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  • Gruper Sementara

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    Gruper sementara

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    6 views1 page

    Gruper Sementara

    Uploaded by

    abdulkohar

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    KEMENTERIAN KESEHATAN REPUBLIK INDONESIA JKN

    Berkas Klaim Individual Pasien 12/08/2023

    Kode Rumah Sakit : 3215145 Kelas Rumah Sakit : C


    Nama RS : RS CITO KARAWANG Jenis Tarif : TARIF RS KELAS C SWASTA

    Nomor Peserta : 0003258364612 Nomor SEP : 0131R0110823V000269


    Nomor Rekam Medis : 00-22-07-24 Tanggal Masuk : 11/08/2023
    Umur Tahun : 66 Tanggal Keluar : 12/08/2023
    Umur Hari : 24283 Jenis Perawatan : 1 - Rawat Inap
    Tanggal Lahir : 15/02/1957 Cara Pulang : 1 - Atas Persetujuan Dokter
    Jenis Kelamin : 1 - Laki-laki LOS : 2 hari
    Kelas Perawatan : 3 - Kelas 3 Berat Lahir : -

    Diagnosa Utama : I50.9 Heart failure, unspecified

    Diagnosa Sekunder : E10.9 Insulin-dependent diabetes mellitus without complications

    Prosedur : -

    ADL Sub Acute : - ADL Chronic : -

    Hasil Grouping

    INA-CBG : I-4-12-I KEGAGALAN JANTUNG (RINGAN) Rp 2,837,800.00


    Sub Acute : - - Rp 0.00
    Chronic : - - Rp 0.00
    Special CMG : - - Rp 0.00

    Total Tarif : Rp 2,837,800.00

    Generated : E-Klaim 5.8.6.202307030847 @ 2023-08-14 13:36:59 Lembar 1 / 1

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