DATA PASIEN RS MARTHA FRISKA

BULAN OKTOBER 2015

NO TGL NAMA PASIEN JENIS KELAMIN / RM JENIS PEMERIKSAAN TARIF
UMUR
1 10/6/2015 HASANUDDIN L/63 TH 110702 HEAD 614,000
2 10/6/2015 FITRIANI P/36 TH 77197 HEAD 614,000
3 10/7/2015 MUCHTAR L/59 TH 110853 HEAD 614,000
4 10/7/2015 M RIZQI KHAIRI HSB L/6 TH 71837 THORAX 665,000
5 10/8/2015 PRIANTO . SH L/48 TH 91759 ABDOMEN 1,407,000
6 10/8/2015 MARIANI P/44 TH 110875 HEAD 614,000
7 10/8/2015 SURATNO L/69 TH 33840 HEAD 614,000
8 10/9/2015 HENDRA L/37 TH 75884 NECK+CONTRAST 1,074,000
9 10/9/2015 AZWAR EFENDI L/49 TH 110010 ABDOMEN 1,407,000
10 10/9/2015 ROHIDI L/26 TH 110625 HEAD 614,000
11 10/9/2015 MAHYUDDIN L/52 TH 110761 ABDOMEN 1,407,000
12 10/9/2015 NELLY CIUTRANESA P/27 TH 10100 SPN 614,000
13 10/9/2015 RISNAWATY P/45 TH 108371 ABDOMEN+CONTRAST 1,790,000
14 10/10/2015 MAIKEL L/16 TH 110958 ABDOMEN 1,407,000
15 10/10/2015 DONNEL SITOMPUL L/49 TH 111056 HEAD 614,000
16 10/10/2015 SITI MAIMUNAH P/63 TH 111068 HEAD 614,000
17 10/10/2015 SURIANTO L/48 TH 110504 ABDOMEN 1,407,000
18 10/13/2015 HENDRY TAMPUBOLON L/40 TH 94907 NASOFARYNX 665,000
19 10/13/2015 M RIZKI L/22 TH 54555 HEAD 614,000
20 10/13/2015 SAUT PRANATA S L/12 TH 111072 HEAD 614,000
21 10/13/2015 ABSALOM ARITONANG L/36 TH 17746 HEAD 614,000
22 10/15/2015 NURUL HIDAYATI P/28 TH 111073 HEAD 614,000
23 10/15/2015 DRS SUWARNO L/60 TH 107229 HEAD 614,000
24 10/15/2015 HARWATI P/54 TH 111041 HEAD 614,000
25 10/15/2015 SARIMIN URIPTO L/73 TH 110751 THORAX+CONTRAST 1,074,000
26 10/15/2015 AZRAIDAH NASUTION P/47 TH 111119 HEAD 614,000
27 10/15/2015 SYAHLIANTO L/50 TH 111067 HEAD 614,000
28 10/16/2015 BUSTAMI L/46 TH 111268 ABDOMEN 1,407,000
29 10/16/2015 SYAHRAN YOHANNES M L/37 TH 111017 SHOULDER JOINT 665,000
30 10/16/2015 NINA CARDINA P/25 TH 604059 LUMBAL 665,000
31 10/16/2015 GUNAWAN L/ 52 TH 109610 SPN 614,000
32 10/16/2015 DARMANSYAH L/45 TH 86868 HEAD 614,000
33 10/16/2015 BANGUN SIBURIAN L/45 TH 111306 ABDOMEN 1,407,000
34 10/16/2015 NUR RIZKIA P/15 TH 110882 HEAD 614,000
35 10/16/2015 ZAINUDDIN L/53 TH 22747 ABDOMEN 1,407,000
36 10/16/2015 NY.HABIBAH P/59 TH 111236 ABDDOMEN 1,407,000
37 10/16/2015 REGI SYAHNANDA P/18 TH 111244 HEAD 614,000
38 10/16/2015 LAILA SARI P/27 TH 111312 HEAD 614,000
39 10/16/2015 ABDUL HALIM L/62 TH 111257 HEAD 614,000
40 10/17/2015 FUADY NASUTION L/72 TH 80867 HEAD 614,000
41 10/17/2015 JAMINAR NABABAN L/43 TH 47498 HEAD 614,000
42 10/19/2015 MARWAN BATUBARA L/54 TH 84166 HEAD 614,000
43 10/19/2015 NABILA P/10 BLN 111453 NECK 665,000
44 10/19/2015 LEGIMIN L/60 TH 111396 HEAD 614,000
45 10/19/2015 YOELI GULO L/48 TH 111435 ABDOMEN 1,407,000
46 10/19/2015 TAAT SETIADI L/22 TH 110497 SPN 614,000
47 10/19/2015 WALDEMAR SITOMPUL L/84 TH 44761 ABDOMEN 1,407,000
48 10/19/2015 A TJIA P/50 TH 91825 HEAD 614,000
49 10/20/2015 JUNAIDI L/29 TH 111491 HEAD 614,000
50 10/21/2015 TUKIRIN L/53 TH 111304 ABDOMEN 1,407,000
51 10/21/2015 ROBERT M SITUMORANG L/62 TH 110598 SPN 614,000
52 10/21/2015 PRISILIA MARGARETTA P/15 TH 103756 SPN 614,000
53 10/21/2015 IRAWAN L/48 TH 111495 HEAD 614,000
54 10/21/2015 JOHN PITER SIHOMBING L/44 TH 102136 HEAD 614,000
55 10/21/2015 AHYAT L/49 TH 74993 ABDOMEN 1,407,000
56 10/21/2015 UMIYANA P/49 TH 111270 HEAD 614,000
57 10/22/2015 HJ NURLEN P/79 TH 1415 HEAD 614,000
58 10/22/2015 SARDO HUTABARAT L/29 TH 111508 ABDOMEN 1,407,000
59 10/22/2015 JUMIRAH P/58 TH 111477 ABDOMEN 1,407,000
60 10/22/2015 SANGALUI HAREFA L/37 TH 110805 NASOFARYNX 665,000
61 10/23/2015 AHMAD ALI L/50 TH 111677 HEAD 614,000
62 10/23/2015 FARIDA HANUM P/56 TH 92837 APPENDIX 1,407,000
63 10/23/2015 PUTRI SIRAIT P/28 TH 109197 HEAD 614,000
64 10/23/2015 JULIADI L/37 TH 111651 ABDOMEN 1,407,000
65 10/23/2015 SUPRAYEDI L/51 TH 110996 SPN 614,000
66 10/26/2015 PANTAS SIMANJUNTAK L/57 TH 27122 ABDOMEN+CONTRAST 1,790,000
67 10/26/2015 IZWAR FADLI NST L/33 TH 111675 HEAD 614,000
68 10/26/2015 MELKYANA BR MARBUN P/31 TH 111759 HEAD 614,000
69 10/26/2015 ROSMAWATI SIMANJUNTAK P/57 TH 99148 ABDOMEN 1,407,000
70 10/26/2015 LAYLA P/32 TH 109237 SPN 614,000
71 10/26/2015 PANTAS TAMBUNAN L/57 TH 111664 HEAD 614,000
72 10/26/2015 SABARIAH P/47 TH 79388 HEAD 614,000
73 10/27/2015 M SYAWAL AGUSTRA L/20 TH 602690 HEAD 614,000
74 10/27/2015 SOEPARNO L/66 TH 11702 HEAD 614,000
75 10/27/2015 HJ SAMIAH DESKY L/61 TH 111664 ABDOMEN 1,407,000
76 10/27/2015 PARLINDUNGAN HUTAPEA L/33 TH 111770 ABDOMEN 1,407,000
77 10/28/2015 SUNYOTO L/24 TH 111096 SPN 614,000
78 10/28/2015 ZICO FAHRINDRA TANJUNG L/33 TH 111937 ABDOMEN 1,407,000
79 10/28/2015 SUKARDI L/61 TH 111110 NECK CONTRAS 1,074,000
80 10/29/2015 KASRIN PURWANTO L/61 TH 80462 SPN 614,000
81 10/29/2015 LISA MILDAYANTI P/29 TH 93309 HEAD 614,000
82 10/30/2015 NURAINUN P/53 TH 112023 HEAD 614,000
83 10/30/2015 NURTINI P/49 TH 111970 SPN 614,000
84 10/31/2015 JULIANI P/33 TH 108451 ABDOMEN 1,407,000
TOTAL 73,060,000

Tanggal, 03 November 2015

Diketahui oleh : Yang membuat laporan
Kasub Instal Radiologi Paur Radiologi

dr. Rahmawan Budiaji,Sp.Rad Hot Joni Nasution ,AMR

Mayor CKM NRP 11010008320973 Lettu Ckm Nrp 219900033806677
 DATA PASIEN RS MARTHA FRISKA
BULAN NOVEMBER 2015
NO TGL NAMA PASIEN JENIS KELAMIN / RM JENIS PEMERIKSAAN TARIF
UMUR
1 11/30/2015 BAZIDUHU ZEBUA L/56 TH 112023 HEAD 614,000
2 11/2/2015 ARI ABEDHEGO P L/14 TH 112175 TEMPORAL BONE 614,000
3 11/2/2015 EFENDI KAMIN L/62 TH 080834 ABDOMEN 1,407,000
4 11/2/2015 TIOMSI NAINGGOLAN P/71 TH 111969 ABDOMEN 1,407,000
5 11/2/2015 IBNU YASIR L/21 TH 102746 HEAD 614,000
6 11/2/2015 ASRUL TANJUNG L/58 TH 105841 SPN 614,000
7 11/3/2015 MUSMIN L/86 TH 111539 HEAD 614,000
8 11/3/2015 ABDUL SALAM L/65 TH 112092 ABDOMEN 1,407,000
9 11/3/2015 RESFIZAR P/41 TH 076213 ABDOMEN 1,407,000
10 11/3/2015 SUPRAPTO L/46 TH 076213 ABDOMEN 1,407,000
11 11/4/2015 AHMAD MUMFARID L/59 TH 111940 NASOFARYNX 665,000
12 11/4/2015 SENEN L/77 TH 107796 HEAD+CONTRAST 818,000
13 11/4/2015 OLOAN PASARIBU L/70 TH 105435 HEAD 614,000
14 11/4/2015 SUSANTI P/32 TH 108100 HEAD 614,000
15 11/4/2015 ROHANA P/47 TH 005588 HEAD 614,000
16 11/4/2015 KALIMAN L/67 TH 112192 HEAD 614,000
17 11/5/2015 REINHARD SIBURIAN L/48 TH 079180 ABDOMEN 1,407,000
18 11/5/2015 ISMAILSYAH L/71 TH 112321 HEAD 614,000
19 11/5/2015 FEDDY RINALDHY L/31 TH 015729 ABDOMEN 1,407,000
20 11/6/2015 POSMAN TAMBUNAN L/57 TH 112349 SPN 614,000
21 11/6/2015 HJ TEGAWATI P/51 TH 015287 HEAD 614,000
22 11/7/2015 SYAHBUDDIN NASUTION L/52 TH 112342 TEMPORAL BONE 614,000
23 11/7/2015 MASDA BR MANALU P/38 TH 041786 HEAD 614,000
24 11/7/2015 JUNAIRAH P/52 TH 094398 ABDOMEN 1,407,000
25 11/7/2015 MHD RIDWAN L/34 TH 112418 ABDOMEN 1,407,000
26 11/9/2015 YONG SHEN L/37 TH 111840 THORAX 665,000
27 11/9/2015 SUGIARTI P/38 TH 110474 SPN 614,000
28 11/9/2015 KASMAN L/18 TH 112430 HEAD 614,000
29 11/9/2015 PITRI MANUNGKALIT P/17 TH 112423 HEAD 614,000
30 11/10/2015 SARIFUDDIN L/54 TH 112142 SPN 614,000
31 11/10/2015 SITOR TAMBA L/54 TH 112463 ABDOMEN 1,407,000
32 11/10/2015 DUMAS SIHOMBING L/53 TH 054174 ABDOMEN 1,407,000
33 11/10/2015 NURHANI P/65 TH 112401 ABDOMEN 1,407,000
34 11/11/2015 KAMARIA MANIK P/59 TH 031413 ABDOMEN 1,407,000
35 11/11/2015 KARBEN SINAGA L/46 TH 112478 ABDOMEN 1,407,000
36 11/11/2015 SAHOTNA P/52 TH 092956 ABDOMEN 1,407,000
37 11/11/2015 FADELI L/31 TH 112531 ABDOMEN 1,407,000
38 11/11/2015 JOHANES ERIC MARPAUNG L/25 TH 015333 SPN 614,000
39 11/11/2015 RONY MARGO BAKTI L/25 TH 112216 HEAD 614,000
40 11/12/2015 INDAH KHOTAMY P/25 TH 111998 HEAD 614,000
41 11/12/2015 HENNY TARIHORAN P/56 TH 045527 THORAX 665,000
42 11/12/2015 ALFIN MURIA HIDAYAT L/15 TH 076372 SPN 614,000
43 11/12/2015 SEMAN L/57 TH 112489 ABDOMEN 1,407,000
44 11/12/2015 SESI P/7 TH 112636 ABDOMEN 1,407,000
45 11/12/2015 MARIATY BR MANALU P/52 TH 112688 HEAD 614,000
46 11/12/2015 ULAKUTA GIRSANG L/70 TH 077893 SPN 614,000
47 11/12/2015 ANWAR NURDIN SITEPU L/68 TH 092562 HEAD 614,000
48 11/12/2015 ZULKARNAINI L/41 TH 079708 HEAD 614,000
49 11/12/2015 INDRIANI SIREGAR P/34 TH 112712 HEAD 614,000
50 11/12/2015 SUPARNI P/64 TH 112306 HEAD 614,000
51 11/12/2015 BELSON L/62 TH 087057 HEAD 614,000
52 11/12/2015 DJEMINAH P/70 TH 112698 ABDOMEN 1,407,000
53 11/13/2015 AMANINAH P/51 TH 112029 THORAX+CONTRAST 1,074,000
54 11/13/2015 HASRINA VIVI A D P/28 TH 112756 ABDOMEN 1,407,000
55 11/13/2015 KARTINI PANGGABEAN P/22 TH 112390 HEAD 614,000
56 11/13/2015 MARIANA P/57 TH 112751 HEAD 614,000
57 11/14/2015 ACHMAD NASUTION L/46 TH 112690 ABDOMEN 1,407,000
58 11/16/2015 SALAMAH P/73 TH 043593 HEAD 614,000
59 11/16/2015 DEVI ANDRIANI P/19 TH 105822 SPN 614,000
60 11/16/2015 TINNER BR NABABAN P/61 TH 112884 HEAD 614,000
61 11/16/2015 M OKVAN PRATAM L/3 TH 112761 HEAD 614,000
62 11/16/2015 HASAN BASRI L/30 TH 112899 SPN 614,000
63 11/16/2015 FAHMI MARUYI L/37 TH 112853 SPN 614,000
64 11/17/2015 JAYA MANIHURUK SH L/37 TH 112560 SPN 614,000
65 11/17/2015 ABDUL SALIM SINAGA L/48 TH 112863 HEAD 614,000
66 11/18/2015 AHMAD YANI L/38 TH 112832 ABDOMEN 1,407,000
67 11/18/2015 EVI JULIANA P/33 TH 112938 ABDOMEN 1,407,000
68 11/18/2015 RAMLI BARUS L/29 TH 113013 TEMPORAL BONE 614,000
69 11/18/2015 SYOFIATY P/65 TH 072632 SPN 614,000
70 11/18/2015 BERLIANA P/29 TH 112993 SPN 614,000
71 11/18/2015 RUSMAIDA BR HUTABARAT P/73 TH 079672 ABDOMEN 1,407,000
72 11/19/2015 YUSNAWATI P/56 TH 071886 ABDOMEN 1,407,000
73 11/20/2015 AMOSTAN GANDA S L/30 TH 112717 LOWER ABDOMEN 946,000
74 11/20/2015 TUMBUR SITOHANG L/52 TH 111254 HEAD 614,000
75 11/21/2015 ROSLAINI PASARIBU P/65 TH 112999 NECK+CONTRAST 1,074,000
76 11/21/2015 MUHAMMAD DIAH L/55 TH 113097 ABDOMEN 1,407,000
77 11/23/2015 MASNIUR P/64 TH 112883 THORAX 665,000
78 11/23/2015 FENTY ANASTASIA H P/26 TH 111824 HEAD 614,000
79 11/23/2015 YUDHA IRAWAN L/45 TH 106731 HEAD 614,000
80 11/23/2015 ASNAH RITONGA P/59 TH 113106 ABDOMEN 1,407,000
81 11/24/2015 SUTINAH P/61 TH 113156 HEAD 614,000
82 11/24/2015 ABD SALAM L/61 TH 113199 ABDOMEN 1,407,000
83 11/24/2015 RUSLI L/54 TH 113061 ABDOMEN 1,407,000
84 11/24/2015 LEGINO L/57 TH 113283 HEAD 614,000
85 11/24/2015 NURMALA BR MARPAUNG P/54 TH 000858 HEAD 614,000
86 11/25/2015 DRS LOKOT TAJUDDIN NST L/60 TH 010690 SPN 614,000
87 11/25/2015 SUWARDI L/12 TH 110250 HEAD 614,000
88 11/25/2015 ZULFA HIDAYAH P/34 TH 112256 SPN 614,000
89 11/25/2015 KINYA L/77 TH 106571 HEAD 614,000
90 11/25/2015 KURNIATI SRI RAHAYU P/22 TH 113344 HEAD 614,000
91 11/27/2015 SURNA P/45 TH 113394 HEAD 614,000
92 11/27/2015 JHON FREUDY HT GALUNG L/32 TH 113384 HEAD 614,000
93 11/27/2015 ASPITA RULIAMIN SINAGA P/70 TH 020896 HEAD 614,000
TOTAL 81,759,000

Tanggal, 30 November 2015

Diketahui oleh : Yang membuat laporan
Kasub Instal Radiologi Paur Radiologi

dr. Rahmawan Budiaji,Sp.Rad Hot Joni Nasution ,AMR

Mayor CKM NRP 11010008320973 Lettu Ckm Nrp 219900033806677
 DATA PASIEN RS MARTHA FRISKA
BULAN NOVEMBER 2015
NO TGL NAMA PASIEN JENIS KELAMIN / RM JENIS PEMERIKSAAN TARIF
UMUR
1 11/30/2015 MUHAMMAD ALI L/43 TH 093359 ABDOMAN 1,407,000
2 11/30/2015 DANIL L/38 TH 113532 ABDOMAN 1,407,000
3 11/30/2015 SUDARMAN L/60 TH 041577 ABDOMAN 1,407,000
4 11/30/2015 SURAHMI P/54 TH 088481 ABDOMAN 1,407,000
5 11/30/2015 MARIA SILALAHI P/16 TH 113503 ABDOMAN 1,407,000
6 11/30/2015 WAGIMIN L/48 TH 112716 SPN 614,000
7 12/2/2015 BAMBANG BUDIANTO L/53 TH 113564 ABDOMAN 1,407,000
8 12/2/2015 BUDIMAN L/23 TH 113520 ABDOMAN 1,407,000
9 12/2/2015 ELLY FARIDA NASUTION P/60 TH 096356 ABDOMAN 1,407,000
10 12/2/2015 NURLIANA SIMATUPANG P/71 TH 091899 HEAD 614,000
11 12/2/2015 NODI SYAHPUTRA L/25 TH 113628 HEAD 614,000
12 12/2/2015 MARIS SINAGA L/65 TH 103338 NECK 665,000
13 12/3/2015 NURMIN HARIANJA P/52 TH 098788 NECK+CONTRAST 1,074,000
14 12/4/2015 SIU SIAN P/53 TH 106801 UPPER ABDOMEN 946,000
15 12/4/2015 INDANI P/37 TH 113535 ABDOMAN 1,407,000
16 12/4/2015 AHMAD MUMFARID L/29 TH 111940 NASOFARYNX+CONTRAST 1,074,000
TOTAL 18,264,000

Tanggal, 30 November 2015

Diketahui oleh : Yang membuat laporan
Kasub Instal Radiologi Paur Radiologi

dr. Rahmawan Budiaji,Sp.Rad Hot Joni Nasution ,AMR

Mayor CKM NRP 11010008320973 Lettu Ckm Nrp 219900033806677
 DATA PASIEN RS MARTHA FRISKA
BULAN NOVEMBER 2015
NO TGL NAMA PASIEN JENIS KELAMIN / RM JENIS PEMERIKSAAN TARIF
UMUR
1 11/2/2015 ARI ABEDHEGO P L/14 TH 112175 TEMPORAL BONE 614,000
2 11/2/2015 EFENDI KAMIN L/62 TH 080834 ABDOMEN 1,407,000
3 11/2/2015 TIOMSI NAINGGOLAN P/71 TH 111969 ABDOMEN 1,407,000
4 11/2/2015 IBNU YASIR L/21 TH 102746 HEAD 614,000
5 11/2/2015 ASRUL TANJUNG L/58 TH 105841 SPN 614,000
6 11/3/2015 BAZIDUHU ZEBUA L/56 TH 112023 HEAD 614,000
7 11/3/2015 MUSMIN L/86 TH 111539 HEAD 614,000
8 11/3/2015 ABDUL SALAM L/65 TH 112092 ABDOMEN 1,407,000
9 11/3/2015 RESFIZAR P/41 TH 076213 ABDOMEN 1,407,000
10 11/3/2015 SUPRAPTO L/46 TH 076213 ABDOMEN 1,407,000
11 11/4/2015 AHMAD MUMFARID L/59 TH 111940 NASOFARYNX 665,000
12 11/4/2015 SENEN L/77 TH 107796 HEAD+CONTRAST 818,000
13 11/4/2015 OLOAN PASARIBU L/70 TH 105435 HEAD 614,000
14 11/4/2015 SUSANTI P/32 TH 108100 HEAD 614,000
15 11/4/2015 ROHANA P/47 TH 005588 HEAD 614,000
16 11/4/2015 KALIMAN L/67 TH 112192 HEAD 614,000
17 11/5/2015 REINHARD SIBURIAN L/48 TH 079180 ABDOMEN 1,407,000
18 11/5/2015 ISMAILSYAH L/71 TH 112321 HEAD 614,000
19 11/5/2015 FEDDY RINALDHY L/31 TH 015729 ABDOMEN 1,407,000
20 11/6/2015 POSMAN TAMBUNAN L/57 TH 112349 SPN 614,000
21 11/6/2015 HJ TEGAWATI P/51 TH 015287 HEAD 614,000
22 11/7/2015 SYAHBUDDIN NASUTION L/52 TH 112342 TEMPORAL BONE 614,000
23 11/7/2015 MASDA BR MANALU P/38 TH 041786 HEAD 614,000
24 11/7/2015 JUNAIRAH P/52 TH 094398 ABDOMEN 1,407,000
25 11/7/2015 MHD RIDWAN L/34 TH 112418 ABDOMEN 1,407,000
26 11/9/2015 YONG SHEN L/37 TH 111840 THORAX 665,000
27 11/9/2015 SUGIARTI P/38 TH 110474 SPN 614,000
28 11/9/2015 KASMAN L/18 TH 112430 HEAD 614,000
29 11/9/2015 PITRI MANUNGKALIT P/17 TH 112423 HEAD 614,000
30 11/10/2015 SARIFUDDIN L/54 TH 112142 SPN 614,000
31 11/10/2015 SITOR TAMBA L/54 TH 112463 ABDOMEN 1,407,000
32 11/10/2015 DUMAS SIHOMBING L/53 TH 054174 ABDOMEN 1,407,000
33 11/10/2015 NURHANI P/65 TH 112401 ABDOMEN 1,407,000
34 11/11/2015 KAMARIA MANIK P/59 TH 031413 ABDOMEN 1,407,000
35 11/11/2015 KARBEN SINAGA L/46 TH 112478 ABDOMEN 1,407,000
36 11/11/2015 SAHOTNA P/52 TH 092956 ABDOMEN 1,407,000
37 11/11/2015 FADELI L/31 TH 112531 ABDOMEN 1,407,000
38 11/11/2015 JOHANES ERIC MARPAUNG L/25 TH 015333 SPN 614,000
39 11/11/2015 RONY MARGO BAKTI L/25 TH 112216 HEAD 614,000
40 11/12/2015 INDAH KHOTAMY P/25 TH 111998 HEAD 614,000
41 11/12/2015 HENNY TARIHORAN P/56 TH 045527 THORAX 665,000
42 11/12/2015 ALFIN MURIA HIDAYAT L/15 TH 076372 SPN 614,000
43 11/12/2015 SEMAN L/57 TH 112489 ABDOMEN 1,407,000
44 11/12/2015 SESI P/7 TH 112636 ABDOMEN 1,407,000
45 11/12/2015 MARIATY BR MANALU P/52 TH 112688 HEAD 614,000
46 11/12/2015 ULAKUTA GIRSANG L/70 TH 077893 SPN 614,000
47 11/12/2015 ANWAR NURDIN SITEPU L/68 TH 092562 HEAD 614,000
48 11/12/2015 ZULKARNAINI L/41 TH 079708 HEAD 614,000
49 11/12/2015 INDRIANI SIREGAR P/34 TH 112712 HEAD 614,000
50 11/12/2015 SUPARNI P/64 TH 112306 HEAD 614,000
51 11/12/2015 BELSON L/62 TH 087057 HEAD 614,000
52 11/12/2015 DJEMINAH P/70 TH 112698 ABDOMEN 1,407,000
53 11/13/2015 AMANINAH P/51 TH 112029 THORAX+CONTRAST 1,074,000
54 11/13/2015 HASRINA VIVI A D P/28 TH 112756 ABDOMEN 1,407,000
55 11/13/2015 KARTINI PANGGABEAN P/22 TH 112390 HEAD 614,000
56 11/13/2015 MARIANA P/57 TH 112751 HEAD 614,000
57 11/14/2015 ACHMAD NASUTION L/46 TH 112690 ABDOMEN 1,407,000
58 11/16/2015 SALAMAH P/73 TH 043593 HEAD 614,000
59 11/16/2015 DEVI ANDRIANI P/19 TH 105822 SPN 614,000
60 11/16/2015 TINNER BR NABABAN P/61 TH 112884 HEAD 614,000
61 11/16/2015 M OKVAN PRATAM L/3 TH 112761 HEAD 614,000
62 11/16/2015 HASAN BASRI L/30 TH 112899 SPN 614,000
63 11/16/2015 FAHMI MARUYI L/37 TH 112853 SPN 614,000
64 11/17/2015 JAYA MANIHURUK SH L/37 TH 112560 SPN 614,000
65 11/17/2015 ABDUL SALIM SINAGA L/48 TH 112863 HEAD 614,000
66 11/18/2015 AHMAD YANI L/38 TH 112832 ABDOMEN 1,407,000
67 11/18/2015 EVI JULIANA P/33 TH 112938 ABDOMEN 1,407,000
68 11/18/2015 RAMLI BARUS L/29 TH 113013 TEMPORAL BONE 614,000
69 11/18/2015 SYOFIATY P/65 TH 072632 SPN 614,000
70 11/18/2015 BERLIANA P/29 TH 112993 SPN 614,000
71 11/18/2015 RUSMAIDA BR HUTABARAT P/73 TH 079672 ABDOMEN 1,407,000
72 11/19/2015 YUSNAWATI P/56 TH 071886 ABDOMEN 1,407,000
73 11/20/2015 AMOSTAN GANDA S L/30 TH 112717 LOWER ABDOMEN 946,000
74 11/20/2015 TUMBUR SITOHANG L/52 TH 111254 HEAD 614,000
75 11/21/2015 ROSLAINI PASARIBU P/65 TH 112999 NECK+CONTRAST 1,074,000
76 11/21/2015 MUHAMMAD DIAH L/55 TH 113097 ABDOMEN 1,407,000
77 11/23/2015 MASNIUR P/64 TH 112883 THORAX 665,000
78 11/23/2015 FENTY ANASTASIA H P/26 TH 111824 HEAD 614,000
79 11/23/2015 YUDHA IRAWAN L/45 TH 106731 HEAD 614,000
80 11/23/2015 ASNAH RITONGA P/59 TH 113106 ABDOMEN 1,407,000
81 11/24/2015 SUTINAH P/61 TH 113156 HEAD 614,000
82 11/24/2015 ABD SALAM L/61 TH 113199 ABDOMEN 1,407,000
83 11/24/2015 RUSLI L/54 TH 113061 ABDOMEN 1,407,000
84 11/24/2015 LEGINO L/57 TH 113283 HEAD 614,000
85 11/24/2015 NURMALA BR MARPAUNG P/54 TH 000858 HEAD 614,000
86 11/25/2015 DRS LOKOT TAJUDDIN NST L/60 TH 010690 SPN 614,000
87 11/25/2015 SUWARDI L/12 TH 110250 HEAD 614,000
88 11/25/2015 ZULFA HIDAYAH P/34 TH 112256 SPN 614,000
89 11/25/2015 KINYA L/77 TH 106571 HEAD 614,000
90 11/25/2015 KURNIATI SRI RAHAYU P/22 TH 113344 HEAD 614,000
91 11/27/2015 SURNA P/45 TH 113394 HEAD 614,000
92 11/27/2015 JHON FREUDY HT GALUNG L/32 TH 113384 HEAD 614,000
93 11/27/2015 ASPITA RULIAMIN SINAGA P/70 TH 020896 HEAD 614,000
94 11/30/2015 MUHAMMAD ALI L/43 TH 093359 ABDOMAN 1,407,000
95 11/30/2015 DANIL L/38 TH 113532 ABDOMAN 1,407,000
96 11/30/2015 SUDARMAN L/60 TH 041577 ABDOMAN 1,407,000
97 11/30/2015 SURAHMI P/54 TH 088481 ABDOMAN 1,407,000
98 11/30/2015 MARIA SILALAHI P/16 TH 113503 ABDOMAN 1,407,000
99 11/30/2015 WAGIMIN L/48 TH 112716 SPN 614,000
TOTAL 89,408,000

Tanggal, 04 Januari 2016

Diketahui oleh : Yang membuat laporan
Kasub Instal Radiologi Paur Radiologi

dr. Rahmawan Budiaji,Sp.Rad Hot Joni Nasution ,AMR

Mayor CKM NRP 11010008320973 Lettu Ckm Nrp 219900033806677
 DATA PASIEN RS MARTHA FRISKA
BULAN DESEMBER 2015
NO TGL NAMA PASIEN JENIS KELAMIN / RM JENIS PEMERIKSAAN TARIF
UMUR
1 12/2/2015 BAMBANG BUDIANTO L/53 TH 113564 ABDOMAN 1,407,000
2 12/2/2015 BUDIMAN L/23 TH 113520 ABDOMAN 1,407,000
3 12/2/2015 ELLY FARIDA NASUTION P/60 TH 096356 ABDOMAN 1,407,000
4 12/2/2015 NURLIANA SIMATUPANG P/71 TH 091899 HEAD 614,000
5 12/2/2015 NODI SYAHPUTRA L/25 TH 113628 HEAD 614,000
6 12/2/2015 MARIS SINAGA L/65 TH 103338 NECK 665,000
7 12/3/2015 NURMIN HARIANJA P/52 TH 098788 NECK+CONTRAST 1,074,000
8 12/4/2015 SIU SIAN P/53 TH 106801 UPPER ABDOMEN 946,000
9 12/4/2015 INDANI P/37 TH 113535 ABDOMAN 1,407,000
10 12/4/2015 AHMAD MUMFARID L/29 TH 111940 NASOFARYNX+CONTRAST 1,074,000
11 12/23/2015 BENYAMIN TARIGAN L/53 TH 114592 ABDOMAN 1,407,000
12 12/23/2015 NOWANSYAH L/31 TH 114589 HEAD 614,000
13 12/23/2015 INDRA ERFIN ISMAIL SH L/58 TH 114548 HEAD 614,000
14 12/23/2015 TIMBUL SITOMPUL L/52 TH 100336 HEAD 614,000
15 12/25/2015 DAVA RIZKY ADITYA L/4 TH 114779 HEAD 614,000
16 12/26/2015 ROHANI P/58 TH 114806 HEAD 614,000
17 12/26/2015 BERLIAN PANJAITAN P/64 TH 013132 HEAD 614,000
18 12/26/2015 HOMINA DAMANIK P/75 TH 050014 HEAD 614,000
19 12/27/2015 YUSNI NASUTION P/51 TH 014911 HEAD 614,000
20 12/28/2015 AZWAR L/61 TH 114506 THORAX+CONTRAST 1,074,000
21 12/28/2015 HADAWIYAH P/49 TH 106085 ABDOMAN 1,407,000
22 12/28/2015 NURICHSAN L/37 TH 114797 HEAD 614,000
23 12/28/2015 KASMINI P/60 TH 114854 HEAD 614,000
24 12/29/2015 NGADIEM P/56 TH 114800 HEAD 614,000
25 12/29/2015 SAURTUA SIPAYUNG L/57 TH 114871 HEAD 614,000
26 12/29/2015 SABARWAN L/54 TH 114876 HEAD 614,000
27 12/29/2015 SAIFUL ANWAR L/57 TH 114948 HEAD 614,000
28 12/29/2015 ASRA P/56 TH 114669 HEAD 614,000
29 12/29/2015 FARIDA P/50 TH 115021 SPN 614,000
30 12/30/2015 SITI AISYAH P/30 TH 106640 SPN 614,000
31 12/30/2015 AHMAD BARUS L/35 TH 115048 NASOFARYNX 665,000
32 12/30/2015 IBNU HADJAR AHMAD L/78 TH 000520 THORAX 665,000
33 12/30/2015 SRI ARMAWITA S P/26 TH 114992 ABDOMAN 1,407,000
34 12/30/2015 SURIADI L/46 TH 115003 ABDOMAN+CONTRAST 1,790,000
35 12/30/2015 MASRAN HRP L/66 TH 093172 HEAD 614,000
36 12/30/2015 SUSILAWATI P/33 TH 108874 HEAD 614,000
37 12/31/2015 LINDA BR SINAGA P/27 TH 115017 HEAD 614,000
38 12/31/2015 ANIYAH BR SINAGA P/60 TH 114977 HEAD 614,000
39 12/31/2015 RUMENDANG SIANIPAR P/50 TH 115042 HEAD 614,000
TOTAL 32,538,000

Tanggal, 04 Januari 2016

Diketahui oleh : Yang membuat laporan
Kasub Instal Radiologi Paur Radiologi

dr. Rahmawan Budiaji,Sp.Rad Hot Joni Nasution ,AMR

Mayor CKM NRP 11010008320973 Lettu Ckm Nrp 21990003380667
Tanggal, 04 Januari 2016
Yang membuat laporan
Paur Radiologi

Hot Joni Nasution ,AMR

tu Ckm Nrp 219900033806677
 DATA PASIEN RS MARTHA FRISKA
BULAN OKTOBER 2015
NO TGL NAMA PASIEN JENIS KELAMIN / RM JENIS PEMERIKSAAN TARIF
UMUR
1 10/7/2015 M RIZQI KHAIRI HSB L/6 TH 71837 THORAX 665,000
2 10/8/2015 PRIANTO . SH L/48 TH 91759 ABDOMEN 1,407,000
3 10/9/2015 HENDRA L/37 TH 75884 NECK+CONTRAST 1,074,000
4 10/9/2015 AZWAR EFENDI L/49 TH 110010 ABDOMEN 1,407,000
5 10/9/2015 MAHYUDDIN L/52 TH 110761 ABDOMEN 1,407,000
6 10/9/2015 RISNAWATY P/45 TH 108371 ABDOMEN+CONTRAST 1,790,000
7 10/10/2015 SITI MAIMUNAH P/63 TH 111068 HEAD 614,000
8 10/10/2015 SURIANTO L/48 TH 110504 ABDOMEN 1,407,000
9 10/13/2015 HENDRY TAMPUBOLON L/40 TH 94907 NASOFARYNX 665,000
10 10/13/2015 ABSALOM ARITONANG L/36 TH 17746 HEAD 614,000
11 10/15/2015 SARIMIN URIPTO L/73 TH 110751 THORAX+CONTRAST 1,074,000
12 10/16/2015 BUSTAMI L/46 TH 111268 ABDOMEN 1,407,000
13 10/16/2015 NINA CARDINA P/25 TH 604059 LUMBAL 665,000
14 10/16/2015 BANGUN SIBURIAN L/45 TH 111306 ABDOMEN 1,407,000
15 10/16/2015 ZAINUDDIN L/53 TH 22747 ABDOMEN 1,407,000
16 10/16/2015 NY.HABIBAH P/59 TH 111236 ABDDOMEN 1,407,000
17 10/16/2015 LAILA SARI P/27 TH 111312 HEAD 614,000
18 10/17/2015 JAMINAR NABABAN L/43 TH 47498 HEAD 614,000
19 10/19/2015 NABILA P/10 BLN 111453 NECK 665,000
20 10/19/2015 YOELI GULO L/48 TH 111435 ABDOMEN 1,407,000
21 10/19/2015 TAAT SETIADI L/22 TH 110497 SPN 614,000
22 10/19/2015 WALDEMAR SITOMPUL L/84 TH 44761 ABDOMEN 1,407,000
23 10/21/2015 TUKIRIN L/53 TH 111304 ABDOMEN 1,407,000
24 10/21/2015 PRISILIA MARGARETTA P/15 TH 103756 SPN 614,000
25 10/21/2015 JOHN PITER SIHOMBING L/44 TH 102136 HEAD 614,000
26 10/21/2015 AHYAT L/49 TH 74993 ABDOMEN 1,407,000
27 10/22/2015 SARDO HUTABARAT L/29 TH 111508 ABDOMEN 1,407,000
28 10/22/2015 JUMIRAH P/58 TH 111477 ABDOMEN 1,407,000
29 10/22/2015 SANGALUI HAREFA L/37 TH 110805 NASOFARYNX 665,000
30 10/23/2015 FARIDA HANUM P/56 TH 92837 APPENDIX 1,407,000
31 10/23/2015 JULIADI L/37 TH 111651 ABDOMEN 1,407,000
32 10/26/2015 ROSMAWATI SIMANJUNTAK P/57 TH 99148 ABDOMEN 1,407,000
33 10/26/2015 PANTAS TAMBUNAN L/57 TH 111664 HEAD 614,000
34 10/26/2015 SABARIAH P/47 TH 79388 HEAD 614,000
35 10/27/2015 M SYAWAL AGUSTRA L/20 TH 602690 HEAD 614,000
36 10/27/2015 HJ SAMIAH DESKY L/61 TH 111664 ABDOMEN 1,407,000
37 10/27/2015 PARLINDUNGAN HUTAPEA L/33 TH 111770 ABDOMEN 1,407,000
38 10/28/2015 ZICO FAHRINDRA TANJUNG L/33 TH 111937 ABDOMEN 1,407,000
39 10/29/2015 LISA MILDAYANTI P/29 TH 93309 HEAD 614,000
40 10/30/2015 NURAINUN P/53 TH 112023 HEAD 614,000
41 10/30/2015 NURTINI P/49 TH 111970 SPN 614,000
43,385,000

Tanggal, 03 November 2015

Diketahui oleh : Yang membuat laporan
Kasub Instal Radiologi Paur Radiologi

dr. Rahmawan Budiaji,Sp.Rad Hot Joni Nasution ,AMR

Mayor CKM NRP 11010008320973 Lettu Ckm Nrp 219900033806677
 DATA PASIEN RS MARTHA FRISKA
BULAN NOVEMBER 2015
NO TGL NAMA PASIEN JENIS KELAMIN / RM JENIS PEMERIKSAAN TARIF
UMUR
1 11/2/2015 TIOMSI NAINGGOLAN P/71 TH 111969 ABDOMEN 1,407,000
2 11/2/2015 IBNU YASIR L/21 TH 102746 HEAD 614,000
3 11/3/2015 ABDUL SALAM L/65 TH 112092 ABDOMEN 1,407,000
4 11/3/2015 RESFIZAR P/41 TH 076213 ABDOMEN 1,407,000
5 11/3/2015 SUPRAPTO L/46 TH 076213 ABDOMEN 1,407,000
6 11/4/2015 SENEN L/77 TH 107796 HEAD+CONTRAST 818,000
7 11/4/2015 OLOAN PASARIBU L/70 TH 105435 HEAD 614,000
8 11/4/2015 ROHANA P/47 TH 005588 HEAD 614,000
9 11/4/2015 KALIMAN L/67 TH 112192 HEAD 614,000
10 11/5/2015 REINHARD SIBURIAN L/48 TH 079180 ABDOMEN 1,407,000
11 11/5/2015 FEDDY RINALDHY L/31 TH 015729 ABDOMEN 1,407,000
12 11/7/2015 SYAHBUDDIN NASUTION L/52 TH 112342 TEMPORAL BONE 614,000
13 11/7/2015 JUNAIRAH P/52 TH 094398 ABDOMEN 1,407,000
14 11/7/2015 MHD RIDWAN L/34 TH 112418 ABDOMEN 1,407,000
15 11/9/2015 SUGIARTI P/38 TH 110474 SPN 614,000
16 11/9/2015 PITRI MANUNGKALIT P/17 TH 112423 HEAD 614,000
17 11/10/2015 SITOR TAMBA L/54 TH 112463 ABDOMEN 1,407,000
18 11/10/2015 DUMAS SIHOMBING L/53 TH 054174 ABDOMEN 1,407,000
19 11/10/2015 NURHANI P/65 TH 112401 ABDOMEN 1,407,000
20 11/11/2015 KAMARIA MANIK P/59 TH 031413 ABDOMEN 1,407,000
21 11/11/2015 KARBEN SINAGA L/46 TH 112478 ABDOMEN 1,407,000
22 11/11/2015 SAHOTNA P/52 TH 092956 ABDOMEN 1,407,000
23 11/12/2015 INDAH KHOTAMY P/25 TH 111998 HEAD 614,000
24 11/12/2015 HENNY TARIHORAN P/56 TH 045527 THORAX 665,000
25 11/12/2015 SEMAN L/57 TH 112489 ABDOMEN 1,407,000
26 11/12/2015 SESI P/7 TH 112636 ABDOMEN 1,407,000
27 11/12/2015 DJEMINAH P/70 TH 112698 ABDOMEN 1,407,000
28 11/13/2015 AMANINAH P/51 TH 112029 THORAX+CONTRAST 1,074,000
29 11/13/2015 HASRINA VIVI A D P/28 TH 112756 ABDOMEN 1,407,000
30 11/14/2015 ACHMAD NASUTION L/46 TH 112690 ABDOMEN 1,407,000
31 11/18/2015 AHMAD YANI L/38 TH 112832 ABDOMEN 1,407,000
32 11/18/2015 EVI JULIANA P/33 TH 112938 ABDOMEN 1,407,000
33 11/18/2015 RUSMAIDA BR HUTABARAT P/73 TH 079672 ABDOMEN 1,407,000
34 11/19/2015 YUSNAWATI P/56 TH 071886 ABDOMEN 1,407,000
35 11/20/2015 AMOSTAN GANDA S L/30 TH 112717 LOWER ABDOMEN 946,000
36 11/21/2015 ROSLAINI PASARIBU P/65 TH 112999 NECK+CONTRAST 1,074,000
37 11/21/2015 MUHAMMAD DIAH L/55 TH 113097 ABDOMEN 1,407,000
38 11/23/2015 MASNIUR P/64 TH 112883 THORAX 665,000
39 11/23/2015 ASNAH RITONGA P/59 TH 113106 ABDOMEN 1,407,000
40 11/24/2015 ABD SALAM L/61 TH 113199 ABDOMEN 1,407,000
41 11/24/2015 RUSLI L/54 TH 113061 ABDOMEN 1,407,000
42 11/24/2015 NURMALA BR MARPAUNG P/54 TH 000858 HEAD 614,000
43 11/25/2015 ZULFA HIDAYAH P/34 TH 112256 SPN 614,000
44 11/25/2015 KINYA L/77 TH 106571 HEAD 614,000
45 11/27/2015 SURNA P/45 TH 113394 HEAD 614,000
46 11/30/2015 MUHAMMAD ALI L/43 TH 093359 ABDOMAN 1,407,000
47 11/30/2015 DANIL L/38 TH 113532 ABDOMAN 1,407,000
48 11/30/2015 SUDARMAN L/60 TH 041577 ABDOMAN 1,407,000
49 11/30/2015 SURAHMI P/54 TH 088481 ABDOMAN 1,407,000
50 11/30/2015 MARIA SILALAHI P/16 TH 113503 ABDOMAN 1,407,000
51 11/30/2015 WAGIMIN L/48 TH 112716 SPN 614,000
TOTAL 58,248,000

Tanggal, 04 Januari 2016

Diketahui oleh : Yang membuat laporan
Kasub Instal Radiologi Paur Radiologi

dr. Rahmawan Budiaji,Sp.Rad Hot Joni Nasution ,AMR

Mayor CKM NRP 11010008320973 Lettu Ckm Nrp 219900033806677
 DATA PASIEN RS MARTHA FRISKA
BULAN DESEMBER 2015
NO TGL NAMA PASIEN JENIS KELAMIN / RM JENIS PEMERIKSAAN TARIF
UMUR
1 12/2/2015 BAMBANG BUDIANTO L/53 TH 113564 ABDOMAN 1,407,000
2 12/2/2015 ELLY FARIDA NASUTION P/60 TH 096356 ABDOMAN 1,407,000
3 12/2/2015 NODI SYAHPUTRA L/25 TH 113628 HEAD 614,000
4 12/4/2015 INDANI P/37 TH 113535 ABDOMAN 1,407,000
5 12/23/2015 BENYAMIN TARIGAN L/53 TH 114592 ABDOMAN 1,407,000
6 12/23/2015 NOWANSYAH L/31 TH 114589 HEAD 614,000
7 12/25/2015 DAVA RIZKY ADITYA L/4 TH 114779 HEAD 614,000
8 12/26/2015 BERLIAN PANJAITAN P/64 TH 013132 HEAD 614,000
9 12/28/2015 AZWAR L/61 TH 114506 THORAX+CONTRAST 1,074,000
10 12/28/2015 HADAWIYAH P/49 TH 106085 ABDOMAN 1,407,000
11 12/28/2015 KASMINI P/60 TH 114854 HEAD 614,000
12 12/29/2015 SAURTUA SIPAYUNG L/57 TH 114871 HEAD 614,000
13 12/29/2015 SABARWAN L/54 TH 114876 HEAD 614,000
14 12/29/2015 ASRA P/56 TH 114669 HEAD 614,000
15 12/30/2015 SITI AISYAH P/30 TH 106640 SPN 614,000
16 12/30/2015 SRI ARMAWITA S P/26 TH 114992 ABDOMAN 1,407,000
17 12/30/2015 SURIADI L/46 TH 115003 ABDOMAN+CONTRAST 1,790,000
18 12/30/2015 MASRAN HRP L/66 TH 093172 HEAD 614,000
19 12/30/2015 SUSILAWATI P/33 TH 108874 HEAD 614,000
TOTAL 18,060,000

Tanggal, 04 Januari 2016

Diketahui oleh : Yang membuat laporan
Kasub Instal Radiologi Paur Radiologi

dr. Rahmawan Budiaji,Sp.Rad Hot Joni Nasution ,AMR

Mayor CKM NRP 11010008320973 Lettu Ckm Nrp 219900033806677
 DATA PASIEN RS MARTHA FRISKA
BULAN OKTOBER 2015
NO TGL NAMA PASIEN JENIS KELAMIN / RM JENIS PEMERIKSAAN TARIF
UMUR
1 10/6/2015 HASANUDDIN L/63 TH 110702 HEAD 614,000
2 10/6/2015 FITRIANI P/36 TH 77197 HEAD 614,000
3 10/7/2015 MUCHTAR L/59 TH 110853 HEAD 614,000
4 10/8/2015 MARIANI P/44 TH 110875 HEAD 614,000
5 10/8/2015 SURATNO L/69 TH 33840 HEAD 614,000
6 10/9/2015 ROHIDI L/26 TH 110625 HEAD 614,000
7 10/9/2015 NELLY CIUTRANESA P/27 TH 10100 SPN 614,000
8 10/10/2015 MAIKEL L/16 TH 110958 ABDOMEN 1,407,000
9 10/10/2015 DONNEL SITOMPUL L/49 TH 111056 HEAD 614,000
10 10/13/2015 M RIZKI L/22 TH 54555 HEAD 614,000
11 10/13/2015 SAUT PRANATA S L/12 TH 111072 HEAD 614,000
12 10/15/2015 NURUL HIDAYATI P/28 TH 111073 HEAD 614,000
13 10/15/2015 DRS SUWARNO L/60 TH 107229 HEAD 614,000
14 10/15/2015 HARWATI P/54 TH 111041 HEAD 614,000
15 10/15/2015 AZRAIDAH NASUTION P/47 TH 111119 HEAD 614,000
16 10/15/2015 SYAHLIANTO L/50 TH 111067 HEAD 614,000
17 10/16/2015 SYAHRAN YOHANNES M L/37 TH 111017 SHOULDER JOINT 665,000
18 10/16/2015 GUNAWAN L/ 52 TH 109610 SPN 614,000
19 10/16/2015 DARMANSYAH L/45 TH 86868 HEAD 614,000
20 10/16/2015 NUR RIZKIA P/15 TH 110882 HEAD 614,000
21 10/16/2015 REGI SYAHNANDA P/18 TH 111244 HEAD 614,000
22 10/16/2015 ABDUL HALIM L/62 TH 111257 HEAD 614,000
23 10/17/2015 FUADY NASUTION L/72 TH 80867 HEAD 614,000
24 10/19/2015 MARWAN BATUBARA L/54 TH 84166 HEAD 614,000
25 10/19/2015 LEGIMIN L/60 TH 111396 HEAD 614,000
26 10/19/2015 A TJIA P/50 TH 91825 HEAD 614,000
27 10/20/2015 JUNAIDI L/29 TH 111491 HEAD 614,000
28 10/21/2015 ROBERT M SITUMORANG L/62 TH 110598 SPN 614,000
29 10/21/2015 IRAWAN L/48 TH 111495 HEAD 614,000
30 10/21/2015 UMIYANA P/49 TH 111270 HEAD 614,000
31 10/22/2015 HJ NURLEN P/79 TH 1415 HEAD 614,000
32 10/23/2015 AHMAD ALI L/50 TH 111677 HEAD 614,000
33 10/23/2015 PUTRI SIRAIT P/28 TH 109197 HEAD 614,000
34 10/23/2015 SUPRAYEDI L/51 TH 110996 SPN 614,000
35 10/26/2015 PANTAS SIMANJUNTAK L/57 TH 27122 ABDOMEN+CONTRAST 1,790,000
36 10/26/2015 IZWAR FADLI NST L/33 TH 111675 HEAD 614,000
37 10/26/2015 MELKYANA BR MARBUN P/31 TH 111759 HEAD 614,000
38 10/26/2015 LAYLA P/32 TH 109237 SPN 614,000
39 10/27/2015 SOEPARNO L/66 TH 11702 HEAD 614,000
40 10/28/2015 SUNYOTO L/24 TH 111096 SPN 614,000
41 10/28/2015 SUKARDI L/61 TH 111110 NECK CONTRAS 1,074,000
42 10/29/2015 KASRIN PURWANTO L/61 TH 80462 SPN 614,000
43 10/31/2015 JULIANI P/33 TH 108451 ABDOMEN 1,407,000
TOTAL 29,675,000

Diketahui oleh : Tanggal, 03 November 2015

Kasub Instal Radiologi Yang membuat laporan
Paur Radiologi

dr. Rahmawan Budiaji,Sp.Rad

Mayor CKM NRP 11010008320973 Hot Joni Nasution ,AMR
Lettu Ckm Nrp 219900033806677
 DATA PASIEN RS MARTHA FRISKA
BULAN NOVEMBER 2015
NO TGL NAMA PASIEN JENIS KELAMIN / RM JENIS PEMERIKSAAN TARIF
UMUR
1 11/2/2015 ARI ABEDHEGO P L/14 TH 112175 TEMPORAL BONE 614,000
2 11/2/2015 EFENDI KAMIN L/62 TH 080834 ABDOMEN 1,407,000
3 11/2/2015 ASRUL TANJUNG L/58 TH 105841 SPN 614,000
4 11/3/2015 BAZIDUHU ZEBUA L/56 TH 112023 HEAD 614,000
5 11/3/2015 MUSMIN L/86 TH 111539 HEAD 614,000
6 11/4/2015 AHMAD MUMFARID L/59 TH 111940 NASOFARYNX 665,000
7 11/4/2015 SUSANTI P/32 TH 108100 HEAD 614,000
8 11/5/2015 ISMAILSYAH L/71 TH 112321 HEAD 614,000
9 11/6/2015 POSMAN TAMBUNAN L/57 TH 112349 SPN 614,000
10 11/6/2015 HJ TEGAWATI P/51 TH 015287 HEAD 614,000
11 11/7/2015 MASDA BR MANALU P/38 TH 041786 HEAD 614,000
12 11/9/2015 YONG SHEN L/37 TH 111840 THORAX 665,000
13 11/9/2015 KASMAN L/18 TH 112430 HEAD 614,000
14 11/10/2015 SARIFUDDIN L/54 TH 112142 SPN 614,000
15 11/11/2015 FADELI L/31 TH 112531 ABDOMEN 1,407,000
16 11/11/2015 JOHANES ERIC MARPAUNG L/25 TH 015333 SPN 614,000
17 11/11/2015 RONY MARGO BAKTI L/25 TH 112216 HEAD 614,000
18 11/12/2015 ALFIN MURIA HIDAYAT L/15 TH 076372 SPN 614,000
19 11/12/2015 MARIATY BR MANALU P/52 TH 112688 HEAD 614,000
20 11/12/2015 ULAKUTA GIRSANG L/70 TH 077893 SPN 614,000
21 11/12/2015 ANWAR NURDIN SITEPU L/68 TH 092562 HEAD 614,000
22 11/12/2015 ZULKARNAINI L/41 TH 079708 HEAD 614,000
23 11/12/2015 INDRIANI SIREGAR P/34 TH 112712 HEAD 614,000
24 11/12/2015 SUPARNI P/64 TH 112306 HEAD 614,000
25 11/12/2015 BELSON L/62 TH 087057 HEAD 614,000
26 11/13/2015 KARTINI PANGGABEAN P/22 TH 112390 HEAD 614,000
27 11/13/2015 MARIANA P/57 TH 112751 HEAD 614,000
28 11/16/2015 SALAMAH P/73 TH 043593 HEAD 614,000
29 11/16/2015 DEVI ANDRIANI P/19 TH 105822 SPN 614,000
30 11/16/2015 TINNER BR NABABAN P/61 TH 112884 HEAD 614,000
31 11/16/2015 M OKVAN PRATAM L/3 TH 112761 HEAD 614,000
32 11/16/2015 HASAN BASRI L/30 TH 112899 SPN 614,000
33 11/16/2015 FAHMI MARUYI L/37 TH 112853 SPN 614,000
34 11/17/2015 JAYA MANIHURUK SH L/37 TH 112560 SPN 614,000
35 11/17/2015 ABDUL SALIM SINAGA L/48 TH 112863 HEAD 614,000
36 11/18/2015 RAMLI BARUS L/29 TH 113013 TEMPORAL BONE 614,000
37 11/18/2015 SYOFIATY P/65 TH 072632 SPN 614,000
38 11/18/2015 BERLIANA P/29 TH 112993 SPN 614,000
39 11/20/2015 TUMBUR SITOHANG L/52 TH 111254 HEAD 614,000
40 11/23/2015 FENTY ANASTASIA H P/26 TH 111824 HEAD 614,000
41 11/23/2015 YUDHA IRAWAN L/45 TH 106731 HEAD 614,000
42 11/24/2015 SUTINAH P/61 TH 113156 HEAD 614,000
43 11/24/2015 LEGINO L/57 TH 113283 HEAD 614,000
44 11/25/2015 DRS LOKOT TAJUDDIN NST L/60 TH 010690 SPN 614,000
45 11/25/2015 SUWARDI L/12 TH 110250 HEAD 614,000
46 11/25/2015 KURNIATI SRI RAHAYU P/22 TH 113344 HEAD 614,000
47 11/27/2015 JHON FREUDY HT GALUNG L/32 TH 113384 HEAD 614,000
48 11/27/2015 ASPITA RULIAMIN SINAGA P/70 TH 020896 HEAD 614,000
TOTAL 31,160,000

Diketahui oleh : Tanggal, 04 Januari 2016

Kasub Instal Radiologi Yang membuat laporan
Paur Radiologi

dr. Rahmawan Budiaji,Sp.Rad

Mayor CKM NRP 11010008320973 Hot Joni Nasution ,AMR
Lettu Ckm Nrp 219900033806677
 DATA PASIEN RS MARTHA FRISKA
BULAN DESEMBER 2015
NO TGL NAMA PASIEN JENIS KELAMIN / RM JENIS PEMERIKSAAN TARIF
UMUR
1 12/2/2015 BUDIMAN L/23 TH 113520 ABDOMAN 1,407,000
2 12/2/2015 NURLIANA SIMATUPANG P/71 TH 091899 HEAD 614,000
3 12/2/2015 MARIS SINAGA L/65 TH 103338 NECK 665,000
4 12/3/2015 NURMIN HARIANJA P/52 TH 098788 NECK+CONTRAST 1,074,000
5 12/4/2015 SIU SIAN P/53 TH 106801 UPPER ABDOMEN 946,000
6 12/4/2015 AHMAD MUMFARID L/29 TH 111940 NASOFARYNX+CONTRAST 1,074,000
7 12/23/2015 INDRA ERFIN ISMAIL SH L/58 TH 114548 HEAD 614,000
8 12/23/2015 TIMBUL SITOMPUL L/52 TH 100336 HEAD 614,000
9 12/26/2015 ROHANI P/58 TH 114806 HEAD 614,000
10 12/26/2015 HOMINA DAMANIK P/75 TH 050014 HEAD 614,000
11 12/27/2015 YUSNI NASUTION P/51 TH 014911 HEAD 614,000
12 12/28/2015 NURICHSAN L/37 TH 114797 HEAD 614,000
13 12/29/2015 NGADIEM P/56 TH 114800 HEAD 614,000
14 12/29/2015 SAIFUL ANWAR L/57 TH 114948 HEAD 614,000
15 12/29/2015 FARIDA P/50 TH 115021 SPN 614,000
16 12/30/2015 AHMAD BARUS L/35 TH 115048 NASOFARYNX 665,000
17 12/30/2015 IBNU HADJAR AHMAD L/78 TH 000520 THORAX 665,000
18 12/31/2015 LINDA BR SINAGA P/27 TH 115017 HEAD 614,000
19 12/31/2015 ANIYAH BR SINAGA P/60 TH 114977 HEAD 614,000
20 12/31/2015 RUMENDANG SIANIPAR P/50 TH 115042 HEAD 614,000
TOTAL 14,478,000

Diketahui oleh : Tanggal, 04 Januari 2016

Kasub Instal Radiologi Yang membuat laporan
Paur Radiologi
dr. Ramawan Budiaji,Sp.Rad
Mayor Ckm Nrp. 11010008320973 Hot Joni Nasution ,AMR
Lettu Ckm Nrp 219900033806677