RSUD SEKAYU

Jl. Kol. Wahid Udin Lingkungan I Kel. Kayuara

Kec. Sekayu Sekayu
Telp. 0714-321855 Fax
Email:

RINCIAN BIAYA PERAWATAN

Periode Perawatan : 07-Jan-2019 s/d 15-Jan-2019

No.Reg / No.RM : REG/IP/190107-0015 / 271772 Ruang Perawatan : Kamar KULIM 1

Nama Pasien : MUHAIMINA BT BANGGEK Kelas / No.Tempat Tidur : III / D0204
Tanggal Lahir : 12-Feb-1955 Penjamin Bayar : PRIBADI
Dokter Utama : dr. Erty Sundarita, SpPD Instansi : PRIBADI
Tanggal Masuk : 07-Jan-2019 Tanggal Keluar : 15-Jan-2019
Hak Kelas : III

Uraian / Transaksi Tanggal Qty Diskon Instansi Pasien

FARMASI IGD
R/ AMBROXOL SYRUP 15MG/ML 06/01/2019 1.00 0.00 0.00 3,589.00
R/ ASAM FOLAT(FOLIC ACID TAB 1 MG ) 06/01/2019 3.00 0.00 0.00 723.00
R/ ASAM TRANEKSAMAT 100 MG/ML INJ 06/01/2019 3.00 0.00 0.00 7,119.00
R/ CAPTOPRIL TAB 25 MG 06/01/2019 1.00 0.00 0.00 601.00
R/ CEFTRIAXON 1 GR INJ 06/01/2019 2.00 0.00 0.00 9,894.00
R/ ESOMEPRAZOLE INJEKSI 4O MG 06/01/2019 1.00 0.00 0.00 28,930.00
R/ IV CATHETER NO 22 06/01/2019 1.00 0.00 0.00 8,222.00
R/ NATRIUM KLORIDA 0.9% 500 MI(NACL) 06/01/2019 1.00 0.00 0.00 6,928.00
R/ OTSU WATER INJ 25 ML 06/01/2019 1.00 0.00 0.00 3,368.00
R/ SPUIT 1 CC 06/01/2019 2.00 0.00 0.00 1,853.00
R/ SPUIT 10CC 06/01/2019 2.00 0.00 0.00 2,616.00
R/ SPUIT 3 CC 06/01/2019 2.00 0.00 0.00 1,787.00
R/ SUCRALFATE SUSPENSI 100 ML 06/01/2019 1.00 0.00 0.00 8,729.00
R/ TRANSFUSI SET "GEA" 06/01/2019 1.00 0.00 0.00 5,076.00
R/ ECOSOL NACL 0,9% 100 ML 06/01/2019 1.00 0.00 0.00 7,671.00
R/ FARMABES INJ'5' 06/01/2019 2.00 0.00 0.00 114,051.00
R/ SPUIT 5 CC 06/01/2019 2.00 0.00 0.00 1,882.00
R/ Three Way Stopcoch 06/01/2019 1.00 0.00 0.00 4,580.00
R/ CLOBAZAM TAB 10 MG 06/01/2019 1.00 0.00 0.00 1,242.00
R/ FUROSEMIDE 10 MG INJEKSI 06/01/2019 1.00 0.00 0.00 1,837.00
R/ SELANG SUNGKUP DEWASA 06/01/2019 1.00 0.00 0.00 16,944.00
R/ SPUIT 3 CC 06/01/2019 1.00 0.00 0.00 1,144.00
R/ SPUIT 5 CC 06/01/2019 1.00 0.00 0.00 1,191.00
TOTAL FARMASI 0.00 0.00 239,977.00
FARMASI RAWAT INAP
R/ ASAM FOLAT(FOLIC ACID TAB 1 MG ) 07/01/2019 3.00 0.00 0.00 723.00
R/ ASAM TRANEKSAMAT 500 MG/5ML INJ 07/01/2019 3.00 0.00 0.00 6,388.00
R/ CEFTRIAXON 1 GR INJ 07/01/2019 2.00 0.00 0.00 9,894.00
R/ NATRIUM KLORIDA 0.9% 500 MI(NACL) 07/01/2019 1.00 0.00 0.00 6,928.00
R/ OMEPRAZOLE 20 MG KAP 07/01/2019 2.00 0.00 0.00 769.00
R/ AMIPAREN INJ 500 07/01/2019 2.00 0.00 0.00 182,150.00
R/ ASAM TRANEKSAMAT 500 MG/5ML INJ 07/01/2019 3.00 0.00 0.00 6,388.00
R/ FARMABES INJ'5' 07/01/2019 2.00 0.00 0.00 114,051.00
R/ SELANG SUNGKUP DEWASA 07/01/2019 1.00 0.00 0.00 16,944.00
R/ ZINC TAB 20 MG 07/01/2019 1.00 0.00 0.00 1,053.00
R/ ECOSOL NACL 0,9% 100 ML 07/01/2019 3.00 0.00 0.00 22,011.00
R/ FARMABES INJ'5' 07/01/2019 6.00 0.00 0.00 341,152.00
R/ FARMABES INJ'5' 08/01/2019 4.00 0.00 0.00 227,601.00
R/ HIDROCHLOROTIAZIDE TAB (HCT) 08/01/2019 1.00 0.00 0.00 664.00
R/ INFUSAN D5 100 ML 08/01/2019 1.00 0.00 0.00 12,060.00
R/ ASAM FOLAT(FOLIC ACID TAB 1 MG ) 08/01/2019 3.00 0.00 0.00 723.00
R/ ASAM TRANEKSAMAT 500 MG/5ML INJ 08/01/2019 3.00 0.00 0.00 6,388.00
R/ CEFTRIAXON 1 GR INJ 08/01/2019 2.00 0.00 0.00 9,894.00
R/ FARMABES INJ'5' 08/01/2019 4.00 0.00 0.00 227,601.00
R/ NATRIUM KLORIDA 0.9% 500 MI(NACL) 08/01/2019 2.00 0.00 0.00 13,356.00
R/ RANITIDIN 25 MG/ML INJ 08/01/2019 2.00 0.00 0.00 2,817.00

15.01.2019 11:36:09 1 of 6
 RSUD SEKAYU
Jl. Kol. Wahid Udin Lingkungan I Kel. Kayuara
Kec. Sekayu Sekayu
Telp. 0714-321855 Fax
Email:

RINCIAN BIAYA PERAWATAN

Periode Perawatan : 07-Jan-2019 s/d 15-Jan-2019

No.Reg / No.RM : REG/IP/190107-0015 / 271772 Ruang Perawatan : Kamar KULIM 1

Nama Pasien : MUHAIMINA BT BANGGEK Kelas / No.Tempat Tidur : III / D0204
Tanggal Lahir : 12-Feb-1955 Penjamin Bayar : PRIBADI
Dokter Utama : dr. Erty Sundarita, SpPD Instansi : PRIBADI
Tanggal Masuk : 07-Jan-2019 Tanggal Keluar : 15-Jan-2019
Hak Kelas : III

Uraian / Transaksi Tanggal Qty Diskon Instansi Pasien

R/ ASERING 500 CC INFUS 09/01/2019 2.00 0.00 0.00 19,847.00
R/ ECOSOL NACL 0,9% 100 ML 09/01/2019 3.00 0.00 0.00 22,011.00
R/ FARMABES INJ'5' 09/01/2019 4.00 0.00 0.00 227,601.00
R/ ASAM FOLAT(FOLIC ACID TAB 1 MG ) 09/01/2019 3.00 0.00 0.00 723.00
R/ ASAM TRANEKSAMAT 500 MG/5ML INJ 09/01/2019 3.00 0.00 0.00 6,388.00
R/ CEFTRIAXON 1 GR INJ 09/01/2019 2.00 0.00 0.00 9,894.00
R/ ECOSOL NACL 0,9% 100 ML 09/01/2019 1.00 0.00 0.00 7,671.00
R/ FUROSEMID TAB 40 MG 09/01/2019 2.00 0.00 0.00 655.00
R/ HIDROCHLOROTIAZIDE TAB (HCT) 09/01/2019 1.00 0.00 0.00 664.00
R/ IV CATHETER NO 22 09/01/2019 2.00 0.00 0.00 15,944.00
R/ RANITIDIN 25 MG/ML INJ 09/01/2019 2.00 0.00 0.00 2,817.00
R/ ERICAF TAB 09/01/2019 2.00 0.00 0.00 12,913.00
R/ INFUSAN D5 100 ML 09/01/2019 1.00 0.00 0.00 12,060.00
R/ NICARDIPINE HCL 10 MG INJ 09/01/2019 2.00 0.00 0.00 47,931.00
R/ ECOSOL NACL 0,9% 100 ML 09/01/2019 4.00 0.00 0.00 29,181.00
R/ NICARDIPINE HCL 10 MG INJ 09/01/2019 6.00 0.00 0.00 142,792.00
R/ SPUIT 10CC 09/01/2019 5.00 0.00 0.00 5,790.00
R/ SPUIT 3 CC 09/01/2019 5.00 0.00 0.00 3,716.00
R/ SPUIT 5 CC 09/01/2019 5.00 0.00 0.00 3,954.00
R/ HIDROCHLOROTIAZIDE TAB (HCT) 10/01/2019 1.00 0.00 0.00 664.00
R/ NATRIUM KLORIDA 0.9% 500 MI(NACL) 10/01/2019 3.00 0.00 0.00 19,783.00
R/ TRANSFUSI SET "TERUMO" 10/01/2019 1.00 0.00 0.00 35,034.00
R/ IV CATHETER NO 22 10/01/2019 6.00 0.00 0.00 46,830.00
R/ ASAM FOLAT(FOLIC ACID TAB 1 MG ) 10/01/2019 3.00 0.00 0.00 723.00
R/ CEFTRIAXON 1 GR INJ 10/01/2019 2.00 0.00 0.00 9,894.00
R/ ECOSOL NACL 0,9% 100 ML 10/01/2019 2.00 0.00 0.00 14,841.00
R/ ERICAF TAB 10/01/2019 2.00 0.00 0.00 12,913.00
R/ FARMABES INJ'5' 10/01/2019 2.00 0.00 0.00 114,051.00
R/ FUROSEMIDE 10 MG INJEKSI 10/01/2019 2.00 0.00 0.00 3,174.00
R/ HIDROCHLOROTIAZIDE TAB (HCT) 10/01/2019 1.00 0.00 0.00 664.00
R/ RANITIDIN 25 MG/ML INJ 10/01/2019 2.00 0.00 0.00 2,817.00
R/ SPUIT 10CC 10/01/2019 2.00 0.00 0.00 2,616.00
R/ SPUIT 3 CC 10/01/2019 2.00 0.00 0.00 1,787.00
R/ COMBIVENT 2.5 ML UDV 10/01/2019 5.00 0.00 0.00 25,596.00
R/ MELOXICAM 7.5 MG TAB 10/01/2019 1.00 0.00 0.00 821.00
R/ CLONIDINE TAB 0,15 MG 11/01/2019 1.00 0.00 0.00 684.00
R/ AMLODIPINE TAB 10 MG 11/01/2019 1.00 0.00 0.00 596.00
R/ ASAM FOLAT(FOLIC ACID TAB 1 MG ) 11/01/2019 3.00 0.00 0.00 723.00
R/ CEFTRIAXON 1 GR INJ 11/01/2019 2.00 0.00 0.00 9,894.00
R/ CLONIDINE TAB 0,15 MG 11/01/2019 3.00 0.00 0.00 1,051.00
R/ FUROSEMIDE 10 MG INJEKSI 11/01/2019 2.00 0.00 0.00 3,174.00
R/ HIDROCHLOROTIAZIDE TAB (HCT) 11/01/2019 1.00 0.00 0.00 664.00
R/ MELOXICAM 7.5 MG TAB 11/01/2019 1.00 0.00 0.00 821.00
R/ RANITIDIN 25 MG/ML INJ 11/01/2019 2.00 0.00 0.00 2,817.00
R/ RETHAPYL SR TAB 11/01/2019 1.00 0.00 0.00 1,683.00
R/ AMLODIPINE TAB 10 MG 12/01/2019 2.00 0.00 0.00 691.00
R/ ASAM FOLAT(FOLIC ACID TAB 1 MG ) 12/01/2019 6.00 0.00 0.00 946.00

15.01.2019 11:36:09 2 of 6
 RSUD SEKAYU
Jl. Kol. Wahid Udin Lingkungan I Kel. Kayuara
Kec. Sekayu Sekayu
Telp. 0714-321855 Fax
Email:

RINCIAN BIAYA PERAWATAN

Periode Perawatan : 07-Jan-2019 s/d 15-Jan-2019

No.Reg / No.RM : REG/IP/190107-0015 / 271772 Ruang Perawatan : Kamar KULIM 1

Nama Pasien : MUHAIMINA BT BANGGEK Kelas / No.Tempat Tidur : III / D0204
Tanggal Lahir : 12-Feb-1955 Penjamin Bayar : PRIBADI
Dokter Utama : dr. Erty Sundarita, SpPD Instansi : PRIBADI
Tanggal Masuk : 07-Jan-2019 Tanggal Keluar : 15-Jan-2019
Hak Kelas : III

Uraian / Transaksi Tanggal Qty Diskon Instansi Pasien

R/ CEFTRIAXON 1 GR INJ 12/01/2019 4.00 0.00 0.00 19,288.00
R/ CLONIDINE TAB 0,15 MG 12/01/2019 6.00 0.00 0.00 1,601.00
R/ ERICAF TAB 12/01/2019 4.00 0.00 0.00 25,326.00
R/ FUROSEMIDE 10 MG INJEKSI 12/01/2019 4.00 0.00 0.00 5,847.00
R/ HIDROCHLOROTIAZIDE TAB (HCT) 12/01/2019 2.00 0.00 0.00 827.00
R/ MELOXICAM 7.5 MG TAB 12/01/2019 2.00 0.00 0.00 1,142.00
R/ NATRIUM KLORIDA 0.9% 500 MI(NACL) 12/01/2019 2.00 0.00 0.00 13,356.00
R/ RANITIDIN 25 MG/ML INJ 12/01/2019 4.00 0.00 0.00 5,133.00
R/ RETHAPYL SR TAB 12/01/2019 2.00 0.00 0.00 2,865.00
R/ SPUIT 10CC 12/01/2019 5.00 0.00 0.00 5,790.00
R/ SPUIT 3 CC 12/01/2019 5.00 0.00 0.00 3,716.00
R/ TRANSFUSI SET "GEA" 12/01/2019 2.00 0.00 0.00 9,652.00
R/ AMLODIPINE TAB 5 MG 14/01/2019 1.00 0.00 0.00 581.00
R/ ASAM FOLAT(FOLIC ACID TAB 1 MG ) 14/01/2019 3.00 0.00 0.00 723.00
R/ CEFTRIAXON 1 GR INJ 14/01/2019 2.00 0.00 0.00 9,894.00
R/ CLONIDINE TAB 0,15 MG 14/01/2019 3.00 0.00 0.00 1,051.00
R/ ERICAF TAB 14/01/2019 2.00 0.00 0.00 12,913.00
R/ FUROSEMID TAB 40 MG 14/01/2019 2.00 0.00 0.00 655.00
R/ HIDROCHLOROTIAZIDE TAB (HCT) 14/01/2019 2.00 0.00 0.00 827.00
R/ INFUS SET MAKRO TYPE Y 14/01/2019 3.00 0.00 0.00 22,341.00
R/ MELOXICAM 7.5 MG TAB 14/01/2019 1.00 0.00 0.00 821.00
R/ NATRIUM KLORIDA 0.9% 500 MI(NACL) 14/01/2019 2.00 0.00 0.00 13,356.00
R/ OMEPRAZOLE 20 MG KAP 14/01/2019 2.00 0.00 0.00 769.00
R/ RETHAPYL SR TAB 14/01/2019 1.00 0.00 0.00 1,683.00
R/ SPUIT 10CC 14/01/2019 3.00 0.00 0.00 3,674.00
R/ SPUIT 3 CC 14/01/2019 3.00 0.00 0.00 2,430.00
R/ SPUIT 5 CC 14/01/2019 3.00 0.00 0.00 2,573.00
R/ AMLODIPINE TAB 5 MG 15/01/2019 1.00 0.00 0.00 581.00
R/ ASAM FOLAT(FOLIC ACID TAB 1 MG ) 15/01/2019 3.00 0.00 0.00 723.00
R/ CEFTRIAXON 1 GR INJ 15/01/2019 2.00 0.00 0.00 9,894.00
R/ CLONIDINE TAB 0,15 MG 15/01/2019 3.00 0.00 0.00 1,051.00
R/ FUROSEMIDE 10 MG INJEKSI 15/01/2019 2.00 0.00 0.00 3,174.00
R/ HIDROCHLOROTIAZIDE TAB (HCT) 15/01/2019 1.00 0.00 0.00 664.00
R/ IV CATHETER NO 20 15/01/2019 2.00 0.00 0.00 15,944.00
R/ IV CATHETER NO 22 15/01/2019 2.00 0.00 0.00 15,944.00
R/ NATRIUM KLORIDA 0.9% 500 MI(NACL) 15/01/2019 3.00 0.00 0.00 19,783.00
R/ RANITIDIN 25 MG/ML INJ 15/01/2019 2.00 0.00 0.00 2,817.00
R/ RETHAPYL SR TAB 15/01/2019 1.00 0.00 0.00 1,683.00
R/ SPUIT 10CC 15/01/2019 3.00 0.00 0.00 3,674.00
R/ SPUIT 3 CC 15/01/2019 3.00 0.00 0.00 2,430.00
R/ AMLODIPINE TAB 10 MG 15/01/2019 7.00 0.00 0.00 1,167.00
R/ ASAM FOLAT(FOLIC ACID TAB 1 MG ) 15/01/2019 21.00 0.00 0.00 2,058.00
R/ CEFIXIM KAPSUL 100 MG 15/01/2019 20.00 0.00 0.00 15,542.00
R/ CLONIDINE TAB 0,15 MG 15/01/2019 21.00 0.00 0.00 4,354.00
R/ FUROSEMID TAB 40 MG 15/01/2019 7.00 0.00 0.00 1,041.00
R/ HIDROCHLOROTIAZIDE TAB (HCT) 15/01/2019 7.00 0.00 0.00 1,645.00
R/ KETOPROFEN TAB 100 MG 15/01/2019 10.00 0.00 0.00 11,752.00

15.01.2019 11:36:09 3 of 6
 RSUD SEKAYU
Jl. Kol. Wahid Udin Lingkungan I Kel. Kayuara
Kec. Sekayu Sekayu
Telp. 0714-321855 Fax
Email:

RINCIAN BIAYA PERAWATAN

Periode Perawatan : 07-Jan-2019 s/d 15-Jan-2019

No.Reg / No.RM : REG/IP/190107-0015 / 271772 Ruang Perawatan : Kamar KULIM 1

Nama Pasien : MUHAIMINA BT BANGGEK Kelas / No.Tempat Tidur : III / D0204
Tanggal Lahir : 12-Feb-1955 Penjamin Bayar : PRIBADI
Dokter Utama : dr. Erty Sundarita, SpPD Instansi : PRIBADI
Tanggal Masuk : 07-Jan-2019 Tanggal Keluar : 15-Jan-2019
Hak Kelas : III

Uraian / Transaksi Tanggal Qty Diskon Instansi Pasien

R/ OMEPRAZOLE 20 MG KAP 15/01/2019 14.00 0.00 0.00 2,382.00
R/ RETHAPYL SR TAB 15/01/2019 7.00 0.00 0.00 8,777.00
R/ SUCRALFATE SUSPENSI 100 ML 15/01/2019 1.00 0.00 0.00 8,729.00
TOTAL FARMASI 0.00 0.00 2,402,702.00
INSTALASI GAWAT DARURAT
Asuhan Keperawatan Besar dr. Mely Ekajayanti 06/01/2019 1.00 0.00 0.00 50,000.00
Berkas RM UGD dr. Mely Ekajayanti 06/01/2019 1.00 0.00 0.00 7,500.00
Oksigen 2 s/d 3 Liter / Menit Jangka Waktu 1s/d4 Jam dr. 06/01/2019 1.00 0.00 0.00 15,000.00
Mely Ekajayanti
Pasang Infus intra venous ekstremitas (DR. UMUM) dr. 06/01/2019 1.00 0.00 0.00 65,000.00
Mely Ekajayanti
Periksa Dokter Umum dr. Mely Ekajayanti 06/01/2019 1.00 0.00 0.00 50,000.00
0.00 0.00 187,500.00
KULIM
Askep IRNA Besar dr. Erty Sundarita, SpPD 07/01/2019 1.00 0.00 0.00 133,800.00
Dokumen RM (selama perawatan) dr. Erty Sundarita, SpPD 07/01/2019 1.00 0.00 0.00 6,500.00
Memasang Infus (DR. SPESIALIS) dr. Erty Sundarita, SpPD07/01/2019 1.00 0.00 0.00 136,400.00
Oksigen 2 s/d 3 Liter / Menit 07/01/2019 24.00 0.00 0.00 480,000.00
Visite Dr. Spesialis dr. Erty Sundarita, SpPD 07/01/2019 1.00 0.00 0.00 35,700.00
Askep IRNA Besar dr. Erty Sundarita, SpPD 08/01/2019 1.00 0.00 0.00 133,800.00
Kelas Perawatan 08/01/2019 1.00 0.00 0.00 40,100.00
Oksigen 2 s/d 3 Liter / Menit Jangka Waktu >10 Jam dr. Erty08/01/2019 7.00 0.00 0.00 70,000.00
Sundarita, SpPD
Visite Dr. Spesialis dr. Erty Sundarita, SpPD 08/01/2019 1.00 0.00 0.00 35,700.00
Askep IRNA Besar dr. Erty Sundarita, SpPD 09/01/2019 1.00 0.00 0.00 133,800.00
Kelas Perawatan 09/01/2019 1.00 0.00 0.00 40,100.00
KONSULTASI GIZI Ahli Gizi 09/01/2019 1.00 0.00 0.00 17,500.00
Visite Dr. Spesialis dr. Erty Sundarita, SpPD 09/01/2019 1.00 0.00 0.00 35,700.00
Askep IRNA Besar dr. Erty Sundarita, SpPD 10/01/2019 1.00 0.00 0.00 133,800.00
Kelas Perawatan 10/01/2019 1.00 0.00 0.00 40,100.00
Memasang Infus (DR. SPESIALIS) dr. Erty Sundarita, SpPD10/01/2019 1.00 0.00 0.00 136,400.00
Visite Dr. Spesialis dr. Erty Sundarita, SpPD 10/01/2019 1.00 0.00 0.00 35,700.00
Kelas Perawatan 11/01/2019 1.00 0.00 0.00 40,100.00
Visite Dr. Spesialis dr. H. M. Syarifuddin. SpPD 11/01/2019 1.00 0.00 0.00 35,700.00
Kelas Perawatan 12/01/2019 1.00 0.00 0.00 40,100.00
Visite Dr. Umum dr. M. Saleh Afif 12/01/2019 1.00 0.00 0.00 17,800.00
Askep IRNA Besar dr. Barikil Qodri Fitrina 13/01/2019 1.00 0.00 0.00 133,800.00
Kelas Perawatan 13/01/2019 1.00 0.00 0.00 40,100.00
Memasang Infus (DR. SPESIALIS) dr. Erty Sundarita, SpPD13/01/2019 1.00 0.00 0.00 136,400.00
Memasang Tranfuse Darah dr. Erty Sundarita, SpPD 13/01/2019 1.00 0.00 0.00 136,400.00
Visite Dr. Umum dr. Barikil Qodri Fitrina 13/01/2019 1.00 0.00 0.00 17,800.00
Kelas Perawatan 14/01/2019 1.00 0.00 0.00 40,100.00
Memasang Tranfuse Darah dr. Erty Sundarita, SpPD 14/01/2019 1.00 0.00 0.00 136,400.00
Visite Dr. Spesialis dr. Erty Sundarita, SpPD 14/01/2019 1.00 0.00 0.00 35,700.00
Visite Dr. Spesialis dr. Herianto, SpPD 14/01/2019 1.00 0.00 0.00 35,700.00
Kelas Perawatan 15/01/2019 1.00 0.00 0.00 40,100.00
Visite Dr. Spesialis dr. Herianto, SpPD 15/01/2019 1.00 0.00 0.00 35,700.00
0.00 0.00 2,567,000.00

15.01.2019 11:36:09 4 of 6
 RSUD SEKAYU
Jl. Kol. Wahid Udin Lingkungan I Kel. Kayuara
Kec. Sekayu Sekayu
Telp. 0714-321855 Fax
Email:

RINCIAN BIAYA PERAWATAN

Periode Perawatan : 07-Jan-2019 s/d 15-Jan-2019

No.Reg / No.RM : REG/IP/190107-0015 / 271772 Ruang Perawatan : Kamar KULIM 1

Nama Pasien : MUHAIMINA BT BANGGEK Kelas / No.Tempat Tidur : III / D0204
Tanggal Lahir : 12-Feb-1955 Penjamin Bayar : PRIBADI
Dokter Utama : dr. Erty Sundarita, SpPD Instansi : PRIBADI
Tanggal Masuk : 07-Jan-2019 Tanggal Keluar : 15-Jan-2019
Hak Kelas : III

Uraian / Transaksi Tanggal Qty Diskon Instansi Pasien

LABORATORIUM
Chlorida 06/01/2019 1.00 0.00 0.00 45,000.00
Darah Lengkap dr. Ruri, Sp.PK 06/01/2019 1.00 0.00 0.00 71,000.00
Gula Darah sewaktu 06/01/2019 1.00 0.00 0.00 21,000.00
HDL 06/01/2019 1.00 0.00 0.00 42,000.00
Kalium 06/01/2019 1.00 0.00 0.00 45,000.00
Kolesterol Total 06/01/2019 1.00 0.00 0.00 35,000.00
LDL 06/01/2019 1.00 0.00 0.00 63,000.00
Natrium 06/01/2019 1.00 0.00 0.00 45,000.00
Trigliserida 06/01/2019 1.00 0.00 0.00 36,000.00
Ureum 06/01/2019 1.00 0.00 0.00 30,000.00
Golongan Darah + Rhesus 07/01/2019 1.00 0.00 0.00 19,000.00
Golongan Darah + Rhesus 07/01/2019 1.00 0.00 0.00 19,000.00
Biaya Pengganti Pengolahan Dar 07/01/2019 2.00 0.00 0.00 924,000.00
Golongan Darah + Rhesus dr. Natasya 07/01/2019 2.00 0.00 0.00 13,400.00
Haemoglobin dr. Ruri, Sp.PK 14/01/2019 1.00 0.00 0.00 46,000.00
TOTAL PEMERIKSAAN LABORATORIUM 0.00 0.00 1,454,400.00
RADIOLOGI
THORAX dr. Martin, Sp.Rad 07/01/2019 1.00 0.00 0.00 120,000.00
Vert. Lumball AP/Lat (2x) dr. Agus Prawira, SpRad 10/01/2019 1.00 0.00 0.00 225,000.00
TOTAL PEMERIKSAAN RADIOLOGI 0.00 0.00 345,000.00
SUB TOTAL 0.00 0.00 7,196,579.00

INSTALASI GAWAT DARURAT

Monitor Bed Side dr. Mely Ekajayanti 06/01/2019 1.00 0.00 0.00 89,200.00
TOTAL BIAYA LAIN-LAIN 0.00 0.00 89,200.00
KULIM
Monitor Bed Side dr. Erty Sundarita, SpPD 07/01/2019 1.00 0.00 0.00 89,200.00
TOTAL BIAYA LAIN-LAIN 0.00 0.00 89,200.00
LABORATORIUM
Kreatinin 06/01/2019 1.00 0.00 0.00 30,000.00
TOTAL PEMERIKSAAN LABORATORIUM 0.00 0.00 30,000.00
SUB TOTAL 0.00 0.00 208,400.00

15.01.2019 11:36:09 5 of 6
 RSUD SEKAYU
Jl. Kol. Wahid Udin Lingkungan I Kel. Kayuara
Kec. Sekayu Sekayu
Telp. 0714-321855 Fax
Email:

RINCIAN BIAYA PERAWATAN

Periode Perawatan : 07-Jan-2019 s/d 15-Jan-2019

No.Reg / No.RM : REG/IP/190107-0015 / 271772 Ruang Perawatan : Kamar KULIM 1

Nama Pasien : MUHAIMINA BT BANGGEK Kelas / No.Tempat Tidur : III / D0204
Tanggal Lahir : 12-Feb-1955 Penjamin Bayar : PRIBADI
Dokter Utama : dr. Erty Sundarita, SpPD Instansi : PRIBADI
Tanggal Masuk : 07-Jan-2019 Tanggal Keluar : 15-Jan-2019
Hak Kelas : III

Uraian / Transaksi Tanggal Qty Diskon Instansi Pasien

TOTAL 0.00 0.00 7,404,979.00

Instansi Pasien
Jumlah Tagihan : 0.00 Jumlah Tagihan : 7,404,979.00
Adm & Pelayanan : 0.00 Adm & Pelayanan : 0.00
0.00 7,404,979.00
Uang Angsuran : 0.00 Uang Angsuran : 0.00
Piutang : 0.00 Piutang : 0.00
Pelunasan : 0.00 Pelunasan : 0.00
Diskon : 0.00 Diskon : 0.00
Diskon Administrasi : 0.00 Diskon Administrasi : 0.00

Sisa Tagihan : 0.00 Sisa Tagihan : 7,404,979.00

Sekayu 15-01-2019 11:36

( Siti Aminah Faradisi, Am.Kep )

15.01.2019 11:36:09 6 of 6