RINCIAN JASA MEDIK PASIEN BPJS PERIODE JULI 2020

NO. NO. SEP Nama Pasien Nama Dokter

1 0319R0160720V001492 ANSAR R YOTOMARUANGI dr. Maharani
2 0319R0160620V001526 ROHADI dr. Maharani
3 0319R0160720V000534 ISWAN M dr. Maharani
4 0319R0160720V001088 BAHRAL dr. Maharani
5 0319R0160620V003062 ANDIK YUWONO DR. MAHARANI
6 0319R0160720V002832 YERNIS MEIRSIK BOHOH DR. MAHARANI
7 0319R0160720V000553 FADLI A MANAHAU DR. MAHARANI
8 0319R0160720V002824 YEYEN TRIANI DR. MAHARANI
9 0319R0160720V002823 ANNISA SUSILAWATI DR. MAHARANI
10 0319R0160620V003059 FITRAN DR. MAHARANI
11 0319R0160620V003050 RUMAEDI DR. MAHARANI
12 0319R0160720V003230 I WAYAN SUWIKKA DR. MAHARANI
13 0319R0160620V003202 DAHRI DR. MAHARANI
14 0319R0160720V001624 MASRUDIN RAPEKAMPU DR. MAHARANI
15 0319R0160720V001661 SUKARDI DR. MAHARANI
16 0319R0160720V001483 RUCI NARARYA DR. MAHARANI
17 0319R0160720V000552 LIDIA DR. MAHARANI
18 0319R0160620V003060 NUR HIKMAH DR. MAHARANI
19 0319R0160720V001658 ARMIN DR. MAHARANI
20 0319R0160620V003055 RAIHAN RIZQIAH DR. MAHARANI
21 0319R0160720V000554 MOH ABBAS MAULANA DR. MAHARANI
22 0319R0160720V001831 MUH REZHA RIZKY DR. MAHARANI
23 0319R0160720V004061 JUWITA VEILICIA DR. MAHARANI
24 0319R0160720V001840 MOH DIFAL IRFAN DR. MAHARANI
25 0319R0160720V001853 RAYA RAMBU RABANI DR. MAHARANI
26 0319R0160720V001493 NELI DJONI DOE DR. MAHARANI
27 0319R0160720V001755 NISYIA ANGRIANI DR. MAHARANI
28 0319R0160720V001618 ELISABETH GANNA DR. MAHARANI
29 0319R0160720V001489 ASMA DR. MAHARANI
30 0319R0160720V001602 NURAIDA DR. MAHARANI
31 0319R0160720V002998 IMRAN TALIBANA DR. MAHARANI
32 0319R0160720V001851 NI LUH MAELA PARWATI DR. MAHARANI
33 0319R0160720V001655 ABD HALIM DR. MAHARANI
34 0319R0160720V002930 SUPARMAN DR. MAHARANI
35 0319R0160720V001844 NURHALIFANI DR. MAHARANI
36 0319R0160720V001856 FITRIANA ANAS SH DR. MAHARANI
37 0319R0160720V000611 CARLA RAHEL KURES DR. MAHARANI
38 0319R0160720V001837 HIJRAH YANTI DR. MAHARANI
39 0319R0160620V003068 PRISCILLA ASRIANI DR. MAHARANI
40 0319R0160720V001492 ANSAR R YOTOMARUANGI DR. MAHARANI
41 0319R0160720V000551 SUTARNO DR. MAHARANI
42 0319R0160720V001490 SUYUTI DR. MAHARANI
43 0319R0160720V001466 JOHANES JAKOBS JOSEPH DR. MAHARANI
44 0319R0160720V001468 SUKRIN LAMARIKI DR. MAHARANI
45 0319R0160720V001552 G. S MARHAENDRA DR. MAHARANI
46 0319R0160720V001696 FITRIANI DR. MAHARANI
47 0319R0160720V002819 DARMAN SANHOKER DR. MAHARANI
48 0319R0160720V002822 YULIANUS FEBRIANTO DUMA DR. MAHARANI
49 0319R0160620V003044 MUH AULIYAUL DR. MAHARANI
50 0319R0160720V002825 MEYTY MAGDALENA DR. MAHARANI
51 0319R0160720V003926 MURITHA LAY KANNY DR. MAHARANI
52 0319R0160720V003931 DIANA DR. MAHARANI
53 0319R0160720V003954 REVAL RAMADHAN DR. MAHARANI
54 0319R0160720V001616 ANUGRAH CHAIRIADI DR. MAHARANI
55 0319R0160720V001754 MUHAMAD RAFLI DR. MAHARANI
56 0319R0160620V003067 ANGGI ASRI MONICA DR. MAHARANI
57 0319R0160720V001852 EKA DEWI SYAM SURYA DR. MAHARANI
58 0319R0160720V002826 HERLINA DR. MAHARANI
59 0319R0160720V001650 LISA ANUGRAH DR. MAHARANI
60 0319R0160620V003090 TASSE DR. MAHARANI
61 0319R0160720V001750 TRIA SUCI ILYAS DR. MAHARANI
62 0319R0160720V001622 ANDI REKA NOVIYANTI DR. MAHARANI
63 0319R0160620V003046 ANNA MELYANA DR. MAHARANI
DR. MAHARANI
LI 2020
Jumlah
Ket
Rp 120,000 Lain
Rp 60,000 Lain
Rp 60,000 Lain
Rp 25,000 Lain
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 60,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 60,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 45,000 Ranap
Rp 55,000 Lain
Rp 3,005,000
REKAPITULASI VISITE & POLI PASIEN UMUM
PERIODE 21 Agustus s/d 20 September 2020
dr. Jenefri Maharani Tamma

JENIS PEL
TGL TGL
KELUAR NAMA PASIEN NO RM RUANGAN KONSUL POLI/IGD K.VIA.TELP. VISITE
MASUK PS PS
JML TARIF RP. JML TARIF RP. JML

19/8/20 23/8/20 I Nengah Sukastra 43292 Trikora 1 60,000 60,000 -

14/9/20 14/9/20 Tri Rahmat 44149 IGD 1 60,000 60,000 -
14/9/20 14/9/20 Harryanto Agung P 44151 IGD 1 60,000 60,000 -
16/9/20 16/9/20 Anwar Bayo 44187 IGD 1 60,000 60,000 -
18/9/20 18/9/20 Deasy Indriasari 44294 IGD 1 60,000 60,000 -
19/9/20 19/9/20 Moh Ridwan 44295 IGD 1 60,000 60,000 -
18/6/20 20/6/20 Asnani 7339 Ceremai 1 50,000 50,000 -
21/8/20 20/9/20 - -
- -
JUMLAH 410,000 -

BAHAN&ALAT;
 JENIS PELAYANAN
VISITE TINDAKAN STATUS PASIEN
TOTAL RP.
TARIF RP. N.TINDAKAN JML TARIF RP.

- - 60,000 UMUM
- - 60,000 UMUM
- - 60,000 UMUM
- - 60,000 UMUM
- - 60,000 UMUM
- - 60,000 UMUM
- - 50,000 InHealth
- JAGA IGD P/S 2 Rp 150,000 300,000 300,000
- JAGA IGD M 4 Rp 200,000 800,000 800,000
- 1,100,000 1,510,000

Jumlah diterima :
konsul : Rp 410,000
K.Via Telp. : Rp -
Visite : Rp -
PART TIME : Rp 1,100,000
Total Jasmed Pasien Umum Rp 1,510,000
Jasmed BPJS Rawat Jalan JULI 2020 Rp -
Jasmed BPJS Visite Rp 265,000
Jasmed BPJS Rawat Inap JULI 2020 Rp 2,740,000
Total Rp 4,515,000
(-)Pajak= Total x 50%x5% Rp 112,875
Total setelah Pajak Rp 4,402,125