+ Tarif Ranap

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
3175410 C 3 CS 1 30/04/2023 01/05/2023 15/07/1987 0 2
1 O13;O80.9;Z37.0 73.59;73.6 - - None None None None O-6-
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0 0 - 0 - 0 - 0 - 0 2780900 603369
0 2 0 0 0 KURNIA NUR ISNAINI, NY 00057622 35 13073
TENGKU MUHAMMAD ISKANDAR, DR., SP.OG 0116R0340423V007831
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0 4 0 0 0 FIE LIN,NN 00057560 21 7822 DR. BETA
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3175410 C 3 CS 1 26/04/2023 01/05/2023 01/02/1967 0 2
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gy_amt":"0","rehab_amt":"0","room_amt":"185000","intensive_amt":"0","drug_amt":"398
6d93866bdffe10ede4b6aac800d430be 30000 0 240000 0 0 0
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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
16:37:51#0#16:22:00#16:22:00#00:00:00#{"co_insidense_ind":"0"}#{"noreg":"2023000107
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"
:
"nursing_amt":"0","ancillary_amt":"0","blood_amt":"0","laboratory_amt":"1302200","r
c98ffbfa7bea3de3b4c952a4f93648df 30000 0 269950 0 0 0
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0 0
3175410 C 3 CS 1 02/05/2023 05/05/2023 22/07/1988 0 2
1 A09.9;E87.6 99.18;99.29;90.59 - - None None None None K-4-
17-II None None None None None None NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN
(SEDANG) 2196300 0 0 - 0 - 0 - 0 - 0
2196300 1312641 0 4 0 0 0 LUTFIA TASMINIYATI ,NY
0116R0340523V000566 0001406612621 3;JKN RSUP;; 5.8.4.202302261000
4 178476 1#0##0#0#0.0#2023-05-30
243b1f518b790618a764acb747122c65 75000 0 160000 0 0 0
0 0 0 0 185000 0 841816 50825 0 0 0
0
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
0 - 0 - 0 - 0 - 0 5262600 1599737
0 3 0 0 0 KURAYATI , NY 00058331 46 16850 DR.
RUDI HERMANSYAH, SP. B 0116R0340523V001546 0000378389676 3;JKN RSUP;;
5.8.4.202302261000 4 178275 1#0##0#0#0.0#2023-05-30
f26df083f3d309c27354708ffb0954fe 0 0 1599737 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
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
0003519252955 3;JKN RSUP;; 5.8.4.202302261000 4 178426
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
None None None None None NEONATAL, BERAT BADAN LAHIR GROUP-5 DENGAN
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;;
5.8.4.202302261000 4 178435 1#0##0#0#0.0#2023-05-30
t_5":
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3175410 C 3 CS 1 06/05/2023 08/05/2023 13/03/1983 0 2
1 O44.1;O86.8 99.18;99.29;90.59 - - None None None None W-4-
16-I None None None None None None GANGGUAN ANTEPARTUM (RINGAN) 2169500
0 0 - 0 - 0 - 0 - 0 2169500
1304152 0 3 0 0 0 UNAH YUNENGSIH, NY 00049980
40 14664 TENGKU MUHAMMAD ISKANDAR, DR., SP.OG 0116R0340523V002223
0001289034099 3;JKN RSUP;; 5.8.4.202302261000 4 171658
1#0##0#0#0.0#2023-05-09
b7492e23d88e2d73cf81903045ffb7e7 525500 0 530000 0 0
0 0 0 0 0 0 0 233756 0 14896 0 0
0
3175410 C 1 CS 1 07/05/2023 08/05/2023 25/02/1985 0 2
- 0 - 0 - 0 - 0 3424200 5109052 0
2 0 0 0 NYI SUMARTINI ,NY 00058241 38 13950 TENGKU
MUHAMMAD ISKANDAR, DR., SP.OG 0116R0340523V002259 0001388601066 3;JKN RSUP;;
5.8.4.202302261000 4 171664 1#0##0#0#0.0#2023-05-09
{"procedure_amt":"322500","surgical_amt":"2565875","consul_amt":"1806125","expert_a
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3175410 C 1 CS 1 04/05/2023 08/05/2023 08/05/1977 0 2
1 I11.9;K30 99.18;99.29;90.59;87.44;89.52 - - None None None
None I-4-17-I None None None None None None HIPERTENSI (RINGAN)
2789500 0 0 - 0 - 0 - 0 - 0
2789500 1049166 0 5 0 0 0 ENUR RATMI.NY
0001614089316 3;JKN RSUP;; 5.8.4.202302261000 4 171666
1#0##0#0#0.0#2023-05-09
45e0e76b3399252f5ddee9c4af963571 0 0 256150 0 0 0
0 116850 0 0 0 0 605159 71007 0 0 0
0
3175410 C 3 CS 1 05/05/2023 08/05/2023 10/10/2002 0 1
1 G43.9 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 1858655 0 4 0 0 0 SALMAN,TN 00058177
20 7512 DR. KHONITA ADIAN UTAMI, SP. N 0116R0340523V001898
0002206786746 3;JKN RSUP;; 5.8.4.202302261000 4 171670
1#0##0#0#0.0#2023-05-09
3523ad51a78dd0df88d4057ef25f7d0d 625000 0 150000 0 0
0 0 0 0 0 740000 0 311173 32482 0 0
0 0
3175410 C 3 CS 1 04/05/2023 08/05/2023 05/11/1978 0 2
1 D27;D64.9;K66.0 68.13;99.04;54.59;99.18;99.29;99.21 - - None
None None None K-1-11-II None None None None None None ADHESIOLISIS
PERITONEAL (SEDANG) 9427500 0 0 - 0 - 0 - 0
- 0 9427500 18228861 0 5 0 0 0 IDA FARIDA,
NY 00057727 44 16251 AHMAD THAMRIN, DR., SP.OG 0116R0340523V001519
0001602774955 3;JKN RSUP;; 5.8.4.202302261000 4 171672
1#0##0#0#0.0#2023-05-09
10:04:56#0#10:01:00#10:01:00#00:00:00#{"co_insidense_ind":"0"}##{"cara_masuk":"outp
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03df436016f466c88742215115759948 572500 7280000 6854480 0
0 0 0 1105120 0 0 0 0 881900 1208882
325979 0 0 0
3175410 C 1 CS 1 06/05/2023 08/05/2023 01/11/1992 0 2
1 O42.0;O13;O82.9;Z37.0 99.29;99.23;99.21;74.99;90.59 - - None
None None None O-6-10-I None None None None None None OPERASI
PEMBEDAHAN CAESAR (RINGAN) 6967500 0 0 - 0 - 0 -
0 - 0 6967500 6461203 0 3 0 0 0 SRI
MULYATI,NY 00058188 30 11143 TENGKU MUHAMMAD ISKANDAR, DR., SP.OG
0116R0340523V001934 0001865055532 3;JKN RSUP;; 5.8.4.202302261000
4 171678 1#0##0#0#0.0#2023-05-09
mt":"392512","device_amt":"717828","consumable_amt":"180113","device_rent_amt":"0",
"drug_chronic_amt":"0","drug_chemo_amt":"0"},"selisih_biaya":
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{"code":"","name":""}} 1 a3a7cbd4bce1a6adb3a79425d1c187e8 241750
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0 392512 717828 180113 0 0 0
3175410 C 3 CS 1 05/05/2023 08/05/2023 03/04/1993 0 2
1 O13;O32.2;O82.9;Z37.0 99.29;99.21;74.99;90.59 - - 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 6109742 0 4 0 0 0 YUD APRIANINGSIH,
NY 00057748 30 10989 TENGKU MUHAMMAD ISKANDAR, DR., SP.OG
0116R0340523V001914 0002597769303 3;JKN RSUP;; 5.8.4.202302261000
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","nursing_amt":"0","ancillary_amt":"0","blood_amt":"0","laboratory_amt":"54000","r
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398520 917901 246321 0 0 0
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
- 0 4337000 1000000 0 1 0 0 0 H.ISMET
USMAN.TN 00014684 71 26062 ASYSYUKRIATI, SP.P ,DR 0116R0340523V003373
0001741154668 3;JKN RSUP;; 5.8.4.202302261000 4 173651
1#0##0#0#0.0#2023-05-22
000231","valid":"1","sitb_response":{"data":
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3175410 C 1 CS 1 13/05/2023 15/05/2023 12/08/1954 0 1
4 I63.9;N18.5;E87.1;J80;I46.9;I49.9 96.71;39.95;38.95;99.18;99.29;99.21
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None PROSEDUR SISTEM PERNAFASAN NON-KOMPLEKS (BERAT) 30929600 0 0
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3 1 3 0 MARYADI,TN 00030434 68 25111 DR. LAILY
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3175410 C 3 CS 1 10/05/2023 15/05/2023 27/04/1994 0 1
1 S42.0 79.39 - - None None None None M-1-60-I None None
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LAIN-LAIN (RINGAN) 6771600 0 0 - 0 - 0 - 0
- 0 6771600 18225549 0 6 0 0 0 TOUFAN
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{"procedure_amt":"317500","surgical_amt":"3640000","consul_amt":"11402400","expert_
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3175410 C 3 CS 1 11/05/2023 15/05/2023 06/02/2005 0 2
1 N83.2;K30 99.29;90.59;88.76;87.44 - - None None None None
W-4-12-I None None None None None None GANGGUAN MENSTRUASI & SISTEM
REPRODUKSI WANITA LAIN-LAIN (RINGAN) 2896600 0 0 - 0 -
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0 NUR RAHMA,NN 00016690 18 6668 DR. BETA AGUSTIA WISMAN,
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4 172454 1#0##0#0#0.0#2023-05-16
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3175410 C 3 CS 1 12/05/2023 15/05/2023 09/08/1971 0 2
1 K21.9 87.49;89.52;90.59;99.21;99.29 - - None None None None
K-4-12-I None None None None None None GANGGUAN ESOFAGUS (RINGAN)
3330600 0 0 - 0 - 0 - 0 - 0
3330600 1932223 0 4 0 0 0 KASWATI,NY 00058418
51 18904 FELIX SATWIKA, DR., SP.PD 0116R0340523V004250
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1#0##0#0#0.0#2023-05-16
798ecad9b3a0efaa1939770bcc801ae1 141750 0 0 0 0 0
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3175410 C 3 CS 1 10/05/2023 15/05/2023 21/06/2004 0 1
1 A91;K30 99.18;99.29;90.59 - - None None None None A-4-
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 3090869 0 6 0 0 0 HAIQAL AQMAL,TN
0001618048181 3;JKN RSUP;; 5.8.4.202302261000 4 172462
1#0##0#0#0.0#2023-05-16
":"1048591","device_amt":"129778","consumable_amt":"0","device_rent_amt":"0","drug_
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3175410 C 3 CS 1 11/05/2023 15/05/2023 10/08/1965 0 2
1 J39.9;L85.3;M54.59;M17.1;I10 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) 1980300 0
0 - 0 - 0 - 0 - 0 1980300 3739685
0 5 0 0 0 MURSIATIN, NY 00058267 57 21093 ADE
DEWI NARALIA, DR. 0116R0340523V004550 0002327473506 3;JKN RSUP;;
5.8.4.202302261000 4 172465 1#0##0#0#0.0#2023-05-16
logy_amt":"160000","rehab_amt":"0","room_amt":"925000","intensive_amt":"0","drug_am
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160000 824200 0 0 925000 0 628301 115000
0 0 0 384
3175410 C 3 CS 1 11/05/2023 15/05/2023 18/11/1978 0 2
1 J18.0;K30 99.18;99.29;90.59;87.44 - - None None None None
COUGH (RINGAN) 3613600 0 0 - 0 - 0 - 0 -
0 3613600 604882 0 5 0 0 0 LILIS ARYANI ,NY
0001744490193 3;JKN RSUP;; 5.8.4.202302261000 4 172473
1#0##0#0#0.0#2023-05-16
{"procedure_amt":"0","surgical_amt":"0","consul_amt":"0","expert_amt":"0","nursing_
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3175410 C 3 CS 1 12/05/2023 15/05/2023 24/05/2010 0 1
1 A09.9;A90 99.18;99.29;90.59;87.44 - - None None None None
- 0 - 0 2196300 695461 0 4 0 0 0
JUAN CHRISTIAN P.A,AN 00058373 12 4736 IRENNE PURNAMA, MSC.,SP.A
0116R0340523V004147 0001624513307 3;JKN RSUP;; 5.8.4.202302261000
4 172824 1#0##0#0#0.0#2023-05-19
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3175410 C 3 CS 1 13/05/2023 15/05/2023 05/07/2017 0 1
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 531254 0 3 0 0 0 AZAM FARIS MAULANA,AN
00060060 5 2138 DR. RAEDY RUWANDA SUSANTO, SP A.
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3175410 C 3 CS 1 12/05/2023 15/05/2023 04/02/2006 0 2
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3175410 C 3 CS 1 12/05/2023 15/05/2023 28/04/2020 0 2
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3613600 2369460 0 4 0 0 0 AIRA CANTKA RAMADHANI,AN
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1#0##0#0#0.0#2023-05-22
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3175410 C 1 CS 1 12/05/2023 15/05/2023 30/05/2020 0 2
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ARETA NADHIRA MECCA,AN 00060024 2 1077 MUSTARI, DR., SP.A
0116R0340523V004270 0003048912347 3;JKN RSUP;; 5.8.4.202302261000
4 173353 1#0##0#0#0.0#2023-05-22
ogy_amt":"178000","rehab_amt":"0","room_amt":"1500000","intensive_amt":"0","drug_am
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3175410 C 1 CS 1 11/05/2023 15/05/2023 03/11/2015 0 2
(RINGAN) 2579000 0 0 - 0 - 0 - 0 - 0
2579000 3607850 0 5 0 0 0 MANDALA HAFIZD
ALFATIH,AN 00058246 7 2746 IRENNE PURNAMA, MSC.,SP.A
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4 173354 1#0##0#0#0.0#2023-05-22
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3175410 C 1 CS 1 03/05/2023 15/05/2023 22/05/1986 0 2
1 I12.0;D63.8 39.95;99.04;99.18;99.29;90.59 - - None None None
0 - 0 4656900 4665591 0 13 0 0 0 FITRIA
RAMADANI,NY 00041263 36 13495 DR. PUJI ASTUTI TRI KUSUMAWATI, SP. PD
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4 173355 1#0##0#0#0.0#2023-05-22
,"nursing_amt":"0","ancillary_amt":"0","blood_amt":"0","laboratory_amt":"2172089","
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3175410 C 1 CS 1 11/05/2023 15/05/2023 24/08/1986 0 1
1 I20.0;K80.8;N20.0;E87.1 99.18;99.29;90.59;87.44;88.76 - - 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 3306590 0 5 0 0 0
RIAN,TN 00058223 36 13409 MARTUA SILALAHI, DR., SP.JP
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4 173356 1#0##0#0#0.0#2023-05-22
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3175410 C 1 CS 1 13/05/2023 15/05/2023 26/06/1986 0 2
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3175410 C 3 CS 1 14/05/2023 16/05/2023 17/08/1960 0 1
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3175410 C 3 CS 1 14/05/2023 16/05/2023 13/02/1995 0 2
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00060086 28 10317 DR. PRIYANKA GANESA UTAMI, SP. N
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3175410 C 3 CS 1 11/05/2023 16/05/2023 25/06/1977 0 2
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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
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5265
3175410 C 3 CS 1 12/05/2023 16/05/2023 31/08/1978 0 2
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0 FITRIAH,NY 00058384 44 16325 FELIX SATWIKA, DR., SP.PD
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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
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3175410 C 1 CS 1 12/05/2023 16/05/2023 13/11/2000 0 1
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3175410 C 1 CS 1 12/05/2023 16/05/2023 02/08/1979 0 2
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3175410 C 1 CS 1 14/05/2023 16/05/2023 30/12/1975 0 2
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5238800 5688037 0 3 0 0 0 SANTA VERONIKA SIBUEA,
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0116R0340523V004654 0000378155079 3;JKN RSUP;; 5.8.4.202302261000
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3175410 C 3 CS 1 14/05/2023 16/05/2023 12/05/1980 0 2
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3175410 C 3 CS 1 13/05/2023 16/05/2023 19/10/1956 0 2
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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
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3855400 0 0 - 0 - 0 - 0 - 0
3855400 2942816 0 4 0 0 0 DJENAH MAGDALENA, NY
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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-
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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
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0001288041581 3;JKN RSUP;; 5.8.4.202302261000 4 173586
1#0##0#0#0.0#2023-05-24
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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
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UTARI ,NY 00051711 53 19368 DR. PRIYANKA GANESA UTAMI, SP. N
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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-
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YOSUA RENHARTA, AN 00060111 11 4187 DR. RAEDY RUWANDA SUSANTO, SP
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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
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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
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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
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0116R0340523V005093 0000377973718 3;JKN RSUP;; 5.8.4.202302261000
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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
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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
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3175410 C 3 CS 1 15/05/2023 17/05/2023 14/04/2000 0 2
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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
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SAMSUDIN,TN 00060075 67 24571 DR. RUDI HERMANSYAH, SP. B
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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
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LAIN (SEDANG) 3278400 0 0 - 0 - 0 - 0 -
0 3278400 1607567 0 3 0 0 0 PATAR TINDAON,TN
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3175410 C 1 CS 1 15/05/2023 17/05/2023 30/11/1972 0 2
1 D21.0 83.39;99.18;99.29;99.21 - - None None None None M-1-
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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
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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,
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4 174331 1#0##0#0#0.0#2023-05-22
9b5fdd326d9c7468f53375a2a5ba5276 0 0 171314 0 0 0
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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
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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
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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
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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
_amt":"319903","device_amt":"33980","consumable_amt":"0","device_rent_amt":"0","dru
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
1 D21.2 83.39;99.18;99.29;90.59 - - None None None None M-1-
6091600 0 0 - 0 - 0 - 0 - 0
6091600 13314885 0 3 0 0 0 RAFFASYA AULIAN,AN
00058322 5 1847 ANDRI SUHANDI, DR., SP. B 0116R0340523V005090
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
1 K30 99.18;99.29;90.59;87.44 - - 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 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
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) 1422200 0
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
:"214732","device_amt":"8150","consumable_amt":"0","device_rent_amt":"0","drug_chro
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
1 N92.1 69.09 - - None None None None W-1-11-I None None
None None None None PROSEDUR DILATASI, KURET, INTRAUTERIN & SERVIK
(RINGAN) 2371700 0 0 - 0 - 0 - 0 - 0
2371700 4185555 0 2 0 0 0 AGUSTINA,NY 00047819
30 11233 AHMAD THAMRIN, DR., SP.OG 0116R0340523V005572
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
SUHANDI, DR., SP. B 0116R0340523V005089 0001609426462 3;JKN RSUP;;
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
None J-4-15-II None None None None None None PERADANGAN DAN INFEKSI
- 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
None J-4-15-I None None None None None None PERADANGAN DAN INFEKSI
- 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
evice_amt":"63385","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0
","drug_chemo_amt":"0"},"selisih_biaya":
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
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) 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
None None None None None PROSEDUR JARINGAN LUNAK (RINGAN) 6091600
0 0 - 0 - 0 - 0 - 0 6091600
12287195 0 3 0 0 0 SRIYANTO,TN 00060264 66 24329
ANDRI SUHANDI, DR., SP. B 0116R0340523V005080 0000045764616 3;JKN
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
1 J22 99.18;99.29;90.59 - - None None None None J-4-21-I
None None None None None None GEJALA, TANDA DAN DIAGNOSIS SISTEM
PERNAFASAN LAIN-LAIN (RINGAN) 3837600 0 0 - 0 - 0 -
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
"device_amt":"0","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0",
"drug_chemo_amt":"0"},"selisih_biaya":
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
1 J22 99.18;99.29;90.59;87.44 - - None None None None J-4-
21-I None None None None None None GEJALA, TANDA DAN DIAGNOSIS SISTEM
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","
drug_chemo_amt":"0"},"selisih_biaya":
60e9bfa835c1e139528311e0337d5774 0 0 18700 0 0 0 0
355300 0 0 0 0 50666 0 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
M-4-17-I None None None None None None MASALAH BAGIAN
PUNGGUNG/PINGGANG BELAKANG (RINGAN) 2969500 0 0 - 0 - 0
- 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
logy_amt":"1157500","rehab_amt":"0","room_amt":"0","intensive_amt":"0","drug_amt":"
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",
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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
amt":"0","ancillary_amt":"0","blood_amt":"0","laboratory_amt":"275000","radiology_a
mt":"0","rehab_amt":"0","room_amt":"0","intensive_amt":"0","drug_amt":"745426","dev
ice_amt":"22294","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0",
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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
SUSANTO, SP A. 0116R0340523V005367 0002077390236 3;JKN RSUP;;
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
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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
60 22048 DR. LAILY RIDAWATI, SP.PD 0116R0340523V004569
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
K-4-18-I None None None None None None GANGGUAN SISTEM PENCERNAAN
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
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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
t":"524133","device_amt":"241211","consumable_amt":"326","device_rent_amt":"0","dru
c16f1c91b479216aa1001e1468fdbe24 752500 0 815350 0 0
0 0 386650 0 0 2305000 0 524133 241211
326 0 0 0
3175410 C 3 CS 1 17/05/2023 18/05/2023 05/10/1994 0 2
1 O15.1;O80.9;Z37.0 73.59;73.6 - - None None None None O-6-
13-III None None None None None None PERSALINAN VAGINAL (BERAT)
3482500 0 0 - 0 - 0 - 0 - 0
3482500 3735754 0 2 0 0 0 RIA ANITA PUTRI,NY
0116R0340523V005588 0002103171175 3;JKN RSUP;; 5.8.4.202302261000
4 174973 1#0##0#0#0.0#2023-05-23
{"code":"","name":""}} 1 0fb9bd3916d69f3efa5fdbdec48466e4 753000 0
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481383 443371 0 0 0 0
3175410 C 3 CS 1 16/05/2023 18/05/2023 10/06/1991 0 2
1 O11;O82.9;Z37.0 74.99 - - None None None None O-6-10-I
5238800 0 0 - 0 - 0 - 0 - 0
5238800 4714604 0 3 0 0 0 HANIFAH ,NY 00060281
31 11663 FAY FERRY PARDOMUAN LAMBOK P. SIMANJUNTAK, DR., SP. OG
0116R0340523V005115 0002332072541 3;JKN RSUP;; 5.8.4.202302261000
4 174988 1#0##0#0#0.0#2023-05-23
06834","device_amt":"568376","consumable_amt":"98394","device_rent_amt":"0","drug_c
{"code":"","name":""}} 1 50511107a77c36e0b3dbdcb9c575ab47 461000
3020000 160000 0 0 0 0 0 0 0 0 0
406834 568376 98394 0 0 0
3175410 C 1 CS 1 17/05/2023 18/05/2023 05/03/1981 0 2
(RINGAN) 3154300 0 0 - 0 - 0 - 0 - 0
3154300 5431367 0 2 0 0 0 DAHLIA, NY 00060429
42 15413 FAY FERRY PARDOMUAN LAMBOK P. SIMANJUNTAK, DR., SP. OG
0116R0340523V005777 0001654714945 3;JKN RSUP;; 5.8.4.202302261000
4 175000 1#0##0#0#0.0#2023-05-23
8fc041b67c06bcaffd2104d5af8ffa3b 220500 2565875 1858125 0
0 0 0 0 0 0 0 0 164830 569178 52859
0 0 0
3175410 C 3 CS 1 15/05/2023 18/05/2023 16/03/2004 0 2
None None None None PROSEDUR PADA RAHIM & ADNEKSA (RINGAN) 6653700
0 0 - 0 - 0 - 0 - 0 6653700
9740892 0 4 0 0 0 SYIFA ISTIANATULLAILA, NN
0001267784752 3;JKN RSUP;; 5.8.4.202302261000 4 175022
1#0##0#0#0.0#2023-05-23
47067cfdf66bc8d76b0ebce6ee7e0f07 448500 3900000 3760000 0
0 0 0 450000 0 0 0 0 318908 656005
207479 0 0 0
3175410 C 3 CS 1 17/05/2023 18/05/2023 26/02/1998 0 2
13-I None None None None None None PERSALINAN VAGINAL (RINGAN) 2173900
0 0 - 0 - 0 - 0 - 0 2173900
1068003 0 2 0 0 0 SITI KHOTIJAH,NY 00060411 25
0000620469617 3;JKN RSUP;; 5.8.4.202302261000 4 175035
1#0##0#0#0.0#2023-05-23
{"code":"","name":""}} 1 37e70b03619ed67009830ef2cdfbc9ee 316400 0
218400 0 0 0 0 91200 0 0 0 0 157708
284295 0 0 0 0
3175410 C 1 CS 1 13/05/2023 18/05/2023 06/03/2022 0 1
4 G41.8;J18.0;J96.0;E87.8;I46.9 38.97;96.72;99.18;99.29;90.59;87.44 -
- None None None None J-1-02-III None None None None None None
VENTILASI MEKANIKAL LONG TERM TANPA TRAKEOSTOMI (BERAT) 71028100 0
0 - 0 - 0 - 0 - 0 71028100 36406079
0 6 1 6 0 NAUFAL AZKAR SAPUTRO, AN 00058362 1
433 DR. RIADY ASHARI, SP. A 0116R0340523V003911 0003267249759 3;JKN
RSUP;; 5.8.4.202302261000 4 175056 1#0##0#0#0.0#2023-05-23
88800","radiology_amt":"255000","rehab_amt":"0","room_amt":"0","intensive_amt":"0",
"drug_amt":"6895880","device_amt":"3871571","consumable_amt":"163872","device_rent_
amt":"0","drug_chronic_amt":"0","drug_chemo_amt":"256"},"selisih_biaya":
74cf5839625af621bf3b33be3304b5d6 2673100 8320000 8237600 0
0 0 255000 5988800 0 0 0 0 6895880
3871571 163872 0 0 256
3175410 C 3 CS 1 15/05/2023 18/05/2023 11/08/2002 0 2
1 J18.0;K30 99.18;99.29;90.59 - - None None None None J-4-
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 587757 0 4 0 0 0 TRI ANGGRAINI, NN
0116R0340523V005105 0000377046742 3;JKN RSUP;; 5.8.4.202302261000
4 174669 1#0##0#0#0.0#2023-05-29
a521a21f7c7ecaf8d0ae2c3864b3ded6 0 0 3900 0 0 0 0
194100 0 0 0 0 372084 17673 0 0 0 0
3175410 C 1 CS 1 15/05/2023 18/05/2023 24/12/1999 0 2
(RINGAN) 4806100 0 0 - 0 - 0 - 0 - 0
4806100 1149215 0 4 0 0 0 DIAH FITRI NURAINI ,NN
0116R0340523V004649 0001429727332 3;JKN RSUP;; 5.8.4.202302261000
4 174719 1#0##0#0#0.0#2023-05-29
3fa927ff646f2b8cc5c15567ec4227b5 0 0 33450 0 0 0 0
635550 0 0 0 0 450983 29232 0 0 0 0
3175410 C 3 CS 1 15/05/2023 18/05/2023 12/03/1992 0 1
1 J18.0;A90 99.18;99.29;90.59 - - None None None None J-4-
(SEDANG) 5078100 0 0 - 0 - 0 - 0 - 0
5078100 900767 0 4 0 0 0 MARIO TRI RAMADHAN ,TN
0116R0340523V005086 0000378209395 3;JKN RSUP;; 5.8.4.202302261000
4 174945 1#0##0#0#0.0#2023-05-29
95a2a84aaf52dfdf1e804c361a37aa97 217500 0 202200 0 0
0 0 231800 0 0 0 0 224492 24775 0 0
0 0
3175410 C 3 CS 1 15/05/2023 18/05/2023 30/09/2000 0 1
1 J39.9 99.18;99.29;90.59 - - None None None None U-4-13-I
None None None None None None PERADANGAN EPIGLOTIS, TELINGA TENGAH,
- 0 - 0 1980300 914331 0 4 0 0 0
A HARIS,TN 00013110 22 8262 DR. PUJI ASTUTI TRI KUSUMAWATI, SP. PD
0116R0340523V004898 0000379132356 3;JKN RSUP;; 5.8.4.202302261000
4 174959 1#0##0#0#0.0#2023-05-29
f6ec70a09ad02bc2552bcb2b5d9bc06a 417500 0 162700 0 0
0 0 51300 0 0 0 0 261604 21227 0 0 0
0
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-
LAIN (RINGAN) 3381400 0 0 - 0 - 0 - 0 -
0 3381400 1742714 0 4 0 0 0 YATIPAH,NY
0116R0340523V005106 0000378542979 3;JKN RSUP;; 5.8.4.202302261000
4 175102 1#0##0#0#0.0#2023-05-23
mt":"329000","rehab_amt":"0","room_amt":"0","intensive_amt":"0","drug_amt":"1151046
d8c0550008f61bf0be6a09c324f73c09 0 0 141000 0 0 0
329000 0 0 0 0 0 1151046 121668 0 0
0 0
3175410 C 3 CS 1 16/05/2023 19/05/2023 12/05/2002 0 2
LAIN-LAIN (RINGAN) 2269000 0 0 - 0 - 0 - 0
- 0 2269000 711553 0 4 0 0 0 ULAN AMELIA,
NN 00060318 21 7674 FELIX SATWIKA, DR., SP.PD 0116R0340523V005436
0001289179078 3;JKN RSUP;; 5.8.4.202302261000 4 175120
1#0##0#0#0.0#2023-05-23
195deb5d598ed88c700dae7edefcffe2 0 0 0 0 0 0 0
0 0 0 0 0 666067 45486 0 0 0 0
3175410 C 3 CS 1 15/05/2023 19/05/2023 06/02/1999 0 1
- 0 - 0 2196300 959184 0 5 0 0 0
BIMA,TN 00060137 24 8864 DR. PUJI ASTUTI TRI KUSUMAWATI, SP. PD
0116R0340523V004819 0000378971188 3;JKN RSUP;; 5.8.4.202302261000
4 175126 1#0##0#0#0.0#2023-05-23
16b9717803c01082921a9ef663f5c1c5 0 0 0 0 0 0 0
0 0 0 0 0 911333 47851 0 0 0 0
3175410 C 3 CS 1 14/05/2023 19/05/2023 15/04/2003 0 2
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
0001739475009 3;JKN RSUP;; 5.8.4.202302261000 4 175139
1#0##0#0#0.0#2023-05-23
[{"id":"2022000133871298","nama":"APRELIA DWI PRATIWI
HASIBUAN","nik":"3172045504031006","jenis_kelamin_id":"2"}],"success":true}}#{"cara
_masuk":"gp","sistole":"0","diastole":"0","total_tarif_rs":"940954","billing_group"
:
mt":"165561","consumable_amt":"0","device_rent_amt":"0","drug_chronic_amt":"0","dru
g_chemo_amt":"0"},"selisih_biaya":
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0 0 0 0 0 775393 165561 0 0 0 0
3175410 C 1 CS 1 15/05/2023 19/05/2023 04/06/1986 0 2
(RINGAN) 2579000 0 0 - 0 - 0 - 0 - 0
2579000 405438 0 5 0 0 0 LAILA JAMILAH, NY
0116R0340523V005096 0002305912904 3;JKN RSUP;; 5.8.4.202302261000
4 175179 1#0##0#0#0.0#2023-05-23
mt":"51552","consumable_amt":"12233","device_rent_amt":"0","drug_chronic_amt":"0","
aee8e2ed414ef0378ecea70dd39cbdb1 0 0 0 0 0 0 0
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3175410 C 1 CS 1 16/05/2023 19/05/2023 26/09/1979 0 2
1 M65.44 82.01 - - None None None None M-1-80-I None
None None None None None PROSEDUR ANGGOTA TUBUH ATAS (RINGAN)
9313000 0 0 - 0 - 0 - 0 - 0
9313000 27428393 0 4 0 0 0 SRI RAHAYUNINGSIH,NY
0000195198985 3;JKN RSUP;; 5.8.4.202302261000 4 175191
1#0##0#0#0.0#2023-05-23
"0","nursing_amt":"0","ancillary_amt":"0","blood_amt":"0","laboratory_amt":"0","rad
ecc14786cf3db2276f72729337c5d0c5 0 8580000 17105000 0 0
0 0 0 0 0 0 0 724375 903226 115792
0 0 0
3175410 C 1 CS 1 16/05/2023 19/05/2023 11/12/1996 0 2
1 J39.9;I10;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 431756 0 4
0 0 0 YUSNIAT KRISNAYANTI Z,NN 00060405 26 9652 FELIX
SATWIKA, DR., SP.PD 0116R0340523V005573 0002150281045 3;JKN RSUP;;
5.8.4.202302261000 4 175197 1#0##0#0#0.0#2023-05-23
mt":"54217","consumable_amt":"22685","device_rent_amt":"0","drug_chronic_amt":"0","
5067bc734ea7cc32a7a293eece50eb48 0 0 0 0 0 0 0
0 0 0 0 0 354854 54217 22685 0 0 0
3175410 C 3 CS 1 16/05/2023 19/05/2023 02/03/2022 0 1
(RINGAN) 3613600 0 0 - 0 - 0 - 0 - 0
3613600 2191672 0 4 0 0 0 AHMAD IKHRAM MAULANA,AN
0116R0340523V005443 0003258056676 3;JKN RSUP;; 5.8.4.202302261000
4 175231 1#0##0#0#0.0#2023-05-23
nursing_amt":"0","ancillary_amt":"0","blood_amt":"0","laboratory_amt":"51300","radi
ology_amt":"0","rehab_amt":"0","room_amt":"740000","intensive_amt":"0","drug_amt":"
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0 51300 0 0 740000 0 307443 192229 0 0
0 0
3175410 C 3 CS 1 17/05/2023 19/05/2023 01/04/2013 0 2
- 0 - 0 2196300 1944341 0 3 0 0 0
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3175410 C 1 CS 1 19/05/2023 22/05/2023 31/01/1982 0 2
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0 10108900 16036758 0 4 0 0 0 SUHARDI
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3175410 C 1 CS 1 21/05/2023 22/05/2023 10/02/1969 0 2
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FATIMAH,NY 00019849 54 19823 DR. LAILY RIDAWATI, SP.PD
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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
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0001224651341 3;JKN RSUP;; 5.8.4.202302261000 4 176633
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2579000 991442 0 4 0 0 0 RIZKI PIRMANSAH,TN
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3175410 C 1 CS 1 18/05/2023 22/05/2023 05/01/1985 0 2
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3175410 C 1 CS 1 18/05/2023 22/05/2023 22/05/2008 0 1
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3175410 C 3 CS 1 21/05/2023 22/05/2023 29/12/2010 0 2
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3175410 C 3 CS 1 17/05/2023 22/05/2023 06/05/1948 0 2
1 I12.0;D64.9;K80.8 38.95;39.95;99.18;99.29;90.59;99.04 - - None
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3175410 C 3 CS 1 19/05/2023 22/05/2023 25/12/1971 0 1
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4 176679 1#0##0#0#0.0#2023-05-26
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3175410 C 3 CS 1 19/05/2023 22/05/2023 30/03/1993 0 1
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0 - 0 2269000 1338507 0 4 0 0 0 IMAN
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3175410 C 3 CS 1 19/05/2023 22/05/2023 25/06/1979 0 1
1 K35.2 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 8492627 0 4 0 0 0 WARID, TN 00060627
43 16034 DR. RUDI HERMANSYAH, SP. B 0116R0340523V006154
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3175410 C 3 CS 1 19/05/2023 22/05/2023 28/01/1984 0 1
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3175410 C 3 CS 1 19/05/2023 22/05/2023 14/06/1959 0 2
1 E11.9;T38.3;E87.8 99.18;99.29;90.59 - - None None None None
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0 HJ SAONIH BT NASA,NY 00054025 63 23350 BETA AGUSTIA WISMAN,
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3175410 C 3 CS 1 19/05/2023 22/05/2023 27/09/2000 0 2
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3175410 C 1 CS 1 21/05/2023 22/05/2023 02/11/1976 0 2
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3154300 5273890 0 2 0 0 0 LATIPAH BT. NURYASIN, NY
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3175410 C 3 CS 1 19/05/2023 22/05/2023 05/08/1960 0 2
3 D43.2;G94.1;G93.6;G40.8 89.52;99.29;99.21;90.59;87.49 - - None
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PENYAKIT SISTEM SARAF LAIN-LAIN (SEDANG) 3733600 0 0 - 0 -
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0 H. BADOHOWI BIN LAMIN .TN 00060640 62 22932 DR. KHONITA ADIAN
5.8.4.202302261000 4 176773 1#0##0#0#0.0#2023-05-26
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3175410 C 3 CS 1 19/05/2023 22/05/2023 06/05/1992 0 1
1 I86.1;L04.3 87.49;90.59;99.21;99.29 - - None None None None
V-4-11-I None None None None None None PENYAKIT SISTEM REPRODUKSI
LAKI-LAKI SELAIN TUMOR (RINGAN) 2973600 0 0 - 0 - 0
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MUHAMAD NUR SIREGAR ,TN 00019313 31 11335 ANDRI SUHANDI, DR., SP. B
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3175410 C 3 CS 1 21/05/2023 22/05/2023 30/11/1996 0 2
1 O20.0 90.59;99.29 - - None None None None W-4-14-I None
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3175410 C 3 CS 1 18/05/2023 22/05/2023 18/10/1961 0 1
1 E11.9;A16.2;I11.9;E87.1 99.18;99.29;90.59;87.44 - - None None
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3175410 C 3 CS 1 18/05/2023 22/05/2023 16/03/1964 0 2
1 J18.0;I10 99.18;99.29;99.21;90.59;87.44 - - None None None
- 0 3613600 1321732 0 5 0 0 0 NURAINI, NY
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4 176215 1#0##0#0#0.0#2023-05-29
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3175410 C 3 CS 1 18/05/2023 22/05/2023 11/05/2007 0 2
1 D21.3;J18.0 99.18;99.29;90.59;87.44 - - None None None None
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3175410 C 3 CS 1 20/05/2023 22/05/2023 04/10/2018 0 2
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3175410 C 3 CS 1 21/05/2023 22/05/2023 15/10/1950 0 1
1 J22;M54.57;I44.2 99.18;99.29;87.44;90.59 - - None None None
None J-4-21-II None None None None None None GEJALA, TANDA DAN
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3175410 C 1 CS 1 20/05/2023 23/05/2023 08/03/1995 0 2
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2579000 4632149 0 4 0 0 0 WANDA FAUZIA, NY
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3175410 C 3 CS 1 21/05/2023 23/05/2023 12/09/1966 0 1
1 E11.2;E87.1 99.18;99.29;90.59;87.44 - - None None None None
N-4-16-II None None None None None None PENYAKIT GINJAL DAN SALURAN
URIN LAIN-LAIN (SEDANG) 4247600 0 0 - 0 - 0 - 0
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3175410 C 1 CS 1 18/05/2023 23/05/2023 23/02/1999 0 2
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4497200 2523968 0 6 0 0 0 OLIVIA WIDHA P,NN
0116R0340523V006094 0001224172653 3;JKN RSUP;; 5.8.4.202302261000
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N-4-13-I None None None None None None BATU URIN (RINGAN)
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1 S62.60 79.34 - - None None None None M-1-80-I None
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7002300 16675791 0 6 0 0 0 YOEL JERICO SIHOMBING,AN
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1 K40.9;I25.1 99.18;99.29;90.59;53.21 - - None None None None
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1 K21.9;E87.8 89.52;87.44;87.49;90.59;99.29 - - None None None
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3175410 C 1 CS 1 24/05/2023 27/05/2023 28/05/1978 0 2
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RIA ANGGRAENI,NY 00060999 44 16432 FELIX SATWIKA, DR., SP.PD
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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
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3175410 C 1 CS 1 23/05/2023 27/05/2023 10/08/1996 0 2
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3175410 C 1 CS 1 24/05/2023 27/05/2023 08/05/2022 0 2
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3175410 C 1 CS 1 24/05/2023 27/05/2023 27/07/1968 0 2
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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
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3175410 C 1 CS 1 25/05/2023 27/05/2023 14/02/1984 0 2
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3175410 C 1 CS 1 26/05/2023 27/05/2023 19/10/1991 0 2
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3175410 C 1 CS 1 24/05/2023 27/05/2023 08/04/1974 0 2
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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
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NYERI DADA (RINGAN) 4189600 0 0 - 0 - 0 - 0
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SILAEN ,NY 00017441 59 21703 MARTUA SILALAHI, DR., SP.JP
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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
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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
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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
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LESTARI,NY 00037034 28 10257 DR. LAILY RIDAWATI, SP.PD
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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
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SULISTIOWATI,NY 00041939 39 14541 MARTUA SILALAHI, DR., SP.JP
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4 178033 1#0##0#0#0.0#2023-05-30
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3175410 C 3 CS 1 24/05/2023 28/05/2023 04/09/2000 0 2
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3175410 C 1 CS 1 25/05/2023 28/05/2023 10/04/2008 0 1
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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
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1939100 1206714 0 3 0 0 0 SUGENG RIYADI S,AN
00061104 15 5705 MUSTARI, DR., SP.A 0116R0340523V008632
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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
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3175410 C 3 CS 1 25/05/2023 28/05/2023 23/02/2022 0 2
1 R50.9 90.59;99.18;99.29 - - None None None None A-4-12-I
None None None None None None DEMAM YANG TIDAK DITENTUKAN (RINGAN)
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
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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
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3175410 C 1 CS 1 23/05/2023 28/05/2023 28/09/1985 0 2
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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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INTERNAL (RINGAN) 4052400 0 0 - 0 - 0 - 0 -
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1#0##0#0#0.0#2023-05-30
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3175410 C 3 CS 1 23/05/2023 28/05/2023 20/05/2002 0 1
1 J22;A91 90.59;99.18;99.21;99.29 - - None None None None
J-4-21-III None None None None None None GEJALA, TANDA DAN DIAGNOSIS
SISTEM PERNAFASAN LAIN-LAIN (BERAT) 6486300 0 0 - 0 - 0
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RANGGA ADITYA, TN 00060890 21 7673 SYARIFUDIN, DR., SP.P
0116R0340523V008150 proses pembuatan 3;JKN RSUP;; 5.8.4.202302261000
4 178102 1#0##0#0#0.0#2023-05-30
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0 0
3175410 C 3 CS 1 22/05/2023 28/05/2023 31/12/1957 0 2
1 A30.1;I25.9 90.59;91.69;99.18;99.21;99.29 - - None None None
- 0 - 0 2269000 2269009 0 7 0 0 0
SITI,NY 00060761 65 23883 DR. ASYSYUKRIATI, SP.P
0116R0340523V007179 0000380139074 3;JKN RSUP;; 5.8.4.202302261000
4 178105 1#0##0#0#0.0#2023-05-30
953b8709a221a83754ce48d3dbb5a97a 100000 0 89300 0 0 0
0 176700 0 0 0 0 1723235 179774 0 0
0 0
3175410 C 3 CS 1 22/05/2023 28/05/2023 05/11/1966 0 2
1 E11.9;I10;I25.1 90.59;99.18;99.29 - - None None None None
E-4-10-I None None None None None None PENYAKIT KENCING MANIS &
0 - 0 - 0 3611500 4645433 0 7 0 0
0 WARTINI,NY 00060831 56 20652 DR. ASYSYUKRIATI, SP.P
0116R0340523V007385 0000379132615 3;JKN RSUP;; 5.8.4.202302261000
4 178109 1#0##0#0#0.0#2023-05-30
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3175410 C 3 CS 1 25/05/2023 28/05/2023 07/12/1993 0 1
(RINGAN) 1939100 0 0 - 0 - 0 - 0 - 0
1939100 880581 0 4 0 0 0 TOPAN ARYO SEGARA ,TN
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1#0##0#0#0.0#2023-05-30
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3175410 C 3 CS 1 25/05/2023 28/05/2023 09/09/1970 0 1
1 I21.9;N30.9;K30;I50.9 89.52;90.59;99.18;99.21;99.29 - - None
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MYOKARD AKUT (SEDANG) 5638000 0 0 - 0 - 0 - 0
- 0 5638000 1814845 0 4 0 0 0 AHMAD YANI,
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1#0##0#0#0.0#2023-05-30
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1 T21.3 86.3 - - None None None None L-1-40-I None None
None None None None PROSEDUR PADA KULIT, JA(RINGAN) BAWAH KULIT DAN
PAYUDARA (RINGAN) 4008400 0 0 - 0 - 0 - 0 -
0 4008400 9557404 0 4 0 0 0 SULHANMIL
POHAN ,AN 00061038 1 528 DR. RUDI HERMANSYAH, SP. B
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3175410 C 3 CS 1 24/05/2023 28/05/2023 02/03/1973 0 1
1 A15.0;N39.0 90.59;91.34;88.76;99.18;99.21;99.29 - - 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 522622 0 5 0 0 0 LUIS
MARIA D.S ,TN 00043395 50 18345 DR. ASYSYUKRIATI, SP.P
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040322","valid":"1","sitb_response":{"data":[{"id":"2022000134040322","nama":"LUIS
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3175410 C 3 CS 1 25/05/2023 29/05/2023 02/02/1966 0 2
1 M48.06;S13.4;E11.9;I25.1 99.29 - - None None None None
- 0 - 0 2969500 4708833 0 5 0 0 0
MATYASIN,TN 00052895 57 20931 DR. KHONITA ADIAN UTAMI, SP. N
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3175410 C 3 CS 1 26/05/2023 29/05/2023 05/06/1969 0 2
1 E11.9;I10;D63.8;E87.6 99.29;99.18;90.59 - - None None None
0 - 0 - 0 5046400 6372600 0 4 0 0
0 ETY HERAWATI,NY 00061102 53 19713 DR. LAILY RIDAWATI, SP.PD
0116R0340523V008628 0001216509017 3;JKN RSUP;; 5.8.4.202302261000
4 178120 1#0##0#0#0.0#2023-05-30
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2834 0 0 0
3175410 C 3 CS 1 27/05/2023 29/05/2023 08/04/1957 0 2
1 E11.9;I11.9;E87.6 89.52;99.29;99.18;90.59 - - None None None
0 - 0 - 0 5046400 4259786 0 3 0 0
0 SELVI MARIA LIAMDO,NY 00018407 66 24155 DR. PUJI ASTUTI TRI
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0 0 0 0
3175410 C 3 CS 1 24/05/2023 29/05/2023 18/06/1992 0 2
1 K21.9;N23 90.59;99.29 - - None None None None K-4-12-I
0 0 - 0 - 0 - 0 - 0 3330600
6758411 0 6 0 0 0 ANAH ROSANDI, NY 00041876 30
11297 FELIX SATWIKA, DR., SP.PD 0116R0340523V008265 0001225988728
3;JKN RSUP;; 5.8.4.202302261000 4 178145 1#0##0#0#0.0#2023-
05-30
974721204f5564f350816ad7f382e377 955750 0 0 0 0 0
200000 267150 0 0 2370000 0 1701124 1264387
0 0 0 0
3175410 C 1 CS 1 28/05/2023 29/05/2023 13/10/1988 0 1
LAIN-LAIN (RINGAN) 3017700 0 0 - 0 - 0 - 0
- 0 3017700 2015278 0 2 0 0 0 AHMAD
YUSUF,TN 00061221 34 12645 FELIX SATWIKA, DR., SP.PD
0116R0340523V009321 0001628096073 3;JKN RSUP;; 5.8.4.202302261000
4 178146 1#0##0#0#0.0#2023-05-30
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3175410 C 1 CS 1 27/05/2023 29/05/2023 10/06/1967 0 2
(RINGAN) 2174700 0 0 - 0 - 0 - 0 - 0
2174700 3313266 0 3 0 0 0 HJ. SITI BADIAH, NY
0116R0340523V009241 0001223922611 3;JKN RSUP;; 5.8.4.202302261000
4 178150 1#0##0#0#0.0#2023-05-30
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0 0 0
3175410 C 3 CS 1 22/05/2023 29/05/2023 15/12/1949 0 1
1 J18.0;E87.2;E87.6;N17.9;J80 99.18;99.29;90.59;93.960 - -
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 22739962 0 8 1 5 0
IRSAD,TN 00056985 73 26821 SYARIFUDIN, DR., SP.P
0116R0340523V007148 0001150890467 3;JKN RSUP;; 5.8.4.202302261000
4 178149 1#0##0#0#0.0#2023-05-30
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0 3154443 0 0 0 0 13504130 5956158 0 0
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3175410 C 3 CS 1 25/05/2023 30/05/2023 25/05/2023 3150 2
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t_5":
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Copyright:

Available Formats

KODE_RS KELAS_RS KELAS_RAWAT KODE_TARIF PTD ADMISSION_DATE

DISCHARGE_DATE BIRTH_DATE BIRTH_WEIGHT SEX DISCHARGE_STATUS

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