TARIF MAKAN PASIEN BPJS RUANG MELATI

Bulan : November 2020

No Tgl KRS Nama Kelas Makan Asnut Konsul Total
1 1-Nov-20 B. Umi 3 409,600 10,000 10,000 429,600
2 P. Dadang 3 260,600 5,000 10,000 275,600
3 2-Nov-20 B. Supiyah 3 243,000 10,000 10,000 263,000
4 P. Saekodin 3 264,000 5,000 10,000 279,000
5 B. Sayem 3 358,000 15,000 10,000 383,000
6 P. Alek 3 282,400 15,000 10,000 307,400
7 3-Nov-20 P. Akik 3 486,000 20,000 10,000 516,000
8 P. Eko 3 337,000 15,000 10,000 362,000
9 4-Nov-20 P. Suwito 3 447,800 15,000 10,000 472,800
10 P. Puji 3 851,600 35,000 10,000 896,600
11 B. Istini 3 95,600 5,000 10,000 110,600
12 B. Siti M 3 308,000 20,000 10,000 338,000
13 5-Nov-20 P Noam 3 282,200 15,000 10,000 307,200
14 P. Masrun 3 217,200 15,000 10,000 242,200
15 P. Slamet 3 394,000 20,000 10,000 424,000
16 P. Suwandi 3 801,000 35,000 10,000 846,000
17 B. Supiyah 3 243,000 15,000 10,000 268,000
18 7-Nov-20 B. Suryatini 3 1,128,000 50,000 10,000 1,188,000
19 P. Mujito 3 358,000 25,000 10,000 393,000
20 P. Mulani 3 183,000 10,000 10,000 203,000
21 P. Musrianto 3 216,000 15,000 10,000 241,000
22 9-Nov-20 B. Kanirah 3 141,600 5,000 10,000 156,600
23 10-Nov-20 B. Anjarwati 3 151,200 10,000 10,000 171,200
24 B. Jamiantik 3 365,600 20,000 10,000 395,600
25 P. Sugeng 3 537,000 25,000 10,000 572,000
26 B. Riani 3 216,000 10,000 10,000 236,000
27 11-Nov-20 Nn. Fatimala 1 486,200 25,000 10,000 521,200
28 Sdr. Roza 2 424,000 20,000 10,000 454,000
29 P. Adi Purnomo 3 131,200 10,000 10,000 151,200
30 B. Tukilah 3 324,000 20,000 10,000 354,000
31 P. Sutikno 3 664,000 40,000 10,000 714,000
32 P. Daroini 3 378,000 20,000 10,000 408,000
33 12-Nov-20 P. Achmadi 3 20,000 5,000 0 25,000
34 P. Rasuni 3 206,800 15,000 10,000 231,800
35 P. Misirin 3 509,200 30,000 10,000 549,200
36 15-Nov-20 B. Masfuah 3 405,600 20,000 10,000 435,600
37 16-Nov-20 P. Agus 3 358,000 20,000 10,000 388,000
38 B. Rufiah 3 0 5,000 10,000 15,000
39 P. Supadi 3 510,600 25,000 10,000 545,600
40 17-Nov-20 B. Suratemi 3 378,000 20,000 10,000 408,000
41 P. Parno 3 439,200 15,000 10,000 464,200
42 18-Nov-20 P. Damiri 2 109,800 5,000 10,000 124,800
43 B. Noa 2 73,200 5,000 0 78,200
44 20-Nov-20 P. Imam 2 314,900 20,000 10,000 344,900
45 B. Siti Rowiyah 2 314,900 20,000 10,000 344,900
46 P. Somo 3 206,800 15,000 10,000 231,800
47 21-Nov-20 P. Cholil 3 206,800 15,000 10,000 231,800
48 22-Nov-20 B. Narmi 3 996,000 65,000 10,000 1,071,000
49 24-Nov-20 P. tukilan 2 352,000 20,000 10,000 382,000
50 P. Miftakhul 2 239,200 10,000 10,000 259,200
51 B. Sriyati 3 302,400 15,000 10,000 327,400
52 25-Nov-20 B. Sri lestari 3 338,000 20,000 10,000 368,000
53 B. Nurul 3 653,500 35,000 10,000 698,500
54 P. Munif 3 604,800 35,000 10,000 649,800
55 26-Nov-20 B. Harnanik 1 914,500 35,000 10,000 959,500
56 B. Nurjanah 3 714,600 5,000 10,000 729,600
57 27-Nov-20 B. Paisah 1 1,130,000 60,000 10,000 1,200,000
58 28-Nov-20 Nn. Febi 2 442,400 30,000 10,000 482,400
59 P. Mulyono 3 509,200 35,000 10,000 554,200
60 B. Herlina 3 594,000 35,000 10,000 639,000
61 B. Takmeeta 2 540,000 35,000 10,000 585,000
62 30-Nov-20 P. Umansyah 3 0 5,000 0 5,000
63 P. Iskabat 3 302,400 15,000 10,000 327,400
Total 24,671,600 1,265,000 600,000 26,536,600
 TARIF MAKAN PASIEN UMUM RUANG MELATI
Bulan : November 2020
No Tgl KRS Nama Kelas Makan Asnut Konsul Total
1 1-Nov-20 P. Sutrisno 3 47,000 5,000 0 52,000
2 2-Nov-09 P. Piarno 3 209,000 5,000 10,000 224,000
3 B. Sutilah 3 131,200 5,000 10,000 146,200
4 6-Nov-20 B. Srikah 3 583,400 35,000 10,000 628,400
5 7-Nov-20 P. Wahyu 3 218,700 15,000 10,000 243,700
6 9-Nov-20 B. Karmini 3 325,800 15,000 10,000 350,800
7 Sdr. Wisnu 3 151,200 5,000 10,000 166,200
8 B. Srifuah 3 54,000 5,000 0 59,000
9 10-Nov-20 B. Siti Khoiriyah 3 347,600 20,000 10,000 377,600
10 11-Nov-20 B. Suti 3 151,200 10,000 10,000 171,200
11 13-Nov-20 B. Tri purnami 3 127,200 10,000 10,000 147,200
12 B. Sri bidayati 3 27,000 5,000 0 32,000
13 14-Nov-20 B. Evi 3 231,200 15,000 10,000 256,200
14 16-Nov-20 P. Cuk 3 282,400 15,000 10,000 307,400
15 17-Nov-20 B. Anis 1 661,900 40,000 10,000 711,900
16 B. Ginah 3 517,600 30,000 10,000 557,600
17 20-Nov-20 P. Wage 3 349,200 25,000 10,000 384,200
18 21-Nov-20 B. Himatul 2 181,600 10,000 10,000 201,600
19 By. Himatul 2 0 5,000 0 5,000
20 P. Sudarmono 2 115,600 5,000 10,000 130,600
21 22-Nov-20 P. Harmadi 3 378,000 20,000 10,000 408,000
Total 5,090,800 300,000 170,000 5,560,800
 TARIF MAKAN PASIEN JAMKESDA RUANG MELATI
Bulan : November 2020
No Tgl KRS Nama Kelas Makan Asnut Konsul Total
1 6-Nov-20 P. Sugiono 3 366,000 15,000 10,000 391,000
2 16-Nov-20 P. Tri 3 322,400 20,000 10,000 352,400
Total 688,400 35,000 20,000 743,400
 TARIF MAKAN PASIEN KEMENKES RUANG MELATI
Bulan : November 2020
No Tgl KRS Nama Kelas Makan Asnut Konsul Total
1 7-Nov-20 P. Agus 1 277,500 15,000 10,000 302,500
2 B. Erma 1 277,500 15,000 10,000 302,500
3 17-Nov-20 P. Erwan 1 304,700 10,000 10,000 324,700
4 27-Nov-20 B. Siti Rokayah 2 80,800 5,000 10,000 95,800
5 28-Nov-20 P. Ahmad 2 54,000 5,000 0 59,000
6 P. Made 2 216,000 10,000 10,000 236,000
7 P. Anggoro 2 135,200 5,000 10,000 150,200
8 29-Nov-20 B. Yayuk 2 40,000 5,000 0 45,000
9 30-Nov-20 P. Ali Pahad ali 2 151,200 5,000 10,000 166,200
Total 1,536,900 75,000 70,000 1,681,900
 TARIF MAKAN PASIEN DINKES RUANG MELATI
Bulan : November 2020
No Tgl KRS Nama Kelas Makan Asnut Konsul Total
1 4-Nov-20 By. Yuni 1 0 5,000 0 5,000
2 B. Yuni 1 185,000 10,000 10,000 205,000
3 5-Nov-20 P. Roza 1 218,000 15,000 10,000 243,000
4 9-Nov-20 P. Adi 1 150,900 10,000 10,000 170,900
5 10-Nov-20 P. Yoyok 1 185,000 5,000 10,000 200,000
6 14-Nov-20 B. Lia 1 185,000 10,000 10,000 205,000
7 17-Nov-20 P. Somo 1 277,500 15,000 10,000 302,500
8 21-Nov-20 P. Miftakhul 2 132,800 10,000 10,000 152,800
9 25-Nov-20 B. Harmini 2 55,600 5,000 10,000 70,600
10 27-Nov-20 P. Badi 2 109,800 5,000 10,000 124,800
11 28-Nov-20 P. Samingan 2 106,400 5,000 10,000 121,400
12 29-Nov-20 P. Panidi 2 216,000 10,000 10,000 236,000
Total 1,822,000 105,000 110,000 2,037,000
 LAPORAN STATUS GIZI PASIEN LAPORAN KONSULTASI GIZI
Bulan : November 2020 Bulan : November 2020
Ruang :Melati Ruang :Melati
Jumlah Status Gizi UMUM BPJS SPM KEMENKES
Tgl No JENIS DIET JUMLAH
Pasien Buruk Kurang Normal Lebih Obesitas 1 2 3 1 2 3 3 1
1 6 1 Alergi 0
2 4 2 Batu Ginjal 0
3 5 3 CVA 0
4 2 4 Diabetes Mellitus 0
5 2 5 Dislipidemia 0
6 5 6 GGK Dialisa 0
7 2 7 Gizi Lansia 0
8 5 8 Hati 0
9 2 9 Hiperemesis 0
10 5 10 Jantung 0
11 2 11 Makanan Balita 0
12 3 12 Makanan Bayi 0
13 6 13 Makanan Ibu Hamil 0
14 4 14 Makanan Ibu Menyusui 0
15 2 15 Makanan Lewat Pipa 0
16 3 16 Motivasi Gizi 0
17 0 17 Lambung 0
18 4 18 Pasca Bedah 0
19 5 19 Rendah Garam 0
20 1 20 Rendah Kalori 0
21 9 21 Rendah Kolesterol 0
22 2 22 Rendah Lemak 0
23 3 23 Rendah Protein 0
24 4 24 Rendah Purin 0
25 7 25 Rendah Serat 0
26 1 26 Rendah Sisa 0
27 4 27 Rendah Trigliserida 0
28 4 28 TETP 0
29 3 29 0
30 4 30
31 4 31
å 113 0 0 0 0 0 32
% 0 0 0 0 0 Jumlah 0 0 0 0 0 0 0 0 0
 LAPORAN SISA MAKAN PASIEN

Bulan : November 2020 Bentuk Makanan : Nasi

Ruang :Melati

No Nama Pasien Intake ( %) Waste (%)

1 P. Solikin 100 0
2 B.Mery 100 0
3 P. Lukmanul 100 0
4 P. Andi 100 0
5 B. Suti 25 75
6 B. Reni 100 0
7 P. Ahm Daerobi 100 0
8 B. Ana 100 0
9 P. Alen 75 25
10 P. Sugeng 100 0
11 B. Desi 50 50

2 100 0
å 1050 150
% 90.625 9.375