Irna Mei 2012

Rekap Pendapatan Rawat Inap
Mei 2012
4/26/2012
Dokter Obgyn
No. Nama Pasien Tindakan Admin JS
Ratna
1 Yunaroh, Ny 20,000 5,000 50,000

Kelas VIP 2 hari 8,000 500,000
hbs ag
golongan darah
hematologi rutin
usg 30,000 80,000
visite 10,000 120,000
28,000 545,000 250,000
2 Ahmad Yaser Arafat, An 25,000 5,000

Kelas 2 1 hari 2,000 80,000
Kelas VIP 7 hari 28,000 1,750,000
hematologi rutin
golongan darah
konsultasi 5,000
visite 35,000
sgpt
sgot
hematologi lengkap
ureum
kreatinin
glukosa sewaktu
trombosit
55,000 1,875,000 -
3 Waryu, Ny 20,000 5,000 50,000

Kelas 2 4 hari 8,000 320,000
ecg 46,500
thorax
kreatinin
ureum
sgpt
sgot
glukosa sewaktu
golongan darah
hematologi rutin
konsultasi 5,000
biaya PA
salpingoofarektomi bilateral 1,350,000 1,350,000
visite 20,000 160,000
28,000 1,746,500 1,560,000
4 Makmuroh, Ny 25,000
Kelas 3 2 hari 2,000 112,000
usg 15,000 40,000
hbs ag
golongan darah
hematologi rutin
visite 10,000 60,000
per vaginum 600,000 525,000
27,000 737,000 625,000
5 Makmuroh, By 15,000
Kelas 3 2 hari 2,000 112,000
visite 5,000
resusitasi 46,500
17,000 163,500 -
6 Tri Yuniati, Nn 25,000 5,000

Kelas 3 2 hari 2,000 112,000
widal
hematologi rutin
visite 5,000
konsultasi 5,000
27,000 127,000 -
7 Suslikha, Ny 20,000 5,000 50,000

Kelas 3 2 hari 2,000 112,000
hbs ag
hematologi rutin
golongan darah
kuretase dengan narkose 250,000 450,000
visite 10,000 60,000
usg 15,000 40,000
22,000 392,000 600,000
8 Risnawati, Ny 20,000 5,000

Kelas 3 4 hari 4,000 224,000
widal
glukosa sewaktu
hematologi rutin
visite 10,000
konsultasi 5,000
24,000 244,000 -
9 Siti Afiatun Nafiah, Ny

Kelas 3 3 hari 3,000 168,000
sectio caesaria 1,000,000 900,000
resusitasi
visite 30,000 90,000
paket sc
diluar paket sc
3,000 1,198,000 990,000
231,000 7,028,000 4,025,000

Dokter Obgyn Dokter Anak Dokter Bedah Dokter Internis
Herlambang Zufrial Arif Bambang S Chanis Fajar Zumaro Willy Eko Djalu Iman Darjito
- - - - - - - - -
30,000
120,000 300,000
- - - 120,000 330,000 - - - -
- - - - - - - - -
- - - - - - - - -
30,000
- - 30,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
80,000
90,000
- - 170,000 - - - - - -
- - 200,000 120,000 330,000 - - - -

Dokter Internis Dokter Gigi Dokter Syaraf Anestesi Orthopedi Psiko Rad
Maretina Dian W Sangkan Fachri Uzer Anton Soemartono Arif Wahyu Dana Alip
- - - - - - - - - -
- - - - - - - - - -
20,000
- - - - - 20,000 - - - -
- - - - - - - - - -
- - - - - - - - - -
30,000
15,000
45,000 - - - - - - - - -
- - - - - - - - - -
60,000
15,000
75,000 - - - - - - - - -
- - - - - - - - - -
120,000 - - - - 20,000 - - - -
Dokter Umum
Anestesi
Djalil Boeing Nurbaity Teguh I Made Kholid Windy Dewi Aros
- - - - - - - - - -
25,000
- 25,000 - - - - - - - -
405,000
- - - - - - - - - 405,000
- - - - - - - - - -
- - - - - - - - - -
25,000
- - - - - 25,000 - - - -
- - - - - - - - - -
25,000
- 25,000 - - - - - - - -
250,000
- - - - - - - - - 250,000
- 50,000 - - - 25,000 - - - 655,000

Askep
Ass. Oprt Ass. Anestesi BAHP Farmasi Laborat Radiologi
Ruangan Ratna Gugah
768,387
36,000
54,000
12,000
38,400
- - - 768,387 104,400 - 36,000 - -
1,636,093
12,000
126,000
265,600
12,000
43,200
43,200
72,000
21,600
21,600
16,800
12,000
- - - 1,636,093 508,000 - 138,000 - -
1,845,941
48,000
69,000
20,700
20,700
20,700
20,700
16,100
11,500
72,000
120,000
270,000 135,000
270,000 135,000 - 1,845,941 302,400 69,000 48,000 - -
344,115
18,000
49,500
11,000
35,200
275,312
- - 275,312 344,115 95,700 - 18,000 - -
94,331
18,000
- - - 94,331 - - 18,000 - -
330,016
18,000
33,000
35,200
- - - 330,016 68,200 - 18,000 - -
101,250 349,218
18,000
49,500
35,200
11,000
75,000
- 101,250 75,000 349,218 95,700 - 18,000 - -
1,104,105
36,000
33,000
15,400
35,200
- - - 1,104,105 83,600 - 36,000 - -

27,000
125,000 75,000
1,000,000 99,000
162,465
125,000 75,000 - 1,162,465 99,000 - 27,000 - -
395,000 311,250 350,312 7,634,671 1,357,000 69,000 357,000 - -

Arif Afit Suhati Wiwik Indra Eko P Andini Roikhatul Dewi Candra Koticha
- - - - - - - - - - -
- - - - - - - - - - -
13,500
- - 13,500 - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - 13,500 - - - - - - - -
Diet
Aisah Ana Eny Endang Pipit Suci Dinda Tika Retno Wulan Rawat Inap
90,000
- - - - - - - - - - 90,000
30,000
315,000
- - - - - - - - - - 345,000
120,000
- - - - - - - - - - 120,000
42,000
- - - - - - - - - - 42,000
42,000
13,500
- - - - 13,500 - - - - - 42,000
42,000
- - - - - - - - - - 42,000
42,000
- - - - - - - - - - 42,000
84,000
- - - - - - - - - - 84,000
63,000
- - - - - - - - - - 63,000
- - - - 13,500 - - - - - 870,000
Diet Ambulance
Rujukan Lain-Lain Total Keringanan DP
Ekstra BBM Sopir Jamsostek
33,000 876,387
634,000 (263,752)
54,000
12,000
38,400
110,000
130,000
33,000 - - - - 1,854,787 (263,752) - -
45,000 1,736,093
124,000
2,219,000 (332,850)
265,600
12,000
35,000
455,000
43,200
43,200
72,000
21,600
21,600
16,800
12,000
45,000 - - - - 5,077,093 (332,850) - -
1,920,941
496,000
60,000
69,000
20,700
20,700
20,700
20,700
16,100
11,500
72,000
25,000
120,000
3,510,000
180,000
- - - - - 6,563,341 - - -
369,115
174,000
55,000
49,500
11,000
35,200
70,000
1,400,312
- - - - - 2,164,127 - - -
109,331
174,000 (174,000)
35,000
60,000
- - - - - 378,331 (174,000) - -
385,016
174,000
33,000
35,200
35,000
20,000
- - - - - 682,216 - - -
525,468
174,000
49,500
35,200
11,000
775,000
70,000
55,000
- - - - - 1,695,168 - - -
1,154,105 (25,000) 1,443,745

348,000
33,000
15,400
35,200
70,000
20,000
- - - - - 1,675,705 (25,000) - 1,443,745
-
261,000
2,350,000
80,000
210,000
1,099,000
162,465
- - - - - 4,162,465 - - -
78,000 - - - - 24,253,233 (795,602) - 1,443,745

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Piutang
Garda Medika Jamkesmas Jasa Raharja Relife Bringin Pos Indonesia
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
876,387
370,248
54,000
12,000
38,400
110,000
130,000
- - 1,591,035
1,736,093
124,000
1,886,150
265,600
12,000
35,000
455,000
43,200
43,200
72,000
21,600
21,600
16,800
12,000
- - 4,744,243
1,920,941
496,000
60,000
69,000
20,700
20,700
20,700
20,700
16,100
11,500
72,000
25,000
120,000
3,510,000
180,000
- - 6,563,341
369,115
174,000
55,000
49,500
11,000
35,200
70,000
1,400,312
- - 2,164,127
109,331
-
35,000
60,000
- - 204,331
385,016
174,000
33,000
35,200
35,000
20,000
- - 682,216
525,468
174,000
49,500
35,200
11,000
775,000
70,000
55,000
- - 1,695,168
(314,640)
348,000
33,000
15,400
35,200
70,000
20,000
- - 206,960
-
261,000
2,350,000
80,000
210,000
1,099,000
162,465
- - 4,162,465
- - 22,013,886
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Mei 2012
4/27/2012
Dokter Obgyn
Ratna
1 Andang Susiyanti, Ny 20,000 5,000 50,000

Kelas 3 3 hari 3,000 168,000
pemeriksaan ginekologi 34,000 8,500
glukosa sewaktu
ecg 30,750
biaya PA
hbs ag
urine lengkap
ureum
rkeatinin
sgpt
sgot
hematologi rutin
golongan darah
marsupialisasi ranula 900,000 675,000
visite 15,000 90,000
23,000 1,152,750 823,500
23,000 1,152,750 823,500

- - - - - - - - -
- - - - - - - - -
Dokter Internis Dokter Gigi Dokter Syaraf Anestesi Orthoped Psiko Rad
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
202,500
- - - - - - - - - 202,500
- - - - - - - - - 202,500
Askep
Ruangan Ratna Gugah
1,017,916
27,000
15,400
120,000
49,500
27,500
19,800
19,800
19,800
19,800
70,400
11,000
135,000 67,500
47,250
23,625
205,875 67,500 - 1,017,916 373,000 - 27,000 - -
205,875 67,500 - 1,017,916 373,000 - 27,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
Diet
63,000
6,750
- 6,750 - - - - - - - - 63,000
- 6,750 - - - - - - - - 63,000
Diet Ambulance
1,092,916
261,000
42,500
15,400
37,500
120,000
49,500
27,500
19,800
19,800
19,800
19,800
70,400
11,000
1,980,000
152,250
- - - - - 3,939,166 - - -
(47,250)
- - - - - 3,939,166 - - -
Piutang
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
1,092,916
261,000
42,500
15,400
37,500
120,000
49,500
27,500
19,800
19,800
19,800
19,800
70,400
11,000
1,980,000
152,250
- - 3,939,166
- - 3,939,166
Mei 2012
4/28/2012
Dokter Obgyn
Ratna
1 Eti Supriyanti, Ny 25,000 5,000

Kelas 1 14 hari 42,000 2,044,000
hbs ag
ureum
kreatinin
sgpt
sgot
glukosa sewaktu
waktu perdarahan
waktu pembekuan
hematologi rutin
golongan darah
biaya PA
pemasangan katether 78,000
hysterectomy total 1,350,000 2,025,000
kistektomy 900,000 675,000
konsultasi 10,000
visite 130,000 650,000
ecg 46,500
usg 45,000 80,000
glukosa puasa
glukosa 2 jam pp
67,000 4,672,500 3,446,000
2 Suciyati, Ny 25,000
Kelas 2 1 hari 2,000 80,000
visite 5,000 40,000
27,000 335,000 640,000
3 Abid Aqila Andi Pranaja, By 25,000 5,000

Kelas 2 5 hari 10,000 400,000
billirubin total
billirubin direct-indirect
infant warmer 200,000
konsultasi 5,000
visite 20,000
35,000 630,000 -
4 Prihatiningsih, Ny 20,000 5,000 50,000
Kelas 3 2 hari 2,000 112,000
hematologi rutin
laserasi jalan lahir 45,000 135,000
per vaginum 600,000 525,000
visite 10,000 60,000
hbs ag
golongan darah
22,000 772,000 770,000
5 Prihatiningsih, By 25,000
Kelas 3 1 hari 1,000 56,000
visite 5,000
resusitasi 46,500
26,000 107,500 -
6 Kusniroh, Ny 20,000 5,000 50,000

Kelas 3 2 hari 2,000 112,000
extirpasi tumor 450,000
biaya PA
visite 15,000 60,000
konsultasi 5,000
hbs ag
hematologi rutin
golongan darah
22,000 633,500 110,000
199,000 7,150,500 4,966,000

100,000
40,000
140,000 - - - - - - - -
- - - - - - - - -
20,000
160,000
- - 180,000 - - - - - -
- - - - - - - - -
30,000
- - 30,000 - - - - - -
337,500
30,000
15,000
- - - - - - 382,500 - -
140,000 - 210,000 - - - 382,500 - -

50,000
500,000 50,000
550,000 - - - - - 50,000 - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
550,000 - - - - - 50,000 - - -
Dokter Umum
Anestesi
25,000
607,500
202,500
- - - - - - - 25,000 - 810,000
- - - - - - - - - -
25,000
- - - - 25,000 - - - - -
- - - - - - - - - -
- - - - - - - - - -
101,250
- - - - - - - - - 101,250
- - - - 25,000 - - 25,000 - 911,250

Askep
Ruangan Ratna Gugah
4,987,628
210,000
51,750
20,700
20,700
20,700
20,700
64,400
9,200
9,200
147,200
11,500
240,000
405,000 202,500
135,000 67,500
32,200
32,200
540,000 270,000 - 4,987,628 680,450 - 210,000 - -
90,000 345,221
12,000
300,000
- 90,000 300,000 345,221 - - 12,000 - -
612,891
60,000
39,600
79,200
- - - 612,891 118,800 - 60,000 - -

272,730
18,000
70,400
275,312
49,500
11,000
- - 275,312 272,730 130,900 - 18,000 - -
104,621
9,000
- - - 104,621 - - 9,000 - -
67,500 1,130,161
18,000
67,500 33,750
120,000
49,500
35,200
11,000
67,500 101,250 - 1,130,161 215,700 - 18,000 - -
607,500 461,250 575,312 7,453,252 1,145,850 - 327,000 - -

27,000
13,500
- - - - - 27,000 - 13,500 - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - 27,000 - 13,500 - - -
Diet
504,000
- - - - - - - - - - 504,000
30,000
- - - - - - - - - - 30,000
150,000
50,000 50,000
- - - - - - - 50,000 50,000 - 150,000

- - - - - - - - - - -
21,000
13,500
- - - - 13,500 - - - - - 21,000
42,000
13,500
- - - - - - 13,500 - - - 42,000
- - - - 13,500 - 13,500 50,000 50,000 - 747,000

Diet Ambulance
5,042,628
2,800,000
51,750
20,700
20,700
20,700
20,700
64,400
9,200
9,200
147,200
11,500
240,000
105,000
4,590,000
1,980,000
80,000
60,000
1,430,000
60,000
165,000
32,200
32,200
- - - - - 16,993,078 - - -
460,221
124,000
1,150,000
45,000
- - - - - 1,779,221 - - -
667,891 (25,000) 1,500,536

620,000
39,600
79,200
300,000
25,000
180,000
- - - - - 1,911,691 (25,000) - 1,500,536

347,730
42,000 174,000
70,400
180,000
1,400,312
70,000
49,500
11,000
42,000 - - - - 2,302,942 - - -
129,621 (10,000)
87,000 (87,000)
35,000
60,000
- - - - - 311,621 (97,000) - -
1,272,661
174,000
990,000
60,000
120,000
105,000
20,000
49,500
35,200
11,000
- - - - - 2,837,361 - - -
42,000 - - - - 26,135,914 (122,000) - 1,500,536

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Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
3,993,078 1,049,550
2,800,000
51,750
20,700
20,700
20,700
20,700
64,400
9,200
9,200
147,200
11,500
240,000
105,000
4,590,000
1,980,000
80,000
60,000
1,430,000
60,000
165,000
32,200
32,200
- 3,993,078 13,000,000
460,221
124,000
1,150,000
45,000
- - 1,779,221
(857,645)
620,000
39,600
79,200
300,000
25,000
180,000
- - 386,155
347,730
174,000
70,400
180,000
1,400,312
70,000
49,500
11,000
- - 2,302,942
119,621
-
35,000
60,000
- - 214,621
1,272,661
174,000
990,000
60,000
120,000
105,000
20,000
49,500
35,200
11,000
- - 2,837,361
- 3,993,078 20,520,300
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Mei 2012
4/29/2012
Dokter Obgyn
Ratna
1 Eti Supriyanti, Ny Pelunasan
- - -
2 Erlina, Ny 25,000 5,000

Kelas 2 2 hari 4,000 160,000
visite 10,000
konsultasi 5,000
widal
hematologi rutin
29,000 180,000 -
3 Nur Faridah, By 15,000

Kelas 3 4 hari 4,000 224,000
visite 20,000
resusitasi 30,000
19,000 274,000 -
4 Nur Faridah, Ny 25,000

Kelas 3 4 hari 4,000 224,000
hbs ag
golongan darah
hematologi rutin
visite 20,000 120,000
29,000 1,544,000 963,750
5 Chika Maslikhatun, Ny 25,000

Kelas 3 2 hari 2,000 112,000
hbs ag
hematologi rutin
golongan darah
per vaginum 600,000 525,000
visite 10,000 60,000
27,000 767,000 720,000
6 Cika Maslikhatun, By 15,000

Kelas 3 2 hari 2,000 112,000
visite 5,000
resusitasi 46,500
17,000 163,500 -
7 Nok Aeni, Ny 20,000 5,000 50,000

Kelas 3 3 hari 3,000 168,000
visite 15,000 90,000
widal
hbs ag
hematologi rutin
golongan darah
23,000 188,000 140,000
144,000 3,116,500 1,823,750

- - - - - - - - -
- - - - - - - - -
90,000
90,000
- - 180,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - 180,000 - - - - - -
- - - - - - - - - -
40,000
20,000
60,000 - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
60,000 - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
25,000
20,000
- - - - - - - - 45,000 -
15,000
- - 15,000 - - - - - - -
253,125
- - - - - - - - - 253,125
- - - - - - - - - -
15,000
- - 15,000 - - - - - - -
- - - - - - - - - -
- - 30,000 - - - - - 45,000 253,125

Askep
Ruangan Ratna Gugah
- - - - - - - - -
956,622
24,000
33,000
35,200
- - - 956,622 68,200 - 24,000 - -
168,847
36,000
- - - 168,847 - - 36,000 - -
1,445,429
36,000
168,750 84,375 180,000
49,500
11,000
70,400
168,750 84,375 180,000 1,445,429 130,900 - 36,000 - -
390,913
18,000
49,500
70,400
11,000
275,312
- - 275,312 390,913 130,900 - 18,000 - -
42,598
18,000
- - - 42,598 - - 18,000 - -
360,009
27,000
33,000
49,500
35,200
11,000
- - - 360,009 128,700 - 27,000 - -
168,750 84,375 455,312 3,364,418 458,700 - 159,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
- - - - - - - - - - -
60,000
- - - - - - - - - - 60,000
84,000
- - - - - - - - - - 84,000
84,000
- - - - - - - - - - 84,000
42,000
- - - - - - - - - - 42,000
42,000
13,500
- - - - - - - - - 13,500 42,000
63,000
- - - - - - - - - - 63,000
- - - - - - - - - 13,500 375,000
Diet Ambulance
- - - - - - - - -
1,011,622
248,000
70,000
25,000
33,000
35,200
- - - - - 1,422,822 - - -
183,847
348,000 (348,000)
125,000
120,000
- - - - - 776,847 (348,000) - -
1,470,429
348,000
2,830,000
49,500
11,000
70,400
140,000
- - - - - 4,919,329 - - -
415,913
174,000
49,500
70,400
11,000
180,000
1,400,312
70,000
- - - - - 2,371,125 - - -
57,598
174,000 (174,000)
20,000
60,000
- - - - - 311,598 (174,000) - -
435,009 (25,000) 879,709

261,000
105,000
33,000
49,500
35,200
11,000
- - - - - 929,709 (25,000) - 879,709
- - - - - 10,731,430 (547,000) - 879,709

-
-
-
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-
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-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
(3,993,079) 3,993,079
- (3,993,079) 3,993,079
1,011,622
248,000
70,000
822,822 (797,822)
33,000
35,200
- 822,822 600,000
183,847
-
125,000
120,000
- - 428,847
1,470,429
348,000
2,830,000
49,500
11,000
70,400
140,000
- - 4,919,329
415,913
174,000
49,500
70,400
11,000
180,000
1,400,312
70,000
- - 2,371,125
57,598
-
20,000
60,000
- - 137,598
(469,700)
261,000
105,000
33,000
49,500
35,200
11,000
- - 25,000
- (3,170,257) 12,474,978
-
-
-
-
-
-
-
-
-
-
-
-
-
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-
-
-
-
-
-
-
Mei 2012
4/30/2012
Dokter Obgyn
Ratna
1 Sumiyati, Ny 25,000
usg 15,000 40,000
per vaginum 600,000 1,050,000
visite 10,000 100,000
33,000 1,170,000 1,460,000
2 Sumiyati, By 15,000
visite 10,000
resusitasi 78,000
23,000 588,000 -
3 Shanty Mulyanti, Ny 25,000

per vaginum 600,000 700,000
visite 10,000 100,000
33,000 1,155,000 1,070,000
4 Shanty Mulyanti, By 15,000

visite 5,000
resusitasi 78,000
23,000 583,000 -
5 Rina Purwanti, By 15,000

Kelas 1 4 hari 12,000 584,000
visite 20,000
resusitasi 30,000
27,000 634,000 -
6 Rina Purwanti, Ny 25,000

Kelas 1 4 hari 12,000 584,000
urine lengkap
hematologi rutin
hbs ag
golongan darah
sectio caesaria 1,300,000 1,687,500
usg 15,000 40,000
visite 20,000 200,000
37,000 1,997,000 1,927,500
7 Dian Noverina, Ny 25,000

Kelas 1 3 hari 9,000 438,000
usg 30,000 80,000
visite 15,000 150,000
hematologi rutin
34,000 483,000 230,000
8 Waryu, Ny 20,000 5,000

Kelas 2 4 hari 8,000 320,000
visite 25,000 160,000
widal
hematologi rutin
28,000 350,000 160,000
9 Istiqomah, By 15,000
Kelas 3 3 hari 3,000 168,000
visite 15,000
resusitasi 93,000
18,000 276,000 -
10 M. Sunarto, Tn 15,000
Kelas 3 1 hari 1,000 56,000
16,000 56,000 -
11 Sutrisno, Tn. 25,000 5,000

Kelas 3 1 hari 1,000 56,000
ambulance
keratinin
ureum
glukosa sewaktu
hematologi rutin
visite 5,000
26,000 66,000 -
12 Istiqomah, Ny 25,000
Kelas 3 3 hari 3,000 168,000
hbs ag
protein urine
ureum
kreatinin
sgpt
sgot
hematologi rutin
golongan darah
visite 15,000 90,000
28,000 1,483,000 933,750
326,000 8,841,000 5,781,250

- - - - - - - - -
50,000
- - 50,000 - - - - - -
- - - - - - - - -
50,000
- - 50,000 - - - - - -
150,000
180,000
- - 330,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
60,000
- - 60,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - 490,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
40,000
40,000 - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
30,000
30,000 - - - - - - - - -
- - - - - - - - - -
70,000 - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
25,000
- - - - - - - - 25,000 -
- - - - - - - - - -
- - - - - - - - - -
25,000
- - - - - - - - 25,000 -
506,250
- - - - - - - - - 506,250
- - - - - - - - - -
25,000
- 25,000 - - - - - - - -
15,000
- - 15,000 - - - - - - -
- - - - - - - - - -
25,000
25,000 - - - - - - - - -
253,125
- - - - - - - - - 253,125
25,000 25,000 15,000 - - - - - 50,000 759,375

Askep
Ruangan Ratna Gugah
353,883
36,000
608,125
- - 608,125 353,883 - - 36,000 - -
211,868
36,000
- - - 211,868 - - 36,000 - -
334,401
36,000
411,250
- - 411,250 334,401 - - 36,000 - -
208,432
36,000
- - - 208,432 - - 36,000 - -
48,825
60,000
- - - 48,825 - - 60,000 - -
2,426,770
60,000
28,750
73,600
51,750
11,500
337,500 168,750 180,000
337,500 168,750 180,000 2,426,770 165,600 - 60,000 - -
970,918
45,000
36,800
- - - 970,918 36,800 - 45,000 - -
1,176,845
48,000
33,000
35,200
- - - 1,176,845 68,200 - 48,000 - -
42,441
27,000
- - - 42,441 - - 27,000 - -
9,000
- - - - - - 9,000 - -
227,381
9,000
19,800
19,800
15,400
35,200
- - - 227,381 90,200 - 9,000 - -
1,608,390
27,000
49,500
4,400
19,800
19,800
19,800
19,800
35,200
11,000
168,750 84,375 180,000
168,750 84,375 180,000 1,608,390 179,300 - 27,000 - -
506,250 253,125 ### 7,610,154 540,100 - 429,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
90,000
- - - - - - - - - - 90,000
90,000
27,000
- - - - - - - - 27,000 - 90,000
90,000
- - - - - - - - - - 90,000
90,000
27,000
- - - - - - - - 27,000 - 90,000
144,000
- - - - - - - - - - 144,000
144,000
27,000
- - - - - - - 27,000 - - 144,000
108,000
- - - - - - - - - - 108,000
120,000
- - - - - - - - - - 120,000
63,000
27,000
- - 27,000 - - - - - - - 63,000
21,000
- - - - - - - - - - 21,000
21,000
- - - - - - - - - - 21,000
63,000
- - - - - - - - - - 63,000
- - 27,000 - - - - 27,000 54,000 - 1,044,000

Diet Ambulance
11,000 389,883
634,000 (234,000)
55,000
315,000
2,258,125
110,000
11,000 - - - - 3,762,008 (234,000) - -
226,868
634,000 (634,000)
85,000
105,000
- - - - - 1,050,868 (634,000) - -
11,000 370,401
634,000 (234,000)
315,000
1,711,250
110,000
11,000 - - - - 3,140,651 (234,000) - -
223,432
634,000 (634,000)
55,000
105,000
- - - - - 1,017,432 (634,000) - -
63,825
800,000 (800,000)
195,000
210,000
- - - - - 1,268,825 (800,000) - -
2,451,770
800,000
28,750
73,600
51,750
11,500
105,000
4,180,000
55,000
220,000
- - - - - 7,977,370 - - -
995,918
600,000
110,000
165,000
36,800 `
- - - - - 1,907,718 - - -
1,226,845
496,000
225,000
33,000
35,200
- - - - - 2,016,045 - - -
57,441
261,000 (261,000)
90,000
120,000
- - - - - 528,441 (261,000) - -
15,000
87,000
- - - - - 102,000 - - -
282,381
87,000
45,000 25,000 70,000
19,800
19,800
15,400
35,200
35,000
- 45,000 25,000 - - 564,581 - - -
1,633,390
261,000
49,500
4,400
19,800
19,800
19,800
19,800
35,200
11,000
2,830,000
105,000
- - - - - 5,008,690 - - -
22,000 45,000 25,000 - - 28,344,629 (2,797,000) - -

-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
389,883
400,000
55,000
315,000
2,258,125
110,000
- - 3,528,008
226,868
-
85,000
105,000
- - 416,868
370,401
400,000
315,000
1,711,250
110,000
- - 2,906,651
223,432
-
55,000
105,000
- - 383,432
63,825
-
195,000
210,000
- - 468,825
2,451,770
800,000
28,750
73,600
51,750
11,500
105,000
4,180,000
55,000
220,000
- - 7,977,370
995,918
600,000
110,000
165,000
36,800
- - 1,907,718
1,226,845
496,000
225,000
33,000
35,200
- - 2,016,045
57,441
-
90,000
120,000
- - 267,441
15,000
87,000
- - 102,000
282,381
87,000
70,000
19,800
19,800
15,400
35,200
35,000
- - 564,581
1,633,390
261,000
49,500
4,400
19,800
19,800
19,800
19,800
35,200
11,000
2,830,000
105,000
- - 5,008,690
- - 25,547,629
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
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Mei 2012
5/1/2012
Dokter Obgyn
Ratna
1 Sudiati, Ny DP pasien
- - -
2 Zaara Hayat Alfia Tushifa, An 25,000 5,000

Kelas 1 8 hari 24,000 1,168,000
widal
hematologi rutin
visite 35,000
49,000 1,208,000 -
3 Nadhifa Rahayu, An 25,000 5,000

Kelas 1 7 hari 21,000 1,022,000
widal
visite 35,000
46,000 1,062,000 -
4 Safzen Yudha Satria, An 20,000 5,000

Kelas 1 5 hari 15,000 730,000
konsultasi 5,000
visite 10,000
widal
hematologi rutin
35,000 750,000 -
5 Khotiah, Ny 25,000
Kelas 3 2 hari 2,000 112,000
per vaginum 600,000 525,000
visite 10,000 60,000
27,000 767,000 720,000
6 Khotiah, By 15,000
Kelas 3 2 hari 2,000 112,000
resusitasi 46,500
visite 5,000
17,000 163,500 -
7 Dwi Mei Indri Astuti, Nn 20,000 5,000 50,000

Kelas 3 2 hari 2,000 112,000
biaya PA
eksisi/konisasi 450,000 540,000
visite 10,000 60,000
22,000 577,000 650,000
8 Fatkhiyah, By 15,000
Kelas 3 4 hari 4,000 224,000
resusitasi 46,500
visite 15,000
19,000 285,500 -
9 Fatkhiyah, Ny 25,000
Kelas 3 4 hari 4,000 224,000
visite 20,000 120,000
per vaginum 600,000 525,000
hbs ag
hematologi rutin
golongan darah
29,000 889,000 780,000
10 Puput Tri Maulida, An 25,000 5,000

Kelas 3 4 hari 4,000 224,000
konsultasi 5,000
visite 20,000
widal
hematologi rutin
29,000 254,000 -
273,000 5,956,000 2,150,000

- - - - - - - - -
300,000
- - 300,000 - - - - - -
300,000
- - 300,000 - - - - - -
25,000
100,000
- - - 125,000 - - - - -
- - - - - - - - -
30,000
- - 30,000 - - - - - -
- - - - - - - - -
60,000
- - 60,000 - - - - - -
- - - - - - - - -
15,000
90,000
- - 105,000 - - - - - -
- - 795,000 125,000 - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
25,000
25,000
- - - - 25,000 - - - 25,000 -
25,000
25,000
- - - - - 25,000 - - 25,000 -
25,000
- 25,000 - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
15,000
- - 15,000 - - - - - - -
- - - - - - - - - -
25,000
15,000
25,000 - 15,000 - - - - - - -
25,000 25,000 30,000 - 25,000 25,000 - - 50,000 -

Askep
Ruangan Ratna Gugah
- - - - - - - - -
2,877,470
120,000
34,500
220,800
- - - 2,877,470 255,300 - 120,000 - -
1,328,763
105,000
34,500
- - - 1,328,763 34,500 - 105,000 - -
636,434
75,000
34,500
36,800
- - - 636,434 71,300 - 75,000 - -
367,624
18,000
275,312
- - 275,312 367,624 - - 18,000 - -
50,256
18,000
- - - 50,256 - - 18,000 - -
67,500 430,628
18,000
120,000
- 67,500 - 430,628 120,000 - 18,000 - -
52,095
36,000
- - - 52,095 - - 36,000 - -
339,729
36,000
275,312
49,500
70,400
11,000
- - 275,312 339,729 130,900 - 36,000 - -
445,521
36,000
33,000
70,400
- - - 445,521 103,400 - 36,000 - -
- 67,500 550,624 6,528,520 715,400 - 462,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Aisah Ana Eny Endang Pipit Suci Dinda Tika Retno Wulan
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
13,500
- - - - 13,500 - - - - -
- - - - - - - - - -
13,500
- - - - - - 13,500 - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - 13,500 - 13,500 - - -
Diet Ambulance
Rawat Inap Ekstra BBM Sopir
- 2,000,000
- - - - - - - - 2,000,000
2,932,470
288,000 1,600,000
34,500
220,800
360,000
288,000 - - - - - 5,147,770 - -
1,383,763
252,000 1,400,000
34,500
360,000
252,000 - - - - - 3,178,263 - -
686,434 (25,000)
180,000 1,000,000
30,000
110,000
34,500
36,800
180,000 - - - - - 1,897,734 (25,000) -
392,624
42,000 174,000
180,000
1,400,312
70,000
42,000 - - - - - 2,216,936 - -
65,256
42,000 174,000 (174,000)
60,000
35,000
42,000 - - - - - 334,256 (174,000) -
573,128
42,000 174,000
120,000
990,000
70,000
42,000 - - - - - 1,927,128 - -
67,095
84,000 348,000 (348,000)
60,000
90,000
84,000 - - - - - 565,095 (348,000) -
364,729
84,000 348,000
140,000
180,000
1,400,312
49,500
70,400
11,000
84,000 - - - - - 2,563,941 - -
500,521
84,000 348,000
20,000
125,000
33,000
70,400
84,000 - - - - - 1,096,921 - -
1,098,000 - - - - - 18,928,044 (547,000) 2,000,000

-
-
-
-
Piutang
Jamsostek Garda Medika Jamkesmas Jasa Raharja Relife Bringin
- - - - - -
- - - - - -
- - - - - -
1,063,659
1,063,659 - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
1,063,659 - - - - -
Jumlah Bayar
Pos Indonesia Asuransi Lain ybs
2,000,000
- - - 2,000,000
2,932,470
1,600,000
34,500
220,800
360,000
- - - 5,147,770
1,383,763
1,400,000
34,500
360,000
- - - 3,178,263
(402,225)
1,000,000
30,000
110,000
34,500
36,800
- - - 809,075
392,624
174,000
180,000
1,400,312
70,000
- - - 2,216,936
65,256
-
60,000
35,000
- - - 160,256
573,128
174,000
120,000
990,000
70,000
- - - 1,927,128
67,095
-
60,000
90,000
- - - 217,095
364,729
348,000
140,000
180,000
1,400,312
49,500
70,400
11,000
- - - 2,563,941
500,521
348,000
20,000
125,000
33,000
70,400
- - - 1,096,921
- - - 19,317,385
-
-
-
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-
Mei 2012
5/2/2012
Dokter Obgyn
Ratna
1 Neva Rahma Zanianti, An 20,000 5,000

Kelas VVIP 4 hari 20,000 1,200,000
widal
golongan darah
hematologi rutin
konsultasi 5,000
visite 15,000
40,000 1,225,000 -
2 Fauzan Resqi Zulfikar, An 25,000 5,000

Kelas VIP 6 hari 24,000 1,500,000
tindakan nebulizer 265,500
fisioterapi dengan alat 60,000
visite 20,000
konsultasi 10,000
laju endap darah
thorax anak
hematologi rutin
49,000 1,860,500 -
3 Tuti Harti, Ny 20,000 5,000 50,000

Kelas 2 2 hari 4,000 160,000
marsupialisasi ranula 450,000 450,000
visite 10,000 80,000
24,000 625,000 580,000
4 Sudiati, Ny 20,000 5,000 50,000

Kelas 2 5 hari 10,000 400,000
visite 25,000 200,000
per vaginum 600,000 700,000
hematologi rutin
hbs ag
golongan darah
30,000 1,280,000 1,550,000
5 Priyatin, Ny 25,000 5,000

Kelas 3 3 hari 3,000 168,000
glukosa sewaktu
widal
hematologi rutin
konsultasi 5,000
visite 15,000
28,000 193,000 -
6 Zulfatun Zakia, By 15,000

Kelas 3 4 hari 4,000 224,000
resusitasi 46,500
visite 15,000
19,000 285,500 -
7 Zulfatun Zakia, Ny 25,000

Kelas 3 4 hari 4,000 224,000
hbs ag
golongan darah
hematologi rutin
per vaginum 600,000 525,000
visite 20,000 120,000
29,000 889,000 780,000
219,000 6,358,000 2,910,000

Dokter Obgyn Dokter Anak Dokter Bedah
Herlambang Zufrial Arif Bambang S Chanis Fajar Zumaro Willy Eko Djalu
35,000
210,000
- - 245,000 - - - - -
240,000
60,000
- - - - 300,000 - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
90,000
- - 90,000 - - - - -
- - - - - - - -
- - 335,000 - 300,000 - - -
Dokter Internis Dokter Gigi Dokter Syaraf Anestesi Orthoped
Iman Darjito Maretina Dian W Sangkan Fachri Uzer Anton Soemartono Arif Wahyu
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
15,000
90,000
- 105,000 - - - - - - -
- - - - - - - - -
- - - - - - - - -
- 105,000 - - - - - - -
Psiko Rad Dokter Umum
Dana Alip Djalil Boeing Nurbaity Teguh I Made Kholid Windy Dewi Aros
25,000
- - - - - - - - - - 25,000
25,000
- - - 25,000 - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
25,000
- - 25,000 - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - 25,000 25,000 - - - - - - 25,000

Askep
Anestesi Ass. Oprt Ass. Anestesi BAHP Farmasi Laborat Radiologi
Ruangan Ratna
1,316,590
84,000
34,500
11,500
116,800
- - - - 1,316,590 162,800 - 84,000 -
2,176,291
108,000
9,600
66,000
38,400
- - - - 2,176,291 48,000 66,000 108,000 -
90,000 452,750
24,000
135,000 90,000 45,000
135,000 90,000 135,000 - 452,750 - - 24,000 -
90,000 712,260
60,000
175,000
35,200
49,500
11,000
- - 90,000 175,000 712,260 95,700 - 60,000 -
369,002
27,000
15,400
33,000
70,400
- - - - 369,002 118,800 - 27,000 -
155,885
36,000
- - - - 155,885 - - 36,000 -
299,967
36,000
49,500
11,000
70,400
275,312
- - - 275,312 299,967 130,900 - 36,000 -
135,000 90,000 225,000 450,312 5,482,745 556,200 66,000 375,000 -

Gugah Arif Afit Suhati Wiwik Indra Eko P Andini Roikhatul Dewi Candra
- - - - - - - - - - -
31,500 63,000
- - - - - 31,500 63,000 - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - 31,500 63,000 - - - -
Koticha Aisah Ana Eny Endang Pipit Suci Dinda Tika Retno Wulan
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
13,500
- - - - - - - 13,500 - - -
- - - - - - - - - - -
- - - - - - - 13,500 - - -
Diet Ambulance
41,000 1,407,590
220,000 1,524,000 (228,600)
34,500
11,500
116,800
40,000
225,000
220,000 41,000 - - - - 3,359,390 (228,600) -
33,000 2,264,291
270,000 1,902,000 (285,300)
360,000
420,000 480,000
260,000
70,000
9,600
66,000
38,400
270,000 33,000 - - - 420,000 5,450,291 (285,300) -
617,750
60,000 248,000
1,170,000
90,000
60,000 - - - - - 2,125,750 - -
877,260 (2,000,000)
150,000 620,000
225,000
850,000 (150,000)
1,475,000
35,200
49,500
11,000
150,000 - - - - - 4,142,960 (150,000) (2,000,000)
424,002 (25,000)
63,000 261,000
15,400
33,000
70,400
20,000
105,000
63,000 - - - - - 928,802 (25,000) -
170,885
84,000 348,000 (348,000)
60,000
105,000
84,000 - - - - - 683,885 (348,000) -
324,967
84,000 348,000
49,500
11,000
70,400
180,000
1,400,312
140,000
84,000 - - - - - 2,524,179 - -
931,000 74,000 - - - 420,000 19,215,257 (1,036,900) (2,000,000)

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-
-
-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
867,802
867,802 - - - - -
- - - - - -
- - - - - -
867,802 - - - - -
Jumlah Bayar
1,407,590
1,295,400
34,500
11,500
116,800
40,000
225,000
- - - 3,130,790
2,264,291
1,616,700
360,000
480,000
260,000
70,000
9,600
66,000
38,400
- - - 5,164,991
617,750
248,000
1,170,000
90,000
- - - 2,125,750
(1,122,740)
620,000
225,000
700,000
1,475,000
35,200
49,500
11,000
- - - 1,992,960
(468,800)
261,000
15,400
33,000
70,400
20,000
105,000
- - - 36,000
170,885
-
60,000
105,000
- - - 335,885
324,967
348,000
49,500
11,000
70,400
180,000
1,400,312
140,000
- - - 2,524,179
- - - 15,310,555
-
-
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-
Mei 2012
5/3/2012
Dokter Obgyn
Ratna
1 Rosmania Rischiyana, Ny 25,000

Kelas 1 3 hari 9,000 438,000
hbs ag
hematoloig rutin
golongan darah
per vaginum 600,000 1,050,000
visite 15,000 150,000
usg 15,000 40,000
34,000 1,113,000 1,375,000
2 Ika Ritno Wanti, Ny 20,000 5,000 50,000

Kelas 2 4 hari 8,000 320,000
hbs ag
hematologi rutin
golongan darah
usg 45,000 120,000
visite 20,000 160,000
28,000 390,000 330,000
3 Erlina, Ny pelunasan
- - -
4 Sodah, Ny 25,000 5,000

Kelas 3 1 hari 1,000 56,000
konsultasi 5,000
visite 5,000
pemasangan katheter 46,500
26,000 117,500 -
5 Mundiroh, Ny 25,000 5,000

Kelas 3 3 hari 3,000 168,000
Kelas 1 4 hari 12,000 584,000
ureum
kreatinin
asam urat
sgpt
sgot
trigliserida
cholesterol
glukosa sewaktu
hematologi rutin
ganti balut 373,500
ecg 30,750
visite 40,000
urine lengkap
konsultasi 5,000
debridement 900,000
40,000 2,152,750 -
128,000 3,773,250 1,705,000

- - - - - - - -
- - - - - - - -
- - - - - - - -
15,000
30,000
- - - - - 45,000 - -
100,000
1,350,000
- - - - - 1,450,000 - -
- - - - - 1,495,000 - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
190,000 50,000
15,000
- 205,000 - - - - - 50,000 -
- 205,000 - - - - - 50,000 -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
25,000
- - - - - - 25,000 - - - -
25,000
- - - 25,000 - - - - - - -
- - - 25,000 - - 25,000 - - - -
Askep
Ruangan Ratna
370,996
45,000
51,750
73,600
11,500
608,125
- - - 608,125 370,996 136,850 - 45,000 -
796,350
48,000
49,500
35,200
11,000
- - - - 796,350 95,700 - 48,000 -
- - - - - - - - -
189,443
9,000
- - - - 189,443 - - 9,000 -
3,529,847
27,000
60,000
20,700
20,700
23,000
20,700
20,700
25,300
20,700
156,800
73,600
27,500
405,000 270,000 135,000
405,000 270,000 135,000 - 3,529,847 409,700 - 87,000 -
405,000 270,000 135,000 608,125 4,886,636 642,250 - 189,000 -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
13,500
- - - - 13,500 - - - - - -
27,000 54,000 27,000
6,750
27,000 6,750 - - - - - 54,000 - - 27,000
27,000 6,750 - - 13,500 - - 54,000 - - 27,000

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
13,500
13,500
- - 27,000 - - - - - - - -
- - 27,000 - - - - - - - -
Diet Ambulance
395,996
108,000 600,000
51,750
73,600
11,500
180,000
2,258,125
165,000
55,000
108,000 - - - - - 3,790,971 - -
871,350
120,000 496,000
49,500
35,200
11,000
165,000
180,000
120,000 - - - - - 1,808,050 - -
- - - - - - - - -
244,443
21,000 87,000
20,000
35,000
60,000
21,000 - - - - - 446,443 - -
3,584,847
63,000 261,000
144,000 800,000
20,700
20,700
23,000
20,700
20,700
25,300
20,700
156,800
73,600
495,000
37,500
60,000
380,000
27,500
20,000
3,060,000
207,000 - - - - - 9,108,047 - -
-
456,000 - - - - - 15,153,511 - -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
395,996
600,000
51,750
73,600
11,500
180,000
2,258,125
165,000
55,000
- - - 3,790,971
871,350
496,000
49,500
35,200
11,000
165,000
180,000
- - - 1,808,050
(822,822) 822,822
- - (822,822) 822,822
244,443
87,000
20,000
35,000
60,000
- - - 446,443
3,584,847
261,000
20,700
20,700
23,000
20,700
20,700
25,300
20,700
156,800
73,600
495,000
37,500
60,000
380,000
27,500
20,000
3,060,000
- - - 8,308,047
- - (822,822) 15,176,333
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Mei 2012
5/4/2012
Dokter Obgyn
Ratna
1 Kosim, Tn 20,000 5,000

Kelas 1 4 hari 12,000 584,000
ecg 42,000
abdomen-bno
thorax
ureum
kreatinin
glukosa sewaktu
hematologi rutin
golongan darah
visite 30,000
konsultasi 5,000
vesicolithotomy (sectio alta) 900,000
32,000 1,635,000 -
2 Hartuti, Ny 20,000 5,000 50,000

Kelas 1 2 hari 6,000 292,000
hbs ag
hematologi rutin
golongand arah
biaya PA
visite 10,000 100,000
26,000 557,000 1,050,000
3 Darmini, By 15,000
Kelas 3 2 hari 2,000 112,000
visite 10,000
resusitasi 46,500
17,000 168,500 -
4 Darmini, Ny 25,000
Kelas 3 2 hari 2,000 112,000
hbs ag
hematologi rutin
golongan darah
per vaginum 600,000 525,000
visite 10,000 60,000
27,000 722,000 585,000
5 Puput Ayu Maulana, Nn 25,000 5,000

Kelas 3 6 hari 6,000 336,000
widal
hematologi ruti
tubex tf/salmonela ig m
31,000 341,000 -
133,000 3,423,500 1,635,000

50,000
18,000
200,000
36,000
1,350,000
- - - - - 1,654,000 - -
- - - - - - - -
60,000
- - - 60,000 - - - -
- - - - - - - -
- - - - - - - -
- - - 60,000 - 1,654,000 - -
75,000
25,000
- 100,000 - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- 100,000 - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
25,000
- - - - 25,000 - - - - - -
- - - - 25,000 - - - - - -
Askep
Ruangan Ratna
2,442,731
60,000
69,000
69,000
20,700
20,700
16,100
36,800
11,500
405,000 270,000 135,000
405,000 270,000 135,000 - 2,442,731 105,800 138,000 60,000 -
135,000 945,341
30,000
51,750
36,800
11,500
120,000
- - 135,000 - 945,341 220,050 - 30,000 -
50,256
18,000
- - - - 50,256 - - 18,000 -
486,066
18,000
49,500
35,200
11,000
275,312
- - - 275,312 486,066 95,700 - 18,000 -
1,438,136
54,000
33,000
105,600
135,000
- - - - 1,438,136 273,600 - 54,000 -
405,000 270,000 270,000 275,312 5,362,530 695,150 138,000 180,000 -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
13,500
- - - - - - - 13,500 - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - 13,500 - - -
Diet Ambulance
2,517,731
144,000 800,000
60,000
69,000
69,000
20,700
20,700
16,100
36,800
11,500
305,000
105,000
30,000
3,060,000
144,000 - - - - - 7,121,531 - -
1,155,341
72,000 400,000
51,750
36,800
11,500
120,000
110,000
1,150,000
72,000 - - - - - 3,035,391 - -
65,256
42,000 174,000 (174,000)
70,000
60,000
42,000 - - - - - 369,256 (174,000) -
511,066
42,000 174,000
49,500
35,200
11,000
1,400,312
70,000
42,000 - - - - - 2,251,078 - -
1,493,136
126,000 522,000
33,000
105,600
135,000
126,000 - - - - - 2,288,736 - -
426,000 - - - - - 15,065,992 (174,000) -

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Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
2,517,731
800,000
60,000
69,000
69,000
20,700
20,700
16,100
36,800
11,500
305,000
105,000
30,000
3,060,000
- - - 7,121,531
1,155,341
400,000
51,750
36,800
11,500
120,000
110,000
1,150,000
- - - 3,035,391
65,256
-
70,000
60,000
- - - 195,256
511,066
174,000
49,500
35,200
11,000
1,400,312
70,000
- - - 2,251,078
1,493,136
522,000
33,000
105,600
135,000
- - - 2,288,736
- - - 14,891,992
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Mei 2012
5/5/2012
Dokter Obgyn
Ratna
1 Riska Nur Aisyah, By 15,000

Kelas 1 4 hari 12,000 584,000
visite 10,000
konsultasi 5,000
resusitasi 78,000
27,000 677,000 -
2 Riska Nur Aisyah, Ny 25,000

Kelas 1 4 hari 12,000 584,000
ambulance
konsultasi 5,000 50,000
hbs ag
golongan darah
hematologi rutin
visite 15,000 150,000
tindakan manual placenta 60,000 360,000
per vaginum 600,000 1,050,000
37,000 1,264,000 1,610,000
3 Nurhayati, Ny
Kelas 3 4 hari 4,000 224,000
resusitasi
visite 30,000 90,000
paket sc
diluar paket sc
4,000 1,259,000 1,020,000
4 Salha Pardiah, Ny
Kelas 3 3 hari 3,000 168,000
resusitasi
visite 25,000 90,000
paket sc
diluar paket sc
usg 15,000 40,000
3,000 1,208,000 1,030,000
71,000 4,408,000 3,660,000

100,000
25,000
- - 25,000 100,000 - - - - -
- - - - - - - - -
80,000
30,000 60,000
- - 110,000 60,000 - - - - -
80,000
60,000
- - 80,000 60,000 - - - - -
- - 215,000 220,000 - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
- - - - - - - - - -
250,000
- - - - - - - - - 250,000
250,000
- - - - - - - - - 250,000
- - - - - - - - - 500,000
Askep
Ruangan Ratna Gugah
338,313
60,000
- - - 338,313 - - 60,000 - -
331,420
60,000
51,750
11,500
36,800
608,125
- - 608,125 331,420 100,050 - 60,000 - -
36,000
125,000 75,000
1,000,000 99,000
226,110
125,000 75,000 - 1,226,110 99,000 - 36,000 - -
27,000
125,000 75,000
1,000,000 99,000
284,852
125,000 75,000 - 1,284,852 99,000 - 27,000 - -
250,000 150,000 608,125 3,180,695 298,050 - 183,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
27,000
- - - - - - - - 27,000 -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - 27,000 -
Diet Ambulance
353,313
144,000 800,000 (800,000)
110,000
30,000
105,000
144,000 - - - - - 1,398,313 (800,000) -
356,420
144,000 800,000
45,000 25,000 70,000
55,000
51,750
11,500
36,800
165,000
420,000
2,258,125
144,000 - 45,000 25,000 - - 4,224,595 - -
-
84,000 348,000
2,350,000
80,000
210,000
35,000
1,099,000
226,110
84,000 - - - - - 4,348,110 - -
-
63,000 261,000
2,350,000
80,000
175,000
1,099,000
284,852
55,000
63,000 - - - - - 4,304,852 - -
435,000 - 45,000 25,000 - - 14,275,870 (800,000) -

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-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Pos Indonesia Afifah ybs
353,313
453,013 (453,013)
110,000
30,000
105,000
- 453,013 - 145,300
356,420
800,000
70,000
55,000
51,750
11,500
36,800
165,000
420,000
4,131,345 (1,873,220)
- 4,131,345 - 93,250
-
348,000
2,350,000
80,000
210,000
35,000
1,099,000
226,110
- - - 4,348,110
-
261,000
2,350,000
80,000
175,000
1,099,000
284,852
55,000
- - - 4,304,852
- 4,584,358 - 8,891,512
-
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Mei 2012
5/6/2012
Dokter Obgyn
Ratna
1 Ike Wahyu Sulistyaningsih, Ny 25,000

Kelas 1 3 hari 9,000 438,000
usg 15,000 40,000
visite 10,000 100,000
per vaginum 600,000 1,050,000
hbs ag
hematologi rutin
golongan darah
34,000 1,113,000 1,375,000
2 Siti Mahwiyah, By 15,000

Kelas 1 4 hari 12,000 584,000
resusitasi 30,000
visite 15,000
27,000 629,000 -
3 Siti Mahwiyah, Ny 25,000

Kelas 1 4 hari 12,000 584,000
hematologi rutin
visite 15,000 150,000
37,000 1,982,000 1,887,500
4 Rosmania Rischiyana, By 25,000

Kelas 1 2 hari 6,000 292,000
visite 5,000
konsultasi 5,000
resusiatsi 78,000
31,000 380,000 -
5 Sudiati, Ny 20,000 5,000 50,000

Kelas 2 2 hari 4,000 160,000
biaya PA
visite 5,000 40,000
24,000 425,000 730,000

6 Sarni, Ny 25,000
Kelas 3 2 hari 2,000 112,000
hbs ag
hematologi rutin
golongan darah
usg 15,000 40,000
visite 5,000 30,000
27,000 387,000 550,000
7 Dariyah, Ny
Kelas 3 3 hari 3,000 168,000
resusitasi
visite 30,000 90,000
paket sc
diluar paket sc
usg 15,000 40,000
3,000 1,213,000 1,030,000
8 Refita Silalahi, Ny 25,000

kelas 3 7 hari 7,000 392,000
widal
hematologi rutin
hbs ag
golongan darah
usg 60,000 160,000
visite 35,000 210,000
32,000 533,500 370,000
9 Sumarni, By 15,000
Kelas 3 1 hari 1,000 56,000
visite 10,000
resusitasi 46,500
16,000 112,500 -
10 Sumarni, Ny 25,000
Kelas 3 2 hari 2,000 112,000
per vaginum 600,000 525,000
visite 5,000 30,000
hbs ag
golongan darah
hematologi rutin
27,000 767,000 720,000

11 Angga Saputra 25,000 5,000
Kelas 3 3 hari 3,000 168,000
visite 15,000
widal
hematologi rutin
28,000 188,000 -
12 Ike Wahyu Sulistianingsih, By 15,000

Kelas 1 2 hari 6,000 292,000
visite 5,000
resusitasi 78,000
21,000 375,000 -
13 Arif Rahman Hakim, AN 20,000 5,000

Kelas 3 5 hari 5,000 280,000
visite 15,000
widal
hematologi rutin
25,000 300,000 -
332,000 8,405,000 6,662,500

- - - - - - - - -
150,000
- - - 150,000 - - - - -
- - - - - - - - -
50,000
25,000
- - 75,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
80,000
30,000 60,000
- - 110,000 60,000 - - - - -
- - - - - - - - -
30,000 30,000
- - 30,000 30,000 - - - - -
- - - - - - - - -
- - - - - - - - -
50,000
- - - 50,000 - - - - -
50,000
90,000
- - 50,000 90,000 - - - - -
- - 265,000 380,000 - - - - -
- - - - - - - - - -
180,000
- - - - - 180,000 - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
90,000
90,000 - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
90,000 - - - - 180,000 - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
- - - - - - - - - -
506,250
- - - - - - - - - 506,250
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
250,000
- - - - - - - - - 250,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
25,000
- - - - - 25,000 - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - 25,000 - - - 756,250
Askep
Ruangan Ratna Gugah
313,214
45,000
280,000
51,750
36,800
11,500
- - 280,000 313,214 100,050 - 45,000 - -
249,882
60,000
- - - 249,882 - - 60,000 - -
2,524,168
60,000
36,800
337,500 168,750 720,000
337,500 168,750 720,000 2,524,168 36,800 - 60,000 - -
165,245
30,000
- - - 165,245 - - 30,000 - -
90,000 418,265
24,000
120,000
- 90,000 - 418,265 120,000 - 24,000 - -

67,500 354,254
18,000
51,750
72,000
11,500
- 67,500 - 354,254 135,250 - 18,000 - -
27,000
125,000 75,000
1,000,000 99,000
271,936
125,000 75,000 - 1,271,936 99,000 - 27,000 - -
1,348,354
63,000
33,000
70,400
49,500
11,000
- - - 1,348,354 163,900 - 63,000 - -
117,165
9,000
- - - 117,165 - - 9,000 - -
342,050
18,000
275,312
49,500
11,000
70,400
- - 275,312 342,050 130,900 - 18,000 - -

1,256,585
27,000
33,000
35,200
- - - 1,256,585 68,200 - 27,000 - -
177,167
30,000
- - - 177,167 - - 30,000 - -
488,393
45,000
33,000
140,800
- - - 488,393 173,800 - 45,000 - -
462,500 401,250 ### 9,026,678 1,027,900 - 456,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
27,000
- - - 27,000 - - - - - -
27,000
- - - - - - - - - 27,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
13,500
- - - - 13,500 - - - - -
13,500
- - - - - - - - - 13,500
- - - - - - - - - -
- - - - - - - - - -
27,000
- - - - - 27,000 - - - -
- - - - - - - - - -
- - - 27,000 13,500 27,000 - - - 40,500

Diet Ambulance
338,214
108,000 600,000
55,000
55,000
110,000
180,000
1,930,000
51,750
36,800
11,500
108,000 - - - - - 3,368,264 - -
264,882
144,000 800,000 (800,000)
210,000
165,000
144,000 - - - - - 1,439,882 (800,000) -
2,549,168
144,000 800,000
55,000
36,800
105,000
165,000
4,720,000
144,000 - - - - - 8,430,968 - -
190,245 (10,000)
72,000 400,000 (400,000)
55,000
30,000
105,000
72,000 - - - - - 780,245 (410,000) -
583,265
60,000 248,000 (150,000)
120,000
850,000
45,000
45,000
60,000 - - - - - 1,891,265 (150,000) -

446,754
42,000 174,000
51,750
72,000
11,500
55,000
35,000
700,000
35,000
42,000 - - - - - 1,581,004 - -
-
63,000 261,000
2,350,000
80,000
210,000
1,099,000
271,936
55,000
63,000 - - - - - 4,326,936 - -
1,373,354
147,000 609,000
33,000
70,400
49,500
11,000
60,000
220,000
245,000
147,000 - - - - - 2,671,254 - -
132,165
21,000 87,000 (87,000)
70,000
60,000
21,000 - - - - - 349,165 (87,000) -
367,050
42,000 174,000
180,000
1,400,312
35,000
35,000
49,500
11,000
70,400
42,000 - - - - - 2,322,262 - -
1,311,585
63,000 261,000
105,000
33,000
35,200
63,000 - - - - - 1,745,785 - -
192,167
72,000 400,000 (400,000)
55,000
105,000
72,000 - - - - - 752,167 (400,000) -
563,393 (25,000)
105,000 435,000
105,000
33,000
140,800
105,000 - - - - - 1,277,193 (25,000) -
1,083,000 - - - - - 30,936,390 (1,872,000) -

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-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
1,200,912
1,200,912 - - - - -
1,200,912 - - - - -
Jumlah Bayar
338,214
600,000
55,000
55,000
110,000
180,000
1,930,000
51,750
36,800
11,500
- - - 3,368,264
264,882
-
210,000
165,000
- - - 639,882
2,549,168
800,000
55,000
36,800
105,000
165,000
4,720,000
- - - 8,430,968
180,245
-
55,000
30,000
105,000
- - - 370,245
583,265
98,000
120,000
850,000
45,000
45,000
- - - 1,741,265
446,754
174,000
51,750
72,000
11,500
55,000
35,000
700,000
35,000
- - - 1,581,004
-
261,000
2,350,000
80,000
210,000
1,099,000
271,936
55,000
- - - 4,326,936
1,373,354
609,000
33,000
70,400
49,500
11,000
60,000
220,000
245,000
- - - 2,671,254
132,165
-
70,000
60,000
- - - 262,165
367,050
174,000
180,000
1,400,312
35,000
35,000
49,500
11,000
70,400
- - - 2,322,262
1,311,585
261,000
105,000
33,000
35,200
- - - 1,745,785
192,167
-
55,000
105,000
- - - 352,167
538,393
(765,912)
105,000
33,000
140,800
- - - 51,281
- - - 27,863,478
-
-
-
-
-
-
-
-
Mei 2012
5/7/2012
Dokter Obgyn
Ratna
1 Nur Asiah, Ny 25,000 5,000

Kelas 1 2 hari 6,000 292,000
usg 15,000 40,000
visite 10,000 100,000
31,000 322,000 140,000
2 Mutoharoh, Ny 20,000 5,000 50,000

Kelas 2 6 hari 12,000 480,000
hematologi rutin
konsultasi 5,000
visite 35,000 240,000
ambulance
usg organ
urine rutin
32,000 525,000 290,000
3 Aldi Romansyah, 20,000 5,000

Kelas 2 3 hari 6,000 240,000
konsultasi 5,000
visite 15,000
laju endap darah
anti tb ig g
thorax
26,000 265,000 -
4 Tantri 25,000 5,000

Kelas 3 4 hari 4,000 224,000
visite 20,000
anti tb ig g
hitung jenis
thorax
laju endap darah
hematologi rutin
widal
29,000 249,000 -
5 Rifki Anugrah Ramadhani, An 25,000 5,000

Kerlas 3 5 hari 5,000 280,000
konsultasi 5,000
visite 25,000
hematologi rutin
widal
30,000 315,000 -
6 Nok Sobiroh, Ny 25,000 5,000

Kelas 3 1 hari 1,000 56,000
ambulance
26,000 61,000 -
7 Poniati, Ny 20,000 5,000 50,000

Kelas 3 3 hari 3,000 168,000
usg 15,000 40,000
visite 15,000 90,000
widal
hbs ag
hematologi rutin
golongan darah
23,000 203,000 180,000
197,000 1,940,000 610,000

- - - - - - - - -
20,000
40,000
- - - - - 60,000 - - -
20,000
120,000
- - - 140,000 - - - - -
60,000 60,000
- - 60,000 60,000 - - - - -
15,000
60,000 90,000
- - 60,000 105,000 - - - - -
- - - - - - - - -
- - - - - - - - -
- - 120,000 305,000 - 60,000 - - -

- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
25,000
- - - - 25,000 - - - - -
- - - - - - - - - -
25,000
- - - - - 25,000 - - - -
25,000
- - - - - - - - 25,000 -
25,000
- - - - 25,000 - - - - -
25,000
- 25,000 - - - - - - - -
- - - - - - - - - -
- 25,000 - - 50,000 25,000 - - 25,000 -

Askep
Ruangan Ratna Gugah
356,302
30,000
- - - 356,302 - - 30,000 - -
685,880
72,000
36,800
400,000
22,000
- - - 685,880 58,800 400,000 72,000 - -
434,100
36,000
8,800
130,000
62,000
- - - 434,100 138,800 62,000 36,000 - -
574,094
36,000
130,000
13,200
66,000
8,800
70,400
33,000
- - - 574,094 255,400 66,000 36,000 - -
748,145
45,000
105,600
33,000
- - - 748,145 138,600 - 45,000 - -
234,996
9,000
- - - 234,996 - - 9,000 - -
653,400
27,000
33,000
49,500
35,200
11,000
- - - 653,400 128,700 - 27,000 - -
- - - 3,686,917 720,300 528,000 255,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Diet Ambulance
411,302
72,000 400,000
55,000
110,000
72,000 - - - - - 976,302 - -
760,880
180,000 744,000
36,800
25,000
315,000
120,000 120,000
400,000
22,000
180,000 - 120,000 - - - 2,423,680 - -
484,100
90,000 372,000
25,000
135,000
8,800
130,000
62,000
90,000 - - - - - 1,216,900 - -
629,094
84,000 348,000
140,000
130,000
13,200
66,000
8,800
70,400
33,000
84,000 - - - - - 1,438,494 - -
803,145 (25,000)
105,000 435,000
20,000
175,000
105,600
33,000
105,000 - - - - - 1,571,745 (25,000) -
289,996 (15,000)
21,000 87,000 (87,000)
60,000 60,000
21,000 - 60,000 - - - 436,996 (102,000) -
728,400
63,000 261,000
55,000
105,000
33,000
49,500
35,200
11,000
63,000 - - - - - 1,278,100 - -
615,000 - 180,000 - - - 9,342,217 (127,000) -

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-
-
-
-
-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
1,438,494
- - 1,438,494 - - -
1,264,114
1,264,114 - - - - -
- - - - - -
- - - - - -
1,264,114 - 1,438,494 - - -
Jumlah Bayar
411,302
400,000
55,000
110,000
- - - 976,302
760,880
744,000
36,800
25,000
315,000
120,000
400,000
22,000
- - - 2,423,680
484,100
372,000
25,000
135,000
8,800
130,000
62,000
- - - 1,216,900
629,094
348,000
140,000
(1,308,494)
13,200
66,000
8,800
70,400
33,000
- - - -
778,145
(829,114)
20,000
175,000
105,600
33,000
- - - 282,631
274,996
-
60,000
- - - 334,996
728,400
261,000
55,000
105,000
33,000
49,500
35,200
11,000
- - - 1,278,100
- - - 6,512,609
-
-
-
-
-
-
-
-
-
-
-
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-
-
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-
-
-
Mei 2012
5/8/2012
Dokter Obgyn
Ratna
1 Waryuni, Ny 25,000 5,000

Kelas VIP 10 hari 40,000 2,500,000
widal
laju endap darah
hematologi rutin
glukosa sewaktu
tindakan nebulizer 88,500
ecg 51,400
visite 45,000
konsultasi 5,000
thorax
65,000 2,783,400 -
2 Siti Faridah, Ny 25,000 5,000

Kelas 3 5 hari 5,000 280,000
tindakan nebuliser 372,000
visite 25,000
ecg 30,750
hematologi rutin
thorax
konsultasi 5,000
30,000 717,750 -
3 Darsinah, Ny 25,000
Kelas 3 3 hari 3,000 168,000
golongan darah
visite 10,000
konsuiltasi 5,000
ureum
kreatinin
sgpt
sgot
glukosa sewaktu
hematologi rutin
28,000 183,000 -
123,000 3,684,150 -
480,000
30,000
- - - - - - - - 510,000
- - - - - - - - -
- - - - - - - - -
- - - - - - - - 510,000
- - - - - - - - - -
150,000
15,000
165,000 - - - - - - - - -
60,000
15,000
75,000 - - - - - - - - -
240,000 - - - - - - - - -
Dokter Umum
Anestesi
25,000
30,000
- - 55,000 - - - - - - -
25,000
- - 25,000 - - - - - - -
- - - - - - - - - -
- - 80,000 - - - - - - -
Askep
Ruangan Ratna Gugah
3,794,032
180,000
36,000
9,600
38,400
100,800
31,500
72,000
- - - 3,794,032 184,800 72,000 180,000 31,500 -
787,651
45,000
35,200
66,000
- - - 787,651 35,200 66,000 45,000 - -
486,170
27,000
11,000
19,800
19,800
19,800
19,800
15,400
35,200
- - - 486,170 140,800 - 27,000 - -
- - - 5,067,853 360,800 138,000 252,000 31,500 -

31,500
15,600
- - 15,600 - 31,500 - - - - - -
27,000 13,500 40,500
6,750
- - - - - - - - 27,000 13,500 47,250
- - - - - - - - - - -
- - 15,600 - 31,500 - - - 27,000 13,500 47,250

Diet
450,000
- - - - - - - - - - 450,000
105,000
27,000
27,000 - - - - - - - - - 105,000
63,000
- - - - - - - - - - 63,000
27,000 - - - - - - - - - 618,000
Diet Ambulance
159,000 4,008,032
3,170,000 (475,500)
36,000
9,600
38,400
100,800
120,000
120,000
67,000
555,000
35,000
72,000
159,000 - - - - 8,331,832 (475,500) - -
842,651
435,000
480,000
175,000
37,500
35,200
66,000
20,000
- - - - - 2,091,351 - - -
511,170 (25,000) 977,969

261,000
11,000
70,000
20,000
19,800
19,800
19,800
19,800
15,400
35,200
- - - - - 1,002,970 (25,000) - 977,969
159,000 - - - - 11,426,153 (500,500) - 977,969

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Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
4,008,032
2,694,500
36,000
9,600
38,400
100,800
120,000
120,000
67,000
555,000
35,000
72,000
- - 7,856,332
842,651
435,000
480,000
175,000
37,500
35,200
66,000
20,000
- - 2,091,351
(491,799)
261,000
11,000
70,000
20,000
19,800
19,800
19,800
19,800
15,400
35,200
- - 1
- - 9,947,684
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Mei 2012
5/9/2012
Dokter Obgyn
Ratna
1 Malawi, Tn 25,000 5,000

Kelas VIP 3 hari 12,000 750,000
glukosa puasa
glukosa 2 jam pp
visite 15,000
ecg 102,800
glukosa sewaktu
konsultasi 5,000
ureum
kreatinin
sgpt
sgot
trigliserida
cholesterol
hematologi rutin
thorax
37,000 877,800 -
2 Warningsih, Nn 20,000 10,000 30,000

Kelas 3 1 hari 1,000 56,000
usg 15,000 40,000
21,000 81,000 70,000
3 Tiara, An 25,000 5,000

Kelas 3 2 hari 2,000 112,000
cruris
waktu perdarahan
waktu pembekuan
golongan darah
hematologi rutin
visite 10,000
27,000 127,000 -
85,000 1,085,800 70,000

- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
180,000
30,000
210,000 - - - - - - - - -
- - - - - - - - - -
30,000 30,000
- - - - - - 30,000 30,000 - -
210,000 - - - - - 30,000 30,000 - -

Dokter Umum
Anestesi
25,000
- 25,000 - - - - - - - -
25,000
25,000 - - - - - - - - -
25,000
- - - - - 25,000 - - - -
25,000 25,000 - - - 25,000 - - - -

Askep
Ruangan Ratna Gugah
1,452,756
54,000
16,800
16,800
33,600
43,200
43,200
21,600
21,600
26,400
21,600
38,400
72,000
- - - 1,452,756 283,200 72,000 54,000 - -
310,255
9,000
- - - 310,255 - - 9,000 - -
312,574
18,000
80,500
8,800
8,800
11,000
35,200
- - - 312,574 63,800 80,500 18,000 - -
- - - 2,075,585 347,000 152,500 81,000 - -

15,600 15,600
15,600 - - - 15,600 - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
15,600 - - - 15,600 - - - - - -
Diet
135,000
- - - - - - - - - - 135,000
21,000
- - - - - - - - - - 21,000
42,000
- - - - - - - - - - 42,000
- - - - - - - - - - 198,000
Diet Ambulance
1,507,756
951,000 (142,650)
16,800
16,800
195,000
134,000
33,600
35,000
43,200
43,200
21,600
21,600
26,400
21,600
38,400
72,000
- - - - - 3,177,956 (142,650) - -
16,500 411,755
87,000 (87,000)
55,000
16,500 - - - - 553,755 (87,000) - -

-
367,574
174,000
80,500
8,800
8,800
11,000
35,200
70,000
- - - - - 755,874 - - -
16,500 - - - - 4,487,585 (229,650) - -

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-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
1,507,756
808,350
16,800
16,800
195,000
134,000
33,600
35,000
43,200
43,200
21,600
21,600
26,400
21,600
38,400
72,000
- - 3,035,306
411,755
-
55,000
- - 466,755
367,574
174,000
80,500
8,800
8,800
11,000
35,200
70,000
- - 755,874
- - 4,257,935
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
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-
-
-
-
-
-
-
-
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-
-
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-
-
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-
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-
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-
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-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
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-
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-
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-
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-
-
-
-
-
-
-
-
-
-
-
-
-
Mei 2012
5/10/2012
Dokter Obgyn
Ratna
1 Listiani, Ny 20,000 5,000 50,000

Kelas 1 2 hari 6,000 292,000
hbs ag
hematologi rutin
golongan darah
visite 5,000 50,000
26,000 557,000 1,050,000
2 Wiwi Badriyah, Ny
Kelas 3 3 hari 3,000 168,000
resusitasi
visite 30,000 90,000
paket sc
diluar paket sc
usg 15,000 40,000
3,000 1,213,000 1,030,000
3 Wiwik Wijayaningsih, Ny 25,000

Kelas 3 4 hari 4,000 224,000
ambulance
hbs ag
hematologi rutin
golongan darah
usg 15,000 40,000
visite 20,000 120,000
29,000 1,605,500 1,003,750
4 Wiwik Wijayaningsih, Bty 25,000

Kelas 3 4 hari 4,000 224,000
visite 20,000
resusitasi 30,000
29,000 274,000 -
5 Mudiah, Ny 20,000 5,000 50,000

Kelas 3 4 hari 4,000 224,000
waktu perdarahan
waktu pembekuan
visite 20,000
ecg 30,750
mastektomy simpleks 1,350,000
hbs ag
golongan darah
hematologi rutin
konsultasi 10,000
24,000 1,639,750 50,000
6 Solikha, Ny 20,000 5,000 50,000

Kelas 3 4 hari 4,000 224,000
usg 15,000 40,000
visite 20,000 120,000
hbs ag
hematologi rutin
golongan darah
24,000 1,610,500 1,053,750
7 Solikha, By 15,000
Kelas 3 4 hari 4,000 224,000
resusitasi 30,000
visite 20,000
19,000 274,000 -
154,000 7,173,750 4,187,500

- - - - - - - - -
80,000
90,000
- - 170,000 - - - - - -
- - - - - - - - -
120,000
90,000
- - 210,000 - - - - - -
60,000
1,012,500
30,000
- - - - - - 1,102,500 - -
- - - - - - - - -
90,000
120,000
- - 210,000 - - - - - -
- - 590,000 - - - 1,102,500 - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
250,000
- - - - - - - - - 250,000
253,125
- - - - - - - - - 253,125
- - - - - - - - - -
15,000 15,000
303,750
- - 15,000 - - 15,000 - - - 303,750
253,125
- - - - - - - - - 253,125
- - - - - - - - - -
- - 15,000 - - 15,000 - - - ###

Askep
Ruangan Ratna Gugah
135,000 644,794
30,000
51,750
36,800
11,500
- 135,000 - 644,794 100,050 - 30,000 - -
27,000
125,000 75,000
1,000,000 99,000
315,343
125,000 75,000 - 1,315,343 99,000 - 27,000 - -
2,037,940
36,000
51,750
107,200
11,500
168,750 84,375 180,000
168,750 84,375 180,000 2,037,940 170,450 - 36,000 - -
217,262
36,000
- - - 217,262 - - 36,000 - -
2,629,667
36,000
8,800
8,800
202,500 101,250
49,500
11,000
105,600
202,500 101,250 - 2,629,667 183,700 - 36,000 - -
1,418,211
36,000
168,750 84,375 180,000

49,500
70,400
11,000
168,750 84,375 180,000 1,418,211 130,900 - 36,000 - -
87,095
36,000
- - - 87,095 - - 36,000 - -
665,000 480,000 360,000 8,350,312 684,100 - 237,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
6,750
- - - - - - - - - 6,750 -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - 6,750 -
Diet
72,000
- - - - - - - - - - 72,000
63,000
- - - - - - - - - - 63,000
84,000
13,500
- - - - - - - 13,500 - - 84,000
84,000
- - - - - - - - - - 84,000
84,000
- - - - - - - - - - 84,000
84,000
13,500
- - 13,500 - - - - - - - 84,000
84,000
- - - - - - - - - - 84,000
- - 13,500 - - - - 13,500 - - 555,000

Diet Ambulance
854,794
400,000
51,750
36,800
11,500
1,150,000 (150,000)
55,000
55,000
- - - - - 2,614,844 (150,000) - -
-
261,000
2,350,000
80,000
210,000
1,099,000
315,343
55,000
- - - - - 4,370,343 - - -
2,062,940
348,000
45,000 25,000 70,000
51,750
107,200
11,500
55,000
60,000
2,830,000
140,000
- 45,000 25,000 - - 5,736,390 - - -
242,262 (10,000)
348,000 (348,000)
140,000
120,000
- - - - - 850,262 (358,000) - -
2,704,667
348,000
8,800
8,800
110,000
37,500
2,970,000
49,500
11,000
105,600
40,000
- - - - - 6,393,867 - - -
1,493,211
348,000
55,000
140,000
60,000
2,830,000
49,500
70,400
11,000
- - - - - 5,057,111 - - -
102,095
348,000 (348,000)
120,000
140,000
- - - - - 710,095 (348,000) - -
- 45,000 25,000 - - 25,732,912 (856,000) - -

-
-
-
-
-
-
-
-
-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
854,794
400,000
51,750
36,800
11,500
1,000,000
55,000
55,000
- - 2,464,844
-
261,000
2,350,000
80,000
210,000
1,099,000
315,343
55,000
- - 4,370,343
2,062,940
348,000
70,000
51,750
107,200
11,500
55,000
60,000
2,830,000
140,000
- - 5,736,390
232,262
-
140,000
120,000
- - 492,262
2,704,667
348,000
8,800
8,800
110,000
37,500
2,970,000
49,500
11,000
105,600
40,000
- - 6,393,867
1,493,211
348,000
55,000
140,000
60,000
2,830,000
49,500
70,400
11,000
- - 5,057,111
102,095
-
120,000
140,000
- - 362,095
- - 24,876,912
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
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-
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-
-
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-
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-
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-
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-
-
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-
-
-
-
-
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-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Mei 2012
5/11/2012
Dokter Obgyn
Ratna
1 Wilinda, Ny 15,000
Kelas 3 2 hari 2,000 112,000
resusitasi 46,500
visite 10,000
17,000 168,500 -
2 Wilinda, Ny 25,000
Kelas 3 2 hari 2,000 112,000
hbs ag
golongan darah
hematologi rutin
per vaginum 600,000 525,000
visite 10,000 60,000
27,000 767,000 720,000
3 Renita Lusiana, Ny 25,000 5,000

Kelas 3 2 hari 2,000 112,000
widal
hematologi rutin
usg 15,000 40,000
visite 10,000 60,000
27,000 142,000 100,000
4 Roeni, Ny 25,000
Kelas 3 3 hari 3,000 168,000
usg 15,000 40,000
hemalogi rutin
per vaginum 600,000 525,000
visite 15,000 90,000
28,000 898,000 1,105,000
5 Roeni, By 15,000
Kelas 3 2 hari 2,000 112,000
visite 10,000
resusitasi 46,500
17,000 168,500 -
6 Siti Kholipah, Ny 25,000
Kelas 3 6 hari 6,000 336,000
hematologi rutin
hbs ag
golongan darah
protein urine
ureum
kreatinin
sgpt
sgot
visite 30,000 180,000
31,000 1,712,500 1,023,750
7 Siti Kholipah, By 15,000

Kelas 3 6 hari 6,000 336,000
visite 30,000
resusitasi 30,000
21,000 396,000 -
8 Hilyatun Nida, Ny 25,000 5,000

Kelas 3 5 hari 5,000 280,000
usg 15,000 40,000
hematologi rutin
visite 20,000 120,000
30,000 1,625,000 1,033,750
9 Hilyatun Nida, By 15,000

Kelas 3 4 hari 4,000 224,000
visite 20,000 120,000
resusitasi 30,000
19,000 274,000 120,000
10 Witri, Ny 15,000 5,000

Kelas 3 1 hari 1,000 56,000
16,000 61,000 -
11 Rohadi, Tn 25,000 5,000

Kelas 3 1 hari 1,000 56,000
ambulance
sgpt
sgot
laju endap darah
hematologi rutin
thorax
26,000 61,000 -
259,000 6,273,500 4,102,500

60,000
- - 60,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
60,000
- - 60,000 - - - - - -
- - - - - - - - -
180,000
90,000
- - 270,000 - - - - - -
- - - - - - - - -
90,000
- - 90,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - 480,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
- - - - - - - - - -
25,000
25,000 - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
253,125
- - - - - - - - - 253,125
- - - - - - - - - -
25,000
253,125
- - 25,000 - - - - - - 253,125
- - - - - - - - - -
25,000
- - - 25,000 - - - - - -
25,000
- - - 25,000 - - - - - -
25,000 - 25,000 50,000 - - - - - 506,250

Askep
Ruangan Ratna Gugah
110,411
18,000
- - - 110,411 - - 18,000 - -
305,596
18,000
49,500
11,000
35,200
275,312
- - 275,312 305,596 95,700 - 18,000 - -
241,216
18,000
33,000
35,200
- - - 241,216 68,200 - 18,000 - -
403,054
27,000
35,200
275,312
- - 275,312 403,054 35,200 - 27,000 - -
46,102
18,000
- - - 46,102 - - 18,000 - -
1,392,199
54,000
70,400
49,500
11,000
4,400
19,800
19,800
19,800
19,800
168,750 84,375 180,000
168,750 84,375 180,000 1,392,199 214,500 - 54,000 - -
72,464
54,000
- - - 72,464 - - 54,000 - -
1,465,294
45,000
35,200
168,750 84,375 180,000
168,750 84,375 180,000 1,465,294 35,200 - 45,000 - -
114,635
36,000
- - - 114,635 - - 36,000 - -
180,771
9,000
- - - 180,771 - - 9,000 - -
240,344
9,000
19,800
19,800
8,800
35,200
66,000
- - - 240,344 83,600 66,000 9,000 - -
337,500 168,750 910,624 4,572,086 532,400 66,000 306,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
42,000
13,500
- - - - - 13,500 - - - - 42,000
42,000
- - - - - - - - - - 42,000
42,000
- - - - - - - - - - 42,000
63,000
- - - - - - - - - - 63,000
42,000
13,500
- - - - - - - - - 13,500 42,000
126,000
13,500
- - 13,500 - - - - - - - 126,000
126,000
- - - - - - - - - - 126,000
105,000
- - - - - - - - - - 105,000
84,000
- - - - - - - - - - 84,000
21,000
- - - - - - - - - - 21,000
21,000
- - - - - - - - - - 21,000
- - 13,500 - - 13,500 - - - 13,500 714,000

Diet Ambulance
125,411
174,000 (174,000)
60,000
70,000
- - - - - 429,411 (174,000) - -
330,596
174,000
49,500
11,000
35,200
180,000
1,400,312
70,000
- - - - - 2,250,608 - - -
296,216
174,000
33,000
35,200
55,000
70,000
- - - - - 663,416 - - -
428,054
261,000
55,000
35,200
550,000
1,400,312
105,000
- - - - - 2,834,566 - - -
61,102
174,000 (174,000)
70,000
60,000
- - - - - 365,102 (174,000) - -
1,417,199
522,000
70,400
49,500
11,000
4,400
19,800
19,800
19,800
19,800
60,000
210,000
2,830,000
- - - - - 5,253,699 - - -
87,464
522,000 (522,000)
210,000
120,000
- - - - - 939,464 (522,000) - -
1,520,294
435,000
55,000
35,000
35,200
140,000
2,830,000
- - - - - 5,050,494 - - -
129,635
348,000 (348,000)
140,000
120,000
- - - - - 737,635 (348,000) - -
225,771
87,000
- - - - - 312,771 - - -
295,344
87,000
45,000 25,000 70,000
19,800
19,800
8,800
35,200
66,000
- 45,000 25,000 - - 601,944 - - -
- 45,000 25,000 - - 19,439,110 (1,218,000) - -

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
125,411
-
60,000
70,000
- - 255,411
330,596
174,000
49,500
11,000
35,200
180,000
1,400,312
70,000
- - 2,250,608
296,216
174,000
33,000
35,200
55,000
70,000
- - 663,416
428,054
261,000
55,000
35,200
550,000
1,400,312
105,000
- - 2,834,566
61,102
-
70,000
60,000
- - 191,102
1,417,199
522,000
70,400
49,500
11,000
4,400
19,800
19,800
19,800
19,800
60,000
210,000
2,830,000
- - 5,253,699
87,464
-
210,000
120,000
- - 417,464
1,520,294
435,000
55,000
35,000
35,200
140,000
2,830,000
- - 5,050,494
129,635
-
140,000
120,000
- - 389,635
225,771
87,000
- - 312,771
295,344
87,000
70,000
19,800
19,800
8,800
35,200
66,000
- - 601,944
- - 18,221,110
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Mei 2012
5/12/2012
Dokter Obgyn
Ratna
1 Toyibah, Ny DP pasien
- - -
2 Mahesa, An 25,000 5,000

Kelas 2 4 hari 8,000 320,000
konsultasi 5,000
widal
hematologi rutin
visite 20,000
33,000 350,000 -
3 Sri Purwatiningsih, Ny 20,000 5,000 50,000

Kelas 3 2 hari 2,000 112,000
businasi/laminaria 15,000 45,000
visite 10,000 60,000
22,000 392,000 605,000
4 Siti Inkhatun Khariyah, 25,000

Kelas 3 2 hari 2,000 112,000
hbs ag
hematologi rutin
golongan darah
per vaginum 600,000 525,000
visite 10,000 60,000
27,000 767,000 720,000
5 Siti Inkhatun Khariyah, By 15,000

Kelas 3 2 hari 2,000 112,000
resusitasi 46,500
17,000 158,500 -
6 Dzyka Afriliana, An 25,000 5,000

Kelas 3 5 hari 5,000 280,000
visite 20,000
konsultasi 5,000
widal
hematologi rutin
30,000 310,000 -
129,000 1,977,500 1,325,000

- - - - - - - - -
20,000
160,000
- - 180,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
120,000
15,000
- - 135,000 - - - - - -
- - 315,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
25,000
- - - - 25,000 - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
25,000
- - - 25,000 - - - - - -
- - - 25,000 25,000 - - - - -
Askep
Ruangan Ratna Gugah
- - - - - - - - -
1,233,743
48,000
33,000
70,400
- - - 1,233,743 103,400 - 48,000 - -
67,500 457,629
18,000
- 67,500 - 457,629 - - 18,000 - -
269,418
18,000
49,500
35,200
11,000
275,312
- - 275,312 269,418 95,700 - 18,000 - -
113,402
18,000
- - - 113,402 - - 18,000 - -
629,678
45,000
33,000
35,200
- - - 629,678 68,200 - 45,000 - -
- 67,500 275,312 2,703,870 267,300 - 147,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
- - - - - - - - - - -
120,000
- - - - - - - - - - 120,000
42,000
- - - - - - - - - - 42,000
42,000
- - - - - - - - - - 42,000
42,000
13,500
- - - - 13,500 - - - - - 42,000
105,000
- - - - - - - - - - 105,000
- - - - 13,500 - - - - - 351,000
Diet Ambulance
- 5,000,000
- - - - - - - 5,000,000 -
1,288,743
496,000
25,000
33,000
70,400
180,000
- - - - - 2,093,143 - - -
600,129
174,000
700,000
60,000
70,000
- - - - - 1,604,129 - - -
294,418
174,000
49,500
35,200
11,000
180,000
1,400,312
70,000
- - - - - 2,214,430 - - -
128,402
174,000 (174,000)
60,000
- - - - - 362,402 (174,000) - -
684,678 (25,000) 1,275,078

435,000
140,000
20,000
33,000
35,200
- - - - - 1,347,878 (25,000) - 1,275,078
- - - - - 7,621,982 (199,000) 5,000,000 1,275,078

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Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
5,000,000
- - 5,000,000
1,288,743
496,000
25,000
33,000
70,400
180,000
- - 2,093,143
600,129
174,000
700,000
60,000
70,000
- - 1,604,129
294,418
174,000
49,500
35,200
11,000
180,000
1,400,312
70,000
- - 2,214,430
128,402
-
60,000
- - 188,402
(615,400)
435,000
140,000
20,000
33,000
35,200
- - 47,800
- - 11,147,904
-
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Mei 2012
5/13/2012
Dokter Obgyn
Ratna
1 Yuliana, Ny 25,000
Kelas VVIP 2 hari 10,000 600,000
hbs ag
hematologi rutin
golongan darah
visite 5,000 70,000
per vginum 800,000 1,400,000
35,000 1,455,000 1,720,000
2 Yuliana, By 15,000
Kelas VVIP 2 hari 10,000 600,000
visite 10,000
resusitasi 99,000
25,000 709,000 -
3 Shofiatun, Ny 25,000 5,000

Kelas 2 4 hari 8,000 320,000
kreatinin
ureum
glukosa sewaktu
widal
hematologi rutin
konsultasi 5,000
visite 15,000
33,000 345,000 -
4 Toyibah, Ny 25,000
Kelas 2 5 hari 10,000 400,000
usg 15,000 40,000
visite 20,000 160,000
hemoglobin
hbs ag
golongan darah
hematologi rutin
35,000 1,797,000 1,365,000
5 Toyibah, By 15,000
Kelas 2 4 hari 8,000 320,000
visite 20,000
resusitasi 30,000
23,000 370,000 -
6 Toyibah, By 15,000
Kelas 2 4 hari 8,000 320,000
visite 20,000
resusiatsi 30,000
23,000 370,000 -
7 Wiyanti, NY 25,000 5,000

Kelas 3 3 hari 3,000 168,000
widal
hematologi rutin
visite 15,000
28,000 188,000 -
8 Suciati, 25,000 5,000

Kelas 3 3 hari 3,000 168,000
konsultasi 5,000
visite 10,000
hematologi rutin
28,000 188,000 -
230,000 5,422,000 3,085,000

- - - - - - - - -
140,000
- - 140,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
160,000
120,000
- - 280,000 - - - - - -
160,000
120,000
- - 280,000 - - - - - -
90,000
- - - - - - - - 90,000
15,000
60,000
- - - - - - 75,000 - -
- - 700,000 - - - 75,000 - 90,000

- - - - - - - - - -
- - - - - - - - - -
20,000
120,000
140,000 - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
140,000 - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
- - - - - - - - - -
25,000
- - - - 25,000 - - - - -
337,500
- - - - - - - - - 337,500
- - - - - - - - - -
- - - - - - - - - -
25,000
- - - - 25,000 - - - - -
25,000
- 25,000 - - - - - - - -
- 25,000 - - 50,000 - - - - 337,500

Askep
Ruangan Ratna Gugah
405,012
42,000
51,750
76,800
11,500
1,055,000
- - 1,055,000 405,012 140,050 - 42,000 - -
50,256
42,000
- - - 50,256 - - 42,000 - -
989,383
48,000
19,800
19,800
15,400
33,000
35,200
- - - 989,383 123,200 - 48,000 - -
2,323,458
60,000
8,800
49,500
11,000
105,600
225,000 112,500 810,000

225,000 112,500 810,000 2,323,458 174,900 - 60,000 - -
24,395
48,000
- - - 24,395 - - 48,000 - -
102,332
48,000
- - - 102,332 - - 48,000 - -
1,061,144
27,000
33,000
70,400
- - - 1,061,144 103,400 - 27,000 - -
741,127
27,000
35,200
- - - 741,127 35,200 - 27,000 - -
225,000 112,500 1,865,000 5,697,107 576,750 - 342,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
110,000
- - - - - - - - - - 110,000
110,000
36,000
- - - - - - 36,000 - - - 110,000
120,000
- - - - - - - - - - 120,000
150,000
18,000
- - 18,000 - - - - - - - 150,000
120,000
- - - - - - - - - - 120,000
120,000
- - - - - - - - - - 120,000
63,000
- - - - - - - - - - 63,000
63,000
- - - - - - - - - - 63,000
- - 18,000 - - - 36,000 - - - 856,000

Diet Ambulance
37,000 467,012
762,000 (114,300)
51,750
76,800
11,500
75,000
75,000
225,000
3,255,000
37,000 - - - - 4,999,062 (114,300) - -
65,256
762,000 (762,000)
150,000
135,000
- - - - - 1,112,256 (762,000) - -
1,044,383
496,000
19,800
19,800
15,400
33,000
35,200
25,000
135,000
- - - - - 1,823,583 - - -
2,348,458
620,000
55,000
45,000
180,000
8,800
49,500
11,000
105,600
75,000
3,910,000
- - - - - 7,408,358 - - -
39,395
496,000 (496,000)
180,000
150,000
- - - - - 865,395 (496,000) - -
117,332
496,000 (496,000)
180,000
150,000
- - - - - 943,332 (496,000) - -
1,116,144
261,000
33,000
70,400
105,000
- - - - - 1,585,544 - - -
796,127
261,000
20,000
70,000
35,200
- - - - - 1,182,327 - - -
37,000 - - - - 19,919,857 (1,868,300) - -

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Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
467,012
647,700
51,750
76,800
11,500
75,000
75,000
225,000
3,255,000
- - 4,884,762
65,256
-
150,000
135,000
- - 350,256
1,044,383
496,000
19,800
19,800
15,400
33,000
35,200
25,000
135,000
- - 1,823,583
2,348,458
620,000
55,000
45,000
180,000
8,800
49,500
11,000
105,600
75,000
3,910,000
- - 7,408,358
39,395
-
180,000
150,000
- - 369,395
117,332
-
180,000
150,000
- - 447,332
1,116,144
261,000
33,000
70,400
105,000
- - 1,585,544
796,127
261,000
20,000
70,000
35,200
- - 1,182,327
- - 18,051,557
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-
-
-
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-
-
-
-
-
-
-
-
-
-
-
-
Mei 2012
5/14/2012
Dokter Obgyn
Ratna
1 Naaman 25,000 5,000

Kelas VIP 4 hari 16,000 1,000,000
konsultasi 5,000
visite 15,000
ecg 51,400
sgpt
sgot
trigliserida
cholesterol
glukosa sewaktu
hematologi rutin
41,000 1,076,400 -
2 Nuryadi 25,000 5,000

Kelas 3 2 hari 2,000 112,000
visite 5,000
konsultasi 10,000
ecg 30,750
glukosa sewaktu
ureum
kreatinin
asam urat
sgpt
sgot
trigliserida
cholesterol
hematologi rutin
abdomen-bno
27,000 162,750 -
3 Damurah, By 25,000
Kelas 3 1 hari 1,000 56,000
resusitasi 46,500
visite 5,000
26,000 107,500 -
4 Damurah, Ny 25,000
Kelas 3 2 hari 2,000 112,000
hbs ag
hematologi lengkap
golongan darah
per vaginum 600,000 525,000
visite 10,000 60,000
27,000 767,000 720,000
5 Anggi 25,000 5,000

Kelas 3 6 hari 6,000 336,000
widal
hematologi rutin
hematologi lengkap
visite 25,000
konsultasi 5,000
31,000 371,000 -
152,000 2,484,650 720,000

120,000
- - - - - - - - 120,000
30,000
30,000
- - - - - - - - 60,000
30,000
- - 30,000 - - - - - -
- - - - - - - - -
150,000
15,000
- - 165,000 - - - - - -
- - 195,000 - - - - - 180,000
30,000
60,000
- - - 90,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 90,000 - - - - - -
Dokter Umum
Anestesi
25,000
- 25,000 - - - - - - - -
25,000
- 25,000 - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
25,000
- - - - - - - - 25,000 -
- 50,000 - - - - - - 25,000 -
Askep
Ruangan Ratna Gugah
1,328,039
72,000
21,600
21,600
26,400
21,600
16,800
38,400
- - - 1,328,039 146,400 - 72,000 - -
486,993
18,000
30,800
19,800
19,800
22,000
19,800
19,800
24,200
19,800
35,200
66,000
- - - 486,993 211,200 66,000 18,000 - -
113,402
9,000
- - - 113,402 - - 9,000 - -
343,104
18,000
49,500
66,000
11,000
275,312
- - 275,312 343,104 126,500 - 18,000 - -
1,203,787
54,000
67,500
36,800
66,000
- - - 1,203,787 170,300 - 54,000 - -
- - 275,312 3,475,325 654,400 66,000 171,000 - -

15,600
- - - 15,600 - - - - - - -
6,750
- - - 6,750 - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - 22,350 - - - - - - -
Diet
180,000
- - - - - - - - - - 180,000
42,000
- - - - - - - - - - 42,000
21,000
13,500
- - - - - 13,500 - - - - 21,000
42,000
- - - - - - - - - - 42,000
126,000
- - - - - - - - - - 126,000
- - - - - 13,500 - - - - 411,000
Diet Ambulance
31,000 1,414,039
1,268,000 (190,200)
35,000
195,000
67,000
21,600
21,600
26,400
21,600
16,800
38,400
31,000 - - - - 3,125,439 (190,200) - -
541,993
174,000
35,000
40,000
37,500
30,800
19,800
19,800
22,000
19,800
19,800
24,200
19,800
35,200
66,000
- - - - - 1,105,693 - - -
138,402 (10,000)
87,000 (87,000)
60,000
35,000
- - - - - 320,402 (97,000) - -
368,104
174,000
49,500
66,000
11,000
180,000
1,400,312
70,000
- - - - - 2,318,916 - - -
1,258,787
522,000
67,500
36,800
66,000
175,000
20,000
- - - - - 2,146,087 - - -
31,000 - - - - 9,016,537 (287,200) - -

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-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
1,414,039
1,077,800
35,000
195,000
67,000
21,600
21,600
26,400
21,600
16,800
38,400
- - 2,935,239
541,993
174,000
35,000
40,000
37,500
30,800
19,800
19,800
22,000
19,800
19,800
24,200
19,800
35,200
66,000
- - 1,105,693
128,402
-
60,000
35,000
- - 223,402
368,104
174,000
49,500
66,000
11,000
180,000
1,400,312
70,000
- - 2,318,916
1,258,787
522,000
67,500
36,800
66,000
175,000
20,000
- - 2,146,087
- - 8,729,337
-
-
-
-
-
-
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-
Mei 2012
5/15/2012
Dokter Obgyn
Ratna
1 Alivia Zaskia Maulida, An 25,000 5,000

Kelas 1 2 hari 6,000 292,000
konsultasi 5,000
visite 10,000
widal
hematologi lengkap
31,000 312,000 -
2 Ashri Septi Purwati, Ny 20,000 5,000 50,000

Kelas 1 2 hari 6,000 292,000
per vaginum 600,000 1,050,000
hematologi lengkap
visite 10,000 100,000
26,000 1,012,000 1,695,000
3 Asri Septi Purwati, By 25,000

Kelas 1 1 hari 3,000 146,000
pasang tindik 10,500
visite 5,000
resusitasi 78,000
28,000 239,500 -
4 Hilda, An 20,000 5,000

Kelas 2 3 hari 6,000 240,000
konsultasi 5,000
visite 10,000
widal
hematologi lengkap
26,000 260,000 -
5 Umroh, Ny 25,000 5,000

Kelas 3 3 hari 3,000 168,000
hematologi lengkap
visite 15,000 90,000
usg 15,000 40,000
28,000 203,000 130,000
6 Raminah, Ny 20,000 5,000 50,000

Kelas 3 5 hari 5,000 280,000
salpingoofarektomi 1,800,000 1,350,000
hematologi rutin
biaya PA
visite 25,000 150,000
25,000 2,190,500 1,558,500
7 Khusnul Khotimah, Ny 25,000

Kelas 3 2 hari 2,000 112,000
visite 10,000 60,000
27,000 372,000 510,000
8 Arzaq Aditia Pratama, An 25,000 5,000

Kelas 3 5 hari 5,000 280,000
widal
hematologi rutin
konsultasi 5,000
visite 20,000
30,000 310,000 -
9 Khusnul Khotimah, Ny 25,000

Kelas 3 2 hari 2,000 112,000
visite 10,000 60,000
27,000 372,000 510,000
248,000 5,271,000 4,403,500

25,000
100,000
- - - - 125,000 - - -
- - - - - - - -
50,000
- - 50,000 - - - - -
20,000
80,000
- - 100,000 - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
15,000
120,000
- - 135,000 - - - - -
- - - - - - - -
- - 285,000 - 125,000 - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
25,000
- - - - - - - - - - 25,000
- - - - - - - - - - -
- - - - - - - - - - -
25,000
- - - - - - - - - 25,000 -
25,000
- - - - - - - - - 25,000 -
- - - - - - - - - - -
- - - - - - - - - - -
25,000
- - - 25,000 - - - - - - -
- - - - - - - - - - -
- - - 25,000 - - - - - 50,000 25,000

Askep
Ruangan
376,174
30,000
34,500
69,000
- - - - 376,174 103,500 - 30,000
481,051
30,000
280,000
69,000
- - - 280,000 481,051 69,000 - 30,000
47,265
15,000
- - - - 47,265 - - 15,000
687,421
36,000
33,000
66,000
- - - - 687,421 99,000 - 36,000
472,533
27,000
66,000
- - - - 472,533 66,000 - 27,000
1,041,263
45,000
405,000 270,000 135,000 798,925
35,200
120,000
405,000 270,000 135,000 798,925 1,041,263 155,200 - 45,000
67,500 390,547
18,000
225,000
- - 67,500 225,000 390,547 - - 18,000
559,114
45,000
33,000
35,200
- - - - 559,114 68,200 - 45,000
67,500 390,547
18,000
225,000
- - 67,500 225,000 390,547 - - 18,000
405,000 270,000 270,000 ### 4,445,915 560,900 - 264,000

Ratna Gugah Arif Afit Suhati Wiwik Indra Eko P Andini Roikhatul Dewi
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
13,500
- - - - - - - - - - 13,500
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - 13,500
Candra Koticha Aisah Ana Eny Endang Pipit Suci Dinda Tika Retno
- - - - - - - - - - -
- - - - - - - - - - -
4,500
27,000
- - - - 4,500 - - - 27,000 - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - 4,500 - - - 27,000 - -
Diet Ambulance
Rujukan Lain-Lain Total Keringanan
Wulan Rawat Inap Ekstra BBM Sopir
431,174
72,000 400,000
30,000
110,000
34,500
69,000
- 72,000 - - - - - 1,074,674 -
556,051
72,000 400,000
180,000
420,000
1,930,000
69,000
110,000
- 72,000 - - - - - 3,665,051 -
72,265 (10,000)
36,000 200,000 (200,000)
15,000
55,000
105,000
- 36,000 - - - - - 447,265 (210,000)
737,421
90,000 372,000
25,000
90,000
33,000
66,000
- 90,000 - - - - - 1,323,421 -
527,533
63,000 261,000
66,000
105,000
55,000
- 63,000 - - - - - 1,014,533 -
1,116,263
105,000 435,000
4,758,925
42,500
60,000
35,200
120,000
175,000
- 105,000 - - - - - 6,742,888 -
483,047
42,000 174,000
925,000
70,000
- 42,000 - - - - - 1,652,047 -
614,114
105,000 435,000
33,000
35,200
20,000
140,000
- 105,000 - - - - - 1,277,314 -
483,047
42,000 174,000
925,000
70,000
- 42,000 - - - - - 1,652,047 -
- 627,000 - - - - - 18,849,240 (210,000)

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Piutang
DP
Jamsostek Garda Medika Jamkesmas Jasa Raharja Relife
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Piutang
Jumlah Bayar
Bringin Pos Indonesia Asuransi Lain ybs
431,174
400,000
30,000
110,000
34,500
69,000
- - - - 1,074,674
556,051
400,000
180,000
420,000
1,930,000
69,000
110,000
- - - - 3,665,051
62,265
-
15,000
55,000
105,000
- - - - 237,265
737,421
372,000
25,000
90,000
33,000
66,000
- - - - 1,323,421
527,533
261,000
66,000
105,000
55,000
- - - - 1,014,533
1,116,263
435,000
4,758,925
42,500
60,000
35,200
120,000
175,000
- - - - 6,742,888
483,047
174,000
925,000
70,000
- - - - 1,652,047
614,114
435,000
33,000
35,200
20,000
140,000
- - - - 1,277,314
483,047
174,000
925,000
70,000
- - - - 1,652,047
- - - - 18,639,240
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Mei 2012
5/16/2012
Dokter Obgyn
Ratna
1 Desy Kurniasih, Ny 20,000 5,000 50,000

Kelas VIP 6 hari 24,000 1,500,000
hematologi rutin
visite 30,000 360,000
hbs ag
golongan darah
44,000 2,923,500 2,378,750
2 Desy Kurniasih, By 15,000

Kelas VIP 5 hari 20,000 1,250,000
resusitasi 30,000
visite 25,000
35,000 1,305,000 -
3 Sustriani Hidayati, Ny 25,000 5,000

Kelas VIP 3 hari 12,000 750,000
glukosa sewaktu
hematologi lengkap
ecg 51,400
visite 5,000
konsultasi 5,000
37,000 816,400 -
4 Sofiatun, By 15,000
Kelas 2 4 hari 8,000 320,000
glukosa sewaktu
konsultasi 5,000
visite 15,000
resusitasi 57,000
23,000 397,000 -
5 Sofiatun, Ny 25,000
Kelas 2 4 hari 8,000 320,000
usg 15,000 40,000
hbs ag
protein urine
ureum
kreatinin
sgpt
sgot
hemoglobin
golongan darah
hematologi lengkap
visite 20,000 160,000
per vaginum 600,000 700,000
33,000 1,057,000 1,080,000
6 Tonari, Ny 25,000 5,000 50,000

Kelas 3 9 hari 9,000 504,000
usg 15,000 40,000
laparatomi eksplorasi 1,350,000 303,750
visite 65,000 270,000
ecg 30,750
hematologi rutin
widal
thorax
ambulance
hbs ag
urine rutin
sedimen urine
ureum
kreatinin
sgpt
sgot
glukosa sewaktu
golongan darah
34,000 2,003,750 672,250
7 Herningsih, Ny 25,000 5,000

Kelas 3 1 hari 1,000 56,000
hbs ag
golongan darah
hematologi lengkap
visite 5,000 30,000
26,000 376,000 660,000
8 Solipah, By 15,000
Kelas 3 3 hari 3,000 168,000
konsultasi 5,000
visite 15,000
resusitasi 46,500
18,000 245,000 -
9 Solipah, Ny 25,000
Kelas 3 3 hari 3,000 168,000
hematologi lengkap
visite 15,000 90,000
per vaginum 600,000 525,000
28,000 843,000 795,000
10 Danar Gundolo Seto 25,000 5,000

Kelas 3 5 hari 5,000 280,000
visite 25,000
widal
hematologi rutin
30,000 310,000 -
308,000 10,276,650 5,586,000

- - - - - - - - -
210,000
300,000
- - 510,000 - - - - - -
- - - - - - - - -
20,000
120,000
- - 140,000 - - - - - -
- - - - - - - - -
1,012,500
120,000
- - - - - - - 1,132,500 -
- - - - - - - - -
15,000
90,000
- - 105,000 - - - - - -
- - - - - - - - -
150,000
- - 150,000 - - - - - -
- - 905,000 - - - - 1,132,500 -
- - - - - - - - - -
- - - - - - - - - -
60,000
30,000
90,000 - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
90,000 - - - - - - - - -
Dokter Umum
Anestesi
590,625
- - - - - - - - - 590,625
- - - - - - - - - -
25,000
- - 25,000 - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
303,750
- - - - - - - - - 303,750
25,000
- - - 25,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
25,000
- - - - - - - - 25,000 -
- - 25,000 25,000 - - - - 25,000 894,375

Askep
Ruangan Ratna Gugah
3,124,218
108,000
76,800
353,750 196,875 220,000

54,000
12,000
353,750 196,875 220,000 3,124,218 142,800 - 108,000 - -
50,256
90,000
- - - 50,256 - - 90,000 - -
711,695
54,000
16,100
72,000
15,600
- - - 711,695 88,100 - 54,000 15,600 -
424,672
48,000
15,400
- - - 424,672 15,400 - 48,000 - -
401,901
48,000
51,750
4,600
20,700
20,700
20,700
20,700
9,200
11,500
66,000
411,250
- - 411,250 401,901 225,850 - 48,000 - -
3,837,254
81,000
202,500 101,250
70,400
33,000
66,000
49,500
22,000
16,500
19,800
19,800
19,800
19,800
15,400
11,000
202,500 101,250 - 3,837,254 297,000 66,000 81,000 - -
324,272
9,000
49,500
11,000
66,000
225,000
- - 225,000 324,272 126,500 - 9,000 - -
165,497
27,000
- - - 165,497 - - 27,000 - -
364,085
27,000
66,000
275,312
- - 275,312 364,085 66,000 - 27,000 - -
659,952
45,000
33,000
35,200
- - - 659,952 68,200 - 45,000 - -
556,250 298,125 ### ### 1,029,850 66,000 537,000 15,600 -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
6,750
- - - - - - - - - 6,750 -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - 6,750 -
Diet
270,000
31,500
- - - - - - - 31,500 - - 270,000
225,000
- - - - - - - - - - 225,000
135,000
- - - - - - - - - - 135,000
120,000
18,000
- - - - - 18,000 - - - - 120,000
120,000
18,000
- - - - - - 18,000 - - - 120,000
189,000
- - - - - - - - - - 189,000
21,000
- - - - - - - - - - 21,000
63,000
4,500
13,500
- - - - 13,500 - - - - 4,500 63,000
63,000
- - - - - - - - - - 63,000
105,000
- - - - - - - - - - 105,000
- - - - 13,500 18,000 18,000 31,500 - 4,500 1,311,000

Diet Ambulance
31,000 3,230,218
1,902,000 (285,300)
76,800
390,000
120,000
4,630,000
54,000
12,000
31,000 - - - - 10,415,018 (285,300) - -
65,256
1,585,000 (1,585,000)
240,000
325,000
- - - - - 2,215,256 (1,585,000) - -
38,000 804,695
951,000 (142,650)
16,100
72,000
67,000
65,000
35,000
38,000 - - - - 2,010,795 (142,650) - -
439,672
496,000 (496,000)
15,400
25,000
135,000
75,000
- - - - - 1,186,072 (496,000) - -
426,901
496,000
55,000
51,750
4,600
20,700
20,700
20,700
20,700
9,200
11,500
75,000
66,000
180,000
225,000
1,711,250
- - - - - 3,395,001 - - -
3,917,254
783,000
42,500
55,000
3,273,750
455,000
37,500
70,400
33,000
66,000
120,000 120,000
49,500
22,000
16,500
19,800
19,800
19,800
19,800
15,400
11,000
- 120,000 - - - 9,047,004 - - -
379,272
87,000
49,500
11,000
66,000
35,000
240,000
925,000
- - - - - 1,792,772 - - -
180,497
261,000 (261,000)
15,000
20,000
105,000
60,000
- - - - - 641,497 (261,000) - -
389,085
261,000
66,000
105,000
240,000
1,400,312
- - - - - 2,461,397 - - -
714,952 (25,000) 1,247,052

435,000
175,000
33,000
35,200
- - - - - 1,393,152 (25,000) - 1,247,052
69,000 120,000 - - - 34,557,964 (2,794,950) - 1,247,052

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-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
3,230,218
1,616,700
76,800
390,000
120,000
4,630,000
54,000
12,000
- - 10,129,718
65,256
-
240,000
325,000
- - 630,256
804,695
808,350
16,100
72,000
67,000
65,000
35,000
- - 1,868,145
439,672
-
15,400
25,000
135,000
75,000
- - 690,072
426,901
496,000
55,000
51,750
4,600
20,700
20,700
20,700
20,700
9,200
11,500
75,000
66,000
180,000
225,000
1,711,250
- - 3,395,001
3,917,254
783,000
42,500
55,000
3,273,750
455,000
37,500
70,400
33,000
66,000
120,000
49,500
22,000
16,500
19,800
19,800
19,800
19,800
15,400
11,000
- - 9,047,004
379,272
87,000
49,500
11,000
66,000
35,000
240,000
925,000
- - 1,792,772
180,497
-
15,000
20,000
105,000
60,000
- - 380,497
389,085
261,000
66,000
105,000
240,000
1,400,312
- - 2,461,397
(557,100)
435,000
175,000
33,000
35,200
- - 121,100
- - 30,515,962
-
-
-
-
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Mei 2012
5/17/2012
Dokter Obgyn
Ratna
1 Ratna Yulianti 25,000 5,000

Kelas 3 3 hari 3,000 168,000
konsultasi 5,000
visite 15,000
widal
hematologi lengkap
28,000 193,000 -
2 Masriah, By 15,000
Kelas 3 3 hari 3,000 168,000
resusiatsi 30,000
visite 15,000
18,000 223,500 -
3 Masriah 25,000
Kelas 3 3 hari 3,000 168,000
ambulance
hemoglobin
visite 15,000 90,000
28,000 1,529,500 933,750
74,000 1,946,000 933,750

- - - - - - - - -
90,000
90,000
- - 180,000 - - - - - -
- - - - - - - - -
- - 180,000 - - - - - -
15,000
90,000
105,000 - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
105,000 - - - - - - - - -
Dokter Umum
Anestesi
25,000
- - - - - 25,000 - - - -
- - - - - - - - - -
253,125
- - - - - - - - - 253,125
- - - - - 25,000 - - - 253,125
Askep
Ruangan Ratna Gugah
960,149
27,000
33,000
66,000
- - - 960,149 99,000 - 27,000 - -
153,374
27,000
- - - 153,374 - - 27,000 - -
1,492,966
27,000
8,800
168,750 84,375 180,000
168,750 84,375 180,000 1,492,966 8,800 - 27,000 - -
168,750 84,375 180,000 2,606,489 107,800 - 81,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
63,000
- - - - - - - - - - 63,000
63,000
4,500
- - - 4,500 - - - - - - 63,000
63,000
13,500
- - - - - 13,500 - - - - 63,000
- - - 4,500 - 13,500 - - - - 189,000

Diet Ambulance
1,015,149 (25,000) 1,428,149

261,000
20,000
105,000
33,000
66,000
- - - - - 1,500,149 (25,000) - 1,428,149
168,374
261,000 (261,000)
15,000
120,000
105,000
- - - - - 669,374 (261,000) - -
1,517,966
261,000
70,000 70,000
8,800
105,000
60,000
2,830,000
- 70,000 - - - 4,852,766 - - -
- 70,000 - - - 7,022,289 (286,000) - 1,428,149

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-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
(438,000)
261,000
20,000
105,000
33,000
66,000
- - 47,000
168,374
-
15,000
120,000
105,000
- - 408,374
1,517,966
261,000
70,000
8,800
105,000
60,000
2,830,000
- - 4,852,766
- - 5,308,140
-
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Mei 2012
5/18/2012
Dokter Obgyn
Ratna
1 Faiqotul Rizki 20,000 5,000 50,000

Kelas 1 2 hari 6,000 292,000
per vaginum 600,000 1,050,000
hematologi rutin
visite 10,000 100,000
26,000 907,000 1,200,000
2 Faiqotul Rizki, By 15,000

Kelas 1 1 hari 3,000 146,000
visite 5,000 50,000
resusitasi 78,000
18,000 229,000 50,000
3 Toriyah, By 15,000
Kelas 2 4 hari 8,000 320,000
visite 10,000
konsultasi 5,000
resusitasi 57,000
23,000 392,000 -
4 Toriyah 25,000
Kelas 2 4 hari 8,000 320,000
per vaginum 600,000 700,000
hbs ag
hematologi lengkap
golongan darah
visite 20,000 160,000
33,000 985,000 950,000
5 Tardi Rizqi Pratama 25,000 5,000

Kelas 3 2 hari 2,000 112,000
ambulance
visite 5,000
konsultasi 10,000
27,000 132,000 -
6 Maemunah 25,000
Kelas 3 2 hari 2,000 112,000
visite 10,000 60,000
usg 15,000 40,000
27,000 387,000 550,000
7 Tasripah, Ny 20,000 5,000 50,000

Kelas 3 8 hari 8,000 448,000
hematologi rutin
usg 15,000 40,000
hematologi lengkap
ecg 30,750
visite 45,000 240,000
biaya PA
salpingoofarektomi unilateral 900,000 675,000
ureum
kreatinin
sgpt
sgot
thorax
28,000 1,522,250 1,013,000
8 Anggi 25,000 5,000

Kelas 3 3 hari 3,000 168,000
konsultasi 5,000
visite 10,000
hematologi rutin
28,000 188,000 -
210,000 4,742,250 3,763,000

- - - - - - - - -
- - - - - - - - -
80,000
20,000
- - 100,000 - - - - - -
- - - - - - - - -
30,000
- - - - - - 30,000 - -
- - - - - - - - -
- - - - - - - - -
15,000
60,000
- - 75,000 - - - - - -
- - 175,000 - - - 30,000 - -
Dokter Internis Dokter Gigi Dokter Syaraf Anestesi Orthoped Psiko
Maretina Dian W Sangkan Fachri Uzer Anton Soemartono Arif Wahyu Dana
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
30,000
- - - - - - 30,000 - -
- - - - - - - - -
- - - - - - 30,000 - -
Rad Dokter Umum
Anestesi
Alip Djalil Boeing Nurbaity Teguh I Made Kholid Windy Dewi Aros
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
25,000
15,000
- - - - - - - 15,000 25,000 - -
- - - - - - - - - - -
202,500
- - - - - - - - - - 202,500
25,000
- - - - - - - 25,000 - - -
- - - - - - - 40,000 25,000 - 202,500

Askep
Ruangan Ratna Gugah
443,353
30,000
280,000
36,800
- - 280,000 443,353 36,800 - 30,000 - -
15,000
- - - - - - 15,000 - -
106,477
48,000
- - - 106,477 - - 48,000 - -
441,178
48,000
411,250
49,500
66,000
11,000
- - 411,250 441,178 126,500 - 48,000 - -
865,173
18,000
- - - 865,173 - - 18,000 - -
67,500 398,649
18,000
225,000
- 67,500 225,000 398,649 - - 18,000 - -
2,551,745
72,000
36,800
66,000
240,000
135,000 67,500
19,800
19,800
19,800
19,800
66,000
135,000 67,500 - 2,551,745 422,000 66,000 72,000 - -
314,959
27,000
35,200
- - - 314,959 35,200 - 27,000 - -
135,000 135,000 916,250 5,121,534 620,500 66,000 276,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
6,750
- - 6,750 - - - - - - - -
- - - - - - - - - - -
- - 6,750 - - - - - - - -
- - - - - - - - - -
27,000
- - 27,000 - - - - - - -
18,000
- - - - - - - - - 18,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
13,500
- - - - - - - 13,500 - -
- - - - - - - - - -
- - 27,000 - - - - 13,500 - 18,000

Diet Ambulance
3,000 521,353
72,000 400,000
1,930,000
36,800
110,000
72,000 3,000 - - - - 2,998,153 - -
15,000
36,000 200,000 (200,000)
55,000
105,000
36,000 - - - - - 375,000 (200,000) -
121,477
120,000 496,000 (496,000)
90,000
25,000
75,000
120,000 - - - - - 807,477 (496,000) -
466,178
120,000 496,000
1,711,250
49,500
66,000
11,000
180,000
135,000
120,000 - - - - - 3,114,928 - -
920,173
42,000 174,000
120,000 120,000
20,000
40,000
42,000 - 120,000 - - - 1,274,173 - -
491,149
42,000 174,000 (15,149)
925,000
70,000
55,000
42,000 - - - - - 1,715,149 (15,149) -
2,626,745
168,000 696,000
40,000
36,800
55,000
66,000
37,500
315,000
60,000
240,000
1,980,000
19,800
19,800
19,800
19,800
66,000
168,000 - - - - - 6,298,245 - -
369,959
63,000 261,000
20,000
70,000
35,200
63,000 - - - - - 756,159 - -
663,000 3,000 120,000 - - - 17,339,284 (711,149) -

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Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
521,353
400,000
1,930,000
36,800
110,000
- - - 2,998,153
15,000
-
55,000
105,000
- - - 175,000
121,477
-
90,000
25,000
75,000
- - - 311,477
466,178
496,000
1,711,250
49,500
66,000
11,000
180,000
135,000
- - - 3,114,928
920,173
174,000
120,000
20,000
40,000
- - - 1,274,173
491,149
158,851
925,000
70,000
55,000
- - - 1,700,000
2,626,745
696,000
40,000
36,800
55,000
66,000
37,500
315,000
60,000
240,000
1,980,000
19,800
19,800
19,800
19,800
66,000
- - - 6,298,245
369,959
261,000
20,000
70,000
35,200
- - - 756,159
- - - 16,628,135
-
-
-
-
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-
-
-
-
-
Mei 2012
5/19/2012
Dokter Obgyn
Ratna
1 Tsabit Althaf Musafar, An 25,000 5,000

Kelas VVIP 6 hari 30,000 1,800,000
konsultasi 10,000
visite 30,000
sgpt
sgot
widal
hematologi rutin
55,000 1,845,000 -
2 Atik Yuniarti, Ny 25,000

Kelas 1 3 hari 9,000 438,000
hbs ag
golongan darah
hematologi rutin
per vaginum 600,000 1,050,000
visite 10,000 100,000
34,000 1,303,000 1,650,000
3 Sulastri 25,000
Kelas 1 2 hari 6,000 292,000
per vaginum 600,000 1,050,000
visite 10,000 100,000
31,000 902,000 1,150,000
4 Sulastri, By 25,000
Kelas 1 1 hari 3,000 146,000
visite 5,000
resusitasi 78,000
28,000 229,000 -
5 Yeni Rahmawati, Ny 25,000

Kelas 3 3 hari 3,000 168,000
hematologi lengkap
per vaginum 600,000 525,000
visite 15,000 90,000
28,000 888,000 930,000
6 Yeni Rahmawati, By 15,000

Kelas 3 3 hari 3,000 168,000
konsultasi 5,000
visite 10,000
resusitasi 46,500
18,000 229,500 -
7 Sukim, Tn 25,000 5,000

Kelas 3 3 hari 3,000 168,000
kreatini
ureum
cholesterol
hematologi rutin
visite 15,000
konsultasi 5,000
asam urat
ecg 30,750
28,000 223,750 -
222,000 5,620,250 3,730,000

70,000
420,000
- - 490,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
50,000
- - 50,000 - - - - - -
- - - - - - - - -
15,000
60,000
- - 75,000 - - - - - -
- - - - - - - - -
- - 615,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
60,000
15,000
75,000 - - - - - - - - -
75,000 - - - - - - - - -
Dokter Umum
Anestesi
25,000
- - - - - - - - 25,000 -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
25,000
15,000
- - 25,000 - - - 15,000 - - -
- - 25,000 - - - 15,000 - 25,000 -

Askep
Ruangan Ratna Gugah
1,858,350
126,000
22,500
22,500
75,000
120,000
- - - 1,858,350 240,000 - 126,000 - -
135,000 572,910
45,000
51,750
11,500
36,800
280,000
- 135,000 280,000 572,910 100,050 - 45,000 - -
248,278
30,000
476,875
- - 476,875 248,278 - - 30,000 - -
200,261
15,000
- - - 200,261 - - 15,000 - -
273,265
27,000
66,000
275,312
- - 275,312 273,265 66,000 - 27,000 - -
143,611
27,000
- - - 143,611 - - 27,000 - -
403,869
27,000
19,800
19,800
19,800
35,200
22,000
- - - 403,869 116,600 - 27,000 - -
- 135,000 ### 3,700,544 522,650 - 297,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
6,750
- - 6,750 - - - - - - - -
- - 6,750 - - - - - - - -
Diet
330,000
- - - - - - - - - - 330,000
108,000
- - - - - - - - - - 108,000
72,000
- - - - - - - - - - 72,000
36,000
27,000
- - - - - - - - 27,000 - 36,000
63,000
- - - - - - - - - - 63,000
63,000
13,500
- - - - 13,500 - - - - - 63,000
63,000
- - - - - - - - - - 63,000
- - - - 13,500 - - - 27,000 - 735,000

Diet Ambulance
57,000 1,970,350 (25,000) 1,810,036

2,286,000 (342,900)
80,000
450,000
22,500
22,500
75,000
120,000
57,000 - - - - 5,026,350 (367,900) - 1,810,036
732,910
600,000
51,750
11,500
36,800
1,930,000
700,000
110,000
55,000
- - - - - 4,227,960 - - -
273,278
400,000
2,126,875
110,000
- - - - - 2,910,153 - - -
225,261
200,000 (200,000)
55,000
105,000
- - - - - 585,261 (200,000) - -
298,265
261,000
180,000
66,000
240,000
1,400,312
105,000
- - - - - 2,550,577 - - -
158,611
261,000 (261,000)
20,000
70,000
60,000
- - - - - 569,611 (261,000) - -
458,869
261,000
19,800
19,800
19,800
35,200
90,000
20,000
22,000
37,500
- - - - - 983,969 - - -
57,000 - - - - 16,853,881 (828,900) - 1,810,036

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-
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-
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-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
135,314
1,943,100
80,000
450,000
22,500
22,500
75,000
120,000
- - 2,848,414
732,910
600,000
51,750
11,500
36,800
1,930,000
700,000
110,000
55,000
- - 4,227,960
273,278
400,000
2,126,875
110,000
- - 2,910,153
225,261
-
55,000
105,000
- - 385,261
298,265
261,000
180,000
66,000
240,000
1,400,312
105,000
- - 2,550,577
158,611
-
20,000
70,000
60,000
- - 308,611
458,869
261,000
19,800
19,800
19,800
35,200
90,000
20,000
22,000
37,500
- - 983,969
- - 14,214,945
-
-
-
-
-
-
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Mei 2012
5/20/2012
Dokter Obgyn
Ratna
1 Ade Andi Trimawan 25,000 5,000

Kelas 1 1 hari 3,000 146,000
ambulance
konsultasi 5,000
abdomen-bno
28,000 156,000 -
2 Imamiyatun Nadhiroh, By 25,000

Kelas 1 2 hari 6,000 292,000
resusitasi 18,000
visite 10,000
31,000 330,500 -
3 Imamiyatun Nadhiroh, Ny 25,000

Kelas 1 2 hari 6,000 292,000
usg 15,000 40,000
per vaginum 600,000 656,250
visite 24,892
31,000 931,892 696,250
4 Poniati, by 15,000
Kelas 3 2 hari 2,000 112,000
visite 5,000
resusitasi 46,500
17,000 163,500 -
5 Poniati, Ny 20,000 5,000 50,000

Kelas 3 2 hari 2,000 112,000
per vaginum 600,000 525,000
visite 5,000 30,000
22,000 727,000 635,000
6 Widiawati, Ny 25,000
Kelas 3 1 hari 1,000 56,000
visite 5,000 30,000
26,000 311,000 480,000
7 Imas Masriyah, Ny
Kelas 3 3 hari 3,000 168,000
resusitasi
visite 30,000 90,000
paket sc
diluar paket sc
3,000 1,198,000 990,000
158,000 3,817,892 2,801,250

25,000
- - - - - - 25,000 - -
50,000
- - 50,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
80,000
90,000
- - 170,000 - - - - - -
- - 220,000 - - - 25,000 - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
25,000
- - - - - - 25,000 - - -
25,000
- - - - - 25,000 - - - -
- - - - - - - - - -
15,000
- - - - - 15,000 - - - -
- - - - - - - - - -
- - - - - - - - - -
250,000
- - - - - - - - - 250,000
- - - - - 40,000 25,000 - - 250,000

Askep
Ruangan Ratna Gugah
158,891
15,000
69,000
- - - 158,891 - 69,000 15,000 - -
59,695
30,000
- - - 59,695 - - 30,000 - -
355,028
30,000
- - - 355,028 - - 30,000 - -
54,543
18,000
- - - 54,543 - - 18,000 - -
487,704
18,000
275,312
- - 275,312 487,704 - - 18,000 - -
67,500 313,788
9,000
225,000
- 67,500 225,000 313,788 - - 9,000 - -
27,000
125,000 75,000
1,000,000 99,000
160,113 96,800
125,000 75,000 - 1,160,113 195,800 - 27,000 - -
125,000 142,500 500,312 2,589,762 195,800 69,000 147,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
36,000
- - - - - - - - - - 36,000
72,000
4,500
- - - - - - - - - 4,500 72,000
72,000
- - - - - - - - - - 72,000
42,000
13,500
- - - - - - - 13,500 - - 42,000
42,000
- - - - - - - - - - 42,000
21,000
- - - - - - - - - - 21,000
63,000
- - - - - - - - - - 63,000
- - - - - - - 13,500 - 4,500 348,000

Diet Ambulance
213,891
200,000
60,000 60,000
30,000
69,000
- 60,000 - - - 572,891 - - -
84,695 (10,000)
400,000 (400,000)
15,000
18,000
85,000
- - - - - 602,695 (410,000) - -
380,028
400,000 (152,000)
55,000
1,256,250
24,892
- - - - - 2,116,170 (152,000) - -
69,543
174,000 (174,000)
20,000
60,000
- - - - - 323,543 (174,000) - -
562,704
174,000
1,400,312
35,000
35,000
- - - - - 2,207,016 - - -
406,288
87,000
925,000
35,000
- - - - - 1,453,288 - - -
-
261,000
2,350,000
80,000
210,000
1,099,000
256,913
- - - - - 4,256,913 - - -
- 60,000 - - - 11,532,516 (736,000) - -

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Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
213,891
200,000
60,000
30,000
69,000
- - 572,891
74,695
-
15,000
18,000
85,000
- - 192,695
380,028
248,000
55,000
1,256,250
24,892
- - 1,964,170
69,543
-
20,000
60,000
- - 149,543
562,704
174,000
1,400,312
35,000
35,000
- - 2,207,016
406,288
87,000
925,000
35,000
- - 1,453,288
-
261,000
2,350,000
80,000
210,000
1,099,000
256,913
- - 4,256,913
- - 10,796,516
-
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Mei 2012
5/21/2012
Dokter Obgyn
Ratna
1 Ria, By 15,000
Kelas 1 3 hari 9,000 438,000
visite 10,000
resusitasi 78,000
24,000 526,000 -
2 Ria, Ny 20,000 5,000 50,000

Kelas 1 4 hari 12,000 584,000
hbs ag
hemoglobin
golongan darah
hematologi rutin
visite 20,000 200,000
per vaginum 600,000 1,050,000
32,000 1,254,000 1,570,000
3 Tuti Sugiarti, By 15,000

Kelas 1 2 hari 6,000 292,000
visite 5,000
resusitasi 78,000
21,000 375,000 -
4 Tuti Sugiarti, Ny 25,000

Kelas 1 2 hari 6,000 292,000
usg 15,000 40,000
hbs ag
protein urine
kreatinin
ureum
sgot
sgpt
golongan darah
hemoglobin
per vaginum 600,000 1,050,000
visite 10,000 100,000
31,000 962,000 1,460,000
5 Rikhmawati, By 15,000
Kelas 2 2 hari 4,000 160,000
visite 5,000
resusitasi 57,000
19,000 222,000 -
6 Rikhmawati, Ny 25,000
Kelas 2 2 hari 4,000 160,000
hbs ag
golongan darah
hemoglobin
per vaginum 600,000 700,000
visite 10,000 80,000
29,000 875,000 1,200,000
7 Irawati 25,000
Kelas 3 3 hari 3,000 168,000
usg 15,000 40,000
visite 15,000 90,000
hematologi lengkap
28,000 1,498,000 973,750
8 Irawati, By 15,000
Kelas 3 3 hari 3,000 168,000
visite 15,000
resusitasi 30,000
18,000 213,000 -
9 Aminudin 25,000 5,000

Kelas 3 2 hari 2,000 112,000
ganti balut 93,000
widal
hematologi lengkap
visite 5,000
konsultasi 5,000
27,000 220,000 -
229,000 6,145,000 5,203,750

50,000
- - 50,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
40,000
- - 40,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
60,000
90,000
- - 150,000 - - - - - -
30,000
- - - - - - - - 30,000
- - 240,000 - - - - - 30,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
25,000
- - - - - 25,000 - - - -
- - - - - - - - - -
25,000
- - - - - 25,000 - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
253,125
- - - - - - - - - 253,125
15,000
- - - - - 15,000 - - - -
25,000
15,000
- - - 15,000 - - 25,000 - - -
- - - 15,000 - 65,000 25,000 - - 253,125

Askep
Ruangan Ratna Gugah
123,801
45,000
- - - 123,801 - - 45,000 - -
348,775
60,000
51,750
9,200
11,500
36,800
280,000
- - 280,000 348,775 109,250 - 60,000 - -
40,252
30,000
- - - 40,252 - - 30,000 - -
372,520
30,000
51,750
4,600
20,700
20,700
20,700
20,700
11,500
9,200
280,000
- - 280,000 372,520 159,850 - 30,000 - -
47,265
24,000
- - - 47,265 - - 24,000 - -
303,411
24,000
49,500
11,000
8,800
411,250
- - 411,250 303,411 69,300 - 24,000 - -
1,462,624
27,000
168,750 84,375 180,000
66,000
168,750 84,375 180,000 1,462,624 66,000 - 27,000 - -
117,165
27,000
- - - 117,165 - - 27,000 - -
932,996
18,000
13,500
33,000
66,000
- - - 932,996 99,000 - 18,000 - 13,500
168,750 84,375 ### 3,748,809 503,400 - 285,000 - 13,500

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
6,750
- - - - - - - 6,750 - - -
- - - - - - - 6,750 - - -
27,000
- - - - 27,000 - - - - -
- - - - - - - - - -
27,000
- - - - - - - - - 27,000
- - - - - - - - - -
18,000
- - - - - 18,000 - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
6,750
- - - - - - - - 6,750 -
- - - - 27,000 18,000 - - 6,750 27,000

Diet Ambulance
138,801
108,000 600,000 (600,000)
85,000
105,000
108,000 - - - - - 928,801 (600,000) -
423,775
144,000 800,000
51,750
9,200
11,500
36,800
315,000
220,000
1,930,000
144,000 - - - - - 3,798,025 - -
55,252
72,000 400,000 (400,000)
30,000
105,000
72,000 - - - - - 590,252 (400,000) -
397,520
72,000 400,000
55,000
51,750
4,600
20,700
20,700
20,700
20,700
11,500
9,200
315,000
1,930,000
110,000
72,000 - - - - - 3,367,370 - -
62,265
60,000 248,000 (248,000)
45,000
75,000
60,000 - - - - - 430,265 (248,000) -
328,411
60,000 248,000
300,000
49,500
11,000
8,800
225,000
1,711,250
90,000
60,000 - - - - - 2,971,961 - -
1,487,624
63,000 261,000
55,000
2,830,000
105,000
66,000
63,000 - - - - - 4,804,624 - -
132,165
63,000 261,000 (261,000)
90,000
120,000
63,000 - - - - - 603,165 (261,000) -
987,996
42,000 174,000
120,000
33,000
66,000
20,000
35,000
42,000 - - - - - 1,435,996 - -
684,000 - - - - - 18,930,459 (1,509,000) -

Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
138,801
-
85,000
105,000
- - - 328,801
423,775
800,000
51,750
9,200
11,500
36,800
315,000
220,000
1,930,000
- - - 3,798,025
55,252
-
30,000
105,000
- - - 190,252
397,520
400,000
55,000
51,750
4,600
20,700
20,700
20,700
20,700
11,500
9,200
315,000
1,930,000
110,000
- - - 3,367,370
62,265
-
45,000
75,000
- - - 182,265
328,411
248,000
300,000
49,500
11,000
8,800
225,000
1,711,250
90,000
- - - 2,971,961
1,487,624
261,000
55,000
2,830,000
105,000
66,000
- - - 4,804,624
132,165
-
90,000
120,000
- - - 342,165
987,996
174,000
120,000
33,000
66,000
20,000
35,000
- - - 1,435,996
- - - 17,421,459
-
-
-
-
-
-
-
-
-
-
Mei 2012
5/22/2012
Dokter Obgyn
Ratna
1 Eti Sumiyati, Ny 25,000

Kelas 3 2 hari 2,000 112,000
Hematologi lengkap
per vaginum 600,000 525,000
visite 10,000 60,000
27,000 1,017,000 1,170,000
2 Eti Sumiyati, By 15,000

Kelas 3 2 hari 2,000 112,000
visite 10,000 60,000
resusitasi 46,500
17,000 168,500 60,000
44,000 1,185,500 1,230,000

- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Askep
Ruangan Ratna Gugah
391,684
18,000
66,000
275,312
- - 275,312 391,684 66,000 - 18,000 - -
45,602
18,000
- - - 45,602 - - 18,000 - -
- - 275,312 437,286 66,000 - 36,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - -
13,500
- - - - 13,500 - - - - -
- - - - 13,500 - - - - -
Diet Ambulance
416,684
42,000 174,000
66,000
700,000 (150,000)
180,000
1,400,312
70,000
42,000 - - - - - 3,006,996 (150,000) -
60,602
42,000 174,000 (174,000)
70,000
60,000
-
42,000 - - - - - 364,602 (174,000) -
-
84,000 - - - - - 3,371,598 (324,000) -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
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-
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-
-
-
-
-
-
-
-
-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
416,684
174,000
66,000
550,000
180,000
1,400,312
70,000
- - - 2,856,996
60,602
-
70,000
60,000
-
- - - 190,602
-
- - - 3,047,598
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
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-
-
-
-
-
-
-
-
-
-
-
-
-
Mei 2012
5/23/2012
Dokter Obgyn
Ratna
1 Yuliana, Ny 25,000
Kelas VVIP 7 hari 35,000 2,100,000
visite 35,000 490,000
60,000 2,234,000 490,000
2 Yuliana, By 20,000 5,000

Perinatologi 6 hari 12,000 480,000
billirubin total
billirubin direct-indirect
hematologi lengkap
golongan darah
infant warmer 200,000
visite 25,000
32,000 710,000 -
3 Sri Sejati 25,000 5,000

Kelas 3 2 hari 2,000 112,000
visite 10,000
kreatijnin
sgpt
sgot
abdomen bno
urine rutin
ureum
glukosa sewaktu
hematologi lengkap
27,000 127,000 -
4 M. Usman Maulana 25,000 5,000

Kelas 3 12 hari 12,000 672,000
trombosit
visite 55,000
hematologi lengkap
thorx anak
hematologi rutin
37,000 732,000 -
5 Siti Maryani 25,000

Kelas 3 2 hari 2,000 112,000
usg 15,000 40,000
visite 5,000 30,000
27,000 387,000 550,000
6 Saatul Lailiyah 15,000

Kelas 3 2 hari 2,000 112,000
resusitasi 46,500
visite 5,000
17,000 163,500 -
7 Saatul Lailiyah 20,000 5,000 50,000

Kelas 3 2 hari 2,000 112,000
hematologi lengkap
per vaginum 600,000 525,000
visite 10,000 60,000
hbs ag
golongan darah
22,000 772,000 770,000
222,000 5,125,500 1,810,000

- - - - - - - - -
50,000
160,000
- - 210,000 - - - - - -
- - - - - - - - -
300,000
- - 300,000 - - - - - -
- - - - - - - - -
30,000
- - 30,000 - - - - - -
- - - - - - - - -
- - 540,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
60,000
60,000 - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
60,000 - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
20,000
- - - - - 20,000 - - - -
25,000
- - - - - - - - 25,000 -
25,000
15,000
- - - - - 15,000 - - 25,000 -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - 35,000 - - 50,000 -
Askep
Ruangan Ratna Gugah
847,596
147,000
- - - 847,596 - - 147,000 - -
219,513
72,000
80,100
160,200
69,000
11,500
- - - 219,513 320,800 - 72,000 - -
508,470
18,000
19,800
19,800
19,800
66,000
22,000
19,800
15,400
66,000
- - - 508,470 182,600 66,000 18,000 - -
1,802,127
108,000
22,000
396,000
60,500
70,400
- - - 1,802,127 488,400 60,500 108,000 - -
67,500 385,833
18,000
225,000
- 67,500 225,000 385,833 - - 18,000 - -
47,265
18,000
- - - 47,265 - - 18,000 - -
348,525
18,000
132,000
118,750
49,500
11,000
- - 118,750 348,525 192,500 - 18,000 - -
- 67,500 343,750 4,159,329 1,184,300 126,500 399,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
36,000
- - - 36,000 - - - - - -
50,000 50,000
- - - - 50,000 - - 50,000 - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
13,500
- - - - - - - 13,500 - -
- - - - - - - - - -
- - - 36,000 50,000 - - 63,500 - -

Diet Ambulance
61,500 934,096
385,000 2,667,000 (400,050)
135,000
525,000
385,000 61,500 - - - - 4,261,096 (400,050) -
294,513
180,000 744,000 (180,000)
80,100
160,200
69,000
11,500
300,000
205,000
180,000 - - - - - 1,864,313 (180,000) -
563,470 (25,000)
42,000 174,000
70,000
19,800
19,800
19,800
66,000
22,000
19,800
15,400
66,000
-
42,000 - - - - - 1,056,070 (25,000) -
-
12,000 1,869,127
252,000 1,044,000
22,000
370,000
396,000
60,500
70,400
252,000 12,000 - - - - 3,832,027 - -
478,333
42,000 174,000
925,000
55,000
35,000
35,000
42,000 - - - - - 1,702,333 - -
62,265
42,000 174,000 (174,000)
60,000
35,000
42,000 - - - - - 331,265 (174,000) -
423,525
42,000 174,000
132,000
180,000
1,243,750
70,000
49,500
11,000
42,000 - - - - - 2,283,775 - -
985,000 73,500 - - - - 15,330,879 (779,050) -

-
-
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-
-
-
-
-
-
-
-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
939,270
939,270 - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
939,270 - - - - -
Jumlah Bayar
934,096
2,266,950
135,000
525,000
- - - 3,861,046
294,513
564,000
80,100
160,200
69,000
11,500
300,000
205,000
- - - 1,684,313
(400,800) ;
174,000
70,000
19,800
19,800
19,800
66,000
22,000
19,800
15,400
66,000
- - - 91,800
1,869,127
1,044,000
22,000
370,000
396,000
60,500
70,400
- - - 3,832,027
478,333
174,000
925,000
55,000
35,000
35,000
- - - 1,702,333
62,265
-
60,000
35,000
- - - 157,265
423,525
174,000
132,000
180,000
1,243,750
70,000
49,500
11,000
- - - 2,283,775
- - - 13,612,559
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
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-
-
Mei 2012
5/24/2012
Dokter Obgyn
Ratna
1 Patrokha
Kelas 3 4 hari 4,000 224,000
resusitasi
visite 45,000 120,000
paket sc
diluar paket sc
tubektomi 75,000 101,250
ekg 15,000 22,500
usg 15,000 40,000
4,000 1,374,000 1,183,750
2 Rustiningsih
Kelas 3 4 hari 4,000 224,000
resusitasi
visite 30,000 90,000
paket sc
diluar paket sc
usg 15,000 40,000
4,000 1,274,000 1,060,000
3 Dyah Ayu Yuliana

Kelas 3 4 hari 4,000 224,000
resusitasi
visite 30,000 90,000
paket sc
diluar paket sc
4,000 1,259,000 1,020,000
4 Siti Arofah Hidayah 25,000

Kelas 3 4 hari 4,000 224,000
hbs ag
golongan darah
hematologi lengkap
visite 15,000 90,000
29,000 1,590,500 963,750
5 Siti Arofah Hidayah 15,000

Kelas 3 4 hari 4,000 224,000
resusitasi 30,000
visite 15,000
49,000 239,000 -
6 Zaskia Elisawati 25,000 5,000

Kelas 3 2 hari 2,000 112,000
visite 5,000
widal
hematologi lengkap
27,000 122,000 -
7 Khotimah/Fatimah 15,000
Kelas 3 2 hari 2,000 112,000
visite 5,000
konsultasi 5,000
cranium
17,000 122,000 -
8 Nur Aliyah 25,000 5,000

Kelas 3 2 hari 2,000 112,000
visite 10,000 60,000
glukosa sewaktu
hematologi lengkap
27,000 127,000 60,000
9 Atikah, By 25,000
Kelas 3 3 hari 3,000 168,000
resusitasi 46,500
visite 15,000
28,000 229,500 -
10 Atikah, Ny 25,000
Kelas 3 3 hari 3,000 168,000
usg 15,000 40,000
ecg 30,750
per vaginum 600,000 525,000
visite 15,000 90,000
hbs ag
protein urine
ureum
kreatinin
sgpt
sgot
hematologi lengkap
golongan darah
28,000 920,250 790,000
11 Suharti, By 25,000
Kelas 3 1 hari 1,000 56,000
visite 5,000
resusitasi 46,500
26,000 107,500 -
12 Suharti, Ny 25,000
Kelas 3 2 hari 2,000 112,000
hematologi lengkap
per vaginum 600,000 525,000
visite 10,000 60,000
27,000 767,000 720,000
13 Siti Kholilah, By 15,000

Kelas 3 1 hari 1,000 56,000
visite 5,000
resusitasi 46,500
16,000 107,500 -
14 Siti Kholilah 25,000

Kelas 3 2 hari 2,000 112,000
usg 15,000 40,000
visite 10,000 60,000
per vaginum 600,000 525,000
27,000 782,000 760,000
313,000 9,021,250 6,557,500

80,000
90,000
- - 170,000 - - - - - -
80,000
90,000
- - 170,000 - - - - - -
80,000
90,000
- - 170,000 - - - - - -
- - - - - - - - -
90,000
90,000
- - 180,000 - - - - - -
30,000
- - 30,000 - - - - - -
30,000
30,000
- - - - - - 60,000 - -
- - - - - - - - -
90,000
- - 90,000 - - - - - -
- - - - - - - - -
30,000
- - 30,000 - - - - - -
- - - - - - - - -
30,000
- - 30,000 - - - - - -
- - - - - - - - -
- - 870,000 - - - 60,000 - -
60,000
60,000 - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
60,000 - - - - - - - - -
Dokter Umum
Anestesi
250,000
- - - - - - - - - 250,000
250,000
- - - - - - - - - 250,000
250,000
- - - - - - - - - 250,000
253,125
- - - - - - - - - 253,125
- - - - - - - - - -
25,000
- - - - - - - - 25,000 -
- - - - - - - - - -
25,000
- - - - - - - - 25,000 -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - 50,000 ###
Askep
Ruangan Ratna Gugah
36,000
125,000 75,000
1,000,000 99,000
301,202 149,500
125,000 75,000 - 1,301,202 248,500 - 36,000 - -
36,000
125,000 75,000
1,000,000 99,000
279,839 66,000
125,000 75,000 - 1,279,839 165,000 - 36,000 - -
36,000
125,000 75,000
1,000,000 99,000
325,731 66,000
125,000 75,000 - 1,325,731 165,000 - 36,000 - -
1,428,195
36,000
49,500
11,000
66,000
168,750 84,375 180,000
168,750 84,375 180,000 1,428,195 126,500 - 36,000 - -
124,842
36,000
- - - 124,842 - - 36,000 - -
491,730
18,000
33,000
66,000
- - - 491,730 99,000 - 18,000 - -
574,163
18,000
132,000
- - - 574,163 - 132,000 18,000 - -
227,919
18,000
15,400
66,000
- - - 227,919 81,400 - 18,000 - -
47,265
27,000
- - - 47,265 - - 27,000 - -
620,250
27,000
275,312
49,500
4,400
19,800
19,800
19,800
19,800
132,000
11,000
- - 275,312 620,250 276,100 - 27,000 - -
47,265
9,000
13,500
- - - 47,265 - - 9,000 13,500 -
402,098
18,000
66,000
275,312
- - 275,312 402,098 66,000 - 18,000 - -
113,402
9,000
- - - 113,402 - - 9,000 - -
347,533
18,000
275,312
- - 275,312 347,533 - - 18,000 - -
543,750 309,375 ### 8,331,434 1,227,500 132,000 342,000 13,500 -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
6,750
- - - - - - - - - 6,750 -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - 6,750 -
Diet
84,000
- - - - - - - - - - 84,000
84,000
- - - - - - - - - - 84,000
84,000
- - - - - - - - - - 84,000
84,000
13,500
- - - - - - - - 13,500 - 84,000
84,000
- - - - - - - - - - 84,000
42,000
- - - - - - - - - - 42,000
42,000
- - - - - - - - - - 42,000
42,000
- - - - - - - - - - 42,000
63,000
13,500
- - - - - - - 13,500 - - 63,000
63,000
13,500
- - - - - - - 13,500 - - 63,000
21,000
- - - - - - - - - - 21,000
42,000
- - - - - - - - - - 42,000
21,000
13,500
- - - - - 13,500 - - - - 21,000
42,000
- - - - - - - - - - 42,000
- - - - - 13,500 - 27,000 13,500 - 798,000

Diet Ambulance
-
348,000
2,350,000
80,000
315,000
1,099,000
450,702
176,250
37,500
55,000
- - - - - 4,911,452 - - -
-
-
348,000
2,350,000
80,000
210,000
1,099,000
345,839
35,000
55,000
- - - - - 4,522,839 - - -
-
348,000
2,350,000
80,000
210,000
1,099,000
391,731
35,000
- - - - - 4,513,731 - - -
1,453,195
348,000
35,000
49,500
11,000
66,000
105,000
60,000
2,830,000
- - - - - 4,957,695 - - -
-
139,842
348,000 (348,000)
120,000
105,000
-
- - - - - 712,842 (348,000) - -
546,730
174,000
35,000
33,000
66,000
- - - - - 854,730 - - -
589,163
174,000
35,000
35,000
132,000
- - - - - 965,163 - - -
282,919 (25,000) 566,517

174,000
70,000
15,400
66,000
- - - - - 608,319 (25,000) - 566,517
72,265
261,000 (261,000)
60,000
105,000
- - - - - 498,265 (261,000) - -
645,250
261,000
55,000
37,500
180,000
1,400,312
60,000
105,000
49,500
4,400
19,800
19,800
19,800
19,800
132,000
11,000
- - - - - 3,020,162 - - -
72,265 (10,000)
87,000 (87,000)
35,000
60,000
- - - - - 254,265 (97,000) - -
427,098
174,000
180,000
66,000
1,400,312
70,000
-
- - - - - 2,317,410 - - -
-
128,402
87,000 (87,000)
35,000
60,000
- - - - - 310,402 (87,000) - -
372,533
174,000
55,000
70,000
180,000
1,400,312
- - - - - 2,251,845 - - -
- - - - - 30,699,120 (818,000) - 566,517

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
-
348,000
2,350,000
80,000
315,000
1,099,000
450,702
176,250
37,500
55,000
- - 4,911,452
-
348,000
2,350,000
80,000
210,000
1,099,000
345,839
35,000
55,000
- - 4,522,839
-
348,000
2,350,000
80,000
210,000
1,099,000
391,731
35,000
- - 4,513,731
1,453,195
348,000
35,000
49,500
11,000
66,000
105,000
60,000
2,830,000
- - 4,957,695
139,842
-
120,000
105,000
-
- - 364,842
546,730
174,000
35,000
33,000
66,000
- - 854,730
589,163
174,000
35,000
35,000
132,000
- - 965,163
(308,598)
174,000
70,000
15,400
66,000
- - 16,802
72,265
-
60,000
105,000
- - 237,265
645,250
261,000
55,000
37,500
180,000
1,400,312
60,000
105,000
49,500
4,400
19,800
19,800
19,800
19,800
132,000
11,000
- - 3,020,162
62,265
-
35,000
60,000
- - 157,265
427,098
174,000
180,000
66,000
1,400,312
70,000
-
- - 2,317,410
-
128,402
-
35,000
60,000
-
- - 223,402
-
372,533
174,000
55,000
70,000
180,000
1,400,312
-
- - 2,251,845
-
- - 29,314,603
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Mei 2012
5/25/2012
Dokter Obgyn
Ratna
1 Yeni Liswanti 25,000

Kelas 2 3 har 6,000 240,000
per vaginum 600,000 700,000
visite 15,000 120,000
31,000 900,000 1,000,000
2 Yeni Liswanti, By 15,000

Kelas 2 2 hari 4,000 160,000
resusitasi 57,000
visite 15,000
19,000 232,000 -
3 Prinsis Dian Primandika 20,000 5,000 50,000

Kelas 2 3 hari 6,000 240,000
per vaginum 600,000 700,000
visite 15,000 120,000
hbs ag
hematologi lengkap
golongan darah
26,000 965,000 1,290,000
4 Prinsis Dian Primandika 15,000

Kelas 2 3 hari 6,000 240,000
resusitasi 57,000
visite 15,000
21,000 312,000 -
5 Leli Fitriatun 15,000

Kelas 3 2 hari 2,000 112,000
visite 5,000
resusitasi 46,500
17,000 163,500 -
6 Leli Fitriatun 15,000 5,000

Kelas 3 2 hari 2,000 112,000
per vaginum 600,000 525,000
visite 5,000 30,000
17,000 832,000 900,000
7 Nur Hidayati Rohmah 15,000

Kelas 3 2 HARI 2,000 112,000
resusitasi 15,000
visite 10,000
17,000 137,000 -
8 Nur Hidayati Rohmah 25,000

Kelas 3 2 HARI 2,000 112,000
usg 15,000 40,000
per vaginum 600,000 525,000
visite 10,000 60,000
hbs ag
hematologi lengkap
golongan darah
27,000 797,000 805,000
9 Masitoh 25,000
Kelas 3 2 hari 2,000 112,000
biaya PA
usg 15,000 40,000
visite 10,000 60,000
businasi/laminaria 15,000 45,000
hbs ag
hematologi lengkap
golongan darah
27,000 402,000 595,000
202,000 4,740,500 4,590,000

- - - - - - - - -
80,000
- - 80,000 - - - - - -
- - - - - - - - -
120,000
- - 120,000 - - - - - -
30,000
- - 30,000 - - - - - -
- - - - - - - - -
45,000
60,000
- - 105,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - 335,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
20,000
- 20,000 - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
15,000
- 15,000 - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- 35,000 - - - - - - - -
Askep
Ruangan Ratna Gugah
408,812
36,000
411,250
- - 411,250 408,812 - - 36,000 - -
47,265
24,000
- - - 47,265 - - 24,000 - -
489,414
36,000
411,250
49,500
66,000
11,000
- - 411,250 489,414 126,500 - 36,000 - -
47,265
36,000
- - - 47,265 - - 36,000 - -
47,265
18,000
- - - 47,265 - - 18,000 - -
305,319
18,000
275,312
- - 275,312 305,319 - - 18,000 - -
115,475
18,000
- - - 115,475 - - 18,000 - -
258,072
18,000
118,750
49,500
132,000
11,000
- - 118,750 258,072 192,500 - 18,000 - -
67,500 461,046
18,000
240,000
225,000
49,500
66,000
11,000
- 67,500 225,000 461,046 366,500 - 18,000 - -
- 67,500 ### 2,179,933 685,500 - 222,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
90,000
- - - - - - - - - - 90,000
60,000
18,000
- - - - - - - 18,000 - - 60,000
90,000
- - - - - - - - - - 90,000
90,000
18,000
- - - - - - - - - 18,000 90,000
42,000
13,500
- - - - - - - 13,500 - - 42,000
42,000
- - - - - - - - - - 42,000
42,000
- - - - - - - - - - 42,000
42,000
- - - - - - - - - - 42,000
42,000
- - - - - - - - - - 42,000
- - - - - - - 31,500 - 18,000 540,000

Diet Ambulance
433,812
372,000
225,000
1,711,250
135,000
- - - - - 2,877,062 - - -
62,265
248,000 (248,000)
75,000
115,000
- - - - - 500,265 (248,000) - -
564,414
372,000
300,000
225,000
1,711,250
135,000
49,500
66,000
11,000
- - - - - 3,434,164 - - -
62,265
372,000 (372,000)
75,000
135,000
- - - - - 644,265 (372,000) - -
62,265
174,000 (174,000)
35,000
60,000
- - - - - 331,265 (174,000) - -
340,319
174,000
35,000
240,000
180,000
1,400,312
35,000
- - - - - 2,404,631 - - -
130,475
174,000 (174,000)
60,000
70,000
- - - - - 434,475 (174,000) - -
283,072
174,000
55,000
240,000
1,243,750
70,000
49,500
132,000
11,000
- - - - - 2,258,322 - - -
553,546
174,000
240,000
55,000
70,000
925,000
60,000
49,500
66,000
11,000
- - - - - 2,204,046 - - -
- - - - - 15,088,495 (968,000) - -
-
Piutang
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
Jumlah Bayar
Asuransi Lain ybs
433,812
372,000
225,000
1,711,250
135,000
- - 2,877,062
62,265
-
75,000
115,000
- - 252,265
564,414
372,000
300,000
225,000
1,711,250
135,000
49,500
66,000
11,000
- - 3,434,164
62,265
-
75,000
135,000
- - 272,265
62,265
-
35,000
60,000
- - 157,265
340,319
174,000
35,000
240,000
180,000
1,400,312
35,000
- - 2,404,631
130,475
-
60,000
70,000
- - 260,475
283,072
174,000
55,000
240,000
1,243,750
70,000
49,500
132,000
11,000
- - 2,258,322
553,546
174,000
240,000
55,000
70,000
925,000
60,000
49,500
66,000
11,000
- - 2,204,046
- - 14,120,495
-
-
-
-
-
-
-
###
Mei 2012
Dokter Obgyn
No. Tanggal Admin JS
Ratna Herlambang Zufrial Arif
4/26/2012 231,000 7,028,000 4,025,000 - -

4/27/2012 23,000 1,152,750 823,500 - -
4/28/2012 199,000 7,150,500 4,966,000 140,000 -
4/29/2012 144,000 3,116,500 1,823,750 - -
4/30/2012 326,000 8,841,000 5,781,250 - -
5/1/2012 273,000 5,956,000 2,150,000 - -
5/2/2012 219,000 6,358,000 2,910,000 - -
5/3/2012 128,000 3,773,250 1,705,000 - -
5/4/2012 133,000 3,423,500 1,635,000 - -
5/5/2012 71,000 4,408,000 3,660,000 - -
5/6/2012 332,000 8,405,000 6,662,500 - -
5/7/2012 197,000 1,940,000 610,000 - -
5/8/2012 123,000 3,684,150 - - -
5/9/2012 85,000 1,085,800 70,000 - -
5/10/2012 154,000 7,173,750 4,187,500 - -
5/11/2012 259,000 6,273,500 4,102,500 - -
5/12/2012 129,000 1,977,500 1,325,000 - -
5/13/2012 230,000 5,422,000 3,085,000 - -
5/14/2012 152,000 2,484,650 720,000 - -
5/15/2012 248,000 5,271,000 4,403,500 - -
5/16/2012 308,000 10,276,650 5,586,000 - -
5/17/2012 74,000 1,946,000 933,750 - -
5/18/2012 210,000 4,742,250 3,763,000 - -
5/19/2012 222,000 5,620,250 3,730,000 - -
5/20/2012 158,000 3,817,892 2,801,250 - -
5/21/2012 229,000 6,145,000 5,203,750 - -
5/22/2012 44,000 1,185,500 1,230,000 - -
5/23/2012 222,000 5,125,500 1,810,000 - -
5/24/2012 313,000 9,021,250 6,557,500 - -
5/25/2012 202,000 4,740,500 4,590,000 - -
5,638,000 147,545,642 90,850,750 140,000 -
1,665,000
333,000
1,332,000
Dokter Anak Dokter Bedah Dokter Internis
Bambang S Chanis Fajar Zumaro Willy Eko Djalu Iman Darjito Maretina
200,000 120,000 330,000 - - - - 120,000

- - - - - - - -
210,000 - - - 382,500 - - 550,000
180,000 - - - - - - 60,000
490,000 - - - - - - 70,000
795,000 125,000 - - - - - -
335,000 - 300,000 - - - - 105,000
- - - 1,495,000 - - - 205,000
- 60,000 - 1,654,000 - - - 100,000
215,000 220,000 - - - - - -
265,000 380,000 - - - - - 90,000
120,000 305,000 - 60,000 - - - -
- - - - - - 510,000 240,000
- - - - - - - 210,000
590,000 - - - 1,102,500 - - -
480,000 - - - - - - -
315,000 - - - - - - -
700,000 - - - 75,000 - 90,000 140,000
195,000 - - - - - 180,000 -
285,000 - 125,000 - - - - -
905,000 - - - - 1,132,500 - 90,000
180,000 - - - - - - 105,000
175,000 - - - 30,000 - - -
615,000 - - - - - - 75,000
220,000 - - - 25,000 - - -
240,000 - - - - - 30,000 -
- - - - - - - -
540,000 - - - - - - 60,000
870,000 - - - 60,000 - - 60,000
335,000 - - - - - - -
9,455,000 1,210,000 755,000 3,209,000 1,675,000 1,132,500 810,000 2,280,000

Dokter Gigi Dokter Syaraf Anestesi Orthoped Psiko Rad
Dian W Sangkan Fachri Uzer Anton Soemartono Arif Wahyu Dana Alip Djalil
- - - - 20,000 - - - - -
- - - - - - - - - -
- - - - - 50,000 - - - -
- - - - - - - - - -
- - - - - - - - - 25,000
- - - - - - - - - 25,000
- - - - - - - - - 25,000
- - - - - 50,000 - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - 180,000 - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - 30,000 30,000 - - 25,000
- - - - - - - - - -
- - - - - - - - - 25,000
- - - - - - - - - -
- - - - - - - - - -
- - 90,000 - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - 30,000 - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - 90,000 - 200,000 ### 30,000 - - 125,000

Dokter Umum
Anestesi
Boeing Nurbaity Teguh I Made Kholid Windy Dewi Aros
50,000 - - - 25,000 - - - 655,000

- - - - - - - - 202,500
- - - 25,000 - - 25,000 - 911,250
- 30,000 - - - - - 45,000 253,125
25,000 15,000 - - - - - 50,000 759,375
25,000 30,000 - 25,000 25,000 - - 50,000 -
25,000 - - - - - - 25,000 135,000
25,000 - - 25,000 - - - - 405,000
- 25,000 - - - - - - 405,000
- - - - - - - - 500,000
- - - - 25,000 - - - 756,250
25,000 - - 50,000 25,000 - - 25,000 -
- 80,000 - - - - - - -
25,000 - - - 25,000 - - - -
- 15,000 - - 15,000 - - - 1,060,000
- 25,000 ### - - - - - 506,250
- - ### 25,000 - - - - -
25,000 - - 50,000 - - - - 337,500
50,000 - - - - - - 25,000 -
25,000 - - - - - 50,000 25,000 405,000
- 25,000 ### - - - - 25,000 894,375
- - - - 25,000 - - - 253,125
- - - - - 40,000 25,000 - 202,500
- 25,000 - - - 15,000 - 25,000 -
- - - - 40,000 25,000 - - 250,000
- - ### - 65,000 25,000 - - 253,125
- - - - - - - - -
- - - - 35,000 - - 50,000 -
- - - - - - - 50,000 1,003,125
35,000 - - - - - - - -
335,000 270,000 ### 200,000 305,000 105,000 100,000 395,000 10,147,500

Askep
Ruangan Ratna
395,000 311,250 350,312 7,634,671 1,357,000 69,000 357,000 -

205,875 67,500 - 1,017,916 373,000 - 27,000 -
607,500 461,250 575,312 7,453,252 1,145,850 - 327,000 -
168,750 84,375 455,312 3,364,418 458,700 - 159,000 -
506,250 253,125 1,379,375 7,610,154 540,100 - 429,000 -
- 67,500 550,624 6,528,520 715,400 - 462,000 -
90,000 225,000 450,312 5,482,745 556,200 66,000 375,000 -
270,000 135,000 608,125 4,886,636 642,250 - 189,000 -
270,000 270,000 275,312 5,362,530 695,150 138,000 180,000 -
250,000 150,000 608,125 3,180,695 298,050 - 183,000 -
462,500 401,250 1,275,312 9,026,678 1,027,900 - 456,000 -
- - - 3,686,917 720,300 528,000 255,000 -
- - - 5,067,853 360,800 138,000 252,000 ###
- - - 2,075,585 347,000 152,500 81,000 -
665,000 480,000 360,000 8,350,312 684,100 - 237,000 -
337,500 168,750 910,624 4,572,086 532,400 66,000 306,000 -
- 67,500 275,312 2,703,870 267,300 - 147,000 -
225,000 112,500 1,865,000 5,697,107 576,750 - 342,000 -
- - 275,312 3,475,325 654,400 66,000 171,000 -
270,000 270,000 1,528,925 4,445,915 560,900 - 264,000 -
556,250 298,125 1,131,562 10,063,802 1,029,850 66,000 537,000 ###
168,750 84,375 180,000 2,606,489 107,800 - 81,000 -
135,000 135,000 916,250 5,121,534 620,500 66,000 276,000 -
- 135,000 1,032,187 3,700,544 522,650 - 297,000 -
125,000 142,500 500,312 2,589,762 195,800 69,000 147,000 -
168,750 84,375 1,151,250 3,748,809 503,400 - 285,000 -
- - 275,312 437,286 66,000 - 36,000 -
- 67,500 343,750 4,159,329 1,184,300 126,500 399,000 -
543,750 309,375 1,005,936 8,331,434 1,227,500 132,000 342,000 ###
- 67,500 1,441,562 2,179,933 685,500 - 222,000 -
6,420,875 4,848,750 19,721,415 144,562,107 18,656,850 ### 7,821,000 ###

- - - 13,500 - - - - - - -
- - - - - - - - - - -
- - - - - - 27,000 - 13,500 - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - ### 63,000 - - - -
27,000 6,750 - - ### - - 54,000 - - 27,000
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - 15,600 - ### - - - 27,000 13,500
- 15,600 - - - ### - - - - -
- - - - - - - - - - 6,750
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - ### - - - - - -
- - - - - - - - - 13,500 -
- - - - - - - - - - 6,750
- - - - - - - - - - -
- - - 6,750 - - - - - - -
- - - 6,750 - - - - - - -
- - - - - - - - - - -
13,500 - - - - - - - 6,750 - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - 6,750
- - - - - - - - - - -
40,500 22,350 - 42,600 ### ### 90,000 54,000 20,250 40,500 60,750
Koticha Aisah Ana Eny Endang Pipit Suci Dinda Tika Retno
- - - - - 13,500 - - - -
- - 6,750 - - - - - - -
- - - - - 13,500 - 13,500 50,000 50,000
- - - - - - - - - -
- - - 27,000 - - - - 27,000 54,000
- - - - - 13,500 - 13,500 - -
- - - - - - - 13,500 - -
- - 27,000 - - - - - - -
- - - - - - - 13,500 - -
- - - - - - - - - 27,000
- - - - 27,000 13,500 27,000 - - -
- - - - - - - - - -
47,250 ### - - - - - - - -
- - - - - - - - - -
- - - 13,500 - - - - 13,500 -
- - - 13,500 - - 13,500 - - -
- - - - - 13,500 - - - -
- - - 18,000 - - - 36,000 - -
- - - - - - 13,500 - - -
- - - 4,500 - - - 27,000 - -
- - - - - 13,500 18,000 18,000 31,500 -
- - - - 4,500 - 13,500 - - -
- - - 27,000 - - - - 13,500 -
- - - - - 13,500 - - - 27,000
- - - - - - - - 13,500 -
- - - - - 27,000 18,000 - - 6,750
- - - - - 13,500 - - - -
- - - - 36,000 50,000 - - 63,500 -
- - - - - - 13,500 - 27,000 13,500
- - - - - - - - 31,500 -
47,250 ### 33,750 103,500 67,500 185,000 117,000 135,000 271,000 178,250
Diet Ambulance
Rujukan Lain-Lain Total Keringanan
Wulan Rawat Inap Ekstra BBM Sopir
- 870,000 78,000 - - - - 24,253,233 (795,602)
- 63,000 - - - - - 3,962,791 -
- 747,000 42,000 - - - - 26,135,914 (122,000)
13,500 375,000 - - - - - 10,731,430 (547,000)
- 1,044,000 22,000 45,000 25,000 - - 28,344,629 (2,797,000)
- 1,098,000 - - - - - 18,928,044 (547,000)
- 931,000 74,000 - - - 420,000 19,215,257 (1,036,900)
- 456,000 - - - - - 15,153,511 -
- 426,000 - - - - - 15,065,992 (174,000)
- 435,000 - 45,000 25,000 - - 14,275,870 (800,000)
40,500 1,083,000 - - - - - 30,936,390 (1,872,000)
- 615,000 - 180,000 - - - 9,342,217 (127,000)
- 618,000 159,000 - - - - 11,426,153 (500,500)
- 198,000 16,500 - - - - 4,487,585 (229,650)
- 555,000 - 45,000 25,000 - - 25,732,912 (856,000)
13,500 714,000 - 45,000 25,000 - - 19,439,110 (1,218,000)
- 351,000 - - - - - 7,621,982 (199,000)
- 856,000 37,000 - - - - 19,919,857 (1,868,300)
- 411,000 31,000 - - - - 9,016,537 (287,200)
- 627,000 - - - - - 18,849,240 (210,000)
4,500 1,311,000 69,000 120,000 - - - 34,557,964 (2,794,950)
- 189,000 - 70,000 - - - 7,022,289 (286,000)
18,000 663,000 3,000 120,000 - - - 17,339,284 (711,149)
- 735,000 57,000 - - - - 16,853,881 (828,900)
4,500 348,000 - 60,000 - - - 11,532,516 (736,000)
27,000 684,000 - - - - - 18,930,459 (1,509,000)
- 84,000 - - - - - 3,371,598 (324,000)
- 985,000 73,500 - - - - 15,330,879 (779,050)
- 798,000 - - - - - 30,699,120 (818,000)
18,000 540,000 - - - - - 15,088,495 (968,000)
-
139,500 18,810,000 662,000 730,000 ### - 420,000 503,565,139 (23,942,201)
Piutang
DP
Jamsostek Garda Medika Jamkesmas Jasa Raharja Relife Bringin Pos Indonesia
- 1,443,745 - - - - - -
- - - - - - - -
- 1,500,536 - - - - - -
- 879,709 - - - - - -
- - - - - - - -
2,000,000 1,063,659 - - - - - -
(2,000,000) 867,802 - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- 1,200,912 - - - - - -
- 1,264,114 - 1,438,494 - - - -
- 977,969 - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
5,000,000 1,275,078 - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- 1,247,052 - - - - - -
- 1,428,149 - - - - - -
- - - - - - - -
- 1,810,036 - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- 939,270 - - - - - -
- 566,517 - - - - - -
- - - - - - - -
5,000,000 16,464,548 - 1,438,494 - - - -

Jumlah Bayar
Asuransi Lain ybs
- - 22,013,886
- - 3,962,791
- 3,993,078 20,520,300
- (3,170,257) 12,474,978
- - 25,547,629
- - 19,317,385
- - 15,310,555
- (822,822) 15,976,333
- - 14,891,992
4,584,358 - 8,891,512
- - 27,863,478
- - 6,512,609
- - 9,947,684
- - 4,257,935
- - 24,876,912
- - 18,221,110
- - 11,147,904
- - 18,051,557
- - 8,729,337
- - 18,639,240
- - 30,515,962
- - 5,308,140
- - 16,628,135
- - 14,214,945
- - 10,796,516
- - 17,421,459
- - 3,047,598
- - 13,612,559
- - 29,314,603
- - 14,120,495
-
4,584,358 (1) 462,135,539
-
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REKAPITULASI PENDAPATAN RAWAT INAP
RSU ADELLA
Mei 2012
Periode : 26/04/2012 - 25/05/2012
1 Administrasi 5,638,000
2 Jasa Sarana 147,545,642
3 Jasa Medis 113,947,250
Spesialis Kandungan 90,990,750
dr. Ratna Trisiyani, Sp. OG 90,850,750
dr. Herlambang, Sp. OG 140,000
Spesialis Anak 11,420,000
dr. Bambang Susilo, Sp. A. 9,455,000
dr. Abdul Khanis, Sp. A 1,210,000
dr. Fajar Danu Aji, Sp. A 755,000
Spesialis Bedah 6,016,500
dr. Ahmad Zumaro, Sp. B 3,209,000
dr. Willy Yulianto, Sp. B 1,675,000
dr. Eko Djalu Atmanto, Sp. B 1,132,500
Spesialis Penyakit Dalam 3,090,000
dr. Iman Darjito, Sp. PD 810,000
dr. Maretina Wahyu Wiyati, Sp. P 2,280,000
Spesialis Syaraf 90,000
dr. Fachri Uzer, Sp. S 90,000
Spesialis Anestesi 360,000
dr. Soemartono, Sp. An. 200,000
dr. Arif Aminudin, Sp. An. 160,000
Spesialis Orthopedi 30,000
dr. Wahyu, Sp. B. Ot. 30,000
Dokter Umum 1,950,000
dr. HM Abdul Djalil, M. Kes. 125,000
dr. Boeing Dewantari 335,000
dr. Nurbaity 270,000
dr. Teguh Sukma Wibowo 115,000
dr. I Made Sutrisna 200,000
dr. Nur Kholid Effendi 305,000
dr. Windy Oliviani 105,000
dr. Dewi Awalia Ulfa 100,000
dr. Ahmad Rosidi 395,000
Anestesi 10,147,500
Ass. Operator 6,420,875
Ass. Anestesi 4,848,750
4 BAHP 19,721,415
5 Farmasi 144,562,107
6 Laboratorium 18,656,850
7 Radiologi 1,683,000
8 Asuhan Keperawatan 9,671,750
Ruangan 7,821,000
Ratna 60,600
Gugah 40,500
Arif 22,350
Suhati 42,600
Wiwik 35,850
Indra 78,600
Eko P 90,000
Andini 54,000
Roikhatul 20,250
Dewi 40,500
Candra 60,750
Koticha 47,250
Aisah 27,000
Ana 33,750
Eny 103,500
Endang 67,500
Pipit 185,000
Suci 117,000
Dinda 135,000
Tika 271,000
Retno 178,250
Wulan 139,500
9 Diet Pasien 19,472,000
Rawat Inap 18,810,000
Ekstra 662,000
10 Ambulance 830,000
BBM 730,000
Sopir 100,000
11 Rujukan -
RB & Klinik Adella -
12 Lain - Lain 420,000
13 Keringanan (23,942,201)
14 DP Pasien 5,000,000
15 Piutang 22,487,399
Jamsostek 16,464,548
Garda Medika -
Jamkesmas 1,438,494
Jasa Raharja -
Relife -
Bringin Life -
Pos Indonesia -
Asuransi Lain 4,584,358
Pasien (1)
TOTAL PENDAPATAN 462,135,539
Slawi, 02 Juni 2012
Dibuat oleh, Diperiksa oleh, Disetujui oleh,

Nina Lestari dr. Nurkholid Effendi dr. HM Abdul Djalil, M. Kes.
Keuangan Kabid Yanmed Direktur
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Rekap Pendapatan Rawat Inap

1 Yunaroh, Ny 20,000 5,000 50,000

28,000 545,000 250,000

2 Ahmad Yaser Arafat, An 25,000 5,000

3 Waryu, Ny 20,000 5,000 50,000

27,000 737,000 625,000

6 Tri Yuniati, Nn 25,000 5,000

7 Suslikha, Ny 20,000 5,000 50,000

22,000 392,000 600,000

8 Risnawati, Ny 20,000 5,000

9 Siti Afiatun Nafiah, Ny

3,000 1,198,000 990,000

231,000 7,028,000 4,025,000

- - 200,000 120,000 330,000 - - - -

- 50,000 - - - 25,000 - - - 655,000

- - - 768,387 104,400 - 36,000 - -

- - - 1,636,093 508,000 - 138,000 - -

- - 275,312 344,115 95,700 - 18,000 - -

- - - 330,016 68,200 - 18,000 - -

- 101,250 75,000 349,218 95,700 - 18,000 - -

- - - 1,104,105 83,600 - 36,000 - -

125,000 75,000 - 1,162,465 99,000 - 27,000 - -

395,000 311,250 350,312 7,634,671 1,357,000 69,000 357,000 - -

33,000 - - - - 1,854,787 (263,752) - -

45,000 - - - - 5,077,093 (332,850) - -

1,154,105 (25,000) 1,443,745

- - - - - 1,675,705 (25,000) - 1,443,745

78,000 - - - - 24,253,233 (795,602) - 1,443,745

1 Andang Susiyanti, Ny 20,000 5,000 50,000

23,000 1,152,750 823,500

23,000 1,152,750 823,500

205,875 67,500 - 1,017,916 373,000 - 27,000 - -

1 Eti Supriyanti, Ny 25,000 5,000

67,000 4,672,500 3,446,000

27,000 335,000 640,000

3 Abid Aqila Andi Pranaja, By 25,000 5,000

22,000 772,000 770,000

6 Kusniroh, Ny 20,000 5,000 50,000

22,000 633,500 110,000

199,000 7,150,500 4,966,000

140,000 - 210,000 - - - 382,500 - -

- - - - 25,000 - - 25,000 - 911,250

540,000 270,000 - 4,987,628 680,450 - 210,000 - -

- 90,000 300,000 345,221 - - 12,000 - -

- - - 612,891 118,800 - 60,000 - -

- - 275,312 272,730 130,900 - 18,000 - -

67,500 101,250 - 1,130,161 215,700 - 18,000 - -

607,500 461,250 575,312 7,453,252 1,145,850 - 327,000 - -

- - - - - - - 50,000 50,000 - 150,000

- - - - 13,500 - 13,500 50,000 50,000 - 747,000

667,891 (25,000) 1,500,536

- - - - - 1,911,691 (25,000) - 1,500,536

42,000 - - - - 26,135,914 (122,000) - 1,500,536

1 Eti Supriyanti, Ny Pelunasan

2 Erlina, Ny 25,000 5,000

3 Nur Faridah, By 15,000

4 Nur Faridah, Ny 25,000

29,000 1,544,000 963,750