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REKAP PENGAJUAN KLAIM JAMINAN COVID-19, NO. 5104036R47020303 / RS FAMILI HUSADA (5104036)
JL ASTINA TIMUR NO 8A / GIANYAR, BALI
No. Tgl. Masuk Tgl. Pulang Nama Pasien Tgl. Lahir No. RM LOS
1 26 Jan 2021 05 Feb 2021 I WAYAN SUSILA 31 Dec 1957 025486 11
2 11 Feb 2021 22 Feb 2021 I MADE DENA 12 Feb 1964 054749 12
3 08 Feb 2021 18 Feb 2021 LUH GEDE ANTARI 13 Apr 1975 010941 11
4 31 Jan 2021 01 Feb 2021 ANAK AGUNG MANIK ASTUTI 18 Jul 1968 063110 2
8 07 Feb 2021 19 Feb 2021 I NYOMAN PASEK SUMERTA 02 Mar 1964 063284 13
26 13 Feb 2021 19 Feb 2021 I WAYAN SANTIKA ADNYANA 10 Jun 1968 008503 7
27 08 Feb 2021 17 Feb 2021 I WAYAN SAMUDRA 01 Jul 1950 063314 10
28 01 Feb 2021 10 Feb 2021 I DEWA GEDE PUTRA 31 Dec 1959 063115 10
29 15 Feb 2021 17 Feb 2021 I MADE TULUS SUARJANA 05 Jun 1973 010695 3
30 16 Feb 2021 17 Feb 2021 AYU NYOMAN KERTI 31 Dec 1960 020870 2
31 13 Feb 2021 23 Feb 2021 I MADE BECOL 31 Dec 1955 010767 11
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32 12 Feb 2021 22 Feb 2021 I WAYAN AGUS SUARTANA 02 Nov 1974 054472 11
33 10 Feb 2021 19 Feb 2021 KADEK HARTANINGSIH 21 Oct 1992 063365 10
34 18 Feb 2021 21 Feb 2021 NI KADEK SENI ASTUTI 05 Jul 1977 056793 4
35 05 Feb 2021 15 Feb 2021 NI MADE KONCI 05 Oct 1965 063260 11
36 14 Feb 2021 15 Feb 2021 NI KETUT NENDRI 31 Dec 1959 021760 2
37 03 Feb 2021 15 Feb 2021 I NYOMAN SUNARTHA 01 Oct 1956 063187 13
53 11 Feb 2021 15 Feb 2021 IDA AYU MADE DEWI PUSPITA 10 Jun 1979 055765 5
54 19 Feb 2021 27 Feb 2021 NGAKAN PUTU PURWA 21 May 1938 026980 9
55 27 Feb 2021 28 Feb 2021 DRS.I KETUT TANTRA YASA 31 Dec 1947 036391 2
56 19 Feb 2021 27 Feb 2021 DESAK MADE SARI 31 Dec 1972 063570 9
57 19 Feb 2021 28 Feb 2021 PUTU SUDIADA 15 Jan 1972 063571 10
58 23 Jan 2021 07 Feb 2021 DESAK KOMPIYANG EKA NINGSIH 29 Oct 1976 029162 16
59 15 Feb 2021 24 Feb 2021 I A KT YUNITA ARIANI 27 Jun 1980 063443 10
60 19 Feb 2021 27 Feb 2021 I WAYAN PURNATA 03 Apr 1965 063568 9
61 23 Feb 2021 24 Feb 2021 DESAK MADE ROTI 01 Jul 1938 049091 2
62 27 Jan 2021 06 Feb 2021 I WAYAN SUJANA 06 Jun 1971 023214 11
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63 28 Jan 2021 07 Feb 2021 DEWA AYU AGUNG SETYAWATI 03 Sep 1968 063027 12
64 17 Feb 2021 27 Feb 2021 NI MADE MURNI 20 Mar 1966 035424 11
65 24 Jan 2021 05 Feb 2021 I KOMANG SUARDANA 14 Feb 1987 062944 13
66 06 Feb 2021 10 Feb 2021 I MADE SUKADANA 21 Jul 1955 063272 5
67 28 Jan 2021 07 Feb 2021 I WAYAN SUKANADI 05 Apr 1984 063054 11
68 15 Feb 2021 24 Feb 2021 NI KETUT DARMINI 31 Dec 1961 009585 10
69 30 Jan 2021 10 Feb 2021 BAIQ NIKMAH 31 Dec 1963 063100 12
70 22 Jan 2021 01 Feb 2021 ANAK AGUNG GEDE RAKA KANYIT 01 Jul 1950 000246 11
71 24 Jan 2021 01 Feb 2021 ANAK AGUNG GDE OKA DARMA 25 Jul 1967 062952 9
72 25 Jan 2021 06 Feb 2021 I WAYAN SUARJANA 11 Mar 1970 062962 13
73 02 Feb 2021 03 Feb 2021 NI WAYAN BURUT 29 Dec 1948 051345 2
74 01 Feb 2021 03 Feb 2021 IDA ROHATI HASAN 04 Sep 1974 063139 3
87 06 Feb 2021 14 Feb 2021 DSK MADE RAI 31 Dec 1947 002539 9
88 15 Feb 2021 24 Feb 2021 I DEWA MADE SUARBAWA 05 Jan 1995 029709 10
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104 26 Feb 2021 27 Feb 2021 I WAYAN NUASTRA 31 Dec 1938 063721 2
SUB TOTAL
TOTAL
E-Klaim 5.6.3.202201201500 @ 2022-02-22 13:01:43
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c19+bronkitis+ C19+Bronkitis+
102,861,000 Terkonfirmasi sinusitis dispepsia 22,000,000 3
93,169,000 Terkonfirmasi c19+asma C19 20,000,000 3
36,169,000 Terkonfirmasi c19+asma c19 8,000,000 3
103,016,000 Terkonfirmasi c19+HT
susp c19 + HT C19,TD
Sus c19 150/90
+ ISK, 22,000,000 1
17,169,000 Suspek + ISK HT di form ugd 4,000,000 1
121,805,000 Terkonfirmasi c19+HT c19,TD 190/83 26,000,000 1
resume sesuai,
83,805,000 Terkonfirmasi asma tak ada C19 + 18,000,000 3
93,497,000 Terkonfirmasi c19 + HT Transaminitis 20,000,000 2
26,669,000 Suspek
balik DPJP, ps
11,488,000 Terkonfirmasi rujuk 4,000,000 1
93,361,000 Terkonfirmasi resume
resume sesuai
sesuai,
112,497,000 Terkonfirmasi ht ada
resume sesuai,
121,805,000 Terkonfirmasi ht tak ada 26,000,000 3
17,194,000 Suspek ps konfirm, ps
11,469,000 Suspek rujuk
93,497,000 Terkonfirmasi resume
resume sesuai
sesuai,
102,997,000 Terkonfirmasi bph ,oa ada
64,997,000 Terkonfirmasi 14,000,000 3
17,194,000 Suspek
46,041,000 Suspek 10,000,000 1
131,386,000 Terkonfirmasi resume sesuai
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resume kurang
112,516,000 Terkonfirmasi lengkap, ht
resume sesuai,
102,997,000 Terkonfirmasi ada, balik dpjp
asma tak ada, 22,000,000 1
121,861,000 Terkonfirmasi vte ada
45,997,000 Terkonfirmasi 10,000,000 2
102,861,000 Terkonfirmasi resume sesuai, asma tak ada 22,000,000 3
93,361,000 Terkonfirmasi resume sesuai, HT tak ada 20,000,000 3
112,361,000 Terkonfirmasi resume sesuai, ht tak ada 24,000,000 3
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resume sesuai,
ps meninggal,
17,169,000 Terkonfirmasi dm tak ada 4,000,000 3
8,217,650,000
8,224,280,000 964,000,000
0%
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20 44233 44243 I WAYAN 21086 063273 11 1.03E+08 Terkonfirmc19+HT
26 44240 44246 I WAYAN 24999 008503 7 64669000 TerkonfirmC19 + HT
27 44235 44244 I WAYAN 18445 063314 10 93305000 Terkonfirmc19 + HT+
31 44240 44250 I MADE B 20454 010767 11 1.03E+08 TerkonfirmC19+HT
35 44232 44242 NI MADE 24020 063260 11 1.03E+08 Terkonfirmc19+HT
36 44241 44242 NI KETUT 21915 021760 2 17169000 Suspek susp c19 +
37 44230 44242 I NYOMAN 20729 063187 13 1.22E+08 Terkonfirmc19+HT
41 44228 44229 ni wayan po 29037 004574 2 11488000 Terkonfirmbalik DPJP, ps rujuk
51 44225 44229 NI WAYAN 23376 035658 5 46041000 Suspek
64 44244 44254 NI MADE 24186 035424 11 1.03E+08 Terkonfirmresume kurang lengkap
76 44221 44229 NI NYOMA 17715 060106 9 83669000 Terkonfirmbalik DPJP, ada CAD
78 44253 44255 I KADEK S 27481 063739 3 21074000 Terkonfirmresume sesuai, ps ruj
88 44242 44251 I DEWA M 34704 029709 10 93169000 Terkonfirmresume sesuai kurang
89 44225 44232 NI NYOMAN 30775 063073 8 72569000 Terkonfirmcoinsiden, balik dpjp,
Resume (-) 22,000,000
C19+Sepsis 14,000,000
C19,Resume 20,000,000
C19, TD 14 22,000,000
C19,TD 15 22,000,000
Sus c19 + 4,000,000
c19,TD 190 26,000,000
balik DPJP, ps rujuk 4,000,000
10,000,000
resume kurang lengkap 22,000,000
balik DPJP, ada CAD 18,000,000
resume sesuai, ps ruj 6,000,000
resume sesuai kurang 20,000,000
coinsiden, balik dpjp, 16,000,000
226,000,000
3 44235 44245 LUH GEDE 27497 010941 11 1.03E+08 Terkonfirmc19 + asma
4 44227 44228 ANAK AGU 25037 063110 2 17169000 Suspek resume sesuai, ht tak
6 44234 44236 I GUSTI A 20820 036992 3 26997000 Suspek resume sesuai, dm ad
8 44234 44246 I NYOMAN 23438 063284 13 1.22E+08 TerkonfirmC19 + HT
9 44235 44245 I KETUT 22850 013538 11 1.03E+08 Terkonfirmc19+CAD
22 44245 44255 MOCH FAD 33350 047052 11 1.03E+08 Terkonfirmc19 + Sinus
23 44244 44255 I KETUT S 26894 051845 12 1.12E+08 Terkonfirmc19 + HT
24 44236 44246 IDA BAGU 24029 057439 11 1.03E+08 Terkonfirmc19 + HT
25 44242 44244 NI NYOMA 22281 063470 3 26669000 Suspek susp c19 +
39 44231 44240 I NYOMAN 18263 049286 10 93497000 Terkonfirmc19 + HT
53 44238 44242 IDA AYU 29016 055765 5 45669000 Suspek hari rawat tidak sesuai
55 44254 44255 DRS.I KE 17532 036391 2 17169000 Suspek resume sesuai, dm ada
61 44250 44251 DESAK MA 14062 049091 2 17169000 Suspek resume sesuai, anemia
66 44233 44237 I MADE S 20291 063272 5 45997000 Terkonfirmasi
70 44218 44228 ANAK AGU 18445 000246 11 1.03E+08 Terkonfirmresume sesuai, HT ti
93 44226 44236 I MADE M 27117 063097 11 1.03E+08 Terkonfirmresume sesuai, bronki
c19, CPPT :22,000,000
resume sesuai, ht tak 4,000,000
resume sesuai, dm ad 6,000,000
C19+CAD 26,000,000
C19, resume22,000,000
c19 + DHF 22,000,000
c19 + DF 24,000,000
c19, riw C 22,000,000
susp c19 + 6,000,000
C19 + Tran 20,000,000
hari rawat tidak sesuai10,000,000
resume sesuai, dm ada 4,000,000
resume sesuai, anemia 4,000,000
10,000,000
resume sesuai, HT ti 22,000,000
resume sesuai, bronki 22,000,000
246,000,000
5 44242 44243 I NYOMAN 20820 007769 2 11469000 Terkonfirmasi
10 44236 44245 MADE DWI 43869 063342 10 73169000 TerkonfirmC19
18 44237 44249 I WAYAN 21550 030185 13 1.22E+08 Terkonfirmasi
21 44244 44246 NI PUTU N 30638 061690 3 26669000 Suspek sus c19 +
30 44243 44244 AYU NYOM 22281 020870 2 17516000 Suspek c19 + HT
32 44239 44249 I WAYAN 27335 054472 11 1.03E+08 Terkonfirmc19+bronkit
33 44237 44246 KADEK HA 33898 063365 10 93169000 Terkonfirmc19+asma
34 44245 44248 NI KADEK 28311 056793 4 36169000 Terkonfirmc19+asma
38 44223 44231 KOMANG 32265 063009 9 83805000 Terkonfirmresume sesuai, asma
44 44229 44241 I WAYAN 18605 012366 13 1.22E+08 Terkonfirmresume sesuai, ht tak
49 44246 44252 NI MADE R 33969 019243 7 64997000 Terkonfirmasi
54 44246 44254 NGAKAN 14021 026980 9 83805000 Terkonfirmasi
57 44246 44255 PUTU SUD 26313 063571 10 93380000 Terkonfirmasi
59 44242 44251 I A KT YU 29399 063443 10 93361000 Terkonfirmasi
67 44224 44234 I WAYAN 30777 063054 11 1.03E+08 Terkonfirmresume sesuai, asma
68 44242 44251 NI KETUT 22646 009585 10 93361000 Terkonfirmresume sesuai, HT ta
69 44226 44237 BAIQ NIK 23376 063100 12 1.12E+08 Terkonfirmresume sesuai, ht tak
71 44220 44228 ANAK AGU 24678 062952 9 83997000 Terkonfirmresume sesuai, HT ti
75 44222 44230 NI NYOMA 30479 062981 9 83669000 Terkonfirmresume sesuai , asma
84 44229 44237 NI KETUT 19724 063179 9 83669000 Terkonfirmresume sesuai,ht tak
91 44232 44237 I MADE SU 21550 047185 6 55169000 Terkonfirmresume sesuai, dm ta
92 44225 44235 NI NENGA 26365 062964 11 1.03E+08 Terkonfirmresume sesuai, ht tak
94 44230 44238 NI WAYAN 33661 010141 9 83669000 Terkonfirmresume sesuai, asma
96 44217 44228 ANAK AGU 23374 049449 12 1.12E+08 Terkonfirmasi
98 44231 44240 NGAKAN P 14976 063225 10 93169000 Terkonfirmasi
99 44243 44252 NI KADEK 25692 028311 10 93169000 Terkonfirmresume sesuai, ht tak
101 44228 44240 PANDE PU 21185 063136 13 1.22E+08 Terkonfirmasi
104 44253 44254 I WAYAN 14245 063721 2 17169000 Terkonfirmresume sesuai, ps me
4,000,000 3
20,000,000 3
26,000,000 3
suspC19 G 6,000,000 3
c19 4,000,000 3
C19+Bronki 22,000,000 3
C19 20,000,000 3
c19 8,000,000 3
resume sesuai, asma 18,000,000 3
resume sesuai, ht tak 26,000,000 3
14,000,000 3
18,000,000 3
20,000,000 3
20,000,000 3
resume sesuai, asma 22,000,000 3
resume sesuai, HT ta 20,000,000 3
resume sesuai, ht tak 24,000,000 3
resume sesuai, HT ti 18,000,000 3
resume sesuai , asma 18,000,000 3
resume sesuai,ht tak 18,000,000 3
resume sesuai, dm ta 12,000,000 3
resume sesuai, ht tak 22,000,000 3
resume sesuai, asma 18,000,000 3
24,000,000 3
20,000,000 3
resume sesuai, ht tak 20,000,000 3
26,000,000 3
resume sesuai, ps me 4,000,000 3
492,000,000