LAPORAN TAGIHAN OBAT IHC PT.

SKS LISTRIK KALIMANTAN

PERIODE MARET 2022
TGL No ID LAYANAN ASURANSI PASIEN DIAGNOSA TINDAKAN / LAYANAN TENAGA MEDIS DITAGIH (Rp) TOTAL

FG Troches - tablet Rp 25,000

3/1/2022 208925 RJ PT.SLK Yosua Weldhin Ispa Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 85,000
D3-1000 Tab Rp 45,000
CHOLESTEROL PORTABLE TES Rp 30,000
3/1/2022 RJ PT.SLK Ahmad Hadani Multicek Blood URIC ACID PORTABLE TEST Candra Wiratama Rp 30,000
188702 GLUCOSE PORTABLE TEST Rp 30,000 Rp 90,000
URIC ACID PORTABLE TEST Rp 30,000
RJ PT.SLK Nurhasnih Multicek Blood CHOLESTEROL PORTABLE TES Candra Wiratama Rp 30,000 Rp 90,000
3/1/2022 178349
GLUCOSE PORTABLE TEST Rp 30,000
D3-1000 Tab Rp 45,000
Ermuno - Tablet Rp 35,000
3/1/2022 208925 RJ PT.SLK Yosua Weldhin Ispa FG Troches - tablet Candra Wiratama Rp 25,000 Rp 127,000
Dexyl 60ML Syr Rp 7,000
Fasidol - Tablet 500 Mg Rp 15,000
Dexyl 60ML Syr Rp 7,000
3/1/2022 188453 RJ PT.SLK Satrio F.P Ispa D3-1000 Tab Candra Wiratama Rp 45,000 Rp 87,000
Ermuno - Tablet Rp 35,000
FG Troches - tablet Rp 25,000
Dexyl 60ML Syr Rp 7,000
3/1/2022 188707 RJ PT.SLK Irfan Rosadi Ali Ispa Candra Wiratama Rp 176,000
D3-1000 Tab Rp 45,000
Immu-Cea Kaplet Rp 99,000
D3-1000 Tab Rp 45,000
3/1/2022 188433 RJ PT.SLK Arif Gunawan Ispa Ermuno - Tablet Candra Wiratama Rp 35,000 Rp 87,000
Dexyl 60ML Syr Rp 7,000
D3-1000 Tab Rp 45,000
3/1/2022 178336 RJ PT.SLK Jakson Situmorang Ispa Ermuno - Tablet Candra Wiratama Rp 35,000 Rp 87,000
Dexyl 60ML Syr Rp 7,000
D3-1000 Tab Rp 45,000
3/1/2022 218049 RJ PT.SLK M. Ravi Ispa Ermuno - Tablet Candra Wiratama Rp 35,000 Rp 123,500
OBH Nelco - Syrup 100 Ml Rp 43,500
D3-1000 Tab Rp 45,000
3/1/2022 218053 RJ PT.SLK Arif Sukarno Hatta Ispa Immu-Cea Kaplet Candra Wiratama Rp 99,000 Rp 187,500
OBH Nelco - Syrup 100 Ml Rp 43,500
D3-1000 Tab Rp 45,000
3/1/2022 218156 RJ PT.SLK Kiki Edward Ispa Immu-Cea Kaplet Candra Wiratama Rp 99,000 Rp 187,500
OBH Nelco - Syrup 100 Ml Rp 43,500
D3-1000 Tab Rp 45,000
3/1/2022 208928 RJ PT.SLK Ahlizar Ispa Immu-Cea Kaplet Candra Wiratama Rp 99,000 Rp 187,500
OBH Nelco - Syrup 100 Ml Rp 43,500
D3-1000 Tab Rp 45,000
3/1/2022 198752 RJ PT.SLK Ludhya Atnies Pratama Ispa Immu-Cea Kaplet Candra Wiratama Rp 99,000 Rp 175,500
OBH Nelco - Syrup 55 Ml Rp 31,500
D3-1000 Tab Rp 45,000
3/1/2022 188436 RJ PT.SLK Hendra Ispa Immu-Cea Kaplet Candra Wiratama Rp 99,000 Rp 175,500
OBH Nelco - Syrup 55 Ml Rp 31,500
CHOLESTEROL PORTABLE TES Rp 30,000
URIC ACID PORTABLE TEST Rp 30,000
3/2/2022 188378 RJ PT.SLK Oktavianus Multicek Blood Candra Wiratama
GLUCOSE PORTABLE TEST Rp 30,000
Selvim - Tablet 10Mg Rp 20,000 Rp 110,000
CHOLESTEROL PORTABLE TES Rp 30,000
URIC ACID PORTABLE TEST Rp 30,000
3/2/2022 208918 RJ PT.SLK Hermawan Multicek Blood Candra Wiratama Rp 110,000
GLUCOSE PORTABLE TEST Rp 30,000
Roverton - Tablet Rp 20,000
Roverton - Tablet Rp 20,000
3/2/2022 188444 RJ PT.SLK Ispa Candra Wiratama Rp 40,000
M.Ridha Lerzin - Tablet 10Mg Rp 20,000
208926 Salonpas Rp 6,000
3/2/2022 RJ PT.SLK Tuah Prabowo Vertigo Candra Wiratama Rp 26,000
Histigo - Tablet 6Mg Rp 20,000
CHOLESTEROL PORTABLE TES Rp 30,000
3/3/2022 158150 RJ PT.SLK Johanes Boyke Multicek Blood URIC ACID PORTABLE TEST Candra Wiratama Rp 30,000 Rp 90,000
GLUCOSE PORTABLE TEST Rp 30,000
3/3/2022 208874 RJ PT.SLK Arialdi Nestacort - Cream 2,5% Candra Wiratama Rp 13,000 Rp 13,000
Brochifar Plus Tablet Rp 20,000
Samcorbex Tab Rp 35,000
3/3/2022 218024 RJ PT.SLK Ahmadi Ispa Candra Wiratama Rp 135,000
Ermuno - Tablet Rp 35,000
D3-1000 Tab Rp 45,000
3/3/2022 188387 RJ PT.SLK Rivan Putra Ardiyanto Ispa Dextral - Tablet Candra Wiratama Rp 20,000 Rp 20,000
3/3/2022 198752 RJ PT.SLK Ludhya Atnies Pratama Wound treatment Perawatan luka kecil Candra Wiratama
small Rp 50,000 Rp 50,000
3/3/2022 168157 RJ PT.SLK Ikhlas Mappatunru Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
Farsifen - Tablet 400Mg Rp 20,000
3/6/2022 208874 RJ PT.SLK Arialdi Candra Wiratama Rp 35,000
Fasidol - Tablet 500 Mg Rp 15,000
3/7/2022 188482 RJ PT.SLK Satrya Forumen Ear Drop Candra Wiratama Rp 41,000 Rp 41,000
3/7/2022 188455 RJ PT.SLK Tegar Wahyudi Tranaco Hansaplast 100s Candra Wiratama Rp 2,000 Rp 2,000
3/7/2022 218156 RJ PT.SLK Kiki Edward ISPA Roverton - Tablet Candra Wiratama Rp 20,000 Rp 20,000
3/8/2022 208889 RJ PT.SLK Gunawan Siagian Ispa FG Troches - tablet Candra Wiratama Rp 25,000 Rp 25,000
3/8/2022 218131 RJ PT.SLK Zheva Bachtiar Alergic Alermax Tablet Candra Wiratama Rp 15,000 Rp 15,000
Farizol - Tablet 500Mg Rp 20,000
3/8/2022 218026 RJ PT.SLK Tuah Prabowo Diarhea Diastrix Tablet Candra Wiratama Rp 15,000 Rp 114,500
Episan 100Ml Syr Rp 79,500
3/8/2022 208874 RJ PT.SLK Arialdi Farsifen - Tablet 400Mg Candra Wiratama Rp 20,000 Rp 20,000
3/9/2022 208923 RJ PT.SLK Mohammad Fadli Febris Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
Farizol - Tablet 500Mg Rp 20,000
3/9/2022 218053 RJ PT.SLK Arif Sokarno Hatta Diarhea Candra Wiratama Rp 30,500
Trianta syrup 60 ml 10,500
3/9/2022 178346 RJ PT.SLK Asmiati Febris Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
3/9/2022 188449 RJ PT.SLK Achmad Nur Fauzi Febris Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
3/9/2022 218154 RJ PT.SLK Ahmad Lufy Febris Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000

3/9/2022 198752 RJ PT.SLK Ludhya Atnies Pratama Wound treatment Perawatan luka kecil Candra Wiratama
small Rp 50,000 Rp 50,000
 LAPORAN TAGIHAN OBAT IHC PT. SKS LISTRIK KALIMANTAN
PERIODE MARET 2022
TGL No ID LAYANAN ASURANSI PASIEN DIAGNOSA TINDAKAN / LAYANAN TENAGA MEDIS DITAGIH (Rp) TOTAL

Ermuno - Tablet Rp 35,000

3/9/2022 RJ PT.SLK Aditya Dwi Jayanto Candra Wiratama
208921 Counterpain Hot - 30gr Rp 55,000 Rp 90,000
3/9/2022 218138 RJ PT.SLK Nuraeda Hayya Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
3/10/2022 218034 RJ PT.SLK Dian Ahmad Nasir Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
Fasidol Forte - Capsul 650mg Rp 20,000
Vesperum Tablet Rp 15,000
Alofar - tablet 300 mg Rp 25,000
3/10/2022 178347 RJ PT.SLK Dwi Cahyanti Multicek Blood Candra Wiratama Rp 150,000
CHOLESTEROL PORTABLE TES Rp 30,000
URIC ACID PORTABLE TEST Rp 30,000
GLUCOSE PORTABLE TEST Rp 30,000
3/10/2022 208898 RJ PT.SLK Hairullah Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
3/10/2022 208923 RJ PT.SLK Mohammad Fadli Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
3/10/2022 218149 RJ PT.SLK Arvian Putra Pangesti Aji Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
3/10/2022 188713 RJ PT.SLK M. Idris Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
3/10/2022 Yusimox - Tablet 500Mg Rp 20,000
218156 RJ PT.SLK Kiki Edward Ispa Candra Wiratama Rp 40,000
Roverton - Tablet Rp 20,000
3/10/2022 208910 RJ PT.SLK Puja Setia Febris Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
3/11/2022 188470 RJ PT.SLK Wawan Rasmana Febris Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
3/11/2022 188387 RJ PT.SLK Rivan Putra Ardiyanto Minta Vitamin D3-1000 Tab Candra Wiratama Rp 45,000 Rp 45,000
Farsifen - Tablet 400Mg Rp 20,000
3/11/2022 208874 RJ PT.SLK Arialdi Candra Wiratama Rp 45,000
Lostacef - Tablet 500 Mg Rp 25,000
Perawatan luka medium Rp 100,000
Wound treatment
3/12/2022 208874 RJ PT.SLK Arialdi medium Injection Candra Wiratama Rp 50,000
Lidocain 2 % - Injection Rp 2,500 Rp 152,500
Wound treatment
3/13/2022 208874 RJ PT.SLK Arialdi medium Candra Wiratama Rp 100,000
Perawatan luka medium Rp 100,000
3/13/2022 188377 RJ PT.SLK M. Aby swasono Fasidol - Tablet 500 Mg Candra Wiratama Rp 6,000 Rp 6,000
Kaditic - Tablet 50Mg Rp 15,000
3/13/2022 218035 RJ PT.SLK Nadya Muntaza Gingtivitis Candra Wiratama Rp 55,000
Milorin - Capsule 300Mg Rp 40,000
CHOLESTEROL PORTABLE TES Rp 30,000
3/13/2022 218970 RJ PT.SLK Sapta Adi Setya Pramuji Ispa URIC ACID PORTABLE TEST Candra Wiratama Rp 30,000 Rp 90,000
GLUCOSE PORTABLE TEST Rp 30,000
Wound treatment
3/13/2022 198752 RJ PT.SLK Ludya Atnies Pratama Candra Wiratama Rp 50,000
small Perawatan luka kecil Rp 50,000
3/14/2022 218136 RJ PT.SLK Ario Bima Tri Wicaksono Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
Wound treatment
3/14/2022 208874 RJ PT.SLK Arialdi Candra Wiratama Rp 100,000
medium Perawatan luka medium Rp 100,000
3/14/2022 198784 RJ PT.SLK Falih aliyun Reco Ear Drop 10 mL Candra Wiratama Rp 12,000 Rp 12,000
3/15/2022 208923 RJ PT.SLK Mohammad Fadli Faringistis FG Troches - tablet Candra Wiratama Rp 25,000 Rp 25,000
Gom Rp 5,500
3/15/2022 218035 RJ PT.SLK Nadya Muntaza Candra Wiratama Rp 48,500
Betadine Obat Kumur 190 Ml Rp 43,000
3/15/2022 178334 RJ PT.SLK Sori Sabungan Barumun Ispa Dextral - Tablet Candra Wiratama Rp 20,000 Rp 20,000
CHOLESTEROL PORTABLE TES Rp 30,000
3/15/2022 188727 RJ PT.SLK Irham Faurizal .R Multicek Blood URIC ACID PORTABLE TEST Candra Wiratama Rp 30,000 Rp 90,000
GLUCOSE PORTABLE TEST Rp 30,000
CHOLESTEROL PORTABLE TES Rp 30,000
3/15/2022 188377 RJ PT.SLK M. Aby swasono Multicek Blood URIC ACID PORTABLE TEST Candra Wiratama Rp 30,000 Rp 90,000
GLUCOSE PORTABLE TEST Rp 30,000
CHOLESTEROL PORTABLE TES Rp 30,000
3/15/2022 158150 RJ PT.SLK Johannes Boyke Apriadi N Multicek Blood URIC ACID PORTABLE TEST Candra Wiratama Rp 30,000 Rp 90,000
GLUCOSE PORTABLE TEST Rp 30,000
Kaditic - Tablet 50Mg Rp 15,000
3/16/2022 218035 RJ PT.SLK Nadya Muntaza Gingtivitis Candra Wiratama Rp 40,000
Lostacef - Tablet 500 Mg Rp 25,000
3/16/2022 218059 RJ PT.SLK Rahadianti Maulidia Ispa Hansaplast 100s Candra Wiratama Rp 5,000 Rp 5,000
Wound treatment Perawatan luka medium
3/16/2022 208874 RJ PT.SLK Arialdi medium Candra Wiratama
Rp 100,000 Rp 100,000
CHOLESTEROL PORTABLE TES Rp 30,000
3/16/2022 178336 RJ PT.SLK Jakson Situmorang Multicek Blood URIC ACID PORTABLE TEST Candra Wiratama Rp 30,000 Rp 90,000
GLUCOSE PORTABLE TEST Rp 30,000
3/16/2022 208898 RJ PT.SLK Hairullah Dyspepsia Trianta Syrup 60 Ml Candra Wiratama Rp 10,500 Rp 10,500
Perawatan luka medium Rp 100,000
Wound treatment
3/16/2022 208874 RJ PT.SLK Arialdi Megatic Tablet Candra Wiratama Rp 15,000 Rp 140,000
medium
Lostacef - Tablet 500 Mg Rp 25,000
GLUCOSE PORTABLE TEST Rp 30,000
Fargetik Rp 20,000
Multicek
3/17/2022 188413 RJ PT.SLK Arif soekarno hatta CHOLESTEROL PORTABLE TES Candra Wiratama Rp 30,000 Rp 165,000
Blood+myalgia
Counterpain Hot - 30gr Rp 55,000
URIC ACID PORTABLE TEST Rp 30,000
GLUCOSE PORTABLE TEST Rp 30,000
3/17/2022 218061 RJ PT.SLK Suharman Multicek Blood CHOLESTEROL PORTABLE TES Candra Wiratama Rp 30,000
Rp 92,000
URIC ACID PORTABLE TEST Rp 30,000
Selvim - Tablet 10Mg Rp 2,000
Fasidol - Tablet 500 Mg Rp 15,000
3/17/2022 188433 RJ PT.SLK Arif Gunawan Faringistis Candra Wiratama Rp 40,000
FG Troches - tablet Rp 25,000
GLUCOSE PORTABLE TEST Rp 30,000
3/17/2022 188708 RJ PT.SLK Ikhwan Arifin Multicek Blood CHOLESTEROL PORTABLE TES Candra Wiratama Rp 30,000 Rp 90,000
URIC ACID PORTABLE TEST Rp 30,000
GLUCOSE PORTABLE TEST Rp 30,000
3/17/2022 188710 RJ PT.SLK Jefriansyah Multicek Blood CHOLESTEROL PORTABLE TES Candra Wiratama Rp 30,000 Rp 90,000
URIC ACID PORTABLE TEST Rp 30,000
GLUCOSE PORTABLE TEST Rp 30,000
3/17/2022 188378 RJ PT.SLK Oktavianus Multicek Blood CHOLESTEROL PORTABLE TES Candra Wiratama Rp 30,000 Rp 90,000
URIC ACID PORTABLE TEST Rp 30,000
 LAPORAN TAGIHAN OBAT IHC PT. SKS LISTRIK KALIMANTAN
PERIODE MARET 2022
TGL No ID LAYANAN ASURANSI PASIEN DIAGNOSA TINDAKAN / LAYANAN TENAGA MEDIS DITAGIH (Rp) TOTAL

GLUCOSE PORTABLE TEST Rp 30,000

3/17/2022 188376 RJ PT.SLK Eko Maryadi Multicek Blood CHOLESTEROL PORTABLE TES Candra Wiratama Rp 30,000 Rp 90,000
URIC ACID PORTABLE TEST Rp 30,000
URIC ACID PORTABLE TEST Rp 30,000
3/17/2022 188411 RJ PT.SLK Andi Tegar Pratama Multicek Blood GLUCOSE PORTABLE TEST Candra Wiratama Rp 30,000 Rp 90,000
CHOLESTEROL PORTABLE TES Rp 30,000
URIC ACID PORTABLE TEST Rp 30,000
3/17/2022 188718 RJ PT.SLK M. Iqbal S Multicek Blood GLUCOSE PORTABLE TEST Candra Wiratama Rp 30,000 Rp 90,000
CHOLESTEROL PORTABLE TEST Rp 30,000
3/17/2022 188727 RJ PT.SLK Irham Faurizal .R Ispa FG Troches - tablet Candra Wiratama Rp 25,000 Rp 25,000
Wound treatment
3/18/2022 208874 RJ PT.SLK Arialdi Perawatan luka sedang Candra Wiratama Rp 100,000
medium Rp 100,000
URIC ACID PORTABLE TEST Rp 30,000
3/19/2022 188422 RJ PT.SLK Pradipto Anggoro Multicek Blood CHOLESTEROL PORTABLE TES Candra Wiratama Rp 30,000 Rp 90,000
GLUCOSE PORTABLE TEST Rp 30,000
URIC ACID PORTABLE TEST Rp 30,000
CHOLESTEROL PORTABLE TES Rp 30,000
3/19/2022 218049 RJ PT.SLK M. Ravi Multicek Blood Candra Wiratama Rp 110,000
Lerzin - Tablet 10Mg Rp 20,000
GLUCOSE PORTABLE TEST Rp 30,000
3/21/2022 208889 RJ PT. SLK Gunawan Siagian Myalgia Counterpain Hot - 30gr Candra Wiratama Rp 55,000 Rp 55,000
3/21/2022 208899 RJ PT. SLK Febi Mahindra Cendo Cenfresh Candra Wiratama Rp 55,000 Rp 55,000
3/21/2022 218026 RJ PT. SLK Tuah Prabowo Minta Vitamin Samcorbex Tab Candra Wiratama Rp 35,000 Rp 35,000
3/22/2022 218968 RJ PT. SLK Marwanto Myalgia Counterpain Hot - 30gr Candra Wiratama Rp 55,000 Rp 55,000
Hansaplast 100s Rp 6,000
3/22/2022 RJ PT. SLK Hairullah Candra Wiratama Rp 10,000
208898 Kassa Steril - OneMed Rp 4,000
3/23/2022 218165 RJ PT. SLK Napolin Faringistis FG Troches - tablet Candra Wiratama Rp 25,000 Rp 25,000
3/23/2022 188716 RJ PT. SLK Rifky amir Cendo Cenfresh - mini dose Candra Wiratama Rp 16,000 Rp 16,000
3/23/2022 208890 RJ PT. SLK Septerli Ispa Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
Gom Rp 5,500
3/23/2022 208927 RJ PT. SLK Ride Wani Yusimox - Tablet 500Mg Candra Wiratama Rp 20,000
Cebex Tab Rp 35,000 Rp 60,500
Episan 100Ml Syr Rp 79,500
3/24/2022 168205 RJ PT. SLK Gatot widianto Gastritis Candra Wiratama
Dobrizol - Kapsul 30Mg Rp 12,500 Rp 92,000
3/24/2022 208926 RJ PT. SLK Seno R Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
3/25/2022 138046 RJ PT. SLK Subhan Hasisi Lerzin - Tablet 10Mg Candra Wiratama Rp 10,000 Rp 10,000
Kasa Steril - One Med Rp 10,000
3/25/2022 218973 RJ PT. SLK Dedy Novrianto Farsifen - Tablet 400Mg Candra Wiratama Rp 20,000
Gom Rp 5,500 Rp 35,500
3/25/2022 RJ PT.SLK Khairul Fasidol Forte - Capsul 650mg Candra Wiratama Rp 20,000 Rp 20,000
GLUCOSE PORTABLE TEST Rp 30,000
3/25/2022 188465 RJ PT. SLK Abdul Wachid Sulaiman Multicek Blood CHOLESTEROL PORTABLE TES Candra Wiratama Rp 30,000 Rp 90,000
URIC ACID PORTABLE TEST Rp 30,000
GLUCOSE PORTABLE TEST Rp 30,000
3/25/2022 188473 RJ PT.SLK Syahrial Multicek Blood CHOLESTEROL PORTABLE TES Candra Wiratama Rp 30,000 Rp 90,000
URIC ACID PORTABLE TEST Rp 30,000
GLUCOSE PORTABLE TEST Rp 30,000
3/25/2022 158150 RJ PT.SLK Johanes Boyke Multicek Blood CHOLESTEROL PORTABLE TES Candra Wiratama Rp 30,000 Rp 90,000
URIC ACID PORTABLE TEST Rp 30,000
Laxana 5Mg Tab Rp 15,000
3/25/2022 188421 RJ PT.SLK Pradibya Januaris Candra Wiratama Rp 45,000
Scopma Plus - Tablet Rp 30,000
3/26/2022 218156 RJ PT.SLK Kiki Edward Alergic Alermax Tablet Candra Wiratama Rp 15,000 Rp 15,000
3/26/2022 188451 RJ PT.SLK Muhamad Raihan Synalten - Cream 5 Gr Candra Wiratama Rp 11,000 Rp 11,000
CHOLESTEROL PORTABLE TES Rp 30,000
3/27/2022 208872 RJ PT.SLK Consen Ellia Anggen Multicek Blood Candra Wiratama Rp 60,000
URIC ACID PORTABLE TEST Rp 30,000
Alermax Tablet Rp 15,000
3/28/2022 188727 RJ PT.SLK Irham Faurizal .R Alergic Candra Wiratama Rp 24,000
Salicyl Talk KF Rp 9,000
3/28/2022 218055 RJ PT.SLK Firman Andi Pratama Febris Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
TOTAL Rp 6,808,500
 TAGIHAN OBAT IHC PT. SKS LISTRIK KALIMANTAN
PERIODE MARET 2022
NO PT JUMLAH
1 SKS LISTRIK KALIMANTAN Rp 6,808,500
2 SOS Rp 273,500
3 GSS Rp 757,000
TOTAL Rp 7,839,000

Disetujui
Dibuat Oleh : Oleh :

Rachel dr. Roshen John

Diperiksa Oleh : Diketahui Oleh: Disetujui Oleh:

Consen Elia Anggen Jakson Situmorang Maulana Muhammad Johanes Boyke Apriadi Nugroho
HRGA HSE Plant Service Head Director
 LAPORAN TAGIHAN OBAT IHC PT. GSS
PERIODE MARET 2022
TGL ID LAYANAN ASURANSI PASIEN DIAGNOSA TINDAKAN / LAYANAN TENAGA MEDIS DITAGIH (Rp) TOTAL

Vitamin D3 1000 Rp 45,000

3/1/2022 2336 RJ PT.GSS Paulus Pati Ispa Immu-Cea Kaplet Candra Wiratama Rp 99,000 Rp 175,500
OBH Nelco - Syrup 55 Ml Rp 31,500
3/3/2022 4719 RJ PT.GSS Kevin Kurniawan Myalgia Fargetik Candra Wiratama 20,000 Rp 20,000
Fasidol - Tablet 500 Mg Rp 10,000
3/4/2022 RJ PT.GSS Ahmad Domi Ispa Dextral - Tablet Candra Wiratama Rp 20,000 Rp 45,000
5085 Vitamin C - Tablet 100 Mg Rp 15,000
Fasidol - Tablet 500 Mg Rp 7,500
3/4/2022 RJ PT. GSS Sandy Pramana Candra Wiratama
5331 Samcorbex Tab Rp 35,000 Rp 42,500
3/2/2022 5085 RJ PT.GSS Ahmad Domi Farsifen - Tablet 400Mg Candra Wiratama Rp 20,000 Rp 20,000
3/6/2022 2357 RJ PT. GSS Mella Herdian Sapratama Gom Candra Wiratama Rp 5,500 Rp 5,500
Fargetik Rp 20,000
3/8/2022 4772 RJ PT. GSS Triarto Candra Wiratama Rp 40,000
Floxifar - Tablet 500Mg Rp 20,000
Aldisa SR tab Rp 90,000
3/8/2022 5360 RJ PT.GSS Hendik Eka Saputra Ispa Candra Wiratama Rp 105,000
Fasidol - Tablet 500 Mg Rp 15,000
Roverton - Tablet Rp 20,000
3/10/2022 5331 RJ PT.GSS Sandy Pramana Ispa Candra Wiratama
Lostacef - Tablet 500 Mg Rp 25,000 Rp 45,000
3/12/2022 5085 RJ PT.GSS Ahmad Domi Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 15,000
3/25/2022 RJ PT.GSS Jonatan Aditama ispa OBH Nelco - Syrup 100 Ml Candra Wiratama Rp 43,500 Rp 43,500
3/25/2022 2336 RJ PT.GSS Paulus Pati Fargetik Candra Wiratama Rp 20,000 Rp 20,000
Diastrix Tablet Rp 15,000
Farizol - Tablet 500Mg Rp 20,000
3/25/2022 2336 RJ PT.GSS Paulus Pati Gingtivitis Candra Wiratama
Kaditic - Tablet 50Mg Rp 15,000
Milorin - Capsule 300Mg Rp 40,000 Rp 90,000
URIC ACID PORTABLE TEST Rp 30,000
3/28/2022 4719 RJ PT.GSS Kevin Kurniawan Multicheck blood CHOLESTEROL PORTABLE TES Candra Wiratama Rp 30,000 Rp 90,000
GLUCOSE PORTABLE TEST Rp 30,000
TOTAL Rp 757,000
 LAPORAN TAGIHAN OBAT IHC PT. SOS
PERIODE MARET 2022
TGL No.ID LAYANAN ASURANSI PASIEN DIAGNOSA TINDAKAN / LAYANAN TENAGA MEDIS DITAGIH (Rp) TOTAL

Roverton - Tablet Rp 20,000

3/1/2022 12007000326 RJ PT.SOS Misrani ISPA Candra Wiratama Rp 45,000
FG Troches - tablet Rp 25,000
3/2/2022 12102000093 RJ PT.SOS Ardianson ISPA Brochifar tabet Candra Wiratama Rp 20,000 Rp 20,000
3/2/2022 12104000465 RJ PT.SOS Wagiman Dyspepsia Trianta Syrup 60 Ml Candra Wiratama Rp 10,000 Rp 10,000
Dextral - Tablet Rp 20,000
3/5/2022 2103000184 RJ PT.SOS Diki Candra ISPA Fasidol - Tablet 500 Mg Candra Wiratama Rp 15,000 Rp 70,000
Samcorbex Tab Rp 35,000
3/5/2022 11808000136 RJ PT.SOS Debi Frendi Myalgia Fargetik Candra Wiratama Rp 20,000 Rp 20,000
3/13/2022 12103000190 RJ PT.SOS Napriadi R Orsaderm Cream 5 Gram Candra Wiratama Rp 8,500 Rp 8,500
Dextral - Tablet Rp 20,000
3/21/2022 12103000190 RJ PT.SOS Napriadi R Hipertensi Sekunder Candra Wiratama Rp 40,000
Zevask - Tablet 5Mg Rp 20,000
Fargetik Rp 20,000
3/26/2022 11906000025 RJ PT.SOS Yester Subur Gingtivitis Candra Wiratama
Milorin - Capsule 300Mg Rp 40,000 Rp 60,000
TOTAL Rp 273,500