No. Kw Nama Pasien Tgl. Masuk Tgl.

Keluar Jenis Biaya

004674/PRI Suhartati 28-May-08 31-May-08 Ambulance Rp 50,000
004684/PRI Indah Dani A 29-May-08 3-Jun-08 Ambulance Rp 100,000
004700/PRI Evi Shofianti 2-Jun-08 5-Jun-08 Ambulance Rp 100,000
004779/PRI Afni Sri Ramdhani 21-Jun-08 25-Jun-08 Ambulan Rp 50,000
004839/PRI Rina Kristanti 1-Jul-08 5-Jul-08 Ambulance Rp 100,000
004906/PRI dr. Lisda 16-Jul-08 17-Jul-08 Ambulan Rp 100,000
004916/PRI Teti H 17-Jul-08 19-Jul-08 Ambulance Rp 100,000
005135/PRI Imas Sukaelah 9-Sep-08 12-Sep-08 Ambulan Rp 100,000
005151/PRI Elin Herlina 13-Sep-08 16-Sep-08 Ambulance Rp 50,000
005240/PRI Cicih 29-Sep-08 2-Oct-08 Ambulance Rp 100,000
005325/PRI Wina Utami Putri 16-Oct-08 19-Oct-08 Ambulance Rp 50,000
005358/PRI Novia Toviani 21-Oct-08 23-Oct-08 Ambulance Rp 100,000
005380/PRI Hj Yulia Ramdiani, SS. 23-Oct-08 26-Oct-08 Ambulance Rp 100,000
005388/PRI Indah Susanti 24-Oct-08 27-Oct-08 Ambulan Rp 100,000
005420/PRI Atin Kurniatin 30-Oct-08 1-Nov-08 Ambulance Rp 100,000
005557/PRI Teti Arifianti 22-Nov-08 25-Nov-08 Ambulan Rp 100,000
005656/PRI Sayem 15-Dec-08 16-Dec-08 Ambulance Rp 100,000
005808/PRI Rospita 13-Jan-09 16-Jan-09 Ambulance Rp 100,000
005812/PRI Sri Tuniasih 14-Jan-09 17-Jan-09 Ambulance Rp 50,000
005879/PRI Rahmi Yuanita Rahman 25-Jan-09 29-Jan-09 Ambulance Rp 100,000
005907/PRI Nur Arfah Widyani 1-Feb-09 4-Feb-09 Ambulance Rp 100,000
005959/PRI Susi Maryani 13-Feb-09 16-Feb-09 Ambulance Rp 100,000
006026/PRI Rita Febriani 26-Feb-09 1-Mar-09 Ambulance Rp 100,000
006084/PRI Atin 11-Mar-09 11-Mar-09 Ambulance Rp 100,000
006382/PRI Yunita 10-May-09 13-May-09 Ambulance Rp 100,000
006398/PRI Nuri Lestari 13-May-09 16-May-09 Ambulance Rp 100,000
006408/PRI Oom Rohmanah 17-May-09 18-May-09 Ambulance Rp 100,000
006580/PRI Gesha Hermanitha P 25-Jun-09 27-Jun-09 Ambulance Rp 100,000
006639/PRI Rosilawati 6-Jul-09 8-Jul-09 Ambulan Rp 200,000
006820/PRI Rose Rosidah 14-Aug-09 15-Aug-09 Ambulan Rp 100,000
007091/PRI Nia Kurniati 8-Oct-09 10-Oct-09 Ambulance Rp 50,000
007098/PRI Rahmatania 10-Oct-09 13-Oct-09 Ambulance Rp 100,000
007116/PRI Nisrin Sarah Amelia 14-Oct-09 15-Oct-09 Ambulance Rp 50,000
007128/PRI Neti Yulianengsih 16-Oct-09 19-Oct-09 Ambulance Rp 50,000
007178/PRI Farida Dwi Astuti 26-Oct-09 28-Oct-09 Ambulance Rp 50,000
007234/PRI Kania Machliawati 10-Nov-09 13-Nov-09 Ambulance Rp 100,000
007429/PRI Imas Suryani 23-Dec-09 26-Dec-09 Ambulan Rp 100,000
007436/PRI Neneng Sumiati 24-Dec-09 28-Dec-09 Ambulance Rp 100,000
007549/PRI Karmilah 25-Jan-10 28-Jan-10 Ambulan Rp 100,000
007638/PRI Bonita Rahmi Mauli Lubis 15-Feb-10 15-Feb-10 Ambulan Rp 100,000
007679/PRI Ijah Chodijah 22-Feb-10 25-Feb-10 Ambulance Rp 100,000
007721/PRI Suhaenah 4-Mar-10 4-Mar-10 Ambulan Rp 100,000
007728/PRI Khusnul Khotimah 4-Mar-10 6-Mar-10 Ambulance Rp 50,000
007759/PRI Fatazah Febyani 10-Mar-10 13-Mar-10 Ambulan Rp 100,000
007804/PRI Hala Nurhalida 21-Mar-10 23-Mar-10 Ambulan Rp 100,000
007845/PRI Silvhy Saphira 29-Mar-10 30-Mar-10 Ambulan Rp 100,000
007878/PRI Wini listriani 4-Apr-10 8-Apr-10 AMBULANCE Rp 200,000
007889/PRI Nurul Latifah 8-Apr-10 10-Apr-10 Ambulan Rp 100,000
007905/PRI Sugiati 10-Apr-10 12-Apr-10 Ambulan Rp 100,000
007910/PRI Hana Jubaedah 13-Apr-10 16-Apr-10 Ambulance Rp 100,000
008034/PRI Detty Kusdianti 21-May-10 22-May-10 Ambulance Rp 100,000
008058/PRI Pida Siti Farida 28-May-10 29-May-10 Ambulance Rp 50,000
008063/PRI Nonie Ayulia 27-May-10 1-Jun-10 Ambulan Rp 100,000
008060/PRI Debby Andina Galuarty 30-May-10 2-Jun-10 Ambulan Rp 300,000
008084/PRI May Mulyani 6-Jun-10 10-Jun-10 Ambulance Rp 100,000
008107/PRI Iis Rosida 16-Jun-10 16-Jun-10 Ambulan Rp 50,000
008168/PRI Sekar 30-Jun-10 2-Jul-10 Ambulance Rp 100,000
008197/PRI Dessy Citra Arisanthy 6-Jul-10 9-Jul-10 Ambulance Rp 100,000
008348/PRI Astri 11-Aug-10 14-Aug-10 Ambulance Rp 100,000
008384/PRI Pupu Widyaningsih 17-Aug-10 19-Aug-10 Ambulance Rp 100,000
008427/PRI Dewi Lestari S.E 29-Aug-10 1-Sep-10 Ambulance Rp 100,000
008432/PRI Setia Wati 1-Sep-10 2-Sep-10 Ambulance Rp 100,000
008441/PRI Ernawati 3-Sep-10 5-Sep-10 Ambulance Rp 100,000
008564/PRI Wina Wulandari 30-Sep-10 3-Oct-10 Ambulance Rp 100,000
008679/PRI Diah Hayu Ramyastri 22-Oct-10 24-Oct-10 Ambulance Rp 100,000
008681/PRI Nor Azizah 23-Oct-10 25-Oct-10 Ambulance Rp 100,000
008684/PRI Wini Yulistiani 23-Oct-10 26-Oct-10 Ambulance Rp 100,000
008732/PRI Karina Dwipuspa Indriya 6-Nov-10 8-Nov-10 Ambulan Rp 100,000
008789/PRI Sri Risyati 17-Nov-10 21-Nov-10 Ambulance Rp 100,000
008853/PRI Rina Suparman 10-Dec-10 13-Dec-10 Ambulance Rp 100,000
008907/PRI Neng Yoyoh 26-Dec-10 27-Dec-10 Ambulance Rp 100,000
008982/PRI Susi Sugiarti 11-Jan-11 14-Jan-11 Ambulan Rp 100,000
009044/PRI Pawestri Hardyaputri 27-Jan-11 30-Jan-11 Ambulance Rp 100,000
009072/PRI Sri Setiyowati 4-Feb-11 7-Feb-11 Ambulance Rp 100,000
009134/PRI Melanie Wulandari 15-Feb-11 16-Feb-11 Ambulance Rp 50,000
009138/PRI Nira 17-Feb-11 20-Feb-11 Ambulance Rp 100,000
009155/PRI Anna Dariani 22-Feb-11 24-Feb-11 Ambulance Rp 100,000
009173/PRI Nida Shahidah 28-Feb-11 2-Mar-11 Ambulance Rp 100,000
009183/PRI Nunung 3-Mar-11 3-Mar-11 Ambulance Rp 50,000
009187/PRI Windy Wendani SE 3-Mar-11 6-Mar-11 Ambulance Rp 100,000
009195/PRI Rita Nurjanah 5-Mar-11 7-Mar-11 Ambulance Rp 100,000
009210/PRI Fuja Viveri Colosa 8-Mar-11 11-Mar-11 Ambulance Rp 100,000
009246/PRI Ike Tresnawati 16-Mar-11 18-Mar-11 Ambulance Rp 100,000
009242/PRI Lilis 15-Mar-11 19-Mar-11 Ambulance Rp 100,000
009359/PRI Hani 19-Apr-11 19-Apr-11 Ambulance Rp 100,000
009376/PRI Nurhayati 21-Apr-11 23-Apr-11 Ambulance Rp 100,000
009449/PRI Wiwin Widianingsih 14-May-11 17-May-11 Ambulance Rp 50,000
009462/PRI Nurul Ramdhani 16-May-11 20-May-11 Ambulance Rp 100,000
009515/PRI Sully Maulina 29-May-11 1-Jun-11 Ambulance Rp 100,000
009539/PRI Dini Munggarani 8-Jun-11 11-Jun-11 Ambulance Rp 100,000
009561/PRI Rizky Respati Herwiyah 10-Jun-11 12-Jun-11 Ambulance Rp 100,000
009548/PRI Maemunah 9-Jun-11 13-Jun-11 AMBULANCE Rp 100,000
009628/PRI Eva Fauziah 2-Jul-11 7-Jul-11 Ambulance Rp 100,000
009646/PRI Rinci 6-Jul-11 12-Jul-11 Ambulance Rp 100,000
009671/PRI Lia Sukmawati 15-Jul-11 16-Jul-11 Ambulance Rp 50,000
009763/PRI Putri Anindita 07.08.2011 10.08.2011 Ambulance Rp 50,000
009798/PRI Wanti Saefudin 17.08.2011 20.08.2011 Ambulance Rp 100,000
010172/PRI Yuli 19.11.2011 19.11.2011 Ambulance Rp 100,000
010178/PRI Onden Dian 20.11.2011 23.11.2011 Ambulance Rp 100,000
010279/PRI Siti Patima 17.12.2011 19.12.2011 Ambulance Rp 50,000
010382/PRI Renny Triana 12.01.2012 15.01.2012 Ambulance Rp 100,000
010588/PRI Endang Andina Sari 07.03.2012 09.03.2012 Ambulance Rp 100,000
010649/PRI Meli Kusnianingsih 24.03.2012 27.03.2012 Ambulance Rp 100,000
010738/PRI Dedeh Yuningsih 12.04.2012 13.04.2012 Ambulance Rp 100,000
010767/PRI Resi Rosmelia 21.04.2012 25.04.2012 Ambulance Rp 100,000
010784/PRI Leni Kusumasari 27.04.2012 30.04.2012 Ambulance Rp 50,000

TOTAL Rp 10,050,000
 Jasa
Rp 10,000
Rp 15,000
Rp 15,000
Rp 10,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 10,000
Rp 15,000
Rp 10,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 10,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 10,000
Rp 15,000
Rp 10,000
Rp 10,000
Rp 10,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 10,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 10,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 10,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 10,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 10,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 10,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 10,000
Rp 10,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 10,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 15,000
Rp 10,000

Rp 1,495,000