<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 Penyakit Dalam<br>Periode : 20 Mei 2020 s/d 31 Mei
2020</td>
</tr>
<tr height="30">
<td width="50%">&nbsp;<b>Tempat Layanan: Poli Spesialis Penyakit
Dalam</b></td>
<td width="50%" align="right">Yang Mencetak: <b>Mordana,
Amd.Keb.</b>&nbsp;</td>
</tr>
<tr>
<td colspan="2">
<div id="jalan">
<table width="120%" border="0" cellpadding="0"
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;002813</td>
<td style="text-
transform:uppercase">&nbsp;SUTINA. NY</td>
<td>&nbsp;54 thn 8 bln</td>
<td>&nbsp;DSN. KOKON </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli Dokter
Spesialis<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">93.000&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;">100.000&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;22/05/2020</td>
<td>&nbsp;023088</td>
<td style="text-
transform:uppercase">&nbsp;ABDUL WARIS. SDR</td>
<td>&nbsp;32 thn 10 bln 17 hr</td>
<td>&nbsp;DSN. TANJUNG ALANG RT 1/1 PADIKE
TALANGO</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;26/05/2020</td>
<td>&nbsp;003259</td>
<td style="text-
transform:uppercase">&nbsp;ADHITYA ABDURACHMAN SALEH. TN.</td>
<td>&nbsp;7 hr</td>
<td>&nbsp;DSN. SEMPANGAN</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;26/05/2020</td>
<td>&nbsp;002897</td>
<td style="text-
transform:uppercase">&nbsp;AHMARIYE. NY</td>
<td>&nbsp;55 thn 1 bln 5 hr</td>
<td>&nbsp;DSN. GUNUNG MALANG POTERAN</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli Dokter
Spesialis<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">93.000&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;">100.000&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;26/05/2020</td>
<td>&nbsp;003265</td>
<td style="text-
transform:uppercase">&nbsp;ATMANIYA. NY</td>
<td>&nbsp;33 thn 4 bln 1 hr</td>
<td>&nbsp;DSN. GELISEK RT 2/10 POTERAN
TALANGO</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;26/05/2020</td>
<td>&nbsp;003263</td>
<td style="text-
transform:uppercase">&nbsp;HARZI. NY</td>
<td>&nbsp;35 thn 7 bln 8 hr</td>
<td>&nbsp;DSN. GELISEK RT 1/10 POTERAN
TALANGO</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;26/05/2020</td>
<td>&nbsp;003264</td>
<td style="text-transform:uppercase">&nbsp;MOH.
TAYYIB. TN</td>
<td>&nbsp;39 thn 10 bln 1 hr</td>
<td>&nbsp;DSN. GELISEK RT 2/10 POTERAN
TALANGO</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;053789</td>
<td style="text-transform:uppercase">&nbsp;NUR
HAYA. TN</td>
<td>&nbsp;85 thn 11 bln 28 hr</td>
<td>&nbsp;DSN CANDII RT. 05/05 PALASA
TALANGO</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli Dokter
Spesialis<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">93.000&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;">100.000&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;023000</td>
<td style="text-
transform:uppercase">&nbsp;PURIYANDI. TN</td>
<td>&nbsp;38 thn 9 bln 8 hr</td>
<td>&nbsp;DSN. GELISEK RT01/10 POTERAN
TALANGO</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;002910</td>
<td style="text-transform:uppercase">&nbsp;SITI
NURHAYATI. NY</td>
<td>&nbsp;70 thn 1 bln 6 hr</td>
<td>&nbsp;JL. AQUARIUS 45 RT 07/04 PABIAN</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli Dokter
Spesialis<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">93.000&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;">100.000&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;002977</td>
<td style="text-
transform:uppercase">&nbsp;WAHYUDI. TN</td>
<td>&nbsp;36 thn 8 bln 4 hr</td>
<td>&nbsp;DSN. KAMP.BARAT</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli Dokter
Spesialis<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">93.000&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;">100.000&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;040652</td>
<td style="text-
transform:uppercase">&nbsp;YOLANDA ATALANTA AULIA PUTRI. NN</td>
<td>&nbsp;21 thn 11 bln 21 hr</td>
<td>&nbsp;DS. JL. ADI SUCIPTO NO 25B MARENGAN
LAOK RT 3/3 KA</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;27/05/2020</td>
<td>&nbsp;003287</td>
<td style="text-
transform:uppercase">&nbsp;MIFTAHOL ABRARI. TN</td>
<td>&nbsp;29 thn 4 bln 6 hr</td>
<td>&nbsp;DSN. TAROMAN RT 2/25 GAPURANA
TALANGO</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;27/05/2020</td>
<td>&nbsp;003288</td>
<td style="text-
transform:uppercase">&nbsp;SALAMAH. NY</td>
<td>&nbsp;26 thn 2 bln 10 hr</td>
<td>&nbsp;DSN. TAROMAN RT 2/25 GAPURANA</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli Umum <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;">43.000&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;">50.000&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;28/05/2020</td>
<td>&nbsp;007563</td>
<td style="text-
transform:uppercase">&nbsp;ACHMAD GUFFRON,A.MA.PD</td>
<td>&nbsp;61 thn 10 bln 15 hr</td>
<td>&nbsp;DESA PAKONDANG RT1/1</td>
<td style="text-align:left; padding-
right:10px;">
Karcis BPJS<br/>- Pemeriksaan Poli Dokter
Spesialis<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">93.000&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;">100.000&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;28/05/2020</td>
<td>&nbsp;003319</td>
<td style="text-
transform:uppercase">&nbsp;ACHMAD SARI I. TN</td>
<td>&nbsp;40 thn 16 hr</td>
<td>&nbsp;KRAJAN RT 6/2 BANJARSARI WETAN
DAGANGAN </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;003327</td>
 <td style="text-
transform:uppercase">&nbsp;ISKANDAR. TN</td>
<td>&nbsp;5 hr</td>
<td>&nbsp;GUYANGAN RT 04/01 GUYANGAN TRUCUK /
PERUMAHAN PT G</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;003333</td>
<td style="text-
transform:uppercase">&nbsp;MAHIYA. NY.</td>
<td>&nbsp;49 thn 7 bln 12 hr</td>
<td>&nbsp;DSN. JAMALENG</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;026289</td>
<td style="text-
transform:uppercase">&nbsp;NARIYA. NY</td>
 <td>&nbsp;45 thn 5 bln 8 hr</td>
<td>&nbsp;DSN. BANITENG 03/06 BANCAMARA
DUNGKEK</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli Dokter
Spesialis<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">93.000&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;">100.000&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;28/05/2020</td>
<td>&nbsp;006125</td>
<td style="text-transform:uppercase">&nbsp;SAMA
ON. TN</td>
<td>&nbsp;57 thn 7 bln 17 hr</td>
<td>&nbsp;UTARA KEBUN KELAPA RT 5/3 KALIANGET
BARAT</td>
<td style="text-align:left; padding-
right:10px;">
Karcis BPJS<br/>- Pemeriksaan Poli Dokter
Spesialis<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">93.000&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;">100.000&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;29/05/2020</td>
<td>&nbsp;003344</td>
<td style="text-
transform:uppercase">&nbsp;ARNAWITO. TN</td>
<td>&nbsp;33 thn 8 bln 24 hr</td>
 <td>&nbsp;DSN. PANGMALENG </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;29/05/2020</td>
<td>&nbsp;003341</td>
<td style="text-
transform:uppercase">&nbsp;ASHIL RACHMAN AUFI. SDR</td>
<td>&nbsp;15 thn 2 bln 7 hr</td>
<td>&nbsp;JL. KADET SUWOKO RT 2/2 PUCANG
TELUH</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;29/05/2020</td>
<td>&nbsp;000870</td>
<td style="text-transform:uppercase">&nbsp;DANY
IZAT FARAIDI. TN</td>
<td>&nbsp;37 thn 4 bln 6 hr</td>
<td>&nbsp;RSIGK / JL. PAHLAWAN PAMOLOKAN
SUMENEP</td>
 <td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli Dokter
Spesialis<br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">93.000&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;">100.000&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;29/05/2020</td>
<td>&nbsp;003345</td>
<td style="text-transform:uppercase">&nbsp;ERNA
PURNAMASARI. NN</td>
<td>&nbsp;17 thn 6 bln 20 hr</td>
<td>&nbsp;DSN. KAUMAN </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;29/05/2020</td>
<td>&nbsp;003343</td>
<td style="text-
transform:uppercase">&nbsp;FITRIYANI. NY</td>
<td>&nbsp;30 thn 6 bln 2 hr</td>
<td>&nbsp;DSN.PANGMALENG </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">26</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003365</td>
<td style="text-
transform:uppercase">&nbsp;ACHMAD JUNAIDI. SDR</td>
<td>&nbsp;25 thn 10 bln 25 hr</td>
<td>&nbsp;LINK RAWA GONDANG </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">27</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003372</td>
<td style="text-transform:uppercase">&nbsp;DWI
ERFIN SETIAWAN. SDR</td>
<td>&nbsp;22 thn 29 hr</td>
<td>&nbsp;GG CENDRAWASIH RT 3/4 PARSANGAN
SUMENEP</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">28</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003363</td>
<td style="text-transform:uppercase">&nbsp;DWI
HANUN APRILIANTI. NN</td>
<td>&nbsp;20 thn 1 bln 20 hr</td>
<td>&nbsp;JL.HAYAM WURUK </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">29</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003366</td>
<td style="text-
transform:uppercase">&nbsp;FAIZATUL HASANA. NN</td>
<td>&nbsp;14 thn 10 bln 21 hr</td>
<td>&nbsp;DSN. SELADAN RT 1/15 POTERAN</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">30</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003371</td>
<td style="text-
transform:uppercase">&nbsp;FATILA. SDR</td>
<td>&nbsp;17 thn 11 bln 11 hr</td>
<td>&nbsp;DSN. ASEM NUNGGAL </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">31</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003367</td>
<td style="text-
transform:uppercase">&nbsp;MASNIYAH. NY</td>
<td>&nbsp;44 thn 7 bln 27 hr</td>
<td>&nbsp;DSN. SELADAN RT 1/15 POTERAN</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">32</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003375</td>
<td style="text-
transform:uppercase">&nbsp;MATSIHWI</td>
<td>&nbsp;27 thn 10 bln 6 hr</td>
<td>&nbsp;DSN. PANGLOROS RT 5/5 GAPURANA
TALANGO</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">33</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003377</td>
<td style="text-transform:uppercase">&nbsp;NUR
A YUNI. NY</td>
<td>&nbsp;18 thn 6 bln 28 hr</td>
<td>&nbsp;DSN. SELLADAN RT 1/8 PALASA
TALANGO</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">34</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003374</td>
<td style="text-transform:uppercase">&nbsp;SARI
ANI. NY</td>
<td>&nbsp;27 thn 6 bln 2 hr</td>
<td>&nbsp;DSN. PALASA RT 2/1 PALASA
TALANGO</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">35</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003376</td>
<td style="text-
transform:uppercase">&nbsp;WIDIYANTO. TN</td>
<td>&nbsp;19 thn 11 bln 29 hr</td>
<td>&nbsp;DSN. GUNTONG RT 1/2 ESSANG
TALANGO</td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">0&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">36</td>
<td>&nbsp;30/05/2020</td>
<td>&nbsp;003368</td>
<td style="text-
transform:uppercase">&nbsp;ZAHRI. TN</td>
<td>&nbsp;60 thn 6 bln 4 hr</td>
<td>&nbsp;DSN. SELADAN </td>
<td style="text-align:left; padding-
right:10px;">
Karcis<br/>- Pemeriksaan Poli<br/>- Pemeriksaan
Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">43.000&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;">50.000&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;">180.000&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">1.973.000&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;">2.225.000&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;20/05/2020</td>
<td>&nbsp;001501</td>
<td style="text-
transform:uppercase">&nbsp;DARIYAH. NY</td>
<td>&nbsp;56 thn 2 bln 14 hr</td>
<td>&nbsp;BATUAN</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;002852</td>
<td style="text-
transform:uppercase">&nbsp;LUTFIYAH. NY.</td>
<td>&nbsp;21 thn 2 bln 25 hr</td>
<td>&nbsp;DSN. DAJA</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;045933</td>
<td style="text-
transform:uppercase">&nbsp;MISNATUN. NY</td>
<td>&nbsp;58 thn 11 bln 22 hr</td>
<td>&nbsp;DSN KEBUN KELAPA RT. 03/03 KALIANGET
BARAT</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;20/05/2020</td>
<td>&nbsp;055170</td>
<td style="text-transform:uppercase">&nbsp;NUR
RASIDI. TN / MOH. NUR RASYIDIY </td>
<td>&nbsp;51 thn 8 bln 6 hr</td>
<td>&nbsp;DSN. MANDALA RT 03 / 04 / TENGEDAN /
BATU PUTIH</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;20/05/2020</td>
<td>&nbsp;057179</td>
<td style="text-transform:uppercase">&nbsp;SITI
MARYAM. NY</td>
<td>&nbsp;50 thn 6 bln 19 hr</td>
<td>&nbsp;JL. DR. RAJIMAN NO 18 RT 01/04
KALIANGET BARAT</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>
<td style="text-align:right; padding-
right:30px;">6</td>
<td>&nbsp;20/05/2020</td>
<td>&nbsp;002631</td>
<td style="text-
transform:uppercase">&nbsp;ZAINUDDIN. TN.</td>
<td>&nbsp;61 thn 10 bln 5 hr</td>
<td>&nbsp;DSN. BIRAMPAK</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;">7</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;050670</td>
<td style="text-transform:uppercase">&nbsp;ACH.
MAS UD. TN</td>
<td>&nbsp;54 thn 9 bln 16 hr</td>
<td>&nbsp;DSN. SALEGADING RT 01/03 SOGIAN
AMBUNTEN</td>
<td style="text-align:left; padding-
right:10px;">
Karcis BPJS<br/>- Pemeriksaan Poli Spesialis
BPJS<br/>- Pemeriksaan Poli<br/>- Rawat Luka Besar Perawat<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">113.000&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;">120.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">10.000&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">8</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;008078</td>
<td style="text-transform:uppercase">&nbsp;IMAM
JAUHARI,DRS.MM. TN</td>
<td>&nbsp;53 thn 3 bln 15 hr</td>
<td>&nbsp;JLN. KANGEAN NO.12/III RT. 01/11
BANGKAL - GILING</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;">9</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;044268</td>
<td style="text-
transform:uppercase">&nbsp;JUHAERAH. NY</td>
<td>&nbsp;53 thn 8 bln 24 hr</td>
<td>&nbsp;DSN LOJIKANTANG </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;">10</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;018385</td>
<td style="text-
transform:uppercase">&nbsp;KUSMIYATI</td>
<td>&nbsp;50 thn 11 bln 24 hr</td>
<td>&nbsp;DSNJ. BUNBARAT RT 05/01 RUBARU</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>
<td style="text-align:right; padding-
right:30px;">11</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;042978</td>
 <td style="text-
transform:uppercase">&nbsp;KUSMIYATI. NY</td>
<td>&nbsp;57 thn 10 bln 13 hr</td>
<td>&nbsp;JL. GERSIK PUTIH BARAT RT 4/3
KALIANGET TIMUR</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;">12</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;002850</td>
<td style="text-
transform:uppercase">&nbsp;MARGI AH. NY</td>
<td>&nbsp;79 thn 10 bln 23 hr</td>
<td>&nbsp;DSN. PANGGUNG</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;">13</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;052390</td>
<td style="text-transform:uppercase">&nbsp;MOH.
SURO. TN</td>
 <td>&nbsp;34 thn 10 bln 4 hr</td>
<td>&nbsp;DSN. KORASEM RT 01/01
PASONGSONGAN</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;">14</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;002879</td>
<td style="text-
transform:uppercase">&nbsp;MUHARIYE. NY</td>
<td>&nbsp;41 thn 11 bln 17 hr</td>
<td>&nbsp;DSN. JULUK LAOK RT 01/01 GALIS RT
01/01 GALIS GILI</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;">15</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;045679</td>
<td style="text-
transform:uppercase">&nbsp;RIHANTO. TN</td>
<td>&nbsp;50 thn 11 hr</td>
 <td>&nbsp;DUSUN PORAJAN </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>
<td style="text-align:right; padding-
right:30px;">16</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;002901</td>
<td style="text-
transform:uppercase">&nbsp;RUSMIYATI. NY</td>
<td>&nbsp;47 thn 6 bln 8 hr</td>
<td>&nbsp;DSN. CAMPOR </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;">17</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;002692</td>
<td style="text-
transform:uppercase">&nbsp;SIYANI. NY</td>
<td>&nbsp;61 thn 11 bln 22 hr</td>
<td>&nbsp;DSN. BUNOT </td>
<td style="text-align:left; padding-
right:10px;">
 Karcis BPJS<br/>- Pemeriksaan Poli Spesialis
BPJS<br/>- Pemeriksaan Poli<br/>- Rawat Luka Besar Perawat<br/>-
</td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">113.000&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;">120.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">10.000&nbsp;</td>
</tr>
<tr>
<td style="text-align:right; padding-
right:30px;">18</td>
<td>&nbsp;26/05/2020</td>
<td>&nbsp;003261</td>
<td style="text-
transform:uppercase">&nbsp;SUHAERA. NY.</td>
<td>&nbsp;69 thn 8 bln 2 hr</td>
<td>&nbsp;DSN. BEDDI</td>
<td style="text-align:left; padding-
right:10px;">
Karcis BPJS<br/>- Pemeriksaan Poli Spesialis
BPJS<br/>- Pemeriksaan Poli Umum <br/>- </td>
<td style="text-align:right; padding-
right:10px;">5.000&nbsp;</td>
<td style="text-align:right; padding-
right:10px;">58.000&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;">65.000&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;27/05/2020</td>
<td>&nbsp;003158</td>
<td style="text-
transform:uppercase">&nbsp;AHMAD KUZAIRI. TN.</td>
<td>&nbsp;46 thn 6 bln 6 hr</td>
<td>&nbsp;DSN. NYAMPLONG</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>
<td style="text-align:right; padding-
right:30px;">20</td>
<td>&nbsp;27/05/2020</td>
<td>&nbsp;039783</td>
<td style="text-
transform:uppercase">&nbsp;MASKIJA. NY</td>
<td>&nbsp;65 thn 25 hr</td>
<td>&nbsp;JL. RAYA MANDING RT.03/04
PAMOLOKAN-SUMENEP.</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;">21</td>
<td>&nbsp;27/05/2020</td>
<td>&nbsp;048583</td>
<td style="text-
transform:uppercase">&nbsp;MUJIONO. TN</td>
<td>&nbsp;61 thn 29 hr</td>
<td>&nbsp;JL. RAYA GAPURA RT 2/7 PARSANGA
SUMENEP</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;">22</td>
<td>&nbsp;27/05/2020</td>
<td>&nbsp;057179</td>
<td style="text-transform:uppercase">&nbsp;SITI
MARYAM. NY</td>
<td>&nbsp;50 thn 6 bln 19 hr</td>
<td>&nbsp;JL. DR. RAJIMAN NO 18 RT 01/04
KALIANGET BARAT</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;">23</td>
<td>&nbsp;27/05/2020</td>
<td>&nbsp;002631</td>
<td style="text-
transform:uppercase">&nbsp;ZAINUDDIN. TN.</td>
<td>&nbsp;61 thn 10 bln 5 hr</td>
<td>&nbsp;DSN. BIRAMPAK</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;">24</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;008203</td>
<td style="text-transform:uppercase">&nbsp;ABD.
SUKUR, TN</td>
<td>&nbsp;54 thn 1 bln 2 hr</td>
<td>&nbsp;KALIANGET TIMUR RT 7/5</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;">25</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;002928</td>
<td style="text-transform:uppercase">&nbsp;ABD.
WARI. H. TN</td>
<td>&nbsp;56 thn 11 bln 16 hr</td>
<td>&nbsp;DSN. MARONGGI</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;">26</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;044371</td>
<td style="text-transform:uppercase">&nbsp;FADA
RUSLAN. TN</td>
<td>&nbsp;48 thn 8 bln 29 hr</td>
<td>&nbsp;PERUM PONDOK INDAH K-7 RT02/06
KOLOR</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;">27</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;002935</td>
<td style="text-transform:uppercase">&nbsp;IMAM
SJAKIR. TN</td>
<td>&nbsp;68 thn 4 bln 23 hr</td>
<td>&nbsp;JL. MATAHARI NO 14 SATELIT RT 01/04
PABIAN</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;">28</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;032320</td>
<td style="text-
transform:uppercase">&nbsp;KARIS SUBROTO . TN</td>
<td>&nbsp;65 thn 7 bln 6 hr</td>
<td>&nbsp;JL. KAWEDANAN NO. 02 PASAR BARU RT
04/02 AMBUNTEN </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;">29</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;039082</td>
<td style="text-
transform:uppercase">&nbsp;LISTINA HAKIM. NY</td>
<td>&nbsp;56 thn 11 bln 4 hr</td>
<td>&nbsp;JL. KAWEDANAN NO. 2 DSN. PASAR BARU
RT 04 / 02 / </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;">30</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;033854</td>
<td style="text-
transform:uppercase">&nbsp;MUHAMMAD HIDAYAT. TN</td>
<td>&nbsp;51 thn 7 bln 28 hr</td>
<td>&nbsp;DSN. GEDUNG RT 4/4 KARANG ANYAR
KALIANGET</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>
<td style="text-align:right; padding-
right:30px;">31</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;001419</td>
<td style="text-
transform:uppercase">&nbsp;RASANI. NY</td>
<td>&nbsp;62 thn 3 bln 17 hr</td>
<td>&nbsp;JL. GAPURA DSN. PATENONGAN </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;">32</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;042557</td>
<td style="text-
transform:uppercase">&nbsp;SAMSUNI. TN</td>
<td>&nbsp;59 thn 3 bln 26 hr</td>
<td>&nbsp;DSN.PANGGUNG RT 04 / RW 01 PALOKLOAN
- GAPURA</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;">33</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;011506</td>
<td style="text-
transform:uppercase">&nbsp;SANIMAN. TN</td>
<td>&nbsp;54 thn 3 hr</td>
<td>&nbsp;JL. GERSIK PUTIH TIMUR RT 1/3
KALIANGET TIMUR</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;">34</td>
<td>&nbsp;28/05/2020</td>
<td>&nbsp;028850</td>
<td style="text-
transform:uppercase">&nbsp;ZAINIYAH. NY</td>
<td>&nbsp;64 thn 11 bln 23 hr</td>
<td>&nbsp;DSN. PESISIR RT 1/2 PAKANDANGAN BARAT
BLUTO</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;">35</td>
<td>&nbsp;29/05/2020</td>
<td>&nbsp;022226</td>
<td style="text-transform:uppercase">&nbsp;HENY
YUNIARTI. NY</td>
<td>&nbsp;52 thn 3 bln 21 hr</td>
<td>&nbsp;BELAKANG KORAMIL RT 8/1 KALIANGET
BARAT</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;">36</td>
<td>&nbsp;29/05/2020</td>
<td>&nbsp;022482</td>
<td style="text-transform:uppercase">&nbsp;I
NYOMAN SUDJANA. TN</td>
<td>&nbsp;61 thn 6 bln 8 hr</td>
<td>&nbsp;JLN. UTARA KORAMIL RT 8/1 KALIANGET
TIMUR</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;">37</td>
<td>&nbsp;29/05/2020</td>
<td>&nbsp;033182</td>
<td style="text-transform:uppercase">&nbsp;JUMA
ANI. NY</td>
<td>&nbsp;46 thn 5 bln 13 hr</td>
<td>&nbsp;DSN PADUREKSO RT. 07/03 - KALIANGET
TIMUR</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;">38</td>
<td>&nbsp;29/05/2020</td>
<td>&nbsp;041086</td>
<td style="text-
transform:uppercase">&nbsp;SYUKKUR. TN</td>
<td>&nbsp;39 thn 5 bln 3 hr</td>
<td>&nbsp;JL. UTARA KORAMIL</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 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;">190.000&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">2.039.000&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;">2.305.000&nbsp;</td>
<td valign="top" style="text-align:right;
padding-right:10px; border-top:1px solid;">20.000&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;">195.000&nbsp;</td>
<td valign="middle" style="text-align:right;
padding-right:10px; border-top:1px solid; border-bottom:1px
solid;">2.092.000&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;">2.365.000&nbsp;</td>
<td valign="middle" style="text-align:right;
padding-right:10px; border-top:1px solid; border-bottom:1px
solid;">20.000&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;12:25&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>Mordana,
Amd.Keb.</b>&nbsp;</td>
</tr>
<tr id="trTombol">
<td colspan="10" class="noline" align="center">
</tr>
</table>
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