Ranap Mei 2023

KODE_RS KELAS_RS KELAS_RAWAT KODE_TARIF PTD ADMISSION_DATE
DISCHARGE_DATE BIRTH_DATE BIRTH_WEIGHT SEX DISCHARGE_STATUS

DIAGLIST PROCLIST ADL1 ADL2 IN_SP IN_SR IN_SI IN_SD INACBG
SUBACUTE CHRONIC SP SR SI SD DESKRIPSI_INACBG TARIF_INACBG
TARIF_SUBACUTE TARIF_CHRONIC DESKRIPSI_SP TARIF_SP DESKRIPSI_SR
TARIF_SR DESKRIPSI_SI TARIF_SI DESKRIPSI_SD TARIF_SD
TOTAL_TARIF TARIF_RS TARIF_POLI_EKS LOS ICU_INDIKATOR ICU_LOS
VENT_HOUR NAMA_PASIEN MRN UMUR_TAHUN UMUR_HARI DPJP SEP NOKARTU
PAYOR_ID CODER_ID VERSI_INACBG VERSI_GROUPER C1 C2 C3
C4 PROSEDUR_NON_BEDAH PROSEDUR_BEDAH KONSULTASI TENAGA_AHLI
KEPERAWATAN PENUNJANG RADIOLOGI LABORATORIUM PELAYANAN_DARAH
REHABILITASI KAMAR_AKOMODASI RAWAT_INTENSIF OBAT ALKES BMHP
SEWA_ALAT OBAT_KRONIS OBAT_KEMO
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0 2 0 0 0 KURNIA NUR ISNAINI, NY 00057622 35 13073
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3175410 C 1 CS 1 27/04/2023 02/05/2023 03/08/1975 0 1
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COUGH (RINGAN) 4209900 0 0 - 0 - 0 - 0 -
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2579000 1400372 0 4 0 0 0 QISYA ALBIRAH HARIRI
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0 0
3175410 C 3 CS 1 01/05/2023 04/05/2023 16/07/2008 0 1
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1939100 1112507 0 4 0 0 0 SADAM AL RIFAI
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3175410 C 3 CS 1 30/04/2023 04/05/2023 15/01/1984 0 2
1 K35.2;J18.0;R10.4 47.09 - - None None None None K-1-13-III
None None None None None None PROSEDUR APPENDIK (BERAT) 3994100
0 0 - 0 - 0 - 0 - 0 3994100
1191856 0 5 0 0 0 MASNI DEWI HARTATI,NY 00057684
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1#0##0#0#0.0#2023-06-06
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3175410 C 3 CS 1 27/04/2023 04/05/2023 09/01/2003 0 2
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 2414815 0 8 0 0 0 HILDA FAUZIAH ALSA ,NN
0001205550472 3;JKN RSUP;; 5.8.4.202302261000 4 181025
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0 0
3175410 C 3 CS 1 01/05/2023 05/05/2023 01/05/2023 3080 1
None None None None NEONATAL, BERAT BADAN LAHIR GROUP-5 DENGAN SINDROMA
DISTRES PERNAFASAN (RINGAN) 4318700 0 0 - 0 - 0 -
0 - 0 4318700 1159498 0 5 1 5 0 BAYI
NYONYA NADA TSURAYA 00057722 0 0 DR. RIADY ASHARI, SP. A
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3175410 C 3 CS 1 29/04/2023 05/05/2023 16/05/1957 0 1
1 B16.9;E87.6 99.18;99.29;90.59 - - None None None None B-4-
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4104300 932227 0 7 0 0 0 MATALIH,TN 00057610
0001011134968 3;JKN RSUP;; 5.8.4.202302261000 4 178391
1#0##0#0#0.0#2023-05-30
gy_amt":"0","rehab_amt":"0","room_amt":"185000","intensive_amt":"0","drug_amt":"398
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0
3175410 C 3 CS 1 01/05/2023 05/05/2023 27/12/1953 0 1
1 N23;A16.2 99.18;99.29;99.21;90.59 - - None None None None
N-4-13-II None None None None None None BATU URIN (SEDANG)
4249600 0 0 - 0 - 0 - 0 - 0
4249600 4050708 0 5 0 0 0 NANA SUBANDI ,TN
0001741155219 3;JKN RSUP;; 5.8.4.202302261000 4 178406
1#0##0#0#0.0#2023-05-30
000224","valid":"1","sitb_response":{"data":[{"id":"2023000107000224","nama":"NANA
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masuk":"gp","sistole":"0","diastole":"0","total_tarif_rs":"4050708","billing_group"
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1 A09.9;E87.6 99.18;99.29;90.59 - - None None None None K-4-
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0 - 0 - 0 - 0 - 0 3385000 155266
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1939100 1279993 0 5 0 0 0 AUREL AMALIA,AN
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3175410 C 3 CS 1 03/05/2023 05/05/2023 11/03/2017 0 2
1 T31.3 86.22 - - None None None None S-4-16-I None None
None None None None LUKA BAKAR (RINGAN) 4817700 0 0 -
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0 0 0 KAMILA PUTRI, AN 00060254 6 2244 DR. RIADY ASHARI,
SP. A 0116R0340523V001003 0002104478346 3;JKN RSUP;; 5.8.4.202302261000
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{"procedure_amt":"105000","surgical_amt":"2380000","consul_amt":"2280000","expert_a
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3175410 C 3 CS 1 30/04/2023 05/05/2023 08/11/2002 0 2
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1939100 4837847 0 6 0 0 0 AYU PRAMESTHY CAHYANI
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3175410 C 1 CS 1 02/05/2023 05/05/2023 23/12/2020 0 1
(RINGAN) 2174700 0 0 - 0 - 0 - 0 - 0
2174700 2234495 0 4 0 0 0 ARFATHAN FAIRELL EL RUMY
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0003064293224 3;JKN RSUP;; 5.8.4.202302261000 4 179971
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3175410 C 1 CS 1 03/05/2023 05/05/2023 29/09/1999 0 2
1 N23 99.18;99.29 - - None None None None N-4-13-I None
None None None None None BATU URIN (RINGAN) 4715300 0 0
- 0 - 0 - 0 - 0 4715300 2329818 0
3 0 0 0 WATI SARI, NY 00060922 23 8617 DR. PUJI
ASTUTI TRI KUSUMAWATI, SP. PD 0116R0340523V001066 0002426426043 3;JKN RSUP;;
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3175410 C 1 CS 1 30/04/2023 05/05/2023 19/10/1997 0 1
1 A49.9;E87.1;I10 99.18;99.29;90.59 - - None None None None
A-4-14-II None None None None None None PENYAKIT INFEKSI BAKTERI DAN
PARASIT LAIN-LAIN (SEDANG) 3759600 0 0 - 0 - 0 -
0 - 0 3759600 3796478 0 6 0 0 0 ADITYA
TRI SAPUTRO,TN 00057425 25 9324 FELIX SATWIKA, SP.PD .DR
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4 180036 1#0##0#0#0.0#2023-06-02
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0 0
3175410 C 3 CS 1 04/05/2023 05/05/2023 17/08/1995 0 2
1 O20.0 99.18;99.29;90.59 - - None None None None W-4-14-I
None None None None None None ABORTUS MENGANCAM (RINGAN) 2223300
0 0 - 0 - 0 - 0 - 0 2223300
2672589 0 2 0 0 0 ULFAWATI ,NY 00058306 27
10122 FAY FERRY PARDOMUAN LAMBOK, SP.OG 0116R0340523V001068
0002791381307 3;JKN RSUP;; 5.8.4.202302261000 4 180429
1#0##0#0#0.0#2023-06-03
5f191b2c81be9d0baafe016db1d8757a 60000 0 270500 0 0 0
0 945500 0 0 925000 0 415759 55830 0 0
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3175410 C 1 CS 1 01/05/2023 05/05/2023 17/09/1972 0 1
(RINGAN) 1792000 0 0 - 0 - 0 - 0 - 0
1792000 3644277 0 5 0 0 0 LUKMAN, TN 00060191
50 18488 DR. LAILY RIDAWATI, SP.PD 0116R0340523V000040
0001223848282 3;JKN RSUP;; 5.8.4.202302261000 4 180499
1#0##0#0#0.0#2023-06-05
adb85ffaa2ec9a481c1d3f357e843c99 30000 0 435000 0 0 0
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0
3175410 C 3 CS 1 02/05/2023 05/05/2023 25/12/1970 0 1
1 S92.50 79.38 - - None None None None M-1-30-I None
None None None None None PROSEDUR KAKI (RINGAN) 6826500 0 0
- 0 - 0 - 0 - 0 6826500 16606955 0
4 0 0 0 AHMAD, TN 00055658 52 19121 ERY WILDAN, DR.,
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4 180584 1#0##0#0#0.0#2023-06-05
{"procedure_amt":"0","surgical_amt":"0","consul_amt":"16606955","expert_amt":"0","n
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3175410 C 3 CS 1 02/05/2023 05/05/2023 06/01/2022 0 2
1 A16.2 99.18;99.29;90.59 - - None None None None J-4-15-I
None None None None None None PERADANGAN DAN INFEKSI PERNAFASAN
(RINGAN) 4337000 0 0 - 0 - 0 - 0 - 0
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1#0##0#0#0.0#2023-06-05
[{"id":"2022000107000466","nama":"ADREENA SHEZA AL
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3175410 C 1 CS 1 01/05/2023 05/05/2023 20/01/1984 0 2
1 E11.5;D64.9 83.39;99.04;99.18 - - None None None None M-1-
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10108900 0 0 - 0 - 0 - 0 - 0
10108900 12840477 0 5 0 0 0 DEVI FRENSILIA
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3175410 C 1 CS 1 03/05/2023 05/05/2023 05/07/1998 0 2
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3175410 C 3 CS 1 02/05/2023 05/05/2023 19/11/1997 0 2
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5238800 0 0 - 0 - 0 - 0 - 0
5238800 5142507 0 4 0 0 0 TUTI ALAWIYAH
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3175410 C 3 CS 1 30/04/2023 05/05/2023 30/04/2023 2820 2
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SINDROMA DISTRES PERNAFASAN (RINGAN) 4318700 0 0 - 0 -
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0 KIKI KURNIASIH PUTRI ,BY NY 00060920 0 0 IRENNE PURNAMA,
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3175410 C 3 CS 1 02/05/2023 05/05/2023 25/06/2008 0 1
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MUHAMMAD FADLI FAIRUS, AN 00057075 14 5424 DR. RIADY ASHARI, SP. A
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{"procedure_amt":"30000","surgical_amt":"0","consul_amt":"86800","expert_amt":"0","
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3175410 C 3 CS 1 04/05/2023 06/05/2023 16/03/1977 0 2
1 D24 85.12 - - None None None None L-1-50-I None None
None None None None PROSEDUR PADA PAYUDARA (RINGAN) 5262600 0
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3175410 C 3 CS 1 24/04/2023 06/05/2023 24/04/2023 1820 2
1 P07.3;P22.8 90.59 - - None None None None P-8-12-II None
None None None None None NEONATAL, BBL 1500 - 1999 GR TANPA PROSEDUR
MAYOR (SEDANG) 10000600 0 0 - 0 - 0 - 0 -
0 10000600 1260845 0 13 1 13 0 BAYI NYONYA
MELLYANA 00061259 0 0 RIADY ASHARI, SP.A 0116R0340423V006231
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1#0##0#0#0.0#2023-05-30
t_5":
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3175410 C 3 CS 1 30/04/2023 06/05/2023 30/04/2023 2750 1
1 P22.8;P70.4 90.59 - - None None None None P-8-08-II None
SINDROMA DISTRES PERNAFASAN (SEDANG) 5910200 0 0 - 0 -
0 - 0 - 0 5910200 1324305 0 7 1 7
0 BAYI NYONYA KURNIA NUR ISNAINI 00058235 0 0 IRENNE
PURNAMA, MSC.,SP.A 0116R0340423V007925 0003520256736 3;JKN RSUP;;
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t_5":
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3175410 C 3 CS 1 04/05/2023 06/05/2023 05/04/2018 0 2
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 1394198 0 3 0 0 0 MUHAMMAD ALFATAR ,AN
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1#0##0#0#0.0#2023-06-02
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3175410 C 3 CS 1 02/05/2023 06/05/2023 25/04/1967 0 2
1 E11.9 99.18;99.29 - - None None None None E-4-10-I None
None None None None None PENYAKIT KENCING MANIS & GANGGUAN NUTRISI/
METABOLIK (RINGAN) 3611500 0 0 - 0 - 0 - 0
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0000377497912 3;JKN RSUP;; 5.8.4.202302261000 4 179681
1#0##0#0#0.0#2023-06-02
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3175410 C 3 CS 1 04/05/2023 06/05/2023 20/02/1987 0 1
0 - 0 - 0 - 0 - 0 3545300 2538564
0 3 0 0 0 ARI BUDI LEKSONO 00060337 36 13222 FELIX
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3175410 C 3 CS 1 04/05/2023 06/05/2023 07/01/1979 0 2
1 E11.9;Y42.3 99.18 - - None None None None E-4-10-I None
None None None None None PENYAKIT KENCING MANIS & GANGGUAN NUTRISI/
METABOLIK (RINGAN) 3611500 0 0 - 0 - 0 - 0
- 0 3611500 1841724 0 3 0 0 0 ADE TATI
HERAWATI, NY 00054818 44 16188 FELIX SATWIKA, SP.PD .DR
0116R0340523V001404 0002226994896 3;JKN RSUP;; 5.8.4.202302261000
4 179876 1#0##0#0#0.0#2023-06-02
fff570e84508c97f6d7e2387c3db6d49 30000 0 285000 0 0 0
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0
3175410 C 3 CS 1 29/04/2023 06/05/2023 15/12/1957 0 2
1 I20.0 99.18;99.29;90.59 - - None None None None I-4-20-I
None None None None None None ANGINA PEKTORIS DAN NYERI DADA (RINGAN)
3596200 0 0 - 0 - 0 - 0 - 0
3596200 2766749 0 8 0 0 0 SUKARSIH,NY 00009432
0002331544781 3;JKN RSUP;; 5.8.4.202302261000 4 179893
1#0##0#0#0.0#2023-06-02
7a9619c4bc88d1a6cd2d2fca66074d15 141750 0 343325 0 0
0 140000 627175 0 0 370000 0 1020168 124331
0 0 0 0
3175410 C 3 CS 1 02/05/2023 06/05/2023 16/12/1976 0 1
1 K30;I10 99.18;99.29;90.59 - - None None None None K-4-
18-I None None None None None None GANGGUAN SISTEM PENCERNAAN LAIN-LAIN
(RINGAN) 1347400 0 0 - 0 - 0 - 0 - 0
1347400 4308506 0 5 0 0 0 ABDUL MALIK,TN
0001878561933 3;JKN RSUP;; 5.8.4.202302261000 4 179935
1#0##0#0#0.0#2023-06-02
radiology_amt":"0","rehab_amt":"0","room_amt":"370000","intensive_amt":"0","drug_am
e24cb2b1010714a254948598825135f4 205000 0 303400 0 0
0 0 1568600 0 0 370000 0 1815407 46099 0
0 0 0
3175410 C 1 CS 1 04/05/2023 06/05/2023 14/10/2017 0 2
(RINGAN) 1792000 0 0 - 0 - 0 - 0 - 0
1792000 1450819 0 3 0 0 0 VLAMARIN ETRANIA A ,AN
00055038 5 2028 DR. RAEDY RUWANDA SUSANTO, SP A.
0116R0340523V001399 0002306053124 3;JKN RSUP;; 5.8.4.202302261000
4 179980 1#0##0#0#0.0#2023-06-02
b1d1c6f5b72a45fbe34e99855238543b 30000 0 157350 0 0 0
0 228650 0 0 700000 0 205201 129618 0
0 0 0
3175410 C 3 CS 1 02/05/2023 06/05/2023 05/05/2012 0 2
1 M08.97 99.18;99.29 - - None None None None M-4-16-I
None None None None None None GANGGUAN JARINGAN KONEKTIF (RINGAN)
2492700 0 0 - 0 - 0 - 0 - 0
2492700 2314543 0 5 0 0 0 MEISYA KANZA SAPUTRI ,AN
0001426983489 3;JKN RSUP;; 5.8.4.202302261000 4 180064
1#0##0#0#0.0#2023-06-02
917540921a8017649ce66491a2a37789 66750 0 243800 0 0 0
178000 258200 0 0 555000 0 826449 186344
0 0 0 0
3175410 C 3 CS 1 03/05/2023 06/05/2023 28/11/1987 0 1
1 L04.0 99.18;99.29;90.59 - - None None None None D-4-14-I
None None None None None None GANGGUAN PADA DARAH & ORGAN PEMBENTUK
DARAH LAIN-LAIN (RINGAN) 2579400 0 0 - 0 - 0 -
0 - 0 2579400 2156977 0 4 0 0 0
NURHAYADI, TN 00060595 35 12940 DR. PUJI ASTUTI TRI KUSUMAWATI, SP.
PD 0116R0340523V000980 0116R0340523V000707 3;JKN RSUP;;
5.8.4.202302261000 4 180108 1#0##0#0#0.0#2023-06-02
06d96309c20df2cdce3da31b3b349adf 30000 0 360900 0 0 0
0 866100 0 0 370000 0 476082 53895 0 0
0 0
3175410 C 3 CS 1 01/05/2023 06/05/2023 11/03/1982 0 1
(RINGAN) 4337000 0 0 - 0 - 0 - 0 - 0
4337000 2853329 0 6 0 0 0 MOCHAMAD AMIN,TN
0000378108718 3;JKN RSUP;; 5.8.4.202302261000 4 178495
1#0##0#0#0.0#2023-06-02
[{"id":"2023000107000232","nama":"MOCHAMAD
AMIN","nik":"3172031103820006","jenis_kelamin_id":"1"}],"success":true}}#{"cara_mas
uk":"gp","sistole":"0","diastole":"0","total_tarif_rs":"2853329","billing_group":
1950be3f72660979fef079373bc116b1 30000 0 225000 0 0 0
200000 0 0 0 1400000 0 870829 127500 0
0 0 0
3175410 C 3 CS 1 02/05/2023 06/05/2023 17/05/1988 0 2
1 D65 99.18;99.29;90.59;99.05 - - None None None None D-4-
11-I None None None None None None GANGGUAN PEMBEKUAN DARAH (RINGAN)
3716900 0 0 - 0 - 0 - 0 - 0
3716900 8925779 0 5 0 0 0 TARIMPEN,NY 00019909
34 12768 DR. BETA AGUSTIA WISMAN, SP.PD 0116R0340523V000456
0001677241552 3;JKN RSUP;; 5.8.4.202302261000 4 180161
1#0##0#0#0.0#2023-06-03
075711ce22957001c9755b47b32ce9ed 30000 0 586825 0 0 0
0 6720675 0 0 740000 0 786483 61796 0 0
0 0
3175410 C 3 CS 1 03/05/2023 06/05/2023 01/04/2022 0 1
(RINGAN) 1635100 0 0 - 0 - 0 - 0 - 0
1635100 2014904 0 4 0 0 0 MUHAMMAD RIZA ABQARI
0003288221447 3;JKN RSUP;; 5.8.4.202302261000 4 180314
1#0##0#0#0.0#2023-06-03
349851aa3a5829176e2e2dce57841cc9 66750 0 258800 0 0 0
140000 541200 0 0 555000 0 271633 181521
0 0 0 0
3175410 C 3 CS 1 05/05/2023 06/05/2023 12/04/1972 0 2
4 I11.9;E11.9 99.18;99.29;90.59 - - None None None None I-4-
17-I None None None None None None HIPERTENSI (RINGAN) 2097400 0
0 - 0 - 0 - 0 - 0 2097400 2461540
0 2 0 0 0 MARWAH, NY 00046548 51 18650 MARTUA
SILALAHI, DR., SP.JP 0116R0340523V001881 0001767401717 3;JKN RSUP;;
5.8.4.202302261000 4 180128 1#0##0#0#0.0#2023-06-03
61c08b90499862e6f7e4559bbb154066 66750 0 155000 0 0 0
140000 0 0 0 555000 0 876624 668166 0
0 0 0
3175410 C 3 CS 1 04/05/2023 06/05/2023 18/08/1956 0 2
1 G44.8;I11.9 99.18;99.29;90.59 - - None None None None G-4-
23-I None None None None None None MIGREN DAN SAKIT KEPALA LAIN (RINGAN)
2133900 0 0 - 0 - 0 - 0 - 0
2133900 1609905 0 3 0 0 0 TIURMA M LENA SINAGA ,NY
0001225282871 3;JKN RSUP;; 5.8.4.202302261000 4 180377
1#0##0#0#0.0#2023-06-03
"676843","device_amt":"43062","consumable_amt":"0","device_rent_amt":"0","drug_chro
997b8855b551e7f9b304a6d3b57a94b3 30000 0 86800 0 0 0 0
218200 0 0 555000 0 676843 43062 0 0 0
0
3175410 C 3 CS 1 03/05/2023 06/05/2023 29/03/2019 0 2
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 287611 0 4 0 0 0 ZIAH NAFIZA, AN
0003052814128 3;JKN RSUP;; 5.8.4.202302261000 4 180421
1#0##0#0#0.0#2023-06-03
178000","rehab_amt":"0","room_amt":"0","intensive_amt":"0","drug_amt":"75272","devi
ce_amt":"34339","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0","
drug_chemo_amt":"0"},"selisih_biaya":
7084755c2c53f9ec63d6efbc13f010b5 0 0 0 0 0 0 178000
0 0 0 0 0 75272 34339 0 0 0 0
3175410 C 3 CS 1 04/05/2023 06/05/2023 18/09/2018 0 1
1 R56.0 99.18;99.29;90.59 - - None None None None G-4-22-I
None None None None None None SERANGAN KEJANG (RINGAN) 2738300
0 0 - 0 - 0 - 0 - 0 2738300 256691
0 3 0 0 0 MUHAMMAD K YUDHAFA,AN 00060336 4 1689
MUSTARI, DR., SP.A 0116R0340523V001523 0003301769316 3;JKN RSUP;;
5.8.4.202302261000 4 180500 1#0##0#0#0.0#2023-06-05
0","rehab_amt":"0","room_amt":"0","intensive_amt":"0","drug_amt":"127035","device_a
mt":"129656","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0","dru
g_chemo_amt":"0"},"selisih_biaya":
e01b9a29c1d6b68d6110f5acd0c6a859 0 0 0 0 0 0 0
0 0 0 0 0 127035 129656 0 0 0 0
3175410 C 3 CS 1 30/04/2023 06/05/2023 02/06/1972 0 1
1 A16.2;E87.1 99.18;99.29;90.59 - - None None None None J-4-
15-II None None None None None None PERADANGAN DAN INFEKSI PERNAFASAN
(SEDANG) 5181500 0 0 - 0 - 0 - 0 - 0
5181500 7309334 0 7 0 0 0 SETIYO,TN 00057608
50 18594 SYARIFUDIN, SP.P .DR 0116R0340423V007894 0002882490849
3;JKN RSUP;; 5.8.4.202302261000 4 179773 1#0##0#0#0.0#2023-
06-05
[{"id":"2023000107000317","nama":"SETIYO","nik":"3175060602720014","jenis_kelamin_i
d":"1"}],"success":true}}#{"cara_masuk":"gp","sistole":"0","diastole":"0","total_ta
rif_rs":"7309334","billing_group":
ug_amt":"2587902","device_amt":"481946","consumable_amt":"0","device_rent_amt":"0",
"drug_chronic_amt":"0","drug_chemo_amt":"585"},"selisih_biaya":
20198d637c95af51d2c86047540bc0b0 36750 0 258700 0 0 0
140000 1003451 0 0 2800000 0 2587902 481946
0 0 0 585
3175410 C 3 CS 1 03/05/2023 06/05/2023 22/05/1992 0 2
1 O34.2;O82.9;O99.0;Z37.0 74.99;99.04 - - None None None None
O-6-10-II None None None None None None OPERASI PEMBEDAHAN CAESAR
(SEDANG) 5533600 0 0 - 0 - 0 - 0 - 0
5533600 6473176 0 4 0 0 0 SILPA MADA FALLO, NY
00058271 30 11303 FAY FERRY PARDOMUAN LAMBOK P. SIMANJUNTAK, DR., SP.
OG 0116R0340523V000944 0002958206771 3;JKN RSUP;; 5.8.4.202302261000
4 180582 1#0##0#0#0.0#2023-06-05
{"code":"","name":""}} 2 ea98d1cb309126f69a107684e3d7cdb8 30000 3020000
229700 0 0 0 0 1413300 0 0 370000 0
679000 602144 129032 0 0 0
3175410 C 3 CS 1 04/05/2023 06/05/2023 20/09/1998 0 2
None None None None PROSEDUR DILATASI, KURET, INTRAUTERIN & SERVIK
(RINGAN) 2371700 0 0 - 0 - 0 - 0 - 0
2371700 4417384 0 3 0 0 0 SISKA ALDALIYA
0002332679005 3;JKN RSUP;; 5.8.4.202302261000 4 180689
1#0##0#0#0.0#2023-06-05
2e016d5278da9896f0426766e7676e31 66750 2036250 1357650 0 0
0 0 258100 0 0 370000 0 89235 208391 31008
0 0 0
3175410 C 3 CS 1 03/05/2023 06/05/2023 31/05/2011 0 1
1 A91 99.18;99.29 - - None None None None A-4-13-I None
1939100 0 0 - 0 - 0 - 0 - 0
1939100 5924025 0 4 0 0 0 ADITYA PRATAMA,AN
0001288525757 3;JKN RSUP;; 5.8.4.202302261000 4 180849
1#0##0#0#0.0#2023-06-06
60360ba6c023630b7edf38abe0a40d73 96750 0 468900 0 0 0
140000 543100 0 0 4185000 0 138126 352149
0 0 0 0
3175410 C 1 CS 1 03/05/2023 06/05/2023 15/01/2019 0 2
None None None None None NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN
(RINGAN) 2174700 0 0 - 0 - 0 - 0 - 0
2174700 2220020 0 4 0 0 0 QIARA AFIAH ,AN
0003520747247 3;JKN RSUP;; 5.8.4.202302261000 4 180853
1#0##0#0#0.0#2023-06-06
80661f5e0ae733b079b16539ed839669 66750 0 407700 0 0 0
140000 596300 0 0 500000 0 166501 342769
0 0 0 0
3175410 C 3 CS 1 04/05/2023 06/05/2023 05/07/1976 0 1
1 D23.2 18.19 - - None None None None L-4-14-I None None
None None None None GANGGUAN PADA KULIT & PAYUDARA LAIN-LAIN (RINGAN)
2675800 0 0 - 0 - 0 - 0 - 0
2675800 11289437 0 3 0 0 0 EDO SULAEMAN
00060381 46 17104 ALDITYAS EKO, DR., SP.THT-KL 0116R0340523V001535
0001285267601 3;JKN RSUP;; 5.8.4.202302261000 4 180933
1#0##0#0#0.0#2023-06-06
3878ed34c6cd1dee40d69fb534e38627 83000 4524000 4357900 0 0
0 0 955100 0 0 370000 0 586728 352323
60386 0 0 0
3175410 C 3 CS 1 03/05/2023 06/05/2023 02/05/1974 0 1
1 E11.5;E87.1 83.39;99.18;99.29 - - None None None None M-1-
7600700 0 0 - 0 - 0 - 0 - 0
7600700 12720768 0 4 0 0 0 ROKIB,TN 00019351
49 17898 RUDI HERMANSSYAH,SP.B DR. 0116R0340523V001040
0000378244899 3;JKN RSUP;; 5.8.4.202302261000 4 180940
1#0##0#0#0.0#2023-06-06
mt":"0","nursing_amt":"0","ancillary_amt":"0","blood_amt":"0","laboratory_amt":"145
0725","radiology_amt":"140000","rehab_amt":"0","room_amt":"1750000","intensive_amt"
:"0","drug_amt":"1364751","device_amt":"305965","consumable_amt":"73052","device_re
nt_amt":"0","drug_chronic_amt":"0","drug_chemo_amt":"0"},"selisih_biaya":
c95b5fc255bb06639a8f78454d174082 157500 3576000 3902775 0
0 0 140000 1450725 0 0 1750000 0 1364751
305965 73052 0 0 0
3175410 C 1 CS 1 04/05/2023 06/05/2023 07/09/1968 0 2
1 K40.3 53.04 - - None None None None K-1-14-I None None
None None None None PROSEDUR HERNIA INGUINAL DAN FEMORAL (RINGAN)
6531300 0 0 - 0 - 0 - 0 - 0
6531300 12246615 0 3 0 0 0 MARYONO,TN 00031059
54 19962 DR. RUDI HERMANSYAH, SP. B 0116R0340523V001424
0001128497512 3;JKN RSUP;; 5.8.4.202302261000 4 181017
1#0##0#0#0.0#2023-06-06
9971d1eecf6090d697c182a22828e0f2 30000 4460000 4254300 0 0
0 0 284700 0 0 1000000 0 674301 1470946
72368 0 0 0
3175410 C 3 CS 1 03/05/2023 06/05/2023 01/11/1991 0 2
5238800 0 0 - 0 - 0 - 0 - 0
5238800 5648983 0 4 0 0 0 HARDINA 00060299
31 11506 TEUKU MUHAMMAD ISKANDAR, SP.OG, DR. 0116R0340523V001046
0000378898367 3;JKN RSUP;; 5.8.4.202302261000 4 180435
1#0##0#0#0.0#2023-06-06
{"code":"","name":""}} 1 3c6075e7dfeda1ee897bb84956a0142e 130000
3020000 262100 0 0 0 0 510900 0 0 370000
0 545815 664841 145327 0 0 0
3175410 C 1 CS 1 04/05/2023 07/05/2023 15/05/1979 0 2
1 H81.1 99.18;99.29;90.59 - - None None None None U-4-11-I
None None None None None None DYSEQUILIBRIUM (RINGAN) 1891500 0
0 - 0 - 0 - 0 - 0 1891500 3800360
0 4 0 0 0 GOWOK PRISWATI ,NY 00039286 43 16060
DR. ADE DEWI NARALIA 0116R0340523V001545 0001638881019 3;JKN RSUP;;
5.8.4.202302261000 4 179965 1#0##0#0#0.0#2023-06-02
a7b0250ce7b23644d9492e6c3e8159bc 157500 0 407700 0 0
0 200000 596300 0 0 2000000 0 349044 89816
0 0 0 0
3175410 C 1 CS 1 04/05/2023 07/05/2023 13/10/2019 0 1
- 0 - 0 2633800 2328570 0 4 0 0 0
AHMAD GHIFARI, AN 00040920 3 1299 RIADY ASHARI, SP.A
0116R0340523V001112 0002898716163 3;JKN RSUP;; 5.8.4.202302261000
4 180501 1#0##0#0#0.0#2023-06-05
b3b2fde3e4efa7b2423b72724bdebac8 180000 0 212000 0 0
0 0 241000 0 0 1000000 0 437012 258558
0 0 0 0
3175410 C 3 CS 1 05/05/2023 07/05/2023 16/12/1993 0 1
1 A09.9;D64.9 99.18;99.29;90.59;99.04 - - None None None None
- 0 - 0 2196300 1161913 0 3 0 0 0
RUDI KRISTIANTO H,TN 00061072 29 10732 FELIX SATWIKA, DR., SP.PD
0116R0340523V002202 0000041675218 3;JKN RSUP;; 5.8.4.202302261000
4 180520 1#0##0#0#0.0#2023-06-05
_amt":"75634","device_amt":"87529","consumable_amt":"0","device_rent_amt":"0","drug
fde63123936f9c5c1c177e9f084e41b2 66750 0 163900 0 0 0
140000 258100 0 0 370000 0 75634 87529 0 0
0 0
3175410 C 3 CS 1 04/05/2023 07/05/2023 22/12/1995 0 2
None None None None PROSEDUR JARINGAN LUNAK (RINGAN) 4580200 0
0 - 0 - 0 - 0 - 0 4580200 1353835
0 4 0 0 0 DEVI PURWANTI, NY 00060003 27 9995 ANDRI
SUHANDI, SP.B ,DR 0116R0340523V001539 0002104192416 3;JKN RSUP;;
5.8.4.202302261000 4 180529 1#0##0#0#0.0#2023-06-05
99171be91ca1abb10c215137cd2dd909 0 0 172900 0 0 0
0 695100 0 0 185000 0 243444 57391 0 0
0 0
3175410 C 3 CS 1 05/05/2023 07/05/2023 04/12/1947 0 1
1 I12.0;E87.6;H81.1 99.18;99.29;90.59 - - None None None None
N-4-10-II None None None None None None TUMOR GINJAL & SALURAN URIN &
GAGAL GINJAL (SEDANG) 3501400 0 0 - 0 - 0 - 0
- 0 3501400 3173754 0 3 0 0 0 MUGENI BIN
MAID, TN 00053284 75 27546 DR. KHONITA ADIAN UTAMI, SP. N
0116R0340523V001931 0001223921248 3;JKN RSUP;; 5.8.4.202302261000
4 180530 1#0##0#0#0.0#2023-06-05
1c378ea4be2dad59d6a9b176e2a46bb5 30000 0 222475 0 0 0
0 1316025 0 0 370000 0 1184429 50825 0 0
0 0
3175410 C 3 CS 1 05/05/2023 07/05/2023 23/07/1982 0 2
1 K21.9;E87.6;I10 99.18;99.29;90.59 - - None None None None
K-4-12-II None None None None None None GANGGUAN ESOFAGUS (SEDANG)
3855400 0 0 - 0 - 0 - 0 - 0
3855400 2383972 0 3 0 0 0 MASRI DEWI FRANSISKA,
M,NY 00011237 40 14896 FELIX SATWIKA, SP.PD .DR 0116R0340523V001557
0002332177481 3;JKN RSUP;; 5.8.4.202302261000 4 180532
1#0##0#0#0.0#2023-06-05
1116a67e92ec6b5bc57135118c25719d 30000 0 200800 0 0 0
0 864200 0 0 370000 0 860034 58938 0 0
0 0
3175410 C 3 CS 1 06/05/2023 07/05/2023 13/07/2003 0 1
1 A49.9 99.18;99.29;90.59 - - None None None None A-4-14-I
None None None None None None PENYAKIT INFEKSI BAKTERI DAN PARASIT
LAIN-LAIN (RINGAN) 2269000 0 0 - 0 - 0 - 0
- 0 2269000 4074871 0 2 0 0 0 DAVA
RAFID,TN 00061000 19 7237 DR. LAILY RIDAWATI, SP.PD
0116R0340523V001947 0001648213378 3;JKN RSUP;; 5.8.4.202302261000
4 180555 1#0##0#0#0.0#2023-06-05
5ac7f5d9a597c04922f39579c416d6f2 66750 0 324300 0 0 0
140000 265800 0 0 1050000 0 2143652 84369 0
0 0 0
3175410 C 3 CS 1 04/05/2023 07/05/2023 12/04/2014 0 2
1939100 0 0 - 0 - 0 - 0 - 0
1939100 2237419 0 4 0 0 0 ADEEVA UFAIRA AGHNIA F
0116R0340523V001401 0001745298358 3;JKN RSUP;; 5.8.4.202302261000
4 180557 1#0##0#0#0.0#2023-06-05
94c51e5931f976fe48a5ea917fd03618 105000 0 332200 0 0
0 0 320800 0 0 925000 0 425140 129279
0 0 0 0
3175410 C 3 CS 1 03/05/2023 07/05/2023 04/07/2018 0 1
(SEDANG) 2196300 0 0 - 0 - 0 - 0 - 0
2196300 3073287 0 5 0 0 0 AZZAM KALIF PUTRA A ,AN
0002470024596 3;JKN RSUP;; 5.8.4.202302261000 4 180568
1#0##0#0#0.0#2023-06-05
":"1104669","device_amt":"129618","consumable_amt":"0","device_rent_amt":"0","drug_
548aa253a390d36ecc4f18634e54657c 30000 0 106500 0 0 0
0 592500 0 0 1110000 0 1104669 129618 0
0 0 0
3175410 C 3 CS 1 04/05/2023 07/05/2023 02/02/2020 0 1
(RINGAN) 1635100 0 0 - 0 - 0 - 0 - 0
1635100 2277735 0 4 0 0 0 ADZRIEL RAFIQ SAPUTRA,AN
00047987 3 1187 MUSTARI, DR., SP.A 0116R0340523V001492
0003066343468 3;JKN RSUP;; 5.8.4.202302261000 4 180603
1#0##0#0#0.0#2023-06-05
8ac4a27c8547cf5485d06534237fa764 30000 0 408000 0 0 0
0 0 0 0 1500000 0 235087 104648 0 0
0 0
3175410 C 3 CS 1 06/05/2023 07/05/2023 04/05/2002 0 2
- 0 - 0 1980300 2166817 0 2 0 0 0
RINI INDRIYANI,NN 00061070 21 7672 DR. LAILY RIDAWATI, SP.PD
0116R0340523V001937 0000377763041 3;JKN RSUP;; 5.8.4.202302261000
4 180736 1#0##0#0#0.0#2023-06-06
fb9d9d0e1309c3b84a1f7674603d200a 66750 0 293800 0 0 0
140000 258200 0 0 555000 0 769224 83843 0
0 0 0
3175410 C 3 CS 1 30/04/2023 07/05/2023 30/06/1980 0 1
1 E88.0;K75.2 99.18;99.29;90.59 - - None None None None E-4-
12-II None None None None None None GANGGUAN METABOLIK BAWAAN (SEDANG)
4992200 0 0 - 0 - 0 - 0 - 0
4992200 11120606 0 8 0 0 0 SUHERMAN,TN 00057691
42 15644 SYARIFUDIN, SP.P .DR 0116R0340523V000014 0003515780496
3;JKN RSUP;; 5.8.4.202302261000 4 180846 1#0##0#0#0.0#2023-
06-06
92b5f4c14816b111110f9528034ef1d5 66750 0 858922 0 0 0
140000 1438525 0 0 350000 0 8215584 50825 0
0 0 0
3175410 C 3 CS 1 03/05/2023 07/05/2023 12/04/1962 0 2
1 I12.0;E87.6;D63.8 38.95;39.95;99.04 - - None None None None
N-1-12-II None None None None None None MEMBUAT BARU, MEREVISI DAN
MEMINDAHKAN ALAT DIALISIS (SEDANG) 8994600 0 0 - 0 - 0
- 0 - 0 8994600 14976579 0 5 0 0 0
DARINUNG,NY 00060019 61 22301 DR. PUJI ASTUTI TRI KUSUMAWATI, SP. PD
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(RINGAN) 1635100 0 0 - 0 - 0 - 0 - 0
1635100 2884270 0 3 0 0 0 KEISYA NAMIRA DARUS ,AN
0002039060035 3;JKN RSUP;; 5.8.4.202302261000 4 180655
1#0##0#0#0.0#2023-06-05
f2dec2bd98f13ed5787e824383aaa5f5 66750 0 568650 0 0 0
140000 253350 0 0 1000000 0 621836 233684
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3175410 C 1 CS 1 07/05/2023 09/05/2023 21/12/1992 0 1
1 D21.0 83.39;99.18;99.29 - - None None None None M-1-50-I
None None None None None None PROSEDUR JARINGAN LUNAK (RINGAN)
6091600 0 0 - 0 - 0 - 0 - 0
6091600 1921069 0 3 0 0 0 ASRUL ,TN 00058402
0003050423684 3;JKN RSUP;; 5.8.4.202302261000 4 180881
1#0##0#0#0.0#2023-06-06
77a1d047d0871cb6015e999328c27165 0 0 212000 0 0 0
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3175410 C 1 CS 1 06/05/2023 09/05/2023 26/09/2008 0 1
(RINGAN) 2579000 0 0 - 0 - 0 - 0 - 0
2579000 2454619 0 4 0 0 0 GILANG TRIROMADHON,AN
0001168648391 3;JKN RSUP;; 5.8.4.202302261000 4 180963
1#0##0#0#0.0#2023-06-06
176134844f871dd0ab35ae3c66488997 30000 0 306000 0 0 0
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0
3175410 C 3 CS 1 06/05/2023 09/05/2023 11/08/1969 0 2
(SEDANG) 2196300 0 0 - 0 - 0 - 0 - 0
2196300 2112465 0 4 0 0 0 SRI LIDIA UTHAMI TOHIRUN
0116R0340523V002088 0001389202964 3;JKN RSUP;; 5.8.4.202302261000
4 180968 1#0##0#0#0.0#2023-06-06
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3175410 C 1 CS 1 07/05/2023 09/05/2023 12/12/1980 0 1
0 - 0 - 0 - 0 - 0 4715300 40001918
0 3 0 0 0 ROHMAT, TN 00057350 42 15486 DR. LAILY
RIDAWATI, SP.PD 0116R0340523V002250 0000378234999 3;JKN RSUP;;
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3175410 C 3 CS 1 07/05/2023 09/05/2023 30/01/2012 0 2
0 - 0 - 0 - 0 - 0 4580200 9280107
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3175410 C 3 CS 1 10/05/2023 10/05/2023 01/01/1952 0 2
3 A16.2;T96;K59.0 99.18;99.29;90.59;87.44 - - None None None
None J-4-15-I None None None None None None PERADANGAN DAN INFEKSI
PERNAFASAN (RINGAN) 4337000 0 0 - 0 - 0 - 0
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3175410 C 3 CS 1 08/05/2023 10/05/2023 03/06/1972 0 2
1 H81.1;E11.9;I10;E87.6 99.18;99.29;90.59 - - None None None
None U-4-11-II None None None None None None DYSEQUILIBRIUM (SEDANG)
1916100 0 0 - 0 - 0 - 0 - 0
1916100 3096550 0 3 0 0 0 EPIH HADIATI, NY
00060144 50 18601 DR. KHONITA ADIAN UTAMI, SP. N
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3175410 C 3 CS 1 07/05/2023 10/05/2023 12/02/2010 0 1
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3175410 C 3 CS 1 04/05/2023 10/05/2023 15/11/2020 0 1
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3175410 C 3 CS 1 06/05/2023 10/05/2023 02/11/1980 0 2
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1635100 3406607 0 5 0 0 0 RINA VARTIKA
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3175410 C 3 CS 1 05/05/2023 10/05/2023 23/05/2007 0 2
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1939100 1823390 0 6 0 0 0 NASHWA SABINA,AN
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3175410 C 1 CS 1 08/05/2023 10/05/2023 15/06/1977 0 1
1 H81.3 99.18;99.29 - - None None None None U-4-11-I None
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- 0 - 0 - 0 - 0 1891500 1915069 0
3 0 0 0 SUSANTO ,TN 00020130 45 16763 DR. PRIYANKA
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200000 241000 0 0 500000 0 309823 158496
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3175410 C 1 CS 1 06/05/2023 10/05/2023 01/02/1958 0 2
1 A49.9;D64.9;E87.8 99.18;99.29;99.04 - - None None None None
0 - 0 3759600 5294618 0 5 0 0 0 PUANI,
NY 00060249 65 23835 BETA AGUSTIA WISMAN, SP.PD, DR
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4 180666 1#0##0#0#0.0#2023-06-05
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0 2834700 0 0 1000000 0 1037011 48607 0 0
0 0
3175410 C 3 CS 1 06/05/2023 10/05/2023 20/09/2006 0 2
1 K30 99.18;99.29;99.21;90.59 - - None None None None K-4-
(RINGAN) 1347400 0 0 - 0 - 0 - 0 - 0
1347400 1087640 0 5 0 0 0 SITI AZIZAH RAHMAH,AN
0000370976433 3;JKN RSUP;; 5.8.4.202302261000 4 180669
1#0##0#0#0.0#2023-06-05
65acf5f6473b4f095819cf4507a25d65 30000 0 166800 0 0 0
0 218200 0 0 370000 0 172550 130090 0
0 0 0
3175410 C 3 CS 1 08/05/2023 11/05/2023 16/11/2019 0 2
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 1582470 0 4 0 0 0 ALESYA SAHILA ANGGARA
0003507009614 3;JKN RSUP;; 5.8.4.202302261000 4 180599
1#0##0#0#0.0#2023-06-05
93ac9bafb154222224aa36f810d004e1 30000 0 232350 0 0 0
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3175410 C 3 CS 1 08/05/2023 11/05/2023 23/04/1998 0 2
2226200 0 0 - 0 - 0 - 0 - 0
2226200 4398003 0 4 0 0 0 SITI MASPUPAH,NY
00058266 25 9146 DR. ASYSYUKRIATI, SP.P 0116R0340523V002635
0000511363282 3;JKN RSUP;; 5.8.4.202302261000 4 180600
1#0##0#0#0.0#2023-06-05
5e12398a9a695182b97d5abd868097ec 60000 0 622150 0 0 0
0 731000 0 0 2000000 0 878078 106775 0
0 0 0
3175410 C 3 CS 1 07/05/2023 11/05/2023 02/11/1998 0 1
(RINGAN) 1635100 0 0 - 0 - 0 - 0 - 0
1635100 2171190 0 5 0 0 0 FARID ABDUL SUKUR, TN
0116R0340523V002305 0000379015514 3;JKN RSUP;; 5.8.4.202302261000
4 180606 1#0##0#0#0.0#2023-06-05
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200000 218200 0 0 555000 0 535634 143806
0 0 0 0
3175410 C 3 CS 1 10/05/2023 11/05/2023 18/10/1992 0 2
1 N92.1 69.09 - - None None None None W-1-11-I None None
(RINGAN) 2371700 0 0 - 0 - 0 - 0 - 0
2371700 2678892 0 2 0 0 0 INDAH FAJARWATI,NY
0002074876176 3;JKN RSUP;; 5.8.4.202302261000 4 180610
1#0##0#0#0.0#2023-06-05
a59fc8e02097fe1932541bf89d5eef40 66750 0 235900 0 0 0
0 708100 0 0 1500000 0 43827 124315 0 0
0 0
3175410 C 3 CS 1 06/05/2023 11/05/2023 15/09/1999 0 2
1 A49.9;K75.8 99.18;99.29;90.59 - - None None None None A-4-
14-II None None None None None None PENYAKIT INFEKSI BAKTERI DAN PARASIT
LAIN-LAIN (SEDANG) 2826800 0 0 - 0 - 0 - 0
- 0 2826800 5785727 0 6 0 0 0 MUTIAH
RAHMAWATI, NY 00060139 23 8634 DR. LAILY RIDAWATI, SP.PD
0116R0340523V001933 0001672458759 3;JKN RSUP;; 5.8.4.202302261000
4 180611 1#0##0#0#0.0#2023-06-05
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3175410 C 3 CS 1 09/05/2023 11/05/2023 20/07/2022 0 2
0 0 - 0 - 0 - 0 - 0 2738300
1574680 0 3 0 0 0 ADELIA PUTRI AZ ZAHRA 00060303
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178000 218200 0 0 555000 0 121308 143622
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3175410 C 3 CS 1 07/05/2023 11/05/2023 31/03/2005 0 2
(RINGAN) 1635100 0 0 - 0 - 0 - 0 - 0
1635100 2031788 0 5 0 0 0 SALWA HALWANI, NN
0116R0340523V002328 0002063055227 3;JKN RSUP;; 5.8.4.202302261000
4 180692 1#0##0#0#0.0#2023-06-05
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3175410 C 3 CS 1 08/05/2023 11/05/2023 02/02/2000 0 2
0 0 - 0 - 0 - 0 - 0 3330600
2643741 0 4 0 0 0 WINDI ,NY 00016743 23 8496
FELIX SATWIKA, SP.PD .DR 0116R0340523V002441 0000377190404 3;JKN
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3175410 C 3 CS 1 10/05/2023 11/05/2023 21/08/2000 0 2
5238800 0 0 - 0 - 0 - 0 - 0
5238800 1182671 0 2 0 0 0 AYU SAPUTRI, NY
0116R0340523V003116 0002178527455 3;JKN RSUP;; 5.8.4.202302261000
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3175410 C 3 CS 1 09/05/2023 11/05/2023 30/04/2001 0 2
None None None None None PERSALINAN PALSU (RINGAN) 1629900 0
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0 3 0 0 0 TALIA ESTUNINGSIH ,NY 00054511 22 8044
AHMAD THAMRIN, DR., SP.OG 0116R0340523V003080 0116R0340523V003060
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3175410 C 1 CS 1 07/05/2023 11/05/2023 12/01/1996 0 2
1 A90;E87.6 99.18;99.29;90.59 - - None None None None A-4-
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(SEDANG) 3278400 0 0 - 0 - 0 - 0 - 0
3278400 5550230 0 5 0 0 0 RIZKIYAH, NY
0116R0340523V002321 0001224051377 3;JKN RSUP;; 5.8.4.202302261000
4 180864 1#0##0#0#0.0#2023-06-06
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3175410 C 3 CS 1 08/05/2023 11/05/2023 22/05/1998 0 2
1 K36 54.19 - - None None None None K-1-40-I None None
None None None None PROSEDUR SISTEM PENCERNAAN LAIN-LAIN (RINGAN)
6274500 0 0 - 0 - 0 - 0 - 0
6274500 13523801 0 4 0 0 0 DAHLIA,NN 00060245
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3;JKN RSUP;; 5.8.4.202302261000 4 180869 1#0##0#0#0.0#2023-
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3175410 C 3 CS 1 08/05/2023 11/05/2023 05/03/2021 0 1
0 0 - 0 - 0 - 0 - 0 2738300
1625523 0 4 0 0 0 MUHAMMAD RIFAN ,AN 00038199
2 794 RIADY ASHARI, SP.A 0116R0340523V002690 0003103802335
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3175410 C 3 CS 1 08/05/2023 11/05/2023 31/12/1971 0 2
1 E11.4;I10 99.18;99.29 - - None None None None G-4-17-I
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3621200 1148834 0 4 0 0 0 TUMINAH ,NY 00058317
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3175410 C 3 CS 1 08/05/2023 11/05/2023 16/01/2009 0 2
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 1700854 0 4 0 0 0 NURSYAHFANI,AN
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3175410 C 1 CS 1 09/05/2023 11/05/2023 27/12/2021 0 1
0 0 - 0 - 0 - 0 - 0 3642000
1861136 0 3 0 0 0 MOCHAMMAD ZYO AL FURQON 00060553
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3175410 C 1 CS 1 05/05/2023 11/05/2023 24/09/1949 0 2
1 E11.2;E87.6 99.18;99.29;90.59 - - None None None None N-4-
16-II None None None None None None PENYAKIT GINJAL DAN SALURAN URIN LAIN-
LAIN (SEDANG) 5649300 0 0 - 0 - 0 - 0 -
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3175410 C 1 CS 1 08/05/2023 11/05/2023 28/11/2019 0 1
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2579000 2100718 0 4 0 0 0 RAYYANZA NIZAR
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3175410 C 3 CS 1 09/05/2023 11/05/2023 12/01/1957 0 1
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3175410 C 3 CS 1 07/05/2023 11/05/2023 15/04/1997 0 2
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6274500 10203415 0 5 0 0 0 LARAS TIKA MUMUAN ,NY
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3175410 C 3 CS 1 06/05/2023 12/05/2023 25/03/1978 0 1
1 R50.9 99.18;99.29 - - None None None None A-4-12-I None
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2721200 0 0 - 0 - 0 - 0 - 0
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3175410 C 3 CS 1 10/05/2023 12/05/2023 13/12/1988 0 2
1 O48;O80.9;Z37.0 73.59 - - None None None None O-6-13-II
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3175410 C 3 CS 1 08/05/2023 12/05/2023 11/04/1968 0 2
1 I64;E87.6 99.18;99.29 - - None None None None G-4-15-II
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3175410 C 3 CS 1 08/05/2023 12/05/2023 17/12/1980 0 2
1 E11.9;K21.9;I10 99.21;99.29 - - None None None None E-4-
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LAILA, NY 00042297 42 15482 FELIX SATWIKA, DR., SP.PD
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3175410 C 3 CS 1 11/05/2023 12/05/2023 18/05/2004 0 2
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2 0 0 0 CINDY MEYLASARI,NN 00058330 18 6932 DR.
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3175410 C 3 CS 1 11/05/2023 12/05/2023 06/07/1974 0 2
1 I20.0;E11.9 90.59;99.29 - - None None None None I-4-20-I
None None None None None None ANGINA PEKTORIS DAN NYERI DADA (RINGAN)
3596200 0 0 - 0 - 0 - 0 - 0
3596200 1593046 0 2 0 0 0 IJAH ,NY 00058323
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1#0##0#0#0.0#2023-06-05
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3175410 C 3 CS 1 09/05/2023 12/05/2023 22/03/2020 0 2
1 J22 90.59;99.29;99.18;93.960 - - None None None None
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NADIRA SALSABILA ZULFA,AN 00048186 3 1143 DR. RIADY ASHARI, SP. A
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3175410 C 3 CS 1 08/05/2023 12/05/2023 16/05/2014 0 1
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ZAIDAN,AN 00058261 8 3279 IRENNE PURNAMA, MSC.,SP.A
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3175410 C 3 CS 1 10/05/2023 12/05/2023 17/07/2015 0 2
(RINGAN) 1635100 0 0 - 0 - 0 - 0 - 0
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3175410 C 3 CS 1 11/05/2023 12/05/2023 22/04/2013 0 1
1 T14.61 83.73 - - None None None None M-1-50-I None
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8370284 0 2 0 0 0 MUHAMAD EMIR FADLY,AN 00058216
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None None None None None PROSEDUR ANGGOTA TUBUH ATAS (RINGAN)
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9313000 4325177 0 3 0 0 0 KEINARRA ZEA K, AN
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3175410 C 1 CS 1 09/05/2023 12/05/2023 07/08/2019 0 2
1 J22 99.18;99.29 - - None None None None J-4-21-I None
None None None None None GEJALA, TANDA DAN DIAGNOSIS SISTEM PERNAFASAN
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ARKAANI A, AN 00049866 3 1371 DR. RIADY ASHARI, SP. A
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4 180789 1#0##0#0#0.0#2023-06-06
3e1c1adf39fc2fa26a0080d894a6b1d3 588000 0 408000 0 0
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3175410 C 1 CS 1 09/05/2023 12/05/2023 18/05/2018 0 2
1 J00 99.18;99.29;99.21 - - None None None None U-4-13-I
- 0 - 0 2633800 2174037 0 4 0 0 0
SHARON E D SILALAHI,AN 00058244 4 1817 DR. RIADY ASHARI, SP. A
0116R0340523V003084 0002459877783 3;JKN RSUP;; 5.8.4.202302261000
4 180790 1#0##0#0#0.0#2023-06-06
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3175410 C 2 CS 1 10/05/2023 12/05/2023 15/03/2011 0 2
2259100 0 0 - 0 - 0 - 0 - 0
2259100 1623988 0 3 0 0 0 NAJWA CAMELIA NUR,AN
0000207227237 3;JKN RSUP;; 5.8.4.202302261000 4 180791
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3175410 C 1 CS 1 10/05/2023 12/05/2023 21/02/1988 0 1
0 - 0 3837600 15648 0 3 0 0 0 FRIDA.NY
0000203290288 3;JKN RSUP;; 5.8.4.202302261000 4 180792
1#0##0#0#0.0#2023-06-06
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3175410 C 1 CS 1 09/05/2023 12/05/2023 02/02/1983 0 2
None None None None None GANGGUAN ESOFAGUS (RINGAN) 4429700 0
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0 4 0 0 0 WINDASARI,NY 00012350 40 14706 DR.
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71e8a80fc59991d0ab8996d7b87908b0 0 0 0 0 0 0 0
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3175410 C 1 CS 1 10/05/2023 12/05/2023 01/10/1980 0 1
2960800 0 0 - 0 - 0 - 0 - 0
2960800 66979 0 3 0 0 0 HERI SUSANTO,TN 00022861
42 15561 DR. ASYSYUKRIATI, SP.P 0116R0340523V003299 0001627296827
3;JKN RSUP;; 5.8.4.202302261000 4 180796 1#0##0#0#0.0#2023-
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3175410 C 1 CS 1 09/05/2023 12/05/2023 10/01/1994 0 1
(RINGAN) 2174700 0 0 - 0 - 0 - 0 - 0
2174700 198905 0 4 0 0 0 ANDIKA.TN 00058278
0001292947367 3;JKN RSUP;; 5.8.4.202302261000 4 180797
1#0##0#0#0.0#2023-06-06
c4792e39cedecb65545ba7d2db283a23 0 0 0 0 0 0 0
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3175410 C 1 CS 1 11/05/2023 12/05/2023 17/12/1978 0 2
None None None None GANGGUAN SISTEM MUSKULOSKELETAL & JA(RINGAN)
0 - 0 4459200 612107 0 2 0 0 0 ESNI
RENITA SINAGA ,NY 00058289 44 16216 ANDRI SUHANDI, DR., SP. B
0116R0340523V003634 0001428999614 3;JKN RSUP;; 5.8.4.202302261000
4 180799 1#0##0#0#0.0#2023-06-06
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3175410 C 1 CS 1 07/05/2023 12/05/2023 22/01/1966 0 1
1 E11.6;J22 99.18;99.21;99.29 - - None None None None E-4-
0 - 0 4803200 1084514 0 6 0 0 0 N.AGUS
ARIEFIN.TN 00058269 57 20924 DR. PUJI ASTUTI TRI KUSUMAWATI, SP. PD
0116R0340523V002288 0001770107927 3;JKN RSUP;; 5.8.4.202302261000
4 180802 1#0##0#0#0.0#2023-06-06
eb40901196402a80a1ebf8de225c8acc 0 0 244500 0 0 0
0 325500 0 0 0 0 505797 7817 0 0 0
900
3175410 C 1 CS 1 10/05/2023 12/05/2023 27/01/1976 0 2
None None None None None None KEGAGALAN JANTUNG (RINGAN) 3774300
0 0 - 0 - 0 - 0 - 0 3774300 175452
0 3 0 0 0 SUHENAH ,NY 00058308 47 17270 FELIX
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3175410 C 1 CS 1 10/05/2023 12/05/2023 09/07/1996 0 2
(SEDANG) 2921000 0 0 - 0 - 0 - 0 - 0
2921000 190057 0 3 0 0 0 YULIANA SARTIKA,NY
0002081734402 3;JKN RSUP;; 5.8.4.202302261000 4 180806
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6766f117138af06f9b870e6e404aae3e 0 0 0 0 0 0 0
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3175410 C 1 CS 1 09/05/2023 12/05/2023 17/11/2002 0 2
- 0 - 0 2633800 179961 0 4 0 0 0
LULU ALFIYAH,R.NN 00020517 20 7478 DR. LAILY RIDAWATI, SP.PD
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4 180809 1#0##0#0#0.0#2023-06-06
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3175410 C 1 CS 1 06/05/2023 12/05/2023 13/11/1952 0 1
0 - 0 3837600 5422764 0 7 0 0 0
SYAMSUL BACHRI, TN 00012644 70 25741 SYARIFUDIN, DR., SP.P
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4 180686 1#0##0#0#0.0#2023-06-06
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3175410 C 3 CS 1 06/05/2023 12/05/2023 10/12/1972 0 1
1 E11.9;R10.4 90.59;99.18;99.29 - - None None None None E-4-
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SUHERMAN ,TN 00057298 50 18409 DR. BETA AGUSTIA WISMAN, SP.PD
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3175410 C 3 CS 1 08/05/2023 12/05/2023 10/01/1961 0 2
1 J22;R04.2;K30 87.49;90.59;99.18;99.29 - - None None None
None J-4-21-I None None None None None None GEJALA, TANDA DAN
DIAGNOSIS SISTEM PERNAFASAN LAIN-LAIN (RINGAN) 2885400 0 0 - 0
- 0 - 0 - 0 2885400 456132 0 5 0
0 0 MAS AH ,NY 00058227 62 22763 DR. ASYSYUKRIATI, SP.P
0116R0340523V002665 0001219263232 3;JKN RSUP;; 5.8.4.202302261000
4 180837 1#0##0#0#0.0#2023-06-06
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3175410 C 3 CS 1 09/05/2023 12/05/2023 14/02/2003 0 1
0 - 0 2885400 200534 0 4 0 0 0 WAHYU
FEBRIANSYAH, TN 00011593 20 7389 SYARIFUDIN, DR., SP.P
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4 180844 1#0##0#0#0.0#2023-06-06
mt":"15809","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0","drug
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3175410 C 3 CS 1 09/05/2023 12/05/2023 07/05/1998 0 2
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 221536 0 4 0 0 0 ANNISA NURUL HIDAYAH S,
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1#0##0#0#0.0#2023-06-06
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3175410 C 3 CS 1 10/05/2023 12/05/2023 16/02/1968 0 1
1 K81.9;J22 90.59;99.18;99.21;99.29;88.76 - - None None None
None B-4-14-I None None None None None None GANGGUAN SALURAN EMPEDU
LAIN-LAIN (RINGAN) 3381400 0 0 - 0 - 0 - 0
- 0 3381400 840046 0 3 0 0 0 SLAMET
HARYANTO,TN 00013219 55 20172 DR. LAILY RIDAWATI, SP.PD
0116R0340523V003115 0000379109092 3;JKN RSUP;; 5.8.4.202302261000
4 180852 1#0##0#0#0.0#2023-06-06
mt":"329000","rehab_amt":"0","room_amt":"0","intensive_amt":"0","drug_amt":"299634"
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329000 0 0 0 0 0 299634 70412 0 0 0
0
3175410 C 3 CS 1 09/05/2023 12/05/2023 03/01/1968 0 1
1 J22;R50.9 99.18;99.21;99.29;90.59 - - None None None None
0 - 0 - 0 2885400 227218 0 4 0 0
0 SURATNO ,TN 00058183 55 20215 DR. LAILY RIDAWATI, SP.PD
0116R0340523V003113 0001278328858 3;JKN RSUP;; 5.8.4.202302261000
4 180855 1#0##0#0#0.0#2023-06-06
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3175410 C 3 CS 1 10/05/2023 12/05/2023 30/04/2023 2680 2
1 P59.9 99.83 - - None None None None B-4-13-I None None
None None None None GANGGUAN HATI LAIN-LAIN (RINGAN) 3385000 0
0 - 0 - 0 - 0 - 0 3385000 90000 0
3 0 0 0 ASMANI ,BY NY 00058277 0 10 DR. RIADY
ASHARI, SP. A 0116R0340523V003114 0003520248131 3;JKN RSUP;;
5.8.4.202302261000 4 180858 1#0##0#0#0.0#2023-06-06
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3175410 C 3 CS 1 10/05/2023 13/05/2023 28/11/1960 0 2
1 E11.5;L03.9 99.21;99.29;90.59 - - None None None None I-4-
15-I None None None None None None PENYAKIT PEMBULUH DARAH PERIFER DAN LAIN-
LAIN (RINGAN) 4621000 0 0 - 0 - 0 - 0 -
0 4621000 526572 0 4 0 0 0 TIJAH, NY
0116R0340523V003455 0001279180089 3;JKN RSUP;; 5.8.4.202302261000
4 179925 1#0##0#0#0.0#2023-06-02
6afa71057505579d5a7bcfb4959ec3c6 0 0 242000 0 0 0
0 158000 0 0 0 0 111298 15274 0 0 0
0
3175410 C 1 CS 1 12/05/2023 13/05/2023 13/02/1998 0 2
13-I None None None None None None PERSALINAN VAGINAL (RINGAN) 2891300
0 0 - 0 - 0 - 0 - 0 2891300
4523265 0 2 0 0 0 WULAN DIAN NINGSIH S,NY 00043208
25 9219 AHMAD THAMRIN, SP.OG. DR 0116R0340523V003901
0001603449472 3;JKN RSUP;; 5.8.4.202302261000 4 179902
1#0##0#0#0.0#2023-06-02
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3175410 C 3 CS 1 05/05/2023 13/05/2023 07/04/1967 0 2
1 K60.2;E11.8;I25.1 90.59;99.21;99.29 - - None None None None
K-4-18-II None None None None None None GANGGUAN SISTEM PENCERNAAN
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3175410 C 2 CS 1 07/05/2023 13/05/2023 06/05/1959 0 1
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U-4-11-II None None None None None None DYSEQUILIBRIUM (SEDANG)
2232300 0 0 - 0 - 0 - 0 - 0
2232300 2373159 0 7 0 0 0 MISMAN,TN 00043305
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56e19542256df7851fb4410c9e62f35f 935000 0 244200 0 0
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3175410 C 1 CS 1 11/05/2023 13/05/2023 15/02/1990 0 2
6967500 0 0 - 0 - 0 - 0 - 0
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3175410 C 3 CS 1 11/05/2023 13/05/2023 21/11/1978 0 2
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5533600 0 0 - 0 - 0 - 0 - 0
5533600 672135 0 3 0 0 0 PUJI RAHAYU. NY
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3175410 C 3 CS 1 10/05/2023 13/05/2023 17/02/1996 0 2
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3175410 C 3 CS 1 12/05/2023 13/05/2023 29/01/1996 0 2
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3175410 C 3 CS 1 10/05/2023 13/05/2023 10/11/1959 0 2
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ANAH,NY 00012134 63 23192 DR. BETA AGUSTIA WISMAN, SP.PD
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3175410 C 3 CS 1 11/05/2023 13/05/2023 03/10/1973 0 2
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3175410 C 3 CS 1 11/05/2023 13/05/2023 10/02/1979 0 2
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HAMZAH,NY 00058332 44 16161 DR. BETA AGUSTIA WISMAN, SP.PD
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3175410 C 3 CS 1 11/05/2023 13/05/2023 21/04/1973 0 1
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AMZAD, TN 00058345 50 18282 DR. BETA AGUSTIA WISMAN, SP.PD
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3175410 C 3 CS 1 11/05/2023 13/05/2023 16/02/1984 0 2
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3175410 C 3 CS 1 03/05/2023 13/05/2023 18/07/1967 0 2
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2675800 206549 0 11 0 0 0 NURHAYATI,NY
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3175410 C 3 CS 1 09/05/2023 13/05/2023 11/05/1954 0 2
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TIHAMIH, NY 00050217 68 25200 DR. KHONITA ADIAN UTAMI, SP. N
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3175410 C 3 CS 1 03/05/2023 13/05/2023 11/10/1963 0 1
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3175410 C 3 CS 1 09/05/2023 13/05/2023 23/05/1966 0 1
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3855400 0 0 - 0 - 0 - 0 - 0
3855400 442278 0 5 0 0 0 ECIH SUKESIH.NY
0116R0340523V003892 0002507873433 3;JKN RSUP;; 5.8.4.202302261000
4 173529 1#0##0#0#0.0#2023-05-22
5647221f1f7649f5335babaf02a4223e 0 0 0 0 0 0 0
0 0 0 0 0 393144 49134 0 0 0 0
3175410 C 3 CS 1 11/05/2023 15/05/2023 07/08/1965 0 2
1 J18.0;I11.9;K30 99.18;99.29;90.59;87.44 - - None None None
- 0 3613600 223402 0 5 0 0 0 HAYATI,NY
0001288520796 3;JKN RSUP;; 5.8.4.202302261000 4 173543
1#0##0#0#0.0#2023-05-22
evice_amt":"3160","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0"
f9e188be17143b4aee0ffae5ac26abea 0 0 4250 0 0 0 0
80750 0 0 0 0 135242 3160 0 0 0 0
3175410 C 3 CS 1 12/05/2023 15/05/2023 16/06/2000 0 2
1 A16.2;A09.9;E87.8 89.52;87.49;90.59;90.29 - - None None None
None J-4-15-II None None None None None None PERADANGAN DAN INFEKSI
PERNAFASAN (SEDANG) 5181500 0 0 - 0 - 0 - 0
- 0 5181500 3884528 0 4 0 0 0 AHMAD
HIFZILLAH, TN 00060021 22 8365 DR. ASYSYUKRIATI, SP.P
0116R0340523V004265 0001640292401 3;JKN RSUP;; 5.8.4.202302261000
4 173481 1#0##0#0#0.0#2023-05-22
000261","valid":"1","sitb_response":{"data":[{"id":"2023000107000261","nama":"AHMAD
HIFZILLAH","nik":"3172041606000008","jenis_kelamin_id":"1"}],"success":true}}#{"car
a_masuk":"gp","sistole":"0","diastole":"0","total_tarif_rs":"3884528","billing_grou
p":
logy_amt":"200000","rehab_amt":"0","room_amt":"1400000","intensive_amt":"0","drug_a
mt":"571836","device_amt":"54342","consumable_amt":"0","device_rent_amt":"0","drug_
460d62c09651b069a43a7b77f132c76d 141750 0 0 0 0 0
200000 1516600 0 0 1400000 0 571836 54342 0
0 0 0
3175410 C 3 CS 1 12/05/2023 15/05/2023 09/10/2000 0 1
1 A16.5 34.04;99.18;99.29;90.59 - - None None None None J-4-
15-I None None None None None None PERADANGAN DAN INFEKSI PERNAFASAN
(RINGAN) 4337000 0 0 - 0 - 0 - 0 - 0
4337000 898765 0 4 0 0 0 SUDRAZAT WISNU P,TN
0001228167966 3;JKN RSUP;; 5.8.4.202302261000 4 173392
1#0##0#0#0.0#2023-05-24
[{"id":"2023000107000274","nama":"SUDRAZAT WISNU
PAMUNGKAS","nik":"3172030910000010","jenis_kelamin_id":"1"}],"success":true}}#{"car
a_masuk":"gp","sistole":"0","diastole":"0","total_tarif_rs":"898765","billing_group
":
0156630ae124ff41c3cd8e410239faf3 0 0 11150 0 0 0 200000
211850 0 0 0 0 374937 100828 0 0 0
0
3175410 C 3 CS 1 05/05/2023 15/05/2023 03/07/1933 0 2
1 I63.9;I12.0 89.52;87.49;90.59;90.29 - - None None None None
G-4-14-II None None None None None None KECEDERAAN PEMBULUH DARAH
OTAK DENGAN INFARK (SEDANG) 5484100 0 0 - 0 - 0 -
0 - 0 5484100 2558601 0 11 0 0 0 SAHMEN
,TN 00058221 89 32813 DR. ASYSYUKRIATI, SP.P 0116R0340523V001911
0000357926613 3;JKN RSUP;; 5.8.4.202302261000 4 173495
1#0##0#0#0.0#2023-05-29
84d4d95582b1bce2f472ef201a5e64e8 83000 0 0 0 0 0 300000
184000 0 0 925000 0 945833 120768 0 0
0 0
3175410 C 1 CS 1 09/05/2023 15/05/2023 27/09/1937 0 1
1 J18.0;E87.1;E11.9 87.49;90.59;99.29;89.52 - - None None None
- 0 6753800 4978759 0 7 0 0 0 W MANGIRING
BUTAR BUTAR SH.TN 00058282 85 31270 SYARIFUDIN, DR., SP.P
0116R0340523V003074 0000045088975 3;JKN RSUP;; 5.8.4.202302261000
4 173362 1#0##0#0#0.0#2023-05-29
ing_amt":"0","ancillary_amt":"0","blood_amt":"0","laboratory_amt":"1064000","radiol
64a9fa8d6e8a231c9234f0d9ac643a09 83000 0 0 0 0 0 250000
1064000 0 0 2500000 0 971562 110197 0 0
0 0
3175410 C 1 CS 1 12/05/2023 15/05/2023 20/11/1992 0 1
1 J35.1 28.2 - - None None None None U-1-15-I None None
None None None None PROSEDUR TONSIL & ADENOID (RINGAN) 5118600 0
0 - 0 - 0 - 0 - 0 5118600 12265489
0 4 0 0 0 PUTRAWAN SAH ARIANTONO,TN 00038555 30
11130 ALDITYAS EKO, DR., SP.THT-KL 0116R0340523V004261 0001603449459
3;JKN RSUP;; 5.8.4.202302261000 4 173357 1#0##0#0#0.0#2023-
05-29
aa1d6464cb09d01999a641c5edba47a3 0 5408000 4992000 0 0
0 0 0 0 0 0 0 996590 784221 84678 0
0 0
3175410 C 1 CS 1 12/05/2023 15/05/2023 02/09/2016 0 1
1 J35.3 28.3;99.18;99.29;99.21 - - None None None None U-1-
15-I None None None None None None PROSEDUR TONSIL & ADENOID (RINGAN)
5118600 0 0 - 0 - 0 - 0 - 0
5118600 15383731 0 4 0 0 0 MUHAMMAD RUSYDAN
HAKIM ,AN 00007985 6 2443 ALDITYAS EKO, DR., SP.THT-KL
0116R0340523V004254 0002256898408 3;JKN RSUP;; 5.8.4.202302261000
4 172823 1#0##0#0#0.0#2023-05-29
amt":"747309","device_amt":"593198","consumable_amt":"93724","device_rent_amt":"0",
57372f63d1ea6157b65dc6e8680b92ef 447500 6188000 5814000 0
0 0 0 0 0 0 1500000 0 747309 593198
93724 0 0 0
3175410 C 3 CS 1 12/05/2023 15/05/2023 28/10/2010 0 1
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 748238 0 4 0 0 0 CHRISTIAN R SIMAMORA, AN
0001404588328 3;JKN RSUP;; 5.8.4.202302261000 4 173107
1#0##0#0#0.0#2023-05-29
3dfb6b7923958b6aac7d902d567f31f2 230000 0 249450 0 0
0 0 179550 0 0 0 0 64147 25091 0 0 0
0
3175410 C 1 CS 1 13/05/2023 15/05/2023 26/06/1986 0 2
1 J18.0;B00.9 87.49;90.29;90.59 - - None None None None J-4-
(SEDANG) 6753800 0 0 - 0 - 0 - 0 - 0
6753800 2828705 0 3 0 0 0 I WAYAN UPAYANE.TN
0001595785882 3;JKN RSUP;; 5.8.4.202302261000 4 173363
1#0##0#0#0.0#2023-05-29
96d26e0ef667c0d2caef27b57117d40e 111750 0 0 0 0 0
200000 225000 0 0 1500000 0 716096 75859 0
0 0 0
3175410 C 3 CS 1 09/05/2023 15/05/2023 31/12/1947 0 2
1 A16.2;I12.0;E16.2 99.18;99.29;90.59;87.44 - - None None None
- 0 5181500 2252527 0 7 0 0 0 MURTIAH ,NY
0001741212562 3;JKN RSUP;; 5.8.4.202302261000 4 173374
1#0##0#0#0.0#2023-06-02
980287","valid":"1","sitb_response":{"data":[{"id":"2023000106980287","nama":"HJ.
MURTIAH","nik":"3172047112470007","jenis_kelamin_id":"2"}],"success":true}}#{"cara_
:
","device_amt":"35458","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt
a68133a19c966ec3cff1c8dcaa71fe13 0 0 968400 0 0 0
0 159600 0 0 0 0 1089069 35458 0 0 0
0
3175410 C 3 CS 1 10/05/2023 15/05/2023 22/10/1990 0 1
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 1344200 0 6 0 0 0 SUN HAJI ,TN
0001270866666 3;JKN RSUP;; 5.8.4.202302261000 4 173387
1#0##0#0#0.0#2023-06-03
"device_amt":"104443","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt"
9a081bd73938d309f29954fe4d31d6f8 0 0 19200 0 0 0 0
364800 0 0 0 0 855757 104443 0 0 0
0
3175410 C 3 CS 1 13/05/2023 15/05/2023 05/10/1978 0 1
1 A16.2;E11.9;I25.1 89.52;99.29;87.44;90.59 - - None None None
- 0 4337000 2595907 0 3 0 0 0 AGUNG
NURHADI,TN 00060051 44 16291 SYARIFUDIN, DR., SP.P 0116R0340523V004540
0001745303679 3;JKN RSUP;; 5.8.4.202302261000 4 173385
1#0##0#0#0.0#2023-06-05
730350","valid":"1","sitb_response":{"data":[{"id":"2020000026730350","nama":"AGUNG
NURHADI","nik":"3175060510780004","jenis_kelamin_id":"1"}],"success":true}}#{"cara_
:
9a517489316267d74441c425ea177f91 141750 0 0 0 0 0
200000 603000 0 0 1050000 0 471311 129846
0 0 0 0
3175410 C 3 CS 1 14/05/2023 16/05/2023 17/08/1960 0 1
4 J44.1;J81;I12.0;D68.9;I46.9 96.71;99.18;99.29;90.59;87.44;37.96 -
- None None None None J-1-20-III None None None None None None
PROSEDUR SISTEM PERNAFASAN NON-KOMPLEKS (BERAT) 23255400 0 0 -
0 - 0 - 0 - 0 23255400 7005794 0 3
1 3 47 ZUBAIR,TN 00003540 62 22915 DR. ASYSYUKRIATI, SP.P
0116R0340523V004584 0001126554761 3;JKN RSUP;; 5.8.4.202302261000
4 173555 1#0##0#0#0.0#2023-05-22
1168152","device_amt":"804126","consumable_amt":"130780","device_rent_amt":"0","dru
99c7adf9ab422ad90d5c86971d6a9149 2063100 0 347261 0 0
0 0 2492375 0 0 0 0 1168152 804126 130780
0 0 0
3175410 C 3 CS 1 14/05/2023 16/05/2023 13/02/1995 0 2
1 G44.2;I84.2;D64.9 87.49;90.59;90.29;99.04 - - None None None
None G-4-23-II None None None None None None MIGREN DAN SAKIT KEPALA
LAIN ((SEDANG) 2677300 0 0 - 0 - 0 - 0 -
0 2677300 3282498 0 3 0 0 0 PEBRI ROMADONI,TN
00060086 28 10317 DR. PRIYANKA GANESA UTAMI, SP. N
0116R0340523V004574 0001292933597 3;JKN RSUP;; 5.8.4.202302261000
4 173579 1#0##0#0#0.0#2023-05-22
921321990704f7ddc1c151e9f9889b84 141750 0 0 0 0 0
200000 2199000 0 0 370000 0 257663 114085
0 0 0 0
3175410 C 3 CS 1 11/05/2023 16/05/2023 25/06/1977 0 2
1 E11.1;E87.6;K80.8 99.18;99.29;90.59;87.44 - - None None None
0 - 0 - 0 5046400 3499355 0 6 0 0
0 NURHAYATI ,NY 00058340 45 16756 DR. PUJI ASTUTI TRI
KUSUMAWATI, SP. PD 0116R0340523V003738 0002100089621 3;JKN RSUP;;
5.8.4.202302261000 4 173598 1#0##0#0#0.0#2023-05-22
2ddbc74417d836d1c917162ec9e8a1b4 0 0 907500 0 0 0
329000 1363500 0 0 0 0 815614 83741 0 0
0 0
3175410 C 3 CS 1 13/05/2023 16/05/2023 07/12/1977 0 2
1 E11.9;N18.5;D63.8;N92.1 39.95;99.04;99.18;99.29;99.21 - - None
None None None E-4-10-II None None None None None None PENYAKIT
KENCING MANIS & GANGGUAN NUTRISI/ METABOLIK (SEDANG) 5046400 0 0 -
0 - 0 - 0 - 0 5046400 3421878 0 4
0 0 0 RIDAH . NY 00005661 45 16593 DR. LAILY RIDAWATI,
SP.PD 0116R0340523V004541 0001739305269 3;JKN RSUP;; 5.8.4.202302261000
4 173618 1#0##0#0#0.0#2023-05-22
2c69f00f7789b3a646c36e984ce3546a 925000 0 83070 0 0 0
0 1818330 0 0 0 0 526831 63382 0 0 0
5265
3175410 C 3 CS 1 12/05/2023 16/05/2023 31/08/1978 0 2
1 E11.1;E88.0;I10 99.18;99.29;90.59;87.44 - - None None None
0 - 0 - 0 5046400 3046419 0 5 1 4
0 FITRIAH,NY 00058384 44 16325 FELIX SATWIKA, DR., SP.PD
0116R0340523V004158 0001223950048 3;JKN RSUP;; 5.8.4.202302261000
4 173625 1#0##0#0#0.0#2023-05-22
8a8f013b442f194a3a2fd70edbec1973 0 0 52150 0 0 0 0
1110850 0 0 0 0 1049432 833987 0 0 0
0
3175410 C 1 CS 1 13/05/2023 16/05/2023 04/04/1981 0 2
1 N39.0;E87.8 99.18;99.29;90.59;87.44;88.76 - - None None None
None N-4-12-II None None None None None None INFEKSI GINJAL DAN
SALURAN URIN (SEDANG) 5852900 0 0 - 0 - 0 - 0
- 0 5852900 1781622 0 4 0 0 0 DUMERI,NY
0001655129665 3;JKN RSUP;; 5.8.4.202302261000 4 173635
1#0##0#0#0.0#2023-05-22
ed06324df00582906987a993e9d7a41d 0 0 174700 0 0 0
364000 355300 0 0 0 0 803415 77907 0 0
0 6300
3175410 C 1 CS 1 12/05/2023 16/05/2023 13/11/2000 0 1
0 0 - 0 - 0 - 0 - 0 4429700
1074427 0 5 0 0 0 SATRIONO FANTO,TN 00060013 22
8215 FELIX SATWIKA, DR., SP.PD 0116R0340523V004262 0002891186256
3;JKN RSUP;; 5.8.4.202302261000 4 173636 1#0##0#0#0.0#2023-
05-22
0c183e9176ed2d199560474603362628 0 0 24252 0 0 0 0
460792 0 0 0 0 520356 69027 0 0 0 0
3175410 C 1 CS 1 12/05/2023 16/05/2023 02/08/1979 0 2
1 K21.9;M65.39 99.18;99.29;90.59;87.44 - - None None None
None K-4-12-I None None None None None None GANGGUAN ESOFAGUS
(RINGAN) 4429700 0 0 - 0 - 0 - 0 - 0
4429700 1466074 0 5 0 0 0 SITI KOMARYANTI ,NY
0001607641064 3;JKN RSUP;; 5.8.4.202302261000 4 173637
1#0##0#0#0.0#2023-05-22
b43d674efedcbd512208fc0c10085a92 0 0 67850 0 0 0 262400
402750 0 0 0 0 684828 48246 0 0 0 0
3175410 C 1 CS 1 14/05/2023 16/05/2023 30/12/1975 0 2
6091600 0 0 - 0 - 0 - 0 - 0
6091600 13141883 0 3 0 0 0 SAFWADI, TN 00060112
0001895722209 3;JKN RSUP;; 5.8.4.202302261000 4 173638
1#0##0#0#0.0#2023-05-22
t":"209379","device_amt":"727790","consumable_amt":"32714","device_rent_amt":"0","d
c77a57d96b6efcc4d683813ad55d490d 83000 10500000 0 0 0 0
0 89000 0 0 1500000 0 209379 727790 32714 0
0 0
3175410 C 3 CS 1 14/05/2023 16/05/2023 01/08/2022 0 1
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 592675 0 3 0 0 0 RIZQ NARENDRA,AN
0116R0340523V004590 0003284374162 3;JKN RSUP;; 5.8.4.202302261000
4 173640 1#0##0#0#0.0#2023-05-22
8a7f30415aa657b534c0f6e64deaf81d 180000 0 160000 0 0
0 0 0 0 0 0 0 223980 28695 0 0 0
0
3175410 C 1 CS 1 14/05/2023 16/05/2023 29/04/2021 0 2
(RINGAN) 2174700 0 0 - 0 - 0 - 0 - 0
2174700 575606 0 3 0 0 0 RAISSA AMANDA A,AN
0116R0340523V004604 0003081303832 3;JKN RSUP;; 5.8.4.202302261000
4 173645 1#0##0#0#0.0#2023-05-22
af1fc2d001ce8926cd37eae359774844 292500 0 206200 0 0
0 0 2200 0 0 0 0 59541 15165 0 0 0 0
3175410 C 1 CS 1 14/05/2023 16/05/2023 09/11/2018 0 2
1 B34.9 99.29;87.44;99.18;99.21;90.59 - - None None None None
LAIN (RINGAN) 2579000 0 0 - 0 - 0 - 0 -
0 2579000 2925992 0 3 0 0 0 SHOFIYAH ALIFAH
ANGRIAWAN,AN 00019659 4 1647 DR. RAEDY RUWANDA SUSANTO, SP A.
0116R0340523V004593 0002751087508 3;JKN RSUP;; 5.8.4.202302261000
4 173690 1#0##0#0#0.0#2023-05-22
60b5a37e941baa84a6f248c7d2289365 570750 0 0 0 0 0
178000 348000 0 0 1500000 0 177224 152018
0 0 0 0
3175410 C 3 CS 1 14/05/2023 16/05/2023 11/01/2022 0 2
1 T22.2 86.22;99.18;99.29;90.59 - - None None None None S-4-
16-I None None None None None None LUKA BAKAR (RINGAN) 4817700 0
0 - 0 - 0 - 0 - 0 4817700 8978216
0 3 0 0 0 SUCI JULIANTI, AN 00060096 1 488 DR.
5.8.4.202302261000 4 173704 1#0##0#0#0.0#2023-05-22
06a858fe41b1acfd11e649c9eef7c3f5 751750 6500000 0 0 0
0 178000 267000 0 0 555000 0 301445 276893
148128 0 0 0
3175410 C 1 CS 1 15/05/2023 16/05/2023 19/05/2015 0 2
(RINGAN) 2579000 0 0 - 0 - 0 - 0 - 0
2579000 1634620 0 2 0 0 0 SYAKILLA PUTRI M,AN
0001855624803 3;JKN RSUP;; 5.8.4.202302261000 4 173730
1#0##0#0#0.0#2023-05-22
ffe5b514d57867ff7d64ef521b4d1084 205000 0 354000 0 0
0 0 0 0 0 1000000 0 59131 16489 0 0 0
0
3175410 C 3 CS 1 15/05/2023 16/05/2023 17/07/1988 0 2
1 O48;O80.9;Z37.0 73.59;73.6 - - None None None None O-6-
0 0 - 0 - 0 - 0 - 0 2780900
4406866 0 2 0 0 0 HANIPA RIANI,NY 00023172 34
12720 TENGKU MUHAMMAD ISKANDAR, DR., SP.OG 0116R0340523V004648
0001775441766 3;JKN RSUP;; 5.8.4.202302261000 4 173797
1#0##0#0#0.0#2023-05-22
{"code":"","name":""}} 1 cafbf2e7eb2d535278531a8d85965120 3899250 0
222850 0 0 0 0 63650 0 0 0 0 149524
71592 0 0 0 0
3175410 C 1 CS 1 12/05/2023 16/05/2023 29/05/1982 0 2
1 N92.0;D68.8;D64.9 69.09;99.04;99.05 - - None None None None
W-1-11-III None None None None None None PROSEDUR DILATASI, KURET,
INTRAUTERIN & SERVIK (BERAT) 5387900 0 0 - 0 - 0 -
0 - 0 5387900 11310972 0 5 0 0 0 ENDANG
SRI WAHYUNI, NY 00060004 40 14958 AHMAD THAMRIN, DR., SP.OG
0116R0340523V004247 0001152347218 3;JKN RSUP;; 5.8.4.202302261000
4 173810 1#0##0#0#0.0#2023-05-22
5d523abd93ae3790dd894305887ad2b2 470500 2565875 2690907 0
0 0 180800 4708110 0 0 0 0 254192 265004
175584 0 0 0
3175410 C 3 CS 1 13/05/2023 16/05/2023 16/09/2001 0 2
1 H60.3;J03.9;A49.9 - - - None None None None U-4-15-I
None None None None None None PENYAKIT TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN LAIN-LAIN (RINGAN) 2990200 0 0 - 0 - 0
- 0 - 0 2990200 2587992 0 4 0 0 0
ALYA FATHIA ANWAR, NY 00060083 21 7909 DR. LAILY RIDAWATI, SP.PD
0116R0340523V004568 0001217448099 3;JKN RSUP;; 5.8.4.202302261000
4 173863 1#0##0#0#0.0#2023-05-22
55cfe94d910f12ffbce16cd1d24f76f6 811750 0 0 0 0 0
200000 225000 0 0 740000 0 553632 57610 0
0 0 0
3175410 C 3 CS 1 14/05/2023 16/05/2023 06/09/1997 0 2
5238800 0 0 - 0 - 0 - 0 - 0
5238800 5688037 0 3 0 0 0 SANTA VERONIKA SIBUEA,
NY 00060109 25 9381 TENGKU MUHAMMAD ISKANDAR, DR., SP.OG
0116R0340523V004624 0002103228595 3;JKN RSUP;; 5.8.4.202302261000
4 173839 1#0##0#0#0.0#2023-05-22
0","radiology_amt":"0","rehab_amt":"0","room_amt":"0","intensive_amt":"0","drug_amt
":"395156","device_amt":"1236596","consumable_amt":"356785","device_rent_amt":"0","
{"code":"","name":""}} 1 d3ddca8fed258b1d07bc53e43891cd4e 465500
3020000 162700 0 0 0 0 51300 0 0 0 0
395156 1236596 356785 0 0 0
3175410 C 1 CS 1 15/05/2023 16/05/2023 29/09/1980 0 2
- 0 - 0 - 0 - 0 3424200 6045396 0
2 0 0 0 RONIDA BUTAR BUTAR, NY 00060196 42 15568 AHMAD
THAMRIN, DR., SP.OG 0116R0340523V004939 0001631766205 3;JKN RSUP;;
5.8.4.202302261000 4 173872 1#0##0#0#0.0#2023-05-22
f3dbdea75fe230ee128327fc974c0fcf 434250 4022000 0 0 0
0 0 267000 0 0 1000000 0 114920 172958
34268 0 0 0
3175410 C 3 CS 1 15/05/2023 16/05/2023 01/01/1993 0 2
1 O80.9;Z37.0 73.59;73.6;99.29;99.18;99.21 - - None None None
None O-6-13-I None None None None None None PERSALINAN VAGINAL
(RINGAN) 2173900 0 0 - 0 - 0 - 0 - 0
2173900 4308590 0 2 0 0 0 YUNINGSIH,NY
0000341923601 3;JKN RSUP;; 5.8.4.202302261000 4 173876
1#0##0#0#0.0#2023-05-22
{"code":"","name":""}} 1 9af833051b3af17612d675daeb9c5f35 3358500 0
0 0 0 0 0 267000 0 0 370000 0 100403
212687 0 0 0 0
3175410 C 3 CS 1 15/05/2023 16/05/2023 13/02/1972 0 2
LAIN-LAIN (RINGAN) 2269000 0 0 - 0 - 0 - 0
- 0 2269000 1746386 0 2 0 0 0 EMPUD ,TN
0116R0340523V004654 0000378155079 3;JKN RSUP;; 5.8.4.202302261000
4 173889 1#0##0#0#0.0#2023-05-22
11f4051765fb4d35e7b1fcdc7625e195 301750 0 0 0 0 0
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3175410 C 3 CS 1 14/05/2023 16/05/2023 12/05/1980 0 2
0 - 0 - 0 - 0 - 0 4580200 10567564
0 3 0 0 0 ATI MARYATI.NY 00058326 43 15707 DR.
5.8.4.202302261000 4 173892 1#0##0#0#0.0#2023-05-22
c6867784060c9ce2e6bcdb19d5086a63 505500 8800000 0 0 0
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3175410 C 3 CS 1 13/05/2023 16/05/2023 19/10/1956 0 2
0 - 0 - 0 5046400 2998406 0 4 0 0
0 NURUL FATHONAH, NY 00051011 66 24312 DR. LAILY RIDAWATI,
SP.PD 0116R0340523V004552 0000377371034 3;JKN RSUP;; 5.8.4.202302261000
4 173923 1#0##0#0#0.0#2023-05-22
3c6043597659bccbfc4c32fcaa17730a 611750 0 0 0 0 0
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3175410 C 3 CS 1 13/05/2023 16/05/2023 31/12/1951 0 2
1 K21.9;N39.0 99.18;99.29;90.59;87.44 - - None None None None
3855400 0 0 - 0 - 0 - 0 - 0
3855400 2942816 0 4 0 0 0 DJENAH MAGDALENA, NY
0001224969502 3;JKN RSUP;; 5.8.4.202302261000 4 173936
1#0##0#0#0.0#2023-05-22
9e5548b5189744177c75363072e7e903 571750 0 0 0 0 0
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3175410 C 3 CS 1 13/05/2023 16/05/2023 12/02/1971 0 1
1 N23;I10 99.18;99.29;90.59 - - None None None None N-4-
0 - 0 - 0 - 0 - 0 3545300 2059931
0 4 0 0 0 HERI SUHENDI,TN 00060067 52 19083 DR.
5.8.4.202302261000 4 173943 1#0##0#0#0.0#2023-05-22
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3175410 C 3 CS 1 11/05/2023 16/05/2023 31/10/1978 0 1
1 K80.8;I10 99.18;99.29;90.59;87.44;88.76 - - None None None
LAIN-LAIN (RINGAN) 3381400 0 0 - 0 - 0 - 0
- 0 3381400 3391501 0 6 0 0 0 YUSUP
SOPYAN,TN 00013812 44 16263 SYARIFUDIN, DR., SP.P 0116R0340523V003893
0001606364932 3;JKN RSUP;; 5.8.4.202302261000 4 174055
1#0##0#0#0.0#2023-05-22
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3175410 C 3 CS 1 12/05/2023 16/05/2023 29/06/1963 0 1
1 A16.2;K75.8 99.18;99.29;90.59;87.44 - - None None None None
J-4-15-II None None None None None None PERADANGAN DAN INFEKSI
- 0 5181500 601688 0 5 0 0 0 SOPIYAN,TN
0001288041581 3;JKN RSUP;; 5.8.4.202302261000 4 173586
1#0##0#0#0.0#2023-05-24
[{"id":"2020000028540018","nama":"SOPIYAN","nik":"3172042906630006","jenis_kelamin_
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3175410 C 3 CS 1 11/05/2023 16/05/2023 15/03/1948 0 2
1 E11.9;J18.0 99.18;99.29;90.59 - - None None None None E-4-
10-III None None None None None None PENYAKIT KENCING MANIS & GANGGUAN
NUTRISI/ METABOLIK (BERAT) 6262900 0 0 - 0 - 0 -
0 - 0 6262900 3012938 0 6 0 0 0 TIMANG
,TN 00058335 75 27450 DR. BETA AGUSTIA WISMAN, SP.PD
0116R0340523V003522 0001836267704 3;JKN RSUP;; 5.8.4.202302261000
4 173972 1#0##0#0#0.0#2023-05-29
94dd48e83ce54a8b3d442770a55c778c 187500 0 430000 0 0
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3175410 C 3 CS 1 14/05/2023 16/05/2023 26/11/2011 0 2
1 J00 87.44;90.59;99.29;99.18 - - None None None None U-4-
13-I None None None None None None PERADANGAN EPIGLOTIS, TELINGA TENGAH,
- 0 - 0 1980300 2169760 0 3 0 0 0
YOSUA RENHARTA, AN 00060111 11 4187 DR. RAEDY RUWANDA SUSANTO, SP
A. 0116R0340523V004636 0001312567705 3;JKN RSUP;; 5.8.4.202302261000
4 174073 1#0##0#0#0.0#2023-05-29
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3175410 C 3 CS 1 10/05/2023 16/05/2023 30/04/1970 0 2
1 E87.6;G72.3 34.04;99.18;99.29;90.59 - - None None None None
E-4-11-II None None None None None None HIPOVOLEMIA & GANGGUAN
ELEKROLIT (SEDANG) 3838900 0 0 - 0 - 0 - 0
- 0 3838900 5809445 0 7 0 0 0 DWI ENI
UTARI ,NY 00051711 53 19368 DR. PRIYANKA GANESA UTAMI, SP. N
0116R0340523V003490 0001631099474 3;JKN RSUP;; 5.8.4.202302261000
4 173607 1#0##0#0#0.0#2023-06-03
e3eefe7eb2f3958cc1347f9c9668c4af 0 0 78400 0 0 0 415000
710600 0 0 0 0 1259056 3346389 0 0 0
0
3175410 C 3 CS 1 13/05/2023 16/05/2023 12/04/2021 0 1
0 - 0 2885400 839040 0 4 0 0 0 M.
FATURRAHMAN,AN 00060028 2 761 DR. RAEDY RUWANDA SUSANTO, SP A.
0116R0340523V004476 0003078169479 3;JKN RSUP;; 5.8.4.202302261000
4 173642 1#0##0#0#0.0#2023-06-03
1adc38eaa63ea147a2508b235103855d 200000 0 242700 0 0
0 0 51300 0 0 0 0 278874 66166 0 0 0
0
3175410 C 3 CS 1 14/05/2023 17/05/2023 23/07/2001 0 2
1 S06.31 87.03;99.18;99.29;86.22 - - None None None None
G-4-24-I None None None None None None TRAUMA KEPALA (RINGAN)
2580000 0 0 - 0 - 0 - 0 - 0
2580000 8147011 0 4 0 0 0 JULIA RIZKI AMELIA,NN
0116R0340523V004592 0002856254051 3;JKN RSUP;; 5.8.4.202302261000
4 174151 1#0##0#0#0.0#2023-05-22
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3175410 C 3 CS 1 14/05/2023 17/05/2023 24/12/1964 0 2
1 I12.0;E87.6 39.95;99.18;99.29;99.21;90.59 - - None None None
0 - 0 3501400 1797298 0 4 0 0 0
SUMIRAH, NY 00060104 58 21325 DR. BETA AGUSTIA WISMAN, SP.PD
0116R0340523V004626 0001267999334 3;JKN RSUP;; 5.8.4.202302261000
4 174185 1#0##0#0#0.0#2023-05-22
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0 323000 0 0 0 0 507443 14855 0 0 0
0
3175410 C 3 CS 1 15/05/2023 17/05/2023 05/02/1976 0 2
LAIN-LAIN (RINGAN) 2269000 0 0 - 0 - 0 - 0
- 0 2269000 196395 0 3 0 0 0 MUKIYAH
0116R0340523V005093 0000377973718 3;JKN RSUP;; 5.8.4.202302261000
4 174198 1#0##0#0#0.0#2023-05-22
mt":"4736","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0","drug_
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3175410 C 3 CS 1 14/05/2023 17/05/2023 05/12/1983 0 2
1 J18.0;E87.6;I12.0;I49.3 99.18;99.29;34.04;90.59 - - None None
None None J-4-16-III None None None None None None SIMPLE PNEUMONIA &
WHOOPING COUGH (BERAT) 6420500 0 0 - 0 - 0 - 0
- 0 6420500 6926344 0 4 1 3 0 ROYETI,NY
0116R0340523V004587 0001132153097 3;JKN RSUP;; 5.8.4.202302261000
4 174219 1#0##0#0#0.0#2023-05-22
t":"547333","device_amt":"1926775","consumable_amt":"0","device_rent_amt":"0","drug
91200c51249a14e17fb16a3773efe581 181600 0 839761 0 0
0 502000 2928875 0 0 0 0 547333 1926775
0 0 0 0
3175410 C 2 CS 1 15/05/2023 17/05/2023 11/10/1995 0 2
0 0 - 0 - 0 - 0 - 0 3880200 168921
0 3 0 0 0 NUR KOMALA SARI ,NY 00060126 27 10078
DR. BETA AGUSTIA WISMAN, SP.PD 0116R0340523V004662 0001217410176
3;JKN RSUP;; 5.8.4.202302261000 4 174247 1#0##0#0#0.0#2023-
05-22
27730bb4e98451c412abfa7c1f1b938c 0 0 0 0 0 0 0
0 0 0 0 0 164174 4747 0 0 0 0
3175410 C 3 CS 1 15/05/2023 17/05/2023 14/04/2000 0 2
0 - 0 - 0 - 0 - 0 4580200 7930337
0 3 0 0 0 INDRI RAHMAWATI,NY 00017811 23 8431
DR. RUDI HERMANSYAH, SP. B 0116R0340523V004980 0000378345284 3;JKN
RSUP;; 5.8.4.202302261000 4 173283 1#0##0#0#0.0#2023-05-22
54e03d89587e860e6bc6787de72a34d9 0 3380000 3120000 0 0
0 0 450000 0 0 0 0 490066 275901 214370
0 0 0
3175410 C 3 CS 1 13/05/2023 17/05/2023 03/02/1956 0 1
1 K35.3;E11.9;I25.1 54.19;99.18;99.29;90.59 - - None None None
None K-1-40-I None None None None None None PROSEDUR SISTEM
PENCERNAAN LAIN-LAIN (RINGAN) 6274500 0 0 - 0 - 0 -
0 - 0 6274500 14289212 0 5 0 0 0
SAMSUDIN,TN 00060075 67 24571 DR. RUDI HERMANSYAH, SP. B
0116R0340523V004546 0001615878573 3;JKN RSUP;; 5.8.4.202302261000
4 174296 1#0##0#0#0.0#2023-05-22
mt":"1215729","device_amt":"858719","consumable_amt":"137764","device_rent_amt":"0"
91f3aaa74eed7f466cf794acfd46a666 0 5460000 5412100 0 0
0 380000 824900 0 0 0 0 1215729 858719
137764 0 0 0
3175410 C 1 CS 1 15/05/2023 17/05/2023 13/09/1991 0 1
1 A90;K75.8 99.18;99.29;90.59;87.44 - - None None None None
A-4-13-II None None None None None None INFEKSI VIRAL & NON-BAKTERIAL
LAIN (SEDANG) 3278400 0 0 - 0 - 0 - 0 -
0 3278400 1607567 0 3 0 0 0 PATAR TINDAON,TN
0116R0340523V005067 0001651404857 3;JKN RSUP;; 5.8.4.202302261000
4 174325 1#0##0#0#0.0#2023-05-22
gy_amt":"0","rehab_amt":"0","room_amt":"0","intensive_amt":"0","drug_amt":"1103442"
7ea5ca6702244e342a5d7ff3bcf0d97e 0 0 22500 0 0 0 0
427500 0 0 0 0 1103442 54125 0 0 0 0
3175410 C 1 CS 1 15/05/2023 17/05/2023 30/11/1972 0 2
50-I None None None None None None PROSEDUR JARINGAN LUNAK (RINGAN)
6091600 0 0 - 0 - 0 - 0 - 0
6091600 11884508 0 3 0 0 0 NOMIATI SEMBIRING ,NY
0001213218393 3;JKN RSUP;; 5.8.4.202302261000 4 174329
1#0##0#0#0.0#2023-05-22
c144aad73a51960cc1710943e662eba1 0 5460000 5040000 0 0
0 0 0 0 0 0 0 482058 754437 148013
0 0 0
3175410 C 1 CS 1 14/05/2023 17/05/2023 09/06/2000 0 1
2 S02.6;J18.0;K75.2;E87.6;S06.1 99.18;99.29;90.59;87.44;87.03 - -
None None None None U-4-14-III None None None None None None
PENYAKIT MULUT DAN GIGI (BERAT) 7942000 0 0 - 0 -
0 - 0 - 0 7942000 3723295 0 4 1 2
0 NIKOLAS ARYA K,TN 00060088 22 8374 DR. PRIYANKA GANESA UTAMI,
SP. N 0116R0340523V004915 0001181246894 3;JKN RSUP;; 5.8.4.202302261000
4 174331 1#0##0#0#0.0#2023-05-22
9b5fdd326d9c7468f53375a2a5ba5276 0 0 171314 0 0 0
452000 1187982 0 0 0 0 1552875 359124 0
0 0 0
3175410 C 1 CS 1 10/05/2023 17/05/2023 10/10/1993 0 2
1 A91;K75.8 99.18;99.29;90.59;87.44;99.05 - - None None None
None A-4-13-II None None None None None None INFEKSI VIRAL & NON-
BAKTERIAL LAIN (SEDANG) 3278400 0 0 - 0 - 0 - 0
- 0 3278400 6492497 0 8 0 0 0 HERLINA
SISKAWATI,NY 00058259 29 10804 DR. BETA AGUSTIA WISMAN, SP.PD
0116R0340523V003435 0001621944202 3;JKN RSUP;; 5.8.4.202302261000
4 174339 1#0##0#0#0.0#2023-05-22
5a6e78984e5f305ced589ac2d9cd381f 0 0 216500 0 0 0
0 4113500 0 0 0 0 1921650 240847 0 0
0 0
3175410 C 1 CS 1 12/05/2023 17/05/2023 21/04/2022 0 1
1 J18.0;A09.9 99.18;99.29;90.59;87.44 - - None None None None
COUGH (RINGAN) 4806100 0 0 - 0 - 0 - 0 -
0 4806100 2903030 0 6 0 0 0 MOSES APRILIO, AN
00051993 1 386 MUSTARI, DR., SP.A 0116R0340523V004269
0003276569013 3;JKN RSUP;; 5.8.4.202302261000 4 174346
1#0##0#0#0.0#2023-05-22
67f60bf04ec1848823c2abd47aa4877c 330000 0 204000 0 0
0 0 0 0 0 2000000 0 286573 82457 0 0
0 0
3175410 C 3 CS 1 14/05/2023 17/05/2023 20/04/2007 0 2
0 - 0 - 0 - 0 - 0 3545300 2355883
0 4 0 0 0 SYAHARA MAHARANI, AN 00060110 16 5868
DR. RAEDY RUWANDA SUSANTO, SP A. 0116R0340523V004632 0000945806422
3;JKN RSUP;; 5.8.4.202302261000 4 174400 1#0##0#0#0.0#2023-
05-23
833e2b3e53ee26260668b11a5922ddec 380000 0 632000 0 0
0 210000 40000 0 0 740000 0 319903 33980 0
0 0 0
3175410 C 1 CS 1 15/05/2023 17/05/2023 24/04/2018 0 1
6091600 0 0 - 0 - 0 - 0 - 0
6091600 13314885 0 3 0 0 0 RAFFASYA AULIAN,AN
0002495949862 3;JKN RSUP;; 5.8.4.202302261000 4 173344
1#0##0#0#0.0#2023-05-23
drug_amt":"198417","device_amt":"233875","consumable_amt":"48593","device_rent_amt"
b9149b3fb6a4518fe5d6560be6093470 180000 5460000 5244000 0
0 0 0 450000 0 0 1500000 0 198417 233875
48593 0 0 0
3175410 C 3 CS 1 12/05/2023 17/05/2023 20/12/2006 0 2
(RINGAN) 1635100 0 0 - 0 - 0 - 0 - 0
1635100 1961228 0 6 0 0 0 MONA ELSA SASKIA, AN
00060012 16 5987 MUSTARI, DR., SP.A 0116R0340523V004255
0001318722592 3;JKN RSUP;; 5.8.4.202302261000 4 174402
1#0##0#0#0.0#2023-05-23
cec157fb8a17d68f8d47583b2dab06e4 280000 0 402000 0 0
0 0 2000 0 0 925000 0 270975 81253 0 0
0 0
3175410 C 3 CS 1 12/05/2023 17/05/2023 06/01/2020 0 2
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 1061802 0 6 0 0 0 AYRA ALFATUNNISSA,AN
00058428 3 1222 MUSTARI, DR., SP.A 0116R0340523V004245
0003067363787 3;JKN RSUP;; 5.8.4.202302261000 4 174403
1#0##0#0#0.0#2023-05-23
b9221b2f470dd816655f3b95a4ff9c51 556000 0 160000 0 0
0 0 0 0 0 0 0 257189 88613 0 0 0
0
3175410 C 1 CS 1 15/05/2023 17/05/2023 16/05/2008 0 1
1 S00.9 87.03;99.18;99.29 - - None None None None L-4-13-I
None None None None None None TRAUMA PADA KULIT, JARINGAN BAWAH KULIT
DAN PAYUDARA (RINGAN) 3268500 0 0 - 0 - 0 - 0
- 0 3268500 773832 0 3 0 0 0 RAFLI
ANUGRAH ILLAHI,AN 00060279 14 5477 DR. RIADY ASHARI, SP. A
0116R0340523V005545 0001224495494 3;JKN RSUP;; 5.8.4.202302261000
4 174404 1#0##0#0#0.0#2023-05-23
074f5219af76bb5e2070f21a9d48337a 180000 0 240000 0 0
0 0 0 0 0 185000 0 61828 107004 0 0
0 0
3175410 C 3 CS 1 13/05/2023 17/05/2023 26/08/2016 0 2
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 1606879 0 5 0 0 0 INAYAH SAFIRA,AN
00020865 6 2451 MUSTARI, DR., SP.A 0116R0340523V004295
0002095445125 3;JKN RSUP;; 5.8.4.202302261000 4 174406
1#0##0#0#0.0#2023-05-23
4d42a64d070d84aeb6915e03f15eb7bc 230000 0 355600 0 0
0 142400 0 0 0 740000 0 87129 51750 0 0
0 0
3175410 C 1 CS 1 15/05/2023 17/05/2023 07/05/2008 0 2
(RINGAN) 2579000 0 0 - 0 - 0 - 0 - 0
2579000 317773 0 3 0 0 0 REFANI DWI SETYOWATI, AN
0002079376209 3;JKN RSUP;; 5.8.4.202302261000 4 174409
1#0##0#0#0.0#2023-05-23
0f71425145139ff77a2fee3aeffa5b0d 180000 0 102000 0 0
0 0 0 0 0 0 0 18006 17767 0 0 0 0
3175410 C 3 CS 1 14/05/2023 17/05/2023 31/12/1957 0 1
1 I63.9;E87.6;E11.9 99.18;99.29;90.59;87.44 - - None None None
None G-4-14-II None None None None None None KECEDERAAN PEMBULUH
DARAH OTAK DENGAN INFARK (SEDANG) 5484100 0 0 - 0 - 0
- 0 - 0 5484100 1754062 0 4 0 0 0
H. NURDIN YAKUB, TN 00060092 65 23875 DR. PRIYANKA GANESA UTAMI,
SP. N 0116R0340523V004596 0001223910235 3;JKN RSUP;; 5.8.4.202302261000
4 174411 1#0##0#0#0.0#2023-05-23
d934e797a6e82f0a424a0953613812ed 217500 0 242000 0 0
0 0 278000 0 0 740000 0 265276 11286 0
0 0 0
3175410 C 3 CS 1 15/05/2023 17/05/2023 10/12/1977 0 1
(RINGAN) 1347400 0 0 - 0 - 0 - 0 - 0
1347400 1108079 0 3 0 0 0 KADIS,TN 00060246
0001165398682 3;JKN RSUP;; 5.8.4.202302261000 4 174412
1#0##0#0#0.0#2023-05-23
25978813dd37707e50058e6a825702dc 345500 0 160000 0 0
0 0 0 0 0 370000 0 232579 0 0 0
0 0
3175410 C 3 CS 1 15/05/2023 17/05/2023 09/02/2005 0 2
0 - 0 - 0 - 0 - 0 1422200 1426382
0 3 0 0 0 YOPITA,NN 00053969 18 6669 DR. KHONITA
ADIAN UTAMI, SP. N 0116R0340523V005099 0000380907314 3;JKN RSUP;;
5.8.4.202302261000 4 174584 1#0##0#0#0.0#2023-05-23
880b717a80a9066f722a05c7ef662538 398500 0 164500 0 0
0 0 85500 0 0 555000 0 214732 8150 0 0
0 0
3175410 C 3 CS 1 16/05/2023 17/05/2023 13/08/1992 0 2
(RINGAN) 2371700 0 0 - 0 - 0 - 0 - 0
2371700 4185555 0 2 0 0 0 AGUSTINA,NY 00047819
0002358639426 3;JKN RSUP;; 5.8.4.202302261000 4 174591
1#0##0#0#0.0#2023-05-23
fd605607cd0d1614a21bbce686ef4fb8 220500 2036250 1113750 0
0 0 0 450000 0 0 0 0 152381 176488
36186 0 0 0
3175410 C 3 CS 1 15/05/2023 17/05/2023 05/06/2001 0 2
0 - 0 - 0 - 0 - 0 4580200 9081088
0 3 0 0 0 LUTFIA HAMDAH,NY 00055221 21 8014 ANDRI
5.8.4.202302261000 4 174597 1#0##0#0#0.0#2023-05-23
57c6f54b860c385632028b4d3b42b982 345500 3380000 3280000 0
0 0 0 450000 0 0 555000 0 325600 698591
46397 0 0 0
3175410 C 3 CS 1 15/05/2023 17/05/2023 21/03/1956 0 2
1 I84.2;I10 49.46 - - None None None None K-1-50-I None
None None None None None PROSEDUR ANAL (RINGAN) 5752700 0 0
- 0 - 0 - 0 - 0 5752700 8651741 0
3 0 0 0 BARKAH, NY 00051753 67 24526 DR. RUDI
HERMANSYAH, SP. B 0116R0340523V005081 0001226154396 3;JKN RSUP;;
5.8.4.202302261000 4 174610 1#0##0#0#0.0#2023-05-23
bc6e3fae3b5dfef9bac96e08cb4c77d8 345500 3380000 3280000 0
0 0 0 0 0 0 555000 0 671826 282529
136886 0 0 0
3175410 C 3 CS 1 16/05/2023 17/05/2023 13/03/1996 0 2
(RINGAN) 2371700 0 0 - 0 - 0 - 0 - 0
2371700 4869726 0 2 0 0 0 KARMILAH, NY
0116R0340523V005537 0000492900063 3;JKN RSUP;; 5.8.4.202302261000
4 174631 1#0##0#0#0.0#2023-05-23
623f3dfe54dc71995f1a45b5c7977246 220500 2565875 1456125 0
0 0 0 0 0 0 0 0 342361 200610 84255
0 0 0
3175410 C 1 CS 1 15/05/2023 17/05/2023 30/03/2004 0 2
6967500 0 0 - 0 - 0 - 0 - 0
6967500 6612182 0 3 0 0 0 EVITA RAHMAWATI, NY
0001224989201 3;JKN RSUP;; 5.8.4.202302261000 4 173268
1#0##0#0#0.0#2023-05-23
{"code":"","name":""}} 1 15d0c1092be8ae48d98de454a08d6857 478500
3320000 204000 0 0 0 0 0 0 0 1500000
0 355588 640430 113664 0 0 0
3175410 C 3 CS 1 15/05/2023 17/05/2023 27/02/2002 0 2
0 0 - 0 - 0 - 0 - 0 3330600 796003
0 3 0 0 0 DIAH AYU MAS,NN 00015881 21 7747 DR.
BETA AGUSTIA WISMAN, SP.PD 0116R0340523V004650 0001607640399 3;JKN RSUP;;
5.8.4.202302261000 4 174645 1#0##0#0#0.0#2023-05-23
,"device_amt":"76600","consumable_amt":"326","device_rent_amt":"0","drug_chronic_am
ae5f5ebd2b241c3e30c6375092713ff5 237500 0 160000 0 0
0 0 0 0 0 0 0 321577 76600 326 0 0
0
3175410 C 2 CS 1 14/05/2023 17/05/2023 19/04/1997 0 1
1 A16.5;E87.1 99.18;99.29;90.59;87.44;34.04 - - None None None
- 0 6036400 971756 0 4 0 0 0 MUHAMMAD
IDRUS, TN 00060106 26 9521 DR. ASYSYUKRIATI, SP.P 0116R0340523V004623
0001284880173 3;JKN RSUP;; 5.8.4.202302261000 4 174271
1#0##0#0#0.0#2023-05-24
[{"id":"2023000106980257","nama":"MUHAMAD
IDRUS","nik":"3172041904970008","jenis_kelamin_id":"1"}],"success":true}}#{"cara_ma
suk":"emd","sistole":"0","diastole":"0","total_tarif_rs":"971756","billing_group":
"device_amt":"305756","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt"
82a49040cdb6917cd156f6f877331614 0 0 12266 0 0 0 0
233063 0 0 0 0 417071 305756 0 0 0
3600
3175410 C 3 CS 1 13/05/2023 17/05/2023 12/05/1964 0 1
1 A16.2;E11.9;I10 99.18;99.29;90.59;87.44 - - None None None
- 0 4337000 865084 0 5 0 0 0 BUNALIH, TN
0002096687946 3;JKN RSUP;; 5.8.4.202302261000 4 174312
1#0##0#0#0.0#2023-05-24
[{"id":"2020000026730110","nama":"BUNALIH","nik":"3175061205640009","jenis_kelamin_
id":"1"}],"success":true}}#{"cara_masuk":"gp","sistole":"0","diastole":"0","total_t
arif_rs":"865084","billing_group":
fb2a558d317c87f0ce9d86598c75a616 0 0 9800 0 0 0 0
426200 0 0 0 0 366936 62148 0 0 0 0
3175410 C 2 CS 1 15/05/2023 17/05/2023 06/07/1988 0 1
1 Z09.8;A16.0 - - - None None None None Z-4-12-II None
None None None None None FAKTOR-FAKTOR YANG MEMPENGARUHI STATUS
KESEHATAN LAIN-LAIN (SEDANG) 3613800 0 0 - 0 - 0 -
0 - 0 3613800 471441 0 3 0 0 0 ENCAR,
TN 00060135 34 12731 DR. ASYSYUKRIATI, SP.P 0116R0340523V004844
0001224044763 3;JKN RSUP;; 5.8.4.202302261000 4 174283
1#0##0#0#0.0#2023-05-26
[{"id":"2023000107000301","nama":"ENCAR","nik":"3172040607880017","jenis_kelamin_id
":"1"}],"success":true}}#{"cara_masuk":"gp","sistole":"0","diastole":"0","total_tar
if_rs":"471441","billing_group":
8aca539fd2a0bd290060109d79ddaab0 0 0 0 0 0 0 0
0 0 0 0 0 424519 46922 0 0 0 0
3175410 C 1 CS 1 10/05/2023 17/05/2023 17/04/1982 0 1
1 I60.9;G93.6 99.18;99.29;99.21;90.59;87.03 - - None None None
None G-4-13-II None None None None None None PERDARAHAN INTRA KRANIAL
BUKAN TRAUMATIK (SEDANG) 6464600 0 0 - 0 - 0 -
0 - 0 6464600 5070142 0 8 0 0 0 ANDI
ZAINAL.TN 00058283 41 14998 DR. PRIYANKA GANESA UTAMI, SP. N
0116R0340523V003375 0002102528259 3;JKN RSUP;; 5.8.4.202302261000
4 174328 1#0##0#0#0.0#2023-05-29
0","rehab_amt":"0","room_amt":"3500000","intensive_amt":"0","drug_amt":"1506757","d
d1aa582d18ca82b1bc59b10039e86e48 0 0 0 0 0 0 0
0 0 0 3500000 0 1506757 63385 0 0 0 0
3175410 C 1 CS 1 13/05/2023 17/05/2023 12/06/2020 0 1
LAIN-LAIN (RINGAN) 3017700 0 0 - 0 - 0 - 0
- 0 3017700 3426305 0 5 0 0 0 MUHAMMAD
HAFIDZ HIDAYAT ,AN 00036608 2 1065 DR. RAEDY RUWANDA SUSANTO, SP A.
0116R0340523V004566 0002937293605 3;JKN RSUP;; 5.8.4.202302261000
4 174342 1#0##0#0#0.0#2023-05-29
233afeaf08ca0cde0e96a98a19774de6 355000 0 564700 0 0
0 0 127300 0 0 2000000 0 291419 87886 0
0 0 0
3175410 C 1 CS 1 15/05/2023 17/05/2023 04/10/1956 0 1
1 D21.2;J22 83.39 - - None None None None M-1-50-I None
0 0 - 0 - 0 - 0 - 0 6091600
12287195 0 3 0 0 0 SRIYANTO,TN 00060264 66 24329
RSUP;; 5.8.4.202302261000 4 174327 1#0##0#0#0.0#2023-05-29
b5625180a08122416793586586652096 0 5460000 5040000 0 0
0 0 450000 0 0 0 0 971963 309264 55968
0 0 0
3175410 C 1 CS 1 15/05/2023 17/05/2023 25/07/2015 0 2
0 - 0 3837600 2764652 0 3 0 0 0
BRITNEY CAITLYN H,AN 00060130 7 2851 IRENNE PURNAMA, MSC.,SP.A
0116R0340523V004760 0002087380438 3;JKN RSUP;; 5.8.4.202302261000
4 174399 1#0##0#0#0.0#2023-05-29
11c6c691c326367f13c7a585a588d246 292500 0 531000 0 0
0 0 0 0 0 1500000 0 358723 82429 0 0
0 0
3175410 C 3 CS 1 15/05/2023 17/05/2023 30/08/2018 0 2
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 884378 0 3 0 0 0 FAREL ADITYA PRATAMA,AN
0002499444167 3;JKN RSUP;; 5.8.4.202302261000 4 174405
1#0##0#0#0.0#2023-05-29
eb25815f90420dd6feaa8a12b608b375 180000 0 240000 0 0
0 0 0 0 0 370000 0 79510 14868 0 0 0
0
3175410 C 1 CS 1 15/05/2023 17/05/2023 27/08/2005 0 1
0 - 0 3837600 320978 0 3 0 0 0 FAJAR
SUWARDIANA,AN 00060227 17 6470 DR. RIADY ASHARI, SP. A
0116R0340523V005041 0001223865821 3;JKN RSUP;; 5.8.4.202302261000
4 174408 1#0##0#0#0.0#2023-05-29
aa5192379970d1b2e6733912aa50069c 180000 0 102000 0 0
0 0 0 0 0 0 0 38978 0 0 0 0 0
3175410 C 1 CS 1 15/05/2023 17/05/2023 03/08/2017 0 2
0 - 0 3837600 1345379 0 3 0 0 0
ARSYILA PUTRI ROMESSA,AN 00060267 5 2111 DR. RIADY ASHARI, SP. A
0116R0340523V005082 0002485481455 3;JKN RSUP;; 5.8.4.202302261000
4 174410 1#0##0#0#0.0#2023-05-29
0b0887f972b960237c855ad925057c39 180000 0 102000 0 0
0 0 0 0 0 1000000 0 45612 17767 0 0 0
0
3175410 C 3 CS 1 16/05/2023 17/05/2023 15/01/1981 0 2
3 J22;E87.8 99.18;99.29;90.59 - - None None None None J-4-
21-II None None None None None None GEJALA, TANDA DAN DIAGNOSIS SISTEM
PERNAFASAN LAIN-LAIN (SEDANG) 4648300 0 0 - 0 - 0 -
0 - 0 4648300 424666 0 2 0 0 0 DEWI
ANGGRAENI,NY 00010022 42 15461 DR. PUJI ASTUTI TRI KUSUMAWATI, SP. PD
0116R0340523V005078 0001472739197 3;JKN RSUP;; 5.8.4.202302261000
4 174205 1#0##0#0#0.0#2023-05-29
gy_amt":"0","rehab_amt":"0","room_amt":"0","intensive_amt":"0","drug_amt":"50666","
device_amt":"0","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0","
60e9bfa835c1e139528311e0337d5774 0 0 18700 0 0 0 0
355300 0 0 0 0 50666 0 0 0 0 0
3175410 C 3 CS 1 13/05/2023 17/05/2023 12/12/1995 0 1
1939100 0 0 - 0 - 0 - 0 - 0
1939100 873988 0 5 0 0 0 BAYU ADITYA P.D, TN
0001794715514 3;JKN RSUP;; 5.8.4.202302261000 4 174322
1#0##0#0#0.0#2023-06-04
bce7d13576ba4de4e5e24cb668b26563 0 0 17250 0 0 0 0
327750 0 0 0 0 433390 95598 0 0 0 0
3175410 C 3 CS 1 13/05/2023 17/05/2023 16/07/2017 0 2
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 1642382 0 5 0 0 0 ALESHA ALMAIRA PUTRI,AN
00060026 5 2127 MUSTARI, DR., SP.A 0116R0340523V004946
0002279331898 3;JKN RSUP;; 5.8.4.202302261000 4 174407
1#0##0#0#0.0#2023-06-04
952b6c21ccb3769ebfc0a0a04532f4c3 230000 0 320000 0 0
0 178000 0 0 0 740000 0 50585 123797 0
0 0 0
3175410 C 3 CS 1 15/05/2023 18/05/2023 22/01/1958 0 2
1 M54.59;D24 99.18;99.29;90.59;87.44 - - None None None None
- 0 - 0 2969500 468943 0 4 0 0 0
ASMANIH BT MOH ALI, NY 00060177 65 23854 DR. KHONITA ADIAN UTAMI, SP.
N 0116R0340523V004990 0001223894542 3;JKN RSUP;; 5.8.4.202302261000
4 172822 1#0##0#0#0.0#2023-05-23
fd60930b589e32278a4a83b7047d1d6f 0 0 0 0 0 0 0
0 0 0 0 0 417760 51183 0 0 0 0
3175410 C 3 CS 1 13/05/2023 18/05/2023 04/02/1972 0 2
1 I63.9;E11.9;E87.6 99.18;99.29;90.59;87.44;87.03 - - None None
- 0 - 0 - 0 5484100 4246692 0 6 0
0 0 RUMKASIH,NY 00060046 51 18726 DR. LAILY RIDAWATI, SP.PD
0116R0340523V005524 0001293323488 3;JKN RSUP;; 5.8.4.202302261000
4 174673 1#0##0#0#0.0#2023-05-23
c39112437e7b067b80b2d8703ea8a17a 0 0 524550 0 0 0
1157500 1772950 0 0 0 0 652596 139096 0
0 0 0
3175410 C 1 CS 1 16/05/2023 18/05/2023 18/05/2021 0 1
LAIN-LAIN (RINGAN) 3017700 0 0 - 0 - 0 - 0
- 0 3017700 2069070 0 3 0 0 0 MUHAMMAD
ZAYN AR RAYYAN ,AN 00060283 1 728 DR. RIADY ASHARI, SP. A
0116R0340523V005118 0003083055513 3;JKN RSUP;; 5.8.4.202302261000
4 174710 1#0##0#0#0.0#2023-05-23
109d9b2fc9c93beaaae286fdb8404d3f 292500 0 512950 0 0
0 0 56050 0 0 1050000 0 142191 15379 0 0
0 0
3175410 C 1 CS 1 15/05/2023 18/05/2023 14/01/2011 0 1
(RINGAN) 2579000 0 0 - 0 - 0 - 0 - 0
2579000 3407468 0 4 0 0 0 AHMAD BILAL AL FARIZI,AN
0001383333052 3;JKN RSUP;; 5.8.4.202302261000 4 174716
1#0##0#0#0.0#2023-05-23
t":"83505","device_amt":"34963","consumable_amt":"0","device_rent_amt":"0","drug_ch
cc78a7b2abcfb19ee9ddfaec9b110ba4 380000 0 718050 0 0
0 0 190950 0 0 2000000 0 83505 34963 0 0
0 0
3175410 C 3 CS 1 16/05/2023 18/05/2023 05/06/2014 0 1
0 - 0 - 0 - 0 - 0 4580200 8991458
0 3 0 0 0 FARIS NAUFAL AZIZ, AN 00057580 8 3267
RSUP;; 5.8.4.202302261000 4 174718 1#0##0#0#0.0#2023-05-23
491b28cf4abb85edf4c081bb55645927 130000 3380000 3200000 0
0 0 0 450000 0 0 370000 0 653500 751354
56604 0 0 0
3175410 C 1 CS 1 14/05/2023 18/05/2023 25/11/1981 0 2
COUGH (RINGAN) 4806100 0 0 - 0 - 0 - 0 -
0 4806100 250575 0 5 0 0 0 YANIH, NY
0000377661328 3;JKN RSUP;; 5.8.4.202302261000 4 174722
1#0##0#0#0.0#2023-05-23
a31225c7ab82fab2cc1f87878cf18044 0 0 0 0 0 0 0
0 0 0 0 0 162157 88418 0 0 0 0
3175410 C 1 CS 1 13/05/2023 18/05/2023 01/04/1973 0 2
1 E11.9;J22 99.18;99.29;90.59;87.44 - - None None None None
E-4-10-I None None None None None None PENYAKIT KENCING MANIS &
GANGGUAN NUTRISI/ METABOLIK (RINGAN) 4803200 0 0 - 0 -
0 - 0 - 0 4803200 1955548 0 6 0 0
0 SUTINAH,NY 00060025 50 18304 FELIX SATWIKA, DR., SP.PD
0116R0340523V004273 0001603459449 3;JKN RSUP;; 5.8.4.202302261000
4 174734 1#0##0#0#0.0#2023-05-23
7858c427952fd4d2beda2e6ca364ab79 0 0 16920 0 0 0 0
1076480 0 0 0 0 770676 91472 0 0 0 0
3175410 C 1 CS 1 11/05/2023 18/05/2023 08/11/2004 0 2
1 J22;I10;K30 99.18;99.29;90.59;87.44 - - None None None None
0 - 0 - 0 3837600 1568419 0 8 0 0
0 ADELIA NOVITA PUSPITA S,NN 00043597 18 6758 SYARIFUDIN, DR.,
SP.P 0116R0340523V003899 0002332112872 3;JKN RSUP;; 5.8.4.202302261000
4 174745 1#0##0#0#0.0#2023-05-23
y_amt":"0","rehab_amt":"0","room_amt":"0","intensive_amt":"0","drug_amt":"1050150",
61496aaacffca1ac78e5a782eaa759f4 0 0 7920 0 0 0 0
425480 0 0 0 0 1050150 84869 0 0 0 0
3175410 C 1 CS 1 16/05/2023 18/05/2023 24/05/1987 0 1
1 J39.9;K30 99.18;99.29;90.59;87.44 - - None None None None
U-4-13-I None None None None None None PERADANGAN EPIGLOTIS, TELINGA
TENGAH, ISPA DAN LARINGOTRAKEITIS (RINGAN) 2633800 0 0 - 0
- 0 - 0 - 0 2633800 147192 0 3 0
0 0 IYAN, TN 00044535 35 13141 SYARIFUDIN, DR., SP.P
0116R0340523V005564 0002052042759 3;JKN RSUP;; 5.8.4.202302261000
4 174754 1#0##0#0#0.0#2023-05-23
2c3110f89ebf028cf7cbd8c50e66c0c0 0 0 0 0 0 0 0
0 0 0 0 0 142878 4314 0 0 0 0
3175410 C 1 CS 1 14/05/2023 18/05/2023 13/07/1995 0 1
1 A49.9;I10;E87.6 99.18;99.29;90.59;88.76;99.21 - - None None
None None A-4-14-II None None None None None None PENYAKIT INFEKSI
BAKTERI DAN PARASIT LAIN-LAIN (SEDANG) 3759600 0 0 - 0 -
0 - 0 - 0 3759600 1042720 0 5 0 0
0 ANDRE VALENTIN R, TN 00060114 27 10167 DR. BETA AGUSTIA WISMAN,
SP.PD 0116R0340523V004638 0001153406316 3;JKN RSUP;; 5.8.4.202302261000
4 174763 1#0##0#0#0.0#2023-05-23
e05bf92aeae69c5fb5c5a8b155a91028 0 0 0 0 0 0 0
275000 0 0 0 0 745426 22294 0 0 0 0
3175410 C 1 CS 1 15/05/2023 18/05/2023 10/08/1992 0 1
(RINGAN) 2579000 0 0 - 0 - 0 - 0 - 0
2579000 521899 0 4 0 0 0 ALDI SAPUTRA ,TN
0116R0340523V004655 0003104396278 3;JKN RSUP;; 5.8.4.202302261000
4 174822 1#0##0#0#0.0#2023-05-23
f38a5f481253393671b76ea8ade17fa0 0 0 0 0 0 0 0
0 0 0 0 0 512406 9493 0 0 0 0
3175410 C 1 CS 1 15/05/2023 18/05/2023 06/12/1997 0 2
(SEDANG) 2921000 0 0 - 0 - 0 - 0 - 0
2921000 840073 0 4 0 0 0 DELLA AMELIA, NY
0116R0340523V005035 0001742929277 3;JKN RSUP;; 5.8.4.202302261000
4 174827 1#0##0#0#0.0#2023-05-23
0d11a47854e4fbde5f67b688bebf4c5b 0 0 11500 0 0 0 0
218500 0 0 0 0 517846 92227 0 0 0 0
3175410 C 1 CS 1 16/05/2023 18/05/2023 09/06/2016 0 1
1 J03.9 99.18;99.29;90.59;87.44 - - None None None None U-4-
13-I None None None None None None PERADANGAN EPIGLOTIS, TELINGA TENGAH,
- 0 - 0 2633800 261137 0 3 0 0 0
EVAN ALKANDER JOSEPH SILALAHI ,AN 00042605 6 2532 DR. RAEDY RUWANDA
5.8.4.202302261000 4 174841 1#0##0#0#0.0#2023-05-23
bda1405192f2424493c72fd3b5a11c68 0 0 6250 0 0 0 0
118750 0 0 0 0 114313 21824 0 0 0 0
3175410 C 1 CS 1 16/05/2023 18/05/2023 30/07/1969 0 1
2 I63.9;G91.8;E11.9;E87.8 99.18;99.29;90.59;87.44;87.03 - - None
None None None G-4-14-II None None None None None None KECEDERAAN
- 0 - 0 - 0 7293900 417255 0 3 0
0 0 INING KARSINI, NY 00047122 53 19648 DR. PRIYANKA GANESA
UTAMI, SP. N 0116R0340523V005550 0000041663024 3;JKN RSUP;;
5.8.4.202302261000 4 174848 1#0##0#0#0.0#2023-05-23
2035f27b328b3f0c23686f733c02ecc1 0 0 4800 0 0 0 0
91200 0 0 0 0 292980 28275 0 0 0 0
3175410 C 1 CS 1 16/05/2023 18/05/2023 01/04/1980 0 1
1 D21.1;I10 83.39;99.18;99.29 - - None None None None M-1-
6091600 0 0 - 0 - 0 - 0 - 0
6091600 10924217 0 3 0 0 0 M.KUDRATULLAH.B.R,TN
0001174596862 3;JKN RSUP;; 5.8.4.202302261000 4 174857
1#0##0#0#0.0#2023-05-23
b3dfde0ad13b9385931ca00e3ab4f70f 0 4576000 4224000 0 0
0 0 450000 0 0 0 0 859321 700549 114347
0 0 0
3175410 C 1 CS 1 13/05/2023 18/05/2023 25/06/1976 0 1
1 I63.9;I61.3 99.18;99.29;90.59;87.03 - - None None None None
G-4-14-III None None None None None None KECEDERAAN PEMBULUH DARAH
OTAK DENGAN INFARK (BERAT) 9483300 0 0 - 0 - 0 -
0 - 0 9483300 1164447 0 6 0 0 0
PUJIANTO, TN 00060082 46 17123 DR. KHONITA ADIAN UTAMI, SP. N
0116R0340523V004561 0001128853179 3;JKN RSUP;; 5.8.4.202302261000
4 174879 1#0##0#0#0.0#2023-05-23
0","rehab_amt":"0","room_amt":"0","intensive_amt":"0","drug_amt":"1039946","device_
amt":"124501","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0","dr
ug_chemo_amt":"0"},"selisih_biaya":
705ac20e36908553377982ed111bfaaf 0 0 0 0 0 0 0
0 0 0 0 0 1039946 124501 0 0 0 0
3175410 C 3 CS 1 16/05/2023 18/05/2023 31/12/1965 0 2
1 B34.9;K30 99.18;99.29;90.59;87.44 - - None None None None
LAIN (RINGAN) 1939100 0 0 - 0 - 0 - 0 -
0 1939100 1167291 0 3 0 0 0 NURAINI,NY
0001257672521 3;JKN RSUP;; 5.8.4.202302261000 4 174899
1#0##0#0#0.0#2023-05-23
2994b7f89cf8741c8140167c195c7a64 395500 0 80000 0 0 0
0 0 0 0 555000 0 136357 434 0 0 0
0
3175410 C 3 CS 1 13/05/2023 18/05/2023 31/12/1962 0 2
1 E11.5;N39.0;E87.1 83.39 - - None None None None M-1-50-II
None None None None None None PROSEDUR JARINGAN LUNAK (SEDANG)
7600700 0 0 - 0 - 0 - 0 - 0
7600700 11473567 0 6 0 0 0 SURIPAH,NY 00020649
0001223730988 3;JKN RSUP;; 5.8.4.202302261000 4 174919
1#0##0#0#0.0#2023-05-23
a5c2d2535e742fc327dacdf69202da1a 0 4576000 4235500 0 0
0 0 698500 0 0 0 0 1270149 439451 253967
0 0 0
3175410 C 3 CS 1 16/05/2023 18/05/2023 16/11/1993 0 2
1 K30;I10 99.18;99.29;90.59;87.44 - - None None None None
LAIN-LAIN (RINGAN) 1347400 0 0 - 0 - 0 - 0
- 0 1347400 1277607 0 3 0 0 0 SRI MAULIDAH
H,NN 00056930 29 10773 SYARIFUDIN, DR., SP.P 0116R0340523V005519
0000998522886 3;JKN RSUP;; 5.8.4.202302261000 4 174941
1#0##0#0#0.0#2023-05-23
e1fd2f31db7401575e4ae2cee35bfde9 395500 0 80000 0 0 0
0 0 0 0 555000 0 246673 434 0 0 0
0
3175410 C 1 CS 1 15/05/2023 18/05/2023 05/03/1982 0 1
1 A09.9;E87.1 99.18;99.29;90.59;87.44 - - None None None None
- 0 - 0 2921000 801516 0 4 0 0 0
HUSNI MUBAROK, TN 00050818 41 15046 DR. PUJI ASTUTI TRI KUSUMAWATI, SP.
PD 0116R0340523V005091 0001454714177 3;JKN RSUP;; 5.8.4.202302261000
4 174951 1#0##0#0#0.0#2023-05-23
"nursing_amt":"0","ancillary_amt":"0","blood_amt":"0","laboratory_amt":"2050","radi
eb232d0178a0b3d7f34ca51b19905140 130000 0 97050 0 0 0
0 2050 0 0 0 0 567662 4754 0 0 0 0
3175410 C 3 CS 1 13/05/2023 18/05/2023 18/07/1958 0 1
1 I67.9;E87.8;I25.1;M17.1 99.18;99.29;90.59;87.44;87.03 - - None
None None None G-4-26-II None None None None None None GANGGUAN -
PENYAKIT SISTEM SARAF LAIN-LAIN (SEDANG) 3733600 0 0 - 0 -
0 - 0 - 0 3733600 5025170 0 6 0 0
0 AHMAD ZAENAL,TN 00060038 64 23675 DR. LAILY RIDAWATI, SP.PD
0116R0340523V004535 0000378823059 3;JKN RSUP;; 5.8.4.202302261000
4 174963 1#0##0#0#0.0#2023-05-23
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3175410 C 3 CS 1 17/05/2023 18/05/2023 05/10/1994 0 2
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3175410 C 3 CS 1 15/05/2023 18/05/2023 30/09/2000 0 1
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A HARIS,TN 00013110 22 8262 DR. PUJI ASTUTI TRI KUSUMAWATI, SP. PD
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3175410 C 3 CS 1 14/05/2023 18/05/2023 17/11/2002 0 2
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(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 1978237 0 5 0 0 0 LULU ALFIYAH,R.NN
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3175410 C 3 CS 1 17/05/2023 18/05/2023 21/05/1983 0 2
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None None I-4-20-III None None None None None None ANGINA PEKTORIS
DAN NYERI DADA (BERAT) 5668100 0 0 - 0 - 0 - 0
- 0 5668100 3128964 0 2 0 0 0 TOMSON
PANGARIBUAN,TN 00060431 39 14606 MARTUA SILALAHI, DR., SP.JP
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3175410 C 3 CS 1 16/05/2023 19/05/2023 29/03/1978 0 2
B-4-14-I None None None None None None GANGGUAN SALURAN EMPEDU LAIN-
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3175410 C 3 CS 1 16/05/2023 19/05/2023 12/05/2002 0 2
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1 A16.2;K30 99.18;99.29;90.59;87.44 - - None None None None
J-4-15-I None None None None None None PERADANGAN DAN INFEKSI
- 0 4337000 940954 0 6 0 0 0 APRELIA DWI
PRATIWI,NN 00049413 20 7334 DR. ASYSYUKRIATI, SP.P 0116R0340523V004630
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1#0##0#0#0.0#2023-05-23
[{"id":"2022000133871298","nama":"APRELIA DWI PRATIWI
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3175410 C 1 CS 1 15/05/2023 19/05/2023 04/06/1986 0 2
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2579000 405438 0 5 0 0 0 LAILA JAMILAH, NY
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3175410 C 3 CS 1 16/05/2023 19/05/2023 24/06/1987 0 2
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3175410 C 1 CS 1 18/05/2023 19/05/2023 23/08/1984 0 2
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3175410 C 3 CS 1 17/05/2023 19/05/2023 15/10/1995 0 2
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101425 0 0 0
3175410 C 3 CS 1 18/05/2023 19/05/2023 27/06/1993 0 2
3756500 0 0 - 0 - 0 - 0 - 0
3756500 5102291 0 2 0 0 0 MADU TARANJANA ,NY
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1#0##0#0#0.0#2023-05-24
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3175410 C 3 CS 1 14/05/2023 19/05/2023 19/09/2004 0 1
LAIN (SEDANG) 2465000 0 0 - 0 - 0 - 0 -
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4 175473 1#0##0#0#0.0#2023-05-24
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3175410 C 3 CS 1 17/05/2023 19/05/2023 30/06/1959 0 2
1 K81.8 99.18;99.29;90.59;87.44 - - None None None None B-4-
14-I None None None None None None GANGGUAN SALURAN EMPEDU LAIN-LAIN
(RINGAN) 3381400 0 0 - 0 - 0 - 0 - 0
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3175410 C 1 CS 1 17/05/2023 19/05/2023 25/12/1997 0 2
1 O21.0;O23.4 99.18;99.29;90.59 - - None None None None W-4-
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FERRY PARDOMUAN LAMBOK P. SIMANJUNTAK, DR., SP. OG 0116R0340523V006049
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3175410 C 3 CS 1 16/05/2023 19/05/2023 12/05/2022 0 1
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3613600 2908756 0 4 0 0 0 MUHAMMAD ARKANZA I,AN
00043762 1 369 MUSTARI, DR., SP.A 0116R0340523V005567
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3175410 C 3 CS 1 12/05/2023 20/05/2023 23/08/2005 0 2
1 C91.0;D64.9;E87.8;J18.0 99.18;99.29;99.04;99.05;99.21 - - None
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3175410 C 3 CS 1 15/05/2023 20/05/2023 05/05/1983 0 1
1 A90;K75.2 99.18;99.29;87.44 - - None None None None A-4-
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2465000 4185246 0 6 0 0 0 JAMES HEFLY PAATH ,TN
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3175410 C 3 CS 1 17/05/2023 20/05/2023 31/12/1964 0 2
1 E11.9;E87.8;K30 99.18;99.29;90.59;87.44 - - None None None
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0 PARINEM, NY 00060532 58 21321 ADE DEWI NARALIA, DR.
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3175410 C 1 CS 1 18/05/2023 20/05/2023 19/07/2021 0 2
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4806100 491090 0 3 0 0 0 RATU RIYANTI MAULANA, AN
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3175410 C 3 CS 1 16/05/2023 21/05/2023 22/09/1973 0 1
1 I20.0;J18.0 99.18;99.29;90.59;87.44 - - None None None None
I-4-20-III None None None None None None ANGINA PEKTORIS DAN NYERI
DADA (BERAT) 5668100 0 0 - 0 - 0 - 0 -
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ABIDIN,TN 00058189 49 18133 MARTUA SILALAHI, DR., SP.JP
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3175410 C 1 CS 1 17/05/2023 21/05/2023 11/08/1970 0 1
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0 - 0 - 0 6711700 4103048 0 5 0 0
0 ROJALI,TN 00037585 52 19272 DR. LAILY RIDAWATI, SP.PD
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3175410 C 3 CS 1 17/05/2023 21/05/2023 23/03/1963 0 2
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U-4-11-I None None None None None None DYSEQUILIBRIUM (RINGAN)
1422200 0 0 - 0 - 0 - 0 - 0
1422200 1778889 0 5 0 0 0 IRMAWATI, NY
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3175410 C 3 CS 1 19/05/2023 21/05/2023 02/10/2016 0 1
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1939100 1161081 0 3 0 0 0 ALIKA NAILA PUTRI,AN
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3175410 C 3 CS 1 18/05/2023 21/05/2023 12/04/2017 0 1
1 A90;L30.9 99.18;99.29;90.59 - - None None None None A-4-
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 2268954 0 4 0 0 0 MUHAMMAD REZA,AN
00052642 6 2227 MUSTARI, DR., SP.A 0116R0340523V006137
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3175410 C 1 CS 1 18/05/2023 21/05/2023 16/03/2021 0 1
1 N47 99.18;99.29;90.59 - - None None None None V-4-11-I
None None None None None None PENYAKIT SISTEM REPRODUKSI LAKI-LAKI
SELAIN TUMOR (RINGAN) 3954800 0 0 - 0 - 0 - 0
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3175410 C 3 CS 1 18/05/2023 21/05/2023 29/04/2017 0 1
1 N47 99.18;99.29;90.59 - - None None None None V-4-11-I
None None None None None None PENYAKIT SISTEM REPRODUKSI LAKI-LAKI
- 0 2973600 2531398 0 4 0 0 0 DIEGO
TIMOTIUS SARYUONO,AN 00060608 6 2210 MUSTARI, DR., SP.A
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3175410 C 3 CS 1 16/05/2023 21/05/2023 19/07/2012 0 1
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 1983195 0 6 0 0 0 MUHAMMAD RICO IHSAN, AN
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1#0##0#0#0.0#2023-05-25
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3175410 C 1 CS 1 18/05/2023 21/05/2023 07/01/2020 0 1
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3175410 C 3 CS 1 19/05/2023 21/05/2023 12/07/1959 0 2
1 K30;E11.9;I10 99.18;99.29;90.59 - - None None None None
LAIN-LAIN (RINGAN) 1347400 0 0 - 0 - 0 - 0
- 0 1347400 484319 0 3 0 0 0
KURNENGSIH,NY 00015448 63 23322 DR. PUJI ASTUTI TRI KUSUMAWATI, SP.
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4 175959 1#0##0#0#0.0#2023-05-25
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3175410 C 3 CS 1 18/05/2023 21/05/2023 14/04/1961 0 2
1 I20.0;K30 99.18;99.29;90.59 - - None None None None I-4-
20-I None None None None None None ANGINA PEKTORIS DAN NYERI DADA (RINGAN)
3596200 0 0 - 0 - 0 - 0 - 0
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3175410 C 3 CS 1 20/05/2023 21/05/2023 05/04/2001 0 2
0 0 - 0 - 0 - 0 - 0 2173900 352453
0 2 0 0 0 DEVI APRIYANI, NY 00055463 22 8080 AHMAD
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3175410 C 3 CS 1 19/05/2023 21/05/2023 01/03/1985 0 2
5238800 0 0 - 0 - 0 - 0 - 0
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3175410 C 1 CS 1 20/05/2023 21/05/2023 16/07/1984 0 2
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3154300 4711181 0 2 0 0 0 EVI AULIA SARI,NY
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1#0##0#0#0.0#2023-05-25
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3175410 C 3 CS 1 20/05/2023 21/05/2023 15/07/1967 0 1
4 I63.9;E87.6;J80;G40.6;I46.9 96.71 - - None None None None
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NON-KOMPLEKS (BERAT) 23255400 0 0 - 0 - 0 - 0
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3175410 C 3 CS 1 14/05/2023 21/05/2023 23/12/1986 0 1
(SEDANG) 2465000 0 0 - 0 - 0 - 0 - 0
2465000 5909966 0 8 0 0 0 ABDUL HAK, TN
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3175410 C 1 CS 1 18/05/2023 21/05/2023 12/03/2016 0 1
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3175410 C 1 CS 1 18/05/2023 21/05/2023 09/09/2018 0 2
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3175410 C 3 CS 1 18/05/2023 21/05/2023 16/12/1962 0 2
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3175410 C 1 CS 1 19/05/2023 21/05/2023 18/12/1998 0 1
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3175410 C 3 CS 1 17/05/2023 21/05/2023 14/02/1996 0 1
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1#0##0#0#0.0#2023-06-04
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3175410 C 3 CS 1 19/05/2023 22/05/2023 21/09/1965 0 1
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3855400 2864293 0 4 0 0 0 NILA ANGGODO, TN
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3175410 C 1 CS 1 19/05/2023 22/05/2023 15/04/1976 0 2
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3175410 C 1 CS 1 19/05/2023 22/05/2023 31/01/1982 0 2
1 M72.28;E11.5 99.29;99.21;90.59;87.44;83.45 - - None None
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LUNAK (SEDANG) 10108900 0 0 - 0 - 0 - 0 -
0 10108900 16036758 0 4 0 0 0 SUHARDI
SIMANJUNTAK,TN 00060654 41 15083 DR. RUDI HERMANSYAH, SP. B
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3175410 C 1 CS 1 21/05/2023 22/05/2023 10/02/1969 0 2
1 I12.0;D64.9 99.29;99.04;87.44;90.59;99.21 - - None None None
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FATIMAH,NY 00019849 54 19823 DR. LAILY RIDAWATI, SP.PD
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3175410 C 1 CS 1 19/05/2023 22/05/2023 02/07/2004 0 2
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3175410 C 3 CS 1 19/05/2023 22/05/2023 07/07/1971 0 2
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2465000 2719642 0 4 0 0 0 SONDANG LISA,NY
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3175410 C 1 CS 1 18/05/2023 22/05/2023 28/05/1984 0 2
1 K81.8;M54.16 99.18;99.29;90.59 - - None None None None
B-4-14-I None None None None None None GANGGUAN SALURAN EMPEDU LAIN-
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0001224651341 3;JKN RSUP;; 5.8.4.202302261000 4 176633
1#0##0#0#0.0#2023-05-25
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3175410 C 1 CS 1 19/05/2023 22/05/2023 29/05/1995 0 1
(RINGAN) 2579000 0 0 - 0 - 0 - 0 - 0
2579000 991442 0 4 0 0 0 RIZKI PIRMANSAH,TN
0116R0340523V006495 0001524462028 3;JKN RSUP;; 5.8.4.202302261000
4 176634 1#0##0#0#0.0#2023-05-25
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3175410 C 1 CS 1 18/05/2023 22/05/2023 05/01/1985 0 2
1 H81.1;I10 87.49;90.29;90.59 - - None None None None U-4-
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3175410 C 3 CS 1 22/05/2023 23/05/2023 21/09/1983 0 2
(RINGAN) 2371700 0 0 - 0 - 0 - 0 - 0
2371700 4298803 0 2 0 0 0 NOOR FAUZIAH RAHMAH,NY
0116R0340523V007406 0001628093114 3;JKN RSUP;; 5.8.4.202302261000
4 176420 1#0##0#0#0.0#2023-05-25
64331c57faff3c67c5259c12674b65b8 220500 2036250 1113750 0
0 0 0 450000 0 0 0 0 225335 134119
118849 0 0 0
3175410 C 1 CS 1 22/05/2023 23/05/2023 02/04/1994 0 2
1 N92.1 69.09;90.59;99.29 - - None None None None W-1-11-I
None None None None None None PROSEDUR DILATASI, KURET, INTRAUTERIN &
SERVIK (RINGAN) 3154300 0 0 - 0 - 0 - 0 -
0 3154300 6061338 0 2 0 0 0 WINARTI,NY
0001226177076 3;JKN RSUP;; 5.8.4.202302261000 4 176426
1#0##0#0#0.0#2023-05-25
f5de67a1b30f8a2dd211fae9f2a856ab 381250 4022000 0 0 0
0 0 267000 0 0 1000000 0 143045 149268
98775 0 0 0
3175410 C 1 CS 1 17/05/2023 23/05/2023 07/11/1964 0 1
4 I12.0;E11.9;D68.9;I48 38.95;39.95;99.18;99.29;90.59;87.44 - -
None None None None N-1-12-III None None None None None None
MEMBUAT BARU, MEREVISI DAN MEMINDAHKAN ALAT DIALISIS (BERAT) 20722300
0 0 - 0 - 0 - 0 - 0 20722300
20228162 0 7 0 0 0 MUKHYIDIN ,TN 00017057 58
21375 MARTUA SILALAHI, DR., SP.JP 0116R0340523V005969 0000040922831
3;JKN RSUP;; 5.8.4.202302261000 4 176430 1#0##0#0#0.0#2023-
05-25
rug_amt":"3931544","device_amt":"4686030","consumable_amt":"331935","device_rent_am
4cb176ce1fc56960819cc572d371b778 2926250 950000 745244 0
0 0 632500 6019199 0 0 0 0 3931544
4686030 331935 0 0 5460
3175410 C 3 CS 1 18/05/2023 23/05/2023 30/12/1959 0 2
1 M54.59;I25.1;E11.9 99.29;89.52;99.18;99.21;87.44;90.59 - -
None None None None M-4-17-I None None None None None None
MASALAH BAGIAN PUNGGUNG/PINGGANG BELAKANG (RINGAN) 2969500 0 0
- 0 - 0 - 0 - 0 2969500 3641968 0
6 0 0 0 SITI JAMILAH, NY 00060606 63 23150 DR. PRIYANKA
5.8.4.202302261000 4 176488 1#0##0#0#0.0#2023-05-25
2465844afd7cb838ec491c66f6f8672e 401750 0 0 0 0 0
509000 945000 0 0 1110000 0 563490 112728
0 0 0 0
3175410 C 3 CS 1 22/05/2023 23/05/2023 16/01/1960 0 2
1 L50.8;W57.0;I49.9 89.52;87.44;90.59;99.18 - - None None None
None L-4-14-I None None None None None None GANGGUAN PADA KULIT &
PAYUDARA LAIN-LAIN (RINGAN) 2675800 0 0 - 0 - 0 -
0 - 0 2675800 1122809 0 2 0 0 0
RUSTA,TN 00010658 63 23137 DR. BETA AGUSTIA WISMAN, SP.PD
0116R0340523V007323 0000379511087 3;JKN RSUP;; 5.8.4.202302261000
4 176497 1#0##0#0#0.0#2023-05-25
98e7eefea86f403329e3e14c66112596 141750 0 0 0 0 0
200000 225000 0 0 370000 0 127350 58709 0
0 0 0
3175410 C 3 CS 1 20/05/2023 23/05/2023 15/08/1974 0 2
1 N23;I25.1 89.52;87.44;90.59;99.18 - - None None None None
N-4-13-I None None None None None None BATU URIN (RINGAN)
3545300 0 0 - 0 - 0 - 0 - 0
3545300 2116082 0 4 0 0 0 FARIDAH,NY 00060714
0001405959952 3;JKN RSUP;; 5.8.4.202302261000 4 176519
1#0##0#0#0.0#2023-05-25
4c5e3019bdcd4c39310d2f1f10ae6be4 451750 0 0 0 0 0
200000 267000 0 0 740000 0 351426 105906
0 0 0 0
3175410 C 3 CS 1 18/05/2023 23/05/2023 29/06/2009 0 1
7002300 0 0 - 0 - 0 - 0 - 0
7002300 16675791 0 6 0 0 0 YOEL JERICO SIHOMBING,AN
0000371343148 3;JKN RSUP;; 5.8.4.202302261000 4 176320
1#0##0#0#0.0#2023-05-29
533734c430d55c60fd3fa0aea3e020c2 330000 3640000 11442100 0
0 0 190000 39900 0 0 0 0 605400 332716
95675 0 0 0
3175410 C 3 CS 1 21/05/2023 23/05/2023 26/04/2017 0 2
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 1854536 0 3 0 0 0 LATIF INDRA ALHAFIDZ,AN
0116R0340523V006916 0002136448214 3;JKN RSUP;; 5.8.4.202302261000
4 176362 1#0##0#0#0.0#2023-05-29
9cec6e91183f23f0cf875baf0e279787 531750 0 0 0 0 0
178000 279000 0 0 555000 0 218261 92525 0
0 0 0
3175410 C 3 CS 1 21/05/2023 23/05/2023 25/04/1989 0 1
1 I11.9;J18.9;K21.9 89.52;99.29;87.49;90.59 - - None None None
None I-4-17-III None None None None None None HIPERTENSI (BERAT)
2663700 0 0 - 0 - 0 - 0 - 0
2663700 2677077 0 3 0 0 0 ABD.ROHIM,TN
0001225782641 3;JKN RSUP;; 5.8.4.202302261000 4 176379
1#0##0#0#0.0#2023-05-29
2e07a9a621efe513d47a6eea751cd1c5 451750 0 0 0 0 0
200000 435000 0 0 1110000 0 407670 72657 0
0 0 0
3175410 C 3 CS 1 21/05/2023 23/05/2023 05/02/1966 0 1
1 I63.9 99.18;99.29;90.59;87.03 - - None None None None G-4-
14-I None None None None None None KECEDERAAN PEMBULUH DARAH OTAK DENGAN
INFARK (RINGAN) 4036200 0 0 - 0 - 0 - 0 -
0 4036200 1953259 0 3 0 0 0 LIU ANYANDI
SUNATOLIM,TN 00060747 57 20924 DR. KHONITA ADIAN UTAMI, SP. N
0116R0340523V006964 0002058983842 3;JKN RSUP;; 5.8.4.202302261000
4 176467 1#0##0#0#0.0#2023-05-29
ursing_amt":"0","ancillary_amt":"0","blood_amt":"0","laboratory_amt":"218200","radi
ology_amt":"1200000","rehab_amt":"150000","room_amt":"0","intensive_amt":"0","drug_
amt":"262768","device_amt":"65491","consumable_amt":"0","device_rent_amt":"0","drug
eb3e6404f910067f799e3e245bfc22f8 50000 0 6800 0 0 0
1200000 218200 0 150000 0 0 262768 65491 0
0 0 0
3175410 C 3 CS 1 15/05/2023 23/05/2023 05/05/1964 0 1
- 0 5181500 5100834 0 9 0 0 0 AGUS
SALEH,TN 00051387 59 21559 DR. ASYSYUKRIATI, SP.P 0116R0340523V004685
0000379297901 3;JKN RSUP;; 5.8.4.202302261000 4 176525
1#0##0#0#0.0#2023-06-02
890517","valid":"1","sitb_response":{"data":[{"id":"2021000106890517","nama":"AGUS
SALEH","nik":"3172040505640001","jenis_kelamin_id":"1"}],"success":true}}#{"cara_ma
1c0121e0ff21f8791b314059bb2ffa8a 2064612 0 712400 0 0
0 0 710600 0 0 0 0 1342556 244924 25742
0 0 0
3175410 C 3 CS 1 10/05/2023 23/05/2023 27/01/1957 0 2
1 J22;E88.0;E87.1 99.18;99.29;90.59 - - None None None None
0 - 0 - 0 4648300 19861786 0 14 0 0
0 ATOH SUNARTI ,NY 00053259 66 24209 DR. ASYSYUKRIATI, SP.P
0116R0340523V003251 0001794263231 3;JKN RSUP;; 5.8.4.202302261000
4 176464 1#0##0#0#0.0#2023-06-04
f7083b34515dc3ea80e5465789e0ffe0 1142500 0 329150 0 0
0 0 1978850 0 0 5850000 0 9832877 681357
47052 0 0 0
3175410 C 1 CS 1 20/05/2023 23/05/2023 21/01/1996 0 2
LAIN-LAIN (RINGAN) 3017700 0 0 - 0 - 0 - 0
- 0 3017700 5409820 0 4 0 0 0 VONNY
DELFIANASARI ZEGA,NY 00060726 27 9981 FELIX SATWIKA, DR., SP.PD
0116R0340523V006898 0002319083616 3;JKN RSUP;; 5.8.4.202302261000
4 176235 1#0##0#0#0.0#2023-06-04
9d9a446884987b9e44fce51b2aa78176 1161750 0 0 0 0 0
200000 225000 0 0 3000000 0 567640 94855 160575
0 0 0
3175410 C 2 CS 1 20/05/2023 23/05/2023 03/01/2022 0 1
1 A09.9;J18.0 99.18;99.29;90.59 - - None None None None K-4-
17-III None None None None None None NYERI ABDOMEN & GASTROENTERITIS
LAIN-LAIN (BERAT) 2961100 0 0 - 0 - 0 - 0 -
0 2961100 1152523 0 4 0 0 0 MUHAMMAD AFIF AL
HAFIZ,AN 00056897 1 502 DR. RAEDY RUWANDA SUSANTO, SP A.
0116R0340523V006889 0003517189029 3;JKN RSUP;; 5.8.4.202302261000
4 176310 1#0##0#0#0.0#2023-06-04
fd551137610f31ff367fb381476e93bc 230000 0 301050 0 0
0 0 268050 0 0 0 0 352214 1209 0 0
0 0
3175410 C 3 CS 1 20/05/2023 23/05/2023 27/07/2022 0 2
1 J18.0;B08.2 87.49;90.59;99.29 - - None None None None J-4-
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 2107933 0 4 0 0 0 KENZO DZUHAIRY, AN
0116R0340523V006900 0003300160948 3;JKN RSUP;; 5.8.4.202302261000
4 176353 1#0##0#0#0.0#2023-06-04
80545bf1a242c23a7ca55582ad8b65ad 656750 0 0 0 0 0
178000 225000 0 0 740000 0 259980 48203 0
0 0 0
3175410 C 3 CS 1 20/05/2023 23/05/2023 25/02/2021 0 2
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 2434274 0 4 0 0 0 UMARUL FARUQ ,AN
0116R0340523V006856 0003132626523 3;JKN RSUP;; 5.8.4.202302261000
4 176367 1#0##0#0#0.0#2023-06-04
49254691e34ce1f674695de716071bd2 581750 0 0 0 0 0
178000 505000 0 0 740000 0 281008 148516
0 0 0 0
3175410 C 2 CS 1 20/05/2023 23/05/2023 03/07/2017 0 2
1 J18.0;K30 90.59;99.29;87.49 - - None None None None J-4-
(RINGAN) 4209900 0 0 - 0 - 0 - 0 - 0
4209900 2854299 0 4 0 0 0 SITI SARAH HARYADI,AN
0116R0340523V006887 0002309522466 3;JKN RSUP;; 5.8.4.202302261000
4 176370 1#0##0#0#0.0#2023-06-04
ad09a5990e421c9b19966be745cb70e3 626750 0 0 0 0 0
178000 267000 0 0 1400000 0 285867 96682 0
0 0 0
3175410 C 3 CS 1 20/05/2023 23/05/2023 26/04/1970 0 2
1 S00.9;A16.2;E87.8 99.18;99.29;90.59 - - None None None None
L-4-13-II None None None None None None TRAUMA PADA KULIT, JARINGAN
BAWAH KULIT DAN PAYUDARA (SEDANG) 3053600 0 0 - 0 - 0
- 0 - 0 3053600 534153 0 4 0 0 0
ASRI YANTI ,NY 00054044 53 19382 DR. PRIYANKA GANESA UTAMI, SP. N
0116R0340523V006870 0001215770962 3;JKN RSUP;; 5.8.4.202302261000
4 176486 1#0##0#0#0.0#2023-06-04
742296","valid":"1","sitb_response":{"data":[{"id":"2022000026742296","nama":"ASRI
YANTI","nik":"3175066604700005","jenis_kelamin_id":"2"}],"success":true}}#{"cara_ma
812f780a8622701ea171232330d21e5b 100000 0 80000 0 0 0
0 0 0 0 0 0 301322 21175 31656 0 0 0
3175410 C 1 CS 1 20/05/2023 23/05/2023 18/09/1969 0 1
1 I20.9;I11.9;E11.9;E87.1 99.18;99.29;90.59 - - None None None
None I-4-20-II None None None None None None ANGINA PEKTORIS DAN
NYERI DADA (SEDANG) 5041800 0 0 - 0 - 0 - 0
- 0 5041800 3371883 0 4 0 0 0 YARDI
EFFENDY,TN 00006729 53 19602 MARTUA SILALAHI, DR., SP.JP
0116R0340523V006866 0001126552048 3;JKN RSUP;; 5.8.4.202302261000
4 176301 1#0##0#0#0.0#2023-06-04
bded70744efde907e08971faa7e556b6 150000 0 871498 0 0
0 0 1294488 0 0 0 0 879740 40403 135754
0 0 0
3175410 C 3 CS 1 20/05/2023 24/05/2023 11/12/1963 0 2
1 E11.4;I11.9 99.18;99.29;90.59 - - None None None None G-4-
17-I None None None None None None GANGUAN SARAF KRANIAL DAN PERIFER
(RINGAN) 3621200 0 0 - 0 - 0 - 0 - 0
3621200 2404104 0 5 0 0 0 LAILAH,NY 00022019
0001223970142 3;JKN RSUP;; 5.8.4.202302261000 4 176828
1#0##0#0#0.0#2023-05-26
f8ad899c1908fe78b8dff6562c326848 230000 0 164000 0 0
0 0 436000 0 0 740000 0 743595 90509 0
0 0 0
3175410 C 2 CS 1 21/05/2023 24/05/2023 21/10/1951 0 2
1 A90;I25.1 99.18;99.29;90.59;87.44 - - None None None None
LAIN (RINGAN) 2259100 0 0 - 0 - 0 - 0 -
0 2259100 2656028 0 4 0 0 0 SUKANI,NY
0000046128677 3;JKN RSUP;; 5.8.4.202302261000 4 176838
1#0##0#0#0.0#2023-05-26
e49170e46599bd76eaa3fa106b91412b 180000 0 107200 0 0
0 0 136800 0 0 1400000 0 793714 38314 0
0 0 0
3175410 C 3 CS 1 21/05/2023 24/05/2023 29/12/1983 0 1
None None None None PROSEDUR APPENDIK (RINGAN) 3631000 0 0
- 0 - 0 - 0 - 0 3631000 9848591 0
4 0 0 0 LISANI,TN 00060745 39 14388 ANDRI SUHANDI,
DR., SP. B 0116R0340523V006957 0000378960726 3;JKN RSUP;;
5.8.4.202302261000 4 176842 1#0##0#0#0.0#2023-05-26
b4c6e983dec1f3c143fd369d07e9b986 203000 3380000 3222200 0
0 0 0 491800 0 0 1400000 0 611989 410240
129362 0 0 0
3175410 C 1 CS 1 16/05/2023 24/05/2023 23/04/1944 0 2
1 E11.9;J18.0;I12.0;E87.6;J80 89.52;87.49;90.29;90.59 - - None
None None None E-4-10-III None None None None None None PENYAKIT
KENCING MANIS & GANGGUAN NUTRISI/ METABOLIK (BERAT) 8329700 0 0 -
0 - 0 - 0 - 0 8329700 18720118 0 9
1 5 0 SATRIN T MONOARFA,TN 00060403 79 28877 FELIX
5.8.4.202302261000 4 176848 1#0##0#0#0.0#2023-05-26
rsing_amt":"0","ancillary_amt":"0","blood_amt":"0","laboratory_amt":"3222502","radi
ology_amt":"451000","rehab_amt":"0","room_amt":"6000000","intensive_amt":"0","drug_
1dbdc44f3e9cff3aec645b2fcfdb5a5e 2262250 0 0 0 0 0
451000 3222502 0 0 6000000 0 6038657 513881
231828 0 0 0
3175410 C 1 CS 1 22/05/2023 24/05/2023 11/12/1961 0 2
1 M17.3;S93.4 88.28;99.29;90.59 - - None None None None M-4-
18-I None None None None None None PENYAKIT TULANG DAN SENDI LAIN-LAIN
(RINGAN) 2984800 0 0 - 0 - 0 - 0 - 0
2984800 2059297 0 3 0 0 0 VERONIKA,NY 00060796
61 22442 ERY WILDAN, DR., SP.OT 0116R0340523V007404 0000040835338
3;JKN RSUP;; 5.8.4.202302261000 4 176855 1#0##0#0#0.0#2023-
05-26
242829c5dd599eccec508757abedf2ab 130000 0 204000 0 0
0 0 0 0 0 1500000 0 115809 34319 75169 0
0 0
3175410 C 1 CS 1 20/05/2023 24/05/2023 14/08/1974 0 2
None None None None None PROSEDUR SISTEM MUSKULOSKLETAL & JARINGAN
0 - 0 9006200 20162932 0 5 0 0 0 NINING
WULANDARI.NY 00058240 48 17811 ERY WILDAN, DR., SP.OT
0116R0340523V006890 0001648032579 3;JKN RSUP;; 5.8.4.202302261000
4 176860 1#0##0#0#0.0#2023-05-26
8852d3db7e759fc48fc9036e751be119 150000 8580000 8838000 0
0 0 211000 0 0 0 0 0 1236783 702899
444250 0 0 0
3175410 C 1 CS 1 22/05/2023 24/05/2023 10/03/1973 0 2
1 D24;I10 85.12 - - None None None None L-1-50-I None
None None None None None PROSEDUR PADA PAYUDARA (RINGAN) 6999300
0 0 - 0 - 0 - 0 - 0 6999300
13560909 0 3 0 0 0 PRIHATIN,NY 00060844 50 18335
RSUP;; 5.8.4.202302261000 4 176861 1#0##0#0#0.0#2023-05-26
e842a03fc2859248a140ad531f7a77b6 100000 5460000 5754000 0
0 0 0 450000 0 0 0 0 737452 666552
392905 0 0 0
3175410 C 1 CS 1 22/05/2023 24/05/2023 16/09/2022 0 1
(RINGAN) 2579000 0 0 - 0 - 0 - 0 - 0
2579000 59507 0 3 0 0 0 AHMAD AL FAIZAN,AN
0003292839775 3;JKN RSUP;; 5.8.4.202302261000 4 176865
1#0##0#0#0.0#2023-05-26
t":"429","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0","drug_ch
40f85a1f8fbe9235cb3a81904e8c8363 0 0 0 0 0 0 0
0 0 0 0 0 59078 429 0 0 0 0
3175410 C 1 CS 1 22/05/2023 24/05/2023 30/08/2020 0 1
1 N47;N48.1 99.18;99.29;90.59 - - None None None None V-4-
11-I None None None None None None PENYAKIT SISTEM REPRODUKSI LAKI-LAKI
- 0 3954800 2431534 0 3 0 0 0 FATIH
HAMIZAN M,AN 00060805 2 995 IRENNE PURNAMA, MSC.,SP.A
0116R0340523V007317 0003128261332 3;JKN RSUP;; 5.8.4.202302261000
4 176866 1#0##0#0#0.0#2023-05-26
e7c7799eba0229a80358e99a6b9020f8 292500 0 531000 0 0
0 0 0 0 0 1500000 0 108034 0 0 0
0 0
3175410 C 1 CS 1 20/05/2023 24/05/2023 06/03/2006 0 1
(RINGAN) 2579000 0 0 - 0 - 0 - 0 - 0
2579000 3462890 0 5 0 0 0 MUHAMMAD NUR HIDAYAT,AN
0116R0340523V006719 0000378751915 3;JKN RSUP;; 5.8.4.202302261000
4 176868 1#0##0#0#0.0#2023-05-26
f9146928f47db9854440d0b3bb754c97 430000 0 13400 0 0 0
0 254600 0 0 2500000 0 259541 5349 0 0
0 0
3175410 C 3 CS 1 21/05/2023 24/05/2023 12/10/2021 0 2
0 - 0 2269000 1825258 0 4 0 0 0 ALESHA
SAVINA ZEHRA,AN 00060732 1 586 DR. RAEDY RUWANDA SUSANTO, SP A.
0116R0340523V006909 0003506946985 3;JKN RSUP;; 5.8.4.202302261000
4 176877 1#0##0#0#0.0#2023-05-26
b19576b2951432fd7669b0683e0ce911 230000 0 549700 0 0
0 0 91300 0 0 740000 0 195469 18789 0 0
0 0
3175410 C 3 CS 1 22/05/2023 24/05/2023 03/03/2009 0 2
0 - 0 - 0 - 0 - 0 3545300 1972912
0 3 0 0 0 NAISELLY TRI HUMAIROTUL W, AN 00060788 14
5193 IRENNE PURNAMA, MSC.,SP.A 0116R0340523V007286 0001283001118
3;JKN RSUP;; 5.8.4.202302261000 4 176879 1#0##0#0#0.0#2023-
05-26
":"67612","device_amt":"0","consumable_amt":"0","device_rent_amt":"0","drug_chronic
8777fbbe5f8e98aa1fbcc2e507de5697 330000 0 310300 0 0
0 0 80000 0 0 1185000 0 67612 0 0 0 0
0
3175410 C 1 CS 1 23/05/2023 24/05/2023 18/03/1985 0 2
(RINGAN) 3154300 0 0 - 0 - 0 - 0 - 0
3154300 4754948 0 2 0 0 0 MAHARANI, NY
OG 0116R0340523V007835 0001262146803 3;JKN RSUP;; 5.8.4.202302261000
4 176883 1#0##0#0#0.0#2023-05-26
4f2867f581b24bdece87080f91ad9b5e 183000 2565875 1558125 0
0 0 0 0 0 0 0 0 141408 198472 108068
0 0 0
3175410 C 3 CS 1 22/05/2023 24/05/2023 08/10/1977 0 2
4580200 0 0 - 0 - 0 - 0 - 0
4580200 10595856 0 3 0 0 0 RAMLAH, NY 00060148
0000378931408 3;JKN RSUP;; 5.8.4.202302261000 4 176885
1#0##0#0#0.0#2023-05-26
023e1b0b64228cecb7c60dd1a31a8356 217500 4576000 4464000 0
0 0 0 0 0 0 555000 0 322243 184942
276171 0 0 0
3175410 C 3 CS 1 21/05/2023 24/05/2023 06/01/1946 0 2
1 H81.1;E87.6;I25.1 99.18;99.29;90.59;87.44 - - None None None
None U-4-11-II None None None None None None DYSEQUILIBRIUM (SEDANG)
1916100 0 0 - 0 - 0 - 0 - 0
1916100 1047372 0 4 0 0 0 SRI MARIYANI,NY
0116R0340523V006966 0000378750802 3;JKN RSUP;; 5.8.4.202302261000
4 176889 1#0##0#0#0.0#2023-05-26
90c885c576f06854bac8e3c18b7a9e8b 0 0 0 0 0 0 0
0 0 0 740000 0 286736 20636 0 0 0 0
3175410 C 3 CS 1 22/05/2023 24/05/2023 13/03/1944 0 1
1 K40.0;I10 53.21 - - None None None None K-1-14-I None
None None None None None PROSEDUR HERNIA INGUINAL DAN FEMORAL (RINGAN)
4910800 0 0 - 0 - 0 - 0 - 0
4910800 11623214 0 3 0 0 0 JAKIDJO, TN 00060294
0002097101035 3;JKN RSUP;; 5.8.4.202302261000 4 176898
1#0##0#0#0.0#2023-05-26
f19dbdb4a6a2d8af2ff91fd296f5aba7 255000 4576000 4509000 0
0 0 0 0 0 0 1050000 0 453530 700026
79658 0 0 0
3175410 C 3 CS 1 22/05/2023 24/05/2023 10/09/1961 0 1
1 K40.9;I25.1 99.18;99.29;90.59;53.21 - - None None None None
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3175410 C 1 CS 1 21/05/2023 24/05/2023 17/01/1993 0 2
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1 O32.8;O82.9;Z37.0 90.59;99.21;99.29;74.99 - - None None None
None O-6-10-I None None None None None None OPERASI PEMBEDAHAN
CAESAR (RINGAN) 5238800 0 0 - 0 - 0 - 0 -
0 5238800 5304898 0 3 0 0 0 IMAS LEHA,NY
OG 0116R0340523V007411 0001224618175 3;JKN RSUP;; 5.8.4.202302261000
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3175410 C 1 CS 1 22/05/2023 24/05/2023 02/07/1982 0 2
4996200 0 0 - 0 - 0 - 0 - 0
4996200 8534080 0 3 0 0 0 NENI NURLAENI,NY
0001376729087 3;JKN RSUP;; 5.8.4.202302261000 4 176950
1#0##0#0#0.0#2023-05-26
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120778 0 0 0
3175410 C 1 CS 1 21/05/2023 24/05/2023 12/02/2003 0 1
(RINGAN) 4806100 0 0 - 0 - 0 - 0 - 0
4806100 3702672 0 4 0 0 0 YAZID ABDULLAH AZZAM ,TN
0001224561284 3;JKN RSUP;; 5.8.4.202302261000 4 176847
1#0##0#0#0.0#2023-05-29
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3175410 C 3 CS 1 22/05/2023 24/05/2023 22/05/2021 0 2
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 468032 0 3 0 0 0 EMBUN NAFEESA ,AN
00051259 1 730 MUSTARI, DR., SP.A 0116R0340523V006997
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1#0##0#0#0.0#2023-05-29
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3175410 C 3 CS 1 20/05/2023 24/05/2023 29/02/2016 0 2
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 677999 0 5 0 0 0 FEBRIANA VALERY N, AN
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3175410 C 3 CS 1 22/05/2023 24/05/2023 22/01/2016 0 1
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5078100 695396 0 3 0 0 0 ABDULLAH FARHAN,AN
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3175410 C 1 CS 1 21/05/2023 24/05/2023 02/11/2021 0 2
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[{"id":"2023000107000312","nama":"BELLVANIA MARCI
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3175410 C 3 CS 1 24/05/2023 25/05/2023 24/05/2023 2960 1
1 P70.4 99.29;90.59 - - None None None None P-8-17-I None
None None None None None NEONATAL, BBL > 2499 GR TANPA PROSEDUR MAYOR
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t_5":
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3175410 C 1 CS 1 24/05/2023 25/05/2023 26/09/1982 0 2
1 A90;E87.8 99.18;99.29;90.59 - - None None None None A-4-
(SEDANG) 3278400 0 0 - 0 - 0 - 0 - 0
3278400 648998 0 2 0 0 0 KASTIYAH, NY
0001627769981 3;JKN RSUP;; 5.8.4.202302261000 4 176988
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0
3175410 C 1 CS 1 21/05/2023 25/05/2023 23/07/2014 0 2
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2174700 7700910 0 5 0 0 0 ELORA AZZAHRA FADHILA,AN
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1#0##0#0#0.0#2023-05-26
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3175410 C 1 CS 1 22/05/2023 25/05/2023 08/07/2013 0 2
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JULIA S,AN 00024253 9 3605 DR. RIADY ASHARI, SP. A 0116R0340523V007416
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3175410 C 3 CS 1 23/05/2023 25/05/2023 28/03/2004 0 2
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3175410 C 3 CS 1 24/05/2023 25/05/2023 14/01/1956 0 2
1 I12.0;E87.6 99.18;99.29;90.59 - - None None None None N-4-
10-II None None None None None None TUMOR GINJAL & SALURAN URIN & GAGAL
GINJAL (SEDANG) 3501400 0 0 - 0 - 0 - 0 -
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0001406611438 3;JKN RSUP;; 5.8.4.202302261000 4 177029
1#0##0#0#0.0#2023-05-26
device_amt":"7078","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0
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3175410 C 3 CS 1 20/05/2023 25/05/2023 22/09/1958 0 2
1 B00.9;A09.9 99.18;99.29;90.59 - - None None None None L-4-
14-I None None None None None None GANGGUAN PADA KULIT & PAYUDARA LAIN-LAIN
(RINGAN) 2675800 0 0 - 0 - 0 - 0 - 0
2675800 1453058 0 6 0 0 0 MAYUNIH,NY 00050007
0001311652653 3;JKN RSUP;; 5.8.4.202302261000 4 177035
1#0##0#0#0.0#2023-05-26
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0
3175410 C 3 CS 1 23/05/2023 25/05/2023 18/07/1997 0 2
1 A90;E87.1;K75.8 99.18;99.29;90.59 - - None None None None
LAIN (SEDANG) 2465000 0 0 - 0 - 0 - 0 -
0 2465000 4572495 0 3 0 0 0 RIZKI JUM ALLIYAH,
NY 00060923 25 9440 DR. PUJI ASTUTI TRI KUSUMAWATI, SP. PD
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3175410 C 3 CS 1 23/05/2023 25/05/2023 03/05/1973 0 2
1 K21.9;I11.9 99.18;99.29;90.59 - - None None None None K-4-
0 0 - 0 - 0 - 0 - 0 3330600
1852685 0 3 0 0 0 TATI HARTATI ,NY 00032478 50
18282 MARTUA SILALAHI, DR., SP.JP 0116R0340523V007444 0001223526194
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3175410 C 3 CS 1 23/05/2023 25/05/2023 11/09/1963 0 2
1 I63.9;I12.0;I25.1 99.18;99.29;90.59;87.44 - - None None None
None G-4-14-II None None None None None None KECEDERAAN PEMBULUH
DARAH OTAK DENGAN INFARK (SEDANG) 5484100 0 0 - 0 - 0
- 0 - 0 5484100 2122827 0 3 0 0 0
HATIJAH, NY 00060880 59 21804 DR. KHONITA ADIAN UTAMI, SP. N
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3175410 C 3 CS 1 23/05/2023 25/05/2023 17/09/1980 0 1
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3175410 C 3 CS 1 24/05/2023 25/05/2023 07/08/1989 0 2
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3663128 0 2 0 0 0 TAZKIYAH IZATI,NY 00060950 33
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1#0##0#0#0.0#2023-05-26
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3175410 C 3 CS 1 22/05/2023 25/05/2023 03/06/1991 0 2
1 O13;O34.2;O82.9;Z37.0 74.99 - - None None None None O-6-
5238800 0 0 - 0 - 0 - 0 - 0
5238800 5410799 0 4 0 0 0 KARTIKA FITRI
BAYUWARTY,NY 00060186 31 11676 AHMAD THAMRIN, DR., SP.OG
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{"code":"","name":""}} 1 a422cbb85a008c6e09266c43be3910c4 625500
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369547 532941 122811 0 0 0
3175410 C 3 CS 1 22/05/2023 25/05/2023 08/05/1998 0 2
5238800 0 0 - 0 - 0 - 0 - 0
5238800 5694410 0 4 0 0 0 DYAH PURNAMASARI,NY
0000377547052 3;JKN RSUP;; 5.8.4.202302261000 4 177158
1#0##0#0#0.0#2023-05-26
{"code":"","name":""}} 1 ef8fb45a61d615c5afc47122c6d0daa1 574250
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3175410 C 3 CS 1 27/04/2023 25/05/2023 11/10/1982 0 2
0 - 0 - 0 2885400 2120899 0 29 0 0
0 HERAWATI ,NY 00057487 40 14808 SYARIFUDIN, DR., SP.P
0116R0340423V007077 0001774785554 3;JKN RSUP;; 5.8.4.202302261000
4 177400 1#0##0#0#0.0#2023-05-29
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3175410 C 3 CS 1 23/05/2023 25/05/2023 23/04/2004 0 2
40-I None None None None None None PROSEDUR SISTEM PENCERNAAN LAIN-LAIN
(RINGAN) 6274500 0 0 - 0 - 0 - 0 - 0
6274500 9124228 0 3 0 0 0 TRIA DWI LESTARI,NN
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1#0##0#0#0.0#2023-05-29
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3175410 C 3 CS 1 21/05/2023 25/05/2023 01/04/2017 0 2
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FATIMATUS ZAHRO,AN 00060738 6 2241 DR. RIADY ASHARI, SP. A
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3175410 C 3 CS 1 21/05/2023 25/05/2023 01/12/2022 0 2
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 4049071 0 5 0 0 0 NATALIA HUTASOIT,AN
00060753 0 171 ADE DEWI NARALIA, DR. 0116R0340523V007114
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3175410 C 3 CS 1 22/05/2023 25/05/2023 08/10/1962 0 2
1 E11.9;J18.0;I10 99.18;99.29;90.59 - - None None None None
E-4-10-III None None None None None None PENYAKIT KENCING MANIS &
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KUSMYATI ,NY 00053059 60 22141 DR. LAILY RIDAWATI, SP.PD
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3175410 C 3 CS 1 22/05/2023 25/05/2023 09/07/1982 0 2
1 J18.0;K21.9;I10 99.18;99.29;90.59;87.44 - - None None None
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HASANAH, NY 00060759 40 14927 SYARIFUDIN, DR., SP.P 0116R0340523V006995
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3175410 C 3 CS 1 21/05/2023 25/05/2023 01/08/1987 0 1
COUGH (RINGAN) 3613600 0 0 - 0 - 0 - 0 -
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DJAYA,TN 00060755 35 13077 DR. LAILY RIDAWATI, SP.PD
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3175410 C 3 CS 1 22/05/2023 25/05/2023 10/09/1972 0 1
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0002694743471 3;JKN RSUP;; 5.8.4.202302261000 4 177021
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3175410 C 2 CS 1 21/05/2023 25/05/2023 01/06/1979 0 1
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None N-4-13-II None None None None None None BATU URIN (SEDANG)
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None None None None None None INFEKSI GINJAL DAN SALURAN URIN (RINGAN)
3263500 0 0 - 0 - 0 - 0 - 0
3263500 5747234 0 5 0 0 0 SINTIA SEPTI AMBARA,NY
0116R0340523V007432 0001844589565 3;JKN RSUP;; 5.8.4.202302261000
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1939100 2119433 0 4 0 0 0 MARIAHTUL QIFTIAH, NY
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3175410 C 3 CS 1 19/05/2023 26/05/2023 22/05/2014 0 2
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3175410 C 3 CS 1 19/05/2023 26/05/2023 07/04/2007 0 2
1 J22;D64.9 99.18;99.29;90.59;87.44;99.04 - - None None None
None J-4-21-II None None None None None None GEJALA, TANDA DAN
- 0 - 0 - 0 4648300 5253458 0 8 0
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1939100 2778752 0 5 0 0 0 AFRIZAL SUMARNA,AN
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3175410 C 3 CS 1 22/05/2023 26/05/2023 11/01/1981 0 2
1 H81.1;N23;I11.9 99.18;99.29;90.59 - - None None None None
U-4-11-I None None None None None None DYSEQUILIBRIUM (RINGAN)
1422200 0 0 - 0 - 0 - 0 - 0
1422200 2920105 0 5 0 0 0 RIA PUSPA ANGGRAINI,NY
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3175410 C 3 CS 1 22/05/2023 26/05/2023 09/05/2023 0 1
1 P59.9;R09.0 99.83;90.59;99.21;93.90 - - None None None None
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(RINGAN) 3385000 0 0 - 0 - 0 - 0 - 0
3385000 5285051 0 5 1 5 0 NUR LENI WIJAYANTI ,BY
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3175410 C 3 CS 1 24/05/2023 26/05/2023 05/04/2002 0 2
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1635100 363851 0 3 0 0 0 UMAIROH.NN 00060948
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3175410 C 3 CS 1 22/05/2023 26/05/2023 03/07/1975 0 2
1 J12.9;I10 99.18;99.29;90.59;87.44 - - None None None None
COUGH (RINGAN) 3613600 0 0 - 0 - 0 - 0 -
0 3613600 1424707 0 5 0 0 0 PARNI, NY
0001456952602 3;JKN RSUP;; 5.8.4.202302261000 4 178039
1#0##0#0#0.0#2023-05-30
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3175410 C 3 CS 1 21/05/2023 26/05/2023 01/01/1980 0 2
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2196300 2999399 0 6 0 0 0 NURPIAH, NY 00060754
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3175410 C 3 CS 1 25/05/2023 26/05/2023 27/07/1991 0 1
LAIN-LAIN (RINGAN) 2269000 0 0 - 0 - 0 - 0
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3175410 C 3 CS 1 23/05/2023 26/05/2023 29/05/1982 0 2
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KHONITA ADIAN UTAMI, SP. N 0116R0340523V007458 0001223965877 3;JKN RSUP;;
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3175410 C 3 CS 1 21/05/2023 26/05/2023 15/04/1994 0 1
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- 0 5181500 1259171 0 6 0 0 0 AHMAD FAJRI
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3175410 C 3 CS 1 24/05/2023 26/05/2023 05/08/1963 0 2
1 L27.0;A16.2;I10 89.52;87.44;90.59;99.29 - - None None None
None L-4-14-II None None None None None None GANGGUAN PADA KULIT &
PAYUDARA LAIN-LAIN (SEDANG) 3687000 0 0 - 0 - 0 -
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MULIYAH ,NY 00038394 59 21842 DR. ASYSYUKRIATI, SP.P
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[{"id":"2023000107000225","nama":"MULIYAH","nik":"3175064508630001","jenis_kelamin_
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3175410 C 3 CS 1 22/05/2023 26/05/2023 12/06/1971 0 1
1 J45.8;E87.1 99.18;99.29;90.59 - - None None None None J-4-
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3175410 C 1 CS 1 24/05/2023 26/05/2023 06/06/1996 0 1
1 J22;K30 99.18;99.29;90.59 - - None None None None J-4-
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KAFIFA PUTRA,TN 00014106 26 9848 SYARIFUDIN, DR., SP.P
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1 I12.0;N39.0;E87.8 99.18;99.29;90.59 - - None None None None
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3175410 C 3 CS 1 23/05/2023 26/05/2023 15/10/1964 0 2
1 A16.2;I10;E11.9 99.18;99.29;90.59 - - None None None None
J-4-15-I None None None None None None PERADANGAN DAN INFEKSI
- 0 4337000 1893143 0 4 0 0 0 NUROH, NY
0001738792203 3;JKN RSUP;; 5.8.4.202302261000 4 178040
1#0##0#0#0.0#2023-06-04
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3175410 C 3 CS 1 23/05/2023 26/05/2023 14/06/1969 0 2
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 4781611 0 4 0 0 0 SEAMI,NY 00011075
53 19701 DR. ASYSYUKRIATI, SP.P 0116R0340523V007434 0000378321636
3;JKN RSUP;; 5.8.4.202302261000 4 178059 1#0##0#0#0.0#2023-
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3175410 C 3 CS 1 24/05/2023 27/05/2023 14/06/1957 0 1
1 E11.5;K04.5;E87.8;I11.9 87.49;99.29;99.17;99.21;90.59 - - None
None None None I-4-15-II None None None None None None PENYAKIT
PEMBULUH DARAH PERIFER DAN LAIN-LAIN (SEDANG) 6286500 0 0 - 0
- 0 - 0 - 0 6286500 1891975 0 4 0
0 0 YUSUP B BUANG, TN 00060997 65 24085 DR. RUDI HERMANSYAH, SP.
B 0116R0340523V008256 0001797897374 3;JKN RSUP;; 5.8.4.202302261000
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3175410 C 3 CS 1 24/05/2023 27/05/2023 02/10/1998 0 2
1 N83.2 54.19;90.59;99.29;99.21 - - None None None None K-1-
40-I None None None None None None PROSEDUR SISTEM PENCERNAAN LAIN-LAIN
(RINGAN) 6274500 0 0 - 0 - 0 - 0 - 0
6274500 9039508 0 4 0 0 0 SITI SUSANTI,NY
0116R0340523V008254 0002836255803 3;JKN RSUP;; 5.8.4.202302261000
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3175410 C 1 CS 1 25/05/2023 27/05/2023 18/02/1978 0 2
1 D21.0 99.21;99.18;99.29;86.3;91.79 - - None None None None
L-1-40-I None None None None None None PROSEDUR PADA KULIT,
JA(RINGAN) BAWAH KULIT DAN PAYUDARA (RINGAN) 5331100 0 0 - 0
- 0 - 0 - 0 5331100 3229476 0 3 0
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3175410 C 1 CS 1 23/05/2023 27/05/2023 10/08/1996 0 2
1 B05.9;D21.0;J06.9 90.59;99.18;99.21;99.29 - - None None None
None A-4-13-I None None None None None None INFEKSI VIRAL & NON-
BAKTERIAL LAIN (RINGAN) 2579000 0 0 - 0 - 0 - 0
- 0 2579000 4314852 0 5 0 0 0 AGUSTIN
PUTRI ARYANI,NY 00060939 26 9782 DR. PUJI ASTUTI TRI KUSUMAWATI, SP. PD
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4 177881 1#0##0#0#0.0#2023-05-29
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3175410 C 1 CS 1 25/05/2023 27/05/2023 22/10/2002 0 1
LAIN-LAIN (RINGAN) 3017700 0 0 - 0 - 0 - 0
- 0 3017700 4214047 0 3 0 0 0 OCTHA DEYAJI
G, TN 00061092 20 7520 DR. LAILY RIDAWATI, SP.PD 0116R0340523V008615
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1#0##0#0#0.0#2023-05-29
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3175410 C 1 CS 1 24/05/2023 27/05/2023 08/05/2022 0 2
1 J22;H10.9 90.59;99.18;99.21;99.29 - - None None None None
0 - 0 - 0 3837600 5476749 0 4 0 0
0 ARETHA LINAVEEN ULI PANGARIBUAN.AN 00060945 1 381 DR. RIADY
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3175410 C 1 CS 1 24/05/2023 27/05/2023 27/07/1968 0 2
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YY01 None None None M-1-04-II None None YY-01-II None None None
PROSEDUR PADA SENDI TUNGKAI BAWAH (SEDANG) 18296300 0 0 HIP
REPLACEMENT / KNEE REPLACEMENT 4422900 - 0 - 0 - 0
22719200 31627159 0 4 0 0 0 SURYATI K,NY
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(RINGAN) 2579000 0 0 - 0 - 0 - 0 - 0
2579000 5327090 0 6 0 0 0 ATHAR KEANU IBRAHIM,AN
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3175410 C 1 CS 1 23/05/2023 27/05/2023 24/08/1992 0 2
1 J22;A90 90.59;99.18;99.29;99.21 - - None None None None
0 - 0 - 0 6182200 5805892 0 5 0 0
0 ANISA RAHMAWATI, NY 00060918 30 11229 SYARIFUDIN, DR., SP.P
0116R0340523V007786 0001218396137 3;JKN RSUP;; 5.8.4.202302261000
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99448 0 0 0
3175410 C 1 CS 1 25/05/2023 27/05/2023 14/02/1984 0 2
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None None None None None None MASALAH BAGIAN PUNGGUNG/PINGGANG BELAKANG
(RINGAN) 3949400 0 0 - 0 - 0 - 0 - 0
3949400 989432 0 3 0 0 0 SITI MISNAH ,NY
0116R0340523V008487 0001774175962 3;JKN RSUP;; 5.8.4.202302261000
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0
3175410 C 1 CS 1 26/05/2023 27/05/2023 19/10/1991 0 2
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NURAFNI,NY 00061116 31 11542 DR. BETA AGUSTIA WISMAN, SP.PD
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3175410 C 1 CS 1 24/05/2023 27/05/2023 08/04/1974 0 2
1 J18.9;E11.9 90.59;87.49;99.18;99.21;99.29 - - None None None
- 0 4806100 1000000 0 4 0 0 0 NURLAELA
00060996 49 17943 ASYSYUKRIATI, SP.P ,DR 0116R0340523V008249
0000045901708 3;JKN RSUP;; 5.8.4.202302261000 4 177944
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3175410 C 2 CS 1 24/05/2023 27/05/2023 22/12/1963 0 2
1 I20.0;M17.0;M53.0 90.59;87.49;99.18;99.29 - - None None None
None I-4-20-I None None None None None None ANGINA PEKTORIS DAN
NYERI DADA (RINGAN) 4189600 0 0 - 0 - 0 - 0
- 0 4189600 815412 0 4 0 0 0 ROSENTY
SILAEN ,NY 00017441 59 21703 MARTUA SILALAHI, DR., SP.JP
0116R0340523V008057 0001455421577 3;JKN RSUP;; 5.8.4.202302261000
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7660e9c6fa48aa76f0ad55eea94b5a33 0 0 0 0 0 0 310000
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3175410 C 3 CS 1 25/05/2023 27/05/2023 11/01/1971 0 2
3330600 0 0 - 0 - 0 - 0 - 0
3330600 621223 0 3 0 0 0 NURHIDAYATI ,NY
0001279245475 3;JKN RSUP;; 5.8.4.202302261000 4 177979
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3175410 C 3 CS 1 25/05/2023 27/05/2023 19/08/1992 0 2
1 N20.2 90.59;89.52;91.34;99.18;99.21;99.29 - - None None None
None N-4-13-I None None None None None None BATU URIN (RINGAN)
3545300 0 0 - 0 - 0 - 0 - 0
3545300 901528 0 3 0 0 0 NURHAMIDA ,NY
0001302653147 3;JKN RSUP;; 5.8.4.202302261000 4 177989
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3175410 C 3 CS 1 18/05/2023 27/05/2023 13/03/1960 0 2
1 E87.8;G40.9;J18.9 90.59;87.49;99.18;99.21;99.29 - - None None
None None E-4-11-III None None None None None None HIPOVOLEMIA &
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0 - 0 4915300 5194237 0 10 0 0 0 MIMIN
RUMINAH, NY 00057327 63 23076 DR. LAILY RIDAWATI, SP.PD
0116R0340523V006075 0002507917318 3;JKN RSUP;; 5.8.4.202302261000
4 177992 1#0##0#0#0.0#2023-05-30
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3175410 C 3 CS 1 25/05/2023 27/05/2023 25/04/1995 0 2
1 N30.9;K21.9 90.59;91.34;99.18;99.21;99.29 - - None None None
None N-4-12-I None None None None None None INFEKSI GINJAL DAN
SALURAN URIN (RINGAN) 2453800 0 0 - 0 - 0 - 0
- 0 2453800 1081642 0 3 0 0 0 AYU
LESTARI,NY 00037034 28 10257 DR. LAILY RIDAWATI, SP.PD
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4 177996 1#0##0#0#0.0#2023-05-30
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3175410 C 2 CS 1 23/05/2023 27/05/2023 19/02/1999 0 2
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WULAN, NN 00060936 24 8859 DR. PUJI ASTUTI TRI KUSUMAWATI, SP. PD
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4 177999 1#0##0#0#0.0#2023-05-30
","device_amt":"0","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0
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0
3175410 C 3 CS 1 23/05/2023 27/05/2023 06/01/1967 0 1
1 K21.9;J22;I25.1;I50.0 90.59;99.18;99.21;99.29 - - None None
None None K-4-12-II None None None None None None GANGGUAN ESOFAGUS
(SEDANG) 3855400 0 0 - 0 - 0 - 0 - 0
3855400 1087152 0 5 0 0 0 MUH.MASTUR EFENDI, TN
0116R0340523V007802 0001406616715 3;JKN RSUP;; 5.8.4.202302261000
4 178003 1#0##0#0#0.0#2023-05-30
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0
3175410 C 1 CS 1 24/05/2023 27/05/2023 17/09/1991 0 2
1 K35.8 91.34;90.59;87.49;88.19;47.09;99.18;99.21;99.29 - - None
None None None K-1-13-I None None None None None None PROSEDUR
APPENDIK (RINGAN) 4829200 0 0 - 0 - 0 - 0 -
0 4829200 13077241 0 4 0 0 0 DWI SEPTIAWATI, NY
0001305774437 3;JKN RSUP;; 5.8.4.202302261000 4 178008
1#0##0#0#0.0#2023-05-30
ology_amt":"982800","rehab_amt":"0","room_amt":"0","intensive_amt":"0","drug_amt":"
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3175410 C 3 CS 1 23/05/2023 27/05/2023 19/05/1984 0 2
1 I84.2;I10 49.46 - - None None None None K-1-50-I None
None None None None None PROSEDUR ANAL (RINGAN) 5752700 0 0
- 0 - 0 - 0 - 0 5752700 13738003 0
5 0 0 0 DURATUN NAFISAH, NY 00056734 39 14248 FELIX
5.8.4.202302261000 4 177968 1#0##0#0#0.0#2023-05-30
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3175410 C 1 CS 1 23/05/2023 27/05/2023 20/12/1979 0 1
1 K40.9;K21.9 53.04 - - None None None None K-1-14-I None
None None None None None PROSEDUR HERNIA INGUINAL DAN FEMORAL (RINGAN)
6531300 0 0 - 0 - 0 - 0 - 0
6531300 16460178 0 5 0 0 0 HENDRA,TN 00060937
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1#0##0#0#0.0#2023-05-30
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3175410 C 3 CS 1 24/05/2023 27/05/2023 31/12/1968 0 2
1 N83.2;I11.9;E87.6 65.99 - - None None None None W-1-20-II
None None None None None None PROSEDUR PADA RAHIM & ADNEKSA (SEDANG)
8314700 0 0 - 0 - 0 - 0 - 0
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0001741175212 3;JKN RSUP;; 5.8.4.202302261000 4 177586
1#0##0#0#0.0#2023-05-30
8fa8f41114bf3c6eb95fe30b9c2935de 415500 3900000 3868000 0
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434702 0 0 0
3175410 C 3 CS 1 30/04/2023 27/05/2023 10/05/1945 0 1
0 - 0 - 0 - 0 - 0 1422200 2692939
0 28 0 0 0 SANMIARTO ,TN 00057629 77 28479 DR.
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3175410 C 3 CS 1 20/05/2023 27/05/2023 18/08/1957 0 2
1 I20.0;H81.3;G44.0;A15.2;J91;I50.0 90.59;99.18;99.29 - - None
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PEKTORIS DAN NYERI DADA (BERAT) 5668100 0 0 - 0 - 0
- 0 - 0 5668100 3863678 0 8 0 0 0
SOLIPAH BUDIYANTI,NY 00060693 65 24016 MARTUA SILALAHI, DR., SP.JP
0116R0340523V006867 0002098378787 3;JKN RSUP;; 5.8.4.202302261000
4 177972 1#0##0#0#0.0#2023-06-02
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3175410 C 3 CS 1 26/05/2023 28/05/2023 16/03/1964 0 2
0 - 0 - 0 - 0 - 0 1916100 6447864
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3175410 C 1 CS 1 26/05/2023 28/05/2023 28/05/1994 0 2
1 O62.4;O82.9;Z37.0 74.99;03.91;99.18;99.21;99.29 - - None None
CAESAR (RINGAN) 6967500 0 0 - 0 - 0 - 0 -
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0116R0340523V008646 0002895013721 3;JKN RSUP;; 5.8.4.202302261000
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1 O34.2;O82.1;Z37.0 74.99;03.91;99.18;99.21;99.29 - - None None
CAESAR (RINGAN) 5238800 0 0 - 0 - 0 - 0 -
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3175410 C 3 CS 1 25/05/2023 28/05/2023 02/08/1983 0 2
1 I20.0;K21.9 90.59;89.52;99.18;99.29 - - None None None None
I-4-20-I None None None None None None ANGINA PEKTORIS DAN NYERI
DADA (RINGAN) 3596200 0 0 - 0 - 0 - 0 -
0 3596200 3106739 0 4 0 0 0 ANI SRI
SULISTIOWATI,NY 00041939 39 14541 MARTUA SILALAHI, DR., SP.JP
0116R0340523V008610 0001228941707 3;JKN RSUP;; 5.8.4.202302261000
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af356357d59418b9bffc341c1b94602f 380000 0 343625 0 0
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3175410 C 3 CS 1 24/05/2023 28/05/2023 04/09/2000 0 2
(RINGAN) 1635100 0 0 - 0 - 0 - 0 - 0
1635100 2980275 0 5 0 0 0 RIZMA ISNAENI, NY
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3175410 C 1 CS 1 25/05/2023 28/05/2023 10/04/2008 0 1
1 M72.66 90.59;99.18;99.21;99.29;86.3 - - None None None
None L-1-40-I None None None None None None PROSEDUR PADA KULIT,
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- 0 - 0 - 0 5331100 14383970 0 4 0
0 0 CHRISTIAN ANDREAS L , AN 00061026 15 5523 DR. RUDI
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3175410 C 3 CS 1 25/05/2023 28/05/2023 20/10/2010 0 1
2721200 0 0 - 0 - 0 - 0 - 0
2721200 49422 0 4 0 0 0 ANDI PAMUNGKAS, AN
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3175410 C 3 CS 1 26/05/2023 28/05/2023 12/10/2007 0 1
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 1206714 0 3 0 0 0 SUGENG RIYADI S,AN
00061104 15 5705 MUSTARI, DR., SP.A 0116R0340523V008632
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c704d2af283f45ebaddea959781d4f18 255000 0 75000 0 0 0
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0
3175410 C 3 CS 1 23/05/2023 28/05/2023 18/07/2008 0 2
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 2951861 0 6 0 0 0 SHAPHIRA NURAENI,AN
0000371285403 3;JKN RSUP;; 5.8.4.202302261000 4 178054
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e9f1d9356a1ec6c96b9c77f59026d5c6 500000 0 488500 0 0
0 0 256500 0 0 925000 0 706723 74228 0
0 0 910
3175410 C 3 CS 1 25/05/2023 28/05/2023 23/02/2022 0 2
2721200 0 0 - 0 - 0 - 0 - 0
2721200 1092349 0 4 0 0 0 AYRA SYAZANI AHMAD,AN
00055663 1 456 MUSTARI, DR., SP.A 0116R0340523V008605
0003256757796 3;JKN RSUP;; 5.8.4.202302261000 4 178061
1#0##0#0#0.0#2023-05-30
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3175410 C 1 CS 1 27/05/2023 28/05/2023 27/02/2000 0 1
(RINGAN) 4497200 0 0 - 0 - 0 - 0 - 0
4497200 778999 0 2 0 0 0 FRANS STEVENARDO H,TN
0116R0340523V008994 0002698915476 3;JKN RSUP;; 5.8.4.202302261000
4 178084 1#0##0#0#0.0#2023-05-30
d5247daeb231125d0418a78184b44ab7 50000 0 102000 0 0 0
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3175410 C 1 CS 1 23/05/2023 28/05/2023 28/09/1985 0 2
0 - 0 - 0 3837600 4356872 0 6 0 0
0 SITI MUNALIFA,NY 00060929 37 13751 SYARIFUDIN, DR., SP.P
0116R0340523V007823 0001641506499 3;JKN RSUP;; 5.8.4.202302261000
4 178089 1#0##0#0#0.0#2023-05-30
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0 0 0
3175410 C 3 CS 1 26/05/2023 28/05/2023 29/12/1959 0 2
1 Z47.0;E11.9 78.63 - - None None None None M-1-40-I None
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POHAN ,AN 00061038 1 528 DR. RUDI HERMANSYAH, SP. B
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YUSUF,TN 00061221 34 12645 FELIX SATWIKA, DR., SP.PD
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3175410 C 3 CS 1 24/05/2023 29/05/2023 06/10/2019 0 2
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3175410 C 3 CS 1 28/05/2023 29/05/2023 31/12/2001 0 2
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1347400 1565758 0 2 0 0 0 EKA DWI DESTIANINGRUM,NY
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3175410 C 3 CS 1 30/04/2023 29/05/2023 04/04/1976 0 2
1 E11.1;E87.1;K75.2 99.18;99.29;90.59 - - None None None None
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3175410 C 3 CS 1 19/05/2023 29/05/2023 03/07/1933 0 1
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0 - 0 3501400 29298131 0 11 0 0 0 SAHMEN
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3175410 C 3 CS 1 28/05/2023 30/05/2023 18/03/1987 0 2
1 O48;O82.9;Z37.0 74.99;03.91;90.59;99.18;99.29 - - None None
CAESAR (RINGAN) 5238800 0 0 - 0 - 0 - 0 -
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0116R0340523V009349 0003075663339 3;JKN RSUP;; 5.8.4.202302261000
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1 O42.1;D64.9;O82.1;Z37.0 74.99;03.91;99.04;99.18;99.21;99.29 - -
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3175410 C 1 CS 1 27/05/2023 30/05/2023 02/05/1998 0 2
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3175410 C 1 CS 1 27/05/2023 30/05/2023 05/06/1991 0 2
1 O42.0;O16;O24.9 90.59;99.18;99.17;99.23;99.29 - - None None
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ANTEPARTUM (SEDANG) 3856500 0 0 - 0 - 0 - 0
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3175410 C 2 CS 1 28/05/2023 30/05/2023 11/09/1993 0 2
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3175410 C 2 CS 1 24/05/2023 30/05/2023 20/09/1985 0 1
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I-4-20-II None None None None None None ANGINA PEKTORIS DAN NYERI
DADA (SEDANG) 4416300 0 0 - 0 - 0 - 0 -
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0000378852164 3;JKN RSUP;; 5.8.4.202302261000 4 178573
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3175410 C 3 CS 1 27/05/2023 30/05/2023 11/05/2012 0 2
LAIN-LAIN (RINGAN) 2269000 0 0 - 0 - 0 - 0
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FREIDEN AWIYARA ,AN 00061199 11 4033 DR. RIADY ASHARI, SP. A
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