HONOR RI BPJS Dari Tanggal : 01-May-2017 s/d 31-May-2017 dr. I Gusti Ngurah Made Wedagama, Sp.

O
Tanggal Kelas Nama Pasien Keterangan Jml Tarif
1 2 3 4 5 6 7 8 9 10
01-May-2017 DarmawangsYOGANTARI, SANG AYU NST -- 1 30,000
01-May-2017 DarmawangsYOGANTARI, SANG AYU PAKET SC UMUM 1 2,750,000
01-May-2017 DarmawangsYOGANTARI, SANG AYU PAKET SC UMUM 1 75,000
01-May-2017 DarmawangsYOGANTARI, SANG AYU Visite Dokter 2 200,000
01-May-2017 Bima 4T HANDRIYANI, NI WAYAN PAKET SC BPJS Murni 1 25,000
01-May-2017 Bima 4T HANDRIYANI, NI WAYAN PAKET SC BPJS Murni 1 770,000
01-May-2017 Bima 3T HANDRIYANI, NI WAYAN Visite Dokter 2 50,000
01-May-2017 Total 0
03-May-2017 Nakula SUNADI. NI WAYAN SC Gomeli 1 2,640,000
03-May-2017 Nakula SUNADI. NI WAYAN SC Gomeli 1 75,000
03-May-2017 Nakula SUNADI. NI WAYAN Visite Dokter 2 137,500
03-May-2017 Total 0
04-May-2017 Bima 4T YANTI NI WAYAN Visite Dokter 1 50,000
04-May-2017 Total 0
05-May-2017 Nakula ARNIASIH, I GUSTI AYU PAKET SC UMUM 1 1,760,000
05-May-2017 Nakula ARNIASIH, I GUSTI AYU PAKET SC UMUM 1 75,000
05-May-2017 Nakula ARNIASIH, I GUSTI AYU Visite Dokter 2 137,500
05-May-2017 Bima 2T SONI ANTARI, NI WAYAN PAKET SC BPJS Murni 1 25,000
05-May-2017 Bima 2T SONI ANTARI, NI WAYAN PAKET SC BPJS Murni 1 980,000
05-May-2017 Bima 2T SONI ANTARI, NI WAYAN Visite Dokter 2 50,000
05-May-2017 Total 0
06-May-2017 Bima 4T JUTIARI, I DEWA AYU MAKonsultasi Via Telp dr. I Gusti Ngurah Made Wedagam 1 25,000
06-May-2017 Bima 4T JUTIARI, I DEWA AYU MAPAKET SC BPJS Murni 1 25,000
06-May-2017 Bima 4T JUTIARI, I DEWA AYU MAPAKET SC BPJS Murni 1 770,000
06-May-2017 Bima 4T JUTIARI, I DEWA AYU MAVisite Dokter 2 50,000
06-May-2017 Total 0
07-May-2017 Bima 3T SUTINI, NI WAYAN PAKET SC BPJS Murni 1 25,000
07-May-2017 Bima 3T SUTINI, NI WAYAN PAKET SC BPJS Murni 1 900,000
07-May-2017 Bima 3T SUTINI, NI WAYAN Visite Dokter 1 90,000
07-May-2017 Total 0
10-May-2017 Bima 4T PERIANI NI WAYAN Konsultasi Via Telp dr. I Gusti Ngurah Made Wedagam 3 25,000
10-May-2017 Bima 4T PERIANI NI WAYAN PARTUS NORMAL BPJSMURNI 1 25,000
10-May-2017 Bima 4T PERIANI NI WAYAN PARTUS NORMAL BPJSMURNI 1 300,000
10-May-2017 Bima 4T PERIANI NI WAYAN Visite Dokter 2 50,000
10-May-2017 Total 0
12-May-2017 Bima 4T WIWIK ULANTARI, NI KA PAKET SC BPJS Murni 1 25,000
12-May-2017 Bima 4T WIWIK ULANTARI, NI KA PAKET SC BPJS Murni 1 770,000
12-May-2017 Bima 4T WIWIK ULANTARI, NI KA Visite Dokter 1 50,000
12-May-2017 Total 0
14-May-2017 Bima 4T ASA, NI LUH PAKET SC BPJS Murni 1 25,000
14-May-2017 Bima 4T ASA, NI LUH PAKET SC BPJS Murni 1 770,000
14-May-2017 Bima 4T ASA, NI LUH Visite Dokter 1 50,000
14-May-2017 Total 0
15-May-2017 Nakula MARIANI NI KETUT Injeksi -- 1 3,000
15-May-2017 Nakula MARIANI NI KETUT PAKET SC UMUM 1 1,760,000
15-May-2017 Nakula MARIANI NI KETUT PAKET SC UMUM 1 75,000
15-May-2017 Nakula MARIANI NI KETUT Visite Dokter 1 137,500
15-May-2017 Total 0
17-May-2017 XX WIRAWATI, LUH PUTU Konsultasi Via Telp 1 25,000
17-May-2017 XX WIRAWATI, LUH PUTU Tindakan Curetage (DC II) 1 522,500
17-May-2017 XX WIRAWATI, LUH PUTU Tindakan Curetage (DC II) 1 75,000
17-May-2017 Nakula WIRAWATI, LUH PUTU Visite Dokter 1 137,500
17-May-2017 Total 0
18-May-2017 Bima 2T LICIN, NI NENGAH CURETAGE BPJS MURNI 1 25,000
18-May-2017 Bima 2T LICIN, NI NENGAH CURETAGE BPJS MURNI 1 50,000
18-May-2017 Bima 2T LICIN, NI NENGAH CURETAGE BPJS MURNI 1 700,000
18-May-2017 Bima 2T LICIN, NI NENGAH Visite Dokter 1 50,000
18-May-2017 Total 0
19-May-2017 Arjuna SUMIASIH, NI KETUT Visite Dokter 1 110,000
19-May-2017 Total 0
22-May-2017 Nakula PADMI. NI WAYAN Partus Patologis 1 1,050,000
22-May-2017 Nakula PADMI. NI WAYAN Partus Patologis 1 75,000
22-May-2017 Nakula PADMI. NI WAYAN Visite Dokter 1 50,000
22-May-2017 Nakula WIDIANI, NI KADEK Konsultasi Via Telp dr. I Gusti Ngurah Made Wedagam 3 25,000
22-May-2017 Nakula WIDIANI, NI KADEK Partus Normal 1 75,000
22-May-2017 Nakula WIDIANI, NI KADEK Partus Normal 1 825,000
22-May-2017 Nakula WIDIANI, NI KADEK Visite Dokter 1 137,500
22-May-2017 Total 0
29-May-2017 Arjuna SRIANTI, NI NYOMAN Partus Patologis 1 75,000
29-May-2017 Arjuna SRIANTI, NI NYOMAN Partus Patologis 1 975,000
29-May-2017 Total 0
31-May-2017 Arjuna WIARTINI, I GUSTI AYU Partus Normal 1 742,500
31-May-2017 Arjuna WIARTINI, I GUSTI AYU Partus Normal 1 75,000
31-May-2017 Arjuna WIARTINI, I GUSTI AYU Visite Dokter 1 110,000
31-May-2017 Total 0
Grand Total 0
TOTAL HONOR : 22,465,500 TOTAL RUMKIT : 0
TOTAL PAJAK : 1,684,913
TOTAL RSU : 0

HONOR NETTO : 20,780,588 Rincian Perhitungan Pajak :

Pajak 2 22,465,500 x
PENERIMA DIREKTUR KEUANGAN / ADM
RS BANGLI MEDIKA CANTI
dr. I Gusti Ngurah Made Wedagama, Sp.OG (K)
NB : Apabila ada kekeliruan mohon hubungi bendahara RSU Bangli Medika Canti.
Paling Lambat 2 Bulan dari Honor di Terima
Terima Kasih atas pelayanan yang diberikan
Printed : 03 Jul 2017 8:58:09AM Page -1 of 1
h Made Wedagama, Sp.OG (K)
Diskon Honor
11 12
30,000
2,750,000
75,000
400,000
25,000
770,000
100,000
4,150,000
2,640,000
75,000
275,000
2,990,000
50,000
50,000
1,760,000
75,000
275,000
25,000
980,000
100,000
3,215,000
25,000
25,000
770,000
100,000
920,000
25,000
900,000
90,000
1,015,000
75,000
25,000
300,000
100,000
500,000
25,000
770,000
50,000
845,000
25,000
770,000
50,000
 845,000
3,000
1,760,000
75,000
137,500
1,975,500
25,000
522,500
75,000
137,500
760,000
25,000
50,000
700,000
50,000
825,000
110,000
110,000
1,050,000
75,000
50,000
75,000
75,000
825,000
137,500
2,287,500
75,000
975,000
1,050,000
742,500
75,000
110,000
927,500
22,465,500

itungan Pajak :
%= 1,684,913
 42856 DarmawanYOGANTARI, SANG A 1 30000 30000
42856 DarmawanYOGANTARI, SANG A 1 2750000 2750000
42856 DarmawanYOGANTARI, SANG A 1 75000 75000
42856 DarmawanYOGANTARI, SANG A 2 200000 400000
3255000
42856 Bima 4T HANDRIYANI, NI WAY 1 25000 25000
42856 Bima 4T HANDRIYANI, NI WAY 1 770000 770000
42856 Bima 3T HANDRIYANI, NI WAY 2 50000 100000
01-May-2017 Total 0 845000 845000 0
42858 Nakula SUNADI. NI WAYAN 1 2640000 2640000
42858 Nakula SUNADI. NI WAYAN 1 75000 75000
42858 Nakula SUNADI. NI WAYAN 2 137500 275000
03-May-2017 Total 0 2852500 2852500 0
42859 Bima 4T YANTI NI WAYAN 1 50000 50000
650000
25000
04-May-2017 Total 0 725000
42860 Nakula ARNIASIH, I GUSTI AY 1 1760000 1760000
42860 Nakula ARNIASIH, I GUSTI AY 1 75000 75000
42860 Nakula ARNIASIH, I GUSTI AY 2 137500 275000
2110000
42860 Bima 2T SONI ANTARI, NI WA 1 25000 25000
42860 Bima 2T SONI ANTARI, NI WA 1 980000 980000
42860 Bima 2T SONI ANTARI, NI WA 2 50000 100000
05-May-2017 Total 0 1055000 1055000 0
42861 Bima 4T JUTIARI, I DEWA AY 1 25000 25000
42861 Bima 4T JUTIARI, I DEWA AY 1 25000 25000
42861 Bima 4T JUTIARI, I DEWA AY 1 770000 770000
42861 Bima 4T JUTIARI, I DEWA AY 2 50000 100000
06-May-2017 Total 0 920000 845000 75000
42862 Bima 3T SUTINI, NI WAYAN 1 25000 25000
42862 Bima 3T SUTINI, NI WAYAN 1 900000 900000
42862 Bima 3T SUTINI, NI WAYAN 1 90000 90000
07-May-2017 Total 0 1015000
42865 Bima 4T PERIANI NI WAYAN 3 25000 75000
42865 Bima 4T PERIANI NI WAYAN 1 25000 25000
42865 Bima 4T PERIANI NI WAYAN 1 300000 300000
42865 Bima 4T PERIANI NI WAYAN 2 50000 100000
10-May-2017 Total 0 500000
42867 Bima 4T WIWIK ULANTARI, NI 1 25000 25000
42867 Bima 4T WIWIK ULANTARI, NI 1 770000 770000
42867 Bima 4T WIWIK ULANTARI, NI 1 50000 50000
12-May-2017 Total 0 845000
42869 Bima 4T ASA, NI LUH 1 25000 25000
42869 Bima 4T ASA, NI LUH 1 770000 770000
 42869 Bima 4T ASA, NI LUH 1 50000 50000
14-May-2017 Total 0 845000
42870 Nakula MARIANI NI KETUT 1 3000 3000
42870 Nakula MARIANI NI KETUT 1 1760000 1760000
42870 Nakula MARIANI NI KETUT 1 75000 75000
42870 Nakula MARIANI NI KETUT 1 137500 137500
15-May-2017 Total 0 1975500
42872 XX WIRAWATI, LUH PUT 1 25000 25000
42872 XX WIRAWATI, LUH PUT 1 522500 522500
42872 XX WIRAWATI, LUH PUT 1 75000 75000
42872 Nakula WIRAWATI, LUH PUT 1 137500 137500
17-May-2017 Total 0 760000
42873 Bima 2T LICIN, NI NENGAH 1 25000 25000
42873 Bima 2T LICIN, NI NENGAH 1 50000 50000
42873 Bima 2T LICIN, NI NENGAH 1 700000 700000
42873 Bima 2T LICIN, NI NENGAH 1 50000 50000
18-May-2017 Total 0 825000
42874 Arjuna SUMIASIH, NI KETUT 1 110000 110000
19-May-2017 Total 0 110000
42877 Nakula PADMI. NI WAYAN 1 1050000 1050000
42877 Nakula PADMI. NI WAYAN 1 75000 75000
42877 Nakula PADMI. NI WAYAN 1 50000 50000
1175000
42877 Nakula WIDIANI, NI KADEK 3 25000 75000
42877 Nakula WIDIANI, NI KADEK 1 75000 75000
42877 Nakula WIDIANI, NI KADEK 1 825000 825000
42877 Nakula WIDIANI, NI KADEK 1 137500 137500
22-May-2017 Total 0 1112500
42884 Arjuna SRIANTI, NI NYOMAN 1 75000 75000
42884 Arjuna SRIANTI, NI NYOMAN 1 975000 975000
29-May-2017 Total 0 1050000
42886 Arjuna WIARTINI, I GUSTI AY 1 742500 742500
42886 Arjuna WIARTINI, I GUSTI AY 1 75000 75000
42886 Arjuna WIARTINI, I GUSTI AY 1 110000 110000
31-May-2017 Total 0 927500