Kode Reg Tanggal Jaminan Diagnosa

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI

RG02304138 22-10-2023 RJ VS RI

RG02304138 22-10-2023 RJ VS RI

RG02304138 22-10-2023 RJ VS RI

RG02304138 22-10-2023 RJ VS RI

RG02304138 22-10-2023 RJ VS RI

RG02304138 22-10-2023 RJ VS RI

RG02304138 22-10-2023 RJ VS RI

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA
RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of
foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA
RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of
foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304138 22-10-2023 RJ VS RI S913 Open wound of other parts of

foot- W110 Fall on and from ladder,
Home

2023-10-23 07:42:28, AQILAH FAZA

AULIA

RG02304160 22-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI

RG02304160 22-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI
RG02304160 22-10-2023 BPJS PBI

RG02304160 22-10-2023 BPJS PBI

RG02304160 22-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI

RG02304160 23-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI

RG02304160 23-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI

RG02304160 23-10-2023 BPJS PBI
RG02304160 23-10-2023 BPJS PBI
RG02304160 23-10-2023 BPJS PBI
RG02304160 23-10-2023 BPJS PBI
RG02304160 23-10-2023 BPJS PBI
RG02304160 23-10-2023 BPJS PBI
RG02304160 23-10-2023 BPJS PBI
RG02304160 23-10-2023 BPJS PBI
RG02304160 23-10-2023 BPJS PBI
RG02304160 23-10-2023 BPJS PBI
RG02304160 23-10-2023 BPJS PBI
RG02304160 23-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI

RG02304160 24-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI
RG02304160 24-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI

RG02304160 24-10-2023 BPJS PBI

RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI

RG02304160 24-10-2023 BPJS PBI

RG02304160 24-10-2023 BPJS PBI

RG02304160 24-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI

RG02304160 24-10-2023 BPJS PBI

RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI
RG02304160 24-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI
RG02304160 24-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI

RG02304160 24-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI

RG02304160 24-10-2023 BPJS PBI S819 Open wound of lower leg, part
unspecified- W870 Exposure to
unspecified electric current, Home

2023-10-25 12:40:37, ASYIFAH KUSUMA

WARDANI
Keadaan Keluar RS Layanan Medis Reg
BELUM SEMBUH UNIT GAWAT DARURAT DOKTER UGD JAGA

BELUM SEMBUH LABORATORIUM

BELUM SEMBUH LABORATORIUM

BELUM SEMBUH LABORATORIUM

BELUM SEMBUH LABORATORIUM

BELUM SEMBUH LABORATORIUM

BELUM SEMBUH LABORATORIUM

BELUM SEMBUH LABORATORIUM

BELUM SEMBUH LABORATORIUM

BELUM SEMBUH UNIT GAWAT DARURAT EKA YOGA WIRATAMA, DR, MMR

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT EKA YOGA WIRATAMA, DR, MMR

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT

BELUM SEMBUH UNIT GAWAT DARURAT ...

SEMBUH JABAL NUR

SEMBUH JABAL NUR dr.TAUFIEK HIKMAWAN YULIARTA

BS, Sp.B
SEMBUH RADIOLOGI AHMAD FAESOL,DR., Sp.Rad.

SEMBUH RADIOLOGI AHMAD FAESOL,DR., Sp.Rad.

SEMBUH RADIOLOGI AHMAD FAESOL,DR., Sp.Rad.

SEMBUH JABAL NUR

SEMBUH JABAL NUR

SEMBUH JABAL NUR

SEMBUH KAMAR OPERASI dr.TAUFIEK HIKMAWAN YULIARTA

BS, Sp.B;AR
SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH KAMAR OPERASI

SEMBUH FARMASI RAWAT INAP

SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH JABAL NUR

SEMBUH JABAL NUR

SEMBUH JABAL NUR

SEMBUH FARMASI RAWAT INAP

SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP

SEMBUH FARMASI RAWAT INAP

SEMBUH FARMASI RAWAT INAP

SEMBUH JABAL NUR dr.TAUFIEK HIKMAWAN YULIARTA

BS, Sp.B

SEMBUH FARMASI RAWAT INAP

SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH FARMASI RAWAT INAP
SEMBUH JABAL NUR
SEMBUH JABAL NUR

SEMBUH JABAL NUR

SEMBUH JABAL NUR

Petugas No.Trs
TRI SUFAHMI RG02304138

ANGGI TU3737363A-01
SAPUTRA
ANGGI TU3737363A-02
SAPUTRA
ANGGI TU3737363A-03
SAPUTRA
ANGGI TU3737363A-04
SAPUTRA
ANGGI TU3737363A-05
SAPUTRA
ANGGI TU3737363A-06
SAPUTRA
ANGGI TU3737363A-07
SAPUTRA
ANGGI TU3737363A-08
SAPUTRA
UNIT GAWAT TU3737371A-01
DARURAT

UNIT GAWAT TU3737371A-02

DARURAT

UNIT GAWAT TU3737371A-03

DARURAT

UNIT GAWAT DU3219693A-07

DARURAT
UNIT GAWAT DU3219693A-08
DARURAT

UNIT GAWAT DU3219693A-09

DARURAT

UNIT GAWAT DU3219693A-10

DARURAT

UNIT GAWAT DU3219693A-11

DARURAT

UNIT GAWAT DU3219693A-99

DARURAT

UNIT GAWAT DU3219693A-01

DARURAT

UNIT GAWAT DU3219693A-02

DARURAT

UNIT GAWAT DU3219693A-03

DARURAT
UNIT GAWAT DU3219693A-04
DARURAT

UNIT GAWAT DU3219693A-05

DARURAT

UNIT GAWAT DU3219693A-06

DARURAT

UNIT GAWAT TU3737371A-04

DARURAT

UNIT GAWAT TU3737371A-05

DARURAT

UNIT GAWAT TU3737371A-06

DARURAT

TASKAGENT BE0163102A-1022
{system}

TRI SUFAHMI RG02304160

SUGENG TU3737388A-01
SUPRIYADI
SUGENG TU3737389A-01
SUPRIYADI
SUGENG TU3737391A-01
SUPRIYADI
TASKAGENT BE0163102A-1023
{system}

ENDANG TU3737614A-01
PUJIANTI

ENDANG TU3737614A-02
PUJIANTI

DESY TU3737854A-01
EKARIANI
DESY DU3220087A-01
EKARIANI
DESY DU3220087A-02
EKARIANI
DESY DU3220087A-21
EKARIANI
DESY DU3220087A-22
EKARIANI
DESY DU3220087A-23
EKARIANI
DESY DU3220087A-15
EKARIANI
DESY DU3220087A-16
EKARIANI
DESY DU3220087A-17
EKARIANI
DESY DU3220087A-18
EKARIANI
DESY DU3220087A-19
EKARIANI
DESY DU3220087A-20
EKARIANI
DESY DU3220087A-09
EKARIANI
DESY DU3220087A-10
EKARIANI
DESY DU3220087A-11
EKARIANI
DESY DU3220087A-12
EKARIANI
DESY DU3220087A-13
EKARIANI
DESY DU3220087A-14
EKARIANI
DESY DU3220087A-03
EKARIANI
DESY DU3220087A-04
EKARIANI
DESY DU3220087A-05
EKARIANI
DESY DU3220087A-06
EKARIANI
DESY DU3220087A-07
EKARIANI
DESY DU3220087A-08
EKARIANI
TRI HARTOYO DU3220015A-02
TRI HARTOYO DU3220015A-99
TRI HARTOYO DU3220015A-01
TRI HARTOYO DU3220017A-01
TRI HARTOYO DU3220017A-99
TRI HARTOYO DU3220096A-01
TRI HARTOYO DU3220096A-02
TRI HARTOYO DU3220096A-99
TRI HARTOYO DU3220404A-01
TRI HARTOYO DU3220404A-02
TRI HARTOYO DU3220404A-03
TRI HARTOYO DU3220404A-04
TRI HARTOYO DU3220404A-99
ANNISA BE0163102A-1024
NUGRAHENI
MUKTISARI

ANNISA TU3739224A-01
NUGRAHENI
MUKTISARI
ANNISA TU3739224A-02
NUGRAHENI
MUKTISARI

TRI HARTOYO DU3221343A-01

TRI HARTOYO DU3221343A-02
TRI HARTOYO DU3221343A-03
TRI HARTOYO DU3221343A-99
TRI HARTOYO DU3221410A-01
TRI HARTOYO DU3221410A-02
TRI HARTOYO DU3221410A-03
TRI HARTOYO DU3221410A-99
ARUM DU3222245A-01
FUJININGSIH
ARUM DU3222245A-02
FUJININGSIH
ARUM DU3222245A-99
FUJININGSIH
ENDANG TU3740439A-01
PUJIANTI

TRI HARTOYO RU0305628A-02

TRI HARTOYO RU0305628A-03
TRI HARTOYO RU0305628A-99
TRI HARTOYO RU0305626A-99
TRI HARTOYO RU0305627A-01
TRI HARTOYO RU0305627A-02
TRI HARTOYO RU0305627A-03
TRI HARTOYO RU0305627A-99
TRI HARTOYO RU0305628A-01
TRI HARTOYO RU0305626A-01
TASKAGENT BL0701134A
{system}
TASKAGENT BL0701135A
{system}

JOKO WAHYUDI RO02304160

JOKO WAHYUDI RO02304160

Keterangan Biaya
REG: RAWAT JALAN 0

DARAH RUTIN (AUTO) 66000

GOL. DARAH 18000

RHESUS 18000

GULA DARAH SEWAKTU STRIP 40000

PT (PROTHROMBIN TIME) 95000

APTT 95000

HBSAG TES 60000

ANTI HIV 115000

UGD CRITICAL CARE RAWAT INAP MASUK BANGS 100000

Nama Petugas Medis : EKA YOGA WIRATAMA, DR, MMR

PENDAFTARAN 20000

EKG DENGAN BACAAN 46000

Nama Petugas Medis : EKA YOGA WIRATAMA, DR, MMR

[001] LIDOCAIN 2% INJ 4 Ampul 10878

[001] TETAGAM P 250IU 1ML 1 Vial 281607

[001] SPUIT TERUMO 3 CC 2 Pieces 4440

[001] RANITIDIN INJ 1 Ampul 1998

[001] KETOROLAC 30MG INJ 1 Vial 2331

PEMBULATAN TRS DU3219693A 80

[001] RINGER LACTATE 500 1 PLABOT 9990

[001] BLOOD SET/TRANFUSI SET GSTC 1 Piec 17316

[001] TRY WAY STOP COCK HEUER 1 Pieces 23421

[001] IV CATH 20 1 Pieces 11100

[001] PRO IV TRANSPARAN 1 Pieces 4773

[001] BRILON 3/0 2 Pieces 122766

PASANG INFUS (IGD) 18000

INJEKSI 2x 20000

UGD JAHIT LUKA TNPA BENANG LEBIH DARI 10 220000

Nama Petugas Medis : ...

[BED-1022]JABAL NUR 477 KL III BED 5-KLA 125000

REG: RAWAT INAP 0

CRURIS AP/ LAT S KIRI - CR 205000
Nama Petugas Medis : AHMAD FAESOL,DR., Sp.Rad.
PEDIS AP/ LAT KIRI - CR 205000
Nama Petugas Medis : AHMAD FAESOL,DR., Sp.Rad.
THORAX DEWASA S - CR 172500
Nama Petugas Medis : AHMAD FAESOL,DR., Sp.Rad.
[BED-1023]JABAL NUR 477 KL III BED 5-KLA 125000

INJEKSI 3x 30000

TINDAKAN PERAWATAN 100

NECROTOMY/DEBRID. 2108000
Nama Petugas Medis : dr.TAUFIEK HIKMAWAN YULIARTA BS, Sp.B;AR
[001] RINGER LACTATE 500 1 PLABOT 9800

[001] SPINOCAN G 25 1 Pieces 48000

[001] CHLORET SOD 0,9% 1 LITER 1 PLABOT 16800

[001] DOUBLE SPIKE 1 Pieces 3300

[001] FM CREPE 4 INCH 1 Pieces 85700

[001] HANDSCOEN ST GDM NON POWDER 7 1 Pi 13900

[001] HANDSCOEND ST GDM NON POWDER 7.5 1 13900

[001] KASA IBS 5 X 7x16 10´s 20 Pieces 40700

[001] DARYANTULLE/ FRAMICETYN 1 Pieces 28000

[001] UNDER PADS 1 Pieces 4000

[001] DERMALON 2-0 1727-51 1 Pieces 62700

[001] FC RUSCH GOLD 16 1 Pieces 28800

[001] AQUADEST OPLOS 25CC 1 PLABOT 4200

[001] URINE BAG 1 Pieces 8600

[001] HANDSCOEN ST 7 1 Pieces 7000

[001] MESS AESCULAP NO. 23 1 Pieces 4700

[001] HANDSCOEND GDM FREE POWDER 6.5 1 P 13900

[001] SPUIT TERUMO 3 CC 1 Pieces 2200

[001] SPUIT NIPRO 5 CC 1 Pieces 1500

[001] SPUIT NIPRO 10 CC 1 Pieces 1900

[001] MARCAIN 0.5% 4 ML INJ 1 Ampul 106200

[001] KETOROLAC 30MG INJ 1 Vial 2300

[001] ONDANSETRON 4MG/2ML INJ 1 Ampul 1700

[001] KETOROLAC 30MG INJ 6 Vial 13500

BIAYA TRS DU3220015A 4000
[001] CEFTRIAXONE 1GR INJ 4 Ampul 30900
[001] RANITIDIN INJ 4 Ampul 7600
BIAYA TRS DU3220017A 4000
[001] SPUIT 10 CC ONE MED 1 Pieces 1400
[001] CHLORET SOD 0,9% 100ML PIGGY 1 PLA 8500
BIAYA TRS DU3220096A 4000
[001] CHLORET SOD 0,9% 100ML PIGGY 1 PLA 8500
[001] SPUIT 10 CC ONE MED 6 PCS 8200
[001] SPUIT 3 CC ONE MED 8 PCS 6500
[001] RINGER LACTATE 500 3 FLB 29300
BIAYA TRS DU3220404A 4000
[BED-1024]JABAL NUR 477 KL III BED 5-KLA 125000

INJEKSI 3x 30000
TINDAKAN PERAWATAN 100

[001] CEFTRIAXONE 1GR INJ 4 Ampul 30900

[001] KETOROLAC 30MG INJ 5 Vial 11200
[001] RANITIDIN INJ 5 Ampul 9500
BIAYA TRS DU3221343A 4000
[001] SPUIT 3 CC ONE MED 4 Pieces 3300
[001] SPUIT 10 CC ONE MED 6 Pieces 8200
[001] RINGER LACTATE 500 1 PLABOT 9800
BIAYA TRS DU3221410A 4000
[001] CEFADROXIL 500MG 15 Tablet 18400

[001] MELOXICAM 7.5MG 15 Tablet 5100

BIAYA TRS DU3222245A 4000

VISITE 70000
Nama Petugas Medis : dr.TAUFIEK HIKMAWAN YULIARTA BS, Sp.B

[RETUR] KETOROLAC 30MG INJ 5 VI -11200

[RETUR] RANITIDIN INJ 4 AMP -7532
PEMBULATAN TRS RU0305628A -64
PEMBULATAN TRS RU0305626A -20
[RETUR] RINGER LACTATE 500 3 FLB -29265.6
[RETUR] SPUIT 10 CC ONE MED 6 PCS -8190
[RETUR] SPUIT 3 CC ONE MED 4 PCS -3220
PEMBULATAN TRS RU0305627A -24.4
[RETUR] CEFTRIAXONE 1GR INJ 4 AMP -30804
[RETUR] KETOROLAC 30MG INJ 2 VI -4480
BIAYA ADMINISTRASI 75000
BIAYA MATERAI 6000

BIAYA ADM R.INAP 75000

METERAI 6000

JUMLAH 5433200
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