Apotek KF - KF.

0576 Periuk Re
Jln. Villa Regency No. 12 A, Ba
0
Laporan Retur

Tanggal Pembuatan Laporan 01/10/2019

No Tanggal ID transaksi Asal Produk

1 02/09/2019 14:35:55 T1112N10263229351 LISINOPRIL 10MG TAB@30 GDXBPJS
2 02/09/2019 14:35:56 T1112N10263229351 INSULIN NOVOMIX FLEXPEN30 BPJS
3 13/09/2019 18:11:33 T1112N10277848393 TARIVID 0.3% EYE DROP 5ML
4 13/09/2019 21:53:11 T1112N10278294133 NELSONS CALENDULA CR 50GR
5 14/09/2019 13:39:37 T1112N1027879564C DERMATIX ULTRA 7 GR
6 17/09/2019 23:33:54 T1112N10283401583 NUTRIMAX C & C SYR 100ML
7 30/09/2019 15:22:15 T1112N10295920240 CANDESARTAN 16MG TAB GDX BPJS
Apotek KF - KF.0576 Periuk Regency
Jln. Villa Regency No. 12 A, Banten, 0
0
Laporan Retur

Nilai Retur Nama Pelanggan

Kuantitas Return
Kuantitas
( Rusak
Return
) ( Kadaluwarsa
Kuantitas Retur
Kuantitas
) ( RusakRetur
) ( Kadaluwarsa )
5,257 Slamet, TN
138,600 Slamet, TN
85,293
180,000
180,576 Pasien Tanya DulU
157,500
41,730 Carsem Ny
Kuantitas Retur ( Lain-lain )
7
1
1
1
1
1
30
 Apotek KF - KF.0576 Per
Jln. Villa Regency No. 12
0
Laporan Pembayaran den
Tanggal Pembuatan
Laporan 10/1/2019

Total
Pendapat Rp2.803.8
an: 91
FOR SERVICE Rp2.803.891

No. Transaksi No. Resep Waktu Nama Pasien

Riddho Handoko
T1112N10300858039 807967/1/30092019/37489 30 September 2019 23:35:11 WIB 1001464294825

T1112N10300856439 807967/1/30092019/37414 30 September 2019 23:31:04 WIB Agus Roni 1001010818553

T1112N1030085284
B 807967/1/30092019/37318 30 September 2019 23:28:45 WIB Subur WicaksonO
T1112N1030084553 Christophora Putri Kartika
B 807967/1/30092019/37138 30 September 2019 23:23:12 WIB Sari
T1112N10300245311 807967/1/30092019/19261 30 September 2019 18:20:24 WIB Sri Juharsih Inhealth
T1112N1025928211F 557883/1/30082019/14568 30 Agustus 2019 14:43:04 WIB Subur 1001009714602
 Apotek KF - KF.0576 Periuk Regency
Jln. Villa Regency No. 12 A, Banten, 0
0
Laporan Pembayaran dengan Jaminan

Nama Pasien Nama Obat Qty Total Harga Poli RS

Riddho Handoko
1001464294825 TRIAMCINOLONE TABLET @ 100 10 9580 Poli Umum
VOLTAREN EMULGEL 1% 50 GRAM 1
Agus Roni 1001010818553 LYRICA 75MG CAP@14 20 518755 Poli Syaraf
Subur WicaksonO NORVASK 5MG TAB@100 INHEA 30 75600 Poli Umum
Christophora Putri Kartika
Sari RANITIDIN 150 MG (DUS 30 TAB) 10 5540 Poli Umum
Sri Juharsih Inhealth LYRICA 75MG CAP@14 30 484200 Poli Syaraf
Subur 1001009714602 NORVASK 5MG TAB@100 INHEA 30 75600 UMUM
1,169,275
 Nama Penjamin

ASURANSI JIWA INHEALTH INDONESIA

PT-INHEALTH FEE FOR SERVICE

ASURANSI JIWA INHEALTH INDONESIA

PT-INHEALTH FEE FOR SERVICE
ASURANSI JIWA INHEALTH INDONESIA
PT-INHEALTH FEE FOR SERVICE
ASURANSI JIWA INHEALTH INDONESIA
PT-INHEALTH FEE FOR SERVICE
ASURANSI JIWA INHEALTH INDONESIA
PT-INHEALTH FEE FOR SERVICE
ASURANSI JIWA INHEALTH INDONESIA
PT-INHEALTH FEE FOR SERVICE
No. Resep Tanggal Nama Pasien Nama Obat

13952 30/09/2019 Wiranto PrB AMLODIPINE 10MG TAB@50 BPJS

12432 30/09/2019 Siti Aisyah NasutioN SERETIDE DISKUS 250MCG
12357 30/09/2019 S.V.NingsiH SERETIDE DISKUS 250MCG
12115 30/09/2019 Zaza Sumarza Prb SERETIDE DISKUS 500MCG
SIMVASTATIN 20MG TAB@50 BPJS
11641 30/09/2019 Ai Sumarni Ny INSULIN NOVOMIX FLEXPEN30 BPJS
CANDESARTAN 8MG TAB GDX BPJS
CANDESARTAN 8MG TAB@30 GDX
FUROSEMIDE 40MG TAB@200 BPJS
SPIRONOLACTONE 25 MG TAB @ 100
11091 30/09/2019 Tn Zaenal Arifin CONCOR 2.5MG TAB@100 BPJS
10921 30/09/2019 Junaedi SPIRIVA 18MCG CAP REFIL@3 BPJS
SERETIDE DISKUS 250MCG
10855 30/09/2019 Nurma Prb SPIRIVA 18MCG CAP REFIL@3 BPJS
13222 27/09/2019 Carsem Ny CANDESARTAN 16MG TAB GDX BPJS
13081 27/09/2019 Tn JunaedI SERETIDE DISKUS 250MCG BPJS
BISOPROLOL FUMARAT 5MG GHX
13005 27/09/2019 Ardi Prb INSULIN NOVOMIX FLEXPEN30 BPJS
12924 27/09/2019 SuratNO INSULIN NOVOMIX FLEXPEN30 BPJS
12849 27/09/2019 Narkom DEPAKOTE ER 500MG TAB@100 BPJS
12706 27/09/2019 Sumiyati Prb SYMBICORT 160/4.5 TURB 120BPJS
24136 26/09/2019 SANUSI SERETIDE DISKUS 250MCG BPJS
SERETIDE DISKUS 500MCG
23127 26/09/2019 Chaidir Koto SPIRIVA 18MCG CAP REFIL@3 BPJS
SPIRONOLACTONE 25 MG TAB @ 100
RAMIPRIL 5MG TAB GDX BPJS
BISOPROLOL 5MG TAB@30 GFA BPJS
22655 26/09/2019 Umiyati Prb BISOPROLOL FUMARAT 5MG GHX
22244 26/09/2019 Suyanto Bunyamin SPIRIVA 18MCG CAP REFIL@3 BPJS
22087 26/09/2019 Semi Umum SYMBICORT 160/4.5 TURB 120BPJS
21855 26/09/2019 Nelvy Syafrida Prb SPIRIVA 18MCG CAP REFIL@3 BPJS
AMLODIPINE 10MG TAB@50 BPJS
21553 26/09/2019 Wati Miswati Prb INSULIN NOVOMIX FLEXPEN30 BPJS
20948 26/09/2019 Tn Amay Prb INSULIN NOVOMIX FLEXPEN30 BPJS
HUMALOG MIX 25 CARTRIGE BPJS
METFORMIN 500 MG TAB ( HEXA )
CAPTOPRIL 25MG TAB GERR BPJS
20117 26/09/2019 MawardI CAPTOPRIL 25 MG (DUS 100 TAB)
CANDESARTAN 8MG TAB GDX BPJS
ASPILET CHEWABLE @ 100 TAB
19873 26/09/2019 Ny. DewI
19873 26/09/2019 Ny. DewI CONCOR 2.5MG TAB@100 BPJS
19681 26/09/2019 Agustinus tn SYMBICORT 160/4.5 TURB 120BPJS
GLIMEPIRIDE 4MG TAB@50 BPJS
19464 26/09/2019 TarmI METFORMIN 500 MG TAB ( HEXA )
17536 26/09/2019 Mahmud Munawar PrB SERETIDE DISKUS 250MCG BPJS
25479 25/09/2019 Santi Nurjanah Prb INSULIN NOVOMIX FLEXPEN30 BPJS
25282 25/09/2019 Basaruddin AMLODIPINE 5MG TAB@50 BPJS
BIOPREXUM 5MG TAB@30 BPJS
24512 25/09/2019 Elida Silitonga GLIMEPIRIDE 1MG TAB@50 BPJS
21868 25/09/2019 Pawestri 392 SYMBICORT 160/4.5 TURB 120BPJS
LEVEMIR FLEXPEN 100IU INJ@5
20092 25/09/2019 Nur Ifroh LISINOPRIL 5MG TAB@30 GDXBPJS
19683 25/09/2019 MujionO AMLODIPINE 10MG TAB@50 BPJS
19565 25/09/2019 Tn PriatiN SPIRIVA 18MCG CAP REFIL@3 BPJS
SPIRIVA 18MCG CAP REFIL@3 BPJS
15049 25/09/2019 Ny Ida RahmawatI SYMBICORT 160/4.5 TURB 120BPJS
14629 25/09/2019 Fatmawati SYMBICORT 160/4.5 TURB 120BPJS
14249 25/09/2019 Sri Amanah Prb INSULIN NOVOMIX FLEXPEN30 BPJS
RAMIPRIL 5MG TAB GDX BPJS
25260 24/09/2019 Ishak,M.PD ADALAT OROS 30MG TAB@30 BPJS
25096 24/09/2019 Pawestri 392 SPIRIVA 18MCG CAP REFIL@3 BPJS
METFORMIN 500 MG TAB ( HEXA )
BISOPROLOL 5MG TAB@30 GFA BPJS
DIOVAN 160MG TAB@30 BPJS
AMLODIPINE 10MG TAB@50 BPJS
20750 24/09/2019 Acih Prb GLIMEPIRIDE 4MG TAB@50 BPJS
20209 24/09/2019 Semi, Ny. SPIRIVA 18MCG CAP REFIL@3 BPJS
Sri Wahyuni Rochayati METFORMIN 500 MG TAB ( HEXA )
15580 24/09/2019 0001315800437 LANTUS SOLOSTER PEN BPJS
SPIRIVA 18MCG CAP REFIL@3 BPJS
14730 24/09/2019 Riko Ermana Prb SYMBICORT 160/4.5 TURB 120BPJS
14547 24/09/2019 Sahroni- SERETIDE DISKUS 250MCG
CANDESARTAN 16MG TAB GDX BPJS
14300 24/09/2019 Tan Tjai Hong INSULIN NOVOMIX FLEXPEN30 BPJS
IRBESARTAN 300MG@20 GNV
GLIMEPIRIDE 2MG TAB@50 BPJS
BISOPROLOL 5MG TAB@30 GFA BPJS
14025 24/09/2019 Tri Soesmiarti S AMLODIPINE 10MG TAB@50 BPJS
12594 24/09/2019 Iyah Marliyah SERETIDE DISKUS 250MCG
SPIRIVA 18MCG CAP REFIL@3 BPJS
6939 23/09/2019 Syahrudin TN SYMBICORT 160/4.5 TURB 120BPJS
5891 23/09/2019 Masriati Ibu AMLODIPINE 10MG TAB@50 BPJS
21629 17/09/2019 Dedi Rahman Saleh Prb FENITOIN 100 MG
19837 17/09/2019 Ny Partini INSULIN NOVOMIX FLEXPEN30 BPJS
METFORMIN 500MG TAB GHX BPJS

18561 17/09/2019 Abdul SomaD

 METFORMIN 500MG TAB GBN BPJS
18561 17/09/2019 Abdul SomaD CANDESARTAN 8MG TAB GDX BPJS
GLIMEPIRIDE 2MG TAB@50 BPJS
5822 16/09/2019 Radias Prb METFORMIN 500MG TAB GBN BPJS
4341 16/09/2019 SalimaN AMLODIPINE 10MG TAB@50 BPJS
4216 16/09/2019 Zaenal Abidin Bpjs LEVEMIR FLEXPEN 100IU INJ@5
4029 16/09/2019 Zaenal Abidin Bpjs INSULIN NOVORAPID FLEXPEN BPJS
3942 16/09/2019 SopiyAH SPIRIVA 18MCG CAP REFIL@3 BPJS
CANDESARTAN 16MG TAB GDX BPJS
ASPILET CHEWABLE @ 100 TAB
3837 16/09/2019 Sumartoyo Prb BISOPROLOL 5MG TAB@30 GFA BPJS
3591 16/09/2019 Tan Wat NiO CANDESARTAN 8MG TAB GDX BPJS
AMLODIPINE 5MG TAB@50 BPJS
3464 16/09/2019 Saro'AH GLIMEPIRIDE 1MG TAB@50 BPJS
BISOPROLOL 5MG TAB@30 GFA BPJS
3282 16/09/2019 ArdI
Siswo Suwarto Darwin INSULIN NOVOMIX FLEXPEN30 BPJS
1237 16/09/2019 Prb SPIRIVA 18MCG CAP REFIL@3 BPJS
1222 16/09/2019 Siti Fatimah Prb SYMBICORT 160/4.5 TURB 120BPJS
1213 16/09/2019 Siti Fatimah Prb SPIRIVA 18MCG CAP REFIL@3 BPJS
1199 16/09/2019 Vince R situmorang ASPILET CHEWABLE @ 100 TAB
1188 16/09/2019 Engkuy Prb SPIRIVA 18MCG CAP REFIL@3 BPJS
CANDESARTAN 8MG TAB GDX BPJS
1180 16/09/2019 Rusli Prb GLIQUIDONE OGB DEXA 30 MG TAB
ASPILET CHEWABLE @ 100 TAB
ALLOPURINOL 300 MG (HEXA)
GLIQUIDONE OGB DEXA 30 MG TAB
14362 14/09/2019 Chairul Shaleh GLIQUIDON 30MG TAB GDX BPJS
METFORMIN 500MG TAB GBN BPJS
ACARBOSE 50MG TAB@100 BPJS
7165 14/09/2019 Ny Djunariah(Prb) GLIMEPIRIDE 2MG TAB@50 BPJS
CONCOR 2.5MG TAB@100 BPJS
FUROSEMIDE 40MG TAB@200 BPJS
AMLODIPINE 10MG TAB@50 BPJS
7038 14/09/2019 Nurma Prb CANDESARTAN 16MG TAB GDX BPJS
6315 14/09/2019 Hikmah Liawati SPIRIVA 18MCG CAP REFIL@3 BPJS
RAMIPRIL 2.5MG TAB@100 GDX
6216 14/09/2019 Tjiu Tek Lie CONCOR 2.5MG TAB@100 BPJS
GLIMEPIRIDE 2 MG (DUS 50 TAB)
GLIMEPIRIDE 2MG TAB@50 BPJS
6013 14/09/2019 Heni Setyowati Prb METFORMIN 500MG TAB GHX BPJS
5895 14/09/2019 Ali Sadikin PHENYTOIN 100MG CAP@100 BPJS
GLIMEPIRIDE 1MG TAB@50 BPJS
5378 12/09/2019 Abdul KohaR METFORMIN 500MG TAB GHX BPJS
5098 12/09/2019 Siti Nurhasanah (Prb) SERETIDE DISKUS 250MCG BPJS
SERETIDE DISKUS 500MCG
3644 07/09/2019 Chaidir Koto Prb
3644 07/09/2019 Chaidir Koto Prb SPIRIVA 18MCG CAP REFIL@3 BPJS
3463 07/09/2019 Enih PrB SPIRIVA 18MCG CAP REFIL@3 BPJS
6037 06/09/2019 Jeje INSULIN NOVOMIX FLEXPEN30 BPJS
5983 06/09/2019 Suradi
Abdul Wahid GLIMEPIRIDE 1MG TAB@50 BPJS
3649 06/09/2019 0000049422655 CANDESARTAN 16MG TAB GDX BPJS
8857 02/09/2019 Muhamad Faizal.Prb SYMBICORT 160/4.5 TURB 120BPJS
LISINOPRIL 10MG TAB@30 GDXBPJS
8419 02/09/2019 Slamet, TN INSULIN NOVOMIX FLEXPEN30 BPJS
TOTAL RESEP PRB SEPTEMBER 2019
Qty Total Harga No. Keanggotaan

30 5,730 0001304633902
1 186,480 0000049219176
1 186,480 0001810209407
1 227,630 0001054083936
30
12 1,672,890 0001125723936
5
25
30
30
15 133,755 0001640896659
3 627,858 0001640829508
1
3 814,338 0001819949073
30 41,730 0001295115647
1 142,800 0001640829508
30
5 719,730 0001469426343
2 277,200 0001788890433
30 230,430 0001640833547
1 169,470 0001328819433
1 142,800 0002062047262
1
3 855,488 0001716532582
30
30
8
22 60,808 0001460872989
3 627,858 0001456037919
1 169,470 0001108913545
3 627,858 0001456481305
30
9 1,253,130 0001887334626
12 1,663,200 0001129115068
4
90
20
40 571,140 0002307925448
30
30
59,340 0001719269785
30 59,340 0001719269785
1 169,470 0001126748452
30
90 24,180 0001968546756
1 142,800 0001645872636
6 831,600 0002005890287
15 2,010 0002059024948
30
30 101,310 000039854226
1 169,470 -pilih-
1
30 154,560 0001205286568
30 5,730 0001143708333
3 627,858 0002091261227
3
1 797,328 0002101653145
1 169,470 0001131486647
10 1,386,000 0001166627226
30
30 170,520 0001730331156
3 627,858 0001627906937
90
30
15
30
30 97,860 000816024835
3 627,858 0001108913545
90
2 223,200 0001315800437
3
1 797,328 0001655508543
1 186,480 0002455570179
30
2 318,930 0001328224015
30
30
30
30 76,680 0004373056931
1 186,480 0001647378595
3
1 797,328 0001627904474
30 5,730 0001284193361
30 10,920 0001286521964
6 831,600 0001370184164
45

36,945 0001286521964
15
30 36,945 0001286521964
30
90 22,620 0001337532838
30 5,730 0001862512795
1 141,120 0001135437693
1 109,620 0001135437693
3 627,858 0001158820288
30
30
30 60,540 0000816914441
30 28,230 0002428403229
30
30 12,390 0001730480286
30
5 705,660 0001469426343
3 627,858 0001437360546
1 169,470 0002253488872
3 627,858 0002253488872
30 6,150 0001303215041
3 627,858 0000818055963
30
60 73,290 0000816222701
30
30
20
10 50,860 000049405792
60
30
30 44,010 000049461963
30
30
30
30 75,420 0001819949073
3 627,858 0002221516811
30
30 37,260 0002097601424
20
10
90 24,690 0001640686105
90 17,730 0001959336213
30
60 17,430 0001399995448
1 142,800 0000815889802
1
855,488 0001716532582
 3 855,488 0001716532582
3 627,858 0002246422329
4 554,400 0000815698721
30 8,370 0002216603698
30 41,730 0000049422655
1 169,470 0001336713592
7
1 143,857 0001105105105
28,330,599