RS.

ASY-SYIFA MEDIKA
Daya Asri, Tulang Bawang Barat, Lampung
0853 2939 8399
E-mail : asyifa_medika@yahoo.co.id

DATA TINDAKAN/PERAWATAN/TAGIHAN

Kode NAMA PERAWATAN/TINDAKAN/TAGIHAN KATEGORI J.S. R.S. BHP/Paket Obat JASA MEDIS DR JASA MEDIS PR KSO MENEJEMEN TOTAL BIAYA DR TOTAL BIAYA PR TTL BIAYA DR PR
RI22621 Pasang Infus RAWAT INAP Rp 6,500.00 13,000 0 0 0 19,500 39,000 0 0
ICU/PICU
RI22639 Pasang Infus RAWAT INAP Rp 6,500.00 13,000 0 0 0 19,500 39,000 0 0
ICU/PICU
RI22660 ASUHAN KEPERAWATAN RAWAT INAP Rp 0.00 0 0 50,000 0 25,000 0 75,000 0
ICU/PICU
RI22661 JASA DPJP RAWAT INAP Rp 0.00 0 120,000 0 0 80,000 200,000 0 0
ICU/PICU
RI22662 JASA DOKTER ANESTESI RAWAT INAP Rp 0.00 0 120,000 0 0 80,000 200,000 0 0
ICU/PICU
RI22663 JASA DOKTER UMUM RAWAT INAP Rp 0.00 0 50,000 0 0 30,000 80,000 0 0
ICU/PICU
RI22664 Administrasi Rawat inap RAWAT INAP Rp 0.00 0 0 0 0 65,000 65,000 0 0
ICU/PICU
RI22665 INFANT WARMER RAWAT INAP Rp 100,000.00 0 0 0 0 0 100,000 0 0
ICU/PICU
RI22667 Observasi RAWAT INAP Rp 0.00 0 0 100,000 0 0 100,000 0 0
ICU/PICU
RI22668 PEMASANGAN INFUS PUMP RAWAT INAP Rp 25,000.00 0 0 25,000 0 0 0 0 50,000
ICU/PICU
RI22669 SUCTION RAWAT INAP Rp 60,000.00 0 0 10,000 0 0 0 70,000 0
ICU/PICU
RI22670 SUCTION RAWAT INAP Rp 60,000.00 0 0 10,000 0 0 0 70,000 0
ICU/PICU
RI22671 Ambulance Asy-Syifa medika ke Metro AMBULANCE Rp 675,000.00 0 0 0 0 0 675,000 0 0
RI22674 ASUHAN KEPERAWATAN RAWAT INAP Rp 0.00 0 0 50,000 0 25,000 0 75,000 0
ICU/PICU
RI22675 JASA DPJP RAWAT INAP Rp 0.00 0 120,000 0 0 80,000 200,000 0 0
ICU/PICU
RI22676 JASA DOKTER ANESTESI RAWAT INAP Rp 0.00 0 120,000 0 0 80,000 200,000 0 0
ICU/PICU
RI22677 JASA DOKTER UMUM RAWAT INAP Rp 0.00 0 50,000 0 0 30,000 80,000 0 0
ICU/PICU
RI22678 PEMBERIAN NUTRISI ENTERNAL RAWAT INAP Rp 10,000.00 0 0 10,000 0 0 0 20,000 0
ICU/PICU
RI22679 PEMBERIAN NUTRISI ENTERNAL RAWAT INAP Rp 10,000.00 0 0 10,000 0 0 0 20,000 0
ICU/PICU
RI22680 PERAWATAN DECUBITUS RAWAT INAP Rp 25,000.00 0 0 25,000 0 0 0 50,000 0
ICU/PICU
RI22681 Pasang Oksigen RAWAT INAP Rp 6,500.00 6,500 0 0 0 6,500 19,500 0 0
ICU/PICU
RI22682 Pasang Cateter RAWAT INAP Rp 6,500.00 13,000 0 0 0 45,500 0 65,000 0

8/30/23, 3:30 PM Page 1 of 4

Kode NAMA PERAWATAN/TINDAKAN/TAGIHAN KATEGORI J.S. R.S. BHP/Paket Obat JASA MEDIS DR JASA MEDIS PR KSO MENEJEMEN TOTAL BIAYA DR TOTAL BIAYA PR TTL BIAYA DR PR
ICU/PICU
RI22683 Pasang NGT RAWAT INAP Rp 6,500.00 19,500 0 0 0 39,000 0 65,000 0
ICU/PICU
RI22685 Observasi RAWAT INAP Rp 0.00 0 0 100,000 0 0 100,000 0 0
ICU/PICU
RI22686 PEMASANGAN INFUS PUMP RAWAT INAP Rp 25,000.00 0 0 25,000 0 0 0 50,000 0
ICU/PICU
RI22687 MONITOR EKG RAWAT INAP Rp 50,000.00 0 0 0 0 0 50,000 0 0
ICU/PICU
RI22688 PERAWATAN JENAZAH RAWAT INAP Rp 5,000.00 15,000 0 0 0 30,000 0 50,000 0
ICU/PICU
RI22689 Resulsitasi Jantung Paru (RJP) RAWAT INAP Rp 6,500.00 13,000 0 0 0 175,500 0 195,000 0
ICU/PICU
RI22690 EKG RAWAT INAP Rp 39,000.00 19,500 0 0 0 39,000 0 97,500 0
ICU/PICU
RI22691 Baca EKG RAWAT INAP Rp 6,500.00 0 0 20,000 0 0 0 26,500 0
ICU/PICU
RI22692 Administrasi Rawat inap RAWAT INAP Rp 0.00 0 0 0 0 65,000 65,000 0 0
ICU/PICU
RI22693 Mandikan Pasien RAWAT INAP Rp 6,500.00 6,500 0 10,000 0 13,000 36,000 30,000 0
ICU/PICU
RI22694 Jasa Sarana Rumah Sakit RAWAT INAP Rp 65,000.00 0 0 0 0 0 65,000 0 0
ICU/PICU
RI22695 PASANG GUDEL RAWAT INAP Rp 6,500.00 6,500 0 0 0 26,000 0 39,000 0
ICU/PICU
RI22696 Lepas Gudel RAWAT INAP Rp 6,500.00 6,500 0 0 0 13,000 26,000 0 0
ICU/PICU
RI22697 Lepas Cateter RAWAT INAP Rp 6,500.00 13,000 0 0 0 19,500 0 39,000 0
ICU/PICU
RI22699 PERAWATAN DECUBITUS RAWAT INAP Rp 25,000.00 0 0 25,000 0 0 0 50,000 0
ICU/PICU
RI22700 Pasang Oksigen RAWAT INAP Rp 6,500.00 6,500 0 0 0 6,500 19,500 0 0
ICU/PICU
RI22701 Pasang Cateter RAWAT INAP Rp 6,500.00 13,000 0 0 0 45,500 0 65,000 0
ICU/PICU
RI22702 Pasang NGT RAWAT INAP Rp 6,500.00 19,500 0 0 0 39,000 0 65,000 0
ICU/PICU
RI22703 Observasi RAWAT INAP Rp 0.00 0 0 100,000 0 0 100,000 0 0
ICU/PICU
RI22704 PEMASANGAN INFUS PUMP RAWAT INAP Rp 25,000.00 0 0 25,000 0 0 0 50,000 0
ICU/PICU
RI22705 MONITOR EKG RAWAT INAP Rp 50,000.00 0 0 0 0 0 50,000 0 0
ICU/PICU
RI22706 PERAWATAN JENAZAH RAWAT INAP Rp 5,000.00 15,000 0 0 0 30,000 0 50,000 0
ICU/PICU
RI22707 Resulsitasi Jantung Paru (RJP) RAWAT INAP Rp 6,500.00 13,000 0 0 0 175,500 0 195,000 0
ICU/PICU
RI22708 EKG RAWAT INAP Rp 39,000.00 19,500 0 0 0 39,000 0 97,500 0
ICU/PICU
RI22709 Baca EKG RAWAT INAP Rp 6,500.00 0 0 20,000 0 0 0 26,500 0
ICU/PICU

8/30/23, 3:30 PM Page 2 of 4

Kode NAMA PERAWATAN/TINDAKAN/TAGIHAN KATEGORI J.S. R.S. BHP/Paket Obat JASA MEDIS DR JASA MEDIS PR KSO MENEJEMEN TOTAL BIAYA DR TOTAL BIAYA PR TTL BIAYA DR PR
RI22710 Administrasi Rawat inap RAWAT INAP Rp 0.00 0 0 0 0 65,000 65,000 0 0
ICU/PICU
RI22711 Mandikan Pasien RAWAT INAP Rp 6,500.00 6,500 0 10,000 0 13,000 36,000 30,000 0
ICU/PICU
RI22712 Jasa Sarana Rumah Sakit RAWAT INAP Rp 65,000.00 0 0 0 0 0 65,000 0 0
ICU/PICU
RI22713 PASANG GUDEL RAWAT INAP Rp 6,500.00 6,500 0 0 0 26,000 0 39,000 0
ICU/PICU
RI22714 Lepas Gudel RAWAT INAP Rp 6,500.00 6,500 0 0 0 13,000 26,000 0 0
ICU/PICU
RI22715 Lepas Cateter RAWAT INAP Rp 6,500.00 13,000 0 0 0 19,500 0 39,000 0
ICU/PICU
RI22716 Kumbah Lambung RAWAT INAP Rp 6,500.00 26,000 0 0 0 299,000 0 331,500 0
ICU/PICU
RI22717 Kumbah Lambung RAWAT INAP Rp 6,500.00 26,000 0 0 0 299,000 0 331,500 0
ICU/PICU
RI22718 PASANG ETT RAWAT INAP Rp 13,000.00 19,500 200,000 0 0 195,000 427,500 0 0
ICU/PICU
RI22719 PEMASANGAN SYRING PUMP RAWAT INAP Rp 25,000.00 0 0 25,000 0 0 0 50,000 0
ICU/PICU
RI22720 Pasang Infus ICU RAWAT INAP Rp 6,500.00 13,000 0 0 0 19,500 0 39,000 0
ICU/PICU
RI22721 Pasang Infus ICU RAWAT INAP Rp 6,500.00 13,000 0 0 0 19,500 0 39,000 0
ICU/PICU
RI22722 Pasang Cateter RAWAT INAP Rp 6,500.00 13,000 0 0 0 45,500 65,000 0 0
ICU/PICU
RI22723 Pasang Cateter RAWAT INAP Rp 6,500.00 13,000 0 0 0 45,500 65,000 0 0
ICU/PICU
RI22724 PASANG GUDEL RAWAT INAP Rp 6,500.00 6,500 0 0 0 26,000 39,000 0 0
ICU/PICU
RI22725 PASANG GUDEL RAWAT INAP Rp 6,500.00 6,500 0 0 0 26,000 39,000 0 0
ICU/PICU
RI22726 MONITOR EKG RAWAT INAP Rp 50,000.00 0 0 0 0 0 0 50,000 0
ICU/PICU
RI22727 MONITOR EKG RAWAT INAP Rp 50,000.00 0 0 0 0 0 0 50,000 0
ICU/PICU
RI22728 Lepas Gudel RAWAT INAP Rp 6,500.00 6,500 0 0 0 13,000 0 26,000 0
ICU/PICU
RI22729 Lepas Gudel RAWAT INAP Rp 6,500.00 6,500 0 0 0 13,000 0 26,000 0
ICU/PICU
RI22730 SUCTION RAWAT INAP Rp 60,000.00 0 0 10,000 0 0 60,000 0 0
ICU/PICU
RI22731 SUCTION RAWAT INAP Rp 60,000.00 0 0 10,000 0 0 60,000 0 0
ICU/PICU
RI22732 EKG RAWAT INAP Rp 39,000.00 19,500 0 0 0 39,000 97,500 0 0
ICU/PICU
RI22733 EKG RAWAT INAP Rp 39,000.00 19,500 0 0 0 39,000 97,500 0 0
ICU/PICU
RI22734 Pasang NGT RAWAT INAP Rp 6,500.00 19,500 0 0 0 39,000 65,000 0 0
ICU/PICU
RI22735 Pasang NGT RAWAT INAP Rp 6,500.00 19,500 0 0 0 39,000 65,000 0 0

8/30/23, 3:30 PM Page 3 of 4

Kode NAMA PERAWATAN/TINDAKAN/TAGIHAN KATEGORI J.S. R.S. BHP/Paket Obat JASA MEDIS DR JASA MEDIS PR KSO MENEJEMEN TOTAL BIAYA DR TOTAL BIAYA PR TTL BIAYA DR PR
ICU/PICU
RI22736 Kumbah Lambung RAWAT INAP Rp 6,500.00 26,000 0 0 0 299,000 331,500 0 0
ICU/PICU
RI22737 Kumbah Lambung RAWAT INAP Rp 6,500.00 26,000 0 0 0 299,000 331,500 0 0
ICU/PICU
RI22740 PASANG ETT RAWAT INAP Rp 13,000.00 19,500 0 200,000 0 195,000 0 427,500 0
ICU/PICU
RI22741 PASANG ETT RAWAT INAP Rp 13,000.00 19,500 200,000 0 0 195,000 427,500 0 0
ICU/PICU
RI22742 PASANG ETT RAWAT INAP Rp 13,000.00 19,500 0 200,000 0 195,000 0 427,500 0
ICU/PICU

8/30/23, 3:30 PM Page 4 of 4