<title>Laporan Pendapatan</title>

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family:Arial, Helvetica, sans-serif; font-size:11px;">
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<td colspan="2">
<b>RSI GARAM KALIANGET</b>
<br />
Jl. Raya Kalianget No.1 Sumenep - Madura <br />
Telp. (0328) 664340 - 667433, Fax. (0328) 667433 <br />
Website : www.rsigaramkalianget.com <br />
<br /></b>
</td>
</tr>
<tr>
<td colspan="2" style="text-align:center; font-size:14px; text-
transform:uppercase; font-weight:bold;" height="70" valign="top">laporan pendapatan
RAWAT JALAN - Poli Spesialis Kesehatan Jiwa<br>Periode : 20 Mei 2020 s/d 31 Mei
2020</td>
</tr>
<tr height="30">
<td width="50%">&nbsp;<b>Tempat Layanan: Poli Spesialis Kesehatan
Jiwa</b></td>
<td width="50%" align="right">Yang Mencetak: <b>Lilik</b>&nbsp;</td>
</tr>
<tr>
<td colspan="2">
<div id="jalan">
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cellspacing="0" style="font-family:Arial, Helvetica, sans-serif; font-size:11px;">
<tr height="30" style="font-weight:bold;">
<td width="12%" style="padding-left:10px;
border-bottom:1px solid; border-top:1px solid;">Status Pasien</td>
<td width="13%" style="border-bottom:1px solid;
border-top:1px solid;">&nbsp;Tgl Kunjungan</td>
<td width="10%" style="border-bottom:1px solid;
border-top:1px solid;">&nbsp;No. RM</td>
<td width="29%" style="border-bottom:1px solid;
border-top:1px solid;">&nbsp;Nama</td>
<td width="19%" style="border-bottom:1px solid;
border-top:1px solid;">&nbsp;Umur</td>
<td width="29%" style="border-bottom:1px solid;
border-top:1px solid;">&nbsp;Alamat</td>
<td width="29%" style="padding-right:10px;
text-align:left; border-bottom:1px solid; border-top:1px
solid;">NamaTindakan&nbsp;</td>
<td width="12%" style="padding-right:10px;
text-align:right; border-bottom:1px solid; border-top:1px solid;">Karcis&nbsp;</td>
<td width="12%" style="padding-right:10px;
text-align:right; border-bottom:1px solid; border-top:1px solid;">Pemeriksaan &
Tindakan&nbsp;</td>
<td width="12%" style="padding-right:10px;
text-align:right; border-bottom:1px solid; border-top:1px
solid;">SewaAlat&nbsp;</td>
<td width="12%" style="padding-right:10px;
text-align:right; border-bottom:1px solid; border-top:1px
solid;">Oksigen&nbsp;</td>
<td width="12%" style="padding-right:10px;
text-align:right; border-bottom:1px solid; border-top:1px solid;">Jaspel&nbsp;</td>
<td width="12%" style="padding-right:10px;
text-align:right; border-bottom:1px solid; border-top:1px solid;">Total&nbsp;</td>
<td width="12%" style="padding-right:10px;
text-align:center; border-bottom:1px solid; border-top:1px
solid;">JS_Tindakan&nbsp;</td>
</tr>
<tr>
<td colspan="7" style="font-weight:bold;
padding-left:10px;">UMUM</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">1</td>
<td>&nbsp;20/05/2020</td>
<td>&nbsp;056580</td>
<td style="text-transform:uppercase">&nbsp;ABD.
RAHMAN. TN</td>
<td>&nbsp;62 thn 10 bln 28 hr</td>
<td>&nbsp;JL. DR. CIPTO GG I-2</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">2</td>
<td>&nbsp;21/05/2020</td>
<td>&nbsp;001771</td>
<td style="text-
transform:uppercase">&nbsp;SAEDI. TN</td>
<td>&nbsp;40 thn 2 bln 26 hr</td>
<td>&nbsp;JL. KARTINI GG1/4 RT 15/05
PANGARANGAN</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
 <td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">3</td>
<td>&nbsp;22/05/2020</td>
<td>&nbsp;055080</td>
<td style="text-
transform:uppercase">&nbsp;MADANI. TN</td>
<td>&nbsp;52 thn 6 bln 20 hr</td>
<td>&nbsp;DSN. NAEAN RT TAMBAAGUNG TENGAH
AMBUNTEN</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">4</td>
<td>&nbsp;22/05/2020</td>
<td>&nbsp;048454</td>
<td style="text-
transform:uppercase">&nbsp;MUHAMMAD AMIR RACHMAN. TN</td>
<td>&nbsp;54 thn 11 bln 11 hr</td>
<td>&nbsp;DSN AENG SOKA RT. 01/01 PRAGAAN LAOK
PRAGGAN</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">5</td>
<td>&nbsp;22/05/2020</td>
<td>&nbsp;027603</td>
<td style="text-
transform:uppercase">&nbsp;MUSTAFA BASYECH. TN</td>
<td>&nbsp;54 thn 5 bln 22 hr</td>
<td>&nbsp;JL. URIP SUMOHARJO GG 1 NO 10A RT 02/
01 PANGARANG</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">6</td>
<td>&nbsp;24/05/2020</td>
<td>&nbsp;003238</td>
<td style="text-
transform:uppercase">&nbsp;AHMADI. TN</td>
<td>&nbsp;49 thn 7 bln 21 hr</td>
<td>&nbsp;DSN. MANDING </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">7</td>
<td>&nbsp;25/05/2020</td>
<td>&nbsp;003241</td>
<td style="text-
transform:uppercase">&nbsp;NUNUNG ZAINUL BASRI. TN.</td>
<td>&nbsp;62 thn 4 bln 8 hr</td>
<td>&nbsp;JL. MERAPI NO. 4</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">8</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;057037</td>
<td style="text-
transform:uppercase">&nbsp;ADRA'I. TN</td>
<td>&nbsp;48 thn 5 bln 2 hr</td>
<td>&nbsp;DSN KOLOR </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
 </tr>
<tr>
<td style="text-align:right; padding-
right:30px;">9</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;057038</td>
<td style="text-
transform:uppercase">&nbsp;AMSANI. NY</td>
<td>&nbsp;40 thn 2 hr</td>
<td>&nbsp;DSN KOLOR </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">10</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;000091</td>
<td style="text-
transform:uppercase">&nbsp;FAIZATUR RAHMAH, AMD.KEP. NY</td>
<td>&nbsp;35 thn 9 bln 8 hr</td>
<td>&nbsp;RSIGK / PERUM BANGKAL JL. POTERAN
NO. 12 B RT 2/5</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
 <td style="text-align:right; padding-
right:30px;">11</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;045322</td>
<td style="text-
transform:uppercase">&nbsp;ISMAIL RAJAB. TN</td>
<td>&nbsp;47 thn 11 bln 6 hr</td>
<td>&nbsp;JL. PAJAGALAN RT 9/5 PAJAGALAN
SUMENEP</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">12</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;003279</td>
<td style="text-transform:uppercase">&nbsp;MAS
UD. TN</td>
<td>&nbsp;48 thn 10 bln 2 hr</td>
<td>&nbsp;DSN. KOTTE</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">13</td>
 <td>&nbsp;26/05/2020</td>
<td>&nbsp;033001</td>
<td style="text-
transform:uppercase">&nbsp;MUHAMMAD MAKSUM. TN</td>
<td>&nbsp;31 thn 5 bln 10 hr</td>
<td>&nbsp;DSN LISUN RT. 08/04 - KALIANGET
TIMUR</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">14</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;009051</td>
<td style="text-
transform:uppercase">&nbsp;SIDIK. TN</td>
<td>&nbsp;62 thn 5 bln 18 hr</td>
<td>&nbsp;SAROAN LAOK RT 1/7 GAPURANA</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">15</td>
<td>&nbsp;27/05/2020</td>
<td>&nbsp;002180</td>
 <td style="text-
transform:uppercase">&nbsp;FAHIM ADIM. SDR (POLI JIWA)</td>
<td>&nbsp;19 thn 2 bln 8 hr</td>
<td>&nbsp;MONCEK TENGAH</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">16</td>
<td>&nbsp;27/05/2020</td>
<td>&nbsp;001146</td>
<td style="text-transform:uppercase">&nbsp;NUR
PUTRIA QADARSIH. HJ. NY</td>
<td>&nbsp;43 thn 2 bln 12 hr</td>
<td>&nbsp;JL. LETNAN MERTA NO. 16 </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">17</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;055221</td>
<td style="text-
transform:uppercase">&nbsp;BARKAH. NY</td>
<td>&nbsp;72 thn 9 bln 12 hr</td>
 <td>&nbsp;BANGSELOK</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">18</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;002444</td>
<td style="text-
transform:uppercase">&nbsp;SABARUDIN. TN</td>
<td>&nbsp;67 thn 5 bln 20 hr</td>
<td>&nbsp;DSN. GELUGUR TENGAH / GANDUSARI</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">19</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;056390</td>
<td style="text-
transform:uppercase">&nbsp;SUNAIYAH. NY</td>
<td>&nbsp;54 thn 15 hr</td>
<td>&nbsp;DSN. LOJIKANTANG RT 01/01 KALIANGET
BARAT</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">20</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003127</td>
<td style="text-
transform:uppercase">&nbsp;ABDUL HAKIM. TN.</td>
<td>&nbsp;32 thn 9 bln 2 hr</td>
<td>&nbsp;DSN. KEBUN</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">21</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;057479</td>
<td style="text-transform:uppercase">&nbsp;ARS.
SUJONO.TN</td>
<td>&nbsp;59 thn 9 bln 12 hr</td>
<td>&nbsp;PANGARANGAN-SUMENEP.</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
 <td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">22</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;051932</td>
<td style="text-transform:uppercase">&nbsp;JUMA
ISAH. NY</td>
<td>&nbsp;58 thn 3 hr</td>
<td>&nbsp;DSN. KEBUN KELAPA RT 1/3 KALIANGET
BARAT</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">23</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;001393</td>
<td style="text-
transform:uppercase">&nbsp;RIZAL HIBRAS. TN</td>
<td>&nbsp;34 thn 9 bln 17 hr</td>
<td>&nbsp;JL. URIP SUMOHARJO RT 2/1
PANGARANGAN</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">24</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003362</td>
<td style="text-
transform:uppercase">&nbsp;SAHURI. TN</td>
<td>&nbsp;60 thn 2 bln 23 hr</td>
<td>&nbsp;DSN. KOMBANG RT 03/02 KOMBANG
TALANGO</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">25</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003381</td>
<td style="text-
transform:uppercase">&nbsp;ZAHRA HIBRAS</td>
<td>&nbsp;62 thn 11 bln 22 hr</td>
<td>&nbsp;JL.URIP SUMAHARJO </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">18.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">25.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr height="30"
style="font-weight:bold">
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td valign="top">&nbsp;</td>
<td valign="top" style="text-align:center;
border-top:1px solid;">TOTAL&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">125.000&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">450.000&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">0&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">0&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">0&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">625.000&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">0&nbsp;</td>
</tr>
<tr>
<td colspan="7" style="font-weight:bold;
padding-left:10px;">BPJS KESEHATAN </td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">1</td>
<td>&nbsp;19/05/2020</td>
<td>&nbsp;043075</td>
<td style="text-transform:uppercase">&nbsp;ADI
ROMANSYAH. SDR</td>
<td>&nbsp;23 thn 5 bln 1 hr</td>
<td>&nbsp;DSN KARANG KOMIS</td>
<td style="text-align:left; padding-
right:10px;">
Karcis BPJS<br/>- Pemeriksaan Poli Spesialis
BPJS<br/>- Pemeriksaan Poli<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">53.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">60.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">2</td>
<td>&nbsp;20/05/2020</td>
<td>&nbsp;050669</td>
<td style="text-
transform:uppercase">&nbsp;LILIK ANDAYANI. NY</td>
<td>&nbsp;41 thn 18 hr</td>
<td>&nbsp;DSN. ARES BARATAN RT 01/03 TALANG
SARONGGI</td>
<td style="text-align:left; padding-
right:10px;">
Karcis BPJS<br/>- Pemeriksaan Poli Spesialis
BPJS<br/>- Pemeriksaan Poli<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">53.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">60.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">3</td>
<td>&nbsp;20/05/2020</td>
<td>&nbsp;030172</td>
<td style="text-
transform:uppercase">&nbsp;YALMIA AGFATILA . NN</td>
<td>&nbsp;23 thn 10 bln 14 hr</td>
<td>&nbsp;JL. CAKRANINGRAT NO 1</td>
<td style="text-align:left; padding-
right:10px;">
Karcis BPJS<br/>- Pemeriksaan Poli Spesialis
BPJS<br/>- Pemeriksaan Poli<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">53.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">60.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">4</td>
<td>&nbsp;22/05/2020</td>
<td>&nbsp;000909</td>
<td style="text-
transform:uppercase">&nbsp;SUMINAH. NY</td>
<td>&nbsp;54 thn 2 bln 28 hr</td>
<td>&nbsp;PT. GARAM / RUMDIS PT. GARAM JL.
DIPONEGORO NO. 16</td>
<td style="text-align:left; padding-
right:10px;">
Karcis BPJS<br/>- Pemeriksaan Poli Spesialis
BPJS<br/>- Pemeriksaan Poli<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">53.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">60.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">5</td>
<td>&nbsp;27/05/2020</td>
<td>&nbsp;001200</td>
<td style="text-
transform:uppercase">&nbsp;ARTANIYA. NY</td>
<td>&nbsp;56 thn 10 bln 24 hr</td>
<td>&nbsp;PALOLOAN- GAPURA</td>
<td style="text-align:left; padding-
right:10px;">
Karcis BPJS<br/>- Pemeriksaan Poli Spesialis
BPJS<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">33.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">2.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">40.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr height="30"
style="font-weight:bold">
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td>&nbsp;</td>
<td valign="top">&nbsp;</td>
<td valign="top" style="text-align:center;
border-top:1px solid;">TOTAL&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">25.000&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">245.000&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">0&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">0&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">0&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">280.000&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">0&nbsp;</td>
</tr>
<tr height="30"
style="font-weight:bold;">
<td colspan="5" style="border-bottom:1px solid;
border-top:1px solid">&nbsp;</td>
<td style="border-bottom:1px solid; border-
top:1px solid">&nbsp;</td>
<td style="border-bottom:1px solid; border-
top:1px solid; text-align:center">GRAND TOTAL&nbsp;</td>
<td valign="middle" style="text-align:right;
padding-right:10px; border-top:1px solid; border-bottom:1px
solid;">30.000&nbsp;</td>
<td valign="middle" style="text-align:right;
padding-right:10px; border-top:1px solid; border-bottom:1px
solid;">278.000&nbsp;</td>
<td valign="middle" style="text-align:right;
padding-right:10px; border-top:1px solid; border-bottom:1px solid;">0&nbsp;</td>
<td valign="middle" style="text-align:right;
padding-right:10px; border-top:1px solid; border-bottom:1px solid;">0&nbsp;</td>
<td valign="middle" style="text-align:right;
padding-right:10px; border-top:1px solid; border-bottom:1px solid;">0&nbsp;</td>
<td valign="middle" style="text-align:right;
padding-right:10px; border-top:1px solid; border-bottom:1px
solid;">320.000&nbsp;</td>
<td valign="middle" style="text-align:right;
padding-right:10px; border-top:1px solid; border-bottom:1px solid;">0&nbsp;</td>
</tr>
</table>
</div>
 </td>
</tr>
<tr>
<td colspan="2">&nbsp;</td>
</tr>
<tr>
<td colspan="14" style="text-align:right">Tgl Cetak:&nbsp;02-06-
2020&nbsp;Jam:&nbsp;12:05&nbsp;</td>
</tr>
<tr>
<td colspan="14" height="50" valign="top" style="text-align:right">Yang
Mencetak,&nbsp;</td>
</tr>
<tr>
<td colspan="14" style="text-align:right"><b>Lilik</b>&nbsp;</td>
</tr>
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