- - L - - - SR
- - L - - - SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
100,000 40,000.00 22,000.00 18,000.00 L 7,200.00 7,200.00 3,600.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
 K SR
K SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 SR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 SR
SR
SR
- - L - - - SR
- - L - - - SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00 1,170.00 NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - L - - - SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
- - - - - NR
K NR
K NR
 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
- - - - - SR
K SR
K SR
SR
SR

32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR

- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
- - L - - - SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 SR
- - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
 K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
- - L - - - SR
7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00 2,295.00 SR
SR
K SR
K SR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
- - L - - - SR
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
 K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - L - - - SR
- - L - - - SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
20,000 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
20,000 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
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
 NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
20,000 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
20,000 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
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
 NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 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 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
20,000 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
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
 - - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
20,000 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
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
SR
 K SR
K SR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
20,000 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
10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00 2,070.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00 1,755.00 NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
 K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
- - - - - SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
20,000 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
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
 K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
20,000 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
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
- - - - - SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
- - - - - SR
 K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00 4,500.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
NR
K NR
K NR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 NR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 NR
NR
K NR
K NR
8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00 3,780.00 NR
- - - - - NR
K NR
K NR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 NR
- - - - - NR
K NR
K NR
20,000 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
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
K SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00 1,800.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00 2,205.00 SR
SR
K SR
K SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00 2,322.00 SR
5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00 1,458.00 SR
SR
K SR
 K SR
5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00 1,080.00 SR
32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00 2,880.00 SR
SR
K SR
K SR
9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00 2,115.00 NR
NR
K NR
K NR
NR

10,702,000 14,135,000 7,774,250 6,360,750 - 2,544,300 2,544,300 1,269,270

-
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN April 2020 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
KODE HARGA JASA JASA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL TOTAL JASA KD AN

dr BAYAR L KLINIK REAGEN KLINIK 55% PEMB. LAB PJ LABORAN
45% 40% 40 %

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
RAWAT INAP
1 26/2/2020 NN.FARHAMIKA AK Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 22,000 22,000 - - - -
BHP 8,000 8,000 K
Spoit + Tempat 15,000 343,000 15,000 K
2 26/2/2020 NY.HJ.LINA FN Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 10,000 10,000 - - - -
BHP 4,000 4,000 K
Spoit + Tempat 10,000 311,000 10,000 K
3 26/2/2020 AN.MUH.FABIAN AK Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
 IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 17,000 17,000 - - - -
BHP 15,000 15,000 K
Spoit + Tempat 30,000 728,000 30,000 K
4 27/2/2020 NN.MARWAH AK Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
Darah Rutin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
Ureum 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Kreatinin 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
SGOT 5,000 5,000 - - - -
SGPT 6,000 6,000 K
Urine Rutin 10,000 209,000 10,000 K
5 18/2/2020 NY.DARNA EI GDS 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 95,000 95,000 - - L - -
L 15,000 15,000 - - - -
BHP 11,000 11,000 K
Spoit + Tempat 18,000 267,000 18,000 K
6 28/2/2020 TN.IRWAN EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 6,000 6,000 - - - -
BHP 7,000 7,000 K
Spoit + Tempat 10,000 115,000 10,000 K
7 3/2/2020 TN. MUH. AYUDHA SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 19,000 19,000 - - - -
BHP 15,000 15,000 K
Spoit + Tempat 35,000 650,000 35,000 K
8 3/3/2020 AN.RATU AISYAH AK Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
 GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 4,000 4,000 - - - -
BHP 4,000 4,000 K
Spoit + Tempat 10,000 165,000 10,000 K
9 3/3/2020 NY.NURJANNAH IB Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 19,000 19,000 - - - -
BHP 17,000 17,000 K
Spoit + Tempat 50,000 439,000 50,000 K
10 5/3/2020 NY.NURINDASARI FN Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 95,000 95,000 - - L - -
Darah Rutin 95,000 95,000 - - L - -
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 11,000 11,000 - - - -
BHP 10,000 10,000 K
Spoit + Tempat 45,000 595,000 45,000 K
12 5/4/2020 NN.A.NUR REZKI KAMARIA SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000 - - - -
29 19/3/2020 NY.HIJRAH AK BHP 6,000 6,000 K
Spoit + Tempat 15,000 138,000 15,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 2,000 2,000 - - - -
BHP 5,000 5,000 K
Spoit + Tempat 10,000 81,000 10,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 6,000 6,000 - - - -
BHP 7,000 7,000 K
30 19/3/2020 TN.PAIRIN AK Spoit + Tempat 10,000 115,000 10,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
 Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 18,000 18,000 - - - -
BHP 10,000 10,000 K
Spoit + Tempat 55,000 581,000 55,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
14 3/2/2020 TN.BAGUS Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 7,000 7,000 - - - -
BHP 2,000 2,000 K
Spoit + Tempat 13,000 243,000 13,000 K
15 3/2/2020 NY.NAIMA EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000 - - - -
BHP 3,000 3,000 K
Spoit + Tempat 25,000 187,000 25,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
31 20/3/2020 TN.H.MUH TARIK SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 5,000 5,000 - - - -
BHP 4,000 4,000 K
Spoit + Tempat 35,000 264,000 35,000 K
32 20/3/2020 NY. MARENDENG EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
17 6/2/2020 TN.SIMON RD GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 7,000 7,000 - - - -
BHP 9,000 9,000 K
 Spoit + Tempat 30,000 278,000 30,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
33 21/3/2020NN.NUR FITRIANI SANJANI SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 9,000 9,000 - - - -
BHP 7,000 7,000 K
Spoit + Tempat 40,000 312,000 40,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
19 3/2/2020 AN. FADLI AK L 2,000 2,000 - - - -
BHP 5,000 5,000 K
Spoit + Tempat 10,000 81,000 10,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
20 5/2/2020 RN.ASNUR EI L 2,000 2,000 - - - -
BHP 6,000 6,000 K
Spoit + Tempat 10,000 104,000 10,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 4,000 4,000 - - - -
BHP 2,000 2,000 K
Spoit + Tempat 15,000 296,000 15,000 K
21 6/2/2020 TN.RIDWANSYAH AA Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
L 3,000 3,000 - - - -
BHP 6,000 6,000 K
Spoit + Tempat 10,000 149,000 10,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
22 5/2/2020 AN. KHANSA AK Darah Rutin 95,000 95,000 - - L - -
IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
Malaria 80,000 60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00
L 13,000 13,000 - - - -
BHP 11,000 11,000 K
23 6/2/2020 NY.HJ.ST.NUR EI Spoit + Tempat 45,000 614,000 45,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 7,000 7,000 - - - -
BHP 9,000 9,000 K
Spoit + Tempat 35,000 504,000 35,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 4,000 4,000 - - - -
24 5/2/2020 TN. RAHMAT HIDAYAT EI BHP 2,000 2,000 K
Spoit + Tempat 13,000 152,000 13,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 4,000 4,000 - - - -
BHP 4,000 4,000 K
Spoit + Tempat 10,000 99,000 10,000 K
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 6,000 6,000 - - - -
BHP 5,000 5,000 K
25 6/2/2020 NY. NUR QADRIANTI FN Spoit + Tempat 13,000 245,000 13,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
27 10/2/2020 NY.JASMITA EI L 2,000 2,000 - - - -
BHP 5,000 5,000 K
Spoit + Tempat 10,000 81,000 10,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 1,000 - - - -
BHP 2,000 2,000 K
Spoit + Tempat 10,000 77,000 10,000 K
 Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
L 10,000 10,000 - - - -
28 9/2/2020 NY. DEWI ANDRIANI FN BHP 8,000 8,000 K
Spoit + Tempat 12,000 144,000 12,000 K
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 4,000 4,000 - - - -
29 7/2/2020 TN.FACHRUDDIN EI BHP 4,000 4,000 K
Spoit + Tempat 10,000 99,000 10,000 K
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 3,000 3,000 - - - -
BHP 4,000 4,000 K
Spoit + Tempat 10,000 50,000 10,000 K
34 21/3/2020 AN. FADHIL FN Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 3,000 3,000 - - - -
BHP 5,000 5,000 K
Spoit + Tempat 10,000 99,000 10,000 K
35 24/3/2020
TN.YUSUF LUMOMBANG SW GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 4,000 4,000 - - - -
BHP 6,000 6,000 K
Spoit + Tempat 10,000 156,000 10,000 K
36 24/3/2020 TN.MUH.IKBAL FN Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 3,000 3,000 - - - -
BHP 5,000 5,000 K
Spoit + Tempat 10,000 99,000 10,000 K
37 25/3/2020 AN.M.RAFARDHAN AK GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00

L 3,000 3,000 - - - -

BHP 6,000 6,000 K

Spoit + Tempat 10,000 141,000 10,000 K
38 21/03/2020 AN.M.NOVAL EI GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
 Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 2,000 2,000 - - - -
BHP 6,000 6,000 K
Spoit + Tempat 10,000 115,000 10,000 K
39 23/03/2020 NY.FATMA IB Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 2,000 - - - -
BHP 6,000 6,000 K
Spoit + Tempat 10,000 110,000 10,000 K
40 20/03/2020AN STEVEE YO ADRIK AK Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 3,000 3,000 - - - -
BHP 5,000 5,000 K
Spoit + Tempat 10,000 99,000 10,000 K
41 20/3/2020 AN. STACIA YO ANDINI AK GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 3,000 3,000 - - - -
BHP 6,000 6,000 K
Spoit + Tempat 10,000 133,000 10,000 K

RAWAT JALAN

1 26/02/20 TN. BAYU LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000 - - - -
BHP 2,000 5,000 K
Spoit + Tempat 14,000 81,000 10,000 K
2 26/02/20 AN. SAHWA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 6,000 K
Spoit + Tempat Darah 94,000 15,000 K
3 26/02/20 AN.SAIRIL LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 6,000 K
Spoit + Tempat Darah 94,000 15,000 K
 4 26/02/20 AN. PUTRA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 6,000 K
Spoit + Tempat Darah 94,000 15,000 K
1 26/02/19 NY.NURHAYATI EI Kolesterol 65,000 65,000
L 10,000 8,000 - - - -
BHP 5,000 15,000 K
Spoit + Tempat 20,000 100,000 17,000 K
2 26/02/19 NY.LEMBANG IR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
3 26/02/19 TN.CHRIS IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 10,000 261,000 15,000 K
4 26/11/2019 NY.SUCILAWATI IR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
5 27/11/2019 HJ.SUHADA IR Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 7,000 5,000
BHP 4,000 4,000 K
Spoit + Tempat 15,000 290,000 10,000 K
6 27/11/2019 TN.MIO SATRIO LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
 GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
7 27/11/2019 NY.RUBA AM Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 4,000 5,000
BHP 4,000 4,000 K
Spoit + Tempat 10,000 87,000 10,000 K
8 27/02/19 NN.NURUL RESKI EI GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 3,000 1,000
BHP 4,000 2,000 K
Spoit + Tempat 10,000 50,000 10,000 K
9 27/02/19 TN.AYYUB EI Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
L 6,000 8,000 - - - -
BHP 10,000 15,000 K
Spoit + Tempat 10,000 214,000 17,000 K
10 28/02/19 TN.ABD.RAUF RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 14,000 110,000 10,000 K
11 28/11/2019 TN.H.MUCHTAR RD Malaria 80,000 60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 4,000 1,000
BHP 4,000 2,000 K
Spoit + Tempat 10,000 120,000 10,000 K
12 28/11/2019 NY.HJ.RAMASIA RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 4,000 5,000
BHP 4,000 4,000 K
Spoit + Tempat 10,000 87,000 10,000 K
13 28/11/2019 TN.ABD.HAMID RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
 GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
14 28/11/2019 NY.MULIANA RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 2,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 83,000 10,000 K
15 28/11/2019 AN.FARHAN IR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
16 29/11/2019 TN.AHMAD WAHYUD LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Malaria 80,000 60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 15,000 196,000 15,000 K
17 29/11/2019 NY.HEPAWATI IR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 14,000 110,000 10,000 K
18 29/11/2019 NY.HADIJAH EI Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
L 2,000 2,000 - - - -
BHP 2,000 2,000 K
Spoit + Tempat 13,000 67,000 10,000 K
19 29/11/2019 TN.HERMIN LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Malaria 80,000 60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 15,000 196,000 15,000 K
20 29/11/2019 NY.HJ.NURHAYATI LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
 Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 15,000 138,000 15,000 K
21 29/11/2019 TN.A.ZAKARIA EI Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 5,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 53,000 10,000 K
22 30/11/2019 AN.NUR IRDINA LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
23 30/11/2019 AN.CRISTIOONO VI LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 15,000 111,000 15,000 K
24 30/11/2019 AN.ST.AFIAH LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 6,000 3,000
BHP 4,000 6,000 K
Spoit + Tempat 15,000 117,000 15,000 K
25 30/11/2019 NY.RATNA SARI LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 14,000 110,000 10,000 K
26 02/12/19 TN.ARIS WIBOWO LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 15,000 111,000 15,000 K
27 02/12/19 AN.ZAHIRA KR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 77,000 15,000 K
28 02/12/19 TN.SALIM KR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 1,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 49,000 10,000 K
29 02/12/19 AN.ARMAN KR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 77,000 15,000 K
30 02/12/19 NY.SURYANI LL SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
HBSAG 90,000 9,500 80,500.00 44,275.00 36,225.00 L 14,490.00 14,490.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 12,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 15,000 489,000 10,000 K
31 02/03/19 TN.MARTEN LL Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
L 1,000 2,000 - - - -
BHP 2,000 2,000 K
Spoit + Tempat 10,000 63,000 10,000 K
32 02/03/19 AN.NURLIANA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Malaria 80,000 60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 15,000 196,000 15,000 K
33 02/03/19 NY.MASNI IR GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 3,000 1,000
BHP 4,000 2,000 K
Spoit + Tempat 10,000 50,000 10,000 K
34 02/12/19 TN.USMAN ALI IM GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 3,000 1,000
BHP 4,000 2,000 K
Spoit + Tempat 10,000 50,000 10,000 K
35 02/12/19 NY.LILI LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 81,000 15,000 K
36 02/12/19 NY.HJ.NARISA AA Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 14,000 110,000 10,000 K
37 02/12/19 AN.DEWI QUMAIRA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 81,000 15,000 K
38 02/12/19 NY.WULANDARI EI Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
L 3,000 2,000 - - - -
BHP 4,000 2,000 K
Spoit + Tempat 10,000 67,000 10,000 K
39 12/03/19 TN.RUSMAN LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 14,000 115,000 15,000 K
40 12/03/19 NY.RAODA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 14,000 115,000 15,000 K
41 12/03/19 NY.WULANDARI EI Urine Rutin 80,000 80,000
L 5,000 2,000 - - - -
BHP 5,000 2,000 K
Spoit + Tempat 10,000 100,000 10,000 K
42 12/03/19 TN.IRSAN LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Malaria 80,000 60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00
L 3,000 3,000
BHP 5,000 6,000 K
Spoit + Tempat 15,000 167,000 15,000 K
43 12/03/19 TN.HERI SULTAN RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
 BHP 2,000 6,000 K
Spoit + Tempat 14,000 81,000 15,000 K
44 12/03/19 BY.ARSYA RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 14,000 115,000 15,000 K
45 12/03/19 TN.A.IDUL FITRI LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Malaria 45,000 60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 12,000 154,000 15,000 K
46 12/04/19 AN.FAHIRA KR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 15,000 111,000 15,000 K
47 12/04/19 TN.CACA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 77,000 15,000 K
48 12/04/19 TN.AMINUDDIN LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 5,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 53,000 10,000 K
49 12/04/19 NY.HASNI IM GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 3,000 1,000
BHP 4,000 2,000 K
Spoit + Tempat 10,000 50,000 10,000 K
50 12/04/19 TN.SUKIRMAN IM GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 3,000 1,000
BHP 4,000 2,000 K
Spoit + Tempat 10,000 50,000 10,000 K
51 12/04/19 NY.HJ.AZIZAH AF Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
 Spoit + Tempat 14,000 110,000 10,000 K
52 12/04/19 TN.IBNU KHOMAR AA Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 6,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 14,000 243,000 10,000 K
53 12/04/19 NY.MASTURA AF Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 4,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 14,000 175,000 10,000 K
54 12/05/19 NY.WAWTI LL GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 4,000 5,000
BHP 3,000 4,000 K
Spoit + Tempat 10,000 39,000 10,000 K
55 12/06/19 TN.DAMALILING RD GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 1,000 1,000
BHP 2,000 2,000 K
Spoit + Tempat 10,000 46,000 10,000 K
56 12/06/19 TN.ZAMAN RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 1,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 49,000 10,000 K
57 12/06/19 AN.AHMAD FAUZAN RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 81,000 15,000 K
58 12/06/19 AN.ZAHWAN RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 81,000 15,000 K
59 12/06/19 AN.JUMRIANTI RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
 BHP 2,000 6,000 K
Spoit + Tempat 14,000 81,000 15,000 K
60 12/07/19 AHMAD RAYYAN RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 77,000 15,000 K
61 12/07/19 AN.SILA RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 15,000 111,000 15,000 K
62 12/07/19 NY.RAMASIA RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 2,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 83,000 10,000 K
63 12/07/19 NY.RATNA EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 81,000 15,000 K
64 12/07/19 NY.HARDINA EI Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 14,000 110,000 10,000 K
65 12/07/19 NY.SARTIKA AF Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 14,000 110,000 10,000 K
66 12/09/19 TN.TASSA AF GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 2,000 1,000
BHP 2,000 2,000 K
Spoit + Tempat 10,000 36,000 10,000 K
67 12/09/19 NY.MASITA RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
 Spoit + Tempat 10,000 77,000 15,000 K
68 12/09/19 AN.M.ALFARO AF Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 228,000 15,000 K
69 12/09/19 NY.HJ.SUHENI RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
70 12/09/19 TN.SUDIRMAN LL GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 1,000 1,000
BHP 2,000 2,000 K
Spoit + Tempat 10,000 46,000 10,000 K
71 12/09/19 TN.JUNAID LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
72 12/09/19 TN.IKBAL RD Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 5,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 15,000 205,000 10,000 K
73 12/09/19 TN.GAMAR RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
74 12/10/19 NY.NESRIANI LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
 BHP 6,000 6,000 K
Spoit + Tempat 14,000 115,000 15,000 K
75 12/10/19 AN.AULIA LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 14,000 110,000 10,000 K
76 12/10/19 AN.MUH YUSUF AR AF Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 7,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 10,000 362,000 15,000 K
77 12/10/19 NY.REZA RESKI IR Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 138,000 15,000 K
78 12/10/19 NY.JUMRIAH SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 5,000 5,000
BHP 4,000 4,000 K
Spoit + Tempat 10,000 166,000 10,000 K
79 12/11/19 TN.RABIUL LL Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
L 1,000 2,000 - - - -
BHP 2,000 2,000 K
Spoit + Tempat 10,000 63,000 10,000 K
80 12/11/19 AN.A.TENRI LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 77,000 15,000 K
81 12/11/19 TN.A.MUHTAR LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
 L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
82 12/11/19 AN.MUH.RAHNA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 106,000 15,000 K
83 12/11/19 NY.DAISYAH LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 3,000
BHP 6,000 K
Spoit + Tempat Darah 64,000 15,000 K
84 12/11/19 NY.HARMONIKA LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
85 12/11/19 NY.SELFIA LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 2,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 83,000 10,000 K
86 12/11/19 AN.MUH.RAFA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 6,000 K
Spoit + Tempat Darah 65,000 15,000 K
87 12/11/19 AN.SATRIO LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 6,000 K
Spoit + Tempat Darah 65,000 15,000 K
88 12/11/19 AN.IDRIS LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 77,000 15,000 K
89 12/11/19 NY.FITRIANI LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 6,000 K
Spoit + Tempat Darah 65,000 15,000 K
90 12/11/19 TN.SAMAN RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 14,000 110,000 10,000 K
91 12/11/19 NY.JUDIA RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
BHP 6,000 4,000 K
L 6,000 5,000
Spoit + Tempat 10,000 205,000 10,000 K
92 12/11/19 AN.AHMAD RIFAI LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 81,000 15,000 K
93 12/11/19 NY.KURSIA RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 3,000 3,000
BHP 3,000 6,000 K
Spoit + Tempat 14,000 175,000 15,000 K
94 12/12/19 AN.DIMAS LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 110,000 15,000 K
95 12/12/19 NY.HASRIANI LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 2,000 3,000
BHP 1,000 6,000 K
Spoit + Tempat 14,000 81,000 15,000 K
96 12/12/19 TN.DEMMA RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 5,000 5,000
BHP 4,000 4,000 K
 Spoit + Tempat 10,000 110,000 10,000 K
97 12/12/19 NY.FADLIA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 110,000 15,000 K
98 12/12/19 TN.MUH.SYAMSUL RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 5,000 3,000
BHP 4,000 6,000 K
Spoit + Tempat 14,000 115,000 15,000 K
99 12/12/19 TN.IRWAN RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 95,000 15,000 K
100 12/12/19 A. MAHARANI RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 111,000 15,000 K
101 12/12/19 NY.HALMIAH SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 115,000 15,000 K
102 12/12/19 NY.HARUNI SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 3,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 166,000 15,000 K
103 13/12/2019 AN. AHMAD RIFAI LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 1,000 6,000 K
Spoit + Tempat 11,000 77,000 15,000 K
104 13/12/2019 AN.M.RASYA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
 BHP 3,000 6,000 K
Spoit + Tempat 14,000 111,000 15,000 K
105 13/12/2019 NY.HADANIA RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 2,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 14,000 76,000 10,000 K
106 14/12/2019 AN.ADZA LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 5,000 3,000
BHP 4,000 6,000 K
Spoit + Tempat 14,000 115,000 15,000 K
107 14/12/2019 NY.HJ.HANIA LL Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 87,000 15,000 K
108 14/12/2019 AN.GLORIA RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 10,000 3,000
BHP 9,000 6,000 K
Spoit + Tempat 14,000 125,000 15,000 K
109 14/12/2019 TN.AGUS AM Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 53,000 15,000 K
110 14/12/2019 TN.RIFKI LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 81,000 15,000 K
111 16/12/2019 AN.MANDIKA AF Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00
L 1,000 3,000
BHP 1,000 6,000 K
Spoit + Tempat 12,000 228,000 15,000 K
16/12/2019 TN.M.KAMIL AF Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 1,000 3,000
 BHP 1,000 6,000 K
Spoit + Tempat 14,000 149,000 15,000 K
16/12/2019 NY.HJ.JATI RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 1,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 49,000 15,000 K
112 20/2/2020 NY.HASNA AM Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 110,000 15,000 K
113 20/2/2020 NY. EMI RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 110,000 15,000 K
114 20/2/2020 TN.H.M.RIDWAN RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 1,000 6,000 K
Spoit + Tempat 11,000 77,000 15,000 K
115 20/2/2020 AN. ALIYAH RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Malaria 80,000 60,000 20,000.00 11,000.00 9,000.00 L 3,600.00 3,600.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 15,000 196,000 15,000 K
116 21/2/2020 NY.FADILLAH RD Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00
L 5,000 3,000
BHP 4,000 6,000 K
Spoit + Tempat 15,000 266,000 15,000 K
117 21/2/2020 NY.RAHMA RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 110,000 15,000 K
118 21/2/2020 TN.JAMALUDDIN AM Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
 L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 110,000 15,000 K
119 21/2/2020 AN.MUH.ALFARIZI IM Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 3,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 10,000 128,000 15,000 K
120 22/2/2020 NY.HJ.NORMA AM Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 3,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 14,000 115,000 15,000 K
121 22/2/2020 HJ.EDDA RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 110,000 15,000 K
122 22/2/2020 TN.ABD LATIF LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 110,000 15,000 K
123 22/2/2020 AN.M.HANIF LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 1,000 3,000
BHP 6,000 K
Spoit + Tempat 5,000 98,000 15,000 K
124 22/2/2020 SANITA IR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 2,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 83,000 10,000 K
125 22/2/2020 TN.H.AHMAD IM GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 5,000 1,000
BHP 4,000 2,000 K
Spoit + Tempat 14,000 56,000 10,000 K
126 22/2/2020 NY. SAMAATI AM Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
 Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 5,000 5,000
BHP 4,000 4,000 K
Spoit + Tempat 14,000 114,000 10,000 K
127 22/2/2020 NY.HANIRA RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
128 22/2/2020 NN. HASNA LL GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 4,000 1,000
BHP 4,000 2,000 K
Spoit + Tempat 14,000 55,000 10,000 K
129 22/2/2020 MIRZA AM Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 1,000 6,000 K
Spoit + Tempat 11,000 77,000 15,000 K
130 25/2/2020 TN.INO LL Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
L 1,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 46,000 10,000 K
131 20/2/2020 HJ.RASDIANA RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 10,000 106,000 10,000 K
132 20/2/2020 TN..AMIRUDDIN RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 1,000 3,000
BHP 6,000 K
Spoit + Tempat 10,000 75,000 15,000 K
133 20/2/2020 TN.RUSDI AM Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 4,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 14,000 134,000 15,000 K
 134 20/2/2020 TN.IKSAN LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 95,000 15,000 K
135 21/2/2020 TN.SAING LABI AM Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 2,000 4,000 K
Spoit + Tempat 14,000 141,000 10,000 K
136 21/2/2020 NY.DIEN HARDIANTI LL Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 2,000 3,000
BHP 2,000 6,000 K
Spoit + Tempat 10,000 95,000 15,000 K
137 25/2/2020 JASWATI IB GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 1,000 1,000
BHP 2,000 2,000 K
Spoit + Tempat 10,000 46,000 10,000 K

25,515,000 25,515,000 776,000 4,038,000 9,234,800 12,116,200 6,663,910 5,452,290 - 2,180,916 2,180,916

Rawat Inap 9,668,000 9,668,000 -

Rawat Jalan 15,847,000 15,847,000 -
Rincian Total Bruto 25,515,000 25,515,000 -
Jasa Laboran 2,180,916

dr. Nur Rahmi, Sp. PK 2,180,916.00

Reagensia 9,234,800.00
Jasa Klinik 6,663,910.00
BHP 4,038,000.00
L 776,000
10,701,910.00
JASA

Dokter
Pengirim
20 %

17

2,880.00 SR
1,170.00 SR
2,070.00 SR
1,755.00 SR
2,295.00 SR
2,295.00 SR
2,322.00 SR
2,115.00 SR
- SR
SR
SR
2,880.00 SR
1,458.00 SR
2,070.00 SR
1,755.00 SR
2,295.00 SR
2,295.00 SR
2,322.00 SR
2,115.00 SR
- SR
SR
SR
2,880.00 SR
2,880.00 SR
2,880.00 SR
2,880.00 SR
2,070.00 SR
1,755.00 SR
2,295.00 SR
2,295.00 SR
3,780.00 SR
1,170.00 SR
4,500.00 SR
1,080.00 SR
2,205.00 SR
- SR
SR
SR
2,880.00 NR
1,458.00 NR
1,755.00 NR
2,322.00 NR
2,115.00 NR
- NR
NR
NR
2,880.00 NR
2,880.00 NR
- NR
- NR
NR
NR
2,880.00 SR
2,205.00 SR
- SR
SR
SR
2,880.00 SR
2,880.00 SR
2,880.00 SR
2,880.00 SR
2,880.00 SR
3,780.00 SR
1,170.00 SR
4,500.00 SR
2,205.00 SR
- SR
SR
SR
2,880.00 NR
3,780.00 NR
1,170.00 NR
- NR
NR
NR
2,880.00 NR
2,880.00 NR
2,880.00 NR
2,880.00 NR
2,880.00 NR
2,115.00 NR
- NR
NR
NR
2,880.00 NR
2,880.00 NR
- NR
- NR
1,170.00 NR
4,500.00 NR
2,205.00 NR
- NR
NR
NR
2,880.00 SR
1,458.00 SR
2,205.00 SR
- SR
SR
SR
2,880.00 NR
- NR
NR
NR
2,880.00 NR
2,205.00 NR
- NR
NR
NR
2,880.00 NR
2,880.00 NR
2,880.00 NR
2,880.00 NR
2,880.00 NR
4,500.00 NR
2,205.00 NR
- NR
NR
NR
2,880.00 NR
1,458.00 NR
2,070.00 NR
1,755.00 NR
2,322.00 NR
2,115.00 NR
- NR
NR
NR
2,880.00 SR
2,880.00 SR
2,205.00 SR
- SR
SR
SR
2,880.00 SR
2,880.00 SR
2,880.00 SR
2,205.00 SR
- SR
SR
SR
2,880.00 SR
1,170.00 SR
1,170.00 SR
1,170.00 SR
2,322.00 SR
2,115.00 SR
- SR
SR
 SR
2,880.00 NR
2,880.00 NR
2,880.00 NR
2,880.00 NR
- NR
NR
NR
2,880.00 NR
- NR
NR
NR
2,880.00 NR
1,458.00 NR
- NR
NR
NR
2,880.00 NR
1,170.00 NR
4,500.00 NR
2,205.00 NR
- NR
NR
NR
2,880.00 NR
1,170.00 NR
1,755.00 NR
- NR
NR
NR
2,880.00 NR
2,880.00 NR
2,880.00 NR
- NR
4,500.00 NR
2,205.00 NR
1,800.00 NR
- NR
NR
 NR
2,880.00 SR
2,880.00 SR
2,880.00 SR
3,780.00 SR
1,170.00 SR
4,500.00 SR
2,205.00 SR
- SR
SR
SR
2,880.00 SR
2,322.00 SR
2,115.00 SR
- SR
SR
SR
2,880.00 SR
1,080.00 SR
- SR
SR
SR
2,070.00 SR
1,755.00 SR
2,880.00 SR
2,322.00 SR
2,115.00 SR
1,458.00 SR
- SR
SR
SR
2,880.00 SR
- SR
SR
SR
2,880.00 SR
- SR
SR
SR
2,880.00 NR
3,780.00 NR
- NR
NR
NR
2,880.00 NR
1,080.00 NR
- NR
NR
NR
1,170.00 NR
- NR
NR
NR
2,880.00 NR
1,080.00 NR
- NR
NR
NR
1,458.00 SR
1,755.00 SR
2,880.00 SR
1,080.00 SR
- SR
SR
SR
2,880.00 SR
1,080.00 SR
- SR
SR
SR
1,458.00 NR
2,880.00 NR
2,322.00 NR
- NR
NR
NR
1,170.00 NR
2,880.00 NR
- NR
NR
NR
2,880.00 NR
2,205.00 NR
- NR
NR
NR
2,880.00 SR
1,080.00 SR
- SR
SR
SR
1,170.00 SR
2,880.00 SR
1,080.00 SR
- SR
SR
SR
SR

2,880.00 SR
- SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
SR
- SR
SR
SR
2,322.00 SR
2,115.00 SR
1,458.00 SR
SR
SR
SR
2,880.00 SR
4,500.00 SR
2,205.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
1,458.00 SR
SR
SR
SR
2,205.00 NR
2,880.00 NR
2,880.00 NR
1,080.00 NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
2,322.00 NR
2,115.00 NR
NR
NR
NR
1,170.00 NR
NR
NR
NR
2,070.00 NR
2,880.00 NR
1,458.00 NR
2,322.00 NR
1,755.00 NR
- NR
NR
NR
2,322.00 SR
2,115.00 SR
1,458.00 SR
SR
SR
SR
1,800.00 SR
1,458.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
1,458.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
1,458.00 SR
SR
SR
SR
2,880.00 SR
1,800.00 SR
2,205.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
1,458.00 SR
SR
SR
SR
3,780.00 SR
- SR
SR
SR
2,880.00 NR
1,800.00 NR
2,205.00 NR
NR
NR
NR
2,880.00 NR
1,458.00 NR
2,205.00 NR
NR
NR
NR
2,322.00 NR
NR
NR
NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
1,458.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,880.00 SR
SR
SR
SR
2,322.00 SR
SR
SR
SR
2,880.00 SR
SR
SR
SR
2,295.00 SR
2,295.00 SR
2,880.00 SR
2,880.00 SR
2,880.00 SR
1,080.00 SR
2,322.00 SR
7,245.00 SR
2,115.00 SR
1,458.00 SR
SR
SR
SR
3,780.00 SR
- SR
SR
SR
2,880.00 SR
1,800.00 SR
2,205.00 SR
SR
SR
SR
1,170.00 SR
SR
SR
SR
1,170.00 SR
SR
SR
SR
2,880.00 SR
SR
SR
SR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
2,880.00 NR
NR
NR
NR
3,780.00 NR
- NR
NR
NR
2,880.00 NR
2,205.00 NR
NR
NR
NR
2,880.00 NR
2,205.00 NR
NR
NR
NR
NR
- NR
NR
NR
2,880.00 NR
1,800.00 NR
NR
NR
NR
2,880.00 NR
NR
 NR
NR
2,880.00 NR
2,205.00 NR
NR
NR
NR
2,880.00 NR
1,800.00 NR
2,205.00 NR
NR
NR
NR
2,880.00 NR
2,205.00 NR
NR
NR
NR
2,880.00 NR
NR
NR
NR
2,322.00 NR
NR
NR
NR
1,170.00 NR
NR
NR
NR
1,170.00 NR
NR
NR
NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
 NR
2,070.00 NR
1,755.00 NR
2,880.00 NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
2,880.00 NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
1,458.00 NR
NR
NR
NR
1,170.00 SR
SR
SR
SR
2,322.00 SR
SR
SR
SR
2,880.00 SR
SR
SR
SR
2,880.00 SR
SR
SR
SR
2,880.00 SR
SR
 SR
SR
2,880.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
SR
SR
SR
2,880.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
1,458.00 SR
SR
SR
SR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
1,458.00 NR
NR
NR
NR
2,880.00 NR
NR
NR
 NR
2,880.00 NR
4,500.00 NR
NR
NR
NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
1,170.00 NR
NR
NR
NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
2,205.00 NR
2,880.00 NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
2,880.00 NR
2,205.00 NR
NR
 NR
NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
2,205.00 NR
2,880.00 NR
2,880.00 NR
4,500.00 NR
2,115.00 NR
NR
NR
NR
2,205.00 SR
2,880.00 SR
1,170.00 SR
SR
SR
SR
2,880.00 SR
3,780.00 SR
1,170.00 SR
SR
SR
SR
3,780.00 SR
- SR
SR
SR
2,880.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
1,458.00 SR
 SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,880.00 NR
NR
NR
NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
2,322.00 NR
2,115.00 NR
NR
NR
NR
2,880.00 NR
NR
NR
NR
2,880.00 NR
NR
NR
NR
2,880.00 NR
NR
NR
NR
2,880.00 NR
NR
NR
NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
2,880.00 NR
2,322.00 NR
2,205.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
NR
2,880.00 NR
NR
NR
NR
2,880.00 NR
2,115.00 NR
1,458.00 NR
2,322.00 NR
NR
NR
NR
2,880.00 NR
2,205.00 NR
NR
NR
NR
2,880.00 NR
NR
NR
NR
2,322.00 NR
2,115.00 NR
1,458.00 NR
NR
NR
 NR
2,880.00 NR
2,205.00 NR
NR
NR
NR
2,880.00 NR
2,205.00 NR
NR
NR
NR
2,880.00 NR
1,080.00 NR
NR
NR
NR
2,880.00 NR
2,205.00 NR
NR
NR
NR
2,880.00 NR
1,170.00 NR
NR
NR
NR
2,880.00 NR
3,780.00 NR
1,170.00 NR
NR
NR
NR
2,880.00 NR
NR
NR
NR
2,880.00 NR
2,205.00 NR
NR
 NR
NR
2,322.00 NR
1,458.00 NR
NR
NR
NR
2,880.00 NR
2,205.00 NR
NR
NR
NR
2,115.00 NR
2,322.00 NR
NR
NR
NR
2,880.00 NR
2,205.00 NR
NR
NR
NR
2,322.00 NR
NR
NR
NR
2,880.00 NR
NR
NR
NR
2,880.00 NR
4,500.00 NR
NR
NR
NR
2,880.00 SR
2,115.00 SR
2,322.00 SR
SR
 SR
SR
2,322.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,880.00 SR
SR
SR
SR
2,880.00 SR
1,800.00 SR
2,205.00 SR
SR
SR
SR
2,205.00 SR
2,880.00 SR
4,500.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
 SR
SR
SR
2,205.00 SR
1,080.00 SR
2,880.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,880.00 SR
2,205.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
SR
SR
SR
1,170.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
1,458.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
1,458.00 SR
SR
SR
SR
1,170.00 SR
SR
SR
SR
2,880.00 SR
SR
SR
SR
2,115.00 SR
SR
SR
SR
2,322.00 SR
2,115.00 SR
1,458.00 SR
SR
SR
SR
2,880.00 NR
NR
NR
NR
2,205.00 NR
2,880.00 NR
1,458.00 NR
NR
NR
NR
 2,880.00 NR
1,080.00 NR
NR
NR
NR
2,880.00 NR
2,322.00 NR
1,458.00 NR
NR
NR
NR
2,880.00 NR
1,080.00 NR
NR
NR
NR
1,170.00 NR
NR
NR
NR

1,090,458
 DAFTAR DISTRIBUSI JASA LABORATORIUM MIFTA POLEWALI BULAN April 2020 RUMAH SAKIT BERSALIN & KLINIK SPESIALIS MIFTA
KODE HARGA JASA JASA

NO TGL NAMA PASIEN URAIAN TARIF TOTAL TOTAL JASA KD AN

dr BAYAR L KLINIK REAGEN KLINIK 55% PEMB. LAB PJ LABORAN
45% 40% 40 %

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
RAWAT INAP
1 26/3/2020 NY.NURSIANI SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00

GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00

L 3,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 159,000 10,000 K
2 26/3/2020 AN.AQILA AK Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

L 3,000 5,000

BHP 5,000 4,000 K

Spoit + Tempat 10,000 99,000 10,000 K
3 27/3/2020 TN. BASRI AA/SW GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00

GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00

GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00

Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00

Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

L 10,000 10,000 - - - -

BHP 10,000 5,000 K

Spoit + Tempat 25,000 344,000 20,000 K
4 27/3/2020 NY. LISTIANI FN/EI Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

 Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

IgG/IgM 150,000 100,000 50,000.00 27,500.00 22,500.00 L 9,000.00 9,000.00

Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00

GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00

Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00

L 9,000 9,000 - - - -

BHP 9,000 8,000 K

Spoit + Tempat 35,000 667,000 30,000 K
5 27/3/2020 NY.A.RAHMAWATI RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00

Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00

GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00

L 4,000 9,000 - - - -

BHP 6,000 8,000 K

Spoit + Tempat 10,000 175,000 30,000 K
6 28/3/2020 AN. BINTANG AK Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 2,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 99,000 10,000 K
7 29/3/2020 AN.ADYAN WILDAN AK GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

L 3,000 5,000

BHP 6,000 4,000 K

Spoit + Tempat 10,000 122,000 10,000 K
8 30/3/2020 NY.MARYAM FN Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

L 2,000 5,000

BHP 6,000 4,000 K

Spoit + Tempat 10,000 99,000 10,000 K
 9 1/4/2020 NY.A.HARDIYANTI FN Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 2,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 99,000 10,000 K
10 3/4/2020 NY.LISNA SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 100,000 10,000 K
11 04.04.20 NY.NURMAYANTI FN HBSAG 90,000 9,500 80,500.00 44,275.00 36,225.00 L 14,490.00 14,490.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 5,000 5,000
BHP 9,000 4,000 K
Spoit + Tempat 10,000 178,000 10,000 K
12 04.04.20 NY.DINI DEWI FN HBSAG 90,000 9,500 80,500.00 44,275.00 36,225.00 L 14,490.00 14,490.00
SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 19,000 10,000 - - - -
BHP 15,000 5,000 K
Spoit + Tempat 30,000 453,000 20,000 K
13 04.04.20 AN. UH. YAFID AK Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 100,000 10,000 K
14 04.04.20 NY. ARMINA FN Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 100,000 10,000 K
15 04.04.20 TN.H.YUSUF EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

 Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00

GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00

L 6,000 9,000 - - - -

BHP 12,000 8,000 K

Spoit + Tempat 15,000 235,000 30,000 K
16 7/4/2020 TN.JAMALUDDIN EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00

GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00

L 6,000 9,000 - - - -

BHP 6,000 8,000 K

Spoit + Tempat 10,000 202,000 30,000 K
17 6/4/2020 NY.HJ.IRMAYANTI FN Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 4,000 9,000 - - - -
BHP 11,000 8,000 K
Spoit + Tempat 10,000 170,000 30,000 K
18 7/4/2020 TN.RAHMAT SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
 GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 6,000 9,000 - - - -
BHP 13,000 8,000 K
Spoit + Tempat 50,000 654,000 30,000 K
19 7/4/2020 NY.MARWAH FN Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 100,000 10,000 K
20 07/4/202O NY.HADIJA FN GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
HBSAG 67,000 9,500 57,500.00 31,625.00 25,875.00 L 10,350.00 10,350.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 200,000 10,000 K
21 9/4/2020 TN.SUPARDI SW Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 6,000 9,000 - - - -
BHP 7,000 8,000 K
Spoit + Tempat 10,000 225,000 30,000 K
22 9/4/2020 TN. RIZAL AA Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00

Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00

GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00

L 3,000 5,000

BHP 5,000 4,000 K

 Spoit + Tempat 20,000 441,000 10,000 K
23 10/4/2020 NY.ROHANI AA Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 5,000 4,000 K
Spoit + Tempat 19,000 199,000 10,000 K
24 12/4/2020 NY.ARMINA FN Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 100,000 10,000 K
25 14/4/2020 NY.MULTAZAM SW Darah Rutin 95,000 95,000 - - L - -
SGOT 65,000 65,000 - - L - -
SGPT 65,000 65,000 - - L - -
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
L 6,000 5,000
BHP 9,000 4,000 K
Spoit + Tempat 40,000 693,000 10,000 K
26 14/4/2020 NY.NUR ATIKA FN HBSAG 70,000 9,500 60,500.00 33,275.00 27,225.00 L 10,890.00 10,890.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 6,000 10,000 - - - -
BHP 10,000 5,000 K
Spoit + Tempat 20,000 339,000 20,000 K
27 14/4/2020 AN.REFALINA AK GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 3,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 123,000 10,000 K
28 15/4/2020 NY.HJ. NURLYA EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00

Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00

GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00

L 5,000 5,000

BHP 10,000 4,000 K

Spoit + Tempat 24,000 388,000 10,000 K
29 17/4/2020 NY. NUR ANAH FN Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

L 3,000 5,000

BHP 6,000 4,000 K

Spoit + Tempat 10,000 100,000 10,000 K
30 20/4/2020 NY.SARTIKA SW GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00

Plano Test 25,000 25,000

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

L 4,000 5,000

BHP 8,000 4,000 K

Spoit + Tempat 14,000 165,000 10,000 K
31 20/4/2020 NN.PUTRI DWI LESTARI EI GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00

Elektrolit 252,000 252,000 - - L - -

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

 L 4,000 5,000

BHP 10,000 4,000 K

Spoit + Tempat 14,000 394,000 10,000 K
32 21/4/2020 AN.ZAHRA AK GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

L 4,000 5,000

BHP 8,000 4,000 K

Spoit + Tempat 14,000 204,000 10,000 K
33 21/4/2020 NY. SUKMAWATI FN Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

L 3,000 5,000

BHP 6,000 4,000 K

Spoit + Tempat 10,000 100,000 10,000 K
34 4/20/2020TN. AHMAD HAMBALI EI GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00

Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

L 3,000 5,000

BHP 7,000 4,000 K

Spoit + Tempat 10,000 134,000 10,000 K
35 4/20/2020 NY. HJ. FARIDA EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00

Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00

Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00

GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00

SGOT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
SGPT 33,000 7,500 25,500.00 14,025.00 11,475.00 L 4,590.00 4,590.00
Ureum 33,000 10,000 23,000.00 12,650.00 10,350.00 L 4,140.00 4,140.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00

L 5,000 5,000

BHP 15,000 4,000 K

Spoit + Tempat 24,000 331,000 10,000 K
36 4/23/2020 NY. DHANA FI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
 Golongan Dara 17,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00

L 4,000 5,000

BHP 10,000 4,000 K

Spoit + Tempat 10,000 105,000 10,000 K

RAWAT JALAN

1 26/3/2020 AN.ALIKA RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 6,000 6,000 K
Spoit + Tempat 15,000 115,000 15,000 K
2 27/3/2020 TN. YUSUF RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 4,000 5,000
BHP 8,000 4,000 K
Spoit + Tempat 10,000 177,000 10,000 K
3 27/3/2020 NY.HJ. NURBAYA RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 4,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 175,000 10,000 K
4 27/3/2020 HJ. RAHMA RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 110,000 10,000 K
5 27/3/2020 NY.RIA IM Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
 L 1,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 81,000 10,000 K
6 27/3/2020 NY.SUDURIA EI Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 110,000 10,000 K
7 28/3/2020 TN. MUSTAFA RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 110,000 10,000 K
8 28/3/2020 NY.SALMIA SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Golongan Dara 15,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 1,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 96,000 10,000 K
9 30/3/2020 NY.LISTIANI FN Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 110,000 10,000 K
10 30/3/2020 NY.SUGIYEM EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 2,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 118,000 10,000 K
11 30/3/2020 TN.ABD.SAMAD AM GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 1,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 40,000 10,000 K
12 31/3/2020 TN.SYAHRIL LL GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 1,000 5,000
BHP 8,000 4,000 K
Spoit + Tempat 10,000 52,000 10,000 K
13 04/01/20 NY. HANIA IM Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 2,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 54,000 10,000 K
14 03/05/20 BAHARIA AM Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 1,000 5,000
BHP 5,000 4,000 K
Spoit + Tempat 10,000 52,000 10,000 K
15 04/03/20 NY.HASRIANI LL GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 1,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 51,000 10,000 K
16 04/04/20 TN.SYARIFUDDIN SW Golongan Dara 15,000 5,000 12,000.00 6,600.00 5,400.00 L 2,160.00 2,160.00
L 3,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 35,000 10,000 K
17 04/06/20 NY.FARASIDAL FN GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 1,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 51,000 10,000 K
18 04/06/20 NY.MESTIDIANTY IM Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 2,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 54,000 10,000 K
19 04/08/20 A. BASSE RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 2,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 82,000 10,000 K
20 04/08/20 TN.SAPRI AM Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 110,000 10,000 K
21 04/08/20 TN.M.KAMIL AM Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 2,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 133,000 10,000 K
22 04/08/20 NY.NURFADLIYAH M FN Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
L 2,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 68,000 10,000 K
23 04/08/20 NN.WULAN EI Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 3,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 122,000 10,000 K
24 04/10/20 TN. ALIMUDDIN IR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 111,000 10,000 K
25 04/10/20 TN.ABD.SAMAD RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 111,000 10,000 K
26 04/11/20 TN.SYAHRIL IR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 111,000 10,000 K
27 04/11/20 TN. FAJAR IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
L 2,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 82,000 10,000 K
28 04/11/20 NY.CICI LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 111,000 10,000 K
29 14/4/2020 NY.HJ.HADIJA LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
 GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 77,000 10,000 K
30 15/4/2020 NY.HJ.RUBA LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 111,000 10,000 K
31 15/4/2020 NY.ROHANI IR Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 7,000 6,000 K
Spoit + Tempat 15,000 116,000 15,000 K
32 15/4/2020 NY.TITI SUARTI EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 4,000 5,000
BHP 10,000 4,000 K
Spoit + Tempat 12,000 181,000 10,000 K
33 16/4/2020 TN.IRWAN RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kreatinin 33,000 13,500 19,500.00 10,725.00 8,775.00 L 3,510.00 3,510.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 139,000 10,000 K
34 16/4/2020 NY.DARMA SW Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 7,000 6,000 K
Spoit + Tempat 15,000 116,000 15,000 K
35 17/4/2020 NY.SANIA EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 7,000 6,000 K
Spoit + Tempat 15,000 116,000 15,000 K
36 18/4/2020 TN.SUTRISNO LL Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
 Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 3,000 4,000 K
Spoit + Tempat 10,000 107,000 10,000 K
37 20/4/2020 NY.SAHARA IR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
L 2,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 54,000 10,000 K
38 20/4/2020 NY.NURMALA KR Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 111,000 10,000 K
39 21/4/2020 TN. ABD. HALIM SW GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 1,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 51,000 10,000 K
40 22/04/20 TN.H. PATURUSI RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 77,000 10,000 K
45 22/04/20 TN. LAPODING IM GDS 33,000 20,000 13,000.00 7,150.00 5,850.00 L 2,340.00 2,340.00
L 1,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 51,000 10,000 K
46 22/04/20 NY. ANDRIANI RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 7,000 4,000 K
Spoit + Tempat 10,000 111,000 10,000 K
47 22/04/20 HJ. SANIA RD Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 3,000 5,000
BHP 7,000 4,000 K
 Spoit + Tempat 10,000 111,000 10,000 K
48 22/04/20 NY. A. MILA EI Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 7,000 6,000 K
Spoit + Tempat 15,000 116,000 15,000 K
49 22/04/20 H. UDIN RD Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 7,000 6,000 K
Spoit + Tempat 15,000 116,000 15,000 K
50 23/04/20 TN. MUH. YUSUF 46 Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Kolesterol 36,000 10,200 25,800.00 14,190.00 11,610.00 L 4,644.00 4,644.00
Asam Urat 33,000 9,500 23,500.00 12,925.00 10,575.00 L 4,230.00 4,230.00
GDS 22,000 5,800 16,200.00 8,910.00 7,290.00 L 2,916.00 2,916.00
L 5,000 5,000
BHP 16,000 4,000 K
Spoit + Tempat 10,000 186,000 10,000 K
51 25/04/20 tn. Ronald 50 Darah Rutin 64,000 32,000 32,000.00 17,600.00 14,400.00 L 5,760.00 5,760.00
Widal 28,000 3,500 24,500.00 13,475.00 11,025.00 L 4,410.00 4,410.00
L 2,000 3,000
BHP 7,000 6,000 K
Spoit + Tempat 15,000 116,000 15,000 K
52 25/04/20 tn. Samsul 68 Urine Rutin 50,000 8,000 42,000.00 23,100.00 18,900.00 L 7,560.00 7,560.00
L 2,000 5,000
BHP 6,000 4,000 K
Spoit + Tempat 10,000 68,000 10,000 K

13,159,000 13,159,000 449,000 1,928,000 4,214,800 6,475,200 3,561,360 2,913,840 - 1,165,536 1,165,536

Rawat Inap 8,396,000 8,396,000 -

Rawat Jalan 4,763,000 4,763,000 -
Rincian Total Bruto 13,159,000 13,159,000 -
Jasa Laboran 1,165,536
dr. Nur Rahmi, Sp. PK 1,165,536.00
Reagensia 4,214,800.00
Jasa Klinik 3,561,360.00
BHP 1,928,000.00
L 449,000
5,489,360.00
JASA

Dokter
Pengirim
20 %

17

2,880.00 DR,GOLDA,GDS,KOL
159,000
1,080.00
2,322.00
1,458.00

2,880.00 99,000 DR,GOLDA

1,080.00

1,170.00 DR,UR,GOLDA,GDS STRIP3,KOL.AU

344,000
1,170.00
1,170.00
2,322.00
2,115.00
2,880.00
3,780.00
1,080.00
-

2,205.00 DR4HBSAG2,WIDAL2,IGG IGM,OT,PT

667,000
2,295.00
2,295.00
2,880.00
2,880.00
2,880.00
2,880.00
4,500.00
2,205.00
2,205.00
1,458.00
2,322.00
-

2,880.00 DR,GDS,KOL,AU
175,000
2,322.00
2,115.00
1,458.00
-

2,880.00 99,000 DR.GOLDA

1,080.00

1,458.00 122,000DR,GOLDA,GDS
2,880.00
1,080.00

2,880.00 99,000 DR,GOLDA

1,080.00
2,880.00 99,000 DR.GOLDA
1,080.00

2,880.00 100,000 DR,GOLDA

1,080.00

7,245.00 DR,GOLDA.HBSAG
178,000
2,880.00

DR2,GOLDA,GDS,UR,CREA,HBSAG,OT,PT
7,245.00 453,000
2,295.00
2,295.00
2,070.00
1,755.00
2,880.00
2,880.00
1,458.00
1,080.00
-

2,880.00 100,000 DR,GOLDA

1,080.00

2,880.00 100,000 DR,GOLDA

1,080.00

2,880.00 DR,GOLDA,GDS,AU,URE,CREA
235,000
1,080.00
 2,070.00
1,755.00
2,115.00
1,458.00
-

2,880.00 DR,GDS STRI,GOLDA,UR,CREA

202,000
1,080.00
2,070.00
1,755.00
1,170.00
-

2,880.00 170,000DR(2X),GOLDA
2,880.00
1,080.00
-

DR,GOLDA,GDS
2,880.00 ,GDS STRIP (10 X),KOL,URE,CERA,UR,
654,000
1,080.00
2,070.00
1,755.00
3,780.00
1,458.00
1,170.00
1,170.00
1,170.00
1,170.00
1,170.00
1,170.00
1,170.00
1,170.00
1,170.00
1,170.00
2,322.00
-

2,880.00 100,000 DR,GOLDA

1,080.00

1,170.00 DR,GOLDA,GDS
200,000 STRIP,HBS AG
5,175.00
2,880.00
1,080.00

2,115.00 DR,GOLDA,GDS,AU,URE,CREA
225,000
2,880.00
1,080.00
2,070.00
1,755.00
1,458.00
-

2,880.00 441,000
DR,GDS,KOL,AU
2,322.00
2,115.00
1,458.00
2,880.00
2,880.00
2,880.00
2,070.00
1,755.00
2,880.00 DR,GOLDA,GDS,KOL,AU
199,000
1,080.00
2,322.00
2,115.00
1,458.00

2,880.00 100,000 DR,GOLDA

1,080.00

- 693,000 DR (2X),GOLDA,UR,CRE,SGOT,SGPT,DR,,BILL TOT,UR,CRE,SGPT (RSUD )

-
-
2,880.00
2,322.00
2,115.00
1,458.00
2,880.00
2,880.00
2,880.00
2,070.00
1,755.00

DR(2X),GOLDA,GDS,CRE,SGPT,HBS
5,445.00 339,000 AG
2,295.00
1,755.00
2,880.00
2,880.00
1,458.00
1,080.00
-
1,458.00 DR,GOLDA,GDS
123,000
2,880.00
1,080.00

DR,UR,GDS,GDSSTRIP,
2,880.00 388,000 KOL,AU, GOLDA
2,322.00
2,115.00
1,458.00
2,880.00
2,880.00
2,070.00
1,755.00

2,880.00 100,000 DR.GOLDA

1,080.00

1,170.00 DR,GOLDA,GDS
165,000 STRIP,PLANO TEST

2,880.00
1,080.00

DR,GOLDA,GDS
1,170.00 394,000 STRIP,ELECTRO (RSUD)
-
2,880.00
1,080.00
1,170.00 DR,GOLDA,GDS STRIP
204,000
2,880.00
2,880.00
1,080.00

2,880.00 100,000 DR,GOLDA

1,080.00

1,170.00
2,880.00
1,080.00

2,880.00
2,322.00
2,115.00
1,458.00
2,295.00
2,295.00
2,070.00
1,755.00

2,880.00
1,080.00

2,880.00 115,000 DR,WIDAL

2,205.00

2,880.00 177,000 DR,GDS,KOL

2,322.00
2,115.00
1,458.00

2,880.00 175,000 DR,GDS,KOL,AU

2,322.00
2,115.00
1,458.00

2,322.00 110,000 GDS,KOL,AU

2,115.00
1,458.00

2,880.00 81,000 DR
2,322.00 110,000 GDS,KOL,AU
2,115.00
1,458.00

2,322.00 110,000 DR,WIDAL

2,115.00
1,458.00

2,880.00 96,000 DR
1,080.00

2,322.00 110,000 GDS,KOL,AU

2,115.00
1,458.00

2,880.00 118,000 DR,KOL

2,322.00

1,458.00 40,000 GDS

1,170.00 52,000 GDS STRIP bioooooo

2,322.00 54,000 KOL

2,322.00 52,000 KOL

1,170.00 51,000 GDS STRIP ( 2 MASKER )

1,080.00 35,000 GOLDA

1,170.00 51,000 GDS STRIP

2,322.00 54,000 KOL

2,880.00 82,000 DR

2,322.00 110,000 GDS,KOL,AU

2,115.00
1,458.00

3,780.00 133,000 DR,UR

2,880.00
3,780.00 68,000 UR

2,322.00 122,000 GDS STRIP,KOL,AU

2,115.00
1,170.00

2,322.00 111,000 GDS,KOL,AU

2,115.00
1,458.00

2,322.00 111,000 GDS,KOL,AU

2,115.00
1,458.00

2,322.00 111,000 GDS,KOL,AU

2,115.00
1,458.00

2,880.00 82,000 DR

2,322.00 111,000 GDS,KOL,AU

2,115.00
1,458.00

2,322.00 77,000 GDS.KOL

1,458.00

2,322.00 111,000 GDS,KOL,AU

2,115.00
1,458.00

2,880.00 116,000 DR,WIDAL

2,205.00

2,880.00 181,000 DR,GDS,KOL,AU

2,322.00
2,115.00
1,458.00

2,880.00 139,000 DR,GDS,CREA

1,755.00
1,458.00

2,880.00 116,000 DR,WIDAL

2,205.00

2,880.00 116,000 GDS,KOL,AU

2,205.00

2,322.00 107,000 GDS,KOL,AU ( BUKAN SAYA TAGIH )

2,115.00
1,458.00

2,322.00 54,000 KOL

2,322.00 111,000 GDS,KOL,AU

2,115.00
1,458.00

1,170.00 51,000 GDS STRIP

2,322.00
1,458.00

1,170.00

2,322.00
2,115.00
1,458.00

2,322.00
2,115.00
1,458.00
2,880.00
2,205.00

2,880.00
2,205.00

2,880.00
2,322.00
2,115.00
1,458.00

2,880.00
2,205.00

3,780.00

582,768