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    2 views2 pages

    Contoh Rekapitulasi Tagihan

    Uploaded by

    Fahrul Rozy

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    LAPORAN REKAPITULASI PELAYANAN KACAMATA

    PRIODE : 01-03-2024 S/D 21-03-2024


    NAMA PROVIDER : OPTIK NEO CILENDEK

    NO NAMA PASIEN NOMOR KARTU LAYANAN TANGGAL TOTAL BIAYA DIJAMIN ASURANSI DIBAYAR PASIEN
    1 SYAH AZZAM K. 8001001000360510 OP ### Rp1,750,000 Rp1,750,000 Rp0
    2 RIDWAN FAZRIN S. 8001001000367226 OP ### Rp1,750,000 Rp1,750,000 Rp0
    3 JOHAN APRIADI 8001001000358627 OP ### Rp2,100,000 Rp1,750,000 Rp350,000
    4 EKO ALDIANO 8001001000361540 OP ### Rp2,000,000 Rp1,750,000 Rp250,000
    5 NORITA DEWI PRAVENTI 8001001000361541 OP ### Rp1,750,000 Rp1,750,000 Rp0
    6 GUTAMA AGUS PRIBADI 8001001000361281 OP ### Rp2,565,000 Rp1,750,000 Rp815,000
    7 MARLINA HERAWATI 8001001000360492 OP ### Rp1,750,000 Rp1,750,000 Rp0
    8 LUKY SETIADI 8001001001072748 OP ### Rp1,750,000 Rp1,750,000 Rp0
    9 ADE RATNA GUMELAR 8001001001072747 OP ### Rp1,750,000 Rp1,750,000 Rp0
    10 M. ERLIO ALFARIZQI 8001001001072749 OP ### Rp641,250 Rp641,250 Rp0
    11 M.ARCELLO VIRENDRA 8001001001072750 OP ### Rp1,750,000 Rp1,750,000 Rp0
    12 TOMMY ADI WINATA 8001001000361663 OP ### Rp1,750,000 Rp1,750,000 Rp0
    13 ABDULLAH GHATHAF W. 8001001000361665 OP ### Rp1,750,000 Rp1,750,000 Rp0
    14 MAHIRA HILWA N. 8001001000366971 OP ### Rp1,800,000 Rp1,750,000 Rp50,000
    15 FAHMI HIDAYAT 8001001000377421 OP ### Rp1,750,000 Rp1,750,000 Rp0
    16 M. DARREL ATTARSYAH 8001001000367229 OP ### Rp2,250,000 Rp1,750,000 Rp500,000
    17 RICKI RAHMAT 8001001000362822 OP ### Rp1,750,000 Rp1,750,000 Rp0
    18 FIRQON YUSUF 8001001000361373 OP ### Rp1,750,000 Rp1,750,000 Rp0
    19 ARLI 8001001000362938 OP ### Rp4,408,000 Rp1,750,000 Rp2,658,000
    20 AISHWARA ADRESIA C. 8001001000361544 OP ### Rp1,750,000 Rp1,750,000 Rp0
    21 ARKANA RAIF UMAR 8001001000361543 OP ### Rp1,750,000 Rp1,750,000 Rp0
    22 ANGGIE HERDIANSYAH 8001001000823592 OP ### Rp1,750,000 Rp1,750,000 Rp0
    23 RIKA KARTIKA SARI 8001001000354917 OP ### Rp1,750,000 Rp1,750,000 Rp0
    24 M. ZEPRI ADRIANSAH 8001001001176708 OP ### Rp1,750,000 Rp1,750,000 Rp0
    25 YULIUS SUDARWANTO 8001001000368615 OP ### Rp1,750,000 Rp1,750,000 Rp0
    26 RIZA RISKY MULATI 8001001001252429 OP ### Rp1,750,000 Rp1,750,000 Rp0
    27 HASANUDIN 8001001001176711 OP ### Rp1,750,000 Rp1,750,000 Rp0
    28 KRISNA WILDAN REZEKI 8001001000365577 OP ### Rp1,750,000 Rp1,750,000 Rp0
    29 BILLY RACHMANSYAH P. 8001001001310373 OP ### Rp1,750,000 Rp1,750,000 Rp0
    TOTAL Rp54,264,250 Rp49,641,250 Rp4,623,000

    Hormat Kami
    OPTIK NEO

    HERRY MULYA BAEHAKY

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