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Piutang

No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 1-Feb-18 Shela Mariana, Ny Rina, dr 119101 Rp 125,000 Rp 125,000
2 1-Feb-18 Awalia Rachmawati, Ny Hendra, dr 422401 Rp 20,000 Rp 824,000 Rp 844,000
3 1-Feb-18 Shela Mariana, Ny Rina, dr 119101 Rp 35,000 Rp 40,000 Rp 75,000
4 1-Feb-18 Prica Athalia, An Kartika, dr 470901 Rp 20,000 Rp 125,000 Rp 90,000 Rp 235,000
5 1-Feb-18 I Arsen Z, An Anna, dr 177501 Rp 20,000 Rp 50,000 Rp 70,000
6 1-Feb-18 Michael Jeremia, An Dini, dr 491501 Rp 25,000 Rp 125,000 Rp 150,000
7 1-Feb-18 Alexander Raphael, An Dini, dr 648000 Rp 20,000 Rp 125,000 Rp 145,000
8 1-Feb-18 Siti Nur, Ny Ajeng, dr 492201 Rp 20,000 Rp 50,000 Rp 70,000
9 1-Feb-18 Fahd Aziz, An Kartika, dr 411701 Rp 20,000 Rp 125,000 Rp 145,000
10 1-Feb-18 Wahyu Pascal, An Kartika, dr 857200 Rp 20,000 Rp 125,000 Rp 145,000
11 1-Feb-18 R Dina, Ny Erna, dr 194701 Rp 20,000 Rp 125,000 Rp 145,000
12 1-Feb-18 Febriana Kartika, Ny Erna, dr 232801 Rp 100,000 Rp 450,000 Rp 550,000
13 1-Feb-18 Aiko Lavina, An Mahe, dr 386700 Rp 20,000 Rp 125,000 Rp 145,000
14 1-Feb-18 Aries Chandra, Ny Erna, dr 707100 Rp 100,000 Rp 450,000 Rp 550,000
15 1-Feb-18 R Dina, Ny Erna, dr 194701 Rp 35,000 Rp 40,000 Rp 75,000
16 1-Feb-18 Shane Edward, An Mahe, dr 945800 Rp 20,000 Rp 125,000 Rp 145,000
17 1-Feb-18 Navalia Arsyilaa, An Kartika, dr 041401 Rp 20,000 Rp 125,000 Rp 145,000
18 1-Feb-18 Yanu Gian, Ny Erna, dr 492301 Rp 25,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 225,000
19 1-Feb-18 Shakila Aishalina, An Mahe, dr 963100 Rp 20,000 Rp 125,000 Rp 145,000
20 1-Feb-18 Senja Siti, Ny Erna, dr 413800 Rp 20,000 Rp 125,000 Rp 145,000
21 1-Feb-18 Irene Sieningsih, Ny Gatut, dr 447701 Rp 20,000 Rp 125,000 Rp 145,000
22 1-Feb-18 Novita Utari, Ny Hendra, dr 059700 Rp 20,000 Rp 824,000 Rp 844,000
23 1-Feb-18 Owen Javera, An Mahe, dr 493001 Rp 25,000 Rp 125,000 Rp 150,000
24 1-Feb-18 Agnola Alessandra, An Mahe, dr 492901 Rp 25,000 Rp 125,000 Rp 150,000
25 1-Feb-18 Irene Sieningsih, Ny Gatut, dr 447701 Rp 35,000 Rp 40,000 Rp 75,000
26 1-Feb-18 Afrista Dyah, Ny Erna, dr 492801 Rp 35,000 Rp 40,000 Rp 75,000
27 1-Feb-18 Ika Nurpratiwi, Ny Erna, dr 347100 Rp 20,000 FREE Rp 35,000 Rp 40,000 Rp 95,000
28 1-Feb-18 Genoveva Mada, An Mahe, dr 016001 Rp 20,000 Rp 125,000 Rp 145,000
29 1-Feb-18 Reynand Setiawan, An Mahe, dr 236601 Rp 20,000 Rp 125,000 Rp 145,000
30 1-Feb-18 Danendra Arkan, An Mahe, dr 709300 Rp 20,000 Rp 125,000 Rp 145,000
31 1-Feb-18 Muhammad Alvaro, An Mahe, dr 313301 Rp 75,000 Rp 75,000

Total Rp 6,318,000
Surabaya, 02 Februari 2018
Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Keterangan
D Mandiri
D BCA
D Mandiri ( USG 2D )
D BCA
Admedika ( Manulife )
KK BCA
D BCA
D BRI ( IGD )
D BCA
D Mandiri
D Mandiri
D BCA( Pasang IUD )
D BCA
D BCA ( Pasang IUD )
D Mandiri ( USG 2D )
D BCA
D Mandiri & Transfer Mandiri
D Mandiri & Transfer Mandiri ( USG 2D )
D BNI
D Mandiri
D Mandiri
D BCA
D BCA
D BCA
D Mandiri ( USG 2D )
D Mandiri ( USG 2D )
D Mandiri ( USG 2D )
KK Citi
D BCA
Admedika ( BNI Life )
D BCA ( Nebul )
Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 01 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 1-Feb-18 Lidya Widayati, Ny Rp 191,000 Rp 191,000
2 1-Feb-18 dr. Putri Rp 38,100 Rp 38,100
3 1-Feb-18 Shela Mariana, Ny Rp 48,800 Rp 48,800
4 29-Nov-17 Nia Rp 28,100 Rp 28,100
5 3-Jan-18 Silvia Margaretna, Nn Rp 34,400 Rp 34,400
6 23-Jan-18 Silvia Margaretna, Nn Rp 60,100 Rp 60,100
7 1-Feb-18 Andini Yulina, Ny Rp 45,900 Rp 45,900
8 1-Feb-18 Josephine Rp 48,000 Rp 48,000
9 1-Feb-18 Iqbal Maulana, An Rp 197,800 Rp 197,800
10 1-Feb-18 Nayshita Alula, An Rp 50,200 Rp 50,200
11 1-Feb-18 Demima, Ny Rp 150,500 Rp 150,500
12 30-Jan-18 Dini Adityarini, dr Rp 36,000 Rp 36,000
13 1-Feb-18 Clarrance Azarious, An Rp 113,600 Rp 113,600
14 1-Feb-18 Clarissa Achiera, An Rp 31,300 Rp 31,300
15 1-Feb-18 Siti Nur, Ny Rp 63,300 Rp 63,300
16 1-Feb-18 Alvaro Gavriel, An Rp 314,600 Rp 314,600
17 1-Feb-18 Agnes Fumiko, An Rp 313,000 Rp 313,000
18 1-Feb-18 Bintang Putra, An Rp 955,700 Rp 955,700
19 1-Feb-18 Belvania Metta, An Rp 1,185,400 Rp 1,185,400
20 1-Feb-18 Viona Queenara, An Rp 82,300 Rp 82,300
21 1-Feb-18 Najwa Putri, An Rp 548,800 Rp 548,800
22 1-Feb-18 Silvi Andriyani, Ny Rp 104,800 Rp 104,800
23 1-Feb-18 Silvi Andriyani, Ny Rp 37,700 Rp 37,700
24 1-Feb-18 Layyina Yasmin, Ny Rp 113,500 Rp 113,500
25 1-Feb-18 Fayyadh Abdulloh, An Rp 80,900 Rp 80,900
26 1-Feb-18 Kai Matthew, An Rp 36,400 Rp 36,400
27 1-Feb-18 Aiko Lavina, An Rp 127,900 Rp 127,900
28 1-Feb-18 Shane Edward, An Rp 15,200 Rp 15,200
29 1-Feb-18 Mikaila, An Rp 114,700 Rp 114,700
30 1-Feb-18 Fadhil Ararya, An Rp 174,300 Rp 174,300
31 1-Feb-18 Fadhil Ararya, An Rp 92,800 Rp 92,800
32 1-Feb-18 Azka Airlangga, An Rp 125,100 Rp 125,100

Total Rp 5,560,200 Rp 5,560,200

Piutang
No Tanggal Nama Pasien Apotek Total
1 1-Feb-18 Shela Mariana, Ny Rp 329,600 Rp 329,600
2 1-Feb-18 I Arsen Z, An Rp 48,700 Rp 48,700
3 1-Feb-18 Kenneth Aditya, An Rp 100,400 Rp 100,400
4 1-Feb-18 Vania Wijaya, An Rp 283,200 Rp 283,200
5 1-Feb-18 Gertrude Bridgetta, An Rp 821,000 Rp 821,000
6 1-Feb-18 Michael Jeremia, An Rp 291,400 Rp 291,400
7 1-Feb-18 Michael Jeremia, An Rp 117,700 Rp 117,700
8 1-Feb-18 Gertrude Bridgetta, An Rp 182,400 Rp 182,400
9 1-Feb-18 Nayshita Alula, An Rp 31,300 Rp 31,300
10 1-Feb-18 Nayshita Alula, An Rp 117,700 Rp 117,700
11 1-Feb-18 Siti Nur, Ny Rp 170,500 Rp 170,500
12 1-Feb-18 Askryev Althaf, An Rp 82,600 Rp 82,600
13 1-Feb-18 Fahd Aziz, An Rp 626,300 Rp 626,300
14 1-Feb-18 Kiano Leeander, An Rp 955,700 Rp 955,700
15 1-Feb-18 Bryant Anthony, An Rp 924,400 Rp 924,400
16 1-Feb-18 Wahyu Pascal, An Rp 507,200 Rp 507,200
17 1-Feb-18 Febriana Kartika, Ny Rp 478,700 Rp 478,700
18 1-Feb-18 Aries Chandra, Ny Rp 598,700 Rp 598,700
19 1-Feb-18 R Dina, Ny Rp 231,000 Rp 231,000
20 1-Feb-18 Navalia Arsyilaa, An Rp 821,000 Rp 821,000
21 1-Feb-18 Yanu Gian, Ny Rp 169,100 Rp 169,100
22 1-Feb-18 Stephanie Yolanda, Ny Rp 177,000 Rp 177,000
23 1-Feb-18 Oliver Andres, An Rp 913,200 Rp 913,200
24 1-Feb-18 Afrista Dyah, Ny Rp 351,500 Rp 351,500
25 1-Feb-18 Ika Nurpratiwi, Ny Rp 58,000 Rp 58,000
26 1-Feb-18 Genoveva Mada, An Rp 75,100 Rp 75,100
27 1-Feb-18 Genoveva Mada, An Rp 122,500 Rp 122,500
28 1-Feb-18 Genoveva Mada, An Rp 507,200 Rp 507,200
29 1-Feb-18 Reynand Setiawan, An Rp 785,100 Rp 785,100
30 1-Feb-18 Shakila Aishalina, An Rp 124,700 Rp 124,700
31 1-Feb-18 Owen Javera, An Rp 52,700 Rp 52,700
32 1-Feb-18 Agnola Alessandra, An Rp 190,700 Rp 190,700
33 1-Feb-18 Danendra Arkan, An Rp 15,200 Rp 15,200
34 1-Feb-18 Muhammad Alvaro, An Rp 158,300 Rp 158,300

Total Rp 11,419,800 Rp 11,419,800

Surabaya, 02 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Apotek Rawat Jalan
l 01 Februari 2018

Ket

Karyawan
Karyawan
Karyawan

Pelunasan

Ket
D Mandiri
Admedika ( Manulife )
D BCA
D BCA
KK BCA
KK BCA
KK BCA
D BCA
D Mandiri
D Mandiri
D BRI Rp. 233.800
Piutang Karyawan
D Mandiri
D BCA
D BCA
D Mandiri
D BCA
D BCA
D Mandiri
D Mandiri & Transfer Mandiri
D Mandiri & Transfer Mandiri
D BCA
D BCA
D Mandiri
D Mandiri
KK Citi
KK Citi
KK Citi
D BCA
D BNI
D BCA
D BCA
Admedika ( BNI Life )
D BCA

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Rawat Jalan Gigi
Tanggal 01 Februari 2018
Tunai
No Tanggal Nama Pasien No.RM No Operator Poli Jasa Dokter Tindakan Total Keterangan
1 1-Feb-18 Rp -
2 1-Feb-18 Rp -

Total Rp -

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 1-Feb-18 Zeindy M, An 405201 Dian, dr Rp 20,000 Rp 1,000,000 Rp 1,020,000 D Permata
2 1-Feb-18

Total

Surabaya, 02 Februari 2018

Penyetor Mengetahui,
Penerima

Ika
Rini Wahyuningati
Laporan Therapy & Kebugaran
Tanggal 01 Februari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 1-Feb-18 An. Farisa Rp 60,000 Rp 60,000 1207
2 31-Jan-18 Ny. Phonix Rp 100,000 Rp 100,000 1206

Total Rp 160,000 Rp 160,000

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 1-Feb-18 Rp -
2 1-Feb-18 Rp -

Total Rp - Rp -

Surabaya, 02 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium
1 2-Feb-18 Nadhila Wiriani, Ny Rina, dr 493501 Rp 25,000 Rp 125,000
2 2-Feb-18 Ethan Cyrus, An Dini, dr 997400 Rp 20,000 Rp 125,000
3 2-Feb-18 Adelia Novita, Nn Rina, dr 493701 Rp 25,000 Rp 125,000
4 2-Feb-18 Azahra Naila, An Dini, dr 112101 Rp 20,000 Rp 125,000
5 2-Feb-18 Nadhila Wiriani, Ny Rina, dr 493501 Rp 35,000 Rp 40,000
6 2-Feb-18 Adelia Novita, Nn Rina, dr 493701 Rp 35,000 Rp 140,000
7 2-Feb-18 Aimar Daru, An Dini, dr 489201 Rp 20,000 Rp 125,000
8 2-Feb-18 Binar Daru, An Dini, dr 489301 Rp 20,000 Rp 125,000
9 2-Feb-18 Aisyah Rizkya, An Dini, dr 494101 Rp 25,000 Rp 125,000
10 2-Feb-18 Ninda Argafani, Ny Fandy, dr 233201 Rp 20,000 Rp 125,000
11 2-Feb-18 Ninda Argafani, Ny Fandy, dr 233201 Rp 35,000 Rp 40,000
12 2-Feb-18 Devano Arkha, An Dini, dr 919100 Rp 20,000 Rp 125,000 Rp 75,000
13 2-Feb-18 Lidya Wijaya, Ny Frans,dr 493201 Rp 20,000 Rp 150,000 Rp 50,000
14 2-Feb-18 Aisyah Rizkya, An Dini, dr 494101 Rp 259,000
15 2-Feb-18 Adlan Rafa, An Leny, dr 487901 Rp 20,000 Rp 125,000
16 2-Feb-18 Louis Lodewy, An Kartika, dr 014900 Rp 20,000 Rp 125,000
17 2-Feb-18 Azzam Al, An Kartika, dr 486601 Rp 20,000 Rp 125,000
18 2-Feb-18 Jonathan Alextrien, An Leny, dr 327701 Rp 20,000 Rp 125,000
19 2-Feb-18 Rayyanka Achmad, An Leny, dr 194901 Rp 20,000 FREE
20 2-Feb-18 Ghiffary Dafreil, An Mahe, dr 494601 Rp 25,000 Rp 125,000
21 2-Feb-18 Darren Lie, An Mahe, dr 265601 Rp 20,000 Rp 125,000
22 2-Feb-18 Jesslyn Tehila, An Mahe, dr 292701 Rp 20,000 Rp 125,000
23 2-Feb-18 Fifi Handayani, Ny Erna, dr 201200 Rp 20,000 Rp 125,000
24 2-Feb-18 Kenisha Cordelia, An Mahe, dr 283801 Rp 20,000 Rp 125,000
25 2-Feb-18 Rayner Angello, An Mahe, dr 396700 Rp 20,000 Rp 125,000
26 2-Feb-18 Kaylee Angeline, An Mahe, dr 286501 CANCEL
27 2-Feb-18 Fifi Handayani, Ny Erna, dr 201200 Rp 35,000 Rp 40,000

Total

Surabaya, 03 Februari 2018


Penyetor

Angga
Total Keterangan
Rp 150,000 D BCA
Rp 145,000 D Mandiri
Rp 150,000 D BCA
Rp 145,000 D BCA
Rp 75,000 D BCA ( USG 2D )
Rp 175,000 D BCA ( USG 2D, Gynec )
Rp 145,000 D MAndiri
Rp 145,000 D MAndiri
Rp 150,000 D BRI
Rp 145,000 D MAndiri
Rp 75,000 D Mandiri ( USG 2D )
Rp 220,000 Admedika ( Jasindo ) Nebul
Rp 220,000 D Niaga ( NST, By phone 1x )
Rp 259,000 D BRI
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 KK HSBC
Rp 20,000 Piutang Karyawan
Rp 150,000 Admedika ( Askrida )
Rp 145,000 D BCA
Rp 145,000 KK BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp - D BCA
Rp 75,000 D BCA ( USG 2D )

Rp 3,749,000
Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 02 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total Ket
1 2-Feb-18 Kai Matthew, An Rp 13,200 Rp 13,200
2 2-Feb-18 Vania Adira, AN Rp 55,000 Rp 55,000
3 2-Feb-18 Marylin, Ny Rp 111,000 Rp 111,000
4 2-Feb-18 Tia Rp 35,000 Rp 35,000
5 2-Feb-18 Aimar Rp 14,600 Rp 14,600
6 2-Feb-18 Lucyana Suryaputra, Ny Rp 179,000 Rp 179,000
7 2-Feb-18 Aruna Aisyah, An Rp 507,200 Rp 507,200
8 2-Feb-18 Naura Assyabiya, An Rp 117,700 Rp 117,700
9 2-Feb-18 Devano Arkha, An Rp 36,300 Rp 36,300
10 2-Feb-18 Vallencia Budiono, An Rp 64,900 Rp 64,900
11 2-Feb-18 Nabilah Bilqis, An Rp 111,400 Rp 111,400
12 2-Feb-18 Louis Lodewy, An Rp 192,700 Rp 192,700
13 2-Feb-18 Cantika Aisha, An Rp 137,400 Rp 137,400
14 2-Feb-18 Cantika Aisha, An Rp 15,900 Rp 15,900
15 2-Feb-18 Ni Nyoman, An Rp 626,300 Rp 626,300
16 2-Feb-18 Aqila Asyyifa, An Rp 68,600 Rp 68,600
17 2-Feb-18 Jacob Rp 21,000 Rp 21,000
18 2-Feb-18 Rahadian Azka, An Rp 924,400 Rp 924,400
19 2-Feb-18 Naufal Rp 117,100 Rp 117,100
20 2-Feb-18 Hanania Alisha, An Rp 256,400 Rp 256,400
21 2-Feb-18 Hanania Alisha, An Rp 26,400 Rp 26,400
22 2-Feb-18 Darren Lie, An Rp 156,000 Rp 156,000
23 2-Feb-18 Al Ghazali, An Rp 136,400 Rp 136,400
24 2-Feb-18 Rayner Angello, An Rp 190,700 Rp 190,700

Total Rp 4,114,600 Rp 4,114,600

Piutang
No Tanggal Nama Pasien Apotek Total Ket
1 2-Feb-18 Adelia Novita, Nn Rp 127,600 Rp 127,600 D BCA
2 2-Feb-18 Ninda Argafani, Ny Rp 82,000 Rp 82,000 D Mandiri
3 2-Feb-18 Ethan Cyrus, An Rp 287,800 Rp 287,800 KK NIAGA
4 2-Feb-18 Ethan Cyrus, An Rp 79,600 Rp 79,600 KK NIAGA
5 2-Feb-18 Devano Arkha, An Rp 389,800 Rp 389,800 Admedika ( Jasindo )
6 2-Feb-18 Azahra Naila, An Rp 78,600 Rp 78,600 D BCA
7 2-Feb-18 Azahra Naila, An Rp 595,000 Rp 595,000 D BCA
8 2-Feb-18 George Ananta, An Rp 256,400 Rp 256,400 D BCA
9 2-Feb-18 Adlan Rafa, An Rp 167,000 Rp 167,000 D BCA
10 2-Feb-18 Jonathan Alextrien, An Rp 924,400 Rp 924,400 KK HSBC
11 2-Feb-18 Jonathan Alextrien, An Rp 78,600 Rp 78,600 KK HSBC
12 2-Feb-18 Rayyanka Rp 456,600 Rp 456,600 Piutang Karyawan
13 2-Feb-18 Ralph Hartman, An Rp 225,200 Rp 225,200 D BCA
14 2-Feb-18 Agha Abrisam, An Rp 238,000 Rp 238,000 D Permata
15 2-Feb-18 Dude Yusuf, An Rp 20,100 Rp 20,100 Piutang Karyawan
16 2-Feb-18 Ghiffary Dafreil, An Rp 131,200 Rp 131,200 Admedika ( Askrida )
17 2-Feb-18 Kenisha Cordelia, An Rp 821,000 Rp 821,000 D BCA
18 2-Feb-18 Jesslyn Tehila, An Rp 924,400 Rp 924,400 KK BCA
19 2-Feb-18 Fifi Handayani, Ny Rp 170,500 Rp 170,500 D BCA

Total Rp 6,053,800 Rp 6,053,800

Surabaya, 03 Januari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Therapy & Kebugaran
Tanggal 02 Februari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 2-Feb-18 Rp -
2 2-Feb-18 Rp -

Total Rp - Rp -

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 2-Feb-18 Rp -
2 2-Feb-18 Rp -

Total Rp - Rp -

Surabaya, 03 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 02 Februari 2018
Tunai
No Tanggal Nama Pasien No.RM No Operator Poli Jasa Dokter Tindakan Total Keterangan
1 2-Feb-18 William Oentono, An 951200 Prima, dr Rp 20,000 Rp 250,000 Rp 270,000
2 2-Feb-18 Rp -

Total Rp 270,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 2-Feb-18 Rp -
2 2-Feb-18 Rp -

Total Rp -

Surabaya, 03 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator
1 3-Feb-18 Heraldin Kinari, An Kartika, dr 603100 Rp 20,000 Rp 125,000
2 3-Feb-18 Gibran Pradana, An Dini, dr 322901 Rp 20,000 Rp 125,000
3 3-Feb-18 Naira Shima, An Dini, dr 379501 Rp 20,000 Rp 125,000
4 3-Feb-18 Sultan Arka, An Mahe, dr 333201 CANCEL
5 3-Feb-18 Hagia Ihan, An Kartika, dr 483401 Rp 20,000 Rp 125,000
6 3-Feb-18 Jehohanan Lesmana, An Sufiandika, dr 392500 Rp 20,000 Rp 50,000
7 3-Feb-18 Danish Arshad, An Dini, dr 495101 Rp 25,000 Rp 125,000
8 3-Feb-18 Arsakha Rayyan, An Kartika, dr 414201 Rp 20,000 Rp 125,000
9 3-Feb-18 Raphael Hugo, An Kartika, dr 785000 Rp 20,000 Rp 125,000
10 3-Feb-18 Ratih Perwitasari, Ny Tik, dr 495001 Rp 35,000 Rp 40,000
11 3-Feb-18 Cherlin Soetantjo, Ny Sufiandika, dr 495301 Rp 25,000 Rp 150,000
12 3-Feb-18 Fernando Miracle, An Dini, dr 789300 Rp 20,000 Rp 125,000
13 3-Feb-18 Karenina Kirana, An Dini, dr 242401 Rp 20,000 FREE
14 3-Feb-18 John Jeddiah, An Dini, dr 153501 Rp 20,000 Rp 125,000
15 3-Feb-18 Danish Arshad, An Dini, dr 495101
16 3-Feb-18 Raisya Marva, An Dini, dr 435201 Rp 25,000 Rp 125,000
17 3-Feb-18 Muhammad Ibrahim, An Dini, dr 999100 Rp 20,000 Rp 125,000
18 3-Feb-18 Callista Angeline, An Dini, dr 234801 Rp 20,000 Rp 125,000
19 3-Feb-18 Ardiansyah Risky, An Mahe, dr 393601 Rp 20,000 Rp 125,000
20 3-Feb-18 Omera Zirco, An Mahe, dr 912600 Rp 20,000 Rp 125,000
21 3-Feb-18 Muhammad Alvaro, An Ajeng, dr 313301 Rp 20,000 Rp 22,500 Rp 52,500
22 3-Feb-18 Danish Arshad, An Dini, dr 495101
23 3-Feb-18 Devano Arkha, An Ajeng, dr 919100 Rp 20,000 Rp 22,500 Rp 52,500
24 3-Feb-18 Fachrizal Amri, An Mahe, dr 097900 Rp 20,000 Rp 125,000
25 3-Feb-18 Oneal Dev, An Mahe, dr 495701 Rp 25,000 Rp 125,000
26 3-Feb-18 Dearlyyn Shea, An Mahe, dr 545500 Rp 20,000 Rp 125,000
27 3-Feb-18 Sanika Assyifa, An Mahe, dr 050001 Rp 20,000 Rp 125,000
28 3-Feb-18 Ni Nyoman, Ny Ajeng, dr 971500 Rp 20,000 Rp 50,000

Total

Surabaya, 04 Februari 2018


Penyetor

Nia
Laboratorium Total Keterangan
Rp 145,000 D Mandiri
Rp 145,000 D BNI
Rp 145,000 D Mandiri
Rp - D Mandiri
Rp 145,000 D BNI
Rp 70,000 D BCA ( IGD )
Rp 150,000 D BNI
Rp 145,000 Admedika ( Takaful )
Rp 145,000 D BCA
Rp 75,000 D BCA ( USG 2D )
Rp 175,000 D BCA ( NST 1X )
Rp 145,000 D BCA
Rp 20,000 D BNI
Rp 145,000 D BCA
Rp 304,000 Rp 304,000 D BNI
Rp 150,000 D BCA
Rp 145,000 Admedika ( BNI Life )
Rp 145,000 Admedika ( Mandiri INH )
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 95,000 D BCA ( Nebul )
Rp 520,000 Rp 520,000 D BNi
Rp 95,000 Admedika ( Jasindo ) Nebul
Rp 145,000 D BNI
Rp 150,000 KK BCA
Rp 145,000 D BCA
Rp 145,000 Admedika ( Lippo )
Rp 70,000 D BNI ( IGD )

Rp 4,049,000

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 03 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total Ket
1 3-Feb-18 Kai Matthew, An Rp 42,100 Rp 42,100
2 3-Feb-18 Lovely Dominique, An Rp 118,700 Rp 118,700
3 3-Feb-18 Lovely Dominique, An Rp 85,100 Rp 85,100
4 3-Feb-18 Nurul Azzah, Ny Rp 27,000 Rp 27,000
5 3-Feb-18 Kasper Ganesha, An Rp 821,000 Rp 821,000
6 3-Feb-18 Angeline Sugianto Rp 70,100 Rp 70,100
7 3-Feb-18 Sakuntari Rp 57,600 Rp 57,600
8 3-Feb-18 Ambariyani Sasmita, Ny Rp 263,400 Rp 263,400
9 3-Feb-18 Retno Palupi Rp 105,600 Rp 105,600
10 3-Feb-18 Yuni Rp 4,200 Rp 4,200 Karyawan
11 3-Feb-18 Muhammad Naufal, An Rp 280,200 Rp 280,200
12 3-Feb-18 Davin Putra, An Rp 183,500 Rp 183,500
13 3-Feb-18 Callista Angeline, An Rp 17,400 Rp 17,400
14 3-Feb-18 Davin Putra, An Rp 6,000 Rp 6,000
15 3-Feb-18 Keisha Andara, An Rp 50,200 Rp 50,200
16 3-Feb-18 Danish Arshad, An Rp 50,200 Rp 50,200
17 3-Feb-18 John Jeddiah, An Rp 99,000 Rp 99,000
18 3-Feb-18 Callista Angeline, An Rp 117,700 Rp 117,700
19 3-Feb-18 Arfa Zulfadhli, An Rp 227,300 Rp 227,300
20 3-Feb-18 Dewi Rp 18,000 Rp 18,000
21 3-Feb-18 Chloe Avangeline, An Rp 82,300 Rp 82,300
22 3-Feb-18 Kiara Rp 3,700 Rp 3,700
23 3-Feb-18 Kiara Rp 17,400 Rp 17,400
24 3-Feb-18 Rafanda Naufalyn, An Rp 151,700 Rp 151,700
25 3-Feb-18 Rafanda Naufalyn, An Rp 55,000 Rp 55,000
26 3-Feb-18 Ranya Alin, An Rp 82,300 Rp 82,300
27 3-Feb-18 Ranya Alin, An Rp 30,000 Rp 30,000

Total Rp 3,066,700 Rp 3,066,700

Piutang
No Tanggal Nama Pasien Apotek Total Ket
1 3-Feb-18 Jehohanan Lesmana, An Rp 155,600 Rp 155,600 D BCA
2 3-Feb-18 Arsakha Rayyan, An Rp 626,300 Rp 626,300 Admedika ( Takaful )
3 3-Feb-18 Raphael Hugo, An Rp 215,800 Rp 215,800 D BCA
4 2-Feb-18 Deby, Nn Rp 171,500 Rp 171,500 Piutang Karyawan
5 3-Feb-18 Heraldin Kinari, An Rp 232,500 Rp 232,500 D BNI
6 3-Feb-18 Heraldin Kinari, An Rp 26,400 Rp 26,400 D BNI
7 3-Feb-18 Auriga Rp 264,000 Rp 264,000 D BCA
8 3-Feb-18 Wilber Hideaki, An Rp 785,100 Rp 785,100 D BCA
9 3-Feb-18 Wilber Hideaki, An Rp 6,000 Rp 6,000 D BCA
10 3-Feb-18 Mega Dewi Rp 32,700 Rp 32,700 D Mandiri
11 3-Feb-18 Gibran Pradana, An Rp 821,000 Rp 821,000 D BNI
12 3-Feb-18 Naira Shima, An Rp 225,200 Rp 225,200 D Mandiri
13 3-Feb-18 Naira Shima, An Rp 101,500 Rp 101,500 D Mandiri
14 3-Feb-18 Aaron Delta, An Rp 507,200 Rp 507,200 D BCA
15 3-Feb-18 Aaric Delta, An Rp 507,200 Rp 507,200 D BCA
16 3-Feb-18 Alfarezel Arsyad, An Rp 1,185,400 Rp 1,185,400 D BCA
17 3-Feb-18 Fernando Miracle, An Rp 279,000 Rp 279,000 D BCA
18 3-Feb-18 Fernando Miracle, An Rp 124,000 Rp 124,000 D BCA
19 3-Feb-18 Gabriel Macray, An Rp 821,000 Rp 821,000 D BCA
20 3-Feb-18 Karenina Kirana, An Rp 785,100 Rp 785,100 D BNI
21 3-Feb-18 Karenina Kirana, An Rp 101,400 Rp 101,400 D BNI
22 3-Feb-18 John Jeddiah, An Rp 497,800 Rp 497,800 D BCA
23 3-Feb-18 Raisya Marva, An Rp 124,800 Rp 124,800 D BCA
24 3-Feb-18 Eldrick Maxwell, An Rp 821,000 Rp 821,000 D BCA
25 3-Feb-18 Eldrick Maxwell, An Rp 75,100 Rp 75,100 D BCA
26 3-Feb-18 Muhammad Ibrahim, An Rp 548,800 Rp 548,800 Admedika ( BNI Life )
27 3-Feb-18 Muhammad Ibrahim, An Rp 117,700 Rp 117,700 D BRI
28 3-Feb-18 Callista Angeline, An Rp 595,000 Rp 595,000 Admedika ( Mandiri INH )
29 3-Feb-18 Marsa Rp 45,600 Rp 45,600 D BCA
30 3-Feb-18 Danish Arshad, An Rp 167,900 Rp 167,900 D BNi
31 3-Feb-18 Omera Zirco, An Rp 548,800 Rp 548,800 D BCA
32 3-Feb-18 Omera Zirco, An Rp 79,500 Rp 79,500 D BCA
33 3-Feb-18 Malva Elaine, An Rp 548,800 Rp 548,800 D BCA
34 3-Feb-18 Danish Arshad, An Rp 101,500 Rp 101,500 D BNI
35 3-Feb-18 Izdihar Khumaini, An Rp 548,800 Rp 548,800 D BCA
36 3-Feb-18 Fatimah Az, An Rp 255,000 Rp 255,000 D BCA
37 3-Feb-18 Fatimah Az, An Rp 821,000 Rp 821,000 D BCA
38 3-Feb-18 Nattaya Gauri, An Rp 785,100 Rp 785,100 KK BCA
39 3-Feb-18 Oneal Dev, An Rp 32,000 Rp 32,000 KK BCA
40 3-Feb-18 Oneal Dev, An Rp 24,000 Rp 24,000 KK BCA
41 3-Feb-18 Sanika Assyifa, An Rp 262,000 Rp 262,000 Admedika ( Lippo )
42 3-Feb-18 Ni Nyoman, Ny Rp 134,500 Rp 134,500 D BNI
43 3-Feb-18 Fachrizal Amri, An Rp 48,200 Rp 48,200 D BNI

Total Rp 15,156,800 Rp 15,156,800

Surabaya, 04 Februari 2018


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Laporan Therapy & Kebugaran
Tanggal 03 Februari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 3-Feb-18 Rp -

Total Rp - Rp -

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 3-Feb-18 Raisya , An Rp 60,000 Rp 60,000 D BCA (1208)
2 3-Feb-18 Rp -

Total Rp 60,000 Rp 60,000

Surabaya, 04 Februari 2018


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 03 Februari 2018
Tunai
No Tanggal Nama Pasien No.RM No Operator Poli Jasa Dokter Tindakan Total Keterangan
1 3-Feb-18 Sabrina Ruela, An 303901 Prima, dr Rp 20,000 Rp 250,000 Rp 270,000
2 3-Feb-18 Rp -

Total Rp 270,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 3-Feb-18 Rp -
2 3-Feb-18 Rp -

Total Rp -

Surabaya, 04 Februari 2018


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Laporan Rawat Jalan
Tanggal 4 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 3-Feb-18 Azka Airlangga, An Atika, dr 345100 Rp 20,000Rp 50,000 Rp 149,000 Rp 219,000
2 3-Feb-18 Muhammad Hariz, An Atika, dr 701500 Rp 20,000Rp 50,000 Rp 70,000
3 4-Feb-18 Al Ghazali, An Atika, dr 346701 Rp 20,000Rp 50,000 Rp 70,000
4 4-Feb-18 Almer Rafaeyza, An Arum, dr 496001 Rp 25,000Rp 50,000 Rp 75,000
5 4-Feb-18 Rashya Pradipta, An Emma, dr 496101 Rp 25,000Rp 125,000 Rp 150,000
6 4-Feb-18 Wahyu Prasetya, An Emma, dr 483001 Rp 20,000Rp 125,000 Rp 145,000
7 4-Feb-18 Judson Connan, An Emma, dr 855400 Rp 20,000Rp 125,000 Rp 75,000 Rp 220,000
8 4-Feb-18 Wahyu Prasetya, An Emma, dr 483001 Rp 75,000 Rp 75,000
9 4-Feb-18 Hamdan Yusuf, An Emma, dr 402701 Rp 20,000 Rp 125,000 Rp 145,000
10 4-Feb-18 Liani Wiajaya, Ny Arum, dr 496201 Rp 25,000 FREE Rp 25,000

Total Rp 1,194,000

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 4-Feb-18 Jacqueline Daniela, An Arum, dr 252001 Rp 20,000 Rp 50,000 Rp 70,000
2 4-Feb-18 Hafidz Naufalt, An Arum, dr 938400 Rp 20,000 Rp 50,000 Rp 75,000 Rp 145,000
3 4-Feb-18 Amalia Husna, An Emma, dr 023400 Rp 20,000 Rp 125,000 Rp 145,000
4 4-Feb-18 Adreena Shakayla, An Emma, dr 238901 Rp 20,000 Rp 125,000 Rp 145,000
5 4-Feb-18 Aaric Delta, An Alit, dr 003801 Rp 20,000 Rp 150,000 Rp 350,000 Rp 520,000

Total Rp 1,025,000

Surabaya, 05 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


at Jalan
uari 2018

Keterangan
IGD
IGD Total
IGD RJ Rp 1,194,000
IGD ARJ Rp 695,300
Rp 1,889,300

Nebul
Endokrin

IGD

Keterangan
D Mandiri ( IGD )
D BCA ( Nebul )
D Mandiri
D Mandiri
D BCA ( ECO )
Laporan Apotek Rawat Jalan
Tanggal 4 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total Ket
1 3-Feb-18 Azka Airlangga, An Rp 28,900 Rp 28,900
2 3-Feb-18 Muhammad Hariz, An Rp 117,200 Rp 117,200
3 4-Feb-18 Al Ghazali, An Rp 91,100 Rp 91,100
4 4-Feb-18 Almer Rafaeyza, An Rp 235,800 Rp 235,800
5 4-Feb-18 Thomas Rp 19,800 Rp 19,800
6 4-Feb-18 Judson Connan, An Rp 110,200 Rp 110,200
7 4-Feb-18 Wahyu Prasetya, An Rp 92,300 Rp 92,300

Total Rp 695,300 Rp 695,300

Piutang
No Tanggal Nama Pasien Apotek Total Ket
1 4-Feb-18 Jacqueline Daniela, An Rp 246,900 Rp 246,900 D Mandiri
2 4-Feb-18 Kartika Patmanigrum, Nn Rp 1,800 Rp 1,800 Piutang Karyawan
3 4-Feb-18 Hafidz Naufalt, An Rp 70,500 Rp 70,500 D BCA
4 4-Feb-18 Angelica Wijaya, Ny Rp 62,500 Rp 62,500 D BCA
5 4-Feb-18 Amalia Husna, An Rp 134,900 Rp 134,900 D Mandiri
6 4-Feb-18 Adreena Shakayla, An Rp 821,000 Rp 821,000 D BCA
7 4-Feb-18 Adreena Shakayla, An Rp 103,900 Rp 103,900 D BCA
8 4-Feb-18 Amalia Husna, An Rp 146,800 Rp 146,800 D Mandiri
9 4-Feb-18 Hamdan Yusuf, An Rp 28,900 Rp 28,900 D BCA
10 4-Feb-18 Hamdan Yusuf, An Rp 595,000 Rp 595,000 D BCA

Total Rp 2,212,200 Rp 2,212,200

Surabaya, 05 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 04 Februari 2017
Tunai
No Tanggal Nama Pasien No.RM No Operator Poli Jasa Dokter Tindakan Total Keterangan
1 4-Feb-18 Rp -
2 4-Feb-18 Rp -

Total Rp -

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 4-Feb-18
2 4-Feb-18
3 4-Feb-18

Total

Surabaya, 05 Februari 2017

Penyetor Mengetahui,
Penerima

Yuli
Rini Wahyuningati
Laporan Therapy & Kebugaran
Tanggal 04 Februari 2017

Tunai
No Tanggal Nama Pasien Nominal Total
1 4-Feb-18 Rp -
2 4-Feb-18 Rp -
3 4-Feb-18 Rp -
4 4-Feb-18 Rp -
5 4-Feb-18 Rp -
6 4-Feb-18 Rp -
7 4-Feb-18 Rp -
8 4-Feb-18 Rp -

Total Rp - Rp -

Piutang
No Tanggal Nama Pasien Nominal Total
1 4-Feb-18 Rp -
2 4-Feb-18 Rp -

Total Rp - Rp -

Surabaya, 05 Februari 2017


Mengetahui,
Penyetor Penerima

Yuli Rini Wahyuningati


bugaran
2017

Ket

Ket
Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 4-Feb-18 Almahyra Zea, An Eka, dr 496401 Rp 25,000 Rp 50,000 Rp 75,000
2 4-Feb-18 Aleta Engrasia, An Ajeng, dr 452400 Rp 20,000 Rp 50,000 Rp 70,000
3 5-Feb-18 Natalia Lisiska, Ny Manggala, dr 956100 Rp 20,000 Rp 150,000 Rp 50,000 Rp 220,000
4 5-Feb-18 Matthew Joseph, An Diana, dr 231400 Rp 20,000 Rp 125,000 Rp 145,000
5 5-Feb-18 Rafanda Najwa, An Diana, dr 273501 Rp 20,000 Rp 125,000 Rp 145,000
6 5-Feb-18 Sora Nadhirah, Ny Rina, dr 462801 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
7 5-Feb-18 Gabrielle Audrina, An Diana, dr 281301 Rp 20,000 Rp 125,000 Rp 145,000
8 5-Feb-18 Javine Chiara, An Diana, dr 467000 Rp 20,000 Rp 125,000 Rp 145,000
9 5-Feb-18 Ayu Sundari, Ny Rina, dr 479401 Rp 35,000 Rp 40,000 Rp 75,000
10 5-Feb-18 Dyah Agung, Ny Anna, dr 469601 Rp 20,000 Rp 50,000 Rp 70,000
11 5-Feb-18 Aniqotun Nafiah, Ny Rina, dr 481101 Rp 35,000 Rp 40,000 Rp 75,000
12 5-Feb-18 Natanael Prayogo, An Diana, dr 387501 Rp 20,000 Rp 125,000 Rp 145,000
13 5-Feb-18 Chevaristo Antares, An Diana, dr 207701 Rp 20,000 Rp 125,000 Rp 145,000
14 5-Feb-18 Sean Bennedict, An Kartika, dr 454401 Rp 20,000 Rp 125,000 Rp 145,000
15 5-Feb-18 Meredith Wynonna, An Diana, dr 081601 Rp 20,000 Rp 125,000 Rp 145,000
16 5-Feb-18 Muhammad Evano, An Diana, dr 242101 Rp 20,000 Rp 125,000 Rp 145,000
17 5-Feb-18 Fathan Azzam, An Diana, dr 542400 Rp 20,000 Rp 125,000 Rp 145,000
18 5-Feb-18 Raffasya Abidazka, An Diana, dr 147101 Rp 20,000 Rp 125,000 Rp 145,000
19 5-Feb-18 Angelina Oesin, An Diana, dr 497401 Rp 25,000 Rp 125,000 Rp 150,000
20 5-Feb-18 Muhammad Geofrizky, An Diana, dr 497201 Rp 25,000 Rp 125,000 Rp 150,000
21 5-Feb-18 Jason Walfrid, An Diana, dr 011001 Rp 20,000 Rp 125,000 Rp 145,000
22 5-Feb-18 Lentera Merah, An Atika, dr 059201 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
23 5-Feb-18 Fardhan Rizki, An Kartika, dr 430101 Rp 20,000 Rp 125,000 Rp 145,000
24 5-Feb-18 Mihrima Mozika, An Kartika, dr 497601 Rp 25,000 Rp 125,000 Rp 150,000
25 5-Feb-18 Emily Zhuang, An Kartika, dr 316801 Rp 20,000 Rp 125,000 Rp 145,000
26 5-Feb-18 Jannie Angevin, An Kartika, dr 255201 Rp 20,000 Rp 125,000 Rp 145,000
27 5-Feb-18 James Richardo, An Kartika, dr 085701 Rp 20,000 Rp 125,000 Rp 145,000
28 5-Feb-18 Felisa Pribadi, An Kartika, dr 457801 Rp 20,000 Rp 125,000 Rp 145,000
29 5-Feb-18 Ririn Widiawati, Ny Fandy, dr 488200 Rp 20,000 Rp 125,000 Rp 145,000
30 5-Feb-18 Ririn Widiawati, Ny Fandy, dr 488200 Rp 35,000 Rp 40,000 Rp 75,000
31 5-Feb-18 Abiya Satya, An Kartika, dr 912900 Rp 20,000 Rp 125,000 Rp 145,000
32 5-Feb-18 Aryasatya Humanis, An Kartika, dr 303101 Rp 20,000 FREE Rp 20,000
33 5-Feb-18 Kiandra Elshanum, An Kartika, dr 903400 Rp 20,000 Rp 125,000 Rp 145,000
34 5-Feb-18 Lentera Merah, An Sufiandika, dr 059201 Rp 50,000 Rp 50,000

Total Rp 4,395,000

Surabaya, 06 Februari 2018


Mengetahu
Penyetor Penerima

Angga Rini Wahyuni


Keterangan
D BCA ( IGD )
D BCA ( IGD )
D BCA ( NST 1x, By Phone 1x )
D BCA
D BCA
D BCA ( USG 2D )
D BCA
D BCA
D BCA ( USG 2D )
Admedika ( Smartcare )
D BNI ( USG 2D )
D Mandiri
D Mandiri
D BCA
Admedika ( Medicillin )
Admedika ( INH )
D BCA
Admedika ( BNI Life )
D BCA
D Mandiri
D BCA
KK BCA ( Nebul )
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BRI
D BRI
D BNI
Piutang Karyawan Yuke CS
Admedika ( Mandiri INH )
kk BCA

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 05 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 4-Feb-18 Cantika Aisha, An Rp 21,500 Rp 21,500
2 4-Feb-18 Abdul Malik, An Rp 141,100 Rp 141,100
3 4-Feb-18 Aniqotun Nafiah, Ny Rp 84,000 Rp 84,000
4 4-Feb-18 Abdul Mannan, An Rp 221,300 Rp 221,300
5 4-Feb-18 Almera Putri, An Rp 114,500 Rp 114,500
6 4-Feb-18 Anson Rp 60,600 Rp 60,600
7 4-Feb-18 Sisca Rp 40,100 Rp 40,100
8 4-Feb-18 Vinencia Rp 32,200 Rp 32,200
9 4-Feb-18 Esti Rp 7,400 Rp 7,400
10 5-Feb-18 Jonathan Mulia, An Rp 37,000 Rp 37,000
11 5-Feb-18 Asri Puspita, Ny Rp 196,000 Rp 196,000
12 5-Feb-18 Laras Sukmawati, Ny Rp 196,000 Rp 196,000
13 5-Feb-18 Dzakiyya Salsabila, An Rp 52,800 Rp 52,800
14 5-Feb-18 Tugba Yilmaz, Ny Rp 120,800 Rp 120,800
15 5-Feb-18 Rosalina Lauwai, Ny Rp 21,100 Rp 21,100
16 5-Feb-18 M Raynor, An Rp 18,100 Rp 18,100
17 5-Feb-18 Matthew Joseph, An Rp 32,500 Rp 32,500
18 5-Feb-18 Erwin Lusiana, Ny Rp 23,500 Rp 23,500
19 5-Feb-18 Agnes Watiningsih, Ny Rp 241,000 Rp 241,000
20 5-Feb-18 Raffasya Abidazka, An Rp 52,800 Rp 52,800
21 5-Feb-18 Arfan Ridho, An Rp 113,200 Rp 113,200
22 8-Jan-18 Sheta Rp 22,100 Rp 22,100
23 17-Jan-18 Sheta Rp 41,200 Rp 41,200
24 23-Jan-18 Sheta Rp 2,100 Rp 2,100
25 24-Jan-18 Sheta Rp 4,200 Rp 4,200
26 24-Jan-18 Sheta Rp 52,100 Rp 52,100
27 2-Feb-18 Rayyanka Rp 456,600 Rp 456,600
28 18-Jan-18 Ersita Nia Rp 13,500 Rp 13,500
29 5-Feb-18 Rafael Evan, An Rp 32,500 Rp 32,500
30 5-Feb-18 I Nyoman Krisna, An Rp 50,200 Rp 50,200
31 5-Feb-18 Wendi Kumalasari, Rp 52,800 Rp 52,800
32 5-Feb-18 Lentera Merah, An Rp 59,300 Rp 59,300
33 5-Feb-18 Axel Derrilianold, An Rp 101,500 Rp 101,500
34 5-Feb-18 Putra Muhammad, An Rp 68,200 Rp 68,200
35 5-Feb-18 Bu Zumaroh Rp 17,700 Rp 17,700
36 21-Dec-17 Anna Securiti Rp 63,200 Rp 63,200
37 5-Feb-18 Judson Connan, An Rp 40,100 Rp 40,100
38 5-Feb-18 Dessy Susanti, Ny Rp 311,500 Rp 311,500
39 5-Feb-18 Nur Zetinazila,Ny Rp 299,500 Rp 299,500
40 5-Feb-18 Hervina Erisnaini, Nu Rp 116,400 Rp 116,400
41 5-Feb-18 Sean bennediict, An Rp 82,300 Rp 82,300
42 5-Feb-18 Daniel Ethan, An Rp 82,300 Rp 82,300
43 5-Feb-18 I Nyoman Krisna, An Rp 29,200 Rp 29,200
44 5-Feb-18 Kamil Abiyyu, An Rp 187,500 Rp 187,500
45 5-Feb-18 Fardhan Rizki, An Rp 32,800 Rp 32,800
46 5-Feb-18 Nailah Anayah, An Rp 113,600 Rp 113,600
47 5-Feb-18 Felisa Pribadi, An Rp 82,300 Rp 82,300
48 5-Feb-18 Maria Andien, An Rp 148,500 Rp 148,500

Total Rp 4,390,700 Rp 4,390,700

Piutang
No Tanggal Nama Pasien Apotek Total
1 4-Feb-18 Almahyra Zea, An Rp 126,100 Rp 126,100
2 4-Feb-18 Aleta Engrasia, An Rp 120,200 Rp 120,200
3 5-Feb-18 Jeslyn Keiko, An Rp 128,100 Rp 128,100
4 5-Feb-18 Javine Chiara, An Rp 291,400 Rp 291,400
5 5-Feb-18 Ayu Sundari, Ny Rp 5,800 Rp 5,800
6 5-Feb-18 Yuliana CANCEL CANCEL
7 5-Feb-18 Dyah Agung, Ny Rp 34,500 Rp 34,500
8 5-Feb-18 Aniqotun Nafiah, Ny Rp 250,500 Rp 250,500
9 5-Feb-18 Natanael Prayogo, An Rp 1,185,400 Rp 1,185,400
10 5-Feb-18 Chevaristo Antares, An Rp 821,000 Rp 821,000
11 5-Feb-18 Chevaristo Antares, An Rp 82,100 Rp 82,100
12 5-Feb-18 Rafanda Najwa, An Rp 1,000 Rp 1,000
13 5-Feb-18 Rafanda Najwa, An Rp 255,000 Rp 255,000
14 5-Feb-18 Meredith Wynonna, An Rp 190,900 Rp 190,900
15 5-Feb-18 Muhammad Evano, An Rp 198,700 Rp 198,700
16 5-Feb-18 Raffasya Abidazka, An Rp 167,400 Rp 167,400
17 5-Feb-18 Fathan Azzam, An Rp 218,900 Rp 218,900
18 5-Feb-18 Gabrielle Audrina, An Rp 121,100 Rp 121,100
19 5-Feb-18 Fadilah Rp 146,500 Rp 146,500
20 5-Feb-18 Muhammad Geofrizky, An Rp 89,000 Rp 89,000
21 5-Feb-18 Eryn Leticia, An Rp 785,100 Rp 785,100
22 5-Feb-18 Jason Walfrid, An Rp 507,200 Rp 507,200
23 5-Feb-18 Lentera Merah, An Rp 71,600 Rp 71,600
24 5-Feb-18 Angelina Oesin, An Rp 74,500 Rp 74,500
25 5-Feb-18 Sheta Fildzah, Ny Rp 33,400 Rp 33,400
26 5-Feb-18 James Richardo, An Rp 309,500 Rp 309,500
27 5-Feb-18 Arilangga Satya, An Rp 626,300 Rp 626,300
28 5-Feb-18 Arilangga Satya, An Rp 28,900 Rp 28,900
29 5-Feb-18 Jannie Angevin, An Rp 953,100 Rp 953,100
30 5-Feb-18 Raniarista Aisyah, An Rp 63,200 Rp 63,200
31 5-Feb-18 Mega Rp 38,100 Rp 38,100
32 5-Feb-18 Mihrimah Mozika, An Rp 335,800 Rp 335,800
33 5-Feb-18 Abiya Satya, An Rp 127,900 Rp 127,900
34 5-Feb-18 Aryasatya Humanis, An Rp 210,100 Rp 210,100
35 5-Feb-18 Kiandra Elshanum, An Rp 188,500 Rp 188,500
36 5-Feb-18 Emily Zhuang, An Rp 225,200 Rp 225,200
37 5-Feb-18 Gregorius Arjuna, An Rp 595,000 Rp 595,000
38 5-Feb-18 Lentera Merah, An Rp 114,700 Rp 114,700
39 5-Feb-18 MEga Rp 147,300 Rp 147,300

Total Rp 9,869,000 Rp 9,869,000

Surabaya, 06 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


lan
8

Ket

Karyawan
Karyawan
Karyawan
Karyawan
Karyawan
Anak Karyawan Sheta Poli
Karyawan

Ket
D BCA
D BCA
D BCA
D BCA
D BCA
KK BCA Rp. 306.900
Admedika ( Smartcare )
D BNI
D Mandiri
D Mandiri
D Mandiri
D BCA
D BCA
Admedika ( Medicillin )
Admedika ( INH )
Admedika ( BNI Life )
D BCA
D BCA
D BRI
D MAndiri
D MAndiri
D BCA
KK BCA
D BCA
Piutang Karyawan
D BCA
D BCA
D BCA
D BCA
D Mandiri
D Mandiri
D BCA
D BNI
Piutang Karyawan Anak dari Yuke CS
Admedika ( Mandiri INH )
D BCA
D BCA
DBCA
D Mandiri

Mengetahui,
Penerima

Rini Wahyuningati
PIJAT BAYI
Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 5-Feb-18 Cellin Rp 80,000 Rp 80,000
2 5-Feb-18 Rp -

Total Rp 80,000 Rp 80,000

Surabaya, 06 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 05 Februari 2018
Tunai
No Tanggal Nama Pasien No.RM No Operator Poli Jasa Dokter Tindakan Total Keterangan
1 5-Feb-18 Rp -
2 5-Feb-18 Rp -

Total Rp -

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 5-Feb-18 Rizha Febryana, Ny 284100 Novi, dr Rp 20,000 Rp 400,000 Rp 420,000 D BCA
2 5-Feb-18 Darrell Anieli, An 400200 Dian, dr Rp 20,000 Rp 250,000 Rp 270,000 D BCA

Total Rp 690,000

Surabaya, 06 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan
Tanggal 6 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 6-Feb-18 Kenzie Warren, An Dini, dr 275501 Rp 20,000 Rp 125,000 Rp 145,000
2 5-Feb-18 Aleta Engrasia, An Sufiandika, dr 452400 Rp 20,000 Rp 50,000 Rp 259,000 Rp 329,000
3 6-Feb-18 Ni Wayan, An Dini, dr 319101 Rp 20,000 Rp 125,000 Rp 145,000
4 6-Feb-18 Muhammad Al Khanza, An Dini, dr 230701 Rp 20,000 Rp 125,000 Rp 145,000
5 6-Feb-18 Olivia Adriel, An Leny, dr 372601 Rp 20,000 Rp 125,000 Rp 145,000
6 6-Feb-18 Sharlyn Chandra, An Dini, dr 343901 Rp 20,000 Rp 125,000 Rp 145,000
7 6-Feb-18 Olivia Raeleen, An Dini, dr 198101 Rp 20,000 Rp 125,000 Rp 145,000
8 6-Feb-18 Achmad Rayyanka, An Dini, dr 489701 Rp 20,000 Rp 125,000 Rp 145,000
9 6-Feb-18 Nahla Safira, Ny Rina, dr 452201 Rp 20,000 Rp 125,000 Rp 145,000
10 6-Feb-18 Trevor Alexander, An Dini, dr 383801 Rp 20,000 Rp 125,000 Rp 145,000
11 6-Feb-18 Dave Immanuel, An Dini, dr 977200 Rp 20,000 Rp 125,000 Rp 145,000
12 6-Feb-18 Amira Jasmine, An Dini, dr 487601 Rp 20,000 Rp 125,000 Rp 145,000
13 6-Feb-18 Kelcey Severine, An Dini, dr 494401 Rp 20,000 Rp 125,000 Rp 145,000
14 5-Feb-18 I Nyoman Krisna, An Diana, dr 475301 Rp 120,000 Rp 120,000
15 6-Feb-18 Dave Immanuel, An Dini, dr 977200 Rp 75,000 Rp 75,000
16 6-Feb-18 Kelcey Severine, An Dini, dr 494401 Rp 80,000 Rp 80,000
17 6-Feb-18 M. Hasan, An Dini, dr 467901 Rp 25,000 Rp 125,000 Rp 75,000 Rp 225,000
18 6-Feb-18 Lentera Merah, An Kartika, dr 059201 Rp 20,000 Rp 125,000 Rp 145,000
19 6-Feb-18 Khairiah, Ny Erna, dr 497600 Rp 20,000 Rp 125,000 Rp 145,000
20 6-Feb-18 Al Fatih, An Leny, dr 103101 Rp 20,000 Rp 125,000 Rp 145,000
21 6-Feb-18 Ellies Liantono, Ny Erna, dr 763000 Rp 20,000 Rp 125,000 Rp 145,000
22 6-Feb-18 Nova Isti, Ny Erna, dr 244901 Rp 20,000 Rp 125,000 Rp 145,000
23 6-Feb-18 Abdillah Ismail, An Kartika, dr 491901 Rp 20,000 FREE Rp 20,000
24 6-Feb-18 Arvila Witama, An Rohim, dr 956900 Rp 20,000 Rp 125,000 Rp 145,000
25 6-Feb-18 Dekka Aatreya, An Kartika, dr 457101 Rp 20,000 Rp 125,000 Rp 145,000
26 6-Feb-18 Bene Cakrawangsa, An Kartika, dr 457201 Rp 20,000 Rp 125,000 Rp 145,000
27 6-Feb-18 Ammar Zain, An Kartika, dr 483601 Rp 20,000 Rp 125,000 Rp 145,000
28 6-Feb-18 Nova Isti, Ny Erna, dr 244901 Rp 35,000 Rp 90,000 Rp 125,000
29 6-Feb-18 Dinaniar Enggar, Ny Erna, dr 483201 Rp 20,000 Rp 125,000 Rp 145,000
30 6-Feb-18 Steve Frederico, An Kartika, dr 414301 Rp 20,000 Rp 125,000 Rp 145,000
31 6-Feb-18 Aiyra Zafina, An Leny, dr 218101 Rp 20,000 Rp 125,000 Rp 145,000
32 6-Feb-18 Sulyantari Rochmadina, NY Erna, dr 498101 Rp 25,000 Rp 125,000 Rp 150,000
33 6-Feb-18 Leily Rizma, Ny Erna, dr 261901 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
34 6-Feb-18 Michelle Pricelia, An Kartika, dr 491401 Rp 20,000 Rp 125,000 Rp 146,000 Rp 291,000
35 6-Feb-18 Deni Anggraeni, Ny Erna, dr 222201 Rp 20,000 Rp 125,000 Rp 145,000
36 6-Feb-18 Sufiandika Nuryandari, Ny Erna, dr 025701 FREE FREE Rp -
37 6-Feb-18 Ellies Liantono, Ny Erna, dr 763000 Rp 35,000 Rp 40,000 Rp 75,000
38 6-Feb-18 Citra Ayu, Ny Erna, dr 120901 Rp 20,000 Rp 125,000 Rp 145,000
39 6-Feb-18 Dewi Nurcahyati, Ny Erna, dr 238001 Rp 20,000 Rp 125,000 Rp 145,000
40 6-Feb-18 Deni Anggraeni, Ny Erna, dr 222201 Rp 35,000 Rp 40,000 Rp 75,000
41 6-Feb-18 Sulyantari Rochmadina, NY Erna, dr 498101 Rp 35,000 Rp 40,000 Rp 75,000
42 6-Feb-18 Rosi, Ny Erna, dr 250501 Rp 20,000 Rp 125,000 Rp 145,000
43 6-Feb-18 Aida Novitasari, Ny Erna, dr 498201 Rp 25,000 Rp 125,000 Rp 150,000
44 6-Feb-18 Marsanthia Jeanneyke, Ny Erna, dr 498301 Rp 25,000 Rp 125,000 Rp 150,000
45 6-Feb-18 Rosi, Ny Erna, dr 250501 Rp 35,000 Rp 40,000 Rp 75,000
46 6-Feb-18 Gavra Corviell,An Leny, dr 457301 Rp 20,000 Rp 125,000 Rp 145,000
47 6-Feb-18 Richie Jose, An Mahe, dr 018901 Rp 20,000 Rp 125,000 Rp 145,000
48 6-Feb-18 Aninditya Candra, An Rohim, dr 903000 Rp 20,000 Rp 125,000 Rp 145,000
49 6-Feb-18 Bindo Al-Hafidz, An Rohim, dr 498401 Rp 25,000 Rp 125,000 Rp 150,000
50 6-Feb-18 Quincy Vallery, An Rohim, dr 407501 Rp 20,000 Rp 125,000 Rp 145,000
51 6-Feb-18 Cheryl Evelyn, An Eka, dr 852300 Rp 20,000 Rp 50,000 Rp 70,000
52 6-Feb-18 Arzachel Marsha, An Mahe, dr 492101 Rp 20,000 Rp 125,000 Rp 145,000
53 6-Feb-18 Hanzel Matthew, An Rohim, dr 307901 Rp 20,000 Rp 125,000 Rp 145,000
54 6-Feb-18 Marsanthia Jeanneyke, Ny Erna, dr 498301 Rp 35,000 Rp 40,000 Rp 75,000
55 6-Feb-18 Ammar Pandu, An Mahe, dr 623800 Rp 20,000 Rp 125,000 Rp 145,000

Total Rp 7,605,000
Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 6-Feb-18 Kania Anggun, An Dini, dr 865000 Rp 20,000 Rp 125,000 Rp 145,000
2 6-Feb-18 Erna Dwi, Ny Rina, dr 260900 Rp 20,000 Rp 125,000 Rp 145,000
3 6-Feb-18 Erna Dwi, Ny Rina, dr 260900 Rp 35,000 Rp 40,000 Rp 75,000
4 6-Feb-18 Mikayla Almahyra, An Kartika, dr 235601 Rp 20,000 Rp 125,000 Rp 145,000
5 6-Feb-18 Shabir Arshad, An Dini, dr 475601 Rp 20,000 Rp 125,000 Rp 145,000
6 6-Feb-18 Tallulah Bellatrix, An Anna, dr 487301 Rp 20,000 Rp 75,000 Rp 95,000
7 6-Feb-18 Kenneth Aditya, An Dini, dr 005800 Rp 20,000 Rp 125,000 Rp 145,000
8 6-Feb-18 Kania Anggun, An Dini, dr 865000 Rp 271,000 Rp 271,000
9 6-Feb-18 John Jeddiah, An Dini, dr 153501 Rp 20,000 Rp 125,000 Rp 145,000
10 6-Feb-18 Achmad Rayyanka, An Dini, dr 489701 Rp 80,000 Rp 80,000
11 6-Feb-18 Frances Eunice, an Kartika, dr 406300 Rp 20,000 Rp 125,000 Rp 145,000
12 6-Feb-18 Akhtar Devakanta, An Dini, dr 336100 Rp 20,000 Rp 125,000 Rp 145,000
13 6-Feb-18 Freya Nathania, An Kartika, dr 254500 Rp 20,000 Rp 125,000 Rp 145,000
14 6-Feb-18 Yohanna Eleanor, An Kartika, dr 394701 Rp 20,000 Rp 125,000 Rp 145,000
15 6-Feb-18 Heraldin Kinari, An Kartika, dr 603100 Rp 20,000 Rp 125,000 Rp 145,000
16 6-Feb-18 Cailynlene Tjoa, An Dini, dr 490001 Rp 20,000 Rp 125,000 Rp 145,000
17 6-Feb-18 Cheryllene Tjoa, An Dini, dr 489901 Rp 20,000 Rp 125,000 Rp 145,000
18 6-Feb-18 Radtya Agustian, An Leny, dr 484101 Rp 20,000 FREE Rp 20,000
19 6-Feb-18 Azzarine Putri, An Leny, dr 284701 Rp 20,000 FREE Rp 20,000
20 6-Feb-18 Oliver Gunawan, An Kartika, dr 613300 Rp 20,000 Rp 125,000 Rp 145,000
21 6-Feb-18 Glenn Gunawan, An Kartika, dr 457601 Rp 20,000 Rp 125,000 Rp 145,000
22 6-Feb-18 Cheryllene Tjoa, An Dini, dr 489901 Rp 80,000 Rp 80,000
23 6-Feb-18 Dude Yusuf, An Kartika, dr 048000 Rp 20,000 FREE Rp 20,000
24 6-Feb-18 Maryam Shabira, An Leny, dr 905900 Rp 20,000 Rp 125,000 Rp 145,000
25 6-Feb-18 Nelson Haslim, An Diana, dr 262800 Rp 20,000 Rp 125,000 Rp 145,000
26 6-Feb-18 Joylyne Renero, An Leny, dr 831900 Rp 20,000 Rp 125,000 Rp 145,000
27 6-Feb-18 Dwayne Axl, An Mahe, dr 294701 Rp 20,000 Rp 125,000 Rp 145,000
28 6-Feb-18 Ariela Maisie, NY Erna, dr 281601 Rp 20,000 FREE Rp 35,000 Rp 40,000 Rp 95,000
29 6-Feb-18 Azka Airlangga, An Mahe, dr 345100 Rp 20,000 Rp 125,000 Rp 145,000
30 6-Feb-18 Khairiah, Ny Erna, dr 497600 Rp 35,000 Rp 40,000 Rp 75,000
31 6-Feb-18 Miranti Dhora, Ny Erna, dr 280801 Rp 20,000 Rp 125,000 Rp 145,000
32 6-Feb-18 Dylan Angelo, An Rohim, dr 366601 Rp 20,000 Rp 125,000 Rp 145,000
33 6-Feb-18 Khaila Areta, An Mahe, dr 238801 Rp 20,000 Rp 125,000 Rp 145,000
34 6-Feb-18 Pearle Sasikirana, An Mahe, dr 382200 Rp 20,000 Rp 125,000 Rp 145,000
35 6-Feb-18 Maryam Shabira, An Leny, dr 905900 Rp 38,000 Rp 38,000
36 6-Feb-18 Patricia Pangestu, An Rohim, dr 408701 Rp 20,000 Rp 125,000 Rp 145,000
37 6-Feb-18 Djie Jenny, Ny Erna, dr 301101 Rp 20,000 Rp 325,000 Rp 375,000 Rp 720,000
38 6-Feb-18 Aqilla Fariza, An Rohim, dr 245301 Rp 20,000 Rp 125,000 Rp 145,000
39 6-Feb-18 Miranti Dhora, Ny Erna, dr 20801 Rp 140,000 Rp 60,000 Rp 200,000
40 6-Feb-18 Ivona hafiqa, An Rohim, dr 404001 Rp 20,000 Rp 125,000 Rp 145,000
41 6-Feb-18 Yuniar Saraswati, Ny Erna, dr 705800 Rp 20,000 FREE Rp 35,000 Rp 40,000 Rp 95,000
42 6-Feb-18 Kenneth Marvelino, An Mahe, dr 235701 Rp 20,000 Rp 125,000 Rp 145,000
43 6-Feb-18 Tistan Brentley, An Rohim, dr 376201 Rp 20,000 Rp 125,000 Rp 145,000
44 6-Feb-18 Adriel Prabaswara, An Rohim, dr 407801 Rp 20,000 Rp 125,000 Rp 145,000

Total Rp 6,234,000

Surabaya, 07 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuning


lan
2018

Keterangan
Total
IGD RJ Rp 7,605,000
ARJ Rp 7,255,900
Rp 14,860,900
RJG Rp 120,000
Rp 14,980,900
PR Rp 60,000
Rp 15,040,900
Px byr Rp 36,600 Akhtar Devakanta, An
Rp 15,077,500
BS RJ Rp (125,000) Azzarine Putri, An
Rp 14,952,500
BS RJ Rp (125,000) Radtya Agustian, An
Rp 14,827,500
Nebul

Nebul
USG 2D, VT

USG 2D

KARYAWAN
USG 2D

USG 2D
USG 2D

USG 2D

IGD

USG 2D
Keterangan
D BCA
D Mandiri
D Mandiri ( USG 2D )
D BCA
D BCA
D BCA ( Tindik Bayi )
D BCA
D BCA
D BCA
D BCA
D BCA
Admedika ( BNI Life )
D BCA
D BCA
D BNI
D BCA
D BCA
D BNI
D BNI
D BCA
D BRI
D BCA
Piutang Karyawan ( Anak Karyawan )
D BNI
D BCA
KK MEGA
D BCA
D BCA
D BCA
D BCA
D Mandiri
D Mandiri
D Mandiri
KK CITI
D BNI
D BCA
D BCA ( USG 4D )
D Mandiri
D Mandiri (USG 2D, Gynec )
Admedika ( FWD )
D BRI ( USG 2D )
D BCA
D BCA
Admedika ( Lipppo )

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 6 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 6-Feb-18 Aleta Engrasia, An Rp 26,400 Rp 26,400
2 6-Feb-18 Aleta Engrasia, An Rp 119,700 Rp 119,700
3 2-Feb-18 Dude Yusuf, An Rp 20,100 Rp 20,100
4 6-Feb-18 Yusdyna Rp 10,500 Rp 10,500
5 6-Feb-18 Amira Jasmine, An Rp 82,200 Rp 82,200
6 6-Feb-18 Belinda Devina Rp 52,000 Rp 52,000
7 6-Feb-18 Ni Wayan, An Rp 821,000 Rp 821,000
8 6-Feb-18 Muhammad Al Khanza, An Rp 785,100 Rp 785,100
9 6-Feb-18 Muhammad Al Khanza, An Rp 75,100 Rp 75,100
10 6-Feb-18 Dave Immanuel, An Rp 208,700 Rp 208,700
11 6-Feb-18 Trevor Alexander, An Rp 821,000 Rp 821,000
12 6-Feb-18 Amas Zuraidah Rp 29,200 Rp 29,200
13 6-Feb-18 Alesha Rp 26,400 Rp 26,400
14 6-Feb-18 Alesha Rp 26,400 Rp 26,400
15 6-Feb-18 M. Hasan, An Rp 163,600 Rp 163,600
16 6-Feb-18 Shabir Arshad, An Rp 42,200 Rp 42,200
17 6-Feb-18 Heraldin Rp 26,400 Rp 26,400
18 6-Feb-18 Lentera Merah, An Rp 104,400 Rp 104,400
19 6-Feb-18 Kartika, dr Rp 28,400 Rp 28,400
20 6-Feb-18 Dekka Aatreya, An Rp 29,200 Rp 29,200
21 6-Feb-18 Dekka Aatreya, An Rp 82,300 Rp 82,300
22 6-Feb-18 Bene Cakrawangsa, An Rp 82,300 Rp 82,300
23 6-Feb-18 Steve Frederico, An Rp 626,300 Rp 626,300
24 6-Feb-18 Nova Isti, Ny Rp 7,300 Rp 7,300
25 6-Feb-18 Dinaniar Enggar, Ny Rp 81,000 Rp 81,000
26 6-Feb-18 Aiyra Zafina, An Rp 225,200 Rp 225,200
27 6-Feb-18 Sulyantari Rochmadina, NY Rp 113,500 Rp 113,500
28 6-Feb-18 Citra Ayu, Ny Rp 158,500 Rp 158,500
29 6-Feb-18 Gavra Corviell,An Rp 82,300 Rp 82,300
30 6-Feb-18 Cheryl Evelyn, An Rp 18,200 Rp 18,200
31 6-Feb-18 Cheryl Evelyn, An Rp 37,700 Rp 37,700
32 6-Feb-18 Hanzel Matthew, An Rp 138,600 Rp 138,600
33 6-Feb-18 Aninditya Candra, An Rp 40,000 Rp 40,000
34 6-Feb-18 Marsanthia Jeanneyke, Ny Rp 307,000 Rp 307,000
35 6-Feb-18 Ammar Pandu, An Rp 105,500 Rp 105,500
36 6-Feb-18 Bindo Al, AN Rp 821,000 Rp 821,000
37 6-Feb-18 Bindo Al, AN Rp 46,100 Rp 46,100
38 6-Feb-18 Quincy Vallery, AN Rp 785,100 Rp 785,100

Total Rp 7,255,900 Rp 7,255,900

Piutang
No Tanggal Nama Pasien Apotek Total
1 6-Feb-18 Vania Rp 110,000 Rp 110,000
2 6-Feb-18 Sitti Riza Rina, dr Rp 431,000 Rp 431,000
3 6-Feb-18 Erna Dwi, Ny Rp 347,300 Rp 347,300
4 6-Feb-18 Retno Palupi, Ny Rp 62,800 Rp 62,800
5 6-Feb-18 Kenzie Warren, An Rp 548,800 Rp 548,800
6 6-Feb-18 Kenzie Warren, An Rp 80,500 Rp 80,500
7 6-Feb-18 Kania Anggun, An Rp 122,200 Rp 122,200
8 6-Feb-18 Olivia Raeleen, An Rp 82,200 Rp 82,200
9 6-Feb-18 Kenneth Aditya, An Rp 595,000 Rp 595,000
10 6-Feb-18 Kenneth Aditya, An Rp 616,700 Rp 616,700
11 6-Feb-18 Akhtar Devakanta, An Rp 220,200 Rp 220,200
12 6-Feb-18 Yohanna Eleanor, An Rp 50,700 Rp 50,700
13 6-Feb-18 Freya Nathania, An Rp 200,900 Rp 200,900
14 6-Feb-18 Mikayla Almahyra, An Rp 921,800 Rp 921,800
15 6-Feb-18 Mikayla Almahyra, An Rp 145,500 Rp 145,500
16 6-Feb-18 Frances Eunice, an Rp 343,400 Rp 343,400
17 6-Feb-18 Heraldin Kinari, An Rp 167,500 Rp 167,500
18 6-Feb-18 Heraldin Kinari, An Rp 111,000 Rp 111,000
19 6-Feb-18 Glenn Gunawan, An Rp 82,300 Rp 82,300
20 6-Feb-18 Oliver Gunawan, An Rp 213,500 Rp 213,500
21 6-Feb-18 Dude Yusuf, An Rp 42,100 Rp 42,100
22 6-Feb-18 Olivia Adriel, An Rp 1,185,400 Rp 1,185,400
23 6-Feb-18 Nelson Haslim, An Rp 200,900 Rp 200,900
24 6-Feb-18 Joylyne Renero, An Rp 534,200 Rp 534,200
25 6-Feb-18 Sufiandika Nuryandari, Ny Rp 307,800 Rp 307,800
26 6-Feb-18 Azzarine Putri, An Rp 225,200 Rp 225,200
27 6-Feb-18 Azzarine Putri, An Rp 127,900 Rp 127,900
28 6-Feb-18 Ariela Maisie, NY Rp 428,500 Rp 428,500
29 6-Feb-18 Khairiah, Ny Rp 245,700 Rp 245,700
30 6-Feb-18 Dewi Nurcahyati, Ny Rp 433,000 Rp 433,000
31 6-Feb-18 Aida Novitasari, Ny Rp 228,100 Rp 228,100
32 6-Feb-18 Maryam Shabira, An Rp 37,500 Rp 37,500
33 6-Feb-18 Maryam Shabira, An Rp 79,800 Rp 79,800
34 6-Feb-18 Dylan Angelo, An Rp 1,185,400 Rp 1,185,400
35 6-Feb-18 Dylan Angelo, An Rp 43,600 Rp 43,600
36 6-Feb-18 Khaila Areta, An Rp 85,700 Rp 85,700
37 6-Feb-18 Khaila Areta, An Rp 45,600 Rp 45,600
38 6-Feb-18 Arvila Witama, An Rp 507,200 Rp 507,200
39 6-Feb-18 Azka Airlangga, An Rp 91,400 Rp 91,400
40 6-Feb-18 Pearle Sasikirana, An Rp 203,500 Rp 203,500
41 6-Feb-18 Patricia Pangestu, An Rp 785,100 Rp 785,100
42 6-Feb-18 Dwayne Axl, An Rp 821,000 Rp 821,000
43 6-Feb-18 Miranti Dhora, Ny Rp 7,300 Rp 7,300
44 6-Feb-18 Djie Jenny, Ny Rp 395,500 Rp 395,500
45 6-Feb-18 Ivona hafiqa, An Rp 785,100 Rp 785,100
46 6-Feb-18 Ivona hafiqa, An Rp 85,800 Rp 85,800
47 6-Feb-18 Ivona hafiqa, An Rp 28,900 Rp 28,900
48 6-Feb-18 Richie Jose, An Rp 504,600 Rp 504,600
49 6-Feb-18 Kenneth Marvelino, An Rp 11,800 Rp 11,800
50 6-Feb-18 Aqilla Fariza, An Rp 785,100 Rp 785,100
51 6-Feb-18 Tistan Brentley, An Rp 1,185,400 Rp 1,185,400
52 6-Feb-18 Adriel Prabaswara, An Rp 785,100 Rp 785,100

Total Rp 17,872,500 Rp 17,872,500

Surabaya, 07 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Laporan Apotek Rawat Jalan
Tanggal 6 Februari 2018

Ket

Anak Karyawan
Karyawan

Ket
D Mandiri
Potong HR
D Mandiri
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
Admedika ( BNI Life )
D BCA
D BCA
D BCA
D BCA
D BCA
D Mandiri
D Mandiri
D BRI
D BRI
Piutang Karyawan
D BCA
D BCA
KK MEGA
D BCA
D BNI
D BNI
D BCA
D BCA
D BCA
D BNI
D BNI
D BNI
D BCA
D BCA
D MAndiri
D MAndiri
D BCA
D BCA
KK BCA
D BCA
D BCA
D Mandiri
D BCA
Admedika ( FWD )
Admedika ( FWD )
Admedika ( FWD )
D BCA
D BCA
D BCA
D BCA
Admedika ( Lipppo )
Laporan Rawat Jalan Gigi
Tanggal 06 Februari 2018
Tunai
No Tanggal Nama Pasien No.RM No Operator Poli Jasa Dokter Tindakan Total Keterangan
1 6-Feb-18 Endro Adi, Tn 695300 Nining, dr Rp 20,000 Rp 100,000 Rp 120,000
2 6-Feb-18 Rp -

Total Rp 120,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 6-Feb-18
2 6-Feb-18
3 6-Feb-18

Total

Surabaya, 02 Februari 2018

Penyetor Mengetahui,
Penerima

Ika
Rini Wahyuningati
Laporan Rawat Jalan
Tanggal 7 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 6-Feb-18 Hafidz Naufalit, An Eka, dr 938400 Rp 20,000 Rp 50,000 Rp 22,500 Rp 52,500 Rp 145,000
2 7-Feb-18 Telge Felisha, An Diana, dr 187501 Rp 20,000 Rp 125,000 Rp 145,000
3 7-Feb-18 Jasmine Shakila, An Diana, dr 488101 Rp 20,000 Rp 125,000 Rp 145,000
4 7-Feb-18 Lucy Puspa, An Anna, dr 150500 Rp 20,000 Rp 50,000 Rp 70,000
5 7-Feb-18 Peter Anderson, An Diana, dr 466300 Rp 20,000 FREE Rp 20,000
6 7-Feb-18 Alexandra Chloe, An Diana, dr 455201 Rp 20,000 FREE Rp 20,000
7 7-Feb-18 Irsyad Arham, An Diana, dr 454900 CANCEL Rp -
8 7-Feb-18 Jessica Meliani, Ny Rina, dr 482001 Rp 35,000 Rp 40,000 Rp 75,000
9 7-Feb-18 Claudia Meliana, Ny Rina, dr 482701 Rp 20,000 Rp 125,000 Rp 145,000
10 7-Feb-18 Okky Puspitasari, Ny Rina, dr 697100 Rp 20,000 Rp 125,000 Rp 145,000
11 7-Feb-18 Fransisco Jordan, An Diana, dr 403901 Rp 20,000 Rp 125,000 Rp 145,000
12 7-Feb-18 Eliza Bagriella, An Diana, dr 319901 Rp 20,000 Rp 125,000 Rp 145,000
13 7-Feb-18 Elika Gabriella, An Diana, dr 320001 Rp 20,000 Rp 125,000 Rp 145,000
14 7-Feb-18 Claudia Meliana, Ny Rina, dr 482701 Rp 35,000 Rp 40,000 Rp 75,000
15 7-Feb-18 Okky Puspitasari, Ny Rina, dr 697100 Rp 35,000 Rp 40,000 Rp 75,000
16 7-Feb-18 Dominic Xavier, An Diana, dr 493901 Rp 20,000 Rp 125,000 Rp 145,000
17 7-Feb-18 Hanif Marsyaf, An Diana, dr 023801 Rp 20,000 FREE Rp 40,000 Rp 60,000
18 7-Feb-18 Aurora Nur, An Diana, dr 487201 Rp 20,000 Rp 125,000 Rp 145,000
19 7-Feb-18 Navalia Arsyilaa, An Anna, dr 041401 Rp 20,000 Rp 50,000 Rp 70,000
20 7-Feb-18 Irsyad Arham, An Diana, dr 454900 Rp 20,000 Rp 50,000 Rp 70,000
21 7-Feb-18 Faidhan Nararya, An Diana, dr 832800 Rp 20,000 Rp 125,000 Rp 145,000
22 7-Feb-18 Zezarea Purbawati, Ny Eighty, dr 499001 Rp 35,000 Rp 40,000 Rp 75,000
23 7-Feb-18 Naira Latisha, An Diana, dr 887200 Rp 20,000 FREE Rp 20,000
24 7-Feb-18 Audrey Nathania, An Diana, dr 494800 Rp 20,000 Rp 125,000 Rp 145,000
25 7-Feb-18 Fatmawati, Ny Erna, dr 499101 Rp 25,000 Rp 125,000 Rp 150,000
26 7-Feb-18 Elisabelle Quinn, An Diana, dr 397901 Rp 20,000 Rp 125,000 Rp 145,000
27 7-Feb-18 Ita Fajria, Ny Erna, dr 242500 Rp 20,000 FREE Rp 35,000 Rp 40,000 Rp 95,000
28 7-Feb-18 Fatmawati, Ny Erna, dr 499101 Rp 35,000 Rp 40,000 Rp 75,000
29 7-Feb-18 Puspita Fitrianingrum, Ny Erna, dr 222101 Rp 20,000 FREE Rp 20,000
30 7-Feb-18 Rosiatul Mahfudhoh, An Emma, dr 193000 Rp 20,000 Rp 125,000 Rp 145,000
31 7-Feb-18 Puspita Fitrianingrum, Ny Erna, dr 222101 Rp 35,000 Rp 40,000 Rp 75,000
32 7-Feb-18 Fahril Faeyza, An Emma, dr 499301 Rp 25,000 Rp 125,000 Rp 150,000
33 7-Feb-18 M. Mahdi, An Emma, dr 445901 Rp 20,000 Rp 125,000 Rp 145,000
34 7-Feb-18 Khayla Dzakiya, An Emma, dr 327101 Rp 20,000 Rp 125,000 Rp 145,000
35 7-Feb-18 Yenny Setiawati, Ny Tik, dr 43481 Rp 35,000 Rp 40,000 Rp 75,000
36 7-Feb-18 Fahril Faeyza, An Emma, dr 499301 Rp 75,000 Rp 75,000
37 7-Feb-18 Febriandiany Tiara, Ny Tik, dr 357901 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
38 7-Feb-18 M. Mahdi, An Emma, dr 445901 Rp 75,000 Rp 75,000
39 7-Feb-18 Yuni Triana, Ny Tik, dr 499501 CANCEL Rp -

Total Rp 3,960,000

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 6-Feb-18 Priscilla Deborah, An Yusuf, dr 190201 Rp 20,000 Rp 50,000 Rp 70,000
2 7-Feb-18 Ghina Yumna, An Diana, dr 289201 Rp 20,000 Rp 125,000 Rp 145,000
3 7-Feb-18 Clarine Eliora, An Diana, dr 520700 Rp 20,000 Rp 125,000 Rp 145,000
4 7-Feb-18 Jessica Meliani, Ny Rina, dr 482001 Rp 20,000 Rp 125,000 Rp 145,000
5 7-Feb-18 Diandra Kayyisa, An Diana, dr 498601 Rp 25,000 Rp 125,000 Rp 150,000
6 7-Feb-18 Nayra Neaswari, An Diana, dr 498801 Rp 25,000 Rp 125,000 Rp 150,000
7 7-Feb-18 Charlene Charissa, An Diana, dr 498901 Rp 25,000 Rp 125,000 Rp 150,000
8 7-Feb-18 Carina Ayny, Ny Erna, dr 305101 Rp 20,000 Rp 125,000 Rp 145,000
9 7-Feb-18 Yenny Setiawati, Ny Tik, dr 43481 Rp 20,000 Rp 125,000 Rp 145,000
10 7-Feb-18 Amaris Sharon, An Diana, dr 379701 Rp 20,000 Rp 125,000 Rp 145,000
11 7-Feb-18 Vania Cleophila, An Diana, dr 974000 Rp 20,000 Rp 125,000 Rp 145,000
12 7-Feb-18 M Hasan, An Anna, dr 497901 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
13 7-Feb-18 Ishmael Rayyan, An Diana, dr 187301 Rp 20,000 FREE Rp 20,000
14 7-Feb-18 Anna, dr Rp 25,000 Rp 150,000 Rp 175,000
Rosalia Santoso, Ny 498701
15 7-Feb-18 Hendra, dr Rp 100,000 Rp 100,000
16 7-Feb-18 Zezarea Purbawati, Ny Eighty, dr 499001 Rp 25,000 Rp 125,000 Rp 150,000
17 7-Feb-18 Ayu Firdayanti, Ny Eighty, dr 283301 Rp 20,000 Rp 125,000 Rp 145,000
18 7-Feb-18 Sebastian Aiden, An Diana, dr 656200 Rp 20,000 Rp 125,000 Rp 145,000
19 7-Feb-18 Mega Putri, Ny Erna, dr 199500 Rp 20,000 Rp 125,000 Rp 145,000
20 7-Feb-18 Kaira Nadindra, An Diana, dr 435201 Rp 20,000 Rp 125,000 Rp 145,000
21 7-Feb-18 Kirana Jihan, An Diana, dr 026200 Rp 20,000 Rp 125,000 Rp 145,000
22 7-Feb-18 Carina Ayny, Ny Erna, dr 305101 Rp 35,000 Rp 40,000 Rp 75,000
23 7-Feb-18 Clifford Alexander, An Diana, dr 335701 Rp 20,000 Rp 125,000 Rp 145,000
24 7-Feb-18 Rika Anggriani, Ny Erna, dr 465201 Rp 20,000 Rp 125,000 Rp 45,000 Rp 40,000 Rp 230,000
25 7-Feb-18 Aisyeningrum, Ny Erna, dr 436601 Rp 20,000 Rp 125,000 Rp 145,000
26 7-Feb-18 Mega Putri, Ny Erna, dr 199500 Rp 35,000 Rp 40,000 Rp 75,000
27 7-Feb-18 Lucky Prasetiowati, Ny Erna, dr 356301 Rp 20,000 Rp 125,000 Rp 145,000
28 7-Feb-18 Dr. Evi Anggraini, Ny Erna, dr 046701 Rp 20,000 FREE Rp 20,000
29 7-Feb-18 Femi Noviasafitri, Ny Erna, dr 363601 Rp 20,000 Rp 125,000 Rp 145,000
30 7-Feb-18 Arinta Sri, Ny Erna, dr 629200 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
31 7-Feb-18 Afa Dian, Ny Erna, dr 502400 Rp 20,000 Rp 125,000 Rp 145,000
32 7-Feb-18 Atina Irani, Ny Erna, dr 253001 Rp 20,000 FREE Rp 35,000 Rp 40,000 Rp 95,000
33 7-Feb-18 Aisyeningrum, Ny Erna, dr 436601 Rp 35,000 Rp 40,000 Rp 75,000
34 7-Feb-18 Femi Noviasafitri, Ny Erna, dr 363601 Rp 35,000 Rp 40,000 Rp 75,000
35 7-Feb-18 Afa Dian, Ny Erna, dr 502400 Rp 35,000 Rp 40,000 Rp 75,000
36 7-Feb-18 Kiara Azzahra, An Emma, dr 594500 Rp 20,000 Rp 125,000 Rp 145,000
37 7-Feb-18 Dyah Agung, Ny Tik, dr 469601 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
38 7-Feb-18 Sanika Assyifa, An Emma, dr 050001 Rp 20,000 Rp 125,000 Rp 145,000
39 7-Feb-18 ZA Keisha, An Emma, dr 499201 Rp 25,000 Rp 125,000 Rp 150,000
40 7-Feb-18 Keyzia Angella, An Emma, dr 478500 Rp 20,000 Rp 125,000 Rp 145,000
41 7-Feb-18 Sullafitri, Ny Tik, dr 382001 Rp 20,000 Rp 125,000 Rp 145,000
42 7-Feb-18 Rosiatul Mahfudhoh, An Emma, dr 193000 Rp 369,000 Rp 369,000
43 7-Feb-18 Hafidz Naufalit, An Arum, dr 93840 Rp 20,000 Rp 50,000 Rp 75,000 Rp 145,000
44 7-Feb-18 Sullafitri, Ny Tik, dr 382001 Rp 35,000 Rp 40,000 Rp 75,000

Total Rp 6,004,000

Surabaya, 08 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuninga


18

Keterangan
IGD, Nebul
Total
RJ Rp 3,960,000
IGD ARJ Rp 4,252,300
Rp 8,212,300
RJG Rp 3,020,000
Rp 11,232,300
USG 2D Px byr Rp 42,100 a/n Ny Arienta
Rp 11,274,400
Px byr Rp 41,900 a/n An. Kiara
Rp 11,316,300
Px byr Rp 5,000 a/n An. Za Keisha
f
USG 2D
USG 2D

IGD
IGD

USG 2D
Anak Karyawan

USG 2D
USG 2D

USG 2D

USG 2D
Endokrin
USG 2D
Endokrin

Keterangan
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D MAYAPADA
D BCA
D BCA
D BCA
D BCA
D BNI ( IGD, Nebul)
D BCA
D BCA
D BCA
D BRI
D Mandiri
D BCA
D BCA
D Mandiri
Admedika ( INH ) Px byr di tmpt Rp. 18.700 ( D Mandiri )
KK BCA ( USG 2D )
D Mandiri
D Mandiri ( USG 2D, Print 1x )
D Mandiri
D BCA ( USG 2D )
D BNI
D Mandiri
D BCA
Admedika ( INH )
D BCA
D Mandiri
D Mandiri (USG 2D )
D BCA ( USG 2D )
D BCA ( USG 2D )
Admedika ( Mandiri INH )
Amedika ( Smartcare )
Admedika ( Lippo )
Admedika ( Lippo )
D BCA
D BCA
D BRI
D Mandiri ( IGD, Nebul )
D BCA ( USG 2D )

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 7 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total Ket
1 7-Feb-18 Eril Lafiana,Ny Rp 58,000 Rp 58,000
2 7-Feb-18 Lucy Puspa, An Rp 350,000 Rp 350,000
3 7-Feb-18 Jasmine Shakila, An Rp 120,800 Rp 120,800
4 7-Feb-18 Eliza Bagriella, An Rp 595,000 Rp 595,000
5 7-Feb-18 Elika Gabriella, An Rp 595,000 Rp 595,000
6 7-Feb-18 Claudia Meliana, Ny Rp 301,000 Rp 301,000
7 7-Feb-18 Okky Puspitasari, Ny Rp 122,500 Rp 122,500
8 7-Feb-18 Hanif Marsyaf, An Rp 23,000 Rp 23,000
9 7-Feb-18 Clarine Eliora, An Rp 3,600 Rp 3,600
10 7-Feb-18 Peter Anderson, An Rp 200,900 Rp 200,900
11 7-Feb-18 Alexandra Chloe, An Rp 112,300 Rp 112,300
12 7-Feb-18 Irsyad Arham, An Rp 115,700 Rp 115,700
13 7-Feb-18 Desi Rp 9,100 Rp 9,100 Karyawan
14 7-Feb-18 Naira Latisha, An Rp 175,000 Rp 175,000
15 6-Feb-18 Afida, Nn Rp 2,100 Rp 2,100 Karyawan
16 7-Feb-18 Faidhan Nararya, An Rp 209,300 Rp 209,300
17 7-Feb-18 Fatmawati, Ny Rp 283,000 Rp 283,000
18 7-Feb-18 Silvi Labibah, Nn Rp 221,500 Rp 221,500
19 7-Feb-18 Silvi Labibah, Nn Rp 17,400 Rp 17,400
20 7-Feb-18 Femi Noviasafitri, Ny Rp 2,400 Rp 2,400
21 7-Feb-18 Rosiatul Mahfudhoh, An Rp 260,000 Rp 260,000
22 7-Feb-18 Yenny Setiawati, Ny Rp 269,300 Rp 269,300
23 7-Feb-18 Fahril Faeyza, An Rp 112,300 Rp 112,300
24 7-Feb-18 Khayla Dzakiya, An Rp 93,100 Rp 93,100

Total Rp 4,252,300 Rp 4,252,300

Piutang
No Tanggal Nama Pasien Apotek Total Ket
1 6-Feb-18 Priscilla Deborah, An Rp 43,100 Rp 43,100 D BCA
2 7-Feb-18 Telge Felisha, An Rp 187,800 Rp 187,800 D NIAGA
3 7-Feb-18 Ghina Yumna, An Rp 1,185,400 Rp 1,185,400 D BCA
4 7-Feb-18 Amaris Sharon, An Rp 1,076,000 Rp 1,076,000 D BCA
5 7-Feb-18 Ishmael Rayyan, An Rp 1,076,000 Rp 1,076,000 D BCA
6 7-Feb-18 Diandra Kayyisa, An Rp 595,000 Rp 595,000 D BCA
7 7-Feb-18 Rosalia Santoso, Ny Rp 7,300 Rp 7,300 D BCA
8 7-Feb-18 Muhammad Zaenul, An Rp 151,400 Rp 151,400 Piutang Karyawan
9 7-Feb-18 Charlene Charissa, An Rp 203,400 Rp 203,400 D Mayapada
10 7-Feb-18 Audrey Nathania, An Rp 200,900 Rp 200,900 D BCA
11 7-Feb-18 Nayra Neaswari, An Rp 121,100 Rp 121,100 D BCA
12 7-Feb-18 Kaira Nadindra, An Rp 119,700 Rp 119,700 D Mandiri
13 7-Feb-18 Kirana Jihan, An Rp 43,600 Rp 43,600 Admedika ( INH )
14 7-Feb-18 Fransisco Jordan, An Rp 225,200 Rp 225,200 KK BCA
15 7-Feb-18 Fransisco Jordan, An Rp 27,700 Rp 27,700 KK BCA
16 7-Feb-18 Elisabelle Quinn, An Rp 785,100 Rp 785,100 D BCA
17 7-Feb-18 Elisabelle Quinn, An Rp 56,600 Rp 56,600 D BCA
18 7-Feb-18 Clifford Alexander, An Rp 225,200 Rp 225,200 D Mandiri
19 7-Feb-18 Carina Ayny, Ny Rp 480,100 Rp 480,100 KK BCA
20 7-Feb-18 Rika Anggriani, Ny Rp 101,500 Rp 101,500 D Mandiri
21 7-Feb-18 Mega Putri, Ny Rp 392,000 Rp 392,000 D BCA
22 7-Feb-18 Dr. Evi Anggraini, Ny Rp 68,700 Rp 68,700 D Mandiri
23 7-Feb-18 Arinta Sri, Ny Rp 200,500 Rp 200,500 Admedika ( INH )
24 7-Feb-18 Atina Irani, Ny Rp 319,500 Rp 319,500 D Mandiri
25 7-Feb-18 Lucky Prasetiowati, Ny Rp 209,000 Rp 209,000 D BNI
26 7-Feb-18 Femi Noviasafitri, Ny Rp 54,500 Rp 54,500 DBCA
27 7-Feb-18 Afa Dian, Ny Rp 200,500 Rp 200,500 DBCA
28 7-Feb-18 Kiara Azzahra, An Rp 273,500 Rp 273,500 Admedika ( INH )
29 7-Feb-18 Dyah Agung, Ny Rp 214,900 Rp 214,900 Amedika ( Smartcare )
30 7-Feb-18 Sanika Assyifa, An Rp 210,300 Rp 210,300 Admedika ( Lippo )
31 7-Feb-18 ZA Keisha, An Rp 145,400 Rp 145,400 Admedika ( Lippo )
32 7-Feb-18 Hafidz Naufalit, An Rp 30,000 Rp 30,000 D Mandiri
33 7-Feb-18 Sullafitri, Ny Rp 338,300 Rp 338,300 D BCA

Total Rp 9,569,200 Rp 9,569,200

Surabaya, 08 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 07 Februari 2018
Tunai
No Tanggal Nama Pasien No.RM No Operator Poli Jasa Dokter Tindakan Total Keterangan
1 7-Feb-18 Silvi Labibah, Nn 490801 Nining, dr Rp 20,000 Rp 3,000,000 Rp 3,020,000

Total Rp 3,020,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 7-Feb-18 Divya Amanta, An 480200 Mashita, dr Rp 20,000 Rp 300,000 Rp 320,000 D BCA
2 7-Feb-18 Scarlett Edelaine, An 372800 Mashita, dr Rp 20,000 Rp 300,000 Rp 320,000 D BCA
3 7-Feb-18 Rp -
Rp 640,000
Total

Surabaya, 08 Februari 2018

Penyetor Mengetahui,
Penerima

Ika
Rini Wahyuningati
Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium
1 8-Feb-18 Nicholas Benedict, An Dini, dr 945700 Rp 20,000 Rp 125,000
2 8-Feb-18 Louis Emrick, An Dini, dr 850600 Rp 20,000 Rp 125,000
3 8-Feb-18 Naluri Ramadhan, AN Dini, dr 499701 Rp 25,000 Rp 125,000
4 8-Feb-18 Austin Tjondro, An Kartika, dr 428301 Rp 20,000 Rp 125,000
5 8-Feb-18 Laili Anizmah, NY Rina, dr 297201 Rp 20,000 Rp 125,000
6 8-Feb-18 Laili Anizmah, NY Rina, dr 297201 Rp 35,000 Rp 40,000
7 8-Feb-18 Tyrone Ignas, An Leny, dr 318901 Rp 20,000 Rp 125,000
8 8-Feb-18 Elvedh Hugo, An Dini, dr 281700 Rp 20,000 Rp 125,000
9 8-Feb-18 Arief Wijaksono, An Dini, dr 2534014 Rp 20,000 Rp 125,000
10 8-Feb-18 Karina Putri, An Dini, dr 827800 Rp 20,000 Rp 125,000
11 8-Feb-18 Ken David, An Kartika, dr 084201 Rp 20,000 Rp 125,000
12 8-Feb-18 Raisya Putri, An Kartika, dr 155601 Rp 20,000 FREE
13 8-Feb-18 Kayonna Kamaratih, An Kartika, dr 101201 Rp 20,000 Rp 125,000
14 8-Feb-18 Pramudhito Habibie, An Leny, dr 122000 Rp 20,000 Rp 125,000
15 8-Feb-18 Kayla Inshirah, An Leny, dr 472301 Rp 20,000 Rp 125,000
16 8-Feb-18 Steve Frederico, An Kartika, dr 414301 Rp 20,000 Rp 125,000
17 8-Feb-18 Winson Clif, An Leny, dr 461101 Rp 20,000 Rp 125,000
18 8-Feb-18 R Dina, Ny Erna, dr 194701 Rp 20,000 Rp 125,000
19 8-Feb-18 Caythleen Abigail, An Kartika, dr 987800 Rp 20,000 Rp 125,000
20 8-Feb-18 Brandon Alexander, An Kartika, dr 562900 Rp 20,000 Rp 125,000
21 8-Feb-18 Elvira Quinn, An Leny, dr 499700 Rp 20,000 Rp 125,000
22 8-Feb-18 Bintang Arkana, An Mahe, dr 995700 Rp 20,000 Rp 125,000
23 8-Feb-18 Harvey Solomon, An Mahe, dr 460801 Rp 20,000 Rp 125,000
24 8-Feb-18 Adelia Oktavius, Ny Agung, dr 407500 Rp 20,000 Rp 125,000
25 8-Feb-18 Khoirul Azam, An Mahe, dr 495901 Rp 147,000
26 8-Feb-18 Haidar, Ny Agung, dr 461901 Rp 20,000 Rp 125,000
27 8-Feb-18 Lanika Shahia, An Mahe, dr 440801 Rp 20,000 Rp 125,000
28 8-Feb-18 Sarah Muhammad, Ny Erna, dr 500101 Rp 25,000 Rp 325,000 Rp 375,000
29 8-Feb-18 Louis Rafaello, An Rohim, dr 479100 Rp 20,000 Rp 125,000
30 8-Feb-18 Elia Elvianti, Ny Erna, dr 500201 Rp 25,000 Rp 125,000 Rp 35,000 Rp 40,000
31 8-Feb-18 Adelia Oktavius, Ny Agung, dr 407500 Rp 50,000 Rp 45,000
32 8-Feb-18 Haidar, Ny Agung, dr 461901 Rp 35,000 Rp 40,000
33 8-Feb-18 Valeska Handoko, An Mahe, dr 445101 Rp 20,000 Rp 125,000
34 8-Feb-18 Tantri Mayang, Ny Erna, dr 392501 Rp 35,000 Rp 40,000
35 8-Feb-18 Jeannifer Chandra, An Pungky, dr '500401 Rp 25,000 Rp 824,000
36 8-Feb-18 Mikayla Alesha, An Mahe, dr 278301 Rp 20,000 Rp 125,000
37 8-Feb-18 Valdo Alaric, An Mahe, dr 665200 Rp 20,000 Rp 125,000
38 8-Feb-18 Gabrielle Alena, An Mahe, dr 143501 Rp 20,000 Rp 125,000
39 8-Feb-18 Khoirul Azam, An Mahe, dr 495901 Rp 20,000 Rp 125,000
40 8-Feb-18 Ceisya Owen, An Rohim, dr 500601 Rp 25,000 Rp 125,000
41 8-Feb-18 Fakhirah Agreina, An Mahe, dr 430801 Rp 20,000 Rp 125,000
42 8-Feb-18 Jocelyn Olivia, An Mahe, dr 460701 Rp 20,000 Rp 125,000

Total

Surabaya, 09 Februari 2017

Penyetor

Nia
Total Keterangan
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 150,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D Mandiri
Rp 75,000 D Mandiri
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D MAndiri
Rp 145,000 Admedika ( Sinarmas )
Rp 145,000 D BCA
Rp 20,000 D BNI ( Anak Karyawan )
Rp 145,000 D BRI
Rp 145,000 D Mandiri
Rp 145,000 D Mandiri
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D MAndiri
Rp 145,000 D Permata
Rp 145,000 D BCA
Rp 145,000 D Mandiri
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 147,000 D Mandiri
Rp 145,000 D BCA
Rp 145,000 D BRI
Rp 725,000 D BCA ( USG 4D )
Rp 145,000 D BCA
Rp 225,000 D BCA (UG 2D )
Rp 95,000 D BCA ( USG 2D, Print 2x )
Rp 75,000 D BCA ( USG 2D )
Rp 145,000 D BCA
Rp 75,000 D BRI ( USG 2D )
Rp 849,000 D BCA
Rp 145,000 D Mandiri
Rp 145,000 Admedika ( Mandiri INH )
Rp 145,000 D BCA
Rp 145,000 D Mandiri
Rp 150,000 D Niaga
Rp 145,000 Admedika ( Lippo )
Rp 145,000 D BCA

Rp 7,081,000

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 08 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 8-Feb-18 Ahmad Uwais, an Rp 106,000 Rp 106,000
2 8-Feb-18 Ahmad Uwais, an Rp 16,500 Rp 16,500
3 8-Feb-18 Emmanuelle Hanafi, An Rp 536,200 Rp 536,200
4 8-Feb-18 Naluri Ramadhan, AN Rp 101,500 Rp 101,500
5 8-Feb-18 Abrisam Muliadi, An Rp 119,700 Rp 119,700
6 8-Feb-18 Danar Rp 3,200 Rp 3,200
7 8-Feb-18 M Azka Hafiz, An Rp 225,200 Rp 225,200
8 8-Feb-18 M Azka Hafiz, An Rp 45,100 Rp 45,100
9 8-Feb-18 Eleanor andromeda, An Rp 28,900 Rp 28,900
10 8-Feb-18 Eleanor andromeda, An Rp 12,100 Rp 12,100
11 8-Feb-18 Helena Nathania, An Rp 19,500 Rp 19,500
12 8-Feb-18 Helena Nathania, An Rp 52,800 Rp 52,800
13 8-Feb-18 Sheila Al, An Rp 184,300 Rp 184,300
14 8-Feb-18 Muthia Sayyidah, An Rp 12,100 Rp 12,100
15 8-Feb-18 Grand Archibald, An Rp 924,400 Rp 924,400
16 8-Feb-18 Putra Rp 72,500 Rp 72,500
17 8-Feb-18 Kayonna Kamaratih, An Rp 12,100 Rp 12,100
18 8-Feb-18 Orlando Noel, An Rp 27,700 Rp 27,700
19 8-Feb-18 Neysha Kirana, An Rp 12,100 Rp 12,100
20 8-Feb-18 Oliver Wynston, An Rp 112,300 Rp 112,300
21 8-Feb-18 Oliver Wynston, An Rp 21,000 Rp 21,000
22 8-Feb-18 Pramudito Habibie, An Rp 68,500 Rp 68,500
23 8-Feb-18 Kayla Inshirah, An Rp 112,300 Rp 112,300
24 8-Feb-18 Ahmad Muwafiq, An Rp 82,300 Rp 82,300
25 8-Feb-18 Rayyan Zulfadli, An Rp 112,300 Rp 112,300
26 8-Feb-18 Sultan Muhammad, An Rp 152,600 Rp 152,600
27 8-Feb-18 Feodora Callista, An Rp 785,100 Rp 785,100
28 8-Feb-18 Muhammad Arvand, An Rp 112,300 Rp 112,300
29 8-Feb-18 Danastri Pramudita, An Rp 225,200 Rp 225,200
30 8-Feb-18 Muhammad Atharayhan, An Rp 112,300 Rp 112,300
31 8-Feb-18 Rosalia Rp 21,500 Rp 21,500
32 8-Feb-18 Azkayra Jasmine, An Rp 112,300 Rp 112,300
33 8-Feb-18 Fairuz Zahra, An Rp 60,100 Rp 60,100
34 8-Feb-18 Aaron Ravanda, An Rp 821,000 Rp 821,000
35 8-Feb-18 Atria Bismatika, An Rp 12,100 Rp 12,100
36 8-Feb-18 Ramon Rp 21,500 Rp 21,500
37 8-Feb-18 Bintang Arkana, An Rp 19,500 Rp 19,500
38 8-Feb-18 Alina Aldita, AN Rp 12,100 Rp 12,100
39 8-Feb-18 Kenzo Alexander, An Rp 12,100 Rp 12,100
40 8-Feb-18 Kenzo Alexander, An Rp 74,500 Rp 74,500
41 8-Feb-18 Salsabillah Firdausi, An Rp 227,600 Rp 227,600

Total Rp 5,802,400 Rp 5,802,400


Piutang
No Tanggal Nama Pasien Apotek Total
1 8-Feb-18 Laili Anizmah, NY Rp 347,300 Rp 347,300
2 8-Feb-18 Louis Emrick, An Rp 233,600 Rp 233,600
3 8-Feb-18 Arief Wijaksono, An Rp 785,100 Rp 785,100
4 8-Feb-18 Kheyla Reavaline, An Rp 595,000 Rp 595,000
5 8-Feb-18 Nicholas Benedict, An Rp 507,200 Rp 507,200
6 8-Feb-18 Nicholas Benedict, An Rp 45,100 Rp 45,100
7 8-Feb-18 Karina Putri, An Rp 595,000 Rp 595,000
8 8-Feb-18 Elvedh Hugo, An Rp 161,900 Rp 161,900
9 8-Feb-18 Raisya Putri, An Rp 10,300 Rp 10,300
10 8-Feb-18 Azka Rais, An Rp 12,100 Rp 12,100
11 8-Feb-18 Austin Tjondro, An Rp 119,700 Rp 119,700
12 8-Feb-18 Austin Tjondro, An Rp 28,900 Rp 28,900
13 8-Feb-18 Ken David, An Rp 83,600 Rp 83,600
14 8-Feb-18 Tryrone Ignas, An Rp 921,900 Rp 921,900
15 8-Feb-18 Matthew Benedictus, An Rp 112,300 Rp 112,300
16 8-Feb-18 Steve Frederico, An Rp 296,100 Rp 296,100
17 8-Feb-18 Winson Clif, An Rp 112,300 Rp 112,300
18 8-Feb-18 Orlando Noel, An Rp 225,200 Rp 225,200
19 8-Feb-18 Orlando Noel, An Rp 28,900 Rp 28,900
20 8-Feb-18 Orlando Noel, An Rp 27,500 Rp 27,500
21 8-Feb-18 Caythleen Abigail, An Rp 12,100 Rp 12,100
22 8-Feb-18 Brandon Alexander, An Rp 12,100 Rp 12,100
23 8-Feb-18 Adzkia Nadhira, An Rp 119,700 Rp 119,700
24 8-Feb-18 Adzkia Nadhira, An Rp 80,500 Rp 80,500
25 8-Feb-18 Harvey Solomom, An Rp 82,300 Rp 82,300
26 8-Feb-18 Elia Elvianti, Ny Rp 451,000 Rp 451,000
27 8-Feb-18 Haidar, Ny Rp 131,300 Rp 131,300
28 8-Feb-18 Tantri Mayang, An Rp 230,500 Rp 230,500
29 8-Feb-18 Mikayla Alesha, An Rp 353,000 Rp 353,000
30 8-Feb-18 Valdo Alaric, An Rp 89,700 Rp 89,700
31 8-Feb-18 Gabrielle Alena, An Rp 12,100 Rp 12,100
32 8-Feb-18 Gabrielle Alena, An Rp 35,400 Rp 35,400
33 8-Feb-18 Ceisya Owen, An Rp 225,200 Rp 225,200
34 8-Feb-18 Ceisya Owen, An Rp 72,500 Rp 72,500
35 8-Feb-18 Fakhirah Agreina, An Rp 96,800 Rp 96,800
36 8-Feb-18 Jocelyn Olivia, An Rp 82,300 Rp 82,300
37 8-Feb-18 Lanika Shahia, An Rp 112,300 Rp 112,300
38 8-Feb-18 Jocelyn Olivia, An Rp 79,500 Rp 79,500
39 8-Feb-18 Valeska Handoko, An Rp 105,800 Rp 105,800

Total Rp 7,633,100 Rp 7,633,100

Surabaya, 09 Februari 2018


Mengetahui,
Penyetor Penerima
Nia Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 08 Februari 2018

Ket
Ket
D Mandiri
D BCA
D Mandiri
D BRI
D BCA
D BCA
Admedika ( Sinarmas )
D BCA
D BNI
D BCA
D BCA
D BCA
D BCA
KK BCA
D BCA
D BCA
D BCA
D Mandiri
D Mandiri
D Mandiri
D Permata
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BNi
D Mandiri
Admedika ( Mandiri INH )
D BCA
D BCA
D BCA
D BCA
Admedika ( Lippo )
D BCA
D BRI
D BCA
D BCA
Laporan Therapy Kebugaran & Pijat Bayi
Tanggal 08 Januari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 6-Feb-18 Mattew, An Rp 60,000 Rp 60,000 1210
2 8-Feb-18 Aira, An Rp 60,000 Rp 60,000 1211
3 8-Feb-18 Rp -

Total Rp 120,000 Rp 120,000

Surabaya, 09 Februari 2018 Mengetahui,


Penerima
Penyetor

Rini Wahyuningati
Nia
Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium
1 9-Feb-18 Kania Anggun, An Dini, dr 865000 Rp 20,000 Rp 125,000
2 9-Feb-18 Navalia Arsyila, An Anna, dr 041401 Rp 20,000 Rp 50,000
3 9-Feb-18 Kiara Azzahra, An Anna, dr 594500 Rp 20,000 Rp 50,000 Rp 369,000
4 9-Feb-18 Vinensia Kenanga, Ny Rina, dr 732900 Rp 35,000 Rp 40,000
5 9-Feb-18 Sean Nathaniel, An Dini, dr 501001 Rp 25,000 Rp 125,000
6 9-Feb-18 Naira Azzahra, An Dini, dr 744500 Rp 259,000
7 9-Feb-18 El Majid, An Dini, dr 387101 Rp 20,000 Rp 125,000
8 9-Feb-18 Danish Arshad, An Dini, dr 495101 Rp 20,000 Rp 125,000
9 9-Feb-18 Vincentius Wilson, An Dini, dr 340800 Rp 20,000 Rp 125,000
10 9-Feb-18 Ashira Navrianna, An Leny, dr 501401 Rp 25,000 Rp 125,000
11 9-Feb-18 Lintang Suska, Ny Brahmantyo, dr 298901 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000
12 9-Feb-18 Clement Adlay, An Kartika, dr 119301 Rp 20,000 Rp 125,000
13 9-Feb-18 Shareefa Jehan, An Kartika, dr 669300 Rp 20,000 Rp 125,000
14 9-Feb-18 Giorgio Salvatore, An Kartika, dr 424301 Rp 20,000 Rp 125,000
15 9-Feb-18 Ukhti Fitria, Ny Arum, dr 501801 Rp 25,000 Rp 50,000
16 9-Feb-18 Nadhira Ananta, An Kartika, dr 473901 Rp 20,000 Rp 125,000
17 9-Feb-18 Rayyan Aalif, An Mahe, dr 136101 CANCEL
18 9-Feb-18 Kirana Dyah, Ny Erna, dr 378301 Rp 20,000 Rp 125,000
19 9-Feb-18 Kirana Dyah, Ny Erna, dr 378301 Rp 35,000 Rp 40,000
20 9-Feb-18 Aldrian Pradipta, An Mahe, dr 887100 Rp 20,000 Rp 125,000
21 9-Feb-18 Lisa Andika, Ny Erna, dr 316001 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000
22 9-Feb-18 Keyaan Akhtar, An Mahe, dr 042601 Rp 20,000 Rp 125,000
23 9-Feb-18 Maria Purwantining, Ny Erna, dr 502001 Rp 35,000 Rp 40,000
24 9-Feb-18 Florencia Pauzil, Ny Erna, dr 007700 Rp 35,000 Rp 40,000
25 9-Feb-18 Aretha Nadia, An Kartika, dr 329801 Rp 20,000 Rp 125,000
26 9-Feb-18 Adreena Clemira, An Kartika, dr 485301 Rp 20,000 Rp 125,000
27 9-Feb-18 M Fadgham, An Kartika, dr 364101 Rp 20,000 Rp 125,000
28 9-Feb-18 M Faeyza, An Kartika, dr 044701 Rp 20,000 Rp 125,000

Total

Surabaya, 10 Februari 2018


Penyetor

Nia
Total Keterangan
Rp 145,000 D BCA
Rp 70,000 D Mandiri
Rp 439,000 Admedika ( Mandiri INH)
Rp 75,000 D BCA ( USG 2D )
Rp 150,000 D BCA
Rp 259,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BNI
Rp 145,000 KK BCA
Rp 150,000 D BCA
Rp 220,000 D BCA ( USG 2D )
Rp 145,000 KK Bukopin
Rp 145,000 KK Mega
Rp 145,000 D BCA
Rp 75,000 D Mandiri ( IGD )
Rp 145,000 D BCA
Rp - D BCA
Rp 145,000 D Niaga
Rp 75,000 D Niaga ( USG 2D )
Rp 145,000 D BCA
Rp 220,000 D BNI ( USG 2D )
Rp 145,000 Admedika ( Askrida )
Rp 75,000 D BCA ( USG 2D )
Rp 75,000 D BCA ( USG 2D )
Rp 145,000 Admedika ( FWD )
Rp 145,000 D BCA
Rp 145,000 Admedika ( Sinarmas )
Rp 145,000 Admedika ( Sinarmas )

Rp 4,058,000
Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 9 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 9-Feb-18 Roisatul Mahfudhoh, An Rp 21,100 Rp 21,100
2 9-Feb-18 Navalia Arsyila, An Rp 48,700 Rp 48,700
3 9-Feb-18 Kholifah Alya, An Rp 158,300 Rp 158,300
4 9-Feb-18 dr Rina Rp 21,900 Rp 21,900
5 9-Feb-18 Yuliana, Ny Rp 76,700 Rp 76,700
6 9-Feb-18 Vinnensia Kenanga, An Rp 82,600 Rp 82,600
7 9-Feb-18 Khanza Nafisash, An Rp 291,400 Rp 291,400
8 9-Feb-18 Alkhalifi Parikesit, An Rp 163,200 Rp 163,200
9 9-Feb-18 Naira Azzahra, An Rp 200,500 Rp 200,500
10 9-Feb-18 Vania Natalie, An Rp 595,000 Rp 595,000
11 9-Feb-18 Cantika Aisha, An Rp 187,700 Rp 187,700
12 9-Feb-18 Mimi Rp 5,000 Rp 5,000
13 9-Feb-18 Cantika Aisha, An Rp 3,700 Rp 3,700
14 9-Feb-18 Cantika Aisha, An Rp 3,700 Rp 3,700
15 9-Feb-18 Dian Rp 134,000 Rp 134,000
16 9-Feb-18 Dian Rp 9,600 Rp 9,600
17 9-Feb-18 Elvano Gabriel, An Rp 803,800 Rp 803,800
18 9-Feb-18 Ukhti Fitria, Ny Rp 901,000 Rp 901,000
19 9-Feb-18 Ukhti Fitria, Ny Rp 500 Rp 500
20 9-Feb-18 Syafira Fadighaniyah, An Rp 225,200 Rp 225,200
21 9-Feb-18 Sakuntari Noviana, Ny Rp 428,500 Rp 428,500
22 9-Feb-18 Indriyani Kristina, Ny Rp 171,800 Rp 171,800
23 9-Feb-18 Indriyani Kristina, Ny Rp 22,000 Rp 22,000
24 9-Feb-18 Michelle Annabella, An Rp 155,100 Rp 155,100
25 9-Feb-18 Arjuna Putra, An Rp 23,800 Rp 23,800
26 9-Feb-18 Putri Rachma, Ny Rp 52,000 Rp 52,000
27 9-Feb-18 Aldrian Pradipta, An Rp 23,800 Rp 23,800

Total Rp 4,810,600 Rp 4,810,600

Piutang
No Tanggal Nama Pasien Apotek Total
1 9-Feb-18 Navalia Arsyila, An Rp 90,700 Rp 90,700
2 9-Feb-18 Kiara Azzahra, An Rp 181,500 Rp 181,500
3 9-Feb-18 Vinensia Kenanga, Ny Rp 204,900 Rp 204,900
4 9-Feb-18 Sean Nathaniel, An Rp 262,300 Rp 262,300
5 9-Feb-18 Miya Octavianti, Ny Rp 93,800 Rp 93,800
6 12-Jan-18 Ellen, Ny Rp 220,000 Rp 220,000
7 25-Jan-18 Ellen, Ny Rp 54,200 Rp 54,200
8 9-Feb-18 Vincentius Wilson, An Rp 101,500 Rp 101,500
9 9-Feb-18 Lintang Suska, Ny Rp 113,800 Rp 113,800
10 9-Feb-18 Azhka Kaindra, An Rp 821,000 Rp 821,000
11 9-Feb-18 Caleb Manuel, An Rp 225,200 Rp 225,200
12 9-Feb-18 Caleb Manuel, An Rp 79,500 Rp 79,500
13 9-Feb-18 Giorgio Salvatore, An Rp 82,300 Rp 82,300
14 9-Feb-18 Axton Ivander, An Rp 821,000 Rp 821,000
15 9-Feb-18 Clement Adlay, An Rp 291,400 Rp 291,400
16 9-Feb-18 Vanessa Wang, An Rp 124,000 Rp 124,000
17 9-Feb-18 Lisa Andika, Ny Rp 299,500 Rp 299,500
18 9-Feb-18 Keyaan Akhtar, An Rp 270,400 Rp 270,400
19 9-Feb-18 Shareefa Jehan, An Rp 153,900 Rp 153,900
20 9-Feb-18 Shareefa Jehan, An Rp 21,100 Rp 21,100
21 9-Feb-18 Nadhira Ananta, An Rp 955,700 Rp 955,700
22 9-Feb-18 Maria Purwantining, Ny Rp 617,500 Rp 617,500
23 9-Feb-18 Aretha Nadia, An Rp 626,300 Rp 626,300
24 9-Feb-18 Hilda Nagita, An Rp 595,000 Rp 595,000
25 9-Feb-18 M Fadgham, An Rp 31,000 Rp 31,000
26 9-Feb-18 M Faeyza, An Rp 213,700 Rp 213,700

Total Rp 7,551,200 Rp 7,551,200

Surabaya, 10 Februari 2018


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Laporan Apotek Rawat Jalan
Tanggal 9 Februari 2018

Ket

Ket
D Mandiri
Admedika ( Mandiri INH )
D BCA
D BCA
D Mandiri
KK BNI
KK BNI
D BCA
D BCA
D Mandiri
D BCA
D BCA
D BCA
D BCA
KK Bukopin
D BCA
D BNI
Admedika ( Askrida )
KK Mega
KK Mega
KK BNI
D BCA
Admedika ( FWD )
D Mandiri
Admedika ( Sinarmas )
Admedika ( Sinarmas )
Laporan Rawat Jalan Gigi
Tanggal 09 Februari 2018
Tunai
No Tanggal Nama Pasien No.RM No Operator Poli Jasa Dokter Tindakan Total Keterangan
1 9-Feb-18 William Oentono, An 951200 Prima, dr Rp 20,000 Rp 20,000 tidak ada tindakan
2 9-Feb-18 Rp -
3 9-Feb-18
4 9-Feb-18
5 9-Feb-18
6 9-Feb-18

Total Rp 20,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 9-Feb-18 Rp -
2 9-Feb-18 Rp -
3 9-Feb-18 Rp -

Total

Surabaya, 10 Februari 2018

Penyetor Mengetahui,
Penerima

Nia
Rini Wahyuningati
Laporan Therapy Kebugaran & Pijat Bayi
Tanggal 09 Januari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 9-Feb-18 An. Gauri Rp 60,000 Rp 60,000 1212
2 9-Feb-18 Rp -
3 9-Feb-18 Rp -

Total Rp 60,000 Rp 60,000

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 27-Nov-17 Bu Ellen Rp 150,000 Rp 150,000 KK BNI ( 1135)
2 9-Feb-18 An Feryal Rp 100,000 Rp 100,000 KK BCA ( 1213 )

Total Rp 250,000 Rp 250,000

Surabaya, 10 Februari 2018


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Laporan Rawat Jalan
Tanggal 10 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 5-Feb-18 I Nyoman Krisna, An Diana, dr 475301 Rp 40,000 Rp 40,000
2 10-Feb-18 Muhammad Hisyam, An Dini, dr 221701 Rp 20,000 Rp 125,000 Rp 145,000
3 10-Feb-18 Rizki Mardalita, Ny Eighty, dr 191701 CANCEL Rp -
4 10-Feb-18 Emily Rachelle, An Dini, dr 236001 Rp 20,000 Rp 125,000 Rp 145,000
5 10-Feb-18 Sora Nadhirah, Ny Eighty, dr 462801 Rp 20,000 Rp 125,000 Rp 145,000
6 10-Feb-18 Tokio Tanaka, An Dini, dr 422001 Rp 20,000 Rp 125,000 Rp 145,000
7 10-Feb-18 Ellen Kartika, Ny Agung, dr 502101 Rp 25,000 Rp 125,000 Rp 150,000
8 10-Feb-18 Muhammad Ibrahim, An Dini, dr 377401 Rp 20,000 FREE Rp 20,000
9 10-Feb-18 Astrid Oktavia, Ny Agung, dr 502201 Rp 25,000 Rp 325,000 Rp 375,000 Rp 725,000
10 10-Feb-18 Giandra Una, An Dini, dr 468001 Rp 20,000 Rp 125,000 Rp 145,000
11 10-Feb-18 Ellen Kartika, Ny Agung, dr 502101 Rp 35,000 Rp 40,000 Rp 75,000
12 10-Feb-18 Aisyah Rusyd, Ny Erna, dr 502301 Rp 25,000 FREE Rp 25,000
13 10-Feb-18 Aulia Shila, An Kartika, dr 502401 Rp 25,000 Rp 125,000 Rp 150,000
14 10-Feb-18 Diah Niken, Ny Eighty, dr 502701 Rp 25,000 Rp 125,000 Rp 150,000
15 10-Feb-18 Ratna Mutiara, Ny Erna, dr 502601 Rp 25,000 FREE Rp 25,000
16 10-Feb-18 Kinanthi Widyadhari, Ny Erna, dr 109301 Rp 20,000 Rp 125,000 Rp 145,000
17 10-Feb-18 Safiyya Annasya, An Kartika, dr 725000 Rp 20,000 Rp 125,000 Rp 145,000
18 10-Feb-18 Clif Felix, An Dini, dr 427801 Rp 20,000 Rp 125,000 Rp 145,000
19 10-Feb-18 Claire Abigail, An Dini, dr 404201 CANCEL Rp -
20 10-Feb-18 Ainaya Khairunnisa, An Kartika, dr 503001 Rp 25,000 Rp 125,000 Rp 150,000
21 10-Feb-18 Muhammad Alfatih, An Kartika, dr 662100 Rp 20,000 Rp 125,000 Rp 145,000
22 10-Feb-18 Maria Annabella, An Kartika, dr 450401 Rp 20,000 Rp 125,000 Rp 145,000
23 10-Feb-18 Juwita Raudlatul, An Eighty, dr 342200 Rp 20,000 FREE Rp 20,000
24 10-Feb-18 Kinanthi Widyadhari, Ny Erna, dr 109301 Rp 35,000 Rp 40,000 Rp 75,000
25 10-Feb-18 Juwita Raudlatul, An Eighty, dr 342200 Rp 35,000 Rp 40,000 Rp 75,000
26 10-Feb-18 Ratna Mutiara, Ny Erna, dr 502501 Rp 35,000 Rp 40,000 Rp 75,000
27 10-Feb-18 Ammar Pandu, An Kartika, dr 623800 Rp 20,000 Rp 125,000 Rp 145,000
28 10-Feb-18 Shofia Muhyia, An Kartika, dr 795400 Rp 20,000 Rp 125,000 Rp 145,000
29 10-Feb-18 Kikandrya Anindya, An Kartika, dr 211800 Rp 20,000 Rp 125,000 Rp 145,000
30 10-Feb-18 Chloe Evangeline, An KARtika, dr 451601 Rp 75,000 Rp 75,000
31 10-Feb-18 Raisa Kamila, An Mahe, dr 259701 Rp 20,000 Rp 125,000 Rp 145,000
32 10-Feb-18 Jamila Sidik, Ny Erna, dr 412701 Rp 20,000 Rp 125,000 Rp 145,000
33 10-Feb-18 Fransisca Warastuti, Ny Erna, dr 503101 Rp 25,000 FREE Rp 35,000 Rp 40,000 Rp 100,000
34 10-Feb-18 Mega Dewi, Ny Erna, dr 857900 FREE FREE Rp -
35 10-Feb-18 Rahmad Cakra, An Mahe, dr 412301 Rp 20,000 Rp 125,000 Rp 145,000
36 10-Feb-18 Siska, Ny Erna, dr 036200 Rp 20,000 Rp 125,000 Rp 100,000 Rp 245,000
37 10-Feb-18 Jamila Sidik, Ny Erna, dr 412701 Rp 40,000 Rp 60,000 Rp 100,000
38 10-Feb-18 Maverick Ivander, AN Mahe, dr 474001 Rp 20,000 Rp 125,000 Rp 145,000
39 10-Feb-18 Almira Naura, An Sufiandika, dr 503401 Rp 25,000 Rp 50,000 Rp 75,000
40 10-Feb-18 Angela Henrich, Ny Kartika, dr 484300 Rp 20,000 Rp 150,000 Rp 50,000 Rp 220,000
41 10-Feb-18 Arzaquna Damario, An Kartika, dr 496501 Rp 20,000 Rp 125,000 Rp 145,000
42 10-Feb-18 Retno Larasati, ny Erna, dr 503601 Rp 25,000 Rp 125,000 Rp 150,000
43 10-Feb-18 Cheryllene Tjoa, An Dini, dr 489901 Rp 20,000 Rp 125,000 Rp 145,000
44 10-Feb-18 Cailynlene Tjoa, An Dini, dr 490001 Rp 20,000 Rp 125,000 Rp 145,000
45 10-Feb-18 Sheeva Artemia, An Dini, dr 298601 Rp 20,000 Rp 125,000 Rp 145,000
46 10-Feb-18 Shankara Timur, An Dini, dr 193901 Rp 20,000 Rp 125,000 Rp 145,000
47 10-Feb-18 Keysha Indira, An Mahe, dr 884700 Rp 20,000 Rp 125,000 Rp 145,000
48 10-Feb-18 Gabriella Olivia, An Mahe, dr 373001 Rp 20,000 Rp 125,000 Rp 145,000
49 10-Feb-18 Agha Abrisam, An Dini, dr 160501 Rp 20,000 Rp 125,000 Rp 145,000
50 10-Feb-18 Kellandra Atallah, An Mahe, dr 495801 Rp 20,000 Rp 125,000 Rp 145,000
51 10-Feb-18 Nathania Earline, An Mahe, dr 438301 Rp 20,000 Rp 125,000 Rp 145,000
52 10-Feb-18 Rafee Bagas, An Mahe, dr 503801 Rp 25,000 Rp 125,000 Rp 150,000
53 10-Feb-18 Alexander Oliver, An Mahe, dr 949700 Rp 20,000 Rp 125,000 Rp 145,000

Total Rp 6,930,000

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 10-Feb-18 Darendra Mercyano, An Dini, dr 969300 Rp 20,000Rp 125,000 Rp 145,000
2 10-Feb-18 Clarrance Azarious, An Dini, dr 491601 Rp 20,000Rp 125,000 Rp 145,000
3 10-Feb-18 Clarissa Achiera, An Dini, dr 491701 Rp 20,000Rp 125,000 Rp 145,000
4 10-Feb-18 RR Ryma, Ny Agung, dr 269600 Rp 20,000Rp 125,000 Rp 145,000
5 10-Feb-18 Vincentius Evano, An Kartika, dr 405501 Rp 20,000Rp 125,000 Rp 145,000
6 10-Feb-18 RR Ryma, Ny Agung, dr 269600 Rp 35,000 Rp 40,000 Rp 75,000
7 10-Feb-18 Chloe Evangeline, An KARtika, dr 451601 Rp 20,000 Rp 125,000 Rp 145,000
8 10-Feb-18 Nur Afidah, Ny Eighty, dr 502901 Rp 25,000 Rp 125,000 Rp 150,000
9 10-Feb-18 Wayne Edreenson, An Kartika, dr 441701 Rp 20,000 Rp 125,000 Rp 145,000
10 10-Feb-18 Talitha Nusaybah, An Kartika, dr 523100 Rp 20,000 Rp 125,000 Rp 145,000
11 10-Feb-18 Meryantina Alfani, Ny Erna, dr 324601 Rp 20,000 Rp 325,000 Rp 375,000 Rp 720,000
12 10-Feb-18 Dina Indriana, Ny Eighty, dr 502801 Rp 25,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 225,000
13 10-Feb-18 Aisyah Rusyd, Ny Erna, dr 502301 Rp 35,000 Rp 40,000 Rp 75,000
14 10-Feb-18 Pradipa Semesta, An Dini, dr 382101 Rp 20,000 FREE Rp 20,000
15 10-Feb-18 Novi Setiowati, Ny Erna, dr 288600 Rp 20,000 Rp 125,000 Rp 145,000
16 10-Feb-18 Kairos Henry, An Kartika, dr 487100 Rp 20,000 Rp 125,000 Rp 145,000
17 10-Feb-18 Arlan Syzdykov, An Dini, dr 466501 Rp 20,000 Rp 125,000 Rp 145,000
18 10-Feb-18 Ghani Aderra, An Kartika, dr 449201 Rp 20,000 Rp 125,000 Rp 145,000
19 10-Feb-18 Kalila Shaqueena, An Kartika, dr 050901 Rp 20,000 Rp 125,000 Rp 145,000
20 10-Feb-18 Talita Shaqueena, An Kartika, dr 051001 Rp 20,000 Rp 125,000 Rp 145,000
21 10-Feb-18 Kairos Henry, An Kartika, dr 487100 Rp 592,000 Rp 592,000
22 10-Feb-18 Wenny Mareta, Ny Erna, dr 296501 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
23 10-Feb-18 Phylicia, Ny Erna, dr 019501 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
24 10-Feb-18 Novi Setiowati, Ny Erna, dr 288600 Rp 35,000 Rp 40,000 Rp 75,000
25 10-Feb-18 Andaru Rasyid, An Kartika, dr 503201 Rp 25,000 Rp 125,000 Rp 150,000
26 10-Feb-18 Retno Larasati, ny Erna, dr 503601 Rp 40,000 Rp 60,000 Rp 100,000
27 10-Feb-18 Muhammad Arshad, An Kartika, dr 421401 Rp 20,000 Rp 125,000 Rp 145,000
28 10-Feb-18 Gibran Faiq, An Dini, dr 086001 Rp 20,000 Rp 125,000 Rp 75,000 Rp 220,000
29 10-Feb-18 Aghsa Maulana, An Mahe, dr 448001 Rp 20,000 Rp 125,000 Rp 145,000
30 10-Feb-18 Arlan Syzdykov, An Dini, dr 466501 Rp 824,000 Rp 824,000
31 10-Feb-18 Salma Uwais, An Mahe, dr 446401 Rp 20,000 Rp 125,000 Rp 145,000
32 10-Feb-18 Achmad Rayyanka, An Dini, dr 489701 Rp 20,000 Rp 125,000 Rp 145,000
33 10-Feb-18 Narendra Satrya, An Dini, dr 153601 Rp 20,000 Rp 125,000 Rp 145,000
34 10-Feb-18 Narayana Satrya, An Dini, dr 153701 Rp 20,000 Rp 125,000 Rp 145,000
35 10-Feb-18 Matthew Caddington, An Dini, dr 315301 Rp 20,000 Rp 125,000 Rp 145,000
36 10-Feb-18 Ruby Abiwara, An Mahe, dr 026801 Rp 20,000 Rp 125,000 Rp 145,000
37 10-Feb-18 Samuel Oliver, An Mahe, dr 382401 Rp 20,000 Rp 125,000 Rp 145,000
38 10-Feb-18 Daviano Arya, An Mahe, dr 593700 Rp 20,000 FREE Rp 20,000
39 10-Feb-18 Giorgio Salvatore, An Mahe, dr 424301 Rp 20,000 Rp 125,000 Rp 145,000
40 10-Feb-18 Clairine Nathania, An Mahe, dr 260701 Rp 20,000 Rp 125,000 Rp 145,000
41 10-Feb-18 Grace Elita, An Mahe, dr 195301 Rp 20,000 Rp 125,000 Rp 145,000
42 10-Feb-18 Peince Xaverio, An Mahe, dr 496301 Rp 20,000 Rp 125,000 Rp 145,000
43 10-Feb-18 Mikael Zheinwaltz, An Mahe, dr 503701 Rp 25,000 Rp 125,000 Rp 150,000
44 10-Feb-18 Calia Anadia, An Mahe, dr 417801 Rp 20,000 Rp 125,000 Rp 145,000
Total Rp 7,896,000

Surabaya, 11 Februari 2017


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Jalan
ari 2018

Keterangan

Total
RJ Rp 6,930,000
ARJ Rp 6,201,600
Rp 13,131,600
P Rp -
Rp 13,131,600
USG 4D RJG Rp 450,000
Rp 13,581,600
USG 2D BS RI Rp (136,400) a/n Ny Eris
Rp 13,445,200
TB Rp 75,000 Viniy, An
Rp 13,520,200
BS RJ Rp (125,000) Daviano Arya, An
Rp 13,395,200
Px byr Rp 49,100 Gibran Faiq, An
Rp 13,444,300

USG 2D
USG 2D
USG 2D

Nebul
USG 2D
FREE Karyawan

Gynec
TVS

NST, BY Phone

Keterangan
D BCA
D BCA
D BCA
D BRI
D BCA
D BRI ( USG 2D )
D BCA
D BNI
D BCA
D BRI ( USG 2D )
KK BCA ( USG 4D )
Admedika ( Medicilin )
D BNI
D BRI
D BCA
D BCA
D BCA
KK BCA
KK BCA
KK BCA
D BCA
D BCA (USG 2D)
D BCA ( USG 2D )
D BCA ( USG 2D )
D BCA
D BRI ( TVS )
Admedika ( Pertamina )
Admedika ( INH )
D BCA
D BCA
D Mandiri
D BCA
D Mandiri
D Mandiri
KK Bukopin
D BCA
D BCA
KK BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 10 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 10-Feb-18 Dian Rp 12,000 Rp 12,000
2 10-Feb-18 Clif Felix, An Rp 595,000 Rp 595,000
3 10-Feb-18 Maria Annabella, An Rp 112,300 Rp 112,300
4 10-Feb-18 Juwita Raudlatul, An Rp 106,700 Rp 106,700
5 10-Feb-18 Vincentius Evano, An Rp 68,500 Rp 68,500
6 10-Feb-18 Kikandrya Anindya, An Rp 52,900 Rp 52,900
7 10-Feb-18 Darendra Mercyano, An Rp 101,500 Rp 101,500
8 10-Feb-18 Chloe Evangeline, An Rp 82,300 Rp 82,300
9 10-Feb-18 Chloe Evangeline, An Rp 36,300 Rp 36,300
10 10-Feb-18 Ainaya Khairunnisa, An Rp 79,500 Rp 79,500
11 10-Feb-18 Ainaya Khairunnisa, An Rp 821,000 Rp 821,000
12 10-Feb-18 Muhammad Alfatih, An Rp 224,000 Rp 224,000
13 10-Feb-18 Dr Ifa Rp 39,500 Rp 39,500
14 10-Feb-18 Ibrahim Rp 70,100 Rp 70,100
15 10-Feb-18 Ammar Pandu, An Rp 332,600 Rp 332,600
16 10-Feb-18 Siska, Ny Rp 7,300 Rp 7,300
17 10-Feb-18 Almira Naura, An Rp 33,000 Rp 33,000
18 10-Feb-18 Malva Rp 89,000 Rp 89,000
19 10-Feb-18 Achmad Rayyanka, AN Rp 39,600 Rp 39,600
20 10-Feb-18 Kairos Henry, An Rp 49,000 Rp 49,000
21 10-Feb-18 Muhammad Ibrahim, An Rp 1,185,400 Rp 1,185,400
22 10-Feb-18 Giandra Una, An Rp 112,300 Rp 112,300
23 10-Feb-18 Sheeva Artemia, An Rp 821,000 Rp 821,000
24 10-Feb-18 Agha Abrisam, An Rp 148,000 Rp 148,000
25 10-Feb-18 Agha Abrisam, An Rp 26,300 Rp 26,300
26 10-Feb-18 Keysha Indira, An Rp 124,700 Rp 124,700
27 10-Feb-18 Maverick Ivander, AN Rp 112,300 Rp 112,300
28 10-Feb-18 Gabriella Olivia, An Rp 386,900 Rp 386,900
29 10-Feb-18 Salma Uwais, An Rp 112,300 Rp 112,300
30 10-Feb-18 Daviano Arya, An Rp 51,500 Rp 51,500
31 10-Feb-18 Nathania Earline, An Rp 112,300 Rp 112,300
32 10-Feb-18 Alexander Oliver, An Rp 15,200 Rp 15,200
33 10-Feb-18 Rafee Bagas, An Rp 41,300 Rp 41,300

Total Rp 6,201,600 Rp 6,201,600

Piutang
No Tanggal Nama Pasien Apotek Total
1 10-Feb-18 RR Ryma, Ny Rp 131,300 Rp 131,300
2 10-Feb-18 Diah Niken, Ny Rp 351,000 Rp 351,000
3 10-Feb-18 Dina Indriana, Ny Rp 518,500 Rp 518,500
4 10-Feb-18 Wayne Edreenson, An Rp 119,700 Rp 119,700
5 10-Feb-18 Talitha Nusaybah, An Rp 291,400 Rp 291,400
6 10-Feb-18 Aisyah Rusyd, Ny Rp 200,500 Rp 200,500
7 10-Feb-18 Aisyah Rusyd, Ny Rp 4,000 Rp 4,000
8 10-Feb-18 Pradipa Semesta, An Rp 821,000 Rp 821,000
9 10-Feb-18 Ghani Aderra, An Rp 112,300 Rp 112,300
10 10-Feb-18 Safiyya Annasya, An Rp 507,200 Rp 507,200
11 10-Feb-18 Sylvy Medtasya, Ny Rp 27,600 Rp 27,600
12 10-Feb-18 Clarrance Azarious, An Rp 112,300 Rp 112,300
13 10-Feb-18 Clarissa Achiera, An Rp 112,300 Rp 112,300
14 10-Feb-18 Kairos Henry, An Rp 247,000 Rp 247,000
15 10-Feb-18 Mega Dewi, Ny Rp 186,000 Rp 186,000
16 10-Feb-18 Novi Setiowati, Ny Rp 563,500 Rp 563,500
17 10-Feb-18 Wenny Mareta, Ny Rp 299,500 Rp 299,500
18 10-Feb-18 Andaru Rasyid, An Rp 112,300 Rp 112,300
19 10-Feb-18 Andaru Rasyid, An Rp 128,000 Rp 128,000
20 10-Feb-18 Emily Rachel, An Rp 548,800 Rp 548,800
21 10-Feb-18 Talita Shaqueena, An Rp 507,200 Rp 507,200
22 10-Feb-18 Talita Shaqueena, An Rp 309,400 Rp 309,400
23 10-Feb-18 Kalila Shaqueena, An Rp 507,200 Rp 507,200
24 10-Feb-18 Muhammad Hisyam, An Rp 548,800 Rp 548,800
25 10-Feb-18 Retno Larasati, ny Rp 254,500 Rp 254,500
26 10-Feb-18 Tokio Tanaka, An Rp 785,100 Rp 785,100
27 10-Feb-18 Tokio Tanaka, An Rp 105,600 Rp 105,600
28 10-Feb-18 Muhammad Arshad, An Rp 28,900 Rp 28,900
29 10-Feb-18 Muhammad Arshad, An Rp 595,000 Rp 595,000
30 10-Feb-18 Gibran Faiq, An Rp 66,700 Rp 66,700
31 10-Feb-18 Gibran Faiq, An Rp 204,000 Rp 204,000
32 10-Feb-18 Arlan Syzdykov, An Rp 119,700 Rp 119,700
33 10-Feb-18 Arlan Syzdykov, An Rp 56,800 Rp 56,800
34 10-Feb-18 Aghsa Maulana, An Rp 112,300 Rp 112,300
35 10-Feb-18 Matthew Caddington, An Rp 821,000 Rp 821,000
36 10-Feb-18 Ruby Abiwara, An Rp 531,600 Rp 531,600
37 10-Feb-18 Kellandra Atallah, An Rp 261,500 Rp 261,500
38 10-Feb-18 Kellandra Atallah, An Rp 279,000 Rp 279,000
39 10-Feb-18 Raisa Kamila, An Rp 924,400 Rp 924,400
40 10-Feb-18 Clairine Nathania, An Rp 924,400 Rp 924,400
41 10-Feb-18 Silvi Labibah, Nn Rp 61,900 Rp 61,900
42 10-Feb-18 Rahmad Cakra, An Rp 225,200 Rp 225,200
43 10-Feb-18 Rahmad Cakra, An Rp 28,900 Rp 28,900
44 10-Feb-18 Giorgio Salvatore, An Rp 112,300 Rp 112,300
45 10-Feb-18 Mikael Zheinwaltz, An Rp 198,700 Rp 198,700

Total Rp 13,964,300 Rp 13,964,300

Surabaya, 11 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Laporan Apotek Rawat Jalan
Tanggal 10 Februari 2018

Ket

Ket
D BRI
D BCA
Admedika ( Medicilin )
D BCA
D BRI
D BNI
D BNI
D BRI
KK BCA
D BCA
Piutang Karyawan
D BCA
D BCA
D BCA
D Mandiri
D BCA
D BCA
D BCA
D BCA
D BCA
KK BNI
KK BNI
KK BNI
D BNI
D BRI
KK BCA
D BCA
Admedika ( Pertamina )
Admedika ( Pertamina )
Admedika ( INH )
Admedika ( INH )
D BCA
D BCA
D BCA
KK Bukopin
D BCA
D BTN
D BTN
D Mandiri
D BCA
D BCA
D BNI
D BNI
D BCA
D BCA
Laporan Therapy Kebugaran & Pijat Bayi
Tanggal 10 Februari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 10-Feb-18 Rp -
2 10-Feb-18 Rp -

Total Rp - Rp -

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 10-Feb-18 Mattew, An Rp 400,000 Rp 400,000 D BCA
2 10-Feb-18 Rp -

Total Rp 400,000 Rp 400,000

Surabaya, 11 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 10 Februari 2018
Tunai
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 10-Feb-18 Aulia Shila, An 502401 Prima, dr Rp 450,000 Rp 450,000
2 10-Feb-18 Rp -

Total Rp 450,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 10-Feb-18 Zalzabila Aulia, An 355400 Prima, dr Rp 20,000 Rp 300,000 Rp 320,000 Admedika ( PGN )
2 10-Feb-18 Angga Indraswara, Tn 925400 Nadia, dr Rp 20,000 Rp 190,000 Rp 210,000 D Mandiri ( Disc 5% )
3 10-Feb-18 Silvi Labibah, Nn 490801 Nining, dr Rp 20,000 Rp 200,000 Rp 220,000 D BCA
4 10-Feb-18 Iswahyuningsih, Ny 490901 Nining, dr Rp 20,000 Rp 700,000 Rp 720,000 D BCA

Total Rp 1,470,000

Surabaya, 11 Februari 2018

Penyetor Mengetahui,
Penerima

Ika
Rini Wahyuningati
Laporan Rawat Jalan
Tanggal 11 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 11-Feb-18 Kanaya Antari, An Ema, dr 727400 Rp 20,000 Rp 125,000 Rp 145,000
2 11-Feb-18 Shareefa Jehan, An Ema, dr 669300 Rp 20,000 Rp 125,000 Rp 145,000
3 11-Feb-18 Fadhilah Mauza, An Atika, dr 504301 Rp 25,000 Rp 50,000 Rp 75,000
4 11-Feb-18 Ananda Raffasya, An Ema, dr 504401 Rp 25,000 Rp 125,000 Rp 150,000
5 11-Feb-18 Allenendra Deara, An Ema, dr 824400 Rp 20,000 Rp 125,000 Rp 145,000
6 11-Feb-18 Ashley Megan, An Atika, dr 674000 Rp 20,000 Rp 50,000 Rp 70,000
7 11-Feb-18 Atika, dr Rp 20,000 Rp 50,000 Rp 150,000 Rp 220,000
R Dina Hernita, Ny 194701
8 11-Feb-18 Erna, dr Rp 50,000 Rp 50,000
9 11-Feb-18 Fattan Naufal, An Atika, dr 983000 Rp 20,000 Rp 50,000 Rp 70,000

Total Rp 1,070,000

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 10-Feb-18 Ghaitsa Farhana, An Eka, dr 997100 Rp 20,000 Rp 50,000 Rp 70,000
2 11-Feb-18 Ahmad Nasrullah, An Ema, dr 504501 Rp 25,000 Rp 125,000 Rp 150,000
3 11-Feb-18 Aryasatya Ranu, An Ema, dr 262501 Rp 20,000 Rp 125,000 Rp 145,000
4 11-Feb-18 Anindita Zhafira, An Ema, dr 327901 Rp 20,000 Rp 125,000 Rp 145,000
5 11-Feb-18 Zahran Rafif, An Ema, dr 635700 Rp 20,000 Rp 125,000 Rp 145,000
6 11-Feb-18 Kanaya Antari, An Atika, dr 727400 Rp 50,000 Rp 50,000
7 11-Feb-18 Shareefa Jehan, An Ema, dr 669300 Rp 369,000 Rp 369,000
8 11-Feb-18 Muhammad Alfareza, An Ema, dr 209501 Rp 20,000 Rp 125,000 Rp 145,000

Total Rp 1,219,000

Surabaya, 12 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


alan
2018

Keterangan

IGD
TOTAL
RJ Rp 1,070,000
IGD ARJ Rp 1,130,000
IGD, NST Rp 2,200,000
Konsul By Phone Px Byr dtm Rp 122,100 a/n M. Alfareza
IGD Rp 2,322,100

Keterangan
D Mandiri
KK BCA
D BRI
D BRI
D BANK JATIM
D BANK JATIM ( IGD )
KK MEGA
Admedika ( FWD )

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 11 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total Ket
1 10-Feb-18 Evi Rahmawati Rp 37,800 Rp 37,800
2 11-Feb-18 Fadhilah Mauza, An Rp 185,600 Rp 185,600
3 11-Feb-18 Ananda Raffasya, An Rp 290,800 Rp 290,800
4 11-Feb-18 Shareefa Jehan, An Rp 290,300 Rp 290,300
5 11-Feb-18 Dr Nur Rochmah Rp 72,100 Rp 72,100
6 11-Feb-18 Arya Kemalsjah, An Rp 6,000 Rp 6,000
7 10-Feb-18 Nur Rochmawati Rp 5,300 Rp 5,300 Karyawan
8 11-Feb-18 Ashley Megan, An Rp 25,000 Rp 25,000
9 11-Feb-18 Fattan Naufal, An Rp 154,300 Rp 154,300
10 11-Feb-18 Fattan Naufal, An Rp 62,800 Rp 62,800

Total Rp 1,130,000 Rp 1,130,000

Piutang
No Tanggal Nama Pasien Apotek Total Ket
1 10-Feb-18 Ghaitsa Farhana, An Rp 253,900 Rp 253,900 D Mandiri
2 11-Feb-18 Kanaya Antari, An Rp 225,200 Rp 225,200 D BANK JATIM
3 11-Feb-18 Kanaya Antari, An Rp 60,400 Rp 60,400 D BANK JATIM
4 11-Feb-18 Zahran Rafif, An Rp 225,200 Rp 225,200 D BANK JATIM
5 11-Feb-18 Ahmad Nasrullah, An Rp 30,500 Rp 30,500 D BCA
6 11-Feb-18 Anindita Zhafira, An Rp 225,200 Rp 225,200 D BRI
7 11-Feb-18 Zahran Rafif, An Rp 548,800 Rp 548,800 D BRI
8 11-Feb-18 Muhammad Alfareza, An Rp 1,076,000 Rp 1,076,000 Admedika ( FWD )
9 11-Feb-18 Allenendra Deara, An Rp 225,200 Rp 225,200 D Mandiri

Total Rp 2,870,400 Rp 2,870,400

Surabaya, 12 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 11-Feb-18 Vania Meliana, An Yusuf, dr 952300 Rp 20,000 Rp 50,000 Rp 70,000
2 12-Feb-18 Arum, dr 504901 Rp 25,000 Rp 50,000 Rp 50,000 Rp 125,000
Renate Gita, Ny
3 12-Feb-18 Poedjo, dr 504901 Rp 50,000 Rp 50,000
4 12-Feb-18 Gavin Alfarizki, An Diana, dr 717700 Rp 20,000 Rp 125,000 Rp 145,000
5 12-Feb-18 Sebastian Ethan, An Diana, dr 495800 Rp 20,000 Rp 125,000 Rp 145,000
6 12-Feb-18 Silvia Ladova, An Diana, dr 639500 Rp 20,000 Rp 125,000 Rp 145,000
7 12-Feb-18 Salsabila Qurrotu, An Diana, dr 503301 Rp 20,000 Rp 125,000 Rp 145,000
8 12-Feb-18 Felisa Pribadi, An Diana, dr 457801 Rp 20,000 Rp 125,000 Rp 145,000
9 12-Feb-18 Akhtar Arsyad, An Diana, dr 389400 Rp 20,000 Rp 125,000 Rp 145,000
10 12-Feb-18 Ahmad Harya, An Diana, dr 035401 Rp 20,000 Rp 125,000 Rp 145,000
11 12-Feb-18 Novi Zakiyah, Ny Dhini, dr 425300 Rp 20,000 Rp 125,000 Rp 145,000
12 12-Feb-18 Uwais El, An Diana, dr 505101 Rp 25,000 Rp 125,000 Rp 150,000
13 12-Feb-18 Stefanie Elovii, An Diana, dr 348600 Rp 20,000 Rp 125,000 Rp 145,000
14 12-Feb-18 Euodia Kerenhappuch, An Arum, dr 622400 Rp 20,000 Rp 50,000 Rp 75,000 Rp 145,000
15 12-Feb-18 Symphony Kirana, An Diana, dr 484001 Rp 20,000 Rp 125,000 Rp 145,000
16 12-Feb-18 Novi Zakiyah, Ny Dhini, dr 425300 Rp 35,000 Rp 40,000 Rp 75,000
17 12-Feb-18 Kimberly Bellvania, AN Diana, dr 345101 Rp 20,000 Rp 125,000 Rp 145,000
18 12-Feb-18 Amani Syarahil, Ny Eighty, dr 505401 Rp 25,000 FREE Rp 25,000
19 12-Feb-18 Melvin Regan, An Diana, dr 250201 Rp 20,000 Rp 125,000 Rp 145,000
20 12-Feb-18 Auliya Ika, Ny Eighty, dr 505501 Rp 25,000 Rp 125,000 Rp 150,000
21 12-Feb-18 Irfaatul Izza, An Diana, dr 505001 Rp 597,000 Rp 597,000
22 12-Feb-18 Putri Rachma, Ny Eighty, dr 501901 Rp 20,000 Rp 125,000 Rp 145,000
23 12-Feb-18 Atharizz Aisy, An Diana, dr 522400 Rp 20,000 Rp 125,000 Rp 145,000
24 12-Feb-18 Raka Arfareqzi, An Diana, dr 560100 Rp 20,000 Rp 125,000 Rp 145,000
25 12-Feb-18 Chelsea Adelia, An Diana, dr 273901 Rp 20,000 Rp 125,000 Rp 145,000
26 12-Feb-18 Putri Rachma, Ny Eighty, dr 501901 Rp 35,000 Rp 40,000 Rp 75,000
27 12-Feb-18 Ananda Febri, An Eka, dr 505801 Rp 25,000 Rp 50,000 Rp 75,000 Rp 150,000
28 12-Feb-18 Angela Heinrich, Ny Benediktus, dr 484300 Rp 20,000 Rp 150,000 Rp 50,000 Rp 220,000
29 12-Feb-18 Sarfaraz Zafran, An Eka, dr 955200 Rp 20,000 Rp 50,000 Rp 70,000

Total Rp 4,222,000
Surabaya, 13 Februari 2018
Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Keterangan
D BCA ( IGD )
D Permata ( IGD, Injeksi )
D Permata ( By Phone 1x )
D Mandiri
D BCA
D BCA
D BCA
D BCA
Admedika ( INH )
D Mandiri
D BNI
D BNI
D BCA
D BCA ( IGD, Nebul )
Admedika ( Sinarmas )
D BNI ( USG 2D )
D BCA
D BCA
D BCA
D MAndiri
D Mandiri
D Mandiri
D BCA
D BCA
D BCA
D Mandiri ( USG 2D
D BCA ( Nebul )
D Mandiri ( NST, By Phone )
D Mandiri ( IGD )
Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 12 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total Ket
1 11-Feb-18 Hedwig Olivia, An Rp 44,700 Rp 44,700
2 11-Feb-18 Abimanyu Arya, An Rp 157,200 Rp 157,200
3 11-Feb-18 Qisya, An Rp 128,700 Rp 128,700
4 11-Feb-18 Ivony Susanto, Ny Rp 68,700 Rp 68,700
5 11-Feb-18 Ivony Susanto, Ny Rp 137,400 Rp 137,400
6 12-Feb-18 Dzulkarnain Dwi, An Rp 75,700 Rp 75,700
7 12-Feb-18 Jevan Alvaro, An Rp 75,700 Rp 75,700
8 12-Feb-18 Dzulkarnain Dwi, An Rp 133,400 Rp 133,400
9 12-Feb-18 Devi Ananta, Ny Rp 155,500 Rp 155,500
10 12-Feb-18 Chintia Kartika, Ny Rp 901,000 Rp 901,000
11 12-Feb-18 Akhtar Arsyad, An Rp 58,000 Rp 58,000
12 12-Feb-18 Clifford Louixander, An Rp 175,100 Rp 175,100
13 12-Feb-18 Symphony Kirana, An Rp 99,200 Rp 99,200
14 12-Feb-18 Yenny Rp 204,000 Rp 204,000
15 12-Feb-18 Euodia Kerenhappuch, An Rp 49,200 Rp 49,200
16 12-Feb-18 Sherly Yunita Rp 147,600 Rp 147,600
17 12-Feb-18 Daveon Rp 5,000 Rp 5,000
18 12-Feb-18 Daveon Rp 82,800 Rp 82,800
19 12-Feb-18 Euodia Kerenhappuch, An Rp 19,800 Rp 19,800
20 12-Feb-18 Irfaatul Izza, An Rp 181,300 Rp 181,300
21 12-Feb-18 Uwais El, An Rp 192,200 Rp 192,200
22 12-Feb-18 Alshameyzea Nabila, An Rp 821,000 Rp 821,000
23 12-Feb-18 Siska, Ny Rp 7,300 Rp 7,300
24 12-Feb-18 Cheryl Poernomo, An Rp 118,700 Rp 118,700
25 12-Feb-18 Auliya Ika, Ny Rp 140,500 Rp 140,500
26 12-Feb-18 Siska, Ny Rp 134,500 Rp 134,500

Total Rp 4,314,200 Rp 4,314,200

Piutang
No Tanggal Nama Pasien Apotek Total Ket
1 11-Feb-18 Vania Meliana, An Rp 23,600 Rp 23,600 D BCA
2 11-Feb-18 Silvi Margaretna, Nn Rp 40,100 Rp 40,100 Piutang Karyawan
3 10-Feb-18 Arzaquna Damario, An Rp 4,200 Rp 4,200 Px blm byr Nb: Poli Kelolosan
4 12-Feb-18 Sheta Fildzah, Ny Rp 58,500 Rp 58,500 Piutang Karyawan
5 12-Feb-18 Renate Gita, Ny Rp 253,400 Rp 253,400 D Permata
6 12-Feb-18 Faye Daniela, An Rp 1,410,600 Rp 1,410,600 D Niaga
7 12-Feb-18 Gavin Alfarizki, An Rp 104,900 Rp 104,900 D Mandiri
8 12-Feb-18 Akhtar Arsyad, An Rp 32,500 Rp 32,500 Admedika ( INH )
9 12-Feb-18 Rayna Ogechi, An Rp 595,000 Rp 595,000 D BCA
10 12-Feb-18 Salsabila Qurrotu, An Rp 143,800 Rp 143,800 D BCA
11 12-Feb-18 Ahmad Harya, An Rp 209,700 Rp 209,700 D Mandiri
12 12-Feb-18 Sebastian Ethan, An Rp 200,900 Rp 200,900 D BCA
13 12-Feb-18 Sebastian Ethan, An Rp 111,000 Rp 111,000 D BCA
14 12-Feb-18 Euodia Kerenhappuch, An Rp 114,500 Rp 114,500 D BCA
15 12-Feb-18 Novi Zakiyah, Ny Rp 191,300 Rp 191,300 D BNI
16 12-Feb-18 Kimberly Bellvania, AN Rp 595,000 Rp 595,000 D BCA
17 12-Feb-18 Melvin Regan, An Rp 785,100 Rp 785,100 D BCA
18 12-Feb-18 Melvin Regan, An Rp 39,800 Rp 39,800 D BCA
19 12-Feb-18 Atharizz Aisy, An Rp 29,100 Rp 29,100 D BCA
20 12-Feb-18 Raka Arfareqzi, An Rp 115,800 Rp 115,800 D BCA
21 12-Feb-18 Stefanie Elovii, An Rp 189,600 Rp 189,600 D BCA
22 12-Feb-18 Chelsea Adelia, An Rp 151,400 Rp 151,400 D BCA
23 12-Feb-18 Putri Rachma, Ny Rp 265,400 Rp 265,400 D MAndiri
24 12-Feb-18 Ananda Febri, An Rp 215,000 Rp 215,000 D BCA
25 12-Feb-18 Sarfaraz Zafran, An Rp 153,500 Rp 153,500 D MAndiri

Total Rp 6,033,700 Rp 6,033,700

Surabaya, 13 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 12 Februari 2018
Tunai
No Tanggal Nama Pasien No. RM No. Operator Poli Jasa Dokter Tindakan Total Keterangan
1 12-Feb-18 Rp -
2 12-Feb-18 Rp -

Total Rp -

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 12-Feb-18 Darrell Anieli, An 400200 Dian, dr Rp 20,000 Rp 250,000 Rp 270,000 D BCA
2 12-Feb-18 Rp -

Total Rp 270,000

Surabaya, 13 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan
Tanggal 13 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 13-Feb-18 Violetta Christiani, An Dini, dr 226600 Rp 20,000 Rp 125,000 Rp 145,000
2 13-Feb-18 Fiorenza Febricia, An Dini, dr 351601 Rp 20,000 Rp 125,000 Rp 145,000
3 13-Feb-18 Catherine Reina, An Dini, dr 473401 Rp 20,000 Rp 125,000 Rp 145,000
4 13-Feb-18 Dzulkarnain Dwi, An Sufiandika, dr 203001 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
5 13-Feb-18 Joanna Beatrice, An Dini, dr 273101 Rp 20,000 Rp 125,000 Rp 145,000
6 13-Feb-18 Melvin Giovanni, An Mahe, dr 469001 Rp 20,000 Rp 125,000 Rp 145,000
7 13-Feb-18 Ravellius Hazel, An Dini, dr 269801 Rp 20,000 Rp 125,000 Rp 145,000
8 13-Feb-18 Eldrick Wilson, An Anna, dr 309401 Rp 20,000 Rp 50,000 Rp 70,000
9 13-Feb-18 Jevan Alvaro, An Anna, dr 250601 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
10 13-Feb-18 Khairan Arsenio, An Leny, dr 846600 Rp 20,000 Rp 125,000 Rp 145,000
11 13-Feb-18 Celio Arzankha, An Mahe, dr 428701 Rp 20,000 Rp 125,000 Rp 145,000
12 13-Feb-18 Muhammad Naufal, An Dini, dr 172001 Rp 20,000 Rp 125,000 Rp 145,000
13 13-Feb-18 Muhammad Al Fatih, An Dini, dr 748400 Rp 20,000 Rp 125,000 Rp 145,000
14 13-Feb-18 Vindria Eka, Ny Dhini, dr 352901 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
15 13-Feb-18 Muhammad Ayyash, An Mahe, dr 239901 Rp 20,000 Rp 125,000 Rp 145,000
16 13-Feb-18 Zerlinda Giovanni, Ny Erna, dr 397001 Rp 20,000 Rp 125,000 Rp 145,000
17 13-Feb-18 Irfaatul Izza, An Anna, dr 505001 Rp 20,000 Rp 50,000 Rp 70,000
18 13-Feb-18 Azizan Daniyal, An Mahe, dr 434401 Rp 20,000 Rp 125,000 Rp 145,000
19 13-Feb-18 Zuanita Shofia, Ny Erna, dr 506401 Rp 25,000 FREE Rp 35,000 Rp 40,000 Rp 100,000
20 13-Feb-18 Malika Eleanora, An Mahe, dr 352301 Rp 20,000 Rp 125,000 Rp 145,000
21 13-Feb-18 Irma Iriyanti, Ny Erna, dr 918100 Rp 20,000 Rp 125,000 Rp 145,000
22 13-Feb-18 Navalia Arsyilaa, An Leny, dr 041401 Rp 20,000 Rp 125,000 Rp 145,000
23 13-Feb-18 Susi Sa'Diyani, Ny Erna, dr 506501 Rp 25,000 Rp 125,000 Rp 150,000
24 13-Feb-18 Nichelle Odelia, AN Rohim, dr 506601 Rp 25,000 Rp 125,000 Rp 150,000
25 13-Feb-18 Nadira Reskiaruci, An Mahe, dr 644100 Rp 20,000 Rp 125,000 Rp 145,000
26 13-Feb-18 Zerlinda Giovanni, Ny Erna, dr 397001 Rp 35,000 Rp 40,000 Rp 250,000 Rp 325,000
27 13-Feb-18 Ririn Erindawati, Ny Erna, dr 371200 Rp 20,000 Rp 125,000 Rp 145,000
28 13-Feb-18 Leily Rizma, Ny Erna, dr 261901 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
29 13-Feb-18 Telge Felisha, An Diana, dr 187501 Rp 20,000 Rp 38,000 Rp 58,000
30 13-Feb-18 Kenzie Albarra, An Mahe, dr 424201 Rp 20,000 Rp 125,000 Rp 145,000
31 13-Feb-18 Ria Kurniasari, Ny Erna, dr 429001 Rp 35,000 Rp 40,000 Rp 75,000
32 13-Feb-18 Susi Sa'Diyani, Ny Erna, dr 506501 Rp 35,000 Rp 40,000 Rp 75,000
33 13-Feb-18 Endah Astutik, Ny Erna, dr 958800 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
34 13-Feb-18 Fardhan Rizki, An Anna, dr 430101 Rp 20,000 Rp 50,000 Rp 70,000
35 13-Feb-18 M Fairuzzabadi, An Rohim, dr 469900 Rp 20,000 Rp 125,000 Rp 145,000
36 13-Feb-18 Adriana Ayra, An Rohim, dr 047201 Rp 20,000 Rp 125,000 Rp 145,000
37 13-Feb-18 Jaden Aldrick, AN Mahe, dr 401701 Rp 20,000 Rp 125,000 Rp 145,000
38 13-Feb-18 Irma Iriyanti, Ny Erna, dr 918100 Rp 35,000 Rp 40,000 Rp 95,000 Rp 170,000
39 13-Feb-18 Jasper Malvin, An Mahe, dr 174601 Rp 20,000 Rp 125,000 Rp 145,000
40 13-Feb-18 Odetta Viront, An Rohim, dr 724000 Rp 20,000 Rp 125,000 Rp 145,000
41 13-Feb-18 Dahlia Intan, Ny Gatut, dr 177201 Rp 20,000 Rp 125,000 Rp 145,000
42 13-Feb-18 Joy Kendrick, An Rohim, dr 467800 Rp 20,000 Rp 125,000 Rp 145,000
43 13-Feb-18 Agatha Djenar, An Rohim, dr 733100 Rp 20,000 Rp 125,000 Rp 145,000
44 13-Feb-18 Arkaditya Hisyam, An Rohim, dr 338701 Rp 20,000 Rp 125,000 Rp 145,000
45 13-Feb-18 Dhayu Sekar, An Rohim, dr 463701 Rp 20,000 Rp 125,000 Rp 145,000
46 13-Feb-18 Anindita Keisha, An Mahe, dr 414701 Rp 20,000 Rp 125,000 Rp 145,000
47 13-Feb-18 Dave Stevenson, An Rohim, dr 506901 Rp 25,000 Rp 125,000 Rp 150,000

Total Rp 6,663,000

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 13-Feb-18 Lidya Widayati, Ny Rina, dr 489401 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
2 13-Feb-18 Felicia Angkawinata, Ny Tik, dr 406001 Rp 20,000 Rp 824,000 Rp 844,000
3 13-Feb-18 Seraphine Aiyana, An Dini, dr 840900 CANCEL Rp -
4 13-Feb-18 Ria Kurniasari, Ny Erna, dr 429001 Rp 20,000 Rp 125,000 Rp 145,000
5 13-Feb-18 Sean Nathaniel, An Dini, dr 426401 Rp 20,000 Rp 125,000 Rp 145,000
6 13-Feb-18 Hamka Syafiq, An Dini, dr 058701 Rp 20,000 Rp 125,000 Rp 145,000
7 13-Feb-18 Haidar Fitrah, An Dini, dr 880600 Rp 20,000 Rp 125,000 Rp 145,000
8 13-Feb-18 Sylvia, NY Tik, dr 462301 Rp 20,000 Rp 429,000 Rp 449,000
9 13-Feb-18 Muhammad Arshad, An Dini, dr 421401 Rp 20,000 Rp 125,000 Rp 145,000
10 13-Feb-18 Kenzie Aufa, An Dini, dr 506101 Rp 25,000 Rp 125,000 Rp 150,000
11 13-Feb-18 Khanza Deriva, An Dini, dr 216701 Rp 20,000 Rp 125,000 Rp 145,000
12 13-Feb-18 Ethan Zayn, An Leny, dr 500001 Rp 20,000 Rp 125,000 Rp 145,000
13 13-Feb-18 Chintya Ardellia, Ny Erna, dr 506301 Rp 25,000 Rp 125,000 Rp 150,000
14 13-Feb-18 Khanza Deriva, An Dini, dr 216701 Rp 256,000 Rp 256,000
15 13-Feb-18 Narul Amalia, Ny Erna, dr 436301 Rp 20,000 Rp 125,000 Rp 145,000
16 13-Feb-18 Ananda Febri, An Anna, dr 505801 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
17 13-Feb-18 Nova Isti, Ny Erna, dr 244901 Rp 20,000 Rp 125,000 Rp 145,000
18 13-Feb-18 Chintya Ardellia, Ny Erna, dr 506301 Rp 35,000 Rp 40,000 Rp 75,000
19 13-Feb-18 Nurul Amalia, Ny Erna, dr 436301 Rp 35,000 Rp 40,000 Rp 75,000
20 13-Feb-18 Arsyila Majid, An Leny, dr 322601 Rp 20,000 Rp 125,000 Rp 145,000
21 13-Feb-18 Intifada, Ny Erna, dr 317301 Rp 20,000 Rp 325,000 Rp 375,000 Rp 720,000
22 13-Feb-18 Nova Isti, Ny Erna, dr 244901 Rp 35,000 Rp 90,000 Rp 125,000
23 13-Feb-18 Zafri Ahmad, An Leny, dr 351201 Rp 20,000 Rp 125,000 Rp 75,000 Rp 259,000 Rp 479,000
24 13-Feb-18 Mikhayla Almeera, An Mahe, dr 479201 Rp 20,000 Rp 125,000 Rp 145,000
25 13-Feb-18 Shahnaz Imaniar, Ny Erna, dr 178401 Rp 20,000 Rp 125,000 Rp 145,000
26 13-Feb-18 Dr Evi Anggraini, Ny Erna, dr 046701 Rp 20,000 FREE Rp 20,000
27 13-Feb-18 Abdillah Ismail, An Rohim, dr 491901 Rp 20,000 Rp 125,000 Rp 145,000
28 13-Feb-18 Eris Tri Sulafiyah, Ny Erna, dr 192401 Rp 20,000 Rp 125,000 Rp 145,000
29 13-Feb-18 Muhammad Al Kautsar, An Rohim, dr 506801 Rp 25,000 Rp 125,000 Rp 150,000
30 13-Feb-18 Dahlia Intan, Ny Gtaut, dr 177201 Rp 100,000 Rp 450,000 Rp 550,000
31 13-Feb-18 Elena Louis, AN Rohim, dr 506701 Rp 25,000 Rp 125,000 Rp 150,000
32 13-Feb-18 Nicole Louis, An Rohim, dr 517300 Rp 20,000 Rp 125,000 Rp 145,000

Total Rp 6,683,000

Surabaya, 14 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Keterangan
TOTAL
RJ Rp 6,663,000
ARJ Rp 8,867,300
IGD, Nebul Rp 15,530,300
RJG Rp 697,500
Rp 16,227,800
BS Mbak Rini Rp (525,000)
IGD Rp 15,702,800
IGD, Nebul PR Rp 120,000
Rp 15,822,800
BS RJ Rp (145,000) Seraphine Aiyana, An
Rp 15,677,800
BS Logistic Rp (5,950,000)
USG 2D Rp 9,727,800

IGD

USG 2D

USG 2D

USG 2D
USG 2D
USG 2D
IGD

USG 2D

Keterangan
D BCA ( USG 2D )
KK ANZ
D BCA
D BCA
KK BCA
D Mandiri
D Mandiri
D BCA
Admedika ( Pertamina )
D BCA
D BCA
D BCA
D BCA
D BCA
D BNI
D BCA
D BCA
D BNI ( USG 2D )
D BNI ( USG 2D )
D BCA
D BRI
D BCA ( USG 2D, VT )
D BRI ( Nebul )
D BNI
D MAndiri
D MAndiri
D Mandiri
D BCA
D BNI
D BRI (Pasang IUD)
Admedika (BNI Life )
Admedika (BNI Life )

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 13 Januari 2018

Tunai
No Tanggal Nama Pasien Apotek Total Ket
1 13-Feb-18 Telge Felisha, An Rp 59,500 Rp 59,500
2 13-Feb-18 Violetta Christiani, An Rp 183,500 Rp 183,500
3 13-Feb-18 Catherine Reina, An Rp 86,000 Rp 86,000
4 13-Feb-18 Arien Puspa, Ny Rp 41,700 Rp 41,700 Karyawan
5 13-Feb-18 Vindria Eka, Ny Rp 251,300 Rp 251,300
6 13-Feb-18 Telge Felisha, An Rp 119,000 Rp 119,000
7 13-Feb-18 Muhammad Naufal, An Rp 334,700 Rp 334,700
8 13-Feb-18 Irfaatul Izza, An Rp 102,200 Rp 102,200
9 13-Feb-18 Khairan Arsenio, An Rp 123,900 Rp 123,900
10 13-Feb-18 Navalia Arsyilaa, An Rp 242,800 Rp 242,800
11 13-Feb-18 Zuanita Shofia, Ny Rp 101,500 Rp 101,500
12 13-Feb-18 Leily Rizma, Ny Rp 106,500 Rp 106,500
13 13-Feb-18 Ria Kurniasari, Ny Rp 221,500 Rp 221,500
14 13-Feb-18 Susi Sa'Diyani, Ny Rp 136,000 Rp 136,000
15 13-Feb-18 Fardhan Rizki, An Rp 345,500 Rp 345,500
16 13-Feb-18 Irma Iriyanti, Ny Rp 428,500 Rp 428,500
17 13-Feb-18 Zafri Ahmad, An Rp 15,900 Rp 15,900
18 13-Feb-18 M Fairuzzabadi, An Rp 97,500 Rp 97,500
19 13-Feb-18 Nichelle Odelia, AN Rp 212,500 Rp 212,500
20 13-Feb-18 Adriana Ayra, An Rp 138,100 Rp 138,100
21 13-Feb-18 Intifada, Ny Rp 200,500 Rp 200,500
22 13-Feb-18 Melvin Giovanni, An Rp 82,300 Rp 82,300
23 13-Feb-18 Celio Arzankha, An Rp 785,100 Rp 785,100
24 13-Feb-18 Celio Arzankha, An Rp 89,000 Rp 89,000
25 13-Feb-18 Joy Kendrick, An Rp 291,400 Rp 291,400
26 13-Feb-18 Joy Kendrick, An Rp 40,700 Rp 40,700
27 13-Feb-18 Jaden Aldrich An Rp 595,000 Rp 595,000
28 13-Feb-18 Muhammad Ayyash, An Rp 225,200 Rp 225,200
29 13-Feb-18 Malika Eleanora, An Rp 921,800 Rp 921,800
30 13-Feb-18 Nadira Reskiaruci, An Rp 24,400 Rp 24,400
31 13-Feb-18 Ratna Rp 22,800 Rp 22,800
32 13-Feb-18 Kenzie Albarra, An Rp 28,900 Rp 28,900
33 13-Feb-18 Kenzie Albarra, An Rp 225,200 Rp 225,200
34 13-Feb-18 Jasper Malvin, An Rp 72,800 Rp 72,800
35 13-Feb-18 Odetta Viront, An Rp 548,800 Rp 548,800
36 13-Feb-18 Agatha Djenar, An Rp 595,000 Rp 595,000
37 13-Feb-18 Anindita Keisha, An Rp 38,200 Rp 38,200
38 13-Feb-18 Dhayu Sekar, An Rp 595,000 Rp 595,000
39 13-Feb-18 Dhayu Sekar, An Rp 42,200 Rp 42,200
40 13-Feb-18 Dave Stevenson, An Rp 94,900 Rp 94,900

Total Rp 8,867,300 Rp 8,867,300

Piutang
No Tanggal Nama Pasien Apotek Total Ket
1 13-Feb-18 Lidya Widayati, Ny Rp 122,500 Rp 122,500 D BCA
2 13-Feb-18 Joanna Beatrice, An Rp 785,100 Rp 785,100 D BCA
3 13-Feb-18 Fiorenza Febricia, An Rp 595,000 Rp 595,000 D Mandiri
4 13-Feb-18 Ravellius Hazel, An Rp 785,100 Rp 785,100 D Mandiri
5 13-Feb-18 Ravellius Hazel, An Rp 144,200 Rp 144,200 D Mandiri
6 13-Feb-18 Sean Nathaniel, An Rp 548,800 Rp 548,800 KK BCA
7 13-Feb-18 Haidar Fitrah, An Rp 277,400 Rp 277,400 D Mandiri
8 13-Feb-18 Hamka Syafiq, An Rp 93,600 Rp 93,600 D Mandiri
9 13-Feb-18 Muhammad Al Fatih, An Rp 785,100 Rp 785,100 D BCA
10 13-Feb-18 Muhammad Al Fatih, An Rp 46,100 Rp 46,100 D BCA
11 13-Feb-18 Muhammad Arshad, An Rp 821,000 Rp 821,000 Admedika ( Pertamina )
12 13-Feb-18 Muhammad Arshad, An Rp 48,700 Rp 48,700 Admedika ( Pertamina )
13 13-Feb-18 Kenzie Aufa, An Rp 403,900 Rp 403,900 D BCA
14 13-Feb-18 Khanza Deriva, An Rp 595,000 Rp 595,000 D BCA
15 13-Feb-18 Chintya Ardellia, Ny Rp 254,500 Rp 254,500 D BNI
16 13-Feb-18 Nurul Amalia, Ny Rp 299,300 Rp 299,300 D BNI
17 13-Feb-18 Arsyila Majid, An Rp 225,200 Rp 225,200 D BCA
18 13-Feb-18 Nova Isti, Ny Rp 7,300 Rp 7,300 D BCA
19 13-Feb-18 Zafri Ahmad, An Rp 180,900 Rp 180,900 D BRI
20 13-Feb-18 Shahnaz Imaniar, Ny Rp 228,500 Rp 228,500 D Mandiri
21 13-Feb-18 Dr Evi Anggraini, Ny Rp 122,500 Rp 122,500 D Mandiri
22 13-Feb-18 Abdillah Ismail, An Rp 46,100 Rp 46,100 D Mandiri
23 13-Feb-18 Arzaquna Damario, An Rp 4,200 Rp 4,200 D BCA
24 13-Feb-18 Eris Tri Sulafiyah, Ny Rp 68,700 Rp 68,700 D BCA
25 13-Feb-18 Eris Tri Sulafiyah, Ny Rp 151,000 Rp 151,000 D BCA
26 13-Feb-18 Azizan Daniyal, An Rp 225,200 Rp 225,200 D BCA
27 13-Feb-18 Azizan Daniyal, An Rp 28,900 Rp 28,900 D BCA
28 13-Feb-18 Dahlia Intan, Ny Rp 337,700 Rp 337,700 D BRI
29 13-Feb-18 Elena Louis, AN Rp 72,800 Rp 72,800 Admedika (BNI Life )
30 13-Feb-18 Nicole Louis, An Rp 82,900 Rp 82,900 Admedika (BNI Life )
31 13-Feb-18 Mikhayla Almeera, An Rp 138,800 Rp 138,800 D BRI
32 13-Feb-18 Arkaditya Hisyam, An Rp 785,100 Rp 785,100 D BNI
33 13-Feb-18 Arkaditya Hisyam, An Rp 60,300 Rp 60,300 D BNI

Total Rp 9,371,400 Rp 9,371,400

Surabaya, 14 Januari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 13 Februari 2018
Tunai
No Tanggal Nama Pasien No. RM No. Operator Poli Jasa Dokter Tindakan Total
1 13-Feb-18 Ratih Atmidji, Ny 954200 Novi, dr Rp 427,500 Rp 427,500
2 13-Feb-18 Rahmatya Meidina, An 227000 Lila, dr Rp 20,000 Rp 250,000 Rp 270,000
3 13-Feb-18 Rp -

Total Rp 697,500

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total
1 13-Feb-18 William Oentono, An 951200 Prima, dr Rp 20,000 Rp 250,000 Rp 270,000
2 13-Feb-18 Rp -
3 13-Feb-18 Rp -

Total Rp 270,000

Surabaya, 13 Februari 2018

Penyetor

Ika
Keterangan
Karyawan

Keterangan
D BCA

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Rawat Jalan
Tanggal 14 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total Keterangan
1 14-Feb-18 Telge Felisha, An Diana, dr 187501 Rp 20,000 Rp 125,000 Rp 145,000
2 14-Feb-18 Dzulkarnain Dwi, An Atika, dr 203001 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000 IGD, Nebul
3 14-Feb-18 Sarfaraz Zafran, An Diana, dr 955200 Rp 20,000 Rp 125,000 Rp 145,000
4 14-Feb-18 Jill Valencia, An Diana, dr 601800 Rp 20,000 Rp 125,000 Rp 145,000
5 14-Feb-18 Giovannia Jeanice, An Diana, dr 213201 Rp 20,000 Rp 125,000 Rp 145,000
6 14-Feb-18 Kanisa Zaskia, An Diana, dr 157001 Rp 20,000 FREE Rp 20,000
7 14-Feb-18 Amilia Annisa, An Diana, dr 402901 Rp 20,000 Rp 125,000 Rp 145,000
8 14-Feb-18 Eril Lafiana, Ny Rina, dr 492501 Rp 20,000 Rp 125,000 Rp 145,000
9 14-Feb-18 Teresa Adawiyah, Ny Rina, dr 507201 Rp 25,000 Rp 125,000 Rp 150,000
10 14-Feb-18 Gavril Harjono, An Diana, dr 690100 Rp 20,000 Rp 125,000 Rp 145,000
11 14-Feb-18 Griffin Harjono, An Diana, dr 653600 Rp 20,000 Rp 125,000 Rp 145,000
12 14-Feb-18 Sulis Nur, Ny Rina, dr 467801 Rp 20,000 Rp 125,000 Rp 145,000
13 14-Feb-18 Eril Lafiana, Ny Rina, dr 492501 Rp 35,000 Rp 40,000 Rp 75,000 USG 2D
14 14-Feb-18 Teresa Adawiyah, Ny Rina, dr 507201 Rp 35,000 Rp 40,000 Rp 75,000 USG 2D
15 14-Feb-18 Cristopher Jayden, An Diana, dr 139001 CANCEL Rp -
16 14-Feb-18 Sulis Nur, Ny Rina, dr 467801 Rp 35,000 Rp 40,000 Rp 75,000 USG 2D
17 14-Feb-18 Rona Riantini, Ny Rina, dr 481901 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000 USG 2D
18 14-Feb-18 Coleta Astri, Ny Tik, dr 507701 Rp 25,000 Rp 125,000 Rp 150,000
19 14-Feb-18 Michael Marcel, An Ema, dr 499601 Rp 20,000 Rp 125,000 Rp 145,000
20 14-Feb-18 Naura Assyabiya, An Diana, dr 622000 Rp 20,000 Rp 125,000 Rp 145,000
21 14-Feb-18 Jason Farrelino, An Diana, dr 191801 Rp 20,000 Rp 125,000 Rp 145,000
22 14-Feb-18 Sunny Santoso, An Diana, dr 474401 Rp 20,000 Rp 125,000 Rp 145,000
23 14-Feb-18 Intan Vidyawati, Ny Rina, dr 507801 Rp 25,000 Rp 125,000 Rp 150,000
24 14-Feb-18 Deka Virgia, Ny Rina, dr 507901 Rp 25,000 Rp 125,000 Rp 150,000
25 14-Feb-18 Intan Vidyawati, Ny Rina, dr 507801 Rp 35,000 Rp 40,000 Rp 75,000 USG 2D
26 14-Feb-18 Deka Virgia, Ny Rina, dr 507901 Rp 35,000 Rp 40,000 Rp 75,000 USG 2D
27 14-Feb-18 Liu Yang Fang, Ny Rina, dr 464800 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000 USG 2D
28 14-Feb-18 Febrinia Dwi, Ny Rina, dr 081901 FREE FREE Rp - FREE Karyawan
29 14-Feb-18 Shierra Bianca, Ny Eighty, dr 508101 Rp 25,000 Rp 125,000 Rp 150,000
30 14-Feb-18 Patricia Quinn, An Eka, dr 264301 Rp 20,000 Rp 50,000 Rp 70,000 IGD
31 14-Feb-18 Shierra Bianca, Ny Eighty, dr 508101 Rp 245,000 Rp 245,000
32 14-Feb-18 Dr Niken Sasadhara, Ny Erna, dr 560800 Rp 20,000 FREE Rp 20,000
33 14-Feb-18 Ratih Dwi, Ny Erna, dr 508301 Rp 25,000 Rp 325,000 FREE Rp 350,000 USG 4D
34 14-Feb-18 Nidya Rahma, Nn Erna, dr 508401 Rp 25,000 Rp 125,000 Rp 150,000
35 14-Feb-18 Arindita Tristi, Ny Erna, dr 341801 Rp 20,000 Rp 125,000 Rp 145,000
36 14-Feb-18 Aisyah Shakila, An Emma, dr 231101 Rp 20,000 Rp 125,000 Rp 145,000
37 14-Feb-18 Rani Nuraini, Ny Erna, dr 508501 Rp 25,000 Rp 125,000 Rp 150,000
38 14-Feb-18 Telge Felisha, An Diana, dr 187501 Rp 250,000 Rp 250,000
39 14-Feb-18 Wulan Nuryuli, Ny Erna, dr 508601 Rp 25,000 Rp 325,000 Rp 375,000 Rp 725,000 USG 4D
40 14-Feb-18 Gendis Putri, An Emma, dr 114101 Rp 20,000 Rp 125,000 Rp 145,000
41 14-Feb-18 Keitaro Gavriel, An Emma, dr 143800 Rp 20,000 Rp 125,000 Rp 145,000
42 14-Feb-18 Ivana Joy, Ny Erna, dr 508901 Rp 25,000 Rp 125,000 Rp 150,000
43 14-Feb-18 Dinaniar Enggar, Ny Erna, dr 483201 Rp 20,000 Rp 125,000 Rp 40,000 Rp 60,000 Rp 245,000 TVS
44 14-Feb-18 Khifdzi Khuzaiman, An Emma, dr 458501 Rp 20,000 Rp 125,000 Rp 145,000
45 14-Feb-18 Arindita Tristi, Ny Erna, dr 341801 Rp 35,000 Rp 40,000 Rp 75,000 USG 2D
46 14-Feb-18 Rani Nuraini, Ny Erna, dr 508501 Rp 35,000 Rp 40,000 Rp 75,000 USG 2D
47 14-Feb-18 Ivana Joy, Ny Erna, dr 508901 Rp 35,000 Rp 140,000 Rp 175,000 USG 2D, Gynec
48 14-Feb-18 Coleta Astri, Ny Tik, dr 507701 Rp 35,000 Rp 40,000 Rp 75,000 USG 2D
49 14-Feb-18 Michael Marcel, An Ema, dr 499601 Rp 80,000 Rp 80,000

Total Rp 7,125,000

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total Keterangan
1 14-Feb-18 Oliver Sky, An Anna, dr 395200 Rp 20,000 Rp 50,000 Rp 70,000 KK MEGA ( IGD )
2 14-Feb-18 Azhka Kaindra, An Anna, dr 224901 Rp 20,000 Rp 50,000 Rp 70,000 D Mandiri ( IGD )
3 14-Feb-18 Aira Anindya, An Anna, dr 132801 Rp 20,000 Rp 50,000 Rp 70,000 Admedika ( INH )
4 14-Feb-18 Oceana Mikhaela, An Diana, dr 217301 Rp 20,000 FREE Rp 20,000 D BCA
5 14-Feb-18 Ricard Laurence, An Diana, dr 507501 CANCEL Rp - KK ANZ
6 14-Feb-18 Raphael Louis, An Diana, dr 507601 Rp 25,000 Rp 125,000 Rp 150,000 KK ANZ
7 14-Feb-18 Jasmine Nabiha, An Diana, dr 038101 Rp 20,000 Rp 125,000 Rp 145,000 D BRI
8 14-Feb-18 Chelsea Adelia, An Diana, dr 273901 Rp 20,000 Rp 125,000 Rp 259,000 Rp 404,000 D BCA
9 14-Feb-18 Aurora Nur, An Alit, dr 487201 Rp 20,000 Rp 150,000 Rp 350,000 Rp 520,000 D BCA ( ECO )
10 14-Feb-18 Liu Yang Fang, Ny Rina, dr 464800 Rp 2,641,000 Rp 2,641,000 D Mandiri
11 14-Feb-18 Joycellin Anggel, Ny Rina, dr 027701 Rp 20,000 Rp 125,000 Rp 145,000 D BCA
12 14-Feb-18 Ava Sidra, An Diana, dr 503000 Rp 20,000 Rp 125,000 Rp 145,000 D Mandiri
13 14-Feb-18 Joycellin Anggel, Ny Rina, dr 027701 Rp 35,000 Rp 40,000 Rp 75,000 D BCA
14 14-Feb-18 Maggie Wang, An Diana, dr 064401 Rp 20,000 Rp 125,000 Rp 145,000 KK Danamon
15 14-Feb-18 Keivel Reeve, An Mahe, dr 500901 Rp 20,000 Rp 147,000 Rp 167,000 D BCA
16 14-Feb-18 Azzahra Shaqueena, An Diana, dr 193301 Rp 20,000 Rp 125,000 Rp 38,000 Rp 183,000 Admedika ( Lippo )
17 14-Feb-18 King El, An Diana, dr 028901 Rp 20,000 Rp 125,000 Rp 145,000 D BCA
18 14-Feb-18 Jibran Alfarisqy, An Emma, dr 719200 Rp 20,000 Rp 125,000 Rp 145,000 D BCA
19 14-Feb-18 Jefferson Immanuel, An Eka, dr 188800 Rp 20,000 Rp 50,000 Rp 70,000 D BCA ( IGD )
20 14-Feb-18 Humaira Malika, An Emma, dr 508701 Rp 25,000 Rp 125,000 Rp 150,000 D BCA
21 14-Feb-18 Keisha Nazeera, An Emma, dr 346100 Rp 20,000 Rp 125,000 Rp 145,000 D Mandiri
22 14-Feb-18 Nur Afrida, Ny Erna, dr 299100 Rp 20,000 Rp 125,000 Rp 145,000 D Mandiri
23 14-Feb-18 Dr Niken Sasadhara, Ny Erna, dr 560800 Rp 35,000 Rp 40,000 Rp 75,000 D Mandiri ( USG 2D )
24 14-Feb-18 Elvandari Yunizar, Ny Erna, dr 486301 Rp 20,000 Rp 125,000 Rp 145,000 D BCA
25 14-Feb-18 Nidya Rahma, Nn Erna, dr 508401 Rp 100,000 Rp 100,000 D BCA ( Gynec )
26 14-Feb-18 Naysilla Afrina, An Emma, dr 325401 Rp 20,000 Rp 125,000 Rp 145,000 D BCA
27 14-Feb-18 Ananda Raffasya, An Emma, dr 504401 Rp 20,000 Rp 125,000 Rp 145,000 D BCA
28 14-Feb-18 Humaira Malika, An Emma, dr 508701 Rp 75,000 Rp 75,000 D BCA ( Endokrin )
29 14-Feb-18 Nur Afrida, Ny Erna, dr 299100 Rp 35,000 Rp 40,000 Rp 75,000 D Mandiri ( USG 2D )
30 14-Feb-18 Elvandari Yunizar, Ny Erna, dr 486301 Rp 40,000 Rp 160,000 Rp 200,000 KK BCA ( TVS, Gynec )

Total Rp 6,710,000

Surabaya, 16 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


TOTAL
RJ Rp 7,125,000
ARJ Rp 5,123,700
Rp 12,248,700
Promo Rp 30,000
Rp 12,278,700
P Rp 60,000
Rp 12,338,700
BS RJ Rp (125,000) a/n Oceana, An
Rp 12,213,700
BS RJ Rp (150,000) a/n Richard , An
Rp 12,063,700
RJG Rp 835,000
Rp 12,898,700
Rp 7.000 D Mandiri
Laporan Apotek Rawat Jalan
Tanggal 14 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total Ket
1 14-Feb-18 Eril Lafiana, Ny Rp 227,500 Rp 227,500
2 14-Feb-18 Desi Rp 32,100 Rp 32,100 Karyawan
3 14-Feb-18 Desi Rp 1,600 Rp 1,600 Karyawan
4 14-Feb-18 Desi Rp 2,800 Rp 2,800 Karyawan
5 14-Feb-18 Sulis Nur, Ny Rp 159,500 Rp 159,500
6 14-Feb-18 Rona Riantini, Ny Rp 131,300 Rp 131,300
7 14-Feb-18 Ni Luh Eka, Ny Rp 1,000 Rp 1,000
8 14-Feb-18 Telge Felisha, An Rp 204,900 Rp 204,900
9 14-Feb-18 Jill Valencia, An Rp 47,900 Rp 47,900
10 14-Feb-18 Giovannia Jeanice, An Rp 821,000 Rp 821,000
11 14-Feb-18 Chelsea Adelia, An Rp 101,500 Rp 101,500
12 14-Feb-18 Patricia Quinn, An Rp 127,900 Rp 127,900
13 14-Feb-18 Ava Sidra, An Rp 6,800 Rp 6,800
14 14-Feb-18 Sunny Santoso, An Rp 3,400 Rp 3,400
15 14-Feb-18 Raphael Louis, An Rp 150,000 Rp 150,000 Pelunasan
16 14-Feb-18 Ava Sidra, An Rp 31,700 Rp 31,700
17 14-Feb-18 Shierra Bianca, Ny Rp 111,800 Rp 111,800
18 14-Feb-18 Jason Farrelino, An Rp 1,076,000 Rp 1,076,000
19 14-Feb-18 Gavril Harjono, An Rp 360,400 Rp 360,400
20 14-Feb-18 Griffin Harjono, An Rp 360,400 Rp 360,400
21 14-Feb-18 Dinaniar Enggar, Ny Rp 68,500 Rp 68,500
22 14-Feb-18 Jibran Alfarisqy, An Rp 96,100 Rp 96,100
23 14-Feb-18 Rani Nuraini, Ny Rp 128,500 Rp 128,500
24 14-Feb-18 Keitaro Gavriel, An Rp 97,900 Rp 97,900
25 14-Feb-18 Khifdzi Khuzaiman, An Rp 25,600 Rp 25,600
26 14-Feb-18 Wulan Nuryuli, Ny Rp 59,600 Rp 59,600
27 14-Feb-18 Michael Marcel, An Rp 29,200 Rp 29,200
28 14-Feb-18 Gendis Putri, An Rp 595,000 Rp 595,000
29 14-Feb-18 Ivana Joy, Ny Rp 7,300 Rp 7,300
30 14-Feb-18 Elvandari Yunizar, Ny Rp 7,300 Rp 7,300
31 14-Feb-18 Naysilla Afrina, An Rp 49,200 Rp 49,200

Total Rp 5,123,700 Rp 5,123,700

Piutang
No Tanggal Nama Pasien Apotek Total Ket
1 14-Feb-18 Oliver Sky, An Rp 195,700 Rp 195,700 KK MEGA
2 14-Feb-18 Azhka Kaindra, An Rp 127,500 Rp 127,500 D Mandiri
3 14-Feb-18 Yemmy Rp 12,800 Rp 12,800 Piutang Karyawan
4 14-Feb-18 Chelsea Adelia, An Rp 58,700 Rp 58,700 D BCA
5 14-Feb-18 Kanisa Zaskia, An Rp 507,200 Rp 507,200 D Mandiri
6 14-Feb-18 Jasmine Nabiha, An Rp 821,000 Rp 821,000 D Mandiri
7 14-Feb-18 Febrinia Dwi, Ny Rp 148,800 Rp 148,800 D BRI
8 14-Feb-18 Sarfaraz Zafran, An Rp 75,300 Rp 75,300 D Mandiri
9 14-Feb-18 Amilia Annisa, An Rp 959,400 Rp 959,400 D BCA
10 14-Feb-18 Oceana Mikhaela, An Rp 821,000 Rp 821,000 D BNI
11 14-Feb-18 Raphael Louis, An Rp 445,000 Rp 445,000 KK BCA
12 14-Feb-18 Azzahra Shaqueena, An Rp 176,200 Rp 176,200 Admedika ( Lippo )
13 14-Feb-18 King El, An Rp 61,900 Rp 61,900 D BCA
14 14-Feb-18 Ava Sidra, An Rp 264,100 Rp 264,100 D Mandiri
15 14-Feb-18 Jefferson Immanuel, An Rp 118,000 Rp 118,000 D BCA
16 14-Feb-18 Isniawati ( R. Bayi ) Rp 66,700 Rp 66,700 Piutang Karyawan
17 14-Feb-18 Dr Niken Sasadhara, Ny Rp 200,500 Rp 200,500 D Mandiri
18 14-Feb-18 Aisyah Shakila, An Rp 123,200 Rp 123,200 D Mandiri
19 14-Feb-18 Nidya Rahma, Nn Rp 291,800 Rp 291,800 D BCA
20 14-Feb-18 Dinaniar Enggar, Ny Rp 254,500 Rp 254,500 D BCA
21 14-Feb-18 Nur Afrida, Ny Rp 374,500 Rp 374,500 D Mandiri
22 14-Feb-18 Keisha Nazeera, An Rp 291,400 Rp 291,400 D Mandiri
23 14-Feb-18 Elvandari Yunizar, Ny Rp 465,000 Rp 465,000 KK BCA

Total Rp 6,860,200 Rp 6,860,200

Surabaya, 15 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Laporan Rawat Jalan
Promo Tanggal 14 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Nominal Total
1 14-Feb-18 Ni Luh Eka, Ny Anna, dr 032601 Rp 15,000 Rp 15,000 Rp 30,000
2 14-Feb-18 Rp -

Total Rp 30,000

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Nominal Total
1 14-Feb-18 Rp -
2 14-Feb-18 Rp -

Total Rp -

Surabaya, 15 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Keterangan
Vaksin Ke-3

Keterangan

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Therapy Kebugaran & Pijat Bayi
Tanggal 14 Februari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 14-Feb-18 Calista, An Rp 60,000 Rp 60,000 1217
2 14-Feb-18 Rp -

Total Rp 60,000 Rp 60,000

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 14-Feb-18 Rp -
2 14-Feb-18 Rp -

Total Rp - Rp -

Surabaya, 15 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 14 Februari 2018
Tunai
No Tanggal Nama Pasien No. RM No. Operator Poli Jasa Dokter Tindakan Total Keterangan
1 14-Feb-18 Fadhlan Rafa, An 713400 Mashita, dr Rp 20,000 Rp 250,000 Rp 270,000
2 14-Feb-18 Silvi Labibah, Nn 490801 Nining, dr Rp 20,000 Rp 200,000 Rp 220,000
3 14-Feb-18 Iswahyuningsih, Ny 490901 Nining, dr Rp 20,000 Rp 200,000 Rp 220,000
4 14-Feb-18 Asad, Tn 508801 Nining, dr Rp 25,000 Rp 100,000 Rp 125,000

Total Rp 835,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 14-Feb-18 Rp -
2 14-Feb-18 Rp -
3 14-Feb-18 Rp -

Total Rp -

Surabaya, 15 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Laporan Rawat Jalan
Tanggal 15 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium
1 15-Feb-18 Eny ,Ny Dhini, dr 509101 Rp 25,000 FREE
2 15-Feb-18 Gerrald Nicholas, An Dini, dr 486500 Rp 20,000 Rp 125,000
3 15-Feb-18 Joyce Kimmie, An Dini, dr 503501 Rp 20,000 Rp 125,000
4 15-Feb-18 Almahyra Shazia, An Leny, dr 029601 Rp 20,000 Rp 125,000
5 15-Feb-18 Anson Benedict, An Dini, dr 55700 Rp 20,000Rp 125,000
6 15-Feb-18 Nadira Shanum, An Dini, dr 444401 Rp 20,000Rp 125,000
7 15-Feb-18 Devano Austin, An Dini, dr 509201 Rp 25,000Rp 125,000
8 15-Feb-18 Abisatya Jezza, An Dini, dr 982000 Rp 20,000Rp 125,000
9 15-Feb-18 Pramita Devi, Ny Rina, dr 436501 Rp 20,000Rp 125,000
10 15-Feb-18 Sakha Alfattah, An Dini, dr 180001 Rp 20,000Rp 125,000
11 15-Feb-18 Pramita Devi, Ny Rina, dr 436501 Rp 35,000 Rp 40,000 Rp 38,000
12 15-Feb-18 Irma Nofitasari, Ny Erna,dr 231401 Rp 20,000 Rp 125,000
13 15-Feb-18 Joyce Kimmie, An Dini, dr 503501 Rp 80,000
14 15-Feb-18 Eny ,Ny Dhini, dr 509101 Rp 90,300
15 15-Feb-18 Mochamad Zieden, An Yusuf, dr 509301 Rp 25,000 Rp 50,000
16 15-Feb-18 Anna Richelle, An Leny, dr 038701 Rp 20,000 Rp 125,000
17 15-Feb-18 Irma Nofitasari, Ny Erna,dr 231401 Rp 35,000 Rp 40,000
18 15-Feb-18 Nova Isti, Ny Erna,dr 244901 Rp 235,000 Rp 40,000
19 15-Feb-18 Dheisa Ayu, Ny Erna,dr 440001 Rp 20,000 FREE Rp 35,000 Rp 40,000
20 15-Feb-18 Puspita Fitrianingrum, Ny Erna,dr 222101 Rp 20,000 FREE
21 15-Feb-18 Puspita Fitrianingrum, Ny Erna,dr 222101 Rp 22,500 Rp 52,500

Total

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium
1 15-Feb-18 Aruna Aisyah, An Dini, dr 022501 Rp 20,000 Rp 125,000
2 15-Feb-18 Caroline Jovanka, An Dini, dr 866300 Rp 20,000 Rp 125,000
3 15-Feb-18 Quinzha Allaika, An Dini, dr 047001 Rp 20,000 Rp 125,000
4 15-Feb-18 Peter Talatas, An Dini, dr 670100 Rp 20,000 Rp 125,000
5 15-Feb-18 Eny ,Ny Dhini, dr 509101 Rp 154,700
6 15-Feb-18 Maulidia Adreena, An Dini, dr 165501 Rp 20,000 Rp 125,000
7 15-Feb-18 Jovan Axelander, An Leny, dr 618200 Rp 20,000 Rp 125,000
8 15-Feb-18 Nova Isti, Ny Erna, dr 244901 Rp 20,000 Rp 125,000
9 15-Feb-18 Gwen Audrey, An Leny, dr 507300 Rp 20,000 Rp 125,000
10 15-Feb-18 Given Giandra, An Leny, dr 435601 Rp 20,000 Rp 125,000
11 15-Feb-18 Galen Kornelius, An Leny, dr 423801 Rp 20,000 Rp 125,000
12 15-Feb-18 Dominic Terrence, An Leny, dr 823900 Rp 20,000 Rp 125,000
13 15-Feb-18 Widiastuti Pratiwi, Ny Erna, dr 254501 Rp 20,000 Rp 125,000
14 15-Feb-18 Widiastuti Pratiwi, Ny Erna, dr 254501 Rp 35,000 Rp 40,000

Total

Surabaya, 16 Februari 2018

Penyetor

Nia
poran Rawat Jalan
gal 15 Februari 2018

Total Keterangan
Rp 25,000
Rp 145,000
Rp 145,000
Rp 145,000
Rp 145,000
Rp 145,000
Rp 150,000
Rp 145,000
Rp 145,000
Rp 145,000
Rp 113,000 USG 2D
Rp 145,000
Rp 80,000
Rp 90,300 Pelunasan
Rp 75,000 IGD
Rp 145,000
Rp 75,000 USG 2D
Rp 275,000 NST,VT, USG 2D
Rp 95,000 USG 2D
Rp 20,000
Rp 75,000 Rawat Luka Kecil

Rp 2,523,300

Total Keterangan
Rp 145,000 D Mandiri
Rp 145,000 D BCA
Rp 145,000 D Mandiri
Rp 145,000 D BCA
Rp 154,700 D BCA
Rp 145,000 Admedika ( BNI Life )
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BRI
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 75,000 D BCA ( USG 2D )

Rp 1,969,700

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Thursday, February 15, 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 14-Feb-18 Yudi Rp 29,100 Rp 29,100
2 14-Feb-18 Isniawati Rp 66,700 Rp 66,700
3 15-Feb-18 Phillip Jasson, An Rp 5,300 Rp 5,300
4 15-Feb-18 Velika Felcia, An Rp 80,500 Rp 80,500
5 15-Feb-18 Gerrald Nicholas, An Rp 252,400 Rp 252,400
6 15-Feb-18 Nadira Shanum, An Rp 188,100 Rp 188,100
7 15-Feb-18 Pramita Devi, Ny Rp 281,500 Rp 281,500
8 15-Feb-18 Devano Austin, An Rp 298,800 Rp 298,800
9 15-Feb-18 Eny ,Ny Rp 34,700 Rp 34,700
10 15-Feb-18 Sakha Alfattah, An Rp 260,000 Rp 260,000
11 14-Feb-18 Yemmy Rp 12,800 Rp 12,800
12 15-Feb-18 Mochamad Zieden, An Rp 58,700 Rp 58,700
13 15-Feb-18 Jovan Axelander, An Rp 111,900 Rp 111,900
14 15-Feb-18 Anna Richelle, An Rp 507,200 Rp 507,200
15 15-Feb-18 Nova Isti, Ny Rp 7,300 Rp 7,300
16 15-Feb-18 Zafri Ahmad, An Rp 42,500 Rp 42,500
17 15-Feb-18 Puspita Fitrianingrum, Ny Rp 172,700 Rp 172,700
18 15-Feb-18 Rp -
19 15-Feb-18 Rp -
20 15-Feb-18 Rp -
21 15-Feb-18 Rp -
22 15-Feb-18 Rp -
23 15-Feb-18 Rp -
24 15-Feb-18 Rp -
25 15-Feb-18 Rp -
26 15-Feb-18 Rp -
27 15-Feb-18 Rp -
28 15-Feb-18 Rp -
29 15-Feb-18 Rp -
30 15-Feb-18 Rp -

Total Rp 2,410,200 Rp 2,410,200

Piutang
No Tanggal Nama Pasien Apotek Total
1 15-Feb-18 Farlian Rp 36,400 Rp 36,400
2 15-Feb-18 Aruna Aisyah, An Rp 821,000 Rp 821,000
3 15-Feb-18 Anson Benedict, An Rp 159,400 Rp 159,400
4 15-Feb-18 Peter Talatas, An Rp 595,000 Rp 595,000
5 15-Feb-18 Abisatya Jezza, An Rp 821,000 Rp 821,000
6 15-Feb-18 Caroline Jovanka, An Rp 181,200 Rp 181,200
7 15-Feb-18 Quinzha Allaika, An Rp 45,100 Rp 45,100
8 15-Feb-18 Quinzha Allaika, An Rp 548,800 Rp 548,800
9 15-Feb-18 Maulidia Adreena, An Rp 143,600 Rp 143,600
10 15-Feb-18 Gwen Audrey, An Rp 113,200 Rp 113,200
11 15-Feb-18 Galen Kornelius, An Rp 232,200 Rp 232,200
12 15-Feb-18 Given Giandra, An Rp 924,400 Rp 924,400
13 15-Feb-18 Widiastuti Pratiwi, Ny Rp 527,500 Rp 527,500
14 15-Feb-18 Rp -
15 15-Feb-18 Rp -
16 15-Feb-18 Rp -
17 15-Feb-18 Rp -
18 15-Feb-18 Rp -
19 15-Feb-18 Rp -
20 15-Feb-18 Rp -
21 15-Feb-18 Rp -
22 15-Feb-18 Rp -
23 15-Feb-18 Rp -
24 15-Feb-18 Rp -
25 15-Feb-18 Rp -
26 15-Feb-18 Rp -
27 15-Feb-18 Rp -
28 15-Feb-18 Rp -
29 15-Feb-18 Rp -
30 15-Feb-18 Rp -

Total Rp 5,148,800 Rp 5,148,800

Surabaya, 16 Februari 2015


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Laporan Apotek Rawat Jalan
Thursday, February 15, 2018

Ket

Ket
Piutang Karyawan
D Mandiri
D BCA
D BCA
D BANK JATIM
D BCA
D Mandiri
D Mandiri
Admedika ( BNI Life )
D BNI
D BCA
D BCA
D BCA
Laporan Rawat Jalan Gigi
Tanggal 15 Februari 2018
Tunai
No Tanggal Nama Pasien No. RM No. Operator Poli Jasa Dokter Tindakan Total Keterangan
1 15-Feb-18 Phillip Jasson, An 462500 Prima, dr Rp 20,000 Rp 100,000 Rp 120,000

Total Rp 120,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 15-Feb-18 Airlangga Rizqy, An 443601 Masyitah, dr Rp 20,000 Rp 250,000 Rp 270,000 D Mandiri
2 15-Feb-18 Scarlett Edelaine, An 372800 Masyitah, dr Rp 20,000 Rp 600,000 Rp 620,000 D BCA
3 15-Feb-18 Rp -

Total Rp 890,000

Surabaya, 16 Februari 2018


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Laporan Rawat Jalan
Tanggal 16 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 15-Feb-18 Mieliena Ayundha, An Yusuf, dr 072200 Rp 20,000 Rp 50,000 Rp 70,000
2 15-Feb-18 Verry Tiara, Nn Yusuf, dr 509701 Rp 25,000 Rp 50,000 Rp 75,000
3 15-Feb-18 Jeannifer Chandra, Ny Ajeng, dr 500401 Rp 20,000 Rp 50,000 Rp 70,000
4 16-Feb-18 Elly Purnamasari, An Mahe, dr 107300 Rp 20,000 Rp 125,000 Rp 145,000
5 16-Feb-18 Anita Widyaningtyas, Ny Erna, dr 316201 Rp 20,000 Rp 95,000 Rp 115,000
6 16-Feb-18 Andi Al-fath, An Atika, dr 510201 Rp 25,000 Rp 50,000 Rp 75,000 Rp 150,000
7 16-Feb-18 Muhammad Alif, An Atika, dr 780500 Rp 20,000 Rp 50,000 Rp 70,000
8 16-Feb-18 Agnia Auliya, An Atika, dr 824700 Rp 20,000 Rp 50,000 Rp 70,000
9 16-Feb-18 Deandra Bidadari, An Mahe, dr 039301 Rp 20,000 Rp 125,000 Rp 75,000 Rp 220,000
10 16-Feb-18 Chairunnisa Khaliqa, An Mahe, dr 131401 Rp 20,000 Rp 125,000 Rp 145,000
11 16-Feb-18 Nazafarin Khaira, An Eka, dr 683700 Rp 20,000 Rp 50,000 Rp 70,000
12 16-Feb-18 S. Qiandra, An Mahe, dr 413501 Rp 20,000 Rp 125,000 Rp 145,000
13 16-Feb-18 Cayden Nathanael, An Mahe, dr 510701 Rp 75,000 Rp 75,000
14 16-Feb-18 Wilford Levinson, An Mahe, dr 510801 Rp 25,000 Rp 125,000 Rp 150,000

Total Rp 1,570,000

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 16-Feb-18 Nashira, An Mahe, dr 348001 Rp 20,000 Rp 125,000 Rp 145,000
2 16-Feb-18 Najandra, An Mahe, dr 347901 Rp 20,000 Rp 125,000 Rp 145,000
3 16-Feb-18 Muhammad Arsyad, An Atika, dr 421401 Rp 20,000 Rp 50,000 Rp 75,000 Rp 145,000
4 16-Feb-18 Rayner Angelo, An Atika, dr 396700 Rp 20,000 Rp 50,000 Rp 22,500 Rp 52,500 Rp 145,000
5 16-Feb-18 Keinarra Kalya, An Atika, dr 276801 Rp 20,000 Rp 50,000 Rp 75,000 Rp 145,000
6 16-Feb-18 Joanne Naomi, An Atika, dr 510401 Rp 25,000 Rp 50,000 Rp 75,000
7 16-Feb-18 Aurantiaca Senja, An Mahe, dr 517500 Rp 20,000 FREE Rp 20,000
8 16-Feb-18 Cayden Nathanael, An Mahe, dr 510701 Rp 25,000 Rp 125,000 Rp 150,000
9 16-Feb-18 Raynald Winson, An Mahe, dr 858800 Rp 20,000 Rp 125,000 Rp 145,000
10 16-Feb-18 Joakim Keenan, An Mahe, dr 728200 Rp 20,000 Rp 125,000 Rp 145,000
11 16-Feb-18 Rafifa Cordelia, An Mahe, dr 401801 Rp 20,000 Rp 125,000 Rp 145,000
12 16-Feb-18 KhaireenaZahirah, An Mahe, dr 935100 Rp 20,000 Rp 125,000 Rp 145,000
13 16-Feb-18 Faeyza Khairi, An Mahe, dr 887400 Rp 20,000 Rp 125,000 Rp 145,000
14 16-Feb-18 Clemira Qayla, An Mahe, dr 510901 Rp 25,000 Rp 125,000 Rp 150,000
15 16-Feb-18 Marcella Tjahjono, An Mahe, dr 511001 Rp 25,000 Rp 125,000 Rp 150,000

Total Rp 1,995,000

Surabaya, 17 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Keterangan
IGD
IGD
IGD Total
RJ Rp 1,570,000
ARJ Rp 2,149,400
IGD,Nebul Rp 3,719,400
IGD BS RJ Rp (125,000) Aurantiaca Senja, An
IGD Rp 3,594,400
Nebul BS Pak H Rp (30,000)
Rp 3,564,400
IGD

Nebul

Keterangan
KK BCA
KK BCA
Admedika ( Pertamina )
D BCA ( Rawat Luka Kecil )
D BCA ( Nebul )
D Mandiri
D BCA
D BCA
D BCA
D BCA
KK BCA
KK BCA
KK BCA
D BCA
KK BCA

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 16 Februari 2017

Tunai
No Tanggal Nama Pasien Apotek Total
1 15-Feb-18 Rudi Rp 13,800 Rp 13,800
2 15-Feb-18 Jeannifer Chandra, Ny Rp 71,200 Rp 71,200
3 15-Feb-18 Novi Rp 70,200 Rp 70,200
4 16-Feb-18 Elly Purnamasari, An Rp 42,600 Rp 42,600
5 16-Feb-18 Elly Purnamasari, An Rp 16,500 Rp 16,500
6 16-Feb-18 Putri Rp 6,000 Rp 6,000
7 16-Feb-18 Andi Al-fath, An Rp 151,100 Rp 151,100
8 16-Feb-18 Keinarra Kalya, An Rp 24,300 Rp 24,300
9 16-Feb-18 Ivony Susanto, NY Rp 68,700 Rp 68,700
10 16-Feb-18 Lim Then, Ny Rp 54,000 Rp 54,000
11 16-Feb-18 Muhammad Alif, An Rp 53,600 Rp 53,600
12 16-Feb-18 Agnia Auliya, An Rp 24,300 Rp 24,300
13 4-Feb-18 Kartika Rp 1,800 Rp 1,800
14 16-Feb-18 Nashira, An Rp 28,900 Rp 28,900
15 16-Feb-18 Najandra, An Rp 92,700 Rp 92,700
16 16-Feb-18 Deandra Bidadari, An Rp 262,000 Rp 262,000
17 16-Feb-18 Nazafarin Khaira, An Rp 166,900 Rp 166,900
18 16-Feb-18 S. Qiandra, An Rp 913,200 Rp 913,200
19 16-Feb-18 Cayden Nathanael, An Rp 87,600 Rp 87,600

Total Rp 2,149,400 Rp 2,149,400

Piutang
No Tanggal Nama Pasien Apotek Total
1 16-Feb-18 dr leny Rp 2,343,000 Rp 2,343,000
2 16-Feb-18 Muhammad Arsyad, An Rp 96,600 Rp 96,600
3 16-Feb-18 Muhammad Arsyad, An Rp 239,400 Rp 239,400
4 16-Feb-18 Rayner Angelo, An Rp 5,100 Rp 5,100
5 16-Feb-18 Keinarra Kalya, An Rp 46,500 Rp 46,500
6 16-Feb-18 Joanne Naomi, An Rp 27,600 Rp 27,600
7 16-Feb-18 Joanne Naomi, An Rp 56,800 Rp 56,800
8 16-Feb-18 Raynald Winson, An Rp 129,100 Rp 129,100
9 16-Feb-18 Aurantiaca Senja, An Rp 209,900 Rp 209,900
10 16-Feb-18 Faeyza Khairi, An Rp 165,900 Rp 165,900
11 16-Feb-18 Rafifa Cordelia, An Rp 99,200 Rp 99,200
12 16-Feb-18 KhaireenaZahirah, An Rp 184,500 Rp 184,500
13 16-Feb-18 Clemira Qayla, An Rp 595,000 Rp 595,000

Total Rp 4,198,600 Rp 4,198,600

Surabaya, 17 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Laporan Apotek Rawat Jalan
Tanggal 16 Februari 2017

Ket

Ket
D BCA
Admedika ( Pertamina )
Admedika ( Pertamina )
D BCA
D BCA
D Mandiri
D Mandiri
D BCA
D BCA
KK BCA
KK BCA
KK BCA
D BCA
Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 17-Feb-18 Azzahra Keisha, An Dini, dr 278401 Rp 20,000 Rp 125,000 Rp 145,000
2 17-Feb-18 Hilda Nagita, An Kartika, dr 827900 Rp 20,000 Rp 125,000 Rp 145,000
3 17-Feb-18 Rucira Sakhi, An Kartika, dr 241501 Rp 20,000 Rp 125,000 Rp 145,000
4 17-Feb-18 Megan Gwyneth, An Dini, dr 419200 Rp 20,000 Rp 125,000 Rp 145,000
5 17-Feb-18 Malika Bilqis, An Dini, dr 511301 Rp 25,000 Rp 125,000 Rp 150,000
6 17-Feb-18 Maheswara Nata, An Dini, dr 418101 Rp 20,000 Rp 125,000 Rp 145,000
7 17-Feb-18 Edgar Adonis, An Kartika, dr 469901 Rp 20,000 Rp 125,000 Rp 145,000
8 17-Feb-18 Ngurah Brahmantya, An Kartika, dr 030500 Rp 20,000 FREE Rp 20,000
9 17-Feb-18 Yani Permatasari, Ny Eighty, dr 511401 Rp 25,000 Rp 125,000 Rp 150,000
10 17-Feb-18 Muhammad Fahreza, an Dini, dr 512001 Rp 25,000 Rp 125,000 Rp 150,000
11 17-Feb-18 Warren Morgan, An Dini, dr 634700 Rp 20,000 Rp 125,000 Rp 145,000
12 17-Feb-18 Wiwin Kusumaningrum, Ny Eighty, dr 512101 Rp 25,000 FREE Rp 25,000
13 17-Feb-18 Tri Sufriani, Ny Eighty, dr 512201 Rp 25,000 Rp 125,000 Rp 150,000
14 17-Feb-18 Stanford Godfrey, An Dini, dr 648500 Rp 20,000 Rp 125,000 Rp 145,000
15 17-Feb-18 Sky Carlson, An Dini, dr 512601 Rp 25,000 Rp 125,000 Rp 150,000
16 17-Feb-18 Yani Permatasari, Ny Eighty, dr 511401 Rp 35,000 Rp 40,000 Rp 75,000
17 17-Feb-18 Lentera Merah, An Kartika, dr 059201 Rp 20,000 Rp 125,000 Rp 145,000
18 17-Feb-18 Gertrude Bridgetta, An Dini, dr 391001 Rp 20,000 Rp 125,000 Rp 145,000
19 17-Feb-18 Sofa Shofia, Ny Eighty, dr 512701 Rp 25,000 Rp 125,000 Rp 150,000
20 17-Feb-18 Kyori Gwenetta, An Kartika, dr 389801 Rp 20,000 Rp 125,000 Rp 145,000
21 17-Feb-18 Cayden Nathanael, An Atika, dr 510701 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
22 17-Feb-18 Juan Ethan, An Kartika, dr 305601 Rp 20,000 Rp 125,000 Rp 145,000
23 17-Feb-18 Airlangga Anargya, An Kartika, dr 970800 Rp 20,000 Rp 125,000 Rp 145,000
24 17-Feb-18 Tri Sufriani, Ny Eighty, dr 512201 Rp 35,000 Rp 40,000 Rp 75,000
25 17-Feb-18 Atina Izzah, Ny Eighty, dr 512801 Rp 25,000 FREE Rp 25,000
26 17-Feb-18 Kevin Anthony, An Kartika, dr 240401 Rp 20,000 Rp 125,000 Rp 145,000
27 17-Feb-18 Njoo Venny, Ny Erna, dr 545700 Rp 35,000 Rp 40,000 Rp 75,000
28 17-Feb-18 Usmah Ulpah, Ny Erna, dr 186400 Rp 35,000 Rp 40,000 Rp 537,000 Rp 612,000
29 17-Feb-18 Glenn Gunawan, An Kartika, dr 457601 Rp 20,000 Rp 125,000 Rp 250,000 Rp 395,000
30 17-Feb-18 Oliver Gunawan, An Kartika, dr 613300 Rp 20,000 Rp 125,000 Rp 145,000
31 17-Feb-18 Muhammad Arshad, An Atika, dr 421401 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
32 17-Feb-18 Ernia Nurdiansari, Ny Eighty, dr 511601 Rp 25,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 225,000
33 17-Feb-18 Ihlana Nairfana, Ny Erna, dr 512901 Rp 25,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 225,000
34 17-Feb-18 Muhammad Fahreza, an Dini, dr 5120001 Rp 75,000 Rp 75,000
35 17-Feb-18 Vinensia Kenanga, Ny Tik, dr 732900 Rp 35,000 Rp 40,000 Rp 75,000
36 17-Feb-18 Emalia Kusuma, Ny Eighty, dr 548000 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
37 17-Feb-18 Qaireen Azzalea, An Dini, dr 512401 Rp 25,000 Rp 125,000 Rp 150,000
38 17-Feb-18 Nina Angela, Ny Erna, dr 513501 Rp 25,000 Rp 125,000 Rp 150,000
39 17-Feb-18 Averroes Hideaki, An Dini, dr 0421000 Rp 20,000 Rp 125,000 Rp 145,000
40 17-Feb-18 Kartika Ayu, Ny Eighty, dr 513101 Rp 35,000 Rp 40,000 Rp 75,000
41 17-Feb-18 Abhipraya Gerdakani, An Atika, dr 279701 Rp 20,000 Rp 50,000 Rp 70,000
42 17-Feb-18 Asmaul Amalia, Ny Eighty, dr 249701 Rp 20,000 Rp125,000 Rp 35,000 Rp 40,000 Rp 220,000
43 17-Feb-18 Gibran Faiq, An Dini, dr 086001 Rp 20,000 Rp125,000 Rp 145,000
44 17-Feb-18 Belicia Brielle, An Dini, dr 643600 Rp 20,000 Rp125,000 Rp 145,000
45 17-Feb-18 Nina Angela, Ny Erna, dr 513501 Rp 35,000 Rp 40,000 Rp 75,000
46 17-Feb-18 Marsanthia Jeanneyke, Ny Erna, dr 498301 Rp 40,000 Rp 60,000 Rp 100,000
47 17-Feb-18 Amira Azzahra, An Mahe, dr 513701 Rp 25,000 FREE Rp 25,000
48 17-Feb-18 James Richardo, An Mahe, dr 085701 Rp 20,000 Rp 125,000 Rp 75,000 Rp 220,000
49 17-Feb-18 Emily Samantha, An Mahe, dr 558500 Rp 20,000 Rp 125,000 Rp 145,000
50 17-Feb-18 Mysha Zea, An Mahe, dr 876700 Rp 20,000 Rp 125,000 Rp 145,000
51 17-Feb-18 M Abdul, An Mahe, dr 351301 Rp 75,000 Rp 75,000

Total Rp 7,272,000

Surabaya, 18 Februari 2018

Penyetor Mengetahui,
Penerima

Angga Rini Wahyuningati


Keterangan
D BCA
D Mandiri
D BRI
D BCA
D BCA
D Mandiri
KK Permata
D Permata
D Mandiri
D Mandiri
D BCA
D BCA
D BCA
D BCA
D BCA
D Mandiri ( USG 2D )
D Mandiri
KK BNI
D BCA
D BNI
D BCA ( IGD, Nebul )
KK BCA
D BNI
D BCA ( USG 2D )
D BCA
D BCA
D BCA ( USG 2D )
D BCA ( USG 2D )
D BCA ( Tongue Tie )
D BCA
Admedika ( Pertamina )
Admedika ( Mandiri INH )
D BNI ( USG 2D )
D Mandiri ( Nebul )
D BCA ( USG 2D )
D BRI ( USG 2D )
Admedika ( Medicilin )
D Mandiri
D BCA
D BCA ( USG 2D )
D BRI
Admedika ( BNI Life )
Admedika ( Mandiri )
Admedika ( Smartcare )
D Mandiri ( USG 2D )
D BCA ( TVS )
D BCA
D BCA ( Nebul )
D BCA
Admedika ( BNI Life )
D BCA ( Nebul )
Laporan Apotek Rawat Jalan
Tanggal 17 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total Ket
1 17-Feb-18 Elisawati Rp 27,000 Rp 27,000
2 17-Feb-18 Aisyah Shakila, An Rp 203,400 Rp 203,400
3 17-Feb-18 Jason Rp 12,100 Rp 12,100
4 17-Feb-18 Cathrine Reina, An Rp 785,100 Rp 785,100
5 17-Feb-18 Abdulloh Farchan, An Rp 120,900 Rp 120,900
6 17-Feb-18 Jonathan Mulia, An Rp 19,500 Rp 19,500
7 17-Feb-18 Edgar Adonis, An Rp 82,300 Rp 82,300
8 17-Feb-18 Ari Murtina, Ny Rp 47,300 Rp 47,300
9 17-Feb-18 Sigrid Marise, Ny Rp 15,000 Rp 15,000
10 17-Feb-18 Ayu diah, Ny Rp 278,600 Rp 278,600
11 17-Feb-18 Sesiliam Evelyn, An Rp 83,500 Rp 83,500
12 17-Feb-18 Liana Martina, Ny Rp 518,500 Rp 518,500
13 17-Feb-18 Rachmawati, Ny Rp 506,500 Rp 506,500
14 17-Feb-18 Ellen Putri, Ny Rp 551,500 Rp 551,500
15 17-Feb-18 Callysta Wijaya, An Rp 12,100 Rp 12,100
16 17-Feb-18 Abraham Bishaka, An Rp 460,900 Rp 460,900
17 17-Feb-18 Moh Arzan, An Rp 12,100 Rp 12,100
18 17-Feb-18 Fransisca Yuliana, Ny Rp 113,500 Rp 113,500
19 17-Feb-18 Alfiandra Farrah, Ny Rp 200,500 Rp 200,500
20 17-Feb-18 Malika Bilqis, An Rp 169,200 Rp 169,200
21 17-Feb-18 Lim Tjen, Ny Rp 52,800 Rp 52,800
22 17-Feb-18 Stanford Godfrey, An Rp 12,100 Rp 12,100
23 17-Feb-18 Sky Carlson, An Rp 12,100 Rp 12,100
24 17-Feb-18 Kartika Ayu, Ny Rp 7,300 Rp 7,300
25 17-Feb-18 Najwa Amira, An Rp 12,100 Rp 12,100
26 17-Feb-18 Najwa Amira, An Rp 124,800 Rp 124,800
27 17-Feb-18 M azka, An Rp 27,700 Rp 27,700
28 17-Feb-18 M azka, An Rp 23,100 Rp 23,100
29 17-Feb-18 Arini Rp 101,700 Rp 101,700
30 17-Feb-18 Riza Dyah, Ny Rp 325,100 Rp 325,100
31 17-Feb-18 Riza Dyah, Ny Rp 28,700 Rp 28,700
32 17-Feb-18 Nova Rp 52,800 Rp 52,800
33 17-Feb-18 Atika, dr Rp 40,100 Rp 40,100
34 17-Feb-18 Sheynwana Chavelle, An Rp 31,300 Rp 31,300
35 17-Feb-18 Karina Prameswari, An Rp 219,300 Rp 219,300
36 17-Feb-18 Amira Azzahra, An Rp 113,600 Rp 113,600
37 17-Feb-18 Naufa Kharisma, An Rp 125,300 Rp 125,300
38 17-Feb-18 Mysha Zea, An Rp 92,500 Rp 92,500
39 17-Feb-18 Alina Aldita, An Rp 100,400 Rp 100,400
40 17-Feb-18 Clairine Quiny, An Rp 68,500 Rp 68,500

Total Rp 5,790,800 Rp 5,790,800

Piutang
No Tanggal Nama Pasien Apotek Total Ket
1 17-Feb-18 Rucira Sakhi, An Rp 548,800 Rp 548,800 D BRI
2 17-Feb-18 Lentera Merah, An Rp 821,000 Rp 821,000 D Mandiri
3 17-Feb-18 Sigrid Marise, Ny Rp 238,700 Rp 238,700 D BCA
4 17-Feb-18 Kevin Anthony, An Rp 97,800 Rp 97,800 D BCA
5 17-Feb-18 Hilda Nagita, An Rp 105,600 Rp 105,600 D Mandiri
6 17-Feb-18 Ngurah Brahmantya, An Rp 325,000 Rp 325,000 D Permata
7 17-Feb-18 Gerrude Bridgetta, An Rp 595,000 Rp 595,000 KK BCA
8 17-Feb-18 Michael Jeremia, An Rp 12,100 Rp 12,100 KK BCA
9 17-Feb-18 Michael Jeremia, An Rp 182,400 Rp 182,400 KK BCA
10 17-Feb-18 Juan Ethan, An Rp 1,185,400 Rp 1,185,400 KK BCA
11 17-Feb-18 Mahesa Nata, An Rp 548,800 Rp 548,800 D Mandiri
12 17-Feb-18 Airlangga Anargya, An Rp 821,000 Rp 821,000 D BNI
13 17-Feb-18 Kyori Gwenetta, An Rp 803,800 Rp 803,800 D BNI
14 17-Feb-18 Njoo Venny, Ny Rp 280,000 Rp 280,000 D BCA
15 17-Feb-18 Fahryan Alfath, An Rp 1,332,900 Rp 1,332,900 D BNi
16 17-Feb-18 Fahryan Alfath, An Rp 1,000 Rp 1,000 D BNi
17 17-Feb-18 Usmah Ulpah, An Rp 200,500 Rp 200,500 D MAndiri
18 17-Feb-18 Oliver Gunawan, An Rp 338,600 Rp 338,600 D BCA
19 17-Feb-18 Glenn Gunawan, An Rp 7,300 Rp 7,300 D BCA
20 17-Feb-18 Megan Gwyneth, An Rp 172,100 Rp 172,100 D Permata
21 17-Feb-18 Ernia Nurdiansari, Ny Rp 260,500 Rp 260,500 Admedika ( Mandiri INH )
22 17-Feb-18 Warren Morgan, An Rp 785,100 Rp 785,100 D BCA
23 17-Feb-18 Ihlana Nairfana, Ny Rp 358,500 Rp 358,500 D BNI
24 17-Feb-18 Muahammad Fahreza, an Rp 127,000 Rp 127,000 D MAndiri
25 17-Feb-18 Azzahra Keisha, An Rp 12,100 Rp 12,100 KK BCA
26 17-Feb-18 Azzahra Keisha, An Rp 78,600 Rp 78,600 KK BCA
27 17-Feb-18 Vinensia Kenanga, Ny Rp 165,700 Rp 165,700 D BCA
28 17-Feb-18 Emalia Kusuma, Ny Rp 35,500 Rp 35,500 D BRI
29 17-Feb-18 Qaireen Azzalea, An Rp 163,300 Rp 163,300 Admedika ( Medicilin )
30 17-Feb-18 Abhipraya Gerdakani, An Rp 145,100 Rp 145,100 D BNI
31 17-Feb-18 Kartika Ayu, Ny Rp 733,000 Rp 733,000 D BCA
32 17-Feb-18 Eva Soesiana, Ny Rp 190,800 Rp 190,800 D BCA
33 17-Feb-18 M Azka, An Rp 485,500 Rp 485,500 D BCA
34 17-Feb-18 Gibran Faiq, An Rp 122,500 Rp 122,500 Admedika ( Mandiri )
35 17-Feb-18 Belicia Brielle, An Rp 365,000 Rp 365,000 Admedika ( Smartcare )
36 17-Feb-18 Averroes Hideaki, An Rp 228,100 Rp 228,100 D BCA
37 17-Feb-18 dr Putri Rp 40,100 Rp 40,100 Piutang Karyawan
38 17-Feb-18 Mega Dewi, Ny Rp 140,100 Rp 140,100 D Mandiri
39 17-Feb-18 Nina Angela, Ny Rp 113,500 Rp 113,500 D Mandiri
40 17-Feb-18 Marsanthia Jeanneyke, Ny Rp 121,500 Rp 121,500 D BCA
41 17-Feb-18 Dr Arum Rp 47,200 Rp 47,200 D BCA
42 17-Feb-18 James Richardo, An Rp 209,900 Rp 209,900 D BCA
43 17-Feb-18 Florentina Rp 492,100 Rp 492,100 D Mandiri
44 17-Feb-18 Mysha Zea, An Rp 58,700 Rp 58,700 Admedika ( BNI Life )
45 17-Feb-18 M Abdul, An Rp 186,900 Rp 186,900 D BCA
46 17-Feb-18 Emily Samantha, An Rp 65,200 Rp 65,200 D BCA

Total Rp 14,349,300 Rp 14,349,300

Surabaya, 18 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Therapy Kebugaran & Pijat Bayi
Tanggal 17 Februari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 17-Feb-18 An. Arsa Rp 60,000 Rp 60,000 1222
2 17-Feb-18 An. Zafran Rp 60,000 Rp 60,000 1221

Total Rp 120,000 Rp 120,000

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 17-Feb-18 An. Rafanda Rp 60,000 Rp 60,000 D BCA ( 1220)
2 17-Feb-18 Rp -

Total Rp 60,000 Rp 60,000

Surabaya, 18 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 17 Februari 2018
Tunai
No Tanggal Nama Pasien No. RM No. Operator Poli Jasa Dokter Tindakan Total Keterangan
1 17-Feb-18 Rp -
2 17-Feb-18 Rp -

Total Rp -

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 17-Feb-18 Zalzabila Aulia, An 355400 Prima, drg Rp 20,000 Rp 250,000 Rp 270,000 Admedika ( PGN )
2 17-Feb-18 Rp -

Total Rp 270,000

Surabaya, 18 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan
Tanggal 18 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 17-Feb-18 Rahmat Hisyam, An Yusuf, dr 333501 Rp 20,000 Rp 50,000 Rp 70,000
2 18-Feb-18 M Fairuzzabadi, An Yusuf, dr 469900 Rp 20,000 Rp 50,000 Rp 70,000
3 18-Feb-18 Arief Wijaksono, An Yusuf, dr 253401 Rp 20,000 Rp 50,000 Rp 70,000
4 18-Feb-18 Faith Manuel, An Ajeng, dr 070501 Rp 20,000 Rp 50,000 Rp 70,000
5 18-Feb-18 Nicholas Conrad, An Ajeng, dr 004900 Rp 20,000 Rp 50,000 Rp 75,000 Rp 50,000 Rp 195,000

6 18-Feb-18 Gavra Corviell, An Ajeng, dr 457301 Rp 20,000 Rp 50,000 Rp 75,000 Rp 145,000


7 18-Feb-18 Axelle Marvilio, An Ajeng, dr 747900 Rp 20,000 Rp 50,000 Rp 70,000
8 18-Feb-18 Aisyah Shakila, An Ajeng, dr 231101 Rp 20,000 Rp 50,000 Rp 75,000 Rp 145,000
9 18-Feb-18 Gavra Corviell, An Leny, dr 457301 Rp 125,000 Rp 125,000
10 18-Feb-18 Maxellino Danko, An Ajeng, dr 514201 Rp 25,000 Rp 50,000 Rp 75,000
11 18-Feb-18 Marisa Laurina, An Ajeng, dr 514401 Rp 25,000 Rp 50,000 Rp 75,000
12 18-Feb-18 Genice Ivanka, An Eka, dr 313201 Rp 20,000 Rp 50,000 Rp 75,000 Rp 145,000
13 18-Feb-18 M Abdul Hafizh, An Eka, dr 351301 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
14 18-Feb-18 Muhammad Azka, An Eka, dr 896500 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
15 18-Feb-18 Mirza Zakiandra, An Emma, dr 658900 Rp 20,000 Rp 125,000 Rp 145,000
16 18-Feb-18 Nayla Ifra, An Emma, dr 887900 Rp 20,000 Rp 125,000 Rp 145,000
17 18-Feb-18 Muhammad Setiawan, An Emma, dr 298201 Rp 20,000 Rp 125,000 Rp 145,000
18 18-Feb-18 Alif Gibran, An Emma, dr 514801 Rp 25,000 Rp 125,000 Rp 150,000
19 18-Feb-18 Asha Locita, An Eka, dr 514701 Rp 25,000 Rp 50,000 Rp 75,000 Rp 150,000
20 18-Feb-18 Fattan Naufal, An Emma, dr 983000 Rp 20,000 Rp 125,000 Rp 145,000

Total Rp 2,325,000

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 17-Feb-18 Raka Arfareqzi, An Arum, dr 560100 Rp 20,000 Rp 50,000 Rp 70,000

2 18-Feb-18 Cayden Nathanael, An Ajeng, dr 510701 Rp 20,000 Rp 50,000 Rp 75,000 Rp 145,000


3 18-Feb-18 Muhammad Arshad, An Ajeng, dr 421401 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
4 18-Feb-18 Antonius Chrisandy, An Diana, dr 185001 Rp 20,000 FREE Rp 20,000
5 18-Feb-18 Gibran Faiq, An Eka, dr 086001 Rp 20,000 Rp 50,000 Rp 70,000
6 18-Feb-18 Jensen Tjitrowardojo, An Eka, dr 064701 Rp 20,000 Rp 50,000 Rp 30,000 Rp 70,000 Rp 170,000

7 18-Feb-18 Vinsensius Alvaro, An Emma, dr 958600 Rp 20,000 Rp 125,000 Rp 145,000


8 18-Feb-18 Marshella Shaqueena, An Emma, dr 514601 Rp 25,000 Rp 125,000 Rp 150,000
9 18-Feb-18 Nafreya Adha, An Emma, dr 174501 Rp 20,000 Rp 125,000 Rp 145,000
10 18-Feb-18 Jose Jeremia, An Emma, dr 084701 Rp 20,000 Rp 125,000 Rp 75,000 Rp 220,000

Total Rp 1,230,000

Surabaya, 19 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Keterangan
IGD
IGD RJ Rp 2,325,000
IGD ARJ Rp 2,437,700
IGD Rp 4,762,700
IGD, Nebul, By Phone 1x dr
Dini, SpA Px byr d Rp 18,500 Gibran Faiq, An
IGD, Nebul Rp 4,781,200
IGD
IGD, Nebul

IGD
IGD
IGD, Nebul
IGD, Nebul
IGD, Nebul

IGD, Nebul

Keterangan
Ikut RI tagihkan dgn Atharizz
Aisy
D BCA ( IGD, Nebul )
Admedika ( Pertamina )
D BCA
Admedika ( INH )
D BCA ( IGD, Rawat Luka
sedang )
D BCA
D BCA
Admedika ( BNI Life )
Admedika ( Lippo )

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 18 Februari 2018
Tunai
No Tanggal Nama Pasien Apotek Total
1 18-Feb-18 M Fairuzzabadi, An Rp 352,900 Rp 352,900
2 18-Feb-18 Arief Wijaksono, An Rp 96,400 Rp 96,400
3 17-Feb-18 Raka Arfareqzi, An Rp 277,600 Rp 277,600
4 17-Feb-18 Rahmat Hisyam, An Rp 48,200 Rp 48,200
5 18-Feb-18 RS Adi Husada Rp 70,200 Rp 70,200
6 18-Feb-18 Faith Manuel, An Rp 82,700 Rp 82,700
7 18-Feb-18 Nicholas Conrad, An Rp 187,700 Rp 187,700
8 18-Feb-18 Elisawati Rp 54,000 Rp 54,000
9 18-Feb-18 Gavra Corviell, An Rp 125,100 Rp 125,100
10 18-Feb-18 Axelle Marvilio, An Rp 263,700 Rp 263,700
11 18-Feb-18 Gavra Corviell, An Rp 20,600 Rp 20,600
12 18-Feb-18 Maxellino Danko, An Rp 99,200 Rp 99,200
13 18-Feb-18 Marisa Laurina, An Rp 187,200 Rp 187,200
14 18-Feb-18 Erlin Rp 9,100 Rp 9,100
15 18-Feb-18 Genice Ivanka, An Rp 62,600 Rp 62,600
16 18-Feb-18 Raka Rp 10,800 Rp 10,800
17 18-Feb-18 Leily Rp 52,800 Rp 52,800
18 18-Feb-18 Han Han Rp 21,500 Rp 21,500
19 18-Feb-18 Asha Locita, An Rp 212,000 Rp 212,000
20 18-Feb-18 Nayla Ifra, An Rp 96,300 Rp 96,300
21 18-Feb-18 Fattan Naufal, An Rp 13,200 Rp 13,200
22 18-Feb-18 Fattan Naufal, An Rp 93,900 Rp 93,900

Total Rp 2,437,700 Rp 2,437,700

Piutang
No Tanggal Nama Pasien Apotek Total
1 18-Feb-18 Mei Puspitosari Rp 41,300 Rp 41,300
2 18-Feb-18 Muhammad Arshad, An Rp 43,000 Rp 43,000
3 18-Feb-18 Putri Rp 120,000 Rp 120,000
4 18-Feb-18 Antonius Chrisandy, An Rp 1,076,000 Rp 1,076,000
5 18-Feb-18 Gibran Faiq, An Rp 114,900 Rp 114,900
6 18-Feb-18 Jensen Tjitrowardojo, An Rp 20,200 Rp 20,200
7 18-Feb-18 Mirza Zakiandra, An Rp 210,200 Rp 210,200
8 18-Feb-18 Nafreya Adha, An Rp 93,100 Rp 93,100
9 18-Feb-18 Jose Jeremia, An Rp 99,800 Rp 99,800

Total Rp 1,818,500 Rp 1,818,500

Surabaya, 19 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


an
8

Ket

Ket
Piutang Karyawan
Admedika ( Pertamina )
D BRI
D BCA
Admedika ( INH )
D BCA
D BCA
Admedika ( BNI Life )
Admedika ( Lippo )
Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 19-Feb-18 Verve Wang, An Diana, dr 309901 Rp 20,000 Rp 125,000 Rp 145,000
2 19-Feb-18 Emily Samantha, An Anna, dr 558500 Rp 20,000 Rp 939,000 Rp 959,000
3 19-Feb-18 Indira Dhewanti, Ny Eighty, dr 515101 Rp 25,000 FREE Rp 25,000
4 19-Feb-18 M Irsyad, An Diana, dr 515001 Rp 25,000 Rp 125,000 Rp 150,000
5 19-Feb-18 Firza Zaydan, An Diana, dr 515401 Rp 25,000 Rp 125,000 Rp 150,000
6 19-Feb-18 Cayden Nathanael, An Anna, dr 510701 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
7 19-Feb-18 Laras Sukmawati, Ny Rina, dr 496901 Rp 35,000 Rp 40,000 Rp 75,000
8 19-Feb-18 Maximilian Avner, An Diana, dr 482901 CANCEL Rp -
9 19-Feb-18 Philiph Jasson, An Diana, dr 462500 Rp 20,000 Rp 125,000 Rp 145,000
10 19-Feb-18 Azzahra Shaqueena, An Diana, dr 193301 Rp 20,000 Rp 125,000 Rp 38,000 Rp 183,000
11 19-Feb-18 Asri Puspa, Ny Rina, dr 362101 Rp 20,000 Rp 125,000 Rp 145,000
12 19-Feb-18 Emirza Aqshal, An Diana, dr 425000 Rp 20,000 Rp 125,000 Rp 145,000
13 19-Feb-18 Usamah Ubaidillah, An Anna, dr 234401 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
14 19-Feb-18 Hana, Ny Fandy, dr 491801 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
15 19-Feb-18 Kanaya Arsyfa, An Diana, dr 587000 Rp 20,000 Rp 125,000 Rp 145,000
16 19-Feb-18 Dwi Uswatun, Ny Rina, dr 515601 Rp 35,000 Rp 40,000 Rp 75,000
17 19-Feb-18 Arsene Chandra, An Diana, dr 807800 Rp 20,000 Rp 125,000 Rp 145,000
18 19-Feb-18 Alysha Alodia, An Anna, dr 515701 Rp 25,000 Rp 50,000 Rp 38,000 Rp 113,000
19 19-Feb-18 Aira Savina, An Diana, dr 346301 Rp 20,000 Rp 125,000 Rp 145,000
20 19-Feb-18 Firza Zaydan, An Diana, dr 515401 Rp 75,000 Rp 75,000
21 19-Feb-18 Calista elora, An Kartika, dr 387201 Rp 20,000 Rp 125,000 Rp 145,000
22 19-Feb-18 Eil Aeesha, An Kartika, dr 111901 Rp 20,000 Rp 125,000 Rp 145,000
23 19-Feb-18 Amelia Rahardjo, Ny Fandy, dr 332201 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
24 19-Feb-18 Linda Chrestina, Ny Fandy, dr 436801 Rp 20,000 Rp 125,000 Rp 145,000
25 19-Feb-18 Eil Aeesha, An Kartika, dr 111901 Rp 75,000 Rp 75,000
26 19-Feb-18 Rizka Windasari, Ny Fandy, dr 473101 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
27 19-Feb-18 Linda Chrestina, Ny Fandy, dr 436801 Rp 35,000 Rp 40,000 Rp 75,000
28 19-Feb-18 Gevyn Angelo, An Kartika, dr 171801 Rp 20,000 Rp 125,000 Rp 145,000
29 19-Feb-18 Shaffiyah Ufaira, An Kartika, dr 516001 Rp 25,000 Rp 125,000 Rp 150,000
30 19-Feb-18 Sandrina Prameswari, An Kartika, dr 773600 Rp 20,000 Rp 125,000 Rp 145,000
31 19-Feb-18 Ardansyah Ibrahim, An Yusuf, dr 785500 Rp 20,000 Rp 50,000 Rp 75,000 Rp 145,000
32 19-Feb-18 Yanu Gian, Ny Fandy, dr 492301 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
33 19-Feb-18 Ferina Presti, Ny Fandy, dr 435801 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
34 19-Feb-18 Nur Zahro, Ny Fandy, dr 294301 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000

Total Rp 5,500,000

Surabaya, 20 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Keterangan
D BCA
D BCA
KK NIAGA
D BCA
D BCA
D BCA ( Nebul )
D BCA ( USG 2D )
D BCA
D BCA
Admedika ( Lippo )
D BNI
D Mandiri
D BNI ( IGD, Nebul )
D BCA ( USG 2D )
Admedika ( Bni Life )
D BRI ( USG 2D )
D BCA
D MAndiri
Admedika ( Garda )
D BCA ( Nebul )
D BCA
D BCA
Admedika ( OCBC )
D MAndiri
D BCA ( Nebul )
Admedika ( BNI Life )
D Mandiri ( USG 2D )
D BCA
Admedika ( MNC Life )
D BRI
D BCA ( Nebul )
D Mandiri ( USG 2D )
D BCA ( USG 2D )
D Mandiri ( USG 2D )

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 19 Januari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 18-Feb-18 Fitri Noer, Ny Rp 46,500 Rp 46,500
2 19-Feb-18 Rudi Rp 18,100 Rp 18,100
3 19-Feb-18 Aluh Rp 63,600 Rp 63,600
4 19-Feb-18 Intan Irawan, Ny Rp 81,000 Rp 81,000
5 19-Feb-18 Hana Humairah, An Rp 897,000 Rp 897,000
6 19-Feb-18 Hana Humairah, An Rp 35,300 Rp 35,300
7 19-Feb-18 Telge Felisha, An Rp 101,500 Rp 101,500
8 19-Feb-18 Valencia Lovely, An Rp 291,400 Rp 291,400
9 19-Feb-18 Emmanuelle Hanafi, An Rp 80,000 Rp 80,000
10 19-Feb-18 Emmanuelle Hanafi, An Rp 291,400 Rp 291,400
11 19-Feb-18 Ratih Rp 2,600 Rp 2,600
12 19-Feb-18 Asri Puspa, Ny Rp 122,500 Rp 122,500
13 19-Feb-18 Michael Owen, An Rp 174,100 Rp 174,100
14 19-Feb-18 Abdullah Putra, An Rp 785,100 Rp 785,100
15 19-Feb-18 Abdullah Putra, An Rp 42,300 Rp 42,300
16 19-Feb-18 Aida Maghfirih, Ny Rp 566,300 Rp 566,300
17 19-Feb-18 Emirza Aqshal, An Rp 27,600 Rp 27,600
18 19-Feb-18 Vania Adira, An Rp 205,100 Rp 205,100
19 19-Feb-18 Dr Anna Rp 36,400 Rp 36,400
20 19-Feb-18 Sylvia Rp 12,000 Rp 12,000
21 19-Feb-18 Agnes Watiningsih, Ny Rp 68,600 Rp 68,600
22 19-Feb-18 Vania Adira, An Rp 46,100 Rp 46,100
23 19-Feb-18 Darita Agustin, Ny Rp 113,500 Rp 113,500
24 19-Feb-18 Yashinta Marta, Ny Rp 70,800 Rp 70,800
25 19-Feb-18 Felicia Stiwennie, An Rp 383,000 Rp 383,000
26 19-Feb-18 Muhammad Zulfikar, An Rp 38,500 Rp 38,500
27 19-Feb-18 Agatha Djenar, An Rp 405,100 Rp 405,100
28 19-Feb-18 Lucyana Suryaputra, Ny Rp 52,000 Rp 52,000
29 19-Feb-18 Kiki Novritalia, Ny Rp 446,500 Rp 446,500
30 19-Feb-18 Kesper Ganesha, An Rp 480,200 Rp 480,200
31 19-Feb-18 Lilis Nurul, Ny Rp 658,800 Rp 658,800
32 19-Feb-18 Carsten Oliver, An Rp 507,200 Rp 507,200
33 19-Feb-18 Fitri Noer, Ny Rp 64,500 Rp 64,500
34 19-Feb-18 Ardansyah Ibrahim, An Rp 26,400 Rp 26,400
35 19-Feb-18 Singgasana Afifah, An Rp 924,400 Rp 924,400

Total Rp 8,165,400 Rp 8,165,400

Piutang
No Tanggal Nama Pasien Apotek Total
1 19-Feb-18 Laras Sukmawati, Ny Rp 334,000 Rp 334,000
2 19-Feb-18 Philiph Jasson, An Rp 200,900 Rp 200,900
3 19-Feb-18 Azzahra Shaqueena, An Rp 59,500 Rp 59,500
4 19-Feb-18 Verve Wang, An Rp 184,200 Rp 184,200
5 19-Feb-18 M Irsyad, An Rp 130,800 Rp 130,800
6 19-Feb-18 M Irsyad, An Rp 133,600 Rp 133,600
7 19-Feb-18 Kanaya Arsyfa, An Rp 60,100 Rp 60,100
8 19-Feb-18 Arsene Chandra, An Rp 595,000 Rp 595,000
9 19-Feb-18 Dwi Uswatun, Ny Rp 347,300 Rp 347,300
10 19-Feb-18 Aira Savina, An Rp 171,800 Rp 171,800
11 19-Feb-18 Firza Zaydan, An Rp 63,300 Rp 63,300
12 19-Feb-18 Alysha Alodia, An Rp 147,700 Rp 147,700
13 19-Feb-18 Firza Zaydan, An Rp 32,700 Rp 32,700
14 19-Feb-18 Silvia Margaretna, Nn Rp 34,400 Rp 34,400
15 19-Feb-18 Indira Dhewanti, Ny Rp 239,500 Rp 239,500
16 19-Feb-18 Joshepine Gracia, An Rp 1,185,400 Rp 1,185,400
17 19-Feb-18 Eil Aeesha, An Rp 132,000 Rp 132,000
18 19-Feb-18 Alfarizky Putra, An Rp 507,200 Rp 507,200
19 19-Feb-18 Amelia Rahardjo, Ny Rp 151,700 Rp 151,700
20 19-Feb-18 Rizka Windasari, Ny Rp 299,500 Rp 299,500
21 19-Feb-18 Sri Windarti, Ny Rp 466,000 Rp 466,000
22 19-Feb-18 Calista Elora, An Rp 1,185,400 Rp 1,185,400
23 19-Feb-18 Nathanael Adinata, An Rp 924,400 Rp 924,400
24 19-Feb-18 Nathanael Adinata, An Rp 26,400 Rp 26,400
25 19-Feb-18 Linda Chrestina, Ny Rp 455,300 Rp 455,300
26 19-Feb-18 Gevyn Angelo, An Rp 372,200 Rp 372,200
27 19-Feb-18 Ardansyah Ibrahim, An Rp 237,700 Rp 237,700
28 19-Feb-18 Ardansyah Ibrahim, An Rp 29,200 Rp 29,200
29 19-Feb-18 Yanu Gian, Ny Rp 7,400 Rp 7,400
30 19-Feb-18 Sandrina Prameswari, An Rp 225,200 Rp 225,200
31 19-Feb-18 Afiqa Bilqis, An Rp 67,200 Rp 67,200
32 19-Feb-18 Shaffiyah Ufaira, An Rp 149,400 Rp 149,400

Total Rp 9,156,400 Rp 9,156,400

Surabaya, 20 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Apotek Rawat Jalan
Tanggal 19 Januari 2018

Ket

Ket
D BCA
D BCA
Admedika ( Lippo )
D BCA
D BCA
D BCA
Admedika ( Bni Life )
D BCA
D BRI
Admedika ( Garda )
D BCA
D Mandiri
D BCA
Piutang Karyawan
D BCA
D BRI
D BCA
D BCA
Admedika ( OCBC )
Admedika ( BNI Life )
D BRI
D BCA
D Mandiri
D Mandiri
D Mandiri
D BCA
D BCA
D BCA
D Mandiri
D BRI
D BCA
Admedika ( MNC Life )
Laporan Therapy Kebugaran & Pijat Bayi
Tanggal 19 Februari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 19-Feb-18 An. Billy Rp 80,000 Rp 80,000 1223
2 19-Feb-18 Rp -

Total Rp 80,000 Rp 80,000

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 19-Feb-18 Rp -
2 19-Feb-18 Rp -

Total Rp - Rp -

Surabaya, 20 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan
Tanggal 20 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 20-Feb-18 Arief Wijaksono, An Atika, dr 253401 Rp 20,000 Rp 50,000 Rp 75,000 Rp 145,000
2 20-Feb-18 Vania Adira, An Diana, dr 445200 Rp 20,000 Rp 40,000 Rp 60,000
3 20-Feb-18 Joyce Kimmie, An Dini, dr 503501 Rp 20,000 Rp 125,000 Rp 145,000
4 20-Feb-18 Oliver Hiro, An Dini, dr 508201 Rp 20,000 Rp 125,000 Rp 145,000
5 20-Feb-18 Abrisam Muliadi, An Dini, dr 449901 Rp 20,000 Rp 125,000 Rp 145,000
6 20-Feb-18 Ravellius Hazel, An Dini, dr 269801 Rp 20,000 Rp 125,000 Rp 145,000
7 20-Feb-18 Lucyana, Ny Rina, dr 516101 Rp 35,000 Rp 40,000 Rp 75,000
8 20-Feb-18 Christabelle Emanuela, An Dini, dr 766700 Rp 20,000 Rp 125,000 Rp 145,000
9 20-Feb-18 Sulis Nur, Ny Rina, dr 467801 Rp 20,000 Rp 125,000 Rp 145,000
10 20-Feb-18 Sulis Nur, Ny Rina, dr 467801 Rp 40,000 Rp 60,000 Rp 100,000
11 20-Feb-18 Olivia Raeleen, An Dini, dr 198101 Rp 20,000 Rp 125,000 Rp 145,000
12 20-Feb-18 Abhinaya Bachtiar, An Dini, dr 529200 Rp 20,000 Rp 125,000 Rp 145,000
13 20-Feb-18 Mei Puspitosari, Ny Anna, dr 572000 Rp 20,000 Rp 20,000
14 20-Feb-18 Mei Puspitosari, Ny Anna, dr 572000 FREE FREE Rp -
15 20-Feb-18 Selfi Megasari, Ny Dini, dr 516201 Rp 25,000 Rp 125,000 Rp 150,000
16 20-Feb-18 Tri Rejeki, Ny Fandy, dr 033900 Rp 20,000 Rp 125,000 Rp 145,000
17 20-Feb-18 Galang Kenzie, An Anna, dr 717100 Rp 20,000 Rp 50,000 Rp 70,000
18 20-Feb-18 Agustina Putri, Ny Erna, dr 389601 Rp 20,000 Rp 125,000 Rp 145,000
19 20-Feb-18 Nabila Ramadhani, An Kartika, dr 733600 Rp 20,000 Rp 125,000 Rp 145,000
20 20-Feb-18 Tri Rejeki, Ny Fandy, dr 033900 Rp 35,000 Rp 40,000 Rp 75,000
21 20-Feb-18 Qenan Zlatan, An Dini, dr 289701 Rp 20,000 Rp 125,000 Rp 145,000
22 20-Feb-18 Isna Farikha, Ny Erna, dr 201401 Rp 20,000 Rp 125,000 Rp 145,000
23 20-Feb-18 Andi Chaerunnisa, Ny Fandy, dr 516301 Rp 25,000 Rp 125,000 Rp 150,000
24 20-Feb-18 Attaraqqie Saleem, An Dini, dr 484701 Rp 20,000 Rp 125,000 Rp 145,000
25 20-Feb-18 Kannasya Shalanda, An Dini, dr 083101 Rp 20,000 Rp 125,000 Rp 145,000
26 20-Feb-18 Edenzo Grant, An Mahe, dr 477801 Rp 20,000 Rp 125,000 Rp 145,000
27 20-Feb-18 Thorikul Haq, An Dini, dr 353201 Rp 20,000 Rp 125,000 Rp 145,000
28 20-Feb-18 Muhammad Fabian, An Dini, dr 506201 Rp 20,000 Rp 125,000 Rp 145,000
29 20-Feb-18 Magnus Jason, An Dini, dr 506001 Rp 20,000 Rp 125,000 Rp 80,000 Rp 225,000
30 20-Feb-18 Rafardhan Arzahanka,An Kartika, dr 323001 Rp 20,000 Rp 125,000 Rp 145,000
31 20-Feb-18 Kanaya Rafanda, An Rohim, dr 507001 Rp 20,000 Rp 125,000 Rp 145,000
32 20-Feb-18 Siti Ratna, Ny Kartika, dr 516601 Rp 25,000 FREE Rp 25,000
33 20-Feb-18 Chloe Madeine, An Mahe, dr 228101 Rp 20,000 Rp 125,000 Rp 145,000
34 20-Feb-18 Almayra Ainur, An Mahe, dr 029501 Rp 20,000 Rp 125,000 Rp 145,000
35 20-Feb-18 Sri Wahyuningsih, Ny Erna, dr 516701 Rp 25,000 Rp 125,000 Rp 150,000
36 20-Feb-18 Azkayra Sitara, An Leny, dr 3074011 Rp 20,000 Rp 125,000 Rp 145,000
37 20-Feb-18 Muhammad Fabian, An Dini, dr 506201 Rp 80,000 Rp 80,000
38 20-Feb-18 Timothy Wang, An Mahe, dr 262001 Rp 20,000 Rp 125,000 Rp 145,000
39 20-Feb-18 Vanessa Wang, An Mahe, dr 501601 Rp 20,000 Rp 125,000 Rp 145,000
40 20-Feb-18 Hayva Harzana, An Kartika, dr 419201 Rp 20,000 Rp 125,000 Rp 145,000
41 20-Feb-18 Ibadillah Hiro, An Mahe, dr 039701 Rp 20,000 Rp 125,000 Rp 145,000
42 20-Feb-18 Senja Siti, Ny Erna, dr 413800 Rp 20,000 Rp 125,000 Rp 145,000
43 20-Feb-18 Mochamad Darel, An Leny, dr 219501 Rp 20,000 Rp 125,000 Rp 145,000
44 20-Feb-18 Dylan Angelo, An Rohim, dr 366601 Rp 20,000 Rp 125,000 Rp 145,000
45 20-Feb-18 Chnitya Ardellia, Ny Erna, dr 506301 Rp 20,000 Rp 125,000 Rp 145,000
46 20-Feb-18 Sagita Indra, Ny Erna, dr 581000 Rp 20,000 Rp 125,000 Rp 145,000
47 20-Feb-18 Sri Wahyuningsih, Ny Erna, dr 516701 Rp 45,000 Rp 40,000 Rp 85,000
48 20-Feb-18 Dwi Ayu, Ny Erna, dr 516501 FREE FREE Rp -
49 20-Feb-18 HJ Siti Alfiyah, Ny Erna, dr 274201 Rp 20,000 Rp 125,000 Rp 145,000
50 20-Feb-18 Jeremy Zivsean, An Leny, dr 939500 Rp 20,000 Rp 125,000 Rp 145,000
51 20-Feb-18 Florencia Pauzil, Ny Erna, dr 007700 Rp 20,000 Rp 125,000 Rp 145,000
52 20-Feb-18 Agustina Putri, Ny Erna, dr 389601 Rp 35,000 Rp 40,000 Rp 75,000
53 20-Feb-18 HJ Siti Alfiyah, Ny Erna, dr 274201 Rp 602,000 Rp 602,000
54 20-Feb-18 M. Abdul Rokhman, An Rohim, dr 065701 Rp 20,000 Rp 125,000 Rp 145,000
55 20-Feb-18 Anita Widyaningtyas, Ny Erna, dr 316201 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
56 20-Feb-18 Dara Fitria, Ny Erna, dr 517101 Rp 25,000 Rp 325,000 Rp 375,000 Rp 725,000
57 20-Feb-18 Windy Zuhrufatu,Ny Erna, dr 517201 Rp 25,000 Rp 125,000 Rp 150,000
58 20-Feb-18 Alkafi Rizky, An Rohim, dr 410601 Rp 20,000 Rp 125,000 Rp 145,000
59 20-Feb-18 Gaven Leets, An Rohim, dr 509001 Rp 20,000 Rp 125,000 Rp 145,000
60 20-Feb-18 Celine Angelina, An Mahe, dr 354401 Rp 20,000 Rp 125,000 Rp 145,000
61 20-Feb-18 Sagita Indra, Ny Erna, dr 581000 Rp 35,000 Rp 40,000 Rp 75,000
62 20-Feb-18 HJ Siti Alfiyah, Ny Erna, dr 274201 Rp 35,000 Rp 40,000 Rp 75,000
63 20-Feb-18 Florencia Pauzil, Ny Erna, dr 007700 Rp 35,000 Rp 40,000 Rp 75,000
64 20-Feb-18 Dahlia Intan, Ny Gatut, dr 177201 Rp 35,000 Rp 40,000 Rp 75,000
65 20-Feb-18 Andreas Wilkins, An Sufiandika, dr 824500 Rp 20,000 Rp 50,000 Rp 70,000
66 20-Feb-18 Corry Mile, Ny Erna, dr 517001 Rp 35,000 Rp 40,000 Rp 75,000
67 20-Feb-18 Windy Zuhrufatu,Ny Erna, dr 517201 Rp 35,000 Rp 40,000 Rp 75,000
68 20-Feb-18 Ivana Nadmi, An Mahe, dr 507401 Rp 20,000 Rp 125,000 Rp 145,000
69 20-Feb-18 Azzahra Shaqueena, An Diana, dr 193301 Rp 20,000 Rp 250,000 Rp 270,000
Total Rp 9,772,000

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 20-Feb-18 Citra Dewi, Ny Erna, dr 455601 Rp 20,000 Rp 125,000 Rp 145,000
2 20-Feb-18 Lucyana, Ny Rina, dr 516101 Rp 20,000 Rp 125,000 Rp 145,000
3 20-Feb-18 Fattan Naufal, An Dini, dr 983000 Rp 20,000 Rp 125,000 Rp 554,000 Rp 699,000
4 20-Feb-18 Muhammad Rayyan, An Dini, dr 537100 Rp 20,000 Rp 125,000 Rp 145,000
5 20-Feb-18 Santi Kusumaningdiyah, Ny Erna, dr 040000 Rp 20,000 Rp 125,000 Rp 145,000
6 20-Feb-18 Andi Chaerunnisa, Ny Fandy, dr 516301 Rp 35,000 Rp 40,000 Rp 75,000
7 20-Feb-18 Abigail Natalia, An Anna, dr 441901 Rp 20,000 Rp 75,000 Rp 95,000
8 20-Feb-18 Indah Roospitowati, Nn Fandy, dr 038501 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
9 20-Feb-18 Ravellius Hazel, An Dini, dr 269801 Rp 75,000 Rp 75,000
10 20-Feb-18 Annisa Nur, An Kartika, dr 816100 Rp 20,000 FREE Rp 20,000
11 20-Feb-18 George Ananta, An Dini, dr 337001 Rp 20,000 Rp 125,000 Rp 145,000
12 20-Feb-18 Gibran Faiq, An Dini, dr 086001 Rp 20,000 Rp 125,000 Rp 145,000
13 20-Feb-18 Alexader Troy, An Dini, dr 477301 Rp 20,000 Rp 125,000 Rp 145,000
14 20-Feb-18 Azahra Safa, An Kartika, dr 171301 Rp 20,000 Rp 125,000 Rp 145,000
15 20-Feb-18 Muhammad Arsyad, An Dini, dr 421401 Rp 20,000 Rp 125,000 Rp 145,000
16 20-Feb-18 Adhitama Arya, An Mahe, dr 239701 Rp 20,000 Rp 125,000 Rp 145,000
17 20-Feb-18 Hamka Syafiq, An Kartika, dr 058701 Rp 20,000 Rp 125,000 Rp 145,000
18 20-Feb-18 Caroline Jovanka, An Dini, dr 866300 Rp 20,000 Rp 125,000 Rp 145,000
19 20-Feb-18 Ahsan Fausto, An Leny, dr 505701 Rp 20,000 Rp 125,000 Rp 145,000
20 20-Feb-18 Femi Noviasafitri, Ny Erna, dr 363601 Rp 20,000 Rp 125,000 Rp 145,000
21 20-Feb-18 Falisha Oyku, An Leny, dr 210701 Rp 20,000 Rp 125,000 Rp 145,000
22 20-Feb-18 Miranti Dhora, Ny Erna, dr 280801 Rp 20,000 Rp 125,000 Rp 145,000
23 20-Feb-18 Muhammad Rayyan, An Dini, dr 537100 Rp 266,000 Rp 266,000
24 20-Feb-18 Galang Kenzie, An Kartika, dr 717100 Rp 125,000 Rp 125,000
25 20-Feb-18 Citra Dewi, Ny Erna, dr 455601 Rp 35,000 Rp 40,000 Rp 75,000
26 20-Feb-18 Godric Genesy, An Kartika, dr 430601 Rp 20,000 Rp 125,000 Rp 145,000
27 20-Feb-18 Sofia Humayra, An Kartika, dr 683300 Rp 20,000 Rp 125,000 Rp 145,000
28 20-Feb-18 Galang Kenzie, An Kartika, dr 717100 Rp 597,000 Rp 597,000
29 20-Feb-18 Corry Mile, Ny Erna, dr 517001 Rp 25,000 Rp 125,000 Rp 150,000
30 20-Feb-18 Relenzo Carlen, An Leny, dr 729900 Rp 20,000 Rp 125,000 Rp 145,000
31 20-Feb-18 Philip Dave, An Rohim,dr 952200 Rp 20,000 Rp 125,000 Rp 145,000
32 20-Feb-18 Jonathan Aletrien, An Leny, dr 327701 Rp 20,000 Rp 125,000 Rp 145,000
33 20-Feb-18 Fardhan Rizki, An Mahe, dr 430101 Rp 20,000 Rp 125,000 Rp 145,000
34 20-Feb-18 Fadhil Rizki, An Mahe, dr 430001 Rp 20,000 Rp 125,000 Rp 145,000
35 20-Feb-18 Alvaro Gavriel, An Mahe, dr 156701 Rp 20,000 Rp 125,000 Rp 145,000
36 20-Feb-18 Santi Kusumaningdiyah, Ny Erna, dr 040000 Rp 35,000 Rp 40,000 Rp 75,000
37 20-Feb-18 Dahlia Intan, Ny Gatut, dr 177201 Rp 20,000 Rp 125,000 Rp 145,000
38 20-Feb-18 Christable Valencia, An Mahe, dr 271301 Rp 20,000 Rp 125,000 Rp 145,000
39 20-Feb-18 Marc Wynstan, An Mahe, dr 475401 Rp 20,000 Rp 125,000 Rp 145,000
40 20-Feb-18 Aldrian Pradipta, An Mahe, dr 887100 Rp 20,000 Rp 125,000 Rp 145,000
41 20-Feb-18 Kaylee Angeline, An Mahe, dr 286501 Rp 20,000 Rp 125,000 Rp 145,000
42 20-Feb-18 Elly Purnamasari, An Dini, dr 107300 Rp 40,000 Rp 40,000
43 20-Feb-18 Eka, dr Rp 25,000 Rp 50,000 Rp 75,000
Marco Dylan, An 517401
44 20-Feb-18 Mahe, dr Rp 125,000 Rp 125,000
45 20-Feb-18 Humairah Fitriana, Ny Erna, dr 032501 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
46 20-Feb-18 Adlan Rafa, An Mahe, dr 487901 Rp 20,000 Rp 125,000 Rp 145,000
47 20-Feb-18 Kenneth Marvelino, An Mahe, dr 235701 Rp 20,000 Rp 125,000 Rp 145,000
48 20-Feb-18 Elly Purnamasari, An Dini, dr 107300 Rp 125,000 Rp 125,000
49 20-Feb-18 Isna Farikha, Ny Erna, dr 201401 CANCEL Rp -

Total Rp 7,552,000

Surabaya, 21 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


an
2018

Keterangan
IGD, Nebul RJ Rp 9,772,000
ARJ Rp 8,539,400
Rp 18,311,400
TB Rp 75,000
Rp 18,386,400
BS ARJ Rp (33,000) An. Nabila
USG 2D Rp 18,353,400
P Rp 940,000
Rp 19,293,400
USG 2D BS RJ Rp (125,000) An. Annisa
Rp 19,168,400
RJG Rp 445,000
Disc 20 % Rp 19,613,400
Px byr Rp 22,000 Humairah Fitriana, Ny
Klinik Laktasi Rp 19,635,400
BS RJ Rp (75,000) Isna Farikha, Ny
IGD Rp 19,560,400

USG 2D

Klinik Laktasi
USG 2D, Print 1X
Karyawan

USG 2D

USG 2D
USG 4D

USG 2D
USG 2D
USG 2D
USG 2D
IGD
USG 2D
USG 2D
Keterangan
D BCA
D BCA
KK BCA
D Mandiri
D BNI
D BRI ( USG 2D )
D BCA ( Tindik Bayi )
D BCA ( USG 2D )
D BCA ( Nebul )
D Mandiri
D BCA
Admedika ( Mandiri INH ) D BCA Rp 41.000
D BCA
D BCA
Admedika ( Pertamina )
D BCA
D Mandiri
D BCA
D BCA
D BCA
D Mandiri
D Mandiri
D BCA
D BCA
D BCA ( USG 2D )
D BCA
Admedika ( Smartcare )
D BCA
D BCA
Admedika ( INH ) D Mandiri Rp 35.900
D BCA
D BCA
D BCA
D BCA
D BCA
D BNI (USG 2D)
D BCA
D BCA
D BCA
D Mandiri
D BCA
D BCA
D BCA ( IGD )
D BCA
Admedika ( FWD )
D BRI ( USG 2D )
D BCA
D MAndiri
D BNI (USG 2D)

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotik Rawat Jalan
Tanggal 20 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total Ket
1 20-Feb-18 Arief Wijaksono, An Rp 40,100 Rp 40,100
2 20-Feb-18 Azzahra Rp 37,500 Rp 37,500
3 20-Feb-18 Azzahra Rp 59,500 Rp 59,500
4 20-Feb-18 Lucyana, Ny Rp 76,700 Rp 76,700
5 20-Feb-18 Sulis Nur, Ny Rp 113,500 Rp 113,500
6 18-Feb-18 Mei Puspitosari, Ny Rp 41,300 Rp 41,300 Karyawan
7 20-Feb-18 Mei Puspitosari, Ny Rp 18,800 Rp 18,800 Karyawan
8 20-Feb-18 Tri Rejeki, Ny Rp 205,200 Rp 205,200
9 20-Feb-18 Abrisam Muliadi, An Rp 28,900 Rp 28,900
10 20-Feb-18 Ravellius Hazel, An Rp 6,100 Rp 6,100
11 20-Feb-18 Melisa Rp 115,600 Rp 115,600
12 20-Feb-18 Olivia Raeleen,An Rp 200,800 Rp 200,800
13 20-Feb-18 Olivia Raeleen,An Rp 37,700 Rp 37,700
14 20-Feb-18 Abhiya Bachtiar, An Rp 299,500 Rp 299,500
15 20-Feb-18 Ely Rp 26,300 Rp 26,300
16 20-Feb-18 Nabila Ramadhani, An Rp 46,600 Rp 46,600
17 20-Feb-18 Hayva Harzana, An Rp 27,700 Rp 27,700
18 20-Feb-18 Hayva Harzana, An Rp 924,400 Rp 924,400
19 20-Feb-18 Mochamad Darel, An Rp 105,500 Rp 105,500
20 20-Feb-18 Selfi Megasari, Ny Rp 122,500 Rp 122,500
21 20-Feb-18 Thorikul Haq, An Rp 595,000 Rp 595,000
22 20-Feb-18 Siti Ratna, Ny Rp 89,500 Rp 89,500
23 20-Feb-18 Siti Ratna, Ny Rp 2,500 Rp 2,500
24 20-Feb-18 Azkayra Sitara, An Rp 913,200 Rp 913,200
25 4-Feb-18 Miranda Rp 4,100 Rp 4,100
26 20-Feb-18 Femi Noviasafitri, Ny Rp 216,500 Rp 216,500
27 20-Feb-18 Azkayra Sitara, An Rp 124,800 Rp 124,800
28 20-Feb-18 Anita Widyaningtyas, Ny Rp 487,000 Rp 487,000
29 20-Feb-18 Mei Puspitosari, Ny Rp 33,900 Rp 33,900
30 20-Feb-18 Felicia Rp 109,700 Rp 109,700
31 20-Feb-18 Sagita Indra, Ny Rp 299,300 Rp 299,300
32 20-Feb-18 Chloe Madeine, An Rp 548,800 Rp 548,800
33 20-Feb-18 Chloe Madeine, An Rp 10,600 Rp 10,600
34 20-Feb-18 HJ Siti Alfiyah, Ny Rp 286,000 Rp 286,000
35 20-Feb-18 Edenzo Grant, An Rp 82,300 Rp 82,300
36 20-Feb-18 Alkafi Rizky, An Rp 108,200 Rp 108,200
37 20-Feb-18 Almahyra Ainur, An Rp 507,200 Rp 507,200
38 20-Feb-18 Gaven Leets, An Rp 61,200 Rp 61,200
39 20-Feb-18 M. Abdul Rokhman, An Rp 141,600 Rp 141,600
40 20-Feb-18 Adhitama Arya, An Rp 548,800 Rp 548,800
41 20-Feb-18 Felicia Rp 17,400 Rp 17,400
42 20-Feb-18 Humairah Fitriana, Ny Rp 60,200 Rp 60,200
43 20-Feb-18 Celine Angelina, An Rp 595,000 Rp 595,000
44 20-Feb-18 Andreas Wilkins, An Rp 131,300 Rp 131,300
45 20-Feb-18 Aldrian Pradipta, An Rp 31,000 Rp 31,000
45 20-Feb-18 Ibadillah Hiro, An Rp 100 Rp 100 Pelunasan

Total Rp 8,539,400 Rp 8,539,400

Piutang
No Tanggal Nama Pasien Apotek Total Ket
1 20-Feb-18 Nunik Woro, Ny Rp 11,700 Rp 11,700 D Mandiri
2 20-Feb-18 Andi Chaerunnisa, Ny Rp 201,000 Rp 201,000 D BRI
3 20-Feb-18 Ravellius Hazel, An Rp 375,300 Rp 375,300 D BCA
4 20-Feb-18 Kannasya Shalanda, An Rp 821,000 Rp 821,000 D MAndiri
5 20-Feb-18 Kannasya Shalanda, An Rp 45,100 Rp 45,100 D MAndiri
6 20-Feb-18 Christabelle Emanuela, An Rp 595,000 Rp 595,000 D BCA
7 20-Feb-18 Gibran Faiq, An Rp 265,000 Rp 265,000 Admedika ( Mandiri INH )
8 20-Feb-18 Alexader Troy, An Rp 82,300 Rp 82,300 D BCA
9 20-Feb-18 Azahra Safa, An Rp 145,200 Rp 145,200 KK BCA
10 20-Feb-18 Laily Rp 118,200 Rp 118,200 D BCA
11 20-Feb-18 Muhammad Arsyad, An Rp 161,900 Rp 161,900 Admedika ( Pertamina )
12 20-Feb-18 Nabila Ramadhani, An Rp 921,800 Rp 921,800 D Mandiri
13 20-Feb-18 Nabila Ramadhani, An Rp 111,800 Rp 111,800 D Mandiri
14 20-Feb-18 Nabila Ramadhani, An Rp 125,400 Rp 125,400 D Mandiri
15 20-Feb-18 Hamka Syafiq, An Rp 40,800 Rp 40,800 D Mandiri
16 20-Feb-18 Muhammad Rayyan, An Rp 184,300 Rp 184,300 D BCA
17 20-Feb-18 Falisha Oyku, An Rp 821,000 Rp 821,000 D Mandiri
18 20-Feb-18 Caroline Jovanka, Anm Rp 68,000 Rp 68,000 D BCA
19 20-Feb-18 Annisa Nur, An Rp 595,000 Rp 595,000 D BCA
20 20-Feb-18 Godric Genesy, An Rp 803,800 Rp 803,800 D BCA
21 20-Feb-18 George Ananta, An Rp 375,400 Rp 375,400 D BCA
22 20-Feb-18 Galang Kenzie, An Rp 289,800 Rp 289,800 D BCA
23 20-Feb-18 Sofia Humayra, An Rp 209,200 Rp 209,200 Admedika ( Smartcare )
24 20-Feb-18 Jeremy Zivsean, An Rp 507,200 Rp 507,200 D BCA
25 20-Feb-18 Relenzo Carlen, An Rp 213,500 Rp 213,500 Admedika (INH )
26 20-Feb-18 Jonathan Rp 24,800 Rp 24,800 D BCA
27 20-Feb-18 Ibadillah Hiro, An Rp 507,100 Rp 507,100 D BCA
28 20-Feb-18 Santi Kusumaningdiyah, Ny Rp 254,500 Rp 254,500 D BNI
29 20-Feb-18 Fardhan Rizki, An Rp 225,200 Rp 225,200 D BCA
30 20-Feb-18 Fardhil Rizki, An Rp 225,200 Rp 225,200 D BCA
31 20-Feb-18 Timothy Wang, An Rp 548,800 Rp 548,800 D BCA
32 20-Feb-18 Christable Valencia, An Rp 225,200 Rp 225,200 D BCA
33 20-Feb-18 Nia Rp 13,800 Rp 13,800 Piutang Karyawan
34 20-Feb-18 Marco Dylan, An Rp 309,400 Rp 309,400 D BCA
35 20-Feb-18 Sarah Rp 393,000 Rp 393,000 D BCA
36 20-Feb-18 Alvaro Gavriel, An Rp 204,700 Rp 204,700 D BCA
37 20-Feb-18 Marc Wynstan, An Rp 82,300 Rp 82,300 D BCA
38 20-Feb-18 Kenneth Marvelino, An Rp 921,800 Rp 921,800 D BCA
39 20-Feb-18 Kaylee Angeline, An Rp 785,100 Rp 785,100 D BCA
40 20-Feb-18 Elly Purnamasari, An Rp 38,500 Rp 38,500 D MAndiri
41 20-Feb-18 Elly Purnamasari, An Rp 99,000 Rp 99,000 D MAndiri
42 20-Feb-18 Adlan Rafa, An Rp 335,800 Rp 335,800 KK Citi

Total Rp 13,282,900 Rp 13,282,900

Surabaya, 21 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Rp 507200
Laporan Rawat Jalan Gigi
Tanggal 20 Februari 2018
Tunai
No Tanggal Nama Pasien No. RM No. Operator Poli Jasa Dokter Tindakan Total Keterangan
1 20-Feb-18 Endro Adi, Tn 695300 Lila, dr Rp 20,000 Rp 300,000 Rp 320,000
2 20-Feb-18 Sri Prihatita, Ny 517301 Lila, dr Rp 25,000 Rp 100,000 Rp 125,000

Total Rp 445,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 20-Feb-18 Indrawati Purwaningrum, Ny 184601 Nadia, dr Rp 20,000 Rp 360,000 Rp 380,000 D BCA ( Disc 10% )
2 20-Feb-18 Rp -

Total Rp 380,000

Surabaya, 22 Februari 2018

Penyetor Mengetahui,
Penerima

Ika
Rini Wahyuningati
Laporan Therapy Kebugaran & Pijat Bayi
Tanggal 20 Februari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 20-Feb-18 An. Dwita Rp 80,000 Rp 80,000 1224
2 20-Feb-18 An. Aira Rp 800,000 Rp 800,000 1225
3 20-Feb-18 An. Reyhan Rp 60,000 Rp 60,000 1226

Total Rp 940,000 Rp 940,000

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 20-Feb-18 Rp -
2 20-Feb-18 Rp -

Total Rp - Rp -

Surabaya, 23 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Laporan Rawat Jalan
Tanggal 21 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 20-Feb-18 Syakira Azmi, An Sufiandika, dr 517501 Rp 25,000 Rp 50,000 Rp 75,000 Rp 150,000
2 21-Feb-18 Dicky Febriantino, Tn Sufiandika, dr 517601 Rp 25,000 Rp 50,000 Rp 75,000
3 21-Feb-18 Ghany Nevaeh, An Diana, dr 412900 Rp 20,000 Rp 125,000 Rp 145,000
4 21-Feb-18 Reagan Danilo, An Diana, dr 360401 Rp 20,000 Rp 125,000 Rp 145,000
5 21-Feb-18 Nicholas Jason, An Diana, dr 934300 Rp 20,000 Rp 125,000 Rp 145,000
6 21-Feb-18 Kania Aira, AN Diana, dr 260601 Rp 20,000 Rp 125,000 Rp 145,000
7 21-Feb-18 Ibrahim Hanif, An Diana, dr 398601 Rp 20,000 Rp 125,000 Rp 145,000
8 21-Feb-18 M. Abdul Hafiz, An Anna, dr 351301 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
9 21-Feb-18 Ika Musriana, Ny Dhini, dr 518201 Rp 25,000 Rp 125,000 Rp 150,000
10 21-Feb-18 Rich Maxmillian, An Diana, dr 351701 Rp 20,000 Rp 125,000 Rp 145,000
11 21-Feb-18 Vania Adira, An Diana, dr 445200 CANCEL Rp -
12 21-Feb-18 Mujiati, Ny Fandy, dr 518001 Rp 25,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 225,000
13 21-Feb-18 Manuel Evander, AN Diana, dr 961900 Rp 20,000 Rp 125,000 Rp 145,000
14 21-Feb-18 Adzril Faizi, An Diana, dr 236101 Rp 20,000 FREE Rp 20,000
15 21-Feb-18 Kyara Queenadiva, An Diana, dr 311701 Rp 20,000 FREE Rp 20,000
16 21-Feb-18 Aldilah Riatrisna, Ny Dhini, dr 017600 Rp 35,000 Rp 40,000 Rp 75,000
17 21-Feb-18 Ika Musriana, Ny Dhini, dr 518201 Rp 35,000 Rp 40,000 Rp 75,000
18 21-Feb-18 Miya Octavianti, Ny Dhini, dr 455101 FREE FREE Rp -
19 21-Feb-18 Aisyah Ayudia, An Diana, dr 526800 Rp 20,000 FREE Rp 20,000
20 21-Feb-18 Sakha Faith, An Diana, dr 570200 Rp 20,000 FREE Rp 20,000
21 21-Feb-18 Haidar Bagas, An Diana, dr 388001 Rp 20,000 FREE Rp 20,000
22 21-Feb-18 Kelcey Severine, An Diana, dr 494401 Rp 20,000 Rp 125,000 Rp 75,000 Rp 220,000
23 21-Feb-18 M. Luki Rajendra, An Diana, dr 299900 Rp 20,000 Rp 125,000 Rp 145,000
24 21-Feb-18 M. Ilham Mahendra, An Diana, dr 819900 Rp 20,000 Rp 125,000 Rp 145,000
25 21-Feb-18 Alden Gavriel, An Diana, dr 420500 Rp 20,000 Rp 125,000 Rp 145,000
26 21-Feb-18 Elok Anggrayni, Ny Erna, dr 439500 Rp 20,000 Rp 125,000 Rp 145,000
27 21-Feb-18 Wiwit Safitri, Ny Erna, dr 696500 Rp 20,000 Rp 125,000 Rp 145,000
28 21-Feb-18 Shirra Bianca, Ny Eighty, dr 508101 Rp 20,000 Rp 125,000 Rp 145,000
29 21-Feb-18 Ika Permana, Ny Rina, dr 518501 Rp 25,000 Rp 125,000 Rp 150,000
30 21-Feb-18 Ravellius Hazel, An Atika, dr 269801 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
31 21-Feb-18 Ika Permana, Ny Rina, dr 518501 Rp 45,000 Rp 40,000 Rp 85,000
32 21-Feb-18 Shirra Bianca, Ny Eighty, dr 508101 Rp 100,000 Rp 100,000
33 21-Feb-18 Ahmad Uwais, An Emma, dr 265501 Rp 20,000 Rp 125,000 Rp 145,000
34 21-Feb-18 Nifsil Mufidah, Ny Erna, dr 142801 Rp 20,000 Rp 125,000 Rp 145,000
35 21-Feb-18 Hanania Alisha, An Emma, dr 452301 Rp 20,000 Rp 125,000 Rp 145,000
36 21-Feb-18 Elok Anggrayni, Ny Erna, dr 439500 Rp 45,000 Rp 40,000 Rp 85,000
37 21-Feb-18 Atina Irani, Ny Erna, dr 253001 Rp 20,000 FREE Rp 35,000 Rp 40,000 Rp 95,000
38 21-Feb-18 Kanaya Antari, An Emma, dr 727400 Rp 20,000 Rp 125,000 Rp 145,000
39 21-Feb-18 Arinditia Triasti, Ny Erna, dr 341801 Rp 20,000 Rp 325,000 Rp 375,000 Rp 720,000
40 21-Feb-18 adzkiya Azzahra, An Emma, dr 087001 Rp 20,000 Rp 200,000 Rp 220,000
41 21-Feb-18 Sujarwati, Ny Erna, dr 462001 Rp 20,000 Rp 125,000 Rp 145,000
42 21-Feb-18 Atyananda Yusuf, An Emma, dr 057400 Rp 20,000 Rp 125,000 Rp 145,000
43 21-Feb-18 Allen Laurell, Ny Erna, dr 518701 Rp 35,000 Rp 40,000 Rp 75,000
44 21-Feb-18 Debby Indah, Ny Fandy, dr 381201 Rp 20,000 Rp 125,000 Rp 145,000
45 21-Feb-18 Devi Sarah, Ny Erna, dr 481601 Rp 35,000 Rp 40,000 Rp 75,000
46 21-Feb-18 Sujarwati, Ny Erna, dr 462001 Rp 35,000 Rp 40,000 Rp 75,000
47 21-Feb-18 Adzril Faizi, An Diana, dr 236101 Rp 30,400 Rp 30,400
48 21-Feb-18 Debby Indah, Ny Fandy, dr 381201 Rp 35,000 Rp 40,000 Rp 75,000
49 21-Feb-18 Nurul Azizah, Ny Fandy, dr 859900 Rp 35,000 Rp 40,000 Rp 75,000
50 21-Feb-18 Kanaya Antari, An Atika, dr 727400 Rp 75,000 Rp 75,000

Total Rp 6,095,400

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 21-Feb-18 Velerie Dawn, An Diana, dr 312701 Rp 20,000 Rp 125,000 Rp 145,000
2 21-Feb-18 Ie Gracelyn, An Diana, dr 510301 Rp 20,000 Rp 125,000 Rp 145,000
3 21-Feb-18 Sinandhasa Manggala, An Diana, dr 371601 Rp 20,000 Rp 125,000 Rp 145,000
4 21-Feb-18 Maximilian Avner, AN Diana, dr 482901 Rp 20,000 Rp 125,000 Rp 145,000
5 21-Feb-18 Blessio Brandon, An Diana, dr 620500 Rp 20,000 Rp 125,000 Rp 145,000
6 21-Feb-18 Velika Felicia, An Diana, dr 271101 Rp 20,000 Rp 125,000 Rp 145,000
7 21-Feb-18 Pramita Devi, Ny Rina, dr 436501 Rp 20,000 Rp 125,000 Rp 145,000
8 21-Feb-18 Tjio Tjai, Ny Rina, dr 518101 Rp 25,000 Rp 125,000 Rp 245,000 Rp 395,000
9 21-Feb-18 Pramita Devi, Ny Rina, dr 436501 Rp 35,000 Rp 40,000 Rp 75,000
10 21-Feb-18 Natanael Prayoga, An Diana, dr 387501 Rp 20,000 Rp 125,000 Rp 145,000
11 21-Feb-18 Aldilah Riatrisna, Ny Dhini, dr 017600 Rp 20,000 Rp 125,000 Rp 145,000
12 21-Feb-18 Vania Adira, An Diana, dr 445200 CANCEL Rp -
13 21-Feb-18 Mikka Sandriana. Ny Fandy, dr 434001 Rp 20,000 Rp 125,000 Rp 145,000
14 21-Feb-18 Michelle Joycelyn, An Diana, dr 265801 Rp 20,000 Rp 125,000 Rp 145,000
15 21-Feb-18 Mikka Sandriana. Ny Fandy, dr 434001 Rp 35,000 Rp 40,000 Rp 75,000
16 21-Feb-18 Elvedh Hugo, An Diana, dr 201700 Rp 20,000 Rp 125,000 Rp 145,000
17 21-Feb-18 Ahmad Harya, An Diana, dr 035401 Rp 20,000 Rp 125,000 Rp 145,000
18 21-Feb-18 Blessio Brandon, An Diana, dr 620500 Rp 872,000 Rp 872,000
19 21-Feb-18 Melvin Regan, An Diana, dr 250201 Rp 20,000 Rp 125,000 Rp 145,000
20 21-Feb-18 Arka Bima, An Diana, dr 284300 Rp 20,000 Rp 125,000 Rp 145,000
21 21-Feb-18 Adzril Faizi, An Diana, dr 236101 Rp 38,000 Rp 38,000
22 21-Feb-18 Ferina Fauzy, Ny Erna, dr 341401 Rp 20,000 Rp 125,000 Rp 145,000
23 21-Feb-18 Ayu Masfufah, Ny Erna, dr 230101 Rp 20,000 Rp 125,000 Rp 145,000
24 21-Feb-18 Erlin Erviana, Nn Atika, dr 518601 Rp 119,200 Rp 119,200
25 21-Feb-18 Mutia Nur, Ny Erna, dr 551800 Rp 20,000 Rp 125,000 Rp 145,000
26 21-Feb-18 Allen Laurell, Ny Erna, dr 518701 Rp 25,000 Rp 125,000 Rp 150,000
27 21-Feb-18 Cynthia Ivana, Ny Erna, dr 982700 Rp 20,000 Rp 125,000 Rp 100,000 Rp 450,000 Rp 695,000
28 21-Feb-18 Ferina Fauzy, Ny Erna, dr 341401 Rp 35,000 Rp 40,000 Rp 75,000
29 21-Feb-18 Mutia Nur, Ny Erna, dr 551800 Rp 35,000 Rp 40,000 Rp 75,000
30 21-Feb-18 Axelle Marvilio, An Emma, dr 747900 Rp 20,000 Rp 125,000 Rp 145,000
31 21-Feb-18 Tjia Nathasya, Ny Erna, dr 518801 Rp 25,000 Rp 125,000 Rp 185,000 Rp 40,000 Rp 375,000
32 21-Feb-18 Devi Sarah, Ny Erna, dr 481601 Rp 20,000 FREE Rp 20,000
33 21-Feb-18 Lucky Lilly, Ny Fandy, dr 398901 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
34 21-Feb-18 Iqlima Orlin, An Emma, dr 821800 Rp 20,000 Rp 125,000 Rp 145,000
35 21-Feb-18 Nurul Azizah, Ny Fandy, dr 859900 Rp 20,000 Rp 125,000 Rp 145,000
36 21-Feb-18 Kirana Larasati, An Atika, dr 332301 Rp 20,000 Rp 50,000 Rp 70,000

Total Rp 6,299,200

Surabaya, 22 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


alan
i 2018

Keterangan
IGD, Nebul RJ Rp 6,095,400
IGD ARJ Rp 6,886,300
Rp 12,981,700
RJG Rp 1,120,000
Rp 14,101,700
BS RJ Rp (145,000) Vania Adira, An
Rp 13,956,700
Nebul P Rp 600,000
Rp 14,556,700
BS Pak Rp (1,400,000)
Rp 13,156,700
USG 2D BS RJ Rp (125,000) Devi Sarah, Ny
Rp 13,031,700

Anak Karyawan
USG 2D
USG 2D
Karyawan

Tindik Bayi
Nebul
USG 2D, Print 1X
Gynec

USG 2D, Print 1X


USG 2D

USG 4D
Endokrin

USG 2D

USG 2D
USG 2D

USG 2D
USG 2D
Pasang NGT

Keterangan
D BCA
D BCA
D BCA
D BCA
D BNI
D BCA
D Mandiri
D BCA
D Mandiri ( USG 2D )
D BCA
D BCA
D BNI
D BRI
D BCA
D BRI ( USG 2D )
D BCA
D BCA
D BNI
D BCA
Admedika ( Medicilin )
Piutang Cucu dr Tik
D BCA
D BCA
Piutang Karyawan
D BCA
D BCA
KK BCA ( Pasang IUD )
D BCA ( USG 2D )
D BCA ( USG 2D )
KK BCA
D BNI ( USG 2D,NST )
D MANdiri
D Mandiri ( USG 2D )
D BCA
D BCA
D Mandiri ( IGD )

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 21 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 20-Feb-18 Syakira Azmi, An Rp 84,100 Rp 84,100
2 20-Feb-18 Elly Purnamasari,An Rp 66,000 Rp 66,000
3 21-Feb-18 Dicky Febriantino, Tn Rp 396,500 Rp 396,500
4 21-Feb-18 Rich Maxmillian, An Rp 125,600 Rp 125,600
5 21-Feb-18 Elvina Rp 130,100 Rp 130,100
6 21-Feb-18 Mujiati, Ny Rp 122,800 Rp 122,800
7 21-Feb-18 Nicholas Jason, An Rp 821,000 Rp 821,000
8 21-Feb-18 Kania Aira, AN Rp 125,000 Rp 125,000
9 21-Feb-18 Kyara Queenadiva, An Rp 43,300 Rp 43,300
10 21-Feb-18 Kyara Queenadiva, An Rp 2,800 Rp 2,800
11 21-Feb-18 Kyara Queenadiva, An Rp 12,000 Rp 12,000
12 21-Feb-18 Adzril Faizi, An Rp 122,100 Rp 122,100
13 21-Feb-18 Adzril Faizi, An Rp 134,700 Rp 134,700
14 21-Feb-18 Ibrahim Hanif, An Rp 225,200 Rp 225,200
15 21-Feb-18 Tallulah Rp 166,500 Rp 166,500
16 21-Feb-18 Manuel Evander, AN Rp 125,000 Rp 125,000
17 21-Feb-18 Ika Musriana, Ny Rp 122,500 Rp 122,500
18 21-Feb-18 Velerie Dawn, An Rp 42,300 Rp 42,300
19 21-Feb-18 Velerie Dawn, An Rp 924,400 Rp 924,400
20 21-Feb-18 M. Luki Rajendra, An Rp 200,900 Rp 200,900
21 21-Feb-18 M. Ilham Mahendra, An Rp 548,800 Rp 548,800
22 21-Feb-18 Adit Rp 5,000 Rp 5,000
23 21-Feb-18 Alden Gavriel, An Rp 342,600 Rp 342,600
24 21-Feb-18 Sakha Faith, An Rp 26,000 Rp 26,000
25 21-Feb-18 Aisyah Ayudia, An Rp 29,100 Rp 29,100
26 21-Feb-18 Desy Rp 52,100 Rp 52,100
27 21-Feb-18 Ika Permana, Ny Rp 122,500 Rp 122,500
28 21-Feb-18 Michelle Joyce;yn, An Rp 183,000 Rp 183,000
29 21-Feb-18 Wiwit Safitri, Ny Rp 494,800 Rp 494,800
30 21-Feb-18 Shirra Bianca, Ny Rp 284,900 Rp 284,900
31 21-Feb-18 Rizka Rp 27,600 Rp 27,600
32 21-Feb-18 Elok Anggrayni, Ny Rp 278,500 Rp 278,500
33 21-Feb-18 Hanania Alisha, An Rp 119,700 Rp 119,700
34 21-Feb-18 Hanania Alisha, An Rp 50,600 Rp 50,600
35 21-Feb-18 Kanaya Antari, An Rp 31,200 Rp 31,200
36 21-Feb-18 Dr Supratiknyo Rp 22,100 Rp 22,100
37 21-Feb-18 Debby Indah, Ny Rp 172,300 Rp 172,300
38 21-Feb-18 Amalia Rp 102,700 Rp 102,700

Total Rp 6,886,300 Rp 6,886,300

Piutang
No Tanggal Nama Pasien Apotek Total
1 21-Feb-18 Tjio Tjai, Ny Rp 7,300 Rp 7,300
2 21-Feb-18 Natanael Prayoga, An Rp 225,200 Rp 225,200
3 21-Feb-18 Ghany Nevaeh, An Rp 121,400 Rp 121,400
4 21-Feb-18 Reagan Danilo, An Rp 225,200 Rp 225,200
5 21-Feb-18 Velika Felicia, An Rp 548,800 Rp 548,800
6 21-Feb-18 Velika Felicia, An Rp 42,300 Rp 42,300
7 21-Feb-18 Mikka Sandriana. Ny Rp 278,500 Rp 278,500
8 21-Feb-18 Ahmad Harya, An Rp 131,700 Rp 131,700
9 21-Feb-18 Sinandhasa Manggala, An Rp 548,800 Rp 548,800
10 21-Feb-18 Miya Octavianti, Ny Rp 248,800 Rp 248,800
11 21-Feb-18 Maximilian Avner, AN Rp 119,700 Rp 119,700
12 21-Feb-18 Blessio Brandon, An Rp 101,500 Rp 101,500
13 21-Feb-18 Melvin Regan, An Rp 147,700 Rp 147,700
14 21-Feb-18 Elvedh Hugo, An Rp 117,100 Rp 117,100
15 21-Feb-18 Yuli Rp 700 Rp 700
16 21-Feb-18 Mei Puspita, Ny Rp 45,100 Rp 45,100
17 21-Feb-18 Cynthia Ivana, Ny Rp 337,700 Rp 337,700
18 21-Feb-18 Ferina Fauzy, Ny Rp 410,500 Rp 410,500
19 21-Feb-18 Nifsil Mufidah, Ny Rp 140,500 Rp 140,500
20 21-Feb-18 Ahmad Uwais, An Rp 924,400 Rp 924,400
21 21-Feb-18 Ahmad Uwais, An Rp 68,500 Rp 68,500
22 21-Feb-18 Lucky Lilly, Ny Rp 186,100 Rp 186,100
23 21-Feb-18 Devi Sarah, Ny Rp 55,500 Rp 55,500
24 21-Feb-18 Nurul Azizah, Ny Rp 138,300 Rp 138,300
25 21-Feb-18 Kirana Larasati, An Rp 108,900 Rp 108,900

Total Rp 5,280,200 Rp 5,280,200

Surabaya, 22 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Laporan Apotek Rawat Jalan
Tanggal 21 Februari 2018

Ket

Ket
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BRI
D BCA
D BCA
D Mandiri
D BCA
D BNI
D BCA
D BCA
Piutang karyawan
Piutang karyawan
KK BCA
D BCA
D BCA
D BCA
D BCA
D Mandiri
KK Niaga
D BCA
D Mandiri
Laporan Rawat Jalan Gigi
Tanggal 21 Februari 2018
Tunai
No Tanggal Nama Pasien No. RM No. Operator Poli Jasa Dokter Tindakan Total Keterangan
1 21-Feb-18 Happy Setiawan, Tn 238301 Nadia, dr Rp 20,000 Rp 1,100,000 Rp 1,120,000
2 21-Feb-18 Rp -

Total Rp 1,120,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 21-Feb-18 Aryasatya Syuja, An 518301 Prima, dr Rp 25,000 Rp 500,000 Rp 525,000 D BCA
2 21-Feb-18 Malvin Lawrence, An 307801 Mashita, dr Rp 20,000 Rp 250,000 Rp 270,000 D BCA

Total Rp 795,000

Surabaya, 22 Februari 2018

Penyetor Mengetahui,
Penerima

Ika
Rini Wahyuningati
Laporan Therapy Kebugaran & Pijat Bayi
Tanggal 21 Februari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 21-Feb-18 An. Hayden Rp 600,000 Rp 600,000 1227
2 21-Feb-18 Rp -

Total Rp 600,000 Rp 600,000

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 21-Feb-18 Carrie, An Rp 200,000 Rp 200,000 D BCA (1228)
2 21-Feb-18 Rp -

Total Rp 200,000 Rp 200,000

Surabaya, 22 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Wahyuningati
Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium
1 22-Feb-18 Hafizhah, An Sufiandika, dr 786700 Rp 20,000 Rp 50,000
2 22-Feb-18 Mikhailo Sean, An Dini, dr 806800 CANCEL
3 22-Feb-18 Felix Jovanno, An Mahe, dr 140601 Rp 20,000 Rp 125,000
4 22-Feb-18 Putri Rachmah, Ny Rina, dr 501901 Rp 20,000 Rp 125,000
5 22-Feb-18 Josefine, An Kartika, dr 046101 Rp 20,000 Rp 125,000
6 22-Feb-18 Anna, dr Rp 20,000 Rp 50,000
Irfaatul Izza, AN 505001
7 22-Feb-18 Diana, dr Rp 50,000
8 22-Feb-18 Putri Rachma, Ny Rina, dr 501901 Rp 35,000 Rp 40,000
9 22-Feb-18 Najandra ,An Mahe, dr 347901 Rp 20,000 Rp 125,000
10 22-Feb-18 Nashira, An Mahe, dr 348001 Rp 20,000 Rp 125,000
11 22-Feb-18 Cholifah, Ny Fandy, dr 475201 Rp 20,000 Rp 125,000
12 22-Feb-18 C Rimbi Edna, Ny Fandy, dr 472801 Rp 20,000 FREE Rp 35,000 Rp 40,000
13 22-Feb-18 Cholifah, Ny Fandy, dr 475201 Rp 35,000 Rp 40,000
14 22-Feb-18 Ryuki Alexis, An Kartika, dr 519301 Rp 25,000 Rp 125,000
15 22-Feb-18 Victoria Aldea, An Leny, dr 072900 Rp 20,000 Rp 125,000
16 22-Feb-18 Vihelki Ebmer, An Kartika, dr 519501 Rp 25,000 Rp 125,000
17 22-Feb-18 Vallery Kimminha, An Kartika, dr 519601 Rp 25,000 Rp 125,000
18 22-Feb-18 Hafidz Kamil, An Kartika, dr 539500 Rp 20,000 Rp 125,000
19 22-Feb-18 Joxin Axelander, An Leny, dr 509401 Rp 20,000 Rp 125,000
20 22-Feb-18 Edgar Adonis, An Kartika, dr 469901 Rp 20,000 Rp 125,000
21 22-Feb-18 Ebrahim Sultan, An Kartika, dr 079801 Rp 20,000 Rp 125,000
22 22-Feb-18 Elena Cheverly, An Leny, dr 350901 Rp 20,000 Rp 125,000
23 22-Feb-18 Michella Dominique, An Leny, dr 133701 Rp 20,000 Rp 125,000
24 22-Feb-18 Glenn Gunawan, An Kartika, dr 457601 Rp 20,000 Rp 125,000
25 22-Feb-18 Martha, Ny Erna, dr 022800 Rp 20,000 Rp 125,000
26 22-Feb-18 Andrian Wardana, An Leny, dr 277401 Rp 20,000 Rp 125,000
27 22-Feb-18 Aisyaningrum, Ny Erna, dr 436601 Rp 20,000 Rp 125,000
28 22-Feb-18 Martha, Ny Erna, dr 022800 Rp 75,000 Rp 175,000
29 22-Feb-18 Aiko Rebecca, An Mahe, dr 793600 Rp 20,000 Rp 125,000
30 22-Feb-18 Joakim Keenan, An Mahe, dr 728200 Rp 20,000 Rp 125,000
31 22-Feb-18 Shafyna Prameswari, An Rohim, dr 471101 Rp 20,000 Rp 125,000
32 22-Feb-18 Mikhayla Almeera, An Mahe, dr 479201 Rp 20,000 Rp 125,000
33 22-Feb-18 Junichi Ratulangi, An Rohim, dr 360400 Rp 20,000 Rp 125,000
34 22-Feb-18 Prince Xaverio, An Mahe, dr 496301 Rp 20,000 Rp 125,000
35 22-Feb-18 Aldriech Rajasanagara, A Mahe, dr 436901 Rp 20,000 Rp 125,000
36 22-Feb-18 Keira Putri, An Rohim, dr 930000 Rp 20,000 Rp 125,000
37 22-Feb-18 Evan Ircham, An Rohim, dr 924500 Rp 20,000 Rp 125,000
38 22-Feb-18 Sri Mega, Ny Agung, dr 520001 Rp 25,000 Rp 125,000 Rp 35,000 Rp 40,000

Total

Surabaya, 23 Februari 2018

Penyetor

Nia
Total Keterangan
Rp 70,000 D BCA
Rp - D BCA
Rp 145,000 D BCA
Rp 145,000 D Mandiri
Rp 145,000 D BCA
Rp 70,000 D Mandiri ( IGD )
Rp 50,000 D Mandiri
Rp 75,000 D Mandiri (USG 2D)
Rp 145,000 D BNI
Rp 145,000 D BNI
Rp 145,000 D BCA
Rp 95,000 D Mandiri ( USG 2D )
Rp 75,000 D BCA ( USG 2D )
Rp 150,000 D BRI
Rp 145,000 D BCA
Rp 150,000 D BCA
Rp 150,000 D BCA
Rp 145,000 D Mandiri
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 250,000 D BCA ( Lepas IUD )
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D Mandiri
Rp 145,000 D BRI
Rp 145,000 Admedika ( BNI Life )
Rp 145,000 D BCA
Rp 145,000 KK BCA
Rp 145,000 Admedika ( Sinarmas )
Rp 145,000 Admedika ( Sinarmas )
Rp 225,000 Admedika ( BNI Life )

Rp 5,130,000

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 22 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 22-Feb-18 Sufiandika Nuryandari, Ny Rp 38,600 Rp 38,600
2 22-Feb-18 Sufiandika Nuryandari, Ny Rp 48,400 Rp 48,400
3 21-Feb-18 Tjia Nathasya, Ny Rp 15,700 Rp 15,700
4 22-Feb-18 Elly Purnamasari, An Rp 20,200 Rp 20,200
5 22-Feb-18 Melani Rp 57,100 Rp 57,100
6 22-Feb-18 Rina Balkis, Ny Rp 347,300 Rp 347,300
7 22-Feb-18 Rs Bedah Rp 70,200 Rp 70,200
8 21-Feb-18 Mei Puspita Rp 45,100 Rp 45,100
9 22-Feb-18 Kartika Rp 15,300 Rp 15,300
10 22-Feb-18 Genice Ivanka, An Rp 25,000 Rp 25,000
11 22-Feb-18 Celine Valerie, An Rp 119,700 Rp 119,700
12 22-Feb-18 MellyaParamita, An Rp 127,900 Rp 127,900
13 22-Feb-18 Giandra Una, An Rp 94,900 Rp 94,900
14 22-Feb-18 Muhammad Rayhan, An Rp 19,500 Rp 19,500
15 22-Feb-18 Glenn Gunawan, An Rp 6,000 Rp 6,000
16 22-Feb-18 Vallery Kimminha, An Rp 31,300 Rp 31,300
17 22-Feb-18 Elika Gabriella, An Rp 255,800 Rp 255,800
18 22-Feb-18 Fathimah Athaya, An Rp 112,300 Rp 112,300
19 22-Feb-18 Fathimah Athaya, An Rp 4,200 Rp 4,200
20 22-Feb-18 Amira Yasmin, An Rp 12,100 Rp 12,100
21 22-Feb-18 Al Fatih, An Rp 12,100 Rp 12,100
22 22-Feb-18 Naufa Kharisma, An Rp 16,100 Rp 16,100
23 22-Feb-18 Rafif Athariz, An Rp 953,100 Rp 953,100
24 22-Feb-18 Lionel Augusto, An Rp 821,000 Rp 821,000
25 22-Feb-18 Rafif Athariz, An Rp 138,600 Rp 138,600
26 22-Feb-18 Felisa Pribadi, An Rp 112,300 Rp 112,300
27 22-Feb-18 Kartika Wulandari, Ny Rp 151,000 Rp 151,000
28 22-Feb-18 Megan Tianna, An Rp 112,300 Rp 112,300
29 22-Feb-18 Vernanda Nabella, An Rp 68,500 Rp 68,500
30 22-Feb-18 Sidney Lovely, An Rp 12,100 Rp 12,100
31 22-Feb-18 Michella Dominique, An Rp 12,100 Rp 12,100
32 22-Feb-18 R Dina, Ny Rp 171,700 Rp 171,700
33 22-Feb-18 Nikmatuz Zuhra, Ny Rp 292,000 Rp 292,000
34 22-Feb-18 R Dina, Ny Rp 5,000 Rp 5,000
35 22-Feb-18 Felix Jovanno, An Rp 94,500 Rp 94,500
36 22-Feb-18 Melvin Giovanni, An Rp 112,300 Rp 112,300
37 22-Feb-18 Altharafisqi Budi, An Rp 12,100 Rp 12,100
38 22-Feb-18 Azka Pradito, An Rp 213,500 Rp 213,500
39 22-Feb-18 Dina Novia, Ny Rp 96,700 Rp 96,700
40 22-Feb-18 Dave Stevenson, An Rp 112,300 Rp 112,300
41 22-Feb-18 Griselda Hadya, An Rp 179,900 Rp 179,900
42 22-Feb-18 Nurlita Shalihati, Ny Rp 189,500 Rp 189,500
43 22-Feb-18 Arsy Mulya, An Rp 12,100 Rp 12,100
44 22-Feb-18 Asasta Mulya, An Rp 12,100 Rp 12,100
45 22-Feb-18 Griselda Hadya, An Rp 27,700 Rp 27,700
46 22-Feb-18 Iz Fadrilah Rp 20,800 Rp 20,800
47 22-Feb-18 Odetta Viront, An Rp 12,100 Rp 12,100
48 22-Feb-18 Kafeel Alaric, An Rp 112,300 Rp 112,300
49 22-Feb-18 Kafeel Alaric, An Rp 26,400 Rp 26,400
50 22-Feb-18 Muhammad Zhafir, An Rp 1,185,400 Rp 1,185,400
51 22-Feb-18 William Wijaya, An Rp 77,600 Rp 77,600
52 22-Feb-18 William Wijaya, An Rp 39,200 Rp 39,200

Total Rp 6,881,000 Rp 6,881,000

Piutang
No Tanggal Nama Pasien Apotek Total
1 22-Feb-18 Hafizhah, An Rp 143,100 Rp 143,100
2 21-Feb-18 Blessio Brandon, An Rp 101,500 Rp 101,500
3 22-Feb-18 Juliana Rp 98,800 Rp 98,800
4 22-Feb-18 Irfaatul Izza, AN Rp 19,900 Rp 19,900
5 22-Feb-18 Putri Rachma, Ny Rp 479,500 Rp 479,500
6 22-Feb-18 C Rimbi Edna, Ny Rp 85,900 Rp 85,900
7 22-Feb-18 Silvia Margaretna Rp 28,400 Rp 28,400
8 22-Feb-18 Yuli Rp 3,400 Rp 3,400
9 22-Feb-18 Silvia Margaretna Retur
10 22-Feb-18 Ryuki Alexis, An Rp 363,000 Rp 363,000
11 22-Feb-18 Josefine, An Rp 101,400 Rp 101,400
12 22-Feb-18 Vihelki Ebmer, An Rp 270,200 Rp 270,200
13 22-Feb-18 Vihelki Ebmer, An Rp 215,000 Rp 215,000
14 22-Feb-18 Elena Cheverly, An Rp 1,076,000 Rp 1,076,000
15 22-Feb-18 Glenn Gunawan, An Rp 112,300 Rp 112,300
16 22-Feb-18 Glenn Gunawan, An Rp 185,500 Rp 185,500
17 22-Feb-18 Glenn Gunawan, An Rp 4,200 Rp 4,200
18 22-Feb-18 Andrian Wardana, An Rp 924,400 Rp 924,400
19 22-Feb-18 Edgar Adonis, An Rp 112,300 Rp 112,300
20 22-Feb-18 Florens Rp 101,000 Rp 101,000
21 22-Feb-18 Ny Liem Rp 82,500 Rp 82,500
22 22-Feb-18 Martha, Ny Rp 261,800 Rp 261,800
23 22-Feb-18 Anny, Ny Rp 290,500 Rp 290,500
24 22-Feb-18 Ebrahim Sultan, An Rp 109,800 Rp 109,800
25 22-Feb-18 Zakia Rp 47,000 Rp 47,000
26 22-Feb-18 Nashira, An Rp 850,000 Rp 850,000
27 22-Feb-18 Najandra ,An Rp 850,000 Rp 850,000
28 22-Feb-18 Viona Queenara, An Rp 119,700 Rp 119,700
29 22-Feb-18 Junichi Ratulangi, An Rp 261,200 Rp 261,200
30 22-Feb-18 Aiko Rebecca, An Rp 507,200 Rp 507,200
31 22-Feb-18 Felix Valentino, An Rp 507,200 Rp 507,200
32 22-Feb-18 Mikhayla Almeera, An Rp 112,300 Rp 112,300
33 22-Feb-18 Aldriech Rajasanagara, An Rp 112,300 Rp 112,300
34 22-Feb-18 Keira Putri, An Rp 246,400 Rp 246,400
35 22-Feb-18 Evan Ircham, An Rp 144,400 Rp 144,400
36 22-Feb-18 Sri Mega, Ny Rp 131,300 Rp 131,300
37 22-Feb-18 Prince Xaverio, An Rp 96,200 Rp 96,200

Total Rp 9,155,600 Rp 9,155,600

Surabaya, 23 Februari 2018


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Laporan Apotek Rawat Jalan
Tanggal 22 Februari 2018

Ket
Ket
D BCA
D BNI
D Mandiri
D Mandiri
D Mandiri
D Mandiri
Piutang Karyawan
Piutang Karyawan
BATAL
D BRI
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BCA
D BNI
D BNI
D BCA
Admedika ( BNI Life )
KK BCA
D BRI
D BRI
KK BCA
Admedika ( Sinarmas )
Admedika ( Sinarmas )
Admedika ( BNI Life )
D BCA
Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium
1 23-Feb-18 Rafardhan Athalla, An Yusuf, dr 520201 Rp 25,000 Rp 50,000
2 23-Feb-18 Sheila Amalia, Ny Rina, dr 704900 Rp 20,000 Rp 125,000
3 23-Feb-18 Nicole Callista, An Leny, dr 281101 CANCEL
4 23-Feb-18 Anita Tri, Ny Rina, dr 270800 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000
5 23-Feb-18 Sheila Amalia, Ny Rina, dr 704900 Rp 35,000 Rp 40,000
6 23-Feb-18 Siti Ruqoyyah, Ny Dhini, dr 267200 Rp 20,000 Rp 125,000
7 23-Feb-18 Siti Ruqoyyah, Ny Dhini, dr 267200 Rp 35,000 Rp 40,000
8 23-Feb-18 Irma Kurnia, Ny Fandy, dr 520401 Rp 35,000 Rp 40,000
9 23-Feb-18 Elvina Stephanie, Ny Fandy, dr 483801 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000
10 23-Feb-18 Zhafirah Arreta, An Kartika, dr 251501 Rp 20,000 Rp 125,000
11 23-Feb-18 Jemima Anggitanauli, An Kartika, dr 477701 Rp 20,000 Rp 125,000
12 23-Feb-18 Vania Adira, An Kartika, dr 445200 Rp 20,000 Rp 125,000
13 23-Feb-18 Muhammadg Gilby, An Kartika, dr 513601 Rp 20,000 Rp 125,000 Rp 321,000
14 23-Feb-18 Lydia Septa, Ny Brahmantyo, dr 462981 Rp 20,000 Rp 125,000
15 23-Feb-18 Lydia Septa, Ny Brahmantyo, dr 462981 Rp 35,000 Rp 40,000
16 23-Feb-18 Raffasya Alief, An Mahe, dr 271701 Rp 20,000 Rp 125,000
17 23-Feb-18 Chindera Anggi, Ny Erna, dr 415400 Rp 20,000 Rp 125,000
18 23-Feb-18 Siti Chalimatus, Ny Erna, dr 520901 Rp 25,000 FREE
19 23-Feb-18 James Richardo, An Mahe, dr 085701 Rp 20,000 Rp 125,000
20 23-Feb-18 Fiorenzo Aaron, An Kartika, dr 457200 Rp 20,000 Rp 125,000
21 23-Feb-18 Reynand Setiawan, An Mahe, dr 236601 Rp 20,000 Rp 125,000
22 23-Feb-18 Athallah arsyad, An Mahe, dr 971700 Rp 20,000 Rp 125,000
23 23-Feb-18 Jesslyn Tehila, An Mahe, dr 292701 Rp 20,000 Rp 125,000
24 23-Feb-18 Felicia Novianti, Nn Brahmantyo, dr 520601 Rp 35,000 Rp 40,000
25 23-Feb-18 Putu Krisna, Nn Erna, dr 521401 Rp 25,000 Rp 125,000
26 23-Feb-18 Lisa Andika. Ny Erna, dr 316001 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000
27 23-Feb-18 Arief Wijaksono, An Putri, dr 253401 Rp 20,000 Rp 22,500 Rp 52,500
28 23-Feb-18 Khoirun Nisa, Ny Erna, dr 521001 Rp 25,000 Rp 125,000 Rp 35,000 Rp 40,000

Total

Surabaya, 24 Februari 2018

Penyetor

Nia
Total Keterangan
Rp 75,000 Admedika ( BNI Life )
Rp 145,000 D BCA
Rp - KK BCA
Rp 220,000 D BCA ( USG 2D )
Rp 75,000 D BCA ( USG 2D )
Rp 145,000 D Mandiri
Rp 75,000 D Mandiri ( USG 2D )
Rp 75,000 D BRI ( USG 2D )
Rp 220,000 D BCA ( USG 2D )
Rp 145,000 D BNI
Rp 145,000 D Mandiri
Rp 145,000 D BNI
Rp 466,000 D BCA
Rp 145,000 D BCA
Rp 75,000 D BCA ( USG 2D )
Rp 145,000 D Mandiri
Rp 145,000 D BCA
Rp 25,000 D BCA
Rp 145,000 D BCA
Rp 145,000 admedika ( FWD )
Rp 145,000 D BCA
Rp 145,000 KK BNI
Rp 145,000 KK OUB
Rp 75,000 Transfer BCA ( USG 2D )
Rp 150,000 D BCA
Rp 220,000 D BNI ( USG 2D )
Rp 95,000 D BCA ( Nebul )
Rp 225,000 Admedika ( Avris )

Rp 3,956,000

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 23 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 23-Feb-18 Revano Anugerah, An Rp 123,100 Rp 123,100
2 23-Feb-18 Asyiffa Qurota'ayun, An Rp 196,000 Rp 196,000
3 23-Feb-18 Natalia Brilianti, Ny Rp 52,000 Rp 52,000
4 23-Feb-18 Dafiz Alsaki, An Rp 190,200 Rp 190,200
5 23-Feb-18 Ludwig Guido, An Rp 404,300 Rp 404,300
6 23-Feb-18 Yunita Maike, Ny Rp 82,000 Rp 82,000
7 23-Feb-18 Braynt Anthony, An Rp 94,400 Rp 94,400
8 23-Feb-18 Jemima Anggitanauli, An Rp 103,300 Rp 103,300
9 23-Feb-18 Arjuna Putra, An Rp 146,500 Rp 146,500
10 23-Feb-18 Arjuna Putra, An Rp 168,900 Rp 168,900
11 23-Feb-18 Nadira Ayasa, An Rp 595,000 Rp 595,000
12 23-Feb-18 Joshua Andrew, An Rp 955,700 Rp 955,700
13 23-Feb-18 Fiorenzo Aaron, An Rp 66,000 Rp 66,000
14 23-Feb-18 Fiorenzo Aaron, An Rp 15,900 Rp 15,900
15 23-Feb-18 Kaithlyn Seraphina, An Rp 57,100 Rp 57,100
16 23-Feb-18 Kaithlyn Seraphina, An Rp 70,300 Rp 70,300
17 23-Feb-18 Alya Raisya, An Rp 82,100 Rp 82,100
18 23-Feb-18 Gabriel Maximilian, An Rp 157,800 Rp 157,800
19 23-Feb-18 Muhammad Rafi, An Rp 42,200 Rp 42,200
20 23-Feb-18 Gabriel Maximilian, An Rp 58,000 Rp 58,000
21 23-Feb-18 Chindera Anggi, Ny Rp 11,900 Rp 11,900
22 23-Feb-18 Siti Chalimatus, Ny Rp 254,500 Rp 254,500
23 23-Feb-18 Rina Setiyawati, Ny Rp 39,500 Rp 39,500
24 23-Feb-18 Eris Tri, Ny Rp 220,300 Rp 220,300

Total Rp 4,187,000 Rp 4,187,000

Piutang
No Tanggal Nama Pasien Apotek Total
1 23-Feb-18 Rafardhan Athalla, An Rp 132,300 Rp 132,300
2 23-Feb-18 Silvia, Nn Rp 43,500 Rp 43,500
3 23-Feb-18 Irma Kurnia, Ny Rp 201,000 Rp 201,000
4 23-Feb-18 Zhafirah Arreta, An Rp 821,000 Rp 821,000
5 23-Feb-18 Nicole Callista, An Rp 955,700 Rp 955,700
6 23-Feb-18 Nicole Callista, An Rp 217,800 Rp 217,800
7 23-Feb-18 I Gusti Ngurah, An Rp 410,500 Rp 410,500
8 23-Feb-18 Leli Rp 5,000 Rp 5,000
9 23-Feb-18 Aisyah Hanif, An Rp 955,700 Rp 955,700
10 23-Feb-18 Lydia Septa, Ny Rp 338,500 Rp 338,500
11 23-Feb-18 Vania Adira, An Rp 85,400 Rp 85,400
12 23-Feb-18 James Richardo, An Rp 46,100 Rp 46,100
13 23-Feb-18 Fiorenzo Aaron, An Rp 159,300 Rp 159,300
14 23-Feb-18 Hervina Rp 57,100 Rp 57,100
15 23-Feb-18 Reynand Setiawan, An Rp 548,800 Rp 548,800
16 23-Feb-18 Raffasya Alief, An Rp 225,200 Rp 225,200
17 23-Feb-18 Athallah arsyad, An Rp 138,800 Rp 138,800
18 23-Feb-18 Jesslyn Tehila, An Rp 548,800 Rp 548,800

Total Rp 5,890,500 Rp 5,890,500

Surabaya, 24 Februari 2018


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Ket

Ket
Ademedika ( BNI Life )
Piutang Karywan
D BRI
D BNI
KK BNI
KK BNI
D BCA
D BCA
D BCA
D BCA
D Mandiri
D BCA
Admedika ( FWD )
KK BNI
D BCA
D Mandiri
KK BNI
KK BNI
Laporan Therapy Kebugaran & Pijat Bayi
Tanggal 23 Februari 2017

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 23-Feb-18 Rp -
2 23-Feb-18 Rp -
3 23-Feb-18 Rp -

Total Rp - Rp -

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 23-Feb-18 Rp -
2 23-Feb-18 Rp -

Total Rp - Rp -

Surabaya, 24 Februari 2017


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 23 Februari 2018
Tunai
No Tanggal Nama Pasien No. RM No. Operator Poli Jasa Dokter Tindakan Total
1 23-Feb-18 Alifia C, Nn 521101 Lila, dr Rp 25,000 Rp 200,000 Rp 225,000
2 23-Feb-18 Harttandyo Anang, Tn 521301 Lila, dr Rp 25,000 Rp 100,000 Rp 125,000
3 23-Feb-18 Rp -

Total Rp 350,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total
1 23-Feb-18 Rp -

Total

Surabaya, 24 Februari 2016

Penyetor Mengetahui,
Penerima

Nia
Rini Wahyuningati
Keterangan

Keterangan
Laporan Rawat Jalan
Promo Tanggal 23 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Nominal Total Keterangan
1 23-Feb-18 Serlina Dwipuspa, Ny Arum, dr 438601 Rp 15,000 Rp 15,000 Rp 30,000

Total Rp 30,000

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Nominal Total Keterangan
1 23-Feb-18 Rp -
2 23-Feb-18 Rp -
3 23-Feb-18 Rp -

Total Rp -

Surabaya, 24 Februari 2018


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 24-Feb-18 Muhammad Jovano, An Kartika, dr 521701 Rp 25,000 Rp 125,000 Rp 150,000
2 24-Feb-18 Azzahra Shaqueena, An Diana, dr 193301 Rp 20,000 Rp 125,000 Rp 145,000
3 24-Feb-18 Sora Nadhirah, Ny Eighty, dr 462801 Rp 20,000 Rp 125,000 Rp 145,000
4 24-Feb-18 Haidar, NY Agung, dr 461901 Rp 20,000 Rp 125,000 Rp 145,000
5 24-Feb-18 Adzkia Nadhira, An Kartika, dr 464501 Rp 20,000 Rp 125,000 Rp 145,000
6 24-Feb-18 Martina Trisiskawaty, Ny Tik, dr 522301 Rp 25,000 Rp 125,000 Rp 150,000
7 24-Feb-18 Amelia Rahardjo, Ny Agung, dr 332201 Rp 20,000 Rp 325,000 Rp 375,000 Rp 720,000
8 24-Feb-18 Laili Anizmah, Ny Eighty, dr 297201 Rp 20,000 Rp 125,000 Rp 145,000
9 24-Feb-18 Haidar, NY Agung, dr 461901 Rp 45,000 Rp 40,000 Rp 85,000
10 24-Feb-18 Laili Anizmah, Ny Eighty, dr 297201 Rp 35,000 Rp 40,000 Rp 75,000
11 24-Feb-18 Chloe Evangeline, An Mahe, dr 451601 Rp 20,000 Rp 125,000 Rp 145,000
12 24-Feb-18 Wahyu Setyani, Ny Eighty, dr 522601 Rp 25,000 Rp 125,000 Rp 150,000
13 24-Feb-18 Sri Asih, Ny Erna, dr 522701 Rp 25,000 Rp 125,000 Rp 150,000
14 24-Feb-18 Susan Anita, Ny Tik, dr 584100 Rp 20,000 Rp 125,000 Rp 145,000
15 24-Feb-18 Yustina Daeli, Ny Tik, dr 522901 Rp 25,000 Rp 125,000 Rp 150,000
16 24-Feb-18 Indah Roospitowati, Ny Prof Bus 038501 Rp 20,000 Rp 150,000 Rp 50,000 Rp 220,000
17 24-Feb-18 Quinneira Alesha, An Kartika, dr 594900 Rp 20,000 Rp 125,000 Rp 145,000
18 24-Feb-18 Yustina Daeli, Ny Tik, dr 522901 Rp 35,000 Rp 40,000 Rp 75,000
19 24-Feb-18 Eva Vindy, Ny Erna, dr 523101 Rp 25,000 Rp 125,000 Rp 150,000
20 24-Feb-18 Eny Setyawati, Ny Erna, dr 521901 Rp 40,000 Rp 160,000 Rp 200,000
21 24-Feb-18 Wiwin Sumirat, Ny Eighty, dr 522401 Rp 100,000 Rp 450,000 Rp 550,000
22 24-Feb-18 Ailangga Anargya, An Kartika, dr 970800 Rp 20,000 Rp 125,000 Rp 145,000
23 24-Feb-18 Ailangga Anargya, An Kartika, dr 970800 Rp 259,000 Rp 259,000
24 24-Feb-18 Elvandari Yunizar, Ny Erna, dr 486301 Rp 20,000 Rp 125,000 Rp 145,000
25 24-Feb-18 Arief Wijaksono, An Yusuf, dr 253401 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
26 24-Feb-18 Widya Emilia, Ny Erna, dr 316501 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
27 24-Feb-18 Wahyu Setyani, Ny Eighty, dr 522601 Rp 35,000 Rp 40,000 Rp 75,000
28 24-Feb-18 Sri Asih, Ny Erna, dr 522701 Rp 35,000 Rp 40,000 Rp 75,000
29 24-Feb-18 Almeer Abdullah, An Yusuf, dr 523201 Rp 25,000 Rp 50,000 Rp 75,000 Rp 150,000
30 24-Feb-18 Sandra Aqila, An Kartika, dr 124901 CANCEL Rp -
31 24-Feb-18 Elvandari Yunizar, Ny Erna, dr 486301 Rp 40,000 Rp 60,000 Rp 100,000
32 24-Feb-18 Alysha Alodia, An Yusuf, dr 515701 Rp 20,000 Rp 50,000 Rp 38,000 Rp 108,000
33 24-Feb-18 Bene Cakrawanga, An Kartika, dr 457201 Rp 20,000 Rp 125,000 Rp 145,000
34 24-Feb-18 Dekka Aatreya, An Kartika, dr 457101 Rp 20,000 Rp 125,000 Rp 145,000
35 24-Feb-18 Eva Vindy, Ny Erna, dr 523101 Rp 35,000 Rp 40,000 Rp 75,000
36 24-Feb-18 Hagiya Azara, An Kartika, dr 444801 Rp 20,000 Rp 125,000 Rp 145,000
37 24-Feb-18 Shane Edward, An Mahe, dr 945800 Rp 20,000 Rp 125,000 Rp 145,000
38 24-Feb-18 Adlan Rafa, An Kartika, dr 487901 Rp 20,000 Rp 125,000 Rp 145,000
39 24-Feb-18 Elizabeth Intan, An Kartika, dr 286100 Rp 20,000 Rp 125,000 Rp 145,000
40 24-Feb-18 Christian Aigner, An Kartika, dr 567900 Rp 20,000 Rp 125,000 Rp 145,000
41 24-Feb-18 Scarlett Edelaine, An Mahe, dr 372800 Rp 20,000 Rp 125,000 Rp 145,000
42 24-Feb-18 Devon Hanindra, An Mahe, dr 234601 Rp 20,000 Rp 125,000 Rp 145,000
43 24-Feb-18 Faeyza Khairi, An Mahe, dr 887400 Rp 20,000 Rp 125,000 Rp 145,000
44 24-Feb-18 Khaireena Zahiran, An Mahe, dr 935100 Rp 20,000 Rp 125,000 Rp 145,000
45 24-Feb-18 Symphony Kirana, An Mahe, dr 484001 Rp 20,000 Rp 125,000 Rp 145,000
46 24-Feb-18 Ibrahim Damar, AN Mahe, dr 413701 Rp 20,000 Rp 125,000 Rp 145,000
47 24-Feb-18 Jocelyn Olivia, An Mahe, dr 460701 Rp 20,000 Rp 125,000 Rp 145,000
48 24-Feb-18 Faeyza Khairi, An Mahe, dr 887400 Rp 75,000 Rp 75,000
49 24-Feb-18 Khaireena Zahiran, An Mahe, dr 935100 Rp 75,000 Rp 75,000
50 24-Feb-18 Ibrahim Damar, AN Mahe, dr 413701 Rp 75,000 Rp 75,000
51 24-Feb-18 Aqiela Syafia, An Mahe, dr 524201 Rp 25,000 Rp 125,000 Rp 150,000
52 24-Feb-18 Ajeng, dr Rp 25,000 Rp 50,000 Rp 150,000 Rp 225,000
Herlina Purnama, Ny 5244001
53 24-Feb-18 Tik, dr Rp 50,000 Rp 50,000
54 24-Feb-18 Arief Wijaksono, An Ajeng, dr 523401 Rp 22,500 Rp 52,500 Rp 75,000
55 24-Feb-18 Alvarenzio Rajendra, An Mahe, dr 523901 Rp 25,000 Rp 125,000 Rp 150,000
56 24-Feb-18 Ellysia Gabrielle, An Mahe, dr 037701 Rp 20,000 Rp 125,000 Rp 145,000

Total Rp 8,482,000

Surabaya, 25 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Keterangan
D Bri
Admedika ( Lippo )
D BCA
D BCA
D BCA
D BCA
D BCA ( USG 4D )
D Mandiri
D BCA (USG 2D, Print 1x )
D Mandiri ( USG 2D )
D BCA
D BCA
D BCA
KK BCA
D BCA
D BCA ( NST, By Phone 1x )
D BCA
D BCA ( USG 2D )
D BCA
D BCA ( Gynec, TVS )
D BCA ( Pasang IUD )
D BNI
D BNI
D BCA
D Mandiri (Nebul )
D BNI ( USG 2D )
D BCA ( USG 2D )
D MAndiri ( USG 2D )
D Mandiri ( Nebul )
D BCA
D BCA ( TVS )
D Mandiri ( IGD )
D Mandiri
D Mandiri
D BCA ( USG 2D )
KK BCA
D BCA
KK CITI
D Mandiri
D Mandiri
D BCA
D BRI
D Niaga
D Niaga
Admedika ( MSIG )
D BRI
D BCA
D Mandiri ( Nebul )
D Mandiri ( Nebul )
D BRI ( Nebul )
D BNI
D Mandiri ( NST,IGD)
D Mandiri (Konsul By phone)
D BCA ( Nebul )
D BCA
D BCA

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 24 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 24-Feb-18 RS Mitra Rp 184,700 Rp 184,700
2 24-Feb-18 Yoona Mizuki, An Rp 13,200 Rp 13,200
3 24-Feb-18 Azdriel Rahandikha, An Rp 101,700 Rp 101,700
4 24-Feb-18 Azdriel Rahandikha, An Rp 58,000 Rp 58,000
5 24-Feb-18 Rina Rp 14,200 Rp 14,200
6 24-Feb-18 Siti Fatimah, Ny Rp 82,000 Rp 82,000
7 24-Feb-18 Umi Lathifah, Ny Rp 101,500 Rp 101,500
8 24-Feb-18 Susan Tri, NY Rp 1,000 Rp 1,000
9 24-Feb-18 Leily Rizma, Ny Rp 70,200 Rp 70,200
10 24-Feb-18 RR Shamia, Ny Rp 337,700 Rp 337,700
11 24-Feb-18 Nur Afidah, Ny Rp 260,500 Rp 260,500
12 24-Feb-18 Rahma Rp 6,000 Rp 6,000
13 24-Feb-18 Rosyidah Asma, An Rp 21,500 Rp 21,500
14 24-Feb-18 Aksa Radika, An Rp 225,200 Rp 225,200
15 24-Feb-18 Silvia Marisa, Ny Rp 219,500 Rp 219,500
16 24-Feb-18 Aniqotun Nafiah, Ny Rp 58,000 Rp 58,000
17 24-Feb-18 Rachma Ayuningtyas, Ny Rp 200,500 Rp 200,500
18 24-Feb-18 Eleanor Andromeda, An Rp 17,400 Rp 17,400
19 24-Feb-18 Sean Bennedict, An Rp 112,300 Rp 112,300
20 24-Feb-18 Eza Rezqiano, An Rp 112,300 Rp 112,300
21 24-Feb-18 Adiba Qirani, An Rp 294,000 Rp 294,000
22 24-Feb-18 Eleanor Andromeda, An Rp 92,600 Rp 92,600
23 24-Feb-18 Arya Maulana, An Rp 278,300 Rp 278,300
24 24-Feb-18 Arya Maulana, An Rp 27,300 Rp 27,300
25 24-Feb-18 Mikhael Adrian, An Rp 239,700 Rp 239,700
26 24-Feb-18 Gwyneth Elora, An Rp 112,300 Rp 112,300
27 24-Feb-18 Arya Maulana, An Rp 30,400 Rp 30,400
28 24-Feb-18 Chloe Evangeline, An Rp 119,700 Rp 119,700
29 24-Feb-18 Dewi Prita, Ny Rp 1,000 Rp 1,000
30 24-Feb-18 Symphony Kirana, An Rp 181,800 Rp 181,800
31 24-Feb-18 Shane Edward, An Rp 39,200 Rp 39,200
32 24-Feb-18 Muhammad Syarief, An Rp 36,400 Rp 36,400
33 24-Feb-18 Scarlett Edelaine, An Rp 10,000 Rp 10,000
34 24-Feb-18 Edmund Diminic, An Rp 39,200 Rp 39,200
35 24-Feb-18 Eldrick Gabriel, An Rp 24,400 Rp 24,400
36 24-Feb-18 Alya Rahma, An Rp 34,900 Rp 34,900
37 24-Feb-18 Keiko Angelic, An Rp 115,200 Rp 115,200
38 24-Feb-18 Kyara Queenadiva, An Rp 5,700 Rp 5,700
39 24-Feb-18 Kyara Queenadiva, An Rp 1,300 Rp 1,300
40 24-Feb-18 Nathania Earline, An Rp 595,000 Rp 595,000
41 24-Feb-18 Arsakha Mahesa, An Rp 507,200 Rp 507,200

Total Rp 4,983,000 Rp 4,983,000

Piutang
No Tanggal Nama Pasien Apotek Total
1 23-Feb-18 Gibran Rp 102,000 Rp 102,000
2 24-Feb-18 Arien Pusparetno, Ny Rp 24,000 Rp 24,000
3 24-Feb-18 Azzahra Shaqueena, An Rp 147,700 Rp 147,700
4 24-Feb-18 Yustina Daeli, Ny Rp 152,500 Rp 152,500
5 24-Feb-18 Eny Setyawati, Ny Rp 387,200 Rp 387,200
6 24-Feb-18 Wiwin Sumirat, Ny Rp 431,900 Rp 431,900
7 24-Feb-18 Ailangga Anargya, An Rp 59,500 Rp 59,500
8 24-Feb-18 Noel Hunter, An Rp 1,185,400 Rp 1,185,400
9 24-Feb-18 Widya Emilia, Ny Rp 512,500 Rp 512,500
10 24-Feb-18 Wahyu Setyani, Ny Rp 121,500 Rp 121,500
11 24-Feb-18 Sri Asih, Ny Rp 233,500 Rp 233,500
12 24-Feb-18 Ameer Abdullah, An Rp 285,600 Rp 285,600
13 24-Feb-18 Adzkia Nadhira, An Rp 375,400 Rp 375,400
14 24-Feb-18 Bene Cakrawanga, An Rp 119,700 Rp 119,700
15 24-Feb-18 Dekka Aatreya, An Rp 112,300 Rp 112,300
16 24-Feb-18 Quinneira Alesha, An Rp 45,000 Rp 45,000
17 24-Feb-18 Quinneira Alesha, An Rp 167,500 Rp 167,500
18 24-Feb-18 Hagiya Azara, An Rp 626,300 Rp 626,300
19 24-Feb-18 Hagiya Azara, An Rp 309,400 Rp 309,400
20 24-Feb-18 Eva Vindy, Ny Rp 113,500 Rp 113,500
21 24-Feb-18 Muhammad Jovano, An Rp 100,300 Rp 100,300
22 24-Feb-18 Adlan Rafa, An Rp 112,300 Rp 112,300
23 24-Feb-18 Christian Aigner, An Rp 595,000 Rp 595,000
24 24-Feb-18 Elizabeth Intan, An Rp 80,500 Rp 80,500
25 24-Feb-18 Elizabeth Intan, An Rp 291,400 Rp 291,400
26 24-Feb-18 Harvey Solomon, An Rp 112,300 Rp 112,300
27 24-Feb-18 Symphony Kirana, An Rp 120,100 Rp 120,100
28 24-Feb-18 Symphony Kirana, An Rp 43,400 Rp 43,400
29 24-Feb-18 Jocelyn Olivia, An Rp 112,300 Rp 112,300
30 24-Feb-18 Faeyza Khairi, An Rp 44,400 Rp 44,400
31 24-Feb-18 Khaireena Zahiran, An Rp 336,800 Rp 336,800
32 24-Feb-18 Ibrahim Damar, AN Rp 91,200 Rp 91,200
33 24-Feb-18 Devon Hanindra, An Rp 548,800 Rp 548,800
34 24-Feb-18 Herlina Purnama, Ny Rp 66,900 Rp 66,900
35 24-Feb-18 Kenisha Cordelia, An Rp 252,400 Rp 252,400
36 24-Feb-18 Aqiela Syafia, An Rp 341,500 Rp 341,500

Total Rp 8,762,000 Rp 8,762,000

Surabaya, 25 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Jalan
018

Ket

Ket
D BCA
Piutang Karyawan
Admedika ( Lippo )
D BCA
D BCA
D BCA
D BNI
D BCA
D BNi
D BCA
D Mandiri
D Mandiri
D BCA
D Mandiri
D Mandiri
D BCA
D BCA
KK BCA
KK BCA
D BCA
D BRI
KK CITI
D Mandiri
D Mandiri
D Mandiri
D BCA
Admedika ( MSIG)
Admedika ( MSIG)
D BCA
D MAndiri
D MAndiri
D BRI
D BRI
D Mandiri
D BCA
D BNI
Laporan Therapy Kebugaran & Pijat Bayi
Tanggal 24 Februari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 24-Feb-18 An. Kimiko Rp 60,000 Rp 60,000 1230
2 24-Feb-18 An. Belden Rp 60,000 Rp 60,000 1231
3 24-Feb-18 An. Jocelyn Rp 150,000 Rp 150,000 1229

Total Rp 270,000 Rp 270,000

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 24-Feb-18 Dina, Ny Rp 50,000 Rp 50,000 Piutang Karyawan (1216)
2 24-Feb-18 Rp -

Total Rp 50,000 Rp 50,000

Surabaya, 25 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 24 Februari 2018
Tunai
No Tanggal Nama Pasien No. RM No. Operator Poli Jasa Dokter Tindakan Total Keterangan
1 24-Feb-18 Angga Indraswara, Tn 925400 Nadia, dr Rp 20,000 Rp 190,000 Rp 210,000 Disc 5%
2 24-Feb-18 Rp -

Total Rp 210,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 24-Feb-18 Rp -

Total

Surabaya, 25 Februari 2018

Penyetor Mengetahui,
Penerima

Angga
Rini Wahyuningati
Laporan Rawat Jalan
Promo Tanggal 24 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Nominal Total Keterangan
1 24-Feb-18 Dewi Prita, Ny Ajeng, dr 447201 Rp 15,000 Rp 15,000 Rp 30,000 Vaksin Ke- 2
2 24-Feb-18 Rp -

Total Rp 30,000

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Nominal Total Keterangan
1 24-Feb-18 Rp -
2 24-Feb-18 Rp -

Total Rp -

Surabaya, 25 Februari 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan
Tanggal 25 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium
1 24-Feb-18 Shaquille Haris, An Ajeng, dr 524501 Rp 25,000 Rp 50,000
2 25-Feb-18 Desak Putu, Ny Arum, dr 178301 Rp 20,000 Rp 50,000
3 25-Feb-18 Tsaqif Hilmi, An Emma, dr 440901 Rp 20,000 Rp 125,000
4 25-Feb-18 Michelle Jesslyn, An Emma, dr 525001 Rp 25,000 Rp 125,000
5 25-Feb-18 Matthew Christopher, An Emma, dr 695900 Rp 20,000 Rp 125,000
6 25-Feb-18 Aiko Lavina, An Emma, dr 386700 Rp 20,000 Rp 125,000
7 25-Feb-18 Margareta Gina, An Emma, dr 683400 Rp 20,000 Rp 125,000

Total

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium
1 24-Feb-18 Melvin Regan, An Ajeng, dr 250201 Rp 20,000 Rp 50,000 Rp 75,000
2 25-Feb-18 Ajeng, dr 195301 Rp 20,000 Rp 50,000
Grace Elita, An
3 25-Feb-18 Mahendra, dr 195301 Rp 125,000
4 25-Feb-18 Abygail Christnindya, An Ajeng, dr 230700 Rp 20,000 Rp 50,000
5 25-Feb-18 Nadhira Ananta, An Arum, dr 473901 Rp 20,000 Rp 50,000 Rp 75,000
6 25-Feb-18 Keitaro Gevareil, An Emma, dr 143800 Rp 20,000 Rp 125,000
7 25-Feb-18 Arief Wijaksono, An Arum, dr 253401 Rp 20,000 Rp 22,500 Rp 52,500
8 25-Feb-18 Michael Marcel, An Emma, dr 499601 Rp 20,000 Rp 125,000
9 25-Feb-18 Muhammad Hasbi, An Emma, dr 524801 Rp 25,000 Rp 125,000
10 25-Feb-18 Malven Syauqi, An Emma, dr 800500 Rp 20,000 Rp 125,000
11 25-Feb-18 Hamdan Yusuf, An Emma, dr 402701 Rp 20,000 Rp 125,000
12 25-Feb-18 Adrianta Fajar, An Emma, dr 459601 Rp 20,000 Rp 200,000
13 25-Feb-18 Eka, dr 524901 Rp 25,000 Rp 50,000 Rp 80,000
Richie Matthew, An
14 25-Feb-18 Emma, dr 524901 Rp 125,000
15 25-Feb-18 Alvaro Gavriel, An Eka, dr 190801 Rp 20,000 Rp 50,000 Rp 75,000

Total

Surabaya, 26 Februari 2018

Penyetor
Nia
Total Keterangan Total
Rp 75,000 IGD RJ Rp 875,000
Rp 70,000 IGD ARJ Rp 1,218,000
Rp 145,000 Rp 2,093,000
Rp 150,000
Rp 145,000
Rp 145,000
Rp 145,000

Rp 875,000

Total Keterangan
Rp 145,000 D BCA ( IGD, Nebul )
Rp 70,000 D BCA ( IGD )
Rp 125,000 D BCA
Rp 70,000 KK Mandiri ( IGD )
Rp 145,000 D BCA ( IGD, Nebul )
Rp 145,000 D BCA
Rp 95,000 D Mandiri ( IGD, Nebul )
Rp 145,000 D Mandiri
Rp 150,000 D BNI
Rp 145,000 D BRI
Rp 145,000 D Mandiri
Rp 220,000 Admedika ( Generali )
Rp 155,000 D BCA ( IGD )
Rp 125,000 D BCA
Rp 145,000 Admedika ( Generali )

Rp 2,025,000

Mengetahui,
Penerima
Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 25 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 24-Feb-18 Kaylie Cllista, An Rp 72,800 Rp 72,800
2 24-Feb-18 Shaquille Haris, An Rp 201,900 Rp 201,900
3 25-Feb-18 Yoona Mizuki, An Rp 13,200 Rp 13,200
4 25-Feb-18 Malven Syauqi, An Rp 90,500 Rp 90,500
5 25-Feb-18 Michael Marcel, An Rp 19,800 Rp 19,800
6 25-Feb-18 Riza Dyah, Ny Rp 254,400 Rp 254,400
7 25-Feb-18 Tsaqif Hilmi, An Rp 59,300 Rp 59,300
8 25-Feb-18 Margareta Gina, An Rp 276,800 Rp 276,800
9 25-Feb-18 Michael Marcel, An Rp 10,900 Rp 10,900
10 25-Feb-18 Michael Marcel, An Rp 10,900 Rp 10,900
11 25-Feb-18 Matthew Christopher, An Rp 135,000 Rp 135,000
12 25-Feb-18 Aiko Lavina, An Rp 72,500 Rp 72,500

Total Rp 1,218,000 Rp 1,218,000

Piutang
No Tanggal Nama Pasien Apotek Total
1 24-Feb-18 Melvin Regan, An Rp 87,600 Rp 87,600
2 24-Feb-18 Grace Elita, An Rp 198,700 Rp 198,700
3 25-Feb-18 Abygail Christnindya, An Rp 24,700 Rp 24,700
4 25-Feb-18 Nadhira Ananta, An Rp 75,100 Rp 75,100
5 25-Feb-18 Nadhira Ananta, An Rp 121,300 Rp 121,300
6 25-Feb-18 Ana ( Security Internal ) Rp 36,400 Rp 36,400
7 25-Feb-18 Muhammad Hasbi, An Rp 364,400 Rp 364,400
8 25-Feb-18 Adrianta Fajar, An Rp 299,500 Rp 299,500
9 25-Feb-18 Hamdan Yusuf, An Rp 548,800 Rp 548,800
10 25-Feb-18 Alvaro Gavriel, An Rp 20,200 Rp 20,200
11 25-Feb-18 Alvaro Gavriel, An Rp 22,200 Rp 22,200
25-Feb-18
Total Rp 1,798,900 Rp 1,798,900

Surabaya, 26 Februari 2018


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Laporan Apotek Rawat Jalan
Tanggal 25 Februari 2018

Ket

Ket
D BCA
D BCA
KK Mandiri
D BCA
D BCA
Piutang Karyawan
D BNI
Admedika ( Generali )
D Mandiri
Admedika ( Generali )
Admedika ( Generali )
Laporan Therapy Kebugaran & Pijat Bayi
Tanggal 25 Februari 2017

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 12-Feb-18 Rp -
2 25-Feb-18 Rp -
3 25-Feb-18 Rp -
4 25-Feb-18 Rp -
5 25-Feb-18 Rp -

Total Rp - Rp -

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 12-Feb-18 Yuke ( CS ) Rp 80,000 Rp 80,000 Piutan Karyawan (1215)
2 25-Feb-18 Rp -

Total Rp 80,000 Rp 80,000

Surabaya, 26 Februari 2017


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan Gigi
Tanggal 25 Februari 2017
Tunai
No Tanggal Nama Pasien No. RM No. Operator Poli Jasa Dokter Tindakan Total Keterangan
1 25-Feb-18 Rp -
2 25-Feb-18

Total Rp -

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 25-Feb-18 Rp -
2 25-Feb-18

Total

Surabaya, 26 Februari 2017

Penyetor Mengetahui,
Penerima

Angga
Rini Wahyuningati
Laporan Rawat Jalan
Promo Tanggal 25 Februari 2017
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Nominal Total Keterangan
1 25-Feb-18 Rp -
2 25-Feb-18 Rp -
3 25-Feb-18

Total Rp -

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Nominal Total Keterangan
1 25-Feb-18 Rp -
2 25-Feb-18 Rp -
3 25-Feb-18 Rp -

Total Rp -

Surabaya, 26 Februari 2017


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


Laporan Rawat Jalan
Tanggal 26 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium
1 26-Feb-18 Chelsea Adelia, An Diana, dr 273901 Rp 20,000 Rp 125,000
2 26-Feb-18 Damian Isaiah, An Diana, dr 525401 Rp 25,000 Rp 125,000
3 26-Feb-18 Imelda, Ny Rina, dr 183000 Rp 20,000 Rp 125,000
4 25-Feb-18 Arief Wijaksono, An Eka, dr 253401 Rp 22,500 Rp 52,500
5 25-Feb-18 Tjie Eveline, Ny Eka, dr 525201 Rp 25,000 Rp 50,000
6 25-Feb-18 Gendis Putri, An Atika, dr 525301 Rp 25,000 Rp 50,000
7 26-Feb-18 Annasya Zaina, An Anna, dr 525501 Rp 25,000 Rp 50,000
8 26-Feb-18 Imelda, Ny Rina, dr 183000 Rp 35,000 Rp 40,000
9 26-Feb-18 Eleanor Cristalin, An Diana, dr 811600 Rp 20,000 Rp 125,000
10 26-Feb-18 Raisya Anjani, An Diana, dr 137701 Rp 20,000 Rp 125,000
11 26-Feb-18 Ahmad Nazril, An Diana, dr 251301 Rp 20,000 Rp 125,000
12 26-Feb-18 Ammar Zain, An Kartika, dr 483601 Rp 20,000 Rp 125,000
13 26-Feb-18 Azdriel Rahandhika, An Anna, dr 522201 Rp 20,000 Rp 22,500 Rp 52,500
14 26-Feb-18 Dwita Lucya, An Diana, dr 473100 Rp 20,000 Rp 125,000
15 6-Feb-18 Dude Yusuf, An Kartika, dr 048000 Rp 20,000 FREE
16 26-Feb-18 Anita Hidayah, Ny Rina, dr 916000 Rp 20,000 Rp 125,000
17 26-Feb-18 Hanifa Almira, An Diana, dr 525701 Rp 25,000 Rp 125,000
18 26-Feb-18 Anita Hidayah, Ny Rina, dr 916000 Rp 35,000 Rp 40,000
19 26-Feb-18 Edward Christian, An Diana, dr 497301 Rp 20,000 Rp 125,000
20 26-Feb-18 Alinka Kaisa, An Diana, dr 141201 Rp 20,000 Rp 125,000
21 26-Feb-18 Qirania Farzana, An Diana, dr 525801 Rp 25,000 Rp 125,000
22 26-Feb-18 Yoona Natallie, An Kartika, dr 439801 Rp 20,000 Rp 125,000
23 26-Feb-18 Jonathan Boediono, An Diana, dr 525601 Rp 25,000 Rp 125,000
24 26-Feb-18 Ines Yulistiara, Ny Eighty, dr 525901 Rp 25,000 Rp 125,000
25 26-Feb-18 Abby Gail, An Diana, dr 514501 Rp 20,000 Rp 125,000
26 26-Feb-18 Sulis Muchsahida, Ny Eighty, dr 526001 Rp 25,000 FREE Rp 45,000 Rp 40,000
27 26-Feb-18 Widiyanti, Ny Eighty, dr 526101 Rp 25,000 Rp 125,000
28 26-Feb-18 Siska, Ny Eighty, dr 036200 Rp 20,000 Rp 125,000
29 26-Feb-18 Puji Lestari, Ny Eighty, dr 246101 Rp 20,000 Rp 125,000
30 26-Feb-18 Nur Roikhana, Ny Eighty, dr 526301 Rp 25,000 Rp 125,000
31 26-Feb-18 Alshameyzea Nabila. An Diana, dr 537400 Rp 20,000 Rp 125,000
32 26-Feb-18 Nur Aini, Ny Anna, dr 526401 Rp 25,000 Rp 50,000 Rp 22,500 Rp 52,500
33 26-Feb-18 Widiyanti, Ny Eighty, dr 526101 Rp 35,000 Rp 40,000
34 26-Feb-18 Woro Setia, Ny Eighty, dr 292800 Rp 35,000 Rp 40,000
35 26-Feb-18 Damarrendra Abiwara, An Kartika, dr 318801 Rp 20,000 Rp 125,000
36 26-Feb-18 Puji Lestari, Ny Eighty, dr 246101 Rp 35,000 Rp 40,000
37 26-Feb-18 Nur Roikhana, Ny Eighty, dr 526301 Rp 35,000 Rp 40,000
38 26-Feb-18 Joy Victoria, An Kartika, dr 483701 Rp 20,000 Rp 125,000
39 26-Feb-18 Marshella Shaqueena, An Kartika, dr 514601 Rp 20,000 Rp 125,000
40 26-Feb-18 Dastan Agastya, An Kartika, dr 445100 Rp 20,000 Rp 125,000
41 26-Feb-18 Alya Rahma, An Yusuf, dr 524301 Rp 20,000 Rp 50,000
42 26-Feb-18 Linda Kumalasari, Ny Fandy, dr 523601 Rp 20,000 Rp 125,000
43 26-Feb-18 Joy Victoria, An Kartika, dr 483701 Rp 75,000
44 26-Feb-18 Shaquille Haris, An Kartika, dr 524501 Rp 20,000 Rp 125,000
45 26-Feb-18 Linda Kumalasari, Ny Fandy, dr 523601 Rp 75,000 Rp 35,000 Rp 40,000
46 26-Feb-18 Melvin Regan, An Yusuf, dr 250201 Rp 20,000 Rp 22,500 Rp 52,500

Total

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium
1 25-Feb-18 Vica, An Eka, dr 525101 Rp 25,000 Rp 50,000
2 26-Feb-18 Eliot Sutjipto, An Diana, dr 892600 Rp 20,000 Rp 125,000
3 26-Feb-18 Kinarian Alesha, An Diana, dr 168101 Rp 20,000 Rp 125,000
4 26-Feb-18 Mola Hidratinum, Ny Anna, dr 343001 Rp 20,000 Rp 50,000
5 26-Feb-18 Mutia Nur, Ny Rina, dr 551800 Rp 20,000 Rp 125,000
6 26-Feb-18 Abygail Christnindya, An Diana, dr 230700 Rp 20,000 Rp 125,000
7 26-Feb-18 Annabelle Dominiqueen, An Anna, dr 10000 Rp 20,000 Rp 50,000
8 26-Feb-18 Mutia Nur, Ny Rina, dr 551800 Rp 45,000 Rp 40,000
9 26-Feb-18 Firyal Artariq, An Diana, dr 490100 Rp 20,000 FREE
10 26-Feb-18 Cathleen Quinnsly, An Diana, dr 514301 Rp 20,000 Rp 125,000
11 26-Feb-18 Ignatius Putra, An Diana, dr 170200 Rp 20,000 Rp 125,000
12 26-Feb-18 Glenn Gunawan, An Diana, dr 457601 Rp 20,000 Rp 125,000
13 26-Feb-18 Ahmad Nazril, An Diana, dr 251301 Rp 75,000
14 26-Feb-18 Muhammad Arsyad, An Diana, dr 421401 Rp 20,000 Rp 125,000
15 26-Feb-18 Sunny Santoso, An Diana, dr 474401 Rp 20,000 Rp 125,000
16 26-Feb-18 Woro Setia, Ny Eighty, dr 292800 Rp 20,000 FREE
17 26-Feb-18 Erlin Erviana, Nn Anna, dr 518601 Rp 79,000
18 26-Feb-18 Khaliluna Manda, An Diana, dr 521000 Rp 20,000 Rp 125,000
19 26-Feb-18 Danar Artha, Ny Eighty, dr 526201 Rp 25,000 FREE
20 26-Feb-18 Danar Artha, Ny Eighty, dr 526201 Rp 35,000 Rp 40,000
21 26-Feb-18 Reynella Aiko, An Diana, dr 116801 Rp 20,000 Rp 125,000 Rp 554,000
22 26-Feb-18 Asmaul Amalia, Ny Eighty, dr 249701 Rp 20,000 Rp 125,000 Rp 185,000 Rp 40,000 Rp 38,000
23 26-Feb-18 Nadhira Ananta, An Yusuf, dr 473901 Rp 20,000 Rp 50,000 Rp 22,500 Rp 52,500
24 26-Feb-18 Vellery Kimminha, An Kartika, dr 519601 Rp 20,000 Rp 125,000
25 26-Feb-18 Citra Primarizki, Ny Fandy, dr 472901 Rp 20,000 Rp 125,000
26 26-Feb-18 Aina Thalita, AN Kartika, dr 362501 Rp 20,000 Rp 125,000
27 26-Feb-18 Moh. Ibrahim Syahputra, An Yusuf, dr 076901 Rp 20,000 Rp 50,000 Rp 22,500 Rp 52,500
28 26-Feb-18 Jennaira M. A, An Kartika, dr 014801 Rp 20,000 FREE
29 26-Feb-18 Citra Primarizki, Ny Fandy, dr 472901 Rp 35,000 Rp 40,000
30 26-Feb-18 Caythleen Abigail, An Kartika, dr 987800 Rp 20,000 Rp 125,000

Total

Surabaya, 27 Februari 2018

Penyetor

Nia
Jalan
ri 2018

Total Keterangan
Rp 145,000
Rp 150,000 Total
Rp 145,000 RJ Rp 5,610,000
Rp 75,000 IGD, Nebul ARJ Rp 5,046,500
Rp 75,000 IGD Rp 10,656,500
Rp 75,000 IGD BS RJ Rp (125,000)
Rp 75,000 IGD Rp 10,531,500
Rp 75,000 USG 2D BS RJ Rp (125,000)
Rp 145,000 Rp 10,406,500
Rp 145,000 Px byr dtmpat Rp 47,500
Rp 145,000 Rp 10,454,000
Rp 145,000 Biaya Resummed Rp 75,000
Rp 95,000 Nebul Rp 10,529,000
Rp 145,000 BS RJ Rp (125,000)
Rp 20,000 Anak Karyawan Rp 10,404,000
Rp 145,000
Rp 150,000
Rp 75,000 USG 2D
Rp 145,000
Rp 145,000
Rp 150,000
Rp 145,000
Rp 150,000
Rp 150,000
Rp 145,000
Rp 110,000 USG 2D
Rp 150,000
Rp 145,000
Rp 145,000
Rp 150,000
Rp 145,000
Rp 150,000 IGD, Nebul
Rp 75,000 USG 2D
Rp 75,000 USG 2D
Rp 145,000
Rp 75,000 USG 2D
Rp 75,000 USG 2D
Rp 145,000
Rp 145,000
Rp 145,000
Rp 70,000 IGD
Rp 145,000
Rp 75,000 Tindik Bayi
Rp 145,000
Rp 150,000 Konsul , USG 2D
Rp 95,000 IGD, Nebul

Rp 5,610,000

Total Keterangan
Rp 75,000 D BCA ( IGD )
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 70,000 D BNI ( IGD )
Rp 145,000 D BCA
Rp 145,000 D Mandiri
Rp 70,000 D BCA ( IGD )
Rp 85,000 D BCA ( USG 2D, Print 1x )
Rp 20,000 D BCA ( Anak Karyawan )
Rp 145,000 D MAndiri
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 75,000 D BCA ( Nebul )
Rp 145,000 Admedika ( Pertamina )
Rp 145,000 D BCA
Rp 20,000 D Mandiri
Rp 79,000 Piutang Karyawan
Rp 145,000 D BCA
Rp 25,000 D MAndiri
Rp 75,000 D Mandiri ( USG 2D )
Rp 699,000 D Mandiri
Rp 408,000 Admedika ( BNI Life )
Rp 145,000 KK BNI ( IGD, Nebul )
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA ( IGD, Nebul )
Rp 20,000 D BCA
Rp 75,000 D BCA
Rp 145,000 D BCA

Rp 4,116,000

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 26 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 25-Feb-18 Ananda Raffasya, AN Rp 28,600 Rp 28,600
2 25-Feb-18 Ananda Raffasya, AN Rp 26,400 Rp 26,400
3 25-Feb-18 Sufiandika, dr Rp 41,900 Rp 41,900
4 25-Feb-18 Arief Wijaksono, An Rp 61,500 Rp 61,500
5 25-Feb-18 Tjie Eveline, Ny Rp 35,500 Rp 35,500
6 25-Feb-18 Gendis Putri, An Rp 57,100 Rp 57,100
7 25-Feb-18 Gendis Putri, An Rp 109,900 Rp 109,900
8 26-Feb-18 Anis Rp 115,600 Rp 115,600
9 26-Feb-18 Annasya Zaina, An Rp 133,000 Rp 133,000
10 26-Feb-18 Imelda, Ny Rp 467,300 Rp 467,300
11 26-Feb-18 Lisa Rp 332,300 Rp 332,300
12 6-Feb-18 Dude Yusuf, An Rp 42,100 Rp 42,100
13 26-Feb-18 Chelsea Adelia, An Rp 112,600 Rp 112,600
14 26-Feb-18 Damian Isaiah, An Rp 59,500 Rp 59,500
15 26-Feb-18 Dwita Lucya, An Rp 200,900 Rp 200,900
16 26-Feb-18 Indah, Ny Rp 21,500 Rp 21,500
17 26-Feb-18 Eliot Sutjipto, An Rp 548,800 Rp 548,800
18 15-Feb-18 Farlian Rp 36,400 Rp 36,400
19 26-Feb-18 Sunny Santoso, An Rp 177,000 Rp 177,000
20 26-Feb-18 Hanifa Almira, An Rp 42,300 Rp 42,300
21 5-Feb-18 Sheta Fildzah, Ny Rp 33,400 Rp 33,400
22 12-Feb-18 Sheta Fildzah, Ny Rp 58,500 Rp 58,500
23 26-Feb-18 Sheta Fildzah, Ny Rp 51,200 Rp 51,200
24 26-Feb-18 Siska, Ny Rp 53,500 Rp 53,500
25 26-Feb-18 Nur Aini, Ny Rp 140,200 Rp 140,200
26 26-Feb-18 Khaliluna Manda, An Rp 26,000 Rp 26,000
27 26-Feb-18 Widiyanti, Ny Rp 32,500 Rp 32,500
28 26-Feb-18 Woro Setia, Ny Rp 121,500 Rp 121,500
29 26-Feb-18 Alshameyzea Nabila. An Rp 59,500 Rp 59,500
30 26-Feb-18 Richie Matthew, An Rp 160,000 Rp 160,000
31 26-Feb-18 Ammar Zain, An Rp 54,000 Rp 54,000
32 26-Feb-18 Ammar Zain, An Rp 5,300 Rp 5,300
33 26-Feb-18 Ammar Zain, An Rp 82,300 Rp 82,300
34 26-Feb-18 Hanifah Rp 16,200 Rp 16,200
35 26-Feb-18 Yoona Natallie, An Rp 924,400 Rp 924,400
36 26-Feb-18 Yoona Natallie, An Rp 32,900 Rp 32,900
37 26-Feb-18 Marshella Shaqueena, An Rp 48,700 Rp 48,700
38 26-Feb-18 Joy Victoria, An Rp 82,300 Rp 82,300
39 26-Feb-18 Vellery Kimminha, An Rp 44,600 Rp 44,600
40 26-Feb-18 Utotok Rp 18,400 Rp 18,400
41 26-Feb-18 Dastan Agastya, An Rp 291,400 Rp 291,400
42 26-Feb-18 Shaquille Haris, An Rp 59,500 Rp 59,500

Total Rp 5,046,500 Rp 5,046,500


Piutang
No Tanggal Nama Pasien Apotek Total
1 26-Feb-18 Vica, An Rp 63,500 Rp 63,500
2 26-Feb-18 Mola Hidratinum, Ny Rp 49,500 Rp 49,500
4 26-Feb-18 Annabelle Dominiqueen, An Rp 174,100 Rp 174,100
5 26-Feb-18 Firyal Artariq, An Rp 217,600 Rp 217,600
6 26-Feb-18 Glenn Gunawan, An Rp 159,600 Rp 159,600
7 26-Feb-18 Glenn Gunawan, An Rp 10,600 Rp 10,600
8 26-Feb-18 Glenn Gunawan, An Rp 62,000 Rp 62,000
9 26-Feb-18 Eleanor Cristallin, An Rp 595,000 Rp 595,000
10 26-Feb-18 Ahmad Nazril, An Rp 20,200 Rp 20,200
11 26-Feb-18 Muhammad Arsyad, An Rp 364,400 Rp 364,400
12 26-Feb-18 Kinarian Alesha, An Rp 138,900 Rp 138,900
13 26-Feb-18 Ahmad Nazril, An Rp 192,500 Rp 192,500
14 26-Feb-18 Alinka Kaisa, An Rp 548,800 Rp 548,800
15 26-Feb-18 Reynella Aiko, An Rp 109,900 Rp 109,900
16 26-Feb-18 Asmaul Amalia, Ny Rp 66,200 Rp 66,200
17 26-Feb-18 Kirana Ayunidya, An Rp 120,100 Rp 120,100
19 26-Feb-18 Moh. Ibrahim Syahputra, An Rp 22,500 Rp 22,500
20 26-Feb-18 Jennaira M. A, An Rp 167,500 Rp 167,500
21 26-Feb-18 Aina Thalita, AN Rp 1,185,400 Rp 1,185,400
22 26-Feb-18 Caythleen Abigail, An Rp 821,000 Rp 821,000

Total Rp 5,089,300 Rp 5,089,300

Surabaya, 27 Februari 2018


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


Laporan Apotek Rawat Jalan
Tanggal 26 Februari 2018

Ket
Ket
D BCA
D BNI
D BCA
KK BCA
D BCA
D BCA
D BCA
D BCA
D BCA
Admedika ( Pertamina )
D BCA
D BCA
D BCA
D Mandiri
Admedika ( BNI Life )
D BCA
D BCA
D BCA
D BCA
D BCA
Laporan Rawat Jalan
Tanggal 27 Februari 2018
Tunai
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 27-Feb-18 Nur Aini, Ny Arum, dr 526401 Rp 20,000 Rp 50,000 Rp 75,000 Rp 145,000
2 27-Feb-18 Bryant Anthony, An Leny, dr 310801 Rp 20,000 Rp 125,000 Rp 145,000
3 27-Feb-18 Alshameyzea Nabila, An Diana, dr 537400 Rp 20,000 Rp 38,000 Rp 58,000
4 27-Feb-18 Febriane Matahang, Ny Fandy, dr 526701 Rp 25,000 Rp 125,000 Rp 245,000 Rp 395,000
5 27-Feb-18 Claudia Meliana, Ny Dhini, dr 482701 Rp 20,000 Rp 125,000 Rp 145,000
6 27-Feb-18 Fenny Augustine, Ny Brahmantyo, dr 371501 Rp 20,000 Rp 125,000 Rp 145,000
7 27-Feb-18 Claudia Meliana, Ny Dhini, dr 482701 Rp 35,000 Rp 40,000 Rp 75,000
8 27-Feb-18 Alvaro Gavriel, An Kartika, dr 156701 CANCEL Rp -
9 27-Feb-18 Putri Rachma, Ny Fandy, dr 501901 Rp 20,000 Rp 125,000 Rp 145,000
10 27-Feb-18 Riza Johan, Tn Anna, dr 999500 Rp 63,200 Rp 63,200
11 27-Feb-18 Putri Rachma, Ny Fandy, dr 501901 Rp 35,000 Rp 40,000 Rp 75,000
12 27-Feb-18 Adzkia Nadhira, An Rohim, dr 464501 Rp 20,000 Rp 75,000 Rp 95,000
13 27-Feb-18 Theo Wulrich, An Leny, dr 517701 Rp 20,000 Rp 125,000 Rp 145,000
14 27-Feb-18 Florencia Pauzil, Ny Erna, dr 007700 Rp 20,000 Rp 125,000 Rp 145,000
15 27-Feb-18 Eleanor Gavrilla, An Kartika, dr 960200 Rp 20,000 Rp 125,000 Rp 145,000
16 27-Feb-18 Owen Zander, An Leny, dr 101001 Rp 20,000 Rp 125,000 Rp 145,000
17 27-Feb-18 Irma Iriyanti, Ny Erna, dr 918100 Rp 20,000 Rp 125,000 Rp 145,000
18 27-Feb-18 Nova Isti, Ny Erna, dr 244901 Rp 20,000 Rp 125,000 Rp 145,000
19 27-Feb-18 Nishreen Nyala, An Leny, dr 510001 Rp 20,000 Rp 125,000 Rp 145,000
20 27-Feb-18 Fenny Augustine, Ny Brahmantyo, dr 371501 Rp 35,000 Rp 40,000 Rp 75,000
21 27-Feb-18 Theo Wulrich, An Leny, dr 517701 Rp 250,000 Rp 90,000 Rp 340,000
22 27-Feb-18 Citra Ayu, Ny Erna, dr 120901 Rp 20,000 FREE Rp 20,000
23 27-Feb-18 Lini Anisfatus, Ny Erna, dr 418301 Rp 20,000 Rp 125,000 Rp 145,000
24 27-Feb-18 Ahmad Syabil, An Mahe, dr 238300 Rp 20,000 Rp 125,000 Rp 145,000
25 27-Feb-18 Irma Iriyanti, Ny Erna, dr 918100 Rp 35,000 Rp 40,000 Rp 75,000
26 27-Feb-18 Syahla Cherry, An Rohim, dr 527301 Rp 25,000 FREE Rp 25,000
27 27-Feb-18 Citra Ayu, Ny Erna, dr 120901 Rp 250,000 Rp 250,000
28 27-Feb-18 Andi Muh, An Mahe, dr 389701 Rp 20,000 Rp 125,000 Rp 145,000
29 27-Feb-18 Lini Anisfatus, Ny Erna, dr 418301 Rp 35,000 Rp 40,000 Rp 75,000
30 27-Feb-18 Teresa Adawiyah, Ny Erna, dr 507201 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
31 27-Feb-18 Muhammad Dzaky, An Rohim, dr 527401 Rp 25,000 Rp 125,000 Rp 150,000
32 27-Feb-18 Nishreen Nyala, An Leny, dr 510001 Rp 90,000 Rp 90,000
33 27-Feb-18 Warda, Ny Erna, dr 527201 Rp 25,000 Rp 325,000 Rp 375,000 Rp 725,000
34 27-Feb-18 Ratutesla Kautsar, An Mahe, dr 833200 Rp 20,000 Rp 125,000 Rp 145,000

Total Rp 5,126,200

Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium Total
1 27-Feb-18 Wayne Edreenson, An Kartika, dr 441701 Rp 20,000 Rp 125,000 Rp 145,000
2 27-Feb-18 Arien Pusparetno, Ny Anna, dr 482700 Rp 211,200 Rp 211,200
3 27-Feb-18 Joycellin Angel, Ny Fandy, dr 027701 Rp 20,000 Rp 125,000 Rp 145,000
4 27-Feb-18 Raphael Hugo, An Kartika, dr 785000 Rp 20,000 Rp 125,000 Rp 145,000
5 27-Feb-18 Ria Natalia, Nn Dhini, dr 526801 Rp 25,000 Rp 125,000 Rp 150,000
6 27-Feb-18 Joycellin Angel, Ny Fandy, dr 027701 Rp 35,000 Rp 40,000 Rp 75,000
7 27-Feb-18 Hanaira Widya, An Kartika, dr 120501 Rp 20,000 Rp 125,000 Rp 145,000
8 27-Feb-18 Nadhira Ananta, An Kartika, dr 473901 Rp 20,000 Rp 125,000 Rp 145,000
9 27-Feb-18 Abdullah Abqory, An Leny, dr 265501 Rp 20,000 Rp 125,000 Rp 145,000
10 27-Feb-18 Theodore Javier, An Kartika, dr 460100 Rp 20,000 Rp 125,000 Rp 145,000
11 27-Feb-18 Nazma Eryshta, An Leny, dr 395801 Rp 20,000 Rp 125,000 Rp 145,000
12 27-Feb-18 Henna Midaayraeva, An Leny, dr 517801 Rp 20,000 Rp 125,000 Rp 145,000
13 27-Feb-18 Haila Milaayraeva, An Leny, dr 517901 Rp 20,000 Rp 125,000 Rp 145,000
14 27-Feb-18 Al Hail, An Leny, dr 272701 Rp 20,000 Rp 125,000 Rp 145,000
15 27-Feb-18 Gabriel Nicholas, An Kartika, dr 151801 Rp 20,000 Rp 125,000 Rp 145,000
16 27-Feb-18 Nadhira Ananta, An Kartika, dr 473901 Rp 75,000 Rp 75,000
17 27-Feb-18 Fitry Yunitasati, An Ajeng, dr 216001 Rp 20,000 Rp 50,000 Rp 50,000 Rp 120,000
18 27-Feb-18 Hanif Marsyad, An Kartika, dr 023801 Rp 20,000 Rp 125,000 Rp 145,000
19 27-Feb-18 Adrian Syahreza, An Mahe, dr 400700 Rp 20,000 Rp 125,000 Rp 145,000
20 27-Feb-18 Hansel Matthew, An Leny, dr 307901 Rp 20,000 Rp 125,000 Rp 145,000
21 27-Feb-18 Vaniah Tanoedjaja, An Mahe, dr 527101 Rp 25,000 Rp 125,000 Rp 150,000
22 27-Feb-18 Haniel Tanoedjaja, An Mahe, dr 527001 Rp 25,000 Rp 125,000 Rp 150,000
23 27-Feb-18 Aline Tanoedjaja, An Mahe, dr 761200 Rp 20,000 Rp 125,000 Rp 145,000
24 27-Feb-18 Ariella Maisie, Ny Erna, dr 281601 Rp 20,000 FREE Rp 35,000 Rp 40,000 Rp 95,000
25 27-Feb-18 Asyraf Akmal, An Leny, dr 526901 Rp 25,000 Rp 125,000 Rp 150,000
26 27-Feb-18 Stefany Clara, An Rohim, dr 442201 Rp 20,000 Rp 125,000 Rp 145,000
27 27-Feb-18 Phylicia, Ny Erna, dr 019501 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000 Rp 220,000
28 27-Feb-18 Muhammad Arvand, An Rohim, dr '432101 Rp 20,000 FREE Rp 20,000
29 27-Feb-18 Sultan Muhammad, An Rohim, dr 499801 Rp 20,000 Rp 125,000 Rp 145,000
30 27-Feb-18 Iqlima Orlin, An Mahe, dr 821800 Rp 20,000 Rp 125,000 Rp 145,000
31 27-Feb-18 Faeyza Khairi, An Mahe, dr 887400 Rp 20,000 Rp 125,000 Rp 145,000
32 27-Feb-18 Faeyza Khairi, An Ajeng, dr 887400 Rp 22,500 Rp 52,500 Rp 75,000
33 27-Feb-18 Rafifa Cordelia, An Mahe, dr 401801 Rp 20,000 Rp 125,000 Rp 145,000
34 27-Feb-18 Khaireena Zahirah, An Ajeng, dr 935100 Rp 20,000 Rp 22,500 Rp 52,500 Rp 95,000
35 27-Feb-18 Dyandra Keisha, An Rohim, dr 420700 Rp 20,000 Rp 125,000 Rp 145,000
36 27-Feb-18 Seraphiel Silvana, An Mahe, dr 227701 Rp 20,000 Rp 125,000 Rp 145,000

Total Rp 4,921,200

Surabaya, 28 Februari 2017


Mengetahui,
Penyetor Penerima

Nia Rini Wahyuningati


an
2018

Keterangan TOTAL
Nebul RJ Rp 5,126,200
ARJ Rp 2,405,100
Rp 7,531,300
PR Rp 240,000
Rp 7,771,300
RJG Rp 170,000
USG 2 Rp 7,941,300
BS RI Rp (398,600) Ny Nova Isti
Rp 7,542,700
Karyawan BS RJ Rp (125,000) Muhammad Arvand, An
USG 2D Rp 7,417,700
Tindik Bayi P Rp 60,000
Rp 7,477,700
Pxbyrdi Rp 125,000 Asyraf Akmal, An
Rp 7,602,700

USG 2D
Tongue Tie

USG 2D

Reposisi IUD

USG 2D
USG 2D
USG 4D

Keterangan
D BCA
Piutang Karyawan
D BCA
D BCA
D BCA
D BCA ( USG 2D )
D BRI Syariah
D BCA
D Mandiri
D BCA
Admedika ( BNI Life )
KK BCA
KK BCA
KK BCA
D BCA
D BCA ( Nebul )
D BCA ( IGD, VT )
D BCA
D Mandiri
D BCA
D Mandiri
D Mandiri
D Mandiri
D BCA ( USG 2D )
Admedika ( Avrist )
D Mandiri
KK BCA ( USG 2D )
D BCA
D BCA
Admedika ( BNI Life )
D Niaga
D Niaga ( IGD, Nebul )
D Niaga
D Niaga ( IGD, Nebul )
Admedika ( FWD ) Px byr di tmpt Rp. 15.000 ( D BCA )
D BCA

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 27 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 27-Feb-18 Nur Aini, Ny Rp 115,200 Rp 115,200
2 27-Feb-18 Njoo Venny, Ny Rp 340,000 Rp 340,000
3 27-Feb-18 Vania, An Rp 117,300 Rp 117,300
4 27-Feb-18 Putri Rachma, Ny Rp 11,300 Rp 11,300
5 27-Feb-18 Widiastuti, Ny Rp 27,000 Rp 27,000
6 27-Feb-18 Bryant Anthony, An Rp 74,500 Rp 74,500
7 27-Feb-18 Eleanor Gavrilla, An Rp 57,000 Rp 57,000
8 27-Feb-18 Eleanor Gavrilla, An Rp 66,000 Rp 66,000
9 27-Feb-18 Theo Wulrich, An Rp 16,000 Rp 16,000
10 27-Feb-18 Owen Zander, An Rp 62,300 Rp 62,300
11 27-Feb-18 Andi Muh, An Rp 785,100 Rp 785,100
12 27-Feb-18 Syahla Cherry, An Rp 68,500 Rp 68,500
13 27-Feb-18 Nishreen Nyala, An Rp 294,700 Rp 294,700
14 27-Feb-18 Nova Isti, Ny Rp 60,100 Rp 60,100
15 27-Feb-18 Ahmad Syabil, An Rp 155,500 Rp 155,500
16 27-Feb-18 Ratutesla Kautsar, An Rp 154,600 Rp 154,600

Total Rp 2,405,100 Rp 2,405,100

Piutang
No Tanggal Nama Pasien Apotek Total
1 27-Feb-18 Novita Permatasari, Ny Rp 3,100 Rp 3,100
2 27-Feb-18 Amel ( Poli ) Rp 24,400 Rp 24,400
3 27-Feb-18 Raphael Hugo, An Rp 595,000 Rp 595,000
4 27-Feb-18 Wayne Edreenson, An Rp 595,000 Rp 595,000
5 27-Feb-18 Abdullah Abqory, An Rp 225,200 Rp 225,200
6 27-Feb-18 Theodore Javier, An Rp 200,900 Rp 200,900
7 27-Feb-18 Hanaira Widya, An Rp 507,200 Rp 507,200
8 27-Feb-18 Nazma Eryshta, An Rp 1,076,000 Rp 1,076,000
9 27-Feb-18 Gabriel Nicholas, An Rp 45,000 Rp 45,000
10 27-Feb-18 Nadhira Ananta, An Rp 91,200 Rp 91,200
11 27-Feb-18 Hanif Marsyad, An Rp 29,300 Rp 29,300
12 27-Feb-18 Hansel Matthew, An Rp 1,076,000 Rp 1,076,000
13 27-Feb-18 Stefany Clara, An Rp 112,100 Rp 112,100
14 27-Feb-18 Iqlima Orlin, An Rp 139,400 Rp 139,400
15 27-Feb-18 Adrian Syahreza, An Rp 241,300 Rp 241,300
16 27-Feb-18 Muhammad Arvand, An Rp 785,100 Rp 785,100
17 27-Feb-18 Faeyza Khairi, An Rp 43,000 Rp 43,000
18 27-Feb-18 Rafifa Cordelia, An Rp 23,800 Rp 23,800
19 27-Feb-18 Dyandra Keisha, An Rp 159,300 Rp 159,300
20 27-Feb-18 Vaniah Tanoedjaja, An Rp 152,500 Rp 152,500
21 27-Feb-18 Aline Tanoedjaja, An Rp 156,000 Rp 156,000
22 27-Feb-18 Haniel Tanoedjaja, An Rp 80,700 Rp 80,700
23 27-Feb-18 Muhammad Dzaky, An Rp 126,600 Rp 126,600

Total Rp 6,488,100 Rp 6,488,100

Surabaya, 28 Februari 2018


Mengetahui,
Penyetor Penerima

Ika Rini Wahyuningati


Laporan Apotek Rawat Jalan
Tanggal 27 Februari 2018

Ket

Ket
Piutang Karyawan
Piutang Karyawan
D BCA
D BCA
D Mandiri
D BCA
D BRI Syariah
Admedika ( BNI Life )
D BCA
D BCA
D BCA
D BCA
D Mandiri
Admedika ( BNI Life )
D Mandiri
D BCA
D Niaga
D Niaga
Admedika ( FWD )
D Mandiri
D Mandiri
D Mandiri
D BCA
Laporan Rawat Jalan Gigi
Tanggal 27 Februari 2018
Tunai
No Tanggal Nama Pasien No. RM No. Operator Poli Jasa Dokter Tindakan Total Keterangan
1 27-Feb-18 Nabila Keiko, An 509600 Muthyah, drg Rp 20,000 Rp 150,000 Rp 170,000
2 27-Feb-18 Rp -

Total Rp 170,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total Keterangan
1 27-Feb-18 Queena Calya, An 185201 Mashita, dr Rp 20,000 Rp 250,000 Rp 270,000 D BCA
2 27-Feb-18 Rp -

Total Rp 270,000

Surabaya, 28 Februari 2018

Penyetor Mengetahui,
Penerima

Ika
Rini Wahyuningati
Laporan Therapy Kebugaran & Pijat Bayi
Tanggal 28 Februari 2018

Tunai
No Tanggal Nama Pasien Nominal Total Ket
1 28-Feb-18 An Atsqia Rp 60,000 Rp 60,000 1232

Total Rp 60,000 Rp 60,000

Piutang
No Tanggal Nama Pasien Nominal Total Ket
1 28-Feb-18 Rp -
2 28-Feb-18 Rp -

Total Rp - Rp -

Surabaya, 28 Februari 2018 Mengetahui,


Penerima
Penyetor

Rini Wahyuningati
Ika
Piutang
No Tanggal Nama Pasien Nama Dokter No. RM Poli Jasa Dokter USG / Tindakan Jasa Operator Laboratorium
1 28-Feb-18 Davin Ferdinand, An Diana, dr 52301 Rp 20,000 Rp 125,000
2 28-Feb-18 Naira Shima, An Dini, dr 379501 Rp 20,000 Rp 125,000
3 28-Feb-18 Christeline Zevanya, An Anna, dr 172101 Rp 20,000 Rp 50,000
4 28-Feb-18 Isna Farikha, Ny Erna, dr 201401 Rp 20,000 Rp 125,000
5 28-Feb-18 Zahrah S. Bahanan, NY Fandy, dr 282401 Rp 20,000 Rp 125,000
6 28-Feb-18 Eugnia Chritavella, An Diana, dr 382201 Rp 20,000 Rp 125,000
7 28-Feb-18 Zahrah S. Bahanan, NY Fandy, dr 282401 Rp 35,000 Rp 40,000
8 28-Feb-18 Yustina Deali, Ny Tik, dr 058000 Rp 20,000 Rp 1,516,000
9 28-Feb-18 Anissa Prdani, Ny Dhini, dr 165301 CANCEL
10 28-Feb-18 Zaretha Christine, An Diana, dr 083001 Rp 20,000 Rp 125,000
11 28-Feb-18 Zakiyah , Ny Erna, dr 521201 Rp 20,000 Rp 125,000
12 28-Feb-18 Nabila Adha, An Anna, dr 527801 Rp 25,000 Rp 50,000
13 28-Feb-18 Mustika Agusti, Ny Eighty, dr 527901 Rp 25,000 Rp 125,000 Rp 35,000 Rp 40,000
14 28-Feb-18 Achmad Rayyanka, An Dini, dr 489701 Rp 20,000 Rp 125,000
15 28-Feb-18 Lilis Suharini, Ny Erna, dr 274301 Rp 20,000 Rp 125,000
16 28-Feb-18 Dinaniar Enggar, Ny Erna, dr 483201 Rp 20,000 Rp 125,000 Rp 40,000 Rp 60,000
17 28-Feb-18 Lenny Wijayanti, Ny Erna, dr 263601 Rp 20,000 Rp 125,000
18 28-Feb-18 Lilis Suharini, Ny Erna, dr 274301 Rp 35,000 Rp 40,000 Rp 607,000
19 28-Feb-18 Octavia Christatnti, Ny Erna, dr 528001 Rp 25,000 Rp 125,000
20 28-Feb-18 Devi Novianty, Ny Erna, dr 233800 Rp 35,000 Rp 40,000
21 28-Feb-18 Charisa, An Emma, dr 342001 Rp 20,000 Rp 125,000
22 28-Feb-18 Lenny Wijayanti, Ny Erna, dr 263601 Rp 35,000 Rp 40,000
23 28-Feb-18 Alana Shanum, An Emma, dr 657700 Rp 20,000 Rp 125,000
24 28-Feb-18 Julian Dwindiasis, Ny Erna, dr 193500 Rp 22,500 Rp 52,500
25 28-Feb-18 Nur Halimah, Ny Fandy, dr 980000 Rp 20,000 Rp 125,000
26 28-Feb-18 Octavia Christatnti, Ny Erna, dr 528001 Rp 35,000 Rp 40,000 Rp 715,000
27 28-Feb-18 Ema Aristiani, Ny Erna, dr 528201 Rp 25,000 Rp 125,000 Rp 35,000 Rp 40,000
28 28-Feb-18 Imelda Magdalena, Ny Fandy, dr 528401 Rp 25,000 Rp 125,000
29 28-Feb-18 Odilia Rhea, An Emma, dr 274401 Rp 20,000 Rp 125,000
30 28-Feb-18 Genoveva Mada, An Emma, dr 016001 Rp 20,000 Rp 125,000
31 28-Feb-18 Nur Halimah, Ny Fandy, dr 980000 Rp 35,000 Rp 40,000
32 28-Feb-18 Elsanita Christifani, Ny Fandy, dr 299901 Rp 20,000 Rp 125,000 Rp 35,000 Rp 40,000
33 28-Feb-18 Imelda Magdalena, Ny Fandy, dr 528401 Rp 40,000 Rp 60,000
34 28-Feb-18 Juvia Hoyaranda, An Dini, dr 528501 Rp 25,000 Rp 125,000
35 28-Feb-18 Shanessa Maldiva, An Dini, dr 333300 Rp 20,000 Rp 125,000
36 28-Feb-18 Marvel Federer, An Dini, dr 234001 Rp 20,000 Rp 125,000

Total

Surabaya, 01 Maret 2018

Penyetor

Angga
Total Keterangan
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 70,000 D BCA ( IGD )
Rp 145,000 D BNI
Rp 145,000 KK BUKOPIN
Rp 145,000 KK BCA
Rp 75,000 KK BCA
Rp 1,536,000 D BCA
Rp - D BCA
Rp 145,000 D Mandiri
Rp 145,000 D BCA
Rp 75,000 D Mandiri ( IGD )
Rp 225,000 Admedika ( Mandiri INH ) Pxbyrditempat Rp. 49800
Rp 145,000 D BCA
Rp 145,000 D Permata
Rp 245,000 D BCA ( TVS )
Rp 145,000 D BCA
Rp 682,000 D Permata ( Usg 2D )
Rp 150,000 D BCA
Rp 75,000 D Mandiri ( USG 2D )
Rp 145,000 D BCA
Rp 75,000 D BCA ( USG 2D )
Rp 145,000 D BCA
Rp 75,000 D Bni ( Rawat Luka )
Rp 145,000 D BCA
Rp 790,000 D BCA ( USG 2D )
Rp 225,000 Admedika ( Mandiri INH )
Rp 150,000 D BCA
Rp 145,000 D BCA
Rp 145,000 D BCA
Rp 75,000 D BCA ( USG 2D )
Rp 220,000 D BCA ( USG 2D )
Rp 100,000 D BCA ( TV )
Rp 150,000 D BCA
Rp 145,000 Admedika ( Generali )
Rp 145,000 Admedika ( Generali )

Rp 7,458,000

Mengetahui,
Penerima

Rini Wahyuningati
Laporan Apotek Rawat Jalan
Tanggal 28 Februari 2018

Tunai
No Tanggal Nama Pasien Apotek Total
1 27-Feb-18 Athiyah Zaimah, An Rp 43,900 Rp 43,900
2 27-Feb-18 Celine Valerie, An Rp 27,700 Rp 27,700
3 27-Feb-18 Celine Valerie, An Rp 32,900 Rp 32,900
4 27-Feb-18 Ratutesla Kautsar, An Rp 7,700 Rp 7,700
5 27-Feb-18 Joycellin Anggel, Ny Rp 81,000 Rp 81,000
6 28-Feb-18 Cheryl Evelyn, An Rp 81,300 Rp 81,300
7 28-Feb-18 Yoona Mizuki, An Rp 31,000 Rp 31,000
8 11-Feb-18 Silvia Margaretna Rp 40,100 Rp 40,100
9 19-Feb-18 Silvia Margaretna Rp 34,400 Rp 34,400
10 22-Feb-18 Silvia Margaretna Rp 43,500 Rp 43,500
11 22-Feb-18 Silvia Margaretna Rp 28,400 Rp 28,400
12 28-Feb-18 Nayla Ifra, An Rp 19,600 Rp 19,600
13 28-Feb-18 Ni Luh Putu, Ny Rp 76,700 Rp 76,700
14 28-Feb-18 Niswatul Hasanah, Ny Rp 347,300 Rp 347,300
15 28-Feb-18 Blessio Brandon, AN Rp 280,000 Rp 280,000
16 28-Feb-18 Hj. Kun Hilya, Ny Rp 227,500 Rp 227,500
17 28-Feb-18 Kirana Ayunidya,An Rp 1,000 Rp 1,000
18 28-Feb-18 Abigail Limantoro, An Rp 213,500 Rp 213,500
19 28-Feb-18 Asyifa Azzahra, An Rp 88,300 Rp 88,300
20 28-Feb-18 Aurelia Ham, An Rp 48,400 Rp 48,400
21 28-Feb-18 Yoona Mizuki, An Rp 41,100 Rp 41,100
22 28-Feb-18 Haris Rp 70,100 Rp 70,100
23 28-Feb-18 Sintawati Handayani, Ny Rp 486,900 Rp 486,900
24 28-Feb-18 Zakiyah, Ny Rp 7,300 Rp 7,300
25 28-Feb-18 Jennaira M. A, An Rp 167,600 Rp 167,600
26 28-Feb-18 Ghani Satya, An Rp 83,600 Rp 83,600
27 28-Feb-18 Wahyu Prasetya, An Rp 921,800 Rp 921,800
28 28-Feb-18 Miracle Angelinus, An Rp 548,800 Rp 548,800
29 28-Feb-18 Wahyu Prasetya, An Rp 122,700 Rp 122,700
30 28-Feb-18 Abiezar Baihaqi, An Rp 595,000 Rp 595,000
31 28-Feb-18 Abiezar Baihaqi, An Rp 236,600 Rp 236,600
32 28-Feb-18 Revina Putri, An Rp 528,300 Rp 528,300
33 28-Feb-18 Shadrina R.A, Nn Rp 68,500 Rp 68,500
34 28-Feb-18 Nur Rofiah, Ny Rp 128,500 Rp 128,500
35 28-Feb-18 Eka Ratna, Ny Rp 122,500 Rp 122,500
36 28-Feb-18 Alfarezel Arsyad, An Rp 924,400 Rp 924,400
37 28-Feb-18 Charissa, AN Rp 35,000 Rp 35,000
38 28-Feb-18 Juvia Hoyaranda, An Rp 62,900 Rp 62,900

Total Rp 6,905,800 Rp 6,905,800

Piutang
No Tanggal Nama Pasien Apotek Total
1 28-Feb-18 Christeline Zevanya, An Rp 58,700 Rp 58,700
2 28-Feb-18 Aksa Radika, An Rp 1,185,400 Rp 1,185,400
3 28-Feb-18 Elisabelle Quinn, An Rp 1,076,000 Rp 1,076,000
4 28-Feb-18 Zaretha Christine, An Rp 85,200 Rp 85,200
5 28-Feb-18 Eugnia Chritavella, An Rp 238,000 Rp 238,000
6 28-Feb-18 Emily Alessandra, An Rp 177,800 Rp 177,800
7 28-Feb-18 Alexandra Chloe, An Rp 924,400 Rp 924,400
8 28-Feb-18 Alexandra Chloe, An Rp 30,400 Rp 30,400
9 28-Feb-18 Mustika Agusti, Ny Rp 272,500 Rp 272,500
10 28-Feb-18 Davin Ferdinand, An Rp 29,200 Rp 29,200
11 28-Feb-18 Dinaniar Enggar, Ny Rp 159,500 Rp 159,500
12 28-Feb-18 Devi Novianty, Ny Rp 101,500 Rp 101,500
13 28-Feb-18 Lenny Wijayanti, Ny Rp 254,500 Rp 254,500
14 28-Feb-18 Keinnara Kalya, An Rp 785,100 Rp 785,100
15 28-Feb-18 Julian Dwindiasis, Ny Rp 151,000 Rp 151,000
16 28-Feb-18 Abraham Bishaka, An Rp 548,800 Rp 548,800
17 28-Feb-18 Naira Shima, AN Rp 223,800 Rp 223,800
18 28-Feb-18 Ema Aristiani, Ny Rp 113,500 Rp 113,500
19 28-Feb-18 Odilia Rhea, An Rp 821,000 Rp 821,000
20 28-Feb-18 Genoveva Mada, An Rp 167,100 Rp 167,100
21 28-Feb-18 Nur Halimah, Ny Rp 122,500 Rp 122,500
22 28-Feb-18 Shanessa Maldiva, An Rp 200,900 Rp 200,900
23 28-Feb-18 Marvel Federer, An Rp 821,000 Rp 821,000

Total Rp 8,547,800 Rp 8,547,800

Surabaya,01 Maret 2018


Mengetahui,
Penyetor Penerima

Angga Rini Wahyuningati


an
8

Ket

Ket
D BCA
D BANK JATIM
D BCA
D Mandiri
KK BCA
D BCA
D BCA
D BCA
Admedika ( Mandiri INH )
D BCA
D BCA
D MAndiri
D BCA
D BCA
D BNI
D BRI
D BCA
Admedika ( Mandiri INH )
D BCA
D BCA
D BCA
Admedika ( Generali )
Admedika ( Generali )
Laporan Rawat Jalan Gigi
Tanggal 28 Februari 2018
Tunai
No Tanggal Nama Pasien No. RM No. Operator Poli Jasa Dokter Tindakan Total
1 28-Feb-18 Ratih Atmidji, Ny 954200 Novi, dr Rp 475,000 Rp 475,000
2 28-Feb-18 Angga Indraswara, Tn 925400 Nadia, dr Rp 20,000 Rp 190,000 Rp 210,000

Total Rp 685,000

Piutang
No Tanggal Nama Pasien No. RM No.Operator Poli Jasa Dokter Tindakan Total
1 28-Feb-18 Rp -
2 28-Feb-18 Rp -

Total

Surabaya, 01 Maret2018

Penyetor Mengetahui,
Penerima

Angga
Rini Wahyuningati
Keterangan
Disc 5%
Disc 5%

Keterangan

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