Rincian Biaya Rawatan Anak1 (AutoRecovered)

RINCIAN BIAYA RAWATAN ANAK
Jan-22
RINCIAN RINCIAN
By. Rici II Jumlah HARGA TOTAL By. Rici II Jumlah HARGA TOTAL
R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 24 8 Rp 22,000 Rp 176,000 VISITE RAWAT INAP ( RG ) 0 Rp 62,500 Rp -
R/Infus Set Mikro 1 Rp 25,000 Rp 25,000 KONSUL AWAL / IGD 0 Rp 125,000 Rp -
R/Infus Makro Set Rp 22,000 Rp - VISITE PERINATOLOGI 9 0 Rp 125,000 Rp 1,125,000
R/Tranfusi Set (Bloodsed One med) Rp 26,000 Rp - VISITE NICU 0 Rp 150,000 Rp -
R/Three way 1 Rp 12,000 Rp 12,000 VISITE PEDIATRIK ( ANAK ) 0 Rp 125,000 Rp -
R/Injection Pump (In staper B braun) Rp 12,000 Rp - DPJP RAWAT GABUNG ( RG ) 0 Rp 24,000 Rp -
R/Blade Rp 6,000 Rp - DPJP PERINATOLOGI 0 Rp 50,000 Rp -
R/Spuit 10 cc (Disp Syringe JMI) 1 Rp 2,000 Rp 2,000 DPJP NICU 0 Rp 63,000 Rp -
R/Spuit 5 cc (Disp Syringe JMI) 2 Rp 2,000 Rp 4,000 DPJP PEDIATRIK ( ANAK ) 0 Rp 50,000 Rp -
R/Spuit 3 cc (Disp Syringe JMI) 4 Rp 4,000 Rp 16,000 TOTAL VISITE Rp 1,125,000
R/Spuit 1 cc (Disp Syringe JMI) 24 Rp 4,000 Rp 96,000
R/Spuit 20 cc (Disp Syringe JMI) Rp 15,000 Rp - PASANG INFUS / INJ. PUMP
R/Selang ETT No. 2,5 Rp 24,000 Rp - JASA DPJP ( T ) 1 Rp 255,000 Rp 255,000
R/Vicryl 3/0 Rp 75,000 Rp - JASA PERAWAT (T) Rp 255,000 Rp -
R/Handscoen no.7,5Maxter Rp 7,000 Rp - PASANG VENA UMBILIKAL Rp 700,000 Rp -
R/NGT No. 8 3 Rp 50,000 Rp 150,000 PASANG CPAP/hari 1 Rp 1,000,000 Rp 1,000,000
R/NGT No.3,5 Rp 43,000 Rp - INTUBASI Rp 625,000 Rp -
ETT No. 3 1 Rp 47,000 Rp 47,000 PASANG OGT 2 Rp 50,000 Rp 100,000
Slang Oksigen Bayi/jam Rp 10,000 Rp - SUCTION BERKALA/HARI Rp 30,000 Rp -
Pampers Rp 41,000 Rp - INJ. IV/IM 2 Rp 20,000 Rp 40,000
R/Umbilical Catheter Rp 83,000 Rp - FOTOTERAPI/HARI 3 Rp 150,000 Rp 450,000
TOTAL ALKES Rp 528,000 MONITOR/HARI 5 Rp 50,000 Rp 250,000
OKSIGEN/JAM Rp 7,000 Rp -
R/IVFD RL Rp 18,000 Rp - TRANFUSI DARAH/KALI Rp 200,000 Rp -
R/Slang Saction Chateter No.8 Rp 21,000 Rp - NEBULIZER/KALI Rp 40,000 Rp -
R/IVFD Nacl 0,9% 100cc Rp 21,000 Rp - PERAWAT BBL/HARI 6 Rp 50,000 Rp 300,000
R/IVFD Nacl 0,9% 500cc Rp 19,000 Rp - PENDAMPING SC 1 Rp 650,000 Rp 650,000
R/IVFD Detrose 10%/ D10% 1 Rp 15,000 Rp 15,000 DILATASI PYMOSIS Rp 75,000 Rp -
R/IVFD Dextrose 5% Rp 11,000 Rp - VTP/HARI Resusitasi Rp 1,000,000 Rp -
R/Inj Ca Glukonas 100 mg/ml Rp 27,000 Rp - INJEKSI ADRENALIN / KALI Rp 50,000 Rp -
R/inj Meropenem 500mg/vial (Merofen) Rp 370,000 Rp - RUJUK PASIEN LUAR KOTA Rp 200,000 Rp -
R/Inj Gentamycin 40 mg 2 Rp 7,000 Rp 14,000 Ipasang Cateter Rp 50,000 Rp -
R/Inj Aminophylline 24 mg/cc Rp 8,000 Rp - Breascare Rp 30,000 Rp -
R/Inj Ranitidine 50 mg 2 Rp 10,000 Rp 20,000 TINDIK BAYI Rp 50,000 Rp -
R/Inj Dexamethasone 5 mg/ml Rp 15,000 Rp - Adm Rp 50,000 Rp -
R/Inj Vit K (vitadion) Rp 18,000 Rp - TOTAL Rp 3,045,000
R/Aquabidest flc (otsu water) 2 Rp 4,000 Rp 8,000 KAMAR Rp -
Mucera Drop Rp 50,000 Rp - Rawatan Nicu/Inkubator 1 1 Rp 250,000 Rp 250,000
R/Praxion syr Rp 34,000 Rp - Rawatan Muthia VVIP 0 Rp 500,000 Rp -
Praxion Drop Rp 30,000 Rp - Rawatan Nicu Box 0 Rp 150,000 Rp -
R/ Bactesin 2 Rp 123,000 Rp 246,000 rawatan perina inkubator 7 0 Rp 200,000 Rp 1,400,000
R/PCT Rp 30,000 Rp - Rawatan Perina 0 Rp 100,000 Rp -
Meropenem Rp 172,000 Rp - Rp 1,650,000
Ab cath 24 Rp 13,000
Ceftadizine Rp 49,000 Rp -
Cefotaxime Rp 16,000 Rp - Rp 6,651,000
Cespan 200mg Rp 50,000 Rp -
Ceftirizine Drop Rp 40,000 Rp -
Fuson Salf Rp 52,000 Rp -
Nistatin 1 Rp 54,000 Rp -
R/ Metronidazole Infus Rp 58,000 Rp -
Combivent Inj Rp 21,000 Rp -
Kaen I B Rp 34,000 Rp -
Kaen 3 B Rp 35,000 Rp -
Kalfoxime 500 Gram Rp 121,000 Rp -
Alcohol Swab Rp 5,000 Rp -
Proris Supp Rp 7,000 Rp -
Ceterizine Tab Rp 1,000 Rp -
Selang Nebu Bayi Rp 19,000 Rp -
Ventolin Rp 14,000 Rp -
Vaporin Rp 7,000 Rp -
Azitramycin Rp -
Omeprazole Rp 29,000 Rp -
Omeprazole Inj Rp 49,000 Rp -
R/Furosemid Rp 3,000 Rp -
R/ Sibital 200 Rp 16,000 Rp -
Xepamol Drop Rp 36,000 Rp -
Enistyn Drop Rp 49,000 Rp -
Asam Uso 2x30mg Rp -
Atropin Rp 3,000 Rp -
Epineprin Rp 14,000 Rp -
Cefspan Syr Rp 147,000 Rp -
PCT Infus (Paracetamol Infus) Rp 94,000 Rp -
Sagestam inj (Gentamicyn 80 mg) Rp 15,000 Rp -
TOTAL OBAT Rp 303,000 `
Jan-22
RINCIAN RINCIAN
By. Rici I Jumlah HARGA TOTAL By. Rici I Jumlah HARGA TOTAL

R/Infus Makro Set Rp 22,000 Rp - VISITE PERINATOLOGI 9 0 Rp 125,000 Rp 1,125,000
R/Spuit 3 cc (Disp Syringe JMI) 2 Rp 4,000 Rp 8,000 TOTAL VISITE Rp 1,125,000
R/Spuit 20 cc (Disp Syringe JMI) Rp 15,000 Rp - PASANG INFUS / INJ. PUMP
R/Selang ETT No. 2,5 1 Rp 24,000 Rp 24,000 JASA DPJP ( T ) 1 Rp 255,000 Rp 255,000
ETT No. 3 Rp 47,000 Rp - PASANG OGT 1 Rp 50,000 Rp 50,000
Slang Oksigen Bayi/jam 1 Rp 10,000 Rp 10,000 SUCTION BERKALA/HARI Rp 30,000 Rp -
R/Umbilical Catheter Rp 83,000 Rp - FOTOTERAPI/HARI 3 Rp 150,000 Rp 450,000
R/Inj Ca Glukonas 100 mg/ml 2 Rp 27,000 Rp 54,000 INJEKSI ADRENALIN / KALI Rp 50,000 Rp -
R/Inj Ranitidine 50 mg Rp 10,000 Rp - TINDIK BAYI Rp 50,000 Rp -
R/Inj Dexamethasone 5 mg/ml Rp 15,000 Rp - Adm 1 Rp 50,000 Rp 50,000
R/ Bactesin 2 Rp 123,000 Rp 246,000 rawatan perina inkubator 7 0 Rp 200,000 Rp 1,400,000
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
Jan-22
RINCIAN RINCIAN
By. Niki Jumlah HARGA TOTAL By. Niki Jumlah HARGA TOTAL

R/IV Catheter 24 Rp 22,000 Rp - VISITE RAWAT INAP ( RG ) 0 Rp 62,500 Rp -
R/Infus Set Mikro Rp 25,000 Rp - KONSUL AWAL / IGD 0 Rp 125,000 Rp -
R/Infus Makro Set Rp 22,000 Rp - VISITE PERINATOLOGI 0 Rp 125,000 Rp -
R/Three way Rp 12,000 Rp - VISITE PEDIATRIK ( ANAK ) 0 Rp 125,000 Rp -
R/Spuit 10 cc (Disp Syringe JMI) Rp 2,000 Rp - DPJP NICU 0 Rp 63,000 Rp -
R/Spuit 5 cc (Disp Syringe JMI) Rp 2,000 Rp - DPJP PEDIATRIK ( ANAK ) 0 Rp 50,000 Rp -
R/Spuit 3 cc (Disp Syringe JMI) Rp 4,000 Rp - TOTAL VISITE Rp -
R/Spuit 1 cc (Disp Syringe JMI) Rp 4,000 Rp -
R/Spuit 20 cc (Disp Syringe JMI) Rp 15,000 Rp - PASANG INFUS / INJ. PUMP Rp -
R/Selang ETT No. 2,5 Rp 24,000 Rp - JASA DPJP ( T ) Rp 255,000 Rp -
R/NGT No. 8 Rp 50,000 Rp - PASANG CPAP/hari Rp 1,000,000 Rp -
ETT No. 3 Rp 47,000 Rp - PASANG OGT Rp 50,000 Rp -
Pampers Rp 41,000 Rp - INJ. IV/IM Rp 20,000 Rp -
R/Umbilical Catheter Rp 83,000 Rp - FOTOTERAPI/HARI Rp 150,000 Rp -
TOTAL ALKES Rp - MONITOR/HARI Rp 50,000 Rp -
R/IVFD Nacl 0,9% 100cc Rp 21,000 Rp - PERAWAT BBL/HARI Rp 50,000 Rp -
R/IVFD Detrose 10%/ D10% Rp 15,000 Rp - DILATASI PYMOSIS Rp 75,000 Rp -
R/Inj Gentamycin 40 mg Rp 7,000 Rp - Ipasang Cateter Rp 50,000 Rp -
R/Inj Vit K (vitadion) Rp 18,000 Rp - TOTAL Rp 650,000
R/Aquabidest flc (otsu water) Rp 4,000 Rp - KAMAR Rp -
Mucera Drop Rp 50,000 Rp - Rawatan Nicu/Inkubator 0 Rp 250,000 Rp -
R/ Bactesin Rp 123,000 Rp - rawatan perina inkubator 0 Rp 200,000 Rp -
Meropenem Rp 172,000 Rp - Rp -
Cefotaxime Rp 16,000 Rp - Rp 650,000
Nistatin Rp 54,000 Rp -
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
TOTAL OBAT Rp - `
Jan-22
RINCIAN RINCIAN
By. Erni Jumlah HARGA TOTAL By. Erni Jumlah HARGA TOTAL

Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
TOTAL OBAT Rp - `
Jan-22
RINCIAN RINCIAN
By fahri Jumlah HARGA TOTAL By fahri Jumlah HARGA TOTAL

R/Three way Rp 12,000 Rp - VISITE PEDIATRIK ( ANAK ) 2 2 Rp 125,000 Rp 250,000
R/Spuit 3 cc (Disp Syringe JMI) Rp 4,000 Rp - TOTAL VISITE Rp 250,000
TOTAL ALKES Rp 120,000 MONITOR/HARI Rp 50,000 Rp -
R/Slang Saction Chateter No.8 Rp 21,000 Rp - NEBULIZER/KALI 2 Rp 40,000 Rp 80,000
R/IVFD Nacl 0,9% 500cc Rp 19,000 Rp - PENDAMPING SC Rp 650,000 Rp -
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
TOTAL OBAT Rp - `
Jan-22
RINCIAN RINCIAN By
By erlinda Jumlah HARGA TOTAL Jumlah HARGA TOTAL
erlinda
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
TOTAL OBAT Rp - `
Jan-22
RINCIAN RINCIAN
By helfi Jumlah HARGA TOTAL By helfi Jumlah HARGA TOTAL

Slang Oksigen Bayi Rp 18,000 Rp - SUCTION BERKALA/HARI Rp 30,000 Rp -
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
TOTAL OBAT Rp - `
Jan-22
RINCIAN RINCIAN
By silvia Jumlah HARGA TOTAL By silvia Jumlah HARGA TOTAL

R/Infus Makro Set Rp 22,000 Rp - VISITE PERINATOLOGI 1 0 Rp 125,000 Rp 125,000
R/Tranfusi Set (Bloodsed One med) Rp 26,000 Rp - VISITE NICU 3 0 Rp 150,000 Rp 450,000
R/Spuit 3 cc (Disp Syringe JMI) 9 Rp 4,000 Rp 36,000 TOTAL VISITE Rp 575,000
R/Vicryl 3/0 Rp 75,000 Rp - JASA PERAWAT (T) 1 Rp 255,000 Rp 255,000
R/ Bactesin 3 Rp 123,000 Rp 369,000 rawatan perina inkubator 1 0 Rp 200,000 Rp 200,000
Meropenem Rp 172,000 Rp - Rp 700,000
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
Jan-22
RINCIAN RINCIAN
By fitra Jumlah HARGA TOTAL By fitra Jumlah HARGA TOTAL

R/NGT No. 8 Rp 50,000 Rp - PASANG CPAP Rp 30,000 Rp -
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
TOTAL OBAT Rp - `
Jan-22
RINCIAN RINCIAN
By Omar Jumlah HARGA TOTAL By Omar Jumlah HARGA TOTAL

R/Three way Rp 12,000 Rp - VISITE PEDIATRIK ( ANAK ) 2 2 Rp 125,000 Rp 250,000
R/Vicryl 3/0 Rp 75,000 Rp - JASA PERAWAT (T) Rp 255,000
R/Umbilical Catheter Rp 83,000 Rp - FOTOTERAPI/HARI 1 Rp 150,000
R/PCT Rp 30,000 Rp - Rawatan Perina 1 0 Rp 100,000 Rp 100,000
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
TOTAL OBAT Rp - `
Jan-22
RINCIAN RINCIAN By
By masita Jumlah HARGA TOTAL Jumlah HARGA TOTAL
masita
R/IV Catheter 24 Rp 22,000 Rp - VISITE RAWAT INAP ( RG ) 1 1 Rp 62,500 Rp 62,500
R/Umbilical Catheter Rp 83,000 Rp - FOTOTERAPI/HARI Rp 150,000
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
TOTAL OBAT Rp - `
Jan-22
RINCIAN RINCIAN
By Thalia Jumlah HARGA TOTAL By Thalia Jumlah HARGA TOTAL

R/Infus Set Mikro 1 Rp 25,000 Rp - KONSUL AWAL / IGD 0 Rp 125,000 Rp -
R/Selang O2 Rp 24,000 Rp - JASA DPJP ( T ) Rp 255,000 Rp -
R/Vicryl 3/0 Rp 75,000 Rp - JASA PERAWAT (T) 1 Rp 255,000
R/NGT No. 8 1 Rp 50,000 Rp 50,000 PASANG CPAP 1 Rp 30,000 Rp 30,000
R/IVFD Nacl 0,9% 100cc 1 Rp 21,000 Rp 21,000 PERAWAT BBL/HARI Rp 50,000 Rp -
R/Inj Ranitidine 50 mg Rp 10,000 Rp - Ambulance 1 Rp 100,000 Rp 100,000
R/Inj Dexamethasone 5 mg/ml Rp 15,000 Rp - TINDIK BAYI Rp 50,000 Rp -
R/Inj Vit K (vitadion) Rp 18,000 Rp - Adm 1 Rp 50,000 Rp 50,000
R/Aquabidest flc (otsu water) Rp 4,000 Rp - TOTAL Rp 880,000
Mucera Drop Rp 50,000 Rp - KAMAR Rp -
R/Praxion syr Rp 34,000 Rp - Rawatan Nicu/Inkubator 0 Rp 250,000 Rp -
Praxion Drop Rp 30,000 Rp - Rawatan Muthia VVIP 0 Rp 500,000 Rp -
R/ Bactesin Rp 123,000 Rp - Rawatan Nicu Box 0 Rp 150,000 Rp -
R/PCT Rp 30,000 Rp - rawatan perina inkubator 0 Rp 200,000 Rp -
Meropenem Rp 172,000 Rp - Rawatan Perina 0 Rp 100,000 Rp -
Ab cath 24 Rp 13,000 Rp -
Cefotaxime Rp 16,000 Rp -
Cespan 200mg Rp 50,000 Rp - Rp 992,000
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
Jan-22
RINCIAN RINCIAN
By Rizka Jumlah HARGA TOTAL By Rizka Jumlah HARGA TOTAL

R/IV Catheter 24 1 Rp 22,000 Rp 22,000 VISITE RAWAT INAP ( RG ) 2 2 Rp 62,500 Rp 125,000
R/Three way 1 Rp 12,000 Rp - VISITE PEDIATRIK ( ANAK ) 0 Rp 125,000 Rp -
R/Spuit 10 cc (Disp Syringe JMI) 1 Rp 2,000 Rp - DPJP NICU 0 Rp 63,000 Rp -
R/Spuit 5 cc (Disp Syringe JMI) 2 Rp 2,000 Rp - DPJP PEDIATRIK ( ANAK ) 0 Rp 50,000 Rp -
R/Selang O2 1 Rp 24,000 Rp 24,000 JASA DPJP ( T ) Rp 255,000 Rp -
R/Vicryl 3/0 Rp 75,000 Rp - JASA PERAWAT (T) 1 Rp 255,000
Slang Oksigen Bayi 1 Rp 18,000 Rp - SUCTION BERKALA/HARI Rp 30,000 Rp -
R/IVFD Nacl 0,9% 100cc 1 Rp 21,000 Rp 21,000 PERAWAT BBL/HARI 2 Rp 50,000 Rp 100,000
R/IVFD Detrose 10%/ D10% 1 Rp 15,000 Rp - DILATASI PYMOSIS Rp 75,000 Rp -
R/IVFD Dextrose 5% Rp 11,000 Rp - VTP/HARI Resusitasi 1 Rp 1,000,000 Rp -
R/ Bactesin 2 Rp 123,000 Rp 246,000 rawatan perina inkubator 0 Rp 200,000 Rp -
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
Sagestam inj (Gentamicyn 80 mg) 1 Rp 15,000 Rp 15,000
Jan-22
RINCIAN RINCIAN
By Maria Jumlah HARGA TOTAL By Maria Jumlah HARGA TOTAL

Kaen 3 B Rp 35,000 Rp -
Slang suction 1 1 Rp 8,000 Rp 8,000
Azitramycin Rp -
Sagestam inj (Gentamicyn 80 mg) Rp 15,000 Rp - `
TOTAL OBAT Rp 8,000
Jan-22
RINCIAN RINCIAN
By Deli Jumlah HARGA TOTAL By Deli Jumlah HARGA TOTAL
R/IV Catheter 26 1 Rp 23,000 Rp - VISITE 0 Rp -

R/Infus Set Mikro 1 Rp 25,000 Rp 25,000 KONSUL AWAL / IGD 1 1 Rp 125,000 Rp 125,000
R/Injection Pump (In staper B braun) Rp 12,000 Rp - DPJP RAWAT GABUNG ( RG ) 1 1 Rp 24,000 Rp 24,000
Selang O2 1 Rp 7,000 Rp 7,000 SUCTION BERKALA/HARI Rp 30,000 Rp -
Slang Oksigen Bayi Rp 18,000 Rp - INJ. IV/IM Rp 20,000 Rp -
Pampers Rp 41,000 Rp - FOTOTERAPI/HARI Rp 150,000
R/Umbilical Catheter Rp 83,000 Rp - MONITOR/HARI Rp 50,000 Rp -
TOTAL ALKES Rp 134,000 OKSIGEN/JAM Rp 7,000 Rp -
Rp - TRANFUSI DARAH/KALI Rp 200,000 Rp -
R/IVFD RL Rp 18,000 Rp - NEBULIZER/KALI Rp 40,000 Rp -
R/Slang Saction Chateter No.8 Rp 21,000 Rp - PERAWAT BBL/HARI Rp 50,000 Rp -
R/IVFD Nacl 0,9% 500cc Rp 19,000 Rp - DILATASI PYMOSIS Rp 75,000 Rp -
R/IVFD Detrose 10%/ D10% 1 Rp 11,000 Rp 11,000 VTP/HARI Resusitasi Rp 1,000,000 Rp -
R/IVFD Dextrose 5% Rp 11,000 Rp - INJEKSI ADRENALIN / KALI Rp 50,000 Rp -
R/Inj Ca Glukonas 100 mg/ml 1 Rp 20,000 Rp 20,000 RUJUK PASIEN LUAR KOTA Rp 200,000 Rp -
R/inj Meropenem 500mg/vial (Merofen) Rp 370,000 Rp - Ipasang Cateter Rp 50,000 Rp -
R/Inj Gentamycin 80 mg 1 Rp 5,000 Rp 5,000 Breascare Rp 30,000 Rp -
R/Inj Gentamycin 40 mg Rp 7,000 Rp - TINDIK BAYI Rp 50,000 Rp -
R/Inj Aminophylline 24 mg/cc Rp 8,000 Rp - Adm 1 Rp 50,000 Rp 50,000
R/Inj Ranitidine 50 mg Rp 10,000 Rp - TOTAL Rp 50,000
R/Inj Dexamethasone 5 mg/ml Rp 15,000 Rp - KAMAR Rp -
R/Inj Vit K (vitadion) Rp 18,000 Rp - Rawatan Nicu/Inkubator 0 Rp 250,000 Rp -
R/Aquabidest flc (otsu water) 1 Rp 4,000 Rp 4,000 Rawatan Muthia VVIP 0 Rp 500,000 Rp -
Mucera Drop Rp 50,000 Rp - Rawatan Nicu Box 0 Rp 150,000 Rp -
R/Praxion syr Rp 34,000 Rp - rawatan perina inkubator 0 Rp 200,000 Rp -
Praxion Drop Rp 30,000 Rp - Rawatan Perina 0 Rp 100,000 Rp -
R/ Bactesin 1 Rp 123,000 Rp 123,000 Rp -
R/PCT Rp 30,000 Rp -
Meropenem Rp 172,000 Rp -
Ab cath 24 Rp 13,000 Rp - Rp 937,000
Cefotaxime Rp 16,000 Rp -
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
Cefixime Syr 1 Rp 16,000 Rp 16,000 `
TOTAL OBAT Rp 179,000
Jan-22
RINCIAN RINCIAN
By Santi Jumlah HARGA TOTAL By Santi Jumlah HARGA TOTAL

R/Infus Set Mikro Rp 25,000 Rp - KONSUL AWAL / IGD 1 1 Rp 125,000 Rp 125,000
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
TOTAL OBAT Rp - `
Jan-22
RINCIAN RINCIAN
By Fika Jumlah HARGA TOTAL By Fika Jumlah HARGA TOTAL

R/NGT No. 8 1 Rp 50,000 Rp 50,000 PASANG CPAP Rp 30,000 Rp -
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
TOTAL OBAT Rp - `
Jan-22
RINCIAN RINCIAN
by Dina Jumlah HARGA TOTAL by Dina Jumlah HARGA TOTAL

Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
TOTAL OBAT Rp - `
Aug-21
RINCIAN RINCIAN
By Rira Jumlah HARGA TOTAL By Rira Jumlah HARGA TOTAL
R/IV Catheter 26 1 1 Rp 13,000 Rp 13,000 VISITE 0 Rp -

R/IV Catheter 24 3 0 Rp 22,000 Rp 66,000 VISITE RAWAT INAP ( RG ) 0 Rp 62,500 Rp -
R/Infus Set Mikro 1 1 Rp 25,000 Rp 25,000 KONSUL AWAL / IGD 0 Rp 125,000 Rp -
R/Infus Makro Set 0 Rp 22,000 Rp - VISITE PERINATOLOGI 1 0 Rp 125,000 Rp 125,000
R/Tranfusi Set (Bloodsed One med) 0 Rp 26,000 Rp - VISITE NICU 2 2 Rp 150,000 Rp 300,000
R/Three way 1 1 Rp 12,000 Rp 12,000 VISITE PEDIATRIK ( ANAK ) 0 Rp 125,000 Rp -
R/Injection Pump (In staper B braun) 0 Rp 12,000 Rp - DPJP RAWAT GABUNG ( RG ) 0 Rp 24,000 Rp -
R/Blade 0 Rp 6,000 Rp - DPJP PERINATOLOGI 0 Rp 50,000 Rp -
R/Spuit 10 cc (Disp Syringe JMI) 1 1 Rp 2,000 Rp 2,000 DPJP NICU 0 Rp 63,000 Rp -
R/Spuit 5 cc (Disp Syringe JMI) 1 1 Rp 2,000 Rp 2,000 DPJP PEDIATRIK ( ANAK ) 0 Rp 50,000 Rp -
R/Spuit 3 cc (Disp Syringe JMI) 10 5 Rp 4,000 Rp 40,000 TOTAL VISITE Rp 425,000
R/Spuit 1 cc (Disp Syringe JMI) 18 3 Rp 4,000 Rp 72,000
R/Spuit 20 cc (Disp Syringe JMI) 0 Rp 15,000 Rp - PASANG INFUS / INJ. PUMP Rp -
R/Selang ETT No. 2,5 0 Rp 24,000 Rp - JASA DPJP ( T ) 0 Rp 255,000 Rp -
R/Vicryl 3/0 0 Rp 75,000 Rp - JASA PERAWAT (T) 1 1 Rp 255,000 Rp 255,000
R/Handscoen no.7,5Maxter 0 Rp 7,000 Rp - PASANG VENA UMBILIKAL 0 Rp 700,000 Rp -
R/NGT No. 8 0 Rp 50,000 Rp - PASANG CPAP 0 Rp 30,000 Rp -
R/NGT No.3,5 0 Rp 43,000 Rp - INTUBASI 0 Rp 625,000 Rp -
ETT No. 3 0 Rp 47,000 Rp - PASANG OGT 0 Rp 50,000 Rp -
Slang Oksigen Bayi 1 1 Rp 18,000 Rp 18,000 SUCTION BERKALA/HARI 0 Rp 30,000 Rp -
Pampers 0 Rp 41,000 Rp - INJ. IV/IM 9 9 Rp 20,000 Rp 180,000
R/Umbilical Catheter 0 Rp 83,000 Rp - FOTOTERAPI/HARI 1 1 Rp 150,000 Rp 150,000
TOTAL ALKES Rp 250,000 MONITOR/HARI 4 4 Rp 50,000 Rp 200,000
OKSIGEN/JAM 48 48 Rp 7,000 Rp 336,000
R/IVFD RL 0 Rp 18,000 Rp - TRANFUSI DARAH/KALI 0 Rp 200,000 Rp -
R/Slang Saction Chateter No.8 0 Rp 21,000 Rp - NEBULIZER/KALI 0 Rp 40,000 Rp -
R/IVFD Nacl 0,9% 100cc 1 1 Rp 21,000 Rp 21,000 PERAWAT BBL/HARI 4 4 Rp 50,000 Rp 200,000
R/IVFD Nacl 0,9% 500cc 0 Rp 19,000 Rp - PENDAMPING SC 0 Rp 650,000 Rp -
R/IVFD Detrose 10%/ D10% 0 Rp 15,000 Rp - DILATASI PYMOSIS 0 Rp 75,000 Rp -
R/IVFD Dextrose 5% 0 Rp 11,000 Rp - VTP/HARI Resusitasi 0 Rp 1,000,000 Rp -
R/Inj Ca Glukonas 100 mg/ml 1 1 Rp 27,000 Rp 27,000 INJEKSI ADRENALIN / KALI 0 Rp 50,000 Rp -
R/inj Meropenem 500mg/vial (Merofen) 0 Rp 370,000 Rp - RUJUK PASIEN LUAR KOTA 0 Rp 200,000 Rp -
R/Inj Gentamycin 40 mg 1 1 Rp 7,000 Rp 7,000 Injek Inotropik 0 Rp 50,000 Rp -
R/Inj Aminophylline 24 mg/cc 0 Rp 8,000 Rp - Breascare 0 Rp 30,000 Rp -
R/Inj Ranitidine 50 mg 0 Rp 10,000 Rp - TINDIK BAYI 0 Rp 50,000 Rp -
R/Inj Dexamethasone 5 mg/ml 0 Rp 15,000 Rp - Adm 1 Rp 50,000 Rp 50,000
R/Inj Vit K (vitadion) 0 Rp 18,000 Rp - TOTAL Rp 1,371,000
R/Aquabidest flc (otsu water) 1 0 Rp 4,000 Rp 4,000 KAMAR Rp -
Mucera Drop 0 Rp 50,000 Rp - Rawatan Nicu/Inkubator 2 2 Rp 250,000 Rp 500,000
R/Praxion syr 0 Rp 34,000 Rp - Rawatan VVIP 0 Rp 500,000 Rp -
Praxion Drop 0 Rp 30,000 Rp - Rawatan Nicu Box 0 Rp 150,000 Rp -
R/ Bactesin 3 1 Rp 123,000 Rp 369,000 rawatan perina inkubator 0 Rp 200,000 Rp -
R/PCT Tab 0 Rp 500 Rp - Rawatan Perina 0 Rp 100,000 Rp -
Meropenem 0 Rp 172,000 Rp - Rp 500,000
Ab cath 24 0 Rp 13,000
Ceftadizine 0 Rp 49,000 Rp -
Cefotaxime 0 Rp 16,000 Rp - Rp 2,974,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 29,740
Ceftirizine Drop 0 Rp 40,000 Rp - Rp 3,003,740
Fuson Salf 0 Rp 52,000 Rp -
R/ Metronidazole Infus 0 Rp 58,000 Rp -
Combivent Inj 0 Rp 21,000 Rp -
Kaen I B 0 Rp 34,000 Rp -
Kaen 3 B 0 Rp 35,000 Rp -
Kalfoxime 500 Gram 0 Rp 121,000 Rp -
Alcohol Swab 0 Rp 5,000 Rp -
Proris Supp 0 Rp - Rp -
Ceterizine Tab 0 Rp 1,000 Rp -
Selang Nebu Bayi 0 Rp 19,000 Rp -
Ventolin 0 Rp 14,000 Rp -
Vaporin 0 Rp 7,000 Rp -
Azitramycin 0 Rp -
Omeprazole 0 Rp 29,000 Rp -
Omeprazole Inj 0 Rp 49,000 Rp -
R/Furosemid 0 Rp 3,000 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Xepamol Drop 1 Rp 36,000 Rp -
Enistyn Drop 0 Rp 49,000 Rp -
Asam Uso 2x30mg 0 Rp -
Atropin 0 Rp 3,000 Rp -
Epineprin 0 Rp 14,000 Rp -
Cefspan Syr 0 Rp 147,000 Rp -
PCT Infus (Paracetamol Infus) 0 Rp 94,000 Rp -
Sagestam inj (Gentamicyn 80 mg) 1 Rp 15,000 Rp -
Jul-21
RINCIAN RINCIAN by sri

By sri ayu Jumlah HARGA TOTAL Jumlah HARGA TOTAL
ayu
R/Spuit 3 cc (Disp Syringe JMI) 5 Rp 4,000 Rp - TOTAL VISITE Rp 825,000
R/Selang ETT No. 2,5 1 1 Rp 24,000 Rp 24,000 JASA DPJP ( T ) 1 1 Rp 255,000 Rp 255,000
R/Vicryl 3/0 0 Rp 75,000 Rp - JASA PERAWAT (T) 0 Rp 255,000 Rp -
R/Handscoen no.7,5Maxter 1 1 Rp 7,000 Rp 7,000 PASANG VENA UMBILIKAL 0 Rp 700,000 Rp -
R/NGT No,5 1 1 Rp 50,000 Rp 50,000 PASANG CPAP 24 0 Rp 30,000 Rp 720,000
ETT No. 8 1 1 Rp 50,000 Rp 50,000 PASANG OGT 1 1 Rp 50,000 Rp 50,000
R/Umbilical Catheter 0 Rp 83,000 Rp - FOTOTERAPI/HARI 0 Rp 150,000
OKSIGEN/JAM 0 Rp 7,000 Rp -
R/IVFD Nacl 0,9% 100cc 1 1 Rp 21,000 Rp 21,000 PERAWAT BBL/HARI 0 Rp 50,000 Rp -
R/IVFD Nacl 0,9% 500cc 0 Rp 19,000 Rp - PENDAMPING SC 1 0 Rp 650,000 Rp 650,000
R/IVFD Detrose 10%/ D10% 2 2 Rp 15,000 Rp 30,000 DILATASI PYMOSIS 0 Rp 75,000 Rp -
R/Inj Gentamycin 40 mg 0 Rp 7,000 Rp - Injek Inotropik 0 Rp 50,000 Rp -
R/ Bactesin 1 1 Rp 123,000 Rp 123,000 rawatan perina inkubator 3 0 Rp 200,000 Rp 600,000
Meropenem 0 Rp 172,000 Rp - Rp 1,350,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 52,270
Nistatin 1 1 Rp 55,000 Rp 55,000
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Sagestam inj (Gentamicyn 80 mg) 3 1 Rp 15,000 Rp 45,000
Jul-21
RINCIAN by RINCIAN
Jumlah HARGA TOTAL by Jumlah HARGA TOTAL
Ernawati
R/Tranfusi Set (Bloodsed One med) 0 Rp 26,000 Rp - VISITE NICU 0 Rp 150,000 Rp -
R/Injection Pump (In staper B braun) 1 0 Rp 12,000 Rp 12,000 DPJP RAWAT GABUNG ( RG ) 0 Rp 24,000 Rp -
R/Selang ETT No. 2,5 0 Rp 24,000 Rp - JASA DPJP ( T ) 1 1 Rp 255,000 Rp 255,000
R/NGT No. 8 1 1 Rp 50,000 Rp 50,000 PASANG CPAP 0 Rp 650,000 e
R/NGT No.3,5 1 1 Rp 43,000 Rp 43,000 INTUBASI 0 Rp 625,000 Rp -
ETT No. 3 0 Rp 47,000 Rp - PASANG OGT 1 1 Rp 50,000 Rp 50,000
Slang Oksigen Bayi 0 Rp 18,000 Rp - SUCTION BERKALA/HARI 0 Rp 30,000 Rp -
Pampers 0 Rp 41,000 Rp - INJ. IV/IM 0 Rp 20,000 Rp -
R/Umbilical Catheter 1 1 Rp 83,000 Rp 83,000 FOTOTERAPI/HARI 0 Rp 150,000
R/PCT Tab 0 Rp 500 Rp - Rawatan Perina 1 0 Rp 100,000 Rp 100,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 27,480
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Jul-21
RINCIAN By RINCIAN
Jumlah HARGA TOTAL by dhian Jumlah HARGA TOTAL
nurbaini
R/IV Catheter 24 0 Rp 22,000 Rp - VISITE RAWAT INAP ( RG ) 0 Rp 62,500 Rp -
R/Infus Makro Set 0 Rp 22,000 Rp - VISITE PERINATOLOGI 0 Rp 125,000 Rp -
R/Spuit 1 cc (Disp Syringe JMI) 3 Rp 4,000 Rp -
R/Selang ETT No. 2,5 1 1 Rp 24,000 Rp 24,000 JASA DPJP ( T ) 0 Rp 255,000 Rp -
R/NGT No. 8 1 1 Rp 50,000 Rp 50,000 PASANG CPAP 9 0 Rp 30,000 Rp 390,000
R/IVFD Nacl 0,9% 100cc 0 Rp 21,000 Rp - PERAWAT BBL/HARI 1 1 Rp 50,000 Rp 50,000
R/Inj Ca Glukonas 100 mg/ml 0 Rp 27,000 Rp - INJEKSI ADRENALIN / KALI 0 Rp 50,000 Rp -
R/Inj Vit K (vitadion) 0 Rp 18,000 Rp - TOTAL Rp 590,000
R/Aquabidest flc (otsu water) 0 Rp 4,000 Rp - KAMAR Rp -
R/ Bactesin 1 Rp 123,000 Rp - rawatan perina inkubator 0 Rp 200,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 10,640
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Jul-21
RINCIAN RINCIAN
By Julia Jumlah HARGA TOTAL by dhian Jumlah HARGA TOTAL

R/NGT No. 8 1 1 Rp 50,000 Rp 50,000 PASANG CPAP 0 Rp 30,000 Rp 390,000
Mucera Drop 0 Rp 50,000 Rp - Rawatan Nicu/Inkubator 0 Rp 250,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 19,260
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
May-21
RINCIAN RINCIAN
By Reni Jumlah HARGA TOTAL By Reni Jumlah HARGA TOTAL

R/NGT No. 8 0 Rp 50,000 Rp - PASANG CPAP 0 Rp 30,000 Rp -
TOTAL ALKES Rp 132,000 MONITOR/HARI 0 Rp 50,000 Rp -
Praxion Drop 1 1 Rp 30,000 Rp 30,000 Rawatan Nicu Box 0 Rp 150,000 Rp -
Meropenem 0 Rp 172,000 Rp - Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 18,310
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Cefixime syr 1 1 Rp 150,000 Rp 150,000
May-21
RINCIAN RINCIAN
by siti Jumlah HARGA TOTAL by siti Jumlah HARGA TOTAL

R/IVFD Nacl 0,9% 100cc 0 Rp 21,000 Rp - PERAWAT BBL/HARI 0 Rp 50,000 Rp -
Ab cath 24 0 Rp 13,000
Cefotaxime 0 Rp 16,000 Rp - Rp 774,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 7,740
Ceftirizine Drop 0 Rp 40,000 Rp - Rp 781,740
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Jun-21
RINCIAN RINCIAN
by Resi Jumlah HARGA TOTAL by resi Jumlah HARGA TOTAL

R/Umbilical Catheter 0 Rp 83,000 Rp - FOTOTERAPI/HARI 1 0 Rp 150,000 Rp 150,000
OKSIGEN/JAM 12 12 Rp 7,000 Rp 84,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 31,460
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
AR/Inj ottogenta 1 1 Rp 15,000 Rp 15,000
May-21
RINCIAN RINCIAN by
by
Jumlah HARGA TOTAL Ramado Jumlah HARGA TOTAL
Ramadona
na
R/Infus Makro Set Rp 22,000 VISITE PERINATOLOGI 1 0 Rp 125,000 Rp 125,000
R/Tranfusi Set (Bloodsed One med) Rp 26,000 VISITE NICU 2 0 Rp 150,000 Rp 300,000
R/Three way Rp 12,000 VISITE PEDIATRIK ( ANAK ) 0 Rp 125,000 Rp -
R/Injection Pump (In staper B braun) 1 Rp 12,000 Rp 12,000 DPJP RAWAT GABUNG ( RG ) 0 Rp 24,000 Rp -
R/Selang ETT No. 2,5 1 Rp 24,000 Rp 24,000 JASA DPJP ( T ) Rp 255,000 Rp -
R/Vicryl 3/0 Rp 75,000 Rp - JASA PERAWAT (T) 1 Rp 255,000 Rp 255,000
Slang Oksigen Bayi 1 Rp 18,000 Rp 18,000 SUCTION BERKALA/HARI Rp 30,000 Rp -
OKSIGEN/JAM 6 Rp 10,000 Rp 60,000
R/Praxion syr Rp 34,000 Rp - Rawatan Reyna (kls 1) 0 Rp 400,000 Rp -
Cespan 200mg Rp 50,000 Rp - Rp 31,560
Ceftirizine Drop Rp 40,000 Rp - Rp 3,187,560
Fuson Salf Rp 52,000 Rp - z
Kaen 3 B Rp 35,000 Rp -
R/Pct (kp) Rp 30,000 Rp -
Azitramycin Rp -
R/oralit Rp 3,000 Rp -
R/Zink Rp 45,000
R/Uplolac Rp 14,000 Rp -
R/Inj Ondansentron Rp 8,000
May-21
RINCIAN RINCIAN by
by ghania Jumlah HARGA TOTAL Jumlah HARGA TOTAL
Ghania
R/Infus Makro Set 1 Rp 22,000 Rp 22,000 VISITE PERINATOLOGI 0 Rp 125,000 Rp -
R/Three way 1 Rp 12,000 Rp 12,000 VISITE PEDIATRIK ( ANAK ) 3 3 Rp 125,000 Rp 375,000
R/Vicryl 3/0 Rp 75,000 Rp - JASA PERAWAT (T) 1 1 Rp 255,000 Rp 255,000
R/NGT No. 8 Rp 50,000 Rp - PASANG CPAP Rp 30,000
R/Aquabidest flc (otsu water) Rp 4,000 Rp 4,000 KAMAR Rp -
R/Praxion syr Rp 34,000 Rp - Rawatan Reyna (kls 1) 3 3 Rp 400,000 Rp 1,200,000
Cespan 200mg Rp 50,000 Rp - Rp 22,830
Kaen 3 B 5 Rp 35,000 Rp 175,000
R/Pct (kp) 1 Rp 30,000 Rp -
Azitramycin Rp -
R/oralit 4 Rp 3,000 Rp 12,000
R/Zink 1 Rp 45,000 Rp 45,000
R/Uplolac 2 Rp 14,000 Rp 28,000
R/Inj Ondansentron 1 Rp 8,000 Rp 8,000
Sagestam inj (Gentamicyn 80 mg) Rp 15,000
May-21
RINCIAN by by RINCIAN by
Jumlah HARGA TOTAL Jumlah HARGA TOTAL
Gofran Gofran
R/Inj Dexamethasone 5 mg/ml Rp 15,000 Rp - Adm Rp 50,000
R/Aquabidest flc (otsu water) Rp 4,000 KAMAR Rp -
Kaen 3 B Rp 35,000 Rp -
Azitramycin Rp -
Sagestam inj (Gentamicyn 80 mg) Rp 15,000
TOTAL OBAT Rp - `
May-21
RINCIAN RINCIAN
by nova Jumlah HARGA TOTAL by nova Jumlah HARGA TOTAL

R/Injection Pump (In staper B braun) 1 Rp 12,000 Rp 12,000 DPJP RAWAT GABUNG ( RG ) 0 Rp 24,000 Rp -
R/Vicryl 3/0 Rp 75,000 Rp - JASA PERAWAT (T) 1 1 Rp 255,000 Rp 255,000
Pampers Rp 41,000 Rp - INJ. IV/IM 9 9 Rp 20,000 Rp 180,000
R/Inj Gentamycin 40 mg 1 1 Rp 7,000 Rp 7,000 Ipasang Cateter Rp 50,000 Rp -
R/Praxion syr Rp 34,000 Rp - Rawatan VVIP 0 Rp 500,000 Rp -
R/PCT Tab Rp 500 Rp - Rawatan Perina 3 0 Rp 100,000 Rp 300,000
Cespan 200mg Rp 50,000 Rp - Rp 24,530
Kaen 3 B Rp 35,000 Rp -
Proris Supp Rp - Rp -
Azitramycin Rp -
Sagestam inj (Gentamicyn 80 mg) Rp 15,000 Rp 15,000
May-21
RINCIAN RINCIAN
by.nora Jumlah HARGA TOTAL by nora Jumlah HARGA TOTAL

R/Tranfusi Set (Bloodsed One med) 0 Rp 26,000 Rp - VISITE NICU 1 Rp 150,000 Rp 150,000
R/Selang ETT No. 2,5 1 Rp 24,000 Rp 24,000 JASA DPJP ( T ) 0 Rp 255,000 Rp -
R/Vicryl 3/0 0 Rp 75,000 Rp - JASA PERAWAT (T) 1 Rp 255,000 Rp 255,000
ETT No. 3 0 Rp 47,000 Rp - PASANG OGT 1 Rp 50,000 Rp 50,000
Pampers 0 Rp 41,000 Rp - INJ. IV/IM 2 Rp 20,000 Rp 40,000
R/IVFD Detrose 10%/ D10% 1 Rp 15,000 Rp 15,000 DILATASI PYMOSIS 0 Rp 75,000 Rp -
R/Inj Ca Glukonas 100 mg/ml 1 Rp 27,000 Rp 27,000 INJEKSI ADRENALIN / KALI 0 Rp 50,000 Rp -
R/Inj Gentamycin 40 mg 0 Rp 7,000 Rp - Ipasang Cateter 0 Rp 50,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 9,920
Fuson Salf 0 Rp 52,000 Rp - z
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
May-21
RINCIAN RINCIAN
by.nora Jumlah HARGA TOTAL by nora Jumlah HARGA TOTAL

R/Tranfusi Set (Bloodsed One med) 0 Rp 26,000 Rp - VISITE NICU 1 Rp 150,000 Rp 150,000
R/Selang ETT No. 2,5 1 Rp 24,000 Rp 24,000 JASA DPJP ( T ) 0 Rp 255,000 Rp -
ETT No. 3 0 Rp 47,000 Rp - PASANG OGT 1 Rp 50,000 Rp 50,000
R/IVFD Detrose 10%/ D10% 1 Rp 15,000 Rp 15,000 DILATASI PYMOSIS 0 Rp 75,000 Rp -
R/Inj Ca Glukonas 100 mg/ml 1 Rp 27,000 Rp 27,000 INJEKSI ADRENALIN / KALI 0 Rp 50,000 Rp -
R/Inj Gentamycin 40 mg 0 Rp 7,000 Rp - Ipasang Cateter 0 Rp 50,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 9,920
Fuson Salf 0 Rp 52,000 Rp - z
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Jun-21
RINCIAN RINCIAN
byrini Jumlah HARGA TOTAL byrini Jumlah HARGA TOTAL

R/Spuit 3 cc (Disp Syringe JMI) 5 Rp 4,000 Rp - TOTAL VISITE Rp -
R/NGT No. 8 0 Rp 50,000 Rp - PASANG CPAP 0 Rp 650,000 e
TOTAL ALKES Rp - MONITOR/HARI 0 Rp 50,000 Rp -
R/Inj Dexamethasone 5 mg/ml 0 Rp 15,000 Rp - Adm Rp 50,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 6,900
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
May-21
RINCIAN RINCIAN by
by Faradila Jumlah HARGA TOTAL Jumlah HARGA TOTAL
faradila
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 6,500
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Apr-21
RINCIAN RINCIAN by
by Nofdia Jumlah HARGA TOTAL Jumlah HARGA TOTAL
Nofdia
R/NGT No. 8 1 1 Rp 50,000 Rp 50,000 PASANG CPAP 8jm 0 Rp 650,000 Rp 240,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 23,500
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Maret 2021
RINCIAN RINCIAN
by Intan Jumlah HARGA TOTAL by Intan Jumlah HARGA TOTAL

Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 6,500
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Apr-21
RINCIAN RINCIAN by
by Kairani Jumlah HARGA TOTAL Jumlah HARGA TOTAL
kairani
R/NGT No. 8 0 Rp 50,000 Rp - PASANG CPAP 0 Rp 650,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 19,670
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Apr-21
RINCIAN RINCIAN
by Nova Jumlah HARGA TOTAL by Nova Jumlah HARGA TOTAL

R/Tranfusi Set (Bloodsed One med) 1 1 Rp 26,000 Rp 26,000 VISITE NICU 1 1 Rp 150,000 Rp 150,000
Praxion Drop 0 Rp 30,000 Rp - Rawatan Nicu Box 1 1 Rp 150,000 Rp 150,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 11,150
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Maret 2021
RINCIAN RINCIAN
By. Tiara Jumlah HARGA TOTAL by tiara Jumlah HARGA TOTAL

R/NGT No. 8 1 1 Rp 50,000 Rp 50,000 PASANG CPAP 7 jam Rp 650,000 Rp 210,000
OKSIGEN/JAM 10 10 Rp 7,000 Rp 70,000
R/IVFD Dextrose 5% 1 1 Rp 11,000 Rp 11,000 VTP/HARI Resusitasi 0 Rp 1,000,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 22,700
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Maret 2021
RINCIAN RINCIAN
by Esi Jumlah HARGA TOTAL by Esi Jumlah HARGA TOTAL

Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 17,490
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Maret 2021
RINCIAN RINCIAN
by Resmi Jumlah HARGA TOTAL by Resmi Jumlah HARGA TOTAL

Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 6,500
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Maret 2021
RINCIAN RINCIAN
by Erni Jumlah HARGA TOTAL by Erni Jumlah HARGA TOTAL

R/ Bactesin 1 Rp 123,000 Rp - rawatan perina inkubator 2 0 Rp 200,000 Rp 400,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 5,500
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Maret 2021
RINCIAN RINCIAN
by rika Jumlah HARGA TOTAL by rika Jumlah HARGA TOTAL

R/NGT No. 8 1 1 Rp 50,000 Rp 50,000 PASANG CPAP 9jm 0 Rp 650,000 Rp 270,000
OKSIGEN/JAM 3 3 Rp 7,000 Rp 21,000
R/Praxion syr 1 1 Rp 34,000 Rp 34,000 Rawatan VVIP 0 Rp 500,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 26,630
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Maret 2021
RINCIAN RINCIAN
by riri Jumlah HARGA TOTAL by riri Jumlah HARGA TOTAL

R/NGT No. 8 1 1 Rp 50,000 Rp 50,000 PASANG CPAP 3,5jm 0 Rp 650,000 Rp 105,000
OKSIGEN/JAM 0 Rp 7,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 14,120
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Maret 2021
RINCIAN RINCIAN
by yusni Jumlah HARGA TOTAL by yusni Jumlah HARGA TOTAL

R/NGT No. 8 0 Rp 45,000 Rp - PASANG CPAP 1 0 Rp 650,000 Rp 30,000
Mucera Drop 0 Rp 50,000 Rp - Rawatan Nicu/Inkubatusi 0 Rp 250,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 7,040
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Maret 2021
RINCIAN RINCIAN by
by syanela Jumlah HARGA TOTAL syanelab Jumlah HARGA TOTAL
y rini
R/Spuit 10 cc (Disp Syringe JMI) 2 2 Rp 2,000 Rp 4,000 DPJP NICU 1 1 Rp 63,000 Rp 63,000
R/Umbilical Catheter 0 Rp 83,000 Rp - FOTOTERAPI/HARI 1 0 Rp 150,000
Mucera Drop 0 Rp 50,000 Rp - Rawatan Nicu/Inkubatusi 1 1 Rp 250,000 Rp 250,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 27,530
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Maret 2021
RINCIAN RINCIAN
by rini Jumlah HARGA TOTAL by rini Jumlah HARGA TOTAL

R/NGT No. 8 1 1 Rp 45,000 Rp 45,000 PASANG CPAP 0 Rp 650,000 Rp 650,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 16,850
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Maret 2021
RINCIAN RINCIAN
by yosi Jumlah HARGA TOTAL by yosi Jumlah HARGA TOTAL

Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 29,870
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Maret 2021
RINCIAN RINCIAN by
by Andini Jumlah HARGA TOTAL Jumlah HARGA TOTAL
Andini
R/NGT No. 5 2 2 Rp 50,000 Rp 100,000 PASANG CPAP 17 jam 0 Rp 650,000 Rp 510,000
OKSIGEN/JAM 1 1 Rp 7,000 Rp 7,000
R/IVFD Nacl 0,9% 500cc 0 Rp 19,000 Rp - PENDAMPING PN 0 Rp 650,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 22,310
Kaen 3 B 0 Rp 35,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Jan-21
RINCIAN RINCIAN
an. Malik Jumlah HARGA TOTAL an. Malik Jumlah HARGA TOTAL

R/Infus Makro Set 1 1 Rp 22,000 Rp 22,000 VISITE PERINATOLOGI 0 Rp 125,000 Rp -
R/Three way 1 1 Rp 12,000 Rp 12,000 VISITE PEDIATRIK ( ANAK ) 3 3 Rp 125,000 Rp 375,000
R/Praxion syr 0 Rp 34,000 Rp - Rawatan VVIP 1 1 Rp 500,000 Rp 500,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 11,180
Kaen 3 B 3 3 Rp 35,000 Rp 105,000
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Jan-21
RINCIAN RINCIAN
by ririn Jumlah HARGA TOTAL by ririn Jumlah HARGA TOTAL

R/Praxion syr 0 Rp 34,000 Rp - Rawatan Purnama 0 Rp 250,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 13,350
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Jan-21
RINCIAN RINCIAN
byira Jumlah HARGA TOTAL by ira Jumlah HARGA TOTAL

R/Selang O2 Bayi 0 Rp 10,000 Rp - DPJP PERINATOLOGI 0 Rp 50,000
ETT no 3 0 Rp 43,000 Rp - JASA PERAWAT (T) 1 0 Rp 255,000 Rp 255,000
R/Handscoen no.7,5 Maxter 2 2 Rp 13,000 Rp 26,000 PASANG VENA UMBILIKAL 0 Rp 700,000 Rp -
R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 0 Rp 650,000 Rp 600,000
R/NGT No.8 2 2 Rp 43,000 Rp 86,000 INTUBASI 0 Rp 625,000 Rp -
R/NGT No. 3,5 0 Rp 43,000 Rp - PASANG OGT 2 0 Rp 50,000 Rp 100,000
TOTAL ALKES Rp 564,000 SUCTION BERKALA/HARI 0 Rp 30,000 Rp -
INJ. IV/IM 9 0 Rp 20,000 Rp 180,000
R/IVFD RL 0 Rp 18,000 Rp - FOTOTERAPI/HARI 0 Rp 150,000 Rp -
R/Slang Saction Chateter No.8 0 Rp 21,000 Rp - MONITOR/HARI 2 0 Rp 50,000 Rp 100,000
R/IVFD Nacl 0,9% 100cc 0 Rp 21,000 Rp - OKSIGEN/JAM 0 Rp 7,000
R/IVFD Nacl 0,9% 500cc 0 Rp 19,000 Rp - TRANFUSI DARAH/KALI 0 Rp 200,000 Rp -
R/IVFD Detrose 10%/ D10% 2 2 Rp 15,000 Rp 30,000 NEBULIZER/KALI 0 Rp 40,000 Rp -
R/IVFD Dextrose 5% 0 Rp 11,000 Rp - PERAWAT BBL/HARI 3 3 Rp 50,000 Rp 150,000
R/Inj Ca Glukonas 100 mg/ml 1 1 Rp 27,000 Rp 27,000 PENDAMPING SC 1 1 Rp 650,000 Rp 650,000
R/inj Meropenem 500mg/vial (Merofen) 0 Rp 370,000 Rp - DILATASI PYMOSIS 0 Rp 75,000 Rp -
R/Inj sagestan 0 Rp 10,000 Rp - VTP/HARI Resusitasi 0 Rp 1,000,000 Rp -
R/Inj Aminophylline 24 mg/cc 0 Rp 8,000 Rp - INJEKSI ADRENALIN / KALI 0 Rp 50,000 Rp -
R/Inj Ranitidine 50 mg 0 Rp 10,000 Rp - RUJUK PASIEN LUAR KOTA 0 Rp 200,000 Rp -
R/Inj Dexamethasone 5 mg/ml 0 Rp 15,000 Rp - Injek Inotropik 0 Rp 50,000 Rp -
R/Inj Vit K (vitadion) 0 Rp 18,000 Rp - Breascare 0 Rp 30,000 Rp -
R/Aquabidest flc (otsu water) 2 0 Rp 4,000 Rp 8,000 Chest Terapi 0 Rp 30,000 Rp -
Mucera Drop 0 Rp 50,000 Rp - Adm 1 Rp 50,000 Rp 50,000
R/Praxion syr 0 Rp 34,000 Rp - TOTAL Rp 2,340,000
Praxion Drop 0 Rp 30,000 Rp - KAMAR Rp -
R/ Bactesin 3 0 Rp 123,000 Rp 369,000 Rawatan Nicu/Inkubatusi 2 2 Rp 250,000 Rp 500,000
R/PCT Tab 0 Rp 500 Rp - Rawatan Purnama 0 Rp 250,000 Rp -
Meropenem 0 Rp 172,000 Rp - Rawatan Nicu Box 0 Rp 150,000 Rp -
Ab cath 24 0 Rp 13,000 rawatan perina inkubator 0 Rp 200,000 Rp -
Ceftadizine 0 Rp 49,000 Rp - Rawatan Perina 2 0 Rp 100,000 Rp 200,000
Cespan 200mg 0 Rp 50,000 Rp -
Ceftirizine Drop 0 Rp 40,000 Rp -
Ceftriaxone 0 Rp 20,000 Rp - , Rp 4,633,000
Nisratin 0 Rp 54,000 Rp - Rp 46,330
R/ Metronidazole Infus 0 Rp 58,000 Rp - Rp 4,679,330
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Xepamol Drop 1 Rp 31,000
Eniisril 0 Rp 54,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Slang Oksigen Bayi 0 Rp 18,000 Rp -
Pampers 0 Rp 41,000 Rp - `
Jan-21
RINCIAN RINCIAN
by putri Jumlah HARGA TOTAL by putri Jumlah HARGA TOTAL

R/Blade 1 1 Rp 6,000 Rp 6,000 DPJP PERINATOLOGI 0 Rp 50,000 Rp -
R/Vicryl 3/0 1 1 Rp 75,000 Rp 75,000 JASA PERAWAT (T) 0 Rp 255,000 Rp -
R/Handscoen no.7,5Maxter 2 2 Rp 7,000 Rp 14,000 PASANG VENA UMBILIKAL 1 1 Rp 700,000 Rp 700,000
R/NGT No. 5 1 1 Rp 50,000 Rp 50,000 PASANG CPAP 0 Rp 650,000
R/NGT No.3,5 0 Rp 43,000 Rp - INTUBASI 1 1 Rp 625,000 Rp 625,000
ETT No. 3 1 1 Rp 47,000 Rp 47,000 PASANG OGT 0 Rp 50,000 Rp -
R/IVFD Nacl 0,9% 500cc 0 Rp 19,000 Rp - PENDAMPING PN 1 0 Rp 650,000 Rp 650,000
Ab cath 24 0 Rp 13,000
Cefotaxime 0 Rp 16,000 Rp - , Rp 2,638,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 26,380
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Epineprin 1 1 Rp 14,000 Rp 14,000
Jan-21
RINCIAN RINCIAN
by vanny Jumlah HARGA TOTAL by vanny Jumlah HARGA TOTAL

ETT no 3 0 Rp 43,000 Rp - JASA PERAWAT (T) 0 Rp 255,000 Rp -
R/Handscoen no.7 Maxter 0 Rp 13,000 Rp - PASANG VENA UMBILIKAL 0 Rp 700,000 Rp -
R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 0 Rp 650,000
R/NGT No.8 0 Rp 43,000 Rp - INTUBASI 0 Rp 625,000 Rp -
R/NGT No. 3,5 0 Rp 43,000 Rp - PASANG OGT 0 Rp 50,000 Rp -
TOTAL ALKES Rp - SUCTION BERKALA/HARI 0 Rp 30,000 Rp -
INJ. IV/IM 0 Rp 20,000 Rp -
R/Slang Saction Chateter No.8 0 Rp 21,000 Rp - MONITOR/HARI 0 Rp 50,000 Rp -
R/IVFD Detrose 10%/ D10% 0 Rp 15,000 Rp - NEBULIZER/KALI 0 Rp 40,000 Rp -
R/IVFD Dextrose 5% 0 Rp 11,000 Rp - PERAWAT BBL/HARI 0 Rp 50,000 Rp -
R/Inj Ca Glukonas 100 mg/ml 0 Rp 27,000 Rp - PENDAMPING SC 1 Rp 650,000 Rp 650,000
R/Aquabidest flc (otsu water) 0 Rp 4,000 Rp - Chest Terapi 0 Rp 30,000 Rp -
Mucera Drop 0 Rp 50,000 Rp - Adm Rp 50,000 Rp -
R/Praxion syr 0 Rp 34,000 Rp - TOTAL Rp 650,000
R/ Bactesin 0 Rp 123,000 Rp - Rawatan Nicu/Inkubatusi 0 Rp 250,000 Rp -
Ceftadizine 0 Rp 49,000 Rp - Rawatan Perina 0 Rp 100,000 Rp -
Cefotaxime 0 Rp 16,000 Rp - Rp -
Ceftriaxone 0 Rp 20,000 Rp - , Rp 650,000
R/ Metronidazole Infus 0 Rp 58,000 Rp - Rp 656,500
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
RINCIAN RINCIAN
by yeyen Jumlah HARGA TOTAL by yeyen Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Mar-21
RINCIAN RINCIAN
by Eliza Jumlah HARGA TOTAL by eliza Jumlah HARGA TOTAL

R/NGT No. 3,5 1 1 Rp 43,000 Rp 43,000 PASANG OGT 0 Rp 50,000 Rp -
R/Inj Ca Glukonas 100 mg/ml 0 Rp 27,000 Rp - PENDAMPING PN 1 Rp 650,000
R/PCT Tab 0 Rp 500 Rp - Rawatan VVIP 0 Rp 500,000 Rp -
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
paracetamol infus 0 Rp 65,000 Rp -
kaen ib 0 Rp 34,000 Rp -
paracetamol drop 0 Rp 20,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
q z
P
-
selvi
Mar-21
RINCIAN RINCIAN
by abbiyu Jumlah HARGA TOTAL byabbiyu Jumlah HARGA TOTAL

R/Three way 1 1 Rp 12,000 Rp 12,000 VISITE PEDIATRIK ( ANAK ) 3 3 Rp 125,000 Rp 375,000
INJ. IV/IM 15 0 Rp 20,000 Rp 300,000
R/Inj Ca Glukonas 100 mg/ml 0 Rp 27,000 Rp - PENDAMPING PN 1 Rp 650,000
R/ Bactesin 6 0 Rp 123,000 Rp 738,000 Rawatan Nicu/Inkubatusi 0 Rp 250,000 Rp -
R/PCT Tab 0 Rp 500 Rp - Rawatan VVIP 3 3 Rp 500,000 Rp 1,500,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
paracetamol infus 1 1 Rp 65,000 Rp 65,000
kaen ib 3 3 Rp 34,000 Rp 102,000
paracetamol drop 1 1 Rp 20,000 Rp 20,000
ETT No. 4 0 Rp 29,000 Rp -
q z
P
-
selvi
Feb-21
RINCIAN RINCIAN
by dwi Jumlah HARGA TOTAL by dwi Jumlah HARGA TOTAL

R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 8 jm 0 Rp 650,000 Rp 240,000
R/Inj Ca Glukonas 100 mg/ml 0 Rp 27,000 Rp - PENDAMPING SC Rp 650,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
RINCIAN RINCIAN by
by yurnalis Jumlah HARGA TOTAL Jumlah HARGA TOTAL
yurnalis
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
RINCIAN RINCIAN
by elvi Jumlah HARGA TOTAL by elvi Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
RINCIAN RINCIAN
by vera 2 Jumlah HARGA TOTAL by vera 2 Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
RINCIAN RINCIAN
By elva Jumlah HARGA TOTAL By elva Jumlah HARGA TOTAL

R/NGT No.8 0 Rp 52,000 Rp - PASANG CPAP 1hri6jm 0 Rp 650,000 Rp 830,000
R/Umbilical Catheter 0 Rp 83,000 Rp - FOTOTERAPI/HARI 1 0 Rp 150,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 29,130
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Jan-21
RINCIAN RINCIAN
By Lusia Jumlah HARGA TOTAL By Lusia Jumlah HARGA TOTAL

R/NGT No.8 1 1 Rp 52,000 Rp 52,000 PASANG CPAP 4jm 0 Rp 650,000 Rp 120,000
Ab cath 24 0 Rp 13,000
Cefotaxime 0 Rp 16,000 Rp - , Rp 446,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 4,460
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Jan-21
RINCIAN RINCIAN
by isra Jumlah HARGA TOTAL by isra Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
RINCIAN By RINCIAN By
Mainoza Mainoza
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 12,670
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Feb-21
RINCIAN RINCIAN
by Tania Jumlah HARGA TOTAL by Tania Jumlah HARGA TOTAL

INJ. IV/IM 6 6 Rp 20,000 Rp 120,000
R/Inj Ca Glukonas 100 mg/ml 0 Rp 27,000 Rp - PENDAMPING SC 1 1 Rp 650,000 Rp 650,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Jan-21
RINCIAN RINCIAN
by isra Jumlah HARGA TOTAL by isra Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Feb-21
RINCIAN RINCIAN by
by Suryani Jumlah HARGA TOTAL Jumlah HARGA TOTAL
Suryani
R/Handscoen no.7 Maxter 1 1 Rp 13,000 Rp 13,000 PASANG VENA UMBILIKAL 0 Rp 700,000 Rp -
R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 1 hr 0 Rp 650,000 Rp 650,000
INJ. IV/IM 3 3 Rp 20,000 Rp 60,000
R/IVFD Nacl 0,9% 100cc 1 1 Rp 21,000 Rp 21,000 OKSIGEN/JAM 0 Rp 7,000
R/inj Meropenem 500mg/vial (Merofen) 0 Rp 370,000 Rp - DILATASI PYMOSIS 0 Rp 75,000
R/Inj sagestan 1 1 Rp 10,000 Rp 10,000 VTP/HARI Resusitasi 0 Rp 1,000,000 Rp -
praxion Drop 0 Rp 35,000 Rp - Adm 1 Rp 50,000 Rp 50,000
Ab cath 24 0 Rp 13,000 rawatan perina inkubator 1 0 Rp 200,000 Rp 200,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Nov-20
RINCIAN RINCIAN
by yeni Jumlah HARGA TOTAL by yeni Jumlah HARGA TOTAL

R/Selang O2 Bayi 0 Rp 10,000 Rp - DPJP PERINATOLOGI 1 0 Rp 50,000 Rp 50,000
INJ. IV/IM 7 7 Rp 20,000 Rp 140,000
R/IVFD RL 0 Rp 18,000 Rp - FOTOTERAPI/HARI 1 0 Rp 150,000 Rp 150,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Jan-21
RINCIAN RINCIAN
by oktari Jumlah HARGA TOTAL by oktari Jumlah HARGA TOTAL

R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 4jm 0 Rp 650,000 Rp 12,000
R/NGT No. 3,5 0 Rp 43,000 Rp - PASANG OGT 1 0 Rp 50,000 Rp -
R/IVFD Nacl 0,9% 100cc 1 1 Rp 21,000 Rp 21,000 OKSIGEN/JAM 0 Rp 7,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Jan-21
RINCIAN RINCIAN
by tatisra Jumlah HARGA TOTAL by tatisra Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
RINCIAN by RINCIAN by
yurlinda yurlinda
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
RINCIAN RINCIAN
by Riska Jumlah HARGA TOTAL by Riska Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
RINCIAN RINCIAN
by mittaa Jumlah HARGA TOTAL bby mita Jumlah HARGA TOTAL

INJ. IV/IM 8 8 Rp 20,000 Rp 160,000
R/IVFD Dextrose 5% 0 Rp 11,000 Rp - PERAWAT BBL/HARI 2 Rp 50,000 Rp 100,000
R/Inj Ca Glukonas 100 mg/ml 0 Rp 27,000 Rp - PENDAMPING SC 0 Rp 650,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Jan-21
RINCIAN RINCIAN by
by atrianni Jumlah HARGA TOTAL Jumlah HARGA TOTAL
atriani
Kaen 3 B 0 Rp 29,000 Rp -
Ceterizine Tab 0 Rp 1,000 Rp - f
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
RINCIAN RINCIAN by
by kartini Jumlah HARGA TOTAL Jumlah HARGA TOTAL
kartini
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
RINCIAN RINCIAN
by Salmi Jumlah HARGA TOTAL by Salmi Jumlah HARGA TOTAL

R/Infus Makro Set 0 Rp 15,000 Rp - VISITE PERINATOLOGI 3 Rp 125,000 Rp 375,000
R/Selang ETT No. 2,5 0 Rp 24,000 Rp - JASA DPJP ( T ) 1 Rp 255,000 Rp 255,000
INJ. IV/IM 9 9 Rp 20,000 Rp 180,000
R/Inj Ca Glukonas 100 mg/ml Rp 27,000 #VALUE! PENDAMPING PN/SC 1 Rp 650,000 Rp 650,000
R/ Bactesin 2 Rp 123,000 Rp 246,000 Rawatan Nicu/Inkubatusi 0 Rp 250,000 Rp -
gentamicyn 1 Rp 7,000 Rp 7,000 Rawatan Nicu Box 0 Rp 150,000 Rp -
Ceftriaxone 0 Rp 20,000 Rp - , #VALUE!
Nisratin 0 Rp 54,000 Rp - #VALUE!
R/ Metronidazole Infus 0 Rp 58,000 Rp - #VALUE!
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT #VALUE!
Jan-21
RINCIAN by Nur RINCIAN by Nur

Asni Asni
R/Spuit 3 cc (Disp Syringe JMI) 5 0 Rp 4,000 Rp 20,000 TOTAL VISITE Rp -
ETT no 3 0 Rp 43,000 Rp - JASA PERAWAT (T) 1 Rp 255,000 Rp 255,000
INJ. IV/IM 6 Rp 20,000 Rp 120,000
R/IVFD Dextrose 5% 0 Rp 11,000 Rp - PERAWAT BBL/HARI 2 Rp 50,000 Rp 100,000
R/Inj Ca Glukonas 100 mg/ml 0 Rp 27,000 Rp - PENDAMPING PN/SC 1 Rp 650,000 Rp 650,000
gentamicyn 1 1 Rp 7,000 Rp 7,000 Rawatan Nicu Box 0 Rp 150,000 Rp -
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Jan-21
RINCIAN RINCIAN
by Novia Jumlah HARGA TOTAL by Novia Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
RINCIAN RINCIAN
by Vina Jumlah HARGA TOTAL by Vina Jumlah HARGA TOTAL

R/Infus Makro Set 0 Rp 15,000 Rp - VISITE PERINATOLOGI 0 0 Rp 125,000 Rp -
R/Selang O2 Bayi 1 1 Rp 10,000 Rp 10,000 DPJP PERINATOLOGI 0 Rp 50,000
ETT no 3 0 Rp 43,000 Rp - JASA PERAWAT (T) 1 Rp 255,000 Rp 255,000
R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 3jam Rp 650,000 Rp 90,000
R/NGT No. 3,5 0 Rp 43,000 Rp - PASANG OGT 1 Rp 50,000 Rp 50,000
INJ. IV/IM 2 Rp 20,000 Rp 40,000
R/Slang Saction Chateter No.8 0 Rp 21,000 Rp - MONITOR/HARI 1 Rp 50,000 Rp 50,000
R/Inj Ca Glukonas 100 mg/ml 0 Rp 27,000 Rp - PENDAMPING SC 0 Rp 650,000 Rp -
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Jan-21
RINCIAN RINCIAN
by Rizik Jumlah HARGA TOTAL by Rizik Jumlah HARGA TOTAL

Rawatan VIP (permata) 1 Rp 500,000 Rp 500,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN RINCIAN
by Mega Jumlah HARGA TOTAL by Mega Jumlah HARGA TOTAL

R/IVFD RL 0 Rp 18,000 Rp - FOTOTERAPI/HARI 0 Rp 150,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Jan-21
Harmawit Jumlah HARGA TOTAL Harmawi Jumlah HARGA TOTAL
a ta
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 20,390
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Jan-21
RINCIAN RINCIAN by Susni

By Susni D Jumlah HARGA TOTAL Jumlah HARGA TOTAL
D
R/NGT No.8 1 1 Rp 52,000 Rp 52,000 PASANG CPAP 5 jam 0 Rp 650,000 Rp 150,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 11,170
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Jan-21
RINCIAN RINCIAN by Siti

by Siti
Jumlah HARGA TOTAL Nurhaliz Jumlah HARGA TOTAL
Nurhalizah
ah
R/Blade 1 1 Rp 6,000 Rp 6,000 DPJP PERINATOLOGI 0 Rp 50,000 Rp -
R/Vicryl 3/0 1 1 Rp 122,000 Rp 122,000 JASA PERAWAT (T) 0 Rp 255,000 Rp -
R/Handscoen no.7,5Maxter 3 3 Rp 7,000 Rp 21,000 PASANG VENA UMBILIKAL 1 1 Rp 700,000 Rp 700,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 19,210
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Jan-21
RINCIAN RINCIAN by
by Dewita Jumlah HARGA TOTAL Jumlah HARGA TOTAL
Dewita
R/Selang O2 Bayi 0 Rp 10,000 Rp - DPJP PERINATOLOGI 0 Rp 50,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 5,280
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Nov-20
RINCIAN RINCIAN
by rirn Jumlah HARGA TOTAL by ririn Jumlah HARGA TOTAL

R/Inj Ranitidine 50 mg 0 Rp 10,000 Rp - TINDIK BAYI 1 1 Rp 50,000 Rp 50,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 7,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Nov-20
RINCIAN RINCIAN
by yosi Jumlah HARGA TOTAL by yosi Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN RINCIAN
by suci Jumlah HARGA TOTAL by Suci Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN RINCIAN
byDewi Jumlah HARGA TOTAL byDewi Jumlah HARGA TOTAL

R/NGT No.5 1 1 Rp 52,000 Rp 52,000 PASANG CPAP 0 Rp 650,000 Rp 90,000
R/Inj Ranitidine 50 mg 0 Rp 10,000 Rp - PASANG KATETER 0 Rp 50,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 20,590
Fuson Salf 1 1 Rp 52,000 Rp 52,000
Nistatin 1 1 Rp 54,000 Rp 54,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Dec-20
RINCIAN RINCIAN
by windri Jumlah HARGA TOTAL by windri Jumlah HARGA TOTAL

R/Selang O2 Bayi 0 Rp 10,000 Rp - DPJP PERINATOLOGI Rp 50,000 Rp -
R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 11jam Rp 650,000
ETT No. 3,5 0 Rp 45,000 Rp - PASANG OGT 1 0 Rp 50,000 Rp 50,000
R/Umbilical Catheter 0 Rp 83,000 Rp - FOTOTERAPI/HARI 0 Rp 150,000 Rp -
R/Inj Ranitidine 50 mg 0 Rp 10,000 Rp - Chest Terapi 0 Rp 30,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 14,560
bactesyn 0 Rp 123,000 Rp -
Dobutamin 0 Rp 78,000 Rp -
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Dec-20
RINCIAN RINCIAN by
by
Jumlah HARGA TOTAL Mustelfi Jumlah HARGA TOTAL
Mustelnia
a
ETT No. 3,5 0 Rp 45,000 Rp - PASANG OGT 0 Rp 50,000 Rp -
R/IVFD Nacl 0,9% 100cc 0 Rp 21,000 Rp - PERAWAT BBL/HARI 3 Rp 50,000 Rp 150,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 18,870
bactesyn 0 Rp 123,000 Rp -
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Dec-20
RINCIAN RINCIAN
by Reni Jumlah HARGA TOTAL by Reni Jumlah HARGA TOTAL

R/Infus Makro Set 1 1 Rp 25,000 Rp 25,000 VISITE PERINATOLOGI 2 Rp 125,000 Rp 250,000
ETT No. 3,5 0 Rp 45,000 Rp - PASANG OGT 1 Rp 50,000 Rp 50,000
R/IVFD Nacl 0,9% 100cc 0 Rp 21,000 Rp - PERAWAT BBL/HARI 3 Rp 50,000 Rp 150,000
R/IVFD Nacl 0,9% 500cc 0 Rp 19,000 Rp - PENDAMPING SC 1 Rp 650,000 Rp 650,000
R/IVFD Dextrose 5% 1 1 Rp 15,000 Rp 15,000 VTP/HARI Resusitasi 0 Rp 1,000,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 24,420
bactesyn 2 2 Rp 123,000 Rp 246,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Dec-20
RINCIAN RINCIAN
Gavin Jumlah HARGA TOTAL Gavin Jumlah HARGA TOTAL

ETT No. 3,5 0 Rp 45,000 Rp - PASANG OGT 0 Rp 50,000
TOTAL ALKES Rp 73,000 MONITOR/HARI 0 Rp 50,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 2,750
Ceftriaxone 0 Rp 20,000 Rp -
Kaen I B 2 0 Rp 24,000 Rp -
Kaen 3 B 0 Rp 29,000 Rp -
Vaporin 6 6 Rp 6,000 Rp 36,000
Zink 1 1 Rp 34,000 Rp 34,000
Liprolac 2 2 Rp 7,000 Rp 14,000
R/ Sibital 200 0 Rp 16,000 Rp -
PCT Infus (Paracetamol Infus) 1 1 Rp 47,000 Rp 47,000
Dec-20
RINCIAN RINCIAN
Gavin Jumlah HARGA TOTAL Gavin Jumlah HARGA TOTAL

ETT No. 3,5 0 Rp 45,000 Rp - PASANG OGT 1 Rp 50,000 Rp 50,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 2,620
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Nov-20
RINCIAN RINCIAN
by Versa Jumlah HARGA TOTAL byVersa Jumlah HARGA TOTAL

R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 0 Rp 650,000 Rp -
ETT No. 3,5 1 1 Rp 45,000 Rp 45,000 PASANG OGT 0 Rp 50,000 Rp -
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 3,500
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Nov-20
RINCIAN byby RINCIAN by

miftahurro Jumlah HARGA TOTAL miftahur Jumlah HARGA TOTAL
hmah rohmah
INJ. IV/IM 9 9 Rp 20,000 Rp 180,000
R/IVFD Nacl 0,9% 100cc 0 Rp 21,000 Rp - OKSIGEN/JAM 0 Rp 7,000 Rp 150,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Nov-20
RINCIAN RINCIAN
by Dona Jumlah HARGA TOTAL byDona Jumlah HARGA TOTAL

R/handsvoen 6,5 1 1 Rp 7,000 Rp 7,000 JASA PERAWAT (T) 0 Rp 255,000 Rp -
R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 4 0 Rp 650,000 Rp 120,000
R/Aquabidest flc (otsu water) 1 0 Rp 4,000 Rp 4,000 KAMAR
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 23,620
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Nov-20
RINCIAN RINCIAN
byDewi Jumlah HARGA TOTAL byDewi Jumlah HARGA TOTAL

R/NGT No.5 1 1 Rp 52,000 Rp 52,000 PASANG CPAP 0 Rp 650,000 Rp 90,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 20,590
Fuson Salf 1 1 Rp 52,000 Rp 52,000
Nistatin 1 1 Rp 54,000 Rp 54,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Nov-20
RINCIAN RINCIAN
by yani Jumlah HARGA TOTAL by yani Jumlah HARGA TOTAL

R/Inj Ranitidine 50 mg 0 Rp 10,000 Rp - PASANG KATETER 1 1 Rp 50,000 Rp 50,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 5,340
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Nov-20
rahmadon Jumlah HARGA TOTAL rahmado Jumlah HARGA TOTAL
a na
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 19,030
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Nov-20
RINCIAN RINCIAN
by reno Jumlah HARGA TOTAL by reno Jumlah HARGA TOTAL

Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 25,690
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Nov-20
RINCIAN RINCIAN
byroza Jumlah HARGA TOTAL byroza Jumlah HARGA TOTAL

Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 6,500
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Nov-20
RINCIAN RINCIAN by dewi

by dewi 2 Jumlah HARGA TOTAL Jumlah HARGA TOTAL
2
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 6,500
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Nov-20
RINCIAN RINCIAN by dewi

by dewi 1 Jumlah HARGA TOTAL Jumlah HARGA TOTAL
1
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 6,500
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Nov-20
RINCIAN RINCIAN
by yulia Jumlah HARGA TOTAL by yulia Jumlah HARGA TOTAL

Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 16,160
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Nov-20
RINCIAN RINCIAN
by febri Jumlah HARGA TOTAL by febri Jumlah HARGA TOTAL

Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 15,940
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Nov-20
RINCIAN RINCIAN
by yendri Jumlah HARGA TOTAL by yendri Jumlah HARGA TOTAL

ETT no 3 1 1 Rp 43,000 Rp 43,000 JASA PERAWAT (T) 0 Rp 255,000 Rp -
R/NGT No. 3,5 1 1 Rp 43,000 Rp 43,000 PASANG OGT 1 1 Rp 50,000 Rp 50,000
R/IVFD Nacl 0,9% 100cc 1 1 Rp 21,000 Rp 21,000 OKSIGEN/JAM 0 Rp 7,000 Rp 150,000
R/Inj Gentamycin 80 mg 0 Rp 6,000 Rp - VTP/HARI Resusitasi 0 Rp 1,000,000 Rp -
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Nov-20
RINCIAN RINCIAN

R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 12 jam 0 Rp 650,000 Rp 360,000
R/NGT No. 3,5 1 1 Rp 43,000 Rp 43,000 PASANG OGT 1 1 Rp 50,000 Rp 50,000
INJ. IV/IM 13 13 Rp 20,000 Rp 260,000
R/IVFD Nacl 0,9% 100cc 0 Rp 21,000 Rp - OKSIGEN/JAM 0 Rp 7,000 Rp -
R/IVFD Dextrose 5% 2 2 Rp 11,000 Rp 22,000 PERAWAT BBL/HARI 4 4 Rp 50,000 Rp 200,000
R/Inj Gentamycin 80 mg 2 2 Rp 6,000 Rp 12,000 VTP/HARI Resusitasi 0 Rp 1,000,000 Rp -
R/Inj Vit K (vitadion) 2 2 Rp 18,000 Rp 36,000 Breascare 0 Rp 30,000 Rp -
Nisratin 2 2 Rp 54,000 Rp 108,000 Rp 41,380
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Nov-20
RINCIAN RINCIAN

R/Umbilical Catheter 0 Rp 83,000 Rp - PASANG OGT 1 1 Rp 50,000 Rp 50,000
INJ. IV/IM 7 7 Rp 20,000 Rp 140,000
R/IVFD Dextrose 5% 1 1 Rp 11,000 Rp 11,000 PERAWAT BBL/HARI 2 2 Rp 50,000 Rp 100,000
Dobutamin 0 Rp 78,000 Rp - Rp 20,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Eniisril 2 2 Rp 54,000 Rp 108,000
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Nov-20
zuraidawa Jumlah HARGA TOTAL zuraidaw Jumlah HARGA TOTAL
ti ati
R/Selang O2 Bayi 1 1 Rp 10,000 Rp 10,000 DPJP PERINATOLOGI 0 Rp 50,000 Rp -
R/IVFD Nacl 0,9% 100cc 1 1 Rp 21,000 Rp 21,000 OKSIGEN/JAM 3 3 Rp 7,000 Rp 21,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Nov-20
RINCIAN RINCIAN by
by rahma Jumlah HARGA TOTAL Jumlah HARGA TOTAL
rahma
R/Umbilical Catheter 0 Rp 83,000 Rp - PASANG OGT 0 Rp 50,000 Rp -
R/Inj Vit K (vitadion) 0 Rp 18,000 Rp - Breascare 1 0 Rp 30,000 Rp 30,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN RINCIAN
by Yesa Jumlah HARGA TOTAL by yesa Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN RINCIAN
by Nadia Jumlah HARGA TOTAL by Nadia Jumlah HARGA TOTAL

R/NGT No.5 1 1 Rp 52,000 Rp 52,000 PASANG CPAP 4 jm 0 Rp 650,000 Rp 120,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN RINCIAN
by vikha Jumlah HARGA TOTAL by vikha Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN RINCIAN by
by
Jumlah HARGA TOTAL fatmawa Jumlah HARGA TOTAL
fatmawati
ti
R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 18 jam 0 Rp 650,000 Rp 540,000
INJ. IV/IM 8 8 Rp 20,000 Rp 160,000
R/Inj Ca Glukonas 100 mg/ml 1 1 Rp 27,000 Rp 27,000 PENDAMPING SC 0 Rp 650,000 Rp -
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Nov-20
RINCIAN by RINCIAN by Des

Desnawati nawati
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
lastarida lastarida
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 6,500
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Nov-20
RINCIAN RINCIAN
by dona Jumlah HARGA TOTAL by dona Jumlah HARGA TOTAL

Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 6,500
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Nov-20
RINCIAN by Sri RINCIAN by Sri

Wahyuni Wahyuni
R/Injection Pump (In staper B braun) 1 0 Rp 10,000 Rp - DPJP RAWAT GABUNG ( RG ) 0 Rp 24,000 Rp -
R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 10 Jam 0 Rp 650,000 Rp 300,000
R/Umbilical Catheter 0 Rp 83,000 Rp - HUKNAH 1 Rp 50,000 Rp 50,000
INJ. IV/IM 9 9 Rp 20,000 Rp 180,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Oct-20
RINCIAN RINCIAN
by ora Jumlah HARGA TOTAL by ora Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN RINCIAN
by zit Jumlah HARGA TOTAL by zit Jumlah HARGA TOTAL

R/Inj Aminophylline 24 mg/cc 0 Rp 8,000 Rp - Breascare 1 0 Rp 30,000 Rp 30,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 21,460
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Nov-20
RINCIAN RINCIAN
by eva Jumlah HARGA TOTAL by eva Jumlah HARGA TOTAL

Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 21,480
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Nov-20
RINCIAN RINCIAN by
by Soleha Jumlah HARGA TOTAL Jumlah HARGA TOTAL
Soleha
R/NGT No.5 0 Rp 52,000 Rp - PASANG CPAP 2 Jam 0 Rp 650,000 Rp 60,000
Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 14,010
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Nov-20
RINCIAN RINCIAN
by Reszia Jumlah HARGA TOTAL by Reszia Jumlah HARGA TOTAL

Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 7,000
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Nov-20
RINCIAN RINCIAN
by melza Jumlah HARGA TOTAL by melza Jumlah HARGA TOTAL

Ab cath 24 0 Rp 13,000
Cespan 200mg 0 Rp 50,000 Rp - Rp 6,500
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
TOTAL OBAT Rp - `
Nov-20
RINCIAN RINCIAN
by Ria Jumlah HARGA TOTAL by Ria Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN RINCIAN
by Febri Jumlah HARGA TOTAL by Febri Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Oct-20
Septiana Septiana
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN RINCIAN
by Yetri Jumlah HARGA TOTAL by Yetri Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN RINCIAN by
by Mardia Jumlah HARGA TOTAL Jumlah HARGA TOTAL
Mardia
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN By Dita RINCIAN by Dita

Gusti Gusti
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Oct-20
RINCIAN RINCIAN
by Wira Jumlah HARGA TOTAL by wira Jumlah HARGA TOTAL

Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
TOTAL OBAT Rp -
Nov-20
RINCIAN RINCIAN
by Nurul Jumlah HARGA TOTAL by Nurul Jumlah HARGA TOTAL

R/Handscoen no.7 Maxter 1 1 Rp 13,000 Rp 13,000 PASANG VENA UMBILIKAL 1 1 Rp 700,000 Rp 700,000
R/Blade 1 1 Rp 6,000 Rp 6,000
INJ. IV/IM 2 2 Rp 20,000 Rp 40,000
R/IVFD Nacl 0,9% 100cc 1 1 Rp 21,000 Rp 21,000 OKSIGEN/JAM 0 Rp 7,000 Rp -
Kaen 3 B 0 Rp 29,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
ETT No.2,5 0 Rp 24,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Feb-18
RINCIAN By Desi RINCIAN By Desi

Ferda Ferda
R/Blade (Pisau B Braun) 0 Rp 6,000 Rp - JASA DPJP ( T ) 0 Rp 255,000 Rp -
R/Inj Ca Glukonas 100 mg/ml 0 Rp 24,000 Rp - PENDAMPING PN 0 Rp 650,000 Rp -
Mucera Drop 0 Rp 50,000 Rp - Adm 0 Rp 50,000 Rp -
R/Praxion syr 0 Rp 34,000 Rp - TOTAL Rp -
Ab cath 24 0 Rp 13,000 rawatan perina inkubator Rp 200,000 Rp -
Ceftriaxone 0 Rp 20,000 Rp - , Rp -
Dobutamin 0 Rp 78,000 Rp - Rp -
R/ Metronidazole Infus 0 Rp 58,000 Rp - Rp -
Kaen 3 B 0 Rp 29,000 Rp -
Ampicilin 0 Rp 15,000 Rp -
Azitramycin 0 Rp -
R/ Sibital 200 0 Rp 16,000 Rp -
Efedrin 0 Rp 38,500 Rp -
ETT No.2,5 0 Rp 29,000 Rp -
ETT No. 4 0 Rp 29,000 Rp -
Sagestam inj (Gentamicyn 80 mg) 0 Rp 14,000
Susu SGM BBLR 0 Rp 41,000 Rp - `
TOTAL OBAT Rp -
KWITANSI PEMBAYARAN PASIEN RAWAT INAP
Rumah Sakit Ibu Dan Anak
ANANDA
Jl. Prof.M.Yamin Pandan Ujung Kota Solok 27322 Sumbar HP 082386897566
APOTEK RSIA ANANDA

Apoteker : YENI ROZA, S.Farm.Apt
503/01/SIPA/DPM-PTSP/I/2018
Salina Resep : dr. Yufi Permana, Sp. OG

Tertulis Tanggal : 15 Mei 2020
Untuk : Mutia Fermanda
NO Nama Obat Jumlah Waktu pemberian /Dosis Harga SatuanTotal

1 IV Catheter NO 18 1 pcs OK 4,288 4,288
2 R/ Tranfusi Set 1 pcs OK 5,198 5,198
3 R/ Foley Catheter 1 pcs OK 14,108 14,108
4 R/ Urine Bag 1 pcs OK 6,534 6,534
5 R/ Spuit 10 Cc 1 pcs OK 1,871 1,871
6 / Spuit 5 Cc Terumo 1 pcs OK 4,154 4,154
7 / Spuit 3 Cc 1 pcs OK 4,247 4,247
8 / Spuit 1 Cc Terumo 8 pcs OK 3,470 27,760
9 Neddle No.24 1 pcs OK 1,579 1,579
10 Spinocath 1 pcs OK 87,900 87,900
11 Blade 1 pcs OK 1,800 1,800
12 Vicryl no 1/0 1 pcs OK 98,380 98,380
13 Vicryl no 3/0 1 pcs OK 59,252 59,252
14 R/ Cromic catgut no 1 1 pcs OK 71,280 71,280
15 R/ Hansdcon no 7. 2 pcs OK 4,856 9,712
16 R/ Hansdcon no 7,5 2 pcs OK 6,804 13,608
17 Dermafix 2 pcs OK 22,935 45,870
18 Pencukur 1 pcs OK 7,020 14,040
19 Klem Umbilical 1 pcs OK 2,970 2970
20 Slang Suction 1 pcs OK
21 IVFD RL 7 pcs OK+Rawatan Obgyn 10,300 72,100
22 Cefriaxone 1 gr 2 pcs OK+Rawatan Obgyn/IV per 8 jam 10,804 21,608
23 R. Injeksi Ketorolac 30 mg 3 ampul OK+Rawatan Obgyn/IV per 8 jam 6,754 13,508
24 R. Injeksi OXYTOCIN 10 iu 1 ampul Rawatan Obgyn 11,475 11,475
25 R. Injeksi Dexamethasone 5mg/ml mg 2 ampul OK 3,375 6,750
26 R. Injeksi Vik K 1 ampul Rawatan Obgyn 17,820 17,820
27 R. Injeksi Hepatitis B 1 ampul Rawatan Perina
28 Buvivacaine spinal 1 ampul OK 78,048 78,048
29 Aquabidest fil 1 pcs OK 3,861 3,861
30 Cefadroxil Tab 500 mg 10 tab 2x1 810 8,100
31 Asa. Mefenamat Tab 21 tab 3x1 387 8,127
32 PCT Tab 500 mg 21 tab 3x1 246 5,166
33 Ketoprofen Supp 200 mg 21 tab 3x1 18,563 389,823
34 Tramadol 100 mg 3 Ampul IV/8Jam 5,618 16,854
35 IV Catheter NO 24 2 pcs Rawatan Perina 22,052 44,104
36 R/ Tranfusi Set Mikro 1 pcs Rawatan Perina 5,198 5,198
37 R/ Three Way 1 pcs Rawatan Perina 11,678 11,678
38 R/ Spuit 10 Cc 1 pcs Rawatan Perina 4,879 4,879
39 R/ Spuit 5 Cc 1 pcs Rawatan Perina 4,154 4,154
40 R/ Spuit 3 Cc Terumo 1 pcs Rawatan Perina 4,247 4,247
41 R/ Spuit 1 Cc Terumo 1 pcs Rawatan Perina 3,470 3,470
42 ETT NO 2.5 1 pcs Rawatan Perina 23,983 23,983
43 R/ IVFD dextrose 10 % 1 pcs Rawatan Perina 14,465 14,465
44 R/ iNJ. Gentamicyn 80 mg 1 vial Rawatan Perina 14,461 14,461
45 R/ Injek. Ca. Gluconas 100mg/ml 2 ampul Rawatan Perina 27,000 54,000
46 R/ Aquabidest Flc 1 pcs Rawatan Perina 3,861 3,861
47 R/ Bactesyn 0.75 1 ampul Rawatan Perina 122,850 122,850
TOTAL Rp1,439,141
APOTEKER
YENI ROZA, S.Farm,Apt

503/01/SIPA/DPM-PTSP/I/2018

Rincian Biaya Rawatan Anak1 (AutoRecovered)

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Rincian Biaya Rawatan Anak1 (AutoRecovered)

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RINCIAN BIAYA RAWATAN ANAK

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 1 Rp 23,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 1 1 Rp 13,000 Rp 13,000 VISITE 0 Rp -

RINCIAN RINCIAN by sri

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 1 1 Rp 13,000 Rp 13,000 VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 2 2 Rp 13,000 Rp 26,000 VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 1 1 Rp 13,000 Rp 13,000 VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 1 1 Rp 13,000 Rp 13,000 VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 1 1 Rp 13,000 Rp 13,000 VISITE 0 Rp -

R/IV Catheter 26 1 1 Rp 13,000 Rp 13,000 VISITE 0 Rp -

RINCIAN by Nur RINCIAN by Nur

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -

R/IV Catheter 26 0 Rp 13,000 Rp - VISITE 0 Rp -