NO NAMA ICD X

1 Angina Pectoris I20.9

2 ASMA J45
3 Bronchitis J20.9
4 Cardiomegali I51.7
5 Cephalgia G44
6 Cholelitiasis K80
7 Cholesterol E78.0
8 CKD III N18.9
9 Combotion T30.0
10 Commond Cold J00
11 Covid B34.2
12 CRS G54.2
13 CTS G56.0
14 Cystitis N30
15 Dermatitis L20
16 Diare R19.7
17 Dislipidemia E78.5
18 Dislokasi Fremur S73
19 DM E11
20 Dyspepsia K30
21 Effusi Pleura J90
22 Faringitis j02.6
23 CKD N18.1
24 Frozen Shoulder M75.0
25 Gastritis k29.7
26 Gastritis K29.7
27 Gastritis Erosiva K29.6
28 Gastritis Kronis K29.5
29 Gastropathi K31.9
30 GEA A09
31 GERD K21
32 Glaucoma H40.9
33 Hematuria R31.9
34 Hepatitis B19
35 HHD I11
36 Hipertiroid E05
37 Hipertrigliserida E78.1
38 HNP M51.9
39 Hordeolum H00
40 Insomnia F51.0
41 ISK N39.0
42 Post Op Femur Z47.1
43 Katarak Post Op Z98.4
44 Katarak Senile H25
45 Konjungtivitis H10
46 Konstipasi K59.0
47 LBP M54.5
48 Musculuskeletal M00
49 Myalgia M79.1
50 Neuropati E11.4
51 NHL Submandibular C85.9
52 Nummular Dermatitis L30.0
53 OA M19
54 S. Typhoid Fever A01.0
55 OMA H66.9
56 Orchitis N45.2
57 Pain Knee M25.5
58 PJK I25
59 Pneumonia Bilateral J18.9
60 Post Of Mastectomy I97.2
61 PPOK J44.1
62 Prediabetes R73
63 Proteinuria R80.9
64 Pseu Dopterygium H11.1
65 Pterygium H11.0
66 PTSD F43.1
67 PV D45
68 Rhinitis Alergi J30.9
69 Spondylosis M47
70 Stiatica M54.3
71 Stomatitis K12.1
72 Takikardia R00
73 Tinea Cruris B35.6
74 Tinea Pedis B35.3
75 Tinitus H93.1
76 Trigger Finger M65.3
77 Uricemia E79.0
78 Urtikaria L50.9
79 Vertigo H81.4
80 Vomiting R11.10
81 CVA Infark I63.9
82 Ca Mammae C50.9
83 Diabetic Neuropati E11.4
84 Anemia D64.9
85 Gastritis R50.6
86 Thalasemia D56.9
87 Selulitis L03.9
88 Gout M10.9
89 Epilepsi G40.9
90 Neurodermatitis L20.8
91 Hypertrigliserida E78.1
92 Colic Abdomen R10.8
93 Cough R05
94 spasme otot M62.838
95 HT I10
96 Gangguan Cemas F41.9
97 Thyrotoxicosis E05
98 BPH N40
99 CHF I50.9
100 ISPA J06.9
101 Oedema R60.9
102 Psoriasis L40.9
103 Mastalgia N64.4
104 Arthritis M13
105 TFA J02.9
106 Parotitis B26.5
107 Febris R50.6
108 Herpes B02
109 TB Paru A15.1
110 Ca. Prostat C61
111 Asma Bronkial J45.9
112 Ulkus Diabetikum E14.2
113 Gangren Pedis I70.2
114 Parkinson G20
115 SLE N39.0
116 GGA N17.8
117 FL K76.0
118 Hiperuricemia E79.0
119 Inkotunensia Urine R32
120 Bell Palsy G51.0
121 Hepatitis C B19.2
122 Neuropati Perifer G90
123 FA J02.9
124 Diabetic Neuropati E10.4
125 S. Dislipidemia E78.5
126 S. Hiperuricemia E79.0
127 Prespiratory Tuberculosis A15
128 S. DM E11
129 Rhinitis J30
130 S. ISK N39.0
131 S. Anemia D64
132 S. GGA N17.8
133 CAD I25.1
134 Stable Angina I20.9
135 Takiaritmia I49.9
136 Post Op Cholitiasis K80.9
137 Sirosis Hepatitis K70.3
138 Prolaps Uteri N93.8
139 S. HT I10
140 Inkontinensia Urin R32
141 Katarak H25.0
142 Diabetic Retinopati E11.3
143 Dislokasi Radius S63.0
144 Pitting Edema R60.9
145 OMA H66.9
146 Presbikusis H91.1
147 Ulkus Pedis E11.6
148 Clavus L84
149 S. Angina Pectoris I20.9
150 S. Hepatitis B19
151 CHD Q24.9
152 S. Mioma D26.0
153 S. Appendik Akut K35.9
154 Trigliserid E78.1
155 Post Op Appendicitis K35.3
156 Myoma Uteri D26.0
157 Appendicitis Akut K35.9
158 Post Op Tumor D21.4
159 S. TB A15.1
160 Post Curretage O03.9
161 Benign Neoplasma D24
162 Hipoglikemia E11.6
163 Hiperglikemia R73.9
164 Osteoma R. Temporalis D16.4
165 Infeksi Mammae L02.0
166 Struma E04.9
167 Otalgia H92
168 Ulkus Gangren I96
169 Polisitemia Vera D45
170 Iskemia I21
171 Tinea B35
172 CKD IV N18.9
173 Disuria R30
174 Low Vision H54.2
175 AF Flutter I48
176 Palpitasi R00.2
177 Keloid L91
178 Limfadenopati R59.0
179 OA Genu M19.9
180 DC I50.9
181 Skin Ulcer L98.4
182 Dislokasi Ankle S93.0
183 Post Op Ganglion M67.4
184 Aritmia I49.8
185 Fever R50.9
186 Kista Lobus Kiri Liver Q44.6
187 S. Kista Ovarium C56
188 Limfadenitis Pada Lymphedema I88.9
189 PJK Post PCI Z98.6
190 Osteoporosis M81.0
191 Skizofrenia F20
192 Trombositemia Sekunder D69.3
193 Polisit Emia Vera D45
194 Skoliosis M41.9
195 Post Menopouse Bleeding N95
196 TIA G45.9
197 Post Op Batu Buli N21.0
198 S. GGK N18
199 S. Trombositopenia D69.0
200 Post URS Z96.0
201 DJ Stent Z46.6
201 Tu. Mammae D24.9
201 Scoliosis Thoracal M41.3
201 Pneumonia J11.0
 Nama Dokter : dr. Cahyo Kusuma Dewanto
Bulan JANUARI 2022

NAMA NOMOR
NO
PASIEN PENSIUN
1 Ny. Siswati 01-9-347128-10

Ny. Sri Sukarmalin Herawati 01-9-303128-31

TANGGAL Diagnosa ICD X

6/20/2022 PJK I25

6/24/2022 DM E11
 Rekap Pasien Dokter Umum

Biaya Jenis Biaya

Nama Dokter
Konsultasi Tindakan Tindakan
Priska Yola

Rp 60,000
Heri Nur R

Rp 60,000
Rp 120,000
Rp 2
Umum

Jumlah
Nama Obat Dosis HNA PPN 10 %
Obat

Glimepirid 2mg 30 1x1 1446 Rp 159

Acarbose 100mg 30 1x1 2025 Rp 223
 LAB
15% Harga TOTAL
Jenis

Rp -
Rp 1,846 Rp 55,375
Rp 2,585 Rp 77,547

Rp 132,922
#REF! #REF!
#REF!
LAB
Total Biaya
Biaya Total

Rp - Rp 60,000

Rp - Rp 192,922
#REF! #REF!
#REF!