NMR NOSEP TGLSEP RIRJ MR NAMAPESERTA DIAGNOSA

31 0433R0040123V000118 2023-01-02 RI 120404 AHMAD SUBAKIR I50.9

92 0433R0040123V000859 2023-01-10 RI 98366 SUNARI I50
232 0433R0040123V002504 2023-01-26 RI 113494 MISNUN I25
244 0433R0040123V002726 2023-01-28 RI 121107 LASTARI I44.2
247 0433R0040123V002732 2023-01-28 RI 121093 NUR AZIZ I21.3
249 0433R0040123V002736 2023-01-28 RI 84941 FAUDI I50.9
POLI
DR YUSUF TL S/D 16/2
DR YUSUF TL S/D 16/2
DR YUSUF TL S/D 16/2
DR YUSUF TL S/D 16/2
DR YUSUF TL S/D 16/2
DR YUSUF TL S/D 16/2
NO NAMA NO RM TGL MRS TGL KRS DOKTER
1 NUR CHOFIFAH 101863 2-Jan 3-Jan dr. Bambang W., MS. SpOT
2 EDDY PURWANTO 47906 3-Jan 4-Jan dr. Bambang W., MS. SpOT
3 MARUWAN 111093 4-Jan 5-Jan dr. Bambang W., MS. SpOT
6 SITI AMINAH 115287 10-Jan 11-Jan dr. Bambang W., MS. SpOT
7 REXA PANDU BAGUS SAMUDRA 119369 10-Jan 11-Jan dr. Bambang W., MS. SpOT
8 JULIO ROYBERT SALINDEHO 83662 10-Jan 11-Jan dr. Bambang W., MS. SpOT
9 ISWIHARTI 120725 11-Jan 12-Jan dr. Bambang W., MS. SpOT
15 HARIADI 102678 11-Jan 12-Jan dr. Bambang W., MS. SpOT
10 SARIAH HJ BINTI ELYAS 117580 12-Jan 13-Jan dr. Bambang W., MS. SpOT
11 NURIYATI 69425 13-Jan 14-Jan dr. Bambang W., MS. SpOT
12 RIATIN BINTI GUNAWAN 120747 13-Jan 15-Jan dr. Bambang W., MS. SpOT
13 JULIO ROYBERT SALINDEHO 83662 14-Jan 15-Jan dr. Bambang W., MS. SpOT
16 HADI BIN SAPII 102654 16-Jan 18-Jan dr. Bambang W., MS. SpOT
25 RAGILIA RIRIS ISLAH NURROHMA 120840 16-Jan 17-Jan dr. Bambang W., MS. SpOT TDK OP
17 AHMAD BIN MUHAMMAD 120863 17-Jan 18-Jan dr. Bambang W., MS. SpOT
18 ADINDA AULIA PUTRI 120864 17-Jan 18-Jan dr. Bambang W., MS. SpOT
26 SUTIARI BINTI BEJO 110350 17-Jan 18-Jan dr. Bambang W., MS. SpOT
19 EIREEN ADZKIA FAHMA RESTYAWAN 119263 18-Jan 19-Jan dr. Bambang W., MS. SpOT
14 SULIKAH BINTI SENIMUN 115372 19-Jan 20-Jan dr. Bambang W., MS. SpOT
21 ASMAIYAH BINTI JAMARI 23645 20-Jan 22-Jan dr. Bambang W., MS. SpOT
22 SRI LESTARI 19284 21-Jan 23-Jan dr. Bambang W., MS. SpOT
33 NGATIYAH BINTI SARPAIN 116647 24-Jan 25-Jan dr. Bambang W., MS. SpOT
23 NINIS SETIAWATI 121020 25-Jan 26-Jan dr. Bambang W., MS. SpOT
34 SHINTA RAHAYU 111515 25-Jan 26-Jan dr. Bambang W., MS. SpOT
28 BAMBANG TRIJANTO 35353 26-Jan 27-Jan dr. Bambang W., MS. SpOT
29 ARIYANTI PUJI ASTUTI 106407 26-Jan 27-Jan dr. Bambang W., MS. SpOT
36 TUKIYEM BINTI BUANG 119886 26-Jan 27-Jan dr. Bambang W., MS. SpOT
4 MINTOROGO 99340 5-Jan 5-Jan Dr. Titis Kurniawan, Sp. B, FINACS
5 LESTARIADI BIN KARSO 120594 9-Jan 10-Jan Dr. Titis Kurniawan, Sp. B, FINACS
20 MUHAMAD TAUFIQ FAJAR 120928 19-Jan 22-Jan Dr. Titis Kurniawan, Sp. B, FINACS
27 TRI IRIANTO 32916 22-Jan 23-Jan Dr. Titis Kurniawan, Sp. B, FINACS BED REST
30 AZHILLANI TAHTA ARSYIKA 118089 23-Jan 24-Jan Dr. Titis Kurniawan, Sp. B, FINACS
31 AYSEL FARDAD A SALIM 109842 23-Jan 24-Jan Dr. Titis Kurniawan, Sp. B, FINACS
32 MASYHADI 120845 23-Jan 24-Jan Dr. Titis Kurniawan, Sp. B, FINACS
35 SALZA MARISKA MAHDALENA 58672 26-Jan 26-Jan Dr. Titis Kurniawan, Sp. B, FINACS
24 KASMANI 27035 29-Jan 31-Jan Dr. Titis Kurniawan, Sp. B, FINACS

NO NAMA NO RM TGL MRS TGL KRS DOKTER

4 MINTOROGO 99340 5-Jan 5-Jan Dr. Titis Kurniawan, Sp. B, FINACS
5 LESTARIADI BIN KARSO 120594 9-Jan 10-Jan Dr. Titis Kurniawan, Sp. B, FINACS
20 MUHAMAD TAUFIQ FAJAR 120928 19-Jan 22-Jan Dr. Titis Kurniawan, Sp. B, FINACS
30 AZHILLANI TAHTA ARSYIKA 118089 23-Jan 24-Jan Dr. Titis Kurniawan, Sp. B, FINACS
31 AYSEL FARDAD A SALIM 109842 23-Jan 24-Jan Dr. Titis Kurniawan, Sp. B, FINACS
32 MASYHADI 120845 23-Jan 24-Jan Dr. Titis Kurniawan, Sp. B, FINACS
NMR NOSEP TGLSEP RIRJ NOKARTU MR NAMAPESEDIAGNOSA
1 0433R0040123V000003 2023-01-01 RI 000263***3534 SA*** M10.97
2 0433R0040123V000004 2023-01-01 RI 000068***1985 kh***** fi O82
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13 0433R0040123V000114 2023-01-02 RI 000273***2669 EK* MU***R11
14 0433R0040123V000118 2023-01-02 RI 000261***6021 AH*** SU*I50.9
15 0433R0040123V000132 2023-01-02 RI 000290***8579 SA*** EG*E11.6
16 0433R0040123V000134 2023-01-02 RI 000068***5718 SU**** I50.9
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36 0433R0040123V000366 2023-01-05 RI 000331***5447 le** fi****K40.9
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44 0433R0040123V000583 2023-01-05 RI 000244***1201 SU****** E11.9
45 0433R0040123V000500 2023-01-06 RI 000330***8409 SR* SU***E16.2
46 0433R0040123V000538 2023-01-06 RI 000079***4433 DE** RA**R50.9
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56 0433R0040123V000670 2023-01-07 RI 000261***7345 MU******R50.9
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70 0433R0040123V000740 2023-01-09 RI 000190***1249 PR***** CR50.9
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72 0433R0040123V000793 2023-01-09 RI 000078***8875 SE*******O80
73 0433R0040123V000815 2023-01-09 RI 000199***0451 NU* FA***O14.9
74 0433R0040123V000816 2023-01-10 RI 000129***5972 KU**** R10.0
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77 0433R0040123V000896 2023-01-10 RI 000078***8686 MI*** R50.9
78 0433R0040123V000899 2023-01-10 RI 000154***1903 RE** PA**T81.3
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80 0433R0040123V000904 2023-01-10 RI 000274***6987 SI** AM**M48.0
81 0433R0040123V000907 2023-01-10 RI 000262***8534 HE*** DE*A09
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89 0433R0040123V000948 2023-01-11 RI 000310***9901 AD*** LA*R11
90 0433R0040123V000957 2023-01-11 RI 000273***0555 CO*** NU*R50.9
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POLI
 KELAS
NO. NAMA PASIEN NO. KUNJUNGAN PERAWAT NO. RM KEADAAN
PULANG
AN

23 NUR CHOFIFAH 202301020123 ANGGREK 1 101863 BAIK

42 EDDY PURWANTO 202301030274 ANGGREK 1 47906 BAIK
47 MARUWAN 202301040440 KRISAN 1C 111093 BAIK
55 MINTOROGO 202301050690 KRISAN 1B 99340 RUJUK RSSA
84 LESTARIADI BIN KARSO 202301091138 MAWAR 5 120594 BAIK
91 SITI AMINAH 202301101331 KRISAN 6B 115287 BAIK
92 REXA PANDU BAGUS SAMUDRA 202301101427 MAWAR 3 119369 BAIK
93 JULIO ROYBERT SALINDEHO 202301101385 MAWAR 1 83662 BAIK
109 ISWIHARTI 202301111494 MAWAR 3 120725 BAIK
120 SARIAH HJ BINTI ELYAS 202301121749 KRISAN 1A 117580 BAIK
126 NURIYATI 202301131875 KRISAN 3A 69425 BAIK
129 RIATIN BINTI GUNAWAN 202301132003 KRISAN 6B 120747 BAIK
133 JULIO ROYBERT SALINDEHO 202301142039 MAWAR 5 83662 BAIK
171 SULIKAH BINTI SENIMUN 202301192716 KRISAN 6B 115372 BAIK
 TOTAL
TGL. MRS TGL. KRS Petugas
Kasir Dokter Pelaksana KESELURUHAN
( SIM RS )

2-Jan 3-Jan ANISA dr. Bambang W., MS. SpOT 8,515,445

3-Jan 4-Jan ANISA dr. Bambang W., MS. SpOT 8,788,827
4-Jan 5-Jan ANISA dr. Bambang W., MS. SpOT 2,516,296
5-Jan 5-Jan NELA Dr. Titis Kurniawan, Sp. B, FINACS 1,766,682
9-Jan 10-Jan ANISA Dr. Titis Kurniawan, Sp. B, FINACS 5,756,376
10-Jan 11-Jan NELA dr. Bambang W., MS. SpOT 2,634,601
10-Jan 11-Jan NELA dr. Bambang W., MS. SpOT 3,538,392
10-Jan 11-Jan NELA dr. Bambang W., MS. SpOT 4,719,526
11-Jan 12-Jan NELA dr. Bambang W., MS. SpOT 3,034,952
12-Jan 13-Jan ANISA dr. Bambang W., MS. SpOT 2,590,003
13-Jan 14-Jan ANISA dr. Bambang W., MS. SpOT 3,082,121
13-Jan 15-Jan ELSYA dr. Bambang W., MS. SpOT 4,071,537
14-Jan 15-Jan ELSYA dr. Bambang W., MS. SpOT 3,812,624
19-Jan 20-Jan ANISA dr. Bambang W., MS. SpOT 2,499,229
 PENUNJANG
RAD, RAD (EKG,PERASA
KAMAR - OBAT - ALKES LAB DAN LAB LUAR , CT OK T, TENAGA
ADMIN RETUR LUAR AHLI (FISIO)
SCAN AMBULAN,
NST)

419,000 269,800 185,126 50,000 115,500 7,025,019 138,000

569,000 339,298 184,510 50,000 110,000 7,025,019 138,000
194,000 159,608 75,188 50,000 28,000
194,000 138,767 284,915 230,000 286,000 313,000
446,500 518,948 1,280,482 324,500 2,733,696 211,000
199,670 114,779 142,652 50,000 118,000
339,670 434,193 639,737 149,500 1,640,292 75,000
339,670 567,162 1,222,902 149,500 465,000 1,640,292 75,000
424,670 148,560 171,722 50,000 145,000
199,670 142,641 80,192 50,000 118,000
199,670 404,296 278,318 50,000 104,500 1,708,337 121,000
247,170 575,684 673,096 135,500 309,500 1,708,337 136,000
452,170 424,391 818,271 149,500 1,640,292 68,000
199,670 131,940 45,119 50,000 91,000
 PEMERIKSA TINDAKAN
DARAH + AN , DOKTER / SEWA ALAT BHP +
KURIR KONSUL OKSIGEN
PERAWAT
DAN VISITE

215,000 30,000 68,000

275,000 30,000 68,000
125,000 1,793,500 23,000 68,000
65,000 23,000 232,000
146,250 27,000 68,000
125,000 1,793,500 23,000 68,000
165,000 27,000 68,000
165,000 27,000 68,000
175,000 1,822,000 30,000 68,000
115,000 1,793,500 23,000 68,000
125,000 23,000 68,000
171,250 23,000 92,000
165,000 27,000 68,000
125,000 1,793,500 23,000 40,000
NO TGL MRS TGL KRS NO RM NAMA PASIEN DPJP KET
1 2023-01-02 1/4/2023 RI 119976 SUYATI DR. ASTARIN, SP.U
2 2023-01-02 1/5/2023 RI 120404 AHMAD SUBAKIR DR.YUSUF, SP. JP
3 2023-01-02 1/6/2023 RI 98075 SITI NURRODIFAH DR. WINDA, SP.N
4 2023-01-10 1/11/2023 RI 98366 SUNARI DR. YUSUF, SP. JP
5 2023-01-10 1/12/2023 RI 45307 MISDI DR. RACHMAD, SP.PD
6 2023-01-10 1/12/2023 RI 120710 BY NY NUR FAIZAH DR. DITYA, SP.A BERKAS DI RM TIDAK LENGKAP
7 2023-01-12 1/13/2023 RI 120756 BY NY ANISAK INTAN DR. DITYA, SP.A BERKAS DI RM TIDAK LENGKAP
8 2023-01-14 1/17/2023 RI 120804 SUGIONO DR. VIDYA, SP.DV BERKAS DI RM TIDAK LENGKAP
9 2023-01-15 1/17/2023 RI 120831 TRAVIO FEYROS DR. DITYA, SP.A BERKAS DI RM TIDAK LENGKAP
10 2023-01-17 1/20/2023 RI 52605 IIN RONI DR. DYAH RETNO, SP.PD BERKAS DI RM TIDAK LENGKAP
11 2023-01-17 1/17/2023 RI 120879 ANIROSITA DR. WINDA, SP.N
12 2023-01-18 1/19/2023 RI 119263 EIREEN ADZKIA DR. BAMBANG, SP.OT
13 2023-01-19 1/21/2023 RI 71090 DEVY NURVITA SARI DR. RETNO, SP.OG BERKAS DI RM TIDAK LENGKAP
14 2023-01-20 1/20/2023 RI 120921 SENIMA DR. VENNY, SP. JP BERKAS DI RM TIDAK LENGKAP
15 2023-01-20 1/23/2023 RI 49574 SAMPUR DR. WARA. SP.P
16 2023-01-20 1/23/2023 RI 120920 BY NY LYLI MUFIDAH DR. HAYKAL, SP.A BERKAS DI RM TIDAK LENGKAP
17 2023-01-26 1/29/2023 RI 113494 MISNU DR. YUSUF, SP. JP
18 2023-01-26 1/27/2023 RI 47419 BUDI ASTUTI DR. TITIS, SP.B
19 2023-01-28 1/31/2023 RI 121107 LASTARI DR. YUSUF, SP. JP
20 2023-01-28 1/31/2023 RI 121093 NUR AZIZ Z DR. YUSUF, SP. JP
21 2023-01-28 1/31/2023 RI 84941 FAUDI DR. YUSUF, SP. JP
22 2023-01-31 1/31/2023 RI 121182 GALUH SEPTYA DR. RETNO, SP.OG
23 2022-12-31 83592 MUSTAKIM MUNIR DR. ASTARIN, SP.U
24 2023-01-10 98912 KUSNAN DR. RACHMAD, SP.PD