| 1 |
1001788497 |
330591 |
|
KURNADI kurang bayar rawat inap |
52 th |
Zuhri Dirgantoro, Sp.PD, FINASIM |
2022-10-24 |
UAP |
KLS III |
|
|
JAMINAN PRIBADI |
|
5 |
|
Rp 7.605.087 |
- |
|
PULANG KRG BYR |
| 2 |
1001816818 |
333951 |
DENDA PELAYANAN |
PORMAN JUPRIADI. S pasien blm bayar rawat inap |
36 th |
Wibowo Mustoko Negoro, Sp.PD |
2022-12-13 |
CEPHALGIA |
KLS III |
|
|
JAMINAN PRIBADI |
|
4 |
|
Rp 3.682.150 |
- |
|
DENDA PELAYANAN |
| 3 |
1001839374 |
336340 |
|
RAJA WIJAYA pasien blm bayar rawat inap |
10 th |
Dini Zuriana, Sp.A |
2023-01-22 |
OF+MORBILI+ISPA |
KLS III |
|
|
JAMINAN PRIBADI |
|
1365 |
|
Rp 4.763.150 |
- |
|
R/BPJS R/JAMKESDA |
| 4 |
1001888303 |
298177 |
|
HERU APRIANSYAH, TN |
39 th |
Firdaus Amansyah, Sp.B |
2023-04-17 |
COMBUSTIO GR II REGIO MANUS D/EKSISI BESAR |
KLS II |
|
|
BPJS KETENAGAKERJAAN TRAUMA CENTRE |
|
3 |
|
Rp 10.464.184 |
- |
|
|
| 5 |
1002148873 |
377074 |
|
LISA RIYANI , BY NY |
1 th |
Anasry Zakaria, dr, Sp.A |
2024-11-23 |
NCB SMK |
KLS I |
|
|
JAMINAN PRIBADI |
|
694 |
|
Rp 13.026.500 |
- |
|
R/ BPJS/1002148998 ambulance |
| 6 |
1002182293 |
386856 |
|
ANGGI CANDRA WINATA |
26 th |
M.Ibnu Joko, Dr, Sp.B |
2025-02-27 |
abses submandibula, Cellulitis and abscess of mouth - K12.2(Diagnosa Utama) |
KLS III |
|
|
JAMINAN PRIBADI |
|
598 |
|
Rp 10.739.810 |
- |
|
R/UHC/pro insisi gol sedang. diamond 11 |
| 7 |
1002182303 |
386861 |
|
SUSMIATI |
53 th |
M.Ibnu Joko, Dr, Sp.B |
2025-02-28 |
Nipple Mass Sinistra ec susp Fibrocystic mamae dd kanker payudara, Benign neoplasm of breast - D24(Diagnosa Utama) |
KLS III |
|
|
JAMINAN PRIBADI |
|
597 |
|
Rp 11.795.950 |
- |
|
R/UHC |
| 8 |
1002187705 |
388151 |
|
AHMAD SYAHRUL NASRULLAH |
3 th |
Damayani Farastuti, Sp.A |
2025-03-17 |
KDK, Other and unspecified convulsions - R56.8(Diagnosa Masuk) |
KLS III |
|
|
JAMINAN PRIBADI |
|
580 |
|
Rp 2.232.460 |
- |
|
R/UHC |
| 9 |
1002196368 |
390221 |
|
CALISTA PUTRI ,BY , NY |
1 th |
Damayani Farastuti, Sp.A |
2025-04-23 |
ASPEKSIA |
KLS I |
|
|
JAMINAN PRIBADI |
|
543 |
|
Rp 6.986.280 |
- |
|
25/04/2025 pindah perina |
| 10 |
1002201052 |
391565 |
|
AMELIA AGUSTIANI PUTRI , BY NY |
1 th |
Anasry Zakaria, dr, Sp.A |
2025-05-10 |
|
KLS III |
|
|
JAMINAN PRIBADI |
|
526 |
|
Rp 0 |
- |
|
|
| 11 |
1002201390 |
391641 |
|
RANTI PURNAMA SARI, BY, NY |
1 th |
Lony Novita ,Dr, Sp.A.,M.Kes |
2025-05-11 |
|
KLS III |
|
|
JAMINAN PRIBADI |
|
525 |
|
Rp 0 |
- |
|
|
| 12 |
1002208452 |
393289 |
|
UTI SUSILAWATI BY ,NY |
1 th |
|
2025-06-04 |
|
KLS III |
|
|
JAMINAN PRIBADI |
|
501 |
|
Rp 0 |
- |
|
|
| 13 |
1002228592 |
398376 |
|
ESTI NUR FATIMAH, BY NY |
1 th |
|
2025-08-15 |
|
KLS I |
|
|
JAMINAN PRIBADI |
|
429 |
|
Rp 0 |
- |
|
|
| 14 |
1002230932 |
398902 |
|
IROS ROSITA, BY, NY |
1 th |
Damayani Farastuti, Sp.A |
2025-08-24 |
Single live birth |
KLS III |
|
|
JAMINAN PRIBADI |
|
420 |
|
Rp 0 |
- |
|
|
| 15 |
1002235195 |
377882 |
|
Tes BY IT IHU dua |
28 th |
Firdaus Artoni, Dr, Sp.OG |
2025-09-09 |
Z09.8 # Follow-up exam after other treatment for other conditions |
KLS I |
|
|
JAMINAN PRIBADI |
|
404 |
|
Rp 0 |
- |
|
test perina |
| 16 |
1002255341 |
405016 |
|
REGITA PUTRINA SUKMA, BY NY |
0 th |
Anasry Zakaria, dr, Sp.A |
2025-11-20 |
|
KLS III |
|
|
JAMINAN PRIBADI |
|
332 |
|
Rp 0 |
- |
|
|
| 17 |
1002263780 |
407051 |
|
WANDA AYU LESTARI, BY NY |
0 th |
Anasry Zakaria, dr, Sp.A |
2025-12-19 |
|
KLS III |
|
|
JAMINAN PRIBADI |
|
303 |
|
Rp 100.000 |
- |
|
|
| 18 |
1002284179 |
412306 |
|
IIS SUMIYATI |
55 th |
Dewi Yusmeliasari, Dr, Sp.AN |
2026-03-05 |
Abdominal pain ec susp Appendisitis dd cholecystitis dd pancreatitis , - (Diagnosa Utama) |
KLS III |
|
|
JAMINAN PRIBADI |
|
5 |
|
Rp 16.667.573 |
- |
|
R/ UHC |
| 19 |
1002286610 |
412797 |
|
TYO ARIF NURROHMAN |
23 th |
M.Ibnu Joko, Dr, Sp.B |
2026-03-14 |
Suspek Fingertip injury digiti 2 manus sinistra, - (Diagnosa Utama)skin loss, - (Diagnosa Sekunder) |
KLS II |
|
|
JAMINAN PRIBADI |
|
3 |
|
Rp 13.140.550 |
- |
|
|
| 20 |
1002297725 |
365013 |
|
M. RIYAD MAHREZ FAUZI N, AN |
8 th |
Damayani Farastuti, Sp.A |
2026-05-04 |
Obs febris + nausea vomitting ec susp food intoxication dd GI tract infection, - (Diagnosa Utama) |
VIP |
|
|
JAMINAN PRIBADI |
|
3 |
|
Rp 7.564.561 |
- |
|
zr novi/ vip titip vvip diamon 3 |
