Lap.

HD7PD BPJS Bln Sept 2023

LAPORAN
Pasien Rawat Inap dan Rawat Ja
Filter: / Kelas Rawat = Semua / Severity = Sem

No. Tgl. Masuk Tgl. Pulang No. RM

1 1 Sep 2023 1 Sep 2023 002268
2 1 Sep 2023 1 Sep 2023 002278
3 1 Sep 2023 1 Sep 2023 002446
4 1 Sep 2023 1 Sep 2023 002486
5 1 Sep 2023 1 Sep 2023 002273
6 1 Sep 2023 1 Sep 2023 002260
7 1 Sep 2023 1 Sep 2023 002276
8 1 Sep 2023 1 Sep 2023 002236
9 1 Sep 2023 1 Sep 2023 001429
10 1 Sep 2023 1 Sep 2023 002573
11 1 Sep 2023 1 Sep 2023 002281
12 1 Sep 2023 1 Sep 2023 002612
13 1 Sep 2023 1 Sep 2023 002284
14 1 Sep 2023 1 Sep 2023 002493
15 1 Sep 2023 1 Sep 2023 002609
16 1 Sep 2023 1 Sep 2023 002595
17 2 Sep 2023 2 Sep 2023 001366
18 2 Sep 2023 2 Sep 2023 002549
19 2 Sep 2023 2 Sep 2023 002447
20 2 Sep 2023 2 Sep 2023 001913
21 2 Sep 2023 2 Sep 2023 001790
22 2 Sep 2023 2 Sep 2023 002256
23 2 Sep 2023 2 Sep 2023 001629
24 2 Sep 2023 2 Sep 2023 001736
25 2 Sep 2023 2 Sep 2023 002516
26 2 Sep 2023 2 Sep 2023 001938
27 2 Sep 2023 2 Sep 2023 002532
28 2 Sep 2023 2 Sep 2023 002608

Page 1
 Lap.HD7PD BPJS Bln Sept 2023

29 2 Sep 2023 2 Sep 2023 002618

30 2 Sep 2023 2 Sep 2023 002471
31 2 Sep 2023 2 Sep 2023 002528
32 2 Sep 2023 2 Sep 2023 002522
33 2 Sep 2023 2 Sep 2023 002613
34 2 Sep 2023 2 Sep 2023 002616
35 2 Sep 2023 2 Sep 2023 002597
36 2 Sep 2023 2 Sep 2023 002551
37 4 Sep 2023 4 Sep 2023 001425
38 4 Sep 2023 4 Sep 2023 001366
39 4 Sep 2023 4 Sep 2023 002498
40 4 Sep 2023 4 Sep 2023 002252
41 4 Sep 2023 4 Sep 2023 002240
42 4 Sep 2023 4 Sep 2023 002267
43 4 Sep 2023 4 Sep 2023 002238
44 4 Sep 2023 4 Sep 2023 001610
45 4 Sep 2023 4 Sep 2023 002628
46 4 Sep 2023 4 Sep 2023 002555
47 4 Sep 2023 4 Sep 2023 002585
48 4 Sep 2023 4 Sep 2023 002593
49 4 Sep 2023 4 Sep 2023 002641
50 4 Sep 2023 4 Sep 2023 002603
51 4 Sep 2023 4 Sep 2023 002265
52 4 Sep 2023 4 Sep 2023 002256
53 4 Sep 2023 4 Sep 2023 001903
54 5 Sep 2023 5 Sep 2023 002486
55 5 Sep 2023 5 Sep 2023 002273
56 5 Sep 2023 5 Sep 2023 002260
57 5 Sep 2023 5 Sep 2023 002268
58 5 Sep 2023 5 Sep 2023 002446
59 5 Sep 2023 5 Sep 2023 002276
60 5 Sep 2023 5 Sep 2023 001429
61 5 Sep 2023 5 Sep 2023 002278

Page 2
 Lap.HD7PD BPJS Bln Sept 2023

62 5 Sep 2023 5 Sep 2023 002236

63 5 Sep 2023 5 Sep 2023 002573
64 5 Sep 2023 5 Sep 2023 002284
65 5 Sep 2023 5 Sep 2023 002612
66 5 Sep 2023 5 Sep 2023 002595
67 5 Sep 2023 5 Sep 2023 002571
68 5 Sep 2023 5 Sep 2023 002609
69 5 Sep 2023 5 Sep 2023 002493
70 5 Sep 2023 5 Sep 2023 002281
71 6 Sep 2023 6 Sep 2023 002549
72 6 Sep 2023 6 Sep 2023 002630
73 6 Sep 2023 6 Sep 2023 001790
74 6 Sep 2023 6 Sep 2023 002447
75 6 Sep 2023 6 Sep 2023 001913
76 6 Sep 2023 6 Sep 2023 001736
77 6 Sep 2023 6 Sep 2023 001629
78 6 Sep 2023 6 Sep 2023 002516
79 6 Sep 2023 6 Sep 2023 001938
80 6 Sep 2023 6 Sep 2023 002532
81 6 Sep 2023 6 Sep 2023 002551
82 6 Sep 2023 6 Sep 2023 002608
83 6 Sep 2023 6 Sep 2023 002618
84 6 Sep 2023 6 Sep 2023 002471
85 6 Sep 2023 6 Sep 2023 002522
86 6 Sep 2023 6 Sep 2023 002528
87 6 Sep 2023 6 Sep 2023 002616
88 6 Sep 2023 6 Sep 2023 002597
89 6 Sep 2023 6 Sep 2023 002613
90 7 Sep 2023 7 Sep 2023 001366
91 7 Sep 2023 7 Sep 2023 001425
92 7 Sep 2023 7 Sep 2023 002252
93 7 Sep 2023 7 Sep 2023 002498
94 7 Sep 2023 7 Sep 2023 002628

Page 3
 Lap.HD7PD BPJS Bln Sept 2023

95 7 Sep 2023 7 Sep 2023 002267

96 7 Sep 2023 7 Sep 2023 001610
97 7 Sep 2023 7 Sep 2023 002238
98 7 Sep 2023 7 Sep 2023 002240
99 7 Sep 2023 7 Sep 2023 002555
100 7 Sep 2023 7 Sep 2023 002585
101 7 Sep 2023 7 Sep 2023 002265
102 7 Sep 2023 7 Sep 2023 002593
103 7 Sep 2023 7 Sep 2023 002641
104 7 Sep 2023 7 Sep 2023 002603
105 7 Sep 2023 7 Sep 2023 001903
106 7 Sep 2023 7 Sep 2023 002638
107 8 Sep 2023 8 Sep 2023 002268
108 8 Sep 2023 8 Sep 2023 002486
109 8 Sep 2023 8 Sep 2023 002260
110 8 Sep 2023 8 Sep 2023 002273
111 8 Sep 2023 8 Sep 2023 002276
112 8 Sep 2023 8 Sep 2023 002278
113 8 Sep 2023 8 Sep 2023 001429
114 8 Sep 2023 8 Sep 2023 002446
115 8 Sep 2023 8 Sep 2023 002236
116 8 Sep 2023 8 Sep 2023 002573
117 8 Sep 2023 8 Sep 2023 002609
118 8 Sep 2023 8 Sep 2023 002284
119 8 Sep 2023 8 Sep 2023 002281
120 8 Sep 2023 8 Sep 2023 002595
121 8 Sep 2023 8 Sep 2023 002612
122 8 Sep 2023 8 Sep 2023 002493
123 8 Sep 2023 8 Sep 2023 002571
124 9 Sep 2023 9 Sep 2023 001629
125 9 Sep 2023 9 Sep 2023 002516
126 9 Sep 2023 9 Sep 2023 001366
127 9 Sep 2023 9 Sep 2023 002549

Page 4
 Lap.HD7PD BPJS Bln Sept 2023

128 9 Sep 2023 9 Sep 2023 001913

129 9 Sep 2023 9 Sep 2023 002447
130 9 Sep 2023 9 Sep 2023 001790
131 9 Sep 2023 9 Sep 2023 002256
132 9 Sep 2023 9 Sep 2023 001736
133 9 Sep 2023 9 Sep 2023 001938
134 9 Sep 2023 9 Sep 2023 002532
135 9 Sep 2023 9 Sep 2023 002551
136 9 Sep 2023 9 Sep 2023 002608
137 9 Sep 2023 9 Sep 2023 002618
138 9 Sep 2023 9 Sep 2023 002528
139 9 Sep 2023 9 Sep 2023 002522
140 9 Sep 2023 9 Sep 2023 002613
141 9 Sep 2023 9 Sep 2023 002616
142 9 Sep 2023 9 Sep 2023 002597
143 9 Sep 2023 9 Sep 2023 002471
144 11 Sep 2023 11 Sep 2023 001366
145 11 Sep 2023 11 Sep 2023 002498
146 11 Sep 2023 11 Sep 2023 002252
147 11 Sep 2023 11 Sep 2023 001425
148 11 Sep 2023 11 Sep 2023 002267
149 11 Sep 2023 11 Sep 2023 002628
150 11 Sep 2023 11 Sep 2023 001610
151 11 Sep 2023 11 Sep 2023 002238
152 11 Sep 2023 11 Sep 2023 002240
153 11 Sep 2023 11 Sep 2023 002555
154 11 Sep 2023 11 Sep 2023 002585
155 11 Sep 2023 11 Sep 2023 001903
156 11 Sep 2023 11 Sep 2023 002641
157 11 Sep 2023 11 Sep 2023 002603
158 11 Sep 2023 11 Sep 2023 002593
159 11 Sep 2023 11 Sep 2023 002265
160 11 Sep 2023 11 Sep 2023 002256

Page 5
 Lap.HD7PD BPJS Bln Sept 2023

161 12 Sep 2023 12 Sep 2023 002486

162 12 Sep 2023 12 Sep 2023 002260
163 12 Sep 2023 12 Sep 2023 002273
164 12 Sep 2023 12 Sep 2023 002268
165 12 Sep 2023 12 Sep 2023 002446
166 12 Sep 2023 12 Sep 2023 002276
167 12 Sep 2023 12 Sep 2023 001429
168 12 Sep 2023 12 Sep 2023 002278
169 12 Sep 2023 12 Sep 2023 002236
170 12 Sep 2023 12 Sep 2023 002573
171 12 Sep 2023 12 Sep 2023 002284
172 12 Sep 2023 12 Sep 2023 002281
173 12 Sep 2023 12 Sep 2023 002571
174 12 Sep 2023 12 Sep 2023 002595
175 12 Sep 2023 12 Sep 2023 002612
176 12 Sep 2023 12 Sep 2023 002493
177 12 Sep 2023 12 Sep 2023 001736
178 12 Sep 2023 12 Sep 2023 001425
179 12 Sep 2023 12 Sep 2023 002525
180 12 Sep 2023 12 Sep 2023 002267
181 12 Sep 2023 12 Sep 2023 002252
182 13 Sep 2023 13 Sep 2023 002549
183 13 Sep 2023 13 Sep 2023 001913
184 13 Sep 2023 13 Sep 2023 001790
185 13 Sep 2023 13 Sep 2023 002447
186 13 Sep 2023 13 Sep 2023 001629
187 13 Sep 2023 13 Sep 2023 001736
188 13 Sep 2023 13 Sep 2023 001938
189 13 Sep 2023 13 Sep 2023 002516
190 13 Sep 2023 13 Sep 2023 002630
191 13 Sep 2023 13 Sep 2023 002532
192 13 Sep 2023 13 Sep 2023 002551
193 13 Sep 2023 13 Sep 2023 002608

Page 6
 Lap.HD7PD BPJS Bln Sept 2023

194 13 Sep 2023 13 Sep 2023 002618

195 13 Sep 2023 13 Sep 2023 002471
196 13 Sep 2023 13 Sep 2023 002522
197 13 Sep 2023 13 Sep 2023 002528
198 13 Sep 2023 13 Sep 2023 002613
199 13 Sep 2023 13 Sep 2023 002597
200 13 Sep 2023 13 Sep 2023 002616
201 14 Sep 2023 14 Sep 2023 001366
202 14 Sep 2023 14 Sep 2023 002252
203 14 Sep 2023 14 Sep 2023 002267
204 14 Sep 2023 14 Sep 2023 001425
205 14 Sep 2023 14 Sep 2023 002498
206 14 Sep 2023 14 Sep 2023 002628
207 14 Sep 2023 14 Sep 2023 002240
208 14 Sep 2023 14 Sep 2023 001610
209 14 Sep 2023 14 Sep 2023 002238
210 14 Sep 2023 14 Sep 2023 002555
211 14 Sep 2023 14 Sep 2023 001903
212 14 Sep 2023 14 Sep 2023 002641
213 14 Sep 2023 14 Sep 2023 002265
214 14 Sep 2023 14 Sep 2023 002603
215 14 Sep 2023 14 Sep 2023 002593
216 14 Sep 2023 14 Sep 2023 002638
217 14 Sep 2023 14 Sep 2023 002375
218 14 Sep 2023 14 Sep 2023 002516
219 14 Sep 2023 14 Sep 2023 002522
220 14 Sep 2023 14 Sep 2023 002493
221 14 Sep 2023 14 Sep 2023 002585
222 15 Sep 2023 15 Sep 2023 002486
223 15 Sep 2023 15 Sep 2023 002260
224 15 Sep 2023 15 Sep 2023 002273
225 15 Sep 2023 15 Sep 2023 002268
226 15 Sep 2023 15 Sep 2023 001429

Page 7
 Lap.HD7PD BPJS Bln Sept 2023

227 15 Sep 2023 15 Sep 2023 002278

228 15 Sep 2023 15 Sep 2023 002236
229 15 Sep 2023 15 Sep 2023 001938
230 15 Sep 2023 15 Sep 2023 002276
231 15 Sep 2023 15 Sep 2023 002609
232 15 Sep 2023 15 Sep 2023 002573
233 15 Sep 2023 15 Sep 2023 002281
234 15 Sep 2023 15 Sep 2023 002612
235 15 Sep 2023 15 Sep 2023 002595
236 15 Sep 2023 15 Sep 2023 002571
237 15 Sep 2023 15 Sep 2023 002284
238 15 Sep 2023 15 Sep 2023 002493
239 16 Sep 2023 16 Sep 2023 001366
240 16 Sep 2023 16 Sep 2023 001913
241 16 Sep 2023 16 Sep 2023 002549
242 16 Sep 2023 16 Sep 2023 001790
243 16 Sep 2023 16 Sep 2023 002256
244 16 Sep 2023 16 Sep 2023 001736
245 16 Sep 2023 16 Sep 2023 002522
246 16 Sep 2023 16 Sep 2023 001629
247 16 Sep 2023 16 Sep 2023 002532
248 16 Sep 2023 16 Sep 2023 002551
249 16 Sep 2023 16 Sep 2023 002528
250 16 Sep 2023 16 Sep 2023 002618
251 16 Sep 2023 16 Sep 2023 002608
252 16 Sep 2023 16 Sep 2023 002616
253 16 Sep 2023 16 Sep 2023 002613
254 16 Sep 2023 16 Sep 2023 002471
255 16 Sep 2023 16 Sep 2023 002597
256 16 Sep 2023 16 Sep 2023 002516
257 18 Sep 2023 18 Sep 2023 001366
258 18 Sep 2023 18 Sep 2023 002498
259 18 Sep 2023 18 Sep 2023 001425

Page 8
 Lap.HD7PD BPJS Bln Sept 2023

260 18 Sep 2023 18 Sep 2023 002252

261 18 Sep 2023 18 Sep 2023 002267
262 18 Sep 2023 18 Sep 2023 002628
263 18 Sep 2023 18 Sep 2023 001610
264 18 Sep 2023 18 Sep 2023 002238
265 18 Sep 2023 18 Sep 2023 002240
266 18 Sep 2023 18 Sep 2023 002555
267 18 Sep 2023 18 Sep 2023 002585
268 18 Sep 2023 18 Sep 2023 002641
269 18 Sep 2023 18 Sep 2023 002593
270 18 Sep 2023 18 Sep 2023 002603
271 18 Sep 2023 18 Sep 2023 002265
272 18 Sep 2023 18 Sep 2023 001903
273 18 Sep 2023 18 Sep 2023 002447
274 18 Sep 2023 18 Sep 2023 002256
275 19 Sep 2023 19 Sep 2023 002486
276 19 Sep 2023 19 Sep 2023 002260
277 19 Sep 2023 19 Sep 2023 002273
278 19 Sep 2023 19 Sep 2023 002268
279 19 Sep 2023 19 Sep 2023 001429
280 19 Sep 2023 19 Sep 2023 002278
281 19 Sep 2023 19 Sep 2023 002236
282 19 Sep 2023 19 Sep 2023 002276
283 19 Sep 2023 19 Sep 2023 002446
284 19 Sep 2023 19 Sep 2023 002573
285 19 Sep 2023 19 Sep 2023 002609
286 19 Sep 2023 19 Sep 2023 002281
287 19 Sep 2023 19 Sep 2023 002284
288 19 Sep 2023 19 Sep 2023 002595
289 19 Sep 2023 19 Sep 2023 002571
290 19 Sep 2023 19 Sep 2023 002493
291 20 Sep 2023 20 Sep 2023 002549
292 20 Sep 2023 20 Sep 2023 001790

Page 9
 Lap.HD7PD BPJS Bln Sept 2023

293 20 Sep 2023 20 Sep 2023 002256

294 20 Sep 2023 20 Sep 2023 001913
295 20 Sep 2023 20 Sep 2023 001629
296 20 Sep 2023 20 Sep 2023 001736
297 20 Sep 2023 20 Sep 2023 002532
298 20 Sep 2023 20 Sep 2023 002516
299 20 Sep 2023 20 Sep 2023 001938
300 20 Sep 2023 20 Sep 2023 002551
301 20 Sep 2023 20 Sep 2023 002618
302 20 Sep 2023 20 Sep 2023 002608
303 20 Sep 2023 20 Sep 2023 002522
304 20 Sep 2023 20 Sep 2023 002528
305 20 Sep 2023 20 Sep 2023 002471
306 20 Sep 2023 20 Sep 2023 002613
307 20 Sep 2023 20 Sep 2023 002597
308 20 Sep 2023 20 Sep 2023 002616
309 21 Sep 2023 21 Sep 2023 002498
310 21 Sep 2023 21 Sep 2023 001366
311 21 Sep 2023 21 Sep 2023 001425
312 21 Sep 2023 21 Sep 2023 002628
313 21 Sep 2023 21 Sep 2023 002252
314 21 Sep 2023 21 Sep 2023 002267
315 21 Sep 2023 21 Sep 2023 001610
316 21 Sep 2023 21 Sep 2023 002240
317 21 Sep 2023 21 Sep 2023 002238
318 21 Sep 2023 21 Sep 2023 002555
319 21 Sep 2023 21 Sep 2023 002585
320 21 Sep 2023 21 Sep 2023 002641
321 21 Sep 2023 21 Sep 2023 002265
322 21 Sep 2023 21 Sep 2023 002603
323 21 Sep 2023 21 Sep 2023 002638
324 21 Sep 2023 21 Sep 2023 001903
325 21 Sep 2023 21 Sep 2023 002280

Page 10
 Lap.HD7PD BPJS Bln Sept 2023

326 21 Sep 2023 21 Sep 2023 001938

327 22 Sep 2023 22 Sep 2023 002268
328 22 Sep 2023 22 Sep 2023 001429
329 22 Sep 2023 22 Sep 2023 002446
330 22 Sep 2023 22 Sep 2023 002278
331 22 Sep 2023 22 Sep 2023 002273
332 22 Sep 2023 22 Sep 2023 002486
333 22 Sep 2023 22 Sep 2023 002276
334 22 Sep 2023 22 Sep 2023 002260
335 22 Sep 2023 22 Sep 2023 002236
336 22 Sep 2023 22 Sep 2023 002609
337 22 Sep 2023 22 Sep 2023 002573
338 22 Sep 2023 22 Sep 2023 002281
339 22 Sep 2023 22 Sep 2023 002284
340 22 Sep 2023 22 Sep 2023 002595
341 22 Sep 2023 22 Sep 2023 002612
342 22 Sep 2023 22 Sep 2023 002571
343 22 Sep 2023 22 Sep 2023 002493
344 23 Sep 2023 23 Sep 2023 001366
345 23 Sep 2023 23 Sep 2023 002549
346 23 Sep 2023 23 Sep 2023 001913
347 23 Sep 2023 23 Sep 2023 001790
348 23 Sep 2023 23 Sep 2023 002516
349 23 Sep 2023 23 Sep 2023 001736
350 23 Sep 2023 23 Sep 2023 001938
351 23 Sep 2023 23 Sep 2023 002447
352 23 Sep 2023 23 Sep 2023 002256
353 23 Sep 2023 23 Sep 2023 001629
354 23 Sep 2023 23 Sep 2023 002532
355 23 Sep 2023 23 Sep 2023 002551
356 23 Sep 2023 23 Sep 2023 002618
357 23 Sep 2023 23 Sep 2023 002608
358 23 Sep 2023 23 Sep 2023 002522

Page 11
 Lap.HD7PD BPJS Bln Sept 2023

359 23 Sep 2023 23 Sep 2023 002528

360 23 Sep 2023 23 Sep 2023 002471
361 23 Sep 2023 23 Sep 2023 002613
362 23 Sep 2023 23 Sep 2023 002597
363 23 Sep 2023 23 Sep 2023 002616
364 23 Sep 2023 23 Sep 2023 002603
365 23 Sep 2023 23 Sep 2023 001903
366 23 Sep 2023 23 Sep 2023 002595
367 23 Sep 2023 23 Sep 2023 002593
368 23 Sep 2023 23 Sep 2023 002498
369 25 Sep 2023 25 Sep 2023 001366
370 25 Sep 2023 25 Sep 2023 002498
371 25 Sep 2023 25 Sep 2023 001425
372 25 Sep 2023 25 Sep 2023 002252
373 25 Sep 2023 25 Sep 2023 002628
374 25 Sep 2023 25 Sep 2023 002267
375 25 Sep 2023 25 Sep 2023 001610
376 25 Sep 2023 25 Sep 2023 002238
377 25 Sep 2023 25 Sep 2023 002240
378 25 Sep 2023 25 Sep 2023 002555
379 25 Sep 2023 25 Sep 2023 002585
380 25 Sep 2023 25 Sep 2023 002641
381 25 Sep 2023 25 Sep 2023 001903
382 25 Sep 2023 25 Sep 2023 002486
383 25 Sep 2023 25 Sep 2023 002603
384 25 Sep 2023 25 Sep 2023 002593
385 25 Sep 2023 25 Sep 2023 002630
386 25 Sep 2023 25 Sep 2023 002265
387 25 Sep 2023 25 Sep 2023 002256
388 26 Sep 2023 26 Sep 2023 002671
389 26 Sep 2023 26 Sep 2023 002573
390 26 Sep 2023 26 Sep 2023 002268
391 26 Sep 2023 26 Sep 2023 001429

Page 12
 Lap.HD7PD BPJS Bln Sept 2023

392 26 Sep 2023 26 Sep 2023 002236

393 26 Sep 2023 26 Sep 2023 002260
394 26 Sep 2023 26 Sep 2023 002273
395 26 Sep 2023 26 Sep 2023 002276
396 26 Sep 2023 26 Sep 2023 002278
397 26 Sep 2023 26 Sep 2023 002609
398 26 Sep 2023 26 Sep 2023 002281
399 26 Sep 2023 26 Sep 2023 002284
400 26 Sep 2023 26 Sep 2023 002571
401 26 Sep 2023 26 Sep 2023 002595
402 26 Sep 2023 26 Sep 2023 002493
403 27 Sep 2023 27 Sep 2023 002549
404 27 Sep 2023 27 Sep 2023 001790
405 27 Sep 2023 27 Sep 2023 001913
406 27 Sep 2023 27 Sep 2023 001629
407 27 Sep 2023 27 Sep 2023 002256
408 27 Sep 2023 27 Sep 2023 002532
409 27 Sep 2023 27 Sep 2023 001736
410 27 Sep 2023 27 Sep 2023 002516
411 27 Sep 2023 27 Sep 2023 001938
412 27 Sep 2023 27 Sep 2023 002551
413 27 Sep 2023 27 Sep 2023 002608
414 27 Sep 2023 27 Sep 2023 002618
415 27 Sep 2023 27 Sep 2023 002471
416 27 Sep 2023 27 Sep 2023 002528
417 27 Sep 2023 27 Sep 2023 002522
418 27 Sep 2023 27 Sep 2023 002613
419 27 Sep 2023 27 Sep 2023 002597
420 28 Sep 2023 28 Sep 2023 001366
421 28 Sep 2023 28 Sep 2023 001425
422 28 Sep 2023 28 Sep 2023 002498
423 28 Sep 2023 28 Sep 2023 002252
424 28 Sep 2023 28 Sep 2023 002628

Page 13
 Lap.HD7PD BPJS Bln Sept 2023

425 28 Sep 2023 28 Sep 2023 002267

426 28 Sep 2023 28 Sep 2023 001610
427 28 Sep 2023 28 Sep 2023 002240
428 28 Sep 2023 28 Sep 2023 002238
429 28 Sep 2023 28 Sep 2023 002555
430 28 Sep 2023 28 Sep 2023 002585
431 28 Sep 2023 28 Sep 2023 002616
432 28 Sep 2023 28 Sep 2023 001903
433 28 Sep 2023 28 Sep 2023 002265
434 28 Sep 2023 28 Sep 2023 002641
435 28 Sep 2023 28 Sep 2023 001429
436 28 Sep 2023 28 Sep 2023 002638
437 28 Sep 2023 28 Sep 2023 002603
438 29 Sep 2023 29 Sep 2023 002268
439 29 Sep 2023 29 Sep 2023 002573
440 29 Sep 2023 29 Sep 2023 002236
441 29 Sep 2023 29 Sep 2023 002276
442 29 Sep 2023 29 Sep 2023 002446
443 29 Sep 2023 29 Sep 2023 002278
444 29 Sep 2023 29 Sep 2023 002273
445 29 Sep 2023 29 Sep 2023 002486
446 29 Sep 2023 29 Sep 2023 002260
447 29 Sep 2023 29 Sep 2023 002284
448 29 Sep 2023 29 Sep 2023 002609
449 29 Sep 2023 29 Sep 2023 002571
450 29 Sep 2023 29 Sep 2023 002671
451 29 Sep 2023 29 Sep 2023 002595
452 29 Sep 2023 29 Sep 2023 002493
453 29 Sep 2023 29 Sep 2023 002281
454 30 Sep 2023 30 Sep 2023 002549
455 30 Sep 2023 30 Sep 2023 001366
456 30 Sep 2023 30 Sep 2023 001790
457 30 Sep 2023 30 Sep 2023 002256

Page 14
 Lap.HD7PD BPJS Bln Sept 2023

458 30 Sep 2023 30 Sep 2023 001736

459 30 Sep 2023 30 Sep 2023 001629
460 30 Sep 2023 30 Sep 2023 002447
461 30 Sep 2023 30 Sep 2023 002516
462 30 Sep 2023 30 Sep 2023 001938
463 30 Sep 2023 30 Sep 2023 002532
464 30 Sep 2023 30 Sep 2023 002551
465 30 Sep 2023 30 Sep 2023 002618
466 30 Sep 2023 30 Sep 2023 002608
467 30 Sep 2023 30 Sep 2023 002471
468 30 Sep 2023 30 Sep 2023 002528
469 30 Sep 2023 30 Sep 2023 002616
470 30 Sep 2023 30 Sep 2023 002522
471 30 Sep 2023 30 Sep 2023 002613
472 30 Sep 2023 30 Sep 2023 002597
473 30 Sep 2023 30 Sep 2023 002486
474 30 Sep 2023 30 Sep 2023 002641
475 30 Sep 2023 30 Sep 2023 002571
Total

Kode RS: K3204005

Page 15
 Lap.HD7PD BPJS Bln Sept 2023

LAPORAN REKAP KLAIM - KLINIK HEMOLIFE

Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Sep 2023 s/d 16 Okt 2023
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D SWASTA

Nama Pasien No. Klaim / SEP INACBG

SULASTRI 0135S0440923V000001 N-3-15-0
ANANG SUBARNAS 0135S0440923V000002 N-3-15-0
LENI KARLINA 0135S0440923V000003 N-3-15-0
IMAS SOLIHAH 0135S0440923V000004 N-3-15-0
SIMIN 0135S0440923V000005 N-3-15-0
ALIS AISAH 0135S0440923V000006 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000007 N-3-15-0
DJARWO SUYARSO 0135S0440923V000008 N-3-15-0
SITI JAHRA 0135S0440923V000009 N-3-15-0
OMBAH 0135S0440923V000010 N-3-15-0
USEP SUPRIANI 0135S0440923V000011 N-3-15-0
ODAS UGAN 0135S0440923V000012 N-3-15-0
FARUK AMRULLAH 0135S0440923V000014 N-3-15-0
AGUS JUNAWA 0135S0440923V000015 N-3-15-0
DADAN SOLIHIN 0135S0440923V000016 N-3-15-0
RANIE MANALU 0135S0440923V000013 D-3-10-0
NANIH MACHENDRAWATY 0135S0440923V000017 N-3-15-0
MASNIAR 0135S0440923V000018 N-3-15-0
SUARTI 0135S0440923V000019 N-3-15-0
NANANG ACHDIAT 0135S0440923V000020 N-3-15-0
YETI SRI HARYATI 0135S0440923V000021 N-3-15-0
E SURATMI 0135S0440923V000022 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000023 N-3-15-0
ANI HANDAYANI 0135S0440923V000024 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000025 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000026 N-3-15-0
KIKIN 0135S0440923V000028 N-3-15-0
AGUS GUNAWAN 0135S0440923V000029 N-3-15-0

Page 16
 Lap.HD7PD BPJS Bln Sept 2023

JUJU SASMITA 0135S0440923V000030 N-3-15-0

DINAR SUTISNA 0135S0440923V000031 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000032 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000033 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000034 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000035 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000036 N-3-15-0
ASEP MULYANA 0135S0440923V000027 N-3-15-0
ASIS 0135S0440923V000037 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000038 N-3-15-0
DUDU GUNAWAN 0135S0440923V000039 N-3-15-0
SUKAESIH 0135S0440923V000040 N-3-15-0
IWAN SUNARYA 0135S0440923V000041 N-3-15-0
SUKIRMAN 0135S0440923V000042 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000043 N-3-15-0
DEDE SURYANA 0135S0440923V000044 N-3-15-0
MAHDUM 0135S0440923V000045 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000046 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000047 N-3-15-0
ANISAH 0135S0440923V000048 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000050 N-3-15-0
DENI 0135S0440923V000051 N-3-15-0
AANG AMRI 0135S0440923V000052 N-3-15-0
E SURATMI 0135S0440923V000053 N-3-15-0
MARLINA 0135S0440923V000049 N-3-15-0
IMAS SOLIHAH 0135S0440923V000054 N-3-15-0
SIMIN 0135S0440923V000055 N-3-15-0
ALIS AISAH 0135S0440923V000056 N-3-15-0
SULASTRI 0135S0440923V000057 N-3-15-0
LENI KARLINA 0135S0440923V000058 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000059 N-3-15-0
SITI JAHRA 0135S0440923V000060 N-3-15-0
ANANG SUBARNAS 0135S0440923V000061 N-3-15-0

Page 17
 Lap.HD7PD BPJS Bln Sept 2023

DJARWO SUYARSO 0135S0440923V000062 N-3-15-0

OMBAH 0135S0440923V000063 N-3-15-0
FARUK AMRULLAH 0135S0440923V000065 N-3-15-0
ODAS UGAN 0135S0440923V000066 N-3-15-0
RANIE MANALU 0135S0440923V000067 N-3-15-0
AAH CAHYANI 0135S0440923V000068 N-3-15-0
DADAN SOLIHIN 0135S0440923V000069 N-3-15-0
AGUS JUNAWA 0135S0440923V000070 N-3-15-0
USEP SUPRIANI 0135S0440923V000064 N-3-15-0
MASNIAR 0135S0440923V000076 N-3-15-0
YUNIAR ARLIAWATI 0135S0440923V000077 N-3-15-0
YETI SRI HARYATI 0135S0440923V000078 N-3-15-0
SUARTI 0135S0440923V000079 N-3-15-0
NANANG ACHDIAT 0135S0440923V000080 N-3-15-0
ANI HANDAYANI 0135S0440923V000081 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000082 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000083 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000084 N-3-15-0
KIKIN 0135S0440923V000085 N-3-15-0
ASEP MULYANA 0135S0440923V000086 N-3-15-0
AGUS GUNAWAN 0135S0440923V000087 N-3-15-0
JUJU SASMITA 0135S0440923V000088 N-3-15-0
DINAR SUTISNA 0135S0440923V000089 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000090 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000091 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000092 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000093 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000094 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000095 N-3-15-0
ASIS 0135S0440923V000096 N-3-15-0
SUKAESIH 0135S0440923V000097 N-3-15-0
DUDU GUNAWAN 0135S0440923V000098 N-3-15-0
MAHDUM 0135S0440923V000099 N-3-15-0

Page 18
 Lap.HD7PD BPJS Bln Sept 2023

SUKIRMAN 0135S0440923V000100 N-3-15-0

DEDE SURYANA 0135S0440923V000101 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000102 N-3-15-0
IWAN SUNARYA 0135S0440923V000103 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000104 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000105 D-3-10-0
AANG AMRI 0135S0440923V000106 N-3-15-0
ANISAH 0135S0440923V000107 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000108 N-3-15-0
DENI 0135S0440923V000109 N-3-15-0
MARLINA 0135S0440923V000110 N-3-15-0
DENDY RIZKI NUGRAHA 0135S0440923V000111 N-3-15-0
SULASTRI 0135S0440923V000112 N-3-15-0
IMAS SOLIHAH 0135S0440923V000113 N-3-15-0
ALIS AISAH 0135S0440923V000114 N-3-15-0
SIMIN 0135S0440923V000115 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000116 N-3-15-0
ANANG SUBARNAS 0135S0440923V000117 N-3-15-0
SITI JAHRA 0135S0440923V000118 N-3-15-0
LENI KARLINA 0135S0440923V000119 N-3-15-0
DJARWO SUYARSO 0135S0440923V000120 N-3-15-0
OMBAH 0135S0440923V000121 N-3-15-0
DADAN SOLIHIN 0135S0440923V000122 N-3-15-0
FARUK AMRULLAH 0135S0440923V000123 N-3-15-0
USEP SUPRIANI 0135S0440923V000124 N-3-15-0
RANIE MANALU 0135S0440923V000125 N-3-15-0
ODAS UGAN 0135S0440923V000126 N-3-15-0
AGUS JUNAWA 0135S0440923V000127 N-3-15-0
AAH CAHYANI 0135S0440923V000128 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000135 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000137 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000129 N-3-15-0
MASNIAR 0135S0440923V000130 N-3-15-0

Page 19
 Lap.HD7PD BPJS Bln Sept 2023

NANANG ACHDIAT 0135S0440923V000131 N-3-15-0

SUARTI 0135S0440923V000132 N-3-15-0
YETI SRI HARYATI 0135S0440923V000133 N-3-15-0
E SURATMI 0135S0440923V000134 N-3-15-0
ANI HANDAYANI 0135S0440923V000136 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000138 N-3-15-0
KIKIN 0135S0440923V000139 N-3-15-0
ASEP MULYANA 0135S0440923V000140 N-3-15-0
AGUS GUNAWAN 0135S0440923V000141 N-3-15-0
JUJU SASMITA 0135S0440923V000142 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000143 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000144 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000146 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000147 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000148 N-3-15-0
DINAR SUTISNA 0135S0440923V000145 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000149 N-3-15-0
DUDU GUNAWAN 0135S0440923V000150 N-3-15-0
SUKAESIH 0135S0440923V000151 N-3-15-0
ASIS 0135S0440923V000152 N-3-15-0
SUKIRMAN 0135S0440923V000153 N-3-15-0
MAHDUM 0135S0440923V000154 N-3-15-0
DEDE SURYANA 0135S0440923V000155 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000156 N-3-15-0
IWAN SUNARYA 0135S0440923V000157 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000158 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000159 N-3-15-0
MARLINA 0135S0440923V000160 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000161 N-3-15-0
DENI 0135S0440923V000162 N-3-15-0
ANISAH 0135S0440923V000163 N-3-15-0
AANG AMRI 0135S0440923V000164 N-3-15-0
E SURATMI 0135S0440923V000165 N-3-15-0

Page 20
 Lap.HD7PD BPJS Bln Sept 2023

IMAS SOLIHAH 0135S0440923V000166 N-3-15-0

ALIS AISAH 0135S0440923V000167 N-3-15-0
SIMIN 0135S0440923V000168 N-3-15-0
SULASTRI 0135S0440923V000169 N-3-15-0
LENI KARLINA 0135S0440923V000170 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000171 N-3-15-0
SITI JAHRA 0135S0440923V000172 N-3-15-0
ANANG SUBARNAS 0135S0440923V000173 N-3-15-0
DJARWO SUYARSO 0135S0440923V000174 N-3-15-0
OMBAH 0135S0440923V000175 N-3-15-0
FARUK AMRULLAH 0135S0440923V000176 N-3-15-0
USEP SUPRIANI 0135S0440923V000177 N-3-15-0
AAH CAHYANI 0135S0440923V000178 N-3-15-0
RANIE MANALU 0135S0440923V000179 N-3-15-0
ODAS UGAN 0135S0440923V000180 N-3-15-0
AGUS JUNAWA 0135S0440923V000181 N-3-15-0
ANI HANDAYANI 0135S0440923V000183 Q-5-44-0
ASIS 0135S0440923V000184 Q-5-44-0
NANI KARYANI 0135S0440923V000185 Q-5-44-0
SUKIRMAN 0135S0440923V000187 Q-5-44-0
SUKAESIH 0135S0440923V000182 Q-5-44-0
MASNIAR 0135S0440923V000188 N-3-15-0
NANANG ACHDIAT 0135S0440923V000189 N-3-15-0
YETI SRI HARYATI 0135S0440923V000190 N-3-15-0
SUARTI 0135S0440923V000191 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000192 N-3-15-0
ANI HANDAYANI 0135S0440923V000193 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000194 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000195 N-3-15-0
YUNIAR ARLIAWATI 0135S0440923V000196 N-3-15-0
KIKIN 0135S0440923V000197 N-3-15-0
ASEP MULYANA 0135S0440923V000198 N-3-15-0
AGUS GUNAWAN 0135S0440923V000199 N-3-15-0

Page 21
 Lap.HD7PD BPJS Bln Sept 2023

JUJU SASMITA 0135S0440923V000200 N-3-15-0

DINAR SUTISNA 0135S0440923V000201 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000202 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000203 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000204 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000205 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000206 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000207 N-3-15-0
SUKAESIH 0135S0440923V000208 N-3-15-0
SUKIRMAN 0135S0440923V000209 N-3-15-0
ASIS 0135S0440923V000210 N-3-15-0
DUDU GUNAWAN 0135S0440923V000211 N-3-15-0
MAHDUM 0135S0440923V000212 N-3-15-0
IWAN SUNARYA 0135S0440923V000213 N-3-15-0
DEDE SURYANA 0135S0440923V000214 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000215 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000216 N-3-15-0
MARLINA 0135S0440923V000218 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000219 N-3-15-0
AANG AMRI 0135S0440923V000220 N-3-15-0
DENI 0135S0440923V000221 N-3-15-0
ANISAH 0135S0440923V000222 N-3-15-0
DENDY RIZKI NUGRAHA 0135S0440923V000223 N-3-15-0
ARIANTO AMIEN 0135S0440923V000224 Q-5-44-0
DANDAN SYARIPUDIN 0135S0440923V000225 Q-5-44-0
DEDIH KUSNAEDI 0135S0440923V000226 Q-5-44-0
AGUS JUNAWA 0135S0440923V000227 Q-5-44-0
IR.ANDRIE KURNIAWAN 0135S0440923V000217 N-3-15-0
IMAS SOLIHAH 0135S0440923V000228 N-3-15-0
ALIS AISAH 0135S0440923V000229 N-3-15-0
SIMIN 0135S0440923V000230 N-3-15-0
SULASTRI 0135S0440923V000231 N-3-15-0
SITI JAHRA 0135S0440923V000232 N-3-15-0

Page 22
 Lap.HD7PD BPJS Bln Sept 2023

ANANG SUBARNAS 0135S0440923V000233 N-3-15-0

DJARWO SUYARSO 0135S0440923V000234 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000235 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000236 N-3-15-0
DADAN SOLIHIN 0135S0440923V000237 N-3-15-0
OMBAH 0135S0440923V000238 N-3-15-0
USEP SUPRIANI 0135S0440923V000239 N-3-15-0
ODAS UGAN 0135S0440923V000240 N-3-15-0
RANIE MANALU 0135S0440923V000241 N-3-15-0
AAH CAHYANI 0135S0440923V000242 N-3-15-0
FARUK AMRULLAH 0135S0440923V000243 N-3-15-0
AGUS JUNAWA 0135S0440923V000244 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000245 N-3-15-0
NANANG ACHDIAT 0135S0440923V000246 N-3-15-0
MASNIAR 0135S0440923V000247 N-3-15-0
YETI SRI HARYATI 0135S0440923V000248 N-3-15-0
E SURATMI 0135S0440923V000249 N-3-15-0
ANI HANDAYANI 0135S0440923V000250 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000251 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000252 N-3-15-0
KIKIN 0135S0440923V000254 N-3-15-0
ASEP MULYANA 0135S0440923V000255 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000256 N-3-15-0
JUJU SASMITA 0135S0440923V000257 N-3-15-0
AGUS GUNAWAN 0135S0440923V000258 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000259 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000260 N-3-15-0
DINAR SUTISNA 0135S0440923V000261 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000262 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000253 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000263 N-3-15-0
DUDU GUNAWAN 0135S0440923V000264 N-3-15-0
ASIS 0135S0440923V000265 N-3-15-0

Page 23
 Lap.HD7PD BPJS Bln Sept 2023

SUKAESIH 0135S0440923V000266 N-3-15-0

SUKIRMAN 0135S0440923V000267 N-3-15-0
MAHDUM 0135S0440923V000268 N-3-15-0
DEDE SURYANA 0135S0440923V000269 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000270 N-3-15-0
IWAN SUNARYA 0135S0440923V000271 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000272 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000273 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000274 N-3-15-0
ANISAH 0135S0440923V000275 N-3-15-0
DENI 0135S0440923V000276 N-3-15-0
AANG AMRI 0135S0440923V000277 N-3-15-0
MARLINA 0135S0440923V000278 N-3-15-0
SUARTI 0135S0440923V000279 N-3-15-0
E SURATMI 0135S0440923V000280 N-3-15-0
IMAS SOLIHAH 0135S0440923V000281 N-3-15-0
ALIS AISAH 0135S0440923V000282 N-3-15-0
SIMIN 0135S0440923V000283 N-3-15-0
SULASTRI 0135S0440923V000284 N-3-15-0
SITI JAHRA 0135S0440923V000285 N-3-15-0
ANANG SUBARNAS 0135S0440923V000286 N-3-15-0
DJARWO SUYARSO 0135S0440923V000287 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000288 N-3-15-0
LENI KARLINA 0135S0440923V000289 N-3-15-0
OMBAH 0135S0440923V000290 N-3-15-0
DADAN SOLIHIN 0135S0440923V000291 N-3-15-0
USEP SUPRIANI 0135S0440923V000292 N-3-15-0
FARUK AMRULLAH 0135S0440923V000293 N-3-15-0
RANIE MANALU 0135S0440923V000294 N-3-15-0
AAH CAHYANI 0135S0440923V000295 D-3-10-0
AGUS JUNAWA 0135S0440923V000296 N-3-15-0
MASNIAR 0135S0440923V000297 N-3-15-0
YETI SRI HARYATI 0135S0440923V000298 N-3-15-0

Page 24
 Lap.HD7PD BPJS Bln Sept 2023

E SURATMI 0135S0440923V000299 N-3-15-0

NANANG ACHDIAT 0135S0440923V000300 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000301 N-3-15-0
ANI HANDAYANI 0135S0440923V000302 N-3-15-0
KIKIN 0135S0440923V000303 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000304 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000305 N-3-15-0
ASEP MULYANA 0135S0440923V000306 N-3-15-0
JUJU SASMITA 0135S0440923V000307 N-3-15-0
AGUS GUNAWAN 0135S0440923V000308 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000309 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000310 N-3-15-0
DINAR SUTISNA 0135S0440923V000311 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000312 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000313 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000314 N-3-15-0
DUDU GUNAWAN 0135S0440923V000315 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000316 N-3-15-0
ASIS 0135S0440923V000317 N-3-15-0
MAHDUM 0135S0440923V000318 N-3-15-0
SUKAESIH 0135S0440923V000319 N-3-15-0
SUKIRMAN 0135S0440923V000320 N-3-15-0
DEDE SURYANA 0135S0440923V000321 N-3-15-0
IWAN SUNARYA 0135S0440923V000322 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000323 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000324 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000325 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000326 N-3-15-0
AANG AMRI 0135S0440923V000327 N-3-15-0
DENI 0135S0440923V000328 N-3-15-0
DENDY RIZKI NUGRAHA 0135S0440923V000329 N-3-15-0
MARLINA 0135S0440923V000330 N-3-15-0
IYON JOHNI 0135S0440923V000331 Q-5-44-0

Page 25
 Lap.HD7PD BPJS Bln Sept 2023

SETIAWAN SAMSUDIN 0135S0440923V000332 Q-5-44-0

SULASTRI 0135S0440923V000333 N-3-15-0
SITI JAHRA 0135S0440923V000334 N-3-15-0
LENI KARLINA 0135S0440923V000335 N-3-15-0
ANANG SUBARNAS 0135S0440923V000336 N-3-15-0
SIMIN 0135S0440923V000337 N-3-15-0
IMAS SOLIHAH 0135S0440923V000338 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000339 N-3-15-0
ALIS AISAH 0135S0440923V000340 N-3-15-0
DJARWO SUYARSO 0135S0440923V000341 N-3-15-0
DADAN SOLIHIN 0135S0440923V000342 N-3-15-0
OMBAH 0135S0440923V000343 N-3-15-0
USEP SUPRIANI 0135S0440923V000344 N-3-15-0
FARUK AMRULLAH 0135S0440923V000345 N-3-15-0
RANIE MANALU 0135S0440923V000346 N-3-15-0
ODAS UGAN 0135S0440923V000347 N-3-15-0
AAH CAHYANI 0135S0440923V000348 N-3-15-0
AGUS JUNAWA 0135S0440923V000349 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000351 N-3-15-0
MASNIAR 0135S0440923V000352 N-3-15-0
NANANG ACHDIAT 0135S0440923V000353 N-3-15-0
YETI SRI HARYATI 0135S0440923V000354 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000355 N-3-15-0
ANI HANDAYANI 0135S0440923V000356 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000357 N-3-15-0
SUARTI 0135S0440923V000358 N-3-15-0
E SURATMI 0135S0440923V000359 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000360 N-3-15-0
KIKIN 0135S0440923V000361 N-3-15-0
ASEP MULYANA 0135S0440923V000362 N-3-15-0
JUJU SASMITA 0135S0440923V000363 N-3-15-0
AGUS GUNAWAN 0135S0440923V000364 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000365 N-3-15-0

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AE JUNAEDI MA'ALI 0135S0440923V000366 N-3-15-0

DINAR SUTISNA 0135S0440923V000367 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000368 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000369 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000370 N-3-15-0
DENI 0135S0440923V000371 Q-5-44-0
MARLINA 0135S0440923V000372 Q-5-44-0
RANIE MANALU 0135S0440923V000373 Q-5-44-0
ANISAH 0135S0440923V000374 Q-5-44-0
DUDU GUNAWAN 0135S0440923V000375 Q-5-44-0
NANIH MACHENDRAWATY 0135S0440923V000376 N-3-15-0
DUDU GUNAWAN 0135S0440923V000377 N-3-15-0
ASIS 0135S0440923V000378 N-3-15-0
SUKAESIH 0135S0440923V000379 N-3-15-0
MAHDUM 0135S0440923V000380 N-3-15-0
SUKIRMAN 0135S0440923V000381 N-3-15-0
DEDE SURYANA 0135S0440923V000382 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000383 N-3-15-0
IWAN SUNARYA 0135S0440923V000384 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000385 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000386 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000387 N-3-15-0
MARLINA 0135S0440923V000388 N-3-15-0
IMAS SOLIHAH 0135S0440923V000389 N-3-15-0
DENI 0135S0440923V000390 N-3-15-0
ANISAH 0135S0440923V000391 N-3-15-0
YUNIAR ARLIAWATI 0135S0440923V000392 N-3-15-0
AANG AMRI 0135S0440923V000393 N-3-15-0
E SURATMI 0135S0440923V000394 N-3-15-0
EHA JUHAELA 0135S0440923V000395 N-3-15-0
OMBAH 0135S0440923V000396 N-3-15-0
SULASTRI 0135S0440923V000397 N-3-15-0
SITI JAHRA 0135S0440923V000398 N-3-15-0

Page 27
 Lap.HD7PD BPJS Bln Sept 2023

DJARWO SUYARSO 0135S0440923V000399 N-3-15-0

ALIS AISAH 0135S0440923V000400 N-3-15-0
SIMIN 0135S0440923V000401 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000402 N-3-15-0
ANANG SUBARNAS 0135S0440923V000403 N-3-15-0
DADAN SOLIHIN 0135S0440923V000404 N-3-15-0
USEP SUPRIANI 0135S0440923V000405 N-3-15-0
FARUK AMRULLAH 0135S0440923V000406 N-3-15-0
AAH CAHYANI 0135S0440923V000407 N-3-15-0
RANIE MANALU 0135S0440923V000408 N-3-15-0
AGUS JUNAWA 0135S0440923V000409 N-3-15-0
MASNIAR 0135S0440923V000410 N-3-15-0
YETI SRI HARYATI 0135S0440923V000411 N-3-15-0
NANANG ACHDIAT 0135S0440923V000412 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000413 N-3-15-0
E SURATMI 0135S0440923V000414 N-3-15-0
KIKIN 0135S0440923V000415 N-3-15-0
ANI HANDAYANI 0135S0440923V000416 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000417 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000418 N-3-15-0
ASEP MULYANA 0135S0440923V000419 N-3-15-0
AGUS GUNAWAN 0135S0440923V000420 N-3-15-0
JUJU SASMITA 0135S0440923V000421 N-3-15-0
DINAR SUTISNA 0135S0440923V000422 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000423 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000424 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000425 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000426 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000427 N-3-15-0
ASIS 0135S0440923V000428 N-3-15-0
DUDU GUNAWAN 0135S0440923V000429 N-3-15-0
SUKAESIH 0135S0440923V000430 N-3-15-0
MAHDUM 0135S0440923V000431 N-3-15-0

Page 28
 Lap.HD7PD BPJS Bln Sept 2023

SUKIRMAN 0135S0440923V000432 N-3-15-0

DEDE SURYANA 0135S0440923V000433 N-3-15-0
IWAN SUNARYA 0135S0440923V000434 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000435 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000436 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000437 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000438 D-3-10-0
MARLINA 0135S0440923V000439 N-3-15-0
AANG AMRI 0135S0440923V000440 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000441 D-3-10-0
SITI JAHRA 0135S0440923V000442 N-3-15-0
DENDY RIZKI NUGRAHA 0135S0440923V000444 N-3-15-0
DENI 0135S0440923V000443 N-3-15-0
SULASTRI 0135S0440923V000445 N-3-15-0
OMBAH 0135S0440923V000446 N-3-15-0
DJARWO SUYARSO 0135S0440923V000447 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000448 N-3-15-0
LENI KARLINA 0135S0440923V000449 N-3-15-0
ANANG SUBARNAS 0135S0440923V000450 N-3-15-0
SIMIN 0135S0440923V000451 N-3-15-0
IMAS SOLIHAH 0135S0440923V000452 N-3-15-0
ALIS AISAH 0135S0440923V000453 N-3-15-0
FARUK AMRULLAH 0135S0440923V000454 N-3-15-0
DADAN SOLIHIN 0135S0440923V000456 N-3-15-0
AAH CAHYANI 0135S0440923V000457 N-3-15-0
EHA JUHAELA 0135S0440923V000458 N-3-15-0
RANIE MANALU 0135S0440923V000459 N-3-15-0
AGUS JUNAWA 0135S0440923V000460 N-3-15-0
USEP SUPRIANI 0135S0440923V000455 N-3-15-0
MASNIAR 0135S0440923V000464 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000465 N-3-15-0
YETI SRI HARYATI 0135S0440923V000466 N-3-15-0
E SURATMI 0135S0440923V000463 N-3-15-0

Page 29
 Lap.HD7PD BPJS Bln Sept 2023

ANI HANDAYANI 0135S0440923V000467 N-3-15-0

DAMAN WARDIMAN 0135S0440923V000468 N-3-15-0
SUARTI 0135S0440923V000469 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000470 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000471 N-3-15-0
KIKIN 0135S0440923V000472 N-3-15-0
ASEP MULYANA 0135S0440923V000473 N-3-15-0
JUJU SASMITA 0135S0440923V000474 N-3-15-0
AGUS GUNAWAN 0135S0440923V000475 N-3-15-0
DINAR SUTISNA 0135S0440923V000476 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000477 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000478 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000479 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000480 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000481 N-3-15-0
IMAS SOLIHAH 0135S0440923V000482 Q-5-44-0
AGUS SETRIAMAN 0135S0440923V000483 Q-5-44-0
AAH CAHYANI 0135S0440923V000484 Q-5-44-0
Total

Page 30
 Lap.HD7PD BPJS Bln Sept 2023

16 Okt 2023
RIF RS KELAS D SWASTA

Top Up Total Tarif Tarif RS Jenis

708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,236 RJ
708,050 925,226 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 1,053,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 1,053,100 RJ
1,104,100 1,675,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,226 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 31
 Lap.HD7PD BPJS Bln Sept 2023

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ

Page 32
 Lap.HD7PD BPJS Bln Sept 2023

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,200 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 1,053,187 RJ
708,050 925,200 RJ
708,050 950,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,226 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,171 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,904 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 33
 Lap.HD7PD BPJS Bln Sept 2023

708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
1,104,100 1,675,500 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,226 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,233 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,208 RJ

Page 34
 Lap.HD7PD BPJS Bln Sept 2023

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 1,053,000 RJ
708,050 1,053,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 945,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 1,053,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 35
 Lap.HD7PD BPJS Bln Sept 2023

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
192,400 229,500 RJ
192,400 232,900 RJ
192,400 223,000 RJ
192,400 229,500 RJ
192,400 229,500 RJ
708,050 925,000 RJ
708,050 925,208 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 927,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ

Page 36
 Lap.HD7PD BPJS Bln Sept 2023

708,050 1,053,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 1,053,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
192,400 236,600 RJ
192,400 219,100 RJ
192,400 218,000 RJ
192,400 218,800 RJ
708,050 1,645,000 RJ
708,050 950,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 37
 Lap.HD7PD BPJS Bln Sept 2023

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ

Page 38
 Lap.HD7PD BPJS Bln Sept 2023

708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,172 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
1,104,100 1,650,500 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 39
 Lap.HD7PD BPJS Bln Sept 2023

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,387 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
192,400 210,000 RJ

Page 40
 Lap.HD7PD BPJS Bln Sept 2023

192,400 219,500 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 41
 Lap.HD7PD BPJS Bln Sept 2023

708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
192,400 219,500 RJ
192,400 229,700 RJ
192,400 220,900 RJ
192,400 218,100 RJ
192,400 225,200 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,200 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 42
 Lap.HD7PD BPJS Bln Sept 2023

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,241 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,208 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 43
 Lap.HD7PD BPJS Bln Sept 2023

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
1,104,100 2,010,500 RJ
708,050 925,000 RJ
708,050 950,000 RJ
1,104,100 1,700,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,233 RJ
708,050 950,000 RJ
708,050 950,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ

Page 44
 Lap.HD7PD BPJS Bln Sept 2023

708,050 925,000 RJ
708,050 950,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
192,400 242,000 RJ
192,400 219,800 RJ
192,400 218,100 RJ
328,506,650 432,998,737

Page 45
 HD

LAPORAN REKAP
Pasien Rawat Inap dan Rawat Jalan, P
Filter: / Kelas Rawat = Semua / Severity = Semua / C

No. Tgl. Masuk Tgl. Pulang No. RM

1 1 Sep 2023 1 Sep 2023 002268
2 1 Sep 2023 1 Sep 2023 002278
3 1 Sep 2023 1 Sep 2023 002446
4 1 Sep 2023 1 Sep 2023 002486
5 1 Sep 2023 1 Sep 2023 002273
6 1 Sep 2023 1 Sep 2023 002260
7 1 Sep 2023 1 Sep 2023 002276
8 1 Sep 2023 1 Sep 2023 002236
9 1 Sep 2023 1 Sep 2023 001429
10 1 Sep 2023 1 Sep 2023 002573
11 1 Sep 2023 1 Sep 2023 002281
12 1 Sep 2023 1 Sep 2023 002612
13 1 Sep 2023 1 Sep 2023 002284
14 1 Sep 2023 1 Sep 2023 002493
15 1 Sep 2023 1 Sep 2023 002609
16 1 Sep 2023 1 Sep 2023 002595
17 2 Sep 2023 2 Sep 2023 001366
18 2 Sep 2023 2 Sep 2023 002549
19 2 Sep 2023 2 Sep 2023 002447
20 2 Sep 2023 2 Sep 2023 001913
21 2 Sep 2023 2 Sep 2023 001790
22 2 Sep 2023 2 Sep 2023 002256
23 2 Sep 2023 2 Sep 2023 001629
24 2 Sep 2023 2 Sep 2023 001736
25 2 Sep 2023 2 Sep 2023 002516
26 2 Sep 2023 2 Sep 2023 001938
27 2 Sep 2023 2 Sep 2023 002532
28 2 Sep 2023 2 Sep 2023 002608

Page 1
 HD

29 2 Sep 2023 2 Sep 2023 002618

30 2 Sep 2023 2 Sep 2023 002471
31 2 Sep 2023 2 Sep 2023 002528
32 2 Sep 2023 2 Sep 2023 002522
33 2 Sep 2023 2 Sep 2023 002613
34 2 Sep 2023 2 Sep 2023 002616
35 2 Sep 2023 2 Sep 2023 002597
36 2 Sep 2023 2 Sep 2023 002551
37 4 Sep 2023 4 Sep 2023 001425
38 4 Sep 2023 4 Sep 2023 001366
39 4 Sep 2023 4 Sep 2023 002498
40 4 Sep 2023 4 Sep 2023 002252
41 4 Sep 2023 4 Sep 2023 002240
42 4 Sep 2023 4 Sep 2023 002267
43 4 Sep 2023 4 Sep 2023 002238
44 4 Sep 2023 4 Sep 2023 001610
45 4 Sep 2023 4 Sep 2023 002628
46 4 Sep 2023 4 Sep 2023 002555
47 4 Sep 2023 4 Sep 2023 002585
48 4 Sep 2023 4 Sep 2023 002593
49 4 Sep 2023 4 Sep 2023 002641
50 4 Sep 2023 4 Sep 2023 002603
51 4 Sep 2023 4 Sep 2023 002265
52 4 Sep 2023 4 Sep 2023 002256
53 4 Sep 2023 4 Sep 2023 001903
54 5 Sep 2023 5 Sep 2023 002486
55 5 Sep 2023 5 Sep 2023 002273
56 5 Sep 2023 5 Sep 2023 002260
57 5 Sep 2023 5 Sep 2023 002268
58 5 Sep 2023 5 Sep 2023 002446
59 5 Sep 2023 5 Sep 2023 002276
60 5 Sep 2023 5 Sep 2023 001429
61 5 Sep 2023 5 Sep 2023 002278

Page 2
 HD

62 5 Sep 2023 5 Sep 2023 002236

63 5 Sep 2023 5 Sep 2023 002573
64 5 Sep 2023 5 Sep 2023 002284
65 5 Sep 2023 5 Sep 2023 002612
66 5 Sep 2023 5 Sep 2023 002595
67 5 Sep 2023 5 Sep 2023 002571
68 5 Sep 2023 5 Sep 2023 002609
69 5 Sep 2023 5 Sep 2023 002493
70 5 Sep 2023 5 Sep 2023 002281
71 6 Sep 2023 6 Sep 2023 002549
72 6 Sep 2023 6 Sep 2023 002630
73 6 Sep 2023 6 Sep 2023 001790
74 6 Sep 2023 6 Sep 2023 002447
75 6 Sep 2023 6 Sep 2023 001913
76 6 Sep 2023 6 Sep 2023 001736
77 6 Sep 2023 6 Sep 2023 001629
78 6 Sep 2023 6 Sep 2023 002516
79 6 Sep 2023 6 Sep 2023 001938
80 6 Sep 2023 6 Sep 2023 002532
81 6 Sep 2023 6 Sep 2023 002551
82 6 Sep 2023 6 Sep 2023 002608
83 6 Sep 2023 6 Sep 2023 002618
84 6 Sep 2023 6 Sep 2023 002471
85 6 Sep 2023 6 Sep 2023 002522
86 6 Sep 2023 6 Sep 2023 002528
87 6 Sep 2023 6 Sep 2023 002616
88 6 Sep 2023 6 Sep 2023 002597
89 6 Sep 2023 6 Sep 2023 002613
90 7 Sep 2023 7 Sep 2023 001366
91 7 Sep 2023 7 Sep 2023 001425
92 7 Sep 2023 7 Sep 2023 002252
93 7 Sep 2023 7 Sep 2023 002498
94 7 Sep 2023 7 Sep 2023 002628

Page 3
 HD

95 7 Sep 2023 7 Sep 2023 002267

96 7 Sep 2023 7 Sep 2023 001610
97 7 Sep 2023 7 Sep 2023 002238
98 7 Sep 2023 7 Sep 2023 002240
99 7 Sep 2023 7 Sep 2023 002555
100 7 Sep 2023 7 Sep 2023 002585
101 7 Sep 2023 7 Sep 2023 002265
102 7 Sep 2023 7 Sep 2023 002593
103 7 Sep 2023 7 Sep 2023 002641
104 7 Sep 2023 7 Sep 2023 002603
105 7 Sep 2023 7 Sep 2023 001903
106 7 Sep 2023 7 Sep 2023 002638
107 8 Sep 2023 8 Sep 2023 002268
108 8 Sep 2023 8 Sep 2023 002486
109 8 Sep 2023 8 Sep 2023 002260
110 8 Sep 2023 8 Sep 2023 002273
111 8 Sep 2023 8 Sep 2023 002276
112 8 Sep 2023 8 Sep 2023 002278
113 8 Sep 2023 8 Sep 2023 001429
114 8 Sep 2023 8 Sep 2023 002446
115 8 Sep 2023 8 Sep 2023 002236
116 8 Sep 2023 8 Sep 2023 002573
117 8 Sep 2023 8 Sep 2023 002609
118 8 Sep 2023 8 Sep 2023 002284
119 8 Sep 2023 8 Sep 2023 002281
120 8 Sep 2023 8 Sep 2023 002595
121 8 Sep 2023 8 Sep 2023 002612
122 8 Sep 2023 8 Sep 2023 002493
123 8 Sep 2023 8 Sep 2023 002571
124 9 Sep 2023 9 Sep 2023 001629
125 9 Sep 2023 9 Sep 2023 002516
126 9 Sep 2023 9 Sep 2023 001366
127 9 Sep 2023 9 Sep 2023 002549

Page 4
 HD

128 9 Sep 2023 9 Sep 2023 001913

129 9 Sep 2023 9 Sep 2023 002447
130 9 Sep 2023 9 Sep 2023 001790
131 9 Sep 2023 9 Sep 2023 002256
132 9 Sep 2023 9 Sep 2023 001736
133 9 Sep 2023 9 Sep 2023 001938
134 9 Sep 2023 9 Sep 2023 002532
135 9 Sep 2023 9 Sep 2023 002551
136 9 Sep 2023 9 Sep 2023 002608
137 9 Sep 2023 9 Sep 2023 002618
138 9 Sep 2023 9 Sep 2023 002528
139 9 Sep 2023 9 Sep 2023 002522
140 9 Sep 2023 9 Sep 2023 002613
141 9 Sep 2023 9 Sep 2023 002616
142 9 Sep 2023 9 Sep 2023 002597
143 9 Sep 2023 9 Sep 2023 002471
144 11 Sep 2023 11 Sep 2023 001366
145 11 Sep 2023 11 Sep 2023 002498
146 11 Sep 2023 11 Sep 2023 002252
147 11 Sep 2023 11 Sep 2023 001425
148 11 Sep 2023 11 Sep 2023 002267
149 11 Sep 2023 11 Sep 2023 002628
150 11 Sep 2023 11 Sep 2023 001610
151 11 Sep 2023 11 Sep 2023 002238
152 11 Sep 2023 11 Sep 2023 002240
153 11 Sep 2023 11 Sep 2023 002555
154 11 Sep 2023 11 Sep 2023 002585
155 11 Sep 2023 11 Sep 2023 001903
156 11 Sep 2023 11 Sep 2023 002641
157 11 Sep 2023 11 Sep 2023 002603
158 11 Sep 2023 11 Sep 2023 002593
159 11 Sep 2023 11 Sep 2023 002265
160 11 Sep 2023 11 Sep 2023 002256

Page 5
 HD

161 12 Sep 2023 12 Sep 2023 002486

162 12 Sep 2023 12 Sep 2023 002260
163 12 Sep 2023 12 Sep 2023 002273
164 12 Sep 2023 12 Sep 2023 002268
165 12 Sep 2023 12 Sep 2023 002446
166 12 Sep 2023 12 Sep 2023 002276
167 12 Sep 2023 12 Sep 2023 001429
168 12 Sep 2023 12 Sep 2023 002278
169 12 Sep 2023 12 Sep 2023 002236
170 12 Sep 2023 12 Sep 2023 002573
171 12 Sep 2023 12 Sep 2023 002284
172 12 Sep 2023 12 Sep 2023 002281
173 12 Sep 2023 12 Sep 2023 002571
174 12 Sep 2023 12 Sep 2023 002595
175 12 Sep 2023 12 Sep 2023 002612
176 12 Sep 2023 12 Sep 2023 002493
177 13 Sep 2023 13 Sep 2023 002549
178 13 Sep 2023 13 Sep 2023 001913
179 13 Sep 2023 13 Sep 2023 001790
180 13 Sep 2023 13 Sep 2023 002447
181 13 Sep 2023 13 Sep 2023 001629
182 13 Sep 2023 13 Sep 2023 001736
183 13 Sep 2023 13 Sep 2023 001938
184 13 Sep 2023 13 Sep 2023 002516
185 13 Sep 2023 13 Sep 2023 002630
186 13 Sep 2023 13 Sep 2023 002532
187 13 Sep 2023 13 Sep 2023 002551
188 13 Sep 2023 13 Sep 2023 002608
189 13 Sep 2023 13 Sep 2023 002618
190 13 Sep 2023 13 Sep 2023 002471
191 13 Sep 2023 13 Sep 2023 002522
192 13 Sep 2023 13 Sep 2023 002528
193 13 Sep 2023 13 Sep 2023 002613

Page 6
 HD

194 13 Sep 2023 13 Sep 2023 002597

195 13 Sep 2023 13 Sep 2023 002616
196 14 Sep 2023 14 Sep 2023 001366
197 14 Sep 2023 14 Sep 2023 002252
198 14 Sep 2023 14 Sep 2023 002267
199 14 Sep 2023 14 Sep 2023 001425
200 14 Sep 2023 14 Sep 2023 002498
201 14 Sep 2023 14 Sep 2023 002628
202 14 Sep 2023 14 Sep 2023 002240
203 14 Sep 2023 14 Sep 2023 001610
204 14 Sep 2023 14 Sep 2023 002238
205 14 Sep 2023 14 Sep 2023 002555
206 14 Sep 2023 14 Sep 2023 001903
207 14 Sep 2023 14 Sep 2023 002641
208 14 Sep 2023 14 Sep 2023 002265
209 14 Sep 2023 14 Sep 2023 002603
210 14 Sep 2023 14 Sep 2023 002593
211 14 Sep 2023 14 Sep 2023 002638
212 14 Sep 2023 14 Sep 2023 002585
213 15 Sep 2023 15 Sep 2023 002486
214 15 Sep 2023 15 Sep 2023 002260
215 15 Sep 2023 15 Sep 2023 002273
216 15 Sep 2023 15 Sep 2023 002268
217 15 Sep 2023 15 Sep 2023 001429
218 15 Sep 2023 15 Sep 2023 002278
219 15 Sep 2023 15 Sep 2023 002236
220 15 Sep 2023 15 Sep 2023 001938
221 15 Sep 2023 15 Sep 2023 002276
222 15 Sep 2023 15 Sep 2023 002609
223 15 Sep 2023 15 Sep 2023 002573
224 15 Sep 2023 15 Sep 2023 002281
225 15 Sep 2023 15 Sep 2023 002612
226 15 Sep 2023 15 Sep 2023 002595

Page 7
 HD

227 15 Sep 2023 15 Sep 2023 002571

228 15 Sep 2023 15 Sep 2023 002284
229 15 Sep 2023 15 Sep 2023 002493
230 16 Sep 2023 16 Sep 2023 001366
231 16 Sep 2023 16 Sep 2023 001913
232 16 Sep 2023 16 Sep 2023 002549
233 16 Sep 2023 16 Sep 2023 001790
234 16 Sep 2023 16 Sep 2023 002256
235 16 Sep 2023 16 Sep 2023 001736
236 16 Sep 2023 16 Sep 2023 002522
237 16 Sep 2023 16 Sep 2023 001629
238 16 Sep 2023 16 Sep 2023 002532
239 16 Sep 2023 16 Sep 2023 002551
240 16 Sep 2023 16 Sep 2023 002528
241 16 Sep 2023 16 Sep 2023 002618
242 16 Sep 2023 16 Sep 2023 002608
243 16 Sep 2023 16 Sep 2023 002616
244 16 Sep 2023 16 Sep 2023 002613
245 16 Sep 2023 16 Sep 2023 002471
246 16 Sep 2023 16 Sep 2023 002597
247 16 Sep 2023 16 Sep 2023 002516
248 18 Sep 2023 18 Sep 2023 001366
249 18 Sep 2023 18 Sep 2023 002498
250 18 Sep 2023 18 Sep 2023 001425
251 18 Sep 2023 18 Sep 2023 002252
252 18 Sep 2023 18 Sep 2023 002267
253 18 Sep 2023 18 Sep 2023 002628
254 18 Sep 2023 18 Sep 2023 001610
255 18 Sep 2023 18 Sep 2023 002238
256 18 Sep 2023 18 Sep 2023 002240
257 18 Sep 2023 18 Sep 2023 002555
258 18 Sep 2023 18 Sep 2023 002585
259 18 Sep 2023 18 Sep 2023 002641

Page 8
 HD

260 18 Sep 2023 18 Sep 2023 002593

261 18 Sep 2023 18 Sep 2023 002603
262 18 Sep 2023 18 Sep 2023 002265
263 18 Sep 2023 18 Sep 2023 001903
264 18 Sep 2023 18 Sep 2023 002447
265 18 Sep 2023 18 Sep 2023 002256
266 19 Sep 2023 19 Sep 2023 002486
267 19 Sep 2023 19 Sep 2023 002260
268 19 Sep 2023 19 Sep 2023 002273
269 19 Sep 2023 19 Sep 2023 002268
270 19 Sep 2023 19 Sep 2023 001429
271 19 Sep 2023 19 Sep 2023 002278
272 19 Sep 2023 19 Sep 2023 002236
273 19 Sep 2023 19 Sep 2023 002276
274 19 Sep 2023 19 Sep 2023 002446
275 19 Sep 2023 19 Sep 2023 002573
276 19 Sep 2023 19 Sep 2023 002609
277 19 Sep 2023 19 Sep 2023 002281
278 19 Sep 2023 19 Sep 2023 002284
279 19 Sep 2023 19 Sep 2023 002595
280 19 Sep 2023 19 Sep 2023 002571
281 19 Sep 2023 19 Sep 2023 002493
282 20 Sep 2023 20 Sep 2023 002549
283 20 Sep 2023 20 Sep 2023 001790
284 20 Sep 2023 20 Sep 2023 002256
285 20 Sep 2023 20 Sep 2023 001913
286 20 Sep 2023 20 Sep 2023 001629
287 20 Sep 2023 20 Sep 2023 001736
288 20 Sep 2023 20 Sep 2023 002532
289 20 Sep 2023 20 Sep 2023 002516
290 20 Sep 2023 20 Sep 2023 001938
291 20 Sep 2023 20 Sep 2023 002551
292 20 Sep 2023 20 Sep 2023 002618

Page 9
 HD

293 20 Sep 2023 20 Sep 2023 002608

294 20 Sep 2023 20 Sep 2023 002522
295 20 Sep 2023 20 Sep 2023 002528
296 20 Sep 2023 20 Sep 2023 002471
297 20 Sep 2023 20 Sep 2023 002613
298 20 Sep 2023 20 Sep 2023 002597
299 20 Sep 2023 20 Sep 2023 002616
300 21 Sep 2023 21 Sep 2023 002498
301 21 Sep 2023 21 Sep 2023 001366
302 21 Sep 2023 21 Sep 2023 001425
303 21 Sep 2023 21 Sep 2023 002628
304 21 Sep 2023 21 Sep 2023 002252
305 21 Sep 2023 21 Sep 2023 002267
306 21 Sep 2023 21 Sep 2023 001610
307 21 Sep 2023 21 Sep 2023 002240
308 21 Sep 2023 21 Sep 2023 002238
309 21 Sep 2023 21 Sep 2023 002555
310 21 Sep 2023 21 Sep 2023 002585
311 21 Sep 2023 21 Sep 2023 002641
312 21 Sep 2023 21 Sep 2023 002265
313 21 Sep 2023 21 Sep 2023 002603
314 21 Sep 2023 21 Sep 2023 002638
315 21 Sep 2023 21 Sep 2023 001903
316 22 Sep 2023 22 Sep 2023 002268
317 22 Sep 2023 22 Sep 2023 001429
318 22 Sep 2023 22 Sep 2023 002446
319 22 Sep 2023 22 Sep 2023 002278
320 22 Sep 2023 22 Sep 2023 002273
321 22 Sep 2023 22 Sep 2023 002486
322 22 Sep 2023 22 Sep 2023 002276
323 22 Sep 2023 22 Sep 2023 002260
324 22 Sep 2023 22 Sep 2023 002236
325 22 Sep 2023 22 Sep 2023 002609

Page 10
 HD

326 22 Sep 2023 22 Sep 2023 002573

327 22 Sep 2023 22 Sep 2023 002281
328 22 Sep 2023 22 Sep 2023 002284
329 22 Sep 2023 22 Sep 2023 002595
330 22 Sep 2023 22 Sep 2023 002612
331 22 Sep 2023 22 Sep 2023 002571
332 22 Sep 2023 22 Sep 2023 002493
333 23 Sep 2023 23 Sep 2023 001366
334 23 Sep 2023 23 Sep 2023 002549
335 23 Sep 2023 23 Sep 2023 001913
336 23 Sep 2023 23 Sep 2023 001790
337 23 Sep 2023 23 Sep 2023 002516
338 23 Sep 2023 23 Sep 2023 001736
339 23 Sep 2023 23 Sep 2023 001938
340 23 Sep 2023 23 Sep 2023 002447
341 23 Sep 2023 23 Sep 2023 002256
342 23 Sep 2023 23 Sep 2023 001629
343 23 Sep 2023 23 Sep 2023 002532
344 23 Sep 2023 23 Sep 2023 002551
345 23 Sep 2023 23 Sep 2023 002618
346 23 Sep 2023 23 Sep 2023 002608
347 23 Sep 2023 23 Sep 2023 002522
348 23 Sep 2023 23 Sep 2023 002528
349 23 Sep 2023 23 Sep 2023 002471
350 23 Sep 2023 23 Sep 2023 002613
351 23 Sep 2023 23 Sep 2023 002597
352 23 Sep 2023 23 Sep 2023 002616
353 25 Sep 2023 25 Sep 2023 001366
354 25 Sep 2023 25 Sep 2023 002498
355 25 Sep 2023 25 Sep 2023 001425
356 25 Sep 2023 25 Sep 2023 002252
357 25 Sep 2023 25 Sep 2023 002628
358 25 Sep 2023 25 Sep 2023 002267

Page 11
 HD

359 25 Sep 2023 25 Sep 2023 001610

360 25 Sep 2023 25 Sep 2023 002238
361 25 Sep 2023 25 Sep 2023 002240
362 25 Sep 2023 25 Sep 2023 002555
363 25 Sep 2023 25 Sep 2023 002585
364 25 Sep 2023 25 Sep 2023 002641
365 25 Sep 2023 25 Sep 2023 001903
366 25 Sep 2023 25 Sep 2023 002486
367 25 Sep 2023 25 Sep 2023 002603
368 25 Sep 2023 25 Sep 2023 002593
369 25 Sep 2023 25 Sep 2023 002630
370 25 Sep 2023 25 Sep 2023 002265
371 25 Sep 2023 25 Sep 2023 002256
372 26 Sep 2023 26 Sep 2023 002671
373 26 Sep 2023 26 Sep 2023 002573
374 26 Sep 2023 26 Sep 2023 002268
375 26 Sep 2023 26 Sep 2023 001429
376 26 Sep 2023 26 Sep 2023 002236
377 26 Sep 2023 26 Sep 2023 002260
378 26 Sep 2023 26 Sep 2023 002273
379 26 Sep 2023 26 Sep 2023 002276
380 26 Sep 2023 26 Sep 2023 002278
381 26 Sep 2023 26 Sep 2023 002609
382 26 Sep 2023 26 Sep 2023 002281
383 26 Sep 2023 26 Sep 2023 002284
384 26 Sep 2023 26 Sep 2023 002571
385 26 Sep 2023 26 Sep 2023 002595
386 26 Sep 2023 26 Sep 2023 002493
387 27 Sep 2023 27 Sep 2023 002549
388 27 Sep 2023 27 Sep 2023 001790
389 27 Sep 2023 27 Sep 2023 001913
390 27 Sep 2023 27 Sep 2023 001629
391 27 Sep 2023 27 Sep 2023 002256

Page 12
 HD

392 27 Sep 2023 27 Sep 2023 002532

393 27 Sep 2023 27 Sep 2023 001736
394 27 Sep 2023 27 Sep 2023 002516
395 27 Sep 2023 27 Sep 2023 001938
396 27 Sep 2023 27 Sep 2023 002551
397 27 Sep 2023 27 Sep 2023 002608
398 27 Sep 2023 27 Sep 2023 002618
399 27 Sep 2023 27 Sep 2023 002471
400 27 Sep 2023 27 Sep 2023 002528
401 27 Sep 2023 27 Sep 2023 002522
402 27 Sep 2023 27 Sep 2023 002613
403 27 Sep 2023 27 Sep 2023 002597
404 28 Sep 2023 28 Sep 2023 001366
405 28 Sep 2023 28 Sep 2023 001425
406 28 Sep 2023 28 Sep 2023 002498
407 28 Sep 2023 28 Sep 2023 002252
408 28 Sep 2023 28 Sep 2023 002628
409 28 Sep 2023 28 Sep 2023 002267
410 28 Sep 2023 28 Sep 2023 001610
411 28 Sep 2023 28 Sep 2023 002240
412 28 Sep 2023 28 Sep 2023 002238
413 28 Sep 2023 28 Sep 2023 002555
414 28 Sep 2023 28 Sep 2023 002585
415 28 Sep 2023 28 Sep 2023 002616
416 28 Sep 2023 28 Sep 2023 001903
417 28 Sep 2023 28 Sep 2023 002265
418 28 Sep 2023 28 Sep 2023 002641
419 28 Sep 2023 28 Sep 2023 001429
420 28 Sep 2023 28 Sep 2023 002638
421 28 Sep 2023 28 Sep 2023 002603
422 29 Sep 2023 29 Sep 2023 002268
423 29 Sep 2023 29 Sep 2023 002573
424 29 Sep 2023 29 Sep 2023 002236

Page 13
 HD

425 29 Sep 2023 29 Sep 2023 002276

426 29 Sep 2023 29 Sep 2023 002446
427 29 Sep 2023 29 Sep 2023 002278
428 29 Sep 2023 29 Sep 2023 002273
429 29 Sep 2023 29 Sep 2023 002486
430 29 Sep 2023 29 Sep 2023 002260
431 29 Sep 2023 29 Sep 2023 002284
432 29 Sep 2023 29 Sep 2023 002609
433 29 Sep 2023 29 Sep 2023 002571
434 29 Sep 2023 29 Sep 2023 002671
435 29 Sep 2023 29 Sep 2023 002595
436 29 Sep 2023 29 Sep 2023 002493
437 29 Sep 2023 29 Sep 2023 002281
438 30 Sep 2023 30 Sep 2023 002549
439 30 Sep 2023 30 Sep 2023 001366
440 30 Sep 2023 30 Sep 2023 001790
441 30 Sep 2023 30 Sep 2023 002256
442 30 Sep 2023 30 Sep 2023 001736
443 30 Sep 2023 30 Sep 2023 001629
444 30 Sep 2023 30 Sep 2023 002447
445 30 Sep 2023 30 Sep 2023 002516
446 30 Sep 2023 30 Sep 2023 001938
447 30 Sep 2023 30 Sep 2023 002532
448 30 Sep 2023 30 Sep 2023 002551
449 30 Sep 2023 30 Sep 2023 002618
450 30 Sep 2023 30 Sep 2023 002608
451 30 Sep 2023 30 Sep 2023 002471
452 30 Sep 2023 30 Sep 2023 002528
453 30 Sep 2023 30 Sep 2023 002616
454 30 Sep 2023 30 Sep 2023 002522
455 30 Sep 2023 30 Sep 2023 002613
456 30 Sep 2023 30 Sep 2023 002597

Page 14
 HD

Kode RS: K3204005

Page 15
 HD

LAPORAN REKAP KLAIM - KLINIK HEMOLIFE

Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Sep 2023 s/d 16 Okt 2023
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D SWASTA

Nama Pasien No. Klaim / SEP INACBG

SULASTRI 0135S0440923V000001 N-3-15-0
ANANG SUBARNAS 0135S0440923V000002 N-3-15-0
LENI KARLINA 0135S0440923V000003 N-3-15-0
IMAS SOLIHAH 0135S0440923V000004 N-3-15-0
SIMIN 0135S0440923V000005 N-3-15-0
ALIS AISAH 0135S0440923V000006 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000007 N-3-15-0
DJARWO SUYARSO 0135S0440923V000008 N-3-15-0
SITI JAHRA 0135S0440923V000009 N-3-15-0
OMBAH 0135S0440923V000010 N-3-15-0
USEP SUPRIANI 0135S0440923V000011 N-3-15-0
ODAS UGAN 0135S0440923V000012 N-3-15-0
FARUK AMRULLAH 0135S0440923V000014 N-3-15-0
AGUS JUNAWA 0135S0440923V000015 N-3-15-0
DADAN SOLIHIN 0135S0440923V000016 N-3-15-0
RANIE MANALU 0135S0440923V000013 D-3-10-0
NANIH MACHENDRAWATY 0135S0440923V000017 N-3-15-0
MASNIAR 0135S0440923V000018 N-3-15-0
SUARTI 0135S0440923V000019 N-3-15-0
NANANG ACHDIAT 0135S0440923V000020 N-3-15-0
YETI SRI HARYATI 0135S0440923V000021 N-3-15-0
E SURATMI 0135S0440923V000022 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000023 N-3-15-0
ANI HANDAYANI 0135S0440923V000024 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000025 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000026 N-3-15-0
KIKIN 0135S0440923V000028 N-3-15-0
AGUS GUNAWAN 0135S0440923V000029 N-3-15-0

Page 16
 HD

JUJU SASMITA 0135S0440923V000030 N-3-15-0

DINAR SUTISNA 0135S0440923V000031 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000032 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000033 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000034 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000035 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000036 N-3-15-0
ASEP MULYANA 0135S0440923V000027 N-3-15-0
ASIS 0135S0440923V000037 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000038 N-3-15-0
DUDU GUNAWAN 0135S0440923V000039 N-3-15-0
SUKAESIH 0135S0440923V000040 N-3-15-0
IWAN SUNARYA 0135S0440923V000041 N-3-15-0
SUKIRMAN 0135S0440923V000042 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000043 N-3-15-0
DEDE SURYANA 0135S0440923V000044 N-3-15-0
MAHDUM 0135S0440923V000045 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000046 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000047 N-3-15-0
ANISAH 0135S0440923V000048 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000050 N-3-15-0
DENI 0135S0440923V000051 N-3-15-0
AANG AMRI 0135S0440923V000052 N-3-15-0
E SURATMI 0135S0440923V000053 N-3-15-0
MARLINA 0135S0440923V000049 N-3-15-0
IMAS SOLIHAH 0135S0440923V000054 N-3-15-0
SIMIN 0135S0440923V000055 N-3-15-0
ALIS AISAH 0135S0440923V000056 N-3-15-0
SULASTRI 0135S0440923V000057 N-3-15-0
LENI KARLINA 0135S0440923V000058 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000059 N-3-15-0
SITI JAHRA 0135S0440923V000060 N-3-15-0
ANANG SUBARNAS 0135S0440923V000061 N-3-15-0

Page 17
 HD

DJARWO SUYARSO 0135S0440923V000062 N-3-15-0

OMBAH 0135S0440923V000063 N-3-15-0
FARUK AMRULLAH 0135S0440923V000065 N-3-15-0
ODAS UGAN 0135S0440923V000066 N-3-15-0
RANIE MANALU 0135S0440923V000067 N-3-15-0
AAH CAHYANI 0135S0440923V000068 N-3-15-0
DADAN SOLIHIN 0135S0440923V000069 N-3-15-0
AGUS JUNAWA 0135S0440923V000070 N-3-15-0
USEP SUPRIANI 0135S0440923V000064 N-3-15-0
MASNIAR 0135S0440923V000076 N-3-15-0
YUNIAR ARLIAWATI 0135S0440923V000077 N-3-15-0
YETI SRI HARYATI 0135S0440923V000078 N-3-15-0
SUARTI 0135S0440923V000079 N-3-15-0
NANANG ACHDIAT 0135S0440923V000080 N-3-15-0
ANI HANDAYANI 0135S0440923V000081 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000082 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000083 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000084 N-3-15-0
KIKIN 0135S0440923V000085 N-3-15-0
ASEP MULYANA 0135S0440923V000086 N-3-15-0
AGUS GUNAWAN 0135S0440923V000087 N-3-15-0
JUJU SASMITA 0135S0440923V000088 N-3-15-0
DINAR SUTISNA 0135S0440923V000089 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000090 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000091 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000092 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000093 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000094 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000095 N-3-15-0
ASIS 0135S0440923V000096 N-3-15-0
SUKAESIH 0135S0440923V000097 N-3-15-0
DUDU GUNAWAN 0135S0440923V000098 N-3-15-0
MAHDUM 0135S0440923V000099 N-3-15-0

Page 18
 HD

SUKIRMAN 0135S0440923V000100 N-3-15-0

DEDE SURYANA 0135S0440923V000101 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000102 N-3-15-0
IWAN SUNARYA 0135S0440923V000103 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000104 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000105 D-3-10-0
AANG AMRI 0135S0440923V000106 N-3-15-0
ANISAH 0135S0440923V000107 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000108 N-3-15-0
DENI 0135S0440923V000109 N-3-15-0
MARLINA 0135S0440923V000110 N-3-15-0
DENDY RIZKI NUGRAHA 0135S0440923V000111 N-3-15-0
SULASTRI 0135S0440923V000112 N-3-15-0
IMAS SOLIHAH 0135S0440923V000113 N-3-15-0
ALIS AISAH 0135S0440923V000114 N-3-15-0
SIMIN 0135S0440923V000115 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000116 N-3-15-0
ANANG SUBARNAS 0135S0440923V000117 N-3-15-0
SITI JAHRA 0135S0440923V000118 N-3-15-0
LENI KARLINA 0135S0440923V000119 N-3-15-0
DJARWO SUYARSO 0135S0440923V000120 N-3-15-0
OMBAH 0135S0440923V000121 N-3-15-0
DADAN SOLIHIN 0135S0440923V000122 N-3-15-0
FARUK AMRULLAH 0135S0440923V000123 N-3-15-0
USEP SUPRIANI 0135S0440923V000124 N-3-15-0
RANIE MANALU 0135S0440923V000125 N-3-15-0
ODAS UGAN 0135S0440923V000126 N-3-15-0
AGUS JUNAWA 0135S0440923V000127 N-3-15-0
AAH CAHYANI 0135S0440923V000128 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000135 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000137 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000129 N-3-15-0
MASNIAR 0135S0440923V000130 N-3-15-0

Page 19
 HD

NANANG ACHDIAT 0135S0440923V000131 N-3-15-0

SUARTI 0135S0440923V000132 N-3-15-0
YETI SRI HARYATI 0135S0440923V000133 N-3-15-0
E SURATMI 0135S0440923V000134 N-3-15-0
ANI HANDAYANI 0135S0440923V000136 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000138 N-3-15-0
KIKIN 0135S0440923V000139 N-3-15-0
ASEP MULYANA 0135S0440923V000140 N-3-15-0
AGUS GUNAWAN 0135S0440923V000141 N-3-15-0
JUJU SASMITA 0135S0440923V000142 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000143 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000144 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000146 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000147 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000148 N-3-15-0
DINAR SUTISNA 0135S0440923V000145 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000149 N-3-15-0
DUDU GUNAWAN 0135S0440923V000150 N-3-15-0
SUKAESIH 0135S0440923V000151 N-3-15-0
ASIS 0135S0440923V000152 N-3-15-0
SUKIRMAN 0135S0440923V000153 N-3-15-0
MAHDUM 0135S0440923V000154 N-3-15-0
DEDE SURYANA 0135S0440923V000155 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000156 N-3-15-0
IWAN SUNARYA 0135S0440923V000157 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000158 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000159 N-3-15-0
MARLINA 0135S0440923V000160 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000161 N-3-15-0
DENI 0135S0440923V000162 N-3-15-0
ANISAH 0135S0440923V000163 N-3-15-0
AANG AMRI 0135S0440923V000164 N-3-15-0
E SURATMI 0135S0440923V000165 N-3-15-0

Page 20
 HD

IMAS SOLIHAH 0135S0440923V000166 N-3-15-0

ALIS AISAH 0135S0440923V000167 N-3-15-0
SIMIN 0135S0440923V000168 N-3-15-0
SULASTRI 0135S0440923V000169 N-3-15-0
LENI KARLINA 0135S0440923V000170 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000171 N-3-15-0
SITI JAHRA 0135S0440923V000172 N-3-15-0
ANANG SUBARNAS 0135S0440923V000173 N-3-15-0
DJARWO SUYARSO 0135S0440923V000174 N-3-15-0
OMBAH 0135S0440923V000175 N-3-15-0
FARUK AMRULLAH 0135S0440923V000176 N-3-15-0
USEP SUPRIANI 0135S0440923V000177 N-3-15-0
AAH CAHYANI 0135S0440923V000178 N-3-15-0
RANIE MANALU 0135S0440923V000179 N-3-15-0
ODAS UGAN 0135S0440923V000180 N-3-15-0
AGUS JUNAWA 0135S0440923V000181 N-3-15-0
MASNIAR 0135S0440923V000188 N-3-15-0
NANANG ACHDIAT 0135S0440923V000189 N-3-15-0
YETI SRI HARYATI 0135S0440923V000190 N-3-15-0
SUARTI 0135S0440923V000191 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000192 N-3-15-0
ANI HANDAYANI 0135S0440923V000193 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000194 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000195 N-3-15-0
YUNIAR ARLIAWATI 0135S0440923V000196 N-3-15-0
KIKIN 0135S0440923V000197 N-3-15-0
ASEP MULYANA 0135S0440923V000198 N-3-15-0
AGUS GUNAWAN 0135S0440923V000199 N-3-15-0
JUJU SASMITA 0135S0440923V000200 N-3-15-0
DINAR SUTISNA 0135S0440923V000201 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000202 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000203 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000204 N-3-15-0

Page 21
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AGNES WIDYASTUTI 0135S0440923V000205 N-3-15-0

FONNY CARTEPILLANTO 0135S0440923V000206 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000207 N-3-15-0
SUKAESIH 0135S0440923V000208 N-3-15-0
SUKIRMAN 0135S0440923V000209 N-3-15-0
ASIS 0135S0440923V000210 N-3-15-0
DUDU GUNAWAN 0135S0440923V000211 N-3-15-0
MAHDUM 0135S0440923V000212 N-3-15-0
IWAN SUNARYA 0135S0440923V000213 N-3-15-0
DEDE SURYANA 0135S0440923V000214 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000215 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000216 N-3-15-0
MARLINA 0135S0440923V000218 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000219 N-3-15-0
AANG AMRI 0135S0440923V000220 N-3-15-0
DENI 0135S0440923V000221 N-3-15-0
ANISAH 0135S0440923V000222 N-3-15-0
DENDY RIZKI NUGRAHA 0135S0440923V000223 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000217 N-3-15-0
IMAS SOLIHAH 0135S0440923V000228 N-3-15-0
ALIS AISAH 0135S0440923V000229 N-3-15-0
SIMIN 0135S0440923V000230 N-3-15-0
SULASTRI 0135S0440923V000231 N-3-15-0
SITI JAHRA 0135S0440923V000232 N-3-15-0
ANANG SUBARNAS 0135S0440923V000233 N-3-15-0
DJARWO SUYARSO 0135S0440923V000234 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000235 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000236 N-3-15-0
DADAN SOLIHIN 0135S0440923V000237 N-3-15-0
OMBAH 0135S0440923V000238 N-3-15-0
USEP SUPRIANI 0135S0440923V000239 N-3-15-0
ODAS UGAN 0135S0440923V000240 N-3-15-0
RANIE MANALU 0135S0440923V000241 N-3-15-0

Page 22
 HD

AAH CAHYANI 0135S0440923V000242 N-3-15-0

FARUK AMRULLAH 0135S0440923V000243 N-3-15-0
AGUS JUNAWA 0135S0440923V000244 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000245 N-3-15-0
NANANG ACHDIAT 0135S0440923V000246 N-3-15-0
MASNIAR 0135S0440923V000247 N-3-15-0
YETI SRI HARYATI 0135S0440923V000248 N-3-15-0
E SURATMI 0135S0440923V000249 N-3-15-0
ANI HANDAYANI 0135S0440923V000250 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000251 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000252 N-3-15-0
KIKIN 0135S0440923V000254 N-3-15-0
ASEP MULYANA 0135S0440923V000255 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000256 N-3-15-0
JUJU SASMITA 0135S0440923V000257 N-3-15-0
AGUS GUNAWAN 0135S0440923V000258 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000259 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000260 N-3-15-0
DINAR SUTISNA 0135S0440923V000261 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000262 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000253 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000263 N-3-15-0
DUDU GUNAWAN 0135S0440923V000264 N-3-15-0
ASIS 0135S0440923V000265 N-3-15-0
SUKAESIH 0135S0440923V000266 N-3-15-0
SUKIRMAN 0135S0440923V000267 N-3-15-0
MAHDUM 0135S0440923V000268 N-3-15-0
DEDE SURYANA 0135S0440923V000269 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000270 N-3-15-0
IWAN SUNARYA 0135S0440923V000271 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000272 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000273 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000274 N-3-15-0

Page 23
 HD

ANISAH 0135S0440923V000275 N-3-15-0

DENI 0135S0440923V000276 N-3-15-0
AANG AMRI 0135S0440923V000277 N-3-15-0
MARLINA 0135S0440923V000278 N-3-15-0
SUARTI 0135S0440923V000279 N-3-15-0
E SURATMI 0135S0440923V000280 N-3-15-0
IMAS SOLIHAH 0135S0440923V000281 N-3-15-0
ALIS AISAH 0135S0440923V000282 N-3-15-0
SIMIN 0135S0440923V000283 N-3-15-0
SULASTRI 0135S0440923V000284 N-3-15-0
SITI JAHRA 0135S0440923V000285 N-3-15-0
ANANG SUBARNAS 0135S0440923V000286 N-3-15-0
DJARWO SUYARSO 0135S0440923V000287 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000288 N-3-15-0
LENI KARLINA 0135S0440923V000289 N-3-15-0
OMBAH 0135S0440923V000290 N-3-15-0
DADAN SOLIHIN 0135S0440923V000291 N-3-15-0
USEP SUPRIANI 0135S0440923V000292 N-3-15-0
FARUK AMRULLAH 0135S0440923V000293 N-3-15-0
RANIE MANALU 0135S0440923V000294 N-3-15-0
AAH CAHYANI 0135S0440923V000295 D-3-10-0
AGUS JUNAWA 0135S0440923V000296 N-3-15-0
MASNIAR 0135S0440923V000297 N-3-15-0
YETI SRI HARYATI 0135S0440923V000298 N-3-15-0
E SURATMI 0135S0440923V000299 N-3-15-0
NANANG ACHDIAT 0135S0440923V000300 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000301 N-3-15-0
ANI HANDAYANI 0135S0440923V000302 N-3-15-0
KIKIN 0135S0440923V000303 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000304 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000305 N-3-15-0
ASEP MULYANA 0135S0440923V000306 N-3-15-0
JUJU SASMITA 0135S0440923V000307 N-3-15-0

Page 24
 HD

AGUS GUNAWAN 0135S0440923V000308 N-3-15-0

DEDIH KUSNAEDI 0135S0440923V000309 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000310 N-3-15-0
DINAR SUTISNA 0135S0440923V000311 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000312 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000313 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000314 N-3-15-0
DUDU GUNAWAN 0135S0440923V000315 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000316 N-3-15-0
ASIS 0135S0440923V000317 N-3-15-0
MAHDUM 0135S0440923V000318 N-3-15-0
SUKAESIH 0135S0440923V000319 N-3-15-0
SUKIRMAN 0135S0440923V000320 N-3-15-0
DEDE SURYANA 0135S0440923V000321 N-3-15-0
IWAN SUNARYA 0135S0440923V000322 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000323 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000324 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000325 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000326 N-3-15-0
AANG AMRI 0135S0440923V000327 N-3-15-0
DENI 0135S0440923V000328 N-3-15-0
DENDY RIZKI NUGRAHA 0135S0440923V000329 N-3-15-0
MARLINA 0135S0440923V000330 N-3-15-0
SULASTRI 0135S0440923V000333 N-3-15-0
SITI JAHRA 0135S0440923V000334 N-3-15-0
LENI KARLINA 0135S0440923V000335 N-3-15-0
ANANG SUBARNAS 0135S0440923V000336 N-3-15-0
SIMIN 0135S0440923V000337 N-3-15-0
IMAS SOLIHAH 0135S0440923V000338 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000339 N-3-15-0
ALIS AISAH 0135S0440923V000340 N-3-15-0
DJARWO SUYARSO 0135S0440923V000341 N-3-15-0
DADAN SOLIHIN 0135S0440923V000342 N-3-15-0

Page 25
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OMBAH 0135S0440923V000343 N-3-15-0

USEP SUPRIANI 0135S0440923V000344 N-3-15-0
FARUK AMRULLAH 0135S0440923V000345 N-3-15-0
RANIE MANALU 0135S0440923V000346 N-3-15-0
ODAS UGAN 0135S0440923V000347 N-3-15-0
AAH CAHYANI 0135S0440923V000348 N-3-15-0
AGUS JUNAWA 0135S0440923V000349 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000351 N-3-15-0
MASNIAR 0135S0440923V000352 N-3-15-0
NANANG ACHDIAT 0135S0440923V000353 N-3-15-0
YETI SRI HARYATI 0135S0440923V000354 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000355 N-3-15-0
ANI HANDAYANI 0135S0440923V000356 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000357 N-3-15-0
SUARTI 0135S0440923V000358 N-3-15-0
E SURATMI 0135S0440923V000359 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000360 N-3-15-0
KIKIN 0135S0440923V000361 N-3-15-0
ASEP MULYANA 0135S0440923V000362 N-3-15-0
JUJU SASMITA 0135S0440923V000363 N-3-15-0
AGUS GUNAWAN 0135S0440923V000364 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000365 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000366 N-3-15-0
DINAR SUTISNA 0135S0440923V000367 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000368 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000369 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000370 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000376 N-3-15-0
DUDU GUNAWAN 0135S0440923V000377 N-3-15-0
ASIS 0135S0440923V000378 N-3-15-0
SUKAESIH 0135S0440923V000379 N-3-15-0
MAHDUM 0135S0440923V000380 N-3-15-0
SUKIRMAN 0135S0440923V000381 N-3-15-0

Page 26
 HD

DEDE SURYANA 0135S0440923V000382 N-3-15-0

KUSMAYADI KOSTAMAN 0135S0440923V000383 N-3-15-0
IWAN SUNARYA 0135S0440923V000384 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000385 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000386 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000387 N-3-15-0
MARLINA 0135S0440923V000388 N-3-15-0
IMAS SOLIHAH 0135S0440923V000389 N-3-15-0
DENI 0135S0440923V000390 N-3-15-0
ANISAH 0135S0440923V000391 N-3-15-0
YUNIAR ARLIAWATI 0135S0440923V000392 N-3-15-0
AANG AMRI 0135S0440923V000393 N-3-15-0
E SURATMI 0135S0440923V000394 N-3-15-0
EHA JUHAELA 0135S0440923V000395 N-3-15-0
OMBAH 0135S0440923V000396 N-3-15-0
SULASTRI 0135S0440923V000397 N-3-15-0
SITI JAHRA 0135S0440923V000398 N-3-15-0
DJARWO SUYARSO 0135S0440923V000399 N-3-15-0
ALIS AISAH 0135S0440923V000400 N-3-15-0
SIMIN 0135S0440923V000401 N-3-15-0
RIDELLA SRINAVO HIARIEJ 0135S0440923V000402 N-3-15-0
ANANG SUBARNAS 0135S0440923V000403 N-3-15-0
DADAN SOLIHIN 0135S0440923V000404 N-3-15-0
USEP SUPRIANI 0135S0440923V000405 N-3-15-0
FARUK AMRULLAH 0135S0440923V000406 N-3-15-0
AAH CAHYANI 0135S0440923V000407 N-3-15-0
RANIE MANALU 0135S0440923V000408 N-3-15-0
AGUS JUNAWA 0135S0440923V000409 N-3-15-0
MASNIAR 0135S0440923V000410 N-3-15-0
YETI SRI HARYATI 0135S0440923V000411 N-3-15-0
NANANG ACHDIAT 0135S0440923V000412 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000413 N-3-15-0
E SURATMI 0135S0440923V000414 N-3-15-0

Page 27
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KIKIN 0135S0440923V000415 N-3-15-0

ANI HANDAYANI 0135S0440923V000416 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000417 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000418 N-3-15-0
ASEP MULYANA 0135S0440923V000419 N-3-15-0
AGUS GUNAWAN 0135S0440923V000420 N-3-15-0
JUJU SASMITA 0135S0440923V000421 N-3-15-0
DINAR SUTISNA 0135S0440923V000422 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000423 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000424 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000425 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000426 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000427 N-3-15-0
ASIS 0135S0440923V000428 N-3-15-0
DUDU GUNAWAN 0135S0440923V000429 N-3-15-0
SUKAESIH 0135S0440923V000430 N-3-15-0
MAHDUM 0135S0440923V000431 N-3-15-0
SUKIRMAN 0135S0440923V000432 N-3-15-0
DEDE SURYANA 0135S0440923V000433 N-3-15-0
IWAN SUNARYA 0135S0440923V000434 N-3-15-0
KUSMAYADI KOSTAMAN 0135S0440923V000435 N-3-15-0
RACHMAD SUHENDROTOMO 0135S0440923V000436 N-3-15-0
IR.ANDRIE KURNIAWAN 0135S0440923V000437 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000438 D-3-10-0
MARLINA 0135S0440923V000439 N-3-15-0
AANG AMRI 0135S0440923V000440 N-3-15-0
AGUS SETRIAMAN 0135S0440923V000441 D-3-10-0
SITI JAHRA 0135S0440923V000442 N-3-15-0
DENDY RIZKI NUGRAHA 0135S0440923V000444 N-3-15-0
DENI 0135S0440923V000443 N-3-15-0
SULASTRI 0135S0440923V000445 N-3-15-0
OMBAH 0135S0440923V000446 N-3-15-0
DJARWO SUYARSO 0135S0440923V000447 N-3-15-0

Page 28
 HD

RIDELLA SRINAVO HIARIEJ 0135S0440923V000448 N-3-15-0

LENI KARLINA 0135S0440923V000449 N-3-15-0
ANANG SUBARNAS 0135S0440923V000450 N-3-15-0
SIMIN 0135S0440923V000451 N-3-15-0
IMAS SOLIHAH 0135S0440923V000452 N-3-15-0
ALIS AISAH 0135S0440923V000453 N-3-15-0
FARUK AMRULLAH 0135S0440923V000454 N-3-15-0
DADAN SOLIHIN 0135S0440923V000456 N-3-15-0
AAH CAHYANI 0135S0440923V000457 N-3-15-0
EHA JUHAELA 0135S0440923V000458 N-3-15-0
RANIE MANALU 0135S0440923V000459 N-3-15-0
AGUS JUNAWA 0135S0440923V000460 N-3-15-0
USEP SUPRIANI 0135S0440923V000455 N-3-15-0
MASNIAR 0135S0440923V000464 N-3-15-0
NANIH MACHENDRAWATY 0135S0440923V000465 N-3-15-0
YETI SRI HARYATI 0135S0440923V000466 N-3-15-0
E SURATMI 0135S0440923V000463 N-3-15-0
ANI HANDAYANI 0135S0440923V000467 N-3-15-0
DAMAN WARDIMAN 0135S0440923V000468 N-3-15-0
SUARTI 0135S0440923V000469 N-3-15-0
DANDAN SYARIPUDIN 0135S0440923V000470 N-3-15-0
SETIAWAN SAMSUDIN 0135S0440923V000471 N-3-15-0
KIKIN 0135S0440923V000472 N-3-15-0
ASEP MULYANA 0135S0440923V000473 N-3-15-0
JUJU SASMITA 0135S0440923V000474 N-3-15-0
AGUS GUNAWAN 0135S0440923V000475 N-3-15-0
DINAR SUTISNA 0135S0440923V000476 N-3-15-0
AE JUNAEDI MA'ALI 0135S0440923V000477 N-3-15-0
FONNY CARTEPILLANTO 0135S0440923V000478 N-3-15-0
DEDIH KUSNAEDI 0135S0440923V000479 N-3-15-0
ADEN ALAMSYAH 0135S0440923V000480 N-3-15-0
AGNES WIDYASTUTI 0135S0440923V000481 N-3-15-0
Tota

Page 29
 HD

Okt 2023
RS KELAS D SWASTA

Top Up Total Tarif Tarif RS Jenis

708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,236 RJ
708,050 925,226 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 1,053,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 1,053,100 RJ
1,104,100 1,675,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,226 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 30
 HD

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ

Page 31
 HD

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,200 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 1,053,187 RJ
708,050 925,200 RJ
708,050 950,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,226 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,171 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,904 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 32
 HD

708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
1,104,100 1,675,500 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,226 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,233 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,208 RJ

Page 33
 HD

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 1,053,000 RJ
708,050 1,053,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 945,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 1,053,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 34
 HD

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,208 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 927,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 1,053,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 35
 HD

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 1,053,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 1,645,000 RJ
708,050 950,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 36
 HD

708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 37
 HD

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,172 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
1,104,100 1,650,500 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ

Page 38
 HD

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,387 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ

Page 39
 HD

708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,200 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ

Page 40
 HD

708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,241 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,208 RJ
708,050 925,187 RJ
708,050 925,000 RJ

Page 41
 HD

708,050 950,000 RJ
708,050 925,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
1,104,100 2,010,500 RJ
708,050 925,000 RJ
708,050 950,000 RJ
1,104,100 1,700,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,187 RJ
708,050 950,000 RJ

Page 42
 HD

708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,233 RJ
708,050 950,000 RJ
708,050 950,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 950,187 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 950,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
708,050 925,000 RJ
Total 324,851,050 428,739,037

Page 43
 PD

LAPORAN RE
Pasien Rawat Inap dan Rawat Jalan
Filter: / Kelas Rawat = Semua / Severity = Semua

No. Tgl. Masuk Tgl. Pulang No. RM

1 12 Sep 2023 12 Sep 2023 001736
2 12 Sep 2023 12 Sep 2023 001425
3 12 Sep 2023 12 Sep 2023 002525
4 12 Sep 2023 12 Sep 2023 002267
5 12 Sep 2023 12 Sep 2023 002252
6 14 Sep 2023 14 Sep 2023 002375
7 14 Sep 2023 14 Sep 2023 002516
8 14 Sep 2023 14 Sep 2023 002522
9 14 Sep 2023 14 Sep 2023 002493
10 21 Sep 2023 21 Sep 2023 002280
11 21 Sep 2023 21 Sep 2023 001938
12 23 Sep 2023 23 Sep 2023 002603
13 23 Sep 2023 23 Sep 2023 001903
14 23 Sep 2023 23 Sep 2023 002595
15 23 Sep 2023 23 Sep 2023 002593
16 23 Sep 2023 23 Sep 2023 002498
17 30 Sep 2023 30 Sep 2023 002486
18 30 Sep 2023 30 Sep 2023 002641
19 30 Sep 2023 30 Sep 2023 002571
Total

Kode RS: K3204005

Page 1
 PD

LAPORAN REKAP KLAIM - KLINIK HEMOLIFE

Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Sep 2023 s/d 16 Okt 2023
ter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D SWASTA

Nama Pasien No. Klaim / SEP INACBG

ANI HANDAYANI 0135S0440923V000183 Q-5-44-0
ASIS 0135S0440923V000184 Q-5-44-0
NANI KARYANI 0135S0440923V000185 Q-5-44-0
SUKIRMAN 0135S0440923V000187 Q-5-44-0
SUKAESIH 0135S0440923V000182 Q-5-44-0
ARIANTO AMIEN 0135S0440923V000224 Q-5-44-0
DANDAN SYARIPUDIN 0135S0440923V000225 Q-5-44-0
DEDIH KUSNAEDI 0135S0440923V000226 Q-5-44-0
AGUS JUNAWA 0135S0440923V000227 Q-5-44-0
IYON JOHNI 0135S0440923V000331 Q-5-44-0
SETIAWAN SAMSUDIN 0135S0440923V000332 Q-5-44-0
DENI 0135S0440923V000371 Q-5-44-0
MARLINA 0135S0440923V000372 Q-5-44-0
RANIE MANALU 0135S0440923V000373 Q-5-44-0
ANISAH 0135S0440923V000374 Q-5-44-0
DUDU GUNAWAN 0135S0440923V000375 Q-5-44-0
IMAS SOLIHAH 0135S0440923V000482 Q-5-44-0
AGUS SETRIAMAN 0135S0440923V000483 Q-5-44-0
AAH CAHYANI 0135S0440923V000484 Q-5-44-0
Total

Page 2
 PD

Okt 2023
RS KELAS D SWASTA

Top Up Total Tarif Tarif RS Jenis

192,400 229,500 RJ
192,400 232,900 RJ
192,400 223,000 RJ
192,400 229,500 RJ
192,400 229,500 RJ
192,400 236,600 RJ
192,400 219,100 RJ
192,400 218,000 RJ
192,400 218,800 RJ
192,400 210,000 RJ
192,400 219,500 RJ
192,400 219,500 RJ
192,400 229,700 RJ
192,400 220,900 RJ
192,400 218,100 RJ
192,400 225,200 RJ
192,400 242,000 RJ
192,400 219,800 RJ
192,400 218,100 RJ
3,655,600 4,259,700

Page 3