PERIODE : JANUARI 2018

Jasa Visite Dokter Spesialis

No No. Reg Tanggal Nama Pasien

dr. Meitha SpA dr. Astrid Sp A dr. Purwitanto SpD dr. Flora SpOG

1 30767 29/12/2017 An. Sayid Rafli Anwar 175,000

30/12/2017 175,000
31/12/2017 175,000
01/01/2018 175,000
02/01/2018 175,000
03/01/2018 175,000
04/01/2018 175,000

2 9268 31/12/2017 An. Nadira Charisa Rahayu 150,000

01/01/2018 150,000
02/01/2018 150,000
03/01/2018 150,000
04/01/2018 150,000

3 30793 01/01/2018 An. Rachel Zuwina Rahayu 150,000

02/01/2018 150,000
03/01/2018 150,000
04/01/2018 150,000

4 30792 01/01/2018 An. Reynand Arga Firizki 150,000

 02/01/2018 150,000
03/01/2018 150,000
04/01/2018 150,000

5 30797 01/01/2018 An. Thomas Brian 175,000

02/01/2018 175,000
03/01/2018 175,000
04/01/2018 175,000
05/01/2018 175,000

6 30584 02/01/2018 An. Abdul Aziz Alsaud 150,000

03/01/2018 150,000
04/01/2018 150,000
05/01/2018 150,000
06/01/2018 150,000
07/01/2018 150,000

7 20094 02/01/2018 An. Agustorey 150,000

03/01/2018 150,000
04/01/2018 150,000
05/01/2018 150,000
06/01/2018 150,000
07/01/2018 150,000

8 27570 04/01/2018 An. Maisha 150,000

05/01/2018 150,000
 06/01/2018 150,000

9 27403 03/01/2018 An. Felix Aksel 150,000

04/01/2018 150,000
05/01/2018 150,000
06/01/2018 150,000
07/01/2018 150,000
08/01/2018 150,000

10 30826 05/01/2018 An. Umair Ibra Asidiq 200,000

06/01/2018 200,000
07/01/2018 200,000
08/01/2018 200,000

11 23762 05/01/2018 An. Muh Hafiz Alfarisi 150,000

06/01/2018 150,000
07/01/2018 150,000
08/01/2018 150,000

12
- 8,600,000 - -
 PASIEN RAWAT INAP

Dokter Spesialis

Dr. Umum Perawat Ahli Gizi Buku KIA

Konsul dari Poli Konsul dr. Nining Konseling
dr. Agung SpOG
Konsul di UGD di UGD Laktasi
75,000 75,000 50,000
50,000
50,000
50,000
50,000
50,000
50,000

75,000 50,000
50,000
50,000
50,000
50,000

75,000 50,000
50,000
50,000
50,000

75,000 50,000
 50,000
50,000
50,000

150,000 75,000 50,000

50,000
50,000
50,000
50,000

75,000 50,000
50,000
50,000
50,000
50,000
50,000

150,000 75,000 50,000

50,000
50,000
50,000
50,000
50,000

150,000 75,000 50,000

50,000
 50,000

75,000 50,000
50,000
50,000
50,000
50,000
50,000

150,000 75,000 50,000

50,000
50,000
50,000

75,000 50,000
50,000
50,000
50,000
- 300,000 375,000 - 825,000 2,700,000 - -
MAP RM Administrasi UGD Jasa Infus Jasa Injeksi Jasa Pasang NGT Jasa Pasang cateter
Tubectomi
dr. Flora SpOG
100,000 80,000 60,500

100,000 80,000 55,000 176,000

100,000 80,000 55,000

100,000 80,000 55,000

 100,000 80,000 60,500

100,000 80,000 110,000

10,000 100,000 80,000 50,000

100,000 80,000 50,000

100,000 80,000 110,000 66,000

100,000 80,000 66,550

100,000 80,000 165,000 88,000

10,000 1,100,000 880,000 837,550 330,000 - - -
 Jasa Tindakan Sectio Caesarea

Sewa Kamar
dr. Flora SpOG dr. Agung SpOGdr. Ade Hashman Sp.An dr. Astrid, SpA staff operator Penata Anestesi Jasa Perawat/Bidan
Bedah
- - - - - - - -
 Partus Normal / Partus Induksi
Harga Alat KesehatanPemeriksaan Penunjang Lab. Wajib Kamar Perawatan Recovery Room Tindakan Jasa Dokter
dan Obat EKG Ibu dan Anak Perineoplasht dr. Flora, SpOG
- - - - - - -
 Tindakan Dokter Spesialis Kebidanan dan Kandungan
tus Normal / Partus Induksi Kuretase
Jasa Dokter Jasa Sewa kamar Jasa Dokter Jasa Dokter Jasa Dokter Jasa Jasa
dr. Agung, SpOG Bidan/Perawat bersalin dr. Flora, SpOG dr. Agung, SpOG dr. Anestesi Crew Anestesi Bidan/Perawat
- - - - - - - -
ialis Kebidanan dan Kandungan
tindakan Jasa Pasang/Lepas Pemeriksaan Manual
Eksterpas USG NST Suntik Monitoring Alat KB Inspekulo Plasenta
dr. Flora TT CTG
- - - - - - - -
 Biaya Service
WB
Vulva Higienis Biaya Persiapan Cost WD
Transfusi Funduscopy Hekting
Transfusi Darah Rawat Luka
Golongan Darah O
- - - - - - - - -
 Jasa Tindakan

Ambulans EKG Echocardiographi

Seka Rawat Jasa Perawat Jasa Dokter Pasang Tampon
Pagi sore Tali Pusat + Mandi Pendamping Pendamping Enterior
- - - - - - - -
 Foto Thorax Ap & Lat Foto
Funduscopy Mantoux Test Fisioterafi Nebulizer Foto Therapy Foto Abdomen
Expertise Colon In Loop

198,000
60,000
- - - - - 258,000 - -
 Infant Infuset Imunisasi Polio
Mucur Extractor Vaksin Hepatitis B
Pemakaian Syring Radiant Pump
Monitor
CTG pamp Warmer
150,000
- - - - 150,000 - - -
 Services
BNO-IVP Cross Matching Cross Insisi
Cost Darah (PRC Tindik TT Ear Pemakaian
Telinga Injeksi irigation Inkubator
- - - - - - - -
dr. Yulius T,Sp.Rad dr. Yulius T,Sp.Rad Loundry
ABDOMEN
USG Abdomen USG Lutut BNO 3 Posisi HEPAR KEPALA ABDOMEN Gallbladder Foto kaki
POLOS
- - - - - - - - - -
Kamar HCU Recovery Room Kamar OK BHP PAMA Kamar Bersalin Kamar Perawatan Makan + Service Ruangan Susu Emla

300,000 100,000 25,000

300,000 100,000
300,000 100,000
300,000 100,000
300,000 100,000
300,000 100,000
300,000 100,000

350,000 25,000
350,000
350,000
350,000
350,000

350,000 25,000
350,000
350,000
350,000

350,000 25,000
350,000
350,000
350,000

300,000 100,000 25,000

300,000 100,000
300,000 100,000
300,000 100,000

350,000 50,000
350,000
350,000
350,000
350,000

170,000 100,000 25,000

170,000 100,000
170,000 100,000
170,000 100,000
170,000 100,000
170,000 100,000

170,000 100,000 25,000

170,000 100,000
350,000 50,000
350,000
350,000
350,000
350,000

425,000 150,000 25,000

425,000 150,000
425,000 150,000
425,000 150,000

350,000 75,000
350,000
350,000
350,000
- - - - - 15,810,000 2,500,000 - 375,000
 Total Pekerjaan OT /
BHP Obat Laboratorium Pemakaian O2 Jumlah
Biaya
Karyawan YBS
Rawat Inap
80,000 1,332,965 630,000 3,083,465
625,000
625,000
625,000
625,000
625,000
625,000
6,833,465 Swasta
80,000 2,126,592 797,000 4,262,592
550,000
550,000
550,000
550,000
6,462,592 PT. KPC
80,000 692,312 223,500 1,880,812
550,000
550,000
550,000
3,530,812 PT. KPC
80,000 670,311 310,500 1,945,811
 550,000
550,000
550,000
3,595,811 PT. KPC
80,000 876,682 282,000 2,354,182
625,000
625,000
625,000
225,000
4,454,182 PT. KPC
80,000 1,455,956 278,500 2,779,456
550,000
550,000
550,000
550,000
200,000
5,179,456 PT. KPC
80,000 913,138 525,000 2,538,138
470,000
470,000
470,000
470,000
470,000
4,888,138 Swasta
80,000 655,603 280,000 1,965,603
470,000
 200,000
2,635,603 Swasta
80,000 1,951,600 375,500 3,438,100
550,000
550,000
550,000
550,000
200,000
5,838,100 PT. KPC
80,000 1,023,523 231,200 2,806,273
825,000
825,000
825,000
5,281,273 PT. PERTAMINA
80,000 1,907,470 394,000 3,514,470
550,000
550,000
550,000
5,164,470 PT. KPC
880,000 13,606,152 4,327,200 - 53,863,902
 Diagnosa Kamar Perawatan

KDS + Intake Oral Tidak Terjamin + Susp. Thypoid Fever

ISK + Susp Thypoid Fever + Intake Oral Tidak Terjamin

Ispa + Intake Oral Tidak Terjamin

Tonsilofaringitis + Intake Oral Tidak Terjamin

Tonsilofaringitis Colli

Typoid Fever + Obs.Vomitus + Intake Oral Tidak Terjamin

Ispa + Intake Oral Tidak Terjamin

GEA Tanpa Dehidrasi + Intake Oral Tidak Terjamin

Tonsilofaringitis + Limpadenitis Colly

Infeksi Bakterial Akut

ISPA + KDS + Infeksi Bakteri Akut + Intake Oral Tidak Terjamin

KEPADA YTH.

dr. MEITHA PE TOGAS, SpA

APARTEMEN GADING MEDITERANIA TOWER B LOBBY B SELATAN NO. 5B FH

KELAPA GADING JAKARTA UTARA

Telepon : 08125531170
KEPADA YTH.

dr. MEITHA PE TOGAS, SpA

APARTEMEN GADING MEDITERANIA TOWER B LOBBY B SELATAN NO. 5B FH

KELAPA GADING JAKARTA UTARA

Telepon : 08125531170

DARI ;

RSIA CAHAYA SANGATTA

JL. YOS SUDARSO III NO. 77 TELUK LINGGA SANGATTA

KUTAI TIMUR

Telepon : 085100502490 /'085231111040