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t. Itlentitas Fasyankes

Nama Faskes RS Umum Premagana

Tl T-I',^h* Cnr^Fi I\I^ IZ^** D^m'*^l.-- rrl.^-J-^ A'-' I)-
Alamat Faskes Jr, rrlsug dEurgDr rau.4''l \uulJ.a t iuuslrqir \Jiiali.uie fayii rt.
Tubuh,Batubulan, Sukawati - Gianyar
Kota Gianyar
Fro?lnsi BAL{
jetris RS
?ipe SWASTAI LAINNYA
Kode 5104023
Bulan Qktober
Pasien ?
J

J*uis Usulan LJ-;;.;+:l

2. Llsulan
No Jenis Nakes Jumlah Orang Nominal
1 DOK]"ER SPESIALIS 0 0
1 DCKTER 2 10"000.000
2 E!]If
l:
AlAIA'T UAe_rAI
UagIJ'lI J'
ET!\41\1 ..i tr1 Cnn fint
J4.JUU.UU'A
& NAKES L-q,INN}A L1 6.785.717
t: .)
DE IGD TRIASE -) 4-285.71fi
l] THR4WAT Iff* YHIASH L!" 10.17s"5?B
fi:Ub irtllt\ljAri U U
fi
U PPDS TINGGI 0
FIDI RS *
rCTAL 1n
rf/ 83.750.8i 5

Setail Usula-rr
NCI Hama NIK Ienis Hari Nominal
1 dr. I Kadek Wibawa 51 0401310i800001 DOKTER 7 5,000,000,il0
1. dr. I Nyoman Purna, &IM 51"7102271168{i002 DOKTER 5,000,000"0s
3 dr. Ni Kadek Erna Mahvuni 51 0302560t]p40003 DOKTER ') 1.428,572.00
n
dr. I Made Raditya Pradnyana 51 02062589950001 DOKTER. 2 1",428,572"**
5 dr. I Made Rai Wiana 32 760?31 i 08S0002 DOKTER 2 1,428,.572_00
6 NAKES_T AII\TT\I
Kadek Fand* Novi Astriai 5!(]4t157X 1910r)*: ? 1,0?1,4?S.fi*
YA
-i NAKES_I.AINN
l Marie llwi Franata, A,Mri.AK 5i7iu4ruu5v4uuu;,
YA
J 1,,07i,42*.tJ{}

NAKES-LAINN fifi
Q
U Luh Titi Cahyaui, A.Md.AK 31" 041)'1480798000:l 2 714 ).Rr\
YA
 Itro Nama NIK Jenis Hari Nominal
q Ni Putu Arista Yuliastari, NAKES*T-{INN
3I i,i UIJJU I Y;}UUUJ 1 357,i43.0S
A.Md"AK YA
NAKES_L&INN
1{} Fiqriya Wahyuning T,vas, .4,.Md s1 fl306501i1860005 1 357,X43.00
YA
11 Ni Kacjek ltridyartirvi, A.Md"AK \1 A 4n 4 4"7 fr4 !14 {l {-t {l ? lliAKES_LATNN 2 ?14,286.!_r0
iYA

1? I Putu Pande Agus Prayoga NAKES-IAINN

510?01 1708900001 1
I 357,143.t)S
YA
Kadek Yustin Siwi Lestari, ITAT/ET T AT\TAT
l\Al\._tr iJ LAlt\ 1\
13 5107065402920fi0 i 2 714,?86.SS
A.Md.Rad YA
4n iiii i'iyuiuan iridah Fr'ima ilewi, l\Ah'trb tJ{ii\r\
II 51070457069?{_}0{l1 ") 714,286.00
iA.Md.Rad YA
i Wayan Jaya Palguna, NAKES*i-{INN
IJ 5 i 0707 1405S30003 1 357,143.0S
A,Md.Rad YA
tr Kadek Ongky Karis*a, NAKES*LAINN
tfi A.Md"Kes
5 i ii4040E02$8il0ii i
YA
t 55 / , t+J.tJU

4n *ewa Ayu Candra Dewl,

LI 5i04015707890004 PEMWAT 13 6,964,286.CI0
A"Md.Kep

15
AA. Islri Mirna Apriantari, NFN AJiTiM
JiLI+U+JdU+YUUIJi)/, rr,r1A vv A r LI O,+16,4 f .r,.UV
A.Md.Kep
1q Ni- Kadek Listiari,A. Md.Keb 5:1 0405691191 0002 BIDAN t5 7.500,00(}.8fi
Ns. Nyoman Sarna Ar*aya,
?il 510806ti907870001 PERAWAT 13 6,964,286"00
S.Kep
Ns.Luh Gde Wida :1n1n1trCn'! OCnnna t LrhvldrAt^r4'r- dnQ tra"i
JIt.JL\.J ] JUUTUUUUUa DED 1"\ A
'1 1
I L,v\lar{'l
jayanthi,S.Kep wraawrJ

Ni Made Sinta Dewi Lestari, !:1 rltn4, n^ta-!'Jnnn. !-aEl"! rrr 4 r C , -!fl!: r?j!: nn
r,Lu / uu*"4ut i,u\j\tv/. rtiiHvvdl (, *r21)J, / r.J.UU
A.Md.Kep
Ni Wayan Henny
AJ i1 04016608890002 BII]AN 11 5,892,859.80
Gusniyanti,SST.Keb
24 Luh Putu Ayu Savitri, A.Md.Kep 5i 04056708930002 PERAtrV,\T 13 6.96.4,286.00
Ni Luh Putu Mariani, A.Md.Keb 51u40147ii3!ri 0CIS2 BII]AN ) 1,071,429.00
I Fande Kadek Dwi Angga,
2* 51 040i 050i 93s003 PEHAi{/AT 1 535,715.80
A.Md.Kep
Ni Made Sonia,AMd.Kep 5104015i0285U003 PERAWAT '1",0v1,429.*tJ
1A K Purnama Dewi, A,Md.Kep 5 1 0403600986008 1 PERAWAT 2 1,071,429.00
?$ Luh Putu Suwartini, A.Md.Kep 51 040s560i97{]002 PEHA}VAT T 535,715.CI0
I N3'srn6r Pande Arik Wijaya,
3* 51040104019600ij3 PEHAWAT 2 1,071,42S.0*
A.Md"Kep
Ns.Ni Koming Ayuk Sutrisni, ,,.
?1
Kep -q I Lr4rJ44L 111l50801 PERAWAT ) 1 n71 4?q nn

37 Luh Mia Candrawati, A.Md.Kep 5 I ?1 0243059b0003 PEHAWAT 1

L 535,715.S0
I lrtryoman Oka Raditya,
510405190592riu02 FEfiAWAT 2 1,A71,42s.*e
A"Md.Kep
Ni Putu Lisa Purnamasari,
34 I:103024712950004 PERAtr&'AT 2 1,071,429.0#
A.Md.Kep
<\ Ni Wayan Sutari, A.Md.Kep 5i fi4064?86s5fi801 r-ts,ttA!vAt 4
I }J5, I I J.UU
I Kadek Agus Dwi Pulra, an/rn nnnlrarrfl a
J{i -l
J i U+TJl.ZOIJOYI.
^ln UUU 1 f fl$'|rvvAI /a 1,071,429.0il
A.Md.Kep
"21 Ni Wyn Parsi
51 04015512870001 PERAWAT 1 535,715.00
Wird.yani,AItid.Kep

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