Ruangan NEONATOLOGI

Jumlah TT

JK Cara bayar
No. NO RM NAMA TGL LAHIR Umur
L P Umum BPJS SKTM Jampersal JR

1 05.01.0 BY.NY SUSIANAH 0HR 29/7/22 0HR 1

2 05.01.32 BY.NY YULI 1 30/7/22 0HR 1
3 05.01.79 BY.NY KHOSIATUL 1 1/8/2022 0HR 1
4 05.01.84 BY.NY SUHARTATIK 1 1/8/2022 0HR 1
5 05.01.90 BY.NY SUTRISMIS 1 1/8/2022 0HR 1
6 05.02.05 BY.NY MERIA 1 2/8/2022 0HR 1
7 05.02.06 BY.NY SISKA 1 2/8/2022 0HR 1
8 05.01.06 BY.NY SUMINAH 1 28/7/22 8HR 1
9 05.02.22 BY.NY ILLA 1 2/8/2022 0HR 1
10 05.02.21 BY.NY HOSITI 1 2/8/2022 0HR 1
11 05.02.14 BY.NY HIDAYATUL 1 2/8/2022 0HR 1
12 05.02.52 BY.NY SETYAWATI 1 3/8/2022 0HR
13 05.02.67 BY.NY HUSNUL 1 4/8/2022 0HR 1
14 05.02.66 BY.NY DELA 1 4/8/2022 0HR
15 05.02.68 BY.NY DWI M 1 4/8/2022 0HR 1
16 05.02.89 BY.NY YANI 1 4/8/2022 0HR 1
17 05.02.91 BY.NY INDRAWATI 1 4/8/2022 0HR 1
18 05.02.92 BY.NY WIWIK 1 4/8/2022 0HR
19 05.02.93 BY.NY SITI NURASIYAH 1 4/8/2022 0HR 1
20 05.03.12 BY.NY SRI W 1 5/8/2022 0HR 1
21 05.03.20 BY.NY INDAH 1 5/8/2022 0HR 1
22 05.03.30 BY.NY MARINI 1 6/8/2022 0HR 1
23 05.03.31 BY.NY UMI 1 6/8/2022 0HR 1
24 05.03.32 BY.NY ERFIN 1 6/8/2022 0HR 1
25 05.03.33 BY.NY TATIK 1 6/8/2022 0HR 1
26 05.03.38 BY.NY DIAH 1 6/8/2022 0HR 1
27 05.02.09 BY.NY LELITA 1 2/8/2022 6HR 1
28 05.03.67 BY.NY LAILATUL 1 8/8/2022 0HR 1
29 05.03.79 BY.NY SITI MUTMAINAH 1 8/8/2022 0HR 1
30 05.03.80 BY.NY FIZEYMATUL 1 8/8/2022 0HR 1
31 05.03.84 BY.NY SULASMANI 1 8/8/2022 0HR 1
32 05.03.86
BY.NY LINDA 1 9/8/2022 0HR 1
33 05.04.03 BY.NY SITI ZAINAB 1 1 9/8/2022 0HR 1
34 05.04.04 BY.NY SITI ZAINAB 2 1 9/8/2022 0HR 1
35 05.04.13 BY.NY SANTIAH 1 9/8/2022 0HR 1
36 05.04.01 BY.NY VIVI 1 9/9/2022 0HR 1
37 05.04.17 BY.NY DISKA 1 10/8/2022 0HR 1

38 05.04.37 BY.NY DIANA 1 11/8/2022 0HR 1

39 05.04.49 BY.NY RUSMINI 1 11/8/2022 0HR 1

40 05.04.54 BY.NY YULIATIN 1 11/8/2022 0HR 1

41 05.04.56 BY.NY ENDRI 1 11/8/2022 0HR 1

42 05/04.58 BY.NY AINIS Z 1 11/8/2022 0HR 1

43 05.04.74 BY.NY NOVI 1 12/8/2022 0HR 1

44 05.04.79 BY.NY DINA 1 12/8/2022 0HR 1

45 05.04.89 BY.NY NUR FADILAH 1 12/8/2022 0HR 1

46 05.04.90 BY.NY ANGGREANI 1 12/8/2022 0HR 1

47 05.05.03 BY.NY MERISA 1 13/8/22 0HR 1

48 05.05.06 BY.NY DWI L 1 14/8/22 0HR 1

49 05.05.34 BY.NY BINTI 1 15/8/22 0HR 1

50 05.05. BY.NY SITI KHOMARIYAH 1 16/8/22 0HR 1

51 05.05.66 BY.NY LAILATUL 1 16/8/22 0HR 1

52 05.06.08 BY.NY INDI 1 18/8/22 0HR 1

53 05.06.06 BY.NY IKE 1 18/8/22 0HR 1

54 05.06.12 BY.NY FATIMAH 1 18/8/22 0HR 1

55 05.06.17 BY.NY HANA 1 18/8/22 0HR 1

56 05.06.33 BY.NY RATNA 1 19/8/22 0HR 1

57 05.06.30 BY.NY AMILATUL 1 19/8/22 0HR 1

58 05.06.28 BY.NY CHUSNUL 1 1 19/8/22 0HR 1

59 05.06.29 BY.NY CHUSNUL 2 1 19/8/22 0HR 1

60 05.06.31 BY.NY IKA 1 19/8/22 0HR 1

61 05.06.62 BY.NY YATIMAH 1 21/8/22 0HR 1

62 05.06.64 BY.NY RANI 1 21/8/22 0HR 1

63 05.06.99 BY.NY ROSINDI 1 22/8/22 0HR 1

64 05.07.17 BY.NY SRI W 1 22/8/22 0HR 1

65 05.07.18 BY.NY WAHYU 1 23/8/22 0HR 1

66 05.07.29 BY.NY DINIK 1 23/8/22 0HR 1

67 05.07.37 BY.NY LILIK 1 24/8/22 0HR 1

68 05.07.38 BY.NY INNAYATI 1 24/8/22 0HR 1

69 05.05.38 BY.NY TIKA 1 14/8/22 9HR 1

70 05.07.40 BY.NY HASANAH 1 25/8/22 0HR 1

71 05.07.76 BY.NY KAWIT 1 25/8/22 0HR

72 05.07.60 BY.NY SITI FATIMAH 1 25/8/22 0HR

73 05.06.65 BY.NY ERNAWATI 1 18/7/22 35 HR 1

74 05.07.85 BY.NY SUMIATI 1 26/8/22 0HR 1

75 05.07.86 BY.NY NARULITA 1 26/8/22 0HR 1

76 05.07.87 BY.NY SINTA 1 26/8/22 0HR 1

77 05.07.98 BY.NY KEVI 1 26/8/22 0HR 1

78 05.08.84 BY.NY ULFATUL 1 26/8/22 0HR 1

79 05.06.98 BY.NY SITI FADILATUS 1 29/8/22 0HR 1
80 05.08.70 BY.NY NILA 1 29/8/22 0HR 1
81 05.08.82 BY.NY WIWIN 1 30/8/22 0HR 1
82 05.09.08 BY.NY FINDRIAS 1 30/8/22 0HR 1
83 05.09.10 BY.NY RISKIANI 1 30/8/22 0HR 1
84 04.91.98 BY.NY MUSAMMATUN 1 17/6/22 36 1
85 05.06.28 BY.NY CHUSNUL 1 1 19/8/22 6HR 1
86 05.06.29 BY.NY CHUSNUL 2 1 19/8/22 6HR 1
87 05.05.38 BY.NY TIKA 1 14/8/22 0HR 1
88 050716 By. Ny. Samsiye 1 23/08/2022 4 hr 1
89 050809 By. Ny. Yuni Novitasari 1 27/08/2022 0 hr 1
90
JUMLAH 19 15 17 15 0 0 0

1 KOLOM WARNA UNGU TIDAK USAH DIISI

2 NAMA RUANGAN & JML TT POJOK KIRI ATAS TOLONG SELALU DIISI
3 PENULISAN NOMOR RM MENGGUNAKAN TANPA TITIK (032215)
4 KOLOM WARNA BIRU WAJIB DI ISI
5 KOLOM WARNA KUNING DIISI JIKA ADA
6 PENGHITUNGAN LAMA DIRAWAT (TGL KRS - TGL MRS), JIKA TGL KRS & MRS SAMA DI HITUNG 1
7 PENULISAN UMUR JIKA SATUAN TAHUN CUKUP DITULIS ANGKA SAJA, JIKA UMUR DI BAWAH 1 TAHUN ( 5 BULAN = 5 B, 7
8 KOLOM PELAYANAN DITULIS SESUAI SPESIALISNYA
9 PENULISAN HURUF MENGGUNAKAN HURUF KAPITAL
10 JIKA PX MRS BULAN SEBELUMNYA DAN KRS BULAN INI, MAKA UTK TGL MRS DI BERI WARNA MERAH
 Kondisi Keluar Status Pulang
Cara bayar Tanggal Lama BRM
dirawat kembali Hidup Mati
Sembuh APS
BPJS TK PG JKN RG Kemkes Lain MRS KRS < 48 > 48 < 48 > 48

29 1 2 1 1
30 1 1 1 1
1 3 2 1 1
1 3 2 1 1
1 2 1 1 1
2 4 2 1 1
2 3 1 1 1
2 5 3 1 1
2 3 1 1 1
2 5 2 1 1
2 3 1 1 1
3 4 1 1 1
4 5 1 1 1
4 5 1 1 1
4 5 1 1 1
4 6 2 1 1
4 6 2 1 1
4 5 1 1 1
4 5 1 1 1
5 7 2 1 1
5 8 3 1 1
6 8 2 1 1
6 8 2 1 1
6 8 2 1 1
6 8 2 1 1
6 9 3 1 1
8 9 1 1 1
8 9 1 1 1
8 10 2 1 1
8 11 3 1 1
8 11 3 1 1
9 11 2 1 1
9 11 2 1 1
9 11 2 1 1
9 12 3 1 1
9 12 3 1 1

10 12 2 1 1

11 11 1 1 1

11 12 1 1 1

11 12 1 1 1

11 13 2 1 1

11 14 3 1 1

12 14 2 1 1

12 13 1 1 1

12 15 3 1 1

12 15 3 1 1

13 13 1 1

14 16 2 1 1

15 17 2 1 1

16 18 2 1 1

16 18 2 1 1

18 20 2 1 1

18 20 2 1 1

18 20 2 1 1

18 21 3 1 1

19 22 3 1 1

19 22 3 1 1

19 20 1 1 1

19 20 1 1 1

19 21 2 1 1

21 23 2 1 1

21 23 2 1 1

22 23 2 1 1

22 24 2 1 1

23 24 1 1 1

23 26 3 1 1

24 25 1 1 1
 24 25 1 1 1

23 24 1 1 1

25 26 1 1 1

1 25 26 1 1 1

25 27 2 1 1

25 26 1 1 1

26 28 2 1 1

26 27 1 1 1

26 28 2 1 1

26 27 1 1 1

26 29 3 1 1
29 29 1 1 1
29 31 2 1 1
30 31 1 1 1
30 31 1 1 1
30 31 1 1 1
22 25 3 1 1
25 29 4 1 1
25 29 4 1 1
14 15 1 1
27 27 1 1 1
27 29 2 1 1

0 0 0 0 0 221 225 61 29 6 0 0 34 1

TAHUN ( 5 BULAN = 5 B, 7 HARI = 7 H)

Status Pulang
Diagnosa Tindakan
Rujuk Pindah Alamat (Desa) Primer ICD (Operasi) Pelayanan
Ruang

MADUREJONA WITH SC+EOS ANAK

PASIRIAN NA+EOS ANAK
PASIRIAN NA EOS ANAK
PASIRIAN NA WITH SC BBLR ANAK
TEMPEH NA EOS ANAK
PENANGGALNA WITH SC EOS ANAK
CANDIPURO NA WITH SC+NEC ANAK
KAMAR KAJANG NA WITH SC ANAK
TUMPENG NA ANAK
TAMBAKREJO NA EOS ANAK
PASIRIAN NA ANAK
CANDIPURO NA ANAK
CANDIPURO NA WITH SC ANAK
SUPITURANG NA ANAK
KALIULING
NA WITH SC +POLICITEMIA ANAK
PASIRIAN NA WITH SC EOS ANAK
PRONOJIWONA WITH SC EOS ANAK
PASIRIAN NA ANAK
CANDIPURO NA WITH SC ANAK
PASIRIAN NA WITH SC BBLR ANAK
PENANGGAL NA WITH SC EOS ANAK
TEMPURSARI NA WITH SC EOS ANAK
PASIRIAN NA WITH SC EOS ANAK
SUMBEREJO NA WITH SC EOS ANAK
SEMEMU NA WITH SC EOS ANAK
GESANG NA WITH SC EOS ANAK
PASIRIAN NP WITH SC BBLR EOS ANAK
TAMAN AYU NA WITH SC ANAK
PASIRIAN NA EOS ANAK
PASIRIAN NA EOS ANAK
PASIRIAN NA EOS ANAK
CANDIPURO NA EOS ANAK
PASIRIAN NP WITH SC ANAK
PASIRIAN NP WITH SC ANAK
TEMPURSARI NA WITH SC ANAK
 PASIRIAN NA POLISITEMIA EOS ANAK

TEMPURSARI NA WITH SC EOS ANAK

SEMEMU NA ANAK

CANDIPURO NA ANAK

TEMPEH NP BBLR ANAK

TEMPEH NA WITH SC EOS ANAK

PRONOJIWONA WITH SC EOS ANAK

PRONOJIWO NA EOS ANAK

PASIRIAN NA WITH SC ANAK

TAMBAK REJO
NA WITH SC+EOS ANAK

PASIRIAN NA EOS ANAK

MADUREJO
NP WITH SC+BBLSAR ANAK

DAWUHAN NA EOS ANAK

PASIRIAN NA WITH SC BBLR ANAK

TEMPURSARINA WITH SC EOS ANAK

BADES NA WITH SC EOS ANAK

JOKARTO NA WITH SC ANAK

SUMBERWULUHNA WITH SC ANAK

SUMBERMUJUR
NA WITH SC EOS ANAK

JARIT NA EOS ANAK

KALIBENDO NA WITH SC ANAK

TEMPURSARI NA EOS ANAK

GONDORUSO NP WITH SC ANAK

GONDORUSO NP WITH SC ANAK

TEMPURSARINA WITH SC EOS ANAK

SUMBERWULUH
NA WITH SC +POLICITEMIA ANAK

SELOK AWAR
NA WITH SC+POLISITEMIA ANAK

SELOKANYAR NA ANAK

PASIRIAN NA WITH SC ANAK

LEMPENI NA WITH SC ANAK

CONDRO NA WITH SC EOS ANAK

PASIRIAN NA WITH SC ANAK

 PASIRIAN NA WITH SC ANAK

TEMPURSARI NA EOS ANAK

NA WITH SC EOS
ORO ORO OMB ANAK

CANDIPURO NA WITH SC ANAK

SELOK AWAR NA EOS ANAK

SUMBERWULUHPNEUMONI

BAGO NA WITH SC EOS

NGUTER NA WITH SC

BAGO NA WITH SC EOS

BADES NA

SUKOREJO NA WITH SC EOS

GONDORUSO NP WITH SC
SUKOSARI NA WITH SC EOS
SUMBERSUKO NP BBLR
JOGOTRUNAN NA WITH SC
CANDIPURO NA WITH SC
CANDIPURO
BRONKOPNEUMONI
GONDORUSO
NP WITH SC+ HIPERBILIRUBIN
NP WITH SC+ HIPERBILIRUBIN
GONDORUSO
NICU TEMPURSARI NA EOS MAS
NA/BBLR + MAS + Asfiksia
Selok Anyar
NA
JARIT
+ Vomiting + Bronchopneumonia