Laporan detail tindakan dan biaya pasien rawat jalan & inap
| No | No.Rawat | No.R.M. | Nama Pasien | Kamar | Cara Bayar | DPJP Registrasi | DPJP Ranap | Tgl.Reg | Jam Reg | Status | Status Bayar | No SEP | Tarif INA-CBG | Tarif RS | Dokter | Paramedis | Dokter+Paramedis | Radiologi | Laboratorium | Operasi | Farmasi | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2026/04/17/000155 | 223835 | DWI FATMA SARI |
Kamar: OK01 - Kamar OK
|
BPJS | dr. Restiko Maleo Fibullah |
dr. H. Ivan SusantoSp.OG
|
2026-04-17 | 16:14:16 | Sudah | Belum Bayar |
0603R0010426V002190 INACBG: 0 |
Rp 0 | Rp 1.304.500 | Rp 0 | Rp 0 | Rp 628.500 | Rp 0 | Rp 676.000 | Rp 0 | Rp 0 | ||
| 2 | 2026/04/17/000150 | 127068 | JURID |
Kamar: VIPB03 - Kamar Kelas I Bawah
|
UMUM | dr. Muhammad Akip Aprianto | - | 2026-04-17 | 15:13:05 | Sudah | Belum Bayar | - | Rp 0 | Rp 523.550 | Rp 0 | Rp 0 | Rp 273.000 | Rp 0 | Rp 162.500 | Rp 0 | Rp 88.050 | ||
| 3 | 2026/04/17/000149 | 063019 | SRIMADI BINTI ALIPIAH |
Kamar: IRCA21 - Kamar IR Non Tindakan
|
BPJS | dr. Muhammad Akip Aprianto |
dr. Made SuwarnoSp.PD.,M.Biomed
|
2026-04-17 | 14:55:10 | Berkas Diterima | Belum Bayar |
0603R0010426V002191 INACBG: 0 |
Rp 0 | Rp 357.500 | Rp 0 | Rp 0 | Rp 195.000 | Rp 0 | Rp 162.500 | Rp 0 | Rp 0 | ||
| 4 | 2026/04/17/000148 | 027423 | KGS. MUHAMMAD FAATIH AL MUKAROM |
Kamar: VIPA04 - Kamar Kelas I Atas
|
BPJS | dr. Muhammad Akip Aprianto |
dr. T. Mirda ZulaichaM.Ked (Ped)+1
|
2026-04-17 | 14:28:24 | Berkas Diterima | Belum Bayar |
0603R0010426V002189 INACBG: 0 |
Rp 0 | Rp 532.868 | Rp 0 | Rp 0 | Rp 273.000 | Rp 0 | Rp 195.000 | Rp 0 | Rp 64.868 | ||
| 5 | 2026/04/17/000145 | 018389 | HASMAWATI |
Kamar: IRKB03 - Kamar IRKB Obsetri
|
BPJS | dr. Mayasari Rizki Utami | - | 2026-04-17 | 13:29:22 | Sudah | Belum Bayar | - | Rp 0 | Rp 1.046.740 | Rp 0 | Rp 0 | Rp 556.400 | Rp 0 | Rp 377.000 | Rp 0 | Rp 113.340 | ||
| 6 | 2026/04/17/000141 | 223826 | NORMAWATI BINTI AKADIN |
Kamar: IRCA05 - Kamar IR Non Tindakan
|
BPJS | dr. Mayasari Rizki Utami |
dr. Natasya Wanda YunizaSp.N
|
2026-04-17 | 12:11:36 | Sudah | Belum Bayar |
0603R0010426V002188 INACBG: 0 |
Rp 0 | Rp 747.929 | Rp 0 | Rp 0 | Rp 271.000 | Rp 162.500 | Rp 240.500 | Rp 0 | Rp 73.929 | ||
| 7 | 2026/04/17/000095 | 223772 | IBRAHIM ARSYAH ALFAREZA |
Kamar: IRS08 - Kamar IR Isolasi
|
BPJS | dr. T. Mirda Zulaicha, M.Ked (Ped), Sp.A |
dr. T. Mirda ZulaichaM.Ked (Ped)+1
|
2026-04-17 | 11:52:02 | Sudah | Belum Bayar |
0603R0010426V002148 INACBG: 0 |
Rp 0 | Rp 314.104 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 106.104 | ||
| 8 | 2026/04/17/000078 | 079047 | NELY JUNIARTI |
Kamar: IRKB10 - Kamar IRKB Obsetri
|
BPJS | dr. Rivai Baharudin Yudha Putra, Sp.OG |
dr. Tomas EdibaSp.OG
|
2026-04-17 | 11:31:33 | Sudah | Belum Bayar |
0603R0010426V002136 INACBG: 0 |
Rp 0 | Rp 1.091.900 | Rp 0 | Rp 0 | Rp 714.900 | Rp 0 | Rp 377.000 | Rp 0 | Rp 0 | ||
| 9 | 2026/04/17/000117 | 223822 | RUSTAM BIN ALI BASAR |
Kamar: IRS05 - Kamar IR Isolasi
|
BPJS | dr. Mayasari Rizki Utami |
dr. Made SuwarnoSp.PD.,M.Biomed
|
2026-04-17 | 10:41:51 | Sudah | Belum Bayar |
0603R0010426V002187 INACBG: 0 |
Rp 0 | Rp 695.233 | Rp 0 | Rp 0 | Rp 245.000 | Rp 162.500 | Rp 195.000 | Rp 0 | Rp 92.733 | ||
| 10 | 2026/04/17/000082 | 223811 | ONISYAH |
Kamar: HCU02 - Kamar HCU
|
BPJS | dr. Mayasari Rizki Utami | - | 2026-04-17 | 09:45:03 | Berkas Diterima | Belum Bayar | - | Rp 0 | Rp 1.815.871 | Rp 0 | Rp 0 | Rp 754.730 | Rp 162.500 | Rp 435.500 | Rp 0 | Rp 463.141 | ||
| 11 | 2026/04/17/000051 | 223803 | LILI AMBARWATI |
Kamar: IRKB04 - Kamar IRKB Obsetri
|
BPJS | dr. Mayasari Rizki Utami |
dr. H. Ivan SusantoSp.OG
|
2026-04-17 | 08:50:57 | Berkas Diterima | Belum Bayar |
0603R0010426V002184 INACBG: 0 |
Rp 0 | Rp 1.237.410 | Rp 0 | Rp 0 | Rp 504.400 | Rp 0 | Rp 377.000 | Rp 0 | Rp 356.010 | ||
| 12 | 2026/04/17/000024 | 223796 | FAISOL BIN RUSLI |
Kamar: IRT05 - Kamar IR Tindakan
|
BPJS | dr. Anggun Nurul Fitria |
dr. Faisal MuttaqienSp. B
|
2026-04-17 | 06:48:32 | Berkas Diterima | Belum Bayar |
0603R0010426V002186 INACBG: 0 |
Rp 0 | Rp 771.983 | Rp 0 | Rp 0 | Rp 306.000 | Rp 162.500 | Rp 214.500 | Rp 0 | Rp 88.983 | ||
| TOTAL | Rp 0 | Rp 10.439.588 | Rp 0 | Rp 0 | Rp 4.799.930 | Rp 650.000 | Rp 3.412.500 | Rp 0 | Rp 1.447.158 | ||||||||||||||