sheet1 -1

LAPORAN REKAP KLAIM - R

Pasien Rawat Inap dan Rawat Jalan, Peri
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara
No. Tgl. Masuk Tgl. Pulang No. RM
1 24 Feb 2023 24 Feb 2023 348378
2 24 Feb 2023 24 Feb 2023 364818
3 24 Feb 2023 24 Feb 2023 291115
4 24 Feb 2023 24 Feb 2023 327309
5 24 Feb 2023 24 Feb 2023 308022
6 24 Feb 2023 24 Feb 2023 307529
7 24 Feb 2023 24 Feb 2023 326362
8 24 Feb 2023 24 Feb 2023 255113
9 24 Feb 2023 24 Feb 2023 278577
10 24 Feb 2023 24 Feb 2023 338000
11 24 Feb 2023 24 Feb 2023 286937
12 24 Feb 2023 24 Feb 2023 354591
13 24 Feb 2023 24 Feb 2023 335826
14 24 Feb 2023 24 Feb 2023 329324
15 24 Feb 2023 24 Feb 2023 369252
16 24 Feb 2023 24 Feb 2023 256551
17 24 Feb 2023 24 Feb 2023 122382
18 24 Feb 2023 24 Feb 2023 276550
19 24 Feb 2023 24 Feb 2023 061060
20 24 Feb 2023 24 Feb 2023 361864
21 24 Feb 2023 24 Feb 2023 186397
22 24 Feb 2023 24 Feb 2023 338239
23 24 Feb 2023 24 Feb 2023 368131
24 24 Feb 2023 24 Feb 2023 244562
25 24 Feb 2023 24 Feb 2023 296111
26 24 Feb 2023 24 Feb 2023 062509
27 24 Feb 2023 24 Feb 2023 175870
28 24 Feb 2023 24 Feb 2023 363482
29 24 Feb 2023 24 Feb 2023 344569
30 24 Feb 2023 24 Feb 2023 361026
31 24 Feb 2023 24 Feb 2023 359150
32 24 Feb 2023 24 Feb 2023 369674
33 24 Feb 2023 24 Feb 2023 037512
34 24 Feb 2023 24 Feb 2023 369693
35 24 Feb 2023 24 Feb 2023 287518
36 24 Feb 2023 24 Feb 2023 277201
37 24 Feb 2023 24 Feb 2023 363212
38 24 Feb 2023 24 Feb 2023 245111
39 24 Feb 2023 24 Feb 2023 162375

Page 1
 sheet1 -1

40 24 Feb 2023 24 Feb 2023 210122

41 24 Feb 2023 24 Feb 2023 274675
42 24 Feb 2023 24 Feb 2023 285723
43 24 Feb 2023 24 Feb 2023 212828
44 24 Feb 2023 24 Feb 2023 370303
45 24 Feb 2023 24 Feb 2023 362743
46 24 Feb 2023 24 Feb 2023 346855
47 24 Feb 2023 24 Feb 2023 369333
48 24 Feb 2023 24 Feb 2023 082225
49 24 Feb 2023 24 Feb 2023 054621
50 24 Feb 2023 24 Feb 2023 169315
51 24 Feb 2023 24 Feb 2023 357700
52 24 Feb 2023 24 Feb 2023 217134
53 24 Feb 2023 24 Feb 2023 166684
54 24 Feb 2023 24 Feb 2023 284886
55 24 Feb 2023 24 Feb 2023 243274
56 24 Feb 2023 24 Feb 2023 347776
57 24 Feb 2023 24 Feb 2023 086683
58 24 Feb 2023 24 Feb 2023 280680
59 24 Feb 2023 24 Feb 2023 119483
60 24 Feb 2023 24 Feb 2023 338369
61 24 Feb 2023 24 Feb 2023 279409
62 24 Feb 2023 24 Feb 2023 043872
63 24 Feb 2023 24 Feb 2023 339818
64 24 Feb 2023 24 Feb 2023 366425
65 24 Feb 2023 24 Feb 2023 368130
66 24 Feb 2023 24 Feb 2023 279235
67 24 Feb 2023 24 Feb 2023 332016
68 24 Feb 2023 24 Feb 2023 202291
69 24 Feb 2023 24 Feb 2023 369042
70 24 Feb 2023 24 Feb 2023 370120
71 24 Feb 2023 24 Feb 2023 233399
72 24 Feb 2023 24 Feb 2023 244293
73 24 Feb 2023 24 Feb 2023 303679
74 24 Feb 2023 24 Feb 2023 369833
75 24 Feb 2023 24 Feb 2023 369423
76 24 Feb 2023 24 Feb 2023 326784
77 24 Feb 2023 24 Feb 2023 295549
78 24 Feb 2023 24 Feb 2023 369422
79 24 Feb 2023 24 Feb 2023 282034
80 24 Feb 2023 24 Feb 2023 360828
81 24 Feb 2023 24 Feb 2023 369285
82 24 Feb 2023 24 Feb 2023 360165

Page 2
 sheet1 -1

83 24 Feb 2023 24 Feb 2023 281570

84 24 Feb 2023 24 Feb 2023 265154
85 24 Feb 2023 24 Feb 2023 350612
86 24 Feb 2023 24 Feb 2023 356495
87 24 Feb 2023 24 Feb 2023 038719
88 24 Feb 2023 24 Feb 2023 184993
89 24 Feb 2023 24 Feb 2023 119472
90 24 Feb 2023 24 Feb 2023 009513
91 24 Feb 2023 24 Feb 2023 351991
92 24 Feb 2023 24 Feb 2023 162336
93 24 Feb 2023 24 Feb 2023 367888
94 24 Feb 2023 24 Feb 2023 366254
95 24 Feb 2023 24 Feb 2023 364726
96 24 Feb 2023 24 Feb 2023 363017
97 24 Feb 2023 24 Feb 2023 004304
98 24 Feb 2023 24 Feb 2023 279368
99 24 Feb 2023 24 Feb 2023 147247
100 24 Feb 2023 24 Feb 2023 001829
101 24 Feb 2023 24 Feb 2023 311859
102 24 Feb 2023 24 Feb 2023 369880
103 24 Feb 2023 24 Feb 2023 358466
104 24 Feb 2023 24 Feb 2023 364244
105 24 Feb 2023 24 Feb 2023 351842
106 24 Feb 2023 24 Feb 2023 351697
107 24 Feb 2023 24 Feb 2023 292792
108 24 Feb 2023 24 Feb 2023 366083
109 24 Feb 2023 24 Feb 2023 154622
110 24 Feb 2023 24 Feb 2023 339858
111 24 Feb 2023 24 Feb 2023 331305
112 24 Feb 2023 24 Feb 2023 004602
113 24 Feb 2023 24 Feb 2023 327154
114 24 Feb 2023 24 Feb 2023 038711
115 24 Feb 2023 24 Feb 2023 001309
116 24 Feb 2023 24 Feb 2023 300282
117 24 Feb 2023 24 Feb 2023 321574
118 24 Feb 2023 24 Feb 2023 280202
119 24 Feb 2023 24 Feb 2023 365467
120 24 Feb 2023 24 Feb 2023 229355
121 24 Feb 2023 24 Feb 2023 306132
122 24 Feb 2023 24 Feb 2023 261349
123 24 Feb 2023 24 Feb 2023 124585
124 24 Feb 2023 24 Feb 2023 309744
125 24 Feb 2023 24 Feb 2023 359631

Page 3
 sheet1 -1

126 24 Feb 2023 24 Feb 2023 350258

127 24 Feb 2023 24 Feb 2023 075802
128 24 Feb 2023 24 Feb 2023 324911
129 24 Feb 2023 24 Feb 2023 369906
130 24 Feb 2023 24 Feb 2023 367081
131 24 Feb 2023 24 Feb 2023 001526
132 24 Feb 2023 24 Feb 2023 338331
133 24 Feb 2023 24 Feb 2023 367507
134 24 Feb 2023 24 Feb 2023 360020
135 24 Feb 2023 24 Feb 2023 368126
136 24 Feb 2023 24 Feb 2023 369955
137 24 Feb 2023 24 Feb 2023 138705
138 24 Feb 2023 24 Feb 2023 104162
139 24 Feb 2023 24 Feb 2023 314137
140 24 Feb 2023 24 Feb 2023 360886
141 24 Feb 2023 24 Feb 2023 249099
142 24 Feb 2023 24 Feb 2023 281569
143 24 Feb 2023 24 Feb 2023 324862
144 24 Feb 2023 24 Feb 2023 169968
145 24 Feb 2023 24 Feb 2023 362023
146 24 Feb 2023 24 Feb 2023 179652
147 24 Feb 2023 24 Feb 2023 366601
148 24 Feb 2023 24 Feb 2023 240260
149 24 Feb 2023 24 Feb 2023 366843
150 24 Feb 2023 24 Feb 2023 287612
151 24 Feb 2023 24 Feb 2023 296878
152 24 Feb 2023 24 Feb 2023 346001
153 24 Feb 2023 24 Feb 2023 341676
154 24 Feb 2023 24 Feb 2023 364031
155 24 Feb 2023 24 Feb 2023 281339
156 24 Feb 2023 24 Feb 2023 368771
157 24 Feb 2023 24 Feb 2023 368334
158 24 Feb 2023 24 Feb 2023 308368
159 24 Feb 2023 24 Feb 2023 352292
160 24 Feb 2023 24 Feb 2023 270224
161 24 Feb 2023 24 Feb 2023 314774
162 24 Feb 2023 24 Feb 2023 350201
163 24 Feb 2023 24 Feb 2023 200990
164 24 Feb 2023 24 Feb 2023 261454
165 24 Feb 2023 24 Feb 2023 365422
166 24 Feb 2023 24 Feb 2023 358546
167 24 Feb 2023 24 Feb 2023 115998
168 24 Feb 2023 24 Feb 2023 214553

Page 4
 sheet1 -1

169 24 Feb 2023 24 Feb 2023 369944

170 24 Feb 2023 24 Feb 2023 337596
171 24 Feb 2023 24 Feb 2023 258207
172 24 Feb 2023 24 Feb 2023 240176
173 24 Feb 2023 24 Feb 2023 338383
174 24 Feb 2023 24 Feb 2023 338988
175 24 Feb 2023 24 Feb 2023 306221
176 24 Feb 2023 24 Feb 2023 230579
177 24 Feb 2023 24 Feb 2023 062334
178 24 Feb 2023 24 Feb 2023 053525
179 24 Feb 2023 24 Feb 2023 363104
180 24 Feb 2023 24 Feb 2023 369883
181 24 Feb 2023 24 Feb 2023 337723
182 24 Feb 2023 24 Feb 2023 369505
183 24 Feb 2023 24 Feb 2023 333145
184 24 Feb 2023 24 Feb 2023 370306
185 24 Feb 2023 24 Feb 2023 364280
186 24 Feb 2023 24 Feb 2023 359795
187 24 Feb 2023 24 Feb 2023 358196
188 24 Feb 2023 24 Feb 2023 366436
189 24 Feb 2023 24 Feb 2023 346460
190 24 Feb 2023 24 Feb 2023 351130
191 24 Feb 2023 24 Feb 2023 364474
192 24 Feb 2023 24 Feb 2023 130736
193 24 Feb 2023 24 Feb 2023 242068
194 24 Feb 2023 24 Feb 2023 113489
195 24 Feb 2023 24 Feb 2023 338667
196 24 Feb 2023 24 Feb 2023 321688
197 24 Feb 2023 24 Feb 2023 360329
198 24 Feb 2023 24 Feb 2023 370307
199 24 Feb 2023 24 Feb 2023 369165
200 24 Feb 2023 24 Feb 2023 206007
201 24 Feb 2023 24 Feb 2023 076030
202 24 Feb 2023 24 Feb 2023 241595
203 24 Feb 2023 24 Feb 2023 327887
204 24 Feb 2023 24 Feb 2023 306171
205 24 Feb 2023 24 Feb 2023 005578
206 24 Feb 2023 24 Feb 2023 251139
207 24 Feb 2023 24 Feb 2023 355264
208 24 Feb 2023 24 Feb 2023 370308
209 24 Feb 2023 24 Feb 2023 055103
210 24 Feb 2023 24 Feb 2023 349023
211 24 Feb 2023 24 Feb 2023 141464

Page 5
 sheet1 -1

212 24 Feb 2023 24 Feb 2023 341209

213 24 Feb 2023 24 Feb 2023 027136
214 24 Feb 2023 24 Feb 2023 280266
215 24 Feb 2023 24 Feb 2023 332077
216 24 Feb 2023 24 Feb 2023 365864
217 24 Feb 2023 24 Feb 2023 361200
218 24 Feb 2023 24 Feb 2023 321140
219 24 Feb 2023 24 Feb 2023 043003
220 24 Feb 2023 24 Feb 2023 240676
221 24 Feb 2023 24 Feb 2023 360027
222 24 Feb 2023 24 Feb 2023 355092
223 24 Feb 2023 24 Feb 2023 369939
224 24 Feb 2023 24 Feb 2023 175697
225 24 Feb 2023 24 Feb 2023 311964
226 24 Feb 2023 24 Feb 2023 278563
227 24 Feb 2023 24 Feb 2023 343111
228 24 Feb 2023 24 Feb 2023 219489
229 24 Feb 2023 24 Feb 2023 005515
230 24 Feb 2023 24 Feb 2023 006012
231 24 Feb 2023 24 Feb 2023 251202
232 24 Feb 2023 24 Feb 2023 345625
233 24 Feb 2023 24 Feb 2023 364037
234 24 Feb 2023 24 Feb 2023 077932
235 24 Feb 2023 24 Feb 2023 135741
236 24 Feb 2023 24 Feb 2023 353697
237 24 Feb 2023 24 Feb 2023 368953
238 24 Feb 2023 24 Feb 2023 303810
239 24 Feb 2023 24 Feb 2023 002150
240 24 Feb 2023 24 Feb 2023 099889
241 24 Feb 2023 24 Feb 2023 333380
242 24 Feb 2023 24 Feb 2023 340419
243 24 Feb 2023 24 Feb 2023 363852
244 24 Feb 2023 24 Feb 2023 360997
245 24 Feb 2023 24 Feb 2023 364369
246 24 Feb 2023 24 Feb 2023 369826
247 24 Feb 2023 24 Feb 2023 354504
248 24 Feb 2023 24 Feb 2023 365625
249 24 Feb 2023 24 Feb 2023 293603
250 24 Feb 2023 24 Feb 2023 369442
251 24 Feb 2023 24 Feb 2023 353967
252 24 Feb 2023 24 Feb 2023 225235
253 24 Feb 2023 24 Feb 2023 020301
254 24 Feb 2023 24 Feb 2023 360288

Page 6
 sheet1 -1

255 24 Feb 2023 24 Feb 2023 359258

256 24 Feb 2023 24 Feb 2023 004913
257 24 Feb 2023 24 Feb 2023 319500
258 24 Feb 2023 24 Feb 2023 310553
259 24 Feb 2023 24 Feb 2023 002903
260 24 Feb 2023 24 Feb 2023 120812
261 24 Feb 2023 24 Feb 2023 369935
262 24 Feb 2023 24 Feb 2023 185795
263 24 Feb 2023 24 Feb 2023 299681
264 24 Feb 2023 24 Feb 2023 369820
265 24 Feb 2023 24 Feb 2023 271997
266 24 Feb 2023 24 Feb 2023 368139
267 24 Feb 2023 24 Feb 2023 327252
268 24 Feb 2023 24 Feb 2023 304762
269 24 Feb 2023 24 Feb 2023 320910
270 24 Feb 2023 24 Feb 2023 350666
271 24 Feb 2023 24 Feb 2023 343507
272 24 Feb 2023 24 Feb 2023 342101
273 24 Feb 2023 24 Feb 2023 319196
274 24 Feb 2023 24 Feb 2023 334474
275 24 Feb 2023 24 Feb 2023 282154
276 24 Feb 2023 24 Feb 2023 354930
277 24 Feb 2023 24 Feb 2023 322422
278 24 Feb 2023 24 Feb 2023 201592
279 24 Feb 2023 24 Feb 2023 361192
280 24 Feb 2023 24 Feb 2023 002312
281 24 Feb 2023 24 Feb 2023 313932
282 24 Feb 2023 24 Feb 2023 368656
283 24 Feb 2023 24 Feb 2023 364336
284 24 Feb 2023 24 Feb 2023 370314
285 24 Feb 2023 24 Feb 2023 086727
286 24 Feb 2023 24 Feb 2023 260735
287 24 Feb 2023 24 Feb 2023 369679
288 24 Feb 2023 24 Feb 2023 369890
289 24 Feb 2023 24 Feb 2023 355563
290 24 Feb 2023 24 Feb 2023 191101
291 24 Feb 2023 24 Feb 2023 334928
292 24 Feb 2023 24 Feb 2023 212526
293 24 Feb 2023 24 Feb 2023 334777
294 24 Feb 2023 24 Feb 2023 322375
295 24 Feb 2023 24 Feb 2023 002517
296 24 Feb 2023 24 Feb 2023 286443
297 24 Feb 2023 24 Feb 2023 370316

Page 7
 sheet1 -1

298 24 Feb 2023 24 Feb 2023 370317

299 24 Feb 2023 24 Feb 2023 326007
300 24 Feb 2023 24 Feb 2023 363073
301 24 Feb 2023 24 Feb 2023 369695
302 24 Feb 2023 24 Feb 2023 337333
303 24 Feb 2023 24 Feb 2023 337171
304 24 Feb 2023 24 Feb 2023 305080
305 24 Feb 2023 24 Feb 2023 265953
306 24 Feb 2023 24 Feb 2023 006821
307 24 Feb 2023 24 Feb 2023 298867
308 24 Feb 2023 24 Feb 2023 037469
309 24 Feb 2023 24 Feb 2023 370055
310 24 Feb 2023 24 Feb 2023 369678
311 24 Feb 2023 24 Feb 2023 366154
312 24 Feb 2023 24 Feb 2023 330899
313 24 Feb 2023 24 Feb 2023 276353
314 24 Feb 2023 24 Feb 2023 363155
315 24 Feb 2023 24 Feb 2023 370322
316 24 Feb 2023 24 Feb 2023 354949
317 24 Feb 2023 24 Feb 2023 366434
318 24 Feb 2023 24 Feb 2023 244052
319 24 Feb 2023 24 Feb 2023 370227
320 24 Feb 2023 24 Feb 2023 132059
321 24 Feb 2023 24 Feb 2023 083774
322 24 Feb 2023 24 Feb 2023 288757
323 24 Feb 2023 24 Feb 2023 207499
324 24 Feb 2023 24 Feb 2023 337797
325 24 Feb 2023 24 Feb 2023 342088
326 24 Feb 2023 24 Feb 2023 370005
327 24 Feb 2023 24 Feb 2023 075641
328 24 Feb 2023 24 Feb 2023 004646
329 24 Feb 2023 24 Feb 2023 311225
330 24 Feb 2023 24 Feb 2023 347922
331 24 Feb 2023 24 Feb 2023 272725
332 24 Feb 2023 24 Feb 2023 325412
333 24 Feb 2023 24 Feb 2023 353415
334 24 Feb 2023 24 Feb 2023 361585
335 24 Feb 2023 24 Feb 2023 363041
336 24 Feb 2023 24 Feb 2023 252154
337 24 Feb 2023 24 Feb 2023 351913
338 24 Feb 2023 24 Feb 2023 357984
339 24 Feb 2023 24 Feb 2023 065719
340 24 Feb 2023 24 Feb 2023 283754

Page 8
 sheet1 -1

341 24 Feb 2023 24 Feb 2023 281193

342 24 Feb 2023 24 Feb 2023 350263
343 24 Feb 2023 24 Feb 2023 220676
344 24 Feb 2023 24 Feb 2023 231987
345 24 Feb 2023 24 Feb 2023 000127
346 24 Feb 2023 24 Feb 2023 246670
347 24 Feb 2023 24 Feb 2023 251843
348 24 Feb 2023 24 Feb 2023 224144
349 24 Feb 2023 24 Feb 2023 128187
350 24 Feb 2023 24 Feb 2023 308417
351 24 Feb 2023 24 Feb 2023 370325
352 24 Feb 2023 24 Feb 2023 281721
353 24 Feb 2023 24 Feb 2023 017227
354 24 Feb 2023 24 Feb 2023 253763
355 24 Feb 2023 24 Feb 2023 367454
356 24 Feb 2023 24 Feb 2023 367542
357 24 Feb 2023 24 Feb 2023 338098
358 24 Feb 2023 24 Feb 2023 329325
359 24 Feb 2023 24 Feb 2023 355262
360 24 Feb 2023 24 Feb 2023 325990
361 24 Feb 2023 24 Feb 2023 363987
362 24 Feb 2023 24 Feb 2023 369433
363 24 Feb 2023 24 Feb 2023 364507
364 24 Feb 2023 24 Feb 2023 352119
365 24 Feb 2023 24 Feb 2023 355210
366 24 Feb 2023 24 Feb 2023 294965
367 24 Feb 2023 24 Feb 2023 334417
368 24 Feb 2023 24 Feb 2023 190588
369 24 Feb 2023 24 Feb 2023 324349
370 24 Feb 2023 24 Feb 2023 366605
371 24 Feb 2023 24 Feb 2023 367601
372 24 Feb 2023 24 Feb 2023 361029
373 24 Feb 2023 24 Feb 2023 239686
374 24 Feb 2023 24 Feb 2023 261880
375 24 Feb 2023 24 Feb 2023 289448
376 24 Feb 2023 24 Feb 2023 368258
377 24 Feb 2023 24 Feb 2023 010704
378 24 Feb 2023 24 Feb 2023 362216
379 24 Feb 2023 24 Feb 2023 054468
380 24 Feb 2023 24 Feb 2023 283209
381 24 Feb 2023 24 Feb 2023 369048
382 24 Feb 2023 24 Feb 2023 307449
383 24 Feb 2023 24 Feb 2023 363736

Page 9
 sheet1 -1

384 24 Feb 2023 24 Feb 2023 320722

385 24 Feb 2023 24 Feb 2023 205470
386 24 Feb 2023 24 Feb 2023 295143
387 24 Feb 2023 24 Feb 2023 260448
388 24 Feb 2023 24 Feb 2023 198205
389 24 Feb 2023 24 Feb 2023 354080
390 24 Feb 2023 24 Feb 2023 267458
391 24 Feb 2023 24 Feb 2023 236855
392 24 Feb 2023 24 Feb 2023 352186
393 24 Feb 2023 24 Feb 2023 291536
394 24 Feb 2023 24 Feb 2023 361885
395 24 Feb 2023 24 Feb 2023 343308
396 24 Feb 2023 24 Feb 2023 370096
397 24 Feb 2023 24 Feb 2023 084085
398 24 Feb 2023 24 Feb 2023 369922
399 24 Feb 2023 24 Feb 2023 172042
400 24 Feb 2023 24 Feb 2023 008613
401 24 Feb 2023 24 Feb 2023 358498
402 24 Feb 2023 24 Feb 2023 295424
403 24 Feb 2023 24 Feb 2023 282464
404 24 Feb 2023 24 Feb 2023 345473
405 24 Feb 2023 24 Feb 2023 255889
406 24 Feb 2023 24 Feb 2023 331258
407 24 Feb 2023 24 Feb 2023 364357
408 24 Feb 2023 24 Feb 2023 355712
409 24 Feb 2023 24 Feb 2023 364842
410 24 Feb 2023 24 Feb 2023 362501
411 24 Feb 2023 24 Feb 2023 335188
412 24 Feb 2023 24 Feb 2023 366813
413 24 Feb 2023 24 Feb 2023 347821
414 24 Feb 2023 24 Feb 2023 359445
415 24 Feb 2023 24 Feb 2023 350712
416 24 Feb 2023 24 Feb 2023 354067
417 24 Feb 2023 24 Feb 2023 008646
418 24 Feb 2023 24 Feb 2023 345431
419 24 Feb 2023 24 Feb 2023 364848
420 24 Feb 2023 24 Feb 2023 310905
421 24 Feb 2023 24 Feb 2023 294302
422 24 Feb 2023 24 Feb 2023 353017
423 24 Feb 2023 24 Feb 2023 322527
424 24 Feb 2023 24 Feb 2023 351818
425 24 Feb 2023 24 Feb 2023 354439
426 24 Feb 2023 24 Feb 2023 341606

Page 10
 sheet1 -1

427 24 Feb 2023 24 Feb 2023 357131

428 24 Feb 2023 24 Feb 2023 353379
429 24 Feb 2023 24 Feb 2023 313686
430 24 Feb 2023 24 Feb 2023 354605
431 24 Feb 2023 24 Feb 2023 360904
432 24 Feb 2023 24 Feb 2023 338981
433 24 Feb 2023 24 Feb 2023 248087
434 24 Feb 2023 24 Feb 2023 267917
435 24 Feb 2023 24 Feb 2023 347646
436 24 Feb 2023 24 Feb 2023 370337
437 24 Feb 2023 24 Feb 2023 364199
438 24 Feb 2023 24 Feb 2023 366388
439 24 Feb 2023 24 Feb 2023 324342
440 24 Feb 2023 24 Feb 2023 312840
441 24 Feb 2023 24 Feb 2023 000490
442 24 Feb 2023 24 Feb 2023 370339
443 24 Feb 2023 24 Feb 2023 086935
444 24 Feb 2023 24 Feb 2023 370165
445 24 Feb 2023 24 Feb 2023 358554
446 24 Feb 2023 24 Feb 2023 367270
447 24 Feb 2023 24 Feb 2023 332724
448 24 Feb 2023 24 Feb 2023 342223
449 24 Feb 2023 24 Feb 2023 276156
450 24 Feb 2023 24 Feb 2023 282695
451 24 Feb 2023 24 Feb 2023 322011
452 24 Feb 2023 24 Feb 2023 339385
453 24 Feb 2023 24 Feb 2023 330666
454 24 Feb 2023 24 Feb 2023 359874
455 24 Feb 2023 24 Feb 2023 363109
456 24 Feb 2023 24 Feb 2023 370351
457 24 Feb 2023 24 Feb 2023 365117
458 24 Feb 2023 24 Feb 2023 342362

Kode RS: 3571031

Page 11
 sheet1 -1

LAPORAN REKAP KLAIM - RS BHAYANGKARA KEDIRI

Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 24 Feb 2023 s/d 24 Feb 2023
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS B PEMERINTAH
Nama Pasien No. Klaim / SEP INACBG
FAYYOLA ATIQA ZAHRA, AN 1317R0030223V008190 Q-5-38-0
RAYHAN DAFFA ARTHUR ,AN 1317R0030223V008191 Q-5-43-0
RUSDI, TN 1317R0030223V008195 N-3-15-0
SUPIRMAN, TN 1317R0030223V008196 N-3-15-0
SUMIATI,NY 1317R0030223V008197 N-3-15-0
MARHENIK,NY 1317R0030223V008199 N-3-15-0
LENY YUTIANINGRUM,NY 1317R0030223V008200 N-3-15-0
HARTININGSIH,NY 1317R0030223V008201 N-3-15-0
M. SUPARMAN,SDR/278577//F.20 1317R0030223V008202 Q-5-44-0
MELANI SETIO, NY 1317R0030223V008203 Q-5-44-0
DANIAR RIZKY ZULKARNAIN,SDR / 286937/JSOST 1317R0030223V008204 Q-5-44-0
MOCH MACHRCUS,SDR 1317R0030223V008205 Q-5-44-0
DEWI IRJA SARI NIRWAN, NY 1317R0030223V008206 N-3-15-0
FARIUL MUNFIDAH,NY 1317R0030223V008207 Q-5-44-0
SUGIYANTO, TN 1317R0030223V008208 Q-5-44-0
YULI SULISTIANI,NY 1317R0030223V008209 N-3-15-0
SUGASI,NY/122382/199741 1317R0030223V008210 Q-5-44-0
JARIYAH,NY/276550//F45.3 1317R0030223V008211 Q-5-44-0
SRI SETYOWATI,NY/061060/ASK/F45.3 1317R0030223V008212 Q-5-44-0
MUKOLIP, NY 1317R0030223V008213 Q-5-44-0
SUMIYATUN,NY/186397/ 1317R0030223V008214 Q-5-44-0
I MADE MAHENDRA WIJAYA,SDR 1317R0030223V008215 Q-5-44-0
AFRIANSYAH ZAKARIA KURNIAWAN,AN 1317R0030223V008216 Z-3-12-0
NURCHOLIS MOH CHOLIL,SDR 1317R0030223V008217 Q-5-44-0
SITI MURTIJAH,NY 1317R0030223V008218 C-3-23-0
TITIN NAMPI WAHYUNI, NY 1317R0030223V008219 Q-5-44-0
KATIMUR, NY 1317R0030223V008220 Q-5-44-0
AINUN NINGRUM, NN 1317R0030223V008221 Z-3-27-0
MUKANI, TN 1317R0030223V008223 Q-5-44-0
AUDY HUSNA RAFIDA, AN 1317R0030223V008224 U-3-16-0
SEKAR ELOK MAHANANI, NN 1317R0030223V008225 Q-5-44-0
TIMAH,NY 1317R0030223V008226 Q-5-44-0
SULISTYOWATI, NY / 037512 / 1317R0030223V008227 U-3-16-0
SUKAMTO,TN 1317R0030223V008228 Q-5-44-0
MIKO ETSA NUGRAHA.SDR 1317R0030223V008229 Q-5-44-0
HELENA RUKIYATI,NY 1317R0030223V008230 Q-5-44-0
NAVAYA AURELIA KURNIA DEVI, NN 1317R0030223V008231 Q-5-44-0
HARIYATI,NY 1317R0030223V008232 Q-5-44-0
ALIYUL DWI A,AN/162375/ASK/ F70 1317R0030223V008233 Q-5-44-0

Page 12
 sheet1 -1

AHMAD HAFIDULMUFID,TN/210122// F.20 1317R0030223V008234 Q-5-44-0

USWATUN KASANAH,NN / 274675//F20 1317R0030223V008236 Q-5-44-0
GUNARNO,TN/285723//F23.2 1317R0030223V008237 Q-5-44-0
RATNA DEWI SAWITRI,NY/212828/JMSOST/F45.3 1317R0030223V008238 Q-5-44-0
SUPARTI, NY 1317R0030223V008239 Q-5-44-0
MOCHAMMAD MUNDZIR TAJUL WAHIDIYIN,SDR 1317R0030223V008240 Q-5-44-0
KUSNUL KHOTIMAH,NY 1317R0030223V008241 Q-5-44-0
MUHAMMAD CHENG HOO ASSYAMSI,AN 1317R0030223V008242 M-3-16-0
CALULA NATHANIA D,AN/082225/KK 1317R0030223V008243 U-3-16-0
PONADI,TN 1317R0030223V008244 Q-5-44-0
RIRIN WAHYUNI, NN/ 1317R0030223V008245 Q-5-44-0
SALI, TN 1317R0030223V008246 C-3-15-0
ANKE DWI PUSPITA R, NY 1317R0030223V008247 N-3-15-0
AGUS SETYAWAN,SDR/166684/JKN/ F20 1317R0030223V008248 Q-5-44-0
ANORA RETNANINGSIH,NY/28.48.86 1317R0030223V008249 Q-5-44-0
FAREL WAHYU PRATAMA,SDR 1317R0030223V008251 Q-5-44-0
CAKHA ATTAR FIRDIAWAN, AN 1317R0030223V008252 Q-5-44-0
DEWI ROCHANA DAMAYANTI,NY/086683/ PC 1317R0030223V008253 U-3-16-0
MUHAMMAD WILDAN FIRDAUS., AN 1317R0030223V008254 Q-5-44-0
CHAROLINA INDAH PUSPITA SARI, NY 1317R0030223V008255 Q-5-44-0
WIWIK RIATI,NY 1317R0030223V008256 Q-5-44-0
SUGENG WIJI HADI P,SDR 1317R0030223V008257 Q-5-44-0
SULISTYANI, NY / 043872/JAMSOSTEK 1317R0030223V008258 Q-5-44-0
TUMINI,NY 1317R0030223V008259 Q-5-44-0
MINTO,TN 1317R0030223V008260 Q-5-44-0
HARIYADI, TN 1317R0030223V008261 Q-5-44-0
NANIK MURTININGSIH,NY 1317R0030223V008262 Q-5-44-0
SUPIYATUN NY 1317R0030223V008263 Q-5-44-0
SUKIRAH, NY / 202291 / JKN//F45.3 1317R0030223V008265 Q-5-44-0
YAHMI,NY 1317R0030223V008266 Q-5-44-0
HESTI RESTU KARTIKA, NY 1317R0030223V008267 Q-5-44-0
SRI RAHAYU,NY/233399/ 1317R0030223V008268 Q-5-44-0
WIWIEK ASTUTIK , NY /24.42.93 / 1317R0030223V008269 C-3-23-0
TONO,TN/ 303679/PURN TNI 1317R0030223V008270 Q-5-44-0
NAMIRA NOMIQ FAUZA, AN 1317R0030223V008271 Q-5-44-0
M.NAZMI NURILHAQQI,AN 1317R0030223V008272 Z-3-12-0
DWI RAHAYU LILIS S, NY 1317R0030223V008273 Q-5-44-0
ANGGA PRIO UTOMO, SDR 1317R0030223V008274 Q-5-44-0
M.NAZMA NURILHAQQI,AN 1317R0030223V008275 Z-3-12-0
MUBIYATI, NY 1317R0030223V008276 Q-5-44-0
MUSRIKIN,NY 1317R0030223V008277 Q-5-44-0
DALLIYA HADIROTI QUDSIYYATI,NN 1317R0030223V008278 Z-3-27-0
SULASMI, NY 1317R0030223V008279 Q-5-44-0

Page 13
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SITI SOFIAH,NY/281570// F41 1317R0030223V008280 Q-5-44-0

JESINTA NUR FADILA,AN/ 265154/JSOST/F23.2 1317R0030223V008281 Q-5-44-0
DIRMAN HARIONO SANTOSA,TN 1317R0030223V008282 U-3-16-0
MARINI,NY 1317R0030223V008283 Q-5-44-0
SRI HARTAMI, NY 1317R0030223V008284 Q-5-44-0
MOCH. ROMADHAN FADLI,TN/184993/TNI/F31 1317R0030223V008285 Q-5-44-0
FUAD KURNIAWAN,SDR/119472//F20 1317R0030223V008286 Q-5-44-0
SLAMET BAHRUL Y,TN/009513//F20 1317R0030223V008287 Q-5-44-0
AMININ, NY 1317R0030223V008288 L-3-10-0
MOH.RAFIF PUTRA RAMDAN,AN/ 162336/ POL C 1317R0030223V008289 Q-5-44-0
IMAM MUKADI, TN 1317R0030223V008290 Q-5-44-0
LILIS SURYANI,NY 1317R0030223V008291 Q-5-44-0
VALENT MAULANA RAFIF PRASETYO,AN 1317R0030223V008292 Q-5-44-0
SUSNY PURWANTI, NY 1317R0030223V008293 Q-5-44-0
SRI WAHYUNI NY / 004304 /ASK 1317R0030223V008294 M-3-16-0
DWI HERMAWAN TN/279368//F20 1317R0030223V008295 Q-5-44-0
AMINAH,NY /147247 /191176/UM/F45.3 1317R0030223V008296 Q-5-44-0
EDDY SUPRIYONO, TN 1317R0030223V008297 M-3-16-0
SUPARMI,NY 1317R0030223V008298 Q-5-44-0
SUTAMAH, NY 1317R0030223V008299 Q-5-44-0
PATONAH, NY 1317R0030223V008300 Q-5-44-0
HERY SETIYAWAN, TN 1317R0030223V008301 Q-5-44-0
ERI ERIYANTO,SDR 1317R0030223V008302 Q-5-44-0
INDRI LESTARI, NN 1317R0030223V008303 Q-5-44-0
RAFA PUTRA ADE PRASETYA,AN/ 1317R0030223V008304 Z-3-12-0
PURWANTI SUGIASTUTIK, NY 1317R0030223V008305 Q-5-44-0
M. FURDIYONO,TN/154622/JKN/ F20 1317R0030223V008306 Q-5-44-0
AGUNG MARDIATPODO,TN 1317R0030223V008307 Q-5-44-0
SRI ANA,NY 1317R0030223V008309 Q-5-44-0
HELEN PRIMADONA ROSANTI,NY 1317R0030223V008310 Q-5-44-0
ANDIENA CALISTA WIBOWO, AN 1317R0030223V008311 M-3-16-0
IKA PURWATI , NY 1317R0030223V008312 N-3-15-0
SHINTA FEBBY GUNAWAN, NN/ 1317R0030223V008313 Q-5-44-0
DIAN WURIJANTI,NY 1317R0030223V008314 Q-5-44-0
SITI MU'RIPAH,NY 1317R0030223V008315 C-3-23-0
HADIYATI, NY 1317R0030223V008316 Q-5-44-0
ALEXA ANDREAN PUTRI MANGOLO,AN 1317R0030223V008317 Q-5-44-0
SITI NUR KHASANAH,NY/ 229355/ 1317R0030223V008318 Z-3-27-0
INDAH WINARNI, NY 1317R0030223V008319 Q-5-44-0
ZAENAL FATONI, TN 1317R0030223V008320 N-3-15-0
LULUK MARSUDI S,TN/124585 / ASK 1317R0030223V008321 Z-3-27-0
ACHDAN ALARIC AHZA WIBOWO,AN 1317R0030223V008322 M-3-16-0
KOTIJAH, NY 1317R0030223V008323 Q-5-44-0

Page 14
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TITIK YULIANTI,NY 1317R0030223V008324 C-3-13-0

ROBERT ARMIN TOBING,TN/075802/POL/F20 1317R0030223V008325 Q-5-44-0
MARINEM, NY 1317R0030223V008326 N-3-15-0
ANA FARIHA MUBAROK, NY 1317R0030223V008327 Q-5-44-0
SRI MURTINI, S.PD, NY 1317R0030223V008328 M-3-16-0
LAILY SHOFA AZZAHRO,NN 1317R0030223V008329 M-3-16-0
SUKARMAN, TN 1317R0030223V008331 Q-5-44-0
LADYVA RISKY ARIESTA PUTRI JOSSA, NN 1317R0030223V008332 U-3-16-0
SAITIK, NY 1317R0030223V008333 Q-5-44-0
CHIKMAH,NY 1317R0030223V008335 Q-5-44-0
SUWARNO, TN 1317R0030223V008336 Z-3-27-0
RAINER IRAWATI,NY / 138705 / POL C/F41 1317R0030223V008337 Q-5-44-0
YOYOK SUGIANTORO,TN 1317R0030223V008338 Q-5-44-0
BEKTI AGUSTINA,NY 1317R0030223V008339 Q-5-44-0
MUHAMMAD RAFFI,AN 1317R0030223V008340 Q-5-44-0
MUHERI,TN 1317R0030223V008341 Q-5-44-0
ROZIQOH, NY 1317R0030223V008342 Q-5-44-0
UTIK NURHAYATI,NY 1317R0030223V008343 Q-5-44-0
PARMINI,NY 1317R0030223V008344 Q-5-44-0
SITI MASFUFAH, NY 1317R0030223V008346 Q-5-44-0
UMINI,NY 1317R0030223V008347 N-3-15-0
SUEP, TN 1317R0030223V008348 Q-5-44-0
SABIIS,NY/240260/JSOST/ F45.3 1317R0030223V008349 Q-5-44-0
AURELIA VIOLA SALSABILA, AN 1317R0030223V008350 Q-5-44-0
NUR ACHMAD DODIK, TN 1317R0030223V008351 Q-5-44-0
SATRIJANINGSIH,NY/296878/ /F45.3 1317R0030223V008352 Q-5-44-0
ENDANG WAHYU SURYANINGSIH, NY 1317R0030223V008353 Q-5-44-0
SITATUL MUNAJAH,NY 1317R0030223V008354 Q-5-44-0
M FAHRI MAULANA ARRASYID,AN 1317R0030223V008355 Z-3-12-0
ENDANG SRI CAHYANI, NY 1317R0030223V008356 C-3-23-0
DIAN ARIANY, NY 1317R0030223V008357 Q-5-44-0
LUSI TRI ANJAR WENI, NN 1317R0030223V008358 Q-5-44-0
PRASETYO,TN 1317R0030223V008359 Q-5-44-0
RETNO MURTININGRUM,NY 1317R0030223V008360 Q-5-44-0
LILIK MUSRIATI,NY 1317R0030223V008361 Q-5-44-0
SULISTIYANI,NY 1317R0030223V008362 Q-5-44-0
YAYUK, NN 1317R0030223V008364 Q-5-44-0
PUTRI LISTYASARI,NN/200990//F20 1317R0030223V008365 Q-5-44-0
ERVIN SEPTIANI TRIASTUTI, NN 1317R0030223V008366 Q-5-44-0
AJMALA HUSNIA NAJWA MARDYANTO, AN 1317R0030223V008367 Q-5-44-0
INSAN JATMIKO, TN 1317R0030223V008368 Q-5-44-0
SANTOSO,TN/115998// JAMSOSTEK 1317R0030223V008369 Q-5-44-0
MUHAMMAD EDI RIYANTO, SDR/214553 1317R0030223V008370 Q-5-44-0

Page 15
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MOHAMAD MASAMSUDIN, SDR 1317R0030223V008371 Q-5-44-0

ATIK NURFITRIANI, NY 1317R0030223V008372 N-3-15-0
MUSRINGAH, NY 1317R0030223V008373 Q-5-44-0
LESTARI PUDJIASTUTI,NY / 1317R0030223V008374 Q-5-44-0
SARIYUN NIDA, NY 1317R0030223V008375 Q-5-44-0
LAMINEM,NY 1317R0030223V008376 Q-5-44-0
PITOYO,TN 1317R0030223V008377 N-3-15-0
DARMANTO,TN 1317R0030223V008378 M-3-16-0
CINDY YOVITA PRANIDYA,AN/062334/KK 1317R0030223V008379 U-3-16-0
BUNGA NURJANAH, NN 1317R0030223V008380 Q-5-44-0
MOH. SODIQ, TN 1317R0030223V008381 Q-5-44-0
EVA YANTI ERIKUSWATIK, NY 1317R0030223V008382 Q-5-44-0
TUMISRI, NY 1317R0030223V008383 N-3-15-0
SRI TANJUNG UMBARWATI, NY 1317R0030223V008384 Q-5-44-0
MARIA MAGDALENA NIKEN SUKENDAH, NY 1317R0030223V008385 Q-5-44-0
SULISTIANAH, NY 1317R0030223V008386 Q-5-12-0
NINIK SUNARTUN, NY 1317R0030223V008387 Q-5-44-0
RETNO YULIANI,NY 1317R0030223V008388 Q-5-44-0
SITI FATIMAH, NY 1317R0030223V008389 Q-5-44-0
TITIK SUKARMIATI, NY 1317R0030223V008390 Q-5-44-0
SUJATI,NY 1317R0030223V008391 C-3-23-0
NETI SRI AFIFAH, NY 1317R0030223V008392 Q-5-44-0
KABIT, TN 1317R0030223V008393 Q-5-44-0
MARKINI,NY/130736/ 1317R0030223V008394 Q-5-44-0
SUKO DWI PANDOYO,TN 1317R0030223V008395 N-3-15-0
KARTUBI,TN 1317R0030223V008396 Q-5-44-0
HANIK MUFARIDA,NY 1317R0030223V008397 Q-5-44-0
ADITYO NUGROHO,SDR 1317R0030223V008398 Q-5-44-0
SUNIATI, NY 1317R0030223V008399 Q-5-44-0
SARTINI,NY 1317R0030223V008400 Q-5-44-0
SUMIATI, NY 1317R0030223V008402 M-3-16-0
YOLANDA YASDIRA S,NN 1317R0030223V008403 U-3-16-0
NUNIK DARWATI,NY 1317R0030223V008404 N-3-15-0
UMARYANI, NY 1317R0030223V008405 Z-3-27-0
SITI AMINAH,NY 1317R0030223V008406 Q-5-44-0
LUKY ANDI TRIMAHANANI,NY 1317R0030223V008407 N-3-15-0
EDDY SUHARTANTO,TN/005578/ASK /F45.3 1317R0030223V008408 Q-5-44-0
SITI MUNAWAROH ,NY 1317R0030223V008409 N-3-15-0
SUHARTI, NY 1317R0030223V008410 Q-5-44-0
SITI LAELAK, NY 1317R0030223V008411 C-3-23-0
WITJAHJADJI,TN/ 055103/ 1317R0030223V008412 Q-5-44-0
SAFINA ARLIA PUTRI,NN 1317R0030223V008413 Q-5-44-0
HANI ATURROSIDAH,NY 1317R0030223V008414 Q-5-44-0

Page 16
 sheet1 -1

LUKATI,NY 1317R0030223V008415 Q-5-44-0

BAMBANG SUGENG,TN/ 1317R0030223V008416 N-3-15-0
RIKA MARIYANI,NY/280266/ 1317R0030223V008417 C-3-13-0
SARI,TN 1317R0030223V008418 Q-5-44-0
SAIFUL HUDA,TN 1317R0030223V008419 Z-3-27-0
NOLA ASMARA GITA,NY 1317R0030223V008420 Q-5-44-0
ANIS WIGATI, NN 1317R0030223V008421 Q-5-44-0
ENDANG SUTJIHARTI, NY 1317R0030223V008422 C-3-23-0
KHAMIM, SDR /240676 / /F45.3 1317R0030223V008423 Q-5-44-0
SITI MARFI'AH, NY 1317R0030223V008424 Q-5-44-0
YULI KARTINI, NY 1317R0030223V008425 N-3-15-0
KENRAYI KUSUMAWARDANI, NN 1317R0030223V008426 Q-5-44-0
DIMAS ARYA WINANDA, AN 1317R0030223V008427 M-3-16-0
JIHAT HADI PRASETYO,SDR 1317R0030223V008428 Q-5-44-0
M.RIYADI VITARA,SDR /278563//F.20 1317R0030223V008429 Q-5-44-0
ARI DIYANTI SANTOSO, NY 1317R0030223V008430 Q-5-44-0
MOHAMAD SOIB, SDR/219489//F20 1317R0030223V008431 Q-5-44-0
ERNAWATI,NY 1317R0030223V008432 Q-5-44-0
SAMUDIONO, TN 1317R0030223V008433 Q-5-44-0
KHOIRUN NADHIFIN,AN/ 251202//F20 1317R0030223V008434 Q-5-44-0
FAKHIH PINDAN HENDRAYANTO,SDR 1317R0030223V008435 Q-5-44-0
RETNO DIAH KUMALASARI, NY 1317R0030223V008436 Q-5-44-0
KEGE SEPTIAN PUTRA MIGARA,TN 1317R0030223V008437 Q-5-44-0
SURYO SUWASONO, TN /135741 / JKN //F45.3 1317R0030223V008439 Q-5-44-0
ENI FAUZIAH,NY 1317R0030223V008440 Q-5-44-0
HAIKAL FATHAN AL MUBAROK,AN 1317R0030223V008441 Q-5-44-0
SUPARTINI,NY/ 303810/ KIS 1317R0030223V008442 Q-5-44-0
EDY SUJAKA,TN/ 002150/ POL 1317R0030223V008443 Q-5-44-0
EDY SUKAMTO, TN /099889/POL/F.20 1317R0030223V008444 Q-5-44-0
IMAM ASMUNIP,SDR 1317R0030223V008445 Q-5-44-0
ASRIKIN,NY 1317R0030223V008446 Q-5-44-0
SUSTRIANA,NY 1317R0030223V008447 Q-5-44-0
NURUL AINI,NY 1317R0030223V008448 Q-5-44-0
MUJIATUN, NY 1317R0030223V008449 Q-5-44-0
HERLIK SARLITA,NY 1317R0030223V008450 Z-3-25-0
SAMSIAH, NY 1317R0030223V008451 Q-5-44-0
MUHAMMAD VRZA MAULANA SYAPUTRA,AN 1317R0030223V008452 Q-5-44-0
SRI UTAMI NURMASARI,NY/29.36.02/POLRI 1317R0030223V008453 Q-5-44-0
MAHMUD DAWAM,SDR 1317R0030223V008454 Z-3-23-0
SRI SUGIARTI,NY 1317R0030223V008455 Q-5-44-0
MUHSIN, TN 1317R0030223V008456 Q-5-44-0
SUMIASIH, NY/020301(ORTU KARY) 1317R0030223V008457 Q-5-44-0
YULIA ARMAYANTI, NY 1317R0030223V008458 Q-5-44-0

Page 17
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PENI,NY 1317R0030223V008459 Q-5-44-0

TITIEN NOORANA E,NY /004913/ 1317R0030223V008460 M-3-16-0
SULISTIANI,NY 1317R0030223V008461 Q-5-44-0
RATRI WULANDARI,NN 1317R0030223V008462 Q-5-44-0
A.A TRI UDIYANI,NY/POL C/002903 1317R0030223V008463 Q-5-44-0
DWI SUCIPTO,SDR/120812// F20 1317R0030223V008464 Q-5-44-0
MUHAMAD KEVIN RANDYANSYAH,AN 1317R0030223V008466 Q-5-44-0
M.ERVAN SETYA W,TN/185795//F20 1317R0030223V008467 Q-5-44-0
SITI CHOTIMAH,NY/299681/UMUM 1317R0030223V008468 Q-5-44-0
KISMAN AL. KISMANTO, TN 1317R0030223V008469 Q-5-44-0
GUNTARI,NY 1317R0030223V008470 Q-5-44-0
KOTIMAH,NY 1317R0030223V008471 Q-5-44-0
SRIANIK NY 1317R0030223V008472 Q-5-44-0
WINARSIH,NY 1317R0030223V008473 Q-5-44-0
RIZQIKA AMALIA,NN/ 1317R0030223V008474 Q-5-44-0
FARIDA LUTHFIYAH,NY 1317R0030223V008475 Q-5-44-0
ELYS WIDARTI, NY 1317R0030223V008476 L-3-10-0
ENY WINARSIH,NY 1317R0030223V008477 Q-5-44-0
PUNIRAH,NY 1317R0030223V008478 Q-5-44-0
ANDY MUDJI RAHARDJO,TN 1317R0030223V008479 U-3-16-0
TUKIANI,NY/282154/ 1317R0030223V008480 Q-5-44-0
SUMIATUN,NY 1317R0030223V008481 Q-5-44-0
SRI PURWATI, NY 1317R0030223V008482 C-3-23-0
AHMAD SAEAN,TN 1317R0030223V008483 Q-5-44-0
MC HENNY DWI RATNA MAWARTI,NY 1317R0030223V008484 Q-5-44-0
PANGGAYUH SULISTYO,TN 1317R0030223V008485 Q-5-44-0
NURUL AINI NY 1317R0030223V008486 C-3-23-0
LAMINEM, NY 1317R0030223V008487 Q-5-44-0
SAMIRAH,NY 1317R0030223V008489 Q-5-44-0
TRIANA WIDYASARI,NY 1317R0030223V008490 Z-3-23-0
NOEGROHO EKO SOESILO,TN 1317R0030223V008491 Q-5-44-0
KOMSIYAH, NY 1317R0030223V008492 Q-5-44-0
RINI LESTARI,NY 1317R0030223V008493 Q-5-44-0
RENJANA ARUNIKA NARENDRA, AN 1317R0030223V008494 Q-5-44-0
DIMAS KURNIAWAN, SDR 1317R0030223V008495 Q-5-44-0
SUPARMIATI,NY 1317R0030223V008496 U-3-16-0
WINARTI, NY 1317R0030223V008497 Q-5-44-0
NGALI,TN /212526 1317R0030223V008498 Q-5-44-0
FRIENDA OCTA PRATICHA,NY 1317R0030223V008499 W-3-12-0
ARIK FITRIANA, NY 1317R0030223V008501 Q-5-44-0
BARKAH RAMSUL,TN/2517/ POL 1317R0030223V008502 U-3-16-0
ANIK MOELJANING ATI,NY 1317R0030223V008503 M-3-16-0
TRI AGUS PURWANTARI,NY 1317R0030223V008504 Q-5-44-0

Page 18
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SUPRIHATI, NY 1317R0030223V008505 Q-5-44-0

RUFIATIN,NY 1317R0030223V008506 Q-5-44-0
NADYA DINI, NN 1317R0030223V008507 Q-5-44-0
MIAJI, TN 1317R0030223V008508 Q-5-44-0
RUMI,NY 1317R0030223V008510 Q-5-44-0
SRI MUJAYANAH, NY 1317R0030223V008511 Z-3-23-0
FIFIN TRI K,NN 1317R0030223V008512 Q-5-44-0
BIKAH SOLEKAH, NY 1317R0030223V008513 C-3-23-0
SUGIYANTO,TN 1317R0030223V008514 Q-5-44-0
CICIK TRI YULIANI,NY/298867/ 1317R0030223V008515 Q-5-44-0
ERLINA ARI R, NY / 037469/- 1317R0030223V008516 Q-5-44-0
SHINTA SISWOYO PUTRI, NY 1317R0030223V008517 M-3-16-0
TEGUH SUMIANA,NY 1317R0030223V008518 Z-3-23-0
ANNISA FARIHA MUMTAZA, AN 1317R0030223V008519 Q-5-44-0
SUGIJONO, TN 1317R0030223V008520 Q-5-44-0
SUKATI, NY 1317R0030223V008521 Z-3-27-0
NURHAYATI,NY 1317R0030223V008522 Q-5-44-0
NINIK SETIOWATI,NY 1317R0030223V008523 L-3-10-0
SULISTYANINGRUM,NN 1317R0030223V008524 Q-5-44-0
PANGANTI PUJI ASTUTI, NY 1317R0030223V008525 Q-5-44-0
SOPIYAH, NY 1317R0030223V008526 Q-5-44-0
SUMARLIK,NY 1317R0030223V008527 Q-5-44-0
SRI UNTARYANIK, NY/132059// F45.3 1317R0030223V008528 Q-5-44-0
DEWI KASIANI,NY/083774//F20 1317R0030223V008529 Q-5-44-0
BUDI HARTINI, NY/ 288757/ 1317R0030223V008530 C-3-23-0
SULASTRI, NY 1317R0030223V008531 Q-5-44-0
SHINTYA DIVA AL MUFINA, NN 1317R0030223V008532 Q-5-44-0
MARNI,NY 1317R0030223V008533 Q-5-44-0
MAKSUN, TN 1317R0030223V008534 Q-5-44-0
INDAH SURYANINGRUM,NN/075641/SOSTEK 1317R0030223V008535 Q-5-44-0
SITI HADIJAH,NY/ 004646/ 1317R0030223V008536 Q-5-44-0
AHMAD DAFFA EKA PRATAMA,SDR 1317R0030223V008537 Q-5-44-0
MISNAWATI, NY 1317R0030223V008538 Q-5-44-0
ALZIO PUTRA RAGA,AN /272725 /JAMSOSTEK 1317R0030223V008539 Q-5-44-0
LULUK MISTACHUL FITRIA, NY 1317R0030223V008540 Q-5-44-0
LANIWATI,NY 1317R0030223V008541 M-3-16-0
PRIYO SUNARJI, S. HUT, TN 1317R0030223V008542 U-3-16-0
SUWARSI, NY 1317R0030223V008543 Q-5-44-0
SUKADI,TN 1317R0030223V008544 Q-5-44-0
GHAITA MERVA BRILIATNA RAFANI, AN 1317R0030223V008545 Q-5-44-0
NABILLA NI'AMATUL MUKARROMAH, NN 1317R0030223V008546 Q-5-44-0
ZAHRA' WULAN ARYANI,NN 1317R0030223V008547 Q-5-44-0
SUYATNO TN 1317R0030223V008548 Q-5-44-0

Page 19
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SRI PURWANTI, NY / 281193 / 1317R0030223V008549 Q-5-44-0

NIKMATUS SOLIKAH,NY 1317R0030223V008550 Q-5-44-0
SUPIATI, NY/220676//F.20 1317R0030223V008551 Q-5-44-0
WINARNI,NY//231987/JKN/ F20 1317R0030223V008552 Q-5-44-0
JAJUK SRIWAHYUNI, NY 1317R0030223V008554 Q-5-44-0
SUPRAPTINI,NY/246670/ 1317R0030223V008555 Q-5-44-0
SOENARTI,NY 1317R0030223V008556 Q-5-44-0
TAN LIAN HWA, NY 1317R0030223V008557 Q-5-44-0
YULINTARI, NN 1317R0030223V008558 Q-5-44-0
RUMIYATI,NY 1317R0030223V008559 Q-5-44-0
DEWI WIDYANINGSIH,NY 1317R0030223V008560 Q-5-44-0
MOKO SIFIANTO,SDR 1317R0030223V008561 Q-5-44-0
HARTATIK, NY 1317R0030223V008562 Q-5-44-0
MARIATUN,NY 1317R0030223V008563 Q-5-44-0
LEGINAH,NN 1317R0030223V008564 Q-5-44-0
KHOSNIA, NY 1317R0030223V008565 L-3-12-0
MUINAH, NY 1317R0030223V008566 Q-5-44-0
DHEA NABILLA AYU SETYOKO,NN 1317R0030223V008567 U-3-16-0
NADIA AISHA PUTRI,AN 1317R0030223V008568 Q-5-44-0
SITI MUNAWAROH,,NY 1317R0030223V008569 C-3-23-0
HESHEN WIRAYUDHA,SDR 1317R0030223V008570 Z-3-27-0
DWI DESKAWATI,NY 1317R0030223V008572 U-3-16-0
BIBIT RAHAYU,NY 1317R0030223V008573 Q-5-44-0
WAHYU NILASARI,NN 1317R0030223V008574 Q-5-44-0
ANINDIRA FELICYA AZAHRA, AN 1317R0030223V008575 Q-5-44-0
MINUK,NY/294965/ 1317R0030223V008576 Q-5-44-0
WIWINDARTI, NY 1317R0030223V008577 Q-5-44-0
SUNARMI,NY / 190588 //F20 1317R0030223V008578 Q-5-44-0
SOLEH FUDDIN TN 1317R0030223V008579 Q-5-44-0
SULAMINAH,NY 1317R0030223V008580 Q-5-44-0
DWI HANDAYANI, NY 1317R0030223V008581 Q-5-44-0
KURNIA COFFEAYANTI, NY 1317R0030223V008582 Q-5-44-0
PURYANTO,TN 1317R0030223V008583 Q-5-44-0
IDE SULISTYOWATI,NN/261880/ASK/ F23.2 1317R0030223V008584 Q-5-44-0
M.HASAN FARIZ MUKADAR,SDR/ 289448/ 1317R0030223V008586 Q-5-44-0
YATEMI, NY 1317R0030223V008587 Q-5-44-0
HERI ANTORO,TN/ 010704/ POL 1317R0030223V008589 M-3-16-0
SULAIMAN,TN 1317R0030223V008590 Z-3-27-0
MUCHAYATUN , NY /054468/ 1317R0030223V008591 C-3-23-0
PURYANTO TN/283209/ M 1317R0030223V008592 Q-5-44-0
WARSONO, TN 1317R0030223V008593 Q-5-44-0
WAHYUDIWANTO,TN/307449/ KIS 1317R0030223V008594 Q-5-44-0
MUHAMMAD BOY, AN 1317R0030223V008595 Z-3-12-0

Page 20
 sheet1 -1

SRI SAYEKTI,NY 1317R0030223V008596 C-3-23-0

RAHAYU ASTUTI, NY 1317R0030223V008597 Q-5-44-0
BERLYAN PUTRI,NN/295143/ /F23.2 1317R0030223V008598 Q-5-44-0
CANDRA WICAKSONO SDR /260448//F20 1317R0030223V008599 Q-5-44-0
RAFARDHAN ATHALLA P.S,AN/198205 1317R0030223V008600 Q-5-44-0
MOH. ANANTA GUMILAR WICAKSONO,SDR 1317R0030223V008601 Q-5-44-0
BINTI MUNAWAROH,NY/267458/UM/ 1317R0030223V008602 Q-5-44-0
ENDAH RUSMINI, NY /236855 / JKN 1317R0030223V008603 Q-5-44-0
AOZORA MECCA RAMADHANI, AN 1317R0030223V008604 Q-5-44-0
WINARSIH,NY 1317R0030223V008605 C-3-13-0
SITI NUR AZZAHRA, AN 1317R0030223V008606 U-3-10-0
ANTOK DWI UTOMO,TN 1317R0030223V008608 Q-5-44-0
BOIMIN, TN 1317R0030223V008609 Q-5-44-0
KING WIRA JAYA PUTRA E.H,AN/ 084085/ PC 1317R0030223V008610 Q-5-42-0
NOVAN ADIYASA FANANI, SDR 1317R0030223V008611 Z-3-27-0
MOHAMAD SHOLEH,TN/172042//F20 1317R0030223V008612 Q-5-44-0
ANIES RASMA YENI, NY 1317R0030223V008613 Q-5-44-0
NABILLA CAHYA NINGRUM, AN 1317R0030223V008614 Q-5-44-0
SA'ADATUL LAILI,NY 1317R0030223V008615 C-3-13-0
LUTFI AZIS,SDR 1317R0030223V008616 Q-5-44-0
RATRI GITANINGRUM, NY 1317R0030223V008620 C-3-13-0
ALTHAFUNNISA ORLIN HARIYANTO, AN 1317R0030223V008621 Q-5-44-0
FIORELLY ZHEVANYA MEWENGKANG,NN 1317R0030223V008622 Q-5-44-0
SITI FATIMAH,NY 1317R0030223V008624 C-3-13-0
SAMI, NY 1317R0030223V008626 C-3-13-0
JUMINEM,NY 1317R0030223V008627 Q-5-44-0
MUNAZIAH, NY 1317R0030223V008628 C-3-13-0
SULISTIANA, NY 1317R0030223V008629 C-3-23-0
SULISTIYANI,NY 1317R0030223V008630 C-3-13-0
MEILINDA AYU RAHMAWATI,NY 1317R0030223V008633 Q-5-44-0
SOEMIJATOEN, NY 1317R0030223V008635 Q-5-44-0
ABDUL UMAR,TN 1317R0030223V008636 N-3-15-0
SISWANDI, SDR 1317R0030223V008637 N-3-15-0
ROBIN HARIJONO,TN 1317R0030223V008638 N-3-15-0
TRIYUDO PRIHANTONO, TN 1317R0030223V008639 Q-5-44-0
TRI RAHAYU,NY 1317R0030223V008641 N-3-15-0
HAWARI ANISATY,NY 1317R0030223V008642 N-3-15-0
HERI WIRATNO,TN 1317R0030223V008643 N-3-15-0
TUTIK SUSIUTAMI, NY 1317R0030223V008644 N-3-15-0
HARDJANTO, TN 1317R0030223V008645 N-3-15-0
FARIHAH ISMAWATI, NY 1317R0030223V008647 N-3-15-0
ENDANG LARASATI, NY 1317R0030223V008648 N-3-15-0
SUPREHATI, NY 1317R0030223V008649 N-3-15-0

Page 21
 sheet1 -1

QOMARIYAH,NY 1317R0030223V008650 N-3-15-0

SRI UTAMI, NY 1317R0030223V008651 N-3-15-0
WIWIK,NY 1317R0030223V008652 N-3-15-0
SUHARDJITO,TN 1317R0030223V008653 N-3-15-0
JUMINTEN, NY 1317R0030223V008654 N-3-15-0
YAINEM,NY 1317R0030223V008655 Q-5-44-0
ERWAN LUKITO, TN 1317R0030223V008656 N-3-15-0
SITI ZULAIKAH,NY 1317R0030223V008657 N-3-15-0
YACOBUS HARIYANTO, TN 1317R0030223V008658 Q-5-44-0
DEFI RACHMAT SOEKAMTO, TN 1317R0030223V008659 Z-3-23-0
BUDI SANTOSO, TN 1317R0030223V008660 N-3-15-0
KUNING, NY 1317R0030223V008661 H-3-12-0
ISTIASIH,NY 1317R0030223V008662 C-3-13-0
SRIPAH,NY 1317R0030223V008667 C-3-23-0
EVI KURNIAWATI, NY 1317R0030223V008670 Q-5-44-0
M. ASLAN HAKI,AN 1317R0030223V008671 Q-5-44-0
DJASRIATI,NY 1317R0030223V008672 Q-5-44-0
SUYATNO,TN 1317R0030223V008673 Q-5-44-0
MUJIATI,NY 1317R0030223V008674 Q-5-44-0
WELLDAN AMILUTHDIN, SDR 1317R0030223V008675 Q-5-44-0
DWI WULAN PRAPTI EKASARI, NY 1317R0030223V008676 K-5-18-0
MARTIN,NY 1317R0030223V008680 Q-5-44-0
SUNARKO,TN 1317R0030223V008682 Z-3-27-0
LASMI, NY 1317R0030223V008684 Q-5-44-0
SITI MUKINAH,NY 1317R0030223V008685 Q-5-44-0
KATIRAWATI, NY 1317R0030223V008686 Q-5-44-0
SEPTIAN DHIKI PRASDIKA,SDR 1317R0030223V008689 Z-3-27-0
WINARNI,NY 1317R0030223V008694 C-3-23-0
MUZAYINIR ROHMAH, NY 1317R0030223V008698 Q-5-44-0
KRISNA SUSELA, TN 1317R0030223V008701 Q-5-42-0
SUHANTO, TN 1317R0030223V009231 Q-5-44-0
SRI GENDUT, NY 1317R0030223V009699 C-3-23-0
T

Page 22
 sheet1 -1

eb 2023
KELAS B PEMERINTAH
Top Up Total Tarif Tarif RS Jenis
272,500 159,465 RJ
275,900 56,630 RJ
896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ
196,100 139,995 RJ
196,100 208,300 RJ
196,100 178,950 RJ
196,100 233,940 RJ
896,700 934,000 RJ
196,100 105,442 RJ
196,100 320,100 RJ
896,700 934,000 RJ
196,100 1,221,765 RJ
196,100 103,330 RJ
196,100 118,978 RJ
196,100 263,300 RJ
196,100 127,550 RJ
196,100 338,010 RJ
168,000 104,000 RJ
196,100 101,890 RJ
424,800 362,460 RJ
196,100 566,872 RJ
196,100 107,344 RJ
202,400 175,260 RJ
196,100 63,264 RJ
353,500 496,500 RJ
196,100 171,960 RJ
196,100 374,960 RJ
353,500 496,500 RJ
196,100 88,200 RJ
196,100 138,968 RJ
196,100 113,300 RJ
196,100 95,860 RJ
196,100 196,437 RJ
196,100 136,100 RJ

Page 23
 sheet1 -1

196,100 496,602 RJ
196,100 179,298 RJ
196,100 119,073 RJ
196,100 117,438 RJ
196,100 119,300 RJ
196,100 268,300 RJ
196,100 386,500 RJ
131,500 44,000 RJ
353,500 313,500 RJ
196,100 120,750 RJ
196,100 121,776 RJ
1,451,400 1,231,816 RJ
896,700 1,350,250 RJ
196,100 257,940 RJ
196,100 373,300 RJ
196,100 87,860 RJ
196,100 390,116 RJ
353,500 389,200 RJ
196,100 124,150 RJ
196,100 268,500 RJ
196,100 98,300 RJ
196,100 158,649 RJ
196,100 113,840 RJ
196,100 225,100 RJ
196,100 373,160 RJ
196,100 102,350 RJ
196,100 263,300 RJ
196,100 101,370 RJ
196,100 127,830 RJ
196,100 238,140 RJ
196,100 104,720 RJ
196,100 93,690 RJ
424,800 1,363,200 RJ
196,100 380,660 RJ
196,100 110,570 RJ
168,000 104,000 RJ
196,100 111,062 RJ
196,100 242,040 RJ
168,000 104,000 RJ
196,100 93,722 RJ
196,100 268,500 RJ
202,400 175,300 RJ
196,100 194,690 RJ

Page 24
 sheet1 -1

196,100 120,398 RJ
196,100 105,435 RJ
353,500 386,500 RJ
196,100 453,300 RJ
196,100 345,950 RJ
196,100 152,710 RJ
196,100 127,380 RJ
196,100 141,645 RJ
586,800 411,500 RJ
196,100 177,970 RJ
196,100 263,300 RJ
196,100 263,300 RJ
196,100 193,815 RJ
196,100 586,500 RJ
131,500 114,000 RJ
196,100 82,080 RJ
196,100 104,330 RJ
131,500 114,000 RJ
196,100 104,230 RJ
196,100 233,615 RJ
196,100 183,250 RJ
196,100 263,160 RJ
196,100 98,210 RJ
196,100 217,280 RJ
168,000 104,000 RJ
196,100 375,100 RJ
196,100 138,090 RJ
196,100 61,500 RJ
196,100 61,500 RJ
196,100 101,910 RJ
131,500 44,000 RJ
896,700 934,000 RJ
196,100 362,820 RJ
196,100 133,830 RJ
424,800 1,363,140 RJ
196,100 93,690 RJ
196,100 102,324 RJ
202,400 146,600 RJ
196,100 220,000 RJ
896,700 934,000 RJ
202,400 179,750 RJ
131,500 44,000 RJ
196,100 98,160 RJ

Page 25
 sheet1 -1

1,467,200 1,369,396 RJ
196,100 128,440 RJ
896,700 934,000 RJ
196,100 61,500 RJ
131,500 114,000 RJ
131,500 44,000 RJ
196,100 98,300 RJ
353,500 386,500 RJ
196,100 263,300 RJ
196,100 208,160 RJ
202,400 229,300 RJ
196,100 108,335 RJ
196,100 350,195 RJ
196,100 116,420 RJ
196,100 335,253 RJ
196,100 263,160 RJ
196,100 412,746 RJ
196,100 153,360 RJ
196,100 209,418 RJ
196,100 423,300 RJ
896,700 934,000 RJ
196,100 99,000 RJ
196,100 110,750 RJ
196,100 475,706 RJ
196,100 662,346 RJ
196,100 101,056 RJ
196,100 234,550 RJ
196,100 159,580 RJ
168,000 104,000 RJ
424,800 1,363,200 RJ
196,100 418,100 RJ
196,100 171,960 RJ
196,100 553,622 RJ
196,100 115,200 RJ
196,100 323,240 RJ
196,100 61,500 RJ
196,100 95,670 RJ
196,100 562,140 RJ
196,100 136,450 RJ
196,100 83,530 RJ
196,100 113,706 RJ
196,100 712,239 RJ
196,100 472,946 RJ

Page 26
 sheet1 -1

196,100 161,492 RJ
896,700 934,000 RJ
196,100 97,188 RJ
196,100 104,700 RJ
196,100 141,388 RJ
196,100 373,160 RJ
896,700 934,000 RJ
131,500 104,000 RJ
353,500 386,500 RJ
196,100 230,390 RJ
196,100 263,550 RJ
196,100 356,476 RJ
896,700 934,000 RJ
196,100 576,500 RJ
196,100 144,100 RJ
245,100 277,500 RJ
196,100 101,450 RJ
196,100 268,500 RJ
196,100 116,550 RJ
196,100 119,030 RJ
424,800 97,800 RJ
196,100 368,300 RJ
196,100 161,790 RJ
196,100 239,880 RJ
896,700 934,000 RJ
196,100 86,100 RJ
196,100 614,630 RJ
196,100 109,509 RJ
196,100 106,340 RJ
196,100 227,200 RJ
131,500 114,000 RJ
353,500 386,500 RJ
896,700 934,000 RJ
202,400 238,120 RJ
196,100 148,383 RJ
896,700 934,000 RJ
196,100 103,078 RJ
896,700 934,000 RJ
196,100 165,920 RJ
424,800 1,379,700 RJ
196,100 98,894 RJ
196,100 751,500 RJ
196,100 77,100 RJ

Page 27
 sheet1 -1

196,100 228,160 RJ
896,700 934,000 RJ
1,467,200 275,320 RJ
196,100 335,487 RJ
202,400 192,680 RJ
196,100 61,500 RJ
196,100 130,548 RJ
424,800 1,394,100 RJ
196,100 198,570 RJ
196,100 640,960 RJ
762,195 934,000 RJ
196,100 145,250 RJ
131,500 44,000 RJ
196,100 548,235 RJ
196,100 532,785 RJ
196,100 410,100 RJ
196,100 604,494 RJ
196,100 83,498 RJ
196,100 124,520 RJ
196,100 168,664 RJ
196,100 123,660 RJ
196,100 208,300 RJ
196,100 92,390 RJ
196,100 136,418 RJ
196,100 208,300 RJ
196,100 127,372 RJ
196,100 108,876 RJ
196,100 263,520 RJ
196,100 159,880 RJ
196,100 122,025 RJ
196,100 98,300 RJ
196,100 127,900 RJ
196,100 263,300 RJ
196,100 208,300 RJ
320,300 175,200 RJ
196,100 263,160 RJ
196,100 396,820 RJ
196,100 71,500 RJ
564,400 479,150 RJ
196,100 91,500 RJ
196,100 127,550 RJ
196,100 275,460 RJ
196,100 71,500 RJ

Page 28
 sheet1 -1

196,100 263,300 RJ
131,500 114,000 RJ
196,100 111,550 RJ
196,100 281,280 RJ
196,100 538,300 RJ
196,100 112,976 RJ
196,100 61,500 RJ
196,100 594,000 RJ
196,100 263,300 RJ
196,100 441,200 RJ
196,100 103,160 RJ
196,100 103,160 RJ
196,100 144,100 RJ
196,100 159,610 RJ
196,100 148,805 RJ
196,100 268,300 RJ
586,800 468,160 RJ
196,100 94,358 RJ
196,100 171,360 RJ
353,500 386,500 RJ
196,100 98,160 RJ
196,100 236,500 RJ
424,800 1,363,200 RJ
196,100 92,168 RJ
196,100 121,440 RJ
196,100 514,000 RJ
424,800 154,800 RJ
196,100 98,300 RJ
196,100 273,160 RJ
564,400 572,500 RJ
196,100 814,093 RJ
196,100 245,154 RJ
196,100 373,160 RJ
196,100 154,340 RJ
196,100 94,040 RJ
353,500 386,500 RJ
196,100 105,950 RJ
196,100 125,370 RJ
327,100 104,700 RJ
196,100 564,480 RJ
353,500 496,500 RJ
131,500 114,000 RJ
196,100 244,160 RJ

Page 29
 sheet1 -1

196,100 115,960 RJ
196,100 86,080 RJ
196,100 97,078 RJ
196,100 366,036 RJ
196,100 296,000 RJ
564,400 361,500 RJ
196,100 565,716 RJ
424,800 97,800 RJ
196,100 93,690 RJ
196,100 305,460 RJ
196,100 219,420 RJ
131,500 44,000 RJ
564,400 511,500 RJ
196,100 175,975 RJ
196,100 97,524 RJ
202,400 337,860 RJ
196,100 263,300 RJ
586,800 489,900 RJ
196,100 189,420 RJ
196,100 559,000 RJ
196,100 167,300 RJ
196,100 106,561 RJ
196,100 393,340 RJ
196,100 228,060 RJ
424,800 97,800 RJ
196,100 121,088 RJ
196,100 118,922 RJ
196,100 216,340 RJ
196,100 212,079 RJ
196,100 98,940 RJ
196,100 145,640 RJ
196,100 197,770 RJ
196,100 98,300 RJ
196,100 216,442 RJ
196,100 98,300 RJ
131,500 114,000 RJ
353,500 472,700 RJ
196,100 263,300 RJ
196,100 327,510 RJ
196,100 144,634 RJ
196,100 98,900 RJ
196,100 103,200 RJ
196,100 107,874 RJ

Page 30
 sheet1 -1

196,100 138,750 RJ
196,100 103,160 RJ
196,100 77,580 RJ
196,100 108,902 RJ
196,100 100,860 RJ
196,100 304,910 RJ
196,100 113,060 RJ
196,100 701,016 RJ
196,100 119,280 RJ
196,100 127,850 RJ
196,100 628,540 RJ
196,100 526,680 RJ
196,100 114,000 RJ
196,100 263,550 RJ
196,100 208,300 RJ
294,900 322,940 RJ
196,100 116,700 RJ
353,500 386,500 RJ
196,100 76,500 RJ
424,800 97,740 RJ
202,400 204,230 RJ
353,500 386,500 RJ
196,100 263,160 RJ
196,100 191,250 RJ
196,100 182,781 RJ
196,100 373,300 RJ
196,100 221,060 RJ
196,100 422,526 RJ
196,100 115,440 RJ
196,100 75,050 RJ
196,100 107,105 RJ
196,100 174,978 RJ
196,100 80,055 RJ
196,100 711,240 RJ
196,100 121,720 RJ
196,100 98,160 RJ
131,500 114,000 RJ
202,400 153,620 RJ
424,800 97,800 RJ
196,100 122,230 RJ
196,100 268,360 RJ
196,100 116,610 RJ
168,000 104,000 RJ

Page 31
 sheet1 -1

424,800 87,500 RJ
196,100 118,924 RJ
196,100 474,696 RJ
196,100 118,050 RJ
196,100 270,810 RJ
196,100 494,355 RJ
196,100 129,080 RJ
196,100 272,040 RJ
196,100 128,739 RJ
1,467,200 1,369,880 RJ
324,700 133,353 RJ
196,100 409,650 RJ
196,100 101,500 RJ
203,700 288,450 RJ
202,400 218,718 RJ
196,100 109,530 RJ
196,100 70,300 RJ
196,100 97,890 RJ
1,467,200 1,850,709 RJ
196,100 1,095,072 RJ
1,467,200 1,409,654 RJ
196,100 66,950 RJ
196,100 182,140 RJ
1,467,200 1,849,163 RJ
1,467,200 1,487,162 RJ
196,100 113,140 RJ
1,467,200 1,615,833 RJ
424,800 154,800 RJ
1,467,200 1,430,717 RJ
196,100 228,170 RJ
196,100 316,940 RJ
896,700 1,350,250 RJ
896,700 934,000 RJ
896,700 934,000 RJ
196,100 106,500 RJ
896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ

Page 32
 sheet1 -1

896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ
896,700 934,000 RJ
196,100 187,483 RJ
896,700 934,000 RJ
896,700 934,000 RJ
196,100 98,300 RJ
564,400 401,700 RJ
896,700 934,000 RJ
240,300 216,748 RJ
1,467,200 1,369,880 RJ
424,800 1,363,200 RJ
196,100 101,500 RJ
196,100 1,002,500 RJ
196,100 266,040 RJ
196,100 121,971 RJ
196,100 113,300 RJ
196,100 801,300 RJ
257,500 68,320 RJ
196,100 103,300 RJ
202,400 365,740 RJ
196,100 394,160 RJ
196,100 125,260 RJ
196,100 152,600 RJ
202,400 96,700 RJ
424,800 1,333,700 RJ
196,100 61,500 RJ
203,700 72,440 RJ
196,100 413,940 RJ
424,800 691,100 RJ
Total 141,456,895 155,608,961

Page 33