Irna Feb

Rekap Pendapatan Rawat Inap
Januari 2012
1/26/2012
Dokter Obgyn
No. Nama Pasien Tindakan Admin JS
Ratna
1 Fenni Arsiani, Ny 25,000 5,000

Kelas vvip 7 hari 35,000 2,100,000
visite 30,000
jamsostek konsultasi 5,000
hematologi rutin
sgot
sgpt
glukosa sewaktu
widal
60,000 2,140,000 -
2 Yeti Nurul S, Ny 40,000

Kelas 1 4 hari 12,000 584,000
visite 15,000
hematologi rutin
golongan darah
hbs ag
sgot
sgpt
ureum
kreatinin
urine lengkap
sectio caesaria 1,300,000 187,500
resusitasi 30,000
pemasangan katether 78,000
52,000 2,007,000 187,500
3 Aisya Syafa Rizqi Azzahra, An 25,000 5,000

Kelas 1 3 hari 9,000 438,000
visite 10,000
konsultasi 5,000
34,000 458,000 -
4 Natik Aflahtul Amal, An 25,000 5,000

Kelas 2 3 hari 6,000 240,000
konsultasi 5,000
visite 15,000
hematologi rutin
widal
31,000 265,000 -
5 Nasibah, Ny 40,000
Kelas 3 2 hari 2,000 112,000
visite 15,000 60,000
per vaginum 600,000 525,000
laserasi jalan lahir 45,000 135,000
resusitasi 15,000
hematologi rutin
42,000 787,000 720,000
6 Datiyah, Ny 40,000
Kelas 3 2 hari 2,000 112,000
visite 15,000 60,000
per vaginum 600,000 525,000
resusitasi 15,000
hematologi rutin
42,000 787,000 720,000
7 Ulfiah, Ny 20,000 5,000 50,000

Kelas 3 2 hari 2,000 112,000
visite 10,000 60,000
businasi/laminaria 15,000 45,000
kuretase dengan narkose 100,000 450,000
hematologi rutin
golongan darah
hbs g
22,000 242,000 605,000
8 Sutriana, Ny
Kelas 3 4 hari 4,000 224,000
resusitasi
visite 35,000 120,000
paket sc
diluar paket sc
tubektomi 75,000 101,250
4,000 1,334,000 1,121,250
287,000 8,020,000 3,353,750

Dokter Obgyn Dokter Anak Dokter Bedah Dokter Internis
Firdaus Zufrial Arif Bambang S Chanis Fajar Zumaro Willy Eko Djalu Iman Darjito
280,000
35,000
- - - - - - - - 315,000
150,000
- - 150,000 - - - - - -
100,000
25,000
- - 125,000 - - - - - -
20,000
120,000
- - 140,000 - - - - - -
30,000
45,000
- - 75,000 - - - - - -
30,000
45,000
- - 75,000 - - - - - -
- - - - - - - - -
80,000
90,000
- - 170,000 - - - - - -
- - 735,000 - - - - - 315,000
Dokter Internis Dokter Gigi Dokter Syaraf Anestesi Paru Psiko Rad
Edy S Dian W Sangkan Fachri Uzer Anton Soemartono Arif M Irfan Dana Alip
- - - - - - - - - -
180,000
- - - - - 180,000 - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - 180,000 - - - -
Dokter Umum
Anestesi
Djalil Boeing Nurbaity Teguh I Made Kholid Windy Dewi Ahmed
25,000
35,000 35,000
- - - - - 25,000 35,000 35,000 - -
506,250
- - - - - - - - - 506,250
25,000
- 25,000 - - - - - - - -
25,000
- 25,000 - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
250,000
- - - - - - - - - 250,000
- 50,000 - - - 25,000 35,000 35,000 - 756,250

Askep
Ass. Oprt Ass. Anestesi BAHP Farmasi Laborat Radiologi
Ruangan Adi Arif
2,978,693
147,000
40,000
22,500
22,500
17,500
37,500
- - - 2,978,693 140,000 - 147,000 - -
117,250 2,951,924
60,000
73,600
11,500
51,750
20,700
20,700
20,700
20,700
28,750
337,500 168,750
337,500 286,000 - 2,951,924 248,400 - 60,000 - -
905,205
45,000
- - - 905,205 - - 45,000 - -
595,759
36,000
35,200
33,000
- - - 595,759 68,200 - 36,000 - -
422,126
18,000
275,312
35,200
- - 275,312 422,126 35,200 - 18,000 - -
509,200
18,000
275,312
35,200
- - 275,312 509,200 35,200 - 18,000 - -
67,500 717,262
18,000
35,200
11,000
49,500
- 67,500 - 717,262 95,700 - 18,000 - -
36,000
125,000 75,000
1,000,000 99,000
318,803
125,000 75,000 - 1,318,803 99,000 - 36,000 - -
462,500 428,500 550,624 ### 721,700 - 378,000 - -

Afit Suhati Wiwik Indra Sugiarti Andini Roikhatul Indah Dewi Candra Koticha
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
Ana Eny Endang Pipit Suci Dinda Tika Retno Wulan Rawat Inap Ekstra
39,000
385,000
- - - - - - - - - 385,000 39,000
144,000
27,000
- - 27,000 - - - - - - 144,000 -
108,000
- - - - - - - - - 108,000 -
90,000
- - - - - - - - - 90,000 -
42,000
- - - - - - - - - 42,000 -
42,000
- - - - - - - - - 42,000 -
42,000
- - - - - - - - - 42,000 -
84,000
- - - - - - - - - 84,000 -
- - 27,000 - - - - - - 937,000 39,000

Ambulance Piutang
Rujukan Lain-Lain Total Keringanan DP
BBM Sopir Jamsostek
3,072,693
2,667,000 (400,050) 2,179,290
380,000
40,000
40,000
22,500
22,500
17,500
37,500
- - - - 6,299,693 (400,050) - 2,179,290
3,109,174
800,000 (800,000)
165,000
73,600
11,500
51,750
20,700
20,700
20,700
20,700
28,750
2,500,000
210,000
105,000
- - - - 7,137,574 (800,000) - -
960,205
600,000
110,000
30,000
- - - - 1,700,205 - - -
650,759
372,000
25,000
135,000
35,200
33,000
- - - - 1,250,959 - - -
462,126
174,000
105,000
1,400,312
180,000
60,000
35,200
- - - - 2,416,638 - - -
549,200
174,000
105,000
1,400,312
60,000
180,000
35,200
- - - - 2,503,712 - - -
859,762
174,000
70,000
60,000
550,000
35,200
11,000
49,500
- - - - 1,809,462 - - -
-
348,000
2,350,000
80,000
245,000
1,099,000
318,803
176,250
- - - - 4,617,053 - - -
- - - - 27,735,296 (1,200,050) - 2,179,290

Piutang
Jumlah Bayar
Garda Medika Asuransi Lain ybs
3,072,693
87,660
380,000
40,000
40,000
22,500
22,500
17,500
37,500
- - - 3,720,353
3,109,174
-
165,000
73,600
11,500
51,750
20,700
20,700
20,700
20,700
28,750
2,500,000
210,000
105,000
- - - 6,337,574
960,205
600,000
110,000
30,000
- - - 1,700,205
650,759
372,000
25,000
135,000
35,200
33,000
- - - 1,250,959
462,126
174,000
105,000
1,400,312
180,000
60,000
35,200
- - - 2,416,638
549,200
174,000
105,000
1,400,312
60,000
180,000
35,200
- - - 2,503,712
859,762
174,000
70,000
60,000
550,000
35,200
11,000
49,500
- - - 1,809,462
-
348,000
2,350,000
80,000
245,000
1,099,000
318,803
176,250
- - - 4,617,053
- - - 24,355,956
Januari 2012
1/27/2012
Dokter Obgyn
Ratna
1 Eri Hernaningsih, Ny DP pasien
- - -
2 Siti Musaropah, Ny 35,000 5,000 50,000

Kelas 1 4 hari 12,000 584,000
visite 35,000 200,000
sgpt
ureum
kreatinin
hbs ag
protein urine
sectio caesaria 1,300,000 1,687,500
resusiatsi 30,000
hematologi rutin
sgot
47,000 2,032,000 1,937,500
3 Seventina Nurul Hidayah, Ny 20,000 5,000 50,000

Kelas 1 2 hari 6,000 292,000
visite 10,000 100,000
per vaginum 600,000 1,050,000
hematologi rutin
hbs ag
26,000 1,007,000 1,650,000
4 Yuli Onara, Ny 35,000 5,000 50,000

Kelas 2 4 hari 8,000 320,000
visite 40,000 160,000
hematologi rutin
hbs ag
resusitasi 30,000
43,000 1,752,000 1,335,000
116,000 4,791,000 4,922,500

- - - - - - - - -
150,000
180,000
- - 330,000 - - - - - -
- - - - - - - - -
160,000
120,000
- - 280,000 - - - - - -
- - 610,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
506,250
- - - - - - - - - 506,250
- - - - - - - - - -
337,500
- - - - - - - - - 337,500
- - - - - - - - - 843,750
Askep
Ruangan Adi Arif Afit
- - - - - - - - - -
2,426,669
60,000
20,700
20,700
20,700
51,750
4,600
337,500 168,750 180,000
73,600
20,700
337,500 168,750 180,000 2,426,669 212,750 - 60,000 - - -
135,000 536,578
30,000
280,000
36,800
51,750
- 135,000 280,000 536,578 88,550 - 30,000 - - -
2,980,146
48,000
70,400
49,500
225,000 112,500 180,000
225,000 112,500 180,000 2,980,146 119,900 - 48,000 - - -
562,500 416,250 640,000 5,943,393 421,200 - 138,000 - - -

Suhati Wiwik Indra Sugiarti Andini Roikhatul Indah Dewi Candra Koticha Ana
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet Ambulance
Eny Endang Pipit Suci Dinda Tika Retno Wulan Rawat Inap Ekstra BBM
- - - - - - - - - - -
144,000
27,000
27,000 - - - - - - - 144,000 - -
72,000
- - - - - - - - 72,000 - -
120,000
18,000
18,000 - - - - - - - 120,000 - -
45,000 - - - - - - - 336,000 - -
Ambulance Piutang
Sopir Jamsostek Garda Medika
- 3,000,000
- - - - - 3,000,000 - -
2,516,669
800,000
385,000
20,700
20,700
20,700
51,750
4,600
4,180,000
210,000
73,600
20,700
105,000
- - - 8,409,419 - - - -
746,578
400,000
110,000
1,930,000
36,800
51,750
550,000
- - - 3,825,128 - - - -
3,070,146 (2,551,044)
496,000
360,000
70,400
49,500
3,280,000
150,000
75,000
- - - 7,551,046 (2,551,044) - - -
- - - 19,785,593 (2,551,044) 3,000,000 - -

Piutang
Jumlah Bayar
Asuransi Lain ybs
3,000,000
- - 3,000,000
2,516,669
800,000
385,000
20,700
20,700
20,700
51,750
4,600
4,180,000
210,000
73,600
20,700
105,000
- - 8,409,419
746,578
400,000
110,000
1,930,000
36,800
51,750
550,000
- - 3,825,128
519,102
496,000
360,000
70,400
49,500
3,280,000
150,000
75,000
- - 5,000,002
- - 20,234,549
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
1/28/2012
Dokter Obgyn
Ratna
1 Kunaeza Nely Awaliyan, An DP pasien
- - -
2 Indah Wulandari, Ny 25,000 5,000 50,000

VK 1 hari 3,000 146,000
visite 5,000 50,000
flebektomi 450,000 423,000
kuretase/diratase kuretase d 450,000 315,000
hematologi rutin
golongan darah
hbs ag
28,000 1,056,000 838,000
3 Muslikhatun, Ny 20,000 5,000 50,000

Kelas 2 2 hari 4,000 160,000
visite 10,000 80,000
kreatinin
sgot
sgpt
urine lengkap
hematologi rutin
hbs ag
golongan darah
ureum
24,000 275,000 730,000
4 Kunaeza Nely Awaliyan, An 25,000 5,000

Kelas 3 2 hari 2,000 112,000
hematologi rutin
visite 15,000
widal
ambulance
27,000 132,000 -
5 Siti Maryam, Ny 20,000 5,000 50,000

Kelas 3 3 hari 3,000 168,000
visite 15,000 90,000
per vaginum 600,000 525,000
hematologi rutin
golongan darah
hbs ag
23,000 888,000 1,115,000
6 Nurenti, Ny 40,000
Kelas 3 2 hari 2,000 112,000
per vaginum 600,000 525,000
resusitasi 46,500
visite 20,000 60,000
hematologi rutin
42,000 823,500 720,000
7 Rohmatun, Ny 40,000 5,000

Kelas 3 3 hari 3,000 168,000
visite 20,000 90,000
sgpt
ureum
kreatini
protein urine
hematologi rutin
usg 15,000 40,000
per vaginum 600,000 525,000
resusitasi 46,500
golongan darah
hbs ag
sgot
thorax
43,000 899,500 790,000
8 Dasmi, Ny 40,000
Kelas 3 1 hari 1,000 56,000
konsultasi 5,000 30,000
visite 5,000
per vaginum 600,000 525,000
rsusitasi 46,500
hematologir utin
41,000 757,500 690,000
9 Karno, Tn 25,000 5,000

Kelas 3 4 hari 4,000 224,000
konsultasi 5,000
ureum
kreatinin
glukosa sewaktu
ecg 30,750
visite 20,000
hematologi rutin
sgot
sgpt
29,000 284,750 -
257,000 5,116,250 4,883,000

- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
60,000
- - 60,000 - - - - - -
- - - - - - - - -
60,000
- - 60,000 - - - - - -
30,000
- - 30,000 - - - - - -
30,000
- - 30,000 - - - - - -
15,000
90,000
- - - - - - - - 105,000
- - 180,000 - - - - - 105,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
30,000
- - - 30,000 - - - - - -
- - - 30,000 - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
202,500
202,500
- - - - - - - - - 405,000
- - - - - - - - - -
25,000
15,000
- - - 25,000 - - 15,000 - - -
- - - - - - - - - -
- - - - - - - - - -
25,000
- - 25,000 - - - - - - -
- - - - - - - - - -
25,000
- - - - - 25,000 - - - -
- - 25,000 25,000 - 25,000 15,000 - - 405,000

Askep
Ruangan Adi Arif
- - - - - - - - -
1,047,340
15,000
135,000 67,500
135,000 67,500
36,800
11,500
51,750
270,000 135,000 - 1,047,340 100,050 - 15,000 - -
90,000 500,528
24,000
19,800
19,800
19,800
27,500
35,200
49,500
11,000
19,800
- 90,000 - 500,528 202,400 - 24,000 - -
620,078
18,000
70,400
33,000
- - - 620,078 103,400 - 18,000 - -
563,073
27,000
118,750
70,400
11,000
49,500
- - 118,750 563,073 130,900 - 27,000 - -
602,013
18,000
275,312
35,200
- - 275,312 602,013 35,200 - 18,000 - -
672,407
27,000
19,800
19,800
19,800
4,400
70,400
275,312
11,000
49,500
19,800
66,000
- - 275,312 672,407 214,500 66,000 27,000 - -
337,127
9,000
485,358
35,200
- - 485,358 337,127 35,200 - 9,000 - -
1,037,149
36,000
19,800
19,800
15,400
35,200
19,800
19,800
- - - 1,037,149 129,800 - 36,000 - -
270,000 225,000 ### 5,379,715 951,450 66,000 174,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
6,750
- - - - - - - - - 6,750 -
- - - - - - - - - 6,750 -
Diet
- - - - - - - - - - -
36,000
- - - - - - - - - 36,000 -
60,000
- - - - - - - - - 60,000 -
42,000
- - - - - - - - - 42,000 -
63,000
- - - - - - - - - 63,000 -
42,000
13,500
- - - - - 13,500 - - - 42,000 -
63,000
13,500
- - - - 13,500 - - - - 63,000 -
21,000
13,500
- - - - - - - 13,500 - 21,000 -
84,000
- - - - - - - - - 84,000 -
- - - - 13,500 13,500 - 13,500 - 411,000 -

Ambulance Piutang
BBM Sopir Jamsostek
- 500,000
- - - - - - 500,000 -
1,127,340
200,000
55,000
1,278,000
1,170,000
36,800
11,500
51,750
- - - - 3,930,390 - - -
665,528
248,000
90,000
19,800
19,800
19,800
27,500
700,000
35,200
49,500
11,000
19,800
- - - - 1,905,928 - - -
675,078
174,000 (500,000)
70,400
90,000
33,000
90,000 30,000 120,000
90,000 30,000 - - 1,162,478 - (500,000) -
638,073
261,000
105,000
1,243,750
550,000
70,400
11,000
49,500
- - - - 2,928,723 - - -
642,013
174,000
1,400,312
60,000
140,000
180,000
35,200
- - - - 2,631,525 - - -
-
742,407
261,000
140,000
19,800
19,800
19,800
4,400
70,400
55,000
1,400,312
60,000
180,000
11,000
49,500
19,800
66,000
- - - - 3,119,219 - - -
377,127
200,000 287,000
35,000
35,000
1,610,358
60,000
35,200
180,000
- - - 200,000 2,619,685 - - -
1,092,149
348,000
20,000
19,800
19,800
15,400
37,500
140,000
35,200
19,800
19,800
- - - - 1,767,449 - - -
90,000 30,000 - 200,000 20,065,397 - - -

Piutang
Jumlah Bayar
500,000
- - - 500,000
1,127,340
200,000
55,000
1,278,000
1,170,000
36,800
11,500
51,750
- - - 3,930,390
665,528
248,000
90,000
19,800
19,800
19,800
27,500
700,000
35,200
49,500
11,000
19,800
- - - 1,905,928
675,078
(326,000)
70,400
90,000
33,000
120,000
- - - 662,478
638,073
261,000
105,000
1,243,750
550,000
70,400
11,000
49,500
- - - 2,928,723
642,013
174,000
1,400,312
60,000
140,000
180,000
35,200
- - - 2,631,525
742,407
261,000
140,000
19,800
19,800
19,800
4,400
70,400
55,000
1,400,312
60,000
180,000
11,000
49,500
19,800
66,000
- - - 3,119,219
377,127
287,000
35,000
35,000
1,610,358
60,000
35,200
180,000
- - - 2,619,685
1,092,149
348,000
20,000
19,800
19,800
15,400
37,500
140,000
35,200
19,800
19,800
- - - 1,767,449
-
- - - 20,065,397
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
1/26/2012
Dokter Obgyn
Ratna Firdaus
1 Bokwi, Ny 25,000
Kelas 3 1 hari 1,000 56,000
visite 5,000
kuretase dengan narkose 100,000
hematologi rutin
golongan darah
hbs ag
26,000 161,000 - -
2 Suciati, Ny 25,000
Kelas 3 4 hari 4,000 224,000
ambulance
rb adella
usg 15,000 40,000
urine lengkap
ureum
kreatinin
sgot
sgpt
visite 15,000 90,000
hematologi rutin
hbs ag
golongan darah
ecg 30,750
29,000 1,594,750 1,003,750 -
55,000 1,755,750 1,003,750 -

Zufrial Arif Bambang S Chanis Fajar Zumaro Willy Eko Djalu Iman Darjito Edy S
50,000
600,000
650,000 - - - - - - - -
15,000
- - - - - - - 15,000 -
650,000 - - - - - - 15,000 -
Dokter Gigi Dokter Syaraf Anestesi Paru Psiko Rad
Dian W Sangkan Fachri Uzer Anton Soemartono Arif M Irfan Dana Alip Djalil
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi Ass. Oprt
Boeing Nurbaity Teguh I Made Kholid Windy Dewi Ahmed
- - - - - - - - - -
253,125 168,750
- - - - - - - - 253,125 168,750
- - - - - - - - 253,125 168,750
Askep
Ass. Anestesi BAHP Farmasi Laborat Radiologi
Ruangan Adi Arif Afit Suhati
90,000 738,487
9,000
35,200
11,000
49,500
90,000 - 738,487 95,700 - 9,000 - - - -
2,185,829
36,000
27,500
39,600
39,600
39,600
39,600
84,375 180,000
70,400
49,500
11,000
84,375 180,000 2,185,829 316,800 - 36,000 - - - -
174,375 180,000 2,924,316 412,500 - 45,000 - - - -

Wiwik Indra Sugiarti Andini Roikhatul Indah Dewi Candra Koticha Ana Eny
- - - - - - - - - - -
6,750
- - - - - - - - 6,750 - -
- - - - - - - - 6,750 - -
Diet Ambulance
Endang Pipit Suci Dinda Tika Retno Wulan Rawat Inap Ekstra BBM Sopir
21,000
- - - - - - - 21,000 - - -
84,000
45,000 25,000
- - - - - - - 84,000 - 45,000 25,000
- - - - - - - 105,000 - 45,000 25,000

Piutang
Jamsostek Garda Medika Asuransi Lain
853,487 (102,000)
87,000
55,000
700,000
35,200
11,000
49,500
- - 1,791,187 (102,000) - - - -
2,210,829
348,000
70,000
153,200 153,200
55,000
27,500
39,600
39,600
39,600
39,600
105,000
2,830,000
70,400
49,500
11,000
37,500
55,000
153,200 - 6,181,329 - - - - -
153,200 - 7,972,516 (102,000) - - - -

-
-
-
-
-
-
-
-
-
-
-
Jumlah Bayar
ybs
751,487
87,000
55,000
700,000
35,200
11,000
49,500
- 1,689,187
2,210,829
348,000
70,000
153,200
55,000
27,500
39,600
39,600
39,600
39,600
105,000
2,830,000
70,400
49,500
11,000
37,500
55,000
- 6,181,329
-
- 7,870,516
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
1/30/2012
Dokter Obgyn
Ratna Firdaus
1 Dedi Hermawan, Sdr. 25,000 5,000

Kelas 3 1 hari 1,000 56,000
ambulance
26,000 61,000 - -
2 Erni Hernaningsih, Ny DP pasien
- - - -
3 Reni Anggraeni, Ny 20,000 5,000

Kelas 1 3 hari 9,000 438,000
visite 15,000
cholesterol
hematologi rutin
widal
sgot
sgpt
ureum
kreatinin
glukosa sewaktu
konsultasi 5,000
29,000 463,000 - -
4 Dyah Eli Kusrini, Ny 40,000

Kelas 1 2 hari 6,000 292,000
visite 15,000 50,000
per vaginum 600,000
resusitasi 78,000
usg 15,000 40,000
46,000 1,005,000 140,000 -
5 Widiyanti, Ny 40,000
Kelas 3 4 hari 4,000 224,000
visite 35,000 90,000
pemasangan katether 42,000 18,000
hematologi rutin
golongan darah
hbs ag
protein urine
resusitasi 30,000
pasang tindik 10,500
44,000 1,646,500 981,750 -
145,000 3,175,500 1,121,750 -

- - - - - - - - -
- - - - - - - - -
50,000
25,000
- - - - - - - 75,000 -
50,000
1,050,000
1,050,000 50,000 - - - - - - -
120,000
90,000
- 210,000 - - - - - - -
1,050,000 260,000 - - - - - 75,000 -

- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi Ass. Oprt
25,000
25,000 - - - - - - - - -
- - - - - - - - - -
25,000
25,000 25,000
- - - - 25,000 25,000 - 25,000 - -
25,000
25,000 - - - - - - - - -
253,125 168,750
- - - - - - - - 253,125 168,750
50,000 - - - 25,000 25,000 - 25,000 253,125 168,750

Askep
244,327
9,000
- - 244,327 - - 9,000 - - - -
- - - - - - - - - -
1,195,676
45,000
20,700
36,800
34,500
20,700
20,700
20,700
20,700
16,100
- - 1,195,676 190,900 - 45,000 - - - -
447,545
30,000
280,000
- 280,000 447,545 - - 30,000 - - - -
1,774,663
36,000
70,400
11,000
49,500
4,400
84,375 180,000
84,375 180,000 1,774,663 135,300 - 36,000 - - - -
84,375 460,000 3,662,211 326,200 - 120,000 - - - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
4,500
- - - - - - - - - - 4,500
- - - - - - - - - - 4,500
Diet Ambulance
21,000
45,000 15,000
- - - - - - - 21,000 - 45,000 15,000
- - - - - - - - - - -
108,000
- - - - - - - 108,000 - - -
72,000
27,000
- - - - - - 27,000 72,000 - - -
84,000
- - - - - - - 84,000 - - -
- - - - - - 27,000 285,000 - 45,000 15,000

Piutang
299,327 (102,000)
87,000
60,000
- - 446,327 (102,000) - - - -
- 8,500,000
- - - - 8,500,000 - - -
1,245,676
600,000
115,000
20,700
36,800
34,500
20,700
20,700
20,700
20,700
16,100
30,000
- - 2,181,576 - - - - -
487,545
400,000
140,000
1,930,000
105,000
55,000
55,000
- - 3,172,545 - - - - -
1,814,663
348,000
245,000
60,000
70,400
11,000
49,500
4,400
2,830,000
120,000
35,000
15,000
- - 5,602,963 - - - - -
- - 11,403,411 (102,000) 8,500,000 - - -

Jumlah Bayar
ybs
197,327
87,000
60,000
- 344,327
8,500,000
- 8,500,000
1,245,676
600,000
115,000
20,700
36,800
34,500
20,700
20,700
20,700
20,700
16,100
30,000
- 2,181,576
487,545
400,000
140,000
1,930,000
105,000
55,000
55,000
- 3,172,545
1,814,663
348,000
245,000
60,000
70,400
11,000
49,500
4,400
2,830,000
120,000
35,000
15,000
- 5,602,963
- 19,801,411
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
1/31/2012
Dokter Obgyn
Ratna
1 Andra Ramadhani, An 25,000 5,000

Kelas 1 4 hari 12,000 584,000
visite 15,000
konsultasi 5,000
hematologi rutin
golongan darah
widal
37,000 609,000 -
2 Siti Zidni, Ny 40,000 5,000 50,000

Kelas 1 2 hari 6,000 292,000
visite 15,000 100,000
per vaginum 600,000 1,050,000
resusitasi 78,000
hematologi rutin
golongan darah
hbs ag
46,000 1,035,000 1,335,000
3 Tasrinah, Ny 20,000 5,000 50,000

Kelas 2 2 hari 4,000 160,000
visite 10,000 80,000
ecg 36,000
urine lengkap
hematologi rutin
golongan darah
sgot
sgpt
ureum
kreatinin
hbs ag
biaya PA
thorax
24,000 326,000 790,000
4 Farah, Ny 40,000
Kelas 1 2 hari 6,000 292,000
visite 5,000
per vaginum 600,000 400,000
glukosa sewaktu
hematologi rutin
46,000 897,000 400,000
5 Karniti, Ny 40,000
Kelas 3 3 hari 3,000 168,000
per vaginum 600,000
resusitasi 46,500
visite 30,000 60,000
hematologi rutin
konsultasi 5,000
laserasi jalan lahir 45,000
43,000 941,000 60,000
5 Ibra Adji Rahmanu, An 25,000 5,000

Kelas 3 7 hari 7,000 392,000
konsultasi 5,000
visite 35,000
hematologi rutin
widal
thorax
urine lengkap
laju endap darah
sgot
sgpt
32,000 437,000 -
6 Eri Hernaningsih, Ny 25,000 5,000

Kelas VIP 14 hari 56,000 3,500,000
visite 105,000
ecg 51,400
sgot
sgpt
ureum
kreatinin
fisioterapi dengan alat 150,000
konsultasi 15,000
hematologi rutin
cholesterol
trigliserida
glukosa sewaktu
widal
laju endap darah
hitung jenis
cranium
ambulance
vert. lumbal
ver. Thorakal
81,000 3,826,400 -
309,000 8,071,400 2,585,000

100,000
25,000
- - - - 125,000 - - - -
50,000
- - 50,000 - - - - - -
- - - - - - - - -
50,000
- - 50,000 - - - - - -
525,000
30,000 90,000
15,000
135,000
- 690,000 105,000 - - - - - -
15,000
180,000
- - - - 195,000 - - - -
360,000
60,000
- - - - - - - - 420,000
- 690,000 205,000 - 320,000 - - - 420,000

- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
420,000
30,000
- - - 450,000 - - - - - -
- - - 450,000 - - - - - -
Dokter Umum
Anestesi
Djalil Boeing Nurbaity Teguh I Made Kholid Dewi Windy Ahmed
25,000
25,000
- - - - - 25,000 - - 25,000 -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
25,000
15,000
- - - - - 25,000 - - 15,000 -
25,000
30,000 30,000 60,000 30,000 60,000 30,000

- 30,000 - 30,000 - 85,000 30,000 60,000 30,000 -
- 30,000 - 30,000 - 135,000 30,000 60,000 70,000 -

Askep
Ruangan Adi Arif
648,935
60,000
110,400
11,500
34,500
- - - 648,935 156,400 - 60,000 - -
542,678
30,000
608,125
36,800
11,500
51,750
- - 608,125 542,678 100,050 - 30,000 - -
90,000 497,047
24,000
27,500
35,200
11,000
19,800
19,800
19,800
19,800
49,500
240,000
69,000
- 90,000 - 497,047 442,400 69,000 24,000 - -
564,942
30,000
16,100
36,800
- - - 564,942 52,900 - 30,000 - -
594,380
27,000
275,312
35,200
- - 275,312 594,380 35,200 - 27,000 - -
2,523,600
63,000
140,800
66,000
60,500
27,500
8,800
19,800
19,800
- - - 2,523,600 282,700 60,500 63,000 - -
24,900 9,268,286
252,000
21,600
21,600
43,200
43,200
115,200
21,600
26,400
50,400
36,000
9,600
14,400
759,000
168,000
168,000
- - 24,900 9,268,286 403,200 1,095,000 252,000 - -
- 90,000 908,337 14,639,868 1,472,850 1,224,500 486,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
15,600
- - - - - - 15,600 - - - -
- - - - - - 15,600 - - - -
Diet
144,000
- - - - - - - - - 144,000 -
72,000
27,000
- - - 27,000 - - - - - 72,000 -
60,000
9,000
- - - - - - 9,000 - - 60,000 -
38,000
72,000
- - - - - - - - - 72,000 38,000
63,000
13,500
13,500
- 13,500 - - - - - - 13,500 63,000 -
147,000
- - - - - - - - - 147,000 -
235,000
630,000
- - - - - - - - - 630,000 235,000
- 13,500 - 27,000 - - 9,000 - 13,500 1,188,000 273,000

Ambulance Piutang
BBM Sopir Jamsostek
703,935
800,000
140,000
30,000
110,400
11,500
34,500
- - - - 1,830,335 - - -
637,678
400,000
165,000
2,258,125
105,000
36,800
11,500
51,750
180,000
- - - - 3,845,853 - - -
662,047
248,000
90,000
45,000
27,500
35,200
11,000
19,800
19,800
19,800
19,800
49,500
700,000
240,000
75,000
69,000
- - - - 2,331,447 - - -
642,942
400,000 (150,842)
55,000
1,000,000
16,100
36,800
- - - - 2,150,842 (150,842) - -
634,380
261,000
1,400,312
60,000
210,000
35,200
20,000
180,000
60,000
- - - - 2,860,892 - - -
2,578,600
609,000
20,000
230,000
140,800
66,000
60,500
27,500
8,800
19,800
19,800
- - - - 3,780,800 - - -
9,583,186
4,438,000 (665,700)
1,125,000
67,000
21,600
21,600
43,200
43,200
1,050,000 1,200,000
105,000
115,200
21,600
26,400
50,400
36,000
9,600
14,400
759,000
135,000 45,000 180,000
168,000
168,000
135,000 45,000 - 1,050,000 18,196,386 (665,700) - -
135,000 45,000 - 1,050,000 34,996,555 (816,542) - -

Piutang
Jumlah Bayar
703,935
800,000
140,000
30,000
110,400
11,500
34,500
- - - 1,830,335
637,678
400,000
165,000
2,258,125
105,000
36,800
11,500
51,750
180,000
- - - 3,845,853
662,047
248,000
90,000
45,000
27,500
35,200
11,000
19,800
19,800
19,800
19,800
49,500
700,000
240,000
75,000
69,000
- - - 2,331,447
642,942
249,158
55,000
1,000,000
16,100
36,800
- - - 2,000,000
634,380
261,000
1,400,312
60,000
210,000
35,200
20,000
180,000
60,000
- - - 2,860,892
2,578,600
180,800 428,200
20,000
230,000
140,800
66,000
60,500
27,500
8,800
19,800
19,800
- - 180,800 3,600,000
9,583,186
3,772,300
1,125,000
67,000
21,600
21,600
43,200
43,200
1,200,000
105,000
115,200
21,600
26,400
50,400
36,000
9,600
14,400
759,000
180,000
168,000
168,000
- - - 17,530,686
- - 180,800 33,999,213
Januari 2012
2/1/2012
Dokter Obgyn
Ratna Firdaus
1 Ghaida Ayu Sofia, An. 25,000 5,000

Kelas 1 5 hari 15,000 730,000
anti tb ig g
visite 25,000
thorax
hematologi rutin
40,000 760,000 - -
2 Riski Miftahudin, An. 25,000 5,000

Kelas 3 4 hari 4,000 224,000
hematologi rutin
widal
konsultasi 5,000
visite 15,000
29,000 249,000 - -
3 Suminto, Tn 25,000 5,000

Kelas 3 5 hari 5,000 280,000
hematologi rutin
widal
visite 15,000
konsultasi 5,000
30,000 305,000 - -
4 Suparni, Ny 15,000 5,000

Kelas 2 5 hari 10,000 400,000
visite 20,000
konsultasi 5,000
cholesterol
trigliserida
sgot
sgpt
ureum
kreatinin
asam urat
thorax
widal
hematologi rutin
ecg 36,000
glukosa sewaktu
25,000 466,000 - -
124,000 1,780,000 - -
250,000
- 250,000 - - - - - - -
15,000
90,000
- 105,000 - - - - - - -
60,000
15,000
- - - - - - - 75,000 -
120,000
20,000
- - - - - - - 140,000 -
- 355,000 - - - - - 215,000 -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi Ass. Oprt
25,000
- - - - 25,000 - - - - -
25,000
- - - - - 25,000 - - - -
25,000
15,000
- - - 25,000 - - - 15,000 - -
20,000
20,000
20,000 - - - - 20,000 - - - -
20,000 - - 25,000 25,000 45,000 - 15,000 - -

Askep
1,431,735
75,000
131,000
63,500
36,800
- - 1,431,735 167,800 63,500 75,000 - - - -
964,720
36,000
70,400
66,000
- - 964,720 136,400 - 36,000 - - - -
1,034,331
45,000
35,200
33,000
- - 1,034,331 68,200 - 45,000 - - - -
915,025
60,000
19,800
24,200
19,800
19,800
19,800
19,800
22,000
66,000
33,000
35,200
9,000
30,800
- - 915,025 244,200 66,000 60,000 - - - 9,000
- - 4,345,811 616,600 129,500 216,000 - - - 9,000

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet Ambulance
180,000
- - - - - - - 180,000 - - -
84,000
- - - - - - - 84,000 - - -
105,000
- - - - - - - 105,000 - - -
150,000
- - - - - - - 150,000 - - -
- - - - - - - 519,000 - - -
Piutang
1,486,735
1,000,000
131,000
275,000
63,500
36,800
- - 2,993,035 - - - - -
1,019,720
348,000
70,400
66,000
20,000
105,000
- - 1,629,120 - - - - -
1,089,331
435,000
35,200
33,000
90,000
20,000
- - 1,702,531 - - - - -
955,025
620,000 (185,000)
160,000
25,000
19,800
24,200
19,800
19,800
19,800
19,800
22,000
66,000
33,000
35,200
45,000
30,800
- - 2,115,225 (185,000) - - - -
- - 8,439,911 (185,000) - - - -
Jumlah Bayar
ybs
1,486,735
1,000,000
131,000
275,000
63,500
36,800
- 2,993,035
1,019,720
348,000
70,400
66,000
20,000
105,000
- 1,629,120
1,089,331
435,000
35,200
33,000
90,000
20,000
- 1,702,531
955,025
435,000
160,000
25,000
19,800
24,200
19,800
19,800
19,800
19,800
22,000
66,000
33,000
35,200
45,000
30,800
- 1,930,225
-
- 8,254,911
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/2/2012
Dokter Obgyn
Ratna
1 Jaidah, Ny 25,000 5,000

Kelas VIP 2 hari 8,000 500,000
konsultasi 5,000
visite 10,000
cholesterol
ecg 51,400
hematologi rutin
sgot
sgpt
ureum
kreatinin
glukosa sewaktu
33,000 571,400 -
33,000 571,400 -
30,000
120,000
- - - - - - - - 150,000
- - - - - - - - 150,000
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
25,000
- - - - - 25,000 - - - -
- - - - - 25,000 - - - -
Askep
Ruangan Adi Arif
728,969
36,000
21,600
38,400
21,600
21,600
21,600
21,600
16,800
- - - 728,969 163,200 - 36,000 - -
- - - 728,969 163,200 - 36,000 - -

15,600
- 15,600 - - - - - - - - -
- 15,600 - - - - - - - - -
Diet
28,000
90,000
- - - - - - - - - 90,000 28,000
- - - - - - - - - 90,000 28,000
Ambulance Piutang
BBM Sopir Jamsostek Garda Medika
811,969
634,000 (95,100)
35,000
130,000
21,600
67,000
38,400
21,600
21,600
21,600
21,600
16,800
- - - - 1,841,169 (95,100) - - -
- - - - 1,841,169 (95,100) - - -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Piutang
Jumlah Bayar
Asuransi Lain ybs
811,969
538,900
35,000
130,000
21,600
67,000
38,400
21,600
21,600
21,600
21,600
16,800
- - 1,746,069
- - 1,746,069
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/3/2012
Dokter Obgyn
Ratna
1 Siti Amiroh, Ny 40,000

Kelas 2 4 hari 8,000 320,000
usg 15,000 40,000
visite 40,000 160,000
resusitasi 30,000
hematologi rutin
golongan darah
hbs ag
sgot
sgpt
ureum
kreatinin
glukosa sewaktu
48,000 1,705,000 1,325,000
2 Esti Rahayu, Nn 25,000

Kelas 3 3 hari 3,000 168,000
visite 15,000 90,000
explorasi jahit 100,000 687,500
hematologi rutin
hbs ag
golongan darah
periksa ginekologi 34,000 8,500
28,000 363,500 786,000
3 Sutirah, Ny 20,000 5,000 50,000

Kelas 3 2 hari 2,000 112,000
visite 10,000 60,000
marsupialisasi ranula 450,000 337,500
biaya PA
hematologi rutin
golongan darah
hbs ag
22,000 577,000 447,500
98,000 2,645,500 2,558,500

160,000
120,000
- - 280,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
- - 280,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
337,500
- - - - - - - - - 337,500
- - - - - - - - - -
101,250
- - - - - - - - - 101,250
- - - - - - - - - 438,750
Askep
2,121,892
48,000
225,000 112,500 180,000
70,400
11,000
49,500
19,800
19,800
19,800
19,800
15,400
225,000 112,500 180,000 2,121,892 225,500 - 48,000 - - -
90,000 1,027,755
27,000
70,400
49,500
11,000
- 90,000 - 1,027,755 130,900 - 27,000 - - -
67,500 784,449
18,000
67,500 33,750
120,000
35,200
11,000
49,500
67,500 101,250 - 784,449 215,700 - 18,000 - - -
292,500 303,750 180,000 3,934,096 572,100 - 93,000 - - -

Suhati Wiwik Indra Sugiarti Andini Roikhatul Indah Dewi Candra Koticha Ana Eny
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
Diet Ambulance
120,000
- - - - - - - 120,000 - - -
63,000
13,500
- - - - 13,500 - - 63,000 - - -
42,000
- - - - - - - 42,000 - - -
- - - - 13,500 - - 225,000 - - -
Piutang
2,161,892
496,000
55,000
360,000
3,280,000
150,000
70,400
11,000
49,500
19,800
19,800
19,800
19,800
15,400
- - 6,728,392 - - - - -
1,142,755
261,000
105,000
787,500
70,400
49,500
11,000
60,000
42,500
- - 2,529,655 - - - - -
926,949
174,000
70,000
990,000
120,000
35,200
11,000
49,500
- - 2,376,649 - - - - -
- - 11,634,696 - - - - -
Jumlah Bayar
ybs
2,161,892
496,000
55,000
360,000
3,280,000
150,000
70,400
11,000
49,500
19,800
19,800
19,800
19,800
15,400
- 6,728,392
1,142,755
261,000
105,000
787,500
70,400
49,500
11,000
60,000
42,500
- 2,529,655
926,949
174,000
70,000
990,000
120,000
35,200
11,000
49,500
- 2,376,649
-
- 11,634,696
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/4/2012
Dokter Obgyn
Ratna
1 Lila, Ny 40,000
Kelas 1 2 hari 6,000 292,000
visite 15,000 100,000
per vaginum 600,000 1,050,000
resusitasi 78,000
hematologi rutin
ecg 46,500
golongan darah
sgot
sgpt
ureum
kreatinin
hbs ag
protein urine
46,000 1,109,500 1,150,000
2 Rina Efriana, Ny 40,000

Kelas 1 2 hari 6,000 292,000
Kelas 3 3 hari 3,000 168,000
visite 60,000 190,000
hematologi rutin
hbs ag
golongan darah
ecg 46,500
resusitasi 30,000
thorax
pemasangan katether 15,000 45,000
konsultasi 5,000
49,000 1,916,500 1,078,750
3 Supriyatin, Ny 40,000
Kelas 3 4 hari 4,000 224,000
per vaginum 600,000 525,000
resusitasi 46,500
visite 35,000 120,000
hematologi rutin
golongan darah
hbs ag
usg 15,000 40,000
44,000 965,500 820,000

4 Untung Subegjo, Tn 25,000 5,000
Kelas 3 3 hari 3,000 168,000
visite 5,000
pelvis
hematologi rutin
ureum
kreatinin
asam urat
glukosa sewaktu
sgot
sgpt
cholesterol
28,000 178,000 -
167,000 4,169,500 3,048,750

50,000
- - 50,000 - - - - - -
150,000 30,000
90,000
15,000
- - 240,000 - - - - - 45,000
90,000
- - 90,000 - - - - - -
30,000
- - - - - 30,000 - - -
- - 380,000 - - 30,000 - - 45,000

- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
25,000
253,125
- 25,000 - - - - - - - 253,125
- - - - - - - - - -
25,000
- 25,000 - - - - - - - -
- 50,000 - - - - - - - 253,125
Askep
Ruangan Adi Arif
1,029,799
30,000
608,125
36,800
11,500
20,700
20,700
20,700
20,700
51,750
4,600
- - 608,125 1,029,799 187,450 - 30,000 - -
1,467,656
30,000
27,000
73,600
51,750
11,500
168,750 84,375 180,000
66,000
168,750 84,375 180,000 1,467,656 136,850 66,000 57,000 - -
601,511
36,000
275,312
35,200
11,000
49,500
- - 275,312 601,511 95,700 - 36,000 - -

1,006,516
27,000
69,000
35,200
19,800
19,800
22,000
15,400
19,800
19,800
19,800
- - - 1,006,516 171,600 69,000 27,000 - -
168,750 84,375 ### 4,105,482 591,600 135,000 150,000 - -

13,500
- - - - - - 13,500 - - - -
13,500
- - - - - - - - 13,500 - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - 13,500 - 13,500 - -
Diet
Ana Eny Endang Pipit Suci Dinda Tika Retno Wulan Rawat Inap
72,000
27,000
27,000
- 27,000 - - - 27,000 - - - 72,000
72,000
63,000
- - - - - - - - - 135,000
84,000
13,500
- - - - - - 13,500 - - 84,000
63,000
- - - - - - - - - 63,000
- 27,000 - - - 27,000 13,500 - - 354,000

Diet Ambulance Piutang
Ekstra BBM Sopir Jamsostek
1,069,799
400,000
165,000
2,258,125
105,000
36,800
60,000
11,500
20,700
20,700
20,700
20,700
51,750
4,600
105,000
- - - - - 4,350,374 - - -
-
1,507,656
400,000
261,000
455,000
73,600
51,750
11,500
60,000
2,830,000
120,000
66,000
60,000
20,000
- - - - - 5,916,506 - - -
641,511
348,000
1,400,312
60,000
245,000
35,200
11,000
49,500
180,000
55,000
- - - - - 3,025,523 - - -
1,061,516
261,000
35,000
69,000
35,200
19,800
19,800
22,000
15,400
19,800
19,800
19,800
- - - - - 1,598,116 - - -
- - - - - 14,890,519 - - -
Piutang
Jumlah Bayar
1,069,799
400,000
165,000
2,258,125
105,000
36,800
60,000
11,500
20,700
20,700
20,700
20,700
51,750
4,600
105,000
- - - 4,350,374
-
1,507,656
400,000
261,000
455,000
73,600
51,750
11,500
60,000
2,830,000
120,000
66,000
60,000
20,000
- - - 5,916,506
641,511
348,000
1,400,312
60,000
245,000
35,200
11,000
49,500
180,000
55,000
- - - 3,025,523
1,061,516
261,000
35,000
69,000
35,200
19,800
19,800
22,000
15,400
19,800
19,800
19,800
- - - 1,598,116
- - - 14,890,519
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/5/2012
Dokter Obgyn
Ratna
1 Suciati, Ny 15,000
Kelas 3 2 hari 2,000 112,000
17,000 112,000 -
2 Naura Zahra, An 25,000 5,000

Kelas 1 3 hari 9,000 438,000
konsultasi 5,000
visite 10,000
hematologi rutin
widal
34,000 458,000 -
3 Suciati, By 15,000
Kelas 2 11 hari 22,000 880,000
resusitasi 30,000
visite 55,000
konsultasi 10,000
hematologi rutin
glukosa sewaktu
infus umbilicalis 30,000
golongan darah
37,000 1,005,000 -
4 Rochawati, Ny 40,000
Kelas 3 4 hari 4,000 224,000
visite 40,000 120,000
resusitasi 30,000
hematologi rutin
golongan darah
hbs ag
rehecting dehisensi 75,000 225,000
usg kandungan 15,000 40,000
44,000 1,730,500 1,228,750
5 Siti Munjilah, Ny 40,000

Kelas 3 4 hari 4,000 224,000
visite 30,000 90,000
per vaginum 600,000 525,000
tindakan manual placenta 60,000 180,000
usg 15,000 40,000
hematologi rutin'
golongan darah
hbs ag
sgot
sgpt
ureum
kreatinin
glukosa sewaktu
protein urine
resusitasi 46,500
44,000 1,025,500 932,500
176,000 4,331,000 2,161,250

Dokter Obgyn Dokter Anak Dokter Bedah
Firdaus Zufrial Arif Bambang S Chanis Fajar Zumaro Willy Eko Djalu
- - - - - - - -
25,000
100,000
- - - - 125,000 - - -
120,000
440,000
40,000
120,000
- - 720,000 - - - - -
120,000
90,000
- - 210,000 - - - - -
90,000
- - 90,000 - - - - -
- - 1,020,000 - 125,000 - - -
Dokter Internis Dokter Gigi Dokter Syaraf Anestesi Paru
Iman Darjito Edy S Dian W Sangkan Fachri Uzer Anton Soemartono Arif M Irfan
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
Psiko Rad Dokter Umum
Dana Alip Djalil Boeing Nurbaity Teguh I Made Kholid Windy Dewi Ahmed
- - - - - - - - - - -
25,000
- - - - - - 25,000 - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - 25,000 - - - -
Askep
Anestesi Ass. Oprt Ass. Anestesi BAHP Farmasi Laborat Radiologi
Ruangan Adi
18,000
- - - - - - - 18,000 -
658,312
45,000
36,800
34,500
- - - - 658,312 71,300 - 45,000 -
1,491,235
132,000
105,600
46,200
11,000
- - - - 1,491,235 162,800 - 132,000 -
1,948,659
36,000
253,125 168,750 84,375 517,500
105,600
11,000
49,500
253,125 168,750 84,375 517,500 1,948,659 166,100 - 36,000 -
741,487
36,000
275,312
70,400
11,000
49,500
19,800
19,800
19,800
19,800
15,400
4,400
- - - 275,312 741,487 229,900 - 36,000 -
253,125 168,750 84,375 792,812 4,839,693 630,100 - 267,000 -

Arif Afit Suhati Wiwik Indra Sugiarti Andini Roikhatul Indah Dewi Candra
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
Koticha Ana Eny Endang Pipit Suci Dinda Tika Retno Wulan Rawat Inap
42,000
- - - - - - - - - - 42,000
108,000
- - - - - - - - - - 108,000
330,000
- - - - - - - - - - 330,000
84,000
13,500
- - - - - 13,500 - - - - 84,000
84,000
13,500
- - - - - - - - 13,500 - 84,000
- - - - - 13,500 - - 13,500 - 648,000

Diet Ambulance Piutan
15,000
174,000
-
- - - - - 189,000 - - -
713,312
600,000
30,000
110,000
36,800
34,500
- - - - - 1,524,612 - - -
1,506,235
1,364,000 (282,500)
150,000
495,000
50,000
105,600
46,200
150,000
11,000
- - - - - 3,878,035 (282,500) - -
1,988,659
348,000
280,000
3,167,500
60,000
120,000
105,600
11,000
49,500
300,000
55,000
- - - - - 6,485,259 - - -
781,487
348,000
210,000
1,400,312
112,500
240,000
55,000
70,400
11,000
49,500
19,800
19,800
19,800
19,800
15,400
4,400
35,000
60,000
-
- - - - - 3,472,199 - - -
-
- - - - - 15,549,105 (282,500) - -
-
-
Piutang
Jumlah Bayar
15,000
174,000
- - - 189,000
713,312
600,000
30,000
110,000
36,800
34,500
- - - 1,524,612
1,506,235
1,081,500
150,000
495,000
50,000
105,600
46,200
150,000
11,000
- - - 3,595,535
1,988,659
348,000
280,000
3,167,500
60,000
120,000
105,600
11,000
49,500
300,000
55,000
- - - 6,485,259
781,487
348,000
210,000
1,400,312
112,500
240,000
55,000
70,400
11,000
49,500
19,800
19,800
19,800
19,800
15,400
4,400
35,000
60,000
- - - 3,472,199
- - - 15,266,605
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/6/2012
Dokter Obgyn
Ratna Firdaus
1 Darwati, Ny 25,000 5,000

Kelas 3 3 hari 3,000 168,000
visite 10,000
hematologi rutin
golongan darah
konsultasi 10,000
pasang/angkat jahit sederhan 28,500
28,000 221,500 - -
2 Ulistiyana, Ny 40,000
Kelas 3 2 hari 2,000 112,000
per vaginum 600,000 525,000
visite 20,000 60,000
uribne lengkap
hematologi rutin
golongan darah
sgot
sgpt
ureum
kreatinin
hbs ag
resusitasi 46,500
42,000 870,000 720,000 -
3 Nurhidayah, Ny 35,000 5,000 50,000

Kelas 3 5 hari 5,000 280,000
resusitasi 30,000
visite 45,000 150,000
hematologi rutin
golongan darah
hbs ag
40,000 1,706,500 1,043,750 -
4 Sutiri, Ny 20,000 5,000 50,000

Kelas 3 6 hari 6,000 336,000
visite 35,000 180,000
hematologi rutin
golongan darah
hbs ag
sgot
sgpt
ureum
kreatinin
ecg 30,750
salpingoofarektomi unilater 1,170,000 675,000
biaya PA
hysterectomi total 1,350,000 1,012,500
hemoglobin
thorax
26,000 2,973,250 1,917,500 -
5 M. Galang Seno Aji, An 25,000 5,000

Kelas 1 3 hari 9,000 438,000
konsultasi 5,000
visite 15,000
hematologi rutin
widal
34,000 463,000 - -
6 Nayla Putri Inayah, An 25,000 5,000

Kelas 1 2 hari 6,000 292,000
Kelas VIP 3 hari 12,000 750,000
visite 25,000
sgot
sgpt
billirubin total
billirubin direct-indirect
hbs ag
43,000 1,072,000 - -
213,000 7,306,250 3,681,250 -

30,000
30,000
18,000
- - - - 78,000 - - - -
60,000
- 60,000 - - - - - - -
90,000
120,000
- 210,000 - - - - - - -
- - - - - - - - -
25,000
150,000
- 175,000 - - - - - - -
290,000
- 290,000 - - - - - - -
- 735,000 - - 78,000 - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
30,000
- - - - - 30,000 - - - -
- - - - - - - - - -
25,000
- - - - - - - - - 25,000
- - - - - 30,000 - - - 25,000
Dokter Umum
Anestesi Ass. Oprt
25,000
15,000
- - - - 25,000 15,000 - - - -
- - - - - - - - - -
253,125 168,750
- - - - - - - - 253,125 168,750
135,000
303,750 202,500
- - - - - - - - 303,750 337,500
25,000
- - - 25,000 - - - - - -
- - - - - - - - - -
- - - 25,000 25,000 15,000 - - 556,875 506,250

Askep
912,865
27,000
35,200
11,000
5,000 13,500
- 5,000 912,865 46,200 - 27,000 - 13,500 - -
535,417
18,000
275,312
27,500
35,200
11,000
19,800
19,800
19,800
19,800
49,500
- 275,312 535,417 202,400 - 18,000 - - - -
2,182,018
45,000
84,375 180,000
70,400
11,000
49,500
84,375 180,000 2,182,018 130,900 - 45,000 - - - -
2,461,962
54,000
140,800
11,000
49,500
19,800
19,800
19,800
19,800
240,000
101,250
17,600
66,000
101,250 - 2,461,962 538,100 66,000 54,000 - - - -
603,090
45,000
36,800
34,500
- - 603,090 71,300 - 45,000 - - - -
550,560
30,000
54,000
21,600
21,600
21,600
43,200
54,000
- - 550,560 162,000 - 84,000 - - - -
185,625 460,312 7,245,912 1,150,900 66,000 273,000 - 13,500 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
6,750
13,500
- - - - - - - - 6,750 13,500 -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - 6,750 13,500 -
Diet Ambulance
63,000
- - - - - - - 63,000 - - -
42,000
13,500
13,500
13,500 - - - - 13,500 - 42,000 - - -
105,000
13,500
- - 13,500 - - - - 105,000 - - -
126,000
- - - - - - - 126,000 - - -
108,000
- - - - - - - 108,000 - - -
30,000
72,000
135,000
- - - - - - - 207,000 30,000 - -
13,500 - 13,500 - - 13,500 - 651,000 30,000 - -

Piutang
967,865
261,000
55,000
35,200
11,000
40,000
65,000
- - 1,435,065 - - - - -
575,417
174,000
1,400,312
180,000
140,000
27,500
60,000
35,200
11,000
19,800
19,800
19,800
19,800
49,500
60,000
- - 2,792,129 - - - - -
2,272,018
435,000
2,830,000
120,000
315,000
70,400
11,000
49,500
60,000
- - 6,162,918 - - - - -
2,536,962
522,000
245,000
140,800
11,000
49,500
19,800
19,800
19,800
19,800
37,500
1,980,000
240,000
60,000
2,970,000
17,600
66,000
- - 8,955,562 - - - - -
658,090
600,000
30,000
165,000
36,800
34,500
- - 1,524,390 - - - - -
635,560
400,000
951,000 (142,650)
315,000
21,600
21,600
21,600
43,200
54,000
- - 2,463,560 (142,650) - - - -
- - 23,333,624 (142,650) - - - -
Jumlah Bayar
ybs
967,865
261,000
55,000
35,200
11,000
40,000
65,000
- 1,435,065
575,417
174,000
1,400,312
180,000
140,000
27,500
60,000
35,200
11,000
19,800
19,800
19,800
19,800
49,500
60,000
- 2,792,129
2,272,018
435,000
2,830,000
120,000
315,000
70,400
11,000
49,500
60,000
- 6,162,918
2,536,962
522,000
245,000
140,800
11,000
49,500
19,800
19,800
19,800
19,800
37,500
1,980,000
240,000
60,000
2,970,000
17,600
66,000
- 8,955,562
658,090
600,000
30,000
165,000
36,800
34,500
- 1,524,390
-
635,560
400,000
808,350
315,000
21,600
21,600
21,600
43,200
54,000
-
- 2,320,910
-
- 23,190,974
Januari 2012
2/7/2012
Dokter Obgyn
Ratna
1 Syarafina Zalfa Putri, An 25,000 5,000

Kelas 1 5 hari 15,000 730,000
visite 25,000
jamsostek widal
40,000 760,000 -
2 Desi Ayu Astuti, Ny 40,000

Kelas 2 5 hari 10,000 400,000
visite 45,000 200,000
hematologi rutin
golongan darah
hbs ag
per vaginum 600,000 700,000
resusitasi 57,000
konsultasi 5,000
50,000 1,152,000 1,080,000
3 Jahrotun, Ny 40,000
Kelas 3 2 hari 2,000 112,000
visite 10,000 30,000
per vaginum 600,000 525,000
hematologi rutin
golongan darah
hbs ag
usg 15,000 40,000
resusitasi 93,000
42,000 895,000 805,000
4 Rokhayatun, Ny 25,000
Kelas 3 2 hari 2,000 112,000
visite 10,000 60,000
per vaginum 600,000 525,000
hematologi rutin
golongan darah
hbs ag
usg 15,000 40,000
resusitasi 46,500
27,000 883,500 1,312,500

5 Dian, Ny
Kelas 3 3 hari 3,000 168,000
usg 15,000 40,000
resusitasi
visite 15,000 90,000
paket sc
diluar paket sc
3,000 1,198,000 1,030,000
6 Maruli, An 25,000 5,000

Kelas 3 2 hari 2,000 112,000
konsultasi 5,000
visite 10,000
hematologi rutin
widal
27,000 132,000 -
7 Samsu Rizal, Tn 25,000 5,000

Kelas 3 3 hari 3,000 168,000
konsultasi 5,000
visite 5,000
hematologi rutin
28,000 183,000 -
8 Temy, Ny 25,000 5,000

Kelas 3 2 hari 2,000 112,000
konsultasi 10,000
visite 5,000
hematologi rutin
sgot
sgpt
glukosa sewaktu
widal
27,000 132,000 -
9 Naswa, An 25,000 5,000

Kelas 2 5 hari 10,000 400,000
visite 25,000
widal
35,000 430,000 -
10 Dian R, By 15,000
Perinatologi 3 hari 6,000 240,000
visite 15,000
resusitasi 30,000
konsultasi 5,000
hematologi rutin
glukosa sewaktu
21,000 320,000 -
11 Andhika Bakti Purnomo, An 25,000 5,000

Kelas 1 4 hari 12,000 584,000
visite 15,000
hematologi rutin
widal
konsultasi 10,000
37,000 614,000 -
337,000 6,699,500 4,227,500

250,000
- - 250,000 - - - - - -
160,000
20,000
- - 180,000 - - - - - -
30,000
- - 30,000 - - - - - -
- - - - - - - - -
80,000
- - 80,000 - - - - - -
15,000
60,000
- - 75,000 - - - - - -
15,000
30,000
- - - - - - - - 45,000
30,000
30,000
- - - - - - - - 60,000
200,000
- - 200,000 - - - - - -
120,000
120,000
20,000
120,000
- - 380,000 - - - - - -
150,000
50,000
- - 200,000 - - - - - -
- - 1,395,000 - - - - - 105,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
25,000
- - - - - 25,000 - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
250,000
- - - - - - - - - 250,000
25,000
25,000 - - - - - - - - -
25,000
- - - - - - 25,000 - - -
25,000
25,000 - - - - - - - - -
25,000
- - - - - 25,000 - - - -
- - - - - - - - - -
25,000
- - - - - - 25,000 - - -
50,000 - - - - 50,000 50,000 - - 250,000

Askep
Ruangan Adi Arif
929,457
75,000
69,000
- - - 929,457 69,000 - 75,000 - -
480,204
60,000
35,200
11,000
49,500
411,250
- - 411,250 480,204 95,700 - 60,000 - -
433,159
18,000
275,312
35,200
11,000
49,500
- - 275,312 433,159 95,700 - 18,000 - -
389,174
18,000
118,750
35,200
11,000
49,500
- - 118,750 389,174 95,700 - 18,000 - -

27,000
125,000 75,000
1,000,000 99,000
215,083 83,600
125,000 75,000 - 1,215,083 182,600 - 27,000 - -
284,682
18,000
35,200
33,000
- - - 284,682 68,200 - 18,000 - -
608,726
27,000
35,200
- - - 608,726 35,200 - 27,000 - -
473,644
18,000
35,200
19,800
19,800
15,400
33,000
- - - 473,644 123,200 - 18,000 - -
614,195
60,000
33,000
- - - 614,195 33,000 - 60,000 - -
238,052
36,000
35,200
15,400
- - - 238,052 50,600 - 36,000 - -
867,084
60,000
36,800
34,500
- - - 867,084 71,300 - 60,000 - -
125,000 75,000 805,312 6,533,460 920,200 - 417,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
180,000
- - - - - - - - - 180,000 -
150,000
18,000
- - - - 18,000 - - - - 150,000 -
42,000
27,000
- - - - 27,000 - - - - 42,000 -
42,000
13,500
- - - - - - - - 13,500 42,000 -
63,000
- - - - - - - - - 63,000 -
42,000
- - - - - - - - - 42,000 -
63,000
- - - - - - - - - 63,000 -
42,000
- - - - - - - - - 42,000 -
150,000
- - - - - - - - - 150,000 -
90,000
- - - - - - - - - 90,000 -
144,000
- - - - - - - - - 144,000 -
- - - - 45,000 - - - 13,500 1,008,000 -

Ambulance Piutang
984,457
1,000,000 (380,000)
275,000 1,614,762
69,000
- - - - 2,328,457 (380,000) - 1,614,762 -
520,204
620,000
405,000
35,200
11,000
49,500
1,711,250
75,000
25,000
225,000
- - - - 3,677,154 - - - -
473,159
174,000
35,000
70,000
1,400,312
240,000
35,200
11,000
49,500
55,000
120,000
- - - - 2,663,171 - - - -
414,174
174,000
70,000
1,243,750
787,500
35,200
11,000
49,500
55,000
60,000
- - - - 2,900,124 - - - -
-
261,000
55,000
2,350,000
80,000
105,000
1,099,000
298,683
- - - - 4,248,683 - - - -
339,682
174,000
20,000
70,000
35,200
33,000
- - - - 671,882 - - - -
663,726
261,000
20,000
35,000
35,200
- - - - 1,014,926 - - - -
528,644
174,000
40,000
35,000
35,200
19,800
19,800
15,400
33,000
- - - - 900,844 - - - -
819,195
470,000
225,000
33,000
- - - - 1,547,195 - - - -
253,052
372,000 (90,000)
135,000
150,000
25,000
150,000
35,200
15,400
- - - - 1,135,652 (90,000) - - -
922,084
800,000
165,000
36,800
34,500
60,000
- - - - 2,018,384 - - - -
- - - - 23,106,472 (470,000) - 1,614,762 -

Piutang
Jumlah Bayar
Asuransi Lain ybs
984,457
620,000
(1,339,762)
69,000
- - 333,695
520,204
620,000
405,000
35,200
11,000
49,500
1,711,250
75,000
25,000
225,000
- - 3,677,154
473,159
174,000
35,000
70,000
1,400,312
240,000
35,200
11,000
49,500
55,000
120,000
- - 2,663,171
414,174
174,000
70,000
1,243,750
787,500
35,200
11,000
49,500
55,000
60,000
- - 2,900,124
-
261,000
55,000
2,350,000
80,000
105,000
1,099,000
298,683
- - 4,248,683
339,682
174,000
20,000
70,000
35,200
33,000
- - 671,882
663,726
261,000
20,000
35,000
35,200
- - 1,014,926
528,644
174,000
40,000
35,000
35,200
19,800
19,800
15,400
33,000
- - 900,844
819,195
470,000
225,000
33,000
- - 1,547,195
253,052
282,000
135,000
150,000
25,000
150,000
35,200
15,400
- - 1,045,652
-
922,084
800,000
165,000
36,800
34,500
60,000
-
- - 2,018,384
-
- - 21,021,710
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/8/2012
Dokter Obgyn
Ratna Firdaus
1 Rina Paridayanti, Ny 25,000 5,000

Kelas VVIP 1 hari 5,000 300,000
ecg 46,500
ambulance
30,000 351,500 - -
2 Siti Rohani, Ny 20,000 5,000 50,000

Kelas VVIP 4 hari 20,000 1,200,000
per vaginum 800,000 1,400,000
kuretase dengan narkose 100,000 1,050,000
hematologi rutin
golongan darah
hbs ag
resusitasi 99,000
visite 20,000 280,000
usg 15,000 40,000
40,000 2,239,000 2,820,000 -
3 Irma, Ny 35,000 5,000 50,000

Kelas VIP 4 hari 16,000 1,000,000
visite 15,000
per vaginum 800,000 718,750
resusitasi 88,500
konsultasi 5,000
51,000 1,913,500 768,750 -
4 Siti Rohani, By 15,000

Kelas 2 3 hari 6,000 240,000
visite 15,000
glukosa sewaktu
konsultasi 5,000
hematologi rutin
golongan darah
21,000 270,500 - -
5 Liza Aryvianingrum, Ny 40,000

Kelas 2 2 hari 4,000 160,000
visite 15,000 80,000
resusitasi 57,000
per vaginum 600,000 700,000
usg 30,000 80,000
hematologi ruitn
golongan darah
hbs ag
44,000 922,000 1,100,000 -
186,000 5,696,500 4,688,750 -

- - - - - - - - -
- - - - - - - - -
180,000
30,000
- 210,000 - - - - - - -
120,000
20,000
- 140,000 - - - - - - -
40,000
- 40,000 - - - - - - -
- 390,000 - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi Ass. Oprt
25,000
25,000 - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
25,000 - - - - - - - - -
Askep
175,785
21,000
- - 175,785 - - 21,000 - - - -
157,500 1,310,145
84,000
1,055,000
40,000
12,500
56,250
157,500 1,055,000 1,310,145 108,750 - 84,000 - - - -
1,046,649
72,000
- - 1,046,649 - - 72,000 - - - -
430,170
36,000
46,200
35,200
11,000
- - 430,170 92,400 - 36,000 - - - -
420,916
24,000
411,250
35,200
11,000
49,500
- 411,250 420,916 95,700 - 24,000 - - - -
157,500 1,466,250 3,383,665 296,850 - 237,000 - - - -

13,500
13,500 - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
13,500 - - - - - - - - - -
Diet Ambulance
30,000
55,000
90,000 30,000
- - - - - - - 55,000 30,000 90,000 30,000
35,000
220,000
36,000
- - - - - 36,000 - 220,000 35,000 - -
28,000
180,000
31,500
- - - - - - 31,500 180,000 28,000 - -
90,000
4,500
- - - - - 4,500 - 90,000 - - -
60,000
18,000
- - - - - - 18,000 60,000 - - -
- - - - - 40,500 49,500 605,000 93,000 90,000 30,000

Piutang
235,785
406,000 (381,000)
60,000
120,000
- - 821,785 (381,000) - - - -
1,577,645
1,524,000 (228,600)
3,255,000
1,150,000
40,000
12,500
56,250
135,000
300,000
55,000
- - 8,105,395 (228,600) - - - -
1,164,649
1,268,000 (468,000)
195,000
1,518,750
120,000
35,000
- - 4,301,399 (468,000) - - - -
445,170
372,000 (90,000)
135,000
46,200
25,000
35,200
11,000
15,000
- - 1,084,570 (90,000) - - - -
460,916
248,000
135,000
75,000
1,711,250
300,000
110,000
35,200
11,000
49,500
- - 3,135,866 - - - - -
- - 17,449,015 ### - - - -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Jumlah Bayar
ybs
235,785
25,000
60,000
120,000
- 440,785
1,577,645
1,295,400
3,255,000
1,150,000
40,000
12,500
56,250
135,000
300,000
55,000
- 7,876,795
1,164,649
800,000
195,000
1,518,750
120,000
35,000
- 3,833,399
445,170
282,000
135,000
46,200
25,000
35,200
11,000
15,000
- 994,570
460,916
248,000
135,000
75,000
1,711,250
300,000
110,000
35,200
11,000
49,500
- 3,135,866
- 16,281,415
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/9/2012
Dokter Obgyn
Ratna Firdaus
1 Pamoran Sitio, Tn 25,000 5,000

Kelas 1 3 hari 9,000 438,000
ecg 93,000
visite 15,000
hematologi rutin
sgot
sgpt
ureum
kreatinin
glukosa sewaktu
34,000 551,000 - -
2 Febri Rizki, Ny 35,000 5,000 50,000

Kelas 1 4 hari 12,000 584,000
per vaginum 600,000 1,050,000
resusitasi 78,000
visite 35,000 200,000
konsultasi 5,000
hematologi rutin
golongan darah
hbs ag
47,000 1,362,500 1,435,000 -
3 Siti Wati Azizah, Ny 40,000

Kelas 3 3 hari 3,000 168,000
visite 20,000 60,000
golongan darah
sgot
sgpt
ureum
kreatinin
glukosa sewaktu
hbs ag
protein urine
hematologi rutin
resusitasi 46,500
usg 15,000 40,000
per vaginum 600,000 525,000
43,000 899,500 790,000 -
4 Ibra Aji Rahmanu, An

Kelas 3 pelunasan
- - - -
124,000 2,813,000 2,225,000 -

150,000
- - - - - - - 150,000 -
150,000
25,000
- 175,000 - - - - - - -
60,000
- 60,000 - - - - - - -
- - - - - - - - -
- 235,000 - - - - - 150,000 -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi Ass. Oprt
25,000
- 25,000 - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- 25,000 - - - - - - - -
Askep
1,103,480
45,000
36,800
20,700
20,700
20,700
20,700
16,100
- - 1,103,480 135,700 - 45,000 - - - -
627,991
60,000
608,125
73,600
11,500
51,750
- 608,125 627,991 136,850 - 60,000 - - - -
523,352
27,000
11,000
39,600
39,600
39,600
39,600
15,400
49,500
8,800
70,400
275,312
- 275,312 523,352 313,500 - 27,000 - - - -
- - - - - - - - - -
- 883,437 2,254,823 586,050 - 132,000 - - - -

13,500 13,500
13,500 - 13,500 - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
13,500 - 13,500 - - - - - - - -
Diet Ambulance
108,000
- - - - - - - 108,000 - - -
144,000
27,000
4,500
4,500 - 27,000 - - - - 144,000 - - -
63,000
13,500
- - - - - - 13,500 63,000 - - -
- - - - - - - - - - -
4,500 - 27,000 - - - 13,500 315,000 - - -

Piutang
1,158,480
600,000
120,000
165,000
36,800
20,700
20,700
20,700
20,700
16,100
- - 2,179,180 - - - - -
717,991
800,000
2,258,125
105,000
385,000
30,000
73,600
11,500
51,750
180,000
15,000
- - 4,627,966 - - - - -
563,352
261,000
140,000
11,000
39,600
39,600
39,600
39,600
15,400
49,500
8,800
70,400
60,000
35,000
55,000
1,400,312
180,000
- - 3,008,164 - - - - -
-
-
- - - - - - - -
- - 9,815,310 - - - - -
Jumlah Bayar
ybs
1,158,480
600,000
120,000
165,000
36,800
20,700
20,700
20,700
20,700
16,100
- 2,179,180
717,991
800,000
2,258,125
105,000
385,000
30,000
73,600
11,500
51,750
180,000
15,000
- 4,627,966
563,352
261,000
140,000
11,000
39,600
39,600
39,600
39,600
15,400
49,500
8,800
70,400
60,000
35,000
55,000
1,400,312
180,000
- 3,008,164
-
-
(180,800) 180,800
-
(180,800) 180,800
-
(180,800) 9,996,110
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/10/2012
Dokter Obgyn
Ratna
1 Annisa Mariatul Ulfah, Ny 40,000

visite 15,000 120,000
per vaginum 800,000 1,225,000
resusitasi 88,500
hematologi rutin
golongan darah
hbs ag
usg 15,000 40,000
48,000 1,463,500 1,700,000
2 Rodatul Jannah, Ny 40,000

Kelas 1 2 hari 6,000 292,000
visite 20,000 100,000
per vaginum 600,000 1,050,000
resusitasi 78,000
usg 15,000 40,000
hematologi rutin
golongan darah
hbs ag
46,000 1,050,000 1,460,000
3 Samilah, Ny 25,000
Kelas 3 2 hari 2,000 112,000
usg 15,000 40,000
visite 5,000 30,000
biaya PA
hematologi rutin
golongan darah
hbs ag
27,000 252,000 595,000
121,000 2,765,500 3,755,000

60,000
- - 60,000 - - - - - -
100,000
- - 100,000 - - - - - -
- - - - - - - - -
- - 160,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Askep
654,129
36,000
523,750
38,400
12,000
54,000
- - 523,750 654,129 104,400 - 36,000 - - -
489,870
30,000
262,500
36,800
11,500
51,750
- - 262,500 489,870 100,050 - 30,000 - - -
67,500 667,233
18,000
120,000
35,200
11,000
49,500
- 67,500 - 667,233 215,700 - 18,000 - - -
- 67,500 786,250 1,811,232 420,150 - 84,000 - - -

Suhati Wiwik Indra Sugiarti Andini Roikhatul Indah Dewi Candra Koticha Ana Eny
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
- - - - - - - - - - - -
Diet Ambulance
38,000
90,000
31,500
- - - - - 31,500 - 90,000 38,000 - -
72,000
27,000
27,000 - - - - - - 72,000 - - -
42,000
- - - - - - - 42,000 - - -
27,000 - - - - 31,500 - 204,000 38,000 - -

Piutang
732,129
634,000 (95,100)
195,000
2,548,750
360,000
120,000
38,400
12,000
54,000
55,000
-
- - 4,749,279 (95,100) - - - -
529,870
400,000
220,000
1,912,500
105,000
55,000
36,800
11,500
51,750
315,000
- - 3,637,420 - - - - -
759,733
174,000
55,000
35,000
60,000
550,000
120,000
35,200
11,000
49,500
35,000
- - 1,884,433 - - - - -
- - 10,271,132 (95,100) - - - -
Jumlah Bayar
ybs
732,129
538,900
195,000
2,548,750
360,000
120,000
38,400
12,000
54,000
55,000
- 4,654,179
529,870
400,000
220,000
1,912,500
105,000
55,000
36,800
11,500
51,750
315,000
- 3,637,420
759,733
174,000
55,000
35,000
60,000
550,000
120,000
35,200
11,000
49,500
35,000
- 1,884,433
-
- 10,176,032
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/11/2012
Dokter Obgyn
Ratna Firdaus
1 Putra Al Pratama, AN 25,000 5,000

Kelas VIP 6 hari 24,000 1,500,000
widal
visite 25,000
49,000 1,530,000 - -
2 Athaillah Ariqul Z, An 25,000 5,000

Kelas VIP 7 hari 28,000 1,750,000
visite 30,000
konsultasi 5,000
hematologi rutin
widal
53,000 1,790,000 - -
3 Indri Ayu Mustika Sari, Ny 40,000

Kelas 1 5 hari 15,000 730,000
ambulance
resusitasi 30,000
visite 50,000 250,000
hematologi rutin
golongan darah
hbs ag
55,000 2,188,000 1,937,500 -
4 Afit Sarwoko, Ny 35,000 5,000 50,000

Kelas 1 2 hari 6,000 292,000
golongand arah
hbs ag
konsultasi 5,000
visite 10,000 100,000
per vaginum 600,000 1,050,000
resusiatsi 78,000
hematologi rutin
ambulance
41,000 1,035,000 1,470,000 -

5 Putri Ananda, AN 25,000 5,000
Kelas 3 4 hari 4,000 224,000
hematologi rutin
widal
visite 20,000
29,000 249,000 - -
6 Sapuroh, Ny
Kelas 3 3 hari 3,000 168,000
rsusitasi
visite 15,000 90,000
paket sc
diluar paket sc
3,000 1,183,000 990,000 -
7 Rohatun, Ny 25,000
Kelas 3 6 hari 6,000 336,000
hematologi rutin
sgpt
ureum
kreatinin
glukosa sewaktu
ecg 30,750
thorax
visite 30,000 150,000
golongan darah
hbs ag
sgot
salpingoofarektomi bilateral 1,300,000 1,012,500
biaya PA
31,000 1,701,750 1,192,500 -
261,000 9,676,750 5,590,000 -

300,000
- 300,000 - - - - - - -
360,000
30,000
- 390,000 - - - - - - -
250,000
- 250,000 - - - - - - -
25,000
- 25,000 - - - - - - -
120,000
- 120,000 - - - - - - -
80,000
- 80,000 - - - - - - -
- - - - - - - - -
- 1,165,000 - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
180,000
- - - - 180,000 - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
30,000
- - - - 30,000 - - - - -
- - - - 210,000 - - - - -
Dokter Umum
Anestesi Ass. Oprt
25,000
- - 25,000 - - - - - - -
25,000
- - - - - - - 25,000 - -
506,250 337,500
- - - - - - - - 506,250 337,500
- - - - - - - - - -
25,000
25,000 - - - - - - - - -
250,000 125,000
- - - - - - - - 250,000 125,000
303,750 202,500
- - - - - - - - 303,750 202,500
25,000 - 25,000 - - - - 25,000 ### 665,000

Askep
3,512,483
108,000
36,000
- - 3,512,483 36,000 - 108,000 - - - -
1,223,145
126,000
38,400
36,000
- - 1,223,145 74,400 - 126,000 - - - -
2,772,443
75,000
168,750 180,000
73,600
11,500
51,750
168,750 180,000 2,772,443 136,850 - 75,000 - - - -
974,719
30,000
11,500
51,750
280,000
36,800
- 280,000 974,719 100,050 - 30,000 - - - -

641,990
36,000
35,200
33,000
- - 641,990 68,200 - 36,000 - - - -
27,000
75,000
1,000,000 99,000
149,333
75,000 - 1,149,333 99,000 - 27,000 - - - -
1,773,555
54,000
105,600
19,800
19,800
19,800
15,400
69,000
11,000
49,500
19,800
101,250 495,500
240,000
101,250 495,500 1,773,555 500,700 69,000 54,000 - - - -
345,000 955,500 ### 1,015,200 69,000 456,000 - - - -

- - - - - - - - - - -
- - - - - - - - - - -
27,000
- - - - - - - - - - 27,000
27,000
- - - - - - - - - - 27,000
- - - - - - - - - - -
- - - - - - - - - - -
6,750
- - - - - - 6,750 - - - -
- - - - - - 6,750 - - - 54,000
Diet Ambulance
30,000
270,000
- - - - - - - 270,000 30,000 - -
38,000
315,000
- - - - - - - 315,000 38,000 - -
180,000
45,000 25,000
- - - - - - - 180,000 - 45,000 25,000
72,000
45,000 15,000
- - - - - - - 72,000 - 45,000 15,000

84,000
- - - - - - - 84,000 - - -
63,000
- - - - - - - 63,000 - - -
126,000
- - - - - - - 126,000 - - -
- - - - - - - 1,110,000 68,000 90,000 40,000

Piutang
3,597,483
1,902,000 (285,300)
36,000
325,000
- - 5,860,483 (285,300) - - - -
1,316,145
2,219,000 (332,850)
390,000
35,000
38,400
36,000
- - 4,034,545 (332,850) - - - -
241,700 3,054,143
1,000,000
70,000
4,180,000
105,000
210,000
550,000
73,600
11,500
51,750
241,700 - 9,305,993 - - - - -
1,064,719
400,000
11,500
51,750
30,000
110,000
1,930,000
105,000
315,000
36,800
60,000
- - 4,114,769 - - - - -
696,990
348,000
35,200
33,000
140,000
- - 1,253,190 - - - - -
-
261,000
2,350,000
80,000
105,000
1,099,000
149,333
- - 4,044,333 - - - - -
1,798,555
522,000
105,600
19,800
19,800
19,800
15,400
37,500
69,000
210,000
11,000
49,500
19,800
3,415,500
240,000
35,000
- - 6,588,255 - - - - -
241,700 - 35,201,568 (618,150) - - - -

Jumlah Bayar
ybs
3,597,483
1,616,700
36,000
325,000
- 5,575,183
1,316,145
1,886,150
390,000
35,000
38,400
36,000
- 3,701,695
3,054,143
1,000,000
70,000
4,180,000
105,000
210,000
550,000
73,600
11,500
51,750
- 9,305,993
1,064,719
400,000
11,500
51,750
30,000
110,000
1,930,000
105,000
315,000
36,800
60,000
- 4,114,769
696,990
348,000
35,200
33,000
140,000
- 1,253,190
-
261,000
2,350,000
80,000
105,000
1,099,000
149,333
- 4,044,333
1,798,555
522,000
105,600
19,800
19,800
19,800
15,400
37,500
69,000
210,000
11,000
49,500
19,800
3,415,500
240,000
35,000
- 6,588,255
- 34,583,418
Januari 2012
2/12/2012
Dokter Obgyn
Ratna Firdaus
1 Sunitah, Ny 25,000 5,000

Kelas 3 1 hari 1,000 56,000
26,000 61,000 - -
2 Devi Rika Ratna, Ny DP pasien
- - - -
3 Ervani Sindiana, Ny 25,000

Kelas 1 3 hari 9,000 438,000
visite 15,000 150,000
usg 30,000 80,000
34,000 583,000 1,130,000 -
4 Efi Elfianingsih, Ny 40,000

Kelas 1 2 hari 6,000 292,000
visite 10,000 100,000
usg 30,000 80,000
per vaginum 600,000 1,050,000
resusitasi 78,000
hematologi rutin
golongan darah
hbs ag
46,000 1,055,000 1,365,000 -
5 Rafa, An 25,000 5,000

Kelas 2 4 hari 8,000 320,000
konsultasi 5,000
hematologi rutin
widal
33,000 330,000 - -
6 Devi Rika Ratna, Ny 40,000

Kelas 3 2 hari 2,000 112,000
visite 15,000 60,000
per vaginum 600,000 525,000
resusitasi 46,500
hematologi rutin
golongand arah
hbs ag
42,000 818,500 720,000 -
7 Asrarul, Ny
Kelas 3 2 hari
visite
per vaginum
tindakan manual placenta
resusitasi
hematologi rutin
- - - -
181,000 2,847,500 3,215,000 -

- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
- - - - - - - - -
20,000
- 20,000 - - - - - - -
30,000
- 30,000 - - - - - - -
- - - - - - - - -
- 50,000 - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi Ass. Oprt
25,000
- - - - - - 25,000 - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
25,000
- 25,000 - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- 25,000 - - - - 25,000 - - -
Askep
83,706
9,000
- - 83,706 - - 9,000 - - - -
- - - - - - - - - -
135,000 573,000
45,000
135,000 - 573,000 - - 45,000 - - - -
590,483
30,000
608,125
36,800
11,500
51,750
- 608,125 590,483 100,050 - 30,000 - - - -
339,889
48,000
70,400
33,000
- - 339,889 103,400 - 48,000 - - - -
494,068
18,000
275,312
35,200
11,000
49,500
- 275,312 494,068 95,700 - 18,000 - - - -
- - - - - - - - - -
135,000 883,437 2,081,146 299,150 - 150,000 - - - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
27,000
- - - - - - - - - - 27,000
- - - - - - - - - - -
- - - - - - - - - - -
13,500
- - - - - - - - - - 13,500
- - - - - - - - - - 40,500
Diet Ambulance
21,000
- - - - - - - 21,000 - - -
- - - - - - - - - - -
108,000
- - - - - - - 108,000 - - -
72,000
- - - - - - - 72,000 - - -
120,000
- - - - - - - 120,000 - - -
42,000
13,500
- - - - - 13,500 - 42,000 - - -
42,000
- - - - - - - 42,000 - - -
- - - - - 13,500 - 405,000 - - -
Piutang
113,706
112,000
- - 225,706 - - - - -
-
- 2,000,000
-
- - - - 2,000,000 - - -
733,000
600,000
165,000
1,000,000
110,000
- - 2,608,000 - - - - -
630,483
400,000
110,000
110,000
2,258,125
180,000
105,000
36,800
11,500
51,750
- - 3,893,658 - - - - -
394,889
496,000
25,000
70,400
33,000
- - 1,019,289 - - - - -
534,068
174,000
105,000 (2,000,000)
1,400,312
180,000
60,000
35,200
11,000
49,500
- - 2,549,080 - (2,000,000) - - -
-
42,000
-
-
-
13,500
-
- - 55,500 - - - - -
- - 10,351,233 - - - - -
Jumlah Bayar
ybs
113,706
112,000
- 225,706
2,000,000
- 2,000,000
733,000
600,000
165,000
1,000,000
110,000
- 2,608,000
630,483
400,000
110,000
110,000
2,258,125
180,000
105,000
36,800
11,500
51,750
- 3,893,658
394,889
496,000
25,000
70,400
33,000
- 1,019,289
534,068
174,000
(1,895,000)
1,400,312
180,000
60,000
35,200
11,000
49,500
- 549,080
-
42,000
-
-
-
13,500
-
- 55,500
- 10,351,233
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/13/2012
Dokter Obgyn
Ratna Firdaus
1 Sapuroh, By 15,000
visite 25,000
konsultasi 5,000
hematologi rutin
glukosa sewaktu
25,000 460,000 - -
2 Muji Rohyatun, Ny 50,000

Kelas 1 2 hari 6,000 292,000
Kelas 3 2 hari 2,000 112,000
ambulance
visite 40,000 160,000
konsultasi 5,000
ecg 46,500
hematologi rutin
sgot
sgpt
kreatinin
glukosa sewaktu
hbs ag
protein urine
ureum
golongan darah
resusitasi 30,000
58,000 1,825,500 1,003,750 -
3 Sumitri, Ny 20,000 5,000 50,000

Kelas 3 7 hari 7,000 392,000
visite 60,000 210,000
widal
urine lengkap
ecg 30,750
hematologi rutin
golongan darah
sgot
sgpt
ureum
kreatinin
hbs ag
ambulance
konsultasi 5,000
periksa gynekologi 34,000 8,500
usg 15,000 40,000
27,000 541,750 308,500 -
110,000 2,827,250 1,312,250 -

200,000
120,000
20,000
- 340,000 - - - - - - -
120,000
15,000
90,000
- 210,000 - - - - - 15,000 -
150,000
15,000
- - - - 150,000 - - 15,000 -
- 550,000 - - 150,000 - - 30,000 -

- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi Ass. Oprt
- - - - - - - - - -
253,125 168,750
- - - - - - - - 253,125 168,750
- - - - - - - - - -
- - - - - - - - 253,125 168,750
Askep
15,000 319,856
60,000
105,600
15,400
- 15,000 319,856 121,000 - 60,000 - - - -
1,950,769
30,000
18,000
73,600
41,400
41,400
41,400
16,100
51,750
9,200
41,400
11,500
84,375 180,000
84,375 180,000 1,950,769 327,750 - 48,000 - - - -
2,768,287
63,000
33,000
27,500
35,200
11,000
19,800
19,800
19,800
19,800
49,500
- - 2,768,287 235,400 - 63,000 - - - -
84,375 195,000 5,038,912 684,150 - 171,000 - - - -

- - - - - - - - - - -
13,500
13,500 - - - - - - - - - -
6,750
- - - - - - - - 6,750 - -
13,500 - - - - - - - 6,750 - -
Diet Ambulance
150,000
- - - - - - - 150,000 - - -
72,000
42,000
45,000 25,000
- - - - - - - 114,000 - 45,000 25,000
147,000
90,000 30,000
- - - - - - - 147,000 - 90,000 30,000
- - - - - - - 411,000 - ### 55,000

Piutang
349,856
620,000 (150,000)
225,000
150,000
25,000
105,600
15,400
- - 1,490,856 (150,000) - - - -
308,200 2,308,969
400,000
174,000
70,000
320,000
20,000
60,000
73,600
41,400
41,400
41,400
16,100
51,750
9,200
41,400
11,500
2,830,000
120,000
308,200 - 6,630,719 - - - - -
2,843,287
609,000
420,000
33,000
27,500
37,500
35,200
11,000
19,800
19,800
19,800
19,800
49,500
120,000
20,000
42,500
55,000
- - 4,382,687 - - - - -
308,200 - 12,504,262 (150,000) - - - -

Jumlah Bayar
ybs
349,856
470,000
225,000
150,000
25,000
105,600
15,400
- 1,340,856
2,308,969
400,000
174,000
70,000
320,000
20,000
60,000
73,600
41,400
41,400
41,400
16,100
51,750
9,200
41,400
11,500
2,830,000
120,000
- 6,630,719
2,843,287
609,000
420,000
33,000
27,500
37,500
35,200
11,000
19,800
19,800
19,800
19,800
49,500
120,000
20,000
42,500
55,000
- 4,382,687
- 12,354,262
Januari 2012
2/14/2012
Dokter Obgyn
Ratna
1 Alisiya Nur Atikoh, An
- - -
2 Irma, By 25,000 5,000

Kelas 2 4 hari 8,000 320,000
infant warmer 100,000
visite 15,000
billirubin direct-indirect
billirubin total
33,000 440,000 -
3 Irma, Ny 15,000
Kelas VIP 4 hari 16,000 1,000,000
31,000 1,000,000 -
33,000 440,000 -
- - - - - - - - -
120,000
- - 120,000 - - - - - -
- - - - - - - - -
- - 120,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
25,000
- - - - 25,000 - - - - -
- - - - - - - - - -
- - - - 25,000 - - - - -
Askep
Ruangan Adi Arif
- - - - - - - - -
508,545
48,000
39,600
19,800
- - - 508,545 59,400 - 48,000 - -
54,125
72,000
- - - 54,125 - - 72,000 - -
- - - 508,545 59,400 - 48,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
- - - - - - - - - -
120,000
50,000
- 50,000 - - - - - - - 120,000
180,000
- - - - - - - - - 180,000
- 50,000 - - - - - - - 120,000
Diet Ambulance Piutang
- 600,000
- - - - - - - 600,000 -
563,545
496,000 (105,000)
150,000
135,000
39,600
19,800
- - - - - 1,403,945 (105,000) - -
42,000 111,125
1,268,000 (190,200)
42,000 - - - - 1,379,125 (190,200) - -
- - - - - 1,403,945 (105,000) 600,000 -

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Piutang
Jumlah Bayar
600,000
- - - 600,000
563,545
391,000
150,000
135,000
39,600
19,800
- - - 1,298,945
111,125
1,077,800
- - - 1,188,925
- - - 1,898,945
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/15/2012
Dokter Obgyn
Ratna Firdaus
1 M. Lufti Hadi, An 25,000 5,000

Kelas 1 4 hari 12,000 584,000
visite 20,000
hematologi rutin
widal
konsultasi 5,000
37,000 614,000 - -
2 Darsono, Tn 25,000 5,000

Kelas 3 3 hari 3,000 168,000
ecg 46,500
visite 20,000
glukosa sewaktu
hbs ag
hematologi rutin
golongan darah
sgot
sgpt
ureum
kreatinin
operasi kategori khusus 2,000,000
thorax
28,000 2,239,500 - -
3 Alisyia Nur Atikoh, An 25,000 5,000

Kelas 3 2 hari 2,000 112,000
pemasangan ET 57,000
visite 15,000
ambulance
konsultasi 5,000
hematologi rutin
sgot
sgpt
hbs ag
27,000 194,000 - -
4 Riyani Andam Dewi, Ny 40,000 5,000

Kelas 3 4 hari 4,000 224,000
visite 35,000 120,000
per vaginum 600,000 525,000
resusitasi 46,500
konsultasi 5,000
hematologi rutin
golongan darah
hbs ag
44,000 960,500 780,000 -
136,000 4,008,000 780,000 -

150,000
25,000
- 175,000 - - - - - - -
90,000
1,500,000
- - - - - - 1,590,000 - -
30,000
15,000
- 45,000 - - - - - - -
90,000
15,000
- 105,000 - - - - - - -
- 325,000 - - - - 1,590,000 - -
- - - - - - - - - -
25,000
30,000
- - - - - 30,000 - - - 25,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - 30,000 - - - 25,000
Dokter Umum
Anestesi Ass. Oprt
25,000
25,000
25,000 - - 25,000 - - - - - -
450,000 300,000
- - - - - - - - 450,000 300,000
25,000
18,000
15,000 15,000
- 33,000 - - 25,000 - - 15,000 - -
25,000
- - - - - - 25,000 - - -
25,000 33,000 - 25,000 25,000 - 25,000 15,000 450,000 300,000

Askep
941,676
60,000
36,800
34,500
- - 941,676 71,300 - 60,000 - - - -
991,044
27,000
13,500
15,400
49,500
35,200
11,000
19,800
19,800
19,800
19,800
150,000
66,000
150,000 - 991,044 190,300 66,000 27,000 - - 13,500 -
464,182
18,000
35,200
19,800
19,800
49,500
- - 464,182 124,300 - 18,000 - - - -
537,832
36,000
275,312
70,400
11,000
49,500
- 275,312 537,832 130,900 - 36,000 - - - -
150,000 275,312 2,934,734 516,800 66,000 141,000 - - 13,500 -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet Ambulance
144,000
- - - - - - - 144,000 - - -
63,000
- - - - - - - 63,000 - - -
42,000
90,000 30,000
- - - - - - - 42,000 - 90,000 30,000
84,000
13,500
- 13,500 - - - - - 84,000 - - -
- 13,500 - - - - - 333,000 - 90,000 30,000

Piutang
996,676
800,000
195,000
36,800
34,500
30,000
- - 2,092,976 - - - - -
1,046,044
261,000
60,000
140,000
15,400
49,500
35,200
11,000
19,800
19,800
19,800
19,800
4,400,000
66,000
- - 6,163,344 - - - - -
519,182
174,000 (87,000)
75,000
75,000
120,000
20,000
35,200
19,800
19,800
49,500
- - 1,107,482 (87,000) - - - -
607,832
348,000
245,000
180,000
1,400,312
60,000
20,000
70,400
11,000
49,500
- - 2,992,044 - - - - -
- - 12,355,846 (87,000) - - - -
Jumlah Bayar
ybs
996,676
800,000
195,000
36,800
34,500
30,000
- 2,092,976
1,046,044
261,000
60,000
140,000
15,400
49,500
35,200
11,000
19,800
19,800
19,800
19,800
4,400,000
66,000
- 6,163,344
519,182
87,000
75,000
75,000
120,000
20,000
35,200
19,800
19,800
49,500
- 1,020,482
607,832
348,000
245,000
180,000
1,400,312
60,000
20,000
70,400
11,000
49,500
- 2,992,044
- 12,268,846
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/16/2012
Dokter Obgyn
Ratna
1 Anis Margowati, Ny 35,000 5,000 50,000

Kelas vvip 5 hari 25,000 1,500,000
visite 40,000 350,000
golongan darah
hbs ag
resusitasi 30,000
usg 15,000 40,000
hematologi ruti
60,000 2,989,000 2,690,000
2 Sri Muliasih, Ny 25,000

Kelas 2 2 hari 4,000 160,000
per vaginum 600,000 700,000
visite 10,000 80,000
golongan darah
hematologi rutin
hbs ag
sgot
sgpt
ureum
kreatinin
glukosa sewaktu
29,000 870,000 1,380,000
3 Feni, Ny 20,000 5,000 50,000

Kelas 2 2 hari 4,000 160,000
visite 10,000 80,000
hematologi rutin
golongan darah
hbs ag
biaya PA
24,000 275,000 730,000
4 Arianingsih, Ny 40,000
Kelas 3 4 hari 4,000 224,000
hematologi rutin
golongan darah
hbs ag
per vaginum 600,000 525,000
visite 35,000 120,000
resusitasi 46,500
44,000 950,500 780,000
5 Ahmad Jaenudin Iqbal, An 25,000 5,000

Kelas 3 4 hari 4,000 224,000
visite 20,000
hematologi rutin
widal
29,000 249,000 -
6 Margareta Jenanut, Ny 40,000

Kelas 3 4 hari 4,000 224,000
visite 35,000 120,000
hematologi rutin
golongan darah
hbs ag
t6indakan manual placenta 60,000 180,000
konsultasi 5,000
44,000 469,000 895,000
7 Nok Kurniasih, Ny 35,000 5,000 50,000

Kelas 3 3 hari 3,000 168,000
per vaginum 600,000 525,000
visite 25,000 90,000
hematologi rutin
golongna darah
hbs ag
resusitasi 15,000
38,000 858,000 800,000
268,000 6,660,500 7,275,000

210,000
240,000
- - 450,000 - - - - - -
- - - - - - - - -
- - - - - - - - -
90,000
- - 90,000 - - - - - -
120,000
- - 120,000 - - - - - -
90,000
15,000
- - 105,000 - - - - - -
60,000
45,000
- - 105,000 - - - - - -
- - 870,000 - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
675,000
- - - - - - - - - 675,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
25,000
- 25,000 - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- 25,000 - - - - - - - 675,000
Askep
Ruangan Adi Arif
4,208,765
105,000
12,500
56,250
450,000 225,000 180,000
120,000
450,000 225,000 180,000 4,208,765 188,750 - 105,000 - -
580,113
24,000
192,500
11,000
35,200
49,500
19,800
19,800
19,800
19,800
15,400
- - 192,500 580,113 190,300 - 24,000 - -
662,829
24,000
35,200
11,000
49,500
120,000
- - - 662,829 215,700 - 24,000 - -
685,511
36,000
70,400
11,000
49,500
275,312
- - 275,312 685,511 130,900 - 36,000 - -
611,428
36,000
35,200
33,000
- - - 611,428 68,200 - 36,000 - -
67,500 624,464
36,000
35,200
11,000
49,500
- 67,500 - 624,464 95,700 - 36,000 - -
381,188
27,000
275,312
35,200
11,000
49,500
- - 275,312 381,188 95,700 - 27,000 - -
450,000 292,500 923,124 7,754,298 985,250 - 288,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
38,000
275,000
36,000
- - - - - - 36,000 - - 275,000 38,000
60,000
- - - - - - - - - 60,000 -
60,000
- - - - - - - - - 60,000 -
84,000
13,500
- - - - - - - 13,500 - 84,000 -
84,000
- - - - - - - - - 84,000 -
84,000
- - - - - - - - - 84,000 -
63,000
- - - - - - - - - 63,000 -
- - - - - - 36,000 13,500 - 710,000 38,000

Ambulance Piutang
4,336,765
1,905,000 (285,750)
600,000
12,500
56,250
5,080,000
270,000
135,000
55,000
120,000
- - - - 12,570,515 (285,750) - - -
605,113
248,000
1,492,500
700,000
90,000
11,000
35,200
49,500
19,800
19,800
19,800
19,800
15,400
- - - - 3,325,913 - - - -
737,829
248,000
90,000
35,200
11,000
49,500
700,000
120,000
- - - - 1,991,529 - - - -
725,511
348,000
70,400
11,000
49,500
1,400,312
245,000
180,000
60,000
- - - - 3,089,723 - - - -
666,428
348,000
140,000
35,200
33,000
- - - - 1,222,628 - - - -
731,964
348,000
245,000
35,200
11,000
49,500
550,000
240,000
20,000
190,000
- - - - 2,420,664 - - - -
471,188
261,000
1,400,312
180,000
175,000
35,200
11,000
49,500
60,000
- - - - 2,643,200 - - - -
- - - - 27,264,172 (285,750) - - -
Piutang
Jumlah Bayar
Asuransi Lain ybs
4,336,765
1,619,250
600,000
12,500
56,250
5,080,000
270,000
135,000
55,000
120,000
- - 12,284,765
605,113
248,000
1,492,500
700,000
90,000
11,000
35,200
49,500
19,800
19,800
19,800
19,800
15,400
- - 3,325,913
737,829
248,000
90,000
35,200
11,000
49,500
700,000
120,000
- - 1,991,529
725,511
348,000
70,400
11,000
49,500
1,400,312
245,000
180,000
60,000
- - 3,089,723
666,428
348,000
140,000
35,200
33,000
- - 1,222,628
731,964
348,000
245,000
35,200
11,000
49,500
550,000
240,000
20,000
190,000
- - 2,420,664
471,188
261,000
1,400,312
180,000
175,000
35,200
11,000
49,500
60,000
- - 2,643,200
- - 26,978,422
Januari 2012
2/17/2012
Dokter Obgyn
Ratna
1 M. Lutfi Annur, An 25,000 5,000

Kelas VIP 3 hari 12,000 750,000
visite 15,000
thorax
hematologi rutin
widal
37,000 775,000 -
2 Nabila Kanza, An 25,000 5,000

visite 10,000
hematologi rutin
widal
33,000 520,000 -
3 Aliyah Indah Utami, Ny 40,000

Kelas 1 4 hari 12,000 584,000
usg 15,000 40,000
protein urine
visite 30,000 150,000
resusitasi 78,000
per vaginum 600,000 1,050,000
hematologi rutin
golongan darah
sgot
sgpt
ureum
kreatinin
glukosa sewaktu
hbs ag
52,000 1,357,000 1,560,000
4 Jumyati, Ny 25,000
Kelas 1 5 hari 15,000 730,000
visite 30,000 250,000
hematologi rutin
40,000 2,138,000 1,937,500
5 Jumyati, By 15,000
visite 20,000
konsultasi 5,000
resusityasi 30,000
glukosa sewaktu
hematologi rutin
golongan darah
23,000 375,000 -
6 Ida Fikriani, By 15,000

visite 20,000
glukosa sewaktu
23,000 350,500 -
7 Uswatun Khasanah, By 15,000

visite 25,000
hematologi rutin
golongan darah
glukosa sewaktu
25,000 455,000 -
8 Kusweni, Ny 25,000 5,000

Kelas 3 3 hari 3,000 168,000
ecg 30,750
visite 15,000
hematologi rutin
sgot
sgpt
ureum
kreatinin
glukosa sewaktu
28,000 218,750 -
9 Rima Dwi Safira, AN 25,000 5,000

Kelas 3 5 hari 5,000 280,000
anti tb ig g
visite 20,000
thorax
hematoloig rutin
30,000 305,000 -
10 Lidiawati, Ny 40,000
Kelas 3 2 hari 2,000 112,000
visite 20,000 60,000
hematologi rutin
per vaginum 600,000 525,000
resusitasi 46,500
golongan darah
hbs ag
42,000 823,500 720,000
11 Siti Maryam, Ny 40,000

Kelas 3 3 hari 3,000 168,000
visite 30,000 90,000
hematologi rutin
golongan darah
hbs ag
per vaginum 600,000 525,000
resusitasi 46,500
konsultasi 5,000
43,000 905,000 750,000
12 Ida Fikriani, Ny 25,000

Kelas 3 4 hari 4,000 224,000
resusitasi 30,000
visite 25,000 120,000
hematologi rutin
golongan darah
glukosa sewaktu
konsultasi 5,000
29,000 1,705,500 1,076,250
13 Nuriyah, Ny 35,000 5,000 50,000

Kelas 3 4 hari 4,000 224,000
visite 35,000 120,000
hematologi rutin
golongan darah
sgot
sgpt
hbs ag
ureum
kreatinin
glukosa sewaktu
protein urine
per vaginum 600,000 525,000
resusitasi 46,500
biaya PA
konsultasi 5,000
39,000 1,015,500 1,145,000
14 Istiqomah, Ny
Kelas 3 4 hari 4,000 224,000
VK 1 hari 3,000 146,000
resusitasi
visite 30,000 90,000
paket sc
diluar paket sc
7,000 1,415,500 1,020,000
15 Uswatun Khasanah, Ny 5,000

Kelas 3 5 hari 5,000 280,000
visite 20,000 120,000
resusitasi
paket sc
diluar paket sc
tubektomy 75,000 101,250
10,000 1,450,000 1,346,250
461,000 ### 9,555,000

180,000
30,000
- - 210,000 - - - - - -
120,000
30,000
- - 150,000 - - - - - -
150,000
- - 150,000 - - - - - -
50,000
- - 50,000 - - - - - -
160,000
20,000
120,000
- - 300,000 - - - - - -
160,000
- - 160,000 - - - - - -
200,000
120,000
- - 320,000 - - - - - -
90,000
- - - - - - - - 90,000
120,000
- - 120,000 - - - - - -
60,000
- - 60,000 - - - - - -
90,000
15,000
- - 105,000 - - - - - -
90,000
30,000
15,000
- - 135,000 - - - - - -
90,000
15,000
- - 105,000 - - - - - -
80,000
90,000
- - 170,000 - - - - - -
80,000
- - 80,000 - - - - - -
- - 2,115,000 - - - - - 90,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
25,000
- - - - - 25,000 - - - -
25,000
- - 25,000 - - - - - - -
- - - - - - - - - -
506,250
- - - - - - - - - 506,250
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
25,000
- - 25,000 - - - - - - -
25,000
- - 25,000 - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
253,125
- - - - - - - - - 253,125
- - - - - - - - - -
250,000
- - - - - - - - - 250,000
25,000
250,000
- 25,000 - - - - - - - 250,000
- 25,000 75,000 - - 25,000 - - - ###

Askep
Ruangan Adi Arif
781,240
54,000
66,000
38,400
36,000
- - - 781,240 74,400 66,000 54,000 - -
502,951
36,000
38,400
36,000
- - - 502,951 74,400 - 36,000 - -
571,193
60,000
4,600
280,000
36,800
11,500
20,700
20,700
20,700
20,700
16,100
51,750
- - 280,000 571,193 203,550 - 60,000 - -
2,449,083
75,000
73,600
337,500 168,750 585,000
337,500 168,750 585,000 2,449,083 73,600 - 75,000 - -
334,506
48,000
30,800
35,200
11,000
- - - 334,506 77,000 - 48,000 - -
5,086
48,000
15,400
- - - 5,086 15,400 - 48,000 - -
233,984
60,000
105,600
11,000
46,200
- - - 233,984 162,800 - 60,000 - -
666,400
27,000
35,200
19,800
19,800
19,800
19,800
15,400
- - - 666,400 129,800 - 27,000 - -
1,120,968
45,000
99,000
60,500
35,200
- - - 1,120,968 134,200 60,500 45,000 - -
499,883
18,000
70,400
275,312
11,000
49,500
- - 275,312 499,883 130,900 - 18,000 - -
549,951
27,000
35,200
11,000
49,500
275,312
- - 275,312 549,951 95,700 - 27,000 - -
1,415,454
36,000
168,750 84,375 517,500
70,400
11,000
15,400
168,750 84,375 517,500 1,415,454 96,800 - 36,000 - -
509,561
36,000
70,400
11,000
19,800
19,800
49,500
19,800
19,800
15,400
4,400
118,750
237,500
120,000
- - 356,250 509,561 349,900 - 36,000 - -
36,000
15,000
125,000 75,000
1,000,000 99,000
428,717
125,000 75,000 - 1,428,717 99,000 - 51,000 - -
45,000
125,000 75,000
1,000,000 99,000
345,539
125,000 75,000 - 1,345,539 99,000 - 45,000 - -
756,250 403,125 ### ### 1,816,450 126,500 666,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
6,750
- - 6,750 - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - 6,750 - - - - - - - -
Diet
135,000
- - - - - - - - - 135,000 -
90,000
- - - - - - - - - 90,000 -
144,000
27,000
- - - - - - 27,000 - - 144,000 -
180,000
27,000
- - - - - 27,000 - - - 180,000 -
120,000
- - - - - - - - - 120,000 -
120,000
4,500
- - 4,500 - - - - - - 120,000 -
150,000
- - - - - - - - - 150,000 -
63,000
- - - - - - - - - 63,000 -
105,000
- - - - - - - - - 105,000 -
42,000
13,500
- - - - - 13,500 - - - 42,000 -
63,000
13,500
4,500
- - - - - - - 4,500 13,500 63,000 -
84,000
13,500
- - 13,500 - - - - - - 84,000 -
84,000
13,500
- - - - - - - - 13,500 84,000 -
84,000
36,000
4,500
- - - - - - 4,500 - - 120,000 -
105,000
- - - - - - - - - 105,000 -
- - 18,000 - - 40,500 31,500 4,500 27,000 1,605,000 -

Ambulance Piutang
836,240 (25,000)
951,000 (142,650) 1,193,856
195,000
35,000
66,000
38,400
36,000
- - - - 2,157,640 (167,650) - 1,193,856 -
557,951 (25,000)
634,000 (234,000) 657,011
130,000 (20,000)
35,000 (5,000)
38,400 (1,600)
36,000 (1,500)
- - - - 1,431,351 (287,100) - 657,011 -
611,193
800,000
55,000
4,600
330,000
105,000
1,930,000
36,800
11,500
20,700
20,700
20,700
20,700
16,100
51,750
315,000
55,000
- - - - 4,404,743 - - - -
2,474,083
1,000,000
330,000
73,600
4,585,000
105,000
- - - - 8,567,683 - - - -
349,506
496,000 (120,000)
180,000
25,000
150,000
30,800
35,200
11,000
- - - - 1,277,506 (120,000) - - -
20,086
496,000 (40,000)
180,000
15,400
15,000
- - - - 726,486 (40,000) - - -
248,984
620,000 (50,000)
225,000
150,000
105,600
11,000
46,200
- - - - 1,406,784 (50,000) - - -
721,400
261,000
37,500
105,000
35,200
19,800
19,800
19,800
19,800
15,400
- - - - 1,254,700 - - - -
1,175,968
435,000
99,000
140,000
60,500
35,200
- - - - 1,945,668 - - - -
539,883
174,000
140,000
70,400
1,400,312
180,000
60,000
11,000
49,500
- - - - 2,625,095 - - - -
589,951
261,000
210,000
35,200
11,000
49,500
1,400,312
180,000
60,000
20,000
15,000
- - - - 2,831,963 - - - -
1,440,454
348,000
3,167,500
120,000
60,000
175,000
187,500
70,400
11,000
15,400
20,000
- - - - 5,615,254 - - - -
599,561
348,000
245,000
70,400
11,000
19,800
19,800
49,500
19,800
19,800
15,400
4,400
1,243,750
787,500
60,000
120,000
20,000
- - - - 3,653,711 - - - -
-
348,000
200,000
2,350,000
80,000
210,000
1,099,000
428,717
35,000
15,000
- - - - 4,765,717 - - - -
30,000
435,000
2,350,000
140,000
80,000
1,099,000
345,539
176,250
300,000
- - - - 4,955,789 - - - -
- - - - 47,620,090 (664,750) - 1,850,867 -

Piutang
Jumlah Bayar
Asuransi Lain ybs
811,240
(385,506)
195,000
35,000
66,000
38,400
36,000
- - 796,134
532,951
487,240 (744,251)
110,000
30,000
36,800
34,500
- 487,240 -
611,193
800,000
55,000
4,600
330,000
105,000
1,930,000
36,800
11,500
20,700
20,700
20,700
20,700
16,100
51,750
315,000
55,000
- - 4,404,743
2,474,083
1,000,000
330,000
73,600
4,585,000
105,000
- - 8,567,683
349,506
376,000
180,000
25,000
150,000
30,800
35,200
11,000
- - 1,157,506
20,086
456,000
180,000
15,400
15,000
- - 686,486
248,984
570,000
225,000
150,000
105,600
11,000
46,200
- - 1,356,784
721,400
261,000
37,500
105,000
35,200
19,800
19,800
19,800
19,800
15,400
- - 1,254,700
1,175,968
435,000
99,000
140,000
60,500
35,200
- - 1,945,668
539,883
174,000
140,000
70,400
1,400,312
180,000
60,000
11,000
49,500
- - 2,625,095
589,951
261,000
210,000
35,200
11,000
49,500
1,400,312
180,000
60,000
20,000
15,000
- - 2,831,963
1,440,454
348,000
3,167,500
120,000
60,000
175,000
187,500
70,400
11,000
15,400
20,000
- - 5,615,254
599,561
348,000
245,000
70,400
11,000
19,800
19,800
49,500
19,800
19,800
15,400
4,400
1,243,750
787,500
60,000
120,000
20,000
- - 3,653,711
-
348,000
200,000
2,350,000
80,000
210,000
1,099,000
428,717
35,000
15,000
- - 4,765,717
30,000
435,000
2,350,000
140,000
80,000
1,099,000
345,539
176,250
300,000
- - 4,955,789
- 487,240 44,617,233
Januari 2012
2/18/2012
Dokter Obgyn
Ratna Firdaus
1 Sanah, Ny 40,000
Kelas 3 4 hari 4,000 224,000
ambulance
rb adella
resusitasi 30,000
visite 35,000 120,000
hematologi rutin
golongan darah
hbs ag
44,000 1,589,000 963,750 -
44,000 1,589,000 963,750 -

90,000
90,000
- 180,000 - - - - - - -
- 180,000 - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi Ass. Oprt
253,125 168,750
- - - - - - - - 253,125 168,750
- - - - - - - - 253,125 168,750
Askep
1,448,822
36,000
84,375 180,000
70,400
11,000
49,500
84,375 180,000 1,448,822 130,900 - 36,000 - - - -
84,375 180,000 1,448,822 130,900 - 36,000 - - - -

- - - - - - - - - - -
- - - - - - - - - - -
Diet Ambulance
84,000
### ###
- - - - - - - 84,000 - ### ###
- - - - - - - 84,000 - ### ###

Piutang
1,488,822
348,000
70,000
291,000 291,000
2,830,000
120,000
245,000
70,400
11,000
49,500
291,000 - 5,523,722 - - - - -
291,000 - 5,523,722 - - - - -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Jumlah Bayar
ybs
1,488,822
348,000
70,000
291,000
2,830,000
120,000
245,000
70,400
11,000
49,500
- 5,523,722
- 5,523,722
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/19/2012
Dokter Obgyn
Ratna Firdaus
1 Oktina Eka P, Nn 25,000 5,000

Kelas 2 6 hari 12,000 480,000
visite 25,000
hematologi rutin
widal
37,000 515,000 - -
2 Ardiana Laela Maulida, Ny 30,000

Kelas VIP 6 hari 24,000 1,500,000
visite 55,000 300,000
hematologi rutin
golongan darah
sgot
sgpt
ureum
kreatinin
hbs ag
urine lengkap
ecg 51,400
resusitasi 30,000
54,000 3,109,900 2,853,750 -
91,000 3,624,900 2,853,750 -

200,000
20,000
- - - - - - - 220,000 -
180,000 60,000
210,000
30,000
- 390,000 - - - - - 90,000 -
- 390,000 - - - - - 310,000 -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi Ass. Oprt
25,000
- - - - 25,000 - - - - -
30,000 30,000
590,625 353,750
- - - 30,000 - 30,000 - - 590,625 353,750
- - - 30,000 25,000 30,000 - - 590,625 353,750

Askep
2,070,271
72,000
70,400
66,000
- - 2,070,271 136,400 - 72,000 - - - -
2,746,598
108,000
76,800
12,000
21,600
21,600
21,600
21,600
54,000
30,000
196,875 512,200
196,875 512,200 2,746,598 259,200 - 108,000 - - - -
196,875 512,200 4,816,869 395,600 - 180,000 - - - -

- - - - - - - - - - -
15,600
- - - - 15,600 - - - - - -
- - - - 15,600 - - - - - -
Diet Ambulance
180,000
- - - - - - - 180,000 - - -
29,000
270,000
31,500
- - - - 31,500 - - 270,000 29,000 - -
- - - - 31,500 - - 450,000 29,000 - -

Piutang
2,125,271 (25,000) 2,296,611

744,000
225,000
25,000
70,400
66,000
- - 3,255,671 (25,000) - 2,296,611 - -
300 2,805,898 (285,300)

1,902,000
655,000
120,000
76,800
12,000
21,600
21,600
21,600
21,600
54,000
30,000
67,000
4,922,200
600,000
240,000
100,000
- 300 11,671,298 (285,300) - - - -
- 300 14,926,969 (310,300) - 2,296,611 - -

-
-
Jumlah Bayar
ybs
(196,340)
744,000
225,000
25,000
70,400
66,000
- 934,060
2,520,598
1,902,000
655,000
120,000
76,800
12,000
21,600
21,600
21,600
21,600
54,000
30,000
67,000
4,922,200
600,000
240,000
100,000
- 11,385,998
-
- 12,320,058
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Januari 2012
2/20/2012
Dokter Obgyn
Ratna
1 Nabila Kanza A, An Pelunasan
- - -
2 Tuti Rahayu, Ny 35,000 5,000 50,000

Kelas VVIP 6 hari 30,000 1,800,000
resusitasi 30,000
visite 45,000 280,000
hematologi rutin
65,000 3,294,500 2,650,000
3 Jon Rita Turnip, Tn 25,000 5,000

Kelas 1 2 hari 6,000 292,000
glukosa sewaktu
ureum
kreatinin
asam urat
cholesterol
trigliserida
hbs ag
ambulance
visite 15,000
konsultasi 5,000
hematologi rutin
golongan darah
sgot
sgpt
31,000 317,000 -
3 Tina Diniati, Ny 40,000

Kelas 3 2 hari 2,000 112,000
per vaginum 600,000 525,000
visite 15,000 60,000
resusitasi 46,500
hematologi rutin
hbs ag
golongan darah
42,000 878,500 900,000
4 Suci Rohani, Ny 35,000 5,000 50,000

Kelas 3 4 hari 4,000 224,000
visite 15,000 90,000
hematologi rutin
golongan darah
hbs ag
per vaginum 600,000 525,000
resusitasi 46,500
39,000 935,500 800,000
5 Sumiati, Ny 40,000
Kelas 3 4 hari 4,000 224,000
resusitasi 30,000
visite 35,000 90,000
glukosa sewaktu
hematologi rutin
golongan darah
44,000 1,651,000 963,750
6 Tuti Maerina, Ny 20,000 5,000 50,000

Kelas VIP 8 hari 32,000 2,000,000
visite 40,000 480,000
hematologi rutin
golongan darah
sgot
sgpt
ureum
kreatinin
glukosa sewaktu
hbs ag
salpingoofarektomi bilateral 1,350,000 2,362,500
hysterektomi total 1,350,000 2,362,500
biaya PA
Ca 125
52,000 4,745,000 5,255,000
273,000 ### ###

- - - - - - - - -
240,000
210,000
- - 450,000 - - - - - -
25,000
- - - - - - - - 25,000
30,000
- - 30,000 - - - - - -
- - - - - - - - -
90,000
60,000
- - 150,000 - - - - - -
- - - - - - - - -
- - 630,000 - - - - - 25,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
Dokter Umum
Anestesi
- - - - - - - - - -
675,000
35,000 35,000
- - - - 35,000 - 35,000 - - 675,000
25,000
25,000 25,000 25,000
- 50,000 - - - - 25,000 25,000 - -

- - - - - - - - - -
- - - - - - - - - -
253,125
15,000 15,000
- - - - 15,000 - 15,000 - - 253,125
708,750
708,750
- - - - - - - - - 1,417,500
- 50,000 - - 50,000 - 75,000 25,000 - 2,345,625

Askep
Ruangan Adi Arif
- - - - - - - - -
3,368,018
126,000
450,000 225,000 720,000
40,000
450,000 225,000 720,000 3,368,018 40,000 - 126,000 - -
532,526
30,000
32,200
20,700
20,700
23,000
20,700
25,300
51,750
36,800
11,500
20,700
20,700
- - - 532,526 284,050 - 30,000 - -
350,102
18,000
275,312
35,200
49,500
11,000
- - 275,312 350,102 95,700 - 18,000 - -
552,391
36,000
70,400
11,000
49,500
275,312
- - 275,312 552,391 130,900 - 36,000 - -
1,556,913
36,000
168,750 84,375 180,000
30,800
70,400
11,000
168,750 84,375 180,000 1,556,913 112,200 - 36,000 - -
4,428,288
144,000
76,800
12,000
21,600
21,600
21,600
21,600
16,800
54,000
472,500 236,250
472,500 236,250
480,000
300,000
945,000 472,500 - 4,428,288 1,026,000 - 144,000 - -
1,563,750 781,875 ### ### 1,688,850 - 390,000 - -

- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - - -
Diet
- - - - - - - - - -
330,000
36,000
4,500
- 36,000 4,500 - - - - - - 330,000
72,000
- - - - - - - - - 72,000
42,000
13,500
- - - - - - - - 13,500 42,000
84,000
13,500
- - - - - - - 13,500 - 84,000
84,000
13,500
4,500
- - - - - 13,500 4,500 - - 84,000
360,000
- - - - - - - - - 360,000
- 36,000 4,500 - - 13,500 4,500 13,500 13,500 972,000

Diet Ambulance Piuta
-
-
- - - - - - - - -
-
38,000 3,496,018
2,286,000 (342,900)
5,620,000
270,000
135,000
605,000
40,000
75,000
15,000
38,000 - - - - 12,542,018 (342,900) - -
587,526
400,000
32,200
20,700
20,700
23,000
20,700
25,300
51,750
90,000 30,000 120,000
90,000
30,000
36,800
11,500
20,700
20,700
- 90,000 30,000 - - 1,511,576 - - -
390,102
174,000
1,400,312
180,000
105,000
60,000
35,200
49,500
11,000
240,000
- - - - - 2,645,114 - - -
642,391
348,000
105,000
70,400
11,000
49,500
1,400,312
180,000
60,000
- - - - - 2,866,603 - - -
1,596,913
348,000
2,830,000
120,000
215,000
60,000
30,800
70,400
11,000
35,000
15,000
- - - - - 5,332,113 - - -
28,000 4,531,288
2,536,000 (380,400)
520,000
76,800
12,000
21,600
21,600
21,600
21,600
16,800
54,000
5,130,000
5,130,000
480,000
300,000
28,000 - - - - 18,873,288 (380,400) - -
66,000 90,000 30,000 - - 43,770,712 (723,300) - -

Piutang
Jumlah Bayar
(487,240) 487,240
- - (487,240) 487,240
3,496,018
1,943,100
5,620,000
270,000
135,000
605,000
40,000
75,000
15,000
- - - 12,199,118
587,526
400,000
32,200
20,700
20,700
23,000
20,700
25,300
51,750
120,000
90,000
30,000
36,800
11,500
20,700
20,700
- - - 1,511,576
390,102
174,000
1,400,312
180,000
105,000
60,000
35,200
49,500
11,000
240,000
- - - 2,645,114
642,391
348,000
105,000
70,400
11,000
49,500
1,400,312
180,000
60,000
- - - 2,866,603
1,596,913
348,000
2,830,000
120,000
215,000
60,000
30,800
70,400
11,000
35,000
15,000
- - - 5,332,113
4,531,288
18,492,888 (16,337,288)
520,000
76,800
12,000
21,600
21,600
21,600
21,600
16,800
54,000
5,130,000
5,130,000
480,000
300,000
- 18,492,888 - -
- 18,492,888 (487,240) 25,041,764

Januari 2012
Dokter Obgyn
No. Tanggal Admin JS
Ratna Firdaus Zufrial Arif
1/26/2012 287,000 8,020,000 3,353,750 - -
1/27/2012 116,000 4,791,000 4,922,500 - -
1/28/2012 257,000 5,116,250 4,883,000 - -
1/29/2012 55,000 1,755,750 1,003,750 - 650,000
1/30/2012 145,000 3,175,500 1,121,750 - 1,050,000
1/31/2012 309,000 8,071,400 2,585,000 - 690,000
2/1/2012 124,000 1,780,000 - - -
2/2/2012 33,000 571,400 - - -
2/3/2012 98,000 2,645,500 2,558,500 - -
2/4/2012 167,000 4,169,500 3,048,750 - -
2/5/2012 176,000 4,331,000 2,161,250 - -
2/6/2012 213,000 7,306,250 3,681,250 - -
2/7/2012 337,000 6,699,500 4,227,500 - -
2/8/2012 186,000 5,696,500 4,688,750 - -
2/9/2012 124,000 2,813,000 2,225,000 - -
2/10/2012 121,000 2,765,500 3,755,000 - -
2/11/2012 261,000 9,676,750 5,590,000 - -
2/12/2012 181,000 2,847,500 3,215,000 - -
2/13/2012 110,000 2,827,250 1,312,250 - -
2/14/2012 33,000 440,000 - - -
2/15/2012 136,000 4,008,000 780,000 - -
2/16/2012 268,000 6,660,500 7,275,000 - -
2/17/2012 461,000 13,809,250 9,555,000 - -
2/18/2012 44,000 1,589,000 963,750 - -
2/19/2012 91,000 3,624,900 2,853,750 - -
2/20/2012 273,000 11,821,500 10,568,750 - -
4,606,000 127,012,700 86,329,250 - 2,390,000
88,719,250
Dokter Anak Dokter Bedah Dokter Internis Dokter Gigi
Bambang S Chanis Fajar Zumaro Willy Eko Djalu Iman Darjito Edy S Dian W
735,000 - - - - - 315,000 - -
610,000 - - - - - - - -
180,000 - - - - - 105,000 - -
- - - - - - 15,000 - -
260,000 - - - - - 75,000 - -
205,000 - 320,000 - - - 420,000 - -
355,000 - - - - - 215,000 - -
- - - - - - 150,000 - -
280,000 - - - - - - - -
380,000 - - 30,000 - - 45,000 - -
1,020,000 - 125,000 - - - - - -
735,000 - - 78,000 - - - - -
1,395,000 - - - - - 105,000 - -
390,000 - - - - - - - -
235,000 - - - - - 150,000 - -
160,000 - - - - - - - -
1,165,000 - - - - - - - -
50,000 - - - - - - - -
550,000 - - 150,000 - - 30,000 - -
120,000 - - - - - - - -
325,000 - - - - 1,590,000 - - -
870,000 - - - - - - - -
2,115,000 - - - - - 90,000 - -
180,000 - - - - - - - -
390,000 - - - - - 310,000 - -
630,000 - - - - - 25,000 - -
13,335,000 - 445,000 258,000 - 1,590,000 2,050,000 - -
13,780,000 1,848,000
Sangkan Fachri Uzer Anton Soemartono Arif M Irfan Dana Alip Djalil Boeing
- - - 180,000 - - - - - 50,000
- - - - - - - - - -
- 30,000 - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 50,000
- 450,000 - - - - - - - 30,000
- - - - - - - - - 20,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 50,000
- - - - - - - - - -
- - - - 30,000 - - - 25,000 -
- - - - - - - - 50,000 -
- - - - - - - - - 25,000
- - - - - - - - - -
- - - - - - - - - -
- - - 210,000 - - - - - 25,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - 30,000 - - - 25,000 25,000
- - - - - - - - - 25,000
- - - - - - - - - 25,000
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 50,000
- 480,000 - 390,000 60,000 - - - 100,000 375,000
Dokter Umum
Anestesi Ass. Oprt
Nurbaity Teguh I Made Kholid Windy Dewi Ahmed
- - - 25,000 35,000 35,000 - 756,250 462,500
- - - - - - - 843,750 562,500
25,000 25,000 - 25,000 15,000 - - 405,000 270,000
- - - - - - - 253,125 168,750
- - - 25,000 25,000 - 25,000 253,125 168,750
- 30,000 - 135,000 30,000 60,000 70,000 - -
- - 25,000 25,000 45,000 - 15,000 - -
- - - 25,000 - - - - -
- - - - - - - 438,750 292,500
- - - - - - - 253,125 168,750
- - 25,000 - - - - 253,125 168,750
- - 25,000 25,000 15,000 - - 556,875 506,250
- - - 50,000 50,000 - - 250,000 125,000
- - - - - - - - -
25,000 - - - - - - - -
- - - - - - - - -
- 25,000 - - - - 25,000 1,060,000 665,000
25,000 - - - - 25,000 - - -
- - - - - - - 253,125 168,750
- - 25,000 - - - - - -
33,000 - 25,000 25,000 - 25,000 15,000 450,000 300,000
- - - - - - - 675,000 450,000
75,000 - - 25,000 - - - 1,259,375 756,250
- - - - - - - 253,125 168,750
- - 30,000 25,000 30,000 - - 590,625 353,750
- - 50,000 - 75,000 25,000 - 2,345,625 1,563,750
183,000 80,000 205,000 410,000 320,000 170,000 150,000 ### 7,320,000
Askep
Ruangan Adi Arif
428,500 550,624 10,398,972 721,700 - 378,000 - -
416,250 640,000 5,943,393 421,200 - 138,000 - -
225,000 1,154,732 5,379,715 951,450 66,000 174,000 - -
174,375 180,000 2,924,316 412,500 - 45,000 - -
84,375 460,000 3,662,211 326,200 - 120,000 - -
90,000 908,337 14,639,868 1,472,850 1,224,500 486,000 - -
- - 4,345,811 616,600 129,500 216,000 - -
- - 728,969 163,200 - 36,000 - -
303,750 180,000 3,934,096 572,100 - 93,000 - -
84,375 1,063,437 4,105,482 591,600 135,000 150,000 - -
84,375 792,812 4,839,693 630,100 - 267,000 - -
185,625 460,312 7,245,912 1,150,900 66,000 273,000 - 13,500
75,000 805,312 6,533,460 920,200 - 417,000 - -
157,500 1,466,250 3,383,665 296,850 - 237,000 - -
- 883,437 2,254,823 586,050 - 132,000 - -
67,500 786,250 1,811,232 420,150 - 84,000 - -
345,000 955,500 12,047,668 1,015,200 69,000 456,000 - -
135,000 883,437 2,081,146 299,150 - 150,000 - -
84,375 195,000 5,038,912 684,150 - 171,000 - -
- - 508,545 59,400 - 48,000 - -
150,000 275,312 2,934,734 516,800 66,000 141,000 - -
292,500 923,124 7,754,298 985,250 - 288,000 - -
403,125 2,289,374 12,414,516 1,816,450 126,500 666,000 - -
84,375 180,000 1,448,822 130,900 - 36,000 - -
196,875 512,200 4,816,869 395,600 - 180,000 - -
781,875 1,450,624 10,788,238 1,688,850 - 390,000 - -
4,849,750 17,996,074 141,965,366 17,845,400 1,882,500 5,772,000 - 13,500
- - - - - - - - - - -
- - - - - - - - - - -
- - - - - - - - - 6,750 -
- - - - - - - - - - 6,750
- - - - - - - - - - -
- - - - - - 15,600 - - - -
- 9,000 - - - - - - - - -
- 15,600 - - - - - - - - -
- - - - - - - - - - -
- - - - - - 13,500 - 13,500 - -
- - - - - - - - - - -
- - - - - - - - - - 6,750
- - - - - - - - - - -
- - 13,500 - - - - - - - -
- - 13,500 - 13,500 - - - - - -
- - - - - - - - - - -
- - - - - - - - 6,750 - -
- - - - - - - - - - -
- - 13,500 - - - - - - - 6,750
- - - - - - - - - - -
13,500 - - - - - - - - - -
- - - - - - - - - - -
- - 6,750 - - - - - - - -
- - - - - - - - - - -
- - - - - - 15,600 - - - -
- - - - - - - - - - -
13,500 24,600 47,250 - 13,500 - 44,700 - 20,250 6,750 20,250
Diet
- - 27,000 - - - - - - 937,000
- 45,000 - - - - - - - 336,000
- - - - 13,500 13,500 - 13,500 - 411,000
- - - - - - - - - 105,000
- 4,500 - - - - - - 27,000 285,000
- 13,500 - 27,000 - - 9,000 - 13,500 1,188,000
- - - - - - - - - 519,000
- - - - - - - - - 90,000
- - - - - - 13,500 - - 225,000
- 27,000 - - - 27,000 13,500 - - 354,000
- - - - 13,500 - - 13,500 - 648,000
13,500 - 13,500 - 13,500 - - 13,500 - 651,000
- - - - 45,000 - - - 13,500 1,008,000
- - - - - - - 40,500 49,500 605,000
- - 4,500 - 27,000 - - - 13,500 315,000
- - 27,000 - - - - 31,500 - 204,000
- 54,000 - - - - - - - 1,110,000
- 40,500 - - - - - 13,500 - 405,000
- - - - - - - - - 411,000
- 50,000 - - - - - - - 120,000
- - - 13,500 - - - - - 333,000
- - - - - - 36,000 13,500 - 710,000
- - 18,000 - - 40,500 31,500 4,500 27,000 1,605,000
- - - - - - - - - 84,000
- - - - - - 31,500 - - 450,000
- 36,000 4,500 - - 13,500 4,500 13,500 13,500 972,000
13,500 270,500 94,500 40,500 112,500 94,500 139,500 157,500 157,500 14,081,000
Diet Ambulance
Ekstra BBM Sopir
39,000 - - - - 27,735,296 (1,200,050) -
- - - - - 19,785,593 (2,551,044) 3,000,000
- 90,000 30,000 - 200,000 20,065,397 - -
- 45,000 25,000 153,200 - 7,972,516 (102,000) -
- 45,000 15,000 - - 11,403,411 (102,000) 8,500,000
273,000 135,000 45,000 - 1,050,000 34,996,555 (816,542) -
- - - - - 8,439,911 (185,000) -
28,000 - - - - 1,841,169 (95,100) -
- - - - - 11,634,696 - -
- - - - - 14,890,519 - -
- - - - - 15,549,105 (282,500) -
30,000 - - - - 23,333,624 (142,650) -
- - - - - 23,106,472 (470,000) -
93,000 90,000 30,000 - - 17,449,015 (1,167,600) -
- - - - - 9,815,310 - -
38,000 - - - - 10,271,132 (95,100) -
68,000 90,000 40,000 241,700 - 35,201,568 (618,150) -
- - - - - 10,351,233 - -
- 135,000 55,000 308,200 - 12,504,262 (150,000) -
- - - - - 1,403,945 (105,000) 600,000
- 90,000 30,000 - - 12,355,846 (87,000) -
38,000 - - - - 27,264,172 (285,750) -
- - - - - 47,620,090 (664,750) -
- 45,000 25,000 291,000 - 5,523,722 - -
29,000 - - - 300 14,926,969 (310,300) -
66,000 90,000 30,000 - - 43,770,712 (723,300) -
702,000 855,000 325,000 994,100 1,250,300 469,212,240 (10,153,836) 12,100,000
Piutang
Jumlah Bayar
Jamsostek Garda Medika Asuransi Lain ybs
2,179,290 - - - 24,355,956
- - - - 20,234,549
- - - - 20,065,397
- - - - 7,870,516
- - - - 19,801,411
- - - 180,800 33,999,213
- - - - 8,254,911
- - - - 1,746,069
- - - - 11,634,696
- - - - 14,890,519
- - - - 15,266,605
- - - - 23,190,974
1,614,762 - - - 21,021,710
- - - - 16,281,415
- - - (180,800) 9,996,110
- - - - 10,176,032
- - - - 34,583,418
- - - - 10,351,233
- - - - 12,354,262
- - - - 1,898,945
- - - - 12,268,846
- - - - 26,978,422
1,850,867 - - 487,240 44,617,233
- - - - 5,523,722
2,296,611 - - - 12,320,058
- - 18,492,888 (487,240) 25,041,764
7,941,530 - 18,492,888 - 444,723,986
REKAPITULASI PENDAPATAN RAWAT INAP
RSU ADELLA
Februari 2012
Periode : 26/01/2012 - 20/02/2012
1 Administrasi 4,606,000
2 Jasa Sarana 127,012,700
3 Jasa Medis 109,320,250
Spesialis Kandungan 88,719,250
dr. Ratna Trisiyani, Sp. OG 86,329,250
dr. Zufrial Arif K, Sp. OG 2,390,000
Spesialis Anak 13,780,000
dr. Bambang Susilo, Sp. A. 13,335,000
dr. Fajar Danu Aji, Sp. A 445,000
Spesialis Bedah 1,848,000
dr. Ahmad Zumaro, Sp. B 258,000
dr. Eko Djalu Atmanto, Sp. B 1,590,000
Spesialis Penyakit Dalam 2,050,000
dr. Iman Darjito, Sp. PD 2,050,000
Spesialis Syaraf 480,000
dr. Fachri Uzer, Sp. S 480,000
Spesialis Anestesi 450,000
dr. Soemartono, Sp. An. 390,000
dr. Arif Aminudin, Sp. An. 60,000
Dokter Umum 1,993,000
dr. HM Abdul Djalil, M. Kes. 100,000
dr. Boeing Dewantari 375,000
dr. Nurbaity 183,000
dr. Teguh Sukma Wibowo 80,000
dr. I Made Sutrisna 205,000
dr. Nur Kholid Effendi 410,000
dr. Windy Oliviani 320,000
dr. Dewi Awalia Ulfa 170,000
dr. Ahmad Rosidi 150,000
Anestesi 11,150,000
Ass. Operator 7,320,000
Ass. Anestesi 4,849,750
4 BAHP 17,996,074
5 Farmasi 141,965,366
6 Laboratorium 17,845,400
7 Radiologi 1,882,500
8 Asuhan Keperawatan 7,056,800
Ruangan 5,772,000
Arif 13,500
Afit 13,500
Suhati 24,600
Wiwik 47,250
Eko P 13,500
Roikhatul 44,700
Dewi 20,250
Candra 6,750
Koticha 20,250
Ana 13,500
Eny 270,500
Endang 94,500
Pipit 40,500
Suci 112,500
Dinda 94,500
Tika 139,500
Retno 157,500
Wulan 157,500
9 Diet Pasien 14,783,000
Rawat Inap 14,081,000
Ekstra 702,000
10 Ambulance 1,180,000
BBM 855,000
Sopir 325,000
11 Rujukan 994,100
RB & Klinik Adella 994,100
12 Lain - Lain 1,250,300
13 Keringanan (10,153,836)
14 DP Pasien 12,100,000
15 Piutang 26,434,418
Jamsostek 7,941,530
Garda Medika -
Asuransi Lain 18,492,888
Pasien -
TOTAL PENDAPATAN 444,723,986
Slawi, 01 Maret 2012
Dibuat oleh, Diperiksa oleh, Disetujui oleh,
Nina Lestari dr. Nurkholid Effendi dr. HM Abdul Djalil, M. Kes.

Keuangan Kabid Yanmed Direktur

Irna Feb

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Rekap Pendapatan Rawat Inap

1 Fenni Arsiani, Ny 25,000 5,000

2 Yeti Nurul S, Ny 40,000

52,000 2,007,000 187,500

3 Aisya Syafa Rizqi Azzahra, An 25,000 5,000

4 Natik Aflahtul Amal, An 25,000 5,000

42,000 787,000 720,000

42,000 787,000 720,000

7 Ulfiah, Ny 20,000 5,000 50,000

22,000 242,000 605,000

4,000 1,334,000 1,121,250

287,000 8,020,000 3,353,750

- - - - - 25,000 35,000 35,000 - -

- 50,000 - - - 25,000 35,000 35,000 - 756,250

- - - 2,978,693 140,000 - 147,000 - -

337,500 286,000 - 2,951,924 248,400 - 60,000 - -

- - - 595,759 68,200 - 36,000 - -

- - 275,312 422,126 35,200 - 18,000 - -

- - 275,312 509,200 35,200 - 18,000 - -

- 67,500 - 717,262 95,700 - 18,000 - -

125,000 75,000 - 1,318,803 99,000 - 36,000 - -

462,500 428,500 550,624 ### 721,700 - 378,000 - -

- - 27,000 - - - - - - 937,000 39,000

- - - - 6,299,693 (400,050) - 2,179,290

- - - - 27,735,296 (1,200,050) - 2,179,290

1 Eri Hernaningsih, Ny DP pasien

2 Siti Musaropah, Ny 35,000 5,000 50,000

47,000 2,032,000 1,937,500

3 Seventina Nurul Hidayah, Ny 20,000 5,000 50,000

26,000 1,007,000 1,650,000

4 Yuli Onara, Ny 35,000 5,000 50,000

43,000 1,752,000 1,335,000

116,000 4,791,000 4,922,500

337,500 168,750 180,000 2,426,669 212,750 - 60,000 - - -

- 135,000 280,000 536,578 88,550 - 30,000 - - -

225,000 112,500 180,000 2,980,146 119,900 - 48,000 - - -

562,500 416,250 640,000 5,943,393 421,200 - 138,000 - - -

- - - 19,785,593 (2,551,044) 3,000,000 - -

1 Kunaeza Nely Awaliyan, An DP pasien

2 Indah Wulandari, Ny 25,000 5,000 50,000

28,000 1,056,000 838,000

3 Muslikhatun, Ny 20,000 5,000 50,000

24,000 275,000 730,000

4 Kunaeza Nely Awaliyan, An 25,000 5,000

5 Siti Maryam, Ny 20,000 5,000 50,000

23,000 888,000 1,115,000

42,000 823,500 720,000

7 Rohmatun, Ny 40,000 5,000

43,000 899,500 790,000

41,000 757,500 690,000

9 Karno, Tn 25,000 5,000

257,000 5,116,250 4,883,000

- - 25,000 25,000 - 25,000 15,000 - - 405,000

270,000 135,000 - 1,047,340 100,050 - 15,000 - -

- 90,000 - 500,528 202,400 - 24,000 - -

- - - 620,078 103,400 - 18,000 - -

- - 118,750 563,073 130,900 - 27,000 - -

- - 275,312 602,013 35,200 - 18,000 - -

- - 275,312 672,407 214,500 66,000 27,000 - -

- - 485,358 337,127 35,200 - 9,000 - -

- - - 1,037,149 129,800 - 36,000 - -

270,000 225,000 ### 5,379,715 951,450 66,000 174,000 - -

- - - - 13,500 13,500 - 13,500 - 411,000 -